hospital_name,,last_updated_on,version,hospital_location,hospital_address,license_number | MN ,"To the best of its knowledge and belief, the hospital has included all applicable standard charge information in accordance with the requirements of 45 CFR 180.50, and the information encoded is true, accurate, and complete as of the date indicated.",general_contract_provisions,,,,,,,,,,,,
Madison Healthcare Services,,4/2/2025,2.0.0,Madison Hospital,"900 2nd Ave Madison, Minnesota 56256",410553,TRUE,"Blue Cross High Value Network plan: 10% reduction applies to facility claims if they meet the guidelines listed here:  https://www.bluecrossmn.com/sites/default/files/DAM/2022-12/2023-BlueCrossMN-Commercial-Network-Guide.pdf Unless specifically listed as all inclusive, charges and base rates may not be all inclusiveand can include additional charges and payments for carve out drug and supplies. For Code type MS-DRG, we included the average charge per case for illustrative purposes, however, the actual charges and the discounted cash price will be dependent on individual circumstances. Any payers who reimburse inpatients on a percent of total billed charges will also vary depending on actual inpatient charges. ",,,,,,,,,,,,
description,,code | 1 ,code | 1 | type,billing_class,setting,drug_unit_of_measurement,drug_type_of_measurement,modifiers,standard_charge | gross ,standard_charge | discounted_cash,standard_charge | min,standard_charge | max,payer_name,plan_name,standard_charge | negotiated_dollar,standard_charge |  negotiated_percentage,standard_charge |  negotiated_algorithm,standard_charge | methodology,additional_generic_notes,additional_payer_notes
Abdominal Paracentesis (Diagnostic Or Therapeutic); With Imaging Guidance (Pbb)Professional Component ,,49083,CPT,Professional,Outpatient,,,26,510,433.5,75.55992,502.86,Aetna,Commercial,433.5,85,,percent of total billed charges,,
Abdominal Paracentesis (Diagnostic Or Therapeutic); With Imaging Guidance (Pbb)Professional Component ,,49083,CPT,Professional,Outpatient,,,26,510,433.5,75.55992,502.86,Aetna,Medicare Advantage,,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Abdominal Paracentesis (Diagnostic Or Therapeutic); With Imaging Guidance (Pbb)Professional Component ,,49083,CPT,Professional,Outpatient,,,26,510,433.5,75.55992,502.86,Aetna,PPO,474.3,93,,percent of total billed charges,,
Abdominal Paracentesis (Diagnostic Or Therapeutic); With Imaging Guidance (Pbb)Professional Component ,,49083,CPT,Professional,Outpatient,,,26,510,433.5,75.55992,502.86,America's PPO,America's PPO,435.744,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Abdominal Paracentesis (Diagnostic Or Therapeutic); With Imaging Guidance (Pbb)Professional Component ,,49083,CPT,Professional,Outpatient,,,26,510,433.5,75.55992,502.86,BlueCross BlueShield Minnesota, Federal Employee Program,,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Abdominal Paracentesis (Diagnostic Or Therapeutic); With Imaging Guidance (Pbb)Professional Component ,,49083,CPT,Professional,Outpatient,,,26,510,433.5,75.55992,502.86,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Abdominal Paracentesis (Diagnostic Or Therapeutic); With Imaging Guidance (Pbb)Professional Component ,,49083,CPT,Professional,Outpatient,,,26,510,433.5,75.55992,502.86,BlueCross BlueShield Minnesota,High Value Network Plan,,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Abdominal Paracentesis (Diagnostic Or Therapeutic); With Imaging Guidance (Pbb)Professional Component ,,49083,CPT,Professional,Outpatient,,,26,510,433.5,75.55992,502.86,BlueCross BlueShield Minnesota,Medicare Advantage,,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Abdominal Paracentesis (Diagnostic Or Therapeutic); With Imaging Guidance (Pbb)Professional Component ,,49083,CPT,Professional,Outpatient,,,26,510,433.5,75.55992,502.86,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Abdominal Paracentesis (Diagnostic Or Therapeutic); With Imaging Guidance (Pbb)Professional Component ,,49083,CPT,Professional,Outpatient,,,26,510,433.5,75.55992,502.86,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,75.55992,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Abdominal Paracentesis (Diagnostic Or Therapeutic); With Imaging Guidance (Pbb)Professional Component ,,49083,CPT,Professional,Outpatient,,,26,510,433.5,75.55992,502.86,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Abdominal Paracentesis (Diagnostic Or Therapeutic); With Imaging Guidance (Pbb)Professional Component ,,49083,CPT,Professional,Outpatient,,,26,510,433.5,75.55992,502.86,CorVel,Worker's Compensation,,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Abdominal Paracentesis (Diagnostic Or Therapeutic); With Imaging Guidance (Pbb)Professional Component ,,49083,CPT,Professional,Outpatient,,,26,510,433.5,75.55992,502.86,First Health Group Corporation,First Health Network,494.7,97,,percent of total billed charges,,
Abdominal Paracentesis (Diagnostic Or Therapeutic); With Imaging Guidance (Pbb)Professional Component ,,49083,CPT,Professional,Outpatient,,,26,510,433.5,75.55992,502.86,"Health Partners, Inc.",Commercial,,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Abdominal Paracentesis (Diagnostic Or Therapeutic); With Imaging Guidance (Pbb)Professional Component ,,49083,CPT,Professional,Outpatient,,,26,510,433.5,75.55992,502.86,"Health Partners, Inc.",Medicare Advantage,,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Abdominal Paracentesis (Diagnostic Or Therapeutic); With Imaging Guidance (Pbb)Professional Component ,,49083,CPT,Professional,Outpatient,,,26,510,433.5,75.55992,502.86,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Abdominal Paracentesis (Diagnostic Or Therapeutic); With Imaging Guidance (Pbb)Professional Component ,,49083,CPT,Professional,Outpatient,,,26,510,433.5,75.55992,502.86,"Health Partners, Inc.",State of Minnesota Advantage Program,,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Abdominal Paracentesis (Diagnostic Or Therapeutic); With Imaging Guidance (Pbb)Professional Component ,,49083,CPT,Professional,Outpatient,,,26,510,433.5,75.55992,502.86,"Health Partners, Inc.",State Public Programs,,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Abdominal Paracentesis (Diagnostic Or Therapeutic); With Imaging Guidance (Pbb)Professional Component ,,49083,CPT,Professional,Outpatient,,,26,510,433.5,75.55992,502.86,Humana Insurance Company,Commercial PPO,,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Abdominal Paracentesis (Diagnostic Or Therapeutic); With Imaging Guidance (Pbb)Professional Component ,,49083,CPT,Professional,Outpatient,,,26,510,433.5,75.55992,502.86,Humana Insurance Company,Medicare PPO,,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Abdominal Paracentesis (Diagnostic Or Therapeutic); With Imaging Guidance (Pbb)Professional Component ,,49083,CPT,Professional,Outpatient,,,26,510,433.5,75.55992,502.86,Medica,Individual & Family,432.48,84.8,,percent of total billed charges,,
Abdominal Paracentesis (Diagnostic Or Therapeutic); With Imaging Guidance (Pbb)Professional Component ,,49083,CPT,Professional,Outpatient,,,26,510,433.5,75.55992,502.86,Medica,Medica Advantage Solution,253.98,49.8,,percent of total billed charges,,
Abdominal Paracentesis (Diagnostic Or Therapeutic); With Imaging Guidance (Pbb)Professional Component ,,49083,CPT,Professional,Outpatient,,,26,510,433.5,75.55992,502.86,Medica,Medical Assistance,,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Abdominal Paracentesis (Diagnostic Or Therapeutic); With Imaging Guidance (Pbb)Professional Component ,,49083,CPT,Professional,Outpatient,,,26,510,433.5,75.55992,502.86,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Abdominal Paracentesis (Diagnostic Or Therapeutic); With Imaging Guidance (Pbb)Professional Component ,,49083,CPT,Professional,Outpatient,,,26,510,433.5,75.55992,502.86,"Multiplan, Inc.","Multiplan, Inc.",479.4,94,,percent of total billed charges,,
Abdominal Paracentesis (Diagnostic Or Therapeutic); With Imaging Guidance (Pbb)Professional Component ,,49083,CPT,Professional,Outpatient,,,26,510,433.5,75.55992,502.86,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,459.51,90.1,,percent of total billed charges,,
Abdominal Paracentesis (Diagnostic Or Therapeutic); With Imaging Guidance (Pbb)Professional Component ,,49083,CPT,Professional,Outpatient,,,26,510,433.5,75.55992,502.86,"Preferred One Administrative Services, INC.",PPO,502.86,98.6,,percent of total billed charges,,
Abdominal Paracentesis (Diagnostic Or Therapeutic); With Imaging Guidance (Pbb)Professional Component ,,49083,CPT,Professional,Outpatient,,,26,510,433.5,75.55992,502.86,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Abdominal Paracentesis (Diagnostic Or Therapeutic); With Imaging Guidance (Pbb)Professional Component ,,49083,CPT,Professional,Outpatient,,,26,510,433.5,75.55992,502.86,PrimeWest Health,MinnesotaCare,80.8491144,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Abdominal Paracentesis (Diagnostic Or Therapeutic); With Imaging Guidance (Pbb)Professional Component ,,49083,CPT,Professional,Outpatient,,,26,510,433.5,75.55992,502.86,Sanford Health Plan,Sanford Health Plan,448.8,88,,percent of total billed charges,,
Abdominal Paracentesis (Diagnostic Or Therapeutic); With Imaging Guidance (Pbb)Professional Component ,,49083,CPT,Professional,Outpatient,,,26,510,433.5,75.55992,502.86,"UCare Health, Inc.",Individual & Family Plan,,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Abdominal Paracentesis (Diagnostic Or Therapeutic); With Imaging Guidance (Pbb)Professional Component ,,49083,CPT,Professional,Outpatient,,,26,510,433.5,75.55992,502.86,"UCare Health, Inc.",Medical Assistance,83.115912,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Abdominal Paracentesis (Diagnostic Or Therapeutic); With Imaging Guidance (Pbb)Professional Component ,,49083,CPT,Professional,Outpatient,,,26,510,433.5,75.55992,502.86,"UCare Health, Inc.",Medicare Advantage,,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Abdominal Paracentesis (Diagnostic Or Therapeutic); With Imaging Guidance (Pbb)Professional Component ,,49083,CPT,Professional,Outpatient,,,26,510,433.5,75.55992,502.86,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Abdominal Paracentesis (Diagnostic Or Therapeutic); With Imaging Guidance (Pbb)Professional Component ,,49083,CPT,Professional,Outpatient,,,26,510,433.5,75.55992,502.86,UnitedHealthcare,Individual & Family,,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Abdominal Paracentesis (Diagnostic Or Therapeutic); With Imaging Guidance (Pbb)Professional Component ,,49083,CPT,Professional,Outpatient,,,26,510,433.5,75.55992,502.86,UnitedHealthcare,Medicare Advantage,,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Abdominal Paracentesis (Diagnostic Or Therapeutic); With Imaging Guidance (Pbb)Professional Component ,,49083,CPT,Professional,Outpatient,,,26,510,433.5,75.55992,502.86,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,75.55992,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Eye Foreign Body Detection (Pro Cah)Professional Component ,,70030,CPT,Professional,Both,,,26,50,42.5,5.45,50,Aetna,Commercial,42.5,85,,percent of total billed charges,,
Xr Eye Foreign Body Detection (Pro Cah)Professional Component ,,70030,CPT,Professional,Both,,,26,50,42.5,5.45,50,Aetna,Medicare Advantage,8.88,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Eye Foreign Body Detection (Pro Cah)Professional Component ,,70030,CPT,Professional,Both,,,26,50,42.5,5.45,50,Aetna,PPO,46.5,93,,percent of total billed charges,,
Xr Eye Foreign Body Detection (Pro Cah)Professional Component ,,70030,CPT,Professional,Both,,,26,50,42.5,5.45,50,America's PPO,America's PPO,42.72,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Xr Eye Foreign Body Detection (Pro Cah)Professional Component ,,70030,CPT,Professional,Both,,,26,50,42.5,5.45,50,BlueCross BlueShield Minnesota, Federal Employee Program,16.62,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Xr Eye Foreign Body Detection (Pro Cah)Professional Component ,,70030,CPT,Professional,Both,,,26,50,42.5,5.45,50,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,16.88592,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Eye Foreign Body Detection (Pro Cah)Professional Component ,,70030,CPT,Professional,Both,,,26,50,42.5,5.45,50,BlueCross BlueShield Minnesota,High Value Network Plan,16.88592,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Eye Foreign Body Detection (Pro Cah)Professional Component ,,70030,CPT,Professional,Both,,,26,50,42.5,5.45,50,BlueCross BlueShield Minnesota,Medicare Advantage,9.9245,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Eye Foreign Body Detection (Pro Cah)Professional Component ,,70030,CPT,Professional,Both,,,26,50,42.5,5.45,50,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,16.88592,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Eye Foreign Body Detection (Pro Cah)Professional Component ,,70030,CPT,Professional,Both,,,26,50,42.5,5.45,50,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,6.28904,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Eye Foreign Body Detection (Pro Cah)Professional Component ,,70030,CPT,Professional,Both,,,26,50,42.5,5.45,50,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),9.9245,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Eye Foreign Body Detection (Pro Cah)Professional Component ,,70030,CPT,Professional,Both,,,26,50,42.5,5.45,50,CorVel,Worker's Compensation,17.0907348,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Xr Eye Foreign Body Detection (Pro Cah)Professional Component ,,70030,CPT,Professional,Both,,,26,50,42.5,5.45,50,First Health Group Corporation,First Health Network,48.5,97,,percent of total billed charges,,
Xr Eye Foreign Body Detection (Pro Cah)Professional Component ,,70030,CPT,Professional,Both,,,26,50,42.5,5.45,50,"Health Partners, Inc.",Commercial,12.89,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Xr Eye Foreign Body Detection (Pro Cah)Professional Component ,,70030,CPT,Professional,Both,,,26,50,42.5,5.45,50,"Health Partners, Inc.",Medicare Advantage,9.9245,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Eye Foreign Body Detection (Pro Cah)Professional Component ,,70030,CPT,Professional,Both,,,26,50,42.5,5.45,50,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),5.45,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Xr Eye Foreign Body Detection (Pro Cah)Professional Component ,,70030,CPT,Professional,Both,,,26,50,42.5,5.45,50,"Health Partners, Inc.",State of Minnesota Advantage Program,11.104735,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Xr Eye Foreign Body Detection (Pro Cah)Professional Component ,,70030,CPT,Professional,Both,,,26,50,42.5,5.45,50,"Health Partners, Inc.",State Public Programs,5.45,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Xr Eye Foreign Body Detection (Pro Cah)Professional Component ,,70030,CPT,Professional,Both,,,26,50,42.5,5.45,50,Humana Insurance Company,Commercial PPO,8.63,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Xr Eye Foreign Body Detection (Pro Cah)Professional Component ,,70030,CPT,Professional,Both,,,26,50,42.5,5.45,50,Humana Insurance Company,Medicare PPO,50,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Xr Eye Foreign Body Detection (Pro Cah)Professional Component ,,70030,CPT,Professional,Both,,,26,50,42.5,5.45,50,Medica,Individual & Family,42.4,84.8,,percent of total billed charges,,
Xr Eye Foreign Body Detection (Pro Cah)Professional Component ,,70030,CPT,Professional,Both,,,26,50,42.5,5.45,50,Medica,Medica Advantage Solution,24.9,49.8,,percent of total billed charges,,
Xr Eye Foreign Body Detection (Pro Cah)Professional Component ,,70030,CPT,Professional,Both,,,26,50,42.5,5.45,50,Medica,Medical Assistance,6.29,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Xr Eye Foreign Body Detection (Pro Cah)Professional Component ,,70030,CPT,Professional,Both,,,26,50,42.5,5.45,50,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,8.63,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Xr Eye Foreign Body Detection (Pro Cah)Professional Component ,,70030,CPT,Professional,Both,,,26,50,42.5,5.45,50,"Multiplan, Inc.","Multiplan, Inc.",47,94,,percent of total billed charges,,
Xr Eye Foreign Body Detection (Pro Cah)Professional Component ,,70030,CPT,Professional,Both,,,26,50,42.5,5.45,50,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,45.05,90.1,,percent of total billed charges,,
Xr Eye Foreign Body Detection (Pro Cah)Professional Component ,,70030,CPT,Professional,Both,,,26,50,42.5,5.45,50,"Preferred One Administrative Services, INC.",PPO,49.3,98.6,,percent of total billed charges,,
Xr Eye Foreign Body Detection (Pro Cah)Professional Component ,,70030,CPT,Professional,Both,,,26,50,42.5,5.45,50,PrimeWest Health,Minnesota Senior Health Options (MSHO),9.9245,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Eye Foreign Body Detection (Pro Cah)Professional Component ,,70030,CPT,Professional,Both,,,26,50,42.5,5.45,50,PrimeWest Health,MinnesotaCare,6.7292728,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Eye Foreign Body Detection (Pro Cah)Professional Component ,,70030,CPT,Professional,Both,,,26,50,42.5,5.45,50,Sanford Health Plan,Sanford Health Plan,44,88,,percent of total billed charges,,
Xr Eye Foreign Body Detection (Pro Cah)Professional Component ,,70030,CPT,Professional,Both,,,26,50,42.5,5.45,50,"UCare Health, Inc.",Individual & Family Plan,14.028928,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Xr Eye Foreign Body Detection (Pro Cah)Professional Component ,,70030,CPT,Professional,Both,,,26,50,42.5,5.45,50,"UCare Health, Inc.",Medical Assistance,6.917944,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Xr Eye Foreign Body Detection (Pro Cah)Professional Component ,,70030,CPT,Professional,Both,,,26,50,42.5,5.45,50,"UCare Health, Inc.",Medicare Advantage,9.9245,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Xr Eye Foreign Body Detection (Pro Cah)Professional Component ,,70030,CPT,Professional,Both,,,26,50,42.5,5.45,50,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),7.9396,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Xr Eye Foreign Body Detection (Pro Cah)Professional Component ,,70030,CPT,Professional,Both,,,26,50,42.5,5.45,50,UnitedHealthcare,Individual & Family,50,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Xr Eye Foreign Body Detection (Pro Cah)Professional Component ,,70030,CPT,Professional,Both,,,26,50,42.5,5.45,50,UnitedHealthcare,Medicare Advantage,9.9245,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Eye Foreign Body Detection (Pro Cah)Professional Component ,,70030,CPT,Professional,Both,,,26,50,42.5,5.45,50,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,6.28904,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Mandible Less Than 4 Views (Pro Cah)Professional Component ,,70100,CPT,Professional,Both,,,26,35,29.75,5.45,35,Aetna,Commercial,29.75,85,,percent of total billed charges,,
Xr Mandible Less Than 4 Views (Pro Cah)Professional Component ,,70100,CPT,Professional,Both,,,26,35,29.75,5.45,35,Aetna,Medicare Advantage,8.88,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Mandible Less Than 4 Views (Pro Cah)Professional Component ,,70100,CPT,Professional,Both,,,26,35,29.75,5.45,35,Aetna,PPO,32.55,93,,percent of total billed charges,,
Xr Mandible Less Than 4 Views (Pro Cah)Professional Component ,,70100,CPT,Professional,Both,,,26,35,29.75,5.45,35,America's PPO,America's PPO,29.904,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Xr Mandible Less Than 4 Views (Pro Cah)Professional Component ,,70100,CPT,Professional,Both,,,26,35,29.75,5.45,35,BlueCross BlueShield Minnesota, Federal Employee Program,16.62,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Xr Mandible Less Than 4 Views (Pro Cah)Professional Component ,,70100,CPT,Professional,Both,,,26,35,29.75,5.45,35,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,16.88592,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Mandible Less Than 4 Views (Pro Cah)Professional Component ,,70100,CPT,Professional,Both,,,26,35,29.75,5.45,35,BlueCross BlueShield Minnesota,High Value Network Plan,16.88592,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Mandible Less Than 4 Views (Pro Cah)Professional Component ,,70100,CPT,Professional,Both,,,26,35,29.75,5.45,35,BlueCross BlueShield Minnesota,Medicare Advantage,9.9245,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Mandible Less Than 4 Views (Pro Cah)Professional Component ,,70100,CPT,Professional,Both,,,26,35,29.75,5.45,35,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,16.88592,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Mandible Less Than 4 Views (Pro Cah)Professional Component ,,70100,CPT,Professional,Both,,,26,35,29.75,5.45,35,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,6.28904,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Mandible Less Than 4 Views (Pro Cah)Professional Component ,,70100,CPT,Professional,Both,,,26,35,29.75,5.45,35,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),9.9245,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Mandible Less Than 4 Views (Pro Cah)Professional Component ,,70100,CPT,Professional,Both,,,26,35,29.75,5.45,35,CorVel,Worker's Compensation,17.0907348,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Xr Mandible Less Than 4 Views (Pro Cah)Professional Component ,,70100,CPT,Professional,Both,,,26,35,29.75,5.45,35,First Health Group Corporation,First Health Network,33.95,97,,percent of total billed charges,,
Xr Mandible Less Than 4 Views (Pro Cah)Professional Component ,,70100,CPT,Professional,Both,,,26,35,29.75,5.45,35,"Health Partners, Inc.",Commercial,12.89,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Xr Mandible Less Than 4 Views (Pro Cah)Professional Component ,,70100,CPT,Professional,Both,,,26,35,29.75,5.45,35,"Health Partners, Inc.",Medicare Advantage,9.9245,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Mandible Less Than 4 Views (Pro Cah)Professional Component ,,70100,CPT,Professional,Both,,,26,35,29.75,5.45,35,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),5.45,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Xr Mandible Less Than 4 Views (Pro Cah)Professional Component ,,70100,CPT,Professional,Both,,,26,35,29.75,5.45,35,"Health Partners, Inc.",State of Minnesota Advantage Program,11.104735,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Xr Mandible Less Than 4 Views (Pro Cah)Professional Component ,,70100,CPT,Professional,Both,,,26,35,29.75,5.45,35,"Health Partners, Inc.",State Public Programs,5.45,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Xr Mandible Less Than 4 Views (Pro Cah)Professional Component ,,70100,CPT,Professional,Both,,,26,35,29.75,5.45,35,Humana Insurance Company,Commercial PPO,8.63,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Xr Mandible Less Than 4 Views (Pro Cah)Professional Component ,,70100,CPT,Professional,Both,,,26,35,29.75,5.45,35,Humana Insurance Company,Medicare PPO,35,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Xr Mandible Less Than 4 Views (Pro Cah)Professional Component ,,70100,CPT,Professional,Both,,,26,35,29.75,5.45,35,Medica,Individual & Family,29.68,84.8,,percent of total billed charges,,
Xr Mandible Less Than 4 Views (Pro Cah)Professional Component ,,70100,CPT,Professional,Both,,,26,35,29.75,5.45,35,Medica,Medica Advantage Solution,17.43,49.8,,percent of total billed charges,,
Xr Mandible Less Than 4 Views (Pro Cah)Professional Component ,,70100,CPT,Professional,Both,,,26,35,29.75,5.45,35,Medica,Medical Assistance,6.29,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Xr Mandible Less Than 4 Views (Pro Cah)Professional Component ,,70100,CPT,Professional,Both,,,26,35,29.75,5.45,35,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,8.63,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Xr Mandible Less Than 4 Views (Pro Cah)Professional Component ,,70100,CPT,Professional,Both,,,26,35,29.75,5.45,35,"Multiplan, Inc.","Multiplan, Inc.",32.9,94,,percent of total billed charges,,
Xr Mandible Less Than 4 Views (Pro Cah)Professional Component ,,70100,CPT,Professional,Both,,,26,35,29.75,5.45,35,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,31.535,90.1,,percent of total billed charges,,
Xr Mandible Less Than 4 Views (Pro Cah)Professional Component ,,70100,CPT,Professional,Both,,,26,35,29.75,5.45,35,"Preferred One Administrative Services, INC.",PPO,34.51,98.6,,percent of total billed charges,,
Xr Mandible Less Than 4 Views (Pro Cah)Professional Component ,,70100,CPT,Professional,Both,,,26,35,29.75,5.45,35,PrimeWest Health,Minnesota Senior Health Options (MSHO),9.9245,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Mandible Less Than 4 Views (Pro Cah)Professional Component ,,70100,CPT,Professional,Both,,,26,35,29.75,5.45,35,PrimeWest Health,MinnesotaCare,6.7292728,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Mandible Less Than 4 Views (Pro Cah)Professional Component ,,70100,CPT,Professional,Both,,,26,35,29.75,5.45,35,Sanford Health Plan,Sanford Health Plan,30.8,88,,percent of total billed charges,,
Xr Mandible Less Than 4 Views (Pro Cah)Professional Component ,,70100,CPT,Professional,Both,,,26,35,29.75,5.45,35,"UCare Health, Inc.",Individual & Family Plan,14.028928,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Xr Mandible Less Than 4 Views (Pro Cah)Professional Component ,,70100,CPT,Professional,Both,,,26,35,29.75,5.45,35,"UCare Health, Inc.",Medical Assistance,6.917944,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Xr Mandible Less Than 4 Views (Pro Cah)Professional Component ,,70100,CPT,Professional,Both,,,26,35,29.75,5.45,35,"UCare Health, Inc.",Medicare Advantage,9.9245,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Xr Mandible Less Than 4 Views (Pro Cah)Professional Component ,,70100,CPT,Professional,Both,,,26,35,29.75,5.45,35,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),7.9396,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Xr Mandible Less Than 4 Views (Pro Cah)Professional Component ,,70100,CPT,Professional,Both,,,26,35,29.75,5.45,35,UnitedHealthcare,Individual & Family,35,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Xr Mandible Less Than 4 Views (Pro Cah)Professional Component ,,70100,CPT,Professional,Both,,,26,35,29.75,5.45,35,UnitedHealthcare,Medicare Advantage,9.9245,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Mandible Less Than 4 Views (Pro Cah)Professional Component ,,70100,CPT,Professional,Both,,,26,35,29.75,5.45,35,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,6.28904,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Mandible Routine Complete (Pro Cah)Professional Component ,,70110,CPT,Professional,Both,,,26,55,46.75,7.41,55,Aetna,Commercial,46.75,85,,percent of total billed charges,,
Xr Mandible Routine Complete (Pro Cah)Professional Component ,,70110,CPT,Professional,Both,,,26,55,46.75,7.41,55,Aetna,Medicare Advantage,12.03,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Mandible Routine Complete (Pro Cah)Professional Component ,,70110,CPT,Professional,Both,,,26,55,46.75,7.41,55,Aetna,PPO,51.15,93,,percent of total billed charges,,
Xr Mandible Routine Complete (Pro Cah)Professional Component ,,70110,CPT,Professional,Both,,,26,55,46.75,7.41,55,America's PPO,America's PPO,46.992,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Xr Mandible Routine Complete (Pro Cah)Professional Component ,,70110,CPT,Professional,Both,,,26,55,46.75,7.41,55,BlueCross BlueShield Minnesota, Federal Employee Program,22.37,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Xr Mandible Routine Complete (Pro Cah)Professional Component ,,70110,CPT,Professional,Both,,,26,55,46.75,7.41,55,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,22.72792,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Mandible Routine Complete (Pro Cah)Professional Component ,,70110,CPT,Professional,Both,,,26,55,46.75,7.41,55,BlueCross BlueShield Minnesota,High Value Network Plan,22.72792,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Mandible Routine Complete (Pro Cah)Professional Component ,,70110,CPT,Professional,Both,,,26,55,46.75,7.41,55,BlueCross BlueShield Minnesota,Medicare Advantage,13.4435,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Mandible Routine Complete (Pro Cah)Professional Component ,,70110,CPT,Professional,Both,,,26,55,46.75,7.41,55,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,22.72792,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Mandible Routine Complete (Pro Cah)Professional Component ,,70110,CPT,Professional,Both,,,26,55,46.75,7.41,55,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,8.55472,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Mandible Routine Complete (Pro Cah)Professional Component ,,70110,CPT,Professional,Both,,,26,55,46.75,7.41,55,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),13.4435,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Mandible Routine Complete (Pro Cah)Professional Component ,,70110,CPT,Professional,Both,,,26,55,46.75,7.41,55,CorVel,Worker's Compensation,23.153499,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Xr Mandible Routine Complete (Pro Cah)Professional Component ,,70110,CPT,Professional,Both,,,26,55,46.75,7.41,55,First Health Group Corporation,First Health Network,53.35,97,,percent of total billed charges,,
Xr Mandible Routine Complete (Pro Cah)Professional Component ,,70110,CPT,Professional,Both,,,26,55,46.75,7.41,55,"Health Partners, Inc.",Commercial,17.54,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Xr Mandible Routine Complete (Pro Cah)Professional Component ,,70110,CPT,Professional,Both,,,26,55,46.75,7.41,55,"Health Partners, Inc.",Medicare Advantage,13.4435,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Mandible Routine Complete (Pro Cah)Professional Component ,,70110,CPT,Professional,Both,,,26,55,46.75,7.41,55,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),7.41,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Xr Mandible Routine Complete (Pro Cah)Professional Component ,,70110,CPT,Professional,Both,,,26,55,46.75,7.41,55,"Health Partners, Inc.",State of Minnesota Advantage Program,15.11071,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Xr Mandible Routine Complete (Pro Cah)Professional Component ,,70110,CPT,Professional,Both,,,26,55,46.75,7.41,55,"Health Partners, Inc.",State Public Programs,7.41,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Xr Mandible Routine Complete (Pro Cah)Professional Component ,,70110,CPT,Professional,Both,,,26,55,46.75,7.41,55,Humana Insurance Company,Commercial PPO,11.69,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Xr Mandible Routine Complete (Pro Cah)Professional Component ,,70110,CPT,Professional,Both,,,26,55,46.75,7.41,55,Humana Insurance Company,Medicare PPO,55,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Xr Mandible Routine Complete (Pro Cah)Professional Component ,,70110,CPT,Professional,Both,,,26,55,46.75,7.41,55,Medica,Individual & Family,46.64,84.8,,percent of total billed charges,,
Xr Mandible Routine Complete (Pro Cah)Professional Component ,,70110,CPT,Professional,Both,,,26,55,46.75,7.41,55,Medica,Medica Advantage Solution,27.39,49.8,,percent of total billed charges,,
Xr Mandible Routine Complete (Pro Cah)Professional Component ,,70110,CPT,Professional,Both,,,26,55,46.75,7.41,55,Medica,Medical Assistance,8.55,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Xr Mandible Routine Complete (Pro Cah)Professional Component ,,70110,CPT,Professional,Both,,,26,55,46.75,7.41,55,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,11.69,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Xr Mandible Routine Complete (Pro Cah)Professional Component ,,70110,CPT,Professional,Both,,,26,55,46.75,7.41,55,"Multiplan, Inc.","Multiplan, Inc.",51.7,94,,percent of total billed charges,,
Xr Mandible Routine Complete (Pro Cah)Professional Component ,,70110,CPT,Professional,Both,,,26,55,46.75,7.41,55,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,49.555,90.1,,percent of total billed charges,,
Xr Mandible Routine Complete (Pro Cah)Professional Component ,,70110,CPT,Professional,Both,,,26,55,46.75,7.41,55,"Preferred One Administrative Services, INC.",PPO,54.23,98.6,,percent of total billed charges,,
Xr Mandible Routine Complete (Pro Cah)Professional Component ,,70110,CPT,Professional,Both,,,26,55,46.75,7.41,55,PrimeWest Health,Minnesota Senior Health Options (MSHO),13.4435,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Mandible Routine Complete (Pro Cah)Professional Component ,,70110,CPT,Professional,Both,,,26,55,46.75,7.41,55,PrimeWest Health,MinnesotaCare,9.1535504,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Mandible Routine Complete (Pro Cah)Professional Component ,,70110,CPT,Professional,Both,,,26,55,46.75,7.41,55,Sanford Health Plan,Sanford Health Plan,48.4,88,,percent of total billed charges,,
Xr Mandible Routine Complete (Pro Cah)Professional Component ,,70110,CPT,Professional,Both,,,26,55,46.75,7.41,55,"UCare Health, Inc.",Individual & Family Plan,19.003264,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Xr Mandible Routine Complete (Pro Cah)Professional Component ,,70110,CPT,Professional,Both,,,26,55,46.75,7.41,55,"UCare Health, Inc.",Medical Assistance,9.410192,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Xr Mandible Routine Complete (Pro Cah)Professional Component ,,70110,CPT,Professional,Both,,,26,55,46.75,7.41,55,"UCare Health, Inc.",Medicare Advantage,13.4435,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Xr Mandible Routine Complete (Pro Cah)Professional Component ,,70110,CPT,Professional,Both,,,26,55,46.75,7.41,55,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),10.7548,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Xr Mandible Routine Complete (Pro Cah)Professional Component ,,70110,CPT,Professional,Both,,,26,55,46.75,7.41,55,UnitedHealthcare,Individual & Family,55,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Xr Mandible Routine Complete (Pro Cah)Professional Component ,,70110,CPT,Professional,Both,,,26,55,46.75,7.41,55,UnitedHealthcare,Medicare Advantage,13.4435,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Mandible Routine Complete (Pro Cah)Professional Component ,,70110,CPT,Professional,Both,,,26,55,46.75,7.41,55,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,8.55472,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Radiologic Examination, Mastoids; Less Than 3 Views Per Side (Pro Cah)Professional Component ",,70120,CPT,Professional,Both,,,26,35,29.75,5.45,35,Aetna,Commercial,29.75,85,,percent of total billed charges,,
"Radiologic Examination, Mastoids; Less Than 3 Views Per Side (Pro Cah)Professional Component ",,70120,CPT,Professional,Both,,,26,35,29.75,5.45,35,Aetna,Medicare Advantage,8.88,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Radiologic Examination, Mastoids; Less Than 3 Views Per Side (Pro Cah)Professional Component ",,70120,CPT,Professional,Both,,,26,35,29.75,5.45,35,Aetna,PPO,32.55,93,,percent of total billed charges,,
"Radiologic Examination, Mastoids; Less Than 3 Views Per Side (Pro Cah)Professional Component ",,70120,CPT,Professional,Both,,,26,35,29.75,5.45,35,America's PPO,America's PPO,29.904,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Radiologic Examination, Mastoids; Less Than 3 Views Per Side (Pro Cah)Professional Component ",,70120,CPT,Professional,Both,,,26,35,29.75,5.45,35,BlueCross BlueShield Minnesota, Federal Employee Program,16.62,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Radiologic Examination, Mastoids; Less Than 3 Views Per Side (Pro Cah)Professional Component ",,70120,CPT,Professional,Both,,,26,35,29.75,5.45,35,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,16.88592,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Radiologic Examination, Mastoids; Less Than 3 Views Per Side (Pro Cah)Professional Component ",,70120,CPT,Professional,Both,,,26,35,29.75,5.45,35,BlueCross BlueShield Minnesota,High Value Network Plan,16.88592,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Radiologic Examination, Mastoids; Less Than 3 Views Per Side (Pro Cah)Professional Component ",,70120,CPT,Professional,Both,,,26,35,29.75,5.45,35,BlueCross BlueShield Minnesota,Medicare Advantage,9.9245,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Radiologic Examination, Mastoids; Less Than 3 Views Per Side (Pro Cah)Professional Component ",,70120,CPT,Professional,Both,,,26,35,29.75,5.45,35,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,16.88592,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Radiologic Examination, Mastoids; Less Than 3 Views Per Side (Pro Cah)Professional Component ",,70120,CPT,Professional,Both,,,26,35,29.75,5.45,35,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,6.28904,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Radiologic Examination, Mastoids; Less Than 3 Views Per Side (Pro Cah)Professional Component ",,70120,CPT,Professional,Both,,,26,35,29.75,5.45,35,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),9.9245,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Radiologic Examination, Mastoids; Less Than 3 Views Per Side (Pro Cah)Professional Component ",,70120,CPT,Professional,Both,,,26,35,29.75,5.45,35,CorVel,Worker's Compensation,17.0907348,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Radiologic Examination, Mastoids; Less Than 3 Views Per Side (Pro Cah)Professional Component ",,70120,CPT,Professional,Both,,,26,35,29.75,5.45,35,First Health Group Corporation,First Health Network,33.95,97,,percent of total billed charges,,
"Radiologic Examination, Mastoids; Less Than 3 Views Per Side (Pro Cah)Professional Component ",,70120,CPT,Professional,Both,,,26,35,29.75,5.45,35,"Health Partners, Inc.",Commercial,12.89,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Radiologic Examination, Mastoids; Less Than 3 Views Per Side (Pro Cah)Professional Component ",,70120,CPT,Professional,Both,,,26,35,29.75,5.45,35,"Health Partners, Inc.",Medicare Advantage,9.9245,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Radiologic Examination, Mastoids; Less Than 3 Views Per Side (Pro Cah)Professional Component ",,70120,CPT,Professional,Both,,,26,35,29.75,5.45,35,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),5.45,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Radiologic Examination, Mastoids; Less Than 3 Views Per Side (Pro Cah)Professional Component ",,70120,CPT,Professional,Both,,,26,35,29.75,5.45,35,"Health Partners, Inc.",State of Minnesota Advantage Program,11.104735,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Radiologic Examination, Mastoids; Less Than 3 Views Per Side (Pro Cah)Professional Component ",,70120,CPT,Professional,Both,,,26,35,29.75,5.45,35,"Health Partners, Inc.",State Public Programs,5.45,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Radiologic Examination, Mastoids; Less Than 3 Views Per Side (Pro Cah)Professional Component ",,70120,CPT,Professional,Both,,,26,35,29.75,5.45,35,Humana Insurance Company,Commercial PPO,8.63,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Radiologic Examination, Mastoids; Less Than 3 Views Per Side (Pro Cah)Professional Component ",,70120,CPT,Professional,Both,,,26,35,29.75,5.45,35,Humana Insurance Company,Medicare PPO,35,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Radiologic Examination, Mastoids; Less Than 3 Views Per Side (Pro Cah)Professional Component ",,70120,CPT,Professional,Both,,,26,35,29.75,5.45,35,Medica,Individual & Family,29.68,84.8,,percent of total billed charges,,
"Radiologic Examination, Mastoids; Less Than 3 Views Per Side (Pro Cah)Professional Component ",,70120,CPT,Professional,Both,,,26,35,29.75,5.45,35,Medica,Medica Advantage Solution,17.43,49.8,,percent of total billed charges,,
"Radiologic Examination, Mastoids; Less Than 3 Views Per Side (Pro Cah)Professional Component ",,70120,CPT,Professional,Both,,,26,35,29.75,5.45,35,Medica,Medical Assistance,6.29,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Radiologic Examination, Mastoids; Less Than 3 Views Per Side (Pro Cah)Professional Component ",,70120,CPT,Professional,Both,,,26,35,29.75,5.45,35,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,8.63,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Radiologic Examination, Mastoids; Less Than 3 Views Per Side (Pro Cah)Professional Component ",,70120,CPT,Professional,Both,,,26,35,29.75,5.45,35,"Multiplan, Inc.","Multiplan, Inc.",32.9,94,,percent of total billed charges,,
"Radiologic Examination, Mastoids; Less Than 3 Views Per Side (Pro Cah)Professional Component ",,70120,CPT,Professional,Both,,,26,35,29.75,5.45,35,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,31.535,90.1,,percent of total billed charges,,
"Radiologic Examination, Mastoids; Less Than 3 Views Per Side (Pro Cah)Professional Component ",,70120,CPT,Professional,Both,,,26,35,29.75,5.45,35,"Preferred One Administrative Services, INC.",PPO,34.51,98.6,,percent of total billed charges,,
"Radiologic Examination, Mastoids; Less Than 3 Views Per Side (Pro Cah)Professional Component ",,70120,CPT,Professional,Both,,,26,35,29.75,5.45,35,PrimeWest Health,Minnesota Senior Health Options (MSHO),9.9245,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Radiologic Examination, Mastoids; Less Than 3 Views Per Side (Pro Cah)Professional Component ",,70120,CPT,Professional,Both,,,26,35,29.75,5.45,35,PrimeWest Health,MinnesotaCare,6.7292728,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Radiologic Examination, Mastoids; Less Than 3 Views Per Side (Pro Cah)Professional Component ",,70120,CPT,Professional,Both,,,26,35,29.75,5.45,35,Sanford Health Plan,Sanford Health Plan,30.8,88,,percent of total billed charges,,
"Radiologic Examination, Mastoids; Less Than 3 Views Per Side (Pro Cah)Professional Component ",,70120,CPT,Professional,Both,,,26,35,29.75,5.45,35,"UCare Health, Inc.",Individual & Family Plan,14.028928,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Radiologic Examination, Mastoids; Less Than 3 Views Per Side (Pro Cah)Professional Component ",,70120,CPT,Professional,Both,,,26,35,29.75,5.45,35,"UCare Health, Inc.",Medical Assistance,6.917944,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Radiologic Examination, Mastoids; Less Than 3 Views Per Side (Pro Cah)Professional Component ",,70120,CPT,Professional,Both,,,26,35,29.75,5.45,35,"UCare Health, Inc.",Medicare Advantage,9.9245,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Radiologic Examination, Mastoids; Less Than 3 Views Per Side (Pro Cah)Professional Component ",,70120,CPT,Professional,Both,,,26,35,29.75,5.45,35,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),7.9396,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Radiologic Examination, Mastoids; Less Than 3 Views Per Side (Pro Cah)Professional Component ",,70120,CPT,Professional,Both,,,26,35,29.75,5.45,35,UnitedHealthcare,Individual & Family,35,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Radiologic Examination, Mastoids; Less Than 3 Views Per Side (Pro Cah)Professional Component ",,70120,CPT,Professional,Both,,,26,35,29.75,5.45,35,UnitedHealthcare,Medicare Advantage,9.9245,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Radiologic Examination, Mastoids; Less Than 3 Views Per Side (Pro Cah)Professional Component ",,70120,CPT,Professional,Both,,,26,35,29.75,5.45,35,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,6.28904,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Radiologic Examination, Mastoids; Complete, Minimum Of 3 Views Per Side (Pro Cah)Professional Component ",,70130,CPT,Professional,Both,,,26,74,62.9,10.25,74,Aetna,Commercial,62.9,85,,percent of total billed charges,,
"Radiologic Examination, Mastoids; Complete, Minimum Of 3 Views Per Side (Pro Cah)Professional Component ",,70130,CPT,Professional,Both,,,26,74,62.9,10.25,74,Aetna,Medicare Advantage,16.58,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Radiologic Examination, Mastoids; Complete, Minimum Of 3 Views Per Side (Pro Cah)Professional Component ",,70130,CPT,Professional,Both,,,26,74,62.9,10.25,74,Aetna,PPO,68.82,93,,percent of total billed charges,,
"Radiologic Examination, Mastoids; Complete, Minimum Of 3 Views Per Side (Pro Cah)Professional Component ",,70130,CPT,Professional,Both,,,26,74,62.9,10.25,74,America's PPO,America's PPO,63.2256,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Radiologic Examination, Mastoids; Complete, Minimum Of 3 Views Per Side (Pro Cah)Professional Component ",,70130,CPT,Professional,Both,,,26,74,62.9,10.25,74,BlueCross BlueShield Minnesota, Federal Employee Program,31.32,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Radiologic Examination, Mastoids; Complete, Minimum Of 3 Views Per Side (Pro Cah)Professional Component ",,70130,CPT,Professional,Both,,,26,74,62.9,10.25,74,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,31.82112,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Radiologic Examination, Mastoids; Complete, Minimum Of 3 Views Per Side (Pro Cah)Professional Component ",,70130,CPT,Professional,Both,,,26,74,62.9,10.25,74,BlueCross BlueShield Minnesota,High Value Network Plan,31.82112,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Radiologic Examination, Mastoids; Complete, Minimum Of 3 Views Per Side (Pro Cah)Professional Component ",,70130,CPT,Professional,Both,,,26,74,62.9,10.25,74,BlueCross BlueShield Minnesota,Medicare Advantage,18.6645,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Radiologic Examination, Mastoids; Complete, Minimum Of 3 Views Per Side (Pro Cah)Professional Component ",,70130,CPT,Professional,Both,,,26,74,62.9,10.25,74,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,31.82112,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Radiologic Examination, Mastoids; Complete, Minimum Of 3 Views Per Side (Pro Cah)Professional Component ",,70130,CPT,Professional,Both,,,26,74,62.9,10.25,74,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,11.8364,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Radiologic Examination, Mastoids; Complete, Minimum Of 3 Views Per Side (Pro Cah)Professional Component ",,70130,CPT,Professional,Both,,,26,74,62.9,10.25,74,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),18.6645,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Radiologic Examination, Mastoids; Complete, Minimum Of 3 Views Per Side (Pro Cah)Professional Component ",,70130,CPT,Professional,Both,,,26,74,62.9,10.25,74,CorVel,Worker's Compensation,32.1576375,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Radiologic Examination, Mastoids; Complete, Minimum Of 3 Views Per Side (Pro Cah)Professional Component ",,70130,CPT,Professional,Both,,,26,74,62.9,10.25,74,First Health Group Corporation,First Health Network,71.78,97,,percent of total billed charges,,
"Radiologic Examination, Mastoids; Complete, Minimum Of 3 Views Per Side (Pro Cah)Professional Component ",,70130,CPT,Professional,Both,,,26,74,62.9,10.25,74,"Health Partners, Inc.",Commercial,24.75,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Radiologic Examination, Mastoids; Complete, Minimum Of 3 Views Per Side (Pro Cah)Professional Component ",,70130,CPT,Professional,Both,,,26,74,62.9,10.25,74,"Health Partners, Inc.",Medicare Advantage,18.6645,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Radiologic Examination, Mastoids; Complete, Minimum Of 3 Views Per Side (Pro Cah)Professional Component ",,70130,CPT,Professional,Both,,,26,74,62.9,10.25,74,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),10.25,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Radiologic Examination, Mastoids; Complete, Minimum Of 3 Views Per Side (Pro Cah)Professional Component ",,70130,CPT,Professional,Both,,,26,74,62.9,10.25,74,"Health Partners, Inc.",State of Minnesota Advantage Program,21.322125,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Radiologic Examination, Mastoids; Complete, Minimum Of 3 Views Per Side (Pro Cah)Professional Component ",,70130,CPT,Professional,Both,,,26,74,62.9,10.25,74,"Health Partners, Inc.",State Public Programs,10.25,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Radiologic Examination, Mastoids; Complete, Minimum Of 3 Views Per Side (Pro Cah)Professional Component ",,70130,CPT,Professional,Both,,,26,74,62.9,10.25,74,Humana Insurance Company,Commercial PPO,16.23,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Radiologic Examination, Mastoids; Complete, Minimum Of 3 Views Per Side (Pro Cah)Professional Component ",,70130,CPT,Professional,Both,,,26,74,62.9,10.25,74,Humana Insurance Company,Medicare PPO,74,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Radiologic Examination, Mastoids; Complete, Minimum Of 3 Views Per Side (Pro Cah)Professional Component ",,70130,CPT,Professional,Both,,,26,74,62.9,10.25,74,Medica,Individual & Family,62.752,84.8,,percent of total billed charges,,
"Radiologic Examination, Mastoids; Complete, Minimum Of 3 Views Per Side (Pro Cah)Professional Component ",,70130,CPT,Professional,Both,,,26,74,62.9,10.25,74,Medica,Medica Advantage Solution,36.852,49.8,,percent of total billed charges,,
"Radiologic Examination, Mastoids; Complete, Minimum Of 3 Views Per Side (Pro Cah)Professional Component ",,70130,CPT,Professional,Both,,,26,74,62.9,10.25,74,Medica,Medical Assistance,11.84,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Radiologic Examination, Mastoids; Complete, Minimum Of 3 Views Per Side (Pro Cah)Professional Component ",,70130,CPT,Professional,Both,,,26,74,62.9,10.25,74,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,16.23,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Radiologic Examination, Mastoids; Complete, Minimum Of 3 Views Per Side (Pro Cah)Professional Component ",,70130,CPT,Professional,Both,,,26,74,62.9,10.25,74,"Multiplan, Inc.","Multiplan, Inc.",69.56,94,,percent of total billed charges,,
"Radiologic Examination, Mastoids; Complete, Minimum Of 3 Views Per Side (Pro Cah)Professional Component ",,70130,CPT,Professional,Both,,,26,74,62.9,10.25,74,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,66.674,90.1,,percent of total billed charges,,
"Radiologic Examination, Mastoids; Complete, Minimum Of 3 Views Per Side (Pro Cah)Professional Component ",,70130,CPT,Professional,Both,,,26,74,62.9,10.25,74,"Preferred One Administrative Services, INC.",PPO,72.964,98.6,,percent of total billed charges,,
"Radiologic Examination, Mastoids; Complete, Minimum Of 3 Views Per Side (Pro Cah)Professional Component ",,70130,CPT,Professional,Both,,,26,74,62.9,10.25,74,PrimeWest Health,Minnesota Senior Health Options (MSHO),18.6645,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Radiologic Examination, Mastoids; Complete, Minimum Of 3 Views Per Side (Pro Cah)Professional Component ",,70130,CPT,Professional,Both,,,26,74,62.9,10.25,74,PrimeWest Health,MinnesotaCare,12.664948,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Radiologic Examination, Mastoids; Complete, Minimum Of 3 Views Per Side (Pro Cah)Professional Component ",,70130,CPT,Professional,Both,,,26,74,62.9,10.25,74,Sanford Health Plan,Sanford Health Plan,65.12,88,,percent of total billed charges,,
"Radiologic Examination, Mastoids; Complete, Minimum Of 3 Views Per Side (Pro Cah)Professional Component ",,70130,CPT,Professional,Both,,,26,74,62.9,10.25,74,"UCare Health, Inc.",Individual & Family Plan,26.383488,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Radiologic Examination, Mastoids; Complete, Minimum Of 3 Views Per Side (Pro Cah)Professional Component ",,70130,CPT,Professional,Both,,,26,74,62.9,10.25,74,"UCare Health, Inc.",Medical Assistance,13.02004,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Radiologic Examination, Mastoids; Complete, Minimum Of 3 Views Per Side (Pro Cah)Professional Component ",,70130,CPT,Professional,Both,,,26,74,62.9,10.25,74,"UCare Health, Inc.",Medicare Advantage,18.6645,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Radiologic Examination, Mastoids; Complete, Minimum Of 3 Views Per Side (Pro Cah)Professional Component ",,70130,CPT,Professional,Both,,,26,74,62.9,10.25,74,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),14.9316,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Radiologic Examination, Mastoids; Complete, Minimum Of 3 Views Per Side (Pro Cah)Professional Component ",,70130,CPT,Professional,Both,,,26,74,62.9,10.25,74,UnitedHealthcare,Individual & Family,74,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Radiologic Examination, Mastoids; Complete, Minimum Of 3 Views Per Side (Pro Cah)Professional Component ",,70130,CPT,Professional,Both,,,26,74,62.9,10.25,74,UnitedHealthcare,Medicare Advantage,18.6645,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Radiologic Examination, Mastoids; Complete, Minimum Of 3 Views Per Side (Pro Cah)Professional Component ",,70130,CPT,Professional,Both,,,26,74,62.9,10.25,74,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,11.8364,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Facial Bones; Less Than 3 Views (Pro Cah)Professional Component ,,70140,CPT,Professional,Both,,,26,63,53.55,6.11,63,Aetna,Commercial,53.55,85,,percent of total billed charges,,
Xr Facial Bones; Less Than 3 Views (Pro Cah)Professional Component ,,70140,CPT,Professional,Both,,,26,63,53.55,6.11,63,Aetna,Medicare Advantage,9.93,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Facial Bones; Less Than 3 Views (Pro Cah)Professional Component ,,70140,CPT,Professional,Both,,,26,63,53.55,6.11,63,Aetna,PPO,58.59,93,,percent of total billed charges,,
Xr Facial Bones; Less Than 3 Views (Pro Cah)Professional Component ,,70140,CPT,Professional,Both,,,26,63,53.55,6.11,63,America's PPO,America's PPO,53.8272,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Xr Facial Bones; Less Than 3 Views (Pro Cah)Professional Component ,,70140,CPT,Professional,Both,,,26,63,53.55,6.11,63,BlueCross BlueShield Minnesota, Federal Employee Program,18.54,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Xr Facial Bones; Less Than 3 Views (Pro Cah)Professional Component ,,70140,CPT,Professional,Both,,,26,63,53.55,6.11,63,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,18.83664,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Facial Bones; Less Than 3 Views (Pro Cah)Professional Component ,,70140,CPT,Professional,Both,,,26,63,53.55,6.11,63,BlueCross BlueShield Minnesota,High Value Network Plan,18.83664,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Facial Bones; Less Than 3 Views (Pro Cah)Professional Component ,,70140,CPT,Professional,Both,,,26,63,53.55,6.11,63,BlueCross BlueShield Minnesota,Medicare Advantage,11.109,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Facial Bones; Less Than 3 Views (Pro Cah)Professional Component ,,70140,CPT,Professional,Both,,,26,63,53.55,6.11,63,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,18.83664,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Facial Bones; Less Than 3 Views (Pro Cah)Professional Component ,,70140,CPT,Professional,Both,,,26,63,53.55,6.11,63,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,7.05104,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Facial Bones; Less Than 3 Views (Pro Cah)Professional Component ,,70140,CPT,Professional,Both,,,26,63,53.55,6.11,63,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),11.109,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Facial Bones; Less Than 3 Views (Pro Cah)Professional Component ,,70140,CPT,Professional,Both,,,26,63,53.55,6.11,63,CorVel,Worker's Compensation,19.123299,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Xr Facial Bones; Less Than 3 Views (Pro Cah)Professional Component ,,70140,CPT,Professional,Both,,,26,63,53.55,6.11,63,First Health Group Corporation,First Health Network,61.11,97,,percent of total billed charges,,
Xr Facial Bones; Less Than 3 Views (Pro Cah)Professional Component ,,70140,CPT,Professional,Both,,,26,63,53.55,6.11,63,"Health Partners, Inc.",Commercial,14.44,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Xr Facial Bones; Less Than 3 Views (Pro Cah)Professional Component ,,70140,CPT,Professional,Both,,,26,63,53.55,6.11,63,"Health Partners, Inc.",Medicare Advantage,11.109,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Facial Bones; Less Than 3 Views (Pro Cah)Professional Component ,,70140,CPT,Professional,Both,,,26,63,53.55,6.11,63,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),6.11,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Xr Facial Bones; Less Than 3 Views (Pro Cah)Professional Component ,,70140,CPT,Professional,Both,,,26,63,53.55,6.11,63,"Health Partners, Inc.",State of Minnesota Advantage Program,12.44006,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Xr Facial Bones; Less Than 3 Views (Pro Cah)Professional Component ,,70140,CPT,Professional,Both,,,26,63,53.55,6.11,63,"Health Partners, Inc.",State Public Programs,6.11,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Xr Facial Bones; Less Than 3 Views (Pro Cah)Professional Component ,,70140,CPT,Professional,Both,,,26,63,53.55,6.11,63,Humana Insurance Company,Commercial PPO,9.66,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Xr Facial Bones; Less Than 3 Views (Pro Cah)Professional Component ,,70140,CPT,Professional,Both,,,26,63,53.55,6.11,63,Humana Insurance Company,Medicare PPO,63,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Xr Facial Bones; Less Than 3 Views (Pro Cah)Professional Component ,,70140,CPT,Professional,Both,,,26,63,53.55,6.11,63,Medica,Individual & Family,53.424,84.8,,percent of total billed charges,,
Xr Facial Bones; Less Than 3 Views (Pro Cah)Professional Component ,,70140,CPT,Professional,Both,,,26,63,53.55,6.11,63,Medica,Medica Advantage Solution,31.374,49.8,,percent of total billed charges,,
Xr Facial Bones; Less Than 3 Views (Pro Cah)Professional Component ,,70140,CPT,Professional,Both,,,26,63,53.55,6.11,63,Medica,Medical Assistance,7.05,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Xr Facial Bones; Less Than 3 Views (Pro Cah)Professional Component ,,70140,CPT,Professional,Both,,,26,63,53.55,6.11,63,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,9.66,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Xr Facial Bones; Less Than 3 Views (Pro Cah)Professional Component ,,70140,CPT,Professional,Both,,,26,63,53.55,6.11,63,"Multiplan, Inc.","Multiplan, Inc.",59.22,94,,percent of total billed charges,,
Xr Facial Bones; Less Than 3 Views (Pro Cah)Professional Component ,,70140,CPT,Professional,Both,,,26,63,53.55,6.11,63,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,56.763,90.1,,percent of total billed charges,,
Xr Facial Bones; Less Than 3 Views (Pro Cah)Professional Component ,,70140,CPT,Professional,Both,,,26,63,53.55,6.11,63,"Preferred One Administrative Services, INC.",PPO,62.118,98.6,,percent of total billed charges,,
Xr Facial Bones; Less Than 3 Views (Pro Cah)Professional Component ,,70140,CPT,Professional,Both,,,26,63,53.55,6.11,63,PrimeWest Health,Minnesota Senior Health Options (MSHO),11.109,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Facial Bones; Less Than 3 Views (Pro Cah)Professional Component ,,70140,CPT,Professional,Both,,,26,63,53.55,6.11,63,PrimeWest Health,MinnesotaCare,7.5446128,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Facial Bones; Less Than 3 Views (Pro Cah)Professional Component ,,70140,CPT,Professional,Both,,,26,63,53.55,6.11,63,Sanford Health Plan,Sanford Health Plan,55.44,88,,percent of total billed charges,,
Xr Facial Bones; Less Than 3 Views (Pro Cah)Professional Component ,,70140,CPT,Professional,Both,,,26,63,53.55,6.11,63,"UCare Health, Inc.",Individual & Family Plan,15.703296,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Xr Facial Bones; Less Than 3 Views (Pro Cah)Professional Component ,,70140,CPT,Professional,Both,,,26,63,53.55,6.11,63,"UCare Health, Inc.",Medical Assistance,7.756144,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Xr Facial Bones; Less Than 3 Views (Pro Cah)Professional Component ,,70140,CPT,Professional,Both,,,26,63,53.55,6.11,63,"UCare Health, Inc.",Medicare Advantage,11.109,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Xr Facial Bones; Less Than 3 Views (Pro Cah)Professional Component ,,70140,CPT,Professional,Both,,,26,63,53.55,6.11,63,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),8.8872,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Xr Facial Bones; Less Than 3 Views (Pro Cah)Professional Component ,,70140,CPT,Professional,Both,,,26,63,53.55,6.11,63,UnitedHealthcare,Individual & Family,63,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Xr Facial Bones; Less Than 3 Views (Pro Cah)Professional Component ,,70140,CPT,Professional,Both,,,26,63,53.55,6.11,63,UnitedHealthcare,Medicare Advantage,11.109,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Facial Bones; Less Than 3 Views (Pro Cah)Professional Component ,,70140,CPT,Professional,Both,,,26,63,53.55,6.11,63,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,7.05104,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Facial Bones Routine Complete (Pro Cah)Professional Component ,,70150,CPT,Professional,Both,,,26,65,55.25,7.85,65,Aetna,Commercial,55.25,85,,percent of total billed charges,,
Xr Facial Bones Routine Complete (Pro Cah)Professional Component ,,70150,CPT,Professional,Both,,,26,65,55.25,7.85,65,Aetna,Medicare Advantage,12.73,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Facial Bones Routine Complete (Pro Cah)Professional Component ,,70150,CPT,Professional,Both,,,26,65,55.25,7.85,65,Aetna,PPO,60.45,93,,percent of total billed charges,,
Xr Facial Bones Routine Complete (Pro Cah)Professional Component ,,70150,CPT,Professional,Both,,,26,65,55.25,7.85,65,America's PPO,America's PPO,55.536,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Xr Facial Bones Routine Complete (Pro Cah)Professional Component ,,70150,CPT,Professional,Both,,,26,65,55.25,7.85,65,BlueCross BlueShield Minnesota, Federal Employee Program,23.65,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Xr Facial Bones Routine Complete (Pro Cah)Professional Component ,,70150,CPT,Professional,Both,,,26,65,55.25,7.85,65,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,24.0284,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Facial Bones Routine Complete (Pro Cah)Professional Component ,,70150,CPT,Professional,Both,,,26,65,55.25,7.85,65,BlueCross BlueShield Minnesota,High Value Network Plan,24.0284,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Facial Bones Routine Complete (Pro Cah)Professional Component ,,70150,CPT,Professional,Both,,,26,65,55.25,7.85,65,BlueCross BlueShield Minnesota,Medicare Advantage,14.2255,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Facial Bones Routine Complete (Pro Cah)Professional Component ,,70150,CPT,Professional,Both,,,26,65,55.25,7.85,65,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,24.0284,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Facial Bones Routine Complete (Pro Cah)Professional Component ,,70150,CPT,Professional,Both,,,26,65,55.25,7.85,65,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,9.06272,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Facial Bones Routine Complete (Pro Cah)Professional Component ,,70150,CPT,Professional,Both,,,26,65,55.25,7.85,65,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),14.2255,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Facial Bones Routine Complete (Pro Cah)Professional Component ,,70150,CPT,Professional,Both,,,26,65,55.25,7.85,65,CorVel,Worker's Compensation,24.5056311,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Xr Facial Bones Routine Complete (Pro Cah)Professional Component ,,70150,CPT,Professional,Both,,,26,65,55.25,7.85,65,First Health Group Corporation,First Health Network,63.05,97,,percent of total billed charges,,
Xr Facial Bones Routine Complete (Pro Cah)Professional Component ,,70150,CPT,Professional,Both,,,26,65,55.25,7.85,65,"Health Partners, Inc.",Commercial,18.56,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Xr Facial Bones Routine Complete (Pro Cah)Professional Component ,,70150,CPT,Professional,Both,,,26,65,55.25,7.85,65,"Health Partners, Inc.",Medicare Advantage,14.2255,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Facial Bones Routine Complete (Pro Cah)Professional Component ,,70150,CPT,Professional,Both,,,26,65,55.25,7.85,65,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),7.85,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Xr Facial Bones Routine Complete (Pro Cah)Professional Component ,,70150,CPT,Professional,Both,,,26,65,55.25,7.85,65,"Health Partners, Inc.",State of Minnesota Advantage Program,15.98944,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Xr Facial Bones Routine Complete (Pro Cah)Professional Component ,,70150,CPT,Professional,Both,,,26,65,55.25,7.85,65,"Health Partners, Inc.",State Public Programs,7.85,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Xr Facial Bones Routine Complete (Pro Cah)Professional Component ,,70150,CPT,Professional,Both,,,26,65,55.25,7.85,65,Humana Insurance Company,Commercial PPO,12.37,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Xr Facial Bones Routine Complete (Pro Cah)Professional Component ,,70150,CPT,Professional,Both,,,26,65,55.25,7.85,65,Humana Insurance Company,Medicare PPO,65,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Xr Facial Bones Routine Complete (Pro Cah)Professional Component ,,70150,CPT,Professional,Both,,,26,65,55.25,7.85,65,Medica,Individual & Family,55.12,84.8,,percent of total billed charges,,
Xr Facial Bones Routine Complete (Pro Cah)Professional Component ,,70150,CPT,Professional,Both,,,26,65,55.25,7.85,65,Medica,Medica Advantage Solution,32.37,49.8,,percent of total billed charges,,
Xr Facial Bones Routine Complete (Pro Cah)Professional Component ,,70150,CPT,Professional,Both,,,26,65,55.25,7.85,65,Medica,Medical Assistance,9.06,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Xr Facial Bones Routine Complete (Pro Cah)Professional Component ,,70150,CPT,Professional,Both,,,26,65,55.25,7.85,65,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,12.37,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Xr Facial Bones Routine Complete (Pro Cah)Professional Component ,,70150,CPT,Professional,Both,,,26,65,55.25,7.85,65,"Multiplan, Inc.","Multiplan, Inc.",61.1,94,,percent of total billed charges,,
Xr Facial Bones Routine Complete (Pro Cah)Professional Component ,,70150,CPT,Professional,Both,,,26,65,55.25,7.85,65,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,58.565,90.1,,percent of total billed charges,,
Xr Facial Bones Routine Complete (Pro Cah)Professional Component ,,70150,CPT,Professional,Both,,,26,65,55.25,7.85,65,"Preferred One Administrative Services, INC.",PPO,64.09,98.6,,percent of total billed charges,,
Xr Facial Bones Routine Complete (Pro Cah)Professional Component ,,70150,CPT,Professional,Both,,,26,65,55.25,7.85,65,PrimeWest Health,Minnesota Senior Health Options (MSHO),14.2255,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Facial Bones Routine Complete (Pro Cah)Professional Component ,,70150,CPT,Professional,Both,,,26,65,55.25,7.85,65,PrimeWest Health,MinnesotaCare,9.6971104,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Facial Bones Routine Complete (Pro Cah)Professional Component ,,70150,CPT,Professional,Both,,,26,65,55.25,7.85,65,Sanford Health Plan,Sanford Health Plan,57.2,88,,percent of total billed charges,,
Xr Facial Bones Routine Complete (Pro Cah)Professional Component ,,70150,CPT,Professional,Both,,,26,65,55.25,7.85,65,"UCare Health, Inc.",Individual & Family Plan,20.108672,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Xr Facial Bones Routine Complete (Pro Cah)Professional Component ,,70150,CPT,Professional,Both,,,26,65,55.25,7.85,65,"UCare Health, Inc.",Medical Assistance,9.968992,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Xr Facial Bones Routine Complete (Pro Cah)Professional Component ,,70150,CPT,Professional,Both,,,26,65,55.25,7.85,65,"UCare Health, Inc.",Medicare Advantage,14.2255,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Xr Facial Bones Routine Complete (Pro Cah)Professional Component ,,70150,CPT,Professional,Both,,,26,65,55.25,7.85,65,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),11.3804,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Xr Facial Bones Routine Complete (Pro Cah)Professional Component ,,70150,CPT,Professional,Both,,,26,65,55.25,7.85,65,UnitedHealthcare,Individual & Family,65,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Xr Facial Bones Routine Complete (Pro Cah)Professional Component ,,70150,CPT,Professional,Both,,,26,65,55.25,7.85,65,UnitedHealthcare,Medicare Advantage,14.2255,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Facial Bones Routine Complete (Pro Cah)Professional Component ,,70150,CPT,Professional,Both,,,26,65,55.25,7.85,65,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,9.06272,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Nasal Bones (Pro Cah)Professional Component ,,70160,CPT,Professional,Both,,,26,38,32.3,5.23,38,Aetna,Commercial,32.3,85,,percent of total billed charges,,
Xr Nasal Bones (Pro Cah)Professional Component ,,70160,CPT,Professional,Both,,,26,38,32.3,5.23,38,Aetna,Medicare Advantage,8.53,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Nasal Bones (Pro Cah)Professional Component ,,70160,CPT,Professional,Both,,,26,38,32.3,5.23,38,Aetna,PPO,35.34,93,,percent of total billed charges,,
Xr Nasal Bones (Pro Cah)Professional Component ,,70160,CPT,Professional,Both,,,26,38,32.3,5.23,38,America's PPO,America's PPO,32.4672,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Xr Nasal Bones (Pro Cah)Professional Component ,,70160,CPT,Professional,Both,,,26,38,32.3,5.23,38,BlueCross BlueShield Minnesota, Federal Employee Program,15.98,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Xr Nasal Bones (Pro Cah)Professional Component ,,70160,CPT,Professional,Both,,,26,38,32.3,5.23,38,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,16.23568,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Nasal Bones (Pro Cah)Professional Component ,,70160,CPT,Professional,Both,,,26,38,32.3,5.23,38,BlueCross BlueShield Minnesota,High Value Network Plan,16.23568,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Nasal Bones (Pro Cah)Professional Component ,,70160,CPT,Professional,Both,,,26,38,32.3,5.23,38,BlueCross BlueShield Minnesota,Medicare Advantage,9.5335,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Nasal Bones (Pro Cah)Professional Component ,,70160,CPT,Professional,Both,,,26,38,32.3,5.23,38,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,16.23568,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Nasal Bones (Pro Cah)Professional Component ,,70160,CPT,Professional,Both,,,26,38,32.3,5.23,38,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,6.03504,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Nasal Bones (Pro Cah)Professional Component ,,70160,CPT,Professional,Both,,,26,38,32.3,5.23,38,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),9.5335,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Nasal Bones (Pro Cah)Professional Component ,,70160,CPT,Professional,Both,,,26,38,32.3,5.23,38,CorVel,Worker's Compensation,16.4190348,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Xr Nasal Bones (Pro Cah)Professional Component ,,70160,CPT,Professional,Both,,,26,38,32.3,5.23,38,First Health Group Corporation,First Health Network,36.86,97,,percent of total billed charges,,
Xr Nasal Bones (Pro Cah)Professional Component ,,70160,CPT,Professional,Both,,,26,38,32.3,5.23,38,"Health Partners, Inc.",Commercial,12.37,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Xr Nasal Bones (Pro Cah)Professional Component ,,70160,CPT,Professional,Both,,,26,38,32.3,5.23,38,"Health Partners, Inc.",Medicare Advantage,9.5335,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Nasal Bones (Pro Cah)Professional Component ,,70160,CPT,Professional,Both,,,26,38,32.3,5.23,38,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),5.23,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Xr Nasal Bones (Pro Cah)Professional Component ,,70160,CPT,Professional,Both,,,26,38,32.3,5.23,38,"Health Partners, Inc.",State of Minnesota Advantage Program,10.656755,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Xr Nasal Bones (Pro Cah)Professional Component ,,70160,CPT,Professional,Both,,,26,38,32.3,5.23,38,"Health Partners, Inc.",State Public Programs,5.23,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Xr Nasal Bones (Pro Cah)Professional Component ,,70160,CPT,Professional,Both,,,26,38,32.3,5.23,38,Humana Insurance Company,Commercial PPO,8.29,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Xr Nasal Bones (Pro Cah)Professional Component ,,70160,CPT,Professional,Both,,,26,38,32.3,5.23,38,Humana Insurance Company,Medicare PPO,38,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Xr Nasal Bones (Pro Cah)Professional Component ,,70160,CPT,Professional,Both,,,26,38,32.3,5.23,38,Medica,Individual & Family,32.224,84.8,,percent of total billed charges,,
Xr Nasal Bones (Pro Cah)Professional Component ,,70160,CPT,Professional,Both,,,26,38,32.3,5.23,38,Medica,Medica Advantage Solution,18.924,49.8,,percent of total billed charges,,
Xr Nasal Bones (Pro Cah)Professional Component ,,70160,CPT,Professional,Both,,,26,38,32.3,5.23,38,Medica,Medical Assistance,6.04,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Xr Nasal Bones (Pro Cah)Professional Component ,,70160,CPT,Professional,Both,,,26,38,32.3,5.23,38,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,8.29,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Xr Nasal Bones (Pro Cah)Professional Component ,,70160,CPT,Professional,Both,,,26,38,32.3,5.23,38,"Multiplan, Inc.","Multiplan, Inc.",35.72,94,,percent of total billed charges,,
Xr Nasal Bones (Pro Cah)Professional Component ,,70160,CPT,Professional,Both,,,26,38,32.3,5.23,38,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,34.238,90.1,,percent of total billed charges,,
Xr Nasal Bones (Pro Cah)Professional Component ,,70160,CPT,Professional,Both,,,26,38,32.3,5.23,38,"Preferred One Administrative Services, INC.",PPO,37.468,98.6,,percent of total billed charges,,
Xr Nasal Bones (Pro Cah)Professional Component ,,70160,CPT,Professional,Both,,,26,38,32.3,5.23,38,PrimeWest Health,Minnesota Senior Health Options (MSHO),9.5335,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Nasal Bones (Pro Cah)Professional Component ,,70160,CPT,Professional,Both,,,26,38,32.3,5.23,38,PrimeWest Health,MinnesotaCare,6.4574928,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Nasal Bones (Pro Cah)Professional Component ,,70160,CPT,Professional,Both,,,26,38,32.3,5.23,38,Sanford Health Plan,Sanford Health Plan,33.44,88,,percent of total billed charges,,
Xr Nasal Bones (Pro Cah)Professional Component ,,70160,CPT,Professional,Both,,,26,38,32.3,5.23,38,"UCare Health, Inc.",Individual & Family Plan,13.476224,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Xr Nasal Bones (Pro Cah)Professional Component ,,70160,CPT,Professional,Both,,,26,38,32.3,5.23,38,"UCare Health, Inc.",Medical Assistance,6.638544,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Xr Nasal Bones (Pro Cah)Professional Component ,,70160,CPT,Professional,Both,,,26,38,32.3,5.23,38,"UCare Health, Inc.",Medicare Advantage,9.5335,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Xr Nasal Bones (Pro Cah)Professional Component ,,70160,CPT,Professional,Both,,,26,38,32.3,5.23,38,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),7.6268,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Xr Nasal Bones (Pro Cah)Professional Component ,,70160,CPT,Professional,Both,,,26,38,32.3,5.23,38,UnitedHealthcare,Individual & Family,38,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Xr Nasal Bones (Pro Cah)Professional Component ,,70160,CPT,Professional,Both,,,26,38,32.3,5.23,38,UnitedHealthcare,Medicare Advantage,9.5335,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Nasal Bones (Pro Cah)Professional Component ,,70160,CPT,Professional,Both,,,26,38,32.3,5.23,38,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,6.03504,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Orbits Greater Than 3 Views (Pro Cah)Professional Component ,,70200,CPT,Professional,Both,,,26,70,59.5,8.5,70,Aetna,Commercial,59.5,85,,percent of total billed charges,,
Xr Orbits Greater Than 3 Views (Pro Cah)Professional Component ,,70200,CPT,Professional,Both,,,26,70,59.5,8.5,70,Aetna,Medicare Advantage,13.78,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Orbits Greater Than 3 Views (Pro Cah)Professional Component ,,70200,CPT,Professional,Both,,,26,70,59.5,8.5,70,Aetna,PPO,65.1,93,,percent of total billed charges,,
Xr Orbits Greater Than 3 Views (Pro Cah)Professional Component ,,70200,CPT,Professional,Both,,,26,70,59.5,8.5,70,America's PPO,America's PPO,59.808,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Xr Orbits Greater Than 3 Views (Pro Cah)Professional Component ,,70200,CPT,Professional,Both,,,26,70,59.5,8.5,70,BlueCross BlueShield Minnesota, Federal Employee Program,25.57,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Xr Orbits Greater Than 3 Views (Pro Cah)Professional Component ,,70200,CPT,Professional,Both,,,26,70,59.5,8.5,70,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,25.97912,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Orbits Greater Than 3 Views (Pro Cah)Professional Component ,,70200,CPT,Professional,Both,,,26,70,59.5,8.5,70,BlueCross BlueShield Minnesota,High Value Network Plan,25.97912,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Orbits Greater Than 3 Views (Pro Cah)Professional Component ,,70200,CPT,Professional,Both,,,26,70,59.5,8.5,70,BlueCross BlueShield Minnesota,Medicare Advantage,15.41,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Orbits Greater Than 3 Views (Pro Cah)Professional Component ,,70200,CPT,Professional,Both,,,26,70,59.5,8.5,70,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,25.97912,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Orbits Greater Than 3 Views (Pro Cah)Professional Component ,,70200,CPT,Professional,Both,,,26,70,59.5,8.5,70,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,9.81456,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Orbits Greater Than 3 Views (Pro Cah)Professional Component ,,70200,CPT,Professional,Both,,,26,70,59.5,8.5,70,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),15.41,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Orbits Greater Than 3 Views (Pro Cah)Professional Component ,,70200,CPT,Professional,Both,,,26,70,59.5,8.5,70,CorVel,Worker's Compensation,26.5294632,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Xr Orbits Greater Than 3 Views (Pro Cah)Professional Component ,,70200,CPT,Professional,Both,,,26,70,59.5,8.5,70,First Health Group Corporation,First Health Network,67.9,97,,percent of total billed charges,,
Xr Orbits Greater Than 3 Views (Pro Cah)Professional Component ,,70200,CPT,Professional,Both,,,26,70,59.5,8.5,70,"Health Partners, Inc.",Commercial,20.11,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Xr Orbits Greater Than 3 Views (Pro Cah)Professional Component ,,70200,CPT,Professional,Both,,,26,70,59.5,8.5,70,"Health Partners, Inc.",Medicare Advantage,15.41,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Orbits Greater Than 3 Views (Pro Cah)Professional Component ,,70200,CPT,Professional,Both,,,26,70,59.5,8.5,70,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),8.5,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Xr Orbits Greater Than 3 Views (Pro Cah)Professional Component ,,70200,CPT,Professional,Both,,,26,70,59.5,8.5,70,"Health Partners, Inc.",State of Minnesota Advantage Program,17.324765,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Xr Orbits Greater Than 3 Views (Pro Cah)Professional Component ,,70200,CPT,Professional,Both,,,26,70,59.5,8.5,70,"Health Partners, Inc.",State Public Programs,8.5,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Xr Orbits Greater Than 3 Views (Pro Cah)Professional Component ,,70200,CPT,Professional,Both,,,26,70,59.5,8.5,70,Humana Insurance Company,Commercial PPO,13.4,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Xr Orbits Greater Than 3 Views (Pro Cah)Professional Component ,,70200,CPT,Professional,Both,,,26,70,59.5,8.5,70,Humana Insurance Company,Medicare PPO,70,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Xr Orbits Greater Than 3 Views (Pro Cah)Professional Component ,,70200,CPT,Professional,Both,,,26,70,59.5,8.5,70,Medica,Individual & Family,59.36,84.8,,percent of total billed charges,,
Xr Orbits Greater Than 3 Views (Pro Cah)Professional Component ,,70200,CPT,Professional,Both,,,26,70,59.5,8.5,70,Medica,Medica Advantage Solution,34.86,49.8,,percent of total billed charges,,
Xr Orbits Greater Than 3 Views (Pro Cah)Professional Component ,,70200,CPT,Professional,Both,,,26,70,59.5,8.5,70,Medica,Medical Assistance,9.81,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Xr Orbits Greater Than 3 Views (Pro Cah)Professional Component ,,70200,CPT,Professional,Both,,,26,70,59.5,8.5,70,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,13.4,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Xr Orbits Greater Than 3 Views (Pro Cah)Professional Component ,,70200,CPT,Professional,Both,,,26,70,59.5,8.5,70,"Multiplan, Inc.","Multiplan, Inc.",65.8,94,,percent of total billed charges,,
Xr Orbits Greater Than 3 Views (Pro Cah)Professional Component ,,70200,CPT,Professional,Both,,,26,70,59.5,8.5,70,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,63.07,90.1,,percent of total billed charges,,
Xr Orbits Greater Than 3 Views (Pro Cah)Professional Component ,,70200,CPT,Professional,Both,,,26,70,59.5,8.5,70,"Preferred One Administrative Services, INC.",PPO,69.02,98.6,,percent of total billed charges,,
Xr Orbits Greater Than 3 Views (Pro Cah)Professional Component ,,70200,CPT,Professional,Both,,,26,70,59.5,8.5,70,PrimeWest Health,Minnesota Senior Health Options (MSHO),15.41,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Orbits Greater Than 3 Views (Pro Cah)Professional Component ,,70200,CPT,Professional,Both,,,26,70,59.5,8.5,70,PrimeWest Health,MinnesotaCare,10.5015792,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Orbits Greater Than 3 Views (Pro Cah)Professional Component ,,70200,CPT,Professional,Both,,,26,70,59.5,8.5,70,Sanford Health Plan,Sanford Health Plan,61.6,88,,percent of total billed charges,,
Xr Orbits Greater Than 3 Views (Pro Cah)Professional Component ,,70200,CPT,Professional,Both,,,26,70,59.5,8.5,70,"UCare Health, Inc.",Individual & Family Plan,21.78304,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Xr Orbits Greater Than 3 Views (Pro Cah)Professional Component ,,70200,CPT,Professional,Both,,,26,70,59.5,8.5,70,"UCare Health, Inc.",Medical Assistance,10.796016,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Xr Orbits Greater Than 3 Views (Pro Cah)Professional Component ,,70200,CPT,Professional,Both,,,26,70,59.5,8.5,70,"UCare Health, Inc.",Medicare Advantage,15.41,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Xr Orbits Greater Than 3 Views (Pro Cah)Professional Component ,,70200,CPT,Professional,Both,,,26,70,59.5,8.5,70,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),12.328,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Xr Orbits Greater Than 3 Views (Pro Cah)Professional Component ,,70200,CPT,Professional,Both,,,26,70,59.5,8.5,70,UnitedHealthcare,Individual & Family,70,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Xr Orbits Greater Than 3 Views (Pro Cah)Professional Component ,,70200,CPT,Professional,Both,,,26,70,59.5,8.5,70,UnitedHealthcare,Medicare Advantage,15.41,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Orbits Greater Than 3 Views (Pro Cah)Professional Component ,,70200,CPT,Professional,Both,,,26,70,59.5,8.5,70,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,9.81456,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Sinus Waters View (Pro Cah)Professional Component ,,70210,CPT,Professional,Both,,,26,39,33.15,5.23,39,Aetna,Commercial,33.15,85,,percent of total billed charges,,
Xr Sinus Waters View (Pro Cah)Professional Component ,,70210,CPT,Professional,Both,,,26,39,33.15,5.23,39,Aetna,Medicare Advantage,8.53,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Sinus Waters View (Pro Cah)Professional Component ,,70210,CPT,Professional,Both,,,26,39,33.15,5.23,39,Aetna,PPO,36.27,93,,percent of total billed charges,,
Xr Sinus Waters View (Pro Cah)Professional Component ,,70210,CPT,Professional,Both,,,26,39,33.15,5.23,39,America's PPO,America's PPO,33.3216,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Xr Sinus Waters View (Pro Cah)Professional Component ,,70210,CPT,Professional,Both,,,26,39,33.15,5.23,39,BlueCross BlueShield Minnesota, Federal Employee Program,15.98,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Xr Sinus Waters View (Pro Cah)Professional Component ,,70210,CPT,Professional,Both,,,26,39,33.15,5.23,39,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,16.23568,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Sinus Waters View (Pro Cah)Professional Component ,,70210,CPT,Professional,Both,,,26,39,33.15,5.23,39,BlueCross BlueShield Minnesota,High Value Network Plan,16.23568,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Sinus Waters View (Pro Cah)Professional Component ,,70210,CPT,Professional,Both,,,26,39,33.15,5.23,39,BlueCross BlueShield Minnesota,Medicare Advantage,9.5335,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Sinus Waters View (Pro Cah)Professional Component ,,70210,CPT,Professional,Both,,,26,39,33.15,5.23,39,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,16.23568,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Sinus Waters View (Pro Cah)Professional Component ,,70210,CPT,Professional,Both,,,26,39,33.15,5.23,39,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,6.03504,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Sinus Waters View (Pro Cah)Professional Component ,,70210,CPT,Professional,Both,,,26,39,33.15,5.23,39,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),9.5335,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Sinus Waters View (Pro Cah)Professional Component ,,70210,CPT,Professional,Both,,,26,39,33.15,5.23,39,CorVel,Worker's Compensation,16.4190348,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Xr Sinus Waters View (Pro Cah)Professional Component ,,70210,CPT,Professional,Both,,,26,39,33.15,5.23,39,First Health Group Corporation,First Health Network,37.83,97,,percent of total billed charges,,
Xr Sinus Waters View (Pro Cah)Professional Component ,,70210,CPT,Professional,Both,,,26,39,33.15,5.23,39,"Health Partners, Inc.",Commercial,12.37,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Xr Sinus Waters View (Pro Cah)Professional Component ,,70210,CPT,Professional,Both,,,26,39,33.15,5.23,39,"Health Partners, Inc.",Medicare Advantage,9.5335,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Sinus Waters View (Pro Cah)Professional Component ,,70210,CPT,Professional,Both,,,26,39,33.15,5.23,39,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),5.23,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Xr Sinus Waters View (Pro Cah)Professional Component ,,70210,CPT,Professional,Both,,,26,39,33.15,5.23,39,"Health Partners, Inc.",State of Minnesota Advantage Program,10.656755,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Xr Sinus Waters View (Pro Cah)Professional Component ,,70210,CPT,Professional,Both,,,26,39,33.15,5.23,39,"Health Partners, Inc.",State Public Programs,5.23,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Xr Sinus Waters View (Pro Cah)Professional Component ,,70210,CPT,Professional,Both,,,26,39,33.15,5.23,39,Humana Insurance Company,Commercial PPO,8.29,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Xr Sinus Waters View (Pro Cah)Professional Component ,,70210,CPT,Professional,Both,,,26,39,33.15,5.23,39,Humana Insurance Company,Medicare PPO,39,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Xr Sinus Waters View (Pro Cah)Professional Component ,,70210,CPT,Professional,Both,,,26,39,33.15,5.23,39,Medica,Individual & Family,33.072,84.8,,percent of total billed charges,,
Xr Sinus Waters View (Pro Cah)Professional Component ,,70210,CPT,Professional,Both,,,26,39,33.15,5.23,39,Medica,Medica Advantage Solution,19.422,49.8,,percent of total billed charges,,
Xr Sinus Waters View (Pro Cah)Professional Component ,,70210,CPT,Professional,Both,,,26,39,33.15,5.23,39,Medica,Medical Assistance,6.04,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Xr Sinus Waters View (Pro Cah)Professional Component ,,70210,CPT,Professional,Both,,,26,39,33.15,5.23,39,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,8.29,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Xr Sinus Waters View (Pro Cah)Professional Component ,,70210,CPT,Professional,Both,,,26,39,33.15,5.23,39,"Multiplan, Inc.","Multiplan, Inc.",36.66,94,,percent of total billed charges,,
Xr Sinus Waters View (Pro Cah)Professional Component ,,70210,CPT,Professional,Both,,,26,39,33.15,5.23,39,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,35.139,90.1,,percent of total billed charges,,
Xr Sinus Waters View (Pro Cah)Professional Component ,,70210,CPT,Professional,Both,,,26,39,33.15,5.23,39,"Preferred One Administrative Services, INC.",PPO,38.454,98.6,,percent of total billed charges,,
Xr Sinus Waters View (Pro Cah)Professional Component ,,70210,CPT,Professional,Both,,,26,39,33.15,5.23,39,PrimeWest Health,Minnesota Senior Health Options (MSHO),9.5335,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Sinus Waters View (Pro Cah)Professional Component ,,70210,CPT,Professional,Both,,,26,39,33.15,5.23,39,PrimeWest Health,MinnesotaCare,6.4574928,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Sinus Waters View (Pro Cah)Professional Component ,,70210,CPT,Professional,Both,,,26,39,33.15,5.23,39,Sanford Health Plan,Sanford Health Plan,34.32,88,,percent of total billed charges,,
Xr Sinus Waters View (Pro Cah)Professional Component ,,70210,CPT,Professional,Both,,,26,39,33.15,5.23,39,"UCare Health, Inc.",Individual & Family Plan,13.476224,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Xr Sinus Waters View (Pro Cah)Professional Component ,,70210,CPT,Professional,Both,,,26,39,33.15,5.23,39,"UCare Health, Inc.",Medical Assistance,6.638544,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Xr Sinus Waters View (Pro Cah)Professional Component ,,70210,CPT,Professional,Both,,,26,39,33.15,5.23,39,"UCare Health, Inc.",Medicare Advantage,9.5335,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Xr Sinus Waters View (Pro Cah)Professional Component ,,70210,CPT,Professional,Both,,,26,39,33.15,5.23,39,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),7.6268,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Xr Sinus Waters View (Pro Cah)Professional Component ,,70210,CPT,Professional,Both,,,26,39,33.15,5.23,39,UnitedHealthcare,Individual & Family,39,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Xr Sinus Waters View (Pro Cah)Professional Component ,,70210,CPT,Professional,Both,,,26,39,33.15,5.23,39,UnitedHealthcare,Medicare Advantage,9.5335,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Sinus Waters View (Pro Cah)Professional Component ,,70210,CPT,Professional,Both,,,26,39,33.15,5.23,39,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,6.03504,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Sinus Routine Complete (Pro Cah)Professional Component ,,70220,CPT,Professional,Both,,,26,58,49.3,6.54,58,Aetna,Commercial,49.3,85,,percent of total billed charges,,
Xr Sinus Routine Complete (Pro Cah)Professional Component ,,70220,CPT,Professional,Both,,,26,58,49.3,6.54,58,Aetna,Medicare Advantage,10.63,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Sinus Routine Complete (Pro Cah)Professional Component ,,70220,CPT,Professional,Both,,,26,58,49.3,6.54,58,Aetna,PPO,53.94,93,,percent of total billed charges,,
Xr Sinus Routine Complete (Pro Cah)Professional Component ,,70220,CPT,Professional,Both,,,26,58,49.3,6.54,58,America's PPO,America's PPO,49.5552,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Xr Sinus Routine Complete (Pro Cah)Professional Component ,,70220,CPT,Professional,Both,,,26,58,49.3,6.54,58,BlueCross BlueShield Minnesota, Federal Employee Program,19.82,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Xr Sinus Routine Complete (Pro Cah)Professional Component ,,70220,CPT,Professional,Both,,,26,58,49.3,6.54,58,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,20.13712,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Sinus Routine Complete (Pro Cah)Professional Component ,,70220,CPT,Professional,Both,,,26,58,49.3,6.54,58,BlueCross BlueShield Minnesota,High Value Network Plan,20.13712,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Sinus Routine Complete (Pro Cah)Professional Component ,,70220,CPT,Professional,Both,,,26,58,49.3,6.54,58,BlueCross BlueShield Minnesota,Medicare Advantage,11.8795,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Sinus Routine Complete (Pro Cah)Professional Component ,,70220,CPT,Professional,Both,,,26,58,49.3,6.54,58,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,20.13712,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Sinus Routine Complete (Pro Cah)Professional Component ,,70220,CPT,Professional,Both,,,26,58,49.3,6.54,58,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,7.54888,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Sinus Routine Complete (Pro Cah)Professional Component ,,70220,CPT,Professional,Both,,,26,58,49.3,6.54,58,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),11.8795,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Sinus Routine Complete (Pro Cah)Professional Component ,,70220,CPT,Professional,Both,,,26,58,49.3,6.54,58,CorVel,Worker's Compensation,20.4579669,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Xr Sinus Routine Complete (Pro Cah)Professional Component ,,70220,CPT,Professional,Both,,,26,58,49.3,6.54,58,First Health Group Corporation,First Health Network,56.26,97,,percent of total billed charges,,
Xr Sinus Routine Complete (Pro Cah)Professional Component ,,70220,CPT,Professional,Both,,,26,58,49.3,6.54,58,"Health Partners, Inc.",Commercial,15.47,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Xr Sinus Routine Complete (Pro Cah)Professional Component ,,70220,CPT,Professional,Both,,,26,58,49.3,6.54,58,"Health Partners, Inc.",Medicare Advantage,11.8795,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Sinus Routine Complete (Pro Cah)Professional Component ,,70220,CPT,Professional,Both,,,26,58,49.3,6.54,58,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),6.54,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Xr Sinus Routine Complete (Pro Cah)Professional Component ,,70220,CPT,Professional,Both,,,26,58,49.3,6.54,58,"Health Partners, Inc.",State of Minnesota Advantage Program,13.327405,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Xr Sinus Routine Complete (Pro Cah)Professional Component ,,70220,CPT,Professional,Both,,,26,58,49.3,6.54,58,"Health Partners, Inc.",State Public Programs,6.54,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Xr Sinus Routine Complete (Pro Cah)Professional Component ,,70220,CPT,Professional,Both,,,26,58,49.3,6.54,58,Humana Insurance Company,Commercial PPO,10.33,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Xr Sinus Routine Complete (Pro Cah)Professional Component ,,70220,CPT,Professional,Both,,,26,58,49.3,6.54,58,Humana Insurance Company,Medicare PPO,58,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Xr Sinus Routine Complete (Pro Cah)Professional Component ,,70220,CPT,Professional,Both,,,26,58,49.3,6.54,58,Medica,Individual & Family,49.184,84.8,,percent of total billed charges,,
Xr Sinus Routine Complete (Pro Cah)Professional Component ,,70220,CPT,Professional,Both,,,26,58,49.3,6.54,58,Medica,Medica Advantage Solution,28.884,49.8,,percent of total billed charges,,
Xr Sinus Routine Complete (Pro Cah)Professional Component ,,70220,CPT,Professional,Both,,,26,58,49.3,6.54,58,Medica,Medical Assistance,7.55,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Xr Sinus Routine Complete (Pro Cah)Professional Component ,,70220,CPT,Professional,Both,,,26,58,49.3,6.54,58,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,10.33,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Xr Sinus Routine Complete (Pro Cah)Professional Component ,,70220,CPT,Professional,Both,,,26,58,49.3,6.54,58,"Multiplan, Inc.","Multiplan, Inc.",54.52,94,,percent of total billed charges,,
Xr Sinus Routine Complete (Pro Cah)Professional Component ,,70220,CPT,Professional,Both,,,26,58,49.3,6.54,58,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,52.258,90.1,,percent of total billed charges,,
Xr Sinus Routine Complete (Pro Cah)Professional Component ,,70220,CPT,Professional,Both,,,26,58,49.3,6.54,58,"Preferred One Administrative Services, INC.",PPO,57.188,98.6,,percent of total billed charges,,
Xr Sinus Routine Complete (Pro Cah)Professional Component ,,70220,CPT,Professional,Both,,,26,58,49.3,6.54,58,PrimeWest Health,Minnesota Senior Health Options (MSHO),11.8795,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Sinus Routine Complete (Pro Cah)Professional Component ,,70220,CPT,Professional,Both,,,26,58,49.3,6.54,58,PrimeWest Health,MinnesotaCare,8.0773016,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Sinus Routine Complete (Pro Cah)Professional Component ,,70220,CPT,Professional,Both,,,26,58,49.3,6.54,58,Sanford Health Plan,Sanford Health Plan,51.04,88,,percent of total billed charges,,
Xr Sinus Routine Complete (Pro Cah)Professional Component ,,70220,CPT,Professional,Both,,,26,58,49.3,6.54,58,"UCare Health, Inc.",Individual & Family Plan,16.792448,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Xr Sinus Routine Complete (Pro Cah)Professional Component ,,70220,CPT,Professional,Both,,,26,58,49.3,6.54,58,"UCare Health, Inc.",Medical Assistance,8.303768,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Xr Sinus Routine Complete (Pro Cah)Professional Component ,,70220,CPT,Professional,Both,,,26,58,49.3,6.54,58,"UCare Health, Inc.",Medicare Advantage,11.8795,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Xr Sinus Routine Complete (Pro Cah)Professional Component ,,70220,CPT,Professional,Both,,,26,58,49.3,6.54,58,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),9.5036,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Xr Sinus Routine Complete (Pro Cah)Professional Component ,,70220,CPT,Professional,Both,,,26,58,49.3,6.54,58,UnitedHealthcare,Individual & Family,58,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Xr Sinus Routine Complete (Pro Cah)Professional Component ,,70220,CPT,Professional,Both,,,26,58,49.3,6.54,58,UnitedHealthcare,Medicare Advantage,11.8795,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Sinus Routine Complete (Pro Cah)Professional Component ,,70220,CPT,Professional,Both,,,26,58,49.3,6.54,58,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,7.54888,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Skull Under 4 Views (Pro Cah)Professional Component ,,70250,CPT,Professional,Both,,,26,51,43.35,5.45,51,Aetna,Commercial,43.35,85,,percent of total billed charges,,
Xr Skull Under 4 Views (Pro Cah)Professional Component ,,70250,CPT,Professional,Both,,,26,51,43.35,5.45,51,Aetna,Medicare Advantage,8.88,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Skull Under 4 Views (Pro Cah)Professional Component ,,70250,CPT,Professional,Both,,,26,51,43.35,5.45,51,Aetna,PPO,47.43,93,,percent of total billed charges,,
Xr Skull Under 4 Views (Pro Cah)Professional Component ,,70250,CPT,Professional,Both,,,26,51,43.35,5.45,51,America's PPO,America's PPO,43.5744,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Xr Skull Under 4 Views (Pro Cah)Professional Component ,,70250,CPT,Professional,Both,,,26,51,43.35,5.45,51,BlueCross BlueShield Minnesota, Federal Employee Program,16.62,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Xr Skull Under 4 Views (Pro Cah)Professional Component ,,70250,CPT,Professional,Both,,,26,51,43.35,5.45,51,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,16.88592,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Skull Under 4 Views (Pro Cah)Professional Component ,,70250,CPT,Professional,Both,,,26,51,43.35,5.45,51,BlueCross BlueShield Minnesota,High Value Network Plan,16.88592,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Skull Under 4 Views (Pro Cah)Professional Component ,,70250,CPT,Professional,Both,,,26,51,43.35,5.45,51,BlueCross BlueShield Minnesota,Medicare Advantage,9.9245,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Skull Under 4 Views (Pro Cah)Professional Component ,,70250,CPT,Professional,Both,,,26,51,43.35,5.45,51,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,16.88592,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Skull Under 4 Views (Pro Cah)Professional Component ,,70250,CPT,Professional,Both,,,26,51,43.35,5.45,51,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,6.28904,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Skull Under 4 Views (Pro Cah)Professional Component ,,70250,CPT,Professional,Both,,,26,51,43.35,5.45,51,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),9.9245,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Skull Under 4 Views (Pro Cah)Professional Component ,,70250,CPT,Professional,Both,,,26,51,43.35,5.45,51,CorVel,Worker's Compensation,17.0907348,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Xr Skull Under 4 Views (Pro Cah)Professional Component ,,70250,CPT,Professional,Both,,,26,51,43.35,5.45,51,First Health Group Corporation,First Health Network,49.47,97,,percent of total billed charges,,
Xr Skull Under 4 Views (Pro Cah)Professional Component ,,70250,CPT,Professional,Both,,,26,51,43.35,5.45,51,"Health Partners, Inc.",Commercial,12.89,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Xr Skull Under 4 Views (Pro Cah)Professional Component ,,70250,CPT,Professional,Both,,,26,51,43.35,5.45,51,"Health Partners, Inc.",Medicare Advantage,9.9245,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Skull Under 4 Views (Pro Cah)Professional Component ,,70250,CPT,Professional,Both,,,26,51,43.35,5.45,51,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),5.45,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Xr Skull Under 4 Views (Pro Cah)Professional Component ,,70250,CPT,Professional,Both,,,26,51,43.35,5.45,51,"Health Partners, Inc.",State of Minnesota Advantage Program,11.104735,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Xr Skull Under 4 Views (Pro Cah)Professional Component ,,70250,CPT,Professional,Both,,,26,51,43.35,5.45,51,"Health Partners, Inc.",State Public Programs,5.45,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Xr Skull Under 4 Views (Pro Cah)Professional Component ,,70250,CPT,Professional,Both,,,26,51,43.35,5.45,51,Humana Insurance Company,Commercial PPO,8.63,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Xr Skull Under 4 Views (Pro Cah)Professional Component ,,70250,CPT,Professional,Both,,,26,51,43.35,5.45,51,Humana Insurance Company,Medicare PPO,51,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Xr Skull Under 4 Views (Pro Cah)Professional Component ,,70250,CPT,Professional,Both,,,26,51,43.35,5.45,51,Medica,Individual & Family,43.248,84.8,,percent of total billed charges,,
Xr Skull Under 4 Views (Pro Cah)Professional Component ,,70250,CPT,Professional,Both,,,26,51,43.35,5.45,51,Medica,Medica Advantage Solution,25.398,49.8,,percent of total billed charges,,
Xr Skull Under 4 Views (Pro Cah)Professional Component ,,70250,CPT,Professional,Both,,,26,51,43.35,5.45,51,Medica,Medical Assistance,6.29,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Xr Skull Under 4 Views (Pro Cah)Professional Component ,,70250,CPT,Professional,Both,,,26,51,43.35,5.45,51,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,8.63,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Xr Skull Under 4 Views (Pro Cah)Professional Component ,,70250,CPT,Professional,Both,,,26,51,43.35,5.45,51,"Multiplan, Inc.","Multiplan, Inc.",47.94,94,,percent of total billed charges,,
Xr Skull Under 4 Views (Pro Cah)Professional Component ,,70250,CPT,Professional,Both,,,26,51,43.35,5.45,51,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,45.951,90.1,,percent of total billed charges,,
Xr Skull Under 4 Views (Pro Cah)Professional Component ,,70250,CPT,Professional,Both,,,26,51,43.35,5.45,51,"Preferred One Administrative Services, INC.",PPO,50.286,98.6,,percent of total billed charges,,
Xr Skull Under 4 Views (Pro Cah)Professional Component ,,70250,CPT,Professional,Both,,,26,51,43.35,5.45,51,PrimeWest Health,Minnesota Senior Health Options (MSHO),9.9245,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Skull Under 4 Views (Pro Cah)Professional Component ,,70250,CPT,Professional,Both,,,26,51,43.35,5.45,51,PrimeWest Health,MinnesotaCare,6.7292728,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Skull Under 4 Views (Pro Cah)Professional Component ,,70250,CPT,Professional,Both,,,26,51,43.35,5.45,51,Sanford Health Plan,Sanford Health Plan,44.88,88,,percent of total billed charges,,
Xr Skull Under 4 Views (Pro Cah)Professional Component ,,70250,CPT,Professional,Both,,,26,51,43.35,5.45,51,"UCare Health, Inc.",Individual & Family Plan,14.028928,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Xr Skull Under 4 Views (Pro Cah)Professional Component ,,70250,CPT,Professional,Both,,,26,51,43.35,5.45,51,"UCare Health, Inc.",Medical Assistance,6.917944,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Xr Skull Under 4 Views (Pro Cah)Professional Component ,,70250,CPT,Professional,Both,,,26,51,43.35,5.45,51,"UCare Health, Inc.",Medicare Advantage,9.9245,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Xr Skull Under 4 Views (Pro Cah)Professional Component ,,70250,CPT,Professional,Both,,,26,51,43.35,5.45,51,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),7.9396,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Xr Skull Under 4 Views (Pro Cah)Professional Component ,,70250,CPT,Professional,Both,,,26,51,43.35,5.45,51,UnitedHealthcare,Individual & Family,51,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Xr Skull Under 4 Views (Pro Cah)Professional Component ,,70250,CPT,Professional,Both,,,26,51,43.35,5.45,51,UnitedHealthcare,Medicare Advantage,9.9245,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Skull Under 4 Views (Pro Cah)Professional Component ,,70250,CPT,Professional,Both,,,26,51,43.35,5.45,51,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,6.28904,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Skull Routine Over 3 Views (Pro Cah)Professional Component ,,70260,CPT,Professional,Both,,,26,80,68,8.5,80,Aetna,Commercial,68,85,,percent of total billed charges,,
Xr Skull Routine Over 3 Views (Pro Cah)Professional Component ,,70260,CPT,Professional,Both,,,26,80,68,8.5,80,Aetna,Medicare Advantage,13.78,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Skull Routine Over 3 Views (Pro Cah)Professional Component ,,70260,CPT,Professional,Both,,,26,80,68,8.5,80,Aetna,PPO,74.4,93,,percent of total billed charges,,
Xr Skull Routine Over 3 Views (Pro Cah)Professional Component ,,70260,CPT,Professional,Both,,,26,80,68,8.5,80,America's PPO,America's PPO,68.352,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Xr Skull Routine Over 3 Views (Pro Cah)Professional Component ,,70260,CPT,Professional,Both,,,26,80,68,8.5,80,BlueCross BlueShield Minnesota, Federal Employee Program,25.57,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Xr Skull Routine Over 3 Views (Pro Cah)Professional Component ,,70260,CPT,Professional,Both,,,26,80,68,8.5,80,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,25.97912,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Skull Routine Over 3 Views (Pro Cah)Professional Component ,,70260,CPT,Professional,Both,,,26,80,68,8.5,80,BlueCross BlueShield Minnesota,High Value Network Plan,25.97912,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Skull Routine Over 3 Views (Pro Cah)Professional Component ,,70260,CPT,Professional,Both,,,26,80,68,8.5,80,BlueCross BlueShield Minnesota,Medicare Advantage,15.41,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Skull Routine Over 3 Views (Pro Cah)Professional Component ,,70260,CPT,Professional,Both,,,26,80,68,8.5,80,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,25.97912,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Skull Routine Over 3 Views (Pro Cah)Professional Component ,,70260,CPT,Professional,Both,,,26,80,68,8.5,80,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,9.81456,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Skull Routine Over 3 Views (Pro Cah)Professional Component ,,70260,CPT,Professional,Both,,,26,80,68,8.5,80,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),15.41,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Skull Routine Over 3 Views (Pro Cah)Professional Component ,,70260,CPT,Professional,Both,,,26,80,68,8.5,80,CorVel,Worker's Compensation,26.5294632,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Xr Skull Routine Over 3 Views (Pro Cah)Professional Component ,,70260,CPT,Professional,Both,,,26,80,68,8.5,80,First Health Group Corporation,First Health Network,77.6,97,,percent of total billed charges,,
Xr Skull Routine Over 3 Views (Pro Cah)Professional Component ,,70260,CPT,Professional,Both,,,26,80,68,8.5,80,"Health Partners, Inc.",Commercial,20.11,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Xr Skull Routine Over 3 Views (Pro Cah)Professional Component ,,70260,CPT,Professional,Both,,,26,80,68,8.5,80,"Health Partners, Inc.",Medicare Advantage,15.41,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Skull Routine Over 3 Views (Pro Cah)Professional Component ,,70260,CPT,Professional,Both,,,26,80,68,8.5,80,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),8.5,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Xr Skull Routine Over 3 Views (Pro Cah)Professional Component ,,70260,CPT,Professional,Both,,,26,80,68,8.5,80,"Health Partners, Inc.",State of Minnesota Advantage Program,17.324765,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Xr Skull Routine Over 3 Views (Pro Cah)Professional Component ,,70260,CPT,Professional,Both,,,26,80,68,8.5,80,"Health Partners, Inc.",State Public Programs,8.5,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Xr Skull Routine Over 3 Views (Pro Cah)Professional Component ,,70260,CPT,Professional,Both,,,26,80,68,8.5,80,Humana Insurance Company,Commercial PPO,13.4,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Xr Skull Routine Over 3 Views (Pro Cah)Professional Component ,,70260,CPT,Professional,Both,,,26,80,68,8.5,80,Humana Insurance Company,Medicare PPO,80,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Xr Skull Routine Over 3 Views (Pro Cah)Professional Component ,,70260,CPT,Professional,Both,,,26,80,68,8.5,80,Medica,Individual & Family,67.84,84.8,,percent of total billed charges,,
Xr Skull Routine Over 3 Views (Pro Cah)Professional Component ,,70260,CPT,Professional,Both,,,26,80,68,8.5,80,Medica,Medica Advantage Solution,39.84,49.8,,percent of total billed charges,,
Xr Skull Routine Over 3 Views (Pro Cah)Professional Component ,,70260,CPT,Professional,Both,,,26,80,68,8.5,80,Medica,Medical Assistance,9.81,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Xr Skull Routine Over 3 Views (Pro Cah)Professional Component ,,70260,CPT,Professional,Both,,,26,80,68,8.5,80,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,13.4,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Xr Skull Routine Over 3 Views (Pro Cah)Professional Component ,,70260,CPT,Professional,Both,,,26,80,68,8.5,80,"Multiplan, Inc.","Multiplan, Inc.",75.2,94,,percent of total billed charges,,
Xr Skull Routine Over 3 Views (Pro Cah)Professional Component ,,70260,CPT,Professional,Both,,,26,80,68,8.5,80,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,72.08,90.1,,percent of total billed charges,,
Xr Skull Routine Over 3 Views (Pro Cah)Professional Component ,,70260,CPT,Professional,Both,,,26,80,68,8.5,80,"Preferred One Administrative Services, INC.",PPO,78.88,98.6,,percent of total billed charges,,
Xr Skull Routine Over 3 Views (Pro Cah)Professional Component ,,70260,CPT,Professional,Both,,,26,80,68,8.5,80,PrimeWest Health,Minnesota Senior Health Options (MSHO),15.41,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Skull Routine Over 3 Views (Pro Cah)Professional Component ,,70260,CPT,Professional,Both,,,26,80,68,8.5,80,PrimeWest Health,MinnesotaCare,10.5015792,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Skull Routine Over 3 Views (Pro Cah)Professional Component ,,70260,CPT,Professional,Both,,,26,80,68,8.5,80,Sanford Health Plan,Sanford Health Plan,70.4,88,,percent of total billed charges,,
Xr Skull Routine Over 3 Views (Pro Cah)Professional Component ,,70260,CPT,Professional,Both,,,26,80,68,8.5,80,"UCare Health, Inc.",Individual & Family Plan,21.78304,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Xr Skull Routine Over 3 Views (Pro Cah)Professional Component ,,70260,CPT,Professional,Both,,,26,80,68,8.5,80,"UCare Health, Inc.",Medical Assistance,10.796016,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Xr Skull Routine Over 3 Views (Pro Cah)Professional Component ,,70260,CPT,Professional,Both,,,26,80,68,8.5,80,"UCare Health, Inc.",Medicare Advantage,15.41,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Xr Skull Routine Over 3 Views (Pro Cah)Professional Component ,,70260,CPT,Professional,Both,,,26,80,68,8.5,80,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),12.328,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Xr Skull Routine Over 3 Views (Pro Cah)Professional Component ,,70260,CPT,Professional,Both,,,26,80,68,8.5,80,UnitedHealthcare,Individual & Family,80,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Xr Skull Routine Over 3 Views (Pro Cah)Professional Component ,,70260,CPT,Professional,Both,,,26,80,68,8.5,80,UnitedHealthcare,Medicare Advantage,15.41,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Skull Routine Over 3 Views (Pro Cah)Professional Component ,,70260,CPT,Professional,Both,,,26,80,68,8.5,80,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,9.81456,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Xr Temporomandibular Joint, Open And Closed Mouth; Unilateral (Pro Cah)Professional Component ",,70328,CPT,Professional,Both,,,26,53,45.05,5.45,53,Aetna,Commercial,45.05,85,,percent of total billed charges,,
"Xr Temporomandibular Joint, Open And Closed Mouth; Unilateral (Pro Cah)Professional Component ",,70328,CPT,Professional,Both,,,26,53,45.05,5.45,53,Aetna,Medicare Advantage,8.88,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Xr Temporomandibular Joint, Open And Closed Mouth; Unilateral (Pro Cah)Professional Component ",,70328,CPT,Professional,Both,,,26,53,45.05,5.45,53,Aetna,PPO,49.29,93,,percent of total billed charges,,
"Xr Temporomandibular Joint, Open And Closed Mouth; Unilateral (Pro Cah)Professional Component ",,70328,CPT,Professional,Both,,,26,53,45.05,5.45,53,America's PPO,America's PPO,45.2832,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Xr Temporomandibular Joint, Open And Closed Mouth; Unilateral (Pro Cah)Professional Component ",,70328,CPT,Professional,Both,,,26,53,45.05,5.45,53,BlueCross BlueShield Minnesota, Federal Employee Program,16.62,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Xr Temporomandibular Joint, Open And Closed Mouth; Unilateral (Pro Cah)Professional Component ",,70328,CPT,Professional,Both,,,26,53,45.05,5.45,53,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,16.88592,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Xr Temporomandibular Joint, Open And Closed Mouth; Unilateral (Pro Cah)Professional Component ",,70328,CPT,Professional,Both,,,26,53,45.05,5.45,53,BlueCross BlueShield Minnesota,High Value Network Plan,16.88592,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Xr Temporomandibular Joint, Open And Closed Mouth; Unilateral (Pro Cah)Professional Component ",,70328,CPT,Professional,Both,,,26,53,45.05,5.45,53,BlueCross BlueShield Minnesota,Medicare Advantage,9.9245,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Xr Temporomandibular Joint, Open And Closed Mouth; Unilateral (Pro Cah)Professional Component ",,70328,CPT,Professional,Both,,,26,53,45.05,5.45,53,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,16.88592,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Xr Temporomandibular Joint, Open And Closed Mouth; Unilateral (Pro Cah)Professional Component ",,70328,CPT,Professional,Both,,,26,53,45.05,5.45,53,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,6.28904,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Xr Temporomandibular Joint, Open And Closed Mouth; Unilateral (Pro Cah)Professional Component ",,70328,CPT,Professional,Both,,,26,53,45.05,5.45,53,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),9.9245,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Xr Temporomandibular Joint, Open And Closed Mouth; Unilateral (Pro Cah)Professional Component ",,70328,CPT,Professional,Both,,,26,53,45.05,5.45,53,CorVel,Worker's Compensation,17.0907348,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Xr Temporomandibular Joint, Open And Closed Mouth; Unilateral (Pro Cah)Professional Component ",,70328,CPT,Professional,Both,,,26,53,45.05,5.45,53,First Health Group Corporation,First Health Network,51.41,97,,percent of total billed charges,,
"Xr Temporomandibular Joint, Open And Closed Mouth; Unilateral (Pro Cah)Professional Component ",,70328,CPT,Professional,Both,,,26,53,45.05,5.45,53,"Health Partners, Inc.",Commercial,12.89,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Xr Temporomandibular Joint, Open And Closed Mouth; Unilateral (Pro Cah)Professional Component ",,70328,CPT,Professional,Both,,,26,53,45.05,5.45,53,"Health Partners, Inc.",Medicare Advantage,9.9245,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Xr Temporomandibular Joint, Open And Closed Mouth; Unilateral (Pro Cah)Professional Component ",,70328,CPT,Professional,Both,,,26,53,45.05,5.45,53,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),5.45,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Xr Temporomandibular Joint, Open And Closed Mouth; Unilateral (Pro Cah)Professional Component ",,70328,CPT,Professional,Both,,,26,53,45.05,5.45,53,"Health Partners, Inc.",State of Minnesota Advantage Program,11.104735,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Xr Temporomandibular Joint, Open And Closed Mouth; Unilateral (Pro Cah)Professional Component ",,70328,CPT,Professional,Both,,,26,53,45.05,5.45,53,"Health Partners, Inc.",State Public Programs,5.45,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Xr Temporomandibular Joint, Open And Closed Mouth; Unilateral (Pro Cah)Professional Component ",,70328,CPT,Professional,Both,,,26,53,45.05,5.45,53,Humana Insurance Company,Commercial PPO,8.63,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Xr Temporomandibular Joint, Open And Closed Mouth; Unilateral (Pro Cah)Professional Component ",,70328,CPT,Professional,Both,,,26,53,45.05,5.45,53,Humana Insurance Company,Medicare PPO,53,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Xr Temporomandibular Joint, Open And Closed Mouth; Unilateral (Pro Cah)Professional Component ",,70328,CPT,Professional,Both,,,26,53,45.05,5.45,53,Medica,Individual & Family,44.944,84.8,,percent of total billed charges,,
"Xr Temporomandibular Joint, Open And Closed Mouth; Unilateral (Pro Cah)Professional Component ",,70328,CPT,Professional,Both,,,26,53,45.05,5.45,53,Medica,Medica Advantage Solution,26.394,49.8,,percent of total billed charges,,
"Xr Temporomandibular Joint, Open And Closed Mouth; Unilateral (Pro Cah)Professional Component ",,70328,CPT,Professional,Both,,,26,53,45.05,5.45,53,Medica,Medical Assistance,6.29,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Xr Temporomandibular Joint, Open And Closed Mouth; Unilateral (Pro Cah)Professional Component ",,70328,CPT,Professional,Both,,,26,53,45.05,5.45,53,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,8.63,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Xr Temporomandibular Joint, Open And Closed Mouth; Unilateral (Pro Cah)Professional Component ",,70328,CPT,Professional,Both,,,26,53,45.05,5.45,53,"Multiplan, Inc.","Multiplan, Inc.",49.82,94,,percent of total billed charges,,
"Xr Temporomandibular Joint, Open And Closed Mouth; Unilateral (Pro Cah)Professional Component ",,70328,CPT,Professional,Both,,,26,53,45.05,5.45,53,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,47.753,90.1,,percent of total billed charges,,
"Xr Temporomandibular Joint, Open And Closed Mouth; Unilateral (Pro Cah)Professional Component ",,70328,CPT,Professional,Both,,,26,53,45.05,5.45,53,"Preferred One Administrative Services, INC.",PPO,52.258,98.6,,percent of total billed charges,,
"Xr Temporomandibular Joint, Open And Closed Mouth; Unilateral (Pro Cah)Professional Component ",,70328,CPT,Professional,Both,,,26,53,45.05,5.45,53,PrimeWest Health,Minnesota Senior Health Options (MSHO),9.9245,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Xr Temporomandibular Joint, Open And Closed Mouth; Unilateral (Pro Cah)Professional Component ",,70328,CPT,Professional,Both,,,26,53,45.05,5.45,53,PrimeWest Health,MinnesotaCare,6.7292728,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Xr Temporomandibular Joint, Open And Closed Mouth; Unilateral (Pro Cah)Professional Component ",,70328,CPT,Professional,Both,,,26,53,45.05,5.45,53,Sanford Health Plan,Sanford Health Plan,46.64,88,,percent of total billed charges,,
"Xr Temporomandibular Joint, Open And Closed Mouth; Unilateral (Pro Cah)Professional Component ",,70328,CPT,Professional,Both,,,26,53,45.05,5.45,53,"UCare Health, Inc.",Individual & Family Plan,14.028928,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Xr Temporomandibular Joint, Open And Closed Mouth; Unilateral (Pro Cah)Professional Component ",,70328,CPT,Professional,Both,,,26,53,45.05,5.45,53,"UCare Health, Inc.",Medical Assistance,6.917944,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Xr Temporomandibular Joint, Open And Closed Mouth; Unilateral (Pro Cah)Professional Component ",,70328,CPT,Professional,Both,,,26,53,45.05,5.45,53,"UCare Health, Inc.",Medicare Advantage,9.9245,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Xr Temporomandibular Joint, Open And Closed Mouth; Unilateral (Pro Cah)Professional Component ",,70328,CPT,Professional,Both,,,26,53,45.05,5.45,53,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),7.9396,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Xr Temporomandibular Joint, Open And Closed Mouth; Unilateral (Pro Cah)Professional Component ",,70328,CPT,Professional,Both,,,26,53,45.05,5.45,53,UnitedHealthcare,Individual & Family,53,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Xr Temporomandibular Joint, Open And Closed Mouth; Unilateral (Pro Cah)Professional Component ",,70328,CPT,Professional,Both,,,26,53,45.05,5.45,53,UnitedHealthcare,Medicare Advantage,9.9245,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Xr Temporomandibular Joint, Open And Closed Mouth; Unilateral (Pro Cah)Professional Component ",,70328,CPT,Professional,Both,,,26,53,45.05,5.45,53,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,6.28904,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Mri, Temporomandibular Joint(S) (Pro Cah)Professional Component ",,70336,CPT,Professional,Both,,,26,546,464.1,44.28,546,Aetna,Commercial,464.1,85,,percent of total billed charges,,
"Mri, Temporomandibular Joint(S) (Pro Cah)Professional Component ",,70336,CPT,Professional,Both,,,26,546,464.1,44.28,546,Aetna,Medicare Advantage,71.11,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Mri, Temporomandibular Joint(S) (Pro Cah)Professional Component ",,70336,CPT,Professional,Both,,,26,546,464.1,44.28,546,Aetna,PPO,507.78,93,,percent of total billed charges,,
"Mri, Temporomandibular Joint(S) (Pro Cah)Professional Component ",,70336,CPT,Professional,Both,,,26,546,464.1,44.28,546,America's PPO,America's PPO,466.5024,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Mri, Temporomandibular Joint(S) (Pro Cah)Professional Component ",,70336,CPT,Professional,Both,,,26,546,464.1,44.28,546,BlueCross BlueShield Minnesota, Federal Employee Program,132.95,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Mri, Temporomandibular Joint(S) (Pro Cah)Professional Component ",,70336,CPT,Professional,Both,,,26,546,464.1,44.28,546,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,135.0772,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Mri, Temporomandibular Joint(S) (Pro Cah)Professional Component ",,70336,CPT,Professional,Both,,,26,546,464.1,44.28,546,BlueCross BlueShield Minnesota,High Value Network Plan,135.0772,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Mri, Temporomandibular Joint(S) (Pro Cah)Professional Component ",,70336,CPT,Professional,Both,,,26,546,464.1,44.28,546,BlueCross BlueShield Minnesota,Medicare Advantage,79.3385,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Mri, Temporomandibular Joint(S) (Pro Cah)Professional Component ",,70336,CPT,Professional,Both,,,26,546,464.1,44.28,546,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,135.0772,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Mri, Temporomandibular Joint(S) (Pro Cah)Professional Component ",,70336,CPT,Professional,Both,,,26,546,464.1,44.28,546,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,51.12512,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Mri, Temporomandibular Joint(S) (Pro Cah)Professional Component ",,70336,CPT,Professional,Both,,,26,546,464.1,44.28,546,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),79.3385,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Mri, Temporomandibular Joint(S) (Pro Cah)Professional Component ",,70336,CPT,Professional,Both,,,26,546,464.1,44.28,546,CorVel,Worker's Compensation,136.69095,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Mri, Temporomandibular Joint(S) (Pro Cah)Professional Component ",,70336,CPT,Professional,Both,,,26,546,464.1,44.28,546,First Health Group Corporation,First Health Network,529.62,97,,percent of total billed charges,,
"Mri, Temporomandibular Joint(S) (Pro Cah)Professional Component ",,70336,CPT,Professional,Both,,,26,546,464.1,44.28,546,"Health Partners, Inc.",Commercial,105.19,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Mri, Temporomandibular Joint(S) (Pro Cah)Professional Component ",,70336,CPT,Professional,Both,,,26,546,464.1,44.28,546,"Health Partners, Inc.",Medicare Advantage,79.3385,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Mri, Temporomandibular Joint(S) (Pro Cah)Professional Component ",,70336,CPT,Professional,Both,,,26,546,464.1,44.28,546,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),44.28,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Mri, Temporomandibular Joint(S) (Pro Cah)Professional Component ",,70336,CPT,Professional,Both,,,26,546,464.1,44.28,546,"Health Partners, Inc.",State of Minnesota Advantage Program,90.621185,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Mri, Temporomandibular Joint(S) (Pro Cah)Professional Component ",,70336,CPT,Professional,Both,,,26,546,464.1,44.28,546,"Health Partners, Inc.",State Public Programs,44.28,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Mri, Temporomandibular Joint(S) (Pro Cah)Professional Component ",,70336,CPT,Professional,Both,,,26,546,464.1,44.28,546,Humana Insurance Company,Commercial PPO,68.99,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Mri, Temporomandibular Joint(S) (Pro Cah)Professional Component ",,70336,CPT,Professional,Both,,,26,546,464.1,44.28,546,Humana Insurance Company,Medicare PPO,546,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Mri, Temporomandibular Joint(S) (Pro Cah)Professional Component ",,70336,CPT,Professional,Both,,,26,546,464.1,44.28,546,Medica,Individual & Family,463.008,84.8,,percent of total billed charges,,
"Mri, Temporomandibular Joint(S) (Pro Cah)Professional Component ",,70336,CPT,Professional,Both,,,26,546,464.1,44.28,546,Medica,Medica Advantage Solution,271.908,49.8,,percent of total billed charges,,
"Mri, Temporomandibular Joint(S) (Pro Cah)Professional Component ",,70336,CPT,Professional,Both,,,26,546,464.1,44.28,546,Medica,Medical Assistance,51.13,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Mri, Temporomandibular Joint(S) (Pro Cah)Professional Component ",,70336,CPT,Professional,Both,,,26,546,464.1,44.28,546,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,68.99,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Mri, Temporomandibular Joint(S) (Pro Cah)Professional Component ",,70336,CPT,Professional,Both,,,26,546,464.1,44.28,546,"Multiplan, Inc.","Multiplan, Inc.",513.24,94,,percent of total billed charges,,
"Mri, Temporomandibular Joint(S) (Pro Cah)Professional Component ",,70336,CPT,Professional,Both,,,26,546,464.1,44.28,546,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,491.946,90.1,,percent of total billed charges,,
"Mri, Temporomandibular Joint(S) (Pro Cah)Professional Component ",,70336,CPT,Professional,Both,,,26,546,464.1,44.28,546,"Preferred One Administrative Services, INC.",PPO,538.356,98.6,,percent of total billed charges,,
"Mri, Temporomandibular Joint(S) (Pro Cah)Professional Component ",,70336,CPT,Professional,Both,,,26,546,464.1,44.28,546,PrimeWest Health,Minnesota Senior Health Options (MSHO),79.3385,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Mri, Temporomandibular Joint(S) (Pro Cah)Professional Component ",,70336,CPT,Professional,Both,,,26,546,464.1,44.28,546,PrimeWest Health,MinnesotaCare,54.7038784,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Mri, Temporomandibular Joint(S) (Pro Cah)Professional Component ",,70336,CPT,Professional,Both,,,26,546,464.1,44.28,546,Sanford Health Plan,Sanford Health Plan,480.48,88,,percent of total billed charges,,
"Mri, Temporomandibular Joint(S) (Pro Cah)Professional Component ",,70336,CPT,Professional,Both,,,26,546,464.1,44.28,546,"UCare Health, Inc.",Individual & Family Plan,112.150144,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Mri, Temporomandibular Joint(S) (Pro Cah)Professional Component ",,70336,CPT,Professional,Both,,,26,546,464.1,44.28,546,"UCare Health, Inc.",Medical Assistance,56.237632,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Mri, Temporomandibular Joint(S) (Pro Cah)Professional Component ",,70336,CPT,Professional,Both,,,26,546,464.1,44.28,546,"UCare Health, Inc.",Medicare Advantage,79.3385,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Mri, Temporomandibular Joint(S) (Pro Cah)Professional Component ",,70336,CPT,Professional,Both,,,26,546,464.1,44.28,546,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),63.4708,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Mri, Temporomandibular Joint(S) (Pro Cah)Professional Component ",,70336,CPT,Professional,Both,,,26,546,464.1,44.28,546,UnitedHealthcare,Individual & Family,546,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Mri, Temporomandibular Joint(S) (Pro Cah)Professional Component ",,70336,CPT,Professional,Both,,,26,546,464.1,44.28,546,UnitedHealthcare,Medicare Advantage,79.3385,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Mri, Temporomandibular Joint(S) (Pro Cah)Professional Component ",,70336,CPT,Professional,Both,,,26,546,464.1,44.28,546,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,51.12512,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Neck Soft Tissue (Pro Cah)Professional Component ,,70360,CPT,Professional,Both,,,26,42,35.7,5.45,42,Aetna,Commercial,35.7,85,,percent of total billed charges,,
Xr Neck Soft Tissue (Pro Cah)Professional Component ,,70360,CPT,Professional,Both,,,26,42,35.7,5.45,42,Aetna,Medicare Advantage,8.88,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Neck Soft Tissue (Pro Cah)Professional Component ,,70360,CPT,Professional,Both,,,26,42,35.7,5.45,42,Aetna,PPO,39.06,93,,percent of total billed charges,,
Xr Neck Soft Tissue (Pro Cah)Professional Component ,,70360,CPT,Professional,Both,,,26,42,35.7,5.45,42,America's PPO,America's PPO,35.8848,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Xr Neck Soft Tissue (Pro Cah)Professional Component ,,70360,CPT,Professional,Both,,,26,42,35.7,5.45,42,BlueCross BlueShield Minnesota, Federal Employee Program,16.62,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Xr Neck Soft Tissue (Pro Cah)Professional Component ,,70360,CPT,Professional,Both,,,26,42,35.7,5.45,42,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,16.88592,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Neck Soft Tissue (Pro Cah)Professional Component ,,70360,CPT,Professional,Both,,,26,42,35.7,5.45,42,BlueCross BlueShield Minnesota,High Value Network Plan,16.88592,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Neck Soft Tissue (Pro Cah)Professional Component ,,70360,CPT,Professional,Both,,,26,42,35.7,5.45,42,BlueCross BlueShield Minnesota,Medicare Advantage,9.9245,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Neck Soft Tissue (Pro Cah)Professional Component ,,70360,CPT,Professional,Both,,,26,42,35.7,5.45,42,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,16.88592,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Neck Soft Tissue (Pro Cah)Professional Component ,,70360,CPT,Professional,Both,,,26,42,35.7,5.45,42,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,6.28904,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Neck Soft Tissue (Pro Cah)Professional Component ,,70360,CPT,Professional,Both,,,26,42,35.7,5.45,42,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),9.9245,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Neck Soft Tissue (Pro Cah)Professional Component ,,70360,CPT,Professional,Both,,,26,42,35.7,5.45,42,CorVel,Worker's Compensation,17.0907348,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Xr Neck Soft Tissue (Pro Cah)Professional Component ,,70360,CPT,Professional,Both,,,26,42,35.7,5.45,42,First Health Group Corporation,First Health Network,40.74,97,,percent of total billed charges,,
Xr Neck Soft Tissue (Pro Cah)Professional Component ,,70360,CPT,Professional,Both,,,26,42,35.7,5.45,42,"Health Partners, Inc.",Commercial,12.89,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Xr Neck Soft Tissue (Pro Cah)Professional Component ,,70360,CPT,Professional,Both,,,26,42,35.7,5.45,42,"Health Partners, Inc.",Medicare Advantage,9.9245,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Neck Soft Tissue (Pro Cah)Professional Component ,,70360,CPT,Professional,Both,,,26,42,35.7,5.45,42,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),5.45,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Xr Neck Soft Tissue (Pro Cah)Professional Component ,,70360,CPT,Professional,Both,,,26,42,35.7,5.45,42,"Health Partners, Inc.",State of Minnesota Advantage Program,11.104735,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Xr Neck Soft Tissue (Pro Cah)Professional Component ,,70360,CPT,Professional,Both,,,26,42,35.7,5.45,42,"Health Partners, Inc.",State Public Programs,5.45,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Xr Neck Soft Tissue (Pro Cah)Professional Component ,,70360,CPT,Professional,Both,,,26,42,35.7,5.45,42,Humana Insurance Company,Commercial PPO,8.63,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Xr Neck Soft Tissue (Pro Cah)Professional Component ,,70360,CPT,Professional,Both,,,26,42,35.7,5.45,42,Humana Insurance Company,Medicare PPO,42,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Xr Neck Soft Tissue (Pro Cah)Professional Component ,,70360,CPT,Professional,Both,,,26,42,35.7,5.45,42,Medica,Individual & Family,35.616,84.8,,percent of total billed charges,,
Xr Neck Soft Tissue (Pro Cah)Professional Component ,,70360,CPT,Professional,Both,,,26,42,35.7,5.45,42,Medica,Medica Advantage Solution,20.916,49.8,,percent of total billed charges,,
Xr Neck Soft Tissue (Pro Cah)Professional Component ,,70360,CPT,Professional,Both,,,26,42,35.7,5.45,42,Medica,Medical Assistance,6.29,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Xr Neck Soft Tissue (Pro Cah)Professional Component ,,70360,CPT,Professional,Both,,,26,42,35.7,5.45,42,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,8.63,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Xr Neck Soft Tissue (Pro Cah)Professional Component ,,70360,CPT,Professional,Both,,,26,42,35.7,5.45,42,"Multiplan, Inc.","Multiplan, Inc.",39.48,94,,percent of total billed charges,,
Xr Neck Soft Tissue (Pro Cah)Professional Component ,,70360,CPT,Professional,Both,,,26,42,35.7,5.45,42,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,37.842,90.1,,percent of total billed charges,,
Xr Neck Soft Tissue (Pro Cah)Professional Component ,,70360,CPT,Professional,Both,,,26,42,35.7,5.45,42,"Preferred One Administrative Services, INC.",PPO,41.412,98.6,,percent of total billed charges,,
Xr Neck Soft Tissue (Pro Cah)Professional Component ,,70360,CPT,Professional,Both,,,26,42,35.7,5.45,42,PrimeWest Health,Minnesota Senior Health Options (MSHO),9.9245,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Neck Soft Tissue (Pro Cah)Professional Component ,,70360,CPT,Professional,Both,,,26,42,35.7,5.45,42,PrimeWest Health,MinnesotaCare,6.7292728,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Neck Soft Tissue (Pro Cah)Professional Component ,,70360,CPT,Professional,Both,,,26,42,35.7,5.45,42,Sanford Health Plan,Sanford Health Plan,36.96,88,,percent of total billed charges,,
Xr Neck Soft Tissue (Pro Cah)Professional Component ,,70360,CPT,Professional,Both,,,26,42,35.7,5.45,42,"UCare Health, Inc.",Individual & Family Plan,14.028928,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Xr Neck Soft Tissue (Pro Cah)Professional Component ,,70360,CPT,Professional,Both,,,26,42,35.7,5.45,42,"UCare Health, Inc.",Medical Assistance,6.917944,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Xr Neck Soft Tissue (Pro Cah)Professional Component ,,70360,CPT,Professional,Both,,,26,42,35.7,5.45,42,"UCare Health, Inc.",Medicare Advantage,9.9245,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Xr Neck Soft Tissue (Pro Cah)Professional Component ,,70360,CPT,Professional,Both,,,26,42,35.7,5.45,42,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),7.9396,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Xr Neck Soft Tissue (Pro Cah)Professional Component ,,70360,CPT,Professional,Both,,,26,42,35.7,5.45,42,UnitedHealthcare,Individual & Family,42,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Xr Neck Soft Tissue (Pro Cah)Professional Component ,,70360,CPT,Professional,Both,,,26,42,35.7,5.45,42,UnitedHealthcare,Medicare Advantage,9.9245,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Neck Soft Tissue (Pro Cah)Professional Component ,,70360,CPT,Professional,Both,,,26,42,35.7,5.45,42,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,6.28904,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Ct Head Routine Wo Iv Contrast (Pro Cah)Professional Component ,,70450,CPT,Professional,Both,,,26,366,311.1,25.52,366,Aetna,Commercial,311.1,85,,percent of total billed charges,,
Ct Head Routine Wo Iv Contrast (Pro Cah)Professional Component ,,70450,CPT,Professional,Both,,,26,366,311.1,25.52,366,Aetna,Medicare Advantage,41.11,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Head Routine Wo Iv Contrast (Pro Cah)Professional Component ,,70450,CPT,Professional,Both,,,26,366,311.1,25.52,366,Aetna,PPO,340.38,93,,percent of total billed charges,,
Ct Head Routine Wo Iv Contrast (Pro Cah)Professional Component ,,70450,CPT,Professional,Both,,,26,366,311.1,25.52,366,America's PPO,America's PPO,312.7104,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Ct Head Routine Wo Iv Contrast (Pro Cah)Professional Component ,,70450,CPT,Professional,Both,,,26,366,311.1,25.52,366,BlueCross BlueShield Minnesota, Federal Employee Program,76.7,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Ct Head Routine Wo Iv Contrast (Pro Cah)Professional Component ,,70450,CPT,Professional,Both,,,26,366,311.1,25.52,366,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,77.9272,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Ct Head Routine Wo Iv Contrast (Pro Cah)Professional Component ,,70450,CPT,Professional,Both,,,26,366,311.1,25.52,366,BlueCross BlueShield Minnesota,High Value Network Plan,77.9272,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Ct Head Routine Wo Iv Contrast (Pro Cah)Professional Component ,,70450,CPT,Professional,Both,,,26,366,311.1,25.52,366,BlueCross BlueShield Minnesota,Medicare Advantage,45.9425,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Head Routine Wo Iv Contrast (Pro Cah)Professional Component ,,70450,CPT,Professional,Both,,,26,366,311.1,25.52,366,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,77.9272,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Ct Head Routine Wo Iv Contrast (Pro Cah)Professional Component ,,70450,CPT,Professional,Both,,,26,366,311.1,25.52,366,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,29.464,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Ct Head Routine Wo Iv Contrast (Pro Cah)Professional Component ,,70450,CPT,Professional,Both,,,26,366,311.1,25.52,366,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),45.9425,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Head Routine Wo Iv Contrast (Pro Cah)Professional Component ,,70450,CPT,Professional,Both,,,26,366,311.1,25.52,366,CorVel,Worker's Compensation,78.4559034,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Ct Head Routine Wo Iv Contrast (Pro Cah)Professional Component ,,70450,CPT,Professional,Both,,,26,366,311.1,25.52,366,First Health Group Corporation,First Health Network,355.02,97,,percent of total billed charges,,
Ct Head Routine Wo Iv Contrast (Pro Cah)Professional Component ,,70450,CPT,Professional,Both,,,26,366,311.1,25.52,366,"Health Partners, Inc.",Commercial,59.81,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Ct Head Routine Wo Iv Contrast (Pro Cah)Professional Component ,,70450,CPT,Professional,Both,,,26,366,311.1,25.52,366,"Health Partners, Inc.",Medicare Advantage,45.9425,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Head Routine Wo Iv Contrast (Pro Cah)Professional Component ,,70450,CPT,Professional,Both,,,26,366,311.1,25.52,366,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),25.52,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Ct Head Routine Wo Iv Contrast (Pro Cah)Professional Component ,,70450,CPT,Professional,Both,,,26,366,311.1,25.52,366,"Health Partners, Inc.",State of Minnesota Advantage Program,51.526315,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Ct Head Routine Wo Iv Contrast (Pro Cah)Professional Component ,,70450,CPT,Professional,Both,,,26,366,311.1,25.52,366,"Health Partners, Inc.",State Public Programs,25.52,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Ct Head Routine Wo Iv Contrast (Pro Cah)Professional Component ,,70450,CPT,Professional,Both,,,26,366,311.1,25.52,366,Humana Insurance Company,Commercial PPO,39.95,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Ct Head Routine Wo Iv Contrast (Pro Cah)Professional Component ,,70450,CPT,Professional,Both,,,26,366,311.1,25.52,366,Humana Insurance Company,Medicare PPO,366,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Ct Head Routine Wo Iv Contrast (Pro Cah)Professional Component ,,70450,CPT,Professional,Both,,,26,366,311.1,25.52,366,Medica,Individual & Family,310.368,84.8,,percent of total billed charges,,
Ct Head Routine Wo Iv Contrast (Pro Cah)Professional Component ,,70450,CPT,Professional,Both,,,26,366,311.1,25.52,366,Medica,Medica Advantage Solution,182.268,49.8,,percent of total billed charges,,
Ct Head Routine Wo Iv Contrast (Pro Cah)Professional Component ,,70450,CPT,Professional,Both,,,26,366,311.1,25.52,366,Medica,Medical Assistance,29.46,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Ct Head Routine Wo Iv Contrast (Pro Cah)Professional Component ,,70450,CPT,Professional,Both,,,26,366,311.1,25.52,366,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,39.95,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Ct Head Routine Wo Iv Contrast (Pro Cah)Professional Component ,,70450,CPT,Professional,Both,,,26,366,311.1,25.52,366,"Multiplan, Inc.","Multiplan, Inc.",344.04,94,,percent of total billed charges,,
Ct Head Routine Wo Iv Contrast (Pro Cah)Professional Component ,,70450,CPT,Professional,Both,,,26,366,311.1,25.52,366,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,329.766,90.1,,percent of total billed charges,,
Ct Head Routine Wo Iv Contrast (Pro Cah)Professional Component ,,70450,CPT,Professional,Both,,,26,366,311.1,25.52,366,"Preferred One Administrative Services, INC.",PPO,360.876,98.6,,percent of total billed charges,,
Ct Head Routine Wo Iv Contrast (Pro Cah)Professional Component ,,70450,CPT,Professional,Both,,,26,366,311.1,25.52,366,PrimeWest Health,Minnesota Senior Health Options (MSHO),45.9425,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Head Routine Wo Iv Contrast (Pro Cah)Professional Component ,,70450,CPT,Professional,Both,,,26,366,311.1,25.52,366,PrimeWest Health,MinnesotaCare,31.52648,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Ct Head Routine Wo Iv Contrast (Pro Cah)Professional Component ,,70450,CPT,Professional,Both,,,26,366,311.1,25.52,366,Sanford Health Plan,Sanford Health Plan,322.08,88,,percent of total billed charges,,
Ct Head Routine Wo Iv Contrast (Pro Cah)Professional Component ,,70450,CPT,Professional,Both,,,26,366,311.1,25.52,366,"UCare Health, Inc.",Individual & Family Plan,64.94272,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Ct Head Routine Wo Iv Contrast (Pro Cah)Professional Component ,,70450,CPT,Professional,Both,,,26,366,311.1,25.52,366,"UCare Health, Inc.",Medical Assistance,32.4104,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Ct Head Routine Wo Iv Contrast (Pro Cah)Professional Component ,,70450,CPT,Professional,Both,,,26,366,311.1,25.52,366,"UCare Health, Inc.",Medicare Advantage,45.9425,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Ct Head Routine Wo Iv Contrast (Pro Cah)Professional Component ,,70450,CPT,Professional,Both,,,26,366,311.1,25.52,366,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),36.754,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Ct Head Routine Wo Iv Contrast (Pro Cah)Professional Component ,,70450,CPT,Professional,Both,,,26,366,311.1,25.52,366,UnitedHealthcare,Individual & Family,366,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Ct Head Routine Wo Iv Contrast (Pro Cah)Professional Component ,,70450,CPT,Professional,Both,,,26,366,311.1,25.52,366,UnitedHealthcare,Medicare Advantage,45.9425,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Head Routine Wo Iv Contrast (Pro Cah)Professional Component ,,70450,CPT,Professional,Both,,,26,366,311.1,25.52,366,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,29.464,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Ct Head W Iv Contrast (Pro Cah)Professional Component ,,70460,CPT,Professional,Both,,,26,406,345.1,34.03,406,Aetna,Commercial,345.1,85,,percent of total billed charges,,
Ct Head W Iv Contrast (Pro Cah)Professional Component ,,70460,CPT,Professional,Both,,,26,406,345.1,34.03,406,Aetna,Medicare Advantage,54.54,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Head W Iv Contrast (Pro Cah)Professional Component ,,70460,CPT,Professional,Both,,,26,406,345.1,34.03,406,Aetna,PPO,377.58,93,,percent of total billed charges,,
Ct Head W Iv Contrast (Pro Cah)Professional Component ,,70460,CPT,Professional,Both,,,26,406,345.1,34.03,406,America's PPO,America's PPO,346.8864,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Ct Head W Iv Contrast (Pro Cah)Professional Component ,,70460,CPT,Professional,Both,,,26,406,345.1,34.03,406,BlueCross BlueShield Minnesota, Federal Employee Program,102.27,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Ct Head W Iv Contrast (Pro Cah)Professional Component ,,70460,CPT,Professional,Both,,,26,406,345.1,34.03,406,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,103.90632,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Ct Head W Iv Contrast (Pro Cah)Professional Component ,,70460,CPT,Professional,Both,,,26,406,345.1,34.03,406,BlueCross BlueShield Minnesota,High Value Network Plan,103.90632,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Ct Head W Iv Contrast (Pro Cah)Professional Component ,,70460,CPT,Professional,Both,,,26,406,345.1,34.03,406,BlueCross BlueShield Minnesota,Medicare Advantage,61.0765,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Head W Iv Contrast (Pro Cah)Professional Component ,,70460,CPT,Professional,Both,,,26,406,345.1,34.03,406,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,103.90632,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Ct Head W Iv Contrast (Pro Cah)Professional Component ,,70460,CPT,Professional,Both,,,26,406,345.1,34.03,406,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,39.28872,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Ct Head W Iv Contrast (Pro Cah)Professional Component ,,70460,CPT,Professional,Both,,,26,406,345.1,34.03,406,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),61.0765,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Head W Iv Contrast (Pro Cah)Professional Component ,,70460,CPT,Professional,Both,,,26,406,345.1,34.03,406,CorVel,Worker's Compensation,104.9853666,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Ct Head W Iv Contrast (Pro Cah)Professional Component ,,70460,CPT,Professional,Both,,,26,406,345.1,34.03,406,First Health Group Corporation,First Health Network,393.82,97,,percent of total billed charges,,
Ct Head W Iv Contrast (Pro Cah)Professional Component ,,70460,CPT,Professional,Both,,,26,406,345.1,34.03,406,"Health Partners, Inc.",Commercial,80.95,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Ct Head W Iv Contrast (Pro Cah)Professional Component ,,70460,CPT,Professional,Both,,,26,406,345.1,34.03,406,"Health Partners, Inc.",Medicare Advantage,61.0765,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Head W Iv Contrast (Pro Cah)Professional Component ,,70460,CPT,Professional,Both,,,26,406,345.1,34.03,406,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),34.03,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Ct Head W Iv Contrast (Pro Cah)Professional Component ,,70460,CPT,Professional,Both,,,26,406,345.1,34.03,406,"Health Partners, Inc.",State of Minnesota Advantage Program,69.738425,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Ct Head W Iv Contrast (Pro Cah)Professional Component ,,70460,CPT,Professional,Both,,,26,406,345.1,34.03,406,"Health Partners, Inc.",State Public Programs,34.03,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Ct Head W Iv Contrast (Pro Cah)Professional Component ,,70460,CPT,Professional,Both,,,26,406,345.1,34.03,406,Humana Insurance Company,Commercial PPO,53.11,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Ct Head W Iv Contrast (Pro Cah)Professional Component ,,70460,CPT,Professional,Both,,,26,406,345.1,34.03,406,Humana Insurance Company,Medicare PPO,406,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Ct Head W Iv Contrast (Pro Cah)Professional Component ,,70460,CPT,Professional,Both,,,26,406,345.1,34.03,406,Medica,Individual & Family,344.288,84.8,,percent of total billed charges,,
Ct Head W Iv Contrast (Pro Cah)Professional Component ,,70460,CPT,Professional,Both,,,26,406,345.1,34.03,406,Medica,Medica Advantage Solution,202.188,49.8,,percent of total billed charges,,
Ct Head W Iv Contrast (Pro Cah)Professional Component ,,70460,CPT,Professional,Both,,,26,406,345.1,34.03,406,Medica,Medical Assistance,39.29,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Ct Head W Iv Contrast (Pro Cah)Professional Component ,,70460,CPT,Professional,Both,,,26,406,345.1,34.03,406,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,53.11,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Ct Head W Iv Contrast (Pro Cah)Professional Component ,,70460,CPT,Professional,Both,,,26,406,345.1,34.03,406,"Multiplan, Inc.","Multiplan, Inc.",381.64,94,,percent of total billed charges,,
Ct Head W Iv Contrast (Pro Cah)Professional Component ,,70460,CPT,Professional,Both,,,26,406,345.1,34.03,406,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,365.806,90.1,,percent of total billed charges,,
Ct Head W Iv Contrast (Pro Cah)Professional Component ,,70460,CPT,Professional,Both,,,26,406,345.1,34.03,406,"Preferred One Administrative Services, INC.",PPO,400.316,98.6,,percent of total billed charges,,
Ct Head W Iv Contrast (Pro Cah)Professional Component ,,70460,CPT,Professional,Both,,,26,406,345.1,34.03,406,PrimeWest Health,Minnesota Senior Health Options (MSHO),61.0765,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Head W Iv Contrast (Pro Cah)Professional Component ,,70460,CPT,Professional,Both,,,26,406,345.1,34.03,406,PrimeWest Health,MinnesotaCare,42.0389304,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Ct Head W Iv Contrast (Pro Cah)Professional Component ,,70460,CPT,Professional,Both,,,26,406,345.1,34.03,406,Sanford Health Plan,Sanford Health Plan,357.28,88,,percent of total billed charges,,
Ct Head W Iv Contrast (Pro Cah)Professional Component ,,70460,CPT,Professional,Both,,,26,406,345.1,34.03,406,"UCare Health, Inc.",Individual & Family Plan,86.335616,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Ct Head W Iv Contrast (Pro Cah)Professional Component ,,70460,CPT,Professional,Both,,,26,406,345.1,34.03,406,"UCare Health, Inc.",Medical Assistance,43.217592,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Ct Head W Iv Contrast (Pro Cah)Professional Component ,,70460,CPT,Professional,Both,,,26,406,345.1,34.03,406,"UCare Health, Inc.",Medicare Advantage,61.0765,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Ct Head W Iv Contrast (Pro Cah)Professional Component ,,70460,CPT,Professional,Both,,,26,406,345.1,34.03,406,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),48.8612,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Ct Head W Iv Contrast (Pro Cah)Professional Component ,,70460,CPT,Professional,Both,,,26,406,345.1,34.03,406,UnitedHealthcare,Individual & Family,406,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Ct Head W Iv Contrast (Pro Cah)Professional Component ,,70460,CPT,Professional,Both,,,26,406,345.1,34.03,406,UnitedHealthcare,Medicare Advantage,61.0765,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Head W Iv Contrast (Pro Cah)Professional Component ,,70460,CPT,Professional,Both,,,26,406,345.1,34.03,406,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,39.28872,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Ct Head Wo W Iv Contrast (Pro Cah)Professional Component ,,70470,CPT,Professional,Both,,,26,508,431.8,38.39,508,Aetna,Commercial,431.8,85,,percent of total billed charges,,
Ct Head Wo W Iv Contrast (Pro Cah)Professional Component ,,70470,CPT,Professional,Both,,,26,508,431.8,38.39,508,Aetna,Medicare Advantage,61.19,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Head Wo W Iv Contrast (Pro Cah)Professional Component ,,70470,CPT,Professional,Both,,,26,508,431.8,38.39,508,Aetna,PPO,472.44,93,,percent of total billed charges,,
Ct Head Wo W Iv Contrast (Pro Cah)Professional Component ,,70470,CPT,Professional,Both,,,26,508,431.8,38.39,508,America's PPO,America's PPO,434.0352,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Ct Head Wo W Iv Contrast (Pro Cah)Professional Component ,,70470,CPT,Professional,Both,,,26,508,431.8,38.39,508,BlueCross BlueShield Minnesota, Federal Employee Program,115.06,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Ct Head Wo W Iv Contrast (Pro Cah)Professional Component ,,70470,CPT,Professional,Both,,,26,508,431.8,38.39,508,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,116.90096,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Ct Head Wo W Iv Contrast (Pro Cah)Professional Component ,,70470,CPT,Professional,Both,,,26,508,431.8,38.39,508,BlueCross BlueShield Minnesota,High Value Network Plan,116.90096,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Ct Head Wo W Iv Contrast (Pro Cah)Professional Component ,,70470,CPT,Professional,Both,,,26,508,431.8,38.39,508,BlueCross BlueShield Minnesota,Medicare Advantage,68.6435,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Head Wo W Iv Contrast (Pro Cah)Professional Component ,,70470,CPT,Professional,Both,,,26,508,431.8,38.39,508,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,116.90096,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Ct Head Wo W Iv Contrast (Pro Cah)Professional Component ,,70470,CPT,Professional,Both,,,26,508,431.8,38.39,508,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,44.32808,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Ct Head Wo W Iv Contrast (Pro Cah)Professional Component ,,70470,CPT,Professional,Both,,,26,508,431.8,38.39,508,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),68.6435,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Head Wo W Iv Contrast (Pro Cah)Professional Component ,,70470,CPT,Professional,Both,,,26,508,431.8,38.39,508,CorVel,Worker's Compensation,118.2655473,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Ct Head Wo W Iv Contrast (Pro Cah)Professional Component ,,70470,CPT,Professional,Both,,,26,508,431.8,38.39,508,First Health Group Corporation,First Health Network,492.76,97,,percent of total billed charges,,
Ct Head Wo W Iv Contrast (Pro Cah)Professional Component ,,70470,CPT,Professional,Both,,,26,508,431.8,38.39,508,"Health Partners, Inc.",Commercial,90.75,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Ct Head Wo W Iv Contrast (Pro Cah)Professional Component ,,70470,CPT,Professional,Both,,,26,508,431.8,38.39,508,"Health Partners, Inc.",Medicare Advantage,68.6435,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Head Wo W Iv Contrast (Pro Cah)Professional Component ,,70470,CPT,Professional,Both,,,26,508,431.8,38.39,508,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),38.39,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Ct Head Wo W Iv Contrast (Pro Cah)Professional Component ,,70470,CPT,Professional,Both,,,26,508,431.8,38.39,508,"Health Partners, Inc.",State of Minnesota Advantage Program,78.181125,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Ct Head Wo W Iv Contrast (Pro Cah)Professional Component ,,70470,CPT,Professional,Both,,,26,508,431.8,38.39,508,"Health Partners, Inc.",State Public Programs,38.39,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Ct Head Wo W Iv Contrast (Pro Cah)Professional Component ,,70470,CPT,Professional,Both,,,26,508,431.8,38.39,508,Humana Insurance Company,Commercial PPO,59.69,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Ct Head Wo W Iv Contrast (Pro Cah)Professional Component ,,70470,CPT,Professional,Both,,,26,508,431.8,38.39,508,Humana Insurance Company,Medicare PPO,508,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Ct Head Wo W Iv Contrast (Pro Cah)Professional Component ,,70470,CPT,Professional,Both,,,26,508,431.8,38.39,508,Medica,Individual & Family,430.784,84.8,,percent of total billed charges,,
Ct Head Wo W Iv Contrast (Pro Cah)Professional Component ,,70470,CPT,Professional,Both,,,26,508,431.8,38.39,508,Medica,Medica Advantage Solution,252.984,49.8,,percent of total billed charges,,
Ct Head Wo W Iv Contrast (Pro Cah)Professional Component ,,70470,CPT,Professional,Both,,,26,508,431.8,38.39,508,Medica,Medical Assistance,44.33,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Ct Head Wo W Iv Contrast (Pro Cah)Professional Component ,,70470,CPT,Professional,Both,,,26,508,431.8,38.39,508,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,59.69,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Ct Head Wo W Iv Contrast (Pro Cah)Professional Component ,,70470,CPT,Professional,Both,,,26,508,431.8,38.39,508,"Multiplan, Inc.","Multiplan, Inc.",477.52,94,,percent of total billed charges,,
Ct Head Wo W Iv Contrast (Pro Cah)Professional Component ,,70470,CPT,Professional,Both,,,26,508,431.8,38.39,508,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,457.708,90.1,,percent of total billed charges,,
Ct Head Wo W Iv Contrast (Pro Cah)Professional Component ,,70470,CPT,Professional,Both,,,26,508,431.8,38.39,508,"Preferred One Administrative Services, INC.",PPO,500.888,98.6,,percent of total billed charges,,
Ct Head Wo W Iv Contrast (Pro Cah)Professional Component ,,70470,CPT,Professional,Both,,,26,508,431.8,38.39,508,PrimeWest Health,Minnesota Senior Health Options (MSHO),68.6435,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Head Wo W Iv Contrast (Pro Cah)Professional Component ,,70470,CPT,Professional,Both,,,26,508,431.8,38.39,508,PrimeWest Health,MinnesotaCare,47.4310456,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Ct Head Wo W Iv Contrast (Pro Cah)Professional Component ,,70470,CPT,Professional,Both,,,26,508,431.8,38.39,508,Sanford Health Plan,Sanford Health Plan,447.04,88,,percent of total billed charges,,
Ct Head Wo W Iv Contrast (Pro Cah)Professional Component ,,70470,CPT,Professional,Both,,,26,508,431.8,38.39,508,"UCare Health, Inc.",Individual & Family Plan,97.032064,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Ct Head Wo W Iv Contrast (Pro Cah)Professional Component ,,70470,CPT,Professional,Both,,,26,508,431.8,38.39,508,"UCare Health, Inc.",Medical Assistance,48.760888,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Ct Head Wo W Iv Contrast (Pro Cah)Professional Component ,,70470,CPT,Professional,Both,,,26,508,431.8,38.39,508,"UCare Health, Inc.",Medicare Advantage,68.6435,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Ct Head Wo W Iv Contrast (Pro Cah)Professional Component ,,70470,CPT,Professional,Both,,,26,508,431.8,38.39,508,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),54.9148,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Ct Head Wo W Iv Contrast (Pro Cah)Professional Component ,,70470,CPT,Professional,Both,,,26,508,431.8,38.39,508,UnitedHealthcare,Individual & Family,508,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Ct Head Wo W Iv Contrast (Pro Cah)Professional Component ,,70470,CPT,Professional,Both,,,26,508,431.8,38.39,508,UnitedHealthcare,Medicare Advantage,68.6435,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Head Wo W Iv Contrast (Pro Cah)Professional Component ,,70470,CPT,Professional,Both,,,26,508,431.8,38.39,508,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,44.32808,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Ct Orbit Post Fossa Sella Ear Ext Wo Con (Pro Cah)Professional Component ,,70480,CPT,Professional,Both,,,26,391,332.35,38.83,391,Aetna,Commercial,332.35,85,,percent of total billed charges,,
Ct Orbit Post Fossa Sella Ear Ext Wo Con (Pro Cah)Professional Component ,,70480,CPT,Professional,Both,,,26,391,332.35,38.83,391,Aetna,Medicare Advantage,61.54,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Orbit Post Fossa Sella Ear Ext Wo Con (Pro Cah)Professional Component ,,70480,CPT,Professional,Both,,,26,391,332.35,38.83,391,Aetna,PPO,363.63,93,,percent of total billed charges,,
Ct Orbit Post Fossa Sella Ear Ext Wo Con (Pro Cah)Professional Component ,,70480,CPT,Professional,Both,,,26,391,332.35,38.83,391,America's PPO,America's PPO,334.0704,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Ct Orbit Post Fossa Sella Ear Ext Wo Con (Pro Cah)Professional Component ,,70480,CPT,Professional,Both,,,26,391,332.35,38.83,391,BlueCross BlueShield Minnesota, Federal Employee Program,116.33,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Ct Orbit Post Fossa Sella Ear Ext Wo Con (Pro Cah)Professional Component ,,70480,CPT,Professional,Both,,,26,391,332.35,38.83,391,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,118.19128,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Ct Orbit Post Fossa Sella Ear Ext Wo Con (Pro Cah)Professional Component ,,70480,CPT,Professional,Both,,,26,391,332.35,38.83,391,BlueCross BlueShield Minnesota,High Value Network Plan,118.19128,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Ct Orbit Post Fossa Sella Ear Ext Wo Con (Pro Cah)Professional Component ,,70480,CPT,Professional,Both,,,26,391,332.35,38.83,391,BlueCross BlueShield Minnesota,Medicare Advantage,69.437,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Orbit Post Fossa Sella Ear Ext Wo Con (Pro Cah)Professional Component ,,70480,CPT,Professional,Both,,,26,391,332.35,38.83,391,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,118.19128,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Ct Orbit Post Fossa Sella Ear Ext Wo Con (Pro Cah)Professional Component ,,70480,CPT,Professional,Both,,,26,391,332.35,38.83,391,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,44.82592,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Ct Orbit Post Fossa Sella Ear Ext Wo Con (Pro Cah)Professional Component ,,70480,CPT,Professional,Both,,,26,391,332.35,38.83,391,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),69.437,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Orbit Post Fossa Sella Ear Ext Wo Con (Pro Cah)Professional Component ,,70480,CPT,Professional,Both,,,26,391,332.35,38.83,391,CorVel,Worker's Compensation,118.9372473,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Ct Orbit Post Fossa Sella Ear Ext Wo Con (Pro Cah)Professional Component ,,70480,CPT,Professional,Both,,,26,391,332.35,38.83,391,First Health Group Corporation,First Health Network,379.27,97,,percent of total billed charges,,
Ct Orbit Post Fossa Sella Ear Ext Wo Con (Pro Cah)Professional Component ,,70480,CPT,Professional,Both,,,26,391,332.35,38.83,391,"Health Partners, Inc.",Commercial,91.27,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Ct Orbit Post Fossa Sella Ear Ext Wo Con (Pro Cah)Professional Component ,,70480,CPT,Professional,Both,,,26,391,332.35,38.83,391,"Health Partners, Inc.",Medicare Advantage,69.437,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Orbit Post Fossa Sella Ear Ext Wo Con (Pro Cah)Professional Component ,,70480,CPT,Professional,Both,,,26,391,332.35,38.83,391,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),38.83,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Ct Orbit Post Fossa Sella Ear Ext Wo Con (Pro Cah)Professional Component ,,70480,CPT,Professional,Both,,,26,391,332.35,38.83,391,"Health Partners, Inc.",State of Minnesota Advantage Program,78.629105,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Ct Orbit Post Fossa Sella Ear Ext Wo Con (Pro Cah)Professional Component ,,70480,CPT,Professional,Both,,,26,391,332.35,38.83,391,"Health Partners, Inc.",State Public Programs,38.83,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Ct Orbit Post Fossa Sella Ear Ext Wo Con (Pro Cah)Professional Component ,,70480,CPT,Professional,Both,,,26,391,332.35,38.83,391,Humana Insurance Company,Commercial PPO,60.38,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Ct Orbit Post Fossa Sella Ear Ext Wo Con (Pro Cah)Professional Component ,,70480,CPT,Professional,Both,,,26,391,332.35,38.83,391,Humana Insurance Company,Medicare PPO,391,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Ct Orbit Post Fossa Sella Ear Ext Wo Con (Pro Cah)Professional Component ,,70480,CPT,Professional,Both,,,26,391,332.35,38.83,391,Medica,Individual & Family,331.568,84.8,,percent of total billed charges,,
Ct Orbit Post Fossa Sella Ear Ext Wo Con (Pro Cah)Professional Component ,,70480,CPT,Professional,Both,,,26,391,332.35,38.83,391,Medica,Medica Advantage Solution,194.718,49.8,,percent of total billed charges,,
Ct Orbit Post Fossa Sella Ear Ext Wo Con (Pro Cah)Professional Component ,,70480,CPT,Professional,Both,,,26,391,332.35,38.83,391,Medica,Medical Assistance,44.83,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Ct Orbit Post Fossa Sella Ear Ext Wo Con (Pro Cah)Professional Component ,,70480,CPT,Professional,Both,,,26,391,332.35,38.83,391,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,60.38,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Ct Orbit Post Fossa Sella Ear Ext Wo Con (Pro Cah)Professional Component ,,70480,CPT,Professional,Both,,,26,391,332.35,38.83,391,"Multiplan, Inc.","Multiplan, Inc.",367.54,94,,percent of total billed charges,,
Ct Orbit Post Fossa Sella Ear Ext Wo Con (Pro Cah)Professional Component ,,70480,CPT,Professional,Both,,,26,391,332.35,38.83,391,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,352.291,90.1,,percent of total billed charges,,
Ct Orbit Post Fossa Sella Ear Ext Wo Con (Pro Cah)Professional Component ,,70480,CPT,Professional,Both,,,26,391,332.35,38.83,391,"Preferred One Administrative Services, INC.",PPO,385.526,98.6,,percent of total billed charges,,
Ct Orbit Post Fossa Sella Ear Ext Wo Con (Pro Cah)Professional Component ,,70480,CPT,Professional,Both,,,26,391,332.35,38.83,391,PrimeWest Health,Minnesota Senior Health Options (MSHO),69.437,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Orbit Post Fossa Sella Ear Ext Wo Con (Pro Cah)Professional Component ,,70480,CPT,Professional,Both,,,26,391,332.35,38.83,391,PrimeWest Health,MinnesotaCare,47.9637344,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Ct Orbit Post Fossa Sella Ear Ext Wo Con (Pro Cah)Professional Component ,,70480,CPT,Professional,Both,,,26,391,332.35,38.83,391,Sanford Health Plan,Sanford Health Plan,344.08,88,,percent of total billed charges,,
Ct Orbit Post Fossa Sella Ear Ext Wo Con (Pro Cah)Professional Component ,,70480,CPT,Professional,Both,,,26,391,332.35,38.83,391,"UCare Health, Inc.",Individual & Family Plan,98.153728,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Ct Orbit Post Fossa Sella Ear Ext Wo Con (Pro Cah)Professional Component ,,70480,CPT,Professional,Both,,,26,391,332.35,38.83,391,"UCare Health, Inc.",Medical Assistance,49.308512,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Ct Orbit Post Fossa Sella Ear Ext Wo Con (Pro Cah)Professional Component ,,70480,CPT,Professional,Both,,,26,391,332.35,38.83,391,"UCare Health, Inc.",Medicare Advantage,69.437,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Ct Orbit Post Fossa Sella Ear Ext Wo Con (Pro Cah)Professional Component ,,70480,CPT,Professional,Both,,,26,391,332.35,38.83,391,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),55.5496,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Ct Orbit Post Fossa Sella Ear Ext Wo Con (Pro Cah)Professional Component ,,70480,CPT,Professional,Both,,,26,391,332.35,38.83,391,UnitedHealthcare,Individual & Family,391,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Ct Orbit Post Fossa Sella Ear Ext Wo Con (Pro Cah)Professional Component ,,70480,CPT,Professional,Both,,,26,391,332.35,38.83,391,UnitedHealthcare,Medicare Advantage,69.437,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Orbit Post Fossa Sella Ear Ext Wo Con (Pro Cah)Professional Component ,,70480,CPT,Professional,Both,,,26,391,332.35,38.83,391,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,44.82592,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Ct Orbits Sella Iac W Iv Contrast (Pro Cah)Professional Component ,,70481,CPT,Professional,Both,,,26,347,294.95,34.03,347,Aetna,Commercial,294.95,85,,percent of total billed charges,,
Ct Orbits Sella Iac W Iv Contrast (Pro Cah)Professional Component ,,70481,CPT,Professional,Both,,,26,347,294.95,34.03,347,Aetna,Medicare Advantage,54.54,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Orbits Sella Iac W Iv Contrast (Pro Cah)Professional Component ,,70481,CPT,Professional,Both,,,26,347,294.95,34.03,347,Aetna,PPO,322.71,93,,percent of total billed charges,,
Ct Orbits Sella Iac W Iv Contrast (Pro Cah)Professional Component ,,70481,CPT,Professional,Both,,,26,347,294.95,34.03,347,America's PPO,America's PPO,296.4768,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Ct Orbits Sella Iac W Iv Contrast (Pro Cah)Professional Component ,,70481,CPT,Professional,Both,,,26,347,294.95,34.03,347,BlueCross BlueShield Minnesota, Federal Employee Program,102.27,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Ct Orbits Sella Iac W Iv Contrast (Pro Cah)Professional Component ,,70481,CPT,Professional,Both,,,26,347,294.95,34.03,347,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,103.90632,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Ct Orbits Sella Iac W Iv Contrast (Pro Cah)Professional Component ,,70481,CPT,Professional,Both,,,26,347,294.95,34.03,347,BlueCross BlueShield Minnesota,High Value Network Plan,103.90632,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Ct Orbits Sella Iac W Iv Contrast (Pro Cah)Professional Component ,,70481,CPT,Professional,Both,,,26,347,294.95,34.03,347,BlueCross BlueShield Minnesota,Medicare Advantage,61.0765,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Orbits Sella Iac W Iv Contrast (Pro Cah)Professional Component ,,70481,CPT,Professional,Both,,,26,347,294.95,34.03,347,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,103.90632,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Ct Orbits Sella Iac W Iv Contrast (Pro Cah)Professional Component ,,70481,CPT,Professional,Both,,,26,347,294.95,34.03,347,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,39.28872,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Ct Orbits Sella Iac W Iv Contrast (Pro Cah)Professional Component ,,70481,CPT,Professional,Both,,,26,347,294.95,34.03,347,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),61.0765,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Orbits Sella Iac W Iv Contrast (Pro Cah)Professional Component ,,70481,CPT,Professional,Both,,,26,347,294.95,34.03,347,CorVel,Worker's Compensation,104.3049345,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Ct Orbits Sella Iac W Iv Contrast (Pro Cah)Professional Component ,,70481,CPT,Professional,Both,,,26,347,294.95,34.03,347,First Health Group Corporation,First Health Network,336.59,97,,percent of total billed charges,,
Ct Orbits Sella Iac W Iv Contrast (Pro Cah)Professional Component ,,70481,CPT,Professional,Both,,,26,347,294.95,34.03,347,"Health Partners, Inc.",Commercial,80.44,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Ct Orbits Sella Iac W Iv Contrast (Pro Cah)Professional Component ,,70481,CPT,Professional,Both,,,26,347,294.95,34.03,347,"Health Partners, Inc.",Medicare Advantage,61.0765,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Orbits Sella Iac W Iv Contrast (Pro Cah)Professional Component ,,70481,CPT,Professional,Both,,,26,347,294.95,34.03,347,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),34.03,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Ct Orbits Sella Iac W Iv Contrast (Pro Cah)Professional Component ,,70481,CPT,Professional,Both,,,26,347,294.95,34.03,347,"Health Partners, Inc.",State of Minnesota Advantage Program,69.29906,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Ct Orbits Sella Iac W Iv Contrast (Pro Cah)Professional Component ,,70481,CPT,Professional,Both,,,26,347,294.95,34.03,347,"Health Partners, Inc.",State Public Programs,34.03,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Ct Orbits Sella Iac W Iv Contrast (Pro Cah)Professional Component ,,70481,CPT,Professional,Both,,,26,347,294.95,34.03,347,Humana Insurance Company,Commercial PPO,53.11,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Ct Orbits Sella Iac W Iv Contrast (Pro Cah)Professional Component ,,70481,CPT,Professional,Both,,,26,347,294.95,34.03,347,Humana Insurance Company,Medicare PPO,347,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Ct Orbits Sella Iac W Iv Contrast (Pro Cah)Professional Component ,,70481,CPT,Professional,Both,,,26,347,294.95,34.03,347,Medica,Individual & Family,294.256,84.8,,percent of total billed charges,,
Ct Orbits Sella Iac W Iv Contrast (Pro Cah)Professional Component ,,70481,CPT,Professional,Both,,,26,347,294.95,34.03,347,Medica,Medica Advantage Solution,172.806,49.8,,percent of total billed charges,,
Ct Orbits Sella Iac W Iv Contrast (Pro Cah)Professional Component ,,70481,CPT,Professional,Both,,,26,347,294.95,34.03,347,Medica,Medical Assistance,39.29,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Ct Orbits Sella Iac W Iv Contrast (Pro Cah)Professional Component ,,70481,CPT,Professional,Both,,,26,347,294.95,34.03,347,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,53.11,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Ct Orbits Sella Iac W Iv Contrast (Pro Cah)Professional Component ,,70481,CPT,Professional,Both,,,26,347,294.95,34.03,347,"Multiplan, Inc.","Multiplan, Inc.",326.18,94,,percent of total billed charges,,
Ct Orbits Sella Iac W Iv Contrast (Pro Cah)Professional Component ,,70481,CPT,Professional,Both,,,26,347,294.95,34.03,347,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,312.647,90.1,,percent of total billed charges,,
Ct Orbits Sella Iac W Iv Contrast (Pro Cah)Professional Component ,,70481,CPT,Professional,Both,,,26,347,294.95,34.03,347,"Preferred One Administrative Services, INC.",PPO,342.142,98.6,,percent of total billed charges,,
Ct Orbits Sella Iac W Iv Contrast (Pro Cah)Professional Component ,,70481,CPT,Professional,Both,,,26,347,294.95,34.03,347,PrimeWest Health,Minnesota Senior Health Options (MSHO),61.0765,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Orbits Sella Iac W Iv Contrast (Pro Cah)Professional Component ,,70481,CPT,Professional,Both,,,26,347,294.95,34.03,347,PrimeWest Health,MinnesotaCare,42.0389304,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Ct Orbits Sella Iac W Iv Contrast (Pro Cah)Professional Component ,,70481,CPT,Professional,Both,,,26,347,294.95,34.03,347,Sanford Health Plan,Sanford Health Plan,305.36,88,,percent of total billed charges,,
Ct Orbits Sella Iac W Iv Contrast (Pro Cah)Professional Component ,,70481,CPT,Professional,Both,,,26,347,294.95,34.03,347,"UCare Health, Inc.",Individual & Family Plan,86.335616,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Ct Orbits Sella Iac W Iv Contrast (Pro Cah)Professional Component ,,70481,CPT,Professional,Both,,,26,347,294.95,34.03,347,"UCare Health, Inc.",Medical Assistance,43.217592,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Ct Orbits Sella Iac W Iv Contrast (Pro Cah)Professional Component ,,70481,CPT,Professional,Both,,,26,347,294.95,34.03,347,"UCare Health, Inc.",Medicare Advantage,61.0765,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Ct Orbits Sella Iac W Iv Contrast (Pro Cah)Professional Component ,,70481,CPT,Professional,Both,,,26,347,294.95,34.03,347,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),48.8612,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Ct Orbits Sella Iac W Iv Contrast (Pro Cah)Professional Component ,,70481,CPT,Professional,Both,,,26,347,294.95,34.03,347,UnitedHealthcare,Individual & Family,347,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Ct Orbits Sella Iac W Iv Contrast (Pro Cah)Professional Component ,,70481,CPT,Professional,Both,,,26,347,294.95,34.03,347,UnitedHealthcare,Medicare Advantage,61.0765,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Orbits Sella Iac W Iv Contrast (Pro Cah)Professional Component ,,70481,CPT,Professional,Both,,,26,347,294.95,34.03,347,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,39.28872,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Ct Orbit, Sella, Or Posterior Fossa Or Ear, Wo/W Contrast (Pro Cah)Professional Component ",,70482,CPT,Professional,Both,,,26,450,382.5,38.17,450,Aetna,Commercial,382.5,85,,percent of total billed charges,,
"Ct Orbit, Sella, Or Posterior Fossa Or Ear, Wo/W Contrast (Pro Cah)Professional Component ",,70482,CPT,Professional,Both,,,26,450,382.5,38.17,450,Aetna,Medicare Advantage,60.84,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Ct Orbit, Sella, Or Posterior Fossa Or Ear, Wo/W Contrast (Pro Cah)Professional Component ",,70482,CPT,Professional,Both,,,26,450,382.5,38.17,450,Aetna,PPO,418.5,93,,percent of total billed charges,,
"Ct Orbit, Sella, Or Posterior Fossa Or Ear, Wo/W Contrast (Pro Cah)Professional Component ",,70482,CPT,Professional,Both,,,26,450,382.5,38.17,450,America's PPO,America's PPO,384.48,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Ct Orbit, Sella, Or Posterior Fossa Or Ear, Wo/W Contrast (Pro Cah)Professional Component ",,70482,CPT,Professional,Both,,,26,450,382.5,38.17,450,BlueCross BlueShield Minnesota, Federal Employee Program,114.42,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Ct Orbit, Sella, Or Posterior Fossa Or Ear, Wo/W Contrast (Pro Cah)Professional Component ",,70482,CPT,Professional,Both,,,26,450,382.5,38.17,450,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,116.25072,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Ct Orbit, Sella, Or Posterior Fossa Or Ear, Wo/W Contrast (Pro Cah)Professional Component ",,70482,CPT,Professional,Both,,,26,450,382.5,38.17,450,BlueCross BlueShield Minnesota,High Value Network Plan,116.25072,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Ct Orbit, Sella, Or Posterior Fossa Or Ear, Wo/W Contrast (Pro Cah)Professional Component ",,70482,CPT,Professional,Both,,,26,450,382.5,38.17,450,BlueCross BlueShield Minnesota,Medicare Advantage,68.2525,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Ct Orbit, Sella, Or Posterior Fossa Or Ear, Wo/W Contrast (Pro Cah)Professional Component ",,70482,CPT,Professional,Both,,,26,450,382.5,38.17,450,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,116.25072,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Ct Orbit, Sella, Or Posterior Fossa Or Ear, Wo/W Contrast (Pro Cah)Professional Component ",,70482,CPT,Professional,Both,,,26,450,382.5,38.17,450,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,44.07408,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Ct Orbit, Sella, Or Posterior Fossa Or Ear, Wo/W Contrast (Pro Cah)Professional Component ",,70482,CPT,Professional,Both,,,26,450,382.5,38.17,450,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),68.2525,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Ct Orbit, Sella, Or Posterior Fossa Or Ear, Wo/W Contrast (Pro Cah)Professional Component ",,70482,CPT,Professional,Both,,,26,450,382.5,38.17,450,CorVel,Worker's Compensation,117.5851152,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Ct Orbit, Sella, Or Posterior Fossa Or Ear, Wo/W Contrast (Pro Cah)Professional Component ",,70482,CPT,Professional,Both,,,26,450,382.5,38.17,450,First Health Group Corporation,First Health Network,436.5,97,,percent of total billed charges,,
"Ct Orbit, Sella, Or Posterior Fossa Or Ear, Wo/W Contrast (Pro Cah)Professional Component ",,70482,CPT,Professional,Both,,,26,450,382.5,38.17,450,"Health Partners, Inc.",Commercial,90.23,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Ct Orbit, Sella, Or Posterior Fossa Or Ear, Wo/W Contrast (Pro Cah)Professional Component ",,70482,CPT,Professional,Both,,,26,450,382.5,38.17,450,"Health Partners, Inc.",Medicare Advantage,68.2525,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Ct Orbit, Sella, Or Posterior Fossa Or Ear, Wo/W Contrast (Pro Cah)Professional Component ",,70482,CPT,Professional,Both,,,26,450,382.5,38.17,450,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),38.17,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Ct Orbit, Sella, Or Posterior Fossa Or Ear, Wo/W Contrast (Pro Cah)Professional Component ",,70482,CPT,Professional,Both,,,26,450,382.5,38.17,450,"Health Partners, Inc.",State of Minnesota Advantage Program,77.733145,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Ct Orbit, Sella, Or Posterior Fossa Or Ear, Wo/W Contrast (Pro Cah)Professional Component ",,70482,CPT,Professional,Both,,,26,450,382.5,38.17,450,"Health Partners, Inc.",State Public Programs,38.17,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Ct Orbit, Sella, Or Posterior Fossa Or Ear, Wo/W Contrast (Pro Cah)Professional Component ",,70482,CPT,Professional,Both,,,26,450,382.5,38.17,450,Humana Insurance Company,Commercial PPO,59.35,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Ct Orbit, Sella, Or Posterior Fossa Or Ear, Wo/W Contrast (Pro Cah)Professional Component ",,70482,CPT,Professional,Both,,,26,450,382.5,38.17,450,Humana Insurance Company,Medicare PPO,450,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Ct Orbit, Sella, Or Posterior Fossa Or Ear, Wo/W Contrast (Pro Cah)Professional Component ",,70482,CPT,Professional,Both,,,26,450,382.5,38.17,450,Medica,Individual & Family,381.6,84.8,,percent of total billed charges,,
"Ct Orbit, Sella, Or Posterior Fossa Or Ear, Wo/W Contrast (Pro Cah)Professional Component ",,70482,CPT,Professional,Both,,,26,450,382.5,38.17,450,Medica,Medica Advantage Solution,224.1,49.8,,percent of total billed charges,,
"Ct Orbit, Sella, Or Posterior Fossa Or Ear, Wo/W Contrast (Pro Cah)Professional Component ",,70482,CPT,Professional,Both,,,26,450,382.5,38.17,450,Medica,Medical Assistance,44.07,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Ct Orbit, Sella, Or Posterior Fossa Or Ear, Wo/W Contrast (Pro Cah)Professional Component ",,70482,CPT,Professional,Both,,,26,450,382.5,38.17,450,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,59.35,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Ct Orbit, Sella, Or Posterior Fossa Or Ear, Wo/W Contrast (Pro Cah)Professional Component ",,70482,CPT,Professional,Both,,,26,450,382.5,38.17,450,"Multiplan, Inc.","Multiplan, Inc.",423,94,,percent of total billed charges,,
"Ct Orbit, Sella, Or Posterior Fossa Or Ear, Wo/W Contrast (Pro Cah)Professional Component ",,70482,CPT,Professional,Both,,,26,450,382.5,38.17,450,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,405.45,90.1,,percent of total billed charges,,
"Ct Orbit, Sella, Or Posterior Fossa Or Ear, Wo/W Contrast (Pro Cah)Professional Component ",,70482,CPT,Professional,Both,,,26,450,382.5,38.17,450,"Preferred One Administrative Services, INC.",PPO,443.7,98.6,,percent of total billed charges,,
"Ct Orbit, Sella, Or Posterior Fossa Or Ear, Wo/W Contrast (Pro Cah)Professional Component ",,70482,CPT,Professional,Both,,,26,450,382.5,38.17,450,PrimeWest Health,Minnesota Senior Health Options (MSHO),68.2525,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Ct Orbit, Sella, Or Posterior Fossa Or Ear, Wo/W Contrast (Pro Cah)Professional Component ",,70482,CPT,Professional,Both,,,26,450,382.5,38.17,450,PrimeWest Health,MinnesotaCare,47.1592656,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Ct Orbit, Sella, Or Posterior Fossa Or Ear, Wo/W Contrast (Pro Cah)Professional Component ",,70482,CPT,Professional,Both,,,26,450,382.5,38.17,450,Sanford Health Plan,Sanford Health Plan,396,88,,percent of total billed charges,,
"Ct Orbit, Sella, Or Posterior Fossa Or Ear, Wo/W Contrast (Pro Cah)Professional Component ",,70482,CPT,Professional,Both,,,26,450,382.5,38.17,450,"UCare Health, Inc.",Individual & Family Plan,96.47936,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Ct Orbit, Sella, Or Posterior Fossa Or Ear, Wo/W Contrast (Pro Cah)Professional Component ",,70482,CPT,Professional,Both,,,26,450,382.5,38.17,450,"UCare Health, Inc.",Medical Assistance,48.481488,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Ct Orbit, Sella, Or Posterior Fossa Or Ear, Wo/W Contrast (Pro Cah)Professional Component ",,70482,CPT,Professional,Both,,,26,450,382.5,38.17,450,"UCare Health, Inc.",Medicare Advantage,68.2525,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Ct Orbit, Sella, Or Posterior Fossa Or Ear, Wo/W Contrast (Pro Cah)Professional Component ",,70482,CPT,Professional,Both,,,26,450,382.5,38.17,450,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),54.602,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Ct Orbit, Sella, Or Posterior Fossa Or Ear, Wo/W Contrast (Pro Cah)Professional Component ",,70482,CPT,Professional,Both,,,26,450,382.5,38.17,450,UnitedHealthcare,Individual & Family,450,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Ct Orbit, Sella, Or Posterior Fossa Or Ear, Wo/W Contrast (Pro Cah)Professional Component ",,70482,CPT,Professional,Both,,,26,450,382.5,38.17,450,UnitedHealthcare,Medicare Advantage,68.2525,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Ct Orbit, Sella, Or Posterior Fossa Or Ear, Wo/W Contrast (Pro Cah)Professional Component ",,70482,CPT,Professional,Both,,,26,450,382.5,38.17,450,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,44.07408,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Ct Maxillofacial Area; Without Contrast Material (Pro Cah)Professional Component ,,70486,CPT,Professional,Both,,,26,186,158.1,25.74,186,Aetna,Commercial,158.1,85,,percent of total billed charges,,
Ct Maxillofacial Area; Without Contrast Material (Pro Cah)Professional Component ,,70486,CPT,Professional,Both,,,26,186,158.1,25.74,186,Aetna,Medicare Advantage,41.11,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Maxillofacial Area; Without Contrast Material (Pro Cah)Professional Component ,,70486,CPT,Professional,Both,,,26,186,158.1,25.74,186,Aetna,PPO,172.98,93,,percent of total billed charges,,
Ct Maxillofacial Area; Without Contrast Material (Pro Cah)Professional Component ,,70486,CPT,Professional,Both,,,26,186,158.1,25.74,186,America's PPO,America's PPO,158.9184,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Ct Maxillofacial Area; Without Contrast Material (Pro Cah)Professional Component ,,70486,CPT,Professional,Both,,,26,186,158.1,25.74,186,BlueCross BlueShield Minnesota, Federal Employee Program,77.34,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Ct Maxillofacial Area; Without Contrast Material (Pro Cah)Professional Component ,,70486,CPT,Professional,Both,,,26,186,158.1,25.74,186,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,78.57744,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Ct Maxillofacial Area; Without Contrast Material (Pro Cah)Professional Component ,,70486,CPT,Professional,Both,,,26,186,158.1,25.74,186,BlueCross BlueShield Minnesota,High Value Network Plan,78.57744,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Ct Maxillofacial Area; Without Contrast Material (Pro Cah)Professional Component ,,70486,CPT,Professional,Both,,,26,186,158.1,25.74,186,BlueCross BlueShield Minnesota,Medicare Advantage,46.345,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Maxillofacial Area; Without Contrast Material (Pro Cah)Professional Component ,,70486,CPT,Professional,Both,,,26,186,158.1,25.74,186,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,78.57744,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Ct Maxillofacial Area; Without Contrast Material (Pro Cah)Professional Component ,,70486,CPT,Professional,Both,,,26,186,158.1,25.74,186,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,29.718,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Ct Maxillofacial Area; Without Contrast Material (Pro Cah)Professional Component ,,70486,CPT,Professional,Both,,,26,186,158.1,25.74,186,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),46.345,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Maxillofacial Area; Without Contrast Material (Pro Cah)Professional Component ,,70486,CPT,Professional,Both,,,26,186,158.1,25.74,186,CorVel,Worker's Compensation,79.1363355,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Ct Maxillofacial Area; Without Contrast Material (Pro Cah)Professional Component ,,70486,CPT,Professional,Both,,,26,186,158.1,25.74,186,First Health Group Corporation,First Health Network,180.42,97,,percent of total billed charges,,
Ct Maxillofacial Area; Without Contrast Material (Pro Cah)Professional Component ,,70486,CPT,Professional,Both,,,26,186,158.1,25.74,186,"Health Partners, Inc.",Commercial,60.33,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Ct Maxillofacial Area; Without Contrast Material (Pro Cah)Professional Component ,,70486,CPT,Professional,Both,,,26,186,158.1,25.74,186,"Health Partners, Inc.",Medicare Advantage,46.345,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Maxillofacial Area; Without Contrast Material (Pro Cah)Professional Component ,,70486,CPT,Professional,Both,,,26,186,158.1,25.74,186,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),25.74,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Ct Maxillofacial Area; Without Contrast Material (Pro Cah)Professional Component ,,70486,CPT,Professional,Both,,,26,186,158.1,25.74,186,"Health Partners, Inc.",State of Minnesota Advantage Program,51.974295,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Ct Maxillofacial Area; Without Contrast Material (Pro Cah)Professional Component ,,70486,CPT,Professional,Both,,,26,186,158.1,25.74,186,"Health Partners, Inc.",State Public Programs,25.74,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Ct Maxillofacial Area; Without Contrast Material (Pro Cah)Professional Component ,,70486,CPT,Professional,Both,,,26,186,158.1,25.74,186,Humana Insurance Company,Commercial PPO,40.3,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Ct Maxillofacial Area; Without Contrast Material (Pro Cah)Professional Component ,,70486,CPT,Professional,Both,,,26,186,158.1,25.74,186,Humana Insurance Company,Medicare PPO,186,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Ct Maxillofacial Area; Without Contrast Material (Pro Cah)Professional Component ,,70486,CPT,Professional,Both,,,26,186,158.1,25.74,186,Medica,Individual & Family,157.728,84.8,,percent of total billed charges,,
Ct Maxillofacial Area; Without Contrast Material (Pro Cah)Professional Component ,,70486,CPT,Professional,Both,,,26,186,158.1,25.74,186,Medica,Medica Advantage Solution,92.628,49.8,,percent of total billed charges,,
Ct Maxillofacial Area; Without Contrast Material (Pro Cah)Professional Component ,,70486,CPT,Professional,Both,,,26,186,158.1,25.74,186,Medica,Medical Assistance,29.72,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Ct Maxillofacial Area; Without Contrast Material (Pro Cah)Professional Component ,,70486,CPT,Professional,Both,,,26,186,158.1,25.74,186,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,40.3,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Ct Maxillofacial Area; Without Contrast Material (Pro Cah)Professional Component ,,70486,CPT,Professional,Both,,,26,186,158.1,25.74,186,"Multiplan, Inc.","Multiplan, Inc.",174.84,94,,percent of total billed charges,,
Ct Maxillofacial Area; Without Contrast Material (Pro Cah)Professional Component ,,70486,CPT,Professional,Both,,,26,186,158.1,25.74,186,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,167.586,90.1,,percent of total billed charges,,
Ct Maxillofacial Area; Without Contrast Material (Pro Cah)Professional Component ,,70486,CPT,Professional,Both,,,26,186,158.1,25.74,186,"Preferred One Administrative Services, INC.",PPO,183.396,98.6,,percent of total billed charges,,
Ct Maxillofacial Area; Without Contrast Material (Pro Cah)Professional Component ,,70486,CPT,Professional,Both,,,26,186,158.1,25.74,186,PrimeWest Health,Minnesota Senior Health Options (MSHO),46.345,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Maxillofacial Area; Without Contrast Material (Pro Cah)Professional Component ,,70486,CPT,Professional,Both,,,26,186,158.1,25.74,186,PrimeWest Health,MinnesotaCare,31.79826,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Ct Maxillofacial Area; Without Contrast Material (Pro Cah)Professional Component ,,70486,CPT,Professional,Both,,,26,186,158.1,25.74,186,Sanford Health Plan,Sanford Health Plan,163.68,88,,percent of total billed charges,,
Ct Maxillofacial Area; Without Contrast Material (Pro Cah)Professional Component ,,70486,CPT,Professional,Both,,,26,186,158.1,25.74,186,"UCare Health, Inc.",Individual & Family Plan,65.51168,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Ct Maxillofacial Area; Without Contrast Material (Pro Cah)Professional Component ,,70486,CPT,Professional,Both,,,26,186,158.1,25.74,186,"UCare Health, Inc.",Medical Assistance,32.6898,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Ct Maxillofacial Area; Without Contrast Material (Pro Cah)Professional Component ,,70486,CPT,Professional,Both,,,26,186,158.1,25.74,186,"UCare Health, Inc.",Medicare Advantage,46.345,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Ct Maxillofacial Area; Without Contrast Material (Pro Cah)Professional Component ,,70486,CPT,Professional,Both,,,26,186,158.1,25.74,186,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),37.076,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Ct Maxillofacial Area; Without Contrast Material (Pro Cah)Professional Component ,,70486,CPT,Professional,Both,,,26,186,158.1,25.74,186,UnitedHealthcare,Individual & Family,186,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Ct Maxillofacial Area; Without Contrast Material (Pro Cah)Professional Component ,,70486,CPT,Professional,Both,,,26,186,158.1,25.74,186,UnitedHealthcare,Medicare Advantage,46.345,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Maxillofacial Area; Without Contrast Material (Pro Cah)Professional Component ,,70486,CPT,Professional,Both,,,26,186,158.1,25.74,186,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,29.718,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Ct Facial Bones W Iv Contrast (Pro Cah)Professional Component ,,70487,CPT,Professional,Both,,,26,480,408,34.03,480,Aetna,Commercial,408,85,,percent of total billed charges,,
Ct Facial Bones W Iv Contrast (Pro Cah)Professional Component ,,70487,CPT,Professional,Both,,,26,480,408,34.03,480,Aetna,Medicare Advantage,54.18,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Facial Bones W Iv Contrast (Pro Cah)Professional Component ,,70487,CPT,Professional,Both,,,26,480,408,34.03,480,Aetna,PPO,446.4,93,,percent of total billed charges,,
Ct Facial Bones W Iv Contrast (Pro Cah)Professional Component ,,70487,CPT,Professional,Both,,,26,480,408,34.03,480,America's PPO,America's PPO,410.112,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Ct Facial Bones W Iv Contrast (Pro Cah)Professional Component ,,70487,CPT,Professional,Both,,,26,480,408,34.03,480,BlueCross BlueShield Minnesota, Federal Employee Program,102.27,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Ct Facial Bones W Iv Contrast (Pro Cah)Professional Component ,,70487,CPT,Professional,Both,,,26,480,408,34.03,480,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,103.90632,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Ct Facial Bones W Iv Contrast (Pro Cah)Professional Component ,,70487,CPT,Professional,Both,,,26,480,408,34.03,480,BlueCross BlueShield Minnesota,High Value Network Plan,103.90632,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Ct Facial Bones W Iv Contrast (Pro Cah)Professional Component ,,70487,CPT,Professional,Both,,,26,480,408,34.03,480,BlueCross BlueShield Minnesota,Medicare Advantage,61.0765,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Facial Bones W Iv Contrast (Pro Cah)Professional Component ,,70487,CPT,Professional,Both,,,26,480,408,34.03,480,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,103.90632,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Ct Facial Bones W Iv Contrast (Pro Cah)Professional Component ,,70487,CPT,Professional,Both,,,26,480,408,34.03,480,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,39.28872,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Ct Facial Bones W Iv Contrast (Pro Cah)Professional Component ,,70487,CPT,Professional,Both,,,26,480,408,34.03,480,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),61.0765,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Facial Bones W Iv Contrast (Pro Cah)Professional Component ,,70487,CPT,Professional,Both,,,26,480,408,34.03,480,CorVel,Worker's Compensation,104.3049345,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Ct Facial Bones W Iv Contrast (Pro Cah)Professional Component ,,70487,CPT,Professional,Both,,,26,480,408,34.03,480,First Health Group Corporation,First Health Network,465.6,97,,percent of total billed charges,,
Ct Facial Bones W Iv Contrast (Pro Cah)Professional Component ,,70487,CPT,Professional,Both,,,26,480,408,34.03,480,"Health Partners, Inc.",Commercial,80.44,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Ct Facial Bones W Iv Contrast (Pro Cah)Professional Component ,,70487,CPT,Professional,Both,,,26,480,408,34.03,480,"Health Partners, Inc.",Medicare Advantage,61.0765,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Facial Bones W Iv Contrast (Pro Cah)Professional Component ,,70487,CPT,Professional,Both,,,26,480,408,34.03,480,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),34.03,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Ct Facial Bones W Iv Contrast (Pro Cah)Professional Component ,,70487,CPT,Professional,Both,,,26,480,408,34.03,480,"Health Partners, Inc.",State of Minnesota Advantage Program,69.29906,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Ct Facial Bones W Iv Contrast (Pro Cah)Professional Component ,,70487,CPT,Professional,Both,,,26,480,408,34.03,480,"Health Partners, Inc.",State Public Programs,34.03,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Ct Facial Bones W Iv Contrast (Pro Cah)Professional Component ,,70487,CPT,Professional,Both,,,26,480,408,34.03,480,Humana Insurance Company,Commercial PPO,53.11,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Ct Facial Bones W Iv Contrast (Pro Cah)Professional Component ,,70487,CPT,Professional,Both,,,26,480,408,34.03,480,Humana Insurance Company,Medicare PPO,480,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Ct Facial Bones W Iv Contrast (Pro Cah)Professional Component ,,70487,CPT,Professional,Both,,,26,480,408,34.03,480,Medica,Individual & Family,407.04,84.8,,percent of total billed charges,,
Ct Facial Bones W Iv Contrast (Pro Cah)Professional Component ,,70487,CPT,Professional,Both,,,26,480,408,34.03,480,Medica,Medica Advantage Solution,239.04,49.8,,percent of total billed charges,,
Ct Facial Bones W Iv Contrast (Pro Cah)Professional Component ,,70487,CPT,Professional,Both,,,26,480,408,34.03,480,Medica,Medical Assistance,39.29,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Ct Facial Bones W Iv Contrast (Pro Cah)Professional Component ,,70487,CPT,Professional,Both,,,26,480,408,34.03,480,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,53.11,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Ct Facial Bones W Iv Contrast (Pro Cah)Professional Component ,,70487,CPT,Professional,Both,,,26,480,408,34.03,480,"Multiplan, Inc.","Multiplan, Inc.",451.2,94,,percent of total billed charges,,
Ct Facial Bones W Iv Contrast (Pro Cah)Professional Component ,,70487,CPT,Professional,Both,,,26,480,408,34.03,480,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,432.48,90.1,,percent of total billed charges,,
Ct Facial Bones W Iv Contrast (Pro Cah)Professional Component ,,70487,CPT,Professional,Both,,,26,480,408,34.03,480,"Preferred One Administrative Services, INC.",PPO,473.28,98.6,,percent of total billed charges,,
Ct Facial Bones W Iv Contrast (Pro Cah)Professional Component ,,70487,CPT,Professional,Both,,,26,480,408,34.03,480,PrimeWest Health,Minnesota Senior Health Options (MSHO),61.0765,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Facial Bones W Iv Contrast (Pro Cah)Professional Component ,,70487,CPT,Professional,Both,,,26,480,408,34.03,480,PrimeWest Health,MinnesotaCare,42.0389304,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Ct Facial Bones W Iv Contrast (Pro Cah)Professional Component ,,70487,CPT,Professional,Both,,,26,480,408,34.03,480,Sanford Health Plan,Sanford Health Plan,422.4,88,,percent of total billed charges,,
Ct Facial Bones W Iv Contrast (Pro Cah)Professional Component ,,70487,CPT,Professional,Both,,,26,480,408,34.03,480,"UCare Health, Inc.",Individual & Family Plan,86.335616,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Ct Facial Bones W Iv Contrast (Pro Cah)Professional Component ,,70487,CPT,Professional,Both,,,26,480,408,34.03,480,"UCare Health, Inc.",Medical Assistance,43.217592,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Ct Facial Bones W Iv Contrast (Pro Cah)Professional Component ,,70487,CPT,Professional,Both,,,26,480,408,34.03,480,"UCare Health, Inc.",Medicare Advantage,61.0765,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Ct Facial Bones W Iv Contrast (Pro Cah)Professional Component ,,70487,CPT,Professional,Both,,,26,480,408,34.03,480,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),48.8612,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Ct Facial Bones W Iv Contrast (Pro Cah)Professional Component ,,70487,CPT,Professional,Both,,,26,480,408,34.03,480,UnitedHealthcare,Individual & Family,480,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Ct Facial Bones W Iv Contrast (Pro Cah)Professional Component ,,70487,CPT,Professional,Both,,,26,480,408,34.03,480,UnitedHealthcare,Medicare Advantage,61.0765,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Facial Bones W Iv Contrast (Pro Cah)Professional Component ,,70487,CPT,Professional,Both,,,26,480,408,34.03,480,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,39.28872,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Ct Maxillofacial W/O & W Contrast (Pro Cah)Professional Component ,,70488,CPT,Professional,Both,,,26,492,418.2,38.39,492,Aetna,Commercial,418.2,85,,percent of total billed charges,,
Ct Maxillofacial W/O & W Contrast (Pro Cah)Professional Component ,,70488,CPT,Professional,Both,,,26,492,418.2,38.39,492,Aetna,Medicare Advantage,61.19,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Maxillofacial W/O & W Contrast (Pro Cah)Professional Component ,,70488,CPT,Professional,Both,,,26,492,418.2,38.39,492,Aetna,PPO,457.56,93,,percent of total billed charges,,
Ct Maxillofacial W/O & W Contrast (Pro Cah)Professional Component ,,70488,CPT,Professional,Both,,,26,492,418.2,38.39,492,America's PPO,America's PPO,420.3648,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Ct Maxillofacial W/O & W Contrast (Pro Cah)Professional Component ,,70488,CPT,Professional,Both,,,26,492,418.2,38.39,492,BlueCross BlueShield Minnesota, Federal Employee Program,115.06,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Ct Maxillofacial W/O & W Contrast (Pro Cah)Professional Component ,,70488,CPT,Professional,Both,,,26,492,418.2,38.39,492,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,116.90096,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Ct Maxillofacial W/O & W Contrast (Pro Cah)Professional Component ,,70488,CPT,Professional,Both,,,26,492,418.2,38.39,492,BlueCross BlueShield Minnesota,High Value Network Plan,116.90096,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Ct Maxillofacial W/O & W Contrast (Pro Cah)Professional Component ,,70488,CPT,Professional,Both,,,26,492,418.2,38.39,492,BlueCross BlueShield Minnesota,Medicare Advantage,68.6435,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Maxillofacial W/O & W Contrast (Pro Cah)Professional Component ,,70488,CPT,Professional,Both,,,26,492,418.2,38.39,492,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,116.90096,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Ct Maxillofacial W/O & W Contrast (Pro Cah)Professional Component ,,70488,CPT,Professional,Both,,,26,492,418.2,38.39,492,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,44.32808,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Ct Maxillofacial W/O & W Contrast (Pro Cah)Professional Component ,,70488,CPT,Professional,Both,,,26,492,418.2,38.39,492,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),68.6435,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Maxillofacial W/O & W Contrast (Pro Cah)Professional Component ,,70488,CPT,Professional,Both,,,26,492,418.2,38.39,492,CorVel,Worker's Compensation,117.5851152,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Ct Maxillofacial W/O & W Contrast (Pro Cah)Professional Component ,,70488,CPT,Professional,Both,,,26,492,418.2,38.39,492,First Health Group Corporation,First Health Network,477.24,97,,percent of total billed charges,,
Ct Maxillofacial W/O & W Contrast (Pro Cah)Professional Component ,,70488,CPT,Professional,Both,,,26,492,418.2,38.39,492,"Health Partners, Inc.",Commercial,90.23,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Ct Maxillofacial W/O & W Contrast (Pro Cah)Professional Component ,,70488,CPT,Professional,Both,,,26,492,418.2,38.39,492,"Health Partners, Inc.",Medicare Advantage,68.6435,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Maxillofacial W/O & W Contrast (Pro Cah)Professional Component ,,70488,CPT,Professional,Both,,,26,492,418.2,38.39,492,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),38.39,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Ct Maxillofacial W/O & W Contrast (Pro Cah)Professional Component ,,70488,CPT,Professional,Both,,,26,492,418.2,38.39,492,"Health Partners, Inc.",State of Minnesota Advantage Program,77.733145,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Ct Maxillofacial W/O & W Contrast (Pro Cah)Professional Component ,,70488,CPT,Professional,Both,,,26,492,418.2,38.39,492,"Health Partners, Inc.",State Public Programs,38.39,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Ct Maxillofacial W/O & W Contrast (Pro Cah)Professional Component ,,70488,CPT,Professional,Both,,,26,492,418.2,38.39,492,Humana Insurance Company,Commercial PPO,59.69,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Ct Maxillofacial W/O & W Contrast (Pro Cah)Professional Component ,,70488,CPT,Professional,Both,,,26,492,418.2,38.39,492,Humana Insurance Company,Medicare PPO,492,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Ct Maxillofacial W/O & W Contrast (Pro Cah)Professional Component ,,70488,CPT,Professional,Both,,,26,492,418.2,38.39,492,Medica,Individual & Family,417.216,84.8,,percent of total billed charges,,
Ct Maxillofacial W/O & W Contrast (Pro Cah)Professional Component ,,70488,CPT,Professional,Both,,,26,492,418.2,38.39,492,Medica,Medica Advantage Solution,245.016,49.8,,percent of total billed charges,,
Ct Maxillofacial W/O & W Contrast (Pro Cah)Professional Component ,,70488,CPT,Professional,Both,,,26,492,418.2,38.39,492,Medica,Medical Assistance,44.33,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Ct Maxillofacial W/O & W Contrast (Pro Cah)Professional Component ,,70488,CPT,Professional,Both,,,26,492,418.2,38.39,492,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,59.69,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Ct Maxillofacial W/O & W Contrast (Pro Cah)Professional Component ,,70488,CPT,Professional,Both,,,26,492,418.2,38.39,492,"Multiplan, Inc.","Multiplan, Inc.",462.48,94,,percent of total billed charges,,
Ct Maxillofacial W/O & W Contrast (Pro Cah)Professional Component ,,70488,CPT,Professional,Both,,,26,492,418.2,38.39,492,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,443.292,90.1,,percent of total billed charges,,
Ct Maxillofacial W/O & W Contrast (Pro Cah)Professional Component ,,70488,CPT,Professional,Both,,,26,492,418.2,38.39,492,"Preferred One Administrative Services, INC.",PPO,485.112,98.6,,percent of total billed charges,,
Ct Maxillofacial W/O & W Contrast (Pro Cah)Professional Component ,,70488,CPT,Professional,Both,,,26,492,418.2,38.39,492,PrimeWest Health,Minnesota Senior Health Options (MSHO),68.6435,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Maxillofacial W/O & W Contrast (Pro Cah)Professional Component ,,70488,CPT,Professional,Both,,,26,492,418.2,38.39,492,PrimeWest Health,MinnesotaCare,47.4310456,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Ct Maxillofacial W/O & W Contrast (Pro Cah)Professional Component ,,70488,CPT,Professional,Both,,,26,492,418.2,38.39,492,Sanford Health Plan,Sanford Health Plan,432.96,88,,percent of total billed charges,,
Ct Maxillofacial W/O & W Contrast (Pro Cah)Professional Component ,,70488,CPT,Professional,Both,,,26,492,418.2,38.39,492,"UCare Health, Inc.",Individual & Family Plan,97.032064,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Ct Maxillofacial W/O & W Contrast (Pro Cah)Professional Component ,,70488,CPT,Professional,Both,,,26,492,418.2,38.39,492,"UCare Health, Inc.",Medical Assistance,48.760888,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Ct Maxillofacial W/O & W Contrast (Pro Cah)Professional Component ,,70488,CPT,Professional,Both,,,26,492,418.2,38.39,492,"UCare Health, Inc.",Medicare Advantage,68.6435,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Ct Maxillofacial W/O & W Contrast (Pro Cah)Professional Component ,,70488,CPT,Professional,Both,,,26,492,418.2,38.39,492,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),54.9148,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Ct Maxillofacial W/O & W Contrast (Pro Cah)Professional Component ,,70488,CPT,Professional,Both,,,26,492,418.2,38.39,492,UnitedHealthcare,Individual & Family,492,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Ct Maxillofacial W/O & W Contrast (Pro Cah)Professional Component ,,70488,CPT,Professional,Both,,,26,492,418.2,38.39,492,UnitedHealthcare,Medicare Advantage,68.6435,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Maxillofacial W/O & W Contrast (Pro Cah)Professional Component ,,70488,CPT,Professional,Both,,,26,492,418.2,38.39,492,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,44.32808,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Ct Neck Nasophar Wo Iv Contrast (Pro Cah)Professional Component ,,70490,CPT,Professional,Both,,,26,430,365.5,38.83,430,Aetna,Commercial,365.5,85,,percent of total billed charges,,
Ct Neck Nasophar Wo Iv Contrast (Pro Cah)Professional Component ,,70490,CPT,Professional,Both,,,26,430,365.5,38.83,430,Aetna,Medicare Advantage,61.54,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Neck Nasophar Wo Iv Contrast (Pro Cah)Professional Component ,,70490,CPT,Professional,Both,,,26,430,365.5,38.83,430,Aetna,PPO,399.9,93,,percent of total billed charges,,
Ct Neck Nasophar Wo Iv Contrast (Pro Cah)Professional Component ,,70490,CPT,Professional,Both,,,26,430,365.5,38.83,430,America's PPO,America's PPO,367.392,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Ct Neck Nasophar Wo Iv Contrast (Pro Cah)Professional Component ,,70490,CPT,Professional,Both,,,26,430,365.5,38.83,430,BlueCross BlueShield Minnesota, Federal Employee Program,116.33,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Ct Neck Nasophar Wo Iv Contrast (Pro Cah)Professional Component ,,70490,CPT,Professional,Both,,,26,430,365.5,38.83,430,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,118.19128,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Ct Neck Nasophar Wo Iv Contrast (Pro Cah)Professional Component ,,70490,CPT,Professional,Both,,,26,430,365.5,38.83,430,BlueCross BlueShield Minnesota,High Value Network Plan,118.19128,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Ct Neck Nasophar Wo Iv Contrast (Pro Cah)Professional Component ,,70490,CPT,Professional,Both,,,26,430,365.5,38.83,430,BlueCross BlueShield Minnesota,Medicare Advantage,69.437,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Neck Nasophar Wo Iv Contrast (Pro Cah)Professional Component ,,70490,CPT,Professional,Both,,,26,430,365.5,38.83,430,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,118.19128,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Ct Neck Nasophar Wo Iv Contrast (Pro Cah)Professional Component ,,70490,CPT,Professional,Both,,,26,430,365.5,38.83,430,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,44.82592,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Ct Neck Nasophar Wo Iv Contrast (Pro Cah)Professional Component ,,70490,CPT,Professional,Both,,,26,430,365.5,38.83,430,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),69.437,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Neck Nasophar Wo Iv Contrast (Pro Cah)Professional Component ,,70490,CPT,Professional,Both,,,26,430,365.5,38.83,430,CorVel,Worker's Compensation,118.9372473,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Ct Neck Nasophar Wo Iv Contrast (Pro Cah)Professional Component ,,70490,CPT,Professional,Both,,,26,430,365.5,38.83,430,First Health Group Corporation,First Health Network,417.1,97,,percent of total billed charges,,
Ct Neck Nasophar Wo Iv Contrast (Pro Cah)Professional Component ,,70490,CPT,Professional,Both,,,26,430,365.5,38.83,430,"Health Partners, Inc.",Commercial,91.27,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Ct Neck Nasophar Wo Iv Contrast (Pro Cah)Professional Component ,,70490,CPT,Professional,Both,,,26,430,365.5,38.83,430,"Health Partners, Inc.",Medicare Advantage,69.437,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Neck Nasophar Wo Iv Contrast (Pro Cah)Professional Component ,,70490,CPT,Professional,Both,,,26,430,365.5,38.83,430,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),38.83,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Ct Neck Nasophar Wo Iv Contrast (Pro Cah)Professional Component ,,70490,CPT,Professional,Both,,,26,430,365.5,38.83,430,"Health Partners, Inc.",State of Minnesota Advantage Program,78.629105,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Ct Neck Nasophar Wo Iv Contrast (Pro Cah)Professional Component ,,70490,CPT,Professional,Both,,,26,430,365.5,38.83,430,"Health Partners, Inc.",State Public Programs,38.83,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Ct Neck Nasophar Wo Iv Contrast (Pro Cah)Professional Component ,,70490,CPT,Professional,Both,,,26,430,365.5,38.83,430,Humana Insurance Company,Commercial PPO,60.38,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Ct Neck Nasophar Wo Iv Contrast (Pro Cah)Professional Component ,,70490,CPT,Professional,Both,,,26,430,365.5,38.83,430,Humana Insurance Company,Medicare PPO,430,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Ct Neck Nasophar Wo Iv Contrast (Pro Cah)Professional Component ,,70490,CPT,Professional,Both,,,26,430,365.5,38.83,430,Medica,Individual & Family,364.64,84.8,,percent of total billed charges,,
Ct Neck Nasophar Wo Iv Contrast (Pro Cah)Professional Component ,,70490,CPT,Professional,Both,,,26,430,365.5,38.83,430,Medica,Medica Advantage Solution,214.14,49.8,,percent of total billed charges,,
Ct Neck Nasophar Wo Iv Contrast (Pro Cah)Professional Component ,,70490,CPT,Professional,Both,,,26,430,365.5,38.83,430,Medica,Medical Assistance,44.83,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Ct Neck Nasophar Wo Iv Contrast (Pro Cah)Professional Component ,,70490,CPT,Professional,Both,,,26,430,365.5,38.83,430,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,60.38,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Ct Neck Nasophar Wo Iv Contrast (Pro Cah)Professional Component ,,70490,CPT,Professional,Both,,,26,430,365.5,38.83,430,"Multiplan, Inc.","Multiplan, Inc.",404.2,94,,percent of total billed charges,,
Ct Neck Nasophar Wo Iv Contrast (Pro Cah)Professional Component ,,70490,CPT,Professional,Both,,,26,430,365.5,38.83,430,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,387.43,90.1,,percent of total billed charges,,
Ct Neck Nasophar Wo Iv Contrast (Pro Cah)Professional Component ,,70490,CPT,Professional,Both,,,26,430,365.5,38.83,430,"Preferred One Administrative Services, INC.",PPO,423.98,98.6,,percent of total billed charges,,
Ct Neck Nasophar Wo Iv Contrast (Pro Cah)Professional Component ,,70490,CPT,Professional,Both,,,26,430,365.5,38.83,430,PrimeWest Health,Minnesota Senior Health Options (MSHO),69.437,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Neck Nasophar Wo Iv Contrast (Pro Cah)Professional Component ,,70490,CPT,Professional,Both,,,26,430,365.5,38.83,430,PrimeWest Health,MinnesotaCare,47.9637344,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Ct Neck Nasophar Wo Iv Contrast (Pro Cah)Professional Component ,,70490,CPT,Professional,Both,,,26,430,365.5,38.83,430,Sanford Health Plan,Sanford Health Plan,378.4,88,,percent of total billed charges,,
Ct Neck Nasophar Wo Iv Contrast (Pro Cah)Professional Component ,,70490,CPT,Professional,Both,,,26,430,365.5,38.83,430,"UCare Health, Inc.",Individual & Family Plan,98.153728,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Ct Neck Nasophar Wo Iv Contrast (Pro Cah)Professional Component ,,70490,CPT,Professional,Both,,,26,430,365.5,38.83,430,"UCare Health, Inc.",Medical Assistance,49.308512,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Ct Neck Nasophar Wo Iv Contrast (Pro Cah)Professional Component ,,70490,CPT,Professional,Both,,,26,430,365.5,38.83,430,"UCare Health, Inc.",Medicare Advantage,69.437,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Ct Neck Nasophar Wo Iv Contrast (Pro Cah)Professional Component ,,70490,CPT,Professional,Both,,,26,430,365.5,38.83,430,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),55.5496,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Ct Neck Nasophar Wo Iv Contrast (Pro Cah)Professional Component ,,70490,CPT,Professional,Both,,,26,430,365.5,38.83,430,UnitedHealthcare,Individual & Family,430,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Ct Neck Nasophar Wo Iv Contrast (Pro Cah)Professional Component ,,70490,CPT,Professional,Both,,,26,430,365.5,38.83,430,UnitedHealthcare,Medicare Advantage,69.437,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Neck Nasophar Wo Iv Contrast (Pro Cah)Professional Component ,,70490,CPT,Professional,Both,,,26,430,365.5,38.83,430,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,44.82592,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Ct Neck Nasophar W Iv Contrast (Pro Cah)Professional Component ,,70491,CPT,Professional,Both,,,26,460,391,41.88,460,Aetna,Commercial,391,85,,percent of total billed charges,,
Ct Neck Nasophar W Iv Contrast (Pro Cah)Professional Component ,,70491,CPT,Professional,Both,,,26,460,391,41.88,460,Aetna,Medicare Advantage,66.44,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Neck Nasophar W Iv Contrast (Pro Cah)Professional Component ,,70491,CPT,Professional,Both,,,26,460,391,41.88,460,Aetna,PPO,427.8,93,,percent of total billed charges,,
Ct Neck Nasophar W Iv Contrast (Pro Cah)Professional Component ,,70491,CPT,Professional,Both,,,26,460,391,41.88,460,America's PPO,America's PPO,393.024,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Ct Neck Nasophar W Iv Contrast (Pro Cah)Professional Component ,,70491,CPT,Professional,Both,,,26,460,391,41.88,460,BlueCross BlueShield Minnesota, Federal Employee Program,125.28,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Ct Neck Nasophar W Iv Contrast (Pro Cah)Professional Component ,,70491,CPT,Professional,Both,,,26,460,391,41.88,460,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,127.28448,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Ct Neck Nasophar W Iv Contrast (Pro Cah)Professional Component ,,70491,CPT,Professional,Both,,,26,460,391,41.88,460,BlueCross BlueShield Minnesota,High Value Network Plan,127.28448,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Ct Neck Nasophar W Iv Contrast (Pro Cah)Professional Component ,,70491,CPT,Professional,Both,,,26,460,391,41.88,460,BlueCross BlueShield Minnesota,Medicare Advantage,74.9225,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Neck Nasophar W Iv Contrast (Pro Cah)Professional Component ,,70491,CPT,Professional,Both,,,26,460,391,41.88,460,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,127.28448,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Ct Neck Nasophar W Iv Contrast (Pro Cah)Professional Component ,,70491,CPT,Professional,Both,,,26,460,391,41.88,460,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,48.35144,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Ct Neck Nasophar W Iv Contrast (Pro Cah)Professional Component ,,70491,CPT,Professional,Both,,,26,460,391,41.88,460,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),74.9225,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Neck Nasophar W Iv Contrast (Pro Cah)Professional Component ,,70491,CPT,Professional,Both,,,26,460,391,41.88,460,CorVel,Worker's Compensation,128.3759757,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Ct Neck Nasophar W Iv Contrast (Pro Cah)Professional Component ,,70491,CPT,Professional,Both,,,26,460,391,41.88,460,First Health Group Corporation,First Health Network,446.2,97,,percent of total billed charges,,
Ct Neck Nasophar W Iv Contrast (Pro Cah)Professional Component ,,70491,CPT,Professional,Both,,,26,460,391,41.88,460,"Health Partners, Inc.",Commercial,98.48,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Ct Neck Nasophar W Iv Contrast (Pro Cah)Professional Component ,,70491,CPT,Professional,Both,,,26,460,391,41.88,460,"Health Partners, Inc.",Medicare Advantage,74.9225,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Neck Nasophar W Iv Contrast (Pro Cah)Professional Component ,,70491,CPT,Professional,Both,,,26,460,391,41.88,460,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),41.88,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Ct Neck Nasophar W Iv Contrast (Pro Cah)Professional Component ,,70491,CPT,Professional,Both,,,26,460,391,41.88,460,"Health Partners, Inc.",State of Minnesota Advantage Program,84.84052,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Ct Neck Nasophar W Iv Contrast (Pro Cah)Professional Component ,,70491,CPT,Professional,Both,,,26,460,391,41.88,460,"Health Partners, Inc.",State Public Programs,41.88,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Ct Neck Nasophar W Iv Contrast (Pro Cah)Professional Component ,,70491,CPT,Professional,Both,,,26,460,391,41.88,460,Humana Insurance Company,Commercial PPO,65.15,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Ct Neck Nasophar W Iv Contrast (Pro Cah)Professional Component ,,70491,CPT,Professional,Both,,,26,460,391,41.88,460,Humana Insurance Company,Medicare PPO,460,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Ct Neck Nasophar W Iv Contrast (Pro Cah)Professional Component ,,70491,CPT,Professional,Both,,,26,460,391,41.88,460,Medica,Individual & Family,390.08,84.8,,percent of total billed charges,,
Ct Neck Nasophar W Iv Contrast (Pro Cah)Professional Component ,,70491,CPT,Professional,Both,,,26,460,391,41.88,460,Medica,Medica Advantage Solution,229.08,49.8,,percent of total billed charges,,
Ct Neck Nasophar W Iv Contrast (Pro Cah)Professional Component ,,70491,CPT,Professional,Both,,,26,460,391,41.88,460,Medica,Medical Assistance,48.35,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Ct Neck Nasophar W Iv Contrast (Pro Cah)Professional Component ,,70491,CPT,Professional,Both,,,26,460,391,41.88,460,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,65.15,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Ct Neck Nasophar W Iv Contrast (Pro Cah)Professional Component ,,70491,CPT,Professional,Both,,,26,460,391,41.88,460,"Multiplan, Inc.","Multiplan, Inc.",432.4,94,,percent of total billed charges,,
Ct Neck Nasophar W Iv Contrast (Pro Cah)Professional Component ,,70491,CPT,Professional,Both,,,26,460,391,41.88,460,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,414.46,90.1,,percent of total billed charges,,
Ct Neck Nasophar W Iv Contrast (Pro Cah)Professional Component ,,70491,CPT,Professional,Both,,,26,460,391,41.88,460,"Preferred One Administrative Services, INC.",PPO,453.56,98.6,,percent of total billed charges,,
Ct Neck Nasophar W Iv Contrast (Pro Cah)Professional Component ,,70491,CPT,Professional,Both,,,26,460,391,41.88,460,PrimeWest Health,Minnesota Senior Health Options (MSHO),74.9225,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Neck Nasophar W Iv Contrast (Pro Cah)Professional Component ,,70491,CPT,Professional,Both,,,26,460,391,41.88,460,PrimeWest Health,MinnesotaCare,51.7360408,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Ct Neck Nasophar W Iv Contrast (Pro Cah)Professional Component ,,70491,CPT,Professional,Both,,,26,460,391,41.88,460,Sanford Health Plan,Sanford Health Plan,404.8,88,,percent of total billed charges,,
Ct Neck Nasophar W Iv Contrast (Pro Cah)Professional Component ,,70491,CPT,Professional,Both,,,26,460,391,41.88,460,"UCare Health, Inc.",Individual & Family Plan,105.90784,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Ct Neck Nasophar W Iv Contrast (Pro Cah)Professional Component ,,70491,CPT,Professional,Both,,,26,460,391,41.88,460,"UCare Health, Inc.",Medical Assistance,53.186584,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Ct Neck Nasophar W Iv Contrast (Pro Cah)Professional Component ,,70491,CPT,Professional,Both,,,26,460,391,41.88,460,"UCare Health, Inc.",Medicare Advantage,74.9225,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Ct Neck Nasophar W Iv Contrast (Pro Cah)Professional Component ,,70491,CPT,Professional,Both,,,26,460,391,41.88,460,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),59.938,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Ct Neck Nasophar W Iv Contrast (Pro Cah)Professional Component ,,70491,CPT,Professional,Both,,,26,460,391,41.88,460,UnitedHealthcare,Individual & Family,460,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Ct Neck Nasophar W Iv Contrast (Pro Cah)Professional Component ,,70491,CPT,Professional,Both,,,26,460,391,41.88,460,UnitedHealthcare,Medicare Advantage,74.9225,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Neck Nasophar W Iv Contrast (Pro Cah)Professional Component ,,70491,CPT,Professional,Both,,,26,460,391,41.88,460,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,48.35144,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Ct Neck Nasopharynx Wo W Iv Contrast (Pro Cah)Professional Component ,,70492,CPT,Professional,Both,,,26,555,471.75,48.65,555,Aetna,Commercial,471.75,85,,percent of total billed charges,,
Ct Neck Nasopharynx Wo W Iv Contrast (Pro Cah)Professional Component ,,70492,CPT,Professional,Both,,,26,555,471.75,48.65,555,Aetna,Medicare Advantage,78.14,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Neck Nasopharynx Wo W Iv Contrast (Pro Cah)Professional Component ,,70492,CPT,Professional,Both,,,26,555,471.75,48.65,555,Aetna,PPO,516.15,93,,percent of total billed charges,,
Ct Neck Nasopharynx Wo W Iv Contrast (Pro Cah)Professional Component ,,70492,CPT,Professional,Both,,,26,555,471.75,48.65,555,America's PPO,America's PPO,474.192,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Ct Neck Nasopharynx Wo W Iv Contrast (Pro Cah)Professional Component ,,70492,CPT,Professional,Both,,,26,555,471.75,48.65,555,BlueCross BlueShield Minnesota, Federal Employee Program,145.74,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Ct Neck Nasopharynx Wo W Iv Contrast (Pro Cah)Professional Component ,,70492,CPT,Professional,Both,,,26,555,471.75,48.65,555,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,148.07184,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Ct Neck Nasopharynx Wo W Iv Contrast (Pro Cah)Professional Component ,,70492,CPT,Professional,Both,,,26,555,471.75,48.65,555,BlueCross BlueShield Minnesota,High Value Network Plan,148.07184,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Ct Neck Nasopharynx Wo W Iv Contrast (Pro Cah)Professional Component ,,70492,CPT,Professional,Both,,,26,555,471.75,48.65,555,BlueCross BlueShield Minnesota,Medicare Advantage,87.1815,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Neck Nasopharynx Wo W Iv Contrast (Pro Cah)Professional Component ,,70492,CPT,Professional,Both,,,26,555,471.75,48.65,555,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,148.07184,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Ct Neck Nasopharynx Wo W Iv Contrast (Pro Cah)Professional Component ,,70492,CPT,Professional,Both,,,26,555,471.75,48.65,555,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,56.16448,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Ct Neck Nasopharynx Wo W Iv Contrast (Pro Cah)Professional Component ,,70492,CPT,Professional,Both,,,26,555,471.75,48.65,555,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),87.1815,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Neck Nasopharynx Wo W Iv Contrast (Pro Cah)Professional Component ,,70492,CPT,Professional,Both,,,26,555,471.75,48.65,555,CorVel,Worker's Compensation,149.7340206,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Ct Neck Nasopharynx Wo W Iv Contrast (Pro Cah)Professional Component ,,70492,CPT,Professional,Both,,,26,555,471.75,48.65,555,First Health Group Corporation,First Health Network,538.35,97,,percent of total billed charges,,
Ct Neck Nasopharynx Wo W Iv Contrast (Pro Cah)Professional Component ,,70492,CPT,Professional,Both,,,26,555,471.75,48.65,555,"Health Partners, Inc.",Commercial,114.98,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Ct Neck Nasopharynx Wo W Iv Contrast (Pro Cah)Professional Component ,,70492,CPT,Professional,Both,,,26,555,471.75,48.65,555,"Health Partners, Inc.",Medicare Advantage,87.1815,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Neck Nasopharynx Wo W Iv Contrast (Pro Cah)Professional Component ,,70492,CPT,Professional,Both,,,26,555,471.75,48.65,555,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),48.65,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Ct Neck Nasopharynx Wo W Iv Contrast (Pro Cah)Professional Component ,,70492,CPT,Professional,Both,,,26,555,471.75,48.65,555,"Health Partners, Inc.",State of Minnesota Advantage Program,99.05527,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Ct Neck Nasopharynx Wo W Iv Contrast (Pro Cah)Professional Component ,,70492,CPT,Professional,Both,,,26,555,471.75,48.65,555,"Health Partners, Inc.",State Public Programs,48.65,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Ct Neck Nasopharynx Wo W Iv Contrast (Pro Cah)Professional Component ,,70492,CPT,Professional,Both,,,26,555,471.75,48.65,555,Humana Insurance Company,Commercial PPO,75.81,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Ct Neck Nasopharynx Wo W Iv Contrast (Pro Cah)Professional Component ,,70492,CPT,Professional,Both,,,26,555,471.75,48.65,555,Humana Insurance Company,Medicare PPO,555,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Ct Neck Nasopharynx Wo W Iv Contrast (Pro Cah)Professional Component ,,70492,CPT,Professional,Both,,,26,555,471.75,48.65,555,Medica,Individual & Family,470.64,84.8,,percent of total billed charges,,
Ct Neck Nasopharynx Wo W Iv Contrast (Pro Cah)Professional Component ,,70492,CPT,Professional,Both,,,26,555,471.75,48.65,555,Medica,Medica Advantage Solution,276.39,49.8,,percent of total billed charges,,
Ct Neck Nasopharynx Wo W Iv Contrast (Pro Cah)Professional Component ,,70492,CPT,Professional,Both,,,26,555,471.75,48.65,555,Medica,Medical Assistance,56.16,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Ct Neck Nasopharynx Wo W Iv Contrast (Pro Cah)Professional Component ,,70492,CPT,Professional,Both,,,26,555,471.75,48.65,555,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,75.81,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Ct Neck Nasopharynx Wo W Iv Contrast (Pro Cah)Professional Component ,,70492,CPT,Professional,Both,,,26,555,471.75,48.65,555,"Multiplan, Inc.","Multiplan, Inc.",521.7,94,,percent of total billed charges,,
Ct Neck Nasopharynx Wo W Iv Contrast (Pro Cah)Professional Component ,,70492,CPT,Professional,Both,,,26,555,471.75,48.65,555,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,500.055,90.1,,percent of total billed charges,,
Ct Neck Nasopharynx Wo W Iv Contrast (Pro Cah)Professional Component ,,70492,CPT,Professional,Both,,,26,555,471.75,48.65,555,"Preferred One Administrative Services, INC.",PPO,547.23,98.6,,percent of total billed charges,,
Ct Neck Nasopharynx Wo W Iv Contrast (Pro Cah)Professional Component ,,70492,CPT,Professional,Both,,,26,555,471.75,48.65,555,PrimeWest Health,Minnesota Senior Health Options (MSHO),87.1815,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Neck Nasopharynx Wo W Iv Contrast (Pro Cah)Professional Component ,,70492,CPT,Professional,Both,,,26,555,471.75,48.65,555,PrimeWest Health,MinnesotaCare,60.0959936,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Ct Neck Nasopharynx Wo W Iv Contrast (Pro Cah)Professional Component ,,70492,CPT,Professional,Both,,,26,555,471.75,48.65,555,Sanford Health Plan,Sanford Health Plan,488.4,88,,percent of total billed charges,,
Ct Neck Nasopharynx Wo W Iv Contrast (Pro Cah)Professional Component ,,70492,CPT,Professional,Both,,,26,555,471.75,48.65,555,"UCare Health, Inc.",Individual & Family Plan,123.236736,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Ct Neck Nasopharynx Wo W Iv Contrast (Pro Cah)Professional Component ,,70492,CPT,Professional,Both,,,26,555,471.75,48.65,555,"UCare Health, Inc.",Medical Assistance,61.780928,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Ct Neck Nasopharynx Wo W Iv Contrast (Pro Cah)Professional Component ,,70492,CPT,Professional,Both,,,26,555,471.75,48.65,555,"UCare Health, Inc.",Medicare Advantage,87.1815,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Ct Neck Nasopharynx Wo W Iv Contrast (Pro Cah)Professional Component ,,70492,CPT,Professional,Both,,,26,555,471.75,48.65,555,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),69.7452,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Ct Neck Nasopharynx Wo W Iv Contrast (Pro Cah)Professional Component ,,70492,CPT,Professional,Both,,,26,555,471.75,48.65,555,UnitedHealthcare,Individual & Family,555,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Ct Neck Nasopharynx Wo W Iv Contrast (Pro Cah)Professional Component ,,70492,CPT,Professional,Both,,,26,555,471.75,48.65,555,UnitedHealthcare,Medicare Advantage,87.1815,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Neck Nasopharynx Wo W Iv Contrast (Pro Cah)Professional Component ,,70492,CPT,Professional,Both,,,26,555,471.75,48.65,555,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,56.16448,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Cta Head (Pro Cah)Professional Component ,,70496,CPT,Professional,Both,,,26,650,552.5,52.79,650,Aetna,Commercial,552.5,85,,percent of total billed charges,,
Cta Head (Pro Cah)Professional Component ,,70496,CPT,Professional,Both,,,26,650,552.5,52.79,650,Aetna,Medicare Advantage,84.09,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Cta Head (Pro Cah)Professional Component ,,70496,CPT,Professional,Both,,,26,650,552.5,52.79,650,Aetna,PPO,604.5,93,,percent of total billed charges,,
Cta Head (Pro Cah)Professional Component ,,70496,CPT,Professional,Both,,,26,650,552.5,52.79,650,America's PPO,America's PPO,555.36,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Cta Head (Pro Cah)Professional Component ,,70496,CPT,Professional,Both,,,26,650,552.5,52.79,650,BlueCross BlueShield Minnesota, Federal Employee Program,158.52,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Cta Head (Pro Cah)Professional Component ,,70496,CPT,Professional,Both,,,26,650,552.5,52.79,650,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,161.05632,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Cta Head (Pro Cah)Professional Component ,,70496,CPT,Professional,Both,,,26,650,552.5,52.79,650,BlueCross BlueShield Minnesota,High Value Network Plan,161.05632,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Cta Head (Pro Cah)Professional Component ,,70496,CPT,Professional,Both,,,26,650,552.5,52.79,650,BlueCross BlueShield Minnesota,Medicare Advantage,94.484,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Cta Head (Pro Cah)Professional Component ,,70496,CPT,Professional,Both,,,26,650,552.5,52.79,650,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,161.05632,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Cta Head (Pro Cah)Professional Component ,,70496,CPT,Professional,Both,,,26,650,552.5,52.79,650,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,60.94984,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Cta Head (Pro Cah)Professional Component ,,70496,CPT,Professional,Both,,,26,650,552.5,52.79,650,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),94.484,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Cta Head (Pro Cah)Professional Component ,,70496,CPT,Professional,Both,,,26,650,552.5,52.79,650,CorVel,Worker's Compensation,161.8682811,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Cta Head (Pro Cah)Professional Component ,,70496,CPT,Professional,Both,,,26,650,552.5,52.79,650,First Health Group Corporation,First Health Network,630.5,97,,percent of total billed charges,,
Cta Head (Pro Cah)Professional Component ,,70496,CPT,Professional,Both,,,26,650,552.5,52.79,650,"Health Partners, Inc.",Commercial,124.27,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Cta Head (Pro Cah)Professional Component ,,70496,CPT,Professional,Both,,,26,650,552.5,52.79,650,"Health Partners, Inc.",Medicare Advantage,94.484,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Cta Head (Pro Cah)Professional Component ,,70496,CPT,Professional,Both,,,26,650,552.5,52.79,650,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),52.79,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Cta Head (Pro Cah)Professional Component ,,70496,CPT,Professional,Both,,,26,650,552.5,52.79,650,"Health Partners, Inc.",State of Minnesota Advantage Program,107.058605,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Cta Head (Pro Cah)Professional Component ,,70496,CPT,Professional,Both,,,26,650,552.5,52.79,650,"Health Partners, Inc.",State Public Programs,52.79,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Cta Head (Pro Cah)Professional Component ,,70496,CPT,Professional,Both,,,26,650,552.5,52.79,650,Humana Insurance Company,Commercial PPO,82.16,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Cta Head (Pro Cah)Professional Component ,,70496,CPT,Professional,Both,,,26,650,552.5,52.79,650,Humana Insurance Company,Medicare PPO,650,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Cta Head (Pro Cah)Professional Component ,,70496,CPT,Professional,Both,,,26,650,552.5,52.79,650,Medica,Individual & Family,551.2,84.8,,percent of total billed charges,,
Cta Head (Pro Cah)Professional Component ,,70496,CPT,Professional,Both,,,26,650,552.5,52.79,650,Medica,Medica Advantage Solution,323.7,49.8,,percent of total billed charges,,
Cta Head (Pro Cah)Professional Component ,,70496,CPT,Professional,Both,,,26,650,552.5,52.79,650,Medica,Medical Assistance,60.95,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Cta Head (Pro Cah)Professional Component ,,70496,CPT,Professional,Both,,,26,650,552.5,52.79,650,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,82.16,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Cta Head (Pro Cah)Professional Component ,,70496,CPT,Professional,Both,,,26,650,552.5,52.79,650,"Multiplan, Inc.","Multiplan, Inc.",611,94,,percent of total billed charges,,
Cta Head (Pro Cah)Professional Component ,,70496,CPT,Professional,Both,,,26,650,552.5,52.79,650,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,585.65,90.1,,percent of total billed charges,,
Cta Head (Pro Cah)Professional Component ,,70496,CPT,Professional,Both,,,26,650,552.5,52.79,650,"Preferred One Administrative Services, INC.",PPO,640.9,98.6,,percent of total billed charges,,
Cta Head (Pro Cah)Professional Component ,,70496,CPT,Professional,Both,,,26,650,552.5,52.79,650,PrimeWest Health,Minnesota Senior Health Options (MSHO),94.484,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Cta Head (Pro Cah)Professional Component ,,70496,CPT,Professional,Both,,,26,650,552.5,52.79,650,PrimeWest Health,MinnesotaCare,65.2163288,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Cta Head (Pro Cah)Professional Component ,,70496,CPT,Professional,Both,,,26,650,552.5,52.79,650,Sanford Health Plan,Sanford Health Plan,572,88,,percent of total billed charges,,
Cta Head (Pro Cah)Professional Component ,,70496,CPT,Professional,Both,,,26,650,552.5,52.79,650,"UCare Health, Inc.",Individual & Family Plan,133.559296,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Cta Head (Pro Cah)Professional Component ,,70496,CPT,Professional,Both,,,26,650,552.5,52.79,650,"UCare Health, Inc.",Medical Assistance,67.044824,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Cta Head (Pro Cah)Professional Component ,,70496,CPT,Professional,Both,,,26,650,552.5,52.79,650,"UCare Health, Inc.",Medicare Advantage,94.484,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Cta Head (Pro Cah)Professional Component ,,70496,CPT,Professional,Both,,,26,650,552.5,52.79,650,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),75.5872,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Cta Head (Pro Cah)Professional Component ,,70496,CPT,Professional,Both,,,26,650,552.5,52.79,650,UnitedHealthcare,Individual & Family,650,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Cta Head (Pro Cah)Professional Component ,,70496,CPT,Professional,Both,,,26,650,552.5,52.79,650,UnitedHealthcare,Medicare Advantage,94.484,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Cta Head (Pro Cah)Professional Component ,,70496,CPT,Professional,Both,,,26,650,552.5,52.79,650,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,60.94984,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Cta Carotids (Pro Cah)Professional Component ,,70498,CPT,Professional,Both,,,26,626,532.1,52.79,626,Aetna,Commercial,532.1,85,,percent of total billed charges,,
Cta Carotids (Pro Cah)Professional Component ,,70498,CPT,Professional,Both,,,26,626,532.1,52.79,626,Aetna,Medicare Advantage,84.09,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Cta Carotids (Pro Cah)Professional Component ,,70498,CPT,Professional,Both,,,26,626,532.1,52.79,626,Aetna,PPO,582.18,93,,percent of total billed charges,,
Cta Carotids (Pro Cah)Professional Component ,,70498,CPT,Professional,Both,,,26,626,532.1,52.79,626,America's PPO,America's PPO,534.8544,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Cta Carotids (Pro Cah)Professional Component ,,70498,CPT,Professional,Both,,,26,626,532.1,52.79,626,BlueCross BlueShield Minnesota, Federal Employee Program,158.52,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Cta Carotids (Pro Cah)Professional Component ,,70498,CPT,Professional,Both,,,26,626,532.1,52.79,626,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,161.05632,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Cta Carotids (Pro Cah)Professional Component ,,70498,CPT,Professional,Both,,,26,626,532.1,52.79,626,BlueCross BlueShield Minnesota,High Value Network Plan,161.05632,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Cta Carotids (Pro Cah)Professional Component ,,70498,CPT,Professional,Both,,,26,626,532.1,52.79,626,BlueCross BlueShield Minnesota,Medicare Advantage,94.484,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Cta Carotids (Pro Cah)Professional Component ,,70498,CPT,Professional,Both,,,26,626,532.1,52.79,626,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,161.05632,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Cta Carotids (Pro Cah)Professional Component ,,70498,CPT,Professional,Both,,,26,626,532.1,52.79,626,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,60.94984,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Cta Carotids (Pro Cah)Professional Component ,,70498,CPT,Professional,Both,,,26,626,532.1,52.79,626,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),94.484,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Cta Carotids (Pro Cah)Professional Component ,,70498,CPT,Professional,Both,,,26,626,532.1,52.79,626,CorVel,Worker's Compensation,161.8682811,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Cta Carotids (Pro Cah)Professional Component ,,70498,CPT,Professional,Both,,,26,626,532.1,52.79,626,First Health Group Corporation,First Health Network,607.22,97,,percent of total billed charges,,
Cta Carotids (Pro Cah)Professional Component ,,70498,CPT,Professional,Both,,,26,626,532.1,52.79,626,"Health Partners, Inc.",Commercial,124.27,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Cta Carotids (Pro Cah)Professional Component ,,70498,CPT,Professional,Both,,,26,626,532.1,52.79,626,"Health Partners, Inc.",Medicare Advantage,94.484,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Cta Carotids (Pro Cah)Professional Component ,,70498,CPT,Professional,Both,,,26,626,532.1,52.79,626,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),52.79,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Cta Carotids (Pro Cah)Professional Component ,,70498,CPT,Professional,Both,,,26,626,532.1,52.79,626,"Health Partners, Inc.",State of Minnesota Advantage Program,107.058605,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Cta Carotids (Pro Cah)Professional Component ,,70498,CPT,Professional,Both,,,26,626,532.1,52.79,626,"Health Partners, Inc.",State Public Programs,52.79,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Cta Carotids (Pro Cah)Professional Component ,,70498,CPT,Professional,Both,,,26,626,532.1,52.79,626,Humana Insurance Company,Commercial PPO,82.16,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Cta Carotids (Pro Cah)Professional Component ,,70498,CPT,Professional,Both,,,26,626,532.1,52.79,626,Humana Insurance Company,Medicare PPO,626,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Cta Carotids (Pro Cah)Professional Component ,,70498,CPT,Professional,Both,,,26,626,532.1,52.79,626,Medica,Individual & Family,530.848,84.8,,percent of total billed charges,,
Cta Carotids (Pro Cah)Professional Component ,,70498,CPT,Professional,Both,,,26,626,532.1,52.79,626,Medica,Medica Advantage Solution,311.748,49.8,,percent of total billed charges,,
Cta Carotids (Pro Cah)Professional Component ,,70498,CPT,Professional,Both,,,26,626,532.1,52.79,626,Medica,Medical Assistance,60.95,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Cta Carotids (Pro Cah)Professional Component ,,70498,CPT,Professional,Both,,,26,626,532.1,52.79,626,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,82.16,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Cta Carotids (Pro Cah)Professional Component ,,70498,CPT,Professional,Both,,,26,626,532.1,52.79,626,"Multiplan, Inc.","Multiplan, Inc.",588.44,94,,percent of total billed charges,,
Cta Carotids (Pro Cah)Professional Component ,,70498,CPT,Professional,Both,,,26,626,532.1,52.79,626,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,564.026,90.1,,percent of total billed charges,,
Cta Carotids (Pro Cah)Professional Component ,,70498,CPT,Professional,Both,,,26,626,532.1,52.79,626,"Preferred One Administrative Services, INC.",PPO,617.236,98.6,,percent of total billed charges,,
Cta Carotids (Pro Cah)Professional Component ,,70498,CPT,Professional,Both,,,26,626,532.1,52.79,626,PrimeWest Health,Minnesota Senior Health Options (MSHO),94.484,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Cta Carotids (Pro Cah)Professional Component ,,70498,CPT,Professional,Both,,,26,626,532.1,52.79,626,PrimeWest Health,MinnesotaCare,65.2163288,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Cta Carotids (Pro Cah)Professional Component ,,70498,CPT,Professional,Both,,,26,626,532.1,52.79,626,Sanford Health Plan,Sanford Health Plan,550.88,88,,percent of total billed charges,,
Cta Carotids (Pro Cah)Professional Component ,,70498,CPT,Professional,Both,,,26,626,532.1,52.79,626,"UCare Health, Inc.",Individual & Family Plan,133.559296,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Cta Carotids (Pro Cah)Professional Component ,,70498,CPT,Professional,Both,,,26,626,532.1,52.79,626,"UCare Health, Inc.",Medical Assistance,67.044824,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Cta Carotids (Pro Cah)Professional Component ,,70498,CPT,Professional,Both,,,26,626,532.1,52.79,626,"UCare Health, Inc.",Medicare Advantage,94.484,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Cta Carotids (Pro Cah)Professional Component ,,70498,CPT,Professional,Both,,,26,626,532.1,52.79,626,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),75.5872,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Cta Carotids (Pro Cah)Professional Component ,,70498,CPT,Professional,Both,,,26,626,532.1,52.79,626,UnitedHealthcare,Individual & Family,626,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Cta Carotids (Pro Cah)Professional Component ,,70498,CPT,Professional,Both,,,26,626,532.1,52.79,626,UnitedHealthcare,Medicare Advantage,94.484,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Cta Carotids (Pro Cah)Professional Component ,,70498,CPT,Professional,Both,,,26,626,532.1,52.79,626,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,60.94984,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Mri Neck, Orbit, Face W/O Contrast (Pro Cah)Professional Component ",,70540,CPT,Professional,Both,,,26,583,495.55,40.57,583,Aetna,Commercial,495.55,85,,percent of total billed charges,,
"Mri Neck, Orbit, Face W/O Contrast (Pro Cah)Professional Component ",,70540,CPT,Professional,Both,,,26,583,495.55,40.57,583,Aetna,Medicare Advantage,64.69,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Mri Neck, Orbit, Face W/O Contrast (Pro Cah)Professional Component ",,70540,CPT,Professional,Both,,,26,583,495.55,40.57,583,Aetna,PPO,542.19,93,,percent of total billed charges,,
"Mri Neck, Orbit, Face W/O Contrast (Pro Cah)Professional Component ",,70540,CPT,Professional,Both,,,26,583,495.55,40.57,583,America's PPO,America's PPO,498.1152,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Mri Neck, Orbit, Face W/O Contrast (Pro Cah)Professional Component ",,70540,CPT,Professional,Both,,,26,583,495.55,40.57,583,BlueCross BlueShield Minnesota, Federal Employee Program,121.45,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Mri Neck, Orbit, Face W/O Contrast (Pro Cah)Professional Component ",,70540,CPT,Professional,Both,,,26,583,495.55,40.57,583,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,123.3932,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Mri Neck, Orbit, Face W/O Contrast (Pro Cah)Professional Component ",,70540,CPT,Professional,Both,,,26,583,495.55,40.57,583,BlueCross BlueShield Minnesota,High Value Network Plan,123.3932,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Mri Neck, Orbit, Face W/O Contrast (Pro Cah)Professional Component ",,70540,CPT,Professional,Both,,,26,583,495.55,40.57,583,BlueCross BlueShield Minnesota,Medicare Advantage,72.565,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Mri Neck, Orbit, Face W/O Contrast (Pro Cah)Professional Component ",,70540,CPT,Professional,Both,,,26,583,495.55,40.57,583,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,123.3932,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Mri Neck, Orbit, Face W/O Contrast (Pro Cah)Professional Component ",,70540,CPT,Professional,Both,,,26,583,495.55,40.57,583,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,46.8376,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Mri Neck, Orbit, Face W/O Contrast (Pro Cah)Professional Component ",,70540,CPT,Professional,Both,,,26,583,495.55,40.57,583,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),72.565,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Mri Neck, Orbit, Face W/O Contrast (Pro Cah)Professional Component ",,70540,CPT,Professional,Both,,,26,583,495.55,40.57,583,CorVel,Worker's Compensation,125.0000115,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Mri Neck, Orbit, Face W/O Contrast (Pro Cah)Professional Component ",,70540,CPT,Professional,Both,,,26,583,495.55,40.57,583,First Health Group Corporation,First Health Network,565.51,97,,percent of total billed charges,,
"Mri Neck, Orbit, Face W/O Contrast (Pro Cah)Professional Component ",,70540,CPT,Professional,Both,,,26,583,495.55,40.57,583,"Health Partners, Inc.",Commercial,95.91,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Mri Neck, Orbit, Face W/O Contrast (Pro Cah)Professional Component ",,70540,CPT,Professional,Both,,,26,583,495.55,40.57,583,"Health Partners, Inc.",Medicare Advantage,72.565,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Mri Neck, Orbit, Face W/O Contrast (Pro Cah)Professional Component ",,70540,CPT,Professional,Both,,,26,583,495.55,40.57,583,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),40.57,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Mri Neck, Orbit, Face W/O Contrast (Pro Cah)Professional Component ",,70540,CPT,Professional,Both,,,26,583,495.55,40.57,583,"Health Partners, Inc.",State of Minnesota Advantage Program,82.626465,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Mri Neck, Orbit, Face W/O Contrast (Pro Cah)Professional Component ",,70540,CPT,Professional,Both,,,26,583,495.55,40.57,583,"Health Partners, Inc.",State Public Programs,40.57,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Mri Neck, Orbit, Face W/O Contrast (Pro Cah)Professional Component ",,70540,CPT,Professional,Both,,,26,583,495.55,40.57,583,Humana Insurance Company,Commercial PPO,63.1,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Mri Neck, Orbit, Face W/O Contrast (Pro Cah)Professional Component ",,70540,CPT,Professional,Both,,,26,583,495.55,40.57,583,Humana Insurance Company,Medicare PPO,583,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Mri Neck, Orbit, Face W/O Contrast (Pro Cah)Professional Component ",,70540,CPT,Professional,Both,,,26,583,495.55,40.57,583,Medica,Individual & Family,494.384,84.8,,percent of total billed charges,,
"Mri Neck, Orbit, Face W/O Contrast (Pro Cah)Professional Component ",,70540,CPT,Professional,Both,,,26,583,495.55,40.57,583,Medica,Medica Advantage Solution,290.334,49.8,,percent of total billed charges,,
"Mri Neck, Orbit, Face W/O Contrast (Pro Cah)Professional Component ",,70540,CPT,Professional,Both,,,26,583,495.55,40.57,583,Medica,Medical Assistance,46.84,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Mri Neck, Orbit, Face W/O Contrast (Pro Cah)Professional Component ",,70540,CPT,Professional,Both,,,26,583,495.55,40.57,583,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,63.1,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Mri Neck, Orbit, Face W/O Contrast (Pro Cah)Professional Component ",,70540,CPT,Professional,Both,,,26,583,495.55,40.57,583,"Multiplan, Inc.","Multiplan, Inc.",548.02,94,,percent of total billed charges,,
"Mri Neck, Orbit, Face W/O Contrast (Pro Cah)Professional Component ",,70540,CPT,Professional,Both,,,26,583,495.55,40.57,583,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,525.283,90.1,,percent of total billed charges,,
"Mri Neck, Orbit, Face W/O Contrast (Pro Cah)Professional Component ",,70540,CPT,Professional,Both,,,26,583,495.55,40.57,583,"Preferred One Administrative Services, INC.",PPO,574.838,98.6,,percent of total billed charges,,
"Mri Neck, Orbit, Face W/O Contrast (Pro Cah)Professional Component ",,70540,CPT,Professional,Both,,,26,583,495.55,40.57,583,PrimeWest Health,Minnesota Senior Health Options (MSHO),72.565,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Mri Neck, Orbit, Face W/O Contrast (Pro Cah)Professional Component ",,70540,CPT,Professional,Both,,,26,583,495.55,40.57,583,PrimeWest Health,MinnesotaCare,50.116232,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Mri Neck, Orbit, Face W/O Contrast (Pro Cah)Professional Component ",,70540,CPT,Professional,Both,,,26,583,495.55,40.57,583,Sanford Health Plan,Sanford Health Plan,513.04,88,,percent of total billed charges,,
"Mri Neck, Orbit, Face W/O Contrast (Pro Cah)Professional Component ",,70540,CPT,Professional,Both,,,26,583,495.55,40.57,583,"UCare Health, Inc.",Individual & Family Plan,102.57536,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Mri Neck, Orbit, Face W/O Contrast (Pro Cah)Professional Component ",,70540,CPT,Professional,Both,,,26,583,495.55,40.57,583,"UCare Health, Inc.",Medical Assistance,51.52136,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Mri Neck, Orbit, Face W/O Contrast (Pro Cah)Professional Component ",,70540,CPT,Professional,Both,,,26,583,495.55,40.57,583,"UCare Health, Inc.",Medicare Advantage,72.565,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Mri Neck, Orbit, Face W/O Contrast (Pro Cah)Professional Component ",,70540,CPT,Professional,Both,,,26,583,495.55,40.57,583,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),58.052,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Mri Neck, Orbit, Face W/O Contrast (Pro Cah)Professional Component ",,70540,CPT,Professional,Both,,,26,583,495.55,40.57,583,UnitedHealthcare,Individual & Family,583,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Mri Neck, Orbit, Face W/O Contrast (Pro Cah)Professional Component ",,70540,CPT,Professional,Both,,,26,583,495.55,40.57,583,UnitedHealthcare,Medicare Advantage,72.565,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Mri Neck, Orbit, Face W/O Contrast (Pro Cah)Professional Component ",,70540,CPT,Professional,Both,,,26,583,495.55,40.57,583,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,46.8376,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Mri, Orbit, Face, And/Or Neck; With Contrast Material(S) (Pro Cah)Professional Component ",,70542,CPT,Professional,Both,,,26,715,607.75,48.86,715,Aetna,Commercial,607.75,85,,percent of total billed charges,,
"Mri, Orbit, Face, And/Or Neck; With Contrast Material(S) (Pro Cah)Professional Component ",,70542,CPT,Professional,Both,,,26,715,607.75,48.86,715,Aetna,Medicare Advantage,78.49,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Mri, Orbit, Face, And/Or Neck; With Contrast Material(S) (Pro Cah)Professional Component ",,70542,CPT,Professional,Both,,,26,715,607.75,48.86,715,Aetna,PPO,664.95,93,,percent of total billed charges,,
"Mri, Orbit, Face, And/Or Neck; With Contrast Material(S) (Pro Cah)Professional Component ",,70542,CPT,Professional,Both,,,26,715,607.75,48.86,715,America's PPO,America's PPO,610.896,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Mri, Orbit, Face, And/Or Neck; With Contrast Material(S) (Pro Cah)Professional Component ",,70542,CPT,Professional,Both,,,26,715,607.75,48.86,715,BlueCross BlueShield Minnesota, Federal Employee Program,146.38,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Mri, Orbit, Face, And/Or Neck; With Contrast Material(S) (Pro Cah)Professional Component ",,70542,CPT,Professional,Both,,,26,715,607.75,48.86,715,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,148.72208,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Mri, Orbit, Face, And/Or Neck; With Contrast Material(S) (Pro Cah)Professional Component ",,70542,CPT,Professional,Both,,,26,715,607.75,48.86,715,BlueCross BlueShield Minnesota,High Value Network Plan,148.72208,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Mri, Orbit, Face, And/Or Neck; With Contrast Material(S) (Pro Cah)Professional Component ",,70542,CPT,Professional,Both,,,26,715,607.75,48.86,715,BlueCross BlueShield Minnesota,Medicare Advantage,87.5725,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Mri, Orbit, Face, And/Or Neck; With Contrast Material(S) (Pro Cah)Professional Component ",,70542,CPT,Professional,Both,,,26,715,607.75,48.86,715,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,148.72208,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Mri, Orbit, Face, And/Or Neck; With Contrast Material(S) (Pro Cah)Professional Component ",,70542,CPT,Professional,Both,,,26,715,607.75,48.86,715,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,56.40832,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Mri, Orbit, Face, And/Or Neck; With Contrast Material(S) (Pro Cah)Professional Component ",,70542,CPT,Professional,Both,,,26,715,607.75,48.86,715,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),87.5725,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Mri, Orbit, Face, And/Or Neck; With Contrast Material(S) (Pro Cah)Professional Component ",,70542,CPT,Professional,Both,,,26,715,607.75,48.86,715,CorVel,Worker's Compensation,150.1773426,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Mri, Orbit, Face, And/Or Neck; With Contrast Material(S) (Pro Cah)Professional Component ",,70542,CPT,Professional,Both,,,26,715,607.75,48.86,715,First Health Group Corporation,First Health Network,693.55,97,,percent of total billed charges,,
"Mri, Orbit, Face, And/Or Neck; With Contrast Material(S) (Pro Cah)Professional Component ",,70542,CPT,Professional,Both,,,26,715,607.75,48.86,715,"Health Partners, Inc.",Commercial,115.5,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Mri, Orbit, Face, And/Or Neck; With Contrast Material(S) (Pro Cah)Professional Component ",,70542,CPT,Professional,Both,,,26,715,607.75,48.86,715,"Health Partners, Inc.",Medicare Advantage,87.5725,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Mri, Orbit, Face, And/Or Neck; With Contrast Material(S) (Pro Cah)Professional Component ",,70542,CPT,Professional,Both,,,26,715,607.75,48.86,715,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),48.86,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Mri, Orbit, Face, And/Or Neck; With Contrast Material(S) (Pro Cah)Professional Component ",,70542,CPT,Professional,Both,,,26,715,607.75,48.86,715,"Health Partners, Inc.",State of Minnesota Advantage Program,99.50325,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Mri, Orbit, Face, And/Or Neck; With Contrast Material(S) (Pro Cah)Professional Component ",,70542,CPT,Professional,Both,,,26,715,607.75,48.86,715,"Health Partners, Inc.",State Public Programs,48.86,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Mri, Orbit, Face, And/Or Neck; With Contrast Material(S) (Pro Cah)Professional Component ",,70542,CPT,Professional,Both,,,26,715,607.75,48.86,715,Humana Insurance Company,Commercial PPO,76.15,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Mri, Orbit, Face, And/Or Neck; With Contrast Material(S) (Pro Cah)Professional Component ",,70542,CPT,Professional,Both,,,26,715,607.75,48.86,715,Humana Insurance Company,Medicare PPO,715,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Mri, Orbit, Face, And/Or Neck; With Contrast Material(S) (Pro Cah)Professional Component ",,70542,CPT,Professional,Both,,,26,715,607.75,48.86,715,Medica,Individual & Family,606.32,84.8,,percent of total billed charges,,
"Mri, Orbit, Face, And/Or Neck; With Contrast Material(S) (Pro Cah)Professional Component ",,70542,CPT,Professional,Both,,,26,715,607.75,48.86,715,Medica,Medica Advantage Solution,356.07,49.8,,percent of total billed charges,,
"Mri, Orbit, Face, And/Or Neck; With Contrast Material(S) (Pro Cah)Professional Component ",,70542,CPT,Professional,Both,,,26,715,607.75,48.86,715,Medica,Medical Assistance,56.41,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Mri, Orbit, Face, And/Or Neck; With Contrast Material(S) (Pro Cah)Professional Component ",,70542,CPT,Professional,Both,,,26,715,607.75,48.86,715,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,76.15,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Mri, Orbit, Face, And/Or Neck; With Contrast Material(S) (Pro Cah)Professional Component ",,70542,CPT,Professional,Both,,,26,715,607.75,48.86,715,"Multiplan, Inc.","Multiplan, Inc.",672.1,94,,percent of total billed charges,,
"Mri, Orbit, Face, And/Or Neck; With Contrast Material(S) (Pro Cah)Professional Component ",,70542,CPT,Professional,Both,,,26,715,607.75,48.86,715,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,644.215,90.1,,percent of total billed charges,,
"Mri, Orbit, Face, And/Or Neck; With Contrast Material(S) (Pro Cah)Professional Component ",,70542,CPT,Professional,Both,,,26,715,607.75,48.86,715,"Preferred One Administrative Services, INC.",PPO,704.99,98.6,,percent of total billed charges,,
"Mri, Orbit, Face, And/Or Neck; With Contrast Material(S) (Pro Cah)Professional Component ",,70542,CPT,Professional,Both,,,26,715,607.75,48.86,715,PrimeWest Health,Minnesota Senior Health Options (MSHO),87.5725,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Mri, Orbit, Face, And/Or Neck; With Contrast Material(S) (Pro Cah)Professional Component ",,70542,CPT,Professional,Both,,,26,715,607.75,48.86,715,PrimeWest Health,MinnesotaCare,60.3569024,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Mri, Orbit, Face, And/Or Neck; With Contrast Material(S) (Pro Cah)Professional Component ",,70542,CPT,Professional,Both,,,26,715,607.75,48.86,715,Sanford Health Plan,Sanford Health Plan,629.2,88,,percent of total billed charges,,
"Mri, Orbit, Face, And/Or Neck; With Contrast Material(S) (Pro Cah)Professional Component ",,70542,CPT,Professional,Both,,,26,715,607.75,48.86,715,"UCare Health, Inc.",Individual & Family Plan,123.78944,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Mri, Orbit, Face, And/Or Neck; With Contrast Material(S) (Pro Cah)Professional Component ",,70542,CPT,Professional,Both,,,26,715,607.75,48.86,715,"UCare Health, Inc.",Medical Assistance,62.049152,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Mri, Orbit, Face, And/Or Neck; With Contrast Material(S) (Pro Cah)Professional Component ",,70542,CPT,Professional,Both,,,26,715,607.75,48.86,715,"UCare Health, Inc.",Medicare Advantage,87.5725,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Mri, Orbit, Face, And/Or Neck; With Contrast Material(S) (Pro Cah)Professional Component ",,70542,CPT,Professional,Both,,,26,715,607.75,48.86,715,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),70.058,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Mri, Orbit, Face, And/Or Neck; With Contrast Material(S) (Pro Cah)Professional Component ",,70542,CPT,Professional,Both,,,26,715,607.75,48.86,715,UnitedHealthcare,Individual & Family,715,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Mri, Orbit, Face, And/Or Neck; With Contrast Material(S) (Pro Cah)Professional Component ",,70542,CPT,Professional,Both,,,26,715,607.75,48.86,715,UnitedHealthcare,Medicare Advantage,87.5725,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Mri, Orbit, Face, And/Or Neck; With Contrast Material(S) (Pro Cah)Professional Component ",,70542,CPT,Professional,Both,,,26,715,607.75,48.86,715,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,56.40832,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Mri Orbit, Face, And/Or Neck; W/O Contrast, Followed By Contrast  And Further Sequences (Pro Cah)Professional Component ",,70543,CPT,Professional,Both,,,26,1103,937.55,64.79,1103,Aetna,Commercial,937.55,85,,percent of total billed charges,,
"Mri Orbit, Face, And/Or Neck; W/O Contrast, Followed By Contrast  And Further Sequences (Pro Cah)Professional Component ",,70543,CPT,Professional,Both,,,26,1103,937.55,64.79,1103,Aetna,Medicare Advantage,103.47,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Mri Orbit, Face, And/Or Neck; W/O Contrast, Followed By Contrast  And Further Sequences (Pro Cah)Professional Component ",,70543,CPT,Professional,Both,,,26,1103,937.55,64.79,1103,Aetna,PPO,1025.79,93,,percent of total billed charges,,
"Mri Orbit, Face, And/Or Neck; W/O Contrast, Followed By Contrast  And Further Sequences (Pro Cah)Professional Component ",,70543,CPT,Professional,Both,,,26,1103,937.55,64.79,1103,America's PPO,America's PPO,942.4032,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Mri Orbit, Face, And/Or Neck; W/O Contrast, Followed By Contrast  And Further Sequences (Pro Cah)Professional Component ",,70543,CPT,Professional,Both,,,26,1103,937.55,64.79,1103,BlueCross BlueShield Minnesota, Federal Employee Program,193.68,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Mri Orbit, Face, And/Or Neck; W/O Contrast, Followed By Contrast  And Further Sequences (Pro Cah)Professional Component ",,70543,CPT,Professional,Both,,,26,1103,937.55,64.79,1103,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,196.77888,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Mri Orbit, Face, And/Or Neck; W/O Contrast, Followed By Contrast  And Further Sequences (Pro Cah)Professional Component ",,70543,CPT,Professional,Both,,,26,1103,937.55,64.79,1103,BlueCross BlueShield Minnesota,High Value Network Plan,196.77888,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Mri Orbit, Face, And/Or Neck; W/O Contrast, Followed By Contrast  And Further Sequences (Pro Cah)Professional Component ",,70543,CPT,Professional,Both,,,26,1103,937.55,64.79,1103,BlueCross BlueShield Minnesota,Medicare Advantage,115.759,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Mri Orbit, Face, And/Or Neck; W/O Contrast, Followed By Contrast  And Further Sequences (Pro Cah)Professional Component ",,70543,CPT,Professional,Both,,,26,1103,937.55,64.79,1103,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,196.77888,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Mri Orbit, Face, And/Or Neck; W/O Contrast, Followed By Contrast  And Further Sequences (Pro Cah)Professional Component ",,70543,CPT,Professional,Both,,,26,1103,937.55,64.79,1103,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,74.79792,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Mri Orbit, Face, And/Or Neck; W/O Contrast, Followed By Contrast  And Further Sequences (Pro Cah)Professional Component ",,70543,CPT,Professional,Both,,,26,1103,937.55,64.79,1103,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),115.759,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Mri Orbit, Face, And/Or Neck; W/O Contrast, Followed By Contrast  And Further Sequences (Pro Cah)Professional Component ",,70543,CPT,Professional,Both,,,26,1103,937.55,64.79,1103,CorVel,Worker's Compensation,198.4994406,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Mri Orbit, Face, And/Or Neck; W/O Contrast, Followed By Contrast  And Further Sequences (Pro Cah)Professional Component ",,70543,CPT,Professional,Both,,,26,1103,937.55,64.79,1103,First Health Group Corporation,First Health Network,1069.91,97,,percent of total billed charges,,
"Mri Orbit, Face, And/Or Neck; W/O Contrast, Followed By Contrast  And Further Sequences (Pro Cah)Professional Component ",,70543,CPT,Professional,Both,,,26,1103,937.55,64.79,1103,"Health Partners, Inc.",Commercial,152.62,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Mri Orbit, Face, And/Or Neck; W/O Contrast, Followed By Contrast  And Further Sequences (Pro Cah)Professional Component ",,70543,CPT,Professional,Both,,,26,1103,937.55,64.79,1103,"Health Partners, Inc.",Medicare Advantage,115.759,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Mri Orbit, Face, And/Or Neck; W/O Contrast, Followed By Contrast  And Further Sequences (Pro Cah)Professional Component ",,70543,CPT,Professional,Both,,,26,1103,937.55,64.79,1103,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),64.79,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Mri Orbit, Face, And/Or Neck; W/O Contrast, Followed By Contrast  And Further Sequences (Pro Cah)Professional Component ",,70543,CPT,Professional,Both,,,26,1103,937.55,64.79,1103,"Health Partners, Inc.",State of Minnesota Advantage Program,131.48213,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Mri Orbit, Face, And/Or Neck; W/O Contrast, Followed By Contrast  And Further Sequences (Pro Cah)Professional Component ",,70543,CPT,Professional,Both,,,26,1103,937.55,64.79,1103,"Health Partners, Inc.",State Public Programs,64.79,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Mri Orbit, Face, And/Or Neck; W/O Contrast, Followed By Contrast  And Further Sequences (Pro Cah)Professional Component ",,70543,CPT,Professional,Both,,,26,1103,937.55,64.79,1103,Humana Insurance Company,Commercial PPO,100.66,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Mri Orbit, Face, And/Or Neck; W/O Contrast, Followed By Contrast  And Further Sequences (Pro Cah)Professional Component ",,70543,CPT,Professional,Both,,,26,1103,937.55,64.79,1103,Humana Insurance Company,Medicare PPO,1103,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Mri Orbit, Face, And/Or Neck; W/O Contrast, Followed By Contrast  And Further Sequences (Pro Cah)Professional Component ",,70543,CPT,Professional,Both,,,26,1103,937.55,64.79,1103,Medica,Individual & Family,935.344,84.8,,percent of total billed charges,,
"Mri Orbit, Face, And/Or Neck; W/O Contrast, Followed By Contrast  And Further Sequences (Pro Cah)Professional Component ",,70543,CPT,Professional,Both,,,26,1103,937.55,64.79,1103,Medica,Medica Advantage Solution,549.294,49.8,,percent of total billed charges,,
"Mri Orbit, Face, And/Or Neck; W/O Contrast, Followed By Contrast  And Further Sequences (Pro Cah)Professional Component ",,70543,CPT,Professional,Both,,,26,1103,937.55,64.79,1103,Medica,Medical Assistance,74.8,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Mri Orbit, Face, And/Or Neck; W/O Contrast, Followed By Contrast  And Further Sequences (Pro Cah)Professional Component ",,70543,CPT,Professional,Both,,,26,1103,937.55,64.79,1103,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,100.66,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Mri Orbit, Face, And/Or Neck; W/O Contrast, Followed By Contrast  And Further Sequences (Pro Cah)Professional Component ",,70543,CPT,Professional,Both,,,26,1103,937.55,64.79,1103,"Multiplan, Inc.","Multiplan, Inc.",1036.82,94,,percent of total billed charges,,
"Mri Orbit, Face, And/Or Neck; W/O Contrast, Followed By Contrast  And Further Sequences (Pro Cah)Professional Component ",,70543,CPT,Professional,Both,,,26,1103,937.55,64.79,1103,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,993.803,90.1,,percent of total billed charges,,
"Mri Orbit, Face, And/Or Neck; W/O Contrast, Followed By Contrast  And Further Sequences (Pro Cah)Professional Component ",,70543,CPT,Professional,Both,,,26,1103,937.55,64.79,1103,"Preferred One Administrative Services, INC.",PPO,1087.558,98.6,,percent of total billed charges,,
"Mri Orbit, Face, And/Or Neck; W/O Contrast, Followed By Contrast  And Further Sequences (Pro Cah)Professional Component ",,70543,CPT,Professional,Both,,,26,1103,937.55,64.79,1103,PrimeWest Health,Minnesota Senior Health Options (MSHO),115.759,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Mri Orbit, Face, And/Or Neck; W/O Contrast, Followed By Contrast  And Further Sequences (Pro Cah)Professional Component ",,70543,CPT,Professional,Both,,,26,1103,937.55,64.79,1103,PrimeWest Health,MinnesotaCare,80.0337744,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Mri Orbit, Face, And/Or Neck; W/O Contrast, Followed By Contrast  And Further Sequences (Pro Cah)Professional Component ",,70543,CPT,Professional,Both,,,26,1103,937.55,64.79,1103,Sanford Health Plan,Sanford Health Plan,970.64,88,,percent of total billed charges,,
"Mri Orbit, Face, And/Or Neck; W/O Contrast, Followed By Contrast  And Further Sequences (Pro Cah)Professional Component ",,70543,CPT,Professional,Both,,,26,1103,937.55,64.79,1103,"UCare Health, Inc.",Individual & Family Plan,163.632896,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Mri Orbit, Face, And/Or Neck; W/O Contrast, Followed By Contrast  And Further Sequences (Pro Cah)Professional Component ",,70543,CPT,Professional,Both,,,26,1103,937.55,64.79,1103,"UCare Health, Inc.",Medical Assistance,82.277712,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Mri Orbit, Face, And/Or Neck; W/O Contrast, Followed By Contrast  And Further Sequences (Pro Cah)Professional Component ",,70543,CPT,Professional,Both,,,26,1103,937.55,64.79,1103,"UCare Health, Inc.",Medicare Advantage,115.759,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Mri Orbit, Face, And/Or Neck; W/O Contrast, Followed By Contrast  And Further Sequences (Pro Cah)Professional Component ",,70543,CPT,Professional,Both,,,26,1103,937.55,64.79,1103,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),92.6072,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Mri Orbit, Face, And/Or Neck; W/O Contrast, Followed By Contrast  And Further Sequences (Pro Cah)Professional Component ",,70543,CPT,Professional,Both,,,26,1103,937.55,64.79,1103,UnitedHealthcare,Individual & Family,1103,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Mri Orbit, Face, And/Or Neck; W/O Contrast, Followed By Contrast  And Further Sequences (Pro Cah)Professional Component ",,70543,CPT,Professional,Both,,,26,1103,937.55,64.79,1103,UnitedHealthcare,Medicare Advantage,115.759,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Mri Orbit, Face, And/Or Neck; W/O Contrast, Followed By Contrast  And Further Sequences (Pro Cah)Professional Component ",,70543,CPT,Professional,Both,,,26,1103,937.55,64.79,1103,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,74.79792,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Mra Head W/O Contrast (Pro Cah)Professional Component ,,70544,CPT,Professional,Both,,,26,560,476,36.21,560,Aetna,Commercial,476,85,,percent of total billed charges,,
Mra Head W/O Contrast (Pro Cah)Professional Component ,,70544,CPT,Professional,Both,,,26,560,476,36.21,560,Aetna,Medicare Advantage,57.69,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Mra Head W/O Contrast (Pro Cah)Professional Component ,,70544,CPT,Professional,Both,,,26,560,476,36.21,560,Aetna,PPO,520.8,93,,percent of total billed charges,,
Mra Head W/O Contrast (Pro Cah)Professional Component ,,70544,CPT,Professional,Both,,,26,560,476,36.21,560,America's PPO,America's PPO,478.464,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Mra Head W/O Contrast (Pro Cah)Professional Component ,,70544,CPT,Professional,Both,,,26,560,476,36.21,560,BlueCross BlueShield Minnesota, Federal Employee Program,108.66,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Mra Head W/O Contrast (Pro Cah)Professional Component ,,70544,CPT,Professional,Both,,,26,560,476,36.21,560,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,110.39856,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Mra Head W/O Contrast (Pro Cah)Professional Component ,,70544,CPT,Professional,Both,,,26,560,476,36.21,560,BlueCross BlueShield Minnesota,High Value Network Plan,110.39856,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Mra Head W/O Contrast (Pro Cah)Professional Component ,,70544,CPT,Professional,Both,,,26,560,476,36.21,560,BlueCross BlueShield Minnesota,Medicare Advantage,64.998,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Mra Head W/O Contrast (Pro Cah)Professional Component ,,70544,CPT,Professional,Both,,,26,560,476,36.21,560,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,110.39856,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Mra Head W/O Contrast (Pro Cah)Professional Component ,,70544,CPT,Professional,Both,,,26,560,476,36.21,560,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,41.8084,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Mra Head W/O Contrast (Pro Cah)Professional Component ,,70544,CPT,Professional,Both,,,26,560,476,36.21,560,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),64.998,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Mra Head W/O Contrast (Pro Cah)Professional Component ,,70544,CPT,Professional,Both,,,26,560,476,36.21,560,CorVel,Worker's Compensation,111.522351,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Mra Head W/O Contrast (Pro Cah)Professional Component ,,70544,CPT,Professional,Both,,,26,560,476,36.21,560,First Health Group Corporation,First Health Network,543.2,97,,percent of total billed charges,,
Mra Head W/O Contrast (Pro Cah)Professional Component ,,70544,CPT,Professional,Both,,,26,560,476,36.21,560,"Health Partners, Inc.",Commercial,85.6,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Mra Head W/O Contrast (Pro Cah)Professional Component ,,70544,CPT,Professional,Both,,,26,560,476,36.21,560,"Health Partners, Inc.",Medicare Advantage,64.998,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Mra Head W/O Contrast (Pro Cah)Professional Component ,,70544,CPT,Professional,Both,,,26,560,476,36.21,560,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),36.21,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Mra Head W/O Contrast (Pro Cah)Professional Component ,,70544,CPT,Professional,Both,,,26,560,476,36.21,560,"Health Partners, Inc.",State of Minnesota Advantage Program,73.7444,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Mra Head W/O Contrast (Pro Cah)Professional Component ,,70544,CPT,Professional,Both,,,26,560,476,36.21,560,"Health Partners, Inc.",State Public Programs,36.21,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Mra Head W/O Contrast (Pro Cah)Professional Component ,,70544,CPT,Professional,Both,,,26,560,476,36.21,560,Humana Insurance Company,Commercial PPO,56.52,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Mra Head W/O Contrast (Pro Cah)Professional Component ,,70544,CPT,Professional,Both,,,26,560,476,36.21,560,Humana Insurance Company,Medicare PPO,560,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Mra Head W/O Contrast (Pro Cah)Professional Component ,,70544,CPT,Professional,Both,,,26,560,476,36.21,560,Medica,Individual & Family,474.88,84.8,,percent of total billed charges,,
Mra Head W/O Contrast (Pro Cah)Professional Component ,,70544,CPT,Professional,Both,,,26,560,476,36.21,560,Medica,Medica Advantage Solution,278.88,49.8,,percent of total billed charges,,
Mra Head W/O Contrast (Pro Cah)Professional Component ,,70544,CPT,Professional,Both,,,26,560,476,36.21,560,Medica,Medical Assistance,41.81,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Mra Head W/O Contrast (Pro Cah)Professional Component ,,70544,CPT,Professional,Both,,,26,560,476,36.21,560,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,56.52,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Mra Head W/O Contrast (Pro Cah)Professional Component ,,70544,CPT,Professional,Both,,,26,560,476,36.21,560,"Multiplan, Inc.","Multiplan, Inc.",526.4,94,,percent of total billed charges,,
Mra Head W/O Contrast (Pro Cah)Professional Component ,,70544,CPT,Professional,Both,,,26,560,476,36.21,560,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,504.56,90.1,,percent of total billed charges,,
Mra Head W/O Contrast (Pro Cah)Professional Component ,,70544,CPT,Professional,Both,,,26,560,476,36.21,560,"Preferred One Administrative Services, INC.",PPO,552.16,98.6,,percent of total billed charges,,
Mra Head W/O Contrast (Pro Cah)Professional Component ,,70544,CPT,Professional,Both,,,26,560,476,36.21,560,PrimeWest Health,Minnesota Senior Health Options (MSHO),64.998,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Mra Head W/O Contrast (Pro Cah)Professional Component ,,70544,CPT,Professional,Both,,,26,560,476,36.21,560,PrimeWest Health,MinnesotaCare,44.734988,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Mra Head W/O Contrast (Pro Cah)Professional Component ,,70544,CPT,Professional,Both,,,26,560,476,36.21,560,Sanford Health Plan,Sanford Health Plan,492.8,88,,percent of total billed charges,,
Mra Head W/O Contrast (Pro Cah)Professional Component ,,70544,CPT,Professional,Both,,,26,560,476,36.21,560,"UCare Health, Inc.",Individual & Family Plan,91.878912,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Mra Head W/O Contrast (Pro Cah)Professional Component ,,70544,CPT,Professional,Both,,,26,560,476,36.21,560,"UCare Health, Inc.",Medical Assistance,45.98924,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Mra Head W/O Contrast (Pro Cah)Professional Component ,,70544,CPT,Professional,Both,,,26,560,476,36.21,560,"UCare Health, Inc.",Medicare Advantage,64.998,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Mra Head W/O Contrast (Pro Cah)Professional Component ,,70544,CPT,Professional,Both,,,26,560,476,36.21,560,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),51.9984,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Mra Head W/O Contrast (Pro Cah)Professional Component ,,70544,CPT,Professional,Both,,,26,560,476,36.21,560,UnitedHealthcare,Individual & Family,560,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Mra Head W/O Contrast (Pro Cah)Professional Component ,,70544,CPT,Professional,Both,,,26,560,476,36.21,560,UnitedHealthcare,Medicare Advantage,64.998,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Mra Head W/O Contrast (Pro Cah)Professional Component ,,70544,CPT,Professional,Both,,,26,560,476,36.21,560,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,41.8084,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Mra Head W/Contrast (Pro Cah)Professional Component ,,70545,CPT,Professional,Both,,,26,608,516.8,35.99,608,Aetna,Commercial,516.8,85,,percent of total billed charges,,
Mra Head W/Contrast (Pro Cah)Professional Component ,,70545,CPT,Professional,Both,,,26,608,516.8,35.99,608,Aetna,Medicare Advantage,57.69,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Mra Head W/Contrast (Pro Cah)Professional Component ,,70545,CPT,Professional,Both,,,26,608,516.8,35.99,608,Aetna,PPO,565.44,93,,percent of total billed charges,,
Mra Head W/Contrast (Pro Cah)Professional Component ,,70545,CPT,Professional,Both,,,26,608,516.8,35.99,608,America's PPO,America's PPO,519.4752,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Mra Head W/Contrast (Pro Cah)Professional Component ,,70545,CPT,Professional,Both,,,26,608,516.8,35.99,608,BlueCross BlueShield Minnesota, Federal Employee Program,108.02,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Mra Head W/Contrast (Pro Cah)Professional Component ,,70545,CPT,Professional,Both,,,26,608,516.8,35.99,608,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,109.74832,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Mra Head W/Contrast (Pro Cah)Professional Component ,,70545,CPT,Professional,Both,,,26,608,516.8,35.99,608,BlueCross BlueShield Minnesota,High Value Network Plan,109.74832,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Mra Head W/Contrast (Pro Cah)Professional Component ,,70545,CPT,Professional,Both,,,26,608,516.8,35.99,608,BlueCross BlueShield Minnesota,Medicare Advantage,64.607,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Mra Head W/Contrast (Pro Cah)Professional Component ,,70545,CPT,Professional,Both,,,26,608,516.8,35.99,608,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,109.74832,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Mra Head W/Contrast (Pro Cah)Professional Component ,,70545,CPT,Professional,Both,,,26,608,516.8,35.99,608,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,41.5544,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Mra Head W/Contrast (Pro Cah)Professional Component ,,70545,CPT,Professional,Both,,,26,608,516.8,35.99,608,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),64.607,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Mra Head W/Contrast (Pro Cah)Professional Component ,,70545,CPT,Professional,Both,,,26,608,516.8,35.99,608,CorVel,Worker's Compensation,110.8419189,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Mra Head W/Contrast (Pro Cah)Professional Component ,,70545,CPT,Professional,Both,,,26,608,516.8,35.99,608,First Health Group Corporation,First Health Network,589.76,97,,percent of total billed charges,,
Mra Head W/Contrast (Pro Cah)Professional Component ,,70545,CPT,Professional,Both,,,26,608,516.8,35.99,608,"Health Partners, Inc.",Commercial,85.08,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Mra Head W/Contrast (Pro Cah)Professional Component ,,70545,CPT,Professional,Both,,,26,608,516.8,35.99,608,"Health Partners, Inc.",Medicare Advantage,64.607,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Mra Head W/Contrast (Pro Cah)Professional Component ,,70545,CPT,Professional,Both,,,26,608,516.8,35.99,608,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),35.99,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Mra Head W/Contrast (Pro Cah)Professional Component ,,70545,CPT,Professional,Both,,,26,608,516.8,35.99,608,"Health Partners, Inc.",State of Minnesota Advantage Program,73.29642,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Mra Head W/Contrast (Pro Cah)Professional Component ,,70545,CPT,Professional,Both,,,26,608,516.8,35.99,608,"Health Partners, Inc.",State Public Programs,35.99,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Mra Head W/Contrast (Pro Cah)Professional Component ,,70545,CPT,Professional,Both,,,26,608,516.8,35.99,608,Humana Insurance Company,Commercial PPO,56.18,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Mra Head W/Contrast (Pro Cah)Professional Component ,,70545,CPT,Professional,Both,,,26,608,516.8,35.99,608,Humana Insurance Company,Medicare PPO,608,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Mra Head W/Contrast (Pro Cah)Professional Component ,,70545,CPT,Professional,Both,,,26,608,516.8,35.99,608,Medica,Individual & Family,515.584,84.8,,percent of total billed charges,,
Mra Head W/Contrast (Pro Cah)Professional Component ,,70545,CPT,Professional,Both,,,26,608,516.8,35.99,608,Medica,Medica Advantage Solution,302.784,49.8,,percent of total billed charges,,
Mra Head W/Contrast (Pro Cah)Professional Component ,,70545,CPT,Professional,Both,,,26,608,516.8,35.99,608,Medica,Medical Assistance,41.55,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Mra Head W/Contrast (Pro Cah)Professional Component ,,70545,CPT,Professional,Both,,,26,608,516.8,35.99,608,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,56.18,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Mra Head W/Contrast (Pro Cah)Professional Component ,,70545,CPT,Professional,Both,,,26,608,516.8,35.99,608,"Multiplan, Inc.","Multiplan, Inc.",571.52,94,,percent of total billed charges,,
Mra Head W/Contrast (Pro Cah)Professional Component ,,70545,CPT,Professional,Both,,,26,608,516.8,35.99,608,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,547.808,90.1,,percent of total billed charges,,
Mra Head W/Contrast (Pro Cah)Professional Component ,,70545,CPT,Professional,Both,,,26,608,516.8,35.99,608,"Preferred One Administrative Services, INC.",PPO,599.488,98.6,,percent of total billed charges,,
Mra Head W/Contrast (Pro Cah)Professional Component ,,70545,CPT,Professional,Both,,,26,608,516.8,35.99,608,PrimeWest Health,Minnesota Senior Health Options (MSHO),64.607,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Mra Head W/Contrast (Pro Cah)Professional Component ,,70545,CPT,Professional,Both,,,26,608,516.8,35.99,608,PrimeWest Health,MinnesotaCare,44.463208,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Mra Head W/Contrast (Pro Cah)Professional Component ,,70545,CPT,Professional,Both,,,26,608,516.8,35.99,608,Sanford Health Plan,Sanford Health Plan,535.04,88,,percent of total billed charges,,
Mra Head W/Contrast (Pro Cah)Professional Component ,,70545,CPT,Professional,Both,,,26,608,516.8,35.99,608,"UCare Health, Inc.",Individual & Family Plan,91.326208,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Mra Head W/Contrast (Pro Cah)Professional Component ,,70545,CPT,Professional,Both,,,26,608,516.8,35.99,608,"UCare Health, Inc.",Medical Assistance,45.70984,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Mra Head W/Contrast (Pro Cah)Professional Component ,,70545,CPT,Professional,Both,,,26,608,516.8,35.99,608,"UCare Health, Inc.",Medicare Advantage,64.607,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Mra Head W/Contrast (Pro Cah)Professional Component ,,70545,CPT,Professional,Both,,,26,608,516.8,35.99,608,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),51.6856,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Mra Head W/Contrast (Pro Cah)Professional Component ,,70545,CPT,Professional,Both,,,26,608,516.8,35.99,608,UnitedHealthcare,Individual & Family,608,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Mra Head W/Contrast (Pro Cah)Professional Component ,,70545,CPT,Professional,Both,,,26,608,516.8,35.99,608,UnitedHealthcare,Medicare Advantage,64.607,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Mra Head W/Contrast (Pro Cah)Professional Component ,,70545,CPT,Professional,Both,,,26,608,516.8,35.99,608,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,41.5544,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Mra Head W/O And W/Contrast (Pro Cah)Professional Component ,,70546,CPT,Professional,Both,,,26,823,699.55,44.5,823,Aetna,Commercial,699.55,85,,percent of total billed charges,,
Mra Head W/O And W/Contrast (Pro Cah)Professional Component ,,70546,CPT,Professional,Both,,,26,823,699.55,44.5,823,Aetna,Medicare Advantage,71.11,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Mra Head W/O And W/Contrast (Pro Cah)Professional Component ,,70546,CPT,Professional,Both,,,26,823,699.55,44.5,823,Aetna,PPO,765.39,93,,percent of total billed charges,,
Mra Head W/O And W/Contrast (Pro Cah)Professional Component ,,70546,CPT,Professional,Both,,,26,823,699.55,44.5,823,America's PPO,America's PPO,703.1712,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Mra Head W/O And W/Contrast (Pro Cah)Professional Component ,,70546,CPT,Professional,Both,,,26,823,699.55,44.5,823,BlueCross BlueShield Minnesota, Federal Employee Program,133.59,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Mra Head W/O And W/Contrast (Pro Cah)Professional Component ,,70546,CPT,Professional,Both,,,26,823,699.55,44.5,823,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,135.72744,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Mra Head W/O And W/Contrast (Pro Cah)Professional Component ,,70546,CPT,Professional,Both,,,26,823,699.55,44.5,823,BlueCross BlueShield Minnesota,High Value Network Plan,135.72744,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Mra Head W/O And W/Contrast (Pro Cah)Professional Component ,,70546,CPT,Professional,Both,,,26,823,699.55,44.5,823,BlueCross BlueShield Minnesota,Medicare Advantage,79.741,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Mra Head W/O And W/Contrast (Pro Cah)Professional Component ,,70546,CPT,Professional,Both,,,26,823,699.55,44.5,823,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,135.72744,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Mra Head W/O And W/Contrast (Pro Cah)Professional Component ,,70546,CPT,Professional,Both,,,26,823,699.55,44.5,823,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,51.37912,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Mra Head W/O And W/Contrast (Pro Cah)Professional Component ,,70546,CPT,Professional,Both,,,26,823,699.55,44.5,823,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),79.741,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Mra Head W/O And W/Contrast (Pro Cah)Professional Component ,,70546,CPT,Professional,Both,,,26,823,699.55,44.5,823,CorVel,Worker's Compensation,137.3713821,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Mra Head W/O And W/Contrast (Pro Cah)Professional Component ,,70546,CPT,Professional,Both,,,26,823,699.55,44.5,823,First Health Group Corporation,First Health Network,798.31,97,,percent of total billed charges,,
Mra Head W/O And W/Contrast (Pro Cah)Professional Component ,,70546,CPT,Professional,Both,,,26,823,699.55,44.5,823,"Health Partners, Inc.",Commercial,105.7,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Mra Head W/O And W/Contrast (Pro Cah)Professional Component ,,70546,CPT,Professional,Both,,,26,823,699.55,44.5,823,"Health Partners, Inc.",Medicare Advantage,79.741,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Mra Head W/O And W/Contrast (Pro Cah)Professional Component ,,70546,CPT,Professional,Both,,,26,823,699.55,44.5,823,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),44.5,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Mra Head W/O And W/Contrast (Pro Cah)Professional Component ,,70546,CPT,Professional,Both,,,26,823,699.55,44.5,823,"Health Partners, Inc.",State of Minnesota Advantage Program,91.06055,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Mra Head W/O And W/Contrast (Pro Cah)Professional Component ,,70546,CPT,Professional,Both,,,26,823,699.55,44.5,823,"Health Partners, Inc.",State Public Programs,44.5,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Mra Head W/O And W/Contrast (Pro Cah)Professional Component ,,70546,CPT,Professional,Both,,,26,823,699.55,44.5,823,Humana Insurance Company,Commercial PPO,69.34,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Mra Head W/O And W/Contrast (Pro Cah)Professional Component ,,70546,CPT,Professional,Both,,,26,823,699.55,44.5,823,Humana Insurance Company,Medicare PPO,823,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Mra Head W/O And W/Contrast (Pro Cah)Professional Component ,,70546,CPT,Professional,Both,,,26,823,699.55,44.5,823,Medica,Individual & Family,697.904,84.8,,percent of total billed charges,,
Mra Head W/O And W/Contrast (Pro Cah)Professional Component ,,70546,CPT,Professional,Both,,,26,823,699.55,44.5,823,Medica,Medica Advantage Solution,409.854,49.8,,percent of total billed charges,,
Mra Head W/O And W/Contrast (Pro Cah)Professional Component ,,70546,CPT,Professional,Both,,,26,823,699.55,44.5,823,Medica,Medical Assistance,51.38,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Mra Head W/O And W/Contrast (Pro Cah)Professional Component ,,70546,CPT,Professional,Both,,,26,823,699.55,44.5,823,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,69.34,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Mra Head W/O And W/Contrast (Pro Cah)Professional Component ,,70546,CPT,Professional,Both,,,26,823,699.55,44.5,823,"Multiplan, Inc.","Multiplan, Inc.",773.62,94,,percent of total billed charges,,
Mra Head W/O And W/Contrast (Pro Cah)Professional Component ,,70546,CPT,Professional,Both,,,26,823,699.55,44.5,823,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,741.523,90.1,,percent of total billed charges,,
Mra Head W/O And W/Contrast (Pro Cah)Professional Component ,,70546,CPT,Professional,Both,,,26,823,699.55,44.5,823,"Preferred One Administrative Services, INC.",PPO,811.478,98.6,,percent of total billed charges,,
Mra Head W/O And W/Contrast (Pro Cah)Professional Component ,,70546,CPT,Professional,Both,,,26,823,699.55,44.5,823,PrimeWest Health,Minnesota Senior Health Options (MSHO),79.741,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Mra Head W/O And W/Contrast (Pro Cah)Professional Component ,,70546,CPT,Professional,Both,,,26,823,699.55,44.5,823,PrimeWest Health,MinnesotaCare,54.9756584,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Mra Head W/O And W/Contrast (Pro Cah)Professional Component ,,70546,CPT,Professional,Both,,,26,823,699.55,44.5,823,Sanford Health Plan,Sanford Health Plan,724.24,88,,percent of total billed charges,,
Mra Head W/O And W/Contrast (Pro Cah)Professional Component ,,70546,CPT,Professional,Both,,,26,823,699.55,44.5,823,"UCare Health, Inc.",Individual & Family Plan,112.719104,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Mra Head W/O And W/Contrast (Pro Cah)Professional Component ,,70546,CPT,Professional,Both,,,26,823,699.55,44.5,823,"UCare Health, Inc.",Medical Assistance,56.517032,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Mra Head W/O And W/Contrast (Pro Cah)Professional Component ,,70546,CPT,Professional,Both,,,26,823,699.55,44.5,823,"UCare Health, Inc.",Medicare Advantage,79.741,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Mra Head W/O And W/Contrast (Pro Cah)Professional Component ,,70546,CPT,Professional,Both,,,26,823,699.55,44.5,823,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),63.7928,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Mra Head W/O And W/Contrast (Pro Cah)Professional Component ,,70546,CPT,Professional,Both,,,26,823,699.55,44.5,823,UnitedHealthcare,Individual & Family,823,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Mra Head W/O And W/Contrast (Pro Cah)Professional Component ,,70546,CPT,Professional,Both,,,26,823,699.55,44.5,823,UnitedHealthcare,Medicare Advantage,79.741,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Mra Head W/O And W/Contrast (Pro Cah)Professional Component ,,70546,CPT,Professional,Both,,,26,823,699.55,44.5,823,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,51.37912,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Mra Neck W/O Contrast (Pro Cah)Professional Component ,,70547,CPT,Professional,Both,,,26,527,447.95,36.21,527,Aetna,Commercial,447.95,85,,percent of total billed charges,,
Mra Neck W/O Contrast (Pro Cah)Professional Component ,,70547,CPT,Professional,Both,,,26,527,447.95,36.21,527,Aetna,Medicare Advantage,58.04,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Mra Neck W/O Contrast (Pro Cah)Professional Component ,,70547,CPT,Professional,Both,,,26,527,447.95,36.21,527,Aetna,PPO,490.11,93,,percent of total billed charges,,
Mra Neck W/O Contrast (Pro Cah)Professional Component ,,70547,CPT,Professional,Both,,,26,527,447.95,36.21,527,America's PPO,America's PPO,450.2688,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Mra Neck W/O Contrast (Pro Cah)Professional Component ,,70547,CPT,Professional,Both,,,26,527,447.95,36.21,527,BlueCross BlueShield Minnesota, Federal Employee Program,108.66,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Mra Neck W/O Contrast (Pro Cah)Professional Component ,,70547,CPT,Professional,Both,,,26,527,447.95,36.21,527,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,110.39856,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Mra Neck W/O Contrast (Pro Cah)Professional Component ,,70547,CPT,Professional,Both,,,26,527,447.95,36.21,527,BlueCross BlueShield Minnesota,High Value Network Plan,110.39856,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Mra Neck W/O Contrast (Pro Cah)Professional Component ,,70547,CPT,Professional,Both,,,26,527,447.95,36.21,527,BlueCross BlueShield Minnesota,Medicare Advantage,64.998,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Mra Neck W/O Contrast (Pro Cah)Professional Component ,,70547,CPT,Professional,Both,,,26,527,447.95,36.21,527,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,110.39856,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Mra Neck W/O Contrast (Pro Cah)Professional Component ,,70547,CPT,Professional,Both,,,26,527,447.95,36.21,527,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,41.8084,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Mra Neck W/O Contrast (Pro Cah)Professional Component ,,70547,CPT,Professional,Both,,,26,527,447.95,36.21,527,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),64.998,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Mra Neck W/O Contrast (Pro Cah)Professional Component ,,70547,CPT,Professional,Both,,,26,527,447.95,36.21,527,CorVel,Worker's Compensation,111.522351,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Mra Neck W/O Contrast (Pro Cah)Professional Component ,,70547,CPT,Professional,Both,,,26,527,447.95,36.21,527,First Health Group Corporation,First Health Network,511.19,97,,percent of total billed charges,,
Mra Neck W/O Contrast (Pro Cah)Professional Component ,,70547,CPT,Professional,Both,,,26,527,447.95,36.21,527,"Health Partners, Inc.",Commercial,85.6,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Mra Neck W/O Contrast (Pro Cah)Professional Component ,,70547,CPT,Professional,Both,,,26,527,447.95,36.21,527,"Health Partners, Inc.",Medicare Advantage,64.998,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Mra Neck W/O Contrast (Pro Cah)Professional Component ,,70547,CPT,Professional,Both,,,26,527,447.95,36.21,527,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),36.21,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Mra Neck W/O Contrast (Pro Cah)Professional Component ,,70547,CPT,Professional,Both,,,26,527,447.95,36.21,527,"Health Partners, Inc.",State of Minnesota Advantage Program,73.7444,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Mra Neck W/O Contrast (Pro Cah)Professional Component ,,70547,CPT,Professional,Both,,,26,527,447.95,36.21,527,"Health Partners, Inc.",State Public Programs,36.21,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Mra Neck W/O Contrast (Pro Cah)Professional Component ,,70547,CPT,Professional,Both,,,26,527,447.95,36.21,527,Humana Insurance Company,Commercial PPO,56.52,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Mra Neck W/O Contrast (Pro Cah)Professional Component ,,70547,CPT,Professional,Both,,,26,527,447.95,36.21,527,Humana Insurance Company,Medicare PPO,527,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Mra Neck W/O Contrast (Pro Cah)Professional Component ,,70547,CPT,Professional,Both,,,26,527,447.95,36.21,527,Medica,Individual & Family,446.896,84.8,,percent of total billed charges,,
Mra Neck W/O Contrast (Pro Cah)Professional Component ,,70547,CPT,Professional,Both,,,26,527,447.95,36.21,527,Medica,Medica Advantage Solution,262.446,49.8,,percent of total billed charges,,
Mra Neck W/O Contrast (Pro Cah)Professional Component ,,70547,CPT,Professional,Both,,,26,527,447.95,36.21,527,Medica,Medical Assistance,41.81,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Mra Neck W/O Contrast (Pro Cah)Professional Component ,,70547,CPT,Professional,Both,,,26,527,447.95,36.21,527,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,56.52,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Mra Neck W/O Contrast (Pro Cah)Professional Component ,,70547,CPT,Professional,Both,,,26,527,447.95,36.21,527,"Multiplan, Inc.","Multiplan, Inc.",495.38,94,,percent of total billed charges,,
Mra Neck W/O Contrast (Pro Cah)Professional Component ,,70547,CPT,Professional,Both,,,26,527,447.95,36.21,527,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,474.827,90.1,,percent of total billed charges,,
Mra Neck W/O Contrast (Pro Cah)Professional Component ,,70547,CPT,Professional,Both,,,26,527,447.95,36.21,527,"Preferred One Administrative Services, INC.",PPO,519.622,98.6,,percent of total billed charges,,
Mra Neck W/O Contrast (Pro Cah)Professional Component ,,70547,CPT,Professional,Both,,,26,527,447.95,36.21,527,PrimeWest Health,Minnesota Senior Health Options (MSHO),64.998,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Mra Neck W/O Contrast (Pro Cah)Professional Component ,,70547,CPT,Professional,Both,,,26,527,447.95,36.21,527,PrimeWest Health,MinnesotaCare,44.734988,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Mra Neck W/O Contrast (Pro Cah)Professional Component ,,70547,CPT,Professional,Both,,,26,527,447.95,36.21,527,Sanford Health Plan,Sanford Health Plan,463.76,88,,percent of total billed charges,,
Mra Neck W/O Contrast (Pro Cah)Professional Component ,,70547,CPT,Professional,Both,,,26,527,447.95,36.21,527,"UCare Health, Inc.",Individual & Family Plan,91.878912,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Mra Neck W/O Contrast (Pro Cah)Professional Component ,,70547,CPT,Professional,Both,,,26,527,447.95,36.21,527,"UCare Health, Inc.",Medical Assistance,45.98924,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Mra Neck W/O Contrast (Pro Cah)Professional Component ,,70547,CPT,Professional,Both,,,26,527,447.95,36.21,527,"UCare Health, Inc.",Medicare Advantage,64.998,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Mra Neck W/O Contrast (Pro Cah)Professional Component ,,70547,CPT,Professional,Both,,,26,527,447.95,36.21,527,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),51.9984,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Mra Neck W/O Contrast (Pro Cah)Professional Component ,,70547,CPT,Professional,Both,,,26,527,447.95,36.21,527,UnitedHealthcare,Individual & Family,527,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Mra Neck W/O Contrast (Pro Cah)Professional Component ,,70547,CPT,Professional,Both,,,26,527,447.95,36.21,527,UnitedHealthcare,Medicare Advantage,64.998,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Mra Neck W/O Contrast (Pro Cah)Professional Component ,,70547,CPT,Professional,Both,,,26,527,447.95,36.21,527,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,41.8084,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Mra Neck W/Contrast (Pro Cah)Professional Component ,,70548,CPT,Professional,Both,,,26,668,567.8,45.15,668,Aetna,Commercial,567.8,85,,percent of total billed charges,,
Mra Neck W/Contrast (Pro Cah)Professional Component ,,70548,CPT,Professional,Both,,,26,668,567.8,45.15,668,Aetna,Medicare Advantage,72.17,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Mra Neck W/Contrast (Pro Cah)Professional Component ,,70548,CPT,Professional,Both,,,26,668,567.8,45.15,668,Aetna,PPO,621.24,93,,percent of total billed charges,,
Mra Neck W/Contrast (Pro Cah)Professional Component ,,70548,CPT,Professional,Both,,,26,668,567.8,45.15,668,America's PPO,America's PPO,570.7392,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Mra Neck W/Contrast (Pro Cah)Professional Component ,,70548,CPT,Professional,Both,,,26,668,567.8,45.15,668,BlueCross BlueShield Minnesota, Federal Employee Program,135.51,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Mra Neck W/Contrast (Pro Cah)Professional Component ,,70548,CPT,Professional,Both,,,26,668,567.8,45.15,668,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,137.67816,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Mra Neck W/Contrast (Pro Cah)Professional Component ,,70548,CPT,Professional,Both,,,26,668,567.8,45.15,668,BlueCross BlueShield Minnesota,High Value Network Plan,137.67816,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Mra Neck W/Contrast (Pro Cah)Professional Component ,,70548,CPT,Professional,Both,,,26,668,567.8,45.15,668,BlueCross BlueShield Minnesota,Medicare Advantage,80.914,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Mra Neck W/Contrast (Pro Cah)Professional Component ,,70548,CPT,Professional,Both,,,26,668,567.8,45.15,668,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,137.67816,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Mra Neck W/Contrast (Pro Cah)Professional Component ,,70548,CPT,Professional,Both,,,26,668,567.8,45.15,668,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,52.13096,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Mra Neck W/Contrast (Pro Cah)Professional Component ,,70548,CPT,Professional,Both,,,26,668,567.8,45.15,668,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),80.914,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Mra Neck W/Contrast (Pro Cah)Professional Component ,,70548,CPT,Professional,Both,,,26,668,567.8,45.15,668,CorVel,Worker's Compensation,139.3952142,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Mra Neck W/Contrast (Pro Cah)Professional Component ,,70548,CPT,Professional,Both,,,26,668,567.8,45.15,668,First Health Group Corporation,First Health Network,647.96,97,,percent of total billed charges,,
Mra Neck W/Contrast (Pro Cah)Professional Component ,,70548,CPT,Professional,Both,,,26,668,567.8,45.15,668,"Health Partners, Inc.",Commercial,107.25,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Mra Neck W/Contrast (Pro Cah)Professional Component ,,70548,CPT,Professional,Both,,,26,668,567.8,45.15,668,"Health Partners, Inc.",Medicare Advantage,80.914,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Mra Neck W/Contrast (Pro Cah)Professional Component ,,70548,CPT,Professional,Both,,,26,668,567.8,45.15,668,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),45.15,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Mra Neck W/Contrast (Pro Cah)Professional Component ,,70548,CPT,Professional,Both,,,26,668,567.8,45.15,668,"Health Partners, Inc.",State of Minnesota Advantage Program,92.395875,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Mra Neck W/Contrast (Pro Cah)Professional Component ,,70548,CPT,Professional,Both,,,26,668,567.8,45.15,668,"Health Partners, Inc.",State Public Programs,45.15,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Mra Neck W/Contrast (Pro Cah)Professional Component ,,70548,CPT,Professional,Both,,,26,668,567.8,45.15,668,Humana Insurance Company,Commercial PPO,70.36,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Mra Neck W/Contrast (Pro Cah)Professional Component ,,70548,CPT,Professional,Both,,,26,668,567.8,45.15,668,Humana Insurance Company,Medicare PPO,668,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Mra Neck W/Contrast (Pro Cah)Professional Component ,,70548,CPT,Professional,Both,,,26,668,567.8,45.15,668,Medica,Individual & Family,566.464,84.8,,percent of total billed charges,,
Mra Neck W/Contrast (Pro Cah)Professional Component ,,70548,CPT,Professional,Both,,,26,668,567.8,45.15,668,Medica,Medica Advantage Solution,332.664,49.8,,percent of total billed charges,,
Mra Neck W/Contrast (Pro Cah)Professional Component ,,70548,CPT,Professional,Both,,,26,668,567.8,45.15,668,Medica,Medical Assistance,52.13,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Mra Neck W/Contrast (Pro Cah)Professional Component ,,70548,CPT,Professional,Both,,,26,668,567.8,45.15,668,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,70.36,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Mra Neck W/Contrast (Pro Cah)Professional Component ,,70548,CPT,Professional,Both,,,26,668,567.8,45.15,668,"Multiplan, Inc.","Multiplan, Inc.",627.92,94,,percent of total billed charges,,
Mra Neck W/Contrast (Pro Cah)Professional Component ,,70548,CPT,Professional,Both,,,26,668,567.8,45.15,668,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,601.868,90.1,,percent of total billed charges,,
Mra Neck W/Contrast (Pro Cah)Professional Component ,,70548,CPT,Professional,Both,,,26,668,567.8,45.15,668,"Preferred One Administrative Services, INC.",PPO,658.648,98.6,,percent of total billed charges,,
Mra Neck W/Contrast (Pro Cah)Professional Component ,,70548,CPT,Professional,Both,,,26,668,567.8,45.15,668,PrimeWest Health,Minnesota Senior Health Options (MSHO),80.914,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Mra Neck W/Contrast (Pro Cah)Professional Component ,,70548,CPT,Professional,Both,,,26,668,567.8,45.15,668,PrimeWest Health,MinnesotaCare,55.7801272,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Mra Neck W/Contrast (Pro Cah)Professional Component ,,70548,CPT,Professional,Both,,,26,668,567.8,45.15,668,Sanford Health Plan,Sanford Health Plan,587.84,88,,percent of total billed charges,,
Mra Neck W/Contrast (Pro Cah)Professional Component ,,70548,CPT,Professional,Both,,,26,668,567.8,45.15,668,"UCare Health, Inc.",Individual & Family Plan,114.377216,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Mra Neck W/Contrast (Pro Cah)Professional Component ,,70548,CPT,Professional,Both,,,26,668,567.8,45.15,668,"UCare Health, Inc.",Medical Assistance,57.344056,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Mra Neck W/Contrast (Pro Cah)Professional Component ,,70548,CPT,Professional,Both,,,26,668,567.8,45.15,668,"UCare Health, Inc.",Medicare Advantage,80.914,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Mra Neck W/Contrast (Pro Cah)Professional Component ,,70548,CPT,Professional,Both,,,26,668,567.8,45.15,668,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),64.7312,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Mra Neck W/Contrast (Pro Cah)Professional Component ,,70548,CPT,Professional,Both,,,26,668,567.8,45.15,668,UnitedHealthcare,Individual & Family,668,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Mra Neck W/Contrast (Pro Cah)Professional Component ,,70548,CPT,Professional,Both,,,26,668,567.8,45.15,668,UnitedHealthcare,Medicare Advantage,80.914,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Mra Neck W/Contrast (Pro Cah)Professional Component ,,70548,CPT,Professional,Both,,,26,668,567.8,45.15,668,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,52.13096,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Mra Neck W/O And W/Contrast (Pro Cah)Professional Component ,,70549,CPT,Professional,Both,,,26,854,725.9,54.31,854,Aetna,Commercial,725.9,85,,percent of total billed charges,,
Mra Neck W/O And W/Contrast (Pro Cah)Professional Component ,,70549,CPT,Professional,Both,,,26,854,725.9,54.31,854,Aetna,Medicare Advantage,86.89,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Mra Neck W/O And W/Contrast (Pro Cah)Professional Component ,,70549,CPT,Professional,Both,,,26,854,725.9,54.31,854,Aetna,PPO,794.22,93,,percent of total billed charges,,
Mra Neck W/O And W/Contrast (Pro Cah)Professional Component ,,70549,CPT,Professional,Both,,,26,854,725.9,54.31,854,America's PPO,America's PPO,729.6576,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Mra Neck W/O And W/Contrast (Pro Cah)Professional Component ,,70549,CPT,Professional,Both,,,26,854,725.9,54.31,854,BlueCross BlueShield Minnesota, Federal Employee Program,163,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Mra Neck W/O And W/Contrast (Pro Cah)Professional Component ,,70549,CPT,Professional,Both,,,26,854,725.9,54.31,854,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,165.608,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Mra Neck W/O And W/Contrast (Pro Cah)Professional Component ,,70549,CPT,Professional,Both,,,26,854,725.9,54.31,854,BlueCross BlueShield Minnesota,High Value Network Plan,165.608,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Mra Neck W/O And W/Contrast (Pro Cah)Professional Component ,,70549,CPT,Professional,Both,,,26,854,725.9,54.31,854,BlueCross BlueShield Minnesota,Medicare Advantage,97.2325,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Mra Neck W/O And W/Contrast (Pro Cah)Professional Component ,,70549,CPT,Professional,Both,,,26,854,725.9,54.31,854,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,165.608,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Mra Neck W/O And W/Contrast (Pro Cah)Professional Component ,,70549,CPT,Professional,Both,,,26,854,725.9,54.31,854,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,62.70752,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Mra Neck W/O And W/Contrast (Pro Cah)Professional Component ,,70549,CPT,Professional,Both,,,26,854,725.9,54.31,854,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),97.2325,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Mra Neck W/O And W/Contrast (Pro Cah)Professional Component ,,70549,CPT,Professional,Both,,,26,854,725.9,54.31,854,CorVel,Worker's Compensation,167.2680774,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Mra Neck W/O And W/Contrast (Pro Cah)Professional Component ,,70549,CPT,Professional,Both,,,26,854,725.9,54.31,854,First Health Group Corporation,First Health Network,828.38,97,,percent of total billed charges,,
Mra Neck W/O And W/Contrast (Pro Cah)Professional Component ,,70549,CPT,Professional,Both,,,26,854,725.9,54.31,854,"Health Partners, Inc.",Commercial,128.39,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Mra Neck W/O And W/Contrast (Pro Cah)Professional Component ,,70549,CPT,Professional,Both,,,26,854,725.9,54.31,854,"Health Partners, Inc.",Medicare Advantage,97.2325,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Mra Neck W/O And W/Contrast (Pro Cah)Professional Component ,,70549,CPT,Professional,Both,,,26,854,725.9,54.31,854,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),54.31,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Mra Neck W/O And W/Contrast (Pro Cah)Professional Component ,,70549,CPT,Professional,Both,,,26,854,725.9,54.31,854,"Health Partners, Inc.",State of Minnesota Advantage Program,110.607985,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Mra Neck W/O And W/Contrast (Pro Cah)Professional Component ,,70549,CPT,Professional,Both,,,26,854,725.9,54.31,854,"Health Partners, Inc.",State Public Programs,54.31,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Mra Neck W/O And W/Contrast (Pro Cah)Professional Component ,,70549,CPT,Professional,Both,,,26,854,725.9,54.31,854,Humana Insurance Company,Commercial PPO,84.55,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Mra Neck W/O And W/Contrast (Pro Cah)Professional Component ,,70549,CPT,Professional,Both,,,26,854,725.9,54.31,854,Humana Insurance Company,Medicare PPO,854,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Mra Neck W/O And W/Contrast (Pro Cah)Professional Component ,,70549,CPT,Professional,Both,,,26,854,725.9,54.31,854,Medica,Individual & Family,724.192,84.8,,percent of total billed charges,,
Mra Neck W/O And W/Contrast (Pro Cah)Professional Component ,,70549,CPT,Professional,Both,,,26,854,725.9,54.31,854,Medica,Medica Advantage Solution,425.292,49.8,,percent of total billed charges,,
Mra Neck W/O And W/Contrast (Pro Cah)Professional Component ,,70549,CPT,Professional,Both,,,26,854,725.9,54.31,854,Medica,Medical Assistance,62.71,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Mra Neck W/O And W/Contrast (Pro Cah)Professional Component ,,70549,CPT,Professional,Both,,,26,854,725.9,54.31,854,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,84.55,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Mra Neck W/O And W/Contrast (Pro Cah)Professional Component ,,70549,CPT,Professional,Both,,,26,854,725.9,54.31,854,"Multiplan, Inc.","Multiplan, Inc.",802.76,94,,percent of total billed charges,,
Mra Neck W/O And W/Contrast (Pro Cah)Professional Component ,,70549,CPT,Professional,Both,,,26,854,725.9,54.31,854,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,769.454,90.1,,percent of total billed charges,,
Mra Neck W/O And W/Contrast (Pro Cah)Professional Component ,,70549,CPT,Professional,Both,,,26,854,725.9,54.31,854,"Preferred One Administrative Services, INC.",PPO,842.044,98.6,,percent of total billed charges,,
Mra Neck W/O And W/Contrast (Pro Cah)Professional Component ,,70549,CPT,Professional,Both,,,26,854,725.9,54.31,854,PrimeWest Health,Minnesota Senior Health Options (MSHO),97.2325,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Mra Neck W/O And W/Contrast (Pro Cah)Professional Component ,,70549,CPT,Professional,Both,,,26,854,725.9,54.31,854,PrimeWest Health,MinnesotaCare,67.0970464,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Mra Neck W/O And W/Contrast (Pro Cah)Professional Component ,,70549,CPT,Professional,Both,,,26,854,725.9,54.31,854,Sanford Health Plan,Sanford Health Plan,751.52,88,,percent of total billed charges,,
Mra Neck W/O And W/Contrast (Pro Cah)Professional Component ,,70549,CPT,Professional,Both,,,26,854,725.9,54.31,854,"UCare Health, Inc.",Individual & Family Plan,137.44448,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Mra Neck W/O And W/Contrast (Pro Cah)Professional Component ,,70549,CPT,Professional,Both,,,26,854,725.9,54.31,854,"UCare Health, Inc.",Medical Assistance,68.978272,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Mra Neck W/O And W/Contrast (Pro Cah)Professional Component ,,70549,CPT,Professional,Both,,,26,854,725.9,54.31,854,"UCare Health, Inc.",Medicare Advantage,97.2325,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Mra Neck W/O And W/Contrast (Pro Cah)Professional Component ,,70549,CPT,Professional,Both,,,26,854,725.9,54.31,854,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),77.786,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Mra Neck W/O And W/Contrast (Pro Cah)Professional Component ,,70549,CPT,Professional,Both,,,26,854,725.9,54.31,854,UnitedHealthcare,Individual & Family,854,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Mra Neck W/O And W/Contrast (Pro Cah)Professional Component ,,70549,CPT,Professional,Both,,,26,854,725.9,54.31,854,UnitedHealthcare,Medicare Advantage,97.2325,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Mra Neck W/O And W/Contrast (Pro Cah)Professional Component ,,70549,CPT,Professional,Both,,,26,854,725.9,54.31,854,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,62.70752,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Mri Brain W/O Contrast (Pro Cah)Professional Component ,,70551,CPT,Professional,Both,,,26,786,668.1,44.71,786,Aetna,Commercial,668.1,85,,percent of total billed charges,,
Mri Brain W/O Contrast (Pro Cah)Professional Component ,,70551,CPT,Professional,Both,,,26,786,668.1,44.71,786,Aetna,Medicare Advantage,71.11,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Mri Brain W/O Contrast (Pro Cah)Professional Component ,,70551,CPT,Professional,Both,,,26,786,668.1,44.71,786,Aetna,PPO,730.98,93,,percent of total billed charges,,
Mri Brain W/O Contrast (Pro Cah)Professional Component ,,70551,CPT,Professional,Both,,,26,786,668.1,44.71,786,America's PPO,America's PPO,671.5584,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Mri Brain W/O Contrast (Pro Cah)Professional Component ,,70551,CPT,Professional,Both,,,26,786,668.1,44.71,786,BlueCross BlueShield Minnesota, Federal Employee Program,134.23,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Mri Brain W/O Contrast (Pro Cah)Professional Component ,,70551,CPT,Professional,Both,,,26,786,668.1,44.71,786,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,136.37768,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Mri Brain W/O Contrast (Pro Cah)Professional Component ,,70551,CPT,Professional,Both,,,26,786,668.1,44.71,786,BlueCross BlueShield Minnesota,High Value Network Plan,136.37768,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Mri Brain W/O Contrast (Pro Cah)Professional Component ,,70551,CPT,Professional,Both,,,26,786,668.1,44.71,786,BlueCross BlueShield Minnesota,Medicare Advantage,80.132,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Mri Brain W/O Contrast (Pro Cah)Professional Component ,,70551,CPT,Professional,Both,,,26,786,668.1,44.71,786,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,136.37768,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Mri Brain W/O Contrast (Pro Cah)Professional Component ,,70551,CPT,Professional,Both,,,26,786,668.1,44.71,786,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,51.62296,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Mri Brain W/O Contrast (Pro Cah)Professional Component ,,70551,CPT,Professional,Both,,,26,786,668.1,44.71,786,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),80.132,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Mri Brain W/O Contrast (Pro Cah)Professional Component ,,70551,CPT,Professional,Both,,,26,786,668.1,44.71,786,CorVel,Worker's Compensation,137.3713821,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Mri Brain W/O Contrast (Pro Cah)Professional Component ,,70551,CPT,Professional,Both,,,26,786,668.1,44.71,786,First Health Group Corporation,First Health Network,762.42,97,,percent of total billed charges,,
Mri Brain W/O Contrast (Pro Cah)Professional Component ,,70551,CPT,Professional,Both,,,26,786,668.1,44.71,786,"Health Partners, Inc.",Commercial,105.7,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Mri Brain W/O Contrast (Pro Cah)Professional Component ,,70551,CPT,Professional,Both,,,26,786,668.1,44.71,786,"Health Partners, Inc.",Medicare Advantage,80.132,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Mri Brain W/O Contrast (Pro Cah)Professional Component ,,70551,CPT,Professional,Both,,,26,786,668.1,44.71,786,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),44.71,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Mri Brain W/O Contrast (Pro Cah)Professional Component ,,70551,CPT,Professional,Both,,,26,786,668.1,44.71,786,"Health Partners, Inc.",State of Minnesota Advantage Program,91.06055,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Mri Brain W/O Contrast (Pro Cah)Professional Component ,,70551,CPT,Professional,Both,,,26,786,668.1,44.71,786,"Health Partners, Inc.",State Public Programs,44.71,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Mri Brain W/O Contrast (Pro Cah)Professional Component ,,70551,CPT,Professional,Both,,,26,786,668.1,44.71,786,Humana Insurance Company,Commercial PPO,69.68,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Mri Brain W/O Contrast (Pro Cah)Professional Component ,,70551,CPT,Professional,Both,,,26,786,668.1,44.71,786,Humana Insurance Company,Medicare PPO,786,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Mri Brain W/O Contrast (Pro Cah)Professional Component ,,70551,CPT,Professional,Both,,,26,786,668.1,44.71,786,Medica,Individual & Family,666.528,84.8,,percent of total billed charges,,
Mri Brain W/O Contrast (Pro Cah)Professional Component ,,70551,CPT,Professional,Both,,,26,786,668.1,44.71,786,Medica,Medica Advantage Solution,391.428,49.8,,percent of total billed charges,,
Mri Brain W/O Contrast (Pro Cah)Professional Component ,,70551,CPT,Professional,Both,,,26,786,668.1,44.71,786,Medica,Medical Assistance,51.62,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Mri Brain W/O Contrast (Pro Cah)Professional Component ,,70551,CPT,Professional,Both,,,26,786,668.1,44.71,786,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,69.68,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Mri Brain W/O Contrast (Pro Cah)Professional Component ,,70551,CPT,Professional,Both,,,26,786,668.1,44.71,786,"Multiplan, Inc.","Multiplan, Inc.",738.84,94,,percent of total billed charges,,
Mri Brain W/O Contrast (Pro Cah)Professional Component ,,70551,CPT,Professional,Both,,,26,786,668.1,44.71,786,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,708.186,90.1,,percent of total billed charges,,
Mri Brain W/O Contrast (Pro Cah)Professional Component ,,70551,CPT,Professional,Both,,,26,786,668.1,44.71,786,"Preferred One Administrative Services, INC.",PPO,774.996,98.6,,percent of total billed charges,,
Mri Brain W/O Contrast (Pro Cah)Professional Component ,,70551,CPT,Professional,Both,,,26,786,668.1,44.71,786,PrimeWest Health,Minnesota Senior Health Options (MSHO),80.132,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Mri Brain W/O Contrast (Pro Cah)Professional Component ,,70551,CPT,Professional,Both,,,26,786,668.1,44.71,786,PrimeWest Health,MinnesotaCare,55.2365672,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Mri Brain W/O Contrast (Pro Cah)Professional Component ,,70551,CPT,Professional,Both,,,26,786,668.1,44.71,786,Sanford Health Plan,Sanford Health Plan,691.68,88,,percent of total billed charges,,
Mri Brain W/O Contrast (Pro Cah)Professional Component ,,70551,CPT,Professional,Both,,,26,786,668.1,44.71,786,"UCare Health, Inc.",Individual & Family Plan,113.271808,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Mri Brain W/O Contrast (Pro Cah)Professional Component ,,70551,CPT,Professional,Both,,,26,786,668.1,44.71,786,"UCare Health, Inc.",Medical Assistance,56.785256,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Mri Brain W/O Contrast (Pro Cah)Professional Component ,,70551,CPT,Professional,Both,,,26,786,668.1,44.71,786,"UCare Health, Inc.",Medicare Advantage,80.132,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Mri Brain W/O Contrast (Pro Cah)Professional Component ,,70551,CPT,Professional,Both,,,26,786,668.1,44.71,786,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),64.1056,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Mri Brain W/O Contrast (Pro Cah)Professional Component ,,70551,CPT,Professional,Both,,,26,786,668.1,44.71,786,UnitedHealthcare,Individual & Family,786,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Mri Brain W/O Contrast (Pro Cah)Professional Component ,,70551,CPT,Professional,Both,,,26,786,668.1,44.71,786,UnitedHealthcare,Medicare Advantage,80.132,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Mri Brain W/O Contrast (Pro Cah)Professional Component ,,70551,CPT,Professional,Both,,,26,786,668.1,44.71,786,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,51.62296,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Mri Brain W/Contrast (Pro Cah)Professional Component ,,70552,CPT,Professional,Both,,,26,760,646,53.88,760,Aetna,Commercial,646,85,,percent of total billed charges,,
Mri Brain W/Contrast (Pro Cah)Professional Component ,,70552,CPT,Professional,Both,,,26,760,646,53.88,760,Aetna,Medicare Advantage,85.84,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Mri Brain W/Contrast (Pro Cah)Professional Component ,,70552,CPT,Professional,Both,,,26,760,646,53.88,760,Aetna,PPO,706.8,93,,percent of total billed charges,,
Mri Brain W/Contrast (Pro Cah)Professional Component ,,70552,CPT,Professional,Both,,,26,760,646,53.88,760,America's PPO,America's PPO,649.344,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Mri Brain W/Contrast (Pro Cah)Professional Component ,,70552,CPT,Professional,Both,,,26,760,646,53.88,760,BlueCross BlueShield Minnesota, Federal Employee Program,161.72,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Mri Brain W/Contrast (Pro Cah)Professional Component ,,70552,CPT,Professional,Both,,,26,760,646,53.88,760,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,164.30752,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Mri Brain W/Contrast (Pro Cah)Professional Component ,,70552,CPT,Professional,Both,,,26,760,646,53.88,760,BlueCross BlueShield Minnesota,High Value Network Plan,164.30752,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Mri Brain W/Contrast (Pro Cah)Professional Component ,,70552,CPT,Professional,Both,,,26,760,646,53.88,760,BlueCross BlueShield Minnesota,Medicare Advantage,96.4505,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Mri Brain W/Contrast (Pro Cah)Professional Component ,,70552,CPT,Professional,Both,,,26,760,646,53.88,760,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,164.30752,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Mri Brain W/Contrast (Pro Cah)Professional Component ,,70552,CPT,Professional,Both,,,26,760,646,53.88,760,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,62.20968,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Mri Brain W/Contrast (Pro Cah)Professional Component ,,70552,CPT,Professional,Both,,,26,760,646,53.88,760,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),96.4505,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Mri Brain W/Contrast (Pro Cah)Professional Component ,,70552,CPT,Professional,Both,,,26,760,646,53.88,760,CorVel,Worker's Compensation,165.2442453,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Mri Brain W/Contrast (Pro Cah)Professional Component ,,70552,CPT,Professional,Both,,,26,760,646,53.88,760,First Health Group Corporation,First Health Network,737.2,97,,percent of total billed charges,,
Mri Brain W/Contrast (Pro Cah)Professional Component ,,70552,CPT,Professional,Both,,,26,760,646,53.88,760,"Health Partners, Inc.",Commercial,126.85,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Mri Brain W/Contrast (Pro Cah)Professional Component ,,70552,CPT,Professional,Both,,,26,760,646,53.88,760,"Health Partners, Inc.",Medicare Advantage,96.4505,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Mri Brain W/Contrast (Pro Cah)Professional Component ,,70552,CPT,Professional,Both,,,26,760,646,53.88,760,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),53.88,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Mri Brain W/Contrast (Pro Cah)Professional Component ,,70552,CPT,Professional,Both,,,26,760,646,53.88,760,"Health Partners, Inc.",State of Minnesota Advantage Program,109.281275,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Mri Brain W/Contrast (Pro Cah)Professional Component ,,70552,CPT,Professional,Both,,,26,760,646,53.88,760,"Health Partners, Inc.",State Public Programs,53.88,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Mri Brain W/Contrast (Pro Cah)Professional Component ,,70552,CPT,Professional,Both,,,26,760,646,53.88,760,Humana Insurance Company,Commercial PPO,83.87,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Mri Brain W/Contrast (Pro Cah)Professional Component ,,70552,CPT,Professional,Both,,,26,760,646,53.88,760,Humana Insurance Company,Medicare PPO,760,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Mri Brain W/Contrast (Pro Cah)Professional Component ,,70552,CPT,Professional,Both,,,26,760,646,53.88,760,Medica,Individual & Family,644.48,84.8,,percent of total billed charges,,
Mri Brain W/Contrast (Pro Cah)Professional Component ,,70552,CPT,Professional,Both,,,26,760,646,53.88,760,Medica,Medica Advantage Solution,378.48,49.8,,percent of total billed charges,,
Mri Brain W/Contrast (Pro Cah)Professional Component ,,70552,CPT,Professional,Both,,,26,760,646,53.88,760,Medica,Medical Assistance,62.21,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Mri Brain W/Contrast (Pro Cah)Professional Component ,,70552,CPT,Professional,Both,,,26,760,646,53.88,760,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,83.87,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Mri Brain W/Contrast (Pro Cah)Professional Component ,,70552,CPT,Professional,Both,,,26,760,646,53.88,760,"Multiplan, Inc.","Multiplan, Inc.",714.4,94,,percent of total billed charges,,
Mri Brain W/Contrast (Pro Cah)Professional Component ,,70552,CPT,Professional,Both,,,26,760,646,53.88,760,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,684.76,90.1,,percent of total billed charges,,
Mri Brain W/Contrast (Pro Cah)Professional Component ,,70552,CPT,Professional,Both,,,26,760,646,53.88,760,"Preferred One Administrative Services, INC.",PPO,749.36,98.6,,percent of total billed charges,,
Mri Brain W/Contrast (Pro Cah)Professional Component ,,70552,CPT,Professional,Both,,,26,760,646,53.88,760,PrimeWest Health,Minnesota Senior Health Options (MSHO),96.4505,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Mri Brain W/Contrast (Pro Cah)Professional Component ,,70552,CPT,Professional,Both,,,26,760,646,53.88,760,PrimeWest Health,MinnesotaCare,66.5643576,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Mri Brain W/Contrast (Pro Cah)Professional Component ,,70552,CPT,Professional,Both,,,26,760,646,53.88,760,Sanford Health Plan,Sanford Health Plan,668.8,88,,percent of total billed charges,,
Mri Brain W/Contrast (Pro Cah)Professional Component ,,70552,CPT,Professional,Both,,,26,760,646,53.88,760,"UCare Health, Inc.",Individual & Family Plan,136.339072,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Mri Brain W/Contrast (Pro Cah)Professional Component ,,70552,CPT,Professional,Both,,,26,760,646,53.88,760,"UCare Health, Inc.",Medical Assistance,68.430648,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Mri Brain W/Contrast (Pro Cah)Professional Component ,,70552,CPT,Professional,Both,,,26,760,646,53.88,760,"UCare Health, Inc.",Medicare Advantage,96.4505,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Mri Brain W/Contrast (Pro Cah)Professional Component ,,70552,CPT,Professional,Both,,,26,760,646,53.88,760,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),77.1604,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Mri Brain W/Contrast (Pro Cah)Professional Component ,,70552,CPT,Professional,Both,,,26,760,646,53.88,760,UnitedHealthcare,Individual & Family,760,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Mri Brain W/Contrast (Pro Cah)Professional Component ,,70552,CPT,Professional,Both,,,26,760,646,53.88,760,UnitedHealthcare,Medicare Advantage,96.4505,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Mri Brain W/Contrast (Pro Cah)Professional Component ,,70552,CPT,Professional,Both,,,26,760,646,53.88,760,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,62.20968,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Mri Brain W/O And W/Contrast (Pro Cah)Professional Component ,,70553,CPT,Professional,Both,,,26,1225,1041.25,69.15,1225,Aetna,Commercial,1041.25,85,,percent of total billed charges,,
Mri Brain W/O And W/Contrast (Pro Cah)Professional Component ,,70553,CPT,Professional,Both,,,26,1225,1041.25,69.15,1225,Aetna,Medicare Advantage,110.6,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Mri Brain W/O And W/Contrast (Pro Cah)Professional Component ,,70553,CPT,Professional,Both,,,26,1225,1041.25,69.15,1225,Aetna,PPO,1139.25,93,,percent of total billed charges,,
Mri Brain W/O And W/Contrast (Pro Cah)Professional Component ,,70553,CPT,Professional,Both,,,26,1225,1041.25,69.15,1225,America's PPO,America's PPO,1046.64,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Mri Brain W/O And W/Contrast (Pro Cah)Professional Component ,,70553,CPT,Professional,Both,,,26,1225,1041.25,69.15,1225,BlueCross BlueShield Minnesota, Federal Employee Program,207.1,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Mri Brain W/O And W/Contrast (Pro Cah)Professional Component ,,70553,CPT,Professional,Both,,,26,1225,1041.25,69.15,1225,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,210.4136,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Mri Brain W/O And W/Contrast (Pro Cah)Professional Component ,,70553,CPT,Professional,Both,,,26,1225,1041.25,69.15,1225,BlueCross BlueShield Minnesota,High Value Network Plan,210.4136,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Mri Brain W/O And W/Contrast (Pro Cah)Professional Component ,,70553,CPT,Professional,Both,,,26,1225,1041.25,69.15,1225,BlueCross BlueShield Minnesota,Medicare Advantage,123.7285,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Mri Brain W/O And W/Contrast (Pro Cah)Professional Component ,,70553,CPT,Professional,Both,,,26,1225,1041.25,69.15,1225,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,210.4136,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Mri Brain W/O And W/Contrast (Pro Cah)Professional Component ,,70553,CPT,Professional,Both,,,26,1225,1041.25,69.15,1225,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,79.83728,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Mri Brain W/O And W/Contrast (Pro Cah)Professional Component ,,70553,CPT,Professional,Both,,,26,1225,1041.25,69.15,1225,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),123.7285,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Mri Brain W/O And W/Contrast (Pro Cah)Professional Component ,,70553,CPT,Professional,Both,,,26,1225,1041.25,69.15,1225,CorVel,Worker's Compensation,212.2229433,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Mri Brain W/O And W/Contrast (Pro Cah)Professional Component ,,70553,CPT,Professional,Both,,,26,1225,1041.25,69.15,1225,First Health Group Corporation,First Health Network,1188.25,97,,percent of total billed charges,,
Mri Brain W/O And W/Contrast (Pro Cah)Professional Component ,,70553,CPT,Professional,Both,,,26,1225,1041.25,69.15,1225,"Health Partners, Inc.",Commercial,162.94,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Mri Brain W/O And W/Contrast (Pro Cah)Professional Component ,,70553,CPT,Professional,Both,,,26,1225,1041.25,69.15,1225,"Health Partners, Inc.",Medicare Advantage,123.7285,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Mri Brain W/O And W/Contrast (Pro Cah)Professional Component ,,70553,CPT,Professional,Both,,,26,1225,1041.25,69.15,1225,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),69.15,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Mri Brain W/O And W/Contrast (Pro Cah)Professional Component ,,70553,CPT,Professional,Both,,,26,1225,1041.25,69.15,1225,"Health Partners, Inc.",State of Minnesota Advantage Program,140.37281,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Mri Brain W/O And W/Contrast (Pro Cah)Professional Component ,,70553,CPT,Professional,Both,,,26,1225,1041.25,69.15,1225,"Health Partners, Inc.",State Public Programs,69.15,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Mri Brain W/O And W/Contrast (Pro Cah)Professional Component ,,70553,CPT,Professional,Both,,,26,1225,1041.25,69.15,1225,Humana Insurance Company,Commercial PPO,107.59,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Mri Brain W/O And W/Contrast (Pro Cah)Professional Component ,,70553,CPT,Professional,Both,,,26,1225,1041.25,69.15,1225,Humana Insurance Company,Medicare PPO,1225,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Mri Brain W/O And W/Contrast (Pro Cah)Professional Component ,,70553,CPT,Professional,Both,,,26,1225,1041.25,69.15,1225,Medica,Individual & Family,1038.8,84.8,,percent of total billed charges,,
Mri Brain W/O And W/Contrast (Pro Cah)Professional Component ,,70553,CPT,Professional,Both,,,26,1225,1041.25,69.15,1225,Medica,Medica Advantage Solution,610.05,49.8,,percent of total billed charges,,
Mri Brain W/O And W/Contrast (Pro Cah)Professional Component ,,70553,CPT,Professional,Both,,,26,1225,1041.25,69.15,1225,Medica,Medical Assistance,79.84,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Mri Brain W/O And W/Contrast (Pro Cah)Professional Component ,,70553,CPT,Professional,Both,,,26,1225,1041.25,69.15,1225,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,107.59,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Mri Brain W/O And W/Contrast (Pro Cah)Professional Component ,,70553,CPT,Professional,Both,,,26,1225,1041.25,69.15,1225,"Multiplan, Inc.","Multiplan, Inc.",1151.5,94,,percent of total billed charges,,
Mri Brain W/O And W/Contrast (Pro Cah)Professional Component ,,70553,CPT,Professional,Both,,,26,1225,1041.25,69.15,1225,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1103.725,90.1,,percent of total billed charges,,
Mri Brain W/O And W/Contrast (Pro Cah)Professional Component ,,70553,CPT,Professional,Both,,,26,1225,1041.25,69.15,1225,"Preferred One Administrative Services, INC.",PPO,1207.85,98.6,,percent of total billed charges,,
Mri Brain W/O And W/Contrast (Pro Cah)Professional Component ,,70553,CPT,Professional,Both,,,26,1225,1041.25,69.15,1225,PrimeWest Health,Minnesota Senior Health Options (MSHO),123.7285,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Mri Brain W/O And W/Contrast (Pro Cah)Professional Component ,,70553,CPT,Professional,Both,,,26,1225,1041.25,69.15,1225,PrimeWest Health,MinnesotaCare,85.4258896,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Mri Brain W/O And W/Contrast (Pro Cah)Professional Component ,,70553,CPT,Professional,Both,,,26,1225,1041.25,69.15,1225,Sanford Health Plan,Sanford Health Plan,1078,88,,percent of total billed charges,,
Mri Brain W/O And W/Contrast (Pro Cah)Professional Component ,,70553,CPT,Professional,Both,,,26,1225,1041.25,69.15,1225,"UCare Health, Inc.",Individual & Family Plan,174.898304,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Mri Brain W/O And W/Contrast (Pro Cah)Professional Component ,,70553,CPT,Professional,Both,,,26,1225,1041.25,69.15,1225,"UCare Health, Inc.",Medical Assistance,87.821008,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Mri Brain W/O And W/Contrast (Pro Cah)Professional Component ,,70553,CPT,Professional,Both,,,26,1225,1041.25,69.15,1225,"UCare Health, Inc.",Medicare Advantage,123.7285,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Mri Brain W/O And W/Contrast (Pro Cah)Professional Component ,,70553,CPT,Professional,Both,,,26,1225,1041.25,69.15,1225,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),98.9828,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Mri Brain W/O And W/Contrast (Pro Cah)Professional Component ,,70553,CPT,Professional,Both,,,26,1225,1041.25,69.15,1225,UnitedHealthcare,Individual & Family,1225,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Mri Brain W/O And W/Contrast (Pro Cah)Professional Component ,,70553,CPT,Professional,Both,,,26,1225,1041.25,69.15,1225,UnitedHealthcare,Medicare Advantage,123.7285,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Mri Brain W/O And W/Contrast (Pro Cah)Professional Component ,,70553,CPT,Professional,Both,,,26,1225,1041.25,69.15,1225,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,79.83728,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Radiologic Examination, Chest; Single View (Pro Cah)Professional Component ",,71045,CPT,Professional,Both,,,26,50,42.5,5.45,50,Aetna,Commercial,42.5,85,,percent of total billed charges,,
"Radiologic Examination, Chest; Single View (Pro Cah)Professional Component ",,71045,CPT,Professional,Both,,,26,50,42.5,5.45,50,Aetna,Medicare Advantage,8.88,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Radiologic Examination, Chest; Single View (Pro Cah)Professional Component ",,71045,CPT,Professional,Both,,,26,50,42.5,5.45,50,Aetna,PPO,46.5,93,,percent of total billed charges,,
"Radiologic Examination, Chest; Single View (Pro Cah)Professional Component ",,71045,CPT,Professional,Both,,,26,50,42.5,5.45,50,America's PPO,America's PPO,42.72,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Radiologic Examination, Chest; Single View (Pro Cah)Professional Component ",,71045,CPT,Professional,Both,,,26,50,42.5,5.45,50,BlueCross BlueShield Minnesota, Federal Employee Program,16.62,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Radiologic Examination, Chest; Single View (Pro Cah)Professional Component ",,71045,CPT,Professional,Both,,,26,50,42.5,5.45,50,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,16.88592,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Radiologic Examination, Chest; Single View (Pro Cah)Professional Component ",,71045,CPT,Professional,Both,,,26,50,42.5,5.45,50,BlueCross BlueShield Minnesota,High Value Network Plan,16.88592,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Radiologic Examination, Chest; Single View (Pro Cah)Professional Component ",,71045,CPT,Professional,Both,,,26,50,42.5,5.45,50,BlueCross BlueShield Minnesota,Medicare Advantage,9.9245,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Radiologic Examination, Chest; Single View (Pro Cah)Professional Component ",,71045,CPT,Professional,Both,,,26,50,42.5,5.45,50,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,16.88592,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Radiologic Examination, Chest; Single View (Pro Cah)Professional Component ",,71045,CPT,Professional,Both,,,26,50,42.5,5.45,50,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,6.28904,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Radiologic Examination, Chest; Single View (Pro Cah)Professional Component ",,71045,CPT,Professional,Both,,,26,50,42.5,5.45,50,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),9.9245,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Radiologic Examination, Chest; Single View (Pro Cah)Professional Component ",,71045,CPT,Professional,Both,,,26,50,42.5,5.45,50,CorVel,Worker's Compensation,17.0907348,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Radiologic Examination, Chest; Single View (Pro Cah)Professional Component ",,71045,CPT,Professional,Both,,,26,50,42.5,5.45,50,First Health Group Corporation,First Health Network,48.5,97,,percent of total billed charges,,
"Radiologic Examination, Chest; Single View (Pro Cah)Professional Component ",,71045,CPT,Professional,Both,,,26,50,42.5,5.45,50,"Health Partners, Inc.",Commercial,12.89,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Radiologic Examination, Chest; Single View (Pro Cah)Professional Component ",,71045,CPT,Professional,Both,,,26,50,42.5,5.45,50,"Health Partners, Inc.",Medicare Advantage,9.9245,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Radiologic Examination, Chest; Single View (Pro Cah)Professional Component ",,71045,CPT,Professional,Both,,,26,50,42.5,5.45,50,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),5.45,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Radiologic Examination, Chest; Single View (Pro Cah)Professional Component ",,71045,CPT,Professional,Both,,,26,50,42.5,5.45,50,"Health Partners, Inc.",State of Minnesota Advantage Program,11.104735,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Radiologic Examination, Chest; Single View (Pro Cah)Professional Component ",,71045,CPT,Professional,Both,,,26,50,42.5,5.45,50,"Health Partners, Inc.",State Public Programs,5.45,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Radiologic Examination, Chest; Single View (Pro Cah)Professional Component ",,71045,CPT,Professional,Both,,,26,50,42.5,5.45,50,Humana Insurance Company,Commercial PPO,8.63,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Radiologic Examination, Chest; Single View (Pro Cah)Professional Component ",,71045,CPT,Professional,Both,,,26,50,42.5,5.45,50,Humana Insurance Company,Medicare PPO,50,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Radiologic Examination, Chest; Single View (Pro Cah)Professional Component ",,71045,CPT,Professional,Both,,,26,50,42.5,5.45,50,Medica,Individual & Family,42.4,84.8,,percent of total billed charges,,
"Radiologic Examination, Chest; Single View (Pro Cah)Professional Component ",,71045,CPT,Professional,Both,,,26,50,42.5,5.45,50,Medica,Medica Advantage Solution,24.9,49.8,,percent of total billed charges,,
"Radiologic Examination, Chest; Single View (Pro Cah)Professional Component ",,71045,CPT,Professional,Both,,,26,50,42.5,5.45,50,Medica,Medical Assistance,6.29,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Radiologic Examination, Chest; Single View (Pro Cah)Professional Component ",,71045,CPT,Professional,Both,,,26,50,42.5,5.45,50,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,8.63,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Radiologic Examination, Chest; Single View (Pro Cah)Professional Component ",,71045,CPT,Professional,Both,,,26,50,42.5,5.45,50,"Multiplan, Inc.","Multiplan, Inc.",47,94,,percent of total billed charges,,
"Radiologic Examination, Chest; Single View (Pro Cah)Professional Component ",,71045,CPT,Professional,Both,,,26,50,42.5,5.45,50,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,45.05,90.1,,percent of total billed charges,,
"Radiologic Examination, Chest; Single View (Pro Cah)Professional Component ",,71045,CPT,Professional,Both,,,26,50,42.5,5.45,50,"Preferred One Administrative Services, INC.",PPO,49.3,98.6,,percent of total billed charges,,
"Radiologic Examination, Chest; Single View (Pro Cah)Professional Component ",,71045,CPT,Professional,Both,,,26,50,42.5,5.45,50,PrimeWest Health,Minnesota Senior Health Options (MSHO),9.9245,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Radiologic Examination, Chest; Single View (Pro Cah)Professional Component ",,71045,CPT,Professional,Both,,,26,50,42.5,5.45,50,PrimeWest Health,MinnesotaCare,6.7292728,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Radiologic Examination, Chest; Single View (Pro Cah)Professional Component ",,71045,CPT,Professional,Both,,,26,50,42.5,5.45,50,Sanford Health Plan,Sanford Health Plan,44,88,,percent of total billed charges,,
"Radiologic Examination, Chest; Single View (Pro Cah)Professional Component ",,71045,CPT,Professional,Both,,,26,50,42.5,5.45,50,"UCare Health, Inc.",Individual & Family Plan,14.028928,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Radiologic Examination, Chest; Single View (Pro Cah)Professional Component ",,71045,CPT,Professional,Both,,,26,50,42.5,5.45,50,"UCare Health, Inc.",Medical Assistance,6.917944,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Radiologic Examination, Chest; Single View (Pro Cah)Professional Component ",,71045,CPT,Professional,Both,,,26,50,42.5,5.45,50,"UCare Health, Inc.",Medicare Advantage,9.9245,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Radiologic Examination, Chest; Single View (Pro Cah)Professional Component ",,71045,CPT,Professional,Both,,,26,50,42.5,5.45,50,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),7.9396,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Radiologic Examination, Chest; Single View (Pro Cah)Professional Component ",,71045,CPT,Professional,Both,,,26,50,42.5,5.45,50,UnitedHealthcare,Individual & Family,50,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Radiologic Examination, Chest; Single View (Pro Cah)Professional Component ",,71045,CPT,Professional,Both,,,26,50,42.5,5.45,50,UnitedHealthcare,Medicare Advantage,9.9245,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Radiologic Examination, Chest; Single View (Pro Cah)Professional Component ",,71045,CPT,Professional,Both,,,26,50,42.5,5.45,50,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,6.28904,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Radiologic Examination, Chest; 2 Views (Pro Cah)Professional Component ",,71046,CPT,Professional,Both,,,26,40,34,6.54,40,Aetna,Commercial,34,85,,percent of total billed charges,,
"Radiologic Examination, Chest; 2 Views (Pro Cah)Professional Component ",,71046,CPT,Professional,Both,,,26,40,34,6.54,40,Aetna,Medicare Advantage,10.63,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Radiologic Examination, Chest; 2 Views (Pro Cah)Professional Component ",,71046,CPT,Professional,Both,,,26,40,34,6.54,40,Aetna,PPO,37.2,93,,percent of total billed charges,,
"Radiologic Examination, Chest; 2 Views (Pro Cah)Professional Component ",,71046,CPT,Professional,Both,,,26,40,34,6.54,40,America's PPO,America's PPO,34.176,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Radiologic Examination, Chest; 2 Views (Pro Cah)Professional Component ",,71046,CPT,Professional,Both,,,26,40,34,6.54,40,BlueCross BlueShield Minnesota, Federal Employee Program,19.82,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Radiologic Examination, Chest; 2 Views (Pro Cah)Professional Component ",,71046,CPT,Professional,Both,,,26,40,34,6.54,40,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,20.13712,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Radiologic Examination, Chest; 2 Views (Pro Cah)Professional Component ",,71046,CPT,Professional,Both,,,26,40,34,6.54,40,BlueCross BlueShield Minnesota,High Value Network Plan,20.13712,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Radiologic Examination, Chest; 2 Views (Pro Cah)Professional Component ",,71046,CPT,Professional,Both,,,26,40,34,6.54,40,BlueCross BlueShield Minnesota,Medicare Advantage,11.8795,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Radiologic Examination, Chest; 2 Views (Pro Cah)Professional Component ",,71046,CPT,Professional,Both,,,26,40,34,6.54,40,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,20.13712,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Radiologic Examination, Chest; 2 Views (Pro Cah)Professional Component ",,71046,CPT,Professional,Both,,,26,40,34,6.54,40,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,7.54888,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Radiologic Examination, Chest; 2 Views (Pro Cah)Professional Component ",,71046,CPT,Professional,Both,,,26,40,34,6.54,40,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),11.8795,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Radiologic Examination, Chest; 2 Views (Pro Cah)Professional Component ",,71046,CPT,Professional,Both,,,26,40,34,6.54,40,CorVel,Worker's Compensation,20.4579669,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Radiologic Examination, Chest; 2 Views (Pro Cah)Professional Component ",,71046,CPT,Professional,Both,,,26,40,34,6.54,40,First Health Group Corporation,First Health Network,38.8,97,,percent of total billed charges,,
"Radiologic Examination, Chest; 2 Views (Pro Cah)Professional Component ",,71046,CPT,Professional,Both,,,26,40,34,6.54,40,"Health Partners, Inc.",Commercial,15.47,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Radiologic Examination, Chest; 2 Views (Pro Cah)Professional Component ",,71046,CPT,Professional,Both,,,26,40,34,6.54,40,"Health Partners, Inc.",Medicare Advantage,11.8795,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Radiologic Examination, Chest; 2 Views (Pro Cah)Professional Component ",,71046,CPT,Professional,Both,,,26,40,34,6.54,40,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),6.54,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Radiologic Examination, Chest; 2 Views (Pro Cah)Professional Component ",,71046,CPT,Professional,Both,,,26,40,34,6.54,40,"Health Partners, Inc.",State of Minnesota Advantage Program,13.327405,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Radiologic Examination, Chest; 2 Views (Pro Cah)Professional Component ",,71046,CPT,Professional,Both,,,26,40,34,6.54,40,"Health Partners, Inc.",State Public Programs,6.54,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Radiologic Examination, Chest; 2 Views (Pro Cah)Professional Component ",,71046,CPT,Professional,Both,,,26,40,34,6.54,40,Humana Insurance Company,Commercial PPO,10.33,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Radiologic Examination, Chest; 2 Views (Pro Cah)Professional Component ",,71046,CPT,Professional,Both,,,26,40,34,6.54,40,Humana Insurance Company,Medicare PPO,40,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Radiologic Examination, Chest; 2 Views (Pro Cah)Professional Component ",,71046,CPT,Professional,Both,,,26,40,34,6.54,40,Medica,Individual & Family,33.92,84.8,,percent of total billed charges,,
"Radiologic Examination, Chest; 2 Views (Pro Cah)Professional Component ",,71046,CPT,Professional,Both,,,26,40,34,6.54,40,Medica,Medica Advantage Solution,19.92,49.8,,percent of total billed charges,,
"Radiologic Examination, Chest; 2 Views (Pro Cah)Professional Component ",,71046,CPT,Professional,Both,,,26,40,34,6.54,40,Medica,Medical Assistance,7.55,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Radiologic Examination, Chest; 2 Views (Pro Cah)Professional Component ",,71046,CPT,Professional,Both,,,26,40,34,6.54,40,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,10.33,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Radiologic Examination, Chest; 2 Views (Pro Cah)Professional Component ",,71046,CPT,Professional,Both,,,26,40,34,6.54,40,"Multiplan, Inc.","Multiplan, Inc.",37.6,94,,percent of total billed charges,,
"Radiologic Examination, Chest; 2 Views (Pro Cah)Professional Component ",,71046,CPT,Professional,Both,,,26,40,34,6.54,40,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,36.04,90.1,,percent of total billed charges,,
"Radiologic Examination, Chest; 2 Views (Pro Cah)Professional Component ",,71046,CPT,Professional,Both,,,26,40,34,6.54,40,"Preferred One Administrative Services, INC.",PPO,39.44,98.6,,percent of total billed charges,,
"Radiologic Examination, Chest; 2 Views (Pro Cah)Professional Component ",,71046,CPT,Professional,Both,,,26,40,34,6.54,40,PrimeWest Health,Minnesota Senior Health Options (MSHO),11.8795,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Radiologic Examination, Chest; 2 Views (Pro Cah)Professional Component ",,71046,CPT,Professional,Both,,,26,40,34,6.54,40,PrimeWest Health,MinnesotaCare,8.0773016,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Radiologic Examination, Chest; 2 Views (Pro Cah)Professional Component ",,71046,CPT,Professional,Both,,,26,40,34,6.54,40,Sanford Health Plan,Sanford Health Plan,35.2,88,,percent of total billed charges,,
"Radiologic Examination, Chest; 2 Views (Pro Cah)Professional Component ",,71046,CPT,Professional,Both,,,26,40,34,6.54,40,"UCare Health, Inc.",Individual & Family Plan,16.792448,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Radiologic Examination, Chest; 2 Views (Pro Cah)Professional Component ",,71046,CPT,Professional,Both,,,26,40,34,6.54,40,"UCare Health, Inc.",Medical Assistance,8.303768,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Radiologic Examination, Chest; 2 Views (Pro Cah)Professional Component ",,71046,CPT,Professional,Both,,,26,40,34,6.54,40,"UCare Health, Inc.",Medicare Advantage,11.8795,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Radiologic Examination, Chest; 2 Views (Pro Cah)Professional Component ",,71046,CPT,Professional,Both,,,26,40,34,6.54,40,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),9.5036,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Radiologic Examination, Chest; 2 Views (Pro Cah)Professional Component ",,71046,CPT,Professional,Both,,,26,40,34,6.54,40,UnitedHealthcare,Individual & Family,40,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Radiologic Examination, Chest; 2 Views (Pro Cah)Professional Component ",,71046,CPT,Professional,Both,,,26,40,34,6.54,40,UnitedHealthcare,Medicare Advantage,11.8795,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Radiologic Examination, Chest; 2 Views (Pro Cah)Professional Component ",,71046,CPT,Professional,Both,,,26,40,34,6.54,40,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,7.54888,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Chest; 3 Views (Pro Cah)Professional Component ,,71047,CPT,Professional,Both,,,26,90,76.5,8.29,90,Aetna,Commercial,76.5,85,,percent of total billed charges,,
Xr Chest; 3 Views (Pro Cah)Professional Component ,,71047,CPT,Professional,Both,,,26,90,76.5,8.29,90,Aetna,Medicare Advantage,13.43,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Chest; 3 Views (Pro Cah)Professional Component ,,71047,CPT,Professional,Both,,,26,90,76.5,8.29,90,Aetna,PPO,83.7,93,,percent of total billed charges,,
Xr Chest; 3 Views (Pro Cah)Professional Component ,,71047,CPT,Professional,Both,,,26,90,76.5,8.29,90,America's PPO,America's PPO,76.896,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Xr Chest; 3 Views (Pro Cah)Professional Component ,,71047,CPT,Professional,Both,,,26,90,76.5,8.29,90,BlueCross BlueShield Minnesota, Federal Employee Program,24.93,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Xr Chest; 3 Views (Pro Cah)Professional Component ,,71047,CPT,Professional,Both,,,26,90,76.5,8.29,90,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,25.32888,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Chest; 3 Views (Pro Cah)Professional Component ,,71047,CPT,Professional,Both,,,26,90,76.5,8.29,90,BlueCross BlueShield Minnesota,High Value Network Plan,25.32888,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Chest; 3 Views (Pro Cah)Professional Component ,,71047,CPT,Professional,Both,,,26,90,76.5,8.29,90,BlueCross BlueShield Minnesota,Medicare Advantage,15.019,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Chest; 3 Views (Pro Cah)Professional Component ,,71047,CPT,Professional,Both,,,26,90,76.5,8.29,90,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,25.32888,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Chest; 3 Views (Pro Cah)Professional Component ,,71047,CPT,Professional,Both,,,26,90,76.5,8.29,90,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,9.57072,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Chest; 3 Views (Pro Cah)Professional Component ,,71047,CPT,Professional,Both,,,26,90,76.5,8.29,90,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),15.019,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Chest; 3 Views (Pro Cah)Professional Component ,,71047,CPT,Professional,Both,,,26,90,76.5,8.29,90,CorVel,Worker's Compensation,25.1773311,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Xr Chest; 3 Views (Pro Cah)Professional Component ,,71047,CPT,Professional,Both,,,26,90,76.5,8.29,90,First Health Group Corporation,First Health Network,87.3,97,,percent of total billed charges,,
Xr Chest; 3 Views (Pro Cah)Professional Component ,,71047,CPT,Professional,Both,,,26,90,76.5,8.29,90,"Health Partners, Inc.",Commercial,19.08,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Xr Chest; 3 Views (Pro Cah)Professional Component ,,71047,CPT,Professional,Both,,,26,90,76.5,8.29,90,"Health Partners, Inc.",Medicare Advantage,15.019,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Chest; 3 Views (Pro Cah)Professional Component ,,71047,CPT,Professional,Both,,,26,90,76.5,8.29,90,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),8.29,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Xr Chest; 3 Views (Pro Cah)Professional Component ,,71047,CPT,Professional,Both,,,26,90,76.5,8.29,90,"Health Partners, Inc.",State of Minnesota Advantage Program,16.43742,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Xr Chest; 3 Views (Pro Cah)Professional Component ,,71047,CPT,Professional,Both,,,26,90,76.5,8.29,90,"Health Partners, Inc.",State Public Programs,8.29,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Xr Chest; 3 Views (Pro Cah)Professional Component ,,71047,CPT,Professional,Both,,,26,90,76.5,8.29,90,Humana Insurance Company,Commercial PPO,13.06,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Xr Chest; 3 Views (Pro Cah)Professional Component ,,71047,CPT,Professional,Both,,,26,90,76.5,8.29,90,Humana Insurance Company,Medicare PPO,90,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Xr Chest; 3 Views (Pro Cah)Professional Component ,,71047,CPT,Professional,Both,,,26,90,76.5,8.29,90,Medica,Individual & Family,76.32,84.8,,percent of total billed charges,,
Xr Chest; 3 Views (Pro Cah)Professional Component ,,71047,CPT,Professional,Both,,,26,90,76.5,8.29,90,Medica,Medica Advantage Solution,44.82,49.8,,percent of total billed charges,,
Xr Chest; 3 Views (Pro Cah)Professional Component ,,71047,CPT,Professional,Both,,,26,90,76.5,8.29,90,Medica,Medical Assistance,9.57,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Xr Chest; 3 Views (Pro Cah)Professional Component ,,71047,CPT,Professional,Both,,,26,90,76.5,8.29,90,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,13.06,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Xr Chest; 3 Views (Pro Cah)Professional Component ,,71047,CPT,Professional,Both,,,26,90,76.5,8.29,90,"Multiplan, Inc.","Multiplan, Inc.",84.6,94,,percent of total billed charges,,
Xr Chest; 3 Views (Pro Cah)Professional Component ,,71047,CPT,Professional,Both,,,26,90,76.5,8.29,90,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,81.09,90.1,,percent of total billed charges,,
Xr Chest; 3 Views (Pro Cah)Professional Component ,,71047,CPT,Professional,Both,,,26,90,76.5,8.29,90,"Preferred One Administrative Services, INC.",PPO,88.74,98.6,,percent of total billed charges,,
Xr Chest; 3 Views (Pro Cah)Professional Component ,,71047,CPT,Professional,Both,,,26,90,76.5,8.29,90,PrimeWest Health,Minnesota Senior Health Options (MSHO),15.019,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Chest; 3 Views (Pro Cah)Professional Component ,,71047,CPT,Professional,Both,,,26,90,76.5,8.29,90,PrimeWest Health,MinnesotaCare,10.2406704,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Chest; 3 Views (Pro Cah)Professional Component ,,71047,CPT,Professional,Both,,,26,90,76.5,8.29,90,Sanford Health Plan,Sanford Health Plan,79.2,88,,percent of total billed charges,,
Xr Chest; 3 Views (Pro Cah)Professional Component ,,71047,CPT,Professional,Both,,,26,90,76.5,8.29,90,"UCare Health, Inc.",Individual & Family Plan,21.230336,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Xr Chest; 3 Views (Pro Cah)Professional Component ,,71047,CPT,Professional,Both,,,26,90,76.5,8.29,90,"UCare Health, Inc.",Medical Assistance,10.527792,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Xr Chest; 3 Views (Pro Cah)Professional Component ,,71047,CPT,Professional,Both,,,26,90,76.5,8.29,90,"UCare Health, Inc.",Medicare Advantage,15.019,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Xr Chest; 3 Views (Pro Cah)Professional Component ,,71047,CPT,Professional,Both,,,26,90,76.5,8.29,90,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),12.0152,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Xr Chest; 3 Views (Pro Cah)Professional Component ,,71047,CPT,Professional,Both,,,26,90,76.5,8.29,90,UnitedHealthcare,Individual & Family,90,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Xr Chest; 3 Views (Pro Cah)Professional Component ,,71047,CPT,Professional,Both,,,26,90,76.5,8.29,90,UnitedHealthcare,Medicare Advantage,15.019,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Chest; 3 Views (Pro Cah)Professional Component ,,71047,CPT,Professional,Both,,,26,90,76.5,8.29,90,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,9.57072,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Radiologic Examination, Chest; 4 Or More Views (Pro Cah)Professional Component ",,71048,CPT,Professional,Both,,,26,105,89.25,9.37,105,Aetna,Commercial,89.25,85,,percent of total billed charges,,
"Radiologic Examination, Chest; 4 Or More Views (Pro Cah)Professional Component ",,71048,CPT,Professional,Both,,,26,105,89.25,9.37,105,Aetna,Medicare Advantage,15.54,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Radiologic Examination, Chest; 4 Or More Views (Pro Cah)Professional Component ",,71048,CPT,Professional,Both,,,26,105,89.25,9.37,105,Aetna,PPO,97.65,93,,percent of total billed charges,,
"Radiologic Examination, Chest; 4 Or More Views (Pro Cah)Professional Component ",,71048,CPT,Professional,Both,,,26,105,89.25,9.37,105,America's PPO,America's PPO,89.712,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Radiologic Examination, Chest; 4 Or More Views (Pro Cah)Professional Component ",,71048,CPT,Professional,Both,,,26,105,89.25,9.37,105,BlueCross BlueShield Minnesota, Federal Employee Program,28.12,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Radiologic Examination, Chest; 4 Or More Views (Pro Cah)Professional Component ",,71048,CPT,Professional,Both,,,26,105,89.25,9.37,105,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,28.56992,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Radiologic Examination, Chest; 4 Or More Views (Pro Cah)Professional Component ",,71048,CPT,Professional,Both,,,26,105,89.25,9.37,105,BlueCross BlueShield Minnesota,High Value Network Plan,28.56992,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Radiologic Examination, Chest; 4 Or More Views (Pro Cah)Professional Component ",,71048,CPT,Professional,Both,,,26,105,89.25,9.37,105,BlueCross BlueShield Minnesota,Medicare Advantage,16.974,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Radiologic Examination, Chest; 4 Or More Views (Pro Cah)Professional Component ",,71048,CPT,Professional,Both,,,26,105,89.25,9.37,105,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,28.56992,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Radiologic Examination, Chest; 4 Or More Views (Pro Cah)Professional Component ",,71048,CPT,Professional,Both,,,26,105,89.25,9.37,105,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,10.8204,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Radiologic Examination, Chest; 4 Or More Views (Pro Cah)Professional Component ",,71048,CPT,Professional,Both,,,26,105,89.25,9.37,105,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),16.974,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Radiologic Examination, Chest; 4 Or More Views (Pro Cah)Professional Component ",,71048,CPT,Professional,Both,,,26,105,89.25,9.37,105,CorVel,Worker's Compensation,29.2249953,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Radiologic Examination, Chest; 4 Or More Views (Pro Cah)Professional Component ",,71048,CPT,Professional,Both,,,26,105,89.25,9.37,105,First Health Group Corporation,First Health Network,101.85,97,,percent of total billed charges,,
"Radiologic Examination, Chest; 4 Or More Views (Pro Cah)Professional Component ",,71048,CPT,Professional,Both,,,26,105,89.25,9.37,105,"Health Partners, Inc.",Commercial,22.17,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Radiologic Examination, Chest; 4 Or More Views (Pro Cah)Professional Component ",,71048,CPT,Professional,Both,,,26,105,89.25,9.37,105,"Health Partners, Inc.",Medicare Advantage,16.974,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Radiologic Examination, Chest; 4 Or More Views (Pro Cah)Professional Component ",,71048,CPT,Professional,Both,,,26,105,89.25,9.37,105,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),9.37,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Radiologic Examination, Chest; 4 Or More Views (Pro Cah)Professional Component ",,71048,CPT,Professional,Both,,,26,105,89.25,9.37,105,"Health Partners, Inc.",State of Minnesota Advantage Program,19.099455,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Radiologic Examination, Chest; 4 Or More Views (Pro Cah)Professional Component ",,71048,CPT,Professional,Both,,,26,105,89.25,9.37,105,"Health Partners, Inc.",State Public Programs,9.37,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Radiologic Examination, Chest; 4 Or More Views (Pro Cah)Professional Component ",,71048,CPT,Professional,Both,,,26,105,89.25,9.37,105,Humana Insurance Company,Commercial PPO,14.76,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Radiologic Examination, Chest; 4 Or More Views (Pro Cah)Professional Component ",,71048,CPT,Professional,Both,,,26,105,89.25,9.37,105,Humana Insurance Company,Medicare PPO,105,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Radiologic Examination, Chest; 4 Or More Views (Pro Cah)Professional Component ",,71048,CPT,Professional,Both,,,26,105,89.25,9.37,105,Medica,Individual & Family,89.04,84.8,,percent of total billed charges,,
"Radiologic Examination, Chest; 4 Or More Views (Pro Cah)Professional Component ",,71048,CPT,Professional,Both,,,26,105,89.25,9.37,105,Medica,Medica Advantage Solution,52.29,49.8,,percent of total billed charges,,
"Radiologic Examination, Chest; 4 Or More Views (Pro Cah)Professional Component ",,71048,CPT,Professional,Both,,,26,105,89.25,9.37,105,Medica,Medical Assistance,10.82,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Radiologic Examination, Chest; 4 Or More Views (Pro Cah)Professional Component ",,71048,CPT,Professional,Both,,,26,105,89.25,9.37,105,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,14.76,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Radiologic Examination, Chest; 4 Or More Views (Pro Cah)Professional Component ",,71048,CPT,Professional,Both,,,26,105,89.25,9.37,105,"Multiplan, Inc.","Multiplan, Inc.",98.7,94,,percent of total billed charges,,
"Radiologic Examination, Chest; 4 Or More Views (Pro Cah)Professional Component ",,71048,CPT,Professional,Both,,,26,105,89.25,9.37,105,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,94.605,90.1,,percent of total billed charges,,
"Radiologic Examination, Chest; 4 Or More Views (Pro Cah)Professional Component ",,71048,CPT,Professional,Both,,,26,105,89.25,9.37,105,"Preferred One Administrative Services, INC.",PPO,103.53,98.6,,percent of total billed charges,,
"Radiologic Examination, Chest; 4 Or More Views (Pro Cah)Professional Component ",,71048,CPT,Professional,Both,,,26,105,89.25,9.37,105,PrimeWest Health,Minnesota Senior Health Options (MSHO),16.974,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Radiologic Examination, Chest; 4 Or More Views (Pro Cah)Professional Component ",,71048,CPT,Professional,Both,,,26,105,89.25,9.37,105,PrimeWest Health,MinnesotaCare,11.577828,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Radiologic Examination, Chest; 4 Or More Views (Pro Cah)Professional Component ",,71048,CPT,Professional,Both,,,26,105,89.25,9.37,105,Sanford Health Plan,Sanford Health Plan,92.4,88,,percent of total billed charges,,
"Radiologic Examination, Chest; 4 Or More Views (Pro Cah)Professional Component ",,71048,CPT,Professional,Both,,,26,105,89.25,9.37,105,"UCare Health, Inc.",Individual & Family Plan,23.993856,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Radiologic Examination, Chest; 4 Or More Views (Pro Cah)Professional Component ",,71048,CPT,Professional,Both,,,26,105,89.25,9.37,105,"UCare Health, Inc.",Medical Assistance,11.90244,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Radiologic Examination, Chest; 4 Or More Views (Pro Cah)Professional Component ",,71048,CPT,Professional,Both,,,26,105,89.25,9.37,105,"UCare Health, Inc.",Medicare Advantage,16.974,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Radiologic Examination, Chest; 4 Or More Views (Pro Cah)Professional Component ",,71048,CPT,Professional,Both,,,26,105,89.25,9.37,105,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),13.5792,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Radiologic Examination, Chest; 4 Or More Views (Pro Cah)Professional Component ",,71048,CPT,Professional,Both,,,26,105,89.25,9.37,105,UnitedHealthcare,Individual & Family,105,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Radiologic Examination, Chest; 4 Or More Views (Pro Cah)Professional Component ",,71048,CPT,Professional,Both,,,26,105,89.25,9.37,105,UnitedHealthcare,Medicare Advantage,16.974,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Radiologic Examination, Chest; 4 Or More Views (Pro Cah)Professional Component ",,71048,CPT,Professional,Both,,,26,105,89.25,9.37,105,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,10.8204,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Ribs Unil (Pro Cah)Professional Component ,,71100,CPT,Professional,Both,,,26,56,47.6,6.76,56,Aetna,Commercial,47.6,85,,percent of total billed charges,,
Xr Ribs Unil (Pro Cah)Professional Component ,,71100,CPT,Professional,Both,,,26,56,47.6,6.76,56,Aetna,Medicare Advantage,10.98,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Ribs Unil (Pro Cah)Professional Component ,,71100,CPT,Professional,Both,,,26,56,47.6,6.76,56,Aetna,PPO,52.08,93,,percent of total billed charges,,
Xr Ribs Unil (Pro Cah)Professional Component ,,71100,CPT,Professional,Both,,,26,56,47.6,6.76,56,America's PPO,America's PPO,47.8464,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Xr Ribs Unil (Pro Cah)Professional Component ,,71100,CPT,Professional,Both,,,26,56,47.6,6.76,56,BlueCross BlueShield Minnesota, Federal Employee Program,20.45,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Xr Ribs Unil (Pro Cah)Professional Component ,,71100,CPT,Professional,Both,,,26,56,47.6,6.76,56,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,20.7772,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Ribs Unil (Pro Cah)Professional Component ,,71100,CPT,Professional,Both,,,26,56,47.6,6.76,56,BlueCross BlueShield Minnesota,High Value Network Plan,20.7772,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Ribs Unil (Pro Cah)Professional Component ,,71100,CPT,Professional,Both,,,26,56,47.6,6.76,56,BlueCross BlueShield Minnesota,Medicare Advantage,12.2705,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Ribs Unil (Pro Cah)Professional Component ,,71100,CPT,Professional,Both,,,26,56,47.6,6.76,56,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,20.7772,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Ribs Unil (Pro Cah)Professional Component ,,71100,CPT,Professional,Both,,,26,56,47.6,6.76,56,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,7.80288,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Ribs Unil (Pro Cah)Professional Component ,,71100,CPT,Professional,Both,,,26,56,47.6,6.76,56,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),12.2705,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Ribs Unil (Pro Cah)Professional Component ,,71100,CPT,Professional,Both,,,26,56,47.6,6.76,56,CorVel,Worker's Compensation,21.138399,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Xr Ribs Unil (Pro Cah)Professional Component ,,71100,CPT,Professional,Both,,,26,56,47.6,6.76,56,First Health Group Corporation,First Health Network,54.32,97,,percent of total billed charges,,
Xr Ribs Unil (Pro Cah)Professional Component ,,71100,CPT,Professional,Both,,,26,56,47.6,6.76,56,"Health Partners, Inc.",Commercial,15.98,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Xr Ribs Unil (Pro Cah)Professional Component ,,71100,CPT,Professional,Both,,,26,56,47.6,6.76,56,"Health Partners, Inc.",Medicare Advantage,12.2705,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Ribs Unil (Pro Cah)Professional Component ,,71100,CPT,Professional,Both,,,26,56,47.6,6.76,56,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),6.76,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Xr Ribs Unil (Pro Cah)Professional Component ,,71100,CPT,Professional,Both,,,26,56,47.6,6.76,56,"Health Partners, Inc.",State of Minnesota Advantage Program,13.76677,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Xr Ribs Unil (Pro Cah)Professional Component ,,71100,CPT,Professional,Both,,,26,56,47.6,6.76,56,"Health Partners, Inc.",State Public Programs,6.76,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Xr Ribs Unil (Pro Cah)Professional Component ,,71100,CPT,Professional,Both,,,26,56,47.6,6.76,56,Humana Insurance Company,Commercial PPO,10.67,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Xr Ribs Unil (Pro Cah)Professional Component ,,71100,CPT,Professional,Both,,,26,56,47.6,6.76,56,Humana Insurance Company,Medicare PPO,56,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Xr Ribs Unil (Pro Cah)Professional Component ,,71100,CPT,Professional,Both,,,26,56,47.6,6.76,56,Medica,Individual & Family,47.488,84.8,,percent of total billed charges,,
Xr Ribs Unil (Pro Cah)Professional Component ,,71100,CPT,Professional,Both,,,26,56,47.6,6.76,56,Medica,Medica Advantage Solution,27.888,49.8,,percent of total billed charges,,
Xr Ribs Unil (Pro Cah)Professional Component ,,71100,CPT,Professional,Both,,,26,56,47.6,6.76,56,Medica,Medical Assistance,7.8,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Xr Ribs Unil (Pro Cah)Professional Component ,,71100,CPT,Professional,Both,,,26,56,47.6,6.76,56,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,10.67,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Xr Ribs Unil (Pro Cah)Professional Component ,,71100,CPT,Professional,Both,,,26,56,47.6,6.76,56,"Multiplan, Inc.","Multiplan, Inc.",52.64,94,,percent of total billed charges,,
Xr Ribs Unil (Pro Cah)Professional Component ,,71100,CPT,Professional,Both,,,26,56,47.6,6.76,56,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,50.456,90.1,,percent of total billed charges,,
Xr Ribs Unil (Pro Cah)Professional Component ,,71100,CPT,Professional,Both,,,26,56,47.6,6.76,56,"Preferred One Administrative Services, INC.",PPO,55.216,98.6,,percent of total billed charges,,
Xr Ribs Unil (Pro Cah)Professional Component ,,71100,CPT,Professional,Both,,,26,56,47.6,6.76,56,PrimeWest Health,Minnesota Senior Health Options (MSHO),12.2705,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Ribs Unil (Pro Cah)Professional Component ,,71100,CPT,Professional,Both,,,26,56,47.6,6.76,56,PrimeWest Health,MinnesotaCare,8.3490816,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Ribs Unil (Pro Cah)Professional Component ,,71100,CPT,Professional,Both,,,26,56,47.6,6.76,56,Sanford Health Plan,Sanford Health Plan,49.28,88,,percent of total billed charges,,
Xr Ribs Unil (Pro Cah)Professional Component ,,71100,CPT,Professional,Both,,,26,56,47.6,6.76,56,"UCare Health, Inc.",Individual & Family Plan,17.345152,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Xr Ribs Unil (Pro Cah)Professional Component ,,71100,CPT,Professional,Both,,,26,56,47.6,6.76,56,"UCare Health, Inc.",Medical Assistance,8.583168,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Xr Ribs Unil (Pro Cah)Professional Component ,,71100,CPT,Professional,Both,,,26,56,47.6,6.76,56,"UCare Health, Inc.",Medicare Advantage,12.2705,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Xr Ribs Unil (Pro Cah)Professional Component ,,71100,CPT,Professional,Both,,,26,56,47.6,6.76,56,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),9.8164,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Xr Ribs Unil (Pro Cah)Professional Component ,,71100,CPT,Professional,Both,,,26,56,47.6,6.76,56,UnitedHealthcare,Individual & Family,56,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Xr Ribs Unil (Pro Cah)Professional Component ,,71100,CPT,Professional,Both,,,26,56,47.6,6.76,56,UnitedHealthcare,Medicare Advantage,12.2705,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Ribs Unil (Pro Cah)Professional Component ,,71100,CPT,Professional,Both,,,26,56,47.6,6.76,56,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,7.80288,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Ribs Unil W Chest 1 View (Pro Cah)Professional Component ,,71101,CPT,Professional,Both,,,26,67,56.95,8.07,67,Aetna,Commercial,56.95,85,,percent of total billed charges,,
Xr Ribs Unil W Chest 1 View (Pro Cah)Professional Component ,,71101,CPT,Professional,Both,,,26,67,56.95,8.07,67,Aetna,Medicare Advantage,13.08,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Ribs Unil W Chest 1 View (Pro Cah)Professional Component ,,71101,CPT,Professional,Both,,,26,67,56.95,8.07,67,Aetna,PPO,62.31,93,,percent of total billed charges,,
Xr Ribs Unil W Chest 1 View (Pro Cah)Professional Component ,,71101,CPT,Professional,Both,,,26,67,56.95,8.07,67,America's PPO,America's PPO,57.2448,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Xr Ribs Unil W Chest 1 View (Pro Cah)Professional Component ,,71101,CPT,Professional,Both,,,26,67,56.95,8.07,67,BlueCross BlueShield Minnesota, Federal Employee Program,24.29,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Xr Ribs Unil W Chest 1 View (Pro Cah)Professional Component ,,71101,CPT,Professional,Both,,,26,67,56.95,8.07,67,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,24.67864,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Ribs Unil W Chest 1 View (Pro Cah)Professional Component ,,71101,CPT,Professional,Both,,,26,67,56.95,8.07,67,BlueCross BlueShield Minnesota,High Value Network Plan,24.67864,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Ribs Unil W Chest 1 View (Pro Cah)Professional Component ,,71101,CPT,Professional,Both,,,26,67,56.95,8.07,67,BlueCross BlueShield Minnesota,Medicare Advantage,14.6165,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Ribs Unil W Chest 1 View (Pro Cah)Professional Component ,,71101,CPT,Professional,Both,,,26,67,56.95,8.07,67,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,24.67864,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Ribs Unil W Chest 1 View (Pro Cah)Professional Component ,,71101,CPT,Professional,Both,,,26,67,56.95,8.07,67,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,9.31672,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Ribs Unil W Chest 1 View (Pro Cah)Professional Component ,,71101,CPT,Professional,Both,,,26,67,56.95,8.07,67,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),14.6165,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Ribs Unil W Chest 1 View (Pro Cah)Professional Component ,,71101,CPT,Professional,Both,,,26,67,56.95,8.07,67,CorVel,Worker's Compensation,25.1773311,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Xr Ribs Unil W Chest 1 View (Pro Cah)Professional Component ,,71101,CPT,Professional,Both,,,26,67,56.95,8.07,67,First Health Group Corporation,First Health Network,64.99,97,,percent of total billed charges,,
Xr Ribs Unil W Chest 1 View (Pro Cah)Professional Component ,,71101,CPT,Professional,Both,,,26,67,56.95,8.07,67,"Health Partners, Inc.",Commercial,19.08,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Xr Ribs Unil W Chest 1 View (Pro Cah)Professional Component ,,71101,CPT,Professional,Both,,,26,67,56.95,8.07,67,"Health Partners, Inc.",Medicare Advantage,14.6165,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Ribs Unil W Chest 1 View (Pro Cah)Professional Component ,,71101,CPT,Professional,Both,,,26,67,56.95,8.07,67,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),8.07,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Xr Ribs Unil W Chest 1 View (Pro Cah)Professional Component ,,71101,CPT,Professional,Both,,,26,67,56.95,8.07,67,"Health Partners, Inc.",State of Minnesota Advantage Program,16.43742,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Xr Ribs Unil W Chest 1 View (Pro Cah)Professional Component ,,71101,CPT,Professional,Both,,,26,67,56.95,8.07,67,"Health Partners, Inc.",State Public Programs,8.07,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Xr Ribs Unil W Chest 1 View (Pro Cah)Professional Component ,,71101,CPT,Professional,Both,,,26,67,56.95,8.07,67,Humana Insurance Company,Commercial PPO,12.71,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Xr Ribs Unil W Chest 1 View (Pro Cah)Professional Component ,,71101,CPT,Professional,Both,,,26,67,56.95,8.07,67,Humana Insurance Company,Medicare PPO,67,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Xr Ribs Unil W Chest 1 View (Pro Cah)Professional Component ,,71101,CPT,Professional,Both,,,26,67,56.95,8.07,67,Medica,Individual & Family,56.816,84.8,,percent of total billed charges,,
Xr Ribs Unil W Chest 1 View (Pro Cah)Professional Component ,,71101,CPT,Professional,Both,,,26,67,56.95,8.07,67,Medica,Medica Advantage Solution,33.366,49.8,,percent of total billed charges,,
Xr Ribs Unil W Chest 1 View (Pro Cah)Professional Component ,,71101,CPT,Professional,Both,,,26,67,56.95,8.07,67,Medica,Medical Assistance,9.32,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Xr Ribs Unil W Chest 1 View (Pro Cah)Professional Component ,,71101,CPT,Professional,Both,,,26,67,56.95,8.07,67,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,12.71,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Xr Ribs Unil W Chest 1 View (Pro Cah)Professional Component ,,71101,CPT,Professional,Both,,,26,67,56.95,8.07,67,"Multiplan, Inc.","Multiplan, Inc.",62.98,94,,percent of total billed charges,,
Xr Ribs Unil W Chest 1 View (Pro Cah)Professional Component ,,71101,CPT,Professional,Both,,,26,67,56.95,8.07,67,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,60.367,90.1,,percent of total billed charges,,
Xr Ribs Unil W Chest 1 View (Pro Cah)Professional Component ,,71101,CPT,Professional,Both,,,26,67,56.95,8.07,67,"Preferred One Administrative Services, INC.",PPO,66.062,98.6,,percent of total billed charges,,
Xr Ribs Unil W Chest 1 View (Pro Cah)Professional Component ,,71101,CPT,Professional,Both,,,26,67,56.95,8.07,67,PrimeWest Health,Minnesota Senior Health Options (MSHO),14.6165,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Ribs Unil W Chest 1 View (Pro Cah)Professional Component ,,71101,CPT,Professional,Both,,,26,67,56.95,8.07,67,PrimeWest Health,MinnesotaCare,9.9688904,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Ribs Unil W Chest 1 View (Pro Cah)Professional Component ,,71101,CPT,Professional,Both,,,26,67,56.95,8.07,67,Sanford Health Plan,Sanford Health Plan,58.96,88,,percent of total billed charges,,
Xr Ribs Unil W Chest 1 View (Pro Cah)Professional Component ,,71101,CPT,Professional,Both,,,26,67,56.95,8.07,67,"UCare Health, Inc.",Individual & Family Plan,20.661376,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Xr Ribs Unil W Chest 1 View (Pro Cah)Professional Component ,,71101,CPT,Professional,Both,,,26,67,56.95,8.07,67,"UCare Health, Inc.",Medical Assistance,10.248392,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Xr Ribs Unil W Chest 1 View (Pro Cah)Professional Component ,,71101,CPT,Professional,Both,,,26,67,56.95,8.07,67,"UCare Health, Inc.",Medicare Advantage,14.6165,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Xr Ribs Unil W Chest 1 View (Pro Cah)Professional Component ,,71101,CPT,Professional,Both,,,26,67,56.95,8.07,67,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),11.6932,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Xr Ribs Unil W Chest 1 View (Pro Cah)Professional Component ,,71101,CPT,Professional,Both,,,26,67,56.95,8.07,67,UnitedHealthcare,Individual & Family,67,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Xr Ribs Unil W Chest 1 View (Pro Cah)Professional Component ,,71101,CPT,Professional,Both,,,26,67,56.95,8.07,67,UnitedHealthcare,Medicare Advantage,14.6165,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Ribs Unil W Chest 1 View (Pro Cah)Professional Component ,,71101,CPT,Professional,Both,,,26,67,56.95,8.07,67,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,9.31672,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Ribs Routine Bil (Pro Cah)Professional Component ,,71110,CPT,Professional,Both,,,26,75,63.75,8.72,75,Aetna,Commercial,63.75,85,,percent of total billed charges,,
Xr Ribs Routine Bil (Pro Cah)Professional Component ,,71110,CPT,Professional,Both,,,26,75,63.75,8.72,75,Aetna,Medicare Advantage,14.13,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Ribs Routine Bil (Pro Cah)Professional Component ,,71110,CPT,Professional,Both,,,26,75,63.75,8.72,75,Aetna,PPO,69.75,93,,percent of total billed charges,,
Xr Ribs Routine Bil (Pro Cah)Professional Component ,,71110,CPT,Professional,Both,,,26,75,63.75,8.72,75,America's PPO,America's PPO,64.08,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Xr Ribs Routine Bil (Pro Cah)Professional Component ,,71110,CPT,Professional,Both,,,26,75,63.75,8.72,75,BlueCross BlueShield Minnesota, Federal Employee Program,26.21,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Xr Ribs Routine Bil (Pro Cah)Professional Component ,,71110,CPT,Professional,Both,,,26,75,63.75,8.72,75,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,26.62936,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Ribs Routine Bil (Pro Cah)Professional Component ,,71110,CPT,Professional,Both,,,26,75,63.75,8.72,75,BlueCross BlueShield Minnesota,High Value Network Plan,26.62936,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Ribs Routine Bil (Pro Cah)Professional Component ,,71110,CPT,Professional,Both,,,26,75,63.75,8.72,75,BlueCross BlueShield Minnesota,Medicare Advantage,15.801,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Ribs Routine Bil (Pro Cah)Professional Component ,,71110,CPT,Professional,Both,,,26,75,63.75,8.72,75,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,26.62936,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Ribs Routine Bil (Pro Cah)Professional Component ,,71110,CPT,Professional,Both,,,26,75,63.75,8.72,75,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,10.06856,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Ribs Routine Bil (Pro Cah)Professional Component ,,71110,CPT,Professional,Both,,,26,75,63.75,8.72,75,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),15.801,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Ribs Routine Bil (Pro Cah)Professional Component ,,71110,CPT,Professional,Both,,,26,75,63.75,8.72,75,CorVel,Worker's Compensation,27.2011632,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Xr Ribs Routine Bil (Pro Cah)Professional Component ,,71110,CPT,Professional,Both,,,26,75,63.75,8.72,75,First Health Group Corporation,First Health Network,72.75,97,,percent of total billed charges,,
Xr Ribs Routine Bil (Pro Cah)Professional Component ,,71110,CPT,Professional,Both,,,26,75,63.75,8.72,75,"Health Partners, Inc.",Commercial,20.62,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Xr Ribs Routine Bil (Pro Cah)Professional Component ,,71110,CPT,Professional,Both,,,26,75,63.75,8.72,75,"Health Partners, Inc.",Medicare Advantage,15.801,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Ribs Routine Bil (Pro Cah)Professional Component ,,71110,CPT,Professional,Both,,,26,75,63.75,8.72,75,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),8.72,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Xr Ribs Routine Bil (Pro Cah)Professional Component ,,71110,CPT,Professional,Both,,,26,75,63.75,8.72,75,"Health Partners, Inc.",State of Minnesota Advantage Program,17.76413,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Xr Ribs Routine Bil (Pro Cah)Professional Component ,,71110,CPT,Professional,Both,,,26,75,63.75,8.72,75,"Health Partners, Inc.",State Public Programs,8.72,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Xr Ribs Routine Bil (Pro Cah)Professional Component ,,71110,CPT,Professional,Both,,,26,75,63.75,8.72,75,Humana Insurance Company,Commercial PPO,13.74,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Xr Ribs Routine Bil (Pro Cah)Professional Component ,,71110,CPT,Professional,Both,,,26,75,63.75,8.72,75,Humana Insurance Company,Medicare PPO,75,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Xr Ribs Routine Bil (Pro Cah)Professional Component ,,71110,CPT,Professional,Both,,,26,75,63.75,8.72,75,Medica,Individual & Family,63.6,84.8,,percent of total billed charges,,
Xr Ribs Routine Bil (Pro Cah)Professional Component ,,71110,CPT,Professional,Both,,,26,75,63.75,8.72,75,Medica,Medica Advantage Solution,37.35,49.8,,percent of total billed charges,,
Xr Ribs Routine Bil (Pro Cah)Professional Component ,,71110,CPT,Professional,Both,,,26,75,63.75,8.72,75,Medica,Medical Assistance,10.07,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Xr Ribs Routine Bil (Pro Cah)Professional Component ,,71110,CPT,Professional,Both,,,26,75,63.75,8.72,75,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,13.74,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Xr Ribs Routine Bil (Pro Cah)Professional Component ,,71110,CPT,Professional,Both,,,26,75,63.75,8.72,75,"Multiplan, Inc.","Multiplan, Inc.",70.5,94,,percent of total billed charges,,
Xr Ribs Routine Bil (Pro Cah)Professional Component ,,71110,CPT,Professional,Both,,,26,75,63.75,8.72,75,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,67.575,90.1,,percent of total billed charges,,
Xr Ribs Routine Bil (Pro Cah)Professional Component ,,71110,CPT,Professional,Both,,,26,75,63.75,8.72,75,"Preferred One Administrative Services, INC.",PPO,73.95,98.6,,percent of total billed charges,,
Xr Ribs Routine Bil (Pro Cah)Professional Component ,,71110,CPT,Professional,Both,,,26,75,63.75,8.72,75,PrimeWest Health,Minnesota Senior Health Options (MSHO),15.801,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Ribs Routine Bil (Pro Cah)Professional Component ,,71110,CPT,Professional,Both,,,26,75,63.75,8.72,75,PrimeWest Health,MinnesotaCare,10.7733592,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Ribs Routine Bil (Pro Cah)Professional Component ,,71110,CPT,Professional,Both,,,26,75,63.75,8.72,75,Sanford Health Plan,Sanford Health Plan,66,88,,percent of total billed charges,,
Xr Ribs Routine Bil (Pro Cah)Professional Component ,,71110,CPT,Professional,Both,,,26,75,63.75,8.72,75,"UCare Health, Inc.",Individual & Family Plan,22.335744,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Xr Ribs Routine Bil (Pro Cah)Professional Component ,,71110,CPT,Professional,Both,,,26,75,63.75,8.72,75,"UCare Health, Inc.",Medical Assistance,11.075416,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Xr Ribs Routine Bil (Pro Cah)Professional Component ,,71110,CPT,Professional,Both,,,26,75,63.75,8.72,75,"UCare Health, Inc.",Medicare Advantage,15.801,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Xr Ribs Routine Bil (Pro Cah)Professional Component ,,71110,CPT,Professional,Both,,,26,75,63.75,8.72,75,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),12.6408,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Xr Ribs Routine Bil (Pro Cah)Professional Component ,,71110,CPT,Professional,Both,,,26,75,63.75,8.72,75,UnitedHealthcare,Individual & Family,75,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Xr Ribs Routine Bil (Pro Cah)Professional Component ,,71110,CPT,Professional,Both,,,26,75,63.75,8.72,75,UnitedHealthcare,Medicare Advantage,15.801,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Ribs Routine Bil (Pro Cah)Professional Component ,,71110,CPT,Professional,Both,,,26,75,63.75,8.72,75,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,10.06856,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Ribs Bil W Chest (Pro Cah)Professional Component ,,71111,CPT,Professional,Both,,,26,81,68.85,9.59,81,Aetna,Commercial,68.85,85,,percent of total billed charges,,
Xr Ribs Bil W Chest (Pro Cah)Professional Component ,,71111,CPT,Professional,Both,,,26,81,68.85,9.59,81,Aetna,Medicare Advantage,15.53,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Ribs Bil W Chest (Pro Cah)Professional Component ,,71111,CPT,Professional,Both,,,26,81,68.85,9.59,81,Aetna,PPO,75.33,93,,percent of total billed charges,,
Xr Ribs Bil W Chest (Pro Cah)Professional Component ,,71111,CPT,Professional,Both,,,26,81,68.85,9.59,81,America's PPO,America's PPO,69.2064,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Xr Ribs Bil W Chest (Pro Cah)Professional Component ,,71111,CPT,Professional,Both,,,26,81,68.85,9.59,81,BlueCross BlueShield Minnesota, Federal Employee Program,29.4,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Xr Ribs Bil W Chest (Pro Cah)Professional Component ,,71111,CPT,Professional,Both,,,26,81,68.85,9.59,81,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,29.8704,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Ribs Bil W Chest (Pro Cah)Professional Component ,,71111,CPT,Professional,Both,,,26,81,68.85,9.59,81,BlueCross BlueShield Minnesota,High Value Network Plan,29.8704,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Ribs Bil W Chest (Pro Cah)Professional Component ,,71111,CPT,Professional,Both,,,26,81,68.85,9.59,81,BlueCross BlueShield Minnesota,Medicare Advantage,17.4915,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Ribs Bil W Chest (Pro Cah)Professional Component ,,71111,CPT,Professional,Both,,,26,81,68.85,9.59,81,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,29.8704,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Ribs Bil W Chest (Pro Cah)Professional Component ,,71111,CPT,Professional,Both,,,26,81,68.85,9.59,81,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,11.0744,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Ribs Bil W Chest (Pro Cah)Professional Component ,,71111,CPT,Professional,Both,,,26,81,68.85,9.59,81,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),17.4915,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Ribs Bil W Chest (Pro Cah)Professional Component ,,71111,CPT,Professional,Both,,,26,81,68.85,9.59,81,CorVel,Worker's Compensation,29.8966953,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Xr Ribs Bil W Chest (Pro Cah)Professional Component ,,71111,CPT,Professional,Both,,,26,81,68.85,9.59,81,First Health Group Corporation,First Health Network,78.57,97,,percent of total billed charges,,
Xr Ribs Bil W Chest (Pro Cah)Professional Component ,,71111,CPT,Professional,Both,,,26,81,68.85,9.59,81,"Health Partners, Inc.",Commercial,22.69,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Xr Ribs Bil W Chest (Pro Cah)Professional Component ,,71111,CPT,Professional,Both,,,26,81,68.85,9.59,81,"Health Partners, Inc.",Medicare Advantage,17.4915,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Ribs Bil W Chest (Pro Cah)Professional Component ,,71111,CPT,Professional,Both,,,26,81,68.85,9.59,81,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),9.59,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Xr Ribs Bil W Chest (Pro Cah)Professional Component ,,71111,CPT,Professional,Both,,,26,81,68.85,9.59,81,"Health Partners, Inc.",State of Minnesota Advantage Program,19.547435,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Xr Ribs Bil W Chest (Pro Cah)Professional Component ,,71111,CPT,Professional,Both,,,26,81,68.85,9.59,81,"Health Partners, Inc.",State Public Programs,9.59,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Xr Ribs Bil W Chest (Pro Cah)Professional Component ,,71111,CPT,Professional,Both,,,26,81,68.85,9.59,81,Humana Insurance Company,Commercial PPO,15.21,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Xr Ribs Bil W Chest (Pro Cah)Professional Component ,,71111,CPT,Professional,Both,,,26,81,68.85,9.59,81,Humana Insurance Company,Medicare PPO,81,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Xr Ribs Bil W Chest (Pro Cah)Professional Component ,,71111,CPT,Professional,Both,,,26,81,68.85,9.59,81,Medica,Individual & Family,68.688,84.8,,percent of total billed charges,,
Xr Ribs Bil W Chest (Pro Cah)Professional Component ,,71111,CPT,Professional,Both,,,26,81,68.85,9.59,81,Medica,Medica Advantage Solution,40.338,49.8,,percent of total billed charges,,
Xr Ribs Bil W Chest (Pro Cah)Professional Component ,,71111,CPT,Professional,Both,,,26,81,68.85,9.59,81,Medica,Medical Assistance,11.07,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Xr Ribs Bil W Chest (Pro Cah)Professional Component ,,71111,CPT,Professional,Both,,,26,81,68.85,9.59,81,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,15.21,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Xr Ribs Bil W Chest (Pro Cah)Professional Component ,,71111,CPT,Professional,Both,,,26,81,68.85,9.59,81,"Multiplan, Inc.","Multiplan, Inc.",76.14,94,,percent of total billed charges,,
Xr Ribs Bil W Chest (Pro Cah)Professional Component ,,71111,CPT,Professional,Both,,,26,81,68.85,9.59,81,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,72.981,90.1,,percent of total billed charges,,
Xr Ribs Bil W Chest (Pro Cah)Professional Component ,,71111,CPT,Professional,Both,,,26,81,68.85,9.59,81,"Preferred One Administrative Services, INC.",PPO,79.866,98.6,,percent of total billed charges,,
Xr Ribs Bil W Chest (Pro Cah)Professional Component ,,71111,CPT,Professional,Both,,,26,81,68.85,9.59,81,PrimeWest Health,Minnesota Senior Health Options (MSHO),17.4915,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Ribs Bil W Chest (Pro Cah)Professional Component ,,71111,CPT,Professional,Both,,,26,81,68.85,9.59,81,PrimeWest Health,MinnesotaCare,11.849608,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Ribs Bil W Chest (Pro Cah)Professional Component ,,71111,CPT,Professional,Both,,,26,81,68.85,9.59,81,Sanford Health Plan,Sanford Health Plan,71.28,88,,percent of total billed charges,,
Xr Ribs Bil W Chest (Pro Cah)Professional Component ,,71111,CPT,Professional,Both,,,26,81,68.85,9.59,81,"UCare Health, Inc.",Individual & Family Plan,24.725376,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Xr Ribs Bil W Chest (Pro Cah)Professional Component ,,71111,CPT,Professional,Both,,,26,81,68.85,9.59,81,"UCare Health, Inc.",Medical Assistance,12.18184,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Xr Ribs Bil W Chest (Pro Cah)Professional Component ,,71111,CPT,Professional,Both,,,26,81,68.85,9.59,81,"UCare Health, Inc.",Medicare Advantage,17.4915,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Xr Ribs Bil W Chest (Pro Cah)Professional Component ,,71111,CPT,Professional,Both,,,26,81,68.85,9.59,81,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),13.9932,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Xr Ribs Bil W Chest (Pro Cah)Professional Component ,,71111,CPT,Professional,Both,,,26,81,68.85,9.59,81,UnitedHealthcare,Individual & Family,81,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Xr Ribs Bil W Chest (Pro Cah)Professional Component ,,71111,CPT,Professional,Both,,,26,81,68.85,9.59,81,UnitedHealthcare,Medicare Advantage,17.4915,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Ribs Bil W Chest (Pro Cah)Professional Component ,,71111,CPT,Professional,Both,,,26,81,68.85,9.59,81,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,11.0744,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Sternum (Pro Cah)Professional Component ,,71120,CPT,Professional,Both,,,26,53,45.05,5.89,53,Aetna,Commercial,45.05,85,,percent of total billed charges,,
Xr Sternum (Pro Cah)Professional Component ,,71120,CPT,Professional,Both,,,26,53,45.05,5.89,53,Aetna,Medicare Advantage,9.58,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Sternum (Pro Cah)Professional Component ,,71120,CPT,Professional,Both,,,26,53,45.05,5.89,53,Aetna,PPO,49.29,93,,percent of total billed charges,,
Xr Sternum (Pro Cah)Professional Component ,,71120,CPT,Professional,Both,,,26,53,45.05,5.89,53,America's PPO,America's PPO,45.2832,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Xr Sternum (Pro Cah)Professional Component ,,71120,CPT,Professional,Both,,,26,53,45.05,5.89,53,BlueCross BlueShield Minnesota, Federal Employee Program,17.9,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Xr Sternum (Pro Cah)Professional Component ,,71120,CPT,Professional,Both,,,26,53,45.05,5.89,53,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,18.1864,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Sternum (Pro Cah)Professional Component ,,71120,CPT,Professional,Both,,,26,53,45.05,5.89,53,BlueCross BlueShield Minnesota,High Value Network Plan,18.1864,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Sternum (Pro Cah)Professional Component ,,71120,CPT,Professional,Both,,,26,53,45.05,5.89,53,BlueCross BlueShield Minnesota,Medicare Advantage,10.7065,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Sternum (Pro Cah)Professional Component ,,71120,CPT,Professional,Both,,,26,53,45.05,5.89,53,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,18.1864,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Sternum (Pro Cah)Professional Component ,,71120,CPT,Professional,Both,,,26,53,45.05,5.89,53,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,6.79704,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Sternum (Pro Cah)Professional Component ,,71120,CPT,Professional,Both,,,26,53,45.05,5.89,53,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),10.7065,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Sternum (Pro Cah)Professional Component ,,71120,CPT,Professional,Both,,,26,53,45.05,5.89,53,CorVel,Worker's Compensation,18.4341348,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Xr Sternum (Pro Cah)Professional Component ,,71120,CPT,Professional,Both,,,26,53,45.05,5.89,53,First Health Group Corporation,First Health Network,51.41,97,,percent of total billed charges,,
Xr Sternum (Pro Cah)Professional Component ,,71120,CPT,Professional,Both,,,26,53,45.05,5.89,53,"Health Partners, Inc.",Commercial,13.92,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Xr Sternum (Pro Cah)Professional Component ,,71120,CPT,Professional,Both,,,26,53,45.05,5.89,53,"Health Partners, Inc.",Medicare Advantage,10.7065,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Sternum (Pro Cah)Professional Component ,,71120,CPT,Professional,Both,,,26,53,45.05,5.89,53,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),5.89,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Xr Sternum (Pro Cah)Professional Component ,,71120,CPT,Professional,Both,,,26,53,45.05,5.89,53,"Health Partners, Inc.",State of Minnesota Advantage Program,11.99208,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Xr Sternum (Pro Cah)Professional Component ,,71120,CPT,Professional,Both,,,26,53,45.05,5.89,53,"Health Partners, Inc.",State Public Programs,5.89,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Xr Sternum (Pro Cah)Professional Component ,,71120,CPT,Professional,Both,,,26,53,45.05,5.89,53,Humana Insurance Company,Commercial PPO,9.31,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Xr Sternum (Pro Cah)Professional Component ,,71120,CPT,Professional,Both,,,26,53,45.05,5.89,53,Humana Insurance Company,Medicare PPO,53,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Xr Sternum (Pro Cah)Professional Component ,,71120,CPT,Professional,Both,,,26,53,45.05,5.89,53,Medica,Individual & Family,44.944,84.8,,percent of total billed charges,,
Xr Sternum (Pro Cah)Professional Component ,,71120,CPT,Professional,Both,,,26,53,45.05,5.89,53,Medica,Medica Advantage Solution,26.394,49.8,,percent of total billed charges,,
Xr Sternum (Pro Cah)Professional Component ,,71120,CPT,Professional,Both,,,26,53,45.05,5.89,53,Medica,Medical Assistance,6.8,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Xr Sternum (Pro Cah)Professional Component ,,71120,CPT,Professional,Both,,,26,53,45.05,5.89,53,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,9.31,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Xr Sternum (Pro Cah)Professional Component ,,71120,CPT,Professional,Both,,,26,53,45.05,5.89,53,"Multiplan, Inc.","Multiplan, Inc.",49.82,94,,percent of total billed charges,,
Xr Sternum (Pro Cah)Professional Component ,,71120,CPT,Professional,Both,,,26,53,45.05,5.89,53,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,47.753,90.1,,percent of total billed charges,,
Xr Sternum (Pro Cah)Professional Component ,,71120,CPT,Professional,Both,,,26,53,45.05,5.89,53,"Preferred One Administrative Services, INC.",PPO,52.258,98.6,,percent of total billed charges,,
Xr Sternum (Pro Cah)Professional Component ,,71120,CPT,Professional,Both,,,26,53,45.05,5.89,53,PrimeWest Health,Minnesota Senior Health Options (MSHO),10.7065,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Sternum (Pro Cah)Professional Component ,,71120,CPT,Professional,Both,,,26,53,45.05,5.89,53,PrimeWest Health,MinnesotaCare,7.2728328,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Sternum (Pro Cah)Professional Component ,,71120,CPT,Professional,Both,,,26,53,45.05,5.89,53,Sanford Health Plan,Sanford Health Plan,46.64,88,,percent of total billed charges,,
Xr Sternum (Pro Cah)Professional Component ,,71120,CPT,Professional,Both,,,26,53,45.05,5.89,53,"UCare Health, Inc.",Individual & Family Plan,15.134336,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Xr Sternum (Pro Cah)Professional Component ,,71120,CPT,Professional,Both,,,26,53,45.05,5.89,53,"UCare Health, Inc.",Medical Assistance,7.476744,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Xr Sternum (Pro Cah)Professional Component ,,71120,CPT,Professional,Both,,,26,53,45.05,5.89,53,"UCare Health, Inc.",Medicare Advantage,10.7065,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Xr Sternum (Pro Cah)Professional Component ,,71120,CPT,Professional,Both,,,26,53,45.05,5.89,53,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),8.5652,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Xr Sternum (Pro Cah)Professional Component ,,71120,CPT,Professional,Both,,,26,53,45.05,5.89,53,UnitedHealthcare,Individual & Family,53,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Xr Sternum (Pro Cah)Professional Component ,,71120,CPT,Professional,Both,,,26,53,45.05,5.89,53,UnitedHealthcare,Medicare Advantage,10.7065,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Sternum (Pro Cah)Professional Component ,,71120,CPT,Professional,Both,,,26,53,45.05,5.89,53,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,6.79704,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Sternoclavicular Joints (Pro Cah)Professional Component ,,71130,CPT,Professional,Both,,,26,58,49.3,6.54,58,Aetna,Commercial,49.3,85,,percent of total billed charges,,
Xr Sternoclavicular Joints (Pro Cah)Professional Component ,,71130,CPT,Professional,Both,,,26,58,49.3,6.54,58,Aetna,Medicare Advantage,10.63,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Sternoclavicular Joints (Pro Cah)Professional Component ,,71130,CPT,Professional,Both,,,26,58,49.3,6.54,58,Aetna,PPO,53.94,93,,percent of total billed charges,,
Xr Sternoclavicular Joints (Pro Cah)Professional Component ,,71130,CPT,Professional,Both,,,26,58,49.3,6.54,58,America's PPO,America's PPO,49.5552,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Xr Sternoclavicular Joints (Pro Cah)Professional Component ,,71130,CPT,Professional,Both,,,26,58,49.3,6.54,58,BlueCross BlueShield Minnesota, Federal Employee Program,19.82,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Xr Sternoclavicular Joints (Pro Cah)Professional Component ,,71130,CPT,Professional,Both,,,26,58,49.3,6.54,58,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,20.13712,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Sternoclavicular Joints (Pro Cah)Professional Component ,,71130,CPT,Professional,Both,,,26,58,49.3,6.54,58,BlueCross BlueShield Minnesota,High Value Network Plan,20.13712,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Sternoclavicular Joints (Pro Cah)Professional Component ,,71130,CPT,Professional,Both,,,26,58,49.3,6.54,58,BlueCross BlueShield Minnesota,Medicare Advantage,11.8795,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Sternoclavicular Joints (Pro Cah)Professional Component ,,71130,CPT,Professional,Both,,,26,58,49.3,6.54,58,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,20.13712,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Sternoclavicular Joints (Pro Cah)Professional Component ,,71130,CPT,Professional,Both,,,26,58,49.3,6.54,58,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,7.54888,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Sternoclavicular Joints (Pro Cah)Professional Component ,,71130,CPT,Professional,Both,,,26,58,49.3,6.54,58,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),11.8795,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Sternoclavicular Joints (Pro Cah)Professional Component ,,71130,CPT,Professional,Both,,,26,58,49.3,6.54,58,CorVel,Worker's Compensation,20.4579669,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Xr Sternoclavicular Joints (Pro Cah)Professional Component ,,71130,CPT,Professional,Both,,,26,58,49.3,6.54,58,First Health Group Corporation,First Health Network,56.26,97,,percent of total billed charges,,
Xr Sternoclavicular Joints (Pro Cah)Professional Component ,,71130,CPT,Professional,Both,,,26,58,49.3,6.54,58,"Health Partners, Inc.",Commercial,15.47,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Xr Sternoclavicular Joints (Pro Cah)Professional Component ,,71130,CPT,Professional,Both,,,26,58,49.3,6.54,58,"Health Partners, Inc.",Medicare Advantage,11.8795,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Sternoclavicular Joints (Pro Cah)Professional Component ,,71130,CPT,Professional,Both,,,26,58,49.3,6.54,58,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),6.54,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Xr Sternoclavicular Joints (Pro Cah)Professional Component ,,71130,CPT,Professional,Both,,,26,58,49.3,6.54,58,"Health Partners, Inc.",State of Minnesota Advantage Program,13.327405,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Xr Sternoclavicular Joints (Pro Cah)Professional Component ,,71130,CPT,Professional,Both,,,26,58,49.3,6.54,58,"Health Partners, Inc.",State Public Programs,6.54,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Xr Sternoclavicular Joints (Pro Cah)Professional Component ,,71130,CPT,Professional,Both,,,26,58,49.3,6.54,58,Humana Insurance Company,Commercial PPO,10.33,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Xr Sternoclavicular Joints (Pro Cah)Professional Component ,,71130,CPT,Professional,Both,,,26,58,49.3,6.54,58,Humana Insurance Company,Medicare PPO,58,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Xr Sternoclavicular Joints (Pro Cah)Professional Component ,,71130,CPT,Professional,Both,,,26,58,49.3,6.54,58,Medica,Individual & Family,49.184,84.8,,percent of total billed charges,,
Xr Sternoclavicular Joints (Pro Cah)Professional Component ,,71130,CPT,Professional,Both,,,26,58,49.3,6.54,58,Medica,Medica Advantage Solution,28.884,49.8,,percent of total billed charges,,
Xr Sternoclavicular Joints (Pro Cah)Professional Component ,,71130,CPT,Professional,Both,,,26,58,49.3,6.54,58,Medica,Medical Assistance,7.55,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Xr Sternoclavicular Joints (Pro Cah)Professional Component ,,71130,CPT,Professional,Both,,,26,58,49.3,6.54,58,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,10.33,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Xr Sternoclavicular Joints (Pro Cah)Professional Component ,,71130,CPT,Professional,Both,,,26,58,49.3,6.54,58,"Multiplan, Inc.","Multiplan, Inc.",54.52,94,,percent of total billed charges,,
Xr Sternoclavicular Joints (Pro Cah)Professional Component ,,71130,CPT,Professional,Both,,,26,58,49.3,6.54,58,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,52.258,90.1,,percent of total billed charges,,
Xr Sternoclavicular Joints (Pro Cah)Professional Component ,,71130,CPT,Professional,Both,,,26,58,49.3,6.54,58,"Preferred One Administrative Services, INC.",PPO,57.188,98.6,,percent of total billed charges,,
Xr Sternoclavicular Joints (Pro Cah)Professional Component ,,71130,CPT,Professional,Both,,,26,58,49.3,6.54,58,PrimeWest Health,Minnesota Senior Health Options (MSHO),11.8795,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Sternoclavicular Joints (Pro Cah)Professional Component ,,71130,CPT,Professional,Both,,,26,58,49.3,6.54,58,PrimeWest Health,MinnesotaCare,8.0773016,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Sternoclavicular Joints (Pro Cah)Professional Component ,,71130,CPT,Professional,Both,,,26,58,49.3,6.54,58,Sanford Health Plan,Sanford Health Plan,51.04,88,,percent of total billed charges,,
Xr Sternoclavicular Joints (Pro Cah)Professional Component ,,71130,CPT,Professional,Both,,,26,58,49.3,6.54,58,"UCare Health, Inc.",Individual & Family Plan,16.792448,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Xr Sternoclavicular Joints (Pro Cah)Professional Component ,,71130,CPT,Professional,Both,,,26,58,49.3,6.54,58,"UCare Health, Inc.",Medical Assistance,8.303768,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Xr Sternoclavicular Joints (Pro Cah)Professional Component ,,71130,CPT,Professional,Both,,,26,58,49.3,6.54,58,"UCare Health, Inc.",Medicare Advantage,11.8795,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Xr Sternoclavicular Joints (Pro Cah)Professional Component ,,71130,CPT,Professional,Both,,,26,58,49.3,6.54,58,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),9.5036,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Xr Sternoclavicular Joints (Pro Cah)Professional Component ,,71130,CPT,Professional,Both,,,26,58,49.3,6.54,58,UnitedHealthcare,Individual & Family,58,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Xr Sternoclavicular Joints (Pro Cah)Professional Component ,,71130,CPT,Professional,Both,,,26,58,49.3,6.54,58,UnitedHealthcare,Medicare Advantage,11.8795,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Sternoclavicular Joints (Pro Cah)Professional Component ,,71130,CPT,Professional,Both,,,26,58,49.3,6.54,58,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,7.54888,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Ct, Thorax, Diagnostic; Without Contrast Material (Pro Cah)Professional Component ",,71250,CPT,Professional,Both,,,26,431,366.35,32.5,431,Aetna,Commercial,366.35,85,,percent of total billed charges,,
"Ct, Thorax, Diagnostic; Without Contrast Material (Pro Cah)Professional Component ",,71250,CPT,Professional,Both,,,26,431,366.35,32.5,431,Aetna,Medicare Advantage,52.09,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Ct, Thorax, Diagnostic; Without Contrast Material (Pro Cah)Professional Component ",,71250,CPT,Professional,Both,,,26,431,366.35,32.5,431,Aetna,PPO,400.83,93,,percent of total billed charges,,
"Ct, Thorax, Diagnostic; Without Contrast Material (Pro Cah)Professional Component ",,71250,CPT,Professional,Both,,,26,431,366.35,32.5,431,America's PPO,America's PPO,368.2464,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Ct, Thorax, Diagnostic; Without Contrast Material (Pro Cah)Professional Component ",,71250,CPT,Professional,Both,,,26,431,366.35,32.5,431,BlueCross BlueShield Minnesota, Federal Employee Program,97.8,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Ct, Thorax, Diagnostic; Without Contrast Material (Pro Cah)Professional Component ",,71250,CPT,Professional,Both,,,26,431,366.35,32.5,431,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,99.3648,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Ct, Thorax, Diagnostic; Without Contrast Material (Pro Cah)Professional Component ",,71250,CPT,Professional,Both,,,26,431,366.35,32.5,431,BlueCross BlueShield Minnesota,High Value Network Plan,99.3648,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Ct, Thorax, Diagnostic; Without Contrast Material (Pro Cah)Professional Component ",,71250,CPT,Professional,Both,,,26,431,366.35,32.5,431,BlueCross BlueShield Minnesota,Medicare Advantage,58.3395,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Ct, Thorax, Diagnostic; Without Contrast Material (Pro Cah)Professional Component ",,71250,CPT,Professional,Both,,,26,431,366.35,32.5,431,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,99.3648,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Ct, Thorax, Diagnostic; Without Contrast Material (Pro Cah)Professional Component ",,71250,CPT,Professional,Both,,,26,431,366.35,32.5,431,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,37.52088,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Ct, Thorax, Diagnostic; Without Contrast Material (Pro Cah)Professional Component ",,71250,CPT,Professional,Both,,,26,431,366.35,32.5,431,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),58.3395,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Ct, Thorax, Diagnostic; Without Contrast Material (Pro Cah)Professional Component ",,71250,CPT,Professional,Both,,,26,431,366.35,32.5,431,CorVel,Worker's Compensation,100.2660024,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Ct, Thorax, Diagnostic; Without Contrast Material (Pro Cah)Professional Component ",,71250,CPT,Professional,Both,,,26,431,366.35,32.5,431,First Health Group Corporation,First Health Network,418.07,97,,percent of total billed charges,,
"Ct, Thorax, Diagnostic; Without Contrast Material (Pro Cah)Professional Component ",,71250,CPT,Professional,Both,,,26,431,366.35,32.5,431,"Health Partners, Inc.",Commercial,77.35,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Ct, Thorax, Diagnostic; Without Contrast Material (Pro Cah)Professional Component ",,71250,CPT,Professional,Both,,,26,431,366.35,32.5,431,"Health Partners, Inc.",Medicare Advantage,58.3395,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Ct, Thorax, Diagnostic; Without Contrast Material (Pro Cah)Professional Component ",,71250,CPT,Professional,Both,,,26,431,366.35,32.5,431,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),32.5,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Ct, Thorax, Diagnostic; Without Contrast Material (Pro Cah)Professional Component ",,71250,CPT,Professional,Both,,,26,431,366.35,32.5,431,"Health Partners, Inc.",State of Minnesota Advantage Program,66.637025,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Ct, Thorax, Diagnostic; Without Contrast Material (Pro Cah)Professional Component ",,71250,CPT,Professional,Both,,,26,431,366.35,32.5,431,"Health Partners, Inc.",State Public Programs,32.5,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Ct, Thorax, Diagnostic; Without Contrast Material (Pro Cah)Professional Component ",,71250,CPT,Professional,Both,,,26,431,366.35,32.5,431,Humana Insurance Company,Commercial PPO,50.73,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Ct, Thorax, Diagnostic; Without Contrast Material (Pro Cah)Professional Component ",,71250,CPT,Professional,Both,,,26,431,366.35,32.5,431,Humana Insurance Company,Medicare PPO,431,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Ct, Thorax, Diagnostic; Without Contrast Material (Pro Cah)Professional Component ",,71250,CPT,Professional,Both,,,26,431,366.35,32.5,431,Medica,Individual & Family,365.488,84.8,,percent of total billed charges,,
"Ct, Thorax, Diagnostic; Without Contrast Material (Pro Cah)Professional Component ",,71250,CPT,Professional,Both,,,26,431,366.35,32.5,431,Medica,Medica Advantage Solution,214.638,49.8,,percent of total billed charges,,
"Ct, Thorax, Diagnostic; Without Contrast Material (Pro Cah)Professional Component ",,71250,CPT,Professional,Both,,,26,431,366.35,32.5,431,Medica,Medical Assistance,37.52,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Ct, Thorax, Diagnostic; Without Contrast Material (Pro Cah)Professional Component ",,71250,CPT,Professional,Both,,,26,431,366.35,32.5,431,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,50.73,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Ct, Thorax, Diagnostic; Without Contrast Material (Pro Cah)Professional Component ",,71250,CPT,Professional,Both,,,26,431,366.35,32.5,431,"Multiplan, Inc.","Multiplan, Inc.",405.14,94,,percent of total billed charges,,
"Ct, Thorax, Diagnostic; Without Contrast Material (Pro Cah)Professional Component ",,71250,CPT,Professional,Both,,,26,431,366.35,32.5,431,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,388.331,90.1,,percent of total billed charges,,
"Ct, Thorax, Diagnostic; Without Contrast Material (Pro Cah)Professional Component ",,71250,CPT,Professional,Both,,,26,431,366.35,32.5,431,"Preferred One Administrative Services, INC.",PPO,424.966,98.6,,percent of total billed charges,,
"Ct, Thorax, Diagnostic; Without Contrast Material (Pro Cah)Professional Component ",,71250,CPT,Professional,Both,,,26,431,366.35,32.5,431,PrimeWest Health,Minnesota Senior Health Options (MSHO),58.3395,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Ct, Thorax, Diagnostic; Without Contrast Material (Pro Cah)Professional Component ",,71250,CPT,Professional,Both,,,26,431,366.35,32.5,431,PrimeWest Health,MinnesotaCare,40.1473416,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Ct, Thorax, Diagnostic; Without Contrast Material (Pro Cah)Professional Component ",,71250,CPT,Professional,Both,,,26,431,366.35,32.5,431,Sanford Health Plan,Sanford Health Plan,379.28,88,,percent of total billed charges,,
"Ct, Thorax, Diagnostic; Without Contrast Material (Pro Cah)Professional Component ",,71250,CPT,Professional,Both,,,26,431,366.35,32.5,431,"UCare Health, Inc.",Individual & Family Plan,82.466688,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Ct, Thorax, Diagnostic; Without Contrast Material (Pro Cah)Professional Component ",,71250,CPT,Professional,Both,,,26,431,366.35,32.5,431,"UCare Health, Inc.",Medical Assistance,41.272968,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Ct, Thorax, Diagnostic; Without Contrast Material (Pro Cah)Professional Component ",,71250,CPT,Professional,Both,,,26,431,366.35,32.5,431,"UCare Health, Inc.",Medicare Advantage,58.3395,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Ct, Thorax, Diagnostic; Without Contrast Material (Pro Cah)Professional Component ",,71250,CPT,Professional,Both,,,26,431,366.35,32.5,431,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),46.6716,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Ct, Thorax, Diagnostic; Without Contrast Material (Pro Cah)Professional Component ",,71250,CPT,Professional,Both,,,26,431,366.35,32.5,431,UnitedHealthcare,Individual & Family,431,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Ct, Thorax, Diagnostic; Without Contrast Material (Pro Cah)Professional Component ",,71250,CPT,Professional,Both,,,26,431,366.35,32.5,431,UnitedHealthcare,Medicare Advantage,58.3395,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Ct, Thorax, Diagnostic; Without Contrast Material (Pro Cah)Professional Component ",,71250,CPT,Professional,Both,,,26,431,366.35,32.5,431,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,37.52088,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Ct, Thorax, Diagnostic; With Contrast Material(S) (Pro Cah)Professional Component ",,71260,CPT,Professional,Both,,,26,402,341.7,35.12,402,Aetna,Commercial,341.7,85,,percent of total billed charges,,
"Ct, Thorax, Diagnostic; With Contrast Material(S) (Pro Cah)Professional Component ",,71260,CPT,Professional,Both,,,26,402,341.7,35.12,402,Aetna,Medicare Advantage,56.29,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Ct, Thorax, Diagnostic; With Contrast Material(S) (Pro Cah)Professional Component ",,71260,CPT,Professional,Both,,,26,402,341.7,35.12,402,Aetna,PPO,373.86,93,,percent of total billed charges,,
"Ct, Thorax, Diagnostic; With Contrast Material(S) (Pro Cah)Professional Component ",,71260,CPT,Professional,Both,,,26,402,341.7,35.12,402,America's PPO,America's PPO,343.4688,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Ct, Thorax, Diagnostic; With Contrast Material(S) (Pro Cah)Professional Component ",,71260,CPT,Professional,Both,,,26,402,341.7,35.12,402,BlueCross BlueShield Minnesota, Federal Employee Program,105.47,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Ct, Thorax, Diagnostic; With Contrast Material(S) (Pro Cah)Professional Component ",,71260,CPT,Professional,Both,,,26,402,341.7,35.12,402,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,107.15752,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Ct, Thorax, Diagnostic; With Contrast Material(S) (Pro Cah)Professional Component ",,71260,CPT,Professional,Both,,,26,402,341.7,35.12,402,BlueCross BlueShield Minnesota,High Value Network Plan,107.15752,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Ct, Thorax, Diagnostic; With Contrast Material(S) (Pro Cah)Professional Component ",,71260,CPT,Professional,Both,,,26,402,341.7,35.12,402,BlueCross BlueShield Minnesota,Medicare Advantage,63.043,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Ct, Thorax, Diagnostic; With Contrast Material(S) (Pro Cah)Professional Component ",,71260,CPT,Professional,Both,,,26,402,341.7,35.12,402,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,107.15752,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Ct, Thorax, Diagnostic; With Contrast Material(S) (Pro Cah)Professional Component ",,71260,CPT,Professional,Both,,,26,402,341.7,35.12,402,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,40.54856,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Ct, Thorax, Diagnostic; With Contrast Material(S) (Pro Cah)Professional Component ",,71260,CPT,Professional,Both,,,26,402,341.7,35.12,402,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),63.043,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Ct, Thorax, Diagnostic; With Contrast Material(S) (Pro Cah)Professional Component ",,71260,CPT,Professional,Both,,,26,402,341.7,35.12,402,CorVel,Worker's Compensation,107.6808987,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Ct, Thorax, Diagnostic; With Contrast Material(S) (Pro Cah)Professional Component ",,71260,CPT,Professional,Both,,,26,402,341.7,35.12,402,First Health Group Corporation,First Health Network,389.94,97,,percent of total billed charges,,
"Ct, Thorax, Diagnostic; With Contrast Material(S) (Pro Cah)Professional Component ",,71260,CPT,Professional,Both,,,26,402,341.7,35.12,402,"Health Partners, Inc.",Commercial,83.02,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Ct, Thorax, Diagnostic; With Contrast Material(S) (Pro Cah)Professional Component ",,71260,CPT,Professional,Both,,,26,402,341.7,35.12,402,"Health Partners, Inc.",Medicare Advantage,63.043,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Ct, Thorax, Diagnostic; With Contrast Material(S) (Pro Cah)Professional Component ",,71260,CPT,Professional,Both,,,26,402,341.7,35.12,402,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),35.12,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Ct, Thorax, Diagnostic; With Contrast Material(S) (Pro Cah)Professional Component ",,71260,CPT,Professional,Both,,,26,402,341.7,35.12,402,"Health Partners, Inc.",State of Minnesota Advantage Program,71.52173,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Ct, Thorax, Diagnostic; With Contrast Material(S) (Pro Cah)Professional Component ",,71260,CPT,Professional,Both,,,26,402,341.7,35.12,402,"Health Partners, Inc.",State Public Programs,35.12,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Ct, Thorax, Diagnostic; With Contrast Material(S) (Pro Cah)Professional Component ",,71260,CPT,Professional,Both,,,26,402,341.7,35.12,402,Humana Insurance Company,Commercial PPO,54.82,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Ct, Thorax, Diagnostic; With Contrast Material(S) (Pro Cah)Professional Component ",,71260,CPT,Professional,Both,,,26,402,341.7,35.12,402,Humana Insurance Company,Medicare PPO,402,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Ct, Thorax, Diagnostic; With Contrast Material(S) (Pro Cah)Professional Component ",,71260,CPT,Professional,Both,,,26,402,341.7,35.12,402,Medica,Individual & Family,340.896,84.8,,percent of total billed charges,,
"Ct, Thorax, Diagnostic; With Contrast Material(S) (Pro Cah)Professional Component ",,71260,CPT,Professional,Both,,,26,402,341.7,35.12,402,Medica,Medica Advantage Solution,200.196,49.8,,percent of total billed charges,,
"Ct, Thorax, Diagnostic; With Contrast Material(S) (Pro Cah)Professional Component ",,71260,CPT,Professional,Both,,,26,402,341.7,35.12,402,Medica,Medical Assistance,40.55,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Ct, Thorax, Diagnostic; With Contrast Material(S) (Pro Cah)Professional Component ",,71260,CPT,Professional,Both,,,26,402,341.7,35.12,402,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,54.82,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Ct, Thorax, Diagnostic; With Contrast Material(S) (Pro Cah)Professional Component ",,71260,CPT,Professional,Both,,,26,402,341.7,35.12,402,"Multiplan, Inc.","Multiplan, Inc.",377.88,94,,percent of total billed charges,,
"Ct, Thorax, Diagnostic; With Contrast Material(S) (Pro Cah)Professional Component ",,71260,CPT,Professional,Both,,,26,402,341.7,35.12,402,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,362.202,90.1,,percent of total billed charges,,
"Ct, Thorax, Diagnostic; With Contrast Material(S) (Pro Cah)Professional Component ",,71260,CPT,Professional,Both,,,26,402,341.7,35.12,402,"Preferred One Administrative Services, INC.",PPO,396.372,98.6,,percent of total billed charges,,
"Ct, Thorax, Diagnostic; With Contrast Material(S) (Pro Cah)Professional Component ",,71260,CPT,Professional,Both,,,26,402,341.7,35.12,402,PrimeWest Health,Minnesota Senior Health Options (MSHO),63.043,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Ct, Thorax, Diagnostic; With Contrast Material(S) (Pro Cah)Professional Component ",,71260,CPT,Professional,Both,,,26,402,341.7,35.12,402,PrimeWest Health,MinnesotaCare,43.3869592,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Ct, Thorax, Diagnostic; With Contrast Material(S) (Pro Cah)Professional Component ",,71260,CPT,Professional,Both,,,26,402,341.7,35.12,402,Sanford Health Plan,Sanford Health Plan,353.76,88,,percent of total billed charges,,
"Ct, Thorax, Diagnostic; With Contrast Material(S) (Pro Cah)Professional Component ",,71260,CPT,Professional,Both,,,26,402,341.7,35.12,402,"UCare Health, Inc.",Individual & Family Plan,89.115392,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Ct, Thorax, Diagnostic; With Contrast Material(S) (Pro Cah)Professional Component ",,71260,CPT,Professional,Both,,,26,402,341.7,35.12,402,"UCare Health, Inc.",Medical Assistance,44.603416,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Ct, Thorax, Diagnostic; With Contrast Material(S) (Pro Cah)Professional Component ",,71260,CPT,Professional,Both,,,26,402,341.7,35.12,402,"UCare Health, Inc.",Medicare Advantage,63.043,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Ct, Thorax, Diagnostic; With Contrast Material(S) (Pro Cah)Professional Component ",,71260,CPT,Professional,Both,,,26,402,341.7,35.12,402,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),50.4344,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Ct, Thorax, Diagnostic; With Contrast Material(S) (Pro Cah)Professional Component ",,71260,CPT,Professional,Both,,,26,402,341.7,35.12,402,UnitedHealthcare,Individual & Family,402,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Ct, Thorax, Diagnostic; With Contrast Material(S) (Pro Cah)Professional Component ",,71260,CPT,Professional,Both,,,26,402,341.7,35.12,402,UnitedHealthcare,Medicare Advantage,63.043,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Ct, Thorax, Diagnostic; With Contrast Material(S) (Pro Cah)Professional Component ",,71260,CPT,Professional,Both,,,26,402,341.7,35.12,402,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,40.54856,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Ct, Thorax, Dx; Wo Contrast, Followed By Contrast Material(S) And Further Sections (Pro Cah)Professional Component ",,71270,CPT,Professional,Both,,,26,541,459.85,37.51,541,Aetna,Commercial,459.85,85,,percent of total billed charges,,
"Ct, Thorax, Dx; Wo Contrast, Followed By Contrast Material(S) And Further Sections (Pro Cah)Professional Component ",,71270,CPT,Professional,Both,,,26,541,459.85,37.51,541,Aetna,Medicare Advantage,60.14,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Ct, Thorax, Dx; Wo Contrast, Followed By Contrast Material(S) And Further Sections (Pro Cah)Professional Component ",,71270,CPT,Professional,Both,,,26,541,459.85,37.51,541,Aetna,PPO,503.13,93,,percent of total billed charges,,
"Ct, Thorax, Dx; Wo Contrast, Followed By Contrast Material(S) And Further Sections (Pro Cah)Professional Component ",,71270,CPT,Professional,Both,,,26,541,459.85,37.51,541,America's PPO,America's PPO,462.2304,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Ct, Thorax, Dx; Wo Contrast, Followed By Contrast Material(S) And Further Sections (Pro Cah)Professional Component ",,71270,CPT,Professional,Both,,,26,541,459.85,37.51,541,BlueCross BlueShield Minnesota, Federal Employee Program,112.5,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Ct, Thorax, Dx; Wo Contrast, Followed By Contrast Material(S) And Further Sections (Pro Cah)Professional Component ",,71270,CPT,Professional,Both,,,26,541,459.85,37.51,541,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,114.3,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Ct, Thorax, Dx; Wo Contrast, Followed By Contrast Material(S) And Further Sections (Pro Cah)Professional Component ",,71270,CPT,Professional,Both,,,26,541,459.85,37.51,541,BlueCross BlueShield Minnesota,High Value Network Plan,114.3,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Ct, Thorax, Dx; Wo Contrast, Followed By Contrast Material(S) And Further Sections (Pro Cah)Professional Component ",,71270,CPT,Professional,Both,,,26,541,459.85,37.51,541,BlueCross BlueShield Minnesota,Medicare Advantage,67.344,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Ct, Thorax, Dx; Wo Contrast, Followed By Contrast Material(S) And Further Sections (Pro Cah)Professional Component ",,71270,CPT,Professional,Both,,,26,541,459.85,37.51,541,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,114.3,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Ct, Thorax, Dx; Wo Contrast, Followed By Contrast Material(S) And Further Sections (Pro Cah)Professional Component ",,71270,CPT,Professional,Both,,,26,541,459.85,37.51,541,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,43.31208,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Ct, Thorax, Dx; Wo Contrast, Followed By Contrast Material(S) And Further Sections (Pro Cah)Professional Component ",,71270,CPT,Professional,Both,,,26,541,459.85,37.51,541,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),67.344,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Ct, Thorax, Dx; Wo Contrast, Followed By Contrast Material(S) And Further Sections (Pro Cah)Professional Component ",,71270,CPT,Professional,Both,,,26,541,459.85,37.51,541,CorVel,Worker's Compensation,116.2417152,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Ct, Thorax, Dx; Wo Contrast, Followed By Contrast Material(S) And Further Sections (Pro Cah)Professional Component ",,71270,CPT,Professional,Both,,,26,541,459.85,37.51,541,First Health Group Corporation,First Health Network,524.77,97,,percent of total billed charges,,
"Ct, Thorax, Dx; Wo Contrast, Followed By Contrast Material(S) And Further Sections (Pro Cah)Professional Component ",,71270,CPT,Professional,Both,,,26,541,459.85,37.51,541,"Health Partners, Inc.",Commercial,89.2,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Ct, Thorax, Dx; Wo Contrast, Followed By Contrast Material(S) And Further Sections (Pro Cah)Professional Component ",,71270,CPT,Professional,Both,,,26,541,459.85,37.51,541,"Health Partners, Inc.",Medicare Advantage,67.344,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Ct, Thorax, Dx; Wo Contrast, Followed By Contrast Material(S) And Further Sections (Pro Cah)Professional Component ",,71270,CPT,Professional,Both,,,26,541,459.85,37.51,541,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),37.51,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Ct, Thorax, Dx; Wo Contrast, Followed By Contrast Material(S) And Further Sections (Pro Cah)Professional Component ",,71270,CPT,Professional,Both,,,26,541,459.85,37.51,541,"Health Partners, Inc.",State of Minnesota Advantage Program,76.8458,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Ct, Thorax, Dx; Wo Contrast, Followed By Contrast Material(S) And Further Sections (Pro Cah)Professional Component ",,71270,CPT,Professional,Both,,,26,541,459.85,37.51,541,"Health Partners, Inc.",State Public Programs,37.51,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Ct, Thorax, Dx; Wo Contrast, Followed By Contrast Material(S) And Further Sections (Pro Cah)Professional Component ",,71270,CPT,Professional,Both,,,26,541,459.85,37.51,541,Humana Insurance Company,Commercial PPO,58.56,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Ct, Thorax, Dx; Wo Contrast, Followed By Contrast Material(S) And Further Sections (Pro Cah)Professional Component ",,71270,CPT,Professional,Both,,,26,541,459.85,37.51,541,Humana Insurance Company,Medicare PPO,541,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Ct, Thorax, Dx; Wo Contrast, Followed By Contrast Material(S) And Further Sections (Pro Cah)Professional Component ",,71270,CPT,Professional,Both,,,26,541,459.85,37.51,541,Medica,Individual & Family,458.768,84.8,,percent of total billed charges,,
"Ct, Thorax, Dx; Wo Contrast, Followed By Contrast Material(S) And Further Sections (Pro Cah)Professional Component ",,71270,CPT,Professional,Both,,,26,541,459.85,37.51,541,Medica,Medica Advantage Solution,269.418,49.8,,percent of total billed charges,,
"Ct, Thorax, Dx; Wo Contrast, Followed By Contrast Material(S) And Further Sections (Pro Cah)Professional Component ",,71270,CPT,Professional,Both,,,26,541,459.85,37.51,541,Medica,Medical Assistance,43.31,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Ct, Thorax, Dx; Wo Contrast, Followed By Contrast Material(S) And Further Sections (Pro Cah)Professional Component ",,71270,CPT,Professional,Both,,,26,541,459.85,37.51,541,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,58.56,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Ct, Thorax, Dx; Wo Contrast, Followed By Contrast Material(S) And Further Sections (Pro Cah)Professional Component ",,71270,CPT,Professional,Both,,,26,541,459.85,37.51,541,"Multiplan, Inc.","Multiplan, Inc.",508.54,94,,percent of total billed charges,,
"Ct, Thorax, Dx; Wo Contrast, Followed By Contrast Material(S) And Further Sections (Pro Cah)Professional Component ",,71270,CPT,Professional,Both,,,26,541,459.85,37.51,541,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,487.441,90.1,,percent of total billed charges,,
"Ct, Thorax, Dx; Wo Contrast, Followed By Contrast Material(S) And Further Sections (Pro Cah)Professional Component ",,71270,CPT,Professional,Both,,,26,541,459.85,37.51,541,"Preferred One Administrative Services, INC.",PPO,533.426,98.6,,percent of total billed charges,,
"Ct, Thorax, Dx; Wo Contrast, Followed By Contrast Material(S) And Further Sections (Pro Cah)Professional Component ",,71270,CPT,Professional,Both,,,26,541,459.85,37.51,541,PrimeWest Health,Minnesota Senior Health Options (MSHO),67.344,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Ct, Thorax, Dx; Wo Contrast, Followed By Contrast Material(S) And Further Sections (Pro Cah)Professional Component ",,71270,CPT,Professional,Both,,,26,541,459.85,37.51,541,PrimeWest Health,MinnesotaCare,46.3439256,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Ct, Thorax, Dx; Wo Contrast, Followed By Contrast Material(S) And Further Sections (Pro Cah)Professional Component ",,71270,CPT,Professional,Both,,,26,541,459.85,37.51,541,Sanford Health Plan,Sanford Health Plan,476.08,88,,percent of total billed charges,,
"Ct, Thorax, Dx; Wo Contrast, Followed By Contrast Material(S) And Further Sections (Pro Cah)Professional Component ",,71270,CPT,Professional,Both,,,26,541,459.85,37.51,541,"UCare Health, Inc.",Individual & Family Plan,95.195136,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Ct, Thorax, Dx; Wo Contrast, Followed By Contrast Material(S) And Further Sections (Pro Cah)Professional Component ",,71270,CPT,Professional,Both,,,26,541,459.85,37.51,541,"UCare Health, Inc.",Medical Assistance,47.643288,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Ct, Thorax, Dx; Wo Contrast, Followed By Contrast Material(S) And Further Sections (Pro Cah)Professional Component ",,71270,CPT,Professional,Both,,,26,541,459.85,37.51,541,"UCare Health, Inc.",Medicare Advantage,67.344,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Ct, Thorax, Dx; Wo Contrast, Followed By Contrast Material(S) And Further Sections (Pro Cah)Professional Component ",,71270,CPT,Professional,Both,,,26,541,459.85,37.51,541,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),53.8752,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Ct, Thorax, Dx; Wo Contrast, Followed By Contrast Material(S) And Further Sections (Pro Cah)Professional Component ",,71270,CPT,Professional,Both,,,26,541,459.85,37.51,541,UnitedHealthcare,Individual & Family,541,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Ct, Thorax, Dx; Wo Contrast, Followed By Contrast Material(S) And Further Sections (Pro Cah)Professional Component ",,71270,CPT,Professional,Both,,,26,541,459.85,37.51,541,UnitedHealthcare,Medicare Advantage,67.344,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Ct, Thorax, Dx; Wo Contrast, Followed By Contrast Material(S) And Further Sections (Pro Cah)Professional Component ",,71270,CPT,Professional,Both,,,26,541,459.85,37.51,541,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,43.31208,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Ct, Thorax, Low Dose For Lung Cancer Screening, Without Contrast Material (Pro Cah)Professional Component ",,71271,CPT,Professional,Both,,,26,348,295.8,32.5,348,Aetna,Commercial,295.8,85,,percent of total billed charges,,
"Ct, Thorax, Low Dose For Lung Cancer Screening, Without Contrast Material (Pro Cah)Professional Component ",,71271,CPT,Professional,Both,,,26,348,295.8,32.5,348,Aetna,Medicare Advantage,52.09,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Ct, Thorax, Low Dose For Lung Cancer Screening, Without Contrast Material (Pro Cah)Professional Component ",,71271,CPT,Professional,Both,,,26,348,295.8,32.5,348,Aetna,PPO,323.64,93,,percent of total billed charges,,
"Ct, Thorax, Low Dose For Lung Cancer Screening, Without Contrast Material (Pro Cah)Professional Component ",,71271,CPT,Professional,Both,,,26,348,295.8,32.5,348,America's PPO,America's PPO,297.3312,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Ct, Thorax, Low Dose For Lung Cancer Screening, Without Contrast Material (Pro Cah)Professional Component ",,71271,CPT,Professional,Both,,,26,348,295.8,32.5,348,BlueCross BlueShield Minnesota, Federal Employee Program,97.8,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Ct, Thorax, Low Dose For Lung Cancer Screening, Without Contrast Material (Pro Cah)Professional Component ",,71271,CPT,Professional,Both,,,26,348,295.8,32.5,348,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,99.3648,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Ct, Thorax, Low Dose For Lung Cancer Screening, Without Contrast Material (Pro Cah)Professional Component ",,71271,CPT,Professional,Both,,,26,348,295.8,32.5,348,BlueCross BlueShield Minnesota,High Value Network Plan,99.3648,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Ct, Thorax, Low Dose For Lung Cancer Screening, Without Contrast Material (Pro Cah)Professional Component ",,71271,CPT,Professional,Both,,,26,348,295.8,32.5,348,BlueCross BlueShield Minnesota,Medicare Advantage,58.3395,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Ct, Thorax, Low Dose For Lung Cancer Screening, Without Contrast Material (Pro Cah)Professional Component ",,71271,CPT,Professional,Both,,,26,348,295.8,32.5,348,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,99.3648,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Ct, Thorax, Low Dose For Lung Cancer Screening, Without Contrast Material (Pro Cah)Professional Component ",,71271,CPT,Professional,Both,,,26,348,295.8,32.5,348,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,37.52088,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Ct, Thorax, Low Dose For Lung Cancer Screening, Without Contrast Material (Pro Cah)Professional Component ",,71271,CPT,Professional,Both,,,26,348,295.8,32.5,348,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),58.3395,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Ct, Thorax, Low Dose For Lung Cancer Screening, Without Contrast Material (Pro Cah)Professional Component ",,71271,CPT,Professional,Both,,,26,348,295.8,32.5,348,CorVel,Worker's Compensation,100.2660024,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Ct, Thorax, Low Dose For Lung Cancer Screening, Without Contrast Material (Pro Cah)Professional Component ",,71271,CPT,Professional,Both,,,26,348,295.8,32.5,348,First Health Group Corporation,First Health Network,337.56,97,,percent of total billed charges,,
"Ct, Thorax, Low Dose For Lung Cancer Screening, Without Contrast Material (Pro Cah)Professional Component ",,71271,CPT,Professional,Both,,,26,348,295.8,32.5,348,"Health Partners, Inc.",Commercial,77.35,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Ct, Thorax, Low Dose For Lung Cancer Screening, Without Contrast Material (Pro Cah)Professional Component ",,71271,CPT,Professional,Both,,,26,348,295.8,32.5,348,"Health Partners, Inc.",Medicare Advantage,58.3395,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Ct, Thorax, Low Dose For Lung Cancer Screening, Without Contrast Material (Pro Cah)Professional Component ",,71271,CPT,Professional,Both,,,26,348,295.8,32.5,348,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),32.5,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Ct, Thorax, Low Dose For Lung Cancer Screening, Without Contrast Material (Pro Cah)Professional Component ",,71271,CPT,Professional,Both,,,26,348,295.8,32.5,348,"Health Partners, Inc.",State of Minnesota Advantage Program,66.637025,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Ct, Thorax, Low Dose For Lung Cancer Screening, Without Contrast Material (Pro Cah)Professional Component ",,71271,CPT,Professional,Both,,,26,348,295.8,32.5,348,"Health Partners, Inc.",State Public Programs,32.5,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Ct, Thorax, Low Dose For Lung Cancer Screening, Without Contrast Material (Pro Cah)Professional Component ",,71271,CPT,Professional,Both,,,26,348,295.8,32.5,348,Humana Insurance Company,Commercial PPO,50.73,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Ct, Thorax, Low Dose For Lung Cancer Screening, Without Contrast Material (Pro Cah)Professional Component ",,71271,CPT,Professional,Both,,,26,348,295.8,32.5,348,Humana Insurance Company,Medicare PPO,348,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Ct, Thorax, Low Dose For Lung Cancer Screening, Without Contrast Material (Pro Cah)Professional Component ",,71271,CPT,Professional,Both,,,26,348,295.8,32.5,348,Medica,Individual & Family,295.104,84.8,,percent of total billed charges,,
"Ct, Thorax, Low Dose For Lung Cancer Screening, Without Contrast Material (Pro Cah)Professional Component ",,71271,CPT,Professional,Both,,,26,348,295.8,32.5,348,Medica,Medica Advantage Solution,173.304,49.8,,percent of total billed charges,,
"Ct, Thorax, Low Dose For Lung Cancer Screening, Without Contrast Material (Pro Cah)Professional Component ",,71271,CPT,Professional,Both,,,26,348,295.8,32.5,348,Medica,Medical Assistance,37.52,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Ct, Thorax, Low Dose For Lung Cancer Screening, Without Contrast Material (Pro Cah)Professional Component ",,71271,CPT,Professional,Both,,,26,348,295.8,32.5,348,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,50.73,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Ct, Thorax, Low Dose For Lung Cancer Screening, Without Contrast Material (Pro Cah)Professional Component ",,71271,CPT,Professional,Both,,,26,348,295.8,32.5,348,"Multiplan, Inc.","Multiplan, Inc.",327.12,94,,percent of total billed charges,,
"Ct, Thorax, Low Dose For Lung Cancer Screening, Without Contrast Material (Pro Cah)Professional Component ",,71271,CPT,Professional,Both,,,26,348,295.8,32.5,348,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,313.548,90.1,,percent of total billed charges,,
"Ct, Thorax, Low Dose For Lung Cancer Screening, Without Contrast Material (Pro Cah)Professional Component ",,71271,CPT,Professional,Both,,,26,348,295.8,32.5,348,"Preferred One Administrative Services, INC.",PPO,343.128,98.6,,percent of total billed charges,,
"Ct, Thorax, Low Dose For Lung Cancer Screening, Without Contrast Material (Pro Cah)Professional Component ",,71271,CPT,Professional,Both,,,26,348,295.8,32.5,348,PrimeWest Health,Minnesota Senior Health Options (MSHO),58.3395,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Ct, Thorax, Low Dose For Lung Cancer Screening, Without Contrast Material (Pro Cah)Professional Component ",,71271,CPT,Professional,Both,,,26,348,295.8,32.5,348,PrimeWest Health,MinnesotaCare,40.1473416,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Ct, Thorax, Low Dose For Lung Cancer Screening, Without Contrast Material (Pro Cah)Professional Component ",,71271,CPT,Professional,Both,,,26,348,295.8,32.5,348,Sanford Health Plan,Sanford Health Plan,306.24,88,,percent of total billed charges,,
"Ct, Thorax, Low Dose For Lung Cancer Screening, Without Contrast Material (Pro Cah)Professional Component ",,71271,CPT,Professional,Both,,,26,348,295.8,32.5,348,"UCare Health, Inc.",Individual & Family Plan,82.466688,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Ct, Thorax, Low Dose For Lung Cancer Screening, Without Contrast Material (Pro Cah)Professional Component ",,71271,CPT,Professional,Both,,,26,348,295.8,32.5,348,"UCare Health, Inc.",Medical Assistance,41.272968,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Ct, Thorax, Low Dose For Lung Cancer Screening, Without Contrast Material (Pro Cah)Professional Component ",,71271,CPT,Professional,Both,,,26,348,295.8,32.5,348,"UCare Health, Inc.",Medicare Advantage,58.3395,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Ct, Thorax, Low Dose For Lung Cancer Screening, Without Contrast Material (Pro Cah)Professional Component ",,71271,CPT,Professional,Both,,,26,348,295.8,32.5,348,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),46.6716,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Ct, Thorax, Low Dose For Lung Cancer Screening, Without Contrast Material (Pro Cah)Professional Component ",,71271,CPT,Professional,Both,,,26,348,295.8,32.5,348,UnitedHealthcare,Individual & Family,348,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Ct, Thorax, Low Dose For Lung Cancer Screening, Without Contrast Material (Pro Cah)Professional Component ",,71271,CPT,Professional,Both,,,26,348,295.8,32.5,348,UnitedHealthcare,Medicare Advantage,58.3395,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Ct, Thorax, Low Dose For Lung Cancer Screening, Without Contrast Material (Pro Cah)Professional Component ",,71271,CPT,Professional,Both,,,26,348,295.8,32.5,348,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,37.52088,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Cta, Chest, W/Contrast,And Image Postprocess (Pro Cah)Professional Component ",,71275,CPT,Professional,Both,,,26,644,547.4,54.75,644,Aetna,Commercial,547.4,85,,percent of total billed charges,,
"Cta, Chest, W/Contrast,And Image Postprocess (Pro Cah)Professional Component ",,71275,CPT,Professional,Both,,,26,644,547.4,54.75,644,Aetna,Medicare Advantage,87.59,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Cta, Chest, W/Contrast,And Image Postprocess (Pro Cah)Professional Component ",,71275,CPT,Professional,Both,,,26,644,547.4,54.75,644,Aetna,PPO,598.92,93,,percent of total billed charges,,
"Cta, Chest, W/Contrast,And Image Postprocess (Pro Cah)Professional Component ",,71275,CPT,Professional,Both,,,26,644,547.4,54.75,644,America's PPO,America's PPO,550.2336,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Cta, Chest, W/Contrast,And Image Postprocess (Pro Cah)Professional Component ",,71275,CPT,Professional,Both,,,26,644,547.4,54.75,644,BlueCross BlueShield Minnesota, Federal Employee Program,164.27,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Cta, Chest, W/Contrast,And Image Postprocess (Pro Cah)Professional Component ",,71275,CPT,Professional,Both,,,26,644,547.4,54.75,644,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,166.89832,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Cta, Chest, W/Contrast,And Image Postprocess (Pro Cah)Professional Component ",,71275,CPT,Professional,Both,,,26,644,547.4,54.75,644,BlueCross BlueShield Minnesota,High Value Network Plan,166.89832,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Cta, Chest, W/Contrast,And Image Postprocess (Pro Cah)Professional Component ",,71275,CPT,Professional,Both,,,26,644,547.4,54.75,644,BlueCross BlueShield Minnesota,Medicare Advantage,98.003,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Cta, Chest, W/Contrast,And Image Postprocess (Pro Cah)Professional Component ",,71275,CPT,Professional,Both,,,26,644,547.4,54.75,644,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,166.89832,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Cta, Chest, W/Contrast,And Image Postprocess (Pro Cah)Professional Component ",,71275,CPT,Professional,Both,,,26,644,547.4,54.75,644,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,63.21552,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Cta, Chest, W/Contrast,And Image Postprocess (Pro Cah)Professional Component ",,71275,CPT,Professional,Both,,,26,644,547.4,54.75,644,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),98.003,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Cta, Chest, W/Contrast,And Image Postprocess (Pro Cah)Professional Component ",,71275,CPT,Professional,Both,,,26,644,547.4,54.75,644,CorVel,Worker's Compensation,168.6114774,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Cta, Chest, W/Contrast,And Image Postprocess (Pro Cah)Professional Component ",,71275,CPT,Professional,Both,,,26,644,547.4,54.75,644,First Health Group Corporation,First Health Network,624.68,97,,percent of total billed charges,,
"Cta, Chest, W/Contrast,And Image Postprocess (Pro Cah)Professional Component ",,71275,CPT,Professional,Both,,,26,644,547.4,54.75,644,"Health Partners, Inc.",Commercial,129.42,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Cta, Chest, W/Contrast,And Image Postprocess (Pro Cah)Professional Component ",,71275,CPT,Professional,Both,,,26,644,547.4,54.75,644,"Health Partners, Inc.",Medicare Advantage,98.003,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Cta, Chest, W/Contrast,And Image Postprocess (Pro Cah)Professional Component ",,71275,CPT,Professional,Both,,,26,644,547.4,54.75,644,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),54.75,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Cta, Chest, W/Contrast,And Image Postprocess (Pro Cah)Professional Component ",,71275,CPT,Professional,Both,,,26,644,547.4,54.75,644,"Health Partners, Inc.",State of Minnesota Advantage Program,111.49533,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Cta, Chest, W/Contrast,And Image Postprocess (Pro Cah)Professional Component ",,71275,CPT,Professional,Both,,,26,644,547.4,54.75,644,"Health Partners, Inc.",State Public Programs,54.75,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Cta, Chest, W/Contrast,And Image Postprocess (Pro Cah)Professional Component ",,71275,CPT,Professional,Both,,,26,644,547.4,54.75,644,Humana Insurance Company,Commercial PPO,85.22,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Cta, Chest, W/Contrast,And Image Postprocess (Pro Cah)Professional Component ",,71275,CPT,Professional,Both,,,26,644,547.4,54.75,644,Humana Insurance Company,Medicare PPO,644,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Cta, Chest, W/Contrast,And Image Postprocess (Pro Cah)Professional Component ",,71275,CPT,Professional,Both,,,26,644,547.4,54.75,644,Medica,Individual & Family,546.112,84.8,,percent of total billed charges,,
"Cta, Chest, W/Contrast,And Image Postprocess (Pro Cah)Professional Component ",,71275,CPT,Professional,Both,,,26,644,547.4,54.75,644,Medica,Medica Advantage Solution,320.712,49.8,,percent of total billed charges,,
"Cta, Chest, W/Contrast,And Image Postprocess (Pro Cah)Professional Component ",,71275,CPT,Professional,Both,,,26,644,547.4,54.75,644,Medica,Medical Assistance,63.22,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Cta, Chest, W/Contrast,And Image Postprocess (Pro Cah)Professional Component ",,71275,CPT,Professional,Both,,,26,644,547.4,54.75,644,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,85.22,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Cta, Chest, W/Contrast,And Image Postprocess (Pro Cah)Professional Component ",,71275,CPT,Professional,Both,,,26,644,547.4,54.75,644,"Multiplan, Inc.","Multiplan, Inc.",605.36,94,,percent of total billed charges,,
"Cta, Chest, W/Contrast,And Image Postprocess (Pro Cah)Professional Component ",,71275,CPT,Professional,Both,,,26,644,547.4,54.75,644,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,580.244,90.1,,percent of total billed charges,,
"Cta, Chest, W/Contrast,And Image Postprocess (Pro Cah)Professional Component ",,71275,CPT,Professional,Both,,,26,644,547.4,54.75,644,"Preferred One Administrative Services, INC.",PPO,634.984,98.6,,percent of total billed charges,,
"Cta, Chest, W/Contrast,And Image Postprocess (Pro Cah)Professional Component ",,71275,CPT,Professional,Both,,,26,644,547.4,54.75,644,PrimeWest Health,Minnesota Senior Health Options (MSHO),98.003,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Cta, Chest, W/Contrast,And Image Postprocess (Pro Cah)Professional Component ",,71275,CPT,Professional,Both,,,26,644,547.4,54.75,644,PrimeWest Health,MinnesotaCare,67.6406064,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Cta, Chest, W/Contrast,And Image Postprocess (Pro Cah)Professional Component ",,71275,CPT,Professional,Both,,,26,644,547.4,54.75,644,Sanford Health Plan,Sanford Health Plan,566.72,88,,percent of total billed charges,,
"Cta, Chest, W/Contrast,And Image Postprocess (Pro Cah)Professional Component ",,71275,CPT,Professional,Both,,,26,644,547.4,54.75,644,"UCare Health, Inc.",Individual & Family Plan,138.533632,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Cta, Chest, W/Contrast,And Image Postprocess (Pro Cah)Professional Component ",,71275,CPT,Professional,Both,,,26,644,547.4,54.75,644,"UCare Health, Inc.",Medical Assistance,69.537072,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Cta, Chest, W/Contrast,And Image Postprocess (Pro Cah)Professional Component ",,71275,CPT,Professional,Both,,,26,644,547.4,54.75,644,"UCare Health, Inc.",Medicare Advantage,98.003,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Cta, Chest, W/Contrast,And Image Postprocess (Pro Cah)Professional Component ",,71275,CPT,Professional,Both,,,26,644,547.4,54.75,644,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),78.4024,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Cta, Chest, W/Contrast,And Image Postprocess (Pro Cah)Professional Component ",,71275,CPT,Professional,Both,,,26,644,547.4,54.75,644,UnitedHealthcare,Individual & Family,644,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Cta, Chest, W/Contrast,And Image Postprocess (Pro Cah)Professional Component ",,71275,CPT,Professional,Both,,,26,644,547.4,54.75,644,UnitedHealthcare,Medicare Advantage,98.003,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Cta, Chest, W/Contrast,And Image Postprocess (Pro Cah)Professional Component ",,71275,CPT,Professional,Both,,,26,644,547.4,54.75,644,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,63.21552,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Mri, Chest (Eg, For Eval Hilar And Mediastinal Lymphadenopathy); W/O Contrast Material(S) (Pro Cah)Professional Component ",,71550,CPT,Professional,Both,,,26,451,383.35,44.06,451,Aetna,Commercial,383.35,85,,percent of total billed charges,,
"Mri, Chest (Eg, For Eval Hilar And Mediastinal Lymphadenopathy); W/O Contrast Material(S) (Pro Cah)Professional Component ",,71550,CPT,Professional,Both,,,26,451,383.35,44.06,451,Aetna,Medicare Advantage,70.42,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Mri, Chest (Eg, For Eval Hilar And Mediastinal Lymphadenopathy); W/O Contrast Material(S) (Pro Cah)Professional Component ",,71550,CPT,Professional,Both,,,26,451,383.35,44.06,451,Aetna,PPO,419.43,93,,percent of total billed charges,,
"Mri, Chest (Eg, For Eval Hilar And Mediastinal Lymphadenopathy); W/O Contrast Material(S) (Pro Cah)Professional Component ",,71550,CPT,Professional,Both,,,26,451,383.35,44.06,451,America's PPO,America's PPO,385.3344,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Mri, Chest (Eg, For Eval Hilar And Mediastinal Lymphadenopathy); W/O Contrast Material(S) (Pro Cah)Professional Component ",,71550,CPT,Professional,Both,,,26,451,383.35,44.06,451,BlueCross BlueShield Minnesota, Federal Employee Program,132.31,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Mri, Chest (Eg, For Eval Hilar And Mediastinal Lymphadenopathy); W/O Contrast Material(S) (Pro Cah)Professional Component ",,71550,CPT,Professional,Both,,,26,451,383.35,44.06,451,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,134.42696,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Mri, Chest (Eg, For Eval Hilar And Mediastinal Lymphadenopathy); W/O Contrast Material(S) (Pro Cah)Professional Component ",,71550,CPT,Professional,Both,,,26,451,383.35,44.06,451,BlueCross BlueShield Minnesota,High Value Network Plan,134.42696,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Mri, Chest (Eg, For Eval Hilar And Mediastinal Lymphadenopathy); W/O Contrast Material(S) (Pro Cah)Professional Component ",,71550,CPT,Professional,Both,,,26,451,383.35,44.06,451,BlueCross BlueShield Minnesota,Medicare Advantage,78.959,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Mri, Chest (Eg, For Eval Hilar And Mediastinal Lymphadenopathy); W/O Contrast Material(S) (Pro Cah)Professional Component ",,71550,CPT,Professional,Both,,,26,451,383.35,44.06,451,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,134.42696,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Mri, Chest (Eg, For Eval Hilar And Mediastinal Lymphadenopathy); W/O Contrast Material(S) (Pro Cah)Professional Component ",,71550,CPT,Professional,Both,,,26,451,383.35,44.06,451,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,50.87112,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Mri, Chest (Eg, For Eval Hilar And Mediastinal Lymphadenopathy); W/O Contrast Material(S) (Pro Cah)Professional Component ",,71550,CPT,Professional,Both,,,26,451,383.35,44.06,451,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),78.959,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Mri, Chest (Eg, For Eval Hilar And Mediastinal Lymphadenopathy); W/O Contrast Material(S) (Pro Cah)Professional Component ",,71550,CPT,Professional,Both,,,26,451,383.35,44.06,451,CorVel,Worker's Compensation,135.34755,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Mri, Chest (Eg, For Eval Hilar And Mediastinal Lymphadenopathy); W/O Contrast Material(S) (Pro Cah)Professional Component ",,71550,CPT,Professional,Both,,,26,451,383.35,44.06,451,First Health Group Corporation,First Health Network,437.47,97,,percent of total billed charges,,
"Mri, Chest (Eg, For Eval Hilar And Mediastinal Lymphadenopathy); W/O Contrast Material(S) (Pro Cah)Professional Component ",,71550,CPT,Professional,Both,,,26,451,383.35,44.06,451,"Health Partners, Inc.",Commercial,104.16,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Mri, Chest (Eg, For Eval Hilar And Mediastinal Lymphadenopathy); W/O Contrast Material(S) (Pro Cah)Professional Component ",,71550,CPT,Professional,Both,,,26,451,383.35,44.06,451,"Health Partners, Inc.",Medicare Advantage,78.959,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Mri, Chest (Eg, For Eval Hilar And Mediastinal Lymphadenopathy); W/O Contrast Material(S) (Pro Cah)Professional Component ",,71550,CPT,Professional,Both,,,26,451,383.35,44.06,451,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),44.06,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Mri, Chest (Eg, For Eval Hilar And Mediastinal Lymphadenopathy); W/O Contrast Material(S) (Pro Cah)Professional Component ",,71550,CPT,Professional,Both,,,26,451,383.35,44.06,451,"Health Partners, Inc.",State of Minnesota Advantage Program,89.73384,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Mri, Chest (Eg, For Eval Hilar And Mediastinal Lymphadenopathy); W/O Contrast Material(S) (Pro Cah)Professional Component ",,71550,CPT,Professional,Both,,,26,451,383.35,44.06,451,"Health Partners, Inc.",State Public Programs,44.06,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Mri, Chest (Eg, For Eval Hilar And Mediastinal Lymphadenopathy); W/O Contrast Material(S) (Pro Cah)Professional Component ",,71550,CPT,Professional,Both,,,26,451,383.35,44.06,451,Humana Insurance Company,Commercial PPO,68.66,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Mri, Chest (Eg, For Eval Hilar And Mediastinal Lymphadenopathy); W/O Contrast Material(S) (Pro Cah)Professional Component ",,71550,CPT,Professional,Both,,,26,451,383.35,44.06,451,Humana Insurance Company,Medicare PPO,451,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Mri, Chest (Eg, For Eval Hilar And Mediastinal Lymphadenopathy); W/O Contrast Material(S) (Pro Cah)Professional Component ",,71550,CPT,Professional,Both,,,26,451,383.35,44.06,451,Medica,Individual & Family,382.448,84.8,,percent of total billed charges,,
"Mri, Chest (Eg, For Eval Hilar And Mediastinal Lymphadenopathy); W/O Contrast Material(S) (Pro Cah)Professional Component ",,71550,CPT,Professional,Both,,,26,451,383.35,44.06,451,Medica,Medica Advantage Solution,224.598,49.8,,percent of total billed charges,,
"Mri, Chest (Eg, For Eval Hilar And Mediastinal Lymphadenopathy); W/O Contrast Material(S) (Pro Cah)Professional Component ",,71550,CPT,Professional,Both,,,26,451,383.35,44.06,451,Medica,Medical Assistance,50.87,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Mri, Chest (Eg, For Eval Hilar And Mediastinal Lymphadenopathy); W/O Contrast Material(S) (Pro Cah)Professional Component ",,71550,CPT,Professional,Both,,,26,451,383.35,44.06,451,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,68.66,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Mri, Chest (Eg, For Eval Hilar And Mediastinal Lymphadenopathy); W/O Contrast Material(S) (Pro Cah)Professional Component ",,71550,CPT,Professional,Both,,,26,451,383.35,44.06,451,"Multiplan, Inc.","Multiplan, Inc.",423.94,94,,percent of total billed charges,,
"Mri, Chest (Eg, For Eval Hilar And Mediastinal Lymphadenopathy); W/O Contrast Material(S) (Pro Cah)Professional Component ",,71550,CPT,Professional,Both,,,26,451,383.35,44.06,451,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,406.351,90.1,,percent of total billed charges,,
"Mri, Chest (Eg, For Eval Hilar And Mediastinal Lymphadenopathy); W/O Contrast Material(S) (Pro Cah)Professional Component ",,71550,CPT,Professional,Both,,,26,451,383.35,44.06,451,"Preferred One Administrative Services, INC.",PPO,444.686,98.6,,percent of total billed charges,,
"Mri, Chest (Eg, For Eval Hilar And Mediastinal Lymphadenopathy); W/O Contrast Material(S) (Pro Cah)Professional Component ",,71550,CPT,Professional,Both,,,26,451,383.35,44.06,451,PrimeWest Health,Minnesota Senior Health Options (MSHO),78.959,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Mri, Chest (Eg, For Eval Hilar And Mediastinal Lymphadenopathy); W/O Contrast Material(S) (Pro Cah)Professional Component ",,71550,CPT,Professional,Both,,,26,451,383.35,44.06,451,PrimeWest Health,MinnesotaCare,54.4320984,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Mri, Chest (Eg, For Eval Hilar And Mediastinal Lymphadenopathy); W/O Contrast Material(S) (Pro Cah)Professional Component ",,71550,CPT,Professional,Both,,,26,451,383.35,44.06,451,Sanford Health Plan,Sanford Health Plan,396.88,88,,percent of total billed charges,,
"Mri, Chest (Eg, For Eval Hilar And Mediastinal Lymphadenopathy); W/O Contrast Material(S) (Pro Cah)Professional Component ",,71550,CPT,Professional,Both,,,26,451,383.35,44.06,451,"UCare Health, Inc.",Individual & Family Plan,111.613696,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Mri, Chest (Eg, For Eval Hilar And Mediastinal Lymphadenopathy); W/O Contrast Material(S) (Pro Cah)Professional Component ",,71550,CPT,Professional,Both,,,26,451,383.35,44.06,451,"UCare Health, Inc.",Medical Assistance,55.958232,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Mri, Chest (Eg, For Eval Hilar And Mediastinal Lymphadenopathy); W/O Contrast Material(S) (Pro Cah)Professional Component ",,71550,CPT,Professional,Both,,,26,451,383.35,44.06,451,"UCare Health, Inc.",Medicare Advantage,78.959,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Mri, Chest (Eg, For Eval Hilar And Mediastinal Lymphadenopathy); W/O Contrast Material(S) (Pro Cah)Professional Component ",,71550,CPT,Professional,Both,,,26,451,383.35,44.06,451,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),63.1672,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Mri, Chest (Eg, For Eval Hilar And Mediastinal Lymphadenopathy); W/O Contrast Material(S) (Pro Cah)Professional Component ",,71550,CPT,Professional,Both,,,26,451,383.35,44.06,451,UnitedHealthcare,Individual & Family,451,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Mri, Chest (Eg, For Eval Hilar And Mediastinal Lymphadenopathy); W/O Contrast Material(S) (Pro Cah)Professional Component ",,71550,CPT,Professional,Both,,,26,451,383.35,44.06,451,UnitedHealthcare,Medicare Advantage,78.959,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Mri, Chest (Eg, For Eval Hilar And Mediastinal Lymphadenopathy); W/O Contrast Material(S) (Pro Cah)Professional Component ",,71550,CPT,Professional,Both,,,26,451,383.35,44.06,451,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,50.87112,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Mri, Chest (Eg, For Eval Of Hilar And Mediastinal Lymphadenopathy); With Contrast Material (Pro Cah)Professional Component ",,71551,CPT,Professional,Both,,,26,463,393.55,52.13,463,Aetna,Commercial,393.55,85,,percent of total billed charges,,
"Mri, Chest (Eg, For Eval Of Hilar And Mediastinal Lymphadenopathy); With Contrast Material (Pro Cah)Professional Component ",,71551,CPT,Professional,Both,,,26,463,393.55,52.13,463,Aetna,Medicare Advantage,83.39,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Mri, Chest (Eg, For Eval Of Hilar And Mediastinal Lymphadenopathy); With Contrast Material (Pro Cah)Professional Component ",,71551,CPT,Professional,Both,,,26,463,393.55,52.13,463,Aetna,PPO,430.59,93,,percent of total billed charges,,
"Mri, Chest (Eg, For Eval Of Hilar And Mediastinal Lymphadenopathy); With Contrast Material (Pro Cah)Professional Component ",,71551,CPT,Professional,Both,,,26,463,393.55,52.13,463,America's PPO,America's PPO,395.5872,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Mri, Chest (Eg, For Eval Of Hilar And Mediastinal Lymphadenopathy); With Contrast Material (Pro Cah)Professional Component ",,71551,CPT,Professional,Both,,,26,463,393.55,52.13,463,BlueCross BlueShield Minnesota, Federal Employee Program,156.6,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Mri, Chest (Eg, For Eval Of Hilar And Mediastinal Lymphadenopathy); With Contrast Material (Pro Cah)Professional Component ",,71551,CPT,Professional,Both,,,26,463,393.55,52.13,463,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,159.1056,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Mri, Chest (Eg, For Eval Of Hilar And Mediastinal Lymphadenopathy); With Contrast Material (Pro Cah)Professional Component ",,71551,CPT,Professional,Both,,,26,463,393.55,52.13,463,BlueCross BlueShield Minnesota,High Value Network Plan,159.1056,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Mri, Chest (Eg, For Eval Of Hilar And Mediastinal Lymphadenopathy); With Contrast Material (Pro Cah)Professional Component ",,71551,CPT,Professional,Both,,,26,463,393.55,52.13,463,BlueCross BlueShield Minnesota,Medicare Advantage,93.311,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Mri, Chest (Eg, For Eval Of Hilar And Mediastinal Lymphadenopathy); With Contrast Material (Pro Cah)Professional Component ",,71551,CPT,Professional,Both,,,26,463,393.55,52.13,463,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,159.1056,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Mri, Chest (Eg, For Eval Of Hilar And Mediastinal Lymphadenopathy); With Contrast Material (Pro Cah)Professional Component ",,71551,CPT,Professional,Both,,,26,463,393.55,52.13,463,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,60.18784,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Mri, Chest (Eg, For Eval Of Hilar And Mediastinal Lymphadenopathy); With Contrast Material (Pro Cah)Professional Component ",,71551,CPT,Professional,Both,,,26,463,393.55,52.13,463,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),93.311,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Mri, Chest (Eg, For Eval Of Hilar And Mediastinal Lymphadenopathy); With Contrast Material (Pro Cah)Professional Component ",,71551,CPT,Professional,Both,,,26,463,393.55,52.13,463,CorVel,Worker's Compensation,160.5248811,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Mri, Chest (Eg, For Eval Of Hilar And Mediastinal Lymphadenopathy); With Contrast Material (Pro Cah)Professional Component ",,71551,CPT,Professional,Both,,,26,463,393.55,52.13,463,First Health Group Corporation,First Health Network,449.11,97,,percent of total billed charges,,
"Mri, Chest (Eg, For Eval Of Hilar And Mediastinal Lymphadenopathy); With Contrast Material (Pro Cah)Professional Component ",,71551,CPT,Professional,Both,,,26,463,393.55,52.13,463,"Health Partners, Inc.",Commercial,123.23,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Mri, Chest (Eg, For Eval Of Hilar And Mediastinal Lymphadenopathy); With Contrast Material (Pro Cah)Professional Component ",,71551,CPT,Professional,Both,,,26,463,393.55,52.13,463,"Health Partners, Inc.",Medicare Advantage,93.311,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Mri, Chest (Eg, For Eval Of Hilar And Mediastinal Lymphadenopathy); With Contrast Material (Pro Cah)Professional Component ",,71551,CPT,Professional,Both,,,26,463,393.55,52.13,463,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),52.13,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Mri, Chest (Eg, For Eval Of Hilar And Mediastinal Lymphadenopathy); With Contrast Material (Pro Cah)Professional Component ",,71551,CPT,Professional,Both,,,26,463,393.55,52.13,463,"Health Partners, Inc.",State of Minnesota Advantage Program,106.162645,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Mri, Chest (Eg, For Eval Of Hilar And Mediastinal Lymphadenopathy); With Contrast Material (Pro Cah)Professional Component ",,71551,CPT,Professional,Both,,,26,463,393.55,52.13,463,"Health Partners, Inc.",State Public Programs,52.13,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Mri, Chest (Eg, For Eval Of Hilar And Mediastinal Lymphadenopathy); With Contrast Material (Pro Cah)Professional Component ",,71551,CPT,Professional,Both,,,26,463,393.55,52.13,463,Humana Insurance Company,Commercial PPO,81.14,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Mri, Chest (Eg, For Eval Of Hilar And Mediastinal Lymphadenopathy); With Contrast Material (Pro Cah)Professional Component ",,71551,CPT,Professional,Both,,,26,463,393.55,52.13,463,Humana Insurance Company,Medicare PPO,463,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Mri, Chest (Eg, For Eval Of Hilar And Mediastinal Lymphadenopathy); With Contrast Material (Pro Cah)Professional Component ",,71551,CPT,Professional,Both,,,26,463,393.55,52.13,463,Medica,Individual & Family,392.624,84.8,,percent of total billed charges,,
"Mri, Chest (Eg, For Eval Of Hilar And Mediastinal Lymphadenopathy); With Contrast Material (Pro Cah)Professional Component ",,71551,CPT,Professional,Both,,,26,463,393.55,52.13,463,Medica,Medica Advantage Solution,230.574,49.8,,percent of total billed charges,,
"Mri, Chest (Eg, For Eval Of Hilar And Mediastinal Lymphadenopathy); With Contrast Material (Pro Cah)Professional Component ",,71551,CPT,Professional,Both,,,26,463,393.55,52.13,463,Medica,Medical Assistance,60.19,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Mri, Chest (Eg, For Eval Of Hilar And Mediastinal Lymphadenopathy); With Contrast Material (Pro Cah)Professional Component ",,71551,CPT,Professional,Both,,,26,463,393.55,52.13,463,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,81.14,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Mri, Chest (Eg, For Eval Of Hilar And Mediastinal Lymphadenopathy); With Contrast Material (Pro Cah)Professional Component ",,71551,CPT,Professional,Both,,,26,463,393.55,52.13,463,"Multiplan, Inc.","Multiplan, Inc.",435.22,94,,percent of total billed charges,,
"Mri, Chest (Eg, For Eval Of Hilar And Mediastinal Lymphadenopathy); With Contrast Material (Pro Cah)Professional Component ",,71551,CPT,Professional,Both,,,26,463,393.55,52.13,463,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,417.163,90.1,,percent of total billed charges,,
"Mri, Chest (Eg, For Eval Of Hilar And Mediastinal Lymphadenopathy); With Contrast Material (Pro Cah)Professional Component ",,71551,CPT,Professional,Both,,,26,463,393.55,52.13,463,"Preferred One Administrative Services, INC.",PPO,456.518,98.6,,percent of total billed charges,,
"Mri, Chest (Eg, For Eval Of Hilar And Mediastinal Lymphadenopathy); With Contrast Material (Pro Cah)Professional Component ",,71551,CPT,Professional,Both,,,26,463,393.55,52.13,463,PrimeWest Health,Minnesota Senior Health Options (MSHO),93.311,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Mri, Chest (Eg, For Eval Of Hilar And Mediastinal Lymphadenopathy); With Contrast Material (Pro Cah)Professional Component ",,71551,CPT,Professional,Both,,,26,463,393.55,52.13,463,PrimeWest Health,MinnesotaCare,64.4009888,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Mri, Chest (Eg, For Eval Of Hilar And Mediastinal Lymphadenopathy); With Contrast Material (Pro Cah)Professional Component ",,71551,CPT,Professional,Both,,,26,463,393.55,52.13,463,Sanford Health Plan,Sanford Health Plan,407.44,88,,percent of total billed charges,,
"Mri, Chest (Eg, For Eval Of Hilar And Mediastinal Lymphadenopathy); With Contrast Material (Pro Cah)Professional Component ",,71551,CPT,Professional,Both,,,26,463,393.55,52.13,463,"UCare Health, Inc.",Individual & Family Plan,131.901184,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Mri, Chest (Eg, For Eval Of Hilar And Mediastinal Lymphadenopathy); With Contrast Material (Pro Cah)Professional Component ",,71551,CPT,Professional,Both,,,26,463,393.55,52.13,463,"UCare Health, Inc.",Medical Assistance,66.206624,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Mri, Chest (Eg, For Eval Of Hilar And Mediastinal Lymphadenopathy); With Contrast Material (Pro Cah)Professional Component ",,71551,CPT,Professional,Both,,,26,463,393.55,52.13,463,"UCare Health, Inc.",Medicare Advantage,93.311,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Mri, Chest (Eg, For Eval Of Hilar And Mediastinal Lymphadenopathy); With Contrast Material (Pro Cah)Professional Component ",,71551,CPT,Professional,Both,,,26,463,393.55,52.13,463,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),74.6488,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Mri, Chest (Eg, For Eval Of Hilar And Mediastinal Lymphadenopathy); With Contrast Material (Pro Cah)Professional Component ",,71551,CPT,Professional,Both,,,26,463,393.55,52.13,463,UnitedHealthcare,Individual & Family,463,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Mri, Chest (Eg, For Eval Of Hilar And Mediastinal Lymphadenopathy); With Contrast Material (Pro Cah)Professional Component ",,71551,CPT,Professional,Both,,,26,463,393.55,52.13,463,UnitedHealthcare,Medicare Advantage,93.311,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Mri, Chest (Eg, For Eval Of Hilar And Mediastinal Lymphadenopathy); With Contrast Material (Pro Cah)Professional Component ",,71551,CPT,Professional,Both,,,26,463,393.55,52.13,463,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,60.18784,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Mri Chest W/O Contrast, Followed By Contrast And Further Sequences (Pro Cah)Professional Component ",,71552,CPT,Professional,Both,,,26,797,677.45,68.06,797,Aetna,Commercial,677.45,85,,percent of total billed charges,,
"Mri Chest W/O Contrast, Followed By Contrast And Further Sequences (Pro Cah)Professional Component ",,71552,CPT,Professional,Both,,,26,797,677.45,68.06,797,Aetna,Medicare Advantage,108.72,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Mri Chest W/O Contrast, Followed By Contrast And Further Sequences (Pro Cah)Professional Component ",,71552,CPT,Professional,Both,,,26,797,677.45,68.06,797,Aetna,PPO,741.21,93,,percent of total billed charges,,
"Mri Chest W/O Contrast, Followed By Contrast And Further Sequences (Pro Cah)Professional Component ",,71552,CPT,Professional,Both,,,26,797,677.45,68.06,797,America's PPO,America's PPO,680.9568,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Mri Chest W/O Contrast, Followed By Contrast And Further Sequences (Pro Cah)Professional Component ",,71552,CPT,Professional,Both,,,26,797,677.45,68.06,797,BlueCross BlueShield Minnesota, Federal Employee Program,203.9,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Mri Chest W/O Contrast, Followed By Contrast And Further Sequences (Pro Cah)Professional Component ",,71552,CPT,Professional,Both,,,26,797,677.45,68.06,797,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,207.1624,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Mri Chest W/O Contrast, Followed By Contrast And Further Sequences (Pro Cah)Professional Component ",,71552,CPT,Professional,Both,,,26,797,677.45,68.06,797,BlueCross BlueShield Minnesota,High Value Network Plan,207.1624,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Mri Chest W/O Contrast, Followed By Contrast And Further Sequences (Pro Cah)Professional Component ",,71552,CPT,Professional,Both,,,26,797,677.45,68.06,797,BlueCross BlueShield Minnesota,Medicare Advantage,122.1645,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Mri Chest W/O Contrast, Followed By Contrast And Further Sequences (Pro Cah)Professional Component ",,71552,CPT,Professional,Both,,,26,797,677.45,68.06,797,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,207.1624,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Mri Chest W/O Contrast, Followed By Contrast And Further Sequences (Pro Cah)Professional Component ",,71552,CPT,Professional,Both,,,26,797,677.45,68.06,797,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,78.57744,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Mri Chest W/O Contrast, Followed By Contrast And Further Sequences (Pro Cah)Professional Component ",,71552,CPT,Professional,Both,,,26,797,677.45,68.06,797,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),122.1645,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Mri Chest W/O Contrast, Followed By Contrast And Further Sequences (Pro Cah)Professional Component ",,71552,CPT,Professional,Both,,,26,797,677.45,68.06,797,CorVel,Worker's Compensation,209.2903011,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Mri Chest W/O Contrast, Followed By Contrast And Further Sequences (Pro Cah)Professional Component ",,71552,CPT,Professional,Both,,,26,797,677.45,68.06,797,First Health Group Corporation,First Health Network,773.09,97,,percent of total billed charges,,
"Mri Chest W/O Contrast, Followed By Contrast And Further Sequences (Pro Cah)Professional Component ",,71552,CPT,Professional,Both,,,26,797,677.45,68.06,797,"Health Partners, Inc.",Commercial,160.87,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Mri Chest W/O Contrast, Followed By Contrast And Further Sequences (Pro Cah)Professional Component ",,71552,CPT,Professional,Both,,,26,797,677.45,68.06,797,"Health Partners, Inc.",Medicare Advantage,122.1645,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Mri Chest W/O Contrast, Followed By Contrast And Further Sequences (Pro Cah)Professional Component ",,71552,CPT,Professional,Both,,,26,797,677.45,68.06,797,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),68.06,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Mri Chest W/O Contrast, Followed By Contrast And Further Sequences (Pro Cah)Professional Component ",,71552,CPT,Professional,Both,,,26,797,677.45,68.06,797,"Health Partners, Inc.",State of Minnesota Advantage Program,138.589505,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Mri Chest W/O Contrast, Followed By Contrast And Further Sequences (Pro Cah)Professional Component ",,71552,CPT,Professional,Both,,,26,797,677.45,68.06,797,"Health Partners, Inc.",State Public Programs,68.06,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Mri Chest W/O Contrast, Followed By Contrast And Further Sequences (Pro Cah)Professional Component ",,71552,CPT,Professional,Both,,,26,797,677.45,68.06,797,Humana Insurance Company,Commercial PPO,106.23,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Mri Chest W/O Contrast, Followed By Contrast And Further Sequences (Pro Cah)Professional Component ",,71552,CPT,Professional,Both,,,26,797,677.45,68.06,797,Humana Insurance Company,Medicare PPO,797,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Mri Chest W/O Contrast, Followed By Contrast And Further Sequences (Pro Cah)Professional Component ",,71552,CPT,Professional,Both,,,26,797,677.45,68.06,797,Medica,Individual & Family,675.856,84.8,,percent of total billed charges,,
"Mri Chest W/O Contrast, Followed By Contrast And Further Sequences (Pro Cah)Professional Component ",,71552,CPT,Professional,Both,,,26,797,677.45,68.06,797,Medica,Medica Advantage Solution,396.906,49.8,,percent of total billed charges,,
"Mri Chest W/O Contrast, Followed By Contrast And Further Sequences (Pro Cah)Professional Component ",,71552,CPT,Professional,Both,,,26,797,677.45,68.06,797,Medica,Medical Assistance,78.58,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Mri Chest W/O Contrast, Followed By Contrast And Further Sequences (Pro Cah)Professional Component ",,71552,CPT,Professional,Both,,,26,797,677.45,68.06,797,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,106.23,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Mri Chest W/O Contrast, Followed By Contrast And Further Sequences (Pro Cah)Professional Component ",,71552,CPT,Professional,Both,,,26,797,677.45,68.06,797,"Multiplan, Inc.","Multiplan, Inc.",749.18,94,,percent of total billed charges,,
"Mri Chest W/O Contrast, Followed By Contrast And Further Sequences (Pro Cah)Professional Component ",,71552,CPT,Professional,Both,,,26,797,677.45,68.06,797,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,718.097,90.1,,percent of total billed charges,,
"Mri Chest W/O Contrast, Followed By Contrast And Further Sequences (Pro Cah)Professional Component ",,71552,CPT,Professional,Both,,,26,797,677.45,68.06,797,"Preferred One Administrative Services, INC.",PPO,785.842,98.6,,percent of total billed charges,,
"Mri Chest W/O Contrast, Followed By Contrast And Further Sequences (Pro Cah)Professional Component ",,71552,CPT,Professional,Both,,,26,797,677.45,68.06,797,PrimeWest Health,Minnesota Senior Health Options (MSHO),122.1645,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Mri Chest W/O Contrast, Followed By Contrast And Further Sequences (Pro Cah)Professional Component ",,71552,CPT,Professional,Both,,,26,797,677.45,68.06,797,PrimeWest Health,MinnesotaCare,84.0778608,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Mri Chest W/O Contrast, Followed By Contrast And Further Sequences (Pro Cah)Professional Component ",,71552,CPT,Professional,Both,,,26,797,677.45,68.06,797,Sanford Health Plan,Sanford Health Plan,701.36,88,,percent of total billed charges,,
"Mri Chest W/O Contrast, Followed By Contrast And Further Sequences (Pro Cah)Professional Component ",,71552,CPT,Professional,Both,,,26,797,677.45,68.06,797,"UCare Health, Inc.",Individual & Family Plan,172.687488,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Mri Chest W/O Contrast, Followed By Contrast And Further Sequences (Pro Cah)Professional Component ",,71552,CPT,Professional,Both,,,26,797,677.45,68.06,797,"UCare Health, Inc.",Medical Assistance,86.435184,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Mri Chest W/O Contrast, Followed By Contrast And Further Sequences (Pro Cah)Professional Component ",,71552,CPT,Professional,Both,,,26,797,677.45,68.06,797,"UCare Health, Inc.",Medicare Advantage,122.1645,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Mri Chest W/O Contrast, Followed By Contrast And Further Sequences (Pro Cah)Professional Component ",,71552,CPT,Professional,Both,,,26,797,677.45,68.06,797,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),97.7316,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Mri Chest W/O Contrast, Followed By Contrast And Further Sequences (Pro Cah)Professional Component ",,71552,CPT,Professional,Both,,,26,797,677.45,68.06,797,UnitedHealthcare,Individual & Family,797,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Mri Chest W/O Contrast, Followed By Contrast And Further Sequences (Pro Cah)Professional Component ",,71552,CPT,Professional,Both,,,26,797,677.45,68.06,797,UnitedHealthcare,Medicare Advantage,122.1645,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Mri Chest W/O Contrast, Followed By Contrast And Further Sequences (Pro Cah)Professional Component ",,71552,CPT,Professional,Both,,,26,797,677.45,68.06,797,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,78.57744,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Mra, Chest (Excluding Myocardium), With Or W/O Contrast Material(S) (Pro Cah)Professional Component ",,71555,CPT,Professional,Both,,,26,708,601.8,54.09,708,Aetna,Commercial,601.8,85,,percent of total billed charges,,
"Mra, Chest (Excluding Myocardium), With Or W/O Contrast Material(S) (Pro Cah)Professional Component ",,71555,CPT,Professional,Both,,,26,708,601.8,54.09,708,Aetna,Medicare Advantage,86.53,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Mra, Chest (Excluding Myocardium), With Or W/O Contrast Material(S) (Pro Cah)Professional Component ",,71555,CPT,Professional,Both,,,26,708,601.8,54.09,708,Aetna,PPO,658.44,93,,percent of total billed charges,,
"Mra, Chest (Excluding Myocardium), With Or W/O Contrast Material(S) (Pro Cah)Professional Component ",,71555,CPT,Professional,Both,,,26,708,601.8,54.09,708,America's PPO,America's PPO,604.9152,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Mra, Chest (Excluding Myocardium), With Or W/O Contrast Material(S) (Pro Cah)Professional Component ",,71555,CPT,Professional,Both,,,26,708,601.8,54.09,708,BlueCross BlueShield Minnesota, Federal Employee Program,162.36,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Mra, Chest (Excluding Myocardium), With Or W/O Contrast Material(S) (Pro Cah)Professional Component ",,71555,CPT,Professional,Both,,,26,708,601.8,54.09,708,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,164.95776,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Mra, Chest (Excluding Myocardium), With Or W/O Contrast Material(S) (Pro Cah)Professional Component ",,71555,CPT,Professional,Both,,,26,708,601.8,54.09,708,BlueCross BlueShield Minnesota,High Value Network Plan,164.95776,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Mra, Chest (Excluding Myocardium), With Or W/O Contrast Material(S) (Pro Cah)Professional Component ",,71555,CPT,Professional,Both,,,26,708,601.8,54.09,708,BlueCross BlueShield Minnesota,Medicare Advantage,96.83,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Mra, Chest (Excluding Myocardium), With Or W/O Contrast Material(S) (Pro Cah)Professional Component ",,71555,CPT,Professional,Both,,,26,708,601.8,54.09,708,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,164.95776,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Mra, Chest (Excluding Myocardium), With Or W/O Contrast Material(S) (Pro Cah)Professional Component ",,71555,CPT,Professional,Both,,,26,708,601.8,54.09,708,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,62.45352,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Mra, Chest (Excluding Myocardium), With Or W/O Contrast Material(S) (Pro Cah)Professional Component ",,71555,CPT,Professional,Both,,,26,708,601.8,54.09,708,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),96.83,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Mra, Chest (Excluding Myocardium), With Or W/O Contrast Material(S) (Pro Cah)Professional Component ",,71555,CPT,Professional,Both,,,26,708,601.8,54.09,708,CorVel,Worker's Compensation,166.5789132,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Mra, Chest (Excluding Myocardium), With Or W/O Contrast Material(S) (Pro Cah)Professional Component ",,71555,CPT,Professional,Both,,,26,708,601.8,54.09,708,First Health Group Corporation,First Health Network,686.76,97,,percent of total billed charges,,
"Mra, Chest (Excluding Myocardium), With Or W/O Contrast Material(S) (Pro Cah)Professional Component ",,71555,CPT,Professional,Both,,,26,708,601.8,54.09,708,"Health Partners, Inc.",Commercial,127.87,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Mra, Chest (Excluding Myocardium), With Or W/O Contrast Material(S) (Pro Cah)Professional Component ",,71555,CPT,Professional,Both,,,26,708,601.8,54.09,708,"Health Partners, Inc.",Medicare Advantage,96.83,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Mra, Chest (Excluding Myocardium), With Or W/O Contrast Material(S) (Pro Cah)Professional Component ",,71555,CPT,Professional,Both,,,26,708,601.8,54.09,708,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),54.09,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Mra, Chest (Excluding Myocardium), With Or W/O Contrast Material(S) (Pro Cah)Professional Component ",,71555,CPT,Professional,Both,,,26,708,601.8,54.09,708,"Health Partners, Inc.",State of Minnesota Advantage Program,110.160005,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Mra, Chest (Excluding Myocardium), With Or W/O Contrast Material(S) (Pro Cah)Professional Component ",,71555,CPT,Professional,Both,,,26,708,601.8,54.09,708,"Health Partners, Inc.",State Public Programs,54.09,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Mra, Chest (Excluding Myocardium), With Or W/O Contrast Material(S) (Pro Cah)Professional Component ",,71555,CPT,Professional,Both,,,26,708,601.8,54.09,708,Humana Insurance Company,Commercial PPO,84.2,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Mra, Chest (Excluding Myocardium), With Or W/O Contrast Material(S) (Pro Cah)Professional Component ",,71555,CPT,Professional,Both,,,26,708,601.8,54.09,708,Humana Insurance Company,Medicare PPO,708,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Mra, Chest (Excluding Myocardium), With Or W/O Contrast Material(S) (Pro Cah)Professional Component ",,71555,CPT,Professional,Both,,,26,708,601.8,54.09,708,Medica,Individual & Family,600.384,84.8,,percent of total billed charges,,
"Mra, Chest (Excluding Myocardium), With Or W/O Contrast Material(S) (Pro Cah)Professional Component ",,71555,CPT,Professional,Both,,,26,708,601.8,54.09,708,Medica,Medica Advantage Solution,352.584,49.8,,percent of total billed charges,,
"Mra, Chest (Excluding Myocardium), With Or W/O Contrast Material(S) (Pro Cah)Professional Component ",,71555,CPT,Professional,Both,,,26,708,601.8,54.09,708,Medica,Medical Assistance,62.45,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Mra, Chest (Excluding Myocardium), With Or W/O Contrast Material(S) (Pro Cah)Professional Component ",,71555,CPT,Professional,Both,,,26,708,601.8,54.09,708,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,84.2,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Mra, Chest (Excluding Myocardium), With Or W/O Contrast Material(S) (Pro Cah)Professional Component ",,71555,CPT,Professional,Both,,,26,708,601.8,54.09,708,"Multiplan, Inc.","Multiplan, Inc.",665.52,94,,percent of total billed charges,,
"Mra, Chest (Excluding Myocardium), With Or W/O Contrast Material(S) (Pro Cah)Professional Component ",,71555,CPT,Professional,Both,,,26,708,601.8,54.09,708,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,637.908,90.1,,percent of total billed charges,,
"Mra, Chest (Excluding Myocardium), With Or W/O Contrast Material(S) (Pro Cah)Professional Component ",,71555,CPT,Professional,Both,,,26,708,601.8,54.09,708,"Preferred One Administrative Services, INC.",PPO,698.088,98.6,,percent of total billed charges,,
"Mra, Chest (Excluding Myocardium), With Or W/O Contrast Material(S) (Pro Cah)Professional Component ",,71555,CPT,Professional,Both,,,26,708,601.8,54.09,708,PrimeWest Health,Minnesota Senior Health Options (MSHO),96.83,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Mra, Chest (Excluding Myocardium), With Or W/O Contrast Material(S) (Pro Cah)Professional Component ",,71555,CPT,Professional,Both,,,26,708,601.8,54.09,708,PrimeWest Health,MinnesotaCare,66.8252664,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Mra, Chest (Excluding Myocardium), With Or W/O Contrast Material(S) (Pro Cah)Professional Component ",,71555,CPT,Professional,Both,,,26,708,601.8,54.09,708,Sanford Health Plan,Sanford Health Plan,623.04,88,,percent of total billed charges,,
"Mra, Chest (Excluding Myocardium), With Or W/O Contrast Material(S) (Pro Cah)Professional Component ",,71555,CPT,Professional,Both,,,26,708,601.8,54.09,708,"UCare Health, Inc.",Individual & Family Plan,136.87552,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Mra, Chest (Excluding Myocardium), With Or W/O Contrast Material(S) (Pro Cah)Professional Component ",,71555,CPT,Professional,Both,,,26,708,601.8,54.09,708,"UCare Health, Inc.",Medical Assistance,68.698872,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Mra, Chest (Excluding Myocardium), With Or W/O Contrast Material(S) (Pro Cah)Professional Component ",,71555,CPT,Professional,Both,,,26,708,601.8,54.09,708,"UCare Health, Inc.",Medicare Advantage,96.83,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Mra, Chest (Excluding Myocardium), With Or W/O Contrast Material(S) (Pro Cah)Professional Component ",,71555,CPT,Professional,Both,,,26,708,601.8,54.09,708,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),77.464,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Mra, Chest (Excluding Myocardium), With Or W/O Contrast Material(S) (Pro Cah)Professional Component ",,71555,CPT,Professional,Both,,,26,708,601.8,54.09,708,UnitedHealthcare,Individual & Family,708,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Mra, Chest (Excluding Myocardium), With Or W/O Contrast Material(S) (Pro Cah)Professional Component ",,71555,CPT,Professional,Both,,,26,708,601.8,54.09,708,UnitedHealthcare,Medicare Advantage,96.83,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Mra, Chest (Excluding Myocardium), With Or W/O Contrast Material(S) (Pro Cah)Professional Component ",,71555,CPT,Professional,Both,,,26,708,601.8,54.09,708,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,62.45352,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Xr, Spine, Single View, Specify Level (Pro Cah)Professional Component ",,72020,CPT,Professional,Both,,,26,40,34,4.8,40,Aetna,Commercial,34,85,,percent of total billed charges,,
"Xr, Spine, Single View, Specify Level (Pro Cah)Professional Component ",,72020,CPT,Professional,Both,,,26,40,34,4.8,40,Aetna,Medicare Advantage,7.83,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Xr, Spine, Single View, Specify Level (Pro Cah)Professional Component ",,72020,CPT,Professional,Both,,,26,40,34,4.8,40,Aetna,PPO,37.2,93,,percent of total billed charges,,
"Xr, Spine, Single View, Specify Level (Pro Cah)Professional Component ",,72020,CPT,Professional,Both,,,26,40,34,4.8,40,America's PPO,America's PPO,34.176,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Xr, Spine, Single View, Specify Level (Pro Cah)Professional Component ",,72020,CPT,Professional,Both,,,26,40,34,4.8,40,BlueCross BlueShield Minnesota, Federal Employee Program,14.7,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Xr, Spine, Single View, Specify Level (Pro Cah)Professional Component ",,72020,CPT,Professional,Both,,,26,40,34,4.8,40,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,14.9352,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Xr, Spine, Single View, Specify Level (Pro Cah)Professional Component ",,72020,CPT,Professional,Both,,,26,40,34,4.8,40,BlueCross BlueShield Minnesota,High Value Network Plan,14.9352,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Xr, Spine, Single View, Specify Level (Pro Cah)Professional Component ",,72020,CPT,Professional,Both,,,26,40,34,4.8,40,BlueCross BlueShield Minnesota,Medicare Advantage,8.74,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Xr, Spine, Single View, Specify Level (Pro Cah)Professional Component ",,72020,CPT,Professional,Both,,,26,40,34,4.8,40,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,14.9352,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Xr, Spine, Single View, Specify Level (Pro Cah)Professional Component ",,72020,CPT,Professional,Both,,,26,40,34,4.8,40,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,5.5372,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Xr, Spine, Single View, Specify Level (Pro Cah)Professional Component ",,72020,CPT,Professional,Both,,,26,40,34,4.8,40,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),8.74,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Xr, Spine, Single View, Specify Level (Pro Cah)Professional Component ",,72020,CPT,Professional,Both,,,26,40,34,4.8,40,CorVel,Worker's Compensation,15.0669027,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Xr, Spine, Single View, Specify Level (Pro Cah)Professional Component ",,72020,CPT,Professional,Both,,,26,40,34,4.8,40,First Health Group Corporation,First Health Network,38.8,97,,percent of total billed charges,,
"Xr, Spine, Single View, Specify Level (Pro Cah)Professional Component ",,72020,CPT,Professional,Both,,,26,40,34,4.8,40,"Health Partners, Inc.",Commercial,11.35,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Xr, Spine, Single View, Specify Level (Pro Cah)Professional Component ",,72020,CPT,Professional,Both,,,26,40,34,4.8,40,"Health Partners, Inc.",Medicare Advantage,8.74,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Xr, Spine, Single View, Specify Level (Pro Cah)Professional Component ",,72020,CPT,Professional,Both,,,26,40,34,4.8,40,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),4.8,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Xr, Spine, Single View, Specify Level (Pro Cah)Professional Component ",,72020,CPT,Professional,Both,,,26,40,34,4.8,40,"Health Partners, Inc.",State of Minnesota Advantage Program,9.778025,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Xr, Spine, Single View, Specify Level (Pro Cah)Professional Component ",,72020,CPT,Professional,Both,,,26,40,34,4.8,40,"Health Partners, Inc.",State Public Programs,4.8,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Xr, Spine, Single View, Specify Level (Pro Cah)Professional Component ",,72020,CPT,Professional,Both,,,26,40,34,4.8,40,Humana Insurance Company,Commercial PPO,7.6,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Xr, Spine, Single View, Specify Level (Pro Cah)Professional Component ",,72020,CPT,Professional,Both,,,26,40,34,4.8,40,Humana Insurance Company,Medicare PPO,40,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Xr, Spine, Single View, Specify Level (Pro Cah)Professional Component ",,72020,CPT,Professional,Both,,,26,40,34,4.8,40,Medica,Individual & Family,33.92,84.8,,percent of total billed charges,,
"Xr, Spine, Single View, Specify Level (Pro Cah)Professional Component ",,72020,CPT,Professional,Both,,,26,40,34,4.8,40,Medica,Medica Advantage Solution,19.92,49.8,,percent of total billed charges,,
"Xr, Spine, Single View, Specify Level (Pro Cah)Professional Component ",,72020,CPT,Professional,Both,,,26,40,34,4.8,40,Medica,Medical Assistance,5.54,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Xr, Spine, Single View, Specify Level (Pro Cah)Professional Component ",,72020,CPT,Professional,Both,,,26,40,34,4.8,40,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,7.6,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Xr, Spine, Single View, Specify Level (Pro Cah)Professional Component ",,72020,CPT,Professional,Both,,,26,40,34,4.8,40,"Multiplan, Inc.","Multiplan, Inc.",37.6,94,,percent of total billed charges,,
"Xr, Spine, Single View, Specify Level (Pro Cah)Professional Component ",,72020,CPT,Professional,Both,,,26,40,34,4.8,40,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,36.04,90.1,,percent of total billed charges,,
"Xr, Spine, Single View, Specify Level (Pro Cah)Professional Component ",,72020,CPT,Professional,Both,,,26,40,34,4.8,40,"Preferred One Administrative Services, INC.",PPO,39.44,98.6,,percent of total billed charges,,
"Xr, Spine, Single View, Specify Level (Pro Cah)Professional Component ",,72020,CPT,Professional,Both,,,26,40,34,4.8,40,PrimeWest Health,Minnesota Senior Health Options (MSHO),8.74,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Xr, Spine, Single View, Specify Level (Pro Cah)Professional Component ",,72020,CPT,Professional,Both,,,26,40,34,4.8,40,PrimeWest Health,MinnesotaCare,5.924804,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Xr, Spine, Single View, Specify Level (Pro Cah)Professional Component ",,72020,CPT,Professional,Both,,,26,40,34,4.8,40,Sanford Health Plan,Sanford Health Plan,35.2,88,,percent of total billed charges,,
"Xr, Spine, Single View, Specify Level (Pro Cah)Professional Component ",,72020,CPT,Professional,Both,,,26,40,34,4.8,40,"UCare Health, Inc.",Individual & Family Plan,12.35456,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Xr, Spine, Single View, Specify Level (Pro Cah)Professional Component ",,72020,CPT,Professional,Both,,,26,40,34,4.8,40,"UCare Health, Inc.",Medical Assistance,6.09092,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Xr, Spine, Single View, Specify Level (Pro Cah)Professional Component ",,72020,CPT,Professional,Both,,,26,40,34,4.8,40,"UCare Health, Inc.",Medicare Advantage,8.74,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Xr, Spine, Single View, Specify Level (Pro Cah)Professional Component ",,72020,CPT,Professional,Both,,,26,40,34,4.8,40,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),6.992,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Xr, Spine, Single View, Specify Level (Pro Cah)Professional Component ",,72020,CPT,Professional,Both,,,26,40,34,4.8,40,UnitedHealthcare,Individual & Family,40,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Xr, Spine, Single View, Specify Level (Pro Cah)Professional Component ",,72020,CPT,Professional,Both,,,26,40,34,4.8,40,UnitedHealthcare,Medicare Advantage,8.74,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Xr, Spine, Single View, Specify Level (Pro Cah)Professional Component ",,72020,CPT,Professional,Both,,,26,40,34,4.8,40,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,5.5372,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Cervical Spine 2 Or 3 Views (Pro Cah)Professional Component ,,72040,CPT,Professional,Both,,,26,52,44.2,6.76,52,Aetna,Commercial,44.2,85,,percent of total billed charges,,
Xr Cervical Spine 2 Or 3 Views (Pro Cah)Professional Component ,,72040,CPT,Professional,Both,,,26,52,44.2,6.76,52,Aetna,Medicare Advantage,10.98,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Cervical Spine 2 Or 3 Views (Pro Cah)Professional Component ,,72040,CPT,Professional,Both,,,26,52,44.2,6.76,52,Aetna,PPO,48.36,93,,percent of total billed charges,,
Xr Cervical Spine 2 Or 3 Views (Pro Cah)Professional Component ,,72040,CPT,Professional,Both,,,26,52,44.2,6.76,52,America's PPO,America's PPO,44.4288,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Xr Cervical Spine 2 Or 3 Views (Pro Cah)Professional Component ,,72040,CPT,Professional,Both,,,26,52,44.2,6.76,52,BlueCross BlueShield Minnesota, Federal Employee Program,20.45,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Xr Cervical Spine 2 Or 3 Views (Pro Cah)Professional Component ,,72040,CPT,Professional,Both,,,26,52,44.2,6.76,52,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,20.7772,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Cervical Spine 2 Or 3 Views (Pro Cah)Professional Component ,,72040,CPT,Professional,Both,,,26,52,44.2,6.76,52,BlueCross BlueShield Minnesota,High Value Network Plan,20.7772,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Cervical Spine 2 Or 3 Views (Pro Cah)Professional Component ,,72040,CPT,Professional,Both,,,26,52,44.2,6.76,52,BlueCross BlueShield Minnesota,Medicare Advantage,12.2705,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Cervical Spine 2 Or 3 Views (Pro Cah)Professional Component ,,72040,CPT,Professional,Both,,,26,52,44.2,6.76,52,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,20.7772,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Cervical Spine 2 Or 3 Views (Pro Cah)Professional Component ,,72040,CPT,Professional,Both,,,26,52,44.2,6.76,52,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,7.80288,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Cervical Spine 2 Or 3 Views (Pro Cah)Professional Component ,,72040,CPT,Professional,Both,,,26,52,44.2,6.76,52,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),12.2705,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Cervical Spine 2 Or 3 Views (Pro Cah)Professional Component ,,72040,CPT,Professional,Both,,,26,52,44.2,6.76,52,CorVel,Worker's Compensation,21.138399,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Xr Cervical Spine 2 Or 3 Views (Pro Cah)Professional Component ,,72040,CPT,Professional,Both,,,26,52,44.2,6.76,52,First Health Group Corporation,First Health Network,50.44,97,,percent of total billed charges,,
Xr Cervical Spine 2 Or 3 Views (Pro Cah)Professional Component ,,72040,CPT,Professional,Both,,,26,52,44.2,6.76,52,"Health Partners, Inc.",Commercial,15.98,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Xr Cervical Spine 2 Or 3 Views (Pro Cah)Professional Component ,,72040,CPT,Professional,Both,,,26,52,44.2,6.76,52,"Health Partners, Inc.",Medicare Advantage,12.2705,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Cervical Spine 2 Or 3 Views (Pro Cah)Professional Component ,,72040,CPT,Professional,Both,,,26,52,44.2,6.76,52,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),6.76,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Xr Cervical Spine 2 Or 3 Views (Pro Cah)Professional Component ,,72040,CPT,Professional,Both,,,26,52,44.2,6.76,52,"Health Partners, Inc.",State of Minnesota Advantage Program,13.76677,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Xr Cervical Spine 2 Or 3 Views (Pro Cah)Professional Component ,,72040,CPT,Professional,Both,,,26,52,44.2,6.76,52,"Health Partners, Inc.",State Public Programs,6.76,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Xr Cervical Spine 2 Or 3 Views (Pro Cah)Professional Component ,,72040,CPT,Professional,Both,,,26,52,44.2,6.76,52,Humana Insurance Company,Commercial PPO,10.67,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Xr Cervical Spine 2 Or 3 Views (Pro Cah)Professional Component ,,72040,CPT,Professional,Both,,,26,52,44.2,6.76,52,Humana Insurance Company,Medicare PPO,52,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Xr Cervical Spine 2 Or 3 Views (Pro Cah)Professional Component ,,72040,CPT,Professional,Both,,,26,52,44.2,6.76,52,Medica,Individual & Family,44.096,84.8,,percent of total billed charges,,
Xr Cervical Spine 2 Or 3 Views (Pro Cah)Professional Component ,,72040,CPT,Professional,Both,,,26,52,44.2,6.76,52,Medica,Medica Advantage Solution,25.896,49.8,,percent of total billed charges,,
Xr Cervical Spine 2 Or 3 Views (Pro Cah)Professional Component ,,72040,CPT,Professional,Both,,,26,52,44.2,6.76,52,Medica,Medical Assistance,7.8,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Xr Cervical Spine 2 Or 3 Views (Pro Cah)Professional Component ,,72040,CPT,Professional,Both,,,26,52,44.2,6.76,52,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,10.67,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Xr Cervical Spine 2 Or 3 Views (Pro Cah)Professional Component ,,72040,CPT,Professional,Both,,,26,52,44.2,6.76,52,"Multiplan, Inc.","Multiplan, Inc.",48.88,94,,percent of total billed charges,,
Xr Cervical Spine 2 Or 3 Views (Pro Cah)Professional Component ,,72040,CPT,Professional,Both,,,26,52,44.2,6.76,52,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,46.852,90.1,,percent of total billed charges,,
Xr Cervical Spine 2 Or 3 Views (Pro Cah)Professional Component ,,72040,CPT,Professional,Both,,,26,52,44.2,6.76,52,"Preferred One Administrative Services, INC.",PPO,51.272,98.6,,percent of total billed charges,,
Xr Cervical Spine 2 Or 3 Views (Pro Cah)Professional Component ,,72040,CPT,Professional,Both,,,26,52,44.2,6.76,52,PrimeWest Health,Minnesota Senior Health Options (MSHO),12.2705,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Cervical Spine 2 Or 3 Views (Pro Cah)Professional Component ,,72040,CPT,Professional,Both,,,26,52,44.2,6.76,52,PrimeWest Health,MinnesotaCare,8.3490816,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Cervical Spine 2 Or 3 Views (Pro Cah)Professional Component ,,72040,CPT,Professional,Both,,,26,52,44.2,6.76,52,Sanford Health Plan,Sanford Health Plan,45.76,88,,percent of total billed charges,,
Xr Cervical Spine 2 Or 3 Views (Pro Cah)Professional Component ,,72040,CPT,Professional,Both,,,26,52,44.2,6.76,52,"UCare Health, Inc.",Individual & Family Plan,17.345152,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Xr Cervical Spine 2 Or 3 Views (Pro Cah)Professional Component ,,72040,CPT,Professional,Both,,,26,52,44.2,6.76,52,"UCare Health, Inc.",Medical Assistance,8.583168,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Xr Cervical Spine 2 Or 3 Views (Pro Cah)Professional Component ,,72040,CPT,Professional,Both,,,26,52,44.2,6.76,52,"UCare Health, Inc.",Medicare Advantage,12.2705,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Xr Cervical Spine 2 Or 3 Views (Pro Cah)Professional Component ,,72040,CPT,Professional,Both,,,26,52,44.2,6.76,52,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),9.8164,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Xr Cervical Spine 2 Or 3 Views (Pro Cah)Professional Component ,,72040,CPT,Professional,Both,,,26,52,44.2,6.76,52,UnitedHealthcare,Individual & Family,52,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Xr Cervical Spine 2 Or 3 Views (Pro Cah)Professional Component ,,72040,CPT,Professional,Both,,,26,52,44.2,6.76,52,UnitedHealthcare,Medicare Advantage,12.2705,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Cervical Spine 2 Or 3 Views (Pro Cah)Professional Component ,,72040,CPT,Professional,Both,,,26,52,44.2,6.76,52,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,7.80288,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Cervical Spine Routine 4 Or 5 Views (Pro Cah)Professional Component ,,72050,CPT,Professional,Both,,,26,70,59.5,8.29,70,Aetna,Commercial,59.5,85,,percent of total billed charges,,
Xr Cervical Spine Routine 4 Or 5 Views (Pro Cah)Professional Component ,,72050,CPT,Professional,Both,,,26,70,59.5,8.29,70,Aetna,Medicare Advantage,13.43,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Cervical Spine Routine 4 Or 5 Views (Pro Cah)Professional Component ,,72050,CPT,Professional,Both,,,26,70,59.5,8.29,70,Aetna,PPO,65.1,93,,percent of total billed charges,,
Xr Cervical Spine Routine 4 Or 5 Views (Pro Cah)Professional Component ,,72050,CPT,Professional,Both,,,26,70,59.5,8.29,70,America's PPO,America's PPO,59.808,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Xr Cervical Spine Routine 4 Or 5 Views (Pro Cah)Professional Component ,,72050,CPT,Professional,Both,,,26,70,59.5,8.29,70,BlueCross BlueShield Minnesota, Federal Employee Program,24.93,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Xr Cervical Spine Routine 4 Or 5 Views (Pro Cah)Professional Component ,,72050,CPT,Professional,Both,,,26,70,59.5,8.29,70,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,25.32888,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Cervical Spine Routine 4 Or 5 Views (Pro Cah)Professional Component ,,72050,CPT,Professional,Both,,,26,70,59.5,8.29,70,BlueCross BlueShield Minnesota,High Value Network Plan,25.32888,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Cervical Spine Routine 4 Or 5 Views (Pro Cah)Professional Component ,,72050,CPT,Professional,Both,,,26,70,59.5,8.29,70,BlueCross BlueShield Minnesota,Medicare Advantage,15.019,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Cervical Spine Routine 4 Or 5 Views (Pro Cah)Professional Component ,,72050,CPT,Professional,Both,,,26,70,59.5,8.29,70,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,25.32888,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Cervical Spine Routine 4 Or 5 Views (Pro Cah)Professional Component ,,72050,CPT,Professional,Both,,,26,70,59.5,8.29,70,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,9.57072,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Cervical Spine Routine 4 Or 5 Views (Pro Cah)Professional Component ,,72050,CPT,Professional,Both,,,26,70,59.5,8.29,70,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),15.019,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Cervical Spine Routine 4 Or 5 Views (Pro Cah)Professional Component ,,72050,CPT,Professional,Both,,,26,70,59.5,8.29,70,CorVel,Worker's Compensation,25.8577632,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Xr Cervical Spine Routine 4 Or 5 Views (Pro Cah)Professional Component ,,72050,CPT,Professional,Both,,,26,70,59.5,8.29,70,First Health Group Corporation,First Health Network,67.9,97,,percent of total billed charges,,
Xr Cervical Spine Routine 4 Or 5 Views (Pro Cah)Professional Component ,,72050,CPT,Professional,Both,,,26,70,59.5,8.29,70,"Health Partners, Inc.",Commercial,19.6,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Xr Cervical Spine Routine 4 Or 5 Views (Pro Cah)Professional Component ,,72050,CPT,Professional,Both,,,26,70,59.5,8.29,70,"Health Partners, Inc.",Medicare Advantage,15.019,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Cervical Spine Routine 4 Or 5 Views (Pro Cah)Professional Component ,,72050,CPT,Professional,Both,,,26,70,59.5,8.29,70,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),8.29,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Xr Cervical Spine Routine 4 Or 5 Views (Pro Cah)Professional Component ,,72050,CPT,Professional,Both,,,26,70,59.5,8.29,70,"Health Partners, Inc.",State of Minnesota Advantage Program,16.8854,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Xr Cervical Spine Routine 4 Or 5 Views (Pro Cah)Professional Component ,,72050,CPT,Professional,Both,,,26,70,59.5,8.29,70,"Health Partners, Inc.",State Public Programs,8.29,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Xr Cervical Spine Routine 4 Or 5 Views (Pro Cah)Professional Component ,,72050,CPT,Professional,Both,,,26,70,59.5,8.29,70,Humana Insurance Company,Commercial PPO,13.06,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Xr Cervical Spine Routine 4 Or 5 Views (Pro Cah)Professional Component ,,72050,CPT,Professional,Both,,,26,70,59.5,8.29,70,Humana Insurance Company,Medicare PPO,70,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Xr Cervical Spine Routine 4 Or 5 Views (Pro Cah)Professional Component ,,72050,CPT,Professional,Both,,,26,70,59.5,8.29,70,Medica,Individual & Family,59.36,84.8,,percent of total billed charges,,
Xr Cervical Spine Routine 4 Or 5 Views (Pro Cah)Professional Component ,,72050,CPT,Professional,Both,,,26,70,59.5,8.29,70,Medica,Medica Advantage Solution,34.86,49.8,,percent of total billed charges,,
Xr Cervical Spine Routine 4 Or 5 Views (Pro Cah)Professional Component ,,72050,CPT,Professional,Both,,,26,70,59.5,8.29,70,Medica,Medical Assistance,9.57,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Xr Cervical Spine Routine 4 Or 5 Views (Pro Cah)Professional Component ,,72050,CPT,Professional,Both,,,26,70,59.5,8.29,70,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,13.06,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Xr Cervical Spine Routine 4 Or 5 Views (Pro Cah)Professional Component ,,72050,CPT,Professional,Both,,,26,70,59.5,8.29,70,"Multiplan, Inc.","Multiplan, Inc.",65.8,94,,percent of total billed charges,,
Xr Cervical Spine Routine 4 Or 5 Views (Pro Cah)Professional Component ,,72050,CPT,Professional,Both,,,26,70,59.5,8.29,70,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,63.07,90.1,,percent of total billed charges,,
Xr Cervical Spine Routine 4 Or 5 Views (Pro Cah)Professional Component ,,72050,CPT,Professional,Both,,,26,70,59.5,8.29,70,"Preferred One Administrative Services, INC.",PPO,69.02,98.6,,percent of total billed charges,,
Xr Cervical Spine Routine 4 Or 5 Views (Pro Cah)Professional Component ,,72050,CPT,Professional,Both,,,26,70,59.5,8.29,70,PrimeWest Health,Minnesota Senior Health Options (MSHO),15.019,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Cervical Spine Routine 4 Or 5 Views (Pro Cah)Professional Component ,,72050,CPT,Professional,Both,,,26,70,59.5,8.29,70,PrimeWest Health,MinnesotaCare,10.2406704,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Cervical Spine Routine 4 Or 5 Views (Pro Cah)Professional Component ,,72050,CPT,Professional,Both,,,26,70,59.5,8.29,70,Sanford Health Plan,Sanford Health Plan,61.6,88,,percent of total billed charges,,
Xr Cervical Spine Routine 4 Or 5 Views (Pro Cah)Professional Component ,,72050,CPT,Professional,Both,,,26,70,59.5,8.29,70,"UCare Health, Inc.",Individual & Family Plan,21.230336,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Xr Cervical Spine Routine 4 Or 5 Views (Pro Cah)Professional Component ,,72050,CPT,Professional,Both,,,26,70,59.5,8.29,70,"UCare Health, Inc.",Medical Assistance,10.527792,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Xr Cervical Spine Routine 4 Or 5 Views (Pro Cah)Professional Component ,,72050,CPT,Professional,Both,,,26,70,59.5,8.29,70,"UCare Health, Inc.",Medicare Advantage,15.019,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Xr Cervical Spine Routine 4 Or 5 Views (Pro Cah)Professional Component ,,72050,CPT,Professional,Both,,,26,70,59.5,8.29,70,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),12.0152,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Xr Cervical Spine Routine 4 Or 5 Views (Pro Cah)Professional Component ,,72050,CPT,Professional,Both,,,26,70,59.5,8.29,70,UnitedHealthcare,Individual & Family,70,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Xr Cervical Spine Routine 4 Or 5 Views (Pro Cah)Professional Component ,,72050,CPT,Professional,Both,,,26,70,59.5,8.29,70,UnitedHealthcare,Medicare Advantage,15.019,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Cervical Spine Routine 4 Or 5 Views (Pro Cah)Professional Component ,,72050,CPT,Professional,Both,,,26,70,59.5,8.29,70,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,9.57072,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Cervical Spine W Flex Ext Obl Ap 6 Or More Views (Pro Cah)Professional Component ,,72052,CPT,Professional,Both,,,26,81,68.85,8.94,81,Aetna,Commercial,68.85,85,,percent of total billed charges,,
Xr Cervical Spine W Flex Ext Obl Ap 6 Or More Views (Pro Cah)Professional Component ,,72052,CPT,Professional,Both,,,26,81,68.85,8.94,81,Aetna,Medicare Advantage,14.48,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Cervical Spine W Flex Ext Obl Ap 6 Or More Views (Pro Cah)Professional Component ,,72052,CPT,Professional,Both,,,26,81,68.85,8.94,81,Aetna,PPO,75.33,93,,percent of total billed charges,,
Xr Cervical Spine W Flex Ext Obl Ap 6 Or More Views (Pro Cah)Professional Component ,,72052,CPT,Professional,Both,,,26,81,68.85,8.94,81,America's PPO,America's PPO,69.2064,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Xr Cervical Spine W Flex Ext Obl Ap 6 Or More Views (Pro Cah)Professional Component ,,72052,CPT,Professional,Both,,,26,81,68.85,8.94,81,BlueCross BlueShield Minnesota, Federal Employee Program,27.49,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Xr Cervical Spine W Flex Ext Obl Ap 6 Or More Views (Pro Cah)Professional Component ,,72052,CPT,Professional,Both,,,26,81,68.85,8.94,81,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,27.92984,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Cervical Spine W Flex Ext Obl Ap 6 Or More Views (Pro Cah)Professional Component ,,72052,CPT,Professional,Both,,,26,81,68.85,8.94,81,BlueCross BlueShield Minnesota,High Value Network Plan,27.92984,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Cervical Spine W Flex Ext Obl Ap 6 Or More Views (Pro Cah)Professional Component ,,72052,CPT,Professional,Both,,,26,81,68.85,8.94,81,BlueCross BlueShield Minnesota,Medicare Advantage,16.3185,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Cervical Spine W Flex Ext Obl Ap 6 Or More Views (Pro Cah)Professional Component ,,72052,CPT,Professional,Both,,,26,81,68.85,8.94,81,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,27.92984,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Cervical Spine W Flex Ext Obl Ap 6 Or More Views (Pro Cah)Professional Component ,,72052,CPT,Professional,Both,,,26,81,68.85,8.94,81,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,10.32256,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Cervical Spine W Flex Ext Obl Ap 6 Or More Views (Pro Cah)Professional Component ,,72052,CPT,Professional,Both,,,26,81,68.85,8.94,81,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),16.3185,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Cervical Spine W Flex Ext Obl Ap 6 Or More Views (Pro Cah)Professional Component ,,72052,CPT,Professional,Both,,,26,81,68.85,8.94,81,CorVel,Worker's Compensation,27.8728632,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Xr Cervical Spine W Flex Ext Obl Ap 6 Or More Views (Pro Cah)Professional Component ,,72052,CPT,Professional,Both,,,26,81,68.85,8.94,81,First Health Group Corporation,First Health Network,78.57,97,,percent of total billed charges,,
Xr Cervical Spine W Flex Ext Obl Ap 6 Or More Views (Pro Cah)Professional Component ,,72052,CPT,Professional,Both,,,26,81,68.85,8.94,81,"Health Partners, Inc.",Commercial,21.14,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Xr Cervical Spine W Flex Ext Obl Ap 6 Or More Views (Pro Cah)Professional Component ,,72052,CPT,Professional,Both,,,26,81,68.85,8.94,81,"Health Partners, Inc.",Medicare Advantage,16.3185,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Cervical Spine W Flex Ext Obl Ap 6 Or More Views (Pro Cah)Professional Component ,,72052,CPT,Professional,Both,,,26,81,68.85,8.94,81,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),8.94,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Xr Cervical Spine W Flex Ext Obl Ap 6 Or More Views (Pro Cah)Professional Component ,,72052,CPT,Professional,Both,,,26,81,68.85,8.94,81,"Health Partners, Inc.",State of Minnesota Advantage Program,18.21211,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Xr Cervical Spine W Flex Ext Obl Ap 6 Or More Views (Pro Cah)Professional Component ,,72052,CPT,Professional,Both,,,26,81,68.85,8.94,81,"Health Partners, Inc.",State Public Programs,8.94,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Xr Cervical Spine W Flex Ext Obl Ap 6 Or More Views (Pro Cah)Professional Component ,,72052,CPT,Professional,Both,,,26,81,68.85,8.94,81,Humana Insurance Company,Commercial PPO,14.19,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Xr Cervical Spine W Flex Ext Obl Ap 6 Or More Views (Pro Cah)Professional Component ,,72052,CPT,Professional,Both,,,26,81,68.85,8.94,81,Humana Insurance Company,Medicare PPO,81,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Xr Cervical Spine W Flex Ext Obl Ap 6 Or More Views (Pro Cah)Professional Component ,,72052,CPT,Professional,Both,,,26,81,68.85,8.94,81,Medica,Individual & Family,68.688,84.8,,percent of total billed charges,,
Xr Cervical Spine W Flex Ext Obl Ap 6 Or More Views (Pro Cah)Professional Component ,,72052,CPT,Professional,Both,,,26,81,68.85,8.94,81,Medica,Medica Advantage Solution,40.338,49.8,,percent of total billed charges,,
Xr Cervical Spine W Flex Ext Obl Ap 6 Or More Views (Pro Cah)Professional Component ,,72052,CPT,Professional,Both,,,26,81,68.85,8.94,81,Medica,Medical Assistance,10.32,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Xr Cervical Spine W Flex Ext Obl Ap 6 Or More Views (Pro Cah)Professional Component ,,72052,CPT,Professional,Both,,,26,81,68.85,8.94,81,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,14.19,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Xr Cervical Spine W Flex Ext Obl Ap 6 Or More Views (Pro Cah)Professional Component ,,72052,CPT,Professional,Both,,,26,81,68.85,8.94,81,"Multiplan, Inc.","Multiplan, Inc.",76.14,94,,percent of total billed charges,,
Xr Cervical Spine W Flex Ext Obl Ap 6 Or More Views (Pro Cah)Professional Component ,,72052,CPT,Professional,Both,,,26,81,68.85,8.94,81,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,72.981,90.1,,percent of total billed charges,,
Xr Cervical Spine W Flex Ext Obl Ap 6 Or More Views (Pro Cah)Professional Component ,,72052,CPT,Professional,Both,,,26,81,68.85,8.94,81,"Preferred One Administrative Services, INC.",PPO,79.866,98.6,,percent of total billed charges,,
Xr Cervical Spine W Flex Ext Obl Ap 6 Or More Views (Pro Cah)Professional Component ,,72052,CPT,Professional,Both,,,26,81,68.85,8.94,81,PrimeWest Health,Minnesota Senior Health Options (MSHO),16.3185,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Cervical Spine W Flex Ext Obl Ap 6 Or More Views (Pro Cah)Professional Component ,,72052,CPT,Professional,Both,,,26,81,68.85,8.94,81,PrimeWest Health,MinnesotaCare,11.0451392,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Cervical Spine W Flex Ext Obl Ap 6 Or More Views (Pro Cah)Professional Component ,,72052,CPT,Professional,Both,,,26,81,68.85,8.94,81,Sanford Health Plan,Sanford Health Plan,71.28,88,,percent of total billed charges,,
Xr Cervical Spine W Flex Ext Obl Ap 6 Or More Views (Pro Cah)Professional Component ,,72052,CPT,Professional,Both,,,26,81,68.85,8.94,81,"UCare Health, Inc.",Individual & Family Plan,23.067264,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Xr Cervical Spine W Flex Ext Obl Ap 6 Or More Views (Pro Cah)Professional Component ,,72052,CPT,Professional,Both,,,26,81,68.85,8.94,81,"UCare Health, Inc.",Medical Assistance,11.354816,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Xr Cervical Spine W Flex Ext Obl Ap 6 Or More Views (Pro Cah)Professional Component ,,72052,CPT,Professional,Both,,,26,81,68.85,8.94,81,"UCare Health, Inc.",Medicare Advantage,16.3185,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Xr Cervical Spine W Flex Ext Obl Ap 6 Or More Views (Pro Cah)Professional Component ,,72052,CPT,Professional,Both,,,26,81,68.85,8.94,81,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),13.0548,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Xr Cervical Spine W Flex Ext Obl Ap 6 Or More Views (Pro Cah)Professional Component ,,72052,CPT,Professional,Both,,,26,81,68.85,8.94,81,UnitedHealthcare,Individual & Family,81,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Xr Cervical Spine W Flex Ext Obl Ap 6 Or More Views (Pro Cah)Professional Component ,,72052,CPT,Professional,Both,,,26,81,68.85,8.94,81,UnitedHealthcare,Medicare Advantage,16.3185,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Cervical Spine W Flex Ext Obl Ap 6 Or More Views (Pro Cah)Professional Component ,,72052,CPT,Professional,Both,,,26,81,68.85,8.94,81,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,10.32256,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Thoracic Spine Ap And Lat (Pro Cah)Professional Component ,,72070,CPT,Professional,Both,,,26,57,48.45,6.11,57,Aetna,Commercial,48.45,85,,percent of total billed charges,,
Xr Thoracic Spine Ap And Lat (Pro Cah)Professional Component ,,72070,CPT,Professional,Both,,,26,57,48.45,6.11,57,Aetna,Medicare Advantage,9.93,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Thoracic Spine Ap And Lat (Pro Cah)Professional Component ,,72070,CPT,Professional,Both,,,26,57,48.45,6.11,57,Aetna,PPO,53.01,93,,percent of total billed charges,,
Xr Thoracic Spine Ap And Lat (Pro Cah)Professional Component ,,72070,CPT,Professional,Both,,,26,57,48.45,6.11,57,America's PPO,America's PPO,48.7008,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Xr Thoracic Spine Ap And Lat (Pro Cah)Professional Component ,,72070,CPT,Professional,Both,,,26,57,48.45,6.11,57,BlueCross BlueShield Minnesota, Federal Employee Program,18.54,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Xr Thoracic Spine Ap And Lat (Pro Cah)Professional Component ,,72070,CPT,Professional,Both,,,26,57,48.45,6.11,57,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,18.83664,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Thoracic Spine Ap And Lat (Pro Cah)Professional Component ,,72070,CPT,Professional,Both,,,26,57,48.45,6.11,57,BlueCross BlueShield Minnesota,High Value Network Plan,18.83664,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Thoracic Spine Ap And Lat (Pro Cah)Professional Component ,,72070,CPT,Professional,Both,,,26,57,48.45,6.11,57,BlueCross BlueShield Minnesota,Medicare Advantage,11.0975,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Thoracic Spine Ap And Lat (Pro Cah)Professional Component ,,72070,CPT,Professional,Both,,,26,57,48.45,6.11,57,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,18.83664,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Thoracic Spine Ap And Lat (Pro Cah)Professional Component ,,72070,CPT,Professional,Both,,,26,57,48.45,6.11,57,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,7.05104,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Thoracic Spine Ap And Lat (Pro Cah)Professional Component ,,72070,CPT,Professional,Both,,,26,57,48.45,6.11,57,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),11.0975,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Thoracic Spine Ap And Lat (Pro Cah)Professional Component ,,72070,CPT,Professional,Both,,,26,57,48.45,6.11,57,CorVel,Worker's Compensation,19.1145669,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Xr Thoracic Spine Ap And Lat (Pro Cah)Professional Component ,,72070,CPT,Professional,Both,,,26,57,48.45,6.11,57,First Health Group Corporation,First Health Network,55.29,97,,percent of total billed charges,,
Xr Thoracic Spine Ap And Lat (Pro Cah)Professional Component ,,72070,CPT,Professional,Both,,,26,57,48.45,6.11,57,"Health Partners, Inc.",Commercial,14.44,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Xr Thoracic Spine Ap And Lat (Pro Cah)Professional Component ,,72070,CPT,Professional,Both,,,26,57,48.45,6.11,57,"Health Partners, Inc.",Medicare Advantage,11.0975,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Thoracic Spine Ap And Lat (Pro Cah)Professional Component ,,72070,CPT,Professional,Both,,,26,57,48.45,6.11,57,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),6.11,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Xr Thoracic Spine Ap And Lat (Pro Cah)Professional Component ,,72070,CPT,Professional,Both,,,26,57,48.45,6.11,57,"Health Partners, Inc.",State of Minnesota Advantage Program,12.44006,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Xr Thoracic Spine Ap And Lat (Pro Cah)Professional Component ,,72070,CPT,Professional,Both,,,26,57,48.45,6.11,57,"Health Partners, Inc.",State Public Programs,6.11,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Xr Thoracic Spine Ap And Lat (Pro Cah)Professional Component ,,72070,CPT,Professional,Both,,,26,57,48.45,6.11,57,Humana Insurance Company,Commercial PPO,9.65,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Xr Thoracic Spine Ap And Lat (Pro Cah)Professional Component ,,72070,CPT,Professional,Both,,,26,57,48.45,6.11,57,Humana Insurance Company,Medicare PPO,57,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Xr Thoracic Spine Ap And Lat (Pro Cah)Professional Component ,,72070,CPT,Professional,Both,,,26,57,48.45,6.11,57,Medica,Individual & Family,48.336,84.8,,percent of total billed charges,,
Xr Thoracic Spine Ap And Lat (Pro Cah)Professional Component ,,72070,CPT,Professional,Both,,,26,57,48.45,6.11,57,Medica,Medica Advantage Solution,28.386,49.8,,percent of total billed charges,,
Xr Thoracic Spine Ap And Lat (Pro Cah)Professional Component ,,72070,CPT,Professional,Both,,,26,57,48.45,6.11,57,Medica,Medical Assistance,7.05,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Xr Thoracic Spine Ap And Lat (Pro Cah)Professional Component ,,72070,CPT,Professional,Both,,,26,57,48.45,6.11,57,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,9.65,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Xr Thoracic Spine Ap And Lat (Pro Cah)Professional Component ,,72070,CPT,Professional,Both,,,26,57,48.45,6.11,57,"Multiplan, Inc.","Multiplan, Inc.",53.58,94,,percent of total billed charges,,
Xr Thoracic Spine Ap And Lat (Pro Cah)Professional Component ,,72070,CPT,Professional,Both,,,26,57,48.45,6.11,57,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,51.357,90.1,,percent of total billed charges,,
Xr Thoracic Spine Ap And Lat (Pro Cah)Professional Component ,,72070,CPT,Professional,Both,,,26,57,48.45,6.11,57,"Preferred One Administrative Services, INC.",PPO,56.202,98.6,,percent of total billed charges,,
Xr Thoracic Spine Ap And Lat (Pro Cah)Professional Component ,,72070,CPT,Professional,Both,,,26,57,48.45,6.11,57,PrimeWest Health,Minnesota Senior Health Options (MSHO),11.0975,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Thoracic Spine Ap And Lat (Pro Cah)Professional Component ,,72070,CPT,Professional,Both,,,26,57,48.45,6.11,57,PrimeWest Health,MinnesotaCare,7.5446128,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Thoracic Spine Ap And Lat (Pro Cah)Professional Component ,,72070,CPT,Professional,Both,,,26,57,48.45,6.11,57,Sanford Health Plan,Sanford Health Plan,50.16,88,,percent of total billed charges,,
Xr Thoracic Spine Ap And Lat (Pro Cah)Professional Component ,,72070,CPT,Professional,Both,,,26,57,48.45,6.11,57,"UCare Health, Inc.",Individual & Family Plan,15.68704,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Xr Thoracic Spine Ap And Lat (Pro Cah)Professional Component ,,72070,CPT,Professional,Both,,,26,57,48.45,6.11,57,"UCare Health, Inc.",Medical Assistance,7.756144,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Xr Thoracic Spine Ap And Lat (Pro Cah)Professional Component ,,72070,CPT,Professional,Both,,,26,57,48.45,6.11,57,"UCare Health, Inc.",Medicare Advantage,11.0975,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Xr Thoracic Spine Ap And Lat (Pro Cah)Professional Component ,,72070,CPT,Professional,Both,,,26,57,48.45,6.11,57,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),8.878,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Xr Thoracic Spine Ap And Lat (Pro Cah)Professional Component ,,72070,CPT,Professional,Both,,,26,57,48.45,6.11,57,UnitedHealthcare,Individual & Family,57,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Xr Thoracic Spine Ap And Lat (Pro Cah)Professional Component ,,72070,CPT,Professional,Both,,,26,57,48.45,6.11,57,UnitedHealthcare,Medicare Advantage,11.0975,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Thoracic Spine Ap And Lat (Pro Cah)Professional Component ,,72070,CPT,Professional,Both,,,26,57,48.45,6.11,57,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,7.05104,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Thoracic Spine Routine 3 Views (Pro Cah)Professional Component ,,72072,CPT,Professional,Both,,,26,60,51,6.76,60,Aetna,Commercial,51,85,,percent of total billed charges,,
Xr Thoracic Spine Routine 3 Views (Pro Cah)Professional Component ,,72072,CPT,Professional,Both,,,26,60,51,6.76,60,Aetna,Medicare Advantage,10.98,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Thoracic Spine Routine 3 Views (Pro Cah)Professional Component ,,72072,CPT,Professional,Both,,,26,60,51,6.76,60,Aetna,PPO,55.8,93,,percent of total billed charges,,
Xr Thoracic Spine Routine 3 Views (Pro Cah)Professional Component ,,72072,CPT,Professional,Both,,,26,60,51,6.76,60,America's PPO,America's PPO,51.264,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Xr Thoracic Spine Routine 3 Views (Pro Cah)Professional Component ,,72072,CPT,Professional,Both,,,26,60,51,6.76,60,BlueCross BlueShield Minnesota, Federal Employee Program,20.45,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Xr Thoracic Spine Routine 3 Views (Pro Cah)Professional Component ,,72072,CPT,Professional,Both,,,26,60,51,6.76,60,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,20.7772,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Thoracic Spine Routine 3 Views (Pro Cah)Professional Component ,,72072,CPT,Professional,Both,,,26,60,51,6.76,60,BlueCross BlueShield Minnesota,High Value Network Plan,20.7772,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Thoracic Spine Routine 3 Views (Pro Cah)Professional Component ,,72072,CPT,Professional,Both,,,26,60,51,6.76,60,BlueCross BlueShield Minnesota,Medicare Advantage,12.2705,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Thoracic Spine Routine 3 Views (Pro Cah)Professional Component ,,72072,CPT,Professional,Both,,,26,60,51,6.76,60,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,20.7772,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Thoracic Spine Routine 3 Views (Pro Cah)Professional Component ,,72072,CPT,Professional,Both,,,26,60,51,6.76,60,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,7.80288,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Thoracic Spine Routine 3 Views (Pro Cah)Professional Component ,,72072,CPT,Professional,Both,,,26,60,51,6.76,60,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),12.2705,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Thoracic Spine Routine 3 Views (Pro Cah)Professional Component ,,72072,CPT,Professional,Both,,,26,60,51,6.76,60,CorVel,Worker's Compensation,21.1296669,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Xr Thoracic Spine Routine 3 Views (Pro Cah)Professional Component ,,72072,CPT,Professional,Both,,,26,60,51,6.76,60,First Health Group Corporation,First Health Network,58.2,97,,percent of total billed charges,,
Xr Thoracic Spine Routine 3 Views (Pro Cah)Professional Component ,,72072,CPT,Professional,Both,,,26,60,51,6.76,60,"Health Partners, Inc.",Commercial,15.98,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Xr Thoracic Spine Routine 3 Views (Pro Cah)Professional Component ,,72072,CPT,Professional,Both,,,26,60,51,6.76,60,"Health Partners, Inc.",Medicare Advantage,12.2705,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Thoracic Spine Routine 3 Views (Pro Cah)Professional Component ,,72072,CPT,Professional,Both,,,26,60,51,6.76,60,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),6.76,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Xr Thoracic Spine Routine 3 Views (Pro Cah)Professional Component ,,72072,CPT,Professional,Both,,,26,60,51,6.76,60,"Health Partners, Inc.",State of Minnesota Advantage Program,13.76677,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Xr Thoracic Spine Routine 3 Views (Pro Cah)Professional Component ,,72072,CPT,Professional,Both,,,26,60,51,6.76,60,"Health Partners, Inc.",State Public Programs,6.76,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Xr Thoracic Spine Routine 3 Views (Pro Cah)Professional Component ,,72072,CPT,Professional,Both,,,26,60,51,6.76,60,Humana Insurance Company,Commercial PPO,10.67,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Xr Thoracic Spine Routine 3 Views (Pro Cah)Professional Component ,,72072,CPT,Professional,Both,,,26,60,51,6.76,60,Humana Insurance Company,Medicare PPO,60,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Xr Thoracic Spine Routine 3 Views (Pro Cah)Professional Component ,,72072,CPT,Professional,Both,,,26,60,51,6.76,60,Medica,Individual & Family,50.88,84.8,,percent of total billed charges,,
Xr Thoracic Spine Routine 3 Views (Pro Cah)Professional Component ,,72072,CPT,Professional,Both,,,26,60,51,6.76,60,Medica,Medica Advantage Solution,29.88,49.8,,percent of total billed charges,,
Xr Thoracic Spine Routine 3 Views (Pro Cah)Professional Component ,,72072,CPT,Professional,Both,,,26,60,51,6.76,60,Medica,Medical Assistance,7.8,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Xr Thoracic Spine Routine 3 Views (Pro Cah)Professional Component ,,72072,CPT,Professional,Both,,,26,60,51,6.76,60,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,10.67,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Xr Thoracic Spine Routine 3 Views (Pro Cah)Professional Component ,,72072,CPT,Professional,Both,,,26,60,51,6.76,60,"Multiplan, Inc.","Multiplan, Inc.",56.4,94,,percent of total billed charges,,
Xr Thoracic Spine Routine 3 Views (Pro Cah)Professional Component ,,72072,CPT,Professional,Both,,,26,60,51,6.76,60,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,54.06,90.1,,percent of total billed charges,,
Xr Thoracic Spine Routine 3 Views (Pro Cah)Professional Component ,,72072,CPT,Professional,Both,,,26,60,51,6.76,60,"Preferred One Administrative Services, INC.",PPO,59.16,98.6,,percent of total billed charges,,
Xr Thoracic Spine Routine 3 Views (Pro Cah)Professional Component ,,72072,CPT,Professional,Both,,,26,60,51,6.76,60,PrimeWest Health,Minnesota Senior Health Options (MSHO),12.2705,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Thoracic Spine Routine 3 Views (Pro Cah)Professional Component ,,72072,CPT,Professional,Both,,,26,60,51,6.76,60,PrimeWest Health,MinnesotaCare,8.3490816,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Thoracic Spine Routine 3 Views (Pro Cah)Professional Component ,,72072,CPT,Professional,Both,,,26,60,51,6.76,60,Sanford Health Plan,Sanford Health Plan,52.8,88,,percent of total billed charges,,
Xr Thoracic Spine Routine 3 Views (Pro Cah)Professional Component ,,72072,CPT,Professional,Both,,,26,60,51,6.76,60,"UCare Health, Inc.",Individual & Family Plan,17.345152,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Xr Thoracic Spine Routine 3 Views (Pro Cah)Professional Component ,,72072,CPT,Professional,Both,,,26,60,51,6.76,60,"UCare Health, Inc.",Medical Assistance,8.583168,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Xr Thoracic Spine Routine 3 Views (Pro Cah)Professional Component ,,72072,CPT,Professional,Both,,,26,60,51,6.76,60,"UCare Health, Inc.",Medicare Advantage,12.2705,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Xr Thoracic Spine Routine 3 Views (Pro Cah)Professional Component ,,72072,CPT,Professional,Both,,,26,60,51,6.76,60,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),9.8164,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Xr Thoracic Spine Routine 3 Views (Pro Cah)Professional Component ,,72072,CPT,Professional,Both,,,26,60,51,6.76,60,UnitedHealthcare,Individual & Family,60,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Xr Thoracic Spine Routine 3 Views (Pro Cah)Professional Component ,,72072,CPT,Professional,Both,,,26,60,51,6.76,60,UnitedHealthcare,Medicare Advantage,12.2705,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Thoracic Spine Routine 3 Views (Pro Cah)Professional Component ,,72072,CPT,Professional,Both,,,26,60,51,6.76,60,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,7.80288,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Thoracic Spine Min 4 Views (Pro Cah)Professional Component ,,72074,CPT,Professional,Both,,,26,68,57.8,7.41,68,Aetna,Commercial,57.8,85,,percent of total billed charges,,
Xr Thoracic Spine Min 4 Views (Pro Cah)Professional Component ,,72074,CPT,Professional,Both,,,26,68,57.8,7.41,68,Aetna,Medicare Advantage,12.03,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Thoracic Spine Min 4 Views (Pro Cah)Professional Component ,,72074,CPT,Professional,Both,,,26,68,57.8,7.41,68,Aetna,PPO,63.24,93,,percent of total billed charges,,
Xr Thoracic Spine Min 4 Views (Pro Cah)Professional Component ,,72074,CPT,Professional,Both,,,26,68,57.8,7.41,68,America's PPO,America's PPO,58.0992,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Xr Thoracic Spine Min 4 Views (Pro Cah)Professional Component ,,72074,CPT,Professional,Both,,,26,68,57.8,7.41,68,BlueCross BlueShield Minnesota, Federal Employee Program,22.37,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Xr Thoracic Spine Min 4 Views (Pro Cah)Professional Component ,,72074,CPT,Professional,Both,,,26,68,57.8,7.41,68,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,22.72792,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Thoracic Spine Min 4 Views (Pro Cah)Professional Component ,,72074,CPT,Professional,Both,,,26,68,57.8,7.41,68,BlueCross BlueShield Minnesota,High Value Network Plan,22.72792,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Thoracic Spine Min 4 Views (Pro Cah)Professional Component ,,72074,CPT,Professional,Both,,,26,68,57.8,7.41,68,BlueCross BlueShield Minnesota,Medicare Advantage,13.4435,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Thoracic Spine Min 4 Views (Pro Cah)Professional Component ,,72074,CPT,Professional,Both,,,26,68,57.8,7.41,68,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,22.72792,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Thoracic Spine Min 4 Views (Pro Cah)Professional Component ,,72074,CPT,Professional,Both,,,26,68,57.8,7.41,68,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,8.55472,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Thoracic Spine Min 4 Views (Pro Cah)Professional Component ,,72074,CPT,Professional,Both,,,26,68,57.8,7.41,68,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),13.4435,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Thoracic Spine Min 4 Views (Pro Cah)Professional Component ,,72074,CPT,Professional,Both,,,26,68,57.8,7.41,68,CorVel,Worker's Compensation,23.153499,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Xr Thoracic Spine Min 4 Views (Pro Cah)Professional Component ,,72074,CPT,Professional,Both,,,26,68,57.8,7.41,68,First Health Group Corporation,First Health Network,65.96,97,,percent of total billed charges,,
Xr Thoracic Spine Min 4 Views (Pro Cah)Professional Component ,,72074,CPT,Professional,Both,,,26,68,57.8,7.41,68,"Health Partners, Inc.",Commercial,17.54,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Xr Thoracic Spine Min 4 Views (Pro Cah)Professional Component ,,72074,CPT,Professional,Both,,,26,68,57.8,7.41,68,"Health Partners, Inc.",Medicare Advantage,13.4435,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Thoracic Spine Min 4 Views (Pro Cah)Professional Component ,,72074,CPT,Professional,Both,,,26,68,57.8,7.41,68,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),7.41,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Xr Thoracic Spine Min 4 Views (Pro Cah)Professional Component ,,72074,CPT,Professional,Both,,,26,68,57.8,7.41,68,"Health Partners, Inc.",State of Minnesota Advantage Program,15.11071,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Xr Thoracic Spine Min 4 Views (Pro Cah)Professional Component ,,72074,CPT,Professional,Both,,,26,68,57.8,7.41,68,"Health Partners, Inc.",State Public Programs,7.41,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Xr Thoracic Spine Min 4 Views (Pro Cah)Professional Component ,,72074,CPT,Professional,Both,,,26,68,57.8,7.41,68,Humana Insurance Company,Commercial PPO,11.69,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Xr Thoracic Spine Min 4 Views (Pro Cah)Professional Component ,,72074,CPT,Professional,Both,,,26,68,57.8,7.41,68,Humana Insurance Company,Medicare PPO,68,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Xr Thoracic Spine Min 4 Views (Pro Cah)Professional Component ,,72074,CPT,Professional,Both,,,26,68,57.8,7.41,68,Medica,Individual & Family,57.664,84.8,,percent of total billed charges,,
Xr Thoracic Spine Min 4 Views (Pro Cah)Professional Component ,,72074,CPT,Professional,Both,,,26,68,57.8,7.41,68,Medica,Medica Advantage Solution,33.864,49.8,,percent of total billed charges,,
Xr Thoracic Spine Min 4 Views (Pro Cah)Professional Component ,,72074,CPT,Professional,Both,,,26,68,57.8,7.41,68,Medica,Medical Assistance,8.55,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Xr Thoracic Spine Min 4 Views (Pro Cah)Professional Component ,,72074,CPT,Professional,Both,,,26,68,57.8,7.41,68,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,11.69,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Xr Thoracic Spine Min 4 Views (Pro Cah)Professional Component ,,72074,CPT,Professional,Both,,,26,68,57.8,7.41,68,"Multiplan, Inc.","Multiplan, Inc.",63.92,94,,percent of total billed charges,,
Xr Thoracic Spine Min 4 Views (Pro Cah)Professional Component ,,72074,CPT,Professional,Both,,,26,68,57.8,7.41,68,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,61.268,90.1,,percent of total billed charges,,
Xr Thoracic Spine Min 4 Views (Pro Cah)Professional Component ,,72074,CPT,Professional,Both,,,26,68,57.8,7.41,68,"Preferred One Administrative Services, INC.",PPO,67.048,98.6,,percent of total billed charges,,
Xr Thoracic Spine Min 4 Views (Pro Cah)Professional Component ,,72074,CPT,Professional,Both,,,26,68,57.8,7.41,68,PrimeWest Health,Minnesota Senior Health Options (MSHO),13.4435,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Thoracic Spine Min 4 Views (Pro Cah)Professional Component ,,72074,CPT,Professional,Both,,,26,68,57.8,7.41,68,PrimeWest Health,MinnesotaCare,9.1535504,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Thoracic Spine Min 4 Views (Pro Cah)Professional Component ,,72074,CPT,Professional,Both,,,26,68,57.8,7.41,68,Sanford Health Plan,Sanford Health Plan,59.84,88,,percent of total billed charges,,
Xr Thoracic Spine Min 4 Views (Pro Cah)Professional Component ,,72074,CPT,Professional,Both,,,26,68,57.8,7.41,68,"UCare Health, Inc.",Individual & Family Plan,19.003264,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Xr Thoracic Spine Min 4 Views (Pro Cah)Professional Component ,,72074,CPT,Professional,Both,,,26,68,57.8,7.41,68,"UCare Health, Inc.",Medical Assistance,9.410192,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Xr Thoracic Spine Min 4 Views (Pro Cah)Professional Component ,,72074,CPT,Professional,Both,,,26,68,57.8,7.41,68,"UCare Health, Inc.",Medicare Advantage,13.4435,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Xr Thoracic Spine Min 4 Views (Pro Cah)Professional Component ,,72074,CPT,Professional,Both,,,26,68,57.8,7.41,68,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),10.7548,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Xr Thoracic Spine Min 4 Views (Pro Cah)Professional Component ,,72074,CPT,Professional,Both,,,26,68,57.8,7.41,68,UnitedHealthcare,Individual & Family,68,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Xr Thoracic Spine Min 4 Views (Pro Cah)Professional Component ,,72074,CPT,Professional,Both,,,26,68,57.8,7.41,68,UnitedHealthcare,Medicare Advantage,13.4435,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Thoracic Spine Min 4 Views (Pro Cah)Professional Component ,,72074,CPT,Professional,Both,,,26,68,57.8,7.41,68,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,8.55472,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Xr Spine; Thoracolumbar Junction, Min 2 Views (Pro Cah)Professional Component ",,72080,CPT,Professional,Both,,,26,66,56.1,6.32,66,Aetna,Commercial,56.1,85,,percent of total billed charges,,
"Xr Spine; Thoracolumbar Junction, Min 2 Views (Pro Cah)Professional Component ",,72080,CPT,Professional,Both,,,26,66,56.1,6.32,66,Aetna,Medicare Advantage,10.28,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Xr Spine; Thoracolumbar Junction, Min 2 Views (Pro Cah)Professional Component ",,72080,CPT,Professional,Both,,,26,66,56.1,6.32,66,Aetna,PPO,61.38,93,,percent of total billed charges,,
"Xr Spine; Thoracolumbar Junction, Min 2 Views (Pro Cah)Professional Component ",,72080,CPT,Professional,Both,,,26,66,56.1,6.32,66,America's PPO,America's PPO,56.3904,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Xr Spine; Thoracolumbar Junction, Min 2 Views (Pro Cah)Professional Component ",,72080,CPT,Professional,Both,,,26,66,56.1,6.32,66,BlueCross BlueShield Minnesota, Federal Employee Program,19.18,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Xr Spine; Thoracolumbar Junction, Min 2 Views (Pro Cah)Professional Component ",,72080,CPT,Professional,Both,,,26,66,56.1,6.32,66,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,19.48688,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Xr Spine; Thoracolumbar Junction, Min 2 Views (Pro Cah)Professional Component ",,72080,CPT,Professional,Both,,,26,66,56.1,6.32,66,BlueCross BlueShield Minnesota,High Value Network Plan,19.48688,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Xr Spine; Thoracolumbar Junction, Min 2 Views (Pro Cah)Professional Component ",,72080,CPT,Professional,Both,,,26,66,56.1,6.32,66,BlueCross BlueShield Minnesota,Medicare Advantage,11.4885,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Xr Spine; Thoracolumbar Junction, Min 2 Views (Pro Cah)Professional Component ",,72080,CPT,Professional,Both,,,26,66,56.1,6.32,66,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,19.48688,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Xr Spine; Thoracolumbar Junction, Min 2 Views (Pro Cah)Professional Component ",,72080,CPT,Professional,Both,,,26,66,56.1,6.32,66,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,7.29488,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Xr Spine; Thoracolumbar Junction, Min 2 Views (Pro Cah)Professional Component ",,72080,CPT,Professional,Both,,,26,66,56.1,6.32,66,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),11.4885,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Xr Spine; Thoracolumbar Junction, Min 2 Views (Pro Cah)Professional Component ",,72080,CPT,Professional,Both,,,26,66,56.1,6.32,66,CorVel,Worker's Compensation,19.7862669,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Xr Spine; Thoracolumbar Junction, Min 2 Views (Pro Cah)Professional Component ",,72080,CPT,Professional,Both,,,26,66,56.1,6.32,66,First Health Group Corporation,First Health Network,64.02,97,,percent of total billed charges,,
"Xr Spine; Thoracolumbar Junction, Min 2 Views (Pro Cah)Professional Component ",,72080,CPT,Professional,Both,,,26,66,56.1,6.32,66,"Health Partners, Inc.",Commercial,14.96,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Xr Spine; Thoracolumbar Junction, Min 2 Views (Pro Cah)Professional Component ",,72080,CPT,Professional,Both,,,26,66,56.1,6.32,66,"Health Partners, Inc.",Medicare Advantage,11.4885,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Xr Spine; Thoracolumbar Junction, Min 2 Views (Pro Cah)Professional Component ",,72080,CPT,Professional,Both,,,26,66,56.1,6.32,66,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),6.32,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Xr Spine; Thoracolumbar Junction, Min 2 Views (Pro Cah)Professional Component ",,72080,CPT,Professional,Both,,,26,66,56.1,6.32,66,"Health Partners, Inc.",State of Minnesota Advantage Program,12.88804,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Xr Spine; Thoracolumbar Junction, Min 2 Views (Pro Cah)Professional Component ",,72080,CPT,Professional,Both,,,26,66,56.1,6.32,66,"Health Partners, Inc.",State Public Programs,6.32,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Xr Spine; Thoracolumbar Junction, Min 2 Views (Pro Cah)Professional Component ",,72080,CPT,Professional,Both,,,26,66,56.1,6.32,66,Humana Insurance Company,Commercial PPO,9.99,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Xr Spine; Thoracolumbar Junction, Min 2 Views (Pro Cah)Professional Component ",,72080,CPT,Professional,Both,,,26,66,56.1,6.32,66,Humana Insurance Company,Medicare PPO,66,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Xr Spine; Thoracolumbar Junction, Min 2 Views (Pro Cah)Professional Component ",,72080,CPT,Professional,Both,,,26,66,56.1,6.32,66,Medica,Individual & Family,55.968,84.8,,percent of total billed charges,,
"Xr Spine; Thoracolumbar Junction, Min 2 Views (Pro Cah)Professional Component ",,72080,CPT,Professional,Both,,,26,66,56.1,6.32,66,Medica,Medica Advantage Solution,32.868,49.8,,percent of total billed charges,,
"Xr Spine; Thoracolumbar Junction, Min 2 Views (Pro Cah)Professional Component ",,72080,CPT,Professional,Both,,,26,66,56.1,6.32,66,Medica,Medical Assistance,7.29,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Xr Spine; Thoracolumbar Junction, Min 2 Views (Pro Cah)Professional Component ",,72080,CPT,Professional,Both,,,26,66,56.1,6.32,66,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,9.99,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Xr Spine; Thoracolumbar Junction, Min 2 Views (Pro Cah)Professional Component ",,72080,CPT,Professional,Both,,,26,66,56.1,6.32,66,"Multiplan, Inc.","Multiplan, Inc.",62.04,94,,percent of total billed charges,,
"Xr Spine; Thoracolumbar Junction, Min 2 Views (Pro Cah)Professional Component ",,72080,CPT,Professional,Both,,,26,66,56.1,6.32,66,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,59.466,90.1,,percent of total billed charges,,
"Xr Spine; Thoracolumbar Junction, Min 2 Views (Pro Cah)Professional Component ",,72080,CPT,Professional,Both,,,26,66,56.1,6.32,66,"Preferred One Administrative Services, INC.",PPO,65.076,98.6,,percent of total billed charges,,
"Xr Spine; Thoracolumbar Junction, Min 2 Views (Pro Cah)Professional Component ",,72080,CPT,Professional,Both,,,26,66,56.1,6.32,66,PrimeWest Health,Minnesota Senior Health Options (MSHO),11.4885,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Xr Spine; Thoracolumbar Junction, Min 2 Views (Pro Cah)Professional Component ",,72080,CPT,Professional,Both,,,26,66,56.1,6.32,66,PrimeWest Health,MinnesotaCare,7.8055216,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Xr Spine; Thoracolumbar Junction, Min 2 Views (Pro Cah)Professional Component ",,72080,CPT,Professional,Both,,,26,66,56.1,6.32,66,Sanford Health Plan,Sanford Health Plan,58.08,88,,percent of total billed charges,,
"Xr Spine; Thoracolumbar Junction, Min 2 Views (Pro Cah)Professional Component ",,72080,CPT,Professional,Both,,,26,66,56.1,6.32,66,"UCare Health, Inc.",Individual & Family Plan,16.239744,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Xr Spine; Thoracolumbar Junction, Min 2 Views (Pro Cah)Professional Component ",,72080,CPT,Professional,Both,,,26,66,56.1,6.32,66,"UCare Health, Inc.",Medical Assistance,8.024368,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Xr Spine; Thoracolumbar Junction, Min 2 Views (Pro Cah)Professional Component ",,72080,CPT,Professional,Both,,,26,66,56.1,6.32,66,"UCare Health, Inc.",Medicare Advantage,11.4885,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Xr Spine; Thoracolumbar Junction, Min 2 Views (Pro Cah)Professional Component ",,72080,CPT,Professional,Both,,,26,66,56.1,6.32,66,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),9.1908,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Xr Spine; Thoracolumbar Junction, Min 2 Views (Pro Cah)Professional Component ",,72080,CPT,Professional,Both,,,26,66,56.1,6.32,66,UnitedHealthcare,Individual & Family,66,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Xr Spine; Thoracolumbar Junction, Min 2 Views (Pro Cah)Professional Component ",,72080,CPT,Professional,Both,,,26,66,56.1,6.32,66,UnitedHealthcare,Medicare Advantage,11.4885,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Xr Spine; Thoracolumbar Junction, Min 2 Views (Pro Cah)Professional Component ",,72080,CPT,Professional,Both,,,26,66,56.1,6.32,66,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,7.29488,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Radiologic Exam, Spine, Entire Thoracic, Lumbar, Incl Skull, Cervical, Sacral Spine;1 View (Pro Cah)Professional Component ",,72081,CPT,Professional,Both,,,26,75,63.75,7.85,75,Aetna,Commercial,63.75,85,,percent of total billed charges,,
"Radiologic Exam, Spine, Entire Thoracic, Lumbar, Incl Skull, Cervical, Sacral Spine;1 View (Pro Cah)Professional Component ",,72081,CPT,Professional,Both,,,26,75,63.75,7.85,75,Aetna,Medicare Advantage,12.73,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Radiologic Exam, Spine, Entire Thoracic, Lumbar, Incl Skull, Cervical, Sacral Spine;1 View (Pro Cah)Professional Component ",,72081,CPT,Professional,Both,,,26,75,63.75,7.85,75,Aetna,PPO,69.75,93,,percent of total billed charges,,
"Radiologic Exam, Spine, Entire Thoracic, Lumbar, Incl Skull, Cervical, Sacral Spine;1 View (Pro Cah)Professional Component ",,72081,CPT,Professional,Both,,,26,75,63.75,7.85,75,America's PPO,America's PPO,64.08,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Radiologic Exam, Spine, Entire Thoracic, Lumbar, Incl Skull, Cervical, Sacral Spine;1 View (Pro Cah)Professional Component ",,72081,CPT,Professional,Both,,,26,75,63.75,7.85,75,BlueCross BlueShield Minnesota, Federal Employee Program,23.65,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Radiologic Exam, Spine, Entire Thoracic, Lumbar, Incl Skull, Cervical, Sacral Spine;1 View (Pro Cah)Professional Component ",,72081,CPT,Professional,Both,,,26,75,63.75,7.85,75,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,24.0284,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Radiologic Exam, Spine, Entire Thoracic, Lumbar, Incl Skull, Cervical, Sacral Spine;1 View (Pro Cah)Professional Component ",,72081,CPT,Professional,Both,,,26,75,63.75,7.85,75,BlueCross BlueShield Minnesota,High Value Network Plan,24.0284,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Radiologic Exam, Spine, Entire Thoracic, Lumbar, Incl Skull, Cervical, Sacral Spine;1 View (Pro Cah)Professional Component ",,72081,CPT,Professional,Both,,,26,75,63.75,7.85,75,BlueCross BlueShield Minnesota,Medicare Advantage,14.2255,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Radiologic Exam, Spine, Entire Thoracic, Lumbar, Incl Skull, Cervical, Sacral Spine;1 View (Pro Cah)Professional Component ",,72081,CPT,Professional,Both,,,26,75,63.75,7.85,75,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,24.0284,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Radiologic Exam, Spine, Entire Thoracic, Lumbar, Incl Skull, Cervical, Sacral Spine;1 View (Pro Cah)Professional Component ",,72081,CPT,Professional,Both,,,26,75,63.75,7.85,75,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,9.06272,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Radiologic Exam, Spine, Entire Thoracic, Lumbar, Incl Skull, Cervical, Sacral Spine;1 View (Pro Cah)Professional Component ",,72081,CPT,Professional,Both,,,26,75,63.75,7.85,75,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),14.2255,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Radiologic Exam, Spine, Entire Thoracic, Lumbar, Incl Skull, Cervical, Sacral Spine;1 View (Pro Cah)Professional Component ",,72081,CPT,Professional,Both,,,26,75,63.75,7.85,75,CorVel,Worker's Compensation,24.5056311,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Radiologic Exam, Spine, Entire Thoracic, Lumbar, Incl Skull, Cervical, Sacral Spine;1 View (Pro Cah)Professional Component ",,72081,CPT,Professional,Both,,,26,75,63.75,7.85,75,First Health Group Corporation,First Health Network,72.75,97,,percent of total billed charges,,
"Radiologic Exam, Spine, Entire Thoracic, Lumbar, Incl Skull, Cervical, Sacral Spine;1 View (Pro Cah)Professional Component ",,72081,CPT,Professional,Both,,,26,75,63.75,7.85,75,"Health Partners, Inc.",Commercial,18.56,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Radiologic Exam, Spine, Entire Thoracic, Lumbar, Incl Skull, Cervical, Sacral Spine;1 View (Pro Cah)Professional Component ",,72081,CPT,Professional,Both,,,26,75,63.75,7.85,75,"Health Partners, Inc.",Medicare Advantage,14.2255,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Radiologic Exam, Spine, Entire Thoracic, Lumbar, Incl Skull, Cervical, Sacral Spine;1 View (Pro Cah)Professional Component ",,72081,CPT,Professional,Both,,,26,75,63.75,7.85,75,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),7.85,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Radiologic Exam, Spine, Entire Thoracic, Lumbar, Incl Skull, Cervical, Sacral Spine;1 View (Pro Cah)Professional Component ",,72081,CPT,Professional,Both,,,26,75,63.75,7.85,75,"Health Partners, Inc.",State of Minnesota Advantage Program,15.98944,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Radiologic Exam, Spine, Entire Thoracic, Lumbar, Incl Skull, Cervical, Sacral Spine;1 View (Pro Cah)Professional Component ",,72081,CPT,Professional,Both,,,26,75,63.75,7.85,75,"Health Partners, Inc.",State Public Programs,7.85,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Radiologic Exam, Spine, Entire Thoracic, Lumbar, Incl Skull, Cervical, Sacral Spine;1 View (Pro Cah)Professional Component ",,72081,CPT,Professional,Both,,,26,75,63.75,7.85,75,Humana Insurance Company,Commercial PPO,12.37,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Radiologic Exam, Spine, Entire Thoracic, Lumbar, Incl Skull, Cervical, Sacral Spine;1 View (Pro Cah)Professional Component ",,72081,CPT,Professional,Both,,,26,75,63.75,7.85,75,Humana Insurance Company,Medicare PPO,75,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Radiologic Exam, Spine, Entire Thoracic, Lumbar, Incl Skull, Cervical, Sacral Spine;1 View (Pro Cah)Professional Component ",,72081,CPT,Professional,Both,,,26,75,63.75,7.85,75,Medica,Individual & Family,63.6,84.8,,percent of total billed charges,,
"Radiologic Exam, Spine, Entire Thoracic, Lumbar, Incl Skull, Cervical, Sacral Spine;1 View (Pro Cah)Professional Component ",,72081,CPT,Professional,Both,,,26,75,63.75,7.85,75,Medica,Medica Advantage Solution,37.35,49.8,,percent of total billed charges,,
"Radiologic Exam, Spine, Entire Thoracic, Lumbar, Incl Skull, Cervical, Sacral Spine;1 View (Pro Cah)Professional Component ",,72081,CPT,Professional,Both,,,26,75,63.75,7.85,75,Medica,Medical Assistance,9.06,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Radiologic Exam, Spine, Entire Thoracic, Lumbar, Incl Skull, Cervical, Sacral Spine;1 View (Pro Cah)Professional Component ",,72081,CPT,Professional,Both,,,26,75,63.75,7.85,75,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,12.37,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Radiologic Exam, Spine, Entire Thoracic, Lumbar, Incl Skull, Cervical, Sacral Spine;1 View (Pro Cah)Professional Component ",,72081,CPT,Professional,Both,,,26,75,63.75,7.85,75,"Multiplan, Inc.","Multiplan, Inc.",70.5,94,,percent of total billed charges,,
"Radiologic Exam, Spine, Entire Thoracic, Lumbar, Incl Skull, Cervical, Sacral Spine;1 View (Pro Cah)Professional Component ",,72081,CPT,Professional,Both,,,26,75,63.75,7.85,75,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,67.575,90.1,,percent of total billed charges,,
"Radiologic Exam, Spine, Entire Thoracic, Lumbar, Incl Skull, Cervical, Sacral Spine;1 View (Pro Cah)Professional Component ",,72081,CPT,Professional,Both,,,26,75,63.75,7.85,75,"Preferred One Administrative Services, INC.",PPO,73.95,98.6,,percent of total billed charges,,
"Radiologic Exam, Spine, Entire Thoracic, Lumbar, Incl Skull, Cervical, Sacral Spine;1 View (Pro Cah)Professional Component ",,72081,CPT,Professional,Both,,,26,75,63.75,7.85,75,PrimeWest Health,Minnesota Senior Health Options (MSHO),14.2255,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Radiologic Exam, Spine, Entire Thoracic, Lumbar, Incl Skull, Cervical, Sacral Spine;1 View (Pro Cah)Professional Component ",,72081,CPT,Professional,Both,,,26,75,63.75,7.85,75,PrimeWest Health,MinnesotaCare,9.6971104,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Radiologic Exam, Spine, Entire Thoracic, Lumbar, Incl Skull, Cervical, Sacral Spine;1 View (Pro Cah)Professional Component ",,72081,CPT,Professional,Both,,,26,75,63.75,7.85,75,Sanford Health Plan,Sanford Health Plan,66,88,,percent of total billed charges,,
"Radiologic Exam, Spine, Entire Thoracic, Lumbar, Incl Skull, Cervical, Sacral Spine;1 View (Pro Cah)Professional Component ",,72081,CPT,Professional,Both,,,26,75,63.75,7.85,75,"UCare Health, Inc.",Individual & Family Plan,20.108672,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Radiologic Exam, Spine, Entire Thoracic, Lumbar, Incl Skull, Cervical, Sacral Spine;1 View (Pro Cah)Professional Component ",,72081,CPT,Professional,Both,,,26,75,63.75,7.85,75,"UCare Health, Inc.",Medical Assistance,9.968992,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Radiologic Exam, Spine, Entire Thoracic, Lumbar, Incl Skull, Cervical, Sacral Spine;1 View (Pro Cah)Professional Component ",,72081,CPT,Professional,Both,,,26,75,63.75,7.85,75,"UCare Health, Inc.",Medicare Advantage,14.2255,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Radiologic Exam, Spine, Entire Thoracic, Lumbar, Incl Skull, Cervical, Sacral Spine;1 View (Pro Cah)Professional Component ",,72081,CPT,Professional,Both,,,26,75,63.75,7.85,75,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),11.3804,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Radiologic Exam, Spine, Entire Thoracic, Lumbar, Incl Skull, Cervical, Sacral Spine;1 View (Pro Cah)Professional Component ",,72081,CPT,Professional,Both,,,26,75,63.75,7.85,75,UnitedHealthcare,Individual & Family,75,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Radiologic Exam, Spine, Entire Thoracic, Lumbar, Incl Skull, Cervical, Sacral Spine;1 View (Pro Cah)Professional Component ",,72081,CPT,Professional,Both,,,26,75,63.75,7.85,75,UnitedHealthcare,Medicare Advantage,14.2255,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Radiologic Exam, Spine, Entire Thoracic, Lumbar, Incl Skull, Cervical, Sacral Spine;1 View (Pro Cah)Professional Component ",,72081,CPT,Professional,Both,,,26,75,63.75,7.85,75,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,9.06272,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Spine Entire Thoracic Lumbar Inc Skull Cerv Sac Spine 2 Or 3 View (Pro Cah)Professional Component ,,72082,CPT,Professional,Both,,,26,90,76.5,9.37,90,Aetna,Commercial,76.5,85,,percent of total billed charges,,
Xr Spine Entire Thoracic Lumbar Inc Skull Cerv Sac Spine 2 Or 3 View (Pro Cah)Professional Component ,,72082,CPT,Professional,Both,,,26,90,76.5,9.37,90,Aetna,Medicare Advantage,15.18,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Spine Entire Thoracic Lumbar Inc Skull Cerv Sac Spine 2 Or 3 View (Pro Cah)Professional Component ,,72082,CPT,Professional,Both,,,26,90,76.5,9.37,90,Aetna,PPO,83.7,93,,percent of total billed charges,,
Xr Spine Entire Thoracic Lumbar Inc Skull Cerv Sac Spine 2 Or 3 View (Pro Cah)Professional Component ,,72082,CPT,Professional,Both,,,26,90,76.5,9.37,90,America's PPO,America's PPO,76.896,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Xr Spine Entire Thoracic Lumbar Inc Skull Cerv Sac Spine 2 Or 3 View (Pro Cah)Professional Component ,,72082,CPT,Professional,Both,,,26,90,76.5,9.37,90,BlueCross BlueShield Minnesota, Federal Employee Program,28.76,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Xr Spine Entire Thoracic Lumbar Inc Skull Cerv Sac Spine 2 Or 3 View (Pro Cah)Professional Component ,,72082,CPT,Professional,Both,,,26,90,76.5,9.37,90,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,29.22016,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Spine Entire Thoracic Lumbar Inc Skull Cerv Sac Spine 2 Or 3 View (Pro Cah)Professional Component ,,72082,CPT,Professional,Both,,,26,90,76.5,9.37,90,BlueCross BlueShield Minnesota,High Value Network Plan,29.22016,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Spine Entire Thoracic Lumbar Inc Skull Cerv Sac Spine 2 Or 3 View (Pro Cah)Professional Component ,,72082,CPT,Professional,Both,,,26,90,76.5,9.37,90,BlueCross BlueShield Minnesota,Medicare Advantage,17.1005,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Spine Entire Thoracic Lumbar Inc Skull Cerv Sac Spine 2 Or 3 View (Pro Cah)Professional Component ,,72082,CPT,Professional,Both,,,26,90,76.5,9.37,90,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,29.22016,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Spine Entire Thoracic Lumbar Inc Skull Cerv Sac Spine 2 Or 3 View (Pro Cah)Professional Component ,,72082,CPT,Professional,Both,,,26,90,76.5,9.37,90,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,10.8204,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Spine Entire Thoracic Lumbar Inc Skull Cerv Sac Spine 2 Or 3 View (Pro Cah)Professional Component ,,72082,CPT,Professional,Both,,,26,90,76.5,9.37,90,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),17.1005,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Spine Entire Thoracic Lumbar Inc Skull Cerv Sac Spine 2 Or 3 View (Pro Cah)Professional Component ,,72082,CPT,Professional,Both,,,26,90,76.5,9.37,90,CorVel,Worker's Compensation,29.4621054,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Xr Spine Entire Thoracic Lumbar Inc Skull Cerv Sac Spine 2 Or 3 View (Pro Cah)Professional Component ,,72082,CPT,Professional,Both,,,26,90,76.5,9.37,90,First Health Group Corporation,First Health Network,87.3,97,,percent of total billed charges,,
Xr Spine Entire Thoracic Lumbar Inc Skull Cerv Sac Spine 2 Or 3 View (Pro Cah)Professional Component ,,72082,CPT,Professional,Both,,,26,90,76.5,9.37,90,"Health Partners, Inc.",Commercial,22.69,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Xr Spine Entire Thoracic Lumbar Inc Skull Cerv Sac Spine 2 Or 3 View (Pro Cah)Professional Component ,,72082,CPT,Professional,Both,,,26,90,76.5,9.37,90,"Health Partners, Inc.",Medicare Advantage,17.1005,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Spine Entire Thoracic Lumbar Inc Skull Cerv Sac Spine 2 Or 3 View (Pro Cah)Professional Component ,,72082,CPT,Professional,Both,,,26,90,76.5,9.37,90,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),9.37,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Xr Spine Entire Thoracic Lumbar Inc Skull Cerv Sac Spine 2 Or 3 View (Pro Cah)Professional Component ,,72082,CPT,Professional,Both,,,26,90,76.5,9.37,90,"Health Partners, Inc.",State of Minnesota Advantage Program,19.547435,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Xr Spine Entire Thoracic Lumbar Inc Skull Cerv Sac Spine 2 Or 3 View (Pro Cah)Professional Component ,,72082,CPT,Professional,Both,,,26,90,76.5,9.37,90,"Health Partners, Inc.",State Public Programs,9.37,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Xr Spine Entire Thoracic Lumbar Inc Skull Cerv Sac Spine 2 Or 3 View (Pro Cah)Professional Component ,,72082,CPT,Professional,Both,,,26,90,76.5,9.37,90,Humana Insurance Company,Commercial PPO,14.87,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Xr Spine Entire Thoracic Lumbar Inc Skull Cerv Sac Spine 2 Or 3 View (Pro Cah)Professional Component ,,72082,CPT,Professional,Both,,,26,90,76.5,9.37,90,Humana Insurance Company,Medicare PPO,90,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Xr Spine Entire Thoracic Lumbar Inc Skull Cerv Sac Spine 2 Or 3 View (Pro Cah)Professional Component ,,72082,CPT,Professional,Both,,,26,90,76.5,9.37,90,Medica,Individual & Family,76.32,84.8,,percent of total billed charges,,
Xr Spine Entire Thoracic Lumbar Inc Skull Cerv Sac Spine 2 Or 3 View (Pro Cah)Professional Component ,,72082,CPT,Professional,Both,,,26,90,76.5,9.37,90,Medica,Medica Advantage Solution,44.82,49.8,,percent of total billed charges,,
Xr Spine Entire Thoracic Lumbar Inc Skull Cerv Sac Spine 2 Or 3 View (Pro Cah)Professional Component ,,72082,CPT,Professional,Both,,,26,90,76.5,9.37,90,Medica,Medical Assistance,10.82,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Xr Spine Entire Thoracic Lumbar Inc Skull Cerv Sac Spine 2 Or 3 View (Pro Cah)Professional Component ,,72082,CPT,Professional,Both,,,26,90,76.5,9.37,90,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,14.87,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Xr Spine Entire Thoracic Lumbar Inc Skull Cerv Sac Spine 2 Or 3 View (Pro Cah)Professional Component ,,72082,CPT,Professional,Both,,,26,90,76.5,9.37,90,"Multiplan, Inc.","Multiplan, Inc.",84.6,94,,percent of total billed charges,,
Xr Spine Entire Thoracic Lumbar Inc Skull Cerv Sac Spine 2 Or 3 View (Pro Cah)Professional Component ,,72082,CPT,Professional,Both,,,26,90,76.5,9.37,90,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,81.09,90.1,,percent of total billed charges,,
Xr Spine Entire Thoracic Lumbar Inc Skull Cerv Sac Spine 2 Or 3 View (Pro Cah)Professional Component ,,72082,CPT,Professional,Both,,,26,90,76.5,9.37,90,"Preferred One Administrative Services, INC.",PPO,88.74,98.6,,percent of total billed charges,,
Xr Spine Entire Thoracic Lumbar Inc Skull Cerv Sac Spine 2 Or 3 View (Pro Cah)Professional Component ,,72082,CPT,Professional,Both,,,26,90,76.5,9.37,90,PrimeWest Health,Minnesota Senior Health Options (MSHO),17.1005,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Spine Entire Thoracic Lumbar Inc Skull Cerv Sac Spine 2 Or 3 View (Pro Cah)Professional Component ,,72082,CPT,Professional,Both,,,26,90,76.5,9.37,90,PrimeWest Health,MinnesotaCare,11.577828,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Spine Entire Thoracic Lumbar Inc Skull Cerv Sac Spine 2 Or 3 View (Pro Cah)Professional Component ,,72082,CPT,Professional,Both,,,26,90,76.5,9.37,90,Sanford Health Plan,Sanford Health Plan,79.2,88,,percent of total billed charges,,
Xr Spine Entire Thoracic Lumbar Inc Skull Cerv Sac Spine 2 Or 3 View (Pro Cah)Professional Component ,,72082,CPT,Professional,Both,,,26,90,76.5,9.37,90,"UCare Health, Inc.",Individual & Family Plan,24.172672,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Xr Spine Entire Thoracic Lumbar Inc Skull Cerv Sac Spine 2 Or 3 View (Pro Cah)Professional Component ,,72082,CPT,Professional,Both,,,26,90,76.5,9.37,90,"UCare Health, Inc.",Medical Assistance,11.90244,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Xr Spine Entire Thoracic Lumbar Inc Skull Cerv Sac Spine 2 Or 3 View (Pro Cah)Professional Component ,,72082,CPT,Professional,Both,,,26,90,76.5,9.37,90,"UCare Health, Inc.",Medicare Advantage,17.1005,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Xr Spine Entire Thoracic Lumbar Inc Skull Cerv Sac Spine 2 Or 3 View (Pro Cah)Professional Component ,,72082,CPT,Professional,Both,,,26,90,76.5,9.37,90,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),13.6804,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Xr Spine Entire Thoracic Lumbar Inc Skull Cerv Sac Spine 2 Or 3 View (Pro Cah)Professional Component ,,72082,CPT,Professional,Both,,,26,90,76.5,9.37,90,UnitedHealthcare,Individual & Family,90,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Xr Spine Entire Thoracic Lumbar Inc Skull Cerv Sac Spine 2 Or 3 View (Pro Cah)Professional Component ,,72082,CPT,Professional,Both,,,26,90,76.5,9.37,90,UnitedHealthcare,Medicare Advantage,17.1005,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Spine Entire Thoracic Lumbar Inc Skull Cerv Sac Spine 2 Or 3 View (Pro Cah)Professional Component ,,72082,CPT,Professional,Both,,,26,90,76.5,9.37,90,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,10.8204,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Lumbar Spine 2 Or 3 Views (Pro Cah)Professional Component ,,72100,CPT,Professional,Both,,,26,56,47.6,6.76,56,Aetna,Commercial,47.6,85,,percent of total billed charges,,
Xr Lumbar Spine 2 Or 3 Views (Pro Cah)Professional Component ,,72100,CPT,Professional,Both,,,26,56,47.6,6.76,56,Aetna,Medicare Advantage,10.98,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Lumbar Spine 2 Or 3 Views (Pro Cah)Professional Component ,,72100,CPT,Professional,Both,,,26,56,47.6,6.76,56,Aetna,PPO,52.08,93,,percent of total billed charges,,
Xr Lumbar Spine 2 Or 3 Views (Pro Cah)Professional Component ,,72100,CPT,Professional,Both,,,26,56,47.6,6.76,56,America's PPO,America's PPO,47.8464,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Xr Lumbar Spine 2 Or 3 Views (Pro Cah)Professional Component ,,72100,CPT,Professional,Both,,,26,56,47.6,6.76,56,BlueCross BlueShield Minnesota, Federal Employee Program,20.45,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Xr Lumbar Spine 2 Or 3 Views (Pro Cah)Professional Component ,,72100,CPT,Professional,Both,,,26,56,47.6,6.76,56,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,20.7772,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Lumbar Spine 2 Or 3 Views (Pro Cah)Professional Component ,,72100,CPT,Professional,Both,,,26,56,47.6,6.76,56,BlueCross BlueShield Minnesota,High Value Network Plan,20.7772,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Lumbar Spine 2 Or 3 Views (Pro Cah)Professional Component ,,72100,CPT,Professional,Both,,,26,56,47.6,6.76,56,BlueCross BlueShield Minnesota,Medicare Advantage,12.2705,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Lumbar Spine 2 Or 3 Views (Pro Cah)Professional Component ,,72100,CPT,Professional,Both,,,26,56,47.6,6.76,56,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,20.7772,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Lumbar Spine 2 Or 3 Views (Pro Cah)Professional Component ,,72100,CPT,Professional,Both,,,26,56,47.6,6.76,56,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,7.80288,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Lumbar Spine 2 Or 3 Views (Pro Cah)Professional Component ,,72100,CPT,Professional,Both,,,26,56,47.6,6.76,56,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),12.2705,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Lumbar Spine 2 Or 3 Views (Pro Cah)Professional Component ,,72100,CPT,Professional,Both,,,26,56,47.6,6.76,56,CorVel,Worker's Compensation,21.138399,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Xr Lumbar Spine 2 Or 3 Views (Pro Cah)Professional Component ,,72100,CPT,Professional,Both,,,26,56,47.6,6.76,56,First Health Group Corporation,First Health Network,54.32,97,,percent of total billed charges,,
Xr Lumbar Spine 2 Or 3 Views (Pro Cah)Professional Component ,,72100,CPT,Professional,Both,,,26,56,47.6,6.76,56,"Health Partners, Inc.",Commercial,15.98,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Xr Lumbar Spine 2 Or 3 Views (Pro Cah)Professional Component ,,72100,CPT,Professional,Both,,,26,56,47.6,6.76,56,"Health Partners, Inc.",Medicare Advantage,12.2705,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Lumbar Spine 2 Or 3 Views (Pro Cah)Professional Component ,,72100,CPT,Professional,Both,,,26,56,47.6,6.76,56,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),6.76,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Xr Lumbar Spine 2 Or 3 Views (Pro Cah)Professional Component ,,72100,CPT,Professional,Both,,,26,56,47.6,6.76,56,"Health Partners, Inc.",State of Minnesota Advantage Program,13.76677,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Xr Lumbar Spine 2 Or 3 Views (Pro Cah)Professional Component ,,72100,CPT,Professional,Both,,,26,56,47.6,6.76,56,"Health Partners, Inc.",State Public Programs,6.76,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Xr Lumbar Spine 2 Or 3 Views (Pro Cah)Professional Component ,,72100,CPT,Professional,Both,,,26,56,47.6,6.76,56,Humana Insurance Company,Commercial PPO,10.67,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Xr Lumbar Spine 2 Or 3 Views (Pro Cah)Professional Component ,,72100,CPT,Professional,Both,,,26,56,47.6,6.76,56,Humana Insurance Company,Medicare PPO,56,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Xr Lumbar Spine 2 Or 3 Views (Pro Cah)Professional Component ,,72100,CPT,Professional,Both,,,26,56,47.6,6.76,56,Medica,Individual & Family,47.488,84.8,,percent of total billed charges,,
Xr Lumbar Spine 2 Or 3 Views (Pro Cah)Professional Component ,,72100,CPT,Professional,Both,,,26,56,47.6,6.76,56,Medica,Medica Advantage Solution,27.888,49.8,,percent of total billed charges,,
Xr Lumbar Spine 2 Or 3 Views (Pro Cah)Professional Component ,,72100,CPT,Professional,Both,,,26,56,47.6,6.76,56,Medica,Medical Assistance,7.8,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Xr Lumbar Spine 2 Or 3 Views (Pro Cah)Professional Component ,,72100,CPT,Professional,Both,,,26,56,47.6,6.76,56,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,10.67,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Xr Lumbar Spine 2 Or 3 Views (Pro Cah)Professional Component ,,72100,CPT,Professional,Both,,,26,56,47.6,6.76,56,"Multiplan, Inc.","Multiplan, Inc.",52.64,94,,percent of total billed charges,,
Xr Lumbar Spine 2 Or 3 Views (Pro Cah)Professional Component ,,72100,CPT,Professional,Both,,,26,56,47.6,6.76,56,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,50.456,90.1,,percent of total billed charges,,
Xr Lumbar Spine 2 Or 3 Views (Pro Cah)Professional Component ,,72100,CPT,Professional,Both,,,26,56,47.6,6.76,56,"Preferred One Administrative Services, INC.",PPO,55.216,98.6,,percent of total billed charges,,
Xr Lumbar Spine 2 Or 3 Views (Pro Cah)Professional Component ,,72100,CPT,Professional,Both,,,26,56,47.6,6.76,56,PrimeWest Health,Minnesota Senior Health Options (MSHO),12.2705,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Lumbar Spine 2 Or 3 Views (Pro Cah)Professional Component ,,72100,CPT,Professional,Both,,,26,56,47.6,6.76,56,PrimeWest Health,MinnesotaCare,8.3490816,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Lumbar Spine 2 Or 3 Views (Pro Cah)Professional Component ,,72100,CPT,Professional,Both,,,26,56,47.6,6.76,56,Sanford Health Plan,Sanford Health Plan,49.28,88,,percent of total billed charges,,
Xr Lumbar Spine 2 Or 3 Views (Pro Cah)Professional Component ,,72100,CPT,Professional,Both,,,26,56,47.6,6.76,56,"UCare Health, Inc.",Individual & Family Plan,17.345152,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Xr Lumbar Spine 2 Or 3 Views (Pro Cah)Professional Component ,,72100,CPT,Professional,Both,,,26,56,47.6,6.76,56,"UCare Health, Inc.",Medical Assistance,8.583168,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Xr Lumbar Spine 2 Or 3 Views (Pro Cah)Professional Component ,,72100,CPT,Professional,Both,,,26,56,47.6,6.76,56,"UCare Health, Inc.",Medicare Advantage,12.2705,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Xr Lumbar Spine 2 Or 3 Views (Pro Cah)Professional Component ,,72100,CPT,Professional,Both,,,26,56,47.6,6.76,56,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),9.8164,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Xr Lumbar Spine 2 Or 3 Views (Pro Cah)Professional Component ,,72100,CPT,Professional,Both,,,26,56,47.6,6.76,56,UnitedHealthcare,Individual & Family,56,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Xr Lumbar Spine 2 Or 3 Views (Pro Cah)Professional Component ,,72100,CPT,Professional,Both,,,26,56,47.6,6.76,56,UnitedHealthcare,Medicare Advantage,12.2705,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Lumbar Spine 2 Or 3 Views (Pro Cah)Professional Component ,,72100,CPT,Professional,Both,,,26,56,47.6,6.76,56,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,7.80288,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Lumbar Spine Routine 4 Views (Pro Cah)Professional Component ,,72110,CPT,Professional,Both,,,26,77,65.45,7.85,77,Aetna,Commercial,65.45,85,,percent of total billed charges,,
Xr Lumbar Spine Routine 4 Views (Pro Cah)Professional Component ,,72110,CPT,Professional,Both,,,26,77,65.45,7.85,77,Aetna,Medicare Advantage,12.73,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Lumbar Spine Routine 4 Views (Pro Cah)Professional Component ,,72110,CPT,Professional,Both,,,26,77,65.45,7.85,77,Aetna,PPO,71.61,93,,percent of total billed charges,,
Xr Lumbar Spine Routine 4 Views (Pro Cah)Professional Component ,,72110,CPT,Professional,Both,,,26,77,65.45,7.85,77,America's PPO,America's PPO,65.7888,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Xr Lumbar Spine Routine 4 Views (Pro Cah)Professional Component ,,72110,CPT,Professional,Both,,,26,77,65.45,7.85,77,BlueCross BlueShield Minnesota, Federal Employee Program,23.65,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Xr Lumbar Spine Routine 4 Views (Pro Cah)Professional Component ,,72110,CPT,Professional,Both,,,26,77,65.45,7.85,77,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,24.0284,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Lumbar Spine Routine 4 Views (Pro Cah)Professional Component ,,72110,CPT,Professional,Both,,,26,77,65.45,7.85,77,BlueCross BlueShield Minnesota,High Value Network Plan,24.0284,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Lumbar Spine Routine 4 Views (Pro Cah)Professional Component ,,72110,CPT,Professional,Both,,,26,77,65.45,7.85,77,BlueCross BlueShield Minnesota,Medicare Advantage,14.2255,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Lumbar Spine Routine 4 Views (Pro Cah)Professional Component ,,72110,CPT,Professional,Both,,,26,77,65.45,7.85,77,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,24.0284,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Lumbar Spine Routine 4 Views (Pro Cah)Professional Component ,,72110,CPT,Professional,Both,,,26,77,65.45,7.85,77,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,9.06272,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Lumbar Spine Routine 4 Views (Pro Cah)Professional Component ,,72110,CPT,Professional,Both,,,26,77,65.45,7.85,77,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),14.2255,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Lumbar Spine Routine 4 Views (Pro Cah)Professional Component ,,72110,CPT,Professional,Both,,,26,77,65.45,7.85,77,CorVel,Worker's Compensation,24.5056311,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Xr Lumbar Spine Routine 4 Views (Pro Cah)Professional Component ,,72110,CPT,Professional,Both,,,26,77,65.45,7.85,77,First Health Group Corporation,First Health Network,74.69,97,,percent of total billed charges,,
Xr Lumbar Spine Routine 4 Views (Pro Cah)Professional Component ,,72110,CPT,Professional,Both,,,26,77,65.45,7.85,77,"Health Partners, Inc.",Commercial,18.56,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Xr Lumbar Spine Routine 4 Views (Pro Cah)Professional Component ,,72110,CPT,Professional,Both,,,26,77,65.45,7.85,77,"Health Partners, Inc.",Medicare Advantage,14.2255,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Lumbar Spine Routine 4 Views (Pro Cah)Professional Component ,,72110,CPT,Professional,Both,,,26,77,65.45,7.85,77,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),7.85,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Xr Lumbar Spine Routine 4 Views (Pro Cah)Professional Component ,,72110,CPT,Professional,Both,,,26,77,65.45,7.85,77,"Health Partners, Inc.",State of Minnesota Advantage Program,15.98944,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Xr Lumbar Spine Routine 4 Views (Pro Cah)Professional Component ,,72110,CPT,Professional,Both,,,26,77,65.45,7.85,77,"Health Partners, Inc.",State Public Programs,7.85,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Xr Lumbar Spine Routine 4 Views (Pro Cah)Professional Component ,,72110,CPT,Professional,Both,,,26,77,65.45,7.85,77,Humana Insurance Company,Commercial PPO,12.37,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Xr Lumbar Spine Routine 4 Views (Pro Cah)Professional Component ,,72110,CPT,Professional,Both,,,26,77,65.45,7.85,77,Humana Insurance Company,Medicare PPO,77,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Xr Lumbar Spine Routine 4 Views (Pro Cah)Professional Component ,,72110,CPT,Professional,Both,,,26,77,65.45,7.85,77,Medica,Individual & Family,65.296,84.8,,percent of total billed charges,,
Xr Lumbar Spine Routine 4 Views (Pro Cah)Professional Component ,,72110,CPT,Professional,Both,,,26,77,65.45,7.85,77,Medica,Medica Advantage Solution,38.346,49.8,,percent of total billed charges,,
Xr Lumbar Spine Routine 4 Views (Pro Cah)Professional Component ,,72110,CPT,Professional,Both,,,26,77,65.45,7.85,77,Medica,Medical Assistance,9.06,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Xr Lumbar Spine Routine 4 Views (Pro Cah)Professional Component ,,72110,CPT,Professional,Both,,,26,77,65.45,7.85,77,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,12.37,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Xr Lumbar Spine Routine 4 Views (Pro Cah)Professional Component ,,72110,CPT,Professional,Both,,,26,77,65.45,7.85,77,"Multiplan, Inc.","Multiplan, Inc.",72.38,94,,percent of total billed charges,,
Xr Lumbar Spine Routine 4 Views (Pro Cah)Professional Component ,,72110,CPT,Professional,Both,,,26,77,65.45,7.85,77,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,69.377,90.1,,percent of total billed charges,,
Xr Lumbar Spine Routine 4 Views (Pro Cah)Professional Component ,,72110,CPT,Professional,Both,,,26,77,65.45,7.85,77,"Preferred One Administrative Services, INC.",PPO,75.922,98.6,,percent of total billed charges,,
Xr Lumbar Spine Routine 4 Views (Pro Cah)Professional Component ,,72110,CPT,Professional,Both,,,26,77,65.45,7.85,77,PrimeWest Health,Minnesota Senior Health Options (MSHO),14.2255,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Lumbar Spine Routine 4 Views (Pro Cah)Professional Component ,,72110,CPT,Professional,Both,,,26,77,65.45,7.85,77,PrimeWest Health,MinnesotaCare,9.6971104,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Lumbar Spine Routine 4 Views (Pro Cah)Professional Component ,,72110,CPT,Professional,Both,,,26,77,65.45,7.85,77,Sanford Health Plan,Sanford Health Plan,67.76,88,,percent of total billed charges,,
Xr Lumbar Spine Routine 4 Views (Pro Cah)Professional Component ,,72110,CPT,Professional,Both,,,26,77,65.45,7.85,77,"UCare Health, Inc.",Individual & Family Plan,20.108672,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Xr Lumbar Spine Routine 4 Views (Pro Cah)Professional Component ,,72110,CPT,Professional,Both,,,26,77,65.45,7.85,77,"UCare Health, Inc.",Medical Assistance,9.968992,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Xr Lumbar Spine Routine 4 Views (Pro Cah)Professional Component ,,72110,CPT,Professional,Both,,,26,77,65.45,7.85,77,"UCare Health, Inc.",Medicare Advantage,14.2255,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Xr Lumbar Spine Routine 4 Views (Pro Cah)Professional Component ,,72110,CPT,Professional,Both,,,26,77,65.45,7.85,77,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),11.3804,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Xr Lumbar Spine Routine 4 Views (Pro Cah)Professional Component ,,72110,CPT,Professional,Both,,,26,77,65.45,7.85,77,UnitedHealthcare,Individual & Family,77,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Xr Lumbar Spine Routine 4 Views (Pro Cah)Professional Component ,,72110,CPT,Professional,Both,,,26,77,65.45,7.85,77,UnitedHealthcare,Medicare Advantage,14.2255,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Lumbar Spine Routine 4 Views (Pro Cah)Professional Component ,,72110,CPT,Professional,Both,,,26,77,65.45,7.85,77,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,9.06272,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Ct Cervical Spine Routine (Pro Cah)Professional Component ,,72125,CPT,Professional,Both,,,26,405,344.25,29.88,405,Aetna,Commercial,344.25,85,,percent of total billed charges,,
Ct Cervical Spine Routine (Pro Cah)Professional Component ,,72125,CPT,Professional,Both,,,26,405,344.25,29.88,405,Aetna,Medicare Advantage,48.23,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Cervical Spine Routine (Pro Cah)Professional Component ,,72125,CPT,Professional,Both,,,26,405,344.25,29.88,405,Aetna,PPO,376.65,93,,percent of total billed charges,,
Ct Cervical Spine Routine (Pro Cah)Professional Component ,,72125,CPT,Professional,Both,,,26,405,344.25,29.88,405,America's PPO,America's PPO,346.032,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Ct Cervical Spine Routine (Pro Cah)Professional Component ,,72125,CPT,Professional,Both,,,26,405,344.25,29.88,405,BlueCross BlueShield Minnesota, Federal Employee Program,89.49,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Ct Cervical Spine Routine (Pro Cah)Professional Component ,,72125,CPT,Professional,Both,,,26,405,344.25,29.88,405,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,90.92184,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Ct Cervical Spine Routine (Pro Cah)Professional Component ,,72125,CPT,Professional,Both,,,26,405,344.25,29.88,405,BlueCross BlueShield Minnesota,High Value Network Plan,90.92184,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Ct Cervical Spine Routine (Pro Cah)Professional Component ,,72125,CPT,Professional,Both,,,26,405,344.25,29.88,405,BlueCross BlueShield Minnesota,Medicare Advantage,53.774,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Cervical Spine Routine (Pro Cah)Professional Component ,,72125,CPT,Professional,Both,,,26,405,344.25,29.88,405,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,90.92184,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Ct Cervical Spine Routine (Pro Cah)Professional Component ,,72125,CPT,Professional,Both,,,26,405,344.25,29.88,405,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,34.50336,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Ct Cervical Spine Routine (Pro Cah)Professional Component ,,72125,CPT,Professional,Both,,,26,405,344.25,29.88,405,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),53.774,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Cervical Spine Routine (Pro Cah)Professional Component ,,72125,CPT,Professional,Both,,,26,405,344.25,29.88,405,CorVel,Worker's Compensation,92.8511061,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Ct Cervical Spine Routine (Pro Cah)Professional Component ,,72125,CPT,Professional,Both,,,26,405,344.25,29.88,405,First Health Group Corporation,First Health Network,392.85,97,,percent of total billed charges,,
Ct Cervical Spine Routine (Pro Cah)Professional Component ,,72125,CPT,Professional,Both,,,26,405,344.25,29.88,405,"Health Partners, Inc.",Commercial,71.16,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Ct Cervical Spine Routine (Pro Cah)Professional Component ,,72125,CPT,Professional,Both,,,26,405,344.25,29.88,405,"Health Partners, Inc.",Medicare Advantage,53.774,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Cervical Spine Routine (Pro Cah)Professional Component ,,72125,CPT,Professional,Both,,,26,405,344.25,29.88,405,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),29.88,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Ct Cervical Spine Routine (Pro Cah)Professional Component ,,72125,CPT,Professional,Both,,,26,405,344.25,29.88,405,"Health Partners, Inc.",State of Minnesota Advantage Program,61.30434,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Ct Cervical Spine Routine (Pro Cah)Professional Component ,,72125,CPT,Professional,Both,,,26,405,344.25,29.88,405,"Health Partners, Inc.",State Public Programs,29.88,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Ct Cervical Spine Routine (Pro Cah)Professional Component ,,72125,CPT,Professional,Both,,,26,405,344.25,29.88,405,Humana Insurance Company,Commercial PPO,46.76,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Ct Cervical Spine Routine (Pro Cah)Professional Component ,,72125,CPT,Professional,Both,,,26,405,344.25,29.88,405,Humana Insurance Company,Medicare PPO,405,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Ct Cervical Spine Routine (Pro Cah)Professional Component ,,72125,CPT,Professional,Both,,,26,405,344.25,29.88,405,Medica,Individual & Family,343.44,84.8,,percent of total billed charges,,
Ct Cervical Spine Routine (Pro Cah)Professional Component ,,72125,CPT,Professional,Both,,,26,405,344.25,29.88,405,Medica,Medica Advantage Solution,201.69,49.8,,percent of total billed charges,,
Ct Cervical Spine Routine (Pro Cah)Professional Component ,,72125,CPT,Professional,Both,,,26,405,344.25,29.88,405,Medica,Medical Assistance,34.5,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Ct Cervical Spine Routine (Pro Cah)Professional Component ,,72125,CPT,Professional,Both,,,26,405,344.25,29.88,405,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,46.76,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Ct Cervical Spine Routine (Pro Cah)Professional Component ,,72125,CPT,Professional,Both,,,26,405,344.25,29.88,405,"Multiplan, Inc.","Multiplan, Inc.",380.7,94,,percent of total billed charges,,
Ct Cervical Spine Routine (Pro Cah)Professional Component ,,72125,CPT,Professional,Both,,,26,405,344.25,29.88,405,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,364.905,90.1,,percent of total billed charges,,
Ct Cervical Spine Routine (Pro Cah)Professional Component ,,72125,CPT,Professional,Both,,,26,405,344.25,29.88,405,"Preferred One Administrative Services, INC.",PPO,399.33,98.6,,percent of total billed charges,,
Ct Cervical Spine Routine (Pro Cah)Professional Component ,,72125,CPT,Professional,Both,,,26,405,344.25,29.88,405,PrimeWest Health,Minnesota Senior Health Options (MSHO),53.774,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Cervical Spine Routine (Pro Cah)Professional Component ,,72125,CPT,Professional,Both,,,26,405,344.25,29.88,405,PrimeWest Health,MinnesotaCare,36.9185952,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Ct Cervical Spine Routine (Pro Cah)Professional Component ,,72125,CPT,Professional,Both,,,26,405,344.25,29.88,405,Sanford Health Plan,Sanford Health Plan,356.4,88,,percent of total billed charges,,
Ct Cervical Spine Routine (Pro Cah)Professional Component ,,72125,CPT,Professional,Both,,,26,405,344.25,29.88,405,"UCare Health, Inc.",Individual & Family Plan,76.013056,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Ct Cervical Spine Routine (Pro Cah)Professional Component ,,72125,CPT,Professional,Both,,,26,405,344.25,29.88,405,"UCare Health, Inc.",Medical Assistance,37.953696,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Ct Cervical Spine Routine (Pro Cah)Professional Component ,,72125,CPT,Professional,Both,,,26,405,344.25,29.88,405,"UCare Health, Inc.",Medicare Advantage,53.774,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Ct Cervical Spine Routine (Pro Cah)Professional Component ,,72125,CPT,Professional,Both,,,26,405,344.25,29.88,405,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),43.0192,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Ct Cervical Spine Routine (Pro Cah)Professional Component ,,72125,CPT,Professional,Both,,,26,405,344.25,29.88,405,UnitedHealthcare,Individual & Family,405,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Ct Cervical Spine Routine (Pro Cah)Professional Component ,,72125,CPT,Professional,Both,,,26,405,344.25,29.88,405,UnitedHealthcare,Medicare Advantage,53.774,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Cervical Spine Routine (Pro Cah)Professional Component ,,72125,CPT,Professional,Both,,,26,405,344.25,29.88,405,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,34.50336,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Ct, Cervical Spine; With Contrast Material (Pro Cah)Professional Component ",,72126,CPT,Professional,Both,,,26,543,461.55,36.64,543,Aetna,Commercial,461.55,85,,percent of total billed charges,,
"Ct, Cervical Spine; With Contrast Material (Pro Cah)Professional Component ",,72126,CPT,Professional,Both,,,26,543,461.55,36.64,543,Aetna,Medicare Advantage,58.74,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Ct, Cervical Spine; With Contrast Material (Pro Cah)Professional Component ",,72126,CPT,Professional,Both,,,26,543,461.55,36.64,543,Aetna,PPO,504.99,93,,percent of total billed charges,,
"Ct, Cervical Spine; With Contrast Material (Pro Cah)Professional Component ",,72126,CPT,Professional,Both,,,26,543,461.55,36.64,543,America's PPO,America's PPO,463.9392,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Ct, Cervical Spine; With Contrast Material (Pro Cah)Professional Component ",,72126,CPT,Professional,Both,,,26,543,461.55,36.64,543,BlueCross BlueShield Minnesota, Federal Employee Program,109.94,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Ct, Cervical Spine; With Contrast Material (Pro Cah)Professional Component ",,72126,CPT,Professional,Both,,,26,543,461.55,36.64,543,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,111.69904,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Ct, Cervical Spine; With Contrast Material (Pro Cah)Professional Component ",,72126,CPT,Professional,Both,,,26,543,461.55,36.64,543,BlueCross BlueShield Minnesota,High Value Network Plan,111.69904,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Ct, Cervical Spine; With Contrast Material (Pro Cah)Professional Component ",,72126,CPT,Professional,Both,,,26,543,461.55,36.64,543,BlueCross BlueShield Minnesota,Medicare Advantage,65.78,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Ct, Cervical Spine; With Contrast Material (Pro Cah)Professional Component ",,72126,CPT,Professional,Both,,,26,543,461.55,36.64,543,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,111.69904,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Ct, Cervical Spine; With Contrast Material (Pro Cah)Professional Component ",,72126,CPT,Professional,Both,,,26,543,461.55,36.64,543,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,42.30624,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Ct, Cervical Spine; With Contrast Material (Pro Cah)Professional Component ",,72126,CPT,Professional,Both,,,26,543,461.55,36.64,543,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),65.78,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Ct, Cervical Spine; With Contrast Material (Pro Cah)Professional Component ",,72126,CPT,Professional,Both,,,26,543,461.55,36.64,543,CorVel,Worker's Compensation,112.865751,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Ct, Cervical Spine; With Contrast Material (Pro Cah)Professional Component ",,72126,CPT,Professional,Both,,,26,543,461.55,36.64,543,First Health Group Corporation,First Health Network,526.71,97,,percent of total billed charges,,
"Ct, Cervical Spine; With Contrast Material (Pro Cah)Professional Component ",,72126,CPT,Professional,Both,,,26,543,461.55,36.64,543,"Health Partners, Inc.",Commercial,86.62,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Ct, Cervical Spine; With Contrast Material (Pro Cah)Professional Component ",,72126,CPT,Professional,Both,,,26,543,461.55,36.64,543,"Health Partners, Inc.",Medicare Advantage,65.78,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Ct, Cervical Spine; With Contrast Material (Pro Cah)Professional Component ",,72126,CPT,Professional,Both,,,26,543,461.55,36.64,543,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),36.64,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Ct, Cervical Spine; With Contrast Material (Pro Cah)Professional Component ",,72126,CPT,Professional,Both,,,26,543,461.55,36.64,543,"Health Partners, Inc.",State of Minnesota Advantage Program,74.62313,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Ct, Cervical Spine; With Contrast Material (Pro Cah)Professional Component ",,72126,CPT,Professional,Both,,,26,543,461.55,36.64,543,"Health Partners, Inc.",State Public Programs,36.64,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Ct, Cervical Spine; With Contrast Material (Pro Cah)Professional Component ",,72126,CPT,Professional,Both,,,26,543,461.55,36.64,543,Humana Insurance Company,Commercial PPO,57.2,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Ct, Cervical Spine; With Contrast Material (Pro Cah)Professional Component ",,72126,CPT,Professional,Both,,,26,543,461.55,36.64,543,Humana Insurance Company,Medicare PPO,543,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Ct, Cervical Spine; With Contrast Material (Pro Cah)Professional Component ",,72126,CPT,Professional,Both,,,26,543,461.55,36.64,543,Medica,Individual & Family,460.464,84.8,,percent of total billed charges,,
"Ct, Cervical Spine; With Contrast Material (Pro Cah)Professional Component ",,72126,CPT,Professional,Both,,,26,543,461.55,36.64,543,Medica,Medica Advantage Solution,270.414,49.8,,percent of total billed charges,,
"Ct, Cervical Spine; With Contrast Material (Pro Cah)Professional Component ",,72126,CPT,Professional,Both,,,26,543,461.55,36.64,543,Medica,Medical Assistance,42.31,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Ct, Cervical Spine; With Contrast Material (Pro Cah)Professional Component ",,72126,CPT,Professional,Both,,,26,543,461.55,36.64,543,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,57.2,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Ct, Cervical Spine; With Contrast Material (Pro Cah)Professional Component ",,72126,CPT,Professional,Both,,,26,543,461.55,36.64,543,"Multiplan, Inc.","Multiplan, Inc.",510.42,94,,percent of total billed charges,,
"Ct, Cervical Spine; With Contrast Material (Pro Cah)Professional Component ",,72126,CPT,Professional,Both,,,26,543,461.55,36.64,543,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,489.243,90.1,,percent of total billed charges,,
"Ct, Cervical Spine; With Contrast Material (Pro Cah)Professional Component ",,72126,CPT,Professional,Both,,,26,543,461.55,36.64,543,"Preferred One Administrative Services, INC.",PPO,535.398,98.6,,percent of total billed charges,,
"Ct, Cervical Spine; With Contrast Material (Pro Cah)Professional Component ",,72126,CPT,Professional,Both,,,26,543,461.55,36.64,543,PrimeWest Health,Minnesota Senior Health Options (MSHO),65.78,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Ct, Cervical Spine; With Contrast Material (Pro Cah)Professional Component ",,72126,CPT,Professional,Both,,,26,543,461.55,36.64,543,PrimeWest Health,MinnesotaCare,45.2676768,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Ct, Cervical Spine; With Contrast Material (Pro Cah)Professional Component ",,72126,CPT,Professional,Both,,,26,543,461.55,36.64,543,Sanford Health Plan,Sanford Health Plan,477.84,88,,percent of total billed charges,,
"Ct, Cervical Spine; With Contrast Material (Pro Cah)Professional Component ",,72126,CPT,Professional,Both,,,26,543,461.55,36.64,543,"UCare Health, Inc.",Individual & Family Plan,92.98432,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Ct, Cervical Spine; With Contrast Material (Pro Cah)Professional Component ",,72126,CPT,Professional,Both,,,26,543,461.55,36.64,543,"UCare Health, Inc.",Medical Assistance,46.536864,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Ct, Cervical Spine; With Contrast Material (Pro Cah)Professional Component ",,72126,CPT,Professional,Both,,,26,543,461.55,36.64,543,"UCare Health, Inc.",Medicare Advantage,65.78,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Ct, Cervical Spine; With Contrast Material (Pro Cah)Professional Component ",,72126,CPT,Professional,Both,,,26,543,461.55,36.64,543,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),52.624,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Ct, Cervical Spine; With Contrast Material (Pro Cah)Professional Component ",,72126,CPT,Professional,Both,,,26,543,461.55,36.64,543,UnitedHealthcare,Individual & Family,543,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Ct, Cervical Spine; With Contrast Material (Pro Cah)Professional Component ",,72126,CPT,Professional,Both,,,26,543,461.55,36.64,543,UnitedHealthcare,Medicare Advantage,65.78,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Ct, Cervical Spine; With Contrast Material (Pro Cah)Professional Component ",,72126,CPT,Professional,Both,,,26,543,461.55,36.64,543,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,42.30624,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Ct,Cervical Spine;W/O Contrast Material,Followed By Contrast Material And Further Sections (Pro Cah)Professional Component ",,72127,CPT,Professional,Both,,,26,521,442.85,38.17,521,Aetna,Commercial,442.85,85,,percent of total billed charges,,
"Ct,Cervical Spine;W/O Contrast Material,Followed By Contrast Material And Further Sections (Pro Cah)Professional Component ",,72127,CPT,Professional,Both,,,26,521,442.85,38.17,521,Aetna,Medicare Advantage,60.84,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Ct,Cervical Spine;W/O Contrast Material,Followed By Contrast Material And Further Sections (Pro Cah)Professional Component ",,72127,CPT,Professional,Both,,,26,521,442.85,38.17,521,Aetna,PPO,484.53,93,,percent of total billed charges,,
"Ct,Cervical Spine;W/O Contrast Material,Followed By Contrast Material And Further Sections (Pro Cah)Professional Component ",,72127,CPT,Professional,Both,,,26,521,442.85,38.17,521,America's PPO,America's PPO,445.1424,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Ct,Cervical Spine;W/O Contrast Material,Followed By Contrast Material And Further Sections (Pro Cah)Professional Component ",,72127,CPT,Professional,Both,,,26,521,442.85,38.17,521,BlueCross BlueShield Minnesota, Federal Employee Program,114.42,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Ct,Cervical Spine;W/O Contrast Material,Followed By Contrast Material And Further Sections (Pro Cah)Professional Component ",,72127,CPT,Professional,Both,,,26,521,442.85,38.17,521,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,116.25072,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Ct,Cervical Spine;W/O Contrast Material,Followed By Contrast Material And Further Sections (Pro Cah)Professional Component ",,72127,CPT,Professional,Both,,,26,521,442.85,38.17,521,BlueCross BlueShield Minnesota,High Value Network Plan,116.25072,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Ct,Cervical Spine;W/O Contrast Material,Followed By Contrast Material And Further Sections (Pro Cah)Professional Component ",,72127,CPT,Professional,Both,,,26,521,442.85,38.17,521,BlueCross BlueShield Minnesota,Medicare Advantage,68.2525,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Ct,Cervical Spine;W/O Contrast Material,Followed By Contrast Material And Further Sections (Pro Cah)Professional Component ",,72127,CPT,Professional,Both,,,26,521,442.85,38.17,521,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,116.25072,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Ct,Cervical Spine;W/O Contrast Material,Followed By Contrast Material And Further Sections (Pro Cah)Professional Component ",,72127,CPT,Professional,Both,,,26,521,442.85,38.17,521,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,44.07408,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Ct,Cervical Spine;W/O Contrast Material,Followed By Contrast Material And Further Sections (Pro Cah)Professional Component ",,72127,CPT,Professional,Both,,,26,521,442.85,38.17,521,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),68.2525,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Ct,Cervical Spine;W/O Contrast Material,Followed By Contrast Material And Further Sections (Pro Cah)Professional Component ",,72127,CPT,Professional,Both,,,26,521,442.85,38.17,521,CorVel,Worker's Compensation,117.8222253,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Ct,Cervical Spine;W/O Contrast Material,Followed By Contrast Material And Further Sections (Pro Cah)Professional Component ",,72127,CPT,Professional,Both,,,26,521,442.85,38.17,521,First Health Group Corporation,First Health Network,505.37,97,,percent of total billed charges,,
"Ct,Cervical Spine;W/O Contrast Material,Followed By Contrast Material And Further Sections (Pro Cah)Professional Component ",,72127,CPT,Professional,Both,,,26,521,442.85,38.17,521,"Health Partners, Inc.",Commercial,90.75,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Ct,Cervical Spine;W/O Contrast Material,Followed By Contrast Material And Further Sections (Pro Cah)Professional Component ",,72127,CPT,Professional,Both,,,26,521,442.85,38.17,521,"Health Partners, Inc.",Medicare Advantage,68.2525,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Ct,Cervical Spine;W/O Contrast Material,Followed By Contrast Material And Further Sections (Pro Cah)Professional Component ",,72127,CPT,Professional,Both,,,26,521,442.85,38.17,521,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),38.17,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Ct,Cervical Spine;W/O Contrast Material,Followed By Contrast Material And Further Sections (Pro Cah)Professional Component ",,72127,CPT,Professional,Both,,,26,521,442.85,38.17,521,"Health Partners, Inc.",State of Minnesota Advantage Program,78.181125,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Ct,Cervical Spine;W/O Contrast Material,Followed By Contrast Material And Further Sections (Pro Cah)Professional Component ",,72127,CPT,Professional,Both,,,26,521,442.85,38.17,521,"Health Partners, Inc.",State Public Programs,38.17,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Ct,Cervical Spine;W/O Contrast Material,Followed By Contrast Material And Further Sections (Pro Cah)Professional Component ",,72127,CPT,Professional,Both,,,26,521,442.85,38.17,521,Humana Insurance Company,Commercial PPO,59.35,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Ct,Cervical Spine;W/O Contrast Material,Followed By Contrast Material And Further Sections (Pro Cah)Professional Component ",,72127,CPT,Professional,Both,,,26,521,442.85,38.17,521,Humana Insurance Company,Medicare PPO,521,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Ct,Cervical Spine;W/O Contrast Material,Followed By Contrast Material And Further Sections (Pro Cah)Professional Component ",,72127,CPT,Professional,Both,,,26,521,442.85,38.17,521,Medica,Individual & Family,441.808,84.8,,percent of total billed charges,,
"Ct,Cervical Spine;W/O Contrast Material,Followed By Contrast Material And Further Sections (Pro Cah)Professional Component ",,72127,CPT,Professional,Both,,,26,521,442.85,38.17,521,Medica,Medica Advantage Solution,259.458,49.8,,percent of total billed charges,,
"Ct,Cervical Spine;W/O Contrast Material,Followed By Contrast Material And Further Sections (Pro Cah)Professional Component ",,72127,CPT,Professional,Both,,,26,521,442.85,38.17,521,Medica,Medical Assistance,44.07,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Ct,Cervical Spine;W/O Contrast Material,Followed By Contrast Material And Further Sections (Pro Cah)Professional Component ",,72127,CPT,Professional,Both,,,26,521,442.85,38.17,521,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,59.35,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Ct,Cervical Spine;W/O Contrast Material,Followed By Contrast Material And Further Sections (Pro Cah)Professional Component ",,72127,CPT,Professional,Both,,,26,521,442.85,38.17,521,"Multiplan, Inc.","Multiplan, Inc.",489.74,94,,percent of total billed charges,,
"Ct,Cervical Spine;W/O Contrast Material,Followed By Contrast Material And Further Sections (Pro Cah)Professional Component ",,72127,CPT,Professional,Both,,,26,521,442.85,38.17,521,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,469.421,90.1,,percent of total billed charges,,
"Ct,Cervical Spine;W/O Contrast Material,Followed By Contrast Material And Further Sections (Pro Cah)Professional Component ",,72127,CPT,Professional,Both,,,26,521,442.85,38.17,521,"Preferred One Administrative Services, INC.",PPO,513.706,98.6,,percent of total billed charges,,
"Ct,Cervical Spine;W/O Contrast Material,Followed By Contrast Material And Further Sections (Pro Cah)Professional Component ",,72127,CPT,Professional,Both,,,26,521,442.85,38.17,521,PrimeWest Health,Minnesota Senior Health Options (MSHO),68.2525,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Ct,Cervical Spine;W/O Contrast Material,Followed By Contrast Material And Further Sections (Pro Cah)Professional Component ",,72127,CPT,Professional,Both,,,26,521,442.85,38.17,521,PrimeWest Health,MinnesotaCare,47.1592656,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Ct,Cervical Spine;W/O Contrast Material,Followed By Contrast Material And Further Sections (Pro Cah)Professional Component ",,72127,CPT,Professional,Both,,,26,521,442.85,38.17,521,Sanford Health Plan,Sanford Health Plan,458.48,88,,percent of total billed charges,,
"Ct,Cervical Spine;W/O Contrast Material,Followed By Contrast Material And Further Sections (Pro Cah)Professional Component ",,72127,CPT,Professional,Both,,,26,521,442.85,38.17,521,"UCare Health, Inc.",Individual & Family Plan,96.47936,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Ct,Cervical Spine;W/O Contrast Material,Followed By Contrast Material And Further Sections (Pro Cah)Professional Component ",,72127,CPT,Professional,Both,,,26,521,442.85,38.17,521,"UCare Health, Inc.",Medical Assistance,48.481488,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Ct,Cervical Spine;W/O Contrast Material,Followed By Contrast Material And Further Sections (Pro Cah)Professional Component ",,72127,CPT,Professional,Both,,,26,521,442.85,38.17,521,"UCare Health, Inc.",Medicare Advantage,68.2525,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Ct,Cervical Spine;W/O Contrast Material,Followed By Contrast Material And Further Sections (Pro Cah)Professional Component ",,72127,CPT,Professional,Both,,,26,521,442.85,38.17,521,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),54.602,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Ct,Cervical Spine;W/O Contrast Material,Followed By Contrast Material And Further Sections (Pro Cah)Professional Component ",,72127,CPT,Professional,Both,,,26,521,442.85,38.17,521,UnitedHealthcare,Individual & Family,521,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Ct,Cervical Spine;W/O Contrast Material,Followed By Contrast Material And Further Sections (Pro Cah)Professional Component ",,72127,CPT,Professional,Both,,,26,521,442.85,38.17,521,UnitedHealthcare,Medicare Advantage,68.2525,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Ct,Cervical Spine;W/O Contrast Material,Followed By Contrast Material And Further Sections (Pro Cah)Professional Component ",,72127,CPT,Professional,Both,,,26,521,442.85,38.17,521,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,44.07408,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Ct Thoracic Spine Routine (Pro Cah)Professional Component ,,72128,CPT,Professional,Both,,,26,405,344.25,29.88,405,Aetna,Commercial,344.25,85,,percent of total billed charges,,
Ct Thoracic Spine Routine (Pro Cah)Professional Component ,,72128,CPT,Professional,Both,,,26,405,344.25,29.88,405,Aetna,Medicare Advantage,48.23,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Thoracic Spine Routine (Pro Cah)Professional Component ,,72128,CPT,Professional,Both,,,26,405,344.25,29.88,405,Aetna,PPO,376.65,93,,percent of total billed charges,,
Ct Thoracic Spine Routine (Pro Cah)Professional Component ,,72128,CPT,Professional,Both,,,26,405,344.25,29.88,405,America's PPO,America's PPO,346.032,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Ct Thoracic Spine Routine (Pro Cah)Professional Component ,,72128,CPT,Professional,Both,,,26,405,344.25,29.88,405,BlueCross BlueShield Minnesota, Federal Employee Program,89.49,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Ct Thoracic Spine Routine (Pro Cah)Professional Component ,,72128,CPT,Professional,Both,,,26,405,344.25,29.88,405,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,90.92184,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Ct Thoracic Spine Routine (Pro Cah)Professional Component ,,72128,CPT,Professional,Both,,,26,405,344.25,29.88,405,BlueCross BlueShield Minnesota,High Value Network Plan,90.92184,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Ct Thoracic Spine Routine (Pro Cah)Professional Component ,,72128,CPT,Professional,Both,,,26,405,344.25,29.88,405,BlueCross BlueShield Minnesota,Medicare Advantage,53.774,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Thoracic Spine Routine (Pro Cah)Professional Component ,,72128,CPT,Professional,Both,,,26,405,344.25,29.88,405,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,90.92184,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Ct Thoracic Spine Routine (Pro Cah)Professional Component ,,72128,CPT,Professional,Both,,,26,405,344.25,29.88,405,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,34.50336,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Ct Thoracic Spine Routine (Pro Cah)Professional Component ,,72128,CPT,Professional,Both,,,26,405,344.25,29.88,405,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),53.774,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Thoracic Spine Routine (Pro Cah)Professional Component ,,72128,CPT,Professional,Both,,,26,405,344.25,29.88,405,CorVel,Worker's Compensation,92.8511061,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Ct Thoracic Spine Routine (Pro Cah)Professional Component ,,72128,CPT,Professional,Both,,,26,405,344.25,29.88,405,First Health Group Corporation,First Health Network,392.85,97,,percent of total billed charges,,
Ct Thoracic Spine Routine (Pro Cah)Professional Component ,,72128,CPT,Professional,Both,,,26,405,344.25,29.88,405,"Health Partners, Inc.",Commercial,71.16,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Ct Thoracic Spine Routine (Pro Cah)Professional Component ,,72128,CPT,Professional,Both,,,26,405,344.25,29.88,405,"Health Partners, Inc.",Medicare Advantage,53.774,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Thoracic Spine Routine (Pro Cah)Professional Component ,,72128,CPT,Professional,Both,,,26,405,344.25,29.88,405,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),29.88,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Ct Thoracic Spine Routine (Pro Cah)Professional Component ,,72128,CPT,Professional,Both,,,26,405,344.25,29.88,405,"Health Partners, Inc.",State of Minnesota Advantage Program,61.30434,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Ct Thoracic Spine Routine (Pro Cah)Professional Component ,,72128,CPT,Professional,Both,,,26,405,344.25,29.88,405,"Health Partners, Inc.",State Public Programs,29.88,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Ct Thoracic Spine Routine (Pro Cah)Professional Component ,,72128,CPT,Professional,Both,,,26,405,344.25,29.88,405,Humana Insurance Company,Commercial PPO,46.76,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Ct Thoracic Spine Routine (Pro Cah)Professional Component ,,72128,CPT,Professional,Both,,,26,405,344.25,29.88,405,Humana Insurance Company,Medicare PPO,405,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Ct Thoracic Spine Routine (Pro Cah)Professional Component ,,72128,CPT,Professional,Both,,,26,405,344.25,29.88,405,Medica,Individual & Family,343.44,84.8,,percent of total billed charges,,
Ct Thoracic Spine Routine (Pro Cah)Professional Component ,,72128,CPT,Professional,Both,,,26,405,344.25,29.88,405,Medica,Medica Advantage Solution,201.69,49.8,,percent of total billed charges,,
Ct Thoracic Spine Routine (Pro Cah)Professional Component ,,72128,CPT,Professional,Both,,,26,405,344.25,29.88,405,Medica,Medical Assistance,34.5,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Ct Thoracic Spine Routine (Pro Cah)Professional Component ,,72128,CPT,Professional,Both,,,26,405,344.25,29.88,405,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,46.76,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Ct Thoracic Spine Routine (Pro Cah)Professional Component ,,72128,CPT,Professional,Both,,,26,405,344.25,29.88,405,"Multiplan, Inc.","Multiplan, Inc.",380.7,94,,percent of total billed charges,,
Ct Thoracic Spine Routine (Pro Cah)Professional Component ,,72128,CPT,Professional,Both,,,26,405,344.25,29.88,405,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,364.905,90.1,,percent of total billed charges,,
Ct Thoracic Spine Routine (Pro Cah)Professional Component ,,72128,CPT,Professional,Both,,,26,405,344.25,29.88,405,"Preferred One Administrative Services, INC.",PPO,399.33,98.6,,percent of total billed charges,,
Ct Thoracic Spine Routine (Pro Cah)Professional Component ,,72128,CPT,Professional,Both,,,26,405,344.25,29.88,405,PrimeWest Health,Minnesota Senior Health Options (MSHO),53.774,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Thoracic Spine Routine (Pro Cah)Professional Component ,,72128,CPT,Professional,Both,,,26,405,344.25,29.88,405,PrimeWest Health,MinnesotaCare,36.9185952,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Ct Thoracic Spine Routine (Pro Cah)Professional Component ,,72128,CPT,Professional,Both,,,26,405,344.25,29.88,405,Sanford Health Plan,Sanford Health Plan,356.4,88,,percent of total billed charges,,
Ct Thoracic Spine Routine (Pro Cah)Professional Component ,,72128,CPT,Professional,Both,,,26,405,344.25,29.88,405,"UCare Health, Inc.",Individual & Family Plan,76.013056,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Ct Thoracic Spine Routine (Pro Cah)Professional Component ,,72128,CPT,Professional,Both,,,26,405,344.25,29.88,405,"UCare Health, Inc.",Medical Assistance,37.953696,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Ct Thoracic Spine Routine (Pro Cah)Professional Component ,,72128,CPT,Professional,Both,,,26,405,344.25,29.88,405,"UCare Health, Inc.",Medicare Advantage,53.774,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Ct Thoracic Spine Routine (Pro Cah)Professional Component ,,72128,CPT,Professional,Both,,,26,405,344.25,29.88,405,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),43.0192,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Ct Thoracic Spine Routine (Pro Cah)Professional Component ,,72128,CPT,Professional,Both,,,26,405,344.25,29.88,405,UnitedHealthcare,Individual & Family,405,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Ct Thoracic Spine Routine (Pro Cah)Professional Component ,,72128,CPT,Professional,Both,,,26,405,344.25,29.88,405,UnitedHealthcare,Medicare Advantage,53.774,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Thoracic Spine Routine (Pro Cah)Professional Component ,,72128,CPT,Professional,Both,,,26,405,344.25,29.88,405,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,34.50336,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Ct, Thoracic Spine; With Contrast Material (Pro Cah)Professional Component ",,72129,CPT,Professional,Both,,,26,475,403.75,36.86,475,Aetna,Commercial,403.75,85,,percent of total billed charges,,
"Ct, Thoracic Spine; With Contrast Material (Pro Cah)Professional Component ",,72129,CPT,Professional,Both,,,26,475,403.75,36.86,475,Aetna,Medicare Advantage,58.74,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Ct, Thoracic Spine; With Contrast Material (Pro Cah)Professional Component ",,72129,CPT,Professional,Both,,,26,475,403.75,36.86,475,Aetna,PPO,441.75,93,,percent of total billed charges,,
"Ct, Thoracic Spine; With Contrast Material (Pro Cah)Professional Component ",,72129,CPT,Professional,Both,,,26,475,403.75,36.86,475,America's PPO,America's PPO,405.84,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Ct, Thoracic Spine; With Contrast Material (Pro Cah)Professional Component ",,72129,CPT,Professional,Both,,,26,475,403.75,36.86,475,BlueCross BlueShield Minnesota, Federal Employee Program,110.58,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Ct, Thoracic Spine; With Contrast Material (Pro Cah)Professional Component ",,72129,CPT,Professional,Both,,,26,475,403.75,36.86,475,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,112.34928,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Ct, Thoracic Spine; With Contrast Material (Pro Cah)Professional Component ",,72129,CPT,Professional,Both,,,26,475,403.75,36.86,475,BlueCross BlueShield Minnesota,High Value Network Plan,112.34928,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Ct, Thoracic Spine; With Contrast Material (Pro Cah)Professional Component ",,72129,CPT,Professional,Both,,,26,475,403.75,36.86,475,BlueCross BlueShield Minnesota,Medicare Advantage,65.9065,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Ct, Thoracic Spine; With Contrast Material (Pro Cah)Professional Component ",,72129,CPT,Professional,Both,,,26,475,403.75,36.86,475,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,112.34928,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Ct, Thoracic Spine; With Contrast Material (Pro Cah)Professional Component ",,72129,CPT,Professional,Both,,,26,475,403.75,36.86,475,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,42.56024,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Ct, Thoracic Spine; With Contrast Material (Pro Cah)Professional Component ",,72129,CPT,Professional,Both,,,26,475,403.75,36.86,475,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),65.9065,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Ct, Thoracic Spine; With Contrast Material (Pro Cah)Professional Component ",,72129,CPT,Professional,Both,,,26,475,403.75,36.86,475,CorVel,Worker's Compensation,113.5461831,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Ct, Thoracic Spine; With Contrast Material (Pro Cah)Professional Component ",,72129,CPT,Professional,Both,,,26,475,403.75,36.86,475,First Health Group Corporation,First Health Network,460.75,97,,percent of total billed charges,,
"Ct, Thoracic Spine; With Contrast Material (Pro Cah)Professional Component ",,72129,CPT,Professional,Both,,,26,475,403.75,36.86,475,"Health Partners, Inc.",Commercial,87.14,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Ct, Thoracic Spine; With Contrast Material (Pro Cah)Professional Component ",,72129,CPT,Professional,Both,,,26,475,403.75,36.86,475,"Health Partners, Inc.",Medicare Advantage,65.9065,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Ct, Thoracic Spine; With Contrast Material (Pro Cah)Professional Component ",,72129,CPT,Professional,Both,,,26,475,403.75,36.86,475,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),36.86,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Ct, Thoracic Spine; With Contrast Material (Pro Cah)Professional Component ",,72129,CPT,Professional,Both,,,26,475,403.75,36.86,475,"Health Partners, Inc.",State of Minnesota Advantage Program,75.07111,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Ct, Thoracic Spine; With Contrast Material (Pro Cah)Professional Component ",,72129,CPT,Professional,Both,,,26,475,403.75,36.86,475,"Health Partners, Inc.",State Public Programs,36.86,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Ct, Thoracic Spine; With Contrast Material (Pro Cah)Professional Component ",,72129,CPT,Professional,Both,,,26,475,403.75,36.86,475,Humana Insurance Company,Commercial PPO,57.31,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Ct, Thoracic Spine; With Contrast Material (Pro Cah)Professional Component ",,72129,CPT,Professional,Both,,,26,475,403.75,36.86,475,Humana Insurance Company,Medicare PPO,475,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Ct, Thoracic Spine; With Contrast Material (Pro Cah)Professional Component ",,72129,CPT,Professional,Both,,,26,475,403.75,36.86,475,Medica,Individual & Family,402.8,84.8,,percent of total billed charges,,
"Ct, Thoracic Spine; With Contrast Material (Pro Cah)Professional Component ",,72129,CPT,Professional,Both,,,26,475,403.75,36.86,475,Medica,Medica Advantage Solution,236.55,49.8,,percent of total billed charges,,
"Ct, Thoracic Spine; With Contrast Material (Pro Cah)Professional Component ",,72129,CPT,Professional,Both,,,26,475,403.75,36.86,475,Medica,Medical Assistance,42.56,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Ct, Thoracic Spine; With Contrast Material (Pro Cah)Professional Component ",,72129,CPT,Professional,Both,,,26,475,403.75,36.86,475,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,57.31,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Ct, Thoracic Spine; With Contrast Material (Pro Cah)Professional Component ",,72129,CPT,Professional,Both,,,26,475,403.75,36.86,475,"Multiplan, Inc.","Multiplan, Inc.",446.5,94,,percent of total billed charges,,
"Ct, Thoracic Spine; With Contrast Material (Pro Cah)Professional Component ",,72129,CPT,Professional,Both,,,26,475,403.75,36.86,475,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,427.975,90.1,,percent of total billed charges,,
"Ct, Thoracic Spine; With Contrast Material (Pro Cah)Professional Component ",,72129,CPT,Professional,Both,,,26,475,403.75,36.86,475,"Preferred One Administrative Services, INC.",PPO,468.35,98.6,,percent of total billed charges,,
"Ct, Thoracic Spine; With Contrast Material (Pro Cah)Professional Component ",,72129,CPT,Professional,Both,,,26,475,403.75,36.86,475,PrimeWest Health,Minnesota Senior Health Options (MSHO),65.9065,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Ct, Thoracic Spine; With Contrast Material (Pro Cah)Professional Component ",,72129,CPT,Professional,Both,,,26,475,403.75,36.86,475,PrimeWest Health,MinnesotaCare,45.5394568,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Ct, Thoracic Spine; With Contrast Material (Pro Cah)Professional Component ",,72129,CPT,Professional,Both,,,26,475,403.75,36.86,475,Sanford Health Plan,Sanford Health Plan,418,88,,percent of total billed charges,,
"Ct, Thoracic Spine; With Contrast Material (Pro Cah)Professional Component ",,72129,CPT,Professional,Both,,,26,475,403.75,36.86,475,"UCare Health, Inc.",Individual & Family Plan,93.163136,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Ct, Thoracic Spine; With Contrast Material (Pro Cah)Professional Component ",,72129,CPT,Professional,Both,,,26,475,403.75,36.86,475,"UCare Health, Inc.",Medical Assistance,46.816264,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Ct, Thoracic Spine; With Contrast Material (Pro Cah)Professional Component ",,72129,CPT,Professional,Both,,,26,475,403.75,36.86,475,"UCare Health, Inc.",Medicare Advantage,65.9065,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Ct, Thoracic Spine; With Contrast Material (Pro Cah)Professional Component ",,72129,CPT,Professional,Both,,,26,475,403.75,36.86,475,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),52.7252,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Ct, Thoracic Spine; With Contrast Material (Pro Cah)Professional Component ",,72129,CPT,Professional,Both,,,26,475,403.75,36.86,475,UnitedHealthcare,Individual & Family,475,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Ct, Thoracic Spine; With Contrast Material (Pro Cah)Professional Component ",,72129,CPT,Professional,Both,,,26,475,403.75,36.86,475,UnitedHealthcare,Medicare Advantage,65.9065,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Ct, Thoracic Spine; With Contrast Material (Pro Cah)Professional Component ",,72129,CPT,Professional,Both,,,26,475,403.75,36.86,475,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,42.56024,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Ct, Thoracic Spine;W/O Contrast Material,Followed By Contrast Material And Further Section (Pro Cah)Professional Component ",,72130,CPT,Professional,Both,,,26,505,429.25,38.39,505,Aetna,Commercial,429.25,85,,percent of total billed charges,,
"Ct, Thoracic Spine;W/O Contrast Material,Followed By Contrast Material And Further Section (Pro Cah)Professional Component ",,72130,CPT,Professional,Both,,,26,505,429.25,38.39,505,Aetna,Medicare Advantage,60.84,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Ct, Thoracic Spine;W/O Contrast Material,Followed By Contrast Material And Further Section (Pro Cah)Professional Component ",,72130,CPT,Professional,Both,,,26,505,429.25,38.39,505,Aetna,PPO,469.65,93,,percent of total billed charges,,
"Ct, Thoracic Spine;W/O Contrast Material,Followed By Contrast Material And Further Section (Pro Cah)Professional Component ",,72130,CPT,Professional,Both,,,26,505,429.25,38.39,505,America's PPO,America's PPO,431.472,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Ct, Thoracic Spine;W/O Contrast Material,Followed By Contrast Material And Further Section (Pro Cah)Professional Component ",,72130,CPT,Professional,Both,,,26,505,429.25,38.39,505,BlueCross BlueShield Minnesota, Federal Employee Program,115.06,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Ct, Thoracic Spine;W/O Contrast Material,Followed By Contrast Material And Further Section (Pro Cah)Professional Component ",,72130,CPT,Professional,Both,,,26,505,429.25,38.39,505,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,116.90096,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Ct, Thoracic Spine;W/O Contrast Material,Followed By Contrast Material And Further Section (Pro Cah)Professional Component ",,72130,CPT,Professional,Both,,,26,505,429.25,38.39,505,BlueCross BlueShield Minnesota,High Value Network Plan,116.90096,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Ct, Thoracic Spine;W/O Contrast Material,Followed By Contrast Material And Further Section (Pro Cah)Professional Component ",,72130,CPT,Professional,Both,,,26,505,429.25,38.39,505,BlueCross BlueShield Minnesota,Medicare Advantage,68.6435,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Ct, Thoracic Spine;W/O Contrast Material,Followed By Contrast Material And Further Section (Pro Cah)Professional Component ",,72130,CPT,Professional,Both,,,26,505,429.25,38.39,505,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,116.90096,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Ct, Thoracic Spine;W/O Contrast Material,Followed By Contrast Material And Further Section (Pro Cah)Professional Component ",,72130,CPT,Professional,Both,,,26,505,429.25,38.39,505,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,44.32808,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Ct, Thoracic Spine;W/O Contrast Material,Followed By Contrast Material And Further Section (Pro Cah)Professional Component ",,72130,CPT,Professional,Both,,,26,505,429.25,38.39,505,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),68.6435,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Ct, Thoracic Spine;W/O Contrast Material,Followed By Contrast Material And Further Section (Pro Cah)Professional Component ",,72130,CPT,Professional,Both,,,26,505,429.25,38.39,505,CorVel,Worker's Compensation,117.5851152,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Ct, Thoracic Spine;W/O Contrast Material,Followed By Contrast Material And Further Section (Pro Cah)Professional Component ",,72130,CPT,Professional,Both,,,26,505,429.25,38.39,505,First Health Group Corporation,First Health Network,489.85,97,,percent of total billed charges,,
"Ct, Thoracic Spine;W/O Contrast Material,Followed By Contrast Material And Further Section (Pro Cah)Professional Component ",,72130,CPT,Professional,Both,,,26,505,429.25,38.39,505,"Health Partners, Inc.",Commercial,90.23,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Ct, Thoracic Spine;W/O Contrast Material,Followed By Contrast Material And Further Section (Pro Cah)Professional Component ",,72130,CPT,Professional,Both,,,26,505,429.25,38.39,505,"Health Partners, Inc.",Medicare Advantage,68.6435,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Ct, Thoracic Spine;W/O Contrast Material,Followed By Contrast Material And Further Section (Pro Cah)Professional Component ",,72130,CPT,Professional,Both,,,26,505,429.25,38.39,505,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),38.39,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Ct, Thoracic Spine;W/O Contrast Material,Followed By Contrast Material And Further Section (Pro Cah)Professional Component ",,72130,CPT,Professional,Both,,,26,505,429.25,38.39,505,"Health Partners, Inc.",State of Minnesota Advantage Program,77.733145,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Ct, Thoracic Spine;W/O Contrast Material,Followed By Contrast Material And Further Section (Pro Cah)Professional Component ",,72130,CPT,Professional,Both,,,26,505,429.25,38.39,505,"Health Partners, Inc.",State Public Programs,38.39,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Ct, Thoracic Spine;W/O Contrast Material,Followed By Contrast Material And Further Section (Pro Cah)Professional Component ",,72130,CPT,Professional,Both,,,26,505,429.25,38.39,505,Humana Insurance Company,Commercial PPO,59.69,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Ct, Thoracic Spine;W/O Contrast Material,Followed By Contrast Material And Further Section (Pro Cah)Professional Component ",,72130,CPT,Professional,Both,,,26,505,429.25,38.39,505,Humana Insurance Company,Medicare PPO,505,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Ct, Thoracic Spine;W/O Contrast Material,Followed By Contrast Material And Further Section (Pro Cah)Professional Component ",,72130,CPT,Professional,Both,,,26,505,429.25,38.39,505,Medica,Individual & Family,428.24,84.8,,percent of total billed charges,,
"Ct, Thoracic Spine;W/O Contrast Material,Followed By Contrast Material And Further Section (Pro Cah)Professional Component ",,72130,CPT,Professional,Both,,,26,505,429.25,38.39,505,Medica,Medica Advantage Solution,251.49,49.8,,percent of total billed charges,,
"Ct, Thoracic Spine;W/O Contrast Material,Followed By Contrast Material And Further Section (Pro Cah)Professional Component ",,72130,CPT,Professional,Both,,,26,505,429.25,38.39,505,Medica,Medical Assistance,44.33,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Ct, Thoracic Spine;W/O Contrast Material,Followed By Contrast Material And Further Section (Pro Cah)Professional Component ",,72130,CPT,Professional,Both,,,26,505,429.25,38.39,505,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,59.69,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Ct, Thoracic Spine;W/O Contrast Material,Followed By Contrast Material And Further Section (Pro Cah)Professional Component ",,72130,CPT,Professional,Both,,,26,505,429.25,38.39,505,"Multiplan, Inc.","Multiplan, Inc.",474.7,94,,percent of total billed charges,,
"Ct, Thoracic Spine;W/O Contrast Material,Followed By Contrast Material And Further Section (Pro Cah)Professional Component ",,72130,CPT,Professional,Both,,,26,505,429.25,38.39,505,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,455.005,90.1,,percent of total billed charges,,
"Ct, Thoracic Spine;W/O Contrast Material,Followed By Contrast Material And Further Section (Pro Cah)Professional Component ",,72130,CPT,Professional,Both,,,26,505,429.25,38.39,505,"Preferred One Administrative Services, INC.",PPO,497.93,98.6,,percent of total billed charges,,
"Ct, Thoracic Spine;W/O Contrast Material,Followed By Contrast Material And Further Section (Pro Cah)Professional Component ",,72130,CPT,Professional,Both,,,26,505,429.25,38.39,505,PrimeWest Health,Minnesota Senior Health Options (MSHO),68.6435,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Ct, Thoracic Spine;W/O Contrast Material,Followed By Contrast Material And Further Section (Pro Cah)Professional Component ",,72130,CPT,Professional,Both,,,26,505,429.25,38.39,505,PrimeWest Health,MinnesotaCare,47.4310456,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Ct, Thoracic Spine;W/O Contrast Material,Followed By Contrast Material And Further Section (Pro Cah)Professional Component ",,72130,CPT,Professional,Both,,,26,505,429.25,38.39,505,Sanford Health Plan,Sanford Health Plan,444.4,88,,percent of total billed charges,,
"Ct, Thoracic Spine;W/O Contrast Material,Followed By Contrast Material And Further Section (Pro Cah)Professional Component ",,72130,CPT,Professional,Both,,,26,505,429.25,38.39,505,"UCare Health, Inc.",Individual & Family Plan,97.032064,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Ct, Thoracic Spine;W/O Contrast Material,Followed By Contrast Material And Further Section (Pro Cah)Professional Component ",,72130,CPT,Professional,Both,,,26,505,429.25,38.39,505,"UCare Health, Inc.",Medical Assistance,48.760888,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Ct, Thoracic Spine;W/O Contrast Material,Followed By Contrast Material And Further Section (Pro Cah)Professional Component ",,72130,CPT,Professional,Both,,,26,505,429.25,38.39,505,"UCare Health, Inc.",Medicare Advantage,68.6435,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Ct, Thoracic Spine;W/O Contrast Material,Followed By Contrast Material And Further Section (Pro Cah)Professional Component ",,72130,CPT,Professional,Both,,,26,505,429.25,38.39,505,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),54.9148,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Ct, Thoracic Spine;W/O Contrast Material,Followed By Contrast Material And Further Section (Pro Cah)Professional Component ",,72130,CPT,Professional,Both,,,26,505,429.25,38.39,505,UnitedHealthcare,Individual & Family,505,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Ct, Thoracic Spine;W/O Contrast Material,Followed By Contrast Material And Further Section (Pro Cah)Professional Component ",,72130,CPT,Professional,Both,,,26,505,429.25,38.39,505,UnitedHealthcare,Medicare Advantage,68.6435,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Ct, Thoracic Spine;W/O Contrast Material,Followed By Contrast Material And Further Section (Pro Cah)Professional Component ",,72130,CPT,Professional,Both,,,26,505,429.25,38.39,505,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,44.32808,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Ct Lumbar Spine Routine (Pro Cah)Professional Component ,,72131,CPT,Professional,Both,,,26,440,374,29.88,440,Aetna,Commercial,374,85,,percent of total billed charges,,
Ct Lumbar Spine Routine (Pro Cah)Professional Component ,,72131,CPT,Professional,Both,,,26,440,374,29.88,440,Aetna,Medicare Advantage,48.23,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Lumbar Spine Routine (Pro Cah)Professional Component ,,72131,CPT,Professional,Both,,,26,440,374,29.88,440,Aetna,PPO,409.2,93,,percent of total billed charges,,
Ct Lumbar Spine Routine (Pro Cah)Professional Component ,,72131,CPT,Professional,Both,,,26,440,374,29.88,440,America's PPO,America's PPO,375.936,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Ct Lumbar Spine Routine (Pro Cah)Professional Component ,,72131,CPT,Professional,Both,,,26,440,374,29.88,440,BlueCross BlueShield Minnesota, Federal Employee Program,89.49,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Ct Lumbar Spine Routine (Pro Cah)Professional Component ,,72131,CPT,Professional,Both,,,26,440,374,29.88,440,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,90.92184,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Ct Lumbar Spine Routine (Pro Cah)Professional Component ,,72131,CPT,Professional,Both,,,26,440,374,29.88,440,BlueCross BlueShield Minnesota,High Value Network Plan,90.92184,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Ct Lumbar Spine Routine (Pro Cah)Professional Component ,,72131,CPT,Professional,Both,,,26,440,374,29.88,440,BlueCross BlueShield Minnesota,Medicare Advantage,53.774,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Lumbar Spine Routine (Pro Cah)Professional Component ,,72131,CPT,Professional,Both,,,26,440,374,29.88,440,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,90.92184,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Ct Lumbar Spine Routine (Pro Cah)Professional Component ,,72131,CPT,Professional,Both,,,26,440,374,29.88,440,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,34.50336,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Ct Lumbar Spine Routine (Pro Cah)Professional Component ,,72131,CPT,Professional,Both,,,26,440,374,29.88,440,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),53.774,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Lumbar Spine Routine (Pro Cah)Professional Component ,,72131,CPT,Professional,Both,,,26,440,374,29.88,440,CorVel,Worker's Compensation,92.8511061,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Ct Lumbar Spine Routine (Pro Cah)Professional Component ,,72131,CPT,Professional,Both,,,26,440,374,29.88,440,First Health Group Corporation,First Health Network,426.8,97,,percent of total billed charges,,
Ct Lumbar Spine Routine (Pro Cah)Professional Component ,,72131,CPT,Professional,Both,,,26,440,374,29.88,440,"Health Partners, Inc.",Commercial,71.16,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Ct Lumbar Spine Routine (Pro Cah)Professional Component ,,72131,CPT,Professional,Both,,,26,440,374,29.88,440,"Health Partners, Inc.",Medicare Advantage,53.774,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Lumbar Spine Routine (Pro Cah)Professional Component ,,72131,CPT,Professional,Both,,,26,440,374,29.88,440,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),29.88,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Ct Lumbar Spine Routine (Pro Cah)Professional Component ,,72131,CPT,Professional,Both,,,26,440,374,29.88,440,"Health Partners, Inc.",State of Minnesota Advantage Program,61.30434,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Ct Lumbar Spine Routine (Pro Cah)Professional Component ,,72131,CPT,Professional,Both,,,26,440,374,29.88,440,"Health Partners, Inc.",State Public Programs,29.88,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Ct Lumbar Spine Routine (Pro Cah)Professional Component ,,72131,CPT,Professional,Both,,,26,440,374,29.88,440,Humana Insurance Company,Commercial PPO,46.76,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Ct Lumbar Spine Routine (Pro Cah)Professional Component ,,72131,CPT,Professional,Both,,,26,440,374,29.88,440,Humana Insurance Company,Medicare PPO,440,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Ct Lumbar Spine Routine (Pro Cah)Professional Component ,,72131,CPT,Professional,Both,,,26,440,374,29.88,440,Medica,Individual & Family,373.12,84.8,,percent of total billed charges,,
Ct Lumbar Spine Routine (Pro Cah)Professional Component ,,72131,CPT,Professional,Both,,,26,440,374,29.88,440,Medica,Medica Advantage Solution,219.12,49.8,,percent of total billed charges,,
Ct Lumbar Spine Routine (Pro Cah)Professional Component ,,72131,CPT,Professional,Both,,,26,440,374,29.88,440,Medica,Medical Assistance,34.5,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Ct Lumbar Spine Routine (Pro Cah)Professional Component ,,72131,CPT,Professional,Both,,,26,440,374,29.88,440,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,46.76,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Ct Lumbar Spine Routine (Pro Cah)Professional Component ,,72131,CPT,Professional,Both,,,26,440,374,29.88,440,"Multiplan, Inc.","Multiplan, Inc.",413.6,94,,percent of total billed charges,,
Ct Lumbar Spine Routine (Pro Cah)Professional Component ,,72131,CPT,Professional,Both,,,26,440,374,29.88,440,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,396.44,90.1,,percent of total billed charges,,
Ct Lumbar Spine Routine (Pro Cah)Professional Component ,,72131,CPT,Professional,Both,,,26,440,374,29.88,440,"Preferred One Administrative Services, INC.",PPO,433.84,98.6,,percent of total billed charges,,
Ct Lumbar Spine Routine (Pro Cah)Professional Component ,,72131,CPT,Professional,Both,,,26,440,374,29.88,440,PrimeWest Health,Minnesota Senior Health Options (MSHO),53.774,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Lumbar Spine Routine (Pro Cah)Professional Component ,,72131,CPT,Professional,Both,,,26,440,374,29.88,440,PrimeWest Health,MinnesotaCare,36.9185952,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Ct Lumbar Spine Routine (Pro Cah)Professional Component ,,72131,CPT,Professional,Both,,,26,440,374,29.88,440,Sanford Health Plan,Sanford Health Plan,387.2,88,,percent of total billed charges,,
Ct Lumbar Spine Routine (Pro Cah)Professional Component ,,72131,CPT,Professional,Both,,,26,440,374,29.88,440,"UCare Health, Inc.",Individual & Family Plan,76.013056,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Ct Lumbar Spine Routine (Pro Cah)Professional Component ,,72131,CPT,Professional,Both,,,26,440,374,29.88,440,"UCare Health, Inc.",Medical Assistance,37.953696,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Ct Lumbar Spine Routine (Pro Cah)Professional Component ,,72131,CPT,Professional,Both,,,26,440,374,29.88,440,"UCare Health, Inc.",Medicare Advantage,53.774,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Ct Lumbar Spine Routine (Pro Cah)Professional Component ,,72131,CPT,Professional,Both,,,26,440,374,29.88,440,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),43.0192,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Ct Lumbar Spine Routine (Pro Cah)Professional Component ,,72131,CPT,Professional,Both,,,26,440,374,29.88,440,UnitedHealthcare,Individual & Family,440,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Ct Lumbar Spine Routine (Pro Cah)Professional Component ,,72131,CPT,Professional,Both,,,26,440,374,29.88,440,UnitedHealthcare,Medicare Advantage,53.774,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Lumbar Spine Routine (Pro Cah)Professional Component ,,72131,CPT,Professional,Both,,,26,440,374,29.88,440,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,34.50336,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Ct Lumbar Spine W Contrast (Pro Cah)Professional Component ,,72132,CPT,Professional,Both,,,26,528,448.8,36.64,528,Aetna,Commercial,448.8,85,,percent of total billed charges,,
Ct Lumbar Spine W Contrast (Pro Cah)Professional Component ,,72132,CPT,Professional,Both,,,26,528,448.8,36.64,528,Aetna,Medicare Advantage,58.74,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Lumbar Spine W Contrast (Pro Cah)Professional Component ,,72132,CPT,Professional,Both,,,26,528,448.8,36.64,528,Aetna,PPO,491.04,93,,percent of total billed charges,,
Ct Lumbar Spine W Contrast (Pro Cah)Professional Component ,,72132,CPT,Professional,Both,,,26,528,448.8,36.64,528,America's PPO,America's PPO,451.1232,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Ct Lumbar Spine W Contrast (Pro Cah)Professional Component ,,72132,CPT,Professional,Both,,,26,528,448.8,36.64,528,BlueCross BlueShield Minnesota, Federal Employee Program,109.94,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Ct Lumbar Spine W Contrast (Pro Cah)Professional Component ,,72132,CPT,Professional,Both,,,26,528,448.8,36.64,528,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,111.69904,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Ct Lumbar Spine W Contrast (Pro Cah)Professional Component ,,72132,CPT,Professional,Both,,,26,528,448.8,36.64,528,BlueCross BlueShield Minnesota,High Value Network Plan,111.69904,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Ct Lumbar Spine W Contrast (Pro Cah)Professional Component ,,72132,CPT,Professional,Both,,,26,528,448.8,36.64,528,BlueCross BlueShield Minnesota,Medicare Advantage,65.78,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Lumbar Spine W Contrast (Pro Cah)Professional Component ,,72132,CPT,Professional,Both,,,26,528,448.8,36.64,528,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,111.69904,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Ct Lumbar Spine W Contrast (Pro Cah)Professional Component ,,72132,CPT,Professional,Both,,,26,528,448.8,36.64,528,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,42.30624,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Ct Lumbar Spine W Contrast (Pro Cah)Professional Component ,,72132,CPT,Professional,Both,,,26,528,448.8,36.64,528,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),65.78,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Lumbar Spine W Contrast (Pro Cah)Professional Component ,,72132,CPT,Professional,Both,,,26,528,448.8,36.64,528,CorVel,Worker's Compensation,112.865751,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Ct Lumbar Spine W Contrast (Pro Cah)Professional Component ,,72132,CPT,Professional,Both,,,26,528,448.8,36.64,528,First Health Group Corporation,First Health Network,512.16,97,,percent of total billed charges,,
Ct Lumbar Spine W Contrast (Pro Cah)Professional Component ,,72132,CPT,Professional,Both,,,26,528,448.8,36.64,528,"Health Partners, Inc.",Commercial,86.62,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Ct Lumbar Spine W Contrast (Pro Cah)Professional Component ,,72132,CPT,Professional,Both,,,26,528,448.8,36.64,528,"Health Partners, Inc.",Medicare Advantage,65.78,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Lumbar Spine W Contrast (Pro Cah)Professional Component ,,72132,CPT,Professional,Both,,,26,528,448.8,36.64,528,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),36.64,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Ct Lumbar Spine W Contrast (Pro Cah)Professional Component ,,72132,CPT,Professional,Both,,,26,528,448.8,36.64,528,"Health Partners, Inc.",State of Minnesota Advantage Program,74.62313,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Ct Lumbar Spine W Contrast (Pro Cah)Professional Component ,,72132,CPT,Professional,Both,,,26,528,448.8,36.64,528,"Health Partners, Inc.",State Public Programs,36.64,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Ct Lumbar Spine W Contrast (Pro Cah)Professional Component ,,72132,CPT,Professional,Both,,,26,528,448.8,36.64,528,Humana Insurance Company,Commercial PPO,57.2,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Ct Lumbar Spine W Contrast (Pro Cah)Professional Component ,,72132,CPT,Professional,Both,,,26,528,448.8,36.64,528,Humana Insurance Company,Medicare PPO,528,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Ct Lumbar Spine W Contrast (Pro Cah)Professional Component ,,72132,CPT,Professional,Both,,,26,528,448.8,36.64,528,Medica,Individual & Family,447.744,84.8,,percent of total billed charges,,
Ct Lumbar Spine W Contrast (Pro Cah)Professional Component ,,72132,CPT,Professional,Both,,,26,528,448.8,36.64,528,Medica,Medica Advantage Solution,262.944,49.8,,percent of total billed charges,,
Ct Lumbar Spine W Contrast (Pro Cah)Professional Component ,,72132,CPT,Professional,Both,,,26,528,448.8,36.64,528,Medica,Medical Assistance,42.31,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Ct Lumbar Spine W Contrast (Pro Cah)Professional Component ,,72132,CPT,Professional,Both,,,26,528,448.8,36.64,528,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,57.2,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Ct Lumbar Spine W Contrast (Pro Cah)Professional Component ,,72132,CPT,Professional,Both,,,26,528,448.8,36.64,528,"Multiplan, Inc.","Multiplan, Inc.",496.32,94,,percent of total billed charges,,
Ct Lumbar Spine W Contrast (Pro Cah)Professional Component ,,72132,CPT,Professional,Both,,,26,528,448.8,36.64,528,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,475.728,90.1,,percent of total billed charges,,
Ct Lumbar Spine W Contrast (Pro Cah)Professional Component ,,72132,CPT,Professional,Both,,,26,528,448.8,36.64,528,"Preferred One Administrative Services, INC.",PPO,520.608,98.6,,percent of total billed charges,,
Ct Lumbar Spine W Contrast (Pro Cah)Professional Component ,,72132,CPT,Professional,Both,,,26,528,448.8,36.64,528,PrimeWest Health,Minnesota Senior Health Options (MSHO),65.78,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Lumbar Spine W Contrast (Pro Cah)Professional Component ,,72132,CPT,Professional,Both,,,26,528,448.8,36.64,528,PrimeWest Health,MinnesotaCare,45.2676768,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Ct Lumbar Spine W Contrast (Pro Cah)Professional Component ,,72132,CPT,Professional,Both,,,26,528,448.8,36.64,528,Sanford Health Plan,Sanford Health Plan,464.64,88,,percent of total billed charges,,
Ct Lumbar Spine W Contrast (Pro Cah)Professional Component ,,72132,CPT,Professional,Both,,,26,528,448.8,36.64,528,"UCare Health, Inc.",Individual & Family Plan,92.98432,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Ct Lumbar Spine W Contrast (Pro Cah)Professional Component ,,72132,CPT,Professional,Both,,,26,528,448.8,36.64,528,"UCare Health, Inc.",Medical Assistance,46.536864,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Ct Lumbar Spine W Contrast (Pro Cah)Professional Component ,,72132,CPT,Professional,Both,,,26,528,448.8,36.64,528,"UCare Health, Inc.",Medicare Advantage,65.78,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Ct Lumbar Spine W Contrast (Pro Cah)Professional Component ,,72132,CPT,Professional,Both,,,26,528,448.8,36.64,528,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),52.624,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Ct Lumbar Spine W Contrast (Pro Cah)Professional Component ,,72132,CPT,Professional,Both,,,26,528,448.8,36.64,528,UnitedHealthcare,Individual & Family,528,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Ct Lumbar Spine W Contrast (Pro Cah)Professional Component ,,72132,CPT,Professional,Both,,,26,528,448.8,36.64,528,UnitedHealthcare,Medicare Advantage,65.78,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Lumbar Spine W Contrast (Pro Cah)Professional Component ,,72132,CPT,Professional,Both,,,26,528,448.8,36.64,528,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,42.30624,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Ct, Lumbar Spine; W/O Contrast Material, Followed By Contrast Material And Further Section (Pro Cah)Professional Component ",,72133,CPT,Professional,Both,,,26,478,406.3,38.39,478,Aetna,Commercial,406.3,85,,percent of total billed charges,,
"Ct, Lumbar Spine; W/O Contrast Material, Followed By Contrast Material And Further Section (Pro Cah)Professional Component ",,72133,CPT,Professional,Both,,,26,478,406.3,38.39,478,Aetna,Medicare Advantage,60.84,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Ct, Lumbar Spine; W/O Contrast Material, Followed By Contrast Material And Further Section (Pro Cah)Professional Component ",,72133,CPT,Professional,Both,,,26,478,406.3,38.39,478,Aetna,PPO,444.54,93,,percent of total billed charges,,
"Ct, Lumbar Spine; W/O Contrast Material, Followed By Contrast Material And Further Section (Pro Cah)Professional Component ",,72133,CPT,Professional,Both,,,26,478,406.3,38.39,478,America's PPO,America's PPO,408.4032,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Ct, Lumbar Spine; W/O Contrast Material, Followed By Contrast Material And Further Section (Pro Cah)Professional Component ",,72133,CPT,Professional,Both,,,26,478,406.3,38.39,478,BlueCross BlueShield Minnesota, Federal Employee Program,115.06,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Ct, Lumbar Spine; W/O Contrast Material, Followed By Contrast Material And Further Section (Pro Cah)Professional Component ",,72133,CPT,Professional,Both,,,26,478,406.3,38.39,478,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,116.90096,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Ct, Lumbar Spine; W/O Contrast Material, Followed By Contrast Material And Further Section (Pro Cah)Professional Component ",,72133,CPT,Professional,Both,,,26,478,406.3,38.39,478,BlueCross BlueShield Minnesota,High Value Network Plan,116.90096,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Ct, Lumbar Spine; W/O Contrast Material, Followed By Contrast Material And Further Section (Pro Cah)Professional Component ",,72133,CPT,Professional,Both,,,26,478,406.3,38.39,478,BlueCross BlueShield Minnesota,Medicare Advantage,68.6435,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Ct, Lumbar Spine; W/O Contrast Material, Followed By Contrast Material And Further Section (Pro Cah)Professional Component ",,72133,CPT,Professional,Both,,,26,478,406.3,38.39,478,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,116.90096,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Ct, Lumbar Spine; W/O Contrast Material, Followed By Contrast Material And Further Section (Pro Cah)Professional Component ",,72133,CPT,Professional,Both,,,26,478,406.3,38.39,478,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,44.32808,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Ct, Lumbar Spine; W/O Contrast Material, Followed By Contrast Material And Further Section (Pro Cah)Professional Component ",,72133,CPT,Professional,Both,,,26,478,406.3,38.39,478,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),68.6435,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Ct, Lumbar Spine; W/O Contrast Material, Followed By Contrast Material And Further Section (Pro Cah)Professional Component ",,72133,CPT,Professional,Both,,,26,478,406.3,38.39,478,CorVel,Worker's Compensation,117.8222253,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Ct, Lumbar Spine; W/O Contrast Material, Followed By Contrast Material And Further Section (Pro Cah)Professional Component ",,72133,CPT,Professional,Both,,,26,478,406.3,38.39,478,First Health Group Corporation,First Health Network,463.66,97,,percent of total billed charges,,
"Ct, Lumbar Spine; W/O Contrast Material, Followed By Contrast Material And Further Section (Pro Cah)Professional Component ",,72133,CPT,Professional,Both,,,26,478,406.3,38.39,478,"Health Partners, Inc.",Commercial,90.75,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Ct, Lumbar Spine; W/O Contrast Material, Followed By Contrast Material And Further Section (Pro Cah)Professional Component ",,72133,CPT,Professional,Both,,,26,478,406.3,38.39,478,"Health Partners, Inc.",Medicare Advantage,68.6435,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Ct, Lumbar Spine; W/O Contrast Material, Followed By Contrast Material And Further Section (Pro Cah)Professional Component ",,72133,CPT,Professional,Both,,,26,478,406.3,38.39,478,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),38.39,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Ct, Lumbar Spine; W/O Contrast Material, Followed By Contrast Material And Further Section (Pro Cah)Professional Component ",,72133,CPT,Professional,Both,,,26,478,406.3,38.39,478,"Health Partners, Inc.",State of Minnesota Advantage Program,78.181125,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Ct, Lumbar Spine; W/O Contrast Material, Followed By Contrast Material And Further Section (Pro Cah)Professional Component ",,72133,CPT,Professional,Both,,,26,478,406.3,38.39,478,"Health Partners, Inc.",State Public Programs,38.39,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Ct, Lumbar Spine; W/O Contrast Material, Followed By Contrast Material And Further Section (Pro Cah)Professional Component ",,72133,CPT,Professional,Both,,,26,478,406.3,38.39,478,Humana Insurance Company,Commercial PPO,59.69,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Ct, Lumbar Spine; W/O Contrast Material, Followed By Contrast Material And Further Section (Pro Cah)Professional Component ",,72133,CPT,Professional,Both,,,26,478,406.3,38.39,478,Humana Insurance Company,Medicare PPO,478,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Ct, Lumbar Spine; W/O Contrast Material, Followed By Contrast Material And Further Section (Pro Cah)Professional Component ",,72133,CPT,Professional,Both,,,26,478,406.3,38.39,478,Medica,Individual & Family,405.344,84.8,,percent of total billed charges,,
"Ct, Lumbar Spine; W/O Contrast Material, Followed By Contrast Material And Further Section (Pro Cah)Professional Component ",,72133,CPT,Professional,Both,,,26,478,406.3,38.39,478,Medica,Medica Advantage Solution,238.044,49.8,,percent of total billed charges,,
"Ct, Lumbar Spine; W/O Contrast Material, Followed By Contrast Material And Further Section (Pro Cah)Professional Component ",,72133,CPT,Professional,Both,,,26,478,406.3,38.39,478,Medica,Medical Assistance,44.33,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Ct, Lumbar Spine; W/O Contrast Material, Followed By Contrast Material And Further Section (Pro Cah)Professional Component ",,72133,CPT,Professional,Both,,,26,478,406.3,38.39,478,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,59.69,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Ct, Lumbar Spine; W/O Contrast Material, Followed By Contrast Material And Further Section (Pro Cah)Professional Component ",,72133,CPT,Professional,Both,,,26,478,406.3,38.39,478,"Multiplan, Inc.","Multiplan, Inc.",449.32,94,,percent of total billed charges,,
"Ct, Lumbar Spine; W/O Contrast Material, Followed By Contrast Material And Further Section (Pro Cah)Professional Component ",,72133,CPT,Professional,Both,,,26,478,406.3,38.39,478,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,430.678,90.1,,percent of total billed charges,,
"Ct, Lumbar Spine; W/O Contrast Material, Followed By Contrast Material And Further Section (Pro Cah)Professional Component ",,72133,CPT,Professional,Both,,,26,478,406.3,38.39,478,"Preferred One Administrative Services, INC.",PPO,471.308,98.6,,percent of total billed charges,,
"Ct, Lumbar Spine; W/O Contrast Material, Followed By Contrast Material And Further Section (Pro Cah)Professional Component ",,72133,CPT,Professional,Both,,,26,478,406.3,38.39,478,PrimeWest Health,Minnesota Senior Health Options (MSHO),68.6435,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Ct, Lumbar Spine; W/O Contrast Material, Followed By Contrast Material And Further Section (Pro Cah)Professional Component ",,72133,CPT,Professional,Both,,,26,478,406.3,38.39,478,PrimeWest Health,MinnesotaCare,47.4310456,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Ct, Lumbar Spine; W/O Contrast Material, Followed By Contrast Material And Further Section (Pro Cah)Professional Component ",,72133,CPT,Professional,Both,,,26,478,406.3,38.39,478,Sanford Health Plan,Sanford Health Plan,420.64,88,,percent of total billed charges,,
"Ct, Lumbar Spine; W/O Contrast Material, Followed By Contrast Material And Further Section (Pro Cah)Professional Component ",,72133,CPT,Professional,Both,,,26,478,406.3,38.39,478,"UCare Health, Inc.",Individual & Family Plan,97.032064,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Ct, Lumbar Spine; W/O Contrast Material, Followed By Contrast Material And Further Section (Pro Cah)Professional Component ",,72133,CPT,Professional,Both,,,26,478,406.3,38.39,478,"UCare Health, Inc.",Medical Assistance,48.760888,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Ct, Lumbar Spine; W/O Contrast Material, Followed By Contrast Material And Further Section (Pro Cah)Professional Component ",,72133,CPT,Professional,Both,,,26,478,406.3,38.39,478,"UCare Health, Inc.",Medicare Advantage,68.6435,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Ct, Lumbar Spine; W/O Contrast Material, Followed By Contrast Material And Further Section (Pro Cah)Professional Component ",,72133,CPT,Professional,Both,,,26,478,406.3,38.39,478,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),54.9148,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Ct, Lumbar Spine; W/O Contrast Material, Followed By Contrast Material And Further Section (Pro Cah)Professional Component ",,72133,CPT,Professional,Both,,,26,478,406.3,38.39,478,UnitedHealthcare,Individual & Family,478,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Ct, Lumbar Spine; W/O Contrast Material, Followed By Contrast Material And Further Section (Pro Cah)Professional Component ",,72133,CPT,Professional,Both,,,26,478,406.3,38.39,478,UnitedHealthcare,Medicare Advantage,68.6435,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Ct, Lumbar Spine; W/O Contrast Material, Followed By Contrast Material And Further Section (Pro Cah)Professional Component ",,72133,CPT,Professional,Both,,,26,478,406.3,38.39,478,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,44.32808,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Mri Cervical Spine W/O Contrast (Pro Cah)Professional Component ,,72141,CPT,Professional,Both,,,26,832,707.2,44.71,832,Aetna,Commercial,707.2,85,,percent of total billed charges,,
Mri Cervical Spine W/O Contrast (Pro Cah)Professional Component ,,72141,CPT,Professional,Both,,,26,832,707.2,44.71,832,Aetna,Medicare Advantage,71.47,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Mri Cervical Spine W/O Contrast (Pro Cah)Professional Component ,,72141,CPT,Professional,Both,,,26,832,707.2,44.71,832,Aetna,PPO,773.76,93,,percent of total billed charges,,
Mri Cervical Spine W/O Contrast (Pro Cah)Professional Component ,,72141,CPT,Professional,Both,,,26,832,707.2,44.71,832,America's PPO,America's PPO,710.8608,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Mri Cervical Spine W/O Contrast (Pro Cah)Professional Component ,,72141,CPT,Professional,Both,,,26,832,707.2,44.71,832,BlueCross BlueShield Minnesota, Federal Employee Program,134.23,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Mri Cervical Spine W/O Contrast (Pro Cah)Professional Component ,,72141,CPT,Professional,Both,,,26,832,707.2,44.71,832,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,136.37768,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Mri Cervical Spine W/O Contrast (Pro Cah)Professional Component ,,72141,CPT,Professional,Both,,,26,832,707.2,44.71,832,BlueCross BlueShield Minnesota,High Value Network Plan,136.37768,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Mri Cervical Spine W/O Contrast (Pro Cah)Professional Component ,,72141,CPT,Professional,Both,,,26,832,707.2,44.71,832,BlueCross BlueShield Minnesota,Medicare Advantage,80.132,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Mri Cervical Spine W/O Contrast (Pro Cah)Professional Component ,,72141,CPT,Professional,Both,,,26,832,707.2,44.71,832,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,136.37768,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Mri Cervical Spine W/O Contrast (Pro Cah)Professional Component ,,72141,CPT,Professional,Both,,,26,832,707.2,44.71,832,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,51.62296,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Mri Cervical Spine W/O Contrast (Pro Cah)Professional Component ,,72141,CPT,Professional,Both,,,26,832,707.2,44.71,832,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),80.132,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Mri Cervical Spine W/O Contrast (Pro Cah)Professional Component ,,72141,CPT,Professional,Both,,,26,832,707.2,44.71,832,CorVel,Worker's Compensation,138.0518142,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Mri Cervical Spine W/O Contrast (Pro Cah)Professional Component ,,72141,CPT,Professional,Both,,,26,832,707.2,44.71,832,First Health Group Corporation,First Health Network,807.04,97,,percent of total billed charges,,
Mri Cervical Spine W/O Contrast (Pro Cah)Professional Component ,,72141,CPT,Professional,Both,,,26,832,707.2,44.71,832,"Health Partners, Inc.",Commercial,106.22,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Mri Cervical Spine W/O Contrast (Pro Cah)Professional Component ,,72141,CPT,Professional,Both,,,26,832,707.2,44.71,832,"Health Partners, Inc.",Medicare Advantage,80.132,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Mri Cervical Spine W/O Contrast (Pro Cah)Professional Component ,,72141,CPT,Professional,Both,,,26,832,707.2,44.71,832,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),44.71,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Mri Cervical Spine W/O Contrast (Pro Cah)Professional Component ,,72141,CPT,Professional,Both,,,26,832,707.2,44.71,832,"Health Partners, Inc.",State of Minnesota Advantage Program,91.50853,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Mri Cervical Spine W/O Contrast (Pro Cah)Professional Component ,,72141,CPT,Professional,Both,,,26,832,707.2,44.71,832,"Health Partners, Inc.",State Public Programs,44.71,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Mri Cervical Spine W/O Contrast (Pro Cah)Professional Component ,,72141,CPT,Professional,Both,,,26,832,707.2,44.71,832,Humana Insurance Company,Commercial PPO,69.68,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Mri Cervical Spine W/O Contrast (Pro Cah)Professional Component ,,72141,CPT,Professional,Both,,,26,832,707.2,44.71,832,Humana Insurance Company,Medicare PPO,832,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Mri Cervical Spine W/O Contrast (Pro Cah)Professional Component ,,72141,CPT,Professional,Both,,,26,832,707.2,44.71,832,Medica,Individual & Family,705.536,84.8,,percent of total billed charges,,
Mri Cervical Spine W/O Contrast (Pro Cah)Professional Component ,,72141,CPT,Professional,Both,,,26,832,707.2,44.71,832,Medica,Medica Advantage Solution,414.336,49.8,,percent of total billed charges,,
Mri Cervical Spine W/O Contrast (Pro Cah)Professional Component ,,72141,CPT,Professional,Both,,,26,832,707.2,44.71,832,Medica,Medical Assistance,51.62,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Mri Cervical Spine W/O Contrast (Pro Cah)Professional Component ,,72141,CPT,Professional,Both,,,26,832,707.2,44.71,832,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,69.68,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Mri Cervical Spine W/O Contrast (Pro Cah)Professional Component ,,72141,CPT,Professional,Both,,,26,832,707.2,44.71,832,"Multiplan, Inc.","Multiplan, Inc.",782.08,94,,percent of total billed charges,,
Mri Cervical Spine W/O Contrast (Pro Cah)Professional Component ,,72141,CPT,Professional,Both,,,26,832,707.2,44.71,832,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,749.632,90.1,,percent of total billed charges,,
Mri Cervical Spine W/O Contrast (Pro Cah)Professional Component ,,72141,CPT,Professional,Both,,,26,832,707.2,44.71,832,"Preferred One Administrative Services, INC.",PPO,820.352,98.6,,percent of total billed charges,,
Mri Cervical Spine W/O Contrast (Pro Cah)Professional Component ,,72141,CPT,Professional,Both,,,26,832,707.2,44.71,832,PrimeWest Health,Minnesota Senior Health Options (MSHO),80.132,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Mri Cervical Spine W/O Contrast (Pro Cah)Professional Component ,,72141,CPT,Professional,Both,,,26,832,707.2,44.71,832,PrimeWest Health,MinnesotaCare,55.2365672,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Mri Cervical Spine W/O Contrast (Pro Cah)Professional Component ,,72141,CPT,Professional,Both,,,26,832,707.2,44.71,832,Sanford Health Plan,Sanford Health Plan,732.16,88,,percent of total billed charges,,
Mri Cervical Spine W/O Contrast (Pro Cah)Professional Component ,,72141,CPT,Professional,Both,,,26,832,707.2,44.71,832,"UCare Health, Inc.",Individual & Family Plan,113.271808,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Mri Cervical Spine W/O Contrast (Pro Cah)Professional Component ,,72141,CPT,Professional,Both,,,26,832,707.2,44.71,832,"UCare Health, Inc.",Medical Assistance,56.785256,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Mri Cervical Spine W/O Contrast (Pro Cah)Professional Component ,,72141,CPT,Professional,Both,,,26,832,707.2,44.71,832,"UCare Health, Inc.",Medicare Advantage,80.132,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Mri Cervical Spine W/O Contrast (Pro Cah)Professional Component ,,72141,CPT,Professional,Both,,,26,832,707.2,44.71,832,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),64.1056,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Mri Cervical Spine W/O Contrast (Pro Cah)Professional Component ,,72141,CPT,Professional,Both,,,26,832,707.2,44.71,832,UnitedHealthcare,Individual & Family,832,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Mri Cervical Spine W/O Contrast (Pro Cah)Professional Component ,,72141,CPT,Professional,Both,,,26,832,707.2,44.71,832,UnitedHealthcare,Medicare Advantage,80.132,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Mri Cervical Spine W/O Contrast (Pro Cah)Professional Component ,,72141,CPT,Professional,Both,,,26,832,707.2,44.71,832,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,51.62296,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Mri Cervical Spine W/Contrast (Pro Cah)Professional Component ,,72142,CPT,Professional,Both,,,26,783,665.55,54.09,783,Aetna,Commercial,665.55,85,,percent of total billed charges,,
Mri Cervical Spine W/Contrast (Pro Cah)Professional Component ,,72142,CPT,Professional,Both,,,26,783,665.55,54.09,783,Aetna,Medicare Advantage,86.19,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Mri Cervical Spine W/Contrast (Pro Cah)Professional Component ,,72142,CPT,Professional,Both,,,26,783,665.55,54.09,783,Aetna,PPO,728.19,93,,percent of total billed charges,,
Mri Cervical Spine W/Contrast (Pro Cah)Professional Component ,,72142,CPT,Professional,Both,,,26,783,665.55,54.09,783,America's PPO,America's PPO,668.9952,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Mri Cervical Spine W/Contrast (Pro Cah)Professional Component ,,72142,CPT,Professional,Both,,,26,783,665.55,54.09,783,BlueCross BlueShield Minnesota, Federal Employee Program,162.36,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Mri Cervical Spine W/Contrast (Pro Cah)Professional Component ,,72142,CPT,Professional,Both,,,26,783,665.55,54.09,783,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,164.95776,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Mri Cervical Spine W/Contrast (Pro Cah)Professional Component ,,72142,CPT,Professional,Both,,,26,783,665.55,54.09,783,BlueCross BlueShield Minnesota,High Value Network Plan,164.95776,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Mri Cervical Spine W/Contrast (Pro Cah)Professional Component ,,72142,CPT,Professional,Both,,,26,783,665.55,54.09,783,BlueCross BlueShield Minnesota,Medicare Advantage,96.8415,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Mri Cervical Spine W/Contrast (Pro Cah)Professional Component ,,72142,CPT,Professional,Both,,,26,783,665.55,54.09,783,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,164.95776,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Mri Cervical Spine W/Contrast (Pro Cah)Professional Component ,,72142,CPT,Professional,Both,,,26,783,665.55,54.09,783,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,62.45352,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Mri Cervical Spine W/Contrast (Pro Cah)Professional Component ,,72142,CPT,Professional,Both,,,26,783,665.55,54.09,783,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),96.8415,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Mri Cervical Spine W/Contrast (Pro Cah)Professional Component ,,72142,CPT,Professional,Both,,,26,783,665.55,54.09,783,CorVel,Worker's Compensation,165.9246774,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Mri Cervical Spine W/Contrast (Pro Cah)Professional Component ,,72142,CPT,Professional,Both,,,26,783,665.55,54.09,783,First Health Group Corporation,First Health Network,759.51,97,,percent of total billed charges,,
Mri Cervical Spine W/Contrast (Pro Cah)Professional Component ,,72142,CPT,Professional,Both,,,26,783,665.55,54.09,783,"Health Partners, Inc.",Commercial,127.36,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Mri Cervical Spine W/Contrast (Pro Cah)Professional Component ,,72142,CPT,Professional,Both,,,26,783,665.55,54.09,783,"Health Partners, Inc.",Medicare Advantage,96.8415,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Mri Cervical Spine W/Contrast (Pro Cah)Professional Component ,,72142,CPT,Professional,Both,,,26,783,665.55,54.09,783,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),54.09,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Mri Cervical Spine W/Contrast (Pro Cah)Professional Component ,,72142,CPT,Professional,Both,,,26,783,665.55,54.09,783,"Health Partners, Inc.",State of Minnesota Advantage Program,109.72064,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Mri Cervical Spine W/Contrast (Pro Cah)Professional Component ,,72142,CPT,Professional,Both,,,26,783,665.55,54.09,783,"Health Partners, Inc.",State Public Programs,54.09,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Mri Cervical Spine W/Contrast (Pro Cah)Professional Component ,,72142,CPT,Professional,Both,,,26,783,665.55,54.09,783,Humana Insurance Company,Commercial PPO,84.21,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Mri Cervical Spine W/Contrast (Pro Cah)Professional Component ,,72142,CPT,Professional,Both,,,26,783,665.55,54.09,783,Humana Insurance Company,Medicare PPO,783,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Mri Cervical Spine W/Contrast (Pro Cah)Professional Component ,,72142,CPT,Professional,Both,,,26,783,665.55,54.09,783,Medica,Individual & Family,663.984,84.8,,percent of total billed charges,,
Mri Cervical Spine W/Contrast (Pro Cah)Professional Component ,,72142,CPT,Professional,Both,,,26,783,665.55,54.09,783,Medica,Medica Advantage Solution,389.934,49.8,,percent of total billed charges,,
Mri Cervical Spine W/Contrast (Pro Cah)Professional Component ,,72142,CPT,Professional,Both,,,26,783,665.55,54.09,783,Medica,Medical Assistance,62.45,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Mri Cervical Spine W/Contrast (Pro Cah)Professional Component ,,72142,CPT,Professional,Both,,,26,783,665.55,54.09,783,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,84.21,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Mri Cervical Spine W/Contrast (Pro Cah)Professional Component ,,72142,CPT,Professional,Both,,,26,783,665.55,54.09,783,"Multiplan, Inc.","Multiplan, Inc.",736.02,94,,percent of total billed charges,,
Mri Cervical Spine W/Contrast (Pro Cah)Professional Component ,,72142,CPT,Professional,Both,,,26,783,665.55,54.09,783,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,705.483,90.1,,percent of total billed charges,,
Mri Cervical Spine W/Contrast (Pro Cah)Professional Component ,,72142,CPT,Professional,Both,,,26,783,665.55,54.09,783,"Preferred One Administrative Services, INC.",PPO,772.038,98.6,,percent of total billed charges,,
Mri Cervical Spine W/Contrast (Pro Cah)Professional Component ,,72142,CPT,Professional,Both,,,26,783,665.55,54.09,783,PrimeWest Health,Minnesota Senior Health Options (MSHO),96.8415,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Mri Cervical Spine W/Contrast (Pro Cah)Professional Component ,,72142,CPT,Professional,Both,,,26,783,665.55,54.09,783,PrimeWest Health,MinnesotaCare,66.8252664,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Mri Cervical Spine W/Contrast (Pro Cah)Professional Component ,,72142,CPT,Professional,Both,,,26,783,665.55,54.09,783,Sanford Health Plan,Sanford Health Plan,689.04,88,,percent of total billed charges,,
Mri Cervical Spine W/Contrast (Pro Cah)Professional Component ,,72142,CPT,Professional,Both,,,26,783,665.55,54.09,783,"UCare Health, Inc.",Individual & Family Plan,136.891776,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Mri Cervical Spine W/Contrast (Pro Cah)Professional Component ,,72142,CPT,Professional,Both,,,26,783,665.55,54.09,783,"UCare Health, Inc.",Medical Assistance,68.698872,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Mri Cervical Spine W/Contrast (Pro Cah)Professional Component ,,72142,CPT,Professional,Both,,,26,783,665.55,54.09,783,"UCare Health, Inc.",Medicare Advantage,96.8415,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Mri Cervical Spine W/Contrast (Pro Cah)Professional Component ,,72142,CPT,Professional,Both,,,26,783,665.55,54.09,783,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),77.4732,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Mri Cervical Spine W/Contrast (Pro Cah)Professional Component ,,72142,CPT,Professional,Both,,,26,783,665.55,54.09,783,UnitedHealthcare,Individual & Family,783,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Mri Cervical Spine W/Contrast (Pro Cah)Professional Component ,,72142,CPT,Professional,Both,,,26,783,665.55,54.09,783,UnitedHealthcare,Medicare Advantage,96.8415,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Mri Cervical Spine W/Contrast (Pro Cah)Professional Component ,,72142,CPT,Professional,Both,,,26,783,665.55,54.09,783,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,62.45352,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Mri Spinal Canal And Contents, Thoracic; Without Contrast Material (Pro Cah)Professional Component ",,72146,CPT,Professional,Both,,,26,850,722.5,44.71,850,Aetna,Commercial,722.5,85,,percent of total billed charges,,
"Mri Spinal Canal And Contents, Thoracic; Without Contrast Material (Pro Cah)Professional Component ",,72146,CPT,Professional,Both,,,26,850,722.5,44.71,850,Aetna,Medicare Advantage,71.47,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Mri Spinal Canal And Contents, Thoracic; Without Contrast Material (Pro Cah)Professional Component ",,72146,CPT,Professional,Both,,,26,850,722.5,44.71,850,Aetna,PPO,790.5,93,,percent of total billed charges,,
"Mri Spinal Canal And Contents, Thoracic; Without Contrast Material (Pro Cah)Professional Component ",,72146,CPT,Professional,Both,,,26,850,722.5,44.71,850,America's PPO,America's PPO,726.24,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Mri Spinal Canal And Contents, Thoracic; Without Contrast Material (Pro Cah)Professional Component ",,72146,CPT,Professional,Both,,,26,850,722.5,44.71,850,BlueCross BlueShield Minnesota, Federal Employee Program,134.23,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Mri Spinal Canal And Contents, Thoracic; Without Contrast Material (Pro Cah)Professional Component ",,72146,CPT,Professional,Both,,,26,850,722.5,44.71,850,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,136.37768,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Mri Spinal Canal And Contents, Thoracic; Without Contrast Material (Pro Cah)Professional Component ",,72146,CPT,Professional,Both,,,26,850,722.5,44.71,850,BlueCross BlueShield Minnesota,High Value Network Plan,136.37768,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Mri Spinal Canal And Contents, Thoracic; Without Contrast Material (Pro Cah)Professional Component ",,72146,CPT,Professional,Both,,,26,850,722.5,44.71,850,BlueCross BlueShield Minnesota,Medicare Advantage,80.132,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Mri Spinal Canal And Contents, Thoracic; Without Contrast Material (Pro Cah)Professional Component ",,72146,CPT,Professional,Both,,,26,850,722.5,44.71,850,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,136.37768,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Mri Spinal Canal And Contents, Thoracic; Without Contrast Material (Pro Cah)Professional Component ",,72146,CPT,Professional,Both,,,26,850,722.5,44.71,850,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,51.62296,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Mri Spinal Canal And Contents, Thoracic; Without Contrast Material (Pro Cah)Professional Component ",,72146,CPT,Professional,Both,,,26,850,722.5,44.71,850,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),80.132,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Mri Spinal Canal And Contents, Thoracic; Without Contrast Material (Pro Cah)Professional Component ",,72146,CPT,Professional,Both,,,26,850,722.5,44.71,850,CorVel,Worker's Compensation,137.3713821,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Mri Spinal Canal And Contents, Thoracic; Without Contrast Material (Pro Cah)Professional Component ",,72146,CPT,Professional,Both,,,26,850,722.5,44.71,850,First Health Group Corporation,First Health Network,824.5,97,,percent of total billed charges,,
"Mri Spinal Canal And Contents, Thoracic; Without Contrast Material (Pro Cah)Professional Component ",,72146,CPT,Professional,Both,,,26,850,722.5,44.71,850,"Health Partners, Inc.",Commercial,105.7,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Mri Spinal Canal And Contents, Thoracic; Without Contrast Material (Pro Cah)Professional Component ",,72146,CPT,Professional,Both,,,26,850,722.5,44.71,850,"Health Partners, Inc.",Medicare Advantage,80.132,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Mri Spinal Canal And Contents, Thoracic; Without Contrast Material (Pro Cah)Professional Component ",,72146,CPT,Professional,Both,,,26,850,722.5,44.71,850,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),44.71,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Mri Spinal Canal And Contents, Thoracic; Without Contrast Material (Pro Cah)Professional Component ",,72146,CPT,Professional,Both,,,26,850,722.5,44.71,850,"Health Partners, Inc.",State of Minnesota Advantage Program,91.06055,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Mri Spinal Canal And Contents, Thoracic; Without Contrast Material (Pro Cah)Professional Component ",,72146,CPT,Professional,Both,,,26,850,722.5,44.71,850,"Health Partners, Inc.",State Public Programs,44.71,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Mri Spinal Canal And Contents, Thoracic; Without Contrast Material (Pro Cah)Professional Component ",,72146,CPT,Professional,Both,,,26,850,722.5,44.71,850,Humana Insurance Company,Commercial PPO,69.68,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Mri Spinal Canal And Contents, Thoracic; Without Contrast Material (Pro Cah)Professional Component ",,72146,CPT,Professional,Both,,,26,850,722.5,44.71,850,Humana Insurance Company,Medicare PPO,850,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Mri Spinal Canal And Contents, Thoracic; Without Contrast Material (Pro Cah)Professional Component ",,72146,CPT,Professional,Both,,,26,850,722.5,44.71,850,Medica,Individual & Family,720.8,84.8,,percent of total billed charges,,
"Mri Spinal Canal And Contents, Thoracic; Without Contrast Material (Pro Cah)Professional Component ",,72146,CPT,Professional,Both,,,26,850,722.5,44.71,850,Medica,Medica Advantage Solution,423.3,49.8,,percent of total billed charges,,
"Mri Spinal Canal And Contents, Thoracic; Without Contrast Material (Pro Cah)Professional Component ",,72146,CPT,Professional,Both,,,26,850,722.5,44.71,850,Medica,Medical Assistance,51.62,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Mri Spinal Canal And Contents, Thoracic; Without Contrast Material (Pro Cah)Professional Component ",,72146,CPT,Professional,Both,,,26,850,722.5,44.71,850,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,69.68,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Mri Spinal Canal And Contents, Thoracic; Without Contrast Material (Pro Cah)Professional Component ",,72146,CPT,Professional,Both,,,26,850,722.5,44.71,850,"Multiplan, Inc.","Multiplan, Inc.",799,94,,percent of total billed charges,,
"Mri Spinal Canal And Contents, Thoracic; Without Contrast Material (Pro Cah)Professional Component ",,72146,CPT,Professional,Both,,,26,850,722.5,44.71,850,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,765.85,90.1,,percent of total billed charges,,
"Mri Spinal Canal And Contents, Thoracic; Without Contrast Material (Pro Cah)Professional Component ",,72146,CPT,Professional,Both,,,26,850,722.5,44.71,850,"Preferred One Administrative Services, INC.",PPO,838.1,98.6,,percent of total billed charges,,
"Mri Spinal Canal And Contents, Thoracic; Without Contrast Material (Pro Cah)Professional Component ",,72146,CPT,Professional,Both,,,26,850,722.5,44.71,850,PrimeWest Health,Minnesota Senior Health Options (MSHO),80.132,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Mri Spinal Canal And Contents, Thoracic; Without Contrast Material (Pro Cah)Professional Component ",,72146,CPT,Professional,Both,,,26,850,722.5,44.71,850,PrimeWest Health,MinnesotaCare,55.2365672,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Mri Spinal Canal And Contents, Thoracic; Without Contrast Material (Pro Cah)Professional Component ",,72146,CPT,Professional,Both,,,26,850,722.5,44.71,850,Sanford Health Plan,Sanford Health Plan,748,88,,percent of total billed charges,,
"Mri Spinal Canal And Contents, Thoracic; Without Contrast Material (Pro Cah)Professional Component ",,72146,CPT,Professional,Both,,,26,850,722.5,44.71,850,"UCare Health, Inc.",Individual & Family Plan,113.271808,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Mri Spinal Canal And Contents, Thoracic; Without Contrast Material (Pro Cah)Professional Component ",,72146,CPT,Professional,Both,,,26,850,722.5,44.71,850,"UCare Health, Inc.",Medical Assistance,56.785256,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Mri Spinal Canal And Contents, Thoracic; Without Contrast Material (Pro Cah)Professional Component ",,72146,CPT,Professional,Both,,,26,850,722.5,44.71,850,"UCare Health, Inc.",Medicare Advantage,80.132,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Mri Spinal Canal And Contents, Thoracic; Without Contrast Material (Pro Cah)Professional Component ",,72146,CPT,Professional,Both,,,26,850,722.5,44.71,850,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),64.1056,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Mri Spinal Canal And Contents, Thoracic; Without Contrast Material (Pro Cah)Professional Component ",,72146,CPT,Professional,Both,,,26,850,722.5,44.71,850,UnitedHealthcare,Individual & Family,850,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Mri Spinal Canal And Contents, Thoracic; Without Contrast Material (Pro Cah)Professional Component ",,72146,CPT,Professional,Both,,,26,850,722.5,44.71,850,UnitedHealthcare,Medicare Advantage,80.132,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Mri Spinal Canal And Contents, Thoracic; Without Contrast Material (Pro Cah)Professional Component ",,72146,CPT,Professional,Both,,,26,850,722.5,44.71,850,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,51.62296,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Mri, Spinal Canal And Contents, Thoracic; With Contrast Material(S) (Pro Cah)Professional Component ",,72147,CPT,Professional,Both,,,26,767,651.95,53.88,767,Aetna,Commercial,651.95,85,,percent of total billed charges,,
"Mri, Spinal Canal And Contents, Thoracic; With Contrast Material(S) (Pro Cah)Professional Component ",,72147,CPT,Professional,Both,,,26,767,651.95,53.88,767,Aetna,Medicare Advantage,86.19,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Mri, Spinal Canal And Contents, Thoracic; With Contrast Material(S) (Pro Cah)Professional Component ",,72147,CPT,Professional,Both,,,26,767,651.95,53.88,767,Aetna,PPO,713.31,93,,percent of total billed charges,,
"Mri, Spinal Canal And Contents, Thoracic; With Contrast Material(S) (Pro Cah)Professional Component ",,72147,CPT,Professional,Both,,,26,767,651.95,53.88,767,America's PPO,America's PPO,655.3248,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Mri, Spinal Canal And Contents, Thoracic; With Contrast Material(S) (Pro Cah)Professional Component ",,72147,CPT,Professional,Both,,,26,767,651.95,53.88,767,BlueCross BlueShield Minnesota, Federal Employee Program,161.72,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Mri, Spinal Canal And Contents, Thoracic; With Contrast Material(S) (Pro Cah)Professional Component ",,72147,CPT,Professional,Both,,,26,767,651.95,53.88,767,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,164.30752,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Mri, Spinal Canal And Contents, Thoracic; With Contrast Material(S) (Pro Cah)Professional Component ",,72147,CPT,Professional,Both,,,26,767,651.95,53.88,767,BlueCross BlueShield Minnesota,High Value Network Plan,164.30752,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Mri, Spinal Canal And Contents, Thoracic; With Contrast Material(S) (Pro Cah)Professional Component ",,72147,CPT,Professional,Both,,,26,767,651.95,53.88,767,BlueCross BlueShield Minnesota,Medicare Advantage,96.4505,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Mri, Spinal Canal And Contents, Thoracic; With Contrast Material(S) (Pro Cah)Professional Component ",,72147,CPT,Professional,Both,,,26,767,651.95,53.88,767,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,164.30752,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Mri, Spinal Canal And Contents, Thoracic; With Contrast Material(S) (Pro Cah)Professional Component ",,72147,CPT,Professional,Both,,,26,767,651.95,53.88,767,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,62.20968,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Mri, Spinal Canal And Contents, Thoracic; With Contrast Material(S) (Pro Cah)Professional Component ",,72147,CPT,Professional,Both,,,26,767,651.95,53.88,767,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),96.4505,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Mri, Spinal Canal And Contents, Thoracic; With Contrast Material(S) (Pro Cah)Professional Component ",,72147,CPT,Professional,Both,,,26,767,651.95,53.88,767,CorVel,Worker's Compensation,165.2442453,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Mri, Spinal Canal And Contents, Thoracic; With Contrast Material(S) (Pro Cah)Professional Component ",,72147,CPT,Professional,Both,,,26,767,651.95,53.88,767,First Health Group Corporation,First Health Network,743.99,97,,percent of total billed charges,,
"Mri, Spinal Canal And Contents, Thoracic; With Contrast Material(S) (Pro Cah)Professional Component ",,72147,CPT,Professional,Both,,,26,767,651.95,53.88,767,"Health Partners, Inc.",Commercial,126.85,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Mri, Spinal Canal And Contents, Thoracic; With Contrast Material(S) (Pro Cah)Professional Component ",,72147,CPT,Professional,Both,,,26,767,651.95,53.88,767,"Health Partners, Inc.",Medicare Advantage,96.4505,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Mri, Spinal Canal And Contents, Thoracic; With Contrast Material(S) (Pro Cah)Professional Component ",,72147,CPT,Professional,Both,,,26,767,651.95,53.88,767,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),53.88,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Mri, Spinal Canal And Contents, Thoracic; With Contrast Material(S) (Pro Cah)Professional Component ",,72147,CPT,Professional,Both,,,26,767,651.95,53.88,767,"Health Partners, Inc.",State of Minnesota Advantage Program,109.281275,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Mri, Spinal Canal And Contents, Thoracic; With Contrast Material(S) (Pro Cah)Professional Component ",,72147,CPT,Professional,Both,,,26,767,651.95,53.88,767,"Health Partners, Inc.",State Public Programs,53.88,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Mri, Spinal Canal And Contents, Thoracic; With Contrast Material(S) (Pro Cah)Professional Component ",,72147,CPT,Professional,Both,,,26,767,651.95,53.88,767,Humana Insurance Company,Commercial PPO,83.87,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Mri, Spinal Canal And Contents, Thoracic; With Contrast Material(S) (Pro Cah)Professional Component ",,72147,CPT,Professional,Both,,,26,767,651.95,53.88,767,Humana Insurance Company,Medicare PPO,767,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Mri, Spinal Canal And Contents, Thoracic; With Contrast Material(S) (Pro Cah)Professional Component ",,72147,CPT,Professional,Both,,,26,767,651.95,53.88,767,Medica,Individual & Family,650.416,84.8,,percent of total billed charges,,
"Mri, Spinal Canal And Contents, Thoracic; With Contrast Material(S) (Pro Cah)Professional Component ",,72147,CPT,Professional,Both,,,26,767,651.95,53.88,767,Medica,Medica Advantage Solution,381.966,49.8,,percent of total billed charges,,
"Mri, Spinal Canal And Contents, Thoracic; With Contrast Material(S) (Pro Cah)Professional Component ",,72147,CPT,Professional,Both,,,26,767,651.95,53.88,767,Medica,Medical Assistance,62.21,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Mri, Spinal Canal And Contents, Thoracic; With Contrast Material(S) (Pro Cah)Professional Component ",,72147,CPT,Professional,Both,,,26,767,651.95,53.88,767,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,83.87,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Mri, Spinal Canal And Contents, Thoracic; With Contrast Material(S) (Pro Cah)Professional Component ",,72147,CPT,Professional,Both,,,26,767,651.95,53.88,767,"Multiplan, Inc.","Multiplan, Inc.",720.98,94,,percent of total billed charges,,
"Mri, Spinal Canal And Contents, Thoracic; With Contrast Material(S) (Pro Cah)Professional Component ",,72147,CPT,Professional,Both,,,26,767,651.95,53.88,767,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,691.067,90.1,,percent of total billed charges,,
"Mri, Spinal Canal And Contents, Thoracic; With Contrast Material(S) (Pro Cah)Professional Component ",,72147,CPT,Professional,Both,,,26,767,651.95,53.88,767,"Preferred One Administrative Services, INC.",PPO,756.262,98.6,,percent of total billed charges,,
"Mri, Spinal Canal And Contents, Thoracic; With Contrast Material(S) (Pro Cah)Professional Component ",,72147,CPT,Professional,Both,,,26,767,651.95,53.88,767,PrimeWest Health,Minnesota Senior Health Options (MSHO),96.4505,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Mri, Spinal Canal And Contents, Thoracic; With Contrast Material(S) (Pro Cah)Professional Component ",,72147,CPT,Professional,Both,,,26,767,651.95,53.88,767,PrimeWest Health,MinnesotaCare,66.5643576,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Mri, Spinal Canal And Contents, Thoracic; With Contrast Material(S) (Pro Cah)Professional Component ",,72147,CPT,Professional,Both,,,26,767,651.95,53.88,767,Sanford Health Plan,Sanford Health Plan,674.96,88,,percent of total billed charges,,
"Mri, Spinal Canal And Contents, Thoracic; With Contrast Material(S) (Pro Cah)Professional Component ",,72147,CPT,Professional,Both,,,26,767,651.95,53.88,767,"UCare Health, Inc.",Individual & Family Plan,136.339072,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Mri, Spinal Canal And Contents, Thoracic; With Contrast Material(S) (Pro Cah)Professional Component ",,72147,CPT,Professional,Both,,,26,767,651.95,53.88,767,"UCare Health, Inc.",Medical Assistance,68.430648,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Mri, Spinal Canal And Contents, Thoracic; With Contrast Material(S) (Pro Cah)Professional Component ",,72147,CPT,Professional,Both,,,26,767,651.95,53.88,767,"UCare Health, Inc.",Medicare Advantage,96.4505,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Mri, Spinal Canal And Contents, Thoracic; With Contrast Material(S) (Pro Cah)Professional Component ",,72147,CPT,Professional,Both,,,26,767,651.95,53.88,767,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),77.1604,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Mri, Spinal Canal And Contents, Thoracic; With Contrast Material(S) (Pro Cah)Professional Component ",,72147,CPT,Professional,Both,,,26,767,651.95,53.88,767,UnitedHealthcare,Individual & Family,767,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Mri, Spinal Canal And Contents, Thoracic; With Contrast Material(S) (Pro Cah)Professional Component ",,72147,CPT,Professional,Both,,,26,767,651.95,53.88,767,UnitedHealthcare,Medicare Advantage,96.4505,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Mri, Spinal Canal And Contents, Thoracic; With Contrast Material(S) (Pro Cah)Professional Component ",,72147,CPT,Professional,Both,,,26,767,651.95,53.88,767,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,62.20968,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Mri Lumbar Spine W/O Contrast (Pro Cah)Professional Component ,,72148,CPT,Professional,Both,,,26,682,579.7,44.71,682,Aetna,Commercial,579.7,85,,percent of total billed charges,,
Mri Lumbar Spine W/O Contrast (Pro Cah)Professional Component ,,72148,CPT,Professional,Both,,,26,682,579.7,44.71,682,Aetna,Medicare Advantage,71.47,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Mri Lumbar Spine W/O Contrast (Pro Cah)Professional Component ,,72148,CPT,Professional,Both,,,26,682,579.7,44.71,682,Aetna,PPO,634.26,93,,percent of total billed charges,,
Mri Lumbar Spine W/O Contrast (Pro Cah)Professional Component ,,72148,CPT,Professional,Both,,,26,682,579.7,44.71,682,America's PPO,America's PPO,582.7008,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Mri Lumbar Spine W/O Contrast (Pro Cah)Professional Component ,,72148,CPT,Professional,Both,,,26,682,579.7,44.71,682,BlueCross BlueShield Minnesota, Federal Employee Program,134.23,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Mri Lumbar Spine W/O Contrast (Pro Cah)Professional Component ,,72148,CPT,Professional,Both,,,26,682,579.7,44.71,682,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,136.37768,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Mri Lumbar Spine W/O Contrast (Pro Cah)Professional Component ,,72148,CPT,Professional,Both,,,26,682,579.7,44.71,682,BlueCross BlueShield Minnesota,High Value Network Plan,136.37768,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Mri Lumbar Spine W/O Contrast (Pro Cah)Professional Component ,,72148,CPT,Professional,Both,,,26,682,579.7,44.71,682,BlueCross BlueShield Minnesota,Medicare Advantage,80.132,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Mri Lumbar Spine W/O Contrast (Pro Cah)Professional Component ,,72148,CPT,Professional,Both,,,26,682,579.7,44.71,682,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,136.37768,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Mri Lumbar Spine W/O Contrast (Pro Cah)Professional Component ,,72148,CPT,Professional,Both,,,26,682,579.7,44.71,682,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,51.62296,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Mri Lumbar Spine W/O Contrast (Pro Cah)Professional Component ,,72148,CPT,Professional,Both,,,26,682,579.7,44.71,682,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),80.132,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Mri Lumbar Spine W/O Contrast (Pro Cah)Professional Component ,,72148,CPT,Professional,Both,,,26,682,579.7,44.71,682,CorVel,Worker's Compensation,138.0518142,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Mri Lumbar Spine W/O Contrast (Pro Cah)Professional Component ,,72148,CPT,Professional,Both,,,26,682,579.7,44.71,682,First Health Group Corporation,First Health Network,661.54,97,,percent of total billed charges,,
Mri Lumbar Spine W/O Contrast (Pro Cah)Professional Component ,,72148,CPT,Professional,Both,,,26,682,579.7,44.71,682,"Health Partners, Inc.",Commercial,106.22,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Mri Lumbar Spine W/O Contrast (Pro Cah)Professional Component ,,72148,CPT,Professional,Both,,,26,682,579.7,44.71,682,"Health Partners, Inc.",Medicare Advantage,80.132,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Mri Lumbar Spine W/O Contrast (Pro Cah)Professional Component ,,72148,CPT,Professional,Both,,,26,682,579.7,44.71,682,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),44.71,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Mri Lumbar Spine W/O Contrast (Pro Cah)Professional Component ,,72148,CPT,Professional,Both,,,26,682,579.7,44.71,682,"Health Partners, Inc.",State of Minnesota Advantage Program,91.50853,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Mri Lumbar Spine W/O Contrast (Pro Cah)Professional Component ,,72148,CPT,Professional,Both,,,26,682,579.7,44.71,682,"Health Partners, Inc.",State Public Programs,44.71,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Mri Lumbar Spine W/O Contrast (Pro Cah)Professional Component ,,72148,CPT,Professional,Both,,,26,682,579.7,44.71,682,Humana Insurance Company,Commercial PPO,69.68,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Mri Lumbar Spine W/O Contrast (Pro Cah)Professional Component ,,72148,CPT,Professional,Both,,,26,682,579.7,44.71,682,Humana Insurance Company,Medicare PPO,682,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Mri Lumbar Spine W/O Contrast (Pro Cah)Professional Component ,,72148,CPT,Professional,Both,,,26,682,579.7,44.71,682,Medica,Individual & Family,578.336,84.8,,percent of total billed charges,,
Mri Lumbar Spine W/O Contrast (Pro Cah)Professional Component ,,72148,CPT,Professional,Both,,,26,682,579.7,44.71,682,Medica,Medica Advantage Solution,339.636,49.8,,percent of total billed charges,,
Mri Lumbar Spine W/O Contrast (Pro Cah)Professional Component ,,72148,CPT,Professional,Both,,,26,682,579.7,44.71,682,Medica,Medical Assistance,51.62,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Mri Lumbar Spine W/O Contrast (Pro Cah)Professional Component ,,72148,CPT,Professional,Both,,,26,682,579.7,44.71,682,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,69.68,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Mri Lumbar Spine W/O Contrast (Pro Cah)Professional Component ,,72148,CPT,Professional,Both,,,26,682,579.7,44.71,682,"Multiplan, Inc.","Multiplan, Inc.",641.08,94,,percent of total billed charges,,
Mri Lumbar Spine W/O Contrast (Pro Cah)Professional Component ,,72148,CPT,Professional,Both,,,26,682,579.7,44.71,682,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,614.482,90.1,,percent of total billed charges,,
Mri Lumbar Spine W/O Contrast (Pro Cah)Professional Component ,,72148,CPT,Professional,Both,,,26,682,579.7,44.71,682,"Preferred One Administrative Services, INC.",PPO,672.452,98.6,,percent of total billed charges,,
Mri Lumbar Spine W/O Contrast (Pro Cah)Professional Component ,,72148,CPT,Professional,Both,,,26,682,579.7,44.71,682,PrimeWest Health,Minnesota Senior Health Options (MSHO),80.132,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Mri Lumbar Spine W/O Contrast (Pro Cah)Professional Component ,,72148,CPT,Professional,Both,,,26,682,579.7,44.71,682,PrimeWest Health,MinnesotaCare,55.2365672,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Mri Lumbar Spine W/O Contrast (Pro Cah)Professional Component ,,72148,CPT,Professional,Both,,,26,682,579.7,44.71,682,Sanford Health Plan,Sanford Health Plan,600.16,88,,percent of total billed charges,,
Mri Lumbar Spine W/O Contrast (Pro Cah)Professional Component ,,72148,CPT,Professional,Both,,,26,682,579.7,44.71,682,"UCare Health, Inc.",Individual & Family Plan,113.271808,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Mri Lumbar Spine W/O Contrast (Pro Cah)Professional Component ,,72148,CPT,Professional,Both,,,26,682,579.7,44.71,682,"UCare Health, Inc.",Medical Assistance,56.785256,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Mri Lumbar Spine W/O Contrast (Pro Cah)Professional Component ,,72148,CPT,Professional,Both,,,26,682,579.7,44.71,682,"UCare Health, Inc.",Medicare Advantage,80.132,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Mri Lumbar Spine W/O Contrast (Pro Cah)Professional Component ,,72148,CPT,Professional,Both,,,26,682,579.7,44.71,682,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),64.1056,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Mri Lumbar Spine W/O Contrast (Pro Cah)Professional Component ,,72148,CPT,Professional,Both,,,26,682,579.7,44.71,682,UnitedHealthcare,Individual & Family,682,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Mri Lumbar Spine W/O Contrast (Pro Cah)Professional Component ,,72148,CPT,Professional,Both,,,26,682,579.7,44.71,682,UnitedHealthcare,Medicare Advantage,80.132,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Mri Lumbar Spine W/O Contrast (Pro Cah)Professional Component ,,72148,CPT,Professional,Both,,,26,682,579.7,44.71,682,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,51.62296,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Mri Lumbar Spine W/Contrast (Pro Cah)Professional Component ,,72149,CPT,Professional,Both,,,26,789,670.65,53.88,789,Aetna,Commercial,670.65,85,,percent of total billed charges,,
Mri Lumbar Spine W/Contrast (Pro Cah)Professional Component ,,72149,CPT,Professional,Both,,,26,789,670.65,53.88,789,Aetna,Medicare Advantage,86.19,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Mri Lumbar Spine W/Contrast (Pro Cah)Professional Component ,,72149,CPT,Professional,Both,,,26,789,670.65,53.88,789,Aetna,PPO,733.77,93,,percent of total billed charges,,
Mri Lumbar Spine W/Contrast (Pro Cah)Professional Component ,,72149,CPT,Professional,Both,,,26,789,670.65,53.88,789,America's PPO,America's PPO,674.1216,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Mri Lumbar Spine W/Contrast (Pro Cah)Professional Component ,,72149,CPT,Professional,Both,,,26,789,670.65,53.88,789,BlueCross BlueShield Minnesota, Federal Employee Program,161.72,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Mri Lumbar Spine W/Contrast (Pro Cah)Professional Component ,,72149,CPT,Professional,Both,,,26,789,670.65,53.88,789,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,164.30752,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Mri Lumbar Spine W/Contrast (Pro Cah)Professional Component ,,72149,CPT,Professional,Both,,,26,789,670.65,53.88,789,BlueCross BlueShield Minnesota,High Value Network Plan,164.30752,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Mri Lumbar Spine W/Contrast (Pro Cah)Professional Component ,,72149,CPT,Professional,Both,,,26,789,670.65,53.88,789,BlueCross BlueShield Minnesota,Medicare Advantage,96.4505,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Mri Lumbar Spine W/Contrast (Pro Cah)Professional Component ,,72149,CPT,Professional,Both,,,26,789,670.65,53.88,789,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,164.30752,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Mri Lumbar Spine W/Contrast (Pro Cah)Professional Component ,,72149,CPT,Professional,Both,,,26,789,670.65,53.88,789,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,62.20968,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Mri Lumbar Spine W/Contrast (Pro Cah)Professional Component ,,72149,CPT,Professional,Both,,,26,789,670.65,53.88,789,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),96.4505,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Mri Lumbar Spine W/Contrast (Pro Cah)Professional Component ,,72149,CPT,Professional,Both,,,26,789,670.65,53.88,789,CorVel,Worker's Compensation,165.2442453,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Mri Lumbar Spine W/Contrast (Pro Cah)Professional Component ,,72149,CPT,Professional,Both,,,26,789,670.65,53.88,789,First Health Group Corporation,First Health Network,765.33,97,,percent of total billed charges,,
Mri Lumbar Spine W/Contrast (Pro Cah)Professional Component ,,72149,CPT,Professional,Both,,,26,789,670.65,53.88,789,"Health Partners, Inc.",Commercial,126.85,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Mri Lumbar Spine W/Contrast (Pro Cah)Professional Component ,,72149,CPT,Professional,Both,,,26,789,670.65,53.88,789,"Health Partners, Inc.",Medicare Advantage,96.4505,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Mri Lumbar Spine W/Contrast (Pro Cah)Professional Component ,,72149,CPT,Professional,Both,,,26,789,670.65,53.88,789,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),53.88,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Mri Lumbar Spine W/Contrast (Pro Cah)Professional Component ,,72149,CPT,Professional,Both,,,26,789,670.65,53.88,789,"Health Partners, Inc.",State of Minnesota Advantage Program,109.281275,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Mri Lumbar Spine W/Contrast (Pro Cah)Professional Component ,,72149,CPT,Professional,Both,,,26,789,670.65,53.88,789,"Health Partners, Inc.",State Public Programs,53.88,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Mri Lumbar Spine W/Contrast (Pro Cah)Professional Component ,,72149,CPT,Professional,Both,,,26,789,670.65,53.88,789,Humana Insurance Company,Commercial PPO,83.87,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Mri Lumbar Spine W/Contrast (Pro Cah)Professional Component ,,72149,CPT,Professional,Both,,,26,789,670.65,53.88,789,Humana Insurance Company,Medicare PPO,789,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Mri Lumbar Spine W/Contrast (Pro Cah)Professional Component ,,72149,CPT,Professional,Both,,,26,789,670.65,53.88,789,Medica,Individual & Family,669.072,84.8,,percent of total billed charges,,
Mri Lumbar Spine W/Contrast (Pro Cah)Professional Component ,,72149,CPT,Professional,Both,,,26,789,670.65,53.88,789,Medica,Medica Advantage Solution,392.922,49.8,,percent of total billed charges,,
Mri Lumbar Spine W/Contrast (Pro Cah)Professional Component ,,72149,CPT,Professional,Both,,,26,789,670.65,53.88,789,Medica,Medical Assistance,62.21,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Mri Lumbar Spine W/Contrast (Pro Cah)Professional Component ,,72149,CPT,Professional,Both,,,26,789,670.65,53.88,789,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,83.87,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Mri Lumbar Spine W/Contrast (Pro Cah)Professional Component ,,72149,CPT,Professional,Both,,,26,789,670.65,53.88,789,"Multiplan, Inc.","Multiplan, Inc.",741.66,94,,percent of total billed charges,,
Mri Lumbar Spine W/Contrast (Pro Cah)Professional Component ,,72149,CPT,Professional,Both,,,26,789,670.65,53.88,789,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,710.889,90.1,,percent of total billed charges,,
Mri Lumbar Spine W/Contrast (Pro Cah)Professional Component ,,72149,CPT,Professional,Both,,,26,789,670.65,53.88,789,"Preferred One Administrative Services, INC.",PPO,777.954,98.6,,percent of total billed charges,,
Mri Lumbar Spine W/Contrast (Pro Cah)Professional Component ,,72149,CPT,Professional,Both,,,26,789,670.65,53.88,789,PrimeWest Health,Minnesota Senior Health Options (MSHO),96.4505,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Mri Lumbar Spine W/Contrast (Pro Cah)Professional Component ,,72149,CPT,Professional,Both,,,26,789,670.65,53.88,789,PrimeWest Health,MinnesotaCare,66.5643576,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Mri Lumbar Spine W/Contrast (Pro Cah)Professional Component ,,72149,CPT,Professional,Both,,,26,789,670.65,53.88,789,Sanford Health Plan,Sanford Health Plan,694.32,88,,percent of total billed charges,,
Mri Lumbar Spine W/Contrast (Pro Cah)Professional Component ,,72149,CPT,Professional,Both,,,26,789,670.65,53.88,789,"UCare Health, Inc.",Individual & Family Plan,136.339072,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Mri Lumbar Spine W/Contrast (Pro Cah)Professional Component ,,72149,CPT,Professional,Both,,,26,789,670.65,53.88,789,"UCare Health, Inc.",Medical Assistance,68.430648,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Mri Lumbar Spine W/Contrast (Pro Cah)Professional Component ,,72149,CPT,Professional,Both,,,26,789,670.65,53.88,789,"UCare Health, Inc.",Medicare Advantage,96.4505,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Mri Lumbar Spine W/Contrast (Pro Cah)Professional Component ,,72149,CPT,Professional,Both,,,26,789,670.65,53.88,789,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),77.1604,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Mri Lumbar Spine W/Contrast (Pro Cah)Professional Component ,,72149,CPT,Professional,Both,,,26,789,670.65,53.88,789,UnitedHealthcare,Individual & Family,789,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Mri Lumbar Spine W/Contrast (Pro Cah)Professional Component ,,72149,CPT,Professional,Both,,,26,789,670.65,53.88,789,UnitedHealthcare,Medicare Advantage,96.4505,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Mri Lumbar Spine W/Contrast (Pro Cah)Professional Component ,,72149,CPT,Professional,Both,,,26,789,670.65,53.88,789,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,62.20968,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Mri Cervical Spine W/O And W/Contrast (Pro Cah)Professional Component ,,72156,CPT,Professional,Both,,,26,1170,994.5,69.15,1170,Aetna,Commercial,994.5,85,,percent of total billed charges,,
Mri Cervical Spine W/O And W/Contrast (Pro Cah)Professional Component ,,72156,CPT,Professional,Both,,,26,1170,994.5,69.15,1170,Aetna,Medicare Advantage,110.6,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Mri Cervical Spine W/O And W/Contrast (Pro Cah)Professional Component ,,72156,CPT,Professional,Both,,,26,1170,994.5,69.15,1170,Aetna,PPO,1088.1,93,,percent of total billed charges,,
Mri Cervical Spine W/O And W/Contrast (Pro Cah)Professional Component ,,72156,CPT,Professional,Both,,,26,1170,994.5,69.15,1170,America's PPO,America's PPO,999.648,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Mri Cervical Spine W/O And W/Contrast (Pro Cah)Professional Component ,,72156,CPT,Professional,Both,,,26,1170,994.5,69.15,1170,BlueCross BlueShield Minnesota, Federal Employee Program,207.1,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Mri Cervical Spine W/O And W/Contrast (Pro Cah)Professional Component ,,72156,CPT,Professional,Both,,,26,1170,994.5,69.15,1170,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,210.4136,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Mri Cervical Spine W/O And W/Contrast (Pro Cah)Professional Component ,,72156,CPT,Professional,Both,,,26,1170,994.5,69.15,1170,BlueCross BlueShield Minnesota,High Value Network Plan,210.4136,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Mri Cervical Spine W/O And W/Contrast (Pro Cah)Professional Component ,,72156,CPT,Professional,Both,,,26,1170,994.5,69.15,1170,BlueCross BlueShield Minnesota,Medicare Advantage,123.7285,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Mri Cervical Spine W/O And W/Contrast (Pro Cah)Professional Component ,,72156,CPT,Professional,Both,,,26,1170,994.5,69.15,1170,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,210.4136,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Mri Cervical Spine W/O And W/Contrast (Pro Cah)Professional Component ,,72156,CPT,Professional,Both,,,26,1170,994.5,69.15,1170,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,79.83728,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Mri Cervical Spine W/O And W/Contrast (Pro Cah)Professional Component ,,72156,CPT,Professional,Both,,,26,1170,994.5,69.15,1170,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),123.7285,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Mri Cervical Spine W/O And W/Contrast (Pro Cah)Professional Component ,,72156,CPT,Professional,Both,,,26,1170,994.5,69.15,1170,CorVel,Worker's Compensation,212.2229433,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Mri Cervical Spine W/O And W/Contrast (Pro Cah)Professional Component ,,72156,CPT,Professional,Both,,,26,1170,994.5,69.15,1170,First Health Group Corporation,First Health Network,1134.9,97,,percent of total billed charges,,
Mri Cervical Spine W/O And W/Contrast (Pro Cah)Professional Component ,,72156,CPT,Professional,Both,,,26,1170,994.5,69.15,1170,"Health Partners, Inc.",Commercial,162.94,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Mri Cervical Spine W/O And W/Contrast (Pro Cah)Professional Component ,,72156,CPT,Professional,Both,,,26,1170,994.5,69.15,1170,"Health Partners, Inc.",Medicare Advantage,123.7285,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Mri Cervical Spine W/O And W/Contrast (Pro Cah)Professional Component ,,72156,CPT,Professional,Both,,,26,1170,994.5,69.15,1170,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),69.15,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Mri Cervical Spine W/O And W/Contrast (Pro Cah)Professional Component ,,72156,CPT,Professional,Both,,,26,1170,994.5,69.15,1170,"Health Partners, Inc.",State of Minnesota Advantage Program,140.37281,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Mri Cervical Spine W/O And W/Contrast (Pro Cah)Professional Component ,,72156,CPT,Professional,Both,,,26,1170,994.5,69.15,1170,"Health Partners, Inc.",State Public Programs,69.15,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Mri Cervical Spine W/O And W/Contrast (Pro Cah)Professional Component ,,72156,CPT,Professional,Both,,,26,1170,994.5,69.15,1170,Humana Insurance Company,Commercial PPO,107.59,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Mri Cervical Spine W/O And W/Contrast (Pro Cah)Professional Component ,,72156,CPT,Professional,Both,,,26,1170,994.5,69.15,1170,Humana Insurance Company,Medicare PPO,1170,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Mri Cervical Spine W/O And W/Contrast (Pro Cah)Professional Component ,,72156,CPT,Professional,Both,,,26,1170,994.5,69.15,1170,Medica,Individual & Family,992.16,84.8,,percent of total billed charges,,
Mri Cervical Spine W/O And W/Contrast (Pro Cah)Professional Component ,,72156,CPT,Professional,Both,,,26,1170,994.5,69.15,1170,Medica,Medica Advantage Solution,582.66,49.8,,percent of total billed charges,,
Mri Cervical Spine W/O And W/Contrast (Pro Cah)Professional Component ,,72156,CPT,Professional,Both,,,26,1170,994.5,69.15,1170,Medica,Medical Assistance,79.84,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Mri Cervical Spine W/O And W/Contrast (Pro Cah)Professional Component ,,72156,CPT,Professional,Both,,,26,1170,994.5,69.15,1170,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,107.59,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Mri Cervical Spine W/O And W/Contrast (Pro Cah)Professional Component ,,72156,CPT,Professional,Both,,,26,1170,994.5,69.15,1170,"Multiplan, Inc.","Multiplan, Inc.",1099.8,94,,percent of total billed charges,,
Mri Cervical Spine W/O And W/Contrast (Pro Cah)Professional Component ,,72156,CPT,Professional,Both,,,26,1170,994.5,69.15,1170,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1054.17,90.1,,percent of total billed charges,,
Mri Cervical Spine W/O And W/Contrast (Pro Cah)Professional Component ,,72156,CPT,Professional,Both,,,26,1170,994.5,69.15,1170,"Preferred One Administrative Services, INC.",PPO,1153.62,98.6,,percent of total billed charges,,
Mri Cervical Spine W/O And W/Contrast (Pro Cah)Professional Component ,,72156,CPT,Professional,Both,,,26,1170,994.5,69.15,1170,PrimeWest Health,Minnesota Senior Health Options (MSHO),123.7285,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Mri Cervical Spine W/O And W/Contrast (Pro Cah)Professional Component ,,72156,CPT,Professional,Both,,,26,1170,994.5,69.15,1170,PrimeWest Health,MinnesotaCare,85.4258896,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Mri Cervical Spine W/O And W/Contrast (Pro Cah)Professional Component ,,72156,CPT,Professional,Both,,,26,1170,994.5,69.15,1170,Sanford Health Plan,Sanford Health Plan,1029.6,88,,percent of total billed charges,,
Mri Cervical Spine W/O And W/Contrast (Pro Cah)Professional Component ,,72156,CPT,Professional,Both,,,26,1170,994.5,69.15,1170,"UCare Health, Inc.",Individual & Family Plan,174.898304,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Mri Cervical Spine W/O And W/Contrast (Pro Cah)Professional Component ,,72156,CPT,Professional,Both,,,26,1170,994.5,69.15,1170,"UCare Health, Inc.",Medical Assistance,87.821008,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Mri Cervical Spine W/O And W/Contrast (Pro Cah)Professional Component ,,72156,CPT,Professional,Both,,,26,1170,994.5,69.15,1170,"UCare Health, Inc.",Medicare Advantage,123.7285,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Mri Cervical Spine W/O And W/Contrast (Pro Cah)Professional Component ,,72156,CPT,Professional,Both,,,26,1170,994.5,69.15,1170,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),98.9828,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Mri Cervical Spine W/O And W/Contrast (Pro Cah)Professional Component ,,72156,CPT,Professional,Both,,,26,1170,994.5,69.15,1170,UnitedHealthcare,Individual & Family,1170,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Mri Cervical Spine W/O And W/Contrast (Pro Cah)Professional Component ,,72156,CPT,Professional,Both,,,26,1170,994.5,69.15,1170,UnitedHealthcare,Medicare Advantage,123.7285,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Mri Cervical Spine W/O And W/Contrast (Pro Cah)Professional Component ,,72156,CPT,Professional,Both,,,26,1170,994.5,69.15,1170,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,79.83728,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Mri Spinal Canal Contents, W/O Contrast, Followed By Contrast Further Sequences; Thoracic (Pro Cah)Professional Component ",,72157,CPT,Professional,Both,,,26,1175,998.75,69.15,1175,Aetna,Commercial,998.75,85,,percent of total billed charges,,
"Mri Spinal Canal Contents, W/O Contrast, Followed By Contrast Further Sequences; Thoracic (Pro Cah)Professional Component ",,72157,CPT,Professional,Both,,,26,1175,998.75,69.15,1175,Aetna,Medicare Advantage,110.6,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Mri Spinal Canal Contents, W/O Contrast, Followed By Contrast Further Sequences; Thoracic (Pro Cah)Professional Component ",,72157,CPT,Professional,Both,,,26,1175,998.75,69.15,1175,Aetna,PPO,1092.75,93,,percent of total billed charges,,
"Mri Spinal Canal Contents, W/O Contrast, Followed By Contrast Further Sequences; Thoracic (Pro Cah)Professional Component ",,72157,CPT,Professional,Both,,,26,1175,998.75,69.15,1175,America's PPO,America's PPO,1003.92,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Mri Spinal Canal Contents, W/O Contrast, Followed By Contrast Further Sequences; Thoracic (Pro Cah)Professional Component ",,72157,CPT,Professional,Both,,,26,1175,998.75,69.15,1175,BlueCross BlueShield Minnesota, Federal Employee Program,207.1,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Mri Spinal Canal Contents, W/O Contrast, Followed By Contrast Further Sequences; Thoracic (Pro Cah)Professional Component ",,72157,CPT,Professional,Both,,,26,1175,998.75,69.15,1175,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,210.4136,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Mri Spinal Canal Contents, W/O Contrast, Followed By Contrast Further Sequences; Thoracic (Pro Cah)Professional Component ",,72157,CPT,Professional,Both,,,26,1175,998.75,69.15,1175,BlueCross BlueShield Minnesota,High Value Network Plan,210.4136,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Mri Spinal Canal Contents, W/O Contrast, Followed By Contrast Further Sequences; Thoracic (Pro Cah)Professional Component ",,72157,CPT,Professional,Both,,,26,1175,998.75,69.15,1175,BlueCross BlueShield Minnesota,Medicare Advantage,123.7285,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Mri Spinal Canal Contents, W/O Contrast, Followed By Contrast Further Sequences; Thoracic (Pro Cah)Professional Component ",,72157,CPT,Professional,Both,,,26,1175,998.75,69.15,1175,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,210.4136,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Mri Spinal Canal Contents, W/O Contrast, Followed By Contrast Further Sequences; Thoracic (Pro Cah)Professional Component ",,72157,CPT,Professional,Both,,,26,1175,998.75,69.15,1175,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,79.83728,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Mri Spinal Canal Contents, W/O Contrast, Followed By Contrast Further Sequences; Thoracic (Pro Cah)Professional Component ",,72157,CPT,Professional,Both,,,26,1175,998.75,69.15,1175,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),123.7285,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Mri Spinal Canal Contents, W/O Contrast, Followed By Contrast Further Sequences; Thoracic (Pro Cah)Professional Component ",,72157,CPT,Professional,Both,,,26,1175,998.75,69.15,1175,CorVel,Worker's Compensation,212.2229433,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Mri Spinal Canal Contents, W/O Contrast, Followed By Contrast Further Sequences; Thoracic (Pro Cah)Professional Component ",,72157,CPT,Professional,Both,,,26,1175,998.75,69.15,1175,First Health Group Corporation,First Health Network,1139.75,97,,percent of total billed charges,,
"Mri Spinal Canal Contents, W/O Contrast, Followed By Contrast Further Sequences; Thoracic (Pro Cah)Professional Component ",,72157,CPT,Professional,Both,,,26,1175,998.75,69.15,1175,"Health Partners, Inc.",Commercial,162.94,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Mri Spinal Canal Contents, W/O Contrast, Followed By Contrast Further Sequences; Thoracic (Pro Cah)Professional Component ",,72157,CPT,Professional,Both,,,26,1175,998.75,69.15,1175,"Health Partners, Inc.",Medicare Advantage,123.7285,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Mri Spinal Canal Contents, W/O Contrast, Followed By Contrast Further Sequences; Thoracic (Pro Cah)Professional Component ",,72157,CPT,Professional,Both,,,26,1175,998.75,69.15,1175,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),69.15,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Mri Spinal Canal Contents, W/O Contrast, Followed By Contrast Further Sequences; Thoracic (Pro Cah)Professional Component ",,72157,CPT,Professional,Both,,,26,1175,998.75,69.15,1175,"Health Partners, Inc.",State of Minnesota Advantage Program,140.37281,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Mri Spinal Canal Contents, W/O Contrast, Followed By Contrast Further Sequences; Thoracic (Pro Cah)Professional Component ",,72157,CPT,Professional,Both,,,26,1175,998.75,69.15,1175,"Health Partners, Inc.",State Public Programs,69.15,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Mri Spinal Canal Contents, W/O Contrast, Followed By Contrast Further Sequences; Thoracic (Pro Cah)Professional Component ",,72157,CPT,Professional,Both,,,26,1175,998.75,69.15,1175,Humana Insurance Company,Commercial PPO,107.59,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Mri Spinal Canal Contents, W/O Contrast, Followed By Contrast Further Sequences; Thoracic (Pro Cah)Professional Component ",,72157,CPT,Professional,Both,,,26,1175,998.75,69.15,1175,Humana Insurance Company,Medicare PPO,1175,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Mri Spinal Canal Contents, W/O Contrast, Followed By Contrast Further Sequences; Thoracic (Pro Cah)Professional Component ",,72157,CPT,Professional,Both,,,26,1175,998.75,69.15,1175,Medica,Individual & Family,996.4,84.8,,percent of total billed charges,,
"Mri Spinal Canal Contents, W/O Contrast, Followed By Contrast Further Sequences; Thoracic (Pro Cah)Professional Component ",,72157,CPT,Professional,Both,,,26,1175,998.75,69.15,1175,Medica,Medica Advantage Solution,585.15,49.8,,percent of total billed charges,,
"Mri Spinal Canal Contents, W/O Contrast, Followed By Contrast Further Sequences; Thoracic (Pro Cah)Professional Component ",,72157,CPT,Professional,Both,,,26,1175,998.75,69.15,1175,Medica,Medical Assistance,79.84,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Mri Spinal Canal Contents, W/O Contrast, Followed By Contrast Further Sequences; Thoracic (Pro Cah)Professional Component ",,72157,CPT,Professional,Both,,,26,1175,998.75,69.15,1175,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,107.59,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Mri Spinal Canal Contents, W/O Contrast, Followed By Contrast Further Sequences; Thoracic (Pro Cah)Professional Component ",,72157,CPT,Professional,Both,,,26,1175,998.75,69.15,1175,"Multiplan, Inc.","Multiplan, Inc.",1104.5,94,,percent of total billed charges,,
"Mri Spinal Canal Contents, W/O Contrast, Followed By Contrast Further Sequences; Thoracic (Pro Cah)Professional Component ",,72157,CPT,Professional,Both,,,26,1175,998.75,69.15,1175,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1058.675,90.1,,percent of total billed charges,,
"Mri Spinal Canal Contents, W/O Contrast, Followed By Contrast Further Sequences; Thoracic (Pro Cah)Professional Component ",,72157,CPT,Professional,Both,,,26,1175,998.75,69.15,1175,"Preferred One Administrative Services, INC.",PPO,1158.55,98.6,,percent of total billed charges,,
"Mri Spinal Canal Contents, W/O Contrast, Followed By Contrast Further Sequences; Thoracic (Pro Cah)Professional Component ",,72157,CPT,Professional,Both,,,26,1175,998.75,69.15,1175,PrimeWest Health,Minnesota Senior Health Options (MSHO),123.7285,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Mri Spinal Canal Contents, W/O Contrast, Followed By Contrast Further Sequences; Thoracic (Pro Cah)Professional Component ",,72157,CPT,Professional,Both,,,26,1175,998.75,69.15,1175,PrimeWest Health,MinnesotaCare,85.4258896,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Mri Spinal Canal Contents, W/O Contrast, Followed By Contrast Further Sequences; Thoracic (Pro Cah)Professional Component ",,72157,CPT,Professional,Both,,,26,1175,998.75,69.15,1175,Sanford Health Plan,Sanford Health Plan,1034,88,,percent of total billed charges,,
"Mri Spinal Canal Contents, W/O Contrast, Followed By Contrast Further Sequences; Thoracic (Pro Cah)Professional Component ",,72157,CPT,Professional,Both,,,26,1175,998.75,69.15,1175,"UCare Health, Inc.",Individual & Family Plan,174.898304,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Mri Spinal Canal Contents, W/O Contrast, Followed By Contrast Further Sequences; Thoracic (Pro Cah)Professional Component ",,72157,CPT,Professional,Both,,,26,1175,998.75,69.15,1175,"UCare Health, Inc.",Medical Assistance,87.821008,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Mri Spinal Canal Contents, W/O Contrast, Followed By Contrast Further Sequences; Thoracic (Pro Cah)Professional Component ",,72157,CPT,Professional,Both,,,26,1175,998.75,69.15,1175,"UCare Health, Inc.",Medicare Advantage,123.7285,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Mri Spinal Canal Contents, W/O Contrast, Followed By Contrast Further Sequences; Thoracic (Pro Cah)Professional Component ",,72157,CPT,Professional,Both,,,26,1175,998.75,69.15,1175,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),98.9828,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Mri Spinal Canal Contents, W/O Contrast, Followed By Contrast Further Sequences; Thoracic (Pro Cah)Professional Component ",,72157,CPT,Professional,Both,,,26,1175,998.75,69.15,1175,UnitedHealthcare,Individual & Family,1175,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Mri Spinal Canal Contents, W/O Contrast, Followed By Contrast Further Sequences; Thoracic (Pro Cah)Professional Component ",,72157,CPT,Professional,Both,,,26,1175,998.75,69.15,1175,UnitedHealthcare,Medicare Advantage,123.7285,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Mri Spinal Canal Contents, W/O Contrast, Followed By Contrast Further Sequences; Thoracic (Pro Cah)Professional Component ",,72157,CPT,Professional,Both,,,26,1175,998.75,69.15,1175,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,79.83728,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Mri Lumbar Spine W/O And W/Contrast (Pro Cah)Professional Component ,,72158,CPT,Professional,Both,,,26,1230,1045.5,69.15,1230,Aetna,Commercial,1045.5,85,,percent of total billed charges,,
Mri Lumbar Spine W/O And W/Contrast (Pro Cah)Professional Component ,,72158,CPT,Professional,Both,,,26,1230,1045.5,69.15,1230,Aetna,Medicare Advantage,110.6,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Mri Lumbar Spine W/O And W/Contrast (Pro Cah)Professional Component ,,72158,CPT,Professional,Both,,,26,1230,1045.5,69.15,1230,Aetna,PPO,1143.9,93,,percent of total billed charges,,
Mri Lumbar Spine W/O And W/Contrast (Pro Cah)Professional Component ,,72158,CPT,Professional,Both,,,26,1230,1045.5,69.15,1230,America's PPO,America's PPO,1050.912,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Mri Lumbar Spine W/O And W/Contrast (Pro Cah)Professional Component ,,72158,CPT,Professional,Both,,,26,1230,1045.5,69.15,1230,BlueCross BlueShield Minnesota, Federal Employee Program,207.1,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Mri Lumbar Spine W/O And W/Contrast (Pro Cah)Professional Component ,,72158,CPT,Professional,Both,,,26,1230,1045.5,69.15,1230,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,210.4136,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Mri Lumbar Spine W/O And W/Contrast (Pro Cah)Professional Component ,,72158,CPT,Professional,Both,,,26,1230,1045.5,69.15,1230,BlueCross BlueShield Minnesota,High Value Network Plan,210.4136,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Mri Lumbar Spine W/O And W/Contrast (Pro Cah)Professional Component ,,72158,CPT,Professional,Both,,,26,1230,1045.5,69.15,1230,BlueCross BlueShield Minnesota,Medicare Advantage,123.7285,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Mri Lumbar Spine W/O And W/Contrast (Pro Cah)Professional Component ,,72158,CPT,Professional,Both,,,26,1230,1045.5,69.15,1230,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,210.4136,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Mri Lumbar Spine W/O And W/Contrast (Pro Cah)Professional Component ,,72158,CPT,Professional,Both,,,26,1230,1045.5,69.15,1230,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,79.83728,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Mri Lumbar Spine W/O And W/Contrast (Pro Cah)Professional Component ,,72158,CPT,Professional,Both,,,26,1230,1045.5,69.15,1230,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),123.7285,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Mri Lumbar Spine W/O And W/Contrast (Pro Cah)Professional Component ,,72158,CPT,Professional,Both,,,26,1230,1045.5,69.15,1230,CorVel,Worker's Compensation,212.2229433,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Mri Lumbar Spine W/O And W/Contrast (Pro Cah)Professional Component ,,72158,CPT,Professional,Both,,,26,1230,1045.5,69.15,1230,First Health Group Corporation,First Health Network,1193.1,97,,percent of total billed charges,,
Mri Lumbar Spine W/O And W/Contrast (Pro Cah)Professional Component ,,72158,CPT,Professional,Both,,,26,1230,1045.5,69.15,1230,"Health Partners, Inc.",Commercial,162.94,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Mri Lumbar Spine W/O And W/Contrast (Pro Cah)Professional Component ,,72158,CPT,Professional,Both,,,26,1230,1045.5,69.15,1230,"Health Partners, Inc.",Medicare Advantage,123.7285,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Mri Lumbar Spine W/O And W/Contrast (Pro Cah)Professional Component ,,72158,CPT,Professional,Both,,,26,1230,1045.5,69.15,1230,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),69.15,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Mri Lumbar Spine W/O And W/Contrast (Pro Cah)Professional Component ,,72158,CPT,Professional,Both,,,26,1230,1045.5,69.15,1230,"Health Partners, Inc.",State of Minnesota Advantage Program,140.37281,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Mri Lumbar Spine W/O And W/Contrast (Pro Cah)Professional Component ,,72158,CPT,Professional,Both,,,26,1230,1045.5,69.15,1230,"Health Partners, Inc.",State Public Programs,69.15,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Mri Lumbar Spine W/O And W/Contrast (Pro Cah)Professional Component ,,72158,CPT,Professional,Both,,,26,1230,1045.5,69.15,1230,Humana Insurance Company,Commercial PPO,107.59,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Mri Lumbar Spine W/O And W/Contrast (Pro Cah)Professional Component ,,72158,CPT,Professional,Both,,,26,1230,1045.5,69.15,1230,Humana Insurance Company,Medicare PPO,1230,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Mri Lumbar Spine W/O And W/Contrast (Pro Cah)Professional Component ,,72158,CPT,Professional,Both,,,26,1230,1045.5,69.15,1230,Medica,Individual & Family,1043.04,84.8,,percent of total billed charges,,
Mri Lumbar Spine W/O And W/Contrast (Pro Cah)Professional Component ,,72158,CPT,Professional,Both,,,26,1230,1045.5,69.15,1230,Medica,Medica Advantage Solution,612.54,49.8,,percent of total billed charges,,
Mri Lumbar Spine W/O And W/Contrast (Pro Cah)Professional Component ,,72158,CPT,Professional,Both,,,26,1230,1045.5,69.15,1230,Medica,Medical Assistance,79.84,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Mri Lumbar Spine W/O And W/Contrast (Pro Cah)Professional Component ,,72158,CPT,Professional,Both,,,26,1230,1045.5,69.15,1230,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,107.59,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Mri Lumbar Spine W/O And W/Contrast (Pro Cah)Professional Component ,,72158,CPT,Professional,Both,,,26,1230,1045.5,69.15,1230,"Multiplan, Inc.","Multiplan, Inc.",1156.2,94,,percent of total billed charges,,
Mri Lumbar Spine W/O And W/Contrast (Pro Cah)Professional Component ,,72158,CPT,Professional,Both,,,26,1230,1045.5,69.15,1230,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1108.23,90.1,,percent of total billed charges,,
Mri Lumbar Spine W/O And W/Contrast (Pro Cah)Professional Component ,,72158,CPT,Professional,Both,,,26,1230,1045.5,69.15,1230,"Preferred One Administrative Services, INC.",PPO,1212.78,98.6,,percent of total billed charges,,
Mri Lumbar Spine W/O And W/Contrast (Pro Cah)Professional Component ,,72158,CPT,Professional,Both,,,26,1230,1045.5,69.15,1230,PrimeWest Health,Minnesota Senior Health Options (MSHO),123.7285,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Mri Lumbar Spine W/O And W/Contrast (Pro Cah)Professional Component ,,72158,CPT,Professional,Both,,,26,1230,1045.5,69.15,1230,PrimeWest Health,MinnesotaCare,85.4258896,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Mri Lumbar Spine W/O And W/Contrast (Pro Cah)Professional Component ,,72158,CPT,Professional,Both,,,26,1230,1045.5,69.15,1230,Sanford Health Plan,Sanford Health Plan,1082.4,88,,percent of total billed charges,,
Mri Lumbar Spine W/O And W/Contrast (Pro Cah)Professional Component ,,72158,CPT,Professional,Both,,,26,1230,1045.5,69.15,1230,"UCare Health, Inc.",Individual & Family Plan,174.898304,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Mri Lumbar Spine W/O And W/Contrast (Pro Cah)Professional Component ,,72158,CPT,Professional,Both,,,26,1230,1045.5,69.15,1230,"UCare Health, Inc.",Medical Assistance,87.821008,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Mri Lumbar Spine W/O And W/Contrast (Pro Cah)Professional Component ,,72158,CPT,Professional,Both,,,26,1230,1045.5,69.15,1230,"UCare Health, Inc.",Medicare Advantage,123.7285,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Mri Lumbar Spine W/O And W/Contrast (Pro Cah)Professional Component ,,72158,CPT,Professional,Both,,,26,1230,1045.5,69.15,1230,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),98.9828,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Mri Lumbar Spine W/O And W/Contrast (Pro Cah)Professional Component ,,72158,CPT,Professional,Both,,,26,1230,1045.5,69.15,1230,UnitedHealthcare,Individual & Family,1230,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Mri Lumbar Spine W/O And W/Contrast (Pro Cah)Professional Component ,,72158,CPT,Professional,Both,,,26,1230,1045.5,69.15,1230,UnitedHealthcare,Medicare Advantage,123.7285,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Mri Lumbar Spine W/O And W/Contrast (Pro Cah)Professional Component ,,72158,CPT,Professional,Both,,,26,1230,1045.5,69.15,1230,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,79.83728,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Pelvis Routine 1 Or 2 Views (Pro Cah)Professional Component ,,72170,CPT,Professional,Both,,,26,50,42.5,5.23,50,Aetna,Commercial,42.5,85,,percent of total billed charges,,
Xr Pelvis Routine 1 Or 2 Views (Pro Cah)Professional Component ,,72170,CPT,Professional,Both,,,26,50,42.5,5.23,50,Aetna,Medicare Advantage,8.53,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Pelvis Routine 1 Or 2 Views (Pro Cah)Professional Component ,,72170,CPT,Professional,Both,,,26,50,42.5,5.23,50,Aetna,PPO,46.5,93,,percent of total billed charges,,
Xr Pelvis Routine 1 Or 2 Views (Pro Cah)Professional Component ,,72170,CPT,Professional,Both,,,26,50,42.5,5.23,50,America's PPO,America's PPO,42.72,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Xr Pelvis Routine 1 Or 2 Views (Pro Cah)Professional Component ,,72170,CPT,Professional,Both,,,26,50,42.5,5.23,50,BlueCross BlueShield Minnesota, Federal Employee Program,15.98,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Xr Pelvis Routine 1 Or 2 Views (Pro Cah)Professional Component ,,72170,CPT,Professional,Both,,,26,50,42.5,5.23,50,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,16.23568,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Pelvis Routine 1 Or 2 Views (Pro Cah)Professional Component ,,72170,CPT,Professional,Both,,,26,50,42.5,5.23,50,BlueCross BlueShield Minnesota,High Value Network Plan,16.23568,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Pelvis Routine 1 Or 2 Views (Pro Cah)Professional Component ,,72170,CPT,Professional,Both,,,26,50,42.5,5.23,50,BlueCross BlueShield Minnesota,Medicare Advantage,9.5335,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Pelvis Routine 1 Or 2 Views (Pro Cah)Professional Component ,,72170,CPT,Professional,Both,,,26,50,42.5,5.23,50,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,16.23568,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Pelvis Routine 1 Or 2 Views (Pro Cah)Professional Component ,,72170,CPT,Professional,Both,,,26,50,42.5,5.23,50,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,6.03504,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Pelvis Routine 1 Or 2 Views (Pro Cah)Professional Component ,,72170,CPT,Professional,Both,,,26,50,42.5,5.23,50,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),9.5335,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Pelvis Routine 1 Or 2 Views (Pro Cah)Professional Component ,,72170,CPT,Professional,Both,,,26,50,42.5,5.23,50,CorVel,Worker's Compensation,16.4190348,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Xr Pelvis Routine 1 Or 2 Views (Pro Cah)Professional Component ,,72170,CPT,Professional,Both,,,26,50,42.5,5.23,50,First Health Group Corporation,First Health Network,48.5,97,,percent of total billed charges,,
Xr Pelvis Routine 1 Or 2 Views (Pro Cah)Professional Component ,,72170,CPT,Professional,Both,,,26,50,42.5,5.23,50,"Health Partners, Inc.",Commercial,12.37,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Xr Pelvis Routine 1 Or 2 Views (Pro Cah)Professional Component ,,72170,CPT,Professional,Both,,,26,50,42.5,5.23,50,"Health Partners, Inc.",Medicare Advantage,9.5335,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Pelvis Routine 1 Or 2 Views (Pro Cah)Professional Component ,,72170,CPT,Professional,Both,,,26,50,42.5,5.23,50,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),5.23,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Xr Pelvis Routine 1 Or 2 Views (Pro Cah)Professional Component ,,72170,CPT,Professional,Both,,,26,50,42.5,5.23,50,"Health Partners, Inc.",State of Minnesota Advantage Program,10.656755,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Xr Pelvis Routine 1 Or 2 Views (Pro Cah)Professional Component ,,72170,CPT,Professional,Both,,,26,50,42.5,5.23,50,"Health Partners, Inc.",State Public Programs,5.23,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Xr Pelvis Routine 1 Or 2 Views (Pro Cah)Professional Component ,,72170,CPT,Professional,Both,,,26,50,42.5,5.23,50,Humana Insurance Company,Commercial PPO,8.29,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Xr Pelvis Routine 1 Or 2 Views (Pro Cah)Professional Component ,,72170,CPT,Professional,Both,,,26,50,42.5,5.23,50,Humana Insurance Company,Medicare PPO,50,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Xr Pelvis Routine 1 Or 2 Views (Pro Cah)Professional Component ,,72170,CPT,Professional,Both,,,26,50,42.5,5.23,50,Medica,Individual & Family,42.4,84.8,,percent of total billed charges,,
Xr Pelvis Routine 1 Or 2 Views (Pro Cah)Professional Component ,,72170,CPT,Professional,Both,,,26,50,42.5,5.23,50,Medica,Medica Advantage Solution,24.9,49.8,,percent of total billed charges,,
Xr Pelvis Routine 1 Or 2 Views (Pro Cah)Professional Component ,,72170,CPT,Professional,Both,,,26,50,42.5,5.23,50,Medica,Medical Assistance,6.04,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Xr Pelvis Routine 1 Or 2 Views (Pro Cah)Professional Component ,,72170,CPT,Professional,Both,,,26,50,42.5,5.23,50,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,8.29,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Xr Pelvis Routine 1 Or 2 Views (Pro Cah)Professional Component ,,72170,CPT,Professional,Both,,,26,50,42.5,5.23,50,"Multiplan, Inc.","Multiplan, Inc.",47,94,,percent of total billed charges,,
Xr Pelvis Routine 1 Or 2 Views (Pro Cah)Professional Component ,,72170,CPT,Professional,Both,,,26,50,42.5,5.23,50,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,45.05,90.1,,percent of total billed charges,,
Xr Pelvis Routine 1 Or 2 Views (Pro Cah)Professional Component ,,72170,CPT,Professional,Both,,,26,50,42.5,5.23,50,"Preferred One Administrative Services, INC.",PPO,49.3,98.6,,percent of total billed charges,,
Xr Pelvis Routine 1 Or 2 Views (Pro Cah)Professional Component ,,72170,CPT,Professional,Both,,,26,50,42.5,5.23,50,PrimeWest Health,Minnesota Senior Health Options (MSHO),9.5335,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Pelvis Routine 1 Or 2 Views (Pro Cah)Professional Component ,,72170,CPT,Professional,Both,,,26,50,42.5,5.23,50,PrimeWest Health,MinnesotaCare,6.4574928,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Pelvis Routine 1 Or 2 Views (Pro Cah)Professional Component ,,72170,CPT,Professional,Both,,,26,50,42.5,5.23,50,Sanford Health Plan,Sanford Health Plan,44,88,,percent of total billed charges,,
Xr Pelvis Routine 1 Or 2 Views (Pro Cah)Professional Component ,,72170,CPT,Professional,Both,,,26,50,42.5,5.23,50,"UCare Health, Inc.",Individual & Family Plan,13.476224,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Xr Pelvis Routine 1 Or 2 Views (Pro Cah)Professional Component ,,72170,CPT,Professional,Both,,,26,50,42.5,5.23,50,"UCare Health, Inc.",Medical Assistance,6.638544,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Xr Pelvis Routine 1 Or 2 Views (Pro Cah)Professional Component ,,72170,CPT,Professional,Both,,,26,50,42.5,5.23,50,"UCare Health, Inc.",Medicare Advantage,9.5335,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Xr Pelvis Routine 1 Or 2 Views (Pro Cah)Professional Component ,,72170,CPT,Professional,Both,,,26,50,42.5,5.23,50,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),7.6268,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Xr Pelvis Routine 1 Or 2 Views (Pro Cah)Professional Component ,,72170,CPT,Professional,Both,,,26,50,42.5,5.23,50,UnitedHealthcare,Individual & Family,50,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Xr Pelvis Routine 1 Or 2 Views (Pro Cah)Professional Component ,,72170,CPT,Professional,Both,,,26,50,42.5,5.23,50,UnitedHealthcare,Medicare Advantage,9.5335,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Pelvis Routine 1 Or 2 Views (Pro Cah)Professional Component ,,72170,CPT,Professional,Both,,,26,50,42.5,5.23,50,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,6.03504,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Ct Pelvis Wo Iv Contrast (Pro Cah)Professional Component ,,72192,CPT,Professional,Both,,,26,470,399.5,32.72,470,Aetna,Commercial,399.5,85,,percent of total billed charges,,
Ct Pelvis Wo Iv Contrast (Pro Cah)Professional Component ,,72192,CPT,Professional,Both,,,26,470,399.5,32.72,470,Aetna,Medicare Advantage,52.43,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Pelvis Wo Iv Contrast (Pro Cah)Professional Component ,,72192,CPT,Professional,Both,,,26,470,399.5,32.72,470,Aetna,PPO,437.1,93,,percent of total billed charges,,
Ct Pelvis Wo Iv Contrast (Pro Cah)Professional Component ,,72192,CPT,Professional,Both,,,26,470,399.5,32.72,470,America's PPO,America's PPO,401.568,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Ct Pelvis Wo Iv Contrast (Pro Cah)Professional Component ,,72192,CPT,Professional,Both,,,26,470,399.5,32.72,470,BlueCross BlueShield Minnesota, Federal Employee Program,98.44,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Ct Pelvis Wo Iv Contrast (Pro Cah)Professional Component ,,72192,CPT,Professional,Both,,,26,470,399.5,32.72,470,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,100.01504,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Ct Pelvis Wo Iv Contrast (Pro Cah)Professional Component ,,72192,CPT,Professional,Both,,,26,470,399.5,32.72,470,BlueCross BlueShield Minnesota,High Value Network Plan,100.01504,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Ct Pelvis Wo Iv Contrast (Pro Cah)Professional Component ,,72192,CPT,Professional,Both,,,26,470,399.5,32.72,470,BlueCross BlueShield Minnesota,Medicare Advantage,58.7305,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Pelvis Wo Iv Contrast (Pro Cah)Professional Component ,,72192,CPT,Professional,Both,,,26,470,399.5,32.72,470,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,100.01504,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Ct Pelvis Wo Iv Contrast (Pro Cah)Professional Component ,,72192,CPT,Professional,Both,,,26,470,399.5,32.72,470,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,37.77488,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Ct Pelvis Wo Iv Contrast (Pro Cah)Professional Component ,,72192,CPT,Professional,Both,,,26,470,399.5,32.72,470,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),58.7305,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Pelvis Wo Iv Contrast (Pro Cah)Professional Component ,,72192,CPT,Professional,Both,,,26,470,399.5,32.72,470,CorVel,Worker's Compensation,100.9377024,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Ct Pelvis Wo Iv Contrast (Pro Cah)Professional Component ,,72192,CPT,Professional,Both,,,26,470,399.5,32.72,470,First Health Group Corporation,First Health Network,455.9,97,,percent of total billed charges,,
Ct Pelvis Wo Iv Contrast (Pro Cah)Professional Component ,,72192,CPT,Professional,Both,,,26,470,399.5,32.72,470,"Health Partners, Inc.",Commercial,77.86,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Ct Pelvis Wo Iv Contrast (Pro Cah)Professional Component ,,72192,CPT,Professional,Both,,,26,470,399.5,32.72,470,"Health Partners, Inc.",Medicare Advantage,58.7305,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Pelvis Wo Iv Contrast (Pro Cah)Professional Component ,,72192,CPT,Professional,Both,,,26,470,399.5,32.72,470,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),32.72,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Ct Pelvis Wo Iv Contrast (Pro Cah)Professional Component ,,72192,CPT,Professional,Both,,,26,470,399.5,32.72,470,"Health Partners, Inc.",State of Minnesota Advantage Program,67.07639,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Ct Pelvis Wo Iv Contrast (Pro Cah)Professional Component ,,72192,CPT,Professional,Both,,,26,470,399.5,32.72,470,"Health Partners, Inc.",State Public Programs,32.72,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Ct Pelvis Wo Iv Contrast (Pro Cah)Professional Component ,,72192,CPT,Professional,Both,,,26,470,399.5,32.72,470,Humana Insurance Company,Commercial PPO,51.07,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Ct Pelvis Wo Iv Contrast (Pro Cah)Professional Component ,,72192,CPT,Professional,Both,,,26,470,399.5,32.72,470,Humana Insurance Company,Medicare PPO,470,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Ct Pelvis Wo Iv Contrast (Pro Cah)Professional Component ,,72192,CPT,Professional,Both,,,26,470,399.5,32.72,470,Medica,Individual & Family,398.56,84.8,,percent of total billed charges,,
Ct Pelvis Wo Iv Contrast (Pro Cah)Professional Component ,,72192,CPT,Professional,Both,,,26,470,399.5,32.72,470,Medica,Medica Advantage Solution,234.06,49.8,,percent of total billed charges,,
Ct Pelvis Wo Iv Contrast (Pro Cah)Professional Component ,,72192,CPT,Professional,Both,,,26,470,399.5,32.72,470,Medica,Medical Assistance,37.77,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Ct Pelvis Wo Iv Contrast (Pro Cah)Professional Component ,,72192,CPT,Professional,Both,,,26,470,399.5,32.72,470,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,51.07,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Ct Pelvis Wo Iv Contrast (Pro Cah)Professional Component ,,72192,CPT,Professional,Both,,,26,470,399.5,32.72,470,"Multiplan, Inc.","Multiplan, Inc.",441.8,94,,percent of total billed charges,,
Ct Pelvis Wo Iv Contrast (Pro Cah)Professional Component ,,72192,CPT,Professional,Both,,,26,470,399.5,32.72,470,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,423.47,90.1,,percent of total billed charges,,
Ct Pelvis Wo Iv Contrast (Pro Cah)Professional Component ,,72192,CPT,Professional,Both,,,26,470,399.5,32.72,470,"Preferred One Administrative Services, INC.",PPO,463.42,98.6,,percent of total billed charges,,
Ct Pelvis Wo Iv Contrast (Pro Cah)Professional Component ,,72192,CPT,Professional,Both,,,26,470,399.5,32.72,470,PrimeWest Health,Minnesota Senior Health Options (MSHO),58.7305,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Pelvis Wo Iv Contrast (Pro Cah)Professional Component ,,72192,CPT,Professional,Both,,,26,470,399.5,32.72,470,PrimeWest Health,MinnesotaCare,40.4191216,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Ct Pelvis Wo Iv Contrast (Pro Cah)Professional Component ,,72192,CPT,Professional,Both,,,26,470,399.5,32.72,470,Sanford Health Plan,Sanford Health Plan,413.6,88,,percent of total billed charges,,
Ct Pelvis Wo Iv Contrast (Pro Cah)Professional Component ,,72192,CPT,Professional,Both,,,26,470,399.5,32.72,470,"UCare Health, Inc.",Individual & Family Plan,83.019392,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Ct Pelvis Wo Iv Contrast (Pro Cah)Professional Component ,,72192,CPT,Professional,Both,,,26,470,399.5,32.72,470,"UCare Health, Inc.",Medical Assistance,41.552368,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Ct Pelvis Wo Iv Contrast (Pro Cah)Professional Component ,,72192,CPT,Professional,Both,,,26,470,399.5,32.72,470,"UCare Health, Inc.",Medicare Advantage,58.7305,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Ct Pelvis Wo Iv Contrast (Pro Cah)Professional Component ,,72192,CPT,Professional,Both,,,26,470,399.5,32.72,470,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),46.9844,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Ct Pelvis Wo Iv Contrast (Pro Cah)Professional Component ,,72192,CPT,Professional,Both,,,26,470,399.5,32.72,470,UnitedHealthcare,Individual & Family,470,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Ct Pelvis Wo Iv Contrast (Pro Cah)Professional Component ,,72192,CPT,Professional,Both,,,26,470,399.5,32.72,470,UnitedHealthcare,Medicare Advantage,58.7305,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Pelvis Wo Iv Contrast (Pro Cah)Professional Component ,,72192,CPT,Professional,Both,,,26,470,399.5,32.72,470,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,37.77488,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Ct Pelvis W Iv Contrast (Pro Cah)Professional Component ,,72193,CPT,Professional,Both,,,26,337,286.45,34.9,337,Aetna,Commercial,286.45,85,,percent of total billed charges,,
Ct Pelvis W Iv Contrast (Pro Cah)Professional Component ,,72193,CPT,Professional,Both,,,26,337,286.45,34.9,337,Aetna,Medicare Advantage,55.94,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Pelvis W Iv Contrast (Pro Cah)Professional Component ,,72193,CPT,Professional,Both,,,26,337,286.45,34.9,337,Aetna,PPO,313.41,93,,percent of total billed charges,,
Ct Pelvis W Iv Contrast (Pro Cah)Professional Component ,,72193,CPT,Professional,Both,,,26,337,286.45,34.9,337,America's PPO,America's PPO,287.9328,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Ct Pelvis W Iv Contrast (Pro Cah)Professional Component ,,72193,CPT,Professional,Both,,,26,337,286.45,34.9,337,BlueCross BlueShield Minnesota, Federal Employee Program,104.83,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Ct Pelvis W Iv Contrast (Pro Cah)Professional Component ,,72193,CPT,Professional,Both,,,26,337,286.45,34.9,337,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,106.50728,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Ct Pelvis W Iv Contrast (Pro Cah)Professional Component ,,72193,CPT,Professional,Both,,,26,337,286.45,34.9,337,BlueCross BlueShield Minnesota,High Value Network Plan,106.50728,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Ct Pelvis W Iv Contrast (Pro Cah)Professional Component ,,72193,CPT,Professional,Both,,,26,337,286.45,34.9,337,BlueCross BlueShield Minnesota,Medicare Advantage,62.652,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Pelvis W Iv Contrast (Pro Cah)Professional Component ,,72193,CPT,Professional,Both,,,26,337,286.45,34.9,337,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,106.50728,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Ct Pelvis W Iv Contrast (Pro Cah)Professional Component ,,72193,CPT,Professional,Both,,,26,337,286.45,34.9,337,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,40.29456,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Ct Pelvis W Iv Contrast (Pro Cah)Professional Component ,,72193,CPT,Professional,Both,,,26,337,286.45,34.9,337,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),62.652,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Pelvis W Iv Contrast (Pro Cah)Professional Component ,,72193,CPT,Professional,Both,,,26,337,286.45,34.9,337,CorVel,Worker's Compensation,107.6808987,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Ct Pelvis W Iv Contrast (Pro Cah)Professional Component ,,72193,CPT,Professional,Both,,,26,337,286.45,34.9,337,First Health Group Corporation,First Health Network,326.89,97,,percent of total billed charges,,
Ct Pelvis W Iv Contrast (Pro Cah)Professional Component ,,72193,CPT,Professional,Both,,,26,337,286.45,34.9,337,"Health Partners, Inc.",Commercial,83.02,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Ct Pelvis W Iv Contrast (Pro Cah)Professional Component ,,72193,CPT,Professional,Both,,,26,337,286.45,34.9,337,"Health Partners, Inc.",Medicare Advantage,62.652,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Pelvis W Iv Contrast (Pro Cah)Professional Component ,,72193,CPT,Professional,Both,,,26,337,286.45,34.9,337,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),34.9,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Ct Pelvis W Iv Contrast (Pro Cah)Professional Component ,,72193,CPT,Professional,Both,,,26,337,286.45,34.9,337,"Health Partners, Inc.",State of Minnesota Advantage Program,71.52173,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Ct Pelvis W Iv Contrast (Pro Cah)Professional Component ,,72193,CPT,Professional,Both,,,26,337,286.45,34.9,337,"Health Partners, Inc.",State Public Programs,34.9,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Ct Pelvis W Iv Contrast (Pro Cah)Professional Component ,,72193,CPT,Professional,Both,,,26,337,286.45,34.9,337,Humana Insurance Company,Commercial PPO,54.48,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Ct Pelvis W Iv Contrast (Pro Cah)Professional Component ,,72193,CPT,Professional,Both,,,26,337,286.45,34.9,337,Humana Insurance Company,Medicare PPO,337,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Ct Pelvis W Iv Contrast (Pro Cah)Professional Component ,,72193,CPT,Professional,Both,,,26,337,286.45,34.9,337,Medica,Individual & Family,285.776,84.8,,percent of total billed charges,,
Ct Pelvis W Iv Contrast (Pro Cah)Professional Component ,,72193,CPT,Professional,Both,,,26,337,286.45,34.9,337,Medica,Medica Advantage Solution,167.826,49.8,,percent of total billed charges,,
Ct Pelvis W Iv Contrast (Pro Cah)Professional Component ,,72193,CPT,Professional,Both,,,26,337,286.45,34.9,337,Medica,Medical Assistance,40.29,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Ct Pelvis W Iv Contrast (Pro Cah)Professional Component ,,72193,CPT,Professional,Both,,,26,337,286.45,34.9,337,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,54.48,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Ct Pelvis W Iv Contrast (Pro Cah)Professional Component ,,72193,CPT,Professional,Both,,,26,337,286.45,34.9,337,"Multiplan, Inc.","Multiplan, Inc.",316.78,94,,percent of total billed charges,,
Ct Pelvis W Iv Contrast (Pro Cah)Professional Component ,,72193,CPT,Professional,Both,,,26,337,286.45,34.9,337,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,303.637,90.1,,percent of total billed charges,,
Ct Pelvis W Iv Contrast (Pro Cah)Professional Component ,,72193,CPT,Professional,Both,,,26,337,286.45,34.9,337,"Preferred One Administrative Services, INC.",PPO,332.282,98.6,,percent of total billed charges,,
Ct Pelvis W Iv Contrast (Pro Cah)Professional Component ,,72193,CPT,Professional,Both,,,26,337,286.45,34.9,337,PrimeWest Health,Minnesota Senior Health Options (MSHO),62.652,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Pelvis W Iv Contrast (Pro Cah)Professional Component ,,72193,CPT,Professional,Both,,,26,337,286.45,34.9,337,PrimeWest Health,MinnesotaCare,43.1151792,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Ct Pelvis W Iv Contrast (Pro Cah)Professional Component ,,72193,CPT,Professional,Both,,,26,337,286.45,34.9,337,Sanford Health Plan,Sanford Health Plan,296.56,88,,percent of total billed charges,,
Ct Pelvis W Iv Contrast (Pro Cah)Professional Component ,,72193,CPT,Professional,Both,,,26,337,286.45,34.9,337,"UCare Health, Inc.",Individual & Family Plan,88.562688,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Ct Pelvis W Iv Contrast (Pro Cah)Professional Component ,,72193,CPT,Professional,Both,,,26,337,286.45,34.9,337,"UCare Health, Inc.",Medical Assistance,44.324016,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Ct Pelvis W Iv Contrast (Pro Cah)Professional Component ,,72193,CPT,Professional,Both,,,26,337,286.45,34.9,337,"UCare Health, Inc.",Medicare Advantage,62.652,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Ct Pelvis W Iv Contrast (Pro Cah)Professional Component ,,72193,CPT,Professional,Both,,,26,337,286.45,34.9,337,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),50.1216,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Ct Pelvis W Iv Contrast (Pro Cah)Professional Component ,,72193,CPT,Professional,Both,,,26,337,286.45,34.9,337,UnitedHealthcare,Individual & Family,337,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Ct Pelvis W Iv Contrast (Pro Cah)Professional Component ,,72193,CPT,Professional,Both,,,26,337,286.45,34.9,337,UnitedHealthcare,Medicare Advantage,62.652,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Pelvis W Iv Contrast (Pro Cah)Professional Component ,,72193,CPT,Professional,Both,,,26,337,286.45,34.9,337,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,40.29456,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Ct Pelvis Wo W Iv Contrast (Pro Cah)Professional Component ,,72194,CPT,Professional,Both,,,26,426,362.1,36.64,426,Aetna,Commercial,362.1,85,,percent of total billed charges,,
Ct Pelvis Wo W Iv Contrast (Pro Cah)Professional Component ,,72194,CPT,Professional,Both,,,26,426,362.1,36.64,426,Aetna,Medicare Advantage,58.74,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Pelvis Wo W Iv Contrast (Pro Cah)Professional Component ,,72194,CPT,Professional,Both,,,26,426,362.1,36.64,426,Aetna,PPO,396.18,93,,percent of total billed charges,,
Ct Pelvis Wo W Iv Contrast (Pro Cah)Professional Component ,,72194,CPT,Professional,Both,,,26,426,362.1,36.64,426,America's PPO,America's PPO,363.9744,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Ct Pelvis Wo W Iv Contrast (Pro Cah)Professional Component ,,72194,CPT,Professional,Both,,,26,426,362.1,36.64,426,BlueCross BlueShield Minnesota, Federal Employee Program,109.94,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Ct Pelvis Wo W Iv Contrast (Pro Cah)Professional Component ,,72194,CPT,Professional,Both,,,26,426,362.1,36.64,426,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,111.69904,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Ct Pelvis Wo W Iv Contrast (Pro Cah)Professional Component ,,72194,CPT,Professional,Both,,,26,426,362.1,36.64,426,BlueCross BlueShield Minnesota,High Value Network Plan,111.69904,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Ct Pelvis Wo W Iv Contrast (Pro Cah)Professional Component ,,72194,CPT,Professional,Both,,,26,426,362.1,36.64,426,BlueCross BlueShield Minnesota,Medicare Advantage,65.78,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Pelvis Wo W Iv Contrast (Pro Cah)Professional Component ,,72194,CPT,Professional,Both,,,26,426,362.1,36.64,426,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,111.69904,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Ct Pelvis Wo W Iv Contrast (Pro Cah)Professional Component ,,72194,CPT,Professional,Both,,,26,426,362.1,36.64,426,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,42.30624,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Ct Pelvis Wo W Iv Contrast (Pro Cah)Professional Component ,,72194,CPT,Professional,Both,,,26,426,362.1,36.64,426,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),65.78,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Pelvis Wo W Iv Contrast (Pro Cah)Professional Component ,,72194,CPT,Professional,Both,,,26,426,362.1,36.64,426,CorVel,Worker's Compensation,112.865751,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Ct Pelvis Wo W Iv Contrast (Pro Cah)Professional Component ,,72194,CPT,Professional,Both,,,26,426,362.1,36.64,426,First Health Group Corporation,First Health Network,413.22,97,,percent of total billed charges,,
Ct Pelvis Wo W Iv Contrast (Pro Cah)Professional Component ,,72194,CPT,Professional,Both,,,26,426,362.1,36.64,426,"Health Partners, Inc.",Commercial,86.62,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Ct Pelvis Wo W Iv Contrast (Pro Cah)Professional Component ,,72194,CPT,Professional,Both,,,26,426,362.1,36.64,426,"Health Partners, Inc.",Medicare Advantage,65.78,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Pelvis Wo W Iv Contrast (Pro Cah)Professional Component ,,72194,CPT,Professional,Both,,,26,426,362.1,36.64,426,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),36.64,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Ct Pelvis Wo W Iv Contrast (Pro Cah)Professional Component ,,72194,CPT,Professional,Both,,,26,426,362.1,36.64,426,"Health Partners, Inc.",State of Minnesota Advantage Program,74.62313,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Ct Pelvis Wo W Iv Contrast (Pro Cah)Professional Component ,,72194,CPT,Professional,Both,,,26,426,362.1,36.64,426,"Health Partners, Inc.",State Public Programs,36.64,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Ct Pelvis Wo W Iv Contrast (Pro Cah)Professional Component ,,72194,CPT,Professional,Both,,,26,426,362.1,36.64,426,Humana Insurance Company,Commercial PPO,57.2,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Ct Pelvis Wo W Iv Contrast (Pro Cah)Professional Component ,,72194,CPT,Professional,Both,,,26,426,362.1,36.64,426,Humana Insurance Company,Medicare PPO,426,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Ct Pelvis Wo W Iv Contrast (Pro Cah)Professional Component ,,72194,CPT,Professional,Both,,,26,426,362.1,36.64,426,Medica,Individual & Family,361.248,84.8,,percent of total billed charges,,
Ct Pelvis Wo W Iv Contrast (Pro Cah)Professional Component ,,72194,CPT,Professional,Both,,,26,426,362.1,36.64,426,Medica,Medica Advantage Solution,212.148,49.8,,percent of total billed charges,,
Ct Pelvis Wo W Iv Contrast (Pro Cah)Professional Component ,,72194,CPT,Professional,Both,,,26,426,362.1,36.64,426,Medica,Medical Assistance,42.31,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Ct Pelvis Wo W Iv Contrast (Pro Cah)Professional Component ,,72194,CPT,Professional,Both,,,26,426,362.1,36.64,426,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,57.2,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Ct Pelvis Wo W Iv Contrast (Pro Cah)Professional Component ,,72194,CPT,Professional,Both,,,26,426,362.1,36.64,426,"Multiplan, Inc.","Multiplan, Inc.",400.44,94,,percent of total billed charges,,
Ct Pelvis Wo W Iv Contrast (Pro Cah)Professional Component ,,72194,CPT,Professional,Both,,,26,426,362.1,36.64,426,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,383.826,90.1,,percent of total billed charges,,
Ct Pelvis Wo W Iv Contrast (Pro Cah)Professional Component ,,72194,CPT,Professional,Both,,,26,426,362.1,36.64,426,"Preferred One Administrative Services, INC.",PPO,420.036,98.6,,percent of total billed charges,,
Ct Pelvis Wo W Iv Contrast (Pro Cah)Professional Component ,,72194,CPT,Professional,Both,,,26,426,362.1,36.64,426,PrimeWest Health,Minnesota Senior Health Options (MSHO),65.78,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Pelvis Wo W Iv Contrast (Pro Cah)Professional Component ,,72194,CPT,Professional,Both,,,26,426,362.1,36.64,426,PrimeWest Health,MinnesotaCare,45.2676768,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Ct Pelvis Wo W Iv Contrast (Pro Cah)Professional Component ,,72194,CPT,Professional,Both,,,26,426,362.1,36.64,426,Sanford Health Plan,Sanford Health Plan,374.88,88,,percent of total billed charges,,
Ct Pelvis Wo W Iv Contrast (Pro Cah)Professional Component ,,72194,CPT,Professional,Both,,,26,426,362.1,36.64,426,"UCare Health, Inc.",Individual & Family Plan,92.98432,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Ct Pelvis Wo W Iv Contrast (Pro Cah)Professional Component ,,72194,CPT,Professional,Both,,,26,426,362.1,36.64,426,"UCare Health, Inc.",Medical Assistance,46.536864,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Ct Pelvis Wo W Iv Contrast (Pro Cah)Professional Component ,,72194,CPT,Professional,Both,,,26,426,362.1,36.64,426,"UCare Health, Inc.",Medicare Advantage,65.78,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Ct Pelvis Wo W Iv Contrast (Pro Cah)Professional Component ,,72194,CPT,Professional,Both,,,26,426,362.1,36.64,426,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),52.624,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Ct Pelvis Wo W Iv Contrast (Pro Cah)Professional Component ,,72194,CPT,Professional,Both,,,26,426,362.1,36.64,426,UnitedHealthcare,Individual & Family,426,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Ct Pelvis Wo W Iv Contrast (Pro Cah)Professional Component ,,72194,CPT,Professional,Both,,,26,426,362.1,36.64,426,UnitedHealthcare,Medicare Advantage,65.78,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Pelvis Wo W Iv Contrast (Pro Cah)Professional Component ,,72194,CPT,Professional,Both,,,26,426,362.1,36.64,426,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,42.30624,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Mri Pelvis W/O Contrast (Pro Cah)Professional Component ,,72195,CPT,Professional,Both,,,26,640,544,44.06,640,Aetna,Commercial,544,85,,percent of total billed charges,,
Mri Pelvis W/O Contrast (Pro Cah)Professional Component ,,72195,CPT,Professional,Both,,,26,640,544,44.06,640,Aetna,Medicare Advantage,70.42,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Mri Pelvis W/O Contrast (Pro Cah)Professional Component ,,72195,CPT,Professional,Both,,,26,640,544,44.06,640,Aetna,PPO,595.2,93,,percent of total billed charges,,
Mri Pelvis W/O Contrast (Pro Cah)Professional Component ,,72195,CPT,Professional,Both,,,26,640,544,44.06,640,America's PPO,America's PPO,546.816,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Mri Pelvis W/O Contrast (Pro Cah)Professional Component ,,72195,CPT,Professional,Both,,,26,640,544,44.06,640,BlueCross BlueShield Minnesota, Federal Employee Program,132.31,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Mri Pelvis W/O Contrast (Pro Cah)Professional Component ,,72195,CPT,Professional,Both,,,26,640,544,44.06,640,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,134.42696,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Mri Pelvis W/O Contrast (Pro Cah)Professional Component ,,72195,CPT,Professional,Both,,,26,640,544,44.06,640,BlueCross BlueShield Minnesota,High Value Network Plan,134.42696,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Mri Pelvis W/O Contrast (Pro Cah)Professional Component ,,72195,CPT,Professional,Both,,,26,640,544,44.06,640,BlueCross BlueShield Minnesota,Medicare Advantage,78.959,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Mri Pelvis W/O Contrast (Pro Cah)Professional Component ,,72195,CPT,Professional,Both,,,26,640,544,44.06,640,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,134.42696,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Mri Pelvis W/O Contrast (Pro Cah)Professional Component ,,72195,CPT,Professional,Both,,,26,640,544,44.06,640,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,50.87112,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Mri Pelvis W/O Contrast (Pro Cah)Professional Component ,,72195,CPT,Professional,Both,,,26,640,544,44.06,640,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),78.959,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Mri Pelvis W/O Contrast (Pro Cah)Professional Component ,,72195,CPT,Professional,Both,,,26,640,544,44.06,640,CorVel,Worker's Compensation,136.0279821,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Mri Pelvis W/O Contrast (Pro Cah)Professional Component ,,72195,CPT,Professional,Both,,,26,640,544,44.06,640,First Health Group Corporation,First Health Network,620.8,97,,percent of total billed charges,,
Mri Pelvis W/O Contrast (Pro Cah)Professional Component ,,72195,CPT,Professional,Both,,,26,640,544,44.06,640,"Health Partners, Inc.",Commercial,104.67,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Mri Pelvis W/O Contrast (Pro Cah)Professional Component ,,72195,CPT,Professional,Both,,,26,640,544,44.06,640,"Health Partners, Inc.",Medicare Advantage,78.959,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Mri Pelvis W/O Contrast (Pro Cah)Professional Component ,,72195,CPT,Professional,Both,,,26,640,544,44.06,640,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),44.06,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Mri Pelvis W/O Contrast (Pro Cah)Professional Component ,,72195,CPT,Professional,Both,,,26,640,544,44.06,640,"Health Partners, Inc.",State of Minnesota Advantage Program,90.173205,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Mri Pelvis W/O Contrast (Pro Cah)Professional Component ,,72195,CPT,Professional,Both,,,26,640,544,44.06,640,"Health Partners, Inc.",State Public Programs,44.06,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Mri Pelvis W/O Contrast (Pro Cah)Professional Component ,,72195,CPT,Professional,Both,,,26,640,544,44.06,640,Humana Insurance Company,Commercial PPO,68.66,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Mri Pelvis W/O Contrast (Pro Cah)Professional Component ,,72195,CPT,Professional,Both,,,26,640,544,44.06,640,Humana Insurance Company,Medicare PPO,640,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Mri Pelvis W/O Contrast (Pro Cah)Professional Component ,,72195,CPT,Professional,Both,,,26,640,544,44.06,640,Medica,Individual & Family,542.72,84.8,,percent of total billed charges,,
Mri Pelvis W/O Contrast (Pro Cah)Professional Component ,,72195,CPT,Professional,Both,,,26,640,544,44.06,640,Medica,Medica Advantage Solution,318.72,49.8,,percent of total billed charges,,
Mri Pelvis W/O Contrast (Pro Cah)Professional Component ,,72195,CPT,Professional,Both,,,26,640,544,44.06,640,Medica,Medical Assistance,50.87,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Mri Pelvis W/O Contrast (Pro Cah)Professional Component ,,72195,CPT,Professional,Both,,,26,640,544,44.06,640,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,68.66,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Mri Pelvis W/O Contrast (Pro Cah)Professional Component ,,72195,CPT,Professional,Both,,,26,640,544,44.06,640,"Multiplan, Inc.","Multiplan, Inc.",601.6,94,,percent of total billed charges,,
Mri Pelvis W/O Contrast (Pro Cah)Professional Component ,,72195,CPT,Professional,Both,,,26,640,544,44.06,640,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,576.64,90.1,,percent of total billed charges,,
Mri Pelvis W/O Contrast (Pro Cah)Professional Component ,,72195,CPT,Professional,Both,,,26,640,544,44.06,640,"Preferred One Administrative Services, INC.",PPO,631.04,98.6,,percent of total billed charges,,
Mri Pelvis W/O Contrast (Pro Cah)Professional Component ,,72195,CPT,Professional,Both,,,26,640,544,44.06,640,PrimeWest Health,Minnesota Senior Health Options (MSHO),78.959,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Mri Pelvis W/O Contrast (Pro Cah)Professional Component ,,72195,CPT,Professional,Both,,,26,640,544,44.06,640,PrimeWest Health,MinnesotaCare,54.4320984,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Mri Pelvis W/O Contrast (Pro Cah)Professional Component ,,72195,CPT,Professional,Both,,,26,640,544,44.06,640,Sanford Health Plan,Sanford Health Plan,563.2,88,,percent of total billed charges,,
Mri Pelvis W/O Contrast (Pro Cah)Professional Component ,,72195,CPT,Professional,Both,,,26,640,544,44.06,640,"UCare Health, Inc.",Individual & Family Plan,111.613696,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Mri Pelvis W/O Contrast (Pro Cah)Professional Component ,,72195,CPT,Professional,Both,,,26,640,544,44.06,640,"UCare Health, Inc.",Medical Assistance,55.958232,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Mri Pelvis W/O Contrast (Pro Cah)Professional Component ,,72195,CPT,Professional,Both,,,26,640,544,44.06,640,"UCare Health, Inc.",Medicare Advantage,78.959,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Mri Pelvis W/O Contrast (Pro Cah)Professional Component ,,72195,CPT,Professional,Both,,,26,640,544,44.06,640,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),63.1672,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Mri Pelvis W/O Contrast (Pro Cah)Professional Component ,,72195,CPT,Professional,Both,,,26,640,544,44.06,640,UnitedHealthcare,Individual & Family,640,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Mri Pelvis W/O Contrast (Pro Cah)Professional Component ,,72195,CPT,Professional,Both,,,26,640,544,44.06,640,UnitedHealthcare,Medicare Advantage,78.959,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Mri Pelvis W/O Contrast (Pro Cah)Professional Component ,,72195,CPT,Professional,Both,,,26,640,544,44.06,640,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,50.87112,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Mri Pelvis W/Contrast (Pro Cah)Professional Component ,,72196,CPT,Professional,Both,,,26,745,633.25,52.13,745,Aetna,Commercial,633.25,85,,percent of total billed charges,,
Mri Pelvis W/Contrast (Pro Cah)Professional Component ,,72196,CPT,Professional,Both,,,26,745,633.25,52.13,745,Aetna,Medicare Advantage,83.74,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Mri Pelvis W/Contrast (Pro Cah)Professional Component ,,72196,CPT,Professional,Both,,,26,745,633.25,52.13,745,Aetna,PPO,692.85,93,,percent of total billed charges,,
Mri Pelvis W/Contrast (Pro Cah)Professional Component ,,72196,CPT,Professional,Both,,,26,745,633.25,52.13,745,America's PPO,America's PPO,636.528,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Mri Pelvis W/Contrast (Pro Cah)Professional Component ,,72196,CPT,Professional,Both,,,26,745,633.25,52.13,745,BlueCross BlueShield Minnesota, Federal Employee Program,156.6,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Mri Pelvis W/Contrast (Pro Cah)Professional Component ,,72196,CPT,Professional,Both,,,26,745,633.25,52.13,745,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,159.1056,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Mri Pelvis W/Contrast (Pro Cah)Professional Component ,,72196,CPT,Professional,Both,,,26,745,633.25,52.13,745,BlueCross BlueShield Minnesota,High Value Network Plan,159.1056,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Mri Pelvis W/Contrast (Pro Cah)Professional Component ,,72196,CPT,Professional,Both,,,26,745,633.25,52.13,745,BlueCross BlueShield Minnesota,Medicare Advantage,93.702,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Mri Pelvis W/Contrast (Pro Cah)Professional Component ,,72196,CPT,Professional,Both,,,26,745,633.25,52.13,745,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,159.1056,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Mri Pelvis W/Contrast (Pro Cah)Professional Component ,,72196,CPT,Professional,Both,,,26,745,633.25,52.13,745,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,60.18784,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Mri Pelvis W/Contrast (Pro Cah)Professional Component ,,72196,CPT,Professional,Both,,,26,745,633.25,52.13,745,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),93.702,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Mri Pelvis W/Contrast (Pro Cah)Professional Component ,,72196,CPT,Professional,Both,,,26,745,633.25,52.13,745,CorVel,Worker's Compensation,160.5248811,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Mri Pelvis W/Contrast (Pro Cah)Professional Component ,,72196,CPT,Professional,Both,,,26,745,633.25,52.13,745,First Health Group Corporation,First Health Network,722.65,97,,percent of total billed charges,,
Mri Pelvis W/Contrast (Pro Cah)Professional Component ,,72196,CPT,Professional,Both,,,26,745,633.25,52.13,745,"Health Partners, Inc.",Commercial,123.23,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Mri Pelvis W/Contrast (Pro Cah)Professional Component ,,72196,CPT,Professional,Both,,,26,745,633.25,52.13,745,"Health Partners, Inc.",Medicare Advantage,93.702,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Mri Pelvis W/Contrast (Pro Cah)Professional Component ,,72196,CPT,Professional,Both,,,26,745,633.25,52.13,745,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),52.13,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Mri Pelvis W/Contrast (Pro Cah)Professional Component ,,72196,CPT,Professional,Both,,,26,745,633.25,52.13,745,"Health Partners, Inc.",State of Minnesota Advantage Program,106.162645,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Mri Pelvis W/Contrast (Pro Cah)Professional Component ,,72196,CPT,Professional,Both,,,26,745,633.25,52.13,745,"Health Partners, Inc.",State Public Programs,52.13,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Mri Pelvis W/Contrast (Pro Cah)Professional Component ,,72196,CPT,Professional,Both,,,26,745,633.25,52.13,745,Humana Insurance Company,Commercial PPO,81.48,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Mri Pelvis W/Contrast (Pro Cah)Professional Component ,,72196,CPT,Professional,Both,,,26,745,633.25,52.13,745,Humana Insurance Company,Medicare PPO,745,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Mri Pelvis W/Contrast (Pro Cah)Professional Component ,,72196,CPT,Professional,Both,,,26,745,633.25,52.13,745,Medica,Individual & Family,631.76,84.8,,percent of total billed charges,,
Mri Pelvis W/Contrast (Pro Cah)Professional Component ,,72196,CPT,Professional,Both,,,26,745,633.25,52.13,745,Medica,Medica Advantage Solution,371.01,49.8,,percent of total billed charges,,
Mri Pelvis W/Contrast (Pro Cah)Professional Component ,,72196,CPT,Professional,Both,,,26,745,633.25,52.13,745,Medica,Medical Assistance,60.19,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Mri Pelvis W/Contrast (Pro Cah)Professional Component ,,72196,CPT,Professional,Both,,,26,745,633.25,52.13,745,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,81.48,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Mri Pelvis W/Contrast (Pro Cah)Professional Component ,,72196,CPT,Professional,Both,,,26,745,633.25,52.13,745,"Multiplan, Inc.","Multiplan, Inc.",700.3,94,,percent of total billed charges,,
Mri Pelvis W/Contrast (Pro Cah)Professional Component ,,72196,CPT,Professional,Both,,,26,745,633.25,52.13,745,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,671.245,90.1,,percent of total billed charges,,
Mri Pelvis W/Contrast (Pro Cah)Professional Component ,,72196,CPT,Professional,Both,,,26,745,633.25,52.13,745,"Preferred One Administrative Services, INC.",PPO,734.57,98.6,,percent of total billed charges,,
Mri Pelvis W/Contrast (Pro Cah)Professional Component ,,72196,CPT,Professional,Both,,,26,745,633.25,52.13,745,PrimeWest Health,Minnesota Senior Health Options (MSHO),93.702,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Mri Pelvis W/Contrast (Pro Cah)Professional Component ,,72196,CPT,Professional,Both,,,26,745,633.25,52.13,745,PrimeWest Health,MinnesotaCare,64.4009888,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Mri Pelvis W/Contrast (Pro Cah)Professional Component ,,72196,CPT,Professional,Both,,,26,745,633.25,52.13,745,Sanford Health Plan,Sanford Health Plan,655.6,88,,percent of total billed charges,,
Mri Pelvis W/Contrast (Pro Cah)Professional Component ,,72196,CPT,Professional,Both,,,26,745,633.25,52.13,745,"UCare Health, Inc.",Individual & Family Plan,132.453888,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Mri Pelvis W/Contrast (Pro Cah)Professional Component ,,72196,CPT,Professional,Both,,,26,745,633.25,52.13,745,"UCare Health, Inc.",Medical Assistance,66.206624,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Mri Pelvis W/Contrast (Pro Cah)Professional Component ,,72196,CPT,Professional,Both,,,26,745,633.25,52.13,745,"UCare Health, Inc.",Medicare Advantage,93.702,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Mri Pelvis W/Contrast (Pro Cah)Professional Component ,,72196,CPT,Professional,Both,,,26,745,633.25,52.13,745,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),74.9616,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Mri Pelvis W/Contrast (Pro Cah)Professional Component ,,72196,CPT,Professional,Both,,,26,745,633.25,52.13,745,UnitedHealthcare,Individual & Family,745,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Mri Pelvis W/Contrast (Pro Cah)Professional Component ,,72196,CPT,Professional,Both,,,26,745,633.25,52.13,745,UnitedHealthcare,Medicare Advantage,93.702,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Mri Pelvis W/Contrast (Pro Cah)Professional Component ,,72196,CPT,Professional,Both,,,26,745,633.25,52.13,745,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,60.18784,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Mri Pelvis W/O And W/Contrast (Pro Cah)Professional Component ,,72197,CPT,Professional,Both,,,26,1122,953.7,66.32,1122,Aetna,Commercial,953.7,85,,percent of total billed charges,,
Mri Pelvis W/O And W/Contrast (Pro Cah)Professional Component ,,72197,CPT,Professional,Both,,,26,1122,953.7,66.32,1122,Aetna,Medicare Advantage,105.92,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Mri Pelvis W/O And W/Contrast (Pro Cah)Professional Component ,,72197,CPT,Professional,Both,,,26,1122,953.7,66.32,1122,Aetna,PPO,1043.46,93,,percent of total billed charges,,
Mri Pelvis W/O And W/Contrast (Pro Cah)Professional Component ,,72197,CPT,Professional,Both,,,26,1122,953.7,66.32,1122,America's PPO,America's PPO,958.6368,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Mri Pelvis W/O And W/Contrast (Pro Cah)Professional Component ,,72197,CPT,Professional,Both,,,26,1122,953.7,66.32,1122,BlueCross BlueShield Minnesota, Federal Employee Program,198.15,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Mri Pelvis W/O And W/Contrast (Pro Cah)Professional Component ,,72197,CPT,Professional,Both,,,26,1122,953.7,66.32,1122,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,201.3204,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Mri Pelvis W/O And W/Contrast (Pro Cah)Professional Component ,,72197,CPT,Professional,Both,,,26,1122,953.7,66.32,1122,BlueCross BlueShield Minnesota,High Value Network Plan,201.3204,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Mri Pelvis W/O And W/Contrast (Pro Cah)Professional Component ,,72197,CPT,Professional,Both,,,26,1122,953.7,66.32,1122,BlueCross BlueShield Minnesota,Medicare Advantage,118.5075,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Mri Pelvis W/O And W/Contrast (Pro Cah)Professional Component ,,72197,CPT,Professional,Both,,,26,1122,953.7,66.32,1122,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,201.3204,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Mri Pelvis W/O And W/Contrast (Pro Cah)Professional Component ,,72197,CPT,Professional,Both,,,26,1122,953.7,66.32,1122,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,76.56576,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Mri Pelvis W/O And W/Contrast (Pro Cah)Professional Component ,,72197,CPT,Professional,Both,,,26,1122,953.7,66.32,1122,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),118.5075,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Mri Pelvis W/O And W/Contrast (Pro Cah)Professional Component ,,72197,CPT,Professional,Both,,,26,1122,953.7,66.32,1122,CorVel,Worker's Compensation,203.8992369,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Mri Pelvis W/O And W/Contrast (Pro Cah)Professional Component ,,72197,CPT,Professional,Both,,,26,1122,953.7,66.32,1122,First Health Group Corporation,First Health Network,1088.34,97,,percent of total billed charges,,
Mri Pelvis W/O And W/Contrast (Pro Cah)Professional Component ,,72197,CPT,Professional,Both,,,26,1122,953.7,66.32,1122,"Health Partners, Inc.",Commercial,156.75,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Mri Pelvis W/O And W/Contrast (Pro Cah)Professional Component ,,72197,CPT,Professional,Both,,,26,1122,953.7,66.32,1122,"Health Partners, Inc.",Medicare Advantage,118.5075,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Mri Pelvis W/O And W/Contrast (Pro Cah)Professional Component ,,72197,CPT,Professional,Both,,,26,1122,953.7,66.32,1122,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),66.32,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Mri Pelvis W/O And W/Contrast (Pro Cah)Professional Component ,,72197,CPT,Professional,Both,,,26,1122,953.7,66.32,1122,"Health Partners, Inc.",State of Minnesota Advantage Program,135.040125,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Mri Pelvis W/O And W/Contrast (Pro Cah)Professional Component ,,72197,CPT,Professional,Both,,,26,1122,953.7,66.32,1122,"Health Partners, Inc.",State Public Programs,66.32,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Mri Pelvis W/O And W/Contrast (Pro Cah)Professional Component ,,72197,CPT,Professional,Both,,,26,1122,953.7,66.32,1122,Humana Insurance Company,Commercial PPO,103.05,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Mri Pelvis W/O And W/Contrast (Pro Cah)Professional Component ,,72197,CPT,Professional,Both,,,26,1122,953.7,66.32,1122,Humana Insurance Company,Medicare PPO,1122,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Mri Pelvis W/O And W/Contrast (Pro Cah)Professional Component ,,72197,CPT,Professional,Both,,,26,1122,953.7,66.32,1122,Medica,Individual & Family,951.456,84.8,,percent of total billed charges,,
Mri Pelvis W/O And W/Contrast (Pro Cah)Professional Component ,,72197,CPT,Professional,Both,,,26,1122,953.7,66.32,1122,Medica,Medica Advantage Solution,558.756,49.8,,percent of total billed charges,,
Mri Pelvis W/O And W/Contrast (Pro Cah)Professional Component ,,72197,CPT,Professional,Both,,,26,1122,953.7,66.32,1122,Medica,Medical Assistance,76.57,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Mri Pelvis W/O And W/Contrast (Pro Cah)Professional Component ,,72197,CPT,Professional,Both,,,26,1122,953.7,66.32,1122,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,103.05,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Mri Pelvis W/O And W/Contrast (Pro Cah)Professional Component ,,72197,CPT,Professional,Both,,,26,1122,953.7,66.32,1122,"Multiplan, Inc.","Multiplan, Inc.",1054.68,94,,percent of total billed charges,,
Mri Pelvis W/O And W/Contrast (Pro Cah)Professional Component ,,72197,CPT,Professional,Both,,,26,1122,953.7,66.32,1122,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1010.922,90.1,,percent of total billed charges,,
Mri Pelvis W/O And W/Contrast (Pro Cah)Professional Component ,,72197,CPT,Professional,Both,,,26,1122,953.7,66.32,1122,"Preferred One Administrative Services, INC.",PPO,1106.292,98.6,,percent of total billed charges,,
Mri Pelvis W/O And W/Contrast (Pro Cah)Professional Component ,,72197,CPT,Professional,Both,,,26,1122,953.7,66.32,1122,PrimeWest Health,Minnesota Senior Health Options (MSHO),118.5075,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Mri Pelvis W/O And W/Contrast (Pro Cah)Professional Component ,,72197,CPT,Professional,Both,,,26,1122,953.7,66.32,1122,PrimeWest Health,MinnesotaCare,81.9253632,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Mri Pelvis W/O And W/Contrast (Pro Cah)Professional Component ,,72197,CPT,Professional,Both,,,26,1122,953.7,66.32,1122,Sanford Health Plan,Sanford Health Plan,987.36,88,,percent of total billed charges,,
Mri Pelvis W/O And W/Contrast (Pro Cah)Professional Component ,,72197,CPT,Professional,Both,,,26,1122,953.7,66.32,1122,"UCare Health, Inc.",Individual & Family Plan,167.51808,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Mri Pelvis W/O And W/Contrast (Pro Cah)Professional Component ,,72197,CPT,Professional,Both,,,26,1122,953.7,66.32,1122,"UCare Health, Inc.",Medical Assistance,84.222336,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Mri Pelvis W/O And W/Contrast (Pro Cah)Professional Component ,,72197,CPT,Professional,Both,,,26,1122,953.7,66.32,1122,"UCare Health, Inc.",Medicare Advantage,118.5075,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Mri Pelvis W/O And W/Contrast (Pro Cah)Professional Component ,,72197,CPT,Professional,Both,,,26,1122,953.7,66.32,1122,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),94.806,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Mri Pelvis W/O And W/Contrast (Pro Cah)Professional Component ,,72197,CPT,Professional,Both,,,26,1122,953.7,66.32,1122,UnitedHealthcare,Individual & Family,1122,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Mri Pelvis W/O And W/Contrast (Pro Cah)Professional Component ,,72197,CPT,Professional,Both,,,26,1122,953.7,66.32,1122,UnitedHealthcare,Medicare Advantage,118.5075,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Mri Pelvis W/O And W/Contrast (Pro Cah)Professional Component ,,72197,CPT,Professional,Both,,,26,1122,953.7,66.32,1122,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,76.56576,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Sacroiliac Joints; Less Than 3 Views (Pro Cah)Professional Component ,,72200,CPT,Professional,Both,,,26,45,38.25,5.02,45,Aetna,Commercial,38.25,85,,percent of total billed charges,,
Xr Sacroiliac Joints; Less Than 3 Views (Pro Cah)Professional Component ,,72200,CPT,Professional,Both,,,26,45,38.25,5.02,45,Aetna,Medicare Advantage,8.18,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Sacroiliac Joints; Less Than 3 Views (Pro Cah)Professional Component ,,72200,CPT,Professional,Both,,,26,45,38.25,5.02,45,Aetna,PPO,41.85,93,,percent of total billed charges,,
Xr Sacroiliac Joints; Less Than 3 Views (Pro Cah)Professional Component ,,72200,CPT,Professional,Both,,,26,45,38.25,5.02,45,America's PPO,America's PPO,38.448,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Xr Sacroiliac Joints; Less Than 3 Views (Pro Cah)Professional Component ,,72200,CPT,Professional,Both,,,26,45,38.25,5.02,45,BlueCross BlueShield Minnesota, Federal Employee Program,15.34,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Xr Sacroiliac Joints; Less Than 3 Views (Pro Cah)Professional Component ,,72200,CPT,Professional,Both,,,26,45,38.25,5.02,45,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,15.58544,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Sacroiliac Joints; Less Than 3 Views (Pro Cah)Professional Component ,,72200,CPT,Professional,Both,,,26,45,38.25,5.02,45,BlueCross BlueShield Minnesota,High Value Network Plan,15.58544,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Sacroiliac Joints; Less Than 3 Views (Pro Cah)Professional Component ,,72200,CPT,Professional,Both,,,26,45,38.25,5.02,45,BlueCross BlueShield Minnesota,Medicare Advantage,9.131,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Sacroiliac Joints; Less Than 3 Views (Pro Cah)Professional Component ,,72200,CPT,Professional,Both,,,26,45,38.25,5.02,45,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,15.58544,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Sacroiliac Joints; Less Than 3 Views (Pro Cah)Professional Component ,,72200,CPT,Professional,Both,,,26,45,38.25,5.02,45,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,5.7912,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Sacroiliac Joints; Less Than 3 Views (Pro Cah)Professional Component ,,72200,CPT,Professional,Both,,,26,45,38.25,5.02,45,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),9.131,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Sacroiliac Joints; Less Than 3 Views (Pro Cah)Professional Component ,,72200,CPT,Professional,Both,,,26,45,38.25,5.02,45,CorVel,Worker's Compensation,15.7386027,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Xr Sacroiliac Joints; Less Than 3 Views (Pro Cah)Professional Component ,,72200,CPT,Professional,Both,,,26,45,38.25,5.02,45,First Health Group Corporation,First Health Network,43.65,97,,percent of total billed charges,,
Xr Sacroiliac Joints; Less Than 3 Views (Pro Cah)Professional Component ,,72200,CPT,Professional,Both,,,26,45,38.25,5.02,45,"Health Partners, Inc.",Commercial,11.86,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Xr Sacroiliac Joints; Less Than 3 Views (Pro Cah)Professional Component ,,72200,CPT,Professional,Both,,,26,45,38.25,5.02,45,"Health Partners, Inc.",Medicare Advantage,9.131,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Sacroiliac Joints; Less Than 3 Views (Pro Cah)Professional Component ,,72200,CPT,Professional,Both,,,26,45,38.25,5.02,45,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),5.02,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Xr Sacroiliac Joints; Less Than 3 Views (Pro Cah)Professional Component ,,72200,CPT,Professional,Both,,,26,45,38.25,5.02,45,"Health Partners, Inc.",State of Minnesota Advantage Program,10.21739,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Xr Sacroiliac Joints; Less Than 3 Views (Pro Cah)Professional Component ,,72200,CPT,Professional,Both,,,26,45,38.25,5.02,45,"Health Partners, Inc.",State Public Programs,5.02,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Xr Sacroiliac Joints; Less Than 3 Views (Pro Cah)Professional Component ,,72200,CPT,Professional,Both,,,26,45,38.25,5.02,45,Humana Insurance Company,Commercial PPO,7.94,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Xr Sacroiliac Joints; Less Than 3 Views (Pro Cah)Professional Component ,,72200,CPT,Professional,Both,,,26,45,38.25,5.02,45,Humana Insurance Company,Medicare PPO,45,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Xr Sacroiliac Joints; Less Than 3 Views (Pro Cah)Professional Component ,,72200,CPT,Professional,Both,,,26,45,38.25,5.02,45,Medica,Individual & Family,38.16,84.8,,percent of total billed charges,,
Xr Sacroiliac Joints; Less Than 3 Views (Pro Cah)Professional Component ,,72200,CPT,Professional,Both,,,26,45,38.25,5.02,45,Medica,Medica Advantage Solution,22.41,49.8,,percent of total billed charges,,
Xr Sacroiliac Joints; Less Than 3 Views (Pro Cah)Professional Component ,,72200,CPT,Professional,Both,,,26,45,38.25,5.02,45,Medica,Medical Assistance,5.79,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Xr Sacroiliac Joints; Less Than 3 Views (Pro Cah)Professional Component ,,72200,CPT,Professional,Both,,,26,45,38.25,5.02,45,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,7.94,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Xr Sacroiliac Joints; Less Than 3 Views (Pro Cah)Professional Component ,,72200,CPT,Professional,Both,,,26,45,38.25,5.02,45,"Multiplan, Inc.","Multiplan, Inc.",42.3,94,,percent of total billed charges,,
Xr Sacroiliac Joints; Less Than 3 Views (Pro Cah)Professional Component ,,72200,CPT,Professional,Both,,,26,45,38.25,5.02,45,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,40.545,90.1,,percent of total billed charges,,
Xr Sacroiliac Joints; Less Than 3 Views (Pro Cah)Professional Component ,,72200,CPT,Professional,Both,,,26,45,38.25,5.02,45,"Preferred One Administrative Services, INC.",PPO,44.37,98.6,,percent of total billed charges,,
Xr Sacroiliac Joints; Less Than 3 Views (Pro Cah)Professional Component ,,72200,CPT,Professional,Both,,,26,45,38.25,5.02,45,PrimeWest Health,Minnesota Senior Health Options (MSHO),9.131,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Sacroiliac Joints; Less Than 3 Views (Pro Cah)Professional Component ,,72200,CPT,Professional,Both,,,26,45,38.25,5.02,45,PrimeWest Health,MinnesotaCare,6.196584,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Sacroiliac Joints; Less Than 3 Views (Pro Cah)Professional Component ,,72200,CPT,Professional,Both,,,26,45,38.25,5.02,45,Sanford Health Plan,Sanford Health Plan,39.6,88,,percent of total billed charges,,
Xr Sacroiliac Joints; Less Than 3 Views (Pro Cah)Professional Component ,,72200,CPT,Professional,Both,,,26,45,38.25,5.02,45,"UCare Health, Inc.",Individual & Family Plan,12.907264,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Xr Sacroiliac Joints; Less Than 3 Views (Pro Cah)Professional Component ,,72200,CPT,Professional,Both,,,26,45,38.25,5.02,45,"UCare Health, Inc.",Medical Assistance,6.37032,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Xr Sacroiliac Joints; Less Than 3 Views (Pro Cah)Professional Component ,,72200,CPT,Professional,Both,,,26,45,38.25,5.02,45,"UCare Health, Inc.",Medicare Advantage,9.131,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Xr Sacroiliac Joints; Less Than 3 Views (Pro Cah)Professional Component ,,72200,CPT,Professional,Both,,,26,45,38.25,5.02,45,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),7.3048,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Xr Sacroiliac Joints; Less Than 3 Views (Pro Cah)Professional Component ,,72200,CPT,Professional,Both,,,26,45,38.25,5.02,45,UnitedHealthcare,Individual & Family,45,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Xr Sacroiliac Joints; Less Than 3 Views (Pro Cah)Professional Component ,,72200,CPT,Professional,Both,,,26,45,38.25,5.02,45,UnitedHealthcare,Medicare Advantage,9.131,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Sacroiliac Joints; Less Than 3 Views (Pro Cah)Professional Component ,,72200,CPT,Professional,Both,,,26,45,38.25,5.02,45,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,5.7912,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Sacroiliac Joints (Pro Cah)Professional Component ,,72202,CPT,Professional,Both,,,26,58,49.3,6.76,58,Aetna,Commercial,49.3,85,,percent of total billed charges,,
Xr Sacroiliac Joints (Pro Cah)Professional Component ,,72202,CPT,Professional,Both,,,26,58,49.3,6.76,58,Aetna,Medicare Advantage,10.98,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Sacroiliac Joints (Pro Cah)Professional Component ,,72202,CPT,Professional,Both,,,26,58,49.3,6.76,58,Aetna,PPO,53.94,93,,percent of total billed charges,,
Xr Sacroiliac Joints (Pro Cah)Professional Component ,,72202,CPT,Professional,Both,,,26,58,49.3,6.76,58,America's PPO,America's PPO,49.5552,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Xr Sacroiliac Joints (Pro Cah)Professional Component ,,72202,CPT,Professional,Both,,,26,58,49.3,6.76,58,BlueCross BlueShield Minnesota, Federal Employee Program,20.45,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Xr Sacroiliac Joints (Pro Cah)Professional Component ,,72202,CPT,Professional,Both,,,26,58,49.3,6.76,58,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,20.7772,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Sacroiliac Joints (Pro Cah)Professional Component ,,72202,CPT,Professional,Both,,,26,58,49.3,6.76,58,BlueCross BlueShield Minnesota,High Value Network Plan,20.7772,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Sacroiliac Joints (Pro Cah)Professional Component ,,72202,CPT,Professional,Both,,,26,58,49.3,6.76,58,BlueCross BlueShield Minnesota,Medicare Advantage,12.2705,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Sacroiliac Joints (Pro Cah)Professional Component ,,72202,CPT,Professional,Both,,,26,58,49.3,6.76,58,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,20.7772,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Sacroiliac Joints (Pro Cah)Professional Component ,,72202,CPT,Professional,Both,,,26,58,49.3,6.76,58,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,7.80288,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Sacroiliac Joints (Pro Cah)Professional Component ,,72202,CPT,Professional,Both,,,26,58,49.3,6.76,58,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),12.2705,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Sacroiliac Joints (Pro Cah)Professional Component ,,72202,CPT,Professional,Both,,,26,58,49.3,6.76,58,CorVel,Worker's Compensation,21.1296669,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Xr Sacroiliac Joints (Pro Cah)Professional Component ,,72202,CPT,Professional,Both,,,26,58,49.3,6.76,58,First Health Group Corporation,First Health Network,56.26,97,,percent of total billed charges,,
Xr Sacroiliac Joints (Pro Cah)Professional Component ,,72202,CPT,Professional,Both,,,26,58,49.3,6.76,58,"Health Partners, Inc.",Commercial,15.98,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Xr Sacroiliac Joints (Pro Cah)Professional Component ,,72202,CPT,Professional,Both,,,26,58,49.3,6.76,58,"Health Partners, Inc.",Medicare Advantage,12.2705,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Sacroiliac Joints (Pro Cah)Professional Component ,,72202,CPT,Professional,Both,,,26,58,49.3,6.76,58,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),6.76,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Xr Sacroiliac Joints (Pro Cah)Professional Component ,,72202,CPT,Professional,Both,,,26,58,49.3,6.76,58,"Health Partners, Inc.",State of Minnesota Advantage Program,13.76677,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Xr Sacroiliac Joints (Pro Cah)Professional Component ,,72202,CPT,Professional,Both,,,26,58,49.3,6.76,58,"Health Partners, Inc.",State Public Programs,6.76,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Xr Sacroiliac Joints (Pro Cah)Professional Component ,,72202,CPT,Professional,Both,,,26,58,49.3,6.76,58,Humana Insurance Company,Commercial PPO,10.67,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Xr Sacroiliac Joints (Pro Cah)Professional Component ,,72202,CPT,Professional,Both,,,26,58,49.3,6.76,58,Humana Insurance Company,Medicare PPO,58,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Xr Sacroiliac Joints (Pro Cah)Professional Component ,,72202,CPT,Professional,Both,,,26,58,49.3,6.76,58,Medica,Individual & Family,49.184,84.8,,percent of total billed charges,,
Xr Sacroiliac Joints (Pro Cah)Professional Component ,,72202,CPT,Professional,Both,,,26,58,49.3,6.76,58,Medica,Medica Advantage Solution,28.884,49.8,,percent of total billed charges,,
Xr Sacroiliac Joints (Pro Cah)Professional Component ,,72202,CPT,Professional,Both,,,26,58,49.3,6.76,58,Medica,Medical Assistance,7.8,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Xr Sacroiliac Joints (Pro Cah)Professional Component ,,72202,CPT,Professional,Both,,,26,58,49.3,6.76,58,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,10.67,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Xr Sacroiliac Joints (Pro Cah)Professional Component ,,72202,CPT,Professional,Both,,,26,58,49.3,6.76,58,"Multiplan, Inc.","Multiplan, Inc.",54.52,94,,percent of total billed charges,,
Xr Sacroiliac Joints (Pro Cah)Professional Component ,,72202,CPT,Professional,Both,,,26,58,49.3,6.76,58,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,52.258,90.1,,percent of total billed charges,,
Xr Sacroiliac Joints (Pro Cah)Professional Component ,,72202,CPT,Professional,Both,,,26,58,49.3,6.76,58,"Preferred One Administrative Services, INC.",PPO,57.188,98.6,,percent of total billed charges,,
Xr Sacroiliac Joints (Pro Cah)Professional Component ,,72202,CPT,Professional,Both,,,26,58,49.3,6.76,58,PrimeWest Health,Minnesota Senior Health Options (MSHO),12.2705,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Sacroiliac Joints (Pro Cah)Professional Component ,,72202,CPT,Professional,Both,,,26,58,49.3,6.76,58,PrimeWest Health,MinnesotaCare,8.3490816,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Sacroiliac Joints (Pro Cah)Professional Component ,,72202,CPT,Professional,Both,,,26,58,49.3,6.76,58,Sanford Health Plan,Sanford Health Plan,51.04,88,,percent of total billed charges,,
Xr Sacroiliac Joints (Pro Cah)Professional Component ,,72202,CPT,Professional,Both,,,26,58,49.3,6.76,58,"UCare Health, Inc.",Individual & Family Plan,17.345152,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Xr Sacroiliac Joints (Pro Cah)Professional Component ,,72202,CPT,Professional,Both,,,26,58,49.3,6.76,58,"UCare Health, Inc.",Medical Assistance,8.583168,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Xr Sacroiliac Joints (Pro Cah)Professional Component ,,72202,CPT,Professional,Both,,,26,58,49.3,6.76,58,"UCare Health, Inc.",Medicare Advantage,12.2705,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Xr Sacroiliac Joints (Pro Cah)Professional Component ,,72202,CPT,Professional,Both,,,26,58,49.3,6.76,58,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),9.8164,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Xr Sacroiliac Joints (Pro Cah)Professional Component ,,72202,CPT,Professional,Both,,,26,58,49.3,6.76,58,UnitedHealthcare,Individual & Family,58,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Xr Sacroiliac Joints (Pro Cah)Professional Component ,,72202,CPT,Professional,Both,,,26,58,49.3,6.76,58,UnitedHealthcare,Medicare Advantage,12.2705,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Sacroiliac Joints (Pro Cah)Professional Component ,,72202,CPT,Professional,Both,,,26,58,49.3,6.76,58,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,7.80288,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Sacrum And Or Coccyx (Pro Cah)Professional Component ,,72220,CPT,Professional,Both,,,26,46,39.1,5.23,46,Aetna,Commercial,39.1,85,,percent of total billed charges,,
Xr Sacrum And Or Coccyx (Pro Cah)Professional Component ,,72220,CPT,Professional,Both,,,26,46,39.1,5.23,46,Aetna,Medicare Advantage,8.53,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Sacrum And Or Coccyx (Pro Cah)Professional Component ,,72220,CPT,Professional,Both,,,26,46,39.1,5.23,46,Aetna,PPO,42.78,93,,percent of total billed charges,,
Xr Sacrum And Or Coccyx (Pro Cah)Professional Component ,,72220,CPT,Professional,Both,,,26,46,39.1,5.23,46,America's PPO,America's PPO,39.3024,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Xr Sacrum And Or Coccyx (Pro Cah)Professional Component ,,72220,CPT,Professional,Both,,,26,46,39.1,5.23,46,BlueCross BlueShield Minnesota, Federal Employee Program,15.98,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Xr Sacrum And Or Coccyx (Pro Cah)Professional Component ,,72220,CPT,Professional,Both,,,26,46,39.1,5.23,46,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,16.23568,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Sacrum And Or Coccyx (Pro Cah)Professional Component ,,72220,CPT,Professional,Both,,,26,46,39.1,5.23,46,BlueCross BlueShield Minnesota,High Value Network Plan,16.23568,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Sacrum And Or Coccyx (Pro Cah)Professional Component ,,72220,CPT,Professional,Both,,,26,46,39.1,5.23,46,BlueCross BlueShield Minnesota,Medicare Advantage,9.5335,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Sacrum And Or Coccyx (Pro Cah)Professional Component ,,72220,CPT,Professional,Both,,,26,46,39.1,5.23,46,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,16.23568,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Sacrum And Or Coccyx (Pro Cah)Professional Component ,,72220,CPT,Professional,Both,,,26,46,39.1,5.23,46,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,6.03504,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Sacrum And Or Coccyx (Pro Cah)Professional Component ,,72220,CPT,Professional,Both,,,26,46,39.1,5.23,46,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),9.5335,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Sacrum And Or Coccyx (Pro Cah)Professional Component ,,72220,CPT,Professional,Both,,,26,46,39.1,5.23,46,CorVel,Worker's Compensation,16.4190348,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Xr Sacrum And Or Coccyx (Pro Cah)Professional Component ,,72220,CPT,Professional,Both,,,26,46,39.1,5.23,46,First Health Group Corporation,First Health Network,44.62,97,,percent of total billed charges,,
Xr Sacrum And Or Coccyx (Pro Cah)Professional Component ,,72220,CPT,Professional,Both,,,26,46,39.1,5.23,46,"Health Partners, Inc.",Commercial,12.37,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Xr Sacrum And Or Coccyx (Pro Cah)Professional Component ,,72220,CPT,Professional,Both,,,26,46,39.1,5.23,46,"Health Partners, Inc.",Medicare Advantage,9.5335,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Sacrum And Or Coccyx (Pro Cah)Professional Component ,,72220,CPT,Professional,Both,,,26,46,39.1,5.23,46,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),5.23,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Xr Sacrum And Or Coccyx (Pro Cah)Professional Component ,,72220,CPT,Professional,Both,,,26,46,39.1,5.23,46,"Health Partners, Inc.",State of Minnesota Advantage Program,10.656755,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Xr Sacrum And Or Coccyx (Pro Cah)Professional Component ,,72220,CPT,Professional,Both,,,26,46,39.1,5.23,46,"Health Partners, Inc.",State Public Programs,5.23,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Xr Sacrum And Or Coccyx (Pro Cah)Professional Component ,,72220,CPT,Professional,Both,,,26,46,39.1,5.23,46,Humana Insurance Company,Commercial PPO,8.29,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Xr Sacrum And Or Coccyx (Pro Cah)Professional Component ,,72220,CPT,Professional,Both,,,26,46,39.1,5.23,46,Humana Insurance Company,Medicare PPO,46,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Xr Sacrum And Or Coccyx (Pro Cah)Professional Component ,,72220,CPT,Professional,Both,,,26,46,39.1,5.23,46,Medica,Individual & Family,39.008,84.8,,percent of total billed charges,,
Xr Sacrum And Or Coccyx (Pro Cah)Professional Component ,,72220,CPT,Professional,Both,,,26,46,39.1,5.23,46,Medica,Medica Advantage Solution,22.908,49.8,,percent of total billed charges,,
Xr Sacrum And Or Coccyx (Pro Cah)Professional Component ,,72220,CPT,Professional,Both,,,26,46,39.1,5.23,46,Medica,Medical Assistance,6.04,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Xr Sacrum And Or Coccyx (Pro Cah)Professional Component ,,72220,CPT,Professional,Both,,,26,46,39.1,5.23,46,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,8.29,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Xr Sacrum And Or Coccyx (Pro Cah)Professional Component ,,72220,CPT,Professional,Both,,,26,46,39.1,5.23,46,"Multiplan, Inc.","Multiplan, Inc.",43.24,94,,percent of total billed charges,,
Xr Sacrum And Or Coccyx (Pro Cah)Professional Component ,,72220,CPT,Professional,Both,,,26,46,39.1,5.23,46,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,41.446,90.1,,percent of total billed charges,,
Xr Sacrum And Or Coccyx (Pro Cah)Professional Component ,,72220,CPT,Professional,Both,,,26,46,39.1,5.23,46,"Preferred One Administrative Services, INC.",PPO,45.356,98.6,,percent of total billed charges,,
Xr Sacrum And Or Coccyx (Pro Cah)Professional Component ,,72220,CPT,Professional,Both,,,26,46,39.1,5.23,46,PrimeWest Health,Minnesota Senior Health Options (MSHO),9.5335,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Sacrum And Or Coccyx (Pro Cah)Professional Component ,,72220,CPT,Professional,Both,,,26,46,39.1,5.23,46,PrimeWest Health,MinnesotaCare,6.4574928,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Sacrum And Or Coccyx (Pro Cah)Professional Component ,,72220,CPT,Professional,Both,,,26,46,39.1,5.23,46,Sanford Health Plan,Sanford Health Plan,40.48,88,,percent of total billed charges,,
Xr Sacrum And Or Coccyx (Pro Cah)Professional Component ,,72220,CPT,Professional,Both,,,26,46,39.1,5.23,46,"UCare Health, Inc.",Individual & Family Plan,13.476224,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Xr Sacrum And Or Coccyx (Pro Cah)Professional Component ,,72220,CPT,Professional,Both,,,26,46,39.1,5.23,46,"UCare Health, Inc.",Medical Assistance,6.638544,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Xr Sacrum And Or Coccyx (Pro Cah)Professional Component ,,72220,CPT,Professional,Both,,,26,46,39.1,5.23,46,"UCare Health, Inc.",Medicare Advantage,9.5335,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Xr Sacrum And Or Coccyx (Pro Cah)Professional Component ,,72220,CPT,Professional,Both,,,26,46,39.1,5.23,46,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),7.6268,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Xr Sacrum And Or Coccyx (Pro Cah)Professional Component ,,72220,CPT,Professional,Both,,,26,46,39.1,5.23,46,UnitedHealthcare,Individual & Family,46,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Xr Sacrum And Or Coccyx (Pro Cah)Professional Component ,,72220,CPT,Professional,Both,,,26,46,39.1,5.23,46,UnitedHealthcare,Medicare Advantage,9.5335,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Sacrum And Or Coccyx (Pro Cah)Professional Component ,,72220,CPT,Professional,Both,,,26,46,39.1,5.23,46,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,6.03504,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Clavicle (Pro Cah)Professional Component ,,73000,CPT,Professional,Both,,,26,41,34.85,5.02,41,Aetna,Commercial,34.85,85,,percent of total billed charges,,
Xr Clavicle (Pro Cah)Professional Component ,,73000,CPT,Professional,Both,,,26,41,34.85,5.02,41,Aetna,Medicare Advantage,8.18,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Clavicle (Pro Cah)Professional Component ,,73000,CPT,Professional,Both,,,26,41,34.85,5.02,41,Aetna,PPO,38.13,93,,percent of total billed charges,,
Xr Clavicle (Pro Cah)Professional Component ,,73000,CPT,Professional,Both,,,26,41,34.85,5.02,41,America's PPO,America's PPO,35.0304,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Xr Clavicle (Pro Cah)Professional Component ,,73000,CPT,Professional,Both,,,26,41,34.85,5.02,41,BlueCross BlueShield Minnesota, Federal Employee Program,15.34,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Xr Clavicle (Pro Cah)Professional Component ,,73000,CPT,Professional,Both,,,26,41,34.85,5.02,41,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,15.58544,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Clavicle (Pro Cah)Professional Component ,,73000,CPT,Professional,Both,,,26,41,34.85,5.02,41,BlueCross BlueShield Minnesota,High Value Network Plan,15.58544,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Clavicle (Pro Cah)Professional Component ,,73000,CPT,Professional,Both,,,26,41,34.85,5.02,41,BlueCross BlueShield Minnesota,Medicare Advantage,9.1425,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Clavicle (Pro Cah)Professional Component ,,73000,CPT,Professional,Both,,,26,41,34.85,5.02,41,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,15.58544,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Clavicle (Pro Cah)Professional Component ,,73000,CPT,Professional,Both,,,26,41,34.85,5.02,41,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,5.7912,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Clavicle (Pro Cah)Professional Component ,,73000,CPT,Professional,Both,,,26,41,34.85,5.02,41,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),9.1425,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Clavicle (Pro Cah)Professional Component ,,73000,CPT,Professional,Both,,,26,41,34.85,5.02,41,CorVel,Worker's Compensation,15.7473348,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Xr Clavicle (Pro Cah)Professional Component ,,73000,CPT,Professional,Both,,,26,41,34.85,5.02,41,First Health Group Corporation,First Health Network,39.77,97,,percent of total billed charges,,
Xr Clavicle (Pro Cah)Professional Component ,,73000,CPT,Professional,Both,,,26,41,34.85,5.02,41,"Health Partners, Inc.",Commercial,11.86,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Xr Clavicle (Pro Cah)Professional Component ,,73000,CPT,Professional,Both,,,26,41,34.85,5.02,41,"Health Partners, Inc.",Medicare Advantage,9.1425,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Clavicle (Pro Cah)Professional Component ,,73000,CPT,Professional,Both,,,26,41,34.85,5.02,41,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),5.02,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Xr Clavicle (Pro Cah)Professional Component ,,73000,CPT,Professional,Both,,,26,41,34.85,5.02,41,"Health Partners, Inc.",State of Minnesota Advantage Program,10.21739,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Xr Clavicle (Pro Cah)Professional Component ,,73000,CPT,Professional,Both,,,26,41,34.85,5.02,41,"Health Partners, Inc.",State Public Programs,5.02,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Xr Clavicle (Pro Cah)Professional Component ,,73000,CPT,Professional,Both,,,26,41,34.85,5.02,41,Humana Insurance Company,Commercial PPO,7.95,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Xr Clavicle (Pro Cah)Professional Component ,,73000,CPT,Professional,Both,,,26,41,34.85,5.02,41,Humana Insurance Company,Medicare PPO,41,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Xr Clavicle (Pro Cah)Professional Component ,,73000,CPT,Professional,Both,,,26,41,34.85,5.02,41,Medica,Individual & Family,34.768,84.8,,percent of total billed charges,,
Xr Clavicle (Pro Cah)Professional Component ,,73000,CPT,Professional,Both,,,26,41,34.85,5.02,41,Medica,Medica Advantage Solution,20.418,49.8,,percent of total billed charges,,
Xr Clavicle (Pro Cah)Professional Component ,,73000,CPT,Professional,Both,,,26,41,34.85,5.02,41,Medica,Medical Assistance,5.79,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Xr Clavicle (Pro Cah)Professional Component ,,73000,CPT,Professional,Both,,,26,41,34.85,5.02,41,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,7.95,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Xr Clavicle (Pro Cah)Professional Component ,,73000,CPT,Professional,Both,,,26,41,34.85,5.02,41,"Multiplan, Inc.","Multiplan, Inc.",38.54,94,,percent of total billed charges,,
Xr Clavicle (Pro Cah)Professional Component ,,73000,CPT,Professional,Both,,,26,41,34.85,5.02,41,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,36.941,90.1,,percent of total billed charges,,
Xr Clavicle (Pro Cah)Professional Component ,,73000,CPT,Professional,Both,,,26,41,34.85,5.02,41,"Preferred One Administrative Services, INC.",PPO,40.426,98.6,,percent of total billed charges,,
Xr Clavicle (Pro Cah)Professional Component ,,73000,CPT,Professional,Both,,,26,41,34.85,5.02,41,PrimeWest Health,Minnesota Senior Health Options (MSHO),9.1425,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Clavicle (Pro Cah)Professional Component ,,73000,CPT,Professional,Both,,,26,41,34.85,5.02,41,PrimeWest Health,MinnesotaCare,6.196584,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Clavicle (Pro Cah)Professional Component ,,73000,CPT,Professional,Both,,,26,41,34.85,5.02,41,Sanford Health Plan,Sanford Health Plan,36.08,88,,percent of total billed charges,,
Xr Clavicle (Pro Cah)Professional Component ,,73000,CPT,Professional,Both,,,26,41,34.85,5.02,41,"UCare Health, Inc.",Individual & Family Plan,12.92352,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Xr Clavicle (Pro Cah)Professional Component ,,73000,CPT,Professional,Both,,,26,41,34.85,5.02,41,"UCare Health, Inc.",Medical Assistance,6.37032,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Xr Clavicle (Pro Cah)Professional Component ,,73000,CPT,Professional,Both,,,26,41,34.85,5.02,41,"UCare Health, Inc.",Medicare Advantage,9.1425,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Xr Clavicle (Pro Cah)Professional Component ,,73000,CPT,Professional,Both,,,26,41,34.85,5.02,41,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),7.314,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Xr Clavicle (Pro Cah)Professional Component ,,73000,CPT,Professional,Both,,,26,41,34.85,5.02,41,UnitedHealthcare,Individual & Family,41,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Xr Clavicle (Pro Cah)Professional Component ,,73000,CPT,Professional,Both,,,26,41,34.85,5.02,41,UnitedHealthcare,Medicare Advantage,9.1425,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Clavicle (Pro Cah)Professional Component ,,73000,CPT,Professional,Both,,,26,41,34.85,5.02,41,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,5.7912,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Scapula (Pro Cah)Professional Component ,,73010,CPT,Professional,Both,,,26,54,45.9,5.45,54,Aetna,Commercial,45.9,85,,percent of total billed charges,,
Xr Scapula (Pro Cah)Professional Component ,,73010,CPT,Professional,Both,,,26,54,45.9,5.45,54,Aetna,Medicare Advantage,8.88,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Scapula (Pro Cah)Professional Component ,,73010,CPT,Professional,Both,,,26,54,45.9,5.45,54,Aetna,PPO,50.22,93,,percent of total billed charges,,
Xr Scapula (Pro Cah)Professional Component ,,73010,CPT,Professional,Both,,,26,54,45.9,5.45,54,America's PPO,America's PPO,46.1376,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Xr Scapula (Pro Cah)Professional Component ,,73010,CPT,Professional,Both,,,26,54,45.9,5.45,54,BlueCross BlueShield Minnesota, Federal Employee Program,16.62,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Xr Scapula (Pro Cah)Professional Component ,,73010,CPT,Professional,Both,,,26,54,45.9,5.45,54,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,16.88592,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Scapula (Pro Cah)Professional Component ,,73010,CPT,Professional,Both,,,26,54,45.9,5.45,54,BlueCross BlueShield Minnesota,High Value Network Plan,16.88592,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Scapula (Pro Cah)Professional Component ,,73010,CPT,Professional,Both,,,26,54,45.9,5.45,54,BlueCross BlueShield Minnesota,Medicare Advantage,9.9245,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Scapula (Pro Cah)Professional Component ,,73010,CPT,Professional,Both,,,26,54,45.9,5.45,54,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,16.88592,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Scapula (Pro Cah)Professional Component ,,73010,CPT,Professional,Both,,,26,54,45.9,5.45,54,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,6.28904,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Scapula (Pro Cah)Professional Component ,,73010,CPT,Professional,Both,,,26,54,45.9,5.45,54,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),9.9245,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Scapula (Pro Cah)Professional Component ,,73010,CPT,Professional,Both,,,26,54,45.9,5.45,54,CorVel,Worker's Compensation,17.0994669,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Xr Scapula (Pro Cah)Professional Component ,,73010,CPT,Professional,Both,,,26,54,45.9,5.45,54,First Health Group Corporation,First Health Network,52.38,97,,percent of total billed charges,,
Xr Scapula (Pro Cah)Professional Component ,,73010,CPT,Professional,Both,,,26,54,45.9,5.45,54,"Health Partners, Inc.",Commercial,12.89,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Xr Scapula (Pro Cah)Professional Component ,,73010,CPT,Professional,Both,,,26,54,45.9,5.45,54,"Health Partners, Inc.",Medicare Advantage,9.9245,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Scapula (Pro Cah)Professional Component ,,73010,CPT,Professional,Both,,,26,54,45.9,5.45,54,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),5.45,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Xr Scapula (Pro Cah)Professional Component ,,73010,CPT,Professional,Both,,,26,54,45.9,5.45,54,"Health Partners, Inc.",State of Minnesota Advantage Program,11.104735,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Xr Scapula (Pro Cah)Professional Component ,,73010,CPT,Professional,Both,,,26,54,45.9,5.45,54,"Health Partners, Inc.",State Public Programs,5.45,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Xr Scapula (Pro Cah)Professional Component ,,73010,CPT,Professional,Both,,,26,54,45.9,5.45,54,Humana Insurance Company,Commercial PPO,8.63,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Xr Scapula (Pro Cah)Professional Component ,,73010,CPT,Professional,Both,,,26,54,45.9,5.45,54,Humana Insurance Company,Medicare PPO,54,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Xr Scapula (Pro Cah)Professional Component ,,73010,CPT,Professional,Both,,,26,54,45.9,5.45,54,Medica,Individual & Family,45.792,84.8,,percent of total billed charges,,
Xr Scapula (Pro Cah)Professional Component ,,73010,CPT,Professional,Both,,,26,54,45.9,5.45,54,Medica,Medica Advantage Solution,26.892,49.8,,percent of total billed charges,,
Xr Scapula (Pro Cah)Professional Component ,,73010,CPT,Professional,Both,,,26,54,45.9,5.45,54,Medica,Medical Assistance,6.29,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Xr Scapula (Pro Cah)Professional Component ,,73010,CPT,Professional,Both,,,26,54,45.9,5.45,54,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,8.63,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Xr Scapula (Pro Cah)Professional Component ,,73010,CPT,Professional,Both,,,26,54,45.9,5.45,54,"Multiplan, Inc.","Multiplan, Inc.",50.76,94,,percent of total billed charges,,
Xr Scapula (Pro Cah)Professional Component ,,73010,CPT,Professional,Both,,,26,54,45.9,5.45,54,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,48.654,90.1,,percent of total billed charges,,
Xr Scapula (Pro Cah)Professional Component ,,73010,CPT,Professional,Both,,,26,54,45.9,5.45,54,"Preferred One Administrative Services, INC.",PPO,53.244,98.6,,percent of total billed charges,,
Xr Scapula (Pro Cah)Professional Component ,,73010,CPT,Professional,Both,,,26,54,45.9,5.45,54,PrimeWest Health,Minnesota Senior Health Options (MSHO),9.9245,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Scapula (Pro Cah)Professional Component ,,73010,CPT,Professional,Both,,,26,54,45.9,5.45,54,PrimeWest Health,MinnesotaCare,6.7292728,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Scapula (Pro Cah)Professional Component ,,73010,CPT,Professional,Both,,,26,54,45.9,5.45,54,Sanford Health Plan,Sanford Health Plan,47.52,88,,percent of total billed charges,,
Xr Scapula (Pro Cah)Professional Component ,,73010,CPT,Professional,Both,,,26,54,45.9,5.45,54,"UCare Health, Inc.",Individual & Family Plan,14.028928,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Xr Scapula (Pro Cah)Professional Component ,,73010,CPT,Professional,Both,,,26,54,45.9,5.45,54,"UCare Health, Inc.",Medical Assistance,6.917944,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Xr Scapula (Pro Cah)Professional Component ,,73010,CPT,Professional,Both,,,26,54,45.9,5.45,54,"UCare Health, Inc.",Medicare Advantage,9.9245,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Xr Scapula (Pro Cah)Professional Component ,,73010,CPT,Professional,Both,,,26,54,45.9,5.45,54,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),7.9396,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Xr Scapula (Pro Cah)Professional Component ,,73010,CPT,Professional,Both,,,26,54,45.9,5.45,54,UnitedHealthcare,Individual & Family,54,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Xr Scapula (Pro Cah)Professional Component ,,73010,CPT,Professional,Both,,,26,54,45.9,5.45,54,UnitedHealthcare,Medicare Advantage,9.9245,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Scapula (Pro Cah)Professional Component ,,73010,CPT,Professional,Both,,,26,54,45.9,5.45,54,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,6.28904,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Shoulder 1 View (Pro Cah)Professional Component ,,73020,CPT,Professional,Both,,,26,50,42.5,4.58,50,Aetna,Commercial,42.5,85,,percent of total billed charges,,
Xr Shoulder 1 View (Pro Cah)Professional Component ,,73020,CPT,Professional,Both,,,26,50,42.5,4.58,50,Aetna,Medicare Advantage,7.48,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Shoulder 1 View (Pro Cah)Professional Component ,,73020,CPT,Professional,Both,,,26,50,42.5,4.58,50,Aetna,PPO,46.5,93,,percent of total billed charges,,
Xr Shoulder 1 View (Pro Cah)Professional Component ,,73020,CPT,Professional,Both,,,26,50,42.5,4.58,50,America's PPO,America's PPO,42.72,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Xr Shoulder 1 View (Pro Cah)Professional Component ,,73020,CPT,Professional,Both,,,26,50,42.5,4.58,50,BlueCross BlueShield Minnesota, Federal Employee Program,14.06,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Xr Shoulder 1 View (Pro Cah)Professional Component ,,73020,CPT,Professional,Both,,,26,50,42.5,4.58,50,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,14.28496,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Shoulder 1 View (Pro Cah)Professional Component ,,73020,CPT,Professional,Both,,,26,50,42.5,4.58,50,BlueCross BlueShield Minnesota,High Value Network Plan,14.28496,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Shoulder 1 View (Pro Cah)Professional Component ,,73020,CPT,Professional,Both,,,26,50,42.5,4.58,50,BlueCross BlueShield Minnesota,Medicare Advantage,8.3605,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Shoulder 1 View (Pro Cah)Professional Component ,,73020,CPT,Professional,Both,,,26,50,42.5,4.58,50,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,14.28496,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Shoulder 1 View (Pro Cah)Professional Component ,,73020,CPT,Professional,Both,,,26,50,42.5,4.58,50,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,5.2832,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Shoulder 1 View (Pro Cah)Professional Component ,,73020,CPT,Professional,Both,,,26,50,42.5,4.58,50,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),8.3605,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Shoulder 1 View (Pro Cah)Professional Component ,,73020,CPT,Professional,Both,,,26,50,42.5,4.58,50,CorVel,Worker's Compensation,14.3952027,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Xr Shoulder 1 View (Pro Cah)Professional Component ,,73020,CPT,Professional,Both,,,26,50,42.5,4.58,50,First Health Group Corporation,First Health Network,48.5,97,,percent of total billed charges,,
Xr Shoulder 1 View (Pro Cah)Professional Component ,,73020,CPT,Professional,Both,,,26,50,42.5,4.58,50,"Health Partners, Inc.",Commercial,10.83,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Xr Shoulder 1 View (Pro Cah)Professional Component ,,73020,CPT,Professional,Both,,,26,50,42.5,4.58,50,"Health Partners, Inc.",Medicare Advantage,8.3605,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Shoulder 1 View (Pro Cah)Professional Component ,,73020,CPT,Professional,Both,,,26,50,42.5,4.58,50,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),4.58,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Xr Shoulder 1 View (Pro Cah)Professional Component ,,73020,CPT,Professional,Both,,,26,50,42.5,4.58,50,"Health Partners, Inc.",State of Minnesota Advantage Program,9.330045,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Xr Shoulder 1 View (Pro Cah)Professional Component ,,73020,CPT,Professional,Both,,,26,50,42.5,4.58,50,"Health Partners, Inc.",State Public Programs,4.58,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Xr Shoulder 1 View (Pro Cah)Professional Component ,,73020,CPT,Professional,Both,,,26,50,42.5,4.58,50,Humana Insurance Company,Commercial PPO,7.27,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Xr Shoulder 1 View (Pro Cah)Professional Component ,,73020,CPT,Professional,Both,,,26,50,42.5,4.58,50,Humana Insurance Company,Medicare PPO,50,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Xr Shoulder 1 View (Pro Cah)Professional Component ,,73020,CPT,Professional,Both,,,26,50,42.5,4.58,50,Medica,Individual & Family,42.4,84.8,,percent of total billed charges,,
Xr Shoulder 1 View (Pro Cah)Professional Component ,,73020,CPT,Professional,Both,,,26,50,42.5,4.58,50,Medica,Medica Advantage Solution,24.9,49.8,,percent of total billed charges,,
Xr Shoulder 1 View (Pro Cah)Professional Component ,,73020,CPT,Professional,Both,,,26,50,42.5,4.58,50,Medica,Medical Assistance,5.28,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Xr Shoulder 1 View (Pro Cah)Professional Component ,,73020,CPT,Professional,Both,,,26,50,42.5,4.58,50,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,7.27,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Xr Shoulder 1 View (Pro Cah)Professional Component ,,73020,CPT,Professional,Both,,,26,50,42.5,4.58,50,"Multiplan, Inc.","Multiplan, Inc.",47,94,,percent of total billed charges,,
Xr Shoulder 1 View (Pro Cah)Professional Component ,,73020,CPT,Professional,Both,,,26,50,42.5,4.58,50,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,45.05,90.1,,percent of total billed charges,,
Xr Shoulder 1 View (Pro Cah)Professional Component ,,73020,CPT,Professional,Both,,,26,50,42.5,4.58,50,"Preferred One Administrative Services, INC.",PPO,49.3,98.6,,percent of total billed charges,,
Xr Shoulder 1 View (Pro Cah)Professional Component ,,73020,CPT,Professional,Both,,,26,50,42.5,4.58,50,PrimeWest Health,Minnesota Senior Health Options (MSHO),8.3605,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Shoulder 1 View (Pro Cah)Professional Component ,,73020,CPT,Professional,Both,,,26,50,42.5,4.58,50,PrimeWest Health,MinnesotaCare,5.653024,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Shoulder 1 View (Pro Cah)Professional Component ,,73020,CPT,Professional,Both,,,26,50,42.5,4.58,50,Sanford Health Plan,Sanford Health Plan,44,88,,percent of total billed charges,,
Xr Shoulder 1 View (Pro Cah)Professional Component ,,73020,CPT,Professional,Both,,,26,50,42.5,4.58,50,"UCare Health, Inc.",Individual & Family Plan,11.818112,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Xr Shoulder 1 View (Pro Cah)Professional Component ,,73020,CPT,Professional,Both,,,26,50,42.5,4.58,50,"UCare Health, Inc.",Medical Assistance,5.81152,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Xr Shoulder 1 View (Pro Cah)Professional Component ,,73020,CPT,Professional,Both,,,26,50,42.5,4.58,50,"UCare Health, Inc.",Medicare Advantage,8.3605,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Xr Shoulder 1 View (Pro Cah)Professional Component ,,73020,CPT,Professional,Both,,,26,50,42.5,4.58,50,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),6.6884,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Xr Shoulder 1 View (Pro Cah)Professional Component ,,73020,CPT,Professional,Both,,,26,50,42.5,4.58,50,UnitedHealthcare,Individual & Family,50,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Xr Shoulder 1 View (Pro Cah)Professional Component ,,73020,CPT,Professional,Both,,,26,50,42.5,4.58,50,UnitedHealthcare,Medicare Advantage,8.3605,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Shoulder 1 View (Pro Cah)Professional Component ,,73020,CPT,Professional,Both,,,26,50,42.5,4.58,50,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,5.2832,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Shoulder Routine  2 Or More Views (Pro Cah)Professional Component ,,73030,CPT,Professional,Both,,,26,50,42.5,5.67,50,Aetna,Commercial,42.5,85,,percent of total billed charges,,
Xr Shoulder Routine  2 Or More Views (Pro Cah)Professional Component ,,73030,CPT,Professional,Both,,,26,50,42.5,5.67,50,Aetna,Medicare Advantage,9.23,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Shoulder Routine  2 Or More Views (Pro Cah)Professional Component ,,73030,CPT,Professional,Both,,,26,50,42.5,5.67,50,Aetna,PPO,46.5,93,,percent of total billed charges,,
Xr Shoulder Routine  2 Or More Views (Pro Cah)Professional Component ,,73030,CPT,Professional,Both,,,26,50,42.5,5.67,50,America's PPO,America's PPO,42.72,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Xr Shoulder Routine  2 Or More Views (Pro Cah)Professional Component ,,73030,CPT,Professional,Both,,,26,50,42.5,5.67,50,BlueCross BlueShield Minnesota, Federal Employee Program,17.26,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Xr Shoulder Routine  2 Or More Views (Pro Cah)Professional Component ,,73030,CPT,Professional,Both,,,26,50,42.5,5.67,50,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,17.53616,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Shoulder Routine  2 Or More Views (Pro Cah)Professional Component ,,73030,CPT,Professional,Both,,,26,50,42.5,5.67,50,BlueCross BlueShield Minnesota,High Value Network Plan,17.53616,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Shoulder Routine  2 Or More Views (Pro Cah)Professional Component ,,73030,CPT,Professional,Both,,,26,50,42.5,5.67,50,BlueCross BlueShield Minnesota,Medicare Advantage,10.3155,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Shoulder Routine  2 Or More Views (Pro Cah)Professional Component ,,73030,CPT,Professional,Both,,,26,50,42.5,5.67,50,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,17.53616,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Shoulder Routine  2 Or More Views (Pro Cah)Professional Component ,,73030,CPT,Professional,Both,,,26,50,42.5,5.67,50,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,6.54304,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Shoulder Routine  2 Or More Views (Pro Cah)Professional Component ,,73030,CPT,Professional,Both,,,26,50,42.5,5.67,50,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),10.3155,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Shoulder Routine  2 Or More Views (Pro Cah)Professional Component ,,73030,CPT,Professional,Both,,,26,50,42.5,5.67,50,CorVel,Worker's Compensation,17.7711669,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Xr Shoulder Routine  2 Or More Views (Pro Cah)Professional Component ,,73030,CPT,Professional,Both,,,26,50,42.5,5.67,50,First Health Group Corporation,First Health Network,48.5,97,,percent of total billed charges,,
Xr Shoulder Routine  2 Or More Views (Pro Cah)Professional Component ,,73030,CPT,Professional,Both,,,26,50,42.5,5.67,50,"Health Partners, Inc.",Commercial,13.41,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Xr Shoulder Routine  2 Or More Views (Pro Cah)Professional Component ,,73030,CPT,Professional,Both,,,26,50,42.5,5.67,50,"Health Partners, Inc.",Medicare Advantage,10.3155,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Shoulder Routine  2 Or More Views (Pro Cah)Professional Component ,,73030,CPT,Professional,Both,,,26,50,42.5,5.67,50,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),5.67,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Xr Shoulder Routine  2 Or More Views (Pro Cah)Professional Component ,,73030,CPT,Professional,Both,,,26,50,42.5,5.67,50,"Health Partners, Inc.",State of Minnesota Advantage Program,11.552715,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Xr Shoulder Routine  2 Or More Views (Pro Cah)Professional Component ,,73030,CPT,Professional,Both,,,26,50,42.5,5.67,50,"Health Partners, Inc.",State Public Programs,5.67,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Xr Shoulder Routine  2 Or More Views (Pro Cah)Professional Component ,,73030,CPT,Professional,Both,,,26,50,42.5,5.67,50,Humana Insurance Company,Commercial PPO,8.97,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Xr Shoulder Routine  2 Or More Views (Pro Cah)Professional Component ,,73030,CPT,Professional,Both,,,26,50,42.5,5.67,50,Humana Insurance Company,Medicare PPO,50,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Xr Shoulder Routine  2 Or More Views (Pro Cah)Professional Component ,,73030,CPT,Professional,Both,,,26,50,42.5,5.67,50,Medica,Individual & Family,42.4,84.8,,percent of total billed charges,,
Xr Shoulder Routine  2 Or More Views (Pro Cah)Professional Component ,,73030,CPT,Professional,Both,,,26,50,42.5,5.67,50,Medica,Medica Advantage Solution,24.9,49.8,,percent of total billed charges,,
Xr Shoulder Routine  2 Or More Views (Pro Cah)Professional Component ,,73030,CPT,Professional,Both,,,26,50,42.5,5.67,50,Medica,Medical Assistance,6.54,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Xr Shoulder Routine  2 Or More Views (Pro Cah)Professional Component ,,73030,CPT,Professional,Both,,,26,50,42.5,5.67,50,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,8.97,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Xr Shoulder Routine  2 Or More Views (Pro Cah)Professional Component ,,73030,CPT,Professional,Both,,,26,50,42.5,5.67,50,"Multiplan, Inc.","Multiplan, Inc.",47,94,,percent of total billed charges,,
Xr Shoulder Routine  2 Or More Views (Pro Cah)Professional Component ,,73030,CPT,Professional,Both,,,26,50,42.5,5.67,50,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,45.05,90.1,,percent of total billed charges,,
Xr Shoulder Routine  2 Or More Views (Pro Cah)Professional Component ,,73030,CPT,Professional,Both,,,26,50,42.5,5.67,50,"Preferred One Administrative Services, INC.",PPO,49.3,98.6,,percent of total billed charges,,
Xr Shoulder Routine  2 Or More Views (Pro Cah)Professional Component ,,73030,CPT,Professional,Both,,,26,50,42.5,5.67,50,PrimeWest Health,Minnesota Senior Health Options (MSHO),10.3155,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Shoulder Routine  2 Or More Views (Pro Cah)Professional Component ,,73030,CPT,Professional,Both,,,26,50,42.5,5.67,50,PrimeWest Health,MinnesotaCare,7.0010528,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Shoulder Routine  2 Or More Views (Pro Cah)Professional Component ,,73030,CPT,Professional,Both,,,26,50,42.5,5.67,50,Sanford Health Plan,Sanford Health Plan,44,88,,percent of total billed charges,,
Xr Shoulder Routine  2 Or More Views (Pro Cah)Professional Component ,,73030,CPT,Professional,Both,,,26,50,42.5,5.67,50,"UCare Health, Inc.",Individual & Family Plan,14.581632,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Xr Shoulder Routine  2 Or More Views (Pro Cah)Professional Component ,,73030,CPT,Professional,Both,,,26,50,42.5,5.67,50,"UCare Health, Inc.",Medical Assistance,7.197344,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Xr Shoulder Routine  2 Or More Views (Pro Cah)Professional Component ,,73030,CPT,Professional,Both,,,26,50,42.5,5.67,50,"UCare Health, Inc.",Medicare Advantage,10.3155,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Xr Shoulder Routine  2 Or More Views (Pro Cah)Professional Component ,,73030,CPT,Professional,Both,,,26,50,42.5,5.67,50,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),8.2524,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Xr Shoulder Routine  2 Or More Views (Pro Cah)Professional Component ,,73030,CPT,Professional,Both,,,26,50,42.5,5.67,50,UnitedHealthcare,Individual & Family,50,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Xr Shoulder Routine  2 Or More Views (Pro Cah)Professional Component ,,73030,CPT,Professional,Both,,,26,50,42.5,5.67,50,UnitedHealthcare,Medicare Advantage,10.3155,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Shoulder Routine  2 Or More Views (Pro Cah)Professional Component ,,73030,CPT,Professional,Both,,,26,50,42.5,5.67,50,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,6.54304,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Acromioclavicular Joints (Pro Cah)Professional Component ,,73050,CPT,Professional,Both,,,26,55,46.75,5.67,55,Aetna,Commercial,46.75,85,,percent of total billed charges,,
Xr Acromioclavicular Joints (Pro Cah)Professional Component ,,73050,CPT,Professional,Both,,,26,55,46.75,5.67,55,Aetna,Medicare Advantage,9.23,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Acromioclavicular Joints (Pro Cah)Professional Component ,,73050,CPT,Professional,Both,,,26,55,46.75,5.67,55,Aetna,PPO,51.15,93,,percent of total billed charges,,
Xr Acromioclavicular Joints (Pro Cah)Professional Component ,,73050,CPT,Professional,Both,,,26,55,46.75,5.67,55,America's PPO,America's PPO,46.992,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Xr Acromioclavicular Joints (Pro Cah)Professional Component ,,73050,CPT,Professional,Both,,,26,55,46.75,5.67,55,BlueCross BlueShield Minnesota, Federal Employee Program,17.26,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Xr Acromioclavicular Joints (Pro Cah)Professional Component ,,73050,CPT,Professional,Both,,,26,55,46.75,5.67,55,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,17.53616,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Acromioclavicular Joints (Pro Cah)Professional Component ,,73050,CPT,Professional,Both,,,26,55,46.75,5.67,55,BlueCross BlueShield Minnesota,High Value Network Plan,17.53616,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Acromioclavicular Joints (Pro Cah)Professional Component ,,73050,CPT,Professional,Both,,,26,55,46.75,5.67,55,BlueCross BlueShield Minnesota,Medicare Advantage,10.3155,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Acromioclavicular Joints (Pro Cah)Professional Component ,,73050,CPT,Professional,Both,,,26,55,46.75,5.67,55,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,17.53616,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Acromioclavicular Joints (Pro Cah)Professional Component ,,73050,CPT,Professional,Both,,,26,55,46.75,5.67,55,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,6.54304,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Acromioclavicular Joints (Pro Cah)Professional Component ,,73050,CPT,Professional,Both,,,26,55,46.75,5.67,55,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),10.3155,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Acromioclavicular Joints (Pro Cah)Professional Component ,,73050,CPT,Professional,Both,,,26,55,46.75,5.67,55,CorVel,Worker's Compensation,17.7711669,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Xr Acromioclavicular Joints (Pro Cah)Professional Component ,,73050,CPT,Professional,Both,,,26,55,46.75,5.67,55,First Health Group Corporation,First Health Network,53.35,97,,percent of total billed charges,,
Xr Acromioclavicular Joints (Pro Cah)Professional Component ,,73050,CPT,Professional,Both,,,26,55,46.75,5.67,55,"Health Partners, Inc.",Commercial,13.41,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Xr Acromioclavicular Joints (Pro Cah)Professional Component ,,73050,CPT,Professional,Both,,,26,55,46.75,5.67,55,"Health Partners, Inc.",Medicare Advantage,10.3155,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Acromioclavicular Joints (Pro Cah)Professional Component ,,73050,CPT,Professional,Both,,,26,55,46.75,5.67,55,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),5.67,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Xr Acromioclavicular Joints (Pro Cah)Professional Component ,,73050,CPT,Professional,Both,,,26,55,46.75,5.67,55,"Health Partners, Inc.",State of Minnesota Advantage Program,11.552715,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Xr Acromioclavicular Joints (Pro Cah)Professional Component ,,73050,CPT,Professional,Both,,,26,55,46.75,5.67,55,"Health Partners, Inc.",State Public Programs,5.67,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Xr Acromioclavicular Joints (Pro Cah)Professional Component ,,73050,CPT,Professional,Both,,,26,55,46.75,5.67,55,Humana Insurance Company,Commercial PPO,8.97,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Xr Acromioclavicular Joints (Pro Cah)Professional Component ,,73050,CPT,Professional,Both,,,26,55,46.75,5.67,55,Humana Insurance Company,Medicare PPO,55,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Xr Acromioclavicular Joints (Pro Cah)Professional Component ,,73050,CPT,Professional,Both,,,26,55,46.75,5.67,55,Medica,Individual & Family,46.64,84.8,,percent of total billed charges,,
Xr Acromioclavicular Joints (Pro Cah)Professional Component ,,73050,CPT,Professional,Both,,,26,55,46.75,5.67,55,Medica,Medica Advantage Solution,27.39,49.8,,percent of total billed charges,,
Xr Acromioclavicular Joints (Pro Cah)Professional Component ,,73050,CPT,Professional,Both,,,26,55,46.75,5.67,55,Medica,Medical Assistance,6.54,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Xr Acromioclavicular Joints (Pro Cah)Professional Component ,,73050,CPT,Professional,Both,,,26,55,46.75,5.67,55,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,8.97,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Xr Acromioclavicular Joints (Pro Cah)Professional Component ,,73050,CPT,Professional,Both,,,26,55,46.75,5.67,55,"Multiplan, Inc.","Multiplan, Inc.",51.7,94,,percent of total billed charges,,
Xr Acromioclavicular Joints (Pro Cah)Professional Component ,,73050,CPT,Professional,Both,,,26,55,46.75,5.67,55,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,49.555,90.1,,percent of total billed charges,,
Xr Acromioclavicular Joints (Pro Cah)Professional Component ,,73050,CPT,Professional,Both,,,26,55,46.75,5.67,55,"Preferred One Administrative Services, INC.",PPO,54.23,98.6,,percent of total billed charges,,
Xr Acromioclavicular Joints (Pro Cah)Professional Component ,,73050,CPT,Professional,Both,,,26,55,46.75,5.67,55,PrimeWest Health,Minnesota Senior Health Options (MSHO),10.3155,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Acromioclavicular Joints (Pro Cah)Professional Component ,,73050,CPT,Professional,Both,,,26,55,46.75,5.67,55,PrimeWest Health,MinnesotaCare,7.0010528,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Acromioclavicular Joints (Pro Cah)Professional Component ,,73050,CPT,Professional,Both,,,26,55,46.75,5.67,55,Sanford Health Plan,Sanford Health Plan,48.4,88,,percent of total billed charges,,
Xr Acromioclavicular Joints (Pro Cah)Professional Component ,,73050,CPT,Professional,Both,,,26,55,46.75,5.67,55,"UCare Health, Inc.",Individual & Family Plan,14.581632,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Xr Acromioclavicular Joints (Pro Cah)Professional Component ,,73050,CPT,Professional,Both,,,26,55,46.75,5.67,55,"UCare Health, Inc.",Medical Assistance,7.197344,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Xr Acromioclavicular Joints (Pro Cah)Professional Component ,,73050,CPT,Professional,Both,,,26,55,46.75,5.67,55,"UCare Health, Inc.",Medicare Advantage,10.3155,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Xr Acromioclavicular Joints (Pro Cah)Professional Component ,,73050,CPT,Professional,Both,,,26,55,46.75,5.67,55,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),8.2524,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Xr Acromioclavicular Joints (Pro Cah)Professional Component ,,73050,CPT,Professional,Both,,,26,55,46.75,5.67,55,UnitedHealthcare,Individual & Family,55,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Xr Acromioclavicular Joints (Pro Cah)Professional Component ,,73050,CPT,Professional,Both,,,26,55,46.75,5.67,55,UnitedHealthcare,Medicare Advantage,10.3155,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Acromioclavicular Joints (Pro Cah)Professional Component ,,73050,CPT,Professional,Both,,,26,55,46.75,5.67,55,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,6.54304,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Humerus Routine 2 Views (Pro Cah)Professional Component ,,73060,CPT,Professional,Both,,,26,45,38.25,5.02,45,Aetna,Commercial,38.25,85,,percent of total billed charges,,
Xr Humerus Routine 2 Views (Pro Cah)Professional Component ,,73060,CPT,Professional,Both,,,26,45,38.25,5.02,45,Aetna,Medicare Advantage,8.18,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Humerus Routine 2 Views (Pro Cah)Professional Component ,,73060,CPT,Professional,Both,,,26,45,38.25,5.02,45,Aetna,PPO,41.85,93,,percent of total billed charges,,
Xr Humerus Routine 2 Views (Pro Cah)Professional Component ,,73060,CPT,Professional,Both,,,26,45,38.25,5.02,45,America's PPO,America's PPO,38.448,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Xr Humerus Routine 2 Views (Pro Cah)Professional Component ,,73060,CPT,Professional,Both,,,26,45,38.25,5.02,45,BlueCross BlueShield Minnesota, Federal Employee Program,15.34,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Xr Humerus Routine 2 Views (Pro Cah)Professional Component ,,73060,CPT,Professional,Both,,,26,45,38.25,5.02,45,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,15.58544,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Humerus Routine 2 Views (Pro Cah)Professional Component ,,73060,CPT,Professional,Both,,,26,45,38.25,5.02,45,BlueCross BlueShield Minnesota,High Value Network Plan,15.58544,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Humerus Routine 2 Views (Pro Cah)Professional Component ,,73060,CPT,Professional,Both,,,26,45,38.25,5.02,45,BlueCross BlueShield Minnesota,Medicare Advantage,9.1425,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Humerus Routine 2 Views (Pro Cah)Professional Component ,,73060,CPT,Professional,Both,,,26,45,38.25,5.02,45,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,15.58544,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Humerus Routine 2 Views (Pro Cah)Professional Component ,,73060,CPT,Professional,Both,,,26,45,38.25,5.02,45,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,5.7912,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Humerus Routine 2 Views (Pro Cah)Professional Component ,,73060,CPT,Professional,Both,,,26,45,38.25,5.02,45,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),9.1425,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Humerus Routine 2 Views (Pro Cah)Professional Component ,,73060,CPT,Professional,Both,,,26,45,38.25,5.02,45,CorVel,Worker's Compensation,15.0669027,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Xr Humerus Routine 2 Views (Pro Cah)Professional Component ,,73060,CPT,Professional,Both,,,26,45,38.25,5.02,45,First Health Group Corporation,First Health Network,43.65,97,,percent of total billed charges,,
Xr Humerus Routine 2 Views (Pro Cah)Professional Component ,,73060,CPT,Professional,Both,,,26,45,38.25,5.02,45,"Health Partners, Inc.",Commercial,11.35,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Xr Humerus Routine 2 Views (Pro Cah)Professional Component ,,73060,CPT,Professional,Both,,,26,45,38.25,5.02,45,"Health Partners, Inc.",Medicare Advantage,9.1425,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Humerus Routine 2 Views (Pro Cah)Professional Component ,,73060,CPT,Professional,Both,,,26,45,38.25,5.02,45,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),5.02,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Xr Humerus Routine 2 Views (Pro Cah)Professional Component ,,73060,CPT,Professional,Both,,,26,45,38.25,5.02,45,"Health Partners, Inc.",State of Minnesota Advantage Program,9.778025,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Xr Humerus Routine 2 Views (Pro Cah)Professional Component ,,73060,CPT,Professional,Both,,,26,45,38.25,5.02,45,"Health Partners, Inc.",State Public Programs,5.02,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Xr Humerus Routine 2 Views (Pro Cah)Professional Component ,,73060,CPT,Professional,Both,,,26,45,38.25,5.02,45,Humana Insurance Company,Commercial PPO,7.95,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Xr Humerus Routine 2 Views (Pro Cah)Professional Component ,,73060,CPT,Professional,Both,,,26,45,38.25,5.02,45,Humana Insurance Company,Medicare PPO,45,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Xr Humerus Routine 2 Views (Pro Cah)Professional Component ,,73060,CPT,Professional,Both,,,26,45,38.25,5.02,45,Medica,Individual & Family,38.16,84.8,,percent of total billed charges,,
Xr Humerus Routine 2 Views (Pro Cah)Professional Component ,,73060,CPT,Professional,Both,,,26,45,38.25,5.02,45,Medica,Medica Advantage Solution,22.41,49.8,,percent of total billed charges,,
Xr Humerus Routine 2 Views (Pro Cah)Professional Component ,,73060,CPT,Professional,Both,,,26,45,38.25,5.02,45,Medica,Medical Assistance,5.79,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Xr Humerus Routine 2 Views (Pro Cah)Professional Component ,,73060,CPT,Professional,Both,,,26,45,38.25,5.02,45,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,7.95,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Xr Humerus Routine 2 Views (Pro Cah)Professional Component ,,73060,CPT,Professional,Both,,,26,45,38.25,5.02,45,"Multiplan, Inc.","Multiplan, Inc.",42.3,94,,percent of total billed charges,,
Xr Humerus Routine 2 Views (Pro Cah)Professional Component ,,73060,CPT,Professional,Both,,,26,45,38.25,5.02,45,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,40.545,90.1,,percent of total billed charges,,
Xr Humerus Routine 2 Views (Pro Cah)Professional Component ,,73060,CPT,Professional,Both,,,26,45,38.25,5.02,45,"Preferred One Administrative Services, INC.",PPO,44.37,98.6,,percent of total billed charges,,
Xr Humerus Routine 2 Views (Pro Cah)Professional Component ,,73060,CPT,Professional,Both,,,26,45,38.25,5.02,45,PrimeWest Health,Minnesota Senior Health Options (MSHO),9.1425,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Humerus Routine 2 Views (Pro Cah)Professional Component ,,73060,CPT,Professional,Both,,,26,45,38.25,5.02,45,PrimeWest Health,MinnesotaCare,6.196584,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Humerus Routine 2 Views (Pro Cah)Professional Component ,,73060,CPT,Professional,Both,,,26,45,38.25,5.02,45,Sanford Health Plan,Sanford Health Plan,39.6,88,,percent of total billed charges,,
Xr Humerus Routine 2 Views (Pro Cah)Professional Component ,,73060,CPT,Professional,Both,,,26,45,38.25,5.02,45,"UCare Health, Inc.",Individual & Family Plan,12.92352,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Xr Humerus Routine 2 Views (Pro Cah)Professional Component ,,73060,CPT,Professional,Both,,,26,45,38.25,5.02,45,"UCare Health, Inc.",Medical Assistance,6.37032,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Xr Humerus Routine 2 Views (Pro Cah)Professional Component ,,73060,CPT,Professional,Both,,,26,45,38.25,5.02,45,"UCare Health, Inc.",Medicare Advantage,9.1425,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Xr Humerus Routine 2 Views (Pro Cah)Professional Component ,,73060,CPT,Professional,Both,,,26,45,38.25,5.02,45,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),7.314,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Xr Humerus Routine 2 Views (Pro Cah)Professional Component ,,73060,CPT,Professional,Both,,,26,45,38.25,5.02,45,UnitedHealthcare,Individual & Family,45,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Xr Humerus Routine 2 Views (Pro Cah)Professional Component ,,73060,CPT,Professional,Both,,,26,45,38.25,5.02,45,UnitedHealthcare,Medicare Advantage,9.1425,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Humerus Routine 2 Views (Pro Cah)Professional Component ,,73060,CPT,Professional,Both,,,26,45,38.25,5.02,45,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,5.7912,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Elbow 2 Views (Pro Cah)Professional Component ,,73070,CPT,Professional,Both,,,26,45,38.25,5.02,45,Aetna,Commercial,38.25,85,,percent of total billed charges,,
Xr Elbow 2 Views (Pro Cah)Professional Component ,,73070,CPT,Professional,Both,,,26,45,38.25,5.02,45,Aetna,Medicare Advantage,8.18,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Elbow 2 Views (Pro Cah)Professional Component ,,73070,CPT,Professional,Both,,,26,45,38.25,5.02,45,Aetna,PPO,41.85,93,,percent of total billed charges,,
Xr Elbow 2 Views (Pro Cah)Professional Component ,,73070,CPT,Professional,Both,,,26,45,38.25,5.02,45,America's PPO,America's PPO,38.448,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Xr Elbow 2 Views (Pro Cah)Professional Component ,,73070,CPT,Professional,Both,,,26,45,38.25,5.02,45,BlueCross BlueShield Minnesota, Federal Employee Program,15.34,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Xr Elbow 2 Views (Pro Cah)Professional Component ,,73070,CPT,Professional,Both,,,26,45,38.25,5.02,45,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,15.58544,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Elbow 2 Views (Pro Cah)Professional Component ,,73070,CPT,Professional,Both,,,26,45,38.25,5.02,45,BlueCross BlueShield Minnesota,High Value Network Plan,15.58544,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Elbow 2 Views (Pro Cah)Professional Component ,,73070,CPT,Professional,Both,,,26,45,38.25,5.02,45,BlueCross BlueShield Minnesota,Medicare Advantage,9.1425,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Elbow 2 Views (Pro Cah)Professional Component ,,73070,CPT,Professional,Both,,,26,45,38.25,5.02,45,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,15.58544,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Elbow 2 Views (Pro Cah)Professional Component ,,73070,CPT,Professional,Both,,,26,45,38.25,5.02,45,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,5.7912,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Elbow 2 Views (Pro Cah)Professional Component ,,73070,CPT,Professional,Both,,,26,45,38.25,5.02,45,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),9.1425,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Elbow 2 Views (Pro Cah)Professional Component ,,73070,CPT,Professional,Both,,,26,45,38.25,5.02,45,CorVel,Worker's Compensation,15.7473348,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Xr Elbow 2 Views (Pro Cah)Professional Component ,,73070,CPT,Professional,Both,,,26,45,38.25,5.02,45,First Health Group Corporation,First Health Network,43.65,97,,percent of total billed charges,,
Xr Elbow 2 Views (Pro Cah)Professional Component ,,73070,CPT,Professional,Both,,,26,45,38.25,5.02,45,"Health Partners, Inc.",Commercial,11.86,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Xr Elbow 2 Views (Pro Cah)Professional Component ,,73070,CPT,Professional,Both,,,26,45,38.25,5.02,45,"Health Partners, Inc.",Medicare Advantage,9.1425,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Elbow 2 Views (Pro Cah)Professional Component ,,73070,CPT,Professional,Both,,,26,45,38.25,5.02,45,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),5.02,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Xr Elbow 2 Views (Pro Cah)Professional Component ,,73070,CPT,Professional,Both,,,26,45,38.25,5.02,45,"Health Partners, Inc.",State of Minnesota Advantage Program,10.21739,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Xr Elbow 2 Views (Pro Cah)Professional Component ,,73070,CPT,Professional,Both,,,26,45,38.25,5.02,45,"Health Partners, Inc.",State Public Programs,5.02,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Xr Elbow 2 Views (Pro Cah)Professional Component ,,73070,CPT,Professional,Both,,,26,45,38.25,5.02,45,Humana Insurance Company,Commercial PPO,7.95,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Xr Elbow 2 Views (Pro Cah)Professional Component ,,73070,CPT,Professional,Both,,,26,45,38.25,5.02,45,Humana Insurance Company,Medicare PPO,45,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Xr Elbow 2 Views (Pro Cah)Professional Component ,,73070,CPT,Professional,Both,,,26,45,38.25,5.02,45,Medica,Individual & Family,38.16,84.8,,percent of total billed charges,,
Xr Elbow 2 Views (Pro Cah)Professional Component ,,73070,CPT,Professional,Both,,,26,45,38.25,5.02,45,Medica,Medica Advantage Solution,22.41,49.8,,percent of total billed charges,,
Xr Elbow 2 Views (Pro Cah)Professional Component ,,73070,CPT,Professional,Both,,,26,45,38.25,5.02,45,Medica,Medical Assistance,5.79,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Xr Elbow 2 Views (Pro Cah)Professional Component ,,73070,CPT,Professional,Both,,,26,45,38.25,5.02,45,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,7.95,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Xr Elbow 2 Views (Pro Cah)Professional Component ,,73070,CPT,Professional,Both,,,26,45,38.25,5.02,45,"Multiplan, Inc.","Multiplan, Inc.",42.3,94,,percent of total billed charges,,
Xr Elbow 2 Views (Pro Cah)Professional Component ,,73070,CPT,Professional,Both,,,26,45,38.25,5.02,45,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,40.545,90.1,,percent of total billed charges,,
Xr Elbow 2 Views (Pro Cah)Professional Component ,,73070,CPT,Professional,Both,,,26,45,38.25,5.02,45,"Preferred One Administrative Services, INC.",PPO,44.37,98.6,,percent of total billed charges,,
Xr Elbow 2 Views (Pro Cah)Professional Component ,,73070,CPT,Professional,Both,,,26,45,38.25,5.02,45,PrimeWest Health,Minnesota Senior Health Options (MSHO),9.1425,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Elbow 2 Views (Pro Cah)Professional Component ,,73070,CPT,Professional,Both,,,26,45,38.25,5.02,45,PrimeWest Health,MinnesotaCare,6.196584,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Elbow 2 Views (Pro Cah)Professional Component ,,73070,CPT,Professional,Both,,,26,45,38.25,5.02,45,Sanford Health Plan,Sanford Health Plan,39.6,88,,percent of total billed charges,,
Xr Elbow 2 Views (Pro Cah)Professional Component ,,73070,CPT,Professional,Both,,,26,45,38.25,5.02,45,"UCare Health, Inc.",Individual & Family Plan,12.92352,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Xr Elbow 2 Views (Pro Cah)Professional Component ,,73070,CPT,Professional,Both,,,26,45,38.25,5.02,45,"UCare Health, Inc.",Medical Assistance,6.37032,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Xr Elbow 2 Views (Pro Cah)Professional Component ,,73070,CPT,Professional,Both,,,26,45,38.25,5.02,45,"UCare Health, Inc.",Medicare Advantage,9.1425,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Xr Elbow 2 Views (Pro Cah)Professional Component ,,73070,CPT,Professional,Both,,,26,45,38.25,5.02,45,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),7.314,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Xr Elbow 2 Views (Pro Cah)Professional Component ,,73070,CPT,Professional,Both,,,26,45,38.25,5.02,45,UnitedHealthcare,Individual & Family,45,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Xr Elbow 2 Views (Pro Cah)Professional Component ,,73070,CPT,Professional,Both,,,26,45,38.25,5.02,45,UnitedHealthcare,Medicare Advantage,9.1425,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Elbow 2 Views (Pro Cah)Professional Component ,,73070,CPT,Professional,Both,,,26,45,38.25,5.02,45,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,5.7912,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Elbow Routine 3 Views (Pro Cah)Professional Component ,,73080,CPT,Professional,Both,,,26,51,43.35,5.23,51,Aetna,Commercial,43.35,85,,percent of total billed charges,,
Xr Elbow Routine 3 Views (Pro Cah)Professional Component ,,73080,CPT,Professional,Both,,,26,51,43.35,5.23,51,Aetna,Medicare Advantage,8.53,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Elbow Routine 3 Views (Pro Cah)Professional Component ,,73080,CPT,Professional,Both,,,26,51,43.35,5.23,51,Aetna,PPO,47.43,93,,percent of total billed charges,,
Xr Elbow Routine 3 Views (Pro Cah)Professional Component ,,73080,CPT,Professional,Both,,,26,51,43.35,5.23,51,America's PPO,America's PPO,43.5744,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Xr Elbow Routine 3 Views (Pro Cah)Professional Component ,,73080,CPT,Professional,Both,,,26,51,43.35,5.23,51,BlueCross BlueShield Minnesota, Federal Employee Program,15.98,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Xr Elbow Routine 3 Views (Pro Cah)Professional Component ,,73080,CPT,Professional,Both,,,26,51,43.35,5.23,51,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,16.23568,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Elbow Routine 3 Views (Pro Cah)Professional Component ,,73080,CPT,Professional,Both,,,26,51,43.35,5.23,51,BlueCross BlueShield Minnesota,High Value Network Plan,16.23568,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Elbow Routine 3 Views (Pro Cah)Professional Component ,,73080,CPT,Professional,Both,,,26,51,43.35,5.23,51,BlueCross BlueShield Minnesota,Medicare Advantage,9.5335,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Elbow Routine 3 Views (Pro Cah)Professional Component ,,73080,CPT,Professional,Both,,,26,51,43.35,5.23,51,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,16.23568,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Elbow Routine 3 Views (Pro Cah)Professional Component ,,73080,CPT,Professional,Both,,,26,51,43.35,5.23,51,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,6.03504,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Elbow Routine 3 Views (Pro Cah)Professional Component ,,73080,CPT,Professional,Both,,,26,51,43.35,5.23,51,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),9.5335,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Elbow Routine 3 Views (Pro Cah)Professional Component ,,73080,CPT,Professional,Both,,,26,51,43.35,5.23,51,CorVel,Worker's Compensation,16.4190348,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Xr Elbow Routine 3 Views (Pro Cah)Professional Component ,,73080,CPT,Professional,Both,,,26,51,43.35,5.23,51,First Health Group Corporation,First Health Network,49.47,97,,percent of total billed charges,,
Xr Elbow Routine 3 Views (Pro Cah)Professional Component ,,73080,CPT,Professional,Both,,,26,51,43.35,5.23,51,"Health Partners, Inc.",Commercial,12.37,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Xr Elbow Routine 3 Views (Pro Cah)Professional Component ,,73080,CPT,Professional,Both,,,26,51,43.35,5.23,51,"Health Partners, Inc.",Medicare Advantage,9.5335,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Elbow Routine 3 Views (Pro Cah)Professional Component ,,73080,CPT,Professional,Both,,,26,51,43.35,5.23,51,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),5.23,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Xr Elbow Routine 3 Views (Pro Cah)Professional Component ,,73080,CPT,Professional,Both,,,26,51,43.35,5.23,51,"Health Partners, Inc.",State of Minnesota Advantage Program,10.656755,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Xr Elbow Routine 3 Views (Pro Cah)Professional Component ,,73080,CPT,Professional,Both,,,26,51,43.35,5.23,51,"Health Partners, Inc.",State Public Programs,5.23,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Xr Elbow Routine 3 Views (Pro Cah)Professional Component ,,73080,CPT,Professional,Both,,,26,51,43.35,5.23,51,Humana Insurance Company,Commercial PPO,8.29,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Xr Elbow Routine 3 Views (Pro Cah)Professional Component ,,73080,CPT,Professional,Both,,,26,51,43.35,5.23,51,Humana Insurance Company,Medicare PPO,51,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Xr Elbow Routine 3 Views (Pro Cah)Professional Component ,,73080,CPT,Professional,Both,,,26,51,43.35,5.23,51,Medica,Individual & Family,43.248,84.8,,percent of total billed charges,,
Xr Elbow Routine 3 Views (Pro Cah)Professional Component ,,73080,CPT,Professional,Both,,,26,51,43.35,5.23,51,Medica,Medica Advantage Solution,25.398,49.8,,percent of total billed charges,,
Xr Elbow Routine 3 Views (Pro Cah)Professional Component ,,73080,CPT,Professional,Both,,,26,51,43.35,5.23,51,Medica,Medical Assistance,6.04,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Xr Elbow Routine 3 Views (Pro Cah)Professional Component ,,73080,CPT,Professional,Both,,,26,51,43.35,5.23,51,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,8.29,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Xr Elbow Routine 3 Views (Pro Cah)Professional Component ,,73080,CPT,Professional,Both,,,26,51,43.35,5.23,51,"Multiplan, Inc.","Multiplan, Inc.",47.94,94,,percent of total billed charges,,
Xr Elbow Routine 3 Views (Pro Cah)Professional Component ,,73080,CPT,Professional,Both,,,26,51,43.35,5.23,51,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,45.951,90.1,,percent of total billed charges,,
Xr Elbow Routine 3 Views (Pro Cah)Professional Component ,,73080,CPT,Professional,Both,,,26,51,43.35,5.23,51,"Preferred One Administrative Services, INC.",PPO,50.286,98.6,,percent of total billed charges,,
Xr Elbow Routine 3 Views (Pro Cah)Professional Component ,,73080,CPT,Professional,Both,,,26,51,43.35,5.23,51,PrimeWest Health,Minnesota Senior Health Options (MSHO),9.5335,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Elbow Routine 3 Views (Pro Cah)Professional Component ,,73080,CPT,Professional,Both,,,26,51,43.35,5.23,51,PrimeWest Health,MinnesotaCare,6.4574928,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Elbow Routine 3 Views (Pro Cah)Professional Component ,,73080,CPT,Professional,Both,,,26,51,43.35,5.23,51,Sanford Health Plan,Sanford Health Plan,44.88,88,,percent of total billed charges,,
Xr Elbow Routine 3 Views (Pro Cah)Professional Component ,,73080,CPT,Professional,Both,,,26,51,43.35,5.23,51,"UCare Health, Inc.",Individual & Family Plan,13.476224,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Xr Elbow Routine 3 Views (Pro Cah)Professional Component ,,73080,CPT,Professional,Both,,,26,51,43.35,5.23,51,"UCare Health, Inc.",Medical Assistance,6.638544,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Xr Elbow Routine 3 Views (Pro Cah)Professional Component ,,73080,CPT,Professional,Both,,,26,51,43.35,5.23,51,"UCare Health, Inc.",Medicare Advantage,9.5335,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Xr Elbow Routine 3 Views (Pro Cah)Professional Component ,,73080,CPT,Professional,Both,,,26,51,43.35,5.23,51,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),7.6268,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Xr Elbow Routine 3 Views (Pro Cah)Professional Component ,,73080,CPT,Professional,Both,,,26,51,43.35,5.23,51,UnitedHealthcare,Individual & Family,51,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Xr Elbow Routine 3 Views (Pro Cah)Professional Component ,,73080,CPT,Professional,Both,,,26,51,43.35,5.23,51,UnitedHealthcare,Medicare Advantage,9.5335,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Elbow Routine 3 Views (Pro Cah)Professional Component ,,73080,CPT,Professional,Both,,,26,51,43.35,5.23,51,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,6.03504,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Forearm Routine 2 Views (Pro Cah)Professional Component ,,73090,CPT,Professional,Both,,,26,45,38.25,4.8,45,Aetna,Commercial,38.25,85,,percent of total billed charges,,
Xr Forearm Routine 2 Views (Pro Cah)Professional Component ,,73090,CPT,Professional,Both,,,26,45,38.25,4.8,45,Aetna,Medicare Advantage,7.83,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Forearm Routine 2 Views (Pro Cah)Professional Component ,,73090,CPT,Professional,Both,,,26,45,38.25,4.8,45,Aetna,PPO,41.85,93,,percent of total billed charges,,
Xr Forearm Routine 2 Views (Pro Cah)Professional Component ,,73090,CPT,Professional,Both,,,26,45,38.25,4.8,45,America's PPO,America's PPO,38.448,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Xr Forearm Routine 2 Views (Pro Cah)Professional Component ,,73090,CPT,Professional,Both,,,26,45,38.25,4.8,45,BlueCross BlueShield Minnesota, Federal Employee Program,14.7,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Xr Forearm Routine 2 Views (Pro Cah)Professional Component ,,73090,CPT,Professional,Both,,,26,45,38.25,4.8,45,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,14.9352,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Forearm Routine 2 Views (Pro Cah)Professional Component ,,73090,CPT,Professional,Both,,,26,45,38.25,4.8,45,BlueCross BlueShield Minnesota,High Value Network Plan,14.9352,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Forearm Routine 2 Views (Pro Cah)Professional Component ,,73090,CPT,Professional,Both,,,26,45,38.25,4.8,45,BlueCross BlueShield Minnesota,Medicare Advantage,8.74,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Forearm Routine 2 Views (Pro Cah)Professional Component ,,73090,CPT,Professional,Both,,,26,45,38.25,4.8,45,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,14.9352,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Forearm Routine 2 Views (Pro Cah)Professional Component ,,73090,CPT,Professional,Both,,,26,45,38.25,4.8,45,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,5.5372,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Forearm Routine 2 Views (Pro Cah)Professional Component ,,73090,CPT,Professional,Both,,,26,45,38.25,4.8,45,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),8.74,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Forearm Routine 2 Views (Pro Cah)Professional Component ,,73090,CPT,Professional,Both,,,26,45,38.25,4.8,45,CorVel,Worker's Compensation,15.0669027,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Xr Forearm Routine 2 Views (Pro Cah)Professional Component ,,73090,CPT,Professional,Both,,,26,45,38.25,4.8,45,First Health Group Corporation,First Health Network,43.65,97,,percent of total billed charges,,
Xr Forearm Routine 2 Views (Pro Cah)Professional Component ,,73090,CPT,Professional,Both,,,26,45,38.25,4.8,45,"Health Partners, Inc.",Commercial,11.35,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Xr Forearm Routine 2 Views (Pro Cah)Professional Component ,,73090,CPT,Professional,Both,,,26,45,38.25,4.8,45,"Health Partners, Inc.",Medicare Advantage,8.74,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Forearm Routine 2 Views (Pro Cah)Professional Component ,,73090,CPT,Professional,Both,,,26,45,38.25,4.8,45,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),4.8,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Xr Forearm Routine 2 Views (Pro Cah)Professional Component ,,73090,CPT,Professional,Both,,,26,45,38.25,4.8,45,"Health Partners, Inc.",State of Minnesota Advantage Program,9.778025,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Xr Forearm Routine 2 Views (Pro Cah)Professional Component ,,73090,CPT,Professional,Both,,,26,45,38.25,4.8,45,"Health Partners, Inc.",State Public Programs,4.8,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Xr Forearm Routine 2 Views (Pro Cah)Professional Component ,,73090,CPT,Professional,Both,,,26,45,38.25,4.8,45,Humana Insurance Company,Commercial PPO,7.6,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Xr Forearm Routine 2 Views (Pro Cah)Professional Component ,,73090,CPT,Professional,Both,,,26,45,38.25,4.8,45,Humana Insurance Company,Medicare PPO,45,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Xr Forearm Routine 2 Views (Pro Cah)Professional Component ,,73090,CPT,Professional,Both,,,26,45,38.25,4.8,45,Medica,Individual & Family,38.16,84.8,,percent of total billed charges,,
Xr Forearm Routine 2 Views (Pro Cah)Professional Component ,,73090,CPT,Professional,Both,,,26,45,38.25,4.8,45,Medica,Medica Advantage Solution,22.41,49.8,,percent of total billed charges,,
Xr Forearm Routine 2 Views (Pro Cah)Professional Component ,,73090,CPT,Professional,Both,,,26,45,38.25,4.8,45,Medica,Medical Assistance,5.54,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Xr Forearm Routine 2 Views (Pro Cah)Professional Component ,,73090,CPT,Professional,Both,,,26,45,38.25,4.8,45,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,7.6,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Xr Forearm Routine 2 Views (Pro Cah)Professional Component ,,73090,CPT,Professional,Both,,,26,45,38.25,4.8,45,"Multiplan, Inc.","Multiplan, Inc.",42.3,94,,percent of total billed charges,,
Xr Forearm Routine 2 Views (Pro Cah)Professional Component ,,73090,CPT,Professional,Both,,,26,45,38.25,4.8,45,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,40.545,90.1,,percent of total billed charges,,
Xr Forearm Routine 2 Views (Pro Cah)Professional Component ,,73090,CPT,Professional,Both,,,26,45,38.25,4.8,45,"Preferred One Administrative Services, INC.",PPO,44.37,98.6,,percent of total billed charges,,
Xr Forearm Routine 2 Views (Pro Cah)Professional Component ,,73090,CPT,Professional,Both,,,26,45,38.25,4.8,45,PrimeWest Health,Minnesota Senior Health Options (MSHO),8.74,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Forearm Routine 2 Views (Pro Cah)Professional Component ,,73090,CPT,Professional,Both,,,26,45,38.25,4.8,45,PrimeWest Health,MinnesotaCare,5.924804,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Forearm Routine 2 Views (Pro Cah)Professional Component ,,73090,CPT,Professional,Both,,,26,45,38.25,4.8,45,Sanford Health Plan,Sanford Health Plan,39.6,88,,percent of total billed charges,,
Xr Forearm Routine 2 Views (Pro Cah)Professional Component ,,73090,CPT,Professional,Both,,,26,45,38.25,4.8,45,"UCare Health, Inc.",Individual & Family Plan,12.35456,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Xr Forearm Routine 2 Views (Pro Cah)Professional Component ,,73090,CPT,Professional,Both,,,26,45,38.25,4.8,45,"UCare Health, Inc.",Medical Assistance,6.09092,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Xr Forearm Routine 2 Views (Pro Cah)Professional Component ,,73090,CPT,Professional,Both,,,26,45,38.25,4.8,45,"UCare Health, Inc.",Medicare Advantage,8.74,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Xr Forearm Routine 2 Views (Pro Cah)Professional Component ,,73090,CPT,Professional,Both,,,26,45,38.25,4.8,45,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),6.992,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Xr Forearm Routine 2 Views (Pro Cah)Professional Component ,,73090,CPT,Professional,Both,,,26,45,38.25,4.8,45,UnitedHealthcare,Individual & Family,45,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Xr Forearm Routine 2 Views (Pro Cah)Professional Component ,,73090,CPT,Professional,Both,,,26,45,38.25,4.8,45,UnitedHealthcare,Medicare Advantage,8.74,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Forearm Routine 2 Views (Pro Cah)Professional Component ,,73090,CPT,Professional,Both,,,26,45,38.25,4.8,45,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,5.5372,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Upper Ext Infant Min 2 Views (Pro Cah)Professional Component ,,73092,CPT,Professional,Both,,,26,40,34,4.8,40,Aetna,Commercial,34,85,,percent of total billed charges,,
Xr Upper Ext Infant Min 2 Views (Pro Cah)Professional Component ,,73092,CPT,Professional,Both,,,26,40,34,4.8,40,Aetna,Medicare Advantage,7.83,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Upper Ext Infant Min 2 Views (Pro Cah)Professional Component ,,73092,CPT,Professional,Both,,,26,40,34,4.8,40,Aetna,PPO,37.2,93,,percent of total billed charges,,
Xr Upper Ext Infant Min 2 Views (Pro Cah)Professional Component ,,73092,CPT,Professional,Both,,,26,40,34,4.8,40,America's PPO,America's PPO,34.176,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Xr Upper Ext Infant Min 2 Views (Pro Cah)Professional Component ,,73092,CPT,Professional,Both,,,26,40,34,4.8,40,BlueCross BlueShield Minnesota, Federal Employee Program,14.7,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Xr Upper Ext Infant Min 2 Views (Pro Cah)Professional Component ,,73092,CPT,Professional,Both,,,26,40,34,4.8,40,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,14.9352,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Upper Ext Infant Min 2 Views (Pro Cah)Professional Component ,,73092,CPT,Professional,Both,,,26,40,34,4.8,40,BlueCross BlueShield Minnesota,High Value Network Plan,14.9352,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Upper Ext Infant Min 2 Views (Pro Cah)Professional Component ,,73092,CPT,Professional,Both,,,26,40,34,4.8,40,BlueCross BlueShield Minnesota,Medicare Advantage,8.74,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Upper Ext Infant Min 2 Views (Pro Cah)Professional Component ,,73092,CPT,Professional,Both,,,26,40,34,4.8,40,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,14.9352,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Upper Ext Infant Min 2 Views (Pro Cah)Professional Component ,,73092,CPT,Professional,Both,,,26,40,34,4.8,40,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,5.5372,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Upper Ext Infant Min 2 Views (Pro Cah)Professional Component ,,73092,CPT,Professional,Both,,,26,40,34,4.8,40,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),8.74,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Upper Ext Infant Min 2 Views (Pro Cah)Professional Component ,,73092,CPT,Professional,Both,,,26,40,34,4.8,40,CorVel,Worker's Compensation,15.0669027,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Xr Upper Ext Infant Min 2 Views (Pro Cah)Professional Component ,,73092,CPT,Professional,Both,,,26,40,34,4.8,40,First Health Group Corporation,First Health Network,38.8,97,,percent of total billed charges,,
Xr Upper Ext Infant Min 2 Views (Pro Cah)Professional Component ,,73092,CPT,Professional,Both,,,26,40,34,4.8,40,"Health Partners, Inc.",Commercial,11.35,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Xr Upper Ext Infant Min 2 Views (Pro Cah)Professional Component ,,73092,CPT,Professional,Both,,,26,40,34,4.8,40,"Health Partners, Inc.",Medicare Advantage,8.74,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Upper Ext Infant Min 2 Views (Pro Cah)Professional Component ,,73092,CPT,Professional,Both,,,26,40,34,4.8,40,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),4.8,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Xr Upper Ext Infant Min 2 Views (Pro Cah)Professional Component ,,73092,CPT,Professional,Both,,,26,40,34,4.8,40,"Health Partners, Inc.",State of Minnesota Advantage Program,9.778025,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Xr Upper Ext Infant Min 2 Views (Pro Cah)Professional Component ,,73092,CPT,Professional,Both,,,26,40,34,4.8,40,"Health Partners, Inc.",State Public Programs,4.8,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Xr Upper Ext Infant Min 2 Views (Pro Cah)Professional Component ,,73092,CPT,Professional,Both,,,26,40,34,4.8,40,Humana Insurance Company,Commercial PPO,7.6,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Xr Upper Ext Infant Min 2 Views (Pro Cah)Professional Component ,,73092,CPT,Professional,Both,,,26,40,34,4.8,40,Humana Insurance Company,Medicare PPO,40,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Xr Upper Ext Infant Min 2 Views (Pro Cah)Professional Component ,,73092,CPT,Professional,Both,,,26,40,34,4.8,40,Medica,Individual & Family,33.92,84.8,,percent of total billed charges,,
Xr Upper Ext Infant Min 2 Views (Pro Cah)Professional Component ,,73092,CPT,Professional,Both,,,26,40,34,4.8,40,Medica,Medica Advantage Solution,19.92,49.8,,percent of total billed charges,,
Xr Upper Ext Infant Min 2 Views (Pro Cah)Professional Component ,,73092,CPT,Professional,Both,,,26,40,34,4.8,40,Medica,Medical Assistance,5.54,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Xr Upper Ext Infant Min 2 Views (Pro Cah)Professional Component ,,73092,CPT,Professional,Both,,,26,40,34,4.8,40,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,7.6,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Xr Upper Ext Infant Min 2 Views (Pro Cah)Professional Component ,,73092,CPT,Professional,Both,,,26,40,34,4.8,40,"Multiplan, Inc.","Multiplan, Inc.",37.6,94,,percent of total billed charges,,
Xr Upper Ext Infant Min 2 Views (Pro Cah)Professional Component ,,73092,CPT,Professional,Both,,,26,40,34,4.8,40,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,36.04,90.1,,percent of total billed charges,,
Xr Upper Ext Infant Min 2 Views (Pro Cah)Professional Component ,,73092,CPT,Professional,Both,,,26,40,34,4.8,40,"Preferred One Administrative Services, INC.",PPO,39.44,98.6,,percent of total billed charges,,
Xr Upper Ext Infant Min 2 Views (Pro Cah)Professional Component ,,73092,CPT,Professional,Both,,,26,40,34,4.8,40,PrimeWest Health,Minnesota Senior Health Options (MSHO),8.74,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Upper Ext Infant Min 2 Views (Pro Cah)Professional Component ,,73092,CPT,Professional,Both,,,26,40,34,4.8,40,PrimeWest Health,MinnesotaCare,5.924804,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Upper Ext Infant Min 2 Views (Pro Cah)Professional Component ,,73092,CPT,Professional,Both,,,26,40,34,4.8,40,Sanford Health Plan,Sanford Health Plan,35.2,88,,percent of total billed charges,,
Xr Upper Ext Infant Min 2 Views (Pro Cah)Professional Component ,,73092,CPT,Professional,Both,,,26,40,34,4.8,40,"UCare Health, Inc.",Individual & Family Plan,12.35456,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Xr Upper Ext Infant Min 2 Views (Pro Cah)Professional Component ,,73092,CPT,Professional,Both,,,26,40,34,4.8,40,"UCare Health, Inc.",Medical Assistance,6.09092,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Xr Upper Ext Infant Min 2 Views (Pro Cah)Professional Component ,,73092,CPT,Professional,Both,,,26,40,34,4.8,40,"UCare Health, Inc.",Medicare Advantage,8.74,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Xr Upper Ext Infant Min 2 Views (Pro Cah)Professional Component ,,73092,CPT,Professional,Both,,,26,40,34,4.8,40,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),6.992,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Xr Upper Ext Infant Min 2 Views (Pro Cah)Professional Component ,,73092,CPT,Professional,Both,,,26,40,34,4.8,40,UnitedHealthcare,Individual & Family,40,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Xr Upper Ext Infant Min 2 Views (Pro Cah)Professional Component ,,73092,CPT,Professional,Both,,,26,40,34,4.8,40,UnitedHealthcare,Medicare Advantage,8.74,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Upper Ext Infant Min 2 Views (Pro Cah)Professional Component ,,73092,CPT,Professional,Both,,,26,40,34,4.8,40,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,5.5372,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Wrist 2 Views (Pro Cah)Professional Component ,,73100,CPT,Professional,Both,,,26,37,31.45,5.02,37,Aetna,Commercial,31.45,85,,percent of total billed charges,,
Xr Wrist 2 Views (Pro Cah)Professional Component ,,73100,CPT,Professional,Both,,,26,37,31.45,5.02,37,Aetna,Medicare Advantage,8.18,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Wrist 2 Views (Pro Cah)Professional Component ,,73100,CPT,Professional,Both,,,26,37,31.45,5.02,37,Aetna,PPO,34.41,93,,percent of total billed charges,,
Xr Wrist 2 Views (Pro Cah)Professional Component ,,73100,CPT,Professional,Both,,,26,37,31.45,5.02,37,America's PPO,America's PPO,31.6128,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Xr Wrist 2 Views (Pro Cah)Professional Component ,,73100,CPT,Professional,Both,,,26,37,31.45,5.02,37,BlueCross BlueShield Minnesota, Federal Employee Program,15.34,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Xr Wrist 2 Views (Pro Cah)Professional Component ,,73100,CPT,Professional,Both,,,26,37,31.45,5.02,37,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,15.58544,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Wrist 2 Views (Pro Cah)Professional Component ,,73100,CPT,Professional,Both,,,26,37,31.45,5.02,37,BlueCross BlueShield Minnesota,High Value Network Plan,15.58544,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Wrist 2 Views (Pro Cah)Professional Component ,,73100,CPT,Professional,Both,,,26,37,31.45,5.02,37,BlueCross BlueShield Minnesota,Medicare Advantage,9.1425,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Wrist 2 Views (Pro Cah)Professional Component ,,73100,CPT,Professional,Both,,,26,37,31.45,5.02,37,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,15.58544,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Wrist 2 Views (Pro Cah)Professional Component ,,73100,CPT,Professional,Both,,,26,37,31.45,5.02,37,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,5.7912,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Wrist 2 Views (Pro Cah)Professional Component ,,73100,CPT,Professional,Both,,,26,37,31.45,5.02,37,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),9.1425,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Wrist 2 Views (Pro Cah)Professional Component ,,73100,CPT,Professional,Both,,,26,37,31.45,5.02,37,CorVel,Worker's Compensation,15.7473348,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Xr Wrist 2 Views (Pro Cah)Professional Component ,,73100,CPT,Professional,Both,,,26,37,31.45,5.02,37,First Health Group Corporation,First Health Network,35.89,97,,percent of total billed charges,,
Xr Wrist 2 Views (Pro Cah)Professional Component ,,73100,CPT,Professional,Both,,,26,37,31.45,5.02,37,"Health Partners, Inc.",Commercial,11.86,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Xr Wrist 2 Views (Pro Cah)Professional Component ,,73100,CPT,Professional,Both,,,26,37,31.45,5.02,37,"Health Partners, Inc.",Medicare Advantage,9.1425,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Wrist 2 Views (Pro Cah)Professional Component ,,73100,CPT,Professional,Both,,,26,37,31.45,5.02,37,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),5.02,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Xr Wrist 2 Views (Pro Cah)Professional Component ,,73100,CPT,Professional,Both,,,26,37,31.45,5.02,37,"Health Partners, Inc.",State of Minnesota Advantage Program,10.21739,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Xr Wrist 2 Views (Pro Cah)Professional Component ,,73100,CPT,Professional,Both,,,26,37,31.45,5.02,37,"Health Partners, Inc.",State Public Programs,5.02,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Xr Wrist 2 Views (Pro Cah)Professional Component ,,73100,CPT,Professional,Both,,,26,37,31.45,5.02,37,Humana Insurance Company,Commercial PPO,7.95,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Xr Wrist 2 Views (Pro Cah)Professional Component ,,73100,CPT,Professional,Both,,,26,37,31.45,5.02,37,Humana Insurance Company,Medicare PPO,37,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Xr Wrist 2 Views (Pro Cah)Professional Component ,,73100,CPT,Professional,Both,,,26,37,31.45,5.02,37,Medica,Individual & Family,31.376,84.8,,percent of total billed charges,,
Xr Wrist 2 Views (Pro Cah)Professional Component ,,73100,CPT,Professional,Both,,,26,37,31.45,5.02,37,Medica,Medica Advantage Solution,18.426,49.8,,percent of total billed charges,,
Xr Wrist 2 Views (Pro Cah)Professional Component ,,73100,CPT,Professional,Both,,,26,37,31.45,5.02,37,Medica,Medical Assistance,5.79,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Xr Wrist 2 Views (Pro Cah)Professional Component ,,73100,CPT,Professional,Both,,,26,37,31.45,5.02,37,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,7.95,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Xr Wrist 2 Views (Pro Cah)Professional Component ,,73100,CPT,Professional,Both,,,26,37,31.45,5.02,37,"Multiplan, Inc.","Multiplan, Inc.",34.78,94,,percent of total billed charges,,
Xr Wrist 2 Views (Pro Cah)Professional Component ,,73100,CPT,Professional,Both,,,26,37,31.45,5.02,37,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,33.337,90.1,,percent of total billed charges,,
Xr Wrist 2 Views (Pro Cah)Professional Component ,,73100,CPT,Professional,Both,,,26,37,31.45,5.02,37,"Preferred One Administrative Services, INC.",PPO,36.482,98.6,,percent of total billed charges,,
Xr Wrist 2 Views (Pro Cah)Professional Component ,,73100,CPT,Professional,Both,,,26,37,31.45,5.02,37,PrimeWest Health,Minnesota Senior Health Options (MSHO),9.1425,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Wrist 2 Views (Pro Cah)Professional Component ,,73100,CPT,Professional,Both,,,26,37,31.45,5.02,37,PrimeWest Health,MinnesotaCare,6.196584,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Wrist 2 Views (Pro Cah)Professional Component ,,73100,CPT,Professional,Both,,,26,37,31.45,5.02,37,Sanford Health Plan,Sanford Health Plan,32.56,88,,percent of total billed charges,,
Xr Wrist 2 Views (Pro Cah)Professional Component ,,73100,CPT,Professional,Both,,,26,37,31.45,5.02,37,"UCare Health, Inc.",Individual & Family Plan,12.92352,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Xr Wrist 2 Views (Pro Cah)Professional Component ,,73100,CPT,Professional,Both,,,26,37,31.45,5.02,37,"UCare Health, Inc.",Medical Assistance,6.37032,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Xr Wrist 2 Views (Pro Cah)Professional Component ,,73100,CPT,Professional,Both,,,26,37,31.45,5.02,37,"UCare Health, Inc.",Medicare Advantage,9.1425,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Xr Wrist 2 Views (Pro Cah)Professional Component ,,73100,CPT,Professional,Both,,,26,37,31.45,5.02,37,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),7.314,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Xr Wrist 2 Views (Pro Cah)Professional Component ,,73100,CPT,Professional,Both,,,26,37,31.45,5.02,37,UnitedHealthcare,Individual & Family,37,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Xr Wrist 2 Views (Pro Cah)Professional Component ,,73100,CPT,Professional,Both,,,26,37,31.45,5.02,37,UnitedHealthcare,Medicare Advantage,9.1425,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Wrist 2 Views (Pro Cah)Professional Component ,,73100,CPT,Professional,Both,,,26,37,31.45,5.02,37,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,5.7912,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Wrist Routine  3 Or More Views (Pro Cah)Professional Component ,,73110,CPT,Professional,Both,,,26,40,34,5.23,40,Aetna,Commercial,34,85,,percent of total billed charges,,
Xr Wrist Routine  3 Or More Views (Pro Cah)Professional Component ,,73110,CPT,Professional,Both,,,26,40,34,5.23,40,Aetna,Medicare Advantage,8.53,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Wrist Routine  3 Or More Views (Pro Cah)Professional Component ,,73110,CPT,Professional,Both,,,26,40,34,5.23,40,Aetna,PPO,37.2,93,,percent of total billed charges,,
Xr Wrist Routine  3 Or More Views (Pro Cah)Professional Component ,,73110,CPT,Professional,Both,,,26,40,34,5.23,40,America's PPO,America's PPO,34.176,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Xr Wrist Routine  3 Or More Views (Pro Cah)Professional Component ,,73110,CPT,Professional,Both,,,26,40,34,5.23,40,BlueCross BlueShield Minnesota, Federal Employee Program,15.98,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Xr Wrist Routine  3 Or More Views (Pro Cah)Professional Component ,,73110,CPT,Professional,Both,,,26,40,34,5.23,40,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,16.23568,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Wrist Routine  3 Or More Views (Pro Cah)Professional Component ,,73110,CPT,Professional,Both,,,26,40,34,5.23,40,BlueCross BlueShield Minnesota,High Value Network Plan,16.23568,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Wrist Routine  3 Or More Views (Pro Cah)Professional Component ,,73110,CPT,Professional,Both,,,26,40,34,5.23,40,BlueCross BlueShield Minnesota,Medicare Advantage,9.5335,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Wrist Routine  3 Or More Views (Pro Cah)Professional Component ,,73110,CPT,Professional,Both,,,26,40,34,5.23,40,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,16.23568,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Wrist Routine  3 Or More Views (Pro Cah)Professional Component ,,73110,CPT,Professional,Both,,,26,40,34,5.23,40,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,6.03504,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Wrist Routine  3 Or More Views (Pro Cah)Professional Component ,,73110,CPT,Professional,Both,,,26,40,34,5.23,40,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),9.5335,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Wrist Routine  3 Or More Views (Pro Cah)Professional Component ,,73110,CPT,Professional,Both,,,26,40,34,5.23,40,CorVel,Worker's Compensation,16.4190348,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Xr Wrist Routine  3 Or More Views (Pro Cah)Professional Component ,,73110,CPT,Professional,Both,,,26,40,34,5.23,40,First Health Group Corporation,First Health Network,38.8,97,,percent of total billed charges,,
Xr Wrist Routine  3 Or More Views (Pro Cah)Professional Component ,,73110,CPT,Professional,Both,,,26,40,34,5.23,40,"Health Partners, Inc.",Commercial,12.37,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Xr Wrist Routine  3 Or More Views (Pro Cah)Professional Component ,,73110,CPT,Professional,Both,,,26,40,34,5.23,40,"Health Partners, Inc.",Medicare Advantage,9.5335,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Wrist Routine  3 Or More Views (Pro Cah)Professional Component ,,73110,CPT,Professional,Both,,,26,40,34,5.23,40,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),5.23,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Xr Wrist Routine  3 Or More Views (Pro Cah)Professional Component ,,73110,CPT,Professional,Both,,,26,40,34,5.23,40,"Health Partners, Inc.",State of Minnesota Advantage Program,10.656755,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Xr Wrist Routine  3 Or More Views (Pro Cah)Professional Component ,,73110,CPT,Professional,Both,,,26,40,34,5.23,40,"Health Partners, Inc.",State Public Programs,5.23,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Xr Wrist Routine  3 Or More Views (Pro Cah)Professional Component ,,73110,CPT,Professional,Both,,,26,40,34,5.23,40,Humana Insurance Company,Commercial PPO,8.29,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Xr Wrist Routine  3 Or More Views (Pro Cah)Professional Component ,,73110,CPT,Professional,Both,,,26,40,34,5.23,40,Humana Insurance Company,Medicare PPO,40,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Xr Wrist Routine  3 Or More Views (Pro Cah)Professional Component ,,73110,CPT,Professional,Both,,,26,40,34,5.23,40,Medica,Individual & Family,33.92,84.8,,percent of total billed charges,,
Xr Wrist Routine  3 Or More Views (Pro Cah)Professional Component ,,73110,CPT,Professional,Both,,,26,40,34,5.23,40,Medica,Medica Advantage Solution,19.92,49.8,,percent of total billed charges,,
Xr Wrist Routine  3 Or More Views (Pro Cah)Professional Component ,,73110,CPT,Professional,Both,,,26,40,34,5.23,40,Medica,Medical Assistance,6.04,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Xr Wrist Routine  3 Or More Views (Pro Cah)Professional Component ,,73110,CPT,Professional,Both,,,26,40,34,5.23,40,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,8.29,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Xr Wrist Routine  3 Or More Views (Pro Cah)Professional Component ,,73110,CPT,Professional,Both,,,26,40,34,5.23,40,"Multiplan, Inc.","Multiplan, Inc.",37.6,94,,percent of total billed charges,,
Xr Wrist Routine  3 Or More Views (Pro Cah)Professional Component ,,73110,CPT,Professional,Both,,,26,40,34,5.23,40,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,36.04,90.1,,percent of total billed charges,,
Xr Wrist Routine  3 Or More Views (Pro Cah)Professional Component ,,73110,CPT,Professional,Both,,,26,40,34,5.23,40,"Preferred One Administrative Services, INC.",PPO,39.44,98.6,,percent of total billed charges,,
Xr Wrist Routine  3 Or More Views (Pro Cah)Professional Component ,,73110,CPT,Professional,Both,,,26,40,34,5.23,40,PrimeWest Health,Minnesota Senior Health Options (MSHO),9.5335,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Wrist Routine  3 Or More Views (Pro Cah)Professional Component ,,73110,CPT,Professional,Both,,,26,40,34,5.23,40,PrimeWest Health,MinnesotaCare,6.4574928,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Wrist Routine  3 Or More Views (Pro Cah)Professional Component ,,73110,CPT,Professional,Both,,,26,40,34,5.23,40,Sanford Health Plan,Sanford Health Plan,35.2,88,,percent of total billed charges,,
Xr Wrist Routine  3 Or More Views (Pro Cah)Professional Component ,,73110,CPT,Professional,Both,,,26,40,34,5.23,40,"UCare Health, Inc.",Individual & Family Plan,13.476224,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Xr Wrist Routine  3 Or More Views (Pro Cah)Professional Component ,,73110,CPT,Professional,Both,,,26,40,34,5.23,40,"UCare Health, Inc.",Medical Assistance,6.638544,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Xr Wrist Routine  3 Or More Views (Pro Cah)Professional Component ,,73110,CPT,Professional,Both,,,26,40,34,5.23,40,"UCare Health, Inc.",Medicare Advantage,9.5335,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Xr Wrist Routine  3 Or More Views (Pro Cah)Professional Component ,,73110,CPT,Professional,Both,,,26,40,34,5.23,40,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),7.6268,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Xr Wrist Routine  3 Or More Views (Pro Cah)Professional Component ,,73110,CPT,Professional,Both,,,26,40,34,5.23,40,UnitedHealthcare,Individual & Family,40,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Xr Wrist Routine  3 Or More Views (Pro Cah)Professional Component ,,73110,CPT,Professional,Both,,,26,40,34,5.23,40,UnitedHealthcare,Medicare Advantage,9.5335,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Wrist Routine  3 Or More Views (Pro Cah)Professional Component ,,73110,CPT,Professional,Both,,,26,40,34,5.23,40,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,6.03504,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Hand 2 Views (Pro Cah)Professional Component ,,73120,CPT,Professional,Both,,,26,36,30.6,5.02,36,Aetna,Commercial,30.6,85,,percent of total billed charges,,
Xr Hand 2 Views (Pro Cah)Professional Component ,,73120,CPT,Professional,Both,,,26,36,30.6,5.02,36,Aetna,Medicare Advantage,8.18,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Hand 2 Views (Pro Cah)Professional Component ,,73120,CPT,Professional,Both,,,26,36,30.6,5.02,36,Aetna,PPO,33.48,93,,percent of total billed charges,,
Xr Hand 2 Views (Pro Cah)Professional Component ,,73120,CPT,Professional,Both,,,26,36,30.6,5.02,36,America's PPO,America's PPO,30.7584,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Xr Hand 2 Views (Pro Cah)Professional Component ,,73120,CPT,Professional,Both,,,26,36,30.6,5.02,36,BlueCross BlueShield Minnesota, Federal Employee Program,15.34,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Xr Hand 2 Views (Pro Cah)Professional Component ,,73120,CPT,Professional,Both,,,26,36,30.6,5.02,36,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,15.58544,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Hand 2 Views (Pro Cah)Professional Component ,,73120,CPT,Professional,Both,,,26,36,30.6,5.02,36,BlueCross BlueShield Minnesota,High Value Network Plan,15.58544,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Hand 2 Views (Pro Cah)Professional Component ,,73120,CPT,Professional,Both,,,26,36,30.6,5.02,36,BlueCross BlueShield Minnesota,Medicare Advantage,9.1425,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Hand 2 Views (Pro Cah)Professional Component ,,73120,CPT,Professional,Both,,,26,36,30.6,5.02,36,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,15.58544,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Hand 2 Views (Pro Cah)Professional Component ,,73120,CPT,Professional,Both,,,26,36,30.6,5.02,36,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,5.7912,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Hand 2 Views (Pro Cah)Professional Component ,,73120,CPT,Professional,Both,,,26,36,30.6,5.02,36,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),9.1425,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Hand 2 Views (Pro Cah)Professional Component ,,73120,CPT,Professional,Both,,,26,36,30.6,5.02,36,CorVel,Worker's Compensation,15.7473348,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Xr Hand 2 Views (Pro Cah)Professional Component ,,73120,CPT,Professional,Both,,,26,36,30.6,5.02,36,First Health Group Corporation,First Health Network,34.92,97,,percent of total billed charges,,
Xr Hand 2 Views (Pro Cah)Professional Component ,,73120,CPT,Professional,Both,,,26,36,30.6,5.02,36,"Health Partners, Inc.",Commercial,11.86,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Xr Hand 2 Views (Pro Cah)Professional Component ,,73120,CPT,Professional,Both,,,26,36,30.6,5.02,36,"Health Partners, Inc.",Medicare Advantage,9.1425,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Hand 2 Views (Pro Cah)Professional Component ,,73120,CPT,Professional,Both,,,26,36,30.6,5.02,36,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),5.02,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Xr Hand 2 Views (Pro Cah)Professional Component ,,73120,CPT,Professional,Both,,,26,36,30.6,5.02,36,"Health Partners, Inc.",State of Minnesota Advantage Program,10.21739,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Xr Hand 2 Views (Pro Cah)Professional Component ,,73120,CPT,Professional,Both,,,26,36,30.6,5.02,36,"Health Partners, Inc.",State Public Programs,5.02,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Xr Hand 2 Views (Pro Cah)Professional Component ,,73120,CPT,Professional,Both,,,26,36,30.6,5.02,36,Humana Insurance Company,Commercial PPO,7.95,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Xr Hand 2 Views (Pro Cah)Professional Component ,,73120,CPT,Professional,Both,,,26,36,30.6,5.02,36,Humana Insurance Company,Medicare PPO,36,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Xr Hand 2 Views (Pro Cah)Professional Component ,,73120,CPT,Professional,Both,,,26,36,30.6,5.02,36,Medica,Individual & Family,30.528,84.8,,percent of total billed charges,,
Xr Hand 2 Views (Pro Cah)Professional Component ,,73120,CPT,Professional,Both,,,26,36,30.6,5.02,36,Medica,Medica Advantage Solution,17.928,49.8,,percent of total billed charges,,
Xr Hand 2 Views (Pro Cah)Professional Component ,,73120,CPT,Professional,Both,,,26,36,30.6,5.02,36,Medica,Medical Assistance,5.79,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Xr Hand 2 Views (Pro Cah)Professional Component ,,73120,CPT,Professional,Both,,,26,36,30.6,5.02,36,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,7.95,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Xr Hand 2 Views (Pro Cah)Professional Component ,,73120,CPT,Professional,Both,,,26,36,30.6,5.02,36,"Multiplan, Inc.","Multiplan, Inc.",33.84,94,,percent of total billed charges,,
Xr Hand 2 Views (Pro Cah)Professional Component ,,73120,CPT,Professional,Both,,,26,36,30.6,5.02,36,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,32.436,90.1,,percent of total billed charges,,
Xr Hand 2 Views (Pro Cah)Professional Component ,,73120,CPT,Professional,Both,,,26,36,30.6,5.02,36,"Preferred One Administrative Services, INC.",PPO,35.496,98.6,,percent of total billed charges,,
Xr Hand 2 Views (Pro Cah)Professional Component ,,73120,CPT,Professional,Both,,,26,36,30.6,5.02,36,PrimeWest Health,Minnesota Senior Health Options (MSHO),9.1425,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Hand 2 Views (Pro Cah)Professional Component ,,73120,CPT,Professional,Both,,,26,36,30.6,5.02,36,PrimeWest Health,MinnesotaCare,6.196584,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Hand 2 Views (Pro Cah)Professional Component ,,73120,CPT,Professional,Both,,,26,36,30.6,5.02,36,Sanford Health Plan,Sanford Health Plan,31.68,88,,percent of total billed charges,,
Xr Hand 2 Views (Pro Cah)Professional Component ,,73120,CPT,Professional,Both,,,26,36,30.6,5.02,36,"UCare Health, Inc.",Individual & Family Plan,12.92352,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Xr Hand 2 Views (Pro Cah)Professional Component ,,73120,CPT,Professional,Both,,,26,36,30.6,5.02,36,"UCare Health, Inc.",Medical Assistance,6.37032,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Xr Hand 2 Views (Pro Cah)Professional Component ,,73120,CPT,Professional,Both,,,26,36,30.6,5.02,36,"UCare Health, Inc.",Medicare Advantage,9.1425,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Xr Hand 2 Views (Pro Cah)Professional Component ,,73120,CPT,Professional,Both,,,26,36,30.6,5.02,36,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),7.314,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Xr Hand 2 Views (Pro Cah)Professional Component ,,73120,CPT,Professional,Both,,,26,36,30.6,5.02,36,UnitedHealthcare,Individual & Family,36,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Xr Hand 2 Views (Pro Cah)Professional Component ,,73120,CPT,Professional,Both,,,26,36,30.6,5.02,36,UnitedHealthcare,Medicare Advantage,9.1425,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Hand 2 Views (Pro Cah)Professional Component ,,73120,CPT,Professional,Both,,,26,36,30.6,5.02,36,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,5.7912,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Hand Routine 3 Views (Pro Cah)Professional Component ,,73130,CPT,Professional,Both,,,26,46,39.1,5.23,46,Aetna,Commercial,39.1,85,,percent of total billed charges,,
Xr Hand Routine 3 Views (Pro Cah)Professional Component ,,73130,CPT,Professional,Both,,,26,46,39.1,5.23,46,Aetna,Medicare Advantage,8.53,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Hand Routine 3 Views (Pro Cah)Professional Component ,,73130,CPT,Professional,Both,,,26,46,39.1,5.23,46,Aetna,PPO,42.78,93,,percent of total billed charges,,
Xr Hand Routine 3 Views (Pro Cah)Professional Component ,,73130,CPT,Professional,Both,,,26,46,39.1,5.23,46,America's PPO,America's PPO,39.3024,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Xr Hand Routine 3 Views (Pro Cah)Professional Component ,,73130,CPT,Professional,Both,,,26,46,39.1,5.23,46,BlueCross BlueShield Minnesota, Federal Employee Program,15.98,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Xr Hand Routine 3 Views (Pro Cah)Professional Component ,,73130,CPT,Professional,Both,,,26,46,39.1,5.23,46,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,16.23568,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Hand Routine 3 Views (Pro Cah)Professional Component ,,73130,CPT,Professional,Both,,,26,46,39.1,5.23,46,BlueCross BlueShield Minnesota,High Value Network Plan,16.23568,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Hand Routine 3 Views (Pro Cah)Professional Component ,,73130,CPT,Professional,Both,,,26,46,39.1,5.23,46,BlueCross BlueShield Minnesota,Medicare Advantage,9.5335,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Hand Routine 3 Views (Pro Cah)Professional Component ,,73130,CPT,Professional,Both,,,26,46,39.1,5.23,46,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,16.23568,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Hand Routine 3 Views (Pro Cah)Professional Component ,,73130,CPT,Professional,Both,,,26,46,39.1,5.23,46,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,6.03504,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Hand Routine 3 Views (Pro Cah)Professional Component ,,73130,CPT,Professional,Both,,,26,46,39.1,5.23,46,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),9.5335,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Hand Routine 3 Views (Pro Cah)Professional Component ,,73130,CPT,Professional,Both,,,26,46,39.1,5.23,46,CorVel,Worker's Compensation,16.4190348,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Xr Hand Routine 3 Views (Pro Cah)Professional Component ,,73130,CPT,Professional,Both,,,26,46,39.1,5.23,46,First Health Group Corporation,First Health Network,44.62,97,,percent of total billed charges,,
Xr Hand Routine 3 Views (Pro Cah)Professional Component ,,73130,CPT,Professional,Both,,,26,46,39.1,5.23,46,"Health Partners, Inc.",Commercial,12.37,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Xr Hand Routine 3 Views (Pro Cah)Professional Component ,,73130,CPT,Professional,Both,,,26,46,39.1,5.23,46,"Health Partners, Inc.",Medicare Advantage,9.5335,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Hand Routine 3 Views (Pro Cah)Professional Component ,,73130,CPT,Professional,Both,,,26,46,39.1,5.23,46,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),5.23,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Xr Hand Routine 3 Views (Pro Cah)Professional Component ,,73130,CPT,Professional,Both,,,26,46,39.1,5.23,46,"Health Partners, Inc.",State of Minnesota Advantage Program,10.656755,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Xr Hand Routine 3 Views (Pro Cah)Professional Component ,,73130,CPT,Professional,Both,,,26,46,39.1,5.23,46,"Health Partners, Inc.",State Public Programs,5.23,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Xr Hand Routine 3 Views (Pro Cah)Professional Component ,,73130,CPT,Professional,Both,,,26,46,39.1,5.23,46,Humana Insurance Company,Commercial PPO,8.29,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Xr Hand Routine 3 Views (Pro Cah)Professional Component ,,73130,CPT,Professional,Both,,,26,46,39.1,5.23,46,Humana Insurance Company,Medicare PPO,46,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Xr Hand Routine 3 Views (Pro Cah)Professional Component ,,73130,CPT,Professional,Both,,,26,46,39.1,5.23,46,Medica,Individual & Family,39.008,84.8,,percent of total billed charges,,
Xr Hand Routine 3 Views (Pro Cah)Professional Component ,,73130,CPT,Professional,Both,,,26,46,39.1,5.23,46,Medica,Medica Advantage Solution,22.908,49.8,,percent of total billed charges,,
Xr Hand Routine 3 Views (Pro Cah)Professional Component ,,73130,CPT,Professional,Both,,,26,46,39.1,5.23,46,Medica,Medical Assistance,6.04,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Xr Hand Routine 3 Views (Pro Cah)Professional Component ,,73130,CPT,Professional,Both,,,26,46,39.1,5.23,46,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,8.29,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Xr Hand Routine 3 Views (Pro Cah)Professional Component ,,73130,CPT,Professional,Both,,,26,46,39.1,5.23,46,"Multiplan, Inc.","Multiplan, Inc.",43.24,94,,percent of total billed charges,,
Xr Hand Routine 3 Views (Pro Cah)Professional Component ,,73130,CPT,Professional,Both,,,26,46,39.1,5.23,46,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,41.446,90.1,,percent of total billed charges,,
Xr Hand Routine 3 Views (Pro Cah)Professional Component ,,73130,CPT,Professional,Both,,,26,46,39.1,5.23,46,"Preferred One Administrative Services, INC.",PPO,45.356,98.6,,percent of total billed charges,,
Xr Hand Routine 3 Views (Pro Cah)Professional Component ,,73130,CPT,Professional,Both,,,26,46,39.1,5.23,46,PrimeWest Health,Minnesota Senior Health Options (MSHO),9.5335,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Hand Routine 3 Views (Pro Cah)Professional Component ,,73130,CPT,Professional,Both,,,26,46,39.1,5.23,46,PrimeWest Health,MinnesotaCare,6.4574928,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Hand Routine 3 Views (Pro Cah)Professional Component ,,73130,CPT,Professional,Both,,,26,46,39.1,5.23,46,Sanford Health Plan,Sanford Health Plan,40.48,88,,percent of total billed charges,,
Xr Hand Routine 3 Views (Pro Cah)Professional Component ,,73130,CPT,Professional,Both,,,26,46,39.1,5.23,46,"UCare Health, Inc.",Individual & Family Plan,13.476224,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Xr Hand Routine 3 Views (Pro Cah)Professional Component ,,73130,CPT,Professional,Both,,,26,46,39.1,5.23,46,"UCare Health, Inc.",Medical Assistance,6.638544,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Xr Hand Routine 3 Views (Pro Cah)Professional Component ,,73130,CPT,Professional,Both,,,26,46,39.1,5.23,46,"UCare Health, Inc.",Medicare Advantage,9.5335,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Xr Hand Routine 3 Views (Pro Cah)Professional Component ,,73130,CPT,Professional,Both,,,26,46,39.1,5.23,46,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),7.6268,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Xr Hand Routine 3 Views (Pro Cah)Professional Component ,,73130,CPT,Professional,Both,,,26,46,39.1,5.23,46,UnitedHealthcare,Individual & Family,46,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Xr Hand Routine 3 Views (Pro Cah)Professional Component ,,73130,CPT,Professional,Both,,,26,46,39.1,5.23,46,UnitedHealthcare,Medicare Advantage,9.5335,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Hand Routine 3 Views (Pro Cah)Professional Component ,,73130,CPT,Professional,Both,,,26,46,39.1,5.23,46,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,6.03504,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Finger (Pro Cah)Professional Component ,,73140,CPT,Professional,Both,,,26,31,26.35,4.14,31,Aetna,Commercial,26.35,85,,percent of total billed charges,,
Xr Finger (Pro Cah)Professional Component ,,73140,CPT,Professional,Both,,,26,31,26.35,4.14,31,Aetna,Medicare Advantage,6.78,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Finger (Pro Cah)Professional Component ,,73140,CPT,Professional,Both,,,26,31,26.35,4.14,31,Aetna,PPO,28.83,93,,percent of total billed charges,,
Xr Finger (Pro Cah)Professional Component ,,73140,CPT,Professional,Both,,,26,31,26.35,4.14,31,America's PPO,America's PPO,26.4864,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Xr Finger (Pro Cah)Professional Component ,,73140,CPT,Professional,Both,,,26,31,26.35,4.14,31,BlueCross BlueShield Minnesota, Federal Employee Program,12.78,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Xr Finger (Pro Cah)Professional Component ,,73140,CPT,Professional,Both,,,26,31,26.35,4.14,31,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,12.98448,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Finger (Pro Cah)Professional Component ,,73140,CPT,Professional,Both,,,26,31,26.35,4.14,31,BlueCross BlueShield Minnesota,High Value Network Plan,12.98448,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Finger (Pro Cah)Professional Component ,,73140,CPT,Professional,Both,,,26,31,26.35,4.14,31,BlueCross BlueShield Minnesota,Medicare Advantage,7.5785,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Finger (Pro Cah)Professional Component ,,73140,CPT,Professional,Both,,,26,31,26.35,4.14,31,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,12.98448,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Finger (Pro Cah)Professional Component ,,73140,CPT,Professional,Both,,,26,31,26.35,4.14,31,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,4.78536,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Finger (Pro Cah)Professional Component ,,73140,CPT,Professional,Both,,,26,31,26.35,4.14,31,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),7.5785,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Finger (Pro Cah)Professional Component ,,73140,CPT,Professional,Both,,,26,31,26.35,4.14,31,CorVel,Worker's Compensation,13.0518027,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Xr Finger (Pro Cah)Professional Component ,,73140,CPT,Professional,Both,,,26,31,26.35,4.14,31,First Health Group Corporation,First Health Network,30.07,97,,percent of total billed charges,,
Xr Finger (Pro Cah)Professional Component ,,73140,CPT,Professional,Both,,,26,31,26.35,4.14,31,"Health Partners, Inc.",Commercial,9.79,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Xr Finger (Pro Cah)Professional Component ,,73140,CPT,Professional,Both,,,26,31,26.35,4.14,31,"Health Partners, Inc.",Medicare Advantage,7.5785,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Finger (Pro Cah)Professional Component ,,73140,CPT,Professional,Both,,,26,31,26.35,4.14,31,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),4.14,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Xr Finger (Pro Cah)Professional Component ,,73140,CPT,Professional,Both,,,26,31,26.35,4.14,31,"Health Partners, Inc.",State of Minnesota Advantage Program,8.434085,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Xr Finger (Pro Cah)Professional Component ,,73140,CPT,Professional,Both,,,26,31,26.35,4.14,31,"Health Partners, Inc.",State Public Programs,4.14,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Xr Finger (Pro Cah)Professional Component ,,73140,CPT,Professional,Both,,,26,31,26.35,4.14,31,Humana Insurance Company,Commercial PPO,6.59,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Xr Finger (Pro Cah)Professional Component ,,73140,CPT,Professional,Both,,,26,31,26.35,4.14,31,Humana Insurance Company,Medicare PPO,31,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Xr Finger (Pro Cah)Professional Component ,,73140,CPT,Professional,Both,,,26,31,26.35,4.14,31,Medica,Individual & Family,26.288,84.8,,percent of total billed charges,,
Xr Finger (Pro Cah)Professional Component ,,73140,CPT,Professional,Both,,,26,31,26.35,4.14,31,Medica,Medica Advantage Solution,15.438,49.8,,percent of total billed charges,,
Xr Finger (Pro Cah)Professional Component ,,73140,CPT,Professional,Both,,,26,31,26.35,4.14,31,Medica,Medical Assistance,4.79,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Xr Finger (Pro Cah)Professional Component ,,73140,CPT,Professional,Both,,,26,31,26.35,4.14,31,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,6.59,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Xr Finger (Pro Cah)Professional Component ,,73140,CPT,Professional,Both,,,26,31,26.35,4.14,31,"Multiplan, Inc.","Multiplan, Inc.",29.14,94,,percent of total billed charges,,
Xr Finger (Pro Cah)Professional Component ,,73140,CPT,Professional,Both,,,26,31,26.35,4.14,31,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,27.931,90.1,,percent of total billed charges,,
Xr Finger (Pro Cah)Professional Component ,,73140,CPT,Professional,Both,,,26,31,26.35,4.14,31,"Preferred One Administrative Services, INC.",PPO,30.566,98.6,,percent of total billed charges,,
Xr Finger (Pro Cah)Professional Component ,,73140,CPT,Professional,Both,,,26,31,26.35,4.14,31,PrimeWest Health,Minnesota Senior Health Options (MSHO),7.5785,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Finger (Pro Cah)Professional Component ,,73140,CPT,Professional,Both,,,26,31,26.35,4.14,31,PrimeWest Health,MinnesotaCare,5.1203352,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Finger (Pro Cah)Professional Component ,,73140,CPT,Professional,Both,,,26,31,26.35,4.14,31,Sanford Health Plan,Sanford Health Plan,27.28,88,,percent of total billed charges,,
Xr Finger (Pro Cah)Professional Component ,,73140,CPT,Professional,Both,,,26,31,26.35,4.14,31,"UCare Health, Inc.",Individual & Family Plan,10.712704,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Xr Finger (Pro Cah)Professional Component ,,73140,CPT,Professional,Both,,,26,31,26.35,4.14,31,"UCare Health, Inc.",Medical Assistance,5.263896,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Xr Finger (Pro Cah)Professional Component ,,73140,CPT,Professional,Both,,,26,31,26.35,4.14,31,"UCare Health, Inc.",Medicare Advantage,7.5785,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Xr Finger (Pro Cah)Professional Component ,,73140,CPT,Professional,Both,,,26,31,26.35,4.14,31,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),6.0628,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Xr Finger (Pro Cah)Professional Component ,,73140,CPT,Professional,Both,,,26,31,26.35,4.14,31,UnitedHealthcare,Individual & Family,31,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Xr Finger (Pro Cah)Professional Component ,,73140,CPT,Professional,Both,,,26,31,26.35,4.14,31,UnitedHealthcare,Medicare Advantage,7.5785,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Finger (Pro Cah)Professional Component ,,73140,CPT,Professional,Both,,,26,31,26.35,4.14,31,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,4.78536,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Ct Upper Extremity Wo Iv Contrast (Pro Cah)Professional Component ,,73200,CPT,Professional,Both,,,26,341,289.85,29.88,341,Aetna,Commercial,289.85,85,,percent of total billed charges,,
Ct Upper Extremity Wo Iv Contrast (Pro Cah)Professional Component ,,73200,CPT,Professional,Both,,,26,341,289.85,29.88,341,Aetna,Medicare Advantage,48.23,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Upper Extremity Wo Iv Contrast (Pro Cah)Professional Component ,,73200,CPT,Professional,Both,,,26,341,289.85,29.88,341,Aetna,PPO,317.13,93,,percent of total billed charges,,
Ct Upper Extremity Wo Iv Contrast (Pro Cah)Professional Component ,,73200,CPT,Professional,Both,,,26,341,289.85,29.88,341,America's PPO,America's PPO,291.3504,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Ct Upper Extremity Wo Iv Contrast (Pro Cah)Professional Component ,,73200,CPT,Professional,Both,,,26,341,289.85,29.88,341,BlueCross BlueShield Minnesota, Federal Employee Program,89.49,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Ct Upper Extremity Wo Iv Contrast (Pro Cah)Professional Component ,,73200,CPT,Professional,Both,,,26,341,289.85,29.88,341,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,90.92184,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Ct Upper Extremity Wo Iv Contrast (Pro Cah)Professional Component ,,73200,CPT,Professional,Both,,,26,341,289.85,29.88,341,BlueCross BlueShield Minnesota,High Value Network Plan,90.92184,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Ct Upper Extremity Wo Iv Contrast (Pro Cah)Professional Component ,,73200,CPT,Professional,Both,,,26,341,289.85,29.88,341,BlueCross BlueShield Minnesota,Medicare Advantage,53.774,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Upper Extremity Wo Iv Contrast (Pro Cah)Professional Component ,,73200,CPT,Professional,Both,,,26,341,289.85,29.88,341,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,90.92184,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Ct Upper Extremity Wo Iv Contrast (Pro Cah)Professional Component ,,73200,CPT,Professional,Both,,,26,341,289.85,29.88,341,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,34.50336,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Ct Upper Extremity Wo Iv Contrast (Pro Cah)Professional Component ,,73200,CPT,Professional,Both,,,26,341,289.85,29.88,341,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),53.774,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Upper Extremity Wo Iv Contrast (Pro Cah)Professional Component ,,73200,CPT,Professional,Both,,,26,341,289.85,29.88,341,CorVel,Worker's Compensation,92.8511061,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Ct Upper Extremity Wo Iv Contrast (Pro Cah)Professional Component ,,73200,CPT,Professional,Both,,,26,341,289.85,29.88,341,First Health Group Corporation,First Health Network,330.77,97,,percent of total billed charges,,
Ct Upper Extremity Wo Iv Contrast (Pro Cah)Professional Component ,,73200,CPT,Professional,Both,,,26,341,289.85,29.88,341,"Health Partners, Inc.",Commercial,71.16,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Ct Upper Extremity Wo Iv Contrast (Pro Cah)Professional Component ,,73200,CPT,Professional,Both,,,26,341,289.85,29.88,341,"Health Partners, Inc.",Medicare Advantage,53.774,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Upper Extremity Wo Iv Contrast (Pro Cah)Professional Component ,,73200,CPT,Professional,Both,,,26,341,289.85,29.88,341,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),29.88,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Ct Upper Extremity Wo Iv Contrast (Pro Cah)Professional Component ,,73200,CPT,Professional,Both,,,26,341,289.85,29.88,341,"Health Partners, Inc.",State of Minnesota Advantage Program,61.30434,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Ct Upper Extremity Wo Iv Contrast (Pro Cah)Professional Component ,,73200,CPT,Professional,Both,,,26,341,289.85,29.88,341,"Health Partners, Inc.",State Public Programs,29.88,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Ct Upper Extremity Wo Iv Contrast (Pro Cah)Professional Component ,,73200,CPT,Professional,Both,,,26,341,289.85,29.88,341,Humana Insurance Company,Commercial PPO,46.76,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Ct Upper Extremity Wo Iv Contrast (Pro Cah)Professional Component ,,73200,CPT,Professional,Both,,,26,341,289.85,29.88,341,Humana Insurance Company,Medicare PPO,341,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Ct Upper Extremity Wo Iv Contrast (Pro Cah)Professional Component ,,73200,CPT,Professional,Both,,,26,341,289.85,29.88,341,Medica,Individual & Family,289.168,84.8,,percent of total billed charges,,
Ct Upper Extremity Wo Iv Contrast (Pro Cah)Professional Component ,,73200,CPT,Professional,Both,,,26,341,289.85,29.88,341,Medica,Medica Advantage Solution,169.818,49.8,,percent of total billed charges,,
Ct Upper Extremity Wo Iv Contrast (Pro Cah)Professional Component ,,73200,CPT,Professional,Both,,,26,341,289.85,29.88,341,Medica,Medical Assistance,34.5,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Ct Upper Extremity Wo Iv Contrast (Pro Cah)Professional Component ,,73200,CPT,Professional,Both,,,26,341,289.85,29.88,341,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,46.76,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Ct Upper Extremity Wo Iv Contrast (Pro Cah)Professional Component ,,73200,CPT,Professional,Both,,,26,341,289.85,29.88,341,"Multiplan, Inc.","Multiplan, Inc.",320.54,94,,percent of total billed charges,,
Ct Upper Extremity Wo Iv Contrast (Pro Cah)Professional Component ,,73200,CPT,Professional,Both,,,26,341,289.85,29.88,341,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,307.241,90.1,,percent of total billed charges,,
Ct Upper Extremity Wo Iv Contrast (Pro Cah)Professional Component ,,73200,CPT,Professional,Both,,,26,341,289.85,29.88,341,"Preferred One Administrative Services, INC.",PPO,336.226,98.6,,percent of total billed charges,,
Ct Upper Extremity Wo Iv Contrast (Pro Cah)Professional Component ,,73200,CPT,Professional,Both,,,26,341,289.85,29.88,341,PrimeWest Health,Minnesota Senior Health Options (MSHO),53.774,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Upper Extremity Wo Iv Contrast (Pro Cah)Professional Component ,,73200,CPT,Professional,Both,,,26,341,289.85,29.88,341,PrimeWest Health,MinnesotaCare,36.9185952,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Ct Upper Extremity Wo Iv Contrast (Pro Cah)Professional Component ,,73200,CPT,Professional,Both,,,26,341,289.85,29.88,341,Sanford Health Plan,Sanford Health Plan,300.08,88,,percent of total billed charges,,
Ct Upper Extremity Wo Iv Contrast (Pro Cah)Professional Component ,,73200,CPT,Professional,Both,,,26,341,289.85,29.88,341,"UCare Health, Inc.",Individual & Family Plan,76.013056,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Ct Upper Extremity Wo Iv Contrast (Pro Cah)Professional Component ,,73200,CPT,Professional,Both,,,26,341,289.85,29.88,341,"UCare Health, Inc.",Medical Assistance,37.953696,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Ct Upper Extremity Wo Iv Contrast (Pro Cah)Professional Component ,,73200,CPT,Professional,Both,,,26,341,289.85,29.88,341,"UCare Health, Inc.",Medicare Advantage,53.774,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Ct Upper Extremity Wo Iv Contrast (Pro Cah)Professional Component ,,73200,CPT,Professional,Both,,,26,341,289.85,29.88,341,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),43.0192,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Ct Upper Extremity Wo Iv Contrast (Pro Cah)Professional Component ,,73200,CPT,Professional,Both,,,26,341,289.85,29.88,341,UnitedHealthcare,Individual & Family,341,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Ct Upper Extremity Wo Iv Contrast (Pro Cah)Professional Component ,,73200,CPT,Professional,Both,,,26,341,289.85,29.88,341,UnitedHealthcare,Medicare Advantage,53.774,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Upper Extremity Wo Iv Contrast (Pro Cah)Professional Component ,,73200,CPT,Professional,Both,,,26,341,289.85,29.88,341,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,34.50336,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Ct Upper Extremity W/Contrast (Pro Cah)Professional Component ,,73201,CPT,Professional,Both,,,26,355,301.75,34.9,355,Aetna,Commercial,301.75,85,,percent of total billed charges,,
Ct Upper Extremity W/Contrast (Pro Cah)Professional Component ,,73201,CPT,Professional,Both,,,26,355,301.75,34.9,355,Aetna,Medicare Advantage,55.94,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Upper Extremity W/Contrast (Pro Cah)Professional Component ,,73201,CPT,Professional,Both,,,26,355,301.75,34.9,355,Aetna,PPO,330.15,93,,percent of total billed charges,,
Ct Upper Extremity W/Contrast (Pro Cah)Professional Component ,,73201,CPT,Professional,Both,,,26,355,301.75,34.9,355,America's PPO,America's PPO,303.312,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Ct Upper Extremity W/Contrast (Pro Cah)Professional Component ,,73201,CPT,Professional,Both,,,26,355,301.75,34.9,355,BlueCross BlueShield Minnesota, Federal Employee Program,104.83,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Ct Upper Extremity W/Contrast (Pro Cah)Professional Component ,,73201,CPT,Professional,Both,,,26,355,301.75,34.9,355,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,106.50728,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Ct Upper Extremity W/Contrast (Pro Cah)Professional Component ,,73201,CPT,Professional,Both,,,26,355,301.75,34.9,355,BlueCross BlueShield Minnesota,High Value Network Plan,106.50728,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Ct Upper Extremity W/Contrast (Pro Cah)Professional Component ,,73201,CPT,Professional,Both,,,26,355,301.75,34.9,355,BlueCross BlueShield Minnesota,Medicare Advantage,62.652,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Upper Extremity W/Contrast (Pro Cah)Professional Component ,,73201,CPT,Professional,Both,,,26,355,301.75,34.9,355,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,106.50728,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Ct Upper Extremity W/Contrast (Pro Cah)Professional Component ,,73201,CPT,Professional,Both,,,26,355,301.75,34.9,355,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,40.29456,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Ct Upper Extremity W/Contrast (Pro Cah)Professional Component ,,73201,CPT,Professional,Both,,,26,355,301.75,34.9,355,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),62.652,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Upper Extremity W/Contrast (Pro Cah)Professional Component ,,73201,CPT,Professional,Both,,,26,355,301.75,34.9,355,CorVel,Worker's Compensation,107.0004666,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Ct Upper Extremity W/Contrast (Pro Cah)Professional Component ,,73201,CPT,Professional,Both,,,26,355,301.75,34.9,355,First Health Group Corporation,First Health Network,344.35,97,,percent of total billed charges,,
Ct Upper Extremity W/Contrast (Pro Cah)Professional Component ,,73201,CPT,Professional,Both,,,26,355,301.75,34.9,355,"Health Partners, Inc.",Commercial,82.5,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Ct Upper Extremity W/Contrast (Pro Cah)Professional Component ,,73201,CPT,Professional,Both,,,26,355,301.75,34.9,355,"Health Partners, Inc.",Medicare Advantage,62.652,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Upper Extremity W/Contrast (Pro Cah)Professional Component ,,73201,CPT,Professional,Both,,,26,355,301.75,34.9,355,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),34.9,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Ct Upper Extremity W/Contrast (Pro Cah)Professional Component ,,73201,CPT,Professional,Both,,,26,355,301.75,34.9,355,"Health Partners, Inc.",State of Minnesota Advantage Program,71.07375,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Ct Upper Extremity W/Contrast (Pro Cah)Professional Component ,,73201,CPT,Professional,Both,,,26,355,301.75,34.9,355,"Health Partners, Inc.",State Public Programs,34.9,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Ct Upper Extremity W/Contrast (Pro Cah)Professional Component ,,73201,CPT,Professional,Both,,,26,355,301.75,34.9,355,Humana Insurance Company,Commercial PPO,54.48,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Ct Upper Extremity W/Contrast (Pro Cah)Professional Component ,,73201,CPT,Professional,Both,,,26,355,301.75,34.9,355,Humana Insurance Company,Medicare PPO,355,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Ct Upper Extremity W/Contrast (Pro Cah)Professional Component ,,73201,CPT,Professional,Both,,,26,355,301.75,34.9,355,Medica,Individual & Family,301.04,84.8,,percent of total billed charges,,
Ct Upper Extremity W/Contrast (Pro Cah)Professional Component ,,73201,CPT,Professional,Both,,,26,355,301.75,34.9,355,Medica,Medica Advantage Solution,176.79,49.8,,percent of total billed charges,,
Ct Upper Extremity W/Contrast (Pro Cah)Professional Component ,,73201,CPT,Professional,Both,,,26,355,301.75,34.9,355,Medica,Medical Assistance,40.29,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Ct Upper Extremity W/Contrast (Pro Cah)Professional Component ,,73201,CPT,Professional,Both,,,26,355,301.75,34.9,355,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,54.48,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Ct Upper Extremity W/Contrast (Pro Cah)Professional Component ,,73201,CPT,Professional,Both,,,26,355,301.75,34.9,355,"Multiplan, Inc.","Multiplan, Inc.",333.7,94,,percent of total billed charges,,
Ct Upper Extremity W/Contrast (Pro Cah)Professional Component ,,73201,CPT,Professional,Both,,,26,355,301.75,34.9,355,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,319.855,90.1,,percent of total billed charges,,
Ct Upper Extremity W/Contrast (Pro Cah)Professional Component ,,73201,CPT,Professional,Both,,,26,355,301.75,34.9,355,"Preferred One Administrative Services, INC.",PPO,350.03,98.6,,percent of total billed charges,,
Ct Upper Extremity W/Contrast (Pro Cah)Professional Component ,,73201,CPT,Professional,Both,,,26,355,301.75,34.9,355,PrimeWest Health,Minnesota Senior Health Options (MSHO),62.652,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Upper Extremity W/Contrast (Pro Cah)Professional Component ,,73201,CPT,Professional,Both,,,26,355,301.75,34.9,355,PrimeWest Health,MinnesotaCare,43.1151792,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Ct Upper Extremity W/Contrast (Pro Cah)Professional Component ,,73201,CPT,Professional,Both,,,26,355,301.75,34.9,355,Sanford Health Plan,Sanford Health Plan,312.4,88,,percent of total billed charges,,
Ct Upper Extremity W/Contrast (Pro Cah)Professional Component ,,73201,CPT,Professional,Both,,,26,355,301.75,34.9,355,"UCare Health, Inc.",Individual & Family Plan,88.562688,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Ct Upper Extremity W/Contrast (Pro Cah)Professional Component ,,73201,CPT,Professional,Both,,,26,355,301.75,34.9,355,"UCare Health, Inc.",Medical Assistance,44.324016,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Ct Upper Extremity W/Contrast (Pro Cah)Professional Component ,,73201,CPT,Professional,Both,,,26,355,301.75,34.9,355,"UCare Health, Inc.",Medicare Advantage,62.652,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Ct Upper Extremity W/Contrast (Pro Cah)Professional Component ,,73201,CPT,Professional,Both,,,26,355,301.75,34.9,355,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),50.1216,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Ct Upper Extremity W/Contrast (Pro Cah)Professional Component ,,73201,CPT,Professional,Both,,,26,355,301.75,34.9,355,UnitedHealthcare,Individual & Family,355,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Ct Upper Extremity W/Contrast (Pro Cah)Professional Component ,,73201,CPT,Professional,Both,,,26,355,301.75,34.9,355,UnitedHealthcare,Medicare Advantage,62.652,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Upper Extremity W/Contrast (Pro Cah)Professional Component ,,73201,CPT,Professional,Both,,,26,355,301.75,34.9,355,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,40.29456,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Ct Upper Extremity Wo W Contrast (Pro Cah)Professional Component ,,73202,CPT,Professional,Both,,,26,350,297.5,36.64,350,Aetna,Commercial,297.5,85,,percent of total billed charges,,
Ct Upper Extremity Wo W Contrast (Pro Cah)Professional Component ,,73202,CPT,Professional,Both,,,26,350,297.5,36.64,350,Aetna,Medicare Advantage,58.74,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Upper Extremity Wo W Contrast (Pro Cah)Professional Component ,,73202,CPT,Professional,Both,,,26,350,297.5,36.64,350,Aetna,PPO,325.5,93,,percent of total billed charges,,
Ct Upper Extremity Wo W Contrast (Pro Cah)Professional Component ,,73202,CPT,Professional,Both,,,26,350,297.5,36.64,350,America's PPO,America's PPO,299.04,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Ct Upper Extremity Wo W Contrast (Pro Cah)Professional Component ,,73202,CPT,Professional,Both,,,26,350,297.5,36.64,350,BlueCross BlueShield Minnesota, Federal Employee Program,109.94,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Ct Upper Extremity Wo W Contrast (Pro Cah)Professional Component ,,73202,CPT,Professional,Both,,,26,350,297.5,36.64,350,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,111.69904,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Ct Upper Extremity Wo W Contrast (Pro Cah)Professional Component ,,73202,CPT,Professional,Both,,,26,350,297.5,36.64,350,BlueCross BlueShield Minnesota,High Value Network Plan,111.69904,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Ct Upper Extremity Wo W Contrast (Pro Cah)Professional Component ,,73202,CPT,Professional,Both,,,26,350,297.5,36.64,350,BlueCross BlueShield Minnesota,Medicare Advantage,65.78,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Upper Extremity Wo W Contrast (Pro Cah)Professional Component ,,73202,CPT,Professional,Both,,,26,350,297.5,36.64,350,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,111.69904,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Ct Upper Extremity Wo W Contrast (Pro Cah)Professional Component ,,73202,CPT,Professional,Both,,,26,350,297.5,36.64,350,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,42.30624,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Ct Upper Extremity Wo W Contrast (Pro Cah)Professional Component ,,73202,CPT,Professional,Both,,,26,350,297.5,36.64,350,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),65.78,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Upper Extremity Wo W Contrast (Pro Cah)Professional Component ,,73202,CPT,Professional,Both,,,26,350,297.5,36.64,350,CorVel,Worker's Compensation,112.865751,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Ct Upper Extremity Wo W Contrast (Pro Cah)Professional Component ,,73202,CPT,Professional,Both,,,26,350,297.5,36.64,350,First Health Group Corporation,First Health Network,339.5,97,,percent of total billed charges,,
Ct Upper Extremity Wo W Contrast (Pro Cah)Professional Component ,,73202,CPT,Professional,Both,,,26,350,297.5,36.64,350,"Health Partners, Inc.",Commercial,86.62,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Ct Upper Extremity Wo W Contrast (Pro Cah)Professional Component ,,73202,CPT,Professional,Both,,,26,350,297.5,36.64,350,"Health Partners, Inc.",Medicare Advantage,65.78,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Upper Extremity Wo W Contrast (Pro Cah)Professional Component ,,73202,CPT,Professional,Both,,,26,350,297.5,36.64,350,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),36.64,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Ct Upper Extremity Wo W Contrast (Pro Cah)Professional Component ,,73202,CPT,Professional,Both,,,26,350,297.5,36.64,350,"Health Partners, Inc.",State of Minnesota Advantage Program,74.62313,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Ct Upper Extremity Wo W Contrast (Pro Cah)Professional Component ,,73202,CPT,Professional,Both,,,26,350,297.5,36.64,350,"Health Partners, Inc.",State Public Programs,36.64,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Ct Upper Extremity Wo W Contrast (Pro Cah)Professional Component ,,73202,CPT,Professional,Both,,,26,350,297.5,36.64,350,Humana Insurance Company,Commercial PPO,57.2,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Ct Upper Extremity Wo W Contrast (Pro Cah)Professional Component ,,73202,CPT,Professional,Both,,,26,350,297.5,36.64,350,Humana Insurance Company,Medicare PPO,350,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Ct Upper Extremity Wo W Contrast (Pro Cah)Professional Component ,,73202,CPT,Professional,Both,,,26,350,297.5,36.64,350,Medica,Individual & Family,296.8,84.8,,percent of total billed charges,,
Ct Upper Extremity Wo W Contrast (Pro Cah)Professional Component ,,73202,CPT,Professional,Both,,,26,350,297.5,36.64,350,Medica,Medica Advantage Solution,174.3,49.8,,percent of total billed charges,,
Ct Upper Extremity Wo W Contrast (Pro Cah)Professional Component ,,73202,CPT,Professional,Both,,,26,350,297.5,36.64,350,Medica,Medical Assistance,42.31,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Ct Upper Extremity Wo W Contrast (Pro Cah)Professional Component ,,73202,CPT,Professional,Both,,,26,350,297.5,36.64,350,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,57.2,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Ct Upper Extremity Wo W Contrast (Pro Cah)Professional Component ,,73202,CPT,Professional,Both,,,26,350,297.5,36.64,350,"Multiplan, Inc.","Multiplan, Inc.",329,94,,percent of total billed charges,,
Ct Upper Extremity Wo W Contrast (Pro Cah)Professional Component ,,73202,CPT,Professional,Both,,,26,350,297.5,36.64,350,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,315.35,90.1,,percent of total billed charges,,
Ct Upper Extremity Wo W Contrast (Pro Cah)Professional Component ,,73202,CPT,Professional,Both,,,26,350,297.5,36.64,350,"Preferred One Administrative Services, INC.",PPO,345.1,98.6,,percent of total billed charges,,
Ct Upper Extremity Wo W Contrast (Pro Cah)Professional Component ,,73202,CPT,Professional,Both,,,26,350,297.5,36.64,350,PrimeWest Health,Minnesota Senior Health Options (MSHO),65.78,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Upper Extremity Wo W Contrast (Pro Cah)Professional Component ,,73202,CPT,Professional,Both,,,26,350,297.5,36.64,350,PrimeWest Health,MinnesotaCare,45.2676768,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Ct Upper Extremity Wo W Contrast (Pro Cah)Professional Component ,,73202,CPT,Professional,Both,,,26,350,297.5,36.64,350,Sanford Health Plan,Sanford Health Plan,308,88,,percent of total billed charges,,
Ct Upper Extremity Wo W Contrast (Pro Cah)Professional Component ,,73202,CPT,Professional,Both,,,26,350,297.5,36.64,350,"UCare Health, Inc.",Individual & Family Plan,92.98432,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Ct Upper Extremity Wo W Contrast (Pro Cah)Professional Component ,,73202,CPT,Professional,Both,,,26,350,297.5,36.64,350,"UCare Health, Inc.",Medical Assistance,46.536864,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Ct Upper Extremity Wo W Contrast (Pro Cah)Professional Component ,,73202,CPT,Professional,Both,,,26,350,297.5,36.64,350,"UCare Health, Inc.",Medicare Advantage,65.78,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Ct Upper Extremity Wo W Contrast (Pro Cah)Professional Component ,,73202,CPT,Professional,Both,,,26,350,297.5,36.64,350,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),52.624,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Ct Upper Extremity Wo W Contrast (Pro Cah)Professional Component ,,73202,CPT,Professional,Both,,,26,350,297.5,36.64,350,UnitedHealthcare,Individual & Family,350,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Ct Upper Extremity Wo W Contrast (Pro Cah)Professional Component ,,73202,CPT,Professional,Both,,,26,350,297.5,36.64,350,UnitedHealthcare,Medicare Advantage,65.78,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Upper Extremity Wo W Contrast (Pro Cah)Professional Component ,,73202,CPT,Professional,Both,,,26,350,297.5,36.64,350,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,42.30624,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Ct Angio Upper Extremity (Pro Cah)Professional Component ,,73206,CPT,Professional,Both,,,26,519,441.15,53.88,519,Aetna,Commercial,441.15,85,,percent of total billed charges,,
Ct Angio Upper Extremity (Pro Cah)Professional Component ,,73206,CPT,Professional,Both,,,26,519,441.15,53.88,519,Aetna,Medicare Advantage,86.18,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Angio Upper Extremity (Pro Cah)Professional Component ,,73206,CPT,Professional,Both,,,26,519,441.15,53.88,519,Aetna,PPO,482.67,93,,percent of total billed charges,,
Ct Angio Upper Extremity (Pro Cah)Professional Component ,,73206,CPT,Professional,Both,,,26,519,441.15,53.88,519,America's PPO,America's PPO,443.4336,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Ct Angio Upper Extremity (Pro Cah)Professional Component ,,73206,CPT,Professional,Both,,,26,519,441.15,53.88,519,BlueCross BlueShield Minnesota, Federal Employee Program,161.72,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Ct Angio Upper Extremity (Pro Cah)Professional Component ,,73206,CPT,Professional,Both,,,26,519,441.15,53.88,519,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,164.30752,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Ct Angio Upper Extremity (Pro Cah)Professional Component ,,73206,CPT,Professional,Both,,,26,519,441.15,53.88,519,BlueCross BlueShield Minnesota,High Value Network Plan,164.30752,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Ct Angio Upper Extremity (Pro Cah)Professional Component ,,73206,CPT,Professional,Both,,,26,519,441.15,53.88,519,BlueCross BlueShield Minnesota,Medicare Advantage,96.4275,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Angio Upper Extremity (Pro Cah)Professional Component ,,73206,CPT,Professional,Both,,,26,519,441.15,53.88,519,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,164.30752,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Ct Angio Upper Extremity (Pro Cah)Professional Component ,,73206,CPT,Professional,Both,,,26,519,441.15,53.88,519,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,62.20968,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Ct Angio Upper Extremity (Pro Cah)Professional Component ,,73206,CPT,Professional,Both,,,26,519,441.15,53.88,519,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),96.4275,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Angio Upper Extremity (Pro Cah)Professional Component ,,73206,CPT,Professional,Both,,,26,519,441.15,53.88,519,CorVel,Worker's Compensation,165.8984811,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Ct Angio Upper Extremity (Pro Cah)Professional Component ,,73206,CPT,Professional,Both,,,26,519,441.15,53.88,519,First Health Group Corporation,First Health Network,503.43,97,,percent of total billed charges,,
Ct Angio Upper Extremity (Pro Cah)Professional Component ,,73206,CPT,Professional,Both,,,26,519,441.15,53.88,519,"Health Partners, Inc.",Commercial,127.36,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Ct Angio Upper Extremity (Pro Cah)Professional Component ,,73206,CPT,Professional,Both,,,26,519,441.15,53.88,519,"Health Partners, Inc.",Medicare Advantage,96.4275,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Angio Upper Extremity (Pro Cah)Professional Component ,,73206,CPT,Professional,Both,,,26,519,441.15,53.88,519,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),53.88,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Ct Angio Upper Extremity (Pro Cah)Professional Component ,,73206,CPT,Professional,Both,,,26,519,441.15,53.88,519,"Health Partners, Inc.",State of Minnesota Advantage Program,109.72064,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Ct Angio Upper Extremity (Pro Cah)Professional Component ,,73206,CPT,Professional,Both,,,26,519,441.15,53.88,519,"Health Partners, Inc.",State Public Programs,53.88,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Ct Angio Upper Extremity (Pro Cah)Professional Component ,,73206,CPT,Professional,Both,,,26,519,441.15,53.88,519,Humana Insurance Company,Commercial PPO,83.85,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Ct Angio Upper Extremity (Pro Cah)Professional Component ,,73206,CPT,Professional,Both,,,26,519,441.15,53.88,519,Humana Insurance Company,Medicare PPO,519,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Ct Angio Upper Extremity (Pro Cah)Professional Component ,,73206,CPT,Professional,Both,,,26,519,441.15,53.88,519,Medica,Individual & Family,440.112,84.8,,percent of total billed charges,,
Ct Angio Upper Extremity (Pro Cah)Professional Component ,,73206,CPT,Professional,Both,,,26,519,441.15,53.88,519,Medica,Medica Advantage Solution,258.462,49.8,,percent of total billed charges,,
Ct Angio Upper Extremity (Pro Cah)Professional Component ,,73206,CPT,Professional,Both,,,26,519,441.15,53.88,519,Medica,Medical Assistance,62.21,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Ct Angio Upper Extremity (Pro Cah)Professional Component ,,73206,CPT,Professional,Both,,,26,519,441.15,53.88,519,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,83.85,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Ct Angio Upper Extremity (Pro Cah)Professional Component ,,73206,CPT,Professional,Both,,,26,519,441.15,53.88,519,"Multiplan, Inc.","Multiplan, Inc.",487.86,94,,percent of total billed charges,,
Ct Angio Upper Extremity (Pro Cah)Professional Component ,,73206,CPT,Professional,Both,,,26,519,441.15,53.88,519,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,467.619,90.1,,percent of total billed charges,,
Ct Angio Upper Extremity (Pro Cah)Professional Component ,,73206,CPT,Professional,Both,,,26,519,441.15,53.88,519,"Preferred One Administrative Services, INC.",PPO,511.734,98.6,,percent of total billed charges,,
Ct Angio Upper Extremity (Pro Cah)Professional Component ,,73206,CPT,Professional,Both,,,26,519,441.15,53.88,519,PrimeWest Health,Minnesota Senior Health Options (MSHO),96.4275,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Angio Upper Extremity (Pro Cah)Professional Component ,,73206,CPT,Professional,Both,,,26,519,441.15,53.88,519,PrimeWest Health,MinnesotaCare,66.5643576,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Ct Angio Upper Extremity (Pro Cah)Professional Component ,,73206,CPT,Professional,Both,,,26,519,441.15,53.88,519,Sanford Health Plan,Sanford Health Plan,456.72,88,,percent of total billed charges,,
Ct Angio Upper Extremity (Pro Cah)Professional Component ,,73206,CPT,Professional,Both,,,26,519,441.15,53.88,519,"UCare Health, Inc.",Individual & Family Plan,136.30656,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Ct Angio Upper Extremity (Pro Cah)Professional Component ,,73206,CPT,Professional,Both,,,26,519,441.15,53.88,519,"UCare Health, Inc.",Medical Assistance,68.430648,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Ct Angio Upper Extremity (Pro Cah)Professional Component ,,73206,CPT,Professional,Both,,,26,519,441.15,53.88,519,"UCare Health, Inc.",Medicare Advantage,96.4275,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Ct Angio Upper Extremity (Pro Cah)Professional Component ,,73206,CPT,Professional,Both,,,26,519,441.15,53.88,519,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),77.142,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Ct Angio Upper Extremity (Pro Cah)Professional Component ,,73206,CPT,Professional,Both,,,26,519,441.15,53.88,519,UnitedHealthcare,Individual & Family,519,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Ct Angio Upper Extremity (Pro Cah)Professional Component ,,73206,CPT,Professional,Both,,,26,519,441.15,53.88,519,UnitedHealthcare,Medicare Advantage,96.4275,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Angio Upper Extremity (Pro Cah)Professional Component ,,73206,CPT,Professional,Both,,,26,519,441.15,53.88,519,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,62.20968,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Mri Upper Extremity, Other Than Joint; Without Contrast Material(S) (Pro Cah)Professional Component ",,73218,CPT,Professional,Both,,,26,436,370.6,41.01,436,Aetna,Commercial,370.6,85,,percent of total billed charges,,
"Mri Upper Extremity, Other Than Joint; Without Contrast Material(S) (Pro Cah)Professional Component ",,73218,CPT,Professional,Both,,,26,436,370.6,41.01,436,Aetna,Medicare Advantage,65.39,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Mri Upper Extremity, Other Than Joint; Without Contrast Material(S) (Pro Cah)Professional Component ",,73218,CPT,Professional,Both,,,26,436,370.6,41.01,436,Aetna,PPO,405.48,93,,percent of total billed charges,,
"Mri Upper Extremity, Other Than Joint; Without Contrast Material(S) (Pro Cah)Professional Component ",,73218,CPT,Professional,Both,,,26,436,370.6,41.01,436,America's PPO,America's PPO,372.5184,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Mri Upper Extremity, Other Than Joint; Without Contrast Material(S) (Pro Cah)Professional Component ",,73218,CPT,Professional,Both,,,26,436,370.6,41.01,436,BlueCross BlueShield Minnesota, Federal Employee Program,122.73,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Mri Upper Extremity, Other Than Joint; Without Contrast Material(S) (Pro Cah)Professional Component ",,73218,CPT,Professional,Both,,,26,436,370.6,41.01,436,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,124.69368,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Mri Upper Extremity, Other Than Joint; Without Contrast Material(S) (Pro Cah)Professional Component ",,73218,CPT,Professional,Both,,,26,436,370.6,41.01,436,BlueCross BlueShield Minnesota,High Value Network Plan,124.69368,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Mri Upper Extremity, Other Than Joint; Without Contrast Material(S) (Pro Cah)Professional Component ",,73218,CPT,Professional,Both,,,26,436,370.6,41.01,436,BlueCross BlueShield Minnesota,Medicare Advantage,73.3585,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Mri Upper Extremity, Other Than Joint; Without Contrast Material(S) (Pro Cah)Professional Component ",,73218,CPT,Professional,Both,,,26,436,370.6,41.01,436,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,124.69368,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Mri Upper Extremity, Other Than Joint; Without Contrast Material(S) (Pro Cah)Professional Component ",,73218,CPT,Professional,Both,,,26,436,370.6,41.01,436,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,47.3456,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Mri Upper Extremity, Other Than Joint; Without Contrast Material(S) (Pro Cah)Professional Component ",,73218,CPT,Professional,Both,,,26,436,370.6,41.01,436,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),73.3585,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Mri Upper Extremity, Other Than Joint; Without Contrast Material(S) (Pro Cah)Professional Component ",,73218,CPT,Professional,Both,,,26,436,370.6,41.01,436,CorVel,Worker's Compensation,126.3608757,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Mri Upper Extremity, Other Than Joint; Without Contrast Material(S) (Pro Cah)Professional Component ",,73218,CPT,Professional,Both,,,26,436,370.6,41.01,436,First Health Group Corporation,First Health Network,422.92,97,,percent of total billed charges,,
"Mri Upper Extremity, Other Than Joint; Without Contrast Material(S) (Pro Cah)Professional Component ",,73218,CPT,Professional,Both,,,26,436,370.6,41.01,436,"Health Partners, Inc.",Commercial,96.94,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Mri Upper Extremity, Other Than Joint; Without Contrast Material(S) (Pro Cah)Professional Component ",,73218,CPT,Professional,Both,,,26,436,370.6,41.01,436,"Health Partners, Inc.",Medicare Advantage,73.3585,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Mri Upper Extremity, Other Than Joint; Without Contrast Material(S) (Pro Cah)Professional Component ",,73218,CPT,Professional,Both,,,26,436,370.6,41.01,436,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),41.01,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Mri Upper Extremity, Other Than Joint; Without Contrast Material(S) (Pro Cah)Professional Component ",,73218,CPT,Professional,Both,,,26,436,370.6,41.01,436,"Health Partners, Inc.",State of Minnesota Advantage Program,83.51381,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Mri Upper Extremity, Other Than Joint; Without Contrast Material(S) (Pro Cah)Professional Component ",,73218,CPT,Professional,Both,,,26,436,370.6,41.01,436,"Health Partners, Inc.",State Public Programs,41.01,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Mri Upper Extremity, Other Than Joint; Without Contrast Material(S) (Pro Cah)Professional Component ",,73218,CPT,Professional,Both,,,26,436,370.6,41.01,436,Humana Insurance Company,Commercial PPO,63.79,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Mri Upper Extremity, Other Than Joint; Without Contrast Material(S) (Pro Cah)Professional Component ",,73218,CPT,Professional,Both,,,26,436,370.6,41.01,436,Humana Insurance Company,Medicare PPO,436,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Mri Upper Extremity, Other Than Joint; Without Contrast Material(S) (Pro Cah)Professional Component ",,73218,CPT,Professional,Both,,,26,436,370.6,41.01,436,Medica,Individual & Family,369.728,84.8,,percent of total billed charges,,
"Mri Upper Extremity, Other Than Joint; Without Contrast Material(S) (Pro Cah)Professional Component ",,73218,CPT,Professional,Both,,,26,436,370.6,41.01,436,Medica,Medica Advantage Solution,217.128,49.8,,percent of total billed charges,,
"Mri Upper Extremity, Other Than Joint; Without Contrast Material(S) (Pro Cah)Professional Component ",,73218,CPT,Professional,Both,,,26,436,370.6,41.01,436,Medica,Medical Assistance,47.35,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Mri Upper Extremity, Other Than Joint; Without Contrast Material(S) (Pro Cah)Professional Component ",,73218,CPT,Professional,Both,,,26,436,370.6,41.01,436,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,63.79,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Mri Upper Extremity, Other Than Joint; Without Contrast Material(S) (Pro Cah)Professional Component ",,73218,CPT,Professional,Both,,,26,436,370.6,41.01,436,"Multiplan, Inc.","Multiplan, Inc.",409.84,94,,percent of total billed charges,,
"Mri Upper Extremity, Other Than Joint; Without Contrast Material(S) (Pro Cah)Professional Component ",,73218,CPT,Professional,Both,,,26,436,370.6,41.01,436,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,392.836,90.1,,percent of total billed charges,,
"Mri Upper Extremity, Other Than Joint; Without Contrast Material(S) (Pro Cah)Professional Component ",,73218,CPT,Professional,Both,,,26,436,370.6,41.01,436,"Preferred One Administrative Services, INC.",PPO,429.896,98.6,,percent of total billed charges,,
"Mri Upper Extremity, Other Than Joint; Without Contrast Material(S) (Pro Cah)Professional Component ",,73218,CPT,Professional,Both,,,26,436,370.6,41.01,436,PrimeWest Health,Minnesota Senior Health Options (MSHO),73.3585,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Mri Upper Extremity, Other Than Joint; Without Contrast Material(S) (Pro Cah)Professional Component ",,73218,CPT,Professional,Both,,,26,436,370.6,41.01,436,PrimeWest Health,MinnesotaCare,50.659792,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Mri Upper Extremity, Other Than Joint; Without Contrast Material(S) (Pro Cah)Professional Component ",,73218,CPT,Professional,Both,,,26,436,370.6,41.01,436,Sanford Health Plan,Sanford Health Plan,383.68,88,,percent of total billed charges,,
"Mri Upper Extremity, Other Than Joint; Without Contrast Material(S) (Pro Cah)Professional Component ",,73218,CPT,Professional,Both,,,26,436,370.6,41.01,436,"UCare Health, Inc.",Individual & Family Plan,103.697024,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Mri Upper Extremity, Other Than Joint; Without Contrast Material(S) (Pro Cah)Professional Component ",,73218,CPT,Professional,Both,,,26,436,370.6,41.01,436,"UCare Health, Inc.",Medical Assistance,52.08016,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Mri Upper Extremity, Other Than Joint; Without Contrast Material(S) (Pro Cah)Professional Component ",,73218,CPT,Professional,Both,,,26,436,370.6,41.01,436,"UCare Health, Inc.",Medicare Advantage,73.3585,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Mri Upper Extremity, Other Than Joint; Without Contrast Material(S) (Pro Cah)Professional Component ",,73218,CPT,Professional,Both,,,26,436,370.6,41.01,436,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),58.6868,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Mri Upper Extremity, Other Than Joint; Without Contrast Material(S) (Pro Cah)Professional Component ",,73218,CPT,Professional,Both,,,26,436,370.6,41.01,436,UnitedHealthcare,Individual & Family,436,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Mri Upper Extremity, Other Than Joint; Without Contrast Material(S) (Pro Cah)Professional Component ",,73218,CPT,Professional,Both,,,26,436,370.6,41.01,436,UnitedHealthcare,Medicare Advantage,73.3585,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Mri Upper Extremity, Other Than Joint; Without Contrast Material(S) (Pro Cah)Professional Component ",,73218,CPT,Professional,Both,,,26,436,370.6,41.01,436,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,47.3456,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Mri, Upper Extremity, Other Than Joint; With Contrast Material(S) (Pro Cah)Professional Component ",,73219,CPT,Professional,Both,,,26,535,454.75,48.86,535,Aetna,Commercial,454.75,85,,percent of total billed charges,,
"Mri, Upper Extremity, Other Than Joint; With Contrast Material(S) (Pro Cah)Professional Component ",,73219,CPT,Professional,Both,,,26,535,454.75,48.86,535,Aetna,Medicare Advantage,78.49,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Mri, Upper Extremity, Other Than Joint; With Contrast Material(S) (Pro Cah)Professional Component ",,73219,CPT,Professional,Both,,,26,535,454.75,48.86,535,Aetna,PPO,497.55,93,,percent of total billed charges,,
"Mri, Upper Extremity, Other Than Joint; With Contrast Material(S) (Pro Cah)Professional Component ",,73219,CPT,Professional,Both,,,26,535,454.75,48.86,535,America's PPO,America's PPO,457.104,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Mri, Upper Extremity, Other Than Joint; With Contrast Material(S) (Pro Cah)Professional Component ",,73219,CPT,Professional,Both,,,26,535,454.75,48.86,535,BlueCross BlueShield Minnesota, Federal Employee Program,146.38,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Mri, Upper Extremity, Other Than Joint; With Contrast Material(S) (Pro Cah)Professional Component ",,73219,CPT,Professional,Both,,,26,535,454.75,48.86,535,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,148.72208,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Mri, Upper Extremity, Other Than Joint; With Contrast Material(S) (Pro Cah)Professional Component ",,73219,CPT,Professional,Both,,,26,535,454.75,48.86,535,BlueCross BlueShield Minnesota,High Value Network Plan,148.72208,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Mri, Upper Extremity, Other Than Joint; With Contrast Material(S) (Pro Cah)Professional Component ",,73219,CPT,Professional,Both,,,26,535,454.75,48.86,535,BlueCross BlueShield Minnesota,Medicare Advantage,87.5725,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Mri, Upper Extremity, Other Than Joint; With Contrast Material(S) (Pro Cah)Professional Component ",,73219,CPT,Professional,Both,,,26,535,454.75,48.86,535,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,148.72208,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Mri, Upper Extremity, Other Than Joint; With Contrast Material(S) (Pro Cah)Professional Component ",,73219,CPT,Professional,Both,,,26,535,454.75,48.86,535,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,56.40832,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Mri, Upper Extremity, Other Than Joint; With Contrast Material(S) (Pro Cah)Professional Component ",,73219,CPT,Professional,Both,,,26,535,454.75,48.86,535,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),87.5725,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Mri, Upper Extremity, Other Than Joint; With Contrast Material(S) (Pro Cah)Professional Component ",,73219,CPT,Professional,Both,,,26,535,454.75,48.86,535,CorVel,Worker's Compensation,151.0948848,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Mri, Upper Extremity, Other Than Joint; With Contrast Material(S) (Pro Cah)Professional Component ",,73219,CPT,Professional,Both,,,26,535,454.75,48.86,535,First Health Group Corporation,First Health Network,518.95,97,,percent of total billed charges,,
"Mri, Upper Extremity, Other Than Joint; With Contrast Material(S) (Pro Cah)Professional Component ",,73219,CPT,Professional,Both,,,26,535,454.75,48.86,535,"Health Partners, Inc.",Commercial,116.02,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Mri, Upper Extremity, Other Than Joint; With Contrast Material(S) (Pro Cah)Professional Component ",,73219,CPT,Professional,Both,,,26,535,454.75,48.86,535,"Health Partners, Inc.",Medicare Advantage,87.5725,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Mri, Upper Extremity, Other Than Joint; With Contrast Material(S) (Pro Cah)Professional Component ",,73219,CPT,Professional,Both,,,26,535,454.75,48.86,535,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),48.86,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Mri, Upper Extremity, Other Than Joint; With Contrast Material(S) (Pro Cah)Professional Component ",,73219,CPT,Professional,Both,,,26,535,454.75,48.86,535,"Health Partners, Inc.",State of Minnesota Advantage Program,99.95123,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Mri, Upper Extremity, Other Than Joint; With Contrast Material(S) (Pro Cah)Professional Component ",,73219,CPT,Professional,Both,,,26,535,454.75,48.86,535,"Health Partners, Inc.",State Public Programs,48.86,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Mri, Upper Extremity, Other Than Joint; With Contrast Material(S) (Pro Cah)Professional Component ",,73219,CPT,Professional,Both,,,26,535,454.75,48.86,535,Humana Insurance Company,Commercial PPO,76.15,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Mri, Upper Extremity, Other Than Joint; With Contrast Material(S) (Pro Cah)Professional Component ",,73219,CPT,Professional,Both,,,26,535,454.75,48.86,535,Humana Insurance Company,Medicare PPO,535,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Mri, Upper Extremity, Other Than Joint; With Contrast Material(S) (Pro Cah)Professional Component ",,73219,CPT,Professional,Both,,,26,535,454.75,48.86,535,Medica,Individual & Family,453.68,84.8,,percent of total billed charges,,
"Mri, Upper Extremity, Other Than Joint; With Contrast Material(S) (Pro Cah)Professional Component ",,73219,CPT,Professional,Both,,,26,535,454.75,48.86,535,Medica,Medica Advantage Solution,266.43,49.8,,percent of total billed charges,,
"Mri, Upper Extremity, Other Than Joint; With Contrast Material(S) (Pro Cah)Professional Component ",,73219,CPT,Professional,Both,,,26,535,454.75,48.86,535,Medica,Medical Assistance,56.41,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Mri, Upper Extremity, Other Than Joint; With Contrast Material(S) (Pro Cah)Professional Component ",,73219,CPT,Professional,Both,,,26,535,454.75,48.86,535,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,76.15,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Mri, Upper Extremity, Other Than Joint; With Contrast Material(S) (Pro Cah)Professional Component ",,73219,CPT,Professional,Both,,,26,535,454.75,48.86,535,"Multiplan, Inc.","Multiplan, Inc.",502.9,94,,percent of total billed charges,,
"Mri, Upper Extremity, Other Than Joint; With Contrast Material(S) (Pro Cah)Professional Component ",,73219,CPT,Professional,Both,,,26,535,454.75,48.86,535,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,482.035,90.1,,percent of total billed charges,,
"Mri, Upper Extremity, Other Than Joint; With Contrast Material(S) (Pro Cah)Professional Component ",,73219,CPT,Professional,Both,,,26,535,454.75,48.86,535,"Preferred One Administrative Services, INC.",PPO,527.51,98.6,,percent of total billed charges,,
"Mri, Upper Extremity, Other Than Joint; With Contrast Material(S) (Pro Cah)Professional Component ",,73219,CPT,Professional,Both,,,26,535,454.75,48.86,535,PrimeWest Health,Minnesota Senior Health Options (MSHO),87.5725,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Mri, Upper Extremity, Other Than Joint; With Contrast Material(S) (Pro Cah)Professional Component ",,73219,CPT,Professional,Both,,,26,535,454.75,48.86,535,PrimeWest Health,MinnesotaCare,60.3569024,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Mri, Upper Extremity, Other Than Joint; With Contrast Material(S) (Pro Cah)Professional Component ",,73219,CPT,Professional,Both,,,26,535,454.75,48.86,535,Sanford Health Plan,Sanford Health Plan,470.8,88,,percent of total billed charges,,
"Mri, Upper Extremity, Other Than Joint; With Contrast Material(S) (Pro Cah)Professional Component ",,73219,CPT,Professional,Both,,,26,535,454.75,48.86,535,"UCare Health, Inc.",Individual & Family Plan,123.78944,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Mri, Upper Extremity, Other Than Joint; With Contrast Material(S) (Pro Cah)Professional Component ",,73219,CPT,Professional,Both,,,26,535,454.75,48.86,535,"UCare Health, Inc.",Medical Assistance,62.049152,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Mri, Upper Extremity, Other Than Joint; With Contrast Material(S) (Pro Cah)Professional Component ",,73219,CPT,Professional,Both,,,26,535,454.75,48.86,535,"UCare Health, Inc.",Medicare Advantage,87.5725,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Mri, Upper Extremity, Other Than Joint; With Contrast Material(S) (Pro Cah)Professional Component ",,73219,CPT,Professional,Both,,,26,535,454.75,48.86,535,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),70.058,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Mri, Upper Extremity, Other Than Joint; With Contrast Material(S) (Pro Cah)Professional Component ",,73219,CPT,Professional,Both,,,26,535,454.75,48.86,535,UnitedHealthcare,Individual & Family,535,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Mri, Upper Extremity, Other Than Joint; With Contrast Material(S) (Pro Cah)Professional Component ",,73219,CPT,Professional,Both,,,26,535,454.75,48.86,535,UnitedHealthcare,Medicare Advantage,87.5725,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Mri, Upper Extremity, Other Than Joint; With Contrast Material(S) (Pro Cah)Professional Component ",,73219,CPT,Professional,Both,,,26,535,454.75,48.86,535,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,56.40832,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Mri Upper Extremity, Other Than Joint; W/O Contrast Followed By Contrast Further Sequences (Pro Cah)Professional Component ",,73220,CPT,Professional,Both,,,26,802,681.7,65.01,802,Aetna,Commercial,681.7,85,,percent of total billed charges,,
"Mri Upper Extremity, Other Than Joint; W/O Contrast Followed By Contrast Further Sequences (Pro Cah)Professional Component ",,73220,CPT,Professional,Both,,,26,802,681.7,65.01,802,Aetna,Medicare Advantage,103.82,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Mri Upper Extremity, Other Than Joint; W/O Contrast Followed By Contrast Further Sequences (Pro Cah)Professional Component ",,73220,CPT,Professional,Both,,,26,802,681.7,65.01,802,Aetna,PPO,745.86,93,,percent of total billed charges,,
"Mri Upper Extremity, Other Than Joint; W/O Contrast Followed By Contrast Further Sequences (Pro Cah)Professional Component ",,73220,CPT,Professional,Both,,,26,802,681.7,65.01,802,America's PPO,America's PPO,685.2288,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Mri Upper Extremity, Other Than Joint; W/O Contrast Followed By Contrast Further Sequences (Pro Cah)Professional Component ",,73220,CPT,Professional,Both,,,26,802,681.7,65.01,802,BlueCross BlueShield Minnesota, Federal Employee Program,194.32,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Mri Upper Extremity, Other Than Joint; W/O Contrast Followed By Contrast Further Sequences (Pro Cah)Professional Component ",,73220,CPT,Professional,Both,,,26,802,681.7,65.01,802,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,197.42912,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Mri Upper Extremity, Other Than Joint; W/O Contrast Followed By Contrast Further Sequences (Pro Cah)Professional Component ",,73220,CPT,Professional,Both,,,26,802,681.7,65.01,802,BlueCross BlueShield Minnesota,High Value Network Plan,197.42912,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Mri Upper Extremity, Other Than Joint; W/O Contrast Followed By Contrast Further Sequences (Pro Cah)Professional Component ",,73220,CPT,Professional,Both,,,26,802,681.7,65.01,802,BlueCross BlueShield Minnesota,Medicare Advantage,116.1615,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Mri Upper Extremity, Other Than Joint; W/O Contrast Followed By Contrast Further Sequences (Pro Cah)Professional Component ",,73220,CPT,Professional,Both,,,26,802,681.7,65.01,802,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,197.42912,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Mri Upper Extremity, Other Than Joint; W/O Contrast Followed By Contrast Further Sequences (Pro Cah)Professional Component ",,73220,CPT,Professional,Both,,,26,802,681.7,65.01,802,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,75.05192,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Mri Upper Extremity, Other Than Joint; W/O Contrast Followed By Contrast Further Sequences (Pro Cah)Professional Component ",,73220,CPT,Professional,Both,,,26,802,681.7,65.01,802,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),116.1615,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Mri Upper Extremity, Other Than Joint; W/O Contrast Followed By Contrast Further Sequences (Pro Cah)Professional Component ",,73220,CPT,Professional,Both,,,26,802,681.7,65.01,802,CorVel,Worker's Compensation,199.8603048,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Mri Upper Extremity, Other Than Joint; W/O Contrast Followed By Contrast Further Sequences (Pro Cah)Professional Component ",,73220,CPT,Professional,Both,,,26,802,681.7,65.01,802,First Health Group Corporation,First Health Network,777.94,97,,percent of total billed charges,,
"Mri Upper Extremity, Other Than Joint; W/O Contrast Followed By Contrast Further Sequences (Pro Cah)Professional Component ",,73220,CPT,Professional,Both,,,26,802,681.7,65.01,802,"Health Partners, Inc.",Commercial,153.66,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Mri Upper Extremity, Other Than Joint; W/O Contrast Followed By Contrast Further Sequences (Pro Cah)Professional Component ",,73220,CPT,Professional,Both,,,26,802,681.7,65.01,802,"Health Partners, Inc.",Medicare Advantage,116.1615,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Mri Upper Extremity, Other Than Joint; W/O Contrast Followed By Contrast Further Sequences (Pro Cah)Professional Component ",,73220,CPT,Professional,Both,,,26,802,681.7,65.01,802,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),65.01,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Mri Upper Extremity, Other Than Joint; W/O Contrast Followed By Contrast Further Sequences (Pro Cah)Professional Component ",,73220,CPT,Professional,Both,,,26,802,681.7,65.01,802,"Health Partners, Inc.",State of Minnesota Advantage Program,132.37809,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Mri Upper Extremity, Other Than Joint; W/O Contrast Followed By Contrast Further Sequences (Pro Cah)Professional Component ",,73220,CPT,Professional,Both,,,26,802,681.7,65.01,802,"Health Partners, Inc.",State Public Programs,65.01,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Mri Upper Extremity, Other Than Joint; W/O Contrast Followed By Contrast Further Sequences (Pro Cah)Professional Component ",,73220,CPT,Professional,Both,,,26,802,681.7,65.01,802,Humana Insurance Company,Commercial PPO,101.01,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Mri Upper Extremity, Other Than Joint; W/O Contrast Followed By Contrast Further Sequences (Pro Cah)Professional Component ",,73220,CPT,Professional,Both,,,26,802,681.7,65.01,802,Humana Insurance Company,Medicare PPO,802,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Mri Upper Extremity, Other Than Joint; W/O Contrast Followed By Contrast Further Sequences (Pro Cah)Professional Component ",,73220,CPT,Professional,Both,,,26,802,681.7,65.01,802,Medica,Individual & Family,680.096,84.8,,percent of total billed charges,,
"Mri Upper Extremity, Other Than Joint; W/O Contrast Followed By Contrast Further Sequences (Pro Cah)Professional Component ",,73220,CPT,Professional,Both,,,26,802,681.7,65.01,802,Medica,Medica Advantage Solution,399.396,49.8,,percent of total billed charges,,
"Mri Upper Extremity, Other Than Joint; W/O Contrast Followed By Contrast Further Sequences (Pro Cah)Professional Component ",,73220,CPT,Professional,Both,,,26,802,681.7,65.01,802,Medica,Medical Assistance,75.05,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Mri Upper Extremity, Other Than Joint; W/O Contrast Followed By Contrast Further Sequences (Pro Cah)Professional Component ",,73220,CPT,Professional,Both,,,26,802,681.7,65.01,802,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,101.01,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Mri Upper Extremity, Other Than Joint; W/O Contrast Followed By Contrast Further Sequences (Pro Cah)Professional Component ",,73220,CPT,Professional,Both,,,26,802,681.7,65.01,802,"Multiplan, Inc.","Multiplan, Inc.",753.88,94,,percent of total billed charges,,
"Mri Upper Extremity, Other Than Joint; W/O Contrast Followed By Contrast Further Sequences (Pro Cah)Professional Component ",,73220,CPT,Professional,Both,,,26,802,681.7,65.01,802,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,722.602,90.1,,percent of total billed charges,,
"Mri Upper Extremity, Other Than Joint; W/O Contrast Followed By Contrast Further Sequences (Pro Cah)Professional Component ",,73220,CPT,Professional,Both,,,26,802,681.7,65.01,802,"Preferred One Administrative Services, INC.",PPO,790.772,98.6,,percent of total billed charges,,
"Mri Upper Extremity, Other Than Joint; W/O Contrast Followed By Contrast Further Sequences (Pro Cah)Professional Component ",,73220,CPT,Professional,Both,,,26,802,681.7,65.01,802,PrimeWest Health,Minnesota Senior Health Options (MSHO),116.1615,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Mri Upper Extremity, Other Than Joint; W/O Contrast Followed By Contrast Further Sequences (Pro Cah)Professional Component ",,73220,CPT,Professional,Both,,,26,802,681.7,65.01,802,PrimeWest Health,MinnesotaCare,80.3055544,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Mri Upper Extremity, Other Than Joint; W/O Contrast Followed By Contrast Further Sequences (Pro Cah)Professional Component ",,73220,CPT,Professional,Both,,,26,802,681.7,65.01,802,Sanford Health Plan,Sanford Health Plan,705.76,88,,percent of total billed charges,,
"Mri Upper Extremity, Other Than Joint; W/O Contrast Followed By Contrast Further Sequences (Pro Cah)Professional Component ",,73220,CPT,Professional,Both,,,26,802,681.7,65.01,802,"UCare Health, Inc.",Individual & Family Plan,164.201856,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Mri Upper Extremity, Other Than Joint; W/O Contrast Followed By Contrast Further Sequences (Pro Cah)Professional Component ",,73220,CPT,Professional,Both,,,26,802,681.7,65.01,802,"UCare Health, Inc.",Medical Assistance,82.557112,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Mri Upper Extremity, Other Than Joint; W/O Contrast Followed By Contrast Further Sequences (Pro Cah)Professional Component ",,73220,CPT,Professional,Both,,,26,802,681.7,65.01,802,"UCare Health, Inc.",Medicare Advantage,116.1615,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Mri Upper Extremity, Other Than Joint; W/O Contrast Followed By Contrast Further Sequences (Pro Cah)Professional Component ",,73220,CPT,Professional,Both,,,26,802,681.7,65.01,802,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),92.9292,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Mri Upper Extremity, Other Than Joint; W/O Contrast Followed By Contrast Further Sequences (Pro Cah)Professional Component ",,73220,CPT,Professional,Both,,,26,802,681.7,65.01,802,UnitedHealthcare,Individual & Family,802,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Mri Upper Extremity, Other Than Joint; W/O Contrast Followed By Contrast Further Sequences (Pro Cah)Professional Component ",,73220,CPT,Professional,Both,,,26,802,681.7,65.01,802,UnitedHealthcare,Medicare Advantage,116.1615,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Mri Upper Extremity, Other Than Joint; W/O Contrast Followed By Contrast Further Sequences (Pro Cah)Professional Component ",,73220,CPT,Professional,Both,,,26,802,681.7,65.01,802,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,75.05192,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Mri Upper Extremity Any Joint W/O Contrast (Pro Cah)Professional Component ,,73221,CPT,Professional,Both,,,26,587,498.95,41.23,587,Aetna,Commercial,498.95,85,,percent of total billed charges,,
Mri Upper Extremity Any Joint W/O Contrast (Pro Cah)Professional Component ,,73221,CPT,Professional,Both,,,26,587,498.95,41.23,587,Aetna,Medicare Advantage,65.87,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Mri Upper Extremity Any Joint W/O Contrast (Pro Cah)Professional Component ,,73221,CPT,Professional,Both,,,26,587,498.95,41.23,587,Aetna,PPO,545.91,93,,percent of total billed charges,,
Mri Upper Extremity Any Joint W/O Contrast (Pro Cah)Professional Component ,,73221,CPT,Professional,Both,,,26,587,498.95,41.23,587,America's PPO,America's PPO,501.5328,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Mri Upper Extremity Any Joint W/O Contrast (Pro Cah)Professional Component ,,73221,CPT,Professional,Both,,,26,587,498.95,41.23,587,BlueCross BlueShield Minnesota, Federal Employee Program,123.37,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Mri Upper Extremity Any Joint W/O Contrast (Pro Cah)Professional Component ,,73221,CPT,Professional,Both,,,26,587,498.95,41.23,587,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,125.34392,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Mri Upper Extremity Any Joint W/O Contrast (Pro Cah)Professional Component ,,73221,CPT,Professional,Both,,,26,587,498.95,41.23,587,BlueCross BlueShield Minnesota,High Value Network Plan,125.34392,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Mri Upper Extremity Any Joint W/O Contrast (Pro Cah)Professional Component ,,73221,CPT,Professional,Both,,,26,587,498.95,41.23,587,BlueCross BlueShield Minnesota,Medicare Advantage,73.7495,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Mri Upper Extremity Any Joint W/O Contrast (Pro Cah)Professional Component ,,73221,CPT,Professional,Both,,,26,587,498.95,41.23,587,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,125.34392,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Mri Upper Extremity Any Joint W/O Contrast (Pro Cah)Professional Component ,,73221,CPT,Professional,Both,,,26,587,498.95,41.23,587,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,47.5996,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Mri Upper Extremity Any Joint W/O Contrast (Pro Cah)Professional Component ,,73221,CPT,Professional,Both,,,26,587,498.95,41.23,587,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),73.7495,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Mri Upper Extremity Any Joint W/O Contrast (Pro Cah)Professional Component ,,73221,CPT,Professional,Both,,,26,587,498.95,41.23,587,CorVel,Worker's Compensation,126.5979858,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Mri Upper Extremity Any Joint W/O Contrast (Pro Cah)Professional Component ,,73221,CPT,Professional,Both,,,26,587,498.95,41.23,587,First Health Group Corporation,First Health Network,569.39,97,,percent of total billed charges,,
Mri Upper Extremity Any Joint W/O Contrast (Pro Cah)Professional Component ,,73221,CPT,Professional,Both,,,26,587,498.95,41.23,587,"Health Partners, Inc.",Commercial,97.45,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Mri Upper Extremity Any Joint W/O Contrast (Pro Cah)Professional Component ,,73221,CPT,Professional,Both,,,26,587,498.95,41.23,587,"Health Partners, Inc.",Medicare Advantage,73.7495,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Mri Upper Extremity Any Joint W/O Contrast (Pro Cah)Professional Component ,,73221,CPT,Professional,Both,,,26,587,498.95,41.23,587,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),41.23,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Mri Upper Extremity Any Joint W/O Contrast (Pro Cah)Professional Component ,,73221,CPT,Professional,Both,,,26,587,498.95,41.23,587,"Health Partners, Inc.",State of Minnesota Advantage Program,83.953175,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Mri Upper Extremity Any Joint W/O Contrast (Pro Cah)Professional Component ,,73221,CPT,Professional,Both,,,26,587,498.95,41.23,587,"Health Partners, Inc.",State Public Programs,41.23,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Mri Upper Extremity Any Joint W/O Contrast (Pro Cah)Professional Component ,,73221,CPT,Professional,Both,,,26,587,498.95,41.23,587,Humana Insurance Company,Commercial PPO,64.13,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Mri Upper Extremity Any Joint W/O Contrast (Pro Cah)Professional Component ,,73221,CPT,Professional,Both,,,26,587,498.95,41.23,587,Humana Insurance Company,Medicare PPO,587,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Mri Upper Extremity Any Joint W/O Contrast (Pro Cah)Professional Component ,,73221,CPT,Professional,Both,,,26,587,498.95,41.23,587,Medica,Individual & Family,497.776,84.8,,percent of total billed charges,,
Mri Upper Extremity Any Joint W/O Contrast (Pro Cah)Professional Component ,,73221,CPT,Professional,Both,,,26,587,498.95,41.23,587,Medica,Medica Advantage Solution,292.326,49.8,,percent of total billed charges,,
Mri Upper Extremity Any Joint W/O Contrast (Pro Cah)Professional Component ,,73221,CPT,Professional,Both,,,26,587,498.95,41.23,587,Medica,Medical Assistance,47.6,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Mri Upper Extremity Any Joint W/O Contrast (Pro Cah)Professional Component ,,73221,CPT,Professional,Both,,,26,587,498.95,41.23,587,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,64.13,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Mri Upper Extremity Any Joint W/O Contrast (Pro Cah)Professional Component ,,73221,CPT,Professional,Both,,,26,587,498.95,41.23,587,"Multiplan, Inc.","Multiplan, Inc.",551.78,94,,percent of total billed charges,,
Mri Upper Extremity Any Joint W/O Contrast (Pro Cah)Professional Component ,,73221,CPT,Professional,Both,,,26,587,498.95,41.23,587,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,528.887,90.1,,percent of total billed charges,,
Mri Upper Extremity Any Joint W/O Contrast (Pro Cah)Professional Component ,,73221,CPT,Professional,Both,,,26,587,498.95,41.23,587,"Preferred One Administrative Services, INC.",PPO,578.782,98.6,,percent of total billed charges,,
Mri Upper Extremity Any Joint W/O Contrast (Pro Cah)Professional Component ,,73221,CPT,Professional,Both,,,26,587,498.95,41.23,587,PrimeWest Health,Minnesota Senior Health Options (MSHO),73.7495,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Mri Upper Extremity Any Joint W/O Contrast (Pro Cah)Professional Component ,,73221,CPT,Professional,Both,,,26,587,498.95,41.23,587,PrimeWest Health,MinnesotaCare,50.931572,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Mri Upper Extremity Any Joint W/O Contrast (Pro Cah)Professional Component ,,73221,CPT,Professional,Both,,,26,587,498.95,41.23,587,Sanford Health Plan,Sanford Health Plan,516.56,88,,percent of total billed charges,,
Mri Upper Extremity Any Joint W/O Contrast (Pro Cah)Professional Component ,,73221,CPT,Professional,Both,,,26,587,498.95,41.23,587,"UCare Health, Inc.",Individual & Family Plan,104.249728,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Mri Upper Extremity Any Joint W/O Contrast (Pro Cah)Professional Component ,,73221,CPT,Professional,Both,,,26,587,498.95,41.23,587,"UCare Health, Inc.",Medical Assistance,52.35956,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Mri Upper Extremity Any Joint W/O Contrast (Pro Cah)Professional Component ,,73221,CPT,Professional,Both,,,26,587,498.95,41.23,587,"UCare Health, Inc.",Medicare Advantage,73.7495,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Mri Upper Extremity Any Joint W/O Contrast (Pro Cah)Professional Component ,,73221,CPT,Professional,Both,,,26,587,498.95,41.23,587,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),58.9996,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Mri Upper Extremity Any Joint W/O Contrast (Pro Cah)Professional Component ,,73221,CPT,Professional,Both,,,26,587,498.95,41.23,587,UnitedHealthcare,Individual & Family,587,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Mri Upper Extremity Any Joint W/O Contrast (Pro Cah)Professional Component ,,73221,CPT,Professional,Both,,,26,587,498.95,41.23,587,UnitedHealthcare,Medicare Advantage,73.7495,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Mri Upper Extremity Any Joint W/O Contrast (Pro Cah)Professional Component ,,73221,CPT,Professional,Both,,,26,587,498.95,41.23,587,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,47.5996,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Mri Any Joint Of Upper Extremity; With Contrast Material(S) (Pro Cah)Professional Component ,,73222,CPT,Professional,Both,,,26,620,527,49.08,620,Aetna,Commercial,527,85,,percent of total billed charges,,
Mri Any Joint Of Upper Extremity; With Contrast Material(S) (Pro Cah)Professional Component ,,73222,CPT,Professional,Both,,,26,620,527,49.08,620,Aetna,Medicare Advantage,78.84,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Mri Any Joint Of Upper Extremity; With Contrast Material(S) (Pro Cah)Professional Component ,,73222,CPT,Professional,Both,,,26,620,527,49.08,620,Aetna,PPO,576.6,93,,percent of total billed charges,,
Mri Any Joint Of Upper Extremity; With Contrast Material(S) (Pro Cah)Professional Component ,,73222,CPT,Professional,Both,,,26,620,527,49.08,620,America's PPO,America's PPO,529.728,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Mri Any Joint Of Upper Extremity; With Contrast Material(S) (Pro Cah)Professional Component ,,73222,CPT,Professional,Both,,,26,620,527,49.08,620,BlueCross BlueShield Minnesota, Federal Employee Program,147.02,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Mri Any Joint Of Upper Extremity; With Contrast Material(S) (Pro Cah)Professional Component ,,73222,CPT,Professional,Both,,,26,620,527,49.08,620,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,149.37232,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Mri Any Joint Of Upper Extremity; With Contrast Material(S) (Pro Cah)Professional Component ,,73222,CPT,Professional,Both,,,26,620,527,49.08,620,BlueCross BlueShield Minnesota,High Value Network Plan,149.37232,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Mri Any Joint Of Upper Extremity; With Contrast Material(S) (Pro Cah)Professional Component ,,73222,CPT,Professional,Both,,,26,620,527,49.08,620,BlueCross BlueShield Minnesota,Medicare Advantage,87.975,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Mri Any Joint Of Upper Extremity; With Contrast Material(S) (Pro Cah)Professional Component ,,73222,CPT,Professional,Both,,,26,620,527,49.08,620,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,149.37232,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Mri Any Joint Of Upper Extremity; With Contrast Material(S) (Pro Cah)Professional Component ,,73222,CPT,Professional,Both,,,26,620,527,49.08,620,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,56.66232,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Mri Any Joint Of Upper Extremity; With Contrast Material(S) (Pro Cah)Professional Component ,,73222,CPT,Professional,Both,,,26,620,527,49.08,620,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),87.975,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Mri Any Joint Of Upper Extremity; With Contrast Material(S) (Pro Cah)Professional Component ,,73222,CPT,Professional,Both,,,26,620,527,49.08,620,CorVel,Worker's Compensation,151.7753169,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Mri Any Joint Of Upper Extremity; With Contrast Material(S) (Pro Cah)Professional Component ,,73222,CPT,Professional,Both,,,26,620,527,49.08,620,First Health Group Corporation,First Health Network,601.4,97,,percent of total billed charges,,
Mri Any Joint Of Upper Extremity; With Contrast Material(S) (Pro Cah)Professional Component ,,73222,CPT,Professional,Both,,,26,620,527,49.08,620,"Health Partners, Inc.",Commercial,116.54,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Mri Any Joint Of Upper Extremity; With Contrast Material(S) (Pro Cah)Professional Component ,,73222,CPT,Professional,Both,,,26,620,527,49.08,620,"Health Partners, Inc.",Medicare Advantage,87.975,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Mri Any Joint Of Upper Extremity; With Contrast Material(S) (Pro Cah)Professional Component ,,73222,CPT,Professional,Both,,,26,620,527,49.08,620,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),49.08,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Mri Any Joint Of Upper Extremity; With Contrast Material(S) (Pro Cah)Professional Component ,,73222,CPT,Professional,Both,,,26,620,527,49.08,620,"Health Partners, Inc.",State of Minnesota Advantage Program,100.39921,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Mri Any Joint Of Upper Extremity; With Contrast Material(S) (Pro Cah)Professional Component ,,73222,CPT,Professional,Both,,,26,620,527,49.08,620,"Health Partners, Inc.",State Public Programs,49.08,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Mri Any Joint Of Upper Extremity; With Contrast Material(S) (Pro Cah)Professional Component ,,73222,CPT,Professional,Both,,,26,620,527,49.08,620,Humana Insurance Company,Commercial PPO,76.5,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Mri Any Joint Of Upper Extremity; With Contrast Material(S) (Pro Cah)Professional Component ,,73222,CPT,Professional,Both,,,26,620,527,49.08,620,Humana Insurance Company,Medicare PPO,620,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Mri Any Joint Of Upper Extremity; With Contrast Material(S) (Pro Cah)Professional Component ,,73222,CPT,Professional,Both,,,26,620,527,49.08,620,Medica,Individual & Family,525.76,84.8,,percent of total billed charges,,
Mri Any Joint Of Upper Extremity; With Contrast Material(S) (Pro Cah)Professional Component ,,73222,CPT,Professional,Both,,,26,620,527,49.08,620,Medica,Medica Advantage Solution,308.76,49.8,,percent of total billed charges,,
Mri Any Joint Of Upper Extremity; With Contrast Material(S) (Pro Cah)Professional Component ,,73222,CPT,Professional,Both,,,26,620,527,49.08,620,Medica,Medical Assistance,56.66,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Mri Any Joint Of Upper Extremity; With Contrast Material(S) (Pro Cah)Professional Component ,,73222,CPT,Professional,Both,,,26,620,527,49.08,620,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,76.5,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Mri Any Joint Of Upper Extremity; With Contrast Material(S) (Pro Cah)Professional Component ,,73222,CPT,Professional,Both,,,26,620,527,49.08,620,"Multiplan, Inc.","Multiplan, Inc.",582.8,94,,percent of total billed charges,,
Mri Any Joint Of Upper Extremity; With Contrast Material(S) (Pro Cah)Professional Component ,,73222,CPT,Professional,Both,,,26,620,527,49.08,620,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,558.62,90.1,,percent of total billed charges,,
Mri Any Joint Of Upper Extremity; With Contrast Material(S) (Pro Cah)Professional Component ,,73222,CPT,Professional,Both,,,26,620,527,49.08,620,"Preferred One Administrative Services, INC.",PPO,611.32,98.6,,percent of total billed charges,,
Mri Any Joint Of Upper Extremity; With Contrast Material(S) (Pro Cah)Professional Component ,,73222,CPT,Professional,Both,,,26,620,527,49.08,620,PrimeWest Health,Minnesota Senior Health Options (MSHO),87.975,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Mri Any Joint Of Upper Extremity; With Contrast Material(S) (Pro Cah)Professional Component ,,73222,CPT,Professional,Both,,,26,620,527,49.08,620,PrimeWest Health,MinnesotaCare,60.6286824,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Mri Any Joint Of Upper Extremity; With Contrast Material(S) (Pro Cah)Professional Component ,,73222,CPT,Professional,Both,,,26,620,527,49.08,620,Sanford Health Plan,Sanford Health Plan,545.6,88,,percent of total billed charges,,
Mri Any Joint Of Upper Extremity; With Contrast Material(S) (Pro Cah)Professional Component ,,73222,CPT,Professional,Both,,,26,620,527,49.08,620,"UCare Health, Inc.",Individual & Family Plan,124.3584,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Mri Any Joint Of Upper Extremity; With Contrast Material(S) (Pro Cah)Professional Component ,,73222,CPT,Professional,Both,,,26,620,527,49.08,620,"UCare Health, Inc.",Medical Assistance,62.328552,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Mri Any Joint Of Upper Extremity; With Contrast Material(S) (Pro Cah)Professional Component ,,73222,CPT,Professional,Both,,,26,620,527,49.08,620,"UCare Health, Inc.",Medicare Advantage,87.975,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Mri Any Joint Of Upper Extremity; With Contrast Material(S) (Pro Cah)Professional Component ,,73222,CPT,Professional,Both,,,26,620,527,49.08,620,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),70.38,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Mri Any Joint Of Upper Extremity; With Contrast Material(S) (Pro Cah)Professional Component ,,73222,CPT,Professional,Both,,,26,620,527,49.08,620,UnitedHealthcare,Individual & Family,620,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Mri Any Joint Of Upper Extremity; With Contrast Material(S) (Pro Cah)Professional Component ,,73222,CPT,Professional,Both,,,26,620,527,49.08,620,UnitedHealthcare,Medicare Advantage,87.975,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Mri Any Joint Of Upper Extremity; With Contrast Material(S) (Pro Cah)Professional Component ,,73222,CPT,Professional,Both,,,26,620,527,49.08,620,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,56.66232,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Mri Any Joint Of Upper Extremity; W/O Contrast  Followed By Contrast And Further Sequences (Pro Cah)Professional Component ,,73223,CPT,Professional,Both,,,26,895,760.75,65.23,895,Aetna,Commercial,760.75,85,,percent of total billed charges,,
Mri Any Joint Of Upper Extremity; W/O Contrast  Followed By Contrast And Further Sequences (Pro Cah)Professional Component ,,73223,CPT,Professional,Both,,,26,895,760.75,65.23,895,Aetna,Medicare Advantage,104.18,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Mri Any Joint Of Upper Extremity; W/O Contrast  Followed By Contrast And Further Sequences (Pro Cah)Professional Component ,,73223,CPT,Professional,Both,,,26,895,760.75,65.23,895,Aetna,PPO,832.35,93,,percent of total billed charges,,
Mri Any Joint Of Upper Extremity; W/O Contrast  Followed By Contrast And Further Sequences (Pro Cah)Professional Component ,,73223,CPT,Professional,Both,,,26,895,760.75,65.23,895,America's PPO,America's PPO,764.688,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Mri Any Joint Of Upper Extremity; W/O Contrast  Followed By Contrast And Further Sequences (Pro Cah)Professional Component ,,73223,CPT,Professional,Both,,,26,895,760.75,65.23,895,BlueCross BlueShield Minnesota, Federal Employee Program,194.96,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Mri Any Joint Of Upper Extremity; W/O Contrast  Followed By Contrast And Further Sequences (Pro Cah)Professional Component ,,73223,CPT,Professional,Both,,,26,895,760.75,65.23,895,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,198.07936,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Mri Any Joint Of Upper Extremity; W/O Contrast  Followed By Contrast And Further Sequences (Pro Cah)Professional Component ,,73223,CPT,Professional,Both,,,26,895,760.75,65.23,895,BlueCross BlueShield Minnesota,High Value Network Plan,198.07936,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Mri Any Joint Of Upper Extremity; W/O Contrast  Followed By Contrast And Further Sequences (Pro Cah)Professional Component ,,73223,CPT,Professional,Both,,,26,895,760.75,65.23,895,BlueCross BlueShield Minnesota,Medicare Advantage,116.5525,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Mri Any Joint Of Upper Extremity; W/O Contrast  Followed By Contrast And Further Sequences (Pro Cah)Professional Component ,,73223,CPT,Professional,Both,,,26,895,760.75,65.23,895,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,198.07936,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Mri Any Joint Of Upper Extremity; W/O Contrast  Followed By Contrast And Further Sequences (Pro Cah)Professional Component ,,73223,CPT,Professional,Both,,,26,895,760.75,65.23,895,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,75.30592,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Mri Any Joint Of Upper Extremity; W/O Contrast  Followed By Contrast And Further Sequences (Pro Cah)Professional Component ,,73223,CPT,Professional,Both,,,26,895,760.75,65.23,895,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),116.5525,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Mri Any Joint Of Upper Extremity; W/O Contrast  Followed By Contrast And Further Sequences (Pro Cah)Professional Component ,,73223,CPT,Professional,Both,,,26,895,760.75,65.23,895,CorVel,Worker's Compensation,199.8603048,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Mri Any Joint Of Upper Extremity; W/O Contrast  Followed By Contrast And Further Sequences (Pro Cah)Professional Component ,,73223,CPT,Professional,Both,,,26,895,760.75,65.23,895,First Health Group Corporation,First Health Network,868.15,97,,percent of total billed charges,,
Mri Any Joint Of Upper Extremity; W/O Contrast  Followed By Contrast And Further Sequences (Pro Cah)Professional Component ,,73223,CPT,Professional,Both,,,26,895,760.75,65.23,895,"Health Partners, Inc.",Commercial,153.66,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Mri Any Joint Of Upper Extremity; W/O Contrast  Followed By Contrast And Further Sequences (Pro Cah)Professional Component ,,73223,CPT,Professional,Both,,,26,895,760.75,65.23,895,"Health Partners, Inc.",Medicare Advantage,116.5525,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Mri Any Joint Of Upper Extremity; W/O Contrast  Followed By Contrast And Further Sequences (Pro Cah)Professional Component ,,73223,CPT,Professional,Both,,,26,895,760.75,65.23,895,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),65.23,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Mri Any Joint Of Upper Extremity; W/O Contrast  Followed By Contrast And Further Sequences (Pro Cah)Professional Component ,,73223,CPT,Professional,Both,,,26,895,760.75,65.23,895,"Health Partners, Inc.",State of Minnesota Advantage Program,132.37809,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Mri Any Joint Of Upper Extremity; W/O Contrast  Followed By Contrast And Further Sequences (Pro Cah)Professional Component ,,73223,CPT,Professional,Both,,,26,895,760.75,65.23,895,"Health Partners, Inc.",State Public Programs,65.23,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Mri Any Joint Of Upper Extremity; W/O Contrast  Followed By Contrast And Further Sequences (Pro Cah)Professional Component ,,73223,CPT,Professional,Both,,,26,895,760.75,65.23,895,Humana Insurance Company,Commercial PPO,101.35,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Mri Any Joint Of Upper Extremity; W/O Contrast  Followed By Contrast And Further Sequences (Pro Cah)Professional Component ,,73223,CPT,Professional,Both,,,26,895,760.75,65.23,895,Humana Insurance Company,Medicare PPO,895,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Mri Any Joint Of Upper Extremity; W/O Contrast  Followed By Contrast And Further Sequences (Pro Cah)Professional Component ,,73223,CPT,Professional,Both,,,26,895,760.75,65.23,895,Medica,Individual & Family,758.96,84.8,,percent of total billed charges,,
Mri Any Joint Of Upper Extremity; W/O Contrast  Followed By Contrast And Further Sequences (Pro Cah)Professional Component ,,73223,CPT,Professional,Both,,,26,895,760.75,65.23,895,Medica,Medica Advantage Solution,445.71,49.8,,percent of total billed charges,,
Mri Any Joint Of Upper Extremity; W/O Contrast  Followed By Contrast And Further Sequences (Pro Cah)Professional Component ,,73223,CPT,Professional,Both,,,26,895,760.75,65.23,895,Medica,Medical Assistance,75.31,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Mri Any Joint Of Upper Extremity; W/O Contrast  Followed By Contrast And Further Sequences (Pro Cah)Professional Component ,,73223,CPT,Professional,Both,,,26,895,760.75,65.23,895,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,101.35,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Mri Any Joint Of Upper Extremity; W/O Contrast  Followed By Contrast And Further Sequences (Pro Cah)Professional Component ,,73223,CPT,Professional,Both,,,26,895,760.75,65.23,895,"Multiplan, Inc.","Multiplan, Inc.",841.3,94,,percent of total billed charges,,
Mri Any Joint Of Upper Extremity; W/O Contrast  Followed By Contrast And Further Sequences (Pro Cah)Professional Component ,,73223,CPT,Professional,Both,,,26,895,760.75,65.23,895,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,806.395,90.1,,percent of total billed charges,,
Mri Any Joint Of Upper Extremity; W/O Contrast  Followed By Contrast And Further Sequences (Pro Cah)Professional Component ,,73223,CPT,Professional,Both,,,26,895,760.75,65.23,895,"Preferred One Administrative Services, INC.",PPO,882.47,98.6,,percent of total billed charges,,
Mri Any Joint Of Upper Extremity; W/O Contrast  Followed By Contrast And Further Sequences (Pro Cah)Professional Component ,,73223,CPT,Professional,Both,,,26,895,760.75,65.23,895,PrimeWest Health,Minnesota Senior Health Options (MSHO),116.5525,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Mri Any Joint Of Upper Extremity; W/O Contrast  Followed By Contrast And Further Sequences (Pro Cah)Professional Component ,,73223,CPT,Professional,Both,,,26,895,760.75,65.23,895,PrimeWest Health,MinnesotaCare,80.5773344,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Mri Any Joint Of Upper Extremity; W/O Contrast  Followed By Contrast And Further Sequences (Pro Cah)Professional Component ,,73223,CPT,Professional,Both,,,26,895,760.75,65.23,895,Sanford Health Plan,Sanford Health Plan,787.6,88,,percent of total billed charges,,
Mri Any Joint Of Upper Extremity; W/O Contrast  Followed By Contrast And Further Sequences (Pro Cah)Professional Component ,,73223,CPT,Professional,Both,,,26,895,760.75,65.23,895,"UCare Health, Inc.",Individual & Family Plan,164.75456,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Mri Any Joint Of Upper Extremity; W/O Contrast  Followed By Contrast And Further Sequences (Pro Cah)Professional Component ,,73223,CPT,Professional,Both,,,26,895,760.75,65.23,895,"UCare Health, Inc.",Medical Assistance,82.836512,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Mri Any Joint Of Upper Extremity; W/O Contrast  Followed By Contrast And Further Sequences (Pro Cah)Professional Component ,,73223,CPT,Professional,Both,,,26,895,760.75,65.23,895,"UCare Health, Inc.",Medicare Advantage,116.5525,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Mri Any Joint Of Upper Extremity; W/O Contrast  Followed By Contrast And Further Sequences (Pro Cah)Professional Component ,,73223,CPT,Professional,Both,,,26,895,760.75,65.23,895,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),93.242,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Mri Any Joint Of Upper Extremity; W/O Contrast  Followed By Contrast And Further Sequences (Pro Cah)Professional Component ,,73223,CPT,Professional,Both,,,26,895,760.75,65.23,895,UnitedHealthcare,Individual & Family,895,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Mri Any Joint Of Upper Extremity; W/O Contrast  Followed By Contrast And Further Sequences (Pro Cah)Professional Component ,,73223,CPT,Professional,Both,,,26,895,760.75,65.23,895,UnitedHealthcare,Medicare Advantage,116.5525,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Mri Any Joint Of Upper Extremity; W/O Contrast  Followed By Contrast And Further Sequences (Pro Cah)Professional Component ,,73223,CPT,Professional,Both,,,26,895,760.75,65.23,895,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,75.30592,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Radiologic Exam, Hip, Unilateral, With Pelvis When Performed; 1 View (Pro Cah)Professional Component ",,73501,CPT,Professional,Both,,,26,55,46.75,5.67,55,Aetna,Commercial,46.75,85,,percent of total billed charges,,
"Radiologic Exam, Hip, Unilateral, With Pelvis When Performed; 1 View (Pro Cah)Professional Component ",,73501,CPT,Professional,Both,,,26,55,46.75,5.67,55,Aetna,Medicare Advantage,9.23,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Radiologic Exam, Hip, Unilateral, With Pelvis When Performed; 1 View (Pro Cah)Professional Component ",,73501,CPT,Professional,Both,,,26,55,46.75,5.67,55,Aetna,PPO,51.15,93,,percent of total billed charges,,
"Radiologic Exam, Hip, Unilateral, With Pelvis When Performed; 1 View (Pro Cah)Professional Component ",,73501,CPT,Professional,Both,,,26,55,46.75,5.67,55,America's PPO,America's PPO,46.992,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Radiologic Exam, Hip, Unilateral, With Pelvis When Performed; 1 View (Pro Cah)Professional Component ",,73501,CPT,Professional,Both,,,26,55,46.75,5.67,55,BlueCross BlueShield Minnesota, Federal Employee Program,17.26,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Radiologic Exam, Hip, Unilateral, With Pelvis When Performed; 1 View (Pro Cah)Professional Component ",,73501,CPT,Professional,Both,,,26,55,46.75,5.67,55,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,17.53616,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Radiologic Exam, Hip, Unilateral, With Pelvis When Performed; 1 View (Pro Cah)Professional Component ",,73501,CPT,Professional,Both,,,26,55,46.75,5.67,55,BlueCross BlueShield Minnesota,High Value Network Plan,17.53616,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Radiologic Exam, Hip, Unilateral, With Pelvis When Performed; 1 View (Pro Cah)Professional Component ",,73501,CPT,Professional,Both,,,26,55,46.75,5.67,55,BlueCross BlueShield Minnesota,Medicare Advantage,10.3155,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Radiologic Exam, Hip, Unilateral, With Pelvis When Performed; 1 View (Pro Cah)Professional Component ",,73501,CPT,Professional,Both,,,26,55,46.75,5.67,55,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,17.53616,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Radiologic Exam, Hip, Unilateral, With Pelvis When Performed; 1 View (Pro Cah)Professional Component ",,73501,CPT,Professional,Both,,,26,55,46.75,5.67,55,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,6.54304,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Radiologic Exam, Hip, Unilateral, With Pelvis When Performed; 1 View (Pro Cah)Professional Component ",,73501,CPT,Professional,Both,,,26,55,46.75,5.67,55,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),10.3155,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Radiologic Exam, Hip, Unilateral, With Pelvis When Performed; 1 View (Pro Cah)Professional Component ",,73501,CPT,Professional,Both,,,26,55,46.75,5.67,55,CorVel,Worker's Compensation,17.7711669,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Radiologic Exam, Hip, Unilateral, With Pelvis When Performed; 1 View (Pro Cah)Professional Component ",,73501,CPT,Professional,Both,,,26,55,46.75,5.67,55,First Health Group Corporation,First Health Network,53.35,97,,percent of total billed charges,,
"Radiologic Exam, Hip, Unilateral, With Pelvis When Performed; 1 View (Pro Cah)Professional Component ",,73501,CPT,Professional,Both,,,26,55,46.75,5.67,55,"Health Partners, Inc.",Commercial,13.41,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Radiologic Exam, Hip, Unilateral, With Pelvis When Performed; 1 View (Pro Cah)Professional Component ",,73501,CPT,Professional,Both,,,26,55,46.75,5.67,55,"Health Partners, Inc.",Medicare Advantage,10.3155,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Radiologic Exam, Hip, Unilateral, With Pelvis When Performed; 1 View (Pro Cah)Professional Component ",,73501,CPT,Professional,Both,,,26,55,46.75,5.67,55,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),5.67,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Radiologic Exam, Hip, Unilateral, With Pelvis When Performed; 1 View (Pro Cah)Professional Component ",,73501,CPT,Professional,Both,,,26,55,46.75,5.67,55,"Health Partners, Inc.",State of Minnesota Advantage Program,11.552715,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Radiologic Exam, Hip, Unilateral, With Pelvis When Performed; 1 View (Pro Cah)Professional Component ",,73501,CPT,Professional,Both,,,26,55,46.75,5.67,55,"Health Partners, Inc.",State Public Programs,5.67,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Radiologic Exam, Hip, Unilateral, With Pelvis When Performed; 1 View (Pro Cah)Professional Component ",,73501,CPT,Professional,Both,,,26,55,46.75,5.67,55,Humana Insurance Company,Commercial PPO,8.97,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Radiologic Exam, Hip, Unilateral, With Pelvis When Performed; 1 View (Pro Cah)Professional Component ",,73501,CPT,Professional,Both,,,26,55,46.75,5.67,55,Humana Insurance Company,Medicare PPO,55,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Radiologic Exam, Hip, Unilateral, With Pelvis When Performed; 1 View (Pro Cah)Professional Component ",,73501,CPT,Professional,Both,,,26,55,46.75,5.67,55,Medica,Individual & Family,46.64,84.8,,percent of total billed charges,,
"Radiologic Exam, Hip, Unilateral, With Pelvis When Performed; 1 View (Pro Cah)Professional Component ",,73501,CPT,Professional,Both,,,26,55,46.75,5.67,55,Medica,Medica Advantage Solution,27.39,49.8,,percent of total billed charges,,
"Radiologic Exam, Hip, Unilateral, With Pelvis When Performed; 1 View (Pro Cah)Professional Component ",,73501,CPT,Professional,Both,,,26,55,46.75,5.67,55,Medica,Medical Assistance,6.54,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Radiologic Exam, Hip, Unilateral, With Pelvis When Performed; 1 View (Pro Cah)Professional Component ",,73501,CPT,Professional,Both,,,26,55,46.75,5.67,55,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,8.97,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Radiologic Exam, Hip, Unilateral, With Pelvis When Performed; 1 View (Pro Cah)Professional Component ",,73501,CPT,Professional,Both,,,26,55,46.75,5.67,55,"Multiplan, Inc.","Multiplan, Inc.",51.7,94,,percent of total billed charges,,
"Radiologic Exam, Hip, Unilateral, With Pelvis When Performed; 1 View (Pro Cah)Professional Component ",,73501,CPT,Professional,Both,,,26,55,46.75,5.67,55,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,49.555,90.1,,percent of total billed charges,,
"Radiologic Exam, Hip, Unilateral, With Pelvis When Performed; 1 View (Pro Cah)Professional Component ",,73501,CPT,Professional,Both,,,26,55,46.75,5.67,55,"Preferred One Administrative Services, INC.",PPO,54.23,98.6,,percent of total billed charges,,
"Radiologic Exam, Hip, Unilateral, With Pelvis When Performed; 1 View (Pro Cah)Professional Component ",,73501,CPT,Professional,Both,,,26,55,46.75,5.67,55,PrimeWest Health,Minnesota Senior Health Options (MSHO),10.3155,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Radiologic Exam, Hip, Unilateral, With Pelvis When Performed; 1 View (Pro Cah)Professional Component ",,73501,CPT,Professional,Both,,,26,55,46.75,5.67,55,PrimeWest Health,MinnesotaCare,7.0010528,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Radiologic Exam, Hip, Unilateral, With Pelvis When Performed; 1 View (Pro Cah)Professional Component ",,73501,CPT,Professional,Both,,,26,55,46.75,5.67,55,Sanford Health Plan,Sanford Health Plan,48.4,88,,percent of total billed charges,,
"Radiologic Exam, Hip, Unilateral, With Pelvis When Performed; 1 View (Pro Cah)Professional Component ",,73501,CPT,Professional,Both,,,26,55,46.75,5.67,55,"UCare Health, Inc.",Individual & Family Plan,14.581632,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Radiologic Exam, Hip, Unilateral, With Pelvis When Performed; 1 View (Pro Cah)Professional Component ",,73501,CPT,Professional,Both,,,26,55,46.75,5.67,55,"UCare Health, Inc.",Medical Assistance,7.197344,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Radiologic Exam, Hip, Unilateral, With Pelvis When Performed; 1 View (Pro Cah)Professional Component ",,73501,CPT,Professional,Both,,,26,55,46.75,5.67,55,"UCare Health, Inc.",Medicare Advantage,10.3155,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Radiologic Exam, Hip, Unilateral, With Pelvis When Performed; 1 View (Pro Cah)Professional Component ",,73501,CPT,Professional,Both,,,26,55,46.75,5.67,55,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),8.2524,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Radiologic Exam, Hip, Unilateral, With Pelvis When Performed; 1 View (Pro Cah)Professional Component ",,73501,CPT,Professional,Both,,,26,55,46.75,5.67,55,UnitedHealthcare,Individual & Family,55,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Radiologic Exam, Hip, Unilateral, With Pelvis When Performed; 1 View (Pro Cah)Professional Component ",,73501,CPT,Professional,Both,,,26,55,46.75,5.67,55,UnitedHealthcare,Medicare Advantage,10.3155,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Radiologic Exam, Hip, Unilateral, With Pelvis When Performed; 1 View (Pro Cah)Professional Component ",,73501,CPT,Professional,Both,,,26,55,46.75,5.67,55,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,6.54304,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Radiologic Exam, Hip, Unilateral, With Pelvis When Performed; 2-3 Views (Pro Cah)Professional Component ",,73502,CPT,Professional,Both,,,26,52,44.2,6.76,52,Aetna,Commercial,44.2,85,,percent of total billed charges,,
"Radiologic Exam, Hip, Unilateral, With Pelvis When Performed; 2-3 Views (Pro Cah)Professional Component ",,73502,CPT,Professional,Both,,,26,52,44.2,6.76,52,Aetna,Medicare Advantage,10.98,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Radiologic Exam, Hip, Unilateral, With Pelvis When Performed; 2-3 Views (Pro Cah)Professional Component ",,73502,CPT,Professional,Both,,,26,52,44.2,6.76,52,Aetna,PPO,48.36,93,,percent of total billed charges,,
"Radiologic Exam, Hip, Unilateral, With Pelvis When Performed; 2-3 Views (Pro Cah)Professional Component ",,73502,CPT,Professional,Both,,,26,52,44.2,6.76,52,America's PPO,America's PPO,44.4288,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Radiologic Exam, Hip, Unilateral, With Pelvis When Performed; 2-3 Views (Pro Cah)Professional Component ",,73502,CPT,Professional,Both,,,26,52,44.2,6.76,52,BlueCross BlueShield Minnesota, Federal Employee Program,20.45,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Radiologic Exam, Hip, Unilateral, With Pelvis When Performed; 2-3 Views (Pro Cah)Professional Component ",,73502,CPT,Professional,Both,,,26,52,44.2,6.76,52,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,20.7772,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Radiologic Exam, Hip, Unilateral, With Pelvis When Performed; 2-3 Views (Pro Cah)Professional Component ",,73502,CPT,Professional,Both,,,26,52,44.2,6.76,52,BlueCross BlueShield Minnesota,High Value Network Plan,20.7772,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Radiologic Exam, Hip, Unilateral, With Pelvis When Performed; 2-3 Views (Pro Cah)Professional Component ",,73502,CPT,Professional,Both,,,26,52,44.2,6.76,52,BlueCross BlueShield Minnesota,Medicare Advantage,12.2705,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Radiologic Exam, Hip, Unilateral, With Pelvis When Performed; 2-3 Views (Pro Cah)Professional Component ",,73502,CPT,Professional,Both,,,26,52,44.2,6.76,52,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,20.7772,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Radiologic Exam, Hip, Unilateral, With Pelvis When Performed; 2-3 Views (Pro Cah)Professional Component ",,73502,CPT,Professional,Both,,,26,52,44.2,6.76,52,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,7.80288,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Radiologic Exam, Hip, Unilateral, With Pelvis When Performed; 2-3 Views (Pro Cah)Professional Component ",,73502,CPT,Professional,Both,,,26,52,44.2,6.76,52,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),12.2705,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Radiologic Exam, Hip, Unilateral, With Pelvis When Performed; 2-3 Views (Pro Cah)Professional Component ",,73502,CPT,Professional,Both,,,26,52,44.2,6.76,52,CorVel,Worker's Compensation,21.138399,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Radiologic Exam, Hip, Unilateral, With Pelvis When Performed; 2-3 Views (Pro Cah)Professional Component ",,73502,CPT,Professional,Both,,,26,52,44.2,6.76,52,First Health Group Corporation,First Health Network,50.44,97,,percent of total billed charges,,
"Radiologic Exam, Hip, Unilateral, With Pelvis When Performed; 2-3 Views (Pro Cah)Professional Component ",,73502,CPT,Professional,Both,,,26,52,44.2,6.76,52,"Health Partners, Inc.",Commercial,15.98,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Radiologic Exam, Hip, Unilateral, With Pelvis When Performed; 2-3 Views (Pro Cah)Professional Component ",,73502,CPT,Professional,Both,,,26,52,44.2,6.76,52,"Health Partners, Inc.",Medicare Advantage,12.2705,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Radiologic Exam, Hip, Unilateral, With Pelvis When Performed; 2-3 Views (Pro Cah)Professional Component ",,73502,CPT,Professional,Both,,,26,52,44.2,6.76,52,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),6.76,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Radiologic Exam, Hip, Unilateral, With Pelvis When Performed; 2-3 Views (Pro Cah)Professional Component ",,73502,CPT,Professional,Both,,,26,52,44.2,6.76,52,"Health Partners, Inc.",State of Minnesota Advantage Program,13.76677,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Radiologic Exam, Hip, Unilateral, With Pelvis When Performed; 2-3 Views (Pro Cah)Professional Component ",,73502,CPT,Professional,Both,,,26,52,44.2,6.76,52,"Health Partners, Inc.",State Public Programs,6.76,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Radiologic Exam, Hip, Unilateral, With Pelvis When Performed; 2-3 Views (Pro Cah)Professional Component ",,73502,CPT,Professional,Both,,,26,52,44.2,6.76,52,Humana Insurance Company,Commercial PPO,10.67,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Radiologic Exam, Hip, Unilateral, With Pelvis When Performed; 2-3 Views (Pro Cah)Professional Component ",,73502,CPT,Professional,Both,,,26,52,44.2,6.76,52,Humana Insurance Company,Medicare PPO,52,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Radiologic Exam, Hip, Unilateral, With Pelvis When Performed; 2-3 Views (Pro Cah)Professional Component ",,73502,CPT,Professional,Both,,,26,52,44.2,6.76,52,Medica,Individual & Family,44.096,84.8,,percent of total billed charges,,
"Radiologic Exam, Hip, Unilateral, With Pelvis When Performed; 2-3 Views (Pro Cah)Professional Component ",,73502,CPT,Professional,Both,,,26,52,44.2,6.76,52,Medica,Medica Advantage Solution,25.896,49.8,,percent of total billed charges,,
"Radiologic Exam, Hip, Unilateral, With Pelvis When Performed; 2-3 Views (Pro Cah)Professional Component ",,73502,CPT,Professional,Both,,,26,52,44.2,6.76,52,Medica,Medical Assistance,7.8,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Radiologic Exam, Hip, Unilateral, With Pelvis When Performed; 2-3 Views (Pro Cah)Professional Component ",,73502,CPT,Professional,Both,,,26,52,44.2,6.76,52,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,10.67,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Radiologic Exam, Hip, Unilateral, With Pelvis When Performed; 2-3 Views (Pro Cah)Professional Component ",,73502,CPT,Professional,Both,,,26,52,44.2,6.76,52,"Multiplan, Inc.","Multiplan, Inc.",48.88,94,,percent of total billed charges,,
"Radiologic Exam, Hip, Unilateral, With Pelvis When Performed; 2-3 Views (Pro Cah)Professional Component ",,73502,CPT,Professional,Both,,,26,52,44.2,6.76,52,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,46.852,90.1,,percent of total billed charges,,
"Radiologic Exam, Hip, Unilateral, With Pelvis When Performed; 2-3 Views (Pro Cah)Professional Component ",,73502,CPT,Professional,Both,,,26,52,44.2,6.76,52,"Preferred One Administrative Services, INC.",PPO,51.272,98.6,,percent of total billed charges,,
"Radiologic Exam, Hip, Unilateral, With Pelvis When Performed; 2-3 Views (Pro Cah)Professional Component ",,73502,CPT,Professional,Both,,,26,52,44.2,6.76,52,PrimeWest Health,Minnesota Senior Health Options (MSHO),12.2705,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Radiologic Exam, Hip, Unilateral, With Pelvis When Performed; 2-3 Views (Pro Cah)Professional Component ",,73502,CPT,Professional,Both,,,26,52,44.2,6.76,52,PrimeWest Health,MinnesotaCare,8.3490816,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Radiologic Exam, Hip, Unilateral, With Pelvis When Performed; 2-3 Views (Pro Cah)Professional Component ",,73502,CPT,Professional,Both,,,26,52,44.2,6.76,52,Sanford Health Plan,Sanford Health Plan,45.76,88,,percent of total billed charges,,
"Radiologic Exam, Hip, Unilateral, With Pelvis When Performed; 2-3 Views (Pro Cah)Professional Component ",,73502,CPT,Professional,Both,,,26,52,44.2,6.76,52,"UCare Health, Inc.",Individual & Family Plan,17.345152,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Radiologic Exam, Hip, Unilateral, With Pelvis When Performed; 2-3 Views (Pro Cah)Professional Component ",,73502,CPT,Professional,Both,,,26,52,44.2,6.76,52,"UCare Health, Inc.",Medical Assistance,8.583168,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Radiologic Exam, Hip, Unilateral, With Pelvis When Performed; 2-3 Views (Pro Cah)Professional Component ",,73502,CPT,Professional,Both,,,26,52,44.2,6.76,52,"UCare Health, Inc.",Medicare Advantage,12.2705,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Radiologic Exam, Hip, Unilateral, With Pelvis When Performed; 2-3 Views (Pro Cah)Professional Component ",,73502,CPT,Professional,Both,,,26,52,44.2,6.76,52,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),9.8164,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Radiologic Exam, Hip, Unilateral, With Pelvis When Performed; 2-3 Views (Pro Cah)Professional Component ",,73502,CPT,Professional,Both,,,26,52,44.2,6.76,52,UnitedHealthcare,Individual & Family,52,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Radiologic Exam, Hip, Unilateral, With Pelvis When Performed; 2-3 Views (Pro Cah)Professional Component ",,73502,CPT,Professional,Both,,,26,52,44.2,6.76,52,UnitedHealthcare,Medicare Advantage,12.2705,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Radiologic Exam, Hip, Unilateral, With Pelvis When Performed; 2-3 Views (Pro Cah)Professional Component ",,73502,CPT,Professional,Both,,,26,52,44.2,6.76,52,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,7.80288,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Xr Hips, Bilateral, With Pelvis When Performed; 2 Views (Pro Cah)Professional Component ",,73521,CPT,Professional,Both,,,26,72,61.2,6.76,72,Aetna,Commercial,61.2,85,,percent of total billed charges,,
"Xr Hips, Bilateral, With Pelvis When Performed; 2 Views (Pro Cah)Professional Component ",,73521,CPT,Professional,Both,,,26,72,61.2,6.76,72,Aetna,Medicare Advantage,10.98,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Xr Hips, Bilateral, With Pelvis When Performed; 2 Views (Pro Cah)Professional Component ",,73521,CPT,Professional,Both,,,26,72,61.2,6.76,72,Aetna,PPO,66.96,93,,percent of total billed charges,,
"Xr Hips, Bilateral, With Pelvis When Performed; 2 Views (Pro Cah)Professional Component ",,73521,CPT,Professional,Both,,,26,72,61.2,6.76,72,America's PPO,America's PPO,61.5168,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Xr Hips, Bilateral, With Pelvis When Performed; 2 Views (Pro Cah)Professional Component ",,73521,CPT,Professional,Both,,,26,72,61.2,6.76,72,BlueCross BlueShield Minnesota, Federal Employee Program,20.45,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Xr Hips, Bilateral, With Pelvis When Performed; 2 Views (Pro Cah)Professional Component ",,73521,CPT,Professional,Both,,,26,72,61.2,6.76,72,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,20.7772,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Xr Hips, Bilateral, With Pelvis When Performed; 2 Views (Pro Cah)Professional Component ",,73521,CPT,Professional,Both,,,26,72,61.2,6.76,72,BlueCross BlueShield Minnesota,High Value Network Plan,20.7772,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Xr Hips, Bilateral, With Pelvis When Performed; 2 Views (Pro Cah)Professional Component ",,73521,CPT,Professional,Both,,,26,72,61.2,6.76,72,BlueCross BlueShield Minnesota,Medicare Advantage,12.2705,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Xr Hips, Bilateral, With Pelvis When Performed; 2 Views (Pro Cah)Professional Component ",,73521,CPT,Professional,Both,,,26,72,61.2,6.76,72,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,20.7772,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Xr Hips, Bilateral, With Pelvis When Performed; 2 Views (Pro Cah)Professional Component ",,73521,CPT,Professional,Both,,,26,72,61.2,6.76,72,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,7.80288,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Xr Hips, Bilateral, With Pelvis When Performed; 2 Views (Pro Cah)Professional Component ",,73521,CPT,Professional,Both,,,26,72,61.2,6.76,72,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),12.2705,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Xr Hips, Bilateral, With Pelvis When Performed; 2 Views (Pro Cah)Professional Component ",,73521,CPT,Professional,Both,,,26,72,61.2,6.76,72,CorVel,Worker's Compensation,21.138399,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Xr Hips, Bilateral, With Pelvis When Performed; 2 Views (Pro Cah)Professional Component ",,73521,CPT,Professional,Both,,,26,72,61.2,6.76,72,First Health Group Corporation,First Health Network,69.84,97,,percent of total billed charges,,
"Xr Hips, Bilateral, With Pelvis When Performed; 2 Views (Pro Cah)Professional Component ",,73521,CPT,Professional,Both,,,26,72,61.2,6.76,72,"Health Partners, Inc.",Commercial,15.98,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Xr Hips, Bilateral, With Pelvis When Performed; 2 Views (Pro Cah)Professional Component ",,73521,CPT,Professional,Both,,,26,72,61.2,6.76,72,"Health Partners, Inc.",Medicare Advantage,12.2705,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Xr Hips, Bilateral, With Pelvis When Performed; 2 Views (Pro Cah)Professional Component ",,73521,CPT,Professional,Both,,,26,72,61.2,6.76,72,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),6.76,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Xr Hips, Bilateral, With Pelvis When Performed; 2 Views (Pro Cah)Professional Component ",,73521,CPT,Professional,Both,,,26,72,61.2,6.76,72,"Health Partners, Inc.",State of Minnesota Advantage Program,13.76677,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Xr Hips, Bilateral, With Pelvis When Performed; 2 Views (Pro Cah)Professional Component ",,73521,CPT,Professional,Both,,,26,72,61.2,6.76,72,"Health Partners, Inc.",State Public Programs,6.76,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Xr Hips, Bilateral, With Pelvis When Performed; 2 Views (Pro Cah)Professional Component ",,73521,CPT,Professional,Both,,,26,72,61.2,6.76,72,Humana Insurance Company,Commercial PPO,10.67,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Xr Hips, Bilateral, With Pelvis When Performed; 2 Views (Pro Cah)Professional Component ",,73521,CPT,Professional,Both,,,26,72,61.2,6.76,72,Humana Insurance Company,Medicare PPO,72,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Xr Hips, Bilateral, With Pelvis When Performed; 2 Views (Pro Cah)Professional Component ",,73521,CPT,Professional,Both,,,26,72,61.2,6.76,72,Medica,Individual & Family,61.056,84.8,,percent of total billed charges,,
"Xr Hips, Bilateral, With Pelvis When Performed; 2 Views (Pro Cah)Professional Component ",,73521,CPT,Professional,Both,,,26,72,61.2,6.76,72,Medica,Medica Advantage Solution,35.856,49.8,,percent of total billed charges,,
"Xr Hips, Bilateral, With Pelvis When Performed; 2 Views (Pro Cah)Professional Component ",,73521,CPT,Professional,Both,,,26,72,61.2,6.76,72,Medica,Medical Assistance,7.8,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Xr Hips, Bilateral, With Pelvis When Performed; 2 Views (Pro Cah)Professional Component ",,73521,CPT,Professional,Both,,,26,72,61.2,6.76,72,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,10.67,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Xr Hips, Bilateral, With Pelvis When Performed; 2 Views (Pro Cah)Professional Component ",,73521,CPT,Professional,Both,,,26,72,61.2,6.76,72,"Multiplan, Inc.","Multiplan, Inc.",67.68,94,,percent of total billed charges,,
"Xr Hips, Bilateral, With Pelvis When Performed; 2 Views (Pro Cah)Professional Component ",,73521,CPT,Professional,Both,,,26,72,61.2,6.76,72,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,64.872,90.1,,percent of total billed charges,,
"Xr Hips, Bilateral, With Pelvis When Performed; 2 Views (Pro Cah)Professional Component ",,73521,CPT,Professional,Both,,,26,72,61.2,6.76,72,"Preferred One Administrative Services, INC.",PPO,70.992,98.6,,percent of total billed charges,,
"Xr Hips, Bilateral, With Pelvis When Performed; 2 Views (Pro Cah)Professional Component ",,73521,CPT,Professional,Both,,,26,72,61.2,6.76,72,PrimeWest Health,Minnesota Senior Health Options (MSHO),12.2705,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Xr Hips, Bilateral, With Pelvis When Performed; 2 Views (Pro Cah)Professional Component ",,73521,CPT,Professional,Both,,,26,72,61.2,6.76,72,PrimeWest Health,MinnesotaCare,8.3490816,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Xr Hips, Bilateral, With Pelvis When Performed; 2 Views (Pro Cah)Professional Component ",,73521,CPT,Professional,Both,,,26,72,61.2,6.76,72,Sanford Health Plan,Sanford Health Plan,63.36,88,,percent of total billed charges,,
"Xr Hips, Bilateral, With Pelvis When Performed; 2 Views (Pro Cah)Professional Component ",,73521,CPT,Professional,Both,,,26,72,61.2,6.76,72,"UCare Health, Inc.",Individual & Family Plan,17.345152,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Xr Hips, Bilateral, With Pelvis When Performed; 2 Views (Pro Cah)Professional Component ",,73521,CPT,Professional,Both,,,26,72,61.2,6.76,72,"UCare Health, Inc.",Medical Assistance,8.583168,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Xr Hips, Bilateral, With Pelvis When Performed; 2 Views (Pro Cah)Professional Component ",,73521,CPT,Professional,Both,,,26,72,61.2,6.76,72,"UCare Health, Inc.",Medicare Advantage,12.2705,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Xr Hips, Bilateral, With Pelvis When Performed; 2 Views (Pro Cah)Professional Component ",,73521,CPT,Professional,Both,,,26,72,61.2,6.76,72,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),9.8164,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Xr Hips, Bilateral, With Pelvis When Performed; 2 Views (Pro Cah)Professional Component ",,73521,CPT,Professional,Both,,,26,72,61.2,6.76,72,UnitedHealthcare,Individual & Family,72,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Xr Hips, Bilateral, With Pelvis When Performed; 2 Views (Pro Cah)Professional Component ",,73521,CPT,Professional,Both,,,26,72,61.2,6.76,72,UnitedHealthcare,Medicare Advantage,12.2705,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Xr Hips, Bilateral, With Pelvis When Performed; 2 Views (Pro Cah)Professional Component ",,73521,CPT,Professional,Both,,,26,72,61.2,6.76,72,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,7.80288,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Xr Hips, Bilateral W/Pelvis When Performed, 3-4 Views (Pro Cah)Professional Component ",,73522,CPT,Professional,Both,,,26,86,73.1,13.89,86,Aetna,Commercial,73.1,85,,percent of total billed charges,,
"Xr Hips, Bilateral W/Pelvis When Performed, 3-4 Views (Pro Cah)Professional Component ",,73522,CPT,Professional,Both,,,26,86,73.1,13.89,86,Aetna,Medicare Advantage,14.48,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Xr Hips, Bilateral W/Pelvis When Performed, 3-4 Views (Pro Cah)Professional Component ",,73522,CPT,Professional,Both,,,26,86,73.1,13.89,86,Aetna,PPO,79.98,93,,percent of total billed charges,,
"Xr Hips, Bilateral W/Pelvis When Performed, 3-4 Views (Pro Cah)Professional Component ",,73522,CPT,Professional,Both,,,26,86,73.1,13.89,86,America's PPO,America's PPO,73.4784,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Xr Hips, Bilateral W/Pelvis When Performed, 3-4 Views (Pro Cah)Professional Component ",,73522,CPT,Professional,Both,,,26,86,73.1,13.89,86,BlueCross BlueShield Minnesota, Federal Employee Program,26.85,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Xr Hips, Bilateral W/Pelvis When Performed, 3-4 Views (Pro Cah)Professional Component ",,73522,CPT,Professional,Both,,,26,86,73.1,13.89,86,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,27.2796,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Xr Hips, Bilateral W/Pelvis When Performed, 3-4 Views (Pro Cah)Professional Component ",,73522,CPT,Professional,Both,,,26,86,73.1,13.89,86,BlueCross BlueShield Minnesota,High Value Network Plan,27.2796,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Xr Hips, Bilateral W/Pelvis When Performed, 3-4 Views (Pro Cah)Professional Component ",,73522,CPT,Professional,Both,,,26,86,73.1,13.89,86,BlueCross BlueShield Minnesota,Medicare Advantage,16.192,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Xr Hips, Bilateral W/Pelvis When Performed, 3-4 Views (Pro Cah)Professional Component ",,73522,CPT,Professional,Both,,,26,86,73.1,13.89,86,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,27.2796,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Xr Hips, Bilateral W/Pelvis When Performed, 3-4 Views (Pro Cah)Professional Component ",,73522,CPT,Professional,Both,,,26,86,73.1,13.89,86,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,40.7924,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Xr Hips, Bilateral W/Pelvis When Performed, 3-4 Views (Pro Cah)Professional Component ",,73522,CPT,Professional,Both,,,26,86,73.1,13.89,86,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),16.192,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Xr Hips, Bilateral W/Pelvis When Performed, 3-4 Views (Pro Cah)Professional Component ",,73522,CPT,Professional,Both,,,26,86,73.1,13.89,86,CorVel,Worker's Compensation,27.8815953,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Xr Hips, Bilateral W/Pelvis When Performed, 3-4 Views (Pro Cah)Professional Component ",,73522,CPT,Professional,Both,,,26,86,73.1,13.89,86,First Health Group Corporation,First Health Network,83.42,97,,percent of total billed charges,,
"Xr Hips, Bilateral W/Pelvis When Performed, 3-4 Views (Pro Cah)Professional Component ",,73522,CPT,Professional,Both,,,26,86,73.1,13.89,86,"Health Partners, Inc.",Commercial,21.14,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Xr Hips, Bilateral W/Pelvis When Performed, 3-4 Views (Pro Cah)Professional Component ",,73522,CPT,Professional,Both,,,26,86,73.1,13.89,86,"Health Partners, Inc.",Medicare Advantage,16.192,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Xr Hips, Bilateral W/Pelvis When Performed, 3-4 Views (Pro Cah)Professional Component ",,73522,CPT,Professional,Both,,,26,86,73.1,13.89,86,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),13.89,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Xr Hips, Bilateral W/Pelvis When Performed, 3-4 Views (Pro Cah)Professional Component ",,73522,CPT,Professional,Both,,,26,86,73.1,13.89,86,"Health Partners, Inc.",State of Minnesota Advantage Program,18.21211,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Xr Hips, Bilateral W/Pelvis When Performed, 3-4 Views (Pro Cah)Professional Component ",,73522,CPT,Professional,Both,,,26,86,73.1,13.89,86,"Health Partners, Inc.",State Public Programs,,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Xr Hips, Bilateral W/Pelvis When Performed, 3-4 Views (Pro Cah)Professional Component ",,73522,CPT,Professional,Both,,,26,86,73.1,13.89,86,Humana Insurance Company,Commercial PPO,14.08,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Xr Hips, Bilateral W/Pelvis When Performed, 3-4 Views (Pro Cah)Professional Component ",,73522,CPT,Professional,Both,,,26,86,73.1,13.89,86,Humana Insurance Company,Medicare PPO,86,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Xr Hips, Bilateral W/Pelvis When Performed, 3-4 Views (Pro Cah)Professional Component ",,73522,CPT,Professional,Both,,,26,86,73.1,13.89,86,Medica,Individual & Family,72.928,84.8,,percent of total billed charges,,
"Xr Hips, Bilateral W/Pelvis When Performed, 3-4 Views (Pro Cah)Professional Component ",,73522,CPT,Professional,Both,,,26,86,73.1,13.89,86,Medica,Medica Advantage Solution,42.828,49.8,,percent of total billed charges,,
"Xr Hips, Bilateral W/Pelvis When Performed, 3-4 Views (Pro Cah)Professional Component ",,73522,CPT,Professional,Both,,,26,86,73.1,13.89,86,Medica,Medical Assistance,,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Xr Hips, Bilateral W/Pelvis When Performed, 3-4 Views (Pro Cah)Professional Component ",,73522,CPT,Professional,Both,,,26,86,73.1,13.89,86,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,14.08,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Xr Hips, Bilateral W/Pelvis When Performed, 3-4 Views (Pro Cah)Professional Component ",,73522,CPT,Professional,Both,,,26,86,73.1,13.89,86,"Multiplan, Inc.","Multiplan, Inc.",80.84,94,,percent of total billed charges,,
"Xr Hips, Bilateral W/Pelvis When Performed, 3-4 Views (Pro Cah)Professional Component ",,73522,CPT,Professional,Both,,,26,86,73.1,13.89,86,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,77.486,90.1,,percent of total billed charges,,
"Xr Hips, Bilateral W/Pelvis When Performed, 3-4 Views (Pro Cah)Professional Component ",,73522,CPT,Professional,Both,,,26,86,73.1,13.89,86,"Preferred One Administrative Services, INC.",PPO,84.796,98.6,,percent of total billed charges,,
"Xr Hips, Bilateral W/Pelvis When Performed, 3-4 Views (Pro Cah)Professional Component ",,73522,CPT,Professional,Both,,,26,86,73.1,13.89,86,PrimeWest Health,Minnesota Senior Health Options (MSHO),16.192,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Xr Hips, Bilateral W/Pelvis When Performed, 3-4 Views (Pro Cah)Professional Component ",,73522,CPT,Professional,Both,,,26,86,73.1,13.89,86,PrimeWest Health,MinnesotaCare,43.647868,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Xr Hips, Bilateral W/Pelvis When Performed, 3-4 Views (Pro Cah)Professional Component ",,73522,CPT,Professional,Both,,,26,86,73.1,13.89,86,Sanford Health Plan,Sanford Health Plan,75.68,88,,percent of total billed charges,,
"Xr Hips, Bilateral W/Pelvis When Performed, 3-4 Views (Pro Cah)Professional Component ",,73522,CPT,Professional,Both,,,26,86,73.1,13.89,86,"UCare Health, Inc.",Individual & Family Plan,22.888448,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Xr Hips, Bilateral W/Pelvis When Performed, 3-4 Views (Pro Cah)Professional Component ",,73522,CPT,Professional,Both,,,26,86,73.1,13.89,86,"UCare Health, Inc.",Medical Assistance,44.87164,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Xr Hips, Bilateral W/Pelvis When Performed, 3-4 Views (Pro Cah)Professional Component ",,73522,CPT,Professional,Both,,,26,86,73.1,13.89,86,"UCare Health, Inc.",Medicare Advantage,16.192,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Xr Hips, Bilateral W/Pelvis When Performed, 3-4 Views (Pro Cah)Professional Component ",,73522,CPT,Professional,Both,,,26,86,73.1,13.89,86,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),40.7924,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Xr Hips, Bilateral W/Pelvis When Performed, 3-4 Views (Pro Cah)Professional Component ",,73522,CPT,Professional,Both,,,26,86,73.1,13.89,86,UnitedHealthcare,Individual & Family,86,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Xr Hips, Bilateral W/Pelvis When Performed, 3-4 Views (Pro Cah)Professional Component ",,73522,CPT,Professional,Both,,,26,86,73.1,13.89,86,UnitedHealthcare,Medicare Advantage,16.192,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Xr Hips, Bilateral W/Pelvis When Performed, 3-4 Views (Pro Cah)Professional Component ",,73522,CPT,Professional,Both,,,26,86,73.1,13.89,86,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,40.7924,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Xr Hips, Bilateral, With Pelvis When Performed; Minimum Of 5 Views (Pro Cah)Professional Component ",,73523,CPT,Professional,Both,,,26,92,78.2,9.37,92,Aetna,Commercial,78.2,85,,percent of total billed charges,,
"Xr Hips, Bilateral, With Pelvis When Performed; Minimum Of 5 Views (Pro Cah)Professional Component ",,73523,CPT,Professional,Both,,,26,92,78.2,9.37,92,Aetna,Medicare Advantage,15.18,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Xr Hips, Bilateral, With Pelvis When Performed; Minimum Of 5 Views (Pro Cah)Professional Component ",,73523,CPT,Professional,Both,,,26,92,78.2,9.37,92,Aetna,PPO,85.56,93,,percent of total billed charges,,
"Xr Hips, Bilateral, With Pelvis When Performed; Minimum Of 5 Views (Pro Cah)Professional Component ",,73523,CPT,Professional,Both,,,26,92,78.2,9.37,92,America's PPO,America's PPO,78.6048,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Xr Hips, Bilateral, With Pelvis When Performed; Minimum Of 5 Views (Pro Cah)Professional Component ",,73523,CPT,Professional,Both,,,26,92,78.2,9.37,92,BlueCross BlueShield Minnesota, Federal Employee Program,28.76,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Xr Hips, Bilateral, With Pelvis When Performed; Minimum Of 5 Views (Pro Cah)Professional Component ",,73523,CPT,Professional,Both,,,26,92,78.2,9.37,92,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,29.22016,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Xr Hips, Bilateral, With Pelvis When Performed; Minimum Of 5 Views (Pro Cah)Professional Component ",,73523,CPT,Professional,Both,,,26,92,78.2,9.37,92,BlueCross BlueShield Minnesota,High Value Network Plan,29.22016,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Xr Hips, Bilateral, With Pelvis When Performed; Minimum Of 5 Views (Pro Cah)Professional Component ",,73523,CPT,Professional,Both,,,26,92,78.2,9.37,92,BlueCross BlueShield Minnesota,Medicare Advantage,17.1005,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Xr Hips, Bilateral, With Pelvis When Performed; Minimum Of 5 Views (Pro Cah)Professional Component ",,73523,CPT,Professional,Both,,,26,92,78.2,9.37,92,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,29.22016,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Xr Hips, Bilateral, With Pelvis When Performed; Minimum Of 5 Views (Pro Cah)Professional Component ",,73523,CPT,Professional,Both,,,26,92,78.2,9.37,92,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,10.8204,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Xr Hips, Bilateral, With Pelvis When Performed; Minimum Of 5 Views (Pro Cah)Professional Component ",,73523,CPT,Professional,Both,,,26,92,78.2,9.37,92,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),17.1005,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Xr Hips, Bilateral, With Pelvis When Performed; Minimum Of 5 Views (Pro Cah)Professional Component ",,73523,CPT,Professional,Both,,,26,92,78.2,9.37,92,CorVel,Worker's Compensation,29.2249953,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Xr Hips, Bilateral, With Pelvis When Performed; Minimum Of 5 Views (Pro Cah)Professional Component ",,73523,CPT,Professional,Both,,,26,92,78.2,9.37,92,First Health Group Corporation,First Health Network,89.24,97,,percent of total billed charges,,
"Xr Hips, Bilateral, With Pelvis When Performed; Minimum Of 5 Views (Pro Cah)Professional Component ",,73523,CPT,Professional,Both,,,26,92,78.2,9.37,92,"Health Partners, Inc.",Commercial,22.17,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Xr Hips, Bilateral, With Pelvis When Performed; Minimum Of 5 Views (Pro Cah)Professional Component ",,73523,CPT,Professional,Both,,,26,92,78.2,9.37,92,"Health Partners, Inc.",Medicare Advantage,17.1005,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Xr Hips, Bilateral, With Pelvis When Performed; Minimum Of 5 Views (Pro Cah)Professional Component ",,73523,CPT,Professional,Both,,,26,92,78.2,9.37,92,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),9.37,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Xr Hips, Bilateral, With Pelvis When Performed; Minimum Of 5 Views (Pro Cah)Professional Component ",,73523,CPT,Professional,Both,,,26,92,78.2,9.37,92,"Health Partners, Inc.",State of Minnesota Advantage Program,19.099455,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Xr Hips, Bilateral, With Pelvis When Performed; Minimum Of 5 Views (Pro Cah)Professional Component ",,73523,CPT,Professional,Both,,,26,92,78.2,9.37,92,"Health Partners, Inc.",State Public Programs,9.37,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Xr Hips, Bilateral, With Pelvis When Performed; Minimum Of 5 Views (Pro Cah)Professional Component ",,73523,CPT,Professional,Both,,,26,92,78.2,9.37,92,Humana Insurance Company,Commercial PPO,14.87,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Xr Hips, Bilateral, With Pelvis When Performed; Minimum Of 5 Views (Pro Cah)Professional Component ",,73523,CPT,Professional,Both,,,26,92,78.2,9.37,92,Humana Insurance Company,Medicare PPO,92,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Xr Hips, Bilateral, With Pelvis When Performed; Minimum Of 5 Views (Pro Cah)Professional Component ",,73523,CPT,Professional,Both,,,26,92,78.2,9.37,92,Medica,Individual & Family,78.016,84.8,,percent of total billed charges,,
"Xr Hips, Bilateral, With Pelvis When Performed; Minimum Of 5 Views (Pro Cah)Professional Component ",,73523,CPT,Professional,Both,,,26,92,78.2,9.37,92,Medica,Medica Advantage Solution,45.816,49.8,,percent of total billed charges,,
"Xr Hips, Bilateral, With Pelvis When Performed; Minimum Of 5 Views (Pro Cah)Professional Component ",,73523,CPT,Professional,Both,,,26,92,78.2,9.37,92,Medica,Medical Assistance,10.82,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Xr Hips, Bilateral, With Pelvis When Performed; Minimum Of 5 Views (Pro Cah)Professional Component ",,73523,CPT,Professional,Both,,,26,92,78.2,9.37,92,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,14.87,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Xr Hips, Bilateral, With Pelvis When Performed; Minimum Of 5 Views (Pro Cah)Professional Component ",,73523,CPT,Professional,Both,,,26,92,78.2,9.37,92,"Multiplan, Inc.","Multiplan, Inc.",86.48,94,,percent of total billed charges,,
"Xr Hips, Bilateral, With Pelvis When Performed; Minimum Of 5 Views (Pro Cah)Professional Component ",,73523,CPT,Professional,Both,,,26,92,78.2,9.37,92,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,82.892,90.1,,percent of total billed charges,,
"Xr Hips, Bilateral, With Pelvis When Performed; Minimum Of 5 Views (Pro Cah)Professional Component ",,73523,CPT,Professional,Both,,,26,92,78.2,9.37,92,"Preferred One Administrative Services, INC.",PPO,90.712,98.6,,percent of total billed charges,,
"Xr Hips, Bilateral, With Pelvis When Performed; Minimum Of 5 Views (Pro Cah)Professional Component ",,73523,CPT,Professional,Both,,,26,92,78.2,9.37,92,PrimeWest Health,Minnesota Senior Health Options (MSHO),17.1005,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Xr Hips, Bilateral, With Pelvis When Performed; Minimum Of 5 Views (Pro Cah)Professional Component ",,73523,CPT,Professional,Both,,,26,92,78.2,9.37,92,PrimeWest Health,MinnesotaCare,11.577828,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Xr Hips, Bilateral, With Pelvis When Performed; Minimum Of 5 Views (Pro Cah)Professional Component ",,73523,CPT,Professional,Both,,,26,92,78.2,9.37,92,Sanford Health Plan,Sanford Health Plan,80.96,88,,percent of total billed charges,,
"Xr Hips, Bilateral, With Pelvis When Performed; Minimum Of 5 Views (Pro Cah)Professional Component ",,73523,CPT,Professional,Both,,,26,92,78.2,9.37,92,"UCare Health, Inc.",Individual & Family Plan,24.172672,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Xr Hips, Bilateral, With Pelvis When Performed; Minimum Of 5 Views (Pro Cah)Professional Component ",,73523,CPT,Professional,Both,,,26,92,78.2,9.37,92,"UCare Health, Inc.",Medical Assistance,11.90244,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Xr Hips, Bilateral, With Pelvis When Performed; Minimum Of 5 Views (Pro Cah)Professional Component ",,73523,CPT,Professional,Both,,,26,92,78.2,9.37,92,"UCare Health, Inc.",Medicare Advantage,17.1005,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Xr Hips, Bilateral, With Pelvis When Performed; Minimum Of 5 Views (Pro Cah)Professional Component ",,73523,CPT,Professional,Both,,,26,92,78.2,9.37,92,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),13.6804,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Xr Hips, Bilateral, With Pelvis When Performed; Minimum Of 5 Views (Pro Cah)Professional Component ",,73523,CPT,Professional,Both,,,26,92,78.2,9.37,92,UnitedHealthcare,Individual & Family,92,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Xr Hips, Bilateral, With Pelvis When Performed; Minimum Of 5 Views (Pro Cah)Professional Component ",,73523,CPT,Professional,Both,,,26,92,78.2,9.37,92,UnitedHealthcare,Medicare Advantage,17.1005,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Xr Hips, Bilateral, With Pelvis When Performed; Minimum Of 5 Views (Pro Cah)Professional Component ",,73523,CPT,Professional,Both,,,26,92,78.2,9.37,92,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,10.8204,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Femur; 1 View (Pro Cah)Professional Component ,,73551,CPT,Professional,Both,,,26,50,42.5,5.02,50,Aetna,Commercial,42.5,85,,percent of total billed charges,,
Xr Femur; 1 View (Pro Cah)Professional Component ,,73551,CPT,Professional,Both,,,26,50,42.5,5.02,50,Aetna,Medicare Advantage,8.18,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Femur; 1 View (Pro Cah)Professional Component ,,73551,CPT,Professional,Both,,,26,50,42.5,5.02,50,Aetna,PPO,46.5,93,,percent of total billed charges,,
Xr Femur; 1 View (Pro Cah)Professional Component ,,73551,CPT,Professional,Both,,,26,50,42.5,5.02,50,America's PPO,America's PPO,42.72,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Xr Femur; 1 View (Pro Cah)Professional Component ,,73551,CPT,Professional,Both,,,26,50,42.5,5.02,50,BlueCross BlueShield Minnesota, Federal Employee Program,15.34,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Xr Femur; 1 View (Pro Cah)Professional Component ,,73551,CPT,Professional,Both,,,26,50,42.5,5.02,50,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,15.58544,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Femur; 1 View (Pro Cah)Professional Component ,,73551,CPT,Professional,Both,,,26,50,42.5,5.02,50,BlueCross BlueShield Minnesota,High Value Network Plan,15.58544,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Femur; 1 View (Pro Cah)Professional Component ,,73551,CPT,Professional,Both,,,26,50,42.5,5.02,50,BlueCross BlueShield Minnesota,Medicare Advantage,9.1425,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Femur; 1 View (Pro Cah)Professional Component ,,73551,CPT,Professional,Both,,,26,50,42.5,5.02,50,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,15.58544,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Femur; 1 View (Pro Cah)Professional Component ,,73551,CPT,Professional,Both,,,26,50,42.5,5.02,50,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,5.7912,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Femur; 1 View (Pro Cah)Professional Component ,,73551,CPT,Professional,Both,,,26,50,42.5,5.02,50,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),9.1425,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Femur; 1 View (Pro Cah)Professional Component ,,73551,CPT,Professional,Both,,,26,50,42.5,5.02,50,CorVel,Worker's Compensation,15.7473348,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Xr Femur; 1 View (Pro Cah)Professional Component ,,73551,CPT,Professional,Both,,,26,50,42.5,5.02,50,First Health Group Corporation,First Health Network,48.5,97,,percent of total billed charges,,
Xr Femur; 1 View (Pro Cah)Professional Component ,,73551,CPT,Professional,Both,,,26,50,42.5,5.02,50,"Health Partners, Inc.",Commercial,11.86,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Xr Femur; 1 View (Pro Cah)Professional Component ,,73551,CPT,Professional,Both,,,26,50,42.5,5.02,50,"Health Partners, Inc.",Medicare Advantage,9.1425,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Femur; 1 View (Pro Cah)Professional Component ,,73551,CPT,Professional,Both,,,26,50,42.5,5.02,50,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),5.02,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Xr Femur; 1 View (Pro Cah)Professional Component ,,73551,CPT,Professional,Both,,,26,50,42.5,5.02,50,"Health Partners, Inc.",State of Minnesota Advantage Program,10.21739,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Xr Femur; 1 View (Pro Cah)Professional Component ,,73551,CPT,Professional,Both,,,26,50,42.5,5.02,50,"Health Partners, Inc.",State Public Programs,5.02,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Xr Femur; 1 View (Pro Cah)Professional Component ,,73551,CPT,Professional,Both,,,26,50,42.5,5.02,50,Humana Insurance Company,Commercial PPO,7.95,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Xr Femur; 1 View (Pro Cah)Professional Component ,,73551,CPT,Professional,Both,,,26,50,42.5,5.02,50,Humana Insurance Company,Medicare PPO,50,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Xr Femur; 1 View (Pro Cah)Professional Component ,,73551,CPT,Professional,Both,,,26,50,42.5,5.02,50,Medica,Individual & Family,42.4,84.8,,percent of total billed charges,,
Xr Femur; 1 View (Pro Cah)Professional Component ,,73551,CPT,Professional,Both,,,26,50,42.5,5.02,50,Medica,Medica Advantage Solution,24.9,49.8,,percent of total billed charges,,
Xr Femur; 1 View (Pro Cah)Professional Component ,,73551,CPT,Professional,Both,,,26,50,42.5,5.02,50,Medica,Medical Assistance,5.79,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Xr Femur; 1 View (Pro Cah)Professional Component ,,73551,CPT,Professional,Both,,,26,50,42.5,5.02,50,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,7.95,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Xr Femur; 1 View (Pro Cah)Professional Component ,,73551,CPT,Professional,Both,,,26,50,42.5,5.02,50,"Multiplan, Inc.","Multiplan, Inc.",47,94,,percent of total billed charges,,
Xr Femur; 1 View (Pro Cah)Professional Component ,,73551,CPT,Professional,Both,,,26,50,42.5,5.02,50,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,45.05,90.1,,percent of total billed charges,,
Xr Femur; 1 View (Pro Cah)Professional Component ,,73551,CPT,Professional,Both,,,26,50,42.5,5.02,50,"Preferred One Administrative Services, INC.",PPO,49.3,98.6,,percent of total billed charges,,
Xr Femur; 1 View (Pro Cah)Professional Component ,,73551,CPT,Professional,Both,,,26,50,42.5,5.02,50,PrimeWest Health,Minnesota Senior Health Options (MSHO),9.1425,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Femur; 1 View (Pro Cah)Professional Component ,,73551,CPT,Professional,Both,,,26,50,42.5,5.02,50,PrimeWest Health,MinnesotaCare,6.196584,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Femur; 1 View (Pro Cah)Professional Component ,,73551,CPT,Professional,Both,,,26,50,42.5,5.02,50,Sanford Health Plan,Sanford Health Plan,44,88,,percent of total billed charges,,
Xr Femur; 1 View (Pro Cah)Professional Component ,,73551,CPT,Professional,Both,,,26,50,42.5,5.02,50,"UCare Health, Inc.",Individual & Family Plan,12.92352,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Xr Femur; 1 View (Pro Cah)Professional Component ,,73551,CPT,Professional,Both,,,26,50,42.5,5.02,50,"UCare Health, Inc.",Medical Assistance,6.37032,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Xr Femur; 1 View (Pro Cah)Professional Component ,,73551,CPT,Professional,Both,,,26,50,42.5,5.02,50,"UCare Health, Inc.",Medicare Advantage,9.1425,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Xr Femur; 1 View (Pro Cah)Professional Component ,,73551,CPT,Professional,Both,,,26,50,42.5,5.02,50,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),7.314,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Xr Femur; 1 View (Pro Cah)Professional Component ,,73551,CPT,Professional,Both,,,26,50,42.5,5.02,50,UnitedHealthcare,Individual & Family,50,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Xr Femur; 1 View (Pro Cah)Professional Component ,,73551,CPT,Professional,Both,,,26,50,42.5,5.02,50,UnitedHealthcare,Medicare Advantage,9.1425,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Femur; 1 View (Pro Cah)Professional Component ,,73551,CPT,Professional,Both,,,26,50,42.5,5.02,50,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,5.7912,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Radiologic Exam, Femur; Minimum 2 Views (Pro Cah)Professional Component ",,73552,CPT,Professional,Both,,,26,55,46.75,5.45,55,Aetna,Commercial,46.75,85,,percent of total billed charges,,
"Radiologic Exam, Femur; Minimum 2 Views (Pro Cah)Professional Component ",,73552,CPT,Professional,Both,,,26,55,46.75,5.45,55,Aetna,Medicare Advantage,8.88,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Radiologic Exam, Femur; Minimum 2 Views (Pro Cah)Professional Component ",,73552,CPT,Professional,Both,,,26,55,46.75,5.45,55,Aetna,PPO,51.15,93,,percent of total billed charges,,
"Radiologic Exam, Femur; Minimum 2 Views (Pro Cah)Professional Component ",,73552,CPT,Professional,Both,,,26,55,46.75,5.45,55,America's PPO,America's PPO,46.992,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Radiologic Exam, Femur; Minimum 2 Views (Pro Cah)Professional Component ",,73552,CPT,Professional,Both,,,26,55,46.75,5.45,55,BlueCross BlueShield Minnesota, Federal Employee Program,16.62,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Radiologic Exam, Femur; Minimum 2 Views (Pro Cah)Professional Component ",,73552,CPT,Professional,Both,,,26,55,46.75,5.45,55,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,16.88592,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Radiologic Exam, Femur; Minimum 2 Views (Pro Cah)Professional Component ",,73552,CPT,Professional,Both,,,26,55,46.75,5.45,55,BlueCross BlueShield Minnesota,High Value Network Plan,16.88592,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Radiologic Exam, Femur; Minimum 2 Views (Pro Cah)Professional Component ",,73552,CPT,Professional,Both,,,26,55,46.75,5.45,55,BlueCross BlueShield Minnesota,Medicare Advantage,9.9245,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Radiologic Exam, Femur; Minimum 2 Views (Pro Cah)Professional Component ",,73552,CPT,Professional,Both,,,26,55,46.75,5.45,55,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,16.88592,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Radiologic Exam, Femur; Minimum 2 Views (Pro Cah)Professional Component ",,73552,CPT,Professional,Both,,,26,55,46.75,5.45,55,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,6.28904,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Radiologic Exam, Femur; Minimum 2 Views (Pro Cah)Professional Component ",,73552,CPT,Professional,Both,,,26,55,46.75,5.45,55,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),9.9245,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Radiologic Exam, Femur; Minimum 2 Views (Pro Cah)Professional Component ",,73552,CPT,Professional,Both,,,26,55,46.75,5.45,55,CorVel,Worker's Compensation,17.0907348,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Radiologic Exam, Femur; Minimum 2 Views (Pro Cah)Professional Component ",,73552,CPT,Professional,Both,,,26,55,46.75,5.45,55,First Health Group Corporation,First Health Network,53.35,97,,percent of total billed charges,,
"Radiologic Exam, Femur; Minimum 2 Views (Pro Cah)Professional Component ",,73552,CPT,Professional,Both,,,26,55,46.75,5.45,55,"Health Partners, Inc.",Commercial,12.89,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Radiologic Exam, Femur; Minimum 2 Views (Pro Cah)Professional Component ",,73552,CPT,Professional,Both,,,26,55,46.75,5.45,55,"Health Partners, Inc.",Medicare Advantage,9.9245,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Radiologic Exam, Femur; Minimum 2 Views (Pro Cah)Professional Component ",,73552,CPT,Professional,Both,,,26,55,46.75,5.45,55,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),5.45,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Radiologic Exam, Femur; Minimum 2 Views (Pro Cah)Professional Component ",,73552,CPT,Professional,Both,,,26,55,46.75,5.45,55,"Health Partners, Inc.",State of Minnesota Advantage Program,11.104735,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Radiologic Exam, Femur; Minimum 2 Views (Pro Cah)Professional Component ",,73552,CPT,Professional,Both,,,26,55,46.75,5.45,55,"Health Partners, Inc.",State Public Programs,5.45,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Radiologic Exam, Femur; Minimum 2 Views (Pro Cah)Professional Component ",,73552,CPT,Professional,Both,,,26,55,46.75,5.45,55,Humana Insurance Company,Commercial PPO,8.63,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Radiologic Exam, Femur; Minimum 2 Views (Pro Cah)Professional Component ",,73552,CPT,Professional,Both,,,26,55,46.75,5.45,55,Humana Insurance Company,Medicare PPO,55,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Radiologic Exam, Femur; Minimum 2 Views (Pro Cah)Professional Component ",,73552,CPT,Professional,Both,,,26,55,46.75,5.45,55,Medica,Individual & Family,46.64,84.8,,percent of total billed charges,,
"Radiologic Exam, Femur; Minimum 2 Views (Pro Cah)Professional Component ",,73552,CPT,Professional,Both,,,26,55,46.75,5.45,55,Medica,Medica Advantage Solution,27.39,49.8,,percent of total billed charges,,
"Radiologic Exam, Femur; Minimum 2 Views (Pro Cah)Professional Component ",,73552,CPT,Professional,Both,,,26,55,46.75,5.45,55,Medica,Medical Assistance,6.29,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Radiologic Exam, Femur; Minimum 2 Views (Pro Cah)Professional Component ",,73552,CPT,Professional,Both,,,26,55,46.75,5.45,55,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,8.63,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Radiologic Exam, Femur; Minimum 2 Views (Pro Cah)Professional Component ",,73552,CPT,Professional,Both,,,26,55,46.75,5.45,55,"Multiplan, Inc.","Multiplan, Inc.",51.7,94,,percent of total billed charges,,
"Radiologic Exam, Femur; Minimum 2 Views (Pro Cah)Professional Component ",,73552,CPT,Professional,Both,,,26,55,46.75,5.45,55,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,49.555,90.1,,percent of total billed charges,,
"Radiologic Exam, Femur; Minimum 2 Views (Pro Cah)Professional Component ",,73552,CPT,Professional,Both,,,26,55,46.75,5.45,55,"Preferred One Administrative Services, INC.",PPO,54.23,98.6,,percent of total billed charges,,
"Radiologic Exam, Femur; Minimum 2 Views (Pro Cah)Professional Component ",,73552,CPT,Professional,Both,,,26,55,46.75,5.45,55,PrimeWest Health,Minnesota Senior Health Options (MSHO),9.9245,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Radiologic Exam, Femur; Minimum 2 Views (Pro Cah)Professional Component ",,73552,CPT,Professional,Both,,,26,55,46.75,5.45,55,PrimeWest Health,MinnesotaCare,6.7292728,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Radiologic Exam, Femur; Minimum 2 Views (Pro Cah)Professional Component ",,73552,CPT,Professional,Both,,,26,55,46.75,5.45,55,Sanford Health Plan,Sanford Health Plan,48.4,88,,percent of total billed charges,,
"Radiologic Exam, Femur; Minimum 2 Views (Pro Cah)Professional Component ",,73552,CPT,Professional,Both,,,26,55,46.75,5.45,55,"UCare Health, Inc.",Individual & Family Plan,14.028928,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Radiologic Exam, Femur; Minimum 2 Views (Pro Cah)Professional Component ",,73552,CPT,Professional,Both,,,26,55,46.75,5.45,55,"UCare Health, Inc.",Medical Assistance,6.917944,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Radiologic Exam, Femur; Minimum 2 Views (Pro Cah)Professional Component ",,73552,CPT,Professional,Both,,,26,55,46.75,5.45,55,"UCare Health, Inc.",Medicare Advantage,9.9245,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Radiologic Exam, Femur; Minimum 2 Views (Pro Cah)Professional Component ",,73552,CPT,Professional,Both,,,26,55,46.75,5.45,55,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),7.9396,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Radiologic Exam, Femur; Minimum 2 Views (Pro Cah)Professional Component ",,73552,CPT,Professional,Both,,,26,55,46.75,5.45,55,UnitedHealthcare,Individual & Family,55,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Radiologic Exam, Femur; Minimum 2 Views (Pro Cah)Professional Component ",,73552,CPT,Professional,Both,,,26,55,46.75,5.45,55,UnitedHealthcare,Medicare Advantage,9.9245,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Radiologic Exam, Femur; Minimum 2 Views (Pro Cah)Professional Component ",,73552,CPT,Professional,Both,,,26,55,46.75,5.45,55,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,6.28904,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Xr, Knee; 1 Or 2 Views (Pro Cah)Professional Component ",,73560,CPT,Professional,Both,,,26,43,36.55,5.02,43,Aetna,Commercial,36.55,85,,percent of total billed charges,,
"Xr, Knee; 1 Or 2 Views (Pro Cah)Professional Component ",,73560,CPT,Professional,Both,,,26,43,36.55,5.02,43,Aetna,Medicare Advantage,8.18,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Xr, Knee; 1 Or 2 Views (Pro Cah)Professional Component ",,73560,CPT,Professional,Both,,,26,43,36.55,5.02,43,Aetna,PPO,39.99,93,,percent of total billed charges,,
"Xr, Knee; 1 Or 2 Views (Pro Cah)Professional Component ",,73560,CPT,Professional,Both,,,26,43,36.55,5.02,43,America's PPO,America's PPO,36.7392,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Xr, Knee; 1 Or 2 Views (Pro Cah)Professional Component ",,73560,CPT,Professional,Both,,,26,43,36.55,5.02,43,BlueCross BlueShield Minnesota, Federal Employee Program,15.34,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Xr, Knee; 1 Or 2 Views (Pro Cah)Professional Component ",,73560,CPT,Professional,Both,,,26,43,36.55,5.02,43,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,15.58544,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Xr, Knee; 1 Or 2 Views (Pro Cah)Professional Component ",,73560,CPT,Professional,Both,,,26,43,36.55,5.02,43,BlueCross BlueShield Minnesota,High Value Network Plan,15.58544,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Xr, Knee; 1 Or 2 Views (Pro Cah)Professional Component ",,73560,CPT,Professional,Both,,,26,43,36.55,5.02,43,BlueCross BlueShield Minnesota,Medicare Advantage,9.1425,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Xr, Knee; 1 Or 2 Views (Pro Cah)Professional Component ",,73560,CPT,Professional,Both,,,26,43,36.55,5.02,43,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,15.58544,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Xr, Knee; 1 Or 2 Views (Pro Cah)Professional Component ",,73560,CPT,Professional,Both,,,26,43,36.55,5.02,43,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,5.7912,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Xr, Knee; 1 Or 2 Views (Pro Cah)Professional Component ",,73560,CPT,Professional,Both,,,26,43,36.55,5.02,43,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),9.1425,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Xr, Knee; 1 Or 2 Views (Pro Cah)Professional Component ",,73560,CPT,Professional,Both,,,26,43,36.55,5.02,43,CorVel,Worker's Compensation,15.7473348,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Xr, Knee; 1 Or 2 Views (Pro Cah)Professional Component ",,73560,CPT,Professional,Both,,,26,43,36.55,5.02,43,First Health Group Corporation,First Health Network,41.71,97,,percent of total billed charges,,
"Xr, Knee; 1 Or 2 Views (Pro Cah)Professional Component ",,73560,CPT,Professional,Both,,,26,43,36.55,5.02,43,"Health Partners, Inc.",Commercial,11.86,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Xr, Knee; 1 Or 2 Views (Pro Cah)Professional Component ",,73560,CPT,Professional,Both,,,26,43,36.55,5.02,43,"Health Partners, Inc.",Medicare Advantage,9.1425,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Xr, Knee; 1 Or 2 Views (Pro Cah)Professional Component ",,73560,CPT,Professional,Both,,,26,43,36.55,5.02,43,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),5.02,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Xr, Knee; 1 Or 2 Views (Pro Cah)Professional Component ",,73560,CPT,Professional,Both,,,26,43,36.55,5.02,43,"Health Partners, Inc.",State of Minnesota Advantage Program,10.21739,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Xr, Knee; 1 Or 2 Views (Pro Cah)Professional Component ",,73560,CPT,Professional,Both,,,26,43,36.55,5.02,43,"Health Partners, Inc.",State Public Programs,5.02,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Xr, Knee; 1 Or 2 Views (Pro Cah)Professional Component ",,73560,CPT,Professional,Both,,,26,43,36.55,5.02,43,Humana Insurance Company,Commercial PPO,7.95,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Xr, Knee; 1 Or 2 Views (Pro Cah)Professional Component ",,73560,CPT,Professional,Both,,,26,43,36.55,5.02,43,Humana Insurance Company,Medicare PPO,43,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Xr, Knee; 1 Or 2 Views (Pro Cah)Professional Component ",,73560,CPT,Professional,Both,,,26,43,36.55,5.02,43,Medica,Individual & Family,36.464,84.8,,percent of total billed charges,,
"Xr, Knee; 1 Or 2 Views (Pro Cah)Professional Component ",,73560,CPT,Professional,Both,,,26,43,36.55,5.02,43,Medica,Medica Advantage Solution,21.414,49.8,,percent of total billed charges,,
"Xr, Knee; 1 Or 2 Views (Pro Cah)Professional Component ",,73560,CPT,Professional,Both,,,26,43,36.55,5.02,43,Medica,Medical Assistance,5.79,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Xr, Knee; 1 Or 2 Views (Pro Cah)Professional Component ",,73560,CPT,Professional,Both,,,26,43,36.55,5.02,43,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,7.95,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Xr, Knee; 1 Or 2 Views (Pro Cah)Professional Component ",,73560,CPT,Professional,Both,,,26,43,36.55,5.02,43,"Multiplan, Inc.","Multiplan, Inc.",40.42,94,,percent of total billed charges,,
"Xr, Knee; 1 Or 2 Views (Pro Cah)Professional Component ",,73560,CPT,Professional,Both,,,26,43,36.55,5.02,43,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,38.743,90.1,,percent of total billed charges,,
"Xr, Knee; 1 Or 2 Views (Pro Cah)Professional Component ",,73560,CPT,Professional,Both,,,26,43,36.55,5.02,43,"Preferred One Administrative Services, INC.",PPO,42.398,98.6,,percent of total billed charges,,
"Xr, Knee; 1 Or 2 Views (Pro Cah)Professional Component ",,73560,CPT,Professional,Both,,,26,43,36.55,5.02,43,PrimeWest Health,Minnesota Senior Health Options (MSHO),9.1425,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Xr, Knee; 1 Or 2 Views (Pro Cah)Professional Component ",,73560,CPT,Professional,Both,,,26,43,36.55,5.02,43,PrimeWest Health,MinnesotaCare,6.196584,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Xr, Knee; 1 Or 2 Views (Pro Cah)Professional Component ",,73560,CPT,Professional,Both,,,26,43,36.55,5.02,43,Sanford Health Plan,Sanford Health Plan,37.84,88,,percent of total billed charges,,
"Xr, Knee; 1 Or 2 Views (Pro Cah)Professional Component ",,73560,CPT,Professional,Both,,,26,43,36.55,5.02,43,"UCare Health, Inc.",Individual & Family Plan,12.92352,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Xr, Knee; 1 Or 2 Views (Pro Cah)Professional Component ",,73560,CPT,Professional,Both,,,26,43,36.55,5.02,43,"UCare Health, Inc.",Medical Assistance,6.37032,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Xr, Knee; 1 Or 2 Views (Pro Cah)Professional Component ",,73560,CPT,Professional,Both,,,26,43,36.55,5.02,43,"UCare Health, Inc.",Medicare Advantage,9.1425,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Xr, Knee; 1 Or 2 Views (Pro Cah)Professional Component ",,73560,CPT,Professional,Both,,,26,43,36.55,5.02,43,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),7.314,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Xr, Knee; 1 Or 2 Views (Pro Cah)Professional Component ",,73560,CPT,Professional,Both,,,26,43,36.55,5.02,43,UnitedHealthcare,Individual & Family,43,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Xr, Knee; 1 Or 2 Views (Pro Cah)Professional Component ",,73560,CPT,Professional,Both,,,26,43,36.55,5.02,43,UnitedHealthcare,Medicare Advantage,9.1425,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Xr, Knee; 1 Or 2 Views (Pro Cah)Professional Component ",,73560,CPT,Professional,Both,,,26,43,36.55,5.02,43,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,5.7912,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Knee 3 Views (Pro Cah)Professional Component ,,73562,CPT,Professional,Both,,,26,50,42.5,5.67,50,Aetna,Commercial,42.5,85,,percent of total billed charges,,
Xr Knee 3 Views (Pro Cah)Professional Component ,,73562,CPT,Professional,Both,,,26,50,42.5,5.67,50,Aetna,Medicare Advantage,9.23,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Knee 3 Views (Pro Cah)Professional Component ,,73562,CPT,Professional,Both,,,26,50,42.5,5.67,50,Aetna,PPO,46.5,93,,percent of total billed charges,,
Xr Knee 3 Views (Pro Cah)Professional Component ,,73562,CPT,Professional,Both,,,26,50,42.5,5.67,50,America's PPO,America's PPO,42.72,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Xr Knee 3 Views (Pro Cah)Professional Component ,,73562,CPT,Professional,Both,,,26,50,42.5,5.67,50,BlueCross BlueShield Minnesota, Federal Employee Program,17.26,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Xr Knee 3 Views (Pro Cah)Professional Component ,,73562,CPT,Professional,Both,,,26,50,42.5,5.67,50,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,17.53616,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Knee 3 Views (Pro Cah)Professional Component ,,73562,CPT,Professional,Both,,,26,50,42.5,5.67,50,BlueCross BlueShield Minnesota,High Value Network Plan,17.53616,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Knee 3 Views (Pro Cah)Professional Component ,,73562,CPT,Professional,Both,,,26,50,42.5,5.67,50,BlueCross BlueShield Minnesota,Medicare Advantage,10.3155,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Knee 3 Views (Pro Cah)Professional Component ,,73562,CPT,Professional,Both,,,26,50,42.5,5.67,50,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,17.53616,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Knee 3 Views (Pro Cah)Professional Component ,,73562,CPT,Professional,Both,,,26,50,42.5,5.67,50,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,6.54304,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Knee 3 Views (Pro Cah)Professional Component ,,73562,CPT,Professional,Both,,,26,50,42.5,5.67,50,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),10.3155,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Knee 3 Views (Pro Cah)Professional Component ,,73562,CPT,Professional,Both,,,26,50,42.5,5.67,50,CorVel,Worker's Compensation,17.7711669,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Xr Knee 3 Views (Pro Cah)Professional Component ,,73562,CPT,Professional,Both,,,26,50,42.5,5.67,50,First Health Group Corporation,First Health Network,48.5,97,,percent of total billed charges,,
Xr Knee 3 Views (Pro Cah)Professional Component ,,73562,CPT,Professional,Both,,,26,50,42.5,5.67,50,"Health Partners, Inc.",Commercial,13.41,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Xr Knee 3 Views (Pro Cah)Professional Component ,,73562,CPT,Professional,Both,,,26,50,42.5,5.67,50,"Health Partners, Inc.",Medicare Advantage,10.3155,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Knee 3 Views (Pro Cah)Professional Component ,,73562,CPT,Professional,Both,,,26,50,42.5,5.67,50,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),5.67,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Xr Knee 3 Views (Pro Cah)Professional Component ,,73562,CPT,Professional,Both,,,26,50,42.5,5.67,50,"Health Partners, Inc.",State of Minnesota Advantage Program,11.552715,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Xr Knee 3 Views (Pro Cah)Professional Component ,,73562,CPT,Professional,Both,,,26,50,42.5,5.67,50,"Health Partners, Inc.",State Public Programs,5.67,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Xr Knee 3 Views (Pro Cah)Professional Component ,,73562,CPT,Professional,Both,,,26,50,42.5,5.67,50,Humana Insurance Company,Commercial PPO,8.97,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Xr Knee 3 Views (Pro Cah)Professional Component ,,73562,CPT,Professional,Both,,,26,50,42.5,5.67,50,Humana Insurance Company,Medicare PPO,50,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Xr Knee 3 Views (Pro Cah)Professional Component ,,73562,CPT,Professional,Both,,,26,50,42.5,5.67,50,Medica,Individual & Family,42.4,84.8,,percent of total billed charges,,
Xr Knee 3 Views (Pro Cah)Professional Component ,,73562,CPT,Professional,Both,,,26,50,42.5,5.67,50,Medica,Medica Advantage Solution,24.9,49.8,,percent of total billed charges,,
Xr Knee 3 Views (Pro Cah)Professional Component ,,73562,CPT,Professional,Both,,,26,50,42.5,5.67,50,Medica,Medical Assistance,6.54,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Xr Knee 3 Views (Pro Cah)Professional Component ,,73562,CPT,Professional,Both,,,26,50,42.5,5.67,50,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,8.97,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Xr Knee 3 Views (Pro Cah)Professional Component ,,73562,CPT,Professional,Both,,,26,50,42.5,5.67,50,"Multiplan, Inc.","Multiplan, Inc.",47,94,,percent of total billed charges,,
Xr Knee 3 Views (Pro Cah)Professional Component ,,73562,CPT,Professional,Both,,,26,50,42.5,5.67,50,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,45.05,90.1,,percent of total billed charges,,
Xr Knee 3 Views (Pro Cah)Professional Component ,,73562,CPT,Professional,Both,,,26,50,42.5,5.67,50,"Preferred One Administrative Services, INC.",PPO,49.3,98.6,,percent of total billed charges,,
Xr Knee 3 Views (Pro Cah)Professional Component ,,73562,CPT,Professional,Both,,,26,50,42.5,5.67,50,PrimeWest Health,Minnesota Senior Health Options (MSHO),10.3155,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Knee 3 Views (Pro Cah)Professional Component ,,73562,CPT,Professional,Both,,,26,50,42.5,5.67,50,PrimeWest Health,MinnesotaCare,7.0010528,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Knee 3 Views (Pro Cah)Professional Component ,,73562,CPT,Professional,Both,,,26,50,42.5,5.67,50,Sanford Health Plan,Sanford Health Plan,44,88,,percent of total billed charges,,
Xr Knee 3 Views (Pro Cah)Professional Component ,,73562,CPT,Professional,Both,,,26,50,42.5,5.67,50,"UCare Health, Inc.",Individual & Family Plan,14.581632,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Xr Knee 3 Views (Pro Cah)Professional Component ,,73562,CPT,Professional,Both,,,26,50,42.5,5.67,50,"UCare Health, Inc.",Medical Assistance,7.197344,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Xr Knee 3 Views (Pro Cah)Professional Component ,,73562,CPT,Professional,Both,,,26,50,42.5,5.67,50,"UCare Health, Inc.",Medicare Advantage,10.3155,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Xr Knee 3 Views (Pro Cah)Professional Component ,,73562,CPT,Professional,Both,,,26,50,42.5,5.67,50,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),8.2524,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Xr Knee 3 Views (Pro Cah)Professional Component ,,73562,CPT,Professional,Both,,,26,50,42.5,5.67,50,UnitedHealthcare,Individual & Family,50,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Xr Knee 3 Views (Pro Cah)Professional Component ,,73562,CPT,Professional,Both,,,26,50,42.5,5.67,50,UnitedHealthcare,Medicare Advantage,10.3155,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Knee 3 Views (Pro Cah)Professional Component ,,73562,CPT,Professional,Both,,,26,50,42.5,5.67,50,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,6.54304,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Knee 4 Views Or More (Pro Cah)Professional Component ,,73564,CPT,Professional,Both,,,26,55,46.75,6.98,55,Aetna,Commercial,46.75,85,,percent of total billed charges,,
Xr Knee 4 Views Or More (Pro Cah)Professional Component ,,73564,CPT,Professional,Both,,,26,55,46.75,6.98,55,Aetna,Medicare Advantage,10.98,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Knee 4 Views Or More (Pro Cah)Professional Component ,,73564,CPT,Professional,Both,,,26,55,46.75,6.98,55,Aetna,PPO,51.15,93,,percent of total billed charges,,
Xr Knee 4 Views Or More (Pro Cah)Professional Component ,,73564,CPT,Professional,Both,,,26,55,46.75,6.98,55,America's PPO,America's PPO,46.992,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Xr Knee 4 Views Or More (Pro Cah)Professional Component ,,73564,CPT,Professional,Both,,,26,55,46.75,6.98,55,BlueCross BlueShield Minnesota, Federal Employee Program,21.09,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Xr Knee 4 Views Or More (Pro Cah)Professional Component ,,73564,CPT,Professional,Both,,,26,55,46.75,6.98,55,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,21.42744,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Knee 4 Views Or More (Pro Cah)Professional Component ,,73564,CPT,Professional,Both,,,26,55,46.75,6.98,55,BlueCross BlueShield Minnesota,High Value Network Plan,21.42744,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Knee 4 Views Or More (Pro Cah)Professional Component ,,73564,CPT,Professional,Both,,,26,55,46.75,6.98,55,BlueCross BlueShield Minnesota,Medicare Advantage,12.673,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Knee 4 Views Or More (Pro Cah)Professional Component ,,73564,CPT,Professional,Both,,,26,55,46.75,6.98,55,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,21.42744,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Knee 4 Views Or More (Pro Cah)Professional Component ,,73564,CPT,Professional,Both,,,26,55,46.75,6.98,55,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,8.05688,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Knee 4 Views Or More (Pro Cah)Professional Component ,,73564,CPT,Professional,Both,,,26,55,46.75,6.98,55,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),12.673,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Knee 4 Views Or More (Pro Cah)Professional Component ,,73564,CPT,Professional,Both,,,26,55,46.75,6.98,55,CorVel,Worker's Compensation,21.138399,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Xr Knee 4 Views Or More (Pro Cah)Professional Component ,,73564,CPT,Professional,Both,,,26,55,46.75,6.98,55,First Health Group Corporation,First Health Network,53.35,97,,percent of total billed charges,,
Xr Knee 4 Views Or More (Pro Cah)Professional Component ,,73564,CPT,Professional,Both,,,26,55,46.75,6.98,55,"Health Partners, Inc.",Commercial,15.98,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Xr Knee 4 Views Or More (Pro Cah)Professional Component ,,73564,CPT,Professional,Both,,,26,55,46.75,6.98,55,"Health Partners, Inc.",Medicare Advantage,12.673,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Knee 4 Views Or More (Pro Cah)Professional Component ,,73564,CPT,Professional,Both,,,26,55,46.75,6.98,55,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),6.98,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Xr Knee 4 Views Or More (Pro Cah)Professional Component ,,73564,CPT,Professional,Both,,,26,55,46.75,6.98,55,"Health Partners, Inc.",State of Minnesota Advantage Program,13.76677,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Xr Knee 4 Views Or More (Pro Cah)Professional Component ,,73564,CPT,Professional,Both,,,26,55,46.75,6.98,55,"Health Partners, Inc.",State Public Programs,6.98,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Xr Knee 4 Views Or More (Pro Cah)Professional Component ,,73564,CPT,Professional,Both,,,26,55,46.75,6.98,55,Humana Insurance Company,Commercial PPO,11.02,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Xr Knee 4 Views Or More (Pro Cah)Professional Component ,,73564,CPT,Professional,Both,,,26,55,46.75,6.98,55,Humana Insurance Company,Medicare PPO,55,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Xr Knee 4 Views Or More (Pro Cah)Professional Component ,,73564,CPT,Professional,Both,,,26,55,46.75,6.98,55,Medica,Individual & Family,46.64,84.8,,percent of total billed charges,,
Xr Knee 4 Views Or More (Pro Cah)Professional Component ,,73564,CPT,Professional,Both,,,26,55,46.75,6.98,55,Medica,Medica Advantage Solution,27.39,49.8,,percent of total billed charges,,
Xr Knee 4 Views Or More (Pro Cah)Professional Component ,,73564,CPT,Professional,Both,,,26,55,46.75,6.98,55,Medica,Medical Assistance,8.06,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Xr Knee 4 Views Or More (Pro Cah)Professional Component ,,73564,CPT,Professional,Both,,,26,55,46.75,6.98,55,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,11.02,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Xr Knee 4 Views Or More (Pro Cah)Professional Component ,,73564,CPT,Professional,Both,,,26,55,46.75,6.98,55,"Multiplan, Inc.","Multiplan, Inc.",51.7,94,,percent of total billed charges,,
Xr Knee 4 Views Or More (Pro Cah)Professional Component ,,73564,CPT,Professional,Both,,,26,55,46.75,6.98,55,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,49.555,90.1,,percent of total billed charges,,
Xr Knee 4 Views Or More (Pro Cah)Professional Component ,,73564,CPT,Professional,Both,,,26,55,46.75,6.98,55,"Preferred One Administrative Services, INC.",PPO,54.23,98.6,,percent of total billed charges,,
Xr Knee 4 Views Or More (Pro Cah)Professional Component ,,73564,CPT,Professional,Both,,,26,55,46.75,6.98,55,PrimeWest Health,Minnesota Senior Health Options (MSHO),12.673,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Knee 4 Views Or More (Pro Cah)Professional Component ,,73564,CPT,Professional,Both,,,26,55,46.75,6.98,55,PrimeWest Health,MinnesotaCare,8.6208616,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Knee 4 Views Or More (Pro Cah)Professional Component ,,73564,CPT,Professional,Both,,,26,55,46.75,6.98,55,Sanford Health Plan,Sanford Health Plan,48.4,88,,percent of total billed charges,,
Xr Knee 4 Views Or More (Pro Cah)Professional Component ,,73564,CPT,Professional,Both,,,26,55,46.75,6.98,55,"UCare Health, Inc.",Individual & Family Plan,17.914112,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Xr Knee 4 Views Or More (Pro Cah)Professional Component ,,73564,CPT,Professional,Both,,,26,55,46.75,6.98,55,"UCare Health, Inc.",Medical Assistance,8.862568,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Xr Knee 4 Views Or More (Pro Cah)Professional Component ,,73564,CPT,Professional,Both,,,26,55,46.75,6.98,55,"UCare Health, Inc.",Medicare Advantage,12.673,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Xr Knee 4 Views Or More (Pro Cah)Professional Component ,,73564,CPT,Professional,Both,,,26,55,46.75,6.98,55,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),10.1384,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Xr Knee 4 Views Or More (Pro Cah)Professional Component ,,73564,CPT,Professional,Both,,,26,55,46.75,6.98,55,UnitedHealthcare,Individual & Family,55,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Xr Knee 4 Views Or More (Pro Cah)Professional Component ,,73564,CPT,Professional,Both,,,26,55,46.75,6.98,55,UnitedHealthcare,Medicare Advantage,12.673,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Knee 4 Views Or More (Pro Cah)Professional Component ,,73564,CPT,Professional,Both,,,26,55,46.75,6.98,55,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,8.05688,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Knees Bil Ap Standing (Pro Cah)Professional Component ,,73565,CPT,Professional,Both,,,26,40,34,5.23,40,Aetna,Commercial,34,85,,percent of total billed charges,,
Xr Knees Bil Ap Standing (Pro Cah)Professional Component ,,73565,CPT,Professional,Both,,,26,40,34,5.23,40,Aetna,Medicare Advantage,8.53,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Knees Bil Ap Standing (Pro Cah)Professional Component ,,73565,CPT,Professional,Both,,,26,40,34,5.23,40,Aetna,PPO,37.2,93,,percent of total billed charges,,
Xr Knees Bil Ap Standing (Pro Cah)Professional Component ,,73565,CPT,Professional,Both,,,26,40,34,5.23,40,America's PPO,America's PPO,34.176,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Xr Knees Bil Ap Standing (Pro Cah)Professional Component ,,73565,CPT,Professional,Both,,,26,40,34,5.23,40,BlueCross BlueShield Minnesota, Federal Employee Program,15.98,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Xr Knees Bil Ap Standing (Pro Cah)Professional Component ,,73565,CPT,Professional,Both,,,26,40,34,5.23,40,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,16.23568,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Knees Bil Ap Standing (Pro Cah)Professional Component ,,73565,CPT,Professional,Both,,,26,40,34,5.23,40,BlueCross BlueShield Minnesota,High Value Network Plan,16.23568,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Knees Bil Ap Standing (Pro Cah)Professional Component ,,73565,CPT,Professional,Both,,,26,40,34,5.23,40,BlueCross BlueShield Minnesota,Medicare Advantage,9.5335,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Knees Bil Ap Standing (Pro Cah)Professional Component ,,73565,CPT,Professional,Both,,,26,40,34,5.23,40,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,16.23568,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Knees Bil Ap Standing (Pro Cah)Professional Component ,,73565,CPT,Professional,Both,,,26,40,34,5.23,40,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,6.03504,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Knees Bil Ap Standing (Pro Cah)Professional Component ,,73565,CPT,Professional,Both,,,26,40,34,5.23,40,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),9.5335,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Knees Bil Ap Standing (Pro Cah)Professional Component ,,73565,CPT,Professional,Both,,,26,40,34,5.23,40,CorVel,Worker's Compensation,16.4277669,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Xr Knees Bil Ap Standing (Pro Cah)Professional Component ,,73565,CPT,Professional,Both,,,26,40,34,5.23,40,First Health Group Corporation,First Health Network,38.8,97,,percent of total billed charges,,
Xr Knees Bil Ap Standing (Pro Cah)Professional Component ,,73565,CPT,Professional,Both,,,26,40,34,5.23,40,"Health Partners, Inc.",Commercial,12.37,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Xr Knees Bil Ap Standing (Pro Cah)Professional Component ,,73565,CPT,Professional,Both,,,26,40,34,5.23,40,"Health Partners, Inc.",Medicare Advantage,9.5335,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Knees Bil Ap Standing (Pro Cah)Professional Component ,,73565,CPT,Professional,Both,,,26,40,34,5.23,40,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),5.23,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Xr Knees Bil Ap Standing (Pro Cah)Professional Component ,,73565,CPT,Professional,Both,,,26,40,34,5.23,40,"Health Partners, Inc.",State of Minnesota Advantage Program,10.656755,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Xr Knees Bil Ap Standing (Pro Cah)Professional Component ,,73565,CPT,Professional,Both,,,26,40,34,5.23,40,"Health Partners, Inc.",State Public Programs,5.23,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Xr Knees Bil Ap Standing (Pro Cah)Professional Component ,,73565,CPT,Professional,Both,,,26,40,34,5.23,40,Humana Insurance Company,Commercial PPO,8.29,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Xr Knees Bil Ap Standing (Pro Cah)Professional Component ,,73565,CPT,Professional,Both,,,26,40,34,5.23,40,Humana Insurance Company,Medicare PPO,40,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Xr Knees Bil Ap Standing (Pro Cah)Professional Component ,,73565,CPT,Professional,Both,,,26,40,34,5.23,40,Medica,Individual & Family,33.92,84.8,,percent of total billed charges,,
Xr Knees Bil Ap Standing (Pro Cah)Professional Component ,,73565,CPT,Professional,Both,,,26,40,34,5.23,40,Medica,Medica Advantage Solution,19.92,49.8,,percent of total billed charges,,
Xr Knees Bil Ap Standing (Pro Cah)Professional Component ,,73565,CPT,Professional,Both,,,26,40,34,5.23,40,Medica,Medical Assistance,6.04,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Xr Knees Bil Ap Standing (Pro Cah)Professional Component ,,73565,CPT,Professional,Both,,,26,40,34,5.23,40,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,8.29,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Xr Knees Bil Ap Standing (Pro Cah)Professional Component ,,73565,CPT,Professional,Both,,,26,40,34,5.23,40,"Multiplan, Inc.","Multiplan, Inc.",37.6,94,,percent of total billed charges,,
Xr Knees Bil Ap Standing (Pro Cah)Professional Component ,,73565,CPT,Professional,Both,,,26,40,34,5.23,40,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,36.04,90.1,,percent of total billed charges,,
Xr Knees Bil Ap Standing (Pro Cah)Professional Component ,,73565,CPT,Professional,Both,,,26,40,34,5.23,40,"Preferred One Administrative Services, INC.",PPO,39.44,98.6,,percent of total billed charges,,
Xr Knees Bil Ap Standing (Pro Cah)Professional Component ,,73565,CPT,Professional,Both,,,26,40,34,5.23,40,PrimeWest Health,Minnesota Senior Health Options (MSHO),9.5335,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Knees Bil Ap Standing (Pro Cah)Professional Component ,,73565,CPT,Professional,Both,,,26,40,34,5.23,40,PrimeWest Health,MinnesotaCare,6.4574928,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Knees Bil Ap Standing (Pro Cah)Professional Component ,,73565,CPT,Professional,Both,,,26,40,34,5.23,40,Sanford Health Plan,Sanford Health Plan,35.2,88,,percent of total billed charges,,
Xr Knees Bil Ap Standing (Pro Cah)Professional Component ,,73565,CPT,Professional,Both,,,26,40,34,5.23,40,"UCare Health, Inc.",Individual & Family Plan,13.476224,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Xr Knees Bil Ap Standing (Pro Cah)Professional Component ,,73565,CPT,Professional,Both,,,26,40,34,5.23,40,"UCare Health, Inc.",Medical Assistance,6.638544,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Xr Knees Bil Ap Standing (Pro Cah)Professional Component ,,73565,CPT,Professional,Both,,,26,40,34,5.23,40,"UCare Health, Inc.",Medicare Advantage,9.5335,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Xr Knees Bil Ap Standing (Pro Cah)Professional Component ,,73565,CPT,Professional,Both,,,26,40,34,5.23,40,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),7.6268,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Xr Knees Bil Ap Standing (Pro Cah)Professional Component ,,73565,CPT,Professional,Both,,,26,40,34,5.23,40,UnitedHealthcare,Individual & Family,40,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Xr Knees Bil Ap Standing (Pro Cah)Professional Component ,,73565,CPT,Professional,Both,,,26,40,34,5.23,40,UnitedHealthcare,Medicare Advantage,9.5335,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Knees Bil Ap Standing (Pro Cah)Professional Component ,,73565,CPT,Professional,Both,,,26,40,34,5.23,40,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,6.03504,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Tibia Fibula  (Pro Cah)Professional Component ,,73590,CPT,Professional,Both,,,26,45,38.25,4.8,45,Aetna,Commercial,38.25,85,,percent of total billed charges,,
Xr Tibia Fibula  (Pro Cah)Professional Component ,,73590,CPT,Professional,Both,,,26,45,38.25,4.8,45,Aetna,Medicare Advantage,7.83,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Tibia Fibula  (Pro Cah)Professional Component ,,73590,CPT,Professional,Both,,,26,45,38.25,4.8,45,Aetna,PPO,41.85,93,,percent of total billed charges,,
Xr Tibia Fibula  (Pro Cah)Professional Component ,,73590,CPT,Professional,Both,,,26,45,38.25,4.8,45,America's PPO,America's PPO,38.448,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Xr Tibia Fibula  (Pro Cah)Professional Component ,,73590,CPT,Professional,Both,,,26,45,38.25,4.8,45,BlueCross BlueShield Minnesota, Federal Employee Program,14.7,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Xr Tibia Fibula  (Pro Cah)Professional Component ,,73590,CPT,Professional,Both,,,26,45,38.25,4.8,45,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,14.9352,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Tibia Fibula  (Pro Cah)Professional Component ,,73590,CPT,Professional,Both,,,26,45,38.25,4.8,45,BlueCross BlueShield Minnesota,High Value Network Plan,14.9352,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Tibia Fibula  (Pro Cah)Professional Component ,,73590,CPT,Professional,Both,,,26,45,38.25,4.8,45,BlueCross BlueShield Minnesota,Medicare Advantage,8.74,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Tibia Fibula  (Pro Cah)Professional Component ,,73590,CPT,Professional,Both,,,26,45,38.25,4.8,45,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,14.9352,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Tibia Fibula  (Pro Cah)Professional Component ,,73590,CPT,Professional,Both,,,26,45,38.25,4.8,45,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,5.5372,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Tibia Fibula  (Pro Cah)Professional Component ,,73590,CPT,Professional,Both,,,26,45,38.25,4.8,45,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),8.74,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Tibia Fibula  (Pro Cah)Professional Component ,,73590,CPT,Professional,Both,,,26,45,38.25,4.8,45,CorVel,Worker's Compensation,15.0669027,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Xr Tibia Fibula  (Pro Cah)Professional Component ,,73590,CPT,Professional,Both,,,26,45,38.25,4.8,45,First Health Group Corporation,First Health Network,43.65,97,,percent of total billed charges,,
Xr Tibia Fibula  (Pro Cah)Professional Component ,,73590,CPT,Professional,Both,,,26,45,38.25,4.8,45,"Health Partners, Inc.",Commercial,11.35,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Xr Tibia Fibula  (Pro Cah)Professional Component ,,73590,CPT,Professional,Both,,,26,45,38.25,4.8,45,"Health Partners, Inc.",Medicare Advantage,8.74,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Tibia Fibula  (Pro Cah)Professional Component ,,73590,CPT,Professional,Both,,,26,45,38.25,4.8,45,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),4.8,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Xr Tibia Fibula  (Pro Cah)Professional Component ,,73590,CPT,Professional,Both,,,26,45,38.25,4.8,45,"Health Partners, Inc.",State of Minnesota Advantage Program,9.778025,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Xr Tibia Fibula  (Pro Cah)Professional Component ,,73590,CPT,Professional,Both,,,26,45,38.25,4.8,45,"Health Partners, Inc.",State Public Programs,4.8,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Xr Tibia Fibula  (Pro Cah)Professional Component ,,73590,CPT,Professional,Both,,,26,45,38.25,4.8,45,Humana Insurance Company,Commercial PPO,7.6,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Xr Tibia Fibula  (Pro Cah)Professional Component ,,73590,CPT,Professional,Both,,,26,45,38.25,4.8,45,Humana Insurance Company,Medicare PPO,45,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Xr Tibia Fibula  (Pro Cah)Professional Component ,,73590,CPT,Professional,Both,,,26,45,38.25,4.8,45,Medica,Individual & Family,38.16,84.8,,percent of total billed charges,,
Xr Tibia Fibula  (Pro Cah)Professional Component ,,73590,CPT,Professional,Both,,,26,45,38.25,4.8,45,Medica,Medica Advantage Solution,22.41,49.8,,percent of total billed charges,,
Xr Tibia Fibula  (Pro Cah)Professional Component ,,73590,CPT,Professional,Both,,,26,45,38.25,4.8,45,Medica,Medical Assistance,5.54,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Xr Tibia Fibula  (Pro Cah)Professional Component ,,73590,CPT,Professional,Both,,,26,45,38.25,4.8,45,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,7.6,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Xr Tibia Fibula  (Pro Cah)Professional Component ,,73590,CPT,Professional,Both,,,26,45,38.25,4.8,45,"Multiplan, Inc.","Multiplan, Inc.",42.3,94,,percent of total billed charges,,
Xr Tibia Fibula  (Pro Cah)Professional Component ,,73590,CPT,Professional,Both,,,26,45,38.25,4.8,45,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,40.545,90.1,,percent of total billed charges,,
Xr Tibia Fibula  (Pro Cah)Professional Component ,,73590,CPT,Professional,Both,,,26,45,38.25,4.8,45,"Preferred One Administrative Services, INC.",PPO,44.37,98.6,,percent of total billed charges,,
Xr Tibia Fibula  (Pro Cah)Professional Component ,,73590,CPT,Professional,Both,,,26,45,38.25,4.8,45,PrimeWest Health,Minnesota Senior Health Options (MSHO),8.74,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Tibia Fibula  (Pro Cah)Professional Component ,,73590,CPT,Professional,Both,,,26,45,38.25,4.8,45,PrimeWest Health,MinnesotaCare,5.924804,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Tibia Fibula  (Pro Cah)Professional Component ,,73590,CPT,Professional,Both,,,26,45,38.25,4.8,45,Sanford Health Plan,Sanford Health Plan,39.6,88,,percent of total billed charges,,
Xr Tibia Fibula  (Pro Cah)Professional Component ,,73590,CPT,Professional,Both,,,26,45,38.25,4.8,45,"UCare Health, Inc.",Individual & Family Plan,12.35456,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Xr Tibia Fibula  (Pro Cah)Professional Component ,,73590,CPT,Professional,Both,,,26,45,38.25,4.8,45,"UCare Health, Inc.",Medical Assistance,6.09092,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Xr Tibia Fibula  (Pro Cah)Professional Component ,,73590,CPT,Professional,Both,,,26,45,38.25,4.8,45,"UCare Health, Inc.",Medicare Advantage,8.74,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Xr Tibia Fibula  (Pro Cah)Professional Component ,,73590,CPT,Professional,Both,,,26,45,38.25,4.8,45,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),6.992,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Xr Tibia Fibula  (Pro Cah)Professional Component ,,73590,CPT,Professional,Both,,,26,45,38.25,4.8,45,UnitedHealthcare,Individual & Family,45,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Xr Tibia Fibula  (Pro Cah)Professional Component ,,73590,CPT,Professional,Both,,,26,45,38.25,4.8,45,UnitedHealthcare,Medicare Advantage,8.74,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Tibia Fibula  (Pro Cah)Professional Component ,,73590,CPT,Professional,Both,,,26,45,38.25,4.8,45,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,5.5372,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Lower Ext  Infant 2 Views (Pro Cah)Professional Component ,,73592,CPT,Professional,Both,,,26,40,34,4.8,40,Aetna,Commercial,34,85,,percent of total billed charges,,
Xr Lower Ext  Infant 2 Views (Pro Cah)Professional Component ,,73592,CPT,Professional,Both,,,26,40,34,4.8,40,Aetna,Medicare Advantage,7.83,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Lower Ext  Infant 2 Views (Pro Cah)Professional Component ,,73592,CPT,Professional,Both,,,26,40,34,4.8,40,Aetna,PPO,37.2,93,,percent of total billed charges,,
Xr Lower Ext  Infant 2 Views (Pro Cah)Professional Component ,,73592,CPT,Professional,Both,,,26,40,34,4.8,40,America's PPO,America's PPO,34.176,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Xr Lower Ext  Infant 2 Views (Pro Cah)Professional Component ,,73592,CPT,Professional,Both,,,26,40,34,4.8,40,BlueCross BlueShield Minnesota, Federal Employee Program,14.7,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Xr Lower Ext  Infant 2 Views (Pro Cah)Professional Component ,,73592,CPT,Professional,Both,,,26,40,34,4.8,40,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,14.9352,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Lower Ext  Infant 2 Views (Pro Cah)Professional Component ,,73592,CPT,Professional,Both,,,26,40,34,4.8,40,BlueCross BlueShield Minnesota,High Value Network Plan,14.9352,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Lower Ext  Infant 2 Views (Pro Cah)Professional Component ,,73592,CPT,Professional,Both,,,26,40,34,4.8,40,BlueCross BlueShield Minnesota,Medicare Advantage,8.74,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Lower Ext  Infant 2 Views (Pro Cah)Professional Component ,,73592,CPT,Professional,Both,,,26,40,34,4.8,40,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,14.9352,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Lower Ext  Infant 2 Views (Pro Cah)Professional Component ,,73592,CPT,Professional,Both,,,26,40,34,4.8,40,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,5.5372,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Lower Ext  Infant 2 Views (Pro Cah)Professional Component ,,73592,CPT,Professional,Both,,,26,40,34,4.8,40,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),8.74,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Lower Ext  Infant 2 Views (Pro Cah)Professional Component ,,73592,CPT,Professional,Both,,,26,40,34,4.8,40,CorVel,Worker's Compensation,15.0669027,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Xr Lower Ext  Infant 2 Views (Pro Cah)Professional Component ,,73592,CPT,Professional,Both,,,26,40,34,4.8,40,First Health Group Corporation,First Health Network,38.8,97,,percent of total billed charges,,
Xr Lower Ext  Infant 2 Views (Pro Cah)Professional Component ,,73592,CPT,Professional,Both,,,26,40,34,4.8,40,"Health Partners, Inc.",Commercial,11.35,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Xr Lower Ext  Infant 2 Views (Pro Cah)Professional Component ,,73592,CPT,Professional,Both,,,26,40,34,4.8,40,"Health Partners, Inc.",Medicare Advantage,8.74,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Lower Ext  Infant 2 Views (Pro Cah)Professional Component ,,73592,CPT,Professional,Both,,,26,40,34,4.8,40,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),4.8,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Xr Lower Ext  Infant 2 Views (Pro Cah)Professional Component ,,73592,CPT,Professional,Both,,,26,40,34,4.8,40,"Health Partners, Inc.",State of Minnesota Advantage Program,9.778025,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Xr Lower Ext  Infant 2 Views (Pro Cah)Professional Component ,,73592,CPT,Professional,Both,,,26,40,34,4.8,40,"Health Partners, Inc.",State Public Programs,4.8,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Xr Lower Ext  Infant 2 Views (Pro Cah)Professional Component ,,73592,CPT,Professional,Both,,,26,40,34,4.8,40,Humana Insurance Company,Commercial PPO,7.6,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Xr Lower Ext  Infant 2 Views (Pro Cah)Professional Component ,,73592,CPT,Professional,Both,,,26,40,34,4.8,40,Humana Insurance Company,Medicare PPO,40,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Xr Lower Ext  Infant 2 Views (Pro Cah)Professional Component ,,73592,CPT,Professional,Both,,,26,40,34,4.8,40,Medica,Individual & Family,33.92,84.8,,percent of total billed charges,,
Xr Lower Ext  Infant 2 Views (Pro Cah)Professional Component ,,73592,CPT,Professional,Both,,,26,40,34,4.8,40,Medica,Medica Advantage Solution,19.92,49.8,,percent of total billed charges,,
Xr Lower Ext  Infant 2 Views (Pro Cah)Professional Component ,,73592,CPT,Professional,Both,,,26,40,34,4.8,40,Medica,Medical Assistance,5.54,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Xr Lower Ext  Infant 2 Views (Pro Cah)Professional Component ,,73592,CPT,Professional,Both,,,26,40,34,4.8,40,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,7.6,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Xr Lower Ext  Infant 2 Views (Pro Cah)Professional Component ,,73592,CPT,Professional,Both,,,26,40,34,4.8,40,"Multiplan, Inc.","Multiplan, Inc.",37.6,94,,percent of total billed charges,,
Xr Lower Ext  Infant 2 Views (Pro Cah)Professional Component ,,73592,CPT,Professional,Both,,,26,40,34,4.8,40,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,36.04,90.1,,percent of total billed charges,,
Xr Lower Ext  Infant 2 Views (Pro Cah)Professional Component ,,73592,CPT,Professional,Both,,,26,40,34,4.8,40,"Preferred One Administrative Services, INC.",PPO,39.44,98.6,,percent of total billed charges,,
Xr Lower Ext  Infant 2 Views (Pro Cah)Professional Component ,,73592,CPT,Professional,Both,,,26,40,34,4.8,40,PrimeWest Health,Minnesota Senior Health Options (MSHO),8.74,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Lower Ext  Infant 2 Views (Pro Cah)Professional Component ,,73592,CPT,Professional,Both,,,26,40,34,4.8,40,PrimeWest Health,MinnesotaCare,5.924804,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Lower Ext  Infant 2 Views (Pro Cah)Professional Component ,,73592,CPT,Professional,Both,,,26,40,34,4.8,40,Sanford Health Plan,Sanford Health Plan,35.2,88,,percent of total billed charges,,
Xr Lower Ext  Infant 2 Views (Pro Cah)Professional Component ,,73592,CPT,Professional,Both,,,26,40,34,4.8,40,"UCare Health, Inc.",Individual & Family Plan,12.35456,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Xr Lower Ext  Infant 2 Views (Pro Cah)Professional Component ,,73592,CPT,Professional,Both,,,26,40,34,4.8,40,"UCare Health, Inc.",Medical Assistance,6.09092,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Xr Lower Ext  Infant 2 Views (Pro Cah)Professional Component ,,73592,CPT,Professional,Both,,,26,40,34,4.8,40,"UCare Health, Inc.",Medicare Advantage,8.74,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Xr Lower Ext  Infant 2 Views (Pro Cah)Professional Component ,,73592,CPT,Professional,Both,,,26,40,34,4.8,40,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),6.992,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Xr Lower Ext  Infant 2 Views (Pro Cah)Professional Component ,,73592,CPT,Professional,Both,,,26,40,34,4.8,40,UnitedHealthcare,Individual & Family,40,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Xr Lower Ext  Infant 2 Views (Pro Cah)Professional Component ,,73592,CPT,Professional,Both,,,26,40,34,4.8,40,UnitedHealthcare,Medicare Advantage,8.74,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Lower Ext  Infant 2 Views (Pro Cah)Professional Component ,,73592,CPT,Professional,Both,,,26,40,34,4.8,40,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,5.5372,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Ankle 2 Views (Pro Cah)Professional Component ,,73600,CPT,Professional,Both,,,26,38,32.3,5.02,38,Aetna,Commercial,32.3,85,,percent of total billed charges,,
Xr Ankle 2 Views (Pro Cah)Professional Component ,,73600,CPT,Professional,Both,,,26,38,32.3,5.02,38,Aetna,Medicare Advantage,8.18,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Ankle 2 Views (Pro Cah)Professional Component ,,73600,CPT,Professional,Both,,,26,38,32.3,5.02,38,Aetna,PPO,35.34,93,,percent of total billed charges,,
Xr Ankle 2 Views (Pro Cah)Professional Component ,,73600,CPT,Professional,Both,,,26,38,32.3,5.02,38,America's PPO,America's PPO,32.4672,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Xr Ankle 2 Views (Pro Cah)Professional Component ,,73600,CPT,Professional,Both,,,26,38,32.3,5.02,38,BlueCross BlueShield Minnesota, Federal Employee Program,15.34,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Xr Ankle 2 Views (Pro Cah)Professional Component ,,73600,CPT,Professional,Both,,,26,38,32.3,5.02,38,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,15.58544,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Ankle 2 Views (Pro Cah)Professional Component ,,73600,CPT,Professional,Both,,,26,38,32.3,5.02,38,BlueCross BlueShield Minnesota,High Value Network Plan,15.58544,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Ankle 2 Views (Pro Cah)Professional Component ,,73600,CPT,Professional,Both,,,26,38,32.3,5.02,38,BlueCross BlueShield Minnesota,Medicare Advantage,9.1425,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Ankle 2 Views (Pro Cah)Professional Component ,,73600,CPT,Professional,Both,,,26,38,32.3,5.02,38,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,15.58544,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Ankle 2 Views (Pro Cah)Professional Component ,,73600,CPT,Professional,Both,,,26,38,32.3,5.02,38,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,5.7912,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Ankle 2 Views (Pro Cah)Professional Component ,,73600,CPT,Professional,Both,,,26,38,32.3,5.02,38,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),9.1425,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Ankle 2 Views (Pro Cah)Professional Component ,,73600,CPT,Professional,Both,,,26,38,32.3,5.02,38,CorVel,Worker's Compensation,15.0669027,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Xr Ankle 2 Views (Pro Cah)Professional Component ,,73600,CPT,Professional,Both,,,26,38,32.3,5.02,38,First Health Group Corporation,First Health Network,36.86,97,,percent of total billed charges,,
Xr Ankle 2 Views (Pro Cah)Professional Component ,,73600,CPT,Professional,Both,,,26,38,32.3,5.02,38,"Health Partners, Inc.",Commercial,11.35,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Xr Ankle 2 Views (Pro Cah)Professional Component ,,73600,CPT,Professional,Both,,,26,38,32.3,5.02,38,"Health Partners, Inc.",Medicare Advantage,9.1425,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Ankle 2 Views (Pro Cah)Professional Component ,,73600,CPT,Professional,Both,,,26,38,32.3,5.02,38,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),5.02,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Xr Ankle 2 Views (Pro Cah)Professional Component ,,73600,CPT,Professional,Both,,,26,38,32.3,5.02,38,"Health Partners, Inc.",State of Minnesota Advantage Program,9.778025,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Xr Ankle 2 Views (Pro Cah)Professional Component ,,73600,CPT,Professional,Both,,,26,38,32.3,5.02,38,"Health Partners, Inc.",State Public Programs,5.02,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Xr Ankle 2 Views (Pro Cah)Professional Component ,,73600,CPT,Professional,Both,,,26,38,32.3,5.02,38,Humana Insurance Company,Commercial PPO,7.95,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Xr Ankle 2 Views (Pro Cah)Professional Component ,,73600,CPT,Professional,Both,,,26,38,32.3,5.02,38,Humana Insurance Company,Medicare PPO,38,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Xr Ankle 2 Views (Pro Cah)Professional Component ,,73600,CPT,Professional,Both,,,26,38,32.3,5.02,38,Medica,Individual & Family,32.224,84.8,,percent of total billed charges,,
Xr Ankle 2 Views (Pro Cah)Professional Component ,,73600,CPT,Professional,Both,,,26,38,32.3,5.02,38,Medica,Medica Advantage Solution,18.924,49.8,,percent of total billed charges,,
Xr Ankle 2 Views (Pro Cah)Professional Component ,,73600,CPT,Professional,Both,,,26,38,32.3,5.02,38,Medica,Medical Assistance,5.79,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Xr Ankle 2 Views (Pro Cah)Professional Component ,,73600,CPT,Professional,Both,,,26,38,32.3,5.02,38,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,7.95,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Xr Ankle 2 Views (Pro Cah)Professional Component ,,73600,CPT,Professional,Both,,,26,38,32.3,5.02,38,"Multiplan, Inc.","Multiplan, Inc.",35.72,94,,percent of total billed charges,,
Xr Ankle 2 Views (Pro Cah)Professional Component ,,73600,CPT,Professional,Both,,,26,38,32.3,5.02,38,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,34.238,90.1,,percent of total billed charges,,
Xr Ankle 2 Views (Pro Cah)Professional Component ,,73600,CPT,Professional,Both,,,26,38,32.3,5.02,38,"Preferred One Administrative Services, INC.",PPO,37.468,98.6,,percent of total billed charges,,
Xr Ankle 2 Views (Pro Cah)Professional Component ,,73600,CPT,Professional,Both,,,26,38,32.3,5.02,38,PrimeWest Health,Minnesota Senior Health Options (MSHO),9.1425,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Ankle 2 Views (Pro Cah)Professional Component ,,73600,CPT,Professional,Both,,,26,38,32.3,5.02,38,PrimeWest Health,MinnesotaCare,6.196584,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Ankle 2 Views (Pro Cah)Professional Component ,,73600,CPT,Professional,Both,,,26,38,32.3,5.02,38,Sanford Health Plan,Sanford Health Plan,33.44,88,,percent of total billed charges,,
Xr Ankle 2 Views (Pro Cah)Professional Component ,,73600,CPT,Professional,Both,,,26,38,32.3,5.02,38,"UCare Health, Inc.",Individual & Family Plan,12.92352,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Xr Ankle 2 Views (Pro Cah)Professional Component ,,73600,CPT,Professional,Both,,,26,38,32.3,5.02,38,"UCare Health, Inc.",Medical Assistance,6.37032,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Xr Ankle 2 Views (Pro Cah)Professional Component ,,73600,CPT,Professional,Both,,,26,38,32.3,5.02,38,"UCare Health, Inc.",Medicare Advantage,9.1425,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Xr Ankle 2 Views (Pro Cah)Professional Component ,,73600,CPT,Professional,Both,,,26,38,32.3,5.02,38,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),7.314,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Xr Ankle 2 Views (Pro Cah)Professional Component ,,73600,CPT,Professional,Both,,,26,38,32.3,5.02,38,UnitedHealthcare,Individual & Family,38,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Xr Ankle 2 Views (Pro Cah)Professional Component ,,73600,CPT,Professional,Both,,,26,38,32.3,5.02,38,UnitedHealthcare,Medicare Advantage,9.1425,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Ankle 2 Views (Pro Cah)Professional Component ,,73600,CPT,Professional,Both,,,26,38,32.3,5.02,38,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,5.7912,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Ankle Routine 3 Views (Pro Cah)Professional Component ,,73610,CPT,Professional,Both,,,26,50,42.5,5.23,50,Aetna,Commercial,42.5,85,,percent of total billed charges,,
Xr Ankle Routine 3 Views (Pro Cah)Professional Component ,,73610,CPT,Professional,Both,,,26,50,42.5,5.23,50,Aetna,Medicare Advantage,8.53,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Ankle Routine 3 Views (Pro Cah)Professional Component ,,73610,CPT,Professional,Both,,,26,50,42.5,5.23,50,Aetna,PPO,46.5,93,,percent of total billed charges,,
Xr Ankle Routine 3 Views (Pro Cah)Professional Component ,,73610,CPT,Professional,Both,,,26,50,42.5,5.23,50,America's PPO,America's PPO,42.72,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Xr Ankle Routine 3 Views (Pro Cah)Professional Component ,,73610,CPT,Professional,Both,,,26,50,42.5,5.23,50,BlueCross BlueShield Minnesota, Federal Employee Program,15.98,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Xr Ankle Routine 3 Views (Pro Cah)Professional Component ,,73610,CPT,Professional,Both,,,26,50,42.5,5.23,50,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,16.23568,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Ankle Routine 3 Views (Pro Cah)Professional Component ,,73610,CPT,Professional,Both,,,26,50,42.5,5.23,50,BlueCross BlueShield Minnesota,High Value Network Plan,16.23568,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Ankle Routine 3 Views (Pro Cah)Professional Component ,,73610,CPT,Professional,Both,,,26,50,42.5,5.23,50,BlueCross BlueShield Minnesota,Medicare Advantage,9.5335,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Ankle Routine 3 Views (Pro Cah)Professional Component ,,73610,CPT,Professional,Both,,,26,50,42.5,5.23,50,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,16.23568,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Ankle Routine 3 Views (Pro Cah)Professional Component ,,73610,CPT,Professional,Both,,,26,50,42.5,5.23,50,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,6.03504,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Ankle Routine 3 Views (Pro Cah)Professional Component ,,73610,CPT,Professional,Both,,,26,50,42.5,5.23,50,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),9.5335,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Ankle Routine 3 Views (Pro Cah)Professional Component ,,73610,CPT,Professional,Both,,,26,50,42.5,5.23,50,CorVel,Worker's Compensation,16.4190348,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Xr Ankle Routine 3 Views (Pro Cah)Professional Component ,,73610,CPT,Professional,Both,,,26,50,42.5,5.23,50,First Health Group Corporation,First Health Network,48.5,97,,percent of total billed charges,,
Xr Ankle Routine 3 Views (Pro Cah)Professional Component ,,73610,CPT,Professional,Both,,,26,50,42.5,5.23,50,"Health Partners, Inc.",Commercial,12.37,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Xr Ankle Routine 3 Views (Pro Cah)Professional Component ,,73610,CPT,Professional,Both,,,26,50,42.5,5.23,50,"Health Partners, Inc.",Medicare Advantage,9.5335,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Ankle Routine 3 Views (Pro Cah)Professional Component ,,73610,CPT,Professional,Both,,,26,50,42.5,5.23,50,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),5.23,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Xr Ankle Routine 3 Views (Pro Cah)Professional Component ,,73610,CPT,Professional,Both,,,26,50,42.5,5.23,50,"Health Partners, Inc.",State of Minnesota Advantage Program,10.656755,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Xr Ankle Routine 3 Views (Pro Cah)Professional Component ,,73610,CPT,Professional,Both,,,26,50,42.5,5.23,50,"Health Partners, Inc.",State Public Programs,5.23,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Xr Ankle Routine 3 Views (Pro Cah)Professional Component ,,73610,CPT,Professional,Both,,,26,50,42.5,5.23,50,Humana Insurance Company,Commercial PPO,8.29,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Xr Ankle Routine 3 Views (Pro Cah)Professional Component ,,73610,CPT,Professional,Both,,,26,50,42.5,5.23,50,Humana Insurance Company,Medicare PPO,50,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Xr Ankle Routine 3 Views (Pro Cah)Professional Component ,,73610,CPT,Professional,Both,,,26,50,42.5,5.23,50,Medica,Individual & Family,42.4,84.8,,percent of total billed charges,,
Xr Ankle Routine 3 Views (Pro Cah)Professional Component ,,73610,CPT,Professional,Both,,,26,50,42.5,5.23,50,Medica,Medica Advantage Solution,24.9,49.8,,percent of total billed charges,,
Xr Ankle Routine 3 Views (Pro Cah)Professional Component ,,73610,CPT,Professional,Both,,,26,50,42.5,5.23,50,Medica,Medical Assistance,6.04,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Xr Ankle Routine 3 Views (Pro Cah)Professional Component ,,73610,CPT,Professional,Both,,,26,50,42.5,5.23,50,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,8.29,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Xr Ankle Routine 3 Views (Pro Cah)Professional Component ,,73610,CPT,Professional,Both,,,26,50,42.5,5.23,50,"Multiplan, Inc.","Multiplan, Inc.",47,94,,percent of total billed charges,,
Xr Ankle Routine 3 Views (Pro Cah)Professional Component ,,73610,CPT,Professional,Both,,,26,50,42.5,5.23,50,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,45.05,90.1,,percent of total billed charges,,
Xr Ankle Routine 3 Views (Pro Cah)Professional Component ,,73610,CPT,Professional,Both,,,26,50,42.5,5.23,50,"Preferred One Administrative Services, INC.",PPO,49.3,98.6,,percent of total billed charges,,
Xr Ankle Routine 3 Views (Pro Cah)Professional Component ,,73610,CPT,Professional,Both,,,26,50,42.5,5.23,50,PrimeWest Health,Minnesota Senior Health Options (MSHO),9.5335,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Ankle Routine 3 Views (Pro Cah)Professional Component ,,73610,CPT,Professional,Both,,,26,50,42.5,5.23,50,PrimeWest Health,MinnesotaCare,6.4574928,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Ankle Routine 3 Views (Pro Cah)Professional Component ,,73610,CPT,Professional,Both,,,26,50,42.5,5.23,50,Sanford Health Plan,Sanford Health Plan,44,88,,percent of total billed charges,,
Xr Ankle Routine 3 Views (Pro Cah)Professional Component ,,73610,CPT,Professional,Both,,,26,50,42.5,5.23,50,"UCare Health, Inc.",Individual & Family Plan,13.476224,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Xr Ankle Routine 3 Views (Pro Cah)Professional Component ,,73610,CPT,Professional,Both,,,26,50,42.5,5.23,50,"UCare Health, Inc.",Medical Assistance,6.638544,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Xr Ankle Routine 3 Views (Pro Cah)Professional Component ,,73610,CPT,Professional,Both,,,26,50,42.5,5.23,50,"UCare Health, Inc.",Medicare Advantage,9.5335,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Xr Ankle Routine 3 Views (Pro Cah)Professional Component ,,73610,CPT,Professional,Both,,,26,50,42.5,5.23,50,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),7.6268,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Xr Ankle Routine 3 Views (Pro Cah)Professional Component ,,73610,CPT,Professional,Both,,,26,50,42.5,5.23,50,UnitedHealthcare,Individual & Family,50,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Xr Ankle Routine 3 Views (Pro Cah)Professional Component ,,73610,CPT,Professional,Both,,,26,50,42.5,5.23,50,UnitedHealthcare,Medicare Advantage,9.5335,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Ankle Routine 3 Views (Pro Cah)Professional Component ,,73610,CPT,Professional,Both,,,26,50,42.5,5.23,50,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,6.03504,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Foot 2 Views (Pro Cah)Professional Component ,,73620,CPT,Professional,Both,,,26,33,28.05,4.58,33,Aetna,Commercial,28.05,85,,percent of total billed charges,,
Xr Foot 2 Views (Pro Cah)Professional Component ,,73620,CPT,Professional,Both,,,26,33,28.05,4.58,33,Aetna,Medicare Advantage,7.47,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Foot 2 Views (Pro Cah)Professional Component ,,73620,CPT,Professional,Both,,,26,33,28.05,4.58,33,Aetna,PPO,30.69,93,,percent of total billed charges,,
Xr Foot 2 Views (Pro Cah)Professional Component ,,73620,CPT,Professional,Both,,,26,33,28.05,4.58,33,America's PPO,America's PPO,28.1952,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Xr Foot 2 Views (Pro Cah)Professional Component ,,73620,CPT,Professional,Both,,,26,33,28.05,4.58,33,BlueCross BlueShield Minnesota, Federal Employee Program,14.06,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Xr Foot 2 Views (Pro Cah)Professional Component ,,73620,CPT,Professional,Both,,,26,33,28.05,4.58,33,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,14.28496,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Foot 2 Views (Pro Cah)Professional Component ,,73620,CPT,Professional,Both,,,26,33,28.05,4.58,33,BlueCross BlueShield Minnesota,High Value Network Plan,14.28496,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Foot 2 Views (Pro Cah)Professional Component ,,73620,CPT,Professional,Both,,,26,33,28.05,4.58,33,BlueCross BlueShield Minnesota,Medicare Advantage,8.349,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Foot 2 Views (Pro Cah)Professional Component ,,73620,CPT,Professional,Both,,,26,33,28.05,4.58,33,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,14.28496,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Foot 2 Views (Pro Cah)Professional Component ,,73620,CPT,Professional,Both,,,26,33,28.05,4.58,33,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,5.2832,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Foot 2 Views (Pro Cah)Professional Component ,,73620,CPT,Professional,Both,,,26,33,28.05,4.58,33,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),8.349,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Foot 2 Views (Pro Cah)Professional Component ,,73620,CPT,Professional,Both,,,26,33,28.05,4.58,33,CorVel,Worker's Compensation,14.3864706,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Xr Foot 2 Views (Pro Cah)Professional Component ,,73620,CPT,Professional,Both,,,26,33,28.05,4.58,33,First Health Group Corporation,First Health Network,32.01,97,,percent of total billed charges,,
Xr Foot 2 Views (Pro Cah)Professional Component ,,73620,CPT,Professional,Both,,,26,33,28.05,4.58,33,"Health Partners, Inc.",Commercial,10.83,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Xr Foot 2 Views (Pro Cah)Professional Component ,,73620,CPT,Professional,Both,,,26,33,28.05,4.58,33,"Health Partners, Inc.",Medicare Advantage,8.349,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Foot 2 Views (Pro Cah)Professional Component ,,73620,CPT,Professional,Both,,,26,33,28.05,4.58,33,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),4.58,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Xr Foot 2 Views (Pro Cah)Professional Component ,,73620,CPT,Professional,Both,,,26,33,28.05,4.58,33,"Health Partners, Inc.",State of Minnesota Advantage Program,9.330045,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Xr Foot 2 Views (Pro Cah)Professional Component ,,73620,CPT,Professional,Both,,,26,33,28.05,4.58,33,"Health Partners, Inc.",State Public Programs,4.58,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Xr Foot 2 Views (Pro Cah)Professional Component ,,73620,CPT,Professional,Both,,,26,33,28.05,4.58,33,Humana Insurance Company,Commercial PPO,7.26,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Xr Foot 2 Views (Pro Cah)Professional Component ,,73620,CPT,Professional,Both,,,26,33,28.05,4.58,33,Humana Insurance Company,Medicare PPO,33,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Xr Foot 2 Views (Pro Cah)Professional Component ,,73620,CPT,Professional,Both,,,26,33,28.05,4.58,33,Medica,Individual & Family,27.984,84.8,,percent of total billed charges,,
Xr Foot 2 Views (Pro Cah)Professional Component ,,73620,CPT,Professional,Both,,,26,33,28.05,4.58,33,Medica,Medica Advantage Solution,16.434,49.8,,percent of total billed charges,,
Xr Foot 2 Views (Pro Cah)Professional Component ,,73620,CPT,Professional,Both,,,26,33,28.05,4.58,33,Medica,Medical Assistance,5.28,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Xr Foot 2 Views (Pro Cah)Professional Component ,,73620,CPT,Professional,Both,,,26,33,28.05,4.58,33,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,7.26,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Xr Foot 2 Views (Pro Cah)Professional Component ,,73620,CPT,Professional,Both,,,26,33,28.05,4.58,33,"Multiplan, Inc.","Multiplan, Inc.",31.02,94,,percent of total billed charges,,
Xr Foot 2 Views (Pro Cah)Professional Component ,,73620,CPT,Professional,Both,,,26,33,28.05,4.58,33,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,29.733,90.1,,percent of total billed charges,,
Xr Foot 2 Views (Pro Cah)Professional Component ,,73620,CPT,Professional,Both,,,26,33,28.05,4.58,33,"Preferred One Administrative Services, INC.",PPO,32.538,98.6,,percent of total billed charges,,
Xr Foot 2 Views (Pro Cah)Professional Component ,,73620,CPT,Professional,Both,,,26,33,28.05,4.58,33,PrimeWest Health,Minnesota Senior Health Options (MSHO),8.349,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Foot 2 Views (Pro Cah)Professional Component ,,73620,CPT,Professional,Both,,,26,33,28.05,4.58,33,PrimeWest Health,MinnesotaCare,5.653024,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Foot 2 Views (Pro Cah)Professional Component ,,73620,CPT,Professional,Both,,,26,33,28.05,4.58,33,Sanford Health Plan,Sanford Health Plan,29.04,88,,percent of total billed charges,,
Xr Foot 2 Views (Pro Cah)Professional Component ,,73620,CPT,Professional,Both,,,26,33,28.05,4.58,33,"UCare Health, Inc.",Individual & Family Plan,11.801856,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Xr Foot 2 Views (Pro Cah)Professional Component ,,73620,CPT,Professional,Both,,,26,33,28.05,4.58,33,"UCare Health, Inc.",Medical Assistance,5.81152,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Xr Foot 2 Views (Pro Cah)Professional Component ,,73620,CPT,Professional,Both,,,26,33,28.05,4.58,33,"UCare Health, Inc.",Medicare Advantage,8.349,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Xr Foot 2 Views (Pro Cah)Professional Component ,,73620,CPT,Professional,Both,,,26,33,28.05,4.58,33,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),6.6792,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Xr Foot 2 Views (Pro Cah)Professional Component ,,73620,CPT,Professional,Both,,,26,33,28.05,4.58,33,UnitedHealthcare,Individual & Family,33,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Xr Foot 2 Views (Pro Cah)Professional Component ,,73620,CPT,Professional,Both,,,26,33,28.05,4.58,33,UnitedHealthcare,Medicare Advantage,8.349,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Foot 2 Views (Pro Cah)Professional Component ,,73620,CPT,Professional,Both,,,26,33,28.05,4.58,33,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,5.2832,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Foot Routine 3 Views (Pro Cah)Professional Component ,,73630,CPT,Professional,Both,,,26,46,39.1,5.02,46,Aetna,Commercial,39.1,85,,percent of total billed charges,,
Xr Foot Routine 3 Views (Pro Cah)Professional Component ,,73630,CPT,Professional,Both,,,26,46,39.1,5.02,46,Aetna,Medicare Advantage,8.18,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Foot Routine 3 Views (Pro Cah)Professional Component ,,73630,CPT,Professional,Both,,,26,46,39.1,5.02,46,Aetna,PPO,42.78,93,,percent of total billed charges,,
Xr Foot Routine 3 Views (Pro Cah)Professional Component ,,73630,CPT,Professional,Both,,,26,46,39.1,5.02,46,America's PPO,America's PPO,39.3024,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Xr Foot Routine 3 Views (Pro Cah)Professional Component ,,73630,CPT,Professional,Both,,,26,46,39.1,5.02,46,BlueCross BlueShield Minnesota, Federal Employee Program,15.34,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Xr Foot Routine 3 Views (Pro Cah)Professional Component ,,73630,CPT,Professional,Both,,,26,46,39.1,5.02,46,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,15.58544,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Foot Routine 3 Views (Pro Cah)Professional Component ,,73630,CPT,Professional,Both,,,26,46,39.1,5.02,46,BlueCross BlueShield Minnesota,High Value Network Plan,15.58544,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Foot Routine 3 Views (Pro Cah)Professional Component ,,73630,CPT,Professional,Both,,,26,46,39.1,5.02,46,BlueCross BlueShield Minnesota,Medicare Advantage,9.131,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Foot Routine 3 Views (Pro Cah)Professional Component ,,73630,CPT,Professional,Both,,,26,46,39.1,5.02,46,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,15.58544,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Foot Routine 3 Views (Pro Cah)Professional Component ,,73630,CPT,Professional,Both,,,26,46,39.1,5.02,46,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,5.7912,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Foot Routine 3 Views (Pro Cah)Professional Component ,,73630,CPT,Professional,Both,,,26,46,39.1,5.02,46,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),9.131,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Foot Routine 3 Views (Pro Cah)Professional Component ,,73630,CPT,Professional,Both,,,26,46,39.1,5.02,46,CorVel,Worker's Compensation,15.7386027,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Xr Foot Routine 3 Views (Pro Cah)Professional Component ,,73630,CPT,Professional,Both,,,26,46,39.1,5.02,46,First Health Group Corporation,First Health Network,44.62,97,,percent of total billed charges,,
Xr Foot Routine 3 Views (Pro Cah)Professional Component ,,73630,CPT,Professional,Both,,,26,46,39.1,5.02,46,"Health Partners, Inc.",Commercial,11.86,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Xr Foot Routine 3 Views (Pro Cah)Professional Component ,,73630,CPT,Professional,Both,,,26,46,39.1,5.02,46,"Health Partners, Inc.",Medicare Advantage,9.131,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Foot Routine 3 Views (Pro Cah)Professional Component ,,73630,CPT,Professional,Both,,,26,46,39.1,5.02,46,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),5.02,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Xr Foot Routine 3 Views (Pro Cah)Professional Component ,,73630,CPT,Professional,Both,,,26,46,39.1,5.02,46,"Health Partners, Inc.",State of Minnesota Advantage Program,10.21739,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Xr Foot Routine 3 Views (Pro Cah)Professional Component ,,73630,CPT,Professional,Both,,,26,46,39.1,5.02,46,"Health Partners, Inc.",State Public Programs,5.02,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Xr Foot Routine 3 Views (Pro Cah)Professional Component ,,73630,CPT,Professional,Both,,,26,46,39.1,5.02,46,Humana Insurance Company,Commercial PPO,7.94,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Xr Foot Routine 3 Views (Pro Cah)Professional Component ,,73630,CPT,Professional,Both,,,26,46,39.1,5.02,46,Humana Insurance Company,Medicare PPO,46,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Xr Foot Routine 3 Views (Pro Cah)Professional Component ,,73630,CPT,Professional,Both,,,26,46,39.1,5.02,46,Medica,Individual & Family,39.008,84.8,,percent of total billed charges,,
Xr Foot Routine 3 Views (Pro Cah)Professional Component ,,73630,CPT,Professional,Both,,,26,46,39.1,5.02,46,Medica,Medica Advantage Solution,22.908,49.8,,percent of total billed charges,,
Xr Foot Routine 3 Views (Pro Cah)Professional Component ,,73630,CPT,Professional,Both,,,26,46,39.1,5.02,46,Medica,Medical Assistance,5.79,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Xr Foot Routine 3 Views (Pro Cah)Professional Component ,,73630,CPT,Professional,Both,,,26,46,39.1,5.02,46,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,7.94,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Xr Foot Routine 3 Views (Pro Cah)Professional Component ,,73630,CPT,Professional,Both,,,26,46,39.1,5.02,46,"Multiplan, Inc.","Multiplan, Inc.",43.24,94,,percent of total billed charges,,
Xr Foot Routine 3 Views (Pro Cah)Professional Component ,,73630,CPT,Professional,Both,,,26,46,39.1,5.02,46,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,41.446,90.1,,percent of total billed charges,,
Xr Foot Routine 3 Views (Pro Cah)Professional Component ,,73630,CPT,Professional,Both,,,26,46,39.1,5.02,46,"Preferred One Administrative Services, INC.",PPO,45.356,98.6,,percent of total billed charges,,
Xr Foot Routine 3 Views (Pro Cah)Professional Component ,,73630,CPT,Professional,Both,,,26,46,39.1,5.02,46,PrimeWest Health,Minnesota Senior Health Options (MSHO),9.131,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Foot Routine 3 Views (Pro Cah)Professional Component ,,73630,CPT,Professional,Both,,,26,46,39.1,5.02,46,PrimeWest Health,MinnesotaCare,6.196584,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Foot Routine 3 Views (Pro Cah)Professional Component ,,73630,CPT,Professional,Both,,,26,46,39.1,5.02,46,Sanford Health Plan,Sanford Health Plan,40.48,88,,percent of total billed charges,,
Xr Foot Routine 3 Views (Pro Cah)Professional Component ,,73630,CPT,Professional,Both,,,26,46,39.1,5.02,46,"UCare Health, Inc.",Individual & Family Plan,12.907264,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Xr Foot Routine 3 Views (Pro Cah)Professional Component ,,73630,CPT,Professional,Both,,,26,46,39.1,5.02,46,"UCare Health, Inc.",Medical Assistance,6.37032,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Xr Foot Routine 3 Views (Pro Cah)Professional Component ,,73630,CPT,Professional,Both,,,26,46,39.1,5.02,46,"UCare Health, Inc.",Medicare Advantage,9.131,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Xr Foot Routine 3 Views (Pro Cah)Professional Component ,,73630,CPT,Professional,Both,,,26,46,39.1,5.02,46,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),7.3048,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Xr Foot Routine 3 Views (Pro Cah)Professional Component ,,73630,CPT,Professional,Both,,,26,46,39.1,5.02,46,UnitedHealthcare,Individual & Family,46,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Xr Foot Routine 3 Views (Pro Cah)Professional Component ,,73630,CPT,Professional,Both,,,26,46,39.1,5.02,46,UnitedHealthcare,Medicare Advantage,9.131,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Foot Routine 3 Views (Pro Cah)Professional Component ,,73630,CPT,Professional,Both,,,26,46,39.1,5.02,46,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,5.7912,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Os Calcis Heel (Pro Cah)Professional Component ,,73650,CPT,Professional,Both,,,26,40,34,4.8,40,Aetna,Commercial,34,85,,percent of total billed charges,,
Xr Os Calcis Heel (Pro Cah)Professional Component ,,73650,CPT,Professional,Both,,,26,40,34,4.8,40,Aetna,Medicare Advantage,7.83,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Os Calcis Heel (Pro Cah)Professional Component ,,73650,CPT,Professional,Both,,,26,40,34,4.8,40,Aetna,PPO,37.2,93,,percent of total billed charges,,
Xr Os Calcis Heel (Pro Cah)Professional Component ,,73650,CPT,Professional,Both,,,26,40,34,4.8,40,America's PPO,America's PPO,34.176,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Xr Os Calcis Heel (Pro Cah)Professional Component ,,73650,CPT,Professional,Both,,,26,40,34,4.8,40,BlueCross BlueShield Minnesota, Federal Employee Program,14.7,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Xr Os Calcis Heel (Pro Cah)Professional Component ,,73650,CPT,Professional,Both,,,26,40,34,4.8,40,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,14.9352,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Os Calcis Heel (Pro Cah)Professional Component ,,73650,CPT,Professional,Both,,,26,40,34,4.8,40,BlueCross BlueShield Minnesota,High Value Network Plan,14.9352,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Os Calcis Heel (Pro Cah)Professional Component ,,73650,CPT,Professional,Both,,,26,40,34,4.8,40,BlueCross BlueShield Minnesota,Medicare Advantage,8.74,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Os Calcis Heel (Pro Cah)Professional Component ,,73650,CPT,Professional,Both,,,26,40,34,4.8,40,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,14.9352,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Os Calcis Heel (Pro Cah)Professional Component ,,73650,CPT,Professional,Both,,,26,40,34,4.8,40,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,5.5372,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Os Calcis Heel (Pro Cah)Professional Component ,,73650,CPT,Professional,Both,,,26,40,34,4.8,40,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),8.74,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Os Calcis Heel (Pro Cah)Professional Component ,,73650,CPT,Professional,Both,,,26,40,34,4.8,40,CorVel,Worker's Compensation,15.0669027,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Xr Os Calcis Heel (Pro Cah)Professional Component ,,73650,CPT,Professional,Both,,,26,40,34,4.8,40,First Health Group Corporation,First Health Network,38.8,97,,percent of total billed charges,,
Xr Os Calcis Heel (Pro Cah)Professional Component ,,73650,CPT,Professional,Both,,,26,40,34,4.8,40,"Health Partners, Inc.",Commercial,11.35,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Xr Os Calcis Heel (Pro Cah)Professional Component ,,73650,CPT,Professional,Both,,,26,40,34,4.8,40,"Health Partners, Inc.",Medicare Advantage,8.74,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Os Calcis Heel (Pro Cah)Professional Component ,,73650,CPT,Professional,Both,,,26,40,34,4.8,40,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),4.8,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Xr Os Calcis Heel (Pro Cah)Professional Component ,,73650,CPT,Professional,Both,,,26,40,34,4.8,40,"Health Partners, Inc.",State of Minnesota Advantage Program,9.778025,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Xr Os Calcis Heel (Pro Cah)Professional Component ,,73650,CPT,Professional,Both,,,26,40,34,4.8,40,"Health Partners, Inc.",State Public Programs,4.8,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Xr Os Calcis Heel (Pro Cah)Professional Component ,,73650,CPT,Professional,Both,,,26,40,34,4.8,40,Humana Insurance Company,Commercial PPO,7.6,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Xr Os Calcis Heel (Pro Cah)Professional Component ,,73650,CPT,Professional,Both,,,26,40,34,4.8,40,Humana Insurance Company,Medicare PPO,40,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Xr Os Calcis Heel (Pro Cah)Professional Component ,,73650,CPT,Professional,Both,,,26,40,34,4.8,40,Medica,Individual & Family,33.92,84.8,,percent of total billed charges,,
Xr Os Calcis Heel (Pro Cah)Professional Component ,,73650,CPT,Professional,Both,,,26,40,34,4.8,40,Medica,Medica Advantage Solution,19.92,49.8,,percent of total billed charges,,
Xr Os Calcis Heel (Pro Cah)Professional Component ,,73650,CPT,Professional,Both,,,26,40,34,4.8,40,Medica,Medical Assistance,5.54,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Xr Os Calcis Heel (Pro Cah)Professional Component ,,73650,CPT,Professional,Both,,,26,40,34,4.8,40,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,7.6,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Xr Os Calcis Heel (Pro Cah)Professional Component ,,73650,CPT,Professional,Both,,,26,40,34,4.8,40,"Multiplan, Inc.","Multiplan, Inc.",37.6,94,,percent of total billed charges,,
Xr Os Calcis Heel (Pro Cah)Professional Component ,,73650,CPT,Professional,Both,,,26,40,34,4.8,40,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,36.04,90.1,,percent of total billed charges,,
Xr Os Calcis Heel (Pro Cah)Professional Component ,,73650,CPT,Professional,Both,,,26,40,34,4.8,40,"Preferred One Administrative Services, INC.",PPO,39.44,98.6,,percent of total billed charges,,
Xr Os Calcis Heel (Pro Cah)Professional Component ,,73650,CPT,Professional,Both,,,26,40,34,4.8,40,PrimeWest Health,Minnesota Senior Health Options (MSHO),8.74,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Os Calcis Heel (Pro Cah)Professional Component ,,73650,CPT,Professional,Both,,,26,40,34,4.8,40,PrimeWest Health,MinnesotaCare,5.924804,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Os Calcis Heel (Pro Cah)Professional Component ,,73650,CPT,Professional,Both,,,26,40,34,4.8,40,Sanford Health Plan,Sanford Health Plan,35.2,88,,percent of total billed charges,,
Xr Os Calcis Heel (Pro Cah)Professional Component ,,73650,CPT,Professional,Both,,,26,40,34,4.8,40,"UCare Health, Inc.",Individual & Family Plan,12.35456,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Xr Os Calcis Heel (Pro Cah)Professional Component ,,73650,CPT,Professional,Both,,,26,40,34,4.8,40,"UCare Health, Inc.",Medical Assistance,6.09092,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Xr Os Calcis Heel (Pro Cah)Professional Component ,,73650,CPT,Professional,Both,,,26,40,34,4.8,40,"UCare Health, Inc.",Medicare Advantage,8.74,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Xr Os Calcis Heel (Pro Cah)Professional Component ,,73650,CPT,Professional,Both,,,26,40,34,4.8,40,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),6.992,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Xr Os Calcis Heel (Pro Cah)Professional Component ,,73650,CPT,Professional,Both,,,26,40,34,4.8,40,UnitedHealthcare,Individual & Family,40,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Xr Os Calcis Heel (Pro Cah)Professional Component ,,73650,CPT,Professional,Both,,,26,40,34,4.8,40,UnitedHealthcare,Medicare Advantage,8.74,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Os Calcis Heel (Pro Cah)Professional Component ,,73650,CPT,Professional,Both,,,26,40,34,4.8,40,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,5.5372,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Toe (Pro Cah)Professional Component ,,73660,CPT,Professional,Both,,,26,31,26.35,3.92,31,Aetna,Commercial,26.35,85,,percent of total billed charges,,
Xr Toe (Pro Cah)Professional Component ,,73660,CPT,Professional,Both,,,26,31,26.35,3.92,31,Aetna,Medicare Advantage,6.43,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Toe (Pro Cah)Professional Component ,,73660,CPT,Professional,Both,,,26,31,26.35,3.92,31,Aetna,PPO,28.83,93,,percent of total billed charges,,
Xr Toe (Pro Cah)Professional Component ,,73660,CPT,Professional,Both,,,26,31,26.35,3.92,31,America's PPO,America's PPO,26.4864,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Xr Toe (Pro Cah)Professional Component ,,73660,CPT,Professional,Both,,,26,31,26.35,3.92,31,BlueCross BlueShield Minnesota, Federal Employee Program,12.14,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Xr Toe (Pro Cah)Professional Component ,,73660,CPT,Professional,Both,,,26,31,26.35,3.92,31,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,12.33424,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Toe (Pro Cah)Professional Component ,,73660,CPT,Professional,Both,,,26,31,26.35,3.92,31,BlueCross BlueShield Minnesota,High Value Network Plan,12.33424,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Toe (Pro Cah)Professional Component ,,73660,CPT,Professional,Both,,,26,31,26.35,3.92,31,BlueCross BlueShield Minnesota,Medicare Advantage,7.176,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Toe (Pro Cah)Professional Component ,,73660,CPT,Professional,Both,,,26,31,26.35,3.92,31,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,12.33424,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Toe (Pro Cah)Professional Component ,,73660,CPT,Professional,Both,,,26,31,26.35,3.92,31,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,4.53136,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Toe (Pro Cah)Professional Component ,,73660,CPT,Professional,Both,,,26,31,26.35,3.92,31,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),7.176,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Toe (Pro Cah)Professional Component ,,73660,CPT,Professional,Both,,,26,31,26.35,3.92,31,CorVel,Worker's Compensation,12.3713706,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Xr Toe (Pro Cah)Professional Component ,,73660,CPT,Professional,Both,,,26,31,26.35,3.92,31,First Health Group Corporation,First Health Network,30.07,97,,percent of total billed charges,,
Xr Toe (Pro Cah)Professional Component ,,73660,CPT,Professional,Both,,,26,31,26.35,3.92,31,"Health Partners, Inc.",Commercial,9.29,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Xr Toe (Pro Cah)Professional Component ,,73660,CPT,Professional,Both,,,26,31,26.35,3.92,31,"Health Partners, Inc.",Medicare Advantage,7.176,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Toe (Pro Cah)Professional Component ,,73660,CPT,Professional,Both,,,26,31,26.35,3.92,31,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3.92,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Xr Toe (Pro Cah)Professional Component ,,73660,CPT,Professional,Both,,,26,31,26.35,3.92,31,"Health Partners, Inc.",State of Minnesota Advantage Program,8.003335,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Xr Toe (Pro Cah)Professional Component ,,73660,CPT,Professional,Both,,,26,31,26.35,3.92,31,"Health Partners, Inc.",State Public Programs,3.92,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Xr Toe (Pro Cah)Professional Component ,,73660,CPT,Professional,Both,,,26,31,26.35,3.92,31,Humana Insurance Company,Commercial PPO,6.24,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Xr Toe (Pro Cah)Professional Component ,,73660,CPT,Professional,Both,,,26,31,26.35,3.92,31,Humana Insurance Company,Medicare PPO,31,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Xr Toe (Pro Cah)Professional Component ,,73660,CPT,Professional,Both,,,26,31,26.35,3.92,31,Medica,Individual & Family,26.288,84.8,,percent of total billed charges,,
Xr Toe (Pro Cah)Professional Component ,,73660,CPT,Professional,Both,,,26,31,26.35,3.92,31,Medica,Medica Advantage Solution,15.438,49.8,,percent of total billed charges,,
Xr Toe (Pro Cah)Professional Component ,,73660,CPT,Professional,Both,,,26,31,26.35,3.92,31,Medica,Medical Assistance,4.53,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Xr Toe (Pro Cah)Professional Component ,,73660,CPT,Professional,Both,,,26,31,26.35,3.92,31,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,6.24,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Xr Toe (Pro Cah)Professional Component ,,73660,CPT,Professional,Both,,,26,31,26.35,3.92,31,"Multiplan, Inc.","Multiplan, Inc.",29.14,94,,percent of total billed charges,,
Xr Toe (Pro Cah)Professional Component ,,73660,CPT,Professional,Both,,,26,31,26.35,3.92,31,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,27.931,90.1,,percent of total billed charges,,
Xr Toe (Pro Cah)Professional Component ,,73660,CPT,Professional,Both,,,26,31,26.35,3.92,31,"Preferred One Administrative Services, INC.",PPO,30.566,98.6,,percent of total billed charges,,
Xr Toe (Pro Cah)Professional Component ,,73660,CPT,Professional,Both,,,26,31,26.35,3.92,31,PrimeWest Health,Minnesota Senior Health Options (MSHO),7.176,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Toe (Pro Cah)Professional Component ,,73660,CPT,Professional,Both,,,26,31,26.35,3.92,31,PrimeWest Health,MinnesotaCare,4.8485552,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Toe (Pro Cah)Professional Component ,,73660,CPT,Professional,Both,,,26,31,26.35,3.92,31,Sanford Health Plan,Sanford Health Plan,27.28,88,,percent of total billed charges,,
Xr Toe (Pro Cah)Professional Component ,,73660,CPT,Professional,Both,,,26,31,26.35,3.92,31,"UCare Health, Inc.",Individual & Family Plan,10.143744,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Xr Toe (Pro Cah)Professional Component ,,73660,CPT,Professional,Both,,,26,31,26.35,3.92,31,"UCare Health, Inc.",Medical Assistance,4.984496,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Xr Toe (Pro Cah)Professional Component ,,73660,CPT,Professional,Both,,,26,31,26.35,3.92,31,"UCare Health, Inc.",Medicare Advantage,7.176,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Xr Toe (Pro Cah)Professional Component ,,73660,CPT,Professional,Both,,,26,31,26.35,3.92,31,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),5.7408,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Xr Toe (Pro Cah)Professional Component ,,73660,CPT,Professional,Both,,,26,31,26.35,3.92,31,UnitedHealthcare,Individual & Family,31,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Xr Toe (Pro Cah)Professional Component ,,73660,CPT,Professional,Both,,,26,31,26.35,3.92,31,UnitedHealthcare,Medicare Advantage,7.176,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Toe (Pro Cah)Professional Component ,,73660,CPT,Professional,Both,,,26,31,26.35,3.92,31,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,4.53136,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Ct Lower Extremity Wo Iv Contrast (Pro Cah)Professional Component ,,73700,CPT,Professional,Both,,,26,390,331.5,29.88,390,Aetna,Commercial,331.5,85,,percent of total billed charges,,
Ct Lower Extremity Wo Iv Contrast (Pro Cah)Professional Component ,,73700,CPT,Professional,Both,,,26,390,331.5,29.88,390,Aetna,Medicare Advantage,48.23,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Lower Extremity Wo Iv Contrast (Pro Cah)Professional Component ,,73700,CPT,Professional,Both,,,26,390,331.5,29.88,390,Aetna,PPO,362.7,93,,percent of total billed charges,,
Ct Lower Extremity Wo Iv Contrast (Pro Cah)Professional Component ,,73700,CPT,Professional,Both,,,26,390,331.5,29.88,390,America's PPO,America's PPO,333.216,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Ct Lower Extremity Wo Iv Contrast (Pro Cah)Professional Component ,,73700,CPT,Professional,Both,,,26,390,331.5,29.88,390,BlueCross BlueShield Minnesota, Federal Employee Program,89.49,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Ct Lower Extremity Wo Iv Contrast (Pro Cah)Professional Component ,,73700,CPT,Professional,Both,,,26,390,331.5,29.88,390,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,90.92184,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Ct Lower Extremity Wo Iv Contrast (Pro Cah)Professional Component ,,73700,CPT,Professional,Both,,,26,390,331.5,29.88,390,BlueCross BlueShield Minnesota,High Value Network Plan,90.92184,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Ct Lower Extremity Wo Iv Contrast (Pro Cah)Professional Component ,,73700,CPT,Professional,Both,,,26,390,331.5,29.88,390,BlueCross BlueShield Minnesota,Medicare Advantage,53.774,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Lower Extremity Wo Iv Contrast (Pro Cah)Professional Component ,,73700,CPT,Professional,Both,,,26,390,331.5,29.88,390,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,90.92184,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Ct Lower Extremity Wo Iv Contrast (Pro Cah)Professional Component ,,73700,CPT,Professional,Both,,,26,390,331.5,29.88,390,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,34.50336,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Ct Lower Extremity Wo Iv Contrast (Pro Cah)Professional Component ,,73700,CPT,Professional,Both,,,26,390,331.5,29.88,390,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),53.774,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Lower Extremity Wo Iv Contrast (Pro Cah)Professional Component ,,73700,CPT,Professional,Both,,,26,390,331.5,29.88,390,CorVel,Worker's Compensation,92.8511061,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Ct Lower Extremity Wo Iv Contrast (Pro Cah)Professional Component ,,73700,CPT,Professional,Both,,,26,390,331.5,29.88,390,First Health Group Corporation,First Health Network,378.3,97,,percent of total billed charges,,
Ct Lower Extremity Wo Iv Contrast (Pro Cah)Professional Component ,,73700,CPT,Professional,Both,,,26,390,331.5,29.88,390,"Health Partners, Inc.",Commercial,71.16,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Ct Lower Extremity Wo Iv Contrast (Pro Cah)Professional Component ,,73700,CPT,Professional,Both,,,26,390,331.5,29.88,390,"Health Partners, Inc.",Medicare Advantage,53.774,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Lower Extremity Wo Iv Contrast (Pro Cah)Professional Component ,,73700,CPT,Professional,Both,,,26,390,331.5,29.88,390,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),29.88,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Ct Lower Extremity Wo Iv Contrast (Pro Cah)Professional Component ,,73700,CPT,Professional,Both,,,26,390,331.5,29.88,390,"Health Partners, Inc.",State of Minnesota Advantage Program,61.30434,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Ct Lower Extremity Wo Iv Contrast (Pro Cah)Professional Component ,,73700,CPT,Professional,Both,,,26,390,331.5,29.88,390,"Health Partners, Inc.",State Public Programs,29.88,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Ct Lower Extremity Wo Iv Contrast (Pro Cah)Professional Component ,,73700,CPT,Professional,Both,,,26,390,331.5,29.88,390,Humana Insurance Company,Commercial PPO,46.76,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Ct Lower Extremity Wo Iv Contrast (Pro Cah)Professional Component ,,73700,CPT,Professional,Both,,,26,390,331.5,29.88,390,Humana Insurance Company,Medicare PPO,390,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Ct Lower Extremity Wo Iv Contrast (Pro Cah)Professional Component ,,73700,CPT,Professional,Both,,,26,390,331.5,29.88,390,Medica,Individual & Family,330.72,84.8,,percent of total billed charges,,
Ct Lower Extremity Wo Iv Contrast (Pro Cah)Professional Component ,,73700,CPT,Professional,Both,,,26,390,331.5,29.88,390,Medica,Medica Advantage Solution,194.22,49.8,,percent of total billed charges,,
Ct Lower Extremity Wo Iv Contrast (Pro Cah)Professional Component ,,73700,CPT,Professional,Both,,,26,390,331.5,29.88,390,Medica,Medical Assistance,34.5,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Ct Lower Extremity Wo Iv Contrast (Pro Cah)Professional Component ,,73700,CPT,Professional,Both,,,26,390,331.5,29.88,390,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,46.76,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Ct Lower Extremity Wo Iv Contrast (Pro Cah)Professional Component ,,73700,CPT,Professional,Both,,,26,390,331.5,29.88,390,"Multiplan, Inc.","Multiplan, Inc.",366.6,94,,percent of total billed charges,,
Ct Lower Extremity Wo Iv Contrast (Pro Cah)Professional Component ,,73700,CPT,Professional,Both,,,26,390,331.5,29.88,390,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,351.39,90.1,,percent of total billed charges,,
Ct Lower Extremity Wo Iv Contrast (Pro Cah)Professional Component ,,73700,CPT,Professional,Both,,,26,390,331.5,29.88,390,"Preferred One Administrative Services, INC.",PPO,384.54,98.6,,percent of total billed charges,,
Ct Lower Extremity Wo Iv Contrast (Pro Cah)Professional Component ,,73700,CPT,Professional,Both,,,26,390,331.5,29.88,390,PrimeWest Health,Minnesota Senior Health Options (MSHO),53.774,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Lower Extremity Wo Iv Contrast (Pro Cah)Professional Component ,,73700,CPT,Professional,Both,,,26,390,331.5,29.88,390,PrimeWest Health,MinnesotaCare,36.9185952,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Ct Lower Extremity Wo Iv Contrast (Pro Cah)Professional Component ,,73700,CPT,Professional,Both,,,26,390,331.5,29.88,390,Sanford Health Plan,Sanford Health Plan,343.2,88,,percent of total billed charges,,
Ct Lower Extremity Wo Iv Contrast (Pro Cah)Professional Component ,,73700,CPT,Professional,Both,,,26,390,331.5,29.88,390,"UCare Health, Inc.",Individual & Family Plan,76.013056,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Ct Lower Extremity Wo Iv Contrast (Pro Cah)Professional Component ,,73700,CPT,Professional,Both,,,26,390,331.5,29.88,390,"UCare Health, Inc.",Medical Assistance,37.953696,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Ct Lower Extremity Wo Iv Contrast (Pro Cah)Professional Component ,,73700,CPT,Professional,Both,,,26,390,331.5,29.88,390,"UCare Health, Inc.",Medicare Advantage,53.774,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Ct Lower Extremity Wo Iv Contrast (Pro Cah)Professional Component ,,73700,CPT,Professional,Both,,,26,390,331.5,29.88,390,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),43.0192,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Ct Lower Extremity Wo Iv Contrast (Pro Cah)Professional Component ,,73700,CPT,Professional,Both,,,26,390,331.5,29.88,390,UnitedHealthcare,Individual & Family,390,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Ct Lower Extremity Wo Iv Contrast (Pro Cah)Professional Component ,,73700,CPT,Professional,Both,,,26,390,331.5,29.88,390,UnitedHealthcare,Medicare Advantage,53.774,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Lower Extremity Wo Iv Contrast (Pro Cah)Professional Component ,,73700,CPT,Professional,Both,,,26,390,331.5,29.88,390,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,34.50336,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Ct Lower Extremity W Iv Contrast (Pro Cah)Professional Component ,,73701,CPT,Professional,Both,,,26,359,305.15,34.9,359,Aetna,Commercial,305.15,85,,percent of total billed charges,,
Ct Lower Extremity W Iv Contrast (Pro Cah)Professional Component ,,73701,CPT,Professional,Both,,,26,359,305.15,34.9,359,Aetna,Medicare Advantage,55.94,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Lower Extremity W Iv Contrast (Pro Cah)Professional Component ,,73701,CPT,Professional,Both,,,26,359,305.15,34.9,359,Aetna,PPO,333.87,93,,percent of total billed charges,,
Ct Lower Extremity W Iv Contrast (Pro Cah)Professional Component ,,73701,CPT,Professional,Both,,,26,359,305.15,34.9,359,America's PPO,America's PPO,306.7296,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Ct Lower Extremity W Iv Contrast (Pro Cah)Professional Component ,,73701,CPT,Professional,Both,,,26,359,305.15,34.9,359,BlueCross BlueShield Minnesota, Federal Employee Program,104.83,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Ct Lower Extremity W Iv Contrast (Pro Cah)Professional Component ,,73701,CPT,Professional,Both,,,26,359,305.15,34.9,359,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,106.50728,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Ct Lower Extremity W Iv Contrast (Pro Cah)Professional Component ,,73701,CPT,Professional,Both,,,26,359,305.15,34.9,359,BlueCross BlueShield Minnesota,High Value Network Plan,106.50728,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Ct Lower Extremity W Iv Contrast (Pro Cah)Professional Component ,,73701,CPT,Professional,Both,,,26,359,305.15,34.9,359,BlueCross BlueShield Minnesota,Medicare Advantage,62.652,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Lower Extremity W Iv Contrast (Pro Cah)Professional Component ,,73701,CPT,Professional,Both,,,26,359,305.15,34.9,359,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,106.50728,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Ct Lower Extremity W Iv Contrast (Pro Cah)Professional Component ,,73701,CPT,Professional,Both,,,26,359,305.15,34.9,359,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,40.29456,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Ct Lower Extremity W Iv Contrast (Pro Cah)Professional Component ,,73701,CPT,Professional,Both,,,26,359,305.15,34.9,359,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),62.652,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Lower Extremity W Iv Contrast (Pro Cah)Professional Component ,,73701,CPT,Professional,Both,,,26,359,305.15,34.9,359,CorVel,Worker's Compensation,107.6808987,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Ct Lower Extremity W Iv Contrast (Pro Cah)Professional Component ,,73701,CPT,Professional,Both,,,26,359,305.15,34.9,359,First Health Group Corporation,First Health Network,348.23,97,,percent of total billed charges,,
Ct Lower Extremity W Iv Contrast (Pro Cah)Professional Component ,,73701,CPT,Professional,Both,,,26,359,305.15,34.9,359,"Health Partners, Inc.",Commercial,83.02,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Ct Lower Extremity W Iv Contrast (Pro Cah)Professional Component ,,73701,CPT,Professional,Both,,,26,359,305.15,34.9,359,"Health Partners, Inc.",Medicare Advantage,62.652,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Lower Extremity W Iv Contrast (Pro Cah)Professional Component ,,73701,CPT,Professional,Both,,,26,359,305.15,34.9,359,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),34.9,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Ct Lower Extremity W Iv Contrast (Pro Cah)Professional Component ,,73701,CPT,Professional,Both,,,26,359,305.15,34.9,359,"Health Partners, Inc.",State of Minnesota Advantage Program,71.52173,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Ct Lower Extremity W Iv Contrast (Pro Cah)Professional Component ,,73701,CPT,Professional,Both,,,26,359,305.15,34.9,359,"Health Partners, Inc.",State Public Programs,34.9,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Ct Lower Extremity W Iv Contrast (Pro Cah)Professional Component ,,73701,CPT,Professional,Both,,,26,359,305.15,34.9,359,Humana Insurance Company,Commercial PPO,54.48,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Ct Lower Extremity W Iv Contrast (Pro Cah)Professional Component ,,73701,CPT,Professional,Both,,,26,359,305.15,34.9,359,Humana Insurance Company,Medicare PPO,359,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Ct Lower Extremity W Iv Contrast (Pro Cah)Professional Component ,,73701,CPT,Professional,Both,,,26,359,305.15,34.9,359,Medica,Individual & Family,304.432,84.8,,percent of total billed charges,,
Ct Lower Extremity W Iv Contrast (Pro Cah)Professional Component ,,73701,CPT,Professional,Both,,,26,359,305.15,34.9,359,Medica,Medica Advantage Solution,178.782,49.8,,percent of total billed charges,,
Ct Lower Extremity W Iv Contrast (Pro Cah)Professional Component ,,73701,CPT,Professional,Both,,,26,359,305.15,34.9,359,Medica,Medical Assistance,40.29,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Ct Lower Extremity W Iv Contrast (Pro Cah)Professional Component ,,73701,CPT,Professional,Both,,,26,359,305.15,34.9,359,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,54.48,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Ct Lower Extremity W Iv Contrast (Pro Cah)Professional Component ,,73701,CPT,Professional,Both,,,26,359,305.15,34.9,359,"Multiplan, Inc.","Multiplan, Inc.",337.46,94,,percent of total billed charges,,
Ct Lower Extremity W Iv Contrast (Pro Cah)Professional Component ,,73701,CPT,Professional,Both,,,26,359,305.15,34.9,359,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,323.459,90.1,,percent of total billed charges,,
Ct Lower Extremity W Iv Contrast (Pro Cah)Professional Component ,,73701,CPT,Professional,Both,,,26,359,305.15,34.9,359,"Preferred One Administrative Services, INC.",PPO,353.974,98.6,,percent of total billed charges,,
Ct Lower Extremity W Iv Contrast (Pro Cah)Professional Component ,,73701,CPT,Professional,Both,,,26,359,305.15,34.9,359,PrimeWest Health,Minnesota Senior Health Options (MSHO),62.652,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Lower Extremity W Iv Contrast (Pro Cah)Professional Component ,,73701,CPT,Professional,Both,,,26,359,305.15,34.9,359,PrimeWest Health,MinnesotaCare,43.1151792,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Ct Lower Extremity W Iv Contrast (Pro Cah)Professional Component ,,73701,CPT,Professional,Both,,,26,359,305.15,34.9,359,Sanford Health Plan,Sanford Health Plan,315.92,88,,percent of total billed charges,,
Ct Lower Extremity W Iv Contrast (Pro Cah)Professional Component ,,73701,CPT,Professional,Both,,,26,359,305.15,34.9,359,"UCare Health, Inc.",Individual & Family Plan,88.562688,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Ct Lower Extremity W Iv Contrast (Pro Cah)Professional Component ,,73701,CPT,Professional,Both,,,26,359,305.15,34.9,359,"UCare Health, Inc.",Medical Assistance,44.324016,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Ct Lower Extremity W Iv Contrast (Pro Cah)Professional Component ,,73701,CPT,Professional,Both,,,26,359,305.15,34.9,359,"UCare Health, Inc.",Medicare Advantage,62.652,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Ct Lower Extremity W Iv Contrast (Pro Cah)Professional Component ,,73701,CPT,Professional,Both,,,26,359,305.15,34.9,359,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),50.1216,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Ct Lower Extremity W Iv Contrast (Pro Cah)Professional Component ,,73701,CPT,Professional,Both,,,26,359,305.15,34.9,359,UnitedHealthcare,Individual & Family,359,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Ct Lower Extremity W Iv Contrast (Pro Cah)Professional Component ,,73701,CPT,Professional,Both,,,26,359,305.15,34.9,359,UnitedHealthcare,Medicare Advantage,62.652,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Lower Extremity W Iv Contrast (Pro Cah)Professional Component ,,73701,CPT,Professional,Both,,,26,359,305.15,34.9,359,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,40.29456,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Ct Lower Extremity W/O & W Contrast (Pro Cah)Professional Component ,,73702,CPT,Professional,Both,,,26,485,412.25,36.42,485,Aetna,Commercial,412.25,85,,percent of total billed charges,,
Ct Lower Extremity W/O & W Contrast (Pro Cah)Professional Component ,,73702,CPT,Professional,Both,,,26,485,412.25,36.42,485,Aetna,Medicare Advantage,58.38,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Lower Extremity W/O & W Contrast (Pro Cah)Professional Component ,,73702,CPT,Professional,Both,,,26,485,412.25,36.42,485,Aetna,PPO,451.05,93,,percent of total billed charges,,
Ct Lower Extremity W/O & W Contrast (Pro Cah)Professional Component ,,73702,CPT,Professional,Both,,,26,485,412.25,36.42,485,America's PPO,America's PPO,414.384,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Ct Lower Extremity W/O & W Contrast (Pro Cah)Professional Component ,,73702,CPT,Professional,Both,,,26,485,412.25,36.42,485,BlueCross BlueShield Minnesota, Federal Employee Program,109.3,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Ct Lower Extremity W/O & W Contrast (Pro Cah)Professional Component ,,73702,CPT,Professional,Both,,,26,485,412.25,36.42,485,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,111.0488,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Ct Lower Extremity W/O & W Contrast (Pro Cah)Professional Component ,,73702,CPT,Professional,Both,,,26,485,412.25,36.42,485,BlueCross BlueShield Minnesota,High Value Network Plan,111.0488,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Ct Lower Extremity W/O & W Contrast (Pro Cah)Professional Component ,,73702,CPT,Professional,Both,,,26,485,412.25,36.42,485,BlueCross BlueShield Minnesota,Medicare Advantage,65.3775,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Lower Extremity W/O & W Contrast (Pro Cah)Professional Component ,,73702,CPT,Professional,Both,,,26,485,412.25,36.42,485,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,111.0488,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Ct Lower Extremity W/O & W Contrast (Pro Cah)Professional Component ,,73702,CPT,Professional,Both,,,26,485,412.25,36.42,485,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,42.05224,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Ct Lower Extremity W/O & W Contrast (Pro Cah)Professional Component ,,73702,CPT,Professional,Both,,,26,485,412.25,36.42,485,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),65.3775,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Lower Extremity W/O & W Contrast (Pro Cah)Professional Component ,,73702,CPT,Professional,Both,,,26,485,412.25,36.42,485,CorVel,Worker's Compensation,112.865751,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Ct Lower Extremity W/O & W Contrast (Pro Cah)Professional Component ,,73702,CPT,Professional,Both,,,26,485,412.25,36.42,485,First Health Group Corporation,First Health Network,470.45,97,,percent of total billed charges,,
Ct Lower Extremity W/O & W Contrast (Pro Cah)Professional Component ,,73702,CPT,Professional,Both,,,26,485,412.25,36.42,485,"Health Partners, Inc.",Commercial,86.62,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Ct Lower Extremity W/O & W Contrast (Pro Cah)Professional Component ,,73702,CPT,Professional,Both,,,26,485,412.25,36.42,485,"Health Partners, Inc.",Medicare Advantage,65.3775,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Lower Extremity W/O & W Contrast (Pro Cah)Professional Component ,,73702,CPT,Professional,Both,,,26,485,412.25,36.42,485,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),36.42,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Ct Lower Extremity W/O & W Contrast (Pro Cah)Professional Component ,,73702,CPT,Professional,Both,,,26,485,412.25,36.42,485,"Health Partners, Inc.",State of Minnesota Advantage Program,74.62313,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Ct Lower Extremity W/O & W Contrast (Pro Cah)Professional Component ,,73702,CPT,Professional,Both,,,26,485,412.25,36.42,485,"Health Partners, Inc.",State Public Programs,36.42,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Ct Lower Extremity W/O & W Contrast (Pro Cah)Professional Component ,,73702,CPT,Professional,Both,,,26,485,412.25,36.42,485,Humana Insurance Company,Commercial PPO,56.85,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Ct Lower Extremity W/O & W Contrast (Pro Cah)Professional Component ,,73702,CPT,Professional,Both,,,26,485,412.25,36.42,485,Humana Insurance Company,Medicare PPO,485,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Ct Lower Extremity W/O & W Contrast (Pro Cah)Professional Component ,,73702,CPT,Professional,Both,,,26,485,412.25,36.42,485,Medica,Individual & Family,411.28,84.8,,percent of total billed charges,,
Ct Lower Extremity W/O & W Contrast (Pro Cah)Professional Component ,,73702,CPT,Professional,Both,,,26,485,412.25,36.42,485,Medica,Medica Advantage Solution,241.53,49.8,,percent of total billed charges,,
Ct Lower Extremity W/O & W Contrast (Pro Cah)Professional Component ,,73702,CPT,Professional,Both,,,26,485,412.25,36.42,485,Medica,Medical Assistance,42.05,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Ct Lower Extremity W/O & W Contrast (Pro Cah)Professional Component ,,73702,CPT,Professional,Both,,,26,485,412.25,36.42,485,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,56.85,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Ct Lower Extremity W/O & W Contrast (Pro Cah)Professional Component ,,73702,CPT,Professional,Both,,,26,485,412.25,36.42,485,"Multiplan, Inc.","Multiplan, Inc.",455.9,94,,percent of total billed charges,,
Ct Lower Extremity W/O & W Contrast (Pro Cah)Professional Component ,,73702,CPT,Professional,Both,,,26,485,412.25,36.42,485,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,436.985,90.1,,percent of total billed charges,,
Ct Lower Extremity W/O & W Contrast (Pro Cah)Professional Component ,,73702,CPT,Professional,Both,,,26,485,412.25,36.42,485,"Preferred One Administrative Services, INC.",PPO,478.21,98.6,,percent of total billed charges,,
Ct Lower Extremity W/O & W Contrast (Pro Cah)Professional Component ,,73702,CPT,Professional,Both,,,26,485,412.25,36.42,485,PrimeWest Health,Minnesota Senior Health Options (MSHO),65.3775,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Lower Extremity W/O & W Contrast (Pro Cah)Professional Component ,,73702,CPT,Professional,Both,,,26,485,412.25,36.42,485,PrimeWest Health,MinnesotaCare,44.9958968,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Ct Lower Extremity W/O & W Contrast (Pro Cah)Professional Component ,,73702,CPT,Professional,Both,,,26,485,412.25,36.42,485,Sanford Health Plan,Sanford Health Plan,426.8,88,,percent of total billed charges,,
Ct Lower Extremity W/O & W Contrast (Pro Cah)Professional Component ,,73702,CPT,Professional,Both,,,26,485,412.25,36.42,485,"UCare Health, Inc.",Individual & Family Plan,92.41536,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Ct Lower Extremity W/O & W Contrast (Pro Cah)Professional Component ,,73702,CPT,Professional,Both,,,26,485,412.25,36.42,485,"UCare Health, Inc.",Medical Assistance,46.257464,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Ct Lower Extremity W/O & W Contrast (Pro Cah)Professional Component ,,73702,CPT,Professional,Both,,,26,485,412.25,36.42,485,"UCare Health, Inc.",Medicare Advantage,65.3775,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Ct Lower Extremity W/O & W Contrast (Pro Cah)Professional Component ,,73702,CPT,Professional,Both,,,26,485,412.25,36.42,485,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),52.302,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Ct Lower Extremity W/O & W Contrast (Pro Cah)Professional Component ,,73702,CPT,Professional,Both,,,26,485,412.25,36.42,485,UnitedHealthcare,Individual & Family,485,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Ct Lower Extremity W/O & W Contrast (Pro Cah)Professional Component ,,73702,CPT,Professional,Both,,,26,485,412.25,36.42,485,UnitedHealthcare,Medicare Advantage,65.3775,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Lower Extremity W/O & W Contrast (Pro Cah)Professional Component ,,73702,CPT,Professional,Both,,,26,485,412.25,36.42,485,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,42.05224,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Cta Lower Extremity (Pro Cah)Professional Component ,,73706,CPT,Professional,Both,,,26,509,432.65,56.72,509,Aetna,Commercial,432.65,85,,percent of total billed charges,,
Cta Lower Extremity (Pro Cah)Professional Component ,,73706,CPT,Professional,Both,,,26,509,432.65,56.72,509,Aetna,Medicare Advantage,90.38,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Cta Lower Extremity (Pro Cah)Professional Component ,,73706,CPT,Professional,Both,,,26,509,432.65,56.72,509,Aetna,PPO,473.37,93,,percent of total billed charges,,
Cta Lower Extremity (Pro Cah)Professional Component ,,73706,CPT,Professional,Both,,,26,509,432.65,56.72,509,America's PPO,America's PPO,434.8896,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Cta Lower Extremity (Pro Cah)Professional Component ,,73706,CPT,Professional,Both,,,26,509,432.65,56.72,509,BlueCross BlueShield Minnesota, Federal Employee Program,170.03,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Cta Lower Extremity (Pro Cah)Professional Component ,,73706,CPT,Professional,Both,,,26,509,432.65,56.72,509,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,172.75048,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Cta Lower Extremity (Pro Cah)Professional Component ,,73706,CPT,Professional,Both,,,26,509,432.65,56.72,509,BlueCross BlueShield Minnesota,High Value Network Plan,172.75048,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Cta Lower Extremity (Pro Cah)Professional Component ,,73706,CPT,Professional,Both,,,26,509,432.65,56.72,509,BlueCross BlueShield Minnesota,Medicare Advantage,101.522,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Cta Lower Extremity (Pro Cah)Professional Component ,,73706,CPT,Professional,Both,,,26,509,432.65,56.72,509,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,172.75048,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Cta Lower Extremity (Pro Cah)Professional Component ,,73706,CPT,Professional,Both,,,26,509,432.65,56.72,509,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,65.4812,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Cta Lower Extremity (Pro Cah)Professional Component ,,73706,CPT,Professional,Both,,,26,509,432.65,56.72,509,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),101.522,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Cta Lower Extremity (Pro Cah)Professional Component ,,73706,CPT,Professional,Both,,,26,509,432.65,56.72,509,CorVel,Worker's Compensation,173.9850774,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Cta Lower Extremity (Pro Cah)Professional Component ,,73706,CPT,Professional,Both,,,26,509,432.65,56.72,509,First Health Group Corporation,First Health Network,493.73,97,,percent of total billed charges,,
Cta Lower Extremity (Pro Cah)Professional Component ,,73706,CPT,Professional,Both,,,26,509,432.65,56.72,509,"Health Partners, Inc.",Commercial,133.54,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Cta Lower Extremity (Pro Cah)Professional Component ,,73706,CPT,Professional,Both,,,26,509,432.65,56.72,509,"Health Partners, Inc.",Medicare Advantage,101.522,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Cta Lower Extremity (Pro Cah)Professional Component ,,73706,CPT,Professional,Both,,,26,509,432.65,56.72,509,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),56.72,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Cta Lower Extremity (Pro Cah)Professional Component ,,73706,CPT,Professional,Both,,,26,509,432.65,56.72,509,"Health Partners, Inc.",State of Minnesota Advantage Program,115.04471,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Cta Lower Extremity (Pro Cah)Professional Component ,,73706,CPT,Professional,Both,,,26,509,432.65,56.72,509,"Health Partners, Inc.",State Public Programs,56.72,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Cta Lower Extremity (Pro Cah)Professional Component ,,73706,CPT,Professional,Both,,,26,509,432.65,56.72,509,Humana Insurance Company,Commercial PPO,88.28,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Cta Lower Extremity (Pro Cah)Professional Component ,,73706,CPT,Professional,Both,,,26,509,432.65,56.72,509,Humana Insurance Company,Medicare PPO,509,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Cta Lower Extremity (Pro Cah)Professional Component ,,73706,CPT,Professional,Both,,,26,509,432.65,56.72,509,Medica,Individual & Family,431.632,84.8,,percent of total billed charges,,
Cta Lower Extremity (Pro Cah)Professional Component ,,73706,CPT,Professional,Both,,,26,509,432.65,56.72,509,Medica,Medica Advantage Solution,253.482,49.8,,percent of total billed charges,,
Cta Lower Extremity (Pro Cah)Professional Component ,,73706,CPT,Professional,Both,,,26,509,432.65,56.72,509,Medica,Medical Assistance,65.48,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Cta Lower Extremity (Pro Cah)Professional Component ,,73706,CPT,Professional,Both,,,26,509,432.65,56.72,509,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,88.28,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Cta Lower Extremity (Pro Cah)Professional Component ,,73706,CPT,Professional,Both,,,26,509,432.65,56.72,509,"Multiplan, Inc.","Multiplan, Inc.",478.46,94,,percent of total billed charges,,
Cta Lower Extremity (Pro Cah)Professional Component ,,73706,CPT,Professional,Both,,,26,509,432.65,56.72,509,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,458.609,90.1,,percent of total billed charges,,
Cta Lower Extremity (Pro Cah)Professional Component ,,73706,CPT,Professional,Both,,,26,509,432.65,56.72,509,"Preferred One Administrative Services, INC.",PPO,501.874,98.6,,percent of total billed charges,,
Cta Lower Extremity (Pro Cah)Professional Component ,,73706,CPT,Professional,Both,,,26,509,432.65,56.72,509,PrimeWest Health,Minnesota Senior Health Options (MSHO),101.522,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Cta Lower Extremity (Pro Cah)Professional Component ,,73706,CPT,Professional,Both,,,26,509,432.65,56.72,509,PrimeWest Health,MinnesotaCare,70.064884,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Cta Lower Extremity (Pro Cah)Professional Component ,,73706,CPT,Professional,Both,,,26,509,432.65,56.72,509,Sanford Health Plan,Sanford Health Plan,447.92,88,,percent of total billed charges,,
Cta Lower Extremity (Pro Cah)Professional Component ,,73706,CPT,Professional,Both,,,26,509,432.65,56.72,509,"UCare Health, Inc.",Individual & Family Plan,143.507968,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Cta Lower Extremity (Pro Cah)Professional Component ,,73706,CPT,Professional,Both,,,26,509,432.65,56.72,509,"UCare Health, Inc.",Medical Assistance,72.02932,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Cta Lower Extremity (Pro Cah)Professional Component ,,73706,CPT,Professional,Both,,,26,509,432.65,56.72,509,"UCare Health, Inc.",Medicare Advantage,101.522,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Cta Lower Extremity (Pro Cah)Professional Component ,,73706,CPT,Professional,Both,,,26,509,432.65,56.72,509,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),81.2176,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Cta Lower Extremity (Pro Cah)Professional Component ,,73706,CPT,Professional,Both,,,26,509,432.65,56.72,509,UnitedHealthcare,Individual & Family,509,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Cta Lower Extremity (Pro Cah)Professional Component ,,73706,CPT,Professional,Both,,,26,509,432.65,56.72,509,UnitedHealthcare,Medicare Advantage,101.522,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Cta Lower Extremity (Pro Cah)Professional Component ,,73706,CPT,Professional,Both,,,26,509,432.65,56.72,509,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,65.4812,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Mri Lower Extremity Other Than Joint; Without Contrast Material(S) (Pro Cah)Professional Component ,,73718,CPT,Professional,Both,,,26,604,513.4,40.79,604,Aetna,Commercial,513.4,85,,percent of total billed charges,,
Mri Lower Extremity Other Than Joint; Without Contrast Material(S) (Pro Cah)Professional Component ,,73718,CPT,Professional,Both,,,26,604,513.4,40.79,604,Aetna,Medicare Advantage,65.04,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Mri Lower Extremity Other Than Joint; Without Contrast Material(S) (Pro Cah)Professional Component ,,73718,CPT,Professional,Both,,,26,604,513.4,40.79,604,Aetna,PPO,561.72,93,,percent of total billed charges,,
Mri Lower Extremity Other Than Joint; Without Contrast Material(S) (Pro Cah)Professional Component ,,73718,CPT,Professional,Both,,,26,604,513.4,40.79,604,America's PPO,America's PPO,516.0576,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Mri Lower Extremity Other Than Joint; Without Contrast Material(S) (Pro Cah)Professional Component ,,73718,CPT,Professional,Both,,,26,604,513.4,40.79,604,BlueCross BlueShield Minnesota, Federal Employee Program,122.09,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Mri Lower Extremity Other Than Joint; Without Contrast Material(S) (Pro Cah)Professional Component ,,73718,CPT,Professional,Both,,,26,604,513.4,40.79,604,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,124.04344,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Mri Lower Extremity Other Than Joint; Without Contrast Material(S) (Pro Cah)Professional Component ,,73718,CPT,Professional,Both,,,26,604,513.4,40.79,604,BlueCross BlueShield Minnesota,High Value Network Plan,124.04344,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Mri Lower Extremity Other Than Joint; Without Contrast Material(S) (Pro Cah)Professional Component ,,73718,CPT,Professional,Both,,,26,604,513.4,40.79,604,BlueCross BlueShield Minnesota,Medicare Advantage,72.956,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Mri Lower Extremity Other Than Joint; Without Contrast Material(S) (Pro Cah)Professional Component ,,73718,CPT,Professional,Both,,,26,604,513.4,40.79,604,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,124.04344,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Mri Lower Extremity Other Than Joint; Without Contrast Material(S) (Pro Cah)Professional Component ,,73718,CPT,Professional,Both,,,26,604,513.4,40.79,604,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,47.0916,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Mri Lower Extremity Other Than Joint; Without Contrast Material(S) (Pro Cah)Professional Component ,,73718,CPT,Professional,Both,,,26,604,513.4,40.79,604,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),72.956,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Mri Lower Extremity Other Than Joint; Without Contrast Material(S) (Pro Cah)Professional Component ,,73718,CPT,Professional,Both,,,26,604,513.4,40.79,604,CorVel,Worker's Compensation,125.0000115,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Mri Lower Extremity Other Than Joint; Without Contrast Material(S) (Pro Cah)Professional Component ,,73718,CPT,Professional,Both,,,26,604,513.4,40.79,604,First Health Group Corporation,First Health Network,585.88,97,,percent of total billed charges,,
Mri Lower Extremity Other Than Joint; Without Contrast Material(S) (Pro Cah)Professional Component ,,73718,CPT,Professional,Both,,,26,604,513.4,40.79,604,"Health Partners, Inc.",Commercial,95.91,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Mri Lower Extremity Other Than Joint; Without Contrast Material(S) (Pro Cah)Professional Component ,,73718,CPT,Professional,Both,,,26,604,513.4,40.79,604,"Health Partners, Inc.",Medicare Advantage,72.956,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Mri Lower Extremity Other Than Joint; Without Contrast Material(S) (Pro Cah)Professional Component ,,73718,CPT,Professional,Both,,,26,604,513.4,40.79,604,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),40.79,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Mri Lower Extremity Other Than Joint; Without Contrast Material(S) (Pro Cah)Professional Component ,,73718,CPT,Professional,Both,,,26,604,513.4,40.79,604,"Health Partners, Inc.",State of Minnesota Advantage Program,82.626465,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Mri Lower Extremity Other Than Joint; Without Contrast Material(S) (Pro Cah)Professional Component ,,73718,CPT,Professional,Both,,,26,604,513.4,40.79,604,"Health Partners, Inc.",State Public Programs,40.79,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Mri Lower Extremity Other Than Joint; Without Contrast Material(S) (Pro Cah)Professional Component ,,73718,CPT,Professional,Both,,,26,604,513.4,40.79,604,Humana Insurance Company,Commercial PPO,63.44,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Mri Lower Extremity Other Than Joint; Without Contrast Material(S) (Pro Cah)Professional Component ,,73718,CPT,Professional,Both,,,26,604,513.4,40.79,604,Humana Insurance Company,Medicare PPO,604,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Mri Lower Extremity Other Than Joint; Without Contrast Material(S) (Pro Cah)Professional Component ,,73718,CPT,Professional,Both,,,26,604,513.4,40.79,604,Medica,Individual & Family,512.192,84.8,,percent of total billed charges,,
Mri Lower Extremity Other Than Joint; Without Contrast Material(S) (Pro Cah)Professional Component ,,73718,CPT,Professional,Both,,,26,604,513.4,40.79,604,Medica,Medica Advantage Solution,300.792,49.8,,percent of total billed charges,,
Mri Lower Extremity Other Than Joint; Without Contrast Material(S) (Pro Cah)Professional Component ,,73718,CPT,Professional,Both,,,26,604,513.4,40.79,604,Medica,Medical Assistance,47.09,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Mri Lower Extremity Other Than Joint; Without Contrast Material(S) (Pro Cah)Professional Component ,,73718,CPT,Professional,Both,,,26,604,513.4,40.79,604,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,63.44,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Mri Lower Extremity Other Than Joint; Without Contrast Material(S) (Pro Cah)Professional Component ,,73718,CPT,Professional,Both,,,26,604,513.4,40.79,604,"Multiplan, Inc.","Multiplan, Inc.",567.76,94,,percent of total billed charges,,
Mri Lower Extremity Other Than Joint; Without Contrast Material(S) (Pro Cah)Professional Component ,,73718,CPT,Professional,Both,,,26,604,513.4,40.79,604,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,544.204,90.1,,percent of total billed charges,,
Mri Lower Extremity Other Than Joint; Without Contrast Material(S) (Pro Cah)Professional Component ,,73718,CPT,Professional,Both,,,26,604,513.4,40.79,604,"Preferred One Administrative Services, INC.",PPO,595.544,98.6,,percent of total billed charges,,
Mri Lower Extremity Other Than Joint; Without Contrast Material(S) (Pro Cah)Professional Component ,,73718,CPT,Professional,Both,,,26,604,513.4,40.79,604,PrimeWest Health,Minnesota Senior Health Options (MSHO),72.956,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Mri Lower Extremity Other Than Joint; Without Contrast Material(S) (Pro Cah)Professional Component ,,73718,CPT,Professional,Both,,,26,604,513.4,40.79,604,PrimeWest Health,MinnesotaCare,50.388012,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Mri Lower Extremity Other Than Joint; Without Contrast Material(S) (Pro Cah)Professional Component ,,73718,CPT,Professional,Both,,,26,604,513.4,40.79,604,Sanford Health Plan,Sanford Health Plan,531.52,88,,percent of total billed charges,,
Mri Lower Extremity Other Than Joint; Without Contrast Material(S) (Pro Cah)Professional Component ,,73718,CPT,Professional,Both,,,26,604,513.4,40.79,604,"UCare Health, Inc.",Individual & Family Plan,103.128064,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Mri Lower Extremity Other Than Joint; Without Contrast Material(S) (Pro Cah)Professional Component ,,73718,CPT,Professional,Both,,,26,604,513.4,40.79,604,"UCare Health, Inc.",Medical Assistance,51.80076,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Mri Lower Extremity Other Than Joint; Without Contrast Material(S) (Pro Cah)Professional Component ,,73718,CPT,Professional,Both,,,26,604,513.4,40.79,604,"UCare Health, Inc.",Medicare Advantage,72.956,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Mri Lower Extremity Other Than Joint; Without Contrast Material(S) (Pro Cah)Professional Component ,,73718,CPT,Professional,Both,,,26,604,513.4,40.79,604,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),58.3648,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Mri Lower Extremity Other Than Joint; Without Contrast Material(S) (Pro Cah)Professional Component ,,73718,CPT,Professional,Both,,,26,604,513.4,40.79,604,UnitedHealthcare,Individual & Family,604,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Mri Lower Extremity Other Than Joint; Without Contrast Material(S) (Pro Cah)Professional Component ,,73718,CPT,Professional,Both,,,26,604,513.4,40.79,604,UnitedHealthcare,Medicare Advantage,72.956,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Mri Lower Extremity Other Than Joint; Without Contrast Material(S) (Pro Cah)Professional Component ,,73718,CPT,Professional,Both,,,26,604,513.4,40.79,604,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,47.0916,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Mri, Lower Extremity Other Than Joint; With Contrast Material(S) (Pro Cah)Professional Component ",,73719,CPT,Professional,Both,,,26,673,572.05,48.86,673,Aetna,Commercial,572.05,85,,percent of total billed charges,,
"Mri, Lower Extremity Other Than Joint; With Contrast Material(S) (Pro Cah)Professional Component ",,73719,CPT,Professional,Both,,,26,673,572.05,48.86,673,Aetna,Medicare Advantage,78.49,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Mri, Lower Extremity Other Than Joint; With Contrast Material(S) (Pro Cah)Professional Component ",,73719,CPT,Professional,Both,,,26,673,572.05,48.86,673,Aetna,PPO,625.89,93,,percent of total billed charges,,
"Mri, Lower Extremity Other Than Joint; With Contrast Material(S) (Pro Cah)Professional Component ",,73719,CPT,Professional,Both,,,26,673,572.05,48.86,673,America's PPO,America's PPO,575.0112,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Mri, Lower Extremity Other Than Joint; With Contrast Material(S) (Pro Cah)Professional Component ",,73719,CPT,Professional,Both,,,26,673,572.05,48.86,673,BlueCross BlueShield Minnesota, Federal Employee Program,146.38,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Mri, Lower Extremity Other Than Joint; With Contrast Material(S) (Pro Cah)Professional Component ",,73719,CPT,Professional,Both,,,26,673,572.05,48.86,673,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,148.72208,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Mri, Lower Extremity Other Than Joint; With Contrast Material(S) (Pro Cah)Professional Component ",,73719,CPT,Professional,Both,,,26,673,572.05,48.86,673,BlueCross BlueShield Minnesota,High Value Network Plan,148.72208,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Mri, Lower Extremity Other Than Joint; With Contrast Material(S) (Pro Cah)Professional Component ",,73719,CPT,Professional,Both,,,26,673,572.05,48.86,673,BlueCross BlueShield Minnesota,Medicare Advantage,87.5725,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Mri, Lower Extremity Other Than Joint; With Contrast Material(S) (Pro Cah)Professional Component ",,73719,CPT,Professional,Both,,,26,673,572.05,48.86,673,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,148.72208,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Mri, Lower Extremity Other Than Joint; With Contrast Material(S) (Pro Cah)Professional Component ",,73719,CPT,Professional,Both,,,26,673,572.05,48.86,673,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,56.40832,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Mri, Lower Extremity Other Than Joint; With Contrast Material(S) (Pro Cah)Professional Component ",,73719,CPT,Professional,Both,,,26,673,572.05,48.86,673,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),87.5725,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Mri, Lower Extremity Other Than Joint; With Contrast Material(S) (Pro Cah)Professional Component ",,73719,CPT,Professional,Both,,,26,673,572.05,48.86,673,CorVel,Worker's Compensation,150.4144527,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Mri, Lower Extremity Other Than Joint; With Contrast Material(S) (Pro Cah)Professional Component ",,73719,CPT,Professional,Both,,,26,673,572.05,48.86,673,First Health Group Corporation,First Health Network,652.81,97,,percent of total billed charges,,
"Mri, Lower Extremity Other Than Joint; With Contrast Material(S) (Pro Cah)Professional Component ",,73719,CPT,Professional,Both,,,26,673,572.05,48.86,673,"Health Partners, Inc.",Commercial,115.5,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Mri, Lower Extremity Other Than Joint; With Contrast Material(S) (Pro Cah)Professional Component ",,73719,CPT,Professional,Both,,,26,673,572.05,48.86,673,"Health Partners, Inc.",Medicare Advantage,87.5725,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Mri, Lower Extremity Other Than Joint; With Contrast Material(S) (Pro Cah)Professional Component ",,73719,CPT,Professional,Both,,,26,673,572.05,48.86,673,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),48.86,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Mri, Lower Extremity Other Than Joint; With Contrast Material(S) (Pro Cah)Professional Component ",,73719,CPT,Professional,Both,,,26,673,572.05,48.86,673,"Health Partners, Inc.",State of Minnesota Advantage Program,99.50325,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Mri, Lower Extremity Other Than Joint; With Contrast Material(S) (Pro Cah)Professional Component ",,73719,CPT,Professional,Both,,,26,673,572.05,48.86,673,"Health Partners, Inc.",State Public Programs,48.86,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Mri, Lower Extremity Other Than Joint; With Contrast Material(S) (Pro Cah)Professional Component ",,73719,CPT,Professional,Both,,,26,673,572.05,48.86,673,Humana Insurance Company,Commercial PPO,76.15,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Mri, Lower Extremity Other Than Joint; With Contrast Material(S) (Pro Cah)Professional Component ",,73719,CPT,Professional,Both,,,26,673,572.05,48.86,673,Humana Insurance Company,Medicare PPO,673,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Mri, Lower Extremity Other Than Joint; With Contrast Material(S) (Pro Cah)Professional Component ",,73719,CPT,Professional,Both,,,26,673,572.05,48.86,673,Medica,Individual & Family,570.704,84.8,,percent of total billed charges,,
"Mri, Lower Extremity Other Than Joint; With Contrast Material(S) (Pro Cah)Professional Component ",,73719,CPT,Professional,Both,,,26,673,572.05,48.86,673,Medica,Medica Advantage Solution,335.154,49.8,,percent of total billed charges,,
"Mri, Lower Extremity Other Than Joint; With Contrast Material(S) (Pro Cah)Professional Component ",,73719,CPT,Professional,Both,,,26,673,572.05,48.86,673,Medica,Medical Assistance,56.41,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Mri, Lower Extremity Other Than Joint; With Contrast Material(S) (Pro Cah)Professional Component ",,73719,CPT,Professional,Both,,,26,673,572.05,48.86,673,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,76.15,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Mri, Lower Extremity Other Than Joint; With Contrast Material(S) (Pro Cah)Professional Component ",,73719,CPT,Professional,Both,,,26,673,572.05,48.86,673,"Multiplan, Inc.","Multiplan, Inc.",632.62,94,,percent of total billed charges,,
"Mri, Lower Extremity Other Than Joint; With Contrast Material(S) (Pro Cah)Professional Component ",,73719,CPT,Professional,Both,,,26,673,572.05,48.86,673,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,606.373,90.1,,percent of total billed charges,,
"Mri, Lower Extremity Other Than Joint; With Contrast Material(S) (Pro Cah)Professional Component ",,73719,CPT,Professional,Both,,,26,673,572.05,48.86,673,"Preferred One Administrative Services, INC.",PPO,663.578,98.6,,percent of total billed charges,,
"Mri, Lower Extremity Other Than Joint; With Contrast Material(S) (Pro Cah)Professional Component ",,73719,CPT,Professional,Both,,,26,673,572.05,48.86,673,PrimeWest Health,Minnesota Senior Health Options (MSHO),87.5725,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Mri, Lower Extremity Other Than Joint; With Contrast Material(S) (Pro Cah)Professional Component ",,73719,CPT,Professional,Both,,,26,673,572.05,48.86,673,PrimeWest Health,MinnesotaCare,60.3569024,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Mri, Lower Extremity Other Than Joint; With Contrast Material(S) (Pro Cah)Professional Component ",,73719,CPT,Professional,Both,,,26,673,572.05,48.86,673,Sanford Health Plan,Sanford Health Plan,592.24,88,,percent of total billed charges,,
"Mri, Lower Extremity Other Than Joint; With Contrast Material(S) (Pro Cah)Professional Component ",,73719,CPT,Professional,Both,,,26,673,572.05,48.86,673,"UCare Health, Inc.",Individual & Family Plan,123.78944,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Mri, Lower Extremity Other Than Joint; With Contrast Material(S) (Pro Cah)Professional Component ",,73719,CPT,Professional,Both,,,26,673,572.05,48.86,673,"UCare Health, Inc.",Medical Assistance,62.049152,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Mri, Lower Extremity Other Than Joint; With Contrast Material(S) (Pro Cah)Professional Component ",,73719,CPT,Professional,Both,,,26,673,572.05,48.86,673,"UCare Health, Inc.",Medicare Advantage,87.5725,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Mri, Lower Extremity Other Than Joint; With Contrast Material(S) (Pro Cah)Professional Component ",,73719,CPT,Professional,Both,,,26,673,572.05,48.86,673,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),70.058,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Mri, Lower Extremity Other Than Joint; With Contrast Material(S) (Pro Cah)Professional Component ",,73719,CPT,Professional,Both,,,26,673,572.05,48.86,673,UnitedHealthcare,Individual & Family,673,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Mri, Lower Extremity Other Than Joint; With Contrast Material(S) (Pro Cah)Professional Component ",,73719,CPT,Professional,Both,,,26,673,572.05,48.86,673,UnitedHealthcare,Medicare Advantage,87.5725,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Mri, Lower Extremity Other Than Joint; With Contrast Material(S) (Pro Cah)Professional Component ",,73719,CPT,Professional,Both,,,26,673,572.05,48.86,673,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,56.40832,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Mri Lower Extremity Other Than Joint; W/O Contrast Followed By Contrast Further Sequences (Pro Cah)Professional Component ,,73720,CPT,Professional,Both,,,26,1009,857.65,65.01,1009,Aetna,Commercial,857.65,85,,percent of total billed charges,,
Mri Lower Extremity Other Than Joint; W/O Contrast Followed By Contrast Further Sequences (Pro Cah)Professional Component ,,73720,CPT,Professional,Both,,,26,1009,857.65,65.01,1009,Aetna,Medicare Advantage,103.82,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Mri Lower Extremity Other Than Joint; W/O Contrast Followed By Contrast Further Sequences (Pro Cah)Professional Component ,,73720,CPT,Professional,Both,,,26,1009,857.65,65.01,1009,Aetna,PPO,938.37,93,,percent of total billed charges,,
Mri Lower Extremity Other Than Joint; W/O Contrast Followed By Contrast Further Sequences (Pro Cah)Professional Component ,,73720,CPT,Professional,Both,,,26,1009,857.65,65.01,1009,America's PPO,America's PPO,862.0896,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Mri Lower Extremity Other Than Joint; W/O Contrast Followed By Contrast Further Sequences (Pro Cah)Professional Component ,,73720,CPT,Professional,Both,,,26,1009,857.65,65.01,1009,BlueCross BlueShield Minnesota, Federal Employee Program,194.32,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Mri Lower Extremity Other Than Joint; W/O Contrast Followed By Contrast Further Sequences (Pro Cah)Professional Component ,,73720,CPT,Professional,Both,,,26,1009,857.65,65.01,1009,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,197.42912,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Mri Lower Extremity Other Than Joint; W/O Contrast Followed By Contrast Further Sequences (Pro Cah)Professional Component ,,73720,CPT,Professional,Both,,,26,1009,857.65,65.01,1009,BlueCross BlueShield Minnesota,High Value Network Plan,197.42912,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Mri Lower Extremity Other Than Joint; W/O Contrast Followed By Contrast Further Sequences (Pro Cah)Professional Component ,,73720,CPT,Professional,Both,,,26,1009,857.65,65.01,1009,BlueCross BlueShield Minnesota,Medicare Advantage,116.1615,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Mri Lower Extremity Other Than Joint; W/O Contrast Followed By Contrast Further Sequences (Pro Cah)Professional Component ,,73720,CPT,Professional,Both,,,26,1009,857.65,65.01,1009,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,197.42912,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Mri Lower Extremity Other Than Joint; W/O Contrast Followed By Contrast Further Sequences (Pro Cah)Professional Component ,,73720,CPT,Professional,Both,,,26,1009,857.65,65.01,1009,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,75.05192,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Mri Lower Extremity Other Than Joint; W/O Contrast Followed By Contrast Further Sequences (Pro Cah)Professional Component ,,73720,CPT,Professional,Both,,,26,1009,857.65,65.01,1009,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),116.1615,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Mri Lower Extremity Other Than Joint; W/O Contrast Followed By Contrast Further Sequences (Pro Cah)Professional Component ,,73720,CPT,Professional,Both,,,26,1009,857.65,65.01,1009,CorVel,Worker's Compensation,199.1798727,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Mri Lower Extremity Other Than Joint; W/O Contrast Followed By Contrast Further Sequences (Pro Cah)Professional Component ,,73720,CPT,Professional,Both,,,26,1009,857.65,65.01,1009,First Health Group Corporation,First Health Network,978.73,97,,percent of total billed charges,,
Mri Lower Extremity Other Than Joint; W/O Contrast Followed By Contrast Further Sequences (Pro Cah)Professional Component ,,73720,CPT,Professional,Both,,,26,1009,857.65,65.01,1009,"Health Partners, Inc.",Commercial,153.14,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Mri Lower Extremity Other Than Joint; W/O Contrast Followed By Contrast Further Sequences (Pro Cah)Professional Component ,,73720,CPT,Professional,Both,,,26,1009,857.65,65.01,1009,"Health Partners, Inc.",Medicare Advantage,116.1615,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Mri Lower Extremity Other Than Joint; W/O Contrast Followed By Contrast Further Sequences (Pro Cah)Professional Component ,,73720,CPT,Professional,Both,,,26,1009,857.65,65.01,1009,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),65.01,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Mri Lower Extremity Other Than Joint; W/O Contrast Followed By Contrast Further Sequences (Pro Cah)Professional Component ,,73720,CPT,Professional,Both,,,26,1009,857.65,65.01,1009,"Health Partners, Inc.",State of Minnesota Advantage Program,131.93011,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Mri Lower Extremity Other Than Joint; W/O Contrast Followed By Contrast Further Sequences (Pro Cah)Professional Component ,,73720,CPT,Professional,Both,,,26,1009,857.65,65.01,1009,"Health Partners, Inc.",State Public Programs,65.01,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Mri Lower Extremity Other Than Joint; W/O Contrast Followed By Contrast Further Sequences (Pro Cah)Professional Component ,,73720,CPT,Professional,Both,,,26,1009,857.65,65.01,1009,Humana Insurance Company,Commercial PPO,101.01,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Mri Lower Extremity Other Than Joint; W/O Contrast Followed By Contrast Further Sequences (Pro Cah)Professional Component ,,73720,CPT,Professional,Both,,,26,1009,857.65,65.01,1009,Humana Insurance Company,Medicare PPO,1009,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Mri Lower Extremity Other Than Joint; W/O Contrast Followed By Contrast Further Sequences (Pro Cah)Professional Component ,,73720,CPT,Professional,Both,,,26,1009,857.65,65.01,1009,Medica,Individual & Family,855.632,84.8,,percent of total billed charges,,
Mri Lower Extremity Other Than Joint; W/O Contrast Followed By Contrast Further Sequences (Pro Cah)Professional Component ,,73720,CPT,Professional,Both,,,26,1009,857.65,65.01,1009,Medica,Medica Advantage Solution,502.482,49.8,,percent of total billed charges,,
Mri Lower Extremity Other Than Joint; W/O Contrast Followed By Contrast Further Sequences (Pro Cah)Professional Component ,,73720,CPT,Professional,Both,,,26,1009,857.65,65.01,1009,Medica,Medical Assistance,75.05,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Mri Lower Extremity Other Than Joint; W/O Contrast Followed By Contrast Further Sequences (Pro Cah)Professional Component ,,73720,CPT,Professional,Both,,,26,1009,857.65,65.01,1009,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,101.01,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Mri Lower Extremity Other Than Joint; W/O Contrast Followed By Contrast Further Sequences (Pro Cah)Professional Component ,,73720,CPT,Professional,Both,,,26,1009,857.65,65.01,1009,"Multiplan, Inc.","Multiplan, Inc.",948.46,94,,percent of total billed charges,,
Mri Lower Extremity Other Than Joint; W/O Contrast Followed By Contrast Further Sequences (Pro Cah)Professional Component ,,73720,CPT,Professional,Both,,,26,1009,857.65,65.01,1009,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,909.109,90.1,,percent of total billed charges,,
Mri Lower Extremity Other Than Joint; W/O Contrast Followed By Contrast Further Sequences (Pro Cah)Professional Component ,,73720,CPT,Professional,Both,,,26,1009,857.65,65.01,1009,"Preferred One Administrative Services, INC.",PPO,994.874,98.6,,percent of total billed charges,,
Mri Lower Extremity Other Than Joint; W/O Contrast Followed By Contrast Further Sequences (Pro Cah)Professional Component ,,73720,CPT,Professional,Both,,,26,1009,857.65,65.01,1009,PrimeWest Health,Minnesota Senior Health Options (MSHO),116.1615,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Mri Lower Extremity Other Than Joint; W/O Contrast Followed By Contrast Further Sequences (Pro Cah)Professional Component ,,73720,CPT,Professional,Both,,,26,1009,857.65,65.01,1009,PrimeWest Health,MinnesotaCare,80.3055544,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Mri Lower Extremity Other Than Joint; W/O Contrast Followed By Contrast Further Sequences (Pro Cah)Professional Component ,,73720,CPT,Professional,Both,,,26,1009,857.65,65.01,1009,Sanford Health Plan,Sanford Health Plan,887.92,88,,percent of total billed charges,,
Mri Lower Extremity Other Than Joint; W/O Contrast Followed By Contrast Further Sequences (Pro Cah)Professional Component ,,73720,CPT,Professional,Both,,,26,1009,857.65,65.01,1009,"UCare Health, Inc.",Individual & Family Plan,164.201856,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Mri Lower Extremity Other Than Joint; W/O Contrast Followed By Contrast Further Sequences (Pro Cah)Professional Component ,,73720,CPT,Professional,Both,,,26,1009,857.65,65.01,1009,"UCare Health, Inc.",Medical Assistance,82.557112,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Mri Lower Extremity Other Than Joint; W/O Contrast Followed By Contrast Further Sequences (Pro Cah)Professional Component ,,73720,CPT,Professional,Both,,,26,1009,857.65,65.01,1009,"UCare Health, Inc.",Medicare Advantage,116.1615,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Mri Lower Extremity Other Than Joint; W/O Contrast Followed By Contrast Further Sequences (Pro Cah)Professional Component ,,73720,CPT,Professional,Both,,,26,1009,857.65,65.01,1009,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),92.9292,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Mri Lower Extremity Other Than Joint; W/O Contrast Followed By Contrast Further Sequences (Pro Cah)Professional Component ,,73720,CPT,Professional,Both,,,26,1009,857.65,65.01,1009,UnitedHealthcare,Individual & Family,1009,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Mri Lower Extremity Other Than Joint; W/O Contrast Followed By Contrast Further Sequences (Pro Cah)Professional Component ,,73720,CPT,Professional,Both,,,26,1009,857.65,65.01,1009,UnitedHealthcare,Medicare Advantage,116.1615,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Mri Lower Extremity Other Than Joint; W/O Contrast Followed By Contrast Further Sequences (Pro Cah)Professional Component ,,73720,CPT,Professional,Both,,,26,1009,857.65,65.01,1009,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,75.05192,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Mri Lower Extremity Any Joint W/O Contrast (Pro Cah)Professional Component ,,73721,CPT,Professional,Both,,,26,585,497.25,41.01,585,Aetna,Commercial,497.25,85,,percent of total billed charges,,
Mri Lower Extremity Any Joint W/O Contrast (Pro Cah)Professional Component ,,73721,CPT,Professional,Both,,,26,585,497.25,41.01,585,Aetna,Medicare Advantage,65.52,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Mri Lower Extremity Any Joint W/O Contrast (Pro Cah)Professional Component ,,73721,CPT,Professional,Both,,,26,585,497.25,41.01,585,Aetna,PPO,544.05,93,,percent of total billed charges,,
Mri Lower Extremity Any Joint W/O Contrast (Pro Cah)Professional Component ,,73721,CPT,Professional,Both,,,26,585,497.25,41.01,585,America's PPO,America's PPO,499.824,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Mri Lower Extremity Any Joint W/O Contrast (Pro Cah)Professional Component ,,73721,CPT,Professional,Both,,,26,585,497.25,41.01,585,BlueCross BlueShield Minnesota, Federal Employee Program,122.73,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Mri Lower Extremity Any Joint W/O Contrast (Pro Cah)Professional Component ,,73721,CPT,Professional,Both,,,26,585,497.25,41.01,585,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,124.69368,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Mri Lower Extremity Any Joint W/O Contrast (Pro Cah)Professional Component ,,73721,CPT,Professional,Both,,,26,585,497.25,41.01,585,BlueCross BlueShield Minnesota,High Value Network Plan,124.69368,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Mri Lower Extremity Any Joint W/O Contrast (Pro Cah)Professional Component ,,73721,CPT,Professional,Both,,,26,585,497.25,41.01,585,BlueCross BlueShield Minnesota,Medicare Advantage,73.3585,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Mri Lower Extremity Any Joint W/O Contrast (Pro Cah)Professional Component ,,73721,CPT,Professional,Both,,,26,585,497.25,41.01,585,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,124.69368,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Mri Lower Extremity Any Joint W/O Contrast (Pro Cah)Professional Component ,,73721,CPT,Professional,Both,,,26,585,497.25,41.01,585,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,47.3456,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Mri Lower Extremity Any Joint W/O Contrast (Pro Cah)Professional Component ,,73721,CPT,Professional,Both,,,26,585,497.25,41.01,585,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),73.3585,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Mri Lower Extremity Any Joint W/O Contrast (Pro Cah)Professional Component ,,73721,CPT,Professional,Both,,,26,585,497.25,41.01,585,CorVel,Worker's Compensation,126.5979858,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Mri Lower Extremity Any Joint W/O Contrast (Pro Cah)Professional Component ,,73721,CPT,Professional,Both,,,26,585,497.25,41.01,585,First Health Group Corporation,First Health Network,567.45,97,,percent of total billed charges,,
Mri Lower Extremity Any Joint W/O Contrast (Pro Cah)Professional Component ,,73721,CPT,Professional,Both,,,26,585,497.25,41.01,585,"Health Partners, Inc.",Commercial,97.45,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Mri Lower Extremity Any Joint W/O Contrast (Pro Cah)Professional Component ,,73721,CPT,Professional,Both,,,26,585,497.25,41.01,585,"Health Partners, Inc.",Medicare Advantage,73.3585,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Mri Lower Extremity Any Joint W/O Contrast (Pro Cah)Professional Component ,,73721,CPT,Professional,Both,,,26,585,497.25,41.01,585,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),41.01,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Mri Lower Extremity Any Joint W/O Contrast (Pro Cah)Professional Component ,,73721,CPT,Professional,Both,,,26,585,497.25,41.01,585,"Health Partners, Inc.",State of Minnesota Advantage Program,83.953175,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Mri Lower Extremity Any Joint W/O Contrast (Pro Cah)Professional Component ,,73721,CPT,Professional,Both,,,26,585,497.25,41.01,585,"Health Partners, Inc.",State Public Programs,41.01,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Mri Lower Extremity Any Joint W/O Contrast (Pro Cah)Professional Component ,,73721,CPT,Professional,Both,,,26,585,497.25,41.01,585,Humana Insurance Company,Commercial PPO,63.79,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Mri Lower Extremity Any Joint W/O Contrast (Pro Cah)Professional Component ,,73721,CPT,Professional,Both,,,26,585,497.25,41.01,585,Humana Insurance Company,Medicare PPO,585,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Mri Lower Extremity Any Joint W/O Contrast (Pro Cah)Professional Component ,,73721,CPT,Professional,Both,,,26,585,497.25,41.01,585,Medica,Individual & Family,496.08,84.8,,percent of total billed charges,,
Mri Lower Extremity Any Joint W/O Contrast (Pro Cah)Professional Component ,,73721,CPT,Professional,Both,,,26,585,497.25,41.01,585,Medica,Medica Advantage Solution,291.33,49.8,,percent of total billed charges,,
Mri Lower Extremity Any Joint W/O Contrast (Pro Cah)Professional Component ,,73721,CPT,Professional,Both,,,26,585,497.25,41.01,585,Medica,Medical Assistance,47.35,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Mri Lower Extremity Any Joint W/O Contrast (Pro Cah)Professional Component ,,73721,CPT,Professional,Both,,,26,585,497.25,41.01,585,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,63.79,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Mri Lower Extremity Any Joint W/O Contrast (Pro Cah)Professional Component ,,73721,CPT,Professional,Both,,,26,585,497.25,41.01,585,"Multiplan, Inc.","Multiplan, Inc.",549.9,94,,percent of total billed charges,,
Mri Lower Extremity Any Joint W/O Contrast (Pro Cah)Professional Component ,,73721,CPT,Professional,Both,,,26,585,497.25,41.01,585,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,527.085,90.1,,percent of total billed charges,,
Mri Lower Extremity Any Joint W/O Contrast (Pro Cah)Professional Component ,,73721,CPT,Professional,Both,,,26,585,497.25,41.01,585,"Preferred One Administrative Services, INC.",PPO,576.81,98.6,,percent of total billed charges,,
Mri Lower Extremity Any Joint W/O Contrast (Pro Cah)Professional Component ,,73721,CPT,Professional,Both,,,26,585,497.25,41.01,585,PrimeWest Health,Minnesota Senior Health Options (MSHO),73.3585,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Mri Lower Extremity Any Joint W/O Contrast (Pro Cah)Professional Component ,,73721,CPT,Professional,Both,,,26,585,497.25,41.01,585,PrimeWest Health,MinnesotaCare,50.659792,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Mri Lower Extremity Any Joint W/O Contrast (Pro Cah)Professional Component ,,73721,CPT,Professional,Both,,,26,585,497.25,41.01,585,Sanford Health Plan,Sanford Health Plan,514.8,88,,percent of total billed charges,,
Mri Lower Extremity Any Joint W/O Contrast (Pro Cah)Professional Component ,,73721,CPT,Professional,Both,,,26,585,497.25,41.01,585,"UCare Health, Inc.",Individual & Family Plan,103.697024,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Mri Lower Extremity Any Joint W/O Contrast (Pro Cah)Professional Component ,,73721,CPT,Professional,Both,,,26,585,497.25,41.01,585,"UCare Health, Inc.",Medical Assistance,52.08016,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Mri Lower Extremity Any Joint W/O Contrast (Pro Cah)Professional Component ,,73721,CPT,Professional,Both,,,26,585,497.25,41.01,585,"UCare Health, Inc.",Medicare Advantage,73.3585,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Mri Lower Extremity Any Joint W/O Contrast (Pro Cah)Professional Component ,,73721,CPT,Professional,Both,,,26,585,497.25,41.01,585,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),58.6868,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Mri Lower Extremity Any Joint W/O Contrast (Pro Cah)Professional Component ,,73721,CPT,Professional,Both,,,26,585,497.25,41.01,585,UnitedHealthcare,Individual & Family,585,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Mri Lower Extremity Any Joint W/O Contrast (Pro Cah)Professional Component ,,73721,CPT,Professional,Both,,,26,585,497.25,41.01,585,UnitedHealthcare,Medicare Advantage,73.3585,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Mri Lower Extremity Any Joint W/O Contrast (Pro Cah)Professional Component ,,73721,CPT,Professional,Both,,,26,585,497.25,41.01,585,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,47.3456,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Mri, Any Joint Of Lower Extremity; With Contrast Material(S) (Pro Cah)Professional Component ",,73722,CPT,Professional,Both,,,26,633,538.05,49.08,633,Aetna,Commercial,538.05,85,,percent of total billed charges,,
"Mri, Any Joint Of Lower Extremity; With Contrast Material(S) (Pro Cah)Professional Component ",,73722,CPT,Professional,Both,,,26,633,538.05,49.08,633,Aetna,Medicare Advantage,78.84,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Mri, Any Joint Of Lower Extremity; With Contrast Material(S) (Pro Cah)Professional Component ",,73722,CPT,Professional,Both,,,26,633,538.05,49.08,633,Aetna,PPO,588.69,93,,percent of total billed charges,,
"Mri, Any Joint Of Lower Extremity; With Contrast Material(S) (Pro Cah)Professional Component ",,73722,CPT,Professional,Both,,,26,633,538.05,49.08,633,America's PPO,America's PPO,540.8352,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Mri, Any Joint Of Lower Extremity; With Contrast Material(S) (Pro Cah)Professional Component ",,73722,CPT,Professional,Both,,,26,633,538.05,49.08,633,BlueCross BlueShield Minnesota, Federal Employee Program,147.02,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Mri, Any Joint Of Lower Extremity; With Contrast Material(S) (Pro Cah)Professional Component ",,73722,CPT,Professional,Both,,,26,633,538.05,49.08,633,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,149.37232,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Mri, Any Joint Of Lower Extremity; With Contrast Material(S) (Pro Cah)Professional Component ",,73722,CPT,Professional,Both,,,26,633,538.05,49.08,633,BlueCross BlueShield Minnesota,High Value Network Plan,149.37232,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Mri, Any Joint Of Lower Extremity; With Contrast Material(S) (Pro Cah)Professional Component ",,73722,CPT,Professional,Both,,,26,633,538.05,49.08,633,BlueCross BlueShield Minnesota,Medicare Advantage,87.975,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Mri, Any Joint Of Lower Extremity; With Contrast Material(S) (Pro Cah)Professional Component ",,73722,CPT,Professional,Both,,,26,633,538.05,49.08,633,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,149.37232,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Mri, Any Joint Of Lower Extremity; With Contrast Material(S) (Pro Cah)Professional Component ",,73722,CPT,Professional,Both,,,26,633,538.05,49.08,633,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,56.66232,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Mri, Any Joint Of Lower Extremity; With Contrast Material(S) (Pro Cah)Professional Component ",,73722,CPT,Professional,Both,,,26,633,538.05,49.08,633,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),87.975,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Mri, Any Joint Of Lower Extremity; With Contrast Material(S) (Pro Cah)Professional Component ",,73722,CPT,Professional,Both,,,26,633,538.05,49.08,633,CorVel,Worker's Compensation,151.7753169,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Mri, Any Joint Of Lower Extremity; With Contrast Material(S) (Pro Cah)Professional Component ",,73722,CPT,Professional,Both,,,26,633,538.05,49.08,633,First Health Group Corporation,First Health Network,614.01,97,,percent of total billed charges,,
"Mri, Any Joint Of Lower Extremity; With Contrast Material(S) (Pro Cah)Professional Component ",,73722,CPT,Professional,Both,,,26,633,538.05,49.08,633,"Health Partners, Inc.",Commercial,116.54,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Mri, Any Joint Of Lower Extremity; With Contrast Material(S) (Pro Cah)Professional Component ",,73722,CPT,Professional,Both,,,26,633,538.05,49.08,633,"Health Partners, Inc.",Medicare Advantage,87.975,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Mri, Any Joint Of Lower Extremity; With Contrast Material(S) (Pro Cah)Professional Component ",,73722,CPT,Professional,Both,,,26,633,538.05,49.08,633,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),49.08,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Mri, Any Joint Of Lower Extremity; With Contrast Material(S) (Pro Cah)Professional Component ",,73722,CPT,Professional,Both,,,26,633,538.05,49.08,633,"Health Partners, Inc.",State of Minnesota Advantage Program,100.39921,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Mri, Any Joint Of Lower Extremity; With Contrast Material(S) (Pro Cah)Professional Component ",,73722,CPT,Professional,Both,,,26,633,538.05,49.08,633,"Health Partners, Inc.",State Public Programs,49.08,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Mri, Any Joint Of Lower Extremity; With Contrast Material(S) (Pro Cah)Professional Component ",,73722,CPT,Professional,Both,,,26,633,538.05,49.08,633,Humana Insurance Company,Commercial PPO,76.5,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Mri, Any Joint Of Lower Extremity; With Contrast Material(S) (Pro Cah)Professional Component ",,73722,CPT,Professional,Both,,,26,633,538.05,49.08,633,Humana Insurance Company,Medicare PPO,633,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Mri, Any Joint Of Lower Extremity; With Contrast Material(S) (Pro Cah)Professional Component ",,73722,CPT,Professional,Both,,,26,633,538.05,49.08,633,Medica,Individual & Family,536.784,84.8,,percent of total billed charges,,
"Mri, Any Joint Of Lower Extremity; With Contrast Material(S) (Pro Cah)Professional Component ",,73722,CPT,Professional,Both,,,26,633,538.05,49.08,633,Medica,Medica Advantage Solution,315.234,49.8,,percent of total billed charges,,
"Mri, Any Joint Of Lower Extremity; With Contrast Material(S) (Pro Cah)Professional Component ",,73722,CPT,Professional,Both,,,26,633,538.05,49.08,633,Medica,Medical Assistance,56.66,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Mri, Any Joint Of Lower Extremity; With Contrast Material(S) (Pro Cah)Professional Component ",,73722,CPT,Professional,Both,,,26,633,538.05,49.08,633,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,76.5,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Mri, Any Joint Of Lower Extremity; With Contrast Material(S) (Pro Cah)Professional Component ",,73722,CPT,Professional,Both,,,26,633,538.05,49.08,633,"Multiplan, Inc.","Multiplan, Inc.",595.02,94,,percent of total billed charges,,
"Mri, Any Joint Of Lower Extremity; With Contrast Material(S) (Pro Cah)Professional Component ",,73722,CPT,Professional,Both,,,26,633,538.05,49.08,633,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,570.333,90.1,,percent of total billed charges,,
"Mri, Any Joint Of Lower Extremity; With Contrast Material(S) (Pro Cah)Professional Component ",,73722,CPT,Professional,Both,,,26,633,538.05,49.08,633,"Preferred One Administrative Services, INC.",PPO,624.138,98.6,,percent of total billed charges,,
"Mri, Any Joint Of Lower Extremity; With Contrast Material(S) (Pro Cah)Professional Component ",,73722,CPT,Professional,Both,,,26,633,538.05,49.08,633,PrimeWest Health,Minnesota Senior Health Options (MSHO),87.975,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Mri, Any Joint Of Lower Extremity; With Contrast Material(S) (Pro Cah)Professional Component ",,73722,CPT,Professional,Both,,,26,633,538.05,49.08,633,PrimeWest Health,MinnesotaCare,60.6286824,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Mri, Any Joint Of Lower Extremity; With Contrast Material(S) (Pro Cah)Professional Component ",,73722,CPT,Professional,Both,,,26,633,538.05,49.08,633,Sanford Health Plan,Sanford Health Plan,557.04,88,,percent of total billed charges,,
"Mri, Any Joint Of Lower Extremity; With Contrast Material(S) (Pro Cah)Professional Component ",,73722,CPT,Professional,Both,,,26,633,538.05,49.08,633,"UCare Health, Inc.",Individual & Family Plan,124.3584,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Mri, Any Joint Of Lower Extremity; With Contrast Material(S) (Pro Cah)Professional Component ",,73722,CPT,Professional,Both,,,26,633,538.05,49.08,633,"UCare Health, Inc.",Medical Assistance,62.328552,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Mri, Any Joint Of Lower Extremity; With Contrast Material(S) (Pro Cah)Professional Component ",,73722,CPT,Professional,Both,,,26,633,538.05,49.08,633,"UCare Health, Inc.",Medicare Advantage,87.975,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Mri, Any Joint Of Lower Extremity; With Contrast Material(S) (Pro Cah)Professional Component ",,73722,CPT,Professional,Both,,,26,633,538.05,49.08,633,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),70.38,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Mri, Any Joint Of Lower Extremity; With Contrast Material(S) (Pro Cah)Professional Component ",,73722,CPT,Professional,Both,,,26,633,538.05,49.08,633,UnitedHealthcare,Individual & Family,633,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Mri, Any Joint Of Lower Extremity; With Contrast Material(S) (Pro Cah)Professional Component ",,73722,CPT,Professional,Both,,,26,633,538.05,49.08,633,UnitedHealthcare,Medicare Advantage,87.975,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Mri, Any Joint Of Lower Extremity; With Contrast Material(S) (Pro Cah)Professional Component ",,73722,CPT,Professional,Both,,,26,633,538.05,49.08,633,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,56.66232,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Mri Any Joint Of Lower Extremity; W/O Contrast, Followed By Contrast And Further Sequences (Pro Cah)Professional Component ",,73723,CPT,Professional,Both,,,26,901,765.85,65.01,901,Aetna,Commercial,765.85,85,,percent of total billed charges,,
"Mri Any Joint Of Lower Extremity; W/O Contrast, Followed By Contrast And Further Sequences (Pro Cah)Professional Component ",,73723,CPT,Professional,Both,,,26,901,765.85,65.01,901,Aetna,Medicare Advantage,103.82,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Mri Any Joint Of Lower Extremity; W/O Contrast, Followed By Contrast And Further Sequences (Pro Cah)Professional Component ",,73723,CPT,Professional,Both,,,26,901,765.85,65.01,901,Aetna,PPO,837.93,93,,percent of total billed charges,,
"Mri Any Joint Of Lower Extremity; W/O Contrast, Followed By Contrast And Further Sequences (Pro Cah)Professional Component ",,73723,CPT,Professional,Both,,,26,901,765.85,65.01,901,America's PPO,America's PPO,769.8144,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Mri Any Joint Of Lower Extremity; W/O Contrast, Followed By Contrast And Further Sequences (Pro Cah)Professional Component ",,73723,CPT,Professional,Both,,,26,901,765.85,65.01,901,BlueCross BlueShield Minnesota, Federal Employee Program,194.32,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Mri Any Joint Of Lower Extremity; W/O Contrast, Followed By Contrast And Further Sequences (Pro Cah)Professional Component ",,73723,CPT,Professional,Both,,,26,901,765.85,65.01,901,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,197.42912,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Mri Any Joint Of Lower Extremity; W/O Contrast, Followed By Contrast And Further Sequences (Pro Cah)Professional Component ",,73723,CPT,Professional,Both,,,26,901,765.85,65.01,901,BlueCross BlueShield Minnesota,High Value Network Plan,197.42912,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Mri Any Joint Of Lower Extremity; W/O Contrast, Followed By Contrast And Further Sequences (Pro Cah)Professional Component ",,73723,CPT,Professional,Both,,,26,901,765.85,65.01,901,BlueCross BlueShield Minnesota,Medicare Advantage,116.1615,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Mri Any Joint Of Lower Extremity; W/O Contrast, Followed By Contrast And Further Sequences (Pro Cah)Professional Component ",,73723,CPT,Professional,Both,,,26,901,765.85,65.01,901,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,197.42912,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Mri Any Joint Of Lower Extremity; W/O Contrast, Followed By Contrast And Further Sequences (Pro Cah)Professional Component ",,73723,CPT,Professional,Both,,,26,901,765.85,65.01,901,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,75.05192,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Mri Any Joint Of Lower Extremity; W/O Contrast, Followed By Contrast And Further Sequences (Pro Cah)Professional Component ",,73723,CPT,Professional,Both,,,26,901,765.85,65.01,901,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),116.1615,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Mri Any Joint Of Lower Extremity; W/O Contrast, Followed By Contrast And Further Sequences (Pro Cah)Professional Component ",,73723,CPT,Professional,Both,,,26,901,765.85,65.01,901,CorVel,Worker's Compensation,199.1798727,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Mri Any Joint Of Lower Extremity; W/O Contrast, Followed By Contrast And Further Sequences (Pro Cah)Professional Component ",,73723,CPT,Professional,Both,,,26,901,765.85,65.01,901,First Health Group Corporation,First Health Network,873.97,97,,percent of total billed charges,,
"Mri Any Joint Of Lower Extremity; W/O Contrast, Followed By Contrast And Further Sequences (Pro Cah)Professional Component ",,73723,CPT,Professional,Both,,,26,901,765.85,65.01,901,"Health Partners, Inc.",Commercial,153.14,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Mri Any Joint Of Lower Extremity; W/O Contrast, Followed By Contrast And Further Sequences (Pro Cah)Professional Component ",,73723,CPT,Professional,Both,,,26,901,765.85,65.01,901,"Health Partners, Inc.",Medicare Advantage,116.1615,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Mri Any Joint Of Lower Extremity; W/O Contrast, Followed By Contrast And Further Sequences (Pro Cah)Professional Component ",,73723,CPT,Professional,Both,,,26,901,765.85,65.01,901,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),65.01,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Mri Any Joint Of Lower Extremity; W/O Contrast, Followed By Contrast And Further Sequences (Pro Cah)Professional Component ",,73723,CPT,Professional,Both,,,26,901,765.85,65.01,901,"Health Partners, Inc.",State of Minnesota Advantage Program,131.93011,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Mri Any Joint Of Lower Extremity; W/O Contrast, Followed By Contrast And Further Sequences (Pro Cah)Professional Component ",,73723,CPT,Professional,Both,,,26,901,765.85,65.01,901,"Health Partners, Inc.",State Public Programs,65.01,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Mri Any Joint Of Lower Extremity; W/O Contrast, Followed By Contrast And Further Sequences (Pro Cah)Professional Component ",,73723,CPT,Professional,Both,,,26,901,765.85,65.01,901,Humana Insurance Company,Commercial PPO,101.01,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Mri Any Joint Of Lower Extremity; W/O Contrast, Followed By Contrast And Further Sequences (Pro Cah)Professional Component ",,73723,CPT,Professional,Both,,,26,901,765.85,65.01,901,Humana Insurance Company,Medicare PPO,901,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Mri Any Joint Of Lower Extremity; W/O Contrast, Followed By Contrast And Further Sequences (Pro Cah)Professional Component ",,73723,CPT,Professional,Both,,,26,901,765.85,65.01,901,Medica,Individual & Family,764.048,84.8,,percent of total billed charges,,
"Mri Any Joint Of Lower Extremity; W/O Contrast, Followed By Contrast And Further Sequences (Pro Cah)Professional Component ",,73723,CPT,Professional,Both,,,26,901,765.85,65.01,901,Medica,Medica Advantage Solution,448.698,49.8,,percent of total billed charges,,
"Mri Any Joint Of Lower Extremity; W/O Contrast, Followed By Contrast And Further Sequences (Pro Cah)Professional Component ",,73723,CPT,Professional,Both,,,26,901,765.85,65.01,901,Medica,Medical Assistance,75.05,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Mri Any Joint Of Lower Extremity; W/O Contrast, Followed By Contrast And Further Sequences (Pro Cah)Professional Component ",,73723,CPT,Professional,Both,,,26,901,765.85,65.01,901,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,101.01,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Mri Any Joint Of Lower Extremity; W/O Contrast, Followed By Contrast And Further Sequences (Pro Cah)Professional Component ",,73723,CPT,Professional,Both,,,26,901,765.85,65.01,901,"Multiplan, Inc.","Multiplan, Inc.",846.94,94,,percent of total billed charges,,
"Mri Any Joint Of Lower Extremity; W/O Contrast, Followed By Contrast And Further Sequences (Pro Cah)Professional Component ",,73723,CPT,Professional,Both,,,26,901,765.85,65.01,901,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,811.801,90.1,,percent of total billed charges,,
"Mri Any Joint Of Lower Extremity; W/O Contrast, Followed By Contrast And Further Sequences (Pro Cah)Professional Component ",,73723,CPT,Professional,Both,,,26,901,765.85,65.01,901,"Preferred One Administrative Services, INC.",PPO,888.386,98.6,,percent of total billed charges,,
"Mri Any Joint Of Lower Extremity; W/O Contrast, Followed By Contrast And Further Sequences (Pro Cah)Professional Component ",,73723,CPT,Professional,Both,,,26,901,765.85,65.01,901,PrimeWest Health,Minnesota Senior Health Options (MSHO),116.1615,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Mri Any Joint Of Lower Extremity; W/O Contrast, Followed By Contrast And Further Sequences (Pro Cah)Professional Component ",,73723,CPT,Professional,Both,,,26,901,765.85,65.01,901,PrimeWest Health,MinnesotaCare,80.3055544,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Mri Any Joint Of Lower Extremity; W/O Contrast, Followed By Contrast And Further Sequences (Pro Cah)Professional Component ",,73723,CPT,Professional,Both,,,26,901,765.85,65.01,901,Sanford Health Plan,Sanford Health Plan,792.88,88,,percent of total billed charges,,
"Mri Any Joint Of Lower Extremity; W/O Contrast, Followed By Contrast And Further Sequences (Pro Cah)Professional Component ",,73723,CPT,Professional,Both,,,26,901,765.85,65.01,901,"UCare Health, Inc.",Individual & Family Plan,164.201856,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Mri Any Joint Of Lower Extremity; W/O Contrast, Followed By Contrast And Further Sequences (Pro Cah)Professional Component ",,73723,CPT,Professional,Both,,,26,901,765.85,65.01,901,"UCare Health, Inc.",Medical Assistance,82.557112,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Mri Any Joint Of Lower Extremity; W/O Contrast, Followed By Contrast And Further Sequences (Pro Cah)Professional Component ",,73723,CPT,Professional,Both,,,26,901,765.85,65.01,901,"UCare Health, Inc.",Medicare Advantage,116.1615,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Mri Any Joint Of Lower Extremity; W/O Contrast, Followed By Contrast And Further Sequences (Pro Cah)Professional Component ",,73723,CPT,Professional,Both,,,26,901,765.85,65.01,901,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),92.9292,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Mri Any Joint Of Lower Extremity; W/O Contrast, Followed By Contrast And Further Sequences (Pro Cah)Professional Component ",,73723,CPT,Professional,Both,,,26,901,765.85,65.01,901,UnitedHealthcare,Individual & Family,901,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Mri Any Joint Of Lower Extremity; W/O Contrast, Followed By Contrast And Further Sequences (Pro Cah)Professional Component ",,73723,CPT,Professional,Both,,,26,901,765.85,65.01,901,UnitedHealthcare,Medicare Advantage,116.1615,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Mri Any Joint Of Lower Extremity; W/O Contrast, Followed By Contrast And Further Sequences (Pro Cah)Professional Component ",,73723,CPT,Professional,Both,,,26,901,765.85,65.01,901,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,75.05192,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Radiologic Examination, Abdomen; 1 View (Pro Cah)Professional Component ",,74018,CPT,Professional,Both,,,26,60,51,5.45,60,Aetna,Commercial,51,85,,percent of total billed charges,,
"Radiologic Examination, Abdomen; 1 View (Pro Cah)Professional Component ",,74018,CPT,Professional,Both,,,26,60,51,5.45,60,Aetna,Medicare Advantage,8.88,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Radiologic Examination, Abdomen; 1 View (Pro Cah)Professional Component ",,74018,CPT,Professional,Both,,,26,60,51,5.45,60,Aetna,PPO,55.8,93,,percent of total billed charges,,
"Radiologic Examination, Abdomen; 1 View (Pro Cah)Professional Component ",,74018,CPT,Professional,Both,,,26,60,51,5.45,60,America's PPO,America's PPO,51.264,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Radiologic Examination, Abdomen; 1 View (Pro Cah)Professional Component ",,74018,CPT,Professional,Both,,,26,60,51,5.45,60,BlueCross BlueShield Minnesota, Federal Employee Program,16.62,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Radiologic Examination, Abdomen; 1 View (Pro Cah)Professional Component ",,74018,CPT,Professional,Both,,,26,60,51,5.45,60,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,16.88592,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Radiologic Examination, Abdomen; 1 View (Pro Cah)Professional Component ",,74018,CPT,Professional,Both,,,26,60,51,5.45,60,BlueCross BlueShield Minnesota,High Value Network Plan,16.88592,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Radiologic Examination, Abdomen; 1 View (Pro Cah)Professional Component ",,74018,CPT,Professional,Both,,,26,60,51,5.45,60,BlueCross BlueShield Minnesota,Medicare Advantage,9.9245,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Radiologic Examination, Abdomen; 1 View (Pro Cah)Professional Component ",,74018,CPT,Professional,Both,,,26,60,51,5.45,60,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,16.88592,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Radiologic Examination, Abdomen; 1 View (Pro Cah)Professional Component ",,74018,CPT,Professional,Both,,,26,60,51,5.45,60,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,6.28904,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Radiologic Examination, Abdomen; 1 View (Pro Cah)Professional Component ",,74018,CPT,Professional,Both,,,26,60,51,5.45,60,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),9.9245,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Radiologic Examination, Abdomen; 1 View (Pro Cah)Professional Component ",,74018,CPT,Professional,Both,,,26,60,51,5.45,60,CorVel,Worker's Compensation,17.0907348,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Radiologic Examination, Abdomen; 1 View (Pro Cah)Professional Component ",,74018,CPT,Professional,Both,,,26,60,51,5.45,60,First Health Group Corporation,First Health Network,58.2,97,,percent of total billed charges,,
"Radiologic Examination, Abdomen; 1 View (Pro Cah)Professional Component ",,74018,CPT,Professional,Both,,,26,60,51,5.45,60,"Health Partners, Inc.",Commercial,12.89,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Radiologic Examination, Abdomen; 1 View (Pro Cah)Professional Component ",,74018,CPT,Professional,Both,,,26,60,51,5.45,60,"Health Partners, Inc.",Medicare Advantage,9.9245,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Radiologic Examination, Abdomen; 1 View (Pro Cah)Professional Component ",,74018,CPT,Professional,Both,,,26,60,51,5.45,60,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),5.45,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Radiologic Examination, Abdomen; 1 View (Pro Cah)Professional Component ",,74018,CPT,Professional,Both,,,26,60,51,5.45,60,"Health Partners, Inc.",State of Minnesota Advantage Program,11.104735,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Radiologic Examination, Abdomen; 1 View (Pro Cah)Professional Component ",,74018,CPT,Professional,Both,,,26,60,51,5.45,60,"Health Partners, Inc.",State Public Programs,5.45,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Radiologic Examination, Abdomen; 1 View (Pro Cah)Professional Component ",,74018,CPT,Professional,Both,,,26,60,51,5.45,60,Humana Insurance Company,Commercial PPO,8.63,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Radiologic Examination, Abdomen; 1 View (Pro Cah)Professional Component ",,74018,CPT,Professional,Both,,,26,60,51,5.45,60,Humana Insurance Company,Medicare PPO,60,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Radiologic Examination, Abdomen; 1 View (Pro Cah)Professional Component ",,74018,CPT,Professional,Both,,,26,60,51,5.45,60,Medica,Individual & Family,50.88,84.8,,percent of total billed charges,,
"Radiologic Examination, Abdomen; 1 View (Pro Cah)Professional Component ",,74018,CPT,Professional,Both,,,26,60,51,5.45,60,Medica,Medica Advantage Solution,29.88,49.8,,percent of total billed charges,,
"Radiologic Examination, Abdomen; 1 View (Pro Cah)Professional Component ",,74018,CPT,Professional,Both,,,26,60,51,5.45,60,Medica,Medical Assistance,6.29,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Radiologic Examination, Abdomen; 1 View (Pro Cah)Professional Component ",,74018,CPT,Professional,Both,,,26,60,51,5.45,60,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,8.63,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Radiologic Examination, Abdomen; 1 View (Pro Cah)Professional Component ",,74018,CPT,Professional,Both,,,26,60,51,5.45,60,"Multiplan, Inc.","Multiplan, Inc.",56.4,94,,percent of total billed charges,,
"Radiologic Examination, Abdomen; 1 View (Pro Cah)Professional Component ",,74018,CPT,Professional,Both,,,26,60,51,5.45,60,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,54.06,90.1,,percent of total billed charges,,
"Radiologic Examination, Abdomen; 1 View (Pro Cah)Professional Component ",,74018,CPT,Professional,Both,,,26,60,51,5.45,60,"Preferred One Administrative Services, INC.",PPO,59.16,98.6,,percent of total billed charges,,
"Radiologic Examination, Abdomen; 1 View (Pro Cah)Professional Component ",,74018,CPT,Professional,Both,,,26,60,51,5.45,60,PrimeWest Health,Minnesota Senior Health Options (MSHO),9.9245,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Radiologic Examination, Abdomen; 1 View (Pro Cah)Professional Component ",,74018,CPT,Professional,Both,,,26,60,51,5.45,60,PrimeWest Health,MinnesotaCare,6.7292728,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Radiologic Examination, Abdomen; 1 View (Pro Cah)Professional Component ",,74018,CPT,Professional,Both,,,26,60,51,5.45,60,Sanford Health Plan,Sanford Health Plan,52.8,88,,percent of total billed charges,,
"Radiologic Examination, Abdomen; 1 View (Pro Cah)Professional Component ",,74018,CPT,Professional,Both,,,26,60,51,5.45,60,"UCare Health, Inc.",Individual & Family Plan,14.028928,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Radiologic Examination, Abdomen; 1 View (Pro Cah)Professional Component ",,74018,CPT,Professional,Both,,,26,60,51,5.45,60,"UCare Health, Inc.",Medical Assistance,6.917944,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Radiologic Examination, Abdomen; 1 View (Pro Cah)Professional Component ",,74018,CPT,Professional,Both,,,26,60,51,5.45,60,"UCare Health, Inc.",Medicare Advantage,9.9245,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Radiologic Examination, Abdomen; 1 View (Pro Cah)Professional Component ",,74018,CPT,Professional,Both,,,26,60,51,5.45,60,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),7.9396,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Radiologic Examination, Abdomen; 1 View (Pro Cah)Professional Component ",,74018,CPT,Professional,Both,,,26,60,51,5.45,60,UnitedHealthcare,Individual & Family,60,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Radiologic Examination, Abdomen; 1 View (Pro Cah)Professional Component ",,74018,CPT,Professional,Both,,,26,60,51,5.45,60,UnitedHealthcare,Medicare Advantage,9.9245,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Radiologic Examination, Abdomen; 1 View (Pro Cah)Professional Component ",,74018,CPT,Professional,Both,,,26,60,51,5.45,60,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,6.28904,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Radiologic Examination, Abdomen; 2 Views (Pro Cah)Professional Component ",,74019,CPT,Professional,Both,,,26,42,35.7,6.98,42,Aetna,Commercial,35.7,85,,percent of total billed charges,,
"Radiologic Examination, Abdomen; 2 Views (Pro Cah)Professional Component ",,74019,CPT,Professional,Both,,,26,42,35.7,6.98,42,Aetna,Medicare Advantage,11.33,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Radiologic Examination, Abdomen; 2 Views (Pro Cah)Professional Component ",,74019,CPT,Professional,Both,,,26,42,35.7,6.98,42,Aetna,PPO,39.06,93,,percent of total billed charges,,
"Radiologic Examination, Abdomen; 2 Views (Pro Cah)Professional Component ",,74019,CPT,Professional,Both,,,26,42,35.7,6.98,42,America's PPO,America's PPO,35.8848,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Radiologic Examination, Abdomen; 2 Views (Pro Cah)Professional Component ",,74019,CPT,Professional,Both,,,26,42,35.7,6.98,42,BlueCross BlueShield Minnesota, Federal Employee Program,21.09,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Radiologic Examination, Abdomen; 2 Views (Pro Cah)Professional Component ",,74019,CPT,Professional,Both,,,26,42,35.7,6.98,42,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,21.42744,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Radiologic Examination, Abdomen; 2 Views (Pro Cah)Professional Component ",,74019,CPT,Professional,Both,,,26,42,35.7,6.98,42,BlueCross BlueShield Minnesota,High Value Network Plan,21.42744,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Radiologic Examination, Abdomen; 2 Views (Pro Cah)Professional Component ",,74019,CPT,Professional,Both,,,26,42,35.7,6.98,42,BlueCross BlueShield Minnesota,Medicare Advantage,12.6615,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Radiologic Examination, Abdomen; 2 Views (Pro Cah)Professional Component ",,74019,CPT,Professional,Both,,,26,42,35.7,6.98,42,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,21.42744,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Radiologic Examination, Abdomen; 2 Views (Pro Cah)Professional Component ",,74019,CPT,Professional,Both,,,26,42,35.7,6.98,42,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,8.05688,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Radiologic Examination, Abdomen; 2 Views (Pro Cah)Professional Component ",,74019,CPT,Professional,Both,,,26,42,35.7,6.98,42,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),12.6615,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Radiologic Examination, Abdomen; 2 Views (Pro Cah)Professional Component ",,74019,CPT,Professional,Both,,,26,42,35.7,6.98,42,CorVel,Worker's Compensation,21.810099,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Radiologic Examination, Abdomen; 2 Views (Pro Cah)Professional Component ",,74019,CPT,Professional,Both,,,26,42,35.7,6.98,42,First Health Group Corporation,First Health Network,40.74,97,,percent of total billed charges,,
"Radiologic Examination, Abdomen; 2 Views (Pro Cah)Professional Component ",,74019,CPT,Professional,Both,,,26,42,35.7,6.98,42,"Health Partners, Inc.",Commercial,16.5,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Radiologic Examination, Abdomen; 2 Views (Pro Cah)Professional Component ",,74019,CPT,Professional,Both,,,26,42,35.7,6.98,42,"Health Partners, Inc.",Medicare Advantage,12.6615,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Radiologic Examination, Abdomen; 2 Views (Pro Cah)Professional Component ",,74019,CPT,Professional,Both,,,26,42,35.7,6.98,42,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),6.98,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Radiologic Examination, Abdomen; 2 Views (Pro Cah)Professional Component ",,74019,CPT,Professional,Both,,,26,42,35.7,6.98,42,"Health Partners, Inc.",State of Minnesota Advantage Program,14.21475,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Radiologic Examination, Abdomen; 2 Views (Pro Cah)Professional Component ",,74019,CPT,Professional,Both,,,26,42,35.7,6.98,42,"Health Partners, Inc.",State Public Programs,6.98,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Radiologic Examination, Abdomen; 2 Views (Pro Cah)Professional Component ",,74019,CPT,Professional,Both,,,26,42,35.7,6.98,42,Humana Insurance Company,Commercial PPO,11.01,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Radiologic Examination, Abdomen; 2 Views (Pro Cah)Professional Component ",,74019,CPT,Professional,Both,,,26,42,35.7,6.98,42,Humana Insurance Company,Medicare PPO,42,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Radiologic Examination, Abdomen; 2 Views (Pro Cah)Professional Component ",,74019,CPT,Professional,Both,,,26,42,35.7,6.98,42,Medica,Individual & Family,35.616,84.8,,percent of total billed charges,,
"Radiologic Examination, Abdomen; 2 Views (Pro Cah)Professional Component ",,74019,CPT,Professional,Both,,,26,42,35.7,6.98,42,Medica,Medica Advantage Solution,20.916,49.8,,percent of total billed charges,,
"Radiologic Examination, Abdomen; 2 Views (Pro Cah)Professional Component ",,74019,CPT,Professional,Both,,,26,42,35.7,6.98,42,Medica,Medical Assistance,8.06,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Radiologic Examination, Abdomen; 2 Views (Pro Cah)Professional Component ",,74019,CPT,Professional,Both,,,26,42,35.7,6.98,42,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,11.01,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Radiologic Examination, Abdomen; 2 Views (Pro Cah)Professional Component ",,74019,CPT,Professional,Both,,,26,42,35.7,6.98,42,"Multiplan, Inc.","Multiplan, Inc.",39.48,94,,percent of total billed charges,,
"Radiologic Examination, Abdomen; 2 Views (Pro Cah)Professional Component ",,74019,CPT,Professional,Both,,,26,42,35.7,6.98,42,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,37.842,90.1,,percent of total billed charges,,
"Radiologic Examination, Abdomen; 2 Views (Pro Cah)Professional Component ",,74019,CPT,Professional,Both,,,26,42,35.7,6.98,42,"Preferred One Administrative Services, INC.",PPO,41.412,98.6,,percent of total billed charges,,
"Radiologic Examination, Abdomen; 2 Views (Pro Cah)Professional Component ",,74019,CPT,Professional,Both,,,26,42,35.7,6.98,42,PrimeWest Health,Minnesota Senior Health Options (MSHO),12.6615,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Radiologic Examination, Abdomen; 2 Views (Pro Cah)Professional Component ",,74019,CPT,Professional,Both,,,26,42,35.7,6.98,42,PrimeWest Health,MinnesotaCare,8.6208616,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Radiologic Examination, Abdomen; 2 Views (Pro Cah)Professional Component ",,74019,CPT,Professional,Both,,,26,42,35.7,6.98,42,Sanford Health Plan,Sanford Health Plan,36.96,88,,percent of total billed charges,,
"Radiologic Examination, Abdomen; 2 Views (Pro Cah)Professional Component ",,74019,CPT,Professional,Both,,,26,42,35.7,6.98,42,"UCare Health, Inc.",Individual & Family Plan,17.897856,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Radiologic Examination, Abdomen; 2 Views (Pro Cah)Professional Component ",,74019,CPT,Professional,Both,,,26,42,35.7,6.98,42,"UCare Health, Inc.",Medical Assistance,8.862568,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Radiologic Examination, Abdomen; 2 Views (Pro Cah)Professional Component ",,74019,CPT,Professional,Both,,,26,42,35.7,6.98,42,"UCare Health, Inc.",Medicare Advantage,12.6615,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Radiologic Examination, Abdomen; 2 Views (Pro Cah)Professional Component ",,74019,CPT,Professional,Both,,,26,42,35.7,6.98,42,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),10.1292,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Radiologic Examination, Abdomen; 2 Views (Pro Cah)Professional Component ",,74019,CPT,Professional,Both,,,26,42,35.7,6.98,42,UnitedHealthcare,Individual & Family,42,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Radiologic Examination, Abdomen; 2 Views (Pro Cah)Professional Component ",,74019,CPT,Professional,Both,,,26,42,35.7,6.98,42,UnitedHealthcare,Medicare Advantage,12.6615,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Radiologic Examination, Abdomen; 2 Views (Pro Cah)Professional Component ",,74019,CPT,Professional,Both,,,26,42,35.7,6.98,42,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,8.05688,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Abdomen; 3 Or More Views (Pro Cah)Professional Component ,,74021,CPT,Professional,Both,,,26,85,72.25,8.07,85,Aetna,Commercial,72.25,85,,percent of total billed charges,,
Xr Abdomen; 3 Or More Views (Pro Cah)Professional Component ,,74021,CPT,Professional,Both,,,26,85,72.25,8.07,85,Aetna,Medicare Advantage,13.08,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Abdomen; 3 Or More Views (Pro Cah)Professional Component ,,74021,CPT,Professional,Both,,,26,85,72.25,8.07,85,Aetna,PPO,79.05,93,,percent of total billed charges,,
Xr Abdomen; 3 Or More Views (Pro Cah)Professional Component ,,74021,CPT,Professional,Both,,,26,85,72.25,8.07,85,America's PPO,America's PPO,72.624,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Xr Abdomen; 3 Or More Views (Pro Cah)Professional Component ,,74021,CPT,Professional,Both,,,26,85,72.25,8.07,85,BlueCross BlueShield Minnesota, Federal Employee Program,24.29,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Xr Abdomen; 3 Or More Views (Pro Cah)Professional Component ,,74021,CPT,Professional,Both,,,26,85,72.25,8.07,85,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,24.67864,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Abdomen; 3 Or More Views (Pro Cah)Professional Component ,,74021,CPT,Professional,Both,,,26,85,72.25,8.07,85,BlueCross BlueShield Minnesota,High Value Network Plan,24.67864,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Abdomen; 3 Or More Views (Pro Cah)Professional Component ,,74021,CPT,Professional,Both,,,26,85,72.25,8.07,85,BlueCross BlueShield Minnesota,Medicare Advantage,14.6165,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Abdomen; 3 Or More Views (Pro Cah)Professional Component ,,74021,CPT,Professional,Both,,,26,85,72.25,8.07,85,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,24.67864,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Abdomen; 3 Or More Views (Pro Cah)Professional Component ,,74021,CPT,Professional,Both,,,26,85,72.25,8.07,85,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,9.31672,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Abdomen; 3 Or More Views (Pro Cah)Professional Component ,,74021,CPT,Professional,Both,,,26,85,72.25,8.07,85,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),14.6165,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Abdomen; 3 Or More Views (Pro Cah)Professional Component ,,74021,CPT,Professional,Both,,,26,85,72.25,8.07,85,CorVel,Worker's Compensation,25.1773311,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Xr Abdomen; 3 Or More Views (Pro Cah)Professional Component ,,74021,CPT,Professional,Both,,,26,85,72.25,8.07,85,First Health Group Corporation,First Health Network,82.45,97,,percent of total billed charges,,
Xr Abdomen; 3 Or More Views (Pro Cah)Professional Component ,,74021,CPT,Professional,Both,,,26,85,72.25,8.07,85,"Health Partners, Inc.",Commercial,19.08,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Xr Abdomen; 3 Or More Views (Pro Cah)Professional Component ,,74021,CPT,Professional,Both,,,26,85,72.25,8.07,85,"Health Partners, Inc.",Medicare Advantage,14.6165,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Abdomen; 3 Or More Views (Pro Cah)Professional Component ,,74021,CPT,Professional,Both,,,26,85,72.25,8.07,85,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),8.07,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Xr Abdomen; 3 Or More Views (Pro Cah)Professional Component ,,74021,CPT,Professional,Both,,,26,85,72.25,8.07,85,"Health Partners, Inc.",State of Minnesota Advantage Program,16.43742,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Xr Abdomen; 3 Or More Views (Pro Cah)Professional Component ,,74021,CPT,Professional,Both,,,26,85,72.25,8.07,85,"Health Partners, Inc.",State Public Programs,8.07,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Xr Abdomen; 3 Or More Views (Pro Cah)Professional Component ,,74021,CPT,Professional,Both,,,26,85,72.25,8.07,85,Humana Insurance Company,Commercial PPO,12.71,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Xr Abdomen; 3 Or More Views (Pro Cah)Professional Component ,,74021,CPT,Professional,Both,,,26,85,72.25,8.07,85,Humana Insurance Company,Medicare PPO,85,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Xr Abdomen; 3 Or More Views (Pro Cah)Professional Component ,,74021,CPT,Professional,Both,,,26,85,72.25,8.07,85,Medica,Individual & Family,72.08,84.8,,percent of total billed charges,,
Xr Abdomen; 3 Or More Views (Pro Cah)Professional Component ,,74021,CPT,Professional,Both,,,26,85,72.25,8.07,85,Medica,Medica Advantage Solution,42.33,49.8,,percent of total billed charges,,
Xr Abdomen; 3 Or More Views (Pro Cah)Professional Component ,,74021,CPT,Professional,Both,,,26,85,72.25,8.07,85,Medica,Medical Assistance,9.32,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Xr Abdomen; 3 Or More Views (Pro Cah)Professional Component ,,74021,CPT,Professional,Both,,,26,85,72.25,8.07,85,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,12.71,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Xr Abdomen; 3 Or More Views (Pro Cah)Professional Component ,,74021,CPT,Professional,Both,,,26,85,72.25,8.07,85,"Multiplan, Inc.","Multiplan, Inc.",79.9,94,,percent of total billed charges,,
Xr Abdomen; 3 Or More Views (Pro Cah)Professional Component ,,74021,CPT,Professional,Both,,,26,85,72.25,8.07,85,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,76.585,90.1,,percent of total billed charges,,
Xr Abdomen; 3 Or More Views (Pro Cah)Professional Component ,,74021,CPT,Professional,Both,,,26,85,72.25,8.07,85,"Preferred One Administrative Services, INC.",PPO,83.81,98.6,,percent of total billed charges,,
Xr Abdomen; 3 Or More Views (Pro Cah)Professional Component ,,74021,CPT,Professional,Both,,,26,85,72.25,8.07,85,PrimeWest Health,Minnesota Senior Health Options (MSHO),14.6165,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Abdomen; 3 Or More Views (Pro Cah)Professional Component ,,74021,CPT,Professional,Both,,,26,85,72.25,8.07,85,PrimeWest Health,MinnesotaCare,9.9688904,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Abdomen; 3 Or More Views (Pro Cah)Professional Component ,,74021,CPT,Professional,Both,,,26,85,72.25,8.07,85,Sanford Health Plan,Sanford Health Plan,74.8,88,,percent of total billed charges,,
Xr Abdomen; 3 Or More Views (Pro Cah)Professional Component ,,74021,CPT,Professional,Both,,,26,85,72.25,8.07,85,"UCare Health, Inc.",Individual & Family Plan,20.661376,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Xr Abdomen; 3 Or More Views (Pro Cah)Professional Component ,,74021,CPT,Professional,Both,,,26,85,72.25,8.07,85,"UCare Health, Inc.",Medical Assistance,10.248392,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Xr Abdomen; 3 Or More Views (Pro Cah)Professional Component ,,74021,CPT,Professional,Both,,,26,85,72.25,8.07,85,"UCare Health, Inc.",Medicare Advantage,14.6165,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Xr Abdomen; 3 Or More Views (Pro Cah)Professional Component ,,74021,CPT,Professional,Both,,,26,85,72.25,8.07,85,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),11.6932,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Xr Abdomen; 3 Or More Views (Pro Cah)Professional Component ,,74021,CPT,Professional,Both,,,26,85,72.25,8.07,85,UnitedHealthcare,Individual & Family,85,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Xr Abdomen; 3 Or More Views (Pro Cah)Professional Component ,,74021,CPT,Professional,Both,,,26,85,72.25,8.07,85,UnitedHealthcare,Medicare Advantage,14.6165,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Abdomen; 3 Or More Views (Pro Cah)Professional Component ,,74021,CPT,Professional,Both,,,26,85,72.25,8.07,85,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,9.31672,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Radiologic Exam, Complete Acute Abdomen Series, W 2 Or More Views Of Abdomn, And A Single View Chest (Pro Cah)Professional Component ",,74022,CPT,Professional,Both,,,26,76,64.6,9.59,76,Aetna,Commercial,64.6,85,,percent of total billed charges,,
"Radiologic Exam, Complete Acute Abdomen Series, W 2 Or More Views Of Abdomn, And A Single View Chest (Pro Cah)Professional Component ",,74022,CPT,Professional,Both,,,26,76,64.6,9.59,76,Aetna,Medicare Advantage,15.53,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Radiologic Exam, Complete Acute Abdomen Series, W 2 Or More Views Of Abdomn, And A Single View Chest (Pro Cah)Professional Component ",,74022,CPT,Professional,Both,,,26,76,64.6,9.59,76,Aetna,PPO,70.68,93,,percent of total billed charges,,
"Radiologic Exam, Complete Acute Abdomen Series, W 2 Or More Views Of Abdomn, And A Single View Chest (Pro Cah)Professional Component ",,74022,CPT,Professional,Both,,,26,76,64.6,9.59,76,America's PPO,America's PPO,64.9344,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Radiologic Exam, Complete Acute Abdomen Series, W 2 Or More Views Of Abdomn, And A Single View Chest (Pro Cah)Professional Component ",,74022,CPT,Professional,Both,,,26,76,64.6,9.59,76,BlueCross BlueShield Minnesota, Federal Employee Program,29.4,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Radiologic Exam, Complete Acute Abdomen Series, W 2 Or More Views Of Abdomn, And A Single View Chest (Pro Cah)Professional Component ",,74022,CPT,Professional,Both,,,26,76,64.6,9.59,76,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,29.8704,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Radiologic Exam, Complete Acute Abdomen Series, W 2 Or More Views Of Abdomn, And A Single View Chest (Pro Cah)Professional Component ",,74022,CPT,Professional,Both,,,26,76,64.6,9.59,76,BlueCross BlueShield Minnesota,High Value Network Plan,29.8704,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Radiologic Exam, Complete Acute Abdomen Series, W 2 Or More Views Of Abdomn, And A Single View Chest (Pro Cah)Professional Component ",,74022,CPT,Professional,Both,,,26,76,64.6,9.59,76,BlueCross BlueShield Minnesota,Medicare Advantage,17.4915,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Radiologic Exam, Complete Acute Abdomen Series, W 2 Or More Views Of Abdomn, And A Single View Chest (Pro Cah)Professional Component ",,74022,CPT,Professional,Both,,,26,76,64.6,9.59,76,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,29.8704,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Radiologic Exam, Complete Acute Abdomen Series, W 2 Or More Views Of Abdomn, And A Single View Chest (Pro Cah)Professional Component ",,74022,CPT,Professional,Both,,,26,76,64.6,9.59,76,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,11.0744,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Radiologic Exam, Complete Acute Abdomen Series, W 2 Or More Views Of Abdomn, And A Single View Chest (Pro Cah)Professional Component ",,74022,CPT,Professional,Both,,,26,76,64.6,9.59,76,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),17.4915,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Radiologic Exam, Complete Acute Abdomen Series, W 2 Or More Views Of Abdomn, And A Single View Chest (Pro Cah)Professional Component ",,74022,CPT,Professional,Both,,,26,76,64.6,9.59,76,CorVel,Worker's Compensation,29.8966953,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Radiologic Exam, Complete Acute Abdomen Series, W 2 Or More Views Of Abdomn, And A Single View Chest (Pro Cah)Professional Component ",,74022,CPT,Professional,Both,,,26,76,64.6,9.59,76,First Health Group Corporation,First Health Network,73.72,97,,percent of total billed charges,,
"Radiologic Exam, Complete Acute Abdomen Series, W 2 Or More Views Of Abdomn, And A Single View Chest (Pro Cah)Professional Component ",,74022,CPT,Professional,Both,,,26,76,64.6,9.59,76,"Health Partners, Inc.",Commercial,22.69,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Radiologic Exam, Complete Acute Abdomen Series, W 2 Or More Views Of Abdomn, And A Single View Chest (Pro Cah)Professional Component ",,74022,CPT,Professional,Both,,,26,76,64.6,9.59,76,"Health Partners, Inc.",Medicare Advantage,17.4915,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Radiologic Exam, Complete Acute Abdomen Series, W 2 Or More Views Of Abdomn, And A Single View Chest (Pro Cah)Professional Component ",,74022,CPT,Professional,Both,,,26,76,64.6,9.59,76,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),9.59,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Radiologic Exam, Complete Acute Abdomen Series, W 2 Or More Views Of Abdomn, And A Single View Chest (Pro Cah)Professional Component ",,74022,CPT,Professional,Both,,,26,76,64.6,9.59,76,"Health Partners, Inc.",State of Minnesota Advantage Program,19.547435,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Radiologic Exam, Complete Acute Abdomen Series, W 2 Or More Views Of Abdomn, And A Single View Chest (Pro Cah)Professional Component ",,74022,CPT,Professional,Both,,,26,76,64.6,9.59,76,"Health Partners, Inc.",State Public Programs,9.59,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Radiologic Exam, Complete Acute Abdomen Series, W 2 Or More Views Of Abdomn, And A Single View Chest (Pro Cah)Professional Component ",,74022,CPT,Professional,Both,,,26,76,64.6,9.59,76,Humana Insurance Company,Commercial PPO,15.21,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Radiologic Exam, Complete Acute Abdomen Series, W 2 Or More Views Of Abdomn, And A Single View Chest (Pro Cah)Professional Component ",,74022,CPT,Professional,Both,,,26,76,64.6,9.59,76,Humana Insurance Company,Medicare PPO,76,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Radiologic Exam, Complete Acute Abdomen Series, W 2 Or More Views Of Abdomn, And A Single View Chest (Pro Cah)Professional Component ",,74022,CPT,Professional,Both,,,26,76,64.6,9.59,76,Medica,Individual & Family,64.448,84.8,,percent of total billed charges,,
"Radiologic Exam, Complete Acute Abdomen Series, W 2 Or More Views Of Abdomn, And A Single View Chest (Pro Cah)Professional Component ",,74022,CPT,Professional,Both,,,26,76,64.6,9.59,76,Medica,Medica Advantage Solution,37.848,49.8,,percent of total billed charges,,
"Radiologic Exam, Complete Acute Abdomen Series, W 2 Or More Views Of Abdomn, And A Single View Chest (Pro Cah)Professional Component ",,74022,CPT,Professional,Both,,,26,76,64.6,9.59,76,Medica,Medical Assistance,11.07,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Radiologic Exam, Complete Acute Abdomen Series, W 2 Or More Views Of Abdomn, And A Single View Chest (Pro Cah)Professional Component ",,74022,CPT,Professional,Both,,,26,76,64.6,9.59,76,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,15.21,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Radiologic Exam, Complete Acute Abdomen Series, W 2 Or More Views Of Abdomn, And A Single View Chest (Pro Cah)Professional Component ",,74022,CPT,Professional,Both,,,26,76,64.6,9.59,76,"Multiplan, Inc.","Multiplan, Inc.",71.44,94,,percent of total billed charges,,
"Radiologic Exam, Complete Acute Abdomen Series, W 2 Or More Views Of Abdomn, And A Single View Chest (Pro Cah)Professional Component ",,74022,CPT,Professional,Both,,,26,76,64.6,9.59,76,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,68.476,90.1,,percent of total billed charges,,
"Radiologic Exam, Complete Acute Abdomen Series, W 2 Or More Views Of Abdomn, And A Single View Chest (Pro Cah)Professional Component ",,74022,CPT,Professional,Both,,,26,76,64.6,9.59,76,"Preferred One Administrative Services, INC.",PPO,74.936,98.6,,percent of total billed charges,,
"Radiologic Exam, Complete Acute Abdomen Series, W 2 Or More Views Of Abdomn, And A Single View Chest (Pro Cah)Professional Component ",,74022,CPT,Professional,Both,,,26,76,64.6,9.59,76,PrimeWest Health,Minnesota Senior Health Options (MSHO),17.4915,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Radiologic Exam, Complete Acute Abdomen Series, W 2 Or More Views Of Abdomn, And A Single View Chest (Pro Cah)Professional Component ",,74022,CPT,Professional,Both,,,26,76,64.6,9.59,76,PrimeWest Health,MinnesotaCare,11.849608,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Radiologic Exam, Complete Acute Abdomen Series, W 2 Or More Views Of Abdomn, And A Single View Chest (Pro Cah)Professional Component ",,74022,CPT,Professional,Both,,,26,76,64.6,9.59,76,Sanford Health Plan,Sanford Health Plan,66.88,88,,percent of total billed charges,,
"Radiologic Exam, Complete Acute Abdomen Series, W 2 Or More Views Of Abdomn, And A Single View Chest (Pro Cah)Professional Component ",,74022,CPT,Professional,Both,,,26,76,64.6,9.59,76,"UCare Health, Inc.",Individual & Family Plan,24.725376,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Radiologic Exam, Complete Acute Abdomen Series, W 2 Or More Views Of Abdomn, And A Single View Chest (Pro Cah)Professional Component ",,74022,CPT,Professional,Both,,,26,76,64.6,9.59,76,"UCare Health, Inc.",Medical Assistance,12.18184,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Radiologic Exam, Complete Acute Abdomen Series, W 2 Or More Views Of Abdomn, And A Single View Chest (Pro Cah)Professional Component ",,74022,CPT,Professional,Both,,,26,76,64.6,9.59,76,"UCare Health, Inc.",Medicare Advantage,17.4915,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Radiologic Exam, Complete Acute Abdomen Series, W 2 Or More Views Of Abdomn, And A Single View Chest (Pro Cah)Professional Component ",,74022,CPT,Professional,Both,,,26,76,64.6,9.59,76,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),13.9932,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Radiologic Exam, Complete Acute Abdomen Series, W 2 Or More Views Of Abdomn, And A Single View Chest (Pro Cah)Professional Component ",,74022,CPT,Professional,Both,,,26,76,64.6,9.59,76,UnitedHealthcare,Individual & Family,76,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Radiologic Exam, Complete Acute Abdomen Series, W 2 Or More Views Of Abdomn, And A Single View Chest (Pro Cah)Professional Component ",,74022,CPT,Professional,Both,,,26,76,64.6,9.59,76,UnitedHealthcare,Medicare Advantage,17.4915,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Radiologic Exam, Complete Acute Abdomen Series, W 2 Or More Views Of Abdomn, And A Single View Chest (Pro Cah)Professional Component ",,74022,CPT,Professional,Both,,,26,76,64.6,9.59,76,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,11.0744,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Ct Abdomen Routine Wo Iv Contrast (Pro Cah)Professional Component ,,74150,CPT,Professional,Both,,,26,477,405.45,35.77,477,Aetna,Commercial,405.45,85,,percent of total billed charges,,
Ct Abdomen Routine Wo Iv Contrast (Pro Cah)Professional Component ,,74150,CPT,Professional,Both,,,26,477,405.45,35.77,477,Aetna,Medicare Advantage,57.34,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Abdomen Routine Wo Iv Contrast (Pro Cah)Professional Component ,,74150,CPT,Professional,Both,,,26,477,405.45,35.77,477,Aetna,PPO,443.61,93,,percent of total billed charges,,
Ct Abdomen Routine Wo Iv Contrast (Pro Cah)Professional Component ,,74150,CPT,Professional,Both,,,26,477,405.45,35.77,477,America's PPO,America's PPO,407.5488,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Ct Abdomen Routine Wo Iv Contrast (Pro Cah)Professional Component ,,74150,CPT,Professional,Both,,,26,477,405.45,35.77,477,BlueCross BlueShield Minnesota, Federal Employee Program,107.39,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Ct Abdomen Routine Wo Iv Contrast (Pro Cah)Professional Component ,,74150,CPT,Professional,Both,,,26,477,405.45,35.77,477,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,109.10824,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Ct Abdomen Routine Wo Iv Contrast (Pro Cah)Professional Component ,,74150,CPT,Professional,Both,,,26,477,405.45,35.77,477,BlueCross BlueShield Minnesota,High Value Network Plan,109.10824,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Ct Abdomen Routine Wo Iv Contrast (Pro Cah)Professional Component ,,74150,CPT,Professional,Both,,,26,477,405.45,35.77,477,BlueCross BlueShield Minnesota,Medicare Advantage,64.216,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Abdomen Routine Wo Iv Contrast (Pro Cah)Professional Component ,,74150,CPT,Professional,Both,,,26,477,405.45,35.77,477,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,109.10824,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Ct Abdomen Routine Wo Iv Contrast (Pro Cah)Professional Component ,,74150,CPT,Professional,Both,,,26,477,405.45,35.77,477,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,41.3004,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Ct Abdomen Routine Wo Iv Contrast (Pro Cah)Professional Component ,,74150,CPT,Professional,Both,,,26,477,405.45,35.77,477,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),64.216,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Abdomen Routine Wo Iv Contrast (Pro Cah)Professional Component ,,74150,CPT,Professional,Both,,,26,477,405.45,35.77,477,CorVel,Worker's Compensation,110.850651,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Ct Abdomen Routine Wo Iv Contrast (Pro Cah)Professional Component ,,74150,CPT,Professional,Both,,,26,477,405.45,35.77,477,First Health Group Corporation,First Health Network,462.69,97,,percent of total billed charges,,
Ct Abdomen Routine Wo Iv Contrast (Pro Cah)Professional Component ,,74150,CPT,Professional,Both,,,26,477,405.45,35.77,477,"Health Partners, Inc.",Commercial,85.08,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Ct Abdomen Routine Wo Iv Contrast (Pro Cah)Professional Component ,,74150,CPT,Professional,Both,,,26,477,405.45,35.77,477,"Health Partners, Inc.",Medicare Advantage,64.216,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Abdomen Routine Wo Iv Contrast (Pro Cah)Professional Component ,,74150,CPT,Professional,Both,,,26,477,405.45,35.77,477,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),35.77,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Ct Abdomen Routine Wo Iv Contrast (Pro Cah)Professional Component ,,74150,CPT,Professional,Both,,,26,477,405.45,35.77,477,"Health Partners, Inc.",State of Minnesota Advantage Program,73.29642,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Ct Abdomen Routine Wo Iv Contrast (Pro Cah)Professional Component ,,74150,CPT,Professional,Both,,,26,477,405.45,35.77,477,"Health Partners, Inc.",State Public Programs,35.77,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Ct Abdomen Routine Wo Iv Contrast (Pro Cah)Professional Component ,,74150,CPT,Professional,Both,,,26,477,405.45,35.77,477,Humana Insurance Company,Commercial PPO,55.84,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Ct Abdomen Routine Wo Iv Contrast (Pro Cah)Professional Component ,,74150,CPT,Professional,Both,,,26,477,405.45,35.77,477,Humana Insurance Company,Medicare PPO,477,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Ct Abdomen Routine Wo Iv Contrast (Pro Cah)Professional Component ,,74150,CPT,Professional,Both,,,26,477,405.45,35.77,477,Medica,Individual & Family,404.496,84.8,,percent of total billed charges,,
Ct Abdomen Routine Wo Iv Contrast (Pro Cah)Professional Component ,,74150,CPT,Professional,Both,,,26,477,405.45,35.77,477,Medica,Medica Advantage Solution,237.546,49.8,,percent of total billed charges,,
Ct Abdomen Routine Wo Iv Contrast (Pro Cah)Professional Component ,,74150,CPT,Professional,Both,,,26,477,405.45,35.77,477,Medica,Medical Assistance,41.3,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Ct Abdomen Routine Wo Iv Contrast (Pro Cah)Professional Component ,,74150,CPT,Professional,Both,,,26,477,405.45,35.77,477,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,55.84,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Ct Abdomen Routine Wo Iv Contrast (Pro Cah)Professional Component ,,74150,CPT,Professional,Both,,,26,477,405.45,35.77,477,"Multiplan, Inc.","Multiplan, Inc.",448.38,94,,percent of total billed charges,,
Ct Abdomen Routine Wo Iv Contrast (Pro Cah)Professional Component ,,74150,CPT,Professional,Both,,,26,477,405.45,35.77,477,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,429.777,90.1,,percent of total billed charges,,
Ct Abdomen Routine Wo Iv Contrast (Pro Cah)Professional Component ,,74150,CPT,Professional,Both,,,26,477,405.45,35.77,477,"Preferred One Administrative Services, INC.",PPO,470.322,98.6,,percent of total billed charges,,
Ct Abdomen Routine Wo Iv Contrast (Pro Cah)Professional Component ,,74150,CPT,Professional,Both,,,26,477,405.45,35.77,477,PrimeWest Health,Minnesota Senior Health Options (MSHO),64.216,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Abdomen Routine Wo Iv Contrast (Pro Cah)Professional Component ,,74150,CPT,Professional,Both,,,26,477,405.45,35.77,477,PrimeWest Health,MinnesotaCare,44.191428,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Ct Abdomen Routine Wo Iv Contrast (Pro Cah)Professional Component ,,74150,CPT,Professional,Both,,,26,477,405.45,35.77,477,Sanford Health Plan,Sanford Health Plan,419.76,88,,percent of total billed charges,,
Ct Abdomen Routine Wo Iv Contrast (Pro Cah)Professional Component ,,74150,CPT,Professional,Both,,,26,477,405.45,35.77,477,"UCare Health, Inc.",Individual & Family Plan,90.773504,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Ct Abdomen Routine Wo Iv Contrast (Pro Cah)Professional Component ,,74150,CPT,Professional,Both,,,26,477,405.45,35.77,477,"UCare Health, Inc.",Medical Assistance,45.43044,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Ct Abdomen Routine Wo Iv Contrast (Pro Cah)Professional Component ,,74150,CPT,Professional,Both,,,26,477,405.45,35.77,477,"UCare Health, Inc.",Medicare Advantage,64.216,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Ct Abdomen Routine Wo Iv Contrast (Pro Cah)Professional Component ,,74150,CPT,Professional,Both,,,26,477,405.45,35.77,477,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),51.3728,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Ct Abdomen Routine Wo Iv Contrast (Pro Cah)Professional Component ,,74150,CPT,Professional,Both,,,26,477,405.45,35.77,477,UnitedHealthcare,Individual & Family,477,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Ct Abdomen Routine Wo Iv Contrast (Pro Cah)Professional Component ,,74150,CPT,Professional,Both,,,26,477,405.45,35.77,477,UnitedHealthcare,Medicare Advantage,64.216,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Abdomen Routine Wo Iv Contrast (Pro Cah)Professional Component ,,74150,CPT,Professional,Both,,,26,477,405.45,35.77,477,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,41.3004,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Ct Abdomen W Iv Contrast (Pro Cah)Professional Component ,,74160,CPT,Professional,Both,,,26,392,333.2,38.39,392,Aetna,Commercial,333.2,85,,percent of total billed charges,,
Ct Abdomen W Iv Contrast (Pro Cah)Professional Component ,,74160,CPT,Professional,Both,,,26,392,333.2,38.39,392,Aetna,Medicare Advantage,61.19,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Abdomen W Iv Contrast (Pro Cah)Professional Component ,,74160,CPT,Professional,Both,,,26,392,333.2,38.39,392,Aetna,PPO,364.56,93,,percent of total billed charges,,
Ct Abdomen W Iv Contrast (Pro Cah)Professional Component ,,74160,CPT,Professional,Both,,,26,392,333.2,38.39,392,America's PPO,America's PPO,334.9248,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Ct Abdomen W Iv Contrast (Pro Cah)Professional Component ,,74160,CPT,Professional,Both,,,26,392,333.2,38.39,392,BlueCross BlueShield Minnesota, Federal Employee Program,115.06,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Ct Abdomen W Iv Contrast (Pro Cah)Professional Component ,,74160,CPT,Professional,Both,,,26,392,333.2,38.39,392,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,116.90096,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Ct Abdomen W Iv Contrast (Pro Cah)Professional Component ,,74160,CPT,Professional,Both,,,26,392,333.2,38.39,392,BlueCross BlueShield Minnesota,High Value Network Plan,116.90096,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Ct Abdomen W Iv Contrast (Pro Cah)Professional Component ,,74160,CPT,Professional,Both,,,26,392,333.2,38.39,392,BlueCross BlueShield Minnesota,Medicare Advantage,68.6435,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Abdomen W Iv Contrast (Pro Cah)Professional Component ,,74160,CPT,Professional,Both,,,26,392,333.2,38.39,392,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,116.90096,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Ct Abdomen W Iv Contrast (Pro Cah)Professional Component ,,74160,CPT,Professional,Both,,,26,392,333.2,38.39,392,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,44.32808,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Ct Abdomen W Iv Contrast (Pro Cah)Professional Component ,,74160,CPT,Professional,Both,,,26,392,333.2,38.39,392,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),68.6435,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Abdomen W Iv Contrast (Pro Cah)Professional Component ,,74160,CPT,Professional,Both,,,26,392,333.2,38.39,392,CorVel,Worker's Compensation,118.2655473,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Ct Abdomen W Iv Contrast (Pro Cah)Professional Component ,,74160,CPT,Professional,Both,,,26,392,333.2,38.39,392,First Health Group Corporation,First Health Network,380.24,97,,percent of total billed charges,,
Ct Abdomen W Iv Contrast (Pro Cah)Professional Component ,,74160,CPT,Professional,Both,,,26,392,333.2,38.39,392,"Health Partners, Inc.",Commercial,90.75,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Ct Abdomen W Iv Contrast (Pro Cah)Professional Component ,,74160,CPT,Professional,Both,,,26,392,333.2,38.39,392,"Health Partners, Inc.",Medicare Advantage,68.6435,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Abdomen W Iv Contrast (Pro Cah)Professional Component ,,74160,CPT,Professional,Both,,,26,392,333.2,38.39,392,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),38.39,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Ct Abdomen W Iv Contrast (Pro Cah)Professional Component ,,74160,CPT,Professional,Both,,,26,392,333.2,38.39,392,"Health Partners, Inc.",State of Minnesota Advantage Program,78.181125,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Ct Abdomen W Iv Contrast (Pro Cah)Professional Component ,,74160,CPT,Professional,Both,,,26,392,333.2,38.39,392,"Health Partners, Inc.",State Public Programs,38.39,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Ct Abdomen W Iv Contrast (Pro Cah)Professional Component ,,74160,CPT,Professional,Both,,,26,392,333.2,38.39,392,Humana Insurance Company,Commercial PPO,59.69,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Ct Abdomen W Iv Contrast (Pro Cah)Professional Component ,,74160,CPT,Professional,Both,,,26,392,333.2,38.39,392,Humana Insurance Company,Medicare PPO,392,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Ct Abdomen W Iv Contrast (Pro Cah)Professional Component ,,74160,CPT,Professional,Both,,,26,392,333.2,38.39,392,Medica,Individual & Family,332.416,84.8,,percent of total billed charges,,
Ct Abdomen W Iv Contrast (Pro Cah)Professional Component ,,74160,CPT,Professional,Both,,,26,392,333.2,38.39,392,Medica,Medica Advantage Solution,195.216,49.8,,percent of total billed charges,,
Ct Abdomen W Iv Contrast (Pro Cah)Professional Component ,,74160,CPT,Professional,Both,,,26,392,333.2,38.39,392,Medica,Medical Assistance,44.33,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Ct Abdomen W Iv Contrast (Pro Cah)Professional Component ,,74160,CPT,Professional,Both,,,26,392,333.2,38.39,392,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,59.69,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Ct Abdomen W Iv Contrast (Pro Cah)Professional Component ,,74160,CPT,Professional,Both,,,26,392,333.2,38.39,392,"Multiplan, Inc.","Multiplan, Inc.",368.48,94,,percent of total billed charges,,
Ct Abdomen W Iv Contrast (Pro Cah)Professional Component ,,74160,CPT,Professional,Both,,,26,392,333.2,38.39,392,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,353.192,90.1,,percent of total billed charges,,
Ct Abdomen W Iv Contrast (Pro Cah)Professional Component ,,74160,CPT,Professional,Both,,,26,392,333.2,38.39,392,"Preferred One Administrative Services, INC.",PPO,386.512,98.6,,percent of total billed charges,,
Ct Abdomen W Iv Contrast (Pro Cah)Professional Component ,,74160,CPT,Professional,Both,,,26,392,333.2,38.39,392,PrimeWest Health,Minnesota Senior Health Options (MSHO),68.6435,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Abdomen W Iv Contrast (Pro Cah)Professional Component ,,74160,CPT,Professional,Both,,,26,392,333.2,38.39,392,PrimeWest Health,MinnesotaCare,47.4310456,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Ct Abdomen W Iv Contrast (Pro Cah)Professional Component ,,74160,CPT,Professional,Both,,,26,392,333.2,38.39,392,Sanford Health Plan,Sanford Health Plan,344.96,88,,percent of total billed charges,,
Ct Abdomen W Iv Contrast (Pro Cah)Professional Component ,,74160,CPT,Professional,Both,,,26,392,333.2,38.39,392,"UCare Health, Inc.",Individual & Family Plan,97.032064,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Ct Abdomen W Iv Contrast (Pro Cah)Professional Component ,,74160,CPT,Professional,Both,,,26,392,333.2,38.39,392,"UCare Health, Inc.",Medical Assistance,48.760888,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Ct Abdomen W Iv Contrast (Pro Cah)Professional Component ,,74160,CPT,Professional,Both,,,26,392,333.2,38.39,392,"UCare Health, Inc.",Medicare Advantage,68.6435,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Ct Abdomen W Iv Contrast (Pro Cah)Professional Component ,,74160,CPT,Professional,Both,,,26,392,333.2,38.39,392,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),54.9148,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Ct Abdomen W Iv Contrast (Pro Cah)Professional Component ,,74160,CPT,Professional,Both,,,26,392,333.2,38.39,392,UnitedHealthcare,Individual & Family,392,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Ct Abdomen W Iv Contrast (Pro Cah)Professional Component ,,74160,CPT,Professional,Both,,,26,392,333.2,38.39,392,UnitedHealthcare,Medicare Advantage,68.6435,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Abdomen W Iv Contrast (Pro Cah)Professional Component ,,74160,CPT,Professional,Both,,,26,392,333.2,38.39,392,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,44.32808,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Ct Abd Wo W Iv Contrast (Pro Cah)Professional Component ,,74170,CPT,Professional,Both,,,26,444,377.4,42.1,444,Aetna,Commercial,377.4,85,,percent of total billed charges,,
Ct Abd Wo W Iv Contrast (Pro Cah)Professional Component ,,74170,CPT,Professional,Both,,,26,444,377.4,42.1,444,Aetna,Medicare Advantage,67.26,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Abd Wo W Iv Contrast (Pro Cah)Professional Component ,,74170,CPT,Professional,Both,,,26,444,377.4,42.1,444,Aetna,PPO,412.92,93,,percent of total billed charges,,
Ct Abd Wo W Iv Contrast (Pro Cah)Professional Component ,,74170,CPT,Professional,Both,,,26,444,377.4,42.1,444,America's PPO,America's PPO,379.3536,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Ct Abd Wo W Iv Contrast (Pro Cah)Professional Component ,,74170,CPT,Professional,Both,,,26,444,377.4,42.1,444,BlueCross BlueShield Minnesota, Federal Employee Program,125.92,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Ct Abd Wo W Iv Contrast (Pro Cah)Professional Component ,,74170,CPT,Professional,Both,,,26,444,377.4,42.1,444,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,127.93472,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Ct Abd Wo W Iv Contrast (Pro Cah)Professional Component ,,74170,CPT,Professional,Both,,,26,444,377.4,42.1,444,BlueCross BlueShield Minnesota,High Value Network Plan,127.93472,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Ct Abd Wo W Iv Contrast (Pro Cah)Professional Component ,,74170,CPT,Professional,Both,,,26,444,377.4,42.1,444,BlueCross BlueShield Minnesota,Medicare Advantage,75.302,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Abd Wo W Iv Contrast (Pro Cah)Professional Component ,,74170,CPT,Professional,Both,,,26,444,377.4,42.1,444,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,127.93472,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Ct Abd Wo W Iv Contrast (Pro Cah)Professional Component ,,74170,CPT,Professional,Both,,,26,444,377.4,42.1,444,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,48.60544,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Ct Abd Wo W Iv Contrast (Pro Cah)Professional Component ,,74170,CPT,Professional,Both,,,26,444,377.4,42.1,444,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),75.302,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Abd Wo W Iv Contrast (Pro Cah)Professional Component ,,74170,CPT,Professional,Both,,,26,444,377.4,42.1,444,CorVel,Worker's Compensation,129.9564858,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Ct Abd Wo W Iv Contrast (Pro Cah)Professional Component ,,74170,CPT,Professional,Both,,,26,444,377.4,42.1,444,First Health Group Corporation,First Health Network,430.68,97,,percent of total billed charges,,
Ct Abd Wo W Iv Contrast (Pro Cah)Professional Component ,,74170,CPT,Professional,Both,,,26,444,377.4,42.1,444,"Health Partners, Inc.",Commercial,100.04,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Ct Abd Wo W Iv Contrast (Pro Cah)Professional Component ,,74170,CPT,Professional,Both,,,26,444,377.4,42.1,444,"Health Partners, Inc.",Medicare Advantage,75.302,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Abd Wo W Iv Contrast (Pro Cah)Professional Component ,,74170,CPT,Professional,Both,,,26,444,377.4,42.1,444,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),42.1,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Ct Abd Wo W Iv Contrast (Pro Cah)Professional Component ,,74170,CPT,Professional,Both,,,26,444,377.4,42.1,444,"Health Partners, Inc.",State of Minnesota Advantage Program,86.18446,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Ct Abd Wo W Iv Contrast (Pro Cah)Professional Component ,,74170,CPT,Professional,Both,,,26,444,377.4,42.1,444,"Health Partners, Inc.",State Public Programs,42.1,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Ct Abd Wo W Iv Contrast (Pro Cah)Professional Component ,,74170,CPT,Professional,Both,,,26,444,377.4,42.1,444,Humana Insurance Company,Commercial PPO,65.48,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Ct Abd Wo W Iv Contrast (Pro Cah)Professional Component ,,74170,CPT,Professional,Both,,,26,444,377.4,42.1,444,Humana Insurance Company,Medicare PPO,444,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Ct Abd Wo W Iv Contrast (Pro Cah)Professional Component ,,74170,CPT,Professional,Both,,,26,444,377.4,42.1,444,Medica,Individual & Family,376.512,84.8,,percent of total billed charges,,
Ct Abd Wo W Iv Contrast (Pro Cah)Professional Component ,,74170,CPT,Professional,Both,,,26,444,377.4,42.1,444,Medica,Medica Advantage Solution,221.112,49.8,,percent of total billed charges,,
Ct Abd Wo W Iv Contrast (Pro Cah)Professional Component ,,74170,CPT,Professional,Both,,,26,444,377.4,42.1,444,Medica,Medical Assistance,48.61,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Ct Abd Wo W Iv Contrast (Pro Cah)Professional Component ,,74170,CPT,Professional,Both,,,26,444,377.4,42.1,444,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,65.48,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Ct Abd Wo W Iv Contrast (Pro Cah)Professional Component ,,74170,CPT,Professional,Both,,,26,444,377.4,42.1,444,"Multiplan, Inc.","Multiplan, Inc.",417.36,94,,percent of total billed charges,,
Ct Abd Wo W Iv Contrast (Pro Cah)Professional Component ,,74170,CPT,Professional,Both,,,26,444,377.4,42.1,444,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,400.044,90.1,,percent of total billed charges,,
Ct Abd Wo W Iv Contrast (Pro Cah)Professional Component ,,74170,CPT,Professional,Both,,,26,444,377.4,42.1,444,"Preferred One Administrative Services, INC.",PPO,437.784,98.6,,percent of total billed charges,,
Ct Abd Wo W Iv Contrast (Pro Cah)Professional Component ,,74170,CPT,Professional,Both,,,26,444,377.4,42.1,444,PrimeWest Health,Minnesota Senior Health Options (MSHO),75.302,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Abd Wo W Iv Contrast (Pro Cah)Professional Component ,,74170,CPT,Professional,Both,,,26,444,377.4,42.1,444,PrimeWest Health,MinnesotaCare,52.0078208,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Ct Abd Wo W Iv Contrast (Pro Cah)Professional Component ,,74170,CPT,Professional,Both,,,26,444,377.4,42.1,444,Sanford Health Plan,Sanford Health Plan,390.72,88,,percent of total billed charges,,
Ct Abd Wo W Iv Contrast (Pro Cah)Professional Component ,,74170,CPT,Professional,Both,,,26,444,377.4,42.1,444,"UCare Health, Inc.",Individual & Family Plan,106.444288,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Ct Abd Wo W Iv Contrast (Pro Cah)Professional Component ,,74170,CPT,Professional,Both,,,26,444,377.4,42.1,444,"UCare Health, Inc.",Medical Assistance,53.465984,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Ct Abd Wo W Iv Contrast (Pro Cah)Professional Component ,,74170,CPT,Professional,Both,,,26,444,377.4,42.1,444,"UCare Health, Inc.",Medicare Advantage,75.302,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Ct Abd Wo W Iv Contrast (Pro Cah)Professional Component ,,74170,CPT,Professional,Both,,,26,444,377.4,42.1,444,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),60.2416,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Ct Abd Wo W Iv Contrast (Pro Cah)Professional Component ,,74170,CPT,Professional,Both,,,26,444,377.4,42.1,444,UnitedHealthcare,Individual & Family,444,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Ct Abd Wo W Iv Contrast (Pro Cah)Professional Component ,,74170,CPT,Professional,Both,,,26,444,377.4,42.1,444,UnitedHealthcare,Medicare Advantage,75.302,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Abd Wo W Iv Contrast (Pro Cah)Professional Component ,,74170,CPT,Professional,Both,,,26,444,377.4,42.1,444,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,48.60544,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Cta Abdomen And Pelvis, W/Contrast, W/Noncontrast Image (Pro Cah)Professional Component ",,74174,CPT,Professional,Both,,,26,642,545.7,65.88,642,Aetna,Commercial,545.7,85,,percent of total billed charges,,
"Cta Abdomen And Pelvis, W/Contrast, W/Noncontrast Image (Pro Cah)Professional Component ",,74174,CPT,Professional,Both,,,26,642,545.7,65.88,642,Aetna,Medicare Advantage,104.98,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Cta Abdomen And Pelvis, W/Contrast, W/Noncontrast Image (Pro Cah)Professional Component ",,74174,CPT,Professional,Both,,,26,642,545.7,65.88,642,Aetna,PPO,597.06,93,,percent of total billed charges,,
"Cta Abdomen And Pelvis, W/Contrast, W/Noncontrast Image (Pro Cah)Professional Component ",,74174,CPT,Professional,Both,,,26,642,545.7,65.88,642,America's PPO,America's PPO,548.5248,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Cta Abdomen And Pelvis, W/Contrast, W/Noncontrast Image (Pro Cah)Professional Component ",,74174,CPT,Professional,Both,,,26,642,545.7,65.88,642,BlueCross BlueShield Minnesota, Federal Employee Program,197.51,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Cta Abdomen And Pelvis, W/Contrast, W/Noncontrast Image (Pro Cah)Professional Component ",,74174,CPT,Professional,Both,,,26,642,545.7,65.88,642,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,200.67016,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Cta Abdomen And Pelvis, W/Contrast, W/Noncontrast Image (Pro Cah)Professional Component ",,74174,CPT,Professional,Both,,,26,642,545.7,65.88,642,BlueCross BlueShield Minnesota,High Value Network Plan,200.67016,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Cta Abdomen And Pelvis, W/Contrast, W/Noncontrast Image (Pro Cah)Professional Component ",,74174,CPT,Professional,Both,,,26,642,545.7,65.88,642,BlueCross BlueShield Minnesota,Medicare Advantage,117.8405,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Cta Abdomen And Pelvis, W/Contrast, W/Noncontrast Image (Pro Cah)Professional Component ",,74174,CPT,Professional,Both,,,26,642,545.7,65.88,642,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,200.67016,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Cta Abdomen And Pelvis, W/Contrast, W/Noncontrast Image (Pro Cah)Professional Component ",,74174,CPT,Professional,Both,,,26,642,545.7,65.88,642,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,76.05776,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Cta Abdomen And Pelvis, W/Contrast, W/Noncontrast Image (Pro Cah)Professional Component ",,74174,CPT,Professional,Both,,,26,642,545.7,65.88,642,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),117.8405,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Cta Abdomen And Pelvis, W/Contrast, W/Noncontrast Image (Pro Cah)Professional Component ",,74174,CPT,Professional,Both,,,26,642,545.7,65.88,642,CorVel,Worker's Compensation,202.0950507,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Cta Abdomen And Pelvis, W/Contrast, W/Noncontrast Image (Pro Cah)Professional Component ",,74174,CPT,Professional,Both,,,26,642,545.7,65.88,642,First Health Group Corporation,First Health Network,622.74,97,,percent of total billed charges,,
"Cta Abdomen And Pelvis, W/Contrast, W/Noncontrast Image (Pro Cah)Professional Component ",,74174,CPT,Professional,Both,,,26,642,545.7,65.88,642,"Health Partners, Inc.",Commercial,155.2,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Cta Abdomen And Pelvis, W/Contrast, W/Noncontrast Image (Pro Cah)Professional Component ",,74174,CPT,Professional,Both,,,26,642,545.7,65.88,642,"Health Partners, Inc.",Medicare Advantage,117.8405,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Cta Abdomen And Pelvis, W/Contrast, W/Noncontrast Image (Pro Cah)Professional Component ",,74174,CPT,Professional,Both,,,26,642,545.7,65.88,642,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),65.88,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Cta Abdomen And Pelvis, W/Contrast, W/Noncontrast Image (Pro Cah)Professional Component ",,74174,CPT,Professional,Both,,,26,642,545.7,65.88,642,"Health Partners, Inc.",State of Minnesota Advantage Program,133.7048,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Cta Abdomen And Pelvis, W/Contrast, W/Noncontrast Image (Pro Cah)Professional Component ",,74174,CPT,Professional,Both,,,26,642,545.7,65.88,642,"Health Partners, Inc.",State Public Programs,65.88,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Cta Abdomen And Pelvis, W/Contrast, W/Noncontrast Image (Pro Cah)Professional Component ",,74174,CPT,Professional,Both,,,26,642,545.7,65.88,642,Humana Insurance Company,Commercial PPO,102.47,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Cta Abdomen And Pelvis, W/Contrast, W/Noncontrast Image (Pro Cah)Professional Component ",,74174,CPT,Professional,Both,,,26,642,545.7,65.88,642,Humana Insurance Company,Medicare PPO,642,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Cta Abdomen And Pelvis, W/Contrast, W/Noncontrast Image (Pro Cah)Professional Component ",,74174,CPT,Professional,Both,,,26,642,545.7,65.88,642,Medica,Individual & Family,544.416,84.8,,percent of total billed charges,,
"Cta Abdomen And Pelvis, W/Contrast, W/Noncontrast Image (Pro Cah)Professional Component ",,74174,CPT,Professional,Both,,,26,642,545.7,65.88,642,Medica,Medica Advantage Solution,319.716,49.8,,percent of total billed charges,,
"Cta Abdomen And Pelvis, W/Contrast, W/Noncontrast Image (Pro Cah)Professional Component ",,74174,CPT,Professional,Both,,,26,642,545.7,65.88,642,Medica,Medical Assistance,76.06,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Cta Abdomen And Pelvis, W/Contrast, W/Noncontrast Image (Pro Cah)Professional Component ",,74174,CPT,Professional,Both,,,26,642,545.7,65.88,642,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,102.47,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Cta Abdomen And Pelvis, W/Contrast, W/Noncontrast Image (Pro Cah)Professional Component ",,74174,CPT,Professional,Both,,,26,642,545.7,65.88,642,"Multiplan, Inc.","Multiplan, Inc.",603.48,94,,percent of total billed charges,,
"Cta Abdomen And Pelvis, W/Contrast, W/Noncontrast Image (Pro Cah)Professional Component ",,74174,CPT,Professional,Both,,,26,642,545.7,65.88,642,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,578.442,90.1,,percent of total billed charges,,
"Cta Abdomen And Pelvis, W/Contrast, W/Noncontrast Image (Pro Cah)Professional Component ",,74174,CPT,Professional,Both,,,26,642,545.7,65.88,642,"Preferred One Administrative Services, INC.",PPO,633.012,98.6,,percent of total billed charges,,
"Cta Abdomen And Pelvis, W/Contrast, W/Noncontrast Image (Pro Cah)Professional Component ",,74174,CPT,Professional,Both,,,26,642,545.7,65.88,642,PrimeWest Health,Minnesota Senior Health Options (MSHO),117.8405,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Cta Abdomen And Pelvis, W/Contrast, W/Noncontrast Image (Pro Cah)Professional Component ",,74174,CPT,Professional,Both,,,26,642,545.7,65.88,642,PrimeWest Health,MinnesotaCare,81.3818032,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Cta Abdomen And Pelvis, W/Contrast, W/Noncontrast Image (Pro Cah)Professional Component ",,74174,CPT,Professional,Both,,,26,642,545.7,65.88,642,Sanford Health Plan,Sanford Health Plan,564.96,88,,percent of total billed charges,,
"Cta Abdomen And Pelvis, W/Contrast, W/Noncontrast Image (Pro Cah)Professional Component ",,74174,CPT,Professional,Both,,,26,642,545.7,65.88,642,"UCare Health, Inc.",Individual & Family Plan,166.575232,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Cta Abdomen And Pelvis, W/Contrast, W/Noncontrast Image (Pro Cah)Professional Component ",,74174,CPT,Professional,Both,,,26,642,545.7,65.88,642,"UCare Health, Inc.",Medical Assistance,83.663536,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Cta Abdomen And Pelvis, W/Contrast, W/Noncontrast Image (Pro Cah)Professional Component ",,74174,CPT,Professional,Both,,,26,642,545.7,65.88,642,"UCare Health, Inc.",Medicare Advantage,117.8405,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Cta Abdomen And Pelvis, W/Contrast, W/Noncontrast Image (Pro Cah)Professional Component ",,74174,CPT,Professional,Both,,,26,642,545.7,65.88,642,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),94.2724,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Cta Abdomen And Pelvis, W/Contrast, W/Noncontrast Image (Pro Cah)Professional Component ",,74174,CPT,Professional,Both,,,26,642,545.7,65.88,642,UnitedHealthcare,Individual & Family,642,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Cta Abdomen And Pelvis, W/Contrast, W/Noncontrast Image (Pro Cah)Professional Component ",,74174,CPT,Professional,Both,,,26,642,545.7,65.88,642,UnitedHealthcare,Medicare Advantage,117.8405,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Cta Abdomen And Pelvis, W/Contrast, W/Noncontrast Image (Pro Cah)Professional Component ",,74174,CPT,Professional,Both,,,26,642,545.7,65.88,642,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,76.05776,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Cta Abdomen (Pro Cah)Professional Component ,,74175,CPT,Professional,Both,,,26,573,487.05,54.53,573,Aetna,Commercial,487.05,85,,percent of total billed charges,,
Cta Abdomen (Pro Cah)Professional Component ,,74175,CPT,Professional,Both,,,26,573,487.05,54.53,573,Aetna,Medicare Advantage,87.24,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Cta Abdomen (Pro Cah)Professional Component ,,74175,CPT,Professional,Both,,,26,573,487.05,54.53,573,Aetna,PPO,532.89,93,,percent of total billed charges,,
Cta Abdomen (Pro Cah)Professional Component ,,74175,CPT,Professional,Both,,,26,573,487.05,54.53,573,America's PPO,America's PPO,489.5712,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Cta Abdomen (Pro Cah)Professional Component ,,74175,CPT,Professional,Both,,,26,573,487.05,54.53,573,BlueCross BlueShield Minnesota, Federal Employee Program,163.64,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Cta Abdomen (Pro Cah)Professional Component ,,74175,CPT,Professional,Both,,,26,573,487.05,54.53,573,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,166.25824,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Cta Abdomen (Pro Cah)Professional Component ,,74175,CPT,Professional,Both,,,26,573,487.05,54.53,573,BlueCross BlueShield Minnesota,High Value Network Plan,166.25824,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Cta Abdomen (Pro Cah)Professional Component ,,74175,CPT,Professional,Both,,,26,573,487.05,54.53,573,BlueCross BlueShield Minnesota,Medicare Advantage,97.612,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Cta Abdomen (Pro Cah)Professional Component ,,74175,CPT,Professional,Both,,,26,573,487.05,54.53,573,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,166.25824,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Cta Abdomen (Pro Cah)Professional Component ,,74175,CPT,Professional,Both,,,26,573,487.05,54.53,573,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,62.96152,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Cta Abdomen (Pro Cah)Professional Component ,,74175,CPT,Professional,Both,,,26,573,487.05,54.53,573,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),97.612,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Cta Abdomen (Pro Cah)Professional Component ,,74175,CPT,Professional,Both,,,26,573,487.05,54.53,573,CorVel,Worker's Compensation,167.2506132,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Cta Abdomen (Pro Cah)Professional Component ,,74175,CPT,Professional,Both,,,26,573,487.05,54.53,573,First Health Group Corporation,First Health Network,555.81,97,,percent of total billed charges,,
Cta Abdomen (Pro Cah)Professional Component ,,74175,CPT,Professional,Both,,,26,573,487.05,54.53,573,"Health Partners, Inc.",Commercial,128.39,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Cta Abdomen (Pro Cah)Professional Component ,,74175,CPT,Professional,Both,,,26,573,487.05,54.53,573,"Health Partners, Inc.",Medicare Advantage,97.612,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Cta Abdomen (Pro Cah)Professional Component ,,74175,CPT,Professional,Both,,,26,573,487.05,54.53,573,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),54.53,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Cta Abdomen (Pro Cah)Professional Component ,,74175,CPT,Professional,Both,,,26,573,487.05,54.53,573,"Health Partners, Inc.",State of Minnesota Advantage Program,110.607985,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Cta Abdomen (Pro Cah)Professional Component ,,74175,CPT,Professional,Both,,,26,573,487.05,54.53,573,"Health Partners, Inc.",State Public Programs,54.53,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Cta Abdomen (Pro Cah)Professional Component ,,74175,CPT,Professional,Both,,,26,573,487.05,54.53,573,Humana Insurance Company,Commercial PPO,84.88,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Cta Abdomen (Pro Cah)Professional Component ,,74175,CPT,Professional,Both,,,26,573,487.05,54.53,573,Humana Insurance Company,Medicare PPO,573,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Cta Abdomen (Pro Cah)Professional Component ,,74175,CPT,Professional,Both,,,26,573,487.05,54.53,573,Medica,Individual & Family,485.904,84.8,,percent of total billed charges,,
Cta Abdomen (Pro Cah)Professional Component ,,74175,CPT,Professional,Both,,,26,573,487.05,54.53,573,Medica,Medica Advantage Solution,285.354,49.8,,percent of total billed charges,,
Cta Abdomen (Pro Cah)Professional Component ,,74175,CPT,Professional,Both,,,26,573,487.05,54.53,573,Medica,Medical Assistance,62.96,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Cta Abdomen (Pro Cah)Professional Component ,,74175,CPT,Professional,Both,,,26,573,487.05,54.53,573,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,84.88,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Cta Abdomen (Pro Cah)Professional Component ,,74175,CPT,Professional,Both,,,26,573,487.05,54.53,573,"Multiplan, Inc.","Multiplan, Inc.",538.62,94,,percent of total billed charges,,
Cta Abdomen (Pro Cah)Professional Component ,,74175,CPT,Professional,Both,,,26,573,487.05,54.53,573,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,516.273,90.1,,percent of total billed charges,,
Cta Abdomen (Pro Cah)Professional Component ,,74175,CPT,Professional,Both,,,26,573,487.05,54.53,573,"Preferred One Administrative Services, INC.",PPO,564.978,98.6,,percent of total billed charges,,
Cta Abdomen (Pro Cah)Professional Component ,,74175,CPT,Professional,Both,,,26,573,487.05,54.53,573,PrimeWest Health,Minnesota Senior Health Options (MSHO),97.612,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Cta Abdomen (Pro Cah)Professional Component ,,74175,CPT,Professional,Both,,,26,573,487.05,54.53,573,PrimeWest Health,MinnesotaCare,67.3688264,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Cta Abdomen (Pro Cah)Professional Component ,,74175,CPT,Professional,Both,,,26,573,487.05,54.53,573,Sanford Health Plan,Sanford Health Plan,504.24,88,,percent of total billed charges,,
Cta Abdomen (Pro Cah)Professional Component ,,74175,CPT,Professional,Both,,,26,573,487.05,54.53,573,"UCare Health, Inc.",Individual & Family Plan,137.980928,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Cta Abdomen (Pro Cah)Professional Component ,,74175,CPT,Professional,Both,,,26,573,487.05,54.53,573,"UCare Health, Inc.",Medical Assistance,69.257672,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Cta Abdomen (Pro Cah)Professional Component ,,74175,CPT,Professional,Both,,,26,573,487.05,54.53,573,"UCare Health, Inc.",Medicare Advantage,97.612,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Cta Abdomen (Pro Cah)Professional Component ,,74175,CPT,Professional,Both,,,26,573,487.05,54.53,573,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),78.0896,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Cta Abdomen (Pro Cah)Professional Component ,,74175,CPT,Professional,Both,,,26,573,487.05,54.53,573,UnitedHealthcare,Individual & Family,573,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Cta Abdomen (Pro Cah)Professional Component ,,74175,CPT,Professional,Both,,,26,573,487.05,54.53,573,UnitedHealthcare,Medicare Advantage,97.612,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Cta Abdomen (Pro Cah)Professional Component ,,74175,CPT,Professional,Both,,,26,573,487.05,54.53,573,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,62.96152,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Ct Abd And Pelvis Without Iv Contrast(Pro Cah)Professional Component ,,74176,CPT,Professional,Both,,,26,636,540.6,52.57,636,Aetna,Commercial,540.6,85,,percent of total billed charges,,
Ct Abd And Pelvis Without Iv Contrast(Pro Cah)Professional Component ,,74176,CPT,Professional,Both,,,26,636,540.6,52.57,636,Aetna,Medicare Advantage,84.09,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Abd And Pelvis Without Iv Contrast(Pro Cah)Professional Component ,,74176,CPT,Professional,Both,,,26,636,540.6,52.57,636,Aetna,PPO,591.48,93,,percent of total billed charges,,
Ct Abd And Pelvis Without Iv Contrast(Pro Cah)Professional Component ,,74176,CPT,Professional,Both,,,26,636,540.6,52.57,636,America's PPO,America's PPO,543.3984,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Ct Abd And Pelvis Without Iv Contrast(Pro Cah)Professional Component ,,74176,CPT,Professional,Both,,,26,636,540.6,52.57,636,BlueCross BlueShield Minnesota, Federal Employee Program,157.88,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Ct Abd And Pelvis Without Iv Contrast(Pro Cah)Professional Component ,,74176,CPT,Professional,Both,,,26,636,540.6,52.57,636,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,160.40608,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Ct Abd And Pelvis Without Iv Contrast(Pro Cah)Professional Component ,,74176,CPT,Professional,Both,,,26,636,540.6,52.57,636,BlueCross BlueShield Minnesota,High Value Network Plan,160.40608,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Ct Abd And Pelvis Without Iv Contrast(Pro Cah)Professional Component ,,74176,CPT,Professional,Both,,,26,636,540.6,52.57,636,BlueCross BlueShield Minnesota,Medicare Advantage,94.093,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Abd And Pelvis Without Iv Contrast(Pro Cah)Professional Component ,,74176,CPT,Professional,Both,,,26,636,540.6,52.57,636,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,160.40608,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Ct Abd And Pelvis Without Iv Contrast(Pro Cah)Professional Component ,,74176,CPT,Professional,Both,,,26,636,540.6,52.57,636,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,60.69584,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Ct Abd And Pelvis Without Iv Contrast(Pro Cah)Professional Component ,,74176,CPT,Professional,Both,,,26,636,540.6,52.57,636,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),94.093,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Abd And Pelvis Without Iv Contrast(Pro Cah)Professional Component ,,74176,CPT,Professional,Both,,,26,636,540.6,52.57,636,CorVel,Worker's Compensation,161.1965811,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Ct Abd And Pelvis Without Iv Contrast(Pro Cah)Professional Component ,,74176,CPT,Professional,Both,,,26,636,540.6,52.57,636,First Health Group Corporation,First Health Network,616.92,97,,percent of total billed charges,,
Ct Abd And Pelvis Without Iv Contrast(Pro Cah)Professional Component ,,74176,CPT,Professional,Both,,,26,636,540.6,52.57,636,"Health Partners, Inc.",Commercial,123.75,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Ct Abd And Pelvis Without Iv Contrast(Pro Cah)Professional Component ,,74176,CPT,Professional,Both,,,26,636,540.6,52.57,636,"Health Partners, Inc.",Medicare Advantage,94.093,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Abd And Pelvis Without Iv Contrast(Pro Cah)Professional Component ,,74176,CPT,Professional,Both,,,26,636,540.6,52.57,636,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),52.57,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Ct Abd And Pelvis Without Iv Contrast(Pro Cah)Professional Component ,,74176,CPT,Professional,Both,,,26,636,540.6,52.57,636,"Health Partners, Inc.",State of Minnesota Advantage Program,106.610625,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Ct Abd And Pelvis Without Iv Contrast(Pro Cah)Professional Component ,,74176,CPT,Professional,Both,,,26,636,540.6,52.57,636,"Health Partners, Inc.",State Public Programs,52.57,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Ct Abd And Pelvis Without Iv Contrast(Pro Cah)Professional Component ,,74176,CPT,Professional,Both,,,26,636,540.6,52.57,636,Humana Insurance Company,Commercial PPO,81.82,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Ct Abd And Pelvis Without Iv Contrast(Pro Cah)Professional Component ,,74176,CPT,Professional,Both,,,26,636,540.6,52.57,636,Humana Insurance Company,Medicare PPO,636,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Ct Abd And Pelvis Without Iv Contrast(Pro Cah)Professional Component ,,74176,CPT,Professional,Both,,,26,636,540.6,52.57,636,Medica,Individual & Family,539.328,84.8,,percent of total billed charges,,
Ct Abd And Pelvis Without Iv Contrast(Pro Cah)Professional Component ,,74176,CPT,Professional,Both,,,26,636,540.6,52.57,636,Medica,Medica Advantage Solution,316.728,49.8,,percent of total billed charges,,
Ct Abd And Pelvis Without Iv Contrast(Pro Cah)Professional Component ,,74176,CPT,Professional,Both,,,26,636,540.6,52.57,636,Medica,Medical Assistance,60.7,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Ct Abd And Pelvis Without Iv Contrast(Pro Cah)Professional Component ,,74176,CPT,Professional,Both,,,26,636,540.6,52.57,636,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,81.82,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Ct Abd And Pelvis Without Iv Contrast(Pro Cah)Professional Component ,,74176,CPT,Professional,Both,,,26,636,540.6,52.57,636,"Multiplan, Inc.","Multiplan, Inc.",597.84,94,,percent of total billed charges,,
Ct Abd And Pelvis Without Iv Contrast(Pro Cah)Professional Component ,,74176,CPT,Professional,Both,,,26,636,540.6,52.57,636,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,573.036,90.1,,percent of total billed charges,,
Ct Abd And Pelvis Without Iv Contrast(Pro Cah)Professional Component ,,74176,CPT,Professional,Both,,,26,636,540.6,52.57,636,"Preferred One Administrative Services, INC.",PPO,627.096,98.6,,percent of total billed charges,,
Ct Abd And Pelvis Without Iv Contrast(Pro Cah)Professional Component ,,74176,CPT,Professional,Both,,,26,636,540.6,52.57,636,PrimeWest Health,Minnesota Senior Health Options (MSHO),94.093,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Abd And Pelvis Without Iv Contrast(Pro Cah)Professional Component ,,74176,CPT,Professional,Both,,,26,636,540.6,52.57,636,PrimeWest Health,MinnesotaCare,64.9445488,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Ct Abd And Pelvis Without Iv Contrast(Pro Cah)Professional Component ,,74176,CPT,Professional,Both,,,26,636,540.6,52.57,636,Sanford Health Plan,Sanford Health Plan,559.68,88,,percent of total billed charges,,
Ct Abd And Pelvis Without Iv Contrast(Pro Cah)Professional Component ,,74176,CPT,Professional,Both,,,26,636,540.6,52.57,636,"UCare Health, Inc.",Individual & Family Plan,133.006592,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Ct Abd And Pelvis Without Iv Contrast(Pro Cah)Professional Component ,,74176,CPT,Professional,Both,,,26,636,540.6,52.57,636,"UCare Health, Inc.",Medical Assistance,66.765424,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Ct Abd And Pelvis Without Iv Contrast(Pro Cah)Professional Component ,,74176,CPT,Professional,Both,,,26,636,540.6,52.57,636,"UCare Health, Inc.",Medicare Advantage,94.093,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Ct Abd And Pelvis Without Iv Contrast(Pro Cah)Professional Component ,,74176,CPT,Professional,Both,,,26,636,540.6,52.57,636,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),75.2744,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Ct Abd And Pelvis Without Iv Contrast(Pro Cah)Professional Component ,,74176,CPT,Professional,Both,,,26,636,540.6,52.57,636,UnitedHealthcare,Individual & Family,636,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Ct Abd And Pelvis Without Iv Contrast(Pro Cah)Professional Component ,,74176,CPT,Professional,Both,,,26,636,540.6,52.57,636,UnitedHealthcare,Medicare Advantage,94.093,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Abd And Pelvis Without Iv Contrast(Pro Cah)Professional Component ,,74176,CPT,Professional,Both,,,26,636,540.6,52.57,636,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,60.69584,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Ct Abd And Pelvis With Iv Contrast (Pro Cah)Professional Component ,,74177,CPT,Professional,Both,,,26,513,436.05,54.97,513,Aetna,Commercial,436.05,85,,percent of total billed charges,,
Ct Abd And Pelvis With Iv Contrast (Pro Cah)Professional Component ,,74177,CPT,Professional,Both,,,26,513,436.05,54.97,513,Aetna,Medicare Advantage,87.94,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Abd And Pelvis With Iv Contrast (Pro Cah)Professional Component ,,74177,CPT,Professional,Both,,,26,513,436.05,54.97,513,Aetna,PPO,477.09,93,,percent of total billed charges,,
Ct Abd And Pelvis With Iv Contrast (Pro Cah)Professional Component ,,74177,CPT,Professional,Both,,,26,513,436.05,54.97,513,America's PPO,America's PPO,438.3072,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Ct Abd And Pelvis With Iv Contrast (Pro Cah)Professional Component ,,74177,CPT,Professional,Both,,,26,513,436.05,54.97,513,BlueCross BlueShield Minnesota, Federal Employee Program,164.91,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Ct Abd And Pelvis With Iv Contrast (Pro Cah)Professional Component ,,74177,CPT,Professional,Both,,,26,513,436.05,54.97,513,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,167.54856,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Ct Abd And Pelvis With Iv Contrast (Pro Cah)Professional Component ,,74177,CPT,Professional,Both,,,26,513,436.05,54.97,513,BlueCross BlueShield Minnesota,High Value Network Plan,167.54856,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Ct Abd And Pelvis With Iv Contrast (Pro Cah)Professional Component ,,74177,CPT,Professional,Both,,,26,513,436.05,54.97,513,BlueCross BlueShield Minnesota,Medicare Advantage,98.4055,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Abd And Pelvis With Iv Contrast (Pro Cah)Professional Component ,,74177,CPT,Professional,Both,,,26,513,436.05,54.97,513,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,167.54856,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Ct Abd And Pelvis With Iv Contrast (Pro Cah)Professional Component ,,74177,CPT,Professional,Both,,,26,513,436.05,54.97,513,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,63.46952,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Ct Abd And Pelvis With Iv Contrast (Pro Cah)Professional Component ,,74177,CPT,Professional,Both,,,26,513,436.05,54.97,513,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),98.4055,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Abd And Pelvis With Iv Contrast (Pro Cah)Professional Component ,,74177,CPT,Professional,Both,,,26,513,436.05,54.97,513,CorVel,Worker's Compensation,169.2919095,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Ct Abd And Pelvis With Iv Contrast (Pro Cah)Professional Component ,,74177,CPT,Professional,Both,,,26,513,436.05,54.97,513,First Health Group Corporation,First Health Network,497.61,97,,percent of total billed charges,,
Ct Abd And Pelvis With Iv Contrast (Pro Cah)Professional Component ,,74177,CPT,Professional,Both,,,26,513,436.05,54.97,513,"Health Partners, Inc.",Commercial,129.94,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Ct Abd And Pelvis With Iv Contrast (Pro Cah)Professional Component ,,74177,CPT,Professional,Both,,,26,513,436.05,54.97,513,"Health Partners, Inc.",Medicare Advantage,98.4055,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Abd And Pelvis With Iv Contrast (Pro Cah)Professional Component ,,74177,CPT,Professional,Both,,,26,513,436.05,54.97,513,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),54.97,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Ct Abd And Pelvis With Iv Contrast (Pro Cah)Professional Component ,,74177,CPT,Professional,Both,,,26,513,436.05,54.97,513,"Health Partners, Inc.",State of Minnesota Advantage Program,111.94331,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Ct Abd And Pelvis With Iv Contrast (Pro Cah)Professional Component ,,74177,CPT,Professional,Both,,,26,513,436.05,54.97,513,"Health Partners, Inc.",State Public Programs,54.97,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Ct Abd And Pelvis With Iv Contrast (Pro Cah)Professional Component ,,74177,CPT,Professional,Both,,,26,513,436.05,54.97,513,Humana Insurance Company,Commercial PPO,85.57,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Ct Abd And Pelvis With Iv Contrast (Pro Cah)Professional Component ,,74177,CPT,Professional,Both,,,26,513,436.05,54.97,513,Humana Insurance Company,Medicare PPO,513,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Ct Abd And Pelvis With Iv Contrast (Pro Cah)Professional Component ,,74177,CPT,Professional,Both,,,26,513,436.05,54.97,513,Medica,Individual & Family,435.024,84.8,,percent of total billed charges,,
Ct Abd And Pelvis With Iv Contrast (Pro Cah)Professional Component ,,74177,CPT,Professional,Both,,,26,513,436.05,54.97,513,Medica,Medica Advantage Solution,255.474,49.8,,percent of total billed charges,,
Ct Abd And Pelvis With Iv Contrast (Pro Cah)Professional Component ,,74177,CPT,Professional,Both,,,26,513,436.05,54.97,513,Medica,Medical Assistance,63.47,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Ct Abd And Pelvis With Iv Contrast (Pro Cah)Professional Component ,,74177,CPT,Professional,Both,,,26,513,436.05,54.97,513,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,85.57,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Ct Abd And Pelvis With Iv Contrast (Pro Cah)Professional Component ,,74177,CPT,Professional,Both,,,26,513,436.05,54.97,513,"Multiplan, Inc.","Multiplan, Inc.",482.22,94,,percent of total billed charges,,
Ct Abd And Pelvis With Iv Contrast (Pro Cah)Professional Component ,,74177,CPT,Professional,Both,,,26,513,436.05,54.97,513,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,462.213,90.1,,percent of total billed charges,,
Ct Abd And Pelvis With Iv Contrast (Pro Cah)Professional Component ,,74177,CPT,Professional,Both,,,26,513,436.05,54.97,513,"Preferred One Administrative Services, INC.",PPO,505.818,98.6,,percent of total billed charges,,
Ct Abd And Pelvis With Iv Contrast (Pro Cah)Professional Component ,,74177,CPT,Professional,Both,,,26,513,436.05,54.97,513,PrimeWest Health,Minnesota Senior Health Options (MSHO),98.4055,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Abd And Pelvis With Iv Contrast (Pro Cah)Professional Component ,,74177,CPT,Professional,Both,,,26,513,436.05,54.97,513,PrimeWest Health,MinnesotaCare,67.9123864,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Ct Abd And Pelvis With Iv Contrast (Pro Cah)Professional Component ,,74177,CPT,Professional,Both,,,26,513,436.05,54.97,513,Sanford Health Plan,Sanford Health Plan,451.44,88,,percent of total billed charges,,
Ct Abd And Pelvis With Iv Contrast (Pro Cah)Professional Component ,,74177,CPT,Professional,Both,,,26,513,436.05,54.97,513,"UCare Health, Inc.",Individual & Family Plan,139.102592,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Ct Abd And Pelvis With Iv Contrast (Pro Cah)Professional Component ,,74177,CPT,Professional,Both,,,26,513,436.05,54.97,513,"UCare Health, Inc.",Medical Assistance,69.816472,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Ct Abd And Pelvis With Iv Contrast (Pro Cah)Professional Component ,,74177,CPT,Professional,Both,,,26,513,436.05,54.97,513,"UCare Health, Inc.",Medicare Advantage,98.4055,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Ct Abd And Pelvis With Iv Contrast (Pro Cah)Professional Component ,,74177,CPT,Professional,Both,,,26,513,436.05,54.97,513,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),78.7244,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Ct Abd And Pelvis With Iv Contrast (Pro Cah)Professional Component ,,74177,CPT,Professional,Both,,,26,513,436.05,54.97,513,UnitedHealthcare,Individual & Family,513,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Ct Abd And Pelvis With Iv Contrast (Pro Cah)Professional Component ,,74177,CPT,Professional,Both,,,26,513,436.05,54.97,513,UnitedHealthcare,Medicare Advantage,98.4055,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Abd And Pelvis With Iv Contrast (Pro Cah)Professional Component ,,74177,CPT,Professional,Both,,,26,513,436.05,54.97,513,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,63.46952,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Ct Abd And Pelvis Wo W Iv Contrast (Pro Cah)Professional Component ,,74178,CPT,Professional,Both,,,26,703,597.55,60.42,703,Aetna,Commercial,597.55,85,,percent of total billed charges,,
Ct Abd And Pelvis Wo W Iv Contrast (Pro Cah)Professional Component ,,74178,CPT,Professional,Both,,,26,703,597.55,60.42,703,Aetna,Medicare Advantage,96.69,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Abd And Pelvis Wo W Iv Contrast (Pro Cah)Professional Component ,,74178,CPT,Professional,Both,,,26,703,597.55,60.42,703,Aetna,PPO,653.79,93,,percent of total billed charges,,
Ct Abd And Pelvis Wo W Iv Contrast (Pro Cah)Professional Component ,,74178,CPT,Professional,Both,,,26,703,597.55,60.42,703,America's PPO,America's PPO,600.6432,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Ct Abd And Pelvis Wo W Iv Contrast (Pro Cah)Professional Component ,,74178,CPT,Professional,Both,,,26,703,597.55,60.42,703,BlueCross BlueShield Minnesota, Federal Employee Program,180.89,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Ct Abd And Pelvis Wo W Iv Contrast (Pro Cah)Professional Component ,,74178,CPT,Professional,Both,,,26,703,597.55,60.42,703,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,183.78424,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Ct Abd And Pelvis Wo W Iv Contrast (Pro Cah)Professional Component ,,74178,CPT,Professional,Both,,,26,703,597.55,60.42,703,BlueCross BlueShield Minnesota,High Value Network Plan,183.78424,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Ct Abd And Pelvis Wo W Iv Contrast (Pro Cah)Professional Component ,,74178,CPT,Professional,Both,,,26,703,597.55,60.42,703,BlueCross BlueShield Minnesota,Medicare Advantage,108.192,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Abd And Pelvis Wo W Iv Contrast (Pro Cah)Professional Component ,,74178,CPT,Professional,Both,,,26,703,597.55,60.42,703,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,183.78424,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Ct Abd And Pelvis Wo W Iv Contrast (Pro Cah)Professional Component ,,74178,CPT,Professional,Both,,,26,703,597.55,60.42,703,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,69.75856,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Ct Abd And Pelvis Wo W Iv Contrast (Pro Cah)Professional Component ,,74178,CPT,Professional,Both,,,26,703,597.55,60.42,703,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),108.192,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Abd And Pelvis Wo W Iv Contrast (Pro Cah)Professional Component ,,74178,CPT,Professional,Both,,,26,703,597.55,60.42,703,CorVel,Worker's Compensation,186.1368021,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Ct Abd And Pelvis Wo W Iv Contrast (Pro Cah)Professional Component ,,74178,CPT,Professional,Both,,,26,703,597.55,60.42,703,First Health Group Corporation,First Health Network,681.91,97,,percent of total billed charges,,
Ct Abd And Pelvis Wo W Iv Contrast (Pro Cah)Professional Component ,,74178,CPT,Professional,Both,,,26,703,597.55,60.42,703,"Health Partners, Inc.",Commercial,142.83,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Ct Abd And Pelvis Wo W Iv Contrast (Pro Cah)Professional Component ,,74178,CPT,Professional,Both,,,26,703,597.55,60.42,703,"Health Partners, Inc.",Medicare Advantage,108.192,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Abd And Pelvis Wo W Iv Contrast (Pro Cah)Professional Component ,,74178,CPT,Professional,Both,,,26,703,597.55,60.42,703,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),60.42,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Ct Abd And Pelvis Wo W Iv Contrast (Pro Cah)Professional Component ,,74178,CPT,Professional,Both,,,26,703,597.55,60.42,703,"Health Partners, Inc.",State of Minnesota Advantage Program,123.048045,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Ct Abd And Pelvis Wo W Iv Contrast (Pro Cah)Professional Component ,,74178,CPT,Professional,Both,,,26,703,597.55,60.42,703,"Health Partners, Inc.",State Public Programs,60.42,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Ct Abd And Pelvis Wo W Iv Contrast (Pro Cah)Professional Component ,,74178,CPT,Professional,Both,,,26,703,597.55,60.42,703,Humana Insurance Company,Commercial PPO,94.08,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Ct Abd And Pelvis Wo W Iv Contrast (Pro Cah)Professional Component ,,74178,CPT,Professional,Both,,,26,703,597.55,60.42,703,Humana Insurance Company,Medicare PPO,703,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Ct Abd And Pelvis Wo W Iv Contrast (Pro Cah)Professional Component ,,74178,CPT,Professional,Both,,,26,703,597.55,60.42,703,Medica,Individual & Family,596.144,84.8,,percent of total billed charges,,
Ct Abd And Pelvis Wo W Iv Contrast (Pro Cah)Professional Component ,,74178,CPT,Professional,Both,,,26,703,597.55,60.42,703,Medica,Medica Advantage Solution,350.094,49.8,,percent of total billed charges,,
Ct Abd And Pelvis Wo W Iv Contrast (Pro Cah)Professional Component ,,74178,CPT,Professional,Both,,,26,703,597.55,60.42,703,Medica,Medical Assistance,69.76,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Ct Abd And Pelvis Wo W Iv Contrast (Pro Cah)Professional Component ,,74178,CPT,Professional,Both,,,26,703,597.55,60.42,703,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,94.08,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Ct Abd And Pelvis Wo W Iv Contrast (Pro Cah)Professional Component ,,74178,CPT,Professional,Both,,,26,703,597.55,60.42,703,"Multiplan, Inc.","Multiplan, Inc.",660.82,94,,percent of total billed charges,,
Ct Abd And Pelvis Wo W Iv Contrast (Pro Cah)Professional Component ,,74178,CPT,Professional,Both,,,26,703,597.55,60.42,703,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,633.403,90.1,,percent of total billed charges,,
Ct Abd And Pelvis Wo W Iv Contrast (Pro Cah)Professional Component ,,74178,CPT,Professional,Both,,,26,703,597.55,60.42,703,"Preferred One Administrative Services, INC.",PPO,693.158,98.6,,percent of total billed charges,,
Ct Abd And Pelvis Wo W Iv Contrast (Pro Cah)Professional Component ,,74178,CPT,Professional,Both,,,26,703,597.55,60.42,703,PrimeWest Health,Minnesota Senior Health Options (MSHO),108.192,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Abd And Pelvis Wo W Iv Contrast (Pro Cah)Professional Component ,,74178,CPT,Professional,Both,,,26,703,597.55,60.42,703,PrimeWest Health,MinnesotaCare,74.6416592,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Ct Abd And Pelvis Wo W Iv Contrast (Pro Cah)Professional Component ,,74178,CPT,Professional,Both,,,26,703,597.55,60.42,703,Sanford Health Plan,Sanford Health Plan,618.64,88,,percent of total billed charges,,
Ct Abd And Pelvis Wo W Iv Contrast (Pro Cah)Professional Component ,,74178,CPT,Professional,Both,,,26,703,597.55,60.42,703,"UCare Health, Inc.",Individual & Family Plan,152.936448,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Ct Abd And Pelvis Wo W Iv Contrast (Pro Cah)Professional Component ,,74178,CPT,Professional,Both,,,26,703,597.55,60.42,703,"UCare Health, Inc.",Medical Assistance,76.734416,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Ct Abd And Pelvis Wo W Iv Contrast (Pro Cah)Professional Component ,,74178,CPT,Professional,Both,,,26,703,597.55,60.42,703,"UCare Health, Inc.",Medicare Advantage,108.192,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Ct Abd And Pelvis Wo W Iv Contrast (Pro Cah)Professional Component ,,74178,CPT,Professional,Both,,,26,703,597.55,60.42,703,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),86.5536,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Ct Abd And Pelvis Wo W Iv Contrast (Pro Cah)Professional Component ,,74178,CPT,Professional,Both,,,26,703,597.55,60.42,703,UnitedHealthcare,Individual & Family,703,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Ct Abd And Pelvis Wo W Iv Contrast (Pro Cah)Professional Component ,,74178,CPT,Professional,Both,,,26,703,597.55,60.42,703,UnitedHealthcare,Medicare Advantage,108.192,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ct Abd And Pelvis Wo W Iv Contrast (Pro Cah)Professional Component ,,74178,CPT,Professional,Both,,,26,703,597.55,60.42,703,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,69.75856,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Mri Abdomen; Without Contrast Material(S) (Pro Cah)Professional Component ,,74181,CPT,Professional,Both,,,26,743,631.55,43.84,743,Aetna,Commercial,631.55,85,,percent of total billed charges,,
Mri Abdomen; Without Contrast Material(S) (Pro Cah)Professional Component ,,74181,CPT,Professional,Both,,,26,743,631.55,43.84,743,Aetna,Medicare Advantage,70.06,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Mri Abdomen; Without Contrast Material(S) (Pro Cah)Professional Component ,,74181,CPT,Professional,Both,,,26,743,631.55,43.84,743,Aetna,PPO,690.99,93,,percent of total billed charges,,
Mri Abdomen; Without Contrast Material(S) (Pro Cah)Professional Component ,,74181,CPT,Professional,Both,,,26,743,631.55,43.84,743,America's PPO,America's PPO,634.8192,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Mri Abdomen; Without Contrast Material(S) (Pro Cah)Professional Component ,,74181,CPT,Professional,Both,,,26,743,631.55,43.84,743,BlueCross BlueShield Minnesota, Federal Employee Program,131.68,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Mri Abdomen; Without Contrast Material(S) (Pro Cah)Professional Component ,,74181,CPT,Professional,Both,,,26,743,631.55,43.84,743,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,133.78688,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Mri Abdomen; Without Contrast Material(S) (Pro Cah)Professional Component ,,74181,CPT,Professional,Both,,,26,743,631.55,43.84,743,BlueCross BlueShield Minnesota,High Value Network Plan,133.78688,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Mri Abdomen; Without Contrast Material(S) (Pro Cah)Professional Component ,,74181,CPT,Professional,Both,,,26,743,631.55,43.84,743,BlueCross BlueShield Minnesota,Medicare Advantage,78.959,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Mri Abdomen; Without Contrast Material(S) (Pro Cah)Professional Component ,,74181,CPT,Professional,Both,,,26,743,631.55,43.84,743,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,133.78688,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Mri Abdomen; Without Contrast Material(S) (Pro Cah)Professional Component ,,74181,CPT,Professional,Both,,,26,743,631.55,43.84,743,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,50.61712,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Mri Abdomen; Without Contrast Material(S) (Pro Cah)Professional Component ,,74181,CPT,Professional,Both,,,26,743,631.55,43.84,743,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),78.959,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Mri Abdomen; Without Contrast Material(S) (Pro Cah)Professional Component ,,74181,CPT,Professional,Both,,,26,743,631.55,43.84,743,CorVel,Worker's Compensation,135.34755,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Mri Abdomen; Without Contrast Material(S) (Pro Cah)Professional Component ,,74181,CPT,Professional,Both,,,26,743,631.55,43.84,743,First Health Group Corporation,First Health Network,720.71,97,,percent of total billed charges,,
Mri Abdomen; Without Contrast Material(S) (Pro Cah)Professional Component ,,74181,CPT,Professional,Both,,,26,743,631.55,43.84,743,"Health Partners, Inc.",Commercial,104.16,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Mri Abdomen; Without Contrast Material(S) (Pro Cah)Professional Component ,,74181,CPT,Professional,Both,,,26,743,631.55,43.84,743,"Health Partners, Inc.",Medicare Advantage,78.959,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Mri Abdomen; Without Contrast Material(S) (Pro Cah)Professional Component ,,74181,CPT,Professional,Both,,,26,743,631.55,43.84,743,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),43.84,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Mri Abdomen; Without Contrast Material(S) (Pro Cah)Professional Component ,,74181,CPT,Professional,Both,,,26,743,631.55,43.84,743,"Health Partners, Inc.",State of Minnesota Advantage Program,89.73384,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Mri Abdomen; Without Contrast Material(S) (Pro Cah)Professional Component ,,74181,CPT,Professional,Both,,,26,743,631.55,43.84,743,"Health Partners, Inc.",State Public Programs,43.84,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Mri Abdomen; Without Contrast Material(S) (Pro Cah)Professional Component ,,74181,CPT,Professional,Both,,,26,743,631.55,43.84,743,Humana Insurance Company,Commercial PPO,68.66,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Mri Abdomen; Without Contrast Material(S) (Pro Cah)Professional Component ,,74181,CPT,Professional,Both,,,26,743,631.55,43.84,743,Humana Insurance Company,Medicare PPO,743,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Mri Abdomen; Without Contrast Material(S) (Pro Cah)Professional Component ,,74181,CPT,Professional,Both,,,26,743,631.55,43.84,743,Medica,Individual & Family,630.064,84.8,,percent of total billed charges,,
Mri Abdomen; Without Contrast Material(S) (Pro Cah)Professional Component ,,74181,CPT,Professional,Both,,,26,743,631.55,43.84,743,Medica,Medica Advantage Solution,370.014,49.8,,percent of total billed charges,,
Mri Abdomen; Without Contrast Material(S) (Pro Cah)Professional Component ,,74181,CPT,Professional,Both,,,26,743,631.55,43.84,743,Medica,Medical Assistance,50.62,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Mri Abdomen; Without Contrast Material(S) (Pro Cah)Professional Component ,,74181,CPT,Professional,Both,,,26,743,631.55,43.84,743,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,68.66,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Mri Abdomen; Without Contrast Material(S) (Pro Cah)Professional Component ,,74181,CPT,Professional,Both,,,26,743,631.55,43.84,743,"Multiplan, Inc.","Multiplan, Inc.",698.42,94,,percent of total billed charges,,
Mri Abdomen; Without Contrast Material(S) (Pro Cah)Professional Component ,,74181,CPT,Professional,Both,,,26,743,631.55,43.84,743,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,669.443,90.1,,percent of total billed charges,,
Mri Abdomen; Without Contrast Material(S) (Pro Cah)Professional Component ,,74181,CPT,Professional,Both,,,26,743,631.55,43.84,743,"Preferred One Administrative Services, INC.",PPO,732.598,98.6,,percent of total billed charges,,
Mri Abdomen; Without Contrast Material(S) (Pro Cah)Professional Component ,,74181,CPT,Professional,Both,,,26,743,631.55,43.84,743,PrimeWest Health,Minnesota Senior Health Options (MSHO),78.959,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Mri Abdomen; Without Contrast Material(S) (Pro Cah)Professional Component ,,74181,CPT,Professional,Both,,,26,743,631.55,43.84,743,PrimeWest Health,MinnesotaCare,54.1603184,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Mri Abdomen; Without Contrast Material(S) (Pro Cah)Professional Component ,,74181,CPT,Professional,Both,,,26,743,631.55,43.84,743,Sanford Health Plan,Sanford Health Plan,653.84,88,,percent of total billed charges,,
Mri Abdomen; Without Contrast Material(S) (Pro Cah)Professional Component ,,74181,CPT,Professional,Both,,,26,743,631.55,43.84,743,"UCare Health, Inc.",Individual & Family Plan,111.613696,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Mri Abdomen; Without Contrast Material(S) (Pro Cah)Professional Component ,,74181,CPT,Professional,Both,,,26,743,631.55,43.84,743,"UCare Health, Inc.",Medical Assistance,55.678832,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Mri Abdomen; Without Contrast Material(S) (Pro Cah)Professional Component ,,74181,CPT,Professional,Both,,,26,743,631.55,43.84,743,"UCare Health, Inc.",Medicare Advantage,78.959,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Mri Abdomen; Without Contrast Material(S) (Pro Cah)Professional Component ,,74181,CPT,Professional,Both,,,26,743,631.55,43.84,743,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),63.1672,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Mri Abdomen; Without Contrast Material(S) (Pro Cah)Professional Component ,,74181,CPT,Professional,Both,,,26,743,631.55,43.84,743,UnitedHealthcare,Individual & Family,743,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Mri Abdomen; Without Contrast Material(S) (Pro Cah)Professional Component ,,74181,CPT,Professional,Both,,,26,743,631.55,43.84,743,UnitedHealthcare,Medicare Advantage,78.959,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Mri Abdomen; Without Contrast Material(S) (Pro Cah)Professional Component ,,74181,CPT,Professional,Both,,,26,743,631.55,43.84,743,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,50.61712,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Mri, Abdomen; With Contrast Material(S) (Pro Cah)Professional Component ",,74182,CPT,Professional,Both,,,26,651,553.35,52.13,651,Aetna,Commercial,553.35,85,,percent of total billed charges,,
"Mri, Abdomen; With Contrast Material(S) (Pro Cah)Professional Component ",,74182,CPT,Professional,Both,,,26,651,553.35,52.13,651,Aetna,Medicare Advantage,83.39,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Mri, Abdomen; With Contrast Material(S) (Pro Cah)Professional Component ",,74182,CPT,Professional,Both,,,26,651,553.35,52.13,651,Aetna,PPO,605.43,93,,percent of total billed charges,,
"Mri, Abdomen; With Contrast Material(S) (Pro Cah)Professional Component ",,74182,CPT,Professional,Both,,,26,651,553.35,52.13,651,America's PPO,America's PPO,556.2144,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Mri, Abdomen; With Contrast Material(S) (Pro Cah)Professional Component ",,74182,CPT,Professional,Both,,,26,651,553.35,52.13,651,BlueCross BlueShield Minnesota, Federal Employee Program,156.6,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Mri, Abdomen; With Contrast Material(S) (Pro Cah)Professional Component ",,74182,CPT,Professional,Both,,,26,651,553.35,52.13,651,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,159.1056,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Mri, Abdomen; With Contrast Material(S) (Pro Cah)Professional Component ",,74182,CPT,Professional,Both,,,26,651,553.35,52.13,651,BlueCross BlueShield Minnesota,High Value Network Plan,159.1056,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Mri, Abdomen; With Contrast Material(S) (Pro Cah)Professional Component ",,74182,CPT,Professional,Both,,,26,651,553.35,52.13,651,BlueCross BlueShield Minnesota,Medicare Advantage,93.311,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Mri, Abdomen; With Contrast Material(S) (Pro Cah)Professional Component ",,74182,CPT,Professional,Both,,,26,651,553.35,52.13,651,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,159.1056,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Mri, Abdomen; With Contrast Material(S) (Pro Cah)Professional Component ",,74182,CPT,Professional,Both,,,26,651,553.35,52.13,651,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,60.18784,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Mri, Abdomen; With Contrast Material(S) (Pro Cah)Professional Component ",,74182,CPT,Professional,Both,,,26,651,553.35,52.13,651,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),93.311,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Mri, Abdomen; With Contrast Material(S) (Pro Cah)Professional Component ",,74182,CPT,Professional,Both,,,26,651,553.35,52.13,651,CorVel,Worker's Compensation,160.5248811,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Mri, Abdomen; With Contrast Material(S) (Pro Cah)Professional Component ",,74182,CPT,Professional,Both,,,26,651,553.35,52.13,651,First Health Group Corporation,First Health Network,631.47,97,,percent of total billed charges,,
"Mri, Abdomen; With Contrast Material(S) (Pro Cah)Professional Component ",,74182,CPT,Professional,Both,,,26,651,553.35,52.13,651,"Health Partners, Inc.",Commercial,123.23,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Mri, Abdomen; With Contrast Material(S) (Pro Cah)Professional Component ",,74182,CPT,Professional,Both,,,26,651,553.35,52.13,651,"Health Partners, Inc.",Medicare Advantage,93.311,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Mri, Abdomen; With Contrast Material(S) (Pro Cah)Professional Component ",,74182,CPT,Professional,Both,,,26,651,553.35,52.13,651,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),52.13,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Mri, Abdomen; With Contrast Material(S) (Pro Cah)Professional Component ",,74182,CPT,Professional,Both,,,26,651,553.35,52.13,651,"Health Partners, Inc.",State of Minnesota Advantage Program,106.162645,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Mri, Abdomen; With Contrast Material(S) (Pro Cah)Professional Component ",,74182,CPT,Professional,Both,,,26,651,553.35,52.13,651,"Health Partners, Inc.",State Public Programs,52.13,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Mri, Abdomen; With Contrast Material(S) (Pro Cah)Professional Component ",,74182,CPT,Professional,Both,,,26,651,553.35,52.13,651,Humana Insurance Company,Commercial PPO,81.14,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Mri, Abdomen; With Contrast Material(S) (Pro Cah)Professional Component ",,74182,CPT,Professional,Both,,,26,651,553.35,52.13,651,Humana Insurance Company,Medicare PPO,651,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Mri, Abdomen; With Contrast Material(S) (Pro Cah)Professional Component ",,74182,CPT,Professional,Both,,,26,651,553.35,52.13,651,Medica,Individual & Family,552.048,84.8,,percent of total billed charges,,
"Mri, Abdomen; With Contrast Material(S) (Pro Cah)Professional Component ",,74182,CPT,Professional,Both,,,26,651,553.35,52.13,651,Medica,Medica Advantage Solution,324.198,49.8,,percent of total billed charges,,
"Mri, Abdomen; With Contrast Material(S) (Pro Cah)Professional Component ",,74182,CPT,Professional,Both,,,26,651,553.35,52.13,651,Medica,Medical Assistance,60.19,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Mri, Abdomen; With Contrast Material(S) (Pro Cah)Professional Component ",,74182,CPT,Professional,Both,,,26,651,553.35,52.13,651,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,81.14,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Mri, Abdomen; With Contrast Material(S) (Pro Cah)Professional Component ",,74182,CPT,Professional,Both,,,26,651,553.35,52.13,651,"Multiplan, Inc.","Multiplan, Inc.",611.94,94,,percent of total billed charges,,
"Mri, Abdomen; With Contrast Material(S) (Pro Cah)Professional Component ",,74182,CPT,Professional,Both,,,26,651,553.35,52.13,651,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,586.551,90.1,,percent of total billed charges,,
"Mri, Abdomen; With Contrast Material(S) (Pro Cah)Professional Component ",,74182,CPT,Professional,Both,,,26,651,553.35,52.13,651,"Preferred One Administrative Services, INC.",PPO,641.886,98.6,,percent of total billed charges,,
"Mri, Abdomen; With Contrast Material(S) (Pro Cah)Professional Component ",,74182,CPT,Professional,Both,,,26,651,553.35,52.13,651,PrimeWest Health,Minnesota Senior Health Options (MSHO),93.311,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Mri, Abdomen; With Contrast Material(S) (Pro Cah)Professional Component ",,74182,CPT,Professional,Both,,,26,651,553.35,52.13,651,PrimeWest Health,MinnesotaCare,64.4009888,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Mri, Abdomen; With Contrast Material(S) (Pro Cah)Professional Component ",,74182,CPT,Professional,Both,,,26,651,553.35,52.13,651,Sanford Health Plan,Sanford Health Plan,572.88,88,,percent of total billed charges,,
"Mri, Abdomen; With Contrast Material(S) (Pro Cah)Professional Component ",,74182,CPT,Professional,Both,,,26,651,553.35,52.13,651,"UCare Health, Inc.",Individual & Family Plan,131.901184,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Mri, Abdomen; With Contrast Material(S) (Pro Cah)Professional Component ",,74182,CPT,Professional,Both,,,26,651,553.35,52.13,651,"UCare Health, Inc.",Medical Assistance,66.206624,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Mri, Abdomen; With Contrast Material(S) (Pro Cah)Professional Component ",,74182,CPT,Professional,Both,,,26,651,553.35,52.13,651,"UCare Health, Inc.",Medicare Advantage,93.311,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Mri, Abdomen; With Contrast Material(S) (Pro Cah)Professional Component ",,74182,CPT,Professional,Both,,,26,651,553.35,52.13,651,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),74.6488,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Mri, Abdomen; With Contrast Material(S) (Pro Cah)Professional Component ",,74182,CPT,Professional,Both,,,26,651,553.35,52.13,651,UnitedHealthcare,Individual & Family,651,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Mri, Abdomen; With Contrast Material(S) (Pro Cah)Professional Component ",,74182,CPT,Professional,Both,,,26,651,553.35,52.13,651,UnitedHealthcare,Medicare Advantage,93.311,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Mri, Abdomen; With Contrast Material(S) (Pro Cah)Professional Component ",,74182,CPT,Professional,Both,,,26,651,553.35,52.13,651,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,60.18784,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Mri Abdomen; W/O Contrast, Followed By With Contrast And Further Sequences (Pro Cah)Professional Component ",,74183,CPT,Professional,Both,,,26,1120,952,66.32,1120,Aetna,Commercial,952,85,,percent of total billed charges,,
"Mri Abdomen; W/O Contrast, Followed By With Contrast And Further Sequences (Pro Cah)Professional Component ",,74183,CPT,Professional,Both,,,26,1120,952,66.32,1120,Aetna,Medicare Advantage,105.92,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Mri Abdomen; W/O Contrast, Followed By With Contrast And Further Sequences (Pro Cah)Professional Component ",,74183,CPT,Professional,Both,,,26,1120,952,66.32,1120,Aetna,PPO,1041.6,93,,percent of total billed charges,,
"Mri Abdomen; W/O Contrast, Followed By With Contrast And Further Sequences (Pro Cah)Professional Component ",,74183,CPT,Professional,Both,,,26,1120,952,66.32,1120,America's PPO,America's PPO,956.928,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Mri Abdomen; W/O Contrast, Followed By With Contrast And Further Sequences (Pro Cah)Professional Component ",,74183,CPT,Professional,Both,,,26,1120,952,66.32,1120,BlueCross BlueShield Minnesota, Federal Employee Program,198.15,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Mri Abdomen; W/O Contrast, Followed By With Contrast And Further Sequences (Pro Cah)Professional Component ",,74183,CPT,Professional,Both,,,26,1120,952,66.32,1120,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,201.3204,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Mri Abdomen; W/O Contrast, Followed By With Contrast And Further Sequences (Pro Cah)Professional Component ",,74183,CPT,Professional,Both,,,26,1120,952,66.32,1120,BlueCross BlueShield Minnesota,High Value Network Plan,201.3204,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Mri Abdomen; W/O Contrast, Followed By With Contrast And Further Sequences (Pro Cah)Professional Component ",,74183,CPT,Professional,Both,,,26,1120,952,66.32,1120,BlueCross BlueShield Minnesota,Medicare Advantage,118.5075,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Mri Abdomen; W/O Contrast, Followed By With Contrast And Further Sequences (Pro Cah)Professional Component ",,74183,CPT,Professional,Both,,,26,1120,952,66.32,1120,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,201.3204,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Mri Abdomen; W/O Contrast, Followed By With Contrast And Further Sequences (Pro Cah)Professional Component ",,74183,CPT,Professional,Both,,,26,1120,952,66.32,1120,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,76.56576,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Mri Abdomen; W/O Contrast, Followed By With Contrast And Further Sequences (Pro Cah)Professional Component ",,74183,CPT,Professional,Both,,,26,1120,952,66.32,1120,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),118.5075,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Mri Abdomen; W/O Contrast, Followed By With Contrast And Further Sequences (Pro Cah)Professional Component ",,74183,CPT,Professional,Both,,,26,1120,952,66.32,1120,CorVel,Worker's Compensation,203.2188048,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Mri Abdomen; W/O Contrast, Followed By With Contrast And Further Sequences (Pro Cah)Professional Component ",,74183,CPT,Professional,Both,,,26,1120,952,66.32,1120,First Health Group Corporation,First Health Network,1086.4,97,,percent of total billed charges,,
"Mri Abdomen; W/O Contrast, Followed By With Contrast And Further Sequences (Pro Cah)Professional Component ",,74183,CPT,Professional,Both,,,26,1120,952,66.32,1120,"Health Partners, Inc.",Commercial,156.23,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Mri Abdomen; W/O Contrast, Followed By With Contrast And Further Sequences (Pro Cah)Professional Component ",,74183,CPT,Professional,Both,,,26,1120,952,66.32,1120,"Health Partners, Inc.",Medicare Advantage,118.5075,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Mri Abdomen; W/O Contrast, Followed By With Contrast And Further Sequences (Pro Cah)Professional Component ",,74183,CPT,Professional,Both,,,26,1120,952,66.32,1120,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),66.32,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Mri Abdomen; W/O Contrast, Followed By With Contrast And Further Sequences (Pro Cah)Professional Component ",,74183,CPT,Professional,Both,,,26,1120,952,66.32,1120,"Health Partners, Inc.",State of Minnesota Advantage Program,134.592145,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Mri Abdomen; W/O Contrast, Followed By With Contrast And Further Sequences (Pro Cah)Professional Component ",,74183,CPT,Professional,Both,,,26,1120,952,66.32,1120,"Health Partners, Inc.",State Public Programs,66.32,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Mri Abdomen; W/O Contrast, Followed By With Contrast And Further Sequences (Pro Cah)Professional Component ",,74183,CPT,Professional,Both,,,26,1120,952,66.32,1120,Humana Insurance Company,Commercial PPO,103.05,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Mri Abdomen; W/O Contrast, Followed By With Contrast And Further Sequences (Pro Cah)Professional Component ",,74183,CPT,Professional,Both,,,26,1120,952,66.32,1120,Humana Insurance Company,Medicare PPO,1120,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Mri Abdomen; W/O Contrast, Followed By With Contrast And Further Sequences (Pro Cah)Professional Component ",,74183,CPT,Professional,Both,,,26,1120,952,66.32,1120,Medica,Individual & Family,949.76,84.8,,percent of total billed charges,,
"Mri Abdomen; W/O Contrast, Followed By With Contrast And Further Sequences (Pro Cah)Professional Component ",,74183,CPT,Professional,Both,,,26,1120,952,66.32,1120,Medica,Medica Advantage Solution,557.76,49.8,,percent of total billed charges,,
"Mri Abdomen; W/O Contrast, Followed By With Contrast And Further Sequences (Pro Cah)Professional Component ",,74183,CPT,Professional,Both,,,26,1120,952,66.32,1120,Medica,Medical Assistance,76.57,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Mri Abdomen; W/O Contrast, Followed By With Contrast And Further Sequences (Pro Cah)Professional Component ",,74183,CPT,Professional,Both,,,26,1120,952,66.32,1120,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,103.05,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Mri Abdomen; W/O Contrast, Followed By With Contrast And Further Sequences (Pro Cah)Professional Component ",,74183,CPT,Professional,Both,,,26,1120,952,66.32,1120,"Multiplan, Inc.","Multiplan, Inc.",1052.8,94,,percent of total billed charges,,
"Mri Abdomen; W/O Contrast, Followed By With Contrast And Further Sequences (Pro Cah)Professional Component ",,74183,CPT,Professional,Both,,,26,1120,952,66.32,1120,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1009.12,90.1,,percent of total billed charges,,
"Mri Abdomen; W/O Contrast, Followed By With Contrast And Further Sequences (Pro Cah)Professional Component ",,74183,CPT,Professional,Both,,,26,1120,952,66.32,1120,"Preferred One Administrative Services, INC.",PPO,1104.32,98.6,,percent of total billed charges,,
"Mri Abdomen; W/O Contrast, Followed By With Contrast And Further Sequences (Pro Cah)Professional Component ",,74183,CPT,Professional,Both,,,26,1120,952,66.32,1120,PrimeWest Health,Minnesota Senior Health Options (MSHO),118.5075,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Mri Abdomen; W/O Contrast, Followed By With Contrast And Further Sequences (Pro Cah)Professional Component ",,74183,CPT,Professional,Both,,,26,1120,952,66.32,1120,PrimeWest Health,MinnesotaCare,81.9253632,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Mri Abdomen; W/O Contrast, Followed By With Contrast And Further Sequences (Pro Cah)Professional Component ",,74183,CPT,Professional,Both,,,26,1120,952,66.32,1120,Sanford Health Plan,Sanford Health Plan,985.6,88,,percent of total billed charges,,
"Mri Abdomen; W/O Contrast, Followed By With Contrast And Further Sequences (Pro Cah)Professional Component ",,74183,CPT,Professional,Both,,,26,1120,952,66.32,1120,"UCare Health, Inc.",Individual & Family Plan,167.51808,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Mri Abdomen; W/O Contrast, Followed By With Contrast And Further Sequences (Pro Cah)Professional Component ",,74183,CPT,Professional,Both,,,26,1120,952,66.32,1120,"UCare Health, Inc.",Medical Assistance,84.222336,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Mri Abdomen; W/O Contrast, Followed By With Contrast And Further Sequences (Pro Cah)Professional Component ",,74183,CPT,Professional,Both,,,26,1120,952,66.32,1120,"UCare Health, Inc.",Medicare Advantage,118.5075,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Mri Abdomen; W/O Contrast, Followed By With Contrast And Further Sequences (Pro Cah)Professional Component ",,74183,CPT,Professional,Both,,,26,1120,952,66.32,1120,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),94.806,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Mri Abdomen; W/O Contrast, Followed By With Contrast And Further Sequences (Pro Cah)Professional Component ",,74183,CPT,Professional,Both,,,26,1120,952,66.32,1120,UnitedHealthcare,Individual & Family,1120,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Mri Abdomen; W/O Contrast, Followed By With Contrast And Further Sequences (Pro Cah)Professional Component ",,74183,CPT,Professional,Both,,,26,1120,952,66.32,1120,UnitedHealthcare,Medicare Advantage,118.5075,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Mri Abdomen; W/O Contrast, Followed By With Contrast And Further Sequences (Pro Cah)Professional Component ",,74183,CPT,Professional,Both,,,26,1120,952,66.32,1120,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,76.56576,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Mra Abdomen, With Or Without Contrast Material(S) (Pro Cah)Professional Component ",,74185,CPT,Professional,Both,,,26,606,515.1,53.88,606,Aetna,Commercial,515.1,85,,percent of total billed charges,,
"Mra Abdomen, With Or Without Contrast Material(S) (Pro Cah)Professional Component ",,74185,CPT,Professional,Both,,,26,606,515.1,53.88,606,Aetna,Medicare Advantage,86.18,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Mra Abdomen, With Or Without Contrast Material(S) (Pro Cah)Professional Component ",,74185,CPT,Professional,Both,,,26,606,515.1,53.88,606,Aetna,PPO,563.58,93,,percent of total billed charges,,
"Mra Abdomen, With Or Without Contrast Material(S) (Pro Cah)Professional Component ",,74185,CPT,Professional,Both,,,26,606,515.1,53.88,606,America's PPO,America's PPO,517.7664,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Mra Abdomen, With Or Without Contrast Material(S) (Pro Cah)Professional Component ",,74185,CPT,Professional,Both,,,26,606,515.1,53.88,606,BlueCross BlueShield Minnesota, Federal Employee Program,161.72,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Mra Abdomen, With Or Without Contrast Material(S) (Pro Cah)Professional Component ",,74185,CPT,Professional,Both,,,26,606,515.1,53.88,606,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,164.30752,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Mra Abdomen, With Or Without Contrast Material(S) (Pro Cah)Professional Component ",,74185,CPT,Professional,Both,,,26,606,515.1,53.88,606,BlueCross BlueShield Minnesota,High Value Network Plan,164.30752,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Mra Abdomen, With Or Without Contrast Material(S) (Pro Cah)Professional Component ",,74185,CPT,Professional,Both,,,26,606,515.1,53.88,606,BlueCross BlueShield Minnesota,Medicare Advantage,96.439,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Mra Abdomen, With Or Without Contrast Material(S) (Pro Cah)Professional Component ",,74185,CPT,Professional,Both,,,26,606,515.1,53.88,606,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,164.30752,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Mra Abdomen, With Or Without Contrast Material(S) (Pro Cah)Professional Component ",,74185,CPT,Professional,Both,,,26,606,515.1,53.88,606,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,62.20968,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Mra Abdomen, With Or Without Contrast Material(S) (Pro Cah)Professional Component ",,74185,CPT,Professional,Both,,,26,606,515.1,53.88,606,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),96.439,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Mra Abdomen, With Or Without Contrast Material(S) (Pro Cah)Professional Component ",,74185,CPT,Professional,Both,,,26,606,515.1,53.88,606,CorVel,Worker's Compensation,165.2267811,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Mra Abdomen, With Or Without Contrast Material(S) (Pro Cah)Professional Component ",,74185,CPT,Professional,Both,,,26,606,515.1,53.88,606,First Health Group Corporation,First Health Network,587.82,97,,percent of total billed charges,,
"Mra Abdomen, With Or Without Contrast Material(S) (Pro Cah)Professional Component ",,74185,CPT,Professional,Both,,,26,606,515.1,53.88,606,"Health Partners, Inc.",Commercial,126.85,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Mra Abdomen, With Or Without Contrast Material(S) (Pro Cah)Professional Component ",,74185,CPT,Professional,Both,,,26,606,515.1,53.88,606,"Health Partners, Inc.",Medicare Advantage,96.439,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Mra Abdomen, With Or Without Contrast Material(S) (Pro Cah)Professional Component ",,74185,CPT,Professional,Both,,,26,606,515.1,53.88,606,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),53.88,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Mra Abdomen, With Or Without Contrast Material(S) (Pro Cah)Professional Component ",,74185,CPT,Professional,Both,,,26,606,515.1,53.88,606,"Health Partners, Inc.",State of Minnesota Advantage Program,109.281275,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Mra Abdomen, With Or Without Contrast Material(S) (Pro Cah)Professional Component ",,74185,CPT,Professional,Both,,,26,606,515.1,53.88,606,"Health Partners, Inc.",State Public Programs,53.88,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Mra Abdomen, With Or Without Contrast Material(S) (Pro Cah)Professional Component ",,74185,CPT,Professional,Both,,,26,606,515.1,53.88,606,Humana Insurance Company,Commercial PPO,83.86,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Mra Abdomen, With Or Without Contrast Material(S) (Pro Cah)Professional Component ",,74185,CPT,Professional,Both,,,26,606,515.1,53.88,606,Humana Insurance Company,Medicare PPO,606,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Mra Abdomen, With Or Without Contrast Material(S) (Pro Cah)Professional Component ",,74185,CPT,Professional,Both,,,26,606,515.1,53.88,606,Medica,Individual & Family,513.888,84.8,,percent of total billed charges,,
"Mra Abdomen, With Or Without Contrast Material(S) (Pro Cah)Professional Component ",,74185,CPT,Professional,Both,,,26,606,515.1,53.88,606,Medica,Medica Advantage Solution,301.788,49.8,,percent of total billed charges,,
"Mra Abdomen, With Or Without Contrast Material(S) (Pro Cah)Professional Component ",,74185,CPT,Professional,Both,,,26,606,515.1,53.88,606,Medica,Medical Assistance,62.21,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Mra Abdomen, With Or Without Contrast Material(S) (Pro Cah)Professional Component ",,74185,CPT,Professional,Both,,,26,606,515.1,53.88,606,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,83.86,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Mra Abdomen, With Or Without Contrast Material(S) (Pro Cah)Professional Component ",,74185,CPT,Professional,Both,,,26,606,515.1,53.88,606,"Multiplan, Inc.","Multiplan, Inc.",569.64,94,,percent of total billed charges,,
"Mra Abdomen, With Or Without Contrast Material(S) (Pro Cah)Professional Component ",,74185,CPT,Professional,Both,,,26,606,515.1,53.88,606,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,546.006,90.1,,percent of total billed charges,,
"Mra Abdomen, With Or Without Contrast Material(S) (Pro Cah)Professional Component ",,74185,CPT,Professional,Both,,,26,606,515.1,53.88,606,"Preferred One Administrative Services, INC.",PPO,597.516,98.6,,percent of total billed charges,,
"Mra Abdomen, With Or Without Contrast Material(S) (Pro Cah)Professional Component ",,74185,CPT,Professional,Both,,,26,606,515.1,53.88,606,PrimeWest Health,Minnesota Senior Health Options (MSHO),96.439,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Mra Abdomen, With Or Without Contrast Material(S) (Pro Cah)Professional Component ",,74185,CPT,Professional,Both,,,26,606,515.1,53.88,606,PrimeWest Health,MinnesotaCare,66.5643576,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Mra Abdomen, With Or Without Contrast Material(S) (Pro Cah)Professional Component ",,74185,CPT,Professional,Both,,,26,606,515.1,53.88,606,Sanford Health Plan,Sanford Health Plan,533.28,88,,percent of total billed charges,,
"Mra Abdomen, With Or Without Contrast Material(S) (Pro Cah)Professional Component ",,74185,CPT,Professional,Both,,,26,606,515.1,53.88,606,"UCare Health, Inc.",Individual & Family Plan,136.322816,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Mra Abdomen, With Or Without Contrast Material(S) (Pro Cah)Professional Component ",,74185,CPT,Professional,Both,,,26,606,515.1,53.88,606,"UCare Health, Inc.",Medical Assistance,68.430648,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Mra Abdomen, With Or Without Contrast Material(S) (Pro Cah)Professional Component ",,74185,CPT,Professional,Both,,,26,606,515.1,53.88,606,"UCare Health, Inc.",Medicare Advantage,96.439,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Mra Abdomen, With Or Without Contrast Material(S) (Pro Cah)Professional Component ",,74185,CPT,Professional,Both,,,26,606,515.1,53.88,606,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),77.1512,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Mra Abdomen, With Or Without Contrast Material(S) (Pro Cah)Professional Component ",,74185,CPT,Professional,Both,,,26,606,515.1,53.88,606,UnitedHealthcare,Individual & Family,606,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Mra Abdomen, With Or Without Contrast Material(S) (Pro Cah)Professional Component ",,74185,CPT,Professional,Both,,,26,606,515.1,53.88,606,UnitedHealthcare,Medicare Advantage,96.439,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Mra Abdomen, With Or Without Contrast Material(S) (Pro Cah)Professional Component ",,74185,CPT,Professional,Both,,,26,606,515.1,53.88,606,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,62.20968,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Radiologic Examination, Esophagus, Incl Scout Chest Radiograph(S)/Delayed Image(S), Single Contrast (Pro Cah)Professional Component ",,74220,CPT,Professional,Both,,,26,111,94.35,18.1,111,Aetna,Commercial,94.35,85,,percent of total billed charges,,
"Radiologic Examination, Esophagus, Incl Scout Chest Radiograph(S)/Delayed Image(S), Single Contrast (Pro Cah)Professional Component ",,74220,CPT,Professional,Both,,,26,111,94.35,18.1,111,Aetna,Medicare Advantage,29.2,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Radiologic Examination, Esophagus, Incl Scout Chest Radiograph(S)/Delayed Image(S), Single Contrast (Pro Cah)Professional Component ",,74220,CPT,Professional,Both,,,26,111,94.35,18.1,111,Aetna,PPO,103.23,93,,percent of total billed charges,,
"Radiologic Examination, Esophagus, Incl Scout Chest Radiograph(S)/Delayed Image(S), Single Contrast (Pro Cah)Professional Component ",,74220,CPT,Professional,Both,,,26,111,94.35,18.1,111,America's PPO,America's PPO,94.8384,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Radiologic Examination, Esophagus, Incl Scout Chest Radiograph(S)/Delayed Image(S), Single Contrast (Pro Cah)Professional Component ",,74220,CPT,Professional,Both,,,26,111,94.35,18.1,111,BlueCross BlueShield Minnesota, Federal Employee Program,54.97,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Radiologic Examination, Esophagus, Incl Scout Chest Radiograph(S)/Delayed Image(S), Single Contrast (Pro Cah)Professional Component ",,74220,CPT,Professional,Both,,,26,111,94.35,18.1,111,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,55.84952,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Radiologic Examination, Esophagus, Incl Scout Chest Radiograph(S)/Delayed Image(S), Single Contrast (Pro Cah)Professional Component ",,74220,CPT,Professional,Both,,,26,111,94.35,18.1,111,BlueCross BlueShield Minnesota,High Value Network Plan,55.84952,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Radiologic Examination, Esophagus, Incl Scout Chest Radiograph(S)/Delayed Image(S), Single Contrast (Pro Cah)Professional Component ",,74220,CPT,Professional,Both,,,26,111,94.35,18.1,111,BlueCross BlueShield Minnesota,Medicare Advantage,32.6255,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Radiologic Examination, Esophagus, Incl Scout Chest Radiograph(S)/Delayed Image(S), Single Contrast (Pro Cah)Professional Component ",,74220,CPT,Professional,Both,,,26,111,94.35,18.1,111,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,55.84952,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Radiologic Examination, Esophagus, Incl Scout Chest Radiograph(S)/Delayed Image(S), Single Contrast (Pro Cah)Professional Component ",,74220,CPT,Professional,Both,,,26,111,94.35,18.1,111,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,20.89912,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Radiologic Examination, Esophagus, Incl Scout Chest Radiograph(S)/Delayed Image(S), Single Contrast (Pro Cah)Professional Component ",,74220,CPT,Professional,Both,,,26,111,94.35,18.1,111,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),32.6255,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Radiologic Examination, Esophagus, Incl Scout Chest Radiograph(S)/Delayed Image(S), Single Contrast (Pro Cah)Professional Component ",,74220,CPT,Professional,Both,,,26,111,94.35,18.1,111,CorVel,Worker's Compensation,55.5395145,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Radiologic Examination, Esophagus, Incl Scout Chest Radiograph(S)/Delayed Image(S), Single Contrast (Pro Cah)Professional Component ",,74220,CPT,Professional,Both,,,26,111,94.35,18.1,111,First Health Group Corporation,First Health Network,107.67,97,,percent of total billed charges,,
"Radiologic Examination, Esophagus, Incl Scout Chest Radiograph(S)/Delayed Image(S), Single Contrast (Pro Cah)Professional Component ",,74220,CPT,Professional,Both,,,26,111,94.35,18.1,111,"Health Partners, Inc.",Commercial,42.29,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Radiologic Examination, Esophagus, Incl Scout Chest Radiograph(S)/Delayed Image(S), Single Contrast (Pro Cah)Professional Component ",,74220,CPT,Professional,Both,,,26,111,94.35,18.1,111,"Health Partners, Inc.",Medicare Advantage,32.6255,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Radiologic Examination, Esophagus, Incl Scout Chest Radiograph(S)/Delayed Image(S), Single Contrast (Pro Cah)Professional Component ",,74220,CPT,Professional,Both,,,26,111,94.35,18.1,111,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),18.1,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Radiologic Examination, Esophagus, Incl Scout Chest Radiograph(S)/Delayed Image(S), Single Contrast (Pro Cah)Professional Component ",,74220,CPT,Professional,Both,,,26,111,94.35,18.1,111,"Health Partners, Inc.",State of Minnesota Advantage Program,36.432835,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Radiologic Examination, Esophagus, Incl Scout Chest Radiograph(S)/Delayed Image(S), Single Contrast (Pro Cah)Professional Component ",,74220,CPT,Professional,Both,,,26,111,94.35,18.1,111,"Health Partners, Inc.",State Public Programs,18.1,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Radiologic Examination, Esophagus, Incl Scout Chest Radiograph(S)/Delayed Image(S), Single Contrast (Pro Cah)Professional Component ",,74220,CPT,Professional,Both,,,26,111,94.35,18.1,111,Humana Insurance Company,Commercial PPO,28.37,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Radiologic Examination, Esophagus, Incl Scout Chest Radiograph(S)/Delayed Image(S), Single Contrast (Pro Cah)Professional Component ",,74220,CPT,Professional,Both,,,26,111,94.35,18.1,111,Humana Insurance Company,Medicare PPO,111,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Radiologic Examination, Esophagus, Incl Scout Chest Radiograph(S)/Delayed Image(S), Single Contrast (Pro Cah)Professional Component ",,74220,CPT,Professional,Both,,,26,111,94.35,18.1,111,Medica,Individual & Family,94.128,84.8,,percent of total billed charges,,
"Radiologic Examination, Esophagus, Incl Scout Chest Radiograph(S)/Delayed Image(S), Single Contrast (Pro Cah)Professional Component ",,74220,CPT,Professional,Both,,,26,111,94.35,18.1,111,Medica,Medica Advantage Solution,55.278,49.8,,percent of total billed charges,,
"Radiologic Examination, Esophagus, Incl Scout Chest Radiograph(S)/Delayed Image(S), Single Contrast (Pro Cah)Professional Component ",,74220,CPT,Professional,Both,,,26,111,94.35,18.1,111,Medica,Medical Assistance,20.9,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Radiologic Examination, Esophagus, Incl Scout Chest Radiograph(S)/Delayed Image(S), Single Contrast (Pro Cah)Professional Component ",,74220,CPT,Professional,Both,,,26,111,94.35,18.1,111,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,28.37,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Radiologic Examination, Esophagus, Incl Scout Chest Radiograph(S)/Delayed Image(S), Single Contrast (Pro Cah)Professional Component ",,74220,CPT,Professional,Both,,,26,111,94.35,18.1,111,"Multiplan, Inc.","Multiplan, Inc.",104.34,94,,percent of total billed charges,,
"Radiologic Examination, Esophagus, Incl Scout Chest Radiograph(S)/Delayed Image(S), Single Contrast (Pro Cah)Professional Component ",,74220,CPT,Professional,Both,,,26,111,94.35,18.1,111,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,100.011,90.1,,percent of total billed charges,,
"Radiologic Examination, Esophagus, Incl Scout Chest Radiograph(S)/Delayed Image(S), Single Contrast (Pro Cah)Professional Component ",,74220,CPT,Professional,Both,,,26,111,94.35,18.1,111,"Preferred One Administrative Services, INC.",PPO,109.446,98.6,,percent of total billed charges,,
"Radiologic Examination, Esophagus, Incl Scout Chest Radiograph(S)/Delayed Image(S), Single Contrast (Pro Cah)Professional Component ",,74220,CPT,Professional,Both,,,26,111,94.35,18.1,111,PrimeWest Health,Minnesota Senior Health Options (MSHO),32.6255,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Radiologic Examination, Esophagus, Incl Scout Chest Radiograph(S)/Delayed Image(S), Single Contrast (Pro Cah)Professional Component ",,74220,CPT,Professional,Both,,,26,111,94.35,18.1,111,PrimeWest Health,MinnesotaCare,22.3620584,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Radiologic Examination, Esophagus, Incl Scout Chest Radiograph(S)/Delayed Image(S), Single Contrast (Pro Cah)Professional Component ",,74220,CPT,Professional,Both,,,26,111,94.35,18.1,111,Sanford Health Plan,Sanford Health Plan,97.68,88,,percent of total billed charges,,
"Radiologic Examination, Esophagus, Incl Scout Chest Radiograph(S)/Delayed Image(S), Single Contrast (Pro Cah)Professional Component ",,74220,CPT,Professional,Both,,,26,111,94.35,18.1,111,"UCare Health, Inc.",Individual & Family Plan,46.118272,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Radiologic Examination, Esophagus, Incl Scout Chest Radiograph(S)/Delayed Image(S), Single Contrast (Pro Cah)Professional Component ",,74220,CPT,Professional,Both,,,26,111,94.35,18.1,111,"UCare Health, Inc.",Medical Assistance,22.989032,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Radiologic Examination, Esophagus, Incl Scout Chest Radiograph(S)/Delayed Image(S), Single Contrast (Pro Cah)Professional Component ",,74220,CPT,Professional,Both,,,26,111,94.35,18.1,111,"UCare Health, Inc.",Medicare Advantage,32.6255,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Radiologic Examination, Esophagus, Incl Scout Chest Radiograph(S)/Delayed Image(S), Single Contrast (Pro Cah)Professional Component ",,74220,CPT,Professional,Both,,,26,111,94.35,18.1,111,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),26.1004,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Radiologic Examination, Esophagus, Incl Scout Chest Radiograph(S)/Delayed Image(S), Single Contrast (Pro Cah)Professional Component ",,74220,CPT,Professional,Both,,,26,111,94.35,18.1,111,UnitedHealthcare,Individual & Family,111,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Radiologic Examination, Esophagus, Incl Scout Chest Radiograph(S)/Delayed Image(S), Single Contrast (Pro Cah)Professional Component ",,74220,CPT,Professional,Both,,,26,111,94.35,18.1,111,UnitedHealthcare,Medicare Advantage,32.6255,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Radiologic Examination, Esophagus, Incl Scout Chest Radiograph(S)/Delayed Image(S), Single Contrast (Pro Cah)Professional Component ",,74220,CPT,Professional,Both,,,26,111,94.35,18.1,111,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,20.89912,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Swallowing Function W/Cineradiography/Videoradiography, Inc Radiograph(S)/Delayed Image(S), Contrast (Procah)Professional Component ",,74230,CPT,Professional,Both,,,26,131,111.35,15.92,131,Aetna,Commercial,111.35,85,,percent of total billed charges,,
"Swallowing Function W/Cineradiography/Videoradiography, Inc Radiograph(S)/Delayed Image(S), Contrast (Procah)Professional Component ",,74230,CPT,Professional,Both,,,26,131,111.35,15.92,131,Aetna,Medicare Advantage,25.7,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Swallowing Function W/Cineradiography/Videoradiography, Inc Radiograph(S)/Delayed Image(S), Contrast (Procah)Professional Component ",,74230,CPT,Professional,Both,,,26,131,111.35,15.92,131,Aetna,PPO,121.83,93,,percent of total billed charges,,
"Swallowing Function W/Cineradiography/Videoradiography, Inc Radiograph(S)/Delayed Image(S), Contrast (Procah)Professional Component ",,74230,CPT,Professional,Both,,,26,131,111.35,15.92,131,America's PPO,America's PPO,111.9264,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Swallowing Function W/Cineradiography/Videoradiography, Inc Radiograph(S)/Delayed Image(S), Contrast (Procah)Professional Component ",,74230,CPT,Professional,Both,,,26,131,111.35,15.92,131,BlueCross BlueShield Minnesota, Federal Employee Program,48.58,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Swallowing Function W/Cineradiography/Videoradiography, Inc Radiograph(S)/Delayed Image(S), Contrast (Procah)Professional Component ",,74230,CPT,Professional,Both,,,26,131,111.35,15.92,131,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,49.35728,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Swallowing Function W/Cineradiography/Videoradiography, Inc Radiograph(S)/Delayed Image(S), Contrast (Procah)Professional Component ",,74230,CPT,Professional,Both,,,26,131,111.35,15.92,131,BlueCross BlueShield Minnesota,High Value Network Plan,49.35728,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Swallowing Function W/Cineradiography/Videoradiography, Inc Radiograph(S)/Delayed Image(S), Contrast (Procah)Professional Component ",,74230,CPT,Professional,Both,,,26,131,111.35,15.92,131,BlueCross BlueShield Minnesota,Medicare Advantage,28.704,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Swallowing Function W/Cineradiography/Videoradiography, Inc Radiograph(S)/Delayed Image(S), Contrast (Procah)Professional Component ",,74230,CPT,Professional,Both,,,26,131,111.35,15.92,131,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,49.35728,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Swallowing Function W/Cineradiography/Videoradiography, Inc Radiograph(S)/Delayed Image(S), Contrast (Procah)Professional Component ",,74230,CPT,Professional,Both,,,26,131,111.35,15.92,131,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,18.37944,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Swallowing Function W/Cineradiography/Videoradiography, Inc Radiograph(S)/Delayed Image(S), Contrast (Procah)Professional Component ",,74230,CPT,Professional,Both,,,26,131,111.35,15.92,131,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),28.704,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Swallowing Function W/Cineradiography/Videoradiography, Inc Radiograph(S)/Delayed Image(S), Contrast (Procah)Professional Component ",,74230,CPT,Professional,Both,,,26,131,111.35,15.92,131,CorVel,Worker's Compensation,49.4767503,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Swallowing Function W/Cineradiography/Videoradiography, Inc Radiograph(S)/Delayed Image(S), Contrast (Procah)Professional Component ",,74230,CPT,Professional,Both,,,26,131,111.35,15.92,131,First Health Group Corporation,First Health Network,127.07,97,,percent of total billed charges,,
"Swallowing Function W/Cineradiography/Videoradiography, Inc Radiograph(S)/Delayed Image(S), Contrast (Procah)Professional Component ",,74230,CPT,Professional,Both,,,26,131,111.35,15.92,131,"Health Partners, Inc.",Commercial,37.64,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Swallowing Function W/Cineradiography/Videoradiography, Inc Radiograph(S)/Delayed Image(S), Contrast (Procah)Professional Component ",,74230,CPT,Professional,Both,,,26,131,111.35,15.92,131,"Health Partners, Inc.",Medicare Advantage,28.704,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Swallowing Function W/Cineradiography/Videoradiography, Inc Radiograph(S)/Delayed Image(S), Contrast (Procah)Professional Component ",,74230,CPT,Professional,Both,,,26,131,111.35,15.92,131,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),15.92,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Swallowing Function W/Cineradiography/Videoradiography, Inc Radiograph(S)/Delayed Image(S), Contrast (Procah)Professional Component ",,74230,CPT,Professional,Both,,,26,131,111.35,15.92,131,"Health Partners, Inc.",State of Minnesota Advantage Program,32.42686,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Swallowing Function W/Cineradiography/Videoradiography, Inc Radiograph(S)/Delayed Image(S), Contrast (Procah)Professional Component ",,74230,CPT,Professional,Both,,,26,131,111.35,15.92,131,"Health Partners, Inc.",State Public Programs,15.92,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Swallowing Function W/Cineradiography/Videoradiography, Inc Radiograph(S)/Delayed Image(S), Contrast (Procah)Professional Component ",,74230,CPT,Professional,Both,,,26,131,111.35,15.92,131,Humana Insurance Company,Commercial PPO,24.96,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Swallowing Function W/Cineradiography/Videoradiography, Inc Radiograph(S)/Delayed Image(S), Contrast (Procah)Professional Component ",,74230,CPT,Professional,Both,,,26,131,111.35,15.92,131,Humana Insurance Company,Medicare PPO,131,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Swallowing Function W/Cineradiography/Videoradiography, Inc Radiograph(S)/Delayed Image(S), Contrast (Procah)Professional Component ",,74230,CPT,Professional,Both,,,26,131,111.35,15.92,131,Medica,Individual & Family,111.088,84.8,,percent of total billed charges,,
"Swallowing Function W/Cineradiography/Videoradiography, Inc Radiograph(S)/Delayed Image(S), Contrast (Procah)Professional Component ",,74230,CPT,Professional,Both,,,26,131,111.35,15.92,131,Medica,Medica Advantage Solution,65.238,49.8,,percent of total billed charges,,
"Swallowing Function W/Cineradiography/Videoradiography, Inc Radiograph(S)/Delayed Image(S), Contrast (Procah)Professional Component ",,74230,CPT,Professional,Both,,,26,131,111.35,15.92,131,Medica,Medical Assistance,18.38,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Swallowing Function W/Cineradiography/Videoradiography, Inc Radiograph(S)/Delayed Image(S), Contrast (Procah)Professional Component ",,74230,CPT,Professional,Both,,,26,131,111.35,15.92,131,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,24.96,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Swallowing Function W/Cineradiography/Videoradiography, Inc Radiograph(S)/Delayed Image(S), Contrast (Procah)Professional Component ",,74230,CPT,Professional,Both,,,26,131,111.35,15.92,131,"Multiplan, Inc.","Multiplan, Inc.",123.14,94,,percent of total billed charges,,
"Swallowing Function W/Cineradiography/Videoradiography, Inc Radiograph(S)/Delayed Image(S), Contrast (Procah)Professional Component ",,74230,CPT,Professional,Both,,,26,131,111.35,15.92,131,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,118.031,90.1,,percent of total billed charges,,
"Swallowing Function W/Cineradiography/Videoradiography, Inc Radiograph(S)/Delayed Image(S), Contrast (Procah)Professional Component ",,74230,CPT,Professional,Both,,,26,131,111.35,15.92,131,"Preferred One Administrative Services, INC.",PPO,129.166,98.6,,percent of total billed charges,,
"Swallowing Function W/Cineradiography/Videoradiography, Inc Radiograph(S)/Delayed Image(S), Contrast (Procah)Professional Component ",,74230,CPT,Professional,Both,,,26,131,111.35,15.92,131,PrimeWest Health,Minnesota Senior Health Options (MSHO),28.704,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Swallowing Function W/Cineradiography/Videoradiography, Inc Radiograph(S)/Delayed Image(S), Contrast (Procah)Professional Component ",,74230,CPT,Professional,Both,,,26,131,111.35,15.92,131,PrimeWest Health,MinnesotaCare,19.6660008,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Swallowing Function W/Cineradiography/Videoradiography, Inc Radiograph(S)/Delayed Image(S), Contrast (Procah)Professional Component ",,74230,CPT,Professional,Both,,,26,131,111.35,15.92,131,Sanford Health Plan,Sanford Health Plan,115.28,88,,percent of total billed charges,,
"Swallowing Function W/Cineradiography/Videoradiography, Inc Radiograph(S)/Delayed Image(S), Contrast (Procah)Professional Component ",,74230,CPT,Professional,Both,,,26,131,111.35,15.92,131,"UCare Health, Inc.",Individual & Family Plan,40.574976,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Swallowing Function W/Cineradiography/Videoradiography, Inc Radiograph(S)/Delayed Image(S), Contrast (Procah)Professional Component ",,74230,CPT,Professional,Both,,,26,131,111.35,15.92,131,"UCare Health, Inc.",Medical Assistance,20.217384,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Swallowing Function W/Cineradiography/Videoradiography, Inc Radiograph(S)/Delayed Image(S), Contrast (Procah)Professional Component ",,74230,CPT,Professional,Both,,,26,131,111.35,15.92,131,"UCare Health, Inc.",Medicare Advantage,28.704,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Swallowing Function W/Cineradiography/Videoradiography, Inc Radiograph(S)/Delayed Image(S), Contrast (Procah)Professional Component ",,74230,CPT,Professional,Both,,,26,131,111.35,15.92,131,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),22.9632,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Swallowing Function W/Cineradiography/Videoradiography, Inc Radiograph(S)/Delayed Image(S), Contrast (Procah)Professional Component ",,74230,CPT,Professional,Both,,,26,131,111.35,15.92,131,UnitedHealthcare,Individual & Family,131,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Swallowing Function W/Cineradiography/Videoradiography, Inc Radiograph(S)/Delayed Image(S), Contrast (Procah)Professional Component ",,74230,CPT,Professional,Both,,,26,131,111.35,15.92,131,UnitedHealthcare,Medicare Advantage,28.704,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Swallowing Function W/Cineradiography/Videoradiography, Inc Radiograph(S)/Delayed Image(S), Contrast (Procah)Professional Component ",,74230,CPT,Professional,Both,,,26,131,111.35,15.92,131,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,18.37944,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Radiologic Examination, Small Intestine, W Mult Serial Images And Abd Radiograph(S), Single-Contrast (Pro Cah)Professional Component ",,74250,CPT,Professional,Both,,,26,141,119.85,24.21,141,Aetna,Commercial,119.85,85,,percent of total billed charges,,
"Radiologic Examination, Small Intestine, W Mult Serial Images And Abd Radiograph(S), Single-Contrast (Pro Cah)Professional Component ",,74250,CPT,Professional,Both,,,26,141,119.85,24.21,141,Aetna,Medicare Advantage,39.01,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Radiologic Examination, Small Intestine, W Mult Serial Images And Abd Radiograph(S), Single-Contrast (Pro Cah)Professional Component ",,74250,CPT,Professional,Both,,,26,141,119.85,24.21,141,Aetna,PPO,131.13,93,,percent of total billed charges,,
"Radiologic Examination, Small Intestine, W Mult Serial Images And Abd Radiograph(S), Single-Contrast (Pro Cah)Professional Component ",,74250,CPT,Professional,Both,,,26,141,119.85,24.21,141,America's PPO,America's PPO,120.4704,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Radiologic Examination, Small Intestine, W Mult Serial Images And Abd Radiograph(S), Single-Contrast (Pro Cah)Professional Component ",,74250,CPT,Professional,Both,,,26,141,119.85,24.21,141,BlueCross BlueShield Minnesota, Federal Employee Program,72.87,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Radiologic Examination, Small Intestine, W Mult Serial Images And Abd Radiograph(S), Single-Contrast (Pro Cah)Professional Component ",,74250,CPT,Professional,Both,,,26,141,119.85,24.21,141,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,74.03592,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Radiologic Examination, Small Intestine, W Mult Serial Images And Abd Radiograph(S), Single-Contrast (Pro Cah)Professional Component ",,74250,CPT,Professional,Both,,,26,141,119.85,24.21,141,BlueCross BlueShield Minnesota,High Value Network Plan,74.03592,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Radiologic Examination, Small Intestine, W Mult Serial Images And Abd Radiograph(S), Single-Contrast (Pro Cah)Professional Component ",,74250,CPT,Professional,Both,,,26,141,119.85,24.21,141,BlueCross BlueShield Minnesota,Medicare Advantage,43.585,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Radiologic Examination, Small Intestine, W Mult Serial Images And Abd Radiograph(S), Single-Contrast (Pro Cah)Professional Component ",,74250,CPT,Professional,Both,,,26,141,119.85,24.21,141,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,74.03592,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Radiologic Examination, Small Intestine, W Mult Serial Images And Abd Radiograph(S), Single-Contrast (Pro Cah)Professional Component ",,74250,CPT,Professional,Both,,,26,141,119.85,24.21,141,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,27.95016,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Radiologic Examination, Small Intestine, W Mult Serial Images And Abd Radiograph(S), Single-Contrast (Pro Cah)Professional Component ",,74250,CPT,Professional,Both,,,26,141,119.85,24.21,141,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),43.585,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Radiologic Examination, Small Intestine, W Mult Serial Images And Abd Radiograph(S), Single-Contrast (Pro Cah)Professional Component ",,74250,CPT,Professional,Both,,,26,141,119.85,24.21,141,CorVel,Worker's Compensation,75.0886713,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Radiologic Examination, Small Intestine, W Mult Serial Images And Abd Radiograph(S), Single-Contrast (Pro Cah)Professional Component ",,74250,CPT,Professional,Both,,,26,141,119.85,24.21,141,First Health Group Corporation,First Health Network,136.77,97,,percent of total billed charges,,
"Radiologic Examination, Small Intestine, W Mult Serial Images And Abd Radiograph(S), Single-Contrast (Pro Cah)Professional Component ",,74250,CPT,Professional,Both,,,26,141,119.85,24.21,141,"Health Partners, Inc.",Commercial,57.23,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Radiologic Examination, Small Intestine, W Mult Serial Images And Abd Radiograph(S), Single-Contrast (Pro Cah)Professional Component ",,74250,CPT,Professional,Both,,,26,141,119.85,24.21,141,"Health Partners, Inc.",Medicare Advantage,43.585,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Radiologic Examination, Small Intestine, W Mult Serial Images And Abd Radiograph(S), Single-Contrast (Pro Cah)Professional Component ",,74250,CPT,Professional,Both,,,26,141,119.85,24.21,141,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),24.21,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Radiologic Examination, Small Intestine, W Mult Serial Images And Abd Radiograph(S), Single-Contrast (Pro Cah)Professional Component ",,74250,CPT,Professional,Both,,,26,141,119.85,24.21,141,"Health Partners, Inc.",State of Minnesota Advantage Program,49.303645,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Radiologic Examination, Small Intestine, W Mult Serial Images And Abd Radiograph(S), Single-Contrast (Pro Cah)Professional Component ",,74250,CPT,Professional,Both,,,26,141,119.85,24.21,141,"Health Partners, Inc.",State Public Programs,24.21,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Radiologic Examination, Small Intestine, W Mult Serial Images And Abd Radiograph(S), Single-Contrast (Pro Cah)Professional Component ",,74250,CPT,Professional,Both,,,26,141,119.85,24.21,141,Humana Insurance Company,Commercial PPO,37.9,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Radiologic Examination, Small Intestine, W Mult Serial Images And Abd Radiograph(S), Single-Contrast (Pro Cah)Professional Component ",,74250,CPT,Professional,Both,,,26,141,119.85,24.21,141,Humana Insurance Company,Medicare PPO,141,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Radiologic Examination, Small Intestine, W Mult Serial Images And Abd Radiograph(S), Single-Contrast (Pro Cah)Professional Component ",,74250,CPT,Professional,Both,,,26,141,119.85,24.21,141,Medica,Individual & Family,119.568,84.8,,percent of total billed charges,,
"Radiologic Examination, Small Intestine, W Mult Serial Images And Abd Radiograph(S), Single-Contrast (Pro Cah)Professional Component ",,74250,CPT,Professional,Both,,,26,141,119.85,24.21,141,Medica,Medica Advantage Solution,70.218,49.8,,percent of total billed charges,,
"Radiologic Examination, Small Intestine, W Mult Serial Images And Abd Radiograph(S), Single-Contrast (Pro Cah)Professional Component ",,74250,CPT,Professional,Both,,,26,141,119.85,24.21,141,Medica,Medical Assistance,27.95,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Radiologic Examination, Small Intestine, W Mult Serial Images And Abd Radiograph(S), Single-Contrast (Pro Cah)Professional Component ",,74250,CPT,Professional,Both,,,26,141,119.85,24.21,141,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,37.9,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Radiologic Examination, Small Intestine, W Mult Serial Images And Abd Radiograph(S), Single-Contrast (Pro Cah)Professional Component ",,74250,CPT,Professional,Both,,,26,141,119.85,24.21,141,"Multiplan, Inc.","Multiplan, Inc.",132.54,94,,percent of total billed charges,,
"Radiologic Examination, Small Intestine, W Mult Serial Images And Abd Radiograph(S), Single-Contrast (Pro Cah)Professional Component ",,74250,CPT,Professional,Both,,,26,141,119.85,24.21,141,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,127.041,90.1,,percent of total billed charges,,
"Radiologic Examination, Small Intestine, W Mult Serial Images And Abd Radiograph(S), Single-Contrast (Pro Cah)Professional Component ",,74250,CPT,Professional,Both,,,26,141,119.85,24.21,141,"Preferred One Administrative Services, INC.",PPO,139.026,98.6,,percent of total billed charges,,
"Radiologic Examination, Small Intestine, W Mult Serial Images And Abd Radiograph(S), Single-Contrast (Pro Cah)Professional Component ",,74250,CPT,Professional,Both,,,26,141,119.85,24.21,141,PrimeWest Health,Minnesota Senior Health Options (MSHO),43.585,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Radiologic Examination, Small Intestine, W Mult Serial Images And Abd Radiograph(S), Single-Contrast (Pro Cah)Professional Component ",,74250,CPT,Professional,Both,,,26,141,119.85,24.21,141,PrimeWest Health,MinnesotaCare,29.9066712,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Radiologic Examination, Small Intestine, W Mult Serial Images And Abd Radiograph(S), Single-Contrast (Pro Cah)Professional Component ",,74250,CPT,Professional,Both,,,26,141,119.85,24.21,141,Sanford Health Plan,Sanford Health Plan,124.08,88,,percent of total billed charges,,
"Radiologic Examination, Small Intestine, W Mult Serial Images And Abd Radiograph(S), Single-Contrast (Pro Cah)Professional Component ",,74250,CPT,Professional,Both,,,26,141,119.85,24.21,141,"UCare Health, Inc.",Individual & Family Plan,61.61024,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Radiologic Examination, Small Intestine, W Mult Serial Images And Abd Radiograph(S), Single-Contrast (Pro Cah)Professional Component ",,74250,CPT,Professional,Both,,,26,141,119.85,24.21,141,"UCare Health, Inc.",Medical Assistance,30.745176,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Radiologic Examination, Small Intestine, W Mult Serial Images And Abd Radiograph(S), Single-Contrast (Pro Cah)Professional Component ",,74250,CPT,Professional,Both,,,26,141,119.85,24.21,141,"UCare Health, Inc.",Medicare Advantage,43.585,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Radiologic Examination, Small Intestine, W Mult Serial Images And Abd Radiograph(S), Single-Contrast (Pro Cah)Professional Component ",,74250,CPT,Professional,Both,,,26,141,119.85,24.21,141,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),34.868,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Radiologic Examination, Small Intestine, W Mult Serial Images And Abd Radiograph(S), Single-Contrast (Pro Cah)Professional Component ",,74250,CPT,Professional,Both,,,26,141,119.85,24.21,141,UnitedHealthcare,Individual & Family,141,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Radiologic Examination, Small Intestine, W Mult Serial Images And Abd Radiograph(S), Single-Contrast (Pro Cah)Professional Component ",,74250,CPT,Professional,Both,,,26,141,119.85,24.21,141,UnitedHealthcare,Medicare Advantage,43.585,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Radiologic Examination, Small Intestine, W Mult Serial Images And Abd Radiograph(S), Single-Contrast (Pro Cah)Professional Component ",,74250,CPT,Professional,Both,,,26,141,119.85,24.21,141,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,27.95016,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Operative Cholangiogram 1St Set (Pro Cah)Professional Component ,,74300,CPT,Professional,Both,,,26,95,80.75,8.07,95,Aetna,Commercial,80.75,85,,percent of total billed charges,,
Xr Operative Cholangiogram 1St Set (Pro Cah)Professional Component ,,74300,CPT,Professional,Both,,,26,95,80.75,8.07,95,Aetna,Medicare Advantage,13.91,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Operative Cholangiogram 1St Set (Pro Cah)Professional Component ,,74300,CPT,Professional,Both,,,26,95,80.75,8.07,95,Aetna,PPO,88.35,93,,percent of total billed charges,,
Xr Operative Cholangiogram 1St Set (Pro Cah)Professional Component ,,74300,CPT,Professional,Both,,,26,95,80.75,8.07,95,America's PPO,America's PPO,81.168,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Xr Operative Cholangiogram 1St Set (Pro Cah)Professional Component ,,74300,CPT,Professional,Both,,,26,95,80.75,8.07,95,BlueCross BlueShield Minnesota, Federal Employee Program,24.93,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Xr Operative Cholangiogram 1St Set (Pro Cah)Professional Component ,,74300,CPT,Professional,Both,,,26,95,80.75,8.07,95,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,25.32888,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Operative Cholangiogram 1St Set (Pro Cah)Professional Component ,,74300,CPT,Professional,Both,,,26,95,80.75,8.07,95,BlueCross BlueShield Minnesota,High Value Network Plan,25.32888,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Operative Cholangiogram 1St Set (Pro Cah)Professional Component ,,74300,CPT,Professional,Both,,,26,95,80.75,8.07,95,BlueCross BlueShield Minnesota,Medicare Advantage,14.743,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Operative Cholangiogram 1St Set (Pro Cah)Professional Component ,,74300,CPT,Professional,Both,,,26,95,80.75,8.07,95,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,25.32888,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Operative Cholangiogram 1St Set (Pro Cah)Professional Component ,,74300,CPT,Professional,Both,,,26,95,80.75,8.07,95,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,9.31672,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Operative Cholangiogram 1St Set (Pro Cah)Professional Component ,,74300,CPT,Professional,Both,,,26,95,80.75,8.07,95,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),14.743,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Operative Cholangiogram 1St Set (Pro Cah)Professional Component ,,74300,CPT,Professional,Both,,,26,95,80.75,8.07,95,CorVel,Worker's Compensation,25.4144412,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Xr Operative Cholangiogram 1St Set (Pro Cah)Professional Component ,,74300,CPT,Professional,Both,,,26,95,80.75,8.07,95,First Health Group Corporation,First Health Network,92.15,97,,percent of total billed charges,,
Xr Operative Cholangiogram 1St Set (Pro Cah)Professional Component ,,74300,CPT,Professional,Both,,,26,95,80.75,8.07,95,"Health Partners, Inc.",Commercial,19.6,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Xr Operative Cholangiogram 1St Set (Pro Cah)Professional Component ,,74300,CPT,Professional,Both,,,26,95,80.75,8.07,95,"Health Partners, Inc.",Medicare Advantage,14.743,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Operative Cholangiogram 1St Set (Pro Cah)Professional Component ,,74300,CPT,Professional,Both,,,26,95,80.75,8.07,95,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),8.07,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Xr Operative Cholangiogram 1St Set (Pro Cah)Professional Component ,,74300,CPT,Professional,Both,,,26,95,80.75,8.07,95,"Health Partners, Inc.",State of Minnesota Advantage Program,16.8854,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Xr Operative Cholangiogram 1St Set (Pro Cah)Professional Component ,,74300,CPT,Professional,Both,,,26,95,80.75,8.07,95,"Health Partners, Inc.",State Public Programs,8.07,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Xr Operative Cholangiogram 1St Set (Pro Cah)Professional Component ,,74300,CPT,Professional,Both,,,26,95,80.75,8.07,95,Humana Insurance Company,Commercial PPO,12.82,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Xr Operative Cholangiogram 1St Set (Pro Cah)Professional Component ,,74300,CPT,Professional,Both,,,26,95,80.75,8.07,95,Humana Insurance Company,Medicare PPO,95,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Xr Operative Cholangiogram 1St Set (Pro Cah)Professional Component ,,74300,CPT,Professional,Both,,,26,95,80.75,8.07,95,Medica,Individual & Family,80.56,84.8,,percent of total billed charges,,
Xr Operative Cholangiogram 1St Set (Pro Cah)Professional Component ,,74300,CPT,Professional,Both,,,26,95,80.75,8.07,95,Medica,Medica Advantage Solution,47.31,49.8,,percent of total billed charges,,
Xr Operative Cholangiogram 1St Set (Pro Cah)Professional Component ,,74300,CPT,Professional,Both,,,26,95,80.75,8.07,95,Medica,Medical Assistance,9.32,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Xr Operative Cholangiogram 1St Set (Pro Cah)Professional Component ,,74300,CPT,Professional,Both,,,26,95,80.75,8.07,95,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,12.82,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Xr Operative Cholangiogram 1St Set (Pro Cah)Professional Component ,,74300,CPT,Professional,Both,,,26,95,80.75,8.07,95,"Multiplan, Inc.","Multiplan, Inc.",89.3,94,,percent of total billed charges,,
Xr Operative Cholangiogram 1St Set (Pro Cah)Professional Component ,,74300,CPT,Professional,Both,,,26,95,80.75,8.07,95,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,85.595,90.1,,percent of total billed charges,,
Xr Operative Cholangiogram 1St Set (Pro Cah)Professional Component ,,74300,CPT,Professional,Both,,,26,95,80.75,8.07,95,"Preferred One Administrative Services, INC.",PPO,93.67,98.6,,percent of total billed charges,,
Xr Operative Cholangiogram 1St Set (Pro Cah)Professional Component ,,74300,CPT,Professional,Both,,,26,95,80.75,8.07,95,PrimeWest Health,Minnesota Senior Health Options (MSHO),14.743,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Operative Cholangiogram 1St Set (Pro Cah)Professional Component ,,74300,CPT,Professional,Both,,,26,95,80.75,8.07,95,PrimeWest Health,MinnesotaCare,9.9688904,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Operative Cholangiogram 1St Set (Pro Cah)Professional Component ,,74300,CPT,Professional,Both,,,26,95,80.75,8.07,95,Sanford Health Plan,Sanford Health Plan,83.6,88,,percent of total billed charges,,
Xr Operative Cholangiogram 1St Set (Pro Cah)Professional Component ,,74300,CPT,Professional,Both,,,26,95,80.75,8.07,95,"UCare Health, Inc.",Individual & Family Plan,20.840192,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Xr Operative Cholangiogram 1St Set (Pro Cah)Professional Component ,,74300,CPT,Professional,Both,,,26,95,80.75,8.07,95,"UCare Health, Inc.",Medical Assistance,10.248392,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Xr Operative Cholangiogram 1St Set (Pro Cah)Professional Component ,,74300,CPT,Professional,Both,,,26,95,80.75,8.07,95,"UCare Health, Inc.",Medicare Advantage,14.743,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Xr Operative Cholangiogram 1St Set (Pro Cah)Professional Component ,,74300,CPT,Professional,Both,,,26,95,80.75,8.07,95,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),11.7944,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Xr Operative Cholangiogram 1St Set (Pro Cah)Professional Component ,,74300,CPT,Professional,Both,,,26,95,80.75,8.07,95,UnitedHealthcare,Individual & Family,95,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Xr Operative Cholangiogram 1St Set (Pro Cah)Professional Component ,,74300,CPT,Professional,Both,,,26,95,80.75,8.07,95,UnitedHealthcare,Medicare Advantage,14.743,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Operative Cholangiogram 1St Set (Pro Cah)Professional Component ,,74300,CPT,Professional,Both,,,26,95,80.75,8.07,95,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,9.31672,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Or Retrograde Pyelogram (Pro Cah)Professional Component ,,74420,CPT,Professional,Both,,,26,188,159.8,15.27,188,Aetna,Commercial,159.8,85,,percent of total billed charges,,
Xr Or Retrograde Pyelogram (Pro Cah)Professional Component ,,74420,CPT,Professional,Both,,,26,188,159.8,15.27,188,Aetna,Medicare Advantage,24.75,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Or Retrograde Pyelogram (Pro Cah)Professional Component ,,74420,CPT,Professional,Both,,,26,188,159.8,15.27,188,Aetna,PPO,174.84,93,,percent of total billed charges,,
Xr Or Retrograde Pyelogram (Pro Cah)Professional Component ,,74420,CPT,Professional,Both,,,26,188,159.8,15.27,188,America's PPO,America's PPO,160.6272,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Xr Or Retrograde Pyelogram (Pro Cah)Professional Component ,,74420,CPT,Professional,Both,,,26,188,159.8,15.27,188,BlueCross BlueShield Minnesota, Federal Employee Program,46.02,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Xr Or Retrograde Pyelogram (Pro Cah)Professional Component ,,74420,CPT,Professional,Both,,,26,188,159.8,15.27,188,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,46.75632,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Or Retrograde Pyelogram (Pro Cah)Professional Component ,,74420,CPT,Professional,Both,,,26,188,159.8,15.27,188,BlueCross BlueShield Minnesota,High Value Network Plan,46.75632,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Or Retrograde Pyelogram (Pro Cah)Professional Component ,,74420,CPT,Professional,Both,,,26,188,159.8,15.27,188,BlueCross BlueShield Minnesota,Medicare Advantage,27.669,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Or Retrograde Pyelogram (Pro Cah)Professional Component ,,74420,CPT,Professional,Both,,,26,188,159.8,15.27,188,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,46.75632,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Or Retrograde Pyelogram (Pro Cah)Professional Component ,,74420,CPT,Professional,Both,,,26,188,159.8,15.27,188,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,17.6276,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Or Retrograde Pyelogram (Pro Cah)Professional Component ,,74420,CPT,Professional,Both,,,26,188,159.8,15.27,188,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),27.669,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Or Retrograde Pyelogram (Pro Cah)Professional Component ,,74420,CPT,Professional,Both,,,26,188,159.8,15.27,188,CorVel,Worker's Compensation,47.650398,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Xr Or Retrograde Pyelogram (Pro Cah)Professional Component ,,74420,CPT,Professional,Both,,,26,188,159.8,15.27,188,First Health Group Corporation,First Health Network,182.36,97,,percent of total billed charges,,
Xr Or Retrograde Pyelogram (Pro Cah)Professional Component ,,74420,CPT,Professional,Both,,,26,188,159.8,15.27,188,"Health Partners, Inc.",Commercial,36.61,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Xr Or Retrograde Pyelogram (Pro Cah)Professional Component ,,74420,CPT,Professional,Both,,,26,188,159.8,15.27,188,"Health Partners, Inc.",Medicare Advantage,27.669,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Or Retrograde Pyelogram (Pro Cah)Professional Component ,,74420,CPT,Professional,Both,,,26,188,159.8,15.27,188,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),15.27,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Xr Or Retrograde Pyelogram (Pro Cah)Professional Component ,,74420,CPT,Professional,Both,,,26,188,159.8,15.27,188,"Health Partners, Inc.",State of Minnesota Advantage Program,31.539515,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Xr Or Retrograde Pyelogram (Pro Cah)Professional Component ,,74420,CPT,Professional,Both,,,26,188,159.8,15.27,188,"Health Partners, Inc.",State Public Programs,15.27,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Xr Or Retrograde Pyelogram (Pro Cah)Professional Component ,,74420,CPT,Professional,Both,,,26,188,159.8,15.27,188,Humana Insurance Company,Commercial PPO,24.06,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Xr Or Retrograde Pyelogram (Pro Cah)Professional Component ,,74420,CPT,Professional,Both,,,26,188,159.8,15.27,188,Humana Insurance Company,Medicare PPO,188,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Xr Or Retrograde Pyelogram (Pro Cah)Professional Component ,,74420,CPT,Professional,Both,,,26,188,159.8,15.27,188,Medica,Individual & Family,159.424,84.8,,percent of total billed charges,,
Xr Or Retrograde Pyelogram (Pro Cah)Professional Component ,,74420,CPT,Professional,Both,,,26,188,159.8,15.27,188,Medica,Medica Advantage Solution,93.624,49.8,,percent of total billed charges,,
Xr Or Retrograde Pyelogram (Pro Cah)Professional Component ,,74420,CPT,Professional,Both,,,26,188,159.8,15.27,188,Medica,Medical Assistance,17.63,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Xr Or Retrograde Pyelogram (Pro Cah)Professional Component ,,74420,CPT,Professional,Both,,,26,188,159.8,15.27,188,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,24.06,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Xr Or Retrograde Pyelogram (Pro Cah)Professional Component ,,74420,CPT,Professional,Both,,,26,188,159.8,15.27,188,"Multiplan, Inc.","Multiplan, Inc.",176.72,94,,percent of total billed charges,,
Xr Or Retrograde Pyelogram (Pro Cah)Professional Component ,,74420,CPT,Professional,Both,,,26,188,159.8,15.27,188,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,169.388,90.1,,percent of total billed charges,,
Xr Or Retrograde Pyelogram (Pro Cah)Professional Component ,,74420,CPT,Professional,Both,,,26,188,159.8,15.27,188,"Preferred One Administrative Services, INC.",PPO,185.368,98.6,,percent of total billed charges,,
Xr Or Retrograde Pyelogram (Pro Cah)Professional Component ,,74420,CPT,Professional,Both,,,26,188,159.8,15.27,188,PrimeWest Health,Minnesota Senior Health Options (MSHO),27.669,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Or Retrograde Pyelogram (Pro Cah)Professional Component ,,74420,CPT,Professional,Both,,,26,188,159.8,15.27,188,PrimeWest Health,MinnesotaCare,18.861532,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Or Retrograde Pyelogram (Pro Cah)Professional Component ,,74420,CPT,Professional,Both,,,26,188,159.8,15.27,188,Sanford Health Plan,Sanford Health Plan,165.44,88,,percent of total billed charges,,
Xr Or Retrograde Pyelogram (Pro Cah)Professional Component ,,74420,CPT,Professional,Both,,,26,188,159.8,15.27,188,"UCare Health, Inc.",Individual & Family Plan,39.111936,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Xr Or Retrograde Pyelogram (Pro Cah)Professional Component ,,74420,CPT,Professional,Both,,,26,188,159.8,15.27,188,"UCare Health, Inc.",Medical Assistance,19.39036,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Xr Or Retrograde Pyelogram (Pro Cah)Professional Component ,,74420,CPT,Professional,Both,,,26,188,159.8,15.27,188,"UCare Health, Inc.",Medicare Advantage,27.669,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Xr Or Retrograde Pyelogram (Pro Cah)Professional Component ,,74420,CPT,Professional,Both,,,26,188,159.8,15.27,188,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),22.1352,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Xr Or Retrograde Pyelogram (Pro Cah)Professional Component ,,74420,CPT,Professional,Both,,,26,188,159.8,15.27,188,UnitedHealthcare,Individual & Family,188,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Xr Or Retrograde Pyelogram (Pro Cah)Professional Component ,,74420,CPT,Professional,Both,,,26,188,159.8,15.27,188,UnitedHealthcare,Medicare Advantage,27.669,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Or Retrograde Pyelogram (Pro Cah)Professional Component ,,74420,CPT,Professional,Both,,,26,188,159.8,15.27,188,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,17.6276,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Cystogram (Pro Cah)Professional Component ,,74430,CPT,Professional,Both,,,26,125,106.25,9.37,125,Aetna,Commercial,106.25,85,,percent of total billed charges,,
Xr Cystogram (Pro Cah)Professional Component ,,74430,CPT,Professional,Both,,,26,125,106.25,9.37,125,Aetna,Medicare Advantage,15.18,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Cystogram (Pro Cah)Professional Component ,,74430,CPT,Professional,Both,,,26,125,106.25,9.37,125,Aetna,PPO,116.25,93,,percent of total billed charges,,
Xr Cystogram (Pro Cah)Professional Component ,,74430,CPT,Professional,Both,,,26,125,106.25,9.37,125,America's PPO,America's PPO,106.8,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Xr Cystogram (Pro Cah)Professional Component ,,74430,CPT,Professional,Both,,,26,125,106.25,9.37,125,BlueCross BlueShield Minnesota, Federal Employee Program,28.76,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Xr Cystogram (Pro Cah)Professional Component ,,74430,CPT,Professional,Both,,,26,125,106.25,9.37,125,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,29.22016,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Cystogram (Pro Cah)Professional Component ,,74430,CPT,Professional,Both,,,26,125,106.25,9.37,125,BlueCross BlueShield Minnesota,High Value Network Plan,29.22016,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Cystogram (Pro Cah)Professional Component ,,74430,CPT,Professional,Both,,,26,125,106.25,9.37,125,BlueCross BlueShield Minnesota,Medicare Advantage,17.089,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Cystogram (Pro Cah)Professional Component ,,74430,CPT,Professional,Both,,,26,125,106.25,9.37,125,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,29.22016,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Cystogram (Pro Cah)Professional Component ,,74430,CPT,Professional,Both,,,26,125,106.25,9.37,125,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,10.8204,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Cystogram (Pro Cah)Professional Component ,,74430,CPT,Professional,Both,,,26,125,106.25,9.37,125,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),17.089,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Cystogram (Pro Cah)Professional Component ,,74430,CPT,Professional,Both,,,26,125,106.25,9.37,125,CorVel,Worker's Compensation,29.2162632,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Xr Cystogram (Pro Cah)Professional Component ,,74430,CPT,Professional,Both,,,26,125,106.25,9.37,125,First Health Group Corporation,First Health Network,121.25,97,,percent of total billed charges,,
Xr Cystogram (Pro Cah)Professional Component ,,74430,CPT,Professional,Both,,,26,125,106.25,9.37,125,"Health Partners, Inc.",Commercial,22.17,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Xr Cystogram (Pro Cah)Professional Component ,,74430,CPT,Professional,Both,,,26,125,106.25,9.37,125,"Health Partners, Inc.",Medicare Advantage,17.089,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Cystogram (Pro Cah)Professional Component ,,74430,CPT,Professional,Both,,,26,125,106.25,9.37,125,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),9.37,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Xr Cystogram (Pro Cah)Professional Component ,,74430,CPT,Professional,Both,,,26,125,106.25,9.37,125,"Health Partners, Inc.",State of Minnesota Advantage Program,19.099455,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Xr Cystogram (Pro Cah)Professional Component ,,74430,CPT,Professional,Both,,,26,125,106.25,9.37,125,"Health Partners, Inc.",State Public Programs,9.37,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Xr Cystogram (Pro Cah)Professional Component ,,74430,CPT,Professional,Both,,,26,125,106.25,9.37,125,Humana Insurance Company,Commercial PPO,14.86,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Xr Cystogram (Pro Cah)Professional Component ,,74430,CPT,Professional,Both,,,26,125,106.25,9.37,125,Humana Insurance Company,Medicare PPO,125,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Xr Cystogram (Pro Cah)Professional Component ,,74430,CPT,Professional,Both,,,26,125,106.25,9.37,125,Medica,Individual & Family,106,84.8,,percent of total billed charges,,
Xr Cystogram (Pro Cah)Professional Component ,,74430,CPT,Professional,Both,,,26,125,106.25,9.37,125,Medica,Medica Advantage Solution,62.25,49.8,,percent of total billed charges,,
Xr Cystogram (Pro Cah)Professional Component ,,74430,CPT,Professional,Both,,,26,125,106.25,9.37,125,Medica,Medical Assistance,10.82,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Xr Cystogram (Pro Cah)Professional Component ,,74430,CPT,Professional,Both,,,26,125,106.25,9.37,125,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,14.86,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Xr Cystogram (Pro Cah)Professional Component ,,74430,CPT,Professional,Both,,,26,125,106.25,9.37,125,"Multiplan, Inc.","Multiplan, Inc.",117.5,94,,percent of total billed charges,,
Xr Cystogram (Pro Cah)Professional Component ,,74430,CPT,Professional,Both,,,26,125,106.25,9.37,125,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,112.625,90.1,,percent of total billed charges,,
Xr Cystogram (Pro Cah)Professional Component ,,74430,CPT,Professional,Both,,,26,125,106.25,9.37,125,"Preferred One Administrative Services, INC.",PPO,123.25,98.6,,percent of total billed charges,,
Xr Cystogram (Pro Cah)Professional Component ,,74430,CPT,Professional,Both,,,26,125,106.25,9.37,125,PrimeWest Health,Minnesota Senior Health Options (MSHO),17.089,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Cystogram (Pro Cah)Professional Component ,,74430,CPT,Professional,Both,,,26,125,106.25,9.37,125,PrimeWest Health,MinnesotaCare,11.577828,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Cystogram (Pro Cah)Professional Component ,,74430,CPT,Professional,Both,,,26,125,106.25,9.37,125,Sanford Health Plan,Sanford Health Plan,110,88,,percent of total billed charges,,
Xr Cystogram (Pro Cah)Professional Component ,,74430,CPT,Professional,Both,,,26,125,106.25,9.37,125,"UCare Health, Inc.",Individual & Family Plan,24.156416,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Xr Cystogram (Pro Cah)Professional Component ,,74430,CPT,Professional,Both,,,26,125,106.25,9.37,125,"UCare Health, Inc.",Medical Assistance,11.90244,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Xr Cystogram (Pro Cah)Professional Component ,,74430,CPT,Professional,Both,,,26,125,106.25,9.37,125,"UCare Health, Inc.",Medicare Advantage,17.089,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Xr Cystogram (Pro Cah)Professional Component ,,74430,CPT,Professional,Both,,,26,125,106.25,9.37,125,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),13.6712,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Xr Cystogram (Pro Cah)Professional Component ,,74430,CPT,Professional,Both,,,26,125,106.25,9.37,125,UnitedHealthcare,Individual & Family,125,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Xr Cystogram (Pro Cah)Professional Component ,,74430,CPT,Professional,Both,,,26,125,106.25,9.37,125,UnitedHealthcare,Medicare Advantage,17.089,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Cystogram (Pro Cah)Professional Component ,,74430,CPT,Professional,Both,,,26,125,106.25,9.37,125,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,10.8204,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Cta Abd Aorta Bil Low Ext Runoff (Pro Cah)Professional Component ,,75635,CPT,Professional,Both,,,26,668,567.8,71.11,668,Aetna,Commercial,567.8,85,,percent of total billed charges,,
Cta Abd Aorta Bil Low Ext Runoff (Pro Cah)Professional Component ,,75635,CPT,Professional,Both,,,26,668,567.8,71.11,668,Aetna,Medicare Advantage,114.33,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Cta Abd Aorta Bil Low Ext Runoff (Pro Cah)Professional Component ,,75635,CPT,Professional,Both,,,26,668,567.8,71.11,668,Aetna,PPO,621.24,93,,percent of total billed charges,,
Cta Abd Aorta Bil Low Ext Runoff (Pro Cah)Professional Component ,,75635,CPT,Professional,Both,,,26,668,567.8,71.11,668,America's PPO,America's PPO,570.7392,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Cta Abd Aorta Bil Low Ext Runoff (Pro Cah)Professional Component ,,75635,CPT,Professional,Both,,,26,668,567.8,71.11,668,BlueCross BlueShield Minnesota, Federal Employee Program,212.85,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Cta Abd Aorta Bil Low Ext Runoff (Pro Cah)Professional Component ,,75635,CPT,Professional,Both,,,26,668,567.8,71.11,668,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,216.2556,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Cta Abd Aorta Bil Low Ext Runoff (Pro Cah)Professional Component ,,75635,CPT,Professional,Both,,,26,668,567.8,71.11,668,BlueCross BlueShield Minnesota,High Value Network Plan,216.2556,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Cta Abd Aorta Bil Low Ext Runoff (Pro Cah)Professional Component ,,75635,CPT,Professional,Both,,,26,668,567.8,71.11,668,BlueCross BlueShield Minnesota,Medicare Advantage,127.2245,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Cta Abd Aorta Bil Low Ext Runoff (Pro Cah)Professional Component ,,75635,CPT,Professional,Both,,,26,668,567.8,71.11,668,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,216.2556,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Cta Abd Aorta Bil Low Ext Runoff (Pro Cah)Professional Component ,,75635,CPT,Professional,Both,,,26,668,567.8,71.11,668,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,82.10296,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Cta Abd Aorta Bil Low Ext Runoff (Pro Cah)Professional Component ,,75635,CPT,Professional,Both,,,26,668,567.8,71.11,668,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),127.2245,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Cta Abd Aorta Bil Low Ext Runoff (Pro Cah)Professional Component ,,75635,CPT,Professional,Both,,,26,668,567.8,71.11,668,CorVel,Worker's Compensation,218.9312112,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Cta Abd Aorta Bil Low Ext Runoff (Pro Cah)Professional Component ,,75635,CPT,Professional,Both,,,26,668,567.8,71.11,668,First Health Group Corporation,First Health Network,647.96,97,,percent of total billed charges,,
Cta Abd Aorta Bil Low Ext Runoff (Pro Cah)Professional Component ,,75635,CPT,Professional,Both,,,26,668,567.8,71.11,668,"Health Partners, Inc.",Commercial,168.1,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Cta Abd Aorta Bil Low Ext Runoff (Pro Cah)Professional Component ,,75635,CPT,Professional,Both,,,26,668,567.8,71.11,668,"Health Partners, Inc.",Medicare Advantage,127.2245,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Cta Abd Aorta Bil Low Ext Runoff (Pro Cah)Professional Component ,,75635,CPT,Professional,Both,,,26,668,567.8,71.11,668,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),71.11,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Cta Abd Aorta Bil Low Ext Runoff (Pro Cah)Professional Component ,,75635,CPT,Professional,Both,,,26,668,567.8,71.11,668,"Health Partners, Inc.",State of Minnesota Advantage Program,144.81815,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Cta Abd Aorta Bil Low Ext Runoff (Pro Cah)Professional Component ,,75635,CPT,Professional,Both,,,26,668,567.8,71.11,668,"Health Partners, Inc.",State Public Programs,71.11,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Cta Abd Aorta Bil Low Ext Runoff (Pro Cah)Professional Component ,,75635,CPT,Professional,Both,,,26,668,567.8,71.11,668,Humana Insurance Company,Commercial PPO,110.63,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Cta Abd Aorta Bil Low Ext Runoff (Pro Cah)Professional Component ,,75635,CPT,Professional,Both,,,26,668,567.8,71.11,668,Humana Insurance Company,Medicare PPO,668,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Cta Abd Aorta Bil Low Ext Runoff (Pro Cah)Professional Component ,,75635,CPT,Professional,Both,,,26,668,567.8,71.11,668,Medica,Individual & Family,566.464,84.8,,percent of total billed charges,,
Cta Abd Aorta Bil Low Ext Runoff (Pro Cah)Professional Component ,,75635,CPT,Professional,Both,,,26,668,567.8,71.11,668,Medica,Medica Advantage Solution,332.664,49.8,,percent of total billed charges,,
Cta Abd Aorta Bil Low Ext Runoff (Pro Cah)Professional Component ,,75635,CPT,Professional,Both,,,26,668,567.8,71.11,668,Medica,Medical Assistance,82.1,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Cta Abd Aorta Bil Low Ext Runoff (Pro Cah)Professional Component ,,75635,CPT,Professional,Both,,,26,668,567.8,71.11,668,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,110.63,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Cta Abd Aorta Bil Low Ext Runoff (Pro Cah)Professional Component ,,75635,CPT,Professional,Both,,,26,668,567.8,71.11,668,"Multiplan, Inc.","Multiplan, Inc.",627.92,94,,percent of total billed charges,,
Cta Abd Aorta Bil Low Ext Runoff (Pro Cah)Professional Component ,,75635,CPT,Professional,Both,,,26,668,567.8,71.11,668,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,601.868,90.1,,percent of total billed charges,,
Cta Abd Aorta Bil Low Ext Runoff (Pro Cah)Professional Component ,,75635,CPT,Professional,Both,,,26,668,567.8,71.11,668,"Preferred One Administrative Services, INC.",PPO,658.648,98.6,,percent of total billed charges,,
Cta Abd Aorta Bil Low Ext Runoff (Pro Cah)Professional Component ,,75635,CPT,Professional,Both,,,26,668,567.8,71.11,668,PrimeWest Health,Minnesota Senior Health Options (MSHO),127.2245,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Cta Abd Aorta Bil Low Ext Runoff (Pro Cah)Professional Component ,,75635,CPT,Professional,Both,,,26,668,567.8,71.11,668,PrimeWest Health,MinnesotaCare,87.8501672,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Cta Abd Aorta Bil Low Ext Runoff (Pro Cah)Professional Component ,,75635,CPT,Professional,Both,,,26,668,567.8,71.11,668,Sanford Health Plan,Sanford Health Plan,587.84,88,,percent of total billed charges,,
Cta Abd Aorta Bil Low Ext Runoff (Pro Cah)Professional Component ,,75635,CPT,Professional,Both,,,26,668,567.8,71.11,668,"UCare Health, Inc.",Individual & Family Plan,179.840128,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Cta Abd Aorta Bil Low Ext Runoff (Pro Cah)Professional Component ,,75635,CPT,Professional,Both,,,26,668,567.8,71.11,668,"UCare Health, Inc.",Medical Assistance,90.313256,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Cta Abd Aorta Bil Low Ext Runoff (Pro Cah)Professional Component ,,75635,CPT,Professional,Both,,,26,668,567.8,71.11,668,"UCare Health, Inc.",Medicare Advantage,127.2245,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Cta Abd Aorta Bil Low Ext Runoff (Pro Cah)Professional Component ,,75635,CPT,Professional,Both,,,26,668,567.8,71.11,668,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),101.7796,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Cta Abd Aorta Bil Low Ext Runoff (Pro Cah)Professional Component ,,75635,CPT,Professional,Both,,,26,668,567.8,71.11,668,UnitedHealthcare,Individual & Family,668,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Cta Abd Aorta Bil Low Ext Runoff (Pro Cah)Professional Component ,,75635,CPT,Professional,Both,,,26,668,567.8,71.11,668,UnitedHealthcare,Medicare Advantage,127.2245,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Cta Abd Aorta Bil Low Ext Runoff (Pro Cah)Professional Component ,,75635,CPT,Professional,Both,,,26,668,567.8,71.11,668,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,82.10296,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Xr From Nose To Rectum Foreign Body, Single View, Child (Pro Cah)Professional Component ",,76010,CPT,Professional,Both,,,26,47,39.95,5.45,47,Aetna,Commercial,39.95,85,,percent of total billed charges,,
"Xr From Nose To Rectum Foreign Body, Single View, Child (Pro Cah)Professional Component ",,76010,CPT,Professional,Both,,,26,47,39.95,5.45,47,Aetna,Medicare Advantage,8.88,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Xr From Nose To Rectum Foreign Body, Single View, Child (Pro Cah)Professional Component ",,76010,CPT,Professional,Both,,,26,47,39.95,5.45,47,Aetna,PPO,43.71,93,,percent of total billed charges,,
"Xr From Nose To Rectum Foreign Body, Single View, Child (Pro Cah)Professional Component ",,76010,CPT,Professional,Both,,,26,47,39.95,5.45,47,America's PPO,America's PPO,40.1568,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Xr From Nose To Rectum Foreign Body, Single View, Child (Pro Cah)Professional Component ",,76010,CPT,Professional,Both,,,26,47,39.95,5.45,47,BlueCross BlueShield Minnesota, Federal Employee Program,16.62,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Xr From Nose To Rectum Foreign Body, Single View, Child (Pro Cah)Professional Component ",,76010,CPT,Professional,Both,,,26,47,39.95,5.45,47,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,16.88592,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Xr From Nose To Rectum Foreign Body, Single View, Child (Pro Cah)Professional Component ",,76010,CPT,Professional,Both,,,26,47,39.95,5.45,47,BlueCross BlueShield Minnesota,High Value Network Plan,16.88592,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Xr From Nose To Rectum Foreign Body, Single View, Child (Pro Cah)Professional Component ",,76010,CPT,Professional,Both,,,26,47,39.95,5.45,47,BlueCross BlueShield Minnesota,Medicare Advantage,9.9245,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Xr From Nose To Rectum Foreign Body, Single View, Child (Pro Cah)Professional Component ",,76010,CPT,Professional,Both,,,26,47,39.95,5.45,47,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,16.88592,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Xr From Nose To Rectum Foreign Body, Single View, Child (Pro Cah)Professional Component ",,76010,CPT,Professional,Both,,,26,47,39.95,5.45,47,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,6.28904,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Xr From Nose To Rectum Foreign Body, Single View, Child (Pro Cah)Professional Component ",,76010,CPT,Professional,Both,,,26,47,39.95,5.45,47,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),9.9245,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Xr From Nose To Rectum Foreign Body, Single View, Child (Pro Cah)Professional Component ",,76010,CPT,Professional,Both,,,26,47,39.95,5.45,47,CorVel,Worker's Compensation,17.0907348,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Xr From Nose To Rectum Foreign Body, Single View, Child (Pro Cah)Professional Component ",,76010,CPT,Professional,Both,,,26,47,39.95,5.45,47,First Health Group Corporation,First Health Network,45.59,97,,percent of total billed charges,,
"Xr From Nose To Rectum Foreign Body, Single View, Child (Pro Cah)Professional Component ",,76010,CPT,Professional,Both,,,26,47,39.95,5.45,47,"Health Partners, Inc.",Commercial,12.89,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Xr From Nose To Rectum Foreign Body, Single View, Child (Pro Cah)Professional Component ",,76010,CPT,Professional,Both,,,26,47,39.95,5.45,47,"Health Partners, Inc.",Medicare Advantage,9.9245,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Xr From Nose To Rectum Foreign Body, Single View, Child (Pro Cah)Professional Component ",,76010,CPT,Professional,Both,,,26,47,39.95,5.45,47,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),5.45,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Xr From Nose To Rectum Foreign Body, Single View, Child (Pro Cah)Professional Component ",,76010,CPT,Professional,Both,,,26,47,39.95,5.45,47,"Health Partners, Inc.",State of Minnesota Advantage Program,11.104735,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Xr From Nose To Rectum Foreign Body, Single View, Child (Pro Cah)Professional Component ",,76010,CPT,Professional,Both,,,26,47,39.95,5.45,47,"Health Partners, Inc.",State Public Programs,5.45,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Xr From Nose To Rectum Foreign Body, Single View, Child (Pro Cah)Professional Component ",,76010,CPT,Professional,Both,,,26,47,39.95,5.45,47,Humana Insurance Company,Commercial PPO,8.63,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Xr From Nose To Rectum Foreign Body, Single View, Child (Pro Cah)Professional Component ",,76010,CPT,Professional,Both,,,26,47,39.95,5.45,47,Humana Insurance Company,Medicare PPO,47,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Xr From Nose To Rectum Foreign Body, Single View, Child (Pro Cah)Professional Component ",,76010,CPT,Professional,Both,,,26,47,39.95,5.45,47,Medica,Individual & Family,39.856,84.8,,percent of total billed charges,,
"Xr From Nose To Rectum Foreign Body, Single View, Child (Pro Cah)Professional Component ",,76010,CPT,Professional,Both,,,26,47,39.95,5.45,47,Medica,Medica Advantage Solution,23.406,49.8,,percent of total billed charges,,
"Xr From Nose To Rectum Foreign Body, Single View, Child (Pro Cah)Professional Component ",,76010,CPT,Professional,Both,,,26,47,39.95,5.45,47,Medica,Medical Assistance,6.29,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Xr From Nose To Rectum Foreign Body, Single View, Child (Pro Cah)Professional Component ",,76010,CPT,Professional,Both,,,26,47,39.95,5.45,47,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,8.63,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Xr From Nose To Rectum Foreign Body, Single View, Child (Pro Cah)Professional Component ",,76010,CPT,Professional,Both,,,26,47,39.95,5.45,47,"Multiplan, Inc.","Multiplan, Inc.",44.18,94,,percent of total billed charges,,
"Xr From Nose To Rectum Foreign Body, Single View, Child (Pro Cah)Professional Component ",,76010,CPT,Professional,Both,,,26,47,39.95,5.45,47,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,42.347,90.1,,percent of total billed charges,,
"Xr From Nose To Rectum Foreign Body, Single View, Child (Pro Cah)Professional Component ",,76010,CPT,Professional,Both,,,26,47,39.95,5.45,47,"Preferred One Administrative Services, INC.",PPO,46.342,98.6,,percent of total billed charges,,
"Xr From Nose To Rectum Foreign Body, Single View, Child (Pro Cah)Professional Component ",,76010,CPT,Professional,Both,,,26,47,39.95,5.45,47,PrimeWest Health,Minnesota Senior Health Options (MSHO),9.9245,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Xr From Nose To Rectum Foreign Body, Single View, Child (Pro Cah)Professional Component ",,76010,CPT,Professional,Both,,,26,47,39.95,5.45,47,PrimeWest Health,MinnesotaCare,6.7292728,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Xr From Nose To Rectum Foreign Body, Single View, Child (Pro Cah)Professional Component ",,76010,CPT,Professional,Both,,,26,47,39.95,5.45,47,Sanford Health Plan,Sanford Health Plan,41.36,88,,percent of total billed charges,,
"Xr From Nose To Rectum Foreign Body, Single View, Child (Pro Cah)Professional Component ",,76010,CPT,Professional,Both,,,26,47,39.95,5.45,47,"UCare Health, Inc.",Individual & Family Plan,14.028928,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Xr From Nose To Rectum Foreign Body, Single View, Child (Pro Cah)Professional Component ",,76010,CPT,Professional,Both,,,26,47,39.95,5.45,47,"UCare Health, Inc.",Medical Assistance,6.917944,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Xr From Nose To Rectum Foreign Body, Single View, Child (Pro Cah)Professional Component ",,76010,CPT,Professional,Both,,,26,47,39.95,5.45,47,"UCare Health, Inc.",Medicare Advantage,9.9245,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Xr From Nose To Rectum Foreign Body, Single View, Child (Pro Cah)Professional Component ",,76010,CPT,Professional,Both,,,26,47,39.95,5.45,47,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),7.9396,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Xr From Nose To Rectum Foreign Body, Single View, Child (Pro Cah)Professional Component ",,76010,CPT,Professional,Both,,,26,47,39.95,5.45,47,UnitedHealthcare,Individual & Family,47,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Xr From Nose To Rectum Foreign Body, Single View, Child (Pro Cah)Professional Component ",,76010,CPT,Professional,Both,,,26,47,39.95,5.45,47,UnitedHealthcare,Medicare Advantage,9.9245,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Xr From Nose To Rectum Foreign Body, Single View, Child (Pro Cah)Professional Component ",,76010,CPT,Professional,Both,,,26,47,39.95,5.45,47,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,6.28904,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Ophthalmic Us, Diag; Corneal Pachymetry, Unilatera;/Bilateral For Corneal Thichness (Procah)Professional Component ",,76514,CPT,Professional,Both,,,26,77,65.45,4.8,77,Aetna,Commercial,65.45,85,,percent of total billed charges,,
"Ophthalmic Us, Diag; Corneal Pachymetry, Unilatera;/Bilateral For Corneal Thichness (Procah)Professional Component ",,76514,CPT,Professional,Both,,,26,77,65.45,4.8,77,Aetna,Medicare Advantage,7.84,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Ophthalmic Us, Diag; Corneal Pachymetry, Unilatera;/Bilateral For Corneal Thichness (Procah)Professional Component ",,76514,CPT,Professional,Both,,,26,77,65.45,4.8,77,Aetna,PPO,71.61,93,,percent of total billed charges,,
"Ophthalmic Us, Diag; Corneal Pachymetry, Unilatera;/Bilateral For Corneal Thichness (Procah)Professional Component ",,76514,CPT,Professional,Both,,,26,77,65.45,4.8,77,America's PPO,America's PPO,65.7888,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Ophthalmic Us, Diag; Corneal Pachymetry, Unilatera;/Bilateral For Corneal Thichness (Procah)Professional Component ",,76514,CPT,Professional,Both,,,26,77,65.45,4.8,77,BlueCross BlueShield Minnesota, Federal Employee Program,14.7,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Ophthalmic Us, Diag; Corneal Pachymetry, Unilatera;/Bilateral For Corneal Thichness (Procah)Professional Component ",,76514,CPT,Professional,Both,,,26,77,65.45,4.8,77,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,14.9352,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Ophthalmic Us, Diag; Corneal Pachymetry, Unilatera;/Bilateral For Corneal Thichness (Procah)Professional Component ",,76514,CPT,Professional,Both,,,26,77,65.45,4.8,77,BlueCross BlueShield Minnesota,High Value Network Plan,14.9352,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Ophthalmic Us, Diag; Corneal Pachymetry, Unilatera;/Bilateral For Corneal Thichness (Procah)Professional Component ",,76514,CPT,Professional,Both,,,26,77,65.45,4.8,77,BlueCross BlueShield Minnesota,Medicare Advantage,8.763,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Ophthalmic Us, Diag; Corneal Pachymetry, Unilatera;/Bilateral For Corneal Thichness (Procah)Professional Component ",,76514,CPT,Professional,Both,,,26,77,65.45,4.8,77,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,14.9352,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Ophthalmic Us, Diag; Corneal Pachymetry, Unilatera;/Bilateral For Corneal Thichness (Procah)Professional Component ",,76514,CPT,Professional,Both,,,26,77,65.45,4.8,77,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,5.5372,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Ophthalmic Us, Diag; Corneal Pachymetry, Unilatera;/Bilateral For Corneal Thichness (Procah)Professional Component ",,76514,CPT,Professional,Both,,,26,77,65.45,4.8,77,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),8.763,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Ophthalmic Us, Diag; Corneal Pachymetry, Unilatera;/Bilateral For Corneal Thichness (Procah)Professional Component ",,76514,CPT,Professional,Both,,,26,77,65.45,4.8,77,CorVel,Worker's Compensation,15.0843669,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Ophthalmic Us, Diag; Corneal Pachymetry, Unilatera;/Bilateral For Corneal Thichness (Procah)Professional Component ",,76514,CPT,Professional,Both,,,26,77,65.45,4.8,77,First Health Group Corporation,First Health Network,74.69,97,,percent of total billed charges,,
"Ophthalmic Us, Diag; Corneal Pachymetry, Unilatera;/Bilateral For Corneal Thichness (Procah)Professional Component ",,76514,CPT,Professional,Both,,,26,77,65.45,4.8,77,"Health Partners, Inc.",Commercial,11.35,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Ophthalmic Us, Diag; Corneal Pachymetry, Unilatera;/Bilateral For Corneal Thichness (Procah)Professional Component ",,76514,CPT,Professional,Both,,,26,77,65.45,4.8,77,"Health Partners, Inc.",Medicare Advantage,8.763,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Ophthalmic Us, Diag; Corneal Pachymetry, Unilatera;/Bilateral For Corneal Thichness (Procah)Professional Component ",,76514,CPT,Professional,Both,,,26,77,65.45,4.8,77,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),4.8,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Ophthalmic Us, Diag; Corneal Pachymetry, Unilatera;/Bilateral For Corneal Thichness (Procah)Professional Component ",,76514,CPT,Professional,Both,,,26,77,65.45,4.8,77,"Health Partners, Inc.",State of Minnesota Advantage Program,9.778025,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Ophthalmic Us, Diag; Corneal Pachymetry, Unilatera;/Bilateral For Corneal Thichness (Procah)Professional Component ",,76514,CPT,Professional,Both,,,26,77,65.45,4.8,77,"Health Partners, Inc.",State Public Programs,4.8,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Ophthalmic Us, Diag; Corneal Pachymetry, Unilatera;/Bilateral For Corneal Thichness (Procah)Professional Component ",,76514,CPT,Professional,Both,,,26,77,65.45,4.8,77,Humana Insurance Company,Commercial PPO,7.62,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Ophthalmic Us, Diag; Corneal Pachymetry, Unilatera;/Bilateral For Corneal Thichness (Procah)Professional Component ",,76514,CPT,Professional,Both,,,26,77,65.45,4.8,77,Humana Insurance Company,Medicare PPO,77,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Ophthalmic Us, Diag; Corneal Pachymetry, Unilatera;/Bilateral For Corneal Thichness (Procah)Professional Component ",,76514,CPT,Professional,Both,,,26,77,65.45,4.8,77,Medica,Individual & Family,65.296,84.8,,percent of total billed charges,,
"Ophthalmic Us, Diag; Corneal Pachymetry, Unilatera;/Bilateral For Corneal Thichness (Procah)Professional Component ",,76514,CPT,Professional,Both,,,26,77,65.45,4.8,77,Medica,Medica Advantage Solution,38.346,49.8,,percent of total billed charges,,
"Ophthalmic Us, Diag; Corneal Pachymetry, Unilatera;/Bilateral For Corneal Thichness (Procah)Professional Component ",,76514,CPT,Professional,Both,,,26,77,65.45,4.8,77,Medica,Medical Assistance,5.54,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Ophthalmic Us, Diag; Corneal Pachymetry, Unilatera;/Bilateral For Corneal Thichness (Procah)Professional Component ",,76514,CPT,Professional,Both,,,26,77,65.45,4.8,77,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,7.62,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Ophthalmic Us, Diag; Corneal Pachymetry, Unilatera;/Bilateral For Corneal Thichness (Procah)Professional Component ",,76514,CPT,Professional,Both,,,26,77,65.45,4.8,77,"Multiplan, Inc.","Multiplan, Inc.",72.38,94,,percent of total billed charges,,
"Ophthalmic Us, Diag; Corneal Pachymetry, Unilatera;/Bilateral For Corneal Thichness (Procah)Professional Component ",,76514,CPT,Professional,Both,,,26,77,65.45,4.8,77,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,69.377,90.1,,percent of total billed charges,,
"Ophthalmic Us, Diag; Corneal Pachymetry, Unilatera;/Bilateral For Corneal Thichness (Procah)Professional Component ",,76514,CPT,Professional,Both,,,26,77,65.45,4.8,77,"Preferred One Administrative Services, INC.",PPO,75.922,98.6,,percent of total billed charges,,
"Ophthalmic Us, Diag; Corneal Pachymetry, Unilatera;/Bilateral For Corneal Thichness (Procah)Professional Component ",,76514,CPT,Professional,Both,,,26,77,65.45,4.8,77,PrimeWest Health,Minnesota Senior Health Options (MSHO),8.763,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Ophthalmic Us, Diag; Corneal Pachymetry, Unilatera;/Bilateral For Corneal Thichness (Procah)Professional Component ",,76514,CPT,Professional,Both,,,26,77,65.45,4.8,77,PrimeWest Health,MinnesotaCare,5.924804,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Ophthalmic Us, Diag; Corneal Pachymetry, Unilatera;/Bilateral For Corneal Thichness (Procah)Professional Component ",,76514,CPT,Professional,Both,,,26,77,65.45,4.8,77,Sanford Health Plan,Sanford Health Plan,67.76,88,,percent of total billed charges,,
"Ophthalmic Us, Diag; Corneal Pachymetry, Unilatera;/Bilateral For Corneal Thichness (Procah)Professional Component ",,76514,CPT,Professional,Both,,,26,77,65.45,4.8,77,"UCare Health, Inc.",Individual & Family Plan,12.387072,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Ophthalmic Us, Diag; Corneal Pachymetry, Unilatera;/Bilateral For Corneal Thichness (Procah)Professional Component ",,76514,CPT,Professional,Both,,,26,77,65.45,4.8,77,"UCare Health, Inc.",Medical Assistance,6.09092,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Ophthalmic Us, Diag; Corneal Pachymetry, Unilatera;/Bilateral For Corneal Thichness (Procah)Professional Component ",,76514,CPT,Professional,Both,,,26,77,65.45,4.8,77,"UCare Health, Inc.",Medicare Advantage,8.763,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Ophthalmic Us, Diag; Corneal Pachymetry, Unilatera;/Bilateral For Corneal Thichness (Procah)Professional Component ",,76514,CPT,Professional,Both,,,26,77,65.45,4.8,77,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),7.0104,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Ophthalmic Us, Diag; Corneal Pachymetry, Unilatera;/Bilateral For Corneal Thichness (Procah)Professional Component ",,76514,CPT,Professional,Both,,,26,77,65.45,4.8,77,UnitedHealthcare,Individual & Family,77,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Ophthalmic Us, Diag; Corneal Pachymetry, Unilatera;/Bilateral For Corneal Thichness (Procah)Professional Component ",,76514,CPT,Professional,Both,,,26,77,65.45,4.8,77,UnitedHealthcare,Medicare Advantage,8.763,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Ophthalmic Us, Diag; Corneal Pachymetry, Unilatera;/Bilateral For Corneal Thichness (Procah)Professional Component ",,76514,CPT,Professional,Both,,,26,77,65.45,4.8,77,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,5.5372,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Us Thyroid/Head/Neck (Pro Cah)Professional Component ,,76536,CPT,Professional,Both,,,26,112,95.2,17.01,112,Aetna,Commercial,95.2,85,,percent of total billed charges,,
Us Thyroid/Head/Neck (Pro Cah)Professional Component ,,76536,CPT,Professional,Both,,,26,112,95.2,17.01,112,Aetna,Medicare Advantage,27.46,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Us Thyroid/Head/Neck (Pro Cah)Professional Component ,,76536,CPT,Professional,Both,,,26,112,95.2,17.01,112,Aetna,PPO,104.16,93,,percent of total billed charges,,
Us Thyroid/Head/Neck (Pro Cah)Professional Component ,,76536,CPT,Professional,Both,,,26,112,95.2,17.01,112,America's PPO,America's PPO,95.6928,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Us Thyroid/Head/Neck (Pro Cah)Professional Component ,,76536,CPT,Professional,Both,,,26,112,95.2,17.01,112,BlueCross BlueShield Minnesota, Federal Employee Program,51.78,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Us Thyroid/Head/Neck (Pro Cah)Professional Component ,,76536,CPT,Professional,Both,,,26,112,95.2,17.01,112,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,52.60848,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Us Thyroid/Head/Neck (Pro Cah)Professional Component ,,76536,CPT,Professional,Both,,,26,112,95.2,17.01,112,BlueCross BlueShield Minnesota,High Value Network Plan,52.60848,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Us Thyroid/Head/Neck (Pro Cah)Professional Component ,,76536,CPT,Professional,Both,,,26,112,95.2,17.01,112,BlueCross BlueShield Minnesota,Medicare Advantage,30.6705,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Us Thyroid/Head/Neck (Pro Cah)Professional Component ,,76536,CPT,Professional,Both,,,26,112,95.2,17.01,112,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,52.60848,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Us Thyroid/Head/Neck (Pro Cah)Professional Component ,,76536,CPT,Professional,Both,,,26,112,95.2,17.01,112,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,19.63928,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Us Thyroid/Head/Neck (Pro Cah)Professional Component ,,76536,CPT,Professional,Both,,,26,112,95.2,17.01,112,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),30.6705,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Us Thyroid/Head/Neck (Pro Cah)Professional Component ,,76536,CPT,Professional,Both,,,26,112,95.2,17.01,112,CorVel,Worker's Compensation,52.8527145,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Us Thyroid/Head/Neck (Pro Cah)Professional Component ,,76536,CPT,Professional,Both,,,26,112,95.2,17.01,112,First Health Group Corporation,First Health Network,108.64,97,,percent of total billed charges,,
Us Thyroid/Head/Neck (Pro Cah)Professional Component ,,76536,CPT,Professional,Both,,,26,112,95.2,17.01,112,"Health Partners, Inc.",Commercial,40.22,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Us Thyroid/Head/Neck (Pro Cah)Professional Component ,,76536,CPT,Professional,Both,,,26,112,95.2,17.01,112,"Health Partners, Inc.",Medicare Advantage,30.6705,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Us Thyroid/Head/Neck (Pro Cah)Professional Component ,,76536,CPT,Professional,Both,,,26,112,95.2,17.01,112,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),17.01,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Us Thyroid/Head/Neck (Pro Cah)Professional Component ,,76536,CPT,Professional,Both,,,26,112,95.2,17.01,112,"Health Partners, Inc.",State of Minnesota Advantage Program,34.64953,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Us Thyroid/Head/Neck (Pro Cah)Professional Component ,,76536,CPT,Professional,Both,,,26,112,95.2,17.01,112,"Health Partners, Inc.",State Public Programs,17.01,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Us Thyroid/Head/Neck (Pro Cah)Professional Component ,,76536,CPT,Professional,Both,,,26,112,95.2,17.01,112,Humana Insurance Company,Commercial PPO,26.67,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Us Thyroid/Head/Neck (Pro Cah)Professional Component ,,76536,CPT,Professional,Both,,,26,112,95.2,17.01,112,Humana Insurance Company,Medicare PPO,112,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Us Thyroid/Head/Neck (Pro Cah)Professional Component ,,76536,CPT,Professional,Both,,,26,112,95.2,17.01,112,Medica,Individual & Family,94.976,84.8,,percent of total billed charges,,
Us Thyroid/Head/Neck (Pro Cah)Professional Component ,,76536,CPT,Professional,Both,,,26,112,95.2,17.01,112,Medica,Medica Advantage Solution,55.776,49.8,,percent of total billed charges,,
Us Thyroid/Head/Neck (Pro Cah)Professional Component ,,76536,CPT,Professional,Both,,,26,112,95.2,17.01,112,Medica,Medical Assistance,19.64,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Us Thyroid/Head/Neck (Pro Cah)Professional Component ,,76536,CPT,Professional,Both,,,26,112,95.2,17.01,112,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,26.67,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Us Thyroid/Head/Neck (Pro Cah)Professional Component ,,76536,CPT,Professional,Both,,,26,112,95.2,17.01,112,"Multiplan, Inc.","Multiplan, Inc.",105.28,94,,percent of total billed charges,,
Us Thyroid/Head/Neck (Pro Cah)Professional Component ,,76536,CPT,Professional,Both,,,26,112,95.2,17.01,112,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,100.912,90.1,,percent of total billed charges,,
Us Thyroid/Head/Neck (Pro Cah)Professional Component ,,76536,CPT,Professional,Both,,,26,112,95.2,17.01,112,"Preferred One Administrative Services, INC.",PPO,110.432,98.6,,percent of total billed charges,,
Us Thyroid/Head/Neck (Pro Cah)Professional Component ,,76536,CPT,Professional,Both,,,26,112,95.2,17.01,112,PrimeWest Health,Minnesota Senior Health Options (MSHO),30.6705,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Us Thyroid/Head/Neck (Pro Cah)Professional Component ,,76536,CPT,Professional,Both,,,26,112,95.2,17.01,112,PrimeWest Health,MinnesotaCare,21.0140296,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Us Thyroid/Head/Neck (Pro Cah)Professional Component ,,76536,CPT,Professional,Both,,,26,112,95.2,17.01,112,Sanford Health Plan,Sanford Health Plan,98.56,88,,percent of total billed charges,,
Us Thyroid/Head/Neck (Pro Cah)Professional Component ,,76536,CPT,Professional,Both,,,26,112,95.2,17.01,112,"UCare Health, Inc.",Individual & Family Plan,43.354752,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Us Thyroid/Head/Neck (Pro Cah)Professional Component ,,76536,CPT,Professional,Both,,,26,112,95.2,17.01,112,"UCare Health, Inc.",Medical Assistance,21.603208,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Us Thyroid/Head/Neck (Pro Cah)Professional Component ,,76536,CPT,Professional,Both,,,26,112,95.2,17.01,112,"UCare Health, Inc.",Medicare Advantage,30.6705,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Us Thyroid/Head/Neck (Pro Cah)Professional Component ,,76536,CPT,Professional,Both,,,26,112,95.2,17.01,112,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),24.5364,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Us Thyroid/Head/Neck (Pro Cah)Professional Component ,,76536,CPT,Professional,Both,,,26,112,95.2,17.01,112,UnitedHealthcare,Individual & Family,112,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Us Thyroid/Head/Neck (Pro Cah)Professional Component ,,76536,CPT,Professional,Both,,,26,112,95.2,17.01,112,UnitedHealthcare,Medicare Advantage,30.6705,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Us Thyroid/Head/Neck (Pro Cah)Professional Component ,,76536,CPT,Professional,Both,,,26,112,95.2,17.01,112,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,19.63928,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Us Chest (Pro Cah)Professional Component ,,76604,CPT,Professional,Both,,,26,164,139.4,17.23,164,Aetna,Commercial,139.4,85,,percent of total billed charges,,
Us Chest (Pro Cah)Professional Component ,,76604,CPT,Professional,Both,,,26,164,139.4,17.23,164,Aetna,Medicare Advantage,27.8,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Us Chest (Pro Cah)Professional Component ,,76604,CPT,Professional,Both,,,26,164,139.4,17.23,164,Aetna,PPO,152.52,93,,percent of total billed charges,,
Us Chest (Pro Cah)Professional Component ,,76604,CPT,Professional,Both,,,26,164,139.4,17.23,164,America's PPO,America's PPO,140.1216,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Us Chest (Pro Cah)Professional Component ,,76604,CPT,Professional,Both,,,26,164,139.4,17.23,164,BlueCross BlueShield Minnesota, Federal Employee Program,52.41,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Us Chest (Pro Cah)Professional Component ,,76604,CPT,Professional,Both,,,26,164,139.4,17.23,164,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,53.24856,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Us Chest (Pro Cah)Professional Component ,,76604,CPT,Professional,Both,,,26,164,139.4,17.23,164,BlueCross BlueShield Minnesota,High Value Network Plan,53.24856,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Us Chest (Pro Cah)Professional Component ,,76604,CPT,Professional,Both,,,26,164,139.4,17.23,164,BlueCross BlueShield Minnesota,Medicare Advantage,31.05,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Us Chest (Pro Cah)Professional Component ,,76604,CPT,Professional,Both,,,26,164,139.4,17.23,164,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,53.24856,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Us Chest (Pro Cah)Professional Component ,,76604,CPT,Professional,Both,,,26,164,139.4,17.23,164,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,19.89328,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Us Chest (Pro Cah)Professional Component ,,76604,CPT,Professional,Both,,,26,164,139.4,17.23,164,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),31.05,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Us Chest (Pro Cah)Professional Component ,,76604,CPT,Professional,Both,,,26,164,139.4,17.23,164,CorVel,Worker's Compensation,53.5069503,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Us Chest (Pro Cah)Professional Component ,,76604,CPT,Professional,Both,,,26,164,139.4,17.23,164,First Health Group Corporation,First Health Network,159.08,97,,percent of total billed charges,,
Us Chest (Pro Cah)Professional Component ,,76604,CPT,Professional,Both,,,26,164,139.4,17.23,164,"Health Partners, Inc.",Commercial,40.73,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Us Chest (Pro Cah)Professional Component ,,76604,CPT,Professional,Both,,,26,164,139.4,17.23,164,"Health Partners, Inc.",Medicare Advantage,31.05,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Us Chest (Pro Cah)Professional Component ,,76604,CPT,Professional,Both,,,26,164,139.4,17.23,164,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),17.23,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Us Chest (Pro Cah)Professional Component ,,76604,CPT,Professional,Both,,,26,164,139.4,17.23,164,"Health Partners, Inc.",State of Minnesota Advantage Program,35.088895,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Us Chest (Pro Cah)Professional Component ,,76604,CPT,Professional,Both,,,26,164,139.4,17.23,164,"Health Partners, Inc.",State Public Programs,17.23,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Us Chest (Pro Cah)Professional Component ,,76604,CPT,Professional,Both,,,26,164,139.4,17.23,164,Humana Insurance Company,Commercial PPO,27,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Us Chest (Pro Cah)Professional Component ,,76604,CPT,Professional,Both,,,26,164,139.4,17.23,164,Humana Insurance Company,Medicare PPO,164,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Us Chest (Pro Cah)Professional Component ,,76604,CPT,Professional,Both,,,26,164,139.4,17.23,164,Medica,Individual & Family,139.072,84.8,,percent of total billed charges,,
Us Chest (Pro Cah)Professional Component ,,76604,CPT,Professional,Both,,,26,164,139.4,17.23,164,Medica,Medica Advantage Solution,81.672,49.8,,percent of total billed charges,,
Us Chest (Pro Cah)Professional Component ,,76604,CPT,Professional,Both,,,26,164,139.4,17.23,164,Medica,Medical Assistance,19.89,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Us Chest (Pro Cah)Professional Component ,,76604,CPT,Professional,Both,,,26,164,139.4,17.23,164,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,27,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Us Chest (Pro Cah)Professional Component ,,76604,CPT,Professional,Both,,,26,164,139.4,17.23,164,"Multiplan, Inc.","Multiplan, Inc.",154.16,94,,percent of total billed charges,,
Us Chest (Pro Cah)Professional Component ,,76604,CPT,Professional,Both,,,26,164,139.4,17.23,164,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,147.764,90.1,,percent of total billed charges,,
Us Chest (Pro Cah)Professional Component ,,76604,CPT,Professional,Both,,,26,164,139.4,17.23,164,"Preferred One Administrative Services, INC.",PPO,161.704,98.6,,percent of total billed charges,,
Us Chest (Pro Cah)Professional Component ,,76604,CPT,Professional,Both,,,26,164,139.4,17.23,164,PrimeWest Health,Minnesota Senior Health Options (MSHO),31.05,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Us Chest (Pro Cah)Professional Component ,,76604,CPT,Professional,Both,,,26,164,139.4,17.23,164,PrimeWest Health,MinnesotaCare,21.2858096,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Us Chest (Pro Cah)Professional Component ,,76604,CPT,Professional,Both,,,26,164,139.4,17.23,164,Sanford Health Plan,Sanford Health Plan,144.32,88,,percent of total billed charges,,
Us Chest (Pro Cah)Professional Component ,,76604,CPT,Professional,Both,,,26,164,139.4,17.23,164,"UCare Health, Inc.",Individual & Family Plan,43.8912,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Us Chest (Pro Cah)Professional Component ,,76604,CPT,Professional,Both,,,26,164,139.4,17.23,164,"UCare Health, Inc.",Medical Assistance,21.882608,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Us Chest (Pro Cah)Professional Component ,,76604,CPT,Professional,Both,,,26,164,139.4,17.23,164,"UCare Health, Inc.",Medicare Advantage,31.05,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Us Chest (Pro Cah)Professional Component ,,76604,CPT,Professional,Both,,,26,164,139.4,17.23,164,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),24.84,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Us Chest (Pro Cah)Professional Component ,,76604,CPT,Professional,Both,,,26,164,139.4,17.23,164,UnitedHealthcare,Individual & Family,164,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Us Chest (Pro Cah)Professional Component ,,76604,CPT,Professional,Both,,,26,164,139.4,17.23,164,UnitedHealthcare,Medicare Advantage,31.05,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Us Chest (Pro Cah)Professional Component ,,76604,CPT,Professional,Both,,,26,164,139.4,17.23,164,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,19.89328,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Us Breast Unilateral Complete (Pro Cah)Professional Component ,,76641,CPT,Professional,Both,,,26,156,132.6,22.03,156,Aetna,Commercial,132.6,85,,percent of total billed charges,,
Us Breast Unilateral Complete (Pro Cah)Professional Component ,,76641,CPT,Professional,Both,,,26,156,132.6,22.03,156,Aetna,Medicare Advantage,35.15,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Us Breast Unilateral Complete (Pro Cah)Professional Component ,,76641,CPT,Professional,Both,,,26,156,132.6,22.03,156,Aetna,PPO,145.08,93,,percent of total billed charges,,
Us Breast Unilateral Complete (Pro Cah)Professional Component ,,76641,CPT,Professional,Both,,,26,156,132.6,22.03,156,America's PPO,America's PPO,133.2864,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Us Breast Unilateral Complete (Pro Cah)Professional Component ,,76641,CPT,Professional,Both,,,26,156,132.6,22.03,156,BlueCross BlueShield Minnesota, Federal Employee Program,66.48,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Us Breast Unilateral Complete (Pro Cah)Professional Component ,,76641,CPT,Professional,Both,,,26,156,132.6,22.03,156,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,67.54368,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Us Breast Unilateral Complete (Pro Cah)Professional Component ,,76641,CPT,Professional,Both,,,26,156,132.6,22.03,156,BlueCross BlueShield Minnesota,High Value Network Plan,67.54368,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Us Breast Unilateral Complete (Pro Cah)Professional Component ,,76641,CPT,Professional,Both,,,26,156,132.6,22.03,156,BlueCross BlueShield Minnesota,Medicare Advantage,39.675,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Us Breast Unilateral Complete (Pro Cah)Professional Component ,,76641,CPT,Professional,Both,,,26,156,132.6,22.03,156,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,67.54368,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Us Breast Unilateral Complete (Pro Cah)Professional Component ,,76641,CPT,Professional,Both,,,26,156,132.6,22.03,156,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,25.43048,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Us Breast Unilateral Complete (Pro Cah)Professional Component ,,76641,CPT,Professional,Both,,,26,156,132.6,22.03,156,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),39.675,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Us Breast Unilateral Complete (Pro Cah)Professional Component ,,76641,CPT,Professional,Both,,,26,156,132.6,22.03,156,CorVel,Worker's Compensation,67.673775,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Us Breast Unilateral Complete (Pro Cah)Professional Component ,,76641,CPT,Professional,Both,,,26,156,132.6,22.03,156,First Health Group Corporation,First Health Network,151.32,97,,percent of total billed charges,,
Us Breast Unilateral Complete (Pro Cah)Professional Component ,,76641,CPT,Professional,Both,,,26,156,132.6,22.03,156,"Health Partners, Inc.",Commercial,51.56,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Us Breast Unilateral Complete (Pro Cah)Professional Component ,,76641,CPT,Professional,Both,,,26,156,132.6,22.03,156,"Health Partners, Inc.",Medicare Advantage,39.675,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Us Breast Unilateral Complete (Pro Cah)Professional Component ,,76641,CPT,Professional,Both,,,26,156,132.6,22.03,156,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),22.03,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Us Breast Unilateral Complete (Pro Cah)Professional Component ,,76641,CPT,Professional,Both,,,26,156,132.6,22.03,156,"Health Partners, Inc.",State of Minnesota Advantage Program,44.41894,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Us Breast Unilateral Complete (Pro Cah)Professional Component ,,76641,CPT,Professional,Both,,,26,156,132.6,22.03,156,"Health Partners, Inc.",State Public Programs,22.03,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Us Breast Unilateral Complete (Pro Cah)Professional Component ,,76641,CPT,Professional,Both,,,26,156,132.6,22.03,156,Humana Insurance Company,Commercial PPO,34.5,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Us Breast Unilateral Complete (Pro Cah)Professional Component ,,76641,CPT,Professional,Both,,,26,156,132.6,22.03,156,Humana Insurance Company,Medicare PPO,156,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Us Breast Unilateral Complete (Pro Cah)Professional Component ,,76641,CPT,Professional,Both,,,26,156,132.6,22.03,156,Medica,Individual & Family,132.288,84.8,,percent of total billed charges,,
Us Breast Unilateral Complete (Pro Cah)Professional Component ,,76641,CPT,Professional,Both,,,26,156,132.6,22.03,156,Medica,Medica Advantage Solution,77.688,49.8,,percent of total billed charges,,
Us Breast Unilateral Complete (Pro Cah)Professional Component ,,76641,CPT,Professional,Both,,,26,156,132.6,22.03,156,Medica,Medical Assistance,25.43,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Us Breast Unilateral Complete (Pro Cah)Professional Component ,,76641,CPT,Professional,Both,,,26,156,132.6,22.03,156,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,34.5,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Us Breast Unilateral Complete (Pro Cah)Professional Component ,,76641,CPT,Professional,Both,,,26,156,132.6,22.03,156,"Multiplan, Inc.","Multiplan, Inc.",146.64,94,,percent of total billed charges,,
Us Breast Unilateral Complete (Pro Cah)Professional Component ,,76641,CPT,Professional,Both,,,26,156,132.6,22.03,156,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,140.556,90.1,,percent of total billed charges,,
Us Breast Unilateral Complete (Pro Cah)Professional Component ,,76641,CPT,Professional,Both,,,26,156,132.6,22.03,156,"Preferred One Administrative Services, INC.",PPO,153.816,98.6,,percent of total billed charges,,
Us Breast Unilateral Complete (Pro Cah)Professional Component ,,76641,CPT,Professional,Both,,,26,156,132.6,22.03,156,PrimeWest Health,Minnesota Senior Health Options (MSHO),39.675,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Us Breast Unilateral Complete (Pro Cah)Professional Component ,,76641,CPT,Professional,Both,,,26,156,132.6,22.03,156,PrimeWest Health,MinnesotaCare,27.2106136,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Us Breast Unilateral Complete (Pro Cah)Professional Component ,,76641,CPT,Professional,Both,,,26,156,132.6,22.03,156,Sanford Health Plan,Sanford Health Plan,137.28,88,,percent of total billed charges,,
Us Breast Unilateral Complete (Pro Cah)Professional Component ,,76641,CPT,Professional,Both,,,26,156,132.6,22.03,156,"UCare Health, Inc.",Individual & Family Plan,56.0832,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Us Breast Unilateral Complete (Pro Cah)Professional Component ,,76641,CPT,Professional,Both,,,26,156,132.6,22.03,156,"UCare Health, Inc.",Medical Assistance,27.973528,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Us Breast Unilateral Complete (Pro Cah)Professional Component ,,76641,CPT,Professional,Both,,,26,156,132.6,22.03,156,"UCare Health, Inc.",Medicare Advantage,39.675,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Us Breast Unilateral Complete (Pro Cah)Professional Component ,,76641,CPT,Professional,Both,,,26,156,132.6,22.03,156,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),31.74,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Us Breast Unilateral Complete (Pro Cah)Professional Component ,,76641,CPT,Professional,Both,,,26,156,132.6,22.03,156,UnitedHealthcare,Individual & Family,156,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Us Breast Unilateral Complete (Pro Cah)Professional Component ,,76641,CPT,Professional,Both,,,26,156,132.6,22.03,156,UnitedHealthcare,Medicare Advantage,39.675,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Us Breast Unilateral Complete (Pro Cah)Professional Component ,,76641,CPT,Professional,Both,,,26,156,132.6,22.03,156,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,25.43048,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Us Breast Unilateral Limited (Pro Cah)Professional Component ,,76642,CPT,Professional,Both,,,26,143,121.55,20.5,143,Aetna,Commercial,121.55,85,,percent of total billed charges,,
Us Breast Unilateral Limited (Pro Cah)Professional Component ,,76642,CPT,Professional,Both,,,26,143,121.55,20.5,143,Aetna,Medicare Advantage,33.06,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Us Breast Unilateral Limited (Pro Cah)Professional Component ,,76642,CPT,Professional,Both,,,26,143,121.55,20.5,143,Aetna,PPO,132.99,93,,percent of total billed charges,,
Us Breast Unilateral Limited (Pro Cah)Professional Component ,,76642,CPT,Professional,Both,,,26,143,121.55,20.5,143,America's PPO,America's PPO,122.1792,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Us Breast Unilateral Limited (Pro Cah)Professional Component ,,76642,CPT,Professional,Both,,,26,143,121.55,20.5,143,BlueCross BlueShield Minnesota, Federal Employee Program,62,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Us Breast Unilateral Limited (Pro Cah)Professional Component ,,76642,CPT,Professional,Both,,,26,143,121.55,20.5,143,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,62.992,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Us Breast Unilateral Limited (Pro Cah)Professional Component ,,76642,CPT,Professional,Both,,,26,143,121.55,20.5,143,BlueCross BlueShield Minnesota,High Value Network Plan,62.992,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Us Breast Unilateral Limited (Pro Cah)Professional Component ,,76642,CPT,Professional,Both,,,26,143,121.55,20.5,143,BlueCross BlueShield Minnesota,Medicare Advantage,36.938,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Us Breast Unilateral Limited (Pro Cah)Professional Component ,,76642,CPT,Professional,Both,,,26,143,121.55,20.5,143,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,62.992,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Us Breast Unilateral Limited (Pro Cah)Professional Component ,,76642,CPT,Professional,Both,,,26,143,121.55,20.5,143,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,23.6728,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Us Breast Unilateral Limited (Pro Cah)Professional Component ,,76642,CPT,Professional,Both,,,26,143,121.55,20.5,143,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),36.938,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Us Breast Unilateral Limited (Pro Cah)Professional Component ,,76642,CPT,Professional,Both,,,26,143,121.55,20.5,143,CorVel,Worker's Compensation,62.9544108,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Us Breast Unilateral Limited (Pro Cah)Professional Component ,,76642,CPT,Professional,Both,,,26,143,121.55,20.5,143,First Health Group Corporation,First Health Network,138.71,97,,percent of total billed charges,,
Us Breast Unilateral Limited (Pro Cah)Professional Component ,,76642,CPT,Professional,Both,,,26,143,121.55,20.5,143,"Health Partners, Inc.",Commercial,47.96,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Us Breast Unilateral Limited (Pro Cah)Professional Component ,,76642,CPT,Professional,Both,,,26,143,121.55,20.5,143,"Health Partners, Inc.",Medicare Advantage,36.938,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Us Breast Unilateral Limited (Pro Cah)Professional Component ,,76642,CPT,Professional,Both,,,26,143,121.55,20.5,143,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),20.5,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Us Breast Unilateral Limited (Pro Cah)Professional Component ,,76642,CPT,Professional,Both,,,26,143,121.55,20.5,143,"Health Partners, Inc.",State of Minnesota Advantage Program,41.31754,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Us Breast Unilateral Limited (Pro Cah)Professional Component ,,76642,CPT,Professional,Both,,,26,143,121.55,20.5,143,"Health Partners, Inc.",State Public Programs,20.5,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Us Breast Unilateral Limited (Pro Cah)Professional Component ,,76642,CPT,Professional,Both,,,26,143,121.55,20.5,143,Humana Insurance Company,Commercial PPO,32.12,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Us Breast Unilateral Limited (Pro Cah)Professional Component ,,76642,CPT,Professional,Both,,,26,143,121.55,20.5,143,Humana Insurance Company,Medicare PPO,143,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Us Breast Unilateral Limited (Pro Cah)Professional Component ,,76642,CPT,Professional,Both,,,26,143,121.55,20.5,143,Medica,Individual & Family,121.264,84.8,,percent of total billed charges,,
Us Breast Unilateral Limited (Pro Cah)Professional Component ,,76642,CPT,Professional,Both,,,26,143,121.55,20.5,143,Medica,Medica Advantage Solution,71.214,49.8,,percent of total billed charges,,
Us Breast Unilateral Limited (Pro Cah)Professional Component ,,76642,CPT,Professional,Both,,,26,143,121.55,20.5,143,Medica,Medical Assistance,23.67,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Us Breast Unilateral Limited (Pro Cah)Professional Component ,,76642,CPT,Professional,Both,,,26,143,121.55,20.5,143,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,32.12,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Us Breast Unilateral Limited (Pro Cah)Professional Component ,,76642,CPT,Professional,Both,,,26,143,121.55,20.5,143,"Multiplan, Inc.","Multiplan, Inc.",134.42,94,,percent of total billed charges,,
Us Breast Unilateral Limited (Pro Cah)Professional Component ,,76642,CPT,Professional,Both,,,26,143,121.55,20.5,143,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,128.843,90.1,,percent of total billed charges,,
Us Breast Unilateral Limited (Pro Cah)Professional Component ,,76642,CPT,Professional,Both,,,26,143,121.55,20.5,143,"Preferred One Administrative Services, INC.",PPO,140.998,98.6,,percent of total billed charges,,
Us Breast Unilateral Limited (Pro Cah)Professional Component ,,76642,CPT,Professional,Both,,,26,143,121.55,20.5,143,PrimeWest Health,Minnesota Senior Health Options (MSHO),36.938,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Us Breast Unilateral Limited (Pro Cah)Professional Component ,,76642,CPT,Professional,Both,,,26,143,121.55,20.5,143,PrimeWest Health,MinnesotaCare,25.329896,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Us Breast Unilateral Limited (Pro Cah)Professional Component ,,76642,CPT,Professional,Both,,,26,143,121.55,20.5,143,Sanford Health Plan,Sanford Health Plan,125.84,88,,percent of total billed charges,,
Us Breast Unilateral Limited (Pro Cah)Professional Component ,,76642,CPT,Professional,Both,,,26,143,121.55,20.5,143,"UCare Health, Inc.",Individual & Family Plan,52.214272,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Us Breast Unilateral Limited (Pro Cah)Professional Component ,,76642,CPT,Professional,Both,,,26,143,121.55,20.5,143,"UCare Health, Inc.",Medical Assistance,26.04008,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Us Breast Unilateral Limited (Pro Cah)Professional Component ,,76642,CPT,Professional,Both,,,26,143,121.55,20.5,143,"UCare Health, Inc.",Medicare Advantage,36.938,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Us Breast Unilateral Limited (Pro Cah)Professional Component ,,76642,CPT,Professional,Both,,,26,143,121.55,20.5,143,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),29.5504,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Us Breast Unilateral Limited (Pro Cah)Professional Component ,,76642,CPT,Professional,Both,,,26,143,121.55,20.5,143,UnitedHealthcare,Individual & Family,143,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Us Breast Unilateral Limited (Pro Cah)Professional Component ,,76642,CPT,Professional,Both,,,26,143,121.55,20.5,143,UnitedHealthcare,Medicare Advantage,36.938,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Us Breast Unilateral Limited (Pro Cah)Professional Component ,,76642,CPT,Professional,Both,,,26,143,121.55,20.5,143,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,23.6728,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Us Us Abd Complete (Pro Cah)Professional Component ,,76700,CPT,Professional,Both,,,26,199,169.15,24.21,199,Aetna,Commercial,169.15,85,,percent of total billed charges,,
Us Us Abd Complete (Pro Cah)Professional Component ,,76700,CPT,Professional,Both,,,26,199,169.15,24.21,199,Aetna,Medicare Advantage,39.01,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Us Us Abd Complete (Pro Cah)Professional Component ,,76700,CPT,Professional,Both,,,26,199,169.15,24.21,199,Aetna,PPO,185.07,93,,percent of total billed charges,,
Us Us Abd Complete (Pro Cah)Professional Component ,,76700,CPT,Professional,Both,,,26,199,169.15,24.21,199,America's PPO,America's PPO,170.0256,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Us Us Abd Complete (Pro Cah)Professional Component ,,76700,CPT,Professional,Both,,,26,199,169.15,24.21,199,BlueCross BlueShield Minnesota, Federal Employee Program,72.87,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Us Us Abd Complete (Pro Cah)Professional Component ,,76700,CPT,Professional,Both,,,26,199,169.15,24.21,199,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,74.03592,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Us Us Abd Complete (Pro Cah)Professional Component ,,76700,CPT,Professional,Both,,,26,199,169.15,24.21,199,BlueCross BlueShield Minnesota,High Value Network Plan,74.03592,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Us Us Abd Complete (Pro Cah)Professional Component ,,76700,CPT,Professional,Both,,,26,199,169.15,24.21,199,BlueCross BlueShield Minnesota,Medicare Advantage,43.585,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Us Us Abd Complete (Pro Cah)Professional Component ,,76700,CPT,Professional,Both,,,26,199,169.15,24.21,199,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,74.03592,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Us Us Abd Complete (Pro Cah)Professional Component ,,76700,CPT,Professional,Both,,,26,199,169.15,24.21,199,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,27.95016,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Us Us Abd Complete (Pro Cah)Professional Component ,,76700,CPT,Professional,Both,,,26,199,169.15,24.21,199,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),43.585,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Us Us Abd Complete (Pro Cah)Professional Component ,,76700,CPT,Professional,Both,,,26,199,169.15,24.21,199,CorVel,Worker's Compensation,75.0886713,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Us Us Abd Complete (Pro Cah)Professional Component ,,76700,CPT,Professional,Both,,,26,199,169.15,24.21,199,First Health Group Corporation,First Health Network,193.03,97,,percent of total billed charges,,
Us Us Abd Complete (Pro Cah)Professional Component ,,76700,CPT,Professional,Both,,,26,199,169.15,24.21,199,"Health Partners, Inc.",Commercial,57.23,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Us Us Abd Complete (Pro Cah)Professional Component ,,76700,CPT,Professional,Both,,,26,199,169.15,24.21,199,"Health Partners, Inc.",Medicare Advantage,43.585,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Us Us Abd Complete (Pro Cah)Professional Component ,,76700,CPT,Professional,Both,,,26,199,169.15,24.21,199,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),24.21,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Us Us Abd Complete (Pro Cah)Professional Component ,,76700,CPT,Professional,Both,,,26,199,169.15,24.21,199,"Health Partners, Inc.",State of Minnesota Advantage Program,49.303645,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Us Us Abd Complete (Pro Cah)Professional Component ,,76700,CPT,Professional,Both,,,26,199,169.15,24.21,199,"Health Partners, Inc.",State Public Programs,24.21,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Us Us Abd Complete (Pro Cah)Professional Component ,,76700,CPT,Professional,Both,,,26,199,169.15,24.21,199,Humana Insurance Company,Commercial PPO,37.9,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Us Us Abd Complete (Pro Cah)Professional Component ,,76700,CPT,Professional,Both,,,26,199,169.15,24.21,199,Humana Insurance Company,Medicare PPO,199,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Us Us Abd Complete (Pro Cah)Professional Component ,,76700,CPT,Professional,Both,,,26,199,169.15,24.21,199,Medica,Individual & Family,168.752,84.8,,percent of total billed charges,,
Us Us Abd Complete (Pro Cah)Professional Component ,,76700,CPT,Professional,Both,,,26,199,169.15,24.21,199,Medica,Medica Advantage Solution,99.102,49.8,,percent of total billed charges,,
Us Us Abd Complete (Pro Cah)Professional Component ,,76700,CPT,Professional,Both,,,26,199,169.15,24.21,199,Medica,Medical Assistance,27.95,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Us Us Abd Complete (Pro Cah)Professional Component ,,76700,CPT,Professional,Both,,,26,199,169.15,24.21,199,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,37.9,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Us Us Abd Complete (Pro Cah)Professional Component ,,76700,CPT,Professional,Both,,,26,199,169.15,24.21,199,"Multiplan, Inc.","Multiplan, Inc.",187.06,94,,percent of total billed charges,,
Us Us Abd Complete (Pro Cah)Professional Component ,,76700,CPT,Professional,Both,,,26,199,169.15,24.21,199,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,179.299,90.1,,percent of total billed charges,,
Us Us Abd Complete (Pro Cah)Professional Component ,,76700,CPT,Professional,Both,,,26,199,169.15,24.21,199,"Preferred One Administrative Services, INC.",PPO,196.214,98.6,,percent of total billed charges,,
Us Us Abd Complete (Pro Cah)Professional Component ,,76700,CPT,Professional,Both,,,26,199,169.15,24.21,199,PrimeWest Health,Minnesota Senior Health Options (MSHO),43.585,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Us Us Abd Complete (Pro Cah)Professional Component ,,76700,CPT,Professional,Both,,,26,199,169.15,24.21,199,PrimeWest Health,MinnesotaCare,29.9066712,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Us Us Abd Complete (Pro Cah)Professional Component ,,76700,CPT,Professional,Both,,,26,199,169.15,24.21,199,Sanford Health Plan,Sanford Health Plan,175.12,88,,percent of total billed charges,,
Us Us Abd Complete (Pro Cah)Professional Component ,,76700,CPT,Professional,Both,,,26,199,169.15,24.21,199,"UCare Health, Inc.",Individual & Family Plan,61.61024,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Us Us Abd Complete (Pro Cah)Professional Component ,,76700,CPT,Professional,Both,,,26,199,169.15,24.21,199,"UCare Health, Inc.",Medical Assistance,30.745176,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Us Us Abd Complete (Pro Cah)Professional Component ,,76700,CPT,Professional,Both,,,26,199,169.15,24.21,199,"UCare Health, Inc.",Medicare Advantage,43.585,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Us Us Abd Complete (Pro Cah)Professional Component ,,76700,CPT,Professional,Both,,,26,199,169.15,24.21,199,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),34.868,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Us Us Abd Complete (Pro Cah)Professional Component ,,76700,CPT,Professional,Both,,,26,199,169.15,24.21,199,UnitedHealthcare,Individual & Family,199,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Us Us Abd Complete (Pro Cah)Professional Component ,,76700,CPT,Professional,Both,,,26,199,169.15,24.21,199,UnitedHealthcare,Medicare Advantage,43.585,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Us Us Abd Complete (Pro Cah)Professional Component ,,76700,CPT,Professional,Both,,,26,199,169.15,24.21,199,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,27.95016,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Us Abdominal, Real Time With Image Documentation; Limited (Pro Cah)Professional Component ",,76705,CPT,Professional,Both,,,26,166,141.1,17.66,166,Aetna,Commercial,141.1,85,,percent of total billed charges,,
"Us Abdominal, Real Time With Image Documentation; Limited (Pro Cah)Professional Component ",,76705,CPT,Professional,Both,,,26,166,141.1,17.66,166,Aetna,Medicare Advantage,28.5,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Us Abdominal, Real Time With Image Documentation; Limited (Pro Cah)Professional Component ",,76705,CPT,Professional,Both,,,26,166,141.1,17.66,166,Aetna,PPO,154.38,93,,percent of total billed charges,,
"Us Abdominal, Real Time With Image Documentation; Limited (Pro Cah)Professional Component ",,76705,CPT,Professional,Both,,,26,166,141.1,17.66,166,America's PPO,America's PPO,141.8304,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Us Abdominal, Real Time With Image Documentation; Limited (Pro Cah)Professional Component ",,76705,CPT,Professional,Both,,,26,166,141.1,17.66,166,BlueCross BlueShield Minnesota, Federal Employee Program,53.69,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Us Abdominal, Real Time With Image Documentation; Limited (Pro Cah)Professional Component ",,76705,CPT,Professional,Both,,,26,166,141.1,17.66,166,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,54.54904,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Us Abdominal, Real Time With Image Documentation; Limited (Pro Cah)Professional Component ",,76705,CPT,Professional,Both,,,26,166,141.1,17.66,166,BlueCross BlueShield Minnesota,High Value Network Plan,54.54904,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Us Abdominal, Real Time With Image Documentation; Limited (Pro Cah)Professional Component ",,76705,CPT,Professional,Both,,,26,166,141.1,17.66,166,BlueCross BlueShield Minnesota,Medicare Advantage,31.8435,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Us Abdominal, Real Time With Image Documentation; Limited (Pro Cah)Professional Component ",,76705,CPT,Professional,Both,,,26,166,141.1,17.66,166,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,54.54904,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Us Abdominal, Real Time With Image Documentation; Limited (Pro Cah)Professional Component ",,76705,CPT,Professional,Both,,,26,166,141.1,17.66,166,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,20.39112,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Us Abdominal, Real Time With Image Documentation; Limited (Pro Cah)Professional Component ",,76705,CPT,Professional,Both,,,26,166,141.1,17.66,166,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),31.8435,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Us Abdominal, Real Time With Image Documentation; Limited (Pro Cah)Professional Component ",,76705,CPT,Professional,Both,,,26,166,141.1,17.66,166,CorVel,Worker's Compensation,54.8678145,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Us Abdominal, Real Time With Image Documentation; Limited (Pro Cah)Professional Component ",,76705,CPT,Professional,Both,,,26,166,141.1,17.66,166,First Health Group Corporation,First Health Network,161.02,97,,percent of total billed charges,,
"Us Abdominal, Real Time With Image Documentation; Limited (Pro Cah)Professional Component ",,76705,CPT,Professional,Both,,,26,166,141.1,17.66,166,"Health Partners, Inc.",Commercial,41.77,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Us Abdominal, Real Time With Image Documentation; Limited (Pro Cah)Professional Component ",,76705,CPT,Professional,Both,,,26,166,141.1,17.66,166,"Health Partners, Inc.",Medicare Advantage,31.8435,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Us Abdominal, Real Time With Image Documentation; Limited (Pro Cah)Professional Component ",,76705,CPT,Professional,Both,,,26,166,141.1,17.66,166,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),17.66,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Us Abdominal, Real Time With Image Documentation; Limited (Pro Cah)Professional Component ",,76705,CPT,Professional,Both,,,26,166,141.1,17.66,166,"Health Partners, Inc.",State of Minnesota Advantage Program,35.984855,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Us Abdominal, Real Time With Image Documentation; Limited (Pro Cah)Professional Component ",,76705,CPT,Professional,Both,,,26,166,141.1,17.66,166,"Health Partners, Inc.",State Public Programs,17.66,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Us Abdominal, Real Time With Image Documentation; Limited (Pro Cah)Professional Component ",,76705,CPT,Professional,Both,,,26,166,141.1,17.66,166,Humana Insurance Company,Commercial PPO,27.69,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Us Abdominal, Real Time With Image Documentation; Limited (Pro Cah)Professional Component ",,76705,CPT,Professional,Both,,,26,166,141.1,17.66,166,Humana Insurance Company,Medicare PPO,166,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Us Abdominal, Real Time With Image Documentation; Limited (Pro Cah)Professional Component ",,76705,CPT,Professional,Both,,,26,166,141.1,17.66,166,Medica,Individual & Family,140.768,84.8,,percent of total billed charges,,
"Us Abdominal, Real Time With Image Documentation; Limited (Pro Cah)Professional Component ",,76705,CPT,Professional,Both,,,26,166,141.1,17.66,166,Medica,Medica Advantage Solution,82.668,49.8,,percent of total billed charges,,
"Us Abdominal, Real Time With Image Documentation; Limited (Pro Cah)Professional Component ",,76705,CPT,Professional,Both,,,26,166,141.1,17.66,166,Medica,Medical Assistance,20.39,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Us Abdominal, Real Time With Image Documentation; Limited (Pro Cah)Professional Component ",,76705,CPT,Professional,Both,,,26,166,141.1,17.66,166,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,27.69,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Us Abdominal, Real Time With Image Documentation; Limited (Pro Cah)Professional Component ",,76705,CPT,Professional,Both,,,26,166,141.1,17.66,166,"Multiplan, Inc.","Multiplan, Inc.",156.04,94,,percent of total billed charges,,
"Us Abdominal, Real Time With Image Documentation; Limited (Pro Cah)Professional Component ",,76705,CPT,Professional,Both,,,26,166,141.1,17.66,166,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,149.566,90.1,,percent of total billed charges,,
"Us Abdominal, Real Time With Image Documentation; Limited (Pro Cah)Professional Component ",,76705,CPT,Professional,Both,,,26,166,141.1,17.66,166,"Preferred One Administrative Services, INC.",PPO,163.676,98.6,,percent of total billed charges,,
"Us Abdominal, Real Time With Image Documentation; Limited (Pro Cah)Professional Component ",,76705,CPT,Professional,Both,,,26,166,141.1,17.66,166,PrimeWest Health,Minnesota Senior Health Options (MSHO),31.8435,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Us Abdominal, Real Time With Image Documentation; Limited (Pro Cah)Professional Component ",,76705,CPT,Professional,Both,,,26,166,141.1,17.66,166,PrimeWest Health,MinnesotaCare,21.8184984,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Us Abdominal, Real Time With Image Documentation; Limited (Pro Cah)Professional Component ",,76705,CPT,Professional,Both,,,26,166,141.1,17.66,166,Sanford Health Plan,Sanford Health Plan,146.08,88,,percent of total billed charges,,
"Us Abdominal, Real Time With Image Documentation; Limited (Pro Cah)Professional Component ",,76705,CPT,Professional,Both,,,26,166,141.1,17.66,166,"UCare Health, Inc.",Individual & Family Plan,45.012864,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Us Abdominal, Real Time With Image Documentation; Limited (Pro Cah)Professional Component ",,76705,CPT,Professional,Both,,,26,166,141.1,17.66,166,"UCare Health, Inc.",Medical Assistance,22.430232,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Us Abdominal, Real Time With Image Documentation; Limited (Pro Cah)Professional Component ",,76705,CPT,Professional,Both,,,26,166,141.1,17.66,166,"UCare Health, Inc.",Medicare Advantage,31.8435,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Us Abdominal, Real Time With Image Documentation; Limited (Pro Cah)Professional Component ",,76705,CPT,Professional,Both,,,26,166,141.1,17.66,166,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),25.4748,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Us Abdominal, Real Time With Image Documentation; Limited (Pro Cah)Professional Component ",,76705,CPT,Professional,Both,,,26,166,141.1,17.66,166,UnitedHealthcare,Individual & Family,166,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Us Abdominal, Real Time With Image Documentation; Limited (Pro Cah)Professional Component ",,76705,CPT,Professional,Both,,,26,166,141.1,17.66,166,UnitedHealthcare,Medicare Advantage,31.8435,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Us Abdominal, Real Time With Image Documentation; Limited (Pro Cah)Professional Component ",,76705,CPT,Professional,Both,,,26,166,141.1,17.66,166,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,20.39112,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Us Abdominal Aorta, Real Time W/Image Document, Screening Abdominal Aortic Aneurysm (Aaa) (Pro Cah)Professional Component ",,76706,CPT,Professional,Both,,,26,143,121.55,16.36,143,Aetna,Commercial,121.55,85,,percent of total billed charges,,
"Us Abdominal Aorta, Real Time W/Image Document, Screening Abdominal Aortic Aneurysm (Aaa) (Pro Cah)Professional Component ",,76706,CPT,Professional,Both,,,26,143,121.55,16.36,143,Aetna,Medicare Advantage,26.75,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Us Abdominal Aorta, Real Time W/Image Document, Screening Abdominal Aortic Aneurysm (Aaa) (Pro Cah)Professional Component ",,76706,CPT,Professional,Both,,,26,143,121.55,16.36,143,Aetna,PPO,132.99,93,,percent of total billed charges,,
"Us Abdominal Aorta, Real Time W/Image Document, Screening Abdominal Aortic Aneurysm (Aaa) (Pro Cah)Professional Component ",,76706,CPT,Professional,Both,,,26,143,121.55,16.36,143,America's PPO,America's PPO,122.1792,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Us Abdominal Aorta, Real Time W/Image Document, Screening Abdominal Aortic Aneurysm (Aaa) (Pro Cah)Professional Component ",,76706,CPT,Professional,Both,,,26,143,121.55,16.36,143,BlueCross BlueShield Minnesota, Federal Employee Program,49.86,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Us Abdominal Aorta, Real Time W/Image Document, Screening Abdominal Aortic Aneurysm (Aaa) (Pro Cah)Professional Component ",,76706,CPT,Professional,Both,,,26,143,121.55,16.36,143,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,50.65776,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Us Abdominal Aorta, Real Time W/Image Document, Screening Abdominal Aortic Aneurysm (Aaa) (Pro Cah)Professional Component ",,76706,CPT,Professional,Both,,,26,143,121.55,16.36,143,BlueCross BlueShield Minnesota,High Value Network Plan,50.65776,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Us Abdominal Aorta, Real Time W/Image Document, Screening Abdominal Aortic Aneurysm (Aaa) (Pro Cah)Professional Component ",,76706,CPT,Professional,Both,,,26,143,121.55,16.36,143,BlueCross BlueShield Minnesota,Medicare Advantage,29.486,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Us Abdominal Aorta, Real Time W/Image Document, Screening Abdominal Aortic Aneurysm (Aaa) (Pro Cah)Professional Component ",,76706,CPT,Professional,Both,,,26,143,121.55,16.36,143,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,50.65776,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Us Abdominal Aorta, Real Time W/Image Document, Screening Abdominal Aortic Aneurysm (Aaa) (Pro Cah)Professional Component ",,76706,CPT,Professional,Both,,,26,143,121.55,16.36,143,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,18.88744,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Us Abdominal Aorta, Real Time W/Image Document, Screening Abdominal Aortic Aneurysm (Aaa) (Pro Cah)Professional Component ",,76706,CPT,Professional,Both,,,26,143,121.55,16.36,143,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),29.486,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Us Abdominal Aorta, Real Time W/Image Document, Screening Abdominal Aortic Aneurysm (Aaa) (Pro Cah)Professional Component ",,76706,CPT,Professional,Both,,,26,143,121.55,16.36,143,CorVel,Worker's Compensation,50.8201503,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Us Abdominal Aorta, Real Time W/Image Document, Screening Abdominal Aortic Aneurysm (Aaa) (Pro Cah)Professional Component ",,76706,CPT,Professional,Both,,,26,143,121.55,16.36,143,First Health Group Corporation,First Health Network,138.71,97,,percent of total billed charges,,
"Us Abdominal Aorta, Real Time W/Image Document, Screening Abdominal Aortic Aneurysm (Aaa) (Pro Cah)Professional Component ",,76706,CPT,Professional,Both,,,26,143,121.55,16.36,143,"Health Partners, Inc.",Commercial,38.67,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Us Abdominal Aorta, Real Time W/Image Document, Screening Abdominal Aortic Aneurysm (Aaa) (Pro Cah)Professional Component ",,76706,CPT,Professional,Both,,,26,143,121.55,16.36,143,"Health Partners, Inc.",Medicare Advantage,29.486,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Us Abdominal Aorta, Real Time W/Image Document, Screening Abdominal Aortic Aneurysm (Aaa) (Pro Cah)Professional Component ",,76706,CPT,Professional,Both,,,26,143,121.55,16.36,143,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),16.36,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Us Abdominal Aorta, Real Time W/Image Document, Screening Abdominal Aortic Aneurysm (Aaa) (Pro Cah)Professional Component ",,76706,CPT,Professional,Both,,,26,143,121.55,16.36,143,"Health Partners, Inc.",State of Minnesota Advantage Program,33.314205,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Us Abdominal Aorta, Real Time W/Image Document, Screening Abdominal Aortic Aneurysm (Aaa) (Pro Cah)Professional Component ",,76706,CPT,Professional,Both,,,26,143,121.55,16.36,143,"Health Partners, Inc.",State Public Programs,16.36,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Us Abdominal Aorta, Real Time W/Image Document, Screening Abdominal Aortic Aneurysm (Aaa) (Pro Cah)Professional Component ",,76706,CPT,Professional,Both,,,26,143,121.55,16.36,143,Humana Insurance Company,Commercial PPO,25.64,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Us Abdominal Aorta, Real Time W/Image Document, Screening Abdominal Aortic Aneurysm (Aaa) (Pro Cah)Professional Component ",,76706,CPT,Professional,Both,,,26,143,121.55,16.36,143,Humana Insurance Company,Medicare PPO,143,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Us Abdominal Aorta, Real Time W/Image Document, Screening Abdominal Aortic Aneurysm (Aaa) (Pro Cah)Professional Component ",,76706,CPT,Professional,Both,,,26,143,121.55,16.36,143,Medica,Individual & Family,121.264,84.8,,percent of total billed charges,,
"Us Abdominal Aorta, Real Time W/Image Document, Screening Abdominal Aortic Aneurysm (Aaa) (Pro Cah)Professional Component ",,76706,CPT,Professional,Both,,,26,143,121.55,16.36,143,Medica,Medica Advantage Solution,71.214,49.8,,percent of total billed charges,,
"Us Abdominal Aorta, Real Time W/Image Document, Screening Abdominal Aortic Aneurysm (Aaa) (Pro Cah)Professional Component ",,76706,CPT,Professional,Both,,,26,143,121.55,16.36,143,Medica,Medical Assistance,18.89,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Us Abdominal Aorta, Real Time W/Image Document, Screening Abdominal Aortic Aneurysm (Aaa) (Pro Cah)Professional Component ",,76706,CPT,Professional,Both,,,26,143,121.55,16.36,143,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,25.64,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Us Abdominal Aorta, Real Time W/Image Document, Screening Abdominal Aortic Aneurysm (Aaa) (Pro Cah)Professional Component ",,76706,CPT,Professional,Both,,,26,143,121.55,16.36,143,"Multiplan, Inc.","Multiplan, Inc.",134.42,94,,percent of total billed charges,,
"Us Abdominal Aorta, Real Time W/Image Document, Screening Abdominal Aortic Aneurysm (Aaa) (Pro Cah)Professional Component ",,76706,CPT,Professional,Both,,,26,143,121.55,16.36,143,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,128.843,90.1,,percent of total billed charges,,
"Us Abdominal Aorta, Real Time W/Image Document, Screening Abdominal Aortic Aneurysm (Aaa) (Pro Cah)Professional Component ",,76706,CPT,Professional,Both,,,26,143,121.55,16.36,143,"Preferred One Administrative Services, INC.",PPO,140.998,98.6,,percent of total billed charges,,
"Us Abdominal Aorta, Real Time W/Image Document, Screening Abdominal Aortic Aneurysm (Aaa) (Pro Cah)Professional Component ",,76706,CPT,Professional,Both,,,26,143,121.55,16.36,143,PrimeWest Health,Minnesota Senior Health Options (MSHO),29.486,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Us Abdominal Aorta, Real Time W/Image Document, Screening Abdominal Aortic Aneurysm (Aaa) (Pro Cah)Professional Component ",,76706,CPT,Professional,Both,,,26,143,121.55,16.36,143,PrimeWest Health,MinnesotaCare,20.2095608,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Us Abdominal Aorta, Real Time W/Image Document, Screening Abdominal Aortic Aneurysm (Aaa) (Pro Cah)Professional Component ",,76706,CPT,Professional,Both,,,26,143,121.55,16.36,143,Sanford Health Plan,Sanford Health Plan,125.84,88,,percent of total billed charges,,
"Us Abdominal Aorta, Real Time W/Image Document, Screening Abdominal Aortic Aneurysm (Aaa) (Pro Cah)Professional Component ",,76706,CPT,Professional,Both,,,26,143,121.55,16.36,143,"UCare Health, Inc.",Individual & Family Plan,41.680384,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Us Abdominal Aorta, Real Time W/Image Document, Screening Abdominal Aortic Aneurysm (Aaa) (Pro Cah)Professional Component ",,76706,CPT,Professional,Both,,,26,143,121.55,16.36,143,"UCare Health, Inc.",Medical Assistance,20.776184,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Us Abdominal Aorta, Real Time W/Image Document, Screening Abdominal Aortic Aneurysm (Aaa) (Pro Cah)Professional Component ",,76706,CPT,Professional,Both,,,26,143,121.55,16.36,143,"UCare Health, Inc.",Medicare Advantage,29.486,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Us Abdominal Aorta, Real Time W/Image Document, Screening Abdominal Aortic Aneurysm (Aaa) (Pro Cah)Professional Component ",,76706,CPT,Professional,Both,,,26,143,121.55,16.36,143,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),23.5888,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Us Abdominal Aorta, Real Time W/Image Document, Screening Abdominal Aortic Aneurysm (Aaa) (Pro Cah)Professional Component ",,76706,CPT,Professional,Both,,,26,143,121.55,16.36,143,UnitedHealthcare,Individual & Family,143,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Us Abdominal Aorta, Real Time W/Image Document, Screening Abdominal Aortic Aneurysm (Aaa) (Pro Cah)Professional Component ",,76706,CPT,Professional,Both,,,26,143,121.55,16.36,143,UnitedHealthcare,Medicare Advantage,29.486,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Us Abdominal Aorta, Real Time W/Image Document, Screening Abdominal Aortic Aneurysm (Aaa) (Pro Cah)Professional Component ",,76706,CPT,Professional,Both,,,26,143,121.55,16.36,143,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,18.88744,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Us Retroperitoneal (Eg, Renal, Aorta, Nodes), Real Time With Image Documentation; Complete (Pro Cah)Professional Component ",,76770,CPT,Professional,Both,,,26,183,155.55,22.03,183,Aetna,Commercial,155.55,85,,percent of total billed charges,,
"Us Retroperitoneal (Eg, Renal, Aorta, Nodes), Real Time With Image Documentation; Complete (Pro Cah)Professional Component ",,76770,CPT,Professional,Both,,,26,183,155.55,22.03,183,Aetna,Medicare Advantage,35.5,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Us Retroperitoneal (Eg, Renal, Aorta, Nodes), Real Time With Image Documentation; Complete (Pro Cah)Professional Component ",,76770,CPT,Professional,Both,,,26,183,155.55,22.03,183,Aetna,PPO,170.19,93,,percent of total billed charges,,
"Us Retroperitoneal (Eg, Renal, Aorta, Nodes), Real Time With Image Documentation; Complete (Pro Cah)Professional Component ",,76770,CPT,Professional,Both,,,26,183,155.55,22.03,183,America's PPO,America's PPO,156.3552,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Us Retroperitoneal (Eg, Renal, Aorta, Nodes), Real Time With Image Documentation; Complete (Pro Cah)Professional Component ",,76770,CPT,Professional,Both,,,26,183,155.55,22.03,183,BlueCross BlueShield Minnesota, Federal Employee Program,66.48,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Us Retroperitoneal (Eg, Renal, Aorta, Nodes), Real Time With Image Documentation; Complete (Pro Cah)Professional Component ",,76770,CPT,Professional,Both,,,26,183,155.55,22.03,183,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,67.54368,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Us Retroperitoneal (Eg, Renal, Aorta, Nodes), Real Time With Image Documentation; Complete (Pro Cah)Professional Component ",,76770,CPT,Professional,Both,,,26,183,155.55,22.03,183,BlueCross BlueShield Minnesota,High Value Network Plan,67.54368,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Us Retroperitoneal (Eg, Renal, Aorta, Nodes), Real Time With Image Documentation; Complete (Pro Cah)Professional Component ",,76770,CPT,Professional,Both,,,26,183,155.55,22.03,183,BlueCross BlueShield Minnesota,Medicare Advantage,39.675,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Us Retroperitoneal (Eg, Renal, Aorta, Nodes), Real Time With Image Documentation; Complete (Pro Cah)Professional Component ",,76770,CPT,Professional,Both,,,26,183,155.55,22.03,183,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,67.54368,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Us Retroperitoneal (Eg, Renal, Aorta, Nodes), Real Time With Image Documentation; Complete (Pro Cah)Professional Component ",,76770,CPT,Professional,Both,,,26,183,155.55,22.03,183,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,25.43048,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Us Retroperitoneal (Eg, Renal, Aorta, Nodes), Real Time With Image Documentation; Complete (Pro Cah)Professional Component ",,76770,CPT,Professional,Both,,,26,183,155.55,22.03,183,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),39.675,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Us Retroperitoneal (Eg, Renal, Aorta, Nodes), Real Time With Image Documentation; Complete (Pro Cah)Professional Component ",,76770,CPT,Professional,Both,,,26,183,155.55,22.03,183,CorVel,Worker's Compensation,68.345475,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Us Retroperitoneal (Eg, Renal, Aorta, Nodes), Real Time With Image Documentation; Complete (Pro Cah)Professional Component ",,76770,CPT,Professional,Both,,,26,183,155.55,22.03,183,First Health Group Corporation,First Health Network,177.51,97,,percent of total billed charges,,
"Us Retroperitoneal (Eg, Renal, Aorta, Nodes), Real Time With Image Documentation; Complete (Pro Cah)Professional Component ",,76770,CPT,Professional,Both,,,26,183,155.55,22.03,183,"Health Partners, Inc.",Commercial,52.08,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Us Retroperitoneal (Eg, Renal, Aorta, Nodes), Real Time With Image Documentation; Complete (Pro Cah)Professional Component ",,76770,CPT,Professional,Both,,,26,183,155.55,22.03,183,"Health Partners, Inc.",Medicare Advantage,39.675,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Us Retroperitoneal (Eg, Renal, Aorta, Nodes), Real Time With Image Documentation; Complete (Pro Cah)Professional Component ",,76770,CPT,Professional,Both,,,26,183,155.55,22.03,183,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),22.03,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Us Retroperitoneal (Eg, Renal, Aorta, Nodes), Real Time With Image Documentation; Complete (Pro Cah)Professional Component ",,76770,CPT,Professional,Both,,,26,183,155.55,22.03,183,"Health Partners, Inc.",State of Minnesota Advantage Program,44.86692,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Us Retroperitoneal (Eg, Renal, Aorta, Nodes), Real Time With Image Documentation; Complete (Pro Cah)Professional Component ",,76770,CPT,Professional,Both,,,26,183,155.55,22.03,183,"Health Partners, Inc.",State Public Programs,22.03,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Us Retroperitoneal (Eg, Renal, Aorta, Nodes), Real Time With Image Documentation; Complete (Pro Cah)Professional Component ",,76770,CPT,Professional,Both,,,26,183,155.55,22.03,183,Humana Insurance Company,Commercial PPO,34.5,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Us Retroperitoneal (Eg, Renal, Aorta, Nodes), Real Time With Image Documentation; Complete (Pro Cah)Professional Component ",,76770,CPT,Professional,Both,,,26,183,155.55,22.03,183,Humana Insurance Company,Medicare PPO,183,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Us Retroperitoneal (Eg, Renal, Aorta, Nodes), Real Time With Image Documentation; Complete (Pro Cah)Professional Component ",,76770,CPT,Professional,Both,,,26,183,155.55,22.03,183,Medica,Individual & Family,155.184,84.8,,percent of total billed charges,,
"Us Retroperitoneal (Eg, Renal, Aorta, Nodes), Real Time With Image Documentation; Complete (Pro Cah)Professional Component ",,76770,CPT,Professional,Both,,,26,183,155.55,22.03,183,Medica,Medica Advantage Solution,91.134,49.8,,percent of total billed charges,,
"Us Retroperitoneal (Eg, Renal, Aorta, Nodes), Real Time With Image Documentation; Complete (Pro Cah)Professional Component ",,76770,CPT,Professional,Both,,,26,183,155.55,22.03,183,Medica,Medical Assistance,25.43,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Us Retroperitoneal (Eg, Renal, Aorta, Nodes), Real Time With Image Documentation; Complete (Pro Cah)Professional Component ",,76770,CPT,Professional,Both,,,26,183,155.55,22.03,183,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,34.5,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Us Retroperitoneal (Eg, Renal, Aorta, Nodes), Real Time With Image Documentation; Complete (Pro Cah)Professional Component ",,76770,CPT,Professional,Both,,,26,183,155.55,22.03,183,"Multiplan, Inc.","Multiplan, Inc.",172.02,94,,percent of total billed charges,,
"Us Retroperitoneal (Eg, Renal, Aorta, Nodes), Real Time With Image Documentation; Complete (Pro Cah)Professional Component ",,76770,CPT,Professional,Both,,,26,183,155.55,22.03,183,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,164.883,90.1,,percent of total billed charges,,
"Us Retroperitoneal (Eg, Renal, Aorta, Nodes), Real Time With Image Documentation; Complete (Pro Cah)Professional Component ",,76770,CPT,Professional,Both,,,26,183,155.55,22.03,183,"Preferred One Administrative Services, INC.",PPO,180.438,98.6,,percent of total billed charges,,
"Us Retroperitoneal (Eg, Renal, Aorta, Nodes), Real Time With Image Documentation; Complete (Pro Cah)Professional Component ",,76770,CPT,Professional,Both,,,26,183,155.55,22.03,183,PrimeWest Health,Minnesota Senior Health Options (MSHO),39.675,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Us Retroperitoneal (Eg, Renal, Aorta, Nodes), Real Time With Image Documentation; Complete (Pro Cah)Professional Component ",,76770,CPT,Professional,Both,,,26,183,155.55,22.03,183,PrimeWest Health,MinnesotaCare,27.2106136,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Us Retroperitoneal (Eg, Renal, Aorta, Nodes), Real Time With Image Documentation; Complete (Pro Cah)Professional Component ",,76770,CPT,Professional,Both,,,26,183,155.55,22.03,183,Sanford Health Plan,Sanford Health Plan,161.04,88,,percent of total billed charges,,
"Us Retroperitoneal (Eg, Renal, Aorta, Nodes), Real Time With Image Documentation; Complete (Pro Cah)Professional Component ",,76770,CPT,Professional,Both,,,26,183,155.55,22.03,183,"UCare Health, Inc.",Individual & Family Plan,56.0832,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Us Retroperitoneal (Eg, Renal, Aorta, Nodes), Real Time With Image Documentation; Complete (Pro Cah)Professional Component ",,76770,CPT,Professional,Both,,,26,183,155.55,22.03,183,"UCare Health, Inc.",Medical Assistance,27.973528,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Us Retroperitoneal (Eg, Renal, Aorta, Nodes), Real Time With Image Documentation; Complete (Pro Cah)Professional Component ",,76770,CPT,Professional,Both,,,26,183,155.55,22.03,183,"UCare Health, Inc.",Medicare Advantage,39.675,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Us Retroperitoneal (Eg, Renal, Aorta, Nodes), Real Time With Image Documentation; Complete (Pro Cah)Professional Component ",,76770,CPT,Professional,Both,,,26,183,155.55,22.03,183,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),31.74,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Us Retroperitoneal (Eg, Renal, Aorta, Nodes), Real Time With Image Documentation; Complete (Pro Cah)Professional Component ",,76770,CPT,Professional,Both,,,26,183,155.55,22.03,183,UnitedHealthcare,Individual & Family,183,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Us Retroperitoneal (Eg, Renal, Aorta, Nodes), Real Time With Image Documentation; Complete (Pro Cah)Professional Component ",,76770,CPT,Professional,Both,,,26,183,155.55,22.03,183,UnitedHealthcare,Medicare Advantage,39.675,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Us Retroperitoneal (Eg, Renal, Aorta, Nodes), Real Time With Image Documentation; Complete (Pro Cah)Professional Component ",,76770,CPT,Professional,Both,,,26,183,155.55,22.03,183,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,25.43048,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Ultrasound, Retroperitoneal, Real Time With Image Documentation; Limited (Pro Cah)Professional Component ",,76775,CPT,Professional,Both,,,26,224,190.4,17.23,224,Aetna,Commercial,190.4,85,,percent of total billed charges,,
"Ultrasound, Retroperitoneal, Real Time With Image Documentation; Limited (Pro Cah)Professional Component ",,76775,CPT,Professional,Both,,,26,224,190.4,17.23,224,Aetna,Medicare Advantage,28.15,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Ultrasound, Retroperitoneal, Real Time With Image Documentation; Limited (Pro Cah)Professional Component ",,76775,CPT,Professional,Both,,,26,224,190.4,17.23,224,Aetna,PPO,208.32,93,,percent of total billed charges,,
"Ultrasound, Retroperitoneal, Real Time With Image Documentation; Limited (Pro Cah)Professional Component ",,76775,CPT,Professional,Both,,,26,224,190.4,17.23,224,America's PPO,America's PPO,191.3856,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Ultrasound, Retroperitoneal, Real Time With Image Documentation; Limited (Pro Cah)Professional Component ",,76775,CPT,Professional,Both,,,26,224,190.4,17.23,224,BlueCross BlueShield Minnesota, Federal Employee Program,52.41,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Ultrasound, Retroperitoneal, Real Time With Image Documentation; Limited (Pro Cah)Professional Component ",,76775,CPT,Professional,Both,,,26,224,190.4,17.23,224,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,53.24856,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Ultrasound, Retroperitoneal, Real Time With Image Documentation; Limited (Pro Cah)Professional Component ",,76775,CPT,Professional,Both,,,26,224,190.4,17.23,224,BlueCross BlueShield Minnesota,High Value Network Plan,53.24856,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Ultrasound, Retroperitoneal, Real Time With Image Documentation; Limited (Pro Cah)Professional Component ",,76775,CPT,Professional,Both,,,26,224,190.4,17.23,224,BlueCross BlueShield Minnesota,Medicare Advantage,31.05,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Ultrasound, Retroperitoneal, Real Time With Image Documentation; Limited (Pro Cah)Professional Component ",,76775,CPT,Professional,Both,,,26,224,190.4,17.23,224,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,53.24856,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Ultrasound, Retroperitoneal, Real Time With Image Documentation; Limited (Pro Cah)Professional Component ",,76775,CPT,Professional,Both,,,26,224,190.4,17.23,224,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,19.89328,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Ultrasound, Retroperitoneal, Real Time With Image Documentation; Limited (Pro Cah)Professional Component ",,76775,CPT,Professional,Both,,,26,224,190.4,17.23,224,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),31.05,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Ultrasound, Retroperitoneal, Real Time With Image Documentation; Limited (Pro Cah)Professional Component ",,76775,CPT,Professional,Both,,,26,224,190.4,17.23,224,CorVel,Worker's Compensation,53.5156824,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Ultrasound, Retroperitoneal, Real Time With Image Documentation; Limited (Pro Cah)Professional Component ",,76775,CPT,Professional,Both,,,26,224,190.4,17.23,224,First Health Group Corporation,First Health Network,217.28,97,,percent of total billed charges,,
"Ultrasound, Retroperitoneal, Real Time With Image Documentation; Limited (Pro Cah)Professional Component ",,76775,CPT,Professional,Both,,,26,224,190.4,17.23,224,"Health Partners, Inc.",Commercial,40.73,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Ultrasound, Retroperitoneal, Real Time With Image Documentation; Limited (Pro Cah)Professional Component ",,76775,CPT,Professional,Both,,,26,224,190.4,17.23,224,"Health Partners, Inc.",Medicare Advantage,31.05,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Ultrasound, Retroperitoneal, Real Time With Image Documentation; Limited (Pro Cah)Professional Component ",,76775,CPT,Professional,Both,,,26,224,190.4,17.23,224,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),17.23,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Ultrasound, Retroperitoneal, Real Time With Image Documentation; Limited (Pro Cah)Professional Component ",,76775,CPT,Professional,Both,,,26,224,190.4,17.23,224,"Health Partners, Inc.",State of Minnesota Advantage Program,35.088895,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Ultrasound, Retroperitoneal, Real Time With Image Documentation; Limited (Pro Cah)Professional Component ",,76775,CPT,Professional,Both,,,26,224,190.4,17.23,224,"Health Partners, Inc.",State Public Programs,17.23,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Ultrasound, Retroperitoneal, Real Time With Image Documentation; Limited (Pro Cah)Professional Component ",,76775,CPT,Professional,Both,,,26,224,190.4,17.23,224,Humana Insurance Company,Commercial PPO,27,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Ultrasound, Retroperitoneal, Real Time With Image Documentation; Limited (Pro Cah)Professional Component ",,76775,CPT,Professional,Both,,,26,224,190.4,17.23,224,Humana Insurance Company,Medicare PPO,224,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Ultrasound, Retroperitoneal, Real Time With Image Documentation; Limited (Pro Cah)Professional Component ",,76775,CPT,Professional,Both,,,26,224,190.4,17.23,224,Medica,Individual & Family,189.952,84.8,,percent of total billed charges,,
"Ultrasound, Retroperitoneal, Real Time With Image Documentation; Limited (Pro Cah)Professional Component ",,76775,CPT,Professional,Both,,,26,224,190.4,17.23,224,Medica,Medica Advantage Solution,111.552,49.8,,percent of total billed charges,,
"Ultrasound, Retroperitoneal, Real Time With Image Documentation; Limited (Pro Cah)Professional Component ",,76775,CPT,Professional,Both,,,26,224,190.4,17.23,224,Medica,Medical Assistance,19.89,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Ultrasound, Retroperitoneal, Real Time With Image Documentation; Limited (Pro Cah)Professional Component ",,76775,CPT,Professional,Both,,,26,224,190.4,17.23,224,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,27,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Ultrasound, Retroperitoneal, Real Time With Image Documentation; Limited (Pro Cah)Professional Component ",,76775,CPT,Professional,Both,,,26,224,190.4,17.23,224,"Multiplan, Inc.","Multiplan, Inc.",210.56,94,,percent of total billed charges,,
"Ultrasound, Retroperitoneal, Real Time With Image Documentation; Limited (Pro Cah)Professional Component ",,76775,CPT,Professional,Both,,,26,224,190.4,17.23,224,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,201.824,90.1,,percent of total billed charges,,
"Ultrasound, Retroperitoneal, Real Time With Image Documentation; Limited (Pro Cah)Professional Component ",,76775,CPT,Professional,Both,,,26,224,190.4,17.23,224,"Preferred One Administrative Services, INC.",PPO,220.864,98.6,,percent of total billed charges,,
"Ultrasound, Retroperitoneal, Real Time With Image Documentation; Limited (Pro Cah)Professional Component ",,76775,CPT,Professional,Both,,,26,224,190.4,17.23,224,PrimeWest Health,Minnesota Senior Health Options (MSHO),31.05,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Ultrasound, Retroperitoneal, Real Time With Image Documentation; Limited (Pro Cah)Professional Component ",,76775,CPT,Professional,Both,,,26,224,190.4,17.23,224,PrimeWest Health,MinnesotaCare,21.2858096,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Ultrasound, Retroperitoneal, Real Time With Image Documentation; Limited (Pro Cah)Professional Component ",,76775,CPT,Professional,Both,,,26,224,190.4,17.23,224,Sanford Health Plan,Sanford Health Plan,197.12,88,,percent of total billed charges,,
"Ultrasound, Retroperitoneal, Real Time With Image Documentation; Limited (Pro Cah)Professional Component ",,76775,CPT,Professional,Both,,,26,224,190.4,17.23,224,"UCare Health, Inc.",Individual & Family Plan,43.8912,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Ultrasound, Retroperitoneal, Real Time With Image Documentation; Limited (Pro Cah)Professional Component ",,76775,CPT,Professional,Both,,,26,224,190.4,17.23,224,"UCare Health, Inc.",Medical Assistance,21.882608,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Ultrasound, Retroperitoneal, Real Time With Image Documentation; Limited (Pro Cah)Professional Component ",,76775,CPT,Professional,Both,,,26,224,190.4,17.23,224,"UCare Health, Inc.",Medicare Advantage,31.05,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Ultrasound, Retroperitoneal, Real Time With Image Documentation; Limited (Pro Cah)Professional Component ",,76775,CPT,Professional,Both,,,26,224,190.4,17.23,224,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),24.84,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Ultrasound, Retroperitoneal, Real Time With Image Documentation; Limited (Pro Cah)Professional Component ",,76775,CPT,Professional,Both,,,26,224,190.4,17.23,224,UnitedHealthcare,Individual & Family,224,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Ultrasound, Retroperitoneal, Real Time With Image Documentation; Limited (Pro Cah)Professional Component ",,76775,CPT,Professional,Both,,,26,224,190.4,17.23,224,UnitedHealthcare,Medicare Advantage,31.05,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Ultrasound, Retroperitoneal, Real Time With Image Documentation; Limited (Pro Cah)Professional Component ",,76775,CPT,Professional,Both,,,26,224,190.4,17.23,224,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,19.89328,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Us Ob Under 14 Wks  Comp (Pro Cah)Professional Component ,,76801,CPT,Professional,Both,,,26,148,125.8,30.11,148,Aetna,Commercial,125.8,85,,percent of total billed charges,,
Us Ob Under 14 Wks  Comp (Pro Cah)Professional Component ,,76801,CPT,Professional,Both,,,26,148,125.8,30.11,148,Aetna,Medicare Advantage,48.12,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Us Ob Under 14 Wks  Comp (Pro Cah)Professional Component ,,76801,CPT,Professional,Both,,,26,148,125.8,30.11,148,Aetna,PPO,137.64,93,,percent of total billed charges,,
Us Ob Under 14 Wks  Comp (Pro Cah)Professional Component ,,76801,CPT,Professional,Both,,,26,148,125.8,30.11,148,America's PPO,America's PPO,126.4512,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Us Ob Under 14 Wks  Comp (Pro Cah)Professional Component ,,76801,CPT,Professional,Both,,,26,148,125.8,30.11,148,BlueCross BlueShield Minnesota, Federal Employee Program,89.49,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Us Ob Under 14 Wks  Comp (Pro Cah)Professional Component ,,76801,CPT,Professional,Both,,,26,148,125.8,30.11,148,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,90.92184,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Us Ob Under 14 Wks  Comp (Pro Cah)Professional Component ,,76801,CPT,Professional,Both,,,26,148,125.8,30.11,148,BlueCross BlueShield Minnesota,High Value Network Plan,90.92184,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Us Ob Under 14 Wks  Comp (Pro Cah)Professional Component ,,76801,CPT,Professional,Both,,,26,148,125.8,30.11,148,BlueCross BlueShield Minnesota,Medicare Advantage,53.7855,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Us Ob Under 14 Wks  Comp (Pro Cah)Professional Component ,,76801,CPT,Professional,Both,,,26,148,125.8,30.11,148,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,90.92184,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Us Ob Under 14 Wks  Comp (Pro Cah)Professional Component ,,76801,CPT,Professional,Both,,,26,148,125.8,30.11,148,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,34.76752,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Us Ob Under 14 Wks  Comp (Pro Cah)Professional Component ,,76801,CPT,Professional,Both,,,26,148,125.8,30.11,148,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),53.7855,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Us Ob Under 14 Wks  Comp (Pro Cah)Professional Component ,,76801,CPT,Professional,Both,,,26,148,125.8,30.11,148,CorVel,Worker's Compensation,91.942296,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Us Ob Under 14 Wks  Comp (Pro Cah)Professional Component ,,76801,CPT,Professional,Both,,,26,148,125.8,30.11,148,First Health Group Corporation,First Health Network,143.56,97,,percent of total billed charges,,
Us Ob Under 14 Wks  Comp (Pro Cah)Professional Component ,,76801,CPT,Professional,Both,,,26,148,125.8,30.11,148,"Health Partners, Inc.",Commercial,70.12,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Us Ob Under 14 Wks  Comp (Pro Cah)Professional Component ,,76801,CPT,Professional,Both,,,26,148,125.8,30.11,148,"Health Partners, Inc.",Medicare Advantage,53.7855,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Us Ob Under 14 Wks  Comp (Pro Cah)Professional Component ,,76801,CPT,Professional,Both,,,26,148,125.8,30.11,148,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),30.11,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Us Ob Under 14 Wks  Comp (Pro Cah)Professional Component ,,76801,CPT,Professional,Both,,,26,148,125.8,30.11,148,"Health Partners, Inc.",State of Minnesota Advantage Program,60.40838,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Us Ob Under 14 Wks  Comp (Pro Cah)Professional Component ,,76801,CPT,Professional,Both,,,26,148,125.8,30.11,148,"Health Partners, Inc.",State Public Programs,30.11,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Us Ob Under 14 Wks  Comp (Pro Cah)Professional Component ,,76801,CPT,Professional,Both,,,26,148,125.8,30.11,148,Humana Insurance Company,Commercial PPO,46.77,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Us Ob Under 14 Wks  Comp (Pro Cah)Professional Component ,,76801,CPT,Professional,Both,,,26,148,125.8,30.11,148,Humana Insurance Company,Medicare PPO,148,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Us Ob Under 14 Wks  Comp (Pro Cah)Professional Component ,,76801,CPT,Professional,Both,,,26,148,125.8,30.11,148,Medica,Individual & Family,125.504,84.8,,percent of total billed charges,,
Us Ob Under 14 Wks  Comp (Pro Cah)Professional Component ,,76801,CPT,Professional,Both,,,26,148,125.8,30.11,148,Medica,Medica Advantage Solution,73.704,49.8,,percent of total billed charges,,
Us Ob Under 14 Wks  Comp (Pro Cah)Professional Component ,,76801,CPT,Professional,Both,,,26,148,125.8,30.11,148,Medica,Medical Assistance,34.77,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Us Ob Under 14 Wks  Comp (Pro Cah)Professional Component ,,76801,CPT,Professional,Both,,,26,148,125.8,30.11,148,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,46.77,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Us Ob Under 14 Wks  Comp (Pro Cah)Professional Component ,,76801,CPT,Professional,Both,,,26,148,125.8,30.11,148,"Multiplan, Inc.","Multiplan, Inc.",139.12,94,,percent of total billed charges,,
Us Ob Under 14 Wks  Comp (Pro Cah)Professional Component ,,76801,CPT,Professional,Both,,,26,148,125.8,30.11,148,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,133.348,90.1,,percent of total billed charges,,
Us Ob Under 14 Wks  Comp (Pro Cah)Professional Component ,,76801,CPT,Professional,Both,,,26,148,125.8,30.11,148,"Preferred One Administrative Services, INC.",PPO,145.928,98.6,,percent of total billed charges,,
Us Ob Under 14 Wks  Comp (Pro Cah)Professional Component ,,76801,CPT,Professional,Both,,,26,148,125.8,30.11,148,PrimeWest Health,Minnesota Senior Health Options (MSHO),53.7855,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Us Ob Under 14 Wks  Comp (Pro Cah)Professional Component ,,76801,CPT,Professional,Both,,,26,148,125.8,30.11,148,PrimeWest Health,MinnesotaCare,37.2012464,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Us Ob Under 14 Wks  Comp (Pro Cah)Professional Component ,,76801,CPT,Professional,Both,,,26,148,125.8,30.11,148,Sanford Health Plan,Sanford Health Plan,130.24,88,,percent of total billed charges,,
Us Ob Under 14 Wks  Comp (Pro Cah)Professional Component ,,76801,CPT,Professional,Both,,,26,148,125.8,30.11,148,"UCare Health, Inc.",Individual & Family Plan,76.029312,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Us Ob Under 14 Wks  Comp (Pro Cah)Professional Component ,,76801,CPT,Professional,Both,,,26,148,125.8,30.11,148,"UCare Health, Inc.",Medical Assistance,38.244272,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Us Ob Under 14 Wks  Comp (Pro Cah)Professional Component ,,76801,CPT,Professional,Both,,,26,148,125.8,30.11,148,"UCare Health, Inc.",Medicare Advantage,53.7855,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Us Ob Under 14 Wks  Comp (Pro Cah)Professional Component ,,76801,CPT,Professional,Both,,,26,148,125.8,30.11,148,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),43.0284,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Us Ob Under 14 Wks  Comp (Pro Cah)Professional Component ,,76801,CPT,Professional,Both,,,26,148,125.8,30.11,148,UnitedHealthcare,Individual & Family,148,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Us Ob Under 14 Wks  Comp (Pro Cah)Professional Component ,,76801,CPT,Professional,Both,,,26,148,125.8,30.11,148,UnitedHealthcare,Medicare Advantage,53.7855,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Us Ob Under 14 Wks  Comp (Pro Cah)Professional Component ,,76801,CPT,Professional,Both,,,26,148,125.8,30.11,148,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,34.76752,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Us Ob Under 14 Wks  Comp Ea Addl Gest (Pro Cah)Professional Component ,,76802,CPT,Professional,Both,,,26,274,232.9,25.31,274,Aetna,Commercial,232.9,85,,percent of total billed charges,,
Us Ob Under 14 Wks  Comp Ea Addl Gest (Pro Cah)Professional Component ,,76802,CPT,Professional,Both,,,26,274,232.9,25.31,274,Aetna,Medicare Advantage,40.41,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Us Ob Under 14 Wks  Comp Ea Addl Gest (Pro Cah)Professional Component ,,76802,CPT,Professional,Both,,,26,274,232.9,25.31,274,Aetna,PPO,254.82,93,,percent of total billed charges,,
Us Ob Under 14 Wks  Comp Ea Addl Gest (Pro Cah)Professional Component ,,76802,CPT,Professional,Both,,,26,274,232.9,25.31,274,America's PPO,America's PPO,234.1056,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Us Ob Under 14 Wks  Comp Ea Addl Gest (Pro Cah)Professional Component ,,76802,CPT,Professional,Both,,,26,274,232.9,25.31,274,BlueCross BlueShield Minnesota, Federal Employee Program,76.06,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Us Ob Under 14 Wks  Comp Ea Addl Gest (Pro Cah)Professional Component ,,76802,CPT,Professional,Both,,,26,274,232.9,25.31,274,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,77.27696,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Us Ob Under 14 Wks  Comp Ea Addl Gest (Pro Cah)Professional Component ,,76802,CPT,Professional,Both,,,26,274,232.9,25.31,274,BlueCross BlueShield Minnesota,High Value Network Plan,77.27696,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Us Ob Under 14 Wks  Comp Ea Addl Gest (Pro Cah)Professional Component ,,76802,CPT,Professional,Both,,,26,274,232.9,25.31,274,BlueCross BlueShield Minnesota,Medicare Advantage,45.563,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Us Ob Under 14 Wks  Comp Ea Addl Gest (Pro Cah)Professional Component ,,76802,CPT,Professional,Both,,,26,274,232.9,25.31,274,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,77.27696,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Us Ob Under 14 Wks  Comp Ea Addl Gest (Pro Cah)Professional Component ,,76802,CPT,Professional,Both,,,26,274,232.9,25.31,274,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,29.22016,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Us Ob Under 14 Wks  Comp Ea Addl Gest (Pro Cah)Professional Component ,,76802,CPT,Professional,Both,,,26,274,232.9,25.31,274,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),45.563,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Us Ob Under 14 Wks  Comp Ea Addl Gest (Pro Cah)Professional Component ,,76802,CPT,Professional,Both,,,26,274,232.9,25.31,274,CorVel,Worker's Compensation,77.7929355,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Us Ob Under 14 Wks  Comp Ea Addl Gest (Pro Cah)Professional Component ,,76802,CPT,Professional,Both,,,26,274,232.9,25.31,274,First Health Group Corporation,First Health Network,265.78,97,,percent of total billed charges,,
Us Ob Under 14 Wks  Comp Ea Addl Gest (Pro Cah)Professional Component ,,76802,CPT,Professional,Both,,,26,274,232.9,25.31,274,"Health Partners, Inc.",Commercial,59.29,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Us Ob Under 14 Wks  Comp Ea Addl Gest (Pro Cah)Professional Component ,,76802,CPT,Professional,Both,,,26,274,232.9,25.31,274,"Health Partners, Inc.",Medicare Advantage,45.563,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Us Ob Under 14 Wks  Comp Ea Addl Gest (Pro Cah)Professional Component ,,76802,CPT,Professional,Both,,,26,274,232.9,25.31,274,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),25.31,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Us Ob Under 14 Wks  Comp Ea Addl Gest (Pro Cah)Professional Component ,,76802,CPT,Professional,Both,,,26,274,232.9,25.31,274,"Health Partners, Inc.",State of Minnesota Advantage Program,51.078335,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Us Ob Under 14 Wks  Comp Ea Addl Gest (Pro Cah)Professional Component ,,76802,CPT,Professional,Both,,,26,274,232.9,25.31,274,"Health Partners, Inc.",State Public Programs,25.31,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Us Ob Under 14 Wks  Comp Ea Addl Gest (Pro Cah)Professional Component ,,76802,CPT,Professional,Both,,,26,274,232.9,25.31,274,Humana Insurance Company,Commercial PPO,39.62,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Us Ob Under 14 Wks  Comp Ea Addl Gest (Pro Cah)Professional Component ,,76802,CPT,Professional,Both,,,26,274,232.9,25.31,274,Humana Insurance Company,Medicare PPO,274,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Us Ob Under 14 Wks  Comp Ea Addl Gest (Pro Cah)Professional Component ,,76802,CPT,Professional,Both,,,26,274,232.9,25.31,274,Medica,Individual & Family,232.352,84.8,,percent of total billed charges,,
Us Ob Under 14 Wks  Comp Ea Addl Gest (Pro Cah)Professional Component ,,76802,CPT,Professional,Both,,,26,274,232.9,25.31,274,Medica,Medica Advantage Solution,136.452,49.8,,percent of total billed charges,,
Us Ob Under 14 Wks  Comp Ea Addl Gest (Pro Cah)Professional Component ,,76802,CPT,Professional,Both,,,26,274,232.9,25.31,274,Medica,Medical Assistance,29.22,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Us Ob Under 14 Wks  Comp Ea Addl Gest (Pro Cah)Professional Component ,,76802,CPT,Professional,Both,,,26,274,232.9,25.31,274,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,39.62,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Us Ob Under 14 Wks  Comp Ea Addl Gest (Pro Cah)Professional Component ,,76802,CPT,Professional,Both,,,26,274,232.9,25.31,274,"Multiplan, Inc.","Multiplan, Inc.",257.56,94,,percent of total billed charges,,
Us Ob Under 14 Wks  Comp Ea Addl Gest (Pro Cah)Professional Component ,,76802,CPT,Professional,Both,,,26,274,232.9,25.31,274,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,246.874,90.1,,percent of total billed charges,,
Us Ob Under 14 Wks  Comp Ea Addl Gest (Pro Cah)Professional Component ,,76802,CPT,Professional,Both,,,26,274,232.9,25.31,274,"Preferred One Administrative Services, INC.",PPO,270.164,98.6,,percent of total billed charges,,
Us Ob Under 14 Wks  Comp Ea Addl Gest (Pro Cah)Professional Component ,,76802,CPT,Professional,Both,,,26,274,232.9,25.31,274,PrimeWest Health,Minnesota Senior Health Options (MSHO),45.563,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Us Ob Under 14 Wks  Comp Ea Addl Gest (Pro Cah)Professional Component ,,76802,CPT,Professional,Both,,,26,274,232.9,25.31,274,PrimeWest Health,MinnesotaCare,31.2655712,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Us Ob Under 14 Wks  Comp Ea Addl Gest (Pro Cah)Professional Component ,,76802,CPT,Professional,Both,,,26,274,232.9,25.31,274,Sanford Health Plan,Sanford Health Plan,241.12,88,,percent of total billed charges,,
Us Ob Under 14 Wks  Comp Ea Addl Gest (Pro Cah)Professional Component ,,76802,CPT,Professional,Both,,,26,274,232.9,25.31,274,"UCare Health, Inc.",Individual & Family Plan,64.406272,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Us Ob Under 14 Wks  Comp Ea Addl Gest (Pro Cah)Professional Component ,,76802,CPT,Professional,Both,,,26,274,232.9,25.31,274,"UCare Health, Inc.",Medical Assistance,32.142176,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Us Ob Under 14 Wks  Comp Ea Addl Gest (Pro Cah)Professional Component ,,76802,CPT,Professional,Both,,,26,274,232.9,25.31,274,"UCare Health, Inc.",Medicare Advantage,45.563,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Us Ob Under 14 Wks  Comp Ea Addl Gest (Pro Cah)Professional Component ,,76802,CPT,Professional,Both,,,26,274,232.9,25.31,274,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),36.4504,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Us Ob Under 14 Wks  Comp Ea Addl Gest (Pro Cah)Professional Component ,,76802,CPT,Professional,Both,,,26,274,232.9,25.31,274,UnitedHealthcare,Individual & Family,274,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Us Ob Under 14 Wks  Comp Ea Addl Gest (Pro Cah)Professional Component ,,76802,CPT,Professional,Both,,,26,274,232.9,25.31,274,UnitedHealthcare,Medicare Advantage,45.563,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Us Ob Under 14 Wks  Comp Ea Addl Gest (Pro Cah)Professional Component ,,76802,CPT,Professional,Both,,,26,274,232.9,25.31,274,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,29.22016,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Us Ob Over 14 Wks Comp (Pro Cah)Professional Component ,,76805,CPT,Professional,Both,,,26,208,176.8,30.33,208,Aetna,Commercial,176.8,85,,percent of total billed charges,,
Us Ob Over 14 Wks Comp (Pro Cah)Professional Component ,,76805,CPT,Professional,Both,,,26,208,176.8,30.33,208,Aetna,Medicare Advantage,48.12,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Us Ob Over 14 Wks Comp (Pro Cah)Professional Component ,,76805,CPT,Professional,Both,,,26,208,176.8,30.33,208,Aetna,PPO,193.44,93,,percent of total billed charges,,
Us Ob Over 14 Wks Comp (Pro Cah)Professional Component ,,76805,CPT,Professional,Both,,,26,208,176.8,30.33,208,America's PPO,America's PPO,177.7152,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Us Ob Over 14 Wks Comp (Pro Cah)Professional Component ,,76805,CPT,Professional,Both,,,26,208,176.8,30.33,208,BlueCross BlueShield Minnesota, Federal Employee Program,90.13,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Us Ob Over 14 Wks Comp (Pro Cah)Professional Component ,,76805,CPT,Professional,Both,,,26,208,176.8,30.33,208,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,91.57208,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Us Ob Over 14 Wks Comp (Pro Cah)Professional Component ,,76805,CPT,Professional,Both,,,26,208,176.8,30.33,208,BlueCross BlueShield Minnesota,High Value Network Plan,91.57208,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Us Ob Over 14 Wks Comp (Pro Cah)Professional Component ,,76805,CPT,Professional,Both,,,26,208,176.8,30.33,208,BlueCross BlueShield Minnesota,Medicare Advantage,54.1765,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Us Ob Over 14 Wks Comp (Pro Cah)Professional Component ,,76805,CPT,Professional,Both,,,26,208,176.8,30.33,208,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,91.57208,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Us Ob Over 14 Wks Comp (Pro Cah)Professional Component ,,76805,CPT,Professional,Both,,,26,208,176.8,30.33,208,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,35.02152,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Us Ob Over 14 Wks Comp (Pro Cah)Professional Component ,,76805,CPT,Professional,Both,,,26,208,176.8,30.33,208,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),54.1765,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Us Ob Over 14 Wks Comp (Pro Cah)Professional Component ,,76805,CPT,Professional,Both,,,26,208,176.8,30.33,208,CorVel,Worker's Compensation,92.6227281,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Us Ob Over 14 Wks Comp (Pro Cah)Professional Component ,,76805,CPT,Professional,Both,,,26,208,176.8,30.33,208,First Health Group Corporation,First Health Network,201.76,97,,percent of total billed charges,,
Us Ob Over 14 Wks Comp (Pro Cah)Professional Component ,,76805,CPT,Professional,Both,,,26,208,176.8,30.33,208,"Health Partners, Inc.",Commercial,70.64,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Us Ob Over 14 Wks Comp (Pro Cah)Professional Component ,,76805,CPT,Professional,Both,,,26,208,176.8,30.33,208,"Health Partners, Inc.",Medicare Advantage,54.1765,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Us Ob Over 14 Wks Comp (Pro Cah)Professional Component ,,76805,CPT,Professional,Both,,,26,208,176.8,30.33,208,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),30.33,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Us Ob Over 14 Wks Comp (Pro Cah)Professional Component ,,76805,CPT,Professional,Both,,,26,208,176.8,30.33,208,"Health Partners, Inc.",State of Minnesota Advantage Program,60.85636,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Us Ob Over 14 Wks Comp (Pro Cah)Professional Component ,,76805,CPT,Professional,Both,,,26,208,176.8,30.33,208,"Health Partners, Inc.",State Public Programs,30.33,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Us Ob Over 14 Wks Comp (Pro Cah)Professional Component ,,76805,CPT,Professional,Both,,,26,208,176.8,30.33,208,Humana Insurance Company,Commercial PPO,47.11,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Us Ob Over 14 Wks Comp (Pro Cah)Professional Component ,,76805,CPT,Professional,Both,,,26,208,176.8,30.33,208,Humana Insurance Company,Medicare PPO,208,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Us Ob Over 14 Wks Comp (Pro Cah)Professional Component ,,76805,CPT,Professional,Both,,,26,208,176.8,30.33,208,Medica,Individual & Family,176.384,84.8,,percent of total billed charges,,
Us Ob Over 14 Wks Comp (Pro Cah)Professional Component ,,76805,CPT,Professional,Both,,,26,208,176.8,30.33,208,Medica,Medica Advantage Solution,103.584,49.8,,percent of total billed charges,,
Us Ob Over 14 Wks Comp (Pro Cah)Professional Component ,,76805,CPT,Professional,Both,,,26,208,176.8,30.33,208,Medica,Medical Assistance,35.02,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Us Ob Over 14 Wks Comp (Pro Cah)Professional Component ,,76805,CPT,Professional,Both,,,26,208,176.8,30.33,208,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,47.11,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Us Ob Over 14 Wks Comp (Pro Cah)Professional Component ,,76805,CPT,Professional,Both,,,26,208,176.8,30.33,208,"Multiplan, Inc.","Multiplan, Inc.",195.52,94,,percent of total billed charges,,
Us Ob Over 14 Wks Comp (Pro Cah)Professional Component ,,76805,CPT,Professional,Both,,,26,208,176.8,30.33,208,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,187.408,90.1,,percent of total billed charges,,
Us Ob Over 14 Wks Comp (Pro Cah)Professional Component ,,76805,CPT,Professional,Both,,,26,208,176.8,30.33,208,"Preferred One Administrative Services, INC.",PPO,205.088,98.6,,percent of total billed charges,,
Us Ob Over 14 Wks Comp (Pro Cah)Professional Component ,,76805,CPT,Professional,Both,,,26,208,176.8,30.33,208,PrimeWest Health,Minnesota Senior Health Options (MSHO),54.1765,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Us Ob Over 14 Wks Comp (Pro Cah)Professional Component ,,76805,CPT,Professional,Both,,,26,208,176.8,30.33,208,PrimeWest Health,MinnesotaCare,37.4730264,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Us Ob Over 14 Wks Comp (Pro Cah)Professional Component ,,76805,CPT,Professional,Both,,,26,208,176.8,30.33,208,Sanford Health Plan,Sanford Health Plan,183.04,88,,percent of total billed charges,,
Us Ob Over 14 Wks Comp (Pro Cah)Professional Component ,,76805,CPT,Professional,Both,,,26,208,176.8,30.33,208,"UCare Health, Inc.",Individual & Family Plan,76.582016,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Us Ob Over 14 Wks Comp (Pro Cah)Professional Component ,,76805,CPT,Professional,Both,,,26,208,176.8,30.33,208,"UCare Health, Inc.",Medical Assistance,38.523672,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Us Ob Over 14 Wks Comp (Pro Cah)Professional Component ,,76805,CPT,Professional,Both,,,26,208,176.8,30.33,208,"UCare Health, Inc.",Medicare Advantage,54.1765,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Us Ob Over 14 Wks Comp (Pro Cah)Professional Component ,,76805,CPT,Professional,Both,,,26,208,176.8,30.33,208,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),43.3412,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Us Ob Over 14 Wks Comp (Pro Cah)Professional Component ,,76805,CPT,Professional,Both,,,26,208,176.8,30.33,208,UnitedHealthcare,Individual & Family,208,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Us Ob Over 14 Wks Comp (Pro Cah)Professional Component ,,76805,CPT,Professional,Both,,,26,208,176.8,30.33,208,UnitedHealthcare,Medicare Advantage,54.1765,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Us Ob Over 14 Wks Comp (Pro Cah)Professional Component ,,76805,CPT,Professional,Both,,,26,208,176.8,30.33,208,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,35.02152,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Us Ob Over 14 Wks  Ea Addl Gest (Pro Cah)Professional Component ,,76810,CPT,Professional,Both,,,26,332,282.2,30.11,332,Aetna,Commercial,282.2,85,,percent of total billed charges,,
Us Ob Over 14 Wks  Ea Addl Gest (Pro Cah)Professional Component ,,76810,CPT,Professional,Both,,,26,332,282.2,30.11,332,Aetna,Medicare Advantage,47.77,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Us Ob Over 14 Wks  Ea Addl Gest (Pro Cah)Professional Component ,,76810,CPT,Professional,Both,,,26,332,282.2,30.11,332,Aetna,PPO,308.76,93,,percent of total billed charges,,
Us Ob Over 14 Wks  Ea Addl Gest (Pro Cah)Professional Component ,,76810,CPT,Professional,Both,,,26,332,282.2,30.11,332,America's PPO,America's PPO,283.6608,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Us Ob Over 14 Wks  Ea Addl Gest (Pro Cah)Professional Component ,,76810,CPT,Professional,Both,,,26,332,282.2,30.11,332,BlueCross BlueShield Minnesota, Federal Employee Program,89.49,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Us Ob Over 14 Wks  Ea Addl Gest (Pro Cah)Professional Component ,,76810,CPT,Professional,Both,,,26,332,282.2,30.11,332,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,90.92184,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Us Ob Over 14 Wks  Ea Addl Gest (Pro Cah)Professional Component ,,76810,CPT,Professional,Both,,,26,332,282.2,30.11,332,BlueCross BlueShield Minnesota,High Value Network Plan,90.92184,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Us Ob Over 14 Wks  Ea Addl Gest (Pro Cah)Professional Component ,,76810,CPT,Professional,Both,,,26,332,282.2,30.11,332,BlueCross BlueShield Minnesota,Medicare Advantage,53.7855,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Us Ob Over 14 Wks  Ea Addl Gest (Pro Cah)Professional Component ,,76810,CPT,Professional,Both,,,26,332,282.2,30.11,332,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,90.92184,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Us Ob Over 14 Wks  Ea Addl Gest (Pro Cah)Professional Component ,,76810,CPT,Professional,Both,,,26,332,282.2,30.11,332,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,34.76752,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Us Ob Over 14 Wks  Ea Addl Gest (Pro Cah)Professional Component ,,76810,CPT,Professional,Both,,,26,332,282.2,30.11,332,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),53.7855,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Us Ob Over 14 Wks  Ea Addl Gest (Pro Cah)Professional Component ,,76810,CPT,Professional,Both,,,26,332,282.2,30.11,332,CorVel,Worker's Compensation,91.270596,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Us Ob Over 14 Wks  Ea Addl Gest (Pro Cah)Professional Component ,,76810,CPT,Professional,Both,,,26,332,282.2,30.11,332,First Health Group Corporation,First Health Network,322.04,97,,percent of total billed charges,,
Us Ob Over 14 Wks  Ea Addl Gest (Pro Cah)Professional Component ,,76810,CPT,Professional,Both,,,26,332,282.2,30.11,332,"Health Partners, Inc.",Commercial,69.61,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Us Ob Over 14 Wks  Ea Addl Gest (Pro Cah)Professional Component ,,76810,CPT,Professional,Both,,,26,332,282.2,30.11,332,"Health Partners, Inc.",Medicare Advantage,53.7855,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Us Ob Over 14 Wks  Ea Addl Gest (Pro Cah)Professional Component ,,76810,CPT,Professional,Both,,,26,332,282.2,30.11,332,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),30.11,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Us Ob Over 14 Wks  Ea Addl Gest (Pro Cah)Professional Component ,,76810,CPT,Professional,Both,,,26,332,282.2,30.11,332,"Health Partners, Inc.",State of Minnesota Advantage Program,59.969015,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Us Ob Over 14 Wks  Ea Addl Gest (Pro Cah)Professional Component ,,76810,CPT,Professional,Both,,,26,332,282.2,30.11,332,"Health Partners, Inc.",State Public Programs,30.11,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Us Ob Over 14 Wks  Ea Addl Gest (Pro Cah)Professional Component ,,76810,CPT,Professional,Both,,,26,332,282.2,30.11,332,Humana Insurance Company,Commercial PPO,46.77,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Us Ob Over 14 Wks  Ea Addl Gest (Pro Cah)Professional Component ,,76810,CPT,Professional,Both,,,26,332,282.2,30.11,332,Humana Insurance Company,Medicare PPO,332,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Us Ob Over 14 Wks  Ea Addl Gest (Pro Cah)Professional Component ,,76810,CPT,Professional,Both,,,26,332,282.2,30.11,332,Medica,Individual & Family,281.536,84.8,,percent of total billed charges,,
Us Ob Over 14 Wks  Ea Addl Gest (Pro Cah)Professional Component ,,76810,CPT,Professional,Both,,,26,332,282.2,30.11,332,Medica,Medica Advantage Solution,165.336,49.8,,percent of total billed charges,,
Us Ob Over 14 Wks  Ea Addl Gest (Pro Cah)Professional Component ,,76810,CPT,Professional,Both,,,26,332,282.2,30.11,332,Medica,Medical Assistance,34.77,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Us Ob Over 14 Wks  Ea Addl Gest (Pro Cah)Professional Component ,,76810,CPT,Professional,Both,,,26,332,282.2,30.11,332,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,46.77,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Us Ob Over 14 Wks  Ea Addl Gest (Pro Cah)Professional Component ,,76810,CPT,Professional,Both,,,26,332,282.2,30.11,332,"Multiplan, Inc.","Multiplan, Inc.",312.08,94,,percent of total billed charges,,
Us Ob Over 14 Wks  Ea Addl Gest (Pro Cah)Professional Component ,,76810,CPT,Professional,Both,,,26,332,282.2,30.11,332,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,299.132,90.1,,percent of total billed charges,,
Us Ob Over 14 Wks  Ea Addl Gest (Pro Cah)Professional Component ,,76810,CPT,Professional,Both,,,26,332,282.2,30.11,332,"Preferred One Administrative Services, INC.",PPO,327.352,98.6,,percent of total billed charges,,
Us Ob Over 14 Wks  Ea Addl Gest (Pro Cah)Professional Component ,,76810,CPT,Professional,Both,,,26,332,282.2,30.11,332,PrimeWest Health,Minnesota Senior Health Options (MSHO),53.7855,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Us Ob Over 14 Wks  Ea Addl Gest (Pro Cah)Professional Component ,,76810,CPT,Professional,Both,,,26,332,282.2,30.11,332,PrimeWest Health,MinnesotaCare,37.2012464,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Us Ob Over 14 Wks  Ea Addl Gest (Pro Cah)Professional Component ,,76810,CPT,Professional,Both,,,26,332,282.2,30.11,332,Sanford Health Plan,Sanford Health Plan,292.16,88,,percent of total billed charges,,
Us Ob Over 14 Wks  Ea Addl Gest (Pro Cah)Professional Component ,,76810,CPT,Professional,Both,,,26,332,282.2,30.11,332,"UCare Health, Inc.",Individual & Family Plan,76.029312,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Us Ob Over 14 Wks  Ea Addl Gest (Pro Cah)Professional Component ,,76810,CPT,Professional,Both,,,26,332,282.2,30.11,332,"UCare Health, Inc.",Medical Assistance,38.244272,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Us Ob Over 14 Wks  Ea Addl Gest (Pro Cah)Professional Component ,,76810,CPT,Professional,Both,,,26,332,282.2,30.11,332,"UCare Health, Inc.",Medicare Advantage,53.7855,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Us Ob Over 14 Wks  Ea Addl Gest (Pro Cah)Professional Component ,,76810,CPT,Professional,Both,,,26,332,282.2,30.11,332,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),43.0284,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Us Ob Over 14 Wks  Ea Addl Gest (Pro Cah)Professional Component ,,76810,CPT,Professional,Both,,,26,332,282.2,30.11,332,UnitedHealthcare,Individual & Family,332,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Us Ob Over 14 Wks  Ea Addl Gest (Pro Cah)Professional Component ,,76810,CPT,Professional,Both,,,26,332,282.2,30.11,332,UnitedHealthcare,Medicare Advantage,53.7855,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Us Ob Over 14 Wks  Ea Addl Gest (Pro Cah)Professional Component ,,76810,CPT,Professional,Both,,,26,332,282.2,30.11,332,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,34.76752,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Pregnant Uterus; Limited (Pro Cah)Professional Component ,,76815,CPT,Professional,Both,,,26,135,114.75,19.64,135,Aetna,Commercial,114.75,85,,percent of total billed charges,,
Pregnant Uterus; Limited (Pro Cah)Professional Component ,,76815,CPT,Professional,Both,,,26,135,114.75,19.64,135,Aetna,Medicare Advantage,31.66,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Pregnant Uterus; Limited (Pro Cah)Professional Component ,,76815,CPT,Professional,Both,,,26,135,114.75,19.64,135,Aetna,PPO,125.55,93,,percent of total billed charges,,
Pregnant Uterus; Limited (Pro Cah)Professional Component ,,76815,CPT,Professional,Both,,,26,135,114.75,19.64,135,America's PPO,America's PPO,115.344,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Pregnant Uterus; Limited (Pro Cah)Professional Component ,,76815,CPT,Professional,Both,,,26,135,114.75,19.64,135,BlueCross BlueShield Minnesota, Federal Employee Program,59.45,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Pregnant Uterus; Limited (Pro Cah)Professional Component ,,76815,CPT,Professional,Both,,,26,135,114.75,19.64,135,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,60.4012,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Pregnant Uterus; Limited (Pro Cah)Professional Component ,,76815,CPT,Professional,Both,,,26,135,114.75,19.64,135,BlueCross BlueShield Minnesota,High Value Network Plan,60.4012,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Pregnant Uterus; Limited (Pro Cah)Professional Component ,,76815,CPT,Professional,Both,,,26,135,114.75,19.64,135,BlueCross BlueShield Minnesota,Medicare Advantage,35.374,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Pregnant Uterus; Limited (Pro Cah)Professional Component ,,76815,CPT,Professional,Both,,,26,135,114.75,19.64,135,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,60.4012,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Pregnant Uterus; Limited (Pro Cah)Professional Component ,,76815,CPT,Professional,Both,,,26,135,114.75,19.64,135,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,22.67712,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Pregnant Uterus; Limited (Pro Cah)Professional Component ,,76815,CPT,Professional,Both,,,26,135,114.75,19.64,135,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),35.374,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Pregnant Uterus; Limited (Pro Cah)Professional Component ,,76815,CPT,Professional,Both,,,26,135,114.75,19.64,135,CorVel,Worker's Compensation,60.2588787,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Pregnant Uterus; Limited (Pro Cah)Professional Component ,,76815,CPT,Professional,Both,,,26,135,114.75,19.64,135,First Health Group Corporation,First Health Network,130.95,97,,percent of total billed charges,,
Pregnant Uterus; Limited (Pro Cah)Professional Component ,,76815,CPT,Professional,Both,,,26,135,114.75,19.64,135,"Health Partners, Inc.",Commercial,45.89,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Pregnant Uterus; Limited (Pro Cah)Professional Component ,,76815,CPT,Professional,Both,,,26,135,114.75,19.64,135,"Health Partners, Inc.",Medicare Advantage,35.374,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Pregnant Uterus; Limited (Pro Cah)Professional Component ,,76815,CPT,Professional,Both,,,26,135,114.75,19.64,135,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),19.64,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Pregnant Uterus; Limited (Pro Cah)Professional Component ,,76815,CPT,Professional,Both,,,26,135,114.75,19.64,135,"Health Partners, Inc.",State of Minnesota Advantage Program,39.534235,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Pregnant Uterus; Limited (Pro Cah)Professional Component ,,76815,CPT,Professional,Both,,,26,135,114.75,19.64,135,"Health Partners, Inc.",State Public Programs,19.64,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Pregnant Uterus; Limited (Pro Cah)Professional Component ,,76815,CPT,Professional,Both,,,26,135,114.75,19.64,135,Humana Insurance Company,Commercial PPO,30.76,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Pregnant Uterus; Limited (Pro Cah)Professional Component ,,76815,CPT,Professional,Both,,,26,135,114.75,19.64,135,Humana Insurance Company,Medicare PPO,135,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Pregnant Uterus; Limited (Pro Cah)Professional Component ,,76815,CPT,Professional,Both,,,26,135,114.75,19.64,135,Medica,Individual & Family,114.48,84.8,,percent of total billed charges,,
Pregnant Uterus; Limited (Pro Cah)Professional Component ,,76815,CPT,Professional,Both,,,26,135,114.75,19.64,135,Medica,Medica Advantage Solution,67.23,49.8,,percent of total billed charges,,
Pregnant Uterus; Limited (Pro Cah)Professional Component ,,76815,CPT,Professional,Both,,,26,135,114.75,19.64,135,Medica,Medical Assistance,22.68,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Pregnant Uterus; Limited (Pro Cah)Professional Component ,,76815,CPT,Professional,Both,,,26,135,114.75,19.64,135,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,30.76,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Pregnant Uterus; Limited (Pro Cah)Professional Component ,,76815,CPT,Professional,Both,,,26,135,114.75,19.64,135,"Multiplan, Inc.","Multiplan, Inc.",126.9,94,,percent of total billed charges,,
Pregnant Uterus; Limited (Pro Cah)Professional Component ,,76815,CPT,Professional,Both,,,26,135,114.75,19.64,135,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,121.635,90.1,,percent of total billed charges,,
Pregnant Uterus; Limited (Pro Cah)Professional Component ,,76815,CPT,Professional,Both,,,26,135,114.75,19.64,135,"Preferred One Administrative Services, INC.",PPO,133.11,98.6,,percent of total billed charges,,
Pregnant Uterus; Limited (Pro Cah)Professional Component ,,76815,CPT,Professional,Both,,,26,135,114.75,19.64,135,PrimeWest Health,Minnesota Senior Health Options (MSHO),35.374,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Pregnant Uterus; Limited (Pro Cah)Professional Component ,,76815,CPT,Professional,Both,,,26,135,114.75,19.64,135,PrimeWest Health,MinnesotaCare,24.2645184,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Pregnant Uterus; Limited (Pro Cah)Professional Component ,,76815,CPT,Professional,Both,,,26,135,114.75,19.64,135,Sanford Health Plan,Sanford Health Plan,118.8,88,,percent of total billed charges,,
Pregnant Uterus; Limited (Pro Cah)Professional Component ,,76815,CPT,Professional,Both,,,26,135,114.75,19.64,135,"UCare Health, Inc.",Individual & Family Plan,50.003456,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Pregnant Uterus; Limited (Pro Cah)Professional Component ,,76815,CPT,Professional,Both,,,26,135,114.75,19.64,135,"UCare Health, Inc.",Medical Assistance,24.944832,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Pregnant Uterus; Limited (Pro Cah)Professional Component ,,76815,CPT,Professional,Both,,,26,135,114.75,19.64,135,"UCare Health, Inc.",Medicare Advantage,35.374,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Pregnant Uterus; Limited (Pro Cah)Professional Component ,,76815,CPT,Professional,Both,,,26,135,114.75,19.64,135,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),28.2992,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Pregnant Uterus; Limited (Pro Cah)Professional Component ,,76815,CPT,Professional,Both,,,26,135,114.75,19.64,135,UnitedHealthcare,Individual & Family,135,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Pregnant Uterus; Limited (Pro Cah)Professional Component ,,76815,CPT,Professional,Both,,,26,135,114.75,19.64,135,UnitedHealthcare,Medicare Advantage,35.374,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Pregnant Uterus; Limited (Pro Cah)Professional Component ,,76815,CPT,Professional,Both,,,26,135,114.75,19.64,135,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,22.67712,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Us Pregnant Uterus, Real Time W/Image Documentation, F/U, Transabd Approach, Per Fetus (Pro Cah)Professional Component ",,76816,CPT,Professional,Both,,,26,151,128.35,25.97,151,Aetna,Commercial,128.35,85,,percent of total billed charges,,
"Us Pregnant Uterus, Real Time W/Image Documentation, F/U, Transabd Approach, Per Fetus (Pro Cah)Professional Component ",,76816,CPT,Professional,Both,,,26,151,128.35,25.97,151,Aetna,Medicare Advantage,41.46,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Us Pregnant Uterus, Real Time W/Image Documentation, F/U, Transabd Approach, Per Fetus (Pro Cah)Professional Component ",,76816,CPT,Professional,Both,,,26,151,128.35,25.97,151,Aetna,PPO,140.43,93,,percent of total billed charges,,
"Us Pregnant Uterus, Real Time W/Image Documentation, F/U, Transabd Approach, Per Fetus (Pro Cah)Professional Component ",,76816,CPT,Professional,Both,,,26,151,128.35,25.97,151,America's PPO,America's PPO,129.0144,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Us Pregnant Uterus, Real Time W/Image Documentation, F/U, Transabd Approach, Per Fetus (Pro Cah)Professional Component ",,76816,CPT,Professional,Both,,,26,151,128.35,25.97,151,BlueCross BlueShield Minnesota, Federal Employee Program,76.7,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Us Pregnant Uterus, Real Time W/Image Documentation, F/U, Transabd Approach, Per Fetus (Pro Cah)Professional Component ",,76816,CPT,Professional,Both,,,26,151,128.35,25.97,151,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,77.9272,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Us Pregnant Uterus, Real Time W/Image Documentation, F/U, Transabd Approach, Per Fetus (Pro Cah)Professional Component ",,76816,CPT,Professional,Both,,,26,151,128.35,25.97,151,BlueCross BlueShield Minnesota,High Value Network Plan,77.9272,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Us Pregnant Uterus, Real Time W/Image Documentation, F/U, Transabd Approach, Per Fetus (Pro Cah)Professional Component ",,76816,CPT,Professional,Both,,,26,151,128.35,25.97,151,BlueCross BlueShield Minnesota,Medicare Advantage,46.483,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Us Pregnant Uterus, Real Time W/Image Documentation, F/U, Transabd Approach, Per Fetus (Pro Cah)Professional Component ",,76816,CPT,Professional,Both,,,26,151,128.35,25.97,151,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,77.9272,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Us Pregnant Uterus, Real Time W/Image Documentation, F/U, Transabd Approach, Per Fetus (Pro Cah)Professional Component ",,76816,CPT,Professional,Both,,,26,151,128.35,25.97,151,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,29.98216,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Us Pregnant Uterus, Real Time W/Image Documentation, F/U, Transabd Approach, Per Fetus (Pro Cah)Professional Component ",,76816,CPT,Professional,Both,,,26,151,128.35,25.97,151,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),46.483,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Us Pregnant Uterus, Real Time W/Image Documentation, F/U, Transabd Approach, Per Fetus (Pro Cah)Professional Component ",,76816,CPT,Professional,Both,,,26,151,128.35,25.97,151,CorVel,Worker's Compensation,79.8167676,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Us Pregnant Uterus, Real Time W/Image Documentation, F/U, Transabd Approach, Per Fetus (Pro Cah)Professional Component ",,76816,CPT,Professional,Both,,,26,151,128.35,25.97,151,First Health Group Corporation,First Health Network,146.47,97,,percent of total billed charges,,
"Us Pregnant Uterus, Real Time W/Image Documentation, F/U, Transabd Approach, Per Fetus (Pro Cah)Professional Component ",,76816,CPT,Professional,Both,,,26,151,128.35,25.97,151,"Health Partners, Inc.",Commercial,60.85,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Us Pregnant Uterus, Real Time W/Image Documentation, F/U, Transabd Approach, Per Fetus (Pro Cah)Professional Component ",,76816,CPT,Professional,Both,,,26,151,128.35,25.97,151,"Health Partners, Inc.",Medicare Advantage,46.483,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Us Pregnant Uterus, Real Time W/Image Documentation, F/U, Transabd Approach, Per Fetus (Pro Cah)Professional Component ",,76816,CPT,Professional,Both,,,26,151,128.35,25.97,151,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),25.97,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Us Pregnant Uterus, Real Time W/Image Documentation, F/U, Transabd Approach, Per Fetus (Pro Cah)Professional Component ",,76816,CPT,Professional,Both,,,26,151,128.35,25.97,151,"Health Partners, Inc.",State of Minnesota Advantage Program,52.422275,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Us Pregnant Uterus, Real Time W/Image Documentation, F/U, Transabd Approach, Per Fetus (Pro Cah)Professional Component ",,76816,CPT,Professional,Both,,,26,151,128.35,25.97,151,"Health Partners, Inc.",State Public Programs,25.97,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Us Pregnant Uterus, Real Time W/Image Documentation, F/U, Transabd Approach, Per Fetus (Pro Cah)Professional Component ",,76816,CPT,Professional,Both,,,26,151,128.35,25.97,151,Humana Insurance Company,Commercial PPO,40.42,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Us Pregnant Uterus, Real Time W/Image Documentation, F/U, Transabd Approach, Per Fetus (Pro Cah)Professional Component ",,76816,CPT,Professional,Both,,,26,151,128.35,25.97,151,Humana Insurance Company,Medicare PPO,151,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Us Pregnant Uterus, Real Time W/Image Documentation, F/U, Transabd Approach, Per Fetus (Pro Cah)Professional Component ",,76816,CPT,Professional,Both,,,26,151,128.35,25.97,151,Medica,Individual & Family,128.048,84.8,,percent of total billed charges,,
"Us Pregnant Uterus, Real Time W/Image Documentation, F/U, Transabd Approach, Per Fetus (Pro Cah)Professional Component ",,76816,CPT,Professional,Both,,,26,151,128.35,25.97,151,Medica,Medica Advantage Solution,75.198,49.8,,percent of total billed charges,,
"Us Pregnant Uterus, Real Time W/Image Documentation, F/U, Transabd Approach, Per Fetus (Pro Cah)Professional Component ",,76816,CPT,Professional,Both,,,26,151,128.35,25.97,151,Medica,Medical Assistance,29.98,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Us Pregnant Uterus, Real Time W/Image Documentation, F/U, Transabd Approach, Per Fetus (Pro Cah)Professional Component ",,76816,CPT,Professional,Both,,,26,151,128.35,25.97,151,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,40.42,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Us Pregnant Uterus, Real Time W/Image Documentation, F/U, Transabd Approach, Per Fetus (Pro Cah)Professional Component ",,76816,CPT,Professional,Both,,,26,151,128.35,25.97,151,"Multiplan, Inc.","Multiplan, Inc.",141.94,94,,percent of total billed charges,,
"Us Pregnant Uterus, Real Time W/Image Documentation, F/U, Transabd Approach, Per Fetus (Pro Cah)Professional Component ",,76816,CPT,Professional,Both,,,26,151,128.35,25.97,151,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,136.051,90.1,,percent of total billed charges,,
"Us Pregnant Uterus, Real Time W/Image Documentation, F/U, Transabd Approach, Per Fetus (Pro Cah)Professional Component ",,76816,CPT,Professional,Both,,,26,151,128.35,25.97,151,"Preferred One Administrative Services, INC.",PPO,148.886,98.6,,percent of total billed charges,,
"Us Pregnant Uterus, Real Time W/Image Documentation, F/U, Transabd Approach, Per Fetus (Pro Cah)Professional Component ",,76816,CPT,Professional,Both,,,26,151,128.35,25.97,151,PrimeWest Health,Minnesota Senior Health Options (MSHO),46.483,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Us Pregnant Uterus, Real Time W/Image Documentation, F/U, Transabd Approach, Per Fetus (Pro Cah)Professional Component ",,76816,CPT,Professional,Both,,,26,151,128.35,25.97,151,PrimeWest Health,MinnesotaCare,32.0809112,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Us Pregnant Uterus, Real Time W/Image Documentation, F/U, Transabd Approach, Per Fetus (Pro Cah)Professional Component ",,76816,CPT,Professional,Both,,,26,151,128.35,25.97,151,Sanford Health Plan,Sanford Health Plan,132.88,88,,percent of total billed charges,,
"Us Pregnant Uterus, Real Time W/Image Documentation, F/U, Transabd Approach, Per Fetus (Pro Cah)Professional Component ",,76816,CPT,Professional,Both,,,26,151,128.35,25.97,151,"UCare Health, Inc.",Individual & Family Plan,65.706752,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Us Pregnant Uterus, Real Time W/Image Documentation, F/U, Transabd Approach, Per Fetus (Pro Cah)Professional Component ",,76816,CPT,Professional,Both,,,26,151,128.35,25.97,151,"UCare Health, Inc.",Medical Assistance,32.980376,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Us Pregnant Uterus, Real Time W/Image Documentation, F/U, Transabd Approach, Per Fetus (Pro Cah)Professional Component ",,76816,CPT,Professional,Both,,,26,151,128.35,25.97,151,"UCare Health, Inc.",Medicare Advantage,46.483,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Us Pregnant Uterus, Real Time W/Image Documentation, F/U, Transabd Approach, Per Fetus (Pro Cah)Professional Component ",,76816,CPT,Professional,Both,,,26,151,128.35,25.97,151,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),37.1864,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Us Pregnant Uterus, Real Time W/Image Documentation, F/U, Transabd Approach, Per Fetus (Pro Cah)Professional Component ",,76816,CPT,Professional,Both,,,26,151,128.35,25.97,151,UnitedHealthcare,Individual & Family,151,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Us Pregnant Uterus, Real Time W/Image Documentation, F/U, Transabd Approach, Per Fetus (Pro Cah)Professional Component ",,76816,CPT,Professional,Both,,,26,151,128.35,25.97,151,UnitedHealthcare,Medicare Advantage,46.483,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Us Pregnant Uterus, Real Time W/Image Documentation, F/U, Transabd Approach, Per Fetus (Pro Cah)Professional Component ",,76816,CPT,Professional,Both,,,26,151,128.35,25.97,151,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,29.98216,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Us Ob Transvaginal (Pro Cah)Professional Component ,,76817,CPT,Professional,Both,,,26,304,258.4,22.7,304,Aetna,Commercial,258.4,85,,percent of total billed charges,,
Us Ob Transvaginal (Pro Cah)Professional Component ,,76817,CPT,Professional,Both,,,26,304,258.4,22.7,304,Aetna,Medicare Advantage,36.56,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Us Ob Transvaginal (Pro Cah)Professional Component ,,76817,CPT,Professional,Both,,,26,304,258.4,22.7,304,Aetna,PPO,282.72,93,,percent of total billed charges,,
Us Ob Transvaginal (Pro Cah)Professional Component ,,76817,CPT,Professional,Both,,,26,304,258.4,22.7,304,America's PPO,America's PPO,259.7376,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Us Ob Transvaginal (Pro Cah)Professional Component ,,76817,CPT,Professional,Both,,,26,304,258.4,22.7,304,BlueCross BlueShield Minnesota, Federal Employee Program,68.39,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Us Ob Transvaginal (Pro Cah)Professional Component ,,76817,CPT,Professional,Both,,,26,304,258.4,22.7,304,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,69.48424,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Us Ob Transvaginal (Pro Cah)Professional Component ,,76817,CPT,Professional,Both,,,26,304,258.4,22.7,304,BlueCross BlueShield Minnesota,High Value Network Plan,69.48424,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Us Ob Transvaginal (Pro Cah)Professional Component ,,76817,CPT,Professional,Both,,,26,304,258.4,22.7,304,BlueCross BlueShield Minnesota,Medicare Advantage,40.8595,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Us Ob Transvaginal (Pro Cah)Professional Component ,,76817,CPT,Professional,Both,,,26,304,258.4,22.7,304,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,69.48424,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Us Ob Transvaginal (Pro Cah)Professional Component ,,76817,CPT,Professional,Both,,,26,304,258.4,22.7,304,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,26.20264,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Us Ob Transvaginal (Pro Cah)Professional Component ,,76817,CPT,Professional,Both,,,26,304,258.4,22.7,304,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),40.8595,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Us Ob Transvaginal (Pro Cah)Professional Component ,,76817,CPT,Professional,Both,,,26,304,258.4,22.7,304,CorVel,Worker's Compensation,70.3780392,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Us Ob Transvaginal (Pro Cah)Professional Component ,,76817,CPT,Professional,Both,,,26,304,258.4,22.7,304,First Health Group Corporation,First Health Network,294.88,97,,percent of total billed charges,,
Us Ob Transvaginal (Pro Cah)Professional Component ,,76817,CPT,Professional,Both,,,26,304,258.4,22.7,304,"Health Partners, Inc.",Commercial,53.62,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Us Ob Transvaginal (Pro Cah)Professional Component ,,76817,CPT,Professional,Both,,,26,304,258.4,22.7,304,"Health Partners, Inc.",Medicare Advantage,40.8595,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Us Ob Transvaginal (Pro Cah)Professional Component ,,76817,CPT,Professional,Both,,,26,304,258.4,22.7,304,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),22.7,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Us Ob Transvaginal (Pro Cah)Professional Component ,,76817,CPT,Professional,Both,,,26,304,258.4,22.7,304,"Health Partners, Inc.",State of Minnesota Advantage Program,46.19363,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Us Ob Transvaginal (Pro Cah)Professional Component ,,76817,CPT,Professional,Both,,,26,304,258.4,22.7,304,"Health Partners, Inc.",State Public Programs,22.7,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Us Ob Transvaginal (Pro Cah)Professional Component ,,76817,CPT,Professional,Both,,,26,304,258.4,22.7,304,Humana Insurance Company,Commercial PPO,35.53,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Us Ob Transvaginal (Pro Cah)Professional Component ,,76817,CPT,Professional,Both,,,26,304,258.4,22.7,304,Humana Insurance Company,Medicare PPO,304,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Us Ob Transvaginal (Pro Cah)Professional Component ,,76817,CPT,Professional,Both,,,26,304,258.4,22.7,304,Medica,Individual & Family,257.792,84.8,,percent of total billed charges,,
Us Ob Transvaginal (Pro Cah)Professional Component ,,76817,CPT,Professional,Both,,,26,304,258.4,22.7,304,Medica,Medica Advantage Solution,151.392,49.8,,percent of total billed charges,,
Us Ob Transvaginal (Pro Cah)Professional Component ,,76817,CPT,Professional,Both,,,26,304,258.4,22.7,304,Medica,Medical Assistance,26.2,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Us Ob Transvaginal (Pro Cah)Professional Component ,,76817,CPT,Professional,Both,,,26,304,258.4,22.7,304,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,35.53,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Us Ob Transvaginal (Pro Cah)Professional Component ,,76817,CPT,Professional,Both,,,26,304,258.4,22.7,304,"Multiplan, Inc.","Multiplan, Inc.",285.76,94,,percent of total billed charges,,
Us Ob Transvaginal (Pro Cah)Professional Component ,,76817,CPT,Professional,Both,,,26,304,258.4,22.7,304,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,273.904,90.1,,percent of total billed charges,,
Us Ob Transvaginal (Pro Cah)Professional Component ,,76817,CPT,Professional,Both,,,26,304,258.4,22.7,304,"Preferred One Administrative Services, INC.",PPO,299.744,98.6,,percent of total billed charges,,
Us Ob Transvaginal (Pro Cah)Professional Component ,,76817,CPT,Professional,Both,,,26,304,258.4,22.7,304,PrimeWest Health,Minnesota Senior Health Options (MSHO),40.8595,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Us Ob Transvaginal (Pro Cah)Professional Component ,,76817,CPT,Professional,Both,,,26,304,258.4,22.7,304,PrimeWest Health,MinnesotaCare,28.0368248,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Us Ob Transvaginal (Pro Cah)Professional Component ,,76817,CPT,Professional,Both,,,26,304,258.4,22.7,304,Sanford Health Plan,Sanford Health Plan,267.52,88,,percent of total billed charges,,
Us Ob Transvaginal (Pro Cah)Professional Component ,,76817,CPT,Professional,Both,,,26,304,258.4,22.7,304,"UCare Health, Inc.",Individual & Family Plan,57.757568,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Us Ob Transvaginal (Pro Cah)Professional Component ,,76817,CPT,Professional,Both,,,26,304,258.4,22.7,304,"UCare Health, Inc.",Medical Assistance,28.822904,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Us Ob Transvaginal (Pro Cah)Professional Component ,,76817,CPT,Professional,Both,,,26,304,258.4,22.7,304,"UCare Health, Inc.",Medicare Advantage,40.8595,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Us Ob Transvaginal (Pro Cah)Professional Component ,,76817,CPT,Professional,Both,,,26,304,258.4,22.7,304,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),32.6876,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Us Ob Transvaginal (Pro Cah)Professional Component ,,76817,CPT,Professional,Both,,,26,304,258.4,22.7,304,UnitedHealthcare,Individual & Family,304,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Us Ob Transvaginal (Pro Cah)Professional Component ,,76817,CPT,Professional,Both,,,26,304,258.4,22.7,304,UnitedHealthcare,Medicare Advantage,40.8595,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Us Ob Transvaginal (Pro Cah)Professional Component ,,76817,CPT,Professional,Both,,,26,304,258.4,22.7,304,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,26.20264,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Fetal Biophysical Profile; W/Non-Stress Testing (Pro Cah)Professional Component ,,76818,CPT,Professional,Both,,,26,286,243.1,32.3,286,Aetna,Commercial,243.1,85,,percent of total billed charges,,
Fetal Biophysical Profile; W/Non-Stress Testing (Pro Cah)Professional Component ,,76818,CPT,Professional,Both,,,26,286,243.1,32.3,286,Aetna,Medicare Advantage,51.27,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Fetal Biophysical Profile; W/Non-Stress Testing (Pro Cah)Professional Component ,,76818,CPT,Professional,Both,,,26,286,243.1,32.3,286,Aetna,PPO,265.98,93,,percent of total billed charges,,
Fetal Biophysical Profile; W/Non-Stress Testing (Pro Cah)Professional Component ,,76818,CPT,Professional,Both,,,26,286,243.1,32.3,286,America's PPO,America's PPO,244.3584,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Fetal Biophysical Profile; W/Non-Stress Testing (Pro Cah)Professional Component ,,76818,CPT,Professional,Both,,,26,286,243.1,32.3,286,BlueCross BlueShield Minnesota, Federal Employee Program,95.88,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Fetal Biophysical Profile; W/Non-Stress Testing (Pro Cah)Professional Component ,,76818,CPT,Professional,Both,,,26,286,243.1,32.3,286,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,97.41408,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Fetal Biophysical Profile; W/Non-Stress Testing (Pro Cah)Professional Component ,,76818,CPT,Professional,Both,,,26,286,243.1,32.3,286,BlueCross BlueShield Minnesota,High Value Network Plan,97.41408,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Fetal Biophysical Profile; W/Non-Stress Testing (Pro Cah)Professional Component ,,76818,CPT,Professional,Both,,,26,286,243.1,32.3,286,BlueCross BlueShield Minnesota,Medicare Advantage,57.707,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Fetal Biophysical Profile; W/Non-Stress Testing (Pro Cah)Professional Component ,,76818,CPT,Professional,Both,,,26,286,243.1,32.3,286,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,97.41408,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Fetal Biophysical Profile; W/Non-Stress Testing (Pro Cah)Professional Component ,,76818,CPT,Professional,Both,,,26,286,243.1,32.3,286,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,37.2872,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Fetal Biophysical Profile; W/Non-Stress Testing (Pro Cah)Professional Component ,,76818,CPT,Professional,Both,,,26,286,243.1,32.3,286,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),57.707,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Fetal Biophysical Profile; W/Non-Stress Testing (Pro Cah)Professional Component ,,76818,CPT,Professional,Both,,,26,286,243.1,32.3,286,CorVel,Worker's Compensation,98.6942244,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Fetal Biophysical Profile; W/Non-Stress Testing (Pro Cah)Professional Component ,,76818,CPT,Professional,Both,,,26,286,243.1,32.3,286,First Health Group Corporation,First Health Network,277.42,97,,percent of total billed charges,,
Fetal Biophysical Profile; W/Non-Stress Testing (Pro Cah)Professional Component ,,76818,CPT,Professional,Both,,,26,286,243.1,32.3,286,"Health Partners, Inc.",Commercial,75.79,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Fetal Biophysical Profile; W/Non-Stress Testing (Pro Cah)Professional Component ,,76818,CPT,Professional,Both,,,26,286,243.1,32.3,286,"Health Partners, Inc.",Medicare Advantage,57.707,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Fetal Biophysical Profile; W/Non-Stress Testing (Pro Cah)Professional Component ,,76818,CPT,Professional,Both,,,26,286,243.1,32.3,286,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),32.3,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Fetal Biophysical Profile; W/Non-Stress Testing (Pro Cah)Professional Component ,,76818,CPT,Professional,Both,,,26,286,243.1,32.3,286,"Health Partners, Inc.",State of Minnesota Advantage Program,65.293085,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Fetal Biophysical Profile; W/Non-Stress Testing (Pro Cah)Professional Component ,,76818,CPT,Professional,Both,,,26,286,243.1,32.3,286,"Health Partners, Inc.",State Public Programs,32.3,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Fetal Biophysical Profile; W/Non-Stress Testing (Pro Cah)Professional Component ,,76818,CPT,Professional,Both,,,26,286,243.1,32.3,286,Humana Insurance Company,Commercial PPO,50.18,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Fetal Biophysical Profile; W/Non-Stress Testing (Pro Cah)Professional Component ,,76818,CPT,Professional,Both,,,26,286,243.1,32.3,286,Humana Insurance Company,Medicare PPO,286,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Fetal Biophysical Profile; W/Non-Stress Testing (Pro Cah)Professional Component ,,76818,CPT,Professional,Both,,,26,286,243.1,32.3,286,Medica,Individual & Family,242.528,84.8,,percent of total billed charges,,
Fetal Biophysical Profile; W/Non-Stress Testing (Pro Cah)Professional Component ,,76818,CPT,Professional,Both,,,26,286,243.1,32.3,286,Medica,Medica Advantage Solution,142.428,49.8,,percent of total billed charges,,
Fetal Biophysical Profile; W/Non-Stress Testing (Pro Cah)Professional Component ,,76818,CPT,Professional,Both,,,26,286,243.1,32.3,286,Medica,Medical Assistance,37.29,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Fetal Biophysical Profile; W/Non-Stress Testing (Pro Cah)Professional Component ,,76818,CPT,Professional,Both,,,26,286,243.1,32.3,286,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,50.18,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Fetal Biophysical Profile; W/Non-Stress Testing (Pro Cah)Professional Component ,,76818,CPT,Professional,Both,,,26,286,243.1,32.3,286,"Multiplan, Inc.","Multiplan, Inc.",268.84,94,,percent of total billed charges,,
Fetal Biophysical Profile; W/Non-Stress Testing (Pro Cah)Professional Component ,,76818,CPT,Professional,Both,,,26,286,243.1,32.3,286,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,257.686,90.1,,percent of total billed charges,,
Fetal Biophysical Profile; W/Non-Stress Testing (Pro Cah)Professional Component ,,76818,CPT,Professional,Both,,,26,286,243.1,32.3,286,"Preferred One Administrative Services, INC.",PPO,281.996,98.6,,percent of total billed charges,,
Fetal Biophysical Profile; W/Non-Stress Testing (Pro Cah)Professional Component ,,76818,CPT,Professional,Both,,,26,286,243.1,32.3,286,PrimeWest Health,Minnesota Senior Health Options (MSHO),57.707,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Fetal Biophysical Profile; W/Non-Stress Testing (Pro Cah)Professional Component ,,76818,CPT,Professional,Both,,,26,286,243.1,32.3,286,PrimeWest Health,MinnesotaCare,39.897304,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Fetal Biophysical Profile; W/Non-Stress Testing (Pro Cah)Professional Component ,,76818,CPT,Professional,Both,,,26,286,243.1,32.3,286,Sanford Health Plan,Sanford Health Plan,251.68,88,,percent of total billed charges,,
Fetal Biophysical Profile; W/Non-Stress Testing (Pro Cah)Professional Component ,,76818,CPT,Professional,Both,,,26,286,243.1,32.3,286,"UCare Health, Inc.",Individual & Family Plan,81.572608,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Fetal Biophysical Profile; W/Non-Stress Testing (Pro Cah)Professional Component ,,76818,CPT,Professional,Both,,,26,286,243.1,32.3,286,"UCare Health, Inc.",Medical Assistance,41.01592,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Fetal Biophysical Profile; W/Non-Stress Testing (Pro Cah)Professional Component ,,76818,CPT,Professional,Both,,,26,286,243.1,32.3,286,"UCare Health, Inc.",Medicare Advantage,57.707,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Fetal Biophysical Profile; W/Non-Stress Testing (Pro Cah)Professional Component ,,76818,CPT,Professional,Both,,,26,286,243.1,32.3,286,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),46.1656,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Fetal Biophysical Profile; W/Non-Stress Testing (Pro Cah)Professional Component ,,76818,CPT,Professional,Both,,,26,286,243.1,32.3,286,UnitedHealthcare,Individual & Family,286,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Fetal Biophysical Profile; W/Non-Stress Testing (Pro Cah)Professional Component ,,76818,CPT,Professional,Both,,,26,286,243.1,32.3,286,UnitedHealthcare,Medicare Advantage,57.707,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Fetal Biophysical Profile; W/Non-Stress Testing (Pro Cah)Professional Component ,,76818,CPT,Professional,Both,,,26,286,243.1,32.3,286,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,37.2872,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Us Fetal Biophysical Profile; Without Non-Stress Testing (Pro Cah)Professional Component ,,76819,CPT,Professional,Both,,,26,221,187.85,23.35,221,Aetna,Commercial,187.85,85,,percent of total billed charges,,
Us Fetal Biophysical Profile; Without Non-Stress Testing (Pro Cah)Professional Component ,,76819,CPT,Professional,Both,,,26,221,187.85,23.35,221,Aetna,Medicare Advantage,37.61,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Us Fetal Biophysical Profile; Without Non-Stress Testing (Pro Cah)Professional Component ,,76819,CPT,Professional,Both,,,26,221,187.85,23.35,221,Aetna,PPO,205.53,93,,percent of total billed charges,,
Us Fetal Biophysical Profile; Without Non-Stress Testing (Pro Cah)Professional Component ,,76819,CPT,Professional,Both,,,26,221,187.85,23.35,221,America's PPO,America's PPO,188.8224,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Us Fetal Biophysical Profile; Without Non-Stress Testing (Pro Cah)Professional Component ,,76819,CPT,Professional,Both,,,26,221,187.85,23.35,221,BlueCross BlueShield Minnesota, Federal Employee Program,69.03,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Us Fetal Biophysical Profile; Without Non-Stress Testing (Pro Cah)Professional Component ,,76819,CPT,Professional,Both,,,26,221,187.85,23.35,221,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,70.13448,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Us Fetal Biophysical Profile; Without Non-Stress Testing (Pro Cah)Professional Component ,,76819,CPT,Professional,Both,,,26,221,187.85,23.35,221,BlueCross BlueShield Minnesota,High Value Network Plan,70.13448,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Us Fetal Biophysical Profile; Without Non-Stress Testing (Pro Cah)Professional Component ,,76819,CPT,Professional,Both,,,26,221,187.85,23.35,221,BlueCross BlueShield Minnesota,Medicare Advantage,41.7795,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Us Fetal Biophysical Profile; Without Non-Stress Testing (Pro Cah)Professional Component ,,76819,CPT,Professional,Both,,,26,221,187.85,23.35,221,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,70.13448,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Us Fetal Biophysical Profile; Without Non-Stress Testing (Pro Cah)Professional Component ,,76819,CPT,Professional,Both,,,26,221,187.85,23.35,221,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,26.95448,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Us Fetal Biophysical Profile; Without Non-Stress Testing (Pro Cah)Professional Component ,,76819,CPT,Professional,Both,,,26,221,187.85,23.35,221,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),41.7795,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Us Fetal Biophysical Profile; Without Non-Stress Testing (Pro Cah)Professional Component ,,76819,CPT,Professional,Both,,,26,221,187.85,23.35,221,CorVel,Worker's Compensation,72.4018713,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Us Fetal Biophysical Profile; Without Non-Stress Testing (Pro Cah)Professional Component ,,76819,CPT,Professional,Both,,,26,221,187.85,23.35,221,First Health Group Corporation,First Health Network,214.37,97,,percent of total billed charges,,
Us Fetal Biophysical Profile; Without Non-Stress Testing (Pro Cah)Professional Component ,,76819,CPT,Professional,Both,,,26,221,187.85,23.35,221,"Health Partners, Inc.",Commercial,55.17,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Us Fetal Biophysical Profile; Without Non-Stress Testing (Pro Cah)Professional Component ,,76819,CPT,Professional,Both,,,26,221,187.85,23.35,221,"Health Partners, Inc.",Medicare Advantage,41.7795,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Us Fetal Biophysical Profile; Without Non-Stress Testing (Pro Cah)Professional Component ,,76819,CPT,Professional,Both,,,26,221,187.85,23.35,221,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),23.35,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Us Fetal Biophysical Profile; Without Non-Stress Testing (Pro Cah)Professional Component ,,76819,CPT,Professional,Both,,,26,221,187.85,23.35,221,"Health Partners, Inc.",State of Minnesota Advantage Program,47.528955,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Us Fetal Biophysical Profile; Without Non-Stress Testing (Pro Cah)Professional Component ,,76819,CPT,Professional,Both,,,26,221,187.85,23.35,221,"Health Partners, Inc.",State Public Programs,23.35,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Us Fetal Biophysical Profile; Without Non-Stress Testing (Pro Cah)Professional Component ,,76819,CPT,Professional,Both,,,26,221,187.85,23.35,221,Humana Insurance Company,Commercial PPO,36.33,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Us Fetal Biophysical Profile; Without Non-Stress Testing (Pro Cah)Professional Component ,,76819,CPT,Professional,Both,,,26,221,187.85,23.35,221,Humana Insurance Company,Medicare PPO,221,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Us Fetal Biophysical Profile; Without Non-Stress Testing (Pro Cah)Professional Component ,,76819,CPT,Professional,Both,,,26,221,187.85,23.35,221,Medica,Individual & Family,187.408,84.8,,percent of total billed charges,,
Us Fetal Biophysical Profile; Without Non-Stress Testing (Pro Cah)Professional Component ,,76819,CPT,Professional,Both,,,26,221,187.85,23.35,221,Medica,Medica Advantage Solution,110.058,49.8,,percent of total billed charges,,
Us Fetal Biophysical Profile; Without Non-Stress Testing (Pro Cah)Professional Component ,,76819,CPT,Professional,Both,,,26,221,187.85,23.35,221,Medica,Medical Assistance,26.95,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Us Fetal Biophysical Profile; Without Non-Stress Testing (Pro Cah)Professional Component ,,76819,CPT,Professional,Both,,,26,221,187.85,23.35,221,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,36.33,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Us Fetal Biophysical Profile; Without Non-Stress Testing (Pro Cah)Professional Component ,,76819,CPT,Professional,Both,,,26,221,187.85,23.35,221,"Multiplan, Inc.","Multiplan, Inc.",207.74,94,,percent of total billed charges,,
Us Fetal Biophysical Profile; Without Non-Stress Testing (Pro Cah)Professional Component ,,76819,CPT,Professional,Both,,,26,221,187.85,23.35,221,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,199.121,90.1,,percent of total billed charges,,
Us Fetal Biophysical Profile; Without Non-Stress Testing (Pro Cah)Professional Component ,,76819,CPT,Professional,Both,,,26,221,187.85,23.35,221,"Preferred One Administrative Services, INC.",PPO,217.906,98.6,,percent of total billed charges,,
Us Fetal Biophysical Profile; Without Non-Stress Testing (Pro Cah)Professional Component ,,76819,CPT,Professional,Both,,,26,221,187.85,23.35,221,PrimeWest Health,Minnesota Senior Health Options (MSHO),41.7795,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Us Fetal Biophysical Profile; Without Non-Stress Testing (Pro Cah)Professional Component ,,76819,CPT,Professional,Both,,,26,221,187.85,23.35,221,PrimeWest Health,MinnesotaCare,28.8412936,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Us Fetal Biophysical Profile; Without Non-Stress Testing (Pro Cah)Professional Component ,,76819,CPT,Professional,Both,,,26,221,187.85,23.35,221,Sanford Health Plan,Sanford Health Plan,194.48,88,,percent of total billed charges,,
Us Fetal Biophysical Profile; Without Non-Stress Testing (Pro Cah)Professional Component ,,76819,CPT,Professional,Both,,,26,221,187.85,23.35,221,"UCare Health, Inc.",Individual & Family Plan,59.058048,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Us Fetal Biophysical Profile; Without Non-Stress Testing (Pro Cah)Professional Component ,,76819,CPT,Professional,Both,,,26,221,187.85,23.35,221,"UCare Health, Inc.",Medical Assistance,29.649928,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Us Fetal Biophysical Profile; Without Non-Stress Testing (Pro Cah)Professional Component ,,76819,CPT,Professional,Both,,,26,221,187.85,23.35,221,"UCare Health, Inc.",Medicare Advantage,41.7795,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Us Fetal Biophysical Profile; Without Non-Stress Testing (Pro Cah)Professional Component ,,76819,CPT,Professional,Both,,,26,221,187.85,23.35,221,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),33.4236,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Us Fetal Biophysical Profile; Without Non-Stress Testing (Pro Cah)Professional Component ,,76819,CPT,Professional,Both,,,26,221,187.85,23.35,221,UnitedHealthcare,Individual & Family,221,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Us Fetal Biophysical Profile; Without Non-Stress Testing (Pro Cah)Professional Component ,,76819,CPT,Professional,Both,,,26,221,187.85,23.35,221,UnitedHealthcare,Medicare Advantage,41.7795,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Us Fetal Biophysical Profile; Without Non-Stress Testing (Pro Cah)Professional Component ,,76819,CPT,Professional,Both,,,26,221,187.85,23.35,221,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,26.95448,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Doppler Velocimetry, Fetal;Umbilical Artery (Pro Cah)Professional Component ",,76820,CPT,Professional,Both,,,26,109,92.65,15.06,109,Aetna,Commercial,92.65,85,,percent of total billed charges,,
"Doppler Velocimetry, Fetal;Umbilical Artery (Pro Cah)Professional Component ",,76820,CPT,Professional,Both,,,26,109,92.65,15.06,109,Aetna,Medicare Advantage,24.41,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Doppler Velocimetry, Fetal;Umbilical Artery (Pro Cah)Professional Component ",,76820,CPT,Professional,Both,,,26,109,92.65,15.06,109,Aetna,PPO,101.37,93,,percent of total billed charges,,
"Doppler Velocimetry, Fetal;Umbilical Artery (Pro Cah)Professional Component ",,76820,CPT,Professional,Both,,,26,109,92.65,15.06,109,America's PPO,America's PPO,93.1296,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Doppler Velocimetry, Fetal;Umbilical Artery (Pro Cah)Professional Component ",,76820,CPT,Professional,Both,,,26,109,92.65,15.06,109,BlueCross BlueShield Minnesota, Federal Employee Program,44.74,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Doppler Velocimetry, Fetal;Umbilical Artery (Pro Cah)Professional Component ",,76820,CPT,Professional,Both,,,26,109,92.65,15.06,109,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,45.45584,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Doppler Velocimetry, Fetal;Umbilical Artery (Pro Cah)Professional Component ",,76820,CPT,Professional,Both,,,26,109,92.65,15.06,109,BlueCross BlueShield Minnesota,High Value Network Plan,45.45584,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Doppler Velocimetry, Fetal;Umbilical Artery (Pro Cah)Professional Component ",,76820,CPT,Professional,Both,,,26,109,92.65,15.06,109,BlueCross BlueShield Minnesota,Medicare Advantage,27.1515,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Doppler Velocimetry, Fetal;Umbilical Artery (Pro Cah)Professional Component ",,76820,CPT,Professional,Both,,,26,109,92.65,15.06,109,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,45.45584,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Doppler Velocimetry, Fetal;Umbilical Artery (Pro Cah)Professional Component ",,76820,CPT,Professional,Both,,,26,109,92.65,15.06,109,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,17.38376,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Doppler Velocimetry, Fetal;Umbilical Artery (Pro Cah)Professional Component ",,76820,CPT,Professional,Both,,,26,109,92.65,15.06,109,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),27.1515,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Doppler Velocimetry, Fetal;Umbilical Artery (Pro Cah)Professional Component ",,76820,CPT,Professional,Both,,,26,109,92.65,15.06,109,CorVel,Worker's Compensation,46.9874301,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Doppler Velocimetry, Fetal;Umbilical Artery (Pro Cah)Professional Component ",,76820,CPT,Professional,Both,,,26,109,92.65,15.06,109,First Health Group Corporation,First Health Network,105.73,97,,percent of total billed charges,,
"Doppler Velocimetry, Fetal;Umbilical Artery (Pro Cah)Professional Component ",,76820,CPT,Professional,Both,,,26,109,92.65,15.06,109,"Health Partners, Inc.",Commercial,36.1,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Doppler Velocimetry, Fetal;Umbilical Artery (Pro Cah)Professional Component ",,76820,CPT,Professional,Both,,,26,109,92.65,15.06,109,"Health Partners, Inc.",Medicare Advantage,27.1515,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Doppler Velocimetry, Fetal;Umbilical Artery (Pro Cah)Professional Component ",,76820,CPT,Professional,Both,,,26,109,92.65,15.06,109,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),15.06,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Doppler Velocimetry, Fetal;Umbilical Artery (Pro Cah)Professional Component ",,76820,CPT,Professional,Both,,,26,109,92.65,15.06,109,"Health Partners, Inc.",State of Minnesota Advantage Program,31.10015,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Doppler Velocimetry, Fetal;Umbilical Artery (Pro Cah)Professional Component ",,76820,CPT,Professional,Both,,,26,109,92.65,15.06,109,"Health Partners, Inc.",State Public Programs,15.06,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Doppler Velocimetry, Fetal;Umbilical Artery (Pro Cah)Professional Component ",,76820,CPT,Professional,Both,,,26,109,92.65,15.06,109,Humana Insurance Company,Commercial PPO,23.61,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Doppler Velocimetry, Fetal;Umbilical Artery (Pro Cah)Professional Component ",,76820,CPT,Professional,Both,,,26,109,92.65,15.06,109,Humana Insurance Company,Medicare PPO,109,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Doppler Velocimetry, Fetal;Umbilical Artery (Pro Cah)Professional Component ",,76820,CPT,Professional,Both,,,26,109,92.65,15.06,109,Medica,Individual & Family,92.432,84.8,,percent of total billed charges,,
"Doppler Velocimetry, Fetal;Umbilical Artery (Pro Cah)Professional Component ",,76820,CPT,Professional,Both,,,26,109,92.65,15.06,109,Medica,Medica Advantage Solution,54.282,49.8,,percent of total billed charges,,
"Doppler Velocimetry, Fetal;Umbilical Artery (Pro Cah)Professional Component ",,76820,CPT,Professional,Both,,,26,109,92.65,15.06,109,Medica,Medical Assistance,17.38,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Doppler Velocimetry, Fetal;Umbilical Artery (Pro Cah)Professional Component ",,76820,CPT,Professional,Both,,,26,109,92.65,15.06,109,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,23.61,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Doppler Velocimetry, Fetal;Umbilical Artery (Pro Cah)Professional Component ",,76820,CPT,Professional,Both,,,26,109,92.65,15.06,109,"Multiplan, Inc.","Multiplan, Inc.",102.46,94,,percent of total billed charges,,
"Doppler Velocimetry, Fetal;Umbilical Artery (Pro Cah)Professional Component ",,76820,CPT,Professional,Both,,,26,109,92.65,15.06,109,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,98.209,90.1,,percent of total billed charges,,
"Doppler Velocimetry, Fetal;Umbilical Artery (Pro Cah)Professional Component ",,76820,CPT,Professional,Both,,,26,109,92.65,15.06,109,"Preferred One Administrative Services, INC.",PPO,107.474,98.6,,percent of total billed charges,,
"Doppler Velocimetry, Fetal;Umbilical Artery (Pro Cah)Professional Component ",,76820,CPT,Professional,Both,,,26,109,92.65,15.06,109,PrimeWest Health,Minnesota Senior Health Options (MSHO),27.1515,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Doppler Velocimetry, Fetal;Umbilical Artery (Pro Cah)Professional Component ",,76820,CPT,Professional,Both,,,26,109,92.65,15.06,109,PrimeWest Health,MinnesotaCare,18.6006232,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Doppler Velocimetry, Fetal;Umbilical Artery (Pro Cah)Professional Component ",,76820,CPT,Professional,Both,,,26,109,92.65,15.06,109,Sanford Health Plan,Sanford Health Plan,95.92,88,,percent of total billed charges,,
"Doppler Velocimetry, Fetal;Umbilical Artery (Pro Cah)Professional Component ",,76820,CPT,Professional,Both,,,26,109,92.65,15.06,109,"UCare Health, Inc.",Individual & Family Plan,38.380416,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Doppler Velocimetry, Fetal;Umbilical Artery (Pro Cah)Professional Component ",,76820,CPT,Professional,Both,,,26,109,92.65,15.06,109,"UCare Health, Inc.",Medical Assistance,19.122136,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Doppler Velocimetry, Fetal;Umbilical Artery (Pro Cah)Professional Component ",,76820,CPT,Professional,Both,,,26,109,92.65,15.06,109,"UCare Health, Inc.",Medicare Advantage,27.1515,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Doppler Velocimetry, Fetal;Umbilical Artery (Pro Cah)Professional Component ",,76820,CPT,Professional,Both,,,26,109,92.65,15.06,109,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),21.7212,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Doppler Velocimetry, Fetal;Umbilical Artery (Pro Cah)Professional Component ",,76820,CPT,Professional,Both,,,26,109,92.65,15.06,109,UnitedHealthcare,Individual & Family,109,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Doppler Velocimetry, Fetal;Umbilical Artery (Pro Cah)Professional Component ",,76820,CPT,Professional,Both,,,26,109,92.65,15.06,109,UnitedHealthcare,Medicare Advantage,27.1515,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Doppler Velocimetry, Fetal;Umbilical Artery (Pro Cah)Professional Component ",,76820,CPT,Professional,Both,,,26,109,92.65,15.06,109,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,17.38376,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Us Transvaginal Non Ob (Pro Cah)Professional Component ,,76830,CPT,Professional,Both,,,26,205,174.25,20.94,205,Aetna,Commercial,174.25,85,,percent of total billed charges,,
Us Transvaginal Non Ob (Pro Cah)Professional Component ,,76830,CPT,Professional,Both,,,26,205,174.25,20.94,205,Aetna,Medicare Advantage,33.41,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Us Transvaginal Non Ob (Pro Cah)Professional Component ,,76830,CPT,Professional,Both,,,26,205,174.25,20.94,205,Aetna,PPO,190.65,93,,percent of total billed charges,,
Us Transvaginal Non Ob (Pro Cah)Professional Component ,,76830,CPT,Professional,Both,,,26,205,174.25,20.94,205,America's PPO,America's PPO,175.152,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Us Transvaginal Non Ob (Pro Cah)Professional Component ,,76830,CPT,Professional,Both,,,26,205,174.25,20.94,205,BlueCross BlueShield Minnesota, Federal Employee Program,63.28,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Us Transvaginal Non Ob (Pro Cah)Professional Component ,,76830,CPT,Professional,Both,,,26,205,174.25,20.94,205,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,64.29248,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Us Transvaginal Non Ob (Pro Cah)Professional Component ,,76830,CPT,Professional,Both,,,26,205,174.25,20.94,205,BlueCross BlueShield Minnesota,High Value Network Plan,64.29248,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Us Transvaginal Non Ob (Pro Cah)Professional Component ,,76830,CPT,Professional,Both,,,26,205,174.25,20.94,205,BlueCross BlueShield Minnesota,Medicare Advantage,37.72,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Us Transvaginal Non Ob (Pro Cah)Professional Component ,,76830,CPT,Professional,Both,,,26,205,174.25,20.94,205,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,64.29248,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Us Transvaginal Non Ob (Pro Cah)Professional Component ,,76830,CPT,Professional,Both,,,26,205,174.25,20.94,205,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,24.17064,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Us Transvaginal Non Ob (Pro Cah)Professional Component ,,76830,CPT,Professional,Both,,,26,205,174.25,20.94,205,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),37.72,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Us Transvaginal Non Ob (Pro Cah)Professional Component ,,76830,CPT,Professional,Both,,,26,205,174.25,20.94,205,CorVel,Worker's Compensation,64.3065429,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Us Transvaginal Non Ob (Pro Cah)Professional Component ,,76830,CPT,Professional,Both,,,26,205,174.25,20.94,205,First Health Group Corporation,First Health Network,198.85,97,,percent of total billed charges,,
Us Transvaginal Non Ob (Pro Cah)Professional Component ,,76830,CPT,Professional,Both,,,26,205,174.25,20.94,205,"Health Partners, Inc.",Commercial,48.98,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Us Transvaginal Non Ob (Pro Cah)Professional Component ,,76830,CPT,Professional,Both,,,26,205,174.25,20.94,205,"Health Partners, Inc.",Medicare Advantage,37.72,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Us Transvaginal Non Ob (Pro Cah)Professional Component ,,76830,CPT,Professional,Both,,,26,205,174.25,20.94,205,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),20.94,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Us Transvaginal Non Ob (Pro Cah)Professional Component ,,76830,CPT,Professional,Both,,,26,205,174.25,20.94,205,"Health Partners, Inc.",State of Minnesota Advantage Program,42.19627,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Us Transvaginal Non Ob (Pro Cah)Professional Component ,,76830,CPT,Professional,Both,,,26,205,174.25,20.94,205,"Health Partners, Inc.",State Public Programs,20.94,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Us Transvaginal Non Ob (Pro Cah)Professional Component ,,76830,CPT,Professional,Both,,,26,205,174.25,20.94,205,Humana Insurance Company,Commercial PPO,32.8,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Us Transvaginal Non Ob (Pro Cah)Professional Component ,,76830,CPT,Professional,Both,,,26,205,174.25,20.94,205,Humana Insurance Company,Medicare PPO,205,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Us Transvaginal Non Ob (Pro Cah)Professional Component ,,76830,CPT,Professional,Both,,,26,205,174.25,20.94,205,Medica,Individual & Family,173.84,84.8,,percent of total billed charges,,
Us Transvaginal Non Ob (Pro Cah)Professional Component ,,76830,CPT,Professional,Both,,,26,205,174.25,20.94,205,Medica,Medica Advantage Solution,102.09,49.8,,percent of total billed charges,,
Us Transvaginal Non Ob (Pro Cah)Professional Component ,,76830,CPT,Professional,Both,,,26,205,174.25,20.94,205,Medica,Medical Assistance,24.17,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Us Transvaginal Non Ob (Pro Cah)Professional Component ,,76830,CPT,Professional,Both,,,26,205,174.25,20.94,205,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,32.8,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Us Transvaginal Non Ob (Pro Cah)Professional Component ,,76830,CPT,Professional,Both,,,26,205,174.25,20.94,205,"Multiplan, Inc.","Multiplan, Inc.",192.7,94,,percent of total billed charges,,
Us Transvaginal Non Ob (Pro Cah)Professional Component ,,76830,CPT,Professional,Both,,,26,205,174.25,20.94,205,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,184.705,90.1,,percent of total billed charges,,
Us Transvaginal Non Ob (Pro Cah)Professional Component ,,76830,CPT,Professional,Both,,,26,205,174.25,20.94,205,"Preferred One Administrative Services, INC.",PPO,202.13,98.6,,percent of total billed charges,,
Us Transvaginal Non Ob (Pro Cah)Professional Component ,,76830,CPT,Professional,Both,,,26,205,174.25,20.94,205,PrimeWest Health,Minnesota Senior Health Options (MSHO),37.72,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Us Transvaginal Non Ob (Pro Cah)Professional Component ,,76830,CPT,Professional,Both,,,26,205,174.25,20.94,205,PrimeWest Health,MinnesotaCare,25.8625848,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Us Transvaginal Non Ob (Pro Cah)Professional Component ,,76830,CPT,Professional,Both,,,26,205,174.25,20.94,205,Sanford Health Plan,Sanford Health Plan,180.4,88,,percent of total billed charges,,
Us Transvaginal Non Ob (Pro Cah)Professional Component ,,76830,CPT,Professional,Both,,,26,205,174.25,20.94,205,"UCare Health, Inc.",Individual & Family Plan,53.31968,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Us Transvaginal Non Ob (Pro Cah)Professional Component ,,76830,CPT,Professional,Both,,,26,205,174.25,20.94,205,"UCare Health, Inc.",Medical Assistance,26.587704,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Us Transvaginal Non Ob (Pro Cah)Professional Component ,,76830,CPT,Professional,Both,,,26,205,174.25,20.94,205,"UCare Health, Inc.",Medicare Advantage,37.72,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Us Transvaginal Non Ob (Pro Cah)Professional Component ,,76830,CPT,Professional,Both,,,26,205,174.25,20.94,205,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),30.176,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Us Transvaginal Non Ob (Pro Cah)Professional Component ,,76830,CPT,Professional,Both,,,26,205,174.25,20.94,205,UnitedHealthcare,Individual & Family,205,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Us Transvaginal Non Ob (Pro Cah)Professional Component ,,76830,CPT,Professional,Both,,,26,205,174.25,20.94,205,UnitedHealthcare,Medicare Advantage,37.72,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Us Transvaginal Non Ob (Pro Cah)Professional Component ,,76830,CPT,Professional,Both,,,26,205,174.25,20.94,205,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,24.17064,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Us Pelvic Non Ob (Pro Cah)Professional Component ,,76856,CPT,Professional,Both,,,26,164,139.4,22.49,164,Aetna,Commercial,139.4,85,,percent of total billed charges,,
Us Pelvic Non Ob (Pro Cah)Professional Component ,,76856,CPT,Professional,Both,,,26,164,139.4,22.49,164,Aetna,Medicare Advantage,33.41,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Us Pelvic Non Ob (Pro Cah)Professional Component ,,76856,CPT,Professional,Both,,,26,164,139.4,22.49,164,Aetna,PPO,152.52,93,,percent of total billed charges,,
Us Pelvic Non Ob (Pro Cah)Professional Component ,,76856,CPT,Professional,Both,,,26,164,139.4,22.49,164,America's PPO,America's PPO,140.1216,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Us Pelvic Non Ob (Pro Cah)Professional Component ,,76856,CPT,Professional,Both,,,26,164,139.4,22.49,164,BlueCross BlueShield Minnesota, Federal Employee Program,62.64,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Us Pelvic Non Ob (Pro Cah)Professional Component ,,76856,CPT,Professional,Both,,,26,164,139.4,22.49,164,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,63.64224,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Us Pelvic Non Ob (Pro Cah)Professional Component ,,76856,CPT,Professional,Both,,,26,164,139.4,22.49,164,BlueCross BlueShield Minnesota,High Value Network Plan,63.64224,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Us Pelvic Non Ob (Pro Cah)Professional Component ,,76856,CPT,Professional,Both,,,26,164,139.4,22.49,164,BlueCross BlueShield Minnesota,Medicare Advantage,37.329,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Us Pelvic Non Ob (Pro Cah)Professional Component ,,76856,CPT,Professional,Both,,,26,164,139.4,22.49,164,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,63.64224,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Us Pelvic Non Ob (Pro Cah)Professional Component ,,76856,CPT,Professional,Both,,,26,164,139.4,22.49,164,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,23.9268,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Us Pelvic Non Ob (Pro Cah)Professional Component ,,76856,CPT,Professional,Both,,,26,164,139.4,22.49,164,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),37.329,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Us Pelvic Non Ob (Pro Cah)Professional Component ,,76856,CPT,Professional,Both,,,26,164,139.4,22.49,164,CorVel,Worker's Compensation,64.3065429,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Us Pelvic Non Ob (Pro Cah)Professional Component ,,76856,CPT,Professional,Both,,,26,164,139.4,22.49,164,First Health Group Corporation,First Health Network,159.08,97,,percent of total billed charges,,
Us Pelvic Non Ob (Pro Cah)Professional Component ,,76856,CPT,Professional,Both,,,26,164,139.4,22.49,164,"Health Partners, Inc.",Commercial,48.98,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Us Pelvic Non Ob (Pro Cah)Professional Component ,,76856,CPT,Professional,Both,,,26,164,139.4,22.49,164,"Health Partners, Inc.",Medicare Advantage,37.329,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Us Pelvic Non Ob (Pro Cah)Professional Component ,,76856,CPT,Professional,Both,,,26,164,139.4,22.49,164,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),22.49,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Us Pelvic Non Ob (Pro Cah)Professional Component ,,76856,CPT,Professional,Both,,,26,164,139.4,22.49,164,"Health Partners, Inc.",State of Minnesota Advantage Program,42.19627,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Us Pelvic Non Ob (Pro Cah)Professional Component ,,76856,CPT,Professional,Both,,,26,164,139.4,22.49,164,"Health Partners, Inc.",State Public Programs,22.49,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Us Pelvic Non Ob (Pro Cah)Professional Component ,,76856,CPT,Professional,Both,,,26,164,139.4,22.49,164,Humana Insurance Company,Commercial PPO,32.46,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Us Pelvic Non Ob (Pro Cah)Professional Component ,,76856,CPT,Professional,Both,,,26,164,139.4,22.49,164,Humana Insurance Company,Medicare PPO,164,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Us Pelvic Non Ob (Pro Cah)Professional Component ,,76856,CPT,Professional,Both,,,26,164,139.4,22.49,164,Medica,Individual & Family,139.072,84.8,,percent of total billed charges,,
Us Pelvic Non Ob (Pro Cah)Professional Component ,,76856,CPT,Professional,Both,,,26,164,139.4,22.49,164,Medica,Medica Advantage Solution,81.672,49.8,,percent of total billed charges,,
Us Pelvic Non Ob (Pro Cah)Professional Component ,,76856,CPT,Professional,Both,,,26,164,139.4,22.49,164,Medica,Medical Assistance,23.93,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Us Pelvic Non Ob (Pro Cah)Professional Component ,,76856,CPT,Professional,Both,,,26,164,139.4,22.49,164,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,32.46,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Us Pelvic Non Ob (Pro Cah)Professional Component ,,76856,CPT,Professional,Both,,,26,164,139.4,22.49,164,"Multiplan, Inc.","Multiplan, Inc.",154.16,94,,percent of total billed charges,,
Us Pelvic Non Ob (Pro Cah)Professional Component ,,76856,CPT,Professional,Both,,,26,164,139.4,22.49,164,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,147.764,90.1,,percent of total billed charges,,
Us Pelvic Non Ob (Pro Cah)Professional Component ,,76856,CPT,Professional,Both,,,26,164,139.4,22.49,164,"Preferred One Administrative Services, INC.",PPO,161.704,98.6,,percent of total billed charges,,
Us Pelvic Non Ob (Pro Cah)Professional Component ,,76856,CPT,Professional,Both,,,26,164,139.4,22.49,164,PrimeWest Health,Minnesota Senior Health Options (MSHO),37.329,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Us Pelvic Non Ob (Pro Cah)Professional Component ,,76856,CPT,Professional,Both,,,26,164,139.4,22.49,164,PrimeWest Health,MinnesotaCare,25.601676,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Us Pelvic Non Ob (Pro Cah)Professional Component ,,76856,CPT,Professional,Both,,,26,164,139.4,22.49,164,Sanford Health Plan,Sanford Health Plan,144.32,88,,percent of total billed charges,,
Us Pelvic Non Ob (Pro Cah)Professional Component ,,76856,CPT,Professional,Both,,,26,164,139.4,22.49,164,"UCare Health, Inc.",Individual & Family Plan,52.766976,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Us Pelvic Non Ob (Pro Cah)Professional Component ,,76856,CPT,Professional,Both,,,26,164,139.4,22.49,164,"UCare Health, Inc.",Medical Assistance,26.31948,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Us Pelvic Non Ob (Pro Cah)Professional Component ,,76856,CPT,Professional,Both,,,26,164,139.4,22.49,164,"UCare Health, Inc.",Medicare Advantage,37.329,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Us Pelvic Non Ob (Pro Cah)Professional Component ,,76856,CPT,Professional,Both,,,26,164,139.4,22.49,164,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),29.8632,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Us Pelvic Non Ob (Pro Cah)Professional Component ,,76856,CPT,Professional,Both,,,26,164,139.4,22.49,164,UnitedHealthcare,Individual & Family,164,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Us Pelvic Non Ob (Pro Cah)Professional Component ,,76856,CPT,Professional,Both,,,26,164,139.4,22.49,164,UnitedHealthcare,Medicare Advantage,37.329,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Us Pelvic Non Ob (Pro Cah)Professional Component ,,76856,CPT,Professional,Both,,,26,164,139.4,22.49,164,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,23.9268,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Us Pelvic Ltd Non Ob (Pro Cah)Professional Component ,,76857,CPT,Professional,Both,,,26,222,188.7,16.09,222,Aetna,Commercial,188.7,85,,percent of total billed charges,,
Us Pelvic Ltd Non Ob (Pro Cah)Professional Component ,,76857,CPT,Professional,Both,,,26,222,188.7,16.09,222,Aetna,Medicare Advantage,23.7,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Us Pelvic Ltd Non Ob (Pro Cah)Professional Component ,,76857,CPT,Professional,Both,,,26,222,188.7,16.09,222,Aetna,PPO,206.46,93,,percent of total billed charges,,
Us Pelvic Ltd Non Ob (Pro Cah)Professional Component ,,76857,CPT,Professional,Both,,,26,222,188.7,16.09,222,America's PPO,America's PPO,189.6768,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Us Pelvic Ltd Non Ob (Pro Cah)Professional Component ,,76857,CPT,Professional,Both,,,26,222,188.7,16.09,222,BlueCross BlueShield Minnesota, Federal Employee Program,44.74,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Us Pelvic Ltd Non Ob (Pro Cah)Professional Component ,,76857,CPT,Professional,Both,,,26,222,188.7,16.09,222,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,45.45584,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Us Pelvic Ltd Non Ob (Pro Cah)Professional Component ,,76857,CPT,Professional,Both,,,26,222,188.7,16.09,222,BlueCross BlueShield Minnesota,High Value Network Plan,45.45584,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Us Pelvic Ltd Non Ob (Pro Cah)Professional Component ,,76857,CPT,Professional,Both,,,26,222,188.7,16.09,222,BlueCross BlueShield Minnesota,Medicare Advantage,26.887,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Us Pelvic Ltd Non Ob (Pro Cah)Professional Component ,,76857,CPT,Professional,Both,,,26,222,188.7,16.09,222,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,45.45584,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Us Pelvic Ltd Non Ob (Pro Cah)Professional Component ,,76857,CPT,Professional,Both,,,26,222,188.7,16.09,222,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,17.1196,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Us Pelvic Ltd Non Ob (Pro Cah)Professional Component ,,76857,CPT,Professional,Both,,,26,222,188.7,16.09,222,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),26.887,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Us Pelvic Ltd Non Ob (Pro Cah)Professional Component ,,76857,CPT,Professional,Both,,,26,222,188.7,16.09,222,CorVel,Worker's Compensation,45.6265659,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Us Pelvic Ltd Non Ob (Pro Cah)Professional Component ,,76857,CPT,Professional,Both,,,26,222,188.7,16.09,222,First Health Group Corporation,First Health Network,215.34,97,,percent of total billed charges,,
Us Pelvic Ltd Non Ob (Pro Cah)Professional Component ,,76857,CPT,Professional,Both,,,26,222,188.7,16.09,222,"Health Partners, Inc.",Commercial,35.06,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Us Pelvic Ltd Non Ob (Pro Cah)Professional Component ,,76857,CPT,Professional,Both,,,26,222,188.7,16.09,222,"Health Partners, Inc.",Medicare Advantage,26.887,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Us Pelvic Ltd Non Ob (Pro Cah)Professional Component ,,76857,CPT,Professional,Both,,,26,222,188.7,16.09,222,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),16.09,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Us Pelvic Ltd Non Ob (Pro Cah)Professional Component ,,76857,CPT,Professional,Both,,,26,222,188.7,16.09,222,"Health Partners, Inc.",State of Minnesota Advantage Program,30.20419,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Us Pelvic Ltd Non Ob (Pro Cah)Professional Component ,,76857,CPT,Professional,Both,,,26,222,188.7,16.09,222,"Health Partners, Inc.",State Public Programs,16.09,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Us Pelvic Ltd Non Ob (Pro Cah)Professional Component ,,76857,CPT,Professional,Both,,,26,222,188.7,16.09,222,Humana Insurance Company,Commercial PPO,23.38,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Us Pelvic Ltd Non Ob (Pro Cah)Professional Component ,,76857,CPT,Professional,Both,,,26,222,188.7,16.09,222,Humana Insurance Company,Medicare PPO,222,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Us Pelvic Ltd Non Ob (Pro Cah)Professional Component ,,76857,CPT,Professional,Both,,,26,222,188.7,16.09,222,Medica,Individual & Family,188.256,84.8,,percent of total billed charges,,
Us Pelvic Ltd Non Ob (Pro Cah)Professional Component ,,76857,CPT,Professional,Both,,,26,222,188.7,16.09,222,Medica,Medica Advantage Solution,110.556,49.8,,percent of total billed charges,,
Us Pelvic Ltd Non Ob (Pro Cah)Professional Component ,,76857,CPT,Professional,Both,,,26,222,188.7,16.09,222,Medica,Medical Assistance,17.12,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Us Pelvic Ltd Non Ob (Pro Cah)Professional Component ,,76857,CPT,Professional,Both,,,26,222,188.7,16.09,222,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,23.38,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Us Pelvic Ltd Non Ob (Pro Cah)Professional Component ,,76857,CPT,Professional,Both,,,26,222,188.7,16.09,222,"Multiplan, Inc.","Multiplan, Inc.",208.68,94,,percent of total billed charges,,
Us Pelvic Ltd Non Ob (Pro Cah)Professional Component ,,76857,CPT,Professional,Both,,,26,222,188.7,16.09,222,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,200.022,90.1,,percent of total billed charges,,
Us Pelvic Ltd Non Ob (Pro Cah)Professional Component ,,76857,CPT,Professional,Both,,,26,222,188.7,16.09,222,"Preferred One Administrative Services, INC.",PPO,218.892,98.6,,percent of total billed charges,,
Us Pelvic Ltd Non Ob (Pro Cah)Professional Component ,,76857,CPT,Professional,Both,,,26,222,188.7,16.09,222,PrimeWest Health,Minnesota Senior Health Options (MSHO),26.887,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Us Pelvic Ltd Non Ob (Pro Cah)Professional Component ,,76857,CPT,Professional,Both,,,26,222,188.7,16.09,222,PrimeWest Health,MinnesotaCare,18.317972,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Us Pelvic Ltd Non Ob (Pro Cah)Professional Component ,,76857,CPT,Professional,Both,,,26,222,188.7,16.09,222,Sanford Health Plan,Sanford Health Plan,195.36,88,,percent of total billed charges,,
Us Pelvic Ltd Non Ob (Pro Cah)Professional Component ,,76857,CPT,Professional,Both,,,26,222,188.7,16.09,222,"UCare Health, Inc.",Individual & Family Plan,38.006528,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Us Pelvic Ltd Non Ob (Pro Cah)Professional Component ,,76857,CPT,Professional,Both,,,26,222,188.7,16.09,222,"UCare Health, Inc.",Medical Assistance,18.83156,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Us Pelvic Ltd Non Ob (Pro Cah)Professional Component ,,76857,CPT,Professional,Both,,,26,222,188.7,16.09,222,"UCare Health, Inc.",Medicare Advantage,26.887,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Us Pelvic Ltd Non Ob (Pro Cah)Professional Component ,,76857,CPT,Professional,Both,,,26,222,188.7,16.09,222,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),21.5096,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Us Pelvic Ltd Non Ob (Pro Cah)Professional Component ,,76857,CPT,Professional,Both,,,26,222,188.7,16.09,222,UnitedHealthcare,Individual & Family,222,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Us Pelvic Ltd Non Ob (Pro Cah)Professional Component ,,76857,CPT,Professional,Both,,,26,222,188.7,16.09,222,UnitedHealthcare,Medicare Advantage,26.887,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Us Pelvic Ltd Non Ob (Pro Cah)Professional Component ,,76857,CPT,Professional,Both,,,26,222,188.7,16.09,222,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,17.1196,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Us Scrotum (Pro Cah)Professional Component ,,76870,CPT,Professional,Both,,,26,163,138.55,20.83,163,Aetna,Commercial,138.55,85,,percent of total billed charges,,
Us Scrotum (Pro Cah)Professional Component ,,76870,CPT,Professional,Both,,,26,163,138.55,20.83,163,Aetna,Medicare Advantage,30.95,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Us Scrotum (Pro Cah)Professional Component ,,76870,CPT,Professional,Both,,,26,163,138.55,20.83,163,Aetna,PPO,151.59,93,,percent of total billed charges,,
Us Scrotum (Pro Cah)Professional Component ,,76870,CPT,Professional,Both,,,26,163,138.55,20.83,163,America's PPO,America's PPO,139.2672,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Us Scrotum (Pro Cah)Professional Component ,,76870,CPT,Professional,Both,,,26,163,138.55,20.83,163,BlueCross BlueShield Minnesota, Federal Employee Program,58.17,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Us Scrotum (Pro Cah)Professional Component ,,76870,CPT,Professional,Both,,,26,163,138.55,20.83,163,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,59.10072,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Us Scrotum (Pro Cah)Professional Component ,,76870,CPT,Professional,Both,,,26,163,138.55,20.83,163,BlueCross BlueShield Minnesota,High Value Network Plan,59.10072,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Us Scrotum (Pro Cah)Professional Component ,,76870,CPT,Professional,Both,,,26,163,138.55,20.83,163,BlueCross BlueShield Minnesota,Medicare Advantage,34.5805,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Us Scrotum (Pro Cah)Professional Component ,,76870,CPT,Professional,Both,,,26,163,138.55,20.83,163,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,59.10072,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Us Scrotum (Pro Cah)Professional Component ,,76870,CPT,Professional,Both,,,26,163,138.55,20.83,163,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,22.15896,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Us Scrotum (Pro Cah)Professional Component ,,76870,CPT,Professional,Both,,,26,163,138.55,20.83,163,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),34.5805,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Us Scrotum (Pro Cah)Professional Component ,,76870,CPT,Professional,Both,,,26,163,138.55,20.83,163,CorVel,Worker's Compensation,59.5871787,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Us Scrotum (Pro Cah)Professional Component ,,76870,CPT,Professional,Both,,,26,163,138.55,20.83,163,First Health Group Corporation,First Health Network,158.11,97,,percent of total billed charges,,
Us Scrotum (Pro Cah)Professional Component ,,76870,CPT,Professional,Both,,,26,163,138.55,20.83,163,"Health Partners, Inc.",Commercial,45.37,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Us Scrotum (Pro Cah)Professional Component ,,76870,CPT,Professional,Both,,,26,163,138.55,20.83,163,"Health Partners, Inc.",Medicare Advantage,34.5805,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Us Scrotum (Pro Cah)Professional Component ,,76870,CPT,Professional,Both,,,26,163,138.55,20.83,163,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),20.83,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Us Scrotum (Pro Cah)Professional Component ,,76870,CPT,Professional,Both,,,26,163,138.55,20.83,163,"Health Partners, Inc.",State of Minnesota Advantage Program,39.086255,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Us Scrotum (Pro Cah)Professional Component ,,76870,CPT,Professional,Both,,,26,163,138.55,20.83,163,"Health Partners, Inc.",State Public Programs,20.83,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Us Scrotum (Pro Cah)Professional Component ,,76870,CPT,Professional,Both,,,26,163,138.55,20.83,163,Humana Insurance Company,Commercial PPO,30.07,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Us Scrotum (Pro Cah)Professional Component ,,76870,CPT,Professional,Both,,,26,163,138.55,20.83,163,Humana Insurance Company,Medicare PPO,163,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Us Scrotum (Pro Cah)Professional Component ,,76870,CPT,Professional,Both,,,26,163,138.55,20.83,163,Medica,Individual & Family,138.224,84.8,,percent of total billed charges,,
Us Scrotum (Pro Cah)Professional Component ,,76870,CPT,Professional,Both,,,26,163,138.55,20.83,163,Medica,Medica Advantage Solution,81.174,49.8,,percent of total billed charges,,
Us Scrotum (Pro Cah)Professional Component ,,76870,CPT,Professional,Both,,,26,163,138.55,20.83,163,Medica,Medical Assistance,22.16,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Us Scrotum (Pro Cah)Professional Component ,,76870,CPT,Professional,Both,,,26,163,138.55,20.83,163,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,30.07,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Us Scrotum (Pro Cah)Professional Component ,,76870,CPT,Professional,Both,,,26,163,138.55,20.83,163,"Multiplan, Inc.","Multiplan, Inc.",153.22,94,,percent of total billed charges,,
Us Scrotum (Pro Cah)Professional Component ,,76870,CPT,Professional,Both,,,26,163,138.55,20.83,163,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,146.863,90.1,,percent of total billed charges,,
Us Scrotum (Pro Cah)Professional Component ,,76870,CPT,Professional,Both,,,26,163,138.55,20.83,163,"Preferred One Administrative Services, INC.",PPO,160.718,98.6,,percent of total billed charges,,
Us Scrotum (Pro Cah)Professional Component ,,76870,CPT,Professional,Both,,,26,163,138.55,20.83,163,PrimeWest Health,Minnesota Senior Health Options (MSHO),34.5805,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Us Scrotum (Pro Cah)Professional Component ,,76870,CPT,Professional,Both,,,26,163,138.55,20.83,163,PrimeWest Health,MinnesotaCare,23.7100872,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Us Scrotum (Pro Cah)Professional Component ,,76870,CPT,Professional,Both,,,26,163,138.55,20.83,163,Sanford Health Plan,Sanford Health Plan,143.44,88,,percent of total billed charges,,
Us Scrotum (Pro Cah)Professional Component ,,76870,CPT,Professional,Both,,,26,163,138.55,20.83,163,"UCare Health, Inc.",Individual & Family Plan,48.881792,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Us Scrotum (Pro Cah)Professional Component ,,76870,CPT,Professional,Both,,,26,163,138.55,20.83,163,"UCare Health, Inc.",Medical Assistance,24.374856,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Us Scrotum (Pro Cah)Professional Component ,,76870,CPT,Professional,Both,,,26,163,138.55,20.83,163,"UCare Health, Inc.",Medicare Advantage,34.5805,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Us Scrotum (Pro Cah)Professional Component ,,76870,CPT,Professional,Both,,,26,163,138.55,20.83,163,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),27.6644,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Us Scrotum (Pro Cah)Professional Component ,,76870,CPT,Professional,Both,,,26,163,138.55,20.83,163,UnitedHealthcare,Individual & Family,163,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Us Scrotum (Pro Cah)Professional Component ,,76870,CPT,Professional,Both,,,26,163,138.55,20.83,163,UnitedHealthcare,Medicare Advantage,34.5805,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Us Scrotum (Pro Cah)Professional Component ,,76870,CPT,Professional,Both,,,26,163,138.55,20.83,163,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,22.15896,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Ultrasound, Limited, Joint Or Focal Evaluation Of Other Nonvascular Extremity Structure(S), Real-Time With Image Documentation (Pro Cah)Professional Component ",,76882,CPT,Professional,Both,,,26,93,79.05,14.69,93,Aetna,Commercial,79.05,85,,percent of total billed charges,,
"Ultrasound, Limited, Joint Or Focal Evaluation Of Other Nonvascular Extremity Structure(S), Real-Time With Image Documentation (Pro Cah)Professional Component ",,76882,CPT,Professional,Both,,,26,93,79.05,14.69,93,Aetna,Medicare Advantage,23.35,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Ultrasound, Limited, Joint Or Focal Evaluation Of Other Nonvascular Extremity Structure(S), Real-Time With Image Documentation (Pro Cah)Professional Component ",,76882,CPT,Professional,Both,,,26,93,79.05,14.69,93,Aetna,PPO,86.49,93,,percent of total billed charges,,
"Ultrasound, Limited, Joint Or Focal Evaluation Of Other Nonvascular Extremity Structure(S), Real-Time With Image Documentation (Pro Cah)Professional Component ",,76882,CPT,Professional,Both,,,26,93,79.05,14.69,93,America's PPO,America's PPO,79.4592,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Ultrasound, Limited, Joint Or Focal Evaluation Of Other Nonvascular Extremity Structure(S), Real-Time With Image Documentation (Pro Cah)Professional Component ",,76882,CPT,Professional,Both,,,26,93,79.05,14.69,93,BlueCross BlueShield Minnesota, Federal Employee Program,,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Ultrasound, Limited, Joint Or Focal Evaluation Of Other Nonvascular Extremity Structure(S), Real-Time With Image Documentation (Pro Cah)Professional Component ",,76882,CPT,Professional,Both,,,26,93,79.05,14.69,93,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Ultrasound, Limited, Joint Or Focal Evaluation Of Other Nonvascular Extremity Structure(S), Real-Time With Image Documentation (Pro Cah)Professional Component ",,76882,CPT,Professional,Both,,,26,93,79.05,14.69,93,BlueCross BlueShield Minnesota,High Value Network Plan,,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Ultrasound, Limited, Joint Or Focal Evaluation Of Other Nonvascular Extremity Structure(S), Real-Time With Image Documentation (Pro Cah)Professional Component ",,76882,CPT,Professional,Both,,,26,93,79.05,14.69,93,BlueCross BlueShield Minnesota,Medicare Advantage,37.329,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Ultrasound, Limited, Joint Or Focal Evaluation Of Other Nonvascular Extremity Structure(S), Real-Time With Image Documentation (Pro Cah)Professional Component ",,76882,CPT,Professional,Both,,,26,93,79.05,14.69,93,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Ultrasound, Limited, Joint Or Focal Evaluation Of Other Nonvascular Extremity Structure(S), Real-Time With Image Documentation (Pro Cah)Professional Component ",,76882,CPT,Professional,Both,,,26,93,79.05,14.69,93,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,16.95704,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Ultrasound, Limited, Joint Or Focal Evaluation Of Other Nonvascular Extremity Structure(S), Real-Time With Image Documentation (Pro Cah)Professional Component ",,76882,CPT,Professional,Both,,,26,93,79.05,14.69,93,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),37.329,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Ultrasound, Limited, Joint Or Focal Evaluation Of Other Nonvascular Extremity Structure(S), Real-Time With Image Documentation (Pro Cah)Professional Component ",,76882,CPT,Professional,Both,,,26,93,79.05,14.69,93,CorVel,Worker's Compensation,44.9548659,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Ultrasound, Limited, Joint Or Focal Evaluation Of Other Nonvascular Extremity Structure(S), Real-Time With Image Documentation (Pro Cah)Professional Component ",,76882,CPT,Professional,Both,,,26,93,79.05,14.69,93,First Health Group Corporation,First Health Network,90.21,97,,percent of total billed charges,,
"Ultrasound, Limited, Joint Or Focal Evaluation Of Other Nonvascular Extremity Structure(S), Real-Time With Image Documentation (Pro Cah)Professional Component ",,76882,CPT,Professional,Both,,,26,93,79.05,14.69,93,"Health Partners, Inc.",Commercial,34.54,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Ultrasound, Limited, Joint Or Focal Evaluation Of Other Nonvascular Extremity Structure(S), Real-Time With Image Documentation (Pro Cah)Professional Component ",,76882,CPT,Professional,Both,,,26,93,79.05,14.69,93,"Health Partners, Inc.",Medicare Advantage,37.329,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Ultrasound, Limited, Joint Or Focal Evaluation Of Other Nonvascular Extremity Structure(S), Real-Time With Image Documentation (Pro Cah)Professional Component ",,76882,CPT,Professional,Both,,,26,93,79.05,14.69,93,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),14.69,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Ultrasound, Limited, Joint Or Focal Evaluation Of Other Nonvascular Extremity Structure(S), Real-Time With Image Documentation (Pro Cah)Professional Component ",,76882,CPT,Professional,Both,,,26,93,79.05,14.69,93,"Health Partners, Inc.",State of Minnesota Advantage Program,29.75621,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Ultrasound, Limited, Joint Or Focal Evaluation Of Other Nonvascular Extremity Structure(S), Real-Time With Image Documentation (Pro Cah)Professional Component ",,76882,CPT,Professional,Both,,,26,93,79.05,14.69,93,"Health Partners, Inc.",State Public Programs,14.69,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Ultrasound, Limited, Joint Or Focal Evaluation Of Other Nonvascular Extremity Structure(S), Real-Time With Image Documentation (Pro Cah)Professional Component ",,76882,CPT,Professional,Both,,,26,93,79.05,14.69,93,Humana Insurance Company,Commercial PPO,32.46,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Ultrasound, Limited, Joint Or Focal Evaluation Of Other Nonvascular Extremity Structure(S), Real-Time With Image Documentation (Pro Cah)Professional Component ",,76882,CPT,Professional,Both,,,26,93,79.05,14.69,93,Humana Insurance Company,Medicare PPO,93,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Ultrasound, Limited, Joint Or Focal Evaluation Of Other Nonvascular Extremity Structure(S), Real-Time With Image Documentation (Pro Cah)Professional Component ",,76882,CPT,Professional,Both,,,26,93,79.05,14.69,93,Medica,Individual & Family,78.864,84.8,,percent of total billed charges,,
"Ultrasound, Limited, Joint Or Focal Evaluation Of Other Nonvascular Extremity Structure(S), Real-Time With Image Documentation (Pro Cah)Professional Component ",,76882,CPT,Professional,Both,,,26,93,79.05,14.69,93,Medica,Medica Advantage Solution,46.314,49.8,,percent of total billed charges,,
"Ultrasound, Limited, Joint Or Focal Evaluation Of Other Nonvascular Extremity Structure(S), Real-Time With Image Documentation (Pro Cah)Professional Component ",,76882,CPT,Professional,Both,,,26,93,79.05,14.69,93,Medica,Medical Assistance,16.96,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Ultrasound, Limited, Joint Or Focal Evaluation Of Other Nonvascular Extremity Structure(S), Real-Time With Image Documentation (Pro Cah)Professional Component ",,76882,CPT,Professional,Both,,,26,93,79.05,14.69,93,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,32.46,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Ultrasound, Limited, Joint Or Focal Evaluation Of Other Nonvascular Extremity Structure(S), Real-Time With Image Documentation (Pro Cah)Professional Component ",,76882,CPT,Professional,Both,,,26,93,79.05,14.69,93,"Multiplan, Inc.","Multiplan, Inc.",87.42,94,,percent of total billed charges,,
"Ultrasound, Limited, Joint Or Focal Evaluation Of Other Nonvascular Extremity Structure(S), Real-Time With Image Documentation (Pro Cah)Professional Component ",,76882,CPT,Professional,Both,,,26,93,79.05,14.69,93,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,83.793,90.1,,percent of total billed charges,,
"Ultrasound, Limited, Joint Or Focal Evaluation Of Other Nonvascular Extremity Structure(S), Real-Time With Image Documentation (Pro Cah)Professional Component ",,76882,CPT,Professional,Both,,,26,93,79.05,14.69,93,"Preferred One Administrative Services, INC.",PPO,91.698,98.6,,percent of total billed charges,,
"Ultrasound, Limited, Joint Or Focal Evaluation Of Other Nonvascular Extremity Structure(S), Real-Time With Image Documentation (Pro Cah)Professional Component ",,76882,CPT,Professional,Both,,,26,93,79.05,14.69,93,PrimeWest Health,Minnesota Senior Health Options (MSHO),37.329,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Ultrasound, Limited, Joint Or Focal Evaluation Of Other Nonvascular Extremity Structure(S), Real-Time With Image Documentation (Pro Cah)Professional Component ",,76882,CPT,Professional,Both,,,26,93,79.05,14.69,93,PrimeWest Health,MinnesotaCare,18.1440328,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Ultrasound, Limited, Joint Or Focal Evaluation Of Other Nonvascular Extremity Structure(S), Real-Time With Image Documentation (Pro Cah)Professional Component ",,76882,CPT,Professional,Both,,,26,93,79.05,14.69,93,Sanford Health Plan,Sanford Health Plan,81.84,88,,percent of total billed charges,,
"Ultrasound, Limited, Joint Or Focal Evaluation Of Other Nonvascular Extremity Structure(S), Real-Time With Image Documentation (Pro Cah)Professional Component ",,76882,CPT,Professional,Both,,,26,93,79.05,14.69,93,"UCare Health, Inc.",Individual & Family Plan,52.766976,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Ultrasound, Limited, Joint Or Focal Evaluation Of Other Nonvascular Extremity Structure(S), Real-Time With Image Documentation (Pro Cah)Professional Component ",,76882,CPT,Professional,Both,,,26,93,79.05,14.69,93,"UCare Health, Inc.",Medical Assistance,18.652744,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Ultrasound, Limited, Joint Or Focal Evaluation Of Other Nonvascular Extremity Structure(S), Real-Time With Image Documentation (Pro Cah)Professional Component ",,76882,CPT,Professional,Both,,,26,93,79.05,14.69,93,"UCare Health, Inc.",Medicare Advantage,37.329,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Ultrasound, Limited, Joint Or Focal Evaluation Of Other Nonvascular Extremity Structure(S), Real-Time With Image Documentation (Pro Cah)Professional Component ",,76882,CPT,Professional,Both,,,26,93,79.05,14.69,93,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),29.8632,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Ultrasound, Limited, Joint Or Focal Evaluation Of Other Nonvascular Extremity Structure(S), Real-Time With Image Documentation (Pro Cah)Professional Component ",,76882,CPT,Professional,Both,,,26,93,79.05,14.69,93,UnitedHealthcare,Individual & Family,93,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Ultrasound, Limited, Joint Or Focal Evaluation Of Other Nonvascular Extremity Structure(S), Real-Time With Image Documentation (Pro Cah)Professional Component ",,76882,CPT,Professional,Both,,,26,93,79.05,14.69,93,UnitedHealthcare,Medicare Advantage,37.329,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Ultrasound, Limited, Joint Or Focal Evaluation Of Other Nonvascular Extremity Structure(S), Real-Time With Image Documentation (Pro Cah)Professional Component ",,76882,CPT,Professional,Both,,,26,93,79.05,14.69,93,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,16.95704,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Us Guide Vascular Access W/Doc & Reporting (Pro Cah)Professional Component ,,76937,CPT,Professional,Both,,,26,75,63.75,8.5,75,Aetna,Commercial,63.75,85,,percent of total billed charges,,
Us Guide Vascular Access W/Doc & Reporting (Pro Cah)Professional Component ,,76937,CPT,Professional,Both,,,26,75,63.75,8.5,75,Aetna,Medicare Advantage,13.54,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Us Guide Vascular Access W/Doc & Reporting (Pro Cah)Professional Component ,,76937,CPT,Professional,Both,,,26,75,63.75,8.5,75,Aetna,PPO,69.75,93,,percent of total billed charges,,
Us Guide Vascular Access W/Doc & Reporting (Pro Cah)Professional Component ,,76937,CPT,Professional,Both,,,26,75,63.75,8.5,75,America's PPO,America's PPO,64.08,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Us Guide Vascular Access W/Doc & Reporting (Pro Cah)Professional Component ,,76937,CPT,Professional,Both,,,26,75,63.75,8.5,75,BlueCross BlueShield Minnesota, Federal Employee Program,26.85,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Us Guide Vascular Access W/Doc & Reporting (Pro Cah)Professional Component ,,76937,CPT,Professional,Both,,,26,75,63.75,8.5,75,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,27.2796,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Us Guide Vascular Access W/Doc & Reporting (Pro Cah)Professional Component ,,76937,CPT,Professional,Both,,,26,75,63.75,8.5,75,BlueCross BlueShield Minnesota,High Value Network Plan,27.2796,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Us Guide Vascular Access W/Doc & Reporting (Pro Cah)Professional Component ,,76937,CPT,Professional,Both,,,26,75,63.75,8.5,75,BlueCross BlueShield Minnesota,Medicare Advantage,15.3755,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Us Guide Vascular Access W/Doc & Reporting (Pro Cah)Professional Component ,,76937,CPT,Professional,Both,,,26,75,63.75,8.5,75,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,27.2796,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Us Guide Vascular Access W/Doc & Reporting (Pro Cah)Professional Component ,,76937,CPT,Professional,Both,,,26,75,63.75,8.5,75,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,9.81456,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Us Guide Vascular Access W/Doc & Reporting (Pro Cah)Professional Component ,,76937,CPT,Professional,Both,,,26,75,63.75,8.5,75,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),15.3755,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Us Guide Vascular Access W/Doc & Reporting (Pro Cah)Professional Component ,,76937,CPT,Professional,Both,,,26,75,63.75,8.5,75,CorVel,Worker's Compensation,26.068677,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Us Guide Vascular Access W/Doc & Reporting (Pro Cah)Professional Component ,,76937,CPT,Professional,Both,,,26,75,63.75,8.5,75,First Health Group Corporation,First Health Network,72.75,97,,percent of total billed charges,,
Us Guide Vascular Access W/Doc & Reporting (Pro Cah)Professional Component ,,76937,CPT,Professional,Both,,,26,75,63.75,8.5,75,"Health Partners, Inc.",Commercial,20.11,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Us Guide Vascular Access W/Doc & Reporting (Pro Cah)Professional Component ,,76937,CPT,Professional,Both,,,26,75,63.75,8.5,75,"Health Partners, Inc.",Medicare Advantage,15.3755,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Us Guide Vascular Access W/Doc & Reporting (Pro Cah)Professional Component ,,76937,CPT,Professional,Both,,,26,75,63.75,8.5,75,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),8.5,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Us Guide Vascular Access W/Doc & Reporting (Pro Cah)Professional Component ,,76937,CPT,Professional,Both,,,26,75,63.75,8.5,75,"Health Partners, Inc.",State of Minnesota Advantage Program,17.324765,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Us Guide Vascular Access W/Doc & Reporting (Pro Cah)Professional Component ,,76937,CPT,Professional,Both,,,26,75,63.75,8.5,75,"Health Partners, Inc.",State Public Programs,8.5,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Us Guide Vascular Access W/Doc & Reporting (Pro Cah)Professional Component ,,76937,CPT,Professional,Both,,,26,75,63.75,8.5,75,Humana Insurance Company,Commercial PPO,13.37,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Us Guide Vascular Access W/Doc & Reporting (Pro Cah)Professional Component ,,76937,CPT,Professional,Both,,,26,75,63.75,8.5,75,Humana Insurance Company,Medicare PPO,75,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Us Guide Vascular Access W/Doc & Reporting (Pro Cah)Professional Component ,,76937,CPT,Professional,Both,,,26,75,63.75,8.5,75,Medica,Individual & Family,63.6,84.8,,percent of total billed charges,,
Us Guide Vascular Access W/Doc & Reporting (Pro Cah)Professional Component ,,76937,CPT,Professional,Both,,,26,75,63.75,8.5,75,Medica,Medica Advantage Solution,37.35,49.8,,percent of total billed charges,,
Us Guide Vascular Access W/Doc & Reporting (Pro Cah)Professional Component ,,76937,CPT,Professional,Both,,,26,75,63.75,8.5,75,Medica,Medical Assistance,9.81,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Us Guide Vascular Access W/Doc & Reporting (Pro Cah)Professional Component ,,76937,CPT,Professional,Both,,,26,75,63.75,8.5,75,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,13.37,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Us Guide Vascular Access W/Doc & Reporting (Pro Cah)Professional Component ,,76937,CPT,Professional,Both,,,26,75,63.75,8.5,75,"Multiplan, Inc.","Multiplan, Inc.",70.5,94,,percent of total billed charges,,
Us Guide Vascular Access W/Doc & Reporting (Pro Cah)Professional Component ,,76937,CPT,Professional,Both,,,26,75,63.75,8.5,75,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,67.575,90.1,,percent of total billed charges,,
Us Guide Vascular Access W/Doc & Reporting (Pro Cah)Professional Component ,,76937,CPT,Professional,Both,,,26,75,63.75,8.5,75,"Preferred One Administrative Services, INC.",PPO,73.95,98.6,,percent of total billed charges,,
Us Guide Vascular Access W/Doc & Reporting (Pro Cah)Professional Component ,,76937,CPT,Professional,Both,,,26,75,63.75,8.5,75,PrimeWest Health,Minnesota Senior Health Options (MSHO),15.3755,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Us Guide Vascular Access W/Doc & Reporting (Pro Cah)Professional Component ,,76937,CPT,Professional,Both,,,26,75,63.75,8.5,75,PrimeWest Health,MinnesotaCare,10.5015792,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Us Guide Vascular Access W/Doc & Reporting (Pro Cah)Professional Component ,,76937,CPT,Professional,Both,,,26,75,63.75,8.5,75,Sanford Health Plan,Sanford Health Plan,66,88,,percent of total billed charges,,
Us Guide Vascular Access W/Doc & Reporting (Pro Cah)Professional Component ,,76937,CPT,Professional,Both,,,26,75,63.75,8.5,75,"UCare Health, Inc.",Individual & Family Plan,21.734272,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Us Guide Vascular Access W/Doc & Reporting (Pro Cah)Professional Component ,,76937,CPT,Professional,Both,,,26,75,63.75,8.5,75,"UCare Health, Inc.",Medical Assistance,10.796016,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Us Guide Vascular Access W/Doc & Reporting (Pro Cah)Professional Component ,,76937,CPT,Professional,Both,,,26,75,63.75,8.5,75,"UCare Health, Inc.",Medicare Advantage,15.3755,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Us Guide Vascular Access W/Doc & Reporting (Pro Cah)Professional Component ,,76937,CPT,Professional,Both,,,26,75,63.75,8.5,75,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),12.3004,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Us Guide Vascular Access W/Doc & Reporting (Pro Cah)Professional Component ,,76937,CPT,Professional,Both,,,26,75,63.75,8.5,75,UnitedHealthcare,Individual & Family,75,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Us Guide Vascular Access W/Doc & Reporting (Pro Cah)Professional Component ,,76937,CPT,Professional,Both,,,26,75,63.75,8.5,75,UnitedHealthcare,Medicare Advantage,15.3755,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Us Guide Vascular Access W/Doc & Reporting (Pro Cah)Professional Component ,,76937,CPT,Professional,Both,,,26,75,63.75,8.5,75,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,9.81456,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Ultrasonic Guidance For Needle Placement, Imaging Supervision And Interpretation (Pro Cah)Professional Component ",,76942,CPT,Professional,Both,,,26,1260,1071,18.97,1260,Aetna,Commercial,1071,85,,percent of total billed charges,,
"Ultrasonic Guidance For Needle Placement, Imaging Supervision And Interpretation (Pro Cah)Professional Component ",,76942,CPT,Professional,Both,,,26,1260,1071,18.97,1260,Aetna,Medicare Advantage,30.59,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Ultrasonic Guidance For Needle Placement, Imaging Supervision And Interpretation (Pro Cah)Professional Component ",,76942,CPT,Professional,Both,,,26,1260,1071,18.97,1260,Aetna,PPO,1171.8,93,,percent of total billed charges,,
"Ultrasonic Guidance For Needle Placement, Imaging Supervision And Interpretation (Pro Cah)Professional Component ",,76942,CPT,Professional,Both,,,26,1260,1071,18.97,1260,America's PPO,America's PPO,1076.544,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Ultrasonic Guidance For Needle Placement, Imaging Supervision And Interpretation (Pro Cah)Professional Component ",,76942,CPT,Professional,Both,,,26,1260,1071,18.97,1260,BlueCross BlueShield Minnesota, Federal Employee Program,57.53,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Ultrasonic Guidance For Needle Placement, Imaging Supervision And Interpretation (Pro Cah)Professional Component ",,76942,CPT,Professional,Both,,,26,1260,1071,18.97,1260,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,58.45048,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Ultrasonic Guidance For Needle Placement, Imaging Supervision And Interpretation (Pro Cah)Professional Component ",,76942,CPT,Professional,Both,,,26,1260,1071,18.97,1260,BlueCross BlueShield Minnesota,High Value Network Plan,58.45048,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Ultrasonic Guidance For Needle Placement, Imaging Supervision And Interpretation (Pro Cah)Professional Component ",,76942,CPT,Professional,Both,,,26,1260,1071,18.97,1260,BlueCross BlueShield Minnesota,Medicare Advantage,34.1665,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Ultrasonic Guidance For Needle Placement, Imaging Supervision And Interpretation (Pro Cah)Professional Component ",,76942,CPT,Professional,Both,,,26,1260,1071,18.97,1260,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,58.45048,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Ultrasonic Guidance For Needle Placement, Imaging Supervision And Interpretation (Pro Cah)Professional Component ",,76942,CPT,Professional,Both,,,26,1260,1071,18.97,1260,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,21.90496,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Ultrasonic Guidance For Needle Placement, Imaging Supervision And Interpretation (Pro Cah)Professional Component ",,76942,CPT,Professional,Both,,,26,1260,1071,18.97,1260,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),34.1665,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Ultrasonic Guidance For Needle Placement, Imaging Supervision And Interpretation (Pro Cah)Professional Component ",,76942,CPT,Professional,Both,,,26,1260,1071,18.97,1260,CorVel,Worker's Compensation,58.8805503,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Ultrasonic Guidance For Needle Placement, Imaging Supervision And Interpretation (Pro Cah)Professional Component ",,76942,CPT,Professional,Both,,,26,1260,1071,18.97,1260,First Health Group Corporation,First Health Network,1222.2,97,,percent of total billed charges,,
"Ultrasonic Guidance For Needle Placement, Imaging Supervision And Interpretation (Pro Cah)Professional Component ",,76942,CPT,Professional,Both,,,26,1260,1071,18.97,1260,"Health Partners, Inc.",Commercial,44.86,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Ultrasonic Guidance For Needle Placement, Imaging Supervision And Interpretation (Pro Cah)Professional Component ",,76942,CPT,Professional,Both,,,26,1260,1071,18.97,1260,"Health Partners, Inc.",Medicare Advantage,34.1665,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Ultrasonic Guidance For Needle Placement, Imaging Supervision And Interpretation (Pro Cah)Professional Component ",,76942,CPT,Professional,Both,,,26,1260,1071,18.97,1260,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),18.97,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Ultrasonic Guidance For Needle Placement, Imaging Supervision And Interpretation (Pro Cah)Professional Component ",,76942,CPT,Professional,Both,,,26,1260,1071,18.97,1260,"Health Partners, Inc.",State of Minnesota Advantage Program,38.64689,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Ultrasonic Guidance For Needle Placement, Imaging Supervision And Interpretation (Pro Cah)Professional Component ",,76942,CPT,Professional,Both,,,26,1260,1071,18.97,1260,"Health Partners, Inc.",State Public Programs,18.97,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Ultrasonic Guidance For Needle Placement, Imaging Supervision And Interpretation (Pro Cah)Professional Component ",,76942,CPT,Professional,Both,,,26,1260,1071,18.97,1260,Humana Insurance Company,Commercial PPO,29.71,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Ultrasonic Guidance For Needle Placement, Imaging Supervision And Interpretation (Pro Cah)Professional Component ",,76942,CPT,Professional,Both,,,26,1260,1071,18.97,1260,Humana Insurance Company,Medicare PPO,1260,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Ultrasonic Guidance For Needle Placement, Imaging Supervision And Interpretation (Pro Cah)Professional Component ",,76942,CPT,Professional,Both,,,26,1260,1071,18.97,1260,Medica,Individual & Family,1068.48,84.8,,percent of total billed charges,,
"Ultrasonic Guidance For Needle Placement, Imaging Supervision And Interpretation (Pro Cah)Professional Component ",,76942,CPT,Professional,Both,,,26,1260,1071,18.97,1260,Medica,Medica Advantage Solution,627.48,49.8,,percent of total billed charges,,
"Ultrasonic Guidance For Needle Placement, Imaging Supervision And Interpretation (Pro Cah)Professional Component ",,76942,CPT,Professional,Both,,,26,1260,1071,18.97,1260,Medica,Medical Assistance,21.9,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Ultrasonic Guidance For Needle Placement, Imaging Supervision And Interpretation (Pro Cah)Professional Component ",,76942,CPT,Professional,Both,,,26,1260,1071,18.97,1260,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,29.71,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Ultrasonic Guidance For Needle Placement, Imaging Supervision And Interpretation (Pro Cah)Professional Component ",,76942,CPT,Professional,Both,,,26,1260,1071,18.97,1260,"Multiplan, Inc.","Multiplan, Inc.",1184.4,94,,percent of total billed charges,,
"Ultrasonic Guidance For Needle Placement, Imaging Supervision And Interpretation (Pro Cah)Professional Component ",,76942,CPT,Professional,Both,,,26,1260,1071,18.97,1260,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1135.26,90.1,,percent of total billed charges,,
"Ultrasonic Guidance For Needle Placement, Imaging Supervision And Interpretation (Pro Cah)Professional Component ",,76942,CPT,Professional,Both,,,26,1260,1071,18.97,1260,"Preferred One Administrative Services, INC.",PPO,1242.36,98.6,,percent of total billed charges,,
"Ultrasonic Guidance For Needle Placement, Imaging Supervision And Interpretation (Pro Cah)Professional Component ",,76942,CPT,Professional,Both,,,26,1260,1071,18.97,1260,PrimeWest Health,Minnesota Senior Health Options (MSHO),34.1665,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Ultrasonic Guidance For Needle Placement, Imaging Supervision And Interpretation (Pro Cah)Professional Component ",,76942,CPT,Professional,Both,,,26,1260,1071,18.97,1260,PrimeWest Health,MinnesotaCare,23.4383072,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Ultrasonic Guidance For Needle Placement, Imaging Supervision And Interpretation (Pro Cah)Professional Component ",,76942,CPT,Professional,Both,,,26,1260,1071,18.97,1260,Sanford Health Plan,Sanford Health Plan,1108.8,88,,percent of total billed charges,,
"Ultrasonic Guidance For Needle Placement, Imaging Supervision And Interpretation (Pro Cah)Professional Component ",,76942,CPT,Professional,Both,,,26,1260,1071,18.97,1260,"UCare Health, Inc.",Individual & Family Plan,48.296576,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Ultrasonic Guidance For Needle Placement, Imaging Supervision And Interpretation (Pro Cah)Professional Component ",,76942,CPT,Professional,Both,,,26,1260,1071,18.97,1260,"UCare Health, Inc.",Medical Assistance,24.095456,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Ultrasonic Guidance For Needle Placement, Imaging Supervision And Interpretation (Pro Cah)Professional Component ",,76942,CPT,Professional,Both,,,26,1260,1071,18.97,1260,"UCare Health, Inc.",Medicare Advantage,34.1665,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Ultrasonic Guidance For Needle Placement, Imaging Supervision And Interpretation (Pro Cah)Professional Component ",,76942,CPT,Professional,Both,,,26,1260,1071,18.97,1260,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),27.3332,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Ultrasonic Guidance For Needle Placement, Imaging Supervision And Interpretation (Pro Cah)Professional Component ",,76942,CPT,Professional,Both,,,26,1260,1071,18.97,1260,UnitedHealthcare,Individual & Family,1260,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Ultrasonic Guidance For Needle Placement, Imaging Supervision And Interpretation (Pro Cah)Professional Component ",,76942,CPT,Professional,Both,,,26,1260,1071,18.97,1260,UnitedHealthcare,Medicare Advantage,34.1665,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Ultrasonic Guidance For Needle Placement, Imaging Supervision And Interpretation (Pro Cah)Professional Component ",,76942,CPT,Professional,Both,,,26,1260,1071,18.97,1260,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,21.90496,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Ultrasound Guidance Needle Placement, Imaging Supervision And Interp (Pbb)Professional Component ",,76942,CPT,Professional,Outpatient,,,26,638,542.3,18.97,638,Aetna,Commercial,542.3,85,,percent of total billed charges,,
"Ultrasound Guidance Needle Placement, Imaging Supervision And Interp (Pbb)Professional Component ",,76942,CPT,Professional,Outpatient,,,26,638,542.3,18.97,638,Aetna,Medicare Advantage,30.59,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Ultrasound Guidance Needle Placement, Imaging Supervision And Interp (Pbb)Professional Component ",,76942,CPT,Professional,Outpatient,,,26,638,542.3,18.97,638,Aetna,PPO,593.34,93,,percent of total billed charges,,
"Ultrasound Guidance Needle Placement, Imaging Supervision And Interp (Pbb)Professional Component ",,76942,CPT,Professional,Outpatient,,,26,638,542.3,18.97,638,America's PPO,America's PPO,545.1072,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Ultrasound Guidance Needle Placement, Imaging Supervision And Interp (Pbb)Professional Component ",,76942,CPT,Professional,Outpatient,,,26,638,542.3,18.97,638,BlueCross BlueShield Minnesota, Federal Employee Program,57.53,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Ultrasound Guidance Needle Placement, Imaging Supervision And Interp (Pbb)Professional Component ",,76942,CPT,Professional,Outpatient,,,26,638,542.3,18.97,638,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,58.45048,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Ultrasound Guidance Needle Placement, Imaging Supervision And Interp (Pbb)Professional Component ",,76942,CPT,Professional,Outpatient,,,26,638,542.3,18.97,638,BlueCross BlueShield Minnesota,High Value Network Plan,58.45048,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Ultrasound Guidance Needle Placement, Imaging Supervision And Interp (Pbb)Professional Component ",,76942,CPT,Professional,Outpatient,,,26,638,542.3,18.97,638,BlueCross BlueShield Minnesota,Medicare Advantage,34.1665,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Ultrasound Guidance Needle Placement, Imaging Supervision And Interp (Pbb)Professional Component ",,76942,CPT,Professional,Outpatient,,,26,638,542.3,18.97,638,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,58.45048,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Ultrasound Guidance Needle Placement, Imaging Supervision And Interp (Pbb)Professional Component ",,76942,CPT,Professional,Outpatient,,,26,638,542.3,18.97,638,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,21.90496,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Ultrasound Guidance Needle Placement, Imaging Supervision And Interp (Pbb)Professional Component ",,76942,CPT,Professional,Outpatient,,,26,638,542.3,18.97,638,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),34.1665,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Ultrasound Guidance Needle Placement, Imaging Supervision And Interp (Pbb)Professional Component ",,76942,CPT,Professional,Outpatient,,,26,638,542.3,18.97,638,CorVel,Worker's Compensation,58.8805503,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Ultrasound Guidance Needle Placement, Imaging Supervision And Interp (Pbb)Professional Component ",,76942,CPT,Professional,Outpatient,,,26,638,542.3,18.97,638,First Health Group Corporation,First Health Network,618.86,97,,percent of total billed charges,,
"Ultrasound Guidance Needle Placement, Imaging Supervision And Interp (Pbb)Professional Component ",,76942,CPT,Professional,Outpatient,,,26,638,542.3,18.97,638,"Health Partners, Inc.",Commercial,44.86,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Ultrasound Guidance Needle Placement, Imaging Supervision And Interp (Pbb)Professional Component ",,76942,CPT,Professional,Outpatient,,,26,638,542.3,18.97,638,"Health Partners, Inc.",Medicare Advantage,34.1665,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Ultrasound Guidance Needle Placement, Imaging Supervision And Interp (Pbb)Professional Component ",,76942,CPT,Professional,Outpatient,,,26,638,542.3,18.97,638,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),18.97,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Ultrasound Guidance Needle Placement, Imaging Supervision And Interp (Pbb)Professional Component ",,76942,CPT,Professional,Outpatient,,,26,638,542.3,18.97,638,"Health Partners, Inc.",State of Minnesota Advantage Program,38.64689,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Ultrasound Guidance Needle Placement, Imaging Supervision And Interp (Pbb)Professional Component ",,76942,CPT,Professional,Outpatient,,,26,638,542.3,18.97,638,"Health Partners, Inc.",State Public Programs,18.97,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Ultrasound Guidance Needle Placement, Imaging Supervision And Interp (Pbb)Professional Component ",,76942,CPT,Professional,Outpatient,,,26,638,542.3,18.97,638,Humana Insurance Company,Commercial PPO,29.71,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Ultrasound Guidance Needle Placement, Imaging Supervision And Interp (Pbb)Professional Component ",,76942,CPT,Professional,Outpatient,,,26,638,542.3,18.97,638,Humana Insurance Company,Medicare PPO,638,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Ultrasound Guidance Needle Placement, Imaging Supervision And Interp (Pbb)Professional Component ",,76942,CPT,Professional,Outpatient,,,26,638,542.3,18.97,638,Medica,Individual & Family,541.024,84.8,,percent of total billed charges,,
"Ultrasound Guidance Needle Placement, Imaging Supervision And Interp (Pbb)Professional Component ",,76942,CPT,Professional,Outpatient,,,26,638,542.3,18.97,638,Medica,Medica Advantage Solution,317.724,49.8,,percent of total billed charges,,
"Ultrasound Guidance Needle Placement, Imaging Supervision And Interp (Pbb)Professional Component ",,76942,CPT,Professional,Outpatient,,,26,638,542.3,18.97,638,Medica,Medical Assistance,21.9,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Ultrasound Guidance Needle Placement, Imaging Supervision And Interp (Pbb)Professional Component ",,76942,CPT,Professional,Outpatient,,,26,638,542.3,18.97,638,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,29.71,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Ultrasound Guidance Needle Placement, Imaging Supervision And Interp (Pbb)Professional Component ",,76942,CPT,Professional,Outpatient,,,26,638,542.3,18.97,638,"Multiplan, Inc.","Multiplan, Inc.",599.72,94,,percent of total billed charges,,
"Ultrasound Guidance Needle Placement, Imaging Supervision And Interp (Pbb)Professional Component ",,76942,CPT,Professional,Outpatient,,,26,638,542.3,18.97,638,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,574.838,90.1,,percent of total billed charges,,
"Ultrasound Guidance Needle Placement, Imaging Supervision And Interp (Pbb)Professional Component ",,76942,CPT,Professional,Outpatient,,,26,638,542.3,18.97,638,"Preferred One Administrative Services, INC.",PPO,629.068,98.6,,percent of total billed charges,,
"Ultrasound Guidance Needle Placement, Imaging Supervision And Interp (Pbb)Professional Component ",,76942,CPT,Professional,Outpatient,,,26,638,542.3,18.97,638,PrimeWest Health,Minnesota Senior Health Options (MSHO),34.1665,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Ultrasound Guidance Needle Placement, Imaging Supervision And Interp (Pbb)Professional Component ",,76942,CPT,Professional,Outpatient,,,26,638,542.3,18.97,638,PrimeWest Health,MinnesotaCare,23.4383072,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Ultrasound Guidance Needle Placement, Imaging Supervision And Interp (Pbb)Professional Component ",,76942,CPT,Professional,Outpatient,,,26,638,542.3,18.97,638,Sanford Health Plan,Sanford Health Plan,561.44,88,,percent of total billed charges,,
"Ultrasound Guidance Needle Placement, Imaging Supervision And Interp (Pbb)Professional Component ",,76942,CPT,Professional,Outpatient,,,26,638,542.3,18.97,638,"UCare Health, Inc.",Individual & Family Plan,48.296576,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Ultrasound Guidance Needle Placement, Imaging Supervision And Interp (Pbb)Professional Component ",,76942,CPT,Professional,Outpatient,,,26,638,542.3,18.97,638,"UCare Health, Inc.",Medical Assistance,24.095456,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Ultrasound Guidance Needle Placement, Imaging Supervision And Interp (Pbb)Professional Component ",,76942,CPT,Professional,Outpatient,,,26,638,542.3,18.97,638,"UCare Health, Inc.",Medicare Advantage,34.1665,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Ultrasound Guidance Needle Placement, Imaging Supervision And Interp (Pbb)Professional Component ",,76942,CPT,Professional,Outpatient,,,26,638,542.3,18.97,638,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),27.3332,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Ultrasound Guidance Needle Placement, Imaging Supervision And Interp (Pbb)Professional Component ",,76942,CPT,Professional,Outpatient,,,26,638,542.3,18.97,638,UnitedHealthcare,Individual & Family,638,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Ultrasound Guidance Needle Placement, Imaging Supervision And Interp (Pbb)Professional Component ",,76942,CPT,Professional,Outpatient,,,26,638,542.3,18.97,638,UnitedHealthcare,Medicare Advantage,34.1665,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Ultrasound Guidance Needle Placement, Imaging Supervision And Interp (Pbb)Professional Component ",,76942,CPT,Professional,Outpatient,,,26,638,542.3,18.97,638,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,21.90496,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Ultrasonic Guidance, Intraoperative (Pro Cah)Professional Component ",,76998,CPT,Professional,Both,,,26,683,580.55,36.64,683,Aetna,Commercial,580.55,85,,percent of total billed charges,,
"Ultrasonic Guidance, Intraoperative (Pro Cah)Professional Component ",,76998,CPT,Professional,Both,,,26,683,580.55,36.64,683,Aetna,Medicare Advantage,58.6,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Ultrasonic Guidance, Intraoperative (Pro Cah)Professional Component ",,76998,CPT,Professional,Both,,,26,683,580.55,36.64,683,Aetna,PPO,635.19,93,,percent of total billed charges,,
"Ultrasonic Guidance, Intraoperative (Pro Cah)Professional Component ",,76998,CPT,Professional,Both,,,26,683,580.55,36.64,683,America's PPO,America's PPO,583.5552,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Ultrasonic Guidance, Intraoperative (Pro Cah)Professional Component ",,76998,CPT,Professional,Both,,,26,683,580.55,36.64,683,BlueCross BlueShield Minnesota, Federal Employee Program,115.7,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Ultrasonic Guidance, Intraoperative (Pro Cah)Professional Component ",,76998,CPT,Professional,Both,,,26,683,580.55,36.64,683,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,117.5512,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Ultrasonic Guidance, Intraoperative (Pro Cah)Professional Component ",,76998,CPT,Professional,Both,,,26,683,580.55,36.64,683,BlueCross BlueShield Minnesota,High Value Network Plan,117.5512,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Ultrasonic Guidance, Intraoperative (Pro Cah)Professional Component ",,76998,CPT,Professional,Both,,,26,683,580.55,36.64,683,BlueCross BlueShield Minnesota,Medicare Advantage,65.5845,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Ultrasonic Guidance, Intraoperative (Pro Cah)Professional Component ",,76998,CPT,Professional,Both,,,26,683,580.55,36.64,683,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,117.5512,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Ultrasonic Guidance, Intraoperative (Pro Cah)Professional Component ",,76998,CPT,Professional,Both,,,26,683,580.55,36.64,683,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,42.30624,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Ultrasonic Guidance, Intraoperative (Pro Cah)Professional Component ",,76998,CPT,Professional,Both,,,26,683,580.55,36.64,683,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),65.5845,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Ultrasonic Guidance, Intraoperative (Pro Cah)Professional Component ",,76998,CPT,Professional,Both,,,26,683,580.55,36.64,683,CorVel,Worker's Compensation,112.8005961,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Ultrasonic Guidance, Intraoperative (Pro Cah)Professional Component ",,76998,CPT,Professional,Both,,,26,683,580.55,36.64,683,First Health Group Corporation,First Health Network,662.51,97,,percent of total billed charges,,
"Ultrasonic Guidance, Intraoperative (Pro Cah)Professional Component ",,76998,CPT,Professional,Both,,,26,683,580.55,36.64,683,"Health Partners, Inc.",Commercial,86.62,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Ultrasonic Guidance, Intraoperative (Pro Cah)Professional Component ",,76998,CPT,Professional,Both,,,26,683,580.55,36.64,683,"Health Partners, Inc.",Medicare Advantage,65.5845,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Ultrasonic Guidance, Intraoperative (Pro Cah)Professional Component ",,76998,CPT,Professional,Both,,,26,683,580.55,36.64,683,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),36.64,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Ultrasonic Guidance, Intraoperative (Pro Cah)Professional Component ",,76998,CPT,Professional,Both,,,26,683,580.55,36.64,683,"Health Partners, Inc.",State of Minnesota Advantage Program,74.62313,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Ultrasonic Guidance, Intraoperative (Pro Cah)Professional Component ",,76998,CPT,Professional,Both,,,26,683,580.55,36.64,683,"Health Partners, Inc.",State Public Programs,36.64,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Ultrasonic Guidance, Intraoperative (Pro Cah)Professional Component ",,76998,CPT,Professional,Both,,,26,683,580.55,36.64,683,Humana Insurance Company,Commercial PPO,57.03,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Ultrasonic Guidance, Intraoperative (Pro Cah)Professional Component ",,76998,CPT,Professional,Both,,,26,683,580.55,36.64,683,Humana Insurance Company,Medicare PPO,683,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Ultrasonic Guidance, Intraoperative (Pro Cah)Professional Component ",,76998,CPT,Professional,Both,,,26,683,580.55,36.64,683,Medica,Individual & Family,579.184,84.8,,percent of total billed charges,,
"Ultrasonic Guidance, Intraoperative (Pro Cah)Professional Component ",,76998,CPT,Professional,Both,,,26,683,580.55,36.64,683,Medica,Medica Advantage Solution,340.134,49.8,,percent of total billed charges,,
"Ultrasonic Guidance, Intraoperative (Pro Cah)Professional Component ",,76998,CPT,Professional,Both,,,26,683,580.55,36.64,683,Medica,Medical Assistance,42.31,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Ultrasonic Guidance, Intraoperative (Pro Cah)Professional Component ",,76998,CPT,Professional,Both,,,26,683,580.55,36.64,683,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,57.03,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Ultrasonic Guidance, Intraoperative (Pro Cah)Professional Component ",,76998,CPT,Professional,Both,,,26,683,580.55,36.64,683,"Multiplan, Inc.","Multiplan, Inc.",642.02,94,,percent of total billed charges,,
"Ultrasonic Guidance, Intraoperative (Pro Cah)Professional Component ",,76998,CPT,Professional,Both,,,26,683,580.55,36.64,683,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,615.383,90.1,,percent of total billed charges,,
"Ultrasonic Guidance, Intraoperative (Pro Cah)Professional Component ",,76998,CPT,Professional,Both,,,26,683,580.55,36.64,683,"Preferred One Administrative Services, INC.",PPO,673.438,98.6,,percent of total billed charges,,
"Ultrasonic Guidance, Intraoperative (Pro Cah)Professional Component ",,76998,CPT,Professional,Both,,,26,683,580.55,36.64,683,PrimeWest Health,Minnesota Senior Health Options (MSHO),65.5845,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Ultrasonic Guidance, Intraoperative (Pro Cah)Professional Component ",,76998,CPT,Professional,Both,,,26,683,580.55,36.64,683,PrimeWest Health,MinnesotaCare,45.2676768,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Ultrasonic Guidance, Intraoperative (Pro Cah)Professional Component ",,76998,CPT,Professional,Both,,,26,683,580.55,36.64,683,Sanford Health Plan,Sanford Health Plan,601.04,88,,percent of total billed charges,,
"Ultrasonic Guidance, Intraoperative (Pro Cah)Professional Component ",,76998,CPT,Professional,Both,,,26,683,580.55,36.64,683,"UCare Health, Inc.",Individual & Family Plan,92.707968,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Ultrasonic Guidance, Intraoperative (Pro Cah)Professional Component ",,76998,CPT,Professional,Both,,,26,683,580.55,36.64,683,"UCare Health, Inc.",Medical Assistance,46.536864,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Ultrasonic Guidance, Intraoperative (Pro Cah)Professional Component ",,76998,CPT,Professional,Both,,,26,683,580.55,36.64,683,"UCare Health, Inc.",Medicare Advantage,65.5845,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Ultrasonic Guidance, Intraoperative (Pro Cah)Professional Component ",,76998,CPT,Professional,Both,,,26,683,580.55,36.64,683,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),52.4676,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Ultrasonic Guidance, Intraoperative (Pro Cah)Professional Component ",,76998,CPT,Professional,Both,,,26,683,580.55,36.64,683,UnitedHealthcare,Individual & Family,683,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Ultrasonic Guidance, Intraoperative (Pro Cah)Professional Component ",,76998,CPT,Professional,Both,,,26,683,580.55,36.64,683,UnitedHealthcare,Medicare Advantage,65.5845,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Ultrasonic Guidance, Intraoperative (Pro Cah)Professional Component ",,76998,CPT,Professional,Both,,,26,683,580.55,36.64,683,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,42.30624,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Diagnostic Mammography, Including Computer-Aided Detection (Cad) When Performed; Unilat (Pro Cah)Professional Component ",,77065,CPT,Professional,Both,,,26,146,124.1,24.21,146,Aetna,Commercial,124.1,85,,percent of total billed charges,,
"Diagnostic Mammography, Including Computer-Aided Detection (Cad) When Performed; Unilat (Pro Cah)Professional Component ",,77065,CPT,Professional,Both,,,26,146,124.1,24.21,146,Aetna,Medicare Advantage,39.01,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Diagnostic Mammography, Including Computer-Aided Detection (Cad) When Performed; Unilat (Pro Cah)Professional Component ",,77065,CPT,Professional,Both,,,26,146,124.1,24.21,146,Aetna,PPO,135.78,93,,percent of total billed charges,,
"Diagnostic Mammography, Including Computer-Aided Detection (Cad) When Performed; Unilat (Pro Cah)Professional Component ",,77065,CPT,Professional,Both,,,26,146,124.1,24.21,146,America's PPO,America's PPO,124.7424,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Diagnostic Mammography, Including Computer-Aided Detection (Cad) When Performed; Unilat (Pro Cah)Professional Component ",,77065,CPT,Professional,Both,,,26,146,124.1,24.21,146,BlueCross BlueShield Minnesota, Federal Employee Program,72.87,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Diagnostic Mammography, Including Computer-Aided Detection (Cad) When Performed; Unilat (Pro Cah)Professional Component ",,77065,CPT,Professional,Both,,,26,146,124.1,24.21,146,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,74.03592,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Diagnostic Mammography, Including Computer-Aided Detection (Cad) When Performed; Unilat (Pro Cah)Professional Component ",,77065,CPT,Professional,Both,,,26,146,124.1,24.21,146,BlueCross BlueShield Minnesota,High Value Network Plan,74.03592,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Diagnostic Mammography, Including Computer-Aided Detection (Cad) When Performed; Unilat (Pro Cah)Professional Component ",,77065,CPT,Professional,Both,,,26,146,124.1,24.21,146,BlueCross BlueShield Minnesota,Medicare Advantage,43.585,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Diagnostic Mammography, Including Computer-Aided Detection (Cad) When Performed; Unilat (Pro Cah)Professional Component ",,77065,CPT,Professional,Both,,,26,146,124.1,24.21,146,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,74.03592,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Diagnostic Mammography, Including Computer-Aided Detection (Cad) When Performed; Unilat (Pro Cah)Professional Component ",,77065,CPT,Professional,Both,,,26,146,124.1,24.21,146,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,27.95016,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Diagnostic Mammography, Including Computer-Aided Detection (Cad) When Performed; Unilat (Pro Cah)Professional Component ",,77065,CPT,Professional,Both,,,26,146,124.1,24.21,146,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),43.585,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Diagnostic Mammography, Including Computer-Aided Detection (Cad) When Performed; Unilat (Pro Cah)Professional Component ",,77065,CPT,Professional,Both,,,26,146,124.1,24.21,146,CorVel,Worker's Compensation,75.0886713,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Diagnostic Mammography, Including Computer-Aided Detection (Cad) When Performed; Unilat (Pro Cah)Professional Component ",,77065,CPT,Professional,Both,,,26,146,124.1,24.21,146,First Health Group Corporation,First Health Network,141.62,97,,percent of total billed charges,,
"Diagnostic Mammography, Including Computer-Aided Detection (Cad) When Performed; Unilat (Pro Cah)Professional Component ",,77065,CPT,Professional,Both,,,26,146,124.1,24.21,146,"Health Partners, Inc.",Commercial,57.23,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Diagnostic Mammography, Including Computer-Aided Detection (Cad) When Performed; Unilat (Pro Cah)Professional Component ",,77065,CPT,Professional,Both,,,26,146,124.1,24.21,146,"Health Partners, Inc.",Medicare Advantage,43.585,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Diagnostic Mammography, Including Computer-Aided Detection (Cad) When Performed; Unilat (Pro Cah)Professional Component ",,77065,CPT,Professional,Both,,,26,146,124.1,24.21,146,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),24.21,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Diagnostic Mammography, Including Computer-Aided Detection (Cad) When Performed; Unilat (Pro Cah)Professional Component ",,77065,CPT,Professional,Both,,,26,146,124.1,24.21,146,"Health Partners, Inc.",State of Minnesota Advantage Program,49.303645,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Diagnostic Mammography, Including Computer-Aided Detection (Cad) When Performed; Unilat (Pro Cah)Professional Component ",,77065,CPT,Professional,Both,,,26,146,124.1,24.21,146,"Health Partners, Inc.",State Public Programs,24.21,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Diagnostic Mammography, Including Computer-Aided Detection (Cad) When Performed; Unilat (Pro Cah)Professional Component ",,77065,CPT,Professional,Both,,,26,146,124.1,24.21,146,Humana Insurance Company,Commercial PPO,37.9,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Diagnostic Mammography, Including Computer-Aided Detection (Cad) When Performed; Unilat (Pro Cah)Professional Component ",,77065,CPT,Professional,Both,,,26,146,124.1,24.21,146,Humana Insurance Company,Medicare PPO,146,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Diagnostic Mammography, Including Computer-Aided Detection (Cad) When Performed; Unilat (Pro Cah)Professional Component ",,77065,CPT,Professional,Both,,,26,146,124.1,24.21,146,Medica,Individual & Family,123.808,84.8,,percent of total billed charges,,
"Diagnostic Mammography, Including Computer-Aided Detection (Cad) When Performed; Unilat (Pro Cah)Professional Component ",,77065,CPT,Professional,Both,,,26,146,124.1,24.21,146,Medica,Medica Advantage Solution,72.708,49.8,,percent of total billed charges,,
"Diagnostic Mammography, Including Computer-Aided Detection (Cad) When Performed; Unilat (Pro Cah)Professional Component ",,77065,CPT,Professional,Both,,,26,146,124.1,24.21,146,Medica,Medical Assistance,27.95,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Diagnostic Mammography, Including Computer-Aided Detection (Cad) When Performed; Unilat (Pro Cah)Professional Component ",,77065,CPT,Professional,Both,,,26,146,124.1,24.21,146,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,37.9,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Diagnostic Mammography, Including Computer-Aided Detection (Cad) When Performed; Unilat (Pro Cah)Professional Component ",,77065,CPT,Professional,Both,,,26,146,124.1,24.21,146,"Multiplan, Inc.","Multiplan, Inc.",137.24,94,,percent of total billed charges,,
"Diagnostic Mammography, Including Computer-Aided Detection (Cad) When Performed; Unilat (Pro Cah)Professional Component ",,77065,CPT,Professional,Both,,,26,146,124.1,24.21,146,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,131.546,90.1,,percent of total billed charges,,
"Diagnostic Mammography, Including Computer-Aided Detection (Cad) When Performed; Unilat (Pro Cah)Professional Component ",,77065,CPT,Professional,Both,,,26,146,124.1,24.21,146,"Preferred One Administrative Services, INC.",PPO,143.956,98.6,,percent of total billed charges,,
"Diagnostic Mammography, Including Computer-Aided Detection (Cad) When Performed; Unilat (Pro Cah)Professional Component ",,77065,CPT,Professional,Both,,,26,146,124.1,24.21,146,PrimeWest Health,Minnesota Senior Health Options (MSHO),43.585,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Diagnostic Mammography, Including Computer-Aided Detection (Cad) When Performed; Unilat (Pro Cah)Professional Component ",,77065,CPT,Professional,Both,,,26,146,124.1,24.21,146,PrimeWest Health,MinnesotaCare,29.9066712,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Diagnostic Mammography, Including Computer-Aided Detection (Cad) When Performed; Unilat (Pro Cah)Professional Component ",,77065,CPT,Professional,Both,,,26,146,124.1,24.21,146,Sanford Health Plan,Sanford Health Plan,128.48,88,,percent of total billed charges,,
"Diagnostic Mammography, Including Computer-Aided Detection (Cad) When Performed; Unilat (Pro Cah)Professional Component ",,77065,CPT,Professional,Both,,,26,146,124.1,24.21,146,"UCare Health, Inc.",Individual & Family Plan,61.61024,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Diagnostic Mammography, Including Computer-Aided Detection (Cad) When Performed; Unilat (Pro Cah)Professional Component ",,77065,CPT,Professional,Both,,,26,146,124.1,24.21,146,"UCare Health, Inc.",Medical Assistance,30.745176,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Diagnostic Mammography, Including Computer-Aided Detection (Cad) When Performed; Unilat (Pro Cah)Professional Component ",,77065,CPT,Professional,Both,,,26,146,124.1,24.21,146,"UCare Health, Inc.",Medicare Advantage,43.585,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Diagnostic Mammography, Including Computer-Aided Detection (Cad) When Performed; Unilat (Pro Cah)Professional Component ",,77065,CPT,Professional,Both,,,26,146,124.1,24.21,146,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),34.868,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Diagnostic Mammography, Including Computer-Aided Detection (Cad) When Performed; Unilat (Pro Cah)Professional Component ",,77065,CPT,Professional,Both,,,26,146,124.1,24.21,146,UnitedHealthcare,Individual & Family,146,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Diagnostic Mammography, Including Computer-Aided Detection (Cad) When Performed; Unilat (Pro Cah)Professional Component ",,77065,CPT,Professional,Both,,,26,146,124.1,24.21,146,UnitedHealthcare,Medicare Advantage,43.585,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Diagnostic Mammography, Including Computer-Aided Detection (Cad) When Performed; Unilat (Pro Cah)Professional Component ",,77065,CPT,Professional,Both,,,26,146,124.1,24.21,146,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,27.95016,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Diagnostic Mammography, Including Computer-Aided Detection (Cad) When Performed; Bilateral (Pro Cah)Professional Component ",,77066,CPT,Professional,Both,,,26,297,252.45,29.88,297,Aetna,Commercial,252.45,85,,percent of total billed charges,,
"Diagnostic Mammography, Including Computer-Aided Detection (Cad) When Performed; Bilateral (Pro Cah)Professional Component ",,77066,CPT,Professional,Both,,,26,297,252.45,29.88,297,Aetna,Medicare Advantage,48.23,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Diagnostic Mammography, Including Computer-Aided Detection (Cad) When Performed; Bilateral (Pro Cah)Professional Component ",,77066,CPT,Professional,Both,,,26,297,252.45,29.88,297,Aetna,PPO,276.21,93,,percent of total billed charges,,
"Diagnostic Mammography, Including Computer-Aided Detection (Cad) When Performed; Bilateral (Pro Cah)Professional Component ",,77066,CPT,Professional,Both,,,26,297,252.45,29.88,297,America's PPO,America's PPO,253.7568,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Diagnostic Mammography, Including Computer-Aided Detection (Cad) When Performed; Bilateral (Pro Cah)Professional Component ",,77066,CPT,Professional,Both,,,26,297,252.45,29.88,297,BlueCross BlueShield Minnesota, Federal Employee Program,89.49,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Diagnostic Mammography, Including Computer-Aided Detection (Cad) When Performed; Bilateral (Pro Cah)Professional Component ",,77066,CPT,Professional,Both,,,26,297,252.45,29.88,297,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,90.92184,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Diagnostic Mammography, Including Computer-Aided Detection (Cad) When Performed; Bilateral (Pro Cah)Professional Component ",,77066,CPT,Professional,Both,,,26,297,252.45,29.88,297,BlueCross BlueShield Minnesota,High Value Network Plan,90.92184,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Diagnostic Mammography, Including Computer-Aided Detection (Cad) When Performed; Bilateral (Pro Cah)Professional Component ",,77066,CPT,Professional,Both,,,26,297,252.45,29.88,297,BlueCross BlueShield Minnesota,Medicare Advantage,53.774,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Diagnostic Mammography, Including Computer-Aided Detection (Cad) When Performed; Bilateral (Pro Cah)Professional Component ",,77066,CPT,Professional,Both,,,26,297,252.45,29.88,297,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,90.92184,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Diagnostic Mammography, Including Computer-Aided Detection (Cad) When Performed; Bilateral (Pro Cah)Professional Component ",,77066,CPT,Professional,Both,,,26,297,252.45,29.88,297,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,34.50336,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Diagnostic Mammography, Including Computer-Aided Detection (Cad) When Performed; Bilateral (Pro Cah)Professional Component ",,77066,CPT,Professional,Both,,,26,297,252.45,29.88,297,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),53.774,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Diagnostic Mammography, Including Computer-Aided Detection (Cad) When Performed; Bilateral (Pro Cah)Professional Component ",,77066,CPT,Professional,Both,,,26,297,252.45,29.88,297,CorVel,Worker's Compensation,92.8511061,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Diagnostic Mammography, Including Computer-Aided Detection (Cad) When Performed; Bilateral (Pro Cah)Professional Component ",,77066,CPT,Professional,Both,,,26,297,252.45,29.88,297,First Health Group Corporation,First Health Network,288.09,97,,percent of total billed charges,,
"Diagnostic Mammography, Including Computer-Aided Detection (Cad) When Performed; Bilateral (Pro Cah)Professional Component ",,77066,CPT,Professional,Both,,,26,297,252.45,29.88,297,"Health Partners, Inc.",Commercial,71.16,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Diagnostic Mammography, Including Computer-Aided Detection (Cad) When Performed; Bilateral (Pro Cah)Professional Component ",,77066,CPT,Professional,Both,,,26,297,252.45,29.88,297,"Health Partners, Inc.",Medicare Advantage,53.774,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Diagnostic Mammography, Including Computer-Aided Detection (Cad) When Performed; Bilateral (Pro Cah)Professional Component ",,77066,CPT,Professional,Both,,,26,297,252.45,29.88,297,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),29.88,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Diagnostic Mammography, Including Computer-Aided Detection (Cad) When Performed; Bilateral (Pro Cah)Professional Component ",,77066,CPT,Professional,Both,,,26,297,252.45,29.88,297,"Health Partners, Inc.",State of Minnesota Advantage Program,61.30434,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Diagnostic Mammography, Including Computer-Aided Detection (Cad) When Performed; Bilateral (Pro Cah)Professional Component ",,77066,CPT,Professional,Both,,,26,297,252.45,29.88,297,"Health Partners, Inc.",State Public Programs,29.88,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Diagnostic Mammography, Including Computer-Aided Detection (Cad) When Performed; Bilateral (Pro Cah)Professional Component ",,77066,CPT,Professional,Both,,,26,297,252.45,29.88,297,Humana Insurance Company,Commercial PPO,46.76,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Diagnostic Mammography, Including Computer-Aided Detection (Cad) When Performed; Bilateral (Pro Cah)Professional Component ",,77066,CPT,Professional,Both,,,26,297,252.45,29.88,297,Humana Insurance Company,Medicare PPO,297,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Diagnostic Mammography, Including Computer-Aided Detection (Cad) When Performed; Bilateral (Pro Cah)Professional Component ",,77066,CPT,Professional,Both,,,26,297,252.45,29.88,297,Medica,Individual & Family,251.856,84.8,,percent of total billed charges,,
"Diagnostic Mammography, Including Computer-Aided Detection (Cad) When Performed; Bilateral (Pro Cah)Professional Component ",,77066,CPT,Professional,Both,,,26,297,252.45,29.88,297,Medica,Medica Advantage Solution,147.906,49.8,,percent of total billed charges,,
"Diagnostic Mammography, Including Computer-Aided Detection (Cad) When Performed; Bilateral (Pro Cah)Professional Component ",,77066,CPT,Professional,Both,,,26,297,252.45,29.88,297,Medica,Medical Assistance,34.5,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Diagnostic Mammography, Including Computer-Aided Detection (Cad) When Performed; Bilateral (Pro Cah)Professional Component ",,77066,CPT,Professional,Both,,,26,297,252.45,29.88,297,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,46.76,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Diagnostic Mammography, Including Computer-Aided Detection (Cad) When Performed; Bilateral (Pro Cah)Professional Component ",,77066,CPT,Professional,Both,,,26,297,252.45,29.88,297,"Multiplan, Inc.","Multiplan, Inc.",279.18,94,,percent of total billed charges,,
"Diagnostic Mammography, Including Computer-Aided Detection (Cad) When Performed; Bilateral (Pro Cah)Professional Component ",,77066,CPT,Professional,Both,,,26,297,252.45,29.88,297,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,267.597,90.1,,percent of total billed charges,,
"Diagnostic Mammography, Including Computer-Aided Detection (Cad) When Performed; Bilateral (Pro Cah)Professional Component ",,77066,CPT,Professional,Both,,,26,297,252.45,29.88,297,"Preferred One Administrative Services, INC.",PPO,292.842,98.6,,percent of total billed charges,,
"Diagnostic Mammography, Including Computer-Aided Detection (Cad) When Performed; Bilateral (Pro Cah)Professional Component ",,77066,CPT,Professional,Both,,,26,297,252.45,29.88,297,PrimeWest Health,Minnesota Senior Health Options (MSHO),53.774,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Diagnostic Mammography, Including Computer-Aided Detection (Cad) When Performed; Bilateral (Pro Cah)Professional Component ",,77066,CPT,Professional,Both,,,26,297,252.45,29.88,297,PrimeWest Health,MinnesotaCare,36.9185952,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Diagnostic Mammography, Including Computer-Aided Detection (Cad) When Performed; Bilateral (Pro Cah)Professional Component ",,77066,CPT,Professional,Both,,,26,297,252.45,29.88,297,Sanford Health Plan,Sanford Health Plan,261.36,88,,percent of total billed charges,,
"Diagnostic Mammography, Including Computer-Aided Detection (Cad) When Performed; Bilateral (Pro Cah)Professional Component ",,77066,CPT,Professional,Both,,,26,297,252.45,29.88,297,"UCare Health, Inc.",Individual & Family Plan,76.013056,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Diagnostic Mammography, Including Computer-Aided Detection (Cad) When Performed; Bilateral (Pro Cah)Professional Component ",,77066,CPT,Professional,Both,,,26,297,252.45,29.88,297,"UCare Health, Inc.",Medical Assistance,37.953696,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Diagnostic Mammography, Including Computer-Aided Detection (Cad) When Performed; Bilateral (Pro Cah)Professional Component ",,77066,CPT,Professional,Both,,,26,297,252.45,29.88,297,"UCare Health, Inc.",Medicare Advantage,53.774,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Diagnostic Mammography, Including Computer-Aided Detection (Cad) When Performed; Bilateral (Pro Cah)Professional Component ",,77066,CPT,Professional,Both,,,26,297,252.45,29.88,297,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),43.0192,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Diagnostic Mammography, Including Computer-Aided Detection (Cad) When Performed; Bilateral (Pro Cah)Professional Component ",,77066,CPT,Professional,Both,,,26,297,252.45,29.88,297,UnitedHealthcare,Individual & Family,297,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Diagnostic Mammography, Including Computer-Aided Detection (Cad) When Performed; Bilateral (Pro Cah)Professional Component ",,77066,CPT,Professional,Both,,,26,297,252.45,29.88,297,UnitedHealthcare,Medicare Advantage,53.774,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Diagnostic Mammography, Including Computer-Aided Detection (Cad) When Performed; Bilateral (Pro Cah)Professional Component ",,77066,CPT,Professional,Both,,,26,297,252.45,29.88,297,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,34.50336,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Screening Mammography, Bilateral (2-View Study Of Each Breast), Incl Cad When Performed (Pro Cah)Professional Component ",,77067,CPT,Professional,Both,,,26,95,80.75,22.9,95,Aetna,Commercial,80.75,85,,percent of total billed charges,,
"Screening Mammography, Bilateral (2-View Study Of Each Breast), Incl Cad When Performed (Pro Cah)Professional Component ",,77067,CPT,Professional,Both,,,26,95,80.75,22.9,95,Aetna,Medicare Advantage,36.91,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Screening Mammography, Bilateral (2-View Study Of Each Breast), Incl Cad When Performed (Pro Cah)Professional Component ",,77067,CPT,Professional,Both,,,26,95,80.75,22.9,95,Aetna,PPO,88.35,93,,percent of total billed charges,,
"Screening Mammography, Bilateral (2-View Study Of Each Breast), Incl Cad When Performed (Pro Cah)Professional Component ",,77067,CPT,Professional,Both,,,26,95,80.75,22.9,95,America's PPO,America's PPO,81.168,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Screening Mammography, Bilateral (2-View Study Of Each Breast), Incl Cad When Performed (Pro Cah)Professional Component ",,77067,CPT,Professional,Both,,,26,95,80.75,22.9,95,BlueCross BlueShield Minnesota, Federal Employee Program,69.03,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Screening Mammography, Bilateral (2-View Study Of Each Breast), Incl Cad When Performed (Pro Cah)Professional Component ",,77067,CPT,Professional,Both,,,26,95,80.75,22.9,95,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,70.13448,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Screening Mammography, Bilateral (2-View Study Of Each Breast), Incl Cad When Performed (Pro Cah)Professional Component ",,77067,CPT,Professional,Both,,,26,95,80.75,22.9,95,BlueCross BlueShield Minnesota,High Value Network Plan,70.13448,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Screening Mammography, Bilateral (2-View Study Of Each Breast), Incl Cad When Performed (Pro Cah)Professional Component ",,77067,CPT,Professional,Both,,,26,95,80.75,22.9,95,BlueCross BlueShield Minnesota,Medicare Advantage,41.239,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Screening Mammography, Bilateral (2-View Study Of Each Breast), Incl Cad When Performed (Pro Cah)Professional Component ",,77067,CPT,Professional,Both,,,26,95,80.75,22.9,95,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,70.13448,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Screening Mammography, Bilateral (2-View Study Of Each Breast), Incl Cad When Performed (Pro Cah)Professional Component ",,77067,CPT,Professional,Both,,,26,95,80.75,22.9,95,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,26.43632,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Screening Mammography, Bilateral (2-View Study Of Each Breast), Incl Cad When Performed (Pro Cah)Professional Component ",,77067,CPT,Professional,Both,,,26,95,80.75,22.9,95,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),41.239,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Screening Mammography, Bilateral (2-View Study Of Each Breast), Incl Cad When Performed (Pro Cah)Professional Component ",,77067,CPT,Professional,Both,,,26,95,80.75,22.9,95,CorVel,Worker's Compensation,70.3693071,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Screening Mammography, Bilateral (2-View Study Of Each Breast), Incl Cad When Performed (Pro Cah)Professional Component ",,77067,CPT,Professional,Both,,,26,95,80.75,22.9,95,First Health Group Corporation,First Health Network,92.15,97,,percent of total billed charges,,
"Screening Mammography, Bilateral (2-View Study Of Each Breast), Incl Cad When Performed (Pro Cah)Professional Component ",,77067,CPT,Professional,Both,,,26,95,80.75,22.9,95,"Health Partners, Inc.",Commercial,53.62,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Screening Mammography, Bilateral (2-View Study Of Each Breast), Incl Cad When Performed (Pro Cah)Professional Component ",,77067,CPT,Professional,Both,,,26,95,80.75,22.9,95,"Health Partners, Inc.",Medicare Advantage,41.239,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Screening Mammography, Bilateral (2-View Study Of Each Breast), Incl Cad When Performed (Pro Cah)Professional Component ",,77067,CPT,Professional,Both,,,26,95,80.75,22.9,95,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),22.9,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Screening Mammography, Bilateral (2-View Study Of Each Breast), Incl Cad When Performed (Pro Cah)Professional Component ",,77067,CPT,Professional,Both,,,26,95,80.75,22.9,95,"Health Partners, Inc.",State of Minnesota Advantage Program,46.19363,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Screening Mammography, Bilateral (2-View Study Of Each Breast), Incl Cad When Performed (Pro Cah)Professional Component ",,77067,CPT,Professional,Both,,,26,95,80.75,22.9,95,"Health Partners, Inc.",State Public Programs,22.9,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Screening Mammography, Bilateral (2-View Study Of Each Breast), Incl Cad When Performed (Pro Cah)Professional Component ",,77067,CPT,Professional,Both,,,26,95,80.75,22.9,95,Humana Insurance Company,Commercial PPO,35.86,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Screening Mammography, Bilateral (2-View Study Of Each Breast), Incl Cad When Performed (Pro Cah)Professional Component ",,77067,CPT,Professional,Both,,,26,95,80.75,22.9,95,Humana Insurance Company,Medicare PPO,95,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Screening Mammography, Bilateral (2-View Study Of Each Breast), Incl Cad When Performed (Pro Cah)Professional Component ",,77067,CPT,Professional,Both,,,26,95,80.75,22.9,95,Medica,Individual & Family,80.56,84.8,,percent of total billed charges,,
"Screening Mammography, Bilateral (2-View Study Of Each Breast), Incl Cad When Performed (Pro Cah)Professional Component ",,77067,CPT,Professional,Both,,,26,95,80.75,22.9,95,Medica,Medica Advantage Solution,47.31,49.8,,percent of total billed charges,,
"Screening Mammography, Bilateral (2-View Study Of Each Breast), Incl Cad When Performed (Pro Cah)Professional Component ",,77067,CPT,Professional,Both,,,26,95,80.75,22.9,95,Medica,Medical Assistance,26.44,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Screening Mammography, Bilateral (2-View Study Of Each Breast), Incl Cad When Performed (Pro Cah)Professional Component ",,77067,CPT,Professional,Both,,,26,95,80.75,22.9,95,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,35.86,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Screening Mammography, Bilateral (2-View Study Of Each Breast), Incl Cad When Performed (Pro Cah)Professional Component ",,77067,CPT,Professional,Both,,,26,95,80.75,22.9,95,"Multiplan, Inc.","Multiplan, Inc.",89.3,94,,percent of total billed charges,,
"Screening Mammography, Bilateral (2-View Study Of Each Breast), Incl Cad When Performed (Pro Cah)Professional Component ",,77067,CPT,Professional,Both,,,26,95,80.75,22.9,95,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,85.595,90.1,,percent of total billed charges,,
"Screening Mammography, Bilateral (2-View Study Of Each Breast), Incl Cad When Performed (Pro Cah)Professional Component ",,77067,CPT,Professional,Both,,,26,95,80.75,22.9,95,"Preferred One Administrative Services, INC.",PPO,93.67,98.6,,percent of total billed charges,,
"Screening Mammography, Bilateral (2-View Study Of Each Breast), Incl Cad When Performed (Pro Cah)Professional Component ",,77067,CPT,Professional,Both,,,26,95,80.75,22.9,95,PrimeWest Health,Minnesota Senior Health Options (MSHO),41.239,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Screening Mammography, Bilateral (2-View Study Of Each Breast), Incl Cad When Performed (Pro Cah)Professional Component ",,77067,CPT,Professional,Both,,,26,95,80.75,22.9,95,PrimeWest Health,MinnesotaCare,28.2868624,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Screening Mammography, Bilateral (2-View Study Of Each Breast), Incl Cad When Performed (Pro Cah)Professional Component ",,77067,CPT,Professional,Both,,,26,95,80.75,22.9,95,Sanford Health Plan,Sanford Health Plan,83.6,88,,percent of total billed charges,,
"Screening Mammography, Bilateral (2-View Study Of Each Breast), Incl Cad When Performed (Pro Cah)Professional Component ",,77067,CPT,Professional,Both,,,26,95,80.75,22.9,95,"UCare Health, Inc.",Individual & Family Plan,58.294016,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Screening Mammography, Bilateral (2-View Study Of Each Breast), Incl Cad When Performed (Pro Cah)Professional Component ",,77067,CPT,Professional,Both,,,26,95,80.75,22.9,95,"UCare Health, Inc.",Medical Assistance,29.079952,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Screening Mammography, Bilateral (2-View Study Of Each Breast), Incl Cad When Performed (Pro Cah)Professional Component ",,77067,CPT,Professional,Both,,,26,95,80.75,22.9,95,"UCare Health, Inc.",Medicare Advantage,41.239,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Screening Mammography, Bilateral (2-View Study Of Each Breast), Incl Cad When Performed (Pro Cah)Professional Component ",,77067,CPT,Professional,Both,,,26,95,80.75,22.9,95,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),32.9912,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Screening Mammography, Bilateral (2-View Study Of Each Breast), Incl Cad When Performed (Pro Cah)Professional Component ",,77067,CPT,Professional,Both,,,26,95,80.75,22.9,95,UnitedHealthcare,Individual & Family,95,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Screening Mammography, Bilateral (2-View Study Of Each Breast), Incl Cad When Performed (Pro Cah)Professional Component ",,77067,CPT,Professional,Both,,,26,95,80.75,22.9,95,UnitedHealthcare,Medicare Advantage,41.239,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Screening Mammography, Bilateral (2-View Study Of Each Breast), Incl Cad When Performed (Pro Cah)Professional Component ",,77067,CPT,Professional,Both,,,26,95,80.75,22.9,95,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,26.43632,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Bone Age (Pro Cah)Professional Component ,,77072,CPT,Professional,Both,,,26,61,51.85,5.67,61,Aetna,Commercial,51.85,85,,percent of total billed charges,,
Xr Bone Age (Pro Cah)Professional Component ,,77072,CPT,Professional,Both,,,26,61,51.85,5.67,61,Aetna,Medicare Advantage,9.23,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Bone Age (Pro Cah)Professional Component ,,77072,CPT,Professional,Both,,,26,61,51.85,5.67,61,Aetna,PPO,56.73,93,,percent of total billed charges,,
Xr Bone Age (Pro Cah)Professional Component ,,77072,CPT,Professional,Both,,,26,61,51.85,5.67,61,America's PPO,America's PPO,52.1184,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Xr Bone Age (Pro Cah)Professional Component ,,77072,CPT,Professional,Both,,,26,61,51.85,5.67,61,BlueCross BlueShield Minnesota, Federal Employee Program,17.26,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Xr Bone Age (Pro Cah)Professional Component ,,77072,CPT,Professional,Both,,,26,61,51.85,5.67,61,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,17.53616,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Bone Age (Pro Cah)Professional Component ,,77072,CPT,Professional,Both,,,26,61,51.85,5.67,61,BlueCross BlueShield Minnesota,High Value Network Plan,17.53616,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Bone Age (Pro Cah)Professional Component ,,77072,CPT,Professional,Both,,,26,61,51.85,5.67,61,BlueCross BlueShield Minnesota,Medicare Advantage,10.3155,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Bone Age (Pro Cah)Professional Component ,,77072,CPT,Professional,Both,,,26,61,51.85,5.67,61,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,17.53616,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Bone Age (Pro Cah)Professional Component ,,77072,CPT,Professional,Both,,,26,61,51.85,5.67,61,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,6.54304,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Bone Age (Pro Cah)Professional Component ,,77072,CPT,Professional,Both,,,26,61,51.85,5.67,61,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),10.3155,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Bone Age (Pro Cah)Professional Component ,,77072,CPT,Professional,Both,,,26,61,51.85,5.67,61,CorVel,Worker's Compensation,17.7624348,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Xr Bone Age (Pro Cah)Professional Component ,,77072,CPT,Professional,Both,,,26,61,51.85,5.67,61,First Health Group Corporation,First Health Network,59.17,97,,percent of total billed charges,,
Xr Bone Age (Pro Cah)Professional Component ,,77072,CPT,Professional,Both,,,26,61,51.85,5.67,61,"Health Partners, Inc.",Commercial,13.41,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Xr Bone Age (Pro Cah)Professional Component ,,77072,CPT,Professional,Both,,,26,61,51.85,5.67,61,"Health Partners, Inc.",Medicare Advantage,10.3155,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Bone Age (Pro Cah)Professional Component ,,77072,CPT,Professional,Both,,,26,61,51.85,5.67,61,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),5.67,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Xr Bone Age (Pro Cah)Professional Component ,,77072,CPT,Professional,Both,,,26,61,51.85,5.67,61,"Health Partners, Inc.",State of Minnesota Advantage Program,11.552715,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Xr Bone Age (Pro Cah)Professional Component ,,77072,CPT,Professional,Both,,,26,61,51.85,5.67,61,"Health Partners, Inc.",State Public Programs,5.67,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Xr Bone Age (Pro Cah)Professional Component ,,77072,CPT,Professional,Both,,,26,61,51.85,5.67,61,Humana Insurance Company,Commercial PPO,8.97,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Xr Bone Age (Pro Cah)Professional Component ,,77072,CPT,Professional,Both,,,26,61,51.85,5.67,61,Humana Insurance Company,Medicare PPO,61,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Xr Bone Age (Pro Cah)Professional Component ,,77072,CPT,Professional,Both,,,26,61,51.85,5.67,61,Medica,Individual & Family,51.728,84.8,,percent of total billed charges,,
Xr Bone Age (Pro Cah)Professional Component ,,77072,CPT,Professional,Both,,,26,61,51.85,5.67,61,Medica,Medica Advantage Solution,30.378,49.8,,percent of total billed charges,,
Xr Bone Age (Pro Cah)Professional Component ,,77072,CPT,Professional,Both,,,26,61,51.85,5.67,61,Medica,Medical Assistance,6.54,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Xr Bone Age (Pro Cah)Professional Component ,,77072,CPT,Professional,Both,,,26,61,51.85,5.67,61,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,8.97,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Xr Bone Age (Pro Cah)Professional Component ,,77072,CPT,Professional,Both,,,26,61,51.85,5.67,61,"Multiplan, Inc.","Multiplan, Inc.",57.34,94,,percent of total billed charges,,
Xr Bone Age (Pro Cah)Professional Component ,,77072,CPT,Professional,Both,,,26,61,51.85,5.67,61,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,54.961,90.1,,percent of total billed charges,,
Xr Bone Age (Pro Cah)Professional Component ,,77072,CPT,Professional,Both,,,26,61,51.85,5.67,61,"Preferred One Administrative Services, INC.",PPO,60.146,98.6,,percent of total billed charges,,
Xr Bone Age (Pro Cah)Professional Component ,,77072,CPT,Professional,Both,,,26,61,51.85,5.67,61,PrimeWest Health,Minnesota Senior Health Options (MSHO),10.3155,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Bone Age (Pro Cah)Professional Component ,,77072,CPT,Professional,Both,,,26,61,51.85,5.67,61,PrimeWest Health,MinnesotaCare,7.0010528,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Bone Age (Pro Cah)Professional Component ,,77072,CPT,Professional,Both,,,26,61,51.85,5.67,61,Sanford Health Plan,Sanford Health Plan,53.68,88,,percent of total billed charges,,
Xr Bone Age (Pro Cah)Professional Component ,,77072,CPT,Professional,Both,,,26,61,51.85,5.67,61,"UCare Health, Inc.",Individual & Family Plan,14.581632,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Xr Bone Age (Pro Cah)Professional Component ,,77072,CPT,Professional,Both,,,26,61,51.85,5.67,61,"UCare Health, Inc.",Medical Assistance,7.197344,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Xr Bone Age (Pro Cah)Professional Component ,,77072,CPT,Professional,Both,,,26,61,51.85,5.67,61,"UCare Health, Inc.",Medicare Advantage,10.3155,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Xr Bone Age (Pro Cah)Professional Component ,,77072,CPT,Professional,Both,,,26,61,51.85,5.67,61,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),8.2524,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Xr Bone Age (Pro Cah)Professional Component ,,77072,CPT,Professional,Both,,,26,61,51.85,5.67,61,UnitedHealthcare,Individual & Family,61,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Xr Bone Age (Pro Cah)Professional Component ,,77072,CPT,Professional,Both,,,26,61,51.85,5.67,61,UnitedHealthcare,Medicare Advantage,10.3155,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Bone Age (Pro Cah)Professional Component ,,77072,CPT,Professional,Both,,,26,61,51.85,5.67,61,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,6.54304,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Bone Survey Complete (Pro Cah)Professional Component ,,77075,CPT,Professional,Both,,,26,140,119,16.58,140,Aetna,Commercial,119,85,,percent of total billed charges,,
Xr Bone Survey Complete (Pro Cah)Professional Component ,,77075,CPT,Professional,Both,,,26,140,119,16.58,140,Aetna,Medicare Advantage,26.75,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Bone Survey Complete (Pro Cah)Professional Component ,,77075,CPT,Professional,Both,,,26,140,119,16.58,140,Aetna,PPO,130.2,93,,percent of total billed charges,,
Xr Bone Survey Complete (Pro Cah)Professional Component ,,77075,CPT,Professional,Both,,,26,140,119,16.58,140,America's PPO,America's PPO,119.616,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Xr Bone Survey Complete (Pro Cah)Professional Component ,,77075,CPT,Professional,Both,,,26,140,119,16.58,140,BlueCross BlueShield Minnesota, Federal Employee Program,50.5,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Xr Bone Survey Complete (Pro Cah)Professional Component ,,77075,CPT,Professional,Both,,,26,140,119,16.58,140,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,51.308,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Bone Survey Complete (Pro Cah)Professional Component ,,77075,CPT,Professional,Both,,,26,140,119,16.58,140,BlueCross BlueShield Minnesota,High Value Network Plan,51.308,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Bone Survey Complete (Pro Cah)Professional Component ,,77075,CPT,Professional,Both,,,26,140,119,16.58,140,BlueCross BlueShield Minnesota,Medicare Advantage,29.8885,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Bone Survey Complete (Pro Cah)Professional Component ,,77075,CPT,Professional,Both,,,26,140,119,16.58,140,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,51.308,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Xr Bone Survey Complete (Pro Cah)Professional Component ,,77075,CPT,Professional,Both,,,26,140,119,16.58,140,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,19.14144,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Bone Survey Complete (Pro Cah)Professional Component ,,77075,CPT,Professional,Both,,,26,140,119,16.58,140,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),29.8885,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Bone Survey Complete (Pro Cah)Professional Component ,,77075,CPT,Professional,Both,,,26,140,119,16.58,140,CorVel,Worker's Compensation,51.5005824,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Xr Bone Survey Complete (Pro Cah)Professional Component ,,77075,CPT,Professional,Both,,,26,140,119,16.58,140,First Health Group Corporation,First Health Network,135.8,97,,percent of total billed charges,,
Xr Bone Survey Complete (Pro Cah)Professional Component ,,77075,CPT,Professional,Both,,,26,140,119,16.58,140,"Health Partners, Inc.",Commercial,39.19,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Xr Bone Survey Complete (Pro Cah)Professional Component ,,77075,CPT,Professional,Both,,,26,140,119,16.58,140,"Health Partners, Inc.",Medicare Advantage,29.8885,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Bone Survey Complete (Pro Cah)Professional Component ,,77075,CPT,Professional,Both,,,26,140,119,16.58,140,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),16.58,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Xr Bone Survey Complete (Pro Cah)Professional Component ,,77075,CPT,Professional,Both,,,26,140,119,16.58,140,"Health Partners, Inc.",State of Minnesota Advantage Program,33.762185,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Xr Bone Survey Complete (Pro Cah)Professional Component ,,77075,CPT,Professional,Both,,,26,140,119,16.58,140,"Health Partners, Inc.",State Public Programs,16.58,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Xr Bone Survey Complete (Pro Cah)Professional Component ,,77075,CPT,Professional,Both,,,26,140,119,16.58,140,Humana Insurance Company,Commercial PPO,25.99,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Xr Bone Survey Complete (Pro Cah)Professional Component ,,77075,CPT,Professional,Both,,,26,140,119,16.58,140,Humana Insurance Company,Medicare PPO,140,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Xr Bone Survey Complete (Pro Cah)Professional Component ,,77075,CPT,Professional,Both,,,26,140,119,16.58,140,Medica,Individual & Family,118.72,84.8,,percent of total billed charges,,
Xr Bone Survey Complete (Pro Cah)Professional Component ,,77075,CPT,Professional,Both,,,26,140,119,16.58,140,Medica,Medica Advantage Solution,69.72,49.8,,percent of total billed charges,,
Xr Bone Survey Complete (Pro Cah)Professional Component ,,77075,CPT,Professional,Both,,,26,140,119,16.58,140,Medica,Medical Assistance,19.14,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Xr Bone Survey Complete (Pro Cah)Professional Component ,,77075,CPT,Professional,Both,,,26,140,119,16.58,140,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,25.99,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Xr Bone Survey Complete (Pro Cah)Professional Component ,,77075,CPT,Professional,Both,,,26,140,119,16.58,140,"Multiplan, Inc.","Multiplan, Inc.",131.6,94,,percent of total billed charges,,
Xr Bone Survey Complete (Pro Cah)Professional Component ,,77075,CPT,Professional,Both,,,26,140,119,16.58,140,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,126.14,90.1,,percent of total billed charges,,
Xr Bone Survey Complete (Pro Cah)Professional Component ,,77075,CPT,Professional,Both,,,26,140,119,16.58,140,"Preferred One Administrative Services, INC.",PPO,138.04,98.6,,percent of total billed charges,,
Xr Bone Survey Complete (Pro Cah)Professional Component ,,77075,CPT,Professional,Both,,,26,140,119,16.58,140,PrimeWest Health,Minnesota Senior Health Options (MSHO),29.8885,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Bone Survey Complete (Pro Cah)Professional Component ,,77075,CPT,Professional,Both,,,26,140,119,16.58,140,PrimeWest Health,MinnesotaCare,20.4813408,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Bone Survey Complete (Pro Cah)Professional Component ,,77075,CPT,Professional,Both,,,26,140,119,16.58,140,Sanford Health Plan,Sanford Health Plan,123.2,88,,percent of total billed charges,,
Xr Bone Survey Complete (Pro Cah)Professional Component ,,77075,CPT,Professional,Both,,,26,140,119,16.58,140,"UCare Health, Inc.",Individual & Family Plan,42.249344,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Xr Bone Survey Complete (Pro Cah)Professional Component ,,77075,CPT,Professional,Both,,,26,140,119,16.58,140,"UCare Health, Inc.",Medical Assistance,21.055584,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Xr Bone Survey Complete (Pro Cah)Professional Component ,,77075,CPT,Professional,Both,,,26,140,119,16.58,140,"UCare Health, Inc.",Medicare Advantage,29.8885,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Xr Bone Survey Complete (Pro Cah)Professional Component ,,77075,CPT,Professional,Both,,,26,140,119,16.58,140,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),23.9108,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Xr Bone Survey Complete (Pro Cah)Professional Component ,,77075,CPT,Professional,Both,,,26,140,119,16.58,140,UnitedHealthcare,Individual & Family,140,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Xr Bone Survey Complete (Pro Cah)Professional Component ,,77075,CPT,Professional,Both,,,26,140,119,16.58,140,UnitedHealthcare,Medicare Advantage,29.8885,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Xr Bone Survey Complete (Pro Cah)Professional Component ,,77075,CPT,Professional,Both,,,26,140,119,16.58,140,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,19.14144,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Radiologic Exam Osseous Survy, Infant (Pro Cah)Professional Component ",,77076,CPT,Professional,Both,,,26,200,170,21.16,200,Aetna,Commercial,170,85,,percent of total billed charges,,
"Radiologic Exam Osseous Survy, Infant (Pro Cah)Professional Component ",,77076,CPT,Professional,Both,,,26,200,170,21.16,200,Aetna,Medicare Advantage,33.75,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Radiologic Exam Osseous Survy, Infant (Pro Cah)Professional Component ",,77076,CPT,Professional,Both,,,26,200,170,21.16,200,Aetna,PPO,186,93,,percent of total billed charges,,
"Radiologic Exam Osseous Survy, Infant (Pro Cah)Professional Component ",,77076,CPT,Professional,Both,,,26,200,170,21.16,200,America's PPO,America's PPO,170.88,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Radiologic Exam Osseous Survy, Infant (Pro Cah)Professional Component ",,77076,CPT,Professional,Both,,,26,200,170,21.16,200,BlueCross BlueShield Minnesota, Federal Employee Program,63.92,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Radiologic Exam Osseous Survy, Infant (Pro Cah)Professional Component ",,77076,CPT,Professional,Both,,,26,200,170,21.16,200,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,64.94272,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Radiologic Exam Osseous Survy, Infant (Pro Cah)Professional Component ",,77076,CPT,Professional,Both,,,26,200,170,21.16,200,BlueCross BlueShield Minnesota,High Value Network Plan,64.94272,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Radiologic Exam Osseous Survy, Infant (Pro Cah)Professional Component ",,77076,CPT,Professional,Both,,,26,200,170,21.16,200,BlueCross BlueShield Minnesota,Medicare Advantage,38.111,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Radiologic Exam Osseous Survy, Infant (Pro Cah)Professional Component ",,77076,CPT,Professional,Both,,,26,200,170,21.16,200,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,64.94272,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Radiologic Exam Osseous Survy, Infant (Pro Cah)Professional Component ",,77076,CPT,Professional,Both,,,26,200,170,21.16,200,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,24.42464,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Radiologic Exam Osseous Survy, Infant (Pro Cah)Professional Component ",,77076,CPT,Professional,Both,,,26,200,170,21.16,200,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),38.111,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Radiologic Exam Osseous Survy, Infant (Pro Cah)Professional Component ",,77076,CPT,Professional,Both,,,26,200,170,21.16,200,CorVel,Worker's Compensation,64.9782429,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Radiologic Exam Osseous Survy, Infant (Pro Cah)Professional Component ",,77076,CPT,Professional,Both,,,26,200,170,21.16,200,First Health Group Corporation,First Health Network,194,97,,percent of total billed charges,,
"Radiologic Exam Osseous Survy, Infant (Pro Cah)Professional Component ",,77076,CPT,Professional,Both,,,26,200,170,21.16,200,"Health Partners, Inc.",Commercial,49.5,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Radiologic Exam Osseous Survy, Infant (Pro Cah)Professional Component ",,77076,CPT,Professional,Both,,,26,200,170,21.16,200,"Health Partners, Inc.",Medicare Advantage,38.111,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Radiologic Exam Osseous Survy, Infant (Pro Cah)Professional Component ",,77076,CPT,Professional,Both,,,26,200,170,21.16,200,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),21.16,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Radiologic Exam Osseous Survy, Infant (Pro Cah)Professional Component ",,77076,CPT,Professional,Both,,,26,200,170,21.16,200,"Health Partners, Inc.",State of Minnesota Advantage Program,42.64425,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Radiologic Exam Osseous Survy, Infant (Pro Cah)Professional Component ",,77076,CPT,Professional,Both,,,26,200,170,21.16,200,"Health Partners, Inc.",State Public Programs,21.16,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Radiologic Exam Osseous Survy, Infant (Pro Cah)Professional Component ",,77076,CPT,Professional,Both,,,26,200,170,21.16,200,Humana Insurance Company,Commercial PPO,33.14,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Radiologic Exam Osseous Survy, Infant (Pro Cah)Professional Component ",,77076,CPT,Professional,Both,,,26,200,170,21.16,200,Humana Insurance Company,Medicare PPO,200,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Radiologic Exam Osseous Survy, Infant (Pro Cah)Professional Component ",,77076,CPT,Professional,Both,,,26,200,170,21.16,200,Medica,Individual & Family,169.6,84.8,,percent of total billed charges,,
"Radiologic Exam Osseous Survy, Infant (Pro Cah)Professional Component ",,77076,CPT,Professional,Both,,,26,200,170,21.16,200,Medica,Medica Advantage Solution,99.6,49.8,,percent of total billed charges,,
"Radiologic Exam Osseous Survy, Infant (Pro Cah)Professional Component ",,77076,CPT,Professional,Both,,,26,200,170,21.16,200,Medica,Medical Assistance,24.42,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Radiologic Exam Osseous Survy, Infant (Pro Cah)Professional Component ",,77076,CPT,Professional,Both,,,26,200,170,21.16,200,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,33.14,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Radiologic Exam Osseous Survy, Infant (Pro Cah)Professional Component ",,77076,CPT,Professional,Both,,,26,200,170,21.16,200,"Multiplan, Inc.","Multiplan, Inc.",188,94,,percent of total billed charges,,
"Radiologic Exam Osseous Survy, Infant (Pro Cah)Professional Component ",,77076,CPT,Professional,Both,,,26,200,170,21.16,200,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,180.2,90.1,,percent of total billed charges,,
"Radiologic Exam Osseous Survy, Infant (Pro Cah)Professional Component ",,77076,CPT,Professional,Both,,,26,200,170,21.16,200,"Preferred One Administrative Services, INC.",PPO,197.2,98.6,,percent of total billed charges,,
"Radiologic Exam Osseous Survy, Infant (Pro Cah)Professional Component ",,77076,CPT,Professional,Both,,,26,200,170,21.16,200,PrimeWest Health,Minnesota Senior Health Options (MSHO),38.111,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Radiologic Exam Osseous Survy, Infant (Pro Cah)Professional Component ",,77076,CPT,Professional,Both,,,26,200,170,21.16,200,PrimeWest Health,MinnesotaCare,26.1343648,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Radiologic Exam Osseous Survy, Infant (Pro Cah)Professional Component ",,77076,CPT,Professional,Both,,,26,200,170,21.16,200,Sanford Health Plan,Sanford Health Plan,176,88,,percent of total billed charges,,
"Radiologic Exam Osseous Survy, Infant (Pro Cah)Professional Component ",,77076,CPT,Professional,Both,,,26,200,170,21.16,200,"UCare Health, Inc.",Individual & Family Plan,53.872384,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Radiologic Exam Osseous Survy, Infant (Pro Cah)Professional Component ",,77076,CPT,Professional,Both,,,26,200,170,21.16,200,"UCare Health, Inc.",Medical Assistance,26.867104,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Radiologic Exam Osseous Survy, Infant (Pro Cah)Professional Component ",,77076,CPT,Professional,Both,,,26,200,170,21.16,200,"UCare Health, Inc.",Medicare Advantage,38.111,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Radiologic Exam Osseous Survy, Infant (Pro Cah)Professional Component ",,77076,CPT,Professional,Both,,,26,200,170,21.16,200,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),30.4888,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Radiologic Exam Osseous Survy, Infant (Pro Cah)Professional Component ",,77076,CPT,Professional,Both,,,26,200,170,21.16,200,UnitedHealthcare,Individual & Family,200,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Radiologic Exam Osseous Survy, Infant (Pro Cah)Professional Component ",,77076,CPT,Professional,Both,,,26,200,170,21.16,200,UnitedHealthcare,Medicare Advantage,38.111,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Radiologic Exam Osseous Survy, Infant (Pro Cah)Professional Component ",,77076,CPT,Professional,Both,,,26,200,170,21.16,200,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,24.42464,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Joint Survey, Single View, 2 Or More Joints (Pro Cah)Professional Component ",,77077,CPT,Professional,Both,,,26,105,89.25,10.25,105,Aetna,Commercial,89.25,85,,percent of total billed charges,,
"Joint Survey, Single View, 2 Or More Joints (Pro Cah)Professional Component ",,77077,CPT,Professional,Both,,,26,105,89.25,10.25,105,Aetna,Medicare Advantage,16.71,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Joint Survey, Single View, 2 Or More Joints (Pro Cah)Professional Component ",,77077,CPT,Professional,Both,,,26,105,89.25,10.25,105,Aetna,PPO,97.65,93,,percent of total billed charges,,
"Joint Survey, Single View, 2 Or More Joints (Pro Cah)Professional Component ",,77077,CPT,Professional,Both,,,26,105,89.25,10.25,105,America's PPO,America's PPO,89.712,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Joint Survey, Single View, 2 Or More Joints (Pro Cah)Professional Component ",,77077,CPT,Professional,Both,,,26,105,89.25,10.25,105,BlueCross BlueShield Minnesota, Federal Employee Program,31.32,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Joint Survey, Single View, 2 Or More Joints (Pro Cah)Professional Component ",,77077,CPT,Professional,Both,,,26,105,89.25,10.25,105,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,31.82112,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Joint Survey, Single View, 2 Or More Joints (Pro Cah)Professional Component ",,77077,CPT,Professional,Both,,,26,105,89.25,10.25,105,BlueCross BlueShield Minnesota,High Value Network Plan,31.82112,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Joint Survey, Single View, 2 Or More Joints (Pro Cah)Professional Component ",,77077,CPT,Professional,Both,,,26,105,89.25,10.25,105,BlueCross BlueShield Minnesota,Medicare Advantage,18.676,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Joint Survey, Single View, 2 Or More Joints (Pro Cah)Professional Component ",,77077,CPT,Professional,Both,,,26,105,89.25,10.25,105,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,31.82112,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Joint Survey, Single View, 2 Or More Joints (Pro Cah)Professional Component ",,77077,CPT,Professional,Both,,,26,105,89.25,10.25,105,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,11.8364,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Joint Survey, Single View, 2 Or More Joints (Pro Cah)Professional Component ",,77077,CPT,Professional,Both,,,26,105,89.25,10.25,105,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),18.676,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Joint Survey, Single View, 2 Or More Joints (Pro Cah)Professional Component ",,77077,CPT,Professional,Both,,,26,105,89.25,10.25,105,CorVel,Worker's Compensation,32.1663696,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Joint Survey, Single View, 2 Or More Joints (Pro Cah)Professional Component ",,77077,CPT,Professional,Both,,,26,105,89.25,10.25,105,First Health Group Corporation,First Health Network,101.85,97,,percent of total billed charges,,
"Joint Survey, Single View, 2 Or More Joints (Pro Cah)Professional Component ",,77077,CPT,Professional,Both,,,26,105,89.25,10.25,105,"Health Partners, Inc.",Commercial,24.75,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Joint Survey, Single View, 2 Or More Joints (Pro Cah)Professional Component ",,77077,CPT,Professional,Both,,,26,105,89.25,10.25,105,"Health Partners, Inc.",Medicare Advantage,18.676,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Joint Survey, Single View, 2 Or More Joints (Pro Cah)Professional Component ",,77077,CPT,Professional,Both,,,26,105,89.25,10.25,105,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),10.25,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Joint Survey, Single View, 2 Or More Joints (Pro Cah)Professional Component ",,77077,CPT,Professional,Both,,,26,105,89.25,10.25,105,"Health Partners, Inc.",State of Minnesota Advantage Program,21.322125,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Joint Survey, Single View, 2 Or More Joints (Pro Cah)Professional Component ",,77077,CPT,Professional,Both,,,26,105,89.25,10.25,105,"Health Partners, Inc.",State Public Programs,10.25,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Joint Survey, Single View, 2 Or More Joints (Pro Cah)Professional Component ",,77077,CPT,Professional,Both,,,26,105,89.25,10.25,105,Humana Insurance Company,Commercial PPO,16.24,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Joint Survey, Single View, 2 Or More Joints (Pro Cah)Professional Component ",,77077,CPT,Professional,Both,,,26,105,89.25,10.25,105,Humana Insurance Company,Medicare PPO,105,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Joint Survey, Single View, 2 Or More Joints (Pro Cah)Professional Component ",,77077,CPT,Professional,Both,,,26,105,89.25,10.25,105,Medica,Individual & Family,89.04,84.8,,percent of total billed charges,,
"Joint Survey, Single View, 2 Or More Joints (Pro Cah)Professional Component ",,77077,CPT,Professional,Both,,,26,105,89.25,10.25,105,Medica,Medica Advantage Solution,52.29,49.8,,percent of total billed charges,,
"Joint Survey, Single View, 2 Or More Joints (Pro Cah)Professional Component ",,77077,CPT,Professional,Both,,,26,105,89.25,10.25,105,Medica,Medical Assistance,11.84,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Joint Survey, Single View, 2 Or More Joints (Pro Cah)Professional Component ",,77077,CPT,Professional,Both,,,26,105,89.25,10.25,105,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,16.24,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Joint Survey, Single View, 2 Or More Joints (Pro Cah)Professional Component ",,77077,CPT,Professional,Both,,,26,105,89.25,10.25,105,"Multiplan, Inc.","Multiplan, Inc.",98.7,94,,percent of total billed charges,,
"Joint Survey, Single View, 2 Or More Joints (Pro Cah)Professional Component ",,77077,CPT,Professional,Both,,,26,105,89.25,10.25,105,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,94.605,90.1,,percent of total billed charges,,
"Joint Survey, Single View, 2 Or More Joints (Pro Cah)Professional Component ",,77077,CPT,Professional,Both,,,26,105,89.25,10.25,105,"Preferred One Administrative Services, INC.",PPO,103.53,98.6,,percent of total billed charges,,
"Joint Survey, Single View, 2 Or More Joints (Pro Cah)Professional Component ",,77077,CPT,Professional,Both,,,26,105,89.25,10.25,105,PrimeWest Health,Minnesota Senior Health Options (MSHO),18.676,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Joint Survey, Single View, 2 Or More Joints (Pro Cah)Professional Component ",,77077,CPT,Professional,Both,,,26,105,89.25,10.25,105,PrimeWest Health,MinnesotaCare,12.664948,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Joint Survey, Single View, 2 Or More Joints (Pro Cah)Professional Component ",,77077,CPT,Professional,Both,,,26,105,89.25,10.25,105,Sanford Health Plan,Sanford Health Plan,92.4,88,,percent of total billed charges,,
"Joint Survey, Single View, 2 Or More Joints (Pro Cah)Professional Component ",,77077,CPT,Professional,Both,,,26,105,89.25,10.25,105,"UCare Health, Inc.",Individual & Family Plan,26.399744,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Joint Survey, Single View, 2 Or More Joints (Pro Cah)Professional Component ",,77077,CPT,Professional,Both,,,26,105,89.25,10.25,105,"UCare Health, Inc.",Medical Assistance,13.02004,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Joint Survey, Single View, 2 Or More Joints (Pro Cah)Professional Component ",,77077,CPT,Professional,Both,,,26,105,89.25,10.25,105,"UCare Health, Inc.",Medicare Advantage,18.676,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Joint Survey, Single View, 2 Or More Joints (Pro Cah)Professional Component ",,77077,CPT,Professional,Both,,,26,105,89.25,10.25,105,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),14.9408,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Joint Survey, Single View, 2 Or More Joints (Pro Cah)Professional Component ",,77077,CPT,Professional,Both,,,26,105,89.25,10.25,105,UnitedHealthcare,Individual & Family,105,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Joint Survey, Single View, 2 Or More Joints (Pro Cah)Professional Component ",,77077,CPT,Professional,Both,,,26,105,89.25,10.25,105,UnitedHealthcare,Medicare Advantage,18.676,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Joint Survey, Single View, 2 Or More Joints (Pro Cah)Professional Component ",,77077,CPT,Professional,Both,,,26,105,89.25,10.25,105,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,11.8364,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Dexa Bone Density (Pro Cah)Professional Component ,,77080,CPT,Professional,Both,,,26,154,130.9,6.39,154,Aetna,Commercial,130.9,85,,percent of total billed charges,,
Dexa Bone Density (Pro Cah)Professional Component ,,77080,CPT,Professional,Both,,,26,154,130.9,6.39,154,Aetna,Medicare Advantage,9.58,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Dexa Bone Density (Pro Cah)Professional Component ,,77080,CPT,Professional,Both,,,26,154,130.9,6.39,154,Aetna,PPO,143.22,93,,percent of total billed charges,,
Dexa Bone Density (Pro Cah)Professional Component ,,77080,CPT,Professional,Both,,,26,154,130.9,6.39,154,America's PPO,America's PPO,131.5776,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Dexa Bone Density (Pro Cah)Professional Component ,,77080,CPT,Professional,Both,,,26,154,130.9,6.39,154,BlueCross BlueShield Minnesota, Federal Employee Program,17.9,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Dexa Bone Density (Pro Cah)Professional Component ,,77080,CPT,Professional,Both,,,26,154,130.9,6.39,154,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,18.1864,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Dexa Bone Density (Pro Cah)Professional Component ,,77080,CPT,Professional,Both,,,26,154,130.9,6.39,154,BlueCross BlueShield Minnesota,High Value Network Plan,18.1864,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Dexa Bone Density (Pro Cah)Professional Component ,,77080,CPT,Professional,Both,,,26,154,130.9,6.39,154,BlueCross BlueShield Minnesota,Medicare Advantage,10.7065,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Dexa Bone Density (Pro Cah)Professional Component ,,77080,CPT,Professional,Both,,,26,154,130.9,6.39,154,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,18.1864,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Dexa Bone Density (Pro Cah)Professional Component ,,77080,CPT,Professional,Both,,,26,154,130.9,6.39,154,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,6.79704,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Dexa Bone Density (Pro Cah)Professional Component ,,77080,CPT,Professional,Both,,,26,154,130.9,6.39,154,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),10.7065,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Dexa Bone Density (Pro Cah)Professional Component ,,77080,CPT,Professional,Both,,,26,154,130.9,6.39,154,CorVel,Worker's Compensation,18.4341348,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Dexa Bone Density (Pro Cah)Professional Component ,,77080,CPT,Professional,Both,,,26,154,130.9,6.39,154,First Health Group Corporation,First Health Network,149.38,97,,percent of total billed charges,,
Dexa Bone Density (Pro Cah)Professional Component ,,77080,CPT,Professional,Both,,,26,154,130.9,6.39,154,"Health Partners, Inc.",Commercial,13.92,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Dexa Bone Density (Pro Cah)Professional Component ,,77080,CPT,Professional,Both,,,26,154,130.9,6.39,154,"Health Partners, Inc.",Medicare Advantage,10.7065,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Dexa Bone Density (Pro Cah)Professional Component ,,77080,CPT,Professional,Both,,,26,154,130.9,6.39,154,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),6.39,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Dexa Bone Density (Pro Cah)Professional Component ,,77080,CPT,Professional,Both,,,26,154,130.9,6.39,154,"Health Partners, Inc.",State of Minnesota Advantage Program,11.99208,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Dexa Bone Density (Pro Cah)Professional Component ,,77080,CPT,Professional,Both,,,26,154,130.9,6.39,154,"Health Partners, Inc.",State Public Programs,6.39,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Dexa Bone Density (Pro Cah)Professional Component ,,77080,CPT,Professional,Both,,,26,154,130.9,6.39,154,Humana Insurance Company,Commercial PPO,9.31,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Dexa Bone Density (Pro Cah)Professional Component ,,77080,CPT,Professional,Both,,,26,154,130.9,6.39,154,Humana Insurance Company,Medicare PPO,154,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Dexa Bone Density (Pro Cah)Professional Component ,,77080,CPT,Professional,Both,,,26,154,130.9,6.39,154,Medica,Individual & Family,130.592,84.8,,percent of total billed charges,,
Dexa Bone Density (Pro Cah)Professional Component ,,77080,CPT,Professional,Both,,,26,154,130.9,6.39,154,Medica,Medica Advantage Solution,76.692,49.8,,percent of total billed charges,,
Dexa Bone Density (Pro Cah)Professional Component ,,77080,CPT,Professional,Both,,,26,154,130.9,6.39,154,Medica,Medical Assistance,6.8,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Dexa Bone Density (Pro Cah)Professional Component ,,77080,CPT,Professional,Both,,,26,154,130.9,6.39,154,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,9.31,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Dexa Bone Density (Pro Cah)Professional Component ,,77080,CPT,Professional,Both,,,26,154,130.9,6.39,154,"Multiplan, Inc.","Multiplan, Inc.",144.76,94,,percent of total billed charges,,
Dexa Bone Density (Pro Cah)Professional Component ,,77080,CPT,Professional,Both,,,26,154,130.9,6.39,154,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,138.754,90.1,,percent of total billed charges,,
Dexa Bone Density (Pro Cah)Professional Component ,,77080,CPT,Professional,Both,,,26,154,130.9,6.39,154,"Preferred One Administrative Services, INC.",PPO,151.844,98.6,,percent of total billed charges,,
Dexa Bone Density (Pro Cah)Professional Component ,,77080,CPT,Professional,Both,,,26,154,130.9,6.39,154,PrimeWest Health,Minnesota Senior Health Options (MSHO),10.7065,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Dexa Bone Density (Pro Cah)Professional Component ,,77080,CPT,Professional,Both,,,26,154,130.9,6.39,154,PrimeWest Health,MinnesotaCare,7.2728328,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Dexa Bone Density (Pro Cah)Professional Component ,,77080,CPT,Professional,Both,,,26,154,130.9,6.39,154,Sanford Health Plan,Sanford Health Plan,135.52,88,,percent of total billed charges,,
Dexa Bone Density (Pro Cah)Professional Component ,,77080,CPT,Professional,Both,,,26,154,130.9,6.39,154,"UCare Health, Inc.",Individual & Family Plan,15.134336,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Dexa Bone Density (Pro Cah)Professional Component ,,77080,CPT,Professional,Both,,,26,154,130.9,6.39,154,"UCare Health, Inc.",Medical Assistance,7.476744,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Dexa Bone Density (Pro Cah)Professional Component ,,77080,CPT,Professional,Both,,,26,154,130.9,6.39,154,"UCare Health, Inc.",Medicare Advantage,10.7065,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Dexa Bone Density (Pro Cah)Professional Component ,,77080,CPT,Professional,Both,,,26,154,130.9,6.39,154,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),8.5652,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Dexa Bone Density (Pro Cah)Professional Component ,,77080,CPT,Professional,Both,,,26,154,130.9,6.39,154,UnitedHealthcare,Individual & Family,154,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Dexa Bone Density (Pro Cah)Professional Component ,,77080,CPT,Professional,Both,,,26,154,130.9,6.39,154,UnitedHealthcare,Medicare Advantage,10.7065,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Dexa Bone Density (Pro Cah)Professional Component ,,77080,CPT,Professional,Both,,,26,154,130.9,6.39,154,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,6.79704,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Dual Energy Xray Abs Orptiometry(Dexa),Peripheral (Radius,Wrist,Heel) (Pro Cah)Professional Component ",,77081,CPT,Professional,Both,,,26,66,56.1,6.63,66,Aetna,Commercial,56.1,85,,percent of total billed charges,,
"Dual Energy Xray Abs Orptiometry(Dexa),Peripheral (Radius,Wrist,Heel) (Pro Cah)Professional Component ",,77081,CPT,Professional,Both,,,26,66,56.1,6.63,66,Aetna,Medicare Advantage,9.93,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Dual Energy Xray Abs Orptiometry(Dexa),Peripheral (Radius,Wrist,Heel) (Pro Cah)Professional Component ",,77081,CPT,Professional,Both,,,26,66,56.1,6.63,66,Aetna,PPO,61.38,93,,percent of total billed charges,,
"Dual Energy Xray Abs Orptiometry(Dexa),Peripheral (Radius,Wrist,Heel) (Pro Cah)Professional Component ",,77081,CPT,Professional,Both,,,26,66,56.1,6.63,66,America's PPO,America's PPO,56.3904,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Dual Energy Xray Abs Orptiometry(Dexa),Peripheral (Radius,Wrist,Heel) (Pro Cah)Professional Component ",,77081,CPT,Professional,Both,,,26,66,56.1,6.63,66,BlueCross BlueShield Minnesota, Federal Employee Program,18.54,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Dual Energy Xray Abs Orptiometry(Dexa),Peripheral (Radius,Wrist,Heel) (Pro Cah)Professional Component ",,77081,CPT,Professional,Both,,,26,66,56.1,6.63,66,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,18.83664,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Dual Energy Xray Abs Orptiometry(Dexa),Peripheral (Radius,Wrist,Heel) (Pro Cah)Professional Component ",,77081,CPT,Professional,Both,,,26,66,56.1,6.63,66,BlueCross BlueShield Minnesota,High Value Network Plan,18.83664,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Dual Energy Xray Abs Orptiometry(Dexa),Peripheral (Radius,Wrist,Heel) (Pro Cah)Professional Component ",,77081,CPT,Professional,Both,,,26,66,56.1,6.63,66,BlueCross BlueShield Minnesota,Medicare Advantage,11.0975,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Dual Energy Xray Abs Orptiometry(Dexa),Peripheral (Radius,Wrist,Heel) (Pro Cah)Professional Component ",,77081,CPT,Professional,Both,,,26,66,56.1,6.63,66,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,18.83664,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Dual Energy Xray Abs Orptiometry(Dexa),Peripheral (Radius,Wrist,Heel) (Pro Cah)Professional Component ",,77081,CPT,Professional,Both,,,26,66,56.1,6.63,66,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,7.05104,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Dual Energy Xray Abs Orptiometry(Dexa),Peripheral (Radius,Wrist,Heel) (Pro Cah)Professional Component ",,77081,CPT,Professional,Both,,,26,66,56.1,6.63,66,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),11.0975,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Dual Energy Xray Abs Orptiometry(Dexa),Peripheral (Radius,Wrist,Heel) (Pro Cah)Professional Component ",,77081,CPT,Professional,Both,,,26,66,56.1,6.63,66,CorVel,Worker's Compensation,19.1145669,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Dual Energy Xray Abs Orptiometry(Dexa),Peripheral (Radius,Wrist,Heel) (Pro Cah)Professional Component ",,77081,CPT,Professional,Both,,,26,66,56.1,6.63,66,First Health Group Corporation,First Health Network,64.02,97,,percent of total billed charges,,
"Dual Energy Xray Abs Orptiometry(Dexa),Peripheral (Radius,Wrist,Heel) (Pro Cah)Professional Component ",,77081,CPT,Professional,Both,,,26,66,56.1,6.63,66,"Health Partners, Inc.",Commercial,14.44,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Dual Energy Xray Abs Orptiometry(Dexa),Peripheral (Radius,Wrist,Heel) (Pro Cah)Professional Component ",,77081,CPT,Professional,Both,,,26,66,56.1,6.63,66,"Health Partners, Inc.",Medicare Advantage,11.0975,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Dual Energy Xray Abs Orptiometry(Dexa),Peripheral (Radius,Wrist,Heel) (Pro Cah)Professional Component ",,77081,CPT,Professional,Both,,,26,66,56.1,6.63,66,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),6.63,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Dual Energy Xray Abs Orptiometry(Dexa),Peripheral (Radius,Wrist,Heel) (Pro Cah)Professional Component ",,77081,CPT,Professional,Both,,,26,66,56.1,6.63,66,"Health Partners, Inc.",State of Minnesota Advantage Program,12.44006,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Dual Energy Xray Abs Orptiometry(Dexa),Peripheral (Radius,Wrist,Heel) (Pro Cah)Professional Component ",,77081,CPT,Professional,Both,,,26,66,56.1,6.63,66,"Health Partners, Inc.",State Public Programs,6.63,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Dual Energy Xray Abs Orptiometry(Dexa),Peripheral (Radius,Wrist,Heel) (Pro Cah)Professional Component ",,77081,CPT,Professional,Both,,,26,66,56.1,6.63,66,Humana Insurance Company,Commercial PPO,9.65,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Dual Energy Xray Abs Orptiometry(Dexa),Peripheral (Radius,Wrist,Heel) (Pro Cah)Professional Component ",,77081,CPT,Professional,Both,,,26,66,56.1,6.63,66,Humana Insurance Company,Medicare PPO,66,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Dual Energy Xray Abs Orptiometry(Dexa),Peripheral (Radius,Wrist,Heel) (Pro Cah)Professional Component ",,77081,CPT,Professional,Both,,,26,66,56.1,6.63,66,Medica,Individual & Family,55.968,84.8,,percent of total billed charges,,
"Dual Energy Xray Abs Orptiometry(Dexa),Peripheral (Radius,Wrist,Heel) (Pro Cah)Professional Component ",,77081,CPT,Professional,Both,,,26,66,56.1,6.63,66,Medica,Medica Advantage Solution,32.868,49.8,,percent of total billed charges,,
"Dual Energy Xray Abs Orptiometry(Dexa),Peripheral (Radius,Wrist,Heel) (Pro Cah)Professional Component ",,77081,CPT,Professional,Both,,,26,66,56.1,6.63,66,Medica,Medical Assistance,7.05,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Dual Energy Xray Abs Orptiometry(Dexa),Peripheral (Radius,Wrist,Heel) (Pro Cah)Professional Component ",,77081,CPT,Professional,Both,,,26,66,56.1,6.63,66,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,9.65,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Dual Energy Xray Abs Orptiometry(Dexa),Peripheral (Radius,Wrist,Heel) (Pro Cah)Professional Component ",,77081,CPT,Professional,Both,,,26,66,56.1,6.63,66,"Multiplan, Inc.","Multiplan, Inc.",62.04,94,,percent of total billed charges,,
"Dual Energy Xray Abs Orptiometry(Dexa),Peripheral (Radius,Wrist,Heel) (Pro Cah)Professional Component ",,77081,CPT,Professional,Both,,,26,66,56.1,6.63,66,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,59.466,90.1,,percent of total billed charges,,
"Dual Energy Xray Abs Orptiometry(Dexa),Peripheral (Radius,Wrist,Heel) (Pro Cah)Professional Component ",,77081,CPT,Professional,Both,,,26,66,56.1,6.63,66,"Preferred One Administrative Services, INC.",PPO,65.076,98.6,,percent of total billed charges,,
"Dual Energy Xray Abs Orptiometry(Dexa),Peripheral (Radius,Wrist,Heel) (Pro Cah)Professional Component ",,77081,CPT,Professional,Both,,,26,66,56.1,6.63,66,PrimeWest Health,Minnesota Senior Health Options (MSHO),11.0975,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Dual Energy Xray Abs Orptiometry(Dexa),Peripheral (Radius,Wrist,Heel) (Pro Cah)Professional Component ",,77081,CPT,Professional,Both,,,26,66,56.1,6.63,66,PrimeWest Health,MinnesotaCare,7.5446128,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Dual Energy Xray Abs Orptiometry(Dexa),Peripheral (Radius,Wrist,Heel) (Pro Cah)Professional Component ",,77081,CPT,Professional,Both,,,26,66,56.1,6.63,66,Sanford Health Plan,Sanford Health Plan,58.08,88,,percent of total billed charges,,
"Dual Energy Xray Abs Orptiometry(Dexa),Peripheral (Radius,Wrist,Heel) (Pro Cah)Professional Component ",,77081,CPT,Professional,Both,,,26,66,56.1,6.63,66,"UCare Health, Inc.",Individual & Family Plan,15.68704,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Dual Energy Xray Abs Orptiometry(Dexa),Peripheral (Radius,Wrist,Heel) (Pro Cah)Professional Component ",,77081,CPT,Professional,Both,,,26,66,56.1,6.63,66,"UCare Health, Inc.",Medical Assistance,7.756144,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Dual Energy Xray Abs Orptiometry(Dexa),Peripheral (Radius,Wrist,Heel) (Pro Cah)Professional Component ",,77081,CPT,Professional,Both,,,26,66,56.1,6.63,66,"UCare Health, Inc.",Medicare Advantage,11.0975,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Dual Energy Xray Abs Orptiometry(Dexa),Peripheral (Radius,Wrist,Heel) (Pro Cah)Professional Component ",,77081,CPT,Professional,Both,,,26,66,56.1,6.63,66,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),8.878,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Dual Energy Xray Abs Orptiometry(Dexa),Peripheral (Radius,Wrist,Heel) (Pro Cah)Professional Component ",,77081,CPT,Professional,Both,,,26,66,56.1,6.63,66,UnitedHealthcare,Individual & Family,66,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Dual Energy Xray Abs Orptiometry(Dexa),Peripheral (Radius,Wrist,Heel) (Pro Cah)Professional Component ",,77081,CPT,Professional,Both,,,26,66,56.1,6.63,66,UnitedHealthcare,Medicare Advantage,11.0975,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Dual Energy Xray Abs Orptiometry(Dexa),Peripheral (Radius,Wrist,Heel) (Pro Cah)Professional Component ",,77081,CPT,Professional,Both,,,26,66,56.1,6.63,66,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,7.05104,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Thyroid Imaging W/Single Or Multiple Uptake(S) Quantitative Msrmnt (Pro Cah)Professional Component ,,78014,CPT,Professional,Both,,,26,121,102.85,14.61,121,Aetna,Commercial,102.85,85,,percent of total billed charges,,
Thyroid Imaging W/Single Or Multiple Uptake(S) Quantitative Msrmnt (Pro Cah)Professional Component ,,78014,CPT,Professional,Both,,,26,121,102.85,14.61,121,Aetna,Medicare Advantage,23.7,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Thyroid Imaging W/Single Or Multiple Uptake(S) Quantitative Msrmnt (Pro Cah)Professional Component ,,78014,CPT,Professional,Both,,,26,121,102.85,14.61,121,Aetna,PPO,112.53,93,,percent of total billed charges,,
Thyroid Imaging W/Single Or Multiple Uptake(S) Quantitative Msrmnt (Pro Cah)Professional Component ,,78014,CPT,Professional,Both,,,26,121,102.85,14.61,121,America's PPO,America's PPO,103.3824,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Thyroid Imaging W/Single Or Multiple Uptake(S) Quantitative Msrmnt (Pro Cah)Professional Component ,,78014,CPT,Professional,Both,,,26,121,102.85,14.61,121,BlueCross BlueShield Minnesota, Federal Employee Program,44.1,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Thyroid Imaging W/Single Or Multiple Uptake(S) Quantitative Msrmnt (Pro Cah)Professional Component ,,78014,CPT,Professional,Both,,,26,121,102.85,14.61,121,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,44.8056,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Thyroid Imaging W/Single Or Multiple Uptake(S) Quantitative Msrmnt (Pro Cah)Professional Component ,,78014,CPT,Professional,Both,,,26,121,102.85,14.61,121,BlueCross BlueShield Minnesota,High Value Network Plan,44.8056,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Thyroid Imaging W/Single Or Multiple Uptake(S) Quantitative Msrmnt (Pro Cah)Professional Component ,,78014,CPT,Professional,Both,,,26,121,102.85,14.61,121,BlueCross BlueShield Minnesota,Medicare Advantage,26.4845,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Thyroid Imaging W/Single Or Multiple Uptake(S) Quantitative Msrmnt (Pro Cah)Professional Component ,,78014,CPT,Professional,Both,,,26,121,102.85,14.61,121,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,44.8056,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Thyroid Imaging W/Single Or Multiple Uptake(S) Quantitative Msrmnt (Pro Cah)Professional Component ,,78014,CPT,Professional,Both,,,26,121,102.85,14.61,121,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,16.8656,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Thyroid Imaging W/Single Or Multiple Uptake(S) Quantitative Msrmnt (Pro Cah)Professional Component ,,78014,CPT,Professional,Both,,,26,121,102.85,14.61,121,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),26.4845,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Thyroid Imaging W/Single Or Multiple Uptake(S) Quantitative Msrmnt (Pro Cah)Professional Component ,,78014,CPT,Professional,Both,,,26,121,102.85,14.61,121,CorVel,Worker's Compensation,45.6265659,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Thyroid Imaging W/Single Or Multiple Uptake(S) Quantitative Msrmnt (Pro Cah)Professional Component ,,78014,CPT,Professional,Both,,,26,121,102.85,14.61,121,First Health Group Corporation,First Health Network,117.37,97,,percent of total billed charges,,
Thyroid Imaging W/Single Or Multiple Uptake(S) Quantitative Msrmnt (Pro Cah)Professional Component ,,78014,CPT,Professional,Both,,,26,121,102.85,14.61,121,"Health Partners, Inc.",Commercial,35.06,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Thyroid Imaging W/Single Or Multiple Uptake(S) Quantitative Msrmnt (Pro Cah)Professional Component ,,78014,CPT,Professional,Both,,,26,121,102.85,14.61,121,"Health Partners, Inc.",Medicare Advantage,26.4845,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Thyroid Imaging W/Single Or Multiple Uptake(S) Quantitative Msrmnt (Pro Cah)Professional Component ,,78014,CPT,Professional,Both,,,26,121,102.85,14.61,121,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),14.61,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Thyroid Imaging W/Single Or Multiple Uptake(S) Quantitative Msrmnt (Pro Cah)Professional Component ,,78014,CPT,Professional,Both,,,26,121,102.85,14.61,121,"Health Partners, Inc.",State of Minnesota Advantage Program,30.20419,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Thyroid Imaging W/Single Or Multiple Uptake(S) Quantitative Msrmnt (Pro Cah)Professional Component ,,78014,CPT,Professional,Both,,,26,121,102.85,14.61,121,"Health Partners, Inc.",State Public Programs,14.61,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Thyroid Imaging W/Single Or Multiple Uptake(S) Quantitative Msrmnt (Pro Cah)Professional Component ,,78014,CPT,Professional,Both,,,26,121,102.85,14.61,121,Humana Insurance Company,Commercial PPO,23.03,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Thyroid Imaging W/Single Or Multiple Uptake(S) Quantitative Msrmnt (Pro Cah)Professional Component ,,78014,CPT,Professional,Both,,,26,121,102.85,14.61,121,Humana Insurance Company,Medicare PPO,121,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Thyroid Imaging W/Single Or Multiple Uptake(S) Quantitative Msrmnt (Pro Cah)Professional Component ,,78014,CPT,Professional,Both,,,26,121,102.85,14.61,121,Medica,Individual & Family,102.608,84.8,,percent of total billed charges,,
Thyroid Imaging W/Single Or Multiple Uptake(S) Quantitative Msrmnt (Pro Cah)Professional Component ,,78014,CPT,Professional,Both,,,26,121,102.85,14.61,121,Medica,Medica Advantage Solution,60.258,49.8,,percent of total billed charges,,
Thyroid Imaging W/Single Or Multiple Uptake(S) Quantitative Msrmnt (Pro Cah)Professional Component ,,78014,CPT,Professional,Both,,,26,121,102.85,14.61,121,Medica,Medical Assistance,16.87,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Thyroid Imaging W/Single Or Multiple Uptake(S) Quantitative Msrmnt (Pro Cah)Professional Component ,,78014,CPT,Professional,Both,,,26,121,102.85,14.61,121,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,23.03,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Thyroid Imaging W/Single Or Multiple Uptake(S) Quantitative Msrmnt (Pro Cah)Professional Component ,,78014,CPT,Professional,Both,,,26,121,102.85,14.61,121,"Multiplan, Inc.","Multiplan, Inc.",113.74,94,,percent of total billed charges,,
Thyroid Imaging W/Single Or Multiple Uptake(S) Quantitative Msrmnt (Pro Cah)Professional Component ,,78014,CPT,Professional,Both,,,26,121,102.85,14.61,121,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,109.021,90.1,,percent of total billed charges,,
Thyroid Imaging W/Single Or Multiple Uptake(S) Quantitative Msrmnt (Pro Cah)Professional Component ,,78014,CPT,Professional,Both,,,26,121,102.85,14.61,121,"Preferred One Administrative Services, INC.",PPO,119.306,98.6,,percent of total billed charges,,
Thyroid Imaging W/Single Or Multiple Uptake(S) Quantitative Msrmnt (Pro Cah)Professional Component ,,78014,CPT,Professional,Both,,,26,121,102.85,14.61,121,PrimeWest Health,Minnesota Senior Health Options (MSHO),26.4845,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Thyroid Imaging W/Single Or Multiple Uptake(S) Quantitative Msrmnt (Pro Cah)Professional Component ,,78014,CPT,Professional,Both,,,26,121,102.85,14.61,121,PrimeWest Health,MinnesotaCare,18.046192,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Thyroid Imaging W/Single Or Multiple Uptake(S) Quantitative Msrmnt (Pro Cah)Professional Component ,,78014,CPT,Professional,Both,,,26,121,102.85,14.61,121,Sanford Health Plan,Sanford Health Plan,106.48,88,,percent of total billed charges,,
Thyroid Imaging W/Single Or Multiple Uptake(S) Quantitative Msrmnt (Pro Cah)Professional Component ,,78014,CPT,Professional,Both,,,26,121,102.85,14.61,121,"UCare Health, Inc.",Individual & Family Plan,37.437568,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Thyroid Imaging W/Single Or Multiple Uptake(S) Quantitative Msrmnt (Pro Cah)Professional Component ,,78014,CPT,Professional,Both,,,26,121,102.85,14.61,121,"UCare Health, Inc.",Medical Assistance,18.55216,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Thyroid Imaging W/Single Or Multiple Uptake(S) Quantitative Msrmnt (Pro Cah)Professional Component ,,78014,CPT,Professional,Both,,,26,121,102.85,14.61,121,"UCare Health, Inc.",Medicare Advantage,26.4845,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Thyroid Imaging W/Single Or Multiple Uptake(S) Quantitative Msrmnt (Pro Cah)Professional Component ,,78014,CPT,Professional,Both,,,26,121,102.85,14.61,121,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),21.1876,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Thyroid Imaging W/Single Or Multiple Uptake(S) Quantitative Msrmnt (Pro Cah)Professional Component ,,78014,CPT,Professional,Both,,,26,121,102.85,14.61,121,UnitedHealthcare,Individual & Family,121,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Thyroid Imaging W/Single Or Multiple Uptake(S) Quantitative Msrmnt (Pro Cah)Professional Component ,,78014,CPT,Professional,Both,,,26,121,102.85,14.61,121,UnitedHealthcare,Medicare Advantage,26.4845,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Thyroid Imaging W/Single Or Multiple Uptake(S) Quantitative Msrmnt (Pro Cah)Professional Component ,,78014,CPT,Professional,Both,,,26,121,102.85,14.61,121,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,16.8656,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Parathyroid Planar Imaging (Inc Subtraction When Performed) (Pro Cah)Professional Component ,,78070,CPT,Professional,Both,,,26,100,85,23.56,100,Aetna,Commercial,85,85,,percent of total billed charges,,
Parathyroid Planar Imaging (Inc Subtraction When Performed) (Pro Cah)Professional Component ,,78070,CPT,Professional,Both,,,26,100,85,23.56,100,Aetna,Medicare Advantage,37.95,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Parathyroid Planar Imaging (Inc Subtraction When Performed) (Pro Cah)Professional Component ,,78070,CPT,Professional,Both,,,26,100,85,23.56,100,Aetna,PPO,93,93,,percent of total billed charges,,
Parathyroid Planar Imaging (Inc Subtraction When Performed) (Pro Cah)Professional Component ,,78070,CPT,Professional,Both,,,26,100,85,23.56,100,America's PPO,America's PPO,85.44,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Parathyroid Planar Imaging (Inc Subtraction When Performed) (Pro Cah)Professional Component ,,78070,CPT,Professional,Both,,,26,100,85,23.56,100,BlueCross BlueShield Minnesota, Federal Employee Program,70.95,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Parathyroid Planar Imaging (Inc Subtraction When Performed) (Pro Cah)Professional Component ,,78070,CPT,Professional,Both,,,26,100,85,23.56,100,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,72.0852,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Parathyroid Planar Imaging (Inc Subtraction When Performed) (Pro Cah)Professional Component ,,78070,CPT,Professional,Both,,,26,100,85,23.56,100,BlueCross BlueShield Minnesota,High Value Network Plan,72.0852,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Parathyroid Planar Imaging (Inc Subtraction When Performed) (Pro Cah)Professional Component ,,78070,CPT,Professional,Both,,,26,100,85,23.56,100,BlueCross BlueShield Minnesota,Medicare Advantage,42.412,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Parathyroid Planar Imaging (Inc Subtraction When Performed) (Pro Cah)Professional Component ,,78070,CPT,Professional,Both,,,26,100,85,23.56,100,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,72.0852,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Parathyroid Planar Imaging (Inc Subtraction When Performed) (Pro Cah)Professional Component ,,78070,CPT,Professional,Both,,,26,100,85,23.56,100,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,27.19832,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Parathyroid Planar Imaging (Inc Subtraction When Performed) (Pro Cah)Professional Component ,,78070,CPT,Professional,Both,,,26,100,85,23.56,100,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),42.412,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Parathyroid Planar Imaging (Inc Subtraction When Performed) (Pro Cah)Professional Component ,,78070,CPT,Professional,Both,,,26,100,85,23.56,100,CorVel,Worker's Compensation,72.375675,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Parathyroid Planar Imaging (Inc Subtraction When Performed) (Pro Cah)Professional Component ,,78070,CPT,Professional,Both,,,26,100,85,23.56,100,First Health Group Corporation,First Health Network,97,97,,percent of total billed charges,,
Parathyroid Planar Imaging (Inc Subtraction When Performed) (Pro Cah)Professional Component ,,78070,CPT,Professional,Both,,,26,100,85,23.56,100,"Health Partners, Inc.",Commercial,55.17,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Parathyroid Planar Imaging (Inc Subtraction When Performed) (Pro Cah)Professional Component ,,78070,CPT,Professional,Both,,,26,100,85,23.56,100,"Health Partners, Inc.",Medicare Advantage,42.412,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Parathyroid Planar Imaging (Inc Subtraction When Performed) (Pro Cah)Professional Component ,,78070,CPT,Professional,Both,,,26,100,85,23.56,100,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),23.56,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Parathyroid Planar Imaging (Inc Subtraction When Performed) (Pro Cah)Professional Component ,,78070,CPT,Professional,Both,,,26,100,85,23.56,100,"Health Partners, Inc.",State of Minnesota Advantage Program,47.528955,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Parathyroid Planar Imaging (Inc Subtraction When Performed) (Pro Cah)Professional Component ,,78070,CPT,Professional,Both,,,26,100,85,23.56,100,"Health Partners, Inc.",State Public Programs,23.56,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Parathyroid Planar Imaging (Inc Subtraction When Performed) (Pro Cah)Professional Component ,,78070,CPT,Professional,Both,,,26,100,85,23.56,100,Humana Insurance Company,Commercial PPO,36.88,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Parathyroid Planar Imaging (Inc Subtraction When Performed) (Pro Cah)Professional Component ,,78070,CPT,Professional,Both,,,26,100,85,23.56,100,Humana Insurance Company,Medicare PPO,100,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Parathyroid Planar Imaging (Inc Subtraction When Performed) (Pro Cah)Professional Component ,,78070,CPT,Professional,Both,,,26,100,85,23.56,100,Medica,Individual & Family,84.8,84.8,,percent of total billed charges,,
Parathyroid Planar Imaging (Inc Subtraction When Performed) (Pro Cah)Professional Component ,,78070,CPT,Professional,Both,,,26,100,85,23.56,100,Medica,Medica Advantage Solution,49.8,49.8,,percent of total billed charges,,
Parathyroid Planar Imaging (Inc Subtraction When Performed) (Pro Cah)Professional Component ,,78070,CPT,Professional,Both,,,26,100,85,23.56,100,Medica,Medical Assistance,27.2,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Parathyroid Planar Imaging (Inc Subtraction When Performed) (Pro Cah)Professional Component ,,78070,CPT,Professional,Both,,,26,100,85,23.56,100,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,36.88,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Parathyroid Planar Imaging (Inc Subtraction When Performed) (Pro Cah)Professional Component ,,78070,CPT,Professional,Both,,,26,100,85,23.56,100,"Multiplan, Inc.","Multiplan, Inc.",94,94,,percent of total billed charges,,
Parathyroid Planar Imaging (Inc Subtraction When Performed) (Pro Cah)Professional Component ,,78070,CPT,Professional,Both,,,26,100,85,23.56,100,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,90.1,90.1,,percent of total billed charges,,
Parathyroid Planar Imaging (Inc Subtraction When Performed) (Pro Cah)Professional Component ,,78070,CPT,Professional,Both,,,26,100,85,23.56,100,"Preferred One Administrative Services, INC.",PPO,98.6,98.6,,percent of total billed charges,,
Parathyroid Planar Imaging (Inc Subtraction When Performed) (Pro Cah)Professional Component ,,78070,CPT,Professional,Both,,,26,100,85,23.56,100,PrimeWest Health,Minnesota Senior Health Options (MSHO),42.412,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Parathyroid Planar Imaging (Inc Subtraction When Performed) (Pro Cah)Professional Component ,,78070,CPT,Professional,Both,,,26,100,85,23.56,100,PrimeWest Health,MinnesotaCare,29.1022024,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Parathyroid Planar Imaging (Inc Subtraction When Performed) (Pro Cah)Professional Component ,,78070,CPT,Professional,Both,,,26,100,85,23.56,100,Sanford Health Plan,Sanford Health Plan,88,88,,percent of total billed charges,,
Parathyroid Planar Imaging (Inc Subtraction When Performed) (Pro Cah)Professional Component ,,78070,CPT,Professional,Both,,,26,100,85,23.56,100,"UCare Health, Inc.",Individual & Family Plan,59.952128,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Parathyroid Planar Imaging (Inc Subtraction When Performed) (Pro Cah)Professional Component ,,78070,CPT,Professional,Both,,,26,100,85,23.56,100,"UCare Health, Inc.",Medical Assistance,29.918152,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Parathyroid Planar Imaging (Inc Subtraction When Performed) (Pro Cah)Professional Component ,,78070,CPT,Professional,Both,,,26,100,85,23.56,100,"UCare Health, Inc.",Medicare Advantage,42.412,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Parathyroid Planar Imaging (Inc Subtraction When Performed) (Pro Cah)Professional Component ,,78070,CPT,Professional,Both,,,26,100,85,23.56,100,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),33.9296,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Parathyroid Planar Imaging (Inc Subtraction When Performed) (Pro Cah)Professional Component ,,78070,CPT,Professional,Both,,,26,100,85,23.56,100,UnitedHealthcare,Individual & Family,100,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Parathyroid Planar Imaging (Inc Subtraction When Performed) (Pro Cah)Professional Component ,,78070,CPT,Professional,Both,,,26,100,85,23.56,100,UnitedHealthcare,Medicare Advantage,42.412,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Parathyroid Planar Imaging (Inc Subtraction When Performed) (Pro Cah)Professional Component ,,78070,CPT,Professional,Both,,,26,100,85,23.56,100,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,27.19832,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Hepatobiliary System Imaging, Incl Gallbladder When Present (Pro Cah)Professional Component ",,78226,CPT,Professional,Both,,,26,139,118.15,21.82,139,Aetna,Commercial,118.15,85,,percent of total billed charges,,
"Hepatobiliary System Imaging, Incl Gallbladder When Present (Pro Cah)Professional Component ",,78226,CPT,Professional,Both,,,26,139,118.15,21.82,139,Aetna,Medicare Advantage,35.15,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Hepatobiliary System Imaging, Incl Gallbladder When Present (Pro Cah)Professional Component ",,78226,CPT,Professional,Both,,,26,139,118.15,21.82,139,Aetna,PPO,129.27,93,,percent of total billed charges,,
"Hepatobiliary System Imaging, Incl Gallbladder When Present (Pro Cah)Professional Component ",,78226,CPT,Professional,Both,,,26,139,118.15,21.82,139,America's PPO,America's PPO,118.7616,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Hepatobiliary System Imaging, Incl Gallbladder When Present (Pro Cah)Professional Component ",,78226,CPT,Professional,Both,,,26,139,118.15,21.82,139,BlueCross BlueShield Minnesota, Federal Employee Program,65.84,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Hepatobiliary System Imaging, Incl Gallbladder When Present (Pro Cah)Professional Component ",,78226,CPT,Professional,Both,,,26,139,118.15,21.82,139,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,66.89344,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Hepatobiliary System Imaging, Incl Gallbladder When Present (Pro Cah)Professional Component ",,78226,CPT,Professional,Both,,,26,139,118.15,21.82,139,BlueCross BlueShield Minnesota,High Value Network Plan,66.89344,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Hepatobiliary System Imaging, Incl Gallbladder When Present (Pro Cah)Professional Component ",,78226,CPT,Professional,Both,,,26,139,118.15,21.82,139,BlueCross BlueShield Minnesota,Medicare Advantage,39.2725,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Hepatobiliary System Imaging, Incl Gallbladder When Present (Pro Cah)Professional Component ",,78226,CPT,Professional,Both,,,26,139,118.15,21.82,139,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,66.89344,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Hepatobiliary System Imaging, Incl Gallbladder When Present (Pro Cah)Professional Component ",,78226,CPT,Professional,Both,,,26,139,118.15,21.82,139,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,25.18664,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Hepatobiliary System Imaging, Incl Gallbladder When Present (Pro Cah)Professional Component ",,78226,CPT,Professional,Both,,,26,139,118.15,21.82,139,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),39.2725,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Hepatobiliary System Imaging, Incl Gallbladder When Present (Pro Cah)Professional Component ",,78226,CPT,Professional,Both,,,26,139,118.15,21.82,139,CorVel,Worker's Compensation,67.6650429,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Hepatobiliary System Imaging, Incl Gallbladder When Present (Pro Cah)Professional Component ",,78226,CPT,Professional,Both,,,26,139,118.15,21.82,139,First Health Group Corporation,First Health Network,134.83,97,,percent of total billed charges,,
"Hepatobiliary System Imaging, Incl Gallbladder When Present (Pro Cah)Professional Component ",,78226,CPT,Professional,Both,,,26,139,118.15,21.82,139,"Health Partners, Inc.",Commercial,51.56,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Hepatobiliary System Imaging, Incl Gallbladder When Present (Pro Cah)Professional Component ",,78226,CPT,Professional,Both,,,26,139,118.15,21.82,139,"Health Partners, Inc.",Medicare Advantage,39.2725,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Hepatobiliary System Imaging, Incl Gallbladder When Present (Pro Cah)Professional Component ",,78226,CPT,Professional,Both,,,26,139,118.15,21.82,139,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),21.82,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Hepatobiliary System Imaging, Incl Gallbladder When Present (Pro Cah)Professional Component ",,78226,CPT,Professional,Both,,,26,139,118.15,21.82,139,"Health Partners, Inc.",State of Minnesota Advantage Program,44.41894,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Hepatobiliary System Imaging, Incl Gallbladder When Present (Pro Cah)Professional Component ",,78226,CPT,Professional,Both,,,26,139,118.15,21.82,139,"Health Partners, Inc.",State Public Programs,21.82,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Hepatobiliary System Imaging, Incl Gallbladder When Present (Pro Cah)Professional Component ",,78226,CPT,Professional,Both,,,26,139,118.15,21.82,139,Humana Insurance Company,Commercial PPO,34.15,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Hepatobiliary System Imaging, Incl Gallbladder When Present (Pro Cah)Professional Component ",,78226,CPT,Professional,Both,,,26,139,118.15,21.82,139,Humana Insurance Company,Medicare PPO,139,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Hepatobiliary System Imaging, Incl Gallbladder When Present (Pro Cah)Professional Component ",,78226,CPT,Professional,Both,,,26,139,118.15,21.82,139,Medica,Individual & Family,117.872,84.8,,percent of total billed charges,,
"Hepatobiliary System Imaging, Incl Gallbladder When Present (Pro Cah)Professional Component ",,78226,CPT,Professional,Both,,,26,139,118.15,21.82,139,Medica,Medica Advantage Solution,69.222,49.8,,percent of total billed charges,,
"Hepatobiliary System Imaging, Incl Gallbladder When Present (Pro Cah)Professional Component ",,78226,CPT,Professional,Both,,,26,139,118.15,21.82,139,Medica,Medical Assistance,25.19,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Hepatobiliary System Imaging, Incl Gallbladder When Present (Pro Cah)Professional Component ",,78226,CPT,Professional,Both,,,26,139,118.15,21.82,139,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,34.15,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Hepatobiliary System Imaging, Incl Gallbladder When Present (Pro Cah)Professional Component ",,78226,CPT,Professional,Both,,,26,139,118.15,21.82,139,"Multiplan, Inc.","Multiplan, Inc.",130.66,94,,percent of total billed charges,,
"Hepatobiliary System Imaging, Incl Gallbladder When Present (Pro Cah)Professional Component ",,78226,CPT,Professional,Both,,,26,139,118.15,21.82,139,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,125.239,90.1,,percent of total billed charges,,
"Hepatobiliary System Imaging, Incl Gallbladder When Present (Pro Cah)Professional Component ",,78226,CPT,Professional,Both,,,26,139,118.15,21.82,139,"Preferred One Administrative Services, INC.",PPO,137.054,98.6,,percent of total billed charges,,
"Hepatobiliary System Imaging, Incl Gallbladder When Present (Pro Cah)Professional Component ",,78226,CPT,Professional,Both,,,26,139,118.15,21.82,139,PrimeWest Health,Minnesota Senior Health Options (MSHO),39.2725,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Hepatobiliary System Imaging, Incl Gallbladder When Present (Pro Cah)Professional Component ",,78226,CPT,Professional,Both,,,26,139,118.15,21.82,139,PrimeWest Health,MinnesotaCare,26.9497048,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Hepatobiliary System Imaging, Incl Gallbladder When Present (Pro Cah)Professional Component ",,78226,CPT,Professional,Both,,,26,139,118.15,21.82,139,Sanford Health Plan,Sanford Health Plan,122.32,88,,percent of total billed charges,,
"Hepatobiliary System Imaging, Incl Gallbladder When Present (Pro Cah)Professional Component ",,78226,CPT,Professional,Both,,,26,139,118.15,21.82,139,"UCare Health, Inc.",Individual & Family Plan,55.51424,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Hepatobiliary System Imaging, Incl Gallbladder When Present (Pro Cah)Professional Component ",,78226,CPT,Professional,Both,,,26,139,118.15,21.82,139,"UCare Health, Inc.",Medical Assistance,27.705304,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Hepatobiliary System Imaging, Incl Gallbladder When Present (Pro Cah)Professional Component ",,78226,CPT,Professional,Both,,,26,139,118.15,21.82,139,"UCare Health, Inc.",Medicare Advantage,39.2725,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Hepatobiliary System Imaging, Incl Gallbladder When Present (Pro Cah)Professional Component ",,78226,CPT,Professional,Both,,,26,139,118.15,21.82,139,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),31.418,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Hepatobiliary System Imaging, Incl Gallbladder When Present (Pro Cah)Professional Component ",,78226,CPT,Professional,Both,,,26,139,118.15,21.82,139,UnitedHealthcare,Individual & Family,139,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Hepatobiliary System Imaging, Incl Gallbladder When Present (Pro Cah)Professional Component ",,78226,CPT,Professional,Both,,,26,139,118.15,21.82,139,UnitedHealthcare,Medicare Advantage,39.2725,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Hepatobiliary System Imaging, Incl Gallbladder When Present (Pro Cah)Professional Component ",,78226,CPT,Professional,Both,,,26,139,118.15,21.82,139,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,25.18664,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Nm Hepatobiliary Scan W/Pharm (Pro Cah)Professional Component ,,78227,CPT,Professional,Both,,,26,135,114.75,26.61,135,Aetna,Commercial,114.75,85,,percent of total billed charges,,
Nm Hepatobiliary Scan W/Pharm (Pro Cah)Professional Component ,,78227,CPT,Professional,Both,,,26,135,114.75,26.61,135,Aetna,Medicare Advantage,42.85,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Nm Hepatobiliary Scan W/Pharm (Pro Cah)Professional Component ,,78227,CPT,Professional,Both,,,26,135,114.75,26.61,135,Aetna,PPO,125.55,93,,percent of total billed charges,,
Nm Hepatobiliary Scan W/Pharm (Pro Cah)Professional Component ,,78227,CPT,Professional,Both,,,26,135,114.75,26.61,135,America's PPO,America's PPO,115.344,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Nm Hepatobiliary Scan W/Pharm (Pro Cah)Professional Component ,,78227,CPT,Professional,Both,,,26,135,114.75,26.61,135,BlueCross BlueShield Minnesota, Federal Employee Program,79.9,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Nm Hepatobiliary Scan W/Pharm (Pro Cah)Professional Component ,,78227,CPT,Professional,Both,,,26,135,114.75,26.61,135,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,81.1784,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Nm Hepatobiliary Scan W/Pharm (Pro Cah)Professional Component ,,78227,CPT,Professional,Both,,,26,135,114.75,26.61,135,BlueCross BlueShield Minnesota,High Value Network Plan,81.1784,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Nm Hepatobiliary Scan W/Pharm (Pro Cah)Professional Component ,,78227,CPT,Professional,Both,,,26,135,114.75,26.61,135,BlueCross BlueShield Minnesota,Medicare Advantage,47.886,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Nm Hepatobiliary Scan W/Pharm (Pro Cah)Professional Component ,,78227,CPT,Professional,Both,,,26,135,114.75,26.61,135,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,81.1784,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Nm Hepatobiliary Scan W/Pharm (Pro Cah)Professional Component ,,78227,CPT,Professional,Both,,,26,135,114.75,26.61,135,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,30.72384,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Nm Hepatobiliary Scan W/Pharm (Pro Cah)Professional Component ,,78227,CPT,Professional,Both,,,26,135,114.75,26.61,135,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),47.886,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Nm Hepatobiliary Scan W/Pharm (Pro Cah)Professional Component ,,78227,CPT,Professional,Both,,,26,135,114.75,26.61,135,CorVel,Worker's Compensation,82.4948355,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Nm Hepatobiliary Scan W/Pharm (Pro Cah)Professional Component ,,78227,CPT,Professional,Both,,,26,135,114.75,26.61,135,First Health Group Corporation,First Health Network,130.95,97,,percent of total billed charges,,
Nm Hepatobiliary Scan W/Pharm (Pro Cah)Professional Component ,,78227,CPT,Professional,Both,,,26,135,114.75,26.61,135,"Health Partners, Inc.",Commercial,62.91,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Nm Hepatobiliary Scan W/Pharm (Pro Cah)Professional Component ,,78227,CPT,Professional,Both,,,26,135,114.75,26.61,135,"Health Partners, Inc.",Medicare Advantage,47.886,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Nm Hepatobiliary Scan W/Pharm (Pro Cah)Professional Component ,,78227,CPT,Professional,Both,,,26,135,114.75,26.61,135,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),26.61,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Nm Hepatobiliary Scan W/Pharm (Pro Cah)Professional Component ,,78227,CPT,Professional,Both,,,26,135,114.75,26.61,135,"Health Partners, Inc.",State of Minnesota Advantage Program,54.196965,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Nm Hepatobiliary Scan W/Pharm (Pro Cah)Professional Component ,,78227,CPT,Professional,Both,,,26,135,114.75,26.61,135,"Health Partners, Inc.",State Public Programs,26.61,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Nm Hepatobiliary Scan W/Pharm (Pro Cah)Professional Component ,,78227,CPT,Professional,Both,,,26,135,114.75,26.61,135,Humana Insurance Company,Commercial PPO,41.64,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Nm Hepatobiliary Scan W/Pharm (Pro Cah)Professional Component ,,78227,CPT,Professional,Both,,,26,135,114.75,26.61,135,Humana Insurance Company,Medicare PPO,135,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Nm Hepatobiliary Scan W/Pharm (Pro Cah)Professional Component ,,78227,CPT,Professional,Both,,,26,135,114.75,26.61,135,Medica,Individual & Family,114.48,84.8,,percent of total billed charges,,
Nm Hepatobiliary Scan W/Pharm (Pro Cah)Professional Component ,,78227,CPT,Professional,Both,,,26,135,114.75,26.61,135,Medica,Medica Advantage Solution,67.23,49.8,,percent of total billed charges,,
Nm Hepatobiliary Scan W/Pharm (Pro Cah)Professional Component ,,78227,CPT,Professional,Both,,,26,135,114.75,26.61,135,Medica,Medical Assistance,30.72,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Nm Hepatobiliary Scan W/Pharm (Pro Cah)Professional Component ,,78227,CPT,Professional,Both,,,26,135,114.75,26.61,135,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,41.64,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Nm Hepatobiliary Scan W/Pharm (Pro Cah)Professional Component ,,78227,CPT,Professional,Both,,,26,135,114.75,26.61,135,"Multiplan, Inc.","Multiplan, Inc.",126.9,94,,percent of total billed charges,,
Nm Hepatobiliary Scan W/Pharm (Pro Cah)Professional Component ,,78227,CPT,Professional,Both,,,26,135,114.75,26.61,135,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,121.635,90.1,,percent of total billed charges,,
Nm Hepatobiliary Scan W/Pharm (Pro Cah)Professional Component ,,78227,CPT,Professional,Both,,,26,135,114.75,26.61,135,"Preferred One Administrative Services, INC.",PPO,133.11,98.6,,percent of total billed charges,,
Nm Hepatobiliary Scan W/Pharm (Pro Cah)Professional Component ,,78227,CPT,Professional,Both,,,26,135,114.75,26.61,135,PrimeWest Health,Minnesota Senior Health Options (MSHO),47.886,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Nm Hepatobiliary Scan W/Pharm (Pro Cah)Professional Component ,,78227,CPT,Professional,Both,,,26,135,114.75,26.61,135,PrimeWest Health,MinnesotaCare,32.8745088,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Nm Hepatobiliary Scan W/Pharm (Pro Cah)Professional Component ,,78227,CPT,Professional,Both,,,26,135,114.75,26.61,135,Sanford Health Plan,Sanford Health Plan,118.8,88,,percent of total billed charges,,
Nm Hepatobiliary Scan W/Pharm (Pro Cah)Professional Component ,,78227,CPT,Professional,Both,,,26,135,114.75,26.61,135,"UCare Health, Inc.",Individual & Family Plan,67.689984,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Nm Hepatobiliary Scan W/Pharm (Pro Cah)Professional Component ,,78227,CPT,Professional,Both,,,26,135,114.75,26.61,135,"UCare Health, Inc.",Medical Assistance,33.796224,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Nm Hepatobiliary Scan W/Pharm (Pro Cah)Professional Component ,,78227,CPT,Professional,Both,,,26,135,114.75,26.61,135,"UCare Health, Inc.",Medicare Advantage,47.886,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Nm Hepatobiliary Scan W/Pharm (Pro Cah)Professional Component ,,78227,CPT,Professional,Both,,,26,135,114.75,26.61,135,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),38.3088,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Nm Hepatobiliary Scan W/Pharm (Pro Cah)Professional Component ,,78227,CPT,Professional,Both,,,26,135,114.75,26.61,135,UnitedHealthcare,Individual & Family,135,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Nm Hepatobiliary Scan W/Pharm (Pro Cah)Professional Component ,,78227,CPT,Professional,Both,,,26,135,114.75,26.61,135,UnitedHealthcare,Medicare Advantage,47.886,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Nm Hepatobiliary Scan W/Pharm (Pro Cah)Professional Component ,,78227,CPT,Professional,Both,,,26,135,114.75,26.61,135,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,30.72384,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Gastric Emptying Imaging Study (Pro Cah)Professional Component ,,78264,CPT,Professional,Both,,,26,126,107.1,23.34,126,Aetna,Commercial,107.1,85,,percent of total billed charges,,
Gastric Emptying Imaging Study (Pro Cah)Professional Component ,,78264,CPT,Professional,Both,,,26,126,107.1,23.34,126,Aetna,Medicare Advantage,37.6,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Gastric Emptying Imaging Study (Pro Cah)Professional Component ,,78264,CPT,Professional,Both,,,26,126,107.1,23.34,126,Aetna,PPO,117.18,93,,percent of total billed charges,,
Gastric Emptying Imaging Study (Pro Cah)Professional Component ,,78264,CPT,Professional,Both,,,26,126,107.1,23.34,126,America's PPO,America's PPO,107.6544,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Gastric Emptying Imaging Study (Pro Cah)Professional Component ,,78264,CPT,Professional,Both,,,26,126,107.1,23.34,126,BlueCross BlueShield Minnesota, Federal Employee Program,70.31,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Gastric Emptying Imaging Study (Pro Cah)Professional Component ,,78264,CPT,Professional,Both,,,26,126,107.1,23.34,126,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,71.43496,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Gastric Emptying Imaging Study (Pro Cah)Professional Component ,,78264,CPT,Professional,Both,,,26,126,107.1,23.34,126,BlueCross BlueShield Minnesota,High Value Network Plan,71.43496,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Gastric Emptying Imaging Study (Pro Cah)Professional Component ,,78264,CPT,Professional,Both,,,26,126,107.1,23.34,126,BlueCross BlueShield Minnesota,Medicare Advantage,42.021,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Gastric Emptying Imaging Study (Pro Cah)Professional Component ,,78264,CPT,Professional,Both,,,26,126,107.1,23.34,126,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,71.43496,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Gastric Emptying Imaging Study (Pro Cah)Professional Component ,,78264,CPT,Professional,Both,,,26,126,107.1,23.34,126,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,26.94432,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Gastric Emptying Imaging Study (Pro Cah)Professional Component ,,78264,CPT,Professional,Both,,,26,126,107.1,23.34,126,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),42.021,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Gastric Emptying Imaging Study (Pro Cah)Professional Component ,,78264,CPT,Professional,Both,,,26,126,107.1,23.34,126,CorVel,Worker's Compensation,72.3844071,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Gastric Emptying Imaging Study (Pro Cah)Professional Component ,,78264,CPT,Professional,Both,,,26,126,107.1,23.34,126,First Health Group Corporation,First Health Network,122.22,97,,percent of total billed charges,,
Gastric Emptying Imaging Study (Pro Cah)Professional Component ,,78264,CPT,Professional,Both,,,26,126,107.1,23.34,126,"Health Partners, Inc.",Commercial,55.17,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Gastric Emptying Imaging Study (Pro Cah)Professional Component ,,78264,CPT,Professional,Both,,,26,126,107.1,23.34,126,"Health Partners, Inc.",Medicare Advantage,42.021,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Gastric Emptying Imaging Study (Pro Cah)Professional Component ,,78264,CPT,Professional,Both,,,26,126,107.1,23.34,126,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),23.34,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Gastric Emptying Imaging Study (Pro Cah)Professional Component ,,78264,CPT,Professional,Both,,,26,126,107.1,23.34,126,"Health Partners, Inc.",State of Minnesota Advantage Program,47.528955,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Gastric Emptying Imaging Study (Pro Cah)Professional Component ,,78264,CPT,Professional,Both,,,26,126,107.1,23.34,126,"Health Partners, Inc.",State Public Programs,23.34,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Gastric Emptying Imaging Study (Pro Cah)Professional Component ,,78264,CPT,Professional,Both,,,26,126,107.1,23.34,126,Humana Insurance Company,Commercial PPO,36.54,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Gastric Emptying Imaging Study (Pro Cah)Professional Component ,,78264,CPT,Professional,Both,,,26,126,107.1,23.34,126,Humana Insurance Company,Medicare PPO,126,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Gastric Emptying Imaging Study (Pro Cah)Professional Component ,,78264,CPT,Professional,Both,,,26,126,107.1,23.34,126,Medica,Individual & Family,106.848,84.8,,percent of total billed charges,,
Gastric Emptying Imaging Study (Pro Cah)Professional Component ,,78264,CPT,Professional,Both,,,26,126,107.1,23.34,126,Medica,Medica Advantage Solution,62.748,49.8,,percent of total billed charges,,
Gastric Emptying Imaging Study (Pro Cah)Professional Component ,,78264,CPT,Professional,Both,,,26,126,107.1,23.34,126,Medica,Medical Assistance,26.94,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Gastric Emptying Imaging Study (Pro Cah)Professional Component ,,78264,CPT,Professional,Both,,,26,126,107.1,23.34,126,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,36.54,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Gastric Emptying Imaging Study (Pro Cah)Professional Component ,,78264,CPT,Professional,Both,,,26,126,107.1,23.34,126,"Multiplan, Inc.","Multiplan, Inc.",118.44,94,,percent of total billed charges,,
Gastric Emptying Imaging Study (Pro Cah)Professional Component ,,78264,CPT,Professional,Both,,,26,126,107.1,23.34,126,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,113.526,90.1,,percent of total billed charges,,
Gastric Emptying Imaging Study (Pro Cah)Professional Component ,,78264,CPT,Professional,Both,,,26,126,107.1,23.34,126,"Preferred One Administrative Services, INC.",PPO,124.236,98.6,,percent of total billed charges,,
Gastric Emptying Imaging Study (Pro Cah)Professional Component ,,78264,CPT,Professional,Both,,,26,126,107.1,23.34,126,PrimeWest Health,Minnesota Senior Health Options (MSHO),42.021,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Gastric Emptying Imaging Study (Pro Cah)Professional Component ,,78264,CPT,Professional,Both,,,26,126,107.1,23.34,126,PrimeWest Health,MinnesotaCare,28.8304224,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Gastric Emptying Imaging Study (Pro Cah)Professional Component ,,78264,CPT,Professional,Both,,,26,126,107.1,23.34,126,Sanford Health Plan,Sanford Health Plan,110.88,88,,percent of total billed charges,,
Gastric Emptying Imaging Study (Pro Cah)Professional Component ,,78264,CPT,Professional,Both,,,26,126,107.1,23.34,126,"UCare Health, Inc.",Individual & Family Plan,59.399424,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Gastric Emptying Imaging Study (Pro Cah)Professional Component ,,78264,CPT,Professional,Both,,,26,126,107.1,23.34,126,"UCare Health, Inc.",Medical Assistance,29.638752,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Gastric Emptying Imaging Study (Pro Cah)Professional Component ,,78264,CPT,Professional,Both,,,26,126,107.1,23.34,126,"UCare Health, Inc.",Medicare Advantage,42.021,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Gastric Emptying Imaging Study (Pro Cah)Professional Component ,,78264,CPT,Professional,Both,,,26,126,107.1,23.34,126,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),33.6168,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Gastric Emptying Imaging Study (Pro Cah)Professional Component ,,78264,CPT,Professional,Both,,,26,126,107.1,23.34,126,UnitedHealthcare,Individual & Family,126,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Gastric Emptying Imaging Study (Pro Cah)Professional Component ,,78264,CPT,Professional,Both,,,26,126,107.1,23.34,126,UnitedHealthcare,Medicare Advantage,42.021,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Gastric Emptying Imaging Study (Pro Cah)Professional Component ,,78264,CPT,Professional,Both,,,26,126,107.1,23.34,126,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,26.94432,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Acute Gastrointestinal Blood Loss Imaging (Pro Cah)Professional Component ,,78278,CPT,Professional,Both,,,26,248,210.8,29.22,248,Aetna,Commercial,210.8,85,,percent of total billed charges,,
Acute Gastrointestinal Blood Loss Imaging (Pro Cah)Professional Component ,,78278,CPT,Professional,Both,,,26,248,210.8,29.22,248,Aetna,Medicare Advantage,47.05,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Acute Gastrointestinal Blood Loss Imaging (Pro Cah)Professional Component ,,78278,CPT,Professional,Both,,,26,248,210.8,29.22,248,Aetna,PPO,230.64,93,,percent of total billed charges,,
Acute Gastrointestinal Blood Loss Imaging (Pro Cah)Professional Component ,,78278,CPT,Professional,Both,,,26,248,210.8,29.22,248,America's PPO,America's PPO,211.8912,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Acute Gastrointestinal Blood Loss Imaging (Pro Cah)Professional Component ,,78278,CPT,Professional,Both,,,26,248,210.8,29.22,248,BlueCross BlueShield Minnesota, Federal Employee Program,87.57,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Acute Gastrointestinal Blood Loss Imaging (Pro Cah)Professional Component ,,78278,CPT,Professional,Both,,,26,248,210.8,29.22,248,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,88.97112,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Acute Gastrointestinal Blood Loss Imaging (Pro Cah)Professional Component ,,78278,CPT,Professional,Both,,,26,248,210.8,29.22,248,BlueCross BlueShield Minnesota,High Value Network Plan,88.97112,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Acute Gastrointestinal Blood Loss Imaging (Pro Cah)Professional Component ,,78278,CPT,Professional,Both,,,26,248,210.8,29.22,248,BlueCross BlueShield Minnesota,Medicare Advantage,52.5895,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Acute Gastrointestinal Blood Loss Imaging (Pro Cah)Professional Component ,,78278,CPT,Professional,Both,,,26,248,210.8,29.22,248,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,88.97112,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Acute Gastrointestinal Blood Loss Imaging (Pro Cah)Professional Component ,,78278,CPT,Professional,Both,,,26,248,210.8,29.22,248,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,33.74136,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Acute Gastrointestinal Blood Loss Imaging (Pro Cah)Professional Component ,,78278,CPT,Professional,Both,,,26,248,210.8,29.22,248,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),52.5895,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Acute Gastrointestinal Blood Loss Imaging (Pro Cah)Professional Component ,,78278,CPT,Professional,Both,,,26,248,210.8,29.22,248,CorVel,Worker's Compensation,90.5814318,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Acute Gastrointestinal Blood Loss Imaging (Pro Cah)Professional Component ,,78278,CPT,Professional,Both,,,26,248,210.8,29.22,248,First Health Group Corporation,First Health Network,240.56,97,,percent of total billed charges,,
Acute Gastrointestinal Blood Loss Imaging (Pro Cah)Professional Component ,,78278,CPT,Professional,Both,,,26,248,210.8,29.22,248,"Health Partners, Inc.",Commercial,69.1,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Acute Gastrointestinal Blood Loss Imaging (Pro Cah)Professional Component ,,78278,CPT,Professional,Both,,,26,248,210.8,29.22,248,"Health Partners, Inc.",Medicare Advantage,52.5895,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Acute Gastrointestinal Blood Loss Imaging (Pro Cah)Professional Component ,,78278,CPT,Professional,Both,,,26,248,210.8,29.22,248,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),29.22,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Acute Gastrointestinal Blood Loss Imaging (Pro Cah)Professional Component ,,78278,CPT,Professional,Both,,,26,248,210.8,29.22,248,"Health Partners, Inc.",State of Minnesota Advantage Program,59.52965,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Acute Gastrointestinal Blood Loss Imaging (Pro Cah)Professional Component ,,78278,CPT,Professional,Both,,,26,248,210.8,29.22,248,"Health Partners, Inc.",State Public Programs,29.22,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Acute Gastrointestinal Blood Loss Imaging (Pro Cah)Professional Component ,,78278,CPT,Professional,Both,,,26,248,210.8,29.22,248,Humana Insurance Company,Commercial PPO,45.73,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Acute Gastrointestinal Blood Loss Imaging (Pro Cah)Professional Component ,,78278,CPT,Professional,Both,,,26,248,210.8,29.22,248,Humana Insurance Company,Medicare PPO,248,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Acute Gastrointestinal Blood Loss Imaging (Pro Cah)Professional Component ,,78278,CPT,Professional,Both,,,26,248,210.8,29.22,248,Medica,Individual & Family,210.304,84.8,,percent of total billed charges,,
Acute Gastrointestinal Blood Loss Imaging (Pro Cah)Professional Component ,,78278,CPT,Professional,Both,,,26,248,210.8,29.22,248,Medica,Medica Advantage Solution,123.504,49.8,,percent of total billed charges,,
Acute Gastrointestinal Blood Loss Imaging (Pro Cah)Professional Component ,,78278,CPT,Professional,Both,,,26,248,210.8,29.22,248,Medica,Medical Assistance,33.74,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Acute Gastrointestinal Blood Loss Imaging (Pro Cah)Professional Component ,,78278,CPT,Professional,Both,,,26,248,210.8,29.22,248,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,45.73,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Acute Gastrointestinal Blood Loss Imaging (Pro Cah)Professional Component ,,78278,CPT,Professional,Both,,,26,248,210.8,29.22,248,"Multiplan, Inc.","Multiplan, Inc.",233.12,94,,percent of total billed charges,,
Acute Gastrointestinal Blood Loss Imaging (Pro Cah)Professional Component ,,78278,CPT,Professional,Both,,,26,248,210.8,29.22,248,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,223.448,90.1,,percent of total billed charges,,
Acute Gastrointestinal Blood Loss Imaging (Pro Cah)Professional Component ,,78278,CPT,Professional,Both,,,26,248,210.8,29.22,248,"Preferred One Administrative Services, INC.",PPO,244.528,98.6,,percent of total billed charges,,
Acute Gastrointestinal Blood Loss Imaging (Pro Cah)Professional Component ,,78278,CPT,Professional,Both,,,26,248,210.8,29.22,248,PrimeWest Health,Minnesota Senior Health Options (MSHO),52.5895,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Acute Gastrointestinal Blood Loss Imaging (Pro Cah)Professional Component ,,78278,CPT,Professional,Both,,,26,248,210.8,29.22,248,PrimeWest Health,MinnesotaCare,36.1032552,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Acute Gastrointestinal Blood Loss Imaging (Pro Cah)Professional Component ,,78278,CPT,Professional,Both,,,26,248,210.8,29.22,248,Sanford Health Plan,Sanford Health Plan,218.24,88,,percent of total billed charges,,
Acute Gastrointestinal Blood Loss Imaging (Pro Cah)Professional Component ,,78278,CPT,Professional,Both,,,26,248,210.8,29.22,248,"UCare Health, Inc.",Individual & Family Plan,74.338688,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Acute Gastrointestinal Blood Loss Imaging (Pro Cah)Professional Component ,,78278,CPT,Professional,Both,,,26,248,210.8,29.22,248,"UCare Health, Inc.",Medical Assistance,37.115496,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Acute Gastrointestinal Blood Loss Imaging (Pro Cah)Professional Component ,,78278,CPT,Professional,Both,,,26,248,210.8,29.22,248,"UCare Health, Inc.",Medicare Advantage,52.5895,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Acute Gastrointestinal Blood Loss Imaging (Pro Cah)Professional Component ,,78278,CPT,Professional,Both,,,26,248,210.8,29.22,248,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),42.0716,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Acute Gastrointestinal Blood Loss Imaging (Pro Cah)Professional Component ,,78278,CPT,Professional,Both,,,26,248,210.8,29.22,248,UnitedHealthcare,Individual & Family,248,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Acute Gastrointestinal Blood Loss Imaging (Pro Cah)Professional Component ,,78278,CPT,Professional,Both,,,26,248,210.8,29.22,248,UnitedHealthcare,Medicare Advantage,52.5895,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Acute Gastrointestinal Blood Loss Imaging (Pro Cah)Professional Component ,,78278,CPT,Professional,Both,,,26,248,210.8,29.22,248,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,33.74136,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Intestine Imaging (Eg, Ectopic Gastric Mucosa, Meckel'S Localization, Volvulus) (Pro Cah)Professional Component ",,78290,CPT,Professional,Both,,,26,110,93.5,20.06,110,Aetna,Commercial,93.5,85,,percent of total billed charges,,
"Intestine Imaging (Eg, Ectopic Gastric Mucosa, Meckel'S Localization, Volvulus) (Pro Cah)Professional Component ",,78290,CPT,Professional,Both,,,26,110,93.5,20.06,110,Aetna,Medicare Advantage,32.35,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Intestine Imaging (Eg, Ectopic Gastric Mucosa, Meckel'S Localization, Volvulus) (Pro Cah)Professional Component ",,78290,CPT,Professional,Both,,,26,110,93.5,20.06,110,Aetna,PPO,102.3,93,,percent of total billed charges,,
"Intestine Imaging (Eg, Ectopic Gastric Mucosa, Meckel'S Localization, Volvulus) (Pro Cah)Professional Component ",,78290,CPT,Professional,Both,,,26,110,93.5,20.06,110,America's PPO,America's PPO,93.984,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Intestine Imaging (Eg, Ectopic Gastric Mucosa, Meckel'S Localization, Volvulus) (Pro Cah)Professional Component ",,78290,CPT,Professional,Both,,,26,110,93.5,20.06,110,BlueCross BlueShield Minnesota, Federal Employee Program,60.72,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Intestine Imaging (Eg, Ectopic Gastric Mucosa, Meckel'S Localization, Volvulus) (Pro Cah)Professional Component ",,78290,CPT,Professional,Both,,,26,110,93.5,20.06,110,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,61.69152,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Intestine Imaging (Eg, Ectopic Gastric Mucosa, Meckel'S Localization, Volvulus) (Pro Cah)Professional Component ",,78290,CPT,Professional,Both,,,26,110,93.5,20.06,110,BlueCross BlueShield Minnesota,High Value Network Plan,61.69152,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Intestine Imaging (Eg, Ectopic Gastric Mucosa, Meckel'S Localization, Volvulus) (Pro Cah)Professional Component ",,78290,CPT,Professional,Both,,,26,110,93.5,20.06,110,BlueCross BlueShield Minnesota,Medicare Advantage,36.1445,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Intestine Imaging (Eg, Ectopic Gastric Mucosa, Meckel'S Localization, Volvulus) (Pro Cah)Professional Component ",,78290,CPT,Professional,Both,,,26,110,93.5,20.06,110,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,61.69152,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Intestine Imaging (Eg, Ectopic Gastric Mucosa, Meckel'S Localization, Volvulus) (Pro Cah)Professional Component ",,78290,CPT,Professional,Both,,,26,110,93.5,20.06,110,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,23.1648,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Intestine Imaging (Eg, Ectopic Gastric Mucosa, Meckel'S Localization, Volvulus) (Pro Cah)Professional Component ",,78290,CPT,Professional,Both,,,26,110,93.5,20.06,110,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),36.1445,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Intestine Imaging (Eg, Ectopic Gastric Mucosa, Meckel'S Localization, Volvulus) (Pro Cah)Professional Component ",,78290,CPT,Professional,Both,,,26,110,93.5,20.06,110,CorVel,Worker's Compensation,61.5935466,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Intestine Imaging (Eg, Ectopic Gastric Mucosa, Meckel'S Localization, Volvulus) (Pro Cah)Professional Component ",,78290,CPT,Professional,Both,,,26,110,93.5,20.06,110,First Health Group Corporation,First Health Network,106.7,97,,percent of total billed charges,,
"Intestine Imaging (Eg, Ectopic Gastric Mucosa, Meckel'S Localization, Volvulus) (Pro Cah)Professional Component ",,78290,CPT,Professional,Both,,,26,110,93.5,20.06,110,"Health Partners, Inc.",Commercial,46.92,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Intestine Imaging (Eg, Ectopic Gastric Mucosa, Meckel'S Localization, Volvulus) (Pro Cah)Professional Component ",,78290,CPT,Professional,Both,,,26,110,93.5,20.06,110,"Health Partners, Inc.",Medicare Advantage,36.1445,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Intestine Imaging (Eg, Ectopic Gastric Mucosa, Meckel'S Localization, Volvulus) (Pro Cah)Professional Component ",,78290,CPT,Professional,Both,,,26,110,93.5,20.06,110,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),20.06,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Intestine Imaging (Eg, Ectopic Gastric Mucosa, Meckel'S Localization, Volvulus) (Pro Cah)Professional Component ",,78290,CPT,Professional,Both,,,26,110,93.5,20.06,110,"Health Partners, Inc.",State of Minnesota Advantage Program,40.42158,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Intestine Imaging (Eg, Ectopic Gastric Mucosa, Meckel'S Localization, Volvulus) (Pro Cah)Professional Component ",,78290,CPT,Professional,Both,,,26,110,93.5,20.06,110,"Health Partners, Inc.",State Public Programs,20.06,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Intestine Imaging (Eg, Ectopic Gastric Mucosa, Meckel'S Localization, Volvulus) (Pro Cah)Professional Component ",,78290,CPT,Professional,Both,,,26,110,93.5,20.06,110,Humana Insurance Company,Commercial PPO,31.43,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Intestine Imaging (Eg, Ectopic Gastric Mucosa, Meckel'S Localization, Volvulus) (Pro Cah)Professional Component ",,78290,CPT,Professional,Both,,,26,110,93.5,20.06,110,Humana Insurance Company,Medicare PPO,110,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Intestine Imaging (Eg, Ectopic Gastric Mucosa, Meckel'S Localization, Volvulus) (Pro Cah)Professional Component ",,78290,CPT,Professional,Both,,,26,110,93.5,20.06,110,Medica,Individual & Family,93.28,84.8,,percent of total billed charges,,
"Intestine Imaging (Eg, Ectopic Gastric Mucosa, Meckel'S Localization, Volvulus) (Pro Cah)Professional Component ",,78290,CPT,Professional,Both,,,26,110,93.5,20.06,110,Medica,Medica Advantage Solution,54.78,49.8,,percent of total billed charges,,
"Intestine Imaging (Eg, Ectopic Gastric Mucosa, Meckel'S Localization, Volvulus) (Pro Cah)Professional Component ",,78290,CPT,Professional,Both,,,26,110,93.5,20.06,110,Medica,Medical Assistance,23.16,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Intestine Imaging (Eg, Ectopic Gastric Mucosa, Meckel'S Localization, Volvulus) (Pro Cah)Professional Component ",,78290,CPT,Professional,Both,,,26,110,93.5,20.06,110,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,31.43,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Intestine Imaging (Eg, Ectopic Gastric Mucosa, Meckel'S Localization, Volvulus) (Pro Cah)Professional Component ",,78290,CPT,Professional,Both,,,26,110,93.5,20.06,110,"Multiplan, Inc.","Multiplan, Inc.",103.4,94,,percent of total billed charges,,
"Intestine Imaging (Eg, Ectopic Gastric Mucosa, Meckel'S Localization, Volvulus) (Pro Cah)Professional Component ",,78290,CPT,Professional,Both,,,26,110,93.5,20.06,110,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,99.11,90.1,,percent of total billed charges,,
"Intestine Imaging (Eg, Ectopic Gastric Mucosa, Meckel'S Localization, Volvulus) (Pro Cah)Professional Component ",,78290,CPT,Professional,Both,,,26,110,93.5,20.06,110,"Preferred One Administrative Services, INC.",PPO,108.46,98.6,,percent of total billed charges,,
"Intestine Imaging (Eg, Ectopic Gastric Mucosa, Meckel'S Localization, Volvulus) (Pro Cah)Professional Component ",,78290,CPT,Professional,Both,,,26,110,93.5,20.06,110,PrimeWest Health,Minnesota Senior Health Options (MSHO),36.1445,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Intestine Imaging (Eg, Ectopic Gastric Mucosa, Meckel'S Localization, Volvulus) (Pro Cah)Professional Component ",,78290,CPT,Professional,Both,,,26,110,93.5,20.06,110,PrimeWest Health,MinnesotaCare,24.786336,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Intestine Imaging (Eg, Ectopic Gastric Mucosa, Meckel'S Localization, Volvulus) (Pro Cah)Professional Component ",,78290,CPT,Professional,Both,,,26,110,93.5,20.06,110,Sanford Health Plan,Sanford Health Plan,96.8,88,,percent of total billed charges,,
"Intestine Imaging (Eg, Ectopic Gastric Mucosa, Meckel'S Localization, Volvulus) (Pro Cah)Professional Component ",,78290,CPT,Professional,Both,,,26,110,93.5,20.06,110,"UCare Health, Inc.",Individual & Family Plan,51.092608,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Intestine Imaging (Eg, Ectopic Gastric Mucosa, Meckel'S Localization, Volvulus) (Pro Cah)Professional Component ",,78290,CPT,Professional,Both,,,26,110,93.5,20.06,110,"UCare Health, Inc.",Medical Assistance,25.48128,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Intestine Imaging (Eg, Ectopic Gastric Mucosa, Meckel'S Localization, Volvulus) (Pro Cah)Professional Component ",,78290,CPT,Professional,Both,,,26,110,93.5,20.06,110,"UCare Health, Inc.",Medicare Advantage,36.1445,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Intestine Imaging (Eg, Ectopic Gastric Mucosa, Meckel'S Localization, Volvulus) (Pro Cah)Professional Component ",,78290,CPT,Professional,Both,,,26,110,93.5,20.06,110,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),28.9156,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Intestine Imaging (Eg, Ectopic Gastric Mucosa, Meckel'S Localization, Volvulus) (Pro Cah)Professional Component ",,78290,CPT,Professional,Both,,,26,110,93.5,20.06,110,UnitedHealthcare,Individual & Family,110,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Intestine Imaging (Eg, Ectopic Gastric Mucosa, Meckel'S Localization, Volvulus) (Pro Cah)Professional Component ",,78290,CPT,Professional,Both,,,26,110,93.5,20.06,110,UnitedHealthcare,Medicare Advantage,36.1445,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Intestine Imaging (Eg, Ectopic Gastric Mucosa, Meckel'S Localization, Volvulus) (Pro Cah)Professional Component ",,78290,CPT,Professional,Both,,,26,110,93.5,20.06,110,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,23.1648,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Nm Bone Scan Ltd (Pro Cah)Professional Component ,,78300,CPT,Professional,Both,,,26,90,76.5,18.54,90,Aetna,Commercial,76.5,85,,percent of total billed charges,,
Nm Bone Scan Ltd (Pro Cah)Professional Component ,,78300,CPT,Professional,Both,,,26,90,76.5,18.54,90,Aetna,Medicare Advantage,29.9,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Nm Bone Scan Ltd (Pro Cah)Professional Component ,,78300,CPT,Professional,Both,,,26,90,76.5,18.54,90,Aetna,PPO,83.7,93,,percent of total billed charges,,
Nm Bone Scan Ltd (Pro Cah)Professional Component ,,78300,CPT,Professional,Both,,,26,90,76.5,18.54,90,America's PPO,America's PPO,76.896,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Nm Bone Scan Ltd (Pro Cah)Professional Component ,,78300,CPT,Professional,Both,,,26,90,76.5,18.54,90,BlueCross BlueShield Minnesota, Federal Employee Program,56.25,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Nm Bone Scan Ltd (Pro Cah)Professional Component ,,78300,CPT,Professional,Both,,,26,90,76.5,18.54,90,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,57.15,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Nm Bone Scan Ltd (Pro Cah)Professional Component ,,78300,CPT,Professional,Both,,,26,90,76.5,18.54,90,BlueCross BlueShield Minnesota,High Value Network Plan,57.15,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Nm Bone Scan Ltd (Pro Cah)Professional Component ,,78300,CPT,Professional,Both,,,26,90,76.5,18.54,90,BlueCross BlueShield Minnesota,Medicare Advantage,33.4075,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Nm Bone Scan Ltd (Pro Cah)Professional Component ,,78300,CPT,Professional,Both,,,26,90,76.5,18.54,90,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,57.15,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Nm Bone Scan Ltd (Pro Cah)Professional Component ,,78300,CPT,Professional,Both,,,26,90,76.5,18.54,90,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,21.40712,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Nm Bone Scan Ltd (Pro Cah)Professional Component ,,78300,CPT,Professional,Both,,,26,90,76.5,18.54,90,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),33.4075,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Nm Bone Scan Ltd (Pro Cah)Professional Component ,,78300,CPT,Professional,Both,,,26,90,76.5,18.54,90,CorVel,Worker's Compensation,57.5633466,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Nm Bone Scan Ltd (Pro Cah)Professional Component ,,78300,CPT,Professional,Both,,,26,90,76.5,18.54,90,First Health Group Corporation,First Health Network,87.3,97,,percent of total billed charges,,
Nm Bone Scan Ltd (Pro Cah)Professional Component ,,78300,CPT,Professional,Both,,,26,90,76.5,18.54,90,"Health Partners, Inc.",Commercial,43.83,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Nm Bone Scan Ltd (Pro Cah)Professional Component ,,78300,CPT,Professional,Both,,,26,90,76.5,18.54,90,"Health Partners, Inc.",Medicare Advantage,33.4075,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Nm Bone Scan Ltd (Pro Cah)Professional Component ,,78300,CPT,Professional,Both,,,26,90,76.5,18.54,90,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),18.54,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Nm Bone Scan Ltd (Pro Cah)Professional Component ,,78300,CPT,Professional,Both,,,26,90,76.5,18.54,90,"Health Partners, Inc.",State of Minnesota Advantage Program,37.759545,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Nm Bone Scan Ltd (Pro Cah)Professional Component ,,78300,CPT,Professional,Both,,,26,90,76.5,18.54,90,"Health Partners, Inc.",State Public Programs,18.54,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Nm Bone Scan Ltd (Pro Cah)Professional Component ,,78300,CPT,Professional,Both,,,26,90,76.5,18.54,90,Humana Insurance Company,Commercial PPO,29.05,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Nm Bone Scan Ltd (Pro Cah)Professional Component ,,78300,CPT,Professional,Both,,,26,90,76.5,18.54,90,Humana Insurance Company,Medicare PPO,90,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Nm Bone Scan Ltd (Pro Cah)Professional Component ,,78300,CPT,Professional,Both,,,26,90,76.5,18.54,90,Medica,Individual & Family,76.32,84.8,,percent of total billed charges,,
Nm Bone Scan Ltd (Pro Cah)Professional Component ,,78300,CPT,Professional,Both,,,26,90,76.5,18.54,90,Medica,Medica Advantage Solution,44.82,49.8,,percent of total billed charges,,
Nm Bone Scan Ltd (Pro Cah)Professional Component ,,78300,CPT,Professional,Both,,,26,90,76.5,18.54,90,Medica,Medical Assistance,21.41,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Nm Bone Scan Ltd (Pro Cah)Professional Component ,,78300,CPT,Professional,Both,,,26,90,76.5,18.54,90,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,29.05,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Nm Bone Scan Ltd (Pro Cah)Professional Component ,,78300,CPT,Professional,Both,,,26,90,76.5,18.54,90,"Multiplan, Inc.","Multiplan, Inc.",84.6,94,,percent of total billed charges,,
Nm Bone Scan Ltd (Pro Cah)Professional Component ,,78300,CPT,Professional,Both,,,26,90,76.5,18.54,90,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,81.09,90.1,,percent of total billed charges,,
Nm Bone Scan Ltd (Pro Cah)Professional Component ,,78300,CPT,Professional,Both,,,26,90,76.5,18.54,90,"Preferred One Administrative Services, INC.",PPO,88.74,98.6,,percent of total billed charges,,
Nm Bone Scan Ltd (Pro Cah)Professional Component ,,78300,CPT,Professional,Both,,,26,90,76.5,18.54,90,PrimeWest Health,Minnesota Senior Health Options (MSHO),33.4075,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Nm Bone Scan Ltd (Pro Cah)Professional Component ,,78300,CPT,Professional,Both,,,26,90,76.5,18.54,90,PrimeWest Health,MinnesotaCare,22.9056184,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Nm Bone Scan Ltd (Pro Cah)Professional Component ,,78300,CPT,Professional,Both,,,26,90,76.5,18.54,90,Sanford Health Plan,Sanford Health Plan,79.2,88,,percent of total billed charges,,
Nm Bone Scan Ltd (Pro Cah)Professional Component ,,78300,CPT,Professional,Both,,,26,90,76.5,18.54,90,"UCare Health, Inc.",Individual & Family Plan,47.22368,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Nm Bone Scan Ltd (Pro Cah)Professional Component ,,78300,CPT,Professional,Both,,,26,90,76.5,18.54,90,"UCare Health, Inc.",Medical Assistance,23.547832,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Nm Bone Scan Ltd (Pro Cah)Professional Component ,,78300,CPT,Professional,Both,,,26,90,76.5,18.54,90,"UCare Health, Inc.",Medicare Advantage,33.4075,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Nm Bone Scan Ltd (Pro Cah)Professional Component ,,78300,CPT,Professional,Both,,,26,90,76.5,18.54,90,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),26.726,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Nm Bone Scan Ltd (Pro Cah)Professional Component ,,78300,CPT,Professional,Both,,,26,90,76.5,18.54,90,UnitedHealthcare,Individual & Family,90,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Nm Bone Scan Ltd (Pro Cah)Professional Component ,,78300,CPT,Professional,Both,,,26,90,76.5,18.54,90,UnitedHealthcare,Medicare Advantage,33.4075,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Nm Bone Scan Ltd (Pro Cah)Professional Component ,,78300,CPT,Professional,Both,,,26,90,76.5,18.54,90,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,21.40712,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Nm Bone Scan Routine Whole Body (Pro Cah)Professional Component ,,78306,CPT,Professional,Both,,,26,146,124.1,25.3,146,Aetna,Commercial,124.1,85,,percent of total billed charges,,
Nm Bone Scan Routine Whole Body (Pro Cah)Professional Component ,,78306,CPT,Professional,Both,,,26,146,124.1,25.3,146,Aetna,Medicare Advantage,40.75,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Nm Bone Scan Routine Whole Body (Pro Cah)Professional Component ,,78306,CPT,Professional,Both,,,26,146,124.1,25.3,146,Aetna,PPO,135.78,93,,percent of total billed charges,,
Nm Bone Scan Routine Whole Body (Pro Cah)Professional Component ,,78306,CPT,Professional,Both,,,26,146,124.1,25.3,146,America's PPO,America's PPO,124.7424,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Nm Bone Scan Routine Whole Body (Pro Cah)Professional Component ,,78306,CPT,Professional,Both,,,26,146,124.1,25.3,146,BlueCross BlueShield Minnesota, Federal Employee Program,76.06,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Nm Bone Scan Routine Whole Body (Pro Cah)Professional Component ,,78306,CPT,Professional,Both,,,26,146,124.1,25.3,146,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,77.27696,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Nm Bone Scan Routine Whole Body (Pro Cah)Professional Component ,,78306,CPT,Professional,Both,,,26,146,124.1,25.3,146,BlueCross BlueShield Minnesota,High Value Network Plan,77.27696,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Nm Bone Scan Routine Whole Body (Pro Cah)Professional Component ,,78306,CPT,Professional,Both,,,26,146,124.1,25.3,146,BlueCross BlueShield Minnesota,Medicare Advantage,45.54,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Nm Bone Scan Routine Whole Body (Pro Cah)Professional Component ,,78306,CPT,Professional,Both,,,26,146,124.1,25.3,146,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,77.27696,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Nm Bone Scan Routine Whole Body (Pro Cah)Professional Component ,,78306,CPT,Professional,Both,,,26,146,124.1,25.3,146,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,29.21,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Nm Bone Scan Routine Whole Body (Pro Cah)Professional Component ,,78306,CPT,Professional,Both,,,26,146,124.1,25.3,146,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),45.54,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Nm Bone Scan Routine Whole Body (Pro Cah)Professional Component ,,78306,CPT,Professional,Both,,,26,146,124.1,25.3,146,CorVel,Worker's Compensation,77.7667392,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Nm Bone Scan Routine Whole Body (Pro Cah)Professional Component ,,78306,CPT,Professional,Both,,,26,146,124.1,25.3,146,First Health Group Corporation,First Health Network,141.62,97,,percent of total billed charges,,
Nm Bone Scan Routine Whole Body (Pro Cah)Professional Component ,,78306,CPT,Professional,Both,,,26,146,124.1,25.3,146,"Health Partners, Inc.",Commercial,59.29,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Nm Bone Scan Routine Whole Body (Pro Cah)Professional Component ,,78306,CPT,Professional,Both,,,26,146,124.1,25.3,146,"Health Partners, Inc.",Medicare Advantage,45.54,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Nm Bone Scan Routine Whole Body (Pro Cah)Professional Component ,,78306,CPT,Professional,Both,,,26,146,124.1,25.3,146,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),25.3,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Nm Bone Scan Routine Whole Body (Pro Cah)Professional Component ,,78306,CPT,Professional,Both,,,26,146,124.1,25.3,146,"Health Partners, Inc.",State of Minnesota Advantage Program,51.078335,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Nm Bone Scan Routine Whole Body (Pro Cah)Professional Component ,,78306,CPT,Professional,Both,,,26,146,124.1,25.3,146,"Health Partners, Inc.",State Public Programs,25.3,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Nm Bone Scan Routine Whole Body (Pro Cah)Professional Component ,,78306,CPT,Professional,Both,,,26,146,124.1,25.3,146,Humana Insurance Company,Commercial PPO,39.6,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Nm Bone Scan Routine Whole Body (Pro Cah)Professional Component ,,78306,CPT,Professional,Both,,,26,146,124.1,25.3,146,Humana Insurance Company,Medicare PPO,146,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Nm Bone Scan Routine Whole Body (Pro Cah)Professional Component ,,78306,CPT,Professional,Both,,,26,146,124.1,25.3,146,Medica,Individual & Family,123.808,84.8,,percent of total billed charges,,
Nm Bone Scan Routine Whole Body (Pro Cah)Professional Component ,,78306,CPT,Professional,Both,,,26,146,124.1,25.3,146,Medica,Medica Advantage Solution,72.708,49.8,,percent of total billed charges,,
Nm Bone Scan Routine Whole Body (Pro Cah)Professional Component ,,78306,CPT,Professional,Both,,,26,146,124.1,25.3,146,Medica,Medical Assistance,29.21,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Nm Bone Scan Routine Whole Body (Pro Cah)Professional Component ,,78306,CPT,Professional,Both,,,26,146,124.1,25.3,146,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,39.6,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Nm Bone Scan Routine Whole Body (Pro Cah)Professional Component ,,78306,CPT,Professional,Both,,,26,146,124.1,25.3,146,"Multiplan, Inc.","Multiplan, Inc.",137.24,94,,percent of total billed charges,,
Nm Bone Scan Routine Whole Body (Pro Cah)Professional Component ,,78306,CPT,Professional,Both,,,26,146,124.1,25.3,146,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,131.546,90.1,,percent of total billed charges,,
Nm Bone Scan Routine Whole Body (Pro Cah)Professional Component ,,78306,CPT,Professional,Both,,,26,146,124.1,25.3,146,"Preferred One Administrative Services, INC.",PPO,143.956,98.6,,percent of total billed charges,,
Nm Bone Scan Routine Whole Body (Pro Cah)Professional Component ,,78306,CPT,Professional,Both,,,26,146,124.1,25.3,146,PrimeWest Health,Minnesota Senior Health Options (MSHO),45.54,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Nm Bone Scan Routine Whole Body (Pro Cah)Professional Component ,,78306,CPT,Professional,Both,,,26,146,124.1,25.3,146,PrimeWest Health,MinnesotaCare,31.2547,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Nm Bone Scan Routine Whole Body (Pro Cah)Professional Component ,,78306,CPT,Professional,Both,,,26,146,124.1,25.3,146,Sanford Health Plan,Sanford Health Plan,128.48,88,,percent of total billed charges,,
Nm Bone Scan Routine Whole Body (Pro Cah)Professional Component ,,78306,CPT,Professional,Both,,,26,146,124.1,25.3,146,"UCare Health, Inc.",Individual & Family Plan,64.37376,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Nm Bone Scan Routine Whole Body (Pro Cah)Professional Component ,,78306,CPT,Professional,Both,,,26,146,124.1,25.3,146,"UCare Health, Inc.",Medical Assistance,32.131,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Nm Bone Scan Routine Whole Body (Pro Cah)Professional Component ,,78306,CPT,Professional,Both,,,26,146,124.1,25.3,146,"UCare Health, Inc.",Medicare Advantage,45.54,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Nm Bone Scan Routine Whole Body (Pro Cah)Professional Component ,,78306,CPT,Professional,Both,,,26,146,124.1,25.3,146,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),36.432,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Nm Bone Scan Routine Whole Body (Pro Cah)Professional Component ,,78306,CPT,Professional,Both,,,26,146,124.1,25.3,146,UnitedHealthcare,Individual & Family,146,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Nm Bone Scan Routine Whole Body (Pro Cah)Professional Component ,,78306,CPT,Professional,Both,,,26,146,124.1,25.3,146,UnitedHealthcare,Medicare Advantage,45.54,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Nm Bone Scan Routine Whole Body (Pro Cah)Professional Component ,,78306,CPT,Professional,Both,,,26,146,124.1,25.3,146,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,29.21,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Nm Bone Scan Three Phase (Pro Cah)Professional Component ,,78315,CPT,Professional,Both,,,26,173,147.05,30.1,173,Aetna,Commercial,147.05,85,,percent of total billed charges,,
Nm Bone Scan Three Phase (Pro Cah)Professional Component ,,78315,CPT,Professional,Both,,,26,173,147.05,30.1,173,Aetna,Medicare Advantage,48.46,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Nm Bone Scan Three Phase (Pro Cah)Professional Component ,,78315,CPT,Professional,Both,,,26,173,147.05,30.1,173,Aetna,PPO,160.89,93,,percent of total billed charges,,
Nm Bone Scan Three Phase (Pro Cah)Professional Component ,,78315,CPT,Professional,Both,,,26,173,147.05,30.1,173,America's PPO,America's PPO,147.8112,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Nm Bone Scan Three Phase (Pro Cah)Professional Component ,,78315,CPT,Professional,Both,,,26,173,147.05,30.1,173,BlueCross BlueShield Minnesota, Federal Employee Program,90.13,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Nm Bone Scan Three Phase (Pro Cah)Professional Component ,,78315,CPT,Professional,Both,,,26,173,147.05,30.1,173,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,91.57208,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Nm Bone Scan Three Phase (Pro Cah)Professional Component ,,78315,CPT,Professional,Both,,,26,173,147.05,30.1,173,BlueCross BlueShield Minnesota,High Value Network Plan,91.57208,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Nm Bone Scan Three Phase (Pro Cah)Professional Component ,,78315,CPT,Professional,Both,,,26,173,147.05,30.1,173,BlueCross BlueShield Minnesota,Medicare Advantage,54.1535,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Nm Bone Scan Three Phase (Pro Cah)Professional Component ,,78315,CPT,Professional,Both,,,26,173,147.05,30.1,173,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,91.57208,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Nm Bone Scan Three Phase (Pro Cah)Professional Component ,,78315,CPT,Professional,Both,,,26,173,147.05,30.1,173,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,34.75736,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Nm Bone Scan Three Phase (Pro Cah)Professional Component ,,78315,CPT,Professional,Both,,,26,173,147.05,30.1,173,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),54.1535,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Nm Bone Scan Three Phase (Pro Cah)Professional Component ,,78315,CPT,Professional,Both,,,26,173,147.05,30.1,173,CorVel,Worker's Compensation,92.5965318,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Nm Bone Scan Three Phase (Pro Cah)Professional Component ,,78315,CPT,Professional,Both,,,26,173,147.05,30.1,173,First Health Group Corporation,First Health Network,167.81,97,,percent of total billed charges,,
Nm Bone Scan Three Phase (Pro Cah)Professional Component ,,78315,CPT,Professional,Both,,,26,173,147.05,30.1,173,"Health Partners, Inc.",Commercial,70.64,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Nm Bone Scan Three Phase (Pro Cah)Professional Component ,,78315,CPT,Professional,Both,,,26,173,147.05,30.1,173,"Health Partners, Inc.",Medicare Advantage,54.1535,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Nm Bone Scan Three Phase (Pro Cah)Professional Component ,,78315,CPT,Professional,Both,,,26,173,147.05,30.1,173,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),30.1,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Nm Bone Scan Three Phase (Pro Cah)Professional Component ,,78315,CPT,Professional,Both,,,26,173,147.05,30.1,173,"Health Partners, Inc.",State of Minnesota Advantage Program,60.85636,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Nm Bone Scan Three Phase (Pro Cah)Professional Component ,,78315,CPT,Professional,Both,,,26,173,147.05,30.1,173,"Health Partners, Inc.",State Public Programs,30.1,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Nm Bone Scan Three Phase (Pro Cah)Professional Component ,,78315,CPT,Professional,Both,,,26,173,147.05,30.1,173,Humana Insurance Company,Commercial PPO,47.09,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Nm Bone Scan Three Phase (Pro Cah)Professional Component ,,78315,CPT,Professional,Both,,,26,173,147.05,30.1,173,Humana Insurance Company,Medicare PPO,173,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Nm Bone Scan Three Phase (Pro Cah)Professional Component ,,78315,CPT,Professional,Both,,,26,173,147.05,30.1,173,Medica,Individual & Family,146.704,84.8,,percent of total billed charges,,
Nm Bone Scan Three Phase (Pro Cah)Professional Component ,,78315,CPT,Professional,Both,,,26,173,147.05,30.1,173,Medica,Medica Advantage Solution,86.154,49.8,,percent of total billed charges,,
Nm Bone Scan Three Phase (Pro Cah)Professional Component ,,78315,CPT,Professional,Both,,,26,173,147.05,30.1,173,Medica,Medical Assistance,34.76,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Nm Bone Scan Three Phase (Pro Cah)Professional Component ,,78315,CPT,Professional,Both,,,26,173,147.05,30.1,173,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,47.09,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Nm Bone Scan Three Phase (Pro Cah)Professional Component ,,78315,CPT,Professional,Both,,,26,173,147.05,30.1,173,"Multiplan, Inc.","Multiplan, Inc.",162.62,94,,percent of total billed charges,,
Nm Bone Scan Three Phase (Pro Cah)Professional Component ,,78315,CPT,Professional,Both,,,26,173,147.05,30.1,173,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,155.873,90.1,,percent of total billed charges,,
Nm Bone Scan Three Phase (Pro Cah)Professional Component ,,78315,CPT,Professional,Both,,,26,173,147.05,30.1,173,"Preferred One Administrative Services, INC.",PPO,170.578,98.6,,percent of total billed charges,,
Nm Bone Scan Three Phase (Pro Cah)Professional Component ,,78315,CPT,Professional,Both,,,26,173,147.05,30.1,173,PrimeWest Health,Minnesota Senior Health Options (MSHO),54.1535,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Nm Bone Scan Three Phase (Pro Cah)Professional Component ,,78315,CPT,Professional,Both,,,26,173,147.05,30.1,173,PrimeWest Health,MinnesotaCare,37.1903752,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Nm Bone Scan Three Phase (Pro Cah)Professional Component ,,78315,CPT,Professional,Both,,,26,173,147.05,30.1,173,Sanford Health Plan,Sanford Health Plan,152.24,88,,percent of total billed charges,,
Nm Bone Scan Three Phase (Pro Cah)Professional Component ,,78315,CPT,Professional,Both,,,26,173,147.05,30.1,173,"UCare Health, Inc.",Individual & Family Plan,76.549504,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Nm Bone Scan Three Phase (Pro Cah)Professional Component ,,78315,CPT,Professional,Both,,,26,173,147.05,30.1,173,"UCare Health, Inc.",Medical Assistance,38.233096,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Nm Bone Scan Three Phase (Pro Cah)Professional Component ,,78315,CPT,Professional,Both,,,26,173,147.05,30.1,173,"UCare Health, Inc.",Medicare Advantage,54.1535,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Nm Bone Scan Three Phase (Pro Cah)Professional Component ,,78315,CPT,Professional,Both,,,26,173,147.05,30.1,173,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),43.3228,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Nm Bone Scan Three Phase (Pro Cah)Professional Component ,,78315,CPT,Professional,Both,,,26,173,147.05,30.1,173,UnitedHealthcare,Individual & Family,173,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Nm Bone Scan Three Phase (Pro Cah)Professional Component ,,78315,CPT,Professional,Both,,,26,173,147.05,30.1,173,UnitedHealthcare,Medicare Advantage,54.1535,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Nm Bone Scan Three Phase (Pro Cah)Professional Component ,,78315,CPT,Professional,Both,,,26,173,147.05,30.1,173,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,34.75736,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Nm Lung Scan Perfusion (Pro Cah)Professional Component ,,78580,CPT,Professional,Both,,,26,212,180.2,21.82,212,Aetna,Commercial,180.2,85,,percent of total billed charges,,
Nm Lung Scan Perfusion (Pro Cah)Professional Component ,,78580,CPT,Professional,Both,,,26,212,180.2,21.82,212,Aetna,Medicare Advantage,35.15,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Nm Lung Scan Perfusion (Pro Cah)Professional Component ,,78580,CPT,Professional,Both,,,26,212,180.2,21.82,212,Aetna,PPO,197.16,93,,percent of total billed charges,,
Nm Lung Scan Perfusion (Pro Cah)Professional Component ,,78580,CPT,Professional,Both,,,26,212,180.2,21.82,212,America's PPO,America's PPO,181.1328,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Nm Lung Scan Perfusion (Pro Cah)Professional Component ,,78580,CPT,Professional,Both,,,26,212,180.2,21.82,212,BlueCross BlueShield Minnesota, Federal Employee Program,65.84,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Nm Lung Scan Perfusion (Pro Cah)Professional Component ,,78580,CPT,Professional,Both,,,26,212,180.2,21.82,212,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,66.89344,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Nm Lung Scan Perfusion (Pro Cah)Professional Component ,,78580,CPT,Professional,Both,,,26,212,180.2,21.82,212,BlueCross BlueShield Minnesota,High Value Network Plan,66.89344,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Nm Lung Scan Perfusion (Pro Cah)Professional Component ,,78580,CPT,Professional,Both,,,26,212,180.2,21.82,212,BlueCross BlueShield Minnesota,Medicare Advantage,39.2725,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Nm Lung Scan Perfusion (Pro Cah)Professional Component ,,78580,CPT,Professional,Both,,,26,212,180.2,21.82,212,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,66.89344,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Nm Lung Scan Perfusion (Pro Cah)Professional Component ,,78580,CPT,Professional,Both,,,26,212,180.2,21.82,212,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,25.18664,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Nm Lung Scan Perfusion (Pro Cah)Professional Component ,,78580,CPT,Professional,Both,,,26,212,180.2,21.82,212,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),39.2725,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Nm Lung Scan Perfusion (Pro Cah)Professional Component ,,78580,CPT,Professional,Both,,,26,212,180.2,21.82,212,CorVel,Worker's Compensation,67.6650429,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Nm Lung Scan Perfusion (Pro Cah)Professional Component ,,78580,CPT,Professional,Both,,,26,212,180.2,21.82,212,First Health Group Corporation,First Health Network,205.64,97,,percent of total billed charges,,
Nm Lung Scan Perfusion (Pro Cah)Professional Component ,,78580,CPT,Professional,Both,,,26,212,180.2,21.82,212,"Health Partners, Inc.",Commercial,51.56,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Nm Lung Scan Perfusion (Pro Cah)Professional Component ,,78580,CPT,Professional,Both,,,26,212,180.2,21.82,212,"Health Partners, Inc.",Medicare Advantage,39.2725,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Nm Lung Scan Perfusion (Pro Cah)Professional Component ,,78580,CPT,Professional,Both,,,26,212,180.2,21.82,212,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),21.82,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Nm Lung Scan Perfusion (Pro Cah)Professional Component ,,78580,CPT,Professional,Both,,,26,212,180.2,21.82,212,"Health Partners, Inc.",State of Minnesota Advantage Program,44.41894,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Nm Lung Scan Perfusion (Pro Cah)Professional Component ,,78580,CPT,Professional,Both,,,26,212,180.2,21.82,212,"Health Partners, Inc.",State Public Programs,21.82,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Nm Lung Scan Perfusion (Pro Cah)Professional Component ,,78580,CPT,Professional,Both,,,26,212,180.2,21.82,212,Humana Insurance Company,Commercial PPO,34.15,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Nm Lung Scan Perfusion (Pro Cah)Professional Component ,,78580,CPT,Professional,Both,,,26,212,180.2,21.82,212,Humana Insurance Company,Medicare PPO,212,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Nm Lung Scan Perfusion (Pro Cah)Professional Component ,,78580,CPT,Professional,Both,,,26,212,180.2,21.82,212,Medica,Individual & Family,179.776,84.8,,percent of total billed charges,,
Nm Lung Scan Perfusion (Pro Cah)Professional Component ,,78580,CPT,Professional,Both,,,26,212,180.2,21.82,212,Medica,Medica Advantage Solution,105.576,49.8,,percent of total billed charges,,
Nm Lung Scan Perfusion (Pro Cah)Professional Component ,,78580,CPT,Professional,Both,,,26,212,180.2,21.82,212,Medica,Medical Assistance,25.19,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Nm Lung Scan Perfusion (Pro Cah)Professional Component ,,78580,CPT,Professional,Both,,,26,212,180.2,21.82,212,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,34.15,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Nm Lung Scan Perfusion (Pro Cah)Professional Component ,,78580,CPT,Professional,Both,,,26,212,180.2,21.82,212,"Multiplan, Inc.","Multiplan, Inc.",199.28,94,,percent of total billed charges,,
Nm Lung Scan Perfusion (Pro Cah)Professional Component ,,78580,CPT,Professional,Both,,,26,212,180.2,21.82,212,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,191.012,90.1,,percent of total billed charges,,
Nm Lung Scan Perfusion (Pro Cah)Professional Component ,,78580,CPT,Professional,Both,,,26,212,180.2,21.82,212,"Preferred One Administrative Services, INC.",PPO,209.032,98.6,,percent of total billed charges,,
Nm Lung Scan Perfusion (Pro Cah)Professional Component ,,78580,CPT,Professional,Both,,,26,212,180.2,21.82,212,PrimeWest Health,Minnesota Senior Health Options (MSHO),39.2725,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Nm Lung Scan Perfusion (Pro Cah)Professional Component ,,78580,CPT,Professional,Both,,,26,212,180.2,21.82,212,PrimeWest Health,MinnesotaCare,26.9497048,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Nm Lung Scan Perfusion (Pro Cah)Professional Component ,,78580,CPT,Professional,Both,,,26,212,180.2,21.82,212,Sanford Health Plan,Sanford Health Plan,186.56,88,,percent of total billed charges,,
Nm Lung Scan Perfusion (Pro Cah)Professional Component ,,78580,CPT,Professional,Both,,,26,212,180.2,21.82,212,"UCare Health, Inc.",Individual & Family Plan,55.51424,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Nm Lung Scan Perfusion (Pro Cah)Professional Component ,,78580,CPT,Professional,Both,,,26,212,180.2,21.82,212,"UCare Health, Inc.",Medical Assistance,27.705304,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Nm Lung Scan Perfusion (Pro Cah)Professional Component ,,78580,CPT,Professional,Both,,,26,212,180.2,21.82,212,"UCare Health, Inc.",Medicare Advantage,39.2725,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Nm Lung Scan Perfusion (Pro Cah)Professional Component ,,78580,CPT,Professional,Both,,,26,212,180.2,21.82,212,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),31.418,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Nm Lung Scan Perfusion (Pro Cah)Professional Component ,,78580,CPT,Professional,Both,,,26,212,180.2,21.82,212,UnitedHealthcare,Individual & Family,212,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Nm Lung Scan Perfusion (Pro Cah)Professional Component ,,78580,CPT,Professional,Both,,,26,212,180.2,21.82,212,UnitedHealthcare,Medicare Advantage,39.2725,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Nm Lung Scan Perfusion (Pro Cah)Professional Component ,,78580,CPT,Professional,Both,,,26,212,180.2,21.82,212,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,25.18664,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Nm Lung Scan Vent And Perf Routine (Pro Cah)Professional Component ,,78582,CPT,Professional,Both,,,26,305,259.25,31.41,305,Aetna,Commercial,259.25,85,,percent of total billed charges,,
Nm Lung Scan Vent And Perf Routine (Pro Cah)Professional Component ,,78582,CPT,Professional,Both,,,26,305,259.25,31.41,305,Aetna,Medicare Advantage,50.55,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Nm Lung Scan Vent And Perf Routine (Pro Cah)Professional Component ,,78582,CPT,Professional,Both,,,26,305,259.25,31.41,305,Aetna,PPO,283.65,93,,percent of total billed charges,,
Nm Lung Scan Vent And Perf Routine (Pro Cah)Professional Component ,,78582,CPT,Professional,Both,,,26,305,259.25,31.41,305,America's PPO,America's PPO,260.592,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Nm Lung Scan Vent And Perf Routine (Pro Cah)Professional Component ,,78582,CPT,Professional,Both,,,26,305,259.25,31.41,305,BlueCross BlueShield Minnesota, Federal Employee Program,93.96,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Nm Lung Scan Vent And Perf Routine (Pro Cah)Professional Component ,,78582,CPT,Professional,Both,,,26,305,259.25,31.41,305,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,95.46336,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Nm Lung Scan Vent And Perf Routine (Pro Cah)Professional Component ,,78582,CPT,Professional,Both,,,26,305,259.25,31.41,305,BlueCross BlueShield Minnesota,High Value Network Plan,95.46336,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Nm Lung Scan Vent And Perf Routine (Pro Cah)Professional Component ,,78582,CPT,Professional,Both,,,26,305,259.25,31.41,305,BlueCross BlueShield Minnesota,Medicare Advantage,56.4995,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Nm Lung Scan Vent And Perf Routine (Pro Cah)Professional Component ,,78582,CPT,Professional,Both,,,26,305,259.25,31.41,305,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,95.46336,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Nm Lung Scan Vent And Perf Routine (Pro Cah)Professional Component ,,78582,CPT,Professional,Both,,,26,305,259.25,31.41,305,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,36.26104,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Nm Lung Scan Vent And Perf Routine (Pro Cah)Professional Component ,,78582,CPT,Professional,Both,,,26,305,259.25,31.41,305,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),56.4995,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Nm Lung Scan Vent And Perf Routine (Pro Cah)Professional Component ,,78582,CPT,Professional,Both,,,26,305,259.25,31.41,305,CorVel,Worker's Compensation,97.315896,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Nm Lung Scan Vent And Perf Routine (Pro Cah)Professional Component ,,78582,CPT,Professional,Both,,,26,305,259.25,31.41,305,First Health Group Corporation,First Health Network,295.85,97,,percent of total billed charges,,
Nm Lung Scan Vent And Perf Routine (Pro Cah)Professional Component ,,78582,CPT,Professional,Both,,,26,305,259.25,31.41,305,"Health Partners, Inc.",Commercial,74.25,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Nm Lung Scan Vent And Perf Routine (Pro Cah)Professional Component ,,78582,CPT,Professional,Both,,,26,305,259.25,31.41,305,"Health Partners, Inc.",Medicare Advantage,56.4995,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Nm Lung Scan Vent And Perf Routine (Pro Cah)Professional Component ,,78582,CPT,Professional,Both,,,26,305,259.25,31.41,305,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),31.41,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Nm Lung Scan Vent And Perf Routine (Pro Cah)Professional Component ,,78582,CPT,Professional,Both,,,26,305,259.25,31.41,305,"Health Partners, Inc.",State of Minnesota Advantage Program,63.966375,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Nm Lung Scan Vent And Perf Routine (Pro Cah)Professional Component ,,78582,CPT,Professional,Both,,,26,305,259.25,31.41,305,"Health Partners, Inc.",State Public Programs,31.41,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Nm Lung Scan Vent And Perf Routine (Pro Cah)Professional Component ,,78582,CPT,Professional,Both,,,26,305,259.25,31.41,305,Humana Insurance Company,Commercial PPO,49.13,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Nm Lung Scan Vent And Perf Routine (Pro Cah)Professional Component ,,78582,CPT,Professional,Both,,,26,305,259.25,31.41,305,Humana Insurance Company,Medicare PPO,305,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Nm Lung Scan Vent And Perf Routine (Pro Cah)Professional Component ,,78582,CPT,Professional,Both,,,26,305,259.25,31.41,305,Medica,Individual & Family,258.64,84.8,,percent of total billed charges,,
Nm Lung Scan Vent And Perf Routine (Pro Cah)Professional Component ,,78582,CPT,Professional,Both,,,26,305,259.25,31.41,305,Medica,Medica Advantage Solution,151.89,49.8,,percent of total billed charges,,
Nm Lung Scan Vent And Perf Routine (Pro Cah)Professional Component ,,78582,CPT,Professional,Both,,,26,305,259.25,31.41,305,Medica,Medical Assistance,36.26,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Nm Lung Scan Vent And Perf Routine (Pro Cah)Professional Component ,,78582,CPT,Professional,Both,,,26,305,259.25,31.41,305,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,49.13,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Nm Lung Scan Vent And Perf Routine (Pro Cah)Professional Component ,,78582,CPT,Professional,Both,,,26,305,259.25,31.41,305,"Multiplan, Inc.","Multiplan, Inc.",286.7,94,,percent of total billed charges,,
Nm Lung Scan Vent And Perf Routine (Pro Cah)Professional Component ,,78582,CPT,Professional,Both,,,26,305,259.25,31.41,305,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,274.805,90.1,,percent of total billed charges,,
Nm Lung Scan Vent And Perf Routine (Pro Cah)Professional Component ,,78582,CPT,Professional,Both,,,26,305,259.25,31.41,305,"Preferred One Administrative Services, INC.",PPO,300.73,98.6,,percent of total billed charges,,
Nm Lung Scan Vent And Perf Routine (Pro Cah)Professional Component ,,78582,CPT,Professional,Both,,,26,305,259.25,31.41,305,PrimeWest Health,Minnesota Senior Health Options (MSHO),56.4995,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Nm Lung Scan Vent And Perf Routine (Pro Cah)Professional Component ,,78582,CPT,Professional,Both,,,26,305,259.25,31.41,305,PrimeWest Health,MinnesotaCare,38.7993128,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Nm Lung Scan Vent And Perf Routine (Pro Cah)Professional Component ,,78582,CPT,Professional,Both,,,26,305,259.25,31.41,305,Sanford Health Plan,Sanford Health Plan,268.4,88,,percent of total billed charges,,
Nm Lung Scan Vent And Perf Routine (Pro Cah)Professional Component ,,78582,CPT,Professional,Both,,,26,305,259.25,31.41,305,"UCare Health, Inc.",Individual & Family Plan,79.865728,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Nm Lung Scan Vent And Perf Routine (Pro Cah)Professional Component ,,78582,CPT,Professional,Both,,,26,305,259.25,31.41,305,"UCare Health, Inc.",Medical Assistance,39.887144,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Nm Lung Scan Vent And Perf Routine (Pro Cah)Professional Component ,,78582,CPT,Professional,Both,,,26,305,259.25,31.41,305,"UCare Health, Inc.",Medicare Advantage,56.4995,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Nm Lung Scan Vent And Perf Routine (Pro Cah)Professional Component ,,78582,CPT,Professional,Both,,,26,305,259.25,31.41,305,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),45.1996,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Nm Lung Scan Vent And Perf Routine (Pro Cah)Professional Component ,,78582,CPT,Professional,Both,,,26,305,259.25,31.41,305,UnitedHealthcare,Individual & Family,305,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Nm Lung Scan Vent And Perf Routine (Pro Cah)Professional Component ,,78582,CPT,Professional,Both,,,26,305,259.25,31.41,305,UnitedHealthcare,Medicare Advantage,56.4995,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Nm Lung Scan Vent And Perf Routine (Pro Cah)Professional Component ,,78582,CPT,Professional,Both,,,26,305,259.25,31.41,305,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,36.26104,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Nm Renogram Mag 3 Routine (Pro Cah)Professional Component ,,78707,CPT,Professional,Both,,,26,192,163.2,27.92,192,Aetna,Commercial,163.2,85,,percent of total billed charges,,
Nm Renogram Mag 3 Routine (Pro Cah)Professional Component ,,78707,CPT,Professional,Both,,,26,192,163.2,27.92,192,Aetna,Medicare Advantage,44.95,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Nm Renogram Mag 3 Routine (Pro Cah)Professional Component ,,78707,CPT,Professional,Both,,,26,192,163.2,27.92,192,Aetna,PPO,178.56,93,,percent of total billed charges,,
Nm Renogram Mag 3 Routine (Pro Cah)Professional Component ,,78707,CPT,Professional,Both,,,26,192,163.2,27.92,192,America's PPO,America's PPO,164.0448,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Nm Renogram Mag 3 Routine (Pro Cah)Professional Component ,,78707,CPT,Professional,Both,,,26,192,163.2,27.92,192,BlueCross BlueShield Minnesota, Federal Employee Program,83.74,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Nm Renogram Mag 3 Routine (Pro Cah)Professional Component ,,78707,CPT,Professional,Both,,,26,192,163.2,27.92,192,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,85.07984,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Nm Renogram Mag 3 Routine (Pro Cah)Professional Component ,,78707,CPT,Professional,Both,,,26,192,163.2,27.92,192,BlueCross BlueShield Minnesota,High Value Network Plan,85.07984,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Nm Renogram Mag 3 Routine (Pro Cah)Professional Component ,,78707,CPT,Professional,Both,,,26,192,163.2,27.92,192,BlueCross BlueShield Minnesota,Medicare Advantage,50.232,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Nm Renogram Mag 3 Routine (Pro Cah)Professional Component ,,78707,CPT,Professional,Both,,,26,192,163.2,27.92,192,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,85.07984,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Nm Renogram Mag 3 Routine (Pro Cah)Professional Component ,,78707,CPT,Professional,Both,,,26,192,163.2,27.92,192,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,32.23768,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Nm Renogram Mag 3 Routine (Pro Cah)Professional Component ,,78707,CPT,Professional,Both,,,26,192,163.2,27.92,192,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),50.232,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Nm Renogram Mag 3 Routine (Pro Cah)Professional Component ,,78707,CPT,Professional,Both,,,26,192,163.2,27.92,192,CorVel,Worker's Compensation,85.8446034,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Nm Renogram Mag 3 Routine (Pro Cah)Professional Component ,,78707,CPT,Professional,Both,,,26,192,163.2,27.92,192,First Health Group Corporation,First Health Network,186.24,97,,percent of total billed charges,,
Nm Renogram Mag 3 Routine (Pro Cah)Professional Component ,,78707,CPT,Professional,Both,,,26,192,163.2,27.92,192,"Health Partners, Inc.",Commercial,65.48,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Nm Renogram Mag 3 Routine (Pro Cah)Professional Component ,,78707,CPT,Professional,Both,,,26,192,163.2,27.92,192,"Health Partners, Inc.",Medicare Advantage,50.232,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Nm Renogram Mag 3 Routine (Pro Cah)Professional Component ,,78707,CPT,Professional,Both,,,26,192,163.2,27.92,192,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),27.92,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Nm Renogram Mag 3 Routine (Pro Cah)Professional Component ,,78707,CPT,Professional,Both,,,26,192,163.2,27.92,192,"Health Partners, Inc.",State of Minnesota Advantage Program,56.41102,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Nm Renogram Mag 3 Routine (Pro Cah)Professional Component ,,78707,CPT,Professional,Both,,,26,192,163.2,27.92,192,"Health Partners, Inc.",State Public Programs,27.92,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Nm Renogram Mag 3 Routine (Pro Cah)Professional Component ,,78707,CPT,Professional,Both,,,26,192,163.2,27.92,192,Humana Insurance Company,Commercial PPO,43.68,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Nm Renogram Mag 3 Routine (Pro Cah)Professional Component ,,78707,CPT,Professional,Both,,,26,192,163.2,27.92,192,Humana Insurance Company,Medicare PPO,192,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Nm Renogram Mag 3 Routine (Pro Cah)Professional Component ,,78707,CPT,Professional,Both,,,26,192,163.2,27.92,192,Medica,Individual & Family,162.816,84.8,,percent of total billed charges,,
Nm Renogram Mag 3 Routine (Pro Cah)Professional Component ,,78707,CPT,Professional,Both,,,26,192,163.2,27.92,192,Medica,Medica Advantage Solution,95.616,49.8,,percent of total billed charges,,
Nm Renogram Mag 3 Routine (Pro Cah)Professional Component ,,78707,CPT,Professional,Both,,,26,192,163.2,27.92,192,Medica,Medical Assistance,32.24,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Nm Renogram Mag 3 Routine (Pro Cah)Professional Component ,,78707,CPT,Professional,Both,,,26,192,163.2,27.92,192,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,43.68,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Nm Renogram Mag 3 Routine (Pro Cah)Professional Component ,,78707,CPT,Professional,Both,,,26,192,163.2,27.92,192,"Multiplan, Inc.","Multiplan, Inc.",180.48,94,,percent of total billed charges,,
Nm Renogram Mag 3 Routine (Pro Cah)Professional Component ,,78707,CPT,Professional,Both,,,26,192,163.2,27.92,192,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,172.992,90.1,,percent of total billed charges,,
Nm Renogram Mag 3 Routine (Pro Cah)Professional Component ,,78707,CPT,Professional,Both,,,26,192,163.2,27.92,192,"Preferred One Administrative Services, INC.",PPO,189.312,98.6,,percent of total billed charges,,
Nm Renogram Mag 3 Routine (Pro Cah)Professional Component ,,78707,CPT,Professional,Both,,,26,192,163.2,27.92,192,PrimeWest Health,Minnesota Senior Health Options (MSHO),50.232,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Nm Renogram Mag 3 Routine (Pro Cah)Professional Component ,,78707,CPT,Professional,Both,,,26,192,163.2,27.92,192,PrimeWest Health,MinnesotaCare,34.4943176,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Nm Renogram Mag 3 Routine (Pro Cah)Professional Component ,,78707,CPT,Professional,Both,,,26,192,163.2,27.92,192,Sanford Health Plan,Sanford Health Plan,168.96,88,,percent of total billed charges,,
Nm Renogram Mag 3 Routine (Pro Cah)Professional Component ,,78707,CPT,Professional,Both,,,26,192,163.2,27.92,192,"UCare Health, Inc.",Individual & Family Plan,71.006208,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Nm Renogram Mag 3 Routine (Pro Cah)Professional Component ,,78707,CPT,Professional,Both,,,26,192,163.2,27.92,192,"UCare Health, Inc.",Medical Assistance,35.461448,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Nm Renogram Mag 3 Routine (Pro Cah)Professional Component ,,78707,CPT,Professional,Both,,,26,192,163.2,27.92,192,"UCare Health, Inc.",Medicare Advantage,50.232,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Nm Renogram Mag 3 Routine (Pro Cah)Professional Component ,,78707,CPT,Professional,Both,,,26,192,163.2,27.92,192,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),40.1856,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Nm Renogram Mag 3 Routine (Pro Cah)Professional Component ,,78707,CPT,Professional,Both,,,26,192,163.2,27.92,192,UnitedHealthcare,Individual & Family,192,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Nm Renogram Mag 3 Routine (Pro Cah)Professional Component ,,78707,CPT,Professional,Both,,,26,192,163.2,27.92,192,UnitedHealthcare,Medicare Advantage,50.232,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Nm Renogram Mag 3 Routine (Pro Cah)Professional Component ,,78707,CPT,Professional,Both,,,26,192,163.2,27.92,192,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,32.23768,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Nm Renogram Mag 3 Single W Lasix (Pro Cah)Professional Component ,,78708,CPT,Professional,Both,,,26,359,305.15,35.55,359,Aetna,Commercial,305.15,85,,percent of total billed charges,,
Nm Renogram Mag 3 Single W Lasix (Pro Cah)Professional Component ,,78708,CPT,Professional,Both,,,26,359,305.15,35.55,359,Aetna,Medicare Advantage,56.98,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Nm Renogram Mag 3 Single W Lasix (Pro Cah)Professional Component ,,78708,CPT,Professional,Both,,,26,359,305.15,35.55,359,Aetna,PPO,333.87,93,,percent of total billed charges,,
Nm Renogram Mag 3 Single W Lasix (Pro Cah)Professional Component ,,78708,CPT,Professional,Both,,,26,359,305.15,35.55,359,America's PPO,America's PPO,306.7296,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Nm Renogram Mag 3 Single W Lasix (Pro Cah)Professional Component ,,78708,CPT,Professional,Both,,,26,359,305.15,35.55,359,BlueCross BlueShield Minnesota, Federal Employee Program,105.47,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Nm Renogram Mag 3 Single W Lasix (Pro Cah)Professional Component ,,78708,CPT,Professional,Both,,,26,359,305.15,35.55,359,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,107.15752,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Nm Renogram Mag 3 Single W Lasix (Pro Cah)Professional Component ,,78708,CPT,Professional,Both,,,26,359,305.15,35.55,359,BlueCross BlueShield Minnesota,High Value Network Plan,107.15752,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Nm Renogram Mag 3 Single W Lasix (Pro Cah)Professional Component ,,78708,CPT,Professional,Both,,,26,359,305.15,35.55,359,BlueCross BlueShield Minnesota,Medicare Advantage,63.549,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Nm Renogram Mag 3 Single W Lasix (Pro Cah)Professional Component ,,78708,CPT,Professional,Both,,,26,359,305.15,35.55,359,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,107.15752,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Nm Renogram Mag 3 Single W Lasix (Pro Cah)Professional Component ,,78708,CPT,Professional,Both,,,26,359,305.15,35.55,359,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,41.0464,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Nm Renogram Mag 3 Single W Lasix (Pro Cah)Professional Component ,,78708,CPT,Professional,Both,,,26,359,305.15,35.55,359,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),63.549,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Nm Renogram Mag 3 Single W Lasix (Pro Cah)Professional Component ,,78708,CPT,Professional,Both,,,26,359,305.15,35.55,359,CorVel,Worker's Compensation,109.6785345,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Nm Renogram Mag 3 Single W Lasix (Pro Cah)Professional Component ,,78708,CPT,Professional,Both,,,26,359,305.15,35.55,359,First Health Group Corporation,First Health Network,348.23,97,,percent of total billed charges,,
Nm Renogram Mag 3 Single W Lasix (Pro Cah)Professional Component ,,78708,CPT,Professional,Both,,,26,359,305.15,35.55,359,"Health Partners, Inc.",Commercial,84.56,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Nm Renogram Mag 3 Single W Lasix (Pro Cah)Professional Component ,,78708,CPT,Professional,Both,,,26,359,305.15,35.55,359,"Health Partners, Inc.",Medicare Advantage,63.549,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Nm Renogram Mag 3 Single W Lasix (Pro Cah)Professional Component ,,78708,CPT,Professional,Both,,,26,359,305.15,35.55,359,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),35.55,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Nm Renogram Mag 3 Single W Lasix (Pro Cah)Professional Component ,,78708,CPT,Professional,Both,,,26,359,305.15,35.55,359,"Health Partners, Inc.",State of Minnesota Advantage Program,72.84844,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Nm Renogram Mag 3 Single W Lasix (Pro Cah)Professional Component ,,78708,CPT,Professional,Both,,,26,359,305.15,35.55,359,"Health Partners, Inc.",State Public Programs,35.55,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Nm Renogram Mag 3 Single W Lasix (Pro Cah)Professional Component ,,78708,CPT,Professional,Both,,,26,359,305.15,35.55,359,Humana Insurance Company,Commercial PPO,55.26,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Nm Renogram Mag 3 Single W Lasix (Pro Cah)Professional Component ,,78708,CPT,Professional,Both,,,26,359,305.15,35.55,359,Humana Insurance Company,Medicare PPO,359,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Nm Renogram Mag 3 Single W Lasix (Pro Cah)Professional Component ,,78708,CPT,Professional,Both,,,26,359,305.15,35.55,359,Medica,Individual & Family,304.432,84.8,,percent of total billed charges,,
Nm Renogram Mag 3 Single W Lasix (Pro Cah)Professional Component ,,78708,CPT,Professional,Both,,,26,359,305.15,35.55,359,Medica,Medica Advantage Solution,178.782,49.8,,percent of total billed charges,,
Nm Renogram Mag 3 Single W Lasix (Pro Cah)Professional Component ,,78708,CPT,Professional,Both,,,26,359,305.15,35.55,359,Medica,Medical Assistance,41.05,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Nm Renogram Mag 3 Single W Lasix (Pro Cah)Professional Component ,,78708,CPT,Professional,Both,,,26,359,305.15,35.55,359,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,55.26,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Nm Renogram Mag 3 Single W Lasix (Pro Cah)Professional Component ,,78708,CPT,Professional,Both,,,26,359,305.15,35.55,359,"Multiplan, Inc.","Multiplan, Inc.",337.46,94,,percent of total billed charges,,
Nm Renogram Mag 3 Single W Lasix (Pro Cah)Professional Component ,,78708,CPT,Professional,Both,,,26,359,305.15,35.55,359,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,323.459,90.1,,percent of total billed charges,,
Nm Renogram Mag 3 Single W Lasix (Pro Cah)Professional Component ,,78708,CPT,Professional,Both,,,26,359,305.15,35.55,359,"Preferred One Administrative Services, INC.",PPO,353.974,98.6,,percent of total billed charges,,
Nm Renogram Mag 3 Single W Lasix (Pro Cah)Professional Component ,,78708,CPT,Professional,Both,,,26,359,305.15,35.55,359,PrimeWest Health,Minnesota Senior Health Options (MSHO),63.549,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Nm Renogram Mag 3 Single W Lasix (Pro Cah)Professional Component ,,78708,CPT,Professional,Both,,,26,359,305.15,35.55,359,PrimeWest Health,MinnesotaCare,43.919648,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Nm Renogram Mag 3 Single W Lasix (Pro Cah)Professional Component ,,78708,CPT,Professional,Both,,,26,359,305.15,35.55,359,Sanford Health Plan,Sanford Health Plan,315.92,88,,percent of total billed charges,,
Nm Renogram Mag 3 Single W Lasix (Pro Cah)Professional Component ,,78708,CPT,Professional,Both,,,26,359,305.15,35.55,359,"UCare Health, Inc.",Individual & Family Plan,89.830656,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Nm Renogram Mag 3 Single W Lasix (Pro Cah)Professional Component ,,78708,CPT,Professional,Both,,,26,359,305.15,35.55,359,"UCare Health, Inc.",Medical Assistance,45.15104,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Nm Renogram Mag 3 Single W Lasix (Pro Cah)Professional Component ,,78708,CPT,Professional,Both,,,26,359,305.15,35.55,359,"UCare Health, Inc.",Medicare Advantage,63.549,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Nm Renogram Mag 3 Single W Lasix (Pro Cah)Professional Component ,,78708,CPT,Professional,Both,,,26,359,305.15,35.55,359,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),50.8392,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Nm Renogram Mag 3 Single W Lasix (Pro Cah)Professional Component ,,78708,CPT,Professional,Both,,,26,359,305.15,35.55,359,UnitedHealthcare,Individual & Family,359,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Nm Renogram Mag 3 Single W Lasix (Pro Cah)Professional Component ,,78708,CPT,Professional,Both,,,26,359,305.15,35.55,359,UnitedHealthcare,Medicare Advantage,63.549,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Nm Renogram Mag 3 Single W Lasix (Pro Cah)Professional Component ,,78708,CPT,Professional,Both,,,26,359,305.15,35.55,359,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,41.0464,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Kidney Imaging Morphology; With Vasc Flow Multiple (Pro Cah)Professional Component ,,78709,CPT,Professional,Both,,,26,407,345.95,41.45,407,Aetna,Commercial,345.95,85,,percent of total billed charges,,
Kidney Imaging Morphology; With Vasc Flow Multiple (Pro Cah)Professional Component ,,78709,CPT,Professional,Both,,,26,407,345.95,41.45,407,Aetna,Medicare Advantage,66.07,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Kidney Imaging Morphology; With Vasc Flow Multiple (Pro Cah)Professional Component ,,78709,CPT,Professional,Both,,,26,407,345.95,41.45,407,Aetna,PPO,378.51,93,,percent of total billed charges,,
Kidney Imaging Morphology; With Vasc Flow Multiple (Pro Cah)Professional Component ,,78709,CPT,Professional,Both,,,26,407,345.95,41.45,407,America's PPO,America's PPO,347.7408,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Kidney Imaging Morphology; With Vasc Flow Multiple (Pro Cah)Professional Component ,,78709,CPT,Professional,Both,,,26,407,345.95,41.45,407,BlueCross BlueShield Minnesota, Federal Employee Program,124,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Kidney Imaging Morphology; With Vasc Flow Multiple (Pro Cah)Professional Component ,,78709,CPT,Professional,Both,,,26,407,345.95,41.45,407,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,125.984,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Kidney Imaging Morphology; With Vasc Flow Multiple (Pro Cah)Professional Component ,,78709,CPT,Professional,Both,,,26,407,345.95,41.45,407,BlueCross BlueShield Minnesota,High Value Network Plan,125.984,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Kidney Imaging Morphology; With Vasc Flow Multiple (Pro Cah)Professional Component ,,78709,CPT,Professional,Both,,,26,407,345.95,41.45,407,BlueCross BlueShield Minnesota,Medicare Advantage,74.3705,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Kidney Imaging Morphology; With Vasc Flow Multiple (Pro Cah)Professional Component ,,78709,CPT,Professional,Both,,,26,407,345.95,41.45,407,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,125.984,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Kidney Imaging Morphology; With Vasc Flow Multiple (Pro Cah)Professional Component ,,78709,CPT,Professional,Both,,,26,407,345.95,41.45,407,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,47.8536,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Kidney Imaging Morphology; With Vasc Flow Multiple (Pro Cah)Professional Component ,,78709,CPT,Professional,Both,,,26,407,345.95,41.45,407,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),74.3705,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Kidney Imaging Morphology; With Vasc Flow Multiple (Pro Cah)Professional Component ,,78709,CPT,Professional,Both,,,26,407,345.95,41.45,407,CorVel,Worker's Compensation,127.6693473,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Kidney Imaging Morphology; With Vasc Flow Multiple (Pro Cah)Professional Component ,,78709,CPT,Professional,Both,,,26,407,345.95,41.45,407,First Health Group Corporation,First Health Network,394.79,97,,percent of total billed charges,,
Kidney Imaging Morphology; With Vasc Flow Multiple (Pro Cah)Professional Component ,,78709,CPT,Professional,Both,,,26,407,345.95,41.45,407,"Health Partners, Inc.",Commercial,97.97,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Kidney Imaging Morphology; With Vasc Flow Multiple (Pro Cah)Professional Component ,,78709,CPT,Professional,Both,,,26,407,345.95,41.45,407,"Health Partners, Inc.",Medicare Advantage,74.3705,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Kidney Imaging Morphology; With Vasc Flow Multiple (Pro Cah)Professional Component ,,78709,CPT,Professional,Both,,,26,407,345.95,41.45,407,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),41.45,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Kidney Imaging Morphology; With Vasc Flow Multiple (Pro Cah)Professional Component ,,78709,CPT,Professional,Both,,,26,407,345.95,41.45,407,"Health Partners, Inc.",State of Minnesota Advantage Program,84.401155,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Kidney Imaging Morphology; With Vasc Flow Multiple (Pro Cah)Professional Component ,,78709,CPT,Professional,Both,,,26,407,345.95,41.45,407,"Health Partners, Inc.",State Public Programs,41.45,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Kidney Imaging Morphology; With Vasc Flow Multiple (Pro Cah)Professional Component ,,78709,CPT,Professional,Both,,,26,407,345.95,41.45,407,Humana Insurance Company,Commercial PPO,64.67,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Kidney Imaging Morphology; With Vasc Flow Multiple (Pro Cah)Professional Component ,,78709,CPT,Professional,Both,,,26,407,345.95,41.45,407,Humana Insurance Company,Medicare PPO,407,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Kidney Imaging Morphology; With Vasc Flow Multiple (Pro Cah)Professional Component ,,78709,CPT,Professional,Both,,,26,407,345.95,41.45,407,Medica,Individual & Family,345.136,84.8,,percent of total billed charges,,
Kidney Imaging Morphology; With Vasc Flow Multiple (Pro Cah)Professional Component ,,78709,CPT,Professional,Both,,,26,407,345.95,41.45,407,Medica,Medica Advantage Solution,202.686,49.8,,percent of total billed charges,,
Kidney Imaging Morphology; With Vasc Flow Multiple (Pro Cah)Professional Component ,,78709,CPT,Professional,Both,,,26,407,345.95,41.45,407,Medica,Medical Assistance,47.85,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Kidney Imaging Morphology; With Vasc Flow Multiple (Pro Cah)Professional Component ,,78709,CPT,Professional,Both,,,26,407,345.95,41.45,407,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,64.67,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Kidney Imaging Morphology; With Vasc Flow Multiple (Pro Cah)Professional Component ,,78709,CPT,Professional,Both,,,26,407,345.95,41.45,407,"Multiplan, Inc.","Multiplan, Inc.",382.58,94,,percent of total billed charges,,
Kidney Imaging Morphology; With Vasc Flow Multiple (Pro Cah)Professional Component ,,78709,CPT,Professional,Both,,,26,407,345.95,41.45,407,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,366.707,90.1,,percent of total billed charges,,
Kidney Imaging Morphology; With Vasc Flow Multiple (Pro Cah)Professional Component ,,78709,CPT,Professional,Both,,,26,407,345.95,41.45,407,"Preferred One Administrative Services, INC.",PPO,401.302,98.6,,percent of total billed charges,,
Kidney Imaging Morphology; With Vasc Flow Multiple (Pro Cah)Professional Component ,,78709,CPT,Professional,Both,,,26,407,345.95,41.45,407,PrimeWest Health,Minnesota Senior Health Options (MSHO),74.3705,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Kidney Imaging Morphology; With Vasc Flow Multiple (Pro Cah)Professional Component ,,78709,CPT,Professional,Both,,,26,407,345.95,41.45,407,PrimeWest Health,MinnesotaCare,51.203352,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Kidney Imaging Morphology; With Vasc Flow Multiple (Pro Cah)Professional Component ,,78709,CPT,Professional,Both,,,26,407,345.95,41.45,407,Sanford Health Plan,Sanford Health Plan,358.16,88,,percent of total billed charges,,
Kidney Imaging Morphology; With Vasc Flow Multiple (Pro Cah)Professional Component ,,78709,CPT,Professional,Both,,,26,407,345.95,41.45,407,"UCare Health, Inc.",Individual & Family Plan,105.127552,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Kidney Imaging Morphology; With Vasc Flow Multiple (Pro Cah)Professional Component ,,78709,CPT,Professional,Both,,,26,407,345.95,41.45,407,"UCare Health, Inc.",Medical Assistance,52.63896,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Kidney Imaging Morphology; With Vasc Flow Multiple (Pro Cah)Professional Component ,,78709,CPT,Professional,Both,,,26,407,345.95,41.45,407,"UCare Health, Inc.",Medicare Advantage,74.3705,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Kidney Imaging Morphology; With Vasc Flow Multiple (Pro Cah)Professional Component ,,78709,CPT,Professional,Both,,,26,407,345.95,41.45,407,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),59.4964,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Kidney Imaging Morphology; With Vasc Flow Multiple (Pro Cah)Professional Component ,,78709,CPT,Professional,Both,,,26,407,345.95,41.45,407,UnitedHealthcare,Individual & Family,407,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Kidney Imaging Morphology; With Vasc Flow Multiple (Pro Cah)Professional Component ,,78709,CPT,Professional,Both,,,26,407,345.95,41.45,407,UnitedHealthcare,Medicare Advantage,74.3705,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Kidney Imaging Morphology; With Vasc Flow Multiple (Pro Cah)Professional Component ,,78709,CPT,Professional,Both,,,26,407,345.95,41.45,407,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,47.8536,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Computerized Ophth Dx Imaging, Post Segment, Optic Nerve (Pro Cah)Professional Component ",,92133,CPT,Professional,Both,,,26,189,160.65,13.52,189,Aetna,Commercial,160.65,85,,percent of total billed charges,,
"Computerized Ophth Dx Imaging, Post Segment, Optic Nerve (Pro Cah)Professional Component ",,92133,CPT,Professional,Both,,,26,189,160.65,13.52,189,Aetna,Medicare Advantage,21.86,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Computerized Ophth Dx Imaging, Post Segment, Optic Nerve (Pro Cah)Professional Component ",,92133,CPT,Professional,Both,,,26,189,160.65,13.52,189,Aetna,PPO,175.77,93,,percent of total billed charges,,
"Computerized Ophth Dx Imaging, Post Segment, Optic Nerve (Pro Cah)Professional Component ",,92133,CPT,Professional,Both,,,26,189,160.65,13.52,189,America's PPO,America's PPO,161.4816,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Computerized Ophth Dx Imaging, Post Segment, Optic Nerve (Pro Cah)Professional Component ",,92133,CPT,Professional,Both,,,26,189,160.65,13.52,189,BlueCross BlueShield Minnesota, Federal Employee Program,36.76,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Computerized Ophth Dx Imaging, Post Segment, Optic Nerve (Pro Cah)Professional Component ",,92133,CPT,Professional,Both,,,26,189,160.65,13.52,189,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,37.34816,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Computerized Ophth Dx Imaging, Post Segment, Optic Nerve (Pro Cah)Professional Component ",,92133,CPT,Professional,Both,,,26,189,160.65,13.52,189,BlueCross BlueShield Minnesota,High Value Network Plan,37.34816,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Computerized Ophth Dx Imaging, Post Segment, Optic Nerve (Pro Cah)Professional Component ",,92133,CPT,Professional,Both,,,26,189,160.65,13.52,189,BlueCross BlueShield Minnesota,Medicare Advantage,24.449,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Computerized Ophth Dx Imaging, Post Segment, Optic Nerve (Pro Cah)Professional Component ",,92133,CPT,Professional,Both,,,26,189,160.65,13.52,189,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,37.34816,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Computerized Ophth Dx Imaging, Post Segment, Optic Nerve (Pro Cah)Professional Component ",,92133,CPT,Professional,Both,,,26,189,160.65,13.52,189,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,15.60576,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Computerized Ophth Dx Imaging, Post Segment, Optic Nerve (Pro Cah)Professional Component ",,92133,CPT,Professional,Both,,,26,189,160.65,13.52,189,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),24.449,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Computerized Ophth Dx Imaging, Post Segment, Optic Nerve (Pro Cah)Professional Component ",,92133,CPT,Professional,Both,,,26,189,160.65,13.52,189,CorVel,Worker's Compensation,42.0746163,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Computerized Ophth Dx Imaging, Post Segment, Optic Nerve (Pro Cah)Professional Component ",,92133,CPT,Professional,Both,,,26,189,160.65,13.52,189,First Health Group Corporation,First Health Network,183.33,97,,percent of total billed charges,,
"Computerized Ophth Dx Imaging, Post Segment, Optic Nerve (Pro Cah)Professional Component ",,92133,CPT,Professional,Both,,,26,189,160.65,13.52,189,"Health Partners, Inc.",Commercial,44.98,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Computerized Ophth Dx Imaging, Post Segment, Optic Nerve (Pro Cah)Professional Component ",,92133,CPT,Professional,Both,,,26,189,160.65,13.52,189,"Health Partners, Inc.",Medicare Advantage,24.449,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Computerized Ophth Dx Imaging, Post Segment, Optic Nerve (Pro Cah)Professional Component ",,92133,CPT,Professional,Both,,,26,189,160.65,13.52,189,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),13.52,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Computerized Ophth Dx Imaging, Post Segment, Optic Nerve (Pro Cah)Professional Component ",,92133,CPT,Professional,Both,,,26,189,160.65,13.52,189,"Health Partners, Inc.",State of Minnesota Advantage Program,38.75027,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Computerized Ophth Dx Imaging, Post Segment, Optic Nerve (Pro Cah)Professional Component ",,92133,CPT,Professional,Both,,,26,189,160.65,13.52,189,"Health Partners, Inc.",State Public Programs,13.52,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Computerized Ophth Dx Imaging, Post Segment, Optic Nerve (Pro Cah)Professional Component ",,92133,CPT,Professional,Both,,,26,189,160.65,13.52,189,Humana Insurance Company,Commercial PPO,21.26,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Computerized Ophth Dx Imaging, Post Segment, Optic Nerve (Pro Cah)Professional Component ",,92133,CPT,Professional,Both,,,26,189,160.65,13.52,189,Humana Insurance Company,Medicare PPO,189,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Computerized Ophth Dx Imaging, Post Segment, Optic Nerve (Pro Cah)Professional Component ",,92133,CPT,Professional,Both,,,26,189,160.65,13.52,189,Medica,Individual & Family,160.272,84.8,,percent of total billed charges,,
"Computerized Ophth Dx Imaging, Post Segment, Optic Nerve (Pro Cah)Professional Component ",,92133,CPT,Professional,Both,,,26,189,160.65,13.52,189,Medica,Medica Advantage Solution,94.122,49.8,,percent of total billed charges,,
"Computerized Ophth Dx Imaging, Post Segment, Optic Nerve (Pro Cah)Professional Component ",,92133,CPT,Professional,Both,,,26,189,160.65,13.52,189,Medica,Medical Assistance,15.61,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Computerized Ophth Dx Imaging, Post Segment, Optic Nerve (Pro Cah)Professional Component ",,92133,CPT,Professional,Both,,,26,189,160.65,13.52,189,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,21.26,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Computerized Ophth Dx Imaging, Post Segment, Optic Nerve (Pro Cah)Professional Component ",,92133,CPT,Professional,Both,,,26,189,160.65,13.52,189,"Multiplan, Inc.","Multiplan, Inc.",177.66,94,,percent of total billed charges,,
"Computerized Ophth Dx Imaging, Post Segment, Optic Nerve (Pro Cah)Professional Component ",,92133,CPT,Professional,Both,,,26,189,160.65,13.52,189,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,170.289,90.1,,percent of total billed charges,,
"Computerized Ophth Dx Imaging, Post Segment, Optic Nerve (Pro Cah)Professional Component ",,92133,CPT,Professional,Both,,,26,189,160.65,13.52,189,"Preferred One Administrative Services, INC.",PPO,186.354,98.6,,percent of total billed charges,,
"Computerized Ophth Dx Imaging, Post Segment, Optic Nerve (Pro Cah)Professional Component ",,92133,CPT,Professional,Both,,,26,189,160.65,13.52,189,PrimeWest Health,Minnesota Senior Health Options (MSHO),24.449,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Computerized Ophth Dx Imaging, Post Segment, Optic Nerve (Pro Cah)Professional Component ",,92133,CPT,Professional,Both,,,26,189,160.65,13.52,189,PrimeWest Health,MinnesotaCare,16.6981632,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Computerized Ophth Dx Imaging, Post Segment, Optic Nerve (Pro Cah)Professional Component ",,92133,CPT,Professional,Both,,,26,189,160.65,13.52,189,Sanford Health Plan,Sanford Health Plan,166.32,88,,percent of total billed charges,,
"Computerized Ophth Dx Imaging, Post Segment, Optic Nerve (Pro Cah)Professional Component ",,92133,CPT,Professional,Both,,,26,189,160.65,13.52,189,"UCare Health, Inc.",Individual & Family Plan,34.560256,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Computerized Ophth Dx Imaging, Post Segment, Optic Nerve (Pro Cah)Professional Component ",,92133,CPT,Professional,Both,,,26,189,160.65,13.52,189,"UCare Health, Inc.",Medical Assistance,17.166336,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Computerized Ophth Dx Imaging, Post Segment, Optic Nerve (Pro Cah)Professional Component ",,92133,CPT,Professional,Both,,,26,189,160.65,13.52,189,"UCare Health, Inc.",Medicare Advantage,24.449,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Computerized Ophth Dx Imaging, Post Segment, Optic Nerve (Pro Cah)Professional Component ",,92133,CPT,Professional,Both,,,26,189,160.65,13.52,189,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),19.5592,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Computerized Ophth Dx Imaging, Post Segment, Optic Nerve (Pro Cah)Professional Component ",,92133,CPT,Professional,Both,,,26,189,160.65,13.52,189,UnitedHealthcare,Individual & Family,189,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Computerized Ophth Dx Imaging, Post Segment, Optic Nerve (Pro Cah)Professional Component ",,92133,CPT,Professional,Both,,,26,189,160.65,13.52,189,UnitedHealthcare,Medicare Advantage,24.449,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Computerized Ophth Dx Imaging, Post Segment, Optic Nerve (Pro Cah)Professional Component ",,92133,CPT,Professional,Both,,,26,189,160.65,13.52,189,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,15.60576,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Computerized Ophth Dx Imaging, Post Segment, Retina (Pro Cah)Professional Component ",,92134,CPT,Professional,Both,,,26,163,138.55,15.7,163,Aetna,Commercial,138.55,85,,percent of total billed charges,,
"Computerized Ophth Dx Imaging, Post Segment, Retina (Pro Cah)Professional Component ",,92134,CPT,Professional,Both,,,26,163,138.55,15.7,163,Aetna,Medicare Advantage,25.37,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Computerized Ophth Dx Imaging, Post Segment, Retina (Pro Cah)Professional Component ",,92134,CPT,Professional,Both,,,26,163,138.55,15.7,163,Aetna,PPO,151.59,93,,percent of total billed charges,,
"Computerized Ophth Dx Imaging, Post Segment, Retina (Pro Cah)Professional Component ",,92134,CPT,Professional,Both,,,26,163,138.55,15.7,163,America's PPO,America's PPO,139.2672,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Computerized Ophth Dx Imaging, Post Segment, Retina (Pro Cah)Professional Component ",,92134,CPT,Professional,Both,,,26,163,138.55,15.7,163,BlueCross BlueShield Minnesota, Federal Employee Program,42.6,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Computerized Ophth Dx Imaging, Post Segment, Retina (Pro Cah)Professional Component ",,92134,CPT,Professional,Both,,,26,163,138.55,15.7,163,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,43.2816,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Computerized Ophth Dx Imaging, Post Segment, Retina (Pro Cah)Professional Component ",,92134,CPT,Professional,Both,,,26,163,138.55,15.7,163,BlueCross BlueShield Minnesota,High Value Network Plan,43.2816,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Computerized Ophth Dx Imaging, Post Segment, Retina (Pro Cah)Professional Component ",,92134,CPT,Professional,Both,,,26,163,138.55,15.7,163,BlueCross BlueShield Minnesota,Medicare Advantage,28.382,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Computerized Ophth Dx Imaging, Post Segment, Retina (Pro Cah)Professional Component ",,92134,CPT,Professional,Both,,,26,163,138.55,15.7,163,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,43.2816,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Computerized Ophth Dx Imaging, Post Segment, Retina (Pro Cah)Professional Component ",,92134,CPT,Professional,Both,,,26,163,138.55,15.7,163,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,18.12544,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Computerized Ophth Dx Imaging, Post Segment, Retina (Pro Cah)Professional Component ",,92134,CPT,Professional,Both,,,26,163,138.55,15.7,163,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),28.382,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Computerized Ophth Dx Imaging, Post Segment, Retina (Pro Cah)Professional Component ",,92134,CPT,Professional,Both,,,26,163,138.55,15.7,163,CorVel,Worker's Compensation,48.8352768,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Computerized Ophth Dx Imaging, Post Segment, Retina (Pro Cah)Professional Component ",,92134,CPT,Professional,Both,,,26,163,138.55,15.7,163,First Health Group Corporation,First Health Network,158.11,97,,percent of total billed charges,,
"Computerized Ophth Dx Imaging, Post Segment, Retina (Pro Cah)Professional Component ",,92134,CPT,Professional,Both,,,26,163,138.55,15.7,163,"Health Partners, Inc.",Commercial,52.24,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Computerized Ophth Dx Imaging, Post Segment, Retina (Pro Cah)Professional Component ",,92134,CPT,Professional,Both,,,26,163,138.55,15.7,163,"Health Partners, Inc.",Medicare Advantage,28.382,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Computerized Ophth Dx Imaging, Post Segment, Retina (Pro Cah)Professional Component ",,92134,CPT,Professional,Both,,,26,163,138.55,15.7,163,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),15.7,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Computerized Ophth Dx Imaging, Post Segment, Retina (Pro Cah)Professional Component ",,92134,CPT,Professional,Both,,,26,163,138.55,15.7,163,"Health Partners, Inc.",State of Minnesota Advantage Program,45.00476,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Computerized Ophth Dx Imaging, Post Segment, Retina (Pro Cah)Professional Component ",,92134,CPT,Professional,Both,,,26,163,138.55,15.7,163,"Health Partners, Inc.",State Public Programs,15.7,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Computerized Ophth Dx Imaging, Post Segment, Retina (Pro Cah)Professional Component ",,92134,CPT,Professional,Both,,,26,163,138.55,15.7,163,Humana Insurance Company,Commercial PPO,24.68,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Computerized Ophth Dx Imaging, Post Segment, Retina (Pro Cah)Professional Component ",,92134,CPT,Professional,Both,,,26,163,138.55,15.7,163,Humana Insurance Company,Medicare PPO,163,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Computerized Ophth Dx Imaging, Post Segment, Retina (Pro Cah)Professional Component ",,92134,CPT,Professional,Both,,,26,163,138.55,15.7,163,Medica,Individual & Family,138.224,84.8,,percent of total billed charges,,
"Computerized Ophth Dx Imaging, Post Segment, Retina (Pro Cah)Professional Component ",,92134,CPT,Professional,Both,,,26,163,138.55,15.7,163,Medica,Medica Advantage Solution,81.174,49.8,,percent of total billed charges,,
"Computerized Ophth Dx Imaging, Post Segment, Retina (Pro Cah)Professional Component ",,92134,CPT,Professional,Both,,,26,163,138.55,15.7,163,Medica,Medical Assistance,18.13,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Computerized Ophth Dx Imaging, Post Segment, Retina (Pro Cah)Professional Component ",,92134,CPT,Professional,Both,,,26,163,138.55,15.7,163,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,24.68,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Computerized Ophth Dx Imaging, Post Segment, Retina (Pro Cah)Professional Component ",,92134,CPT,Professional,Both,,,26,163,138.55,15.7,163,"Multiplan, Inc.","Multiplan, Inc.",153.22,94,,percent of total billed charges,,
"Computerized Ophth Dx Imaging, Post Segment, Retina (Pro Cah)Professional Component ",,92134,CPT,Professional,Both,,,26,163,138.55,15.7,163,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,146.863,90.1,,percent of total billed charges,,
"Computerized Ophth Dx Imaging, Post Segment, Retina (Pro Cah)Professional Component ",,92134,CPT,Professional,Both,,,26,163,138.55,15.7,163,"Preferred One Administrative Services, INC.",PPO,160.718,98.6,,percent of total billed charges,,
"Computerized Ophth Dx Imaging, Post Segment, Retina (Pro Cah)Professional Component ",,92134,CPT,Professional,Both,,,26,163,138.55,15.7,163,PrimeWest Health,Minnesota Senior Health Options (MSHO),28.382,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Computerized Ophth Dx Imaging, Post Segment, Retina (Pro Cah)Professional Component ",,92134,CPT,Professional,Both,,,26,163,138.55,15.7,163,PrimeWest Health,MinnesotaCare,19.3942208,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Computerized Ophth Dx Imaging, Post Segment, Retina (Pro Cah)Professional Component ",,92134,CPT,Professional,Both,,,26,163,138.55,15.7,163,Sanford Health Plan,Sanford Health Plan,143.44,88,,percent of total billed charges,,
"Computerized Ophth Dx Imaging, Post Segment, Retina (Pro Cah)Professional Component ",,92134,CPT,Professional,Both,,,26,163,138.55,15.7,163,"UCare Health, Inc.",Individual & Family Plan,40.119808,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Computerized Ophth Dx Imaging, Post Segment, Retina (Pro Cah)Professional Component ",,92134,CPT,Professional,Both,,,26,163,138.55,15.7,163,"UCare Health, Inc.",Medical Assistance,19.937984,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Computerized Ophth Dx Imaging, Post Segment, Retina (Pro Cah)Professional Component ",,92134,CPT,Professional,Both,,,26,163,138.55,15.7,163,"UCare Health, Inc.",Medicare Advantage,28.382,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Computerized Ophth Dx Imaging, Post Segment, Retina (Pro Cah)Professional Component ",,92134,CPT,Professional,Both,,,26,163,138.55,15.7,163,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),22.7056,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Computerized Ophth Dx Imaging, Post Segment, Retina (Pro Cah)Professional Component ",,92134,CPT,Professional,Both,,,26,163,138.55,15.7,163,UnitedHealthcare,Individual & Family,163,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Computerized Ophth Dx Imaging, Post Segment, Retina (Pro Cah)Professional Component ",,92134,CPT,Professional,Both,,,26,163,138.55,15.7,163,UnitedHealthcare,Medicare Advantage,28.382,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Computerized Ophth Dx Imaging, Post Segment, Retina (Pro Cah)Professional Component ",,92134,CPT,Professional,Both,,,26,163,138.55,15.7,163,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,18.12544,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Ophthalmic Biometry With Intraocular Lens Power Calculation (Pro Cah)Professional Component ,,92136,CPT,Professional,Both,,,26,194,164.9,19.19,194,Aetna,Commercial,164.9,85,,percent of total billed charges,,
Ophthalmic Biometry With Intraocular Lens Power Calculation (Pro Cah)Professional Component ,,92136,CPT,Professional,Both,,,26,194,164.9,19.19,194,Aetna,Medicare Advantage,30.63,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ophthalmic Biometry With Intraocular Lens Power Calculation (Pro Cah)Professional Component ,,92136,CPT,Professional,Both,,,26,194,164.9,19.19,194,Aetna,PPO,180.42,93,,percent of total billed charges,,
Ophthalmic Biometry With Intraocular Lens Power Calculation (Pro Cah)Professional Component ,,92136,CPT,Professional,Both,,,26,194,164.9,19.19,194,America's PPO,America's PPO,165.7536,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Ophthalmic Biometry With Intraocular Lens Power Calculation (Pro Cah)Professional Component ,,92136,CPT,Professional,Both,,,26,194,164.9,19.19,194,BlueCross BlueShield Minnesota, Federal Employee Program,51.93,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Ophthalmic Biometry With Intraocular Lens Power Calculation (Pro Cah)Professional Component ,,92136,CPT,Professional,Both,,,26,194,164.9,19.19,194,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,52.76088,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Ophthalmic Biometry With Intraocular Lens Power Calculation (Pro Cah)Professional Component ,,92136,CPT,Professional,Both,,,26,194,164.9,19.19,194,BlueCross BlueShield Minnesota,High Value Network Plan,52.76088,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Ophthalmic Biometry With Intraocular Lens Power Calculation (Pro Cah)Professional Component ,,92136,CPT,Professional,Both,,,26,194,164.9,19.19,194,BlueCross BlueShield Minnesota,Medicare Advantage,34.6725,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ophthalmic Biometry With Intraocular Lens Power Calculation (Pro Cah)Professional Component ,,92136,CPT,Professional,Both,,,26,194,164.9,19.19,194,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,52.76088,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Ophthalmic Biometry With Intraocular Lens Power Calculation (Pro Cah)Professional Component ,,92136,CPT,Professional,Both,,,26,194,164.9,19.19,194,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,22.15896,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Ophthalmic Biometry With Intraocular Lens Power Calculation (Pro Cah)Professional Component ,,92136,CPT,Professional,Both,,,26,194,164.9,19.19,194,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),34.6725,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ophthalmic Biometry With Intraocular Lens Power Calculation (Pro Cah)Professional Component ,,92136,CPT,Professional,Both,,,26,194,164.9,19.19,194,CorVel,Worker's Compensation,58.9631694,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Ophthalmic Biometry With Intraocular Lens Power Calculation (Pro Cah)Professional Component ,,92136,CPT,Professional,Both,,,26,194,164.9,19.19,194,First Health Group Corporation,First Health Network,188.18,97,,percent of total billed charges,,
Ophthalmic Biometry With Intraocular Lens Power Calculation (Pro Cah)Professional Component ,,92136,CPT,Professional,Both,,,26,194,164.9,19.19,194,"Health Partners, Inc.",Commercial,63.12,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Ophthalmic Biometry With Intraocular Lens Power Calculation (Pro Cah)Professional Component ,,92136,CPT,Professional,Both,,,26,194,164.9,19.19,194,"Health Partners, Inc.",Medicare Advantage,34.6725,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ophthalmic Biometry With Intraocular Lens Power Calculation (Pro Cah)Professional Component ,,92136,CPT,Professional,Both,,,26,194,164.9,19.19,194,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),19.19,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Ophthalmic Biometry With Intraocular Lens Power Calculation (Pro Cah)Professional Component ,,92136,CPT,Professional,Both,,,26,194,164.9,19.19,194,"Health Partners, Inc.",State of Minnesota Advantage Program,54.37788,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Ophthalmic Biometry With Intraocular Lens Power Calculation (Pro Cah)Professional Component ,,92136,CPT,Professional,Both,,,26,194,164.9,19.19,194,"Health Partners, Inc.",State Public Programs,19.19,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Ophthalmic Biometry With Intraocular Lens Power Calculation (Pro Cah)Professional Component ,,92136,CPT,Professional,Both,,,26,194,164.9,19.19,194,Humana Insurance Company,Commercial PPO,30.15,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Ophthalmic Biometry With Intraocular Lens Power Calculation (Pro Cah)Professional Component ,,92136,CPT,Professional,Both,,,26,194,164.9,19.19,194,Humana Insurance Company,Medicare PPO,194,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Ophthalmic Biometry With Intraocular Lens Power Calculation (Pro Cah)Professional Component ,,92136,CPT,Professional,Both,,,26,194,164.9,19.19,194,Medica,Individual & Family,164.512,84.8,,percent of total billed charges,,
Ophthalmic Biometry With Intraocular Lens Power Calculation (Pro Cah)Professional Component ,,92136,CPT,Professional,Both,,,26,194,164.9,19.19,194,Medica,Medica Advantage Solution,96.612,49.8,,percent of total billed charges,,
Ophthalmic Biometry With Intraocular Lens Power Calculation (Pro Cah)Professional Component ,,92136,CPT,Professional,Both,,,26,194,164.9,19.19,194,Medica,Medical Assistance,22.16,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Ophthalmic Biometry With Intraocular Lens Power Calculation (Pro Cah)Professional Component ,,92136,CPT,Professional,Both,,,26,194,164.9,19.19,194,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,30.15,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Ophthalmic Biometry With Intraocular Lens Power Calculation (Pro Cah)Professional Component ,,92136,CPT,Professional,Both,,,26,194,164.9,19.19,194,"Multiplan, Inc.","Multiplan, Inc.",182.36,94,,percent of total billed charges,,
Ophthalmic Biometry With Intraocular Lens Power Calculation (Pro Cah)Professional Component ,,92136,CPT,Professional,Both,,,26,194,164.9,19.19,194,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,174.794,90.1,,percent of total billed charges,,
Ophthalmic Biometry With Intraocular Lens Power Calculation (Pro Cah)Professional Component ,,92136,CPT,Professional,Both,,,26,194,164.9,19.19,194,"Preferred One Administrative Services, INC.",PPO,191.284,98.6,,percent of total billed charges,,
Ophthalmic Biometry With Intraocular Lens Power Calculation (Pro Cah)Professional Component ,,92136,CPT,Professional,Both,,,26,194,164.9,19.19,194,PrimeWest Health,Minnesota Senior Health Options (MSHO),34.6725,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ophthalmic Biometry With Intraocular Lens Power Calculation (Pro Cah)Professional Component ,,92136,CPT,Professional,Both,,,26,194,164.9,19.19,194,PrimeWest Health,MinnesotaCare,23.7100872,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Ophthalmic Biometry With Intraocular Lens Power Calculation (Pro Cah)Professional Component ,,92136,CPT,Professional,Both,,,26,194,164.9,19.19,194,Sanford Health Plan,Sanford Health Plan,170.72,88,,percent of total billed charges,,
Ophthalmic Biometry With Intraocular Lens Power Calculation (Pro Cah)Professional Component ,,92136,CPT,Professional,Both,,,26,194,164.9,19.19,194,"UCare Health, Inc.",Individual & Family Plan,49.01184,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Ophthalmic Biometry With Intraocular Lens Power Calculation (Pro Cah)Professional Component ,,92136,CPT,Professional,Both,,,26,194,164.9,19.19,194,"UCare Health, Inc.",Medical Assistance,24.374856,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Ophthalmic Biometry With Intraocular Lens Power Calculation (Pro Cah)Professional Component ,,92136,CPT,Professional,Both,,,26,194,164.9,19.19,194,"UCare Health, Inc.",Medicare Advantage,34.6725,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Ophthalmic Biometry With Intraocular Lens Power Calculation (Pro Cah)Professional Component ,,92136,CPT,Professional,Both,,,26,194,164.9,19.19,194,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),27.738,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Ophthalmic Biometry With Intraocular Lens Power Calculation (Pro Cah)Professional Component ,,92136,CPT,Professional,Both,,,26,194,164.9,19.19,194,UnitedHealthcare,Individual & Family,194,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Ophthalmic Biometry With Intraocular Lens Power Calculation (Pro Cah)Professional Component ,,92136,CPT,Professional,Both,,,26,194,164.9,19.19,194,UnitedHealthcare,Medicare Advantage,34.6725,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ophthalmic Biometry With Intraocular Lens Power Calculation (Pro Cah)Professional Component ,,92136,CPT,Professional,Both,,,26,194,164.9,19.19,194,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,22.15896,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Fundus Photography With Interp And Report (Pro Cah)Professional Component ,,92250,CPT,Professional,Both,,,26,128,108.8,13.31,128,Aetna,Commercial,108.8,85,,percent of total billed charges,,
Fundus Photography With Interp And Report (Pro Cah)Professional Component ,,92250,CPT,Professional,Both,,,26,128,108.8,13.31,128,Aetna,Medicare Advantage,21.15,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Fundus Photography With Interp And Report (Pro Cah)Professional Component ,,92250,CPT,Professional,Both,,,26,128,108.8,13.31,128,Aetna,PPO,119.04,93,,percent of total billed charges,,
Fundus Photography With Interp And Report (Pro Cah)Professional Component ,,92250,CPT,Professional,Both,,,26,128,108.8,13.31,128,America's PPO,America's PPO,109.3632,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Fundus Photography With Interp And Report (Pro Cah)Professional Component ,,92250,CPT,Professional,Both,,,26,128,108.8,13.31,128,BlueCross BlueShield Minnesota, Federal Employee Program,36.18,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Fundus Photography With Interp And Report (Pro Cah)Professional Component ,,92250,CPT,Professional,Both,,,26,128,108.8,13.31,128,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,36.75888,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Fundus Photography With Interp And Report (Pro Cah)Professional Component ,,92250,CPT,Professional,Both,,,26,128,108.8,13.31,128,BlueCross BlueShield Minnesota,High Value Network Plan,36.75888,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Fundus Photography With Interp And Report (Pro Cah)Professional Component ,,92250,CPT,Professional,Both,,,26,128,108.8,13.31,128,BlueCross BlueShield Minnesota,Medicare Advantage,24.058,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Fundus Photography With Interp And Report (Pro Cah)Professional Component ,,92250,CPT,Professional,Both,,,26,128,108.8,13.31,128,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,36.75888,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Fundus Photography With Interp And Report (Pro Cah)Professional Component ,,92250,CPT,Professional,Both,,,26,128,108.8,13.31,128,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,15.36192,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Fundus Photography With Interp And Report (Pro Cah)Professional Component ,,92250,CPT,Professional,Both,,,26,128,108.8,13.31,128,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),24.058,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Fundus Photography With Interp And Report (Pro Cah)Professional Component ,,92250,CPT,Professional,Both,,,26,128,108.8,13.31,128,CorVel,Worker's Compensation,40.7137521,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Fundus Photography With Interp And Report (Pro Cah)Professional Component ,,92250,CPT,Professional,Both,,,26,128,108.8,13.31,128,First Health Group Corporation,First Health Network,124.16,97,,percent of total billed charges,,
Fundus Photography With Interp And Report (Pro Cah)Professional Component ,,92250,CPT,Professional,Both,,,26,128,108.8,13.31,128,"Health Partners, Inc.",Commercial,43.54,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Fundus Photography With Interp And Report (Pro Cah)Professional Component ,,92250,CPT,Professional,Both,,,26,128,108.8,13.31,128,"Health Partners, Inc.",Medicare Advantage,24.058,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Fundus Photography With Interp And Report (Pro Cah)Professional Component ,,92250,CPT,Professional,Both,,,26,128,108.8,13.31,128,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),13.31,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Fundus Photography With Interp And Report (Pro Cah)Professional Component ,,92250,CPT,Professional,Both,,,26,128,108.8,13.31,128,"Health Partners, Inc.",State of Minnesota Advantage Program,37.50971,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Fundus Photography With Interp And Report (Pro Cah)Professional Component ,,92250,CPT,Professional,Both,,,26,128,108.8,13.31,128,"Health Partners, Inc.",State Public Programs,13.31,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Fundus Photography With Interp And Report (Pro Cah)Professional Component ,,92250,CPT,Professional,Both,,,26,128,108.8,13.31,128,Humana Insurance Company,Commercial PPO,20.92,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Fundus Photography With Interp And Report (Pro Cah)Professional Component ,,92250,CPT,Professional,Both,,,26,128,108.8,13.31,128,Humana Insurance Company,Medicare PPO,128,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Fundus Photography With Interp And Report (Pro Cah)Professional Component ,,92250,CPT,Professional,Both,,,26,128,108.8,13.31,128,Medica,Individual & Family,108.544,84.8,,percent of total billed charges,,
Fundus Photography With Interp And Report (Pro Cah)Professional Component ,,92250,CPT,Professional,Both,,,26,128,108.8,13.31,128,Medica,Medica Advantage Solution,63.744,49.8,,percent of total billed charges,,
Fundus Photography With Interp And Report (Pro Cah)Professional Component ,,92250,CPT,Professional,Both,,,26,128,108.8,13.31,128,Medica,Medical Assistance,15.36,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Fundus Photography With Interp And Report (Pro Cah)Professional Component ,,92250,CPT,Professional,Both,,,26,128,108.8,13.31,128,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,20.92,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Fundus Photography With Interp And Report (Pro Cah)Professional Component ,,92250,CPT,Professional,Both,,,26,128,108.8,13.31,128,"Multiplan, Inc.","Multiplan, Inc.",120.32,94,,percent of total billed charges,,
Fundus Photography With Interp And Report (Pro Cah)Professional Component ,,92250,CPT,Professional,Both,,,26,128,108.8,13.31,128,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,115.328,90.1,,percent of total billed charges,,
Fundus Photography With Interp And Report (Pro Cah)Professional Component ,,92250,CPT,Professional,Both,,,26,128,108.8,13.31,128,"Preferred One Administrative Services, INC.",PPO,126.208,98.6,,percent of total billed charges,,
Fundus Photography With Interp And Report (Pro Cah)Professional Component ,,92250,CPT,Professional,Both,,,26,128,108.8,13.31,128,PrimeWest Health,Minnesota Senior Health Options (MSHO),24.058,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Fundus Photography With Interp And Report (Pro Cah)Professional Component ,,92250,CPT,Professional,Both,,,26,128,108.8,13.31,128,PrimeWest Health,MinnesotaCare,16.4372544,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Fundus Photography With Interp And Report (Pro Cah)Professional Component ,,92250,CPT,Professional,Both,,,26,128,108.8,13.31,128,Sanford Health Plan,Sanford Health Plan,112.64,88,,percent of total billed charges,,
Fundus Photography With Interp And Report (Pro Cah)Professional Component ,,92250,CPT,Professional,Both,,,26,128,108.8,13.31,128,"UCare Health, Inc.",Individual & Family Plan,34.007552,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Fundus Photography With Interp And Report (Pro Cah)Professional Component ,,92250,CPT,Professional,Both,,,26,128,108.8,13.31,128,"UCare Health, Inc.",Medical Assistance,16.898112,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Fundus Photography With Interp And Report (Pro Cah)Professional Component ,,92250,CPT,Professional,Both,,,26,128,108.8,13.31,128,"UCare Health, Inc.",Medicare Advantage,24.058,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Fundus Photography With Interp And Report (Pro Cah)Professional Component ,,92250,CPT,Professional,Both,,,26,128,108.8,13.31,128,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),19.2464,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Fundus Photography With Interp And Report (Pro Cah)Professional Component ,,92250,CPT,Professional,Both,,,26,128,108.8,13.31,128,UnitedHealthcare,Individual & Family,128,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Fundus Photography With Interp And Report (Pro Cah)Professional Component ,,92250,CPT,Professional,Both,,,26,128,108.8,13.31,128,UnitedHealthcare,Medicare Advantage,24.058,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Fundus Photography With Interp And Report (Pro Cah)Professional Component ,,92250,CPT,Professional,Both,,,26,128,108.8,13.31,128,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,15.36192,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
External Ocular Photography W Interp And Report For Doc Of Medical Progress (Procah)Professional Component ,,92285,CPT,Professional,Both,,,26,102,86.7,1.74,102,Aetna,Commercial,86.7,85,,percent of total billed charges,,
External Ocular Photography W Interp And Report For Doc Of Medical Progress (Procah)Professional Component ,,92285,CPT,Professional,Both,,,26,102,86.7,1.74,102,Aetna,Medicare Advantage,2.93,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
External Ocular Photography W Interp And Report For Doc Of Medical Progress (Procah)Professional Component ,,92285,CPT,Professional,Both,,,26,102,86.7,1.74,102,Aetna,PPO,94.86,93,,percent of total billed charges,,
External Ocular Photography W Interp And Report For Doc Of Medical Progress (Procah)Professional Component ,,92285,CPT,Professional,Both,,,26,102,86.7,1.74,102,America's PPO,America's PPO,87.1488,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
External Ocular Photography W Interp And Report For Doc Of Medical Progress (Procah)Professional Component ,,92285,CPT,Professional,Both,,,26,102,86.7,1.74,102,BlueCross BlueShield Minnesota, Federal Employee Program,5.25,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
External Ocular Photography W Interp And Report For Doc Of Medical Progress (Procah)Professional Component ,,92285,CPT,Professional,Both,,,26,102,86.7,1.74,102,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5.334,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
External Ocular Photography W Interp And Report For Doc Of Medical Progress (Procah)Professional Component ,,92285,CPT,Professional,Both,,,26,102,86.7,1.74,102,BlueCross BlueShield Minnesota,High Value Network Plan,5.334,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
External Ocular Photography W Interp And Report For Doc Of Medical Progress (Procah)Professional Component ,,92285,CPT,Professional,Both,,,26,102,86.7,1.74,102,BlueCross BlueShield Minnesota,Medicare Advantage,3.266,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
External Ocular Photography W Interp And Report For Doc Of Medical Progress (Procah)Professional Component ,,92285,CPT,Professional,Both,,,26,102,86.7,1.74,102,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,5.334,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
External Ocular Photography W Interp And Report For Doc Of Medical Progress (Procah)Professional Component ,,92285,CPT,Professional,Both,,,26,102,86.7,1.74,102,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,2.01168,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
External Ocular Photography W Interp And Report For Doc Of Medical Progress (Procah)Professional Component ,,92285,CPT,Professional,Both,,,26,102,86.7,1.74,102,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),3.266,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
External Ocular Photography W Interp And Report For Doc Of Medical Progress (Procah)Professional Component ,,92285,CPT,Professional,Both,,,26,102,86.7,1.74,102,CorVel,Worker's Compensation,5.6369064,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
External Ocular Photography W Interp And Report For Doc Of Medical Progress (Procah)Professional Component ,,92285,CPT,Professional,Both,,,26,102,86.7,1.74,102,First Health Group Corporation,First Health Network,98.94,97,,percent of total billed charges,,
External Ocular Photography W Interp And Report For Doc Of Medical Progress (Procah)Professional Component ,,92285,CPT,Professional,Both,,,26,102,86.7,1.74,102,"Health Partners, Inc.",Commercial,5.8,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
External Ocular Photography W Interp And Report For Doc Of Medical Progress (Procah)Professional Component ,,92285,CPT,Professional,Both,,,26,102,86.7,1.74,102,"Health Partners, Inc.",Medicare Advantage,3.266,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
External Ocular Photography W Interp And Report For Doc Of Medical Progress (Procah)Professional Component ,,92285,CPT,Professional,Both,,,26,102,86.7,1.74,102,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1.74,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
External Ocular Photography W Interp And Report For Doc Of Medical Progress (Procah)Professional Component ,,92285,CPT,Professional,Both,,,26,102,86.7,1.74,102,"Health Partners, Inc.",State of Minnesota Advantage Program,4.9967,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
External Ocular Photography W Interp And Report For Doc Of Medical Progress (Procah)Professional Component ,,92285,CPT,Professional,Both,,,26,102,86.7,1.74,102,"Health Partners, Inc.",State Public Programs,1.74,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
External Ocular Photography W Interp And Report For Doc Of Medical Progress (Procah)Professional Component ,,92285,CPT,Professional,Both,,,26,102,86.7,1.74,102,Humana Insurance Company,Commercial PPO,2.84,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
External Ocular Photography W Interp And Report For Doc Of Medical Progress (Procah)Professional Component ,,92285,CPT,Professional,Both,,,26,102,86.7,1.74,102,Humana Insurance Company,Medicare PPO,102,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
External Ocular Photography W Interp And Report For Doc Of Medical Progress (Procah)Professional Component ,,92285,CPT,Professional,Both,,,26,102,86.7,1.74,102,Medica,Individual & Family,86.496,84.8,,percent of total billed charges,,
External Ocular Photography W Interp And Report For Doc Of Medical Progress (Procah)Professional Component ,,92285,CPT,Professional,Both,,,26,102,86.7,1.74,102,Medica,Medica Advantage Solution,50.796,49.8,,percent of total billed charges,,
External Ocular Photography W Interp And Report For Doc Of Medical Progress (Procah)Professional Component ,,92285,CPT,Professional,Both,,,26,102,86.7,1.74,102,Medica,Medical Assistance,2.01,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
External Ocular Photography W Interp And Report For Doc Of Medical Progress (Procah)Professional Component ,,92285,CPT,Professional,Both,,,26,102,86.7,1.74,102,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.84,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
External Ocular Photography W Interp And Report For Doc Of Medical Progress (Procah)Professional Component ,,92285,CPT,Professional,Both,,,26,102,86.7,1.74,102,"Multiplan, Inc.","Multiplan, Inc.",95.88,94,,percent of total billed charges,,
External Ocular Photography W Interp And Report For Doc Of Medical Progress (Procah)Professional Component ,,92285,CPT,Professional,Both,,,26,102,86.7,1.74,102,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,91.902,90.1,,percent of total billed charges,,
External Ocular Photography W Interp And Report For Doc Of Medical Progress (Procah)Professional Component ,,92285,CPT,Professional,Both,,,26,102,86.7,1.74,102,"Preferred One Administrative Services, INC.",PPO,100.572,98.6,,percent of total billed charges,,
External Ocular Photography W Interp And Report For Doc Of Medical Progress (Procah)Professional Component ,,92285,CPT,Professional,Both,,,26,102,86.7,1.74,102,PrimeWest Health,Minnesota Senior Health Options (MSHO),3.266,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
External Ocular Photography W Interp And Report For Doc Of Medical Progress (Procah)Professional Component ,,92285,CPT,Professional,Both,,,26,102,86.7,1.74,102,PrimeWest Health,MinnesotaCare,2.1524976,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
External Ocular Photography W Interp And Report For Doc Of Medical Progress (Procah)Professional Component ,,92285,CPT,Professional,Both,,,26,102,86.7,1.74,102,Sanford Health Plan,Sanford Health Plan,89.76,88,,percent of total billed charges,,
External Ocular Photography W Interp And Report For Doc Of Medical Progress (Procah)Professional Component ,,92285,CPT,Professional,Both,,,26,102,86.7,1.74,102,"UCare Health, Inc.",Individual & Family Plan,4.616704,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
External Ocular Photography W Interp And Report For Doc Of Medical Progress (Procah)Professional Component ,,92285,CPT,Professional,Both,,,26,102,86.7,1.74,102,"UCare Health, Inc.",Medical Assistance,2.212848,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
External Ocular Photography W Interp And Report For Doc Of Medical Progress (Procah)Professional Component ,,92285,CPT,Professional,Both,,,26,102,86.7,1.74,102,"UCare Health, Inc.",Medicare Advantage,3.266,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
External Ocular Photography W Interp And Report For Doc Of Medical Progress (Procah)Professional Component ,,92285,CPT,Professional,Both,,,26,102,86.7,1.74,102,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.6128,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
External Ocular Photography W Interp And Report For Doc Of Medical Progress (Procah)Professional Component ,,92285,CPT,Professional,Both,,,26,102,86.7,1.74,102,UnitedHealthcare,Individual & Family,102,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
External Ocular Photography W Interp And Report For Doc Of Medical Progress (Procah)Professional Component ,,92285,CPT,Professional,Both,,,26,102,86.7,1.74,102,UnitedHealthcare,Medicare Advantage,3.266,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
External Ocular Photography W Interp And Report For Doc Of Medical Progress (Procah)Professional Component ,,92285,CPT,Professional,Both,,,26,102,86.7,1.74,102,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.01168,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Us Carotid Bilateral Routine (Pro Cah)Professional Component ,,93880,CPT,Professional,Both,,,26,170,144.5,23.56,170,Aetna,Commercial,144.5,85,,percent of total billed charges,,
Us Carotid Bilateral Routine (Pro Cah)Professional Component ,,93880,CPT,Professional,Both,,,26,170,144.5,23.56,170,Aetna,Medicare Advantage,37.84,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Us Carotid Bilateral Routine (Pro Cah)Professional Component ,,93880,CPT,Professional,Both,,,26,170,144.5,23.56,170,Aetna,PPO,158.1,93,,percent of total billed charges,,
Us Carotid Bilateral Routine (Pro Cah)Professional Component ,,93880,CPT,Professional,Both,,,26,170,144.5,23.56,170,America's PPO,America's PPO,145.248,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Us Carotid Bilateral Routine (Pro Cah)Professional Component ,,93880,CPT,Professional,Both,,,26,170,144.5,23.56,170,BlueCross BlueShield Minnesota, Federal Employee Program,65.94,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Us Carotid Bilateral Routine (Pro Cah)Professional Component ,,93880,CPT,Professional,Both,,,26,170,144.5,23.56,170,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,66.99504,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Us Carotid Bilateral Routine (Pro Cah)Professional Component ,,93880,CPT,Professional,Both,,,26,170,144.5,23.56,170,BlueCross BlueShield Minnesota,High Value Network Plan,66.99504,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Us Carotid Bilateral Routine (Pro Cah)Professional Component ,,93880,CPT,Professional,Both,,,26,170,144.5,23.56,170,BlueCross BlueShield Minnesota,Medicare Advantage,42.389,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Us Carotid Bilateral Routine (Pro Cah)Professional Component ,,93880,CPT,Professional,Both,,,26,170,144.5,23.56,170,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,66.99504,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Us Carotid Bilateral Routine (Pro Cah)Professional Component ,,93880,CPT,Professional,Both,,,26,170,144.5,23.56,170,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,27.19832,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Us Carotid Bilateral Routine (Pro Cah)Professional Component ,,93880,CPT,Professional,Both,,,26,170,144.5,23.56,170,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),42.389,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Us Carotid Bilateral Routine (Pro Cah)Professional Component ,,93880,CPT,Professional,Both,,,26,170,144.5,23.56,170,CorVel,Worker's Compensation,73.3241154,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Us Carotid Bilateral Routine (Pro Cah)Professional Component ,,93880,CPT,Professional,Both,,,26,170,144.5,23.56,170,First Health Group Corporation,First Health Network,164.9,97,,percent of total billed charges,,
Us Carotid Bilateral Routine (Pro Cah)Professional Component ,,93880,CPT,Professional,Both,,,26,170,144.5,23.56,170,"Health Partners, Inc.",Commercial,79.09,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Us Carotid Bilateral Routine (Pro Cah)Professional Component ,,93880,CPT,Professional,Both,,,26,170,144.5,23.56,170,"Health Partners, Inc.",Medicare Advantage,42.389,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Us Carotid Bilateral Routine (Pro Cah)Professional Component ,,93880,CPT,Professional,Both,,,26,170,144.5,23.56,170,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),23.56,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Us Carotid Bilateral Routine (Pro Cah)Professional Component ,,93880,CPT,Professional,Both,,,26,170,144.5,23.56,170,"Health Partners, Inc.",State of Minnesota Advantage Program,68.136035,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Us Carotid Bilateral Routine (Pro Cah)Professional Component ,,93880,CPT,Professional,Both,,,26,170,144.5,23.56,170,"Health Partners, Inc.",State Public Programs,23.56,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Us Carotid Bilateral Routine (Pro Cah)Professional Component ,,93880,CPT,Professional,Both,,,26,170,144.5,23.56,170,Humana Insurance Company,Commercial PPO,36.86,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Us Carotid Bilateral Routine (Pro Cah)Professional Component ,,93880,CPT,Professional,Both,,,26,170,144.5,23.56,170,Humana Insurance Company,Medicare PPO,170,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Us Carotid Bilateral Routine (Pro Cah)Professional Component ,,93880,CPT,Professional,Both,,,26,170,144.5,23.56,170,Medica,Individual & Family,144.16,84.8,,percent of total billed charges,,
Us Carotid Bilateral Routine (Pro Cah)Professional Component ,,93880,CPT,Professional,Both,,,26,170,144.5,23.56,170,Medica,Medica Advantage Solution,84.66,49.8,,percent of total billed charges,,
Us Carotid Bilateral Routine (Pro Cah)Professional Component ,,93880,CPT,Professional,Both,,,26,170,144.5,23.56,170,Medica,Medical Assistance,27.2,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Us Carotid Bilateral Routine (Pro Cah)Professional Component ,,93880,CPT,Professional,Both,,,26,170,144.5,23.56,170,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,36.86,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Us Carotid Bilateral Routine (Pro Cah)Professional Component ,,93880,CPT,Professional,Both,,,26,170,144.5,23.56,170,"Multiplan, Inc.","Multiplan, Inc.",159.8,94,,percent of total billed charges,,
Us Carotid Bilateral Routine (Pro Cah)Professional Component ,,93880,CPT,Professional,Both,,,26,170,144.5,23.56,170,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,153.17,90.1,,percent of total billed charges,,
Us Carotid Bilateral Routine (Pro Cah)Professional Component ,,93880,CPT,Professional,Both,,,26,170,144.5,23.56,170,"Preferred One Administrative Services, INC.",PPO,167.62,98.6,,percent of total billed charges,,
Us Carotid Bilateral Routine (Pro Cah)Professional Component ,,93880,CPT,Professional,Both,,,26,170,144.5,23.56,170,PrimeWest Health,Minnesota Senior Health Options (MSHO),42.389,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Us Carotid Bilateral Routine (Pro Cah)Professional Component ,,93880,CPT,Professional,Both,,,26,170,144.5,23.56,170,PrimeWest Health,MinnesotaCare,29.1022024,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Us Carotid Bilateral Routine (Pro Cah)Professional Component ,,93880,CPT,Professional,Both,,,26,170,144.5,23.56,170,Sanford Health Plan,Sanford Health Plan,149.6,88,,percent of total billed charges,,
Us Carotid Bilateral Routine (Pro Cah)Professional Component ,,93880,CPT,Professional,Both,,,26,170,144.5,23.56,170,"UCare Health, Inc.",Individual & Family Plan,59.919616,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Us Carotid Bilateral Routine (Pro Cah)Professional Component ,,93880,CPT,Professional,Both,,,26,170,144.5,23.56,170,"UCare Health, Inc.",Medical Assistance,29.918152,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Us Carotid Bilateral Routine (Pro Cah)Professional Component ,,93880,CPT,Professional,Both,,,26,170,144.5,23.56,170,"UCare Health, Inc.",Medicare Advantage,42.389,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Us Carotid Bilateral Routine (Pro Cah)Professional Component ,,93880,CPT,Professional,Both,,,26,170,144.5,23.56,170,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),33.9112,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Us Carotid Bilateral Routine (Pro Cah)Professional Component ,,93880,CPT,Professional,Both,,,26,170,144.5,23.56,170,UnitedHealthcare,Individual & Family,170,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Us Carotid Bilateral Routine (Pro Cah)Professional Component ,,93880,CPT,Professional,Both,,,26,170,144.5,23.56,170,UnitedHealthcare,Medicare Advantage,42.389,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Us Carotid Bilateral Routine (Pro Cah)Professional Component ,,93880,CPT,Professional,Both,,,26,170,144.5,23.56,170,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,27.19832,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Duplex Scan Of Extracranial Arteries; Unilateral Or Limited Study (Pro Cah)Professional Component ,,93882,CPT,Professional,Both,,,26,101,85.85,14.4,101,Aetna,Commercial,85.85,85,,percent of total billed charges,,
Duplex Scan Of Extracranial Arteries; Unilateral Or Limited Study (Pro Cah)Professional Component ,,93882,CPT,Professional,Both,,,26,101,85.85,14.4,101,Aetna,Medicare Advantage,23.49,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Duplex Scan Of Extracranial Arteries; Unilateral Or Limited Study (Pro Cah)Professional Component ,,93882,CPT,Professional,Both,,,26,101,85.85,14.4,101,Aetna,PPO,93.93,93,,percent of total billed charges,,
Duplex Scan Of Extracranial Arteries; Unilateral Or Limited Study (Pro Cah)Professional Component ,,93882,CPT,Professional,Both,,,26,101,85.85,14.4,101,America's PPO,America's PPO,86.2944,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Duplex Scan Of Extracranial Arteries; Unilateral Or Limited Study (Pro Cah)Professional Component ,,93882,CPT,Professional,Both,,,26,101,85.85,14.4,101,BlueCross BlueShield Minnesota, Federal Employee Program,41.43,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Duplex Scan Of Extracranial Arteries; Unilateral Or Limited Study (Pro Cah)Professional Component ,,93882,CPT,Professional,Both,,,26,101,85.85,14.4,101,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,42.09288,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Duplex Scan Of Extracranial Arteries; Unilateral Or Limited Study (Pro Cah)Professional Component ,,93882,CPT,Professional,Both,,,26,101,85.85,14.4,101,BlueCross BlueShield Minnesota,High Value Network Plan,42.09288,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Duplex Scan Of Extracranial Arteries; Unilateral Or Limited Study (Pro Cah)Professional Component ,,93882,CPT,Professional,Both,,,26,101,85.85,14.4,101,BlueCross BlueShield Minnesota,Medicare Advantage,25.9325,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Duplex Scan Of Extracranial Arteries; Unilateral Or Limited Study (Pro Cah)Professional Component ,,93882,CPT,Professional,Both,,,26,101,85.85,14.4,101,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,42.09288,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Duplex Scan Of Extracranial Arteries; Unilateral Or Limited Study (Pro Cah)Professional Component ,,93882,CPT,Professional,Both,,,26,101,85.85,14.4,101,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,16.62176,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Duplex Scan Of Extracranial Arteries; Unilateral Or Limited Study (Pro Cah)Professional Component ,,93882,CPT,Professional,Both,,,26,101,85.85,14.4,101,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),25.9325,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Duplex Scan Of Extracranial Arteries; Unilateral Or Limited Study (Pro Cah)Professional Component ,,93882,CPT,Professional,Both,,,26,101,85.85,14.4,101,CorVel,Worker's Compensation,45.0079302,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Duplex Scan Of Extracranial Arteries; Unilateral Or Limited Study (Pro Cah)Professional Component ,,93882,CPT,Professional,Both,,,26,101,85.85,14.4,101,First Health Group Corporation,First Health Network,97.97,97,,percent of total billed charges,,
Duplex Scan Of Extracranial Arteries; Unilateral Or Limited Study (Pro Cah)Professional Component ,,93882,CPT,Professional,Both,,,26,101,85.85,14.4,101,"Health Partners, Inc.",Commercial,48.61,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Duplex Scan Of Extracranial Arteries; Unilateral Or Limited Study (Pro Cah)Professional Component ,,93882,CPT,Professional,Both,,,26,101,85.85,14.4,101,"Health Partners, Inc.",Medicare Advantage,25.9325,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Duplex Scan Of Extracranial Arteries; Unilateral Or Limited Study (Pro Cah)Professional Component ,,93882,CPT,Professional,Both,,,26,101,85.85,14.4,101,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),14.4,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Duplex Scan Of Extracranial Arteries; Unilateral Or Limited Study (Pro Cah)Professional Component ,,93882,CPT,Professional,Both,,,26,101,85.85,14.4,101,"Health Partners, Inc.",State of Minnesota Advantage Program,41.877515,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Duplex Scan Of Extracranial Arteries; Unilateral Or Limited Study (Pro Cah)Professional Component ,,93882,CPT,Professional,Both,,,26,101,85.85,14.4,101,"Health Partners, Inc.",State Public Programs,14.4,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Duplex Scan Of Extracranial Arteries; Unilateral Or Limited Study (Pro Cah)Professional Component ,,93882,CPT,Professional,Both,,,26,101,85.85,14.4,101,Humana Insurance Company,Commercial PPO,22.55,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Duplex Scan Of Extracranial Arteries; Unilateral Or Limited Study (Pro Cah)Professional Component ,,93882,CPT,Professional,Both,,,26,101,85.85,14.4,101,Humana Insurance Company,Medicare PPO,101,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Duplex Scan Of Extracranial Arteries; Unilateral Or Limited Study (Pro Cah)Professional Component ,,93882,CPT,Professional,Both,,,26,101,85.85,14.4,101,Medica,Individual & Family,85.648,84.8,,percent of total billed charges,,
Duplex Scan Of Extracranial Arteries; Unilateral Or Limited Study (Pro Cah)Professional Component ,,93882,CPT,Professional,Both,,,26,101,85.85,14.4,101,Medica,Medica Advantage Solution,50.298,49.8,,percent of total billed charges,,
Duplex Scan Of Extracranial Arteries; Unilateral Or Limited Study (Pro Cah)Professional Component ,,93882,CPT,Professional,Both,,,26,101,85.85,14.4,101,Medica,Medical Assistance,16.62,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Duplex Scan Of Extracranial Arteries; Unilateral Or Limited Study (Pro Cah)Professional Component ,,93882,CPT,Professional,Both,,,26,101,85.85,14.4,101,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,22.55,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Duplex Scan Of Extracranial Arteries; Unilateral Or Limited Study (Pro Cah)Professional Component ,,93882,CPT,Professional,Both,,,26,101,85.85,14.4,101,"Multiplan, Inc.","Multiplan, Inc.",94.94,94,,percent of total billed charges,,
Duplex Scan Of Extracranial Arteries; Unilateral Or Limited Study (Pro Cah)Professional Component ,,93882,CPT,Professional,Both,,,26,101,85.85,14.4,101,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,91.001,90.1,,percent of total billed charges,,
Duplex Scan Of Extracranial Arteries; Unilateral Or Limited Study (Pro Cah)Professional Component ,,93882,CPT,Professional,Both,,,26,101,85.85,14.4,101,"Preferred One Administrative Services, INC.",PPO,99.586,98.6,,percent of total billed charges,,
Duplex Scan Of Extracranial Arteries; Unilateral Or Limited Study (Pro Cah)Professional Component ,,93882,CPT,Professional,Both,,,26,101,85.85,14.4,101,PrimeWest Health,Minnesota Senior Health Options (MSHO),25.9325,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Duplex Scan Of Extracranial Arteries; Unilateral Or Limited Study (Pro Cah)Professional Component ,,93882,CPT,Professional,Both,,,26,101,85.85,14.4,101,PrimeWest Health,MinnesotaCare,17.7852832,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Duplex Scan Of Extracranial Arteries; Unilateral Or Limited Study (Pro Cah)Professional Component ,,93882,CPT,Professional,Both,,,26,101,85.85,14.4,101,Sanford Health Plan,Sanford Health Plan,88.88,88,,percent of total billed charges,,
Duplex Scan Of Extracranial Arteries; Unilateral Or Limited Study (Pro Cah)Professional Component ,,93882,CPT,Professional,Both,,,26,101,85.85,14.4,101,"UCare Health, Inc.",Individual & Family Plan,36.65728,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Duplex Scan Of Extracranial Arteries; Unilateral Or Limited Study (Pro Cah)Professional Component ,,93882,CPT,Professional,Both,,,26,101,85.85,14.4,101,"UCare Health, Inc.",Medical Assistance,18.283936,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Duplex Scan Of Extracranial Arteries; Unilateral Or Limited Study (Pro Cah)Professional Component ,,93882,CPT,Professional,Both,,,26,101,85.85,14.4,101,"UCare Health, Inc.",Medicare Advantage,25.9325,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Duplex Scan Of Extracranial Arteries; Unilateral Or Limited Study (Pro Cah)Professional Component ,,93882,CPT,Professional,Both,,,26,101,85.85,14.4,101,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),20.746,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Duplex Scan Of Extracranial Arteries; Unilateral Or Limited Study (Pro Cah)Professional Component ,,93882,CPT,Professional,Both,,,26,101,85.85,14.4,101,UnitedHealthcare,Individual & Family,101,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Duplex Scan Of Extracranial Arteries; Unilateral Or Limited Study (Pro Cah)Professional Component ,,93882,CPT,Professional,Both,,,26,101,85.85,14.4,101,UnitedHealthcare,Medicare Advantage,25.9325,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Duplex Scan Of Extracranial Arteries; Unilateral Or Limited Study (Pro Cah)Professional Component ,,93882,CPT,Professional,Both,,,26,101,85.85,14.4,101,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,16.62176,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Us Dop Ankle Brachial Index (Pro Cah)Professional Component ,,93922,CPT,Professional,Both,,,26,65,55.25,7.2,65,Aetna,Commercial,55.25,85,,percent of total billed charges,,
Us Dop Ankle Brachial Index (Pro Cah)Professional Component ,,93922,CPT,Professional,Both,,,26,65,55.25,7.2,65,Aetna,Medicare Advantage,12.04,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Us Dop Ankle Brachial Index (Pro Cah)Professional Component ,,93922,CPT,Professional,Both,,,26,65,55.25,7.2,65,Aetna,PPO,60.45,93,,percent of total billed charges,,
Us Dop Ankle Brachial Index (Pro Cah)Professional Component ,,93922,CPT,Professional,Both,,,26,65,55.25,7.2,65,America's PPO,America's PPO,55.536,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Us Dop Ankle Brachial Index (Pro Cah)Professional Component ,,93922,CPT,Professional,Both,,,26,65,55.25,7.2,65,BlueCross BlueShield Minnesota, Federal Employee Program,21.01,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Us Dop Ankle Brachial Index (Pro Cah)Professional Component ,,93922,CPT,Professional,Both,,,26,65,55.25,7.2,65,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,21.34616,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Us Dop Ankle Brachial Index (Pro Cah)Professional Component ,,93922,CPT,Professional,Both,,,26,65,55.25,7.2,65,BlueCross BlueShield Minnesota,High Value Network Plan,21.34616,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Us Dop Ankle Brachial Index (Pro Cah)Professional Component ,,93922,CPT,Professional,Both,,,26,65,55.25,7.2,65,BlueCross BlueShield Minnesota,Medicare Advantage,13.0295,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Us Dop Ankle Brachial Index (Pro Cah)Professional Component ,,93922,CPT,Professional,Both,,,26,65,55.25,7.2,65,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,21.34616,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Us Dop Ankle Brachial Index (Pro Cah)Professional Component ,,93922,CPT,Professional,Both,,,26,65,55.25,7.2,65,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,8.31088,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Us Dop Ankle Brachial Index (Pro Cah)Professional Component ,,93922,CPT,Professional,Both,,,26,65,55.25,7.2,65,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),13.0295,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Us Dop Ankle Brachial Index (Pro Cah)Professional Component ,,93922,CPT,Professional,Both,,,26,65,55.25,7.2,65,CorVel,Worker's Compensation,22.5039651,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Us Dop Ankle Brachial Index (Pro Cah)Professional Component ,,93922,CPT,Professional,Both,,,26,65,55.25,7.2,65,First Health Group Corporation,First Health Network,63.05,97,,percent of total billed charges,,
Us Dop Ankle Brachial Index (Pro Cah)Professional Component ,,93922,CPT,Professional,Both,,,26,65,55.25,7.2,65,"Health Partners, Inc.",Commercial,23.95,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Us Dop Ankle Brachial Index (Pro Cah)Professional Component ,,93922,CPT,Professional,Both,,,26,65,55.25,7.2,65,"Health Partners, Inc.",Medicare Advantage,13.0295,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Us Dop Ankle Brachial Index (Pro Cah)Professional Component ,,93922,CPT,Professional,Both,,,26,65,55.25,7.2,65,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),7.2,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Us Dop Ankle Brachial Index (Pro Cah)Professional Component ,,93922,CPT,Professional,Both,,,26,65,55.25,7.2,65,"Health Partners, Inc.",State of Minnesota Advantage Program,20.632925,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Us Dop Ankle Brachial Index (Pro Cah)Professional Component ,,93922,CPT,Professional,Both,,,26,65,55.25,7.2,65,"Health Partners, Inc.",State Public Programs,7.2,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Us Dop Ankle Brachial Index (Pro Cah)Professional Component ,,93922,CPT,Professional,Both,,,26,65,55.25,7.2,65,Humana Insurance Company,Commercial PPO,11.33,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Us Dop Ankle Brachial Index (Pro Cah)Professional Component ,,93922,CPT,Professional,Both,,,26,65,55.25,7.2,65,Humana Insurance Company,Medicare PPO,65,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Us Dop Ankle Brachial Index (Pro Cah)Professional Component ,,93922,CPT,Professional,Both,,,26,65,55.25,7.2,65,Medica,Individual & Family,55.12,84.8,,percent of total billed charges,,
Us Dop Ankle Brachial Index (Pro Cah)Professional Component ,,93922,CPT,Professional,Both,,,26,65,55.25,7.2,65,Medica,Medica Advantage Solution,32.37,49.8,,percent of total billed charges,,
Us Dop Ankle Brachial Index (Pro Cah)Professional Component ,,93922,CPT,Professional,Both,,,26,65,55.25,7.2,65,Medica,Medical Assistance,8.31,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Us Dop Ankle Brachial Index (Pro Cah)Professional Component ,,93922,CPT,Professional,Both,,,26,65,55.25,7.2,65,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,11.33,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Us Dop Ankle Brachial Index (Pro Cah)Professional Component ,,93922,CPT,Professional,Both,,,26,65,55.25,7.2,65,"Multiplan, Inc.","Multiplan, Inc.",61.1,94,,percent of total billed charges,,
Us Dop Ankle Brachial Index (Pro Cah)Professional Component ,,93922,CPT,Professional,Both,,,26,65,55.25,7.2,65,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,58.565,90.1,,percent of total billed charges,,
Us Dop Ankle Brachial Index (Pro Cah)Professional Component ,,93922,CPT,Professional,Both,,,26,65,55.25,7.2,65,"Preferred One Administrative Services, INC.",PPO,64.09,98.6,,percent of total billed charges,,
Us Dop Ankle Brachial Index (Pro Cah)Professional Component ,,93922,CPT,Professional,Both,,,26,65,55.25,7.2,65,PrimeWest Health,Minnesota Senior Health Options (MSHO),13.0295,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Us Dop Ankle Brachial Index (Pro Cah)Professional Component ,,93922,CPT,Professional,Both,,,26,65,55.25,7.2,65,PrimeWest Health,MinnesotaCare,8.8926416,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Us Dop Ankle Brachial Index (Pro Cah)Professional Component ,,93922,CPT,Professional,Both,,,26,65,55.25,7.2,65,Sanford Health Plan,Sanford Health Plan,57.2,88,,percent of total billed charges,,
Us Dop Ankle Brachial Index (Pro Cah)Professional Component ,,93922,CPT,Professional,Both,,,26,65,55.25,7.2,65,"UCare Health, Inc.",Individual & Family Plan,18.418048,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Us Dop Ankle Brachial Index (Pro Cah)Professional Component ,,93922,CPT,Professional,Both,,,26,65,55.25,7.2,65,"UCare Health, Inc.",Medical Assistance,9.141968,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Us Dop Ankle Brachial Index (Pro Cah)Professional Component ,,93922,CPT,Professional,Both,,,26,65,55.25,7.2,65,"UCare Health, Inc.",Medicare Advantage,13.0295,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Us Dop Ankle Brachial Index (Pro Cah)Professional Component ,,93922,CPT,Professional,Both,,,26,65,55.25,7.2,65,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),10.4236,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Us Dop Ankle Brachial Index (Pro Cah)Professional Component ,,93922,CPT,Professional,Both,,,26,65,55.25,7.2,65,UnitedHealthcare,Individual & Family,65,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Us Dop Ankle Brachial Index (Pro Cah)Professional Component ,,93922,CPT,Professional,Both,,,26,65,55.25,7.2,65,UnitedHealthcare,Medicare Advantage,13.0295,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Us Dop Ankle Brachial Index (Pro Cah)Professional Component ,,93922,CPT,Professional,Both,,,26,65,55.25,7.2,65,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,8.31088,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Us Ext Art Bilat (Pro Cah)Professional Component ,,93923,CPT,Professional,Both,,,26,118,100.3,13.09,118,Aetna,Commercial,100.3,85,,percent of total billed charges,,
Us Ext Art Bilat (Pro Cah)Professional Component ,,93923,CPT,Professional,Both,,,26,118,100.3,13.09,118,Aetna,Medicare Advantage,20.91,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Us Ext Art Bilat (Pro Cah)Professional Component ,,93923,CPT,Professional,Both,,,26,118,100.3,13.09,118,Aetna,PPO,109.74,93,,percent of total billed charges,,
Us Ext Art Bilat (Pro Cah)Professional Component ,,93923,CPT,Professional,Both,,,26,118,100.3,13.09,118,America's PPO,America's PPO,100.8192,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Us Ext Art Bilat (Pro Cah)Professional Component ,,93923,CPT,Professional,Both,,,26,118,100.3,13.09,118,BlueCross BlueShield Minnesota, Federal Employee Program,37.34,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Us Ext Art Bilat (Pro Cah)Professional Component ,,93923,CPT,Professional,Both,,,26,118,100.3,13.09,118,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,37.93744,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Us Ext Art Bilat (Pro Cah)Professional Component ,,93923,CPT,Professional,Both,,,26,118,100.3,13.09,118,BlueCross BlueShield Minnesota,High Value Network Plan,37.93744,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Us Ext Art Bilat (Pro Cah)Professional Component ,,93923,CPT,Professional,Both,,,26,118,100.3,13.09,118,BlueCross BlueShield Minnesota,Medicare Advantage,23.46,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Us Ext Art Bilat (Pro Cah)Professional Component ,,93923,CPT,Professional,Both,,,26,118,100.3,13.09,118,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,37.93744,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Us Ext Art Bilat (Pro Cah)Professional Component ,,93923,CPT,Professional,Both,,,26,118,100.3,13.09,118,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,15.10792,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Us Ext Art Bilat (Pro Cah)Professional Component ,,93923,CPT,Professional,Both,,,26,118,100.3,13.09,118,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),23.46,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Us Ext Art Bilat (Pro Cah)Professional Component ,,93923,CPT,Professional,Both,,,26,118,100.3,13.09,118,CorVel,Worker's Compensation,40.731888,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Us Ext Art Bilat (Pro Cah)Professional Component ,,93923,CPT,Professional,Both,,,26,118,100.3,13.09,118,First Health Group Corporation,First Health Network,114.46,97,,percent of total billed charges,,
Us Ext Art Bilat (Pro Cah)Professional Component ,,93923,CPT,Professional,Both,,,26,118,100.3,13.09,118,"Health Partners, Inc.",Commercial,43.54,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Us Ext Art Bilat (Pro Cah)Professional Component ,,93923,CPT,Professional,Both,,,26,118,100.3,13.09,118,"Health Partners, Inc.",Medicare Advantage,23.46,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Us Ext Art Bilat (Pro Cah)Professional Component ,,93923,CPT,Professional,Both,,,26,118,100.3,13.09,118,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),13.09,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Us Ext Art Bilat (Pro Cah)Professional Component ,,93923,CPT,Professional,Both,,,26,118,100.3,13.09,118,"Health Partners, Inc.",State of Minnesota Advantage Program,37.50971,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Us Ext Art Bilat (Pro Cah)Professional Component ,,93923,CPT,Professional,Both,,,26,118,100.3,13.09,118,"Health Partners, Inc.",State Public Programs,13.09,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Us Ext Art Bilat (Pro Cah)Professional Component ,,93923,CPT,Professional,Both,,,26,118,100.3,13.09,118,Humana Insurance Company,Commercial PPO,20.4,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Us Ext Art Bilat (Pro Cah)Professional Component ,,93923,CPT,Professional,Both,,,26,118,100.3,13.09,118,Humana Insurance Company,Medicare PPO,118,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Us Ext Art Bilat (Pro Cah)Professional Component ,,93923,CPT,Professional,Both,,,26,118,100.3,13.09,118,Medica,Individual & Family,100.064,84.8,,percent of total billed charges,,
Us Ext Art Bilat (Pro Cah)Professional Component ,,93923,CPT,Professional,Both,,,26,118,100.3,13.09,118,Medica,Medica Advantage Solution,58.764,49.8,,percent of total billed charges,,
Us Ext Art Bilat (Pro Cah)Professional Component ,,93923,CPT,Professional,Both,,,26,118,100.3,13.09,118,Medica,Medical Assistance,15.11,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Us Ext Art Bilat (Pro Cah)Professional Component ,,93923,CPT,Professional,Both,,,26,118,100.3,13.09,118,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,20.4,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Us Ext Art Bilat (Pro Cah)Professional Component ,,93923,CPT,Professional,Both,,,26,118,100.3,13.09,118,"Multiplan, Inc.","Multiplan, Inc.",110.92,94,,percent of total billed charges,,
Us Ext Art Bilat (Pro Cah)Professional Component ,,93923,CPT,Professional,Both,,,26,118,100.3,13.09,118,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,106.318,90.1,,percent of total billed charges,,
Us Ext Art Bilat (Pro Cah)Professional Component ,,93923,CPT,Professional,Both,,,26,118,100.3,13.09,118,"Preferred One Administrative Services, INC.",PPO,116.348,98.6,,percent of total billed charges,,
Us Ext Art Bilat (Pro Cah)Professional Component ,,93923,CPT,Professional,Both,,,26,118,100.3,13.09,118,PrimeWest Health,Minnesota Senior Health Options (MSHO),23.46,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Us Ext Art Bilat (Pro Cah)Professional Component ,,93923,CPT,Professional,Both,,,26,118,100.3,13.09,118,PrimeWest Health,MinnesotaCare,16.1654744,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Us Ext Art Bilat (Pro Cah)Professional Component ,,93923,CPT,Professional,Both,,,26,118,100.3,13.09,118,Sanford Health Plan,Sanford Health Plan,103.84,88,,percent of total billed charges,,
Us Ext Art Bilat (Pro Cah)Professional Component ,,93923,CPT,Professional,Both,,,26,118,100.3,13.09,118,"UCare Health, Inc.",Individual & Family Plan,33.16224,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Us Ext Art Bilat (Pro Cah)Professional Component ,,93923,CPT,Professional,Both,,,26,118,100.3,13.09,118,"UCare Health, Inc.",Medical Assistance,16.618712,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Us Ext Art Bilat (Pro Cah)Professional Component ,,93923,CPT,Professional,Both,,,26,118,100.3,13.09,118,"UCare Health, Inc.",Medicare Advantage,23.46,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Us Ext Art Bilat (Pro Cah)Professional Component ,,93923,CPT,Professional,Both,,,26,118,100.3,13.09,118,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),18.768,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Us Ext Art Bilat (Pro Cah)Professional Component ,,93923,CPT,Professional,Both,,,26,118,100.3,13.09,118,UnitedHealthcare,Individual & Family,118,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Us Ext Art Bilat (Pro Cah)Professional Component ,,93923,CPT,Professional,Both,,,26,118,100.3,13.09,118,UnitedHealthcare,Medicare Advantage,23.46,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Us Ext Art Bilat (Pro Cah)Professional Component ,,93923,CPT,Professional,Both,,,26,118,100.3,13.09,118,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,15.10792,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Us Doppler Artery Low Extremity Complete Bilat (Pro Cah)Professional Component ,,93925,CPT,Professional,Both,,,26,134,113.9,23.12,134,Aetna,Commercial,113.9,85,,percent of total billed charges,,
Us Doppler Artery Low Extremity Complete Bilat (Pro Cah)Professional Component ,,93925,CPT,Professional,Both,,,26,134,113.9,23.12,134,Aetna,Medicare Advantage,37.37,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Us Doppler Artery Low Extremity Complete Bilat (Pro Cah)Professional Component ,,93925,CPT,Professional,Both,,,26,134,113.9,23.12,134,Aetna,PPO,124.62,93,,percent of total billed charges,,
Us Doppler Artery Low Extremity Complete Bilat (Pro Cah)Professional Component ,,93925,CPT,Professional,Both,,,26,134,113.9,23.12,134,America's PPO,America's PPO,114.4896,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Us Doppler Artery Low Extremity Complete Bilat (Pro Cah)Professional Component ,,93925,CPT,Professional,Both,,,26,134,113.9,23.12,134,BlueCross BlueShield Minnesota, Federal Employee Program,64.19,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Us Doppler Artery Low Extremity Complete Bilat (Pro Cah)Professional Component ,,93925,CPT,Professional,Both,,,26,134,113.9,23.12,134,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,65.21704,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Us Doppler Artery Low Extremity Complete Bilat (Pro Cah)Professional Component ,,93925,CPT,Professional,Both,,,26,134,113.9,23.12,134,BlueCross BlueShield Minnesota,High Value Network Plan,65.21704,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Us Doppler Artery Low Extremity Complete Bilat (Pro Cah)Professional Component ,,93925,CPT,Professional,Both,,,26,134,113.9,23.12,134,BlueCross BlueShield Minnesota,Medicare Advantage,41.469,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Us Doppler Artery Low Extremity Complete Bilat (Pro Cah)Professional Component ,,93925,CPT,Professional,Both,,,26,134,113.9,23.12,134,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,65.21704,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Us Doppler Artery Low Extremity Complete Bilat (Pro Cah)Professional Component ,,93925,CPT,Professional,Both,,,26,134,113.9,23.12,134,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,26.69032,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Us Doppler Artery Low Extremity Complete Bilat (Pro Cah)Professional Component ,,93925,CPT,Professional,Both,,,26,134,113.9,23.12,134,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),41.469,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Us Doppler Artery Low Extremity Complete Bilat (Pro Cah)Professional Component ,,93925,CPT,Professional,Both,,,26,134,113.9,23.12,134,CorVel,Worker's Compensation,72.4065732,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Us Doppler Artery Low Extremity Complete Bilat (Pro Cah)Professional Component ,,93925,CPT,Professional,Both,,,26,134,113.9,23.12,134,First Health Group Corporation,First Health Network,129.98,97,,percent of total billed charges,,
Us Doppler Artery Low Extremity Complete Bilat (Pro Cah)Professional Component ,,93925,CPT,Professional,Both,,,26,134,113.9,23.12,134,"Health Partners, Inc.",Commercial,77.63,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Us Doppler Artery Low Extremity Complete Bilat (Pro Cah)Professional Component ,,93925,CPT,Professional,Both,,,26,134,113.9,23.12,134,"Health Partners, Inc.",Medicare Advantage,41.469,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Us Doppler Artery Low Extremity Complete Bilat (Pro Cah)Professional Component ,,93925,CPT,Professional,Both,,,26,134,113.9,23.12,134,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),23.12,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Us Doppler Artery Low Extremity Complete Bilat (Pro Cah)Professional Component ,,93925,CPT,Professional,Both,,,26,134,113.9,23.12,134,"Health Partners, Inc.",State of Minnesota Advantage Program,66.878245,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Us Doppler Artery Low Extremity Complete Bilat (Pro Cah)Professional Component ,,93925,CPT,Professional,Both,,,26,134,113.9,23.12,134,"Health Partners, Inc.",State Public Programs,23.12,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Us Doppler Artery Low Extremity Complete Bilat (Pro Cah)Professional Component ,,93925,CPT,Professional,Both,,,26,134,113.9,23.12,134,Humana Insurance Company,Commercial PPO,36.06,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Us Doppler Artery Low Extremity Complete Bilat (Pro Cah)Professional Component ,,93925,CPT,Professional,Both,,,26,134,113.9,23.12,134,Humana Insurance Company,Medicare PPO,134,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Us Doppler Artery Low Extremity Complete Bilat (Pro Cah)Professional Component ,,93925,CPT,Professional,Both,,,26,134,113.9,23.12,134,Medica,Individual & Family,113.632,84.8,,percent of total billed charges,,
Us Doppler Artery Low Extremity Complete Bilat (Pro Cah)Professional Component ,,93925,CPT,Professional,Both,,,26,134,113.9,23.12,134,Medica,Medica Advantage Solution,66.732,49.8,,percent of total billed charges,,
Us Doppler Artery Low Extremity Complete Bilat (Pro Cah)Professional Component ,,93925,CPT,Professional,Both,,,26,134,113.9,23.12,134,Medica,Medical Assistance,26.69,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Us Doppler Artery Low Extremity Complete Bilat (Pro Cah)Professional Component ,,93925,CPT,Professional,Both,,,26,134,113.9,23.12,134,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,36.06,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Us Doppler Artery Low Extremity Complete Bilat (Pro Cah)Professional Component ,,93925,CPT,Professional,Both,,,26,134,113.9,23.12,134,"Multiplan, Inc.","Multiplan, Inc.",125.96,94,,percent of total billed charges,,
Us Doppler Artery Low Extremity Complete Bilat (Pro Cah)Professional Component ,,93925,CPT,Professional,Both,,,26,134,113.9,23.12,134,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,120.734,90.1,,percent of total billed charges,,
Us Doppler Artery Low Extremity Complete Bilat (Pro Cah)Professional Component ,,93925,CPT,Professional,Both,,,26,134,113.9,23.12,134,"Preferred One Administrative Services, INC.",PPO,132.124,98.6,,percent of total billed charges,,
Us Doppler Artery Low Extremity Complete Bilat (Pro Cah)Professional Component ,,93925,CPT,Professional,Both,,,26,134,113.9,23.12,134,PrimeWest Health,Minnesota Senior Health Options (MSHO),41.469,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Us Doppler Artery Low Extremity Complete Bilat (Pro Cah)Professional Component ,,93925,CPT,Professional,Both,,,26,134,113.9,23.12,134,PrimeWest Health,MinnesotaCare,28.5586424,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Us Doppler Artery Low Extremity Complete Bilat (Pro Cah)Professional Component ,,93925,CPT,Professional,Both,,,26,134,113.9,23.12,134,Sanford Health Plan,Sanford Health Plan,117.92,88,,percent of total billed charges,,
Us Doppler Artery Low Extremity Complete Bilat (Pro Cah)Professional Component ,,93925,CPT,Professional,Both,,,26,134,113.9,23.12,134,"UCare Health, Inc.",Individual & Family Plan,58.619136,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Us Doppler Artery Low Extremity Complete Bilat (Pro Cah)Professional Component ,,93925,CPT,Professional,Both,,,26,134,113.9,23.12,134,"UCare Health, Inc.",Medical Assistance,29.359352,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Us Doppler Artery Low Extremity Complete Bilat (Pro Cah)Professional Component ,,93925,CPT,Professional,Both,,,26,134,113.9,23.12,134,"UCare Health, Inc.",Medicare Advantage,41.469,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Us Doppler Artery Low Extremity Complete Bilat (Pro Cah)Professional Component ,,93925,CPT,Professional,Both,,,26,134,113.9,23.12,134,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),33.1752,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Us Doppler Artery Low Extremity Complete Bilat (Pro Cah)Professional Component ,,93925,CPT,Professional,Both,,,26,134,113.9,23.12,134,UnitedHealthcare,Individual & Family,134,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Us Doppler Artery Low Extremity Complete Bilat (Pro Cah)Professional Component ,,93925,CPT,Professional,Both,,,26,134,113.9,23.12,134,UnitedHealthcare,Medicare Advantage,41.469,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Us Doppler Artery Low Extremity Complete Bilat (Pro Cah)Professional Component ,,93925,CPT,Professional,Both,,,26,134,113.9,23.12,134,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,26.69032,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Us Doppler Artery Extremity (Pro Cah)Professional Component ,,93926,CPT,Professional,Both,,,26,106,90.1,13.96,106,Aetna,Commercial,90.1,85,,percent of total billed charges,,
Us Doppler Artery Extremity (Pro Cah)Professional Component ,,93926,CPT,Professional,Both,,,26,106,90.1,13.96,106,Aetna,Medicare Advantage,22.66,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Us Doppler Artery Extremity (Pro Cah)Professional Component ,,93926,CPT,Professional,Both,,,26,106,90.1,13.96,106,Aetna,PPO,98.58,93,,percent of total billed charges,,
Us Doppler Artery Extremity (Pro Cah)Professional Component ,,93926,CPT,Professional,Both,,,26,106,90.1,13.96,106,America's PPO,America's PPO,90.5664,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Us Doppler Artery Extremity (Pro Cah)Professional Component ,,93926,CPT,Professional,Both,,,26,106,90.1,13.96,106,BlueCross BlueShield Minnesota, Federal Employee Program,39.09,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Us Doppler Artery Extremity (Pro Cah)Professional Component ,,93926,CPT,Professional,Both,,,26,106,90.1,13.96,106,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,39.71544,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Us Doppler Artery Extremity (Pro Cah)Professional Component ,,93926,CPT,Professional,Both,,,26,106,90.1,13.96,106,BlueCross BlueShield Minnesota,High Value Network Plan,39.71544,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Us Doppler Artery Extremity (Pro Cah)Professional Component ,,93926,CPT,Professional,Both,,,26,106,90.1,13.96,106,BlueCross BlueShield Minnesota,Medicare Advantage,25.1505,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Us Doppler Artery Extremity (Pro Cah)Professional Component ,,93926,CPT,Professional,Both,,,26,106,90.1,13.96,106,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,39.71544,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Us Doppler Artery Extremity (Pro Cah)Professional Component ,,93926,CPT,Professional,Both,,,26,106,90.1,13.96,106,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,16.11376,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Us Doppler Artery Extremity (Pro Cah)Professional Component ,,93926,CPT,Professional,Both,,,26,106,90.1,13.96,106,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),25.1505,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Us Doppler Artery Extremity (Pro Cah)Professional Component ,,93926,CPT,Professional,Both,,,26,106,90.1,13.96,106,CorVel,Worker's Compensation,43.6161678,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Us Doppler Artery Extremity (Pro Cah)Professional Component ,,93926,CPT,Professional,Both,,,26,106,90.1,13.96,106,First Health Group Corporation,First Health Network,102.82,97,,percent of total billed charges,,
Us Doppler Artery Extremity (Pro Cah)Professional Component ,,93926,CPT,Professional,Both,,,26,106,90.1,13.96,106,"Health Partners, Inc.",Commercial,47.16,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Us Doppler Artery Extremity (Pro Cah)Professional Component ,,93926,CPT,Professional,Both,,,26,106,90.1,13.96,106,"Health Partners, Inc.",Medicare Advantage,25.1505,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Us Doppler Artery Extremity (Pro Cah)Professional Component ,,93926,CPT,Professional,Both,,,26,106,90.1,13.96,106,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),13.96,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Us Doppler Artery Extremity (Pro Cah)Professional Component ,,93926,CPT,Professional,Both,,,26,106,90.1,13.96,106,"Health Partners, Inc.",State of Minnesota Advantage Program,40.62834,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Us Doppler Artery Extremity (Pro Cah)Professional Component ,,93926,CPT,Professional,Both,,,26,106,90.1,13.96,106,"Health Partners, Inc.",State Public Programs,13.96,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Us Doppler Artery Extremity (Pro Cah)Professional Component ,,93926,CPT,Professional,Both,,,26,106,90.1,13.96,106,Humana Insurance Company,Commercial PPO,21.87,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Us Doppler Artery Extremity (Pro Cah)Professional Component ,,93926,CPT,Professional,Both,,,26,106,90.1,13.96,106,Humana Insurance Company,Medicare PPO,106,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Us Doppler Artery Extremity (Pro Cah)Professional Component ,,93926,CPT,Professional,Both,,,26,106,90.1,13.96,106,Medica,Individual & Family,89.888,84.8,,percent of total billed charges,,
Us Doppler Artery Extremity (Pro Cah)Professional Component ,,93926,CPT,Professional,Both,,,26,106,90.1,13.96,106,Medica,Medica Advantage Solution,52.788,49.8,,percent of total billed charges,,
Us Doppler Artery Extremity (Pro Cah)Professional Component ,,93926,CPT,Professional,Both,,,26,106,90.1,13.96,106,Medica,Medical Assistance,16.11,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Us Doppler Artery Extremity (Pro Cah)Professional Component ,,93926,CPT,Professional,Both,,,26,106,90.1,13.96,106,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,21.87,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Us Doppler Artery Extremity (Pro Cah)Professional Component ,,93926,CPT,Professional,Both,,,26,106,90.1,13.96,106,"Multiplan, Inc.","Multiplan, Inc.",99.64,94,,percent of total billed charges,,
Us Doppler Artery Extremity (Pro Cah)Professional Component ,,93926,CPT,Professional,Both,,,26,106,90.1,13.96,106,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,95.506,90.1,,percent of total billed charges,,
Us Doppler Artery Extremity (Pro Cah)Professional Component ,,93926,CPT,Professional,Both,,,26,106,90.1,13.96,106,"Preferred One Administrative Services, INC.",PPO,104.516,98.6,,percent of total billed charges,,
Us Doppler Artery Extremity (Pro Cah)Professional Component ,,93926,CPT,Professional,Both,,,26,106,90.1,13.96,106,PrimeWest Health,Minnesota Senior Health Options (MSHO),25.1505,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Us Doppler Artery Extremity (Pro Cah)Professional Component ,,93926,CPT,Professional,Both,,,26,106,90.1,13.96,106,PrimeWest Health,MinnesotaCare,17.2417232,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Us Doppler Artery Extremity (Pro Cah)Professional Component ,,93926,CPT,Professional,Both,,,26,106,90.1,13.96,106,Sanford Health Plan,Sanford Health Plan,93.28,88,,percent of total billed charges,,
Us Doppler Artery Extremity (Pro Cah)Professional Component ,,93926,CPT,Professional,Both,,,26,106,90.1,13.96,106,"UCare Health, Inc.",Individual & Family Plan,35.551872,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Us Doppler Artery Extremity (Pro Cah)Professional Component ,,93926,CPT,Professional,Both,,,26,106,90.1,13.96,106,"UCare Health, Inc.",Medical Assistance,17.725136,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Us Doppler Artery Extremity (Pro Cah)Professional Component ,,93926,CPT,Professional,Both,,,26,106,90.1,13.96,106,"UCare Health, Inc.",Medicare Advantage,25.1505,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Us Doppler Artery Extremity (Pro Cah)Professional Component ,,93926,CPT,Professional,Both,,,26,106,90.1,13.96,106,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),20.1204,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Us Doppler Artery Extremity (Pro Cah)Professional Component ,,93926,CPT,Professional,Both,,,26,106,90.1,13.96,106,UnitedHealthcare,Individual & Family,106,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Us Doppler Artery Extremity (Pro Cah)Professional Component ,,93926,CPT,Professional,Both,,,26,106,90.1,13.96,106,UnitedHealthcare,Medicare Advantage,25.1505,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Us Doppler Artery Extremity (Pro Cah)Professional Component ,,93926,CPT,Professional,Both,,,26,106,90.1,13.96,106,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,16.11376,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Duplex Scan Of Upper Extremity Arteries Or Arterial Bypass Grafts;Complete Bil Study (Pro Cah)Professional Component ,,93930,CPT,Professional,Both,,,26,157,133.45,23.34,157,Aetna,Commercial,133.45,85,,percent of total billed charges,,
Duplex Scan Of Upper Extremity Arteries Or Arterial Bypass Grafts;Complete Bil Study (Pro Cah)Professional Component ,,93930,CPT,Professional,Both,,,26,157,133.45,23.34,157,Aetna,Medicare Advantage,37.86,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Duplex Scan Of Upper Extremity Arteries Or Arterial Bypass Grafts;Complete Bil Study (Pro Cah)Professional Component ,,93930,CPT,Professional,Both,,,26,157,133.45,23.34,157,Aetna,PPO,146.01,93,,percent of total billed charges,,
Duplex Scan Of Upper Extremity Arteries Or Arterial Bypass Grafts;Complete Bil Study (Pro Cah)Professional Component ,,93930,CPT,Professional,Both,,,26,157,133.45,23.34,157,America's PPO,America's PPO,134.1408,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Duplex Scan Of Upper Extremity Arteries Or Arterial Bypass Grafts;Complete Bil Study (Pro Cah)Professional Component ,,93930,CPT,Professional,Both,,,26,157,133.45,23.34,157,BlueCross BlueShield Minnesota, Federal Employee Program,65.35,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Duplex Scan Of Upper Extremity Arteries Or Arterial Bypass Grafts;Complete Bil Study (Pro Cah)Professional Component ,,93930,CPT,Professional,Both,,,26,157,133.45,23.34,157,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,66.3956,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Duplex Scan Of Upper Extremity Arteries Or Arterial Bypass Grafts;Complete Bil Study (Pro Cah)Professional Component ,,93930,CPT,Professional,Both,,,26,157,133.45,23.34,157,BlueCross BlueShield Minnesota,High Value Network Plan,66.3956,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Duplex Scan Of Upper Extremity Arteries Or Arterial Bypass Grafts;Complete Bil Study (Pro Cah)Professional Component ,,93930,CPT,Professional,Both,,,26,157,133.45,23.34,157,BlueCross BlueShield Minnesota,Medicare Advantage,41.722,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Duplex Scan Of Upper Extremity Arteries Or Arterial Bypass Grafts;Complete Bil Study (Pro Cah)Professional Component ,,93930,CPT,Professional,Both,,,26,157,133.45,23.34,157,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,66.3956,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Duplex Scan Of Upper Extremity Arteries Or Arterial Bypass Grafts;Complete Bil Study (Pro Cah)Professional Component ,,93930,CPT,Professional,Both,,,26,157,133.45,23.34,157,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,26.94432,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Duplex Scan Of Upper Extremity Arteries Or Arterial Bypass Grafts;Complete Bil Study (Pro Cah)Professional Component ,,93930,CPT,Professional,Both,,,26,157,133.45,23.34,157,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),41.722,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Duplex Scan Of Upper Extremity Arteries Or Arterial Bypass Grafts;Complete Bil Study (Pro Cah)Professional Component ,,93930,CPT,Professional,Both,,,26,157,133.45,23.34,157,CorVel,Worker's Compensation,72.2003613,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Duplex Scan Of Upper Extremity Arteries Or Arterial Bypass Grafts;Complete Bil Study (Pro Cah)Professional Component ,,93930,CPT,Professional,Both,,,26,157,133.45,23.34,157,First Health Group Corporation,First Health Network,152.29,97,,percent of total billed charges,,
Duplex Scan Of Upper Extremity Arteries Or Arterial Bypass Grafts;Complete Bil Study (Pro Cah)Professional Component ,,93930,CPT,Professional,Both,,,26,157,133.45,23.34,157,"Health Partners, Inc.",Commercial,77.63,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Duplex Scan Of Upper Extremity Arteries Or Arterial Bypass Grafts;Complete Bil Study (Pro Cah)Professional Component ,,93930,CPT,Professional,Both,,,26,157,133.45,23.34,157,"Health Partners, Inc.",Medicare Advantage,41.722,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Duplex Scan Of Upper Extremity Arteries Or Arterial Bypass Grafts;Complete Bil Study (Pro Cah)Professional Component ,,93930,CPT,Professional,Both,,,26,157,133.45,23.34,157,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),23.34,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Duplex Scan Of Upper Extremity Arteries Or Arterial Bypass Grafts;Complete Bil Study (Pro Cah)Professional Component ,,93930,CPT,Professional,Both,,,26,157,133.45,23.34,157,"Health Partners, Inc.",State of Minnesota Advantage Program,66.878245,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Duplex Scan Of Upper Extremity Arteries Or Arterial Bypass Grafts;Complete Bil Study (Pro Cah)Professional Component ,,93930,CPT,Professional,Both,,,26,157,133.45,23.34,157,"Health Partners, Inc.",State Public Programs,23.34,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Duplex Scan Of Upper Extremity Arteries Or Arterial Bypass Grafts;Complete Bil Study (Pro Cah)Professional Component ,,93930,CPT,Professional,Both,,,26,157,133.45,23.34,157,Humana Insurance Company,Commercial PPO,36.28,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Duplex Scan Of Upper Extremity Arteries Or Arterial Bypass Grafts;Complete Bil Study (Pro Cah)Professional Component ,,93930,CPT,Professional,Both,,,26,157,133.45,23.34,157,Humana Insurance Company,Medicare PPO,157,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Duplex Scan Of Upper Extremity Arteries Or Arterial Bypass Grafts;Complete Bil Study (Pro Cah)Professional Component ,,93930,CPT,Professional,Both,,,26,157,133.45,23.34,157,Medica,Individual & Family,133.136,84.8,,percent of total billed charges,,
Duplex Scan Of Upper Extremity Arteries Or Arterial Bypass Grafts;Complete Bil Study (Pro Cah)Professional Component ,,93930,CPT,Professional,Both,,,26,157,133.45,23.34,157,Medica,Medica Advantage Solution,78.186,49.8,,percent of total billed charges,,
Duplex Scan Of Upper Extremity Arteries Or Arterial Bypass Grafts;Complete Bil Study (Pro Cah)Professional Component ,,93930,CPT,Professional,Both,,,26,157,133.45,23.34,157,Medica,Medical Assistance,26.94,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Duplex Scan Of Upper Extremity Arteries Or Arterial Bypass Grafts;Complete Bil Study (Pro Cah)Professional Component ,,93930,CPT,Professional,Both,,,26,157,133.45,23.34,157,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,36.28,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Duplex Scan Of Upper Extremity Arteries Or Arterial Bypass Grafts;Complete Bil Study (Pro Cah)Professional Component ,,93930,CPT,Professional,Both,,,26,157,133.45,23.34,157,"Multiplan, Inc.","Multiplan, Inc.",147.58,94,,percent of total billed charges,,
Duplex Scan Of Upper Extremity Arteries Or Arterial Bypass Grafts;Complete Bil Study (Pro Cah)Professional Component ,,93930,CPT,Professional,Both,,,26,157,133.45,23.34,157,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,141.457,90.1,,percent of total billed charges,,
Duplex Scan Of Upper Extremity Arteries Or Arterial Bypass Grafts;Complete Bil Study (Pro Cah)Professional Component ,,93930,CPT,Professional,Both,,,26,157,133.45,23.34,157,"Preferred One Administrative Services, INC.",PPO,154.802,98.6,,percent of total billed charges,,
Duplex Scan Of Upper Extremity Arteries Or Arterial Bypass Grafts;Complete Bil Study (Pro Cah)Professional Component ,,93930,CPT,Professional,Both,,,26,157,133.45,23.34,157,PrimeWest Health,Minnesota Senior Health Options (MSHO),41.722,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Duplex Scan Of Upper Extremity Arteries Or Arterial Bypass Grafts;Complete Bil Study (Pro Cah)Professional Component ,,93930,CPT,Professional,Both,,,26,157,133.45,23.34,157,PrimeWest Health,MinnesotaCare,28.8304224,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Duplex Scan Of Upper Extremity Arteries Or Arterial Bypass Grafts;Complete Bil Study (Pro Cah)Professional Component ,,93930,CPT,Professional,Both,,,26,157,133.45,23.34,157,Sanford Health Plan,Sanford Health Plan,138.16,88,,percent of total billed charges,,
Duplex Scan Of Upper Extremity Arteries Or Arterial Bypass Grafts;Complete Bil Study (Pro Cah)Professional Component ,,93930,CPT,Professional,Both,,,26,157,133.45,23.34,157,"UCare Health, Inc.",Individual & Family Plan,58.976768,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Duplex Scan Of Upper Extremity Arteries Or Arterial Bypass Grafts;Complete Bil Study (Pro Cah)Professional Component ,,93930,CPT,Professional,Both,,,26,157,133.45,23.34,157,"UCare Health, Inc.",Medical Assistance,29.638752,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Duplex Scan Of Upper Extremity Arteries Or Arterial Bypass Grafts;Complete Bil Study (Pro Cah)Professional Component ,,93930,CPT,Professional,Both,,,26,157,133.45,23.34,157,"UCare Health, Inc.",Medicare Advantage,41.722,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Duplex Scan Of Upper Extremity Arteries Or Arterial Bypass Grafts;Complete Bil Study (Pro Cah)Professional Component ,,93930,CPT,Professional,Both,,,26,157,133.45,23.34,157,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),33.3776,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Duplex Scan Of Upper Extremity Arteries Or Arterial Bypass Grafts;Complete Bil Study (Pro Cah)Professional Component ,,93930,CPT,Professional,Both,,,26,157,133.45,23.34,157,UnitedHealthcare,Individual & Family,157,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Duplex Scan Of Upper Extremity Arteries Or Arterial Bypass Grafts;Complete Bil Study (Pro Cah)Professional Component ,,93930,CPT,Professional,Both,,,26,157,133.45,23.34,157,UnitedHealthcare,Medicare Advantage,41.722,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Duplex Scan Of Upper Extremity Arteries Or Arterial Bypass Grafts;Complete Bil Study (Pro Cah)Professional Component ,,93930,CPT,Professional,Both,,,26,157,133.45,23.34,157,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,26.94432,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Duplex Scan Of Upper Extremity Arteries Or Arterial Bg Unilateral Or Limited (Pro Cah)Professional Component ,,93931,CPT,Professional,Both,,,26,104,88.4,14.18,104,Aetna,Commercial,88.4,85,,percent of total billed charges,,
Duplex Scan Of Upper Extremity Arteries Or Arterial Bg Unilateral Or Limited (Pro Cah)Professional Component ,,93931,CPT,Professional,Both,,,26,104,88.4,14.18,104,Aetna,Medicare Advantage,23.36,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Duplex Scan Of Upper Extremity Arteries Or Arterial Bg Unilateral Or Limited (Pro Cah)Professional Component ,,93931,CPT,Professional,Both,,,26,104,88.4,14.18,104,Aetna,PPO,96.72,93,,percent of total billed charges,,
Duplex Scan Of Upper Extremity Arteries Or Arterial Bg Unilateral Or Limited (Pro Cah)Professional Component ,,93931,CPT,Professional,Both,,,26,104,88.4,14.18,104,America's PPO,America's PPO,88.8576,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Duplex Scan Of Upper Extremity Arteries Or Arterial Bg Unilateral Or Limited (Pro Cah)Professional Component ,,93931,CPT,Professional,Both,,,26,104,88.4,14.18,104,BlueCross BlueShield Minnesota, Federal Employee Program,39.68,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Duplex Scan Of Upper Extremity Arteries Or Arterial Bg Unilateral Or Limited (Pro Cah)Professional Component ,,93931,CPT,Professional,Both,,,26,104,88.4,14.18,104,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,40.31488,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Duplex Scan Of Upper Extremity Arteries Or Arterial Bg Unilateral Or Limited (Pro Cah)Professional Component ,,93931,CPT,Professional,Both,,,26,104,88.4,14.18,104,BlueCross BlueShield Minnesota,High Value Network Plan,40.31488,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Duplex Scan Of Upper Extremity Arteries Or Arterial Bg Unilateral Or Limited (Pro Cah)Professional Component ,,93931,CPT,Professional,Both,,,26,104,88.4,14.18,104,BlueCross BlueShield Minnesota,Medicare Advantage,25.553,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Duplex Scan Of Upper Extremity Arteries Or Arterial Bg Unilateral Or Limited (Pro Cah)Professional Component ,,93931,CPT,Professional,Both,,,26,104,88.4,14.18,104,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,40.31488,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Duplex Scan Of Upper Extremity Arteries Or Arterial Bg Unilateral Or Limited (Pro Cah)Professional Component ,,93931,CPT,Professional,Both,,,26,104,88.4,14.18,104,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,16.36776,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Duplex Scan Of Upper Extremity Arteries Or Arterial Bg Unilateral Or Limited (Pro Cah)Professional Component ,,93931,CPT,Professional,Both,,,26,104,88.4,14.18,104,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),25.553,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Duplex Scan Of Upper Extremity Arteries Or Arterial Bg Unilateral Or Limited (Pro Cah)Professional Component ,,93931,CPT,Professional,Both,,,26,104,88.4,14.18,104,CorVel,Worker's Compensation,44.977032,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Duplex Scan Of Upper Extremity Arteries Or Arterial Bg Unilateral Or Limited (Pro Cah)Professional Component ,,93931,CPT,Professional,Both,,,26,104,88.4,14.18,104,First Health Group Corporation,First Health Network,100.88,97,,percent of total billed charges,,
Duplex Scan Of Upper Extremity Arteries Or Arterial Bg Unilateral Or Limited (Pro Cah)Professional Component ,,93931,CPT,Professional,Both,,,26,104,88.4,14.18,104,"Health Partners, Inc.",Commercial,48.61,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Duplex Scan Of Upper Extremity Arteries Or Arterial Bg Unilateral Or Limited (Pro Cah)Professional Component ,,93931,CPT,Professional,Both,,,26,104,88.4,14.18,104,"Health Partners, Inc.",Medicare Advantage,25.553,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Duplex Scan Of Upper Extremity Arteries Or Arterial Bg Unilateral Or Limited (Pro Cah)Professional Component ,,93931,CPT,Professional,Both,,,26,104,88.4,14.18,104,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),14.18,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Duplex Scan Of Upper Extremity Arteries Or Arterial Bg Unilateral Or Limited (Pro Cah)Professional Component ,,93931,CPT,Professional,Both,,,26,104,88.4,14.18,104,"Health Partners, Inc.",State of Minnesota Advantage Program,41.877515,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Duplex Scan Of Upper Extremity Arteries Or Arterial Bg Unilateral Or Limited (Pro Cah)Professional Component ,,93931,CPT,Professional,Both,,,26,104,88.4,14.18,104,"Health Partners, Inc.",State Public Programs,14.18,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Duplex Scan Of Upper Extremity Arteries Or Arterial Bg Unilateral Or Limited (Pro Cah)Professional Component ,,93931,CPT,Professional,Both,,,26,104,88.4,14.18,104,Humana Insurance Company,Commercial PPO,22.22,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Duplex Scan Of Upper Extremity Arteries Or Arterial Bg Unilateral Or Limited (Pro Cah)Professional Component ,,93931,CPT,Professional,Both,,,26,104,88.4,14.18,104,Humana Insurance Company,Medicare PPO,104,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Duplex Scan Of Upper Extremity Arteries Or Arterial Bg Unilateral Or Limited (Pro Cah)Professional Component ,,93931,CPT,Professional,Both,,,26,104,88.4,14.18,104,Medica,Individual & Family,88.192,84.8,,percent of total billed charges,,
Duplex Scan Of Upper Extremity Arteries Or Arterial Bg Unilateral Or Limited (Pro Cah)Professional Component ,,93931,CPT,Professional,Both,,,26,104,88.4,14.18,104,Medica,Medica Advantage Solution,51.792,49.8,,percent of total billed charges,,
Duplex Scan Of Upper Extremity Arteries Or Arterial Bg Unilateral Or Limited (Pro Cah)Professional Component ,,93931,CPT,Professional,Both,,,26,104,88.4,14.18,104,Medica,Medical Assistance,16.37,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Duplex Scan Of Upper Extremity Arteries Or Arterial Bg Unilateral Or Limited (Pro Cah)Professional Component ,,93931,CPT,Professional,Both,,,26,104,88.4,14.18,104,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,22.22,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Duplex Scan Of Upper Extremity Arteries Or Arterial Bg Unilateral Or Limited (Pro Cah)Professional Component ,,93931,CPT,Professional,Both,,,26,104,88.4,14.18,104,"Multiplan, Inc.","Multiplan, Inc.",97.76,94,,percent of total billed charges,,
Duplex Scan Of Upper Extremity Arteries Or Arterial Bg Unilateral Or Limited (Pro Cah)Professional Component ,,93931,CPT,Professional,Both,,,26,104,88.4,14.18,104,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,93.704,90.1,,percent of total billed charges,,
Duplex Scan Of Upper Extremity Arteries Or Arterial Bg Unilateral Or Limited (Pro Cah)Professional Component ,,93931,CPT,Professional,Both,,,26,104,88.4,14.18,104,"Preferred One Administrative Services, INC.",PPO,102.544,98.6,,percent of total billed charges,,
Duplex Scan Of Upper Extremity Arteries Or Arterial Bg Unilateral Or Limited (Pro Cah)Professional Component ,,93931,CPT,Professional,Both,,,26,104,88.4,14.18,104,PrimeWest Health,Minnesota Senior Health Options (MSHO),25.553,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Duplex Scan Of Upper Extremity Arteries Or Arterial Bg Unilateral Or Limited (Pro Cah)Professional Component ,,93931,CPT,Professional,Both,,,26,104,88.4,14.18,104,PrimeWest Health,MinnesotaCare,17.5135032,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Duplex Scan Of Upper Extremity Arteries Or Arterial Bg Unilateral Or Limited (Pro Cah)Professional Component ,,93931,CPT,Professional,Both,,,26,104,88.4,14.18,104,Sanford Health Plan,Sanford Health Plan,91.52,88,,percent of total billed charges,,
Duplex Scan Of Upper Extremity Arteries Or Arterial Bg Unilateral Or Limited (Pro Cah)Professional Component ,,93931,CPT,Professional,Both,,,26,104,88.4,14.18,104,"UCare Health, Inc.",Individual & Family Plan,36.120832,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Duplex Scan Of Upper Extremity Arteries Or Arterial Bg Unilateral Or Limited (Pro Cah)Professional Component ,,93931,CPT,Professional,Both,,,26,104,88.4,14.18,104,"UCare Health, Inc.",Medical Assistance,18.004536,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Duplex Scan Of Upper Extremity Arteries Or Arterial Bg Unilateral Or Limited (Pro Cah)Professional Component ,,93931,CPT,Professional,Both,,,26,104,88.4,14.18,104,"UCare Health, Inc.",Medicare Advantage,25.553,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Duplex Scan Of Upper Extremity Arteries Or Arterial Bg Unilateral Or Limited (Pro Cah)Professional Component ,,93931,CPT,Professional,Both,,,26,104,88.4,14.18,104,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),20.4424,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Duplex Scan Of Upper Extremity Arteries Or Arterial Bg Unilateral Or Limited (Pro Cah)Professional Component ,,93931,CPT,Professional,Both,,,26,104,88.4,14.18,104,UnitedHealthcare,Individual & Family,104,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Duplex Scan Of Upper Extremity Arteries Or Arterial Bg Unilateral Or Limited (Pro Cah)Professional Component ,,93931,CPT,Professional,Both,,,26,104,88.4,14.18,104,UnitedHealthcare,Medicare Advantage,25.553,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Duplex Scan Of Upper Extremity Arteries Or Arterial Bg Unilateral Or Limited (Pro Cah)Professional Component ,,93931,CPT,Professional,Both,,,26,104,88.4,14.18,104,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,16.36776,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Us Ext Vein Bilat Complete (Pro Cah)Professional Component ,,93970,CPT,Professional,Both,,,26,166,141.1,20.5,166,Aetna,Commercial,141.1,85,,percent of total billed charges,,
Us Ext Vein Bilat Complete (Pro Cah)Professional Component ,,93970,CPT,Professional,Both,,,26,166,141.1,20.5,166,Aetna,Medicare Advantage,32.82,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Us Ext Vein Bilat Complete (Pro Cah)Professional Component ,,93970,CPT,Professional,Both,,,26,166,141.1,20.5,166,Aetna,PPO,154.38,93,,percent of total billed charges,,
Us Ext Vein Bilat Complete (Pro Cah)Professional Component ,,93970,CPT,Professional,Both,,,26,166,141.1,20.5,166,America's PPO,America's PPO,141.8304,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Us Ext Vein Bilat Complete (Pro Cah)Professional Component ,,93970,CPT,Professional,Both,,,26,166,141.1,20.5,166,BlueCross BlueShield Minnesota, Federal Employee Program,57.18,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Us Ext Vein Bilat Complete (Pro Cah)Professional Component ,,93970,CPT,Professional,Both,,,26,166,141.1,20.5,166,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,58.09488,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Us Ext Vein Bilat Complete (Pro Cah)Professional Component ,,93970,CPT,Professional,Both,,,26,166,141.1,20.5,166,BlueCross BlueShield Minnesota,High Value Network Plan,58.09488,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Us Ext Vein Bilat Complete (Pro Cah)Professional Component ,,93970,CPT,Professional,Both,,,26,166,141.1,20.5,166,BlueCross BlueShield Minnesota,Medicare Advantage,36.777,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Us Ext Vein Bilat Complete (Pro Cah)Professional Component ,,93970,CPT,Professional,Both,,,26,166,141.1,20.5,166,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,58.09488,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Us Ext Vein Bilat Complete (Pro Cah)Professional Component ,,93970,CPT,Professional,Both,,,26,166,141.1,20.5,166,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,23.6728,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Us Ext Vein Bilat Complete (Pro Cah)Professional Component ,,93970,CPT,Professional,Both,,,26,166,141.1,20.5,166,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),36.777,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Us Ext Vein Bilat Complete (Pro Cah)Professional Component ,,93970,CPT,Professional,Both,,,26,166,141.1,20.5,166,CorVel,Worker's Compensation,63.6482769,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Us Ext Vein Bilat Complete (Pro Cah)Professional Component ,,93970,CPT,Professional,Both,,,26,166,141.1,20.5,166,First Health Group Corporation,First Health Network,161.02,97,,percent of total billed charges,,
Us Ext Vein Bilat Complete (Pro Cah)Professional Component ,,93970,CPT,Professional,Both,,,26,166,141.1,20.5,166,"Health Partners, Inc.",Commercial,68.2,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Us Ext Vein Bilat Complete (Pro Cah)Professional Component ,,93970,CPT,Professional,Both,,,26,166,141.1,20.5,166,"Health Partners, Inc.",Medicare Advantage,36.777,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Us Ext Vein Bilat Complete (Pro Cah)Professional Component ,,93970,CPT,Professional,Both,,,26,166,141.1,20.5,166,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),20.5,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Us Ext Vein Bilat Complete (Pro Cah)Professional Component ,,93970,CPT,Professional,Both,,,26,166,141.1,20.5,166,"Health Partners, Inc.",State of Minnesota Advantage Program,58.7543,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Us Ext Vein Bilat Complete (Pro Cah)Professional Component ,,93970,CPT,Professional,Both,,,26,166,141.1,20.5,166,"Health Partners, Inc.",State Public Programs,20.5,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Us Ext Vein Bilat Complete (Pro Cah)Professional Component ,,93970,CPT,Professional,Both,,,26,166,141.1,20.5,166,Humana Insurance Company,Commercial PPO,31.98,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Us Ext Vein Bilat Complete (Pro Cah)Professional Component ,,93970,CPT,Professional,Both,,,26,166,141.1,20.5,166,Humana Insurance Company,Medicare PPO,166,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Us Ext Vein Bilat Complete (Pro Cah)Professional Component ,,93970,CPT,Professional,Both,,,26,166,141.1,20.5,166,Medica,Individual & Family,140.768,84.8,,percent of total billed charges,,
Us Ext Vein Bilat Complete (Pro Cah)Professional Component ,,93970,CPT,Professional,Both,,,26,166,141.1,20.5,166,Medica,Medica Advantage Solution,82.668,49.8,,percent of total billed charges,,
Us Ext Vein Bilat Complete (Pro Cah)Professional Component ,,93970,CPT,Professional,Both,,,26,166,141.1,20.5,166,Medica,Medical Assistance,23.67,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Us Ext Vein Bilat Complete (Pro Cah)Professional Component ,,93970,CPT,Professional,Both,,,26,166,141.1,20.5,166,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,31.98,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Us Ext Vein Bilat Complete (Pro Cah)Professional Component ,,93970,CPT,Professional,Both,,,26,166,141.1,20.5,166,"Multiplan, Inc.","Multiplan, Inc.",156.04,94,,percent of total billed charges,,
Us Ext Vein Bilat Complete (Pro Cah)Professional Component ,,93970,CPT,Professional,Both,,,26,166,141.1,20.5,166,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,149.566,90.1,,percent of total billed charges,,
Us Ext Vein Bilat Complete (Pro Cah)Professional Component ,,93970,CPT,Professional,Both,,,26,166,141.1,20.5,166,"Preferred One Administrative Services, INC.",PPO,163.676,98.6,,percent of total billed charges,,
Us Ext Vein Bilat Complete (Pro Cah)Professional Component ,,93970,CPT,Professional,Both,,,26,166,141.1,20.5,166,PrimeWest Health,Minnesota Senior Health Options (MSHO),36.777,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Us Ext Vein Bilat Complete (Pro Cah)Professional Component ,,93970,CPT,Professional,Both,,,26,166,141.1,20.5,166,PrimeWest Health,MinnesotaCare,25.329896,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Us Ext Vein Bilat Complete (Pro Cah)Professional Component ,,93970,CPT,Professional,Both,,,26,166,141.1,20.5,166,Sanford Health Plan,Sanford Health Plan,146.08,88,,percent of total billed charges,,
Us Ext Vein Bilat Complete (Pro Cah)Professional Component ,,93970,CPT,Professional,Both,,,26,166,141.1,20.5,166,"UCare Health, Inc.",Individual & Family Plan,51.986688,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Us Ext Vein Bilat Complete (Pro Cah)Professional Component ,,93970,CPT,Professional,Both,,,26,166,141.1,20.5,166,"UCare Health, Inc.",Medical Assistance,26.04008,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Us Ext Vein Bilat Complete (Pro Cah)Professional Component ,,93970,CPT,Professional,Both,,,26,166,141.1,20.5,166,"UCare Health, Inc.",Medicare Advantage,36.777,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Us Ext Vein Bilat Complete (Pro Cah)Professional Component ,,93970,CPT,Professional,Both,,,26,166,141.1,20.5,166,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),29.4216,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Us Ext Vein Bilat Complete (Pro Cah)Professional Component ,,93970,CPT,Professional,Both,,,26,166,141.1,20.5,166,UnitedHealthcare,Individual & Family,166,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Us Ext Vein Bilat Complete (Pro Cah)Professional Component ,,93970,CPT,Professional,Both,,,26,166,141.1,20.5,166,UnitedHealthcare,Medicare Advantage,36.777,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Us Ext Vein Bilat Complete (Pro Cah)Professional Component ,,93970,CPT,Professional,Both,,,26,166,141.1,20.5,166,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,23.6728,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Us Ext Vein Unilat Or Lmtd (Pro Cah)Professional Component ,,93971,CPT,Professional,Both,,,26,120,102,13.09,120,Aetna,Commercial,102,85,,percent of total billed charges,,
Us Ext Vein Unilat Or Lmtd (Pro Cah)Professional Component ,,93971,CPT,Professional,Both,,,26,120,102,13.09,120,Aetna,Medicare Advantage,21.14,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Us Ext Vein Unilat Or Lmtd (Pro Cah)Professional Component ,,93971,CPT,Professional,Both,,,26,120,102,13.09,120,Aetna,PPO,111.6,93,,percent of total billed charges,,
Us Ext Vein Unilat Or Lmtd (Pro Cah)Professional Component ,,93971,CPT,Professional,Both,,,26,120,102,13.09,120,America's PPO,America's PPO,102.528,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Us Ext Vein Unilat Or Lmtd (Pro Cah)Professional Component ,,93971,CPT,Professional,Both,,,26,120,102,13.09,120,BlueCross BlueShield Minnesota, Federal Employee Program,36.76,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Us Ext Vein Unilat Or Lmtd (Pro Cah)Professional Component ,,93971,CPT,Professional,Both,,,26,120,102,13.09,120,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,37.34816,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Us Ext Vein Unilat Or Lmtd (Pro Cah)Professional Component ,,93971,CPT,Professional,Both,,,26,120,102,13.09,120,BlueCross BlueShield Minnesota,High Value Network Plan,37.34816,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Us Ext Vein Unilat Or Lmtd (Pro Cah)Professional Component ,,93971,CPT,Professional,Both,,,26,120,102,13.09,120,BlueCross BlueShield Minnesota,Medicare Advantage,23.6095,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Us Ext Vein Unilat Or Lmtd (Pro Cah)Professional Component ,,93971,CPT,Professional,Both,,,26,120,102,13.09,120,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,37.34816,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Us Ext Vein Unilat Or Lmtd (Pro Cah)Professional Component ,,93971,CPT,Professional,Both,,,26,120,102,13.09,120,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,15.10792,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Us Ext Vein Unilat Or Lmtd (Pro Cah)Professional Component ,,93971,CPT,Professional,Both,,,26,120,102,13.09,120,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),23.6095,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Us Ext Vein Unilat Or Lmtd (Pro Cah)Professional Component ,,93971,CPT,Professional,Both,,,26,120,102,13.09,120,CorVel,Worker's Compensation,40.7009898,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Us Ext Vein Unilat Or Lmtd (Pro Cah)Professional Component ,,93971,CPT,Professional,Both,,,26,120,102,13.09,120,First Health Group Corporation,First Health Network,116.4,97,,percent of total billed charges,,
Us Ext Vein Unilat Or Lmtd (Pro Cah)Professional Component ,,93971,CPT,Professional,Both,,,26,120,102,13.09,120,"Health Partners, Inc.",Commercial,43.54,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Us Ext Vein Unilat Or Lmtd (Pro Cah)Professional Component ,,93971,CPT,Professional,Both,,,26,120,102,13.09,120,"Health Partners, Inc.",Medicare Advantage,23.6095,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Us Ext Vein Unilat Or Lmtd (Pro Cah)Professional Component ,,93971,CPT,Professional,Both,,,26,120,102,13.09,120,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),13.09,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Us Ext Vein Unilat Or Lmtd (Pro Cah)Professional Component ,,93971,CPT,Professional,Both,,,26,120,102,13.09,120,"Health Partners, Inc.",State of Minnesota Advantage Program,37.50971,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Us Ext Vein Unilat Or Lmtd (Pro Cah)Professional Component ,,93971,CPT,Professional,Both,,,26,120,102,13.09,120,"Health Partners, Inc.",State Public Programs,13.09,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Us Ext Vein Unilat Or Lmtd (Pro Cah)Professional Component ,,93971,CPT,Professional,Both,,,26,120,102,13.09,120,Humana Insurance Company,Commercial PPO,20.53,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Us Ext Vein Unilat Or Lmtd (Pro Cah)Professional Component ,,93971,CPT,Professional,Both,,,26,120,102,13.09,120,Humana Insurance Company,Medicare PPO,120,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Us Ext Vein Unilat Or Lmtd (Pro Cah)Professional Component ,,93971,CPT,Professional,Both,,,26,120,102,13.09,120,Medica,Individual & Family,101.76,84.8,,percent of total billed charges,,
Us Ext Vein Unilat Or Lmtd (Pro Cah)Professional Component ,,93971,CPT,Professional,Both,,,26,120,102,13.09,120,Medica,Medica Advantage Solution,59.76,49.8,,percent of total billed charges,,
Us Ext Vein Unilat Or Lmtd (Pro Cah)Professional Component ,,93971,CPT,Professional,Both,,,26,120,102,13.09,120,Medica,Medical Assistance,15.11,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Us Ext Vein Unilat Or Lmtd (Pro Cah)Professional Component ,,93971,CPT,Professional,Both,,,26,120,102,13.09,120,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,20.53,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Us Ext Vein Unilat Or Lmtd (Pro Cah)Professional Component ,,93971,CPT,Professional,Both,,,26,120,102,13.09,120,"Multiplan, Inc.","Multiplan, Inc.",112.8,94,,percent of total billed charges,,
Us Ext Vein Unilat Or Lmtd (Pro Cah)Professional Component ,,93971,CPT,Professional,Both,,,26,120,102,13.09,120,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,108.12,90.1,,percent of total billed charges,,
Us Ext Vein Unilat Or Lmtd (Pro Cah)Professional Component ,,93971,CPT,Professional,Both,,,26,120,102,13.09,120,"Preferred One Administrative Services, INC.",PPO,118.32,98.6,,percent of total billed charges,,
Us Ext Vein Unilat Or Lmtd (Pro Cah)Professional Component ,,93971,CPT,Professional,Both,,,26,120,102,13.09,120,PrimeWest Health,Minnesota Senior Health Options (MSHO),23.6095,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Us Ext Vein Unilat Or Lmtd (Pro Cah)Professional Component ,,93971,CPT,Professional,Both,,,26,120,102,13.09,120,PrimeWest Health,MinnesotaCare,16.1654744,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Us Ext Vein Unilat Or Lmtd (Pro Cah)Professional Component ,,93971,CPT,Professional,Both,,,26,120,102,13.09,120,Sanford Health Plan,Sanford Health Plan,105.6,88,,percent of total billed charges,,
Us Ext Vein Unilat Or Lmtd (Pro Cah)Professional Component ,,93971,CPT,Professional,Both,,,26,120,102,13.09,120,"UCare Health, Inc.",Individual & Family Plan,33.373568,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Us Ext Vein Unilat Or Lmtd (Pro Cah)Professional Component ,,93971,CPT,Professional,Both,,,26,120,102,13.09,120,"UCare Health, Inc.",Medical Assistance,16.618712,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Us Ext Vein Unilat Or Lmtd (Pro Cah)Professional Component ,,93971,CPT,Professional,Both,,,26,120,102,13.09,120,"UCare Health, Inc.",Medicare Advantage,23.6095,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Us Ext Vein Unilat Or Lmtd (Pro Cah)Professional Component ,,93971,CPT,Professional,Both,,,26,120,102,13.09,120,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),18.8876,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Us Ext Vein Unilat Or Lmtd (Pro Cah)Professional Component ,,93971,CPT,Professional,Both,,,26,120,102,13.09,120,UnitedHealthcare,Individual & Family,120,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Us Ext Vein Unilat Or Lmtd (Pro Cah)Professional Component ,,93971,CPT,Professional,Both,,,26,120,102,13.09,120,UnitedHealthcare,Medicare Advantage,23.6095,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Us Ext Vein Unilat Or Lmtd (Pro Cah)Professional Component ,,93971,CPT,Professional,Both,,,26,120,102,13.09,120,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,15.10792,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Us Dop Organs Complete (Pro Cah)Professional Component ,,93975,CPT,Professional,Both,,,26,240,204,37.17,240,Aetna,Commercial,204,85,,percent of total billed charges,,
Us Dop Organs Complete (Pro Cah)Professional Component ,,93975,CPT,Professional,Both,,,26,240,204,37.17,240,Aetna,Medicare Advantage,55.02,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Us Dop Organs Complete (Pro Cah)Professional Component ,,93975,CPT,Professional,Both,,,26,240,204,37.17,240,Aetna,PPO,223.2,93,,percent of total billed charges,,
Us Dop Organs Complete (Pro Cah)Professional Component ,,93975,CPT,Professional,Both,,,26,240,204,37.17,240,America's PPO,America's PPO,205.056,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Us Dop Organs Complete (Pro Cah)Professional Component ,,93975,CPT,Professional,Both,,,26,240,204,37.17,240,BlueCross BlueShield Minnesota, Federal Employee Program,95.69,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Us Dop Organs Complete (Pro Cah)Professional Component ,,93975,CPT,Professional,Both,,,26,240,204,37.17,240,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,97.22104,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Us Dop Organs Complete (Pro Cah)Professional Component ,,93975,CPT,Professional,Both,,,26,240,204,37.17,240,BlueCross BlueShield Minnesota,High Value Network Plan,97.22104,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Us Dop Organs Complete (Pro Cah)Professional Component ,,93975,CPT,Professional,Both,,,26,240,204,37.17,240,BlueCross BlueShield Minnesota,Medicare Advantage,61.571,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Us Dop Organs Complete (Pro Cah)Professional Component ,,93975,CPT,Professional,Both,,,26,240,204,37.17,240,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,97.22104,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Us Dop Organs Complete (Pro Cah)Professional Component ,,93975,CPT,Professional,Both,,,26,240,204,37.17,240,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,39.54272,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Us Dop Organs Complete (Pro Cah)Professional Component ,,93975,CPT,Professional,Both,,,26,240,204,37.17,240,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),61.571,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Us Dop Organs Complete (Pro Cah)Professional Component ,,93975,CPT,Professional,Both,,,26,240,204,37.17,240,CorVel,Worker's Compensation,105.9076107,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Us Dop Organs Complete (Pro Cah)Professional Component ,,93975,CPT,Professional,Both,,,26,240,204,37.17,240,First Health Group Corporation,First Health Network,232.8,97,,percent of total billed charges,,
Us Dop Organs Complete (Pro Cah)Professional Component ,,93975,CPT,Professional,Both,,,26,240,204,37.17,240,"Health Partners, Inc.",Commercial,113.9,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Us Dop Organs Complete (Pro Cah)Professional Component ,,93975,CPT,Professional,Both,,,26,240,204,37.17,240,"Health Partners, Inc.",Medicare Advantage,61.571,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Us Dop Organs Complete (Pro Cah)Professional Component ,,93975,CPT,Professional,Both,,,26,240,204,37.17,240,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),37.17,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Us Dop Organs Complete (Pro Cah)Professional Component ,,93975,CPT,Professional,Both,,,26,240,204,37.17,240,"Health Partners, Inc.",State of Minnesota Advantage Program,98.12485,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Us Dop Organs Complete (Pro Cah)Professional Component ,,93975,CPT,Professional,Both,,,26,240,204,37.17,240,"Health Partners, Inc.",State Public Programs,37.17,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Us Dop Organs Complete (Pro Cah)Professional Component ,,93975,CPT,Professional,Both,,,26,240,204,37.17,240,Humana Insurance Company,Commercial PPO,53.54,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Us Dop Organs Complete (Pro Cah)Professional Component ,,93975,CPT,Professional,Both,,,26,240,204,37.17,240,Humana Insurance Company,Medicare PPO,240,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Us Dop Organs Complete (Pro Cah)Professional Component ,,93975,CPT,Professional,Both,,,26,240,204,37.17,240,Medica,Individual & Family,203.52,84.8,,percent of total billed charges,,
Us Dop Organs Complete (Pro Cah)Professional Component ,,93975,CPT,Professional,Both,,,26,240,204,37.17,240,Medica,Medica Advantage Solution,119.52,49.8,,percent of total billed charges,,
Us Dop Organs Complete (Pro Cah)Professional Component ,,93975,CPT,Professional,Both,,,26,240,204,37.17,240,Medica,Medical Assistance,39.54,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Us Dop Organs Complete (Pro Cah)Professional Component ,,93975,CPT,Professional,Both,,,26,240,204,37.17,240,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,53.54,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Us Dop Organs Complete (Pro Cah)Professional Component ,,93975,CPT,Professional,Both,,,26,240,204,37.17,240,"Multiplan, Inc.","Multiplan, Inc.",225.6,94,,percent of total billed charges,,
Us Dop Organs Complete (Pro Cah)Professional Component ,,93975,CPT,Professional,Both,,,26,240,204,37.17,240,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,216.24,90.1,,percent of total billed charges,,
Us Dop Organs Complete (Pro Cah)Professional Component ,,93975,CPT,Professional,Both,,,26,240,204,37.17,240,"Preferred One Administrative Services, INC.",PPO,236.64,98.6,,percent of total billed charges,,
Us Dop Organs Complete (Pro Cah)Professional Component ,,93975,CPT,Professional,Both,,,26,240,204,37.17,240,PrimeWest Health,Minnesota Senior Health Options (MSHO),61.571,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Us Dop Organs Complete (Pro Cah)Professional Component ,,93975,CPT,Professional,Both,,,26,240,204,37.17,240,PrimeWest Health,MinnesotaCare,42.3107104,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Us Dop Organs Complete (Pro Cah)Professional Component ,,93975,CPT,Professional,Both,,,26,240,204,37.17,240,Sanford Health Plan,Sanford Health Plan,211.2,88,,percent of total billed charges,,
Us Dop Organs Complete (Pro Cah)Professional Component ,,93975,CPT,Professional,Both,,,26,240,204,37.17,240,"UCare Health, Inc.",Individual & Family Plan,87.034624,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Us Dop Organs Complete (Pro Cah)Professional Component ,,93975,CPT,Professional,Both,,,26,240,204,37.17,240,"UCare Health, Inc.",Medical Assistance,43.496992,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Us Dop Organs Complete (Pro Cah)Professional Component ,,93975,CPT,Professional,Both,,,26,240,204,37.17,240,"UCare Health, Inc.",Medicare Advantage,61.571,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Us Dop Organs Complete (Pro Cah)Professional Component ,,93975,CPT,Professional,Both,,,26,240,204,37.17,240,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),49.2568,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Us Dop Organs Complete (Pro Cah)Professional Component ,,93975,CPT,Professional,Both,,,26,240,204,37.17,240,UnitedHealthcare,Individual & Family,240,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Us Dop Organs Complete (Pro Cah)Professional Component ,,93975,CPT,Professional,Both,,,26,240,204,37.17,240,UnitedHealthcare,Medicare Advantage,61.571,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Us Dop Organs Complete (Pro Cah)Professional Component ,,93975,CPT,Professional,Both,,,26,240,204,37.17,240,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,39.54272,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Us Dop Organs Limited (Pro Cah)Professional Component ,,93976,CPT,Professional,Both,,,26,193,164.05,25.8,193,Aetna,Commercial,164.05,85,,percent of total billed charges,,
Us Dop Organs Limited (Pro Cah)Professional Component ,,93976,CPT,Professional,Both,,,26,193,164.05,25.8,193,Aetna,Medicare Advantage,38.3,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Us Dop Organs Limited (Pro Cah)Professional Component ,,93976,CPT,Professional,Both,,,26,193,164.05,25.8,193,Aetna,PPO,179.49,93,,percent of total billed charges,,
Us Dop Organs Limited (Pro Cah)Professional Component ,,93976,CPT,Professional,Both,,,26,193,164.05,25.8,193,America's PPO,America's PPO,164.8992,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Us Dop Organs Limited (Pro Cah)Professional Component ,,93976,CPT,Professional,Both,,,26,193,164.05,25.8,193,BlueCross BlueShield Minnesota, Federal Employee Program,65.35,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Us Dop Organs Limited (Pro Cah)Professional Component ,,93976,CPT,Professional,Both,,,26,193,164.05,25.8,193,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,66.3956,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Us Dop Organs Limited (Pro Cah)Professional Component ,,93976,CPT,Professional,Both,,,26,193,164.05,25.8,193,BlueCross BlueShield Minnesota,High Value Network Plan,66.3956,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Us Dop Organs Limited (Pro Cah)Professional Component ,,93976,CPT,Professional,Both,,,26,193,164.05,25.8,193,BlueCross BlueShield Minnesota,Medicare Advantage,42.803,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Us Dop Organs Limited (Pro Cah)Professional Component ,,93976,CPT,Professional,Both,,,26,193,164.05,25.8,193,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,66.3956,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Us Dop Organs Limited (Pro Cah)Professional Component ,,93976,CPT,Professional,Both,,,26,193,164.05,25.8,193,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,27.45232,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Us Dop Organs Limited (Pro Cah)Professional Component ,,93976,CPT,Professional,Both,,,26,193,164.05,25.8,193,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),42.803,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Us Dop Organs Limited (Pro Cah)Professional Component ,,93976,CPT,Professional,Both,,,26,193,164.05,25.8,193,CorVel,Worker's Compensation,73.7365392,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Us Dop Organs Limited (Pro Cah)Professional Component ,,93976,CPT,Professional,Both,,,26,193,164.05,25.8,193,First Health Group Corporation,First Health Network,187.21,97,,percent of total billed charges,,
Us Dop Organs Limited (Pro Cah)Professional Component ,,93976,CPT,Professional,Both,,,26,193,164.05,25.8,193,"Health Partners, Inc.",Commercial,79.09,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Us Dop Organs Limited (Pro Cah)Professional Component ,,93976,CPT,Professional,Both,,,26,193,164.05,25.8,193,"Health Partners, Inc.",Medicare Advantage,42.803,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Us Dop Organs Limited (Pro Cah)Professional Component ,,93976,CPT,Professional,Both,,,26,193,164.05,25.8,193,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),25.8,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Us Dop Organs Limited (Pro Cah)Professional Component ,,93976,CPT,Professional,Both,,,26,193,164.05,25.8,193,"Health Partners, Inc.",State of Minnesota Advantage Program,68.136035,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Us Dop Organs Limited (Pro Cah)Professional Component ,,93976,CPT,Professional,Both,,,26,193,164.05,25.8,193,"Health Partners, Inc.",State Public Programs,25.8,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Us Dop Organs Limited (Pro Cah)Professional Component ,,93976,CPT,Professional,Both,,,26,193,164.05,25.8,193,Humana Insurance Company,Commercial PPO,37.22,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Us Dop Organs Limited (Pro Cah)Professional Component ,,93976,CPT,Professional,Both,,,26,193,164.05,25.8,193,Humana Insurance Company,Medicare PPO,193,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Us Dop Organs Limited (Pro Cah)Professional Component ,,93976,CPT,Professional,Both,,,26,193,164.05,25.8,193,Medica,Individual & Family,163.664,84.8,,percent of total billed charges,,
Us Dop Organs Limited (Pro Cah)Professional Component ,,93976,CPT,Professional,Both,,,26,193,164.05,25.8,193,Medica,Medica Advantage Solution,96.114,49.8,,percent of total billed charges,,
Us Dop Organs Limited (Pro Cah)Professional Component ,,93976,CPT,Professional,Both,,,26,193,164.05,25.8,193,Medica,Medical Assistance,27.45,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Us Dop Organs Limited (Pro Cah)Professional Component ,,93976,CPT,Professional,Both,,,26,193,164.05,25.8,193,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,37.22,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Us Dop Organs Limited (Pro Cah)Professional Component ,,93976,CPT,Professional,Both,,,26,193,164.05,25.8,193,"Multiplan, Inc.","Multiplan, Inc.",181.42,94,,percent of total billed charges,,
Us Dop Organs Limited (Pro Cah)Professional Component ,,93976,CPT,Professional,Both,,,26,193,164.05,25.8,193,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,173.893,90.1,,percent of total billed charges,,
Us Dop Organs Limited (Pro Cah)Professional Component ,,93976,CPT,Professional,Both,,,26,193,164.05,25.8,193,"Preferred One Administrative Services, INC.",PPO,190.298,98.6,,percent of total billed charges,,
Us Dop Organs Limited (Pro Cah)Professional Component ,,93976,CPT,Professional,Both,,,26,193,164.05,25.8,193,PrimeWest Health,Minnesota Senior Health Options (MSHO),42.803,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Us Dop Organs Limited (Pro Cah)Professional Component ,,93976,CPT,Professional,Both,,,26,193,164.05,25.8,193,PrimeWest Health,MinnesotaCare,29.3739824,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Us Dop Organs Limited (Pro Cah)Professional Component ,,93976,CPT,Professional,Both,,,26,193,164.05,25.8,193,Sanford Health Plan,Sanford Health Plan,169.84,88,,percent of total billed charges,,
Us Dop Organs Limited (Pro Cah)Professional Component ,,93976,CPT,Professional,Both,,,26,193,164.05,25.8,193,"UCare Health, Inc.",Individual & Family Plan,60.504832,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Us Dop Organs Limited (Pro Cah)Professional Component ,,93976,CPT,Professional,Both,,,26,193,164.05,25.8,193,"UCare Health, Inc.",Medical Assistance,30.197552,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Us Dop Organs Limited (Pro Cah)Professional Component ,,93976,CPT,Professional,Both,,,26,193,164.05,25.8,193,"UCare Health, Inc.",Medicare Advantage,42.803,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Us Dop Organs Limited (Pro Cah)Professional Component ,,93976,CPT,Professional,Both,,,26,193,164.05,25.8,193,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),34.2424,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Us Dop Organs Limited (Pro Cah)Professional Component ,,93976,CPT,Professional,Both,,,26,193,164.05,25.8,193,UnitedHealthcare,Individual & Family,193,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Us Dop Organs Limited (Pro Cah)Professional Component ,,93976,CPT,Professional,Both,,,26,193,164.05,25.8,193,UnitedHealthcare,Medicare Advantage,42.803,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Us Dop Organs Limited (Pro Cah)Professional Component ,,93976,CPT,Professional,Both,,,26,193,164.05,25.8,193,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,27.45232,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Duplex Scan Of Aorta, Inferior Vena Cava, Iliac Vasculature, Or Bypass Grafts; Complete Study (Pro Cah)Professional Component ",,93978,CPT,Professional,Both,,,26,162,137.7,22.9,162,Aetna,Commercial,137.7,85,,percent of total billed charges,,
"Duplex Scan Of Aorta, Inferior Vena Cava, Iliac Vasculature, Or Bypass Grafts; Complete Study (Pro Cah)Professional Component ",,93978,CPT,Professional,Both,,,26,162,137.7,22.9,162,Aetna,Medicare Advantage,37.28,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Duplex Scan Of Aorta, Inferior Vena Cava, Iliac Vasculature, Or Bypass Grafts; Complete Study (Pro Cah)Professional Component ",,93978,CPT,Professional,Both,,,26,162,137.7,22.9,162,Aetna,PPO,150.66,93,,percent of total billed charges,,
"Duplex Scan Of Aorta, Inferior Vena Cava, Iliac Vasculature, Or Bypass Grafts; Complete Study (Pro Cah)Professional Component ",,93978,CPT,Professional,Both,,,26,162,137.7,22.9,162,America's PPO,America's PPO,138.4128,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Duplex Scan Of Aorta, Inferior Vena Cava, Iliac Vasculature, Or Bypass Grafts; Complete Study (Pro Cah)Professional Component ",,93978,CPT,Professional,Both,,,26,162,137.7,22.9,162,BlueCross BlueShield Minnesota, Federal Employee Program,65.35,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Duplex Scan Of Aorta, Inferior Vena Cava, Iliac Vasculature, Or Bypass Grafts; Complete Study (Pro Cah)Professional Component ",,93978,CPT,Professional,Both,,,26,162,137.7,22.9,162,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,66.3956,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Duplex Scan Of Aorta, Inferior Vena Cava, Iliac Vasculature, Or Bypass Grafts; Complete Study (Pro Cah)Professional Component ",,93978,CPT,Professional,Both,,,26,162,137.7,22.9,162,BlueCross BlueShield Minnesota,High Value Network Plan,66.3956,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Duplex Scan Of Aorta, Inferior Vena Cava, Iliac Vasculature, Or Bypass Grafts; Complete Study (Pro Cah)Professional Component ",,93978,CPT,Professional,Both,,,26,162,137.7,22.9,162,BlueCross BlueShield Minnesota,Medicare Advantage,41.1815,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Duplex Scan Of Aorta, Inferior Vena Cava, Iliac Vasculature, Or Bypass Grafts; Complete Study (Pro Cah)Professional Component ",,93978,CPT,Professional,Both,,,26,162,137.7,22.9,162,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,66.3956,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Duplex Scan Of Aorta, Inferior Vena Cava, Iliac Vasculature, Or Bypass Grafts; Complete Study (Pro Cah)Professional Component ",,93978,CPT,Professional,Both,,,26,162,137.7,22.9,162,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,26.43632,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Duplex Scan Of Aorta, Inferior Vena Cava, Iliac Vasculature, Or Bypass Grafts; Complete Study (Pro Cah)Professional Component ",,93978,CPT,Professional,Both,,,26,162,137.7,22.9,162,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),41.1815,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Duplex Scan Of Aorta, Inferior Vena Cava, Iliac Vasculature, Or Bypass Grafts; Complete Study (Pro Cah)Professional Component ",,93978,CPT,Professional,Both,,,26,162,137.7,22.9,162,CorVel,Worker's Compensation,71.7570393,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Duplex Scan Of Aorta, Inferior Vena Cava, Iliac Vasculature, Or Bypass Grafts; Complete Study (Pro Cah)Professional Component ",,93978,CPT,Professional,Both,,,26,162,137.7,22.9,162,First Health Group Corporation,First Health Network,157.14,97,,percent of total billed charges,,
"Duplex Scan Of Aorta, Inferior Vena Cava, Iliac Vasculature, Or Bypass Grafts; Complete Study (Pro Cah)Professional Component ",,93978,CPT,Professional,Both,,,26,162,137.7,22.9,162,"Health Partners, Inc.",Commercial,77.63,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Duplex Scan Of Aorta, Inferior Vena Cava, Iliac Vasculature, Or Bypass Grafts; Complete Study (Pro Cah)Professional Component ",,93978,CPT,Professional,Both,,,26,162,137.7,22.9,162,"Health Partners, Inc.",Medicare Advantage,41.1815,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Duplex Scan Of Aorta, Inferior Vena Cava, Iliac Vasculature, Or Bypass Grafts; Complete Study (Pro Cah)Professional Component ",,93978,CPT,Professional,Both,,,26,162,137.7,22.9,162,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),22.9,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Duplex Scan Of Aorta, Inferior Vena Cava, Iliac Vasculature, Or Bypass Grafts; Complete Study (Pro Cah)Professional Component ",,93978,CPT,Professional,Both,,,26,162,137.7,22.9,162,"Health Partners, Inc.",State of Minnesota Advantage Program,66.878245,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Duplex Scan Of Aorta, Inferior Vena Cava, Iliac Vasculature, Or Bypass Grafts; Complete Study (Pro Cah)Professional Component ",,93978,CPT,Professional,Both,,,26,162,137.7,22.9,162,"Health Partners, Inc.",State Public Programs,22.9,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Duplex Scan Of Aorta, Inferior Vena Cava, Iliac Vasculature, Or Bypass Grafts; Complete Study (Pro Cah)Professional Component ",,93978,CPT,Professional,Both,,,26,162,137.7,22.9,162,Humana Insurance Company,Commercial PPO,35.81,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Duplex Scan Of Aorta, Inferior Vena Cava, Iliac Vasculature, Or Bypass Grafts; Complete Study (Pro Cah)Professional Component ",,93978,CPT,Professional,Both,,,26,162,137.7,22.9,162,Humana Insurance Company,Medicare PPO,162,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Duplex Scan Of Aorta, Inferior Vena Cava, Iliac Vasculature, Or Bypass Grafts; Complete Study (Pro Cah)Professional Component ",,93978,CPT,Professional,Both,,,26,162,137.7,22.9,162,Medica,Individual & Family,137.376,84.8,,percent of total billed charges,,
"Duplex Scan Of Aorta, Inferior Vena Cava, Iliac Vasculature, Or Bypass Grafts; Complete Study (Pro Cah)Professional Component ",,93978,CPT,Professional,Both,,,26,162,137.7,22.9,162,Medica,Medica Advantage Solution,80.676,49.8,,percent of total billed charges,,
"Duplex Scan Of Aorta, Inferior Vena Cava, Iliac Vasculature, Or Bypass Grafts; Complete Study (Pro Cah)Professional Component ",,93978,CPT,Professional,Both,,,26,162,137.7,22.9,162,Medica,Medical Assistance,26.44,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Duplex Scan Of Aorta, Inferior Vena Cava, Iliac Vasculature, Or Bypass Grafts; Complete Study (Pro Cah)Professional Component ",,93978,CPT,Professional,Both,,,26,162,137.7,22.9,162,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,35.81,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Duplex Scan Of Aorta, Inferior Vena Cava, Iliac Vasculature, Or Bypass Grafts; Complete Study (Pro Cah)Professional Component ",,93978,CPT,Professional,Both,,,26,162,137.7,22.9,162,"Multiplan, Inc.","Multiplan, Inc.",152.28,94,,percent of total billed charges,,
"Duplex Scan Of Aorta, Inferior Vena Cava, Iliac Vasculature, Or Bypass Grafts; Complete Study (Pro Cah)Professional Component ",,93978,CPT,Professional,Both,,,26,162,137.7,22.9,162,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,145.962,90.1,,percent of total billed charges,,
"Duplex Scan Of Aorta, Inferior Vena Cava, Iliac Vasculature, Or Bypass Grafts; Complete Study (Pro Cah)Professional Component ",,93978,CPT,Professional,Both,,,26,162,137.7,22.9,162,"Preferred One Administrative Services, INC.",PPO,159.732,98.6,,percent of total billed charges,,
"Duplex Scan Of Aorta, Inferior Vena Cava, Iliac Vasculature, Or Bypass Grafts; Complete Study (Pro Cah)Professional Component ",,93978,CPT,Professional,Both,,,26,162,137.7,22.9,162,PrimeWest Health,Minnesota Senior Health Options (MSHO),41.1815,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Duplex Scan Of Aorta, Inferior Vena Cava, Iliac Vasculature, Or Bypass Grafts; Complete Study (Pro Cah)Professional Component ",,93978,CPT,Professional,Both,,,26,162,137.7,22.9,162,PrimeWest Health,MinnesotaCare,28.2868624,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Duplex Scan Of Aorta, Inferior Vena Cava, Iliac Vasculature, Or Bypass Grafts; Complete Study (Pro Cah)Professional Component ",,93978,CPT,Professional,Both,,,26,162,137.7,22.9,162,Sanford Health Plan,Sanford Health Plan,142.56,88,,percent of total billed charges,,
"Duplex Scan Of Aorta, Inferior Vena Cava, Iliac Vasculature, Or Bypass Grafts; Complete Study (Pro Cah)Professional Component ",,93978,CPT,Professional,Both,,,26,162,137.7,22.9,162,"UCare Health, Inc.",Individual & Family Plan,58.212736,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Duplex Scan Of Aorta, Inferior Vena Cava, Iliac Vasculature, Or Bypass Grafts; Complete Study (Pro Cah)Professional Component ",,93978,CPT,Professional,Both,,,26,162,137.7,22.9,162,"UCare Health, Inc.",Medical Assistance,29.079952,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Duplex Scan Of Aorta, Inferior Vena Cava, Iliac Vasculature, Or Bypass Grafts; Complete Study (Pro Cah)Professional Component ",,93978,CPT,Professional,Both,,,26,162,137.7,22.9,162,"UCare Health, Inc.",Medicare Advantage,41.1815,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Duplex Scan Of Aorta, Inferior Vena Cava, Iliac Vasculature, Or Bypass Grafts; Complete Study (Pro Cah)Professional Component ",,93978,CPT,Professional,Both,,,26,162,137.7,22.9,162,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),32.9452,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Duplex Scan Of Aorta, Inferior Vena Cava, Iliac Vasculature, Or Bypass Grafts; Complete Study (Pro Cah)Professional Component ",,93978,CPT,Professional,Both,,,26,162,137.7,22.9,162,UnitedHealthcare,Individual & Family,162,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Duplex Scan Of Aorta, Inferior Vena Cava, Iliac Vasculature, Or Bypass Grafts; Complete Study (Pro Cah)Professional Component ",,93978,CPT,Professional,Both,,,26,162,137.7,22.9,162,UnitedHealthcare,Medicare Advantage,41.1815,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Duplex Scan Of Aorta, Inferior Vena Cava, Iliac Vasculature, Or Bypass Grafts; Complete Study (Pro Cah)Professional Component ",,93978,CPT,Professional,Both,,,26,162,137.7,22.9,162,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,26.43632,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Shunt Abdomen 2 ViewsPartial Reduction/Discontinuation,,74019,CPT,Facility,Both,,,52,319,271.15,91.4254,319,Aetna,Commercial,293.48,92,,percent of total billed charges,,
Xr Shunt Abdomen 2 ViewsPartial Reduction/Discontinuation,,74019,CPT,Facility,Outpatient,,,52,319,271.15,91.4254,319,Aetna,Medicare Advantage,156.31,49,,percent of total billed charges,,
Xr Shunt Abdomen 2 ViewsPartial Reduction/Discontinuation,,74019,CPT,Facility,Inpatient,,,52,319,271.15,91.4254,319,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Xr Shunt Abdomen 2 ViewsPartial Reduction/Discontinuation,,74019,CPT,Facility,Both,,,52,319,271.15,91.4254,319,Aetna,PPO,296.67,93,,percent of total billed charges,,
Xr Shunt Abdomen 2 ViewsPartial Reduction/Discontinuation,,74019,CPT,Facility,Both,,,52,319,271.15,91.4254,319,America's PPO,America's PPO,306.3357,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Xr Shunt Abdomen 2 ViewsPartial Reduction/Discontinuation,,74019,CPT,Facility,Both,,,52,319,271.15,91.4254,319,BlueCross BlueShield Minnesota, Federal Employee Program,313.896,98.4,,percent of total billed charges,,
Xr Shunt Abdomen 2 ViewsPartial Reduction/Discontinuation,,74019,CPT,Facility,Both,,,52,319,271.15,91.4254,319,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,319,100,,percent of total billed charges,,
Xr Shunt Abdomen 2 ViewsPartial Reduction/Discontinuation,,74019,CPT,Facility,Both,,,52,319,271.15,91.4254,319,BlueCross BlueShield Minnesota,High Value Network Plan,287.1,90,,percent of total billed charges,,
Xr Shunt Abdomen 2 ViewsPartial Reduction/Discontinuation,,74019,CPT,Facility,Outpatient,,,52,319,271.15,91.4254,319,BlueCross BlueShield Minnesota,Medicare Advantage,156.31,49,,percent of total billed charges,,
Xr Shunt Abdomen 2 ViewsPartial Reduction/Discontinuation,,74019,CPT,Facility,Inpatient,,,52,319,271.15,91.4254,319,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Xr Shunt Abdomen 2 ViewsPartial Reduction/Discontinuation,,74019,CPT,Facility,Both,,,52,319,271.15,91.4254,319,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,282.5383,88.57,,percent of total billed charges,,
Xr Shunt Abdomen 2 ViewsPartial Reduction/Discontinuation,,74019,CPT,Facility,Both,,,52,319,271.15,91.4254,319,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,91.4254,28.66,,percent of total billed charges,,
Xr Shunt Abdomen 2 ViewsPartial Reduction/Discontinuation,,74019,CPT,Facility,Outpatient,,,52,319,271.15,91.4254,319,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),156.31,49,,percent of total billed charges,,
Xr Shunt Abdomen 2 ViewsPartial Reduction/Discontinuation,,74019,CPT,Facility,Inpatient,,,52,319,271.15,91.4254,319,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Xr Shunt Abdomen 2 ViewsPartial Reduction/Discontinuation,,74019,CPT,Facility,Both,,,52,319,271.15,91.4254,319,CorVel,Worker's Compensation,319,100,,percent of total billed charges,,
Xr Shunt Abdomen 2 ViewsPartial Reduction/Discontinuation,,74019,CPT,Facility,Both,,,52,319,271.15,91.4254,319,First Health Group Corporation,First Health Network,309.43,97,,percent of total billed charges,,
Xr Shunt Abdomen 2 ViewsPartial Reduction/Discontinuation,,74019,CPT,Facility,Both,,,52,319,271.15,91.4254,319,"Health Partners, Inc.",Commercial,301.774,94.6,,percent of total billed charges,,
Xr Shunt Abdomen 2 ViewsPartial Reduction/Discontinuation,,74019,CPT,Facility,Outpatient,,,52,319,271.15,91.4254,319,"Health Partners, Inc.",Medicare Advantage,156.31,49,,percent of total billed charges,,
Xr Shunt Abdomen 2 ViewsPartial Reduction/Discontinuation,,74019,CPT,Facility,Inpatient,,,52,319,271.15,91.4254,319,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Shunt Abdomen 2 ViewsPartial Reduction/Discontinuation,,74019,CPT,Facility,Both,,,52,319,271.15,91.4254,319,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),191.4,60,,percent of total billed charges,,
Xr Shunt Abdomen 2 ViewsPartial Reduction/Discontinuation,,74019,CPT,Facility,Both,,,52,319,271.15,91.4254,319,"Health Partners, Inc.",State of Minnesota Advantage Program,259.985,81.5,,percent of total billed charges,,
Xr Shunt Abdomen 2 ViewsPartial Reduction/Discontinuation,,74019,CPT,Facility,Both,,,52,319,271.15,91.4254,319,"Health Partners, Inc.",State Public Programs,159.5,50,,percent of total billed charges,,
Xr Shunt Abdomen 2 ViewsPartial Reduction/Discontinuation,,74019,CPT,Facility,Both,,,52,319,271.15,91.4254,319,Humana Insurance Company,Commercial PPO,303.05,95,,percent of total billed charges,,
Xr Shunt Abdomen 2 ViewsPartial Reduction/Discontinuation,,74019,CPT,Facility,Outpatient,,,52,319,271.15,91.4254,319,Humana Insurance Company,Medicare PPO,156.31,49,,percent of total billed charges,,
Xr Shunt Abdomen 2 ViewsPartial Reduction/Discontinuation,,74019,CPT,Facility,Inpatient,,,52,319,271.15,91.4254,319,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Xr Shunt Abdomen 2 ViewsPartial Reduction/Discontinuation,,74019,CPT,Facility,Both,,,52,319,271.15,91.4254,319,Medica,Individual & Family,316.129,99.1,,percent of total billed charges,,
Xr Shunt Abdomen 2 ViewsPartial Reduction/Discontinuation,,74019,CPT,Facility,Outpatient,,,52,319,271.15,91.4254,319,Medica,Medica Advantage Solution,158.862,49.8,,percent of total billed charges,,
Xr Shunt Abdomen 2 ViewsPartial Reduction/Discontinuation,,74019,CPT,Facility,Inpatient,,,52,319,271.15,91.4254,319,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Xr Shunt Abdomen 2 ViewsPartial Reduction/Discontinuation,,74019,CPT,Facility,Outpatient,,,52,319,271.15,91.4254,319,Medica,Medical Assistance,142.274,44.6,,percent of total billed charges,,
Xr Shunt Abdomen 2 ViewsPartial Reduction/Discontinuation,,74019,CPT,Facility,Inpatient,,,52,319,271.15,91.4254,319,Medica,Medical Assistance,,,,,Included in per diem rate,
Xr Shunt Abdomen 2 ViewsPartial Reduction/Discontinuation,,74019,CPT,Facility,Outpatient,,,52,319,271.15,91.4254,319,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,158.862,49.8,,percent of total billed charges,,
Xr Shunt Abdomen 2 ViewsPartial Reduction/Discontinuation,,74019,CPT,Facility,Inpatient,,,52,319,271.15,91.4254,319,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Xr Shunt Abdomen 2 ViewsPartial Reduction/Discontinuation,,74019,CPT,Facility,Both,,,52,319,271.15,91.4254,319,"Multiplan, Inc.","Multiplan, Inc.",299.86,94,,percent of total billed charges,,
Xr Shunt Abdomen 2 ViewsPartial Reduction/Discontinuation,,74019,CPT,Facility,Outpatient,,,52,319,271.15,91.4254,319,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,287.419,90.1,,percent of total billed charges,,
Xr Shunt Abdomen 2 ViewsPartial Reduction/Discontinuation,,74019,CPT,Facility,Inpatient,,,52,319,271.15,91.4254,319,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Xr Shunt Abdomen 2 ViewsPartial Reduction/Discontinuation,,74019,CPT,Facility,Both,,,52,319,271.15,91.4254,319,"Preferred One Administrative Services, INC.",PPO,314.534,98.6,,percent of total billed charges,,
Xr Shunt Abdomen 2 ViewsPartial Reduction/Discontinuation,,74019,CPT,Facility,Outpatient,,,52,319,271.15,91.4254,319,PrimeWest Health,Minnesota Senior Health Options (MSHO),164.1255,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Xr Shunt Abdomen 2 ViewsPartial Reduction/Discontinuation,,74019,CPT,Facility,Inpatient,,,52,319,271.15,91.4254,319,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Shunt Abdomen 2 ViewsPartial Reduction/Discontinuation,,74019,CPT,Facility,Outpatient,,,52,319,271.15,91.4254,319,PrimeWest Health,MinnesotaCare,163.8384,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Xr Shunt Abdomen 2 ViewsPartial Reduction/Discontinuation,,74019,CPT,Facility,Inpatient,,,52,319,271.15,91.4254,319,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Xr Shunt Abdomen 2 ViewsPartial Reduction/Discontinuation,,74019,CPT,Facility,Both,,,52,319,271.15,91.4254,319,Sanford Health Plan,Sanford Health Plan,293.48,92,,percent of total billed charges,,
Xr Shunt Abdomen 2 ViewsPartial Reduction/Discontinuation,,74019,CPT,Facility,Outpatient,,,52,319,271.15,91.4254,319,"UCare Health, Inc.",Individual & Family Plan,179.7565,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Xr Shunt Abdomen 2 ViewsPartial Reduction/Discontinuation,,74019,CPT,Facility,Inpatient,,,52,319,271.15,91.4254,319,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Xr Shunt Abdomen 2 ViewsPartial Reduction/Discontinuation,,74019,CPT,Facility,Outpatient,,,52,319,271.15,91.4254,319,"UCare Health, Inc.",Medical Assistance,160.9993,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Shunt Abdomen 2 ViewsPartial Reduction/Discontinuation,,74019,CPT,Facility,Inpatient,,,52,319,271.15,91.4254,319,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Xr Shunt Abdomen 2 ViewsPartial Reduction/Discontinuation,,74019,CPT,Facility,Outpatient,,,52,319,271.15,91.4254,319,"UCare Health, Inc.",Medicare Advantage,160.9993,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Shunt Abdomen 2 ViewsPartial Reduction/Discontinuation,,74019,CPT,Facility,Inpatient,,,52,319,271.15,91.4254,319,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Shunt Abdomen 2 ViewsPartial Reduction/Discontinuation,,74019,CPT,Facility,Outpatient,,,52,319,271.15,91.4254,319,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),160.9993,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Shunt Abdomen 2 ViewsPartial Reduction/Discontinuation,,74019,CPT,Facility,Inpatient,,,52,319,271.15,91.4254,319,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Shunt Abdomen 2 ViewsPartial Reduction/Discontinuation,,74019,CPT,Facility,Both,,,52,319,271.15,91.4254,319,UnitedHealthcare,Individual & Family,299.86,94,,percent of total billed charges,,
Xr Shunt Abdomen 2 ViewsPartial Reduction/Discontinuation,,74019,CPT,Facility,Outpatient,,,52,319,271.15,91.4254,319,UnitedHealthcare,Medicare Advantage,156.31,49,,percent of total billed charges,,
Xr Shunt Abdomen 2 ViewsPartial Reduction/Discontinuation,,74019,CPT,Facility,Inpatient,,,52,319,271.15,91.4254,319,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Xr Shunt Abdomen 2 ViewsPartial Reduction/Discontinuation,,74019,CPT,Facility,Outpatient,,,52,319,271.15,91.4254,319,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,153.12,48,,percent of total billed charges,,100% of DHS outpatient percentage
Xr Shunt Abdomen 2 ViewsPartial Reduction/Discontinuation,,74019,CPT,Facility,Inpatient,,,52,319,271.15,91.4254,319,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Mammo Sage Screen UniPartial Reduction/Discontinuation,,77067,CPT,Facility,Both,,,52,464,394.4,132.9824,464,Aetna,Commercial,426.88,92,,percent of total billed charges,,
Mammo Sage Screen UniPartial Reduction/Discontinuation,,77067,CPT,Facility,Outpatient,,,52,464,394.4,132.9824,464,Aetna,Medicare Advantage,227.36,49,,percent of total billed charges,,
Mammo Sage Screen UniPartial Reduction/Discontinuation,,77067,CPT,Facility,Inpatient,,,52,464,394.4,132.9824,464,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Mammo Sage Screen UniPartial Reduction/Discontinuation,,77067,CPT,Facility,Both,,,52,464,394.4,132.9824,464,Aetna,PPO,431.52,93,,percent of total billed charges,,
Mammo Sage Screen UniPartial Reduction/Discontinuation,,77067,CPT,Facility,Both,,,52,464,394.4,132.9824,464,America's PPO,America's PPO,445.5792,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Mammo Sage Screen UniPartial Reduction/Discontinuation,,77067,CPT,Facility,Both,,,52,464,394.4,132.9824,464,BlueCross BlueShield Minnesota, Federal Employee Program,456.576,98.4,,percent of total billed charges,,
Mammo Sage Screen UniPartial Reduction/Discontinuation,,77067,CPT,Facility,Both,,,52,464,394.4,132.9824,464,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,464,100,,percent of total billed charges,,
Mammo Sage Screen UniPartial Reduction/Discontinuation,,77067,CPT,Facility,Both,,,52,464,394.4,132.9824,464,BlueCross BlueShield Minnesota,High Value Network Plan,417.6,90,,percent of total billed charges,,
Mammo Sage Screen UniPartial Reduction/Discontinuation,,77067,CPT,Facility,Outpatient,,,52,464,394.4,132.9824,464,BlueCross BlueShield Minnesota,Medicare Advantage,227.36,49,,percent of total billed charges,,
Mammo Sage Screen UniPartial Reduction/Discontinuation,,77067,CPT,Facility,Inpatient,,,52,464,394.4,132.9824,464,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Mammo Sage Screen UniPartial Reduction/Discontinuation,,77067,CPT,Facility,Both,,,52,464,394.4,132.9824,464,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,410.9648,88.57,,percent of total billed charges,,
Mammo Sage Screen UniPartial Reduction/Discontinuation,,77067,CPT,Facility,Both,,,52,464,394.4,132.9824,464,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,132.9824,28.66,,percent of total billed charges,,
Mammo Sage Screen UniPartial Reduction/Discontinuation,,77067,CPT,Facility,Outpatient,,,52,464,394.4,132.9824,464,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),227.36,49,,percent of total billed charges,,
Mammo Sage Screen UniPartial Reduction/Discontinuation,,77067,CPT,Facility,Inpatient,,,52,464,394.4,132.9824,464,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Mammo Sage Screen UniPartial Reduction/Discontinuation,,77067,CPT,Facility,Both,,,52,464,394.4,132.9824,464,CorVel,Worker's Compensation,464,100,,percent of total billed charges,,
Mammo Sage Screen UniPartial Reduction/Discontinuation,,77067,CPT,Facility,Both,,,52,464,394.4,132.9824,464,First Health Group Corporation,First Health Network,450.08,97,,percent of total billed charges,,
Mammo Sage Screen UniPartial Reduction/Discontinuation,,77067,CPT,Facility,Both,,,52,464,394.4,132.9824,464,"Health Partners, Inc.",Commercial,438.944,94.6,,percent of total billed charges,,
Mammo Sage Screen UniPartial Reduction/Discontinuation,,77067,CPT,Facility,Outpatient,,,52,464,394.4,132.9824,464,"Health Partners, Inc.",Medicare Advantage,227.36,49,,percent of total billed charges,,
Mammo Sage Screen UniPartial Reduction/Discontinuation,,77067,CPT,Facility,Inpatient,,,52,464,394.4,132.9824,464,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mammo Sage Screen UniPartial Reduction/Discontinuation,,77067,CPT,Facility,Both,,,52,464,394.4,132.9824,464,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),278.4,60,,percent of total billed charges,,
Mammo Sage Screen UniPartial Reduction/Discontinuation,,77067,CPT,Facility,Both,,,52,464,394.4,132.9824,464,"Health Partners, Inc.",State of Minnesota Advantage Program,378.16,81.5,,percent of total billed charges,,
Mammo Sage Screen UniPartial Reduction/Discontinuation,,77067,CPT,Facility,Both,,,52,464,394.4,132.9824,464,"Health Partners, Inc.",State Public Programs,232,50,,percent of total billed charges,,
Mammo Sage Screen UniPartial Reduction/Discontinuation,,77067,CPT,Facility,Both,,,52,464,394.4,132.9824,464,Humana Insurance Company,Commercial PPO,440.8,95,,percent of total billed charges,,
Mammo Sage Screen UniPartial Reduction/Discontinuation,,77067,CPT,Facility,Outpatient,,,52,464,394.4,132.9824,464,Humana Insurance Company,Medicare PPO,227.36,49,,percent of total billed charges,,
Mammo Sage Screen UniPartial Reduction/Discontinuation,,77067,CPT,Facility,Inpatient,,,52,464,394.4,132.9824,464,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Mammo Sage Screen UniPartial Reduction/Discontinuation,,77067,CPT,Facility,Both,,,52,464,394.4,132.9824,464,Medica,Individual & Family,459.824,99.1,,percent of total billed charges,,
Mammo Sage Screen UniPartial Reduction/Discontinuation,,77067,CPT,Facility,Outpatient,,,52,464,394.4,132.9824,464,Medica,Medica Advantage Solution,231.072,49.8,,percent of total billed charges,,
Mammo Sage Screen UniPartial Reduction/Discontinuation,,77067,CPT,Facility,Inpatient,,,52,464,394.4,132.9824,464,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Mammo Sage Screen UniPartial Reduction/Discontinuation,,77067,CPT,Facility,Outpatient,,,52,464,394.4,132.9824,464,Medica,Medical Assistance,206.944,44.6,,percent of total billed charges,,
Mammo Sage Screen UniPartial Reduction/Discontinuation,,77067,CPT,Facility,Inpatient,,,52,464,394.4,132.9824,464,Medica,Medical Assistance,,,,,Included in per diem rate,
Mammo Sage Screen UniPartial Reduction/Discontinuation,,77067,CPT,Facility,Outpatient,,,52,464,394.4,132.9824,464,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,231.072,49.8,,percent of total billed charges,,
Mammo Sage Screen UniPartial Reduction/Discontinuation,,77067,CPT,Facility,Inpatient,,,52,464,394.4,132.9824,464,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Mammo Sage Screen UniPartial Reduction/Discontinuation,,77067,CPT,Facility,Both,,,52,464,394.4,132.9824,464,"Multiplan, Inc.","Multiplan, Inc.",436.16,94,,percent of total billed charges,,
Mammo Sage Screen UniPartial Reduction/Discontinuation,,77067,CPT,Facility,Outpatient,,,52,464,394.4,132.9824,464,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,418.064,90.1,,percent of total billed charges,,
Mammo Sage Screen UniPartial Reduction/Discontinuation,,77067,CPT,Facility,Inpatient,,,52,464,394.4,132.9824,464,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Mammo Sage Screen UniPartial Reduction/Discontinuation,,77067,CPT,Facility,Both,,,52,464,394.4,132.9824,464,"Preferred One Administrative Services, INC.",PPO,457.504,98.6,,percent of total billed charges,,
Mammo Sage Screen UniPartial Reduction/Discontinuation,,77067,CPT,Facility,Outpatient,,,52,464,394.4,132.9824,464,PrimeWest Health,Minnesota Senior Health Options (MSHO),238.728,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Mammo Sage Screen UniPartial Reduction/Discontinuation,,77067,CPT,Facility,Inpatient,,,52,464,394.4,132.9824,464,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mammo Sage Screen UniPartial Reduction/Discontinuation,,77067,CPT,Facility,Outpatient,,,52,464,394.4,132.9824,464,PrimeWest Health,MinnesotaCare,238.3104,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Mammo Sage Screen UniPartial Reduction/Discontinuation,,77067,CPT,Facility,Inpatient,,,52,464,394.4,132.9824,464,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Mammo Sage Screen UniPartial Reduction/Discontinuation,,77067,CPT,Facility,Both,,,52,464,394.4,132.9824,464,Sanford Health Plan,Sanford Health Plan,426.88,92,,percent of total billed charges,,
Mammo Sage Screen UniPartial Reduction/Discontinuation,,77067,CPT,Facility,Outpatient,,,52,464,394.4,132.9824,464,"UCare Health, Inc.",Individual & Family Plan,261.464,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Mammo Sage Screen UniPartial Reduction/Discontinuation,,77067,CPT,Facility,Inpatient,,,52,464,394.4,132.9824,464,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Mammo Sage Screen UniPartial Reduction/Discontinuation,,77067,CPT,Facility,Outpatient,,,52,464,394.4,132.9824,464,"UCare Health, Inc.",Medical Assistance,234.1808,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mammo Sage Screen UniPartial Reduction/Discontinuation,,77067,CPT,Facility,Inpatient,,,52,464,394.4,132.9824,464,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Mammo Sage Screen UniPartial Reduction/Discontinuation,,77067,CPT,Facility,Outpatient,,,52,464,394.4,132.9824,464,"UCare Health, Inc.",Medicare Advantage,234.1808,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mammo Sage Screen UniPartial Reduction/Discontinuation,,77067,CPT,Facility,Inpatient,,,52,464,394.4,132.9824,464,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mammo Sage Screen UniPartial Reduction/Discontinuation,,77067,CPT,Facility,Outpatient,,,52,464,394.4,132.9824,464,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),234.1808,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mammo Sage Screen UniPartial Reduction/Discontinuation,,77067,CPT,Facility,Inpatient,,,52,464,394.4,132.9824,464,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mammo Sage Screen UniPartial Reduction/Discontinuation,,77067,CPT,Facility,Both,,,52,464,394.4,132.9824,464,UnitedHealthcare,Individual & Family,436.16,94,,percent of total billed charges,,
Mammo Sage Screen UniPartial Reduction/Discontinuation,,77067,CPT,Facility,Outpatient,,,52,464,394.4,132.9824,464,UnitedHealthcare,Medicare Advantage,227.36,49,,percent of total billed charges,,
Mammo Sage Screen UniPartial Reduction/Discontinuation,,77067,CPT,Facility,Inpatient,,,52,464,394.4,132.9824,464,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Mammo Sage Screen UniPartial Reduction/Discontinuation,,77067,CPT,Facility,Outpatient,,,52,464,394.4,132.9824,464,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,222.72,48,,percent of total billed charges,,100% of DHS outpatient percentage
Mammo Sage Screen UniPartial Reduction/Discontinuation,,77067,CPT,Facility,Inpatient,,,52,464,394.4,132.9824,464,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Mammo Screen UniPartial Reduction/Discontinuation,,77067,CPT,Facility,Both,,,52,464,394.4,132.9824,464,Aetna,Commercial,426.88,92,,percent of total billed charges,,
Mammo Screen UniPartial Reduction/Discontinuation,,77067,CPT,Facility,Outpatient,,,52,464,394.4,132.9824,464,Aetna,Medicare Advantage,227.36,49,,percent of total billed charges,,
Mammo Screen UniPartial Reduction/Discontinuation,,77067,CPT,Facility,Inpatient,,,52,464,394.4,132.9824,464,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Mammo Screen UniPartial Reduction/Discontinuation,,77067,CPT,Facility,Both,,,52,464,394.4,132.9824,464,Aetna,PPO,431.52,93,,percent of total billed charges,,
Mammo Screen UniPartial Reduction/Discontinuation,,77067,CPT,Facility,Both,,,52,464,394.4,132.9824,464,America's PPO,America's PPO,445.5792,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Mammo Screen UniPartial Reduction/Discontinuation,,77067,CPT,Facility,Both,,,52,464,394.4,132.9824,464,BlueCross BlueShield Minnesota, Federal Employee Program,456.576,98.4,,percent of total billed charges,,
Mammo Screen UniPartial Reduction/Discontinuation,,77067,CPT,Facility,Both,,,52,464,394.4,132.9824,464,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,464,100,,percent of total billed charges,,
Mammo Screen UniPartial Reduction/Discontinuation,,77067,CPT,Facility,Both,,,52,464,394.4,132.9824,464,BlueCross BlueShield Minnesota,High Value Network Plan,417.6,90,,percent of total billed charges,,
Mammo Screen UniPartial Reduction/Discontinuation,,77067,CPT,Facility,Outpatient,,,52,464,394.4,132.9824,464,BlueCross BlueShield Minnesota,Medicare Advantage,227.36,49,,percent of total billed charges,,
Mammo Screen UniPartial Reduction/Discontinuation,,77067,CPT,Facility,Inpatient,,,52,464,394.4,132.9824,464,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Mammo Screen UniPartial Reduction/Discontinuation,,77067,CPT,Facility,Both,,,52,464,394.4,132.9824,464,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,410.9648,88.57,,percent of total billed charges,,
Mammo Screen UniPartial Reduction/Discontinuation,,77067,CPT,Facility,Both,,,52,464,394.4,132.9824,464,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,132.9824,28.66,,percent of total billed charges,,
Mammo Screen UniPartial Reduction/Discontinuation,,77067,CPT,Facility,Outpatient,,,52,464,394.4,132.9824,464,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),227.36,49,,percent of total billed charges,,
Mammo Screen UniPartial Reduction/Discontinuation,,77067,CPT,Facility,Inpatient,,,52,464,394.4,132.9824,464,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Mammo Screen UniPartial Reduction/Discontinuation,,77067,CPT,Facility,Both,,,52,464,394.4,132.9824,464,CorVel,Worker's Compensation,464,100,,percent of total billed charges,,
Mammo Screen UniPartial Reduction/Discontinuation,,77067,CPT,Facility,Both,,,52,464,394.4,132.9824,464,First Health Group Corporation,First Health Network,450.08,97,,percent of total billed charges,,
Mammo Screen UniPartial Reduction/Discontinuation,,77067,CPT,Facility,Both,,,52,464,394.4,132.9824,464,"Health Partners, Inc.",Commercial,438.944,94.6,,percent of total billed charges,,
Mammo Screen UniPartial Reduction/Discontinuation,,77067,CPT,Facility,Outpatient,,,52,464,394.4,132.9824,464,"Health Partners, Inc.",Medicare Advantage,227.36,49,,percent of total billed charges,,
Mammo Screen UniPartial Reduction/Discontinuation,,77067,CPT,Facility,Inpatient,,,52,464,394.4,132.9824,464,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mammo Screen UniPartial Reduction/Discontinuation,,77067,CPT,Facility,Both,,,52,464,394.4,132.9824,464,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),278.4,60,,percent of total billed charges,,
Mammo Screen UniPartial Reduction/Discontinuation,,77067,CPT,Facility,Both,,,52,464,394.4,132.9824,464,"Health Partners, Inc.",State of Minnesota Advantage Program,378.16,81.5,,percent of total billed charges,,
Mammo Screen UniPartial Reduction/Discontinuation,,77067,CPT,Facility,Both,,,52,464,394.4,132.9824,464,"Health Partners, Inc.",State Public Programs,232,50,,percent of total billed charges,,
Mammo Screen UniPartial Reduction/Discontinuation,,77067,CPT,Facility,Both,,,52,464,394.4,132.9824,464,Humana Insurance Company,Commercial PPO,440.8,95,,percent of total billed charges,,
Mammo Screen UniPartial Reduction/Discontinuation,,77067,CPT,Facility,Outpatient,,,52,464,394.4,132.9824,464,Humana Insurance Company,Medicare PPO,227.36,49,,percent of total billed charges,,
Mammo Screen UniPartial Reduction/Discontinuation,,77067,CPT,Facility,Inpatient,,,52,464,394.4,132.9824,464,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Mammo Screen UniPartial Reduction/Discontinuation,,77067,CPT,Facility,Both,,,52,464,394.4,132.9824,464,Medica,Individual & Family,459.824,99.1,,percent of total billed charges,,
Mammo Screen UniPartial Reduction/Discontinuation,,77067,CPT,Facility,Outpatient,,,52,464,394.4,132.9824,464,Medica,Medica Advantage Solution,231.072,49.8,,percent of total billed charges,,
Mammo Screen UniPartial Reduction/Discontinuation,,77067,CPT,Facility,Inpatient,,,52,464,394.4,132.9824,464,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Mammo Screen UniPartial Reduction/Discontinuation,,77067,CPT,Facility,Outpatient,,,52,464,394.4,132.9824,464,Medica,Medical Assistance,206.944,44.6,,percent of total billed charges,,
Mammo Screen UniPartial Reduction/Discontinuation,,77067,CPT,Facility,Inpatient,,,52,464,394.4,132.9824,464,Medica,Medical Assistance,,,,,Included in per diem rate,
Mammo Screen UniPartial Reduction/Discontinuation,,77067,CPT,Facility,Outpatient,,,52,464,394.4,132.9824,464,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,231.072,49.8,,percent of total billed charges,,
Mammo Screen UniPartial Reduction/Discontinuation,,77067,CPT,Facility,Inpatient,,,52,464,394.4,132.9824,464,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Mammo Screen UniPartial Reduction/Discontinuation,,77067,CPT,Facility,Both,,,52,464,394.4,132.9824,464,"Multiplan, Inc.","Multiplan, Inc.",436.16,94,,percent of total billed charges,,
Mammo Screen UniPartial Reduction/Discontinuation,,77067,CPT,Facility,Outpatient,,,52,464,394.4,132.9824,464,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,418.064,90.1,,percent of total billed charges,,
Mammo Screen UniPartial Reduction/Discontinuation,,77067,CPT,Facility,Inpatient,,,52,464,394.4,132.9824,464,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Mammo Screen UniPartial Reduction/Discontinuation,,77067,CPT,Facility,Both,,,52,464,394.4,132.9824,464,"Preferred One Administrative Services, INC.",PPO,457.504,98.6,,percent of total billed charges,,
Mammo Screen UniPartial Reduction/Discontinuation,,77067,CPT,Facility,Outpatient,,,52,464,394.4,132.9824,464,PrimeWest Health,Minnesota Senior Health Options (MSHO),238.728,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Mammo Screen UniPartial Reduction/Discontinuation,,77067,CPT,Facility,Inpatient,,,52,464,394.4,132.9824,464,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mammo Screen UniPartial Reduction/Discontinuation,,77067,CPT,Facility,Outpatient,,,52,464,394.4,132.9824,464,PrimeWest Health,MinnesotaCare,238.3104,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Mammo Screen UniPartial Reduction/Discontinuation,,77067,CPT,Facility,Inpatient,,,52,464,394.4,132.9824,464,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Mammo Screen UniPartial Reduction/Discontinuation,,77067,CPT,Facility,Both,,,52,464,394.4,132.9824,464,Sanford Health Plan,Sanford Health Plan,426.88,92,,percent of total billed charges,,
Mammo Screen UniPartial Reduction/Discontinuation,,77067,CPT,Facility,Outpatient,,,52,464,394.4,132.9824,464,"UCare Health, Inc.",Individual & Family Plan,261.464,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Mammo Screen UniPartial Reduction/Discontinuation,,77067,CPT,Facility,Inpatient,,,52,464,394.4,132.9824,464,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Mammo Screen UniPartial Reduction/Discontinuation,,77067,CPT,Facility,Outpatient,,,52,464,394.4,132.9824,464,"UCare Health, Inc.",Medical Assistance,234.1808,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mammo Screen UniPartial Reduction/Discontinuation,,77067,CPT,Facility,Inpatient,,,52,464,394.4,132.9824,464,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Mammo Screen UniPartial Reduction/Discontinuation,,77067,CPT,Facility,Outpatient,,,52,464,394.4,132.9824,464,"UCare Health, Inc.",Medicare Advantage,234.1808,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mammo Screen UniPartial Reduction/Discontinuation,,77067,CPT,Facility,Inpatient,,,52,464,394.4,132.9824,464,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mammo Screen UniPartial Reduction/Discontinuation,,77067,CPT,Facility,Outpatient,,,52,464,394.4,132.9824,464,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),234.1808,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mammo Screen UniPartial Reduction/Discontinuation,,77067,CPT,Facility,Inpatient,,,52,464,394.4,132.9824,464,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mammo Screen UniPartial Reduction/Discontinuation,,77067,CPT,Facility,Both,,,52,464,394.4,132.9824,464,UnitedHealthcare,Individual & Family,436.16,94,,percent of total billed charges,,
Mammo Screen UniPartial Reduction/Discontinuation,,77067,CPT,Facility,Outpatient,,,52,464,394.4,132.9824,464,UnitedHealthcare,Medicare Advantage,227.36,49,,percent of total billed charges,,
Mammo Screen UniPartial Reduction/Discontinuation,,77067,CPT,Facility,Inpatient,,,52,464,394.4,132.9824,464,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Mammo Screen UniPartial Reduction/Discontinuation,,77067,CPT,Facility,Outpatient,,,52,464,394.4,132.9824,464,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,222.72,48,,percent of total billed charges,,100% of DHS outpatient percentage
Mammo Screen UniPartial Reduction/Discontinuation,,77067,CPT,Facility,Inpatient,,,52,464,394.4,132.9824,464,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Mammo Screen W Implants UniPartial Reduction/Discontinuation,,77067,CPT,Facility,Both,,,52,464,394.4,132.9824,464,Aetna,Commercial,426.88,92,,percent of total billed charges,,
Mammo Screen W Implants UniPartial Reduction/Discontinuation,,77067,CPT,Facility,Outpatient,,,52,464,394.4,132.9824,464,Aetna,Medicare Advantage,227.36,49,,percent of total billed charges,,
Mammo Screen W Implants UniPartial Reduction/Discontinuation,,77067,CPT,Facility,Inpatient,,,52,464,394.4,132.9824,464,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Mammo Screen W Implants UniPartial Reduction/Discontinuation,,77067,CPT,Facility,Both,,,52,464,394.4,132.9824,464,Aetna,PPO,431.52,93,,percent of total billed charges,,
Mammo Screen W Implants UniPartial Reduction/Discontinuation,,77067,CPT,Facility,Both,,,52,464,394.4,132.9824,464,America's PPO,America's PPO,445.5792,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Mammo Screen W Implants UniPartial Reduction/Discontinuation,,77067,CPT,Facility,Both,,,52,464,394.4,132.9824,464,BlueCross BlueShield Minnesota, Federal Employee Program,456.576,98.4,,percent of total billed charges,,
Mammo Screen W Implants UniPartial Reduction/Discontinuation,,77067,CPT,Facility,Both,,,52,464,394.4,132.9824,464,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,464,100,,percent of total billed charges,,
Mammo Screen W Implants UniPartial Reduction/Discontinuation,,77067,CPT,Facility,Both,,,52,464,394.4,132.9824,464,BlueCross BlueShield Minnesota,High Value Network Plan,417.6,90,,percent of total billed charges,,
Mammo Screen W Implants UniPartial Reduction/Discontinuation,,77067,CPT,Facility,Outpatient,,,52,464,394.4,132.9824,464,BlueCross BlueShield Minnesota,Medicare Advantage,227.36,49,,percent of total billed charges,,
Mammo Screen W Implants UniPartial Reduction/Discontinuation,,77067,CPT,Facility,Inpatient,,,52,464,394.4,132.9824,464,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Mammo Screen W Implants UniPartial Reduction/Discontinuation,,77067,CPT,Facility,Both,,,52,464,394.4,132.9824,464,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,410.9648,88.57,,percent of total billed charges,,
Mammo Screen W Implants UniPartial Reduction/Discontinuation,,77067,CPT,Facility,Both,,,52,464,394.4,132.9824,464,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,132.9824,28.66,,percent of total billed charges,,
Mammo Screen W Implants UniPartial Reduction/Discontinuation,,77067,CPT,Facility,Outpatient,,,52,464,394.4,132.9824,464,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),227.36,49,,percent of total billed charges,,
Mammo Screen W Implants UniPartial Reduction/Discontinuation,,77067,CPT,Facility,Inpatient,,,52,464,394.4,132.9824,464,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Mammo Screen W Implants UniPartial Reduction/Discontinuation,,77067,CPT,Facility,Both,,,52,464,394.4,132.9824,464,CorVel,Worker's Compensation,464,100,,percent of total billed charges,,
Mammo Screen W Implants UniPartial Reduction/Discontinuation,,77067,CPT,Facility,Both,,,52,464,394.4,132.9824,464,First Health Group Corporation,First Health Network,450.08,97,,percent of total billed charges,,
Mammo Screen W Implants UniPartial Reduction/Discontinuation,,77067,CPT,Facility,Both,,,52,464,394.4,132.9824,464,"Health Partners, Inc.",Commercial,438.944,94.6,,percent of total billed charges,,
Mammo Screen W Implants UniPartial Reduction/Discontinuation,,77067,CPT,Facility,Outpatient,,,52,464,394.4,132.9824,464,"Health Partners, Inc.",Medicare Advantage,227.36,49,,percent of total billed charges,,
Mammo Screen W Implants UniPartial Reduction/Discontinuation,,77067,CPT,Facility,Inpatient,,,52,464,394.4,132.9824,464,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mammo Screen W Implants UniPartial Reduction/Discontinuation,,77067,CPT,Facility,Both,,,52,464,394.4,132.9824,464,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),278.4,60,,percent of total billed charges,,
Mammo Screen W Implants UniPartial Reduction/Discontinuation,,77067,CPT,Facility,Both,,,52,464,394.4,132.9824,464,"Health Partners, Inc.",State of Minnesota Advantage Program,378.16,81.5,,percent of total billed charges,,
Mammo Screen W Implants UniPartial Reduction/Discontinuation,,77067,CPT,Facility,Both,,,52,464,394.4,132.9824,464,"Health Partners, Inc.",State Public Programs,232,50,,percent of total billed charges,,
Mammo Screen W Implants UniPartial Reduction/Discontinuation,,77067,CPT,Facility,Both,,,52,464,394.4,132.9824,464,Humana Insurance Company,Commercial PPO,440.8,95,,percent of total billed charges,,
Mammo Screen W Implants UniPartial Reduction/Discontinuation,,77067,CPT,Facility,Outpatient,,,52,464,394.4,132.9824,464,Humana Insurance Company,Medicare PPO,227.36,49,,percent of total billed charges,,
Mammo Screen W Implants UniPartial Reduction/Discontinuation,,77067,CPT,Facility,Inpatient,,,52,464,394.4,132.9824,464,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Mammo Screen W Implants UniPartial Reduction/Discontinuation,,77067,CPT,Facility,Both,,,52,464,394.4,132.9824,464,Medica,Individual & Family,459.824,99.1,,percent of total billed charges,,
Mammo Screen W Implants UniPartial Reduction/Discontinuation,,77067,CPT,Facility,Outpatient,,,52,464,394.4,132.9824,464,Medica,Medica Advantage Solution,231.072,49.8,,percent of total billed charges,,
Mammo Screen W Implants UniPartial Reduction/Discontinuation,,77067,CPT,Facility,Inpatient,,,52,464,394.4,132.9824,464,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Mammo Screen W Implants UniPartial Reduction/Discontinuation,,77067,CPT,Facility,Outpatient,,,52,464,394.4,132.9824,464,Medica,Medical Assistance,206.944,44.6,,percent of total billed charges,,
Mammo Screen W Implants UniPartial Reduction/Discontinuation,,77067,CPT,Facility,Inpatient,,,52,464,394.4,132.9824,464,Medica,Medical Assistance,,,,,Included in per diem rate,
Mammo Screen W Implants UniPartial Reduction/Discontinuation,,77067,CPT,Facility,Outpatient,,,52,464,394.4,132.9824,464,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,231.072,49.8,,percent of total billed charges,,
Mammo Screen W Implants UniPartial Reduction/Discontinuation,,77067,CPT,Facility,Inpatient,,,52,464,394.4,132.9824,464,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Mammo Screen W Implants UniPartial Reduction/Discontinuation,,77067,CPT,Facility,Both,,,52,464,394.4,132.9824,464,"Multiplan, Inc.","Multiplan, Inc.",436.16,94,,percent of total billed charges,,
Mammo Screen W Implants UniPartial Reduction/Discontinuation,,77067,CPT,Facility,Outpatient,,,52,464,394.4,132.9824,464,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,418.064,90.1,,percent of total billed charges,,
Mammo Screen W Implants UniPartial Reduction/Discontinuation,,77067,CPT,Facility,Inpatient,,,52,464,394.4,132.9824,464,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Mammo Screen W Implants UniPartial Reduction/Discontinuation,,77067,CPT,Facility,Both,,,52,464,394.4,132.9824,464,"Preferred One Administrative Services, INC.",PPO,457.504,98.6,,percent of total billed charges,,
Mammo Screen W Implants UniPartial Reduction/Discontinuation,,77067,CPT,Facility,Outpatient,,,52,464,394.4,132.9824,464,PrimeWest Health,Minnesota Senior Health Options (MSHO),238.728,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Mammo Screen W Implants UniPartial Reduction/Discontinuation,,77067,CPT,Facility,Inpatient,,,52,464,394.4,132.9824,464,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mammo Screen W Implants UniPartial Reduction/Discontinuation,,77067,CPT,Facility,Outpatient,,,52,464,394.4,132.9824,464,PrimeWest Health,MinnesotaCare,238.3104,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Mammo Screen W Implants UniPartial Reduction/Discontinuation,,77067,CPT,Facility,Inpatient,,,52,464,394.4,132.9824,464,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Mammo Screen W Implants UniPartial Reduction/Discontinuation,,77067,CPT,Facility,Both,,,52,464,394.4,132.9824,464,Sanford Health Plan,Sanford Health Plan,426.88,92,,percent of total billed charges,,
Mammo Screen W Implants UniPartial Reduction/Discontinuation,,77067,CPT,Facility,Outpatient,,,52,464,394.4,132.9824,464,"UCare Health, Inc.",Individual & Family Plan,261.464,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Mammo Screen W Implants UniPartial Reduction/Discontinuation,,77067,CPT,Facility,Inpatient,,,52,464,394.4,132.9824,464,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Mammo Screen W Implants UniPartial Reduction/Discontinuation,,77067,CPT,Facility,Outpatient,,,52,464,394.4,132.9824,464,"UCare Health, Inc.",Medical Assistance,234.1808,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mammo Screen W Implants UniPartial Reduction/Discontinuation,,77067,CPT,Facility,Inpatient,,,52,464,394.4,132.9824,464,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Mammo Screen W Implants UniPartial Reduction/Discontinuation,,77067,CPT,Facility,Outpatient,,,52,464,394.4,132.9824,464,"UCare Health, Inc.",Medicare Advantage,234.1808,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mammo Screen W Implants UniPartial Reduction/Discontinuation,,77067,CPT,Facility,Inpatient,,,52,464,394.4,132.9824,464,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mammo Screen W Implants UniPartial Reduction/Discontinuation,,77067,CPT,Facility,Outpatient,,,52,464,394.4,132.9824,464,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),234.1808,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mammo Screen W Implants UniPartial Reduction/Discontinuation,,77067,CPT,Facility,Inpatient,,,52,464,394.4,132.9824,464,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mammo Screen W Implants UniPartial Reduction/Discontinuation,,77067,CPT,Facility,Both,,,52,464,394.4,132.9824,464,UnitedHealthcare,Individual & Family,436.16,94,,percent of total billed charges,,
Mammo Screen W Implants UniPartial Reduction/Discontinuation,,77067,CPT,Facility,Outpatient,,,52,464,394.4,132.9824,464,UnitedHealthcare,Medicare Advantage,227.36,49,,percent of total billed charges,,
Mammo Screen W Implants UniPartial Reduction/Discontinuation,,77067,CPT,Facility,Inpatient,,,52,464,394.4,132.9824,464,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Mammo Screen W Implants UniPartial Reduction/Discontinuation,,77067,CPT,Facility,Outpatient,,,52,464,394.4,132.9824,464,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,222.72,48,,percent of total billed charges,,100% of DHS outpatient percentage
Mammo Screen W Implants UniPartial Reduction/Discontinuation,,77067,CPT,Facility,Inpatient,,,52,464,394.4,132.9824,464,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Adalimumab (Mayo)OutsideLaboratory,,80145,CPT,Facility,Both,,,90,415,352.75,118.939,415,Aetna,Commercial,381.8,92,,percent of total billed charges,,
Adalimumab (Mayo)OutsideLaboratory,,80145,CPT,Facility,Outpatient,,,90,415,352.75,118.939,415,Aetna,Medicare Advantage,203.35,49,,percent of total billed charges,,
Adalimumab (Mayo)OutsideLaboratory,,80145,CPT,Facility,Inpatient,,,90,415,352.75,118.939,415,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Adalimumab (Mayo)OutsideLaboratory,,80145,CPT,Facility,Both,,,90,415,352.75,118.939,415,Aetna,PPO,385.95,93,,percent of total billed charges,,
Adalimumab (Mayo)OutsideLaboratory,,80145,CPT,Facility,Both,,,90,415,352.75,118.939,415,America's PPO,America's PPO,398.5245,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Adalimumab (Mayo)OutsideLaboratory,,80145,CPT,Facility,Both,,,90,415,352.75,118.939,415,BlueCross BlueShield Minnesota, Federal Employee Program,408.36,98.4,,percent of total billed charges,,
Adalimumab (Mayo)OutsideLaboratory,,80145,CPT,Facility,Both,,,90,415,352.75,118.939,415,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,415,100,,percent of total billed charges,,
Adalimumab (Mayo)OutsideLaboratory,,80145,CPT,Facility,Both,,,90,415,352.75,118.939,415,BlueCross BlueShield Minnesota,High Value Network Plan,373.5,90,,percent of total billed charges,,
Adalimumab (Mayo)OutsideLaboratory,,80145,CPT,Facility,Outpatient,,,90,415,352.75,118.939,415,BlueCross BlueShield Minnesota,Medicare Advantage,203.35,49,,percent of total billed charges,,
Adalimumab (Mayo)OutsideLaboratory,,80145,CPT,Facility,Inpatient,,,90,415,352.75,118.939,415,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Adalimumab (Mayo)OutsideLaboratory,,80145,CPT,Facility,Both,,,90,415,352.75,118.939,415,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,367.5655,88.57,,percent of total billed charges,,
Adalimumab (Mayo)OutsideLaboratory,,80145,CPT,Facility,Both,,,90,415,352.75,118.939,415,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,118.939,28.66,,percent of total billed charges,,
Adalimumab (Mayo)OutsideLaboratory,,80145,CPT,Facility,Outpatient,,,90,415,352.75,118.939,415,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),203.35,49,,percent of total billed charges,,
Adalimumab (Mayo)OutsideLaboratory,,80145,CPT,Facility,Inpatient,,,90,415,352.75,118.939,415,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Adalimumab (Mayo)OutsideLaboratory,,80145,CPT,Facility,Both,,,90,415,352.75,118.939,415,CorVel,Worker's Compensation,415,100,,percent of total billed charges,,
Adalimumab (Mayo)OutsideLaboratory,,80145,CPT,Facility,Both,,,90,415,352.75,118.939,415,First Health Group Corporation,First Health Network,402.55,97,,percent of total billed charges,,
Adalimumab (Mayo)OutsideLaboratory,,80145,CPT,Facility,Both,,,90,415,352.75,118.939,415,"Health Partners, Inc.",Commercial,392.59,94.6,,percent of total billed charges,,
Adalimumab (Mayo)OutsideLaboratory,,80145,CPT,Facility,Outpatient,,,90,415,352.75,118.939,415,"Health Partners, Inc.",Medicare Advantage,203.35,49,,percent of total billed charges,,
Adalimumab (Mayo)OutsideLaboratory,,80145,CPT,Facility,Inpatient,,,90,415,352.75,118.939,415,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Adalimumab (Mayo)OutsideLaboratory,,80145,CPT,Facility,Both,,,90,415,352.75,118.939,415,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),249,60,,percent of total billed charges,,
Adalimumab (Mayo)OutsideLaboratory,,80145,CPT,Facility,Both,,,90,415,352.75,118.939,415,"Health Partners, Inc.",State of Minnesota Advantage Program,338.225,81.5,,percent of total billed charges,,
Adalimumab (Mayo)OutsideLaboratory,,80145,CPT,Facility,Both,,,90,415,352.75,118.939,415,"Health Partners, Inc.",State Public Programs,207.5,50,,percent of total billed charges,,
Adalimumab (Mayo)OutsideLaboratory,,80145,CPT,Facility,Both,,,90,415,352.75,118.939,415,Humana Insurance Company,Commercial PPO,394.25,95,,percent of total billed charges,,
Adalimumab (Mayo)OutsideLaboratory,,80145,CPT,Facility,Outpatient,,,90,415,352.75,118.939,415,Humana Insurance Company,Medicare PPO,203.35,49,,percent of total billed charges,,
Adalimumab (Mayo)OutsideLaboratory,,80145,CPT,Facility,Inpatient,,,90,415,352.75,118.939,415,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Adalimumab (Mayo)OutsideLaboratory,,80145,CPT,Facility,Both,,,90,415,352.75,118.939,415,Medica,Individual & Family,411.265,99.1,,percent of total billed charges,,
Adalimumab (Mayo)OutsideLaboratory,,80145,CPT,Facility,Outpatient,,,90,415,352.75,118.939,415,Medica,Medica Advantage Solution,206.67,49.8,,percent of total billed charges,,
Adalimumab (Mayo)OutsideLaboratory,,80145,CPT,Facility,Inpatient,,,90,415,352.75,118.939,415,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Adalimumab (Mayo)OutsideLaboratory,,80145,CPT,Facility,Outpatient,,,90,415,352.75,118.939,415,Medica,Medical Assistance,185.09,44.6,,percent of total billed charges,,
Adalimumab (Mayo)OutsideLaboratory,,80145,CPT,Facility,Inpatient,,,90,415,352.75,118.939,415,Medica,Medical Assistance,,,,,Included in per diem rate,
Adalimumab (Mayo)OutsideLaboratory,,80145,CPT,Facility,Outpatient,,,90,415,352.75,118.939,415,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,206.67,49.8,,percent of total billed charges,,
Adalimumab (Mayo)OutsideLaboratory,,80145,CPT,Facility,Inpatient,,,90,415,352.75,118.939,415,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Adalimumab (Mayo)OutsideLaboratory,,80145,CPT,Facility,Both,,,90,415,352.75,118.939,415,"Multiplan, Inc.","Multiplan, Inc.",390.1,94,,percent of total billed charges,,
Adalimumab (Mayo)OutsideLaboratory,,80145,CPT,Facility,Outpatient,,,90,415,352.75,118.939,415,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,358.56,86.4,,percent of total billed charges,,
Adalimumab (Mayo)OutsideLaboratory,,80145,CPT,Facility,Inpatient,,,90,415,352.75,118.939,415,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Adalimumab (Mayo)OutsideLaboratory,,80145,CPT,Facility,Both,,,90,415,352.75,118.939,415,"Preferred One Administrative Services, INC.",PPO,409.19,98.6,,percent of total billed charges,,
Adalimumab (Mayo)OutsideLaboratory,,80145,CPT,Facility,Outpatient,,,90,415,352.75,118.939,415,PrimeWest Health,Minnesota Senior Health Options (MSHO),213.5175,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Adalimumab (Mayo)OutsideLaboratory,,80145,CPT,Facility,Inpatient,,,90,415,352.75,118.939,415,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Adalimumab (Mayo)OutsideLaboratory,,80145,CPT,Facility,Outpatient,,,90,415,352.75,118.939,415,PrimeWest Health,MinnesotaCare,213.144,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Adalimumab (Mayo)OutsideLaboratory,,80145,CPT,Facility,Inpatient,,,90,415,352.75,118.939,415,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Adalimumab (Mayo)OutsideLaboratory,,80145,CPT,Facility,Both,,,90,415,352.75,118.939,415,Sanford Health Plan,Sanford Health Plan,381.8,92,,percent of total billed charges,,
Adalimumab (Mayo)OutsideLaboratory,,80145,CPT,Facility,Outpatient,,,90,415,352.75,118.939,415,"UCare Health, Inc.",Individual & Family Plan,233.8525,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Adalimumab (Mayo)OutsideLaboratory,,80145,CPT,Facility,Inpatient,,,90,415,352.75,118.939,415,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Adalimumab (Mayo)OutsideLaboratory,,80145,CPT,Facility,Outpatient,,,90,415,352.75,118.939,415,"UCare Health, Inc.",Medical Assistance,209.4505,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Adalimumab (Mayo)OutsideLaboratory,,80145,CPT,Facility,Inpatient,,,90,415,352.75,118.939,415,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Adalimumab (Mayo)OutsideLaboratory,,80145,CPT,Facility,Outpatient,,,90,415,352.75,118.939,415,"UCare Health, Inc.",Medicare Advantage,209.4505,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Adalimumab (Mayo)OutsideLaboratory,,80145,CPT,Facility,Inpatient,,,90,415,352.75,118.939,415,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Adalimumab (Mayo)OutsideLaboratory,,80145,CPT,Facility,Outpatient,,,90,415,352.75,118.939,415,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),209.4505,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Adalimumab (Mayo)OutsideLaboratory,,80145,CPT,Facility,Inpatient,,,90,415,352.75,118.939,415,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Adalimumab (Mayo)OutsideLaboratory,,80145,CPT,Facility,Both,,,90,415,352.75,118.939,415,UnitedHealthcare,Individual & Family,390.1,94,,percent of total billed charges,,
Adalimumab (Mayo)OutsideLaboratory,,80145,CPT,Facility,Outpatient,,,90,415,352.75,118.939,415,UnitedHealthcare,Medicare Advantage,203.35,49,,percent of total billed charges,,
Adalimumab (Mayo)OutsideLaboratory,,80145,CPT,Facility,Inpatient,,,90,415,352.75,118.939,415,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Adalimumab (Mayo)OutsideLaboratory,,80145,CPT,Facility,Outpatient,,,90,415,352.75,118.939,415,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,199.2,48,,percent of total billed charges,,100% of DHS outpatient percentage
Adalimumab (Mayo)OutsideLaboratory,,80145,CPT,Facility,Inpatient,,,90,415,352.75,118.939,415,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Amikacin, Peak, S (Mayo)OutsideLaboratory",,80150,CPT,Facility,Both,,,90,181,153.85,51.8746,181,Aetna,Commercial,166.52,92,,percent of total billed charges,,
"Amikacin, Peak, S (Mayo)OutsideLaboratory",,80150,CPT,Facility,Outpatient,,,90,181,153.85,51.8746,181,Aetna,Medicare Advantage,88.69,49,,percent of total billed charges,,
"Amikacin, Peak, S (Mayo)OutsideLaboratory",,80150,CPT,Facility,Inpatient,,,90,181,153.85,51.8746,181,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Amikacin, Peak, S (Mayo)OutsideLaboratory",,80150,CPT,Facility,Both,,,90,181,153.85,51.8746,181,Aetna,PPO,168.33,93,,percent of total billed charges,,
"Amikacin, Peak, S (Mayo)OutsideLaboratory",,80150,CPT,Facility,Both,,,90,181,153.85,51.8746,181,America's PPO,America's PPO,173.8143,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Amikacin, Peak, S (Mayo)OutsideLaboratory",,80150,CPT,Facility,Both,,,90,181,153.85,51.8746,181,BlueCross BlueShield Minnesota, Federal Employee Program,178.104,98.4,,percent of total billed charges,,
"Amikacin, Peak, S (Mayo)OutsideLaboratory",,80150,CPT,Facility,Both,,,90,181,153.85,51.8746,181,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,181,100,,percent of total billed charges,,
"Amikacin, Peak, S (Mayo)OutsideLaboratory",,80150,CPT,Facility,Both,,,90,181,153.85,51.8746,181,BlueCross BlueShield Minnesota,High Value Network Plan,162.9,90,,percent of total billed charges,,
"Amikacin, Peak, S (Mayo)OutsideLaboratory",,80150,CPT,Facility,Outpatient,,,90,181,153.85,51.8746,181,BlueCross BlueShield Minnesota,Medicare Advantage,88.69,49,,percent of total billed charges,,
"Amikacin, Peak, S (Mayo)OutsideLaboratory",,80150,CPT,Facility,Inpatient,,,90,181,153.85,51.8746,181,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Amikacin, Peak, S (Mayo)OutsideLaboratory",,80150,CPT,Facility,Both,,,90,181,153.85,51.8746,181,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,160.3117,88.57,,percent of total billed charges,,
"Amikacin, Peak, S (Mayo)OutsideLaboratory",,80150,CPT,Facility,Both,,,90,181,153.85,51.8746,181,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,51.8746,28.66,,percent of total billed charges,,
"Amikacin, Peak, S (Mayo)OutsideLaboratory",,80150,CPT,Facility,Outpatient,,,90,181,153.85,51.8746,181,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),88.69,49,,percent of total billed charges,,
"Amikacin, Peak, S (Mayo)OutsideLaboratory",,80150,CPT,Facility,Inpatient,,,90,181,153.85,51.8746,181,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Amikacin, Peak, S (Mayo)OutsideLaboratory",,80150,CPT,Facility,Both,,,90,181,153.85,51.8746,181,CorVel,Worker's Compensation,181,100,,percent of total billed charges,,
"Amikacin, Peak, S (Mayo)OutsideLaboratory",,80150,CPT,Facility,Both,,,90,181,153.85,51.8746,181,First Health Group Corporation,First Health Network,175.57,97,,percent of total billed charges,,
"Amikacin, Peak, S (Mayo)OutsideLaboratory",,80150,CPT,Facility,Both,,,90,181,153.85,51.8746,181,"Health Partners, Inc.",Commercial,171.226,94.6,,percent of total billed charges,,
"Amikacin, Peak, S (Mayo)OutsideLaboratory",,80150,CPT,Facility,Outpatient,,,90,181,153.85,51.8746,181,"Health Partners, Inc.",Medicare Advantage,88.69,49,,percent of total billed charges,,
"Amikacin, Peak, S (Mayo)OutsideLaboratory",,80150,CPT,Facility,Inpatient,,,90,181,153.85,51.8746,181,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Amikacin, Peak, S (Mayo)OutsideLaboratory",,80150,CPT,Facility,Both,,,90,181,153.85,51.8746,181,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),108.6,60,,percent of total billed charges,,
"Amikacin, Peak, S (Mayo)OutsideLaboratory",,80150,CPT,Facility,Both,,,90,181,153.85,51.8746,181,"Health Partners, Inc.",State of Minnesota Advantage Program,147.515,81.5,,percent of total billed charges,,
"Amikacin, Peak, S (Mayo)OutsideLaboratory",,80150,CPT,Facility,Both,,,90,181,153.85,51.8746,181,"Health Partners, Inc.",State Public Programs,90.5,50,,percent of total billed charges,,
"Amikacin, Peak, S (Mayo)OutsideLaboratory",,80150,CPT,Facility,Both,,,90,181,153.85,51.8746,181,Humana Insurance Company,Commercial PPO,171.95,95,,percent of total billed charges,,
"Amikacin, Peak, S (Mayo)OutsideLaboratory",,80150,CPT,Facility,Outpatient,,,90,181,153.85,51.8746,181,Humana Insurance Company,Medicare PPO,88.69,49,,percent of total billed charges,,
"Amikacin, Peak, S (Mayo)OutsideLaboratory",,80150,CPT,Facility,Inpatient,,,90,181,153.85,51.8746,181,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Amikacin, Peak, S (Mayo)OutsideLaboratory",,80150,CPT,Facility,Both,,,90,181,153.85,51.8746,181,Medica,Individual & Family,179.371,99.1,,percent of total billed charges,,
"Amikacin, Peak, S (Mayo)OutsideLaboratory",,80150,CPT,Facility,Outpatient,,,90,181,153.85,51.8746,181,Medica,Medica Advantage Solution,90.138,49.8,,percent of total billed charges,,
"Amikacin, Peak, S (Mayo)OutsideLaboratory",,80150,CPT,Facility,Inpatient,,,90,181,153.85,51.8746,181,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Amikacin, Peak, S (Mayo)OutsideLaboratory",,80150,CPT,Facility,Outpatient,,,90,181,153.85,51.8746,181,Medica,Medical Assistance,80.726,44.6,,percent of total billed charges,,
"Amikacin, Peak, S (Mayo)OutsideLaboratory",,80150,CPT,Facility,Inpatient,,,90,181,153.85,51.8746,181,Medica,Medical Assistance,,,,,Included in per diem rate,
"Amikacin, Peak, S (Mayo)OutsideLaboratory",,80150,CPT,Facility,Outpatient,,,90,181,153.85,51.8746,181,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,90.138,49.8,,percent of total billed charges,,
"Amikacin, Peak, S (Mayo)OutsideLaboratory",,80150,CPT,Facility,Inpatient,,,90,181,153.85,51.8746,181,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Amikacin, Peak, S (Mayo)OutsideLaboratory",,80150,CPT,Facility,Both,,,90,181,153.85,51.8746,181,"Multiplan, Inc.","Multiplan, Inc.",170.14,94,,percent of total billed charges,,
"Amikacin, Peak, S (Mayo)OutsideLaboratory",,80150,CPT,Facility,Outpatient,,,90,181,153.85,51.8746,181,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,156.384,86.4,,percent of total billed charges,,
"Amikacin, Peak, S (Mayo)OutsideLaboratory",,80150,CPT,Facility,Inpatient,,,90,181,153.85,51.8746,181,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Amikacin, Peak, S (Mayo)OutsideLaboratory",,80150,CPT,Facility,Both,,,90,181,153.85,51.8746,181,"Preferred One Administrative Services, INC.",PPO,178.466,98.6,,percent of total billed charges,,
"Amikacin, Peak, S (Mayo)OutsideLaboratory",,80150,CPT,Facility,Outpatient,,,90,181,153.85,51.8746,181,PrimeWest Health,Minnesota Senior Health Options (MSHO),93.1245,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Amikacin, Peak, S (Mayo)OutsideLaboratory",,80150,CPT,Facility,Inpatient,,,90,181,153.85,51.8746,181,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Amikacin, Peak, S (Mayo)OutsideLaboratory",,80150,CPT,Facility,Outpatient,,,90,181,153.85,51.8746,181,PrimeWest Health,MinnesotaCare,92.9616,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Amikacin, Peak, S (Mayo)OutsideLaboratory",,80150,CPT,Facility,Inpatient,,,90,181,153.85,51.8746,181,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Amikacin, Peak, S (Mayo)OutsideLaboratory",,80150,CPT,Facility,Both,,,90,181,153.85,51.8746,181,Sanford Health Plan,Sanford Health Plan,166.52,92,,percent of total billed charges,,
"Amikacin, Peak, S (Mayo)OutsideLaboratory",,80150,CPT,Facility,Outpatient,,,90,181,153.85,51.8746,181,"UCare Health, Inc.",Individual & Family Plan,101.9935,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Amikacin, Peak, S (Mayo)OutsideLaboratory",,80150,CPT,Facility,Inpatient,,,90,181,153.85,51.8746,181,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Amikacin, Peak, S (Mayo)OutsideLaboratory",,80150,CPT,Facility,Outpatient,,,90,181,153.85,51.8746,181,"UCare Health, Inc.",Medical Assistance,91.3507,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Amikacin, Peak, S (Mayo)OutsideLaboratory",,80150,CPT,Facility,Inpatient,,,90,181,153.85,51.8746,181,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Amikacin, Peak, S (Mayo)OutsideLaboratory",,80150,CPT,Facility,Outpatient,,,90,181,153.85,51.8746,181,"UCare Health, Inc.",Medicare Advantage,91.3507,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Amikacin, Peak, S (Mayo)OutsideLaboratory",,80150,CPT,Facility,Inpatient,,,90,181,153.85,51.8746,181,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Amikacin, Peak, S (Mayo)OutsideLaboratory",,80150,CPT,Facility,Outpatient,,,90,181,153.85,51.8746,181,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),91.3507,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Amikacin, Peak, S (Mayo)OutsideLaboratory",,80150,CPT,Facility,Inpatient,,,90,181,153.85,51.8746,181,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Amikacin, Peak, S (Mayo)OutsideLaboratory",,80150,CPT,Facility,Both,,,90,181,153.85,51.8746,181,UnitedHealthcare,Individual & Family,170.14,94,,percent of total billed charges,,
"Amikacin, Peak, S (Mayo)OutsideLaboratory",,80150,CPT,Facility,Outpatient,,,90,181,153.85,51.8746,181,UnitedHealthcare,Medicare Advantage,88.69,49,,percent of total billed charges,,
"Amikacin, Peak, S (Mayo)OutsideLaboratory",,80150,CPT,Facility,Inpatient,,,90,181,153.85,51.8746,181,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Amikacin, Peak, S (Mayo)OutsideLaboratory",,80150,CPT,Facility,Outpatient,,,90,181,153.85,51.8746,181,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,86.88,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Amikacin, Peak, S (Mayo)OutsideLaboratory",,80150,CPT,Facility,Inpatient,,,90,181,153.85,51.8746,181,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Amikacin, Trough, S (Mayo)OutsideLaboratory",,80150,CPT,Facility,Both,,,90,181,153.85,51.8746,181,Aetna,Commercial,166.52,92,,percent of total billed charges,,
"Amikacin, Trough, S (Mayo)OutsideLaboratory",,80150,CPT,Facility,Outpatient,,,90,181,153.85,51.8746,181,Aetna,Medicare Advantage,88.69,49,,percent of total billed charges,,
"Amikacin, Trough, S (Mayo)OutsideLaboratory",,80150,CPT,Facility,Inpatient,,,90,181,153.85,51.8746,181,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Amikacin, Trough, S (Mayo)OutsideLaboratory",,80150,CPT,Facility,Both,,,90,181,153.85,51.8746,181,Aetna,PPO,168.33,93,,percent of total billed charges,,
"Amikacin, Trough, S (Mayo)OutsideLaboratory",,80150,CPT,Facility,Both,,,90,181,153.85,51.8746,181,America's PPO,America's PPO,173.8143,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Amikacin, Trough, S (Mayo)OutsideLaboratory",,80150,CPT,Facility,Both,,,90,181,153.85,51.8746,181,BlueCross BlueShield Minnesota, Federal Employee Program,178.104,98.4,,percent of total billed charges,,
"Amikacin, Trough, S (Mayo)OutsideLaboratory",,80150,CPT,Facility,Both,,,90,181,153.85,51.8746,181,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,181,100,,percent of total billed charges,,
"Amikacin, Trough, S (Mayo)OutsideLaboratory",,80150,CPT,Facility,Both,,,90,181,153.85,51.8746,181,BlueCross BlueShield Minnesota,High Value Network Plan,162.9,90,,percent of total billed charges,,
"Amikacin, Trough, S (Mayo)OutsideLaboratory",,80150,CPT,Facility,Outpatient,,,90,181,153.85,51.8746,181,BlueCross BlueShield Minnesota,Medicare Advantage,88.69,49,,percent of total billed charges,,
"Amikacin, Trough, S (Mayo)OutsideLaboratory",,80150,CPT,Facility,Inpatient,,,90,181,153.85,51.8746,181,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Amikacin, Trough, S (Mayo)OutsideLaboratory",,80150,CPT,Facility,Both,,,90,181,153.85,51.8746,181,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,160.3117,88.57,,percent of total billed charges,,
"Amikacin, Trough, S (Mayo)OutsideLaboratory",,80150,CPT,Facility,Both,,,90,181,153.85,51.8746,181,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,51.8746,28.66,,percent of total billed charges,,
"Amikacin, Trough, S (Mayo)OutsideLaboratory",,80150,CPT,Facility,Outpatient,,,90,181,153.85,51.8746,181,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),88.69,49,,percent of total billed charges,,
"Amikacin, Trough, S (Mayo)OutsideLaboratory",,80150,CPT,Facility,Inpatient,,,90,181,153.85,51.8746,181,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Amikacin, Trough, S (Mayo)OutsideLaboratory",,80150,CPT,Facility,Both,,,90,181,153.85,51.8746,181,CorVel,Worker's Compensation,181,100,,percent of total billed charges,,
"Amikacin, Trough, S (Mayo)OutsideLaboratory",,80150,CPT,Facility,Both,,,90,181,153.85,51.8746,181,First Health Group Corporation,First Health Network,175.57,97,,percent of total billed charges,,
"Amikacin, Trough, S (Mayo)OutsideLaboratory",,80150,CPT,Facility,Both,,,90,181,153.85,51.8746,181,"Health Partners, Inc.",Commercial,171.226,94.6,,percent of total billed charges,,
"Amikacin, Trough, S (Mayo)OutsideLaboratory",,80150,CPT,Facility,Outpatient,,,90,181,153.85,51.8746,181,"Health Partners, Inc.",Medicare Advantage,88.69,49,,percent of total billed charges,,
"Amikacin, Trough, S (Mayo)OutsideLaboratory",,80150,CPT,Facility,Inpatient,,,90,181,153.85,51.8746,181,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Amikacin, Trough, S (Mayo)OutsideLaboratory",,80150,CPT,Facility,Both,,,90,181,153.85,51.8746,181,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),108.6,60,,percent of total billed charges,,
"Amikacin, Trough, S (Mayo)OutsideLaboratory",,80150,CPT,Facility,Both,,,90,181,153.85,51.8746,181,"Health Partners, Inc.",State of Minnesota Advantage Program,147.515,81.5,,percent of total billed charges,,
"Amikacin, Trough, S (Mayo)OutsideLaboratory",,80150,CPT,Facility,Both,,,90,181,153.85,51.8746,181,"Health Partners, Inc.",State Public Programs,90.5,50,,percent of total billed charges,,
"Amikacin, Trough, S (Mayo)OutsideLaboratory",,80150,CPT,Facility,Both,,,90,181,153.85,51.8746,181,Humana Insurance Company,Commercial PPO,171.95,95,,percent of total billed charges,,
"Amikacin, Trough, S (Mayo)OutsideLaboratory",,80150,CPT,Facility,Outpatient,,,90,181,153.85,51.8746,181,Humana Insurance Company,Medicare PPO,88.69,49,,percent of total billed charges,,
"Amikacin, Trough, S (Mayo)OutsideLaboratory",,80150,CPT,Facility,Inpatient,,,90,181,153.85,51.8746,181,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Amikacin, Trough, S (Mayo)OutsideLaboratory",,80150,CPT,Facility,Both,,,90,181,153.85,51.8746,181,Medica,Individual & Family,179.371,99.1,,percent of total billed charges,,
"Amikacin, Trough, S (Mayo)OutsideLaboratory",,80150,CPT,Facility,Outpatient,,,90,181,153.85,51.8746,181,Medica,Medica Advantage Solution,90.138,49.8,,percent of total billed charges,,
"Amikacin, Trough, S (Mayo)OutsideLaboratory",,80150,CPT,Facility,Inpatient,,,90,181,153.85,51.8746,181,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Amikacin, Trough, S (Mayo)OutsideLaboratory",,80150,CPT,Facility,Outpatient,,,90,181,153.85,51.8746,181,Medica,Medical Assistance,80.726,44.6,,percent of total billed charges,,
"Amikacin, Trough, S (Mayo)OutsideLaboratory",,80150,CPT,Facility,Inpatient,,,90,181,153.85,51.8746,181,Medica,Medical Assistance,,,,,Included in per diem rate,
"Amikacin, Trough, S (Mayo)OutsideLaboratory",,80150,CPT,Facility,Outpatient,,,90,181,153.85,51.8746,181,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,90.138,49.8,,percent of total billed charges,,
"Amikacin, Trough, S (Mayo)OutsideLaboratory",,80150,CPT,Facility,Inpatient,,,90,181,153.85,51.8746,181,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Amikacin, Trough, S (Mayo)OutsideLaboratory",,80150,CPT,Facility,Both,,,90,181,153.85,51.8746,181,"Multiplan, Inc.","Multiplan, Inc.",170.14,94,,percent of total billed charges,,
"Amikacin, Trough, S (Mayo)OutsideLaboratory",,80150,CPT,Facility,Outpatient,,,90,181,153.85,51.8746,181,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,156.384,86.4,,percent of total billed charges,,
"Amikacin, Trough, S (Mayo)OutsideLaboratory",,80150,CPT,Facility,Inpatient,,,90,181,153.85,51.8746,181,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Amikacin, Trough, S (Mayo)OutsideLaboratory",,80150,CPT,Facility,Both,,,90,181,153.85,51.8746,181,"Preferred One Administrative Services, INC.",PPO,178.466,98.6,,percent of total billed charges,,
"Amikacin, Trough, S (Mayo)OutsideLaboratory",,80150,CPT,Facility,Outpatient,,,90,181,153.85,51.8746,181,PrimeWest Health,Minnesota Senior Health Options (MSHO),93.1245,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Amikacin, Trough, S (Mayo)OutsideLaboratory",,80150,CPT,Facility,Inpatient,,,90,181,153.85,51.8746,181,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Amikacin, Trough, S (Mayo)OutsideLaboratory",,80150,CPT,Facility,Outpatient,,,90,181,153.85,51.8746,181,PrimeWest Health,MinnesotaCare,92.9616,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Amikacin, Trough, S (Mayo)OutsideLaboratory",,80150,CPT,Facility,Inpatient,,,90,181,153.85,51.8746,181,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Amikacin, Trough, S (Mayo)OutsideLaboratory",,80150,CPT,Facility,Both,,,90,181,153.85,51.8746,181,Sanford Health Plan,Sanford Health Plan,166.52,92,,percent of total billed charges,,
"Amikacin, Trough, S (Mayo)OutsideLaboratory",,80150,CPT,Facility,Outpatient,,,90,181,153.85,51.8746,181,"UCare Health, Inc.",Individual & Family Plan,101.9935,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Amikacin, Trough, S (Mayo)OutsideLaboratory",,80150,CPT,Facility,Inpatient,,,90,181,153.85,51.8746,181,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Amikacin, Trough, S (Mayo)OutsideLaboratory",,80150,CPT,Facility,Outpatient,,,90,181,153.85,51.8746,181,"UCare Health, Inc.",Medical Assistance,91.3507,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Amikacin, Trough, S (Mayo)OutsideLaboratory",,80150,CPT,Facility,Inpatient,,,90,181,153.85,51.8746,181,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Amikacin, Trough, S (Mayo)OutsideLaboratory",,80150,CPT,Facility,Outpatient,,,90,181,153.85,51.8746,181,"UCare Health, Inc.",Medicare Advantage,91.3507,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Amikacin, Trough, S (Mayo)OutsideLaboratory",,80150,CPT,Facility,Inpatient,,,90,181,153.85,51.8746,181,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Amikacin, Trough, S (Mayo)OutsideLaboratory",,80150,CPT,Facility,Outpatient,,,90,181,153.85,51.8746,181,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),91.3507,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Amikacin, Trough, S (Mayo)OutsideLaboratory",,80150,CPT,Facility,Inpatient,,,90,181,153.85,51.8746,181,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Amikacin, Trough, S (Mayo)OutsideLaboratory",,80150,CPT,Facility,Both,,,90,181,153.85,51.8746,181,UnitedHealthcare,Individual & Family,170.14,94,,percent of total billed charges,,
"Amikacin, Trough, S (Mayo)OutsideLaboratory",,80150,CPT,Facility,Outpatient,,,90,181,153.85,51.8746,181,UnitedHealthcare,Medicare Advantage,88.69,49,,percent of total billed charges,,
"Amikacin, Trough, S (Mayo)OutsideLaboratory",,80150,CPT,Facility,Inpatient,,,90,181,153.85,51.8746,181,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Amikacin, Trough, S (Mayo)OutsideLaboratory",,80150,CPT,Facility,Outpatient,,,90,181,153.85,51.8746,181,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,86.88,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Amikacin, Trough, S (Mayo)OutsideLaboratory",,80150,CPT,Facility,Inpatient,,,90,181,153.85,51.8746,181,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Amiodarone, S (Mayo)OutsideLaboratory",,80151,CPT,Facility,Both,,,90,79,67.15,22.6414,79,Aetna,Commercial,72.68,92,,percent of total billed charges,,
"Amiodarone, S (Mayo)OutsideLaboratory",,80151,CPT,Facility,Outpatient,,,90,79,67.15,22.6414,79,Aetna,Medicare Advantage,38.71,49,,percent of total billed charges,,
"Amiodarone, S (Mayo)OutsideLaboratory",,80151,CPT,Facility,Inpatient,,,90,79,67.15,22.6414,79,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Amiodarone, S (Mayo)OutsideLaboratory",,80151,CPT,Facility,Both,,,90,79,67.15,22.6414,79,Aetna,PPO,73.47,93,,percent of total billed charges,,
"Amiodarone, S (Mayo)OutsideLaboratory",,80151,CPT,Facility,Both,,,90,79,67.15,22.6414,79,America's PPO,America's PPO,75.8637,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Amiodarone, S (Mayo)OutsideLaboratory",,80151,CPT,Facility,Both,,,90,79,67.15,22.6414,79,BlueCross BlueShield Minnesota, Federal Employee Program,77.736,98.4,,percent of total billed charges,,
"Amiodarone, S (Mayo)OutsideLaboratory",,80151,CPT,Facility,Both,,,90,79,67.15,22.6414,79,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,79,100,,percent of total billed charges,,
"Amiodarone, S (Mayo)OutsideLaboratory",,80151,CPT,Facility,Both,,,90,79,67.15,22.6414,79,BlueCross BlueShield Minnesota,High Value Network Plan,71.1,90,,percent of total billed charges,,
"Amiodarone, S (Mayo)OutsideLaboratory",,80151,CPT,Facility,Outpatient,,,90,79,67.15,22.6414,79,BlueCross BlueShield Minnesota,Medicare Advantage,38.71,49,,percent of total billed charges,,
"Amiodarone, S (Mayo)OutsideLaboratory",,80151,CPT,Facility,Inpatient,,,90,79,67.15,22.6414,79,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Amiodarone, S (Mayo)OutsideLaboratory",,80151,CPT,Facility,Both,,,90,79,67.15,22.6414,79,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,69.9703,88.57,,percent of total billed charges,,
"Amiodarone, S (Mayo)OutsideLaboratory",,80151,CPT,Facility,Both,,,90,79,67.15,22.6414,79,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,22.6414,28.66,,percent of total billed charges,,
"Amiodarone, S (Mayo)OutsideLaboratory",,80151,CPT,Facility,Outpatient,,,90,79,67.15,22.6414,79,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),38.71,49,,percent of total billed charges,,
"Amiodarone, S (Mayo)OutsideLaboratory",,80151,CPT,Facility,Inpatient,,,90,79,67.15,22.6414,79,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Amiodarone, S (Mayo)OutsideLaboratory",,80151,CPT,Facility,Both,,,90,79,67.15,22.6414,79,CorVel,Worker's Compensation,79,100,,percent of total billed charges,,
"Amiodarone, S (Mayo)OutsideLaboratory",,80151,CPT,Facility,Both,,,90,79,67.15,22.6414,79,First Health Group Corporation,First Health Network,76.63,97,,percent of total billed charges,,
"Amiodarone, S (Mayo)OutsideLaboratory",,80151,CPT,Facility,Both,,,90,79,67.15,22.6414,79,"Health Partners, Inc.",Commercial,74.734,94.6,,percent of total billed charges,,
"Amiodarone, S (Mayo)OutsideLaboratory",,80151,CPT,Facility,Outpatient,,,90,79,67.15,22.6414,79,"Health Partners, Inc.",Medicare Advantage,38.71,49,,percent of total billed charges,,
"Amiodarone, S (Mayo)OutsideLaboratory",,80151,CPT,Facility,Inpatient,,,90,79,67.15,22.6414,79,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Amiodarone, S (Mayo)OutsideLaboratory",,80151,CPT,Facility,Both,,,90,79,67.15,22.6414,79,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),47.4,60,,percent of total billed charges,,
"Amiodarone, S (Mayo)OutsideLaboratory",,80151,CPT,Facility,Both,,,90,79,67.15,22.6414,79,"Health Partners, Inc.",State of Minnesota Advantage Program,64.385,81.5,,percent of total billed charges,,
"Amiodarone, S (Mayo)OutsideLaboratory",,80151,CPT,Facility,Both,,,90,79,67.15,22.6414,79,"Health Partners, Inc.",State Public Programs,39.5,50,,percent of total billed charges,,
"Amiodarone, S (Mayo)OutsideLaboratory",,80151,CPT,Facility,Both,,,90,79,67.15,22.6414,79,Humana Insurance Company,Commercial PPO,75.05,95,,percent of total billed charges,,
"Amiodarone, S (Mayo)OutsideLaboratory",,80151,CPT,Facility,Outpatient,,,90,79,67.15,22.6414,79,Humana Insurance Company,Medicare PPO,38.71,49,,percent of total billed charges,,
"Amiodarone, S (Mayo)OutsideLaboratory",,80151,CPT,Facility,Inpatient,,,90,79,67.15,22.6414,79,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Amiodarone, S (Mayo)OutsideLaboratory",,80151,CPT,Facility,Both,,,90,79,67.15,22.6414,79,Medica,Individual & Family,78.289,99.1,,percent of total billed charges,,
"Amiodarone, S (Mayo)OutsideLaboratory",,80151,CPT,Facility,Outpatient,,,90,79,67.15,22.6414,79,Medica,Medica Advantage Solution,39.342,49.8,,percent of total billed charges,,
"Amiodarone, S (Mayo)OutsideLaboratory",,80151,CPT,Facility,Inpatient,,,90,79,67.15,22.6414,79,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Amiodarone, S (Mayo)OutsideLaboratory",,80151,CPT,Facility,Outpatient,,,90,79,67.15,22.6414,79,Medica,Medical Assistance,35.234,44.6,,percent of total billed charges,,
"Amiodarone, S (Mayo)OutsideLaboratory",,80151,CPT,Facility,Inpatient,,,90,79,67.15,22.6414,79,Medica,Medical Assistance,,,,,Included in per diem rate,
"Amiodarone, S (Mayo)OutsideLaboratory",,80151,CPT,Facility,Outpatient,,,90,79,67.15,22.6414,79,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,39.342,49.8,,percent of total billed charges,,
"Amiodarone, S (Mayo)OutsideLaboratory",,80151,CPT,Facility,Inpatient,,,90,79,67.15,22.6414,79,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Amiodarone, S (Mayo)OutsideLaboratory",,80151,CPT,Facility,Both,,,90,79,67.15,22.6414,79,"Multiplan, Inc.","Multiplan, Inc.",74.26,94,,percent of total billed charges,,
"Amiodarone, S (Mayo)OutsideLaboratory",,80151,CPT,Facility,Outpatient,,,90,79,67.15,22.6414,79,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,68.256,86.4,,percent of total billed charges,,
"Amiodarone, S (Mayo)OutsideLaboratory",,80151,CPT,Facility,Inpatient,,,90,79,67.15,22.6414,79,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Amiodarone, S (Mayo)OutsideLaboratory",,80151,CPT,Facility,Both,,,90,79,67.15,22.6414,79,"Preferred One Administrative Services, INC.",PPO,77.894,98.6,,percent of total billed charges,,
"Amiodarone, S (Mayo)OutsideLaboratory",,80151,CPT,Facility,Outpatient,,,90,79,67.15,22.6414,79,PrimeWest Health,Minnesota Senior Health Options (MSHO),40.6455,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Amiodarone, S (Mayo)OutsideLaboratory",,80151,CPT,Facility,Inpatient,,,90,79,67.15,22.6414,79,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Amiodarone, S (Mayo)OutsideLaboratory",,80151,CPT,Facility,Outpatient,,,90,79,67.15,22.6414,79,PrimeWest Health,MinnesotaCare,40.5744,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Amiodarone, S (Mayo)OutsideLaboratory",,80151,CPT,Facility,Inpatient,,,90,79,67.15,22.6414,79,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Amiodarone, S (Mayo)OutsideLaboratory",,80151,CPT,Facility,Both,,,90,79,67.15,22.6414,79,Sanford Health Plan,Sanford Health Plan,72.68,92,,percent of total billed charges,,
"Amiodarone, S (Mayo)OutsideLaboratory",,80151,CPT,Facility,Outpatient,,,90,79,67.15,22.6414,79,"UCare Health, Inc.",Individual & Family Plan,44.5165,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Amiodarone, S (Mayo)OutsideLaboratory",,80151,CPT,Facility,Inpatient,,,90,79,67.15,22.6414,79,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Amiodarone, S (Mayo)OutsideLaboratory",,80151,CPT,Facility,Outpatient,,,90,79,67.15,22.6414,79,"UCare Health, Inc.",Medical Assistance,39.8713,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Amiodarone, S (Mayo)OutsideLaboratory",,80151,CPT,Facility,Inpatient,,,90,79,67.15,22.6414,79,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Amiodarone, S (Mayo)OutsideLaboratory",,80151,CPT,Facility,Outpatient,,,90,79,67.15,22.6414,79,"UCare Health, Inc.",Medicare Advantage,39.8713,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Amiodarone, S (Mayo)OutsideLaboratory",,80151,CPT,Facility,Inpatient,,,90,79,67.15,22.6414,79,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Amiodarone, S (Mayo)OutsideLaboratory",,80151,CPT,Facility,Outpatient,,,90,79,67.15,22.6414,79,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),39.8713,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Amiodarone, S (Mayo)OutsideLaboratory",,80151,CPT,Facility,Inpatient,,,90,79,67.15,22.6414,79,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Amiodarone, S (Mayo)OutsideLaboratory",,80151,CPT,Facility,Both,,,90,79,67.15,22.6414,79,UnitedHealthcare,Individual & Family,74.26,94,,percent of total billed charges,,
"Amiodarone, S (Mayo)OutsideLaboratory",,80151,CPT,Facility,Outpatient,,,90,79,67.15,22.6414,79,UnitedHealthcare,Medicare Advantage,38.71,49,,percent of total billed charges,,
"Amiodarone, S (Mayo)OutsideLaboratory",,80151,CPT,Facility,Inpatient,,,90,79,67.15,22.6414,79,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Amiodarone, S (Mayo)OutsideLaboratory",,80151,CPT,Facility,Outpatient,,,90,79,67.15,22.6414,79,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,37.92,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Amiodarone, S (Mayo)OutsideLaboratory",,80151,CPT,Facility,Inpatient,,,90,79,67.15,22.6414,79,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Carbamazepine, Tot, S (Mayo)OutsideLaboratory",,80156,CPT,Facility,Both,,,90,92,78.2,26.3672,92,Aetna,Commercial,84.64,92,,percent of total billed charges,,
"Carbamazepine, Tot, S (Mayo)OutsideLaboratory",,80156,CPT,Facility,Outpatient,,,90,92,78.2,26.3672,92,Aetna,Medicare Advantage,45.08,49,,percent of total billed charges,,
"Carbamazepine, Tot, S (Mayo)OutsideLaboratory",,80156,CPT,Facility,Inpatient,,,90,92,78.2,26.3672,92,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Carbamazepine, Tot, S (Mayo)OutsideLaboratory",,80156,CPT,Facility,Both,,,90,92,78.2,26.3672,92,Aetna,PPO,85.56,93,,percent of total billed charges,,
"Carbamazepine, Tot, S (Mayo)OutsideLaboratory",,80156,CPT,Facility,Both,,,90,92,78.2,26.3672,92,America's PPO,America's PPO,88.3476,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Carbamazepine, Tot, S (Mayo)OutsideLaboratory",,80156,CPT,Facility,Both,,,90,92,78.2,26.3672,92,BlueCross BlueShield Minnesota, Federal Employee Program,90.528,98.4,,percent of total billed charges,,
"Carbamazepine, Tot, S (Mayo)OutsideLaboratory",,80156,CPT,Facility,Both,,,90,92,78.2,26.3672,92,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,92,100,,percent of total billed charges,,
"Carbamazepine, Tot, S (Mayo)OutsideLaboratory",,80156,CPT,Facility,Both,,,90,92,78.2,26.3672,92,BlueCross BlueShield Minnesota,High Value Network Plan,82.8,90,,percent of total billed charges,,
"Carbamazepine, Tot, S (Mayo)OutsideLaboratory",,80156,CPT,Facility,Outpatient,,,90,92,78.2,26.3672,92,BlueCross BlueShield Minnesota,Medicare Advantage,45.08,49,,percent of total billed charges,,
"Carbamazepine, Tot, S (Mayo)OutsideLaboratory",,80156,CPT,Facility,Inpatient,,,90,92,78.2,26.3672,92,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Carbamazepine, Tot, S (Mayo)OutsideLaboratory",,80156,CPT,Facility,Both,,,90,92,78.2,26.3672,92,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,81.4844,88.57,,percent of total billed charges,,
"Carbamazepine, Tot, S (Mayo)OutsideLaboratory",,80156,CPT,Facility,Both,,,90,92,78.2,26.3672,92,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,26.3672,28.66,,percent of total billed charges,,
"Carbamazepine, Tot, S (Mayo)OutsideLaboratory",,80156,CPT,Facility,Outpatient,,,90,92,78.2,26.3672,92,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),45.08,49,,percent of total billed charges,,
"Carbamazepine, Tot, S (Mayo)OutsideLaboratory",,80156,CPT,Facility,Inpatient,,,90,92,78.2,26.3672,92,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Carbamazepine, Tot, S (Mayo)OutsideLaboratory",,80156,CPT,Facility,Both,,,90,92,78.2,26.3672,92,CorVel,Worker's Compensation,92,100,,percent of total billed charges,,
"Carbamazepine, Tot, S (Mayo)OutsideLaboratory",,80156,CPT,Facility,Both,,,90,92,78.2,26.3672,92,First Health Group Corporation,First Health Network,89.24,97,,percent of total billed charges,,
"Carbamazepine, Tot, S (Mayo)OutsideLaboratory",,80156,CPT,Facility,Both,,,90,92,78.2,26.3672,92,"Health Partners, Inc.",Commercial,87.032,94.6,,percent of total billed charges,,
"Carbamazepine, Tot, S (Mayo)OutsideLaboratory",,80156,CPT,Facility,Outpatient,,,90,92,78.2,26.3672,92,"Health Partners, Inc.",Medicare Advantage,45.08,49,,percent of total billed charges,,
"Carbamazepine, Tot, S (Mayo)OutsideLaboratory",,80156,CPT,Facility,Inpatient,,,90,92,78.2,26.3672,92,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Carbamazepine, Tot, S (Mayo)OutsideLaboratory",,80156,CPT,Facility,Both,,,90,92,78.2,26.3672,92,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),55.2,60,,percent of total billed charges,,
"Carbamazepine, Tot, S (Mayo)OutsideLaboratory",,80156,CPT,Facility,Both,,,90,92,78.2,26.3672,92,"Health Partners, Inc.",State of Minnesota Advantage Program,74.98,81.5,,percent of total billed charges,,
"Carbamazepine, Tot, S (Mayo)OutsideLaboratory",,80156,CPT,Facility,Both,,,90,92,78.2,26.3672,92,"Health Partners, Inc.",State Public Programs,46,50,,percent of total billed charges,,
"Carbamazepine, Tot, S (Mayo)OutsideLaboratory",,80156,CPT,Facility,Both,,,90,92,78.2,26.3672,92,Humana Insurance Company,Commercial PPO,87.4,95,,percent of total billed charges,,
"Carbamazepine, Tot, S (Mayo)OutsideLaboratory",,80156,CPT,Facility,Outpatient,,,90,92,78.2,26.3672,92,Humana Insurance Company,Medicare PPO,45.08,49,,percent of total billed charges,,
"Carbamazepine, Tot, S (Mayo)OutsideLaboratory",,80156,CPT,Facility,Inpatient,,,90,92,78.2,26.3672,92,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Carbamazepine, Tot, S (Mayo)OutsideLaboratory",,80156,CPT,Facility,Both,,,90,92,78.2,26.3672,92,Medica,Individual & Family,91.172,99.1,,percent of total billed charges,,
"Carbamazepine, Tot, S (Mayo)OutsideLaboratory",,80156,CPT,Facility,Outpatient,,,90,92,78.2,26.3672,92,Medica,Medica Advantage Solution,45.816,49.8,,percent of total billed charges,,
"Carbamazepine, Tot, S (Mayo)OutsideLaboratory",,80156,CPT,Facility,Inpatient,,,90,92,78.2,26.3672,92,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Carbamazepine, Tot, S (Mayo)OutsideLaboratory",,80156,CPT,Facility,Outpatient,,,90,92,78.2,26.3672,92,Medica,Medical Assistance,41.032,44.6,,percent of total billed charges,,
"Carbamazepine, Tot, S (Mayo)OutsideLaboratory",,80156,CPT,Facility,Inpatient,,,90,92,78.2,26.3672,92,Medica,Medical Assistance,,,,,Included in per diem rate,
"Carbamazepine, Tot, S (Mayo)OutsideLaboratory",,80156,CPT,Facility,Outpatient,,,90,92,78.2,26.3672,92,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,45.816,49.8,,percent of total billed charges,,
"Carbamazepine, Tot, S (Mayo)OutsideLaboratory",,80156,CPT,Facility,Inpatient,,,90,92,78.2,26.3672,92,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Carbamazepine, Tot, S (Mayo)OutsideLaboratory",,80156,CPT,Facility,Both,,,90,92,78.2,26.3672,92,"Multiplan, Inc.","Multiplan, Inc.",86.48,94,,percent of total billed charges,,
"Carbamazepine, Tot, S (Mayo)OutsideLaboratory",,80156,CPT,Facility,Outpatient,,,90,92,78.2,26.3672,92,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,79.488,86.4,,percent of total billed charges,,
"Carbamazepine, Tot, S (Mayo)OutsideLaboratory",,80156,CPT,Facility,Inpatient,,,90,92,78.2,26.3672,92,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Carbamazepine, Tot, S (Mayo)OutsideLaboratory",,80156,CPT,Facility,Both,,,90,92,78.2,26.3672,92,"Preferred One Administrative Services, INC.",PPO,90.712,98.6,,percent of total billed charges,,
"Carbamazepine, Tot, S (Mayo)OutsideLaboratory",,80156,CPT,Facility,Outpatient,,,90,92,78.2,26.3672,92,PrimeWest Health,Minnesota Senior Health Options (MSHO),47.334,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Carbamazepine, Tot, S (Mayo)OutsideLaboratory",,80156,CPT,Facility,Inpatient,,,90,92,78.2,26.3672,92,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Carbamazepine, Tot, S (Mayo)OutsideLaboratory",,80156,CPT,Facility,Outpatient,,,90,92,78.2,26.3672,92,PrimeWest Health,MinnesotaCare,47.2512,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Carbamazepine, Tot, S (Mayo)OutsideLaboratory",,80156,CPT,Facility,Inpatient,,,90,92,78.2,26.3672,92,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Carbamazepine, Tot, S (Mayo)OutsideLaboratory",,80156,CPT,Facility,Both,,,90,92,78.2,26.3672,92,Sanford Health Plan,Sanford Health Plan,84.64,92,,percent of total billed charges,,
"Carbamazepine, Tot, S (Mayo)OutsideLaboratory",,80156,CPT,Facility,Outpatient,,,90,92,78.2,26.3672,92,"UCare Health, Inc.",Individual & Family Plan,51.842,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Carbamazepine, Tot, S (Mayo)OutsideLaboratory",,80156,CPT,Facility,Inpatient,,,90,92,78.2,26.3672,92,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Carbamazepine, Tot, S (Mayo)OutsideLaboratory",,80156,CPT,Facility,Outpatient,,,90,92,78.2,26.3672,92,"UCare Health, Inc.",Medical Assistance,46.4324,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Carbamazepine, Tot, S (Mayo)OutsideLaboratory",,80156,CPT,Facility,Inpatient,,,90,92,78.2,26.3672,92,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Carbamazepine, Tot, S (Mayo)OutsideLaboratory",,80156,CPT,Facility,Outpatient,,,90,92,78.2,26.3672,92,"UCare Health, Inc.",Medicare Advantage,46.4324,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Carbamazepine, Tot, S (Mayo)OutsideLaboratory",,80156,CPT,Facility,Inpatient,,,90,92,78.2,26.3672,92,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Carbamazepine, Tot, S (Mayo)OutsideLaboratory",,80156,CPT,Facility,Outpatient,,,90,92,78.2,26.3672,92,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),46.4324,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Carbamazepine, Tot, S (Mayo)OutsideLaboratory",,80156,CPT,Facility,Inpatient,,,90,92,78.2,26.3672,92,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Carbamazepine, Tot, S (Mayo)OutsideLaboratory",,80156,CPT,Facility,Both,,,90,92,78.2,26.3672,92,UnitedHealthcare,Individual & Family,86.48,94,,percent of total billed charges,,
"Carbamazepine, Tot, S (Mayo)OutsideLaboratory",,80156,CPT,Facility,Outpatient,,,90,92,78.2,26.3672,92,UnitedHealthcare,Medicare Advantage,45.08,49,,percent of total billed charges,,
"Carbamazepine, Tot, S (Mayo)OutsideLaboratory",,80156,CPT,Facility,Inpatient,,,90,92,78.2,26.3672,92,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Carbamazepine, Tot, S (Mayo)OutsideLaboratory",,80156,CPT,Facility,Outpatient,,,90,92,78.2,26.3672,92,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,44.16,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Carbamazepine, Tot, S (Mayo)OutsideLaboratory",,80156,CPT,Facility,Inpatient,,,90,92,78.2,26.3672,92,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Carbamazepine, Free, S (Mayo)OutsideLaboratory",,80157,CPT,Facility,Both,,,90,92,78.2,26.3672,92,Aetna,Commercial,84.64,92,,percent of total billed charges,,
"Carbamazepine, Free, S (Mayo)OutsideLaboratory",,80157,CPT,Facility,Outpatient,,,90,92,78.2,26.3672,92,Aetna,Medicare Advantage,45.08,49,,percent of total billed charges,,
"Carbamazepine, Free, S (Mayo)OutsideLaboratory",,80157,CPT,Facility,Inpatient,,,90,92,78.2,26.3672,92,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Carbamazepine, Free, S (Mayo)OutsideLaboratory",,80157,CPT,Facility,Both,,,90,92,78.2,26.3672,92,Aetna,PPO,85.56,93,,percent of total billed charges,,
"Carbamazepine, Free, S (Mayo)OutsideLaboratory",,80157,CPT,Facility,Both,,,90,92,78.2,26.3672,92,America's PPO,America's PPO,88.3476,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Carbamazepine, Free, S (Mayo)OutsideLaboratory",,80157,CPT,Facility,Both,,,90,92,78.2,26.3672,92,BlueCross BlueShield Minnesota, Federal Employee Program,90.528,98.4,,percent of total billed charges,,
"Carbamazepine, Free, S (Mayo)OutsideLaboratory",,80157,CPT,Facility,Both,,,90,92,78.2,26.3672,92,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,92,100,,percent of total billed charges,,
"Carbamazepine, Free, S (Mayo)OutsideLaboratory",,80157,CPT,Facility,Both,,,90,92,78.2,26.3672,92,BlueCross BlueShield Minnesota,High Value Network Plan,82.8,90,,percent of total billed charges,,
"Carbamazepine, Free, S (Mayo)OutsideLaboratory",,80157,CPT,Facility,Outpatient,,,90,92,78.2,26.3672,92,BlueCross BlueShield Minnesota,Medicare Advantage,45.08,49,,percent of total billed charges,,
"Carbamazepine, Free, S (Mayo)OutsideLaboratory",,80157,CPT,Facility,Inpatient,,,90,92,78.2,26.3672,92,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Carbamazepine, Free, S (Mayo)OutsideLaboratory",,80157,CPT,Facility,Both,,,90,92,78.2,26.3672,92,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,81.4844,88.57,,percent of total billed charges,,
"Carbamazepine, Free, S (Mayo)OutsideLaboratory",,80157,CPT,Facility,Both,,,90,92,78.2,26.3672,92,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,26.3672,28.66,,percent of total billed charges,,
"Carbamazepine, Free, S (Mayo)OutsideLaboratory",,80157,CPT,Facility,Outpatient,,,90,92,78.2,26.3672,92,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),45.08,49,,percent of total billed charges,,
"Carbamazepine, Free, S (Mayo)OutsideLaboratory",,80157,CPT,Facility,Inpatient,,,90,92,78.2,26.3672,92,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Carbamazepine, Free, S (Mayo)OutsideLaboratory",,80157,CPT,Facility,Both,,,90,92,78.2,26.3672,92,CorVel,Worker's Compensation,92,100,,percent of total billed charges,,
"Carbamazepine, Free, S (Mayo)OutsideLaboratory",,80157,CPT,Facility,Both,,,90,92,78.2,26.3672,92,First Health Group Corporation,First Health Network,89.24,97,,percent of total billed charges,,
"Carbamazepine, Free, S (Mayo)OutsideLaboratory",,80157,CPT,Facility,Both,,,90,92,78.2,26.3672,92,"Health Partners, Inc.",Commercial,87.032,94.6,,percent of total billed charges,,
"Carbamazepine, Free, S (Mayo)OutsideLaboratory",,80157,CPT,Facility,Outpatient,,,90,92,78.2,26.3672,92,"Health Partners, Inc.",Medicare Advantage,45.08,49,,percent of total billed charges,,
"Carbamazepine, Free, S (Mayo)OutsideLaboratory",,80157,CPT,Facility,Inpatient,,,90,92,78.2,26.3672,92,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Carbamazepine, Free, S (Mayo)OutsideLaboratory",,80157,CPT,Facility,Both,,,90,92,78.2,26.3672,92,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),55.2,60,,percent of total billed charges,,
"Carbamazepine, Free, S (Mayo)OutsideLaboratory",,80157,CPT,Facility,Both,,,90,92,78.2,26.3672,92,"Health Partners, Inc.",State of Minnesota Advantage Program,74.98,81.5,,percent of total billed charges,,
"Carbamazepine, Free, S (Mayo)OutsideLaboratory",,80157,CPT,Facility,Both,,,90,92,78.2,26.3672,92,"Health Partners, Inc.",State Public Programs,46,50,,percent of total billed charges,,
"Carbamazepine, Free, S (Mayo)OutsideLaboratory",,80157,CPT,Facility,Both,,,90,92,78.2,26.3672,92,Humana Insurance Company,Commercial PPO,87.4,95,,percent of total billed charges,,
"Carbamazepine, Free, S (Mayo)OutsideLaboratory",,80157,CPT,Facility,Outpatient,,,90,92,78.2,26.3672,92,Humana Insurance Company,Medicare PPO,45.08,49,,percent of total billed charges,,
"Carbamazepine, Free, S (Mayo)OutsideLaboratory",,80157,CPT,Facility,Inpatient,,,90,92,78.2,26.3672,92,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Carbamazepine, Free, S (Mayo)OutsideLaboratory",,80157,CPT,Facility,Both,,,90,92,78.2,26.3672,92,Medica,Individual & Family,91.172,99.1,,percent of total billed charges,,
"Carbamazepine, Free, S (Mayo)OutsideLaboratory",,80157,CPT,Facility,Outpatient,,,90,92,78.2,26.3672,92,Medica,Medica Advantage Solution,45.816,49.8,,percent of total billed charges,,
"Carbamazepine, Free, S (Mayo)OutsideLaboratory",,80157,CPT,Facility,Inpatient,,,90,92,78.2,26.3672,92,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Carbamazepine, Free, S (Mayo)OutsideLaboratory",,80157,CPT,Facility,Outpatient,,,90,92,78.2,26.3672,92,Medica,Medical Assistance,41.032,44.6,,percent of total billed charges,,
"Carbamazepine, Free, S (Mayo)OutsideLaboratory",,80157,CPT,Facility,Inpatient,,,90,92,78.2,26.3672,92,Medica,Medical Assistance,,,,,Included in per diem rate,
"Carbamazepine, Free, S (Mayo)OutsideLaboratory",,80157,CPT,Facility,Outpatient,,,90,92,78.2,26.3672,92,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,45.816,49.8,,percent of total billed charges,,
"Carbamazepine, Free, S (Mayo)OutsideLaboratory",,80157,CPT,Facility,Inpatient,,,90,92,78.2,26.3672,92,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Carbamazepine, Free, S (Mayo)OutsideLaboratory",,80157,CPT,Facility,Both,,,90,92,78.2,26.3672,92,"Multiplan, Inc.","Multiplan, Inc.",86.48,94,,percent of total billed charges,,
"Carbamazepine, Free, S (Mayo)OutsideLaboratory",,80157,CPT,Facility,Outpatient,,,90,92,78.2,26.3672,92,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,79.488,86.4,,percent of total billed charges,,
"Carbamazepine, Free, S (Mayo)OutsideLaboratory",,80157,CPT,Facility,Inpatient,,,90,92,78.2,26.3672,92,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Carbamazepine, Free, S (Mayo)OutsideLaboratory",,80157,CPT,Facility,Both,,,90,92,78.2,26.3672,92,"Preferred One Administrative Services, INC.",PPO,90.712,98.6,,percent of total billed charges,,
"Carbamazepine, Free, S (Mayo)OutsideLaboratory",,80157,CPT,Facility,Outpatient,,,90,92,78.2,26.3672,92,PrimeWest Health,Minnesota Senior Health Options (MSHO),47.334,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Carbamazepine, Free, S (Mayo)OutsideLaboratory",,80157,CPT,Facility,Inpatient,,,90,92,78.2,26.3672,92,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Carbamazepine, Free, S (Mayo)OutsideLaboratory",,80157,CPT,Facility,Outpatient,,,90,92,78.2,26.3672,92,PrimeWest Health,MinnesotaCare,47.2512,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Carbamazepine, Free, S (Mayo)OutsideLaboratory",,80157,CPT,Facility,Inpatient,,,90,92,78.2,26.3672,92,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Carbamazepine, Free, S (Mayo)OutsideLaboratory",,80157,CPT,Facility,Both,,,90,92,78.2,26.3672,92,Sanford Health Plan,Sanford Health Plan,84.64,92,,percent of total billed charges,,
"Carbamazepine, Free, S (Mayo)OutsideLaboratory",,80157,CPT,Facility,Outpatient,,,90,92,78.2,26.3672,92,"UCare Health, Inc.",Individual & Family Plan,51.842,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Carbamazepine, Free, S (Mayo)OutsideLaboratory",,80157,CPT,Facility,Inpatient,,,90,92,78.2,26.3672,92,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Carbamazepine, Free, S (Mayo)OutsideLaboratory",,80157,CPT,Facility,Outpatient,,,90,92,78.2,26.3672,92,"UCare Health, Inc.",Medical Assistance,46.4324,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Carbamazepine, Free, S (Mayo)OutsideLaboratory",,80157,CPT,Facility,Inpatient,,,90,92,78.2,26.3672,92,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Carbamazepine, Free, S (Mayo)OutsideLaboratory",,80157,CPT,Facility,Outpatient,,,90,92,78.2,26.3672,92,"UCare Health, Inc.",Medicare Advantage,46.4324,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Carbamazepine, Free, S (Mayo)OutsideLaboratory",,80157,CPT,Facility,Inpatient,,,90,92,78.2,26.3672,92,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Carbamazepine, Free, S (Mayo)OutsideLaboratory",,80157,CPT,Facility,Outpatient,,,90,92,78.2,26.3672,92,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),46.4324,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Carbamazepine, Free, S (Mayo)OutsideLaboratory",,80157,CPT,Facility,Inpatient,,,90,92,78.2,26.3672,92,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Carbamazepine, Free, S (Mayo)OutsideLaboratory",,80157,CPT,Facility,Both,,,90,92,78.2,26.3672,92,UnitedHealthcare,Individual & Family,86.48,94,,percent of total billed charges,,
"Carbamazepine, Free, S (Mayo)OutsideLaboratory",,80157,CPT,Facility,Outpatient,,,90,92,78.2,26.3672,92,UnitedHealthcare,Medicare Advantage,45.08,49,,percent of total billed charges,,
"Carbamazepine, Free, S (Mayo)OutsideLaboratory",,80157,CPT,Facility,Inpatient,,,90,92,78.2,26.3672,92,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Carbamazepine, Free, S (Mayo)OutsideLaboratory",,80157,CPT,Facility,Outpatient,,,90,92,78.2,26.3672,92,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,44.16,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Carbamazepine, Free, S (Mayo)OutsideLaboratory",,80157,CPT,Facility,Inpatient,,,90,92,78.2,26.3672,92,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Cyclosporine, B (Mayo)OutsideLaboratory",,80158,CPT,Facility,Both,,,90,71,60.35,20.3486,71,Aetna,Commercial,65.32,92,,percent of total billed charges,,
"Cyclosporine, B (Mayo)OutsideLaboratory",,80158,CPT,Facility,Outpatient,,,90,71,60.35,20.3486,71,Aetna,Medicare Advantage,34.79,49,,percent of total billed charges,,
"Cyclosporine, B (Mayo)OutsideLaboratory",,80158,CPT,Facility,Inpatient,,,90,71,60.35,20.3486,71,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Cyclosporine, B (Mayo)OutsideLaboratory",,80158,CPT,Facility,Both,,,90,71,60.35,20.3486,71,Aetna,PPO,66.03,93,,percent of total billed charges,,
"Cyclosporine, B (Mayo)OutsideLaboratory",,80158,CPT,Facility,Both,,,90,71,60.35,20.3486,71,America's PPO,America's PPO,68.1813,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Cyclosporine, B (Mayo)OutsideLaboratory",,80158,CPT,Facility,Both,,,90,71,60.35,20.3486,71,BlueCross BlueShield Minnesota, Federal Employee Program,69.864,98.4,,percent of total billed charges,,
"Cyclosporine, B (Mayo)OutsideLaboratory",,80158,CPT,Facility,Both,,,90,71,60.35,20.3486,71,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,71,100,,percent of total billed charges,,
"Cyclosporine, B (Mayo)OutsideLaboratory",,80158,CPT,Facility,Both,,,90,71,60.35,20.3486,71,BlueCross BlueShield Minnesota,High Value Network Plan,63.9,90,,percent of total billed charges,,
"Cyclosporine, B (Mayo)OutsideLaboratory",,80158,CPT,Facility,Outpatient,,,90,71,60.35,20.3486,71,BlueCross BlueShield Minnesota,Medicare Advantage,34.79,49,,percent of total billed charges,,
"Cyclosporine, B (Mayo)OutsideLaboratory",,80158,CPT,Facility,Inpatient,,,90,71,60.35,20.3486,71,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Cyclosporine, B (Mayo)OutsideLaboratory",,80158,CPT,Facility,Both,,,90,71,60.35,20.3486,71,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,62.8847,88.57,,percent of total billed charges,,
"Cyclosporine, B (Mayo)OutsideLaboratory",,80158,CPT,Facility,Both,,,90,71,60.35,20.3486,71,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,20.3486,28.66,,percent of total billed charges,,
"Cyclosporine, B (Mayo)OutsideLaboratory",,80158,CPT,Facility,Outpatient,,,90,71,60.35,20.3486,71,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),34.79,49,,percent of total billed charges,,
"Cyclosporine, B (Mayo)OutsideLaboratory",,80158,CPT,Facility,Inpatient,,,90,71,60.35,20.3486,71,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Cyclosporine, B (Mayo)OutsideLaboratory",,80158,CPT,Facility,Both,,,90,71,60.35,20.3486,71,CorVel,Worker's Compensation,71,100,,percent of total billed charges,,
"Cyclosporine, B (Mayo)OutsideLaboratory",,80158,CPT,Facility,Both,,,90,71,60.35,20.3486,71,First Health Group Corporation,First Health Network,68.87,97,,percent of total billed charges,,
"Cyclosporine, B (Mayo)OutsideLaboratory",,80158,CPT,Facility,Both,,,90,71,60.35,20.3486,71,"Health Partners, Inc.",Commercial,67.166,94.6,,percent of total billed charges,,
"Cyclosporine, B (Mayo)OutsideLaboratory",,80158,CPT,Facility,Outpatient,,,90,71,60.35,20.3486,71,"Health Partners, Inc.",Medicare Advantage,34.79,49,,percent of total billed charges,,
"Cyclosporine, B (Mayo)OutsideLaboratory",,80158,CPT,Facility,Inpatient,,,90,71,60.35,20.3486,71,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Cyclosporine, B (Mayo)OutsideLaboratory",,80158,CPT,Facility,Both,,,90,71,60.35,20.3486,71,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),42.6,60,,percent of total billed charges,,
"Cyclosporine, B (Mayo)OutsideLaboratory",,80158,CPT,Facility,Both,,,90,71,60.35,20.3486,71,"Health Partners, Inc.",State of Minnesota Advantage Program,57.865,81.5,,percent of total billed charges,,
"Cyclosporine, B (Mayo)OutsideLaboratory",,80158,CPT,Facility,Both,,,90,71,60.35,20.3486,71,"Health Partners, Inc.",State Public Programs,35.5,50,,percent of total billed charges,,
"Cyclosporine, B (Mayo)OutsideLaboratory",,80158,CPT,Facility,Both,,,90,71,60.35,20.3486,71,Humana Insurance Company,Commercial PPO,67.45,95,,percent of total billed charges,,
"Cyclosporine, B (Mayo)OutsideLaboratory",,80158,CPT,Facility,Outpatient,,,90,71,60.35,20.3486,71,Humana Insurance Company,Medicare PPO,34.79,49,,percent of total billed charges,,
"Cyclosporine, B (Mayo)OutsideLaboratory",,80158,CPT,Facility,Inpatient,,,90,71,60.35,20.3486,71,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Cyclosporine, B (Mayo)OutsideLaboratory",,80158,CPT,Facility,Both,,,90,71,60.35,20.3486,71,Medica,Individual & Family,70.361,99.1,,percent of total billed charges,,
"Cyclosporine, B (Mayo)OutsideLaboratory",,80158,CPT,Facility,Outpatient,,,90,71,60.35,20.3486,71,Medica,Medica Advantage Solution,35.358,49.8,,percent of total billed charges,,
"Cyclosporine, B (Mayo)OutsideLaboratory",,80158,CPT,Facility,Inpatient,,,90,71,60.35,20.3486,71,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Cyclosporine, B (Mayo)OutsideLaboratory",,80158,CPT,Facility,Outpatient,,,90,71,60.35,20.3486,71,Medica,Medical Assistance,31.666,44.6,,percent of total billed charges,,
"Cyclosporine, B (Mayo)OutsideLaboratory",,80158,CPT,Facility,Inpatient,,,90,71,60.35,20.3486,71,Medica,Medical Assistance,,,,,Included in per diem rate,
"Cyclosporine, B (Mayo)OutsideLaboratory",,80158,CPT,Facility,Outpatient,,,90,71,60.35,20.3486,71,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,35.358,49.8,,percent of total billed charges,,
"Cyclosporine, B (Mayo)OutsideLaboratory",,80158,CPT,Facility,Inpatient,,,90,71,60.35,20.3486,71,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Cyclosporine, B (Mayo)OutsideLaboratory",,80158,CPT,Facility,Both,,,90,71,60.35,20.3486,71,"Multiplan, Inc.","Multiplan, Inc.",66.74,94,,percent of total billed charges,,
"Cyclosporine, B (Mayo)OutsideLaboratory",,80158,CPT,Facility,Outpatient,,,90,71,60.35,20.3486,71,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,61.344,86.4,,percent of total billed charges,,
"Cyclosporine, B (Mayo)OutsideLaboratory",,80158,CPT,Facility,Inpatient,,,90,71,60.35,20.3486,71,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Cyclosporine, B (Mayo)OutsideLaboratory",,80158,CPT,Facility,Both,,,90,71,60.35,20.3486,71,"Preferred One Administrative Services, INC.",PPO,70.006,98.6,,percent of total billed charges,,
"Cyclosporine, B (Mayo)OutsideLaboratory",,80158,CPT,Facility,Outpatient,,,90,71,60.35,20.3486,71,PrimeWest Health,Minnesota Senior Health Options (MSHO),36.5295,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Cyclosporine, B (Mayo)OutsideLaboratory",,80158,CPT,Facility,Inpatient,,,90,71,60.35,20.3486,71,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Cyclosporine, B (Mayo)OutsideLaboratory",,80158,CPT,Facility,Outpatient,,,90,71,60.35,20.3486,71,PrimeWest Health,MinnesotaCare,36.4656,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Cyclosporine, B (Mayo)OutsideLaboratory",,80158,CPT,Facility,Inpatient,,,90,71,60.35,20.3486,71,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Cyclosporine, B (Mayo)OutsideLaboratory",,80158,CPT,Facility,Both,,,90,71,60.35,20.3486,71,Sanford Health Plan,Sanford Health Plan,65.32,92,,percent of total billed charges,,
"Cyclosporine, B (Mayo)OutsideLaboratory",,80158,CPT,Facility,Outpatient,,,90,71,60.35,20.3486,71,"UCare Health, Inc.",Individual & Family Plan,40.0085,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Cyclosporine, B (Mayo)OutsideLaboratory",,80158,CPT,Facility,Inpatient,,,90,71,60.35,20.3486,71,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Cyclosporine, B (Mayo)OutsideLaboratory",,80158,CPT,Facility,Outpatient,,,90,71,60.35,20.3486,71,"UCare Health, Inc.",Medical Assistance,35.8337,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Cyclosporine, B (Mayo)OutsideLaboratory",,80158,CPT,Facility,Inpatient,,,90,71,60.35,20.3486,71,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Cyclosporine, B (Mayo)OutsideLaboratory",,80158,CPT,Facility,Outpatient,,,90,71,60.35,20.3486,71,"UCare Health, Inc.",Medicare Advantage,35.8337,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Cyclosporine, B (Mayo)OutsideLaboratory",,80158,CPT,Facility,Inpatient,,,90,71,60.35,20.3486,71,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Cyclosporine, B (Mayo)OutsideLaboratory",,80158,CPT,Facility,Outpatient,,,90,71,60.35,20.3486,71,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),35.8337,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Cyclosporine, B (Mayo)OutsideLaboratory",,80158,CPT,Facility,Inpatient,,,90,71,60.35,20.3486,71,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Cyclosporine, B (Mayo)OutsideLaboratory",,80158,CPT,Facility,Both,,,90,71,60.35,20.3486,71,UnitedHealthcare,Individual & Family,66.74,94,,percent of total billed charges,,
"Cyclosporine, B (Mayo)OutsideLaboratory",,80158,CPT,Facility,Outpatient,,,90,71,60.35,20.3486,71,UnitedHealthcare,Medicare Advantage,34.79,49,,percent of total billed charges,,
"Cyclosporine, B (Mayo)OutsideLaboratory",,80158,CPT,Facility,Inpatient,,,90,71,60.35,20.3486,71,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Cyclosporine, B (Mayo)OutsideLaboratory",,80158,CPT,Facility,Outpatient,,,90,71,60.35,20.3486,71,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,34.08,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Cyclosporine, B (Mayo)OutsideLaboratory",,80158,CPT,Facility,Inpatient,,,90,71,60.35,20.3486,71,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Clozapine, S (Mayo)OutsideLaboratory",,80159,CPT,Facility,Both,,,90,223,189.55,63.9118,223,Aetna,Commercial,205.16,92,,percent of total billed charges,,
"Clozapine, S (Mayo)OutsideLaboratory",,80159,CPT,Facility,Outpatient,,,90,223,189.55,63.9118,223,Aetna,Medicare Advantage,109.27,49,,percent of total billed charges,,
"Clozapine, S (Mayo)OutsideLaboratory",,80159,CPT,Facility,Inpatient,,,90,223,189.55,63.9118,223,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Clozapine, S (Mayo)OutsideLaboratory",,80159,CPT,Facility,Both,,,90,223,189.55,63.9118,223,Aetna,PPO,207.39,93,,percent of total billed charges,,
"Clozapine, S (Mayo)OutsideLaboratory",,80159,CPT,Facility,Both,,,90,223,189.55,63.9118,223,America's PPO,America's PPO,214.1469,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Clozapine, S (Mayo)OutsideLaboratory",,80159,CPT,Facility,Both,,,90,223,189.55,63.9118,223,BlueCross BlueShield Minnesota, Federal Employee Program,219.432,98.4,,percent of total billed charges,,
"Clozapine, S (Mayo)OutsideLaboratory",,80159,CPT,Facility,Both,,,90,223,189.55,63.9118,223,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,223,100,,percent of total billed charges,,
"Clozapine, S (Mayo)OutsideLaboratory",,80159,CPT,Facility,Both,,,90,223,189.55,63.9118,223,BlueCross BlueShield Minnesota,High Value Network Plan,200.7,90,,percent of total billed charges,,
"Clozapine, S (Mayo)OutsideLaboratory",,80159,CPT,Facility,Outpatient,,,90,223,189.55,63.9118,223,BlueCross BlueShield Minnesota,Medicare Advantage,109.27,49,,percent of total billed charges,,
"Clozapine, S (Mayo)OutsideLaboratory",,80159,CPT,Facility,Inpatient,,,90,223,189.55,63.9118,223,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Clozapine, S (Mayo)OutsideLaboratory",,80159,CPT,Facility,Both,,,90,223,189.55,63.9118,223,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,197.5111,88.57,,percent of total billed charges,,
"Clozapine, S (Mayo)OutsideLaboratory",,80159,CPT,Facility,Both,,,90,223,189.55,63.9118,223,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,63.9118,28.66,,percent of total billed charges,,
"Clozapine, S (Mayo)OutsideLaboratory",,80159,CPT,Facility,Outpatient,,,90,223,189.55,63.9118,223,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),109.27,49,,percent of total billed charges,,
"Clozapine, S (Mayo)OutsideLaboratory",,80159,CPT,Facility,Inpatient,,,90,223,189.55,63.9118,223,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Clozapine, S (Mayo)OutsideLaboratory",,80159,CPT,Facility,Both,,,90,223,189.55,63.9118,223,CorVel,Worker's Compensation,223,100,,percent of total billed charges,,
"Clozapine, S (Mayo)OutsideLaboratory",,80159,CPT,Facility,Both,,,90,223,189.55,63.9118,223,First Health Group Corporation,First Health Network,216.31,97,,percent of total billed charges,,
"Clozapine, S (Mayo)OutsideLaboratory",,80159,CPT,Facility,Both,,,90,223,189.55,63.9118,223,"Health Partners, Inc.",Commercial,210.958,94.6,,percent of total billed charges,,
"Clozapine, S (Mayo)OutsideLaboratory",,80159,CPT,Facility,Outpatient,,,90,223,189.55,63.9118,223,"Health Partners, Inc.",Medicare Advantage,109.27,49,,percent of total billed charges,,
"Clozapine, S (Mayo)OutsideLaboratory",,80159,CPT,Facility,Inpatient,,,90,223,189.55,63.9118,223,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Clozapine, S (Mayo)OutsideLaboratory",,80159,CPT,Facility,Both,,,90,223,189.55,63.9118,223,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),133.8,60,,percent of total billed charges,,
"Clozapine, S (Mayo)OutsideLaboratory",,80159,CPT,Facility,Both,,,90,223,189.55,63.9118,223,"Health Partners, Inc.",State of Minnesota Advantage Program,181.745,81.5,,percent of total billed charges,,
"Clozapine, S (Mayo)OutsideLaboratory",,80159,CPT,Facility,Both,,,90,223,189.55,63.9118,223,"Health Partners, Inc.",State Public Programs,111.5,50,,percent of total billed charges,,
"Clozapine, S (Mayo)OutsideLaboratory",,80159,CPT,Facility,Both,,,90,223,189.55,63.9118,223,Humana Insurance Company,Commercial PPO,211.85,95,,percent of total billed charges,,
"Clozapine, S (Mayo)OutsideLaboratory",,80159,CPT,Facility,Outpatient,,,90,223,189.55,63.9118,223,Humana Insurance Company,Medicare PPO,109.27,49,,percent of total billed charges,,
"Clozapine, S (Mayo)OutsideLaboratory",,80159,CPT,Facility,Inpatient,,,90,223,189.55,63.9118,223,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Clozapine, S (Mayo)OutsideLaboratory",,80159,CPT,Facility,Both,,,90,223,189.55,63.9118,223,Medica,Individual & Family,220.993,99.1,,percent of total billed charges,,
"Clozapine, S (Mayo)OutsideLaboratory",,80159,CPT,Facility,Outpatient,,,90,223,189.55,63.9118,223,Medica,Medica Advantage Solution,111.054,49.8,,percent of total billed charges,,
"Clozapine, S (Mayo)OutsideLaboratory",,80159,CPT,Facility,Inpatient,,,90,223,189.55,63.9118,223,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Clozapine, S (Mayo)OutsideLaboratory",,80159,CPT,Facility,Outpatient,,,90,223,189.55,63.9118,223,Medica,Medical Assistance,99.458,44.6,,percent of total billed charges,,
"Clozapine, S (Mayo)OutsideLaboratory",,80159,CPT,Facility,Inpatient,,,90,223,189.55,63.9118,223,Medica,Medical Assistance,,,,,Included in per diem rate,
"Clozapine, S (Mayo)OutsideLaboratory",,80159,CPT,Facility,Outpatient,,,90,223,189.55,63.9118,223,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,111.054,49.8,,percent of total billed charges,,
"Clozapine, S (Mayo)OutsideLaboratory",,80159,CPT,Facility,Inpatient,,,90,223,189.55,63.9118,223,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Clozapine, S (Mayo)OutsideLaboratory",,80159,CPT,Facility,Both,,,90,223,189.55,63.9118,223,"Multiplan, Inc.","Multiplan, Inc.",209.62,94,,percent of total billed charges,,
"Clozapine, S (Mayo)OutsideLaboratory",,80159,CPT,Facility,Outpatient,,,90,223,189.55,63.9118,223,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,192.672,86.4,,percent of total billed charges,,
"Clozapine, S (Mayo)OutsideLaboratory",,80159,CPT,Facility,Inpatient,,,90,223,189.55,63.9118,223,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Clozapine, S (Mayo)OutsideLaboratory",,80159,CPT,Facility,Both,,,90,223,189.55,63.9118,223,"Preferred One Administrative Services, INC.",PPO,219.878,98.6,,percent of total billed charges,,
"Clozapine, S (Mayo)OutsideLaboratory",,80159,CPT,Facility,Outpatient,,,90,223,189.55,63.9118,223,PrimeWest Health,Minnesota Senior Health Options (MSHO),114.7335,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Clozapine, S (Mayo)OutsideLaboratory",,80159,CPT,Facility,Inpatient,,,90,223,189.55,63.9118,223,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Clozapine, S (Mayo)OutsideLaboratory",,80159,CPT,Facility,Outpatient,,,90,223,189.55,63.9118,223,PrimeWest Health,MinnesotaCare,114.5328,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Clozapine, S (Mayo)OutsideLaboratory",,80159,CPT,Facility,Inpatient,,,90,223,189.55,63.9118,223,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Clozapine, S (Mayo)OutsideLaboratory",,80159,CPT,Facility,Both,,,90,223,189.55,63.9118,223,Sanford Health Plan,Sanford Health Plan,205.16,92,,percent of total billed charges,,
"Clozapine, S (Mayo)OutsideLaboratory",,80159,CPT,Facility,Outpatient,,,90,223,189.55,63.9118,223,"UCare Health, Inc.",Individual & Family Plan,125.6605,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Clozapine, S (Mayo)OutsideLaboratory",,80159,CPT,Facility,Inpatient,,,90,223,189.55,63.9118,223,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Clozapine, S (Mayo)OutsideLaboratory",,80159,CPT,Facility,Outpatient,,,90,223,189.55,63.9118,223,"UCare Health, Inc.",Medical Assistance,112.5481,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Clozapine, S (Mayo)OutsideLaboratory",,80159,CPT,Facility,Inpatient,,,90,223,189.55,63.9118,223,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Clozapine, S (Mayo)OutsideLaboratory",,80159,CPT,Facility,Outpatient,,,90,223,189.55,63.9118,223,"UCare Health, Inc.",Medicare Advantage,112.5481,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Clozapine, S (Mayo)OutsideLaboratory",,80159,CPT,Facility,Inpatient,,,90,223,189.55,63.9118,223,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Clozapine, S (Mayo)OutsideLaboratory",,80159,CPT,Facility,Outpatient,,,90,223,189.55,63.9118,223,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),112.5481,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Clozapine, S (Mayo)OutsideLaboratory",,80159,CPT,Facility,Inpatient,,,90,223,189.55,63.9118,223,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Clozapine, S (Mayo)OutsideLaboratory",,80159,CPT,Facility,Both,,,90,223,189.55,63.9118,223,UnitedHealthcare,Individual & Family,209.62,94,,percent of total billed charges,,
"Clozapine, S (Mayo)OutsideLaboratory",,80159,CPT,Facility,Outpatient,,,90,223,189.55,63.9118,223,UnitedHealthcare,Medicare Advantage,109.27,49,,percent of total billed charges,,
"Clozapine, S (Mayo)OutsideLaboratory",,80159,CPT,Facility,Inpatient,,,90,223,189.55,63.9118,223,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Clozapine, S (Mayo)OutsideLaboratory",,80159,CPT,Facility,Outpatient,,,90,223,189.55,63.9118,223,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,107.04,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Clozapine, S (Mayo)OutsideLaboratory",,80159,CPT,Facility,Inpatient,,,90,223,189.55,63.9118,223,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Valproic Acid, Total, S (Mayo)OutsideLaboratory",,80164,CPT,Facility,Both,,,90,102,86.7,29.2332,102,Aetna,Commercial,93.84,92,,percent of total billed charges,,
"Valproic Acid, Total, S (Mayo)OutsideLaboratory",,80164,CPT,Facility,Outpatient,,,90,102,86.7,29.2332,102,Aetna,Medicare Advantage,49.98,49,,percent of total billed charges,,
"Valproic Acid, Total, S (Mayo)OutsideLaboratory",,80164,CPT,Facility,Inpatient,,,90,102,86.7,29.2332,102,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Valproic Acid, Total, S (Mayo)OutsideLaboratory",,80164,CPT,Facility,Both,,,90,102,86.7,29.2332,102,Aetna,PPO,94.86,93,,percent of total billed charges,,
"Valproic Acid, Total, S (Mayo)OutsideLaboratory",,80164,CPT,Facility,Both,,,90,102,86.7,29.2332,102,America's PPO,America's PPO,97.9506,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Valproic Acid, Total, S (Mayo)OutsideLaboratory",,80164,CPT,Facility,Both,,,90,102,86.7,29.2332,102,BlueCross BlueShield Minnesota, Federal Employee Program,100.368,98.4,,percent of total billed charges,,
"Valproic Acid, Total, S (Mayo)OutsideLaboratory",,80164,CPT,Facility,Both,,,90,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,102,100,,percent of total billed charges,,
"Valproic Acid, Total, S (Mayo)OutsideLaboratory",,80164,CPT,Facility,Both,,,90,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,High Value Network Plan,91.8,90,,percent of total billed charges,,
"Valproic Acid, Total, S (Mayo)OutsideLaboratory",,80164,CPT,Facility,Outpatient,,,90,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,Medicare Advantage,49.98,49,,percent of total billed charges,,
"Valproic Acid, Total, S (Mayo)OutsideLaboratory",,80164,CPT,Facility,Inpatient,,,90,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Valproic Acid, Total, S (Mayo)OutsideLaboratory",,80164,CPT,Facility,Both,,,90,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,90.3414,88.57,,percent of total billed charges,,
"Valproic Acid, Total, S (Mayo)OutsideLaboratory",,80164,CPT,Facility,Both,,,90,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,29.2332,28.66,,percent of total billed charges,,
"Valproic Acid, Total, S (Mayo)OutsideLaboratory",,80164,CPT,Facility,Outpatient,,,90,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),49.98,49,,percent of total billed charges,,
"Valproic Acid, Total, S (Mayo)OutsideLaboratory",,80164,CPT,Facility,Inpatient,,,90,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Valproic Acid, Total, S (Mayo)OutsideLaboratory",,80164,CPT,Facility,Both,,,90,102,86.7,29.2332,102,CorVel,Worker's Compensation,102,100,,percent of total billed charges,,
"Valproic Acid, Total, S (Mayo)OutsideLaboratory",,80164,CPT,Facility,Both,,,90,102,86.7,29.2332,102,First Health Group Corporation,First Health Network,98.94,97,,percent of total billed charges,,
"Valproic Acid, Total, S (Mayo)OutsideLaboratory",,80164,CPT,Facility,Both,,,90,102,86.7,29.2332,102,"Health Partners, Inc.",Commercial,96.492,94.6,,percent of total billed charges,,
"Valproic Acid, Total, S (Mayo)OutsideLaboratory",,80164,CPT,Facility,Outpatient,,,90,102,86.7,29.2332,102,"Health Partners, Inc.",Medicare Advantage,49.98,49,,percent of total billed charges,,
"Valproic Acid, Total, S (Mayo)OutsideLaboratory",,80164,CPT,Facility,Inpatient,,,90,102,86.7,29.2332,102,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Valproic Acid, Total, S (Mayo)OutsideLaboratory",,80164,CPT,Facility,Both,,,90,102,86.7,29.2332,102,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),61.2,60,,percent of total billed charges,,
"Valproic Acid, Total, S (Mayo)OutsideLaboratory",,80164,CPT,Facility,Both,,,90,102,86.7,29.2332,102,"Health Partners, Inc.",State of Minnesota Advantage Program,83.13,81.5,,percent of total billed charges,,
"Valproic Acid, Total, S (Mayo)OutsideLaboratory",,80164,CPT,Facility,Both,,,90,102,86.7,29.2332,102,"Health Partners, Inc.",State Public Programs,51,50,,percent of total billed charges,,
"Valproic Acid, Total, S (Mayo)OutsideLaboratory",,80164,CPT,Facility,Both,,,90,102,86.7,29.2332,102,Humana Insurance Company,Commercial PPO,96.9,95,,percent of total billed charges,,
"Valproic Acid, Total, S (Mayo)OutsideLaboratory",,80164,CPT,Facility,Outpatient,,,90,102,86.7,29.2332,102,Humana Insurance Company,Medicare PPO,49.98,49,,percent of total billed charges,,
"Valproic Acid, Total, S (Mayo)OutsideLaboratory",,80164,CPT,Facility,Inpatient,,,90,102,86.7,29.2332,102,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Valproic Acid, Total, S (Mayo)OutsideLaboratory",,80164,CPT,Facility,Both,,,90,102,86.7,29.2332,102,Medica,Individual & Family,101.082,99.1,,percent of total billed charges,,
"Valproic Acid, Total, S (Mayo)OutsideLaboratory",,80164,CPT,Facility,Outpatient,,,90,102,86.7,29.2332,102,Medica,Medica Advantage Solution,50.796,49.8,,percent of total billed charges,,
"Valproic Acid, Total, S (Mayo)OutsideLaboratory",,80164,CPT,Facility,Inpatient,,,90,102,86.7,29.2332,102,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Valproic Acid, Total, S (Mayo)OutsideLaboratory",,80164,CPT,Facility,Outpatient,,,90,102,86.7,29.2332,102,Medica,Medical Assistance,45.492,44.6,,percent of total billed charges,,
"Valproic Acid, Total, S (Mayo)OutsideLaboratory",,80164,CPT,Facility,Inpatient,,,90,102,86.7,29.2332,102,Medica,Medical Assistance,,,,,Included in per diem rate,
"Valproic Acid, Total, S (Mayo)OutsideLaboratory",,80164,CPT,Facility,Outpatient,,,90,102,86.7,29.2332,102,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,50.796,49.8,,percent of total billed charges,,
"Valproic Acid, Total, S (Mayo)OutsideLaboratory",,80164,CPT,Facility,Inpatient,,,90,102,86.7,29.2332,102,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Valproic Acid, Total, S (Mayo)OutsideLaboratory",,80164,CPT,Facility,Both,,,90,102,86.7,29.2332,102,"Multiplan, Inc.","Multiplan, Inc.",95.88,94,,percent of total billed charges,,
"Valproic Acid, Total, S (Mayo)OutsideLaboratory",,80164,CPT,Facility,Outpatient,,,90,102,86.7,29.2332,102,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,88.128,86.4,,percent of total billed charges,,
"Valproic Acid, Total, S (Mayo)OutsideLaboratory",,80164,CPT,Facility,Inpatient,,,90,102,86.7,29.2332,102,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Valproic Acid, Total, S (Mayo)OutsideLaboratory",,80164,CPT,Facility,Both,,,90,102,86.7,29.2332,102,"Preferred One Administrative Services, INC.",PPO,100.572,98.6,,percent of total billed charges,,
"Valproic Acid, Total, S (Mayo)OutsideLaboratory",,80164,CPT,Facility,Outpatient,,,90,102,86.7,29.2332,102,PrimeWest Health,Minnesota Senior Health Options (MSHO),52.479,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Valproic Acid, Total, S (Mayo)OutsideLaboratory",,80164,CPT,Facility,Inpatient,,,90,102,86.7,29.2332,102,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Valproic Acid, Total, S (Mayo)OutsideLaboratory",,80164,CPT,Facility,Outpatient,,,90,102,86.7,29.2332,102,PrimeWest Health,MinnesotaCare,52.3872,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Valproic Acid, Total, S (Mayo)OutsideLaboratory",,80164,CPT,Facility,Inpatient,,,90,102,86.7,29.2332,102,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Valproic Acid, Total, S (Mayo)OutsideLaboratory",,80164,CPT,Facility,Both,,,90,102,86.7,29.2332,102,Sanford Health Plan,Sanford Health Plan,93.84,92,,percent of total billed charges,,
"Valproic Acid, Total, S (Mayo)OutsideLaboratory",,80164,CPT,Facility,Outpatient,,,90,102,86.7,29.2332,102,"UCare Health, Inc.",Individual & Family Plan,57.477,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Valproic Acid, Total, S (Mayo)OutsideLaboratory",,80164,CPT,Facility,Inpatient,,,90,102,86.7,29.2332,102,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Valproic Acid, Total, S (Mayo)OutsideLaboratory",,80164,CPT,Facility,Outpatient,,,90,102,86.7,29.2332,102,"UCare Health, Inc.",Medical Assistance,51.4794,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Valproic Acid, Total, S (Mayo)OutsideLaboratory",,80164,CPT,Facility,Inpatient,,,90,102,86.7,29.2332,102,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Valproic Acid, Total, S (Mayo)OutsideLaboratory",,80164,CPT,Facility,Outpatient,,,90,102,86.7,29.2332,102,"UCare Health, Inc.",Medicare Advantage,51.4794,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Valproic Acid, Total, S (Mayo)OutsideLaboratory",,80164,CPT,Facility,Inpatient,,,90,102,86.7,29.2332,102,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Valproic Acid, Total, S (Mayo)OutsideLaboratory",,80164,CPT,Facility,Outpatient,,,90,102,86.7,29.2332,102,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),51.4794,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Valproic Acid, Total, S (Mayo)OutsideLaboratory",,80164,CPT,Facility,Inpatient,,,90,102,86.7,29.2332,102,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Valproic Acid, Total, S (Mayo)OutsideLaboratory",,80164,CPT,Facility,Both,,,90,102,86.7,29.2332,102,UnitedHealthcare,Individual & Family,95.88,94,,percent of total billed charges,,
"Valproic Acid, Total, S (Mayo)OutsideLaboratory",,80164,CPT,Facility,Outpatient,,,90,102,86.7,29.2332,102,UnitedHealthcare,Medicare Advantage,49.98,49,,percent of total billed charges,,
"Valproic Acid, Total, S (Mayo)OutsideLaboratory",,80164,CPT,Facility,Inpatient,,,90,102,86.7,29.2332,102,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Valproic Acid, Total, S (Mayo)OutsideLaboratory",,80164,CPT,Facility,Outpatient,,,90,102,86.7,29.2332,102,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,48.96,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Valproic Acid, Total, S (Mayo)OutsideLaboratory",,80164,CPT,Facility,Inpatient,,,90,102,86.7,29.2332,102,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Felbamate (Felbatol), S (Mayo)OutsideLaboratory",,80167,CPT,Facility,Both,,,90,108,91.8,30.9528,108,Aetna,Commercial,99.36,92,,percent of total billed charges,,
"Felbamate (Felbatol), S (Mayo)OutsideLaboratory",,80167,CPT,Facility,Outpatient,,,90,108,91.8,30.9528,108,Aetna,Medicare Advantage,52.92,49,,percent of total billed charges,,
"Felbamate (Felbatol), S (Mayo)OutsideLaboratory",,80167,CPT,Facility,Inpatient,,,90,108,91.8,30.9528,108,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Felbamate (Felbatol), S (Mayo)OutsideLaboratory",,80167,CPT,Facility,Both,,,90,108,91.8,30.9528,108,Aetna,PPO,100.44,93,,percent of total billed charges,,
"Felbamate (Felbatol), S (Mayo)OutsideLaboratory",,80167,CPT,Facility,Both,,,90,108,91.8,30.9528,108,America's PPO,America's PPO,103.7124,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Felbamate (Felbatol), S (Mayo)OutsideLaboratory",,80167,CPT,Facility,Both,,,90,108,91.8,30.9528,108,BlueCross BlueShield Minnesota, Federal Employee Program,106.272,98.4,,percent of total billed charges,,
"Felbamate (Felbatol), S (Mayo)OutsideLaboratory",,80167,CPT,Facility,Both,,,90,108,91.8,30.9528,108,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,108,100,,percent of total billed charges,,
"Felbamate (Felbatol), S (Mayo)OutsideLaboratory",,80167,CPT,Facility,Both,,,90,108,91.8,30.9528,108,BlueCross BlueShield Minnesota,High Value Network Plan,97.2,90,,percent of total billed charges,,
"Felbamate (Felbatol), S (Mayo)OutsideLaboratory",,80167,CPT,Facility,Outpatient,,,90,108,91.8,30.9528,108,BlueCross BlueShield Minnesota,Medicare Advantage,52.92,49,,percent of total billed charges,,
"Felbamate (Felbatol), S (Mayo)OutsideLaboratory",,80167,CPT,Facility,Inpatient,,,90,108,91.8,30.9528,108,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Felbamate (Felbatol), S (Mayo)OutsideLaboratory",,80167,CPT,Facility,Both,,,90,108,91.8,30.9528,108,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,95.6556,88.57,,percent of total billed charges,,
"Felbamate (Felbatol), S (Mayo)OutsideLaboratory",,80167,CPT,Facility,Both,,,90,108,91.8,30.9528,108,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,30.9528,28.66,,percent of total billed charges,,
"Felbamate (Felbatol), S (Mayo)OutsideLaboratory",,80167,CPT,Facility,Outpatient,,,90,108,91.8,30.9528,108,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),52.92,49,,percent of total billed charges,,
"Felbamate (Felbatol), S (Mayo)OutsideLaboratory",,80167,CPT,Facility,Inpatient,,,90,108,91.8,30.9528,108,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Felbamate (Felbatol), S (Mayo)OutsideLaboratory",,80167,CPT,Facility,Both,,,90,108,91.8,30.9528,108,CorVel,Worker's Compensation,108,100,,percent of total billed charges,,
"Felbamate (Felbatol), S (Mayo)OutsideLaboratory",,80167,CPT,Facility,Both,,,90,108,91.8,30.9528,108,First Health Group Corporation,First Health Network,104.76,97,,percent of total billed charges,,
"Felbamate (Felbatol), S (Mayo)OutsideLaboratory",,80167,CPT,Facility,Both,,,90,108,91.8,30.9528,108,"Health Partners, Inc.",Commercial,102.168,94.6,,percent of total billed charges,,
"Felbamate (Felbatol), S (Mayo)OutsideLaboratory",,80167,CPT,Facility,Outpatient,,,90,108,91.8,30.9528,108,"Health Partners, Inc.",Medicare Advantage,52.92,49,,percent of total billed charges,,
"Felbamate (Felbatol), S (Mayo)OutsideLaboratory",,80167,CPT,Facility,Inpatient,,,90,108,91.8,30.9528,108,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Felbamate (Felbatol), S (Mayo)OutsideLaboratory",,80167,CPT,Facility,Both,,,90,108,91.8,30.9528,108,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),64.8,60,,percent of total billed charges,,
"Felbamate (Felbatol), S (Mayo)OutsideLaboratory",,80167,CPT,Facility,Both,,,90,108,91.8,30.9528,108,"Health Partners, Inc.",State of Minnesota Advantage Program,88.02,81.5,,percent of total billed charges,,
"Felbamate (Felbatol), S (Mayo)OutsideLaboratory",,80167,CPT,Facility,Both,,,90,108,91.8,30.9528,108,"Health Partners, Inc.",State Public Programs,54,50,,percent of total billed charges,,
"Felbamate (Felbatol), S (Mayo)OutsideLaboratory",,80167,CPT,Facility,Both,,,90,108,91.8,30.9528,108,Humana Insurance Company,Commercial PPO,102.6,95,,percent of total billed charges,,
"Felbamate (Felbatol), S (Mayo)OutsideLaboratory",,80167,CPT,Facility,Outpatient,,,90,108,91.8,30.9528,108,Humana Insurance Company,Medicare PPO,52.92,49,,percent of total billed charges,,
"Felbamate (Felbatol), S (Mayo)OutsideLaboratory",,80167,CPT,Facility,Inpatient,,,90,108,91.8,30.9528,108,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Felbamate (Felbatol), S (Mayo)OutsideLaboratory",,80167,CPT,Facility,Both,,,90,108,91.8,30.9528,108,Medica,Individual & Family,107.028,99.1,,percent of total billed charges,,
"Felbamate (Felbatol), S (Mayo)OutsideLaboratory",,80167,CPT,Facility,Outpatient,,,90,108,91.8,30.9528,108,Medica,Medica Advantage Solution,53.784,49.8,,percent of total billed charges,,
"Felbamate (Felbatol), S (Mayo)OutsideLaboratory",,80167,CPT,Facility,Inpatient,,,90,108,91.8,30.9528,108,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Felbamate (Felbatol), S (Mayo)OutsideLaboratory",,80167,CPT,Facility,Outpatient,,,90,108,91.8,30.9528,108,Medica,Medical Assistance,48.168,44.6,,percent of total billed charges,,
"Felbamate (Felbatol), S (Mayo)OutsideLaboratory",,80167,CPT,Facility,Inpatient,,,90,108,91.8,30.9528,108,Medica,Medical Assistance,,,,,Included in per diem rate,
"Felbamate (Felbatol), S (Mayo)OutsideLaboratory",,80167,CPT,Facility,Outpatient,,,90,108,91.8,30.9528,108,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,53.784,49.8,,percent of total billed charges,,
"Felbamate (Felbatol), S (Mayo)OutsideLaboratory",,80167,CPT,Facility,Inpatient,,,90,108,91.8,30.9528,108,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Felbamate (Felbatol), S (Mayo)OutsideLaboratory",,80167,CPT,Facility,Both,,,90,108,91.8,30.9528,108,"Multiplan, Inc.","Multiplan, Inc.",101.52,94,,percent of total billed charges,,
"Felbamate (Felbatol), S (Mayo)OutsideLaboratory",,80167,CPT,Facility,Outpatient,,,90,108,91.8,30.9528,108,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,93.312,86.4,,percent of total billed charges,,
"Felbamate (Felbatol), S (Mayo)OutsideLaboratory",,80167,CPT,Facility,Inpatient,,,90,108,91.8,30.9528,108,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Felbamate (Felbatol), S (Mayo)OutsideLaboratory",,80167,CPT,Facility,Both,,,90,108,91.8,30.9528,108,"Preferred One Administrative Services, INC.",PPO,106.488,98.6,,percent of total billed charges,,
"Felbamate (Felbatol), S (Mayo)OutsideLaboratory",,80167,CPT,Facility,Outpatient,,,90,108,91.8,30.9528,108,PrimeWest Health,Minnesota Senior Health Options (MSHO),55.566,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Felbamate (Felbatol), S (Mayo)OutsideLaboratory",,80167,CPT,Facility,Inpatient,,,90,108,91.8,30.9528,108,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Felbamate (Felbatol), S (Mayo)OutsideLaboratory",,80167,CPT,Facility,Outpatient,,,90,108,91.8,30.9528,108,PrimeWest Health,MinnesotaCare,55.4688,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Felbamate (Felbatol), S (Mayo)OutsideLaboratory",,80167,CPT,Facility,Inpatient,,,90,108,91.8,30.9528,108,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Felbamate (Felbatol), S (Mayo)OutsideLaboratory",,80167,CPT,Facility,Both,,,90,108,91.8,30.9528,108,Sanford Health Plan,Sanford Health Plan,99.36,92,,percent of total billed charges,,
"Felbamate (Felbatol), S (Mayo)OutsideLaboratory",,80167,CPT,Facility,Outpatient,,,90,108,91.8,30.9528,108,"UCare Health, Inc.",Individual & Family Plan,60.858,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Felbamate (Felbatol), S (Mayo)OutsideLaboratory",,80167,CPT,Facility,Inpatient,,,90,108,91.8,30.9528,108,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Felbamate (Felbatol), S (Mayo)OutsideLaboratory",,80167,CPT,Facility,Outpatient,,,90,108,91.8,30.9528,108,"UCare Health, Inc.",Medical Assistance,54.5076,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Felbamate (Felbatol), S (Mayo)OutsideLaboratory",,80167,CPT,Facility,Inpatient,,,90,108,91.8,30.9528,108,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Felbamate (Felbatol), S (Mayo)OutsideLaboratory",,80167,CPT,Facility,Outpatient,,,90,108,91.8,30.9528,108,"UCare Health, Inc.",Medicare Advantage,54.5076,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Felbamate (Felbatol), S (Mayo)OutsideLaboratory",,80167,CPT,Facility,Inpatient,,,90,108,91.8,30.9528,108,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Felbamate (Felbatol), S (Mayo)OutsideLaboratory",,80167,CPT,Facility,Outpatient,,,90,108,91.8,30.9528,108,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),54.5076,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Felbamate (Felbatol), S (Mayo)OutsideLaboratory",,80167,CPT,Facility,Inpatient,,,90,108,91.8,30.9528,108,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Felbamate (Felbatol), S (Mayo)OutsideLaboratory",,80167,CPT,Facility,Both,,,90,108,91.8,30.9528,108,UnitedHealthcare,Individual & Family,101.52,94,,percent of total billed charges,,
"Felbamate (Felbatol), S (Mayo)OutsideLaboratory",,80167,CPT,Facility,Outpatient,,,90,108,91.8,30.9528,108,UnitedHealthcare,Medicare Advantage,52.92,49,,percent of total billed charges,,
"Felbamate (Felbatol), S (Mayo)OutsideLaboratory",,80167,CPT,Facility,Inpatient,,,90,108,91.8,30.9528,108,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Felbamate (Felbatol), S (Mayo)OutsideLaboratory",,80167,CPT,Facility,Outpatient,,,90,108,91.8,30.9528,108,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,51.84,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Felbamate (Felbatol), S (Mayo)OutsideLaboratory",,80167,CPT,Facility,Inpatient,,,90,108,91.8,30.9528,108,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Ethosuximide, S (Mayo)OutsideLaboratory",,80168,CPT,Facility,Both,,,90,136,115.6,38.9776,136,Aetna,Commercial,125.12,92,,percent of total billed charges,,
"Ethosuximide, S (Mayo)OutsideLaboratory",,80168,CPT,Facility,Outpatient,,,90,136,115.6,38.9776,136,Aetna,Medicare Advantage,66.64,49,,percent of total billed charges,,
"Ethosuximide, S (Mayo)OutsideLaboratory",,80168,CPT,Facility,Inpatient,,,90,136,115.6,38.9776,136,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Ethosuximide, S (Mayo)OutsideLaboratory",,80168,CPT,Facility,Both,,,90,136,115.6,38.9776,136,Aetna,PPO,126.48,93,,percent of total billed charges,,
"Ethosuximide, S (Mayo)OutsideLaboratory",,80168,CPT,Facility,Both,,,90,136,115.6,38.9776,136,America's PPO,America's PPO,130.6008,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Ethosuximide, S (Mayo)OutsideLaboratory",,80168,CPT,Facility,Both,,,90,136,115.6,38.9776,136,BlueCross BlueShield Minnesota, Federal Employee Program,133.824,98.4,,percent of total billed charges,,
"Ethosuximide, S (Mayo)OutsideLaboratory",,80168,CPT,Facility,Both,,,90,136,115.6,38.9776,136,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,136,100,,percent of total billed charges,,
"Ethosuximide, S (Mayo)OutsideLaboratory",,80168,CPT,Facility,Both,,,90,136,115.6,38.9776,136,BlueCross BlueShield Minnesota,High Value Network Plan,122.4,90,,percent of total billed charges,,
"Ethosuximide, S (Mayo)OutsideLaboratory",,80168,CPT,Facility,Outpatient,,,90,136,115.6,38.9776,136,BlueCross BlueShield Minnesota,Medicare Advantage,66.64,49,,percent of total billed charges,,
"Ethosuximide, S (Mayo)OutsideLaboratory",,80168,CPT,Facility,Inpatient,,,90,136,115.6,38.9776,136,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Ethosuximide, S (Mayo)OutsideLaboratory",,80168,CPT,Facility,Both,,,90,136,115.6,38.9776,136,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,120.4552,88.57,,percent of total billed charges,,
"Ethosuximide, S (Mayo)OutsideLaboratory",,80168,CPT,Facility,Both,,,90,136,115.6,38.9776,136,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,38.9776,28.66,,percent of total billed charges,,
"Ethosuximide, S (Mayo)OutsideLaboratory",,80168,CPT,Facility,Outpatient,,,90,136,115.6,38.9776,136,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),66.64,49,,percent of total billed charges,,
"Ethosuximide, S (Mayo)OutsideLaboratory",,80168,CPT,Facility,Inpatient,,,90,136,115.6,38.9776,136,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Ethosuximide, S (Mayo)OutsideLaboratory",,80168,CPT,Facility,Both,,,90,136,115.6,38.9776,136,CorVel,Worker's Compensation,136,100,,percent of total billed charges,,
"Ethosuximide, S (Mayo)OutsideLaboratory",,80168,CPT,Facility,Both,,,90,136,115.6,38.9776,136,First Health Group Corporation,First Health Network,131.92,97,,percent of total billed charges,,
"Ethosuximide, S (Mayo)OutsideLaboratory",,80168,CPT,Facility,Both,,,90,136,115.6,38.9776,136,"Health Partners, Inc.",Commercial,128.656,94.6,,percent of total billed charges,,
"Ethosuximide, S (Mayo)OutsideLaboratory",,80168,CPT,Facility,Outpatient,,,90,136,115.6,38.9776,136,"Health Partners, Inc.",Medicare Advantage,66.64,49,,percent of total billed charges,,
"Ethosuximide, S (Mayo)OutsideLaboratory",,80168,CPT,Facility,Inpatient,,,90,136,115.6,38.9776,136,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Ethosuximide, S (Mayo)OutsideLaboratory",,80168,CPT,Facility,Both,,,90,136,115.6,38.9776,136,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),81.6,60,,percent of total billed charges,,
"Ethosuximide, S (Mayo)OutsideLaboratory",,80168,CPT,Facility,Both,,,90,136,115.6,38.9776,136,"Health Partners, Inc.",State of Minnesota Advantage Program,110.84,81.5,,percent of total billed charges,,
"Ethosuximide, S (Mayo)OutsideLaboratory",,80168,CPT,Facility,Both,,,90,136,115.6,38.9776,136,"Health Partners, Inc.",State Public Programs,68,50,,percent of total billed charges,,
"Ethosuximide, S (Mayo)OutsideLaboratory",,80168,CPT,Facility,Both,,,90,136,115.6,38.9776,136,Humana Insurance Company,Commercial PPO,129.2,95,,percent of total billed charges,,
"Ethosuximide, S (Mayo)OutsideLaboratory",,80168,CPT,Facility,Outpatient,,,90,136,115.6,38.9776,136,Humana Insurance Company,Medicare PPO,66.64,49,,percent of total billed charges,,
"Ethosuximide, S (Mayo)OutsideLaboratory",,80168,CPT,Facility,Inpatient,,,90,136,115.6,38.9776,136,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Ethosuximide, S (Mayo)OutsideLaboratory",,80168,CPT,Facility,Both,,,90,136,115.6,38.9776,136,Medica,Individual & Family,134.776,99.1,,percent of total billed charges,,
"Ethosuximide, S (Mayo)OutsideLaboratory",,80168,CPT,Facility,Outpatient,,,90,136,115.6,38.9776,136,Medica,Medica Advantage Solution,67.728,49.8,,percent of total billed charges,,
"Ethosuximide, S (Mayo)OutsideLaboratory",,80168,CPT,Facility,Inpatient,,,90,136,115.6,38.9776,136,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Ethosuximide, S (Mayo)OutsideLaboratory",,80168,CPT,Facility,Outpatient,,,90,136,115.6,38.9776,136,Medica,Medical Assistance,60.656,44.6,,percent of total billed charges,,
"Ethosuximide, S (Mayo)OutsideLaboratory",,80168,CPT,Facility,Inpatient,,,90,136,115.6,38.9776,136,Medica,Medical Assistance,,,,,Included in per diem rate,
"Ethosuximide, S (Mayo)OutsideLaboratory",,80168,CPT,Facility,Outpatient,,,90,136,115.6,38.9776,136,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,67.728,49.8,,percent of total billed charges,,
"Ethosuximide, S (Mayo)OutsideLaboratory",,80168,CPT,Facility,Inpatient,,,90,136,115.6,38.9776,136,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Ethosuximide, S (Mayo)OutsideLaboratory",,80168,CPT,Facility,Both,,,90,136,115.6,38.9776,136,"Multiplan, Inc.","Multiplan, Inc.",127.84,94,,percent of total billed charges,,
"Ethosuximide, S (Mayo)OutsideLaboratory",,80168,CPT,Facility,Outpatient,,,90,136,115.6,38.9776,136,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,117.504,86.4,,percent of total billed charges,,
"Ethosuximide, S (Mayo)OutsideLaboratory",,80168,CPT,Facility,Inpatient,,,90,136,115.6,38.9776,136,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Ethosuximide, S (Mayo)OutsideLaboratory",,80168,CPT,Facility,Both,,,90,136,115.6,38.9776,136,"Preferred One Administrative Services, INC.",PPO,134.096,98.6,,percent of total billed charges,,
"Ethosuximide, S (Mayo)OutsideLaboratory",,80168,CPT,Facility,Outpatient,,,90,136,115.6,38.9776,136,PrimeWest Health,Minnesota Senior Health Options (MSHO),69.972,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Ethosuximide, S (Mayo)OutsideLaboratory",,80168,CPT,Facility,Inpatient,,,90,136,115.6,38.9776,136,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Ethosuximide, S (Mayo)OutsideLaboratory",,80168,CPT,Facility,Outpatient,,,90,136,115.6,38.9776,136,PrimeWest Health,MinnesotaCare,69.8496,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Ethosuximide, S (Mayo)OutsideLaboratory",,80168,CPT,Facility,Inpatient,,,90,136,115.6,38.9776,136,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Ethosuximide, S (Mayo)OutsideLaboratory",,80168,CPT,Facility,Both,,,90,136,115.6,38.9776,136,Sanford Health Plan,Sanford Health Plan,125.12,92,,percent of total billed charges,,
"Ethosuximide, S (Mayo)OutsideLaboratory",,80168,CPT,Facility,Outpatient,,,90,136,115.6,38.9776,136,"UCare Health, Inc.",Individual & Family Plan,76.636,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Ethosuximide, S (Mayo)OutsideLaboratory",,80168,CPT,Facility,Inpatient,,,90,136,115.6,38.9776,136,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Ethosuximide, S (Mayo)OutsideLaboratory",,80168,CPT,Facility,Outpatient,,,90,136,115.6,38.9776,136,"UCare Health, Inc.",Medical Assistance,68.6392,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Ethosuximide, S (Mayo)OutsideLaboratory",,80168,CPT,Facility,Inpatient,,,90,136,115.6,38.9776,136,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Ethosuximide, S (Mayo)OutsideLaboratory",,80168,CPT,Facility,Outpatient,,,90,136,115.6,38.9776,136,"UCare Health, Inc.",Medicare Advantage,68.6392,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Ethosuximide, S (Mayo)OutsideLaboratory",,80168,CPT,Facility,Inpatient,,,90,136,115.6,38.9776,136,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Ethosuximide, S (Mayo)OutsideLaboratory",,80168,CPT,Facility,Outpatient,,,90,136,115.6,38.9776,136,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),68.6392,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Ethosuximide, S (Mayo)OutsideLaboratory",,80168,CPT,Facility,Inpatient,,,90,136,115.6,38.9776,136,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Ethosuximide, S (Mayo)OutsideLaboratory",,80168,CPT,Facility,Both,,,90,136,115.6,38.9776,136,UnitedHealthcare,Individual & Family,127.84,94,,percent of total billed charges,,
"Ethosuximide, S (Mayo)OutsideLaboratory",,80168,CPT,Facility,Outpatient,,,90,136,115.6,38.9776,136,UnitedHealthcare,Medicare Advantage,66.64,49,,percent of total billed charges,,
"Ethosuximide, S (Mayo)OutsideLaboratory",,80168,CPT,Facility,Inpatient,,,90,136,115.6,38.9776,136,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Ethosuximide, S (Mayo)OutsideLaboratory",,80168,CPT,Facility,Outpatient,,,90,136,115.6,38.9776,136,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,65.28,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Ethosuximide, S (Mayo)OutsideLaboratory",,80168,CPT,Facility,Inpatient,,,90,136,115.6,38.9776,136,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Lamotrigine, S (Mayo)OutsideLaboratory",,80175,CPT,Facility,Both,,,90,160,136,45.856,160,Aetna,Commercial,147.2,92,,percent of total billed charges,,
"Lamotrigine, S (Mayo)OutsideLaboratory",,80175,CPT,Facility,Outpatient,,,90,160,136,45.856,160,Aetna,Medicare Advantage,78.4,49,,percent of total billed charges,,
"Lamotrigine, S (Mayo)OutsideLaboratory",,80175,CPT,Facility,Inpatient,,,90,160,136,45.856,160,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Lamotrigine, S (Mayo)OutsideLaboratory",,80175,CPT,Facility,Both,,,90,160,136,45.856,160,Aetna,PPO,148.8,93,,percent of total billed charges,,
"Lamotrigine, S (Mayo)OutsideLaboratory",,80175,CPT,Facility,Both,,,90,160,136,45.856,160,America's PPO,America's PPO,153.648,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Lamotrigine, S (Mayo)OutsideLaboratory",,80175,CPT,Facility,Both,,,90,160,136,45.856,160,BlueCross BlueShield Minnesota, Federal Employee Program,157.44,98.4,,percent of total billed charges,,
"Lamotrigine, S (Mayo)OutsideLaboratory",,80175,CPT,Facility,Both,,,90,160,136,45.856,160,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,160,100,,percent of total billed charges,,
"Lamotrigine, S (Mayo)OutsideLaboratory",,80175,CPT,Facility,Both,,,90,160,136,45.856,160,BlueCross BlueShield Minnesota,High Value Network Plan,144,90,,percent of total billed charges,,
"Lamotrigine, S (Mayo)OutsideLaboratory",,80175,CPT,Facility,Outpatient,,,90,160,136,45.856,160,BlueCross BlueShield Minnesota,Medicare Advantage,78.4,49,,percent of total billed charges,,
"Lamotrigine, S (Mayo)OutsideLaboratory",,80175,CPT,Facility,Inpatient,,,90,160,136,45.856,160,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Lamotrigine, S (Mayo)OutsideLaboratory",,80175,CPT,Facility,Both,,,90,160,136,45.856,160,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,141.712,88.57,,percent of total billed charges,,
"Lamotrigine, S (Mayo)OutsideLaboratory",,80175,CPT,Facility,Both,,,90,160,136,45.856,160,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,45.856,28.66,,percent of total billed charges,,
"Lamotrigine, S (Mayo)OutsideLaboratory",,80175,CPT,Facility,Outpatient,,,90,160,136,45.856,160,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),78.4,49,,percent of total billed charges,,
"Lamotrigine, S (Mayo)OutsideLaboratory",,80175,CPT,Facility,Inpatient,,,90,160,136,45.856,160,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Lamotrigine, S (Mayo)OutsideLaboratory",,80175,CPT,Facility,Both,,,90,160,136,45.856,160,CorVel,Worker's Compensation,160,100,,percent of total billed charges,,
"Lamotrigine, S (Mayo)OutsideLaboratory",,80175,CPT,Facility,Both,,,90,160,136,45.856,160,First Health Group Corporation,First Health Network,155.2,97,,percent of total billed charges,,
"Lamotrigine, S (Mayo)OutsideLaboratory",,80175,CPT,Facility,Both,,,90,160,136,45.856,160,"Health Partners, Inc.",Commercial,151.36,94.6,,percent of total billed charges,,
"Lamotrigine, S (Mayo)OutsideLaboratory",,80175,CPT,Facility,Outpatient,,,90,160,136,45.856,160,"Health Partners, Inc.",Medicare Advantage,78.4,49,,percent of total billed charges,,
"Lamotrigine, S (Mayo)OutsideLaboratory",,80175,CPT,Facility,Inpatient,,,90,160,136,45.856,160,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Lamotrigine, S (Mayo)OutsideLaboratory",,80175,CPT,Facility,Both,,,90,160,136,45.856,160,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),96,60,,percent of total billed charges,,
"Lamotrigine, S (Mayo)OutsideLaboratory",,80175,CPT,Facility,Both,,,90,160,136,45.856,160,"Health Partners, Inc.",State of Minnesota Advantage Program,130.4,81.5,,percent of total billed charges,,
"Lamotrigine, S (Mayo)OutsideLaboratory",,80175,CPT,Facility,Both,,,90,160,136,45.856,160,"Health Partners, Inc.",State Public Programs,80,50,,percent of total billed charges,,
"Lamotrigine, S (Mayo)OutsideLaboratory",,80175,CPT,Facility,Both,,,90,160,136,45.856,160,Humana Insurance Company,Commercial PPO,152,95,,percent of total billed charges,,
"Lamotrigine, S (Mayo)OutsideLaboratory",,80175,CPT,Facility,Outpatient,,,90,160,136,45.856,160,Humana Insurance Company,Medicare PPO,78.4,49,,percent of total billed charges,,
"Lamotrigine, S (Mayo)OutsideLaboratory",,80175,CPT,Facility,Inpatient,,,90,160,136,45.856,160,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Lamotrigine, S (Mayo)OutsideLaboratory",,80175,CPT,Facility,Both,,,90,160,136,45.856,160,Medica,Individual & Family,158.56,99.1,,percent of total billed charges,,
"Lamotrigine, S (Mayo)OutsideLaboratory",,80175,CPT,Facility,Outpatient,,,90,160,136,45.856,160,Medica,Medica Advantage Solution,79.68,49.8,,percent of total billed charges,,
"Lamotrigine, S (Mayo)OutsideLaboratory",,80175,CPT,Facility,Inpatient,,,90,160,136,45.856,160,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Lamotrigine, S (Mayo)OutsideLaboratory",,80175,CPT,Facility,Outpatient,,,90,160,136,45.856,160,Medica,Medical Assistance,71.36,44.6,,percent of total billed charges,,
"Lamotrigine, S (Mayo)OutsideLaboratory",,80175,CPT,Facility,Inpatient,,,90,160,136,45.856,160,Medica,Medical Assistance,,,,,Included in per diem rate,
"Lamotrigine, S (Mayo)OutsideLaboratory",,80175,CPT,Facility,Outpatient,,,90,160,136,45.856,160,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,79.68,49.8,,percent of total billed charges,,
"Lamotrigine, S (Mayo)OutsideLaboratory",,80175,CPT,Facility,Inpatient,,,90,160,136,45.856,160,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Lamotrigine, S (Mayo)OutsideLaboratory",,80175,CPT,Facility,Both,,,90,160,136,45.856,160,"Multiplan, Inc.","Multiplan, Inc.",150.4,94,,percent of total billed charges,,
"Lamotrigine, S (Mayo)OutsideLaboratory",,80175,CPT,Facility,Outpatient,,,90,160,136,45.856,160,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,138.24,86.4,,percent of total billed charges,,
"Lamotrigine, S (Mayo)OutsideLaboratory",,80175,CPT,Facility,Inpatient,,,90,160,136,45.856,160,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Lamotrigine, S (Mayo)OutsideLaboratory",,80175,CPT,Facility,Both,,,90,160,136,45.856,160,"Preferred One Administrative Services, INC.",PPO,157.76,98.6,,percent of total billed charges,,
"Lamotrigine, S (Mayo)OutsideLaboratory",,80175,CPT,Facility,Outpatient,,,90,160,136,45.856,160,PrimeWest Health,Minnesota Senior Health Options (MSHO),82.32,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Lamotrigine, S (Mayo)OutsideLaboratory",,80175,CPT,Facility,Inpatient,,,90,160,136,45.856,160,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Lamotrigine, S (Mayo)OutsideLaboratory",,80175,CPT,Facility,Outpatient,,,90,160,136,45.856,160,PrimeWest Health,MinnesotaCare,82.176,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Lamotrigine, S (Mayo)OutsideLaboratory",,80175,CPT,Facility,Inpatient,,,90,160,136,45.856,160,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Lamotrigine, S (Mayo)OutsideLaboratory",,80175,CPT,Facility,Both,,,90,160,136,45.856,160,Sanford Health Plan,Sanford Health Plan,147.2,92,,percent of total billed charges,,
"Lamotrigine, S (Mayo)OutsideLaboratory",,80175,CPT,Facility,Outpatient,,,90,160,136,45.856,160,"UCare Health, Inc.",Individual & Family Plan,90.16,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Lamotrigine, S (Mayo)OutsideLaboratory",,80175,CPT,Facility,Inpatient,,,90,160,136,45.856,160,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Lamotrigine, S (Mayo)OutsideLaboratory",,80175,CPT,Facility,Outpatient,,,90,160,136,45.856,160,"UCare Health, Inc.",Medical Assistance,80.752,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Lamotrigine, S (Mayo)OutsideLaboratory",,80175,CPT,Facility,Inpatient,,,90,160,136,45.856,160,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Lamotrigine, S (Mayo)OutsideLaboratory",,80175,CPT,Facility,Outpatient,,,90,160,136,45.856,160,"UCare Health, Inc.",Medicare Advantage,80.752,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Lamotrigine, S (Mayo)OutsideLaboratory",,80175,CPT,Facility,Inpatient,,,90,160,136,45.856,160,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Lamotrigine, S (Mayo)OutsideLaboratory",,80175,CPT,Facility,Outpatient,,,90,160,136,45.856,160,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),80.752,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Lamotrigine, S (Mayo)OutsideLaboratory",,80175,CPT,Facility,Inpatient,,,90,160,136,45.856,160,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Lamotrigine, S (Mayo)OutsideLaboratory",,80175,CPT,Facility,Both,,,90,160,136,45.856,160,UnitedHealthcare,Individual & Family,150.4,94,,percent of total billed charges,,
"Lamotrigine, S (Mayo)OutsideLaboratory",,80175,CPT,Facility,Outpatient,,,90,160,136,45.856,160,UnitedHealthcare,Medicare Advantage,78.4,49,,percent of total billed charges,,
"Lamotrigine, S (Mayo)OutsideLaboratory",,80175,CPT,Facility,Inpatient,,,90,160,136,45.856,160,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Lamotrigine, S (Mayo)OutsideLaboratory",,80175,CPT,Facility,Outpatient,,,90,160,136,45.856,160,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,76.8,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Lamotrigine, S (Mayo)OutsideLaboratory",,80175,CPT,Facility,Inpatient,,,90,160,136,45.856,160,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Levetiracetam, S (Mayo)OutsideLaboratory",,80177,CPT,Facility,Both,,,90,157,133.45,44.9962,157,Aetna,Commercial,144.44,92,,percent of total billed charges,,
"Levetiracetam, S (Mayo)OutsideLaboratory",,80177,CPT,Facility,Outpatient,,,90,157,133.45,44.9962,157,Aetna,Medicare Advantage,76.93,49,,percent of total billed charges,,
"Levetiracetam, S (Mayo)OutsideLaboratory",,80177,CPT,Facility,Inpatient,,,90,157,133.45,44.9962,157,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Levetiracetam, S (Mayo)OutsideLaboratory",,80177,CPT,Facility,Both,,,90,157,133.45,44.9962,157,Aetna,PPO,146.01,93,,percent of total billed charges,,
"Levetiracetam, S (Mayo)OutsideLaboratory",,80177,CPT,Facility,Both,,,90,157,133.45,44.9962,157,America's PPO,America's PPO,150.7671,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Levetiracetam, S (Mayo)OutsideLaboratory",,80177,CPT,Facility,Both,,,90,157,133.45,44.9962,157,BlueCross BlueShield Minnesota, Federal Employee Program,154.488,98.4,,percent of total billed charges,,
"Levetiracetam, S (Mayo)OutsideLaboratory",,80177,CPT,Facility,Both,,,90,157,133.45,44.9962,157,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,157,100,,percent of total billed charges,,
"Levetiracetam, S (Mayo)OutsideLaboratory",,80177,CPT,Facility,Both,,,90,157,133.45,44.9962,157,BlueCross BlueShield Minnesota,High Value Network Plan,141.3,90,,percent of total billed charges,,
"Levetiracetam, S (Mayo)OutsideLaboratory",,80177,CPT,Facility,Outpatient,,,90,157,133.45,44.9962,157,BlueCross BlueShield Minnesota,Medicare Advantage,76.93,49,,percent of total billed charges,,
"Levetiracetam, S (Mayo)OutsideLaboratory",,80177,CPT,Facility,Inpatient,,,90,157,133.45,44.9962,157,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Levetiracetam, S (Mayo)OutsideLaboratory",,80177,CPT,Facility,Both,,,90,157,133.45,44.9962,157,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,139.0549,88.57,,percent of total billed charges,,
"Levetiracetam, S (Mayo)OutsideLaboratory",,80177,CPT,Facility,Both,,,90,157,133.45,44.9962,157,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,44.9962,28.66,,percent of total billed charges,,
"Levetiracetam, S (Mayo)OutsideLaboratory",,80177,CPT,Facility,Outpatient,,,90,157,133.45,44.9962,157,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),76.93,49,,percent of total billed charges,,
"Levetiracetam, S (Mayo)OutsideLaboratory",,80177,CPT,Facility,Inpatient,,,90,157,133.45,44.9962,157,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Levetiracetam, S (Mayo)OutsideLaboratory",,80177,CPT,Facility,Both,,,90,157,133.45,44.9962,157,CorVel,Worker's Compensation,157,100,,percent of total billed charges,,
"Levetiracetam, S (Mayo)OutsideLaboratory",,80177,CPT,Facility,Both,,,90,157,133.45,44.9962,157,First Health Group Corporation,First Health Network,152.29,97,,percent of total billed charges,,
"Levetiracetam, S (Mayo)OutsideLaboratory",,80177,CPT,Facility,Both,,,90,157,133.45,44.9962,157,"Health Partners, Inc.",Commercial,148.522,94.6,,percent of total billed charges,,
"Levetiracetam, S (Mayo)OutsideLaboratory",,80177,CPT,Facility,Outpatient,,,90,157,133.45,44.9962,157,"Health Partners, Inc.",Medicare Advantage,76.93,49,,percent of total billed charges,,
"Levetiracetam, S (Mayo)OutsideLaboratory",,80177,CPT,Facility,Inpatient,,,90,157,133.45,44.9962,157,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Levetiracetam, S (Mayo)OutsideLaboratory",,80177,CPT,Facility,Both,,,90,157,133.45,44.9962,157,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),94.2,60,,percent of total billed charges,,
"Levetiracetam, S (Mayo)OutsideLaboratory",,80177,CPT,Facility,Both,,,90,157,133.45,44.9962,157,"Health Partners, Inc.",State of Minnesota Advantage Program,127.955,81.5,,percent of total billed charges,,
"Levetiracetam, S (Mayo)OutsideLaboratory",,80177,CPT,Facility,Both,,,90,157,133.45,44.9962,157,"Health Partners, Inc.",State Public Programs,78.5,50,,percent of total billed charges,,
"Levetiracetam, S (Mayo)OutsideLaboratory",,80177,CPT,Facility,Both,,,90,157,133.45,44.9962,157,Humana Insurance Company,Commercial PPO,149.15,95,,percent of total billed charges,,
"Levetiracetam, S (Mayo)OutsideLaboratory",,80177,CPT,Facility,Outpatient,,,90,157,133.45,44.9962,157,Humana Insurance Company,Medicare PPO,76.93,49,,percent of total billed charges,,
"Levetiracetam, S (Mayo)OutsideLaboratory",,80177,CPT,Facility,Inpatient,,,90,157,133.45,44.9962,157,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Levetiracetam, S (Mayo)OutsideLaboratory",,80177,CPT,Facility,Both,,,90,157,133.45,44.9962,157,Medica,Individual & Family,155.587,99.1,,percent of total billed charges,,
"Levetiracetam, S (Mayo)OutsideLaboratory",,80177,CPT,Facility,Outpatient,,,90,157,133.45,44.9962,157,Medica,Medica Advantage Solution,78.186,49.8,,percent of total billed charges,,
"Levetiracetam, S (Mayo)OutsideLaboratory",,80177,CPT,Facility,Inpatient,,,90,157,133.45,44.9962,157,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Levetiracetam, S (Mayo)OutsideLaboratory",,80177,CPT,Facility,Outpatient,,,90,157,133.45,44.9962,157,Medica,Medical Assistance,70.022,44.6,,percent of total billed charges,,
"Levetiracetam, S (Mayo)OutsideLaboratory",,80177,CPT,Facility,Inpatient,,,90,157,133.45,44.9962,157,Medica,Medical Assistance,,,,,Included in per diem rate,
"Levetiracetam, S (Mayo)OutsideLaboratory",,80177,CPT,Facility,Outpatient,,,90,157,133.45,44.9962,157,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,78.186,49.8,,percent of total billed charges,,
"Levetiracetam, S (Mayo)OutsideLaboratory",,80177,CPT,Facility,Inpatient,,,90,157,133.45,44.9962,157,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Levetiracetam, S (Mayo)OutsideLaboratory",,80177,CPT,Facility,Both,,,90,157,133.45,44.9962,157,"Multiplan, Inc.","Multiplan, Inc.",147.58,94,,percent of total billed charges,,
"Levetiracetam, S (Mayo)OutsideLaboratory",,80177,CPT,Facility,Outpatient,,,90,157,133.45,44.9962,157,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,135.648,86.4,,percent of total billed charges,,
"Levetiracetam, S (Mayo)OutsideLaboratory",,80177,CPT,Facility,Inpatient,,,90,157,133.45,44.9962,157,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Levetiracetam, S (Mayo)OutsideLaboratory",,80177,CPT,Facility,Both,,,90,157,133.45,44.9962,157,"Preferred One Administrative Services, INC.",PPO,154.802,98.6,,percent of total billed charges,,
"Levetiracetam, S (Mayo)OutsideLaboratory",,80177,CPT,Facility,Outpatient,,,90,157,133.45,44.9962,157,PrimeWest Health,Minnesota Senior Health Options (MSHO),80.7765,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Levetiracetam, S (Mayo)OutsideLaboratory",,80177,CPT,Facility,Inpatient,,,90,157,133.45,44.9962,157,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Levetiracetam, S (Mayo)OutsideLaboratory",,80177,CPT,Facility,Outpatient,,,90,157,133.45,44.9962,157,PrimeWest Health,MinnesotaCare,80.6352,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Levetiracetam, S (Mayo)OutsideLaboratory",,80177,CPT,Facility,Inpatient,,,90,157,133.45,44.9962,157,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Levetiracetam, S (Mayo)OutsideLaboratory",,80177,CPT,Facility,Both,,,90,157,133.45,44.9962,157,Sanford Health Plan,Sanford Health Plan,144.44,92,,percent of total billed charges,,
"Levetiracetam, S (Mayo)OutsideLaboratory",,80177,CPT,Facility,Outpatient,,,90,157,133.45,44.9962,157,"UCare Health, Inc.",Individual & Family Plan,88.4695,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Levetiracetam, S (Mayo)OutsideLaboratory",,80177,CPT,Facility,Inpatient,,,90,157,133.45,44.9962,157,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Levetiracetam, S (Mayo)OutsideLaboratory",,80177,CPT,Facility,Outpatient,,,90,157,133.45,44.9962,157,"UCare Health, Inc.",Medical Assistance,79.2379,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Levetiracetam, S (Mayo)OutsideLaboratory",,80177,CPT,Facility,Inpatient,,,90,157,133.45,44.9962,157,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Levetiracetam, S (Mayo)OutsideLaboratory",,80177,CPT,Facility,Outpatient,,,90,157,133.45,44.9962,157,"UCare Health, Inc.",Medicare Advantage,79.2379,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Levetiracetam, S (Mayo)OutsideLaboratory",,80177,CPT,Facility,Inpatient,,,90,157,133.45,44.9962,157,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Levetiracetam, S (Mayo)OutsideLaboratory",,80177,CPT,Facility,Outpatient,,,90,157,133.45,44.9962,157,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),79.2379,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Levetiracetam, S (Mayo)OutsideLaboratory",,80177,CPT,Facility,Inpatient,,,90,157,133.45,44.9962,157,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Levetiracetam, S (Mayo)OutsideLaboratory",,80177,CPT,Facility,Both,,,90,157,133.45,44.9962,157,UnitedHealthcare,Individual & Family,147.58,94,,percent of total billed charges,,
"Levetiracetam, S (Mayo)OutsideLaboratory",,80177,CPT,Facility,Outpatient,,,90,157,133.45,44.9962,157,UnitedHealthcare,Medicare Advantage,76.93,49,,percent of total billed charges,,
"Levetiracetam, S (Mayo)OutsideLaboratory",,80177,CPT,Facility,Inpatient,,,90,157,133.45,44.9962,157,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Levetiracetam, S (Mayo)OutsideLaboratory",,80177,CPT,Facility,Outpatient,,,90,157,133.45,44.9962,157,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,75.36,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Levetiracetam, S (Mayo)OutsideLaboratory",,80177,CPT,Facility,Inpatient,,,90,157,133.45,44.9962,157,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Mycophenolic Acid, S (Mayo)OutsideLaboratory",,80180,CPT,Facility,Both,,,90,122,103.7,34.9652,122,Aetna,Commercial,112.24,92,,percent of total billed charges,,
"Mycophenolic Acid, S (Mayo)OutsideLaboratory",,80180,CPT,Facility,Outpatient,,,90,122,103.7,34.9652,122,Aetna,Medicare Advantage,59.78,49,,percent of total billed charges,,
"Mycophenolic Acid, S (Mayo)OutsideLaboratory",,80180,CPT,Facility,Inpatient,,,90,122,103.7,34.9652,122,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Mycophenolic Acid, S (Mayo)OutsideLaboratory",,80180,CPT,Facility,Both,,,90,122,103.7,34.9652,122,Aetna,PPO,113.46,93,,percent of total billed charges,,
"Mycophenolic Acid, S (Mayo)OutsideLaboratory",,80180,CPT,Facility,Both,,,90,122,103.7,34.9652,122,America's PPO,America's PPO,117.1566,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Mycophenolic Acid, S (Mayo)OutsideLaboratory",,80180,CPT,Facility,Both,,,90,122,103.7,34.9652,122,BlueCross BlueShield Minnesota, Federal Employee Program,120.048,98.4,,percent of total billed charges,,
"Mycophenolic Acid, S (Mayo)OutsideLaboratory",,80180,CPT,Facility,Both,,,90,122,103.7,34.9652,122,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,122,100,,percent of total billed charges,,
"Mycophenolic Acid, S (Mayo)OutsideLaboratory",,80180,CPT,Facility,Both,,,90,122,103.7,34.9652,122,BlueCross BlueShield Minnesota,High Value Network Plan,109.8,90,,percent of total billed charges,,
"Mycophenolic Acid, S (Mayo)OutsideLaboratory",,80180,CPT,Facility,Outpatient,,,90,122,103.7,34.9652,122,BlueCross BlueShield Minnesota,Medicare Advantage,59.78,49,,percent of total billed charges,,
"Mycophenolic Acid, S (Mayo)OutsideLaboratory",,80180,CPT,Facility,Inpatient,,,90,122,103.7,34.9652,122,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Mycophenolic Acid, S (Mayo)OutsideLaboratory",,80180,CPT,Facility,Both,,,90,122,103.7,34.9652,122,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,108.0554,88.57,,percent of total billed charges,,
"Mycophenolic Acid, S (Mayo)OutsideLaboratory",,80180,CPT,Facility,Both,,,90,122,103.7,34.9652,122,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,34.9652,28.66,,percent of total billed charges,,
"Mycophenolic Acid, S (Mayo)OutsideLaboratory",,80180,CPT,Facility,Outpatient,,,90,122,103.7,34.9652,122,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),59.78,49,,percent of total billed charges,,
"Mycophenolic Acid, S (Mayo)OutsideLaboratory",,80180,CPT,Facility,Inpatient,,,90,122,103.7,34.9652,122,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Mycophenolic Acid, S (Mayo)OutsideLaboratory",,80180,CPT,Facility,Both,,,90,122,103.7,34.9652,122,CorVel,Worker's Compensation,122,100,,percent of total billed charges,,
"Mycophenolic Acid, S (Mayo)OutsideLaboratory",,80180,CPT,Facility,Both,,,90,122,103.7,34.9652,122,First Health Group Corporation,First Health Network,118.34,97,,percent of total billed charges,,
"Mycophenolic Acid, S (Mayo)OutsideLaboratory",,80180,CPT,Facility,Both,,,90,122,103.7,34.9652,122,"Health Partners, Inc.",Commercial,115.412,94.6,,percent of total billed charges,,
"Mycophenolic Acid, S (Mayo)OutsideLaboratory",,80180,CPT,Facility,Outpatient,,,90,122,103.7,34.9652,122,"Health Partners, Inc.",Medicare Advantage,59.78,49,,percent of total billed charges,,
"Mycophenolic Acid, S (Mayo)OutsideLaboratory",,80180,CPT,Facility,Inpatient,,,90,122,103.7,34.9652,122,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Mycophenolic Acid, S (Mayo)OutsideLaboratory",,80180,CPT,Facility,Both,,,90,122,103.7,34.9652,122,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),73.2,60,,percent of total billed charges,,
"Mycophenolic Acid, S (Mayo)OutsideLaboratory",,80180,CPT,Facility,Both,,,90,122,103.7,34.9652,122,"Health Partners, Inc.",State of Minnesota Advantage Program,99.43,81.5,,percent of total billed charges,,
"Mycophenolic Acid, S (Mayo)OutsideLaboratory",,80180,CPT,Facility,Both,,,90,122,103.7,34.9652,122,"Health Partners, Inc.",State Public Programs,61,50,,percent of total billed charges,,
"Mycophenolic Acid, S (Mayo)OutsideLaboratory",,80180,CPT,Facility,Both,,,90,122,103.7,34.9652,122,Humana Insurance Company,Commercial PPO,115.9,95,,percent of total billed charges,,
"Mycophenolic Acid, S (Mayo)OutsideLaboratory",,80180,CPT,Facility,Outpatient,,,90,122,103.7,34.9652,122,Humana Insurance Company,Medicare PPO,59.78,49,,percent of total billed charges,,
"Mycophenolic Acid, S (Mayo)OutsideLaboratory",,80180,CPT,Facility,Inpatient,,,90,122,103.7,34.9652,122,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Mycophenolic Acid, S (Mayo)OutsideLaboratory",,80180,CPT,Facility,Both,,,90,122,103.7,34.9652,122,Medica,Individual & Family,120.902,99.1,,percent of total billed charges,,
"Mycophenolic Acid, S (Mayo)OutsideLaboratory",,80180,CPT,Facility,Outpatient,,,90,122,103.7,34.9652,122,Medica,Medica Advantage Solution,60.756,49.8,,percent of total billed charges,,
"Mycophenolic Acid, S (Mayo)OutsideLaboratory",,80180,CPT,Facility,Inpatient,,,90,122,103.7,34.9652,122,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Mycophenolic Acid, S (Mayo)OutsideLaboratory",,80180,CPT,Facility,Outpatient,,,90,122,103.7,34.9652,122,Medica,Medical Assistance,54.412,44.6,,percent of total billed charges,,
"Mycophenolic Acid, S (Mayo)OutsideLaboratory",,80180,CPT,Facility,Inpatient,,,90,122,103.7,34.9652,122,Medica,Medical Assistance,,,,,Included in per diem rate,
"Mycophenolic Acid, S (Mayo)OutsideLaboratory",,80180,CPT,Facility,Outpatient,,,90,122,103.7,34.9652,122,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,60.756,49.8,,percent of total billed charges,,
"Mycophenolic Acid, S (Mayo)OutsideLaboratory",,80180,CPT,Facility,Inpatient,,,90,122,103.7,34.9652,122,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Mycophenolic Acid, S (Mayo)OutsideLaboratory",,80180,CPT,Facility,Both,,,90,122,103.7,34.9652,122,"Multiplan, Inc.","Multiplan, Inc.",114.68,94,,percent of total billed charges,,
"Mycophenolic Acid, S (Mayo)OutsideLaboratory",,80180,CPT,Facility,Outpatient,,,90,122,103.7,34.9652,122,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,105.408,86.4,,percent of total billed charges,,
"Mycophenolic Acid, S (Mayo)OutsideLaboratory",,80180,CPT,Facility,Inpatient,,,90,122,103.7,34.9652,122,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Mycophenolic Acid, S (Mayo)OutsideLaboratory",,80180,CPT,Facility,Both,,,90,122,103.7,34.9652,122,"Preferred One Administrative Services, INC.",PPO,120.292,98.6,,percent of total billed charges,,
"Mycophenolic Acid, S (Mayo)OutsideLaboratory",,80180,CPT,Facility,Outpatient,,,90,122,103.7,34.9652,122,PrimeWest Health,Minnesota Senior Health Options (MSHO),62.769,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Mycophenolic Acid, S (Mayo)OutsideLaboratory",,80180,CPT,Facility,Inpatient,,,90,122,103.7,34.9652,122,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Mycophenolic Acid, S (Mayo)OutsideLaboratory",,80180,CPT,Facility,Outpatient,,,90,122,103.7,34.9652,122,PrimeWest Health,MinnesotaCare,62.6592,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Mycophenolic Acid, S (Mayo)OutsideLaboratory",,80180,CPT,Facility,Inpatient,,,90,122,103.7,34.9652,122,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Mycophenolic Acid, S (Mayo)OutsideLaboratory",,80180,CPT,Facility,Both,,,90,122,103.7,34.9652,122,Sanford Health Plan,Sanford Health Plan,112.24,92,,percent of total billed charges,,
"Mycophenolic Acid, S (Mayo)OutsideLaboratory",,80180,CPT,Facility,Outpatient,,,90,122,103.7,34.9652,122,"UCare Health, Inc.",Individual & Family Plan,68.747,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Mycophenolic Acid, S (Mayo)OutsideLaboratory",,80180,CPT,Facility,Inpatient,,,90,122,103.7,34.9652,122,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Mycophenolic Acid, S (Mayo)OutsideLaboratory",,80180,CPT,Facility,Outpatient,,,90,122,103.7,34.9652,122,"UCare Health, Inc.",Medical Assistance,61.5734,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Mycophenolic Acid, S (Mayo)OutsideLaboratory",,80180,CPT,Facility,Inpatient,,,90,122,103.7,34.9652,122,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Mycophenolic Acid, S (Mayo)OutsideLaboratory",,80180,CPT,Facility,Outpatient,,,90,122,103.7,34.9652,122,"UCare Health, Inc.",Medicare Advantage,61.5734,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Mycophenolic Acid, S (Mayo)OutsideLaboratory",,80180,CPT,Facility,Inpatient,,,90,122,103.7,34.9652,122,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Mycophenolic Acid, S (Mayo)OutsideLaboratory",,80180,CPT,Facility,Outpatient,,,90,122,103.7,34.9652,122,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),61.5734,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Mycophenolic Acid, S (Mayo)OutsideLaboratory",,80180,CPT,Facility,Inpatient,,,90,122,103.7,34.9652,122,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Mycophenolic Acid, S (Mayo)OutsideLaboratory",,80180,CPT,Facility,Both,,,90,122,103.7,34.9652,122,UnitedHealthcare,Individual & Family,114.68,94,,percent of total billed charges,,
"Mycophenolic Acid, S (Mayo)OutsideLaboratory",,80180,CPT,Facility,Outpatient,,,90,122,103.7,34.9652,122,UnitedHealthcare,Medicare Advantage,59.78,49,,percent of total billed charges,,
"Mycophenolic Acid, S (Mayo)OutsideLaboratory",,80180,CPT,Facility,Inpatient,,,90,122,103.7,34.9652,122,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Mycophenolic Acid, S (Mayo)OutsideLaboratory",,80180,CPT,Facility,Outpatient,,,90,122,103.7,34.9652,122,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,58.56,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Mycophenolic Acid, S (Mayo)OutsideLaboratory",,80180,CPT,Facility,Inpatient,,,90,122,103.7,34.9652,122,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Oxcarbazepine Metabolite, S (Mayo)OutsideLaboratory",,80183,CPT,Facility,Both,,,90,144,122.4,41.2704,144,Aetna,Commercial,132.48,92,,percent of total billed charges,,
"Oxcarbazepine Metabolite, S (Mayo)OutsideLaboratory",,80183,CPT,Facility,Outpatient,,,90,144,122.4,41.2704,144,Aetna,Medicare Advantage,70.56,49,,percent of total billed charges,,
"Oxcarbazepine Metabolite, S (Mayo)OutsideLaboratory",,80183,CPT,Facility,Inpatient,,,90,144,122.4,41.2704,144,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Oxcarbazepine Metabolite, S (Mayo)OutsideLaboratory",,80183,CPT,Facility,Both,,,90,144,122.4,41.2704,144,Aetna,PPO,133.92,93,,percent of total billed charges,,
"Oxcarbazepine Metabolite, S (Mayo)OutsideLaboratory",,80183,CPT,Facility,Both,,,90,144,122.4,41.2704,144,America's PPO,America's PPO,138.2832,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Oxcarbazepine Metabolite, S (Mayo)OutsideLaboratory",,80183,CPT,Facility,Both,,,90,144,122.4,41.2704,144,BlueCross BlueShield Minnesota, Federal Employee Program,141.696,98.4,,percent of total billed charges,,
"Oxcarbazepine Metabolite, S (Mayo)OutsideLaboratory",,80183,CPT,Facility,Both,,,90,144,122.4,41.2704,144,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,144,100,,percent of total billed charges,,
"Oxcarbazepine Metabolite, S (Mayo)OutsideLaboratory",,80183,CPT,Facility,Both,,,90,144,122.4,41.2704,144,BlueCross BlueShield Minnesota,High Value Network Plan,129.6,90,,percent of total billed charges,,
"Oxcarbazepine Metabolite, S (Mayo)OutsideLaboratory",,80183,CPT,Facility,Outpatient,,,90,144,122.4,41.2704,144,BlueCross BlueShield Minnesota,Medicare Advantage,70.56,49,,percent of total billed charges,,
"Oxcarbazepine Metabolite, S (Mayo)OutsideLaboratory",,80183,CPT,Facility,Inpatient,,,90,144,122.4,41.2704,144,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Oxcarbazepine Metabolite, S (Mayo)OutsideLaboratory",,80183,CPT,Facility,Both,,,90,144,122.4,41.2704,144,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,127.5408,88.57,,percent of total billed charges,,
"Oxcarbazepine Metabolite, S (Mayo)OutsideLaboratory",,80183,CPT,Facility,Both,,,90,144,122.4,41.2704,144,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,41.2704,28.66,,percent of total billed charges,,
"Oxcarbazepine Metabolite, S (Mayo)OutsideLaboratory",,80183,CPT,Facility,Outpatient,,,90,144,122.4,41.2704,144,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),70.56,49,,percent of total billed charges,,
"Oxcarbazepine Metabolite, S (Mayo)OutsideLaboratory",,80183,CPT,Facility,Inpatient,,,90,144,122.4,41.2704,144,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Oxcarbazepine Metabolite, S (Mayo)OutsideLaboratory",,80183,CPT,Facility,Both,,,90,144,122.4,41.2704,144,CorVel,Worker's Compensation,144,100,,percent of total billed charges,,
"Oxcarbazepine Metabolite, S (Mayo)OutsideLaboratory",,80183,CPT,Facility,Both,,,90,144,122.4,41.2704,144,First Health Group Corporation,First Health Network,139.68,97,,percent of total billed charges,,
"Oxcarbazepine Metabolite, S (Mayo)OutsideLaboratory",,80183,CPT,Facility,Both,,,90,144,122.4,41.2704,144,"Health Partners, Inc.",Commercial,136.224,94.6,,percent of total billed charges,,
"Oxcarbazepine Metabolite, S (Mayo)OutsideLaboratory",,80183,CPT,Facility,Outpatient,,,90,144,122.4,41.2704,144,"Health Partners, Inc.",Medicare Advantage,70.56,49,,percent of total billed charges,,
"Oxcarbazepine Metabolite, S (Mayo)OutsideLaboratory",,80183,CPT,Facility,Inpatient,,,90,144,122.4,41.2704,144,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Oxcarbazepine Metabolite, S (Mayo)OutsideLaboratory",,80183,CPT,Facility,Both,,,90,144,122.4,41.2704,144,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),86.4,60,,percent of total billed charges,,
"Oxcarbazepine Metabolite, S (Mayo)OutsideLaboratory",,80183,CPT,Facility,Both,,,90,144,122.4,41.2704,144,"Health Partners, Inc.",State of Minnesota Advantage Program,117.36,81.5,,percent of total billed charges,,
"Oxcarbazepine Metabolite, S (Mayo)OutsideLaboratory",,80183,CPT,Facility,Both,,,90,144,122.4,41.2704,144,"Health Partners, Inc.",State Public Programs,72,50,,percent of total billed charges,,
"Oxcarbazepine Metabolite, S (Mayo)OutsideLaboratory",,80183,CPT,Facility,Both,,,90,144,122.4,41.2704,144,Humana Insurance Company,Commercial PPO,136.8,95,,percent of total billed charges,,
"Oxcarbazepine Metabolite, S (Mayo)OutsideLaboratory",,80183,CPT,Facility,Outpatient,,,90,144,122.4,41.2704,144,Humana Insurance Company,Medicare PPO,70.56,49,,percent of total billed charges,,
"Oxcarbazepine Metabolite, S (Mayo)OutsideLaboratory",,80183,CPT,Facility,Inpatient,,,90,144,122.4,41.2704,144,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Oxcarbazepine Metabolite, S (Mayo)OutsideLaboratory",,80183,CPT,Facility,Both,,,90,144,122.4,41.2704,144,Medica,Individual & Family,142.704,99.1,,percent of total billed charges,,
"Oxcarbazepine Metabolite, S (Mayo)OutsideLaboratory",,80183,CPT,Facility,Outpatient,,,90,144,122.4,41.2704,144,Medica,Medica Advantage Solution,71.712,49.8,,percent of total billed charges,,
"Oxcarbazepine Metabolite, S (Mayo)OutsideLaboratory",,80183,CPT,Facility,Inpatient,,,90,144,122.4,41.2704,144,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Oxcarbazepine Metabolite, S (Mayo)OutsideLaboratory",,80183,CPT,Facility,Outpatient,,,90,144,122.4,41.2704,144,Medica,Medical Assistance,64.224,44.6,,percent of total billed charges,,
"Oxcarbazepine Metabolite, S (Mayo)OutsideLaboratory",,80183,CPT,Facility,Inpatient,,,90,144,122.4,41.2704,144,Medica,Medical Assistance,,,,,Included in per diem rate,
"Oxcarbazepine Metabolite, S (Mayo)OutsideLaboratory",,80183,CPT,Facility,Outpatient,,,90,144,122.4,41.2704,144,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,71.712,49.8,,percent of total billed charges,,
"Oxcarbazepine Metabolite, S (Mayo)OutsideLaboratory",,80183,CPT,Facility,Inpatient,,,90,144,122.4,41.2704,144,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Oxcarbazepine Metabolite, S (Mayo)OutsideLaboratory",,80183,CPT,Facility,Both,,,90,144,122.4,41.2704,144,"Multiplan, Inc.","Multiplan, Inc.",135.36,94,,percent of total billed charges,,
"Oxcarbazepine Metabolite, S (Mayo)OutsideLaboratory",,80183,CPT,Facility,Outpatient,,,90,144,122.4,41.2704,144,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,124.416,86.4,,percent of total billed charges,,
"Oxcarbazepine Metabolite, S (Mayo)OutsideLaboratory",,80183,CPT,Facility,Inpatient,,,90,144,122.4,41.2704,144,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Oxcarbazepine Metabolite, S (Mayo)OutsideLaboratory",,80183,CPT,Facility,Both,,,90,144,122.4,41.2704,144,"Preferred One Administrative Services, INC.",PPO,141.984,98.6,,percent of total billed charges,,
"Oxcarbazepine Metabolite, S (Mayo)OutsideLaboratory",,80183,CPT,Facility,Outpatient,,,90,144,122.4,41.2704,144,PrimeWest Health,Minnesota Senior Health Options (MSHO),74.088,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Oxcarbazepine Metabolite, S (Mayo)OutsideLaboratory",,80183,CPT,Facility,Inpatient,,,90,144,122.4,41.2704,144,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Oxcarbazepine Metabolite, S (Mayo)OutsideLaboratory",,80183,CPT,Facility,Outpatient,,,90,144,122.4,41.2704,144,PrimeWest Health,MinnesotaCare,73.9584,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Oxcarbazepine Metabolite, S (Mayo)OutsideLaboratory",,80183,CPT,Facility,Inpatient,,,90,144,122.4,41.2704,144,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Oxcarbazepine Metabolite, S (Mayo)OutsideLaboratory",,80183,CPT,Facility,Both,,,90,144,122.4,41.2704,144,Sanford Health Plan,Sanford Health Plan,132.48,92,,percent of total billed charges,,
"Oxcarbazepine Metabolite, S (Mayo)OutsideLaboratory",,80183,CPT,Facility,Outpatient,,,90,144,122.4,41.2704,144,"UCare Health, Inc.",Individual & Family Plan,81.144,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Oxcarbazepine Metabolite, S (Mayo)OutsideLaboratory",,80183,CPT,Facility,Inpatient,,,90,144,122.4,41.2704,144,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Oxcarbazepine Metabolite, S (Mayo)OutsideLaboratory",,80183,CPT,Facility,Outpatient,,,90,144,122.4,41.2704,144,"UCare Health, Inc.",Medical Assistance,72.6768,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Oxcarbazepine Metabolite, S (Mayo)OutsideLaboratory",,80183,CPT,Facility,Inpatient,,,90,144,122.4,41.2704,144,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Oxcarbazepine Metabolite, S (Mayo)OutsideLaboratory",,80183,CPT,Facility,Outpatient,,,90,144,122.4,41.2704,144,"UCare Health, Inc.",Medicare Advantage,72.6768,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Oxcarbazepine Metabolite, S (Mayo)OutsideLaboratory",,80183,CPT,Facility,Inpatient,,,90,144,122.4,41.2704,144,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Oxcarbazepine Metabolite, S (Mayo)OutsideLaboratory",,80183,CPT,Facility,Outpatient,,,90,144,122.4,41.2704,144,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),72.6768,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Oxcarbazepine Metabolite, S (Mayo)OutsideLaboratory",,80183,CPT,Facility,Inpatient,,,90,144,122.4,41.2704,144,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Oxcarbazepine Metabolite, S (Mayo)OutsideLaboratory",,80183,CPT,Facility,Both,,,90,144,122.4,41.2704,144,UnitedHealthcare,Individual & Family,135.36,94,,percent of total billed charges,,
"Oxcarbazepine Metabolite, S (Mayo)OutsideLaboratory",,80183,CPT,Facility,Outpatient,,,90,144,122.4,41.2704,144,UnitedHealthcare,Medicare Advantage,70.56,49,,percent of total billed charges,,
"Oxcarbazepine Metabolite, S (Mayo)OutsideLaboratory",,80183,CPT,Facility,Inpatient,,,90,144,122.4,41.2704,144,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Oxcarbazepine Metabolite, S (Mayo)OutsideLaboratory",,80183,CPT,Facility,Outpatient,,,90,144,122.4,41.2704,144,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,69.12,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Oxcarbazepine Metabolite, S (Mayo)OutsideLaboratory",,80183,CPT,Facility,Inpatient,,,90,144,122.4,41.2704,144,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Phenobarbital (Mayo)OutsideLaboratory,,80184,CPT,Facility,Both,,,90,96,81.6,27.5136,96,Aetna,Commercial,88.32,92,,percent of total billed charges,,
Phenobarbital (Mayo)OutsideLaboratory,,80184,CPT,Facility,Outpatient,,,90,96,81.6,27.5136,96,Aetna,Medicare Advantage,47.04,49,,percent of total billed charges,,
Phenobarbital (Mayo)OutsideLaboratory,,80184,CPT,Facility,Inpatient,,,90,96,81.6,27.5136,96,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Phenobarbital (Mayo)OutsideLaboratory,,80184,CPT,Facility,Both,,,90,96,81.6,27.5136,96,Aetna,PPO,89.28,93,,percent of total billed charges,,
Phenobarbital (Mayo)OutsideLaboratory,,80184,CPT,Facility,Both,,,90,96,81.6,27.5136,96,America's PPO,America's PPO,92.1888,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Phenobarbital (Mayo)OutsideLaboratory,,80184,CPT,Facility,Both,,,90,96,81.6,27.5136,96,BlueCross BlueShield Minnesota, Federal Employee Program,94.464,98.4,,percent of total billed charges,,
Phenobarbital (Mayo)OutsideLaboratory,,80184,CPT,Facility,Both,,,90,96,81.6,27.5136,96,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,96,100,,percent of total billed charges,,
Phenobarbital (Mayo)OutsideLaboratory,,80184,CPT,Facility,Both,,,90,96,81.6,27.5136,96,BlueCross BlueShield Minnesota,High Value Network Plan,86.4,90,,percent of total billed charges,,
Phenobarbital (Mayo)OutsideLaboratory,,80184,CPT,Facility,Outpatient,,,90,96,81.6,27.5136,96,BlueCross BlueShield Minnesota,Medicare Advantage,47.04,49,,percent of total billed charges,,
Phenobarbital (Mayo)OutsideLaboratory,,80184,CPT,Facility,Inpatient,,,90,96,81.6,27.5136,96,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Phenobarbital (Mayo)OutsideLaboratory,,80184,CPT,Facility,Both,,,90,96,81.6,27.5136,96,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,85.0272,88.57,,percent of total billed charges,,
Phenobarbital (Mayo)OutsideLaboratory,,80184,CPT,Facility,Both,,,90,96,81.6,27.5136,96,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,27.5136,28.66,,percent of total billed charges,,
Phenobarbital (Mayo)OutsideLaboratory,,80184,CPT,Facility,Outpatient,,,90,96,81.6,27.5136,96,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),47.04,49,,percent of total billed charges,,
Phenobarbital (Mayo)OutsideLaboratory,,80184,CPT,Facility,Inpatient,,,90,96,81.6,27.5136,96,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Phenobarbital (Mayo)OutsideLaboratory,,80184,CPT,Facility,Both,,,90,96,81.6,27.5136,96,CorVel,Worker's Compensation,96,100,,percent of total billed charges,,
Phenobarbital (Mayo)OutsideLaboratory,,80184,CPT,Facility,Both,,,90,96,81.6,27.5136,96,First Health Group Corporation,First Health Network,93.12,97,,percent of total billed charges,,
Phenobarbital (Mayo)OutsideLaboratory,,80184,CPT,Facility,Both,,,90,96,81.6,27.5136,96,"Health Partners, Inc.",Commercial,90.816,94.6,,percent of total billed charges,,
Phenobarbital (Mayo)OutsideLaboratory,,80184,CPT,Facility,Outpatient,,,90,96,81.6,27.5136,96,"Health Partners, Inc.",Medicare Advantage,47.04,49,,percent of total billed charges,,
Phenobarbital (Mayo)OutsideLaboratory,,80184,CPT,Facility,Inpatient,,,90,96,81.6,27.5136,96,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Phenobarbital (Mayo)OutsideLaboratory,,80184,CPT,Facility,Both,,,90,96,81.6,27.5136,96,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),57.6,60,,percent of total billed charges,,
Phenobarbital (Mayo)OutsideLaboratory,,80184,CPT,Facility,Both,,,90,96,81.6,27.5136,96,"Health Partners, Inc.",State of Minnesota Advantage Program,78.24,81.5,,percent of total billed charges,,
Phenobarbital (Mayo)OutsideLaboratory,,80184,CPT,Facility,Both,,,90,96,81.6,27.5136,96,"Health Partners, Inc.",State Public Programs,48,50,,percent of total billed charges,,
Phenobarbital (Mayo)OutsideLaboratory,,80184,CPT,Facility,Both,,,90,96,81.6,27.5136,96,Humana Insurance Company,Commercial PPO,91.2,95,,percent of total billed charges,,
Phenobarbital (Mayo)OutsideLaboratory,,80184,CPT,Facility,Outpatient,,,90,96,81.6,27.5136,96,Humana Insurance Company,Medicare PPO,47.04,49,,percent of total billed charges,,
Phenobarbital (Mayo)OutsideLaboratory,,80184,CPT,Facility,Inpatient,,,90,96,81.6,27.5136,96,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Phenobarbital (Mayo)OutsideLaboratory,,80184,CPT,Facility,Both,,,90,96,81.6,27.5136,96,Medica,Individual & Family,95.136,99.1,,percent of total billed charges,,
Phenobarbital (Mayo)OutsideLaboratory,,80184,CPT,Facility,Outpatient,,,90,96,81.6,27.5136,96,Medica,Medica Advantage Solution,47.808,49.8,,percent of total billed charges,,
Phenobarbital (Mayo)OutsideLaboratory,,80184,CPT,Facility,Inpatient,,,90,96,81.6,27.5136,96,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Phenobarbital (Mayo)OutsideLaboratory,,80184,CPT,Facility,Outpatient,,,90,96,81.6,27.5136,96,Medica,Medical Assistance,42.816,44.6,,percent of total billed charges,,
Phenobarbital (Mayo)OutsideLaboratory,,80184,CPT,Facility,Inpatient,,,90,96,81.6,27.5136,96,Medica,Medical Assistance,,,,,Included in per diem rate,
Phenobarbital (Mayo)OutsideLaboratory,,80184,CPT,Facility,Outpatient,,,90,96,81.6,27.5136,96,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,47.808,49.8,,percent of total billed charges,,
Phenobarbital (Mayo)OutsideLaboratory,,80184,CPT,Facility,Inpatient,,,90,96,81.6,27.5136,96,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Phenobarbital (Mayo)OutsideLaboratory,,80184,CPT,Facility,Both,,,90,96,81.6,27.5136,96,"Multiplan, Inc.","Multiplan, Inc.",90.24,94,,percent of total billed charges,,
Phenobarbital (Mayo)OutsideLaboratory,,80184,CPT,Facility,Outpatient,,,90,96,81.6,27.5136,96,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,82.944,86.4,,percent of total billed charges,,
Phenobarbital (Mayo)OutsideLaboratory,,80184,CPT,Facility,Inpatient,,,90,96,81.6,27.5136,96,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Phenobarbital (Mayo)OutsideLaboratory,,80184,CPT,Facility,Both,,,90,96,81.6,27.5136,96,"Preferred One Administrative Services, INC.",PPO,94.656,98.6,,percent of total billed charges,,
Phenobarbital (Mayo)OutsideLaboratory,,80184,CPT,Facility,Outpatient,,,90,96,81.6,27.5136,96,PrimeWest Health,Minnesota Senior Health Options (MSHO),49.392,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Phenobarbital (Mayo)OutsideLaboratory,,80184,CPT,Facility,Inpatient,,,90,96,81.6,27.5136,96,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Phenobarbital (Mayo)OutsideLaboratory,,80184,CPT,Facility,Outpatient,,,90,96,81.6,27.5136,96,PrimeWest Health,MinnesotaCare,49.3056,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Phenobarbital (Mayo)OutsideLaboratory,,80184,CPT,Facility,Inpatient,,,90,96,81.6,27.5136,96,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Phenobarbital (Mayo)OutsideLaboratory,,80184,CPT,Facility,Both,,,90,96,81.6,27.5136,96,Sanford Health Plan,Sanford Health Plan,88.32,92,,percent of total billed charges,,
Phenobarbital (Mayo)OutsideLaboratory,,80184,CPT,Facility,Outpatient,,,90,96,81.6,27.5136,96,"UCare Health, Inc.",Individual & Family Plan,54.096,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Phenobarbital (Mayo)OutsideLaboratory,,80184,CPT,Facility,Inpatient,,,90,96,81.6,27.5136,96,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Phenobarbital (Mayo)OutsideLaboratory,,80184,CPT,Facility,Outpatient,,,90,96,81.6,27.5136,96,"UCare Health, Inc.",Medical Assistance,48.4512,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Phenobarbital (Mayo)OutsideLaboratory,,80184,CPT,Facility,Inpatient,,,90,96,81.6,27.5136,96,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Phenobarbital (Mayo)OutsideLaboratory,,80184,CPT,Facility,Outpatient,,,90,96,81.6,27.5136,96,"UCare Health, Inc.",Medicare Advantage,48.4512,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Phenobarbital (Mayo)OutsideLaboratory,,80184,CPT,Facility,Inpatient,,,90,96,81.6,27.5136,96,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Phenobarbital (Mayo)OutsideLaboratory,,80184,CPT,Facility,Outpatient,,,90,96,81.6,27.5136,96,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),48.4512,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Phenobarbital (Mayo)OutsideLaboratory,,80184,CPT,Facility,Inpatient,,,90,96,81.6,27.5136,96,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Phenobarbital (Mayo)OutsideLaboratory,,80184,CPT,Facility,Both,,,90,96,81.6,27.5136,96,UnitedHealthcare,Individual & Family,90.24,94,,percent of total billed charges,,
Phenobarbital (Mayo)OutsideLaboratory,,80184,CPT,Facility,Outpatient,,,90,96,81.6,27.5136,96,UnitedHealthcare,Medicare Advantage,47.04,49,,percent of total billed charges,,
Phenobarbital (Mayo)OutsideLaboratory,,80184,CPT,Facility,Inpatient,,,90,96,81.6,27.5136,96,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Phenobarbital (Mayo)OutsideLaboratory,,80184,CPT,Facility,Outpatient,,,90,96,81.6,27.5136,96,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,46.08,48,,percent of total billed charges,,100% of DHS outpatient percentage
Phenobarbital (Mayo)OutsideLaboratory,,80184,CPT,Facility,Inpatient,,,90,96,81.6,27.5136,96,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Phenytoin, Total, S (Mayo)OutsideLaboratory",,80185,CPT,Facility,Both,,,90,73,62.05,20.9218,73,Aetna,Commercial,67.16,92,,percent of total billed charges,,
"Phenytoin, Total, S (Mayo)OutsideLaboratory",,80185,CPT,Facility,Outpatient,,,90,73,62.05,20.9218,73,Aetna,Medicare Advantage,35.77,49,,percent of total billed charges,,
"Phenytoin, Total, S (Mayo)OutsideLaboratory",,80185,CPT,Facility,Inpatient,,,90,73,62.05,20.9218,73,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Phenytoin, Total, S (Mayo)OutsideLaboratory",,80185,CPT,Facility,Both,,,90,73,62.05,20.9218,73,Aetna,PPO,67.89,93,,percent of total billed charges,,
"Phenytoin, Total, S (Mayo)OutsideLaboratory",,80185,CPT,Facility,Both,,,90,73,62.05,20.9218,73,America's PPO,America's PPO,70.1019,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Phenytoin, Total, S (Mayo)OutsideLaboratory",,80185,CPT,Facility,Both,,,90,73,62.05,20.9218,73,BlueCross BlueShield Minnesota, Federal Employee Program,71.832,98.4,,percent of total billed charges,,
"Phenytoin, Total, S (Mayo)OutsideLaboratory",,80185,CPT,Facility,Both,,,90,73,62.05,20.9218,73,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,73,100,,percent of total billed charges,,
"Phenytoin, Total, S (Mayo)OutsideLaboratory",,80185,CPT,Facility,Both,,,90,73,62.05,20.9218,73,BlueCross BlueShield Minnesota,High Value Network Plan,65.7,90,,percent of total billed charges,,
"Phenytoin, Total, S (Mayo)OutsideLaboratory",,80185,CPT,Facility,Outpatient,,,90,73,62.05,20.9218,73,BlueCross BlueShield Minnesota,Medicare Advantage,35.77,49,,percent of total billed charges,,
"Phenytoin, Total, S (Mayo)OutsideLaboratory",,80185,CPT,Facility,Inpatient,,,90,73,62.05,20.9218,73,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Phenytoin, Total, S (Mayo)OutsideLaboratory",,80185,CPT,Facility,Both,,,90,73,62.05,20.9218,73,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,64.6561,88.57,,percent of total billed charges,,
"Phenytoin, Total, S (Mayo)OutsideLaboratory",,80185,CPT,Facility,Both,,,90,73,62.05,20.9218,73,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,20.9218,28.66,,percent of total billed charges,,
"Phenytoin, Total, S (Mayo)OutsideLaboratory",,80185,CPT,Facility,Outpatient,,,90,73,62.05,20.9218,73,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),35.77,49,,percent of total billed charges,,
"Phenytoin, Total, S (Mayo)OutsideLaboratory",,80185,CPT,Facility,Inpatient,,,90,73,62.05,20.9218,73,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Phenytoin, Total, S (Mayo)OutsideLaboratory",,80185,CPT,Facility,Both,,,90,73,62.05,20.9218,73,CorVel,Worker's Compensation,73,100,,percent of total billed charges,,
"Phenytoin, Total, S (Mayo)OutsideLaboratory",,80185,CPT,Facility,Both,,,90,73,62.05,20.9218,73,First Health Group Corporation,First Health Network,70.81,97,,percent of total billed charges,,
"Phenytoin, Total, S (Mayo)OutsideLaboratory",,80185,CPT,Facility,Both,,,90,73,62.05,20.9218,73,"Health Partners, Inc.",Commercial,69.058,94.6,,percent of total billed charges,,
"Phenytoin, Total, S (Mayo)OutsideLaboratory",,80185,CPT,Facility,Outpatient,,,90,73,62.05,20.9218,73,"Health Partners, Inc.",Medicare Advantage,35.77,49,,percent of total billed charges,,
"Phenytoin, Total, S (Mayo)OutsideLaboratory",,80185,CPT,Facility,Inpatient,,,90,73,62.05,20.9218,73,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Phenytoin, Total, S (Mayo)OutsideLaboratory",,80185,CPT,Facility,Both,,,90,73,62.05,20.9218,73,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),43.8,60,,percent of total billed charges,,
"Phenytoin, Total, S (Mayo)OutsideLaboratory",,80185,CPT,Facility,Both,,,90,73,62.05,20.9218,73,"Health Partners, Inc.",State of Minnesota Advantage Program,59.495,81.5,,percent of total billed charges,,
"Phenytoin, Total, S (Mayo)OutsideLaboratory",,80185,CPT,Facility,Both,,,90,73,62.05,20.9218,73,"Health Partners, Inc.",State Public Programs,36.5,50,,percent of total billed charges,,
"Phenytoin, Total, S (Mayo)OutsideLaboratory",,80185,CPT,Facility,Both,,,90,73,62.05,20.9218,73,Humana Insurance Company,Commercial PPO,69.35,95,,percent of total billed charges,,
"Phenytoin, Total, S (Mayo)OutsideLaboratory",,80185,CPT,Facility,Outpatient,,,90,73,62.05,20.9218,73,Humana Insurance Company,Medicare PPO,35.77,49,,percent of total billed charges,,
"Phenytoin, Total, S (Mayo)OutsideLaboratory",,80185,CPT,Facility,Inpatient,,,90,73,62.05,20.9218,73,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Phenytoin, Total, S (Mayo)OutsideLaboratory",,80185,CPT,Facility,Both,,,90,73,62.05,20.9218,73,Medica,Individual & Family,72.343,99.1,,percent of total billed charges,,
"Phenytoin, Total, S (Mayo)OutsideLaboratory",,80185,CPT,Facility,Outpatient,,,90,73,62.05,20.9218,73,Medica,Medica Advantage Solution,36.354,49.8,,percent of total billed charges,,
"Phenytoin, Total, S (Mayo)OutsideLaboratory",,80185,CPT,Facility,Inpatient,,,90,73,62.05,20.9218,73,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Phenytoin, Total, S (Mayo)OutsideLaboratory",,80185,CPT,Facility,Outpatient,,,90,73,62.05,20.9218,73,Medica,Medical Assistance,32.558,44.6,,percent of total billed charges,,
"Phenytoin, Total, S (Mayo)OutsideLaboratory",,80185,CPT,Facility,Inpatient,,,90,73,62.05,20.9218,73,Medica,Medical Assistance,,,,,Included in per diem rate,
"Phenytoin, Total, S (Mayo)OutsideLaboratory",,80185,CPT,Facility,Outpatient,,,90,73,62.05,20.9218,73,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,36.354,49.8,,percent of total billed charges,,
"Phenytoin, Total, S (Mayo)OutsideLaboratory",,80185,CPT,Facility,Inpatient,,,90,73,62.05,20.9218,73,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Phenytoin, Total, S (Mayo)OutsideLaboratory",,80185,CPT,Facility,Both,,,90,73,62.05,20.9218,73,"Multiplan, Inc.","Multiplan, Inc.",68.62,94,,percent of total billed charges,,
"Phenytoin, Total, S (Mayo)OutsideLaboratory",,80185,CPT,Facility,Outpatient,,,90,73,62.05,20.9218,73,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,63.072,86.4,,percent of total billed charges,,
"Phenytoin, Total, S (Mayo)OutsideLaboratory",,80185,CPT,Facility,Inpatient,,,90,73,62.05,20.9218,73,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Phenytoin, Total, S (Mayo)OutsideLaboratory",,80185,CPT,Facility,Both,,,90,73,62.05,20.9218,73,"Preferred One Administrative Services, INC.",PPO,71.978,98.6,,percent of total billed charges,,
"Phenytoin, Total, S (Mayo)OutsideLaboratory",,80185,CPT,Facility,Outpatient,,,90,73,62.05,20.9218,73,PrimeWest Health,Minnesota Senior Health Options (MSHO),37.5585,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Phenytoin, Total, S (Mayo)OutsideLaboratory",,80185,CPT,Facility,Inpatient,,,90,73,62.05,20.9218,73,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Phenytoin, Total, S (Mayo)OutsideLaboratory",,80185,CPT,Facility,Outpatient,,,90,73,62.05,20.9218,73,PrimeWest Health,MinnesotaCare,37.4928,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Phenytoin, Total, S (Mayo)OutsideLaboratory",,80185,CPT,Facility,Inpatient,,,90,73,62.05,20.9218,73,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Phenytoin, Total, S (Mayo)OutsideLaboratory",,80185,CPT,Facility,Both,,,90,73,62.05,20.9218,73,Sanford Health Plan,Sanford Health Plan,67.16,92,,percent of total billed charges,,
"Phenytoin, Total, S (Mayo)OutsideLaboratory",,80185,CPT,Facility,Outpatient,,,90,73,62.05,20.9218,73,"UCare Health, Inc.",Individual & Family Plan,41.1355,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Phenytoin, Total, S (Mayo)OutsideLaboratory",,80185,CPT,Facility,Inpatient,,,90,73,62.05,20.9218,73,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Phenytoin, Total, S (Mayo)OutsideLaboratory",,80185,CPT,Facility,Outpatient,,,90,73,62.05,20.9218,73,"UCare Health, Inc.",Medical Assistance,36.8431,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Phenytoin, Total, S (Mayo)OutsideLaboratory",,80185,CPT,Facility,Inpatient,,,90,73,62.05,20.9218,73,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Phenytoin, Total, S (Mayo)OutsideLaboratory",,80185,CPT,Facility,Outpatient,,,90,73,62.05,20.9218,73,"UCare Health, Inc.",Medicare Advantage,36.8431,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Phenytoin, Total, S (Mayo)OutsideLaboratory",,80185,CPT,Facility,Inpatient,,,90,73,62.05,20.9218,73,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Phenytoin, Total, S (Mayo)OutsideLaboratory",,80185,CPT,Facility,Outpatient,,,90,73,62.05,20.9218,73,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),36.8431,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Phenytoin, Total, S (Mayo)OutsideLaboratory",,80185,CPT,Facility,Inpatient,,,90,73,62.05,20.9218,73,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Phenytoin, Total, S (Mayo)OutsideLaboratory",,80185,CPT,Facility,Both,,,90,73,62.05,20.9218,73,UnitedHealthcare,Individual & Family,68.62,94,,percent of total billed charges,,
"Phenytoin, Total, S (Mayo)OutsideLaboratory",,80185,CPT,Facility,Outpatient,,,90,73,62.05,20.9218,73,UnitedHealthcare,Medicare Advantage,35.77,49,,percent of total billed charges,,
"Phenytoin, Total, S (Mayo)OutsideLaboratory",,80185,CPT,Facility,Inpatient,,,90,73,62.05,20.9218,73,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Phenytoin, Total, S (Mayo)OutsideLaboratory",,80185,CPT,Facility,Outpatient,,,90,73,62.05,20.9218,73,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,35.04,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Phenytoin, Total, S (Mayo)OutsideLaboratory",,80185,CPT,Facility,Inpatient,,,90,73,62.05,20.9218,73,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Phenytoin, Free, Pnyf (Mayo)OutsideLaboratory",,80186,CPT,Facility,Both,,,90,125,106.25,35.825,125,Aetna,Commercial,115,92,,percent of total billed charges,,
"Phenytoin, Free, Pnyf (Mayo)OutsideLaboratory",,80186,CPT,Facility,Outpatient,,,90,125,106.25,35.825,125,Aetna,Medicare Advantage,61.25,49,,percent of total billed charges,,
"Phenytoin, Free, Pnyf (Mayo)OutsideLaboratory",,80186,CPT,Facility,Inpatient,,,90,125,106.25,35.825,125,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Phenytoin, Free, Pnyf (Mayo)OutsideLaboratory",,80186,CPT,Facility,Both,,,90,125,106.25,35.825,125,Aetna,PPO,116.25,93,,percent of total billed charges,,
"Phenytoin, Free, Pnyf (Mayo)OutsideLaboratory",,80186,CPT,Facility,Both,,,90,125,106.25,35.825,125,America's PPO,America's PPO,120.0375,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Phenytoin, Free, Pnyf (Mayo)OutsideLaboratory",,80186,CPT,Facility,Both,,,90,125,106.25,35.825,125,BlueCross BlueShield Minnesota, Federal Employee Program,123,98.4,,percent of total billed charges,,
"Phenytoin, Free, Pnyf (Mayo)OutsideLaboratory",,80186,CPT,Facility,Both,,,90,125,106.25,35.825,125,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,125,100,,percent of total billed charges,,
"Phenytoin, Free, Pnyf (Mayo)OutsideLaboratory",,80186,CPT,Facility,Both,,,90,125,106.25,35.825,125,BlueCross BlueShield Minnesota,High Value Network Plan,112.5,90,,percent of total billed charges,,
"Phenytoin, Free, Pnyf (Mayo)OutsideLaboratory",,80186,CPT,Facility,Outpatient,,,90,125,106.25,35.825,125,BlueCross BlueShield Minnesota,Medicare Advantage,61.25,49,,percent of total billed charges,,
"Phenytoin, Free, Pnyf (Mayo)OutsideLaboratory",,80186,CPT,Facility,Inpatient,,,90,125,106.25,35.825,125,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Phenytoin, Free, Pnyf (Mayo)OutsideLaboratory",,80186,CPT,Facility,Both,,,90,125,106.25,35.825,125,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,110.7125,88.57,,percent of total billed charges,,
"Phenytoin, Free, Pnyf (Mayo)OutsideLaboratory",,80186,CPT,Facility,Both,,,90,125,106.25,35.825,125,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,35.825,28.66,,percent of total billed charges,,
"Phenytoin, Free, Pnyf (Mayo)OutsideLaboratory",,80186,CPT,Facility,Outpatient,,,90,125,106.25,35.825,125,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),61.25,49,,percent of total billed charges,,
"Phenytoin, Free, Pnyf (Mayo)OutsideLaboratory",,80186,CPT,Facility,Inpatient,,,90,125,106.25,35.825,125,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Phenytoin, Free, Pnyf (Mayo)OutsideLaboratory",,80186,CPT,Facility,Both,,,90,125,106.25,35.825,125,CorVel,Worker's Compensation,125,100,,percent of total billed charges,,
"Phenytoin, Free, Pnyf (Mayo)OutsideLaboratory",,80186,CPT,Facility,Both,,,90,125,106.25,35.825,125,First Health Group Corporation,First Health Network,121.25,97,,percent of total billed charges,,
"Phenytoin, Free, Pnyf (Mayo)OutsideLaboratory",,80186,CPT,Facility,Both,,,90,125,106.25,35.825,125,"Health Partners, Inc.",Commercial,118.25,94.6,,percent of total billed charges,,
"Phenytoin, Free, Pnyf (Mayo)OutsideLaboratory",,80186,CPT,Facility,Outpatient,,,90,125,106.25,35.825,125,"Health Partners, Inc.",Medicare Advantage,61.25,49,,percent of total billed charges,,
"Phenytoin, Free, Pnyf (Mayo)OutsideLaboratory",,80186,CPT,Facility,Inpatient,,,90,125,106.25,35.825,125,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Phenytoin, Free, Pnyf (Mayo)OutsideLaboratory",,80186,CPT,Facility,Both,,,90,125,106.25,35.825,125,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),75,60,,percent of total billed charges,,
"Phenytoin, Free, Pnyf (Mayo)OutsideLaboratory",,80186,CPT,Facility,Both,,,90,125,106.25,35.825,125,"Health Partners, Inc.",State of Minnesota Advantage Program,101.875,81.5,,percent of total billed charges,,
"Phenytoin, Free, Pnyf (Mayo)OutsideLaboratory",,80186,CPT,Facility,Both,,,90,125,106.25,35.825,125,"Health Partners, Inc.",State Public Programs,62.5,50,,percent of total billed charges,,
"Phenytoin, Free, Pnyf (Mayo)OutsideLaboratory",,80186,CPT,Facility,Both,,,90,125,106.25,35.825,125,Humana Insurance Company,Commercial PPO,118.75,95,,percent of total billed charges,,
"Phenytoin, Free, Pnyf (Mayo)OutsideLaboratory",,80186,CPT,Facility,Outpatient,,,90,125,106.25,35.825,125,Humana Insurance Company,Medicare PPO,61.25,49,,percent of total billed charges,,
"Phenytoin, Free, Pnyf (Mayo)OutsideLaboratory",,80186,CPT,Facility,Inpatient,,,90,125,106.25,35.825,125,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Phenytoin, Free, Pnyf (Mayo)OutsideLaboratory",,80186,CPT,Facility,Both,,,90,125,106.25,35.825,125,Medica,Individual & Family,123.875,99.1,,percent of total billed charges,,
"Phenytoin, Free, Pnyf (Mayo)OutsideLaboratory",,80186,CPT,Facility,Outpatient,,,90,125,106.25,35.825,125,Medica,Medica Advantage Solution,62.25,49.8,,percent of total billed charges,,
"Phenytoin, Free, Pnyf (Mayo)OutsideLaboratory",,80186,CPT,Facility,Inpatient,,,90,125,106.25,35.825,125,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Phenytoin, Free, Pnyf (Mayo)OutsideLaboratory",,80186,CPT,Facility,Outpatient,,,90,125,106.25,35.825,125,Medica,Medical Assistance,55.75,44.6,,percent of total billed charges,,
"Phenytoin, Free, Pnyf (Mayo)OutsideLaboratory",,80186,CPT,Facility,Inpatient,,,90,125,106.25,35.825,125,Medica,Medical Assistance,,,,,Included in per diem rate,
"Phenytoin, Free, Pnyf (Mayo)OutsideLaboratory",,80186,CPT,Facility,Outpatient,,,90,125,106.25,35.825,125,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,62.25,49.8,,percent of total billed charges,,
"Phenytoin, Free, Pnyf (Mayo)OutsideLaboratory",,80186,CPT,Facility,Inpatient,,,90,125,106.25,35.825,125,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Phenytoin, Free, Pnyf (Mayo)OutsideLaboratory",,80186,CPT,Facility,Both,,,90,125,106.25,35.825,125,"Multiplan, Inc.","Multiplan, Inc.",117.5,94,,percent of total billed charges,,
"Phenytoin, Free, Pnyf (Mayo)OutsideLaboratory",,80186,CPT,Facility,Outpatient,,,90,125,106.25,35.825,125,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,108,86.4,,percent of total billed charges,,
"Phenytoin, Free, Pnyf (Mayo)OutsideLaboratory",,80186,CPT,Facility,Inpatient,,,90,125,106.25,35.825,125,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Phenytoin, Free, Pnyf (Mayo)OutsideLaboratory",,80186,CPT,Facility,Both,,,90,125,106.25,35.825,125,"Preferred One Administrative Services, INC.",PPO,123.25,98.6,,percent of total billed charges,,
"Phenytoin, Free, Pnyf (Mayo)OutsideLaboratory",,80186,CPT,Facility,Outpatient,,,90,125,106.25,35.825,125,PrimeWest Health,Minnesota Senior Health Options (MSHO),64.3125,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Phenytoin, Free, Pnyf (Mayo)OutsideLaboratory",,80186,CPT,Facility,Inpatient,,,90,125,106.25,35.825,125,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Phenytoin, Free, Pnyf (Mayo)OutsideLaboratory",,80186,CPT,Facility,Outpatient,,,90,125,106.25,35.825,125,PrimeWest Health,MinnesotaCare,64.2,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Phenytoin, Free, Pnyf (Mayo)OutsideLaboratory",,80186,CPT,Facility,Inpatient,,,90,125,106.25,35.825,125,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Phenytoin, Free, Pnyf (Mayo)OutsideLaboratory",,80186,CPT,Facility,Both,,,90,125,106.25,35.825,125,Sanford Health Plan,Sanford Health Plan,115,92,,percent of total billed charges,,
"Phenytoin, Free, Pnyf (Mayo)OutsideLaboratory",,80186,CPT,Facility,Outpatient,,,90,125,106.25,35.825,125,"UCare Health, Inc.",Individual & Family Plan,70.4375,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Phenytoin, Free, Pnyf (Mayo)OutsideLaboratory",,80186,CPT,Facility,Inpatient,,,90,125,106.25,35.825,125,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Phenytoin, Free, Pnyf (Mayo)OutsideLaboratory",,80186,CPT,Facility,Outpatient,,,90,125,106.25,35.825,125,"UCare Health, Inc.",Medical Assistance,63.0875,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Phenytoin, Free, Pnyf (Mayo)OutsideLaboratory",,80186,CPT,Facility,Inpatient,,,90,125,106.25,35.825,125,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Phenytoin, Free, Pnyf (Mayo)OutsideLaboratory",,80186,CPT,Facility,Outpatient,,,90,125,106.25,35.825,125,"UCare Health, Inc.",Medicare Advantage,63.0875,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Phenytoin, Free, Pnyf (Mayo)OutsideLaboratory",,80186,CPT,Facility,Inpatient,,,90,125,106.25,35.825,125,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Phenytoin, Free, Pnyf (Mayo)OutsideLaboratory",,80186,CPT,Facility,Outpatient,,,90,125,106.25,35.825,125,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),63.0875,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Phenytoin, Free, Pnyf (Mayo)OutsideLaboratory",,80186,CPT,Facility,Inpatient,,,90,125,106.25,35.825,125,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Phenytoin, Free, Pnyf (Mayo)OutsideLaboratory",,80186,CPT,Facility,Both,,,90,125,106.25,35.825,125,UnitedHealthcare,Individual & Family,117.5,94,,percent of total billed charges,,
"Phenytoin, Free, Pnyf (Mayo)OutsideLaboratory",,80186,CPT,Facility,Outpatient,,,90,125,106.25,35.825,125,UnitedHealthcare,Medicare Advantage,61.25,49,,percent of total billed charges,,
"Phenytoin, Free, Pnyf (Mayo)OutsideLaboratory",,80186,CPT,Facility,Inpatient,,,90,125,106.25,35.825,125,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Phenytoin, Free, Pnyf (Mayo)OutsideLaboratory",,80186,CPT,Facility,Outpatient,,,90,125,106.25,35.825,125,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,60,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Phenytoin, Free, Pnyf (Mayo)OutsideLaboratory",,80186,CPT,Facility,Inpatient,,,90,125,106.25,35.825,125,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Phenytoin, Free, S (Mayo)OutsideLaboratory",,80186,CPT,Facility,Both,,,90,73,62.05,20.9218,73,Aetna,Commercial,67.16,92,,percent of total billed charges,,
"Phenytoin, Free, S (Mayo)OutsideLaboratory",,80186,CPT,Facility,Outpatient,,,90,73,62.05,20.9218,73,Aetna,Medicare Advantage,35.77,49,,percent of total billed charges,,
"Phenytoin, Free, S (Mayo)OutsideLaboratory",,80186,CPT,Facility,Inpatient,,,90,73,62.05,20.9218,73,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Phenytoin, Free, S (Mayo)OutsideLaboratory",,80186,CPT,Facility,Both,,,90,73,62.05,20.9218,73,Aetna,PPO,67.89,93,,percent of total billed charges,,
"Phenytoin, Free, S (Mayo)OutsideLaboratory",,80186,CPT,Facility,Both,,,90,73,62.05,20.9218,73,America's PPO,America's PPO,70.1019,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Phenytoin, Free, S (Mayo)OutsideLaboratory",,80186,CPT,Facility,Both,,,90,73,62.05,20.9218,73,BlueCross BlueShield Minnesota, Federal Employee Program,71.832,98.4,,percent of total billed charges,,
"Phenytoin, Free, S (Mayo)OutsideLaboratory",,80186,CPT,Facility,Both,,,90,73,62.05,20.9218,73,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,73,100,,percent of total billed charges,,
"Phenytoin, Free, S (Mayo)OutsideLaboratory",,80186,CPT,Facility,Both,,,90,73,62.05,20.9218,73,BlueCross BlueShield Minnesota,High Value Network Plan,65.7,90,,percent of total billed charges,,
"Phenytoin, Free, S (Mayo)OutsideLaboratory",,80186,CPT,Facility,Outpatient,,,90,73,62.05,20.9218,73,BlueCross BlueShield Minnesota,Medicare Advantage,35.77,49,,percent of total billed charges,,
"Phenytoin, Free, S (Mayo)OutsideLaboratory",,80186,CPT,Facility,Inpatient,,,90,73,62.05,20.9218,73,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Phenytoin, Free, S (Mayo)OutsideLaboratory",,80186,CPT,Facility,Both,,,90,73,62.05,20.9218,73,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,64.6561,88.57,,percent of total billed charges,,
"Phenytoin, Free, S (Mayo)OutsideLaboratory",,80186,CPT,Facility,Both,,,90,73,62.05,20.9218,73,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,20.9218,28.66,,percent of total billed charges,,
"Phenytoin, Free, S (Mayo)OutsideLaboratory",,80186,CPT,Facility,Outpatient,,,90,73,62.05,20.9218,73,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),35.77,49,,percent of total billed charges,,
"Phenytoin, Free, S (Mayo)OutsideLaboratory",,80186,CPT,Facility,Inpatient,,,90,73,62.05,20.9218,73,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Phenytoin, Free, S (Mayo)OutsideLaboratory",,80186,CPT,Facility,Both,,,90,73,62.05,20.9218,73,CorVel,Worker's Compensation,73,100,,percent of total billed charges,,
"Phenytoin, Free, S (Mayo)OutsideLaboratory",,80186,CPT,Facility,Both,,,90,73,62.05,20.9218,73,First Health Group Corporation,First Health Network,70.81,97,,percent of total billed charges,,
"Phenytoin, Free, S (Mayo)OutsideLaboratory",,80186,CPT,Facility,Both,,,90,73,62.05,20.9218,73,"Health Partners, Inc.",Commercial,69.058,94.6,,percent of total billed charges,,
"Phenytoin, Free, S (Mayo)OutsideLaboratory",,80186,CPT,Facility,Outpatient,,,90,73,62.05,20.9218,73,"Health Partners, Inc.",Medicare Advantage,35.77,49,,percent of total billed charges,,
"Phenytoin, Free, S (Mayo)OutsideLaboratory",,80186,CPT,Facility,Inpatient,,,90,73,62.05,20.9218,73,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Phenytoin, Free, S (Mayo)OutsideLaboratory",,80186,CPT,Facility,Both,,,90,73,62.05,20.9218,73,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),43.8,60,,percent of total billed charges,,
"Phenytoin, Free, S (Mayo)OutsideLaboratory",,80186,CPT,Facility,Both,,,90,73,62.05,20.9218,73,"Health Partners, Inc.",State of Minnesota Advantage Program,59.495,81.5,,percent of total billed charges,,
"Phenytoin, Free, S (Mayo)OutsideLaboratory",,80186,CPT,Facility,Both,,,90,73,62.05,20.9218,73,"Health Partners, Inc.",State Public Programs,36.5,50,,percent of total billed charges,,
"Phenytoin, Free, S (Mayo)OutsideLaboratory",,80186,CPT,Facility,Both,,,90,73,62.05,20.9218,73,Humana Insurance Company,Commercial PPO,69.35,95,,percent of total billed charges,,
"Phenytoin, Free, S (Mayo)OutsideLaboratory",,80186,CPT,Facility,Outpatient,,,90,73,62.05,20.9218,73,Humana Insurance Company,Medicare PPO,35.77,49,,percent of total billed charges,,
"Phenytoin, Free, S (Mayo)OutsideLaboratory",,80186,CPT,Facility,Inpatient,,,90,73,62.05,20.9218,73,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Phenytoin, Free, S (Mayo)OutsideLaboratory",,80186,CPT,Facility,Both,,,90,73,62.05,20.9218,73,Medica,Individual & Family,72.343,99.1,,percent of total billed charges,,
"Phenytoin, Free, S (Mayo)OutsideLaboratory",,80186,CPT,Facility,Outpatient,,,90,73,62.05,20.9218,73,Medica,Medica Advantage Solution,36.354,49.8,,percent of total billed charges,,
"Phenytoin, Free, S (Mayo)OutsideLaboratory",,80186,CPT,Facility,Inpatient,,,90,73,62.05,20.9218,73,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Phenytoin, Free, S (Mayo)OutsideLaboratory",,80186,CPT,Facility,Outpatient,,,90,73,62.05,20.9218,73,Medica,Medical Assistance,32.558,44.6,,percent of total billed charges,,
"Phenytoin, Free, S (Mayo)OutsideLaboratory",,80186,CPT,Facility,Inpatient,,,90,73,62.05,20.9218,73,Medica,Medical Assistance,,,,,Included in per diem rate,
"Phenytoin, Free, S (Mayo)OutsideLaboratory",,80186,CPT,Facility,Outpatient,,,90,73,62.05,20.9218,73,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,36.354,49.8,,percent of total billed charges,,
"Phenytoin, Free, S (Mayo)OutsideLaboratory",,80186,CPT,Facility,Inpatient,,,90,73,62.05,20.9218,73,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Phenytoin, Free, S (Mayo)OutsideLaboratory",,80186,CPT,Facility,Both,,,90,73,62.05,20.9218,73,"Multiplan, Inc.","Multiplan, Inc.",68.62,94,,percent of total billed charges,,
"Phenytoin, Free, S (Mayo)OutsideLaboratory",,80186,CPT,Facility,Outpatient,,,90,73,62.05,20.9218,73,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,63.072,86.4,,percent of total billed charges,,
"Phenytoin, Free, S (Mayo)OutsideLaboratory",,80186,CPT,Facility,Inpatient,,,90,73,62.05,20.9218,73,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Phenytoin, Free, S (Mayo)OutsideLaboratory",,80186,CPT,Facility,Both,,,90,73,62.05,20.9218,73,"Preferred One Administrative Services, INC.",PPO,71.978,98.6,,percent of total billed charges,,
"Phenytoin, Free, S (Mayo)OutsideLaboratory",,80186,CPT,Facility,Outpatient,,,90,73,62.05,20.9218,73,PrimeWest Health,Minnesota Senior Health Options (MSHO),37.5585,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Phenytoin, Free, S (Mayo)OutsideLaboratory",,80186,CPT,Facility,Inpatient,,,90,73,62.05,20.9218,73,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Phenytoin, Free, S (Mayo)OutsideLaboratory",,80186,CPT,Facility,Outpatient,,,90,73,62.05,20.9218,73,PrimeWest Health,MinnesotaCare,37.4928,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Phenytoin, Free, S (Mayo)OutsideLaboratory",,80186,CPT,Facility,Inpatient,,,90,73,62.05,20.9218,73,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Phenytoin, Free, S (Mayo)OutsideLaboratory",,80186,CPT,Facility,Both,,,90,73,62.05,20.9218,73,Sanford Health Plan,Sanford Health Plan,67.16,92,,percent of total billed charges,,
"Phenytoin, Free, S (Mayo)OutsideLaboratory",,80186,CPT,Facility,Outpatient,,,90,73,62.05,20.9218,73,"UCare Health, Inc.",Individual & Family Plan,41.1355,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Phenytoin, Free, S (Mayo)OutsideLaboratory",,80186,CPT,Facility,Inpatient,,,90,73,62.05,20.9218,73,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Phenytoin, Free, S (Mayo)OutsideLaboratory",,80186,CPT,Facility,Outpatient,,,90,73,62.05,20.9218,73,"UCare Health, Inc.",Medical Assistance,36.8431,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Phenytoin, Free, S (Mayo)OutsideLaboratory",,80186,CPT,Facility,Inpatient,,,90,73,62.05,20.9218,73,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Phenytoin, Free, S (Mayo)OutsideLaboratory",,80186,CPT,Facility,Outpatient,,,90,73,62.05,20.9218,73,"UCare Health, Inc.",Medicare Advantage,36.8431,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Phenytoin, Free, S (Mayo)OutsideLaboratory",,80186,CPT,Facility,Inpatient,,,90,73,62.05,20.9218,73,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Phenytoin, Free, S (Mayo)OutsideLaboratory",,80186,CPT,Facility,Outpatient,,,90,73,62.05,20.9218,73,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),36.8431,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Phenytoin, Free, S (Mayo)OutsideLaboratory",,80186,CPT,Facility,Inpatient,,,90,73,62.05,20.9218,73,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Phenytoin, Free, S (Mayo)OutsideLaboratory",,80186,CPT,Facility,Both,,,90,73,62.05,20.9218,73,UnitedHealthcare,Individual & Family,68.62,94,,percent of total billed charges,,
"Phenytoin, Free, S (Mayo)OutsideLaboratory",,80186,CPT,Facility,Outpatient,,,90,73,62.05,20.9218,73,UnitedHealthcare,Medicare Advantage,35.77,49,,percent of total billed charges,,
"Phenytoin, Free, S (Mayo)OutsideLaboratory",,80186,CPT,Facility,Inpatient,,,90,73,62.05,20.9218,73,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Phenytoin, Free, S (Mayo)OutsideLaboratory",,80186,CPT,Facility,Outpatient,,,90,73,62.05,20.9218,73,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,35.04,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Phenytoin, Free, S (Mayo)OutsideLaboratory",,80186,CPT,Facility,Inpatient,,,90,73,62.05,20.9218,73,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Itraconazole, S (Mayo)OutsideLaboratory",,80189,CPT,Facility,Both,,,90,131,111.35,37.5446,131,Aetna,Commercial,120.52,92,,percent of total billed charges,,
"Itraconazole, S (Mayo)OutsideLaboratory",,80189,CPT,Facility,Outpatient,,,90,131,111.35,37.5446,131,Aetna,Medicare Advantage,64.19,49,,percent of total billed charges,,
"Itraconazole, S (Mayo)OutsideLaboratory",,80189,CPT,Facility,Inpatient,,,90,131,111.35,37.5446,131,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Itraconazole, S (Mayo)OutsideLaboratory",,80189,CPT,Facility,Both,,,90,131,111.35,37.5446,131,Aetna,PPO,121.83,93,,percent of total billed charges,,
"Itraconazole, S (Mayo)OutsideLaboratory",,80189,CPT,Facility,Both,,,90,131,111.35,37.5446,131,America's PPO,America's PPO,125.7993,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Itraconazole, S (Mayo)OutsideLaboratory",,80189,CPT,Facility,Both,,,90,131,111.35,37.5446,131,BlueCross BlueShield Minnesota, Federal Employee Program,128.904,98.4,,percent of total billed charges,,
"Itraconazole, S (Mayo)OutsideLaboratory",,80189,CPT,Facility,Both,,,90,131,111.35,37.5446,131,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,131,100,,percent of total billed charges,,
"Itraconazole, S (Mayo)OutsideLaboratory",,80189,CPT,Facility,Both,,,90,131,111.35,37.5446,131,BlueCross BlueShield Minnesota,High Value Network Plan,117.9,90,,percent of total billed charges,,
"Itraconazole, S (Mayo)OutsideLaboratory",,80189,CPT,Facility,Outpatient,,,90,131,111.35,37.5446,131,BlueCross BlueShield Minnesota,Medicare Advantage,64.19,49,,percent of total billed charges,,
"Itraconazole, S (Mayo)OutsideLaboratory",,80189,CPT,Facility,Inpatient,,,90,131,111.35,37.5446,131,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Itraconazole, S (Mayo)OutsideLaboratory",,80189,CPT,Facility,Both,,,90,131,111.35,37.5446,131,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,116.0267,88.57,,percent of total billed charges,,
"Itraconazole, S (Mayo)OutsideLaboratory",,80189,CPT,Facility,Both,,,90,131,111.35,37.5446,131,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,37.5446,28.66,,percent of total billed charges,,
"Itraconazole, S (Mayo)OutsideLaboratory",,80189,CPT,Facility,Outpatient,,,90,131,111.35,37.5446,131,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),64.19,49,,percent of total billed charges,,
"Itraconazole, S (Mayo)OutsideLaboratory",,80189,CPT,Facility,Inpatient,,,90,131,111.35,37.5446,131,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Itraconazole, S (Mayo)OutsideLaboratory",,80189,CPT,Facility,Both,,,90,131,111.35,37.5446,131,CorVel,Worker's Compensation,131,100,,percent of total billed charges,,
"Itraconazole, S (Mayo)OutsideLaboratory",,80189,CPT,Facility,Both,,,90,131,111.35,37.5446,131,First Health Group Corporation,First Health Network,127.07,97,,percent of total billed charges,,
"Itraconazole, S (Mayo)OutsideLaboratory",,80189,CPT,Facility,Both,,,90,131,111.35,37.5446,131,"Health Partners, Inc.",Commercial,123.926,94.6,,percent of total billed charges,,
"Itraconazole, S (Mayo)OutsideLaboratory",,80189,CPT,Facility,Outpatient,,,90,131,111.35,37.5446,131,"Health Partners, Inc.",Medicare Advantage,64.19,49,,percent of total billed charges,,
"Itraconazole, S (Mayo)OutsideLaboratory",,80189,CPT,Facility,Inpatient,,,90,131,111.35,37.5446,131,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Itraconazole, S (Mayo)OutsideLaboratory",,80189,CPT,Facility,Both,,,90,131,111.35,37.5446,131,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),78.6,60,,percent of total billed charges,,
"Itraconazole, S (Mayo)OutsideLaboratory",,80189,CPT,Facility,Both,,,90,131,111.35,37.5446,131,"Health Partners, Inc.",State of Minnesota Advantage Program,106.765,81.5,,percent of total billed charges,,
"Itraconazole, S (Mayo)OutsideLaboratory",,80189,CPT,Facility,Both,,,90,131,111.35,37.5446,131,"Health Partners, Inc.",State Public Programs,65.5,50,,percent of total billed charges,,
"Itraconazole, S (Mayo)OutsideLaboratory",,80189,CPT,Facility,Both,,,90,131,111.35,37.5446,131,Humana Insurance Company,Commercial PPO,124.45,95,,percent of total billed charges,,
"Itraconazole, S (Mayo)OutsideLaboratory",,80189,CPT,Facility,Outpatient,,,90,131,111.35,37.5446,131,Humana Insurance Company,Medicare PPO,64.19,49,,percent of total billed charges,,
"Itraconazole, S (Mayo)OutsideLaboratory",,80189,CPT,Facility,Inpatient,,,90,131,111.35,37.5446,131,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Itraconazole, S (Mayo)OutsideLaboratory",,80189,CPT,Facility,Both,,,90,131,111.35,37.5446,131,Medica,Individual & Family,129.821,99.1,,percent of total billed charges,,
"Itraconazole, S (Mayo)OutsideLaboratory",,80189,CPT,Facility,Outpatient,,,90,131,111.35,37.5446,131,Medica,Medica Advantage Solution,65.238,49.8,,percent of total billed charges,,
"Itraconazole, S (Mayo)OutsideLaboratory",,80189,CPT,Facility,Inpatient,,,90,131,111.35,37.5446,131,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Itraconazole, S (Mayo)OutsideLaboratory",,80189,CPT,Facility,Outpatient,,,90,131,111.35,37.5446,131,Medica,Medical Assistance,58.426,44.6,,percent of total billed charges,,
"Itraconazole, S (Mayo)OutsideLaboratory",,80189,CPT,Facility,Inpatient,,,90,131,111.35,37.5446,131,Medica,Medical Assistance,,,,,Included in per diem rate,
"Itraconazole, S (Mayo)OutsideLaboratory",,80189,CPT,Facility,Outpatient,,,90,131,111.35,37.5446,131,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,65.238,49.8,,percent of total billed charges,,
"Itraconazole, S (Mayo)OutsideLaboratory",,80189,CPT,Facility,Inpatient,,,90,131,111.35,37.5446,131,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Itraconazole, S (Mayo)OutsideLaboratory",,80189,CPT,Facility,Both,,,90,131,111.35,37.5446,131,"Multiplan, Inc.","Multiplan, Inc.",123.14,94,,percent of total billed charges,,
"Itraconazole, S (Mayo)OutsideLaboratory",,80189,CPT,Facility,Outpatient,,,90,131,111.35,37.5446,131,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,113.184,86.4,,percent of total billed charges,,
"Itraconazole, S (Mayo)OutsideLaboratory",,80189,CPT,Facility,Inpatient,,,90,131,111.35,37.5446,131,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Itraconazole, S (Mayo)OutsideLaboratory",,80189,CPT,Facility,Both,,,90,131,111.35,37.5446,131,"Preferred One Administrative Services, INC.",PPO,129.166,98.6,,percent of total billed charges,,
"Itraconazole, S (Mayo)OutsideLaboratory",,80189,CPT,Facility,Outpatient,,,90,131,111.35,37.5446,131,PrimeWest Health,Minnesota Senior Health Options (MSHO),67.3995,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Itraconazole, S (Mayo)OutsideLaboratory",,80189,CPT,Facility,Inpatient,,,90,131,111.35,37.5446,131,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Itraconazole, S (Mayo)OutsideLaboratory",,80189,CPT,Facility,Outpatient,,,90,131,111.35,37.5446,131,PrimeWest Health,MinnesotaCare,67.2816,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Itraconazole, S (Mayo)OutsideLaboratory",,80189,CPT,Facility,Inpatient,,,90,131,111.35,37.5446,131,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Itraconazole, S (Mayo)OutsideLaboratory",,80189,CPT,Facility,Both,,,90,131,111.35,37.5446,131,Sanford Health Plan,Sanford Health Plan,120.52,92,,percent of total billed charges,,
"Itraconazole, S (Mayo)OutsideLaboratory",,80189,CPT,Facility,Outpatient,,,90,131,111.35,37.5446,131,"UCare Health, Inc.",Individual & Family Plan,73.8185,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Itraconazole, S (Mayo)OutsideLaboratory",,80189,CPT,Facility,Inpatient,,,90,131,111.35,37.5446,131,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Itraconazole, S (Mayo)OutsideLaboratory",,80189,CPT,Facility,Outpatient,,,90,131,111.35,37.5446,131,"UCare Health, Inc.",Medical Assistance,66.1157,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Itraconazole, S (Mayo)OutsideLaboratory",,80189,CPT,Facility,Inpatient,,,90,131,111.35,37.5446,131,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Itraconazole, S (Mayo)OutsideLaboratory",,80189,CPT,Facility,Outpatient,,,90,131,111.35,37.5446,131,"UCare Health, Inc.",Medicare Advantage,66.1157,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Itraconazole, S (Mayo)OutsideLaboratory",,80189,CPT,Facility,Inpatient,,,90,131,111.35,37.5446,131,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Itraconazole, S (Mayo)OutsideLaboratory",,80189,CPT,Facility,Outpatient,,,90,131,111.35,37.5446,131,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),66.1157,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Itraconazole, S (Mayo)OutsideLaboratory",,80189,CPT,Facility,Inpatient,,,90,131,111.35,37.5446,131,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Itraconazole, S (Mayo)OutsideLaboratory",,80189,CPT,Facility,Both,,,90,131,111.35,37.5446,131,UnitedHealthcare,Individual & Family,123.14,94,,percent of total billed charges,,
"Itraconazole, S (Mayo)OutsideLaboratory",,80189,CPT,Facility,Outpatient,,,90,131,111.35,37.5446,131,UnitedHealthcare,Medicare Advantage,64.19,49,,percent of total billed charges,,
"Itraconazole, S (Mayo)OutsideLaboratory",,80189,CPT,Facility,Inpatient,,,90,131,111.35,37.5446,131,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Itraconazole, S (Mayo)OutsideLaboratory",,80189,CPT,Facility,Outpatient,,,90,131,111.35,37.5446,131,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,62.88,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Itraconazole, S (Mayo)OutsideLaboratory",,80189,CPT,Facility,Inpatient,,,90,131,111.35,37.5446,131,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Tacrolimus, B (Mayo)OutsideLaboratory",,80197,CPT,Facility,Both,,,90,215,182.75,61.619,215,Aetna,Commercial,197.8,92,,percent of total billed charges,,
"Tacrolimus, B (Mayo)OutsideLaboratory",,80197,CPT,Facility,Outpatient,,,90,215,182.75,61.619,215,Aetna,Medicare Advantage,105.35,49,,percent of total billed charges,,
"Tacrolimus, B (Mayo)OutsideLaboratory",,80197,CPT,Facility,Inpatient,,,90,215,182.75,61.619,215,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Tacrolimus, B (Mayo)OutsideLaboratory",,80197,CPT,Facility,Both,,,90,215,182.75,61.619,215,Aetna,PPO,199.95,93,,percent of total billed charges,,
"Tacrolimus, B (Mayo)OutsideLaboratory",,80197,CPT,Facility,Both,,,90,215,182.75,61.619,215,America's PPO,America's PPO,206.4645,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Tacrolimus, B (Mayo)OutsideLaboratory",,80197,CPT,Facility,Both,,,90,215,182.75,61.619,215,BlueCross BlueShield Minnesota, Federal Employee Program,211.56,98.4,,percent of total billed charges,,
"Tacrolimus, B (Mayo)OutsideLaboratory",,80197,CPT,Facility,Both,,,90,215,182.75,61.619,215,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,215,100,,percent of total billed charges,,
"Tacrolimus, B (Mayo)OutsideLaboratory",,80197,CPT,Facility,Both,,,90,215,182.75,61.619,215,BlueCross BlueShield Minnesota,High Value Network Plan,193.5,90,,percent of total billed charges,,
"Tacrolimus, B (Mayo)OutsideLaboratory",,80197,CPT,Facility,Outpatient,,,90,215,182.75,61.619,215,BlueCross BlueShield Minnesota,Medicare Advantage,105.35,49,,percent of total billed charges,,
"Tacrolimus, B (Mayo)OutsideLaboratory",,80197,CPT,Facility,Inpatient,,,90,215,182.75,61.619,215,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Tacrolimus, B (Mayo)OutsideLaboratory",,80197,CPT,Facility,Both,,,90,215,182.75,61.619,215,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,190.4255,88.57,,percent of total billed charges,,
"Tacrolimus, B (Mayo)OutsideLaboratory",,80197,CPT,Facility,Both,,,90,215,182.75,61.619,215,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,61.619,28.66,,percent of total billed charges,,
"Tacrolimus, B (Mayo)OutsideLaboratory",,80197,CPT,Facility,Outpatient,,,90,215,182.75,61.619,215,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),105.35,49,,percent of total billed charges,,
"Tacrolimus, B (Mayo)OutsideLaboratory",,80197,CPT,Facility,Inpatient,,,90,215,182.75,61.619,215,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Tacrolimus, B (Mayo)OutsideLaboratory",,80197,CPT,Facility,Both,,,90,215,182.75,61.619,215,CorVel,Worker's Compensation,215,100,,percent of total billed charges,,
"Tacrolimus, B (Mayo)OutsideLaboratory",,80197,CPT,Facility,Both,,,90,215,182.75,61.619,215,First Health Group Corporation,First Health Network,208.55,97,,percent of total billed charges,,
"Tacrolimus, B (Mayo)OutsideLaboratory",,80197,CPT,Facility,Both,,,90,215,182.75,61.619,215,"Health Partners, Inc.",Commercial,203.39,94.6,,percent of total billed charges,,
"Tacrolimus, B (Mayo)OutsideLaboratory",,80197,CPT,Facility,Outpatient,,,90,215,182.75,61.619,215,"Health Partners, Inc.",Medicare Advantage,105.35,49,,percent of total billed charges,,
"Tacrolimus, B (Mayo)OutsideLaboratory",,80197,CPT,Facility,Inpatient,,,90,215,182.75,61.619,215,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Tacrolimus, B (Mayo)OutsideLaboratory",,80197,CPT,Facility,Both,,,90,215,182.75,61.619,215,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),129,60,,percent of total billed charges,,
"Tacrolimus, B (Mayo)OutsideLaboratory",,80197,CPT,Facility,Both,,,90,215,182.75,61.619,215,"Health Partners, Inc.",State of Minnesota Advantage Program,175.225,81.5,,percent of total billed charges,,
"Tacrolimus, B (Mayo)OutsideLaboratory",,80197,CPT,Facility,Both,,,90,215,182.75,61.619,215,"Health Partners, Inc.",State Public Programs,107.5,50,,percent of total billed charges,,
"Tacrolimus, B (Mayo)OutsideLaboratory",,80197,CPT,Facility,Both,,,90,215,182.75,61.619,215,Humana Insurance Company,Commercial PPO,204.25,95,,percent of total billed charges,,
"Tacrolimus, B (Mayo)OutsideLaboratory",,80197,CPT,Facility,Outpatient,,,90,215,182.75,61.619,215,Humana Insurance Company,Medicare PPO,105.35,49,,percent of total billed charges,,
"Tacrolimus, B (Mayo)OutsideLaboratory",,80197,CPT,Facility,Inpatient,,,90,215,182.75,61.619,215,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Tacrolimus, B (Mayo)OutsideLaboratory",,80197,CPT,Facility,Both,,,90,215,182.75,61.619,215,Medica,Individual & Family,213.065,99.1,,percent of total billed charges,,
"Tacrolimus, B (Mayo)OutsideLaboratory",,80197,CPT,Facility,Outpatient,,,90,215,182.75,61.619,215,Medica,Medica Advantage Solution,107.07,49.8,,percent of total billed charges,,
"Tacrolimus, B (Mayo)OutsideLaboratory",,80197,CPT,Facility,Inpatient,,,90,215,182.75,61.619,215,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Tacrolimus, B (Mayo)OutsideLaboratory",,80197,CPT,Facility,Outpatient,,,90,215,182.75,61.619,215,Medica,Medical Assistance,95.89,44.6,,percent of total billed charges,,
"Tacrolimus, B (Mayo)OutsideLaboratory",,80197,CPT,Facility,Inpatient,,,90,215,182.75,61.619,215,Medica,Medical Assistance,,,,,Included in per diem rate,
"Tacrolimus, B (Mayo)OutsideLaboratory",,80197,CPT,Facility,Outpatient,,,90,215,182.75,61.619,215,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,107.07,49.8,,percent of total billed charges,,
"Tacrolimus, B (Mayo)OutsideLaboratory",,80197,CPT,Facility,Inpatient,,,90,215,182.75,61.619,215,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Tacrolimus, B (Mayo)OutsideLaboratory",,80197,CPT,Facility,Both,,,90,215,182.75,61.619,215,"Multiplan, Inc.","Multiplan, Inc.",202.1,94,,percent of total billed charges,,
"Tacrolimus, B (Mayo)OutsideLaboratory",,80197,CPT,Facility,Outpatient,,,90,215,182.75,61.619,215,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,185.76,86.4,,percent of total billed charges,,
"Tacrolimus, B (Mayo)OutsideLaboratory",,80197,CPT,Facility,Inpatient,,,90,215,182.75,61.619,215,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Tacrolimus, B (Mayo)OutsideLaboratory",,80197,CPT,Facility,Both,,,90,215,182.75,61.619,215,"Preferred One Administrative Services, INC.",PPO,211.99,98.6,,percent of total billed charges,,
"Tacrolimus, B (Mayo)OutsideLaboratory",,80197,CPT,Facility,Outpatient,,,90,215,182.75,61.619,215,PrimeWest Health,Minnesota Senior Health Options (MSHO),110.6175,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Tacrolimus, B (Mayo)OutsideLaboratory",,80197,CPT,Facility,Inpatient,,,90,215,182.75,61.619,215,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Tacrolimus, B (Mayo)OutsideLaboratory",,80197,CPT,Facility,Outpatient,,,90,215,182.75,61.619,215,PrimeWest Health,MinnesotaCare,110.424,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Tacrolimus, B (Mayo)OutsideLaboratory",,80197,CPT,Facility,Inpatient,,,90,215,182.75,61.619,215,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Tacrolimus, B (Mayo)OutsideLaboratory",,80197,CPT,Facility,Both,,,90,215,182.75,61.619,215,Sanford Health Plan,Sanford Health Plan,197.8,92,,percent of total billed charges,,
"Tacrolimus, B (Mayo)OutsideLaboratory",,80197,CPT,Facility,Outpatient,,,90,215,182.75,61.619,215,"UCare Health, Inc.",Individual & Family Plan,121.1525,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Tacrolimus, B (Mayo)OutsideLaboratory",,80197,CPT,Facility,Inpatient,,,90,215,182.75,61.619,215,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Tacrolimus, B (Mayo)OutsideLaboratory",,80197,CPT,Facility,Outpatient,,,90,215,182.75,61.619,215,"UCare Health, Inc.",Medical Assistance,108.5105,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Tacrolimus, B (Mayo)OutsideLaboratory",,80197,CPT,Facility,Inpatient,,,90,215,182.75,61.619,215,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Tacrolimus, B (Mayo)OutsideLaboratory",,80197,CPT,Facility,Outpatient,,,90,215,182.75,61.619,215,"UCare Health, Inc.",Medicare Advantage,108.5105,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Tacrolimus, B (Mayo)OutsideLaboratory",,80197,CPT,Facility,Inpatient,,,90,215,182.75,61.619,215,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Tacrolimus, B (Mayo)OutsideLaboratory",,80197,CPT,Facility,Outpatient,,,90,215,182.75,61.619,215,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),108.5105,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Tacrolimus, B (Mayo)OutsideLaboratory",,80197,CPT,Facility,Inpatient,,,90,215,182.75,61.619,215,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Tacrolimus, B (Mayo)OutsideLaboratory",,80197,CPT,Facility,Both,,,90,215,182.75,61.619,215,UnitedHealthcare,Individual & Family,202.1,94,,percent of total billed charges,,
"Tacrolimus, B (Mayo)OutsideLaboratory",,80197,CPT,Facility,Outpatient,,,90,215,182.75,61.619,215,UnitedHealthcare,Medicare Advantage,105.35,49,,percent of total billed charges,,
"Tacrolimus, B (Mayo)OutsideLaboratory",,80197,CPT,Facility,Inpatient,,,90,215,182.75,61.619,215,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Tacrolimus, B (Mayo)OutsideLaboratory",,80197,CPT,Facility,Outpatient,,,90,215,182.75,61.619,215,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,103.2,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Tacrolimus, B (Mayo)OutsideLaboratory",,80197,CPT,Facility,Inpatient,,,90,215,182.75,61.619,215,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Topiramate, S (Mayo)OutsideLaboratory",,80201,CPT,Facility,Both,,,90,154,130.9,44.1364,154,Aetna,Commercial,141.68,92,,percent of total billed charges,,
"Topiramate, S (Mayo)OutsideLaboratory",,80201,CPT,Facility,Outpatient,,,90,154,130.9,44.1364,154,Aetna,Medicare Advantage,75.46,49,,percent of total billed charges,,
"Topiramate, S (Mayo)OutsideLaboratory",,80201,CPT,Facility,Inpatient,,,90,154,130.9,44.1364,154,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Topiramate, S (Mayo)OutsideLaboratory",,80201,CPT,Facility,Both,,,90,154,130.9,44.1364,154,Aetna,PPO,143.22,93,,percent of total billed charges,,
"Topiramate, S (Mayo)OutsideLaboratory",,80201,CPT,Facility,Both,,,90,154,130.9,44.1364,154,America's PPO,America's PPO,147.8862,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Topiramate, S (Mayo)OutsideLaboratory",,80201,CPT,Facility,Both,,,90,154,130.9,44.1364,154,BlueCross BlueShield Minnesota, Federal Employee Program,151.536,98.4,,percent of total billed charges,,
"Topiramate, S (Mayo)OutsideLaboratory",,80201,CPT,Facility,Both,,,90,154,130.9,44.1364,154,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,154,100,,percent of total billed charges,,
"Topiramate, S (Mayo)OutsideLaboratory",,80201,CPT,Facility,Both,,,90,154,130.9,44.1364,154,BlueCross BlueShield Minnesota,High Value Network Plan,138.6,90,,percent of total billed charges,,
"Topiramate, S (Mayo)OutsideLaboratory",,80201,CPT,Facility,Outpatient,,,90,154,130.9,44.1364,154,BlueCross BlueShield Minnesota,Medicare Advantage,75.46,49,,percent of total billed charges,,
"Topiramate, S (Mayo)OutsideLaboratory",,80201,CPT,Facility,Inpatient,,,90,154,130.9,44.1364,154,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Topiramate, S (Mayo)OutsideLaboratory",,80201,CPT,Facility,Both,,,90,154,130.9,44.1364,154,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,136.3978,88.57,,percent of total billed charges,,
"Topiramate, S (Mayo)OutsideLaboratory",,80201,CPT,Facility,Both,,,90,154,130.9,44.1364,154,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,44.1364,28.66,,percent of total billed charges,,
"Topiramate, S (Mayo)OutsideLaboratory",,80201,CPT,Facility,Outpatient,,,90,154,130.9,44.1364,154,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),75.46,49,,percent of total billed charges,,
"Topiramate, S (Mayo)OutsideLaboratory",,80201,CPT,Facility,Inpatient,,,90,154,130.9,44.1364,154,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Topiramate, S (Mayo)OutsideLaboratory",,80201,CPT,Facility,Both,,,90,154,130.9,44.1364,154,CorVel,Worker's Compensation,154,100,,percent of total billed charges,,
"Topiramate, S (Mayo)OutsideLaboratory",,80201,CPT,Facility,Both,,,90,154,130.9,44.1364,154,First Health Group Corporation,First Health Network,149.38,97,,percent of total billed charges,,
"Topiramate, S (Mayo)OutsideLaboratory",,80201,CPT,Facility,Both,,,90,154,130.9,44.1364,154,"Health Partners, Inc.",Commercial,145.684,94.6,,percent of total billed charges,,
"Topiramate, S (Mayo)OutsideLaboratory",,80201,CPT,Facility,Outpatient,,,90,154,130.9,44.1364,154,"Health Partners, Inc.",Medicare Advantage,75.46,49,,percent of total billed charges,,
"Topiramate, S (Mayo)OutsideLaboratory",,80201,CPT,Facility,Inpatient,,,90,154,130.9,44.1364,154,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Topiramate, S (Mayo)OutsideLaboratory",,80201,CPT,Facility,Both,,,90,154,130.9,44.1364,154,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),92.4,60,,percent of total billed charges,,
"Topiramate, S (Mayo)OutsideLaboratory",,80201,CPT,Facility,Both,,,90,154,130.9,44.1364,154,"Health Partners, Inc.",State of Minnesota Advantage Program,125.51,81.5,,percent of total billed charges,,
"Topiramate, S (Mayo)OutsideLaboratory",,80201,CPT,Facility,Both,,,90,154,130.9,44.1364,154,"Health Partners, Inc.",State Public Programs,77,50,,percent of total billed charges,,
"Topiramate, S (Mayo)OutsideLaboratory",,80201,CPT,Facility,Both,,,90,154,130.9,44.1364,154,Humana Insurance Company,Commercial PPO,146.3,95,,percent of total billed charges,,
"Topiramate, S (Mayo)OutsideLaboratory",,80201,CPT,Facility,Outpatient,,,90,154,130.9,44.1364,154,Humana Insurance Company,Medicare PPO,75.46,49,,percent of total billed charges,,
"Topiramate, S (Mayo)OutsideLaboratory",,80201,CPT,Facility,Inpatient,,,90,154,130.9,44.1364,154,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Topiramate, S (Mayo)OutsideLaboratory",,80201,CPT,Facility,Both,,,90,154,130.9,44.1364,154,Medica,Individual & Family,152.614,99.1,,percent of total billed charges,,
"Topiramate, S (Mayo)OutsideLaboratory",,80201,CPT,Facility,Outpatient,,,90,154,130.9,44.1364,154,Medica,Medica Advantage Solution,76.692,49.8,,percent of total billed charges,,
"Topiramate, S (Mayo)OutsideLaboratory",,80201,CPT,Facility,Inpatient,,,90,154,130.9,44.1364,154,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Topiramate, S (Mayo)OutsideLaboratory",,80201,CPT,Facility,Outpatient,,,90,154,130.9,44.1364,154,Medica,Medical Assistance,68.684,44.6,,percent of total billed charges,,
"Topiramate, S (Mayo)OutsideLaboratory",,80201,CPT,Facility,Inpatient,,,90,154,130.9,44.1364,154,Medica,Medical Assistance,,,,,Included in per diem rate,
"Topiramate, S (Mayo)OutsideLaboratory",,80201,CPT,Facility,Outpatient,,,90,154,130.9,44.1364,154,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,76.692,49.8,,percent of total billed charges,,
"Topiramate, S (Mayo)OutsideLaboratory",,80201,CPT,Facility,Inpatient,,,90,154,130.9,44.1364,154,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Topiramate, S (Mayo)OutsideLaboratory",,80201,CPT,Facility,Both,,,90,154,130.9,44.1364,154,"Multiplan, Inc.","Multiplan, Inc.",144.76,94,,percent of total billed charges,,
"Topiramate, S (Mayo)OutsideLaboratory",,80201,CPT,Facility,Outpatient,,,90,154,130.9,44.1364,154,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,133.056,86.4,,percent of total billed charges,,
"Topiramate, S (Mayo)OutsideLaboratory",,80201,CPT,Facility,Inpatient,,,90,154,130.9,44.1364,154,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Topiramate, S (Mayo)OutsideLaboratory",,80201,CPT,Facility,Both,,,90,154,130.9,44.1364,154,"Preferred One Administrative Services, INC.",PPO,151.844,98.6,,percent of total billed charges,,
"Topiramate, S (Mayo)OutsideLaboratory",,80201,CPT,Facility,Outpatient,,,90,154,130.9,44.1364,154,PrimeWest Health,Minnesota Senior Health Options (MSHO),79.233,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Topiramate, S (Mayo)OutsideLaboratory",,80201,CPT,Facility,Inpatient,,,90,154,130.9,44.1364,154,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Topiramate, S (Mayo)OutsideLaboratory",,80201,CPT,Facility,Outpatient,,,90,154,130.9,44.1364,154,PrimeWest Health,MinnesotaCare,79.0944,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Topiramate, S (Mayo)OutsideLaboratory",,80201,CPT,Facility,Inpatient,,,90,154,130.9,44.1364,154,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Topiramate, S (Mayo)OutsideLaboratory",,80201,CPT,Facility,Both,,,90,154,130.9,44.1364,154,Sanford Health Plan,Sanford Health Plan,141.68,92,,percent of total billed charges,,
"Topiramate, S (Mayo)OutsideLaboratory",,80201,CPT,Facility,Outpatient,,,90,154,130.9,44.1364,154,"UCare Health, Inc.",Individual & Family Plan,86.779,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Topiramate, S (Mayo)OutsideLaboratory",,80201,CPT,Facility,Inpatient,,,90,154,130.9,44.1364,154,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Topiramate, S (Mayo)OutsideLaboratory",,80201,CPT,Facility,Outpatient,,,90,154,130.9,44.1364,154,"UCare Health, Inc.",Medical Assistance,77.7238,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Topiramate, S (Mayo)OutsideLaboratory",,80201,CPT,Facility,Inpatient,,,90,154,130.9,44.1364,154,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Topiramate, S (Mayo)OutsideLaboratory",,80201,CPT,Facility,Outpatient,,,90,154,130.9,44.1364,154,"UCare Health, Inc.",Medicare Advantage,77.7238,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Topiramate, S (Mayo)OutsideLaboratory",,80201,CPT,Facility,Inpatient,,,90,154,130.9,44.1364,154,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Topiramate, S (Mayo)OutsideLaboratory",,80201,CPT,Facility,Outpatient,,,90,154,130.9,44.1364,154,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),77.7238,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Topiramate, S (Mayo)OutsideLaboratory",,80201,CPT,Facility,Inpatient,,,90,154,130.9,44.1364,154,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Topiramate, S (Mayo)OutsideLaboratory",,80201,CPT,Facility,Both,,,90,154,130.9,44.1364,154,UnitedHealthcare,Individual & Family,144.76,94,,percent of total billed charges,,
"Topiramate, S (Mayo)OutsideLaboratory",,80201,CPT,Facility,Outpatient,,,90,154,130.9,44.1364,154,UnitedHealthcare,Medicare Advantage,75.46,49,,percent of total billed charges,,
"Topiramate, S (Mayo)OutsideLaboratory",,80201,CPT,Facility,Inpatient,,,90,154,130.9,44.1364,154,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Topiramate, S (Mayo)OutsideLaboratory",,80201,CPT,Facility,Outpatient,,,90,154,130.9,44.1364,154,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,73.92,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Topiramate, S (Mayo)OutsideLaboratory",,80201,CPT,Facility,Inpatient,,,90,154,130.9,44.1364,154,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Zonisamide, S (Mayo)OutsideLaboratory",,80203,CPT,Facility,Both,,,90,133,113.05,38.1178,133,Aetna,Commercial,122.36,92,,percent of total billed charges,,
"Zonisamide, S (Mayo)OutsideLaboratory",,80203,CPT,Facility,Outpatient,,,90,133,113.05,38.1178,133,Aetna,Medicare Advantage,65.17,49,,percent of total billed charges,,
"Zonisamide, S (Mayo)OutsideLaboratory",,80203,CPT,Facility,Inpatient,,,90,133,113.05,38.1178,133,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Zonisamide, S (Mayo)OutsideLaboratory",,80203,CPT,Facility,Both,,,90,133,113.05,38.1178,133,Aetna,PPO,123.69,93,,percent of total billed charges,,
"Zonisamide, S (Mayo)OutsideLaboratory",,80203,CPT,Facility,Both,,,90,133,113.05,38.1178,133,America's PPO,America's PPO,127.7199,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Zonisamide, S (Mayo)OutsideLaboratory",,80203,CPT,Facility,Both,,,90,133,113.05,38.1178,133,BlueCross BlueShield Minnesota, Federal Employee Program,130.872,98.4,,percent of total billed charges,,
"Zonisamide, S (Mayo)OutsideLaboratory",,80203,CPT,Facility,Both,,,90,133,113.05,38.1178,133,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,133,100,,percent of total billed charges,,
"Zonisamide, S (Mayo)OutsideLaboratory",,80203,CPT,Facility,Both,,,90,133,113.05,38.1178,133,BlueCross BlueShield Minnesota,High Value Network Plan,119.7,90,,percent of total billed charges,,
"Zonisamide, S (Mayo)OutsideLaboratory",,80203,CPT,Facility,Outpatient,,,90,133,113.05,38.1178,133,BlueCross BlueShield Minnesota,Medicare Advantage,65.17,49,,percent of total billed charges,,
"Zonisamide, S (Mayo)OutsideLaboratory",,80203,CPT,Facility,Inpatient,,,90,133,113.05,38.1178,133,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Zonisamide, S (Mayo)OutsideLaboratory",,80203,CPT,Facility,Both,,,90,133,113.05,38.1178,133,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,117.7981,88.57,,percent of total billed charges,,
"Zonisamide, S (Mayo)OutsideLaboratory",,80203,CPT,Facility,Both,,,90,133,113.05,38.1178,133,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,38.1178,28.66,,percent of total billed charges,,
"Zonisamide, S (Mayo)OutsideLaboratory",,80203,CPT,Facility,Outpatient,,,90,133,113.05,38.1178,133,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),65.17,49,,percent of total billed charges,,
"Zonisamide, S (Mayo)OutsideLaboratory",,80203,CPT,Facility,Inpatient,,,90,133,113.05,38.1178,133,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Zonisamide, S (Mayo)OutsideLaboratory",,80203,CPT,Facility,Both,,,90,133,113.05,38.1178,133,CorVel,Worker's Compensation,133,100,,percent of total billed charges,,
"Zonisamide, S (Mayo)OutsideLaboratory",,80203,CPT,Facility,Both,,,90,133,113.05,38.1178,133,First Health Group Corporation,First Health Network,129.01,97,,percent of total billed charges,,
"Zonisamide, S (Mayo)OutsideLaboratory",,80203,CPT,Facility,Both,,,90,133,113.05,38.1178,133,"Health Partners, Inc.",Commercial,125.818,94.6,,percent of total billed charges,,
"Zonisamide, S (Mayo)OutsideLaboratory",,80203,CPT,Facility,Outpatient,,,90,133,113.05,38.1178,133,"Health Partners, Inc.",Medicare Advantage,65.17,49,,percent of total billed charges,,
"Zonisamide, S (Mayo)OutsideLaboratory",,80203,CPT,Facility,Inpatient,,,90,133,113.05,38.1178,133,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Zonisamide, S (Mayo)OutsideLaboratory",,80203,CPT,Facility,Both,,,90,133,113.05,38.1178,133,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),79.8,60,,percent of total billed charges,,
"Zonisamide, S (Mayo)OutsideLaboratory",,80203,CPT,Facility,Both,,,90,133,113.05,38.1178,133,"Health Partners, Inc.",State of Minnesota Advantage Program,108.395,81.5,,percent of total billed charges,,
"Zonisamide, S (Mayo)OutsideLaboratory",,80203,CPT,Facility,Both,,,90,133,113.05,38.1178,133,"Health Partners, Inc.",State Public Programs,66.5,50,,percent of total billed charges,,
"Zonisamide, S (Mayo)OutsideLaboratory",,80203,CPT,Facility,Both,,,90,133,113.05,38.1178,133,Humana Insurance Company,Commercial PPO,126.35,95,,percent of total billed charges,,
"Zonisamide, S (Mayo)OutsideLaboratory",,80203,CPT,Facility,Outpatient,,,90,133,113.05,38.1178,133,Humana Insurance Company,Medicare PPO,65.17,49,,percent of total billed charges,,
"Zonisamide, S (Mayo)OutsideLaboratory",,80203,CPT,Facility,Inpatient,,,90,133,113.05,38.1178,133,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Zonisamide, S (Mayo)OutsideLaboratory",,80203,CPT,Facility,Both,,,90,133,113.05,38.1178,133,Medica,Individual & Family,131.803,99.1,,percent of total billed charges,,
"Zonisamide, S (Mayo)OutsideLaboratory",,80203,CPT,Facility,Outpatient,,,90,133,113.05,38.1178,133,Medica,Medica Advantage Solution,66.234,49.8,,percent of total billed charges,,
"Zonisamide, S (Mayo)OutsideLaboratory",,80203,CPT,Facility,Inpatient,,,90,133,113.05,38.1178,133,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Zonisamide, S (Mayo)OutsideLaboratory",,80203,CPT,Facility,Outpatient,,,90,133,113.05,38.1178,133,Medica,Medical Assistance,59.318,44.6,,percent of total billed charges,,
"Zonisamide, S (Mayo)OutsideLaboratory",,80203,CPT,Facility,Inpatient,,,90,133,113.05,38.1178,133,Medica,Medical Assistance,,,,,Included in per diem rate,
"Zonisamide, S (Mayo)OutsideLaboratory",,80203,CPT,Facility,Outpatient,,,90,133,113.05,38.1178,133,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,66.234,49.8,,percent of total billed charges,,
"Zonisamide, S (Mayo)OutsideLaboratory",,80203,CPT,Facility,Inpatient,,,90,133,113.05,38.1178,133,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Zonisamide, S (Mayo)OutsideLaboratory",,80203,CPT,Facility,Both,,,90,133,113.05,38.1178,133,"Multiplan, Inc.","Multiplan, Inc.",125.02,94,,percent of total billed charges,,
"Zonisamide, S (Mayo)OutsideLaboratory",,80203,CPT,Facility,Outpatient,,,90,133,113.05,38.1178,133,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,114.912,86.4,,percent of total billed charges,,
"Zonisamide, S (Mayo)OutsideLaboratory",,80203,CPT,Facility,Inpatient,,,90,133,113.05,38.1178,133,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Zonisamide, S (Mayo)OutsideLaboratory",,80203,CPT,Facility,Both,,,90,133,113.05,38.1178,133,"Preferred One Administrative Services, INC.",PPO,131.138,98.6,,percent of total billed charges,,
"Zonisamide, S (Mayo)OutsideLaboratory",,80203,CPT,Facility,Outpatient,,,90,133,113.05,38.1178,133,PrimeWest Health,Minnesota Senior Health Options (MSHO),68.4285,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Zonisamide, S (Mayo)OutsideLaboratory",,80203,CPT,Facility,Inpatient,,,90,133,113.05,38.1178,133,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Zonisamide, S (Mayo)OutsideLaboratory",,80203,CPT,Facility,Outpatient,,,90,133,113.05,38.1178,133,PrimeWest Health,MinnesotaCare,68.3088,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Zonisamide, S (Mayo)OutsideLaboratory",,80203,CPT,Facility,Inpatient,,,90,133,113.05,38.1178,133,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Zonisamide, S (Mayo)OutsideLaboratory",,80203,CPT,Facility,Both,,,90,133,113.05,38.1178,133,Sanford Health Plan,Sanford Health Plan,122.36,92,,percent of total billed charges,,
"Zonisamide, S (Mayo)OutsideLaboratory",,80203,CPT,Facility,Outpatient,,,90,133,113.05,38.1178,133,"UCare Health, Inc.",Individual & Family Plan,74.9455,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Zonisamide, S (Mayo)OutsideLaboratory",,80203,CPT,Facility,Inpatient,,,90,133,113.05,38.1178,133,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Zonisamide, S (Mayo)OutsideLaboratory",,80203,CPT,Facility,Outpatient,,,90,133,113.05,38.1178,133,"UCare Health, Inc.",Medical Assistance,67.1251,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Zonisamide, S (Mayo)OutsideLaboratory",,80203,CPT,Facility,Inpatient,,,90,133,113.05,38.1178,133,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Zonisamide, S (Mayo)OutsideLaboratory",,80203,CPT,Facility,Outpatient,,,90,133,113.05,38.1178,133,"UCare Health, Inc.",Medicare Advantage,67.1251,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Zonisamide, S (Mayo)OutsideLaboratory",,80203,CPT,Facility,Inpatient,,,90,133,113.05,38.1178,133,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Zonisamide, S (Mayo)OutsideLaboratory",,80203,CPT,Facility,Outpatient,,,90,133,113.05,38.1178,133,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),67.1251,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Zonisamide, S (Mayo)OutsideLaboratory",,80203,CPT,Facility,Inpatient,,,90,133,113.05,38.1178,133,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Zonisamide, S (Mayo)OutsideLaboratory",,80203,CPT,Facility,Both,,,90,133,113.05,38.1178,133,UnitedHealthcare,Individual & Family,125.02,94,,percent of total billed charges,,
"Zonisamide, S (Mayo)OutsideLaboratory",,80203,CPT,Facility,Outpatient,,,90,133,113.05,38.1178,133,UnitedHealthcare,Medicare Advantage,65.17,49,,percent of total billed charges,,
"Zonisamide, S (Mayo)OutsideLaboratory",,80203,CPT,Facility,Inpatient,,,90,133,113.05,38.1178,133,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Zonisamide, S (Mayo)OutsideLaboratory",,80203,CPT,Facility,Outpatient,,,90,133,113.05,38.1178,133,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,63.84,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Zonisamide, S (Mayo)OutsideLaboratory",,80203,CPT,Facility,Inpatient,,,90,133,113.05,38.1178,133,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Methotrexate, S (Mayo)OutsideLaboratory",,80204,CPT,Facility,Both,,,90,92,78.2,26.3672,92,Aetna,Commercial,84.64,92,,percent of total billed charges,,
"Methotrexate, S (Mayo)OutsideLaboratory",,80204,CPT,Facility,Outpatient,,,90,92,78.2,26.3672,92,Aetna,Medicare Advantage,45.08,49,,percent of total billed charges,,
"Methotrexate, S (Mayo)OutsideLaboratory",,80204,CPT,Facility,Inpatient,,,90,92,78.2,26.3672,92,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Methotrexate, S (Mayo)OutsideLaboratory",,80204,CPT,Facility,Both,,,90,92,78.2,26.3672,92,Aetna,PPO,85.56,93,,percent of total billed charges,,
"Methotrexate, S (Mayo)OutsideLaboratory",,80204,CPT,Facility,Both,,,90,92,78.2,26.3672,92,America's PPO,America's PPO,88.3476,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Methotrexate, S (Mayo)OutsideLaboratory",,80204,CPT,Facility,Both,,,90,92,78.2,26.3672,92,BlueCross BlueShield Minnesota, Federal Employee Program,90.528,98.4,,percent of total billed charges,,
"Methotrexate, S (Mayo)OutsideLaboratory",,80204,CPT,Facility,Both,,,90,92,78.2,26.3672,92,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,92,100,,percent of total billed charges,,
"Methotrexate, S (Mayo)OutsideLaboratory",,80204,CPT,Facility,Both,,,90,92,78.2,26.3672,92,BlueCross BlueShield Minnesota,High Value Network Plan,82.8,90,,percent of total billed charges,,
"Methotrexate, S (Mayo)OutsideLaboratory",,80204,CPT,Facility,Outpatient,,,90,92,78.2,26.3672,92,BlueCross BlueShield Minnesota,Medicare Advantage,45.08,49,,percent of total billed charges,,
"Methotrexate, S (Mayo)OutsideLaboratory",,80204,CPT,Facility,Inpatient,,,90,92,78.2,26.3672,92,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Methotrexate, S (Mayo)OutsideLaboratory",,80204,CPT,Facility,Both,,,90,92,78.2,26.3672,92,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,81.4844,88.57,,percent of total billed charges,,
"Methotrexate, S (Mayo)OutsideLaboratory",,80204,CPT,Facility,Both,,,90,92,78.2,26.3672,92,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,26.3672,28.66,,percent of total billed charges,,
"Methotrexate, S (Mayo)OutsideLaboratory",,80204,CPT,Facility,Outpatient,,,90,92,78.2,26.3672,92,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),45.08,49,,percent of total billed charges,,
"Methotrexate, S (Mayo)OutsideLaboratory",,80204,CPT,Facility,Inpatient,,,90,92,78.2,26.3672,92,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Methotrexate, S (Mayo)OutsideLaboratory",,80204,CPT,Facility,Both,,,90,92,78.2,26.3672,92,CorVel,Worker's Compensation,92,100,,percent of total billed charges,,
"Methotrexate, S (Mayo)OutsideLaboratory",,80204,CPT,Facility,Both,,,90,92,78.2,26.3672,92,First Health Group Corporation,First Health Network,89.24,97,,percent of total billed charges,,
"Methotrexate, S (Mayo)OutsideLaboratory",,80204,CPT,Facility,Both,,,90,92,78.2,26.3672,92,"Health Partners, Inc.",Commercial,87.032,94.6,,percent of total billed charges,,
"Methotrexate, S (Mayo)OutsideLaboratory",,80204,CPT,Facility,Outpatient,,,90,92,78.2,26.3672,92,"Health Partners, Inc.",Medicare Advantage,45.08,49,,percent of total billed charges,,
"Methotrexate, S (Mayo)OutsideLaboratory",,80204,CPT,Facility,Inpatient,,,90,92,78.2,26.3672,92,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Methotrexate, S (Mayo)OutsideLaboratory",,80204,CPT,Facility,Both,,,90,92,78.2,26.3672,92,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),55.2,60,,percent of total billed charges,,
"Methotrexate, S (Mayo)OutsideLaboratory",,80204,CPT,Facility,Both,,,90,92,78.2,26.3672,92,"Health Partners, Inc.",State of Minnesota Advantage Program,74.98,81.5,,percent of total billed charges,,
"Methotrexate, S (Mayo)OutsideLaboratory",,80204,CPT,Facility,Both,,,90,92,78.2,26.3672,92,"Health Partners, Inc.",State Public Programs,46,50,,percent of total billed charges,,
"Methotrexate, S (Mayo)OutsideLaboratory",,80204,CPT,Facility,Both,,,90,92,78.2,26.3672,92,Humana Insurance Company,Commercial PPO,87.4,95,,percent of total billed charges,,
"Methotrexate, S (Mayo)OutsideLaboratory",,80204,CPT,Facility,Outpatient,,,90,92,78.2,26.3672,92,Humana Insurance Company,Medicare PPO,45.08,49,,percent of total billed charges,,
"Methotrexate, S (Mayo)OutsideLaboratory",,80204,CPT,Facility,Inpatient,,,90,92,78.2,26.3672,92,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Methotrexate, S (Mayo)OutsideLaboratory",,80204,CPT,Facility,Both,,,90,92,78.2,26.3672,92,Medica,Individual & Family,91.172,99.1,,percent of total billed charges,,
"Methotrexate, S (Mayo)OutsideLaboratory",,80204,CPT,Facility,Outpatient,,,90,92,78.2,26.3672,92,Medica,Medica Advantage Solution,45.816,49.8,,percent of total billed charges,,
"Methotrexate, S (Mayo)OutsideLaboratory",,80204,CPT,Facility,Inpatient,,,90,92,78.2,26.3672,92,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Methotrexate, S (Mayo)OutsideLaboratory",,80204,CPT,Facility,Outpatient,,,90,92,78.2,26.3672,92,Medica,Medical Assistance,41.032,44.6,,percent of total billed charges,,
"Methotrexate, S (Mayo)OutsideLaboratory",,80204,CPT,Facility,Inpatient,,,90,92,78.2,26.3672,92,Medica,Medical Assistance,,,,,Included in per diem rate,
"Methotrexate, S (Mayo)OutsideLaboratory",,80204,CPT,Facility,Outpatient,,,90,92,78.2,26.3672,92,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,45.816,49.8,,percent of total billed charges,,
"Methotrexate, S (Mayo)OutsideLaboratory",,80204,CPT,Facility,Inpatient,,,90,92,78.2,26.3672,92,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Methotrexate, S (Mayo)OutsideLaboratory",,80204,CPT,Facility,Both,,,90,92,78.2,26.3672,92,"Multiplan, Inc.","Multiplan, Inc.",86.48,94,,percent of total billed charges,,
"Methotrexate, S (Mayo)OutsideLaboratory",,80204,CPT,Facility,Outpatient,,,90,92,78.2,26.3672,92,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,79.488,86.4,,percent of total billed charges,,
"Methotrexate, S (Mayo)OutsideLaboratory",,80204,CPT,Facility,Inpatient,,,90,92,78.2,26.3672,92,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Methotrexate, S (Mayo)OutsideLaboratory",,80204,CPT,Facility,Both,,,90,92,78.2,26.3672,92,"Preferred One Administrative Services, INC.",PPO,90.712,98.6,,percent of total billed charges,,
"Methotrexate, S (Mayo)OutsideLaboratory",,80204,CPT,Facility,Outpatient,,,90,92,78.2,26.3672,92,PrimeWest Health,Minnesota Senior Health Options (MSHO),47.334,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Methotrexate, S (Mayo)OutsideLaboratory",,80204,CPT,Facility,Inpatient,,,90,92,78.2,26.3672,92,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Methotrexate, S (Mayo)OutsideLaboratory",,80204,CPT,Facility,Outpatient,,,90,92,78.2,26.3672,92,PrimeWest Health,MinnesotaCare,47.2512,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Methotrexate, S (Mayo)OutsideLaboratory",,80204,CPT,Facility,Inpatient,,,90,92,78.2,26.3672,92,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Methotrexate, S (Mayo)OutsideLaboratory",,80204,CPT,Facility,Both,,,90,92,78.2,26.3672,92,Sanford Health Plan,Sanford Health Plan,84.64,92,,percent of total billed charges,,
"Methotrexate, S (Mayo)OutsideLaboratory",,80204,CPT,Facility,Outpatient,,,90,92,78.2,26.3672,92,"UCare Health, Inc.",Individual & Family Plan,51.842,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Methotrexate, S (Mayo)OutsideLaboratory",,80204,CPT,Facility,Inpatient,,,90,92,78.2,26.3672,92,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Methotrexate, S (Mayo)OutsideLaboratory",,80204,CPT,Facility,Outpatient,,,90,92,78.2,26.3672,92,"UCare Health, Inc.",Medical Assistance,46.4324,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Methotrexate, S (Mayo)OutsideLaboratory",,80204,CPT,Facility,Inpatient,,,90,92,78.2,26.3672,92,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Methotrexate, S (Mayo)OutsideLaboratory",,80204,CPT,Facility,Outpatient,,,90,92,78.2,26.3672,92,"UCare Health, Inc.",Medicare Advantage,46.4324,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Methotrexate, S (Mayo)OutsideLaboratory",,80204,CPT,Facility,Inpatient,,,90,92,78.2,26.3672,92,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Methotrexate, S (Mayo)OutsideLaboratory",,80204,CPT,Facility,Outpatient,,,90,92,78.2,26.3672,92,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),46.4324,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Methotrexate, S (Mayo)OutsideLaboratory",,80204,CPT,Facility,Inpatient,,,90,92,78.2,26.3672,92,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Methotrexate, S (Mayo)OutsideLaboratory",,80204,CPT,Facility,Both,,,90,92,78.2,26.3672,92,UnitedHealthcare,Individual & Family,86.48,94,,percent of total billed charges,,
"Methotrexate, S (Mayo)OutsideLaboratory",,80204,CPT,Facility,Outpatient,,,90,92,78.2,26.3672,92,UnitedHealthcare,Medicare Advantage,45.08,49,,percent of total billed charges,,
"Methotrexate, S (Mayo)OutsideLaboratory",,80204,CPT,Facility,Inpatient,,,90,92,78.2,26.3672,92,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Methotrexate, S (Mayo)OutsideLaboratory",,80204,CPT,Facility,Outpatient,,,90,92,78.2,26.3672,92,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,44.16,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Methotrexate, S (Mayo)OutsideLaboratory",,80204,CPT,Facility,Inpatient,,,90,92,78.2,26.3672,92,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Lacosamide (Mayo)OutsideLaboratory,,80235,CPT,Facility,Both,,,90,160,136,45.856,160,Aetna,Commercial,147.2,92,,percent of total billed charges,,
Lacosamide (Mayo)OutsideLaboratory,,80235,CPT,Facility,Outpatient,,,90,160,136,45.856,160,Aetna,Medicare Advantage,78.4,49,,percent of total billed charges,,
Lacosamide (Mayo)OutsideLaboratory,,80235,CPT,Facility,Inpatient,,,90,160,136,45.856,160,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Lacosamide (Mayo)OutsideLaboratory,,80235,CPT,Facility,Both,,,90,160,136,45.856,160,Aetna,PPO,148.8,93,,percent of total billed charges,,
Lacosamide (Mayo)OutsideLaboratory,,80235,CPT,Facility,Both,,,90,160,136,45.856,160,America's PPO,America's PPO,153.648,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Lacosamide (Mayo)OutsideLaboratory,,80235,CPT,Facility,Both,,,90,160,136,45.856,160,BlueCross BlueShield Minnesota, Federal Employee Program,157.44,98.4,,percent of total billed charges,,
Lacosamide (Mayo)OutsideLaboratory,,80235,CPT,Facility,Both,,,90,160,136,45.856,160,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,160,100,,percent of total billed charges,,
Lacosamide (Mayo)OutsideLaboratory,,80235,CPT,Facility,Both,,,90,160,136,45.856,160,BlueCross BlueShield Minnesota,High Value Network Plan,144,90,,percent of total billed charges,,
Lacosamide (Mayo)OutsideLaboratory,,80235,CPT,Facility,Outpatient,,,90,160,136,45.856,160,BlueCross BlueShield Minnesota,Medicare Advantage,78.4,49,,percent of total billed charges,,
Lacosamide (Mayo)OutsideLaboratory,,80235,CPT,Facility,Inpatient,,,90,160,136,45.856,160,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Lacosamide (Mayo)OutsideLaboratory,,80235,CPT,Facility,Both,,,90,160,136,45.856,160,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,141.712,88.57,,percent of total billed charges,,
Lacosamide (Mayo)OutsideLaboratory,,80235,CPT,Facility,Both,,,90,160,136,45.856,160,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,45.856,28.66,,percent of total billed charges,,
Lacosamide (Mayo)OutsideLaboratory,,80235,CPT,Facility,Outpatient,,,90,160,136,45.856,160,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),78.4,49,,percent of total billed charges,,
Lacosamide (Mayo)OutsideLaboratory,,80235,CPT,Facility,Inpatient,,,90,160,136,45.856,160,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Lacosamide (Mayo)OutsideLaboratory,,80235,CPT,Facility,Both,,,90,160,136,45.856,160,CorVel,Worker's Compensation,160,100,,percent of total billed charges,,
Lacosamide (Mayo)OutsideLaboratory,,80235,CPT,Facility,Both,,,90,160,136,45.856,160,First Health Group Corporation,First Health Network,155.2,97,,percent of total billed charges,,
Lacosamide (Mayo)OutsideLaboratory,,80235,CPT,Facility,Both,,,90,160,136,45.856,160,"Health Partners, Inc.",Commercial,151.36,94.6,,percent of total billed charges,,
Lacosamide (Mayo)OutsideLaboratory,,80235,CPT,Facility,Outpatient,,,90,160,136,45.856,160,"Health Partners, Inc.",Medicare Advantage,78.4,49,,percent of total billed charges,,
Lacosamide (Mayo)OutsideLaboratory,,80235,CPT,Facility,Inpatient,,,90,160,136,45.856,160,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Lacosamide (Mayo)OutsideLaboratory,,80235,CPT,Facility,Both,,,90,160,136,45.856,160,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),96,60,,percent of total billed charges,,
Lacosamide (Mayo)OutsideLaboratory,,80235,CPT,Facility,Both,,,90,160,136,45.856,160,"Health Partners, Inc.",State of Minnesota Advantage Program,130.4,81.5,,percent of total billed charges,,
Lacosamide (Mayo)OutsideLaboratory,,80235,CPT,Facility,Both,,,90,160,136,45.856,160,"Health Partners, Inc.",State Public Programs,80,50,,percent of total billed charges,,
Lacosamide (Mayo)OutsideLaboratory,,80235,CPT,Facility,Both,,,90,160,136,45.856,160,Humana Insurance Company,Commercial PPO,152,95,,percent of total billed charges,,
Lacosamide (Mayo)OutsideLaboratory,,80235,CPT,Facility,Outpatient,,,90,160,136,45.856,160,Humana Insurance Company,Medicare PPO,78.4,49,,percent of total billed charges,,
Lacosamide (Mayo)OutsideLaboratory,,80235,CPT,Facility,Inpatient,,,90,160,136,45.856,160,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Lacosamide (Mayo)OutsideLaboratory,,80235,CPT,Facility,Both,,,90,160,136,45.856,160,Medica,Individual & Family,158.56,99.1,,percent of total billed charges,,
Lacosamide (Mayo)OutsideLaboratory,,80235,CPT,Facility,Outpatient,,,90,160,136,45.856,160,Medica,Medica Advantage Solution,79.68,49.8,,percent of total billed charges,,
Lacosamide (Mayo)OutsideLaboratory,,80235,CPT,Facility,Inpatient,,,90,160,136,45.856,160,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Lacosamide (Mayo)OutsideLaboratory,,80235,CPT,Facility,Outpatient,,,90,160,136,45.856,160,Medica,Medical Assistance,71.36,44.6,,percent of total billed charges,,
Lacosamide (Mayo)OutsideLaboratory,,80235,CPT,Facility,Inpatient,,,90,160,136,45.856,160,Medica,Medical Assistance,,,,,Included in per diem rate,
Lacosamide (Mayo)OutsideLaboratory,,80235,CPT,Facility,Outpatient,,,90,160,136,45.856,160,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,79.68,49.8,,percent of total billed charges,,
Lacosamide (Mayo)OutsideLaboratory,,80235,CPT,Facility,Inpatient,,,90,160,136,45.856,160,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Lacosamide (Mayo)OutsideLaboratory,,80235,CPT,Facility,Both,,,90,160,136,45.856,160,"Multiplan, Inc.","Multiplan, Inc.",150.4,94,,percent of total billed charges,,
Lacosamide (Mayo)OutsideLaboratory,,80235,CPT,Facility,Outpatient,,,90,160,136,45.856,160,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,138.24,86.4,,percent of total billed charges,,
Lacosamide (Mayo)OutsideLaboratory,,80235,CPT,Facility,Inpatient,,,90,160,136,45.856,160,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Lacosamide (Mayo)OutsideLaboratory,,80235,CPT,Facility,Both,,,90,160,136,45.856,160,"Preferred One Administrative Services, INC.",PPO,157.76,98.6,,percent of total billed charges,,
Lacosamide (Mayo)OutsideLaboratory,,80235,CPT,Facility,Outpatient,,,90,160,136,45.856,160,PrimeWest Health,Minnesota Senior Health Options (MSHO),82.32,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Lacosamide (Mayo)OutsideLaboratory,,80235,CPT,Facility,Inpatient,,,90,160,136,45.856,160,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Lacosamide (Mayo)OutsideLaboratory,,80235,CPT,Facility,Outpatient,,,90,160,136,45.856,160,PrimeWest Health,MinnesotaCare,82.176,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Lacosamide (Mayo)OutsideLaboratory,,80235,CPT,Facility,Inpatient,,,90,160,136,45.856,160,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Lacosamide (Mayo)OutsideLaboratory,,80235,CPT,Facility,Both,,,90,160,136,45.856,160,Sanford Health Plan,Sanford Health Plan,147.2,92,,percent of total billed charges,,
Lacosamide (Mayo)OutsideLaboratory,,80235,CPT,Facility,Outpatient,,,90,160,136,45.856,160,"UCare Health, Inc.",Individual & Family Plan,90.16,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Lacosamide (Mayo)OutsideLaboratory,,80235,CPT,Facility,Inpatient,,,90,160,136,45.856,160,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Lacosamide (Mayo)OutsideLaboratory,,80235,CPT,Facility,Outpatient,,,90,160,136,45.856,160,"UCare Health, Inc.",Medical Assistance,80.752,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Lacosamide (Mayo)OutsideLaboratory,,80235,CPT,Facility,Inpatient,,,90,160,136,45.856,160,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Lacosamide (Mayo)OutsideLaboratory,,80235,CPT,Facility,Outpatient,,,90,160,136,45.856,160,"UCare Health, Inc.",Medicare Advantage,80.752,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Lacosamide (Mayo)OutsideLaboratory,,80235,CPT,Facility,Inpatient,,,90,160,136,45.856,160,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Lacosamide (Mayo)OutsideLaboratory,,80235,CPT,Facility,Outpatient,,,90,160,136,45.856,160,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),80.752,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Lacosamide (Mayo)OutsideLaboratory,,80235,CPT,Facility,Inpatient,,,90,160,136,45.856,160,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Lacosamide (Mayo)OutsideLaboratory,,80235,CPT,Facility,Both,,,90,160,136,45.856,160,UnitedHealthcare,Individual & Family,150.4,94,,percent of total billed charges,,
Lacosamide (Mayo)OutsideLaboratory,,80235,CPT,Facility,Outpatient,,,90,160,136,45.856,160,UnitedHealthcare,Medicare Advantage,78.4,49,,percent of total billed charges,,
Lacosamide (Mayo)OutsideLaboratory,,80235,CPT,Facility,Inpatient,,,90,160,136,45.856,160,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Lacosamide (Mayo)OutsideLaboratory,,80235,CPT,Facility,Outpatient,,,90,160,136,45.856,160,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,76.8,48,,percent of total billed charges,,100% of DHS outpatient percentage
Lacosamide (Mayo)OutsideLaboratory,,80235,CPT,Facility,Inpatient,,,90,160,136,45.856,160,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Citalopram (Mayo)OutsideLaboratory,,80299,CPT,Facility,Both,,,90,157,133.45,44.9962,157,Aetna,Commercial,144.44,92,,percent of total billed charges,,
Citalopram (Mayo)OutsideLaboratory,,80299,CPT,Facility,Outpatient,,,90,157,133.45,44.9962,157,Aetna,Medicare Advantage,76.93,49,,percent of total billed charges,,
Citalopram (Mayo)OutsideLaboratory,,80299,CPT,Facility,Inpatient,,,90,157,133.45,44.9962,157,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Citalopram (Mayo)OutsideLaboratory,,80299,CPT,Facility,Both,,,90,157,133.45,44.9962,157,Aetna,PPO,146.01,93,,percent of total billed charges,,
Citalopram (Mayo)OutsideLaboratory,,80299,CPT,Facility,Both,,,90,157,133.45,44.9962,157,America's PPO,America's PPO,150.7671,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Citalopram (Mayo)OutsideLaboratory,,80299,CPT,Facility,Both,,,90,157,133.45,44.9962,157,BlueCross BlueShield Minnesota, Federal Employee Program,154.488,98.4,,percent of total billed charges,,
Citalopram (Mayo)OutsideLaboratory,,80299,CPT,Facility,Both,,,90,157,133.45,44.9962,157,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,157,100,,percent of total billed charges,,
Citalopram (Mayo)OutsideLaboratory,,80299,CPT,Facility,Both,,,90,157,133.45,44.9962,157,BlueCross BlueShield Minnesota,High Value Network Plan,141.3,90,,percent of total billed charges,,
Citalopram (Mayo)OutsideLaboratory,,80299,CPT,Facility,Outpatient,,,90,157,133.45,44.9962,157,BlueCross BlueShield Minnesota,Medicare Advantage,76.93,49,,percent of total billed charges,,
Citalopram (Mayo)OutsideLaboratory,,80299,CPT,Facility,Inpatient,,,90,157,133.45,44.9962,157,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Citalopram (Mayo)OutsideLaboratory,,80299,CPT,Facility,Both,,,90,157,133.45,44.9962,157,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,139.0549,88.57,,percent of total billed charges,,
Citalopram (Mayo)OutsideLaboratory,,80299,CPT,Facility,Both,,,90,157,133.45,44.9962,157,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,44.9962,28.66,,percent of total billed charges,,
Citalopram (Mayo)OutsideLaboratory,,80299,CPT,Facility,Outpatient,,,90,157,133.45,44.9962,157,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),76.93,49,,percent of total billed charges,,
Citalopram (Mayo)OutsideLaboratory,,80299,CPT,Facility,Inpatient,,,90,157,133.45,44.9962,157,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Citalopram (Mayo)OutsideLaboratory,,80299,CPT,Facility,Both,,,90,157,133.45,44.9962,157,CorVel,Worker's Compensation,157,100,,percent of total billed charges,,
Citalopram (Mayo)OutsideLaboratory,,80299,CPT,Facility,Both,,,90,157,133.45,44.9962,157,First Health Group Corporation,First Health Network,152.29,97,,percent of total billed charges,,
Citalopram (Mayo)OutsideLaboratory,,80299,CPT,Facility,Both,,,90,157,133.45,44.9962,157,"Health Partners, Inc.",Commercial,148.522,94.6,,percent of total billed charges,,
Citalopram (Mayo)OutsideLaboratory,,80299,CPT,Facility,Outpatient,,,90,157,133.45,44.9962,157,"Health Partners, Inc.",Medicare Advantage,76.93,49,,percent of total billed charges,,
Citalopram (Mayo)OutsideLaboratory,,80299,CPT,Facility,Inpatient,,,90,157,133.45,44.9962,157,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Citalopram (Mayo)OutsideLaboratory,,80299,CPT,Facility,Both,,,90,157,133.45,44.9962,157,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),94.2,60,,percent of total billed charges,,
Citalopram (Mayo)OutsideLaboratory,,80299,CPT,Facility,Both,,,90,157,133.45,44.9962,157,"Health Partners, Inc.",State of Minnesota Advantage Program,127.955,81.5,,percent of total billed charges,,
Citalopram (Mayo)OutsideLaboratory,,80299,CPT,Facility,Both,,,90,157,133.45,44.9962,157,"Health Partners, Inc.",State Public Programs,78.5,50,,percent of total billed charges,,
Citalopram (Mayo)OutsideLaboratory,,80299,CPT,Facility,Both,,,90,157,133.45,44.9962,157,Humana Insurance Company,Commercial PPO,149.15,95,,percent of total billed charges,,
Citalopram (Mayo)OutsideLaboratory,,80299,CPT,Facility,Outpatient,,,90,157,133.45,44.9962,157,Humana Insurance Company,Medicare PPO,76.93,49,,percent of total billed charges,,
Citalopram (Mayo)OutsideLaboratory,,80299,CPT,Facility,Inpatient,,,90,157,133.45,44.9962,157,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Citalopram (Mayo)OutsideLaboratory,,80299,CPT,Facility,Both,,,90,157,133.45,44.9962,157,Medica,Individual & Family,155.587,99.1,,percent of total billed charges,,
Citalopram (Mayo)OutsideLaboratory,,80299,CPT,Facility,Outpatient,,,90,157,133.45,44.9962,157,Medica,Medica Advantage Solution,78.186,49.8,,percent of total billed charges,,
Citalopram (Mayo)OutsideLaboratory,,80299,CPT,Facility,Inpatient,,,90,157,133.45,44.9962,157,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Citalopram (Mayo)OutsideLaboratory,,80299,CPT,Facility,Outpatient,,,90,157,133.45,44.9962,157,Medica,Medical Assistance,70.022,44.6,,percent of total billed charges,,
Citalopram (Mayo)OutsideLaboratory,,80299,CPT,Facility,Inpatient,,,90,157,133.45,44.9962,157,Medica,Medical Assistance,,,,,Included in per diem rate,
Citalopram (Mayo)OutsideLaboratory,,80299,CPT,Facility,Outpatient,,,90,157,133.45,44.9962,157,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,78.186,49.8,,percent of total billed charges,,
Citalopram (Mayo)OutsideLaboratory,,80299,CPT,Facility,Inpatient,,,90,157,133.45,44.9962,157,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Citalopram (Mayo)OutsideLaboratory,,80299,CPT,Facility,Both,,,90,157,133.45,44.9962,157,"Multiplan, Inc.","Multiplan, Inc.",147.58,94,,percent of total billed charges,,
Citalopram (Mayo)OutsideLaboratory,,80299,CPT,Facility,Outpatient,,,90,157,133.45,44.9962,157,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,135.648,86.4,,percent of total billed charges,,
Citalopram (Mayo)OutsideLaboratory,,80299,CPT,Facility,Inpatient,,,90,157,133.45,44.9962,157,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Citalopram (Mayo)OutsideLaboratory,,80299,CPT,Facility,Both,,,90,157,133.45,44.9962,157,"Preferred One Administrative Services, INC.",PPO,154.802,98.6,,percent of total billed charges,,
Citalopram (Mayo)OutsideLaboratory,,80299,CPT,Facility,Outpatient,,,90,157,133.45,44.9962,157,PrimeWest Health,Minnesota Senior Health Options (MSHO),80.7765,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Citalopram (Mayo)OutsideLaboratory,,80299,CPT,Facility,Inpatient,,,90,157,133.45,44.9962,157,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Citalopram (Mayo)OutsideLaboratory,,80299,CPT,Facility,Outpatient,,,90,157,133.45,44.9962,157,PrimeWest Health,MinnesotaCare,80.6352,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Citalopram (Mayo)OutsideLaboratory,,80299,CPT,Facility,Inpatient,,,90,157,133.45,44.9962,157,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Citalopram (Mayo)OutsideLaboratory,,80299,CPT,Facility,Both,,,90,157,133.45,44.9962,157,Sanford Health Plan,Sanford Health Plan,144.44,92,,percent of total billed charges,,
Citalopram (Mayo)OutsideLaboratory,,80299,CPT,Facility,Outpatient,,,90,157,133.45,44.9962,157,"UCare Health, Inc.",Individual & Family Plan,88.4695,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Citalopram (Mayo)OutsideLaboratory,,80299,CPT,Facility,Inpatient,,,90,157,133.45,44.9962,157,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Citalopram (Mayo)OutsideLaboratory,,80299,CPT,Facility,Outpatient,,,90,157,133.45,44.9962,157,"UCare Health, Inc.",Medical Assistance,79.2379,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Citalopram (Mayo)OutsideLaboratory,,80299,CPT,Facility,Inpatient,,,90,157,133.45,44.9962,157,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Citalopram (Mayo)OutsideLaboratory,,80299,CPT,Facility,Outpatient,,,90,157,133.45,44.9962,157,"UCare Health, Inc.",Medicare Advantage,79.2379,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Citalopram (Mayo)OutsideLaboratory,,80299,CPT,Facility,Inpatient,,,90,157,133.45,44.9962,157,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Citalopram (Mayo)OutsideLaboratory,,80299,CPT,Facility,Outpatient,,,90,157,133.45,44.9962,157,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),79.2379,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Citalopram (Mayo)OutsideLaboratory,,80299,CPT,Facility,Inpatient,,,90,157,133.45,44.9962,157,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Citalopram (Mayo)OutsideLaboratory,,80299,CPT,Facility,Both,,,90,157,133.45,44.9962,157,UnitedHealthcare,Individual & Family,147.58,94,,percent of total billed charges,,
Citalopram (Mayo)OutsideLaboratory,,80299,CPT,Facility,Outpatient,,,90,157,133.45,44.9962,157,UnitedHealthcare,Medicare Advantage,76.93,49,,percent of total billed charges,,
Citalopram (Mayo)OutsideLaboratory,,80299,CPT,Facility,Inpatient,,,90,157,133.45,44.9962,157,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Citalopram (Mayo)OutsideLaboratory,,80299,CPT,Facility,Outpatient,,,90,157,133.45,44.9962,157,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,75.36,48,,percent of total billed charges,,100% of DHS outpatient percentage
Citalopram (Mayo)OutsideLaboratory,,80299,CPT,Facility,Inpatient,,,90,157,133.45,44.9962,157,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Fluoxetine, S (Mayo)OutsideLaboratory",,80299,CPT,Facility,Both,,,90,160,136,45.856,160,Aetna,Commercial,147.2,92,,percent of total billed charges,,
"Fluoxetine, S (Mayo)OutsideLaboratory",,80299,CPT,Facility,Outpatient,,,90,160,136,45.856,160,Aetna,Medicare Advantage,78.4,49,,percent of total billed charges,,
"Fluoxetine, S (Mayo)OutsideLaboratory",,80299,CPT,Facility,Inpatient,,,90,160,136,45.856,160,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Fluoxetine, S (Mayo)OutsideLaboratory",,80299,CPT,Facility,Both,,,90,160,136,45.856,160,Aetna,PPO,148.8,93,,percent of total billed charges,,
"Fluoxetine, S (Mayo)OutsideLaboratory",,80299,CPT,Facility,Both,,,90,160,136,45.856,160,America's PPO,America's PPO,153.648,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Fluoxetine, S (Mayo)OutsideLaboratory",,80299,CPT,Facility,Both,,,90,160,136,45.856,160,BlueCross BlueShield Minnesota, Federal Employee Program,157.44,98.4,,percent of total billed charges,,
"Fluoxetine, S (Mayo)OutsideLaboratory",,80299,CPT,Facility,Both,,,90,160,136,45.856,160,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,160,100,,percent of total billed charges,,
"Fluoxetine, S (Mayo)OutsideLaboratory",,80299,CPT,Facility,Both,,,90,160,136,45.856,160,BlueCross BlueShield Minnesota,High Value Network Plan,144,90,,percent of total billed charges,,
"Fluoxetine, S (Mayo)OutsideLaboratory",,80299,CPT,Facility,Outpatient,,,90,160,136,45.856,160,BlueCross BlueShield Minnesota,Medicare Advantage,78.4,49,,percent of total billed charges,,
"Fluoxetine, S (Mayo)OutsideLaboratory",,80299,CPT,Facility,Inpatient,,,90,160,136,45.856,160,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Fluoxetine, S (Mayo)OutsideLaboratory",,80299,CPT,Facility,Both,,,90,160,136,45.856,160,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,141.712,88.57,,percent of total billed charges,,
"Fluoxetine, S (Mayo)OutsideLaboratory",,80299,CPT,Facility,Both,,,90,160,136,45.856,160,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,45.856,28.66,,percent of total billed charges,,
"Fluoxetine, S (Mayo)OutsideLaboratory",,80299,CPT,Facility,Outpatient,,,90,160,136,45.856,160,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),78.4,49,,percent of total billed charges,,
"Fluoxetine, S (Mayo)OutsideLaboratory",,80299,CPT,Facility,Inpatient,,,90,160,136,45.856,160,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Fluoxetine, S (Mayo)OutsideLaboratory",,80299,CPT,Facility,Both,,,90,160,136,45.856,160,CorVel,Worker's Compensation,160,100,,percent of total billed charges,,
"Fluoxetine, S (Mayo)OutsideLaboratory",,80299,CPT,Facility,Both,,,90,160,136,45.856,160,First Health Group Corporation,First Health Network,155.2,97,,percent of total billed charges,,
"Fluoxetine, S (Mayo)OutsideLaboratory",,80299,CPT,Facility,Both,,,90,160,136,45.856,160,"Health Partners, Inc.",Commercial,151.36,94.6,,percent of total billed charges,,
"Fluoxetine, S (Mayo)OutsideLaboratory",,80299,CPT,Facility,Outpatient,,,90,160,136,45.856,160,"Health Partners, Inc.",Medicare Advantage,78.4,49,,percent of total billed charges,,
"Fluoxetine, S (Mayo)OutsideLaboratory",,80299,CPT,Facility,Inpatient,,,90,160,136,45.856,160,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Fluoxetine, S (Mayo)OutsideLaboratory",,80299,CPT,Facility,Both,,,90,160,136,45.856,160,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),96,60,,percent of total billed charges,,
"Fluoxetine, S (Mayo)OutsideLaboratory",,80299,CPT,Facility,Both,,,90,160,136,45.856,160,"Health Partners, Inc.",State of Minnesota Advantage Program,130.4,81.5,,percent of total billed charges,,
"Fluoxetine, S (Mayo)OutsideLaboratory",,80299,CPT,Facility,Both,,,90,160,136,45.856,160,"Health Partners, Inc.",State Public Programs,80,50,,percent of total billed charges,,
"Fluoxetine, S (Mayo)OutsideLaboratory",,80299,CPT,Facility,Both,,,90,160,136,45.856,160,Humana Insurance Company,Commercial PPO,152,95,,percent of total billed charges,,
"Fluoxetine, S (Mayo)OutsideLaboratory",,80299,CPT,Facility,Outpatient,,,90,160,136,45.856,160,Humana Insurance Company,Medicare PPO,78.4,49,,percent of total billed charges,,
"Fluoxetine, S (Mayo)OutsideLaboratory",,80299,CPT,Facility,Inpatient,,,90,160,136,45.856,160,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Fluoxetine, S (Mayo)OutsideLaboratory",,80299,CPT,Facility,Both,,,90,160,136,45.856,160,Medica,Individual & Family,158.56,99.1,,percent of total billed charges,,
"Fluoxetine, S (Mayo)OutsideLaboratory",,80299,CPT,Facility,Outpatient,,,90,160,136,45.856,160,Medica,Medica Advantage Solution,79.68,49.8,,percent of total billed charges,,
"Fluoxetine, S (Mayo)OutsideLaboratory",,80299,CPT,Facility,Inpatient,,,90,160,136,45.856,160,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Fluoxetine, S (Mayo)OutsideLaboratory",,80299,CPT,Facility,Outpatient,,,90,160,136,45.856,160,Medica,Medical Assistance,71.36,44.6,,percent of total billed charges,,
"Fluoxetine, S (Mayo)OutsideLaboratory",,80299,CPT,Facility,Inpatient,,,90,160,136,45.856,160,Medica,Medical Assistance,,,,,Included in per diem rate,
"Fluoxetine, S (Mayo)OutsideLaboratory",,80299,CPT,Facility,Outpatient,,,90,160,136,45.856,160,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,79.68,49.8,,percent of total billed charges,,
"Fluoxetine, S (Mayo)OutsideLaboratory",,80299,CPT,Facility,Inpatient,,,90,160,136,45.856,160,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Fluoxetine, S (Mayo)OutsideLaboratory",,80299,CPT,Facility,Both,,,90,160,136,45.856,160,"Multiplan, Inc.","Multiplan, Inc.",150.4,94,,percent of total billed charges,,
"Fluoxetine, S (Mayo)OutsideLaboratory",,80299,CPT,Facility,Outpatient,,,90,160,136,45.856,160,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,138.24,86.4,,percent of total billed charges,,
"Fluoxetine, S (Mayo)OutsideLaboratory",,80299,CPT,Facility,Inpatient,,,90,160,136,45.856,160,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Fluoxetine, S (Mayo)OutsideLaboratory",,80299,CPT,Facility,Both,,,90,160,136,45.856,160,"Preferred One Administrative Services, INC.",PPO,157.76,98.6,,percent of total billed charges,,
"Fluoxetine, S (Mayo)OutsideLaboratory",,80299,CPT,Facility,Outpatient,,,90,160,136,45.856,160,PrimeWest Health,Minnesota Senior Health Options (MSHO),82.32,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Fluoxetine, S (Mayo)OutsideLaboratory",,80299,CPT,Facility,Inpatient,,,90,160,136,45.856,160,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Fluoxetine, S (Mayo)OutsideLaboratory",,80299,CPT,Facility,Outpatient,,,90,160,136,45.856,160,PrimeWest Health,MinnesotaCare,82.176,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Fluoxetine, S (Mayo)OutsideLaboratory",,80299,CPT,Facility,Inpatient,,,90,160,136,45.856,160,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Fluoxetine, S (Mayo)OutsideLaboratory",,80299,CPT,Facility,Both,,,90,160,136,45.856,160,Sanford Health Plan,Sanford Health Plan,147.2,92,,percent of total billed charges,,
"Fluoxetine, S (Mayo)OutsideLaboratory",,80299,CPT,Facility,Outpatient,,,90,160,136,45.856,160,"UCare Health, Inc.",Individual & Family Plan,90.16,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Fluoxetine, S (Mayo)OutsideLaboratory",,80299,CPT,Facility,Inpatient,,,90,160,136,45.856,160,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Fluoxetine, S (Mayo)OutsideLaboratory",,80299,CPT,Facility,Outpatient,,,90,160,136,45.856,160,"UCare Health, Inc.",Medical Assistance,80.752,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Fluoxetine, S (Mayo)OutsideLaboratory",,80299,CPT,Facility,Inpatient,,,90,160,136,45.856,160,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Fluoxetine, S (Mayo)OutsideLaboratory",,80299,CPT,Facility,Outpatient,,,90,160,136,45.856,160,"UCare Health, Inc.",Medicare Advantage,80.752,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Fluoxetine, S (Mayo)OutsideLaboratory",,80299,CPT,Facility,Inpatient,,,90,160,136,45.856,160,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Fluoxetine, S (Mayo)OutsideLaboratory",,80299,CPT,Facility,Outpatient,,,90,160,136,45.856,160,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),80.752,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Fluoxetine, S (Mayo)OutsideLaboratory",,80299,CPT,Facility,Inpatient,,,90,160,136,45.856,160,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Fluoxetine, S (Mayo)OutsideLaboratory",,80299,CPT,Facility,Both,,,90,160,136,45.856,160,UnitedHealthcare,Individual & Family,150.4,94,,percent of total billed charges,,
"Fluoxetine, S (Mayo)OutsideLaboratory",,80299,CPT,Facility,Outpatient,,,90,160,136,45.856,160,UnitedHealthcare,Medicare Advantage,78.4,49,,percent of total billed charges,,
"Fluoxetine, S (Mayo)OutsideLaboratory",,80299,CPT,Facility,Inpatient,,,90,160,136,45.856,160,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Fluoxetine, S (Mayo)OutsideLaboratory",,80299,CPT,Facility,Outpatient,,,90,160,136,45.856,160,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,76.8,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Fluoxetine, S (Mayo)OutsideLaboratory",,80299,CPT,Facility,Inpatient,,,90,160,136,45.856,160,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Confirmed Drug Abuse Panel, U (Mayo)OutsideLaboratory",,80307,CPT,Facility,Both,,,90,139,118.15,39.8374,139,Aetna,Commercial,127.88,92,,percent of total billed charges,,
"Confirmed Drug Abuse Panel, U (Mayo)OutsideLaboratory",,80307,CPT,Facility,Outpatient,,,90,139,118.15,39.8374,139,Aetna,Medicare Advantage,68.11,49,,percent of total billed charges,,
"Confirmed Drug Abuse Panel, U (Mayo)OutsideLaboratory",,80307,CPT,Facility,Inpatient,,,90,139,118.15,39.8374,139,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Confirmed Drug Abuse Panel, U (Mayo)OutsideLaboratory",,80307,CPT,Facility,Both,,,90,139,118.15,39.8374,139,Aetna,PPO,129.27,93,,percent of total billed charges,,
"Confirmed Drug Abuse Panel, U (Mayo)OutsideLaboratory",,80307,CPT,Facility,Both,,,90,139,118.15,39.8374,139,America's PPO,America's PPO,133.4817,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Confirmed Drug Abuse Panel, U (Mayo)OutsideLaboratory",,80307,CPT,Facility,Both,,,90,139,118.15,39.8374,139,BlueCross BlueShield Minnesota, Federal Employee Program,136.776,98.4,,percent of total billed charges,,
"Confirmed Drug Abuse Panel, U (Mayo)OutsideLaboratory",,80307,CPT,Facility,Both,,,90,139,118.15,39.8374,139,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,139,100,,percent of total billed charges,,
"Confirmed Drug Abuse Panel, U (Mayo)OutsideLaboratory",,80307,CPT,Facility,Both,,,90,139,118.15,39.8374,139,BlueCross BlueShield Minnesota,High Value Network Plan,125.1,90,,percent of total billed charges,,
"Confirmed Drug Abuse Panel, U (Mayo)OutsideLaboratory",,80307,CPT,Facility,Outpatient,,,90,139,118.15,39.8374,139,BlueCross BlueShield Minnesota,Medicare Advantage,68.11,49,,percent of total billed charges,,
"Confirmed Drug Abuse Panel, U (Mayo)OutsideLaboratory",,80307,CPT,Facility,Inpatient,,,90,139,118.15,39.8374,139,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Confirmed Drug Abuse Panel, U (Mayo)OutsideLaboratory",,80307,CPT,Facility,Both,,,90,139,118.15,39.8374,139,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,123.1123,88.57,,percent of total billed charges,,
"Confirmed Drug Abuse Panel, U (Mayo)OutsideLaboratory",,80307,CPT,Facility,Both,,,90,139,118.15,39.8374,139,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,39.8374,28.66,,percent of total billed charges,,
"Confirmed Drug Abuse Panel, U (Mayo)OutsideLaboratory",,80307,CPT,Facility,Outpatient,,,90,139,118.15,39.8374,139,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),68.11,49,,percent of total billed charges,,
"Confirmed Drug Abuse Panel, U (Mayo)OutsideLaboratory",,80307,CPT,Facility,Inpatient,,,90,139,118.15,39.8374,139,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Confirmed Drug Abuse Panel, U (Mayo)OutsideLaboratory",,80307,CPT,Facility,Both,,,90,139,118.15,39.8374,139,CorVel,Worker's Compensation,139,100,,percent of total billed charges,,
"Confirmed Drug Abuse Panel, U (Mayo)OutsideLaboratory",,80307,CPT,Facility,Both,,,90,139,118.15,39.8374,139,First Health Group Corporation,First Health Network,134.83,97,,percent of total billed charges,,
"Confirmed Drug Abuse Panel, U (Mayo)OutsideLaboratory",,80307,CPT,Facility,Both,,,90,139,118.15,39.8374,139,"Health Partners, Inc.",Commercial,131.494,94.6,,percent of total billed charges,,
"Confirmed Drug Abuse Panel, U (Mayo)OutsideLaboratory",,80307,CPT,Facility,Outpatient,,,90,139,118.15,39.8374,139,"Health Partners, Inc.",Medicare Advantage,68.11,49,,percent of total billed charges,,
"Confirmed Drug Abuse Panel, U (Mayo)OutsideLaboratory",,80307,CPT,Facility,Inpatient,,,90,139,118.15,39.8374,139,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Confirmed Drug Abuse Panel, U (Mayo)OutsideLaboratory",,80307,CPT,Facility,Both,,,90,139,118.15,39.8374,139,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),83.4,60,,percent of total billed charges,,
"Confirmed Drug Abuse Panel, U (Mayo)OutsideLaboratory",,80307,CPT,Facility,Both,,,90,139,118.15,39.8374,139,"Health Partners, Inc.",State of Minnesota Advantage Program,113.285,81.5,,percent of total billed charges,,
"Confirmed Drug Abuse Panel, U (Mayo)OutsideLaboratory",,80307,CPT,Facility,Both,,,90,139,118.15,39.8374,139,"Health Partners, Inc.",State Public Programs,69.5,50,,percent of total billed charges,,
"Confirmed Drug Abuse Panel, U (Mayo)OutsideLaboratory",,80307,CPT,Facility,Both,,,90,139,118.15,39.8374,139,Humana Insurance Company,Commercial PPO,132.05,95,,percent of total billed charges,,
"Confirmed Drug Abuse Panel, U (Mayo)OutsideLaboratory",,80307,CPT,Facility,Outpatient,,,90,139,118.15,39.8374,139,Humana Insurance Company,Medicare PPO,68.11,49,,percent of total billed charges,,
"Confirmed Drug Abuse Panel, U (Mayo)OutsideLaboratory",,80307,CPT,Facility,Inpatient,,,90,139,118.15,39.8374,139,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Confirmed Drug Abuse Panel, U (Mayo)OutsideLaboratory",,80307,CPT,Facility,Both,,,90,139,118.15,39.8374,139,Medica,Individual & Family,137.749,99.1,,percent of total billed charges,,
"Confirmed Drug Abuse Panel, U (Mayo)OutsideLaboratory",,80307,CPT,Facility,Outpatient,,,90,139,118.15,39.8374,139,Medica,Medica Advantage Solution,69.222,49.8,,percent of total billed charges,,
"Confirmed Drug Abuse Panel, U (Mayo)OutsideLaboratory",,80307,CPT,Facility,Inpatient,,,90,139,118.15,39.8374,139,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Confirmed Drug Abuse Panel, U (Mayo)OutsideLaboratory",,80307,CPT,Facility,Outpatient,,,90,139,118.15,39.8374,139,Medica,Medical Assistance,61.994,44.6,,percent of total billed charges,,
"Confirmed Drug Abuse Panel, U (Mayo)OutsideLaboratory",,80307,CPT,Facility,Inpatient,,,90,139,118.15,39.8374,139,Medica,Medical Assistance,,,,,Included in per diem rate,
"Confirmed Drug Abuse Panel, U (Mayo)OutsideLaboratory",,80307,CPT,Facility,Outpatient,,,90,139,118.15,39.8374,139,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,69.222,49.8,,percent of total billed charges,,
"Confirmed Drug Abuse Panel, U (Mayo)OutsideLaboratory",,80307,CPT,Facility,Inpatient,,,90,139,118.15,39.8374,139,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Confirmed Drug Abuse Panel, U (Mayo)OutsideLaboratory",,80307,CPT,Facility,Both,,,90,139,118.15,39.8374,139,"Multiplan, Inc.","Multiplan, Inc.",130.66,94,,percent of total billed charges,,
"Confirmed Drug Abuse Panel, U (Mayo)OutsideLaboratory",,80307,CPT,Facility,Outpatient,,,90,139,118.15,39.8374,139,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,120.096,86.4,,percent of total billed charges,,
"Confirmed Drug Abuse Panel, U (Mayo)OutsideLaboratory",,80307,CPT,Facility,Inpatient,,,90,139,118.15,39.8374,139,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Confirmed Drug Abuse Panel, U (Mayo)OutsideLaboratory",,80307,CPT,Facility,Both,,,90,139,118.15,39.8374,139,"Preferred One Administrative Services, INC.",PPO,137.054,98.6,,percent of total billed charges,,
"Confirmed Drug Abuse Panel, U (Mayo)OutsideLaboratory",,80307,CPT,Facility,Outpatient,,,90,139,118.15,39.8374,139,PrimeWest Health,Minnesota Senior Health Options (MSHO),71.5155,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Confirmed Drug Abuse Panel, U (Mayo)OutsideLaboratory",,80307,CPT,Facility,Inpatient,,,90,139,118.15,39.8374,139,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Confirmed Drug Abuse Panel, U (Mayo)OutsideLaboratory",,80307,CPT,Facility,Outpatient,,,90,139,118.15,39.8374,139,PrimeWest Health,MinnesotaCare,71.3904,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Confirmed Drug Abuse Panel, U (Mayo)OutsideLaboratory",,80307,CPT,Facility,Inpatient,,,90,139,118.15,39.8374,139,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Confirmed Drug Abuse Panel, U (Mayo)OutsideLaboratory",,80307,CPT,Facility,Both,,,90,139,118.15,39.8374,139,Sanford Health Plan,Sanford Health Plan,127.88,92,,percent of total billed charges,,
"Confirmed Drug Abuse Panel, U (Mayo)OutsideLaboratory",,80307,CPT,Facility,Outpatient,,,90,139,118.15,39.8374,139,"UCare Health, Inc.",Individual & Family Plan,78.3265,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Confirmed Drug Abuse Panel, U (Mayo)OutsideLaboratory",,80307,CPT,Facility,Inpatient,,,90,139,118.15,39.8374,139,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Confirmed Drug Abuse Panel, U (Mayo)OutsideLaboratory",,80307,CPT,Facility,Outpatient,,,90,139,118.15,39.8374,139,"UCare Health, Inc.",Medical Assistance,70.1533,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Confirmed Drug Abuse Panel, U (Mayo)OutsideLaboratory",,80307,CPT,Facility,Inpatient,,,90,139,118.15,39.8374,139,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Confirmed Drug Abuse Panel, U (Mayo)OutsideLaboratory",,80307,CPT,Facility,Outpatient,,,90,139,118.15,39.8374,139,"UCare Health, Inc.",Medicare Advantage,70.1533,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Confirmed Drug Abuse Panel, U (Mayo)OutsideLaboratory",,80307,CPT,Facility,Inpatient,,,90,139,118.15,39.8374,139,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Confirmed Drug Abuse Panel, U (Mayo)OutsideLaboratory",,80307,CPT,Facility,Outpatient,,,90,139,118.15,39.8374,139,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),70.1533,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Confirmed Drug Abuse Panel, U (Mayo)OutsideLaboratory",,80307,CPT,Facility,Inpatient,,,90,139,118.15,39.8374,139,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Confirmed Drug Abuse Panel, U (Mayo)OutsideLaboratory",,80307,CPT,Facility,Both,,,90,139,118.15,39.8374,139,UnitedHealthcare,Individual & Family,130.66,94,,percent of total billed charges,,
"Confirmed Drug Abuse Panel, U (Mayo)OutsideLaboratory",,80307,CPT,Facility,Outpatient,,,90,139,118.15,39.8374,139,UnitedHealthcare,Medicare Advantage,68.11,49,,percent of total billed charges,,
"Confirmed Drug Abuse Panel, U (Mayo)OutsideLaboratory",,80307,CPT,Facility,Inpatient,,,90,139,118.15,39.8374,139,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Confirmed Drug Abuse Panel, U (Mayo)OutsideLaboratory",,80307,CPT,Facility,Outpatient,,,90,139,118.15,39.8374,139,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,66.72,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Confirmed Drug Abuse Panel, U (Mayo)OutsideLaboratory",,80307,CPT,Facility,Inpatient,,,90,139,118.15,39.8374,139,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Drug Abuse Survey W Conf, Random, Urine (Mayo)OutsideLaboratory",,80307,CPT,Facility,Both,,,90,139,118.15,39.8374,139,Aetna,Commercial,127.88,92,,percent of total billed charges,,
"Drug Abuse Survey W Conf, Random, Urine (Mayo)OutsideLaboratory",,80307,CPT,Facility,Outpatient,,,90,139,118.15,39.8374,139,Aetna,Medicare Advantage,68.11,49,,percent of total billed charges,,
"Drug Abuse Survey W Conf, Random, Urine (Mayo)OutsideLaboratory",,80307,CPT,Facility,Inpatient,,,90,139,118.15,39.8374,139,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Drug Abuse Survey W Conf, Random, Urine (Mayo)OutsideLaboratory",,80307,CPT,Facility,Both,,,90,139,118.15,39.8374,139,Aetna,PPO,129.27,93,,percent of total billed charges,,
"Drug Abuse Survey W Conf, Random, Urine (Mayo)OutsideLaboratory",,80307,CPT,Facility,Both,,,90,139,118.15,39.8374,139,America's PPO,America's PPO,133.4817,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Drug Abuse Survey W Conf, Random, Urine (Mayo)OutsideLaboratory",,80307,CPT,Facility,Both,,,90,139,118.15,39.8374,139,BlueCross BlueShield Minnesota, Federal Employee Program,136.776,98.4,,percent of total billed charges,,
"Drug Abuse Survey W Conf, Random, Urine (Mayo)OutsideLaboratory",,80307,CPT,Facility,Both,,,90,139,118.15,39.8374,139,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,139,100,,percent of total billed charges,,
"Drug Abuse Survey W Conf, Random, Urine (Mayo)OutsideLaboratory",,80307,CPT,Facility,Both,,,90,139,118.15,39.8374,139,BlueCross BlueShield Minnesota,High Value Network Plan,125.1,90,,percent of total billed charges,,
"Drug Abuse Survey W Conf, Random, Urine (Mayo)OutsideLaboratory",,80307,CPT,Facility,Outpatient,,,90,139,118.15,39.8374,139,BlueCross BlueShield Minnesota,Medicare Advantage,68.11,49,,percent of total billed charges,,
"Drug Abuse Survey W Conf, Random, Urine (Mayo)OutsideLaboratory",,80307,CPT,Facility,Inpatient,,,90,139,118.15,39.8374,139,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Drug Abuse Survey W Conf, Random, Urine (Mayo)OutsideLaboratory",,80307,CPT,Facility,Both,,,90,139,118.15,39.8374,139,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,123.1123,88.57,,percent of total billed charges,,
"Drug Abuse Survey W Conf, Random, Urine (Mayo)OutsideLaboratory",,80307,CPT,Facility,Both,,,90,139,118.15,39.8374,139,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,39.8374,28.66,,percent of total billed charges,,
"Drug Abuse Survey W Conf, Random, Urine (Mayo)OutsideLaboratory",,80307,CPT,Facility,Outpatient,,,90,139,118.15,39.8374,139,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),68.11,49,,percent of total billed charges,,
"Drug Abuse Survey W Conf, Random, Urine (Mayo)OutsideLaboratory",,80307,CPT,Facility,Inpatient,,,90,139,118.15,39.8374,139,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Drug Abuse Survey W Conf, Random, Urine (Mayo)OutsideLaboratory",,80307,CPT,Facility,Both,,,90,139,118.15,39.8374,139,CorVel,Worker's Compensation,139,100,,percent of total billed charges,,
"Drug Abuse Survey W Conf, Random, Urine (Mayo)OutsideLaboratory",,80307,CPT,Facility,Both,,,90,139,118.15,39.8374,139,First Health Group Corporation,First Health Network,134.83,97,,percent of total billed charges,,
"Drug Abuse Survey W Conf, Random, Urine (Mayo)OutsideLaboratory",,80307,CPT,Facility,Both,,,90,139,118.15,39.8374,139,"Health Partners, Inc.",Commercial,131.494,94.6,,percent of total billed charges,,
"Drug Abuse Survey W Conf, Random, Urine (Mayo)OutsideLaboratory",,80307,CPT,Facility,Outpatient,,,90,139,118.15,39.8374,139,"Health Partners, Inc.",Medicare Advantage,68.11,49,,percent of total billed charges,,
"Drug Abuse Survey W Conf, Random, Urine (Mayo)OutsideLaboratory",,80307,CPT,Facility,Inpatient,,,90,139,118.15,39.8374,139,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Drug Abuse Survey W Conf, Random, Urine (Mayo)OutsideLaboratory",,80307,CPT,Facility,Both,,,90,139,118.15,39.8374,139,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),83.4,60,,percent of total billed charges,,
"Drug Abuse Survey W Conf, Random, Urine (Mayo)OutsideLaboratory",,80307,CPT,Facility,Both,,,90,139,118.15,39.8374,139,"Health Partners, Inc.",State of Minnesota Advantage Program,113.285,81.5,,percent of total billed charges,,
"Drug Abuse Survey W Conf, Random, Urine (Mayo)OutsideLaboratory",,80307,CPT,Facility,Both,,,90,139,118.15,39.8374,139,"Health Partners, Inc.",State Public Programs,69.5,50,,percent of total billed charges,,
"Drug Abuse Survey W Conf, Random, Urine (Mayo)OutsideLaboratory",,80307,CPT,Facility,Both,,,90,139,118.15,39.8374,139,Humana Insurance Company,Commercial PPO,132.05,95,,percent of total billed charges,,
"Drug Abuse Survey W Conf, Random, Urine (Mayo)OutsideLaboratory",,80307,CPT,Facility,Outpatient,,,90,139,118.15,39.8374,139,Humana Insurance Company,Medicare PPO,68.11,49,,percent of total billed charges,,
"Drug Abuse Survey W Conf, Random, Urine (Mayo)OutsideLaboratory",,80307,CPT,Facility,Inpatient,,,90,139,118.15,39.8374,139,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Drug Abuse Survey W Conf, Random, Urine (Mayo)OutsideLaboratory",,80307,CPT,Facility,Both,,,90,139,118.15,39.8374,139,Medica,Individual & Family,137.749,99.1,,percent of total billed charges,,
"Drug Abuse Survey W Conf, Random, Urine (Mayo)OutsideLaboratory",,80307,CPT,Facility,Outpatient,,,90,139,118.15,39.8374,139,Medica,Medica Advantage Solution,69.222,49.8,,percent of total billed charges,,
"Drug Abuse Survey W Conf, Random, Urine (Mayo)OutsideLaboratory",,80307,CPT,Facility,Inpatient,,,90,139,118.15,39.8374,139,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Drug Abuse Survey W Conf, Random, Urine (Mayo)OutsideLaboratory",,80307,CPT,Facility,Outpatient,,,90,139,118.15,39.8374,139,Medica,Medical Assistance,61.994,44.6,,percent of total billed charges,,
"Drug Abuse Survey W Conf, Random, Urine (Mayo)OutsideLaboratory",,80307,CPT,Facility,Inpatient,,,90,139,118.15,39.8374,139,Medica,Medical Assistance,,,,,Included in per diem rate,
"Drug Abuse Survey W Conf, Random, Urine (Mayo)OutsideLaboratory",,80307,CPT,Facility,Outpatient,,,90,139,118.15,39.8374,139,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,69.222,49.8,,percent of total billed charges,,
"Drug Abuse Survey W Conf, Random, Urine (Mayo)OutsideLaboratory",,80307,CPT,Facility,Inpatient,,,90,139,118.15,39.8374,139,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Drug Abuse Survey W Conf, Random, Urine (Mayo)OutsideLaboratory",,80307,CPT,Facility,Both,,,90,139,118.15,39.8374,139,"Multiplan, Inc.","Multiplan, Inc.",130.66,94,,percent of total billed charges,,
"Drug Abuse Survey W Conf, Random, Urine (Mayo)OutsideLaboratory",,80307,CPT,Facility,Outpatient,,,90,139,118.15,39.8374,139,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,120.096,86.4,,percent of total billed charges,,
"Drug Abuse Survey W Conf, Random, Urine (Mayo)OutsideLaboratory",,80307,CPT,Facility,Inpatient,,,90,139,118.15,39.8374,139,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Drug Abuse Survey W Conf, Random, Urine (Mayo)OutsideLaboratory",,80307,CPT,Facility,Both,,,90,139,118.15,39.8374,139,"Preferred One Administrative Services, INC.",PPO,137.054,98.6,,percent of total billed charges,,
"Drug Abuse Survey W Conf, Random, Urine (Mayo)OutsideLaboratory",,80307,CPT,Facility,Outpatient,,,90,139,118.15,39.8374,139,PrimeWest Health,Minnesota Senior Health Options (MSHO),71.5155,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Drug Abuse Survey W Conf, Random, Urine (Mayo)OutsideLaboratory",,80307,CPT,Facility,Inpatient,,,90,139,118.15,39.8374,139,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Drug Abuse Survey W Conf, Random, Urine (Mayo)OutsideLaboratory",,80307,CPT,Facility,Outpatient,,,90,139,118.15,39.8374,139,PrimeWest Health,MinnesotaCare,71.3904,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Drug Abuse Survey W Conf, Random, Urine (Mayo)OutsideLaboratory",,80307,CPT,Facility,Inpatient,,,90,139,118.15,39.8374,139,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Drug Abuse Survey W Conf, Random, Urine (Mayo)OutsideLaboratory",,80307,CPT,Facility,Both,,,90,139,118.15,39.8374,139,Sanford Health Plan,Sanford Health Plan,127.88,92,,percent of total billed charges,,
"Drug Abuse Survey W Conf, Random, Urine (Mayo)OutsideLaboratory",,80307,CPT,Facility,Outpatient,,,90,139,118.15,39.8374,139,"UCare Health, Inc.",Individual & Family Plan,78.3265,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Drug Abuse Survey W Conf, Random, Urine (Mayo)OutsideLaboratory",,80307,CPT,Facility,Inpatient,,,90,139,118.15,39.8374,139,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Drug Abuse Survey W Conf, Random, Urine (Mayo)OutsideLaboratory",,80307,CPT,Facility,Outpatient,,,90,139,118.15,39.8374,139,"UCare Health, Inc.",Medical Assistance,70.1533,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Drug Abuse Survey W Conf, Random, Urine (Mayo)OutsideLaboratory",,80307,CPT,Facility,Inpatient,,,90,139,118.15,39.8374,139,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Drug Abuse Survey W Conf, Random, Urine (Mayo)OutsideLaboratory",,80307,CPT,Facility,Outpatient,,,90,139,118.15,39.8374,139,"UCare Health, Inc.",Medicare Advantage,70.1533,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Drug Abuse Survey W Conf, Random, Urine (Mayo)OutsideLaboratory",,80307,CPT,Facility,Inpatient,,,90,139,118.15,39.8374,139,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Drug Abuse Survey W Conf, Random, Urine (Mayo)OutsideLaboratory",,80307,CPT,Facility,Outpatient,,,90,139,118.15,39.8374,139,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),70.1533,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Drug Abuse Survey W Conf, Random, Urine (Mayo)OutsideLaboratory",,80307,CPT,Facility,Inpatient,,,90,139,118.15,39.8374,139,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Drug Abuse Survey W Conf, Random, Urine (Mayo)OutsideLaboratory",,80307,CPT,Facility,Both,,,90,139,118.15,39.8374,139,UnitedHealthcare,Individual & Family,130.66,94,,percent of total billed charges,,
"Drug Abuse Survey W Conf, Random, Urine (Mayo)OutsideLaboratory",,80307,CPT,Facility,Outpatient,,,90,139,118.15,39.8374,139,UnitedHealthcare,Medicare Advantage,68.11,49,,percent of total billed charges,,
"Drug Abuse Survey W Conf, Random, Urine (Mayo)OutsideLaboratory",,80307,CPT,Facility,Inpatient,,,90,139,118.15,39.8374,139,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Drug Abuse Survey W Conf, Random, Urine (Mayo)OutsideLaboratory",,80307,CPT,Facility,Outpatient,,,90,139,118.15,39.8374,139,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,66.72,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Drug Abuse Survey W Conf, Random, Urine (Mayo)OutsideLaboratory",,80307,CPT,Facility,Inpatient,,,90,139,118.15,39.8374,139,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Ethanol, Urine (Mayo)OutsideLaboratory",,80320,CPT,Facility,Both,,,90,161,136.85,46.1426,161,Aetna,Commercial,148.12,92,,percent of total billed charges,,
"Ethanol, Urine (Mayo)OutsideLaboratory",,80320,CPT,Facility,Outpatient,,,90,161,136.85,46.1426,161,Aetna,Medicare Advantage,78.89,49,,percent of total billed charges,,
"Ethanol, Urine (Mayo)OutsideLaboratory",,80320,CPT,Facility,Inpatient,,,90,161,136.85,46.1426,161,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Ethanol, Urine (Mayo)OutsideLaboratory",,80320,CPT,Facility,Both,,,90,161,136.85,46.1426,161,Aetna,PPO,149.73,93,,percent of total billed charges,,
"Ethanol, Urine (Mayo)OutsideLaboratory",,80320,CPT,Facility,Both,,,90,161,136.85,46.1426,161,America's PPO,America's PPO,154.6083,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Ethanol, Urine (Mayo)OutsideLaboratory",,80320,CPT,Facility,Both,,,90,161,136.85,46.1426,161,BlueCross BlueShield Minnesota, Federal Employee Program,158.424,98.4,,percent of total billed charges,,
"Ethanol, Urine (Mayo)OutsideLaboratory",,80320,CPT,Facility,Both,,,90,161,136.85,46.1426,161,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,161,100,,percent of total billed charges,,
"Ethanol, Urine (Mayo)OutsideLaboratory",,80320,CPT,Facility,Both,,,90,161,136.85,46.1426,161,BlueCross BlueShield Minnesota,High Value Network Plan,144.9,90,,percent of total billed charges,,
"Ethanol, Urine (Mayo)OutsideLaboratory",,80320,CPT,Facility,Outpatient,,,90,161,136.85,46.1426,161,BlueCross BlueShield Minnesota,Medicare Advantage,78.89,49,,percent of total billed charges,,
"Ethanol, Urine (Mayo)OutsideLaboratory",,80320,CPT,Facility,Inpatient,,,90,161,136.85,46.1426,161,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Ethanol, Urine (Mayo)OutsideLaboratory",,80320,CPT,Facility,Both,,,90,161,136.85,46.1426,161,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,142.5977,88.57,,percent of total billed charges,,
"Ethanol, Urine (Mayo)OutsideLaboratory",,80320,CPT,Facility,Both,,,90,161,136.85,46.1426,161,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,46.1426,28.66,,percent of total billed charges,,
"Ethanol, Urine (Mayo)OutsideLaboratory",,80320,CPT,Facility,Outpatient,,,90,161,136.85,46.1426,161,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),78.89,49,,percent of total billed charges,,
"Ethanol, Urine (Mayo)OutsideLaboratory",,80320,CPT,Facility,Inpatient,,,90,161,136.85,46.1426,161,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Ethanol, Urine (Mayo)OutsideLaboratory",,80320,CPT,Facility,Both,,,90,161,136.85,46.1426,161,CorVel,Worker's Compensation,161,100,,percent of total billed charges,,
"Ethanol, Urine (Mayo)OutsideLaboratory",,80320,CPT,Facility,Both,,,90,161,136.85,46.1426,161,First Health Group Corporation,First Health Network,156.17,97,,percent of total billed charges,,
"Ethanol, Urine (Mayo)OutsideLaboratory",,80320,CPT,Facility,Both,,,90,161,136.85,46.1426,161,"Health Partners, Inc.",Commercial,152.306,94.6,,percent of total billed charges,,
"Ethanol, Urine (Mayo)OutsideLaboratory",,80320,CPT,Facility,Outpatient,,,90,161,136.85,46.1426,161,"Health Partners, Inc.",Medicare Advantage,78.89,49,,percent of total billed charges,,
"Ethanol, Urine (Mayo)OutsideLaboratory",,80320,CPT,Facility,Inpatient,,,90,161,136.85,46.1426,161,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Ethanol, Urine (Mayo)OutsideLaboratory",,80320,CPT,Facility,Both,,,90,161,136.85,46.1426,161,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),96.6,60,,percent of total billed charges,,
"Ethanol, Urine (Mayo)OutsideLaboratory",,80320,CPT,Facility,Both,,,90,161,136.85,46.1426,161,"Health Partners, Inc.",State of Minnesota Advantage Program,131.215,81.5,,percent of total billed charges,,
"Ethanol, Urine (Mayo)OutsideLaboratory",,80320,CPT,Facility,Both,,,90,161,136.85,46.1426,161,"Health Partners, Inc.",State Public Programs,80.5,50,,percent of total billed charges,,
"Ethanol, Urine (Mayo)OutsideLaboratory",,80320,CPT,Facility,Both,,,90,161,136.85,46.1426,161,Humana Insurance Company,Commercial PPO,152.95,95,,percent of total billed charges,,
"Ethanol, Urine (Mayo)OutsideLaboratory",,80320,CPT,Facility,Outpatient,,,90,161,136.85,46.1426,161,Humana Insurance Company,Medicare PPO,78.89,49,,percent of total billed charges,,
"Ethanol, Urine (Mayo)OutsideLaboratory",,80320,CPT,Facility,Inpatient,,,90,161,136.85,46.1426,161,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Ethanol, Urine (Mayo)OutsideLaboratory",,80320,CPT,Facility,Both,,,90,161,136.85,46.1426,161,Medica,Individual & Family,159.551,99.1,,percent of total billed charges,,
"Ethanol, Urine (Mayo)OutsideLaboratory",,80320,CPT,Facility,Outpatient,,,90,161,136.85,46.1426,161,Medica,Medica Advantage Solution,80.178,49.8,,percent of total billed charges,,
"Ethanol, Urine (Mayo)OutsideLaboratory",,80320,CPT,Facility,Inpatient,,,90,161,136.85,46.1426,161,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Ethanol, Urine (Mayo)OutsideLaboratory",,80320,CPT,Facility,Outpatient,,,90,161,136.85,46.1426,161,Medica,Medical Assistance,71.806,44.6,,percent of total billed charges,,
"Ethanol, Urine (Mayo)OutsideLaboratory",,80320,CPT,Facility,Inpatient,,,90,161,136.85,46.1426,161,Medica,Medical Assistance,,,,,Included in per diem rate,
"Ethanol, Urine (Mayo)OutsideLaboratory",,80320,CPT,Facility,Outpatient,,,90,161,136.85,46.1426,161,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,80.178,49.8,,percent of total billed charges,,
"Ethanol, Urine (Mayo)OutsideLaboratory",,80320,CPT,Facility,Inpatient,,,90,161,136.85,46.1426,161,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Ethanol, Urine (Mayo)OutsideLaboratory",,80320,CPT,Facility,Both,,,90,161,136.85,46.1426,161,"Multiplan, Inc.","Multiplan, Inc.",151.34,94,,percent of total billed charges,,
"Ethanol, Urine (Mayo)OutsideLaboratory",,80320,CPT,Facility,Outpatient,,,90,161,136.85,46.1426,161,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,139.104,86.4,,percent of total billed charges,,
"Ethanol, Urine (Mayo)OutsideLaboratory",,80320,CPT,Facility,Inpatient,,,90,161,136.85,46.1426,161,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Ethanol, Urine (Mayo)OutsideLaboratory",,80320,CPT,Facility,Both,,,90,161,136.85,46.1426,161,"Preferred One Administrative Services, INC.",PPO,158.746,98.6,,percent of total billed charges,,
"Ethanol, Urine (Mayo)OutsideLaboratory",,80320,CPT,Facility,Outpatient,,,90,161,136.85,46.1426,161,PrimeWest Health,Minnesota Senior Health Options (MSHO),82.8345,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Ethanol, Urine (Mayo)OutsideLaboratory",,80320,CPT,Facility,Inpatient,,,90,161,136.85,46.1426,161,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Ethanol, Urine (Mayo)OutsideLaboratory",,80320,CPT,Facility,Outpatient,,,90,161,136.85,46.1426,161,PrimeWest Health,MinnesotaCare,82.6896,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Ethanol, Urine (Mayo)OutsideLaboratory",,80320,CPT,Facility,Inpatient,,,90,161,136.85,46.1426,161,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Ethanol, Urine (Mayo)OutsideLaboratory",,80320,CPT,Facility,Both,,,90,161,136.85,46.1426,161,Sanford Health Plan,Sanford Health Plan,148.12,92,,percent of total billed charges,,
"Ethanol, Urine (Mayo)OutsideLaboratory",,80320,CPT,Facility,Outpatient,,,90,161,136.85,46.1426,161,"UCare Health, Inc.",Individual & Family Plan,90.7235,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Ethanol, Urine (Mayo)OutsideLaboratory",,80320,CPT,Facility,Inpatient,,,90,161,136.85,46.1426,161,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Ethanol, Urine (Mayo)OutsideLaboratory",,80320,CPT,Facility,Outpatient,,,90,161,136.85,46.1426,161,"UCare Health, Inc.",Medical Assistance,81.2567,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Ethanol, Urine (Mayo)OutsideLaboratory",,80320,CPT,Facility,Inpatient,,,90,161,136.85,46.1426,161,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Ethanol, Urine (Mayo)OutsideLaboratory",,80320,CPT,Facility,Outpatient,,,90,161,136.85,46.1426,161,"UCare Health, Inc.",Medicare Advantage,81.2567,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Ethanol, Urine (Mayo)OutsideLaboratory",,80320,CPT,Facility,Inpatient,,,90,161,136.85,46.1426,161,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Ethanol, Urine (Mayo)OutsideLaboratory",,80320,CPT,Facility,Outpatient,,,90,161,136.85,46.1426,161,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),81.2567,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Ethanol, Urine (Mayo)OutsideLaboratory",,80320,CPT,Facility,Inpatient,,,90,161,136.85,46.1426,161,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Ethanol, Urine (Mayo)OutsideLaboratory",,80320,CPT,Facility,Both,,,90,161,136.85,46.1426,161,UnitedHealthcare,Individual & Family,151.34,94,,percent of total billed charges,,
"Ethanol, Urine (Mayo)OutsideLaboratory",,80320,CPT,Facility,Outpatient,,,90,161,136.85,46.1426,161,UnitedHealthcare,Medicare Advantage,78.89,49,,percent of total billed charges,,
"Ethanol, Urine (Mayo)OutsideLaboratory",,80320,CPT,Facility,Inpatient,,,90,161,136.85,46.1426,161,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Ethanol, Urine (Mayo)OutsideLaboratory",,80320,CPT,Facility,Outpatient,,,90,161,136.85,46.1426,161,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,77.28,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Ethanol, Urine (Mayo)OutsideLaboratory",,80320,CPT,Facility,Inpatient,,,90,161,136.85,46.1426,161,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Nicotine And Metabolites, S (Mayo)OutsideLaboratory",,80323,CPT,Facility,Both,,,90,150,127.5,42.99,150,Aetna,Commercial,138,92,,percent of total billed charges,,
"Nicotine And Metabolites, S (Mayo)OutsideLaboratory",,80323,CPT,Facility,Outpatient,,,90,150,127.5,42.99,150,Aetna,Medicare Advantage,73.5,49,,percent of total billed charges,,
"Nicotine And Metabolites, S (Mayo)OutsideLaboratory",,80323,CPT,Facility,Inpatient,,,90,150,127.5,42.99,150,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Nicotine And Metabolites, S (Mayo)OutsideLaboratory",,80323,CPT,Facility,Both,,,90,150,127.5,42.99,150,Aetna,PPO,139.5,93,,percent of total billed charges,,
"Nicotine And Metabolites, S (Mayo)OutsideLaboratory",,80323,CPT,Facility,Both,,,90,150,127.5,42.99,150,America's PPO,America's PPO,144.045,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Nicotine And Metabolites, S (Mayo)OutsideLaboratory",,80323,CPT,Facility,Both,,,90,150,127.5,42.99,150,BlueCross BlueShield Minnesota, Federal Employee Program,147.6,98.4,,percent of total billed charges,,
"Nicotine And Metabolites, S (Mayo)OutsideLaboratory",,80323,CPT,Facility,Both,,,90,150,127.5,42.99,150,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,150,100,,percent of total billed charges,,
"Nicotine And Metabolites, S (Mayo)OutsideLaboratory",,80323,CPT,Facility,Both,,,90,150,127.5,42.99,150,BlueCross BlueShield Minnesota,High Value Network Plan,135,90,,percent of total billed charges,,
"Nicotine And Metabolites, S (Mayo)OutsideLaboratory",,80323,CPT,Facility,Outpatient,,,90,150,127.5,42.99,150,BlueCross BlueShield Minnesota,Medicare Advantage,73.5,49,,percent of total billed charges,,
"Nicotine And Metabolites, S (Mayo)OutsideLaboratory",,80323,CPT,Facility,Inpatient,,,90,150,127.5,42.99,150,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Nicotine And Metabolites, S (Mayo)OutsideLaboratory",,80323,CPT,Facility,Both,,,90,150,127.5,42.99,150,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,132.855,88.57,,percent of total billed charges,,
"Nicotine And Metabolites, S (Mayo)OutsideLaboratory",,80323,CPT,Facility,Both,,,90,150,127.5,42.99,150,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,42.99,28.66,,percent of total billed charges,,
"Nicotine And Metabolites, S (Mayo)OutsideLaboratory",,80323,CPT,Facility,Outpatient,,,90,150,127.5,42.99,150,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),73.5,49,,percent of total billed charges,,
"Nicotine And Metabolites, S (Mayo)OutsideLaboratory",,80323,CPT,Facility,Inpatient,,,90,150,127.5,42.99,150,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Nicotine And Metabolites, S (Mayo)OutsideLaboratory",,80323,CPT,Facility,Both,,,90,150,127.5,42.99,150,CorVel,Worker's Compensation,150,100,,percent of total billed charges,,
"Nicotine And Metabolites, S (Mayo)OutsideLaboratory",,80323,CPT,Facility,Both,,,90,150,127.5,42.99,150,First Health Group Corporation,First Health Network,145.5,97,,percent of total billed charges,,
"Nicotine And Metabolites, S (Mayo)OutsideLaboratory",,80323,CPT,Facility,Both,,,90,150,127.5,42.99,150,"Health Partners, Inc.",Commercial,141.9,94.6,,percent of total billed charges,,
"Nicotine And Metabolites, S (Mayo)OutsideLaboratory",,80323,CPT,Facility,Outpatient,,,90,150,127.5,42.99,150,"Health Partners, Inc.",Medicare Advantage,73.5,49,,percent of total billed charges,,
"Nicotine And Metabolites, S (Mayo)OutsideLaboratory",,80323,CPT,Facility,Inpatient,,,90,150,127.5,42.99,150,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Nicotine And Metabolites, S (Mayo)OutsideLaboratory",,80323,CPT,Facility,Both,,,90,150,127.5,42.99,150,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),90,60,,percent of total billed charges,,
"Nicotine And Metabolites, S (Mayo)OutsideLaboratory",,80323,CPT,Facility,Both,,,90,150,127.5,42.99,150,"Health Partners, Inc.",State of Minnesota Advantage Program,122.25,81.5,,percent of total billed charges,,
"Nicotine And Metabolites, S (Mayo)OutsideLaboratory",,80323,CPT,Facility,Both,,,90,150,127.5,42.99,150,"Health Partners, Inc.",State Public Programs,75,50,,percent of total billed charges,,
"Nicotine And Metabolites, S (Mayo)OutsideLaboratory",,80323,CPT,Facility,Both,,,90,150,127.5,42.99,150,Humana Insurance Company,Commercial PPO,142.5,95,,percent of total billed charges,,
"Nicotine And Metabolites, S (Mayo)OutsideLaboratory",,80323,CPT,Facility,Outpatient,,,90,150,127.5,42.99,150,Humana Insurance Company,Medicare PPO,73.5,49,,percent of total billed charges,,
"Nicotine And Metabolites, S (Mayo)OutsideLaboratory",,80323,CPT,Facility,Inpatient,,,90,150,127.5,42.99,150,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Nicotine And Metabolites, S (Mayo)OutsideLaboratory",,80323,CPT,Facility,Both,,,90,150,127.5,42.99,150,Medica,Individual & Family,148.65,99.1,,percent of total billed charges,,
"Nicotine And Metabolites, S (Mayo)OutsideLaboratory",,80323,CPT,Facility,Outpatient,,,90,150,127.5,42.99,150,Medica,Medica Advantage Solution,74.7,49.8,,percent of total billed charges,,
"Nicotine And Metabolites, S (Mayo)OutsideLaboratory",,80323,CPT,Facility,Inpatient,,,90,150,127.5,42.99,150,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Nicotine And Metabolites, S (Mayo)OutsideLaboratory",,80323,CPT,Facility,Outpatient,,,90,150,127.5,42.99,150,Medica,Medical Assistance,66.9,44.6,,percent of total billed charges,,
"Nicotine And Metabolites, S (Mayo)OutsideLaboratory",,80323,CPT,Facility,Inpatient,,,90,150,127.5,42.99,150,Medica,Medical Assistance,,,,,Included in per diem rate,
"Nicotine And Metabolites, S (Mayo)OutsideLaboratory",,80323,CPT,Facility,Outpatient,,,90,150,127.5,42.99,150,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,74.7,49.8,,percent of total billed charges,,
"Nicotine And Metabolites, S (Mayo)OutsideLaboratory",,80323,CPT,Facility,Inpatient,,,90,150,127.5,42.99,150,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Nicotine And Metabolites, S (Mayo)OutsideLaboratory",,80323,CPT,Facility,Both,,,90,150,127.5,42.99,150,"Multiplan, Inc.","Multiplan, Inc.",141,94,,percent of total billed charges,,
"Nicotine And Metabolites, S (Mayo)OutsideLaboratory",,80323,CPT,Facility,Outpatient,,,90,150,127.5,42.99,150,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,129.6,86.4,,percent of total billed charges,,
"Nicotine And Metabolites, S (Mayo)OutsideLaboratory",,80323,CPT,Facility,Inpatient,,,90,150,127.5,42.99,150,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Nicotine And Metabolites, S (Mayo)OutsideLaboratory",,80323,CPT,Facility,Both,,,90,150,127.5,42.99,150,"Preferred One Administrative Services, INC.",PPO,147.9,98.6,,percent of total billed charges,,
"Nicotine And Metabolites, S (Mayo)OutsideLaboratory",,80323,CPT,Facility,Outpatient,,,90,150,127.5,42.99,150,PrimeWest Health,Minnesota Senior Health Options (MSHO),77.175,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Nicotine And Metabolites, S (Mayo)OutsideLaboratory",,80323,CPT,Facility,Inpatient,,,90,150,127.5,42.99,150,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Nicotine And Metabolites, S (Mayo)OutsideLaboratory",,80323,CPT,Facility,Outpatient,,,90,150,127.5,42.99,150,PrimeWest Health,MinnesotaCare,77.04,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Nicotine And Metabolites, S (Mayo)OutsideLaboratory",,80323,CPT,Facility,Inpatient,,,90,150,127.5,42.99,150,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Nicotine And Metabolites, S (Mayo)OutsideLaboratory",,80323,CPT,Facility,Both,,,90,150,127.5,42.99,150,Sanford Health Plan,Sanford Health Plan,138,92,,percent of total billed charges,,
"Nicotine And Metabolites, S (Mayo)OutsideLaboratory",,80323,CPT,Facility,Outpatient,,,90,150,127.5,42.99,150,"UCare Health, Inc.",Individual & Family Plan,84.525,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Nicotine And Metabolites, S (Mayo)OutsideLaboratory",,80323,CPT,Facility,Inpatient,,,90,150,127.5,42.99,150,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Nicotine And Metabolites, S (Mayo)OutsideLaboratory",,80323,CPT,Facility,Outpatient,,,90,150,127.5,42.99,150,"UCare Health, Inc.",Medical Assistance,75.705,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Nicotine And Metabolites, S (Mayo)OutsideLaboratory",,80323,CPT,Facility,Inpatient,,,90,150,127.5,42.99,150,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Nicotine And Metabolites, S (Mayo)OutsideLaboratory",,80323,CPT,Facility,Outpatient,,,90,150,127.5,42.99,150,"UCare Health, Inc.",Medicare Advantage,75.705,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Nicotine And Metabolites, S (Mayo)OutsideLaboratory",,80323,CPT,Facility,Inpatient,,,90,150,127.5,42.99,150,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Nicotine And Metabolites, S (Mayo)OutsideLaboratory",,80323,CPT,Facility,Outpatient,,,90,150,127.5,42.99,150,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),75.705,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Nicotine And Metabolites, S (Mayo)OutsideLaboratory",,80323,CPT,Facility,Inpatient,,,90,150,127.5,42.99,150,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Nicotine And Metabolites, S (Mayo)OutsideLaboratory",,80323,CPT,Facility,Both,,,90,150,127.5,42.99,150,UnitedHealthcare,Individual & Family,141,94,,percent of total billed charges,,
"Nicotine And Metabolites, S (Mayo)OutsideLaboratory",,80323,CPT,Facility,Outpatient,,,90,150,127.5,42.99,150,UnitedHealthcare,Medicare Advantage,73.5,49,,percent of total billed charges,,
"Nicotine And Metabolites, S (Mayo)OutsideLaboratory",,80323,CPT,Facility,Inpatient,,,90,150,127.5,42.99,150,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Nicotine And Metabolites, S (Mayo)OutsideLaboratory",,80323,CPT,Facility,Outpatient,,,90,150,127.5,42.99,150,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,72,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Nicotine And Metabolites, S (Mayo)OutsideLaboratory",,80323,CPT,Facility,Inpatient,,,90,150,127.5,42.99,150,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Nicotine And Metabolites, U (Mayo)OutsideLaboratory",,80323,CPT,Facility,Both,,,90,150,127.5,42.99,150,Aetna,Commercial,138,92,,percent of total billed charges,,
"Nicotine And Metabolites, U (Mayo)OutsideLaboratory",,80323,CPT,Facility,Outpatient,,,90,150,127.5,42.99,150,Aetna,Medicare Advantage,73.5,49,,percent of total billed charges,,
"Nicotine And Metabolites, U (Mayo)OutsideLaboratory",,80323,CPT,Facility,Inpatient,,,90,150,127.5,42.99,150,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Nicotine And Metabolites, U (Mayo)OutsideLaboratory",,80323,CPT,Facility,Both,,,90,150,127.5,42.99,150,Aetna,PPO,139.5,93,,percent of total billed charges,,
"Nicotine And Metabolites, U (Mayo)OutsideLaboratory",,80323,CPT,Facility,Both,,,90,150,127.5,42.99,150,America's PPO,America's PPO,144.045,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Nicotine And Metabolites, U (Mayo)OutsideLaboratory",,80323,CPT,Facility,Both,,,90,150,127.5,42.99,150,BlueCross BlueShield Minnesota, Federal Employee Program,147.6,98.4,,percent of total billed charges,,
"Nicotine And Metabolites, U (Mayo)OutsideLaboratory",,80323,CPT,Facility,Both,,,90,150,127.5,42.99,150,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,150,100,,percent of total billed charges,,
"Nicotine And Metabolites, U (Mayo)OutsideLaboratory",,80323,CPT,Facility,Both,,,90,150,127.5,42.99,150,BlueCross BlueShield Minnesota,High Value Network Plan,135,90,,percent of total billed charges,,
"Nicotine And Metabolites, U (Mayo)OutsideLaboratory",,80323,CPT,Facility,Outpatient,,,90,150,127.5,42.99,150,BlueCross BlueShield Minnesota,Medicare Advantage,73.5,49,,percent of total billed charges,,
"Nicotine And Metabolites, U (Mayo)OutsideLaboratory",,80323,CPT,Facility,Inpatient,,,90,150,127.5,42.99,150,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Nicotine And Metabolites, U (Mayo)OutsideLaboratory",,80323,CPT,Facility,Both,,,90,150,127.5,42.99,150,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,132.855,88.57,,percent of total billed charges,,
"Nicotine And Metabolites, U (Mayo)OutsideLaboratory",,80323,CPT,Facility,Both,,,90,150,127.5,42.99,150,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,42.99,28.66,,percent of total billed charges,,
"Nicotine And Metabolites, U (Mayo)OutsideLaboratory",,80323,CPT,Facility,Outpatient,,,90,150,127.5,42.99,150,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),73.5,49,,percent of total billed charges,,
"Nicotine And Metabolites, U (Mayo)OutsideLaboratory",,80323,CPT,Facility,Inpatient,,,90,150,127.5,42.99,150,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Nicotine And Metabolites, U (Mayo)OutsideLaboratory",,80323,CPT,Facility,Both,,,90,150,127.5,42.99,150,CorVel,Worker's Compensation,150,100,,percent of total billed charges,,
"Nicotine And Metabolites, U (Mayo)OutsideLaboratory",,80323,CPT,Facility,Both,,,90,150,127.5,42.99,150,First Health Group Corporation,First Health Network,145.5,97,,percent of total billed charges,,
"Nicotine And Metabolites, U (Mayo)OutsideLaboratory",,80323,CPT,Facility,Both,,,90,150,127.5,42.99,150,"Health Partners, Inc.",Commercial,141.9,94.6,,percent of total billed charges,,
"Nicotine And Metabolites, U (Mayo)OutsideLaboratory",,80323,CPT,Facility,Outpatient,,,90,150,127.5,42.99,150,"Health Partners, Inc.",Medicare Advantage,73.5,49,,percent of total billed charges,,
"Nicotine And Metabolites, U (Mayo)OutsideLaboratory",,80323,CPT,Facility,Inpatient,,,90,150,127.5,42.99,150,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Nicotine And Metabolites, U (Mayo)OutsideLaboratory",,80323,CPT,Facility,Both,,,90,150,127.5,42.99,150,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),90,60,,percent of total billed charges,,
"Nicotine And Metabolites, U (Mayo)OutsideLaboratory",,80323,CPT,Facility,Both,,,90,150,127.5,42.99,150,"Health Partners, Inc.",State of Minnesota Advantage Program,122.25,81.5,,percent of total billed charges,,
"Nicotine And Metabolites, U (Mayo)OutsideLaboratory",,80323,CPT,Facility,Both,,,90,150,127.5,42.99,150,"Health Partners, Inc.",State Public Programs,75,50,,percent of total billed charges,,
"Nicotine And Metabolites, U (Mayo)OutsideLaboratory",,80323,CPT,Facility,Both,,,90,150,127.5,42.99,150,Humana Insurance Company,Commercial PPO,142.5,95,,percent of total billed charges,,
"Nicotine And Metabolites, U (Mayo)OutsideLaboratory",,80323,CPT,Facility,Outpatient,,,90,150,127.5,42.99,150,Humana Insurance Company,Medicare PPO,73.5,49,,percent of total billed charges,,
"Nicotine And Metabolites, U (Mayo)OutsideLaboratory",,80323,CPT,Facility,Inpatient,,,90,150,127.5,42.99,150,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Nicotine And Metabolites, U (Mayo)OutsideLaboratory",,80323,CPT,Facility,Both,,,90,150,127.5,42.99,150,Medica,Individual & Family,148.65,99.1,,percent of total billed charges,,
"Nicotine And Metabolites, U (Mayo)OutsideLaboratory",,80323,CPT,Facility,Outpatient,,,90,150,127.5,42.99,150,Medica,Medica Advantage Solution,74.7,49.8,,percent of total billed charges,,
"Nicotine And Metabolites, U (Mayo)OutsideLaboratory",,80323,CPT,Facility,Inpatient,,,90,150,127.5,42.99,150,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Nicotine And Metabolites, U (Mayo)OutsideLaboratory",,80323,CPT,Facility,Outpatient,,,90,150,127.5,42.99,150,Medica,Medical Assistance,66.9,44.6,,percent of total billed charges,,
"Nicotine And Metabolites, U (Mayo)OutsideLaboratory",,80323,CPT,Facility,Inpatient,,,90,150,127.5,42.99,150,Medica,Medical Assistance,,,,,Included in per diem rate,
"Nicotine And Metabolites, U (Mayo)OutsideLaboratory",,80323,CPT,Facility,Outpatient,,,90,150,127.5,42.99,150,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,74.7,49.8,,percent of total billed charges,,
"Nicotine And Metabolites, U (Mayo)OutsideLaboratory",,80323,CPT,Facility,Inpatient,,,90,150,127.5,42.99,150,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Nicotine And Metabolites, U (Mayo)OutsideLaboratory",,80323,CPT,Facility,Both,,,90,150,127.5,42.99,150,"Multiplan, Inc.","Multiplan, Inc.",141,94,,percent of total billed charges,,
"Nicotine And Metabolites, U (Mayo)OutsideLaboratory",,80323,CPT,Facility,Outpatient,,,90,150,127.5,42.99,150,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,129.6,86.4,,percent of total billed charges,,
"Nicotine And Metabolites, U (Mayo)OutsideLaboratory",,80323,CPT,Facility,Inpatient,,,90,150,127.5,42.99,150,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Nicotine And Metabolites, U (Mayo)OutsideLaboratory",,80323,CPT,Facility,Both,,,90,150,127.5,42.99,150,"Preferred One Administrative Services, INC.",PPO,147.9,98.6,,percent of total billed charges,,
"Nicotine And Metabolites, U (Mayo)OutsideLaboratory",,80323,CPT,Facility,Outpatient,,,90,150,127.5,42.99,150,PrimeWest Health,Minnesota Senior Health Options (MSHO),77.175,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Nicotine And Metabolites, U (Mayo)OutsideLaboratory",,80323,CPT,Facility,Inpatient,,,90,150,127.5,42.99,150,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Nicotine And Metabolites, U (Mayo)OutsideLaboratory",,80323,CPT,Facility,Outpatient,,,90,150,127.5,42.99,150,PrimeWest Health,MinnesotaCare,77.04,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Nicotine And Metabolites, U (Mayo)OutsideLaboratory",,80323,CPT,Facility,Inpatient,,,90,150,127.5,42.99,150,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Nicotine And Metabolites, U (Mayo)OutsideLaboratory",,80323,CPT,Facility,Both,,,90,150,127.5,42.99,150,Sanford Health Plan,Sanford Health Plan,138,92,,percent of total billed charges,,
"Nicotine And Metabolites, U (Mayo)OutsideLaboratory",,80323,CPT,Facility,Outpatient,,,90,150,127.5,42.99,150,"UCare Health, Inc.",Individual & Family Plan,84.525,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Nicotine And Metabolites, U (Mayo)OutsideLaboratory",,80323,CPT,Facility,Inpatient,,,90,150,127.5,42.99,150,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Nicotine And Metabolites, U (Mayo)OutsideLaboratory",,80323,CPT,Facility,Outpatient,,,90,150,127.5,42.99,150,"UCare Health, Inc.",Medical Assistance,75.705,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Nicotine And Metabolites, U (Mayo)OutsideLaboratory",,80323,CPT,Facility,Inpatient,,,90,150,127.5,42.99,150,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Nicotine And Metabolites, U (Mayo)OutsideLaboratory",,80323,CPT,Facility,Outpatient,,,90,150,127.5,42.99,150,"UCare Health, Inc.",Medicare Advantage,75.705,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Nicotine And Metabolites, U (Mayo)OutsideLaboratory",,80323,CPT,Facility,Inpatient,,,90,150,127.5,42.99,150,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Nicotine And Metabolites, U (Mayo)OutsideLaboratory",,80323,CPT,Facility,Outpatient,,,90,150,127.5,42.99,150,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),75.705,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Nicotine And Metabolites, U (Mayo)OutsideLaboratory",,80323,CPT,Facility,Inpatient,,,90,150,127.5,42.99,150,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Nicotine And Metabolites, U (Mayo)OutsideLaboratory",,80323,CPT,Facility,Both,,,90,150,127.5,42.99,150,UnitedHealthcare,Individual & Family,141,94,,percent of total billed charges,,
"Nicotine And Metabolites, U (Mayo)OutsideLaboratory",,80323,CPT,Facility,Outpatient,,,90,150,127.5,42.99,150,UnitedHealthcare,Medicare Advantage,73.5,49,,percent of total billed charges,,
"Nicotine And Metabolites, U (Mayo)OutsideLaboratory",,80323,CPT,Facility,Inpatient,,,90,150,127.5,42.99,150,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Nicotine And Metabolites, U (Mayo)OutsideLaboratory",,80323,CPT,Facility,Outpatient,,,90,150,127.5,42.99,150,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,72,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Nicotine And Metabolites, U (Mayo)OutsideLaboratory",,80323,CPT,Facility,Inpatient,,,90,150,127.5,42.99,150,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Amphetamines Confirmation, Coc, M (Mayo)OutsideLaboratory",,80324,CPT,Facility,Both,,,90,125,106.25,35.825,125,Aetna,Commercial,115,92,,percent of total billed charges,,
"Amphetamines Confirmation, Coc, M (Mayo)OutsideLaboratory",,80324,CPT,Facility,Outpatient,,,90,125,106.25,35.825,125,Aetna,Medicare Advantage,61.25,49,,percent of total billed charges,,
"Amphetamines Confirmation, Coc, M (Mayo)OutsideLaboratory",,80324,CPT,Facility,Inpatient,,,90,125,106.25,35.825,125,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Amphetamines Confirmation, Coc, M (Mayo)OutsideLaboratory",,80324,CPT,Facility,Both,,,90,125,106.25,35.825,125,Aetna,PPO,116.25,93,,percent of total billed charges,,
"Amphetamines Confirmation, Coc, M (Mayo)OutsideLaboratory",,80324,CPT,Facility,Both,,,90,125,106.25,35.825,125,America's PPO,America's PPO,120.0375,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Amphetamines Confirmation, Coc, M (Mayo)OutsideLaboratory",,80324,CPT,Facility,Both,,,90,125,106.25,35.825,125,BlueCross BlueShield Minnesota, Federal Employee Program,123,98.4,,percent of total billed charges,,
"Amphetamines Confirmation, Coc, M (Mayo)OutsideLaboratory",,80324,CPT,Facility,Both,,,90,125,106.25,35.825,125,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,125,100,,percent of total billed charges,,
"Amphetamines Confirmation, Coc, M (Mayo)OutsideLaboratory",,80324,CPT,Facility,Both,,,90,125,106.25,35.825,125,BlueCross BlueShield Minnesota,High Value Network Plan,112.5,90,,percent of total billed charges,,
"Amphetamines Confirmation, Coc, M (Mayo)OutsideLaboratory",,80324,CPT,Facility,Outpatient,,,90,125,106.25,35.825,125,BlueCross BlueShield Minnesota,Medicare Advantage,61.25,49,,percent of total billed charges,,
"Amphetamines Confirmation, Coc, M (Mayo)OutsideLaboratory",,80324,CPT,Facility,Inpatient,,,90,125,106.25,35.825,125,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Amphetamines Confirmation, Coc, M (Mayo)OutsideLaboratory",,80324,CPT,Facility,Both,,,90,125,106.25,35.825,125,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,110.7125,88.57,,percent of total billed charges,,
"Amphetamines Confirmation, Coc, M (Mayo)OutsideLaboratory",,80324,CPT,Facility,Both,,,90,125,106.25,35.825,125,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,35.825,28.66,,percent of total billed charges,,
"Amphetamines Confirmation, Coc, M (Mayo)OutsideLaboratory",,80324,CPT,Facility,Outpatient,,,90,125,106.25,35.825,125,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),61.25,49,,percent of total billed charges,,
"Amphetamines Confirmation, Coc, M (Mayo)OutsideLaboratory",,80324,CPT,Facility,Inpatient,,,90,125,106.25,35.825,125,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Amphetamines Confirmation, Coc, M (Mayo)OutsideLaboratory",,80324,CPT,Facility,Both,,,90,125,106.25,35.825,125,CorVel,Worker's Compensation,125,100,,percent of total billed charges,,
"Amphetamines Confirmation, Coc, M (Mayo)OutsideLaboratory",,80324,CPT,Facility,Both,,,90,125,106.25,35.825,125,First Health Group Corporation,First Health Network,121.25,97,,percent of total billed charges,,
"Amphetamines Confirmation, Coc, M (Mayo)OutsideLaboratory",,80324,CPT,Facility,Both,,,90,125,106.25,35.825,125,"Health Partners, Inc.",Commercial,118.25,94.6,,percent of total billed charges,,
"Amphetamines Confirmation, Coc, M (Mayo)OutsideLaboratory",,80324,CPT,Facility,Outpatient,,,90,125,106.25,35.825,125,"Health Partners, Inc.",Medicare Advantage,61.25,49,,percent of total billed charges,,
"Amphetamines Confirmation, Coc, M (Mayo)OutsideLaboratory",,80324,CPT,Facility,Inpatient,,,90,125,106.25,35.825,125,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Amphetamines Confirmation, Coc, M (Mayo)OutsideLaboratory",,80324,CPT,Facility,Both,,,90,125,106.25,35.825,125,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),75,60,,percent of total billed charges,,
"Amphetamines Confirmation, Coc, M (Mayo)OutsideLaboratory",,80324,CPT,Facility,Both,,,90,125,106.25,35.825,125,"Health Partners, Inc.",State of Minnesota Advantage Program,101.875,81.5,,percent of total billed charges,,
"Amphetamines Confirmation, Coc, M (Mayo)OutsideLaboratory",,80324,CPT,Facility,Both,,,90,125,106.25,35.825,125,"Health Partners, Inc.",State Public Programs,62.5,50,,percent of total billed charges,,
"Amphetamines Confirmation, Coc, M (Mayo)OutsideLaboratory",,80324,CPT,Facility,Both,,,90,125,106.25,35.825,125,Humana Insurance Company,Commercial PPO,118.75,95,,percent of total billed charges,,
"Amphetamines Confirmation, Coc, M (Mayo)OutsideLaboratory",,80324,CPT,Facility,Outpatient,,,90,125,106.25,35.825,125,Humana Insurance Company,Medicare PPO,61.25,49,,percent of total billed charges,,
"Amphetamines Confirmation, Coc, M (Mayo)OutsideLaboratory",,80324,CPT,Facility,Inpatient,,,90,125,106.25,35.825,125,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Amphetamines Confirmation, Coc, M (Mayo)OutsideLaboratory",,80324,CPT,Facility,Both,,,90,125,106.25,35.825,125,Medica,Individual & Family,123.875,99.1,,percent of total billed charges,,
"Amphetamines Confirmation, Coc, M (Mayo)OutsideLaboratory",,80324,CPT,Facility,Outpatient,,,90,125,106.25,35.825,125,Medica,Medica Advantage Solution,62.25,49.8,,percent of total billed charges,,
"Amphetamines Confirmation, Coc, M (Mayo)OutsideLaboratory",,80324,CPT,Facility,Inpatient,,,90,125,106.25,35.825,125,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Amphetamines Confirmation, Coc, M (Mayo)OutsideLaboratory",,80324,CPT,Facility,Outpatient,,,90,125,106.25,35.825,125,Medica,Medical Assistance,55.75,44.6,,percent of total billed charges,,
"Amphetamines Confirmation, Coc, M (Mayo)OutsideLaboratory",,80324,CPT,Facility,Inpatient,,,90,125,106.25,35.825,125,Medica,Medical Assistance,,,,,Included in per diem rate,
"Amphetamines Confirmation, Coc, M (Mayo)OutsideLaboratory",,80324,CPT,Facility,Outpatient,,,90,125,106.25,35.825,125,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,62.25,49.8,,percent of total billed charges,,
"Amphetamines Confirmation, Coc, M (Mayo)OutsideLaboratory",,80324,CPT,Facility,Inpatient,,,90,125,106.25,35.825,125,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Amphetamines Confirmation, Coc, M (Mayo)OutsideLaboratory",,80324,CPT,Facility,Both,,,90,125,106.25,35.825,125,"Multiplan, Inc.","Multiplan, Inc.",117.5,94,,percent of total billed charges,,
"Amphetamines Confirmation, Coc, M (Mayo)OutsideLaboratory",,80324,CPT,Facility,Outpatient,,,90,125,106.25,35.825,125,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,108,86.4,,percent of total billed charges,,
"Amphetamines Confirmation, Coc, M (Mayo)OutsideLaboratory",,80324,CPT,Facility,Inpatient,,,90,125,106.25,35.825,125,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Amphetamines Confirmation, Coc, M (Mayo)OutsideLaboratory",,80324,CPT,Facility,Both,,,90,125,106.25,35.825,125,"Preferred One Administrative Services, INC.",PPO,123.25,98.6,,percent of total billed charges,,
"Amphetamines Confirmation, Coc, M (Mayo)OutsideLaboratory",,80324,CPT,Facility,Outpatient,,,90,125,106.25,35.825,125,PrimeWest Health,Minnesota Senior Health Options (MSHO),64.3125,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Amphetamines Confirmation, Coc, M (Mayo)OutsideLaboratory",,80324,CPT,Facility,Inpatient,,,90,125,106.25,35.825,125,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Amphetamines Confirmation, Coc, M (Mayo)OutsideLaboratory",,80324,CPT,Facility,Outpatient,,,90,125,106.25,35.825,125,PrimeWest Health,MinnesotaCare,64.2,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Amphetamines Confirmation, Coc, M (Mayo)OutsideLaboratory",,80324,CPT,Facility,Inpatient,,,90,125,106.25,35.825,125,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Amphetamines Confirmation, Coc, M (Mayo)OutsideLaboratory",,80324,CPT,Facility,Both,,,90,125,106.25,35.825,125,Sanford Health Plan,Sanford Health Plan,115,92,,percent of total billed charges,,
"Amphetamines Confirmation, Coc, M (Mayo)OutsideLaboratory",,80324,CPT,Facility,Outpatient,,,90,125,106.25,35.825,125,"UCare Health, Inc.",Individual & Family Plan,70.4375,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Amphetamines Confirmation, Coc, M (Mayo)OutsideLaboratory",,80324,CPT,Facility,Inpatient,,,90,125,106.25,35.825,125,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Amphetamines Confirmation, Coc, M (Mayo)OutsideLaboratory",,80324,CPT,Facility,Outpatient,,,90,125,106.25,35.825,125,"UCare Health, Inc.",Medical Assistance,63.0875,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Amphetamines Confirmation, Coc, M (Mayo)OutsideLaboratory",,80324,CPT,Facility,Inpatient,,,90,125,106.25,35.825,125,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Amphetamines Confirmation, Coc, M (Mayo)OutsideLaboratory",,80324,CPT,Facility,Outpatient,,,90,125,106.25,35.825,125,"UCare Health, Inc.",Medicare Advantage,63.0875,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Amphetamines Confirmation, Coc, M (Mayo)OutsideLaboratory",,80324,CPT,Facility,Inpatient,,,90,125,106.25,35.825,125,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Amphetamines Confirmation, Coc, M (Mayo)OutsideLaboratory",,80324,CPT,Facility,Outpatient,,,90,125,106.25,35.825,125,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),63.0875,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Amphetamines Confirmation, Coc, M (Mayo)OutsideLaboratory",,80324,CPT,Facility,Inpatient,,,90,125,106.25,35.825,125,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Amphetamines Confirmation, Coc, M (Mayo)OutsideLaboratory",,80324,CPT,Facility,Both,,,90,125,106.25,35.825,125,UnitedHealthcare,Individual & Family,117.5,94,,percent of total billed charges,,
"Amphetamines Confirmation, Coc, M (Mayo)OutsideLaboratory",,80324,CPT,Facility,Outpatient,,,90,125,106.25,35.825,125,UnitedHealthcare,Medicare Advantage,61.25,49,,percent of total billed charges,,
"Amphetamines Confirmation, Coc, M (Mayo)OutsideLaboratory",,80324,CPT,Facility,Inpatient,,,90,125,106.25,35.825,125,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Amphetamines Confirmation, Coc, M (Mayo)OutsideLaboratory",,80324,CPT,Facility,Outpatient,,,90,125,106.25,35.825,125,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,60,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Amphetamines Confirmation, Coc, M (Mayo)OutsideLaboratory",,80324,CPT,Facility,Inpatient,,,90,125,106.25,35.825,125,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Amphetamines, Confirmation, M (Mayo)OutsideLaboratory",,80324,CPT,Facility,Both,,,90,125,106.25,35.825,125,Aetna,Commercial,115,92,,percent of total billed charges,,
"Amphetamines, Confirmation, M (Mayo)OutsideLaboratory",,80324,CPT,Facility,Outpatient,,,90,125,106.25,35.825,125,Aetna,Medicare Advantage,61.25,49,,percent of total billed charges,,
"Amphetamines, Confirmation, M (Mayo)OutsideLaboratory",,80324,CPT,Facility,Inpatient,,,90,125,106.25,35.825,125,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Amphetamines, Confirmation, M (Mayo)OutsideLaboratory",,80324,CPT,Facility,Both,,,90,125,106.25,35.825,125,Aetna,PPO,116.25,93,,percent of total billed charges,,
"Amphetamines, Confirmation, M (Mayo)OutsideLaboratory",,80324,CPT,Facility,Both,,,90,125,106.25,35.825,125,America's PPO,America's PPO,120.0375,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Amphetamines, Confirmation, M (Mayo)OutsideLaboratory",,80324,CPT,Facility,Both,,,90,125,106.25,35.825,125,BlueCross BlueShield Minnesota, Federal Employee Program,123,98.4,,percent of total billed charges,,
"Amphetamines, Confirmation, M (Mayo)OutsideLaboratory",,80324,CPT,Facility,Both,,,90,125,106.25,35.825,125,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,125,100,,percent of total billed charges,,
"Amphetamines, Confirmation, M (Mayo)OutsideLaboratory",,80324,CPT,Facility,Both,,,90,125,106.25,35.825,125,BlueCross BlueShield Minnesota,High Value Network Plan,112.5,90,,percent of total billed charges,,
"Amphetamines, Confirmation, M (Mayo)OutsideLaboratory",,80324,CPT,Facility,Outpatient,,,90,125,106.25,35.825,125,BlueCross BlueShield Minnesota,Medicare Advantage,61.25,49,,percent of total billed charges,,
"Amphetamines, Confirmation, M (Mayo)OutsideLaboratory",,80324,CPT,Facility,Inpatient,,,90,125,106.25,35.825,125,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Amphetamines, Confirmation, M (Mayo)OutsideLaboratory",,80324,CPT,Facility,Both,,,90,125,106.25,35.825,125,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,110.7125,88.57,,percent of total billed charges,,
"Amphetamines, Confirmation, M (Mayo)OutsideLaboratory",,80324,CPT,Facility,Both,,,90,125,106.25,35.825,125,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,35.825,28.66,,percent of total billed charges,,
"Amphetamines, Confirmation, M (Mayo)OutsideLaboratory",,80324,CPT,Facility,Outpatient,,,90,125,106.25,35.825,125,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),61.25,49,,percent of total billed charges,,
"Amphetamines, Confirmation, M (Mayo)OutsideLaboratory",,80324,CPT,Facility,Inpatient,,,90,125,106.25,35.825,125,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Amphetamines, Confirmation, M (Mayo)OutsideLaboratory",,80324,CPT,Facility,Both,,,90,125,106.25,35.825,125,CorVel,Worker's Compensation,125,100,,percent of total billed charges,,
"Amphetamines, Confirmation, M (Mayo)OutsideLaboratory",,80324,CPT,Facility,Both,,,90,125,106.25,35.825,125,First Health Group Corporation,First Health Network,121.25,97,,percent of total billed charges,,
"Amphetamines, Confirmation, M (Mayo)OutsideLaboratory",,80324,CPT,Facility,Both,,,90,125,106.25,35.825,125,"Health Partners, Inc.",Commercial,118.25,94.6,,percent of total billed charges,,
"Amphetamines, Confirmation, M (Mayo)OutsideLaboratory",,80324,CPT,Facility,Outpatient,,,90,125,106.25,35.825,125,"Health Partners, Inc.",Medicare Advantage,61.25,49,,percent of total billed charges,,
"Amphetamines, Confirmation, M (Mayo)OutsideLaboratory",,80324,CPT,Facility,Inpatient,,,90,125,106.25,35.825,125,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Amphetamines, Confirmation, M (Mayo)OutsideLaboratory",,80324,CPT,Facility,Both,,,90,125,106.25,35.825,125,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),75,60,,percent of total billed charges,,
"Amphetamines, Confirmation, M (Mayo)OutsideLaboratory",,80324,CPT,Facility,Both,,,90,125,106.25,35.825,125,"Health Partners, Inc.",State of Minnesota Advantage Program,101.875,81.5,,percent of total billed charges,,
"Amphetamines, Confirmation, M (Mayo)OutsideLaboratory",,80324,CPT,Facility,Both,,,90,125,106.25,35.825,125,"Health Partners, Inc.",State Public Programs,62.5,50,,percent of total billed charges,,
"Amphetamines, Confirmation, M (Mayo)OutsideLaboratory",,80324,CPT,Facility,Both,,,90,125,106.25,35.825,125,Humana Insurance Company,Commercial PPO,118.75,95,,percent of total billed charges,,
"Amphetamines, Confirmation, M (Mayo)OutsideLaboratory",,80324,CPT,Facility,Outpatient,,,90,125,106.25,35.825,125,Humana Insurance Company,Medicare PPO,61.25,49,,percent of total billed charges,,
"Amphetamines, Confirmation, M (Mayo)OutsideLaboratory",,80324,CPT,Facility,Inpatient,,,90,125,106.25,35.825,125,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Amphetamines, Confirmation, M (Mayo)OutsideLaboratory",,80324,CPT,Facility,Both,,,90,125,106.25,35.825,125,Medica,Individual & Family,123.875,99.1,,percent of total billed charges,,
"Amphetamines, Confirmation, M (Mayo)OutsideLaboratory",,80324,CPT,Facility,Outpatient,,,90,125,106.25,35.825,125,Medica,Medica Advantage Solution,62.25,49.8,,percent of total billed charges,,
"Amphetamines, Confirmation, M (Mayo)OutsideLaboratory",,80324,CPT,Facility,Inpatient,,,90,125,106.25,35.825,125,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Amphetamines, Confirmation, M (Mayo)OutsideLaboratory",,80324,CPT,Facility,Outpatient,,,90,125,106.25,35.825,125,Medica,Medical Assistance,55.75,44.6,,percent of total billed charges,,
"Amphetamines, Confirmation, M (Mayo)OutsideLaboratory",,80324,CPT,Facility,Inpatient,,,90,125,106.25,35.825,125,Medica,Medical Assistance,,,,,Included in per diem rate,
"Amphetamines, Confirmation, M (Mayo)OutsideLaboratory",,80324,CPT,Facility,Outpatient,,,90,125,106.25,35.825,125,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,62.25,49.8,,percent of total billed charges,,
"Amphetamines, Confirmation, M (Mayo)OutsideLaboratory",,80324,CPT,Facility,Inpatient,,,90,125,106.25,35.825,125,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Amphetamines, Confirmation, M (Mayo)OutsideLaboratory",,80324,CPT,Facility,Both,,,90,125,106.25,35.825,125,"Multiplan, Inc.","Multiplan, Inc.",117.5,94,,percent of total billed charges,,
"Amphetamines, Confirmation, M (Mayo)OutsideLaboratory",,80324,CPT,Facility,Outpatient,,,90,125,106.25,35.825,125,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,108,86.4,,percent of total billed charges,,
"Amphetamines, Confirmation, M (Mayo)OutsideLaboratory",,80324,CPT,Facility,Inpatient,,,90,125,106.25,35.825,125,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Amphetamines, Confirmation, M (Mayo)OutsideLaboratory",,80324,CPT,Facility,Both,,,90,125,106.25,35.825,125,"Preferred One Administrative Services, INC.",PPO,123.25,98.6,,percent of total billed charges,,
"Amphetamines, Confirmation, M (Mayo)OutsideLaboratory",,80324,CPT,Facility,Outpatient,,,90,125,106.25,35.825,125,PrimeWest Health,Minnesota Senior Health Options (MSHO),64.3125,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Amphetamines, Confirmation, M (Mayo)OutsideLaboratory",,80324,CPT,Facility,Inpatient,,,90,125,106.25,35.825,125,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Amphetamines, Confirmation, M (Mayo)OutsideLaboratory",,80324,CPT,Facility,Outpatient,,,90,125,106.25,35.825,125,PrimeWest Health,MinnesotaCare,64.2,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Amphetamines, Confirmation, M (Mayo)OutsideLaboratory",,80324,CPT,Facility,Inpatient,,,90,125,106.25,35.825,125,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Amphetamines, Confirmation, M (Mayo)OutsideLaboratory",,80324,CPT,Facility,Both,,,90,125,106.25,35.825,125,Sanford Health Plan,Sanford Health Plan,115,92,,percent of total billed charges,,
"Amphetamines, Confirmation, M (Mayo)OutsideLaboratory",,80324,CPT,Facility,Outpatient,,,90,125,106.25,35.825,125,"UCare Health, Inc.",Individual & Family Plan,70.4375,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Amphetamines, Confirmation, M (Mayo)OutsideLaboratory",,80324,CPT,Facility,Inpatient,,,90,125,106.25,35.825,125,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Amphetamines, Confirmation, M (Mayo)OutsideLaboratory",,80324,CPT,Facility,Outpatient,,,90,125,106.25,35.825,125,"UCare Health, Inc.",Medical Assistance,63.0875,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Amphetamines, Confirmation, M (Mayo)OutsideLaboratory",,80324,CPT,Facility,Inpatient,,,90,125,106.25,35.825,125,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Amphetamines, Confirmation, M (Mayo)OutsideLaboratory",,80324,CPT,Facility,Outpatient,,,90,125,106.25,35.825,125,"UCare Health, Inc.",Medicare Advantage,63.0875,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Amphetamines, Confirmation, M (Mayo)OutsideLaboratory",,80324,CPT,Facility,Inpatient,,,90,125,106.25,35.825,125,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Amphetamines, Confirmation, M (Mayo)OutsideLaboratory",,80324,CPT,Facility,Outpatient,,,90,125,106.25,35.825,125,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),63.0875,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Amphetamines, Confirmation, M (Mayo)OutsideLaboratory",,80324,CPT,Facility,Inpatient,,,90,125,106.25,35.825,125,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Amphetamines, Confirmation, M (Mayo)OutsideLaboratory",,80324,CPT,Facility,Both,,,90,125,106.25,35.825,125,UnitedHealthcare,Individual & Family,117.5,94,,percent of total billed charges,,
"Amphetamines, Confirmation, M (Mayo)OutsideLaboratory",,80324,CPT,Facility,Outpatient,,,90,125,106.25,35.825,125,UnitedHealthcare,Medicare Advantage,61.25,49,,percent of total billed charges,,
"Amphetamines, Confirmation, M (Mayo)OutsideLaboratory",,80324,CPT,Facility,Inpatient,,,90,125,106.25,35.825,125,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Amphetamines, Confirmation, M (Mayo)OutsideLaboratory",,80324,CPT,Facility,Outpatient,,,90,125,106.25,35.825,125,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,60,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Amphetamines, Confirmation, M (Mayo)OutsideLaboratory",,80324,CPT,Facility,Inpatient,,,90,125,106.25,35.825,125,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Amphetamines Confirmation, U (Mayo)OutsideLaboratory",,80325,CPT,Facility,Both,,,90,125,106.25,35.825,125,Aetna,Commercial,115,92,,percent of total billed charges,,
"Amphetamines Confirmation, U (Mayo)OutsideLaboratory",,80325,CPT,Facility,Outpatient,,,90,125,106.25,35.825,125,Aetna,Medicare Advantage,61.25,49,,percent of total billed charges,,
"Amphetamines Confirmation, U (Mayo)OutsideLaboratory",,80325,CPT,Facility,Inpatient,,,90,125,106.25,35.825,125,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Amphetamines Confirmation, U (Mayo)OutsideLaboratory",,80325,CPT,Facility,Both,,,90,125,106.25,35.825,125,Aetna,PPO,116.25,93,,percent of total billed charges,,
"Amphetamines Confirmation, U (Mayo)OutsideLaboratory",,80325,CPT,Facility,Both,,,90,125,106.25,35.825,125,America's PPO,America's PPO,120.0375,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Amphetamines Confirmation, U (Mayo)OutsideLaboratory",,80325,CPT,Facility,Both,,,90,125,106.25,35.825,125,BlueCross BlueShield Minnesota, Federal Employee Program,123,98.4,,percent of total billed charges,,
"Amphetamines Confirmation, U (Mayo)OutsideLaboratory",,80325,CPT,Facility,Both,,,90,125,106.25,35.825,125,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,125,100,,percent of total billed charges,,
"Amphetamines Confirmation, U (Mayo)OutsideLaboratory",,80325,CPT,Facility,Both,,,90,125,106.25,35.825,125,BlueCross BlueShield Minnesota,High Value Network Plan,112.5,90,,percent of total billed charges,,
"Amphetamines Confirmation, U (Mayo)OutsideLaboratory",,80325,CPT,Facility,Outpatient,,,90,125,106.25,35.825,125,BlueCross BlueShield Minnesota,Medicare Advantage,61.25,49,,percent of total billed charges,,
"Amphetamines Confirmation, U (Mayo)OutsideLaboratory",,80325,CPT,Facility,Inpatient,,,90,125,106.25,35.825,125,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Amphetamines Confirmation, U (Mayo)OutsideLaboratory",,80325,CPT,Facility,Both,,,90,125,106.25,35.825,125,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,110.7125,88.57,,percent of total billed charges,,
"Amphetamines Confirmation, U (Mayo)OutsideLaboratory",,80325,CPT,Facility,Both,,,90,125,106.25,35.825,125,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,35.825,28.66,,percent of total billed charges,,
"Amphetamines Confirmation, U (Mayo)OutsideLaboratory",,80325,CPT,Facility,Outpatient,,,90,125,106.25,35.825,125,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),61.25,49,,percent of total billed charges,,
"Amphetamines Confirmation, U (Mayo)OutsideLaboratory",,80325,CPT,Facility,Inpatient,,,90,125,106.25,35.825,125,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Amphetamines Confirmation, U (Mayo)OutsideLaboratory",,80325,CPT,Facility,Both,,,90,125,106.25,35.825,125,CorVel,Worker's Compensation,125,100,,percent of total billed charges,,
"Amphetamines Confirmation, U (Mayo)OutsideLaboratory",,80325,CPT,Facility,Both,,,90,125,106.25,35.825,125,First Health Group Corporation,First Health Network,121.25,97,,percent of total billed charges,,
"Amphetamines Confirmation, U (Mayo)OutsideLaboratory",,80325,CPT,Facility,Both,,,90,125,106.25,35.825,125,"Health Partners, Inc.",Commercial,118.25,94.6,,percent of total billed charges,,
"Amphetamines Confirmation, U (Mayo)OutsideLaboratory",,80325,CPT,Facility,Outpatient,,,90,125,106.25,35.825,125,"Health Partners, Inc.",Medicare Advantage,61.25,49,,percent of total billed charges,,
"Amphetamines Confirmation, U (Mayo)OutsideLaboratory",,80325,CPT,Facility,Inpatient,,,90,125,106.25,35.825,125,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Amphetamines Confirmation, U (Mayo)OutsideLaboratory",,80325,CPT,Facility,Both,,,90,125,106.25,35.825,125,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),75,60,,percent of total billed charges,,
"Amphetamines Confirmation, U (Mayo)OutsideLaboratory",,80325,CPT,Facility,Both,,,90,125,106.25,35.825,125,"Health Partners, Inc.",State of Minnesota Advantage Program,101.875,81.5,,percent of total billed charges,,
"Amphetamines Confirmation, U (Mayo)OutsideLaboratory",,80325,CPT,Facility,Both,,,90,125,106.25,35.825,125,"Health Partners, Inc.",State Public Programs,62.5,50,,percent of total billed charges,,
"Amphetamines Confirmation, U (Mayo)OutsideLaboratory",,80325,CPT,Facility,Both,,,90,125,106.25,35.825,125,Humana Insurance Company,Commercial PPO,118.75,95,,percent of total billed charges,,
"Amphetamines Confirmation, U (Mayo)OutsideLaboratory",,80325,CPT,Facility,Outpatient,,,90,125,106.25,35.825,125,Humana Insurance Company,Medicare PPO,61.25,49,,percent of total billed charges,,
"Amphetamines Confirmation, U (Mayo)OutsideLaboratory",,80325,CPT,Facility,Inpatient,,,90,125,106.25,35.825,125,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Amphetamines Confirmation, U (Mayo)OutsideLaboratory",,80325,CPT,Facility,Both,,,90,125,106.25,35.825,125,Medica,Individual & Family,123.875,99.1,,percent of total billed charges,,
"Amphetamines Confirmation, U (Mayo)OutsideLaboratory",,80325,CPT,Facility,Outpatient,,,90,125,106.25,35.825,125,Medica,Medica Advantage Solution,62.25,49.8,,percent of total billed charges,,
"Amphetamines Confirmation, U (Mayo)OutsideLaboratory",,80325,CPT,Facility,Inpatient,,,90,125,106.25,35.825,125,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Amphetamines Confirmation, U (Mayo)OutsideLaboratory",,80325,CPT,Facility,Outpatient,,,90,125,106.25,35.825,125,Medica,Medical Assistance,55.75,44.6,,percent of total billed charges,,
"Amphetamines Confirmation, U (Mayo)OutsideLaboratory",,80325,CPT,Facility,Inpatient,,,90,125,106.25,35.825,125,Medica,Medical Assistance,,,,,Included in per diem rate,
"Amphetamines Confirmation, U (Mayo)OutsideLaboratory",,80325,CPT,Facility,Outpatient,,,90,125,106.25,35.825,125,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,62.25,49.8,,percent of total billed charges,,
"Amphetamines Confirmation, U (Mayo)OutsideLaboratory",,80325,CPT,Facility,Inpatient,,,90,125,106.25,35.825,125,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Amphetamines Confirmation, U (Mayo)OutsideLaboratory",,80325,CPT,Facility,Both,,,90,125,106.25,35.825,125,"Multiplan, Inc.","Multiplan, Inc.",117.5,94,,percent of total billed charges,,
"Amphetamines Confirmation, U (Mayo)OutsideLaboratory",,80325,CPT,Facility,Outpatient,,,90,125,106.25,35.825,125,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,108,86.4,,percent of total billed charges,,
"Amphetamines Confirmation, U (Mayo)OutsideLaboratory",,80325,CPT,Facility,Inpatient,,,90,125,106.25,35.825,125,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Amphetamines Confirmation, U (Mayo)OutsideLaboratory",,80325,CPT,Facility,Both,,,90,125,106.25,35.825,125,"Preferred One Administrative Services, INC.",PPO,123.25,98.6,,percent of total billed charges,,
"Amphetamines Confirmation, U (Mayo)OutsideLaboratory",,80325,CPT,Facility,Outpatient,,,90,125,106.25,35.825,125,PrimeWest Health,Minnesota Senior Health Options (MSHO),64.3125,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Amphetamines Confirmation, U (Mayo)OutsideLaboratory",,80325,CPT,Facility,Inpatient,,,90,125,106.25,35.825,125,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Amphetamines Confirmation, U (Mayo)OutsideLaboratory",,80325,CPT,Facility,Outpatient,,,90,125,106.25,35.825,125,PrimeWest Health,MinnesotaCare,64.2,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Amphetamines Confirmation, U (Mayo)OutsideLaboratory",,80325,CPT,Facility,Inpatient,,,90,125,106.25,35.825,125,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Amphetamines Confirmation, U (Mayo)OutsideLaboratory",,80325,CPT,Facility,Both,,,90,125,106.25,35.825,125,Sanford Health Plan,Sanford Health Plan,115,92,,percent of total billed charges,,
"Amphetamines Confirmation, U (Mayo)OutsideLaboratory",,80325,CPT,Facility,Outpatient,,,90,125,106.25,35.825,125,"UCare Health, Inc.",Individual & Family Plan,70.4375,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Amphetamines Confirmation, U (Mayo)OutsideLaboratory",,80325,CPT,Facility,Inpatient,,,90,125,106.25,35.825,125,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Amphetamines Confirmation, U (Mayo)OutsideLaboratory",,80325,CPT,Facility,Outpatient,,,90,125,106.25,35.825,125,"UCare Health, Inc.",Medical Assistance,63.0875,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Amphetamines Confirmation, U (Mayo)OutsideLaboratory",,80325,CPT,Facility,Inpatient,,,90,125,106.25,35.825,125,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Amphetamines Confirmation, U (Mayo)OutsideLaboratory",,80325,CPT,Facility,Outpatient,,,90,125,106.25,35.825,125,"UCare Health, Inc.",Medicare Advantage,63.0875,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Amphetamines Confirmation, U (Mayo)OutsideLaboratory",,80325,CPT,Facility,Inpatient,,,90,125,106.25,35.825,125,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Amphetamines Confirmation, U (Mayo)OutsideLaboratory",,80325,CPT,Facility,Outpatient,,,90,125,106.25,35.825,125,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),63.0875,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Amphetamines Confirmation, U (Mayo)OutsideLaboratory",,80325,CPT,Facility,Inpatient,,,90,125,106.25,35.825,125,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Amphetamines Confirmation, U (Mayo)OutsideLaboratory",,80325,CPT,Facility,Both,,,90,125,106.25,35.825,125,UnitedHealthcare,Individual & Family,117.5,94,,percent of total billed charges,,
"Amphetamines Confirmation, U (Mayo)OutsideLaboratory",,80325,CPT,Facility,Outpatient,,,90,125,106.25,35.825,125,UnitedHealthcare,Medicare Advantage,61.25,49,,percent of total billed charges,,
"Amphetamines Confirmation, U (Mayo)OutsideLaboratory",,80325,CPT,Facility,Inpatient,,,90,125,106.25,35.825,125,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Amphetamines Confirmation, U (Mayo)OutsideLaboratory",,80325,CPT,Facility,Outpatient,,,90,125,106.25,35.825,125,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,60,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Amphetamines Confirmation, U (Mayo)OutsideLaboratory",,80325,CPT,Facility,Inpatient,,,90,125,106.25,35.825,125,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Antidepressants, Class; 3-5 (Mayo)OutsideLaboratory",,80333,CPT,Facility,Both,,,90,124,105.4,35.5384,124,Aetna,Commercial,114.08,92,,percent of total billed charges,,
"Antidepressants, Class; 3-5 (Mayo)OutsideLaboratory",,80333,CPT,Facility,Outpatient,,,90,124,105.4,35.5384,124,Aetna,Medicare Advantage,60.76,49,,percent of total billed charges,,
"Antidepressants, Class; 3-5 (Mayo)OutsideLaboratory",,80333,CPT,Facility,Inpatient,,,90,124,105.4,35.5384,124,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Antidepressants, Class; 3-5 (Mayo)OutsideLaboratory",,80333,CPT,Facility,Both,,,90,124,105.4,35.5384,124,Aetna,PPO,115.32,93,,percent of total billed charges,,
"Antidepressants, Class; 3-5 (Mayo)OutsideLaboratory",,80333,CPT,Facility,Both,,,90,124,105.4,35.5384,124,America's PPO,America's PPO,119.0772,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Antidepressants, Class; 3-5 (Mayo)OutsideLaboratory",,80333,CPT,Facility,Both,,,90,124,105.4,35.5384,124,BlueCross BlueShield Minnesota, Federal Employee Program,122.016,98.4,,percent of total billed charges,,
"Antidepressants, Class; 3-5 (Mayo)OutsideLaboratory",,80333,CPT,Facility,Both,,,90,124,105.4,35.5384,124,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,124,100,,percent of total billed charges,,
"Antidepressants, Class; 3-5 (Mayo)OutsideLaboratory",,80333,CPT,Facility,Both,,,90,124,105.4,35.5384,124,BlueCross BlueShield Minnesota,High Value Network Plan,111.6,90,,percent of total billed charges,,
"Antidepressants, Class; 3-5 (Mayo)OutsideLaboratory",,80333,CPT,Facility,Outpatient,,,90,124,105.4,35.5384,124,BlueCross BlueShield Minnesota,Medicare Advantage,60.76,49,,percent of total billed charges,,
"Antidepressants, Class; 3-5 (Mayo)OutsideLaboratory",,80333,CPT,Facility,Inpatient,,,90,124,105.4,35.5384,124,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Antidepressants, Class; 3-5 (Mayo)OutsideLaboratory",,80333,CPT,Facility,Both,,,90,124,105.4,35.5384,124,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,109.8268,88.57,,percent of total billed charges,,
"Antidepressants, Class; 3-5 (Mayo)OutsideLaboratory",,80333,CPT,Facility,Both,,,90,124,105.4,35.5384,124,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,35.5384,28.66,,percent of total billed charges,,
"Antidepressants, Class; 3-5 (Mayo)OutsideLaboratory",,80333,CPT,Facility,Outpatient,,,90,124,105.4,35.5384,124,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),60.76,49,,percent of total billed charges,,
"Antidepressants, Class; 3-5 (Mayo)OutsideLaboratory",,80333,CPT,Facility,Inpatient,,,90,124,105.4,35.5384,124,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Antidepressants, Class; 3-5 (Mayo)OutsideLaboratory",,80333,CPT,Facility,Both,,,90,124,105.4,35.5384,124,CorVel,Worker's Compensation,124,100,,percent of total billed charges,,
"Antidepressants, Class; 3-5 (Mayo)OutsideLaboratory",,80333,CPT,Facility,Both,,,90,124,105.4,35.5384,124,First Health Group Corporation,First Health Network,120.28,97,,percent of total billed charges,,
"Antidepressants, Class; 3-5 (Mayo)OutsideLaboratory",,80333,CPT,Facility,Both,,,90,124,105.4,35.5384,124,"Health Partners, Inc.",Commercial,117.304,94.6,,percent of total billed charges,,
"Antidepressants, Class; 3-5 (Mayo)OutsideLaboratory",,80333,CPT,Facility,Outpatient,,,90,124,105.4,35.5384,124,"Health Partners, Inc.",Medicare Advantage,60.76,49,,percent of total billed charges,,
"Antidepressants, Class; 3-5 (Mayo)OutsideLaboratory",,80333,CPT,Facility,Inpatient,,,90,124,105.4,35.5384,124,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Antidepressants, Class; 3-5 (Mayo)OutsideLaboratory",,80333,CPT,Facility,Both,,,90,124,105.4,35.5384,124,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),74.4,60,,percent of total billed charges,,
"Antidepressants, Class; 3-5 (Mayo)OutsideLaboratory",,80333,CPT,Facility,Both,,,90,124,105.4,35.5384,124,"Health Partners, Inc.",State of Minnesota Advantage Program,101.06,81.5,,percent of total billed charges,,
"Antidepressants, Class; 3-5 (Mayo)OutsideLaboratory",,80333,CPT,Facility,Both,,,90,124,105.4,35.5384,124,"Health Partners, Inc.",State Public Programs,62,50,,percent of total billed charges,,
"Antidepressants, Class; 3-5 (Mayo)OutsideLaboratory",,80333,CPT,Facility,Both,,,90,124,105.4,35.5384,124,Humana Insurance Company,Commercial PPO,117.8,95,,percent of total billed charges,,
"Antidepressants, Class; 3-5 (Mayo)OutsideLaboratory",,80333,CPT,Facility,Outpatient,,,90,124,105.4,35.5384,124,Humana Insurance Company,Medicare PPO,60.76,49,,percent of total billed charges,,
"Antidepressants, Class; 3-5 (Mayo)OutsideLaboratory",,80333,CPT,Facility,Inpatient,,,90,124,105.4,35.5384,124,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Antidepressants, Class; 3-5 (Mayo)OutsideLaboratory",,80333,CPT,Facility,Both,,,90,124,105.4,35.5384,124,Medica,Individual & Family,122.884,99.1,,percent of total billed charges,,
"Antidepressants, Class; 3-5 (Mayo)OutsideLaboratory",,80333,CPT,Facility,Outpatient,,,90,124,105.4,35.5384,124,Medica,Medica Advantage Solution,61.752,49.8,,percent of total billed charges,,
"Antidepressants, Class; 3-5 (Mayo)OutsideLaboratory",,80333,CPT,Facility,Inpatient,,,90,124,105.4,35.5384,124,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Antidepressants, Class; 3-5 (Mayo)OutsideLaboratory",,80333,CPT,Facility,Outpatient,,,90,124,105.4,35.5384,124,Medica,Medical Assistance,55.304,44.6,,percent of total billed charges,,
"Antidepressants, Class; 3-5 (Mayo)OutsideLaboratory",,80333,CPT,Facility,Inpatient,,,90,124,105.4,35.5384,124,Medica,Medical Assistance,,,,,Included in per diem rate,
"Antidepressants, Class; 3-5 (Mayo)OutsideLaboratory",,80333,CPT,Facility,Outpatient,,,90,124,105.4,35.5384,124,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,61.752,49.8,,percent of total billed charges,,
"Antidepressants, Class; 3-5 (Mayo)OutsideLaboratory",,80333,CPT,Facility,Inpatient,,,90,124,105.4,35.5384,124,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Antidepressants, Class; 3-5 (Mayo)OutsideLaboratory",,80333,CPT,Facility,Both,,,90,124,105.4,35.5384,124,"Multiplan, Inc.","Multiplan, Inc.",116.56,94,,percent of total billed charges,,
"Antidepressants, Class; 3-5 (Mayo)OutsideLaboratory",,80333,CPT,Facility,Outpatient,,,90,124,105.4,35.5384,124,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,107.136,86.4,,percent of total billed charges,,
"Antidepressants, Class; 3-5 (Mayo)OutsideLaboratory",,80333,CPT,Facility,Inpatient,,,90,124,105.4,35.5384,124,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Antidepressants, Class; 3-5 (Mayo)OutsideLaboratory",,80333,CPT,Facility,Both,,,90,124,105.4,35.5384,124,"Preferred One Administrative Services, INC.",PPO,122.264,98.6,,percent of total billed charges,,
"Antidepressants, Class; 3-5 (Mayo)OutsideLaboratory",,80333,CPT,Facility,Outpatient,,,90,124,105.4,35.5384,124,PrimeWest Health,Minnesota Senior Health Options (MSHO),63.798,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Antidepressants, Class; 3-5 (Mayo)OutsideLaboratory",,80333,CPT,Facility,Inpatient,,,90,124,105.4,35.5384,124,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Antidepressants, Class; 3-5 (Mayo)OutsideLaboratory",,80333,CPT,Facility,Outpatient,,,90,124,105.4,35.5384,124,PrimeWest Health,MinnesotaCare,63.6864,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Antidepressants, Class; 3-5 (Mayo)OutsideLaboratory",,80333,CPT,Facility,Inpatient,,,90,124,105.4,35.5384,124,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Antidepressants, Class; 3-5 (Mayo)OutsideLaboratory",,80333,CPT,Facility,Both,,,90,124,105.4,35.5384,124,Sanford Health Plan,Sanford Health Plan,114.08,92,,percent of total billed charges,,
"Antidepressants, Class; 3-5 (Mayo)OutsideLaboratory",,80333,CPT,Facility,Outpatient,,,90,124,105.4,35.5384,124,"UCare Health, Inc.",Individual & Family Plan,69.874,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Antidepressants, Class; 3-5 (Mayo)OutsideLaboratory",,80333,CPT,Facility,Inpatient,,,90,124,105.4,35.5384,124,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Antidepressants, Class; 3-5 (Mayo)OutsideLaboratory",,80333,CPT,Facility,Outpatient,,,90,124,105.4,35.5384,124,"UCare Health, Inc.",Medical Assistance,62.5828,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Antidepressants, Class; 3-5 (Mayo)OutsideLaboratory",,80333,CPT,Facility,Inpatient,,,90,124,105.4,35.5384,124,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Antidepressants, Class; 3-5 (Mayo)OutsideLaboratory",,80333,CPT,Facility,Outpatient,,,90,124,105.4,35.5384,124,"UCare Health, Inc.",Medicare Advantage,62.5828,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Antidepressants, Class; 3-5 (Mayo)OutsideLaboratory",,80333,CPT,Facility,Inpatient,,,90,124,105.4,35.5384,124,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Antidepressants, Class; 3-5 (Mayo)OutsideLaboratory",,80333,CPT,Facility,Outpatient,,,90,124,105.4,35.5384,124,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),62.5828,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Antidepressants, Class; 3-5 (Mayo)OutsideLaboratory",,80333,CPT,Facility,Inpatient,,,90,124,105.4,35.5384,124,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Antidepressants, Class; 3-5 (Mayo)OutsideLaboratory",,80333,CPT,Facility,Both,,,90,124,105.4,35.5384,124,UnitedHealthcare,Individual & Family,116.56,94,,percent of total billed charges,,
"Antidepressants, Class; 3-5 (Mayo)OutsideLaboratory",,80333,CPT,Facility,Outpatient,,,90,124,105.4,35.5384,124,UnitedHealthcare,Medicare Advantage,60.76,49,,percent of total billed charges,,
"Antidepressants, Class; 3-5 (Mayo)OutsideLaboratory",,80333,CPT,Facility,Inpatient,,,90,124,105.4,35.5384,124,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Antidepressants, Class; 3-5 (Mayo)OutsideLaboratory",,80333,CPT,Facility,Outpatient,,,90,124,105.4,35.5384,124,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,59.52,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Antidepressants, Class; 3-5 (Mayo)OutsideLaboratory",,80333,CPT,Facility,Inpatient,,,90,124,105.4,35.5384,124,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Amitriptyline And Nortriptyline, S (Mayo)OutsideLaboratory",,80335,CPT,Facility,Both,,,90,173,147.05,49.5818,173,Aetna,Commercial,159.16,92,,percent of total billed charges,,
"Amitriptyline And Nortriptyline, S (Mayo)OutsideLaboratory",,80335,CPT,Facility,Outpatient,,,90,173,147.05,49.5818,173,Aetna,Medicare Advantage,84.77,49,,percent of total billed charges,,
"Amitriptyline And Nortriptyline, S (Mayo)OutsideLaboratory",,80335,CPT,Facility,Inpatient,,,90,173,147.05,49.5818,173,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Amitriptyline And Nortriptyline, S (Mayo)OutsideLaboratory",,80335,CPT,Facility,Both,,,90,173,147.05,49.5818,173,Aetna,PPO,160.89,93,,percent of total billed charges,,
"Amitriptyline And Nortriptyline, S (Mayo)OutsideLaboratory",,80335,CPT,Facility,Both,,,90,173,147.05,49.5818,173,America's PPO,America's PPO,166.1319,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Amitriptyline And Nortriptyline, S (Mayo)OutsideLaboratory",,80335,CPT,Facility,Both,,,90,173,147.05,49.5818,173,BlueCross BlueShield Minnesota, Federal Employee Program,170.232,98.4,,percent of total billed charges,,
"Amitriptyline And Nortriptyline, S (Mayo)OutsideLaboratory",,80335,CPT,Facility,Both,,,90,173,147.05,49.5818,173,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,173,100,,percent of total billed charges,,
"Amitriptyline And Nortriptyline, S (Mayo)OutsideLaboratory",,80335,CPT,Facility,Both,,,90,173,147.05,49.5818,173,BlueCross BlueShield Minnesota,High Value Network Plan,155.7,90,,percent of total billed charges,,
"Amitriptyline And Nortriptyline, S (Mayo)OutsideLaboratory",,80335,CPT,Facility,Outpatient,,,90,173,147.05,49.5818,173,BlueCross BlueShield Minnesota,Medicare Advantage,84.77,49,,percent of total billed charges,,
"Amitriptyline And Nortriptyline, S (Mayo)OutsideLaboratory",,80335,CPT,Facility,Inpatient,,,90,173,147.05,49.5818,173,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Amitriptyline And Nortriptyline, S (Mayo)OutsideLaboratory",,80335,CPT,Facility,Both,,,90,173,147.05,49.5818,173,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,153.2261,88.57,,percent of total billed charges,,
"Amitriptyline And Nortriptyline, S (Mayo)OutsideLaboratory",,80335,CPT,Facility,Both,,,90,173,147.05,49.5818,173,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,49.5818,28.66,,percent of total billed charges,,
"Amitriptyline And Nortriptyline, S (Mayo)OutsideLaboratory",,80335,CPT,Facility,Outpatient,,,90,173,147.05,49.5818,173,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),84.77,49,,percent of total billed charges,,
"Amitriptyline And Nortriptyline, S (Mayo)OutsideLaboratory",,80335,CPT,Facility,Inpatient,,,90,173,147.05,49.5818,173,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Amitriptyline And Nortriptyline, S (Mayo)OutsideLaboratory",,80335,CPT,Facility,Both,,,90,173,147.05,49.5818,173,CorVel,Worker's Compensation,173,100,,percent of total billed charges,,
"Amitriptyline And Nortriptyline, S (Mayo)OutsideLaboratory",,80335,CPT,Facility,Both,,,90,173,147.05,49.5818,173,First Health Group Corporation,First Health Network,167.81,97,,percent of total billed charges,,
"Amitriptyline And Nortriptyline, S (Mayo)OutsideLaboratory",,80335,CPT,Facility,Both,,,90,173,147.05,49.5818,173,"Health Partners, Inc.",Commercial,163.658,94.6,,percent of total billed charges,,
"Amitriptyline And Nortriptyline, S (Mayo)OutsideLaboratory",,80335,CPT,Facility,Outpatient,,,90,173,147.05,49.5818,173,"Health Partners, Inc.",Medicare Advantage,84.77,49,,percent of total billed charges,,
"Amitriptyline And Nortriptyline, S (Mayo)OutsideLaboratory",,80335,CPT,Facility,Inpatient,,,90,173,147.05,49.5818,173,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Amitriptyline And Nortriptyline, S (Mayo)OutsideLaboratory",,80335,CPT,Facility,Both,,,90,173,147.05,49.5818,173,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),103.8,60,,percent of total billed charges,,
"Amitriptyline And Nortriptyline, S (Mayo)OutsideLaboratory",,80335,CPT,Facility,Both,,,90,173,147.05,49.5818,173,"Health Partners, Inc.",State of Minnesota Advantage Program,140.995,81.5,,percent of total billed charges,,
"Amitriptyline And Nortriptyline, S (Mayo)OutsideLaboratory",,80335,CPT,Facility,Both,,,90,173,147.05,49.5818,173,"Health Partners, Inc.",State Public Programs,86.5,50,,percent of total billed charges,,
"Amitriptyline And Nortriptyline, S (Mayo)OutsideLaboratory",,80335,CPT,Facility,Both,,,90,173,147.05,49.5818,173,Humana Insurance Company,Commercial PPO,164.35,95,,percent of total billed charges,,
"Amitriptyline And Nortriptyline, S (Mayo)OutsideLaboratory",,80335,CPT,Facility,Outpatient,,,90,173,147.05,49.5818,173,Humana Insurance Company,Medicare PPO,84.77,49,,percent of total billed charges,,
"Amitriptyline And Nortriptyline, S (Mayo)OutsideLaboratory",,80335,CPT,Facility,Inpatient,,,90,173,147.05,49.5818,173,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Amitriptyline And Nortriptyline, S (Mayo)OutsideLaboratory",,80335,CPT,Facility,Both,,,90,173,147.05,49.5818,173,Medica,Individual & Family,171.443,99.1,,percent of total billed charges,,
"Amitriptyline And Nortriptyline, S (Mayo)OutsideLaboratory",,80335,CPT,Facility,Outpatient,,,90,173,147.05,49.5818,173,Medica,Medica Advantage Solution,86.154,49.8,,percent of total billed charges,,
"Amitriptyline And Nortriptyline, S (Mayo)OutsideLaboratory",,80335,CPT,Facility,Inpatient,,,90,173,147.05,49.5818,173,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Amitriptyline And Nortriptyline, S (Mayo)OutsideLaboratory",,80335,CPT,Facility,Outpatient,,,90,173,147.05,49.5818,173,Medica,Medical Assistance,77.158,44.6,,percent of total billed charges,,
"Amitriptyline And Nortriptyline, S (Mayo)OutsideLaboratory",,80335,CPT,Facility,Inpatient,,,90,173,147.05,49.5818,173,Medica,Medical Assistance,,,,,Included in per diem rate,
"Amitriptyline And Nortriptyline, S (Mayo)OutsideLaboratory",,80335,CPT,Facility,Outpatient,,,90,173,147.05,49.5818,173,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,86.154,49.8,,percent of total billed charges,,
"Amitriptyline And Nortriptyline, S (Mayo)OutsideLaboratory",,80335,CPT,Facility,Inpatient,,,90,173,147.05,49.5818,173,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Amitriptyline And Nortriptyline, S (Mayo)OutsideLaboratory",,80335,CPT,Facility,Both,,,90,173,147.05,49.5818,173,"Multiplan, Inc.","Multiplan, Inc.",162.62,94,,percent of total billed charges,,
"Amitriptyline And Nortriptyline, S (Mayo)OutsideLaboratory",,80335,CPT,Facility,Outpatient,,,90,173,147.05,49.5818,173,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,149.472,86.4,,percent of total billed charges,,
"Amitriptyline And Nortriptyline, S (Mayo)OutsideLaboratory",,80335,CPT,Facility,Inpatient,,,90,173,147.05,49.5818,173,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Amitriptyline And Nortriptyline, S (Mayo)OutsideLaboratory",,80335,CPT,Facility,Both,,,90,173,147.05,49.5818,173,"Preferred One Administrative Services, INC.",PPO,170.578,98.6,,percent of total billed charges,,
"Amitriptyline And Nortriptyline, S (Mayo)OutsideLaboratory",,80335,CPT,Facility,Outpatient,,,90,173,147.05,49.5818,173,PrimeWest Health,Minnesota Senior Health Options (MSHO),89.0085,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Amitriptyline And Nortriptyline, S (Mayo)OutsideLaboratory",,80335,CPT,Facility,Inpatient,,,90,173,147.05,49.5818,173,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Amitriptyline And Nortriptyline, S (Mayo)OutsideLaboratory",,80335,CPT,Facility,Outpatient,,,90,173,147.05,49.5818,173,PrimeWest Health,MinnesotaCare,88.8528,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Amitriptyline And Nortriptyline, S (Mayo)OutsideLaboratory",,80335,CPT,Facility,Inpatient,,,90,173,147.05,49.5818,173,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Amitriptyline And Nortriptyline, S (Mayo)OutsideLaboratory",,80335,CPT,Facility,Both,,,90,173,147.05,49.5818,173,Sanford Health Plan,Sanford Health Plan,159.16,92,,percent of total billed charges,,
"Amitriptyline And Nortriptyline, S (Mayo)OutsideLaboratory",,80335,CPT,Facility,Outpatient,,,90,173,147.05,49.5818,173,"UCare Health, Inc.",Individual & Family Plan,97.4855,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Amitriptyline And Nortriptyline, S (Mayo)OutsideLaboratory",,80335,CPT,Facility,Inpatient,,,90,173,147.05,49.5818,173,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Amitriptyline And Nortriptyline, S (Mayo)OutsideLaboratory",,80335,CPT,Facility,Outpatient,,,90,173,147.05,49.5818,173,"UCare Health, Inc.",Medical Assistance,87.3131,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Amitriptyline And Nortriptyline, S (Mayo)OutsideLaboratory",,80335,CPT,Facility,Inpatient,,,90,173,147.05,49.5818,173,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Amitriptyline And Nortriptyline, S (Mayo)OutsideLaboratory",,80335,CPT,Facility,Outpatient,,,90,173,147.05,49.5818,173,"UCare Health, Inc.",Medicare Advantage,87.3131,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Amitriptyline And Nortriptyline, S (Mayo)OutsideLaboratory",,80335,CPT,Facility,Inpatient,,,90,173,147.05,49.5818,173,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Amitriptyline And Nortriptyline, S (Mayo)OutsideLaboratory",,80335,CPT,Facility,Outpatient,,,90,173,147.05,49.5818,173,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),87.3131,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Amitriptyline And Nortriptyline, S (Mayo)OutsideLaboratory",,80335,CPT,Facility,Inpatient,,,90,173,147.05,49.5818,173,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Amitriptyline And Nortriptyline, S (Mayo)OutsideLaboratory",,80335,CPT,Facility,Both,,,90,173,147.05,49.5818,173,UnitedHealthcare,Individual & Family,162.62,94,,percent of total billed charges,,
"Amitriptyline And Nortriptyline, S (Mayo)OutsideLaboratory",,80335,CPT,Facility,Outpatient,,,90,173,147.05,49.5818,173,UnitedHealthcare,Medicare Advantage,84.77,49,,percent of total billed charges,,
"Amitriptyline And Nortriptyline, S (Mayo)OutsideLaboratory",,80335,CPT,Facility,Inpatient,,,90,173,147.05,49.5818,173,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Amitriptyline And Nortriptyline, S (Mayo)OutsideLaboratory",,80335,CPT,Facility,Outpatient,,,90,173,147.05,49.5818,173,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,83.04,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Amitriptyline And Nortriptyline, S (Mayo)OutsideLaboratory",,80335,CPT,Facility,Inpatient,,,90,173,147.05,49.5818,173,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Desipramine, S (Mayo)OutsideLaboratory",,80335,CPT,Facility,Both,,,90,56,47.6,16.0496,56,Aetna,Commercial,51.52,92,,percent of total billed charges,,
"Desipramine, S (Mayo)OutsideLaboratory",,80335,CPT,Facility,Outpatient,,,90,56,47.6,16.0496,56,Aetna,Medicare Advantage,27.44,49,,percent of total billed charges,,
"Desipramine, S (Mayo)OutsideLaboratory",,80335,CPT,Facility,Inpatient,,,90,56,47.6,16.0496,56,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Desipramine, S (Mayo)OutsideLaboratory",,80335,CPT,Facility,Both,,,90,56,47.6,16.0496,56,Aetna,PPO,52.08,93,,percent of total billed charges,,
"Desipramine, S (Mayo)OutsideLaboratory",,80335,CPT,Facility,Both,,,90,56,47.6,16.0496,56,America's PPO,America's PPO,53.7768,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Desipramine, S (Mayo)OutsideLaboratory",,80335,CPT,Facility,Both,,,90,56,47.6,16.0496,56,BlueCross BlueShield Minnesota, Federal Employee Program,55.104,98.4,,percent of total billed charges,,
"Desipramine, S (Mayo)OutsideLaboratory",,80335,CPT,Facility,Both,,,90,56,47.6,16.0496,56,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,56,100,,percent of total billed charges,,
"Desipramine, S (Mayo)OutsideLaboratory",,80335,CPT,Facility,Both,,,90,56,47.6,16.0496,56,BlueCross BlueShield Minnesota,High Value Network Plan,50.4,90,,percent of total billed charges,,
"Desipramine, S (Mayo)OutsideLaboratory",,80335,CPT,Facility,Outpatient,,,90,56,47.6,16.0496,56,BlueCross BlueShield Minnesota,Medicare Advantage,27.44,49,,percent of total billed charges,,
"Desipramine, S (Mayo)OutsideLaboratory",,80335,CPT,Facility,Inpatient,,,90,56,47.6,16.0496,56,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Desipramine, S (Mayo)OutsideLaboratory",,80335,CPT,Facility,Both,,,90,56,47.6,16.0496,56,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,49.5992,88.57,,percent of total billed charges,,
"Desipramine, S (Mayo)OutsideLaboratory",,80335,CPT,Facility,Both,,,90,56,47.6,16.0496,56,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,16.0496,28.66,,percent of total billed charges,,
"Desipramine, S (Mayo)OutsideLaboratory",,80335,CPT,Facility,Outpatient,,,90,56,47.6,16.0496,56,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),27.44,49,,percent of total billed charges,,
"Desipramine, S (Mayo)OutsideLaboratory",,80335,CPT,Facility,Inpatient,,,90,56,47.6,16.0496,56,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Desipramine, S (Mayo)OutsideLaboratory",,80335,CPT,Facility,Both,,,90,56,47.6,16.0496,56,CorVel,Worker's Compensation,56,100,,percent of total billed charges,,
"Desipramine, S (Mayo)OutsideLaboratory",,80335,CPT,Facility,Both,,,90,56,47.6,16.0496,56,First Health Group Corporation,First Health Network,54.32,97,,percent of total billed charges,,
"Desipramine, S (Mayo)OutsideLaboratory",,80335,CPT,Facility,Both,,,90,56,47.6,16.0496,56,"Health Partners, Inc.",Commercial,52.976,94.6,,percent of total billed charges,,
"Desipramine, S (Mayo)OutsideLaboratory",,80335,CPT,Facility,Outpatient,,,90,56,47.6,16.0496,56,"Health Partners, Inc.",Medicare Advantage,27.44,49,,percent of total billed charges,,
"Desipramine, S (Mayo)OutsideLaboratory",,80335,CPT,Facility,Inpatient,,,90,56,47.6,16.0496,56,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Desipramine, S (Mayo)OutsideLaboratory",,80335,CPT,Facility,Both,,,90,56,47.6,16.0496,56,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),33.6,60,,percent of total billed charges,,
"Desipramine, S (Mayo)OutsideLaboratory",,80335,CPT,Facility,Both,,,90,56,47.6,16.0496,56,"Health Partners, Inc.",State of Minnesota Advantage Program,45.64,81.5,,percent of total billed charges,,
"Desipramine, S (Mayo)OutsideLaboratory",,80335,CPT,Facility,Both,,,90,56,47.6,16.0496,56,"Health Partners, Inc.",State Public Programs,28,50,,percent of total billed charges,,
"Desipramine, S (Mayo)OutsideLaboratory",,80335,CPT,Facility,Both,,,90,56,47.6,16.0496,56,Humana Insurance Company,Commercial PPO,53.2,95,,percent of total billed charges,,
"Desipramine, S (Mayo)OutsideLaboratory",,80335,CPT,Facility,Outpatient,,,90,56,47.6,16.0496,56,Humana Insurance Company,Medicare PPO,27.44,49,,percent of total billed charges,,
"Desipramine, S (Mayo)OutsideLaboratory",,80335,CPT,Facility,Inpatient,,,90,56,47.6,16.0496,56,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Desipramine, S (Mayo)OutsideLaboratory",,80335,CPT,Facility,Both,,,90,56,47.6,16.0496,56,Medica,Individual & Family,55.496,99.1,,percent of total billed charges,,
"Desipramine, S (Mayo)OutsideLaboratory",,80335,CPT,Facility,Outpatient,,,90,56,47.6,16.0496,56,Medica,Medica Advantage Solution,27.888,49.8,,percent of total billed charges,,
"Desipramine, S (Mayo)OutsideLaboratory",,80335,CPT,Facility,Inpatient,,,90,56,47.6,16.0496,56,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Desipramine, S (Mayo)OutsideLaboratory",,80335,CPT,Facility,Outpatient,,,90,56,47.6,16.0496,56,Medica,Medical Assistance,24.976,44.6,,percent of total billed charges,,
"Desipramine, S (Mayo)OutsideLaboratory",,80335,CPT,Facility,Inpatient,,,90,56,47.6,16.0496,56,Medica,Medical Assistance,,,,,Included in per diem rate,
"Desipramine, S (Mayo)OutsideLaboratory",,80335,CPT,Facility,Outpatient,,,90,56,47.6,16.0496,56,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,27.888,49.8,,percent of total billed charges,,
"Desipramine, S (Mayo)OutsideLaboratory",,80335,CPT,Facility,Inpatient,,,90,56,47.6,16.0496,56,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Desipramine, S (Mayo)OutsideLaboratory",,80335,CPT,Facility,Both,,,90,56,47.6,16.0496,56,"Multiplan, Inc.","Multiplan, Inc.",52.64,94,,percent of total billed charges,,
"Desipramine, S (Mayo)OutsideLaboratory",,80335,CPT,Facility,Outpatient,,,90,56,47.6,16.0496,56,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,48.384,86.4,,percent of total billed charges,,
"Desipramine, S (Mayo)OutsideLaboratory",,80335,CPT,Facility,Inpatient,,,90,56,47.6,16.0496,56,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Desipramine, S (Mayo)OutsideLaboratory",,80335,CPT,Facility,Both,,,90,56,47.6,16.0496,56,"Preferred One Administrative Services, INC.",PPO,55.216,98.6,,percent of total billed charges,,
"Desipramine, S (Mayo)OutsideLaboratory",,80335,CPT,Facility,Outpatient,,,90,56,47.6,16.0496,56,PrimeWest Health,Minnesota Senior Health Options (MSHO),28.812,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Desipramine, S (Mayo)OutsideLaboratory",,80335,CPT,Facility,Inpatient,,,90,56,47.6,16.0496,56,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Desipramine, S (Mayo)OutsideLaboratory",,80335,CPT,Facility,Outpatient,,,90,56,47.6,16.0496,56,PrimeWest Health,MinnesotaCare,28.7616,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Desipramine, S (Mayo)OutsideLaboratory",,80335,CPT,Facility,Inpatient,,,90,56,47.6,16.0496,56,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Desipramine, S (Mayo)OutsideLaboratory",,80335,CPT,Facility,Both,,,90,56,47.6,16.0496,56,Sanford Health Plan,Sanford Health Plan,51.52,92,,percent of total billed charges,,
"Desipramine, S (Mayo)OutsideLaboratory",,80335,CPT,Facility,Outpatient,,,90,56,47.6,16.0496,56,"UCare Health, Inc.",Individual & Family Plan,31.556,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Desipramine, S (Mayo)OutsideLaboratory",,80335,CPT,Facility,Inpatient,,,90,56,47.6,16.0496,56,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Desipramine, S (Mayo)OutsideLaboratory",,80335,CPT,Facility,Outpatient,,,90,56,47.6,16.0496,56,"UCare Health, Inc.",Medical Assistance,28.2632,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Desipramine, S (Mayo)OutsideLaboratory",,80335,CPT,Facility,Inpatient,,,90,56,47.6,16.0496,56,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Desipramine, S (Mayo)OutsideLaboratory",,80335,CPT,Facility,Outpatient,,,90,56,47.6,16.0496,56,"UCare Health, Inc.",Medicare Advantage,28.2632,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Desipramine, S (Mayo)OutsideLaboratory",,80335,CPT,Facility,Inpatient,,,90,56,47.6,16.0496,56,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Desipramine, S (Mayo)OutsideLaboratory",,80335,CPT,Facility,Outpatient,,,90,56,47.6,16.0496,56,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),28.2632,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Desipramine, S (Mayo)OutsideLaboratory",,80335,CPT,Facility,Inpatient,,,90,56,47.6,16.0496,56,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Desipramine, S (Mayo)OutsideLaboratory",,80335,CPT,Facility,Both,,,90,56,47.6,16.0496,56,UnitedHealthcare,Individual & Family,52.64,94,,percent of total billed charges,,
"Desipramine, S (Mayo)OutsideLaboratory",,80335,CPT,Facility,Outpatient,,,90,56,47.6,16.0496,56,UnitedHealthcare,Medicare Advantage,27.44,49,,percent of total billed charges,,
"Desipramine, S (Mayo)OutsideLaboratory",,80335,CPT,Facility,Inpatient,,,90,56,47.6,16.0496,56,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Desipramine, S (Mayo)OutsideLaboratory",,80335,CPT,Facility,Outpatient,,,90,56,47.6,16.0496,56,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,26.88,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Desipramine, S (Mayo)OutsideLaboratory",,80335,CPT,Facility,Inpatient,,,90,56,47.6,16.0496,56,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Nortriptyline, S (Mayo)OutsideLaboratory",,80335,CPT,Facility,Both,,,90,65,55.25,18.629,65,Aetna,Commercial,59.8,92,,percent of total billed charges,,
"Nortriptyline, S (Mayo)OutsideLaboratory",,80335,CPT,Facility,Outpatient,,,90,65,55.25,18.629,65,Aetna,Medicare Advantage,31.85,49,,percent of total billed charges,,
"Nortriptyline, S (Mayo)OutsideLaboratory",,80335,CPT,Facility,Inpatient,,,90,65,55.25,18.629,65,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Nortriptyline, S (Mayo)OutsideLaboratory",,80335,CPT,Facility,Both,,,90,65,55.25,18.629,65,Aetna,PPO,60.45,93,,percent of total billed charges,,
"Nortriptyline, S (Mayo)OutsideLaboratory",,80335,CPT,Facility,Both,,,90,65,55.25,18.629,65,America's PPO,America's PPO,62.4195,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Nortriptyline, S (Mayo)OutsideLaboratory",,80335,CPT,Facility,Both,,,90,65,55.25,18.629,65,BlueCross BlueShield Minnesota, Federal Employee Program,63.96,98.4,,percent of total billed charges,,
"Nortriptyline, S (Mayo)OutsideLaboratory",,80335,CPT,Facility,Both,,,90,65,55.25,18.629,65,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,65,100,,percent of total billed charges,,
"Nortriptyline, S (Mayo)OutsideLaboratory",,80335,CPT,Facility,Both,,,90,65,55.25,18.629,65,BlueCross BlueShield Minnesota,High Value Network Plan,58.5,90,,percent of total billed charges,,
"Nortriptyline, S (Mayo)OutsideLaboratory",,80335,CPT,Facility,Outpatient,,,90,65,55.25,18.629,65,BlueCross BlueShield Minnesota,Medicare Advantage,31.85,49,,percent of total billed charges,,
"Nortriptyline, S (Mayo)OutsideLaboratory",,80335,CPT,Facility,Inpatient,,,90,65,55.25,18.629,65,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Nortriptyline, S (Mayo)OutsideLaboratory",,80335,CPT,Facility,Both,,,90,65,55.25,18.629,65,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,57.5705,88.57,,percent of total billed charges,,
"Nortriptyline, S (Mayo)OutsideLaboratory",,80335,CPT,Facility,Both,,,90,65,55.25,18.629,65,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,18.629,28.66,,percent of total billed charges,,
"Nortriptyline, S (Mayo)OutsideLaboratory",,80335,CPT,Facility,Outpatient,,,90,65,55.25,18.629,65,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),31.85,49,,percent of total billed charges,,
"Nortriptyline, S (Mayo)OutsideLaboratory",,80335,CPT,Facility,Inpatient,,,90,65,55.25,18.629,65,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Nortriptyline, S (Mayo)OutsideLaboratory",,80335,CPT,Facility,Both,,,90,65,55.25,18.629,65,CorVel,Worker's Compensation,65,100,,percent of total billed charges,,
"Nortriptyline, S (Mayo)OutsideLaboratory",,80335,CPT,Facility,Both,,,90,65,55.25,18.629,65,First Health Group Corporation,First Health Network,63.05,97,,percent of total billed charges,,
"Nortriptyline, S (Mayo)OutsideLaboratory",,80335,CPT,Facility,Both,,,90,65,55.25,18.629,65,"Health Partners, Inc.",Commercial,61.49,94.6,,percent of total billed charges,,
"Nortriptyline, S (Mayo)OutsideLaboratory",,80335,CPT,Facility,Outpatient,,,90,65,55.25,18.629,65,"Health Partners, Inc.",Medicare Advantage,31.85,49,,percent of total billed charges,,
"Nortriptyline, S (Mayo)OutsideLaboratory",,80335,CPT,Facility,Inpatient,,,90,65,55.25,18.629,65,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Nortriptyline, S (Mayo)OutsideLaboratory",,80335,CPT,Facility,Both,,,90,65,55.25,18.629,65,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),39,60,,percent of total billed charges,,
"Nortriptyline, S (Mayo)OutsideLaboratory",,80335,CPT,Facility,Both,,,90,65,55.25,18.629,65,"Health Partners, Inc.",State of Minnesota Advantage Program,52.975,81.5,,percent of total billed charges,,
"Nortriptyline, S (Mayo)OutsideLaboratory",,80335,CPT,Facility,Both,,,90,65,55.25,18.629,65,"Health Partners, Inc.",State Public Programs,32.5,50,,percent of total billed charges,,
"Nortriptyline, S (Mayo)OutsideLaboratory",,80335,CPT,Facility,Both,,,90,65,55.25,18.629,65,Humana Insurance Company,Commercial PPO,61.75,95,,percent of total billed charges,,
"Nortriptyline, S (Mayo)OutsideLaboratory",,80335,CPT,Facility,Outpatient,,,90,65,55.25,18.629,65,Humana Insurance Company,Medicare PPO,31.85,49,,percent of total billed charges,,
"Nortriptyline, S (Mayo)OutsideLaboratory",,80335,CPT,Facility,Inpatient,,,90,65,55.25,18.629,65,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Nortriptyline, S (Mayo)OutsideLaboratory",,80335,CPT,Facility,Both,,,90,65,55.25,18.629,65,Medica,Individual & Family,64.415,99.1,,percent of total billed charges,,
"Nortriptyline, S (Mayo)OutsideLaboratory",,80335,CPT,Facility,Outpatient,,,90,65,55.25,18.629,65,Medica,Medica Advantage Solution,32.37,49.8,,percent of total billed charges,,
"Nortriptyline, S (Mayo)OutsideLaboratory",,80335,CPT,Facility,Inpatient,,,90,65,55.25,18.629,65,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Nortriptyline, S (Mayo)OutsideLaboratory",,80335,CPT,Facility,Outpatient,,,90,65,55.25,18.629,65,Medica,Medical Assistance,28.99,44.6,,percent of total billed charges,,
"Nortriptyline, S (Mayo)OutsideLaboratory",,80335,CPT,Facility,Inpatient,,,90,65,55.25,18.629,65,Medica,Medical Assistance,,,,,Included in per diem rate,
"Nortriptyline, S (Mayo)OutsideLaboratory",,80335,CPT,Facility,Outpatient,,,90,65,55.25,18.629,65,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,32.37,49.8,,percent of total billed charges,,
"Nortriptyline, S (Mayo)OutsideLaboratory",,80335,CPT,Facility,Inpatient,,,90,65,55.25,18.629,65,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Nortriptyline, S (Mayo)OutsideLaboratory",,80335,CPT,Facility,Both,,,90,65,55.25,18.629,65,"Multiplan, Inc.","Multiplan, Inc.",61.1,94,,percent of total billed charges,,
"Nortriptyline, S (Mayo)OutsideLaboratory",,80335,CPT,Facility,Outpatient,,,90,65,55.25,18.629,65,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,56.16,86.4,,percent of total billed charges,,
"Nortriptyline, S (Mayo)OutsideLaboratory",,80335,CPT,Facility,Inpatient,,,90,65,55.25,18.629,65,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Nortriptyline, S (Mayo)OutsideLaboratory",,80335,CPT,Facility,Both,,,90,65,55.25,18.629,65,"Preferred One Administrative Services, INC.",PPO,64.09,98.6,,percent of total billed charges,,
"Nortriptyline, S (Mayo)OutsideLaboratory",,80335,CPT,Facility,Outpatient,,,90,65,55.25,18.629,65,PrimeWest Health,Minnesota Senior Health Options (MSHO),33.4425,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Nortriptyline, S (Mayo)OutsideLaboratory",,80335,CPT,Facility,Inpatient,,,90,65,55.25,18.629,65,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Nortriptyline, S (Mayo)OutsideLaboratory",,80335,CPT,Facility,Outpatient,,,90,65,55.25,18.629,65,PrimeWest Health,MinnesotaCare,33.384,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Nortriptyline, S (Mayo)OutsideLaboratory",,80335,CPT,Facility,Inpatient,,,90,65,55.25,18.629,65,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Nortriptyline, S (Mayo)OutsideLaboratory",,80335,CPT,Facility,Both,,,90,65,55.25,18.629,65,Sanford Health Plan,Sanford Health Plan,59.8,92,,percent of total billed charges,,
"Nortriptyline, S (Mayo)OutsideLaboratory",,80335,CPT,Facility,Outpatient,,,90,65,55.25,18.629,65,"UCare Health, Inc.",Individual & Family Plan,36.6275,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Nortriptyline, S (Mayo)OutsideLaboratory",,80335,CPT,Facility,Inpatient,,,90,65,55.25,18.629,65,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Nortriptyline, S (Mayo)OutsideLaboratory",,80335,CPT,Facility,Outpatient,,,90,65,55.25,18.629,65,"UCare Health, Inc.",Medical Assistance,32.8055,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Nortriptyline, S (Mayo)OutsideLaboratory",,80335,CPT,Facility,Inpatient,,,90,65,55.25,18.629,65,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Nortriptyline, S (Mayo)OutsideLaboratory",,80335,CPT,Facility,Outpatient,,,90,65,55.25,18.629,65,"UCare Health, Inc.",Medicare Advantage,32.8055,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Nortriptyline, S (Mayo)OutsideLaboratory",,80335,CPT,Facility,Inpatient,,,90,65,55.25,18.629,65,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Nortriptyline, S (Mayo)OutsideLaboratory",,80335,CPT,Facility,Outpatient,,,90,65,55.25,18.629,65,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),32.8055,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Nortriptyline, S (Mayo)OutsideLaboratory",,80335,CPT,Facility,Inpatient,,,90,65,55.25,18.629,65,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Nortriptyline, S (Mayo)OutsideLaboratory",,80335,CPT,Facility,Both,,,90,65,55.25,18.629,65,UnitedHealthcare,Individual & Family,61.1,94,,percent of total billed charges,,
"Nortriptyline, S (Mayo)OutsideLaboratory",,80335,CPT,Facility,Outpatient,,,90,65,55.25,18.629,65,UnitedHealthcare,Medicare Advantage,31.85,49,,percent of total billed charges,,
"Nortriptyline, S (Mayo)OutsideLaboratory",,80335,CPT,Facility,Inpatient,,,90,65,55.25,18.629,65,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Nortriptyline, S (Mayo)OutsideLaboratory",,80335,CPT,Facility,Outpatient,,,90,65,55.25,18.629,65,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,31.2,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Nortriptyline, S (Mayo)OutsideLaboratory",,80335,CPT,Facility,Inpatient,,,90,65,55.25,18.629,65,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Tricyclic And Cyclicals 6/More (Mayo)OutsideLaboratory,,80337,CPT,Facility,Both,,,90,90,76.5,25.794,90,Aetna,Commercial,82.8,92,,percent of total billed charges,,
Tricyclic And Cyclicals 6/More (Mayo)OutsideLaboratory,,80337,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,Aetna,Medicare Advantage,44.1,49,,percent of total billed charges,,
Tricyclic And Cyclicals 6/More (Mayo)OutsideLaboratory,,80337,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Tricyclic And Cyclicals 6/More (Mayo)OutsideLaboratory,,80337,CPT,Facility,Both,,,90,90,76.5,25.794,90,Aetna,PPO,83.7,93,,percent of total billed charges,,
Tricyclic And Cyclicals 6/More (Mayo)OutsideLaboratory,,80337,CPT,Facility,Both,,,90,90,76.5,25.794,90,America's PPO,America's PPO,86.427,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Tricyclic And Cyclicals 6/More (Mayo)OutsideLaboratory,,80337,CPT,Facility,Both,,,90,90,76.5,25.794,90,BlueCross BlueShield Minnesota, Federal Employee Program,88.56,98.4,,percent of total billed charges,,
Tricyclic And Cyclicals 6/More (Mayo)OutsideLaboratory,,80337,CPT,Facility,Both,,,90,90,76.5,25.794,90,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,90,100,,percent of total billed charges,,
Tricyclic And Cyclicals 6/More (Mayo)OutsideLaboratory,,80337,CPT,Facility,Both,,,90,90,76.5,25.794,90,BlueCross BlueShield Minnesota,High Value Network Plan,81,90,,percent of total billed charges,,
Tricyclic And Cyclicals 6/More (Mayo)OutsideLaboratory,,80337,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,BlueCross BlueShield Minnesota,Medicare Advantage,44.1,49,,percent of total billed charges,,
Tricyclic And Cyclicals 6/More (Mayo)OutsideLaboratory,,80337,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Tricyclic And Cyclicals 6/More (Mayo)OutsideLaboratory,,80337,CPT,Facility,Both,,,90,90,76.5,25.794,90,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,79.713,88.57,,percent of total billed charges,,
Tricyclic And Cyclicals 6/More (Mayo)OutsideLaboratory,,80337,CPT,Facility,Both,,,90,90,76.5,25.794,90,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,25.794,28.66,,percent of total billed charges,,
Tricyclic And Cyclicals 6/More (Mayo)OutsideLaboratory,,80337,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),44.1,49,,percent of total billed charges,,
Tricyclic And Cyclicals 6/More (Mayo)OutsideLaboratory,,80337,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Tricyclic And Cyclicals 6/More (Mayo)OutsideLaboratory,,80337,CPT,Facility,Both,,,90,90,76.5,25.794,90,CorVel,Worker's Compensation,90,100,,percent of total billed charges,,
Tricyclic And Cyclicals 6/More (Mayo)OutsideLaboratory,,80337,CPT,Facility,Both,,,90,90,76.5,25.794,90,First Health Group Corporation,First Health Network,87.3,97,,percent of total billed charges,,
Tricyclic And Cyclicals 6/More (Mayo)OutsideLaboratory,,80337,CPT,Facility,Both,,,90,90,76.5,25.794,90,"Health Partners, Inc.",Commercial,85.14,94.6,,percent of total billed charges,,
Tricyclic And Cyclicals 6/More (Mayo)OutsideLaboratory,,80337,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,"Health Partners, Inc.",Medicare Advantage,44.1,49,,percent of total billed charges,,
Tricyclic And Cyclicals 6/More (Mayo)OutsideLaboratory,,80337,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Tricyclic And Cyclicals 6/More (Mayo)OutsideLaboratory,,80337,CPT,Facility,Both,,,90,90,76.5,25.794,90,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),54,60,,percent of total billed charges,,
Tricyclic And Cyclicals 6/More (Mayo)OutsideLaboratory,,80337,CPT,Facility,Both,,,90,90,76.5,25.794,90,"Health Partners, Inc.",State of Minnesota Advantage Program,73.35,81.5,,percent of total billed charges,,
Tricyclic And Cyclicals 6/More (Mayo)OutsideLaboratory,,80337,CPT,Facility,Both,,,90,90,76.5,25.794,90,"Health Partners, Inc.",State Public Programs,45,50,,percent of total billed charges,,
Tricyclic And Cyclicals 6/More (Mayo)OutsideLaboratory,,80337,CPT,Facility,Both,,,90,90,76.5,25.794,90,Humana Insurance Company,Commercial PPO,85.5,95,,percent of total billed charges,,
Tricyclic And Cyclicals 6/More (Mayo)OutsideLaboratory,,80337,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,Humana Insurance Company,Medicare PPO,44.1,49,,percent of total billed charges,,
Tricyclic And Cyclicals 6/More (Mayo)OutsideLaboratory,,80337,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Tricyclic And Cyclicals 6/More (Mayo)OutsideLaboratory,,80337,CPT,Facility,Both,,,90,90,76.5,25.794,90,Medica,Individual & Family,89.19,99.1,,percent of total billed charges,,
Tricyclic And Cyclicals 6/More (Mayo)OutsideLaboratory,,80337,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,Medica,Medica Advantage Solution,44.82,49.8,,percent of total billed charges,,
Tricyclic And Cyclicals 6/More (Mayo)OutsideLaboratory,,80337,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Tricyclic And Cyclicals 6/More (Mayo)OutsideLaboratory,,80337,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,Medica,Medical Assistance,40.14,44.6,,percent of total billed charges,,
Tricyclic And Cyclicals 6/More (Mayo)OutsideLaboratory,,80337,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,Medica,Medical Assistance,,,,,Included in per diem rate,
Tricyclic And Cyclicals 6/More (Mayo)OutsideLaboratory,,80337,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,44.82,49.8,,percent of total billed charges,,
Tricyclic And Cyclicals 6/More (Mayo)OutsideLaboratory,,80337,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Tricyclic And Cyclicals 6/More (Mayo)OutsideLaboratory,,80337,CPT,Facility,Both,,,90,90,76.5,25.794,90,"Multiplan, Inc.","Multiplan, Inc.",84.6,94,,percent of total billed charges,,
Tricyclic And Cyclicals 6/More (Mayo)OutsideLaboratory,,80337,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,77.76,86.4,,percent of total billed charges,,
Tricyclic And Cyclicals 6/More (Mayo)OutsideLaboratory,,80337,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Tricyclic And Cyclicals 6/More (Mayo)OutsideLaboratory,,80337,CPT,Facility,Both,,,90,90,76.5,25.794,90,"Preferred One Administrative Services, INC.",PPO,88.74,98.6,,percent of total billed charges,,
Tricyclic And Cyclicals 6/More (Mayo)OutsideLaboratory,,80337,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,PrimeWest Health,Minnesota Senior Health Options (MSHO),46.305,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Tricyclic And Cyclicals 6/More (Mayo)OutsideLaboratory,,80337,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Tricyclic And Cyclicals 6/More (Mayo)OutsideLaboratory,,80337,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,PrimeWest Health,MinnesotaCare,46.224,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Tricyclic And Cyclicals 6/More (Mayo)OutsideLaboratory,,80337,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Tricyclic And Cyclicals 6/More (Mayo)OutsideLaboratory,,80337,CPT,Facility,Both,,,90,90,76.5,25.794,90,Sanford Health Plan,Sanford Health Plan,82.8,92,,percent of total billed charges,,
Tricyclic And Cyclicals 6/More (Mayo)OutsideLaboratory,,80337,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,"UCare Health, Inc.",Individual & Family Plan,50.715,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Tricyclic And Cyclicals 6/More (Mayo)OutsideLaboratory,,80337,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Tricyclic And Cyclicals 6/More (Mayo)OutsideLaboratory,,80337,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,"UCare Health, Inc.",Medical Assistance,45.423,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Tricyclic And Cyclicals 6/More (Mayo)OutsideLaboratory,,80337,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Tricyclic And Cyclicals 6/More (Mayo)OutsideLaboratory,,80337,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,"UCare Health, Inc.",Medicare Advantage,45.423,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Tricyclic And Cyclicals 6/More (Mayo)OutsideLaboratory,,80337,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Tricyclic And Cyclicals 6/More (Mayo)OutsideLaboratory,,80337,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),45.423,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Tricyclic And Cyclicals 6/More (Mayo)OutsideLaboratory,,80337,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Tricyclic And Cyclicals 6/More (Mayo)OutsideLaboratory,,80337,CPT,Facility,Both,,,90,90,76.5,25.794,90,UnitedHealthcare,Individual & Family,84.6,94,,percent of total billed charges,,
Tricyclic And Cyclicals 6/More (Mayo)OutsideLaboratory,,80337,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,UnitedHealthcare,Medicare Advantage,44.1,49,,percent of total billed charges,,
Tricyclic And Cyclicals 6/More (Mayo)OutsideLaboratory,,80337,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Tricyclic And Cyclicals 6/More (Mayo)OutsideLaboratory,,80337,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,43.2,48,,percent of total billed charges,,100% of DHS outpatient percentage
Tricyclic And Cyclicals 6/More (Mayo)OutsideLaboratory,,80337,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Clobazam (Onfi) (Mayo)OutsideLaboratory,,80339,CPT,Facility,Both,,,90,171,145.35,49.0086,171,Aetna,Commercial,157.32,92,,percent of total billed charges,,
Clobazam (Onfi) (Mayo)OutsideLaboratory,,80339,CPT,Facility,Outpatient,,,90,171,145.35,49.0086,171,Aetna,Medicare Advantage,83.79,49,,percent of total billed charges,,
Clobazam (Onfi) (Mayo)OutsideLaboratory,,80339,CPT,Facility,Inpatient,,,90,171,145.35,49.0086,171,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Clobazam (Onfi) (Mayo)OutsideLaboratory,,80339,CPT,Facility,Both,,,90,171,145.35,49.0086,171,Aetna,PPO,159.03,93,,percent of total billed charges,,
Clobazam (Onfi) (Mayo)OutsideLaboratory,,80339,CPT,Facility,Both,,,90,171,145.35,49.0086,171,America's PPO,America's PPO,164.2113,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Clobazam (Onfi) (Mayo)OutsideLaboratory,,80339,CPT,Facility,Both,,,90,171,145.35,49.0086,171,BlueCross BlueShield Minnesota, Federal Employee Program,168.264,98.4,,percent of total billed charges,,
Clobazam (Onfi) (Mayo)OutsideLaboratory,,80339,CPT,Facility,Both,,,90,171,145.35,49.0086,171,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,171,100,,percent of total billed charges,,
Clobazam (Onfi) (Mayo)OutsideLaboratory,,80339,CPT,Facility,Both,,,90,171,145.35,49.0086,171,BlueCross BlueShield Minnesota,High Value Network Plan,153.9,90,,percent of total billed charges,,
Clobazam (Onfi) (Mayo)OutsideLaboratory,,80339,CPT,Facility,Outpatient,,,90,171,145.35,49.0086,171,BlueCross BlueShield Minnesota,Medicare Advantage,83.79,49,,percent of total billed charges,,
Clobazam (Onfi) (Mayo)OutsideLaboratory,,80339,CPT,Facility,Inpatient,,,90,171,145.35,49.0086,171,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Clobazam (Onfi) (Mayo)OutsideLaboratory,,80339,CPT,Facility,Both,,,90,171,145.35,49.0086,171,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,151.4547,88.57,,percent of total billed charges,,
Clobazam (Onfi) (Mayo)OutsideLaboratory,,80339,CPT,Facility,Both,,,90,171,145.35,49.0086,171,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,49.0086,28.66,,percent of total billed charges,,
Clobazam (Onfi) (Mayo)OutsideLaboratory,,80339,CPT,Facility,Outpatient,,,90,171,145.35,49.0086,171,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),83.79,49,,percent of total billed charges,,
Clobazam (Onfi) (Mayo)OutsideLaboratory,,80339,CPT,Facility,Inpatient,,,90,171,145.35,49.0086,171,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Clobazam (Onfi) (Mayo)OutsideLaboratory,,80339,CPT,Facility,Both,,,90,171,145.35,49.0086,171,CorVel,Worker's Compensation,171,100,,percent of total billed charges,,
Clobazam (Onfi) (Mayo)OutsideLaboratory,,80339,CPT,Facility,Both,,,90,171,145.35,49.0086,171,First Health Group Corporation,First Health Network,165.87,97,,percent of total billed charges,,
Clobazam (Onfi) (Mayo)OutsideLaboratory,,80339,CPT,Facility,Both,,,90,171,145.35,49.0086,171,"Health Partners, Inc.",Commercial,161.766,94.6,,percent of total billed charges,,
Clobazam (Onfi) (Mayo)OutsideLaboratory,,80339,CPT,Facility,Outpatient,,,90,171,145.35,49.0086,171,"Health Partners, Inc.",Medicare Advantage,83.79,49,,percent of total billed charges,,
Clobazam (Onfi) (Mayo)OutsideLaboratory,,80339,CPT,Facility,Inpatient,,,90,171,145.35,49.0086,171,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Clobazam (Onfi) (Mayo)OutsideLaboratory,,80339,CPT,Facility,Both,,,90,171,145.35,49.0086,171,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),102.6,60,,percent of total billed charges,,
Clobazam (Onfi) (Mayo)OutsideLaboratory,,80339,CPT,Facility,Both,,,90,171,145.35,49.0086,171,"Health Partners, Inc.",State of Minnesota Advantage Program,139.365,81.5,,percent of total billed charges,,
Clobazam (Onfi) (Mayo)OutsideLaboratory,,80339,CPT,Facility,Both,,,90,171,145.35,49.0086,171,"Health Partners, Inc.",State Public Programs,85.5,50,,percent of total billed charges,,
Clobazam (Onfi) (Mayo)OutsideLaboratory,,80339,CPT,Facility,Both,,,90,171,145.35,49.0086,171,Humana Insurance Company,Commercial PPO,162.45,95,,percent of total billed charges,,
Clobazam (Onfi) (Mayo)OutsideLaboratory,,80339,CPT,Facility,Outpatient,,,90,171,145.35,49.0086,171,Humana Insurance Company,Medicare PPO,83.79,49,,percent of total billed charges,,
Clobazam (Onfi) (Mayo)OutsideLaboratory,,80339,CPT,Facility,Inpatient,,,90,171,145.35,49.0086,171,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Clobazam (Onfi) (Mayo)OutsideLaboratory,,80339,CPT,Facility,Both,,,90,171,145.35,49.0086,171,Medica,Individual & Family,169.461,99.1,,percent of total billed charges,,
Clobazam (Onfi) (Mayo)OutsideLaboratory,,80339,CPT,Facility,Outpatient,,,90,171,145.35,49.0086,171,Medica,Medica Advantage Solution,85.158,49.8,,percent of total billed charges,,
Clobazam (Onfi) (Mayo)OutsideLaboratory,,80339,CPT,Facility,Inpatient,,,90,171,145.35,49.0086,171,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Clobazam (Onfi) (Mayo)OutsideLaboratory,,80339,CPT,Facility,Outpatient,,,90,171,145.35,49.0086,171,Medica,Medical Assistance,76.266,44.6,,percent of total billed charges,,
Clobazam (Onfi) (Mayo)OutsideLaboratory,,80339,CPT,Facility,Inpatient,,,90,171,145.35,49.0086,171,Medica,Medical Assistance,,,,,Included in per diem rate,
Clobazam (Onfi) (Mayo)OutsideLaboratory,,80339,CPT,Facility,Outpatient,,,90,171,145.35,49.0086,171,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,85.158,49.8,,percent of total billed charges,,
Clobazam (Onfi) (Mayo)OutsideLaboratory,,80339,CPT,Facility,Inpatient,,,90,171,145.35,49.0086,171,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Clobazam (Onfi) (Mayo)OutsideLaboratory,,80339,CPT,Facility,Both,,,90,171,145.35,49.0086,171,"Multiplan, Inc.","Multiplan, Inc.",160.74,94,,percent of total billed charges,,
Clobazam (Onfi) (Mayo)OutsideLaboratory,,80339,CPT,Facility,Outpatient,,,90,171,145.35,49.0086,171,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,147.744,86.4,,percent of total billed charges,,
Clobazam (Onfi) (Mayo)OutsideLaboratory,,80339,CPT,Facility,Inpatient,,,90,171,145.35,49.0086,171,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Clobazam (Onfi) (Mayo)OutsideLaboratory,,80339,CPT,Facility,Both,,,90,171,145.35,49.0086,171,"Preferred One Administrative Services, INC.",PPO,168.606,98.6,,percent of total billed charges,,
Clobazam (Onfi) (Mayo)OutsideLaboratory,,80339,CPT,Facility,Outpatient,,,90,171,145.35,49.0086,171,PrimeWest Health,Minnesota Senior Health Options (MSHO),87.9795,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Clobazam (Onfi) (Mayo)OutsideLaboratory,,80339,CPT,Facility,Inpatient,,,90,171,145.35,49.0086,171,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Clobazam (Onfi) (Mayo)OutsideLaboratory,,80339,CPT,Facility,Outpatient,,,90,171,145.35,49.0086,171,PrimeWest Health,MinnesotaCare,87.8256,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Clobazam (Onfi) (Mayo)OutsideLaboratory,,80339,CPT,Facility,Inpatient,,,90,171,145.35,49.0086,171,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Clobazam (Onfi) (Mayo)OutsideLaboratory,,80339,CPT,Facility,Both,,,90,171,145.35,49.0086,171,Sanford Health Plan,Sanford Health Plan,157.32,92,,percent of total billed charges,,
Clobazam (Onfi) (Mayo)OutsideLaboratory,,80339,CPT,Facility,Outpatient,,,90,171,145.35,49.0086,171,"UCare Health, Inc.",Individual & Family Plan,96.3585,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Clobazam (Onfi) (Mayo)OutsideLaboratory,,80339,CPT,Facility,Inpatient,,,90,171,145.35,49.0086,171,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Clobazam (Onfi) (Mayo)OutsideLaboratory,,80339,CPT,Facility,Outpatient,,,90,171,145.35,49.0086,171,"UCare Health, Inc.",Medical Assistance,86.3037,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Clobazam (Onfi) (Mayo)OutsideLaboratory,,80339,CPT,Facility,Inpatient,,,90,171,145.35,49.0086,171,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Clobazam (Onfi) (Mayo)OutsideLaboratory,,80339,CPT,Facility,Outpatient,,,90,171,145.35,49.0086,171,"UCare Health, Inc.",Medicare Advantage,86.3037,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Clobazam (Onfi) (Mayo)OutsideLaboratory,,80339,CPT,Facility,Inpatient,,,90,171,145.35,49.0086,171,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Clobazam (Onfi) (Mayo)OutsideLaboratory,,80339,CPT,Facility,Outpatient,,,90,171,145.35,49.0086,171,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),86.3037,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Clobazam (Onfi) (Mayo)OutsideLaboratory,,80339,CPT,Facility,Inpatient,,,90,171,145.35,49.0086,171,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Clobazam (Onfi) (Mayo)OutsideLaboratory,,80339,CPT,Facility,Both,,,90,171,145.35,49.0086,171,UnitedHealthcare,Individual & Family,160.74,94,,percent of total billed charges,,
Clobazam (Onfi) (Mayo)OutsideLaboratory,,80339,CPT,Facility,Outpatient,,,90,171,145.35,49.0086,171,UnitedHealthcare,Medicare Advantage,83.79,49,,percent of total billed charges,,
Clobazam (Onfi) (Mayo)OutsideLaboratory,,80339,CPT,Facility,Inpatient,,,90,171,145.35,49.0086,171,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Clobazam (Onfi) (Mayo)OutsideLaboratory,,80339,CPT,Facility,Outpatient,,,90,171,145.35,49.0086,171,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,82.08,48,,percent of total billed charges,,100% of DHS outpatient percentage
Clobazam (Onfi) (Mayo)OutsideLaboratory,,80339,CPT,Facility,Inpatient,,,90,171,145.35,49.0086,171,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Buprenorphine & Metabolite, Urine, Random (Mayo)OutsideLaboratory",,80348,CPT,Facility,Both,,,90,379,322.15,108.6214,379,Aetna,Commercial,348.68,92,,percent of total billed charges,,
"Buprenorphine & Metabolite, Urine, Random (Mayo)OutsideLaboratory",,80348,CPT,Facility,Outpatient,,,90,379,322.15,108.6214,379,Aetna,Medicare Advantage,185.71,49,,percent of total billed charges,,
"Buprenorphine & Metabolite, Urine, Random (Mayo)OutsideLaboratory",,80348,CPT,Facility,Inpatient,,,90,379,322.15,108.6214,379,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Buprenorphine & Metabolite, Urine, Random (Mayo)OutsideLaboratory",,80348,CPT,Facility,Both,,,90,379,322.15,108.6214,379,Aetna,PPO,352.47,93,,percent of total billed charges,,
"Buprenorphine & Metabolite, Urine, Random (Mayo)OutsideLaboratory",,80348,CPT,Facility,Both,,,90,379,322.15,108.6214,379,America's PPO,America's PPO,363.9537,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Buprenorphine & Metabolite, Urine, Random (Mayo)OutsideLaboratory",,80348,CPT,Facility,Both,,,90,379,322.15,108.6214,379,BlueCross BlueShield Minnesota, Federal Employee Program,372.936,98.4,,percent of total billed charges,,
"Buprenorphine & Metabolite, Urine, Random (Mayo)OutsideLaboratory",,80348,CPT,Facility,Both,,,90,379,322.15,108.6214,379,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,379,100,,percent of total billed charges,,
"Buprenorphine & Metabolite, Urine, Random (Mayo)OutsideLaboratory",,80348,CPT,Facility,Both,,,90,379,322.15,108.6214,379,BlueCross BlueShield Minnesota,High Value Network Plan,341.1,90,,percent of total billed charges,,
"Buprenorphine & Metabolite, Urine, Random (Mayo)OutsideLaboratory",,80348,CPT,Facility,Outpatient,,,90,379,322.15,108.6214,379,BlueCross BlueShield Minnesota,Medicare Advantage,185.71,49,,percent of total billed charges,,
"Buprenorphine & Metabolite, Urine, Random (Mayo)OutsideLaboratory",,80348,CPT,Facility,Inpatient,,,90,379,322.15,108.6214,379,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Buprenorphine & Metabolite, Urine, Random (Mayo)OutsideLaboratory",,80348,CPT,Facility,Both,,,90,379,322.15,108.6214,379,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,335.6803,88.57,,percent of total billed charges,,
"Buprenorphine & Metabolite, Urine, Random (Mayo)OutsideLaboratory",,80348,CPT,Facility,Both,,,90,379,322.15,108.6214,379,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,108.6214,28.66,,percent of total billed charges,,
"Buprenorphine & Metabolite, Urine, Random (Mayo)OutsideLaboratory",,80348,CPT,Facility,Outpatient,,,90,379,322.15,108.6214,379,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),185.71,49,,percent of total billed charges,,
"Buprenorphine & Metabolite, Urine, Random (Mayo)OutsideLaboratory",,80348,CPT,Facility,Inpatient,,,90,379,322.15,108.6214,379,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Buprenorphine & Metabolite, Urine, Random (Mayo)OutsideLaboratory",,80348,CPT,Facility,Both,,,90,379,322.15,108.6214,379,CorVel,Worker's Compensation,379,100,,percent of total billed charges,,
"Buprenorphine & Metabolite, Urine, Random (Mayo)OutsideLaboratory",,80348,CPT,Facility,Both,,,90,379,322.15,108.6214,379,First Health Group Corporation,First Health Network,367.63,97,,percent of total billed charges,,
"Buprenorphine & Metabolite, Urine, Random (Mayo)OutsideLaboratory",,80348,CPT,Facility,Both,,,90,379,322.15,108.6214,379,"Health Partners, Inc.",Commercial,358.534,94.6,,percent of total billed charges,,
"Buprenorphine & Metabolite, Urine, Random (Mayo)OutsideLaboratory",,80348,CPT,Facility,Outpatient,,,90,379,322.15,108.6214,379,"Health Partners, Inc.",Medicare Advantage,185.71,49,,percent of total billed charges,,
"Buprenorphine & Metabolite, Urine, Random (Mayo)OutsideLaboratory",,80348,CPT,Facility,Inpatient,,,90,379,322.15,108.6214,379,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Buprenorphine & Metabolite, Urine, Random (Mayo)OutsideLaboratory",,80348,CPT,Facility,Both,,,90,379,322.15,108.6214,379,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),227.4,60,,percent of total billed charges,,
"Buprenorphine & Metabolite, Urine, Random (Mayo)OutsideLaboratory",,80348,CPT,Facility,Both,,,90,379,322.15,108.6214,379,"Health Partners, Inc.",State of Minnesota Advantage Program,308.885,81.5,,percent of total billed charges,,
"Buprenorphine & Metabolite, Urine, Random (Mayo)OutsideLaboratory",,80348,CPT,Facility,Both,,,90,379,322.15,108.6214,379,"Health Partners, Inc.",State Public Programs,189.5,50,,percent of total billed charges,,
"Buprenorphine & Metabolite, Urine, Random (Mayo)OutsideLaboratory",,80348,CPT,Facility,Both,,,90,379,322.15,108.6214,379,Humana Insurance Company,Commercial PPO,360.05,95,,percent of total billed charges,,
"Buprenorphine & Metabolite, Urine, Random (Mayo)OutsideLaboratory",,80348,CPT,Facility,Outpatient,,,90,379,322.15,108.6214,379,Humana Insurance Company,Medicare PPO,185.71,49,,percent of total billed charges,,
"Buprenorphine & Metabolite, Urine, Random (Mayo)OutsideLaboratory",,80348,CPT,Facility,Inpatient,,,90,379,322.15,108.6214,379,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Buprenorphine & Metabolite, Urine, Random (Mayo)OutsideLaboratory",,80348,CPT,Facility,Both,,,90,379,322.15,108.6214,379,Medica,Individual & Family,375.589,99.1,,percent of total billed charges,,
"Buprenorphine & Metabolite, Urine, Random (Mayo)OutsideLaboratory",,80348,CPT,Facility,Outpatient,,,90,379,322.15,108.6214,379,Medica,Medica Advantage Solution,188.742,49.8,,percent of total billed charges,,
"Buprenorphine & Metabolite, Urine, Random (Mayo)OutsideLaboratory",,80348,CPT,Facility,Inpatient,,,90,379,322.15,108.6214,379,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Buprenorphine & Metabolite, Urine, Random (Mayo)OutsideLaboratory",,80348,CPT,Facility,Outpatient,,,90,379,322.15,108.6214,379,Medica,Medical Assistance,169.034,44.6,,percent of total billed charges,,
"Buprenorphine & Metabolite, Urine, Random (Mayo)OutsideLaboratory",,80348,CPT,Facility,Inpatient,,,90,379,322.15,108.6214,379,Medica,Medical Assistance,,,,,Included in per diem rate,
"Buprenorphine & Metabolite, Urine, Random (Mayo)OutsideLaboratory",,80348,CPT,Facility,Outpatient,,,90,379,322.15,108.6214,379,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,188.742,49.8,,percent of total billed charges,,
"Buprenorphine & Metabolite, Urine, Random (Mayo)OutsideLaboratory",,80348,CPT,Facility,Inpatient,,,90,379,322.15,108.6214,379,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Buprenorphine & Metabolite, Urine, Random (Mayo)OutsideLaboratory",,80348,CPT,Facility,Both,,,90,379,322.15,108.6214,379,"Multiplan, Inc.","Multiplan, Inc.",356.26,94,,percent of total billed charges,,
"Buprenorphine & Metabolite, Urine, Random (Mayo)OutsideLaboratory",,80348,CPT,Facility,Outpatient,,,90,379,322.15,108.6214,379,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,327.456,86.4,,percent of total billed charges,,
"Buprenorphine & Metabolite, Urine, Random (Mayo)OutsideLaboratory",,80348,CPT,Facility,Inpatient,,,90,379,322.15,108.6214,379,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Buprenorphine & Metabolite, Urine, Random (Mayo)OutsideLaboratory",,80348,CPT,Facility,Both,,,90,379,322.15,108.6214,379,"Preferred One Administrative Services, INC.",PPO,373.694,98.6,,percent of total billed charges,,
"Buprenorphine & Metabolite, Urine, Random (Mayo)OutsideLaboratory",,80348,CPT,Facility,Outpatient,,,90,379,322.15,108.6214,379,PrimeWest Health,Minnesota Senior Health Options (MSHO),194.9955,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Buprenorphine & Metabolite, Urine, Random (Mayo)OutsideLaboratory",,80348,CPT,Facility,Inpatient,,,90,379,322.15,108.6214,379,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Buprenorphine & Metabolite, Urine, Random (Mayo)OutsideLaboratory",,80348,CPT,Facility,Outpatient,,,90,379,322.15,108.6214,379,PrimeWest Health,MinnesotaCare,194.6544,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Buprenorphine & Metabolite, Urine, Random (Mayo)OutsideLaboratory",,80348,CPT,Facility,Inpatient,,,90,379,322.15,108.6214,379,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Buprenorphine & Metabolite, Urine, Random (Mayo)OutsideLaboratory",,80348,CPT,Facility,Both,,,90,379,322.15,108.6214,379,Sanford Health Plan,Sanford Health Plan,348.68,92,,percent of total billed charges,,
"Buprenorphine & Metabolite, Urine, Random (Mayo)OutsideLaboratory",,80348,CPT,Facility,Outpatient,,,90,379,322.15,108.6214,379,"UCare Health, Inc.",Individual & Family Plan,213.5665,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Buprenorphine & Metabolite, Urine, Random (Mayo)OutsideLaboratory",,80348,CPT,Facility,Inpatient,,,90,379,322.15,108.6214,379,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Buprenorphine & Metabolite, Urine, Random (Mayo)OutsideLaboratory",,80348,CPT,Facility,Outpatient,,,90,379,322.15,108.6214,379,"UCare Health, Inc.",Medical Assistance,191.2813,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Buprenorphine & Metabolite, Urine, Random (Mayo)OutsideLaboratory",,80348,CPT,Facility,Inpatient,,,90,379,322.15,108.6214,379,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Buprenorphine & Metabolite, Urine, Random (Mayo)OutsideLaboratory",,80348,CPT,Facility,Outpatient,,,90,379,322.15,108.6214,379,"UCare Health, Inc.",Medicare Advantage,191.2813,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Buprenorphine & Metabolite, Urine, Random (Mayo)OutsideLaboratory",,80348,CPT,Facility,Inpatient,,,90,379,322.15,108.6214,379,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Buprenorphine & Metabolite, Urine, Random (Mayo)OutsideLaboratory",,80348,CPT,Facility,Outpatient,,,90,379,322.15,108.6214,379,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),191.2813,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Buprenorphine & Metabolite, Urine, Random (Mayo)OutsideLaboratory",,80348,CPT,Facility,Inpatient,,,90,379,322.15,108.6214,379,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Buprenorphine & Metabolite, Urine, Random (Mayo)OutsideLaboratory",,80348,CPT,Facility,Both,,,90,379,322.15,108.6214,379,UnitedHealthcare,Individual & Family,356.26,94,,percent of total billed charges,,
"Buprenorphine & Metabolite, Urine, Random (Mayo)OutsideLaboratory",,80348,CPT,Facility,Outpatient,,,90,379,322.15,108.6214,379,UnitedHealthcare,Medicare Advantage,185.71,49,,percent of total billed charges,,
"Buprenorphine & Metabolite, Urine, Random (Mayo)OutsideLaboratory",,80348,CPT,Facility,Inpatient,,,90,379,322.15,108.6214,379,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Buprenorphine & Metabolite, Urine, Random (Mayo)OutsideLaboratory",,80348,CPT,Facility,Outpatient,,,90,379,322.15,108.6214,379,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,181.92,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Buprenorphine & Metabolite, Urine, Random (Mayo)OutsideLaboratory",,80348,CPT,Facility,Inpatient,,,90,379,322.15,108.6214,379,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Fentanyl W/Metabolite Conf, U (Mayo)OutsideLaboratory",,80354,CPT,Facility,Both,,,90,469,398.65,134.4154,469,Aetna,Commercial,431.48,92,,percent of total billed charges,,
"Fentanyl W/Metabolite Conf, U (Mayo)OutsideLaboratory",,80354,CPT,Facility,Outpatient,,,90,469,398.65,134.4154,469,Aetna,Medicare Advantage,229.81,49,,percent of total billed charges,,
"Fentanyl W/Metabolite Conf, U (Mayo)OutsideLaboratory",,80354,CPT,Facility,Inpatient,,,90,469,398.65,134.4154,469,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Fentanyl W/Metabolite Conf, U (Mayo)OutsideLaboratory",,80354,CPT,Facility,Both,,,90,469,398.65,134.4154,469,Aetna,PPO,436.17,93,,percent of total billed charges,,
"Fentanyl W/Metabolite Conf, U (Mayo)OutsideLaboratory",,80354,CPT,Facility,Both,,,90,469,398.65,134.4154,469,America's PPO,America's PPO,450.3807,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Fentanyl W/Metabolite Conf, U (Mayo)OutsideLaboratory",,80354,CPT,Facility,Both,,,90,469,398.65,134.4154,469,BlueCross BlueShield Minnesota, Federal Employee Program,461.496,98.4,,percent of total billed charges,,
"Fentanyl W/Metabolite Conf, U (Mayo)OutsideLaboratory",,80354,CPT,Facility,Both,,,90,469,398.65,134.4154,469,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,469,100,,percent of total billed charges,,
"Fentanyl W/Metabolite Conf, U (Mayo)OutsideLaboratory",,80354,CPT,Facility,Both,,,90,469,398.65,134.4154,469,BlueCross BlueShield Minnesota,High Value Network Plan,422.1,90,,percent of total billed charges,,
"Fentanyl W/Metabolite Conf, U (Mayo)OutsideLaboratory",,80354,CPT,Facility,Outpatient,,,90,469,398.65,134.4154,469,BlueCross BlueShield Minnesota,Medicare Advantage,229.81,49,,percent of total billed charges,,
"Fentanyl W/Metabolite Conf, U (Mayo)OutsideLaboratory",,80354,CPT,Facility,Inpatient,,,90,469,398.65,134.4154,469,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Fentanyl W/Metabolite Conf, U (Mayo)OutsideLaboratory",,80354,CPT,Facility,Both,,,90,469,398.65,134.4154,469,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,415.3933,88.57,,percent of total billed charges,,
"Fentanyl W/Metabolite Conf, U (Mayo)OutsideLaboratory",,80354,CPT,Facility,Both,,,90,469,398.65,134.4154,469,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,134.4154,28.66,,percent of total billed charges,,
"Fentanyl W/Metabolite Conf, U (Mayo)OutsideLaboratory",,80354,CPT,Facility,Outpatient,,,90,469,398.65,134.4154,469,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),229.81,49,,percent of total billed charges,,
"Fentanyl W/Metabolite Conf, U (Mayo)OutsideLaboratory",,80354,CPT,Facility,Inpatient,,,90,469,398.65,134.4154,469,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Fentanyl W/Metabolite Conf, U (Mayo)OutsideLaboratory",,80354,CPT,Facility,Both,,,90,469,398.65,134.4154,469,CorVel,Worker's Compensation,469,100,,percent of total billed charges,,
"Fentanyl W/Metabolite Conf, U (Mayo)OutsideLaboratory",,80354,CPT,Facility,Both,,,90,469,398.65,134.4154,469,First Health Group Corporation,First Health Network,454.93,97,,percent of total billed charges,,
"Fentanyl W/Metabolite Conf, U (Mayo)OutsideLaboratory",,80354,CPT,Facility,Both,,,90,469,398.65,134.4154,469,"Health Partners, Inc.",Commercial,443.674,94.6,,percent of total billed charges,,
"Fentanyl W/Metabolite Conf, U (Mayo)OutsideLaboratory",,80354,CPT,Facility,Outpatient,,,90,469,398.65,134.4154,469,"Health Partners, Inc.",Medicare Advantage,229.81,49,,percent of total billed charges,,
"Fentanyl W/Metabolite Conf, U (Mayo)OutsideLaboratory",,80354,CPT,Facility,Inpatient,,,90,469,398.65,134.4154,469,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Fentanyl W/Metabolite Conf, U (Mayo)OutsideLaboratory",,80354,CPT,Facility,Both,,,90,469,398.65,134.4154,469,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),281.4,60,,percent of total billed charges,,
"Fentanyl W/Metabolite Conf, U (Mayo)OutsideLaboratory",,80354,CPT,Facility,Both,,,90,469,398.65,134.4154,469,"Health Partners, Inc.",State of Minnesota Advantage Program,382.235,81.5,,percent of total billed charges,,
"Fentanyl W/Metabolite Conf, U (Mayo)OutsideLaboratory",,80354,CPT,Facility,Both,,,90,469,398.65,134.4154,469,"Health Partners, Inc.",State Public Programs,234.5,50,,percent of total billed charges,,
"Fentanyl W/Metabolite Conf, U (Mayo)OutsideLaboratory",,80354,CPT,Facility,Both,,,90,469,398.65,134.4154,469,Humana Insurance Company,Commercial PPO,445.55,95,,percent of total billed charges,,
"Fentanyl W/Metabolite Conf, U (Mayo)OutsideLaboratory",,80354,CPT,Facility,Outpatient,,,90,469,398.65,134.4154,469,Humana Insurance Company,Medicare PPO,229.81,49,,percent of total billed charges,,
"Fentanyl W/Metabolite Conf, U (Mayo)OutsideLaboratory",,80354,CPT,Facility,Inpatient,,,90,469,398.65,134.4154,469,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Fentanyl W/Metabolite Conf, U (Mayo)OutsideLaboratory",,80354,CPT,Facility,Both,,,90,469,398.65,134.4154,469,Medica,Individual & Family,464.779,99.1,,percent of total billed charges,,
"Fentanyl W/Metabolite Conf, U (Mayo)OutsideLaboratory",,80354,CPT,Facility,Outpatient,,,90,469,398.65,134.4154,469,Medica,Medica Advantage Solution,233.562,49.8,,percent of total billed charges,,
"Fentanyl W/Metabolite Conf, U (Mayo)OutsideLaboratory",,80354,CPT,Facility,Inpatient,,,90,469,398.65,134.4154,469,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Fentanyl W/Metabolite Conf, U (Mayo)OutsideLaboratory",,80354,CPT,Facility,Outpatient,,,90,469,398.65,134.4154,469,Medica,Medical Assistance,209.174,44.6,,percent of total billed charges,,
"Fentanyl W/Metabolite Conf, U (Mayo)OutsideLaboratory",,80354,CPT,Facility,Inpatient,,,90,469,398.65,134.4154,469,Medica,Medical Assistance,,,,,Included in per diem rate,
"Fentanyl W/Metabolite Conf, U (Mayo)OutsideLaboratory",,80354,CPT,Facility,Outpatient,,,90,469,398.65,134.4154,469,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,233.562,49.8,,percent of total billed charges,,
"Fentanyl W/Metabolite Conf, U (Mayo)OutsideLaboratory",,80354,CPT,Facility,Inpatient,,,90,469,398.65,134.4154,469,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Fentanyl W/Metabolite Conf, U (Mayo)OutsideLaboratory",,80354,CPT,Facility,Both,,,90,469,398.65,134.4154,469,"Multiplan, Inc.","Multiplan, Inc.",440.86,94,,percent of total billed charges,,
"Fentanyl W/Metabolite Conf, U (Mayo)OutsideLaboratory",,80354,CPT,Facility,Outpatient,,,90,469,398.65,134.4154,469,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,405.216,86.4,,percent of total billed charges,,
"Fentanyl W/Metabolite Conf, U (Mayo)OutsideLaboratory",,80354,CPT,Facility,Inpatient,,,90,469,398.65,134.4154,469,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Fentanyl W/Metabolite Conf, U (Mayo)OutsideLaboratory",,80354,CPT,Facility,Both,,,90,469,398.65,134.4154,469,"Preferred One Administrative Services, INC.",PPO,462.434,98.6,,percent of total billed charges,,
"Fentanyl W/Metabolite Conf, U (Mayo)OutsideLaboratory",,80354,CPT,Facility,Outpatient,,,90,469,398.65,134.4154,469,PrimeWest Health,Minnesota Senior Health Options (MSHO),241.3005,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Fentanyl W/Metabolite Conf, U (Mayo)OutsideLaboratory",,80354,CPT,Facility,Inpatient,,,90,469,398.65,134.4154,469,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Fentanyl W/Metabolite Conf, U (Mayo)OutsideLaboratory",,80354,CPT,Facility,Outpatient,,,90,469,398.65,134.4154,469,PrimeWest Health,MinnesotaCare,240.8784,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Fentanyl W/Metabolite Conf, U (Mayo)OutsideLaboratory",,80354,CPT,Facility,Inpatient,,,90,469,398.65,134.4154,469,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Fentanyl W/Metabolite Conf, U (Mayo)OutsideLaboratory",,80354,CPT,Facility,Both,,,90,469,398.65,134.4154,469,Sanford Health Plan,Sanford Health Plan,431.48,92,,percent of total billed charges,,
"Fentanyl W/Metabolite Conf, U (Mayo)OutsideLaboratory",,80354,CPT,Facility,Outpatient,,,90,469,398.65,134.4154,469,"UCare Health, Inc.",Individual & Family Plan,264.2815,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Fentanyl W/Metabolite Conf, U (Mayo)OutsideLaboratory",,80354,CPT,Facility,Inpatient,,,90,469,398.65,134.4154,469,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Fentanyl W/Metabolite Conf, U (Mayo)OutsideLaboratory",,80354,CPT,Facility,Outpatient,,,90,469,398.65,134.4154,469,"UCare Health, Inc.",Medical Assistance,236.7043,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Fentanyl W/Metabolite Conf, U (Mayo)OutsideLaboratory",,80354,CPT,Facility,Inpatient,,,90,469,398.65,134.4154,469,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Fentanyl W/Metabolite Conf, U (Mayo)OutsideLaboratory",,80354,CPT,Facility,Outpatient,,,90,469,398.65,134.4154,469,"UCare Health, Inc.",Medicare Advantage,236.7043,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Fentanyl W/Metabolite Conf, U (Mayo)OutsideLaboratory",,80354,CPT,Facility,Inpatient,,,90,469,398.65,134.4154,469,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Fentanyl W/Metabolite Conf, U (Mayo)OutsideLaboratory",,80354,CPT,Facility,Outpatient,,,90,469,398.65,134.4154,469,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),236.7043,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Fentanyl W/Metabolite Conf, U (Mayo)OutsideLaboratory",,80354,CPT,Facility,Inpatient,,,90,469,398.65,134.4154,469,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Fentanyl W/Metabolite Conf, U (Mayo)OutsideLaboratory",,80354,CPT,Facility,Both,,,90,469,398.65,134.4154,469,UnitedHealthcare,Individual & Family,440.86,94,,percent of total billed charges,,
"Fentanyl W/Metabolite Conf, U (Mayo)OutsideLaboratory",,80354,CPT,Facility,Outpatient,,,90,469,398.65,134.4154,469,UnitedHealthcare,Medicare Advantage,229.81,49,,percent of total billed charges,,
"Fentanyl W/Metabolite Conf, U (Mayo)OutsideLaboratory",,80354,CPT,Facility,Inpatient,,,90,469,398.65,134.4154,469,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Fentanyl W/Metabolite Conf, U (Mayo)OutsideLaboratory",,80354,CPT,Facility,Outpatient,,,90,469,398.65,134.4154,469,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,225.12,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Fentanyl W/Metabolite Conf, U (Mayo)OutsideLaboratory",,80354,CPT,Facility,Inpatient,,,90,469,398.65,134.4154,469,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Methylenedioxyamphetamines (Mayo)OutsideLaboratory,,80359,CPT,Facility,Both,,,90,66,56.1,18.9156,66,Aetna,Commercial,60.72,92,,percent of total billed charges,,
Methylenedioxyamphetamines (Mayo)OutsideLaboratory,,80359,CPT,Facility,Outpatient,,,90,66,56.1,18.9156,66,Aetna,Medicare Advantage,32.34,49,,percent of total billed charges,,
Methylenedioxyamphetamines (Mayo)OutsideLaboratory,,80359,CPT,Facility,Inpatient,,,90,66,56.1,18.9156,66,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Methylenedioxyamphetamines (Mayo)OutsideLaboratory,,80359,CPT,Facility,Both,,,90,66,56.1,18.9156,66,Aetna,PPO,61.38,93,,percent of total billed charges,,
Methylenedioxyamphetamines (Mayo)OutsideLaboratory,,80359,CPT,Facility,Both,,,90,66,56.1,18.9156,66,America's PPO,America's PPO,63.3798,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Methylenedioxyamphetamines (Mayo)OutsideLaboratory,,80359,CPT,Facility,Both,,,90,66,56.1,18.9156,66,BlueCross BlueShield Minnesota, Federal Employee Program,64.944,98.4,,percent of total billed charges,,
Methylenedioxyamphetamines (Mayo)OutsideLaboratory,,80359,CPT,Facility,Both,,,90,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,66,100,,percent of total billed charges,,
Methylenedioxyamphetamines (Mayo)OutsideLaboratory,,80359,CPT,Facility,Both,,,90,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,High Value Network Plan,59.4,90,,percent of total billed charges,,
Methylenedioxyamphetamines (Mayo)OutsideLaboratory,,80359,CPT,Facility,Outpatient,,,90,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,Medicare Advantage,32.34,49,,percent of total billed charges,,
Methylenedioxyamphetamines (Mayo)OutsideLaboratory,,80359,CPT,Facility,Inpatient,,,90,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Methylenedioxyamphetamines (Mayo)OutsideLaboratory,,80359,CPT,Facility,Both,,,90,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,58.4562,88.57,,percent of total billed charges,,
Methylenedioxyamphetamines (Mayo)OutsideLaboratory,,80359,CPT,Facility,Both,,,90,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,18.9156,28.66,,percent of total billed charges,,
Methylenedioxyamphetamines (Mayo)OutsideLaboratory,,80359,CPT,Facility,Outpatient,,,90,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),32.34,49,,percent of total billed charges,,
Methylenedioxyamphetamines (Mayo)OutsideLaboratory,,80359,CPT,Facility,Inpatient,,,90,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Methylenedioxyamphetamines (Mayo)OutsideLaboratory,,80359,CPT,Facility,Both,,,90,66,56.1,18.9156,66,CorVel,Worker's Compensation,66,100,,percent of total billed charges,,
Methylenedioxyamphetamines (Mayo)OutsideLaboratory,,80359,CPT,Facility,Both,,,90,66,56.1,18.9156,66,First Health Group Corporation,First Health Network,64.02,97,,percent of total billed charges,,
Methylenedioxyamphetamines (Mayo)OutsideLaboratory,,80359,CPT,Facility,Both,,,90,66,56.1,18.9156,66,"Health Partners, Inc.",Commercial,62.436,94.6,,percent of total billed charges,,
Methylenedioxyamphetamines (Mayo)OutsideLaboratory,,80359,CPT,Facility,Outpatient,,,90,66,56.1,18.9156,66,"Health Partners, Inc.",Medicare Advantage,32.34,49,,percent of total billed charges,,
Methylenedioxyamphetamines (Mayo)OutsideLaboratory,,80359,CPT,Facility,Inpatient,,,90,66,56.1,18.9156,66,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Methylenedioxyamphetamines (Mayo)OutsideLaboratory,,80359,CPT,Facility,Both,,,90,66,56.1,18.9156,66,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),39.6,60,,percent of total billed charges,,
Methylenedioxyamphetamines (Mayo)OutsideLaboratory,,80359,CPT,Facility,Both,,,90,66,56.1,18.9156,66,"Health Partners, Inc.",State of Minnesota Advantage Program,53.79,81.5,,percent of total billed charges,,
Methylenedioxyamphetamines (Mayo)OutsideLaboratory,,80359,CPT,Facility,Both,,,90,66,56.1,18.9156,66,"Health Partners, Inc.",State Public Programs,33,50,,percent of total billed charges,,
Methylenedioxyamphetamines (Mayo)OutsideLaboratory,,80359,CPT,Facility,Both,,,90,66,56.1,18.9156,66,Humana Insurance Company,Commercial PPO,62.7,95,,percent of total billed charges,,
Methylenedioxyamphetamines (Mayo)OutsideLaboratory,,80359,CPT,Facility,Outpatient,,,90,66,56.1,18.9156,66,Humana Insurance Company,Medicare PPO,32.34,49,,percent of total billed charges,,
Methylenedioxyamphetamines (Mayo)OutsideLaboratory,,80359,CPT,Facility,Inpatient,,,90,66,56.1,18.9156,66,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Methylenedioxyamphetamines (Mayo)OutsideLaboratory,,80359,CPT,Facility,Both,,,90,66,56.1,18.9156,66,Medica,Individual & Family,65.406,99.1,,percent of total billed charges,,
Methylenedioxyamphetamines (Mayo)OutsideLaboratory,,80359,CPT,Facility,Outpatient,,,90,66,56.1,18.9156,66,Medica,Medica Advantage Solution,32.868,49.8,,percent of total billed charges,,
Methylenedioxyamphetamines (Mayo)OutsideLaboratory,,80359,CPT,Facility,Inpatient,,,90,66,56.1,18.9156,66,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Methylenedioxyamphetamines (Mayo)OutsideLaboratory,,80359,CPT,Facility,Outpatient,,,90,66,56.1,18.9156,66,Medica,Medical Assistance,29.436,44.6,,percent of total billed charges,,
Methylenedioxyamphetamines (Mayo)OutsideLaboratory,,80359,CPT,Facility,Inpatient,,,90,66,56.1,18.9156,66,Medica,Medical Assistance,,,,,Included in per diem rate,
Methylenedioxyamphetamines (Mayo)OutsideLaboratory,,80359,CPT,Facility,Outpatient,,,90,66,56.1,18.9156,66,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,32.868,49.8,,percent of total billed charges,,
Methylenedioxyamphetamines (Mayo)OutsideLaboratory,,80359,CPT,Facility,Inpatient,,,90,66,56.1,18.9156,66,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Methylenedioxyamphetamines (Mayo)OutsideLaboratory,,80359,CPT,Facility,Both,,,90,66,56.1,18.9156,66,"Multiplan, Inc.","Multiplan, Inc.",62.04,94,,percent of total billed charges,,
Methylenedioxyamphetamines (Mayo)OutsideLaboratory,,80359,CPT,Facility,Outpatient,,,90,66,56.1,18.9156,66,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,57.024,86.4,,percent of total billed charges,,
Methylenedioxyamphetamines (Mayo)OutsideLaboratory,,80359,CPT,Facility,Inpatient,,,90,66,56.1,18.9156,66,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Methylenedioxyamphetamines (Mayo)OutsideLaboratory,,80359,CPT,Facility,Both,,,90,66,56.1,18.9156,66,"Preferred One Administrative Services, INC.",PPO,65.076,98.6,,percent of total billed charges,,
Methylenedioxyamphetamines (Mayo)OutsideLaboratory,,80359,CPT,Facility,Outpatient,,,90,66,56.1,18.9156,66,PrimeWest Health,Minnesota Senior Health Options (MSHO),33.957,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Methylenedioxyamphetamines (Mayo)OutsideLaboratory,,80359,CPT,Facility,Inpatient,,,90,66,56.1,18.9156,66,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Methylenedioxyamphetamines (Mayo)OutsideLaboratory,,80359,CPT,Facility,Outpatient,,,90,66,56.1,18.9156,66,PrimeWest Health,MinnesotaCare,33.8976,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Methylenedioxyamphetamines (Mayo)OutsideLaboratory,,80359,CPT,Facility,Inpatient,,,90,66,56.1,18.9156,66,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Methylenedioxyamphetamines (Mayo)OutsideLaboratory,,80359,CPT,Facility,Both,,,90,66,56.1,18.9156,66,Sanford Health Plan,Sanford Health Plan,60.72,92,,percent of total billed charges,,
Methylenedioxyamphetamines (Mayo)OutsideLaboratory,,80359,CPT,Facility,Outpatient,,,90,66,56.1,18.9156,66,"UCare Health, Inc.",Individual & Family Plan,37.191,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Methylenedioxyamphetamines (Mayo)OutsideLaboratory,,80359,CPT,Facility,Inpatient,,,90,66,56.1,18.9156,66,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Methylenedioxyamphetamines (Mayo)OutsideLaboratory,,80359,CPT,Facility,Outpatient,,,90,66,56.1,18.9156,66,"UCare Health, Inc.",Medical Assistance,33.3102,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Methylenedioxyamphetamines (Mayo)OutsideLaboratory,,80359,CPT,Facility,Inpatient,,,90,66,56.1,18.9156,66,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Methylenedioxyamphetamines (Mayo)OutsideLaboratory,,80359,CPT,Facility,Outpatient,,,90,66,56.1,18.9156,66,"UCare Health, Inc.",Medicare Advantage,33.3102,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Methylenedioxyamphetamines (Mayo)OutsideLaboratory,,80359,CPT,Facility,Inpatient,,,90,66,56.1,18.9156,66,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Methylenedioxyamphetamines (Mayo)OutsideLaboratory,,80359,CPT,Facility,Outpatient,,,90,66,56.1,18.9156,66,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),33.3102,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Methylenedioxyamphetamines (Mayo)OutsideLaboratory,,80359,CPT,Facility,Inpatient,,,90,66,56.1,18.9156,66,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Methylenedioxyamphetamines (Mayo)OutsideLaboratory,,80359,CPT,Facility,Both,,,90,66,56.1,18.9156,66,UnitedHealthcare,Individual & Family,62.04,94,,percent of total billed charges,,
Methylenedioxyamphetamines (Mayo)OutsideLaboratory,,80359,CPT,Facility,Outpatient,,,90,66,56.1,18.9156,66,UnitedHealthcare,Medicare Advantage,32.34,49,,percent of total billed charges,,
Methylenedioxyamphetamines (Mayo)OutsideLaboratory,,80359,CPT,Facility,Inpatient,,,90,66,56.1,18.9156,66,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Methylenedioxyamphetamines (Mayo)OutsideLaboratory,,80359,CPT,Facility,Outpatient,,,90,66,56.1,18.9156,66,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,31.68,48,,percent of total billed charges,,100% of DHS outpatient percentage
Methylenedioxyamphetamines (Mayo)OutsideLaboratory,,80359,CPT,Facility,Inpatient,,,90,66,56.1,18.9156,66,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Methylphenidate (Ritalin) (Mayo)OutsideLaboratory,,80360,CPT,Facility,Both,,,90,172,146.2,49.2952,172,Aetna,Commercial,158.24,92,,percent of total billed charges,,
Methylphenidate (Ritalin) (Mayo)OutsideLaboratory,,80360,CPT,Facility,Outpatient,,,90,172,146.2,49.2952,172,Aetna,Medicare Advantage,84.28,49,,percent of total billed charges,,
Methylphenidate (Ritalin) (Mayo)OutsideLaboratory,,80360,CPT,Facility,Inpatient,,,90,172,146.2,49.2952,172,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Methylphenidate (Ritalin) (Mayo)OutsideLaboratory,,80360,CPT,Facility,Both,,,90,172,146.2,49.2952,172,Aetna,PPO,159.96,93,,percent of total billed charges,,
Methylphenidate (Ritalin) (Mayo)OutsideLaboratory,,80360,CPT,Facility,Both,,,90,172,146.2,49.2952,172,America's PPO,America's PPO,165.1716,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Methylphenidate (Ritalin) (Mayo)OutsideLaboratory,,80360,CPT,Facility,Both,,,90,172,146.2,49.2952,172,BlueCross BlueShield Minnesota, Federal Employee Program,169.248,98.4,,percent of total billed charges,,
Methylphenidate (Ritalin) (Mayo)OutsideLaboratory,,80360,CPT,Facility,Both,,,90,172,146.2,49.2952,172,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,172,100,,percent of total billed charges,,
Methylphenidate (Ritalin) (Mayo)OutsideLaboratory,,80360,CPT,Facility,Both,,,90,172,146.2,49.2952,172,BlueCross BlueShield Minnesota,High Value Network Plan,154.8,90,,percent of total billed charges,,
Methylphenidate (Ritalin) (Mayo)OutsideLaboratory,,80360,CPT,Facility,Outpatient,,,90,172,146.2,49.2952,172,BlueCross BlueShield Minnesota,Medicare Advantage,84.28,49,,percent of total billed charges,,
Methylphenidate (Ritalin) (Mayo)OutsideLaboratory,,80360,CPT,Facility,Inpatient,,,90,172,146.2,49.2952,172,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Methylphenidate (Ritalin) (Mayo)OutsideLaboratory,,80360,CPT,Facility,Both,,,90,172,146.2,49.2952,172,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,152.3404,88.57,,percent of total billed charges,,
Methylphenidate (Ritalin) (Mayo)OutsideLaboratory,,80360,CPT,Facility,Both,,,90,172,146.2,49.2952,172,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,49.2952,28.66,,percent of total billed charges,,
Methylphenidate (Ritalin) (Mayo)OutsideLaboratory,,80360,CPT,Facility,Outpatient,,,90,172,146.2,49.2952,172,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),84.28,49,,percent of total billed charges,,
Methylphenidate (Ritalin) (Mayo)OutsideLaboratory,,80360,CPT,Facility,Inpatient,,,90,172,146.2,49.2952,172,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Methylphenidate (Ritalin) (Mayo)OutsideLaboratory,,80360,CPT,Facility,Both,,,90,172,146.2,49.2952,172,CorVel,Worker's Compensation,172,100,,percent of total billed charges,,
Methylphenidate (Ritalin) (Mayo)OutsideLaboratory,,80360,CPT,Facility,Both,,,90,172,146.2,49.2952,172,First Health Group Corporation,First Health Network,166.84,97,,percent of total billed charges,,
Methylphenidate (Ritalin) (Mayo)OutsideLaboratory,,80360,CPT,Facility,Both,,,90,172,146.2,49.2952,172,"Health Partners, Inc.",Commercial,162.712,94.6,,percent of total billed charges,,
Methylphenidate (Ritalin) (Mayo)OutsideLaboratory,,80360,CPT,Facility,Outpatient,,,90,172,146.2,49.2952,172,"Health Partners, Inc.",Medicare Advantage,84.28,49,,percent of total billed charges,,
Methylphenidate (Ritalin) (Mayo)OutsideLaboratory,,80360,CPT,Facility,Inpatient,,,90,172,146.2,49.2952,172,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Methylphenidate (Ritalin) (Mayo)OutsideLaboratory,,80360,CPT,Facility,Both,,,90,172,146.2,49.2952,172,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),103.2,60,,percent of total billed charges,,
Methylphenidate (Ritalin) (Mayo)OutsideLaboratory,,80360,CPT,Facility,Both,,,90,172,146.2,49.2952,172,"Health Partners, Inc.",State of Minnesota Advantage Program,140.18,81.5,,percent of total billed charges,,
Methylphenidate (Ritalin) (Mayo)OutsideLaboratory,,80360,CPT,Facility,Both,,,90,172,146.2,49.2952,172,"Health Partners, Inc.",State Public Programs,86,50,,percent of total billed charges,,
Methylphenidate (Ritalin) (Mayo)OutsideLaboratory,,80360,CPT,Facility,Both,,,90,172,146.2,49.2952,172,Humana Insurance Company,Commercial PPO,163.4,95,,percent of total billed charges,,
Methylphenidate (Ritalin) (Mayo)OutsideLaboratory,,80360,CPT,Facility,Outpatient,,,90,172,146.2,49.2952,172,Humana Insurance Company,Medicare PPO,84.28,49,,percent of total billed charges,,
Methylphenidate (Ritalin) (Mayo)OutsideLaboratory,,80360,CPT,Facility,Inpatient,,,90,172,146.2,49.2952,172,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Methylphenidate (Ritalin) (Mayo)OutsideLaboratory,,80360,CPT,Facility,Both,,,90,172,146.2,49.2952,172,Medica,Individual & Family,170.452,99.1,,percent of total billed charges,,
Methylphenidate (Ritalin) (Mayo)OutsideLaboratory,,80360,CPT,Facility,Outpatient,,,90,172,146.2,49.2952,172,Medica,Medica Advantage Solution,85.656,49.8,,percent of total billed charges,,
Methylphenidate (Ritalin) (Mayo)OutsideLaboratory,,80360,CPT,Facility,Inpatient,,,90,172,146.2,49.2952,172,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Methylphenidate (Ritalin) (Mayo)OutsideLaboratory,,80360,CPT,Facility,Outpatient,,,90,172,146.2,49.2952,172,Medica,Medical Assistance,76.712,44.6,,percent of total billed charges,,
Methylphenidate (Ritalin) (Mayo)OutsideLaboratory,,80360,CPT,Facility,Inpatient,,,90,172,146.2,49.2952,172,Medica,Medical Assistance,,,,,Included in per diem rate,
Methylphenidate (Ritalin) (Mayo)OutsideLaboratory,,80360,CPT,Facility,Outpatient,,,90,172,146.2,49.2952,172,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,85.656,49.8,,percent of total billed charges,,
Methylphenidate (Ritalin) (Mayo)OutsideLaboratory,,80360,CPT,Facility,Inpatient,,,90,172,146.2,49.2952,172,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Methylphenidate (Ritalin) (Mayo)OutsideLaboratory,,80360,CPT,Facility,Both,,,90,172,146.2,49.2952,172,"Multiplan, Inc.","Multiplan, Inc.",161.68,94,,percent of total billed charges,,
Methylphenidate (Ritalin) (Mayo)OutsideLaboratory,,80360,CPT,Facility,Outpatient,,,90,172,146.2,49.2952,172,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,148.608,86.4,,percent of total billed charges,,
Methylphenidate (Ritalin) (Mayo)OutsideLaboratory,,80360,CPT,Facility,Inpatient,,,90,172,146.2,49.2952,172,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Methylphenidate (Ritalin) (Mayo)OutsideLaboratory,,80360,CPT,Facility,Both,,,90,172,146.2,49.2952,172,"Preferred One Administrative Services, INC.",PPO,169.592,98.6,,percent of total billed charges,,
Methylphenidate (Ritalin) (Mayo)OutsideLaboratory,,80360,CPT,Facility,Outpatient,,,90,172,146.2,49.2952,172,PrimeWest Health,Minnesota Senior Health Options (MSHO),88.494,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Methylphenidate (Ritalin) (Mayo)OutsideLaboratory,,80360,CPT,Facility,Inpatient,,,90,172,146.2,49.2952,172,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Methylphenidate (Ritalin) (Mayo)OutsideLaboratory,,80360,CPT,Facility,Outpatient,,,90,172,146.2,49.2952,172,PrimeWest Health,MinnesotaCare,88.3392,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Methylphenidate (Ritalin) (Mayo)OutsideLaboratory,,80360,CPT,Facility,Inpatient,,,90,172,146.2,49.2952,172,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Methylphenidate (Ritalin) (Mayo)OutsideLaboratory,,80360,CPT,Facility,Both,,,90,172,146.2,49.2952,172,Sanford Health Plan,Sanford Health Plan,158.24,92,,percent of total billed charges,,
Methylphenidate (Ritalin) (Mayo)OutsideLaboratory,,80360,CPT,Facility,Outpatient,,,90,172,146.2,49.2952,172,"UCare Health, Inc.",Individual & Family Plan,96.922,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Methylphenidate (Ritalin) (Mayo)OutsideLaboratory,,80360,CPT,Facility,Inpatient,,,90,172,146.2,49.2952,172,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Methylphenidate (Ritalin) (Mayo)OutsideLaboratory,,80360,CPT,Facility,Outpatient,,,90,172,146.2,49.2952,172,"UCare Health, Inc.",Medical Assistance,86.8084,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Methylphenidate (Ritalin) (Mayo)OutsideLaboratory,,80360,CPT,Facility,Inpatient,,,90,172,146.2,49.2952,172,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Methylphenidate (Ritalin) (Mayo)OutsideLaboratory,,80360,CPT,Facility,Outpatient,,,90,172,146.2,49.2952,172,"UCare Health, Inc.",Medicare Advantage,86.8084,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Methylphenidate (Ritalin) (Mayo)OutsideLaboratory,,80360,CPT,Facility,Inpatient,,,90,172,146.2,49.2952,172,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Methylphenidate (Ritalin) (Mayo)OutsideLaboratory,,80360,CPT,Facility,Outpatient,,,90,172,146.2,49.2952,172,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),86.8084,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Methylphenidate (Ritalin) (Mayo)OutsideLaboratory,,80360,CPT,Facility,Inpatient,,,90,172,146.2,49.2952,172,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Methylphenidate (Ritalin) (Mayo)OutsideLaboratory,,80360,CPT,Facility,Both,,,90,172,146.2,49.2952,172,UnitedHealthcare,Individual & Family,161.68,94,,percent of total billed charges,,
Methylphenidate (Ritalin) (Mayo)OutsideLaboratory,,80360,CPT,Facility,Outpatient,,,90,172,146.2,49.2952,172,UnitedHealthcare,Medicare Advantage,84.28,49,,percent of total billed charges,,
Methylphenidate (Ritalin) (Mayo)OutsideLaboratory,,80360,CPT,Facility,Inpatient,,,90,172,146.2,49.2952,172,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Methylphenidate (Ritalin) (Mayo)OutsideLaboratory,,80360,CPT,Facility,Outpatient,,,90,172,146.2,49.2952,172,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,82.56,48,,percent of total billed charges,,100% of DHS outpatient percentage
Methylphenidate (Ritalin) (Mayo)OutsideLaboratory,,80360,CPT,Facility,Inpatient,,,90,172,146.2,49.2952,172,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Opiate Confirmation, U (Mayo)OutsideLaboratory",,80361,CPT,Facility,Both,,,90,163,138.55,46.7158,163,Aetna,Commercial,149.96,92,,percent of total billed charges,,
"Opiate Confirmation, U (Mayo)OutsideLaboratory",,80361,CPT,Facility,Outpatient,,,90,163,138.55,46.7158,163,Aetna,Medicare Advantage,79.87,49,,percent of total billed charges,,
"Opiate Confirmation, U (Mayo)OutsideLaboratory",,80361,CPT,Facility,Inpatient,,,90,163,138.55,46.7158,163,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Opiate Confirmation, U (Mayo)OutsideLaboratory",,80361,CPT,Facility,Both,,,90,163,138.55,46.7158,163,Aetna,PPO,151.59,93,,percent of total billed charges,,
"Opiate Confirmation, U (Mayo)OutsideLaboratory",,80361,CPT,Facility,Both,,,90,163,138.55,46.7158,163,America's PPO,America's PPO,156.5289,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Opiate Confirmation, U (Mayo)OutsideLaboratory",,80361,CPT,Facility,Both,,,90,163,138.55,46.7158,163,BlueCross BlueShield Minnesota, Federal Employee Program,160.392,98.4,,percent of total billed charges,,
"Opiate Confirmation, U (Mayo)OutsideLaboratory",,80361,CPT,Facility,Both,,,90,163,138.55,46.7158,163,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,163,100,,percent of total billed charges,,
"Opiate Confirmation, U (Mayo)OutsideLaboratory",,80361,CPT,Facility,Both,,,90,163,138.55,46.7158,163,BlueCross BlueShield Minnesota,High Value Network Plan,146.7,90,,percent of total billed charges,,
"Opiate Confirmation, U (Mayo)OutsideLaboratory",,80361,CPT,Facility,Outpatient,,,90,163,138.55,46.7158,163,BlueCross BlueShield Minnesota,Medicare Advantage,79.87,49,,percent of total billed charges,,
"Opiate Confirmation, U (Mayo)OutsideLaboratory",,80361,CPT,Facility,Inpatient,,,90,163,138.55,46.7158,163,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Opiate Confirmation, U (Mayo)OutsideLaboratory",,80361,CPT,Facility,Both,,,90,163,138.55,46.7158,163,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,144.3691,88.57,,percent of total billed charges,,
"Opiate Confirmation, U (Mayo)OutsideLaboratory",,80361,CPT,Facility,Both,,,90,163,138.55,46.7158,163,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,46.7158,28.66,,percent of total billed charges,,
"Opiate Confirmation, U (Mayo)OutsideLaboratory",,80361,CPT,Facility,Outpatient,,,90,163,138.55,46.7158,163,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),79.87,49,,percent of total billed charges,,
"Opiate Confirmation, U (Mayo)OutsideLaboratory",,80361,CPT,Facility,Inpatient,,,90,163,138.55,46.7158,163,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Opiate Confirmation, U (Mayo)OutsideLaboratory",,80361,CPT,Facility,Both,,,90,163,138.55,46.7158,163,CorVel,Worker's Compensation,163,100,,percent of total billed charges,,
"Opiate Confirmation, U (Mayo)OutsideLaboratory",,80361,CPT,Facility,Both,,,90,163,138.55,46.7158,163,First Health Group Corporation,First Health Network,158.11,97,,percent of total billed charges,,
"Opiate Confirmation, U (Mayo)OutsideLaboratory",,80361,CPT,Facility,Both,,,90,163,138.55,46.7158,163,"Health Partners, Inc.",Commercial,154.198,94.6,,percent of total billed charges,,
"Opiate Confirmation, U (Mayo)OutsideLaboratory",,80361,CPT,Facility,Outpatient,,,90,163,138.55,46.7158,163,"Health Partners, Inc.",Medicare Advantage,79.87,49,,percent of total billed charges,,
"Opiate Confirmation, U (Mayo)OutsideLaboratory",,80361,CPT,Facility,Inpatient,,,90,163,138.55,46.7158,163,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Opiate Confirmation, U (Mayo)OutsideLaboratory",,80361,CPT,Facility,Both,,,90,163,138.55,46.7158,163,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),97.8,60,,percent of total billed charges,,
"Opiate Confirmation, U (Mayo)OutsideLaboratory",,80361,CPT,Facility,Both,,,90,163,138.55,46.7158,163,"Health Partners, Inc.",State of Minnesota Advantage Program,132.845,81.5,,percent of total billed charges,,
"Opiate Confirmation, U (Mayo)OutsideLaboratory",,80361,CPT,Facility,Both,,,90,163,138.55,46.7158,163,"Health Partners, Inc.",State Public Programs,81.5,50,,percent of total billed charges,,
"Opiate Confirmation, U (Mayo)OutsideLaboratory",,80361,CPT,Facility,Both,,,90,163,138.55,46.7158,163,Humana Insurance Company,Commercial PPO,154.85,95,,percent of total billed charges,,
"Opiate Confirmation, U (Mayo)OutsideLaboratory",,80361,CPT,Facility,Outpatient,,,90,163,138.55,46.7158,163,Humana Insurance Company,Medicare PPO,79.87,49,,percent of total billed charges,,
"Opiate Confirmation, U (Mayo)OutsideLaboratory",,80361,CPT,Facility,Inpatient,,,90,163,138.55,46.7158,163,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Opiate Confirmation, U (Mayo)OutsideLaboratory",,80361,CPT,Facility,Both,,,90,163,138.55,46.7158,163,Medica,Individual & Family,161.533,99.1,,percent of total billed charges,,
"Opiate Confirmation, U (Mayo)OutsideLaboratory",,80361,CPT,Facility,Outpatient,,,90,163,138.55,46.7158,163,Medica,Medica Advantage Solution,81.174,49.8,,percent of total billed charges,,
"Opiate Confirmation, U (Mayo)OutsideLaboratory",,80361,CPT,Facility,Inpatient,,,90,163,138.55,46.7158,163,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Opiate Confirmation, U (Mayo)OutsideLaboratory",,80361,CPT,Facility,Outpatient,,,90,163,138.55,46.7158,163,Medica,Medical Assistance,72.698,44.6,,percent of total billed charges,,
"Opiate Confirmation, U (Mayo)OutsideLaboratory",,80361,CPT,Facility,Inpatient,,,90,163,138.55,46.7158,163,Medica,Medical Assistance,,,,,Included in per diem rate,
"Opiate Confirmation, U (Mayo)OutsideLaboratory",,80361,CPT,Facility,Outpatient,,,90,163,138.55,46.7158,163,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,81.174,49.8,,percent of total billed charges,,
"Opiate Confirmation, U (Mayo)OutsideLaboratory",,80361,CPT,Facility,Inpatient,,,90,163,138.55,46.7158,163,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Opiate Confirmation, U (Mayo)OutsideLaboratory",,80361,CPT,Facility,Both,,,90,163,138.55,46.7158,163,"Multiplan, Inc.","Multiplan, Inc.",153.22,94,,percent of total billed charges,,
"Opiate Confirmation, U (Mayo)OutsideLaboratory",,80361,CPT,Facility,Outpatient,,,90,163,138.55,46.7158,163,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,140.832,86.4,,percent of total billed charges,,
"Opiate Confirmation, U (Mayo)OutsideLaboratory",,80361,CPT,Facility,Inpatient,,,90,163,138.55,46.7158,163,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Opiate Confirmation, U (Mayo)OutsideLaboratory",,80361,CPT,Facility,Both,,,90,163,138.55,46.7158,163,"Preferred One Administrative Services, INC.",PPO,160.718,98.6,,percent of total billed charges,,
"Opiate Confirmation, U (Mayo)OutsideLaboratory",,80361,CPT,Facility,Outpatient,,,90,163,138.55,46.7158,163,PrimeWest Health,Minnesota Senior Health Options (MSHO),83.8635,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Opiate Confirmation, U (Mayo)OutsideLaboratory",,80361,CPT,Facility,Inpatient,,,90,163,138.55,46.7158,163,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Opiate Confirmation, U (Mayo)OutsideLaboratory",,80361,CPT,Facility,Outpatient,,,90,163,138.55,46.7158,163,PrimeWest Health,MinnesotaCare,83.7168,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Opiate Confirmation, U (Mayo)OutsideLaboratory",,80361,CPT,Facility,Inpatient,,,90,163,138.55,46.7158,163,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Opiate Confirmation, U (Mayo)OutsideLaboratory",,80361,CPT,Facility,Both,,,90,163,138.55,46.7158,163,Sanford Health Plan,Sanford Health Plan,149.96,92,,percent of total billed charges,,
"Opiate Confirmation, U (Mayo)OutsideLaboratory",,80361,CPT,Facility,Outpatient,,,90,163,138.55,46.7158,163,"UCare Health, Inc.",Individual & Family Plan,91.8505,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Opiate Confirmation, U (Mayo)OutsideLaboratory",,80361,CPT,Facility,Inpatient,,,90,163,138.55,46.7158,163,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Opiate Confirmation, U (Mayo)OutsideLaboratory",,80361,CPT,Facility,Outpatient,,,90,163,138.55,46.7158,163,"UCare Health, Inc.",Medical Assistance,82.2661,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Opiate Confirmation, U (Mayo)OutsideLaboratory",,80361,CPT,Facility,Inpatient,,,90,163,138.55,46.7158,163,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Opiate Confirmation, U (Mayo)OutsideLaboratory",,80361,CPT,Facility,Outpatient,,,90,163,138.55,46.7158,163,"UCare Health, Inc.",Medicare Advantage,82.2661,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Opiate Confirmation, U (Mayo)OutsideLaboratory",,80361,CPT,Facility,Inpatient,,,90,163,138.55,46.7158,163,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Opiate Confirmation, U (Mayo)OutsideLaboratory",,80361,CPT,Facility,Outpatient,,,90,163,138.55,46.7158,163,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),82.2661,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Opiate Confirmation, U (Mayo)OutsideLaboratory",,80361,CPT,Facility,Inpatient,,,90,163,138.55,46.7158,163,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Opiate Confirmation, U (Mayo)OutsideLaboratory",,80361,CPT,Facility,Both,,,90,163,138.55,46.7158,163,UnitedHealthcare,Individual & Family,153.22,94,,percent of total billed charges,,
"Opiate Confirmation, U (Mayo)OutsideLaboratory",,80361,CPT,Facility,Outpatient,,,90,163,138.55,46.7158,163,UnitedHealthcare,Medicare Advantage,79.87,49,,percent of total billed charges,,
"Opiate Confirmation, U (Mayo)OutsideLaboratory",,80361,CPT,Facility,Inpatient,,,90,163,138.55,46.7158,163,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Opiate Confirmation, U (Mayo)OutsideLaboratory",,80361,CPT,Facility,Outpatient,,,90,163,138.55,46.7158,163,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,78.24,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Opiate Confirmation, U (Mayo)OutsideLaboratory",,80361,CPT,Facility,Inpatient,,,90,163,138.55,46.7158,163,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Oxycodone (Mayo)OutsideLaboratory,,80365,CPT,Facility,Both,,,90,167,141.95,47.8622,167,Aetna,Commercial,153.64,92,,percent of total billed charges,,
Oxycodone (Mayo)OutsideLaboratory,,80365,CPT,Facility,Outpatient,,,90,167,141.95,47.8622,167,Aetna,Medicare Advantage,81.83,49,,percent of total billed charges,,
Oxycodone (Mayo)OutsideLaboratory,,80365,CPT,Facility,Inpatient,,,90,167,141.95,47.8622,167,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Oxycodone (Mayo)OutsideLaboratory,,80365,CPT,Facility,Both,,,90,167,141.95,47.8622,167,Aetna,PPO,155.31,93,,percent of total billed charges,,
Oxycodone (Mayo)OutsideLaboratory,,80365,CPT,Facility,Both,,,90,167,141.95,47.8622,167,America's PPO,America's PPO,160.3701,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Oxycodone (Mayo)OutsideLaboratory,,80365,CPT,Facility,Both,,,90,167,141.95,47.8622,167,BlueCross BlueShield Minnesota, Federal Employee Program,164.328,98.4,,percent of total billed charges,,
Oxycodone (Mayo)OutsideLaboratory,,80365,CPT,Facility,Both,,,90,167,141.95,47.8622,167,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,167,100,,percent of total billed charges,,
Oxycodone (Mayo)OutsideLaboratory,,80365,CPT,Facility,Both,,,90,167,141.95,47.8622,167,BlueCross BlueShield Minnesota,High Value Network Plan,150.3,90,,percent of total billed charges,,
Oxycodone (Mayo)OutsideLaboratory,,80365,CPT,Facility,Outpatient,,,90,167,141.95,47.8622,167,BlueCross BlueShield Minnesota,Medicare Advantage,81.83,49,,percent of total billed charges,,
Oxycodone (Mayo)OutsideLaboratory,,80365,CPT,Facility,Inpatient,,,90,167,141.95,47.8622,167,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Oxycodone (Mayo)OutsideLaboratory,,80365,CPT,Facility,Both,,,90,167,141.95,47.8622,167,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,147.9119,88.57,,percent of total billed charges,,
Oxycodone (Mayo)OutsideLaboratory,,80365,CPT,Facility,Both,,,90,167,141.95,47.8622,167,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,47.8622,28.66,,percent of total billed charges,,
Oxycodone (Mayo)OutsideLaboratory,,80365,CPT,Facility,Outpatient,,,90,167,141.95,47.8622,167,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),81.83,49,,percent of total billed charges,,
Oxycodone (Mayo)OutsideLaboratory,,80365,CPT,Facility,Inpatient,,,90,167,141.95,47.8622,167,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Oxycodone (Mayo)OutsideLaboratory,,80365,CPT,Facility,Both,,,90,167,141.95,47.8622,167,CorVel,Worker's Compensation,167,100,,percent of total billed charges,,
Oxycodone (Mayo)OutsideLaboratory,,80365,CPT,Facility,Both,,,90,167,141.95,47.8622,167,First Health Group Corporation,First Health Network,161.99,97,,percent of total billed charges,,
Oxycodone (Mayo)OutsideLaboratory,,80365,CPT,Facility,Both,,,90,167,141.95,47.8622,167,"Health Partners, Inc.",Commercial,157.982,94.6,,percent of total billed charges,,
Oxycodone (Mayo)OutsideLaboratory,,80365,CPT,Facility,Outpatient,,,90,167,141.95,47.8622,167,"Health Partners, Inc.",Medicare Advantage,81.83,49,,percent of total billed charges,,
Oxycodone (Mayo)OutsideLaboratory,,80365,CPT,Facility,Inpatient,,,90,167,141.95,47.8622,167,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Oxycodone (Mayo)OutsideLaboratory,,80365,CPT,Facility,Both,,,90,167,141.95,47.8622,167,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),100.2,60,,percent of total billed charges,,
Oxycodone (Mayo)OutsideLaboratory,,80365,CPT,Facility,Both,,,90,167,141.95,47.8622,167,"Health Partners, Inc.",State of Minnesota Advantage Program,136.105,81.5,,percent of total billed charges,,
Oxycodone (Mayo)OutsideLaboratory,,80365,CPT,Facility,Both,,,90,167,141.95,47.8622,167,"Health Partners, Inc.",State Public Programs,83.5,50,,percent of total billed charges,,
Oxycodone (Mayo)OutsideLaboratory,,80365,CPT,Facility,Both,,,90,167,141.95,47.8622,167,Humana Insurance Company,Commercial PPO,158.65,95,,percent of total billed charges,,
Oxycodone (Mayo)OutsideLaboratory,,80365,CPT,Facility,Outpatient,,,90,167,141.95,47.8622,167,Humana Insurance Company,Medicare PPO,81.83,49,,percent of total billed charges,,
Oxycodone (Mayo)OutsideLaboratory,,80365,CPT,Facility,Inpatient,,,90,167,141.95,47.8622,167,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Oxycodone (Mayo)OutsideLaboratory,,80365,CPT,Facility,Both,,,90,167,141.95,47.8622,167,Medica,Individual & Family,165.497,99.1,,percent of total billed charges,,
Oxycodone (Mayo)OutsideLaboratory,,80365,CPT,Facility,Outpatient,,,90,167,141.95,47.8622,167,Medica,Medica Advantage Solution,83.166,49.8,,percent of total billed charges,,
Oxycodone (Mayo)OutsideLaboratory,,80365,CPT,Facility,Inpatient,,,90,167,141.95,47.8622,167,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Oxycodone (Mayo)OutsideLaboratory,,80365,CPT,Facility,Outpatient,,,90,167,141.95,47.8622,167,Medica,Medical Assistance,74.482,44.6,,percent of total billed charges,,
Oxycodone (Mayo)OutsideLaboratory,,80365,CPT,Facility,Inpatient,,,90,167,141.95,47.8622,167,Medica,Medical Assistance,,,,,Included in per diem rate,
Oxycodone (Mayo)OutsideLaboratory,,80365,CPT,Facility,Outpatient,,,90,167,141.95,47.8622,167,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,83.166,49.8,,percent of total billed charges,,
Oxycodone (Mayo)OutsideLaboratory,,80365,CPT,Facility,Inpatient,,,90,167,141.95,47.8622,167,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Oxycodone (Mayo)OutsideLaboratory,,80365,CPT,Facility,Both,,,90,167,141.95,47.8622,167,"Multiplan, Inc.","Multiplan, Inc.",156.98,94,,percent of total billed charges,,
Oxycodone (Mayo)OutsideLaboratory,,80365,CPT,Facility,Outpatient,,,90,167,141.95,47.8622,167,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,144.288,86.4,,percent of total billed charges,,
Oxycodone (Mayo)OutsideLaboratory,,80365,CPT,Facility,Inpatient,,,90,167,141.95,47.8622,167,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Oxycodone (Mayo)OutsideLaboratory,,80365,CPT,Facility,Both,,,90,167,141.95,47.8622,167,"Preferred One Administrative Services, INC.",PPO,164.662,98.6,,percent of total billed charges,,
Oxycodone (Mayo)OutsideLaboratory,,80365,CPT,Facility,Outpatient,,,90,167,141.95,47.8622,167,PrimeWest Health,Minnesota Senior Health Options (MSHO),85.9215,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Oxycodone (Mayo)OutsideLaboratory,,80365,CPT,Facility,Inpatient,,,90,167,141.95,47.8622,167,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Oxycodone (Mayo)OutsideLaboratory,,80365,CPT,Facility,Outpatient,,,90,167,141.95,47.8622,167,PrimeWest Health,MinnesotaCare,85.7712,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Oxycodone (Mayo)OutsideLaboratory,,80365,CPT,Facility,Inpatient,,,90,167,141.95,47.8622,167,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Oxycodone (Mayo)OutsideLaboratory,,80365,CPT,Facility,Both,,,90,167,141.95,47.8622,167,Sanford Health Plan,Sanford Health Plan,153.64,92,,percent of total billed charges,,
Oxycodone (Mayo)OutsideLaboratory,,80365,CPT,Facility,Outpatient,,,90,167,141.95,47.8622,167,"UCare Health, Inc.",Individual & Family Plan,94.1045,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Oxycodone (Mayo)OutsideLaboratory,,80365,CPT,Facility,Inpatient,,,90,167,141.95,47.8622,167,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Oxycodone (Mayo)OutsideLaboratory,,80365,CPT,Facility,Outpatient,,,90,167,141.95,47.8622,167,"UCare Health, Inc.",Medical Assistance,84.2849,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Oxycodone (Mayo)OutsideLaboratory,,80365,CPT,Facility,Inpatient,,,90,167,141.95,47.8622,167,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Oxycodone (Mayo)OutsideLaboratory,,80365,CPT,Facility,Outpatient,,,90,167,141.95,47.8622,167,"UCare Health, Inc.",Medicare Advantage,84.2849,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Oxycodone (Mayo)OutsideLaboratory,,80365,CPT,Facility,Inpatient,,,90,167,141.95,47.8622,167,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Oxycodone (Mayo)OutsideLaboratory,,80365,CPT,Facility,Outpatient,,,90,167,141.95,47.8622,167,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),84.2849,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Oxycodone (Mayo)OutsideLaboratory,,80365,CPT,Facility,Inpatient,,,90,167,141.95,47.8622,167,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Oxycodone (Mayo)OutsideLaboratory,,80365,CPT,Facility,Both,,,90,167,141.95,47.8622,167,UnitedHealthcare,Individual & Family,156.98,94,,percent of total billed charges,,
Oxycodone (Mayo)OutsideLaboratory,,80365,CPT,Facility,Outpatient,,,90,167,141.95,47.8622,167,UnitedHealthcare,Medicare Advantage,81.83,49,,percent of total billed charges,,
Oxycodone (Mayo)OutsideLaboratory,,80365,CPT,Facility,Inpatient,,,90,167,141.95,47.8622,167,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Oxycodone (Mayo)OutsideLaboratory,,80365,CPT,Facility,Outpatient,,,90,167,141.95,47.8622,167,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,80.16,48,,percent of total billed charges,,100% of DHS outpatient percentage
Oxycodone (Mayo)OutsideLaboratory,,80365,CPT,Facility,Inpatient,,,90,167,141.95,47.8622,167,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Oxycodone, Meconium (Mayo)OutsideLaboratory",,80365,CPT,Facility,Both,,,90,167,141.95,47.8622,167,Aetna,Commercial,153.64,92,,percent of total billed charges,,
"Oxycodone, Meconium (Mayo)OutsideLaboratory",,80365,CPT,Facility,Outpatient,,,90,167,141.95,47.8622,167,Aetna,Medicare Advantage,81.83,49,,percent of total billed charges,,
"Oxycodone, Meconium (Mayo)OutsideLaboratory",,80365,CPT,Facility,Inpatient,,,90,167,141.95,47.8622,167,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Oxycodone, Meconium (Mayo)OutsideLaboratory",,80365,CPT,Facility,Both,,,90,167,141.95,47.8622,167,Aetna,PPO,155.31,93,,percent of total billed charges,,
"Oxycodone, Meconium (Mayo)OutsideLaboratory",,80365,CPT,Facility,Both,,,90,167,141.95,47.8622,167,America's PPO,America's PPO,160.3701,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Oxycodone, Meconium (Mayo)OutsideLaboratory",,80365,CPT,Facility,Both,,,90,167,141.95,47.8622,167,BlueCross BlueShield Minnesota, Federal Employee Program,164.328,98.4,,percent of total billed charges,,
"Oxycodone, Meconium (Mayo)OutsideLaboratory",,80365,CPT,Facility,Both,,,90,167,141.95,47.8622,167,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,167,100,,percent of total billed charges,,
"Oxycodone, Meconium (Mayo)OutsideLaboratory",,80365,CPT,Facility,Both,,,90,167,141.95,47.8622,167,BlueCross BlueShield Minnesota,High Value Network Plan,150.3,90,,percent of total billed charges,,
"Oxycodone, Meconium (Mayo)OutsideLaboratory",,80365,CPT,Facility,Outpatient,,,90,167,141.95,47.8622,167,BlueCross BlueShield Minnesota,Medicare Advantage,81.83,49,,percent of total billed charges,,
"Oxycodone, Meconium (Mayo)OutsideLaboratory",,80365,CPT,Facility,Inpatient,,,90,167,141.95,47.8622,167,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Oxycodone, Meconium (Mayo)OutsideLaboratory",,80365,CPT,Facility,Both,,,90,167,141.95,47.8622,167,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,147.9119,88.57,,percent of total billed charges,,
"Oxycodone, Meconium (Mayo)OutsideLaboratory",,80365,CPT,Facility,Both,,,90,167,141.95,47.8622,167,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,47.8622,28.66,,percent of total billed charges,,
"Oxycodone, Meconium (Mayo)OutsideLaboratory",,80365,CPT,Facility,Outpatient,,,90,167,141.95,47.8622,167,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),81.83,49,,percent of total billed charges,,
"Oxycodone, Meconium (Mayo)OutsideLaboratory",,80365,CPT,Facility,Inpatient,,,90,167,141.95,47.8622,167,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Oxycodone, Meconium (Mayo)OutsideLaboratory",,80365,CPT,Facility,Both,,,90,167,141.95,47.8622,167,CorVel,Worker's Compensation,167,100,,percent of total billed charges,,
"Oxycodone, Meconium (Mayo)OutsideLaboratory",,80365,CPT,Facility,Both,,,90,167,141.95,47.8622,167,First Health Group Corporation,First Health Network,161.99,97,,percent of total billed charges,,
"Oxycodone, Meconium (Mayo)OutsideLaboratory",,80365,CPT,Facility,Both,,,90,167,141.95,47.8622,167,"Health Partners, Inc.",Commercial,157.982,94.6,,percent of total billed charges,,
"Oxycodone, Meconium (Mayo)OutsideLaboratory",,80365,CPT,Facility,Outpatient,,,90,167,141.95,47.8622,167,"Health Partners, Inc.",Medicare Advantage,81.83,49,,percent of total billed charges,,
"Oxycodone, Meconium (Mayo)OutsideLaboratory",,80365,CPT,Facility,Inpatient,,,90,167,141.95,47.8622,167,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Oxycodone, Meconium (Mayo)OutsideLaboratory",,80365,CPT,Facility,Both,,,90,167,141.95,47.8622,167,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),100.2,60,,percent of total billed charges,,
"Oxycodone, Meconium (Mayo)OutsideLaboratory",,80365,CPT,Facility,Both,,,90,167,141.95,47.8622,167,"Health Partners, Inc.",State of Minnesota Advantage Program,136.105,81.5,,percent of total billed charges,,
"Oxycodone, Meconium (Mayo)OutsideLaboratory",,80365,CPT,Facility,Both,,,90,167,141.95,47.8622,167,"Health Partners, Inc.",State Public Programs,83.5,50,,percent of total billed charges,,
"Oxycodone, Meconium (Mayo)OutsideLaboratory",,80365,CPT,Facility,Both,,,90,167,141.95,47.8622,167,Humana Insurance Company,Commercial PPO,158.65,95,,percent of total billed charges,,
"Oxycodone, Meconium (Mayo)OutsideLaboratory",,80365,CPT,Facility,Outpatient,,,90,167,141.95,47.8622,167,Humana Insurance Company,Medicare PPO,81.83,49,,percent of total billed charges,,
"Oxycodone, Meconium (Mayo)OutsideLaboratory",,80365,CPT,Facility,Inpatient,,,90,167,141.95,47.8622,167,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Oxycodone, Meconium (Mayo)OutsideLaboratory",,80365,CPT,Facility,Both,,,90,167,141.95,47.8622,167,Medica,Individual & Family,165.497,99.1,,percent of total billed charges,,
"Oxycodone, Meconium (Mayo)OutsideLaboratory",,80365,CPT,Facility,Outpatient,,,90,167,141.95,47.8622,167,Medica,Medica Advantage Solution,83.166,49.8,,percent of total billed charges,,
"Oxycodone, Meconium (Mayo)OutsideLaboratory",,80365,CPT,Facility,Inpatient,,,90,167,141.95,47.8622,167,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Oxycodone, Meconium (Mayo)OutsideLaboratory",,80365,CPT,Facility,Outpatient,,,90,167,141.95,47.8622,167,Medica,Medical Assistance,74.482,44.6,,percent of total billed charges,,
"Oxycodone, Meconium (Mayo)OutsideLaboratory",,80365,CPT,Facility,Inpatient,,,90,167,141.95,47.8622,167,Medica,Medical Assistance,,,,,Included in per diem rate,
"Oxycodone, Meconium (Mayo)OutsideLaboratory",,80365,CPT,Facility,Outpatient,,,90,167,141.95,47.8622,167,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,83.166,49.8,,percent of total billed charges,,
"Oxycodone, Meconium (Mayo)OutsideLaboratory",,80365,CPT,Facility,Inpatient,,,90,167,141.95,47.8622,167,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Oxycodone, Meconium (Mayo)OutsideLaboratory",,80365,CPT,Facility,Both,,,90,167,141.95,47.8622,167,"Multiplan, Inc.","Multiplan, Inc.",156.98,94,,percent of total billed charges,,
"Oxycodone, Meconium (Mayo)OutsideLaboratory",,80365,CPT,Facility,Outpatient,,,90,167,141.95,47.8622,167,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,144.288,86.4,,percent of total billed charges,,
"Oxycodone, Meconium (Mayo)OutsideLaboratory",,80365,CPT,Facility,Inpatient,,,90,167,141.95,47.8622,167,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Oxycodone, Meconium (Mayo)OutsideLaboratory",,80365,CPT,Facility,Both,,,90,167,141.95,47.8622,167,"Preferred One Administrative Services, INC.",PPO,164.662,98.6,,percent of total billed charges,,
"Oxycodone, Meconium (Mayo)OutsideLaboratory",,80365,CPT,Facility,Outpatient,,,90,167,141.95,47.8622,167,PrimeWest Health,Minnesota Senior Health Options (MSHO),85.9215,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Oxycodone, Meconium (Mayo)OutsideLaboratory",,80365,CPT,Facility,Inpatient,,,90,167,141.95,47.8622,167,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Oxycodone, Meconium (Mayo)OutsideLaboratory",,80365,CPT,Facility,Outpatient,,,90,167,141.95,47.8622,167,PrimeWest Health,MinnesotaCare,85.7712,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Oxycodone, Meconium (Mayo)OutsideLaboratory",,80365,CPT,Facility,Inpatient,,,90,167,141.95,47.8622,167,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Oxycodone, Meconium (Mayo)OutsideLaboratory",,80365,CPT,Facility,Both,,,90,167,141.95,47.8622,167,Sanford Health Plan,Sanford Health Plan,153.64,92,,percent of total billed charges,,
"Oxycodone, Meconium (Mayo)OutsideLaboratory",,80365,CPT,Facility,Outpatient,,,90,167,141.95,47.8622,167,"UCare Health, Inc.",Individual & Family Plan,94.1045,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Oxycodone, Meconium (Mayo)OutsideLaboratory",,80365,CPT,Facility,Inpatient,,,90,167,141.95,47.8622,167,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Oxycodone, Meconium (Mayo)OutsideLaboratory",,80365,CPT,Facility,Outpatient,,,90,167,141.95,47.8622,167,"UCare Health, Inc.",Medical Assistance,84.2849,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Oxycodone, Meconium (Mayo)OutsideLaboratory",,80365,CPT,Facility,Inpatient,,,90,167,141.95,47.8622,167,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Oxycodone, Meconium (Mayo)OutsideLaboratory",,80365,CPT,Facility,Outpatient,,,90,167,141.95,47.8622,167,"UCare Health, Inc.",Medicare Advantage,84.2849,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Oxycodone, Meconium (Mayo)OutsideLaboratory",,80365,CPT,Facility,Inpatient,,,90,167,141.95,47.8622,167,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Oxycodone, Meconium (Mayo)OutsideLaboratory",,80365,CPT,Facility,Outpatient,,,90,167,141.95,47.8622,167,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),84.2849,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Oxycodone, Meconium (Mayo)OutsideLaboratory",,80365,CPT,Facility,Inpatient,,,90,167,141.95,47.8622,167,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Oxycodone, Meconium (Mayo)OutsideLaboratory",,80365,CPT,Facility,Both,,,90,167,141.95,47.8622,167,UnitedHealthcare,Individual & Family,156.98,94,,percent of total billed charges,,
"Oxycodone, Meconium (Mayo)OutsideLaboratory",,80365,CPT,Facility,Outpatient,,,90,167,141.95,47.8622,167,UnitedHealthcare,Medicare Advantage,81.83,49,,percent of total billed charges,,
"Oxycodone, Meconium (Mayo)OutsideLaboratory",,80365,CPT,Facility,Inpatient,,,90,167,141.95,47.8622,167,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Oxycodone, Meconium (Mayo)OutsideLaboratory",,80365,CPT,Facility,Outpatient,,,90,167,141.95,47.8622,167,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,80.16,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Oxycodone, Meconium (Mayo)OutsideLaboratory",,80365,CPT,Facility,Inpatient,,,90,167,141.95,47.8622,167,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Oxycodone, Urine (Mayo)OutsideLaboratory",,80365,CPT,Facility,Both,,,90,167,141.95,47.8622,167,Aetna,Commercial,153.64,92,,percent of total billed charges,,
"Oxycodone, Urine (Mayo)OutsideLaboratory",,80365,CPT,Facility,Outpatient,,,90,167,141.95,47.8622,167,Aetna,Medicare Advantage,81.83,49,,percent of total billed charges,,
"Oxycodone, Urine (Mayo)OutsideLaboratory",,80365,CPT,Facility,Inpatient,,,90,167,141.95,47.8622,167,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Oxycodone, Urine (Mayo)OutsideLaboratory",,80365,CPT,Facility,Both,,,90,167,141.95,47.8622,167,Aetna,PPO,155.31,93,,percent of total billed charges,,
"Oxycodone, Urine (Mayo)OutsideLaboratory",,80365,CPT,Facility,Both,,,90,167,141.95,47.8622,167,America's PPO,America's PPO,160.3701,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Oxycodone, Urine (Mayo)OutsideLaboratory",,80365,CPT,Facility,Both,,,90,167,141.95,47.8622,167,BlueCross BlueShield Minnesota, Federal Employee Program,164.328,98.4,,percent of total billed charges,,
"Oxycodone, Urine (Mayo)OutsideLaboratory",,80365,CPT,Facility,Both,,,90,167,141.95,47.8622,167,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,167,100,,percent of total billed charges,,
"Oxycodone, Urine (Mayo)OutsideLaboratory",,80365,CPT,Facility,Both,,,90,167,141.95,47.8622,167,BlueCross BlueShield Minnesota,High Value Network Plan,150.3,90,,percent of total billed charges,,
"Oxycodone, Urine (Mayo)OutsideLaboratory",,80365,CPT,Facility,Outpatient,,,90,167,141.95,47.8622,167,BlueCross BlueShield Minnesota,Medicare Advantage,81.83,49,,percent of total billed charges,,
"Oxycodone, Urine (Mayo)OutsideLaboratory",,80365,CPT,Facility,Inpatient,,,90,167,141.95,47.8622,167,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Oxycodone, Urine (Mayo)OutsideLaboratory",,80365,CPT,Facility,Both,,,90,167,141.95,47.8622,167,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,147.9119,88.57,,percent of total billed charges,,
"Oxycodone, Urine (Mayo)OutsideLaboratory",,80365,CPT,Facility,Both,,,90,167,141.95,47.8622,167,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,47.8622,28.66,,percent of total billed charges,,
"Oxycodone, Urine (Mayo)OutsideLaboratory",,80365,CPT,Facility,Outpatient,,,90,167,141.95,47.8622,167,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),81.83,49,,percent of total billed charges,,
"Oxycodone, Urine (Mayo)OutsideLaboratory",,80365,CPT,Facility,Inpatient,,,90,167,141.95,47.8622,167,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Oxycodone, Urine (Mayo)OutsideLaboratory",,80365,CPT,Facility,Both,,,90,167,141.95,47.8622,167,CorVel,Worker's Compensation,167,100,,percent of total billed charges,,
"Oxycodone, Urine (Mayo)OutsideLaboratory",,80365,CPT,Facility,Both,,,90,167,141.95,47.8622,167,First Health Group Corporation,First Health Network,161.99,97,,percent of total billed charges,,
"Oxycodone, Urine (Mayo)OutsideLaboratory",,80365,CPT,Facility,Both,,,90,167,141.95,47.8622,167,"Health Partners, Inc.",Commercial,157.982,94.6,,percent of total billed charges,,
"Oxycodone, Urine (Mayo)OutsideLaboratory",,80365,CPT,Facility,Outpatient,,,90,167,141.95,47.8622,167,"Health Partners, Inc.",Medicare Advantage,81.83,49,,percent of total billed charges,,
"Oxycodone, Urine (Mayo)OutsideLaboratory",,80365,CPT,Facility,Inpatient,,,90,167,141.95,47.8622,167,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Oxycodone, Urine (Mayo)OutsideLaboratory",,80365,CPT,Facility,Both,,,90,167,141.95,47.8622,167,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),100.2,60,,percent of total billed charges,,
"Oxycodone, Urine (Mayo)OutsideLaboratory",,80365,CPT,Facility,Both,,,90,167,141.95,47.8622,167,"Health Partners, Inc.",State of Minnesota Advantage Program,136.105,81.5,,percent of total billed charges,,
"Oxycodone, Urine (Mayo)OutsideLaboratory",,80365,CPT,Facility,Both,,,90,167,141.95,47.8622,167,"Health Partners, Inc.",State Public Programs,83.5,50,,percent of total billed charges,,
"Oxycodone, Urine (Mayo)OutsideLaboratory",,80365,CPT,Facility,Both,,,90,167,141.95,47.8622,167,Humana Insurance Company,Commercial PPO,158.65,95,,percent of total billed charges,,
"Oxycodone, Urine (Mayo)OutsideLaboratory",,80365,CPT,Facility,Outpatient,,,90,167,141.95,47.8622,167,Humana Insurance Company,Medicare PPO,81.83,49,,percent of total billed charges,,
"Oxycodone, Urine (Mayo)OutsideLaboratory",,80365,CPT,Facility,Inpatient,,,90,167,141.95,47.8622,167,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Oxycodone, Urine (Mayo)OutsideLaboratory",,80365,CPT,Facility,Both,,,90,167,141.95,47.8622,167,Medica,Individual & Family,165.497,99.1,,percent of total billed charges,,
"Oxycodone, Urine (Mayo)OutsideLaboratory",,80365,CPT,Facility,Outpatient,,,90,167,141.95,47.8622,167,Medica,Medica Advantage Solution,83.166,49.8,,percent of total billed charges,,
"Oxycodone, Urine (Mayo)OutsideLaboratory",,80365,CPT,Facility,Inpatient,,,90,167,141.95,47.8622,167,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Oxycodone, Urine (Mayo)OutsideLaboratory",,80365,CPT,Facility,Outpatient,,,90,167,141.95,47.8622,167,Medica,Medical Assistance,74.482,44.6,,percent of total billed charges,,
"Oxycodone, Urine (Mayo)OutsideLaboratory",,80365,CPT,Facility,Inpatient,,,90,167,141.95,47.8622,167,Medica,Medical Assistance,,,,,Included in per diem rate,
"Oxycodone, Urine (Mayo)OutsideLaboratory",,80365,CPT,Facility,Outpatient,,,90,167,141.95,47.8622,167,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,83.166,49.8,,percent of total billed charges,,
"Oxycodone, Urine (Mayo)OutsideLaboratory",,80365,CPT,Facility,Inpatient,,,90,167,141.95,47.8622,167,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Oxycodone, Urine (Mayo)OutsideLaboratory",,80365,CPT,Facility,Both,,,90,167,141.95,47.8622,167,"Multiplan, Inc.","Multiplan, Inc.",156.98,94,,percent of total billed charges,,
"Oxycodone, Urine (Mayo)OutsideLaboratory",,80365,CPT,Facility,Outpatient,,,90,167,141.95,47.8622,167,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,144.288,86.4,,percent of total billed charges,,
"Oxycodone, Urine (Mayo)OutsideLaboratory",,80365,CPT,Facility,Inpatient,,,90,167,141.95,47.8622,167,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Oxycodone, Urine (Mayo)OutsideLaboratory",,80365,CPT,Facility,Both,,,90,167,141.95,47.8622,167,"Preferred One Administrative Services, INC.",PPO,164.662,98.6,,percent of total billed charges,,
"Oxycodone, Urine (Mayo)OutsideLaboratory",,80365,CPT,Facility,Outpatient,,,90,167,141.95,47.8622,167,PrimeWest Health,Minnesota Senior Health Options (MSHO),85.9215,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Oxycodone, Urine (Mayo)OutsideLaboratory",,80365,CPT,Facility,Inpatient,,,90,167,141.95,47.8622,167,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Oxycodone, Urine (Mayo)OutsideLaboratory",,80365,CPT,Facility,Outpatient,,,90,167,141.95,47.8622,167,PrimeWest Health,MinnesotaCare,85.7712,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Oxycodone, Urine (Mayo)OutsideLaboratory",,80365,CPT,Facility,Inpatient,,,90,167,141.95,47.8622,167,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Oxycodone, Urine (Mayo)OutsideLaboratory",,80365,CPT,Facility,Both,,,90,167,141.95,47.8622,167,Sanford Health Plan,Sanford Health Plan,153.64,92,,percent of total billed charges,,
"Oxycodone, Urine (Mayo)OutsideLaboratory",,80365,CPT,Facility,Outpatient,,,90,167,141.95,47.8622,167,"UCare Health, Inc.",Individual & Family Plan,94.1045,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Oxycodone, Urine (Mayo)OutsideLaboratory",,80365,CPT,Facility,Inpatient,,,90,167,141.95,47.8622,167,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Oxycodone, Urine (Mayo)OutsideLaboratory",,80365,CPT,Facility,Outpatient,,,90,167,141.95,47.8622,167,"UCare Health, Inc.",Medical Assistance,84.2849,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Oxycodone, Urine (Mayo)OutsideLaboratory",,80365,CPT,Facility,Inpatient,,,90,167,141.95,47.8622,167,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Oxycodone, Urine (Mayo)OutsideLaboratory",,80365,CPT,Facility,Outpatient,,,90,167,141.95,47.8622,167,"UCare Health, Inc.",Medicare Advantage,84.2849,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Oxycodone, Urine (Mayo)OutsideLaboratory",,80365,CPT,Facility,Inpatient,,,90,167,141.95,47.8622,167,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Oxycodone, Urine (Mayo)OutsideLaboratory",,80365,CPT,Facility,Outpatient,,,90,167,141.95,47.8622,167,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),84.2849,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Oxycodone, Urine (Mayo)OutsideLaboratory",,80365,CPT,Facility,Inpatient,,,90,167,141.95,47.8622,167,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Oxycodone, Urine (Mayo)OutsideLaboratory",,80365,CPT,Facility,Both,,,90,167,141.95,47.8622,167,UnitedHealthcare,Individual & Family,156.98,94,,percent of total billed charges,,
"Oxycodone, Urine (Mayo)OutsideLaboratory",,80365,CPT,Facility,Outpatient,,,90,167,141.95,47.8622,167,UnitedHealthcare,Medicare Advantage,81.83,49,,percent of total billed charges,,
"Oxycodone, Urine (Mayo)OutsideLaboratory",,80365,CPT,Facility,Inpatient,,,90,167,141.95,47.8622,167,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Oxycodone, Urine (Mayo)OutsideLaboratory",,80365,CPT,Facility,Outpatient,,,90,167,141.95,47.8622,167,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,80.16,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Oxycodone, Urine (Mayo)OutsideLaboratory",,80365,CPT,Facility,Inpatient,,,90,167,141.95,47.8622,167,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Pregabalin, S (Mayo)OutsideLaboratory",,80366,CPT,Facility,Both,,,90,160,136,45.856,160,Aetna,Commercial,147.2,92,,percent of total billed charges,,
"Pregabalin, S (Mayo)OutsideLaboratory",,80366,CPT,Facility,Outpatient,,,90,160,136,45.856,160,Aetna,Medicare Advantage,78.4,49,,percent of total billed charges,,
"Pregabalin, S (Mayo)OutsideLaboratory",,80366,CPT,Facility,Inpatient,,,90,160,136,45.856,160,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Pregabalin, S (Mayo)OutsideLaboratory",,80366,CPT,Facility,Both,,,90,160,136,45.856,160,Aetna,PPO,148.8,93,,percent of total billed charges,,
"Pregabalin, S (Mayo)OutsideLaboratory",,80366,CPT,Facility,Both,,,90,160,136,45.856,160,America's PPO,America's PPO,153.648,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Pregabalin, S (Mayo)OutsideLaboratory",,80366,CPT,Facility,Both,,,90,160,136,45.856,160,BlueCross BlueShield Minnesota, Federal Employee Program,157.44,98.4,,percent of total billed charges,,
"Pregabalin, S (Mayo)OutsideLaboratory",,80366,CPT,Facility,Both,,,90,160,136,45.856,160,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,160,100,,percent of total billed charges,,
"Pregabalin, S (Mayo)OutsideLaboratory",,80366,CPT,Facility,Both,,,90,160,136,45.856,160,BlueCross BlueShield Minnesota,High Value Network Plan,144,90,,percent of total billed charges,,
"Pregabalin, S (Mayo)OutsideLaboratory",,80366,CPT,Facility,Outpatient,,,90,160,136,45.856,160,BlueCross BlueShield Minnesota,Medicare Advantage,78.4,49,,percent of total billed charges,,
"Pregabalin, S (Mayo)OutsideLaboratory",,80366,CPT,Facility,Inpatient,,,90,160,136,45.856,160,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Pregabalin, S (Mayo)OutsideLaboratory",,80366,CPT,Facility,Both,,,90,160,136,45.856,160,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,141.712,88.57,,percent of total billed charges,,
"Pregabalin, S (Mayo)OutsideLaboratory",,80366,CPT,Facility,Both,,,90,160,136,45.856,160,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,45.856,28.66,,percent of total billed charges,,
"Pregabalin, S (Mayo)OutsideLaboratory",,80366,CPT,Facility,Outpatient,,,90,160,136,45.856,160,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),78.4,49,,percent of total billed charges,,
"Pregabalin, S (Mayo)OutsideLaboratory",,80366,CPT,Facility,Inpatient,,,90,160,136,45.856,160,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Pregabalin, S (Mayo)OutsideLaboratory",,80366,CPT,Facility,Both,,,90,160,136,45.856,160,CorVel,Worker's Compensation,160,100,,percent of total billed charges,,
"Pregabalin, S (Mayo)OutsideLaboratory",,80366,CPT,Facility,Both,,,90,160,136,45.856,160,First Health Group Corporation,First Health Network,155.2,97,,percent of total billed charges,,
"Pregabalin, S (Mayo)OutsideLaboratory",,80366,CPT,Facility,Both,,,90,160,136,45.856,160,"Health Partners, Inc.",Commercial,151.36,94.6,,percent of total billed charges,,
"Pregabalin, S (Mayo)OutsideLaboratory",,80366,CPT,Facility,Outpatient,,,90,160,136,45.856,160,"Health Partners, Inc.",Medicare Advantage,78.4,49,,percent of total billed charges,,
"Pregabalin, S (Mayo)OutsideLaboratory",,80366,CPT,Facility,Inpatient,,,90,160,136,45.856,160,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Pregabalin, S (Mayo)OutsideLaboratory",,80366,CPT,Facility,Both,,,90,160,136,45.856,160,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),96,60,,percent of total billed charges,,
"Pregabalin, S (Mayo)OutsideLaboratory",,80366,CPT,Facility,Both,,,90,160,136,45.856,160,"Health Partners, Inc.",State of Minnesota Advantage Program,130.4,81.5,,percent of total billed charges,,
"Pregabalin, S (Mayo)OutsideLaboratory",,80366,CPT,Facility,Both,,,90,160,136,45.856,160,"Health Partners, Inc.",State Public Programs,80,50,,percent of total billed charges,,
"Pregabalin, S (Mayo)OutsideLaboratory",,80366,CPT,Facility,Both,,,90,160,136,45.856,160,Humana Insurance Company,Commercial PPO,152,95,,percent of total billed charges,,
"Pregabalin, S (Mayo)OutsideLaboratory",,80366,CPT,Facility,Outpatient,,,90,160,136,45.856,160,Humana Insurance Company,Medicare PPO,78.4,49,,percent of total billed charges,,
"Pregabalin, S (Mayo)OutsideLaboratory",,80366,CPT,Facility,Inpatient,,,90,160,136,45.856,160,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Pregabalin, S (Mayo)OutsideLaboratory",,80366,CPT,Facility,Both,,,90,160,136,45.856,160,Medica,Individual & Family,158.56,99.1,,percent of total billed charges,,
"Pregabalin, S (Mayo)OutsideLaboratory",,80366,CPT,Facility,Outpatient,,,90,160,136,45.856,160,Medica,Medica Advantage Solution,79.68,49.8,,percent of total billed charges,,
"Pregabalin, S (Mayo)OutsideLaboratory",,80366,CPT,Facility,Inpatient,,,90,160,136,45.856,160,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Pregabalin, S (Mayo)OutsideLaboratory",,80366,CPT,Facility,Outpatient,,,90,160,136,45.856,160,Medica,Medical Assistance,71.36,44.6,,percent of total billed charges,,
"Pregabalin, S (Mayo)OutsideLaboratory",,80366,CPT,Facility,Inpatient,,,90,160,136,45.856,160,Medica,Medical Assistance,,,,,Included in per diem rate,
"Pregabalin, S (Mayo)OutsideLaboratory",,80366,CPT,Facility,Outpatient,,,90,160,136,45.856,160,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,79.68,49.8,,percent of total billed charges,,
"Pregabalin, S (Mayo)OutsideLaboratory",,80366,CPT,Facility,Inpatient,,,90,160,136,45.856,160,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Pregabalin, S (Mayo)OutsideLaboratory",,80366,CPT,Facility,Both,,,90,160,136,45.856,160,"Multiplan, Inc.","Multiplan, Inc.",150.4,94,,percent of total billed charges,,
"Pregabalin, S (Mayo)OutsideLaboratory",,80366,CPT,Facility,Outpatient,,,90,160,136,45.856,160,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,138.24,86.4,,percent of total billed charges,,
"Pregabalin, S (Mayo)OutsideLaboratory",,80366,CPT,Facility,Inpatient,,,90,160,136,45.856,160,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Pregabalin, S (Mayo)OutsideLaboratory",,80366,CPT,Facility,Both,,,90,160,136,45.856,160,"Preferred One Administrative Services, INC.",PPO,157.76,98.6,,percent of total billed charges,,
"Pregabalin, S (Mayo)OutsideLaboratory",,80366,CPT,Facility,Outpatient,,,90,160,136,45.856,160,PrimeWest Health,Minnesota Senior Health Options (MSHO),82.32,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Pregabalin, S (Mayo)OutsideLaboratory",,80366,CPT,Facility,Inpatient,,,90,160,136,45.856,160,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Pregabalin, S (Mayo)OutsideLaboratory",,80366,CPT,Facility,Outpatient,,,90,160,136,45.856,160,PrimeWest Health,MinnesotaCare,82.176,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Pregabalin, S (Mayo)OutsideLaboratory",,80366,CPT,Facility,Inpatient,,,90,160,136,45.856,160,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Pregabalin, S (Mayo)OutsideLaboratory",,80366,CPT,Facility,Both,,,90,160,136,45.856,160,Sanford Health Plan,Sanford Health Plan,147.2,92,,percent of total billed charges,,
"Pregabalin, S (Mayo)OutsideLaboratory",,80366,CPT,Facility,Outpatient,,,90,160,136,45.856,160,"UCare Health, Inc.",Individual & Family Plan,90.16,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Pregabalin, S (Mayo)OutsideLaboratory",,80366,CPT,Facility,Inpatient,,,90,160,136,45.856,160,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Pregabalin, S (Mayo)OutsideLaboratory",,80366,CPT,Facility,Outpatient,,,90,160,136,45.856,160,"UCare Health, Inc.",Medical Assistance,80.752,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Pregabalin, S (Mayo)OutsideLaboratory",,80366,CPT,Facility,Inpatient,,,90,160,136,45.856,160,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Pregabalin, S (Mayo)OutsideLaboratory",,80366,CPT,Facility,Outpatient,,,90,160,136,45.856,160,"UCare Health, Inc.",Medicare Advantage,80.752,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Pregabalin, S (Mayo)OutsideLaboratory",,80366,CPT,Facility,Inpatient,,,90,160,136,45.856,160,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Pregabalin, S (Mayo)OutsideLaboratory",,80366,CPT,Facility,Outpatient,,,90,160,136,45.856,160,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),80.752,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Pregabalin, S (Mayo)OutsideLaboratory",,80366,CPT,Facility,Inpatient,,,90,160,136,45.856,160,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Pregabalin, S (Mayo)OutsideLaboratory",,80366,CPT,Facility,Both,,,90,160,136,45.856,160,UnitedHealthcare,Individual & Family,150.4,94,,percent of total billed charges,,
"Pregabalin, S (Mayo)OutsideLaboratory",,80366,CPT,Facility,Outpatient,,,90,160,136,45.856,160,UnitedHealthcare,Medicare Advantage,78.4,49,,percent of total billed charges,,
"Pregabalin, S (Mayo)OutsideLaboratory",,80366,CPT,Facility,Inpatient,,,90,160,136,45.856,160,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Pregabalin, S (Mayo)OutsideLaboratory",,80366,CPT,Facility,Outpatient,,,90,160,136,45.856,160,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,76.8,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Pregabalin, S (Mayo)OutsideLaboratory",,80366,CPT,Facility,Inpatient,,,90,160,136,45.856,160,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Skeletal Muscle Relaxants (Mayo)OutsideLaboratory,,80369,CPT,Facility,Both,,,90,113,96.05,32.3858,113,Aetna,Commercial,103.96,92,,percent of total billed charges,,
Skeletal Muscle Relaxants (Mayo)OutsideLaboratory,,80369,CPT,Facility,Outpatient,,,90,113,96.05,32.3858,113,Aetna,Medicare Advantage,55.37,49,,percent of total billed charges,,
Skeletal Muscle Relaxants (Mayo)OutsideLaboratory,,80369,CPT,Facility,Inpatient,,,90,113,96.05,32.3858,113,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Skeletal Muscle Relaxants (Mayo)OutsideLaboratory,,80369,CPT,Facility,Both,,,90,113,96.05,32.3858,113,Aetna,PPO,105.09,93,,percent of total billed charges,,
Skeletal Muscle Relaxants (Mayo)OutsideLaboratory,,80369,CPT,Facility,Both,,,90,113,96.05,32.3858,113,America's PPO,America's PPO,108.5139,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Skeletal Muscle Relaxants (Mayo)OutsideLaboratory,,80369,CPT,Facility,Both,,,90,113,96.05,32.3858,113,BlueCross BlueShield Minnesota, Federal Employee Program,111.192,98.4,,percent of total billed charges,,
Skeletal Muscle Relaxants (Mayo)OutsideLaboratory,,80369,CPT,Facility,Both,,,90,113,96.05,32.3858,113,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,113,100,,percent of total billed charges,,
Skeletal Muscle Relaxants (Mayo)OutsideLaboratory,,80369,CPT,Facility,Both,,,90,113,96.05,32.3858,113,BlueCross BlueShield Minnesota,High Value Network Plan,101.7,90,,percent of total billed charges,,
Skeletal Muscle Relaxants (Mayo)OutsideLaboratory,,80369,CPT,Facility,Outpatient,,,90,113,96.05,32.3858,113,BlueCross BlueShield Minnesota,Medicare Advantage,55.37,49,,percent of total billed charges,,
Skeletal Muscle Relaxants (Mayo)OutsideLaboratory,,80369,CPT,Facility,Inpatient,,,90,113,96.05,32.3858,113,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Skeletal Muscle Relaxants (Mayo)OutsideLaboratory,,80369,CPT,Facility,Both,,,90,113,96.05,32.3858,113,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,100.0841,88.57,,percent of total billed charges,,
Skeletal Muscle Relaxants (Mayo)OutsideLaboratory,,80369,CPT,Facility,Both,,,90,113,96.05,32.3858,113,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,32.3858,28.66,,percent of total billed charges,,
Skeletal Muscle Relaxants (Mayo)OutsideLaboratory,,80369,CPT,Facility,Outpatient,,,90,113,96.05,32.3858,113,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),55.37,49,,percent of total billed charges,,
Skeletal Muscle Relaxants (Mayo)OutsideLaboratory,,80369,CPT,Facility,Inpatient,,,90,113,96.05,32.3858,113,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Skeletal Muscle Relaxants (Mayo)OutsideLaboratory,,80369,CPT,Facility,Both,,,90,113,96.05,32.3858,113,CorVel,Worker's Compensation,113,100,,percent of total billed charges,,
Skeletal Muscle Relaxants (Mayo)OutsideLaboratory,,80369,CPT,Facility,Both,,,90,113,96.05,32.3858,113,First Health Group Corporation,First Health Network,109.61,97,,percent of total billed charges,,
Skeletal Muscle Relaxants (Mayo)OutsideLaboratory,,80369,CPT,Facility,Both,,,90,113,96.05,32.3858,113,"Health Partners, Inc.",Commercial,106.898,94.6,,percent of total billed charges,,
Skeletal Muscle Relaxants (Mayo)OutsideLaboratory,,80369,CPT,Facility,Outpatient,,,90,113,96.05,32.3858,113,"Health Partners, Inc.",Medicare Advantage,55.37,49,,percent of total billed charges,,
Skeletal Muscle Relaxants (Mayo)OutsideLaboratory,,80369,CPT,Facility,Inpatient,,,90,113,96.05,32.3858,113,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Skeletal Muscle Relaxants (Mayo)OutsideLaboratory,,80369,CPT,Facility,Both,,,90,113,96.05,32.3858,113,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),67.8,60,,percent of total billed charges,,
Skeletal Muscle Relaxants (Mayo)OutsideLaboratory,,80369,CPT,Facility,Both,,,90,113,96.05,32.3858,113,"Health Partners, Inc.",State of Minnesota Advantage Program,92.095,81.5,,percent of total billed charges,,
Skeletal Muscle Relaxants (Mayo)OutsideLaboratory,,80369,CPT,Facility,Both,,,90,113,96.05,32.3858,113,"Health Partners, Inc.",State Public Programs,56.5,50,,percent of total billed charges,,
Skeletal Muscle Relaxants (Mayo)OutsideLaboratory,,80369,CPT,Facility,Both,,,90,113,96.05,32.3858,113,Humana Insurance Company,Commercial PPO,107.35,95,,percent of total billed charges,,
Skeletal Muscle Relaxants (Mayo)OutsideLaboratory,,80369,CPT,Facility,Outpatient,,,90,113,96.05,32.3858,113,Humana Insurance Company,Medicare PPO,55.37,49,,percent of total billed charges,,
Skeletal Muscle Relaxants (Mayo)OutsideLaboratory,,80369,CPT,Facility,Inpatient,,,90,113,96.05,32.3858,113,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Skeletal Muscle Relaxants (Mayo)OutsideLaboratory,,80369,CPT,Facility,Both,,,90,113,96.05,32.3858,113,Medica,Individual & Family,111.983,99.1,,percent of total billed charges,,
Skeletal Muscle Relaxants (Mayo)OutsideLaboratory,,80369,CPT,Facility,Outpatient,,,90,113,96.05,32.3858,113,Medica,Medica Advantage Solution,56.274,49.8,,percent of total billed charges,,
Skeletal Muscle Relaxants (Mayo)OutsideLaboratory,,80369,CPT,Facility,Inpatient,,,90,113,96.05,32.3858,113,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Skeletal Muscle Relaxants (Mayo)OutsideLaboratory,,80369,CPT,Facility,Outpatient,,,90,113,96.05,32.3858,113,Medica,Medical Assistance,50.398,44.6,,percent of total billed charges,,
Skeletal Muscle Relaxants (Mayo)OutsideLaboratory,,80369,CPT,Facility,Inpatient,,,90,113,96.05,32.3858,113,Medica,Medical Assistance,,,,,Included in per diem rate,
Skeletal Muscle Relaxants (Mayo)OutsideLaboratory,,80369,CPT,Facility,Outpatient,,,90,113,96.05,32.3858,113,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,56.274,49.8,,percent of total billed charges,,
Skeletal Muscle Relaxants (Mayo)OutsideLaboratory,,80369,CPT,Facility,Inpatient,,,90,113,96.05,32.3858,113,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Skeletal Muscle Relaxants (Mayo)OutsideLaboratory,,80369,CPT,Facility,Both,,,90,113,96.05,32.3858,113,"Multiplan, Inc.","Multiplan, Inc.",106.22,94,,percent of total billed charges,,
Skeletal Muscle Relaxants (Mayo)OutsideLaboratory,,80369,CPT,Facility,Outpatient,,,90,113,96.05,32.3858,113,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,97.632,86.4,,percent of total billed charges,,
Skeletal Muscle Relaxants (Mayo)OutsideLaboratory,,80369,CPT,Facility,Inpatient,,,90,113,96.05,32.3858,113,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Skeletal Muscle Relaxants (Mayo)OutsideLaboratory,,80369,CPT,Facility,Both,,,90,113,96.05,32.3858,113,"Preferred One Administrative Services, INC.",PPO,111.418,98.6,,percent of total billed charges,,
Skeletal Muscle Relaxants (Mayo)OutsideLaboratory,,80369,CPT,Facility,Outpatient,,,90,113,96.05,32.3858,113,PrimeWest Health,Minnesota Senior Health Options (MSHO),58.1385,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Skeletal Muscle Relaxants (Mayo)OutsideLaboratory,,80369,CPT,Facility,Inpatient,,,90,113,96.05,32.3858,113,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Skeletal Muscle Relaxants (Mayo)OutsideLaboratory,,80369,CPT,Facility,Outpatient,,,90,113,96.05,32.3858,113,PrimeWest Health,MinnesotaCare,58.0368,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Skeletal Muscle Relaxants (Mayo)OutsideLaboratory,,80369,CPT,Facility,Inpatient,,,90,113,96.05,32.3858,113,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Skeletal Muscle Relaxants (Mayo)OutsideLaboratory,,80369,CPT,Facility,Both,,,90,113,96.05,32.3858,113,Sanford Health Plan,Sanford Health Plan,103.96,92,,percent of total billed charges,,
Skeletal Muscle Relaxants (Mayo)OutsideLaboratory,,80369,CPT,Facility,Outpatient,,,90,113,96.05,32.3858,113,"UCare Health, Inc.",Individual & Family Plan,63.6755,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Skeletal Muscle Relaxants (Mayo)OutsideLaboratory,,80369,CPT,Facility,Inpatient,,,90,113,96.05,32.3858,113,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Skeletal Muscle Relaxants (Mayo)OutsideLaboratory,,80369,CPT,Facility,Outpatient,,,90,113,96.05,32.3858,113,"UCare Health, Inc.",Medical Assistance,57.0311,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Skeletal Muscle Relaxants (Mayo)OutsideLaboratory,,80369,CPT,Facility,Inpatient,,,90,113,96.05,32.3858,113,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Skeletal Muscle Relaxants (Mayo)OutsideLaboratory,,80369,CPT,Facility,Outpatient,,,90,113,96.05,32.3858,113,"UCare Health, Inc.",Medicare Advantage,57.0311,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Skeletal Muscle Relaxants (Mayo)OutsideLaboratory,,80369,CPT,Facility,Inpatient,,,90,113,96.05,32.3858,113,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Skeletal Muscle Relaxants (Mayo)OutsideLaboratory,,80369,CPT,Facility,Outpatient,,,90,113,96.05,32.3858,113,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),57.0311,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Skeletal Muscle Relaxants (Mayo)OutsideLaboratory,,80369,CPT,Facility,Inpatient,,,90,113,96.05,32.3858,113,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Skeletal Muscle Relaxants (Mayo)OutsideLaboratory,,80369,CPT,Facility,Both,,,90,113,96.05,32.3858,113,UnitedHealthcare,Individual & Family,106.22,94,,percent of total billed charges,,
Skeletal Muscle Relaxants (Mayo)OutsideLaboratory,,80369,CPT,Facility,Outpatient,,,90,113,96.05,32.3858,113,UnitedHealthcare,Medicare Advantage,55.37,49,,percent of total billed charges,,
Skeletal Muscle Relaxants (Mayo)OutsideLaboratory,,80369,CPT,Facility,Inpatient,,,90,113,96.05,32.3858,113,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Skeletal Muscle Relaxants (Mayo)OutsideLaboratory,,80369,CPT,Facility,Outpatient,,,90,113,96.05,32.3858,113,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,54.24,48,,percent of total billed charges,,100% of DHS outpatient percentage
Skeletal Muscle Relaxants (Mayo)OutsideLaboratory,,80369,CPT,Facility,Inpatient,,,90,113,96.05,32.3858,113,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Tramadol And Metabolite, U (Mayo)OutsideLaboratory",,80373,CPT,Facility,Both,,,90,120,102,34.392,120,Aetna,Commercial,110.4,92,,percent of total billed charges,,
"Tramadol And Metabolite, U (Mayo)OutsideLaboratory",,80373,CPT,Facility,Outpatient,,,90,120,102,34.392,120,Aetna,Medicare Advantage,58.8,49,,percent of total billed charges,,
"Tramadol And Metabolite, U (Mayo)OutsideLaboratory",,80373,CPT,Facility,Inpatient,,,90,120,102,34.392,120,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Tramadol And Metabolite, U (Mayo)OutsideLaboratory",,80373,CPT,Facility,Both,,,90,120,102,34.392,120,Aetna,PPO,111.6,93,,percent of total billed charges,,
"Tramadol And Metabolite, U (Mayo)OutsideLaboratory",,80373,CPT,Facility,Both,,,90,120,102,34.392,120,America's PPO,America's PPO,115.236,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Tramadol And Metabolite, U (Mayo)OutsideLaboratory",,80373,CPT,Facility,Both,,,90,120,102,34.392,120,BlueCross BlueShield Minnesota, Federal Employee Program,118.08,98.4,,percent of total billed charges,,
"Tramadol And Metabolite, U (Mayo)OutsideLaboratory",,80373,CPT,Facility,Both,,,90,120,102,34.392,120,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,120,100,,percent of total billed charges,,
"Tramadol And Metabolite, U (Mayo)OutsideLaboratory",,80373,CPT,Facility,Both,,,90,120,102,34.392,120,BlueCross BlueShield Minnesota,High Value Network Plan,108,90,,percent of total billed charges,,
"Tramadol And Metabolite, U (Mayo)OutsideLaboratory",,80373,CPT,Facility,Outpatient,,,90,120,102,34.392,120,BlueCross BlueShield Minnesota,Medicare Advantage,58.8,49,,percent of total billed charges,,
"Tramadol And Metabolite, U (Mayo)OutsideLaboratory",,80373,CPT,Facility,Inpatient,,,90,120,102,34.392,120,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Tramadol And Metabolite, U (Mayo)OutsideLaboratory",,80373,CPT,Facility,Both,,,90,120,102,34.392,120,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,106.284,88.57,,percent of total billed charges,,
"Tramadol And Metabolite, U (Mayo)OutsideLaboratory",,80373,CPT,Facility,Both,,,90,120,102,34.392,120,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,34.392,28.66,,percent of total billed charges,,
"Tramadol And Metabolite, U (Mayo)OutsideLaboratory",,80373,CPT,Facility,Outpatient,,,90,120,102,34.392,120,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),58.8,49,,percent of total billed charges,,
"Tramadol And Metabolite, U (Mayo)OutsideLaboratory",,80373,CPT,Facility,Inpatient,,,90,120,102,34.392,120,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Tramadol And Metabolite, U (Mayo)OutsideLaboratory",,80373,CPT,Facility,Both,,,90,120,102,34.392,120,CorVel,Worker's Compensation,120,100,,percent of total billed charges,,
"Tramadol And Metabolite, U (Mayo)OutsideLaboratory",,80373,CPT,Facility,Both,,,90,120,102,34.392,120,First Health Group Corporation,First Health Network,116.4,97,,percent of total billed charges,,
"Tramadol And Metabolite, U (Mayo)OutsideLaboratory",,80373,CPT,Facility,Both,,,90,120,102,34.392,120,"Health Partners, Inc.",Commercial,113.52,94.6,,percent of total billed charges,,
"Tramadol And Metabolite, U (Mayo)OutsideLaboratory",,80373,CPT,Facility,Outpatient,,,90,120,102,34.392,120,"Health Partners, Inc.",Medicare Advantage,58.8,49,,percent of total billed charges,,
"Tramadol And Metabolite, U (Mayo)OutsideLaboratory",,80373,CPT,Facility,Inpatient,,,90,120,102,34.392,120,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Tramadol And Metabolite, U (Mayo)OutsideLaboratory",,80373,CPT,Facility,Both,,,90,120,102,34.392,120,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),72,60,,percent of total billed charges,,
"Tramadol And Metabolite, U (Mayo)OutsideLaboratory",,80373,CPT,Facility,Both,,,90,120,102,34.392,120,"Health Partners, Inc.",State of Minnesota Advantage Program,97.8,81.5,,percent of total billed charges,,
"Tramadol And Metabolite, U (Mayo)OutsideLaboratory",,80373,CPT,Facility,Both,,,90,120,102,34.392,120,"Health Partners, Inc.",State Public Programs,60,50,,percent of total billed charges,,
"Tramadol And Metabolite, U (Mayo)OutsideLaboratory",,80373,CPT,Facility,Both,,,90,120,102,34.392,120,Humana Insurance Company,Commercial PPO,114,95,,percent of total billed charges,,
"Tramadol And Metabolite, U (Mayo)OutsideLaboratory",,80373,CPT,Facility,Outpatient,,,90,120,102,34.392,120,Humana Insurance Company,Medicare PPO,58.8,49,,percent of total billed charges,,
"Tramadol And Metabolite, U (Mayo)OutsideLaboratory",,80373,CPT,Facility,Inpatient,,,90,120,102,34.392,120,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Tramadol And Metabolite, U (Mayo)OutsideLaboratory",,80373,CPT,Facility,Both,,,90,120,102,34.392,120,Medica,Individual & Family,118.92,99.1,,percent of total billed charges,,
"Tramadol And Metabolite, U (Mayo)OutsideLaboratory",,80373,CPT,Facility,Outpatient,,,90,120,102,34.392,120,Medica,Medica Advantage Solution,59.76,49.8,,percent of total billed charges,,
"Tramadol And Metabolite, U (Mayo)OutsideLaboratory",,80373,CPT,Facility,Inpatient,,,90,120,102,34.392,120,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Tramadol And Metabolite, U (Mayo)OutsideLaboratory",,80373,CPT,Facility,Outpatient,,,90,120,102,34.392,120,Medica,Medical Assistance,53.52,44.6,,percent of total billed charges,,
"Tramadol And Metabolite, U (Mayo)OutsideLaboratory",,80373,CPT,Facility,Inpatient,,,90,120,102,34.392,120,Medica,Medical Assistance,,,,,Included in per diem rate,
"Tramadol And Metabolite, U (Mayo)OutsideLaboratory",,80373,CPT,Facility,Outpatient,,,90,120,102,34.392,120,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,59.76,49.8,,percent of total billed charges,,
"Tramadol And Metabolite, U (Mayo)OutsideLaboratory",,80373,CPT,Facility,Inpatient,,,90,120,102,34.392,120,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Tramadol And Metabolite, U (Mayo)OutsideLaboratory",,80373,CPT,Facility,Both,,,90,120,102,34.392,120,"Multiplan, Inc.","Multiplan, Inc.",112.8,94,,percent of total billed charges,,
"Tramadol And Metabolite, U (Mayo)OutsideLaboratory",,80373,CPT,Facility,Outpatient,,,90,120,102,34.392,120,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,103.68,86.4,,percent of total billed charges,,
"Tramadol And Metabolite, U (Mayo)OutsideLaboratory",,80373,CPT,Facility,Inpatient,,,90,120,102,34.392,120,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Tramadol And Metabolite, U (Mayo)OutsideLaboratory",,80373,CPT,Facility,Both,,,90,120,102,34.392,120,"Preferred One Administrative Services, INC.",PPO,118.32,98.6,,percent of total billed charges,,
"Tramadol And Metabolite, U (Mayo)OutsideLaboratory",,80373,CPT,Facility,Outpatient,,,90,120,102,34.392,120,PrimeWest Health,Minnesota Senior Health Options (MSHO),61.74,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Tramadol And Metabolite, U (Mayo)OutsideLaboratory",,80373,CPT,Facility,Inpatient,,,90,120,102,34.392,120,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Tramadol And Metabolite, U (Mayo)OutsideLaboratory",,80373,CPT,Facility,Outpatient,,,90,120,102,34.392,120,PrimeWest Health,MinnesotaCare,61.632,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Tramadol And Metabolite, U (Mayo)OutsideLaboratory",,80373,CPT,Facility,Inpatient,,,90,120,102,34.392,120,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Tramadol And Metabolite, U (Mayo)OutsideLaboratory",,80373,CPT,Facility,Both,,,90,120,102,34.392,120,Sanford Health Plan,Sanford Health Plan,110.4,92,,percent of total billed charges,,
"Tramadol And Metabolite, U (Mayo)OutsideLaboratory",,80373,CPT,Facility,Outpatient,,,90,120,102,34.392,120,"UCare Health, Inc.",Individual & Family Plan,67.62,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Tramadol And Metabolite, U (Mayo)OutsideLaboratory",,80373,CPT,Facility,Inpatient,,,90,120,102,34.392,120,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Tramadol And Metabolite, U (Mayo)OutsideLaboratory",,80373,CPT,Facility,Outpatient,,,90,120,102,34.392,120,"UCare Health, Inc.",Medical Assistance,60.564,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Tramadol And Metabolite, U (Mayo)OutsideLaboratory",,80373,CPT,Facility,Inpatient,,,90,120,102,34.392,120,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Tramadol And Metabolite, U (Mayo)OutsideLaboratory",,80373,CPT,Facility,Outpatient,,,90,120,102,34.392,120,"UCare Health, Inc.",Medicare Advantage,60.564,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Tramadol And Metabolite, U (Mayo)OutsideLaboratory",,80373,CPT,Facility,Inpatient,,,90,120,102,34.392,120,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Tramadol And Metabolite, U (Mayo)OutsideLaboratory",,80373,CPT,Facility,Outpatient,,,90,120,102,34.392,120,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),60.564,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Tramadol And Metabolite, U (Mayo)OutsideLaboratory",,80373,CPT,Facility,Inpatient,,,90,120,102,34.392,120,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Tramadol And Metabolite, U (Mayo)OutsideLaboratory",,80373,CPT,Facility,Both,,,90,120,102,34.392,120,UnitedHealthcare,Individual & Family,112.8,94,,percent of total billed charges,,
"Tramadol And Metabolite, U (Mayo)OutsideLaboratory",,80373,CPT,Facility,Outpatient,,,90,120,102,34.392,120,UnitedHealthcare,Medicare Advantage,58.8,49,,percent of total billed charges,,
"Tramadol And Metabolite, U (Mayo)OutsideLaboratory",,80373,CPT,Facility,Inpatient,,,90,120,102,34.392,120,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Tramadol And Metabolite, U (Mayo)OutsideLaboratory",,80373,CPT,Facility,Outpatient,,,90,120,102,34.392,120,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,57.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Tramadol And Metabolite, U (Mayo)OutsideLaboratory",,80373,CPT,Facility,Inpatient,,,90,120,102,34.392,120,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Cystic Fibrosis, Cftr Gene, Variant Panel, Varies (Mayo)OutsideLaboratory",,81220,CPT,Facility,Both,,,90,400,340,114.64,400,Aetna,Commercial,368,92,,percent of total billed charges,,
"Cystic Fibrosis, Cftr Gene, Variant Panel, Varies (Mayo)OutsideLaboratory",,81220,CPT,Facility,Outpatient,,,90,400,340,114.64,400,Aetna,Medicare Advantage,196,49,,percent of total billed charges,,
"Cystic Fibrosis, Cftr Gene, Variant Panel, Varies (Mayo)OutsideLaboratory",,81220,CPT,Facility,Inpatient,,,90,400,340,114.64,400,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Cystic Fibrosis, Cftr Gene, Variant Panel, Varies (Mayo)OutsideLaboratory",,81220,CPT,Facility,Both,,,90,400,340,114.64,400,Aetna,PPO,372,93,,percent of total billed charges,,
"Cystic Fibrosis, Cftr Gene, Variant Panel, Varies (Mayo)OutsideLaboratory",,81220,CPT,Facility,Both,,,90,400,340,114.64,400,America's PPO,America's PPO,384.12,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Cystic Fibrosis, Cftr Gene, Variant Panel, Varies (Mayo)OutsideLaboratory",,81220,CPT,Facility,Both,,,90,400,340,114.64,400,BlueCross BlueShield Minnesota, Federal Employee Program,393.6,98.4,,percent of total billed charges,,
"Cystic Fibrosis, Cftr Gene, Variant Panel, Varies (Mayo)OutsideLaboratory",,81220,CPT,Facility,Both,,,90,400,340,114.64,400,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,400,100,,percent of total billed charges,,
"Cystic Fibrosis, Cftr Gene, Variant Panel, Varies (Mayo)OutsideLaboratory",,81220,CPT,Facility,Both,,,90,400,340,114.64,400,BlueCross BlueShield Minnesota,High Value Network Plan,360,90,,percent of total billed charges,,
"Cystic Fibrosis, Cftr Gene, Variant Panel, Varies (Mayo)OutsideLaboratory",,81220,CPT,Facility,Outpatient,,,90,400,340,114.64,400,BlueCross BlueShield Minnesota,Medicare Advantage,196,49,,percent of total billed charges,,
"Cystic Fibrosis, Cftr Gene, Variant Panel, Varies (Mayo)OutsideLaboratory",,81220,CPT,Facility,Inpatient,,,90,400,340,114.64,400,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Cystic Fibrosis, Cftr Gene, Variant Panel, Varies (Mayo)OutsideLaboratory",,81220,CPT,Facility,Both,,,90,400,340,114.64,400,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,354.28,88.57,,percent of total billed charges,,
"Cystic Fibrosis, Cftr Gene, Variant Panel, Varies (Mayo)OutsideLaboratory",,81220,CPT,Facility,Both,,,90,400,340,114.64,400,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,114.64,28.66,,percent of total billed charges,,
"Cystic Fibrosis, Cftr Gene, Variant Panel, Varies (Mayo)OutsideLaboratory",,81220,CPT,Facility,Outpatient,,,90,400,340,114.64,400,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),196,49,,percent of total billed charges,,
"Cystic Fibrosis, Cftr Gene, Variant Panel, Varies (Mayo)OutsideLaboratory",,81220,CPT,Facility,Inpatient,,,90,400,340,114.64,400,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Cystic Fibrosis, Cftr Gene, Variant Panel, Varies (Mayo)OutsideLaboratory",,81220,CPT,Facility,Both,,,90,400,340,114.64,400,CorVel,Worker's Compensation,400,100,,percent of total billed charges,,
"Cystic Fibrosis, Cftr Gene, Variant Panel, Varies (Mayo)OutsideLaboratory",,81220,CPT,Facility,Both,,,90,400,340,114.64,400,First Health Group Corporation,First Health Network,388,97,,percent of total billed charges,,
"Cystic Fibrosis, Cftr Gene, Variant Panel, Varies (Mayo)OutsideLaboratory",,81220,CPT,Facility,Both,,,90,400,340,114.64,400,"Health Partners, Inc.",Commercial,378.4,94.6,,percent of total billed charges,,
"Cystic Fibrosis, Cftr Gene, Variant Panel, Varies (Mayo)OutsideLaboratory",,81220,CPT,Facility,Outpatient,,,90,400,340,114.64,400,"Health Partners, Inc.",Medicare Advantage,196,49,,percent of total billed charges,,
"Cystic Fibrosis, Cftr Gene, Variant Panel, Varies (Mayo)OutsideLaboratory",,81220,CPT,Facility,Inpatient,,,90,400,340,114.64,400,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Cystic Fibrosis, Cftr Gene, Variant Panel, Varies (Mayo)OutsideLaboratory",,81220,CPT,Facility,Both,,,90,400,340,114.64,400,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),240,60,,percent of total billed charges,,
"Cystic Fibrosis, Cftr Gene, Variant Panel, Varies (Mayo)OutsideLaboratory",,81220,CPT,Facility,Both,,,90,400,340,114.64,400,"Health Partners, Inc.",State of Minnesota Advantage Program,326,81.5,,percent of total billed charges,,
"Cystic Fibrosis, Cftr Gene, Variant Panel, Varies (Mayo)OutsideLaboratory",,81220,CPT,Facility,Both,,,90,400,340,114.64,400,"Health Partners, Inc.",State Public Programs,200,50,,percent of total billed charges,,
"Cystic Fibrosis, Cftr Gene, Variant Panel, Varies (Mayo)OutsideLaboratory",,81220,CPT,Facility,Both,,,90,400,340,114.64,400,Humana Insurance Company,Commercial PPO,380,95,,percent of total billed charges,,
"Cystic Fibrosis, Cftr Gene, Variant Panel, Varies (Mayo)OutsideLaboratory",,81220,CPT,Facility,Outpatient,,,90,400,340,114.64,400,Humana Insurance Company,Medicare PPO,196,49,,percent of total billed charges,,
"Cystic Fibrosis, Cftr Gene, Variant Panel, Varies (Mayo)OutsideLaboratory",,81220,CPT,Facility,Inpatient,,,90,400,340,114.64,400,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Cystic Fibrosis, Cftr Gene, Variant Panel, Varies (Mayo)OutsideLaboratory",,81220,CPT,Facility,Both,,,90,400,340,114.64,400,Medica,Individual & Family,396.4,99.1,,percent of total billed charges,,
"Cystic Fibrosis, Cftr Gene, Variant Panel, Varies (Mayo)OutsideLaboratory",,81220,CPT,Facility,Outpatient,,,90,400,340,114.64,400,Medica,Medica Advantage Solution,199.2,49.8,,percent of total billed charges,,
"Cystic Fibrosis, Cftr Gene, Variant Panel, Varies (Mayo)OutsideLaboratory",,81220,CPT,Facility,Inpatient,,,90,400,340,114.64,400,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Cystic Fibrosis, Cftr Gene, Variant Panel, Varies (Mayo)OutsideLaboratory",,81220,CPT,Facility,Outpatient,,,90,400,340,114.64,400,Medica,Medical Assistance,178.4,44.6,,percent of total billed charges,,
"Cystic Fibrosis, Cftr Gene, Variant Panel, Varies (Mayo)OutsideLaboratory",,81220,CPT,Facility,Inpatient,,,90,400,340,114.64,400,Medica,Medical Assistance,,,,,Included in per diem rate,
"Cystic Fibrosis, Cftr Gene, Variant Panel, Varies (Mayo)OutsideLaboratory",,81220,CPT,Facility,Outpatient,,,90,400,340,114.64,400,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,199.2,49.8,,percent of total billed charges,,
"Cystic Fibrosis, Cftr Gene, Variant Panel, Varies (Mayo)OutsideLaboratory",,81220,CPT,Facility,Inpatient,,,90,400,340,114.64,400,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Cystic Fibrosis, Cftr Gene, Variant Panel, Varies (Mayo)OutsideLaboratory",,81220,CPT,Facility,Both,,,90,400,340,114.64,400,"Multiplan, Inc.","Multiplan, Inc.",376,94,,percent of total billed charges,,
"Cystic Fibrosis, Cftr Gene, Variant Panel, Varies (Mayo)OutsideLaboratory",,81220,CPT,Facility,Outpatient,,,90,400,340,114.64,400,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,345.6,86.4,,percent of total billed charges,,
"Cystic Fibrosis, Cftr Gene, Variant Panel, Varies (Mayo)OutsideLaboratory",,81220,CPT,Facility,Inpatient,,,90,400,340,114.64,400,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Cystic Fibrosis, Cftr Gene, Variant Panel, Varies (Mayo)OutsideLaboratory",,81220,CPT,Facility,Both,,,90,400,340,114.64,400,"Preferred One Administrative Services, INC.",PPO,394.4,98.6,,percent of total billed charges,,
"Cystic Fibrosis, Cftr Gene, Variant Panel, Varies (Mayo)OutsideLaboratory",,81220,CPT,Facility,Outpatient,,,90,400,340,114.64,400,PrimeWest Health,Minnesota Senior Health Options (MSHO),205.8,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Cystic Fibrosis, Cftr Gene, Variant Panel, Varies (Mayo)OutsideLaboratory",,81220,CPT,Facility,Inpatient,,,90,400,340,114.64,400,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Cystic Fibrosis, Cftr Gene, Variant Panel, Varies (Mayo)OutsideLaboratory",,81220,CPT,Facility,Outpatient,,,90,400,340,114.64,400,PrimeWest Health,MinnesotaCare,205.44,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Cystic Fibrosis, Cftr Gene, Variant Panel, Varies (Mayo)OutsideLaboratory",,81220,CPT,Facility,Inpatient,,,90,400,340,114.64,400,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Cystic Fibrosis, Cftr Gene, Variant Panel, Varies (Mayo)OutsideLaboratory",,81220,CPT,Facility,Both,,,90,400,340,114.64,400,Sanford Health Plan,Sanford Health Plan,368,92,,percent of total billed charges,,
"Cystic Fibrosis, Cftr Gene, Variant Panel, Varies (Mayo)OutsideLaboratory",,81220,CPT,Facility,Outpatient,,,90,400,340,114.64,400,"UCare Health, Inc.",Individual & Family Plan,225.4,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Cystic Fibrosis, Cftr Gene, Variant Panel, Varies (Mayo)OutsideLaboratory",,81220,CPT,Facility,Inpatient,,,90,400,340,114.64,400,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Cystic Fibrosis, Cftr Gene, Variant Panel, Varies (Mayo)OutsideLaboratory",,81220,CPT,Facility,Outpatient,,,90,400,340,114.64,400,"UCare Health, Inc.",Medical Assistance,201.88,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Cystic Fibrosis, Cftr Gene, Variant Panel, Varies (Mayo)OutsideLaboratory",,81220,CPT,Facility,Inpatient,,,90,400,340,114.64,400,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Cystic Fibrosis, Cftr Gene, Variant Panel, Varies (Mayo)OutsideLaboratory",,81220,CPT,Facility,Outpatient,,,90,400,340,114.64,400,"UCare Health, Inc.",Medicare Advantage,201.88,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Cystic Fibrosis, Cftr Gene, Variant Panel, Varies (Mayo)OutsideLaboratory",,81220,CPT,Facility,Inpatient,,,90,400,340,114.64,400,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Cystic Fibrosis, Cftr Gene, Variant Panel, Varies (Mayo)OutsideLaboratory",,81220,CPT,Facility,Outpatient,,,90,400,340,114.64,400,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),201.88,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Cystic Fibrosis, Cftr Gene, Variant Panel, Varies (Mayo)OutsideLaboratory",,81220,CPT,Facility,Inpatient,,,90,400,340,114.64,400,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Cystic Fibrosis, Cftr Gene, Variant Panel, Varies (Mayo)OutsideLaboratory",,81220,CPT,Facility,Both,,,90,400,340,114.64,400,UnitedHealthcare,Individual & Family,376,94,,percent of total billed charges,,
"Cystic Fibrosis, Cftr Gene, Variant Panel, Varies (Mayo)OutsideLaboratory",,81220,CPT,Facility,Outpatient,,,90,400,340,114.64,400,UnitedHealthcare,Medicare Advantage,196,49,,percent of total billed charges,,
"Cystic Fibrosis, Cftr Gene, Variant Panel, Varies (Mayo)OutsideLaboratory",,81220,CPT,Facility,Inpatient,,,90,400,340,114.64,400,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Cystic Fibrosis, Cftr Gene, Variant Panel, Varies (Mayo)OutsideLaboratory",,81220,CPT,Facility,Outpatient,,,90,400,340,114.64,400,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,192,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Cystic Fibrosis, Cftr Gene, Variant Panel, Varies (Mayo)OutsideLaboratory",,81220,CPT,Facility,Inpatient,,,90,400,340,114.64,400,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Cystic Fibrosis, Cftr Gene Analysis, Duplication/Deletion Variants (Mayo)OutsideLaboratory",,81222,CPT,Facility,Both,,,90,340,289,97.444,340,Aetna,Commercial,312.8,92,,percent of total billed charges,,
"Cystic Fibrosis, Cftr Gene Analysis, Duplication/Deletion Variants (Mayo)OutsideLaboratory",,81222,CPT,Facility,Outpatient,,,90,340,289,97.444,340,Aetna,Medicare Advantage,166.6,49,,percent of total billed charges,,
"Cystic Fibrosis, Cftr Gene Analysis, Duplication/Deletion Variants (Mayo)OutsideLaboratory",,81222,CPT,Facility,Inpatient,,,90,340,289,97.444,340,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Cystic Fibrosis, Cftr Gene Analysis, Duplication/Deletion Variants (Mayo)OutsideLaboratory",,81222,CPT,Facility,Both,,,90,340,289,97.444,340,Aetna,PPO,316.2,93,,percent of total billed charges,,
"Cystic Fibrosis, Cftr Gene Analysis, Duplication/Deletion Variants (Mayo)OutsideLaboratory",,81222,CPT,Facility,Both,,,90,340,289,97.444,340,America's PPO,America's PPO,326.502,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Cystic Fibrosis, Cftr Gene Analysis, Duplication/Deletion Variants (Mayo)OutsideLaboratory",,81222,CPT,Facility,Both,,,90,340,289,97.444,340,BlueCross BlueShield Minnesota, Federal Employee Program,334.56,98.4,,percent of total billed charges,,
"Cystic Fibrosis, Cftr Gene Analysis, Duplication/Deletion Variants (Mayo)OutsideLaboratory",,81222,CPT,Facility,Both,,,90,340,289,97.444,340,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,340,100,,percent of total billed charges,,
"Cystic Fibrosis, Cftr Gene Analysis, Duplication/Deletion Variants (Mayo)OutsideLaboratory",,81222,CPT,Facility,Both,,,90,340,289,97.444,340,BlueCross BlueShield Minnesota,High Value Network Plan,306,90,,percent of total billed charges,,
"Cystic Fibrosis, Cftr Gene Analysis, Duplication/Deletion Variants (Mayo)OutsideLaboratory",,81222,CPT,Facility,Outpatient,,,90,340,289,97.444,340,BlueCross BlueShield Minnesota,Medicare Advantage,166.6,49,,percent of total billed charges,,
"Cystic Fibrosis, Cftr Gene Analysis, Duplication/Deletion Variants (Mayo)OutsideLaboratory",,81222,CPT,Facility,Inpatient,,,90,340,289,97.444,340,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Cystic Fibrosis, Cftr Gene Analysis, Duplication/Deletion Variants (Mayo)OutsideLaboratory",,81222,CPT,Facility,Both,,,90,340,289,97.444,340,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,301.138,88.57,,percent of total billed charges,,
"Cystic Fibrosis, Cftr Gene Analysis, Duplication/Deletion Variants (Mayo)OutsideLaboratory",,81222,CPT,Facility,Both,,,90,340,289,97.444,340,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,97.444,28.66,,percent of total billed charges,,
"Cystic Fibrosis, Cftr Gene Analysis, Duplication/Deletion Variants (Mayo)OutsideLaboratory",,81222,CPT,Facility,Outpatient,,,90,340,289,97.444,340,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),166.6,49,,percent of total billed charges,,
"Cystic Fibrosis, Cftr Gene Analysis, Duplication/Deletion Variants (Mayo)OutsideLaboratory",,81222,CPT,Facility,Inpatient,,,90,340,289,97.444,340,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Cystic Fibrosis, Cftr Gene Analysis, Duplication/Deletion Variants (Mayo)OutsideLaboratory",,81222,CPT,Facility,Both,,,90,340,289,97.444,340,CorVel,Worker's Compensation,340,100,,percent of total billed charges,,
"Cystic Fibrosis, Cftr Gene Analysis, Duplication/Deletion Variants (Mayo)OutsideLaboratory",,81222,CPT,Facility,Both,,,90,340,289,97.444,340,First Health Group Corporation,First Health Network,329.8,97,,percent of total billed charges,,
"Cystic Fibrosis, Cftr Gene Analysis, Duplication/Deletion Variants (Mayo)OutsideLaboratory",,81222,CPT,Facility,Both,,,90,340,289,97.444,340,"Health Partners, Inc.",Commercial,321.64,94.6,,percent of total billed charges,,
"Cystic Fibrosis, Cftr Gene Analysis, Duplication/Deletion Variants (Mayo)OutsideLaboratory",,81222,CPT,Facility,Outpatient,,,90,340,289,97.444,340,"Health Partners, Inc.",Medicare Advantage,166.6,49,,percent of total billed charges,,
"Cystic Fibrosis, Cftr Gene Analysis, Duplication/Deletion Variants (Mayo)OutsideLaboratory",,81222,CPT,Facility,Inpatient,,,90,340,289,97.444,340,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Cystic Fibrosis, Cftr Gene Analysis, Duplication/Deletion Variants (Mayo)OutsideLaboratory",,81222,CPT,Facility,Both,,,90,340,289,97.444,340,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),204,60,,percent of total billed charges,,
"Cystic Fibrosis, Cftr Gene Analysis, Duplication/Deletion Variants (Mayo)OutsideLaboratory",,81222,CPT,Facility,Both,,,90,340,289,97.444,340,"Health Partners, Inc.",State of Minnesota Advantage Program,277.1,81.5,,percent of total billed charges,,
"Cystic Fibrosis, Cftr Gene Analysis, Duplication/Deletion Variants (Mayo)OutsideLaboratory",,81222,CPT,Facility,Both,,,90,340,289,97.444,340,"Health Partners, Inc.",State Public Programs,170,50,,percent of total billed charges,,
"Cystic Fibrosis, Cftr Gene Analysis, Duplication/Deletion Variants (Mayo)OutsideLaboratory",,81222,CPT,Facility,Both,,,90,340,289,97.444,340,Humana Insurance Company,Commercial PPO,323,95,,percent of total billed charges,,
"Cystic Fibrosis, Cftr Gene Analysis, Duplication/Deletion Variants (Mayo)OutsideLaboratory",,81222,CPT,Facility,Outpatient,,,90,340,289,97.444,340,Humana Insurance Company,Medicare PPO,166.6,49,,percent of total billed charges,,
"Cystic Fibrosis, Cftr Gene Analysis, Duplication/Deletion Variants (Mayo)OutsideLaboratory",,81222,CPT,Facility,Inpatient,,,90,340,289,97.444,340,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Cystic Fibrosis, Cftr Gene Analysis, Duplication/Deletion Variants (Mayo)OutsideLaboratory",,81222,CPT,Facility,Both,,,90,340,289,97.444,340,Medica,Individual & Family,336.94,99.1,,percent of total billed charges,,
"Cystic Fibrosis, Cftr Gene Analysis, Duplication/Deletion Variants (Mayo)OutsideLaboratory",,81222,CPT,Facility,Outpatient,,,90,340,289,97.444,340,Medica,Medica Advantage Solution,169.32,49.8,,percent of total billed charges,,
"Cystic Fibrosis, Cftr Gene Analysis, Duplication/Deletion Variants (Mayo)OutsideLaboratory",,81222,CPT,Facility,Inpatient,,,90,340,289,97.444,340,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Cystic Fibrosis, Cftr Gene Analysis, Duplication/Deletion Variants (Mayo)OutsideLaboratory",,81222,CPT,Facility,Outpatient,,,90,340,289,97.444,340,Medica,Medical Assistance,151.64,44.6,,percent of total billed charges,,
"Cystic Fibrosis, Cftr Gene Analysis, Duplication/Deletion Variants (Mayo)OutsideLaboratory",,81222,CPT,Facility,Inpatient,,,90,340,289,97.444,340,Medica,Medical Assistance,,,,,Included in per diem rate,
"Cystic Fibrosis, Cftr Gene Analysis, Duplication/Deletion Variants (Mayo)OutsideLaboratory",,81222,CPT,Facility,Outpatient,,,90,340,289,97.444,340,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,169.32,49.8,,percent of total billed charges,,
"Cystic Fibrosis, Cftr Gene Analysis, Duplication/Deletion Variants (Mayo)OutsideLaboratory",,81222,CPT,Facility,Inpatient,,,90,340,289,97.444,340,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Cystic Fibrosis, Cftr Gene Analysis, Duplication/Deletion Variants (Mayo)OutsideLaboratory",,81222,CPT,Facility,Both,,,90,340,289,97.444,340,"Multiplan, Inc.","Multiplan, Inc.",319.6,94,,percent of total billed charges,,
"Cystic Fibrosis, Cftr Gene Analysis, Duplication/Deletion Variants (Mayo)OutsideLaboratory",,81222,CPT,Facility,Outpatient,,,90,340,289,97.444,340,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,293.76,86.4,,percent of total billed charges,,
"Cystic Fibrosis, Cftr Gene Analysis, Duplication/Deletion Variants (Mayo)OutsideLaboratory",,81222,CPT,Facility,Inpatient,,,90,340,289,97.444,340,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Cystic Fibrosis, Cftr Gene Analysis, Duplication/Deletion Variants (Mayo)OutsideLaboratory",,81222,CPT,Facility,Both,,,90,340,289,97.444,340,"Preferred One Administrative Services, INC.",PPO,335.24,98.6,,percent of total billed charges,,
"Cystic Fibrosis, Cftr Gene Analysis, Duplication/Deletion Variants (Mayo)OutsideLaboratory",,81222,CPT,Facility,Outpatient,,,90,340,289,97.444,340,PrimeWest Health,Minnesota Senior Health Options (MSHO),174.93,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Cystic Fibrosis, Cftr Gene Analysis, Duplication/Deletion Variants (Mayo)OutsideLaboratory",,81222,CPT,Facility,Inpatient,,,90,340,289,97.444,340,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Cystic Fibrosis, Cftr Gene Analysis, Duplication/Deletion Variants (Mayo)OutsideLaboratory",,81222,CPT,Facility,Outpatient,,,90,340,289,97.444,340,PrimeWest Health,MinnesotaCare,174.624,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Cystic Fibrosis, Cftr Gene Analysis, Duplication/Deletion Variants (Mayo)OutsideLaboratory",,81222,CPT,Facility,Inpatient,,,90,340,289,97.444,340,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Cystic Fibrosis, Cftr Gene Analysis, Duplication/Deletion Variants (Mayo)OutsideLaboratory",,81222,CPT,Facility,Both,,,90,340,289,97.444,340,Sanford Health Plan,Sanford Health Plan,312.8,92,,percent of total billed charges,,
"Cystic Fibrosis, Cftr Gene Analysis, Duplication/Deletion Variants (Mayo)OutsideLaboratory",,81222,CPT,Facility,Outpatient,,,90,340,289,97.444,340,"UCare Health, Inc.",Individual & Family Plan,191.59,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Cystic Fibrosis, Cftr Gene Analysis, Duplication/Deletion Variants (Mayo)OutsideLaboratory",,81222,CPT,Facility,Inpatient,,,90,340,289,97.444,340,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Cystic Fibrosis, Cftr Gene Analysis, Duplication/Deletion Variants (Mayo)OutsideLaboratory",,81222,CPT,Facility,Outpatient,,,90,340,289,97.444,340,"UCare Health, Inc.",Medical Assistance,171.598,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Cystic Fibrosis, Cftr Gene Analysis, Duplication/Deletion Variants (Mayo)OutsideLaboratory",,81222,CPT,Facility,Inpatient,,,90,340,289,97.444,340,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Cystic Fibrosis, Cftr Gene Analysis, Duplication/Deletion Variants (Mayo)OutsideLaboratory",,81222,CPT,Facility,Outpatient,,,90,340,289,97.444,340,"UCare Health, Inc.",Medicare Advantage,171.598,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Cystic Fibrosis, Cftr Gene Analysis, Duplication/Deletion Variants (Mayo)OutsideLaboratory",,81222,CPT,Facility,Inpatient,,,90,340,289,97.444,340,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Cystic Fibrosis, Cftr Gene Analysis, Duplication/Deletion Variants (Mayo)OutsideLaboratory",,81222,CPT,Facility,Outpatient,,,90,340,289,97.444,340,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),171.598,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Cystic Fibrosis, Cftr Gene Analysis, Duplication/Deletion Variants (Mayo)OutsideLaboratory",,81222,CPT,Facility,Inpatient,,,90,340,289,97.444,340,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Cystic Fibrosis, Cftr Gene Analysis, Duplication/Deletion Variants (Mayo)OutsideLaboratory",,81222,CPT,Facility,Both,,,90,340,289,97.444,340,UnitedHealthcare,Individual & Family,319.6,94,,percent of total billed charges,,
"Cystic Fibrosis, Cftr Gene Analysis, Duplication/Deletion Variants (Mayo)OutsideLaboratory",,81222,CPT,Facility,Outpatient,,,90,340,289,97.444,340,UnitedHealthcare,Medicare Advantage,166.6,49,,percent of total billed charges,,
"Cystic Fibrosis, Cftr Gene Analysis, Duplication/Deletion Variants (Mayo)OutsideLaboratory",,81222,CPT,Facility,Inpatient,,,90,340,289,97.444,340,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Cystic Fibrosis, Cftr Gene Analysis, Duplication/Deletion Variants (Mayo)OutsideLaboratory",,81222,CPT,Facility,Outpatient,,,90,340,289,97.444,340,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,163.2,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Cystic Fibrosis, Cftr Gene Analysis, Duplication/Deletion Variants (Mayo)OutsideLaboratory",,81222,CPT,Facility,Inpatient,,,90,340,289,97.444,340,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Prothrombin G20210A Mutation, B (Mayo)OutsideLaboratory",,81240,CPT,Facility,Both,,,90,145,123.25,41.557,145,Aetna,Commercial,133.4,92,,percent of total billed charges,,
"Prothrombin G20210A Mutation, B (Mayo)OutsideLaboratory",,81240,CPT,Facility,Outpatient,,,90,145,123.25,41.557,145,Aetna,Medicare Advantage,71.05,49,,percent of total billed charges,,
"Prothrombin G20210A Mutation, B (Mayo)OutsideLaboratory",,81240,CPT,Facility,Inpatient,,,90,145,123.25,41.557,145,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Prothrombin G20210A Mutation, B (Mayo)OutsideLaboratory",,81240,CPT,Facility,Both,,,90,145,123.25,41.557,145,Aetna,PPO,134.85,93,,percent of total billed charges,,
"Prothrombin G20210A Mutation, B (Mayo)OutsideLaboratory",,81240,CPT,Facility,Both,,,90,145,123.25,41.557,145,America's PPO,America's PPO,139.2435,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Prothrombin G20210A Mutation, B (Mayo)OutsideLaboratory",,81240,CPT,Facility,Both,,,90,145,123.25,41.557,145,BlueCross BlueShield Minnesota, Federal Employee Program,142.68,98.4,,percent of total billed charges,,
"Prothrombin G20210A Mutation, B (Mayo)OutsideLaboratory",,81240,CPT,Facility,Both,,,90,145,123.25,41.557,145,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,145,100,,percent of total billed charges,,
"Prothrombin G20210A Mutation, B (Mayo)OutsideLaboratory",,81240,CPT,Facility,Both,,,90,145,123.25,41.557,145,BlueCross BlueShield Minnesota,High Value Network Plan,130.5,90,,percent of total billed charges,,
"Prothrombin G20210A Mutation, B (Mayo)OutsideLaboratory",,81240,CPT,Facility,Outpatient,,,90,145,123.25,41.557,145,BlueCross BlueShield Minnesota,Medicare Advantage,71.05,49,,percent of total billed charges,,
"Prothrombin G20210A Mutation, B (Mayo)OutsideLaboratory",,81240,CPT,Facility,Inpatient,,,90,145,123.25,41.557,145,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Prothrombin G20210A Mutation, B (Mayo)OutsideLaboratory",,81240,CPT,Facility,Both,,,90,145,123.25,41.557,145,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,128.4265,88.57,,percent of total billed charges,,
"Prothrombin G20210A Mutation, B (Mayo)OutsideLaboratory",,81240,CPT,Facility,Both,,,90,145,123.25,41.557,145,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,41.557,28.66,,percent of total billed charges,,
"Prothrombin G20210A Mutation, B (Mayo)OutsideLaboratory",,81240,CPT,Facility,Outpatient,,,90,145,123.25,41.557,145,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),71.05,49,,percent of total billed charges,,
"Prothrombin G20210A Mutation, B (Mayo)OutsideLaboratory",,81240,CPT,Facility,Inpatient,,,90,145,123.25,41.557,145,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Prothrombin G20210A Mutation, B (Mayo)OutsideLaboratory",,81240,CPT,Facility,Both,,,90,145,123.25,41.557,145,CorVel,Worker's Compensation,145,100,,percent of total billed charges,,
"Prothrombin G20210A Mutation, B (Mayo)OutsideLaboratory",,81240,CPT,Facility,Both,,,90,145,123.25,41.557,145,First Health Group Corporation,First Health Network,140.65,97,,percent of total billed charges,,
"Prothrombin G20210A Mutation, B (Mayo)OutsideLaboratory",,81240,CPT,Facility,Both,,,90,145,123.25,41.557,145,"Health Partners, Inc.",Commercial,137.17,94.6,,percent of total billed charges,,
"Prothrombin G20210A Mutation, B (Mayo)OutsideLaboratory",,81240,CPT,Facility,Outpatient,,,90,145,123.25,41.557,145,"Health Partners, Inc.",Medicare Advantage,71.05,49,,percent of total billed charges,,
"Prothrombin G20210A Mutation, B (Mayo)OutsideLaboratory",,81240,CPT,Facility,Inpatient,,,90,145,123.25,41.557,145,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Prothrombin G20210A Mutation, B (Mayo)OutsideLaboratory",,81240,CPT,Facility,Both,,,90,145,123.25,41.557,145,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),87,60,,percent of total billed charges,,
"Prothrombin G20210A Mutation, B (Mayo)OutsideLaboratory",,81240,CPT,Facility,Both,,,90,145,123.25,41.557,145,"Health Partners, Inc.",State of Minnesota Advantage Program,118.175,81.5,,percent of total billed charges,,
"Prothrombin G20210A Mutation, B (Mayo)OutsideLaboratory",,81240,CPT,Facility,Both,,,90,145,123.25,41.557,145,"Health Partners, Inc.",State Public Programs,72.5,50,,percent of total billed charges,,
"Prothrombin G20210A Mutation, B (Mayo)OutsideLaboratory",,81240,CPT,Facility,Both,,,90,145,123.25,41.557,145,Humana Insurance Company,Commercial PPO,137.75,95,,percent of total billed charges,,
"Prothrombin G20210A Mutation, B (Mayo)OutsideLaboratory",,81240,CPT,Facility,Outpatient,,,90,145,123.25,41.557,145,Humana Insurance Company,Medicare PPO,71.05,49,,percent of total billed charges,,
"Prothrombin G20210A Mutation, B (Mayo)OutsideLaboratory",,81240,CPT,Facility,Inpatient,,,90,145,123.25,41.557,145,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Prothrombin G20210A Mutation, B (Mayo)OutsideLaboratory",,81240,CPT,Facility,Both,,,90,145,123.25,41.557,145,Medica,Individual & Family,143.695,99.1,,percent of total billed charges,,
"Prothrombin G20210A Mutation, B (Mayo)OutsideLaboratory",,81240,CPT,Facility,Outpatient,,,90,145,123.25,41.557,145,Medica,Medica Advantage Solution,72.21,49.8,,percent of total billed charges,,
"Prothrombin G20210A Mutation, B (Mayo)OutsideLaboratory",,81240,CPT,Facility,Inpatient,,,90,145,123.25,41.557,145,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Prothrombin G20210A Mutation, B (Mayo)OutsideLaboratory",,81240,CPT,Facility,Outpatient,,,90,145,123.25,41.557,145,Medica,Medical Assistance,64.67,44.6,,percent of total billed charges,,
"Prothrombin G20210A Mutation, B (Mayo)OutsideLaboratory",,81240,CPT,Facility,Inpatient,,,90,145,123.25,41.557,145,Medica,Medical Assistance,,,,,Included in per diem rate,
"Prothrombin G20210A Mutation, B (Mayo)OutsideLaboratory",,81240,CPT,Facility,Outpatient,,,90,145,123.25,41.557,145,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,72.21,49.8,,percent of total billed charges,,
"Prothrombin G20210A Mutation, B (Mayo)OutsideLaboratory",,81240,CPT,Facility,Inpatient,,,90,145,123.25,41.557,145,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Prothrombin G20210A Mutation, B (Mayo)OutsideLaboratory",,81240,CPT,Facility,Both,,,90,145,123.25,41.557,145,"Multiplan, Inc.","Multiplan, Inc.",136.3,94,,percent of total billed charges,,
"Prothrombin G20210A Mutation, B (Mayo)OutsideLaboratory",,81240,CPT,Facility,Outpatient,,,90,145,123.25,41.557,145,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,125.28,86.4,,percent of total billed charges,,
"Prothrombin G20210A Mutation, B (Mayo)OutsideLaboratory",,81240,CPT,Facility,Inpatient,,,90,145,123.25,41.557,145,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Prothrombin G20210A Mutation, B (Mayo)OutsideLaboratory",,81240,CPT,Facility,Both,,,90,145,123.25,41.557,145,"Preferred One Administrative Services, INC.",PPO,142.97,98.6,,percent of total billed charges,,
"Prothrombin G20210A Mutation, B (Mayo)OutsideLaboratory",,81240,CPT,Facility,Outpatient,,,90,145,123.25,41.557,145,PrimeWest Health,Minnesota Senior Health Options (MSHO),74.6025,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Prothrombin G20210A Mutation, B (Mayo)OutsideLaboratory",,81240,CPT,Facility,Inpatient,,,90,145,123.25,41.557,145,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Prothrombin G20210A Mutation, B (Mayo)OutsideLaboratory",,81240,CPT,Facility,Outpatient,,,90,145,123.25,41.557,145,PrimeWest Health,MinnesotaCare,74.472,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Prothrombin G20210A Mutation, B (Mayo)OutsideLaboratory",,81240,CPT,Facility,Inpatient,,,90,145,123.25,41.557,145,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Prothrombin G20210A Mutation, B (Mayo)OutsideLaboratory",,81240,CPT,Facility,Both,,,90,145,123.25,41.557,145,Sanford Health Plan,Sanford Health Plan,133.4,92,,percent of total billed charges,,
"Prothrombin G20210A Mutation, B (Mayo)OutsideLaboratory",,81240,CPT,Facility,Outpatient,,,90,145,123.25,41.557,145,"UCare Health, Inc.",Individual & Family Plan,81.7075,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Prothrombin G20210A Mutation, B (Mayo)OutsideLaboratory",,81240,CPT,Facility,Inpatient,,,90,145,123.25,41.557,145,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Prothrombin G20210A Mutation, B (Mayo)OutsideLaboratory",,81240,CPT,Facility,Outpatient,,,90,145,123.25,41.557,145,"UCare Health, Inc.",Medical Assistance,73.1815,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Prothrombin G20210A Mutation, B (Mayo)OutsideLaboratory",,81240,CPT,Facility,Inpatient,,,90,145,123.25,41.557,145,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Prothrombin G20210A Mutation, B (Mayo)OutsideLaboratory",,81240,CPT,Facility,Outpatient,,,90,145,123.25,41.557,145,"UCare Health, Inc.",Medicare Advantage,73.1815,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Prothrombin G20210A Mutation, B (Mayo)OutsideLaboratory",,81240,CPT,Facility,Inpatient,,,90,145,123.25,41.557,145,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Prothrombin G20210A Mutation, B (Mayo)OutsideLaboratory",,81240,CPT,Facility,Outpatient,,,90,145,123.25,41.557,145,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),73.1815,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Prothrombin G20210A Mutation, B (Mayo)OutsideLaboratory",,81240,CPT,Facility,Inpatient,,,90,145,123.25,41.557,145,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Prothrombin G20210A Mutation, B (Mayo)OutsideLaboratory",,81240,CPT,Facility,Both,,,90,145,123.25,41.557,145,UnitedHealthcare,Individual & Family,136.3,94,,percent of total billed charges,,
"Prothrombin G20210A Mutation, B (Mayo)OutsideLaboratory",,81240,CPT,Facility,Outpatient,,,90,145,123.25,41.557,145,UnitedHealthcare,Medicare Advantage,71.05,49,,percent of total billed charges,,
"Prothrombin G20210A Mutation, B (Mayo)OutsideLaboratory",,81240,CPT,Facility,Inpatient,,,90,145,123.25,41.557,145,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Prothrombin G20210A Mutation, B (Mayo)OutsideLaboratory",,81240,CPT,Facility,Outpatient,,,90,145,123.25,41.557,145,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,69.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Prothrombin G20210A Mutation, B (Mayo)OutsideLaboratory",,81240,CPT,Facility,Inpatient,,,90,145,123.25,41.557,145,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Prothrombin Gene Analysis, G20210A Mutation, Blood (Mayo)OutsideLaboratory",,81240,CPT,Facility,Both,,,90,145,123.25,41.557,145,Aetna,Commercial,133.4,92,,percent of total billed charges,,
"Prothrombin Gene Analysis, G20210A Mutation, Blood (Mayo)OutsideLaboratory",,81240,CPT,Facility,Outpatient,,,90,145,123.25,41.557,145,Aetna,Medicare Advantage,71.05,49,,percent of total billed charges,,
"Prothrombin Gene Analysis, G20210A Mutation, Blood (Mayo)OutsideLaboratory",,81240,CPT,Facility,Inpatient,,,90,145,123.25,41.557,145,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Prothrombin Gene Analysis, G20210A Mutation, Blood (Mayo)OutsideLaboratory",,81240,CPT,Facility,Both,,,90,145,123.25,41.557,145,Aetna,PPO,134.85,93,,percent of total billed charges,,
"Prothrombin Gene Analysis, G20210A Mutation, Blood (Mayo)OutsideLaboratory",,81240,CPT,Facility,Both,,,90,145,123.25,41.557,145,America's PPO,America's PPO,139.2435,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Prothrombin Gene Analysis, G20210A Mutation, Blood (Mayo)OutsideLaboratory",,81240,CPT,Facility,Both,,,90,145,123.25,41.557,145,BlueCross BlueShield Minnesota, Federal Employee Program,142.68,98.4,,percent of total billed charges,,
"Prothrombin Gene Analysis, G20210A Mutation, Blood (Mayo)OutsideLaboratory",,81240,CPT,Facility,Both,,,90,145,123.25,41.557,145,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,145,100,,percent of total billed charges,,
"Prothrombin Gene Analysis, G20210A Mutation, Blood (Mayo)OutsideLaboratory",,81240,CPT,Facility,Both,,,90,145,123.25,41.557,145,BlueCross BlueShield Minnesota,High Value Network Plan,130.5,90,,percent of total billed charges,,
"Prothrombin Gene Analysis, G20210A Mutation, Blood (Mayo)OutsideLaboratory",,81240,CPT,Facility,Outpatient,,,90,145,123.25,41.557,145,BlueCross BlueShield Minnesota,Medicare Advantage,71.05,49,,percent of total billed charges,,
"Prothrombin Gene Analysis, G20210A Mutation, Blood (Mayo)OutsideLaboratory",,81240,CPT,Facility,Inpatient,,,90,145,123.25,41.557,145,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Prothrombin Gene Analysis, G20210A Mutation, Blood (Mayo)OutsideLaboratory",,81240,CPT,Facility,Both,,,90,145,123.25,41.557,145,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,128.4265,88.57,,percent of total billed charges,,
"Prothrombin Gene Analysis, G20210A Mutation, Blood (Mayo)OutsideLaboratory",,81240,CPT,Facility,Both,,,90,145,123.25,41.557,145,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,41.557,28.66,,percent of total billed charges,,
"Prothrombin Gene Analysis, G20210A Mutation, Blood (Mayo)OutsideLaboratory",,81240,CPT,Facility,Outpatient,,,90,145,123.25,41.557,145,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),71.05,49,,percent of total billed charges,,
"Prothrombin Gene Analysis, G20210A Mutation, Blood (Mayo)OutsideLaboratory",,81240,CPT,Facility,Inpatient,,,90,145,123.25,41.557,145,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Prothrombin Gene Analysis, G20210A Mutation, Blood (Mayo)OutsideLaboratory",,81240,CPT,Facility,Both,,,90,145,123.25,41.557,145,CorVel,Worker's Compensation,145,100,,percent of total billed charges,,
"Prothrombin Gene Analysis, G20210A Mutation, Blood (Mayo)OutsideLaboratory",,81240,CPT,Facility,Both,,,90,145,123.25,41.557,145,First Health Group Corporation,First Health Network,140.65,97,,percent of total billed charges,,
"Prothrombin Gene Analysis, G20210A Mutation, Blood (Mayo)OutsideLaboratory",,81240,CPT,Facility,Both,,,90,145,123.25,41.557,145,"Health Partners, Inc.",Commercial,137.17,94.6,,percent of total billed charges,,
"Prothrombin Gene Analysis, G20210A Mutation, Blood (Mayo)OutsideLaboratory",,81240,CPT,Facility,Outpatient,,,90,145,123.25,41.557,145,"Health Partners, Inc.",Medicare Advantage,71.05,49,,percent of total billed charges,,
"Prothrombin Gene Analysis, G20210A Mutation, Blood (Mayo)OutsideLaboratory",,81240,CPT,Facility,Inpatient,,,90,145,123.25,41.557,145,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Prothrombin Gene Analysis, G20210A Mutation, Blood (Mayo)OutsideLaboratory",,81240,CPT,Facility,Both,,,90,145,123.25,41.557,145,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),87,60,,percent of total billed charges,,
"Prothrombin Gene Analysis, G20210A Mutation, Blood (Mayo)OutsideLaboratory",,81240,CPT,Facility,Both,,,90,145,123.25,41.557,145,"Health Partners, Inc.",State of Minnesota Advantage Program,118.175,81.5,,percent of total billed charges,,
"Prothrombin Gene Analysis, G20210A Mutation, Blood (Mayo)OutsideLaboratory",,81240,CPT,Facility,Both,,,90,145,123.25,41.557,145,"Health Partners, Inc.",State Public Programs,72.5,50,,percent of total billed charges,,
"Prothrombin Gene Analysis, G20210A Mutation, Blood (Mayo)OutsideLaboratory",,81240,CPT,Facility,Both,,,90,145,123.25,41.557,145,Humana Insurance Company,Commercial PPO,137.75,95,,percent of total billed charges,,
"Prothrombin Gene Analysis, G20210A Mutation, Blood (Mayo)OutsideLaboratory",,81240,CPT,Facility,Outpatient,,,90,145,123.25,41.557,145,Humana Insurance Company,Medicare PPO,71.05,49,,percent of total billed charges,,
"Prothrombin Gene Analysis, G20210A Mutation, Blood (Mayo)OutsideLaboratory",,81240,CPT,Facility,Inpatient,,,90,145,123.25,41.557,145,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Prothrombin Gene Analysis, G20210A Mutation, Blood (Mayo)OutsideLaboratory",,81240,CPT,Facility,Both,,,90,145,123.25,41.557,145,Medica,Individual & Family,143.695,99.1,,percent of total billed charges,,
"Prothrombin Gene Analysis, G20210A Mutation, Blood (Mayo)OutsideLaboratory",,81240,CPT,Facility,Outpatient,,,90,145,123.25,41.557,145,Medica,Medica Advantage Solution,72.21,49.8,,percent of total billed charges,,
"Prothrombin Gene Analysis, G20210A Mutation, Blood (Mayo)OutsideLaboratory",,81240,CPT,Facility,Inpatient,,,90,145,123.25,41.557,145,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Prothrombin Gene Analysis, G20210A Mutation, Blood (Mayo)OutsideLaboratory",,81240,CPT,Facility,Outpatient,,,90,145,123.25,41.557,145,Medica,Medical Assistance,64.67,44.6,,percent of total billed charges,,
"Prothrombin Gene Analysis, G20210A Mutation, Blood (Mayo)OutsideLaboratory",,81240,CPT,Facility,Inpatient,,,90,145,123.25,41.557,145,Medica,Medical Assistance,,,,,Included in per diem rate,
"Prothrombin Gene Analysis, G20210A Mutation, Blood (Mayo)OutsideLaboratory",,81240,CPT,Facility,Outpatient,,,90,145,123.25,41.557,145,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,72.21,49.8,,percent of total billed charges,,
"Prothrombin Gene Analysis, G20210A Mutation, Blood (Mayo)OutsideLaboratory",,81240,CPT,Facility,Inpatient,,,90,145,123.25,41.557,145,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Prothrombin Gene Analysis, G20210A Mutation, Blood (Mayo)OutsideLaboratory",,81240,CPT,Facility,Both,,,90,145,123.25,41.557,145,"Multiplan, Inc.","Multiplan, Inc.",136.3,94,,percent of total billed charges,,
"Prothrombin Gene Analysis, G20210A Mutation, Blood (Mayo)OutsideLaboratory",,81240,CPT,Facility,Outpatient,,,90,145,123.25,41.557,145,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,125.28,86.4,,percent of total billed charges,,
"Prothrombin Gene Analysis, G20210A Mutation, Blood (Mayo)OutsideLaboratory",,81240,CPT,Facility,Inpatient,,,90,145,123.25,41.557,145,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Prothrombin Gene Analysis, G20210A Mutation, Blood (Mayo)OutsideLaboratory",,81240,CPT,Facility,Both,,,90,145,123.25,41.557,145,"Preferred One Administrative Services, INC.",PPO,142.97,98.6,,percent of total billed charges,,
"Prothrombin Gene Analysis, G20210A Mutation, Blood (Mayo)OutsideLaboratory",,81240,CPT,Facility,Outpatient,,,90,145,123.25,41.557,145,PrimeWest Health,Minnesota Senior Health Options (MSHO),74.6025,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Prothrombin Gene Analysis, G20210A Mutation, Blood (Mayo)OutsideLaboratory",,81240,CPT,Facility,Inpatient,,,90,145,123.25,41.557,145,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Prothrombin Gene Analysis, G20210A Mutation, Blood (Mayo)OutsideLaboratory",,81240,CPT,Facility,Outpatient,,,90,145,123.25,41.557,145,PrimeWest Health,MinnesotaCare,74.472,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Prothrombin Gene Analysis, G20210A Mutation, Blood (Mayo)OutsideLaboratory",,81240,CPT,Facility,Inpatient,,,90,145,123.25,41.557,145,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Prothrombin Gene Analysis, G20210A Mutation, Blood (Mayo)OutsideLaboratory",,81240,CPT,Facility,Both,,,90,145,123.25,41.557,145,Sanford Health Plan,Sanford Health Plan,133.4,92,,percent of total billed charges,,
"Prothrombin Gene Analysis, G20210A Mutation, Blood (Mayo)OutsideLaboratory",,81240,CPT,Facility,Outpatient,,,90,145,123.25,41.557,145,"UCare Health, Inc.",Individual & Family Plan,81.7075,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Prothrombin Gene Analysis, G20210A Mutation, Blood (Mayo)OutsideLaboratory",,81240,CPT,Facility,Inpatient,,,90,145,123.25,41.557,145,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Prothrombin Gene Analysis, G20210A Mutation, Blood (Mayo)OutsideLaboratory",,81240,CPT,Facility,Outpatient,,,90,145,123.25,41.557,145,"UCare Health, Inc.",Medical Assistance,73.1815,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Prothrombin Gene Analysis, G20210A Mutation, Blood (Mayo)OutsideLaboratory",,81240,CPT,Facility,Inpatient,,,90,145,123.25,41.557,145,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Prothrombin Gene Analysis, G20210A Mutation, Blood (Mayo)OutsideLaboratory",,81240,CPT,Facility,Outpatient,,,90,145,123.25,41.557,145,"UCare Health, Inc.",Medicare Advantage,73.1815,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Prothrombin Gene Analysis, G20210A Mutation, Blood (Mayo)OutsideLaboratory",,81240,CPT,Facility,Inpatient,,,90,145,123.25,41.557,145,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Prothrombin Gene Analysis, G20210A Mutation, Blood (Mayo)OutsideLaboratory",,81240,CPT,Facility,Outpatient,,,90,145,123.25,41.557,145,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),73.1815,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Prothrombin Gene Analysis, G20210A Mutation, Blood (Mayo)OutsideLaboratory",,81240,CPT,Facility,Inpatient,,,90,145,123.25,41.557,145,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Prothrombin Gene Analysis, G20210A Mutation, Blood (Mayo)OutsideLaboratory",,81240,CPT,Facility,Both,,,90,145,123.25,41.557,145,UnitedHealthcare,Individual & Family,136.3,94,,percent of total billed charges,,
"Prothrombin Gene Analysis, G20210A Mutation, Blood (Mayo)OutsideLaboratory",,81240,CPT,Facility,Outpatient,,,90,145,123.25,41.557,145,UnitedHealthcare,Medicare Advantage,71.05,49,,percent of total billed charges,,
"Prothrombin Gene Analysis, G20210A Mutation, Blood (Mayo)OutsideLaboratory",,81240,CPT,Facility,Inpatient,,,90,145,123.25,41.557,145,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Prothrombin Gene Analysis, G20210A Mutation, Blood (Mayo)OutsideLaboratory",,81240,CPT,Facility,Outpatient,,,90,145,123.25,41.557,145,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,69.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Prothrombin Gene Analysis, G20210A Mutation, Blood (Mayo)OutsideLaboratory",,81240,CPT,Facility,Inpatient,,,90,145,123.25,41.557,145,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Factor V Leiden (R506Q) Mutation, B (Mayo)OutsideLaboratory",,81241,CPT,Facility,Both,,,90,175,148.75,50.155,175,Aetna,Commercial,161,92,,percent of total billed charges,,
"Factor V Leiden (R506Q) Mutation, B (Mayo)OutsideLaboratory",,81241,CPT,Facility,Outpatient,,,90,175,148.75,50.155,175,Aetna,Medicare Advantage,85.75,49,,percent of total billed charges,,
"Factor V Leiden (R506Q) Mutation, B (Mayo)OutsideLaboratory",,81241,CPT,Facility,Inpatient,,,90,175,148.75,50.155,175,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Factor V Leiden (R506Q) Mutation, B (Mayo)OutsideLaboratory",,81241,CPT,Facility,Both,,,90,175,148.75,50.155,175,Aetna,PPO,162.75,93,,percent of total billed charges,,
"Factor V Leiden (R506Q) Mutation, B (Mayo)OutsideLaboratory",,81241,CPT,Facility,Both,,,90,175,148.75,50.155,175,America's PPO,America's PPO,168.0525,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Factor V Leiden (R506Q) Mutation, B (Mayo)OutsideLaboratory",,81241,CPT,Facility,Both,,,90,175,148.75,50.155,175,BlueCross BlueShield Minnesota, Federal Employee Program,172.2,98.4,,percent of total billed charges,,
"Factor V Leiden (R506Q) Mutation, B (Mayo)OutsideLaboratory",,81241,CPT,Facility,Both,,,90,175,148.75,50.155,175,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,175,100,,percent of total billed charges,,
"Factor V Leiden (R506Q) Mutation, B (Mayo)OutsideLaboratory",,81241,CPT,Facility,Both,,,90,175,148.75,50.155,175,BlueCross BlueShield Minnesota,High Value Network Plan,157.5,90,,percent of total billed charges,,
"Factor V Leiden (R506Q) Mutation, B (Mayo)OutsideLaboratory",,81241,CPT,Facility,Outpatient,,,90,175,148.75,50.155,175,BlueCross BlueShield Minnesota,Medicare Advantage,85.75,49,,percent of total billed charges,,
"Factor V Leiden (R506Q) Mutation, B (Mayo)OutsideLaboratory",,81241,CPT,Facility,Inpatient,,,90,175,148.75,50.155,175,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Factor V Leiden (R506Q) Mutation, B (Mayo)OutsideLaboratory",,81241,CPT,Facility,Both,,,90,175,148.75,50.155,175,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,154.9975,88.57,,percent of total billed charges,,
"Factor V Leiden (R506Q) Mutation, B (Mayo)OutsideLaboratory",,81241,CPT,Facility,Both,,,90,175,148.75,50.155,175,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,50.155,28.66,,percent of total billed charges,,
"Factor V Leiden (R506Q) Mutation, B (Mayo)OutsideLaboratory",,81241,CPT,Facility,Outpatient,,,90,175,148.75,50.155,175,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),85.75,49,,percent of total billed charges,,
"Factor V Leiden (R506Q) Mutation, B (Mayo)OutsideLaboratory",,81241,CPT,Facility,Inpatient,,,90,175,148.75,50.155,175,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Factor V Leiden (R506Q) Mutation, B (Mayo)OutsideLaboratory",,81241,CPT,Facility,Both,,,90,175,148.75,50.155,175,CorVel,Worker's Compensation,175,100,,percent of total billed charges,,
"Factor V Leiden (R506Q) Mutation, B (Mayo)OutsideLaboratory",,81241,CPT,Facility,Both,,,90,175,148.75,50.155,175,First Health Group Corporation,First Health Network,169.75,97,,percent of total billed charges,,
"Factor V Leiden (R506Q) Mutation, B (Mayo)OutsideLaboratory",,81241,CPT,Facility,Both,,,90,175,148.75,50.155,175,"Health Partners, Inc.",Commercial,165.55,94.6,,percent of total billed charges,,
"Factor V Leiden (R506Q) Mutation, B (Mayo)OutsideLaboratory",,81241,CPT,Facility,Outpatient,,,90,175,148.75,50.155,175,"Health Partners, Inc.",Medicare Advantage,85.75,49,,percent of total billed charges,,
"Factor V Leiden (R506Q) Mutation, B (Mayo)OutsideLaboratory",,81241,CPT,Facility,Inpatient,,,90,175,148.75,50.155,175,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Factor V Leiden (R506Q) Mutation, B (Mayo)OutsideLaboratory",,81241,CPT,Facility,Both,,,90,175,148.75,50.155,175,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),105,60,,percent of total billed charges,,
"Factor V Leiden (R506Q) Mutation, B (Mayo)OutsideLaboratory",,81241,CPT,Facility,Both,,,90,175,148.75,50.155,175,"Health Partners, Inc.",State of Minnesota Advantage Program,142.625,81.5,,percent of total billed charges,,
"Factor V Leiden (R506Q) Mutation, B (Mayo)OutsideLaboratory",,81241,CPT,Facility,Both,,,90,175,148.75,50.155,175,"Health Partners, Inc.",State Public Programs,87.5,50,,percent of total billed charges,,
"Factor V Leiden (R506Q) Mutation, B (Mayo)OutsideLaboratory",,81241,CPT,Facility,Both,,,90,175,148.75,50.155,175,Humana Insurance Company,Commercial PPO,166.25,95,,percent of total billed charges,,
"Factor V Leiden (R506Q) Mutation, B (Mayo)OutsideLaboratory",,81241,CPT,Facility,Outpatient,,,90,175,148.75,50.155,175,Humana Insurance Company,Medicare PPO,85.75,49,,percent of total billed charges,,
"Factor V Leiden (R506Q) Mutation, B (Mayo)OutsideLaboratory",,81241,CPT,Facility,Inpatient,,,90,175,148.75,50.155,175,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Factor V Leiden (R506Q) Mutation, B (Mayo)OutsideLaboratory",,81241,CPT,Facility,Both,,,90,175,148.75,50.155,175,Medica,Individual & Family,173.425,99.1,,percent of total billed charges,,
"Factor V Leiden (R506Q) Mutation, B (Mayo)OutsideLaboratory",,81241,CPT,Facility,Outpatient,,,90,175,148.75,50.155,175,Medica,Medica Advantage Solution,87.15,49.8,,percent of total billed charges,,
"Factor V Leiden (R506Q) Mutation, B (Mayo)OutsideLaboratory",,81241,CPT,Facility,Inpatient,,,90,175,148.75,50.155,175,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Factor V Leiden (R506Q) Mutation, B (Mayo)OutsideLaboratory",,81241,CPT,Facility,Outpatient,,,90,175,148.75,50.155,175,Medica,Medical Assistance,78.05,44.6,,percent of total billed charges,,
"Factor V Leiden (R506Q) Mutation, B (Mayo)OutsideLaboratory",,81241,CPT,Facility,Inpatient,,,90,175,148.75,50.155,175,Medica,Medical Assistance,,,,,Included in per diem rate,
"Factor V Leiden (R506Q) Mutation, B (Mayo)OutsideLaboratory",,81241,CPT,Facility,Outpatient,,,90,175,148.75,50.155,175,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,87.15,49.8,,percent of total billed charges,,
"Factor V Leiden (R506Q) Mutation, B (Mayo)OutsideLaboratory",,81241,CPT,Facility,Inpatient,,,90,175,148.75,50.155,175,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Factor V Leiden (R506Q) Mutation, B (Mayo)OutsideLaboratory",,81241,CPT,Facility,Both,,,90,175,148.75,50.155,175,"Multiplan, Inc.","Multiplan, Inc.",164.5,94,,percent of total billed charges,,
"Factor V Leiden (R506Q) Mutation, B (Mayo)OutsideLaboratory",,81241,CPT,Facility,Outpatient,,,90,175,148.75,50.155,175,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,151.2,86.4,,percent of total billed charges,,
"Factor V Leiden (R506Q) Mutation, B (Mayo)OutsideLaboratory",,81241,CPT,Facility,Inpatient,,,90,175,148.75,50.155,175,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Factor V Leiden (R506Q) Mutation, B (Mayo)OutsideLaboratory",,81241,CPT,Facility,Both,,,90,175,148.75,50.155,175,"Preferred One Administrative Services, INC.",PPO,172.55,98.6,,percent of total billed charges,,
"Factor V Leiden (R506Q) Mutation, B (Mayo)OutsideLaboratory",,81241,CPT,Facility,Outpatient,,,90,175,148.75,50.155,175,PrimeWest Health,Minnesota Senior Health Options (MSHO),90.0375,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Factor V Leiden (R506Q) Mutation, B (Mayo)OutsideLaboratory",,81241,CPT,Facility,Inpatient,,,90,175,148.75,50.155,175,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Factor V Leiden (R506Q) Mutation, B (Mayo)OutsideLaboratory",,81241,CPT,Facility,Outpatient,,,90,175,148.75,50.155,175,PrimeWest Health,MinnesotaCare,89.88,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Factor V Leiden (R506Q) Mutation, B (Mayo)OutsideLaboratory",,81241,CPT,Facility,Inpatient,,,90,175,148.75,50.155,175,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Factor V Leiden (R506Q) Mutation, B (Mayo)OutsideLaboratory",,81241,CPT,Facility,Both,,,90,175,148.75,50.155,175,Sanford Health Plan,Sanford Health Plan,161,92,,percent of total billed charges,,
"Factor V Leiden (R506Q) Mutation, B (Mayo)OutsideLaboratory",,81241,CPT,Facility,Outpatient,,,90,175,148.75,50.155,175,"UCare Health, Inc.",Individual & Family Plan,98.6125,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Factor V Leiden (R506Q) Mutation, B (Mayo)OutsideLaboratory",,81241,CPT,Facility,Inpatient,,,90,175,148.75,50.155,175,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Factor V Leiden (R506Q) Mutation, B (Mayo)OutsideLaboratory",,81241,CPT,Facility,Outpatient,,,90,175,148.75,50.155,175,"UCare Health, Inc.",Medical Assistance,88.3225,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Factor V Leiden (R506Q) Mutation, B (Mayo)OutsideLaboratory",,81241,CPT,Facility,Inpatient,,,90,175,148.75,50.155,175,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Factor V Leiden (R506Q) Mutation, B (Mayo)OutsideLaboratory",,81241,CPT,Facility,Outpatient,,,90,175,148.75,50.155,175,"UCare Health, Inc.",Medicare Advantage,88.3225,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Factor V Leiden (R506Q) Mutation, B (Mayo)OutsideLaboratory",,81241,CPT,Facility,Inpatient,,,90,175,148.75,50.155,175,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Factor V Leiden (R506Q) Mutation, B (Mayo)OutsideLaboratory",,81241,CPT,Facility,Outpatient,,,90,175,148.75,50.155,175,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),88.3225,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Factor V Leiden (R506Q) Mutation, B (Mayo)OutsideLaboratory",,81241,CPT,Facility,Inpatient,,,90,175,148.75,50.155,175,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Factor V Leiden (R506Q) Mutation, B (Mayo)OutsideLaboratory",,81241,CPT,Facility,Both,,,90,175,148.75,50.155,175,UnitedHealthcare,Individual & Family,164.5,94,,percent of total billed charges,,
"Factor V Leiden (R506Q) Mutation, B (Mayo)OutsideLaboratory",,81241,CPT,Facility,Outpatient,,,90,175,148.75,50.155,175,UnitedHealthcare,Medicare Advantage,85.75,49,,percent of total billed charges,,
"Factor V Leiden (R506Q) Mutation, B (Mayo)OutsideLaboratory",,81241,CPT,Facility,Inpatient,,,90,175,148.75,50.155,175,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Factor V Leiden (R506Q) Mutation, B (Mayo)OutsideLaboratory",,81241,CPT,Facility,Outpatient,,,90,175,148.75,50.155,175,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,84,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Factor V Leiden (R506Q) Mutation, B (Mayo)OutsideLaboratory",,81241,CPT,Facility,Inpatient,,,90,175,148.75,50.155,175,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Fragile X Syndrome, Mol. Analysis (Mayo)OutsideLaboratory",,81243,CPT,Facility,Both,,,90,783,665.55,224.4078,783,Aetna,Commercial,720.36,92,,percent of total billed charges,,
"Fragile X Syndrome, Mol. Analysis (Mayo)OutsideLaboratory",,81243,CPT,Facility,Outpatient,,,90,783,665.55,224.4078,783,Aetna,Medicare Advantage,383.67,49,,percent of total billed charges,,
"Fragile X Syndrome, Mol. Analysis (Mayo)OutsideLaboratory",,81243,CPT,Facility,Inpatient,,,90,783,665.55,224.4078,783,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Fragile X Syndrome, Mol. Analysis (Mayo)OutsideLaboratory",,81243,CPT,Facility,Both,,,90,783,665.55,224.4078,783,Aetna,PPO,728.19,93,,percent of total billed charges,,
"Fragile X Syndrome, Mol. Analysis (Mayo)OutsideLaboratory",,81243,CPT,Facility,Both,,,90,783,665.55,224.4078,783,America's PPO,America's PPO,751.9149,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Fragile X Syndrome, Mol. Analysis (Mayo)OutsideLaboratory",,81243,CPT,Facility,Both,,,90,783,665.55,224.4078,783,BlueCross BlueShield Minnesota, Federal Employee Program,770.472,98.4,,percent of total billed charges,,
"Fragile X Syndrome, Mol. Analysis (Mayo)OutsideLaboratory",,81243,CPT,Facility,Both,,,90,783,665.55,224.4078,783,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,783,100,,percent of total billed charges,,
"Fragile X Syndrome, Mol. Analysis (Mayo)OutsideLaboratory",,81243,CPT,Facility,Both,,,90,783,665.55,224.4078,783,BlueCross BlueShield Minnesota,High Value Network Plan,704.7,90,,percent of total billed charges,,
"Fragile X Syndrome, Mol. Analysis (Mayo)OutsideLaboratory",,81243,CPT,Facility,Outpatient,,,90,783,665.55,224.4078,783,BlueCross BlueShield Minnesota,Medicare Advantage,383.67,49,,percent of total billed charges,,
"Fragile X Syndrome, Mol. Analysis (Mayo)OutsideLaboratory",,81243,CPT,Facility,Inpatient,,,90,783,665.55,224.4078,783,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Fragile X Syndrome, Mol. Analysis (Mayo)OutsideLaboratory",,81243,CPT,Facility,Both,,,90,783,665.55,224.4078,783,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,693.5031,88.57,,percent of total billed charges,,
"Fragile X Syndrome, Mol. Analysis (Mayo)OutsideLaboratory",,81243,CPT,Facility,Both,,,90,783,665.55,224.4078,783,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,224.4078,28.66,,percent of total billed charges,,
"Fragile X Syndrome, Mol. Analysis (Mayo)OutsideLaboratory",,81243,CPT,Facility,Outpatient,,,90,783,665.55,224.4078,783,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),383.67,49,,percent of total billed charges,,
"Fragile X Syndrome, Mol. Analysis (Mayo)OutsideLaboratory",,81243,CPT,Facility,Inpatient,,,90,783,665.55,224.4078,783,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Fragile X Syndrome, Mol. Analysis (Mayo)OutsideLaboratory",,81243,CPT,Facility,Both,,,90,783,665.55,224.4078,783,CorVel,Worker's Compensation,783,100,,percent of total billed charges,,
"Fragile X Syndrome, Mol. Analysis (Mayo)OutsideLaboratory",,81243,CPT,Facility,Both,,,90,783,665.55,224.4078,783,First Health Group Corporation,First Health Network,759.51,97,,percent of total billed charges,,
"Fragile X Syndrome, Mol. Analysis (Mayo)OutsideLaboratory",,81243,CPT,Facility,Both,,,90,783,665.55,224.4078,783,"Health Partners, Inc.",Commercial,740.718,94.6,,percent of total billed charges,,
"Fragile X Syndrome, Mol. Analysis (Mayo)OutsideLaboratory",,81243,CPT,Facility,Outpatient,,,90,783,665.55,224.4078,783,"Health Partners, Inc.",Medicare Advantage,383.67,49,,percent of total billed charges,,
"Fragile X Syndrome, Mol. Analysis (Mayo)OutsideLaboratory",,81243,CPT,Facility,Inpatient,,,90,783,665.55,224.4078,783,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Fragile X Syndrome, Mol. Analysis (Mayo)OutsideLaboratory",,81243,CPT,Facility,Both,,,90,783,665.55,224.4078,783,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),469.8,60,,percent of total billed charges,,
"Fragile X Syndrome, Mol. Analysis (Mayo)OutsideLaboratory",,81243,CPT,Facility,Both,,,90,783,665.55,224.4078,783,"Health Partners, Inc.",State of Minnesota Advantage Program,638.145,81.5,,percent of total billed charges,,
"Fragile X Syndrome, Mol. Analysis (Mayo)OutsideLaboratory",,81243,CPT,Facility,Both,,,90,783,665.55,224.4078,783,"Health Partners, Inc.",State Public Programs,391.5,50,,percent of total billed charges,,
"Fragile X Syndrome, Mol. Analysis (Mayo)OutsideLaboratory",,81243,CPT,Facility,Both,,,90,783,665.55,224.4078,783,Humana Insurance Company,Commercial PPO,743.85,95,,percent of total billed charges,,
"Fragile X Syndrome, Mol. Analysis (Mayo)OutsideLaboratory",,81243,CPT,Facility,Outpatient,,,90,783,665.55,224.4078,783,Humana Insurance Company,Medicare PPO,383.67,49,,percent of total billed charges,,
"Fragile X Syndrome, Mol. Analysis (Mayo)OutsideLaboratory",,81243,CPT,Facility,Inpatient,,,90,783,665.55,224.4078,783,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Fragile X Syndrome, Mol. Analysis (Mayo)OutsideLaboratory",,81243,CPT,Facility,Both,,,90,783,665.55,224.4078,783,Medica,Individual & Family,775.953,99.1,,percent of total billed charges,,
"Fragile X Syndrome, Mol. Analysis (Mayo)OutsideLaboratory",,81243,CPT,Facility,Outpatient,,,90,783,665.55,224.4078,783,Medica,Medica Advantage Solution,389.934,49.8,,percent of total billed charges,,
"Fragile X Syndrome, Mol. Analysis (Mayo)OutsideLaboratory",,81243,CPT,Facility,Inpatient,,,90,783,665.55,224.4078,783,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Fragile X Syndrome, Mol. Analysis (Mayo)OutsideLaboratory",,81243,CPT,Facility,Outpatient,,,90,783,665.55,224.4078,783,Medica,Medical Assistance,349.218,44.6,,percent of total billed charges,,
"Fragile X Syndrome, Mol. Analysis (Mayo)OutsideLaboratory",,81243,CPT,Facility,Inpatient,,,90,783,665.55,224.4078,783,Medica,Medical Assistance,,,,,Included in per diem rate,
"Fragile X Syndrome, Mol. Analysis (Mayo)OutsideLaboratory",,81243,CPT,Facility,Outpatient,,,90,783,665.55,224.4078,783,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,389.934,49.8,,percent of total billed charges,,
"Fragile X Syndrome, Mol. Analysis (Mayo)OutsideLaboratory",,81243,CPT,Facility,Inpatient,,,90,783,665.55,224.4078,783,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Fragile X Syndrome, Mol. Analysis (Mayo)OutsideLaboratory",,81243,CPT,Facility,Both,,,90,783,665.55,224.4078,783,"Multiplan, Inc.","Multiplan, Inc.",736.02,94,,percent of total billed charges,,
"Fragile X Syndrome, Mol. Analysis (Mayo)OutsideLaboratory",,81243,CPT,Facility,Outpatient,,,90,783,665.55,224.4078,783,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,676.512,86.4,,percent of total billed charges,,
"Fragile X Syndrome, Mol. Analysis (Mayo)OutsideLaboratory",,81243,CPT,Facility,Inpatient,,,90,783,665.55,224.4078,783,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Fragile X Syndrome, Mol. Analysis (Mayo)OutsideLaboratory",,81243,CPT,Facility,Both,,,90,783,665.55,224.4078,783,"Preferred One Administrative Services, INC.",PPO,772.038,98.6,,percent of total billed charges,,
"Fragile X Syndrome, Mol. Analysis (Mayo)OutsideLaboratory",,81243,CPT,Facility,Outpatient,,,90,783,665.55,224.4078,783,PrimeWest Health,Minnesota Senior Health Options (MSHO),402.8535,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Fragile X Syndrome, Mol. Analysis (Mayo)OutsideLaboratory",,81243,CPT,Facility,Inpatient,,,90,783,665.55,224.4078,783,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Fragile X Syndrome, Mol. Analysis (Mayo)OutsideLaboratory",,81243,CPT,Facility,Outpatient,,,90,783,665.55,224.4078,783,PrimeWest Health,MinnesotaCare,402.1488,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Fragile X Syndrome, Mol. Analysis (Mayo)OutsideLaboratory",,81243,CPT,Facility,Inpatient,,,90,783,665.55,224.4078,783,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Fragile X Syndrome, Mol. Analysis (Mayo)OutsideLaboratory",,81243,CPT,Facility,Both,,,90,783,665.55,224.4078,783,Sanford Health Plan,Sanford Health Plan,720.36,92,,percent of total billed charges,,
"Fragile X Syndrome, Mol. Analysis (Mayo)OutsideLaboratory",,81243,CPT,Facility,Outpatient,,,90,783,665.55,224.4078,783,"UCare Health, Inc.",Individual & Family Plan,441.2205,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Fragile X Syndrome, Mol. Analysis (Mayo)OutsideLaboratory",,81243,CPT,Facility,Inpatient,,,90,783,665.55,224.4078,783,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Fragile X Syndrome, Mol. Analysis (Mayo)OutsideLaboratory",,81243,CPT,Facility,Outpatient,,,90,783,665.55,224.4078,783,"UCare Health, Inc.",Medical Assistance,395.1801,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Fragile X Syndrome, Mol. Analysis (Mayo)OutsideLaboratory",,81243,CPT,Facility,Inpatient,,,90,783,665.55,224.4078,783,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Fragile X Syndrome, Mol. Analysis (Mayo)OutsideLaboratory",,81243,CPT,Facility,Outpatient,,,90,783,665.55,224.4078,783,"UCare Health, Inc.",Medicare Advantage,395.1801,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Fragile X Syndrome, Mol. Analysis (Mayo)OutsideLaboratory",,81243,CPT,Facility,Inpatient,,,90,783,665.55,224.4078,783,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Fragile X Syndrome, Mol. Analysis (Mayo)OutsideLaboratory",,81243,CPT,Facility,Outpatient,,,90,783,665.55,224.4078,783,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),395.1801,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Fragile X Syndrome, Mol. Analysis (Mayo)OutsideLaboratory",,81243,CPT,Facility,Inpatient,,,90,783,665.55,224.4078,783,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Fragile X Syndrome, Mol. Analysis (Mayo)OutsideLaboratory",,81243,CPT,Facility,Both,,,90,783,665.55,224.4078,783,UnitedHealthcare,Individual & Family,736.02,94,,percent of total billed charges,,
"Fragile X Syndrome, Mol. Analysis (Mayo)OutsideLaboratory",,81243,CPT,Facility,Outpatient,,,90,783,665.55,224.4078,783,UnitedHealthcare,Medicare Advantage,383.67,49,,percent of total billed charges,,
"Fragile X Syndrome, Mol. Analysis (Mayo)OutsideLaboratory",,81243,CPT,Facility,Inpatient,,,90,783,665.55,224.4078,783,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Fragile X Syndrome, Mol. Analysis (Mayo)OutsideLaboratory",,81243,CPT,Facility,Outpatient,,,90,783,665.55,224.4078,783,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,375.84,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Fragile X Syndrome, Mol. Analysis (Mayo)OutsideLaboratory",,81243,CPT,Facility,Inpatient,,,90,783,665.55,224.4078,783,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Hemochromatosis Hfe Gene Analysis, B (Mayo)OutsideLaboratory",,81256,CPT,Facility,Both,,,90,485,412.25,139.001,485,Aetna,Commercial,446.2,92,,percent of total billed charges,,
"Hemochromatosis Hfe Gene Analysis, B (Mayo)OutsideLaboratory",,81256,CPT,Facility,Outpatient,,,90,485,412.25,139.001,485,Aetna,Medicare Advantage,237.65,49,,percent of total billed charges,,
"Hemochromatosis Hfe Gene Analysis, B (Mayo)OutsideLaboratory",,81256,CPT,Facility,Inpatient,,,90,485,412.25,139.001,485,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Hemochromatosis Hfe Gene Analysis, B (Mayo)OutsideLaboratory",,81256,CPT,Facility,Both,,,90,485,412.25,139.001,485,Aetna,PPO,451.05,93,,percent of total billed charges,,
"Hemochromatosis Hfe Gene Analysis, B (Mayo)OutsideLaboratory",,81256,CPT,Facility,Both,,,90,485,412.25,139.001,485,America's PPO,America's PPO,465.7455,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Hemochromatosis Hfe Gene Analysis, B (Mayo)OutsideLaboratory",,81256,CPT,Facility,Both,,,90,485,412.25,139.001,485,BlueCross BlueShield Minnesota, Federal Employee Program,477.24,98.4,,percent of total billed charges,,
"Hemochromatosis Hfe Gene Analysis, B (Mayo)OutsideLaboratory",,81256,CPT,Facility,Both,,,90,485,412.25,139.001,485,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,485,100,,percent of total billed charges,,
"Hemochromatosis Hfe Gene Analysis, B (Mayo)OutsideLaboratory",,81256,CPT,Facility,Both,,,90,485,412.25,139.001,485,BlueCross BlueShield Minnesota,High Value Network Plan,436.5,90,,percent of total billed charges,,
"Hemochromatosis Hfe Gene Analysis, B (Mayo)OutsideLaboratory",,81256,CPT,Facility,Outpatient,,,90,485,412.25,139.001,485,BlueCross BlueShield Minnesota,Medicare Advantage,237.65,49,,percent of total billed charges,,
"Hemochromatosis Hfe Gene Analysis, B (Mayo)OutsideLaboratory",,81256,CPT,Facility,Inpatient,,,90,485,412.25,139.001,485,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Hemochromatosis Hfe Gene Analysis, B (Mayo)OutsideLaboratory",,81256,CPT,Facility,Both,,,90,485,412.25,139.001,485,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,429.5645,88.57,,percent of total billed charges,,
"Hemochromatosis Hfe Gene Analysis, B (Mayo)OutsideLaboratory",,81256,CPT,Facility,Both,,,90,485,412.25,139.001,485,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,139.001,28.66,,percent of total billed charges,,
"Hemochromatosis Hfe Gene Analysis, B (Mayo)OutsideLaboratory",,81256,CPT,Facility,Outpatient,,,90,485,412.25,139.001,485,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),237.65,49,,percent of total billed charges,,
"Hemochromatosis Hfe Gene Analysis, B (Mayo)OutsideLaboratory",,81256,CPT,Facility,Inpatient,,,90,485,412.25,139.001,485,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Hemochromatosis Hfe Gene Analysis, B (Mayo)OutsideLaboratory",,81256,CPT,Facility,Both,,,90,485,412.25,139.001,485,CorVel,Worker's Compensation,485,100,,percent of total billed charges,,
"Hemochromatosis Hfe Gene Analysis, B (Mayo)OutsideLaboratory",,81256,CPT,Facility,Both,,,90,485,412.25,139.001,485,First Health Group Corporation,First Health Network,470.45,97,,percent of total billed charges,,
"Hemochromatosis Hfe Gene Analysis, B (Mayo)OutsideLaboratory",,81256,CPT,Facility,Both,,,90,485,412.25,139.001,485,"Health Partners, Inc.",Commercial,458.81,94.6,,percent of total billed charges,,
"Hemochromatosis Hfe Gene Analysis, B (Mayo)OutsideLaboratory",,81256,CPT,Facility,Outpatient,,,90,485,412.25,139.001,485,"Health Partners, Inc.",Medicare Advantage,237.65,49,,percent of total billed charges,,
"Hemochromatosis Hfe Gene Analysis, B (Mayo)OutsideLaboratory",,81256,CPT,Facility,Inpatient,,,90,485,412.25,139.001,485,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Hemochromatosis Hfe Gene Analysis, B (Mayo)OutsideLaboratory",,81256,CPT,Facility,Both,,,90,485,412.25,139.001,485,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),291,60,,percent of total billed charges,,
"Hemochromatosis Hfe Gene Analysis, B (Mayo)OutsideLaboratory",,81256,CPT,Facility,Both,,,90,485,412.25,139.001,485,"Health Partners, Inc.",State of Minnesota Advantage Program,395.275,81.5,,percent of total billed charges,,
"Hemochromatosis Hfe Gene Analysis, B (Mayo)OutsideLaboratory",,81256,CPT,Facility,Both,,,90,485,412.25,139.001,485,"Health Partners, Inc.",State Public Programs,242.5,50,,percent of total billed charges,,
"Hemochromatosis Hfe Gene Analysis, B (Mayo)OutsideLaboratory",,81256,CPT,Facility,Both,,,90,485,412.25,139.001,485,Humana Insurance Company,Commercial PPO,460.75,95,,percent of total billed charges,,
"Hemochromatosis Hfe Gene Analysis, B (Mayo)OutsideLaboratory",,81256,CPT,Facility,Outpatient,,,90,485,412.25,139.001,485,Humana Insurance Company,Medicare PPO,237.65,49,,percent of total billed charges,,
"Hemochromatosis Hfe Gene Analysis, B (Mayo)OutsideLaboratory",,81256,CPT,Facility,Inpatient,,,90,485,412.25,139.001,485,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Hemochromatosis Hfe Gene Analysis, B (Mayo)OutsideLaboratory",,81256,CPT,Facility,Both,,,90,485,412.25,139.001,485,Medica,Individual & Family,480.635,99.1,,percent of total billed charges,,
"Hemochromatosis Hfe Gene Analysis, B (Mayo)OutsideLaboratory",,81256,CPT,Facility,Outpatient,,,90,485,412.25,139.001,485,Medica,Medica Advantage Solution,241.53,49.8,,percent of total billed charges,,
"Hemochromatosis Hfe Gene Analysis, B (Mayo)OutsideLaboratory",,81256,CPT,Facility,Inpatient,,,90,485,412.25,139.001,485,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Hemochromatosis Hfe Gene Analysis, B (Mayo)OutsideLaboratory",,81256,CPT,Facility,Outpatient,,,90,485,412.25,139.001,485,Medica,Medical Assistance,216.31,44.6,,percent of total billed charges,,
"Hemochromatosis Hfe Gene Analysis, B (Mayo)OutsideLaboratory",,81256,CPT,Facility,Inpatient,,,90,485,412.25,139.001,485,Medica,Medical Assistance,,,,,Included in per diem rate,
"Hemochromatosis Hfe Gene Analysis, B (Mayo)OutsideLaboratory",,81256,CPT,Facility,Outpatient,,,90,485,412.25,139.001,485,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,241.53,49.8,,percent of total billed charges,,
"Hemochromatosis Hfe Gene Analysis, B (Mayo)OutsideLaboratory",,81256,CPT,Facility,Inpatient,,,90,485,412.25,139.001,485,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Hemochromatosis Hfe Gene Analysis, B (Mayo)OutsideLaboratory",,81256,CPT,Facility,Both,,,90,485,412.25,139.001,485,"Multiplan, Inc.","Multiplan, Inc.",455.9,94,,percent of total billed charges,,
"Hemochromatosis Hfe Gene Analysis, B (Mayo)OutsideLaboratory",,81256,CPT,Facility,Outpatient,,,90,485,412.25,139.001,485,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,419.04,86.4,,percent of total billed charges,,
"Hemochromatosis Hfe Gene Analysis, B (Mayo)OutsideLaboratory",,81256,CPT,Facility,Inpatient,,,90,485,412.25,139.001,485,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Hemochromatosis Hfe Gene Analysis, B (Mayo)OutsideLaboratory",,81256,CPT,Facility,Both,,,90,485,412.25,139.001,485,"Preferred One Administrative Services, INC.",PPO,478.21,98.6,,percent of total billed charges,,
"Hemochromatosis Hfe Gene Analysis, B (Mayo)OutsideLaboratory",,81256,CPT,Facility,Outpatient,,,90,485,412.25,139.001,485,PrimeWest Health,Minnesota Senior Health Options (MSHO),249.5325,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Hemochromatosis Hfe Gene Analysis, B (Mayo)OutsideLaboratory",,81256,CPT,Facility,Inpatient,,,90,485,412.25,139.001,485,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Hemochromatosis Hfe Gene Analysis, B (Mayo)OutsideLaboratory",,81256,CPT,Facility,Outpatient,,,90,485,412.25,139.001,485,PrimeWest Health,MinnesotaCare,249.096,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Hemochromatosis Hfe Gene Analysis, B (Mayo)OutsideLaboratory",,81256,CPT,Facility,Inpatient,,,90,485,412.25,139.001,485,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Hemochromatosis Hfe Gene Analysis, B (Mayo)OutsideLaboratory",,81256,CPT,Facility,Both,,,90,485,412.25,139.001,485,Sanford Health Plan,Sanford Health Plan,446.2,92,,percent of total billed charges,,
"Hemochromatosis Hfe Gene Analysis, B (Mayo)OutsideLaboratory",,81256,CPT,Facility,Outpatient,,,90,485,412.25,139.001,485,"UCare Health, Inc.",Individual & Family Plan,273.2975,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Hemochromatosis Hfe Gene Analysis, B (Mayo)OutsideLaboratory",,81256,CPT,Facility,Inpatient,,,90,485,412.25,139.001,485,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Hemochromatosis Hfe Gene Analysis, B (Mayo)OutsideLaboratory",,81256,CPT,Facility,Outpatient,,,90,485,412.25,139.001,485,"UCare Health, Inc.",Medical Assistance,244.7795,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Hemochromatosis Hfe Gene Analysis, B (Mayo)OutsideLaboratory",,81256,CPT,Facility,Inpatient,,,90,485,412.25,139.001,485,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Hemochromatosis Hfe Gene Analysis, B (Mayo)OutsideLaboratory",,81256,CPT,Facility,Outpatient,,,90,485,412.25,139.001,485,"UCare Health, Inc.",Medicare Advantage,244.7795,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Hemochromatosis Hfe Gene Analysis, B (Mayo)OutsideLaboratory",,81256,CPT,Facility,Inpatient,,,90,485,412.25,139.001,485,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Hemochromatosis Hfe Gene Analysis, B (Mayo)OutsideLaboratory",,81256,CPT,Facility,Outpatient,,,90,485,412.25,139.001,485,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),244.7795,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Hemochromatosis Hfe Gene Analysis, B (Mayo)OutsideLaboratory",,81256,CPT,Facility,Inpatient,,,90,485,412.25,139.001,485,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Hemochromatosis Hfe Gene Analysis, B (Mayo)OutsideLaboratory",,81256,CPT,Facility,Both,,,90,485,412.25,139.001,485,UnitedHealthcare,Individual & Family,455.9,94,,percent of total billed charges,,
"Hemochromatosis Hfe Gene Analysis, B (Mayo)OutsideLaboratory",,81256,CPT,Facility,Outpatient,,,90,485,412.25,139.001,485,UnitedHealthcare,Medicare Advantage,237.65,49,,percent of total billed charges,,
"Hemochromatosis Hfe Gene Analysis, B (Mayo)OutsideLaboratory",,81256,CPT,Facility,Inpatient,,,90,485,412.25,139.001,485,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Hemochromatosis Hfe Gene Analysis, B (Mayo)OutsideLaboratory",,81256,CPT,Facility,Outpatient,,,90,485,412.25,139.001,485,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,232.8,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Hemochromatosis Hfe Gene Analysis, B (Mayo)OutsideLaboratory",,81256,CPT,Facility,Inpatient,,,90,485,412.25,139.001,485,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Jak2 (Janus Kinase 2) Gene Analysis, P.Val617Phe (V617F) Variant (Mayo)OutsideLaboratory",,81270,CPT,Facility,Both,,,90,963,818.55,275.9958,963,Aetna,Commercial,885.96,92,,percent of total billed charges,,
"Jak2 (Janus Kinase 2) Gene Analysis, P.Val617Phe (V617F) Variant (Mayo)OutsideLaboratory",,81270,CPT,Facility,Outpatient,,,90,963,818.55,275.9958,963,Aetna,Medicare Advantage,471.87,49,,percent of total billed charges,,
"Jak2 (Janus Kinase 2) Gene Analysis, P.Val617Phe (V617F) Variant (Mayo)OutsideLaboratory",,81270,CPT,Facility,Inpatient,,,90,963,818.55,275.9958,963,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Jak2 (Janus Kinase 2) Gene Analysis, P.Val617Phe (V617F) Variant (Mayo)OutsideLaboratory",,81270,CPT,Facility,Both,,,90,963,818.55,275.9958,963,Aetna,PPO,895.59,93,,percent of total billed charges,,
"Jak2 (Janus Kinase 2) Gene Analysis, P.Val617Phe (V617F) Variant (Mayo)OutsideLaboratory",,81270,CPT,Facility,Both,,,90,963,818.55,275.9958,963,America's PPO,America's PPO,924.7689,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Jak2 (Janus Kinase 2) Gene Analysis, P.Val617Phe (V617F) Variant (Mayo)OutsideLaboratory",,81270,CPT,Facility,Both,,,90,963,818.55,275.9958,963,BlueCross BlueShield Minnesota, Federal Employee Program,947.592,98.4,,percent of total billed charges,,
"Jak2 (Janus Kinase 2) Gene Analysis, P.Val617Phe (V617F) Variant (Mayo)OutsideLaboratory",,81270,CPT,Facility,Both,,,90,963,818.55,275.9958,963,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,963,100,,percent of total billed charges,,
"Jak2 (Janus Kinase 2) Gene Analysis, P.Val617Phe (V617F) Variant (Mayo)OutsideLaboratory",,81270,CPT,Facility,Both,,,90,963,818.55,275.9958,963,BlueCross BlueShield Minnesota,High Value Network Plan,866.7,90,,percent of total billed charges,,
"Jak2 (Janus Kinase 2) Gene Analysis, P.Val617Phe (V617F) Variant (Mayo)OutsideLaboratory",,81270,CPT,Facility,Outpatient,,,90,963,818.55,275.9958,963,BlueCross BlueShield Minnesota,Medicare Advantage,471.87,49,,percent of total billed charges,,
"Jak2 (Janus Kinase 2) Gene Analysis, P.Val617Phe (V617F) Variant (Mayo)OutsideLaboratory",,81270,CPT,Facility,Inpatient,,,90,963,818.55,275.9958,963,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Jak2 (Janus Kinase 2) Gene Analysis, P.Val617Phe (V617F) Variant (Mayo)OutsideLaboratory",,81270,CPT,Facility,Both,,,90,963,818.55,275.9958,963,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,852.9291,88.57,,percent of total billed charges,,
"Jak2 (Janus Kinase 2) Gene Analysis, P.Val617Phe (V617F) Variant (Mayo)OutsideLaboratory",,81270,CPT,Facility,Both,,,90,963,818.55,275.9958,963,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,275.9958,28.66,,percent of total billed charges,,
"Jak2 (Janus Kinase 2) Gene Analysis, P.Val617Phe (V617F) Variant (Mayo)OutsideLaboratory",,81270,CPT,Facility,Outpatient,,,90,963,818.55,275.9958,963,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),471.87,49,,percent of total billed charges,,
"Jak2 (Janus Kinase 2) Gene Analysis, P.Val617Phe (V617F) Variant (Mayo)OutsideLaboratory",,81270,CPT,Facility,Inpatient,,,90,963,818.55,275.9958,963,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Jak2 (Janus Kinase 2) Gene Analysis, P.Val617Phe (V617F) Variant (Mayo)OutsideLaboratory",,81270,CPT,Facility,Both,,,90,963,818.55,275.9958,963,CorVel,Worker's Compensation,963,100,,percent of total billed charges,,
"Jak2 (Janus Kinase 2) Gene Analysis, P.Val617Phe (V617F) Variant (Mayo)OutsideLaboratory",,81270,CPT,Facility,Both,,,90,963,818.55,275.9958,963,First Health Group Corporation,First Health Network,934.11,97,,percent of total billed charges,,
"Jak2 (Janus Kinase 2) Gene Analysis, P.Val617Phe (V617F) Variant (Mayo)OutsideLaboratory",,81270,CPT,Facility,Both,,,90,963,818.55,275.9958,963,"Health Partners, Inc.",Commercial,910.998,94.6,,percent of total billed charges,,
"Jak2 (Janus Kinase 2) Gene Analysis, P.Val617Phe (V617F) Variant (Mayo)OutsideLaboratory",,81270,CPT,Facility,Outpatient,,,90,963,818.55,275.9958,963,"Health Partners, Inc.",Medicare Advantage,471.87,49,,percent of total billed charges,,
"Jak2 (Janus Kinase 2) Gene Analysis, P.Val617Phe (V617F) Variant (Mayo)OutsideLaboratory",,81270,CPT,Facility,Inpatient,,,90,963,818.55,275.9958,963,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Jak2 (Janus Kinase 2) Gene Analysis, P.Val617Phe (V617F) Variant (Mayo)OutsideLaboratory",,81270,CPT,Facility,Both,,,90,963,818.55,275.9958,963,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),577.8,60,,percent of total billed charges,,
"Jak2 (Janus Kinase 2) Gene Analysis, P.Val617Phe (V617F) Variant (Mayo)OutsideLaboratory",,81270,CPT,Facility,Both,,,90,963,818.55,275.9958,963,"Health Partners, Inc.",State of Minnesota Advantage Program,784.845,81.5,,percent of total billed charges,,
"Jak2 (Janus Kinase 2) Gene Analysis, P.Val617Phe (V617F) Variant (Mayo)OutsideLaboratory",,81270,CPT,Facility,Both,,,90,963,818.55,275.9958,963,"Health Partners, Inc.",State Public Programs,481.5,50,,percent of total billed charges,,
"Jak2 (Janus Kinase 2) Gene Analysis, P.Val617Phe (V617F) Variant (Mayo)OutsideLaboratory",,81270,CPT,Facility,Both,,,90,963,818.55,275.9958,963,Humana Insurance Company,Commercial PPO,914.85,95,,percent of total billed charges,,
"Jak2 (Janus Kinase 2) Gene Analysis, P.Val617Phe (V617F) Variant (Mayo)OutsideLaboratory",,81270,CPT,Facility,Outpatient,,,90,963,818.55,275.9958,963,Humana Insurance Company,Medicare PPO,471.87,49,,percent of total billed charges,,
"Jak2 (Janus Kinase 2) Gene Analysis, P.Val617Phe (V617F) Variant (Mayo)OutsideLaboratory",,81270,CPT,Facility,Inpatient,,,90,963,818.55,275.9958,963,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Jak2 (Janus Kinase 2) Gene Analysis, P.Val617Phe (V617F) Variant (Mayo)OutsideLaboratory",,81270,CPT,Facility,Both,,,90,963,818.55,275.9958,963,Medica,Individual & Family,954.333,99.1,,percent of total billed charges,,
"Jak2 (Janus Kinase 2) Gene Analysis, P.Val617Phe (V617F) Variant (Mayo)OutsideLaboratory",,81270,CPT,Facility,Outpatient,,,90,963,818.55,275.9958,963,Medica,Medica Advantage Solution,479.574,49.8,,percent of total billed charges,,
"Jak2 (Janus Kinase 2) Gene Analysis, P.Val617Phe (V617F) Variant (Mayo)OutsideLaboratory",,81270,CPT,Facility,Inpatient,,,90,963,818.55,275.9958,963,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Jak2 (Janus Kinase 2) Gene Analysis, P.Val617Phe (V617F) Variant (Mayo)OutsideLaboratory",,81270,CPT,Facility,Outpatient,,,90,963,818.55,275.9958,963,Medica,Medical Assistance,429.498,44.6,,percent of total billed charges,,
"Jak2 (Janus Kinase 2) Gene Analysis, P.Val617Phe (V617F) Variant (Mayo)OutsideLaboratory",,81270,CPT,Facility,Inpatient,,,90,963,818.55,275.9958,963,Medica,Medical Assistance,,,,,Included in per diem rate,
"Jak2 (Janus Kinase 2) Gene Analysis, P.Val617Phe (V617F) Variant (Mayo)OutsideLaboratory",,81270,CPT,Facility,Outpatient,,,90,963,818.55,275.9958,963,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,479.574,49.8,,percent of total billed charges,,
"Jak2 (Janus Kinase 2) Gene Analysis, P.Val617Phe (V617F) Variant (Mayo)OutsideLaboratory",,81270,CPT,Facility,Inpatient,,,90,963,818.55,275.9958,963,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Jak2 (Janus Kinase 2) Gene Analysis, P.Val617Phe (V617F) Variant (Mayo)OutsideLaboratory",,81270,CPT,Facility,Both,,,90,963,818.55,275.9958,963,"Multiplan, Inc.","Multiplan, Inc.",905.22,94,,percent of total billed charges,,
"Jak2 (Janus Kinase 2) Gene Analysis, P.Val617Phe (V617F) Variant (Mayo)OutsideLaboratory",,81270,CPT,Facility,Outpatient,,,90,963,818.55,275.9958,963,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,832.032,86.4,,percent of total billed charges,,
"Jak2 (Janus Kinase 2) Gene Analysis, P.Val617Phe (V617F) Variant (Mayo)OutsideLaboratory",,81270,CPT,Facility,Inpatient,,,90,963,818.55,275.9958,963,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Jak2 (Janus Kinase 2) Gene Analysis, P.Val617Phe (V617F) Variant (Mayo)OutsideLaboratory",,81270,CPT,Facility,Both,,,90,963,818.55,275.9958,963,"Preferred One Administrative Services, INC.",PPO,949.518,98.6,,percent of total billed charges,,
"Jak2 (Janus Kinase 2) Gene Analysis, P.Val617Phe (V617F) Variant (Mayo)OutsideLaboratory",,81270,CPT,Facility,Outpatient,,,90,963,818.55,275.9958,963,PrimeWest Health,Minnesota Senior Health Options (MSHO),495.4635,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Jak2 (Janus Kinase 2) Gene Analysis, P.Val617Phe (V617F) Variant (Mayo)OutsideLaboratory",,81270,CPT,Facility,Inpatient,,,90,963,818.55,275.9958,963,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Jak2 (Janus Kinase 2) Gene Analysis, P.Val617Phe (V617F) Variant (Mayo)OutsideLaboratory",,81270,CPT,Facility,Outpatient,,,90,963,818.55,275.9958,963,PrimeWest Health,MinnesotaCare,494.5968,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Jak2 (Janus Kinase 2) Gene Analysis, P.Val617Phe (V617F) Variant (Mayo)OutsideLaboratory",,81270,CPT,Facility,Inpatient,,,90,963,818.55,275.9958,963,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Jak2 (Janus Kinase 2) Gene Analysis, P.Val617Phe (V617F) Variant (Mayo)OutsideLaboratory",,81270,CPT,Facility,Both,,,90,963,818.55,275.9958,963,Sanford Health Plan,Sanford Health Plan,885.96,92,,percent of total billed charges,,
"Jak2 (Janus Kinase 2) Gene Analysis, P.Val617Phe (V617F) Variant (Mayo)OutsideLaboratory",,81270,CPT,Facility,Outpatient,,,90,963,818.55,275.9958,963,"UCare Health, Inc.",Individual & Family Plan,542.6505,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Jak2 (Janus Kinase 2) Gene Analysis, P.Val617Phe (V617F) Variant (Mayo)OutsideLaboratory",,81270,CPT,Facility,Inpatient,,,90,963,818.55,275.9958,963,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Jak2 (Janus Kinase 2) Gene Analysis, P.Val617Phe (V617F) Variant (Mayo)OutsideLaboratory",,81270,CPT,Facility,Outpatient,,,90,963,818.55,275.9958,963,"UCare Health, Inc.",Medical Assistance,486.0261,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Jak2 (Janus Kinase 2) Gene Analysis, P.Val617Phe (V617F) Variant (Mayo)OutsideLaboratory",,81270,CPT,Facility,Inpatient,,,90,963,818.55,275.9958,963,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Jak2 (Janus Kinase 2) Gene Analysis, P.Val617Phe (V617F) Variant (Mayo)OutsideLaboratory",,81270,CPT,Facility,Outpatient,,,90,963,818.55,275.9958,963,"UCare Health, Inc.",Medicare Advantage,486.0261,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Jak2 (Janus Kinase 2) Gene Analysis, P.Val617Phe (V617F) Variant (Mayo)OutsideLaboratory",,81270,CPT,Facility,Inpatient,,,90,963,818.55,275.9958,963,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Jak2 (Janus Kinase 2) Gene Analysis, P.Val617Phe (V617F) Variant (Mayo)OutsideLaboratory",,81270,CPT,Facility,Outpatient,,,90,963,818.55,275.9958,963,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),486.0261,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Jak2 (Janus Kinase 2) Gene Analysis, P.Val617Phe (V617F) Variant (Mayo)OutsideLaboratory",,81270,CPT,Facility,Inpatient,,,90,963,818.55,275.9958,963,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Jak2 (Janus Kinase 2) Gene Analysis, P.Val617Phe (V617F) Variant (Mayo)OutsideLaboratory",,81270,CPT,Facility,Both,,,90,963,818.55,275.9958,963,UnitedHealthcare,Individual & Family,905.22,94,,percent of total billed charges,,
"Jak2 (Janus Kinase 2) Gene Analysis, P.Val617Phe (V617F) Variant (Mayo)OutsideLaboratory",,81270,CPT,Facility,Outpatient,,,90,963,818.55,275.9958,963,UnitedHealthcare,Medicare Advantage,471.87,49,,percent of total billed charges,,
"Jak2 (Janus Kinase 2) Gene Analysis, P.Val617Phe (V617F) Variant (Mayo)OutsideLaboratory",,81270,CPT,Facility,Inpatient,,,90,963,818.55,275.9958,963,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Jak2 (Janus Kinase 2) Gene Analysis, P.Val617Phe (V617F) Variant (Mayo)OutsideLaboratory",,81270,CPT,Facility,Outpatient,,,90,963,818.55,275.9958,963,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,462.24,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Jak2 (Janus Kinase 2) Gene Analysis, P.Val617Phe (V617F) Variant (Mayo)OutsideLaboratory",,81270,CPT,Facility,Inpatient,,,90,963,818.55,275.9958,963,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Jak2 V617F Mutation Detection, B (Mayo)OutsideLaboratory",,81270,CPT,Facility,Both,,,90,963,818.55,275.9958,963,Aetna,Commercial,885.96,92,,percent of total billed charges,,
"Jak2 V617F Mutation Detection, B (Mayo)OutsideLaboratory",,81270,CPT,Facility,Outpatient,,,90,963,818.55,275.9958,963,Aetna,Medicare Advantage,471.87,49,,percent of total billed charges,,
"Jak2 V617F Mutation Detection, B (Mayo)OutsideLaboratory",,81270,CPT,Facility,Inpatient,,,90,963,818.55,275.9958,963,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Jak2 V617F Mutation Detection, B (Mayo)OutsideLaboratory",,81270,CPT,Facility,Both,,,90,963,818.55,275.9958,963,Aetna,PPO,895.59,93,,percent of total billed charges,,
"Jak2 V617F Mutation Detection, B (Mayo)OutsideLaboratory",,81270,CPT,Facility,Both,,,90,963,818.55,275.9958,963,America's PPO,America's PPO,924.7689,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Jak2 V617F Mutation Detection, B (Mayo)OutsideLaboratory",,81270,CPT,Facility,Both,,,90,963,818.55,275.9958,963,BlueCross BlueShield Minnesota, Federal Employee Program,947.592,98.4,,percent of total billed charges,,
"Jak2 V617F Mutation Detection, B (Mayo)OutsideLaboratory",,81270,CPT,Facility,Both,,,90,963,818.55,275.9958,963,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,963,100,,percent of total billed charges,,
"Jak2 V617F Mutation Detection, B (Mayo)OutsideLaboratory",,81270,CPT,Facility,Both,,,90,963,818.55,275.9958,963,BlueCross BlueShield Minnesota,High Value Network Plan,866.7,90,,percent of total billed charges,,
"Jak2 V617F Mutation Detection, B (Mayo)OutsideLaboratory",,81270,CPT,Facility,Outpatient,,,90,963,818.55,275.9958,963,BlueCross BlueShield Minnesota,Medicare Advantage,471.87,49,,percent of total billed charges,,
"Jak2 V617F Mutation Detection, B (Mayo)OutsideLaboratory",,81270,CPT,Facility,Inpatient,,,90,963,818.55,275.9958,963,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Jak2 V617F Mutation Detection, B (Mayo)OutsideLaboratory",,81270,CPT,Facility,Both,,,90,963,818.55,275.9958,963,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,852.9291,88.57,,percent of total billed charges,,
"Jak2 V617F Mutation Detection, B (Mayo)OutsideLaboratory",,81270,CPT,Facility,Both,,,90,963,818.55,275.9958,963,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,275.9958,28.66,,percent of total billed charges,,
"Jak2 V617F Mutation Detection, B (Mayo)OutsideLaboratory",,81270,CPT,Facility,Outpatient,,,90,963,818.55,275.9958,963,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),471.87,49,,percent of total billed charges,,
"Jak2 V617F Mutation Detection, B (Mayo)OutsideLaboratory",,81270,CPT,Facility,Inpatient,,,90,963,818.55,275.9958,963,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Jak2 V617F Mutation Detection, B (Mayo)OutsideLaboratory",,81270,CPT,Facility,Both,,,90,963,818.55,275.9958,963,CorVel,Worker's Compensation,963,100,,percent of total billed charges,,
"Jak2 V617F Mutation Detection, B (Mayo)OutsideLaboratory",,81270,CPT,Facility,Both,,,90,963,818.55,275.9958,963,First Health Group Corporation,First Health Network,934.11,97,,percent of total billed charges,,
"Jak2 V617F Mutation Detection, B (Mayo)OutsideLaboratory",,81270,CPT,Facility,Both,,,90,963,818.55,275.9958,963,"Health Partners, Inc.",Commercial,910.998,94.6,,percent of total billed charges,,
"Jak2 V617F Mutation Detection, B (Mayo)OutsideLaboratory",,81270,CPT,Facility,Outpatient,,,90,963,818.55,275.9958,963,"Health Partners, Inc.",Medicare Advantage,471.87,49,,percent of total billed charges,,
"Jak2 V617F Mutation Detection, B (Mayo)OutsideLaboratory",,81270,CPT,Facility,Inpatient,,,90,963,818.55,275.9958,963,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Jak2 V617F Mutation Detection, B (Mayo)OutsideLaboratory",,81270,CPT,Facility,Both,,,90,963,818.55,275.9958,963,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),577.8,60,,percent of total billed charges,,
"Jak2 V617F Mutation Detection, B (Mayo)OutsideLaboratory",,81270,CPT,Facility,Both,,,90,963,818.55,275.9958,963,"Health Partners, Inc.",State of Minnesota Advantage Program,784.845,81.5,,percent of total billed charges,,
"Jak2 V617F Mutation Detection, B (Mayo)OutsideLaboratory",,81270,CPT,Facility,Both,,,90,963,818.55,275.9958,963,"Health Partners, Inc.",State Public Programs,481.5,50,,percent of total billed charges,,
"Jak2 V617F Mutation Detection, B (Mayo)OutsideLaboratory",,81270,CPT,Facility,Both,,,90,963,818.55,275.9958,963,Humana Insurance Company,Commercial PPO,914.85,95,,percent of total billed charges,,
"Jak2 V617F Mutation Detection, B (Mayo)OutsideLaboratory",,81270,CPT,Facility,Outpatient,,,90,963,818.55,275.9958,963,Humana Insurance Company,Medicare PPO,471.87,49,,percent of total billed charges,,
"Jak2 V617F Mutation Detection, B (Mayo)OutsideLaboratory",,81270,CPT,Facility,Inpatient,,,90,963,818.55,275.9958,963,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Jak2 V617F Mutation Detection, B (Mayo)OutsideLaboratory",,81270,CPT,Facility,Both,,,90,963,818.55,275.9958,963,Medica,Individual & Family,954.333,99.1,,percent of total billed charges,,
"Jak2 V617F Mutation Detection, B (Mayo)OutsideLaboratory",,81270,CPT,Facility,Outpatient,,,90,963,818.55,275.9958,963,Medica,Medica Advantage Solution,479.574,49.8,,percent of total billed charges,,
"Jak2 V617F Mutation Detection, B (Mayo)OutsideLaboratory",,81270,CPT,Facility,Inpatient,,,90,963,818.55,275.9958,963,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Jak2 V617F Mutation Detection, B (Mayo)OutsideLaboratory",,81270,CPT,Facility,Outpatient,,,90,963,818.55,275.9958,963,Medica,Medical Assistance,429.498,44.6,,percent of total billed charges,,
"Jak2 V617F Mutation Detection, B (Mayo)OutsideLaboratory",,81270,CPT,Facility,Inpatient,,,90,963,818.55,275.9958,963,Medica,Medical Assistance,,,,,Included in per diem rate,
"Jak2 V617F Mutation Detection, B (Mayo)OutsideLaboratory",,81270,CPT,Facility,Outpatient,,,90,963,818.55,275.9958,963,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,479.574,49.8,,percent of total billed charges,,
"Jak2 V617F Mutation Detection, B (Mayo)OutsideLaboratory",,81270,CPT,Facility,Inpatient,,,90,963,818.55,275.9958,963,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Jak2 V617F Mutation Detection, B (Mayo)OutsideLaboratory",,81270,CPT,Facility,Both,,,90,963,818.55,275.9958,963,"Multiplan, Inc.","Multiplan, Inc.",905.22,94,,percent of total billed charges,,
"Jak2 V617F Mutation Detection, B (Mayo)OutsideLaboratory",,81270,CPT,Facility,Outpatient,,,90,963,818.55,275.9958,963,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,832.032,86.4,,percent of total billed charges,,
"Jak2 V617F Mutation Detection, B (Mayo)OutsideLaboratory",,81270,CPT,Facility,Inpatient,,,90,963,818.55,275.9958,963,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Jak2 V617F Mutation Detection, B (Mayo)OutsideLaboratory",,81270,CPT,Facility,Both,,,90,963,818.55,275.9958,963,"Preferred One Administrative Services, INC.",PPO,949.518,98.6,,percent of total billed charges,,
"Jak2 V617F Mutation Detection, B (Mayo)OutsideLaboratory",,81270,CPT,Facility,Outpatient,,,90,963,818.55,275.9958,963,PrimeWest Health,Minnesota Senior Health Options (MSHO),495.4635,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Jak2 V617F Mutation Detection, B (Mayo)OutsideLaboratory",,81270,CPT,Facility,Inpatient,,,90,963,818.55,275.9958,963,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Jak2 V617F Mutation Detection, B (Mayo)OutsideLaboratory",,81270,CPT,Facility,Outpatient,,,90,963,818.55,275.9958,963,PrimeWest Health,MinnesotaCare,494.5968,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Jak2 V617F Mutation Detection, B (Mayo)OutsideLaboratory",,81270,CPT,Facility,Inpatient,,,90,963,818.55,275.9958,963,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Jak2 V617F Mutation Detection, B (Mayo)OutsideLaboratory",,81270,CPT,Facility,Both,,,90,963,818.55,275.9958,963,Sanford Health Plan,Sanford Health Plan,885.96,92,,percent of total billed charges,,
"Jak2 V617F Mutation Detection, B (Mayo)OutsideLaboratory",,81270,CPT,Facility,Outpatient,,,90,963,818.55,275.9958,963,"UCare Health, Inc.",Individual & Family Plan,542.6505,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Jak2 V617F Mutation Detection, B (Mayo)OutsideLaboratory",,81270,CPT,Facility,Inpatient,,,90,963,818.55,275.9958,963,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Jak2 V617F Mutation Detection, B (Mayo)OutsideLaboratory",,81270,CPT,Facility,Outpatient,,,90,963,818.55,275.9958,963,"UCare Health, Inc.",Medical Assistance,486.0261,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Jak2 V617F Mutation Detection, B (Mayo)OutsideLaboratory",,81270,CPT,Facility,Inpatient,,,90,963,818.55,275.9958,963,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Jak2 V617F Mutation Detection, B (Mayo)OutsideLaboratory",,81270,CPT,Facility,Outpatient,,,90,963,818.55,275.9958,963,"UCare Health, Inc.",Medicare Advantage,486.0261,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Jak2 V617F Mutation Detection, B (Mayo)OutsideLaboratory",,81270,CPT,Facility,Inpatient,,,90,963,818.55,275.9958,963,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Jak2 V617F Mutation Detection, B (Mayo)OutsideLaboratory",,81270,CPT,Facility,Outpatient,,,90,963,818.55,275.9958,963,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),486.0261,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Jak2 V617F Mutation Detection, B (Mayo)OutsideLaboratory",,81270,CPT,Facility,Inpatient,,,90,963,818.55,275.9958,963,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Jak2 V617F Mutation Detection, B (Mayo)OutsideLaboratory",,81270,CPT,Facility,Both,,,90,963,818.55,275.9958,963,UnitedHealthcare,Individual & Family,905.22,94,,percent of total billed charges,,
"Jak2 V617F Mutation Detection, B (Mayo)OutsideLaboratory",,81270,CPT,Facility,Outpatient,,,90,963,818.55,275.9958,963,UnitedHealthcare,Medicare Advantage,471.87,49,,percent of total billed charges,,
"Jak2 V617F Mutation Detection, B (Mayo)OutsideLaboratory",,81270,CPT,Facility,Inpatient,,,90,963,818.55,275.9958,963,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Jak2 V617F Mutation Detection, B (Mayo)OutsideLaboratory",,81270,CPT,Facility,Outpatient,,,90,963,818.55,275.9958,963,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,462.24,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Jak2 V617F Mutation Detection, B (Mayo)OutsideLaboratory",,81270,CPT,Facility,Inpatient,,,90,963,818.55,275.9958,963,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Jak2 V617F Mutation Detection, Bm (Mayo)OutsideLaboratory",,81270,CPT,Facility,Both,,,90,963,818.55,275.9958,963,Aetna,Commercial,885.96,92,,percent of total billed charges,,
"Jak2 V617F Mutation Detection, Bm (Mayo)OutsideLaboratory",,81270,CPT,Facility,Outpatient,,,90,963,818.55,275.9958,963,Aetna,Medicare Advantage,471.87,49,,percent of total billed charges,,
"Jak2 V617F Mutation Detection, Bm (Mayo)OutsideLaboratory",,81270,CPT,Facility,Inpatient,,,90,963,818.55,275.9958,963,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Jak2 V617F Mutation Detection, Bm (Mayo)OutsideLaboratory",,81270,CPT,Facility,Both,,,90,963,818.55,275.9958,963,Aetna,PPO,895.59,93,,percent of total billed charges,,
"Jak2 V617F Mutation Detection, Bm (Mayo)OutsideLaboratory",,81270,CPT,Facility,Both,,,90,963,818.55,275.9958,963,America's PPO,America's PPO,924.7689,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Jak2 V617F Mutation Detection, Bm (Mayo)OutsideLaboratory",,81270,CPT,Facility,Both,,,90,963,818.55,275.9958,963,BlueCross BlueShield Minnesota, Federal Employee Program,947.592,98.4,,percent of total billed charges,,
"Jak2 V617F Mutation Detection, Bm (Mayo)OutsideLaboratory",,81270,CPT,Facility,Both,,,90,963,818.55,275.9958,963,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,963,100,,percent of total billed charges,,
"Jak2 V617F Mutation Detection, Bm (Mayo)OutsideLaboratory",,81270,CPT,Facility,Both,,,90,963,818.55,275.9958,963,BlueCross BlueShield Minnesota,High Value Network Plan,866.7,90,,percent of total billed charges,,
"Jak2 V617F Mutation Detection, Bm (Mayo)OutsideLaboratory",,81270,CPT,Facility,Outpatient,,,90,963,818.55,275.9958,963,BlueCross BlueShield Minnesota,Medicare Advantage,471.87,49,,percent of total billed charges,,
"Jak2 V617F Mutation Detection, Bm (Mayo)OutsideLaboratory",,81270,CPT,Facility,Inpatient,,,90,963,818.55,275.9958,963,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Jak2 V617F Mutation Detection, Bm (Mayo)OutsideLaboratory",,81270,CPT,Facility,Both,,,90,963,818.55,275.9958,963,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,852.9291,88.57,,percent of total billed charges,,
"Jak2 V617F Mutation Detection, Bm (Mayo)OutsideLaboratory",,81270,CPT,Facility,Both,,,90,963,818.55,275.9958,963,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,275.9958,28.66,,percent of total billed charges,,
"Jak2 V617F Mutation Detection, Bm (Mayo)OutsideLaboratory",,81270,CPT,Facility,Outpatient,,,90,963,818.55,275.9958,963,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),471.87,49,,percent of total billed charges,,
"Jak2 V617F Mutation Detection, Bm (Mayo)OutsideLaboratory",,81270,CPT,Facility,Inpatient,,,90,963,818.55,275.9958,963,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Jak2 V617F Mutation Detection, Bm (Mayo)OutsideLaboratory",,81270,CPT,Facility,Both,,,90,963,818.55,275.9958,963,CorVel,Worker's Compensation,963,100,,percent of total billed charges,,
"Jak2 V617F Mutation Detection, Bm (Mayo)OutsideLaboratory",,81270,CPT,Facility,Both,,,90,963,818.55,275.9958,963,First Health Group Corporation,First Health Network,934.11,97,,percent of total billed charges,,
"Jak2 V617F Mutation Detection, Bm (Mayo)OutsideLaboratory",,81270,CPT,Facility,Both,,,90,963,818.55,275.9958,963,"Health Partners, Inc.",Commercial,910.998,94.6,,percent of total billed charges,,
"Jak2 V617F Mutation Detection, Bm (Mayo)OutsideLaboratory",,81270,CPT,Facility,Outpatient,,,90,963,818.55,275.9958,963,"Health Partners, Inc.",Medicare Advantage,471.87,49,,percent of total billed charges,,
"Jak2 V617F Mutation Detection, Bm (Mayo)OutsideLaboratory",,81270,CPT,Facility,Inpatient,,,90,963,818.55,275.9958,963,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Jak2 V617F Mutation Detection, Bm (Mayo)OutsideLaboratory",,81270,CPT,Facility,Both,,,90,963,818.55,275.9958,963,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),577.8,60,,percent of total billed charges,,
"Jak2 V617F Mutation Detection, Bm (Mayo)OutsideLaboratory",,81270,CPT,Facility,Both,,,90,963,818.55,275.9958,963,"Health Partners, Inc.",State of Minnesota Advantage Program,784.845,81.5,,percent of total billed charges,,
"Jak2 V617F Mutation Detection, Bm (Mayo)OutsideLaboratory",,81270,CPT,Facility,Both,,,90,963,818.55,275.9958,963,"Health Partners, Inc.",State Public Programs,481.5,50,,percent of total billed charges,,
"Jak2 V617F Mutation Detection, Bm (Mayo)OutsideLaboratory",,81270,CPT,Facility,Both,,,90,963,818.55,275.9958,963,Humana Insurance Company,Commercial PPO,914.85,95,,percent of total billed charges,,
"Jak2 V617F Mutation Detection, Bm (Mayo)OutsideLaboratory",,81270,CPT,Facility,Outpatient,,,90,963,818.55,275.9958,963,Humana Insurance Company,Medicare PPO,471.87,49,,percent of total billed charges,,
"Jak2 V617F Mutation Detection, Bm (Mayo)OutsideLaboratory",,81270,CPT,Facility,Inpatient,,,90,963,818.55,275.9958,963,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Jak2 V617F Mutation Detection, Bm (Mayo)OutsideLaboratory",,81270,CPT,Facility,Both,,,90,963,818.55,275.9958,963,Medica,Individual & Family,954.333,99.1,,percent of total billed charges,,
"Jak2 V617F Mutation Detection, Bm (Mayo)OutsideLaboratory",,81270,CPT,Facility,Outpatient,,,90,963,818.55,275.9958,963,Medica,Medica Advantage Solution,479.574,49.8,,percent of total billed charges,,
"Jak2 V617F Mutation Detection, Bm (Mayo)OutsideLaboratory",,81270,CPT,Facility,Inpatient,,,90,963,818.55,275.9958,963,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Jak2 V617F Mutation Detection, Bm (Mayo)OutsideLaboratory",,81270,CPT,Facility,Outpatient,,,90,963,818.55,275.9958,963,Medica,Medical Assistance,429.498,44.6,,percent of total billed charges,,
"Jak2 V617F Mutation Detection, Bm (Mayo)OutsideLaboratory",,81270,CPT,Facility,Inpatient,,,90,963,818.55,275.9958,963,Medica,Medical Assistance,,,,,Included in per diem rate,
"Jak2 V617F Mutation Detection, Bm (Mayo)OutsideLaboratory",,81270,CPT,Facility,Outpatient,,,90,963,818.55,275.9958,963,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,479.574,49.8,,percent of total billed charges,,
"Jak2 V617F Mutation Detection, Bm (Mayo)OutsideLaboratory",,81270,CPT,Facility,Inpatient,,,90,963,818.55,275.9958,963,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Jak2 V617F Mutation Detection, Bm (Mayo)OutsideLaboratory",,81270,CPT,Facility,Both,,,90,963,818.55,275.9958,963,"Multiplan, Inc.","Multiplan, Inc.",905.22,94,,percent of total billed charges,,
"Jak2 V617F Mutation Detection, Bm (Mayo)OutsideLaboratory",,81270,CPT,Facility,Outpatient,,,90,963,818.55,275.9958,963,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,832.032,86.4,,percent of total billed charges,,
"Jak2 V617F Mutation Detection, Bm (Mayo)OutsideLaboratory",,81270,CPT,Facility,Inpatient,,,90,963,818.55,275.9958,963,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Jak2 V617F Mutation Detection, Bm (Mayo)OutsideLaboratory",,81270,CPT,Facility,Both,,,90,963,818.55,275.9958,963,"Preferred One Administrative Services, INC.",PPO,949.518,98.6,,percent of total billed charges,,
"Jak2 V617F Mutation Detection, Bm (Mayo)OutsideLaboratory",,81270,CPT,Facility,Outpatient,,,90,963,818.55,275.9958,963,PrimeWest Health,Minnesota Senior Health Options (MSHO),495.4635,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Jak2 V617F Mutation Detection, Bm (Mayo)OutsideLaboratory",,81270,CPT,Facility,Inpatient,,,90,963,818.55,275.9958,963,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Jak2 V617F Mutation Detection, Bm (Mayo)OutsideLaboratory",,81270,CPT,Facility,Outpatient,,,90,963,818.55,275.9958,963,PrimeWest Health,MinnesotaCare,494.5968,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Jak2 V617F Mutation Detection, Bm (Mayo)OutsideLaboratory",,81270,CPT,Facility,Inpatient,,,90,963,818.55,275.9958,963,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Jak2 V617F Mutation Detection, Bm (Mayo)OutsideLaboratory",,81270,CPT,Facility,Both,,,90,963,818.55,275.9958,963,Sanford Health Plan,Sanford Health Plan,885.96,92,,percent of total billed charges,,
"Jak2 V617F Mutation Detection, Bm (Mayo)OutsideLaboratory",,81270,CPT,Facility,Outpatient,,,90,963,818.55,275.9958,963,"UCare Health, Inc.",Individual & Family Plan,542.6505,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Jak2 V617F Mutation Detection, Bm (Mayo)OutsideLaboratory",,81270,CPT,Facility,Inpatient,,,90,963,818.55,275.9958,963,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Jak2 V617F Mutation Detection, Bm (Mayo)OutsideLaboratory",,81270,CPT,Facility,Outpatient,,,90,963,818.55,275.9958,963,"UCare Health, Inc.",Medical Assistance,486.0261,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Jak2 V617F Mutation Detection, Bm (Mayo)OutsideLaboratory",,81270,CPT,Facility,Inpatient,,,90,963,818.55,275.9958,963,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Jak2 V617F Mutation Detection, Bm (Mayo)OutsideLaboratory",,81270,CPT,Facility,Outpatient,,,90,963,818.55,275.9958,963,"UCare Health, Inc.",Medicare Advantage,486.0261,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Jak2 V617F Mutation Detection, Bm (Mayo)OutsideLaboratory",,81270,CPT,Facility,Inpatient,,,90,963,818.55,275.9958,963,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Jak2 V617F Mutation Detection, Bm (Mayo)OutsideLaboratory",,81270,CPT,Facility,Outpatient,,,90,963,818.55,275.9958,963,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),486.0261,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Jak2 V617F Mutation Detection, Bm (Mayo)OutsideLaboratory",,81270,CPT,Facility,Inpatient,,,90,963,818.55,275.9958,963,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Jak2 V617F Mutation Detection, Bm (Mayo)OutsideLaboratory",,81270,CPT,Facility,Both,,,90,963,818.55,275.9958,963,UnitedHealthcare,Individual & Family,905.22,94,,percent of total billed charges,,
"Jak2 V617F Mutation Detection, Bm (Mayo)OutsideLaboratory",,81270,CPT,Facility,Outpatient,,,90,963,818.55,275.9958,963,UnitedHealthcare,Medicare Advantage,471.87,49,,percent of total billed charges,,
"Jak2 V617F Mutation Detection, Bm (Mayo)OutsideLaboratory",,81270,CPT,Facility,Inpatient,,,90,963,818.55,275.9958,963,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Jak2 V617F Mutation Detection, Bm (Mayo)OutsideLaboratory",,81270,CPT,Facility,Outpatient,,,90,963,818.55,275.9958,963,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,462.24,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Jak2 V617F Mutation Detection, Bm (Mayo)OutsideLaboratory",,81270,CPT,Facility,Inpatient,,,90,963,818.55,275.9958,963,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Mpn (Jak2 V617F, Calr, Mpl) Reflex (Mayo)OutsideLaboratory",,81270,CPT,Facility,Both,,,90,529,449.65,151.6114,529,Aetna,Commercial,486.68,92,,percent of total billed charges,,
"Mpn (Jak2 V617F, Calr, Mpl) Reflex (Mayo)OutsideLaboratory",,81270,CPT,Facility,Outpatient,,,90,529,449.65,151.6114,529,Aetna,Medicare Advantage,259.21,49,,percent of total billed charges,,
"Mpn (Jak2 V617F, Calr, Mpl) Reflex (Mayo)OutsideLaboratory",,81270,CPT,Facility,Inpatient,,,90,529,449.65,151.6114,529,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Mpn (Jak2 V617F, Calr, Mpl) Reflex (Mayo)OutsideLaboratory",,81270,CPT,Facility,Both,,,90,529,449.65,151.6114,529,Aetna,PPO,491.97,93,,percent of total billed charges,,
"Mpn (Jak2 V617F, Calr, Mpl) Reflex (Mayo)OutsideLaboratory",,81270,CPT,Facility,Both,,,90,529,449.65,151.6114,529,America's PPO,America's PPO,507.9987,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Mpn (Jak2 V617F, Calr, Mpl) Reflex (Mayo)OutsideLaboratory",,81270,CPT,Facility,Both,,,90,529,449.65,151.6114,529,BlueCross BlueShield Minnesota, Federal Employee Program,520.536,98.4,,percent of total billed charges,,
"Mpn (Jak2 V617F, Calr, Mpl) Reflex (Mayo)OutsideLaboratory",,81270,CPT,Facility,Both,,,90,529,449.65,151.6114,529,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,529,100,,percent of total billed charges,,
"Mpn (Jak2 V617F, Calr, Mpl) Reflex (Mayo)OutsideLaboratory",,81270,CPT,Facility,Both,,,90,529,449.65,151.6114,529,BlueCross BlueShield Minnesota,High Value Network Plan,476.1,90,,percent of total billed charges,,
"Mpn (Jak2 V617F, Calr, Mpl) Reflex (Mayo)OutsideLaboratory",,81270,CPT,Facility,Outpatient,,,90,529,449.65,151.6114,529,BlueCross BlueShield Minnesota,Medicare Advantage,259.21,49,,percent of total billed charges,,
"Mpn (Jak2 V617F, Calr, Mpl) Reflex (Mayo)OutsideLaboratory",,81270,CPT,Facility,Inpatient,,,90,529,449.65,151.6114,529,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Mpn (Jak2 V617F, Calr, Mpl) Reflex (Mayo)OutsideLaboratory",,81270,CPT,Facility,Both,,,90,529,449.65,151.6114,529,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,468.5353,88.57,,percent of total billed charges,,
"Mpn (Jak2 V617F, Calr, Mpl) Reflex (Mayo)OutsideLaboratory",,81270,CPT,Facility,Both,,,90,529,449.65,151.6114,529,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,151.6114,28.66,,percent of total billed charges,,
"Mpn (Jak2 V617F, Calr, Mpl) Reflex (Mayo)OutsideLaboratory",,81270,CPT,Facility,Outpatient,,,90,529,449.65,151.6114,529,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),259.21,49,,percent of total billed charges,,
"Mpn (Jak2 V617F, Calr, Mpl) Reflex (Mayo)OutsideLaboratory",,81270,CPT,Facility,Inpatient,,,90,529,449.65,151.6114,529,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Mpn (Jak2 V617F, Calr, Mpl) Reflex (Mayo)OutsideLaboratory",,81270,CPT,Facility,Both,,,90,529,449.65,151.6114,529,CorVel,Worker's Compensation,529,100,,percent of total billed charges,,
"Mpn (Jak2 V617F, Calr, Mpl) Reflex (Mayo)OutsideLaboratory",,81270,CPT,Facility,Both,,,90,529,449.65,151.6114,529,First Health Group Corporation,First Health Network,513.13,97,,percent of total billed charges,,
"Mpn (Jak2 V617F, Calr, Mpl) Reflex (Mayo)OutsideLaboratory",,81270,CPT,Facility,Both,,,90,529,449.65,151.6114,529,"Health Partners, Inc.",Commercial,500.434,94.6,,percent of total billed charges,,
"Mpn (Jak2 V617F, Calr, Mpl) Reflex (Mayo)OutsideLaboratory",,81270,CPT,Facility,Outpatient,,,90,529,449.65,151.6114,529,"Health Partners, Inc.",Medicare Advantage,259.21,49,,percent of total billed charges,,
"Mpn (Jak2 V617F, Calr, Mpl) Reflex (Mayo)OutsideLaboratory",,81270,CPT,Facility,Inpatient,,,90,529,449.65,151.6114,529,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Mpn (Jak2 V617F, Calr, Mpl) Reflex (Mayo)OutsideLaboratory",,81270,CPT,Facility,Both,,,90,529,449.65,151.6114,529,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),317.4,60,,percent of total billed charges,,
"Mpn (Jak2 V617F, Calr, Mpl) Reflex (Mayo)OutsideLaboratory",,81270,CPT,Facility,Both,,,90,529,449.65,151.6114,529,"Health Partners, Inc.",State of Minnesota Advantage Program,431.135,81.5,,percent of total billed charges,,
"Mpn (Jak2 V617F, Calr, Mpl) Reflex (Mayo)OutsideLaboratory",,81270,CPT,Facility,Both,,,90,529,449.65,151.6114,529,"Health Partners, Inc.",State Public Programs,264.5,50,,percent of total billed charges,,
"Mpn (Jak2 V617F, Calr, Mpl) Reflex (Mayo)OutsideLaboratory",,81270,CPT,Facility,Both,,,90,529,449.65,151.6114,529,Humana Insurance Company,Commercial PPO,502.55,95,,percent of total billed charges,,
"Mpn (Jak2 V617F, Calr, Mpl) Reflex (Mayo)OutsideLaboratory",,81270,CPT,Facility,Outpatient,,,90,529,449.65,151.6114,529,Humana Insurance Company,Medicare PPO,259.21,49,,percent of total billed charges,,
"Mpn (Jak2 V617F, Calr, Mpl) Reflex (Mayo)OutsideLaboratory",,81270,CPT,Facility,Inpatient,,,90,529,449.65,151.6114,529,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Mpn (Jak2 V617F, Calr, Mpl) Reflex (Mayo)OutsideLaboratory",,81270,CPT,Facility,Both,,,90,529,449.65,151.6114,529,Medica,Individual & Family,524.239,99.1,,percent of total billed charges,,
"Mpn (Jak2 V617F, Calr, Mpl) Reflex (Mayo)OutsideLaboratory",,81270,CPT,Facility,Outpatient,,,90,529,449.65,151.6114,529,Medica,Medica Advantage Solution,263.442,49.8,,percent of total billed charges,,
"Mpn (Jak2 V617F, Calr, Mpl) Reflex (Mayo)OutsideLaboratory",,81270,CPT,Facility,Inpatient,,,90,529,449.65,151.6114,529,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Mpn (Jak2 V617F, Calr, Mpl) Reflex (Mayo)OutsideLaboratory",,81270,CPT,Facility,Outpatient,,,90,529,449.65,151.6114,529,Medica,Medical Assistance,235.934,44.6,,percent of total billed charges,,
"Mpn (Jak2 V617F, Calr, Mpl) Reflex (Mayo)OutsideLaboratory",,81270,CPT,Facility,Inpatient,,,90,529,449.65,151.6114,529,Medica,Medical Assistance,,,,,Included in per diem rate,
"Mpn (Jak2 V617F, Calr, Mpl) Reflex (Mayo)OutsideLaboratory",,81270,CPT,Facility,Outpatient,,,90,529,449.65,151.6114,529,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,263.442,49.8,,percent of total billed charges,,
"Mpn (Jak2 V617F, Calr, Mpl) Reflex (Mayo)OutsideLaboratory",,81270,CPT,Facility,Inpatient,,,90,529,449.65,151.6114,529,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Mpn (Jak2 V617F, Calr, Mpl) Reflex (Mayo)OutsideLaboratory",,81270,CPT,Facility,Both,,,90,529,449.65,151.6114,529,"Multiplan, Inc.","Multiplan, Inc.",497.26,94,,percent of total billed charges,,
"Mpn (Jak2 V617F, Calr, Mpl) Reflex (Mayo)OutsideLaboratory",,81270,CPT,Facility,Outpatient,,,90,529,449.65,151.6114,529,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,457.056,86.4,,percent of total billed charges,,
"Mpn (Jak2 V617F, Calr, Mpl) Reflex (Mayo)OutsideLaboratory",,81270,CPT,Facility,Inpatient,,,90,529,449.65,151.6114,529,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Mpn (Jak2 V617F, Calr, Mpl) Reflex (Mayo)OutsideLaboratory",,81270,CPT,Facility,Both,,,90,529,449.65,151.6114,529,"Preferred One Administrative Services, INC.",PPO,521.594,98.6,,percent of total billed charges,,
"Mpn (Jak2 V617F, Calr, Mpl) Reflex (Mayo)OutsideLaboratory",,81270,CPT,Facility,Outpatient,,,90,529,449.65,151.6114,529,PrimeWest Health,Minnesota Senior Health Options (MSHO),272.1705,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Mpn (Jak2 V617F, Calr, Mpl) Reflex (Mayo)OutsideLaboratory",,81270,CPT,Facility,Inpatient,,,90,529,449.65,151.6114,529,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Mpn (Jak2 V617F, Calr, Mpl) Reflex (Mayo)OutsideLaboratory",,81270,CPT,Facility,Outpatient,,,90,529,449.65,151.6114,529,PrimeWest Health,MinnesotaCare,271.6944,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Mpn (Jak2 V617F, Calr, Mpl) Reflex (Mayo)OutsideLaboratory",,81270,CPT,Facility,Inpatient,,,90,529,449.65,151.6114,529,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Mpn (Jak2 V617F, Calr, Mpl) Reflex (Mayo)OutsideLaboratory",,81270,CPT,Facility,Both,,,90,529,449.65,151.6114,529,Sanford Health Plan,Sanford Health Plan,486.68,92,,percent of total billed charges,,
"Mpn (Jak2 V617F, Calr, Mpl) Reflex (Mayo)OutsideLaboratory",,81270,CPT,Facility,Outpatient,,,90,529,449.65,151.6114,529,"UCare Health, Inc.",Individual & Family Plan,298.0915,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Mpn (Jak2 V617F, Calr, Mpl) Reflex (Mayo)OutsideLaboratory",,81270,CPT,Facility,Inpatient,,,90,529,449.65,151.6114,529,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Mpn (Jak2 V617F, Calr, Mpl) Reflex (Mayo)OutsideLaboratory",,81270,CPT,Facility,Outpatient,,,90,529,449.65,151.6114,529,"UCare Health, Inc.",Medical Assistance,266.9863,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Mpn (Jak2 V617F, Calr, Mpl) Reflex (Mayo)OutsideLaboratory",,81270,CPT,Facility,Inpatient,,,90,529,449.65,151.6114,529,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Mpn (Jak2 V617F, Calr, Mpl) Reflex (Mayo)OutsideLaboratory",,81270,CPT,Facility,Outpatient,,,90,529,449.65,151.6114,529,"UCare Health, Inc.",Medicare Advantage,266.9863,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Mpn (Jak2 V617F, Calr, Mpl) Reflex (Mayo)OutsideLaboratory",,81270,CPT,Facility,Inpatient,,,90,529,449.65,151.6114,529,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Mpn (Jak2 V617F, Calr, Mpl) Reflex (Mayo)OutsideLaboratory",,81270,CPT,Facility,Outpatient,,,90,529,449.65,151.6114,529,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),266.9863,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Mpn (Jak2 V617F, Calr, Mpl) Reflex (Mayo)OutsideLaboratory",,81270,CPT,Facility,Inpatient,,,90,529,449.65,151.6114,529,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Mpn (Jak2 V617F, Calr, Mpl) Reflex (Mayo)OutsideLaboratory",,81270,CPT,Facility,Both,,,90,529,449.65,151.6114,529,UnitedHealthcare,Individual & Family,497.26,94,,percent of total billed charges,,
"Mpn (Jak2 V617F, Calr, Mpl) Reflex (Mayo)OutsideLaboratory",,81270,CPT,Facility,Outpatient,,,90,529,449.65,151.6114,529,UnitedHealthcare,Medicare Advantage,259.21,49,,percent of total billed charges,,
"Mpn (Jak2 V617F, Calr, Mpl) Reflex (Mayo)OutsideLaboratory",,81270,CPT,Facility,Inpatient,,,90,529,449.65,151.6114,529,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Mpn (Jak2 V617F, Calr, Mpl) Reflex (Mayo)OutsideLaboratory",,81270,CPT,Facility,Outpatient,,,90,529,449.65,151.6114,529,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,253.92,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Mpn (Jak2 V617F, Calr, Mpl) Reflex (Mayo)OutsideLaboratory",,81270,CPT,Facility,Inpatient,,,90,529,449.65,151.6114,529,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Huntington Disease Analysis (Mayo)OutsideLaboratory,,81271,CPT,Facility,Both,,,90,663,563.55,190.0158,663,Aetna,Commercial,609.96,92,,percent of total billed charges,,
Huntington Disease Analysis (Mayo)OutsideLaboratory,,81271,CPT,Facility,Outpatient,,,90,663,563.55,190.0158,663,Aetna,Medicare Advantage,324.87,49,,percent of total billed charges,,
Huntington Disease Analysis (Mayo)OutsideLaboratory,,81271,CPT,Facility,Inpatient,,,90,663,563.55,190.0158,663,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Huntington Disease Analysis (Mayo)OutsideLaboratory,,81271,CPT,Facility,Both,,,90,663,563.55,190.0158,663,Aetna,PPO,616.59,93,,percent of total billed charges,,
Huntington Disease Analysis (Mayo)OutsideLaboratory,,81271,CPT,Facility,Both,,,90,663,563.55,190.0158,663,America's PPO,America's PPO,636.6789,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Huntington Disease Analysis (Mayo)OutsideLaboratory,,81271,CPT,Facility,Both,,,90,663,563.55,190.0158,663,BlueCross BlueShield Minnesota, Federal Employee Program,652.392,98.4,,percent of total billed charges,,
Huntington Disease Analysis (Mayo)OutsideLaboratory,,81271,CPT,Facility,Both,,,90,663,563.55,190.0158,663,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,663,100,,percent of total billed charges,,
Huntington Disease Analysis (Mayo)OutsideLaboratory,,81271,CPT,Facility,Both,,,90,663,563.55,190.0158,663,BlueCross BlueShield Minnesota,High Value Network Plan,596.7,90,,percent of total billed charges,,
Huntington Disease Analysis (Mayo)OutsideLaboratory,,81271,CPT,Facility,Outpatient,,,90,663,563.55,190.0158,663,BlueCross BlueShield Minnesota,Medicare Advantage,324.87,49,,percent of total billed charges,,
Huntington Disease Analysis (Mayo)OutsideLaboratory,,81271,CPT,Facility,Inpatient,,,90,663,563.55,190.0158,663,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Huntington Disease Analysis (Mayo)OutsideLaboratory,,81271,CPT,Facility,Both,,,90,663,563.55,190.0158,663,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,587.2191,88.57,,percent of total billed charges,,
Huntington Disease Analysis (Mayo)OutsideLaboratory,,81271,CPT,Facility,Both,,,90,663,563.55,190.0158,663,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,190.0158,28.66,,percent of total billed charges,,
Huntington Disease Analysis (Mayo)OutsideLaboratory,,81271,CPT,Facility,Outpatient,,,90,663,563.55,190.0158,663,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),324.87,49,,percent of total billed charges,,
Huntington Disease Analysis (Mayo)OutsideLaboratory,,81271,CPT,Facility,Inpatient,,,90,663,563.55,190.0158,663,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Huntington Disease Analysis (Mayo)OutsideLaboratory,,81271,CPT,Facility,Both,,,90,663,563.55,190.0158,663,CorVel,Worker's Compensation,663,100,,percent of total billed charges,,
Huntington Disease Analysis (Mayo)OutsideLaboratory,,81271,CPT,Facility,Both,,,90,663,563.55,190.0158,663,First Health Group Corporation,First Health Network,643.11,97,,percent of total billed charges,,
Huntington Disease Analysis (Mayo)OutsideLaboratory,,81271,CPT,Facility,Both,,,90,663,563.55,190.0158,663,"Health Partners, Inc.",Commercial,627.198,94.6,,percent of total billed charges,,
Huntington Disease Analysis (Mayo)OutsideLaboratory,,81271,CPT,Facility,Outpatient,,,90,663,563.55,190.0158,663,"Health Partners, Inc.",Medicare Advantage,324.87,49,,percent of total billed charges,,
Huntington Disease Analysis (Mayo)OutsideLaboratory,,81271,CPT,Facility,Inpatient,,,90,663,563.55,190.0158,663,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Huntington Disease Analysis (Mayo)OutsideLaboratory,,81271,CPT,Facility,Both,,,90,663,563.55,190.0158,663,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),397.8,60,,percent of total billed charges,,
Huntington Disease Analysis (Mayo)OutsideLaboratory,,81271,CPT,Facility,Both,,,90,663,563.55,190.0158,663,"Health Partners, Inc.",State of Minnesota Advantage Program,540.345,81.5,,percent of total billed charges,,
Huntington Disease Analysis (Mayo)OutsideLaboratory,,81271,CPT,Facility,Both,,,90,663,563.55,190.0158,663,"Health Partners, Inc.",State Public Programs,331.5,50,,percent of total billed charges,,
Huntington Disease Analysis (Mayo)OutsideLaboratory,,81271,CPT,Facility,Both,,,90,663,563.55,190.0158,663,Humana Insurance Company,Commercial PPO,629.85,95,,percent of total billed charges,,
Huntington Disease Analysis (Mayo)OutsideLaboratory,,81271,CPT,Facility,Outpatient,,,90,663,563.55,190.0158,663,Humana Insurance Company,Medicare PPO,324.87,49,,percent of total billed charges,,
Huntington Disease Analysis (Mayo)OutsideLaboratory,,81271,CPT,Facility,Inpatient,,,90,663,563.55,190.0158,663,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Huntington Disease Analysis (Mayo)OutsideLaboratory,,81271,CPT,Facility,Both,,,90,663,563.55,190.0158,663,Medica,Individual & Family,657.033,99.1,,percent of total billed charges,,
Huntington Disease Analysis (Mayo)OutsideLaboratory,,81271,CPT,Facility,Outpatient,,,90,663,563.55,190.0158,663,Medica,Medica Advantage Solution,330.174,49.8,,percent of total billed charges,,
Huntington Disease Analysis (Mayo)OutsideLaboratory,,81271,CPT,Facility,Inpatient,,,90,663,563.55,190.0158,663,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Huntington Disease Analysis (Mayo)OutsideLaboratory,,81271,CPT,Facility,Outpatient,,,90,663,563.55,190.0158,663,Medica,Medical Assistance,295.698,44.6,,percent of total billed charges,,
Huntington Disease Analysis (Mayo)OutsideLaboratory,,81271,CPT,Facility,Inpatient,,,90,663,563.55,190.0158,663,Medica,Medical Assistance,,,,,Included in per diem rate,
Huntington Disease Analysis (Mayo)OutsideLaboratory,,81271,CPT,Facility,Outpatient,,,90,663,563.55,190.0158,663,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,330.174,49.8,,percent of total billed charges,,
Huntington Disease Analysis (Mayo)OutsideLaboratory,,81271,CPT,Facility,Inpatient,,,90,663,563.55,190.0158,663,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Huntington Disease Analysis (Mayo)OutsideLaboratory,,81271,CPT,Facility,Both,,,90,663,563.55,190.0158,663,"Multiplan, Inc.","Multiplan, Inc.",623.22,94,,percent of total billed charges,,
Huntington Disease Analysis (Mayo)OutsideLaboratory,,81271,CPT,Facility,Outpatient,,,90,663,563.55,190.0158,663,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,572.832,86.4,,percent of total billed charges,,
Huntington Disease Analysis (Mayo)OutsideLaboratory,,81271,CPT,Facility,Inpatient,,,90,663,563.55,190.0158,663,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Huntington Disease Analysis (Mayo)OutsideLaboratory,,81271,CPT,Facility,Both,,,90,663,563.55,190.0158,663,"Preferred One Administrative Services, INC.",PPO,653.718,98.6,,percent of total billed charges,,
Huntington Disease Analysis (Mayo)OutsideLaboratory,,81271,CPT,Facility,Outpatient,,,90,663,563.55,190.0158,663,PrimeWest Health,Minnesota Senior Health Options (MSHO),341.1135,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Huntington Disease Analysis (Mayo)OutsideLaboratory,,81271,CPT,Facility,Inpatient,,,90,663,563.55,190.0158,663,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Huntington Disease Analysis (Mayo)OutsideLaboratory,,81271,CPT,Facility,Outpatient,,,90,663,563.55,190.0158,663,PrimeWest Health,MinnesotaCare,340.5168,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Huntington Disease Analysis (Mayo)OutsideLaboratory,,81271,CPT,Facility,Inpatient,,,90,663,563.55,190.0158,663,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Huntington Disease Analysis (Mayo)OutsideLaboratory,,81271,CPT,Facility,Both,,,90,663,563.55,190.0158,663,Sanford Health Plan,Sanford Health Plan,609.96,92,,percent of total billed charges,,
Huntington Disease Analysis (Mayo)OutsideLaboratory,,81271,CPT,Facility,Outpatient,,,90,663,563.55,190.0158,663,"UCare Health, Inc.",Individual & Family Plan,373.6005,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Huntington Disease Analysis (Mayo)OutsideLaboratory,,81271,CPT,Facility,Inpatient,,,90,663,563.55,190.0158,663,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Huntington Disease Analysis (Mayo)OutsideLaboratory,,81271,CPT,Facility,Outpatient,,,90,663,563.55,190.0158,663,"UCare Health, Inc.",Medical Assistance,334.6161,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Huntington Disease Analysis (Mayo)OutsideLaboratory,,81271,CPT,Facility,Inpatient,,,90,663,563.55,190.0158,663,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Huntington Disease Analysis (Mayo)OutsideLaboratory,,81271,CPT,Facility,Outpatient,,,90,663,563.55,190.0158,663,"UCare Health, Inc.",Medicare Advantage,334.6161,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Huntington Disease Analysis (Mayo)OutsideLaboratory,,81271,CPT,Facility,Inpatient,,,90,663,563.55,190.0158,663,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Huntington Disease Analysis (Mayo)OutsideLaboratory,,81271,CPT,Facility,Outpatient,,,90,663,563.55,190.0158,663,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),334.6161,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Huntington Disease Analysis (Mayo)OutsideLaboratory,,81271,CPT,Facility,Inpatient,,,90,663,563.55,190.0158,663,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Huntington Disease Analysis (Mayo)OutsideLaboratory,,81271,CPT,Facility,Both,,,90,663,563.55,190.0158,663,UnitedHealthcare,Individual & Family,623.22,94,,percent of total billed charges,,
Huntington Disease Analysis (Mayo)OutsideLaboratory,,81271,CPT,Facility,Outpatient,,,90,663,563.55,190.0158,663,UnitedHealthcare,Medicare Advantage,324.87,49,,percent of total billed charges,,
Huntington Disease Analysis (Mayo)OutsideLaboratory,,81271,CPT,Facility,Inpatient,,,90,663,563.55,190.0158,663,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Huntington Disease Analysis (Mayo)OutsideLaboratory,,81271,CPT,Facility,Outpatient,,,90,663,563.55,190.0158,663,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,318.24,48,,percent of total billed charges,,100% of DHS outpatient percentage
Huntington Disease Analysis (Mayo)OutsideLaboratory,,81271,CPT,Facility,Inpatient,,,90,663,563.55,190.0158,663,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Hla Class Ii Typing, Celiac (Mayo)OutsideLaboratory",,81376,CPT,Facility,Both,,,90,191,162.35,54.7406,191,Aetna,Commercial,175.72,92,,percent of total billed charges,,
"Hla Class Ii Typing, Celiac (Mayo)OutsideLaboratory",,81376,CPT,Facility,Outpatient,,,90,191,162.35,54.7406,191,Aetna,Medicare Advantage,93.59,49,,percent of total billed charges,,
"Hla Class Ii Typing, Celiac (Mayo)OutsideLaboratory",,81376,CPT,Facility,Inpatient,,,90,191,162.35,54.7406,191,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Hla Class Ii Typing, Celiac (Mayo)OutsideLaboratory",,81376,CPT,Facility,Both,,,90,191,162.35,54.7406,191,Aetna,PPO,177.63,93,,percent of total billed charges,,
"Hla Class Ii Typing, Celiac (Mayo)OutsideLaboratory",,81376,CPT,Facility,Both,,,90,191,162.35,54.7406,191,America's PPO,America's PPO,183.4173,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Hla Class Ii Typing, Celiac (Mayo)OutsideLaboratory",,81376,CPT,Facility,Both,,,90,191,162.35,54.7406,191,BlueCross BlueShield Minnesota, Federal Employee Program,187.944,98.4,,percent of total billed charges,,
"Hla Class Ii Typing, Celiac (Mayo)OutsideLaboratory",,81376,CPT,Facility,Both,,,90,191,162.35,54.7406,191,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,191,100,,percent of total billed charges,,
"Hla Class Ii Typing, Celiac (Mayo)OutsideLaboratory",,81376,CPT,Facility,Both,,,90,191,162.35,54.7406,191,BlueCross BlueShield Minnesota,High Value Network Plan,171.9,90,,percent of total billed charges,,
"Hla Class Ii Typing, Celiac (Mayo)OutsideLaboratory",,81376,CPT,Facility,Outpatient,,,90,191,162.35,54.7406,191,BlueCross BlueShield Minnesota,Medicare Advantage,93.59,49,,percent of total billed charges,,
"Hla Class Ii Typing, Celiac (Mayo)OutsideLaboratory",,81376,CPT,Facility,Inpatient,,,90,191,162.35,54.7406,191,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Hla Class Ii Typing, Celiac (Mayo)OutsideLaboratory",,81376,CPT,Facility,Both,,,90,191,162.35,54.7406,191,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,169.1687,88.57,,percent of total billed charges,,
"Hla Class Ii Typing, Celiac (Mayo)OutsideLaboratory",,81376,CPT,Facility,Both,,,90,191,162.35,54.7406,191,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,54.7406,28.66,,percent of total billed charges,,
"Hla Class Ii Typing, Celiac (Mayo)OutsideLaboratory",,81376,CPT,Facility,Outpatient,,,90,191,162.35,54.7406,191,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),93.59,49,,percent of total billed charges,,
"Hla Class Ii Typing, Celiac (Mayo)OutsideLaboratory",,81376,CPT,Facility,Inpatient,,,90,191,162.35,54.7406,191,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Hla Class Ii Typing, Celiac (Mayo)OutsideLaboratory",,81376,CPT,Facility,Both,,,90,191,162.35,54.7406,191,CorVel,Worker's Compensation,191,100,,percent of total billed charges,,
"Hla Class Ii Typing, Celiac (Mayo)OutsideLaboratory",,81376,CPT,Facility,Both,,,90,191,162.35,54.7406,191,First Health Group Corporation,First Health Network,185.27,97,,percent of total billed charges,,
"Hla Class Ii Typing, Celiac (Mayo)OutsideLaboratory",,81376,CPT,Facility,Both,,,90,191,162.35,54.7406,191,"Health Partners, Inc.",Commercial,180.686,94.6,,percent of total billed charges,,
"Hla Class Ii Typing, Celiac (Mayo)OutsideLaboratory",,81376,CPT,Facility,Outpatient,,,90,191,162.35,54.7406,191,"Health Partners, Inc.",Medicare Advantage,93.59,49,,percent of total billed charges,,
"Hla Class Ii Typing, Celiac (Mayo)OutsideLaboratory",,81376,CPT,Facility,Inpatient,,,90,191,162.35,54.7406,191,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Hla Class Ii Typing, Celiac (Mayo)OutsideLaboratory",,81376,CPT,Facility,Both,,,90,191,162.35,54.7406,191,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),114.6,60,,percent of total billed charges,,
"Hla Class Ii Typing, Celiac (Mayo)OutsideLaboratory",,81376,CPT,Facility,Both,,,90,191,162.35,54.7406,191,"Health Partners, Inc.",State of Minnesota Advantage Program,155.665,81.5,,percent of total billed charges,,
"Hla Class Ii Typing, Celiac (Mayo)OutsideLaboratory",,81376,CPT,Facility,Both,,,90,191,162.35,54.7406,191,"Health Partners, Inc.",State Public Programs,95.5,50,,percent of total billed charges,,
"Hla Class Ii Typing, Celiac (Mayo)OutsideLaboratory",,81376,CPT,Facility,Both,,,90,191,162.35,54.7406,191,Humana Insurance Company,Commercial PPO,181.45,95,,percent of total billed charges,,
"Hla Class Ii Typing, Celiac (Mayo)OutsideLaboratory",,81376,CPT,Facility,Outpatient,,,90,191,162.35,54.7406,191,Humana Insurance Company,Medicare PPO,93.59,49,,percent of total billed charges,,
"Hla Class Ii Typing, Celiac (Mayo)OutsideLaboratory",,81376,CPT,Facility,Inpatient,,,90,191,162.35,54.7406,191,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Hla Class Ii Typing, Celiac (Mayo)OutsideLaboratory",,81376,CPT,Facility,Both,,,90,191,162.35,54.7406,191,Medica,Individual & Family,189.281,99.1,,percent of total billed charges,,
"Hla Class Ii Typing, Celiac (Mayo)OutsideLaboratory",,81376,CPT,Facility,Outpatient,,,90,191,162.35,54.7406,191,Medica,Medica Advantage Solution,95.118,49.8,,percent of total billed charges,,
"Hla Class Ii Typing, Celiac (Mayo)OutsideLaboratory",,81376,CPT,Facility,Inpatient,,,90,191,162.35,54.7406,191,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Hla Class Ii Typing, Celiac (Mayo)OutsideLaboratory",,81376,CPT,Facility,Outpatient,,,90,191,162.35,54.7406,191,Medica,Medical Assistance,85.186,44.6,,percent of total billed charges,,
"Hla Class Ii Typing, Celiac (Mayo)OutsideLaboratory",,81376,CPT,Facility,Inpatient,,,90,191,162.35,54.7406,191,Medica,Medical Assistance,,,,,Included in per diem rate,
"Hla Class Ii Typing, Celiac (Mayo)OutsideLaboratory",,81376,CPT,Facility,Outpatient,,,90,191,162.35,54.7406,191,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,95.118,49.8,,percent of total billed charges,,
"Hla Class Ii Typing, Celiac (Mayo)OutsideLaboratory",,81376,CPT,Facility,Inpatient,,,90,191,162.35,54.7406,191,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Hla Class Ii Typing, Celiac (Mayo)OutsideLaboratory",,81376,CPT,Facility,Both,,,90,191,162.35,54.7406,191,"Multiplan, Inc.","Multiplan, Inc.",179.54,94,,percent of total billed charges,,
"Hla Class Ii Typing, Celiac (Mayo)OutsideLaboratory",,81376,CPT,Facility,Outpatient,,,90,191,162.35,54.7406,191,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,165.024,86.4,,percent of total billed charges,,
"Hla Class Ii Typing, Celiac (Mayo)OutsideLaboratory",,81376,CPT,Facility,Inpatient,,,90,191,162.35,54.7406,191,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Hla Class Ii Typing, Celiac (Mayo)OutsideLaboratory",,81376,CPT,Facility,Both,,,90,191,162.35,54.7406,191,"Preferred One Administrative Services, INC.",PPO,188.326,98.6,,percent of total billed charges,,
"Hla Class Ii Typing, Celiac (Mayo)OutsideLaboratory",,81376,CPT,Facility,Outpatient,,,90,191,162.35,54.7406,191,PrimeWest Health,Minnesota Senior Health Options (MSHO),98.2695,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Hla Class Ii Typing, Celiac (Mayo)OutsideLaboratory",,81376,CPT,Facility,Inpatient,,,90,191,162.35,54.7406,191,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Hla Class Ii Typing, Celiac (Mayo)OutsideLaboratory",,81376,CPT,Facility,Outpatient,,,90,191,162.35,54.7406,191,PrimeWest Health,MinnesotaCare,98.0976,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Hla Class Ii Typing, Celiac (Mayo)OutsideLaboratory",,81376,CPT,Facility,Inpatient,,,90,191,162.35,54.7406,191,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Hla Class Ii Typing, Celiac (Mayo)OutsideLaboratory",,81376,CPT,Facility,Both,,,90,191,162.35,54.7406,191,Sanford Health Plan,Sanford Health Plan,175.72,92,,percent of total billed charges,,
"Hla Class Ii Typing, Celiac (Mayo)OutsideLaboratory",,81376,CPT,Facility,Outpatient,,,90,191,162.35,54.7406,191,"UCare Health, Inc.",Individual & Family Plan,107.6285,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Hla Class Ii Typing, Celiac (Mayo)OutsideLaboratory",,81376,CPT,Facility,Inpatient,,,90,191,162.35,54.7406,191,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Hla Class Ii Typing, Celiac (Mayo)OutsideLaboratory",,81376,CPT,Facility,Outpatient,,,90,191,162.35,54.7406,191,"UCare Health, Inc.",Medical Assistance,96.3977,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Hla Class Ii Typing, Celiac (Mayo)OutsideLaboratory",,81376,CPT,Facility,Inpatient,,,90,191,162.35,54.7406,191,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Hla Class Ii Typing, Celiac (Mayo)OutsideLaboratory",,81376,CPT,Facility,Outpatient,,,90,191,162.35,54.7406,191,"UCare Health, Inc.",Medicare Advantage,96.3977,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Hla Class Ii Typing, Celiac (Mayo)OutsideLaboratory",,81376,CPT,Facility,Inpatient,,,90,191,162.35,54.7406,191,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Hla Class Ii Typing, Celiac (Mayo)OutsideLaboratory",,81376,CPT,Facility,Outpatient,,,90,191,162.35,54.7406,191,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),96.3977,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Hla Class Ii Typing, Celiac (Mayo)OutsideLaboratory",,81376,CPT,Facility,Inpatient,,,90,191,162.35,54.7406,191,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Hla Class Ii Typing, Celiac (Mayo)OutsideLaboratory",,81376,CPT,Facility,Both,,,90,191,162.35,54.7406,191,UnitedHealthcare,Individual & Family,179.54,94,,percent of total billed charges,,
"Hla Class Ii Typing, Celiac (Mayo)OutsideLaboratory",,81376,CPT,Facility,Outpatient,,,90,191,162.35,54.7406,191,UnitedHealthcare,Medicare Advantage,93.59,49,,percent of total billed charges,,
"Hla Class Ii Typing, Celiac (Mayo)OutsideLaboratory",,81376,CPT,Facility,Inpatient,,,90,191,162.35,54.7406,191,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Hla Class Ii Typing, Celiac (Mayo)OutsideLaboratory",,81376,CPT,Facility,Outpatient,,,90,191,162.35,54.7406,191,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,91.68,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Hla Class Ii Typing, Celiac (Mayo)OutsideLaboratory",,81376,CPT,Facility,Inpatient,,,90,191,162.35,54.7406,191,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Unlisted Molecular Pathology (Mayo)OutsideLaboratory,,81479,CPT,Facility,Both,,,90,20,17,5.732,20,Aetna,Commercial,18.4,92,,percent of total billed charges,,
Unlisted Molecular Pathology (Mayo)OutsideLaboratory,,81479,CPT,Facility,Outpatient,,,90,20,17,5.732,20,Aetna,Medicare Advantage,9.8,49,,percent of total billed charges,,
Unlisted Molecular Pathology (Mayo)OutsideLaboratory,,81479,CPT,Facility,Inpatient,,,90,20,17,5.732,20,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Unlisted Molecular Pathology (Mayo)OutsideLaboratory,,81479,CPT,Facility,Both,,,90,20,17,5.732,20,Aetna,PPO,18.6,93,,percent of total billed charges,,
Unlisted Molecular Pathology (Mayo)OutsideLaboratory,,81479,CPT,Facility,Both,,,90,20,17,5.732,20,America's PPO,America's PPO,19.206,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Unlisted Molecular Pathology (Mayo)OutsideLaboratory,,81479,CPT,Facility,Both,,,90,20,17,5.732,20,BlueCross BlueShield Minnesota, Federal Employee Program,19.68,98.4,,percent of total billed charges,,
Unlisted Molecular Pathology (Mayo)OutsideLaboratory,,81479,CPT,Facility,Both,,,90,20,17,5.732,20,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,20,100,,percent of total billed charges,,
Unlisted Molecular Pathology (Mayo)OutsideLaboratory,,81479,CPT,Facility,Both,,,90,20,17,5.732,20,BlueCross BlueShield Minnesota,High Value Network Plan,18,90,,percent of total billed charges,,
Unlisted Molecular Pathology (Mayo)OutsideLaboratory,,81479,CPT,Facility,Outpatient,,,90,20,17,5.732,20,BlueCross BlueShield Minnesota,Medicare Advantage,9.8,49,,percent of total billed charges,,
Unlisted Molecular Pathology (Mayo)OutsideLaboratory,,81479,CPT,Facility,Inpatient,,,90,20,17,5.732,20,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Unlisted Molecular Pathology (Mayo)OutsideLaboratory,,81479,CPT,Facility,Both,,,90,20,17,5.732,20,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,17.714,88.57,,percent of total billed charges,,
Unlisted Molecular Pathology (Mayo)OutsideLaboratory,,81479,CPT,Facility,Both,,,90,20,17,5.732,20,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,5.732,28.66,,percent of total billed charges,,
Unlisted Molecular Pathology (Mayo)OutsideLaboratory,,81479,CPT,Facility,Outpatient,,,90,20,17,5.732,20,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),9.8,49,,percent of total billed charges,,
Unlisted Molecular Pathology (Mayo)OutsideLaboratory,,81479,CPT,Facility,Inpatient,,,90,20,17,5.732,20,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Unlisted Molecular Pathology (Mayo)OutsideLaboratory,,81479,CPT,Facility,Both,,,90,20,17,5.732,20,CorVel,Worker's Compensation,20,100,,percent of total billed charges,,
Unlisted Molecular Pathology (Mayo)OutsideLaboratory,,81479,CPT,Facility,Both,,,90,20,17,5.732,20,First Health Group Corporation,First Health Network,19.4,97,,percent of total billed charges,,
Unlisted Molecular Pathology (Mayo)OutsideLaboratory,,81479,CPT,Facility,Both,,,90,20,17,5.732,20,"Health Partners, Inc.",Commercial,18.92,94.6,,percent of total billed charges,,
Unlisted Molecular Pathology (Mayo)OutsideLaboratory,,81479,CPT,Facility,Outpatient,,,90,20,17,5.732,20,"Health Partners, Inc.",Medicare Advantage,9.8,49,,percent of total billed charges,,
Unlisted Molecular Pathology (Mayo)OutsideLaboratory,,81479,CPT,Facility,Inpatient,,,90,20,17,5.732,20,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Unlisted Molecular Pathology (Mayo)OutsideLaboratory,,81479,CPT,Facility,Both,,,90,20,17,5.732,20,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),12,60,,percent of total billed charges,,
Unlisted Molecular Pathology (Mayo)OutsideLaboratory,,81479,CPT,Facility,Both,,,90,20,17,5.732,20,"Health Partners, Inc.",State of Minnesota Advantage Program,16.3,81.5,,percent of total billed charges,,
Unlisted Molecular Pathology (Mayo)OutsideLaboratory,,81479,CPT,Facility,Both,,,90,20,17,5.732,20,"Health Partners, Inc.",State Public Programs,10,50,,percent of total billed charges,,
Unlisted Molecular Pathology (Mayo)OutsideLaboratory,,81479,CPT,Facility,Both,,,90,20,17,5.732,20,Humana Insurance Company,Commercial PPO,19,95,,percent of total billed charges,,
Unlisted Molecular Pathology (Mayo)OutsideLaboratory,,81479,CPT,Facility,Outpatient,,,90,20,17,5.732,20,Humana Insurance Company,Medicare PPO,9.8,49,,percent of total billed charges,,
Unlisted Molecular Pathology (Mayo)OutsideLaboratory,,81479,CPT,Facility,Inpatient,,,90,20,17,5.732,20,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Unlisted Molecular Pathology (Mayo)OutsideLaboratory,,81479,CPT,Facility,Both,,,90,20,17,5.732,20,Medica,Individual & Family,19.82,99.1,,percent of total billed charges,,
Unlisted Molecular Pathology (Mayo)OutsideLaboratory,,81479,CPT,Facility,Outpatient,,,90,20,17,5.732,20,Medica,Medica Advantage Solution,9.96,49.8,,percent of total billed charges,,
Unlisted Molecular Pathology (Mayo)OutsideLaboratory,,81479,CPT,Facility,Inpatient,,,90,20,17,5.732,20,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Unlisted Molecular Pathology (Mayo)OutsideLaboratory,,81479,CPT,Facility,Outpatient,,,90,20,17,5.732,20,Medica,Medical Assistance,8.92,44.6,,percent of total billed charges,,
Unlisted Molecular Pathology (Mayo)OutsideLaboratory,,81479,CPT,Facility,Inpatient,,,90,20,17,5.732,20,Medica,Medical Assistance,,,,,Included in per diem rate,
Unlisted Molecular Pathology (Mayo)OutsideLaboratory,,81479,CPT,Facility,Outpatient,,,90,20,17,5.732,20,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,9.96,49.8,,percent of total billed charges,,
Unlisted Molecular Pathology (Mayo)OutsideLaboratory,,81479,CPT,Facility,Inpatient,,,90,20,17,5.732,20,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Unlisted Molecular Pathology (Mayo)OutsideLaboratory,,81479,CPT,Facility,Both,,,90,20,17,5.732,20,"Multiplan, Inc.","Multiplan, Inc.",18.8,94,,percent of total billed charges,,
Unlisted Molecular Pathology (Mayo)OutsideLaboratory,,81479,CPT,Facility,Outpatient,,,90,20,17,5.732,20,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,17.28,86.4,,percent of total billed charges,,
Unlisted Molecular Pathology (Mayo)OutsideLaboratory,,81479,CPT,Facility,Inpatient,,,90,20,17,5.732,20,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Unlisted Molecular Pathology (Mayo)OutsideLaboratory,,81479,CPT,Facility,Both,,,90,20,17,5.732,20,"Preferred One Administrative Services, INC.",PPO,19.72,98.6,,percent of total billed charges,,
Unlisted Molecular Pathology (Mayo)OutsideLaboratory,,81479,CPT,Facility,Outpatient,,,90,20,17,5.732,20,PrimeWest Health,Minnesota Senior Health Options (MSHO),10.29,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Unlisted Molecular Pathology (Mayo)OutsideLaboratory,,81479,CPT,Facility,Inpatient,,,90,20,17,5.732,20,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Unlisted Molecular Pathology (Mayo)OutsideLaboratory,,81479,CPT,Facility,Outpatient,,,90,20,17,5.732,20,PrimeWest Health,MinnesotaCare,10.272,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Unlisted Molecular Pathology (Mayo)OutsideLaboratory,,81479,CPT,Facility,Inpatient,,,90,20,17,5.732,20,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Unlisted Molecular Pathology (Mayo)OutsideLaboratory,,81479,CPT,Facility,Both,,,90,20,17,5.732,20,Sanford Health Plan,Sanford Health Plan,18.4,92,,percent of total billed charges,,
Unlisted Molecular Pathology (Mayo)OutsideLaboratory,,81479,CPT,Facility,Outpatient,,,90,20,17,5.732,20,"UCare Health, Inc.",Individual & Family Plan,11.27,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Unlisted Molecular Pathology (Mayo)OutsideLaboratory,,81479,CPT,Facility,Inpatient,,,90,20,17,5.732,20,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Unlisted Molecular Pathology (Mayo)OutsideLaboratory,,81479,CPT,Facility,Outpatient,,,90,20,17,5.732,20,"UCare Health, Inc.",Medical Assistance,10.094,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Unlisted Molecular Pathology (Mayo)OutsideLaboratory,,81479,CPT,Facility,Inpatient,,,90,20,17,5.732,20,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Unlisted Molecular Pathology (Mayo)OutsideLaboratory,,81479,CPT,Facility,Outpatient,,,90,20,17,5.732,20,"UCare Health, Inc.",Medicare Advantage,10.094,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Unlisted Molecular Pathology (Mayo)OutsideLaboratory,,81479,CPT,Facility,Inpatient,,,90,20,17,5.732,20,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Unlisted Molecular Pathology (Mayo)OutsideLaboratory,,81479,CPT,Facility,Outpatient,,,90,20,17,5.732,20,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),10.094,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Unlisted Molecular Pathology (Mayo)OutsideLaboratory,,81479,CPT,Facility,Inpatient,,,90,20,17,5.732,20,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Unlisted Molecular Pathology (Mayo)OutsideLaboratory,,81479,CPT,Facility,Both,,,90,20,17,5.732,20,UnitedHealthcare,Individual & Family,18.8,94,,percent of total billed charges,,
Unlisted Molecular Pathology (Mayo)OutsideLaboratory,,81479,CPT,Facility,Outpatient,,,90,20,17,5.732,20,UnitedHealthcare,Medicare Advantage,9.8,49,,percent of total billed charges,,
Unlisted Molecular Pathology (Mayo)OutsideLaboratory,,81479,CPT,Facility,Inpatient,,,90,20,17,5.732,20,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Unlisted Molecular Pathology (Mayo)OutsideLaboratory,,81479,CPT,Facility,Outpatient,,,90,20,17,5.732,20,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,9.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
Unlisted Molecular Pathology (Mayo)OutsideLaboratory,,81479,CPT,Facility,Inpatient,,,90,20,17,5.732,20,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Quad Scrn (2Nd Tri) Maternal, S (Mayo)OutsideLaboratory",,81511,CPT,Facility,Both,,,90,122,103.7,34.9652,122,Aetna,Commercial,112.24,92,,percent of total billed charges,,
"Quad Scrn (2Nd Tri) Maternal, S (Mayo)OutsideLaboratory",,81511,CPT,Facility,Outpatient,,,90,122,103.7,34.9652,122,Aetna,Medicare Advantage,59.78,49,,percent of total billed charges,,
"Quad Scrn (2Nd Tri) Maternal, S (Mayo)OutsideLaboratory",,81511,CPT,Facility,Inpatient,,,90,122,103.7,34.9652,122,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Quad Scrn (2Nd Tri) Maternal, S (Mayo)OutsideLaboratory",,81511,CPT,Facility,Both,,,90,122,103.7,34.9652,122,Aetna,PPO,113.46,93,,percent of total billed charges,,
"Quad Scrn (2Nd Tri) Maternal, S (Mayo)OutsideLaboratory",,81511,CPT,Facility,Both,,,90,122,103.7,34.9652,122,America's PPO,America's PPO,117.1566,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Quad Scrn (2Nd Tri) Maternal, S (Mayo)OutsideLaboratory",,81511,CPT,Facility,Both,,,90,122,103.7,34.9652,122,BlueCross BlueShield Minnesota, Federal Employee Program,120.048,98.4,,percent of total billed charges,,
"Quad Scrn (2Nd Tri) Maternal, S (Mayo)OutsideLaboratory",,81511,CPT,Facility,Both,,,90,122,103.7,34.9652,122,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,122,100,,percent of total billed charges,,
"Quad Scrn (2Nd Tri) Maternal, S (Mayo)OutsideLaboratory",,81511,CPT,Facility,Both,,,90,122,103.7,34.9652,122,BlueCross BlueShield Minnesota,High Value Network Plan,109.8,90,,percent of total billed charges,,
"Quad Scrn (2Nd Tri) Maternal, S (Mayo)OutsideLaboratory",,81511,CPT,Facility,Outpatient,,,90,122,103.7,34.9652,122,BlueCross BlueShield Minnesota,Medicare Advantage,59.78,49,,percent of total billed charges,,
"Quad Scrn (2Nd Tri) Maternal, S (Mayo)OutsideLaboratory",,81511,CPT,Facility,Inpatient,,,90,122,103.7,34.9652,122,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Quad Scrn (2Nd Tri) Maternal, S (Mayo)OutsideLaboratory",,81511,CPT,Facility,Both,,,90,122,103.7,34.9652,122,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,108.0554,88.57,,percent of total billed charges,,
"Quad Scrn (2Nd Tri) Maternal, S (Mayo)OutsideLaboratory",,81511,CPT,Facility,Both,,,90,122,103.7,34.9652,122,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,34.9652,28.66,,percent of total billed charges,,
"Quad Scrn (2Nd Tri) Maternal, S (Mayo)OutsideLaboratory",,81511,CPT,Facility,Outpatient,,,90,122,103.7,34.9652,122,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),59.78,49,,percent of total billed charges,,
"Quad Scrn (2Nd Tri) Maternal, S (Mayo)OutsideLaboratory",,81511,CPT,Facility,Inpatient,,,90,122,103.7,34.9652,122,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Quad Scrn (2Nd Tri) Maternal, S (Mayo)OutsideLaboratory",,81511,CPT,Facility,Both,,,90,122,103.7,34.9652,122,CorVel,Worker's Compensation,122,100,,percent of total billed charges,,
"Quad Scrn (2Nd Tri) Maternal, S (Mayo)OutsideLaboratory",,81511,CPT,Facility,Both,,,90,122,103.7,34.9652,122,First Health Group Corporation,First Health Network,118.34,97,,percent of total billed charges,,
"Quad Scrn (2Nd Tri) Maternal, S (Mayo)OutsideLaboratory",,81511,CPT,Facility,Both,,,90,122,103.7,34.9652,122,"Health Partners, Inc.",Commercial,115.412,94.6,,percent of total billed charges,,
"Quad Scrn (2Nd Tri) Maternal, S (Mayo)OutsideLaboratory",,81511,CPT,Facility,Outpatient,,,90,122,103.7,34.9652,122,"Health Partners, Inc.",Medicare Advantage,59.78,49,,percent of total billed charges,,
"Quad Scrn (2Nd Tri) Maternal, S (Mayo)OutsideLaboratory",,81511,CPT,Facility,Inpatient,,,90,122,103.7,34.9652,122,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Quad Scrn (2Nd Tri) Maternal, S (Mayo)OutsideLaboratory",,81511,CPT,Facility,Both,,,90,122,103.7,34.9652,122,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),73.2,60,,percent of total billed charges,,
"Quad Scrn (2Nd Tri) Maternal, S (Mayo)OutsideLaboratory",,81511,CPT,Facility,Both,,,90,122,103.7,34.9652,122,"Health Partners, Inc.",State of Minnesota Advantage Program,99.43,81.5,,percent of total billed charges,,
"Quad Scrn (2Nd Tri) Maternal, S (Mayo)OutsideLaboratory",,81511,CPT,Facility,Both,,,90,122,103.7,34.9652,122,"Health Partners, Inc.",State Public Programs,61,50,,percent of total billed charges,,
"Quad Scrn (2Nd Tri) Maternal, S (Mayo)OutsideLaboratory",,81511,CPT,Facility,Both,,,90,122,103.7,34.9652,122,Humana Insurance Company,Commercial PPO,115.9,95,,percent of total billed charges,,
"Quad Scrn (2Nd Tri) Maternal, S (Mayo)OutsideLaboratory",,81511,CPT,Facility,Outpatient,,,90,122,103.7,34.9652,122,Humana Insurance Company,Medicare PPO,59.78,49,,percent of total billed charges,,
"Quad Scrn (2Nd Tri) Maternal, S (Mayo)OutsideLaboratory",,81511,CPT,Facility,Inpatient,,,90,122,103.7,34.9652,122,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Quad Scrn (2Nd Tri) Maternal, S (Mayo)OutsideLaboratory",,81511,CPT,Facility,Both,,,90,122,103.7,34.9652,122,Medica,Individual & Family,120.902,99.1,,percent of total billed charges,,
"Quad Scrn (2Nd Tri) Maternal, S (Mayo)OutsideLaboratory",,81511,CPT,Facility,Outpatient,,,90,122,103.7,34.9652,122,Medica,Medica Advantage Solution,60.756,49.8,,percent of total billed charges,,
"Quad Scrn (2Nd Tri) Maternal, S (Mayo)OutsideLaboratory",,81511,CPT,Facility,Inpatient,,,90,122,103.7,34.9652,122,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Quad Scrn (2Nd Tri) Maternal, S (Mayo)OutsideLaboratory",,81511,CPT,Facility,Outpatient,,,90,122,103.7,34.9652,122,Medica,Medical Assistance,54.412,44.6,,percent of total billed charges,,
"Quad Scrn (2Nd Tri) Maternal, S (Mayo)OutsideLaboratory",,81511,CPT,Facility,Inpatient,,,90,122,103.7,34.9652,122,Medica,Medical Assistance,,,,,Included in per diem rate,
"Quad Scrn (2Nd Tri) Maternal, S (Mayo)OutsideLaboratory",,81511,CPT,Facility,Outpatient,,,90,122,103.7,34.9652,122,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,60.756,49.8,,percent of total billed charges,,
"Quad Scrn (2Nd Tri) Maternal, S (Mayo)OutsideLaboratory",,81511,CPT,Facility,Inpatient,,,90,122,103.7,34.9652,122,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Quad Scrn (2Nd Tri) Maternal, S (Mayo)OutsideLaboratory",,81511,CPT,Facility,Both,,,90,122,103.7,34.9652,122,"Multiplan, Inc.","Multiplan, Inc.",114.68,94,,percent of total billed charges,,
"Quad Scrn (2Nd Tri) Maternal, S (Mayo)OutsideLaboratory",,81511,CPT,Facility,Outpatient,,,90,122,103.7,34.9652,122,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,105.408,86.4,,percent of total billed charges,,
"Quad Scrn (2Nd Tri) Maternal, S (Mayo)OutsideLaboratory",,81511,CPT,Facility,Inpatient,,,90,122,103.7,34.9652,122,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Quad Scrn (2Nd Tri) Maternal, S (Mayo)OutsideLaboratory",,81511,CPT,Facility,Both,,,90,122,103.7,34.9652,122,"Preferred One Administrative Services, INC.",PPO,120.292,98.6,,percent of total billed charges,,
"Quad Scrn (2Nd Tri) Maternal, S (Mayo)OutsideLaboratory",,81511,CPT,Facility,Outpatient,,,90,122,103.7,34.9652,122,PrimeWest Health,Minnesota Senior Health Options (MSHO),62.769,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Quad Scrn (2Nd Tri) Maternal, S (Mayo)OutsideLaboratory",,81511,CPT,Facility,Inpatient,,,90,122,103.7,34.9652,122,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Quad Scrn (2Nd Tri) Maternal, S (Mayo)OutsideLaboratory",,81511,CPT,Facility,Outpatient,,,90,122,103.7,34.9652,122,PrimeWest Health,MinnesotaCare,62.6592,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Quad Scrn (2Nd Tri) Maternal, S (Mayo)OutsideLaboratory",,81511,CPT,Facility,Inpatient,,,90,122,103.7,34.9652,122,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Quad Scrn (2Nd Tri) Maternal, S (Mayo)OutsideLaboratory",,81511,CPT,Facility,Both,,,90,122,103.7,34.9652,122,Sanford Health Plan,Sanford Health Plan,112.24,92,,percent of total billed charges,,
"Quad Scrn (2Nd Tri) Maternal, S (Mayo)OutsideLaboratory",,81511,CPT,Facility,Outpatient,,,90,122,103.7,34.9652,122,"UCare Health, Inc.",Individual & Family Plan,68.747,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Quad Scrn (2Nd Tri) Maternal, S (Mayo)OutsideLaboratory",,81511,CPT,Facility,Inpatient,,,90,122,103.7,34.9652,122,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Quad Scrn (2Nd Tri) Maternal, S (Mayo)OutsideLaboratory",,81511,CPT,Facility,Outpatient,,,90,122,103.7,34.9652,122,"UCare Health, Inc.",Medical Assistance,61.5734,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Quad Scrn (2Nd Tri) Maternal, S (Mayo)OutsideLaboratory",,81511,CPT,Facility,Inpatient,,,90,122,103.7,34.9652,122,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Quad Scrn (2Nd Tri) Maternal, S (Mayo)OutsideLaboratory",,81511,CPT,Facility,Outpatient,,,90,122,103.7,34.9652,122,"UCare Health, Inc.",Medicare Advantage,61.5734,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Quad Scrn (2Nd Tri) Maternal, S (Mayo)OutsideLaboratory",,81511,CPT,Facility,Inpatient,,,90,122,103.7,34.9652,122,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Quad Scrn (2Nd Tri) Maternal, S (Mayo)OutsideLaboratory",,81511,CPT,Facility,Outpatient,,,90,122,103.7,34.9652,122,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),61.5734,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Quad Scrn (2Nd Tri) Maternal, S (Mayo)OutsideLaboratory",,81511,CPT,Facility,Inpatient,,,90,122,103.7,34.9652,122,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Quad Scrn (2Nd Tri) Maternal, S (Mayo)OutsideLaboratory",,81511,CPT,Facility,Both,,,90,122,103.7,34.9652,122,UnitedHealthcare,Individual & Family,114.68,94,,percent of total billed charges,,
"Quad Scrn (2Nd Tri) Maternal, S (Mayo)OutsideLaboratory",,81511,CPT,Facility,Outpatient,,,90,122,103.7,34.9652,122,UnitedHealthcare,Medicare Advantage,59.78,49,,percent of total billed charges,,
"Quad Scrn (2Nd Tri) Maternal, S (Mayo)OutsideLaboratory",,81511,CPT,Facility,Inpatient,,,90,122,103.7,34.9652,122,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Quad Scrn (2Nd Tri) Maternal, S (Mayo)OutsideLaboratory",,81511,CPT,Facility,Outpatient,,,90,122,103.7,34.9652,122,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,58.56,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Quad Scrn (2Nd Tri) Maternal, S (Mayo)OutsideLaboratory",,81511,CPT,Facility,Inpatient,,,90,122,103.7,34.9652,122,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Beta-Hydroxybutyrate, S (Mayo)OutsideLaboratory",,82010,CPT,Facility,Both,,,90,86,73.1,24.6476,86,Aetna,Commercial,79.12,92,,percent of total billed charges,,
"Beta-Hydroxybutyrate, S (Mayo)OutsideLaboratory",,82010,CPT,Facility,Outpatient,,,90,86,73.1,24.6476,86,Aetna,Medicare Advantage,42.14,49,,percent of total billed charges,,
"Beta-Hydroxybutyrate, S (Mayo)OutsideLaboratory",,82010,CPT,Facility,Inpatient,,,90,86,73.1,24.6476,86,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Beta-Hydroxybutyrate, S (Mayo)OutsideLaboratory",,82010,CPT,Facility,Both,,,90,86,73.1,24.6476,86,Aetna,PPO,79.98,93,,percent of total billed charges,,
"Beta-Hydroxybutyrate, S (Mayo)OutsideLaboratory",,82010,CPT,Facility,Both,,,90,86,73.1,24.6476,86,America's PPO,America's PPO,82.5858,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Beta-Hydroxybutyrate, S (Mayo)OutsideLaboratory",,82010,CPT,Facility,Both,,,90,86,73.1,24.6476,86,BlueCross BlueShield Minnesota, Federal Employee Program,84.624,98.4,,percent of total billed charges,,
"Beta-Hydroxybutyrate, S (Mayo)OutsideLaboratory",,82010,CPT,Facility,Both,,,90,86,73.1,24.6476,86,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,86,100,,percent of total billed charges,,
"Beta-Hydroxybutyrate, S (Mayo)OutsideLaboratory",,82010,CPT,Facility,Both,,,90,86,73.1,24.6476,86,BlueCross BlueShield Minnesota,High Value Network Plan,77.4,90,,percent of total billed charges,,
"Beta-Hydroxybutyrate, S (Mayo)OutsideLaboratory",,82010,CPT,Facility,Outpatient,,,90,86,73.1,24.6476,86,BlueCross BlueShield Minnesota,Medicare Advantage,42.14,49,,percent of total billed charges,,
"Beta-Hydroxybutyrate, S (Mayo)OutsideLaboratory",,82010,CPT,Facility,Inpatient,,,90,86,73.1,24.6476,86,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Beta-Hydroxybutyrate, S (Mayo)OutsideLaboratory",,82010,CPT,Facility,Both,,,90,86,73.1,24.6476,86,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,76.1702,88.57,,percent of total billed charges,,
"Beta-Hydroxybutyrate, S (Mayo)OutsideLaboratory",,82010,CPT,Facility,Both,,,90,86,73.1,24.6476,86,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,24.6476,28.66,,percent of total billed charges,,
"Beta-Hydroxybutyrate, S (Mayo)OutsideLaboratory",,82010,CPT,Facility,Outpatient,,,90,86,73.1,24.6476,86,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),42.14,49,,percent of total billed charges,,
"Beta-Hydroxybutyrate, S (Mayo)OutsideLaboratory",,82010,CPT,Facility,Inpatient,,,90,86,73.1,24.6476,86,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Beta-Hydroxybutyrate, S (Mayo)OutsideLaboratory",,82010,CPT,Facility,Both,,,90,86,73.1,24.6476,86,CorVel,Worker's Compensation,86,100,,percent of total billed charges,,
"Beta-Hydroxybutyrate, S (Mayo)OutsideLaboratory",,82010,CPT,Facility,Both,,,90,86,73.1,24.6476,86,First Health Group Corporation,First Health Network,83.42,97,,percent of total billed charges,,
"Beta-Hydroxybutyrate, S (Mayo)OutsideLaboratory",,82010,CPT,Facility,Both,,,90,86,73.1,24.6476,86,"Health Partners, Inc.",Commercial,81.356,94.6,,percent of total billed charges,,
"Beta-Hydroxybutyrate, S (Mayo)OutsideLaboratory",,82010,CPT,Facility,Outpatient,,,90,86,73.1,24.6476,86,"Health Partners, Inc.",Medicare Advantage,42.14,49,,percent of total billed charges,,
"Beta-Hydroxybutyrate, S (Mayo)OutsideLaboratory",,82010,CPT,Facility,Inpatient,,,90,86,73.1,24.6476,86,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Beta-Hydroxybutyrate, S (Mayo)OutsideLaboratory",,82010,CPT,Facility,Both,,,90,86,73.1,24.6476,86,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),51.6,60,,percent of total billed charges,,
"Beta-Hydroxybutyrate, S (Mayo)OutsideLaboratory",,82010,CPT,Facility,Both,,,90,86,73.1,24.6476,86,"Health Partners, Inc.",State of Minnesota Advantage Program,70.09,81.5,,percent of total billed charges,,
"Beta-Hydroxybutyrate, S (Mayo)OutsideLaboratory",,82010,CPT,Facility,Both,,,90,86,73.1,24.6476,86,"Health Partners, Inc.",State Public Programs,43,50,,percent of total billed charges,,
"Beta-Hydroxybutyrate, S (Mayo)OutsideLaboratory",,82010,CPT,Facility,Both,,,90,86,73.1,24.6476,86,Humana Insurance Company,Commercial PPO,81.7,95,,percent of total billed charges,,
"Beta-Hydroxybutyrate, S (Mayo)OutsideLaboratory",,82010,CPT,Facility,Outpatient,,,90,86,73.1,24.6476,86,Humana Insurance Company,Medicare PPO,42.14,49,,percent of total billed charges,,
"Beta-Hydroxybutyrate, S (Mayo)OutsideLaboratory",,82010,CPT,Facility,Inpatient,,,90,86,73.1,24.6476,86,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Beta-Hydroxybutyrate, S (Mayo)OutsideLaboratory",,82010,CPT,Facility,Both,,,90,86,73.1,24.6476,86,Medica,Individual & Family,85.226,99.1,,percent of total billed charges,,
"Beta-Hydroxybutyrate, S (Mayo)OutsideLaboratory",,82010,CPT,Facility,Outpatient,,,90,86,73.1,24.6476,86,Medica,Medica Advantage Solution,42.828,49.8,,percent of total billed charges,,
"Beta-Hydroxybutyrate, S (Mayo)OutsideLaboratory",,82010,CPT,Facility,Inpatient,,,90,86,73.1,24.6476,86,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Beta-Hydroxybutyrate, S (Mayo)OutsideLaboratory",,82010,CPT,Facility,Outpatient,,,90,86,73.1,24.6476,86,Medica,Medical Assistance,38.356,44.6,,percent of total billed charges,,
"Beta-Hydroxybutyrate, S (Mayo)OutsideLaboratory",,82010,CPT,Facility,Inpatient,,,90,86,73.1,24.6476,86,Medica,Medical Assistance,,,,,Included in per diem rate,
"Beta-Hydroxybutyrate, S (Mayo)OutsideLaboratory",,82010,CPT,Facility,Outpatient,,,90,86,73.1,24.6476,86,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,42.828,49.8,,percent of total billed charges,,
"Beta-Hydroxybutyrate, S (Mayo)OutsideLaboratory",,82010,CPT,Facility,Inpatient,,,90,86,73.1,24.6476,86,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Beta-Hydroxybutyrate, S (Mayo)OutsideLaboratory",,82010,CPT,Facility,Both,,,90,86,73.1,24.6476,86,"Multiplan, Inc.","Multiplan, Inc.",80.84,94,,percent of total billed charges,,
"Beta-Hydroxybutyrate, S (Mayo)OutsideLaboratory",,82010,CPT,Facility,Outpatient,,,90,86,73.1,24.6476,86,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,74.304,86.4,,percent of total billed charges,,
"Beta-Hydroxybutyrate, S (Mayo)OutsideLaboratory",,82010,CPT,Facility,Inpatient,,,90,86,73.1,24.6476,86,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Beta-Hydroxybutyrate, S (Mayo)OutsideLaboratory",,82010,CPT,Facility,Both,,,90,86,73.1,24.6476,86,"Preferred One Administrative Services, INC.",PPO,84.796,98.6,,percent of total billed charges,,
"Beta-Hydroxybutyrate, S (Mayo)OutsideLaboratory",,82010,CPT,Facility,Outpatient,,,90,86,73.1,24.6476,86,PrimeWest Health,Minnesota Senior Health Options (MSHO),44.247,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Beta-Hydroxybutyrate, S (Mayo)OutsideLaboratory",,82010,CPT,Facility,Inpatient,,,90,86,73.1,24.6476,86,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Beta-Hydroxybutyrate, S (Mayo)OutsideLaboratory",,82010,CPT,Facility,Outpatient,,,90,86,73.1,24.6476,86,PrimeWest Health,MinnesotaCare,44.1696,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Beta-Hydroxybutyrate, S (Mayo)OutsideLaboratory",,82010,CPT,Facility,Inpatient,,,90,86,73.1,24.6476,86,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Beta-Hydroxybutyrate, S (Mayo)OutsideLaboratory",,82010,CPT,Facility,Both,,,90,86,73.1,24.6476,86,Sanford Health Plan,Sanford Health Plan,79.12,92,,percent of total billed charges,,
"Beta-Hydroxybutyrate, S (Mayo)OutsideLaboratory",,82010,CPT,Facility,Outpatient,,,90,86,73.1,24.6476,86,"UCare Health, Inc.",Individual & Family Plan,48.461,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Beta-Hydroxybutyrate, S (Mayo)OutsideLaboratory",,82010,CPT,Facility,Inpatient,,,90,86,73.1,24.6476,86,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Beta-Hydroxybutyrate, S (Mayo)OutsideLaboratory",,82010,CPT,Facility,Outpatient,,,90,86,73.1,24.6476,86,"UCare Health, Inc.",Medical Assistance,43.4042,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Beta-Hydroxybutyrate, S (Mayo)OutsideLaboratory",,82010,CPT,Facility,Inpatient,,,90,86,73.1,24.6476,86,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Beta-Hydroxybutyrate, S (Mayo)OutsideLaboratory",,82010,CPT,Facility,Outpatient,,,90,86,73.1,24.6476,86,"UCare Health, Inc.",Medicare Advantage,43.4042,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Beta-Hydroxybutyrate, S (Mayo)OutsideLaboratory",,82010,CPT,Facility,Inpatient,,,90,86,73.1,24.6476,86,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Beta-Hydroxybutyrate, S (Mayo)OutsideLaboratory",,82010,CPT,Facility,Outpatient,,,90,86,73.1,24.6476,86,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),43.4042,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Beta-Hydroxybutyrate, S (Mayo)OutsideLaboratory",,82010,CPT,Facility,Inpatient,,,90,86,73.1,24.6476,86,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Beta-Hydroxybutyrate, S (Mayo)OutsideLaboratory",,82010,CPT,Facility,Both,,,90,86,73.1,24.6476,86,UnitedHealthcare,Individual & Family,80.84,94,,percent of total billed charges,,
"Beta-Hydroxybutyrate, S (Mayo)OutsideLaboratory",,82010,CPT,Facility,Outpatient,,,90,86,73.1,24.6476,86,UnitedHealthcare,Medicare Advantage,42.14,49,,percent of total billed charges,,
"Beta-Hydroxybutyrate, S (Mayo)OutsideLaboratory",,82010,CPT,Facility,Inpatient,,,90,86,73.1,24.6476,86,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Beta-Hydroxybutyrate, S (Mayo)OutsideLaboratory",,82010,CPT,Facility,Outpatient,,,90,86,73.1,24.6476,86,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,41.28,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Beta-Hydroxybutyrate, S (Mayo)OutsideLaboratory",,82010,CPT,Facility,Inpatient,,,90,86,73.1,24.6476,86,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Acylcarnitines, Quantitative, P (Mayo)OutsideLaboratory",,82017,CPT,Facility,Both,,,90,117,99.45,33.5322,117,Aetna,Commercial,107.64,92,,percent of total billed charges,,
"Acylcarnitines, Quantitative, P (Mayo)OutsideLaboratory",,82017,CPT,Facility,Outpatient,,,90,117,99.45,33.5322,117,Aetna,Medicare Advantage,57.33,49,,percent of total billed charges,,
"Acylcarnitines, Quantitative, P (Mayo)OutsideLaboratory",,82017,CPT,Facility,Inpatient,,,90,117,99.45,33.5322,117,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Acylcarnitines, Quantitative, P (Mayo)OutsideLaboratory",,82017,CPT,Facility,Both,,,90,117,99.45,33.5322,117,Aetna,PPO,108.81,93,,percent of total billed charges,,
"Acylcarnitines, Quantitative, P (Mayo)OutsideLaboratory",,82017,CPT,Facility,Both,,,90,117,99.45,33.5322,117,America's PPO,America's PPO,112.3551,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Acylcarnitines, Quantitative, P (Mayo)OutsideLaboratory",,82017,CPT,Facility,Both,,,90,117,99.45,33.5322,117,BlueCross BlueShield Minnesota, Federal Employee Program,115.128,98.4,,percent of total billed charges,,
"Acylcarnitines, Quantitative, P (Mayo)OutsideLaboratory",,82017,CPT,Facility,Both,,,90,117,99.45,33.5322,117,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,117,100,,percent of total billed charges,,
"Acylcarnitines, Quantitative, P (Mayo)OutsideLaboratory",,82017,CPT,Facility,Both,,,90,117,99.45,33.5322,117,BlueCross BlueShield Minnesota,High Value Network Plan,105.3,90,,percent of total billed charges,,
"Acylcarnitines, Quantitative, P (Mayo)OutsideLaboratory",,82017,CPT,Facility,Outpatient,,,90,117,99.45,33.5322,117,BlueCross BlueShield Minnesota,Medicare Advantage,57.33,49,,percent of total billed charges,,
"Acylcarnitines, Quantitative, P (Mayo)OutsideLaboratory",,82017,CPT,Facility,Inpatient,,,90,117,99.45,33.5322,117,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Acylcarnitines, Quantitative, P (Mayo)OutsideLaboratory",,82017,CPT,Facility,Both,,,90,117,99.45,33.5322,117,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,103.6269,88.57,,percent of total billed charges,,
"Acylcarnitines, Quantitative, P (Mayo)OutsideLaboratory",,82017,CPT,Facility,Both,,,90,117,99.45,33.5322,117,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,33.5322,28.66,,percent of total billed charges,,
"Acylcarnitines, Quantitative, P (Mayo)OutsideLaboratory",,82017,CPT,Facility,Outpatient,,,90,117,99.45,33.5322,117,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),57.33,49,,percent of total billed charges,,
"Acylcarnitines, Quantitative, P (Mayo)OutsideLaboratory",,82017,CPT,Facility,Inpatient,,,90,117,99.45,33.5322,117,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Acylcarnitines, Quantitative, P (Mayo)OutsideLaboratory",,82017,CPT,Facility,Both,,,90,117,99.45,33.5322,117,CorVel,Worker's Compensation,117,100,,percent of total billed charges,,
"Acylcarnitines, Quantitative, P (Mayo)OutsideLaboratory",,82017,CPT,Facility,Both,,,90,117,99.45,33.5322,117,First Health Group Corporation,First Health Network,113.49,97,,percent of total billed charges,,
"Acylcarnitines, Quantitative, P (Mayo)OutsideLaboratory",,82017,CPT,Facility,Both,,,90,117,99.45,33.5322,117,"Health Partners, Inc.",Commercial,110.682,94.6,,percent of total billed charges,,
"Acylcarnitines, Quantitative, P (Mayo)OutsideLaboratory",,82017,CPT,Facility,Outpatient,,,90,117,99.45,33.5322,117,"Health Partners, Inc.",Medicare Advantage,57.33,49,,percent of total billed charges,,
"Acylcarnitines, Quantitative, P (Mayo)OutsideLaboratory",,82017,CPT,Facility,Inpatient,,,90,117,99.45,33.5322,117,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Acylcarnitines, Quantitative, P (Mayo)OutsideLaboratory",,82017,CPT,Facility,Both,,,90,117,99.45,33.5322,117,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),70.2,60,,percent of total billed charges,,
"Acylcarnitines, Quantitative, P (Mayo)OutsideLaboratory",,82017,CPT,Facility,Both,,,90,117,99.45,33.5322,117,"Health Partners, Inc.",State of Minnesota Advantage Program,95.355,81.5,,percent of total billed charges,,
"Acylcarnitines, Quantitative, P (Mayo)OutsideLaboratory",,82017,CPT,Facility,Both,,,90,117,99.45,33.5322,117,"Health Partners, Inc.",State Public Programs,58.5,50,,percent of total billed charges,,
"Acylcarnitines, Quantitative, P (Mayo)OutsideLaboratory",,82017,CPT,Facility,Both,,,90,117,99.45,33.5322,117,Humana Insurance Company,Commercial PPO,111.15,95,,percent of total billed charges,,
"Acylcarnitines, Quantitative, P (Mayo)OutsideLaboratory",,82017,CPT,Facility,Outpatient,,,90,117,99.45,33.5322,117,Humana Insurance Company,Medicare PPO,57.33,49,,percent of total billed charges,,
"Acylcarnitines, Quantitative, P (Mayo)OutsideLaboratory",,82017,CPT,Facility,Inpatient,,,90,117,99.45,33.5322,117,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Acylcarnitines, Quantitative, P (Mayo)OutsideLaboratory",,82017,CPT,Facility,Both,,,90,117,99.45,33.5322,117,Medica,Individual & Family,115.947,99.1,,percent of total billed charges,,
"Acylcarnitines, Quantitative, P (Mayo)OutsideLaboratory",,82017,CPT,Facility,Outpatient,,,90,117,99.45,33.5322,117,Medica,Medica Advantage Solution,58.266,49.8,,percent of total billed charges,,
"Acylcarnitines, Quantitative, P (Mayo)OutsideLaboratory",,82017,CPT,Facility,Inpatient,,,90,117,99.45,33.5322,117,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Acylcarnitines, Quantitative, P (Mayo)OutsideLaboratory",,82017,CPT,Facility,Outpatient,,,90,117,99.45,33.5322,117,Medica,Medical Assistance,52.182,44.6,,percent of total billed charges,,
"Acylcarnitines, Quantitative, P (Mayo)OutsideLaboratory",,82017,CPT,Facility,Inpatient,,,90,117,99.45,33.5322,117,Medica,Medical Assistance,,,,,Included in per diem rate,
"Acylcarnitines, Quantitative, P (Mayo)OutsideLaboratory",,82017,CPT,Facility,Outpatient,,,90,117,99.45,33.5322,117,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,58.266,49.8,,percent of total billed charges,,
"Acylcarnitines, Quantitative, P (Mayo)OutsideLaboratory",,82017,CPT,Facility,Inpatient,,,90,117,99.45,33.5322,117,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Acylcarnitines, Quantitative, P (Mayo)OutsideLaboratory",,82017,CPT,Facility,Both,,,90,117,99.45,33.5322,117,"Multiplan, Inc.","Multiplan, Inc.",109.98,94,,percent of total billed charges,,
"Acylcarnitines, Quantitative, P (Mayo)OutsideLaboratory",,82017,CPT,Facility,Outpatient,,,90,117,99.45,33.5322,117,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,101.088,86.4,,percent of total billed charges,,
"Acylcarnitines, Quantitative, P (Mayo)OutsideLaboratory",,82017,CPT,Facility,Inpatient,,,90,117,99.45,33.5322,117,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Acylcarnitines, Quantitative, P (Mayo)OutsideLaboratory",,82017,CPT,Facility,Both,,,90,117,99.45,33.5322,117,"Preferred One Administrative Services, INC.",PPO,115.362,98.6,,percent of total billed charges,,
"Acylcarnitines, Quantitative, P (Mayo)OutsideLaboratory",,82017,CPT,Facility,Outpatient,,,90,117,99.45,33.5322,117,PrimeWest Health,Minnesota Senior Health Options (MSHO),60.1965,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Acylcarnitines, Quantitative, P (Mayo)OutsideLaboratory",,82017,CPT,Facility,Inpatient,,,90,117,99.45,33.5322,117,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Acylcarnitines, Quantitative, P (Mayo)OutsideLaboratory",,82017,CPT,Facility,Outpatient,,,90,117,99.45,33.5322,117,PrimeWest Health,MinnesotaCare,60.0912,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Acylcarnitines, Quantitative, P (Mayo)OutsideLaboratory",,82017,CPT,Facility,Inpatient,,,90,117,99.45,33.5322,117,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Acylcarnitines, Quantitative, P (Mayo)OutsideLaboratory",,82017,CPT,Facility,Both,,,90,117,99.45,33.5322,117,Sanford Health Plan,Sanford Health Plan,107.64,92,,percent of total billed charges,,
"Acylcarnitines, Quantitative, P (Mayo)OutsideLaboratory",,82017,CPT,Facility,Outpatient,,,90,117,99.45,33.5322,117,"UCare Health, Inc.",Individual & Family Plan,65.9295,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Acylcarnitines, Quantitative, P (Mayo)OutsideLaboratory",,82017,CPT,Facility,Inpatient,,,90,117,99.45,33.5322,117,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Acylcarnitines, Quantitative, P (Mayo)OutsideLaboratory",,82017,CPT,Facility,Outpatient,,,90,117,99.45,33.5322,117,"UCare Health, Inc.",Medical Assistance,59.0499,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Acylcarnitines, Quantitative, P (Mayo)OutsideLaboratory",,82017,CPT,Facility,Inpatient,,,90,117,99.45,33.5322,117,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Acylcarnitines, Quantitative, P (Mayo)OutsideLaboratory",,82017,CPT,Facility,Outpatient,,,90,117,99.45,33.5322,117,"UCare Health, Inc.",Medicare Advantage,59.0499,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Acylcarnitines, Quantitative, P (Mayo)OutsideLaboratory",,82017,CPT,Facility,Inpatient,,,90,117,99.45,33.5322,117,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Acylcarnitines, Quantitative, P (Mayo)OutsideLaboratory",,82017,CPT,Facility,Outpatient,,,90,117,99.45,33.5322,117,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),59.0499,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Acylcarnitines, Quantitative, P (Mayo)OutsideLaboratory",,82017,CPT,Facility,Inpatient,,,90,117,99.45,33.5322,117,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Acylcarnitines, Quantitative, P (Mayo)OutsideLaboratory",,82017,CPT,Facility,Both,,,90,117,99.45,33.5322,117,UnitedHealthcare,Individual & Family,109.98,94,,percent of total billed charges,,
"Acylcarnitines, Quantitative, P (Mayo)OutsideLaboratory",,82017,CPT,Facility,Outpatient,,,90,117,99.45,33.5322,117,UnitedHealthcare,Medicare Advantage,57.33,49,,percent of total billed charges,,
"Acylcarnitines, Quantitative, P (Mayo)OutsideLaboratory",,82017,CPT,Facility,Inpatient,,,90,117,99.45,33.5322,117,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Acylcarnitines, Quantitative, P (Mayo)OutsideLaboratory",,82017,CPT,Facility,Outpatient,,,90,117,99.45,33.5322,117,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,56.16,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Acylcarnitines, Quantitative, P (Mayo)OutsideLaboratory",,82017,CPT,Facility,Inpatient,,,90,117,99.45,33.5322,117,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Adrenocorticotropic Hormone, P (Mayo)OutsideLaboratory",,82024,CPT,Facility,Both,,,90,206,175.1,59.0396,206,Aetna,Commercial,189.52,92,,percent of total billed charges,,
"Adrenocorticotropic Hormone, P (Mayo)OutsideLaboratory",,82024,CPT,Facility,Outpatient,,,90,206,175.1,59.0396,206,Aetna,Medicare Advantage,100.94,49,,percent of total billed charges,,
"Adrenocorticotropic Hormone, P (Mayo)OutsideLaboratory",,82024,CPT,Facility,Inpatient,,,90,206,175.1,59.0396,206,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Adrenocorticotropic Hormone, P (Mayo)OutsideLaboratory",,82024,CPT,Facility,Both,,,90,206,175.1,59.0396,206,Aetna,PPO,191.58,93,,percent of total billed charges,,
"Adrenocorticotropic Hormone, P (Mayo)OutsideLaboratory",,82024,CPT,Facility,Both,,,90,206,175.1,59.0396,206,America's PPO,America's PPO,197.8218,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Adrenocorticotropic Hormone, P (Mayo)OutsideLaboratory",,82024,CPT,Facility,Both,,,90,206,175.1,59.0396,206,BlueCross BlueShield Minnesota, Federal Employee Program,202.704,98.4,,percent of total billed charges,,
"Adrenocorticotropic Hormone, P (Mayo)OutsideLaboratory",,82024,CPT,Facility,Both,,,90,206,175.1,59.0396,206,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,206,100,,percent of total billed charges,,
"Adrenocorticotropic Hormone, P (Mayo)OutsideLaboratory",,82024,CPT,Facility,Both,,,90,206,175.1,59.0396,206,BlueCross BlueShield Minnesota,High Value Network Plan,185.4,90,,percent of total billed charges,,
"Adrenocorticotropic Hormone, P (Mayo)OutsideLaboratory",,82024,CPT,Facility,Outpatient,,,90,206,175.1,59.0396,206,BlueCross BlueShield Minnesota,Medicare Advantage,100.94,49,,percent of total billed charges,,
"Adrenocorticotropic Hormone, P (Mayo)OutsideLaboratory",,82024,CPT,Facility,Inpatient,,,90,206,175.1,59.0396,206,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Adrenocorticotropic Hormone, P (Mayo)OutsideLaboratory",,82024,CPT,Facility,Both,,,90,206,175.1,59.0396,206,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,182.4542,88.57,,percent of total billed charges,,
"Adrenocorticotropic Hormone, P (Mayo)OutsideLaboratory",,82024,CPT,Facility,Both,,,90,206,175.1,59.0396,206,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,59.0396,28.66,,percent of total billed charges,,
"Adrenocorticotropic Hormone, P (Mayo)OutsideLaboratory",,82024,CPT,Facility,Outpatient,,,90,206,175.1,59.0396,206,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),100.94,49,,percent of total billed charges,,
"Adrenocorticotropic Hormone, P (Mayo)OutsideLaboratory",,82024,CPT,Facility,Inpatient,,,90,206,175.1,59.0396,206,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Adrenocorticotropic Hormone, P (Mayo)OutsideLaboratory",,82024,CPT,Facility,Both,,,90,206,175.1,59.0396,206,CorVel,Worker's Compensation,206,100,,percent of total billed charges,,
"Adrenocorticotropic Hormone, P (Mayo)OutsideLaboratory",,82024,CPT,Facility,Both,,,90,206,175.1,59.0396,206,First Health Group Corporation,First Health Network,199.82,97,,percent of total billed charges,,
"Adrenocorticotropic Hormone, P (Mayo)OutsideLaboratory",,82024,CPT,Facility,Both,,,90,206,175.1,59.0396,206,"Health Partners, Inc.",Commercial,194.876,94.6,,percent of total billed charges,,
"Adrenocorticotropic Hormone, P (Mayo)OutsideLaboratory",,82024,CPT,Facility,Outpatient,,,90,206,175.1,59.0396,206,"Health Partners, Inc.",Medicare Advantage,100.94,49,,percent of total billed charges,,
"Adrenocorticotropic Hormone, P (Mayo)OutsideLaboratory",,82024,CPT,Facility,Inpatient,,,90,206,175.1,59.0396,206,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Adrenocorticotropic Hormone, P (Mayo)OutsideLaboratory",,82024,CPT,Facility,Both,,,90,206,175.1,59.0396,206,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),123.6,60,,percent of total billed charges,,
"Adrenocorticotropic Hormone, P (Mayo)OutsideLaboratory",,82024,CPT,Facility,Both,,,90,206,175.1,59.0396,206,"Health Partners, Inc.",State of Minnesota Advantage Program,167.89,81.5,,percent of total billed charges,,
"Adrenocorticotropic Hormone, P (Mayo)OutsideLaboratory",,82024,CPT,Facility,Both,,,90,206,175.1,59.0396,206,"Health Partners, Inc.",State Public Programs,103,50,,percent of total billed charges,,
"Adrenocorticotropic Hormone, P (Mayo)OutsideLaboratory",,82024,CPT,Facility,Both,,,90,206,175.1,59.0396,206,Humana Insurance Company,Commercial PPO,195.7,95,,percent of total billed charges,,
"Adrenocorticotropic Hormone, P (Mayo)OutsideLaboratory",,82024,CPT,Facility,Outpatient,,,90,206,175.1,59.0396,206,Humana Insurance Company,Medicare PPO,100.94,49,,percent of total billed charges,,
"Adrenocorticotropic Hormone, P (Mayo)OutsideLaboratory",,82024,CPT,Facility,Inpatient,,,90,206,175.1,59.0396,206,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Adrenocorticotropic Hormone, P (Mayo)OutsideLaboratory",,82024,CPT,Facility,Both,,,90,206,175.1,59.0396,206,Medica,Individual & Family,204.146,99.1,,percent of total billed charges,,
"Adrenocorticotropic Hormone, P (Mayo)OutsideLaboratory",,82024,CPT,Facility,Outpatient,,,90,206,175.1,59.0396,206,Medica,Medica Advantage Solution,102.588,49.8,,percent of total billed charges,,
"Adrenocorticotropic Hormone, P (Mayo)OutsideLaboratory",,82024,CPT,Facility,Inpatient,,,90,206,175.1,59.0396,206,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Adrenocorticotropic Hormone, P (Mayo)OutsideLaboratory",,82024,CPT,Facility,Outpatient,,,90,206,175.1,59.0396,206,Medica,Medical Assistance,91.876,44.6,,percent of total billed charges,,
"Adrenocorticotropic Hormone, P (Mayo)OutsideLaboratory",,82024,CPT,Facility,Inpatient,,,90,206,175.1,59.0396,206,Medica,Medical Assistance,,,,,Included in per diem rate,
"Adrenocorticotropic Hormone, P (Mayo)OutsideLaboratory",,82024,CPT,Facility,Outpatient,,,90,206,175.1,59.0396,206,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,102.588,49.8,,percent of total billed charges,,
"Adrenocorticotropic Hormone, P (Mayo)OutsideLaboratory",,82024,CPT,Facility,Inpatient,,,90,206,175.1,59.0396,206,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Adrenocorticotropic Hormone, P (Mayo)OutsideLaboratory",,82024,CPT,Facility,Both,,,90,206,175.1,59.0396,206,"Multiplan, Inc.","Multiplan, Inc.",193.64,94,,percent of total billed charges,,
"Adrenocorticotropic Hormone, P (Mayo)OutsideLaboratory",,82024,CPT,Facility,Outpatient,,,90,206,175.1,59.0396,206,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,177.984,86.4,,percent of total billed charges,,
"Adrenocorticotropic Hormone, P (Mayo)OutsideLaboratory",,82024,CPT,Facility,Inpatient,,,90,206,175.1,59.0396,206,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Adrenocorticotropic Hormone, P (Mayo)OutsideLaboratory",,82024,CPT,Facility,Both,,,90,206,175.1,59.0396,206,"Preferred One Administrative Services, INC.",PPO,203.116,98.6,,percent of total billed charges,,
"Adrenocorticotropic Hormone, P (Mayo)OutsideLaboratory",,82024,CPT,Facility,Outpatient,,,90,206,175.1,59.0396,206,PrimeWest Health,Minnesota Senior Health Options (MSHO),105.987,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Adrenocorticotropic Hormone, P (Mayo)OutsideLaboratory",,82024,CPT,Facility,Inpatient,,,90,206,175.1,59.0396,206,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Adrenocorticotropic Hormone, P (Mayo)OutsideLaboratory",,82024,CPT,Facility,Outpatient,,,90,206,175.1,59.0396,206,PrimeWest Health,MinnesotaCare,105.8016,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Adrenocorticotropic Hormone, P (Mayo)OutsideLaboratory",,82024,CPT,Facility,Inpatient,,,90,206,175.1,59.0396,206,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Adrenocorticotropic Hormone, P (Mayo)OutsideLaboratory",,82024,CPT,Facility,Both,,,90,206,175.1,59.0396,206,Sanford Health Plan,Sanford Health Plan,189.52,92,,percent of total billed charges,,
"Adrenocorticotropic Hormone, P (Mayo)OutsideLaboratory",,82024,CPT,Facility,Outpatient,,,90,206,175.1,59.0396,206,"UCare Health, Inc.",Individual & Family Plan,116.081,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Adrenocorticotropic Hormone, P (Mayo)OutsideLaboratory",,82024,CPT,Facility,Inpatient,,,90,206,175.1,59.0396,206,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Adrenocorticotropic Hormone, P (Mayo)OutsideLaboratory",,82024,CPT,Facility,Outpatient,,,90,206,175.1,59.0396,206,"UCare Health, Inc.",Medical Assistance,103.9682,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Adrenocorticotropic Hormone, P (Mayo)OutsideLaboratory",,82024,CPT,Facility,Inpatient,,,90,206,175.1,59.0396,206,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Adrenocorticotropic Hormone, P (Mayo)OutsideLaboratory",,82024,CPT,Facility,Outpatient,,,90,206,175.1,59.0396,206,"UCare Health, Inc.",Medicare Advantage,103.9682,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Adrenocorticotropic Hormone, P (Mayo)OutsideLaboratory",,82024,CPT,Facility,Inpatient,,,90,206,175.1,59.0396,206,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Adrenocorticotropic Hormone, P (Mayo)OutsideLaboratory",,82024,CPT,Facility,Outpatient,,,90,206,175.1,59.0396,206,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),103.9682,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Adrenocorticotropic Hormone, P (Mayo)OutsideLaboratory",,82024,CPT,Facility,Inpatient,,,90,206,175.1,59.0396,206,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Adrenocorticotropic Hormone, P (Mayo)OutsideLaboratory",,82024,CPT,Facility,Both,,,90,206,175.1,59.0396,206,UnitedHealthcare,Individual & Family,193.64,94,,percent of total billed charges,,
"Adrenocorticotropic Hormone, P (Mayo)OutsideLaboratory",,82024,CPT,Facility,Outpatient,,,90,206,175.1,59.0396,206,UnitedHealthcare,Medicare Advantage,100.94,49,,percent of total billed charges,,
"Adrenocorticotropic Hormone, P (Mayo)OutsideLaboratory",,82024,CPT,Facility,Inpatient,,,90,206,175.1,59.0396,206,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Adrenocorticotropic Hormone, P (Mayo)OutsideLaboratory",,82024,CPT,Facility,Outpatient,,,90,206,175.1,59.0396,206,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,98.88,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Adrenocorticotropic Hormone, P (Mayo)OutsideLaboratory",,82024,CPT,Facility,Inpatient,,,90,206,175.1,59.0396,206,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Aldolase, S (Mayo)OutsideLaboratory",,82085,CPT,Facility,Both,,,90,112,95.2,32.0992,112,Aetna,Commercial,103.04,92,,percent of total billed charges,,
"Aldolase, S (Mayo)OutsideLaboratory",,82085,CPT,Facility,Outpatient,,,90,112,95.2,32.0992,112,Aetna,Medicare Advantage,54.88,49,,percent of total billed charges,,
"Aldolase, S (Mayo)OutsideLaboratory",,82085,CPT,Facility,Inpatient,,,90,112,95.2,32.0992,112,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Aldolase, S (Mayo)OutsideLaboratory",,82085,CPT,Facility,Both,,,90,112,95.2,32.0992,112,Aetna,PPO,104.16,93,,percent of total billed charges,,
"Aldolase, S (Mayo)OutsideLaboratory",,82085,CPT,Facility,Both,,,90,112,95.2,32.0992,112,America's PPO,America's PPO,107.5536,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Aldolase, S (Mayo)OutsideLaboratory",,82085,CPT,Facility,Both,,,90,112,95.2,32.0992,112,BlueCross BlueShield Minnesota, Federal Employee Program,110.208,98.4,,percent of total billed charges,,
"Aldolase, S (Mayo)OutsideLaboratory",,82085,CPT,Facility,Both,,,90,112,95.2,32.0992,112,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,112,100,,percent of total billed charges,,
"Aldolase, S (Mayo)OutsideLaboratory",,82085,CPT,Facility,Both,,,90,112,95.2,32.0992,112,BlueCross BlueShield Minnesota,High Value Network Plan,100.8,90,,percent of total billed charges,,
"Aldolase, S (Mayo)OutsideLaboratory",,82085,CPT,Facility,Outpatient,,,90,112,95.2,32.0992,112,BlueCross BlueShield Minnesota,Medicare Advantage,54.88,49,,percent of total billed charges,,
"Aldolase, S (Mayo)OutsideLaboratory",,82085,CPT,Facility,Inpatient,,,90,112,95.2,32.0992,112,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Aldolase, S (Mayo)OutsideLaboratory",,82085,CPT,Facility,Both,,,90,112,95.2,32.0992,112,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,99.1984,88.57,,percent of total billed charges,,
"Aldolase, S (Mayo)OutsideLaboratory",,82085,CPT,Facility,Both,,,90,112,95.2,32.0992,112,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,32.0992,28.66,,percent of total billed charges,,
"Aldolase, S (Mayo)OutsideLaboratory",,82085,CPT,Facility,Outpatient,,,90,112,95.2,32.0992,112,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),54.88,49,,percent of total billed charges,,
"Aldolase, S (Mayo)OutsideLaboratory",,82085,CPT,Facility,Inpatient,,,90,112,95.2,32.0992,112,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Aldolase, S (Mayo)OutsideLaboratory",,82085,CPT,Facility,Both,,,90,112,95.2,32.0992,112,CorVel,Worker's Compensation,112,100,,percent of total billed charges,,
"Aldolase, S (Mayo)OutsideLaboratory",,82085,CPT,Facility,Both,,,90,112,95.2,32.0992,112,First Health Group Corporation,First Health Network,108.64,97,,percent of total billed charges,,
"Aldolase, S (Mayo)OutsideLaboratory",,82085,CPT,Facility,Both,,,90,112,95.2,32.0992,112,"Health Partners, Inc.",Commercial,105.952,94.6,,percent of total billed charges,,
"Aldolase, S (Mayo)OutsideLaboratory",,82085,CPT,Facility,Outpatient,,,90,112,95.2,32.0992,112,"Health Partners, Inc.",Medicare Advantage,54.88,49,,percent of total billed charges,,
"Aldolase, S (Mayo)OutsideLaboratory",,82085,CPT,Facility,Inpatient,,,90,112,95.2,32.0992,112,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Aldolase, S (Mayo)OutsideLaboratory",,82085,CPT,Facility,Both,,,90,112,95.2,32.0992,112,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),67.2,60,,percent of total billed charges,,
"Aldolase, S (Mayo)OutsideLaboratory",,82085,CPT,Facility,Both,,,90,112,95.2,32.0992,112,"Health Partners, Inc.",State of Minnesota Advantage Program,91.28,81.5,,percent of total billed charges,,
"Aldolase, S (Mayo)OutsideLaboratory",,82085,CPT,Facility,Both,,,90,112,95.2,32.0992,112,"Health Partners, Inc.",State Public Programs,56,50,,percent of total billed charges,,
"Aldolase, S (Mayo)OutsideLaboratory",,82085,CPT,Facility,Both,,,90,112,95.2,32.0992,112,Humana Insurance Company,Commercial PPO,106.4,95,,percent of total billed charges,,
"Aldolase, S (Mayo)OutsideLaboratory",,82085,CPT,Facility,Outpatient,,,90,112,95.2,32.0992,112,Humana Insurance Company,Medicare PPO,54.88,49,,percent of total billed charges,,
"Aldolase, S (Mayo)OutsideLaboratory",,82085,CPT,Facility,Inpatient,,,90,112,95.2,32.0992,112,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Aldolase, S (Mayo)OutsideLaboratory",,82085,CPT,Facility,Both,,,90,112,95.2,32.0992,112,Medica,Individual & Family,110.992,99.1,,percent of total billed charges,,
"Aldolase, S (Mayo)OutsideLaboratory",,82085,CPT,Facility,Outpatient,,,90,112,95.2,32.0992,112,Medica,Medica Advantage Solution,55.776,49.8,,percent of total billed charges,,
"Aldolase, S (Mayo)OutsideLaboratory",,82085,CPT,Facility,Inpatient,,,90,112,95.2,32.0992,112,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Aldolase, S (Mayo)OutsideLaboratory",,82085,CPT,Facility,Outpatient,,,90,112,95.2,32.0992,112,Medica,Medical Assistance,49.952,44.6,,percent of total billed charges,,
"Aldolase, S (Mayo)OutsideLaboratory",,82085,CPT,Facility,Inpatient,,,90,112,95.2,32.0992,112,Medica,Medical Assistance,,,,,Included in per diem rate,
"Aldolase, S (Mayo)OutsideLaboratory",,82085,CPT,Facility,Outpatient,,,90,112,95.2,32.0992,112,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,55.776,49.8,,percent of total billed charges,,
"Aldolase, S (Mayo)OutsideLaboratory",,82085,CPT,Facility,Inpatient,,,90,112,95.2,32.0992,112,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Aldolase, S (Mayo)OutsideLaboratory",,82085,CPT,Facility,Both,,,90,112,95.2,32.0992,112,"Multiplan, Inc.","Multiplan, Inc.",105.28,94,,percent of total billed charges,,
"Aldolase, S (Mayo)OutsideLaboratory",,82085,CPT,Facility,Outpatient,,,90,112,95.2,32.0992,112,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,96.768,86.4,,percent of total billed charges,,
"Aldolase, S (Mayo)OutsideLaboratory",,82085,CPT,Facility,Inpatient,,,90,112,95.2,32.0992,112,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Aldolase, S (Mayo)OutsideLaboratory",,82085,CPT,Facility,Both,,,90,112,95.2,32.0992,112,"Preferred One Administrative Services, INC.",PPO,110.432,98.6,,percent of total billed charges,,
"Aldolase, S (Mayo)OutsideLaboratory",,82085,CPT,Facility,Outpatient,,,90,112,95.2,32.0992,112,PrimeWest Health,Minnesota Senior Health Options (MSHO),57.624,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Aldolase, S (Mayo)OutsideLaboratory",,82085,CPT,Facility,Inpatient,,,90,112,95.2,32.0992,112,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Aldolase, S (Mayo)OutsideLaboratory",,82085,CPT,Facility,Outpatient,,,90,112,95.2,32.0992,112,PrimeWest Health,MinnesotaCare,57.5232,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Aldolase, S (Mayo)OutsideLaboratory",,82085,CPT,Facility,Inpatient,,,90,112,95.2,32.0992,112,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Aldolase, S (Mayo)OutsideLaboratory",,82085,CPT,Facility,Both,,,90,112,95.2,32.0992,112,Sanford Health Plan,Sanford Health Plan,103.04,92,,percent of total billed charges,,
"Aldolase, S (Mayo)OutsideLaboratory",,82085,CPT,Facility,Outpatient,,,90,112,95.2,32.0992,112,"UCare Health, Inc.",Individual & Family Plan,63.112,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Aldolase, S (Mayo)OutsideLaboratory",,82085,CPT,Facility,Inpatient,,,90,112,95.2,32.0992,112,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Aldolase, S (Mayo)OutsideLaboratory",,82085,CPT,Facility,Outpatient,,,90,112,95.2,32.0992,112,"UCare Health, Inc.",Medical Assistance,56.5264,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Aldolase, S (Mayo)OutsideLaboratory",,82085,CPT,Facility,Inpatient,,,90,112,95.2,32.0992,112,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Aldolase, S (Mayo)OutsideLaboratory",,82085,CPT,Facility,Outpatient,,,90,112,95.2,32.0992,112,"UCare Health, Inc.",Medicare Advantage,56.5264,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Aldolase, S (Mayo)OutsideLaboratory",,82085,CPT,Facility,Inpatient,,,90,112,95.2,32.0992,112,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Aldolase, S (Mayo)OutsideLaboratory",,82085,CPT,Facility,Outpatient,,,90,112,95.2,32.0992,112,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),56.5264,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Aldolase, S (Mayo)OutsideLaboratory",,82085,CPT,Facility,Inpatient,,,90,112,95.2,32.0992,112,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Aldolase, S (Mayo)OutsideLaboratory",,82085,CPT,Facility,Both,,,90,112,95.2,32.0992,112,UnitedHealthcare,Individual & Family,105.28,94,,percent of total billed charges,,
"Aldolase, S (Mayo)OutsideLaboratory",,82085,CPT,Facility,Outpatient,,,90,112,95.2,32.0992,112,UnitedHealthcare,Medicare Advantage,54.88,49,,percent of total billed charges,,
"Aldolase, S (Mayo)OutsideLaboratory",,82085,CPT,Facility,Inpatient,,,90,112,95.2,32.0992,112,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Aldolase, S (Mayo)OutsideLaboratory",,82085,CPT,Facility,Outpatient,,,90,112,95.2,32.0992,112,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,53.76,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Aldolase, S (Mayo)OutsideLaboratory",,82085,CPT,Facility,Inpatient,,,90,112,95.2,32.0992,112,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Aldosterone, S (Mayo)OutsideLaboratory",,82088,CPT,Facility,Both,,,90,133,113.05,38.1178,133,Aetna,Commercial,122.36,92,,percent of total billed charges,,
"Aldosterone, S (Mayo)OutsideLaboratory",,82088,CPT,Facility,Outpatient,,,90,133,113.05,38.1178,133,Aetna,Medicare Advantage,65.17,49,,percent of total billed charges,,
"Aldosterone, S (Mayo)OutsideLaboratory",,82088,CPT,Facility,Inpatient,,,90,133,113.05,38.1178,133,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Aldosterone, S (Mayo)OutsideLaboratory",,82088,CPT,Facility,Both,,,90,133,113.05,38.1178,133,Aetna,PPO,123.69,93,,percent of total billed charges,,
"Aldosterone, S (Mayo)OutsideLaboratory",,82088,CPT,Facility,Both,,,90,133,113.05,38.1178,133,America's PPO,America's PPO,127.7199,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Aldosterone, S (Mayo)OutsideLaboratory",,82088,CPT,Facility,Both,,,90,133,113.05,38.1178,133,BlueCross BlueShield Minnesota, Federal Employee Program,130.872,98.4,,percent of total billed charges,,
"Aldosterone, S (Mayo)OutsideLaboratory",,82088,CPT,Facility,Both,,,90,133,113.05,38.1178,133,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,133,100,,percent of total billed charges,,
"Aldosterone, S (Mayo)OutsideLaboratory",,82088,CPT,Facility,Both,,,90,133,113.05,38.1178,133,BlueCross BlueShield Minnesota,High Value Network Plan,119.7,90,,percent of total billed charges,,
"Aldosterone, S (Mayo)OutsideLaboratory",,82088,CPT,Facility,Outpatient,,,90,133,113.05,38.1178,133,BlueCross BlueShield Minnesota,Medicare Advantage,65.17,49,,percent of total billed charges,,
"Aldosterone, S (Mayo)OutsideLaboratory",,82088,CPT,Facility,Inpatient,,,90,133,113.05,38.1178,133,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Aldosterone, S (Mayo)OutsideLaboratory",,82088,CPT,Facility,Both,,,90,133,113.05,38.1178,133,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,117.7981,88.57,,percent of total billed charges,,
"Aldosterone, S (Mayo)OutsideLaboratory",,82088,CPT,Facility,Both,,,90,133,113.05,38.1178,133,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,38.1178,28.66,,percent of total billed charges,,
"Aldosterone, S (Mayo)OutsideLaboratory",,82088,CPT,Facility,Outpatient,,,90,133,113.05,38.1178,133,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),65.17,49,,percent of total billed charges,,
"Aldosterone, S (Mayo)OutsideLaboratory",,82088,CPT,Facility,Inpatient,,,90,133,113.05,38.1178,133,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Aldosterone, S (Mayo)OutsideLaboratory",,82088,CPT,Facility,Both,,,90,133,113.05,38.1178,133,CorVel,Worker's Compensation,133,100,,percent of total billed charges,,
"Aldosterone, S (Mayo)OutsideLaboratory",,82088,CPT,Facility,Both,,,90,133,113.05,38.1178,133,First Health Group Corporation,First Health Network,129.01,97,,percent of total billed charges,,
"Aldosterone, S (Mayo)OutsideLaboratory",,82088,CPT,Facility,Both,,,90,133,113.05,38.1178,133,"Health Partners, Inc.",Commercial,125.818,94.6,,percent of total billed charges,,
"Aldosterone, S (Mayo)OutsideLaboratory",,82088,CPT,Facility,Outpatient,,,90,133,113.05,38.1178,133,"Health Partners, Inc.",Medicare Advantage,65.17,49,,percent of total billed charges,,
"Aldosterone, S (Mayo)OutsideLaboratory",,82088,CPT,Facility,Inpatient,,,90,133,113.05,38.1178,133,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Aldosterone, S (Mayo)OutsideLaboratory",,82088,CPT,Facility,Both,,,90,133,113.05,38.1178,133,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),79.8,60,,percent of total billed charges,,
"Aldosterone, S (Mayo)OutsideLaboratory",,82088,CPT,Facility,Both,,,90,133,113.05,38.1178,133,"Health Partners, Inc.",State of Minnesota Advantage Program,108.395,81.5,,percent of total billed charges,,
"Aldosterone, S (Mayo)OutsideLaboratory",,82088,CPT,Facility,Both,,,90,133,113.05,38.1178,133,"Health Partners, Inc.",State Public Programs,66.5,50,,percent of total billed charges,,
"Aldosterone, S (Mayo)OutsideLaboratory",,82088,CPT,Facility,Both,,,90,133,113.05,38.1178,133,Humana Insurance Company,Commercial PPO,126.35,95,,percent of total billed charges,,
"Aldosterone, S (Mayo)OutsideLaboratory",,82088,CPT,Facility,Outpatient,,,90,133,113.05,38.1178,133,Humana Insurance Company,Medicare PPO,65.17,49,,percent of total billed charges,,
"Aldosterone, S (Mayo)OutsideLaboratory",,82088,CPT,Facility,Inpatient,,,90,133,113.05,38.1178,133,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Aldosterone, S (Mayo)OutsideLaboratory",,82088,CPT,Facility,Both,,,90,133,113.05,38.1178,133,Medica,Individual & Family,131.803,99.1,,percent of total billed charges,,
"Aldosterone, S (Mayo)OutsideLaboratory",,82088,CPT,Facility,Outpatient,,,90,133,113.05,38.1178,133,Medica,Medica Advantage Solution,66.234,49.8,,percent of total billed charges,,
"Aldosterone, S (Mayo)OutsideLaboratory",,82088,CPT,Facility,Inpatient,,,90,133,113.05,38.1178,133,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Aldosterone, S (Mayo)OutsideLaboratory",,82088,CPT,Facility,Outpatient,,,90,133,113.05,38.1178,133,Medica,Medical Assistance,59.318,44.6,,percent of total billed charges,,
"Aldosterone, S (Mayo)OutsideLaboratory",,82088,CPT,Facility,Inpatient,,,90,133,113.05,38.1178,133,Medica,Medical Assistance,,,,,Included in per diem rate,
"Aldosterone, S (Mayo)OutsideLaboratory",,82088,CPT,Facility,Outpatient,,,90,133,113.05,38.1178,133,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,66.234,49.8,,percent of total billed charges,,
"Aldosterone, S (Mayo)OutsideLaboratory",,82088,CPT,Facility,Inpatient,,,90,133,113.05,38.1178,133,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Aldosterone, S (Mayo)OutsideLaboratory",,82088,CPT,Facility,Both,,,90,133,113.05,38.1178,133,"Multiplan, Inc.","Multiplan, Inc.",125.02,94,,percent of total billed charges,,
"Aldosterone, S (Mayo)OutsideLaboratory",,82088,CPT,Facility,Outpatient,,,90,133,113.05,38.1178,133,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,114.912,86.4,,percent of total billed charges,,
"Aldosterone, S (Mayo)OutsideLaboratory",,82088,CPT,Facility,Inpatient,,,90,133,113.05,38.1178,133,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Aldosterone, S (Mayo)OutsideLaboratory",,82088,CPT,Facility,Both,,,90,133,113.05,38.1178,133,"Preferred One Administrative Services, INC.",PPO,131.138,98.6,,percent of total billed charges,,
"Aldosterone, S (Mayo)OutsideLaboratory",,82088,CPT,Facility,Outpatient,,,90,133,113.05,38.1178,133,PrimeWest Health,Minnesota Senior Health Options (MSHO),68.4285,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Aldosterone, S (Mayo)OutsideLaboratory",,82088,CPT,Facility,Inpatient,,,90,133,113.05,38.1178,133,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Aldosterone, S (Mayo)OutsideLaboratory",,82088,CPT,Facility,Outpatient,,,90,133,113.05,38.1178,133,PrimeWest Health,MinnesotaCare,68.3088,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Aldosterone, S (Mayo)OutsideLaboratory",,82088,CPT,Facility,Inpatient,,,90,133,113.05,38.1178,133,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Aldosterone, S (Mayo)OutsideLaboratory",,82088,CPT,Facility,Both,,,90,133,113.05,38.1178,133,Sanford Health Plan,Sanford Health Plan,122.36,92,,percent of total billed charges,,
"Aldosterone, S (Mayo)OutsideLaboratory",,82088,CPT,Facility,Outpatient,,,90,133,113.05,38.1178,133,"UCare Health, Inc.",Individual & Family Plan,74.9455,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Aldosterone, S (Mayo)OutsideLaboratory",,82088,CPT,Facility,Inpatient,,,90,133,113.05,38.1178,133,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Aldosterone, S (Mayo)OutsideLaboratory",,82088,CPT,Facility,Outpatient,,,90,133,113.05,38.1178,133,"UCare Health, Inc.",Medical Assistance,67.1251,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Aldosterone, S (Mayo)OutsideLaboratory",,82088,CPT,Facility,Inpatient,,,90,133,113.05,38.1178,133,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Aldosterone, S (Mayo)OutsideLaboratory",,82088,CPT,Facility,Outpatient,,,90,133,113.05,38.1178,133,"UCare Health, Inc.",Medicare Advantage,67.1251,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Aldosterone, S (Mayo)OutsideLaboratory",,82088,CPT,Facility,Inpatient,,,90,133,113.05,38.1178,133,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Aldosterone, S (Mayo)OutsideLaboratory",,82088,CPT,Facility,Outpatient,,,90,133,113.05,38.1178,133,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),67.1251,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Aldosterone, S (Mayo)OutsideLaboratory",,82088,CPT,Facility,Inpatient,,,90,133,113.05,38.1178,133,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Aldosterone, S (Mayo)OutsideLaboratory",,82088,CPT,Facility,Both,,,90,133,113.05,38.1178,133,UnitedHealthcare,Individual & Family,125.02,94,,percent of total billed charges,,
"Aldosterone, S (Mayo)OutsideLaboratory",,82088,CPT,Facility,Outpatient,,,90,133,113.05,38.1178,133,UnitedHealthcare,Medicare Advantage,65.17,49,,percent of total billed charges,,
"Aldosterone, S (Mayo)OutsideLaboratory",,82088,CPT,Facility,Inpatient,,,90,133,113.05,38.1178,133,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Aldosterone, S (Mayo)OutsideLaboratory",,82088,CPT,Facility,Outpatient,,,90,133,113.05,38.1178,133,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,63.84,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Aldosterone, S (Mayo)OutsideLaboratory",,82088,CPT,Facility,Inpatient,,,90,133,113.05,38.1178,133,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Alpha-1-Antitrypsin, Random, F (Mayo)OutsideLaboratory",,82103,CPT,Facility,Both,,,90,112,95.2,32.0992,112,Aetna,Commercial,103.04,92,,percent of total billed charges,,
"Alpha-1-Antitrypsin, Random, F (Mayo)OutsideLaboratory",,82103,CPT,Facility,Outpatient,,,90,112,95.2,32.0992,112,Aetna,Medicare Advantage,54.88,49,,percent of total billed charges,,
"Alpha-1-Antitrypsin, Random, F (Mayo)OutsideLaboratory",,82103,CPT,Facility,Inpatient,,,90,112,95.2,32.0992,112,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Alpha-1-Antitrypsin, Random, F (Mayo)OutsideLaboratory",,82103,CPT,Facility,Both,,,90,112,95.2,32.0992,112,Aetna,PPO,104.16,93,,percent of total billed charges,,
"Alpha-1-Antitrypsin, Random, F (Mayo)OutsideLaboratory",,82103,CPT,Facility,Both,,,90,112,95.2,32.0992,112,America's PPO,America's PPO,107.5536,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Alpha-1-Antitrypsin, Random, F (Mayo)OutsideLaboratory",,82103,CPT,Facility,Both,,,90,112,95.2,32.0992,112,BlueCross BlueShield Minnesota, Federal Employee Program,110.208,98.4,,percent of total billed charges,,
"Alpha-1-Antitrypsin, Random, F (Mayo)OutsideLaboratory",,82103,CPT,Facility,Both,,,90,112,95.2,32.0992,112,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,112,100,,percent of total billed charges,,
"Alpha-1-Antitrypsin, Random, F (Mayo)OutsideLaboratory",,82103,CPT,Facility,Both,,,90,112,95.2,32.0992,112,BlueCross BlueShield Minnesota,High Value Network Plan,100.8,90,,percent of total billed charges,,
"Alpha-1-Antitrypsin, Random, F (Mayo)OutsideLaboratory",,82103,CPT,Facility,Outpatient,,,90,112,95.2,32.0992,112,BlueCross BlueShield Minnesota,Medicare Advantage,54.88,49,,percent of total billed charges,,
"Alpha-1-Antitrypsin, Random, F (Mayo)OutsideLaboratory",,82103,CPT,Facility,Inpatient,,,90,112,95.2,32.0992,112,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Alpha-1-Antitrypsin, Random, F (Mayo)OutsideLaboratory",,82103,CPT,Facility,Both,,,90,112,95.2,32.0992,112,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,99.1984,88.57,,percent of total billed charges,,
"Alpha-1-Antitrypsin, Random, F (Mayo)OutsideLaboratory",,82103,CPT,Facility,Both,,,90,112,95.2,32.0992,112,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,32.0992,28.66,,percent of total billed charges,,
"Alpha-1-Antitrypsin, Random, F (Mayo)OutsideLaboratory",,82103,CPT,Facility,Outpatient,,,90,112,95.2,32.0992,112,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),54.88,49,,percent of total billed charges,,
"Alpha-1-Antitrypsin, Random, F (Mayo)OutsideLaboratory",,82103,CPT,Facility,Inpatient,,,90,112,95.2,32.0992,112,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Alpha-1-Antitrypsin, Random, F (Mayo)OutsideLaboratory",,82103,CPT,Facility,Both,,,90,112,95.2,32.0992,112,CorVel,Worker's Compensation,112,100,,percent of total billed charges,,
"Alpha-1-Antitrypsin, Random, F (Mayo)OutsideLaboratory",,82103,CPT,Facility,Both,,,90,112,95.2,32.0992,112,First Health Group Corporation,First Health Network,108.64,97,,percent of total billed charges,,
"Alpha-1-Antitrypsin, Random, F (Mayo)OutsideLaboratory",,82103,CPT,Facility,Both,,,90,112,95.2,32.0992,112,"Health Partners, Inc.",Commercial,105.952,94.6,,percent of total billed charges,,
"Alpha-1-Antitrypsin, Random, F (Mayo)OutsideLaboratory",,82103,CPT,Facility,Outpatient,,,90,112,95.2,32.0992,112,"Health Partners, Inc.",Medicare Advantage,54.88,49,,percent of total billed charges,,
"Alpha-1-Antitrypsin, Random, F (Mayo)OutsideLaboratory",,82103,CPT,Facility,Inpatient,,,90,112,95.2,32.0992,112,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Alpha-1-Antitrypsin, Random, F (Mayo)OutsideLaboratory",,82103,CPT,Facility,Both,,,90,112,95.2,32.0992,112,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),67.2,60,,percent of total billed charges,,
"Alpha-1-Antitrypsin, Random, F (Mayo)OutsideLaboratory",,82103,CPT,Facility,Both,,,90,112,95.2,32.0992,112,"Health Partners, Inc.",State of Minnesota Advantage Program,91.28,81.5,,percent of total billed charges,,
"Alpha-1-Antitrypsin, Random, F (Mayo)OutsideLaboratory",,82103,CPT,Facility,Both,,,90,112,95.2,32.0992,112,"Health Partners, Inc.",State Public Programs,56,50,,percent of total billed charges,,
"Alpha-1-Antitrypsin, Random, F (Mayo)OutsideLaboratory",,82103,CPT,Facility,Both,,,90,112,95.2,32.0992,112,Humana Insurance Company,Commercial PPO,106.4,95,,percent of total billed charges,,
"Alpha-1-Antitrypsin, Random, F (Mayo)OutsideLaboratory",,82103,CPT,Facility,Outpatient,,,90,112,95.2,32.0992,112,Humana Insurance Company,Medicare PPO,54.88,49,,percent of total billed charges,,
"Alpha-1-Antitrypsin, Random, F (Mayo)OutsideLaboratory",,82103,CPT,Facility,Inpatient,,,90,112,95.2,32.0992,112,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Alpha-1-Antitrypsin, Random, F (Mayo)OutsideLaboratory",,82103,CPT,Facility,Both,,,90,112,95.2,32.0992,112,Medica,Individual & Family,110.992,99.1,,percent of total billed charges,,
"Alpha-1-Antitrypsin, Random, F (Mayo)OutsideLaboratory",,82103,CPT,Facility,Outpatient,,,90,112,95.2,32.0992,112,Medica,Medica Advantage Solution,55.776,49.8,,percent of total billed charges,,
"Alpha-1-Antitrypsin, Random, F (Mayo)OutsideLaboratory",,82103,CPT,Facility,Inpatient,,,90,112,95.2,32.0992,112,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Alpha-1-Antitrypsin, Random, F (Mayo)OutsideLaboratory",,82103,CPT,Facility,Outpatient,,,90,112,95.2,32.0992,112,Medica,Medical Assistance,49.952,44.6,,percent of total billed charges,,
"Alpha-1-Antitrypsin, Random, F (Mayo)OutsideLaboratory",,82103,CPT,Facility,Inpatient,,,90,112,95.2,32.0992,112,Medica,Medical Assistance,,,,,Included in per diem rate,
"Alpha-1-Antitrypsin, Random, F (Mayo)OutsideLaboratory",,82103,CPT,Facility,Outpatient,,,90,112,95.2,32.0992,112,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,55.776,49.8,,percent of total billed charges,,
"Alpha-1-Antitrypsin, Random, F (Mayo)OutsideLaboratory",,82103,CPT,Facility,Inpatient,,,90,112,95.2,32.0992,112,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Alpha-1-Antitrypsin, Random, F (Mayo)OutsideLaboratory",,82103,CPT,Facility,Both,,,90,112,95.2,32.0992,112,"Multiplan, Inc.","Multiplan, Inc.",105.28,94,,percent of total billed charges,,
"Alpha-1-Antitrypsin, Random, F (Mayo)OutsideLaboratory",,82103,CPT,Facility,Outpatient,,,90,112,95.2,32.0992,112,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,96.768,86.4,,percent of total billed charges,,
"Alpha-1-Antitrypsin, Random, F (Mayo)OutsideLaboratory",,82103,CPT,Facility,Inpatient,,,90,112,95.2,32.0992,112,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Alpha-1-Antitrypsin, Random, F (Mayo)OutsideLaboratory",,82103,CPT,Facility,Both,,,90,112,95.2,32.0992,112,"Preferred One Administrative Services, INC.",PPO,110.432,98.6,,percent of total billed charges,,
"Alpha-1-Antitrypsin, Random, F (Mayo)OutsideLaboratory",,82103,CPT,Facility,Outpatient,,,90,112,95.2,32.0992,112,PrimeWest Health,Minnesota Senior Health Options (MSHO),57.624,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Alpha-1-Antitrypsin, Random, F (Mayo)OutsideLaboratory",,82103,CPT,Facility,Inpatient,,,90,112,95.2,32.0992,112,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Alpha-1-Antitrypsin, Random, F (Mayo)OutsideLaboratory",,82103,CPT,Facility,Outpatient,,,90,112,95.2,32.0992,112,PrimeWest Health,MinnesotaCare,57.5232,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Alpha-1-Antitrypsin, Random, F (Mayo)OutsideLaboratory",,82103,CPT,Facility,Inpatient,,,90,112,95.2,32.0992,112,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Alpha-1-Antitrypsin, Random, F (Mayo)OutsideLaboratory",,82103,CPT,Facility,Both,,,90,112,95.2,32.0992,112,Sanford Health Plan,Sanford Health Plan,103.04,92,,percent of total billed charges,,
"Alpha-1-Antitrypsin, Random, F (Mayo)OutsideLaboratory",,82103,CPT,Facility,Outpatient,,,90,112,95.2,32.0992,112,"UCare Health, Inc.",Individual & Family Plan,63.112,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Alpha-1-Antitrypsin, Random, F (Mayo)OutsideLaboratory",,82103,CPT,Facility,Inpatient,,,90,112,95.2,32.0992,112,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Alpha-1-Antitrypsin, Random, F (Mayo)OutsideLaboratory",,82103,CPT,Facility,Outpatient,,,90,112,95.2,32.0992,112,"UCare Health, Inc.",Medical Assistance,56.5264,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Alpha-1-Antitrypsin, Random, F (Mayo)OutsideLaboratory",,82103,CPT,Facility,Inpatient,,,90,112,95.2,32.0992,112,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Alpha-1-Antitrypsin, Random, F (Mayo)OutsideLaboratory",,82103,CPT,Facility,Outpatient,,,90,112,95.2,32.0992,112,"UCare Health, Inc.",Medicare Advantage,56.5264,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Alpha-1-Antitrypsin, Random, F (Mayo)OutsideLaboratory",,82103,CPT,Facility,Inpatient,,,90,112,95.2,32.0992,112,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Alpha-1-Antitrypsin, Random, F (Mayo)OutsideLaboratory",,82103,CPT,Facility,Outpatient,,,90,112,95.2,32.0992,112,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),56.5264,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Alpha-1-Antitrypsin, Random, F (Mayo)OutsideLaboratory",,82103,CPT,Facility,Inpatient,,,90,112,95.2,32.0992,112,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Alpha-1-Antitrypsin, Random, F (Mayo)OutsideLaboratory",,82103,CPT,Facility,Both,,,90,112,95.2,32.0992,112,UnitedHealthcare,Individual & Family,105.28,94,,percent of total billed charges,,
"Alpha-1-Antitrypsin, Random, F (Mayo)OutsideLaboratory",,82103,CPT,Facility,Outpatient,,,90,112,95.2,32.0992,112,UnitedHealthcare,Medicare Advantage,54.88,49,,percent of total billed charges,,
"Alpha-1-Antitrypsin, Random, F (Mayo)OutsideLaboratory",,82103,CPT,Facility,Inpatient,,,90,112,95.2,32.0992,112,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Alpha-1-Antitrypsin, Random, F (Mayo)OutsideLaboratory",,82103,CPT,Facility,Outpatient,,,90,112,95.2,32.0992,112,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,53.76,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Alpha-1-Antitrypsin, Random, F (Mayo)OutsideLaboratory",,82103,CPT,Facility,Inpatient,,,90,112,95.2,32.0992,112,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Alpha-1-Antitrypsin, S (Mayo)OutsideLaboratory",,82103,CPT,Facility,Both,,,90,112,95.2,32.0992,112,Aetna,Commercial,103.04,92,,percent of total billed charges,,
"Alpha-1-Antitrypsin, S (Mayo)OutsideLaboratory",,82103,CPT,Facility,Outpatient,,,90,112,95.2,32.0992,112,Aetna,Medicare Advantage,54.88,49,,percent of total billed charges,,
"Alpha-1-Antitrypsin, S (Mayo)OutsideLaboratory",,82103,CPT,Facility,Inpatient,,,90,112,95.2,32.0992,112,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Alpha-1-Antitrypsin, S (Mayo)OutsideLaboratory",,82103,CPT,Facility,Both,,,90,112,95.2,32.0992,112,Aetna,PPO,104.16,93,,percent of total billed charges,,
"Alpha-1-Antitrypsin, S (Mayo)OutsideLaboratory",,82103,CPT,Facility,Both,,,90,112,95.2,32.0992,112,America's PPO,America's PPO,107.5536,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Alpha-1-Antitrypsin, S (Mayo)OutsideLaboratory",,82103,CPT,Facility,Both,,,90,112,95.2,32.0992,112,BlueCross BlueShield Minnesota, Federal Employee Program,110.208,98.4,,percent of total billed charges,,
"Alpha-1-Antitrypsin, S (Mayo)OutsideLaboratory",,82103,CPT,Facility,Both,,,90,112,95.2,32.0992,112,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,112,100,,percent of total billed charges,,
"Alpha-1-Antitrypsin, S (Mayo)OutsideLaboratory",,82103,CPT,Facility,Both,,,90,112,95.2,32.0992,112,BlueCross BlueShield Minnesota,High Value Network Plan,100.8,90,,percent of total billed charges,,
"Alpha-1-Antitrypsin, S (Mayo)OutsideLaboratory",,82103,CPT,Facility,Outpatient,,,90,112,95.2,32.0992,112,BlueCross BlueShield Minnesota,Medicare Advantage,54.88,49,,percent of total billed charges,,
"Alpha-1-Antitrypsin, S (Mayo)OutsideLaboratory",,82103,CPT,Facility,Inpatient,,,90,112,95.2,32.0992,112,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Alpha-1-Antitrypsin, S (Mayo)OutsideLaboratory",,82103,CPT,Facility,Both,,,90,112,95.2,32.0992,112,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,99.1984,88.57,,percent of total billed charges,,
"Alpha-1-Antitrypsin, S (Mayo)OutsideLaboratory",,82103,CPT,Facility,Both,,,90,112,95.2,32.0992,112,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,32.0992,28.66,,percent of total billed charges,,
"Alpha-1-Antitrypsin, S (Mayo)OutsideLaboratory",,82103,CPT,Facility,Outpatient,,,90,112,95.2,32.0992,112,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),54.88,49,,percent of total billed charges,,
"Alpha-1-Antitrypsin, S (Mayo)OutsideLaboratory",,82103,CPT,Facility,Inpatient,,,90,112,95.2,32.0992,112,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Alpha-1-Antitrypsin, S (Mayo)OutsideLaboratory",,82103,CPT,Facility,Both,,,90,112,95.2,32.0992,112,CorVel,Worker's Compensation,112,100,,percent of total billed charges,,
"Alpha-1-Antitrypsin, S (Mayo)OutsideLaboratory",,82103,CPT,Facility,Both,,,90,112,95.2,32.0992,112,First Health Group Corporation,First Health Network,108.64,97,,percent of total billed charges,,
"Alpha-1-Antitrypsin, S (Mayo)OutsideLaboratory",,82103,CPT,Facility,Both,,,90,112,95.2,32.0992,112,"Health Partners, Inc.",Commercial,105.952,94.6,,percent of total billed charges,,
"Alpha-1-Antitrypsin, S (Mayo)OutsideLaboratory",,82103,CPT,Facility,Outpatient,,,90,112,95.2,32.0992,112,"Health Partners, Inc.",Medicare Advantage,54.88,49,,percent of total billed charges,,
"Alpha-1-Antitrypsin, S (Mayo)OutsideLaboratory",,82103,CPT,Facility,Inpatient,,,90,112,95.2,32.0992,112,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Alpha-1-Antitrypsin, S (Mayo)OutsideLaboratory",,82103,CPT,Facility,Both,,,90,112,95.2,32.0992,112,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),67.2,60,,percent of total billed charges,,
"Alpha-1-Antitrypsin, S (Mayo)OutsideLaboratory",,82103,CPT,Facility,Both,,,90,112,95.2,32.0992,112,"Health Partners, Inc.",State of Minnesota Advantage Program,91.28,81.5,,percent of total billed charges,,
"Alpha-1-Antitrypsin, S (Mayo)OutsideLaboratory",,82103,CPT,Facility,Both,,,90,112,95.2,32.0992,112,"Health Partners, Inc.",State Public Programs,56,50,,percent of total billed charges,,
"Alpha-1-Antitrypsin, S (Mayo)OutsideLaboratory",,82103,CPT,Facility,Both,,,90,112,95.2,32.0992,112,Humana Insurance Company,Commercial PPO,106.4,95,,percent of total billed charges,,
"Alpha-1-Antitrypsin, S (Mayo)OutsideLaboratory",,82103,CPT,Facility,Outpatient,,,90,112,95.2,32.0992,112,Humana Insurance Company,Medicare PPO,54.88,49,,percent of total billed charges,,
"Alpha-1-Antitrypsin, S (Mayo)OutsideLaboratory",,82103,CPT,Facility,Inpatient,,,90,112,95.2,32.0992,112,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Alpha-1-Antitrypsin, S (Mayo)OutsideLaboratory",,82103,CPT,Facility,Both,,,90,112,95.2,32.0992,112,Medica,Individual & Family,110.992,99.1,,percent of total billed charges,,
"Alpha-1-Antitrypsin, S (Mayo)OutsideLaboratory",,82103,CPT,Facility,Outpatient,,,90,112,95.2,32.0992,112,Medica,Medica Advantage Solution,55.776,49.8,,percent of total billed charges,,
"Alpha-1-Antitrypsin, S (Mayo)OutsideLaboratory",,82103,CPT,Facility,Inpatient,,,90,112,95.2,32.0992,112,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Alpha-1-Antitrypsin, S (Mayo)OutsideLaboratory",,82103,CPT,Facility,Outpatient,,,90,112,95.2,32.0992,112,Medica,Medical Assistance,49.952,44.6,,percent of total billed charges,,
"Alpha-1-Antitrypsin, S (Mayo)OutsideLaboratory",,82103,CPT,Facility,Inpatient,,,90,112,95.2,32.0992,112,Medica,Medical Assistance,,,,,Included in per diem rate,
"Alpha-1-Antitrypsin, S (Mayo)OutsideLaboratory",,82103,CPT,Facility,Outpatient,,,90,112,95.2,32.0992,112,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,55.776,49.8,,percent of total billed charges,,
"Alpha-1-Antitrypsin, S (Mayo)OutsideLaboratory",,82103,CPT,Facility,Inpatient,,,90,112,95.2,32.0992,112,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Alpha-1-Antitrypsin, S (Mayo)OutsideLaboratory",,82103,CPT,Facility,Both,,,90,112,95.2,32.0992,112,"Multiplan, Inc.","Multiplan, Inc.",105.28,94,,percent of total billed charges,,
"Alpha-1-Antitrypsin, S (Mayo)OutsideLaboratory",,82103,CPT,Facility,Outpatient,,,90,112,95.2,32.0992,112,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,96.768,86.4,,percent of total billed charges,,
"Alpha-1-Antitrypsin, S (Mayo)OutsideLaboratory",,82103,CPT,Facility,Inpatient,,,90,112,95.2,32.0992,112,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Alpha-1-Antitrypsin, S (Mayo)OutsideLaboratory",,82103,CPT,Facility,Both,,,90,112,95.2,32.0992,112,"Preferred One Administrative Services, INC.",PPO,110.432,98.6,,percent of total billed charges,,
"Alpha-1-Antitrypsin, S (Mayo)OutsideLaboratory",,82103,CPT,Facility,Outpatient,,,90,112,95.2,32.0992,112,PrimeWest Health,Minnesota Senior Health Options (MSHO),57.624,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Alpha-1-Antitrypsin, S (Mayo)OutsideLaboratory",,82103,CPT,Facility,Inpatient,,,90,112,95.2,32.0992,112,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Alpha-1-Antitrypsin, S (Mayo)OutsideLaboratory",,82103,CPT,Facility,Outpatient,,,90,112,95.2,32.0992,112,PrimeWest Health,MinnesotaCare,57.5232,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Alpha-1-Antitrypsin, S (Mayo)OutsideLaboratory",,82103,CPT,Facility,Inpatient,,,90,112,95.2,32.0992,112,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Alpha-1-Antitrypsin, S (Mayo)OutsideLaboratory",,82103,CPT,Facility,Both,,,90,112,95.2,32.0992,112,Sanford Health Plan,Sanford Health Plan,103.04,92,,percent of total billed charges,,
"Alpha-1-Antitrypsin, S (Mayo)OutsideLaboratory",,82103,CPT,Facility,Outpatient,,,90,112,95.2,32.0992,112,"UCare Health, Inc.",Individual & Family Plan,63.112,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Alpha-1-Antitrypsin, S (Mayo)OutsideLaboratory",,82103,CPT,Facility,Inpatient,,,90,112,95.2,32.0992,112,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Alpha-1-Antitrypsin, S (Mayo)OutsideLaboratory",,82103,CPT,Facility,Outpatient,,,90,112,95.2,32.0992,112,"UCare Health, Inc.",Medical Assistance,56.5264,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Alpha-1-Antitrypsin, S (Mayo)OutsideLaboratory",,82103,CPT,Facility,Inpatient,,,90,112,95.2,32.0992,112,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Alpha-1-Antitrypsin, S (Mayo)OutsideLaboratory",,82103,CPT,Facility,Outpatient,,,90,112,95.2,32.0992,112,"UCare Health, Inc.",Medicare Advantage,56.5264,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Alpha-1-Antitrypsin, S (Mayo)OutsideLaboratory",,82103,CPT,Facility,Inpatient,,,90,112,95.2,32.0992,112,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Alpha-1-Antitrypsin, S (Mayo)OutsideLaboratory",,82103,CPT,Facility,Outpatient,,,90,112,95.2,32.0992,112,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),56.5264,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Alpha-1-Antitrypsin, S (Mayo)OutsideLaboratory",,82103,CPT,Facility,Inpatient,,,90,112,95.2,32.0992,112,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Alpha-1-Antitrypsin, S (Mayo)OutsideLaboratory",,82103,CPT,Facility,Both,,,90,112,95.2,32.0992,112,UnitedHealthcare,Individual & Family,105.28,94,,percent of total billed charges,,
"Alpha-1-Antitrypsin, S (Mayo)OutsideLaboratory",,82103,CPT,Facility,Outpatient,,,90,112,95.2,32.0992,112,UnitedHealthcare,Medicare Advantage,54.88,49,,percent of total billed charges,,
"Alpha-1-Antitrypsin, S (Mayo)OutsideLaboratory",,82103,CPT,Facility,Inpatient,,,90,112,95.2,32.0992,112,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Alpha-1-Antitrypsin, S (Mayo)OutsideLaboratory",,82103,CPT,Facility,Outpatient,,,90,112,95.2,32.0992,112,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,53.76,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Alpha-1-Antitrypsin, S (Mayo)OutsideLaboratory",,82103,CPT,Facility,Inpatient,,,90,112,95.2,32.0992,112,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Alpha-1-Antitrypsin Phenotype (Mayo)OutsideLaboratory,,82104,CPT,Facility,Both,,,90,187,158.95,53.5942,187,Aetna,Commercial,172.04,92,,percent of total billed charges,,
Alpha-1-Antitrypsin Phenotype (Mayo)OutsideLaboratory,,82104,CPT,Facility,Outpatient,,,90,187,158.95,53.5942,187,Aetna,Medicare Advantage,91.63,49,,percent of total billed charges,,
Alpha-1-Antitrypsin Phenotype (Mayo)OutsideLaboratory,,82104,CPT,Facility,Inpatient,,,90,187,158.95,53.5942,187,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Alpha-1-Antitrypsin Phenotype (Mayo)OutsideLaboratory,,82104,CPT,Facility,Both,,,90,187,158.95,53.5942,187,Aetna,PPO,173.91,93,,percent of total billed charges,,
Alpha-1-Antitrypsin Phenotype (Mayo)OutsideLaboratory,,82104,CPT,Facility,Both,,,90,187,158.95,53.5942,187,America's PPO,America's PPO,179.5761,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Alpha-1-Antitrypsin Phenotype (Mayo)OutsideLaboratory,,82104,CPT,Facility,Both,,,90,187,158.95,53.5942,187,BlueCross BlueShield Minnesota, Federal Employee Program,184.008,98.4,,percent of total billed charges,,
Alpha-1-Antitrypsin Phenotype (Mayo)OutsideLaboratory,,82104,CPT,Facility,Both,,,90,187,158.95,53.5942,187,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,187,100,,percent of total billed charges,,
Alpha-1-Antitrypsin Phenotype (Mayo)OutsideLaboratory,,82104,CPT,Facility,Both,,,90,187,158.95,53.5942,187,BlueCross BlueShield Minnesota,High Value Network Plan,168.3,90,,percent of total billed charges,,
Alpha-1-Antitrypsin Phenotype (Mayo)OutsideLaboratory,,82104,CPT,Facility,Outpatient,,,90,187,158.95,53.5942,187,BlueCross BlueShield Minnesota,Medicare Advantage,91.63,49,,percent of total billed charges,,
Alpha-1-Antitrypsin Phenotype (Mayo)OutsideLaboratory,,82104,CPT,Facility,Inpatient,,,90,187,158.95,53.5942,187,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Alpha-1-Antitrypsin Phenotype (Mayo)OutsideLaboratory,,82104,CPT,Facility,Both,,,90,187,158.95,53.5942,187,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,165.6259,88.57,,percent of total billed charges,,
Alpha-1-Antitrypsin Phenotype (Mayo)OutsideLaboratory,,82104,CPT,Facility,Both,,,90,187,158.95,53.5942,187,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,53.5942,28.66,,percent of total billed charges,,
Alpha-1-Antitrypsin Phenotype (Mayo)OutsideLaboratory,,82104,CPT,Facility,Outpatient,,,90,187,158.95,53.5942,187,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),91.63,49,,percent of total billed charges,,
Alpha-1-Antitrypsin Phenotype (Mayo)OutsideLaboratory,,82104,CPT,Facility,Inpatient,,,90,187,158.95,53.5942,187,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Alpha-1-Antitrypsin Phenotype (Mayo)OutsideLaboratory,,82104,CPT,Facility,Both,,,90,187,158.95,53.5942,187,CorVel,Worker's Compensation,187,100,,percent of total billed charges,,
Alpha-1-Antitrypsin Phenotype (Mayo)OutsideLaboratory,,82104,CPT,Facility,Both,,,90,187,158.95,53.5942,187,First Health Group Corporation,First Health Network,181.39,97,,percent of total billed charges,,
Alpha-1-Antitrypsin Phenotype (Mayo)OutsideLaboratory,,82104,CPT,Facility,Both,,,90,187,158.95,53.5942,187,"Health Partners, Inc.",Commercial,176.902,94.6,,percent of total billed charges,,
Alpha-1-Antitrypsin Phenotype (Mayo)OutsideLaboratory,,82104,CPT,Facility,Outpatient,,,90,187,158.95,53.5942,187,"Health Partners, Inc.",Medicare Advantage,91.63,49,,percent of total billed charges,,
Alpha-1-Antitrypsin Phenotype (Mayo)OutsideLaboratory,,82104,CPT,Facility,Inpatient,,,90,187,158.95,53.5942,187,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Alpha-1-Antitrypsin Phenotype (Mayo)OutsideLaboratory,,82104,CPT,Facility,Both,,,90,187,158.95,53.5942,187,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),112.2,60,,percent of total billed charges,,
Alpha-1-Antitrypsin Phenotype (Mayo)OutsideLaboratory,,82104,CPT,Facility,Both,,,90,187,158.95,53.5942,187,"Health Partners, Inc.",State of Minnesota Advantage Program,152.405,81.5,,percent of total billed charges,,
Alpha-1-Antitrypsin Phenotype (Mayo)OutsideLaboratory,,82104,CPT,Facility,Both,,,90,187,158.95,53.5942,187,"Health Partners, Inc.",State Public Programs,93.5,50,,percent of total billed charges,,
Alpha-1-Antitrypsin Phenotype (Mayo)OutsideLaboratory,,82104,CPT,Facility,Both,,,90,187,158.95,53.5942,187,Humana Insurance Company,Commercial PPO,177.65,95,,percent of total billed charges,,
Alpha-1-Antitrypsin Phenotype (Mayo)OutsideLaboratory,,82104,CPT,Facility,Outpatient,,,90,187,158.95,53.5942,187,Humana Insurance Company,Medicare PPO,91.63,49,,percent of total billed charges,,
Alpha-1-Antitrypsin Phenotype (Mayo)OutsideLaboratory,,82104,CPT,Facility,Inpatient,,,90,187,158.95,53.5942,187,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Alpha-1-Antitrypsin Phenotype (Mayo)OutsideLaboratory,,82104,CPT,Facility,Both,,,90,187,158.95,53.5942,187,Medica,Individual & Family,185.317,99.1,,percent of total billed charges,,
Alpha-1-Antitrypsin Phenotype (Mayo)OutsideLaboratory,,82104,CPT,Facility,Outpatient,,,90,187,158.95,53.5942,187,Medica,Medica Advantage Solution,93.126,49.8,,percent of total billed charges,,
Alpha-1-Antitrypsin Phenotype (Mayo)OutsideLaboratory,,82104,CPT,Facility,Inpatient,,,90,187,158.95,53.5942,187,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Alpha-1-Antitrypsin Phenotype (Mayo)OutsideLaboratory,,82104,CPT,Facility,Outpatient,,,90,187,158.95,53.5942,187,Medica,Medical Assistance,83.402,44.6,,percent of total billed charges,,
Alpha-1-Antitrypsin Phenotype (Mayo)OutsideLaboratory,,82104,CPT,Facility,Inpatient,,,90,187,158.95,53.5942,187,Medica,Medical Assistance,,,,,Included in per diem rate,
Alpha-1-Antitrypsin Phenotype (Mayo)OutsideLaboratory,,82104,CPT,Facility,Outpatient,,,90,187,158.95,53.5942,187,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,93.126,49.8,,percent of total billed charges,,
Alpha-1-Antitrypsin Phenotype (Mayo)OutsideLaboratory,,82104,CPT,Facility,Inpatient,,,90,187,158.95,53.5942,187,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Alpha-1-Antitrypsin Phenotype (Mayo)OutsideLaboratory,,82104,CPT,Facility,Both,,,90,187,158.95,53.5942,187,"Multiplan, Inc.","Multiplan, Inc.",175.78,94,,percent of total billed charges,,
Alpha-1-Antitrypsin Phenotype (Mayo)OutsideLaboratory,,82104,CPT,Facility,Outpatient,,,90,187,158.95,53.5942,187,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,161.568,86.4,,percent of total billed charges,,
Alpha-1-Antitrypsin Phenotype (Mayo)OutsideLaboratory,,82104,CPT,Facility,Inpatient,,,90,187,158.95,53.5942,187,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Alpha-1-Antitrypsin Phenotype (Mayo)OutsideLaboratory,,82104,CPT,Facility,Both,,,90,187,158.95,53.5942,187,"Preferred One Administrative Services, INC.",PPO,184.382,98.6,,percent of total billed charges,,
Alpha-1-Antitrypsin Phenotype (Mayo)OutsideLaboratory,,82104,CPT,Facility,Outpatient,,,90,187,158.95,53.5942,187,PrimeWest Health,Minnesota Senior Health Options (MSHO),96.2115,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Alpha-1-Antitrypsin Phenotype (Mayo)OutsideLaboratory,,82104,CPT,Facility,Inpatient,,,90,187,158.95,53.5942,187,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Alpha-1-Antitrypsin Phenotype (Mayo)OutsideLaboratory,,82104,CPT,Facility,Outpatient,,,90,187,158.95,53.5942,187,PrimeWest Health,MinnesotaCare,96.0432,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Alpha-1-Antitrypsin Phenotype (Mayo)OutsideLaboratory,,82104,CPT,Facility,Inpatient,,,90,187,158.95,53.5942,187,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Alpha-1-Antitrypsin Phenotype (Mayo)OutsideLaboratory,,82104,CPT,Facility,Both,,,90,187,158.95,53.5942,187,Sanford Health Plan,Sanford Health Plan,172.04,92,,percent of total billed charges,,
Alpha-1-Antitrypsin Phenotype (Mayo)OutsideLaboratory,,82104,CPT,Facility,Outpatient,,,90,187,158.95,53.5942,187,"UCare Health, Inc.",Individual & Family Plan,105.3745,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Alpha-1-Antitrypsin Phenotype (Mayo)OutsideLaboratory,,82104,CPT,Facility,Inpatient,,,90,187,158.95,53.5942,187,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Alpha-1-Antitrypsin Phenotype (Mayo)OutsideLaboratory,,82104,CPT,Facility,Outpatient,,,90,187,158.95,53.5942,187,"UCare Health, Inc.",Medical Assistance,94.3789,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Alpha-1-Antitrypsin Phenotype (Mayo)OutsideLaboratory,,82104,CPT,Facility,Inpatient,,,90,187,158.95,53.5942,187,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Alpha-1-Antitrypsin Phenotype (Mayo)OutsideLaboratory,,82104,CPT,Facility,Outpatient,,,90,187,158.95,53.5942,187,"UCare Health, Inc.",Medicare Advantage,94.3789,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Alpha-1-Antitrypsin Phenotype (Mayo)OutsideLaboratory,,82104,CPT,Facility,Inpatient,,,90,187,158.95,53.5942,187,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Alpha-1-Antitrypsin Phenotype (Mayo)OutsideLaboratory,,82104,CPT,Facility,Outpatient,,,90,187,158.95,53.5942,187,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),94.3789,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Alpha-1-Antitrypsin Phenotype (Mayo)OutsideLaboratory,,82104,CPT,Facility,Inpatient,,,90,187,158.95,53.5942,187,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Alpha-1-Antitrypsin Phenotype (Mayo)OutsideLaboratory,,82104,CPT,Facility,Both,,,90,187,158.95,53.5942,187,UnitedHealthcare,Individual & Family,175.78,94,,percent of total billed charges,,
Alpha-1-Antitrypsin Phenotype (Mayo)OutsideLaboratory,,82104,CPT,Facility,Outpatient,,,90,187,158.95,53.5942,187,UnitedHealthcare,Medicare Advantage,91.63,49,,percent of total billed charges,,
Alpha-1-Antitrypsin Phenotype (Mayo)OutsideLaboratory,,82104,CPT,Facility,Inpatient,,,90,187,158.95,53.5942,187,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Alpha-1-Antitrypsin Phenotype (Mayo)OutsideLaboratory,,82104,CPT,Facility,Outpatient,,,90,187,158.95,53.5942,187,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,89.76,48,,percent of total billed charges,,100% of DHS outpatient percentage
Alpha-1-Antitrypsin Phenotype (Mayo)OutsideLaboratory,,82104,CPT,Facility,Inpatient,,,90,187,158.95,53.5942,187,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Alpha-Fetoprotein, Tumor Marker, S (Mayo)OutsideLaboratory",,82105,CPT,Facility,Both,,,90,123,104.55,35.2518,123,Aetna,Commercial,113.16,92,,percent of total billed charges,,
"Alpha-Fetoprotein, Tumor Marker, S (Mayo)OutsideLaboratory",,82105,CPT,Facility,Outpatient,,,90,123,104.55,35.2518,123,Aetna,Medicare Advantage,60.27,49,,percent of total billed charges,,
"Alpha-Fetoprotein, Tumor Marker, S (Mayo)OutsideLaboratory",,82105,CPT,Facility,Inpatient,,,90,123,104.55,35.2518,123,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Alpha-Fetoprotein, Tumor Marker, S (Mayo)OutsideLaboratory",,82105,CPT,Facility,Both,,,90,123,104.55,35.2518,123,Aetna,PPO,114.39,93,,percent of total billed charges,,
"Alpha-Fetoprotein, Tumor Marker, S (Mayo)OutsideLaboratory",,82105,CPT,Facility,Both,,,90,123,104.55,35.2518,123,America's PPO,America's PPO,118.1169,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Alpha-Fetoprotein, Tumor Marker, S (Mayo)OutsideLaboratory",,82105,CPT,Facility,Both,,,90,123,104.55,35.2518,123,BlueCross BlueShield Minnesota, Federal Employee Program,121.032,98.4,,percent of total billed charges,,
"Alpha-Fetoprotein, Tumor Marker, S (Mayo)OutsideLaboratory",,82105,CPT,Facility,Both,,,90,123,104.55,35.2518,123,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,123,100,,percent of total billed charges,,
"Alpha-Fetoprotein, Tumor Marker, S (Mayo)OutsideLaboratory",,82105,CPT,Facility,Both,,,90,123,104.55,35.2518,123,BlueCross BlueShield Minnesota,High Value Network Plan,110.7,90,,percent of total billed charges,,
"Alpha-Fetoprotein, Tumor Marker, S (Mayo)OutsideLaboratory",,82105,CPT,Facility,Outpatient,,,90,123,104.55,35.2518,123,BlueCross BlueShield Minnesota,Medicare Advantage,60.27,49,,percent of total billed charges,,
"Alpha-Fetoprotein, Tumor Marker, S (Mayo)OutsideLaboratory",,82105,CPT,Facility,Inpatient,,,90,123,104.55,35.2518,123,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Alpha-Fetoprotein, Tumor Marker, S (Mayo)OutsideLaboratory",,82105,CPT,Facility,Both,,,90,123,104.55,35.2518,123,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,108.9411,88.57,,percent of total billed charges,,
"Alpha-Fetoprotein, Tumor Marker, S (Mayo)OutsideLaboratory",,82105,CPT,Facility,Both,,,90,123,104.55,35.2518,123,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,35.2518,28.66,,percent of total billed charges,,
"Alpha-Fetoprotein, Tumor Marker, S (Mayo)OutsideLaboratory",,82105,CPT,Facility,Outpatient,,,90,123,104.55,35.2518,123,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),60.27,49,,percent of total billed charges,,
"Alpha-Fetoprotein, Tumor Marker, S (Mayo)OutsideLaboratory",,82105,CPT,Facility,Inpatient,,,90,123,104.55,35.2518,123,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Alpha-Fetoprotein, Tumor Marker, S (Mayo)OutsideLaboratory",,82105,CPT,Facility,Both,,,90,123,104.55,35.2518,123,CorVel,Worker's Compensation,123,100,,percent of total billed charges,,
"Alpha-Fetoprotein, Tumor Marker, S (Mayo)OutsideLaboratory",,82105,CPT,Facility,Both,,,90,123,104.55,35.2518,123,First Health Group Corporation,First Health Network,119.31,97,,percent of total billed charges,,
"Alpha-Fetoprotein, Tumor Marker, S (Mayo)OutsideLaboratory",,82105,CPT,Facility,Both,,,90,123,104.55,35.2518,123,"Health Partners, Inc.",Commercial,116.358,94.6,,percent of total billed charges,,
"Alpha-Fetoprotein, Tumor Marker, S (Mayo)OutsideLaboratory",,82105,CPT,Facility,Outpatient,,,90,123,104.55,35.2518,123,"Health Partners, Inc.",Medicare Advantage,60.27,49,,percent of total billed charges,,
"Alpha-Fetoprotein, Tumor Marker, S (Mayo)OutsideLaboratory",,82105,CPT,Facility,Inpatient,,,90,123,104.55,35.2518,123,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Alpha-Fetoprotein, Tumor Marker, S (Mayo)OutsideLaboratory",,82105,CPT,Facility,Both,,,90,123,104.55,35.2518,123,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),73.8,60,,percent of total billed charges,,
"Alpha-Fetoprotein, Tumor Marker, S (Mayo)OutsideLaboratory",,82105,CPT,Facility,Both,,,90,123,104.55,35.2518,123,"Health Partners, Inc.",State of Minnesota Advantage Program,100.245,81.5,,percent of total billed charges,,
"Alpha-Fetoprotein, Tumor Marker, S (Mayo)OutsideLaboratory",,82105,CPT,Facility,Both,,,90,123,104.55,35.2518,123,"Health Partners, Inc.",State Public Programs,61.5,50,,percent of total billed charges,,
"Alpha-Fetoprotein, Tumor Marker, S (Mayo)OutsideLaboratory",,82105,CPT,Facility,Both,,,90,123,104.55,35.2518,123,Humana Insurance Company,Commercial PPO,116.85,95,,percent of total billed charges,,
"Alpha-Fetoprotein, Tumor Marker, S (Mayo)OutsideLaboratory",,82105,CPT,Facility,Outpatient,,,90,123,104.55,35.2518,123,Humana Insurance Company,Medicare PPO,60.27,49,,percent of total billed charges,,
"Alpha-Fetoprotein, Tumor Marker, S (Mayo)OutsideLaboratory",,82105,CPT,Facility,Inpatient,,,90,123,104.55,35.2518,123,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Alpha-Fetoprotein, Tumor Marker, S (Mayo)OutsideLaboratory",,82105,CPT,Facility,Both,,,90,123,104.55,35.2518,123,Medica,Individual & Family,121.893,99.1,,percent of total billed charges,,
"Alpha-Fetoprotein, Tumor Marker, S (Mayo)OutsideLaboratory",,82105,CPT,Facility,Outpatient,,,90,123,104.55,35.2518,123,Medica,Medica Advantage Solution,61.254,49.8,,percent of total billed charges,,
"Alpha-Fetoprotein, Tumor Marker, S (Mayo)OutsideLaboratory",,82105,CPT,Facility,Inpatient,,,90,123,104.55,35.2518,123,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Alpha-Fetoprotein, Tumor Marker, S (Mayo)OutsideLaboratory",,82105,CPT,Facility,Outpatient,,,90,123,104.55,35.2518,123,Medica,Medical Assistance,54.858,44.6,,percent of total billed charges,,
"Alpha-Fetoprotein, Tumor Marker, S (Mayo)OutsideLaboratory",,82105,CPT,Facility,Inpatient,,,90,123,104.55,35.2518,123,Medica,Medical Assistance,,,,,Included in per diem rate,
"Alpha-Fetoprotein, Tumor Marker, S (Mayo)OutsideLaboratory",,82105,CPT,Facility,Outpatient,,,90,123,104.55,35.2518,123,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,61.254,49.8,,percent of total billed charges,,
"Alpha-Fetoprotein, Tumor Marker, S (Mayo)OutsideLaboratory",,82105,CPT,Facility,Inpatient,,,90,123,104.55,35.2518,123,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Alpha-Fetoprotein, Tumor Marker, S (Mayo)OutsideLaboratory",,82105,CPT,Facility,Both,,,90,123,104.55,35.2518,123,"Multiplan, Inc.","Multiplan, Inc.",115.62,94,,percent of total billed charges,,
"Alpha-Fetoprotein, Tumor Marker, S (Mayo)OutsideLaboratory",,82105,CPT,Facility,Outpatient,,,90,123,104.55,35.2518,123,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,106.272,86.4,,percent of total billed charges,,
"Alpha-Fetoprotein, Tumor Marker, S (Mayo)OutsideLaboratory",,82105,CPT,Facility,Inpatient,,,90,123,104.55,35.2518,123,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Alpha-Fetoprotein, Tumor Marker, S (Mayo)OutsideLaboratory",,82105,CPT,Facility,Both,,,90,123,104.55,35.2518,123,"Preferred One Administrative Services, INC.",PPO,121.278,98.6,,percent of total billed charges,,
"Alpha-Fetoprotein, Tumor Marker, S (Mayo)OutsideLaboratory",,82105,CPT,Facility,Outpatient,,,90,123,104.55,35.2518,123,PrimeWest Health,Minnesota Senior Health Options (MSHO),63.2835,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Alpha-Fetoprotein, Tumor Marker, S (Mayo)OutsideLaboratory",,82105,CPT,Facility,Inpatient,,,90,123,104.55,35.2518,123,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Alpha-Fetoprotein, Tumor Marker, S (Mayo)OutsideLaboratory",,82105,CPT,Facility,Outpatient,,,90,123,104.55,35.2518,123,PrimeWest Health,MinnesotaCare,63.1728,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Alpha-Fetoprotein, Tumor Marker, S (Mayo)OutsideLaboratory",,82105,CPT,Facility,Inpatient,,,90,123,104.55,35.2518,123,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Alpha-Fetoprotein, Tumor Marker, S (Mayo)OutsideLaboratory",,82105,CPT,Facility,Both,,,90,123,104.55,35.2518,123,Sanford Health Plan,Sanford Health Plan,113.16,92,,percent of total billed charges,,
"Alpha-Fetoprotein, Tumor Marker, S (Mayo)OutsideLaboratory",,82105,CPT,Facility,Outpatient,,,90,123,104.55,35.2518,123,"UCare Health, Inc.",Individual & Family Plan,69.3105,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Alpha-Fetoprotein, Tumor Marker, S (Mayo)OutsideLaboratory",,82105,CPT,Facility,Inpatient,,,90,123,104.55,35.2518,123,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Alpha-Fetoprotein, Tumor Marker, S (Mayo)OutsideLaboratory",,82105,CPT,Facility,Outpatient,,,90,123,104.55,35.2518,123,"UCare Health, Inc.",Medical Assistance,62.0781,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Alpha-Fetoprotein, Tumor Marker, S (Mayo)OutsideLaboratory",,82105,CPT,Facility,Inpatient,,,90,123,104.55,35.2518,123,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Alpha-Fetoprotein, Tumor Marker, S (Mayo)OutsideLaboratory",,82105,CPT,Facility,Outpatient,,,90,123,104.55,35.2518,123,"UCare Health, Inc.",Medicare Advantage,62.0781,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Alpha-Fetoprotein, Tumor Marker, S (Mayo)OutsideLaboratory",,82105,CPT,Facility,Inpatient,,,90,123,104.55,35.2518,123,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Alpha-Fetoprotein, Tumor Marker, S (Mayo)OutsideLaboratory",,82105,CPT,Facility,Outpatient,,,90,123,104.55,35.2518,123,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),62.0781,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Alpha-Fetoprotein, Tumor Marker, S (Mayo)OutsideLaboratory",,82105,CPT,Facility,Inpatient,,,90,123,104.55,35.2518,123,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Alpha-Fetoprotein, Tumor Marker, S (Mayo)OutsideLaboratory",,82105,CPT,Facility,Both,,,90,123,104.55,35.2518,123,UnitedHealthcare,Individual & Family,115.62,94,,percent of total billed charges,,
"Alpha-Fetoprotein, Tumor Marker, S (Mayo)OutsideLaboratory",,82105,CPT,Facility,Outpatient,,,90,123,104.55,35.2518,123,UnitedHealthcare,Medicare Advantage,60.27,49,,percent of total billed charges,,
"Alpha-Fetoprotein, Tumor Marker, S (Mayo)OutsideLaboratory",,82105,CPT,Facility,Inpatient,,,90,123,104.55,35.2518,123,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Alpha-Fetoprotein, Tumor Marker, S (Mayo)OutsideLaboratory",,82105,CPT,Facility,Outpatient,,,90,123,104.55,35.2518,123,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,59.04,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Alpha-Fetoprotein, Tumor Marker, S (Mayo)OutsideLaboratory",,82105,CPT,Facility,Inpatient,,,90,123,104.55,35.2518,123,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Amino Acids, Qn, P (Mayo)OutsideLaboratory",,82139,CPT,Facility,Both,,,90,326,277.1,93.4316,326,Aetna,Commercial,299.92,92,,percent of total billed charges,,
"Amino Acids, Qn, P (Mayo)OutsideLaboratory",,82139,CPT,Facility,Outpatient,,,90,326,277.1,93.4316,326,Aetna,Medicare Advantage,159.74,49,,percent of total billed charges,,
"Amino Acids, Qn, P (Mayo)OutsideLaboratory",,82139,CPT,Facility,Inpatient,,,90,326,277.1,93.4316,326,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Amino Acids, Qn, P (Mayo)OutsideLaboratory",,82139,CPT,Facility,Both,,,90,326,277.1,93.4316,326,Aetna,PPO,303.18,93,,percent of total billed charges,,
"Amino Acids, Qn, P (Mayo)OutsideLaboratory",,82139,CPT,Facility,Both,,,90,326,277.1,93.4316,326,America's PPO,America's PPO,313.0578,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Amino Acids, Qn, P (Mayo)OutsideLaboratory",,82139,CPT,Facility,Both,,,90,326,277.1,93.4316,326,BlueCross BlueShield Minnesota, Federal Employee Program,320.784,98.4,,percent of total billed charges,,
"Amino Acids, Qn, P (Mayo)OutsideLaboratory",,82139,CPT,Facility,Both,,,90,326,277.1,93.4316,326,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,326,100,,percent of total billed charges,,
"Amino Acids, Qn, P (Mayo)OutsideLaboratory",,82139,CPT,Facility,Both,,,90,326,277.1,93.4316,326,BlueCross BlueShield Minnesota,High Value Network Plan,293.4,90,,percent of total billed charges,,
"Amino Acids, Qn, P (Mayo)OutsideLaboratory",,82139,CPT,Facility,Outpatient,,,90,326,277.1,93.4316,326,BlueCross BlueShield Minnesota,Medicare Advantage,159.74,49,,percent of total billed charges,,
"Amino Acids, Qn, P (Mayo)OutsideLaboratory",,82139,CPT,Facility,Inpatient,,,90,326,277.1,93.4316,326,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Amino Acids, Qn, P (Mayo)OutsideLaboratory",,82139,CPT,Facility,Both,,,90,326,277.1,93.4316,326,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,288.7382,88.57,,percent of total billed charges,,
"Amino Acids, Qn, P (Mayo)OutsideLaboratory",,82139,CPT,Facility,Both,,,90,326,277.1,93.4316,326,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,93.4316,28.66,,percent of total billed charges,,
"Amino Acids, Qn, P (Mayo)OutsideLaboratory",,82139,CPT,Facility,Outpatient,,,90,326,277.1,93.4316,326,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),159.74,49,,percent of total billed charges,,
"Amino Acids, Qn, P (Mayo)OutsideLaboratory",,82139,CPT,Facility,Inpatient,,,90,326,277.1,93.4316,326,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Amino Acids, Qn, P (Mayo)OutsideLaboratory",,82139,CPT,Facility,Both,,,90,326,277.1,93.4316,326,CorVel,Worker's Compensation,326,100,,percent of total billed charges,,
"Amino Acids, Qn, P (Mayo)OutsideLaboratory",,82139,CPT,Facility,Both,,,90,326,277.1,93.4316,326,First Health Group Corporation,First Health Network,316.22,97,,percent of total billed charges,,
"Amino Acids, Qn, P (Mayo)OutsideLaboratory",,82139,CPT,Facility,Both,,,90,326,277.1,93.4316,326,"Health Partners, Inc.",Commercial,308.396,94.6,,percent of total billed charges,,
"Amino Acids, Qn, P (Mayo)OutsideLaboratory",,82139,CPT,Facility,Outpatient,,,90,326,277.1,93.4316,326,"Health Partners, Inc.",Medicare Advantage,159.74,49,,percent of total billed charges,,
"Amino Acids, Qn, P (Mayo)OutsideLaboratory",,82139,CPT,Facility,Inpatient,,,90,326,277.1,93.4316,326,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Amino Acids, Qn, P (Mayo)OutsideLaboratory",,82139,CPT,Facility,Both,,,90,326,277.1,93.4316,326,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),195.6,60,,percent of total billed charges,,
"Amino Acids, Qn, P (Mayo)OutsideLaboratory",,82139,CPT,Facility,Both,,,90,326,277.1,93.4316,326,"Health Partners, Inc.",State of Minnesota Advantage Program,265.69,81.5,,percent of total billed charges,,
"Amino Acids, Qn, P (Mayo)OutsideLaboratory",,82139,CPT,Facility,Both,,,90,326,277.1,93.4316,326,"Health Partners, Inc.",State Public Programs,163,50,,percent of total billed charges,,
"Amino Acids, Qn, P (Mayo)OutsideLaboratory",,82139,CPT,Facility,Both,,,90,326,277.1,93.4316,326,Humana Insurance Company,Commercial PPO,309.7,95,,percent of total billed charges,,
"Amino Acids, Qn, P (Mayo)OutsideLaboratory",,82139,CPT,Facility,Outpatient,,,90,326,277.1,93.4316,326,Humana Insurance Company,Medicare PPO,159.74,49,,percent of total billed charges,,
"Amino Acids, Qn, P (Mayo)OutsideLaboratory",,82139,CPT,Facility,Inpatient,,,90,326,277.1,93.4316,326,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Amino Acids, Qn, P (Mayo)OutsideLaboratory",,82139,CPT,Facility,Both,,,90,326,277.1,93.4316,326,Medica,Individual & Family,323.066,99.1,,percent of total billed charges,,
"Amino Acids, Qn, P (Mayo)OutsideLaboratory",,82139,CPT,Facility,Outpatient,,,90,326,277.1,93.4316,326,Medica,Medica Advantage Solution,162.348,49.8,,percent of total billed charges,,
"Amino Acids, Qn, P (Mayo)OutsideLaboratory",,82139,CPT,Facility,Inpatient,,,90,326,277.1,93.4316,326,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Amino Acids, Qn, P (Mayo)OutsideLaboratory",,82139,CPT,Facility,Outpatient,,,90,326,277.1,93.4316,326,Medica,Medical Assistance,145.396,44.6,,percent of total billed charges,,
"Amino Acids, Qn, P (Mayo)OutsideLaboratory",,82139,CPT,Facility,Inpatient,,,90,326,277.1,93.4316,326,Medica,Medical Assistance,,,,,Included in per diem rate,
"Amino Acids, Qn, P (Mayo)OutsideLaboratory",,82139,CPT,Facility,Outpatient,,,90,326,277.1,93.4316,326,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,162.348,49.8,,percent of total billed charges,,
"Amino Acids, Qn, P (Mayo)OutsideLaboratory",,82139,CPT,Facility,Inpatient,,,90,326,277.1,93.4316,326,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Amino Acids, Qn, P (Mayo)OutsideLaboratory",,82139,CPT,Facility,Both,,,90,326,277.1,93.4316,326,"Multiplan, Inc.","Multiplan, Inc.",306.44,94,,percent of total billed charges,,
"Amino Acids, Qn, P (Mayo)OutsideLaboratory",,82139,CPT,Facility,Outpatient,,,90,326,277.1,93.4316,326,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,281.664,86.4,,percent of total billed charges,,
"Amino Acids, Qn, P (Mayo)OutsideLaboratory",,82139,CPT,Facility,Inpatient,,,90,326,277.1,93.4316,326,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Amino Acids, Qn, P (Mayo)OutsideLaboratory",,82139,CPT,Facility,Both,,,90,326,277.1,93.4316,326,"Preferred One Administrative Services, INC.",PPO,321.436,98.6,,percent of total billed charges,,
"Amino Acids, Qn, P (Mayo)OutsideLaboratory",,82139,CPT,Facility,Outpatient,,,90,326,277.1,93.4316,326,PrimeWest Health,Minnesota Senior Health Options (MSHO),167.727,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Amino Acids, Qn, P (Mayo)OutsideLaboratory",,82139,CPT,Facility,Inpatient,,,90,326,277.1,93.4316,326,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Amino Acids, Qn, P (Mayo)OutsideLaboratory",,82139,CPT,Facility,Outpatient,,,90,326,277.1,93.4316,326,PrimeWest Health,MinnesotaCare,167.4336,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Amino Acids, Qn, P (Mayo)OutsideLaboratory",,82139,CPT,Facility,Inpatient,,,90,326,277.1,93.4316,326,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Amino Acids, Qn, P (Mayo)OutsideLaboratory",,82139,CPT,Facility,Both,,,90,326,277.1,93.4316,326,Sanford Health Plan,Sanford Health Plan,299.92,92,,percent of total billed charges,,
"Amino Acids, Qn, P (Mayo)OutsideLaboratory",,82139,CPT,Facility,Outpatient,,,90,326,277.1,93.4316,326,"UCare Health, Inc.",Individual & Family Plan,183.701,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Amino Acids, Qn, P (Mayo)OutsideLaboratory",,82139,CPT,Facility,Inpatient,,,90,326,277.1,93.4316,326,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Amino Acids, Qn, P (Mayo)OutsideLaboratory",,82139,CPT,Facility,Outpatient,,,90,326,277.1,93.4316,326,"UCare Health, Inc.",Medical Assistance,164.5322,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Amino Acids, Qn, P (Mayo)OutsideLaboratory",,82139,CPT,Facility,Inpatient,,,90,326,277.1,93.4316,326,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Amino Acids, Qn, P (Mayo)OutsideLaboratory",,82139,CPT,Facility,Outpatient,,,90,326,277.1,93.4316,326,"UCare Health, Inc.",Medicare Advantage,164.5322,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Amino Acids, Qn, P (Mayo)OutsideLaboratory",,82139,CPT,Facility,Inpatient,,,90,326,277.1,93.4316,326,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Amino Acids, Qn, P (Mayo)OutsideLaboratory",,82139,CPT,Facility,Outpatient,,,90,326,277.1,93.4316,326,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),164.5322,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Amino Acids, Qn, P (Mayo)OutsideLaboratory",,82139,CPT,Facility,Inpatient,,,90,326,277.1,93.4316,326,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Amino Acids, Qn, P (Mayo)OutsideLaboratory",,82139,CPT,Facility,Both,,,90,326,277.1,93.4316,326,UnitedHealthcare,Individual & Family,306.44,94,,percent of total billed charges,,
"Amino Acids, Qn, P (Mayo)OutsideLaboratory",,82139,CPT,Facility,Outpatient,,,90,326,277.1,93.4316,326,UnitedHealthcare,Medicare Advantage,159.74,49,,percent of total billed charges,,
"Amino Acids, Qn, P (Mayo)OutsideLaboratory",,82139,CPT,Facility,Inpatient,,,90,326,277.1,93.4316,326,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Amino Acids, Qn, P (Mayo)OutsideLaboratory",,82139,CPT,Facility,Outpatient,,,90,326,277.1,93.4316,326,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,156.48,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Amino Acids, Qn, P (Mayo)OutsideLaboratory",,82139,CPT,Facility,Inpatient,,,90,326,277.1,93.4316,326,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Ammonium (Mayo)OutsideLaboratory,,82140,CPT,Facility,Both,,,90,162,137.7,46.4292,162,Aetna,Commercial,149.04,92,,percent of total billed charges,,
Ammonium (Mayo)OutsideLaboratory,,82140,CPT,Facility,Outpatient,,,90,162,137.7,46.4292,162,Aetna,Medicare Advantage,79.38,49,,percent of total billed charges,,
Ammonium (Mayo)OutsideLaboratory,,82140,CPT,Facility,Inpatient,,,90,162,137.7,46.4292,162,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Ammonium (Mayo)OutsideLaboratory,,82140,CPT,Facility,Both,,,90,162,137.7,46.4292,162,Aetna,PPO,150.66,93,,percent of total billed charges,,
Ammonium (Mayo)OutsideLaboratory,,82140,CPT,Facility,Both,,,90,162,137.7,46.4292,162,America's PPO,America's PPO,155.5686,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Ammonium (Mayo)OutsideLaboratory,,82140,CPT,Facility,Both,,,90,162,137.7,46.4292,162,BlueCross BlueShield Minnesota, Federal Employee Program,159.408,98.4,,percent of total billed charges,,
Ammonium (Mayo)OutsideLaboratory,,82140,CPT,Facility,Both,,,90,162,137.7,46.4292,162,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,162,100,,percent of total billed charges,,
Ammonium (Mayo)OutsideLaboratory,,82140,CPT,Facility,Both,,,90,162,137.7,46.4292,162,BlueCross BlueShield Minnesota,High Value Network Plan,145.8,90,,percent of total billed charges,,
Ammonium (Mayo)OutsideLaboratory,,82140,CPT,Facility,Outpatient,,,90,162,137.7,46.4292,162,BlueCross BlueShield Minnesota,Medicare Advantage,79.38,49,,percent of total billed charges,,
Ammonium (Mayo)OutsideLaboratory,,82140,CPT,Facility,Inpatient,,,90,162,137.7,46.4292,162,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Ammonium (Mayo)OutsideLaboratory,,82140,CPT,Facility,Both,,,90,162,137.7,46.4292,162,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,143.4834,88.57,,percent of total billed charges,,
Ammonium (Mayo)OutsideLaboratory,,82140,CPT,Facility,Both,,,90,162,137.7,46.4292,162,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,46.4292,28.66,,percent of total billed charges,,
Ammonium (Mayo)OutsideLaboratory,,82140,CPT,Facility,Outpatient,,,90,162,137.7,46.4292,162,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),79.38,49,,percent of total billed charges,,
Ammonium (Mayo)OutsideLaboratory,,82140,CPT,Facility,Inpatient,,,90,162,137.7,46.4292,162,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Ammonium (Mayo)OutsideLaboratory,,82140,CPT,Facility,Both,,,90,162,137.7,46.4292,162,CorVel,Worker's Compensation,162,100,,percent of total billed charges,,
Ammonium (Mayo)OutsideLaboratory,,82140,CPT,Facility,Both,,,90,162,137.7,46.4292,162,First Health Group Corporation,First Health Network,157.14,97,,percent of total billed charges,,
Ammonium (Mayo)OutsideLaboratory,,82140,CPT,Facility,Both,,,90,162,137.7,46.4292,162,"Health Partners, Inc.",Commercial,153.252,94.6,,percent of total billed charges,,
Ammonium (Mayo)OutsideLaboratory,,82140,CPT,Facility,Outpatient,,,90,162,137.7,46.4292,162,"Health Partners, Inc.",Medicare Advantage,79.38,49,,percent of total billed charges,,
Ammonium (Mayo)OutsideLaboratory,,82140,CPT,Facility,Inpatient,,,90,162,137.7,46.4292,162,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ammonium (Mayo)OutsideLaboratory,,82140,CPT,Facility,Both,,,90,162,137.7,46.4292,162,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),97.2,60,,percent of total billed charges,,
Ammonium (Mayo)OutsideLaboratory,,82140,CPT,Facility,Both,,,90,162,137.7,46.4292,162,"Health Partners, Inc.",State of Minnesota Advantage Program,132.03,81.5,,percent of total billed charges,,
Ammonium (Mayo)OutsideLaboratory,,82140,CPT,Facility,Both,,,90,162,137.7,46.4292,162,"Health Partners, Inc.",State Public Programs,81,50,,percent of total billed charges,,
Ammonium (Mayo)OutsideLaboratory,,82140,CPT,Facility,Both,,,90,162,137.7,46.4292,162,Humana Insurance Company,Commercial PPO,153.9,95,,percent of total billed charges,,
Ammonium (Mayo)OutsideLaboratory,,82140,CPT,Facility,Outpatient,,,90,162,137.7,46.4292,162,Humana Insurance Company,Medicare PPO,79.38,49,,percent of total billed charges,,
Ammonium (Mayo)OutsideLaboratory,,82140,CPT,Facility,Inpatient,,,90,162,137.7,46.4292,162,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Ammonium (Mayo)OutsideLaboratory,,82140,CPT,Facility,Both,,,90,162,137.7,46.4292,162,Medica,Individual & Family,160.542,99.1,,percent of total billed charges,,
Ammonium (Mayo)OutsideLaboratory,,82140,CPT,Facility,Outpatient,,,90,162,137.7,46.4292,162,Medica,Medica Advantage Solution,80.676,49.8,,percent of total billed charges,,
Ammonium (Mayo)OutsideLaboratory,,82140,CPT,Facility,Inpatient,,,90,162,137.7,46.4292,162,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Ammonium (Mayo)OutsideLaboratory,,82140,CPT,Facility,Outpatient,,,90,162,137.7,46.4292,162,Medica,Medical Assistance,72.252,44.6,,percent of total billed charges,,
Ammonium (Mayo)OutsideLaboratory,,82140,CPT,Facility,Inpatient,,,90,162,137.7,46.4292,162,Medica,Medical Assistance,,,,,Included in per diem rate,
Ammonium (Mayo)OutsideLaboratory,,82140,CPT,Facility,Outpatient,,,90,162,137.7,46.4292,162,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,80.676,49.8,,percent of total billed charges,,
Ammonium (Mayo)OutsideLaboratory,,82140,CPT,Facility,Inpatient,,,90,162,137.7,46.4292,162,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Ammonium (Mayo)OutsideLaboratory,,82140,CPT,Facility,Both,,,90,162,137.7,46.4292,162,"Multiplan, Inc.","Multiplan, Inc.",152.28,94,,percent of total billed charges,,
Ammonium (Mayo)OutsideLaboratory,,82140,CPT,Facility,Outpatient,,,90,162,137.7,46.4292,162,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,139.968,86.4,,percent of total billed charges,,
Ammonium (Mayo)OutsideLaboratory,,82140,CPT,Facility,Inpatient,,,90,162,137.7,46.4292,162,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Ammonium (Mayo)OutsideLaboratory,,82140,CPT,Facility,Both,,,90,162,137.7,46.4292,162,"Preferred One Administrative Services, INC.",PPO,159.732,98.6,,percent of total billed charges,,
Ammonium (Mayo)OutsideLaboratory,,82140,CPT,Facility,Outpatient,,,90,162,137.7,46.4292,162,PrimeWest Health,Minnesota Senior Health Options (MSHO),83.349,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Ammonium (Mayo)OutsideLaboratory,,82140,CPT,Facility,Inpatient,,,90,162,137.7,46.4292,162,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ammonium (Mayo)OutsideLaboratory,,82140,CPT,Facility,Outpatient,,,90,162,137.7,46.4292,162,PrimeWest Health,MinnesotaCare,83.2032,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Ammonium (Mayo)OutsideLaboratory,,82140,CPT,Facility,Inpatient,,,90,162,137.7,46.4292,162,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Ammonium (Mayo)OutsideLaboratory,,82140,CPT,Facility,Both,,,90,162,137.7,46.4292,162,Sanford Health Plan,Sanford Health Plan,149.04,92,,percent of total billed charges,,
Ammonium (Mayo)OutsideLaboratory,,82140,CPT,Facility,Outpatient,,,90,162,137.7,46.4292,162,"UCare Health, Inc.",Individual & Family Plan,91.287,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Ammonium (Mayo)OutsideLaboratory,,82140,CPT,Facility,Inpatient,,,90,162,137.7,46.4292,162,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Ammonium (Mayo)OutsideLaboratory,,82140,CPT,Facility,Outpatient,,,90,162,137.7,46.4292,162,"UCare Health, Inc.",Medical Assistance,81.7614,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ammonium (Mayo)OutsideLaboratory,,82140,CPT,Facility,Inpatient,,,90,162,137.7,46.4292,162,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Ammonium (Mayo)OutsideLaboratory,,82140,CPT,Facility,Outpatient,,,90,162,137.7,46.4292,162,"UCare Health, Inc.",Medicare Advantage,81.7614,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ammonium (Mayo)OutsideLaboratory,,82140,CPT,Facility,Inpatient,,,90,162,137.7,46.4292,162,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ammonium (Mayo)OutsideLaboratory,,82140,CPT,Facility,Outpatient,,,90,162,137.7,46.4292,162,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),81.7614,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ammonium (Mayo)OutsideLaboratory,,82140,CPT,Facility,Inpatient,,,90,162,137.7,46.4292,162,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ammonium (Mayo)OutsideLaboratory,,82140,CPT,Facility,Both,,,90,162,137.7,46.4292,162,UnitedHealthcare,Individual & Family,152.28,94,,percent of total billed charges,,
Ammonium (Mayo)OutsideLaboratory,,82140,CPT,Facility,Outpatient,,,90,162,137.7,46.4292,162,UnitedHealthcare,Medicare Advantage,79.38,49,,percent of total billed charges,,
Ammonium (Mayo)OutsideLaboratory,,82140,CPT,Facility,Inpatient,,,90,162,137.7,46.4292,162,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Ammonium (Mayo)OutsideLaboratory,,82140,CPT,Facility,Outpatient,,,90,162,137.7,46.4292,162,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,77.76,48,,percent of total billed charges,,100% of DHS outpatient percentage
Ammonium (Mayo)OutsideLaboratory,,82140,CPT,Facility,Inpatient,,,90,162,137.7,46.4292,162,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Amylase, Isoenzymes (Mayo)OutsideLaboratory",,82150,CPT,Facility,Both,,,90,133,113.05,38.1178,133,Aetna,Commercial,122.36,92,,percent of total billed charges,,
"Amylase, Isoenzymes (Mayo)OutsideLaboratory",,82150,CPT,Facility,Outpatient,,,90,133,113.05,38.1178,133,Aetna,Medicare Advantage,65.17,49,,percent of total billed charges,,
"Amylase, Isoenzymes (Mayo)OutsideLaboratory",,82150,CPT,Facility,Inpatient,,,90,133,113.05,38.1178,133,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Amylase, Isoenzymes (Mayo)OutsideLaboratory",,82150,CPT,Facility,Both,,,90,133,113.05,38.1178,133,Aetna,PPO,123.69,93,,percent of total billed charges,,
"Amylase, Isoenzymes (Mayo)OutsideLaboratory",,82150,CPT,Facility,Both,,,90,133,113.05,38.1178,133,America's PPO,America's PPO,127.7199,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Amylase, Isoenzymes (Mayo)OutsideLaboratory",,82150,CPT,Facility,Both,,,90,133,113.05,38.1178,133,BlueCross BlueShield Minnesota, Federal Employee Program,130.872,98.4,,percent of total billed charges,,
"Amylase, Isoenzymes (Mayo)OutsideLaboratory",,82150,CPT,Facility,Both,,,90,133,113.05,38.1178,133,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,133,100,,percent of total billed charges,,
"Amylase, Isoenzymes (Mayo)OutsideLaboratory",,82150,CPT,Facility,Both,,,90,133,113.05,38.1178,133,BlueCross BlueShield Minnesota,High Value Network Plan,119.7,90,,percent of total billed charges,,
"Amylase, Isoenzymes (Mayo)OutsideLaboratory",,82150,CPT,Facility,Outpatient,,,90,133,113.05,38.1178,133,BlueCross BlueShield Minnesota,Medicare Advantage,65.17,49,,percent of total billed charges,,
"Amylase, Isoenzymes (Mayo)OutsideLaboratory",,82150,CPT,Facility,Inpatient,,,90,133,113.05,38.1178,133,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Amylase, Isoenzymes (Mayo)OutsideLaboratory",,82150,CPT,Facility,Both,,,90,133,113.05,38.1178,133,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,117.7981,88.57,,percent of total billed charges,,
"Amylase, Isoenzymes (Mayo)OutsideLaboratory",,82150,CPT,Facility,Both,,,90,133,113.05,38.1178,133,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,38.1178,28.66,,percent of total billed charges,,
"Amylase, Isoenzymes (Mayo)OutsideLaboratory",,82150,CPT,Facility,Outpatient,,,90,133,113.05,38.1178,133,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),65.17,49,,percent of total billed charges,,
"Amylase, Isoenzymes (Mayo)OutsideLaboratory",,82150,CPT,Facility,Inpatient,,,90,133,113.05,38.1178,133,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Amylase, Isoenzymes (Mayo)OutsideLaboratory",,82150,CPT,Facility,Both,,,90,133,113.05,38.1178,133,CorVel,Worker's Compensation,133,100,,percent of total billed charges,,
"Amylase, Isoenzymes (Mayo)OutsideLaboratory",,82150,CPT,Facility,Both,,,90,133,113.05,38.1178,133,First Health Group Corporation,First Health Network,129.01,97,,percent of total billed charges,,
"Amylase, Isoenzymes (Mayo)OutsideLaboratory",,82150,CPT,Facility,Both,,,90,133,113.05,38.1178,133,"Health Partners, Inc.",Commercial,125.818,94.6,,percent of total billed charges,,
"Amylase, Isoenzymes (Mayo)OutsideLaboratory",,82150,CPT,Facility,Outpatient,,,90,133,113.05,38.1178,133,"Health Partners, Inc.",Medicare Advantage,65.17,49,,percent of total billed charges,,
"Amylase, Isoenzymes (Mayo)OutsideLaboratory",,82150,CPT,Facility,Inpatient,,,90,133,113.05,38.1178,133,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Amylase, Isoenzymes (Mayo)OutsideLaboratory",,82150,CPT,Facility,Both,,,90,133,113.05,38.1178,133,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),79.8,60,,percent of total billed charges,,
"Amylase, Isoenzymes (Mayo)OutsideLaboratory",,82150,CPT,Facility,Both,,,90,133,113.05,38.1178,133,"Health Partners, Inc.",State of Minnesota Advantage Program,108.395,81.5,,percent of total billed charges,,
"Amylase, Isoenzymes (Mayo)OutsideLaboratory",,82150,CPT,Facility,Both,,,90,133,113.05,38.1178,133,"Health Partners, Inc.",State Public Programs,66.5,50,,percent of total billed charges,,
"Amylase, Isoenzymes (Mayo)OutsideLaboratory",,82150,CPT,Facility,Both,,,90,133,113.05,38.1178,133,Humana Insurance Company,Commercial PPO,126.35,95,,percent of total billed charges,,
"Amylase, Isoenzymes (Mayo)OutsideLaboratory",,82150,CPT,Facility,Outpatient,,,90,133,113.05,38.1178,133,Humana Insurance Company,Medicare PPO,65.17,49,,percent of total billed charges,,
"Amylase, Isoenzymes (Mayo)OutsideLaboratory",,82150,CPT,Facility,Inpatient,,,90,133,113.05,38.1178,133,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Amylase, Isoenzymes (Mayo)OutsideLaboratory",,82150,CPT,Facility,Both,,,90,133,113.05,38.1178,133,Medica,Individual & Family,131.803,99.1,,percent of total billed charges,,
"Amylase, Isoenzymes (Mayo)OutsideLaboratory",,82150,CPT,Facility,Outpatient,,,90,133,113.05,38.1178,133,Medica,Medica Advantage Solution,66.234,49.8,,percent of total billed charges,,
"Amylase, Isoenzymes (Mayo)OutsideLaboratory",,82150,CPT,Facility,Inpatient,,,90,133,113.05,38.1178,133,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Amylase, Isoenzymes (Mayo)OutsideLaboratory",,82150,CPT,Facility,Outpatient,,,90,133,113.05,38.1178,133,Medica,Medical Assistance,59.318,44.6,,percent of total billed charges,,
"Amylase, Isoenzymes (Mayo)OutsideLaboratory",,82150,CPT,Facility,Inpatient,,,90,133,113.05,38.1178,133,Medica,Medical Assistance,,,,,Included in per diem rate,
"Amylase, Isoenzymes (Mayo)OutsideLaboratory",,82150,CPT,Facility,Outpatient,,,90,133,113.05,38.1178,133,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,66.234,49.8,,percent of total billed charges,,
"Amylase, Isoenzymes (Mayo)OutsideLaboratory",,82150,CPT,Facility,Inpatient,,,90,133,113.05,38.1178,133,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Amylase, Isoenzymes (Mayo)OutsideLaboratory",,82150,CPT,Facility,Both,,,90,133,113.05,38.1178,133,"Multiplan, Inc.","Multiplan, Inc.",125.02,94,,percent of total billed charges,,
"Amylase, Isoenzymes (Mayo)OutsideLaboratory",,82150,CPT,Facility,Outpatient,,,90,133,113.05,38.1178,133,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,114.912,86.4,,percent of total billed charges,,
"Amylase, Isoenzymes (Mayo)OutsideLaboratory",,82150,CPT,Facility,Inpatient,,,90,133,113.05,38.1178,133,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Amylase, Isoenzymes (Mayo)OutsideLaboratory",,82150,CPT,Facility,Both,,,90,133,113.05,38.1178,133,"Preferred One Administrative Services, INC.",PPO,131.138,98.6,,percent of total billed charges,,
"Amylase, Isoenzymes (Mayo)OutsideLaboratory",,82150,CPT,Facility,Outpatient,,,90,133,113.05,38.1178,133,PrimeWest Health,Minnesota Senior Health Options (MSHO),68.4285,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Amylase, Isoenzymes (Mayo)OutsideLaboratory",,82150,CPT,Facility,Inpatient,,,90,133,113.05,38.1178,133,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Amylase, Isoenzymes (Mayo)OutsideLaboratory",,82150,CPT,Facility,Outpatient,,,90,133,113.05,38.1178,133,PrimeWest Health,MinnesotaCare,68.3088,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Amylase, Isoenzymes (Mayo)OutsideLaboratory",,82150,CPT,Facility,Inpatient,,,90,133,113.05,38.1178,133,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Amylase, Isoenzymes (Mayo)OutsideLaboratory",,82150,CPT,Facility,Both,,,90,133,113.05,38.1178,133,Sanford Health Plan,Sanford Health Plan,122.36,92,,percent of total billed charges,,
"Amylase, Isoenzymes (Mayo)OutsideLaboratory",,82150,CPT,Facility,Outpatient,,,90,133,113.05,38.1178,133,"UCare Health, Inc.",Individual & Family Plan,74.9455,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Amylase, Isoenzymes (Mayo)OutsideLaboratory",,82150,CPT,Facility,Inpatient,,,90,133,113.05,38.1178,133,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Amylase, Isoenzymes (Mayo)OutsideLaboratory",,82150,CPT,Facility,Outpatient,,,90,133,113.05,38.1178,133,"UCare Health, Inc.",Medical Assistance,67.1251,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Amylase, Isoenzymes (Mayo)OutsideLaboratory",,82150,CPT,Facility,Inpatient,,,90,133,113.05,38.1178,133,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Amylase, Isoenzymes (Mayo)OutsideLaboratory",,82150,CPT,Facility,Outpatient,,,90,133,113.05,38.1178,133,"UCare Health, Inc.",Medicare Advantage,67.1251,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Amylase, Isoenzymes (Mayo)OutsideLaboratory",,82150,CPT,Facility,Inpatient,,,90,133,113.05,38.1178,133,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Amylase, Isoenzymes (Mayo)OutsideLaboratory",,82150,CPT,Facility,Outpatient,,,90,133,113.05,38.1178,133,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),67.1251,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Amylase, Isoenzymes (Mayo)OutsideLaboratory",,82150,CPT,Facility,Inpatient,,,90,133,113.05,38.1178,133,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Amylase, Isoenzymes (Mayo)OutsideLaboratory",,82150,CPT,Facility,Both,,,90,133,113.05,38.1178,133,UnitedHealthcare,Individual & Family,125.02,94,,percent of total billed charges,,
"Amylase, Isoenzymes (Mayo)OutsideLaboratory",,82150,CPT,Facility,Outpatient,,,90,133,113.05,38.1178,133,UnitedHealthcare,Medicare Advantage,65.17,49,,percent of total billed charges,,
"Amylase, Isoenzymes (Mayo)OutsideLaboratory",,82150,CPT,Facility,Inpatient,,,90,133,113.05,38.1178,133,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Amylase, Isoenzymes (Mayo)OutsideLaboratory",,82150,CPT,Facility,Outpatient,,,90,133,113.05,38.1178,133,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,63.84,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Amylase, Isoenzymes (Mayo)OutsideLaboratory",,82150,CPT,Facility,Inpatient,,,90,133,113.05,38.1178,133,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Androstenedione, S (Mayo)OutsideLaboratory",,82157,CPT,Facility,Both,,,90,201,170.85,57.6066,201,Aetna,Commercial,184.92,92,,percent of total billed charges,,
"Androstenedione, S (Mayo)OutsideLaboratory",,82157,CPT,Facility,Outpatient,,,90,201,170.85,57.6066,201,Aetna,Medicare Advantage,98.49,49,,percent of total billed charges,,
"Androstenedione, S (Mayo)OutsideLaboratory",,82157,CPT,Facility,Inpatient,,,90,201,170.85,57.6066,201,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Androstenedione, S (Mayo)OutsideLaboratory",,82157,CPT,Facility,Both,,,90,201,170.85,57.6066,201,Aetna,PPO,186.93,93,,percent of total billed charges,,
"Androstenedione, S (Mayo)OutsideLaboratory",,82157,CPT,Facility,Both,,,90,201,170.85,57.6066,201,America's PPO,America's PPO,193.0203,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Androstenedione, S (Mayo)OutsideLaboratory",,82157,CPT,Facility,Both,,,90,201,170.85,57.6066,201,BlueCross BlueShield Minnesota, Federal Employee Program,197.784,98.4,,percent of total billed charges,,
"Androstenedione, S (Mayo)OutsideLaboratory",,82157,CPT,Facility,Both,,,90,201,170.85,57.6066,201,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,201,100,,percent of total billed charges,,
"Androstenedione, S (Mayo)OutsideLaboratory",,82157,CPT,Facility,Both,,,90,201,170.85,57.6066,201,BlueCross BlueShield Minnesota,High Value Network Plan,180.9,90,,percent of total billed charges,,
"Androstenedione, S (Mayo)OutsideLaboratory",,82157,CPT,Facility,Outpatient,,,90,201,170.85,57.6066,201,BlueCross BlueShield Minnesota,Medicare Advantage,98.49,49,,percent of total billed charges,,
"Androstenedione, S (Mayo)OutsideLaboratory",,82157,CPT,Facility,Inpatient,,,90,201,170.85,57.6066,201,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Androstenedione, S (Mayo)OutsideLaboratory",,82157,CPT,Facility,Both,,,90,201,170.85,57.6066,201,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,178.0257,88.57,,percent of total billed charges,,
"Androstenedione, S (Mayo)OutsideLaboratory",,82157,CPT,Facility,Both,,,90,201,170.85,57.6066,201,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,57.6066,28.66,,percent of total billed charges,,
"Androstenedione, S (Mayo)OutsideLaboratory",,82157,CPT,Facility,Outpatient,,,90,201,170.85,57.6066,201,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),98.49,49,,percent of total billed charges,,
"Androstenedione, S (Mayo)OutsideLaboratory",,82157,CPT,Facility,Inpatient,,,90,201,170.85,57.6066,201,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Androstenedione, S (Mayo)OutsideLaboratory",,82157,CPT,Facility,Both,,,90,201,170.85,57.6066,201,CorVel,Worker's Compensation,201,100,,percent of total billed charges,,
"Androstenedione, S (Mayo)OutsideLaboratory",,82157,CPT,Facility,Both,,,90,201,170.85,57.6066,201,First Health Group Corporation,First Health Network,194.97,97,,percent of total billed charges,,
"Androstenedione, S (Mayo)OutsideLaboratory",,82157,CPT,Facility,Both,,,90,201,170.85,57.6066,201,"Health Partners, Inc.",Commercial,190.146,94.6,,percent of total billed charges,,
"Androstenedione, S (Mayo)OutsideLaboratory",,82157,CPT,Facility,Outpatient,,,90,201,170.85,57.6066,201,"Health Partners, Inc.",Medicare Advantage,98.49,49,,percent of total billed charges,,
"Androstenedione, S (Mayo)OutsideLaboratory",,82157,CPT,Facility,Inpatient,,,90,201,170.85,57.6066,201,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Androstenedione, S (Mayo)OutsideLaboratory",,82157,CPT,Facility,Both,,,90,201,170.85,57.6066,201,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),120.6,60,,percent of total billed charges,,
"Androstenedione, S (Mayo)OutsideLaboratory",,82157,CPT,Facility,Both,,,90,201,170.85,57.6066,201,"Health Partners, Inc.",State of Minnesota Advantage Program,163.815,81.5,,percent of total billed charges,,
"Androstenedione, S (Mayo)OutsideLaboratory",,82157,CPT,Facility,Both,,,90,201,170.85,57.6066,201,"Health Partners, Inc.",State Public Programs,100.5,50,,percent of total billed charges,,
"Androstenedione, S (Mayo)OutsideLaboratory",,82157,CPT,Facility,Both,,,90,201,170.85,57.6066,201,Humana Insurance Company,Commercial PPO,190.95,95,,percent of total billed charges,,
"Androstenedione, S (Mayo)OutsideLaboratory",,82157,CPT,Facility,Outpatient,,,90,201,170.85,57.6066,201,Humana Insurance Company,Medicare PPO,98.49,49,,percent of total billed charges,,
"Androstenedione, S (Mayo)OutsideLaboratory",,82157,CPT,Facility,Inpatient,,,90,201,170.85,57.6066,201,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Androstenedione, S (Mayo)OutsideLaboratory",,82157,CPT,Facility,Both,,,90,201,170.85,57.6066,201,Medica,Individual & Family,199.191,99.1,,percent of total billed charges,,
"Androstenedione, S (Mayo)OutsideLaboratory",,82157,CPT,Facility,Outpatient,,,90,201,170.85,57.6066,201,Medica,Medica Advantage Solution,100.098,49.8,,percent of total billed charges,,
"Androstenedione, S (Mayo)OutsideLaboratory",,82157,CPT,Facility,Inpatient,,,90,201,170.85,57.6066,201,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Androstenedione, S (Mayo)OutsideLaboratory",,82157,CPT,Facility,Outpatient,,,90,201,170.85,57.6066,201,Medica,Medical Assistance,89.646,44.6,,percent of total billed charges,,
"Androstenedione, S (Mayo)OutsideLaboratory",,82157,CPT,Facility,Inpatient,,,90,201,170.85,57.6066,201,Medica,Medical Assistance,,,,,Included in per diem rate,
"Androstenedione, S (Mayo)OutsideLaboratory",,82157,CPT,Facility,Outpatient,,,90,201,170.85,57.6066,201,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,100.098,49.8,,percent of total billed charges,,
"Androstenedione, S (Mayo)OutsideLaboratory",,82157,CPT,Facility,Inpatient,,,90,201,170.85,57.6066,201,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Androstenedione, S (Mayo)OutsideLaboratory",,82157,CPT,Facility,Both,,,90,201,170.85,57.6066,201,"Multiplan, Inc.","Multiplan, Inc.",188.94,94,,percent of total billed charges,,
"Androstenedione, S (Mayo)OutsideLaboratory",,82157,CPT,Facility,Outpatient,,,90,201,170.85,57.6066,201,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,173.664,86.4,,percent of total billed charges,,
"Androstenedione, S (Mayo)OutsideLaboratory",,82157,CPT,Facility,Inpatient,,,90,201,170.85,57.6066,201,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Androstenedione, S (Mayo)OutsideLaboratory",,82157,CPT,Facility,Both,,,90,201,170.85,57.6066,201,"Preferred One Administrative Services, INC.",PPO,198.186,98.6,,percent of total billed charges,,
"Androstenedione, S (Mayo)OutsideLaboratory",,82157,CPT,Facility,Outpatient,,,90,201,170.85,57.6066,201,PrimeWest Health,Minnesota Senior Health Options (MSHO),103.4145,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Androstenedione, S (Mayo)OutsideLaboratory",,82157,CPT,Facility,Inpatient,,,90,201,170.85,57.6066,201,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Androstenedione, S (Mayo)OutsideLaboratory",,82157,CPT,Facility,Outpatient,,,90,201,170.85,57.6066,201,PrimeWest Health,MinnesotaCare,103.2336,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Androstenedione, S (Mayo)OutsideLaboratory",,82157,CPT,Facility,Inpatient,,,90,201,170.85,57.6066,201,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Androstenedione, S (Mayo)OutsideLaboratory",,82157,CPT,Facility,Both,,,90,201,170.85,57.6066,201,Sanford Health Plan,Sanford Health Plan,184.92,92,,percent of total billed charges,,
"Androstenedione, S (Mayo)OutsideLaboratory",,82157,CPT,Facility,Outpatient,,,90,201,170.85,57.6066,201,"UCare Health, Inc.",Individual & Family Plan,113.2635,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Androstenedione, S (Mayo)OutsideLaboratory",,82157,CPT,Facility,Inpatient,,,90,201,170.85,57.6066,201,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Androstenedione, S (Mayo)OutsideLaboratory",,82157,CPT,Facility,Outpatient,,,90,201,170.85,57.6066,201,"UCare Health, Inc.",Medical Assistance,101.4447,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Androstenedione, S (Mayo)OutsideLaboratory",,82157,CPT,Facility,Inpatient,,,90,201,170.85,57.6066,201,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Androstenedione, S (Mayo)OutsideLaboratory",,82157,CPT,Facility,Outpatient,,,90,201,170.85,57.6066,201,"UCare Health, Inc.",Medicare Advantage,101.4447,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Androstenedione, S (Mayo)OutsideLaboratory",,82157,CPT,Facility,Inpatient,,,90,201,170.85,57.6066,201,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Androstenedione, S (Mayo)OutsideLaboratory",,82157,CPT,Facility,Outpatient,,,90,201,170.85,57.6066,201,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),101.4447,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Androstenedione, S (Mayo)OutsideLaboratory",,82157,CPT,Facility,Inpatient,,,90,201,170.85,57.6066,201,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Androstenedione, S (Mayo)OutsideLaboratory",,82157,CPT,Facility,Both,,,90,201,170.85,57.6066,201,UnitedHealthcare,Individual & Family,188.94,94,,percent of total billed charges,,
"Androstenedione, S (Mayo)OutsideLaboratory",,82157,CPT,Facility,Outpatient,,,90,201,170.85,57.6066,201,UnitedHealthcare,Medicare Advantage,98.49,49,,percent of total billed charges,,
"Androstenedione, S (Mayo)OutsideLaboratory",,82157,CPT,Facility,Inpatient,,,90,201,170.85,57.6066,201,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Androstenedione, S (Mayo)OutsideLaboratory",,82157,CPT,Facility,Outpatient,,,90,201,170.85,57.6066,201,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,96.48,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Androstenedione, S (Mayo)OutsideLaboratory",,82157,CPT,Facility,Inpatient,,,90,201,170.85,57.6066,201,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Angiotensin Converting Enzyme, S (Mayo)OutsideLaboratory",,82164,CPT,Facility,Both,,,90,68,57.8,19.4888,68,Aetna,Commercial,62.56,92,,percent of total billed charges,,
"Angiotensin Converting Enzyme, S (Mayo)OutsideLaboratory",,82164,CPT,Facility,Outpatient,,,90,68,57.8,19.4888,68,Aetna,Medicare Advantage,33.32,49,,percent of total billed charges,,
"Angiotensin Converting Enzyme, S (Mayo)OutsideLaboratory",,82164,CPT,Facility,Inpatient,,,90,68,57.8,19.4888,68,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Angiotensin Converting Enzyme, S (Mayo)OutsideLaboratory",,82164,CPT,Facility,Both,,,90,68,57.8,19.4888,68,Aetna,PPO,63.24,93,,percent of total billed charges,,
"Angiotensin Converting Enzyme, S (Mayo)OutsideLaboratory",,82164,CPT,Facility,Both,,,90,68,57.8,19.4888,68,America's PPO,America's PPO,65.3004,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Angiotensin Converting Enzyme, S (Mayo)OutsideLaboratory",,82164,CPT,Facility,Both,,,90,68,57.8,19.4888,68,BlueCross BlueShield Minnesota, Federal Employee Program,66.912,98.4,,percent of total billed charges,,
"Angiotensin Converting Enzyme, S (Mayo)OutsideLaboratory",,82164,CPT,Facility,Both,,,90,68,57.8,19.4888,68,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,68,100,,percent of total billed charges,,
"Angiotensin Converting Enzyme, S (Mayo)OutsideLaboratory",,82164,CPT,Facility,Both,,,90,68,57.8,19.4888,68,BlueCross BlueShield Minnesota,High Value Network Plan,61.2,90,,percent of total billed charges,,
"Angiotensin Converting Enzyme, S (Mayo)OutsideLaboratory",,82164,CPT,Facility,Outpatient,,,90,68,57.8,19.4888,68,BlueCross BlueShield Minnesota,Medicare Advantage,33.32,49,,percent of total billed charges,,
"Angiotensin Converting Enzyme, S (Mayo)OutsideLaboratory",,82164,CPT,Facility,Inpatient,,,90,68,57.8,19.4888,68,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Angiotensin Converting Enzyme, S (Mayo)OutsideLaboratory",,82164,CPT,Facility,Both,,,90,68,57.8,19.4888,68,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,60.2276,88.57,,percent of total billed charges,,
"Angiotensin Converting Enzyme, S (Mayo)OutsideLaboratory",,82164,CPT,Facility,Both,,,90,68,57.8,19.4888,68,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,19.4888,28.66,,percent of total billed charges,,
"Angiotensin Converting Enzyme, S (Mayo)OutsideLaboratory",,82164,CPT,Facility,Outpatient,,,90,68,57.8,19.4888,68,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),33.32,49,,percent of total billed charges,,
"Angiotensin Converting Enzyme, S (Mayo)OutsideLaboratory",,82164,CPT,Facility,Inpatient,,,90,68,57.8,19.4888,68,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Angiotensin Converting Enzyme, S (Mayo)OutsideLaboratory",,82164,CPT,Facility,Both,,,90,68,57.8,19.4888,68,CorVel,Worker's Compensation,68,100,,percent of total billed charges,,
"Angiotensin Converting Enzyme, S (Mayo)OutsideLaboratory",,82164,CPT,Facility,Both,,,90,68,57.8,19.4888,68,First Health Group Corporation,First Health Network,65.96,97,,percent of total billed charges,,
"Angiotensin Converting Enzyme, S (Mayo)OutsideLaboratory",,82164,CPT,Facility,Both,,,90,68,57.8,19.4888,68,"Health Partners, Inc.",Commercial,64.328,94.6,,percent of total billed charges,,
"Angiotensin Converting Enzyme, S (Mayo)OutsideLaboratory",,82164,CPT,Facility,Outpatient,,,90,68,57.8,19.4888,68,"Health Partners, Inc.",Medicare Advantage,33.32,49,,percent of total billed charges,,
"Angiotensin Converting Enzyme, S (Mayo)OutsideLaboratory",,82164,CPT,Facility,Inpatient,,,90,68,57.8,19.4888,68,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Angiotensin Converting Enzyme, S (Mayo)OutsideLaboratory",,82164,CPT,Facility,Both,,,90,68,57.8,19.4888,68,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),40.8,60,,percent of total billed charges,,
"Angiotensin Converting Enzyme, S (Mayo)OutsideLaboratory",,82164,CPT,Facility,Both,,,90,68,57.8,19.4888,68,"Health Partners, Inc.",State of Minnesota Advantage Program,55.42,81.5,,percent of total billed charges,,
"Angiotensin Converting Enzyme, S (Mayo)OutsideLaboratory",,82164,CPT,Facility,Both,,,90,68,57.8,19.4888,68,"Health Partners, Inc.",State Public Programs,34,50,,percent of total billed charges,,
"Angiotensin Converting Enzyme, S (Mayo)OutsideLaboratory",,82164,CPT,Facility,Both,,,90,68,57.8,19.4888,68,Humana Insurance Company,Commercial PPO,64.6,95,,percent of total billed charges,,
"Angiotensin Converting Enzyme, S (Mayo)OutsideLaboratory",,82164,CPT,Facility,Outpatient,,,90,68,57.8,19.4888,68,Humana Insurance Company,Medicare PPO,33.32,49,,percent of total billed charges,,
"Angiotensin Converting Enzyme, S (Mayo)OutsideLaboratory",,82164,CPT,Facility,Inpatient,,,90,68,57.8,19.4888,68,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Angiotensin Converting Enzyme, S (Mayo)OutsideLaboratory",,82164,CPT,Facility,Both,,,90,68,57.8,19.4888,68,Medica,Individual & Family,67.388,99.1,,percent of total billed charges,,
"Angiotensin Converting Enzyme, S (Mayo)OutsideLaboratory",,82164,CPT,Facility,Outpatient,,,90,68,57.8,19.4888,68,Medica,Medica Advantage Solution,33.864,49.8,,percent of total billed charges,,
"Angiotensin Converting Enzyme, S (Mayo)OutsideLaboratory",,82164,CPT,Facility,Inpatient,,,90,68,57.8,19.4888,68,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Angiotensin Converting Enzyme, S (Mayo)OutsideLaboratory",,82164,CPT,Facility,Outpatient,,,90,68,57.8,19.4888,68,Medica,Medical Assistance,30.328,44.6,,percent of total billed charges,,
"Angiotensin Converting Enzyme, S (Mayo)OutsideLaboratory",,82164,CPT,Facility,Inpatient,,,90,68,57.8,19.4888,68,Medica,Medical Assistance,,,,,Included in per diem rate,
"Angiotensin Converting Enzyme, S (Mayo)OutsideLaboratory",,82164,CPT,Facility,Outpatient,,,90,68,57.8,19.4888,68,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,33.864,49.8,,percent of total billed charges,,
"Angiotensin Converting Enzyme, S (Mayo)OutsideLaboratory",,82164,CPT,Facility,Inpatient,,,90,68,57.8,19.4888,68,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Angiotensin Converting Enzyme, S (Mayo)OutsideLaboratory",,82164,CPT,Facility,Both,,,90,68,57.8,19.4888,68,"Multiplan, Inc.","Multiplan, Inc.",63.92,94,,percent of total billed charges,,
"Angiotensin Converting Enzyme, S (Mayo)OutsideLaboratory",,82164,CPT,Facility,Outpatient,,,90,68,57.8,19.4888,68,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,58.752,86.4,,percent of total billed charges,,
"Angiotensin Converting Enzyme, S (Mayo)OutsideLaboratory",,82164,CPT,Facility,Inpatient,,,90,68,57.8,19.4888,68,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Angiotensin Converting Enzyme, S (Mayo)OutsideLaboratory",,82164,CPT,Facility,Both,,,90,68,57.8,19.4888,68,"Preferred One Administrative Services, INC.",PPO,67.048,98.6,,percent of total billed charges,,
"Angiotensin Converting Enzyme, S (Mayo)OutsideLaboratory",,82164,CPT,Facility,Outpatient,,,90,68,57.8,19.4888,68,PrimeWest Health,Minnesota Senior Health Options (MSHO),34.986,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Angiotensin Converting Enzyme, S (Mayo)OutsideLaboratory",,82164,CPT,Facility,Inpatient,,,90,68,57.8,19.4888,68,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Angiotensin Converting Enzyme, S (Mayo)OutsideLaboratory",,82164,CPT,Facility,Outpatient,,,90,68,57.8,19.4888,68,PrimeWest Health,MinnesotaCare,34.9248,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Angiotensin Converting Enzyme, S (Mayo)OutsideLaboratory",,82164,CPT,Facility,Inpatient,,,90,68,57.8,19.4888,68,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Angiotensin Converting Enzyme, S (Mayo)OutsideLaboratory",,82164,CPT,Facility,Both,,,90,68,57.8,19.4888,68,Sanford Health Plan,Sanford Health Plan,62.56,92,,percent of total billed charges,,
"Angiotensin Converting Enzyme, S (Mayo)OutsideLaboratory",,82164,CPT,Facility,Outpatient,,,90,68,57.8,19.4888,68,"UCare Health, Inc.",Individual & Family Plan,38.318,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Angiotensin Converting Enzyme, S (Mayo)OutsideLaboratory",,82164,CPT,Facility,Inpatient,,,90,68,57.8,19.4888,68,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Angiotensin Converting Enzyme, S (Mayo)OutsideLaboratory",,82164,CPT,Facility,Outpatient,,,90,68,57.8,19.4888,68,"UCare Health, Inc.",Medical Assistance,34.3196,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Angiotensin Converting Enzyme, S (Mayo)OutsideLaboratory",,82164,CPT,Facility,Inpatient,,,90,68,57.8,19.4888,68,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Angiotensin Converting Enzyme, S (Mayo)OutsideLaboratory",,82164,CPT,Facility,Outpatient,,,90,68,57.8,19.4888,68,"UCare Health, Inc.",Medicare Advantage,34.3196,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Angiotensin Converting Enzyme, S (Mayo)OutsideLaboratory",,82164,CPT,Facility,Inpatient,,,90,68,57.8,19.4888,68,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Angiotensin Converting Enzyme, S (Mayo)OutsideLaboratory",,82164,CPT,Facility,Outpatient,,,90,68,57.8,19.4888,68,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),34.3196,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Angiotensin Converting Enzyme, S (Mayo)OutsideLaboratory",,82164,CPT,Facility,Inpatient,,,90,68,57.8,19.4888,68,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Angiotensin Converting Enzyme, S (Mayo)OutsideLaboratory",,82164,CPT,Facility,Both,,,90,68,57.8,19.4888,68,UnitedHealthcare,Individual & Family,63.92,94,,percent of total billed charges,,
"Angiotensin Converting Enzyme, S (Mayo)OutsideLaboratory",,82164,CPT,Facility,Outpatient,,,90,68,57.8,19.4888,68,UnitedHealthcare,Medicare Advantage,33.32,49,,percent of total billed charges,,
"Angiotensin Converting Enzyme, S (Mayo)OutsideLaboratory",,82164,CPT,Facility,Inpatient,,,90,68,57.8,19.4888,68,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Angiotensin Converting Enzyme, S (Mayo)OutsideLaboratory",,82164,CPT,Facility,Outpatient,,,90,68,57.8,19.4888,68,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,32.64,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Angiotensin Converting Enzyme, S (Mayo)OutsideLaboratory",,82164,CPT,Facility,Inpatient,,,90,68,57.8,19.4888,68,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Apolipoprotein B, P (Mayo)OutsideLaboratory",,82172,CPT,Facility,Both,,,90,61,51.85,17.4826,61,Aetna,Commercial,56.12,92,,percent of total billed charges,,
"Apolipoprotein B, P (Mayo)OutsideLaboratory",,82172,CPT,Facility,Outpatient,,,90,61,51.85,17.4826,61,Aetna,Medicare Advantage,29.89,49,,percent of total billed charges,,
"Apolipoprotein B, P (Mayo)OutsideLaboratory",,82172,CPT,Facility,Inpatient,,,90,61,51.85,17.4826,61,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Apolipoprotein B, P (Mayo)OutsideLaboratory",,82172,CPT,Facility,Both,,,90,61,51.85,17.4826,61,Aetna,PPO,56.73,93,,percent of total billed charges,,
"Apolipoprotein B, P (Mayo)OutsideLaboratory",,82172,CPT,Facility,Both,,,90,61,51.85,17.4826,61,America's PPO,America's PPO,58.5783,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Apolipoprotein B, P (Mayo)OutsideLaboratory",,82172,CPT,Facility,Both,,,90,61,51.85,17.4826,61,BlueCross BlueShield Minnesota, Federal Employee Program,60.024,98.4,,percent of total billed charges,,
"Apolipoprotein B, P (Mayo)OutsideLaboratory",,82172,CPT,Facility,Both,,,90,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,61,100,,percent of total billed charges,,
"Apolipoprotein B, P (Mayo)OutsideLaboratory",,82172,CPT,Facility,Both,,,90,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,High Value Network Plan,54.9,90,,percent of total billed charges,,
"Apolipoprotein B, P (Mayo)OutsideLaboratory",,82172,CPT,Facility,Outpatient,,,90,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,Medicare Advantage,29.89,49,,percent of total billed charges,,
"Apolipoprotein B, P (Mayo)OutsideLaboratory",,82172,CPT,Facility,Inpatient,,,90,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Apolipoprotein B, P (Mayo)OutsideLaboratory",,82172,CPT,Facility,Both,,,90,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,54.0277,88.57,,percent of total billed charges,,
"Apolipoprotein B, P (Mayo)OutsideLaboratory",,82172,CPT,Facility,Both,,,90,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,17.4826,28.66,,percent of total billed charges,,
"Apolipoprotein B, P (Mayo)OutsideLaboratory",,82172,CPT,Facility,Outpatient,,,90,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),29.89,49,,percent of total billed charges,,
"Apolipoprotein B, P (Mayo)OutsideLaboratory",,82172,CPT,Facility,Inpatient,,,90,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Apolipoprotein B, P (Mayo)OutsideLaboratory",,82172,CPT,Facility,Both,,,90,61,51.85,17.4826,61,CorVel,Worker's Compensation,61,100,,percent of total billed charges,,
"Apolipoprotein B, P (Mayo)OutsideLaboratory",,82172,CPT,Facility,Both,,,90,61,51.85,17.4826,61,First Health Group Corporation,First Health Network,59.17,97,,percent of total billed charges,,
"Apolipoprotein B, P (Mayo)OutsideLaboratory",,82172,CPT,Facility,Both,,,90,61,51.85,17.4826,61,"Health Partners, Inc.",Commercial,57.706,94.6,,percent of total billed charges,,
"Apolipoprotein B, P (Mayo)OutsideLaboratory",,82172,CPT,Facility,Outpatient,,,90,61,51.85,17.4826,61,"Health Partners, Inc.",Medicare Advantage,29.89,49,,percent of total billed charges,,
"Apolipoprotein B, P (Mayo)OutsideLaboratory",,82172,CPT,Facility,Inpatient,,,90,61,51.85,17.4826,61,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Apolipoprotein B, P (Mayo)OutsideLaboratory",,82172,CPT,Facility,Both,,,90,61,51.85,17.4826,61,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),36.6,60,,percent of total billed charges,,
"Apolipoprotein B, P (Mayo)OutsideLaboratory",,82172,CPT,Facility,Both,,,90,61,51.85,17.4826,61,"Health Partners, Inc.",State of Minnesota Advantage Program,49.715,81.5,,percent of total billed charges,,
"Apolipoprotein B, P (Mayo)OutsideLaboratory",,82172,CPT,Facility,Both,,,90,61,51.85,17.4826,61,"Health Partners, Inc.",State Public Programs,30.5,50,,percent of total billed charges,,
"Apolipoprotein B, P (Mayo)OutsideLaboratory",,82172,CPT,Facility,Both,,,90,61,51.85,17.4826,61,Humana Insurance Company,Commercial PPO,57.95,95,,percent of total billed charges,,
"Apolipoprotein B, P (Mayo)OutsideLaboratory",,82172,CPT,Facility,Outpatient,,,90,61,51.85,17.4826,61,Humana Insurance Company,Medicare PPO,29.89,49,,percent of total billed charges,,
"Apolipoprotein B, P (Mayo)OutsideLaboratory",,82172,CPT,Facility,Inpatient,,,90,61,51.85,17.4826,61,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Apolipoprotein B, P (Mayo)OutsideLaboratory",,82172,CPT,Facility,Both,,,90,61,51.85,17.4826,61,Medica,Individual & Family,60.451,99.1,,percent of total billed charges,,
"Apolipoprotein B, P (Mayo)OutsideLaboratory",,82172,CPT,Facility,Outpatient,,,90,61,51.85,17.4826,61,Medica,Medica Advantage Solution,30.378,49.8,,percent of total billed charges,,
"Apolipoprotein B, P (Mayo)OutsideLaboratory",,82172,CPT,Facility,Inpatient,,,90,61,51.85,17.4826,61,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Apolipoprotein B, P (Mayo)OutsideLaboratory",,82172,CPT,Facility,Outpatient,,,90,61,51.85,17.4826,61,Medica,Medical Assistance,27.206,44.6,,percent of total billed charges,,
"Apolipoprotein B, P (Mayo)OutsideLaboratory",,82172,CPT,Facility,Inpatient,,,90,61,51.85,17.4826,61,Medica,Medical Assistance,,,,,Included in per diem rate,
"Apolipoprotein B, P (Mayo)OutsideLaboratory",,82172,CPT,Facility,Outpatient,,,90,61,51.85,17.4826,61,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,30.378,49.8,,percent of total billed charges,,
"Apolipoprotein B, P (Mayo)OutsideLaboratory",,82172,CPT,Facility,Inpatient,,,90,61,51.85,17.4826,61,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Apolipoprotein B, P (Mayo)OutsideLaboratory",,82172,CPT,Facility,Both,,,90,61,51.85,17.4826,61,"Multiplan, Inc.","Multiplan, Inc.",57.34,94,,percent of total billed charges,,
"Apolipoprotein B, P (Mayo)OutsideLaboratory",,82172,CPT,Facility,Outpatient,,,90,61,51.85,17.4826,61,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,52.704,86.4,,percent of total billed charges,,
"Apolipoprotein B, P (Mayo)OutsideLaboratory",,82172,CPT,Facility,Inpatient,,,90,61,51.85,17.4826,61,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Apolipoprotein B, P (Mayo)OutsideLaboratory",,82172,CPT,Facility,Both,,,90,61,51.85,17.4826,61,"Preferred One Administrative Services, INC.",PPO,60.146,98.6,,percent of total billed charges,,
"Apolipoprotein B, P (Mayo)OutsideLaboratory",,82172,CPT,Facility,Outpatient,,,90,61,51.85,17.4826,61,PrimeWest Health,Minnesota Senior Health Options (MSHO),31.3845,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Apolipoprotein B, P (Mayo)OutsideLaboratory",,82172,CPT,Facility,Inpatient,,,90,61,51.85,17.4826,61,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Apolipoprotein B, P (Mayo)OutsideLaboratory",,82172,CPT,Facility,Outpatient,,,90,61,51.85,17.4826,61,PrimeWest Health,MinnesotaCare,31.3296,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Apolipoprotein B, P (Mayo)OutsideLaboratory",,82172,CPT,Facility,Inpatient,,,90,61,51.85,17.4826,61,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Apolipoprotein B, P (Mayo)OutsideLaboratory",,82172,CPT,Facility,Both,,,90,61,51.85,17.4826,61,Sanford Health Plan,Sanford Health Plan,56.12,92,,percent of total billed charges,,
"Apolipoprotein B, P (Mayo)OutsideLaboratory",,82172,CPT,Facility,Outpatient,,,90,61,51.85,17.4826,61,"UCare Health, Inc.",Individual & Family Plan,34.3735,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Apolipoprotein B, P (Mayo)OutsideLaboratory",,82172,CPT,Facility,Inpatient,,,90,61,51.85,17.4826,61,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Apolipoprotein B, P (Mayo)OutsideLaboratory",,82172,CPT,Facility,Outpatient,,,90,61,51.85,17.4826,61,"UCare Health, Inc.",Medical Assistance,30.7867,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Apolipoprotein B, P (Mayo)OutsideLaboratory",,82172,CPT,Facility,Inpatient,,,90,61,51.85,17.4826,61,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Apolipoprotein B, P (Mayo)OutsideLaboratory",,82172,CPT,Facility,Outpatient,,,90,61,51.85,17.4826,61,"UCare Health, Inc.",Medicare Advantage,30.7867,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Apolipoprotein B, P (Mayo)OutsideLaboratory",,82172,CPT,Facility,Inpatient,,,90,61,51.85,17.4826,61,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Apolipoprotein B, P (Mayo)OutsideLaboratory",,82172,CPT,Facility,Outpatient,,,90,61,51.85,17.4826,61,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),30.7867,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Apolipoprotein B, P (Mayo)OutsideLaboratory",,82172,CPT,Facility,Inpatient,,,90,61,51.85,17.4826,61,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Apolipoprotein B, P (Mayo)OutsideLaboratory",,82172,CPT,Facility,Both,,,90,61,51.85,17.4826,61,UnitedHealthcare,Individual & Family,57.34,94,,percent of total billed charges,,
"Apolipoprotein B, P (Mayo)OutsideLaboratory",,82172,CPT,Facility,Outpatient,,,90,61,51.85,17.4826,61,UnitedHealthcare,Medicare Advantage,29.89,49,,percent of total billed charges,,
"Apolipoprotein B, P (Mayo)OutsideLaboratory",,82172,CPT,Facility,Inpatient,,,90,61,51.85,17.4826,61,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Apolipoprotein B, P (Mayo)OutsideLaboratory",,82172,CPT,Facility,Outpatient,,,90,61,51.85,17.4826,61,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,29.28,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Apolipoprotein B, P (Mayo)OutsideLaboratory",,82172,CPT,Facility,Inpatient,,,90,61,51.85,17.4826,61,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Ascorbic Acid, P (Mayo)OutsideLaboratory",,82180,CPT,Facility,Both,,,90,111,94.35,31.8126,111,Aetna,Commercial,102.12,92,,percent of total billed charges,,
"Ascorbic Acid, P (Mayo)OutsideLaboratory",,82180,CPT,Facility,Outpatient,,,90,111,94.35,31.8126,111,Aetna,Medicare Advantage,54.39,49,,percent of total billed charges,,
"Ascorbic Acid, P (Mayo)OutsideLaboratory",,82180,CPT,Facility,Inpatient,,,90,111,94.35,31.8126,111,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Ascorbic Acid, P (Mayo)OutsideLaboratory",,82180,CPT,Facility,Both,,,90,111,94.35,31.8126,111,Aetna,PPO,103.23,93,,percent of total billed charges,,
"Ascorbic Acid, P (Mayo)OutsideLaboratory",,82180,CPT,Facility,Both,,,90,111,94.35,31.8126,111,America's PPO,America's PPO,106.5933,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Ascorbic Acid, P (Mayo)OutsideLaboratory",,82180,CPT,Facility,Both,,,90,111,94.35,31.8126,111,BlueCross BlueShield Minnesota, Federal Employee Program,109.224,98.4,,percent of total billed charges,,
"Ascorbic Acid, P (Mayo)OutsideLaboratory",,82180,CPT,Facility,Both,,,90,111,94.35,31.8126,111,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,111,100,,percent of total billed charges,,
"Ascorbic Acid, P (Mayo)OutsideLaboratory",,82180,CPT,Facility,Both,,,90,111,94.35,31.8126,111,BlueCross BlueShield Minnesota,High Value Network Plan,99.9,90,,percent of total billed charges,,
"Ascorbic Acid, P (Mayo)OutsideLaboratory",,82180,CPT,Facility,Outpatient,,,90,111,94.35,31.8126,111,BlueCross BlueShield Minnesota,Medicare Advantage,54.39,49,,percent of total billed charges,,
"Ascorbic Acid, P (Mayo)OutsideLaboratory",,82180,CPT,Facility,Inpatient,,,90,111,94.35,31.8126,111,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Ascorbic Acid, P (Mayo)OutsideLaboratory",,82180,CPT,Facility,Both,,,90,111,94.35,31.8126,111,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,98.3127,88.57,,percent of total billed charges,,
"Ascorbic Acid, P (Mayo)OutsideLaboratory",,82180,CPT,Facility,Both,,,90,111,94.35,31.8126,111,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,31.8126,28.66,,percent of total billed charges,,
"Ascorbic Acid, P (Mayo)OutsideLaboratory",,82180,CPT,Facility,Outpatient,,,90,111,94.35,31.8126,111,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),54.39,49,,percent of total billed charges,,
"Ascorbic Acid, P (Mayo)OutsideLaboratory",,82180,CPT,Facility,Inpatient,,,90,111,94.35,31.8126,111,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Ascorbic Acid, P (Mayo)OutsideLaboratory",,82180,CPT,Facility,Both,,,90,111,94.35,31.8126,111,CorVel,Worker's Compensation,111,100,,percent of total billed charges,,
"Ascorbic Acid, P (Mayo)OutsideLaboratory",,82180,CPT,Facility,Both,,,90,111,94.35,31.8126,111,First Health Group Corporation,First Health Network,107.67,97,,percent of total billed charges,,
"Ascorbic Acid, P (Mayo)OutsideLaboratory",,82180,CPT,Facility,Both,,,90,111,94.35,31.8126,111,"Health Partners, Inc.",Commercial,105.006,94.6,,percent of total billed charges,,
"Ascorbic Acid, P (Mayo)OutsideLaboratory",,82180,CPT,Facility,Outpatient,,,90,111,94.35,31.8126,111,"Health Partners, Inc.",Medicare Advantage,54.39,49,,percent of total billed charges,,
"Ascorbic Acid, P (Mayo)OutsideLaboratory",,82180,CPT,Facility,Inpatient,,,90,111,94.35,31.8126,111,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Ascorbic Acid, P (Mayo)OutsideLaboratory",,82180,CPT,Facility,Both,,,90,111,94.35,31.8126,111,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),66.6,60,,percent of total billed charges,,
"Ascorbic Acid, P (Mayo)OutsideLaboratory",,82180,CPT,Facility,Both,,,90,111,94.35,31.8126,111,"Health Partners, Inc.",State of Minnesota Advantage Program,90.465,81.5,,percent of total billed charges,,
"Ascorbic Acid, P (Mayo)OutsideLaboratory",,82180,CPT,Facility,Both,,,90,111,94.35,31.8126,111,"Health Partners, Inc.",State Public Programs,55.5,50,,percent of total billed charges,,
"Ascorbic Acid, P (Mayo)OutsideLaboratory",,82180,CPT,Facility,Both,,,90,111,94.35,31.8126,111,Humana Insurance Company,Commercial PPO,105.45,95,,percent of total billed charges,,
"Ascorbic Acid, P (Mayo)OutsideLaboratory",,82180,CPT,Facility,Outpatient,,,90,111,94.35,31.8126,111,Humana Insurance Company,Medicare PPO,54.39,49,,percent of total billed charges,,
"Ascorbic Acid, P (Mayo)OutsideLaboratory",,82180,CPT,Facility,Inpatient,,,90,111,94.35,31.8126,111,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Ascorbic Acid, P (Mayo)OutsideLaboratory",,82180,CPT,Facility,Both,,,90,111,94.35,31.8126,111,Medica,Individual & Family,110.001,99.1,,percent of total billed charges,,
"Ascorbic Acid, P (Mayo)OutsideLaboratory",,82180,CPT,Facility,Outpatient,,,90,111,94.35,31.8126,111,Medica,Medica Advantage Solution,55.278,49.8,,percent of total billed charges,,
"Ascorbic Acid, P (Mayo)OutsideLaboratory",,82180,CPT,Facility,Inpatient,,,90,111,94.35,31.8126,111,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Ascorbic Acid, P (Mayo)OutsideLaboratory",,82180,CPT,Facility,Outpatient,,,90,111,94.35,31.8126,111,Medica,Medical Assistance,49.506,44.6,,percent of total billed charges,,
"Ascorbic Acid, P (Mayo)OutsideLaboratory",,82180,CPT,Facility,Inpatient,,,90,111,94.35,31.8126,111,Medica,Medical Assistance,,,,,Included in per diem rate,
"Ascorbic Acid, P (Mayo)OutsideLaboratory",,82180,CPT,Facility,Outpatient,,,90,111,94.35,31.8126,111,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,55.278,49.8,,percent of total billed charges,,
"Ascorbic Acid, P (Mayo)OutsideLaboratory",,82180,CPT,Facility,Inpatient,,,90,111,94.35,31.8126,111,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Ascorbic Acid, P (Mayo)OutsideLaboratory",,82180,CPT,Facility,Both,,,90,111,94.35,31.8126,111,"Multiplan, Inc.","Multiplan, Inc.",104.34,94,,percent of total billed charges,,
"Ascorbic Acid, P (Mayo)OutsideLaboratory",,82180,CPT,Facility,Outpatient,,,90,111,94.35,31.8126,111,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,95.904,86.4,,percent of total billed charges,,
"Ascorbic Acid, P (Mayo)OutsideLaboratory",,82180,CPT,Facility,Inpatient,,,90,111,94.35,31.8126,111,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Ascorbic Acid, P (Mayo)OutsideLaboratory",,82180,CPT,Facility,Both,,,90,111,94.35,31.8126,111,"Preferred One Administrative Services, INC.",PPO,109.446,98.6,,percent of total billed charges,,
"Ascorbic Acid, P (Mayo)OutsideLaboratory",,82180,CPT,Facility,Outpatient,,,90,111,94.35,31.8126,111,PrimeWest Health,Minnesota Senior Health Options (MSHO),57.1095,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Ascorbic Acid, P (Mayo)OutsideLaboratory",,82180,CPT,Facility,Inpatient,,,90,111,94.35,31.8126,111,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Ascorbic Acid, P (Mayo)OutsideLaboratory",,82180,CPT,Facility,Outpatient,,,90,111,94.35,31.8126,111,PrimeWest Health,MinnesotaCare,57.0096,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Ascorbic Acid, P (Mayo)OutsideLaboratory",,82180,CPT,Facility,Inpatient,,,90,111,94.35,31.8126,111,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Ascorbic Acid, P (Mayo)OutsideLaboratory",,82180,CPT,Facility,Both,,,90,111,94.35,31.8126,111,Sanford Health Plan,Sanford Health Plan,102.12,92,,percent of total billed charges,,
"Ascorbic Acid, P (Mayo)OutsideLaboratory",,82180,CPT,Facility,Outpatient,,,90,111,94.35,31.8126,111,"UCare Health, Inc.",Individual & Family Plan,62.5485,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Ascorbic Acid, P (Mayo)OutsideLaboratory",,82180,CPT,Facility,Inpatient,,,90,111,94.35,31.8126,111,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Ascorbic Acid, P (Mayo)OutsideLaboratory",,82180,CPT,Facility,Outpatient,,,90,111,94.35,31.8126,111,"UCare Health, Inc.",Medical Assistance,56.0217,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Ascorbic Acid, P (Mayo)OutsideLaboratory",,82180,CPT,Facility,Inpatient,,,90,111,94.35,31.8126,111,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Ascorbic Acid, P (Mayo)OutsideLaboratory",,82180,CPT,Facility,Outpatient,,,90,111,94.35,31.8126,111,"UCare Health, Inc.",Medicare Advantage,56.0217,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Ascorbic Acid, P (Mayo)OutsideLaboratory",,82180,CPT,Facility,Inpatient,,,90,111,94.35,31.8126,111,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Ascorbic Acid, P (Mayo)OutsideLaboratory",,82180,CPT,Facility,Outpatient,,,90,111,94.35,31.8126,111,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),56.0217,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Ascorbic Acid, P (Mayo)OutsideLaboratory",,82180,CPT,Facility,Inpatient,,,90,111,94.35,31.8126,111,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Ascorbic Acid, P (Mayo)OutsideLaboratory",,82180,CPT,Facility,Both,,,90,111,94.35,31.8126,111,UnitedHealthcare,Individual & Family,104.34,94,,percent of total billed charges,,
"Ascorbic Acid, P (Mayo)OutsideLaboratory",,82180,CPT,Facility,Outpatient,,,90,111,94.35,31.8126,111,UnitedHealthcare,Medicare Advantage,54.39,49,,percent of total billed charges,,
"Ascorbic Acid, P (Mayo)OutsideLaboratory",,82180,CPT,Facility,Inpatient,,,90,111,94.35,31.8126,111,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Ascorbic Acid, P (Mayo)OutsideLaboratory",,82180,CPT,Facility,Outpatient,,,90,111,94.35,31.8126,111,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,53.28,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Ascorbic Acid, P (Mayo)OutsideLaboratory",,82180,CPT,Facility,Inpatient,,,90,111,94.35,31.8126,111,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Beta-2-Microglobulin, S (Mayo)OutsideLaboratory",,82232,CPT,Facility,Both,,,90,51,43.35,14.6166,51,Aetna,Commercial,46.92,92,,percent of total billed charges,,
"Beta-2-Microglobulin, S (Mayo)OutsideLaboratory",,82232,CPT,Facility,Outpatient,,,90,51,43.35,14.6166,51,Aetna,Medicare Advantage,24.99,49,,percent of total billed charges,,
"Beta-2-Microglobulin, S (Mayo)OutsideLaboratory",,82232,CPT,Facility,Inpatient,,,90,51,43.35,14.6166,51,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Beta-2-Microglobulin, S (Mayo)OutsideLaboratory",,82232,CPT,Facility,Both,,,90,51,43.35,14.6166,51,Aetna,PPO,47.43,93,,percent of total billed charges,,
"Beta-2-Microglobulin, S (Mayo)OutsideLaboratory",,82232,CPT,Facility,Both,,,90,51,43.35,14.6166,51,America's PPO,America's PPO,48.9753,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Beta-2-Microglobulin, S (Mayo)OutsideLaboratory",,82232,CPT,Facility,Both,,,90,51,43.35,14.6166,51,BlueCross BlueShield Minnesota, Federal Employee Program,50.184,98.4,,percent of total billed charges,,
"Beta-2-Microglobulin, S (Mayo)OutsideLaboratory",,82232,CPT,Facility,Both,,,90,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,51,100,,percent of total billed charges,,
"Beta-2-Microglobulin, S (Mayo)OutsideLaboratory",,82232,CPT,Facility,Both,,,90,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,High Value Network Plan,45.9,90,,percent of total billed charges,,
"Beta-2-Microglobulin, S (Mayo)OutsideLaboratory",,82232,CPT,Facility,Outpatient,,,90,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,Medicare Advantage,24.99,49,,percent of total billed charges,,
"Beta-2-Microglobulin, S (Mayo)OutsideLaboratory",,82232,CPT,Facility,Inpatient,,,90,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Beta-2-Microglobulin, S (Mayo)OutsideLaboratory",,82232,CPT,Facility,Both,,,90,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,45.1707,88.57,,percent of total billed charges,,
"Beta-2-Microglobulin, S (Mayo)OutsideLaboratory",,82232,CPT,Facility,Both,,,90,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,14.6166,28.66,,percent of total billed charges,,
"Beta-2-Microglobulin, S (Mayo)OutsideLaboratory",,82232,CPT,Facility,Outpatient,,,90,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),24.99,49,,percent of total billed charges,,
"Beta-2-Microglobulin, S (Mayo)OutsideLaboratory",,82232,CPT,Facility,Inpatient,,,90,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Beta-2-Microglobulin, S (Mayo)OutsideLaboratory",,82232,CPT,Facility,Both,,,90,51,43.35,14.6166,51,CorVel,Worker's Compensation,51,100,,percent of total billed charges,,
"Beta-2-Microglobulin, S (Mayo)OutsideLaboratory",,82232,CPT,Facility,Both,,,90,51,43.35,14.6166,51,First Health Group Corporation,First Health Network,49.47,97,,percent of total billed charges,,
"Beta-2-Microglobulin, S (Mayo)OutsideLaboratory",,82232,CPT,Facility,Both,,,90,51,43.35,14.6166,51,"Health Partners, Inc.",Commercial,48.246,94.6,,percent of total billed charges,,
"Beta-2-Microglobulin, S (Mayo)OutsideLaboratory",,82232,CPT,Facility,Outpatient,,,90,51,43.35,14.6166,51,"Health Partners, Inc.",Medicare Advantage,24.99,49,,percent of total billed charges,,
"Beta-2-Microglobulin, S (Mayo)OutsideLaboratory",,82232,CPT,Facility,Inpatient,,,90,51,43.35,14.6166,51,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Beta-2-Microglobulin, S (Mayo)OutsideLaboratory",,82232,CPT,Facility,Both,,,90,51,43.35,14.6166,51,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),30.6,60,,percent of total billed charges,,
"Beta-2-Microglobulin, S (Mayo)OutsideLaboratory",,82232,CPT,Facility,Both,,,90,51,43.35,14.6166,51,"Health Partners, Inc.",State of Minnesota Advantage Program,41.565,81.5,,percent of total billed charges,,
"Beta-2-Microglobulin, S (Mayo)OutsideLaboratory",,82232,CPT,Facility,Both,,,90,51,43.35,14.6166,51,"Health Partners, Inc.",State Public Programs,25.5,50,,percent of total billed charges,,
"Beta-2-Microglobulin, S (Mayo)OutsideLaboratory",,82232,CPT,Facility,Both,,,90,51,43.35,14.6166,51,Humana Insurance Company,Commercial PPO,48.45,95,,percent of total billed charges,,
"Beta-2-Microglobulin, S (Mayo)OutsideLaboratory",,82232,CPT,Facility,Outpatient,,,90,51,43.35,14.6166,51,Humana Insurance Company,Medicare PPO,24.99,49,,percent of total billed charges,,
"Beta-2-Microglobulin, S (Mayo)OutsideLaboratory",,82232,CPT,Facility,Inpatient,,,90,51,43.35,14.6166,51,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Beta-2-Microglobulin, S (Mayo)OutsideLaboratory",,82232,CPT,Facility,Both,,,90,51,43.35,14.6166,51,Medica,Individual & Family,50.541,99.1,,percent of total billed charges,,
"Beta-2-Microglobulin, S (Mayo)OutsideLaboratory",,82232,CPT,Facility,Outpatient,,,90,51,43.35,14.6166,51,Medica,Medica Advantage Solution,25.398,49.8,,percent of total billed charges,,
"Beta-2-Microglobulin, S (Mayo)OutsideLaboratory",,82232,CPT,Facility,Inpatient,,,90,51,43.35,14.6166,51,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Beta-2-Microglobulin, S (Mayo)OutsideLaboratory",,82232,CPT,Facility,Outpatient,,,90,51,43.35,14.6166,51,Medica,Medical Assistance,22.746,44.6,,percent of total billed charges,,
"Beta-2-Microglobulin, S (Mayo)OutsideLaboratory",,82232,CPT,Facility,Inpatient,,,90,51,43.35,14.6166,51,Medica,Medical Assistance,,,,,Included in per diem rate,
"Beta-2-Microglobulin, S (Mayo)OutsideLaboratory",,82232,CPT,Facility,Outpatient,,,90,51,43.35,14.6166,51,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,25.398,49.8,,percent of total billed charges,,
"Beta-2-Microglobulin, S (Mayo)OutsideLaboratory",,82232,CPT,Facility,Inpatient,,,90,51,43.35,14.6166,51,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Beta-2-Microglobulin, S (Mayo)OutsideLaboratory",,82232,CPT,Facility,Both,,,90,51,43.35,14.6166,51,"Multiplan, Inc.","Multiplan, Inc.",47.94,94,,percent of total billed charges,,
"Beta-2-Microglobulin, S (Mayo)OutsideLaboratory",,82232,CPT,Facility,Outpatient,,,90,51,43.35,14.6166,51,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,44.064,86.4,,percent of total billed charges,,
"Beta-2-Microglobulin, S (Mayo)OutsideLaboratory",,82232,CPT,Facility,Inpatient,,,90,51,43.35,14.6166,51,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Beta-2-Microglobulin, S (Mayo)OutsideLaboratory",,82232,CPT,Facility,Both,,,90,51,43.35,14.6166,51,"Preferred One Administrative Services, INC.",PPO,50.286,98.6,,percent of total billed charges,,
"Beta-2-Microglobulin, S (Mayo)OutsideLaboratory",,82232,CPT,Facility,Outpatient,,,90,51,43.35,14.6166,51,PrimeWest Health,Minnesota Senior Health Options (MSHO),26.2395,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Beta-2-Microglobulin, S (Mayo)OutsideLaboratory",,82232,CPT,Facility,Inpatient,,,90,51,43.35,14.6166,51,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Beta-2-Microglobulin, S (Mayo)OutsideLaboratory",,82232,CPT,Facility,Outpatient,,,90,51,43.35,14.6166,51,PrimeWest Health,MinnesotaCare,26.1936,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Beta-2-Microglobulin, S (Mayo)OutsideLaboratory",,82232,CPT,Facility,Inpatient,,,90,51,43.35,14.6166,51,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Beta-2-Microglobulin, S (Mayo)OutsideLaboratory",,82232,CPT,Facility,Both,,,90,51,43.35,14.6166,51,Sanford Health Plan,Sanford Health Plan,46.92,92,,percent of total billed charges,,
"Beta-2-Microglobulin, S (Mayo)OutsideLaboratory",,82232,CPT,Facility,Outpatient,,,90,51,43.35,14.6166,51,"UCare Health, Inc.",Individual & Family Plan,28.7385,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Beta-2-Microglobulin, S (Mayo)OutsideLaboratory",,82232,CPT,Facility,Inpatient,,,90,51,43.35,14.6166,51,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Beta-2-Microglobulin, S (Mayo)OutsideLaboratory",,82232,CPT,Facility,Outpatient,,,90,51,43.35,14.6166,51,"UCare Health, Inc.",Medical Assistance,25.7397,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Beta-2-Microglobulin, S (Mayo)OutsideLaboratory",,82232,CPT,Facility,Inpatient,,,90,51,43.35,14.6166,51,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Beta-2-Microglobulin, S (Mayo)OutsideLaboratory",,82232,CPT,Facility,Outpatient,,,90,51,43.35,14.6166,51,"UCare Health, Inc.",Medicare Advantage,25.7397,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Beta-2-Microglobulin, S (Mayo)OutsideLaboratory",,82232,CPT,Facility,Inpatient,,,90,51,43.35,14.6166,51,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Beta-2-Microglobulin, S (Mayo)OutsideLaboratory",,82232,CPT,Facility,Outpatient,,,90,51,43.35,14.6166,51,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),25.7397,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Beta-2-Microglobulin, S (Mayo)OutsideLaboratory",,82232,CPT,Facility,Inpatient,,,90,51,43.35,14.6166,51,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Beta-2-Microglobulin, S (Mayo)OutsideLaboratory",,82232,CPT,Facility,Both,,,90,51,43.35,14.6166,51,UnitedHealthcare,Individual & Family,47.94,94,,percent of total billed charges,,
"Beta-2-Microglobulin, S (Mayo)OutsideLaboratory",,82232,CPT,Facility,Outpatient,,,90,51,43.35,14.6166,51,UnitedHealthcare,Medicare Advantage,24.99,49,,percent of total billed charges,,
"Beta-2-Microglobulin, S (Mayo)OutsideLaboratory",,82232,CPT,Facility,Inpatient,,,90,51,43.35,14.6166,51,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Beta-2-Microglobulin, S (Mayo)OutsideLaboratory",,82232,CPT,Facility,Outpatient,,,90,51,43.35,14.6166,51,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,24.48,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Beta-2-Microglobulin, S (Mayo)OutsideLaboratory",,82232,CPT,Facility,Inpatient,,,90,51,43.35,14.6166,51,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Bile Acids, Total, S (Mayo)OutsideLaboratory",,82239,CPT,Facility,Both,,,90,154,130.9,44.1364,154,Aetna,Commercial,141.68,92,,percent of total billed charges,,
"Bile Acids, Total, S (Mayo)OutsideLaboratory",,82239,CPT,Facility,Outpatient,,,90,154,130.9,44.1364,154,Aetna,Medicare Advantage,75.46,49,,percent of total billed charges,,
"Bile Acids, Total, S (Mayo)OutsideLaboratory",,82239,CPT,Facility,Inpatient,,,90,154,130.9,44.1364,154,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Bile Acids, Total, S (Mayo)OutsideLaboratory",,82239,CPT,Facility,Both,,,90,154,130.9,44.1364,154,Aetna,PPO,143.22,93,,percent of total billed charges,,
"Bile Acids, Total, S (Mayo)OutsideLaboratory",,82239,CPT,Facility,Both,,,90,154,130.9,44.1364,154,America's PPO,America's PPO,147.8862,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Bile Acids, Total, S (Mayo)OutsideLaboratory",,82239,CPT,Facility,Both,,,90,154,130.9,44.1364,154,BlueCross BlueShield Minnesota, Federal Employee Program,151.536,98.4,,percent of total billed charges,,
"Bile Acids, Total, S (Mayo)OutsideLaboratory",,82239,CPT,Facility,Both,,,90,154,130.9,44.1364,154,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,154,100,,percent of total billed charges,,
"Bile Acids, Total, S (Mayo)OutsideLaboratory",,82239,CPT,Facility,Both,,,90,154,130.9,44.1364,154,BlueCross BlueShield Minnesota,High Value Network Plan,138.6,90,,percent of total billed charges,,
"Bile Acids, Total, S (Mayo)OutsideLaboratory",,82239,CPT,Facility,Outpatient,,,90,154,130.9,44.1364,154,BlueCross BlueShield Minnesota,Medicare Advantage,75.46,49,,percent of total billed charges,,
"Bile Acids, Total, S (Mayo)OutsideLaboratory",,82239,CPT,Facility,Inpatient,,,90,154,130.9,44.1364,154,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Bile Acids, Total, S (Mayo)OutsideLaboratory",,82239,CPT,Facility,Both,,,90,154,130.9,44.1364,154,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,136.3978,88.57,,percent of total billed charges,,
"Bile Acids, Total, S (Mayo)OutsideLaboratory",,82239,CPT,Facility,Both,,,90,154,130.9,44.1364,154,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,44.1364,28.66,,percent of total billed charges,,
"Bile Acids, Total, S (Mayo)OutsideLaboratory",,82239,CPT,Facility,Outpatient,,,90,154,130.9,44.1364,154,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),75.46,49,,percent of total billed charges,,
"Bile Acids, Total, S (Mayo)OutsideLaboratory",,82239,CPT,Facility,Inpatient,,,90,154,130.9,44.1364,154,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Bile Acids, Total, S (Mayo)OutsideLaboratory",,82239,CPT,Facility,Both,,,90,154,130.9,44.1364,154,CorVel,Worker's Compensation,154,100,,percent of total billed charges,,
"Bile Acids, Total, S (Mayo)OutsideLaboratory",,82239,CPT,Facility,Both,,,90,154,130.9,44.1364,154,First Health Group Corporation,First Health Network,149.38,97,,percent of total billed charges,,
"Bile Acids, Total, S (Mayo)OutsideLaboratory",,82239,CPT,Facility,Both,,,90,154,130.9,44.1364,154,"Health Partners, Inc.",Commercial,145.684,94.6,,percent of total billed charges,,
"Bile Acids, Total, S (Mayo)OutsideLaboratory",,82239,CPT,Facility,Outpatient,,,90,154,130.9,44.1364,154,"Health Partners, Inc.",Medicare Advantage,75.46,49,,percent of total billed charges,,
"Bile Acids, Total, S (Mayo)OutsideLaboratory",,82239,CPT,Facility,Inpatient,,,90,154,130.9,44.1364,154,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Bile Acids, Total, S (Mayo)OutsideLaboratory",,82239,CPT,Facility,Both,,,90,154,130.9,44.1364,154,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),92.4,60,,percent of total billed charges,,
"Bile Acids, Total, S (Mayo)OutsideLaboratory",,82239,CPT,Facility,Both,,,90,154,130.9,44.1364,154,"Health Partners, Inc.",State of Minnesota Advantage Program,125.51,81.5,,percent of total billed charges,,
"Bile Acids, Total, S (Mayo)OutsideLaboratory",,82239,CPT,Facility,Both,,,90,154,130.9,44.1364,154,"Health Partners, Inc.",State Public Programs,77,50,,percent of total billed charges,,
"Bile Acids, Total, S (Mayo)OutsideLaboratory",,82239,CPT,Facility,Both,,,90,154,130.9,44.1364,154,Humana Insurance Company,Commercial PPO,146.3,95,,percent of total billed charges,,
"Bile Acids, Total, S (Mayo)OutsideLaboratory",,82239,CPT,Facility,Outpatient,,,90,154,130.9,44.1364,154,Humana Insurance Company,Medicare PPO,75.46,49,,percent of total billed charges,,
"Bile Acids, Total, S (Mayo)OutsideLaboratory",,82239,CPT,Facility,Inpatient,,,90,154,130.9,44.1364,154,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Bile Acids, Total, S (Mayo)OutsideLaboratory",,82239,CPT,Facility,Both,,,90,154,130.9,44.1364,154,Medica,Individual & Family,152.614,99.1,,percent of total billed charges,,
"Bile Acids, Total, S (Mayo)OutsideLaboratory",,82239,CPT,Facility,Outpatient,,,90,154,130.9,44.1364,154,Medica,Medica Advantage Solution,76.692,49.8,,percent of total billed charges,,
"Bile Acids, Total, S (Mayo)OutsideLaboratory",,82239,CPT,Facility,Inpatient,,,90,154,130.9,44.1364,154,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Bile Acids, Total, S (Mayo)OutsideLaboratory",,82239,CPT,Facility,Outpatient,,,90,154,130.9,44.1364,154,Medica,Medical Assistance,68.684,44.6,,percent of total billed charges,,
"Bile Acids, Total, S (Mayo)OutsideLaboratory",,82239,CPT,Facility,Inpatient,,,90,154,130.9,44.1364,154,Medica,Medical Assistance,,,,,Included in per diem rate,
"Bile Acids, Total, S (Mayo)OutsideLaboratory",,82239,CPT,Facility,Outpatient,,,90,154,130.9,44.1364,154,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,76.692,49.8,,percent of total billed charges,,
"Bile Acids, Total, S (Mayo)OutsideLaboratory",,82239,CPT,Facility,Inpatient,,,90,154,130.9,44.1364,154,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Bile Acids, Total, S (Mayo)OutsideLaboratory",,82239,CPT,Facility,Both,,,90,154,130.9,44.1364,154,"Multiplan, Inc.","Multiplan, Inc.",144.76,94,,percent of total billed charges,,
"Bile Acids, Total, S (Mayo)OutsideLaboratory",,82239,CPT,Facility,Outpatient,,,90,154,130.9,44.1364,154,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,133.056,86.4,,percent of total billed charges,,
"Bile Acids, Total, S (Mayo)OutsideLaboratory",,82239,CPT,Facility,Inpatient,,,90,154,130.9,44.1364,154,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Bile Acids, Total, S (Mayo)OutsideLaboratory",,82239,CPT,Facility,Both,,,90,154,130.9,44.1364,154,"Preferred One Administrative Services, INC.",PPO,151.844,98.6,,percent of total billed charges,,
"Bile Acids, Total, S (Mayo)OutsideLaboratory",,82239,CPT,Facility,Outpatient,,,90,154,130.9,44.1364,154,PrimeWest Health,Minnesota Senior Health Options (MSHO),79.233,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Bile Acids, Total, S (Mayo)OutsideLaboratory",,82239,CPT,Facility,Inpatient,,,90,154,130.9,44.1364,154,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Bile Acids, Total, S (Mayo)OutsideLaboratory",,82239,CPT,Facility,Outpatient,,,90,154,130.9,44.1364,154,PrimeWest Health,MinnesotaCare,79.0944,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Bile Acids, Total, S (Mayo)OutsideLaboratory",,82239,CPT,Facility,Inpatient,,,90,154,130.9,44.1364,154,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Bile Acids, Total, S (Mayo)OutsideLaboratory",,82239,CPT,Facility,Both,,,90,154,130.9,44.1364,154,Sanford Health Plan,Sanford Health Plan,141.68,92,,percent of total billed charges,,
"Bile Acids, Total, S (Mayo)OutsideLaboratory",,82239,CPT,Facility,Outpatient,,,90,154,130.9,44.1364,154,"UCare Health, Inc.",Individual & Family Plan,86.779,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Bile Acids, Total, S (Mayo)OutsideLaboratory",,82239,CPT,Facility,Inpatient,,,90,154,130.9,44.1364,154,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Bile Acids, Total, S (Mayo)OutsideLaboratory",,82239,CPT,Facility,Outpatient,,,90,154,130.9,44.1364,154,"UCare Health, Inc.",Medical Assistance,77.7238,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Bile Acids, Total, S (Mayo)OutsideLaboratory",,82239,CPT,Facility,Inpatient,,,90,154,130.9,44.1364,154,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Bile Acids, Total, S (Mayo)OutsideLaboratory",,82239,CPT,Facility,Outpatient,,,90,154,130.9,44.1364,154,"UCare Health, Inc.",Medicare Advantage,77.7238,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Bile Acids, Total, S (Mayo)OutsideLaboratory",,82239,CPT,Facility,Inpatient,,,90,154,130.9,44.1364,154,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Bile Acids, Total, S (Mayo)OutsideLaboratory",,82239,CPT,Facility,Outpatient,,,90,154,130.9,44.1364,154,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),77.7238,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Bile Acids, Total, S (Mayo)OutsideLaboratory",,82239,CPT,Facility,Inpatient,,,90,154,130.9,44.1364,154,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Bile Acids, Total, S (Mayo)OutsideLaboratory",,82239,CPT,Facility,Both,,,90,154,130.9,44.1364,154,UnitedHealthcare,Individual & Family,144.76,94,,percent of total billed charges,,
"Bile Acids, Total, S (Mayo)OutsideLaboratory",,82239,CPT,Facility,Outpatient,,,90,154,130.9,44.1364,154,UnitedHealthcare,Medicare Advantage,75.46,49,,percent of total billed charges,,
"Bile Acids, Total, S (Mayo)OutsideLaboratory",,82239,CPT,Facility,Inpatient,,,90,154,130.9,44.1364,154,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Bile Acids, Total, S (Mayo)OutsideLaboratory",,82239,CPT,Facility,Outpatient,,,90,154,130.9,44.1364,154,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,73.92,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Bile Acids, Total, S (Mayo)OutsideLaboratory",,82239,CPT,Facility,Inpatient,,,90,154,130.9,44.1364,154,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Biotinidase (Mdh)OutsideLaboratory,,82261,CPT,Facility,Both,,,90,34,28.9,9.7444,34,Aetna,Commercial,31.28,92,,percent of total billed charges,,
Biotinidase (Mdh)OutsideLaboratory,,82261,CPT,Facility,Outpatient,,,90,34,28.9,9.7444,34,Aetna,Medicare Advantage,16.66,49,,percent of total billed charges,,
Biotinidase (Mdh)OutsideLaboratory,,82261,CPT,Facility,Inpatient,,,90,34,28.9,9.7444,34,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Biotinidase (Mdh)OutsideLaboratory,,82261,CPT,Facility,Both,,,90,34,28.9,9.7444,34,Aetna,PPO,31.62,93,,percent of total billed charges,,
Biotinidase (Mdh)OutsideLaboratory,,82261,CPT,Facility,Both,,,90,34,28.9,9.7444,34,America's PPO,America's PPO,32.6502,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Biotinidase (Mdh)OutsideLaboratory,,82261,CPT,Facility,Both,,,90,34,28.9,9.7444,34,BlueCross BlueShield Minnesota, Federal Employee Program,33.456,98.4,,percent of total billed charges,,
Biotinidase (Mdh)OutsideLaboratory,,82261,CPT,Facility,Both,,,90,34,28.9,9.7444,34,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,34,100,,percent of total billed charges,,
Biotinidase (Mdh)OutsideLaboratory,,82261,CPT,Facility,Both,,,90,34,28.9,9.7444,34,BlueCross BlueShield Minnesota,High Value Network Plan,30.6,90,,percent of total billed charges,,
Biotinidase (Mdh)OutsideLaboratory,,82261,CPT,Facility,Outpatient,,,90,34,28.9,9.7444,34,BlueCross BlueShield Minnesota,Medicare Advantage,16.66,49,,percent of total billed charges,,
Biotinidase (Mdh)OutsideLaboratory,,82261,CPT,Facility,Inpatient,,,90,34,28.9,9.7444,34,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Biotinidase (Mdh)OutsideLaboratory,,82261,CPT,Facility,Both,,,90,34,28.9,9.7444,34,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,30.1138,88.57,,percent of total billed charges,,
Biotinidase (Mdh)OutsideLaboratory,,82261,CPT,Facility,Both,,,90,34,28.9,9.7444,34,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,9.7444,28.66,,percent of total billed charges,,
Biotinidase (Mdh)OutsideLaboratory,,82261,CPT,Facility,Outpatient,,,90,34,28.9,9.7444,34,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),16.66,49,,percent of total billed charges,,
Biotinidase (Mdh)OutsideLaboratory,,82261,CPT,Facility,Inpatient,,,90,34,28.9,9.7444,34,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Biotinidase (Mdh)OutsideLaboratory,,82261,CPT,Facility,Both,,,90,34,28.9,9.7444,34,CorVel,Worker's Compensation,34,100,,percent of total billed charges,,
Biotinidase (Mdh)OutsideLaboratory,,82261,CPT,Facility,Both,,,90,34,28.9,9.7444,34,First Health Group Corporation,First Health Network,32.98,97,,percent of total billed charges,,
Biotinidase (Mdh)OutsideLaboratory,,82261,CPT,Facility,Both,,,90,34,28.9,9.7444,34,"Health Partners, Inc.",Commercial,32.164,94.6,,percent of total billed charges,,
Biotinidase (Mdh)OutsideLaboratory,,82261,CPT,Facility,Outpatient,,,90,34,28.9,9.7444,34,"Health Partners, Inc.",Medicare Advantage,16.66,49,,percent of total billed charges,,
Biotinidase (Mdh)OutsideLaboratory,,82261,CPT,Facility,Inpatient,,,90,34,28.9,9.7444,34,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Biotinidase (Mdh)OutsideLaboratory,,82261,CPT,Facility,Both,,,90,34,28.9,9.7444,34,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),20.4,60,,percent of total billed charges,,
Biotinidase (Mdh)OutsideLaboratory,,82261,CPT,Facility,Both,,,90,34,28.9,9.7444,34,"Health Partners, Inc.",State of Minnesota Advantage Program,27.71,81.5,,percent of total billed charges,,
Biotinidase (Mdh)OutsideLaboratory,,82261,CPT,Facility,Both,,,90,34,28.9,9.7444,34,"Health Partners, Inc.",State Public Programs,17,50,,percent of total billed charges,,
Biotinidase (Mdh)OutsideLaboratory,,82261,CPT,Facility,Both,,,90,34,28.9,9.7444,34,Humana Insurance Company,Commercial PPO,32.3,95,,percent of total billed charges,,
Biotinidase (Mdh)OutsideLaboratory,,82261,CPT,Facility,Outpatient,,,90,34,28.9,9.7444,34,Humana Insurance Company,Medicare PPO,16.66,49,,percent of total billed charges,,
Biotinidase (Mdh)OutsideLaboratory,,82261,CPT,Facility,Inpatient,,,90,34,28.9,9.7444,34,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Biotinidase (Mdh)OutsideLaboratory,,82261,CPT,Facility,Both,,,90,34,28.9,9.7444,34,Medica,Individual & Family,33.694,99.1,,percent of total billed charges,,
Biotinidase (Mdh)OutsideLaboratory,,82261,CPT,Facility,Outpatient,,,90,34,28.9,9.7444,34,Medica,Medica Advantage Solution,16.932,49.8,,percent of total billed charges,,
Biotinidase (Mdh)OutsideLaboratory,,82261,CPT,Facility,Inpatient,,,90,34,28.9,9.7444,34,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Biotinidase (Mdh)OutsideLaboratory,,82261,CPT,Facility,Outpatient,,,90,34,28.9,9.7444,34,Medica,Medical Assistance,15.164,44.6,,percent of total billed charges,,
Biotinidase (Mdh)OutsideLaboratory,,82261,CPT,Facility,Inpatient,,,90,34,28.9,9.7444,34,Medica,Medical Assistance,,,,,Included in per diem rate,
Biotinidase (Mdh)OutsideLaboratory,,82261,CPT,Facility,Outpatient,,,90,34,28.9,9.7444,34,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,16.932,49.8,,percent of total billed charges,,
Biotinidase (Mdh)OutsideLaboratory,,82261,CPT,Facility,Inpatient,,,90,34,28.9,9.7444,34,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Biotinidase (Mdh)OutsideLaboratory,,82261,CPT,Facility,Both,,,90,34,28.9,9.7444,34,"Multiplan, Inc.","Multiplan, Inc.",31.96,94,,percent of total billed charges,,
Biotinidase (Mdh)OutsideLaboratory,,82261,CPT,Facility,Outpatient,,,90,34,28.9,9.7444,34,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,29.376,86.4,,percent of total billed charges,,
Biotinidase (Mdh)OutsideLaboratory,,82261,CPT,Facility,Inpatient,,,90,34,28.9,9.7444,34,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Biotinidase (Mdh)OutsideLaboratory,,82261,CPT,Facility,Both,,,90,34,28.9,9.7444,34,"Preferred One Administrative Services, INC.",PPO,33.524,98.6,,percent of total billed charges,,
Biotinidase (Mdh)OutsideLaboratory,,82261,CPT,Facility,Outpatient,,,90,34,28.9,9.7444,34,PrimeWest Health,Minnesota Senior Health Options (MSHO),17.493,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Biotinidase (Mdh)OutsideLaboratory,,82261,CPT,Facility,Inpatient,,,90,34,28.9,9.7444,34,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Biotinidase (Mdh)OutsideLaboratory,,82261,CPT,Facility,Outpatient,,,90,34,28.9,9.7444,34,PrimeWest Health,MinnesotaCare,17.4624,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Biotinidase (Mdh)OutsideLaboratory,,82261,CPT,Facility,Inpatient,,,90,34,28.9,9.7444,34,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Biotinidase (Mdh)OutsideLaboratory,,82261,CPT,Facility,Both,,,90,34,28.9,9.7444,34,Sanford Health Plan,Sanford Health Plan,31.28,92,,percent of total billed charges,,
Biotinidase (Mdh)OutsideLaboratory,,82261,CPT,Facility,Outpatient,,,90,34,28.9,9.7444,34,"UCare Health, Inc.",Individual & Family Plan,19.159,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Biotinidase (Mdh)OutsideLaboratory,,82261,CPT,Facility,Inpatient,,,90,34,28.9,9.7444,34,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Biotinidase (Mdh)OutsideLaboratory,,82261,CPT,Facility,Outpatient,,,90,34,28.9,9.7444,34,"UCare Health, Inc.",Medical Assistance,17.1598,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Biotinidase (Mdh)OutsideLaboratory,,82261,CPT,Facility,Inpatient,,,90,34,28.9,9.7444,34,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Biotinidase (Mdh)OutsideLaboratory,,82261,CPT,Facility,Outpatient,,,90,34,28.9,9.7444,34,"UCare Health, Inc.",Medicare Advantage,17.1598,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Biotinidase (Mdh)OutsideLaboratory,,82261,CPT,Facility,Inpatient,,,90,34,28.9,9.7444,34,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Biotinidase (Mdh)OutsideLaboratory,,82261,CPT,Facility,Outpatient,,,90,34,28.9,9.7444,34,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),17.1598,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Biotinidase (Mdh)OutsideLaboratory,,82261,CPT,Facility,Inpatient,,,90,34,28.9,9.7444,34,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Biotinidase (Mdh)OutsideLaboratory,,82261,CPT,Facility,Both,,,90,34,28.9,9.7444,34,UnitedHealthcare,Individual & Family,31.96,94,,percent of total billed charges,,
Biotinidase (Mdh)OutsideLaboratory,,82261,CPT,Facility,Outpatient,,,90,34,28.9,9.7444,34,UnitedHealthcare,Medicare Advantage,16.66,49,,percent of total billed charges,,
Biotinidase (Mdh)OutsideLaboratory,,82261,CPT,Facility,Inpatient,,,90,34,28.9,9.7444,34,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Biotinidase (Mdh)OutsideLaboratory,,82261,CPT,Facility,Outpatient,,,90,34,28.9,9.7444,34,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,16.32,48,,percent of total billed charges,,100% of DHS outpatient percentage
Biotinidase (Mdh)OutsideLaboratory,,82261,CPT,Facility,Inpatient,,,90,34,28.9,9.7444,34,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Cadmium, B (Mayo)OutsideLaboratory",,82300,CPT,Facility,Both,,,90,94,79.9,26.9404,94,Aetna,Commercial,86.48,92,,percent of total billed charges,,
"Cadmium, B (Mayo)OutsideLaboratory",,82300,CPT,Facility,Outpatient,,,90,94,79.9,26.9404,94,Aetna,Medicare Advantage,46.06,49,,percent of total billed charges,,
"Cadmium, B (Mayo)OutsideLaboratory",,82300,CPT,Facility,Inpatient,,,90,94,79.9,26.9404,94,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Cadmium, B (Mayo)OutsideLaboratory",,82300,CPT,Facility,Both,,,90,94,79.9,26.9404,94,Aetna,PPO,87.42,93,,percent of total billed charges,,
"Cadmium, B (Mayo)OutsideLaboratory",,82300,CPT,Facility,Both,,,90,94,79.9,26.9404,94,America's PPO,America's PPO,90.2682,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Cadmium, B (Mayo)OutsideLaboratory",,82300,CPT,Facility,Both,,,90,94,79.9,26.9404,94,BlueCross BlueShield Minnesota, Federal Employee Program,92.496,98.4,,percent of total billed charges,,
"Cadmium, B (Mayo)OutsideLaboratory",,82300,CPT,Facility,Both,,,90,94,79.9,26.9404,94,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,94,100,,percent of total billed charges,,
"Cadmium, B (Mayo)OutsideLaboratory",,82300,CPT,Facility,Both,,,90,94,79.9,26.9404,94,BlueCross BlueShield Minnesota,High Value Network Plan,84.6,90,,percent of total billed charges,,
"Cadmium, B (Mayo)OutsideLaboratory",,82300,CPT,Facility,Outpatient,,,90,94,79.9,26.9404,94,BlueCross BlueShield Minnesota,Medicare Advantage,46.06,49,,percent of total billed charges,,
"Cadmium, B (Mayo)OutsideLaboratory",,82300,CPT,Facility,Inpatient,,,90,94,79.9,26.9404,94,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Cadmium, B (Mayo)OutsideLaboratory",,82300,CPT,Facility,Both,,,90,94,79.9,26.9404,94,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,83.2558,88.57,,percent of total billed charges,,
"Cadmium, B (Mayo)OutsideLaboratory",,82300,CPT,Facility,Both,,,90,94,79.9,26.9404,94,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,26.9404,28.66,,percent of total billed charges,,
"Cadmium, B (Mayo)OutsideLaboratory",,82300,CPT,Facility,Outpatient,,,90,94,79.9,26.9404,94,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),46.06,49,,percent of total billed charges,,
"Cadmium, B (Mayo)OutsideLaboratory",,82300,CPT,Facility,Inpatient,,,90,94,79.9,26.9404,94,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Cadmium, B (Mayo)OutsideLaboratory",,82300,CPT,Facility,Both,,,90,94,79.9,26.9404,94,CorVel,Worker's Compensation,94,100,,percent of total billed charges,,
"Cadmium, B (Mayo)OutsideLaboratory",,82300,CPT,Facility,Both,,,90,94,79.9,26.9404,94,First Health Group Corporation,First Health Network,91.18,97,,percent of total billed charges,,
"Cadmium, B (Mayo)OutsideLaboratory",,82300,CPT,Facility,Both,,,90,94,79.9,26.9404,94,"Health Partners, Inc.",Commercial,88.924,94.6,,percent of total billed charges,,
"Cadmium, B (Mayo)OutsideLaboratory",,82300,CPT,Facility,Outpatient,,,90,94,79.9,26.9404,94,"Health Partners, Inc.",Medicare Advantage,46.06,49,,percent of total billed charges,,
"Cadmium, B (Mayo)OutsideLaboratory",,82300,CPT,Facility,Inpatient,,,90,94,79.9,26.9404,94,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Cadmium, B (Mayo)OutsideLaboratory",,82300,CPT,Facility,Both,,,90,94,79.9,26.9404,94,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),56.4,60,,percent of total billed charges,,
"Cadmium, B (Mayo)OutsideLaboratory",,82300,CPT,Facility,Both,,,90,94,79.9,26.9404,94,"Health Partners, Inc.",State of Minnesota Advantage Program,76.61,81.5,,percent of total billed charges,,
"Cadmium, B (Mayo)OutsideLaboratory",,82300,CPT,Facility,Both,,,90,94,79.9,26.9404,94,"Health Partners, Inc.",State Public Programs,47,50,,percent of total billed charges,,
"Cadmium, B (Mayo)OutsideLaboratory",,82300,CPT,Facility,Both,,,90,94,79.9,26.9404,94,Humana Insurance Company,Commercial PPO,89.3,95,,percent of total billed charges,,
"Cadmium, B (Mayo)OutsideLaboratory",,82300,CPT,Facility,Outpatient,,,90,94,79.9,26.9404,94,Humana Insurance Company,Medicare PPO,46.06,49,,percent of total billed charges,,
"Cadmium, B (Mayo)OutsideLaboratory",,82300,CPT,Facility,Inpatient,,,90,94,79.9,26.9404,94,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Cadmium, B (Mayo)OutsideLaboratory",,82300,CPT,Facility,Both,,,90,94,79.9,26.9404,94,Medica,Individual & Family,93.154,99.1,,percent of total billed charges,,
"Cadmium, B (Mayo)OutsideLaboratory",,82300,CPT,Facility,Outpatient,,,90,94,79.9,26.9404,94,Medica,Medica Advantage Solution,46.812,49.8,,percent of total billed charges,,
"Cadmium, B (Mayo)OutsideLaboratory",,82300,CPT,Facility,Inpatient,,,90,94,79.9,26.9404,94,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Cadmium, B (Mayo)OutsideLaboratory",,82300,CPT,Facility,Outpatient,,,90,94,79.9,26.9404,94,Medica,Medical Assistance,41.924,44.6,,percent of total billed charges,,
"Cadmium, B (Mayo)OutsideLaboratory",,82300,CPT,Facility,Inpatient,,,90,94,79.9,26.9404,94,Medica,Medical Assistance,,,,,Included in per diem rate,
"Cadmium, B (Mayo)OutsideLaboratory",,82300,CPT,Facility,Outpatient,,,90,94,79.9,26.9404,94,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,46.812,49.8,,percent of total billed charges,,
"Cadmium, B (Mayo)OutsideLaboratory",,82300,CPT,Facility,Inpatient,,,90,94,79.9,26.9404,94,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Cadmium, B (Mayo)OutsideLaboratory",,82300,CPT,Facility,Both,,,90,94,79.9,26.9404,94,"Multiplan, Inc.","Multiplan, Inc.",88.36,94,,percent of total billed charges,,
"Cadmium, B (Mayo)OutsideLaboratory",,82300,CPT,Facility,Outpatient,,,90,94,79.9,26.9404,94,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,81.216,86.4,,percent of total billed charges,,
"Cadmium, B (Mayo)OutsideLaboratory",,82300,CPT,Facility,Inpatient,,,90,94,79.9,26.9404,94,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Cadmium, B (Mayo)OutsideLaboratory",,82300,CPT,Facility,Both,,,90,94,79.9,26.9404,94,"Preferred One Administrative Services, INC.",PPO,92.684,98.6,,percent of total billed charges,,
"Cadmium, B (Mayo)OutsideLaboratory",,82300,CPT,Facility,Outpatient,,,90,94,79.9,26.9404,94,PrimeWest Health,Minnesota Senior Health Options (MSHO),48.363,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Cadmium, B (Mayo)OutsideLaboratory",,82300,CPT,Facility,Inpatient,,,90,94,79.9,26.9404,94,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Cadmium, B (Mayo)OutsideLaboratory",,82300,CPT,Facility,Outpatient,,,90,94,79.9,26.9404,94,PrimeWest Health,MinnesotaCare,48.2784,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Cadmium, B (Mayo)OutsideLaboratory",,82300,CPT,Facility,Inpatient,,,90,94,79.9,26.9404,94,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Cadmium, B (Mayo)OutsideLaboratory",,82300,CPT,Facility,Both,,,90,94,79.9,26.9404,94,Sanford Health Plan,Sanford Health Plan,86.48,92,,percent of total billed charges,,
"Cadmium, B (Mayo)OutsideLaboratory",,82300,CPT,Facility,Outpatient,,,90,94,79.9,26.9404,94,"UCare Health, Inc.",Individual & Family Plan,52.969,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Cadmium, B (Mayo)OutsideLaboratory",,82300,CPT,Facility,Inpatient,,,90,94,79.9,26.9404,94,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Cadmium, B (Mayo)OutsideLaboratory",,82300,CPT,Facility,Outpatient,,,90,94,79.9,26.9404,94,"UCare Health, Inc.",Medical Assistance,47.4418,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Cadmium, B (Mayo)OutsideLaboratory",,82300,CPT,Facility,Inpatient,,,90,94,79.9,26.9404,94,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Cadmium, B (Mayo)OutsideLaboratory",,82300,CPT,Facility,Outpatient,,,90,94,79.9,26.9404,94,"UCare Health, Inc.",Medicare Advantage,47.4418,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Cadmium, B (Mayo)OutsideLaboratory",,82300,CPT,Facility,Inpatient,,,90,94,79.9,26.9404,94,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Cadmium, B (Mayo)OutsideLaboratory",,82300,CPT,Facility,Outpatient,,,90,94,79.9,26.9404,94,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),47.4418,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Cadmium, B (Mayo)OutsideLaboratory",,82300,CPT,Facility,Inpatient,,,90,94,79.9,26.9404,94,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Cadmium, B (Mayo)OutsideLaboratory",,82300,CPT,Facility,Both,,,90,94,79.9,26.9404,94,UnitedHealthcare,Individual & Family,88.36,94,,percent of total billed charges,,
"Cadmium, B (Mayo)OutsideLaboratory",,82300,CPT,Facility,Outpatient,,,90,94,79.9,26.9404,94,UnitedHealthcare,Medicare Advantage,46.06,49,,percent of total billed charges,,
"Cadmium, B (Mayo)OutsideLaboratory",,82300,CPT,Facility,Inpatient,,,90,94,79.9,26.9404,94,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Cadmium, B (Mayo)OutsideLaboratory",,82300,CPT,Facility,Outpatient,,,90,94,79.9,26.9404,94,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,45.12,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Cadmium, B (Mayo)OutsideLaboratory",,82300,CPT,Facility,Inpatient,,,90,94,79.9,26.9404,94,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Calcitonin, S (Mayo)OutsideLaboratory",,82308,CPT,Facility,Both,,,90,185,157.25,53.021,185,Aetna,Commercial,170.2,92,,percent of total billed charges,,
"Calcitonin, S (Mayo)OutsideLaboratory",,82308,CPT,Facility,Outpatient,,,90,185,157.25,53.021,185,Aetna,Medicare Advantage,90.65,49,,percent of total billed charges,,
"Calcitonin, S (Mayo)OutsideLaboratory",,82308,CPT,Facility,Inpatient,,,90,185,157.25,53.021,185,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Calcitonin, S (Mayo)OutsideLaboratory",,82308,CPT,Facility,Both,,,90,185,157.25,53.021,185,Aetna,PPO,172.05,93,,percent of total billed charges,,
"Calcitonin, S (Mayo)OutsideLaboratory",,82308,CPT,Facility,Both,,,90,185,157.25,53.021,185,America's PPO,America's PPO,177.6555,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Calcitonin, S (Mayo)OutsideLaboratory",,82308,CPT,Facility,Both,,,90,185,157.25,53.021,185,BlueCross BlueShield Minnesota, Federal Employee Program,182.04,98.4,,percent of total billed charges,,
"Calcitonin, S (Mayo)OutsideLaboratory",,82308,CPT,Facility,Both,,,90,185,157.25,53.021,185,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,185,100,,percent of total billed charges,,
"Calcitonin, S (Mayo)OutsideLaboratory",,82308,CPT,Facility,Both,,,90,185,157.25,53.021,185,BlueCross BlueShield Minnesota,High Value Network Plan,166.5,90,,percent of total billed charges,,
"Calcitonin, S (Mayo)OutsideLaboratory",,82308,CPT,Facility,Outpatient,,,90,185,157.25,53.021,185,BlueCross BlueShield Minnesota,Medicare Advantage,90.65,49,,percent of total billed charges,,
"Calcitonin, S (Mayo)OutsideLaboratory",,82308,CPT,Facility,Inpatient,,,90,185,157.25,53.021,185,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Calcitonin, S (Mayo)OutsideLaboratory",,82308,CPT,Facility,Both,,,90,185,157.25,53.021,185,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,163.8545,88.57,,percent of total billed charges,,
"Calcitonin, S (Mayo)OutsideLaboratory",,82308,CPT,Facility,Both,,,90,185,157.25,53.021,185,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,53.021,28.66,,percent of total billed charges,,
"Calcitonin, S (Mayo)OutsideLaboratory",,82308,CPT,Facility,Outpatient,,,90,185,157.25,53.021,185,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),90.65,49,,percent of total billed charges,,
"Calcitonin, S (Mayo)OutsideLaboratory",,82308,CPT,Facility,Inpatient,,,90,185,157.25,53.021,185,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Calcitonin, S (Mayo)OutsideLaboratory",,82308,CPT,Facility,Both,,,90,185,157.25,53.021,185,CorVel,Worker's Compensation,185,100,,percent of total billed charges,,
"Calcitonin, S (Mayo)OutsideLaboratory",,82308,CPT,Facility,Both,,,90,185,157.25,53.021,185,First Health Group Corporation,First Health Network,179.45,97,,percent of total billed charges,,
"Calcitonin, S (Mayo)OutsideLaboratory",,82308,CPT,Facility,Both,,,90,185,157.25,53.021,185,"Health Partners, Inc.",Commercial,175.01,94.6,,percent of total billed charges,,
"Calcitonin, S (Mayo)OutsideLaboratory",,82308,CPT,Facility,Outpatient,,,90,185,157.25,53.021,185,"Health Partners, Inc.",Medicare Advantage,90.65,49,,percent of total billed charges,,
"Calcitonin, S (Mayo)OutsideLaboratory",,82308,CPT,Facility,Inpatient,,,90,185,157.25,53.021,185,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Calcitonin, S (Mayo)OutsideLaboratory",,82308,CPT,Facility,Both,,,90,185,157.25,53.021,185,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),111,60,,percent of total billed charges,,
"Calcitonin, S (Mayo)OutsideLaboratory",,82308,CPT,Facility,Both,,,90,185,157.25,53.021,185,"Health Partners, Inc.",State of Minnesota Advantage Program,150.775,81.5,,percent of total billed charges,,
"Calcitonin, S (Mayo)OutsideLaboratory",,82308,CPT,Facility,Both,,,90,185,157.25,53.021,185,"Health Partners, Inc.",State Public Programs,92.5,50,,percent of total billed charges,,
"Calcitonin, S (Mayo)OutsideLaboratory",,82308,CPT,Facility,Both,,,90,185,157.25,53.021,185,Humana Insurance Company,Commercial PPO,175.75,95,,percent of total billed charges,,
"Calcitonin, S (Mayo)OutsideLaboratory",,82308,CPT,Facility,Outpatient,,,90,185,157.25,53.021,185,Humana Insurance Company,Medicare PPO,90.65,49,,percent of total billed charges,,
"Calcitonin, S (Mayo)OutsideLaboratory",,82308,CPT,Facility,Inpatient,,,90,185,157.25,53.021,185,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Calcitonin, S (Mayo)OutsideLaboratory",,82308,CPT,Facility,Both,,,90,185,157.25,53.021,185,Medica,Individual & Family,183.335,99.1,,percent of total billed charges,,
"Calcitonin, S (Mayo)OutsideLaboratory",,82308,CPT,Facility,Outpatient,,,90,185,157.25,53.021,185,Medica,Medica Advantage Solution,92.13,49.8,,percent of total billed charges,,
"Calcitonin, S (Mayo)OutsideLaboratory",,82308,CPT,Facility,Inpatient,,,90,185,157.25,53.021,185,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Calcitonin, S (Mayo)OutsideLaboratory",,82308,CPT,Facility,Outpatient,,,90,185,157.25,53.021,185,Medica,Medical Assistance,82.51,44.6,,percent of total billed charges,,
"Calcitonin, S (Mayo)OutsideLaboratory",,82308,CPT,Facility,Inpatient,,,90,185,157.25,53.021,185,Medica,Medical Assistance,,,,,Included in per diem rate,
"Calcitonin, S (Mayo)OutsideLaboratory",,82308,CPT,Facility,Outpatient,,,90,185,157.25,53.021,185,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,92.13,49.8,,percent of total billed charges,,
"Calcitonin, S (Mayo)OutsideLaboratory",,82308,CPT,Facility,Inpatient,,,90,185,157.25,53.021,185,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Calcitonin, S (Mayo)OutsideLaboratory",,82308,CPT,Facility,Both,,,90,185,157.25,53.021,185,"Multiplan, Inc.","Multiplan, Inc.",173.9,94,,percent of total billed charges,,
"Calcitonin, S (Mayo)OutsideLaboratory",,82308,CPT,Facility,Outpatient,,,90,185,157.25,53.021,185,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,159.84,86.4,,percent of total billed charges,,
"Calcitonin, S (Mayo)OutsideLaboratory",,82308,CPT,Facility,Inpatient,,,90,185,157.25,53.021,185,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Calcitonin, S (Mayo)OutsideLaboratory",,82308,CPT,Facility,Both,,,90,185,157.25,53.021,185,"Preferred One Administrative Services, INC.",PPO,182.41,98.6,,percent of total billed charges,,
"Calcitonin, S (Mayo)OutsideLaboratory",,82308,CPT,Facility,Outpatient,,,90,185,157.25,53.021,185,PrimeWest Health,Minnesota Senior Health Options (MSHO),95.1825,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Calcitonin, S (Mayo)OutsideLaboratory",,82308,CPT,Facility,Inpatient,,,90,185,157.25,53.021,185,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Calcitonin, S (Mayo)OutsideLaboratory",,82308,CPT,Facility,Outpatient,,,90,185,157.25,53.021,185,PrimeWest Health,MinnesotaCare,95.016,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Calcitonin, S (Mayo)OutsideLaboratory",,82308,CPT,Facility,Inpatient,,,90,185,157.25,53.021,185,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Calcitonin, S (Mayo)OutsideLaboratory",,82308,CPT,Facility,Both,,,90,185,157.25,53.021,185,Sanford Health Plan,Sanford Health Plan,170.2,92,,percent of total billed charges,,
"Calcitonin, S (Mayo)OutsideLaboratory",,82308,CPT,Facility,Outpatient,,,90,185,157.25,53.021,185,"UCare Health, Inc.",Individual & Family Plan,104.2475,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Calcitonin, S (Mayo)OutsideLaboratory",,82308,CPT,Facility,Inpatient,,,90,185,157.25,53.021,185,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Calcitonin, S (Mayo)OutsideLaboratory",,82308,CPT,Facility,Outpatient,,,90,185,157.25,53.021,185,"UCare Health, Inc.",Medical Assistance,93.3695,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Calcitonin, S (Mayo)OutsideLaboratory",,82308,CPT,Facility,Inpatient,,,90,185,157.25,53.021,185,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Calcitonin, S (Mayo)OutsideLaboratory",,82308,CPT,Facility,Outpatient,,,90,185,157.25,53.021,185,"UCare Health, Inc.",Medicare Advantage,93.3695,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Calcitonin, S (Mayo)OutsideLaboratory",,82308,CPT,Facility,Inpatient,,,90,185,157.25,53.021,185,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Calcitonin, S (Mayo)OutsideLaboratory",,82308,CPT,Facility,Outpatient,,,90,185,157.25,53.021,185,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),93.3695,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Calcitonin, S (Mayo)OutsideLaboratory",,82308,CPT,Facility,Inpatient,,,90,185,157.25,53.021,185,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Calcitonin, S (Mayo)OutsideLaboratory",,82308,CPT,Facility,Both,,,90,185,157.25,53.021,185,UnitedHealthcare,Individual & Family,173.9,94,,percent of total billed charges,,
"Calcitonin, S (Mayo)OutsideLaboratory",,82308,CPT,Facility,Outpatient,,,90,185,157.25,53.021,185,UnitedHealthcare,Medicare Advantage,90.65,49,,percent of total billed charges,,
"Calcitonin, S (Mayo)OutsideLaboratory",,82308,CPT,Facility,Inpatient,,,90,185,157.25,53.021,185,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Calcitonin, S (Mayo)OutsideLaboratory",,82308,CPT,Facility,Outpatient,,,90,185,157.25,53.021,185,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,88.8,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Calcitonin, S (Mayo)OutsideLaboratory",,82308,CPT,Facility,Inpatient,,,90,185,157.25,53.021,185,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Calcium; Urine (Mayo)OutsideLaboratory,,82340,CPT,Facility,Both,,,90,59,50.15,16.9094,59,Aetna,Commercial,54.28,92,,percent of total billed charges,,
Calcium; Urine (Mayo)OutsideLaboratory,,82340,CPT,Facility,Outpatient,,,90,59,50.15,16.9094,59,Aetna,Medicare Advantage,28.91,49,,percent of total billed charges,,
Calcium; Urine (Mayo)OutsideLaboratory,,82340,CPT,Facility,Inpatient,,,90,59,50.15,16.9094,59,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Calcium; Urine (Mayo)OutsideLaboratory,,82340,CPT,Facility,Both,,,90,59,50.15,16.9094,59,Aetna,PPO,54.87,93,,percent of total billed charges,,
Calcium; Urine (Mayo)OutsideLaboratory,,82340,CPT,Facility,Both,,,90,59,50.15,16.9094,59,America's PPO,America's PPO,56.6577,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Calcium; Urine (Mayo)OutsideLaboratory,,82340,CPT,Facility,Both,,,90,59,50.15,16.9094,59,BlueCross BlueShield Minnesota, Federal Employee Program,58.056,98.4,,percent of total billed charges,,
Calcium; Urine (Mayo)OutsideLaboratory,,82340,CPT,Facility,Both,,,90,59,50.15,16.9094,59,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,59,100,,percent of total billed charges,,
Calcium; Urine (Mayo)OutsideLaboratory,,82340,CPT,Facility,Both,,,90,59,50.15,16.9094,59,BlueCross BlueShield Minnesota,High Value Network Plan,53.1,90,,percent of total billed charges,,
Calcium; Urine (Mayo)OutsideLaboratory,,82340,CPT,Facility,Outpatient,,,90,59,50.15,16.9094,59,BlueCross BlueShield Minnesota,Medicare Advantage,28.91,49,,percent of total billed charges,,
Calcium; Urine (Mayo)OutsideLaboratory,,82340,CPT,Facility,Inpatient,,,90,59,50.15,16.9094,59,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Calcium; Urine (Mayo)OutsideLaboratory,,82340,CPT,Facility,Both,,,90,59,50.15,16.9094,59,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,52.2563,88.57,,percent of total billed charges,,
Calcium; Urine (Mayo)OutsideLaboratory,,82340,CPT,Facility,Both,,,90,59,50.15,16.9094,59,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,16.9094,28.66,,percent of total billed charges,,
Calcium; Urine (Mayo)OutsideLaboratory,,82340,CPT,Facility,Outpatient,,,90,59,50.15,16.9094,59,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),28.91,49,,percent of total billed charges,,
Calcium; Urine (Mayo)OutsideLaboratory,,82340,CPT,Facility,Inpatient,,,90,59,50.15,16.9094,59,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Calcium; Urine (Mayo)OutsideLaboratory,,82340,CPT,Facility,Both,,,90,59,50.15,16.9094,59,CorVel,Worker's Compensation,59,100,,percent of total billed charges,,
Calcium; Urine (Mayo)OutsideLaboratory,,82340,CPT,Facility,Both,,,90,59,50.15,16.9094,59,First Health Group Corporation,First Health Network,57.23,97,,percent of total billed charges,,
Calcium; Urine (Mayo)OutsideLaboratory,,82340,CPT,Facility,Both,,,90,59,50.15,16.9094,59,"Health Partners, Inc.",Commercial,55.814,94.6,,percent of total billed charges,,
Calcium; Urine (Mayo)OutsideLaboratory,,82340,CPT,Facility,Outpatient,,,90,59,50.15,16.9094,59,"Health Partners, Inc.",Medicare Advantage,28.91,49,,percent of total billed charges,,
Calcium; Urine (Mayo)OutsideLaboratory,,82340,CPT,Facility,Inpatient,,,90,59,50.15,16.9094,59,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Calcium; Urine (Mayo)OutsideLaboratory,,82340,CPT,Facility,Both,,,90,59,50.15,16.9094,59,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),35.4,60,,percent of total billed charges,,
Calcium; Urine (Mayo)OutsideLaboratory,,82340,CPT,Facility,Both,,,90,59,50.15,16.9094,59,"Health Partners, Inc.",State of Minnesota Advantage Program,48.085,81.5,,percent of total billed charges,,
Calcium; Urine (Mayo)OutsideLaboratory,,82340,CPT,Facility,Both,,,90,59,50.15,16.9094,59,"Health Partners, Inc.",State Public Programs,29.5,50,,percent of total billed charges,,
Calcium; Urine (Mayo)OutsideLaboratory,,82340,CPT,Facility,Both,,,90,59,50.15,16.9094,59,Humana Insurance Company,Commercial PPO,56.05,95,,percent of total billed charges,,
Calcium; Urine (Mayo)OutsideLaboratory,,82340,CPT,Facility,Outpatient,,,90,59,50.15,16.9094,59,Humana Insurance Company,Medicare PPO,28.91,49,,percent of total billed charges,,
Calcium; Urine (Mayo)OutsideLaboratory,,82340,CPT,Facility,Inpatient,,,90,59,50.15,16.9094,59,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Calcium; Urine (Mayo)OutsideLaboratory,,82340,CPT,Facility,Both,,,90,59,50.15,16.9094,59,Medica,Individual & Family,58.469,99.1,,percent of total billed charges,,
Calcium; Urine (Mayo)OutsideLaboratory,,82340,CPT,Facility,Outpatient,,,90,59,50.15,16.9094,59,Medica,Medica Advantage Solution,29.382,49.8,,percent of total billed charges,,
Calcium; Urine (Mayo)OutsideLaboratory,,82340,CPT,Facility,Inpatient,,,90,59,50.15,16.9094,59,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Calcium; Urine (Mayo)OutsideLaboratory,,82340,CPT,Facility,Outpatient,,,90,59,50.15,16.9094,59,Medica,Medical Assistance,26.314,44.6,,percent of total billed charges,,
Calcium; Urine (Mayo)OutsideLaboratory,,82340,CPT,Facility,Inpatient,,,90,59,50.15,16.9094,59,Medica,Medical Assistance,,,,,Included in per diem rate,
Calcium; Urine (Mayo)OutsideLaboratory,,82340,CPT,Facility,Outpatient,,,90,59,50.15,16.9094,59,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,29.382,49.8,,percent of total billed charges,,
Calcium; Urine (Mayo)OutsideLaboratory,,82340,CPT,Facility,Inpatient,,,90,59,50.15,16.9094,59,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Calcium; Urine (Mayo)OutsideLaboratory,,82340,CPT,Facility,Both,,,90,59,50.15,16.9094,59,"Multiplan, Inc.","Multiplan, Inc.",55.46,94,,percent of total billed charges,,
Calcium; Urine (Mayo)OutsideLaboratory,,82340,CPT,Facility,Outpatient,,,90,59,50.15,16.9094,59,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,50.976,86.4,,percent of total billed charges,,
Calcium; Urine (Mayo)OutsideLaboratory,,82340,CPT,Facility,Inpatient,,,90,59,50.15,16.9094,59,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Calcium; Urine (Mayo)OutsideLaboratory,,82340,CPT,Facility,Both,,,90,59,50.15,16.9094,59,"Preferred One Administrative Services, INC.",PPO,58.174,98.6,,percent of total billed charges,,
Calcium; Urine (Mayo)OutsideLaboratory,,82340,CPT,Facility,Outpatient,,,90,59,50.15,16.9094,59,PrimeWest Health,Minnesota Senior Health Options (MSHO),30.3555,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Calcium; Urine (Mayo)OutsideLaboratory,,82340,CPT,Facility,Inpatient,,,90,59,50.15,16.9094,59,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Calcium; Urine (Mayo)OutsideLaboratory,,82340,CPT,Facility,Outpatient,,,90,59,50.15,16.9094,59,PrimeWest Health,MinnesotaCare,30.3024,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Calcium; Urine (Mayo)OutsideLaboratory,,82340,CPT,Facility,Inpatient,,,90,59,50.15,16.9094,59,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Calcium; Urine (Mayo)OutsideLaboratory,,82340,CPT,Facility,Both,,,90,59,50.15,16.9094,59,Sanford Health Plan,Sanford Health Plan,54.28,92,,percent of total billed charges,,
Calcium; Urine (Mayo)OutsideLaboratory,,82340,CPT,Facility,Outpatient,,,90,59,50.15,16.9094,59,"UCare Health, Inc.",Individual & Family Plan,33.2465,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Calcium; Urine (Mayo)OutsideLaboratory,,82340,CPT,Facility,Inpatient,,,90,59,50.15,16.9094,59,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Calcium; Urine (Mayo)OutsideLaboratory,,82340,CPT,Facility,Outpatient,,,90,59,50.15,16.9094,59,"UCare Health, Inc.",Medical Assistance,29.7773,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Calcium; Urine (Mayo)OutsideLaboratory,,82340,CPT,Facility,Inpatient,,,90,59,50.15,16.9094,59,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Calcium; Urine (Mayo)OutsideLaboratory,,82340,CPT,Facility,Outpatient,,,90,59,50.15,16.9094,59,"UCare Health, Inc.",Medicare Advantage,29.7773,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Calcium; Urine (Mayo)OutsideLaboratory,,82340,CPT,Facility,Inpatient,,,90,59,50.15,16.9094,59,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Calcium; Urine (Mayo)OutsideLaboratory,,82340,CPT,Facility,Outpatient,,,90,59,50.15,16.9094,59,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),29.7773,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Calcium; Urine (Mayo)OutsideLaboratory,,82340,CPT,Facility,Inpatient,,,90,59,50.15,16.9094,59,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Calcium; Urine (Mayo)OutsideLaboratory,,82340,CPT,Facility,Both,,,90,59,50.15,16.9094,59,UnitedHealthcare,Individual & Family,55.46,94,,percent of total billed charges,,
Calcium; Urine (Mayo)OutsideLaboratory,,82340,CPT,Facility,Outpatient,,,90,59,50.15,16.9094,59,UnitedHealthcare,Medicare Advantage,28.91,49,,percent of total billed charges,,
Calcium; Urine (Mayo)OutsideLaboratory,,82340,CPT,Facility,Inpatient,,,90,59,50.15,16.9094,59,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Calcium; Urine (Mayo)OutsideLaboratory,,82340,CPT,Facility,Outpatient,,,90,59,50.15,16.9094,59,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,28.32,48,,percent of total billed charges,,100% of DHS outpatient percentage
Calcium; Urine (Mayo)OutsideLaboratory,,82340,CPT,Facility,Inpatient,,,90,59,50.15,16.9094,59,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Kidney Stone Analysis (Mayo)OutsideLaboratory,,82365,CPT,Facility,Both,,,90,88,74.8,25.2208,88,Aetna,Commercial,80.96,92,,percent of total billed charges,,
Kidney Stone Analysis (Mayo)OutsideLaboratory,,82365,CPT,Facility,Outpatient,,,90,88,74.8,25.2208,88,Aetna,Medicare Advantage,43.12,49,,percent of total billed charges,,
Kidney Stone Analysis (Mayo)OutsideLaboratory,,82365,CPT,Facility,Inpatient,,,90,88,74.8,25.2208,88,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Kidney Stone Analysis (Mayo)OutsideLaboratory,,82365,CPT,Facility,Both,,,90,88,74.8,25.2208,88,Aetna,PPO,81.84,93,,percent of total billed charges,,
Kidney Stone Analysis (Mayo)OutsideLaboratory,,82365,CPT,Facility,Both,,,90,88,74.8,25.2208,88,America's PPO,America's PPO,84.5064,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Kidney Stone Analysis (Mayo)OutsideLaboratory,,82365,CPT,Facility,Both,,,90,88,74.8,25.2208,88,BlueCross BlueShield Minnesota, Federal Employee Program,86.592,98.4,,percent of total billed charges,,
Kidney Stone Analysis (Mayo)OutsideLaboratory,,82365,CPT,Facility,Both,,,90,88,74.8,25.2208,88,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,88,100,,percent of total billed charges,,
Kidney Stone Analysis (Mayo)OutsideLaboratory,,82365,CPT,Facility,Both,,,90,88,74.8,25.2208,88,BlueCross BlueShield Minnesota,High Value Network Plan,79.2,90,,percent of total billed charges,,
Kidney Stone Analysis (Mayo)OutsideLaboratory,,82365,CPT,Facility,Outpatient,,,90,88,74.8,25.2208,88,BlueCross BlueShield Minnesota,Medicare Advantage,43.12,49,,percent of total billed charges,,
Kidney Stone Analysis (Mayo)OutsideLaboratory,,82365,CPT,Facility,Inpatient,,,90,88,74.8,25.2208,88,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Kidney Stone Analysis (Mayo)OutsideLaboratory,,82365,CPT,Facility,Both,,,90,88,74.8,25.2208,88,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,77.9416,88.57,,percent of total billed charges,,
Kidney Stone Analysis (Mayo)OutsideLaboratory,,82365,CPT,Facility,Both,,,90,88,74.8,25.2208,88,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,25.2208,28.66,,percent of total billed charges,,
Kidney Stone Analysis (Mayo)OutsideLaboratory,,82365,CPT,Facility,Outpatient,,,90,88,74.8,25.2208,88,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),43.12,49,,percent of total billed charges,,
Kidney Stone Analysis (Mayo)OutsideLaboratory,,82365,CPT,Facility,Inpatient,,,90,88,74.8,25.2208,88,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Kidney Stone Analysis (Mayo)OutsideLaboratory,,82365,CPT,Facility,Both,,,90,88,74.8,25.2208,88,CorVel,Worker's Compensation,88,100,,percent of total billed charges,,
Kidney Stone Analysis (Mayo)OutsideLaboratory,,82365,CPT,Facility,Both,,,90,88,74.8,25.2208,88,First Health Group Corporation,First Health Network,85.36,97,,percent of total billed charges,,
Kidney Stone Analysis (Mayo)OutsideLaboratory,,82365,CPT,Facility,Both,,,90,88,74.8,25.2208,88,"Health Partners, Inc.",Commercial,83.248,94.6,,percent of total billed charges,,
Kidney Stone Analysis (Mayo)OutsideLaboratory,,82365,CPT,Facility,Outpatient,,,90,88,74.8,25.2208,88,"Health Partners, Inc.",Medicare Advantage,43.12,49,,percent of total billed charges,,
Kidney Stone Analysis (Mayo)OutsideLaboratory,,82365,CPT,Facility,Inpatient,,,90,88,74.8,25.2208,88,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Kidney Stone Analysis (Mayo)OutsideLaboratory,,82365,CPT,Facility,Both,,,90,88,74.8,25.2208,88,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),52.8,60,,percent of total billed charges,,
Kidney Stone Analysis (Mayo)OutsideLaboratory,,82365,CPT,Facility,Both,,,90,88,74.8,25.2208,88,"Health Partners, Inc.",State of Minnesota Advantage Program,71.72,81.5,,percent of total billed charges,,
Kidney Stone Analysis (Mayo)OutsideLaboratory,,82365,CPT,Facility,Both,,,90,88,74.8,25.2208,88,"Health Partners, Inc.",State Public Programs,44,50,,percent of total billed charges,,
Kidney Stone Analysis (Mayo)OutsideLaboratory,,82365,CPT,Facility,Both,,,90,88,74.8,25.2208,88,Humana Insurance Company,Commercial PPO,83.6,95,,percent of total billed charges,,
Kidney Stone Analysis (Mayo)OutsideLaboratory,,82365,CPT,Facility,Outpatient,,,90,88,74.8,25.2208,88,Humana Insurance Company,Medicare PPO,43.12,49,,percent of total billed charges,,
Kidney Stone Analysis (Mayo)OutsideLaboratory,,82365,CPT,Facility,Inpatient,,,90,88,74.8,25.2208,88,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Kidney Stone Analysis (Mayo)OutsideLaboratory,,82365,CPT,Facility,Both,,,90,88,74.8,25.2208,88,Medica,Individual & Family,87.208,99.1,,percent of total billed charges,,
Kidney Stone Analysis (Mayo)OutsideLaboratory,,82365,CPT,Facility,Outpatient,,,90,88,74.8,25.2208,88,Medica,Medica Advantage Solution,43.824,49.8,,percent of total billed charges,,
Kidney Stone Analysis (Mayo)OutsideLaboratory,,82365,CPT,Facility,Inpatient,,,90,88,74.8,25.2208,88,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Kidney Stone Analysis (Mayo)OutsideLaboratory,,82365,CPT,Facility,Outpatient,,,90,88,74.8,25.2208,88,Medica,Medical Assistance,39.248,44.6,,percent of total billed charges,,
Kidney Stone Analysis (Mayo)OutsideLaboratory,,82365,CPT,Facility,Inpatient,,,90,88,74.8,25.2208,88,Medica,Medical Assistance,,,,,Included in per diem rate,
Kidney Stone Analysis (Mayo)OutsideLaboratory,,82365,CPT,Facility,Outpatient,,,90,88,74.8,25.2208,88,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,43.824,49.8,,percent of total billed charges,,
Kidney Stone Analysis (Mayo)OutsideLaboratory,,82365,CPT,Facility,Inpatient,,,90,88,74.8,25.2208,88,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Kidney Stone Analysis (Mayo)OutsideLaboratory,,82365,CPT,Facility,Both,,,90,88,74.8,25.2208,88,"Multiplan, Inc.","Multiplan, Inc.",82.72,94,,percent of total billed charges,,
Kidney Stone Analysis (Mayo)OutsideLaboratory,,82365,CPT,Facility,Outpatient,,,90,88,74.8,25.2208,88,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,76.032,86.4,,percent of total billed charges,,
Kidney Stone Analysis (Mayo)OutsideLaboratory,,82365,CPT,Facility,Inpatient,,,90,88,74.8,25.2208,88,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Kidney Stone Analysis (Mayo)OutsideLaboratory,,82365,CPT,Facility,Both,,,90,88,74.8,25.2208,88,"Preferred One Administrative Services, INC.",PPO,86.768,98.6,,percent of total billed charges,,
Kidney Stone Analysis (Mayo)OutsideLaboratory,,82365,CPT,Facility,Outpatient,,,90,88,74.8,25.2208,88,PrimeWest Health,Minnesota Senior Health Options (MSHO),45.276,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Kidney Stone Analysis (Mayo)OutsideLaboratory,,82365,CPT,Facility,Inpatient,,,90,88,74.8,25.2208,88,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Kidney Stone Analysis (Mayo)OutsideLaboratory,,82365,CPT,Facility,Outpatient,,,90,88,74.8,25.2208,88,PrimeWest Health,MinnesotaCare,45.1968,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Kidney Stone Analysis (Mayo)OutsideLaboratory,,82365,CPT,Facility,Inpatient,,,90,88,74.8,25.2208,88,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Kidney Stone Analysis (Mayo)OutsideLaboratory,,82365,CPT,Facility,Both,,,90,88,74.8,25.2208,88,Sanford Health Plan,Sanford Health Plan,80.96,92,,percent of total billed charges,,
Kidney Stone Analysis (Mayo)OutsideLaboratory,,82365,CPT,Facility,Outpatient,,,90,88,74.8,25.2208,88,"UCare Health, Inc.",Individual & Family Plan,49.588,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Kidney Stone Analysis (Mayo)OutsideLaboratory,,82365,CPT,Facility,Inpatient,,,90,88,74.8,25.2208,88,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Kidney Stone Analysis (Mayo)OutsideLaboratory,,82365,CPT,Facility,Outpatient,,,90,88,74.8,25.2208,88,"UCare Health, Inc.",Medical Assistance,44.4136,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Kidney Stone Analysis (Mayo)OutsideLaboratory,,82365,CPT,Facility,Inpatient,,,90,88,74.8,25.2208,88,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Kidney Stone Analysis (Mayo)OutsideLaboratory,,82365,CPT,Facility,Outpatient,,,90,88,74.8,25.2208,88,"UCare Health, Inc.",Medicare Advantage,44.4136,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Kidney Stone Analysis (Mayo)OutsideLaboratory,,82365,CPT,Facility,Inpatient,,,90,88,74.8,25.2208,88,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Kidney Stone Analysis (Mayo)OutsideLaboratory,,82365,CPT,Facility,Outpatient,,,90,88,74.8,25.2208,88,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),44.4136,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Kidney Stone Analysis (Mayo)OutsideLaboratory,,82365,CPT,Facility,Inpatient,,,90,88,74.8,25.2208,88,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Kidney Stone Analysis (Mayo)OutsideLaboratory,,82365,CPT,Facility,Both,,,90,88,74.8,25.2208,88,UnitedHealthcare,Individual & Family,82.72,94,,percent of total billed charges,,
Kidney Stone Analysis (Mayo)OutsideLaboratory,,82365,CPT,Facility,Outpatient,,,90,88,74.8,25.2208,88,UnitedHealthcare,Medicare Advantage,43.12,49,,percent of total billed charges,,
Kidney Stone Analysis (Mayo)OutsideLaboratory,,82365,CPT,Facility,Inpatient,,,90,88,74.8,25.2208,88,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Kidney Stone Analysis (Mayo)OutsideLaboratory,,82365,CPT,Facility,Outpatient,,,90,88,74.8,25.2208,88,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,42.24,48,,percent of total billed charges,,100% of DHS outpatient percentage
Kidney Stone Analysis (Mayo)OutsideLaboratory,,82365,CPT,Facility,Inpatient,,,90,88,74.8,25.2208,88,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Carnitine, P (Mayo)OutsideLaboratory",,82379,CPT,Facility,Both,,,90,186,158.1,53.3076,186,Aetna,Commercial,171.12,92,,percent of total billed charges,,
"Carnitine, P (Mayo)OutsideLaboratory",,82379,CPT,Facility,Outpatient,,,90,186,158.1,53.3076,186,Aetna,Medicare Advantage,91.14,49,,percent of total billed charges,,
"Carnitine, P (Mayo)OutsideLaboratory",,82379,CPT,Facility,Inpatient,,,90,186,158.1,53.3076,186,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Carnitine, P (Mayo)OutsideLaboratory",,82379,CPT,Facility,Both,,,90,186,158.1,53.3076,186,Aetna,PPO,172.98,93,,percent of total billed charges,,
"Carnitine, P (Mayo)OutsideLaboratory",,82379,CPT,Facility,Both,,,90,186,158.1,53.3076,186,America's PPO,America's PPO,178.6158,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Carnitine, P (Mayo)OutsideLaboratory",,82379,CPT,Facility,Both,,,90,186,158.1,53.3076,186,BlueCross BlueShield Minnesota, Federal Employee Program,183.024,98.4,,percent of total billed charges,,
"Carnitine, P (Mayo)OutsideLaboratory",,82379,CPT,Facility,Both,,,90,186,158.1,53.3076,186,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,186,100,,percent of total billed charges,,
"Carnitine, P (Mayo)OutsideLaboratory",,82379,CPT,Facility,Both,,,90,186,158.1,53.3076,186,BlueCross BlueShield Minnesota,High Value Network Plan,167.4,90,,percent of total billed charges,,
"Carnitine, P (Mayo)OutsideLaboratory",,82379,CPT,Facility,Outpatient,,,90,186,158.1,53.3076,186,BlueCross BlueShield Minnesota,Medicare Advantage,91.14,49,,percent of total billed charges,,
"Carnitine, P (Mayo)OutsideLaboratory",,82379,CPT,Facility,Inpatient,,,90,186,158.1,53.3076,186,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Carnitine, P (Mayo)OutsideLaboratory",,82379,CPT,Facility,Both,,,90,186,158.1,53.3076,186,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,164.7402,88.57,,percent of total billed charges,,
"Carnitine, P (Mayo)OutsideLaboratory",,82379,CPT,Facility,Both,,,90,186,158.1,53.3076,186,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,53.3076,28.66,,percent of total billed charges,,
"Carnitine, P (Mayo)OutsideLaboratory",,82379,CPT,Facility,Outpatient,,,90,186,158.1,53.3076,186,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),91.14,49,,percent of total billed charges,,
"Carnitine, P (Mayo)OutsideLaboratory",,82379,CPT,Facility,Inpatient,,,90,186,158.1,53.3076,186,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Carnitine, P (Mayo)OutsideLaboratory",,82379,CPT,Facility,Both,,,90,186,158.1,53.3076,186,CorVel,Worker's Compensation,186,100,,percent of total billed charges,,
"Carnitine, P (Mayo)OutsideLaboratory",,82379,CPT,Facility,Both,,,90,186,158.1,53.3076,186,First Health Group Corporation,First Health Network,180.42,97,,percent of total billed charges,,
"Carnitine, P (Mayo)OutsideLaboratory",,82379,CPT,Facility,Both,,,90,186,158.1,53.3076,186,"Health Partners, Inc.",Commercial,175.956,94.6,,percent of total billed charges,,
"Carnitine, P (Mayo)OutsideLaboratory",,82379,CPT,Facility,Outpatient,,,90,186,158.1,53.3076,186,"Health Partners, Inc.",Medicare Advantage,91.14,49,,percent of total billed charges,,
"Carnitine, P (Mayo)OutsideLaboratory",,82379,CPT,Facility,Inpatient,,,90,186,158.1,53.3076,186,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Carnitine, P (Mayo)OutsideLaboratory",,82379,CPT,Facility,Both,,,90,186,158.1,53.3076,186,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),111.6,60,,percent of total billed charges,,
"Carnitine, P (Mayo)OutsideLaboratory",,82379,CPT,Facility,Both,,,90,186,158.1,53.3076,186,"Health Partners, Inc.",State of Minnesota Advantage Program,151.59,81.5,,percent of total billed charges,,
"Carnitine, P (Mayo)OutsideLaboratory",,82379,CPT,Facility,Both,,,90,186,158.1,53.3076,186,"Health Partners, Inc.",State Public Programs,93,50,,percent of total billed charges,,
"Carnitine, P (Mayo)OutsideLaboratory",,82379,CPT,Facility,Both,,,90,186,158.1,53.3076,186,Humana Insurance Company,Commercial PPO,176.7,95,,percent of total billed charges,,
"Carnitine, P (Mayo)OutsideLaboratory",,82379,CPT,Facility,Outpatient,,,90,186,158.1,53.3076,186,Humana Insurance Company,Medicare PPO,91.14,49,,percent of total billed charges,,
"Carnitine, P (Mayo)OutsideLaboratory",,82379,CPT,Facility,Inpatient,,,90,186,158.1,53.3076,186,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Carnitine, P (Mayo)OutsideLaboratory",,82379,CPT,Facility,Both,,,90,186,158.1,53.3076,186,Medica,Individual & Family,184.326,99.1,,percent of total billed charges,,
"Carnitine, P (Mayo)OutsideLaboratory",,82379,CPT,Facility,Outpatient,,,90,186,158.1,53.3076,186,Medica,Medica Advantage Solution,92.628,49.8,,percent of total billed charges,,
"Carnitine, P (Mayo)OutsideLaboratory",,82379,CPT,Facility,Inpatient,,,90,186,158.1,53.3076,186,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Carnitine, P (Mayo)OutsideLaboratory",,82379,CPT,Facility,Outpatient,,,90,186,158.1,53.3076,186,Medica,Medical Assistance,82.956,44.6,,percent of total billed charges,,
"Carnitine, P (Mayo)OutsideLaboratory",,82379,CPT,Facility,Inpatient,,,90,186,158.1,53.3076,186,Medica,Medical Assistance,,,,,Included in per diem rate,
"Carnitine, P (Mayo)OutsideLaboratory",,82379,CPT,Facility,Outpatient,,,90,186,158.1,53.3076,186,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,92.628,49.8,,percent of total billed charges,,
"Carnitine, P (Mayo)OutsideLaboratory",,82379,CPT,Facility,Inpatient,,,90,186,158.1,53.3076,186,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Carnitine, P (Mayo)OutsideLaboratory",,82379,CPT,Facility,Both,,,90,186,158.1,53.3076,186,"Multiplan, Inc.","Multiplan, Inc.",174.84,94,,percent of total billed charges,,
"Carnitine, P (Mayo)OutsideLaboratory",,82379,CPT,Facility,Outpatient,,,90,186,158.1,53.3076,186,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,160.704,86.4,,percent of total billed charges,,
"Carnitine, P (Mayo)OutsideLaboratory",,82379,CPT,Facility,Inpatient,,,90,186,158.1,53.3076,186,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Carnitine, P (Mayo)OutsideLaboratory",,82379,CPT,Facility,Both,,,90,186,158.1,53.3076,186,"Preferred One Administrative Services, INC.",PPO,183.396,98.6,,percent of total billed charges,,
"Carnitine, P (Mayo)OutsideLaboratory",,82379,CPT,Facility,Outpatient,,,90,186,158.1,53.3076,186,PrimeWest Health,Minnesota Senior Health Options (MSHO),95.697,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Carnitine, P (Mayo)OutsideLaboratory",,82379,CPT,Facility,Inpatient,,,90,186,158.1,53.3076,186,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Carnitine, P (Mayo)OutsideLaboratory",,82379,CPT,Facility,Outpatient,,,90,186,158.1,53.3076,186,PrimeWest Health,MinnesotaCare,95.5296,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Carnitine, P (Mayo)OutsideLaboratory",,82379,CPT,Facility,Inpatient,,,90,186,158.1,53.3076,186,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Carnitine, P (Mayo)OutsideLaboratory",,82379,CPT,Facility,Both,,,90,186,158.1,53.3076,186,Sanford Health Plan,Sanford Health Plan,171.12,92,,percent of total billed charges,,
"Carnitine, P (Mayo)OutsideLaboratory",,82379,CPT,Facility,Outpatient,,,90,186,158.1,53.3076,186,"UCare Health, Inc.",Individual & Family Plan,104.811,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Carnitine, P (Mayo)OutsideLaboratory",,82379,CPT,Facility,Inpatient,,,90,186,158.1,53.3076,186,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Carnitine, P (Mayo)OutsideLaboratory",,82379,CPT,Facility,Outpatient,,,90,186,158.1,53.3076,186,"UCare Health, Inc.",Medical Assistance,93.8742,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Carnitine, P (Mayo)OutsideLaboratory",,82379,CPT,Facility,Inpatient,,,90,186,158.1,53.3076,186,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Carnitine, P (Mayo)OutsideLaboratory",,82379,CPT,Facility,Outpatient,,,90,186,158.1,53.3076,186,"UCare Health, Inc.",Medicare Advantage,93.8742,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Carnitine, P (Mayo)OutsideLaboratory",,82379,CPT,Facility,Inpatient,,,90,186,158.1,53.3076,186,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Carnitine, P (Mayo)OutsideLaboratory",,82379,CPT,Facility,Outpatient,,,90,186,158.1,53.3076,186,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),93.8742,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Carnitine, P (Mayo)OutsideLaboratory",,82379,CPT,Facility,Inpatient,,,90,186,158.1,53.3076,186,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Carnitine, P (Mayo)OutsideLaboratory",,82379,CPT,Facility,Both,,,90,186,158.1,53.3076,186,UnitedHealthcare,Individual & Family,174.84,94,,percent of total billed charges,,
"Carnitine, P (Mayo)OutsideLaboratory",,82379,CPT,Facility,Outpatient,,,90,186,158.1,53.3076,186,UnitedHealthcare,Medicare Advantage,91.14,49,,percent of total billed charges,,
"Carnitine, P (Mayo)OutsideLaboratory",,82379,CPT,Facility,Inpatient,,,90,186,158.1,53.3076,186,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Carnitine, P (Mayo)OutsideLaboratory",,82379,CPT,Facility,Outpatient,,,90,186,158.1,53.3076,186,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,89.28,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Carnitine, P (Mayo)OutsideLaboratory",,82379,CPT,Facility,Inpatient,,,90,186,158.1,53.3076,186,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Carnitine, S (Mayo)OutsideLaboratory",,82379,CPT,Facility,Both,,,90,186,158.1,53.3076,186,Aetna,Commercial,171.12,92,,percent of total billed charges,,
"Carnitine, S (Mayo)OutsideLaboratory",,82379,CPT,Facility,Outpatient,,,90,186,158.1,53.3076,186,Aetna,Medicare Advantage,91.14,49,,percent of total billed charges,,
"Carnitine, S (Mayo)OutsideLaboratory",,82379,CPT,Facility,Inpatient,,,90,186,158.1,53.3076,186,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Carnitine, S (Mayo)OutsideLaboratory",,82379,CPT,Facility,Both,,,90,186,158.1,53.3076,186,Aetna,PPO,172.98,93,,percent of total billed charges,,
"Carnitine, S (Mayo)OutsideLaboratory",,82379,CPT,Facility,Both,,,90,186,158.1,53.3076,186,America's PPO,America's PPO,178.6158,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Carnitine, S (Mayo)OutsideLaboratory",,82379,CPT,Facility,Both,,,90,186,158.1,53.3076,186,BlueCross BlueShield Minnesota, Federal Employee Program,183.024,98.4,,percent of total billed charges,,
"Carnitine, S (Mayo)OutsideLaboratory",,82379,CPT,Facility,Both,,,90,186,158.1,53.3076,186,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,186,100,,percent of total billed charges,,
"Carnitine, S (Mayo)OutsideLaboratory",,82379,CPT,Facility,Both,,,90,186,158.1,53.3076,186,BlueCross BlueShield Minnesota,High Value Network Plan,167.4,90,,percent of total billed charges,,
"Carnitine, S (Mayo)OutsideLaboratory",,82379,CPT,Facility,Outpatient,,,90,186,158.1,53.3076,186,BlueCross BlueShield Minnesota,Medicare Advantage,91.14,49,,percent of total billed charges,,
"Carnitine, S (Mayo)OutsideLaboratory",,82379,CPT,Facility,Inpatient,,,90,186,158.1,53.3076,186,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Carnitine, S (Mayo)OutsideLaboratory",,82379,CPT,Facility,Both,,,90,186,158.1,53.3076,186,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,164.7402,88.57,,percent of total billed charges,,
"Carnitine, S (Mayo)OutsideLaboratory",,82379,CPT,Facility,Both,,,90,186,158.1,53.3076,186,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,53.3076,28.66,,percent of total billed charges,,
"Carnitine, S (Mayo)OutsideLaboratory",,82379,CPT,Facility,Outpatient,,,90,186,158.1,53.3076,186,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),91.14,49,,percent of total billed charges,,
"Carnitine, S (Mayo)OutsideLaboratory",,82379,CPT,Facility,Inpatient,,,90,186,158.1,53.3076,186,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Carnitine, S (Mayo)OutsideLaboratory",,82379,CPT,Facility,Both,,,90,186,158.1,53.3076,186,CorVel,Worker's Compensation,186,100,,percent of total billed charges,,
"Carnitine, S (Mayo)OutsideLaboratory",,82379,CPT,Facility,Both,,,90,186,158.1,53.3076,186,First Health Group Corporation,First Health Network,180.42,97,,percent of total billed charges,,
"Carnitine, S (Mayo)OutsideLaboratory",,82379,CPT,Facility,Both,,,90,186,158.1,53.3076,186,"Health Partners, Inc.",Commercial,175.956,94.6,,percent of total billed charges,,
"Carnitine, S (Mayo)OutsideLaboratory",,82379,CPT,Facility,Outpatient,,,90,186,158.1,53.3076,186,"Health Partners, Inc.",Medicare Advantage,91.14,49,,percent of total billed charges,,
"Carnitine, S (Mayo)OutsideLaboratory",,82379,CPT,Facility,Inpatient,,,90,186,158.1,53.3076,186,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Carnitine, S (Mayo)OutsideLaboratory",,82379,CPT,Facility,Both,,,90,186,158.1,53.3076,186,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),111.6,60,,percent of total billed charges,,
"Carnitine, S (Mayo)OutsideLaboratory",,82379,CPT,Facility,Both,,,90,186,158.1,53.3076,186,"Health Partners, Inc.",State of Minnesota Advantage Program,151.59,81.5,,percent of total billed charges,,
"Carnitine, S (Mayo)OutsideLaboratory",,82379,CPT,Facility,Both,,,90,186,158.1,53.3076,186,"Health Partners, Inc.",State Public Programs,93,50,,percent of total billed charges,,
"Carnitine, S (Mayo)OutsideLaboratory",,82379,CPT,Facility,Both,,,90,186,158.1,53.3076,186,Humana Insurance Company,Commercial PPO,176.7,95,,percent of total billed charges,,
"Carnitine, S (Mayo)OutsideLaboratory",,82379,CPT,Facility,Outpatient,,,90,186,158.1,53.3076,186,Humana Insurance Company,Medicare PPO,91.14,49,,percent of total billed charges,,
"Carnitine, S (Mayo)OutsideLaboratory",,82379,CPT,Facility,Inpatient,,,90,186,158.1,53.3076,186,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Carnitine, S (Mayo)OutsideLaboratory",,82379,CPT,Facility,Both,,,90,186,158.1,53.3076,186,Medica,Individual & Family,184.326,99.1,,percent of total billed charges,,
"Carnitine, S (Mayo)OutsideLaboratory",,82379,CPT,Facility,Outpatient,,,90,186,158.1,53.3076,186,Medica,Medica Advantage Solution,92.628,49.8,,percent of total billed charges,,
"Carnitine, S (Mayo)OutsideLaboratory",,82379,CPT,Facility,Inpatient,,,90,186,158.1,53.3076,186,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Carnitine, S (Mayo)OutsideLaboratory",,82379,CPT,Facility,Outpatient,,,90,186,158.1,53.3076,186,Medica,Medical Assistance,82.956,44.6,,percent of total billed charges,,
"Carnitine, S (Mayo)OutsideLaboratory",,82379,CPT,Facility,Inpatient,,,90,186,158.1,53.3076,186,Medica,Medical Assistance,,,,,Included in per diem rate,
"Carnitine, S (Mayo)OutsideLaboratory",,82379,CPT,Facility,Outpatient,,,90,186,158.1,53.3076,186,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,92.628,49.8,,percent of total billed charges,,
"Carnitine, S (Mayo)OutsideLaboratory",,82379,CPT,Facility,Inpatient,,,90,186,158.1,53.3076,186,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Carnitine, S (Mayo)OutsideLaboratory",,82379,CPT,Facility,Both,,,90,186,158.1,53.3076,186,"Multiplan, Inc.","Multiplan, Inc.",174.84,94,,percent of total billed charges,,
"Carnitine, S (Mayo)OutsideLaboratory",,82379,CPT,Facility,Outpatient,,,90,186,158.1,53.3076,186,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,160.704,86.4,,percent of total billed charges,,
"Carnitine, S (Mayo)OutsideLaboratory",,82379,CPT,Facility,Inpatient,,,90,186,158.1,53.3076,186,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Carnitine, S (Mayo)OutsideLaboratory",,82379,CPT,Facility,Both,,,90,186,158.1,53.3076,186,"Preferred One Administrative Services, INC.",PPO,183.396,98.6,,percent of total billed charges,,
"Carnitine, S (Mayo)OutsideLaboratory",,82379,CPT,Facility,Outpatient,,,90,186,158.1,53.3076,186,PrimeWest Health,Minnesota Senior Health Options (MSHO),95.697,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Carnitine, S (Mayo)OutsideLaboratory",,82379,CPT,Facility,Inpatient,,,90,186,158.1,53.3076,186,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Carnitine, S (Mayo)OutsideLaboratory",,82379,CPT,Facility,Outpatient,,,90,186,158.1,53.3076,186,PrimeWest Health,MinnesotaCare,95.5296,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Carnitine, S (Mayo)OutsideLaboratory",,82379,CPT,Facility,Inpatient,,,90,186,158.1,53.3076,186,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Carnitine, S (Mayo)OutsideLaboratory",,82379,CPT,Facility,Both,,,90,186,158.1,53.3076,186,Sanford Health Plan,Sanford Health Plan,171.12,92,,percent of total billed charges,,
"Carnitine, S (Mayo)OutsideLaboratory",,82379,CPT,Facility,Outpatient,,,90,186,158.1,53.3076,186,"UCare Health, Inc.",Individual & Family Plan,104.811,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Carnitine, S (Mayo)OutsideLaboratory",,82379,CPT,Facility,Inpatient,,,90,186,158.1,53.3076,186,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Carnitine, S (Mayo)OutsideLaboratory",,82379,CPT,Facility,Outpatient,,,90,186,158.1,53.3076,186,"UCare Health, Inc.",Medical Assistance,93.8742,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Carnitine, S (Mayo)OutsideLaboratory",,82379,CPT,Facility,Inpatient,,,90,186,158.1,53.3076,186,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Carnitine, S (Mayo)OutsideLaboratory",,82379,CPT,Facility,Outpatient,,,90,186,158.1,53.3076,186,"UCare Health, Inc.",Medicare Advantage,93.8742,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Carnitine, S (Mayo)OutsideLaboratory",,82379,CPT,Facility,Inpatient,,,90,186,158.1,53.3076,186,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Carnitine, S (Mayo)OutsideLaboratory",,82379,CPT,Facility,Outpatient,,,90,186,158.1,53.3076,186,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),93.8742,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Carnitine, S (Mayo)OutsideLaboratory",,82379,CPT,Facility,Inpatient,,,90,186,158.1,53.3076,186,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Carnitine, S (Mayo)OutsideLaboratory",,82379,CPT,Facility,Both,,,90,186,158.1,53.3076,186,UnitedHealthcare,Individual & Family,174.84,94,,percent of total billed charges,,
"Carnitine, S (Mayo)OutsideLaboratory",,82379,CPT,Facility,Outpatient,,,90,186,158.1,53.3076,186,UnitedHealthcare,Medicare Advantage,91.14,49,,percent of total billed charges,,
"Carnitine, S (Mayo)OutsideLaboratory",,82379,CPT,Facility,Inpatient,,,90,186,158.1,53.3076,186,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Carnitine, S (Mayo)OutsideLaboratory",,82379,CPT,Facility,Outpatient,,,90,186,158.1,53.3076,186,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,89.28,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Carnitine, S (Mayo)OutsideLaboratory",,82379,CPT,Facility,Inpatient,,,90,186,158.1,53.3076,186,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Catecholamine Fract, Free, P (Mayo)OutsideLaboratory",,82384,CPT,Facility,Both,,,90,104,88.4,29.8064,104,Aetna,Commercial,95.68,92,,percent of total billed charges,,
"Catecholamine Fract, Free, P (Mayo)OutsideLaboratory",,82384,CPT,Facility,Outpatient,,,90,104,88.4,29.8064,104,Aetna,Medicare Advantage,50.96,49,,percent of total billed charges,,
"Catecholamine Fract, Free, P (Mayo)OutsideLaboratory",,82384,CPT,Facility,Inpatient,,,90,104,88.4,29.8064,104,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Catecholamine Fract, Free, P (Mayo)OutsideLaboratory",,82384,CPT,Facility,Both,,,90,104,88.4,29.8064,104,Aetna,PPO,96.72,93,,percent of total billed charges,,
"Catecholamine Fract, Free, P (Mayo)OutsideLaboratory",,82384,CPT,Facility,Both,,,90,104,88.4,29.8064,104,America's PPO,America's PPO,99.8712,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Catecholamine Fract, Free, P (Mayo)OutsideLaboratory",,82384,CPT,Facility,Both,,,90,104,88.4,29.8064,104,BlueCross BlueShield Minnesota, Federal Employee Program,102.336,98.4,,percent of total billed charges,,
"Catecholamine Fract, Free, P (Mayo)OutsideLaboratory",,82384,CPT,Facility,Both,,,90,104,88.4,29.8064,104,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,104,100,,percent of total billed charges,,
"Catecholamine Fract, Free, P (Mayo)OutsideLaboratory",,82384,CPT,Facility,Both,,,90,104,88.4,29.8064,104,BlueCross BlueShield Minnesota,High Value Network Plan,93.6,90,,percent of total billed charges,,
"Catecholamine Fract, Free, P (Mayo)OutsideLaboratory",,82384,CPT,Facility,Outpatient,,,90,104,88.4,29.8064,104,BlueCross BlueShield Minnesota,Medicare Advantage,50.96,49,,percent of total billed charges,,
"Catecholamine Fract, Free, P (Mayo)OutsideLaboratory",,82384,CPT,Facility,Inpatient,,,90,104,88.4,29.8064,104,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Catecholamine Fract, Free, P (Mayo)OutsideLaboratory",,82384,CPT,Facility,Both,,,90,104,88.4,29.8064,104,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,92.1128,88.57,,percent of total billed charges,,
"Catecholamine Fract, Free, P (Mayo)OutsideLaboratory",,82384,CPT,Facility,Both,,,90,104,88.4,29.8064,104,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,29.8064,28.66,,percent of total billed charges,,
"Catecholamine Fract, Free, P (Mayo)OutsideLaboratory",,82384,CPT,Facility,Outpatient,,,90,104,88.4,29.8064,104,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),50.96,49,,percent of total billed charges,,
"Catecholamine Fract, Free, P (Mayo)OutsideLaboratory",,82384,CPT,Facility,Inpatient,,,90,104,88.4,29.8064,104,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Catecholamine Fract, Free, P (Mayo)OutsideLaboratory",,82384,CPT,Facility,Both,,,90,104,88.4,29.8064,104,CorVel,Worker's Compensation,104,100,,percent of total billed charges,,
"Catecholamine Fract, Free, P (Mayo)OutsideLaboratory",,82384,CPT,Facility,Both,,,90,104,88.4,29.8064,104,First Health Group Corporation,First Health Network,100.88,97,,percent of total billed charges,,
"Catecholamine Fract, Free, P (Mayo)OutsideLaboratory",,82384,CPT,Facility,Both,,,90,104,88.4,29.8064,104,"Health Partners, Inc.",Commercial,98.384,94.6,,percent of total billed charges,,
"Catecholamine Fract, Free, P (Mayo)OutsideLaboratory",,82384,CPT,Facility,Outpatient,,,90,104,88.4,29.8064,104,"Health Partners, Inc.",Medicare Advantage,50.96,49,,percent of total billed charges,,
"Catecholamine Fract, Free, P (Mayo)OutsideLaboratory",,82384,CPT,Facility,Inpatient,,,90,104,88.4,29.8064,104,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Catecholamine Fract, Free, P (Mayo)OutsideLaboratory",,82384,CPT,Facility,Both,,,90,104,88.4,29.8064,104,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),62.4,60,,percent of total billed charges,,
"Catecholamine Fract, Free, P (Mayo)OutsideLaboratory",,82384,CPT,Facility,Both,,,90,104,88.4,29.8064,104,"Health Partners, Inc.",State of Minnesota Advantage Program,84.76,81.5,,percent of total billed charges,,
"Catecholamine Fract, Free, P (Mayo)OutsideLaboratory",,82384,CPT,Facility,Both,,,90,104,88.4,29.8064,104,"Health Partners, Inc.",State Public Programs,52,50,,percent of total billed charges,,
"Catecholamine Fract, Free, P (Mayo)OutsideLaboratory",,82384,CPT,Facility,Both,,,90,104,88.4,29.8064,104,Humana Insurance Company,Commercial PPO,98.8,95,,percent of total billed charges,,
"Catecholamine Fract, Free, P (Mayo)OutsideLaboratory",,82384,CPT,Facility,Outpatient,,,90,104,88.4,29.8064,104,Humana Insurance Company,Medicare PPO,50.96,49,,percent of total billed charges,,
"Catecholamine Fract, Free, P (Mayo)OutsideLaboratory",,82384,CPT,Facility,Inpatient,,,90,104,88.4,29.8064,104,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Catecholamine Fract, Free, P (Mayo)OutsideLaboratory",,82384,CPT,Facility,Both,,,90,104,88.4,29.8064,104,Medica,Individual & Family,103.064,99.1,,percent of total billed charges,,
"Catecholamine Fract, Free, P (Mayo)OutsideLaboratory",,82384,CPT,Facility,Outpatient,,,90,104,88.4,29.8064,104,Medica,Medica Advantage Solution,51.792,49.8,,percent of total billed charges,,
"Catecholamine Fract, Free, P (Mayo)OutsideLaboratory",,82384,CPT,Facility,Inpatient,,,90,104,88.4,29.8064,104,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Catecholamine Fract, Free, P (Mayo)OutsideLaboratory",,82384,CPT,Facility,Outpatient,,,90,104,88.4,29.8064,104,Medica,Medical Assistance,46.384,44.6,,percent of total billed charges,,
"Catecholamine Fract, Free, P (Mayo)OutsideLaboratory",,82384,CPT,Facility,Inpatient,,,90,104,88.4,29.8064,104,Medica,Medical Assistance,,,,,Included in per diem rate,
"Catecholamine Fract, Free, P (Mayo)OutsideLaboratory",,82384,CPT,Facility,Outpatient,,,90,104,88.4,29.8064,104,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,51.792,49.8,,percent of total billed charges,,
"Catecholamine Fract, Free, P (Mayo)OutsideLaboratory",,82384,CPT,Facility,Inpatient,,,90,104,88.4,29.8064,104,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Catecholamine Fract, Free, P (Mayo)OutsideLaboratory",,82384,CPT,Facility,Both,,,90,104,88.4,29.8064,104,"Multiplan, Inc.","Multiplan, Inc.",97.76,94,,percent of total billed charges,,
"Catecholamine Fract, Free, P (Mayo)OutsideLaboratory",,82384,CPT,Facility,Outpatient,,,90,104,88.4,29.8064,104,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,89.856,86.4,,percent of total billed charges,,
"Catecholamine Fract, Free, P (Mayo)OutsideLaboratory",,82384,CPT,Facility,Inpatient,,,90,104,88.4,29.8064,104,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Catecholamine Fract, Free, P (Mayo)OutsideLaboratory",,82384,CPT,Facility,Both,,,90,104,88.4,29.8064,104,"Preferred One Administrative Services, INC.",PPO,102.544,98.6,,percent of total billed charges,,
"Catecholamine Fract, Free, P (Mayo)OutsideLaboratory",,82384,CPT,Facility,Outpatient,,,90,104,88.4,29.8064,104,PrimeWest Health,Minnesota Senior Health Options (MSHO),53.508,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Catecholamine Fract, Free, P (Mayo)OutsideLaboratory",,82384,CPT,Facility,Inpatient,,,90,104,88.4,29.8064,104,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Catecholamine Fract, Free, P (Mayo)OutsideLaboratory",,82384,CPT,Facility,Outpatient,,,90,104,88.4,29.8064,104,PrimeWest Health,MinnesotaCare,53.4144,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Catecholamine Fract, Free, P (Mayo)OutsideLaboratory",,82384,CPT,Facility,Inpatient,,,90,104,88.4,29.8064,104,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Catecholamine Fract, Free, P (Mayo)OutsideLaboratory",,82384,CPT,Facility,Both,,,90,104,88.4,29.8064,104,Sanford Health Plan,Sanford Health Plan,95.68,92,,percent of total billed charges,,
"Catecholamine Fract, Free, P (Mayo)OutsideLaboratory",,82384,CPT,Facility,Outpatient,,,90,104,88.4,29.8064,104,"UCare Health, Inc.",Individual & Family Plan,58.604,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Catecholamine Fract, Free, P (Mayo)OutsideLaboratory",,82384,CPT,Facility,Inpatient,,,90,104,88.4,29.8064,104,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Catecholamine Fract, Free, P (Mayo)OutsideLaboratory",,82384,CPT,Facility,Outpatient,,,90,104,88.4,29.8064,104,"UCare Health, Inc.",Medical Assistance,52.4888,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Catecholamine Fract, Free, P (Mayo)OutsideLaboratory",,82384,CPT,Facility,Inpatient,,,90,104,88.4,29.8064,104,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Catecholamine Fract, Free, P (Mayo)OutsideLaboratory",,82384,CPT,Facility,Outpatient,,,90,104,88.4,29.8064,104,"UCare Health, Inc.",Medicare Advantage,52.4888,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Catecholamine Fract, Free, P (Mayo)OutsideLaboratory",,82384,CPT,Facility,Inpatient,,,90,104,88.4,29.8064,104,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Catecholamine Fract, Free, P (Mayo)OutsideLaboratory",,82384,CPT,Facility,Outpatient,,,90,104,88.4,29.8064,104,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),52.4888,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Catecholamine Fract, Free, P (Mayo)OutsideLaboratory",,82384,CPT,Facility,Inpatient,,,90,104,88.4,29.8064,104,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Catecholamine Fract, Free, P (Mayo)OutsideLaboratory",,82384,CPT,Facility,Both,,,90,104,88.4,29.8064,104,UnitedHealthcare,Individual & Family,97.76,94,,percent of total billed charges,,
"Catecholamine Fract, Free, P (Mayo)OutsideLaboratory",,82384,CPT,Facility,Outpatient,,,90,104,88.4,29.8064,104,UnitedHealthcare,Medicare Advantage,50.96,49,,percent of total billed charges,,
"Catecholamine Fract, Free, P (Mayo)OutsideLaboratory",,82384,CPT,Facility,Inpatient,,,90,104,88.4,29.8064,104,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Catecholamine Fract, Free, P (Mayo)OutsideLaboratory",,82384,CPT,Facility,Outpatient,,,90,104,88.4,29.8064,104,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,49.92,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Catecholamine Fract, Free, P (Mayo)OutsideLaboratory",,82384,CPT,Facility,Inpatient,,,90,104,88.4,29.8064,104,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Catecholamine Fract, Free, U (Mayo)OutsideLaboratory",,82384,CPT,Facility,Both,,,90,104,88.4,29.8064,104,Aetna,Commercial,95.68,92,,percent of total billed charges,,
"Catecholamine Fract, Free, U (Mayo)OutsideLaboratory",,82384,CPT,Facility,Outpatient,,,90,104,88.4,29.8064,104,Aetna,Medicare Advantage,50.96,49,,percent of total billed charges,,
"Catecholamine Fract, Free, U (Mayo)OutsideLaboratory",,82384,CPT,Facility,Inpatient,,,90,104,88.4,29.8064,104,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Catecholamine Fract, Free, U (Mayo)OutsideLaboratory",,82384,CPT,Facility,Both,,,90,104,88.4,29.8064,104,Aetna,PPO,96.72,93,,percent of total billed charges,,
"Catecholamine Fract, Free, U (Mayo)OutsideLaboratory",,82384,CPT,Facility,Both,,,90,104,88.4,29.8064,104,America's PPO,America's PPO,99.8712,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Catecholamine Fract, Free, U (Mayo)OutsideLaboratory",,82384,CPT,Facility,Both,,,90,104,88.4,29.8064,104,BlueCross BlueShield Minnesota, Federal Employee Program,102.336,98.4,,percent of total billed charges,,
"Catecholamine Fract, Free, U (Mayo)OutsideLaboratory",,82384,CPT,Facility,Both,,,90,104,88.4,29.8064,104,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,104,100,,percent of total billed charges,,
"Catecholamine Fract, Free, U (Mayo)OutsideLaboratory",,82384,CPT,Facility,Both,,,90,104,88.4,29.8064,104,BlueCross BlueShield Minnesota,High Value Network Plan,93.6,90,,percent of total billed charges,,
"Catecholamine Fract, Free, U (Mayo)OutsideLaboratory",,82384,CPT,Facility,Outpatient,,,90,104,88.4,29.8064,104,BlueCross BlueShield Minnesota,Medicare Advantage,50.96,49,,percent of total billed charges,,
"Catecholamine Fract, Free, U (Mayo)OutsideLaboratory",,82384,CPT,Facility,Inpatient,,,90,104,88.4,29.8064,104,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Catecholamine Fract, Free, U (Mayo)OutsideLaboratory",,82384,CPT,Facility,Both,,,90,104,88.4,29.8064,104,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,92.1128,88.57,,percent of total billed charges,,
"Catecholamine Fract, Free, U (Mayo)OutsideLaboratory",,82384,CPT,Facility,Both,,,90,104,88.4,29.8064,104,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,29.8064,28.66,,percent of total billed charges,,
"Catecholamine Fract, Free, U (Mayo)OutsideLaboratory",,82384,CPT,Facility,Outpatient,,,90,104,88.4,29.8064,104,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),50.96,49,,percent of total billed charges,,
"Catecholamine Fract, Free, U (Mayo)OutsideLaboratory",,82384,CPT,Facility,Inpatient,,,90,104,88.4,29.8064,104,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Catecholamine Fract, Free, U (Mayo)OutsideLaboratory",,82384,CPT,Facility,Both,,,90,104,88.4,29.8064,104,CorVel,Worker's Compensation,104,100,,percent of total billed charges,,
"Catecholamine Fract, Free, U (Mayo)OutsideLaboratory",,82384,CPT,Facility,Both,,,90,104,88.4,29.8064,104,First Health Group Corporation,First Health Network,100.88,97,,percent of total billed charges,,
"Catecholamine Fract, Free, U (Mayo)OutsideLaboratory",,82384,CPT,Facility,Both,,,90,104,88.4,29.8064,104,"Health Partners, Inc.",Commercial,98.384,94.6,,percent of total billed charges,,
"Catecholamine Fract, Free, U (Mayo)OutsideLaboratory",,82384,CPT,Facility,Outpatient,,,90,104,88.4,29.8064,104,"Health Partners, Inc.",Medicare Advantage,50.96,49,,percent of total billed charges,,
"Catecholamine Fract, Free, U (Mayo)OutsideLaboratory",,82384,CPT,Facility,Inpatient,,,90,104,88.4,29.8064,104,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Catecholamine Fract, Free, U (Mayo)OutsideLaboratory",,82384,CPT,Facility,Both,,,90,104,88.4,29.8064,104,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),62.4,60,,percent of total billed charges,,
"Catecholamine Fract, Free, U (Mayo)OutsideLaboratory",,82384,CPT,Facility,Both,,,90,104,88.4,29.8064,104,"Health Partners, Inc.",State of Minnesota Advantage Program,84.76,81.5,,percent of total billed charges,,
"Catecholamine Fract, Free, U (Mayo)OutsideLaboratory",,82384,CPT,Facility,Both,,,90,104,88.4,29.8064,104,"Health Partners, Inc.",State Public Programs,52,50,,percent of total billed charges,,
"Catecholamine Fract, Free, U (Mayo)OutsideLaboratory",,82384,CPT,Facility,Both,,,90,104,88.4,29.8064,104,Humana Insurance Company,Commercial PPO,98.8,95,,percent of total billed charges,,
"Catecholamine Fract, Free, U (Mayo)OutsideLaboratory",,82384,CPT,Facility,Outpatient,,,90,104,88.4,29.8064,104,Humana Insurance Company,Medicare PPO,50.96,49,,percent of total billed charges,,
"Catecholamine Fract, Free, U (Mayo)OutsideLaboratory",,82384,CPT,Facility,Inpatient,,,90,104,88.4,29.8064,104,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Catecholamine Fract, Free, U (Mayo)OutsideLaboratory",,82384,CPT,Facility,Both,,,90,104,88.4,29.8064,104,Medica,Individual & Family,103.064,99.1,,percent of total billed charges,,
"Catecholamine Fract, Free, U (Mayo)OutsideLaboratory",,82384,CPT,Facility,Outpatient,,,90,104,88.4,29.8064,104,Medica,Medica Advantage Solution,51.792,49.8,,percent of total billed charges,,
"Catecholamine Fract, Free, U (Mayo)OutsideLaboratory",,82384,CPT,Facility,Inpatient,,,90,104,88.4,29.8064,104,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Catecholamine Fract, Free, U (Mayo)OutsideLaboratory",,82384,CPT,Facility,Outpatient,,,90,104,88.4,29.8064,104,Medica,Medical Assistance,46.384,44.6,,percent of total billed charges,,
"Catecholamine Fract, Free, U (Mayo)OutsideLaboratory",,82384,CPT,Facility,Inpatient,,,90,104,88.4,29.8064,104,Medica,Medical Assistance,,,,,Included in per diem rate,
"Catecholamine Fract, Free, U (Mayo)OutsideLaboratory",,82384,CPT,Facility,Outpatient,,,90,104,88.4,29.8064,104,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,51.792,49.8,,percent of total billed charges,,
"Catecholamine Fract, Free, U (Mayo)OutsideLaboratory",,82384,CPT,Facility,Inpatient,,,90,104,88.4,29.8064,104,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Catecholamine Fract, Free, U (Mayo)OutsideLaboratory",,82384,CPT,Facility,Both,,,90,104,88.4,29.8064,104,"Multiplan, Inc.","Multiplan, Inc.",97.76,94,,percent of total billed charges,,
"Catecholamine Fract, Free, U (Mayo)OutsideLaboratory",,82384,CPT,Facility,Outpatient,,,90,104,88.4,29.8064,104,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,89.856,86.4,,percent of total billed charges,,
"Catecholamine Fract, Free, U (Mayo)OutsideLaboratory",,82384,CPT,Facility,Inpatient,,,90,104,88.4,29.8064,104,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Catecholamine Fract, Free, U (Mayo)OutsideLaboratory",,82384,CPT,Facility,Both,,,90,104,88.4,29.8064,104,"Preferred One Administrative Services, INC.",PPO,102.544,98.6,,percent of total billed charges,,
"Catecholamine Fract, Free, U (Mayo)OutsideLaboratory",,82384,CPT,Facility,Outpatient,,,90,104,88.4,29.8064,104,PrimeWest Health,Minnesota Senior Health Options (MSHO),53.508,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Catecholamine Fract, Free, U (Mayo)OutsideLaboratory",,82384,CPT,Facility,Inpatient,,,90,104,88.4,29.8064,104,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Catecholamine Fract, Free, U (Mayo)OutsideLaboratory",,82384,CPT,Facility,Outpatient,,,90,104,88.4,29.8064,104,PrimeWest Health,MinnesotaCare,53.4144,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Catecholamine Fract, Free, U (Mayo)OutsideLaboratory",,82384,CPT,Facility,Inpatient,,,90,104,88.4,29.8064,104,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Catecholamine Fract, Free, U (Mayo)OutsideLaboratory",,82384,CPT,Facility,Both,,,90,104,88.4,29.8064,104,Sanford Health Plan,Sanford Health Plan,95.68,92,,percent of total billed charges,,
"Catecholamine Fract, Free, U (Mayo)OutsideLaboratory",,82384,CPT,Facility,Outpatient,,,90,104,88.4,29.8064,104,"UCare Health, Inc.",Individual & Family Plan,58.604,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Catecholamine Fract, Free, U (Mayo)OutsideLaboratory",,82384,CPT,Facility,Inpatient,,,90,104,88.4,29.8064,104,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Catecholamine Fract, Free, U (Mayo)OutsideLaboratory",,82384,CPT,Facility,Outpatient,,,90,104,88.4,29.8064,104,"UCare Health, Inc.",Medical Assistance,52.4888,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Catecholamine Fract, Free, U (Mayo)OutsideLaboratory",,82384,CPT,Facility,Inpatient,,,90,104,88.4,29.8064,104,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Catecholamine Fract, Free, U (Mayo)OutsideLaboratory",,82384,CPT,Facility,Outpatient,,,90,104,88.4,29.8064,104,"UCare Health, Inc.",Medicare Advantage,52.4888,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Catecholamine Fract, Free, U (Mayo)OutsideLaboratory",,82384,CPT,Facility,Inpatient,,,90,104,88.4,29.8064,104,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Catecholamine Fract, Free, U (Mayo)OutsideLaboratory",,82384,CPT,Facility,Outpatient,,,90,104,88.4,29.8064,104,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),52.4888,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Catecholamine Fract, Free, U (Mayo)OutsideLaboratory",,82384,CPT,Facility,Inpatient,,,90,104,88.4,29.8064,104,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Catecholamine Fract, Free, U (Mayo)OutsideLaboratory",,82384,CPT,Facility,Both,,,90,104,88.4,29.8064,104,UnitedHealthcare,Individual & Family,97.76,94,,percent of total billed charges,,
"Catecholamine Fract, Free, U (Mayo)OutsideLaboratory",,82384,CPT,Facility,Outpatient,,,90,104,88.4,29.8064,104,UnitedHealthcare,Medicare Advantage,50.96,49,,percent of total billed charges,,
"Catecholamine Fract, Free, U (Mayo)OutsideLaboratory",,82384,CPT,Facility,Inpatient,,,90,104,88.4,29.8064,104,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Catecholamine Fract, Free, U (Mayo)OutsideLaboratory",,82384,CPT,Facility,Outpatient,,,90,104,88.4,29.8064,104,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,49.92,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Catecholamine Fract, Free, U (Mayo)OutsideLaboratory",,82384,CPT,Facility,Inpatient,,,90,104,88.4,29.8064,104,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Ceruloplasmin, S (Mayo)OutsideLaboratory",,82390,CPT,Facility,Both,,,90,89,75.65,25.5074,89,Aetna,Commercial,81.88,92,,percent of total billed charges,,
"Ceruloplasmin, S (Mayo)OutsideLaboratory",,82390,CPT,Facility,Outpatient,,,90,89,75.65,25.5074,89,Aetna,Medicare Advantage,43.61,49,,percent of total billed charges,,
"Ceruloplasmin, S (Mayo)OutsideLaboratory",,82390,CPT,Facility,Inpatient,,,90,89,75.65,25.5074,89,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Ceruloplasmin, S (Mayo)OutsideLaboratory",,82390,CPT,Facility,Both,,,90,89,75.65,25.5074,89,Aetna,PPO,82.77,93,,percent of total billed charges,,
"Ceruloplasmin, S (Mayo)OutsideLaboratory",,82390,CPT,Facility,Both,,,90,89,75.65,25.5074,89,America's PPO,America's PPO,85.4667,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Ceruloplasmin, S (Mayo)OutsideLaboratory",,82390,CPT,Facility,Both,,,90,89,75.65,25.5074,89,BlueCross BlueShield Minnesota, Federal Employee Program,87.576,98.4,,percent of total billed charges,,
"Ceruloplasmin, S (Mayo)OutsideLaboratory",,82390,CPT,Facility,Both,,,90,89,75.65,25.5074,89,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,89,100,,percent of total billed charges,,
"Ceruloplasmin, S (Mayo)OutsideLaboratory",,82390,CPT,Facility,Both,,,90,89,75.65,25.5074,89,BlueCross BlueShield Minnesota,High Value Network Plan,80.1,90,,percent of total billed charges,,
"Ceruloplasmin, S (Mayo)OutsideLaboratory",,82390,CPT,Facility,Outpatient,,,90,89,75.65,25.5074,89,BlueCross BlueShield Minnesota,Medicare Advantage,43.61,49,,percent of total billed charges,,
"Ceruloplasmin, S (Mayo)OutsideLaboratory",,82390,CPT,Facility,Inpatient,,,90,89,75.65,25.5074,89,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Ceruloplasmin, S (Mayo)OutsideLaboratory",,82390,CPT,Facility,Both,,,90,89,75.65,25.5074,89,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,78.8273,88.57,,percent of total billed charges,,
"Ceruloplasmin, S (Mayo)OutsideLaboratory",,82390,CPT,Facility,Both,,,90,89,75.65,25.5074,89,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,25.5074,28.66,,percent of total billed charges,,
"Ceruloplasmin, S (Mayo)OutsideLaboratory",,82390,CPT,Facility,Outpatient,,,90,89,75.65,25.5074,89,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),43.61,49,,percent of total billed charges,,
"Ceruloplasmin, S (Mayo)OutsideLaboratory",,82390,CPT,Facility,Inpatient,,,90,89,75.65,25.5074,89,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Ceruloplasmin, S (Mayo)OutsideLaboratory",,82390,CPT,Facility,Both,,,90,89,75.65,25.5074,89,CorVel,Worker's Compensation,89,100,,percent of total billed charges,,
"Ceruloplasmin, S (Mayo)OutsideLaboratory",,82390,CPT,Facility,Both,,,90,89,75.65,25.5074,89,First Health Group Corporation,First Health Network,86.33,97,,percent of total billed charges,,
"Ceruloplasmin, S (Mayo)OutsideLaboratory",,82390,CPT,Facility,Both,,,90,89,75.65,25.5074,89,"Health Partners, Inc.",Commercial,84.194,94.6,,percent of total billed charges,,
"Ceruloplasmin, S (Mayo)OutsideLaboratory",,82390,CPT,Facility,Outpatient,,,90,89,75.65,25.5074,89,"Health Partners, Inc.",Medicare Advantage,43.61,49,,percent of total billed charges,,
"Ceruloplasmin, S (Mayo)OutsideLaboratory",,82390,CPT,Facility,Inpatient,,,90,89,75.65,25.5074,89,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Ceruloplasmin, S (Mayo)OutsideLaboratory",,82390,CPT,Facility,Both,,,90,89,75.65,25.5074,89,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),53.4,60,,percent of total billed charges,,
"Ceruloplasmin, S (Mayo)OutsideLaboratory",,82390,CPT,Facility,Both,,,90,89,75.65,25.5074,89,"Health Partners, Inc.",State of Minnesota Advantage Program,72.535,81.5,,percent of total billed charges,,
"Ceruloplasmin, S (Mayo)OutsideLaboratory",,82390,CPT,Facility,Both,,,90,89,75.65,25.5074,89,"Health Partners, Inc.",State Public Programs,44.5,50,,percent of total billed charges,,
"Ceruloplasmin, S (Mayo)OutsideLaboratory",,82390,CPT,Facility,Both,,,90,89,75.65,25.5074,89,Humana Insurance Company,Commercial PPO,84.55,95,,percent of total billed charges,,
"Ceruloplasmin, S (Mayo)OutsideLaboratory",,82390,CPT,Facility,Outpatient,,,90,89,75.65,25.5074,89,Humana Insurance Company,Medicare PPO,43.61,49,,percent of total billed charges,,
"Ceruloplasmin, S (Mayo)OutsideLaboratory",,82390,CPT,Facility,Inpatient,,,90,89,75.65,25.5074,89,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Ceruloplasmin, S (Mayo)OutsideLaboratory",,82390,CPT,Facility,Both,,,90,89,75.65,25.5074,89,Medica,Individual & Family,88.199,99.1,,percent of total billed charges,,
"Ceruloplasmin, S (Mayo)OutsideLaboratory",,82390,CPT,Facility,Outpatient,,,90,89,75.65,25.5074,89,Medica,Medica Advantage Solution,44.322,49.8,,percent of total billed charges,,
"Ceruloplasmin, S (Mayo)OutsideLaboratory",,82390,CPT,Facility,Inpatient,,,90,89,75.65,25.5074,89,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Ceruloplasmin, S (Mayo)OutsideLaboratory",,82390,CPT,Facility,Outpatient,,,90,89,75.65,25.5074,89,Medica,Medical Assistance,39.694,44.6,,percent of total billed charges,,
"Ceruloplasmin, S (Mayo)OutsideLaboratory",,82390,CPT,Facility,Inpatient,,,90,89,75.65,25.5074,89,Medica,Medical Assistance,,,,,Included in per diem rate,
"Ceruloplasmin, S (Mayo)OutsideLaboratory",,82390,CPT,Facility,Outpatient,,,90,89,75.65,25.5074,89,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,44.322,49.8,,percent of total billed charges,,
"Ceruloplasmin, S (Mayo)OutsideLaboratory",,82390,CPT,Facility,Inpatient,,,90,89,75.65,25.5074,89,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Ceruloplasmin, S (Mayo)OutsideLaboratory",,82390,CPT,Facility,Both,,,90,89,75.65,25.5074,89,"Multiplan, Inc.","Multiplan, Inc.",83.66,94,,percent of total billed charges,,
"Ceruloplasmin, S (Mayo)OutsideLaboratory",,82390,CPT,Facility,Outpatient,,,90,89,75.65,25.5074,89,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,76.896,86.4,,percent of total billed charges,,
"Ceruloplasmin, S (Mayo)OutsideLaboratory",,82390,CPT,Facility,Inpatient,,,90,89,75.65,25.5074,89,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Ceruloplasmin, S (Mayo)OutsideLaboratory",,82390,CPT,Facility,Both,,,90,89,75.65,25.5074,89,"Preferred One Administrative Services, INC.",PPO,87.754,98.6,,percent of total billed charges,,
"Ceruloplasmin, S (Mayo)OutsideLaboratory",,82390,CPT,Facility,Outpatient,,,90,89,75.65,25.5074,89,PrimeWest Health,Minnesota Senior Health Options (MSHO),45.7905,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Ceruloplasmin, S (Mayo)OutsideLaboratory",,82390,CPT,Facility,Inpatient,,,90,89,75.65,25.5074,89,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Ceruloplasmin, S (Mayo)OutsideLaboratory",,82390,CPT,Facility,Outpatient,,,90,89,75.65,25.5074,89,PrimeWest Health,MinnesotaCare,45.7104,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Ceruloplasmin, S (Mayo)OutsideLaboratory",,82390,CPT,Facility,Inpatient,,,90,89,75.65,25.5074,89,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Ceruloplasmin, S (Mayo)OutsideLaboratory",,82390,CPT,Facility,Both,,,90,89,75.65,25.5074,89,Sanford Health Plan,Sanford Health Plan,81.88,92,,percent of total billed charges,,
"Ceruloplasmin, S (Mayo)OutsideLaboratory",,82390,CPT,Facility,Outpatient,,,90,89,75.65,25.5074,89,"UCare Health, Inc.",Individual & Family Plan,50.1515,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Ceruloplasmin, S (Mayo)OutsideLaboratory",,82390,CPT,Facility,Inpatient,,,90,89,75.65,25.5074,89,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Ceruloplasmin, S (Mayo)OutsideLaboratory",,82390,CPT,Facility,Outpatient,,,90,89,75.65,25.5074,89,"UCare Health, Inc.",Medical Assistance,44.9183,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Ceruloplasmin, S (Mayo)OutsideLaboratory",,82390,CPT,Facility,Inpatient,,,90,89,75.65,25.5074,89,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Ceruloplasmin, S (Mayo)OutsideLaboratory",,82390,CPT,Facility,Outpatient,,,90,89,75.65,25.5074,89,"UCare Health, Inc.",Medicare Advantage,44.9183,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Ceruloplasmin, S (Mayo)OutsideLaboratory",,82390,CPT,Facility,Inpatient,,,90,89,75.65,25.5074,89,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Ceruloplasmin, S (Mayo)OutsideLaboratory",,82390,CPT,Facility,Outpatient,,,90,89,75.65,25.5074,89,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),44.9183,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Ceruloplasmin, S (Mayo)OutsideLaboratory",,82390,CPT,Facility,Inpatient,,,90,89,75.65,25.5074,89,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Ceruloplasmin, S (Mayo)OutsideLaboratory",,82390,CPT,Facility,Both,,,90,89,75.65,25.5074,89,UnitedHealthcare,Individual & Family,83.66,94,,percent of total billed charges,,
"Ceruloplasmin, S (Mayo)OutsideLaboratory",,82390,CPT,Facility,Outpatient,,,90,89,75.65,25.5074,89,UnitedHealthcare,Medicare Advantage,43.61,49,,percent of total billed charges,,
"Ceruloplasmin, S (Mayo)OutsideLaboratory",,82390,CPT,Facility,Inpatient,,,90,89,75.65,25.5074,89,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Ceruloplasmin, S (Mayo)OutsideLaboratory",,82390,CPT,Facility,Outpatient,,,90,89,75.65,25.5074,89,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,42.72,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Ceruloplasmin, S (Mayo)OutsideLaboratory",,82390,CPT,Facility,Inpatient,,,90,89,75.65,25.5074,89,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Chemiluminescent Assay (Mayo)OutsideLaboratory,,82397,CPT,Facility,Both,,,90,110,93.5,31.526,110,Aetna,Commercial,101.2,92,,percent of total billed charges,,
Chemiluminescent Assay (Mayo)OutsideLaboratory,,82397,CPT,Facility,Outpatient,,,90,110,93.5,31.526,110,Aetna,Medicare Advantage,53.9,49,,percent of total billed charges,,
Chemiluminescent Assay (Mayo)OutsideLaboratory,,82397,CPT,Facility,Inpatient,,,90,110,93.5,31.526,110,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Chemiluminescent Assay (Mayo)OutsideLaboratory,,82397,CPT,Facility,Both,,,90,110,93.5,31.526,110,Aetna,PPO,102.3,93,,percent of total billed charges,,
Chemiluminescent Assay (Mayo)OutsideLaboratory,,82397,CPT,Facility,Both,,,90,110,93.5,31.526,110,America's PPO,America's PPO,105.633,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Chemiluminescent Assay (Mayo)OutsideLaboratory,,82397,CPT,Facility,Both,,,90,110,93.5,31.526,110,BlueCross BlueShield Minnesota, Federal Employee Program,108.24,98.4,,percent of total billed charges,,
Chemiluminescent Assay (Mayo)OutsideLaboratory,,82397,CPT,Facility,Both,,,90,110,93.5,31.526,110,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,110,100,,percent of total billed charges,,
Chemiluminescent Assay (Mayo)OutsideLaboratory,,82397,CPT,Facility,Both,,,90,110,93.5,31.526,110,BlueCross BlueShield Minnesota,High Value Network Plan,99,90,,percent of total billed charges,,
Chemiluminescent Assay (Mayo)OutsideLaboratory,,82397,CPT,Facility,Outpatient,,,90,110,93.5,31.526,110,BlueCross BlueShield Minnesota,Medicare Advantage,53.9,49,,percent of total billed charges,,
Chemiluminescent Assay (Mayo)OutsideLaboratory,,82397,CPT,Facility,Inpatient,,,90,110,93.5,31.526,110,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Chemiluminescent Assay (Mayo)OutsideLaboratory,,82397,CPT,Facility,Both,,,90,110,93.5,31.526,110,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,97.427,88.57,,percent of total billed charges,,
Chemiluminescent Assay (Mayo)OutsideLaboratory,,82397,CPT,Facility,Both,,,90,110,93.5,31.526,110,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,31.526,28.66,,percent of total billed charges,,
Chemiluminescent Assay (Mayo)OutsideLaboratory,,82397,CPT,Facility,Outpatient,,,90,110,93.5,31.526,110,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),53.9,49,,percent of total billed charges,,
Chemiluminescent Assay (Mayo)OutsideLaboratory,,82397,CPT,Facility,Inpatient,,,90,110,93.5,31.526,110,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Chemiluminescent Assay (Mayo)OutsideLaboratory,,82397,CPT,Facility,Both,,,90,110,93.5,31.526,110,CorVel,Worker's Compensation,110,100,,percent of total billed charges,,
Chemiluminescent Assay (Mayo)OutsideLaboratory,,82397,CPT,Facility,Both,,,90,110,93.5,31.526,110,First Health Group Corporation,First Health Network,106.7,97,,percent of total billed charges,,
Chemiluminescent Assay (Mayo)OutsideLaboratory,,82397,CPT,Facility,Both,,,90,110,93.5,31.526,110,"Health Partners, Inc.",Commercial,104.06,94.6,,percent of total billed charges,,
Chemiluminescent Assay (Mayo)OutsideLaboratory,,82397,CPT,Facility,Outpatient,,,90,110,93.5,31.526,110,"Health Partners, Inc.",Medicare Advantage,53.9,49,,percent of total billed charges,,
Chemiluminescent Assay (Mayo)OutsideLaboratory,,82397,CPT,Facility,Inpatient,,,90,110,93.5,31.526,110,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Chemiluminescent Assay (Mayo)OutsideLaboratory,,82397,CPT,Facility,Both,,,90,110,93.5,31.526,110,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),66,60,,percent of total billed charges,,
Chemiluminescent Assay (Mayo)OutsideLaboratory,,82397,CPT,Facility,Both,,,90,110,93.5,31.526,110,"Health Partners, Inc.",State of Minnesota Advantage Program,89.65,81.5,,percent of total billed charges,,
Chemiluminescent Assay (Mayo)OutsideLaboratory,,82397,CPT,Facility,Both,,,90,110,93.5,31.526,110,"Health Partners, Inc.",State Public Programs,55,50,,percent of total billed charges,,
Chemiluminescent Assay (Mayo)OutsideLaboratory,,82397,CPT,Facility,Both,,,90,110,93.5,31.526,110,Humana Insurance Company,Commercial PPO,104.5,95,,percent of total billed charges,,
Chemiluminescent Assay (Mayo)OutsideLaboratory,,82397,CPT,Facility,Outpatient,,,90,110,93.5,31.526,110,Humana Insurance Company,Medicare PPO,53.9,49,,percent of total billed charges,,
Chemiluminescent Assay (Mayo)OutsideLaboratory,,82397,CPT,Facility,Inpatient,,,90,110,93.5,31.526,110,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Chemiluminescent Assay (Mayo)OutsideLaboratory,,82397,CPT,Facility,Both,,,90,110,93.5,31.526,110,Medica,Individual & Family,109.01,99.1,,percent of total billed charges,,
Chemiluminescent Assay (Mayo)OutsideLaboratory,,82397,CPT,Facility,Outpatient,,,90,110,93.5,31.526,110,Medica,Medica Advantage Solution,54.78,49.8,,percent of total billed charges,,
Chemiluminescent Assay (Mayo)OutsideLaboratory,,82397,CPT,Facility,Inpatient,,,90,110,93.5,31.526,110,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Chemiluminescent Assay (Mayo)OutsideLaboratory,,82397,CPT,Facility,Outpatient,,,90,110,93.5,31.526,110,Medica,Medical Assistance,49.06,44.6,,percent of total billed charges,,
Chemiluminescent Assay (Mayo)OutsideLaboratory,,82397,CPT,Facility,Inpatient,,,90,110,93.5,31.526,110,Medica,Medical Assistance,,,,,Included in per diem rate,
Chemiluminescent Assay (Mayo)OutsideLaboratory,,82397,CPT,Facility,Outpatient,,,90,110,93.5,31.526,110,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,54.78,49.8,,percent of total billed charges,,
Chemiluminescent Assay (Mayo)OutsideLaboratory,,82397,CPT,Facility,Inpatient,,,90,110,93.5,31.526,110,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Chemiluminescent Assay (Mayo)OutsideLaboratory,,82397,CPT,Facility,Both,,,90,110,93.5,31.526,110,"Multiplan, Inc.","Multiplan, Inc.",103.4,94,,percent of total billed charges,,
Chemiluminescent Assay (Mayo)OutsideLaboratory,,82397,CPT,Facility,Outpatient,,,90,110,93.5,31.526,110,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,95.04,86.4,,percent of total billed charges,,
Chemiluminescent Assay (Mayo)OutsideLaboratory,,82397,CPT,Facility,Inpatient,,,90,110,93.5,31.526,110,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Chemiluminescent Assay (Mayo)OutsideLaboratory,,82397,CPT,Facility,Both,,,90,110,93.5,31.526,110,"Preferred One Administrative Services, INC.",PPO,108.46,98.6,,percent of total billed charges,,
Chemiluminescent Assay (Mayo)OutsideLaboratory,,82397,CPT,Facility,Outpatient,,,90,110,93.5,31.526,110,PrimeWest Health,Minnesota Senior Health Options (MSHO),56.595,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Chemiluminescent Assay (Mayo)OutsideLaboratory,,82397,CPT,Facility,Inpatient,,,90,110,93.5,31.526,110,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Chemiluminescent Assay (Mayo)OutsideLaboratory,,82397,CPT,Facility,Outpatient,,,90,110,93.5,31.526,110,PrimeWest Health,MinnesotaCare,56.496,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Chemiluminescent Assay (Mayo)OutsideLaboratory,,82397,CPT,Facility,Inpatient,,,90,110,93.5,31.526,110,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Chemiluminescent Assay (Mayo)OutsideLaboratory,,82397,CPT,Facility,Both,,,90,110,93.5,31.526,110,Sanford Health Plan,Sanford Health Plan,101.2,92,,percent of total billed charges,,
Chemiluminescent Assay (Mayo)OutsideLaboratory,,82397,CPT,Facility,Outpatient,,,90,110,93.5,31.526,110,"UCare Health, Inc.",Individual & Family Plan,61.985,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Chemiluminescent Assay (Mayo)OutsideLaboratory,,82397,CPT,Facility,Inpatient,,,90,110,93.5,31.526,110,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Chemiluminescent Assay (Mayo)OutsideLaboratory,,82397,CPT,Facility,Outpatient,,,90,110,93.5,31.526,110,"UCare Health, Inc.",Medical Assistance,55.517,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Chemiluminescent Assay (Mayo)OutsideLaboratory,,82397,CPT,Facility,Inpatient,,,90,110,93.5,31.526,110,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Chemiluminescent Assay (Mayo)OutsideLaboratory,,82397,CPT,Facility,Outpatient,,,90,110,93.5,31.526,110,"UCare Health, Inc.",Medicare Advantage,55.517,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Chemiluminescent Assay (Mayo)OutsideLaboratory,,82397,CPT,Facility,Inpatient,,,90,110,93.5,31.526,110,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Chemiluminescent Assay (Mayo)OutsideLaboratory,,82397,CPT,Facility,Outpatient,,,90,110,93.5,31.526,110,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),55.517,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Chemiluminescent Assay (Mayo)OutsideLaboratory,,82397,CPT,Facility,Inpatient,,,90,110,93.5,31.526,110,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Chemiluminescent Assay (Mayo)OutsideLaboratory,,82397,CPT,Facility,Both,,,90,110,93.5,31.526,110,UnitedHealthcare,Individual & Family,103.4,94,,percent of total billed charges,,
Chemiluminescent Assay (Mayo)OutsideLaboratory,,82397,CPT,Facility,Outpatient,,,90,110,93.5,31.526,110,UnitedHealthcare,Medicare Advantage,53.9,49,,percent of total billed charges,,
Chemiluminescent Assay (Mayo)OutsideLaboratory,,82397,CPT,Facility,Inpatient,,,90,110,93.5,31.526,110,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Chemiluminescent Assay (Mayo)OutsideLaboratory,,82397,CPT,Facility,Outpatient,,,90,110,93.5,31.526,110,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,52.8,48,,percent of total billed charges,,100% of DHS outpatient percentage
Chemiluminescent Assay (Mayo)OutsideLaboratory,,82397,CPT,Facility,Inpatient,,,90,110,93.5,31.526,110,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Chloride; Other Source (Mayo)OutsideLaboratory,,82438,CPT,Facility,Both,,,90,60,51,17.196,60,Aetna,Commercial,55.2,92,,percent of total billed charges,,
Chloride; Other Source (Mayo)OutsideLaboratory,,82438,CPT,Facility,Outpatient,,,90,60,51,17.196,60,Aetna,Medicare Advantage,29.4,49,,percent of total billed charges,,
Chloride; Other Source (Mayo)OutsideLaboratory,,82438,CPT,Facility,Inpatient,,,90,60,51,17.196,60,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Chloride; Other Source (Mayo)OutsideLaboratory,,82438,CPT,Facility,Both,,,90,60,51,17.196,60,Aetna,PPO,55.8,93,,percent of total billed charges,,
Chloride; Other Source (Mayo)OutsideLaboratory,,82438,CPT,Facility,Both,,,90,60,51,17.196,60,America's PPO,America's PPO,57.618,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Chloride; Other Source (Mayo)OutsideLaboratory,,82438,CPT,Facility,Both,,,90,60,51,17.196,60,BlueCross BlueShield Minnesota, Federal Employee Program,59.04,98.4,,percent of total billed charges,,
Chloride; Other Source (Mayo)OutsideLaboratory,,82438,CPT,Facility,Both,,,90,60,51,17.196,60,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,60,100,,percent of total billed charges,,
Chloride; Other Source (Mayo)OutsideLaboratory,,82438,CPT,Facility,Both,,,90,60,51,17.196,60,BlueCross BlueShield Minnesota,High Value Network Plan,54,90,,percent of total billed charges,,
Chloride; Other Source (Mayo)OutsideLaboratory,,82438,CPT,Facility,Outpatient,,,90,60,51,17.196,60,BlueCross BlueShield Minnesota,Medicare Advantage,29.4,49,,percent of total billed charges,,
Chloride; Other Source (Mayo)OutsideLaboratory,,82438,CPT,Facility,Inpatient,,,90,60,51,17.196,60,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Chloride; Other Source (Mayo)OutsideLaboratory,,82438,CPT,Facility,Both,,,90,60,51,17.196,60,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,53.142,88.57,,percent of total billed charges,,
Chloride; Other Source (Mayo)OutsideLaboratory,,82438,CPT,Facility,Both,,,90,60,51,17.196,60,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,17.196,28.66,,percent of total billed charges,,
Chloride; Other Source (Mayo)OutsideLaboratory,,82438,CPT,Facility,Outpatient,,,90,60,51,17.196,60,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),29.4,49,,percent of total billed charges,,
Chloride; Other Source (Mayo)OutsideLaboratory,,82438,CPT,Facility,Inpatient,,,90,60,51,17.196,60,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Chloride; Other Source (Mayo)OutsideLaboratory,,82438,CPT,Facility,Both,,,90,60,51,17.196,60,CorVel,Worker's Compensation,60,100,,percent of total billed charges,,
Chloride; Other Source (Mayo)OutsideLaboratory,,82438,CPT,Facility,Both,,,90,60,51,17.196,60,First Health Group Corporation,First Health Network,58.2,97,,percent of total billed charges,,
Chloride; Other Source (Mayo)OutsideLaboratory,,82438,CPT,Facility,Both,,,90,60,51,17.196,60,"Health Partners, Inc.",Commercial,56.76,94.6,,percent of total billed charges,,
Chloride; Other Source (Mayo)OutsideLaboratory,,82438,CPT,Facility,Outpatient,,,90,60,51,17.196,60,"Health Partners, Inc.",Medicare Advantage,29.4,49,,percent of total billed charges,,
Chloride; Other Source (Mayo)OutsideLaboratory,,82438,CPT,Facility,Inpatient,,,90,60,51,17.196,60,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Chloride; Other Source (Mayo)OutsideLaboratory,,82438,CPT,Facility,Both,,,90,60,51,17.196,60,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),36,60,,percent of total billed charges,,
Chloride; Other Source (Mayo)OutsideLaboratory,,82438,CPT,Facility,Both,,,90,60,51,17.196,60,"Health Partners, Inc.",State of Minnesota Advantage Program,48.9,81.5,,percent of total billed charges,,
Chloride; Other Source (Mayo)OutsideLaboratory,,82438,CPT,Facility,Both,,,90,60,51,17.196,60,"Health Partners, Inc.",State Public Programs,30,50,,percent of total billed charges,,
Chloride; Other Source (Mayo)OutsideLaboratory,,82438,CPT,Facility,Both,,,90,60,51,17.196,60,Humana Insurance Company,Commercial PPO,57,95,,percent of total billed charges,,
Chloride; Other Source (Mayo)OutsideLaboratory,,82438,CPT,Facility,Outpatient,,,90,60,51,17.196,60,Humana Insurance Company,Medicare PPO,29.4,49,,percent of total billed charges,,
Chloride; Other Source (Mayo)OutsideLaboratory,,82438,CPT,Facility,Inpatient,,,90,60,51,17.196,60,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Chloride; Other Source (Mayo)OutsideLaboratory,,82438,CPT,Facility,Both,,,90,60,51,17.196,60,Medica,Individual & Family,59.46,99.1,,percent of total billed charges,,
Chloride; Other Source (Mayo)OutsideLaboratory,,82438,CPT,Facility,Outpatient,,,90,60,51,17.196,60,Medica,Medica Advantage Solution,29.88,49.8,,percent of total billed charges,,
Chloride; Other Source (Mayo)OutsideLaboratory,,82438,CPT,Facility,Inpatient,,,90,60,51,17.196,60,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Chloride; Other Source (Mayo)OutsideLaboratory,,82438,CPT,Facility,Outpatient,,,90,60,51,17.196,60,Medica,Medical Assistance,26.76,44.6,,percent of total billed charges,,
Chloride; Other Source (Mayo)OutsideLaboratory,,82438,CPT,Facility,Inpatient,,,90,60,51,17.196,60,Medica,Medical Assistance,,,,,Included in per diem rate,
Chloride; Other Source (Mayo)OutsideLaboratory,,82438,CPT,Facility,Outpatient,,,90,60,51,17.196,60,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,29.88,49.8,,percent of total billed charges,,
Chloride; Other Source (Mayo)OutsideLaboratory,,82438,CPT,Facility,Inpatient,,,90,60,51,17.196,60,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Chloride; Other Source (Mayo)OutsideLaboratory,,82438,CPT,Facility,Both,,,90,60,51,17.196,60,"Multiplan, Inc.","Multiplan, Inc.",56.4,94,,percent of total billed charges,,
Chloride; Other Source (Mayo)OutsideLaboratory,,82438,CPT,Facility,Outpatient,,,90,60,51,17.196,60,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,51.84,86.4,,percent of total billed charges,,
Chloride; Other Source (Mayo)OutsideLaboratory,,82438,CPT,Facility,Inpatient,,,90,60,51,17.196,60,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Chloride; Other Source (Mayo)OutsideLaboratory,,82438,CPT,Facility,Both,,,90,60,51,17.196,60,"Preferred One Administrative Services, INC.",PPO,59.16,98.6,,percent of total billed charges,,
Chloride; Other Source (Mayo)OutsideLaboratory,,82438,CPT,Facility,Outpatient,,,90,60,51,17.196,60,PrimeWest Health,Minnesota Senior Health Options (MSHO),30.87,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Chloride; Other Source (Mayo)OutsideLaboratory,,82438,CPT,Facility,Inpatient,,,90,60,51,17.196,60,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Chloride; Other Source (Mayo)OutsideLaboratory,,82438,CPT,Facility,Outpatient,,,90,60,51,17.196,60,PrimeWest Health,MinnesotaCare,30.816,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Chloride; Other Source (Mayo)OutsideLaboratory,,82438,CPT,Facility,Inpatient,,,90,60,51,17.196,60,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Chloride; Other Source (Mayo)OutsideLaboratory,,82438,CPT,Facility,Both,,,90,60,51,17.196,60,Sanford Health Plan,Sanford Health Plan,55.2,92,,percent of total billed charges,,
Chloride; Other Source (Mayo)OutsideLaboratory,,82438,CPT,Facility,Outpatient,,,90,60,51,17.196,60,"UCare Health, Inc.",Individual & Family Plan,33.81,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Chloride; Other Source (Mayo)OutsideLaboratory,,82438,CPT,Facility,Inpatient,,,90,60,51,17.196,60,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Chloride; Other Source (Mayo)OutsideLaboratory,,82438,CPT,Facility,Outpatient,,,90,60,51,17.196,60,"UCare Health, Inc.",Medical Assistance,30.282,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Chloride; Other Source (Mayo)OutsideLaboratory,,82438,CPT,Facility,Inpatient,,,90,60,51,17.196,60,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Chloride; Other Source (Mayo)OutsideLaboratory,,82438,CPT,Facility,Outpatient,,,90,60,51,17.196,60,"UCare Health, Inc.",Medicare Advantage,30.282,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Chloride; Other Source (Mayo)OutsideLaboratory,,82438,CPT,Facility,Inpatient,,,90,60,51,17.196,60,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Chloride; Other Source (Mayo)OutsideLaboratory,,82438,CPT,Facility,Outpatient,,,90,60,51,17.196,60,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),30.282,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Chloride; Other Source (Mayo)OutsideLaboratory,,82438,CPT,Facility,Inpatient,,,90,60,51,17.196,60,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Chloride; Other Source (Mayo)OutsideLaboratory,,82438,CPT,Facility,Both,,,90,60,51,17.196,60,UnitedHealthcare,Individual & Family,56.4,94,,percent of total billed charges,,
Chloride; Other Source (Mayo)OutsideLaboratory,,82438,CPT,Facility,Outpatient,,,90,60,51,17.196,60,UnitedHealthcare,Medicare Advantage,29.4,49,,percent of total billed charges,,
Chloride; Other Source (Mayo)OutsideLaboratory,,82438,CPT,Facility,Inpatient,,,90,60,51,17.196,60,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Chloride; Other Source (Mayo)OutsideLaboratory,,82438,CPT,Facility,Outpatient,,,90,60,51,17.196,60,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,28.8,48,,percent of total billed charges,,100% of DHS outpatient percentage
Chloride; Other Source (Mayo)OutsideLaboratory,,82438,CPT,Facility,Inpatient,,,90,60,51,17.196,60,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Chromium, S (Mayo)OutsideLaboratory",,82495,CPT,Facility,Both,,,90,73,62.05,20.9218,73,Aetna,Commercial,67.16,92,,percent of total billed charges,,
"Chromium, S (Mayo)OutsideLaboratory",,82495,CPT,Facility,Outpatient,,,90,73,62.05,20.9218,73,Aetna,Medicare Advantage,35.77,49,,percent of total billed charges,,
"Chromium, S (Mayo)OutsideLaboratory",,82495,CPT,Facility,Inpatient,,,90,73,62.05,20.9218,73,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Chromium, S (Mayo)OutsideLaboratory",,82495,CPT,Facility,Both,,,90,73,62.05,20.9218,73,Aetna,PPO,67.89,93,,percent of total billed charges,,
"Chromium, S (Mayo)OutsideLaboratory",,82495,CPT,Facility,Both,,,90,73,62.05,20.9218,73,America's PPO,America's PPO,70.1019,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Chromium, S (Mayo)OutsideLaboratory",,82495,CPT,Facility,Both,,,90,73,62.05,20.9218,73,BlueCross BlueShield Minnesota, Federal Employee Program,71.832,98.4,,percent of total billed charges,,
"Chromium, S (Mayo)OutsideLaboratory",,82495,CPT,Facility,Both,,,90,73,62.05,20.9218,73,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,73,100,,percent of total billed charges,,
"Chromium, S (Mayo)OutsideLaboratory",,82495,CPT,Facility,Both,,,90,73,62.05,20.9218,73,BlueCross BlueShield Minnesota,High Value Network Plan,65.7,90,,percent of total billed charges,,
"Chromium, S (Mayo)OutsideLaboratory",,82495,CPT,Facility,Outpatient,,,90,73,62.05,20.9218,73,BlueCross BlueShield Minnesota,Medicare Advantage,35.77,49,,percent of total billed charges,,
"Chromium, S (Mayo)OutsideLaboratory",,82495,CPT,Facility,Inpatient,,,90,73,62.05,20.9218,73,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Chromium, S (Mayo)OutsideLaboratory",,82495,CPT,Facility,Both,,,90,73,62.05,20.9218,73,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,64.6561,88.57,,percent of total billed charges,,
"Chromium, S (Mayo)OutsideLaboratory",,82495,CPT,Facility,Both,,,90,73,62.05,20.9218,73,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,20.9218,28.66,,percent of total billed charges,,
"Chromium, S (Mayo)OutsideLaboratory",,82495,CPT,Facility,Outpatient,,,90,73,62.05,20.9218,73,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),35.77,49,,percent of total billed charges,,
"Chromium, S (Mayo)OutsideLaboratory",,82495,CPT,Facility,Inpatient,,,90,73,62.05,20.9218,73,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Chromium, S (Mayo)OutsideLaboratory",,82495,CPT,Facility,Both,,,90,73,62.05,20.9218,73,CorVel,Worker's Compensation,73,100,,percent of total billed charges,,
"Chromium, S (Mayo)OutsideLaboratory",,82495,CPT,Facility,Both,,,90,73,62.05,20.9218,73,First Health Group Corporation,First Health Network,70.81,97,,percent of total billed charges,,
"Chromium, S (Mayo)OutsideLaboratory",,82495,CPT,Facility,Both,,,90,73,62.05,20.9218,73,"Health Partners, Inc.",Commercial,69.058,94.6,,percent of total billed charges,,
"Chromium, S (Mayo)OutsideLaboratory",,82495,CPT,Facility,Outpatient,,,90,73,62.05,20.9218,73,"Health Partners, Inc.",Medicare Advantage,35.77,49,,percent of total billed charges,,
"Chromium, S (Mayo)OutsideLaboratory",,82495,CPT,Facility,Inpatient,,,90,73,62.05,20.9218,73,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Chromium, S (Mayo)OutsideLaboratory",,82495,CPT,Facility,Both,,,90,73,62.05,20.9218,73,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),43.8,60,,percent of total billed charges,,
"Chromium, S (Mayo)OutsideLaboratory",,82495,CPT,Facility,Both,,,90,73,62.05,20.9218,73,"Health Partners, Inc.",State of Minnesota Advantage Program,59.495,81.5,,percent of total billed charges,,
"Chromium, S (Mayo)OutsideLaboratory",,82495,CPT,Facility,Both,,,90,73,62.05,20.9218,73,"Health Partners, Inc.",State Public Programs,36.5,50,,percent of total billed charges,,
"Chromium, S (Mayo)OutsideLaboratory",,82495,CPT,Facility,Both,,,90,73,62.05,20.9218,73,Humana Insurance Company,Commercial PPO,69.35,95,,percent of total billed charges,,
"Chromium, S (Mayo)OutsideLaboratory",,82495,CPT,Facility,Outpatient,,,90,73,62.05,20.9218,73,Humana Insurance Company,Medicare PPO,35.77,49,,percent of total billed charges,,
"Chromium, S (Mayo)OutsideLaboratory",,82495,CPT,Facility,Inpatient,,,90,73,62.05,20.9218,73,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Chromium, S (Mayo)OutsideLaboratory",,82495,CPT,Facility,Both,,,90,73,62.05,20.9218,73,Medica,Individual & Family,72.343,99.1,,percent of total billed charges,,
"Chromium, S (Mayo)OutsideLaboratory",,82495,CPT,Facility,Outpatient,,,90,73,62.05,20.9218,73,Medica,Medica Advantage Solution,36.354,49.8,,percent of total billed charges,,
"Chromium, S (Mayo)OutsideLaboratory",,82495,CPT,Facility,Inpatient,,,90,73,62.05,20.9218,73,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Chromium, S (Mayo)OutsideLaboratory",,82495,CPT,Facility,Outpatient,,,90,73,62.05,20.9218,73,Medica,Medical Assistance,32.558,44.6,,percent of total billed charges,,
"Chromium, S (Mayo)OutsideLaboratory",,82495,CPT,Facility,Inpatient,,,90,73,62.05,20.9218,73,Medica,Medical Assistance,,,,,Included in per diem rate,
"Chromium, S (Mayo)OutsideLaboratory",,82495,CPT,Facility,Outpatient,,,90,73,62.05,20.9218,73,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,36.354,49.8,,percent of total billed charges,,
"Chromium, S (Mayo)OutsideLaboratory",,82495,CPT,Facility,Inpatient,,,90,73,62.05,20.9218,73,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Chromium, S (Mayo)OutsideLaboratory",,82495,CPT,Facility,Both,,,90,73,62.05,20.9218,73,"Multiplan, Inc.","Multiplan, Inc.",68.62,94,,percent of total billed charges,,
"Chromium, S (Mayo)OutsideLaboratory",,82495,CPT,Facility,Outpatient,,,90,73,62.05,20.9218,73,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,63.072,86.4,,percent of total billed charges,,
"Chromium, S (Mayo)OutsideLaboratory",,82495,CPT,Facility,Inpatient,,,90,73,62.05,20.9218,73,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Chromium, S (Mayo)OutsideLaboratory",,82495,CPT,Facility,Both,,,90,73,62.05,20.9218,73,"Preferred One Administrative Services, INC.",PPO,71.978,98.6,,percent of total billed charges,,
"Chromium, S (Mayo)OutsideLaboratory",,82495,CPT,Facility,Outpatient,,,90,73,62.05,20.9218,73,PrimeWest Health,Minnesota Senior Health Options (MSHO),37.5585,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Chromium, S (Mayo)OutsideLaboratory",,82495,CPT,Facility,Inpatient,,,90,73,62.05,20.9218,73,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Chromium, S (Mayo)OutsideLaboratory",,82495,CPT,Facility,Outpatient,,,90,73,62.05,20.9218,73,PrimeWest Health,MinnesotaCare,37.4928,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Chromium, S (Mayo)OutsideLaboratory",,82495,CPT,Facility,Inpatient,,,90,73,62.05,20.9218,73,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Chromium, S (Mayo)OutsideLaboratory",,82495,CPT,Facility,Both,,,90,73,62.05,20.9218,73,Sanford Health Plan,Sanford Health Plan,67.16,92,,percent of total billed charges,,
"Chromium, S (Mayo)OutsideLaboratory",,82495,CPT,Facility,Outpatient,,,90,73,62.05,20.9218,73,"UCare Health, Inc.",Individual & Family Plan,41.1355,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Chromium, S (Mayo)OutsideLaboratory",,82495,CPT,Facility,Inpatient,,,90,73,62.05,20.9218,73,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Chromium, S (Mayo)OutsideLaboratory",,82495,CPT,Facility,Outpatient,,,90,73,62.05,20.9218,73,"UCare Health, Inc.",Medical Assistance,36.8431,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Chromium, S (Mayo)OutsideLaboratory",,82495,CPT,Facility,Inpatient,,,90,73,62.05,20.9218,73,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Chromium, S (Mayo)OutsideLaboratory",,82495,CPT,Facility,Outpatient,,,90,73,62.05,20.9218,73,"UCare Health, Inc.",Medicare Advantage,36.8431,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Chromium, S (Mayo)OutsideLaboratory",,82495,CPT,Facility,Inpatient,,,90,73,62.05,20.9218,73,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Chromium, S (Mayo)OutsideLaboratory",,82495,CPT,Facility,Outpatient,,,90,73,62.05,20.9218,73,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),36.8431,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Chromium, S (Mayo)OutsideLaboratory",,82495,CPT,Facility,Inpatient,,,90,73,62.05,20.9218,73,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Chromium, S (Mayo)OutsideLaboratory",,82495,CPT,Facility,Both,,,90,73,62.05,20.9218,73,UnitedHealthcare,Individual & Family,68.62,94,,percent of total billed charges,,
"Chromium, S (Mayo)OutsideLaboratory",,82495,CPT,Facility,Outpatient,,,90,73,62.05,20.9218,73,UnitedHealthcare,Medicare Advantage,35.77,49,,percent of total billed charges,,
"Chromium, S (Mayo)OutsideLaboratory",,82495,CPT,Facility,Inpatient,,,90,73,62.05,20.9218,73,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Chromium, S (Mayo)OutsideLaboratory",,82495,CPT,Facility,Outpatient,,,90,73,62.05,20.9218,73,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,35.04,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Chromium, S (Mayo)OutsideLaboratory",,82495,CPT,Facility,Inpatient,,,90,73,62.05,20.9218,73,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Citrate Excretion, 24 Hour, Urine (Mayo)OutsideLaboratory",,82507,CPT,Facility,Both,,,90,125,106.25,35.825,125,Aetna,Commercial,115,92,,percent of total billed charges,,
"Citrate Excretion, 24 Hour, Urine (Mayo)OutsideLaboratory",,82507,CPT,Facility,Outpatient,,,90,125,106.25,35.825,125,Aetna,Medicare Advantage,61.25,49,,percent of total billed charges,,
"Citrate Excretion, 24 Hour, Urine (Mayo)OutsideLaboratory",,82507,CPT,Facility,Inpatient,,,90,125,106.25,35.825,125,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Citrate Excretion, 24 Hour, Urine (Mayo)OutsideLaboratory",,82507,CPT,Facility,Both,,,90,125,106.25,35.825,125,Aetna,PPO,116.25,93,,percent of total billed charges,,
"Citrate Excretion, 24 Hour, Urine (Mayo)OutsideLaboratory",,82507,CPT,Facility,Both,,,90,125,106.25,35.825,125,America's PPO,America's PPO,120.0375,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Citrate Excretion, 24 Hour, Urine (Mayo)OutsideLaboratory",,82507,CPT,Facility,Both,,,90,125,106.25,35.825,125,BlueCross BlueShield Minnesota, Federal Employee Program,123,98.4,,percent of total billed charges,,
"Citrate Excretion, 24 Hour, Urine (Mayo)OutsideLaboratory",,82507,CPT,Facility,Both,,,90,125,106.25,35.825,125,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,125,100,,percent of total billed charges,,
"Citrate Excretion, 24 Hour, Urine (Mayo)OutsideLaboratory",,82507,CPT,Facility,Both,,,90,125,106.25,35.825,125,BlueCross BlueShield Minnesota,High Value Network Plan,112.5,90,,percent of total billed charges,,
"Citrate Excretion, 24 Hour, Urine (Mayo)OutsideLaboratory",,82507,CPT,Facility,Outpatient,,,90,125,106.25,35.825,125,BlueCross BlueShield Minnesota,Medicare Advantage,61.25,49,,percent of total billed charges,,
"Citrate Excretion, 24 Hour, Urine (Mayo)OutsideLaboratory",,82507,CPT,Facility,Inpatient,,,90,125,106.25,35.825,125,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Citrate Excretion, 24 Hour, Urine (Mayo)OutsideLaboratory",,82507,CPT,Facility,Both,,,90,125,106.25,35.825,125,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,110.7125,88.57,,percent of total billed charges,,
"Citrate Excretion, 24 Hour, Urine (Mayo)OutsideLaboratory",,82507,CPT,Facility,Both,,,90,125,106.25,35.825,125,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,35.825,28.66,,percent of total billed charges,,
"Citrate Excretion, 24 Hour, Urine (Mayo)OutsideLaboratory",,82507,CPT,Facility,Outpatient,,,90,125,106.25,35.825,125,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),61.25,49,,percent of total billed charges,,
"Citrate Excretion, 24 Hour, Urine (Mayo)OutsideLaboratory",,82507,CPT,Facility,Inpatient,,,90,125,106.25,35.825,125,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Citrate Excretion, 24 Hour, Urine (Mayo)OutsideLaboratory",,82507,CPT,Facility,Both,,,90,125,106.25,35.825,125,CorVel,Worker's Compensation,125,100,,percent of total billed charges,,
"Citrate Excretion, 24 Hour, Urine (Mayo)OutsideLaboratory",,82507,CPT,Facility,Both,,,90,125,106.25,35.825,125,First Health Group Corporation,First Health Network,121.25,97,,percent of total billed charges,,
"Citrate Excretion, 24 Hour, Urine (Mayo)OutsideLaboratory",,82507,CPT,Facility,Both,,,90,125,106.25,35.825,125,"Health Partners, Inc.",Commercial,118.25,94.6,,percent of total billed charges,,
"Citrate Excretion, 24 Hour, Urine (Mayo)OutsideLaboratory",,82507,CPT,Facility,Outpatient,,,90,125,106.25,35.825,125,"Health Partners, Inc.",Medicare Advantage,61.25,49,,percent of total billed charges,,
"Citrate Excretion, 24 Hour, Urine (Mayo)OutsideLaboratory",,82507,CPT,Facility,Inpatient,,,90,125,106.25,35.825,125,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Citrate Excretion, 24 Hour, Urine (Mayo)OutsideLaboratory",,82507,CPT,Facility,Both,,,90,125,106.25,35.825,125,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),75,60,,percent of total billed charges,,
"Citrate Excretion, 24 Hour, Urine (Mayo)OutsideLaboratory",,82507,CPT,Facility,Both,,,90,125,106.25,35.825,125,"Health Partners, Inc.",State of Minnesota Advantage Program,101.875,81.5,,percent of total billed charges,,
"Citrate Excretion, 24 Hour, Urine (Mayo)OutsideLaboratory",,82507,CPT,Facility,Both,,,90,125,106.25,35.825,125,"Health Partners, Inc.",State Public Programs,62.5,50,,percent of total billed charges,,
"Citrate Excretion, 24 Hour, Urine (Mayo)OutsideLaboratory",,82507,CPT,Facility,Both,,,90,125,106.25,35.825,125,Humana Insurance Company,Commercial PPO,118.75,95,,percent of total billed charges,,
"Citrate Excretion, 24 Hour, Urine (Mayo)OutsideLaboratory",,82507,CPT,Facility,Outpatient,,,90,125,106.25,35.825,125,Humana Insurance Company,Medicare PPO,61.25,49,,percent of total billed charges,,
"Citrate Excretion, 24 Hour, Urine (Mayo)OutsideLaboratory",,82507,CPT,Facility,Inpatient,,,90,125,106.25,35.825,125,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Citrate Excretion, 24 Hour, Urine (Mayo)OutsideLaboratory",,82507,CPT,Facility,Both,,,90,125,106.25,35.825,125,Medica,Individual & Family,123.875,99.1,,percent of total billed charges,,
"Citrate Excretion, 24 Hour, Urine (Mayo)OutsideLaboratory",,82507,CPT,Facility,Outpatient,,,90,125,106.25,35.825,125,Medica,Medica Advantage Solution,62.25,49.8,,percent of total billed charges,,
"Citrate Excretion, 24 Hour, Urine (Mayo)OutsideLaboratory",,82507,CPT,Facility,Inpatient,,,90,125,106.25,35.825,125,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Citrate Excretion, 24 Hour, Urine (Mayo)OutsideLaboratory",,82507,CPT,Facility,Outpatient,,,90,125,106.25,35.825,125,Medica,Medical Assistance,55.75,44.6,,percent of total billed charges,,
"Citrate Excretion, 24 Hour, Urine (Mayo)OutsideLaboratory",,82507,CPT,Facility,Inpatient,,,90,125,106.25,35.825,125,Medica,Medical Assistance,,,,,Included in per diem rate,
"Citrate Excretion, 24 Hour, Urine (Mayo)OutsideLaboratory",,82507,CPT,Facility,Outpatient,,,90,125,106.25,35.825,125,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,62.25,49.8,,percent of total billed charges,,
"Citrate Excretion, 24 Hour, Urine (Mayo)OutsideLaboratory",,82507,CPT,Facility,Inpatient,,,90,125,106.25,35.825,125,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Citrate Excretion, 24 Hour, Urine (Mayo)OutsideLaboratory",,82507,CPT,Facility,Both,,,90,125,106.25,35.825,125,"Multiplan, Inc.","Multiplan, Inc.",117.5,94,,percent of total billed charges,,
"Citrate Excretion, 24 Hour, Urine (Mayo)OutsideLaboratory",,82507,CPT,Facility,Outpatient,,,90,125,106.25,35.825,125,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,108,86.4,,percent of total billed charges,,
"Citrate Excretion, 24 Hour, Urine (Mayo)OutsideLaboratory",,82507,CPT,Facility,Inpatient,,,90,125,106.25,35.825,125,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Citrate Excretion, 24 Hour, Urine (Mayo)OutsideLaboratory",,82507,CPT,Facility,Both,,,90,125,106.25,35.825,125,"Preferred One Administrative Services, INC.",PPO,123.25,98.6,,percent of total billed charges,,
"Citrate Excretion, 24 Hour, Urine (Mayo)OutsideLaboratory",,82507,CPT,Facility,Outpatient,,,90,125,106.25,35.825,125,PrimeWest Health,Minnesota Senior Health Options (MSHO),64.3125,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Citrate Excretion, 24 Hour, Urine (Mayo)OutsideLaboratory",,82507,CPT,Facility,Inpatient,,,90,125,106.25,35.825,125,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Citrate Excretion, 24 Hour, Urine (Mayo)OutsideLaboratory",,82507,CPT,Facility,Outpatient,,,90,125,106.25,35.825,125,PrimeWest Health,MinnesotaCare,64.2,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Citrate Excretion, 24 Hour, Urine (Mayo)OutsideLaboratory",,82507,CPT,Facility,Inpatient,,,90,125,106.25,35.825,125,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Citrate Excretion, 24 Hour, Urine (Mayo)OutsideLaboratory",,82507,CPT,Facility,Both,,,90,125,106.25,35.825,125,Sanford Health Plan,Sanford Health Plan,115,92,,percent of total billed charges,,
"Citrate Excretion, 24 Hour, Urine (Mayo)OutsideLaboratory",,82507,CPT,Facility,Outpatient,,,90,125,106.25,35.825,125,"UCare Health, Inc.",Individual & Family Plan,70.4375,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Citrate Excretion, 24 Hour, Urine (Mayo)OutsideLaboratory",,82507,CPT,Facility,Inpatient,,,90,125,106.25,35.825,125,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Citrate Excretion, 24 Hour, Urine (Mayo)OutsideLaboratory",,82507,CPT,Facility,Outpatient,,,90,125,106.25,35.825,125,"UCare Health, Inc.",Medical Assistance,63.0875,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Citrate Excretion, 24 Hour, Urine (Mayo)OutsideLaboratory",,82507,CPT,Facility,Inpatient,,,90,125,106.25,35.825,125,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Citrate Excretion, 24 Hour, Urine (Mayo)OutsideLaboratory",,82507,CPT,Facility,Outpatient,,,90,125,106.25,35.825,125,"UCare Health, Inc.",Medicare Advantage,63.0875,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Citrate Excretion, 24 Hour, Urine (Mayo)OutsideLaboratory",,82507,CPT,Facility,Inpatient,,,90,125,106.25,35.825,125,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Citrate Excretion, 24 Hour, Urine (Mayo)OutsideLaboratory",,82507,CPT,Facility,Outpatient,,,90,125,106.25,35.825,125,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),63.0875,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Citrate Excretion, 24 Hour, Urine (Mayo)OutsideLaboratory",,82507,CPT,Facility,Inpatient,,,90,125,106.25,35.825,125,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Citrate Excretion, 24 Hour, Urine (Mayo)OutsideLaboratory",,82507,CPT,Facility,Both,,,90,125,106.25,35.825,125,UnitedHealthcare,Individual & Family,117.5,94,,percent of total billed charges,,
"Citrate Excretion, 24 Hour, Urine (Mayo)OutsideLaboratory",,82507,CPT,Facility,Outpatient,,,90,125,106.25,35.825,125,UnitedHealthcare,Medicare Advantage,61.25,49,,percent of total billed charges,,
"Citrate Excretion, 24 Hour, Urine (Mayo)OutsideLaboratory",,82507,CPT,Facility,Inpatient,,,90,125,106.25,35.825,125,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Citrate Excretion, 24 Hour, Urine (Mayo)OutsideLaboratory",,82507,CPT,Facility,Outpatient,,,90,125,106.25,35.825,125,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,60,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Citrate Excretion, 24 Hour, Urine (Mayo)OutsideLaboratory",,82507,CPT,Facility,Inpatient,,,90,125,106.25,35.825,125,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Citrate Excretion, U (Mayo)OutsideLaboratory",,82507,CPT,Facility,Both,,,90,125,106.25,35.825,125,Aetna,Commercial,115,92,,percent of total billed charges,,
"Citrate Excretion, U (Mayo)OutsideLaboratory",,82507,CPT,Facility,Outpatient,,,90,125,106.25,35.825,125,Aetna,Medicare Advantage,61.25,49,,percent of total billed charges,,
"Citrate Excretion, U (Mayo)OutsideLaboratory",,82507,CPT,Facility,Inpatient,,,90,125,106.25,35.825,125,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Citrate Excretion, U (Mayo)OutsideLaboratory",,82507,CPT,Facility,Both,,,90,125,106.25,35.825,125,Aetna,PPO,116.25,93,,percent of total billed charges,,
"Citrate Excretion, U (Mayo)OutsideLaboratory",,82507,CPT,Facility,Both,,,90,125,106.25,35.825,125,America's PPO,America's PPO,120.0375,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Citrate Excretion, U (Mayo)OutsideLaboratory",,82507,CPT,Facility,Both,,,90,125,106.25,35.825,125,BlueCross BlueShield Minnesota, Federal Employee Program,123,98.4,,percent of total billed charges,,
"Citrate Excretion, U (Mayo)OutsideLaboratory",,82507,CPT,Facility,Both,,,90,125,106.25,35.825,125,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,125,100,,percent of total billed charges,,
"Citrate Excretion, U (Mayo)OutsideLaboratory",,82507,CPT,Facility,Both,,,90,125,106.25,35.825,125,BlueCross BlueShield Minnesota,High Value Network Plan,112.5,90,,percent of total billed charges,,
"Citrate Excretion, U (Mayo)OutsideLaboratory",,82507,CPT,Facility,Outpatient,,,90,125,106.25,35.825,125,BlueCross BlueShield Minnesota,Medicare Advantage,61.25,49,,percent of total billed charges,,
"Citrate Excretion, U (Mayo)OutsideLaboratory",,82507,CPT,Facility,Inpatient,,,90,125,106.25,35.825,125,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Citrate Excretion, U (Mayo)OutsideLaboratory",,82507,CPT,Facility,Both,,,90,125,106.25,35.825,125,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,110.7125,88.57,,percent of total billed charges,,
"Citrate Excretion, U (Mayo)OutsideLaboratory",,82507,CPT,Facility,Both,,,90,125,106.25,35.825,125,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,35.825,28.66,,percent of total billed charges,,
"Citrate Excretion, U (Mayo)OutsideLaboratory",,82507,CPT,Facility,Outpatient,,,90,125,106.25,35.825,125,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),61.25,49,,percent of total billed charges,,
"Citrate Excretion, U (Mayo)OutsideLaboratory",,82507,CPT,Facility,Inpatient,,,90,125,106.25,35.825,125,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Citrate Excretion, U (Mayo)OutsideLaboratory",,82507,CPT,Facility,Both,,,90,125,106.25,35.825,125,CorVel,Worker's Compensation,125,100,,percent of total billed charges,,
"Citrate Excretion, U (Mayo)OutsideLaboratory",,82507,CPT,Facility,Both,,,90,125,106.25,35.825,125,First Health Group Corporation,First Health Network,121.25,97,,percent of total billed charges,,
"Citrate Excretion, U (Mayo)OutsideLaboratory",,82507,CPT,Facility,Both,,,90,125,106.25,35.825,125,"Health Partners, Inc.",Commercial,118.25,94.6,,percent of total billed charges,,
"Citrate Excretion, U (Mayo)OutsideLaboratory",,82507,CPT,Facility,Outpatient,,,90,125,106.25,35.825,125,"Health Partners, Inc.",Medicare Advantage,61.25,49,,percent of total billed charges,,
"Citrate Excretion, U (Mayo)OutsideLaboratory",,82507,CPT,Facility,Inpatient,,,90,125,106.25,35.825,125,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Citrate Excretion, U (Mayo)OutsideLaboratory",,82507,CPT,Facility,Both,,,90,125,106.25,35.825,125,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),75,60,,percent of total billed charges,,
"Citrate Excretion, U (Mayo)OutsideLaboratory",,82507,CPT,Facility,Both,,,90,125,106.25,35.825,125,"Health Partners, Inc.",State of Minnesota Advantage Program,101.875,81.5,,percent of total billed charges,,
"Citrate Excretion, U (Mayo)OutsideLaboratory",,82507,CPT,Facility,Both,,,90,125,106.25,35.825,125,"Health Partners, Inc.",State Public Programs,62.5,50,,percent of total billed charges,,
"Citrate Excretion, U (Mayo)OutsideLaboratory",,82507,CPT,Facility,Both,,,90,125,106.25,35.825,125,Humana Insurance Company,Commercial PPO,118.75,95,,percent of total billed charges,,
"Citrate Excretion, U (Mayo)OutsideLaboratory",,82507,CPT,Facility,Outpatient,,,90,125,106.25,35.825,125,Humana Insurance Company,Medicare PPO,61.25,49,,percent of total billed charges,,
"Citrate Excretion, U (Mayo)OutsideLaboratory",,82507,CPT,Facility,Inpatient,,,90,125,106.25,35.825,125,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Citrate Excretion, U (Mayo)OutsideLaboratory",,82507,CPT,Facility,Both,,,90,125,106.25,35.825,125,Medica,Individual & Family,123.875,99.1,,percent of total billed charges,,
"Citrate Excretion, U (Mayo)OutsideLaboratory",,82507,CPT,Facility,Outpatient,,,90,125,106.25,35.825,125,Medica,Medica Advantage Solution,62.25,49.8,,percent of total billed charges,,
"Citrate Excretion, U (Mayo)OutsideLaboratory",,82507,CPT,Facility,Inpatient,,,90,125,106.25,35.825,125,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Citrate Excretion, U (Mayo)OutsideLaboratory",,82507,CPT,Facility,Outpatient,,,90,125,106.25,35.825,125,Medica,Medical Assistance,55.75,44.6,,percent of total billed charges,,
"Citrate Excretion, U (Mayo)OutsideLaboratory",,82507,CPT,Facility,Inpatient,,,90,125,106.25,35.825,125,Medica,Medical Assistance,,,,,Included in per diem rate,
"Citrate Excretion, U (Mayo)OutsideLaboratory",,82507,CPT,Facility,Outpatient,,,90,125,106.25,35.825,125,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,62.25,49.8,,percent of total billed charges,,
"Citrate Excretion, U (Mayo)OutsideLaboratory",,82507,CPT,Facility,Inpatient,,,90,125,106.25,35.825,125,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Citrate Excretion, U (Mayo)OutsideLaboratory",,82507,CPT,Facility,Both,,,90,125,106.25,35.825,125,"Multiplan, Inc.","Multiplan, Inc.",117.5,94,,percent of total billed charges,,
"Citrate Excretion, U (Mayo)OutsideLaboratory",,82507,CPT,Facility,Outpatient,,,90,125,106.25,35.825,125,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,108,86.4,,percent of total billed charges,,
"Citrate Excretion, U (Mayo)OutsideLaboratory",,82507,CPT,Facility,Inpatient,,,90,125,106.25,35.825,125,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Citrate Excretion, U (Mayo)OutsideLaboratory",,82507,CPT,Facility,Both,,,90,125,106.25,35.825,125,"Preferred One Administrative Services, INC.",PPO,123.25,98.6,,percent of total billed charges,,
"Citrate Excretion, U (Mayo)OutsideLaboratory",,82507,CPT,Facility,Outpatient,,,90,125,106.25,35.825,125,PrimeWest Health,Minnesota Senior Health Options (MSHO),64.3125,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Citrate Excretion, U (Mayo)OutsideLaboratory",,82507,CPT,Facility,Inpatient,,,90,125,106.25,35.825,125,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Citrate Excretion, U (Mayo)OutsideLaboratory",,82507,CPT,Facility,Outpatient,,,90,125,106.25,35.825,125,PrimeWest Health,MinnesotaCare,64.2,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Citrate Excretion, U (Mayo)OutsideLaboratory",,82507,CPT,Facility,Inpatient,,,90,125,106.25,35.825,125,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Citrate Excretion, U (Mayo)OutsideLaboratory",,82507,CPT,Facility,Both,,,90,125,106.25,35.825,125,Sanford Health Plan,Sanford Health Plan,115,92,,percent of total billed charges,,
"Citrate Excretion, U (Mayo)OutsideLaboratory",,82507,CPT,Facility,Outpatient,,,90,125,106.25,35.825,125,"UCare Health, Inc.",Individual & Family Plan,70.4375,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Citrate Excretion, U (Mayo)OutsideLaboratory",,82507,CPT,Facility,Inpatient,,,90,125,106.25,35.825,125,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Citrate Excretion, U (Mayo)OutsideLaboratory",,82507,CPT,Facility,Outpatient,,,90,125,106.25,35.825,125,"UCare Health, Inc.",Medical Assistance,63.0875,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Citrate Excretion, U (Mayo)OutsideLaboratory",,82507,CPT,Facility,Inpatient,,,90,125,106.25,35.825,125,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Citrate Excretion, U (Mayo)OutsideLaboratory",,82507,CPT,Facility,Outpatient,,,90,125,106.25,35.825,125,"UCare Health, Inc.",Medicare Advantage,63.0875,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Citrate Excretion, U (Mayo)OutsideLaboratory",,82507,CPT,Facility,Inpatient,,,90,125,106.25,35.825,125,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Citrate Excretion, U (Mayo)OutsideLaboratory",,82507,CPT,Facility,Outpatient,,,90,125,106.25,35.825,125,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),63.0875,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Citrate Excretion, U (Mayo)OutsideLaboratory",,82507,CPT,Facility,Inpatient,,,90,125,106.25,35.825,125,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Citrate Excretion, U (Mayo)OutsideLaboratory",,82507,CPT,Facility,Both,,,90,125,106.25,35.825,125,UnitedHealthcare,Individual & Family,117.5,94,,percent of total billed charges,,
"Citrate Excretion, U (Mayo)OutsideLaboratory",,82507,CPT,Facility,Outpatient,,,90,125,106.25,35.825,125,UnitedHealthcare,Medicare Advantage,61.25,49,,percent of total billed charges,,
"Citrate Excretion, U (Mayo)OutsideLaboratory",,82507,CPT,Facility,Inpatient,,,90,125,106.25,35.825,125,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Citrate Excretion, U (Mayo)OutsideLaboratory",,82507,CPT,Facility,Outpatient,,,90,125,106.25,35.825,125,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,60,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Citrate Excretion, U (Mayo)OutsideLaboratory",,82507,CPT,Facility,Inpatient,,,90,125,106.25,35.825,125,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Beta-Crosslaps (B-Ctx), S (Mayo)OutsideLaboratory",,82523,CPT,Facility,Both,,,90,102,86.7,29.2332,102,Aetna,Commercial,93.84,92,,percent of total billed charges,,
"Beta-Crosslaps (B-Ctx), S (Mayo)OutsideLaboratory",,82523,CPT,Facility,Outpatient,,,90,102,86.7,29.2332,102,Aetna,Medicare Advantage,49.98,49,,percent of total billed charges,,
"Beta-Crosslaps (B-Ctx), S (Mayo)OutsideLaboratory",,82523,CPT,Facility,Inpatient,,,90,102,86.7,29.2332,102,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Beta-Crosslaps (B-Ctx), S (Mayo)OutsideLaboratory",,82523,CPT,Facility,Both,,,90,102,86.7,29.2332,102,Aetna,PPO,94.86,93,,percent of total billed charges,,
"Beta-Crosslaps (B-Ctx), S (Mayo)OutsideLaboratory",,82523,CPT,Facility,Both,,,90,102,86.7,29.2332,102,America's PPO,America's PPO,97.9506,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Beta-Crosslaps (B-Ctx), S (Mayo)OutsideLaboratory",,82523,CPT,Facility,Both,,,90,102,86.7,29.2332,102,BlueCross BlueShield Minnesota, Federal Employee Program,100.368,98.4,,percent of total billed charges,,
"Beta-Crosslaps (B-Ctx), S (Mayo)OutsideLaboratory",,82523,CPT,Facility,Both,,,90,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,102,100,,percent of total billed charges,,
"Beta-Crosslaps (B-Ctx), S (Mayo)OutsideLaboratory",,82523,CPT,Facility,Both,,,90,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,High Value Network Plan,91.8,90,,percent of total billed charges,,
"Beta-Crosslaps (B-Ctx), S (Mayo)OutsideLaboratory",,82523,CPT,Facility,Outpatient,,,90,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,Medicare Advantage,49.98,49,,percent of total billed charges,,
"Beta-Crosslaps (B-Ctx), S (Mayo)OutsideLaboratory",,82523,CPT,Facility,Inpatient,,,90,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Beta-Crosslaps (B-Ctx), S (Mayo)OutsideLaboratory",,82523,CPT,Facility,Both,,,90,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,90.3414,88.57,,percent of total billed charges,,
"Beta-Crosslaps (B-Ctx), S (Mayo)OutsideLaboratory",,82523,CPT,Facility,Both,,,90,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,29.2332,28.66,,percent of total billed charges,,
"Beta-Crosslaps (B-Ctx), S (Mayo)OutsideLaboratory",,82523,CPT,Facility,Outpatient,,,90,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),49.98,49,,percent of total billed charges,,
"Beta-Crosslaps (B-Ctx), S (Mayo)OutsideLaboratory",,82523,CPT,Facility,Inpatient,,,90,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Beta-Crosslaps (B-Ctx), S (Mayo)OutsideLaboratory",,82523,CPT,Facility,Both,,,90,102,86.7,29.2332,102,CorVel,Worker's Compensation,102,100,,percent of total billed charges,,
"Beta-Crosslaps (B-Ctx), S (Mayo)OutsideLaboratory",,82523,CPT,Facility,Both,,,90,102,86.7,29.2332,102,First Health Group Corporation,First Health Network,98.94,97,,percent of total billed charges,,
"Beta-Crosslaps (B-Ctx), S (Mayo)OutsideLaboratory",,82523,CPT,Facility,Both,,,90,102,86.7,29.2332,102,"Health Partners, Inc.",Commercial,96.492,94.6,,percent of total billed charges,,
"Beta-Crosslaps (B-Ctx), S (Mayo)OutsideLaboratory",,82523,CPT,Facility,Outpatient,,,90,102,86.7,29.2332,102,"Health Partners, Inc.",Medicare Advantage,49.98,49,,percent of total billed charges,,
"Beta-Crosslaps (B-Ctx), S (Mayo)OutsideLaboratory",,82523,CPT,Facility,Inpatient,,,90,102,86.7,29.2332,102,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Beta-Crosslaps (B-Ctx), S (Mayo)OutsideLaboratory",,82523,CPT,Facility,Both,,,90,102,86.7,29.2332,102,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),61.2,60,,percent of total billed charges,,
"Beta-Crosslaps (B-Ctx), S (Mayo)OutsideLaboratory",,82523,CPT,Facility,Both,,,90,102,86.7,29.2332,102,"Health Partners, Inc.",State of Minnesota Advantage Program,83.13,81.5,,percent of total billed charges,,
"Beta-Crosslaps (B-Ctx), S (Mayo)OutsideLaboratory",,82523,CPT,Facility,Both,,,90,102,86.7,29.2332,102,"Health Partners, Inc.",State Public Programs,51,50,,percent of total billed charges,,
"Beta-Crosslaps (B-Ctx), S (Mayo)OutsideLaboratory",,82523,CPT,Facility,Both,,,90,102,86.7,29.2332,102,Humana Insurance Company,Commercial PPO,96.9,95,,percent of total billed charges,,
"Beta-Crosslaps (B-Ctx), S (Mayo)OutsideLaboratory",,82523,CPT,Facility,Outpatient,,,90,102,86.7,29.2332,102,Humana Insurance Company,Medicare PPO,49.98,49,,percent of total billed charges,,
"Beta-Crosslaps (B-Ctx), S (Mayo)OutsideLaboratory",,82523,CPT,Facility,Inpatient,,,90,102,86.7,29.2332,102,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Beta-Crosslaps (B-Ctx), S (Mayo)OutsideLaboratory",,82523,CPT,Facility,Both,,,90,102,86.7,29.2332,102,Medica,Individual & Family,101.082,99.1,,percent of total billed charges,,
"Beta-Crosslaps (B-Ctx), S (Mayo)OutsideLaboratory",,82523,CPT,Facility,Outpatient,,,90,102,86.7,29.2332,102,Medica,Medica Advantage Solution,50.796,49.8,,percent of total billed charges,,
"Beta-Crosslaps (B-Ctx), S (Mayo)OutsideLaboratory",,82523,CPT,Facility,Inpatient,,,90,102,86.7,29.2332,102,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Beta-Crosslaps (B-Ctx), S (Mayo)OutsideLaboratory",,82523,CPT,Facility,Outpatient,,,90,102,86.7,29.2332,102,Medica,Medical Assistance,45.492,44.6,,percent of total billed charges,,
"Beta-Crosslaps (B-Ctx), S (Mayo)OutsideLaboratory",,82523,CPT,Facility,Inpatient,,,90,102,86.7,29.2332,102,Medica,Medical Assistance,,,,,Included in per diem rate,
"Beta-Crosslaps (B-Ctx), S (Mayo)OutsideLaboratory",,82523,CPT,Facility,Outpatient,,,90,102,86.7,29.2332,102,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,50.796,49.8,,percent of total billed charges,,
"Beta-Crosslaps (B-Ctx), S (Mayo)OutsideLaboratory",,82523,CPT,Facility,Inpatient,,,90,102,86.7,29.2332,102,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Beta-Crosslaps (B-Ctx), S (Mayo)OutsideLaboratory",,82523,CPT,Facility,Both,,,90,102,86.7,29.2332,102,"Multiplan, Inc.","Multiplan, Inc.",95.88,94,,percent of total billed charges,,
"Beta-Crosslaps (B-Ctx), S (Mayo)OutsideLaboratory",,82523,CPT,Facility,Outpatient,,,90,102,86.7,29.2332,102,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,88.128,86.4,,percent of total billed charges,,
"Beta-Crosslaps (B-Ctx), S (Mayo)OutsideLaboratory",,82523,CPT,Facility,Inpatient,,,90,102,86.7,29.2332,102,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Beta-Crosslaps (B-Ctx), S (Mayo)OutsideLaboratory",,82523,CPT,Facility,Both,,,90,102,86.7,29.2332,102,"Preferred One Administrative Services, INC.",PPO,100.572,98.6,,percent of total billed charges,,
"Beta-Crosslaps (B-Ctx), S (Mayo)OutsideLaboratory",,82523,CPT,Facility,Outpatient,,,90,102,86.7,29.2332,102,PrimeWest Health,Minnesota Senior Health Options (MSHO),52.479,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Beta-Crosslaps (B-Ctx), S (Mayo)OutsideLaboratory",,82523,CPT,Facility,Inpatient,,,90,102,86.7,29.2332,102,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Beta-Crosslaps (B-Ctx), S (Mayo)OutsideLaboratory",,82523,CPT,Facility,Outpatient,,,90,102,86.7,29.2332,102,PrimeWest Health,MinnesotaCare,52.3872,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Beta-Crosslaps (B-Ctx), S (Mayo)OutsideLaboratory",,82523,CPT,Facility,Inpatient,,,90,102,86.7,29.2332,102,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Beta-Crosslaps (B-Ctx), S (Mayo)OutsideLaboratory",,82523,CPT,Facility,Both,,,90,102,86.7,29.2332,102,Sanford Health Plan,Sanford Health Plan,93.84,92,,percent of total billed charges,,
"Beta-Crosslaps (B-Ctx), S (Mayo)OutsideLaboratory",,82523,CPT,Facility,Outpatient,,,90,102,86.7,29.2332,102,"UCare Health, Inc.",Individual & Family Plan,57.477,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Beta-Crosslaps (B-Ctx), S (Mayo)OutsideLaboratory",,82523,CPT,Facility,Inpatient,,,90,102,86.7,29.2332,102,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Beta-Crosslaps (B-Ctx), S (Mayo)OutsideLaboratory",,82523,CPT,Facility,Outpatient,,,90,102,86.7,29.2332,102,"UCare Health, Inc.",Medical Assistance,51.4794,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Beta-Crosslaps (B-Ctx), S (Mayo)OutsideLaboratory",,82523,CPT,Facility,Inpatient,,,90,102,86.7,29.2332,102,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Beta-Crosslaps (B-Ctx), S (Mayo)OutsideLaboratory",,82523,CPT,Facility,Outpatient,,,90,102,86.7,29.2332,102,"UCare Health, Inc.",Medicare Advantage,51.4794,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Beta-Crosslaps (B-Ctx), S (Mayo)OutsideLaboratory",,82523,CPT,Facility,Inpatient,,,90,102,86.7,29.2332,102,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Beta-Crosslaps (B-Ctx), S (Mayo)OutsideLaboratory",,82523,CPT,Facility,Outpatient,,,90,102,86.7,29.2332,102,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),51.4794,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Beta-Crosslaps (B-Ctx), S (Mayo)OutsideLaboratory",,82523,CPT,Facility,Inpatient,,,90,102,86.7,29.2332,102,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Beta-Crosslaps (B-Ctx), S (Mayo)OutsideLaboratory",,82523,CPT,Facility,Both,,,90,102,86.7,29.2332,102,UnitedHealthcare,Individual & Family,95.88,94,,percent of total billed charges,,
"Beta-Crosslaps (B-Ctx), S (Mayo)OutsideLaboratory",,82523,CPT,Facility,Outpatient,,,90,102,86.7,29.2332,102,UnitedHealthcare,Medicare Advantage,49.98,49,,percent of total billed charges,,
"Beta-Crosslaps (B-Ctx), S (Mayo)OutsideLaboratory",,82523,CPT,Facility,Inpatient,,,90,102,86.7,29.2332,102,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Beta-Crosslaps (B-Ctx), S (Mayo)OutsideLaboratory",,82523,CPT,Facility,Outpatient,,,90,102,86.7,29.2332,102,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,48.96,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Beta-Crosslaps (B-Ctx), S (Mayo)OutsideLaboratory",,82523,CPT,Facility,Inpatient,,,90,102,86.7,29.2332,102,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Copper, 24 Hr, U (Mayo)OutsideLaboratory",,82525,CPT,Facility,Both,,,90,72,61.2,20.6352,72,Aetna,Commercial,66.24,92,,percent of total billed charges,,
"Copper, 24 Hr, U (Mayo)OutsideLaboratory",,82525,CPT,Facility,Outpatient,,,90,72,61.2,20.6352,72,Aetna,Medicare Advantage,35.28,49,,percent of total billed charges,,
"Copper, 24 Hr, U (Mayo)OutsideLaboratory",,82525,CPT,Facility,Inpatient,,,90,72,61.2,20.6352,72,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Copper, 24 Hr, U (Mayo)OutsideLaboratory",,82525,CPT,Facility,Both,,,90,72,61.2,20.6352,72,Aetna,PPO,66.96,93,,percent of total billed charges,,
"Copper, 24 Hr, U (Mayo)OutsideLaboratory",,82525,CPT,Facility,Both,,,90,72,61.2,20.6352,72,America's PPO,America's PPO,69.1416,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Copper, 24 Hr, U (Mayo)OutsideLaboratory",,82525,CPT,Facility,Both,,,90,72,61.2,20.6352,72,BlueCross BlueShield Minnesota, Federal Employee Program,70.848,98.4,,percent of total billed charges,,
"Copper, 24 Hr, U (Mayo)OutsideLaboratory",,82525,CPT,Facility,Both,,,90,72,61.2,20.6352,72,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,72,100,,percent of total billed charges,,
"Copper, 24 Hr, U (Mayo)OutsideLaboratory",,82525,CPT,Facility,Both,,,90,72,61.2,20.6352,72,BlueCross BlueShield Minnesota,High Value Network Plan,64.8,90,,percent of total billed charges,,
"Copper, 24 Hr, U (Mayo)OutsideLaboratory",,82525,CPT,Facility,Outpatient,,,90,72,61.2,20.6352,72,BlueCross BlueShield Minnesota,Medicare Advantage,35.28,49,,percent of total billed charges,,
"Copper, 24 Hr, U (Mayo)OutsideLaboratory",,82525,CPT,Facility,Inpatient,,,90,72,61.2,20.6352,72,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Copper, 24 Hr, U (Mayo)OutsideLaboratory",,82525,CPT,Facility,Both,,,90,72,61.2,20.6352,72,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,63.7704,88.57,,percent of total billed charges,,
"Copper, 24 Hr, U (Mayo)OutsideLaboratory",,82525,CPT,Facility,Both,,,90,72,61.2,20.6352,72,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,20.6352,28.66,,percent of total billed charges,,
"Copper, 24 Hr, U (Mayo)OutsideLaboratory",,82525,CPT,Facility,Outpatient,,,90,72,61.2,20.6352,72,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),35.28,49,,percent of total billed charges,,
"Copper, 24 Hr, U (Mayo)OutsideLaboratory",,82525,CPT,Facility,Inpatient,,,90,72,61.2,20.6352,72,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Copper, 24 Hr, U (Mayo)OutsideLaboratory",,82525,CPT,Facility,Both,,,90,72,61.2,20.6352,72,CorVel,Worker's Compensation,72,100,,percent of total billed charges,,
"Copper, 24 Hr, U (Mayo)OutsideLaboratory",,82525,CPT,Facility,Both,,,90,72,61.2,20.6352,72,First Health Group Corporation,First Health Network,69.84,97,,percent of total billed charges,,
"Copper, 24 Hr, U (Mayo)OutsideLaboratory",,82525,CPT,Facility,Both,,,90,72,61.2,20.6352,72,"Health Partners, Inc.",Commercial,68.112,94.6,,percent of total billed charges,,
"Copper, 24 Hr, U (Mayo)OutsideLaboratory",,82525,CPT,Facility,Outpatient,,,90,72,61.2,20.6352,72,"Health Partners, Inc.",Medicare Advantage,35.28,49,,percent of total billed charges,,
"Copper, 24 Hr, U (Mayo)OutsideLaboratory",,82525,CPT,Facility,Inpatient,,,90,72,61.2,20.6352,72,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Copper, 24 Hr, U (Mayo)OutsideLaboratory",,82525,CPT,Facility,Both,,,90,72,61.2,20.6352,72,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),43.2,60,,percent of total billed charges,,
"Copper, 24 Hr, U (Mayo)OutsideLaboratory",,82525,CPT,Facility,Both,,,90,72,61.2,20.6352,72,"Health Partners, Inc.",State of Minnesota Advantage Program,58.68,81.5,,percent of total billed charges,,
"Copper, 24 Hr, U (Mayo)OutsideLaboratory",,82525,CPT,Facility,Both,,,90,72,61.2,20.6352,72,"Health Partners, Inc.",State Public Programs,36,50,,percent of total billed charges,,
"Copper, 24 Hr, U (Mayo)OutsideLaboratory",,82525,CPT,Facility,Both,,,90,72,61.2,20.6352,72,Humana Insurance Company,Commercial PPO,68.4,95,,percent of total billed charges,,
"Copper, 24 Hr, U (Mayo)OutsideLaboratory",,82525,CPT,Facility,Outpatient,,,90,72,61.2,20.6352,72,Humana Insurance Company,Medicare PPO,35.28,49,,percent of total billed charges,,
"Copper, 24 Hr, U (Mayo)OutsideLaboratory",,82525,CPT,Facility,Inpatient,,,90,72,61.2,20.6352,72,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Copper, 24 Hr, U (Mayo)OutsideLaboratory",,82525,CPT,Facility,Both,,,90,72,61.2,20.6352,72,Medica,Individual & Family,71.352,99.1,,percent of total billed charges,,
"Copper, 24 Hr, U (Mayo)OutsideLaboratory",,82525,CPT,Facility,Outpatient,,,90,72,61.2,20.6352,72,Medica,Medica Advantage Solution,35.856,49.8,,percent of total billed charges,,
"Copper, 24 Hr, U (Mayo)OutsideLaboratory",,82525,CPT,Facility,Inpatient,,,90,72,61.2,20.6352,72,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Copper, 24 Hr, U (Mayo)OutsideLaboratory",,82525,CPT,Facility,Outpatient,,,90,72,61.2,20.6352,72,Medica,Medical Assistance,32.112,44.6,,percent of total billed charges,,
"Copper, 24 Hr, U (Mayo)OutsideLaboratory",,82525,CPT,Facility,Inpatient,,,90,72,61.2,20.6352,72,Medica,Medical Assistance,,,,,Included in per diem rate,
"Copper, 24 Hr, U (Mayo)OutsideLaboratory",,82525,CPT,Facility,Outpatient,,,90,72,61.2,20.6352,72,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,35.856,49.8,,percent of total billed charges,,
"Copper, 24 Hr, U (Mayo)OutsideLaboratory",,82525,CPT,Facility,Inpatient,,,90,72,61.2,20.6352,72,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Copper, 24 Hr, U (Mayo)OutsideLaboratory",,82525,CPT,Facility,Both,,,90,72,61.2,20.6352,72,"Multiplan, Inc.","Multiplan, Inc.",67.68,94,,percent of total billed charges,,
"Copper, 24 Hr, U (Mayo)OutsideLaboratory",,82525,CPT,Facility,Outpatient,,,90,72,61.2,20.6352,72,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,62.208,86.4,,percent of total billed charges,,
"Copper, 24 Hr, U (Mayo)OutsideLaboratory",,82525,CPT,Facility,Inpatient,,,90,72,61.2,20.6352,72,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Copper, 24 Hr, U (Mayo)OutsideLaboratory",,82525,CPT,Facility,Both,,,90,72,61.2,20.6352,72,"Preferred One Administrative Services, INC.",PPO,70.992,98.6,,percent of total billed charges,,
"Copper, 24 Hr, U (Mayo)OutsideLaboratory",,82525,CPT,Facility,Outpatient,,,90,72,61.2,20.6352,72,PrimeWest Health,Minnesota Senior Health Options (MSHO),37.044,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Copper, 24 Hr, U (Mayo)OutsideLaboratory",,82525,CPT,Facility,Inpatient,,,90,72,61.2,20.6352,72,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Copper, 24 Hr, U (Mayo)OutsideLaboratory",,82525,CPT,Facility,Outpatient,,,90,72,61.2,20.6352,72,PrimeWest Health,MinnesotaCare,36.9792,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Copper, 24 Hr, U (Mayo)OutsideLaboratory",,82525,CPT,Facility,Inpatient,,,90,72,61.2,20.6352,72,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Copper, 24 Hr, U (Mayo)OutsideLaboratory",,82525,CPT,Facility,Both,,,90,72,61.2,20.6352,72,Sanford Health Plan,Sanford Health Plan,66.24,92,,percent of total billed charges,,
"Copper, 24 Hr, U (Mayo)OutsideLaboratory",,82525,CPT,Facility,Outpatient,,,90,72,61.2,20.6352,72,"UCare Health, Inc.",Individual & Family Plan,40.572,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Copper, 24 Hr, U (Mayo)OutsideLaboratory",,82525,CPT,Facility,Inpatient,,,90,72,61.2,20.6352,72,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Copper, 24 Hr, U (Mayo)OutsideLaboratory",,82525,CPT,Facility,Outpatient,,,90,72,61.2,20.6352,72,"UCare Health, Inc.",Medical Assistance,36.3384,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Copper, 24 Hr, U (Mayo)OutsideLaboratory",,82525,CPT,Facility,Inpatient,,,90,72,61.2,20.6352,72,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Copper, 24 Hr, U (Mayo)OutsideLaboratory",,82525,CPT,Facility,Outpatient,,,90,72,61.2,20.6352,72,"UCare Health, Inc.",Medicare Advantage,36.3384,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Copper, 24 Hr, U (Mayo)OutsideLaboratory",,82525,CPT,Facility,Inpatient,,,90,72,61.2,20.6352,72,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Copper, 24 Hr, U (Mayo)OutsideLaboratory",,82525,CPT,Facility,Outpatient,,,90,72,61.2,20.6352,72,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),36.3384,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Copper, 24 Hr, U (Mayo)OutsideLaboratory",,82525,CPT,Facility,Inpatient,,,90,72,61.2,20.6352,72,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Copper, 24 Hr, U (Mayo)OutsideLaboratory",,82525,CPT,Facility,Both,,,90,72,61.2,20.6352,72,UnitedHealthcare,Individual & Family,67.68,94,,percent of total billed charges,,
"Copper, 24 Hr, U (Mayo)OutsideLaboratory",,82525,CPT,Facility,Outpatient,,,90,72,61.2,20.6352,72,UnitedHealthcare,Medicare Advantage,35.28,49,,percent of total billed charges,,
"Copper, 24 Hr, U (Mayo)OutsideLaboratory",,82525,CPT,Facility,Inpatient,,,90,72,61.2,20.6352,72,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Copper, 24 Hr, U (Mayo)OutsideLaboratory",,82525,CPT,Facility,Outpatient,,,90,72,61.2,20.6352,72,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,34.56,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Copper, 24 Hr, U (Mayo)OutsideLaboratory",,82525,CPT,Facility,Inpatient,,,90,72,61.2,20.6352,72,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Copper, S (Mayo)OutsideLaboratory",,82525,CPT,Facility,Both,,,90,72,61.2,20.6352,72,Aetna,Commercial,66.24,92,,percent of total billed charges,,
"Copper, S (Mayo)OutsideLaboratory",,82525,CPT,Facility,Outpatient,,,90,72,61.2,20.6352,72,Aetna,Medicare Advantage,35.28,49,,percent of total billed charges,,
"Copper, S (Mayo)OutsideLaboratory",,82525,CPT,Facility,Inpatient,,,90,72,61.2,20.6352,72,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Copper, S (Mayo)OutsideLaboratory",,82525,CPT,Facility,Both,,,90,72,61.2,20.6352,72,Aetna,PPO,66.96,93,,percent of total billed charges,,
"Copper, S (Mayo)OutsideLaboratory",,82525,CPT,Facility,Both,,,90,72,61.2,20.6352,72,America's PPO,America's PPO,69.1416,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Copper, S (Mayo)OutsideLaboratory",,82525,CPT,Facility,Both,,,90,72,61.2,20.6352,72,BlueCross BlueShield Minnesota, Federal Employee Program,70.848,98.4,,percent of total billed charges,,
"Copper, S (Mayo)OutsideLaboratory",,82525,CPT,Facility,Both,,,90,72,61.2,20.6352,72,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,72,100,,percent of total billed charges,,
"Copper, S (Mayo)OutsideLaboratory",,82525,CPT,Facility,Both,,,90,72,61.2,20.6352,72,BlueCross BlueShield Minnesota,High Value Network Plan,64.8,90,,percent of total billed charges,,
"Copper, S (Mayo)OutsideLaboratory",,82525,CPT,Facility,Outpatient,,,90,72,61.2,20.6352,72,BlueCross BlueShield Minnesota,Medicare Advantage,35.28,49,,percent of total billed charges,,
"Copper, S (Mayo)OutsideLaboratory",,82525,CPT,Facility,Inpatient,,,90,72,61.2,20.6352,72,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Copper, S (Mayo)OutsideLaboratory",,82525,CPT,Facility,Both,,,90,72,61.2,20.6352,72,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,63.7704,88.57,,percent of total billed charges,,
"Copper, S (Mayo)OutsideLaboratory",,82525,CPT,Facility,Both,,,90,72,61.2,20.6352,72,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,20.6352,28.66,,percent of total billed charges,,
"Copper, S (Mayo)OutsideLaboratory",,82525,CPT,Facility,Outpatient,,,90,72,61.2,20.6352,72,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),35.28,49,,percent of total billed charges,,
"Copper, S (Mayo)OutsideLaboratory",,82525,CPT,Facility,Inpatient,,,90,72,61.2,20.6352,72,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Copper, S (Mayo)OutsideLaboratory",,82525,CPT,Facility,Both,,,90,72,61.2,20.6352,72,CorVel,Worker's Compensation,72,100,,percent of total billed charges,,
"Copper, S (Mayo)OutsideLaboratory",,82525,CPT,Facility,Both,,,90,72,61.2,20.6352,72,First Health Group Corporation,First Health Network,69.84,97,,percent of total billed charges,,
"Copper, S (Mayo)OutsideLaboratory",,82525,CPT,Facility,Both,,,90,72,61.2,20.6352,72,"Health Partners, Inc.",Commercial,68.112,94.6,,percent of total billed charges,,
"Copper, S (Mayo)OutsideLaboratory",,82525,CPT,Facility,Outpatient,,,90,72,61.2,20.6352,72,"Health Partners, Inc.",Medicare Advantage,35.28,49,,percent of total billed charges,,
"Copper, S (Mayo)OutsideLaboratory",,82525,CPT,Facility,Inpatient,,,90,72,61.2,20.6352,72,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Copper, S (Mayo)OutsideLaboratory",,82525,CPT,Facility,Both,,,90,72,61.2,20.6352,72,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),43.2,60,,percent of total billed charges,,
"Copper, S (Mayo)OutsideLaboratory",,82525,CPT,Facility,Both,,,90,72,61.2,20.6352,72,"Health Partners, Inc.",State of Minnesota Advantage Program,58.68,81.5,,percent of total billed charges,,
"Copper, S (Mayo)OutsideLaboratory",,82525,CPT,Facility,Both,,,90,72,61.2,20.6352,72,"Health Partners, Inc.",State Public Programs,36,50,,percent of total billed charges,,
"Copper, S (Mayo)OutsideLaboratory",,82525,CPT,Facility,Both,,,90,72,61.2,20.6352,72,Humana Insurance Company,Commercial PPO,68.4,95,,percent of total billed charges,,
"Copper, S (Mayo)OutsideLaboratory",,82525,CPT,Facility,Outpatient,,,90,72,61.2,20.6352,72,Humana Insurance Company,Medicare PPO,35.28,49,,percent of total billed charges,,
"Copper, S (Mayo)OutsideLaboratory",,82525,CPT,Facility,Inpatient,,,90,72,61.2,20.6352,72,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Copper, S (Mayo)OutsideLaboratory",,82525,CPT,Facility,Both,,,90,72,61.2,20.6352,72,Medica,Individual & Family,71.352,99.1,,percent of total billed charges,,
"Copper, S (Mayo)OutsideLaboratory",,82525,CPT,Facility,Outpatient,,,90,72,61.2,20.6352,72,Medica,Medica Advantage Solution,35.856,49.8,,percent of total billed charges,,
"Copper, S (Mayo)OutsideLaboratory",,82525,CPT,Facility,Inpatient,,,90,72,61.2,20.6352,72,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Copper, S (Mayo)OutsideLaboratory",,82525,CPT,Facility,Outpatient,,,90,72,61.2,20.6352,72,Medica,Medical Assistance,32.112,44.6,,percent of total billed charges,,
"Copper, S (Mayo)OutsideLaboratory",,82525,CPT,Facility,Inpatient,,,90,72,61.2,20.6352,72,Medica,Medical Assistance,,,,,Included in per diem rate,
"Copper, S (Mayo)OutsideLaboratory",,82525,CPT,Facility,Outpatient,,,90,72,61.2,20.6352,72,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,35.856,49.8,,percent of total billed charges,,
"Copper, S (Mayo)OutsideLaboratory",,82525,CPT,Facility,Inpatient,,,90,72,61.2,20.6352,72,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Copper, S (Mayo)OutsideLaboratory",,82525,CPT,Facility,Both,,,90,72,61.2,20.6352,72,"Multiplan, Inc.","Multiplan, Inc.",67.68,94,,percent of total billed charges,,
"Copper, S (Mayo)OutsideLaboratory",,82525,CPT,Facility,Outpatient,,,90,72,61.2,20.6352,72,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,62.208,86.4,,percent of total billed charges,,
"Copper, S (Mayo)OutsideLaboratory",,82525,CPT,Facility,Inpatient,,,90,72,61.2,20.6352,72,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Copper, S (Mayo)OutsideLaboratory",,82525,CPT,Facility,Both,,,90,72,61.2,20.6352,72,"Preferred One Administrative Services, INC.",PPO,70.992,98.6,,percent of total billed charges,,
"Copper, S (Mayo)OutsideLaboratory",,82525,CPT,Facility,Outpatient,,,90,72,61.2,20.6352,72,PrimeWest Health,Minnesota Senior Health Options (MSHO),37.044,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Copper, S (Mayo)OutsideLaboratory",,82525,CPT,Facility,Inpatient,,,90,72,61.2,20.6352,72,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Copper, S (Mayo)OutsideLaboratory",,82525,CPT,Facility,Outpatient,,,90,72,61.2,20.6352,72,PrimeWest Health,MinnesotaCare,36.9792,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Copper, S (Mayo)OutsideLaboratory",,82525,CPT,Facility,Inpatient,,,90,72,61.2,20.6352,72,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Copper, S (Mayo)OutsideLaboratory",,82525,CPT,Facility,Both,,,90,72,61.2,20.6352,72,Sanford Health Plan,Sanford Health Plan,66.24,92,,percent of total billed charges,,
"Copper, S (Mayo)OutsideLaboratory",,82525,CPT,Facility,Outpatient,,,90,72,61.2,20.6352,72,"UCare Health, Inc.",Individual & Family Plan,40.572,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Copper, S (Mayo)OutsideLaboratory",,82525,CPT,Facility,Inpatient,,,90,72,61.2,20.6352,72,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Copper, S (Mayo)OutsideLaboratory",,82525,CPT,Facility,Outpatient,,,90,72,61.2,20.6352,72,"UCare Health, Inc.",Medical Assistance,36.3384,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Copper, S (Mayo)OutsideLaboratory",,82525,CPT,Facility,Inpatient,,,90,72,61.2,20.6352,72,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Copper, S (Mayo)OutsideLaboratory",,82525,CPT,Facility,Outpatient,,,90,72,61.2,20.6352,72,"UCare Health, Inc.",Medicare Advantage,36.3384,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Copper, S (Mayo)OutsideLaboratory",,82525,CPT,Facility,Inpatient,,,90,72,61.2,20.6352,72,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Copper, S (Mayo)OutsideLaboratory",,82525,CPT,Facility,Outpatient,,,90,72,61.2,20.6352,72,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),36.3384,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Copper, S (Mayo)OutsideLaboratory",,82525,CPT,Facility,Inpatient,,,90,72,61.2,20.6352,72,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Copper, S (Mayo)OutsideLaboratory",,82525,CPT,Facility,Both,,,90,72,61.2,20.6352,72,UnitedHealthcare,Individual & Family,67.68,94,,percent of total billed charges,,
"Copper, S (Mayo)OutsideLaboratory",,82525,CPT,Facility,Outpatient,,,90,72,61.2,20.6352,72,UnitedHealthcare,Medicare Advantage,35.28,49,,percent of total billed charges,,
"Copper, S (Mayo)OutsideLaboratory",,82525,CPT,Facility,Inpatient,,,90,72,61.2,20.6352,72,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Copper, S (Mayo)OutsideLaboratory",,82525,CPT,Facility,Outpatient,,,90,72,61.2,20.6352,72,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,34.56,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Copper, S (Mayo)OutsideLaboratory",,82525,CPT,Facility,Inpatient,,,90,72,61.2,20.6352,72,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Cortisol, Free, U (Mayo)OutsideLaboratory",,82530,CPT,Facility,Both,,,90,90,76.5,25.794,90,Aetna,Commercial,82.8,92,,percent of total billed charges,,
"Cortisol, Free, U (Mayo)OutsideLaboratory",,82530,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,Aetna,Medicare Advantage,44.1,49,,percent of total billed charges,,
"Cortisol, Free, U (Mayo)OutsideLaboratory",,82530,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Cortisol, Free, U (Mayo)OutsideLaboratory",,82530,CPT,Facility,Both,,,90,90,76.5,25.794,90,Aetna,PPO,83.7,93,,percent of total billed charges,,
"Cortisol, Free, U (Mayo)OutsideLaboratory",,82530,CPT,Facility,Both,,,90,90,76.5,25.794,90,America's PPO,America's PPO,86.427,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Cortisol, Free, U (Mayo)OutsideLaboratory",,82530,CPT,Facility,Both,,,90,90,76.5,25.794,90,BlueCross BlueShield Minnesota, Federal Employee Program,88.56,98.4,,percent of total billed charges,,
"Cortisol, Free, U (Mayo)OutsideLaboratory",,82530,CPT,Facility,Both,,,90,90,76.5,25.794,90,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,90,100,,percent of total billed charges,,
"Cortisol, Free, U (Mayo)OutsideLaboratory",,82530,CPT,Facility,Both,,,90,90,76.5,25.794,90,BlueCross BlueShield Minnesota,High Value Network Plan,81,90,,percent of total billed charges,,
"Cortisol, Free, U (Mayo)OutsideLaboratory",,82530,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,BlueCross BlueShield Minnesota,Medicare Advantage,44.1,49,,percent of total billed charges,,
"Cortisol, Free, U (Mayo)OutsideLaboratory",,82530,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Cortisol, Free, U (Mayo)OutsideLaboratory",,82530,CPT,Facility,Both,,,90,90,76.5,25.794,90,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,79.713,88.57,,percent of total billed charges,,
"Cortisol, Free, U (Mayo)OutsideLaboratory",,82530,CPT,Facility,Both,,,90,90,76.5,25.794,90,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,25.794,28.66,,percent of total billed charges,,
"Cortisol, Free, U (Mayo)OutsideLaboratory",,82530,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),44.1,49,,percent of total billed charges,,
"Cortisol, Free, U (Mayo)OutsideLaboratory",,82530,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Cortisol, Free, U (Mayo)OutsideLaboratory",,82530,CPT,Facility,Both,,,90,90,76.5,25.794,90,CorVel,Worker's Compensation,90,100,,percent of total billed charges,,
"Cortisol, Free, U (Mayo)OutsideLaboratory",,82530,CPT,Facility,Both,,,90,90,76.5,25.794,90,First Health Group Corporation,First Health Network,87.3,97,,percent of total billed charges,,
"Cortisol, Free, U (Mayo)OutsideLaboratory",,82530,CPT,Facility,Both,,,90,90,76.5,25.794,90,"Health Partners, Inc.",Commercial,85.14,94.6,,percent of total billed charges,,
"Cortisol, Free, U (Mayo)OutsideLaboratory",,82530,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,"Health Partners, Inc.",Medicare Advantage,44.1,49,,percent of total billed charges,,
"Cortisol, Free, U (Mayo)OutsideLaboratory",,82530,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Cortisol, Free, U (Mayo)OutsideLaboratory",,82530,CPT,Facility,Both,,,90,90,76.5,25.794,90,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),54,60,,percent of total billed charges,,
"Cortisol, Free, U (Mayo)OutsideLaboratory",,82530,CPT,Facility,Both,,,90,90,76.5,25.794,90,"Health Partners, Inc.",State of Minnesota Advantage Program,73.35,81.5,,percent of total billed charges,,
"Cortisol, Free, U (Mayo)OutsideLaboratory",,82530,CPT,Facility,Both,,,90,90,76.5,25.794,90,"Health Partners, Inc.",State Public Programs,45,50,,percent of total billed charges,,
"Cortisol, Free, U (Mayo)OutsideLaboratory",,82530,CPT,Facility,Both,,,90,90,76.5,25.794,90,Humana Insurance Company,Commercial PPO,85.5,95,,percent of total billed charges,,
"Cortisol, Free, U (Mayo)OutsideLaboratory",,82530,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,Humana Insurance Company,Medicare PPO,44.1,49,,percent of total billed charges,,
"Cortisol, Free, U (Mayo)OutsideLaboratory",,82530,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Cortisol, Free, U (Mayo)OutsideLaboratory",,82530,CPT,Facility,Both,,,90,90,76.5,25.794,90,Medica,Individual & Family,89.19,99.1,,percent of total billed charges,,
"Cortisol, Free, U (Mayo)OutsideLaboratory",,82530,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,Medica,Medica Advantage Solution,44.82,49.8,,percent of total billed charges,,
"Cortisol, Free, U (Mayo)OutsideLaboratory",,82530,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Cortisol, Free, U (Mayo)OutsideLaboratory",,82530,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,Medica,Medical Assistance,40.14,44.6,,percent of total billed charges,,
"Cortisol, Free, U (Mayo)OutsideLaboratory",,82530,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,Medica,Medical Assistance,,,,,Included in per diem rate,
"Cortisol, Free, U (Mayo)OutsideLaboratory",,82530,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,44.82,49.8,,percent of total billed charges,,
"Cortisol, Free, U (Mayo)OutsideLaboratory",,82530,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Cortisol, Free, U (Mayo)OutsideLaboratory",,82530,CPT,Facility,Both,,,90,90,76.5,25.794,90,"Multiplan, Inc.","Multiplan, Inc.",84.6,94,,percent of total billed charges,,
"Cortisol, Free, U (Mayo)OutsideLaboratory",,82530,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,77.76,86.4,,percent of total billed charges,,
"Cortisol, Free, U (Mayo)OutsideLaboratory",,82530,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Cortisol, Free, U (Mayo)OutsideLaboratory",,82530,CPT,Facility,Both,,,90,90,76.5,25.794,90,"Preferred One Administrative Services, INC.",PPO,88.74,98.6,,percent of total billed charges,,
"Cortisol, Free, U (Mayo)OutsideLaboratory",,82530,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,PrimeWest Health,Minnesota Senior Health Options (MSHO),46.305,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Cortisol, Free, U (Mayo)OutsideLaboratory",,82530,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Cortisol, Free, U (Mayo)OutsideLaboratory",,82530,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,PrimeWest Health,MinnesotaCare,46.224,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Cortisol, Free, U (Mayo)OutsideLaboratory",,82530,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Cortisol, Free, U (Mayo)OutsideLaboratory",,82530,CPT,Facility,Both,,,90,90,76.5,25.794,90,Sanford Health Plan,Sanford Health Plan,82.8,92,,percent of total billed charges,,
"Cortisol, Free, U (Mayo)OutsideLaboratory",,82530,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,"UCare Health, Inc.",Individual & Family Plan,50.715,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Cortisol, Free, U (Mayo)OutsideLaboratory",,82530,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Cortisol, Free, U (Mayo)OutsideLaboratory",,82530,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,"UCare Health, Inc.",Medical Assistance,45.423,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Cortisol, Free, U (Mayo)OutsideLaboratory",,82530,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Cortisol, Free, U (Mayo)OutsideLaboratory",,82530,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,"UCare Health, Inc.",Medicare Advantage,45.423,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Cortisol, Free, U (Mayo)OutsideLaboratory",,82530,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Cortisol, Free, U (Mayo)OutsideLaboratory",,82530,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),45.423,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Cortisol, Free, U (Mayo)OutsideLaboratory",,82530,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Cortisol, Free, U (Mayo)OutsideLaboratory",,82530,CPT,Facility,Both,,,90,90,76.5,25.794,90,UnitedHealthcare,Individual & Family,84.6,94,,percent of total billed charges,,
"Cortisol, Free, U (Mayo)OutsideLaboratory",,82530,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,UnitedHealthcare,Medicare Advantage,44.1,49,,percent of total billed charges,,
"Cortisol, Free, U (Mayo)OutsideLaboratory",,82530,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Cortisol, Free, U (Mayo)OutsideLaboratory",,82530,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,43.2,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Cortisol, Free, U (Mayo)OutsideLaboratory",,82530,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Cortisol/Cortisone, Free, U (Mayo)OutsideLaboratory",,82530,CPT,Facility,Both,,,90,84,71.4,24.0744,84,Aetna,Commercial,77.28,92,,percent of total billed charges,,
"Cortisol/Cortisone, Free, U (Mayo)OutsideLaboratory",,82530,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,Aetna,Medicare Advantage,41.16,49,,percent of total billed charges,,
"Cortisol/Cortisone, Free, U (Mayo)OutsideLaboratory",,82530,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Cortisol/Cortisone, Free, U (Mayo)OutsideLaboratory",,82530,CPT,Facility,Both,,,90,84,71.4,24.0744,84,Aetna,PPO,78.12,93,,percent of total billed charges,,
"Cortisol/Cortisone, Free, U (Mayo)OutsideLaboratory",,82530,CPT,Facility,Both,,,90,84,71.4,24.0744,84,America's PPO,America's PPO,80.6652,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Cortisol/Cortisone, Free, U (Mayo)OutsideLaboratory",,82530,CPT,Facility,Both,,,90,84,71.4,24.0744,84,BlueCross BlueShield Minnesota, Federal Employee Program,82.656,98.4,,percent of total billed charges,,
"Cortisol/Cortisone, Free, U (Mayo)OutsideLaboratory",,82530,CPT,Facility,Both,,,90,84,71.4,24.0744,84,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,84,100,,percent of total billed charges,,
"Cortisol/Cortisone, Free, U (Mayo)OutsideLaboratory",,82530,CPT,Facility,Both,,,90,84,71.4,24.0744,84,BlueCross BlueShield Minnesota,High Value Network Plan,75.6,90,,percent of total billed charges,,
"Cortisol/Cortisone, Free, U (Mayo)OutsideLaboratory",,82530,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,BlueCross BlueShield Minnesota,Medicare Advantage,41.16,49,,percent of total billed charges,,
"Cortisol/Cortisone, Free, U (Mayo)OutsideLaboratory",,82530,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Cortisol/Cortisone, Free, U (Mayo)OutsideLaboratory",,82530,CPT,Facility,Both,,,90,84,71.4,24.0744,84,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,74.3988,88.57,,percent of total billed charges,,
"Cortisol/Cortisone, Free, U (Mayo)OutsideLaboratory",,82530,CPT,Facility,Both,,,90,84,71.4,24.0744,84,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,24.0744,28.66,,percent of total billed charges,,
"Cortisol/Cortisone, Free, U (Mayo)OutsideLaboratory",,82530,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),41.16,49,,percent of total billed charges,,
"Cortisol/Cortisone, Free, U (Mayo)OutsideLaboratory",,82530,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Cortisol/Cortisone, Free, U (Mayo)OutsideLaboratory",,82530,CPT,Facility,Both,,,90,84,71.4,24.0744,84,CorVel,Worker's Compensation,84,100,,percent of total billed charges,,
"Cortisol/Cortisone, Free, U (Mayo)OutsideLaboratory",,82530,CPT,Facility,Both,,,90,84,71.4,24.0744,84,First Health Group Corporation,First Health Network,81.48,97,,percent of total billed charges,,
"Cortisol/Cortisone, Free, U (Mayo)OutsideLaboratory",,82530,CPT,Facility,Both,,,90,84,71.4,24.0744,84,"Health Partners, Inc.",Commercial,79.464,94.6,,percent of total billed charges,,
"Cortisol/Cortisone, Free, U (Mayo)OutsideLaboratory",,82530,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,"Health Partners, Inc.",Medicare Advantage,41.16,49,,percent of total billed charges,,
"Cortisol/Cortisone, Free, U (Mayo)OutsideLaboratory",,82530,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Cortisol/Cortisone, Free, U (Mayo)OutsideLaboratory",,82530,CPT,Facility,Both,,,90,84,71.4,24.0744,84,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),50.4,60,,percent of total billed charges,,
"Cortisol/Cortisone, Free, U (Mayo)OutsideLaboratory",,82530,CPT,Facility,Both,,,90,84,71.4,24.0744,84,"Health Partners, Inc.",State of Minnesota Advantage Program,68.46,81.5,,percent of total billed charges,,
"Cortisol/Cortisone, Free, U (Mayo)OutsideLaboratory",,82530,CPT,Facility,Both,,,90,84,71.4,24.0744,84,"Health Partners, Inc.",State Public Programs,42,50,,percent of total billed charges,,
"Cortisol/Cortisone, Free, U (Mayo)OutsideLaboratory",,82530,CPT,Facility,Both,,,90,84,71.4,24.0744,84,Humana Insurance Company,Commercial PPO,79.8,95,,percent of total billed charges,,
"Cortisol/Cortisone, Free, U (Mayo)OutsideLaboratory",,82530,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,Humana Insurance Company,Medicare PPO,41.16,49,,percent of total billed charges,,
"Cortisol/Cortisone, Free, U (Mayo)OutsideLaboratory",,82530,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Cortisol/Cortisone, Free, U (Mayo)OutsideLaboratory",,82530,CPT,Facility,Both,,,90,84,71.4,24.0744,84,Medica,Individual & Family,83.244,99.1,,percent of total billed charges,,
"Cortisol/Cortisone, Free, U (Mayo)OutsideLaboratory",,82530,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,Medica,Medica Advantage Solution,41.832,49.8,,percent of total billed charges,,
"Cortisol/Cortisone, Free, U (Mayo)OutsideLaboratory",,82530,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Cortisol/Cortisone, Free, U (Mayo)OutsideLaboratory",,82530,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,Medica,Medical Assistance,37.464,44.6,,percent of total billed charges,,
"Cortisol/Cortisone, Free, U (Mayo)OutsideLaboratory",,82530,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,Medica,Medical Assistance,,,,,Included in per diem rate,
"Cortisol/Cortisone, Free, U (Mayo)OutsideLaboratory",,82530,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,41.832,49.8,,percent of total billed charges,,
"Cortisol/Cortisone, Free, U (Mayo)OutsideLaboratory",,82530,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Cortisol/Cortisone, Free, U (Mayo)OutsideLaboratory",,82530,CPT,Facility,Both,,,90,84,71.4,24.0744,84,"Multiplan, Inc.","Multiplan, Inc.",78.96,94,,percent of total billed charges,,
"Cortisol/Cortisone, Free, U (Mayo)OutsideLaboratory",,82530,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,72.576,86.4,,percent of total billed charges,,
"Cortisol/Cortisone, Free, U (Mayo)OutsideLaboratory",,82530,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Cortisol/Cortisone, Free, U (Mayo)OutsideLaboratory",,82530,CPT,Facility,Both,,,90,84,71.4,24.0744,84,"Preferred One Administrative Services, INC.",PPO,82.824,98.6,,percent of total billed charges,,
"Cortisol/Cortisone, Free, U (Mayo)OutsideLaboratory",,82530,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,PrimeWest Health,Minnesota Senior Health Options (MSHO),43.218,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Cortisol/Cortisone, Free, U (Mayo)OutsideLaboratory",,82530,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Cortisol/Cortisone, Free, U (Mayo)OutsideLaboratory",,82530,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,PrimeWest Health,MinnesotaCare,43.1424,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Cortisol/Cortisone, Free, U (Mayo)OutsideLaboratory",,82530,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Cortisol/Cortisone, Free, U (Mayo)OutsideLaboratory",,82530,CPT,Facility,Both,,,90,84,71.4,24.0744,84,Sanford Health Plan,Sanford Health Plan,77.28,92,,percent of total billed charges,,
"Cortisol/Cortisone, Free, U (Mayo)OutsideLaboratory",,82530,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,"UCare Health, Inc.",Individual & Family Plan,47.334,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Cortisol/Cortisone, Free, U (Mayo)OutsideLaboratory",,82530,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Cortisol/Cortisone, Free, U (Mayo)OutsideLaboratory",,82530,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,"UCare Health, Inc.",Medical Assistance,42.3948,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Cortisol/Cortisone, Free, U (Mayo)OutsideLaboratory",,82530,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Cortisol/Cortisone, Free, U (Mayo)OutsideLaboratory",,82530,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,"UCare Health, Inc.",Medicare Advantage,42.3948,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Cortisol/Cortisone, Free, U (Mayo)OutsideLaboratory",,82530,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Cortisol/Cortisone, Free, U (Mayo)OutsideLaboratory",,82530,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),42.3948,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Cortisol/Cortisone, Free, U (Mayo)OutsideLaboratory",,82530,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Cortisol/Cortisone, Free, U (Mayo)OutsideLaboratory",,82530,CPT,Facility,Both,,,90,84,71.4,24.0744,84,UnitedHealthcare,Individual & Family,78.96,94,,percent of total billed charges,,
"Cortisol/Cortisone, Free, U (Mayo)OutsideLaboratory",,82530,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,UnitedHealthcare,Medicare Advantage,41.16,49,,percent of total billed charges,,
"Cortisol/Cortisone, Free, U (Mayo)OutsideLaboratory",,82530,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Cortisol/Cortisone, Free, U (Mayo)OutsideLaboratory",,82530,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,40.32,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Cortisol/Cortisone, Free, U (Mayo)OutsideLaboratory",,82530,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Cortisol, Total (Mayo)OutsideLaboratory",,82533,CPT,Facility,Both,,,90,125,106.25,35.825,125,Aetna,Commercial,115,92,,percent of total billed charges,,
"Cortisol, Total (Mayo)OutsideLaboratory",,82533,CPT,Facility,Outpatient,,,90,125,106.25,35.825,125,Aetna,Medicare Advantage,61.25,49,,percent of total billed charges,,
"Cortisol, Total (Mayo)OutsideLaboratory",,82533,CPT,Facility,Inpatient,,,90,125,106.25,35.825,125,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Cortisol, Total (Mayo)OutsideLaboratory",,82533,CPT,Facility,Both,,,90,125,106.25,35.825,125,Aetna,PPO,116.25,93,,percent of total billed charges,,
"Cortisol, Total (Mayo)OutsideLaboratory",,82533,CPT,Facility,Both,,,90,125,106.25,35.825,125,America's PPO,America's PPO,120.0375,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Cortisol, Total (Mayo)OutsideLaboratory",,82533,CPT,Facility,Both,,,90,125,106.25,35.825,125,BlueCross BlueShield Minnesota, Federal Employee Program,123,98.4,,percent of total billed charges,,
"Cortisol, Total (Mayo)OutsideLaboratory",,82533,CPT,Facility,Both,,,90,125,106.25,35.825,125,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,125,100,,percent of total billed charges,,
"Cortisol, Total (Mayo)OutsideLaboratory",,82533,CPT,Facility,Both,,,90,125,106.25,35.825,125,BlueCross BlueShield Minnesota,High Value Network Plan,112.5,90,,percent of total billed charges,,
"Cortisol, Total (Mayo)OutsideLaboratory",,82533,CPT,Facility,Outpatient,,,90,125,106.25,35.825,125,BlueCross BlueShield Minnesota,Medicare Advantage,61.25,49,,percent of total billed charges,,
"Cortisol, Total (Mayo)OutsideLaboratory",,82533,CPT,Facility,Inpatient,,,90,125,106.25,35.825,125,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Cortisol, Total (Mayo)OutsideLaboratory",,82533,CPT,Facility,Both,,,90,125,106.25,35.825,125,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,110.7125,88.57,,percent of total billed charges,,
"Cortisol, Total (Mayo)OutsideLaboratory",,82533,CPT,Facility,Both,,,90,125,106.25,35.825,125,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,35.825,28.66,,percent of total billed charges,,
"Cortisol, Total (Mayo)OutsideLaboratory",,82533,CPT,Facility,Outpatient,,,90,125,106.25,35.825,125,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),61.25,49,,percent of total billed charges,,
"Cortisol, Total (Mayo)OutsideLaboratory",,82533,CPT,Facility,Inpatient,,,90,125,106.25,35.825,125,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Cortisol, Total (Mayo)OutsideLaboratory",,82533,CPT,Facility,Both,,,90,125,106.25,35.825,125,CorVel,Worker's Compensation,125,100,,percent of total billed charges,,
"Cortisol, Total (Mayo)OutsideLaboratory",,82533,CPT,Facility,Both,,,90,125,106.25,35.825,125,First Health Group Corporation,First Health Network,121.25,97,,percent of total billed charges,,
"Cortisol, Total (Mayo)OutsideLaboratory",,82533,CPT,Facility,Both,,,90,125,106.25,35.825,125,"Health Partners, Inc.",Commercial,118.25,94.6,,percent of total billed charges,,
"Cortisol, Total (Mayo)OutsideLaboratory",,82533,CPT,Facility,Outpatient,,,90,125,106.25,35.825,125,"Health Partners, Inc.",Medicare Advantage,61.25,49,,percent of total billed charges,,
"Cortisol, Total (Mayo)OutsideLaboratory",,82533,CPT,Facility,Inpatient,,,90,125,106.25,35.825,125,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Cortisol, Total (Mayo)OutsideLaboratory",,82533,CPT,Facility,Both,,,90,125,106.25,35.825,125,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),75,60,,percent of total billed charges,,
"Cortisol, Total (Mayo)OutsideLaboratory",,82533,CPT,Facility,Both,,,90,125,106.25,35.825,125,"Health Partners, Inc.",State of Minnesota Advantage Program,101.875,81.5,,percent of total billed charges,,
"Cortisol, Total (Mayo)OutsideLaboratory",,82533,CPT,Facility,Both,,,90,125,106.25,35.825,125,"Health Partners, Inc.",State Public Programs,62.5,50,,percent of total billed charges,,
"Cortisol, Total (Mayo)OutsideLaboratory",,82533,CPT,Facility,Both,,,90,125,106.25,35.825,125,Humana Insurance Company,Commercial PPO,118.75,95,,percent of total billed charges,,
"Cortisol, Total (Mayo)OutsideLaboratory",,82533,CPT,Facility,Outpatient,,,90,125,106.25,35.825,125,Humana Insurance Company,Medicare PPO,61.25,49,,percent of total billed charges,,
"Cortisol, Total (Mayo)OutsideLaboratory",,82533,CPT,Facility,Inpatient,,,90,125,106.25,35.825,125,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Cortisol, Total (Mayo)OutsideLaboratory",,82533,CPT,Facility,Both,,,90,125,106.25,35.825,125,Medica,Individual & Family,123.875,99.1,,percent of total billed charges,,
"Cortisol, Total (Mayo)OutsideLaboratory",,82533,CPT,Facility,Outpatient,,,90,125,106.25,35.825,125,Medica,Medica Advantage Solution,62.25,49.8,,percent of total billed charges,,
"Cortisol, Total (Mayo)OutsideLaboratory",,82533,CPT,Facility,Inpatient,,,90,125,106.25,35.825,125,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Cortisol, Total (Mayo)OutsideLaboratory",,82533,CPT,Facility,Outpatient,,,90,125,106.25,35.825,125,Medica,Medical Assistance,55.75,44.6,,percent of total billed charges,,
"Cortisol, Total (Mayo)OutsideLaboratory",,82533,CPT,Facility,Inpatient,,,90,125,106.25,35.825,125,Medica,Medical Assistance,,,,,Included in per diem rate,
"Cortisol, Total (Mayo)OutsideLaboratory",,82533,CPT,Facility,Outpatient,,,90,125,106.25,35.825,125,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,62.25,49.8,,percent of total billed charges,,
"Cortisol, Total (Mayo)OutsideLaboratory",,82533,CPT,Facility,Inpatient,,,90,125,106.25,35.825,125,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Cortisol, Total (Mayo)OutsideLaboratory",,82533,CPT,Facility,Both,,,90,125,106.25,35.825,125,"Multiplan, Inc.","Multiplan, Inc.",117.5,94,,percent of total billed charges,,
"Cortisol, Total (Mayo)OutsideLaboratory",,82533,CPT,Facility,Outpatient,,,90,125,106.25,35.825,125,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,108,86.4,,percent of total billed charges,,
"Cortisol, Total (Mayo)OutsideLaboratory",,82533,CPT,Facility,Inpatient,,,90,125,106.25,35.825,125,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Cortisol, Total (Mayo)OutsideLaboratory",,82533,CPT,Facility,Both,,,90,125,106.25,35.825,125,"Preferred One Administrative Services, INC.",PPO,123.25,98.6,,percent of total billed charges,,
"Cortisol, Total (Mayo)OutsideLaboratory",,82533,CPT,Facility,Outpatient,,,90,125,106.25,35.825,125,PrimeWest Health,Minnesota Senior Health Options (MSHO),64.3125,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Cortisol, Total (Mayo)OutsideLaboratory",,82533,CPT,Facility,Inpatient,,,90,125,106.25,35.825,125,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Cortisol, Total (Mayo)OutsideLaboratory",,82533,CPT,Facility,Outpatient,,,90,125,106.25,35.825,125,PrimeWest Health,MinnesotaCare,64.2,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Cortisol, Total (Mayo)OutsideLaboratory",,82533,CPT,Facility,Inpatient,,,90,125,106.25,35.825,125,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Cortisol, Total (Mayo)OutsideLaboratory",,82533,CPT,Facility,Both,,,90,125,106.25,35.825,125,Sanford Health Plan,Sanford Health Plan,115,92,,percent of total billed charges,,
"Cortisol, Total (Mayo)OutsideLaboratory",,82533,CPT,Facility,Outpatient,,,90,125,106.25,35.825,125,"UCare Health, Inc.",Individual & Family Plan,70.4375,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Cortisol, Total (Mayo)OutsideLaboratory",,82533,CPT,Facility,Inpatient,,,90,125,106.25,35.825,125,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Cortisol, Total (Mayo)OutsideLaboratory",,82533,CPT,Facility,Outpatient,,,90,125,106.25,35.825,125,"UCare Health, Inc.",Medical Assistance,63.0875,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Cortisol, Total (Mayo)OutsideLaboratory",,82533,CPT,Facility,Inpatient,,,90,125,106.25,35.825,125,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Cortisol, Total (Mayo)OutsideLaboratory",,82533,CPT,Facility,Outpatient,,,90,125,106.25,35.825,125,"UCare Health, Inc.",Medicare Advantage,63.0875,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Cortisol, Total (Mayo)OutsideLaboratory",,82533,CPT,Facility,Inpatient,,,90,125,106.25,35.825,125,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Cortisol, Total (Mayo)OutsideLaboratory",,82533,CPT,Facility,Outpatient,,,90,125,106.25,35.825,125,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),63.0875,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Cortisol, Total (Mayo)OutsideLaboratory",,82533,CPT,Facility,Inpatient,,,90,125,106.25,35.825,125,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Cortisol, Total (Mayo)OutsideLaboratory",,82533,CPT,Facility,Both,,,90,125,106.25,35.825,125,UnitedHealthcare,Individual & Family,117.5,94,,percent of total billed charges,,
"Cortisol, Total (Mayo)OutsideLaboratory",,82533,CPT,Facility,Outpatient,,,90,125,106.25,35.825,125,UnitedHealthcare,Medicare Advantage,61.25,49,,percent of total billed charges,,
"Cortisol, Total (Mayo)OutsideLaboratory",,82533,CPT,Facility,Inpatient,,,90,125,106.25,35.825,125,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Cortisol, Total (Mayo)OutsideLaboratory",,82533,CPT,Facility,Outpatient,,,90,125,106.25,35.825,125,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,60,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Cortisol, Total (Mayo)OutsideLaboratory",,82533,CPT,Facility,Inpatient,,,90,125,106.25,35.825,125,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Creatine, Urine  (Mayo)OutsideLaboratory",,82540,CPT,Facility,Both,,,90,72,61.2,20.6352,72,Aetna,Commercial,66.24,92,,percent of total billed charges,,
"Creatine, Urine  (Mayo)OutsideLaboratory",,82540,CPT,Facility,Outpatient,,,90,72,61.2,20.6352,72,Aetna,Medicare Advantage,35.28,49,,percent of total billed charges,,
"Creatine, Urine  (Mayo)OutsideLaboratory",,82540,CPT,Facility,Inpatient,,,90,72,61.2,20.6352,72,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Creatine, Urine  (Mayo)OutsideLaboratory",,82540,CPT,Facility,Both,,,90,72,61.2,20.6352,72,Aetna,PPO,66.96,93,,percent of total billed charges,,
"Creatine, Urine  (Mayo)OutsideLaboratory",,82540,CPT,Facility,Both,,,90,72,61.2,20.6352,72,America's PPO,America's PPO,69.1416,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Creatine, Urine  (Mayo)OutsideLaboratory",,82540,CPT,Facility,Both,,,90,72,61.2,20.6352,72,BlueCross BlueShield Minnesota, Federal Employee Program,70.848,98.4,,percent of total billed charges,,
"Creatine, Urine  (Mayo)OutsideLaboratory",,82540,CPT,Facility,Both,,,90,72,61.2,20.6352,72,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,72,100,,percent of total billed charges,,
"Creatine, Urine  (Mayo)OutsideLaboratory",,82540,CPT,Facility,Both,,,90,72,61.2,20.6352,72,BlueCross BlueShield Minnesota,High Value Network Plan,64.8,90,,percent of total billed charges,,
"Creatine, Urine  (Mayo)OutsideLaboratory",,82540,CPT,Facility,Outpatient,,,90,72,61.2,20.6352,72,BlueCross BlueShield Minnesota,Medicare Advantage,35.28,49,,percent of total billed charges,,
"Creatine, Urine  (Mayo)OutsideLaboratory",,82540,CPT,Facility,Inpatient,,,90,72,61.2,20.6352,72,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Creatine, Urine  (Mayo)OutsideLaboratory",,82540,CPT,Facility,Both,,,90,72,61.2,20.6352,72,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,63.7704,88.57,,percent of total billed charges,,
"Creatine, Urine  (Mayo)OutsideLaboratory",,82540,CPT,Facility,Both,,,90,72,61.2,20.6352,72,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,20.6352,28.66,,percent of total billed charges,,
"Creatine, Urine  (Mayo)OutsideLaboratory",,82540,CPT,Facility,Outpatient,,,90,72,61.2,20.6352,72,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),35.28,49,,percent of total billed charges,,
"Creatine, Urine  (Mayo)OutsideLaboratory",,82540,CPT,Facility,Inpatient,,,90,72,61.2,20.6352,72,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Creatine, Urine  (Mayo)OutsideLaboratory",,82540,CPT,Facility,Both,,,90,72,61.2,20.6352,72,CorVel,Worker's Compensation,72,100,,percent of total billed charges,,
"Creatine, Urine  (Mayo)OutsideLaboratory",,82540,CPT,Facility,Both,,,90,72,61.2,20.6352,72,First Health Group Corporation,First Health Network,69.84,97,,percent of total billed charges,,
"Creatine, Urine  (Mayo)OutsideLaboratory",,82540,CPT,Facility,Both,,,90,72,61.2,20.6352,72,"Health Partners, Inc.",Commercial,68.112,94.6,,percent of total billed charges,,
"Creatine, Urine  (Mayo)OutsideLaboratory",,82540,CPT,Facility,Outpatient,,,90,72,61.2,20.6352,72,"Health Partners, Inc.",Medicare Advantage,35.28,49,,percent of total billed charges,,
"Creatine, Urine  (Mayo)OutsideLaboratory",,82540,CPT,Facility,Inpatient,,,90,72,61.2,20.6352,72,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Creatine, Urine  (Mayo)OutsideLaboratory",,82540,CPT,Facility,Both,,,90,72,61.2,20.6352,72,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),43.2,60,,percent of total billed charges,,
"Creatine, Urine  (Mayo)OutsideLaboratory",,82540,CPT,Facility,Both,,,90,72,61.2,20.6352,72,"Health Partners, Inc.",State of Minnesota Advantage Program,58.68,81.5,,percent of total billed charges,,
"Creatine, Urine  (Mayo)OutsideLaboratory",,82540,CPT,Facility,Both,,,90,72,61.2,20.6352,72,"Health Partners, Inc.",State Public Programs,36,50,,percent of total billed charges,,
"Creatine, Urine  (Mayo)OutsideLaboratory",,82540,CPT,Facility,Both,,,90,72,61.2,20.6352,72,Humana Insurance Company,Commercial PPO,68.4,95,,percent of total billed charges,,
"Creatine, Urine  (Mayo)OutsideLaboratory",,82540,CPT,Facility,Outpatient,,,90,72,61.2,20.6352,72,Humana Insurance Company,Medicare PPO,35.28,49,,percent of total billed charges,,
"Creatine, Urine  (Mayo)OutsideLaboratory",,82540,CPT,Facility,Inpatient,,,90,72,61.2,20.6352,72,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Creatine, Urine  (Mayo)OutsideLaboratory",,82540,CPT,Facility,Both,,,90,72,61.2,20.6352,72,Medica,Individual & Family,71.352,99.1,,percent of total billed charges,,
"Creatine, Urine  (Mayo)OutsideLaboratory",,82540,CPT,Facility,Outpatient,,,90,72,61.2,20.6352,72,Medica,Medica Advantage Solution,35.856,49.8,,percent of total billed charges,,
"Creatine, Urine  (Mayo)OutsideLaboratory",,82540,CPT,Facility,Inpatient,,,90,72,61.2,20.6352,72,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Creatine, Urine  (Mayo)OutsideLaboratory",,82540,CPT,Facility,Outpatient,,,90,72,61.2,20.6352,72,Medica,Medical Assistance,32.112,44.6,,percent of total billed charges,,
"Creatine, Urine  (Mayo)OutsideLaboratory",,82540,CPT,Facility,Inpatient,,,90,72,61.2,20.6352,72,Medica,Medical Assistance,,,,,Included in per diem rate,
"Creatine, Urine  (Mayo)OutsideLaboratory",,82540,CPT,Facility,Outpatient,,,90,72,61.2,20.6352,72,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,35.856,49.8,,percent of total billed charges,,
"Creatine, Urine  (Mayo)OutsideLaboratory",,82540,CPT,Facility,Inpatient,,,90,72,61.2,20.6352,72,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Creatine, Urine  (Mayo)OutsideLaboratory",,82540,CPT,Facility,Both,,,90,72,61.2,20.6352,72,"Multiplan, Inc.","Multiplan, Inc.",67.68,94,,percent of total billed charges,,
"Creatine, Urine  (Mayo)OutsideLaboratory",,82540,CPT,Facility,Outpatient,,,90,72,61.2,20.6352,72,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,62.208,86.4,,percent of total billed charges,,
"Creatine, Urine  (Mayo)OutsideLaboratory",,82540,CPT,Facility,Inpatient,,,90,72,61.2,20.6352,72,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Creatine, Urine  (Mayo)OutsideLaboratory",,82540,CPT,Facility,Both,,,90,72,61.2,20.6352,72,"Preferred One Administrative Services, INC.",PPO,70.992,98.6,,percent of total billed charges,,
"Creatine, Urine  (Mayo)OutsideLaboratory",,82540,CPT,Facility,Outpatient,,,90,72,61.2,20.6352,72,PrimeWest Health,Minnesota Senior Health Options (MSHO),37.044,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Creatine, Urine  (Mayo)OutsideLaboratory",,82540,CPT,Facility,Inpatient,,,90,72,61.2,20.6352,72,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Creatine, Urine  (Mayo)OutsideLaboratory",,82540,CPT,Facility,Outpatient,,,90,72,61.2,20.6352,72,PrimeWest Health,MinnesotaCare,36.9792,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Creatine, Urine  (Mayo)OutsideLaboratory",,82540,CPT,Facility,Inpatient,,,90,72,61.2,20.6352,72,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Creatine, Urine  (Mayo)OutsideLaboratory",,82540,CPT,Facility,Both,,,90,72,61.2,20.6352,72,Sanford Health Plan,Sanford Health Plan,66.24,92,,percent of total billed charges,,
"Creatine, Urine  (Mayo)OutsideLaboratory",,82540,CPT,Facility,Outpatient,,,90,72,61.2,20.6352,72,"UCare Health, Inc.",Individual & Family Plan,40.572,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Creatine, Urine  (Mayo)OutsideLaboratory",,82540,CPT,Facility,Inpatient,,,90,72,61.2,20.6352,72,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Creatine, Urine  (Mayo)OutsideLaboratory",,82540,CPT,Facility,Outpatient,,,90,72,61.2,20.6352,72,"UCare Health, Inc.",Medical Assistance,36.3384,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Creatine, Urine  (Mayo)OutsideLaboratory",,82540,CPT,Facility,Inpatient,,,90,72,61.2,20.6352,72,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Creatine, Urine  (Mayo)OutsideLaboratory",,82540,CPT,Facility,Outpatient,,,90,72,61.2,20.6352,72,"UCare Health, Inc.",Medicare Advantage,36.3384,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Creatine, Urine  (Mayo)OutsideLaboratory",,82540,CPT,Facility,Inpatient,,,90,72,61.2,20.6352,72,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Creatine, Urine  (Mayo)OutsideLaboratory",,82540,CPT,Facility,Outpatient,,,90,72,61.2,20.6352,72,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),36.3384,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Creatine, Urine  (Mayo)OutsideLaboratory",,82540,CPT,Facility,Inpatient,,,90,72,61.2,20.6352,72,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Creatine, Urine  (Mayo)OutsideLaboratory",,82540,CPT,Facility,Both,,,90,72,61.2,20.6352,72,UnitedHealthcare,Individual & Family,67.68,94,,percent of total billed charges,,
"Creatine, Urine  (Mayo)OutsideLaboratory",,82540,CPT,Facility,Outpatient,,,90,72,61.2,20.6352,72,UnitedHealthcare,Medicare Advantage,35.28,49,,percent of total billed charges,,
"Creatine, Urine  (Mayo)OutsideLaboratory",,82540,CPT,Facility,Inpatient,,,90,72,61.2,20.6352,72,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Creatine, Urine  (Mayo)OutsideLaboratory",,82540,CPT,Facility,Outpatient,,,90,72,61.2,20.6352,72,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,34.56,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Creatine, Urine  (Mayo)OutsideLaboratory",,82540,CPT,Facility,Inpatient,,,90,72,61.2,20.6352,72,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"A1At Proteotype S/Z, Lc-Ms/Ms, S (Mayo)OutsideLaboratory",,82542,CPT,Facility,Both,,,90,102,86.7,29.2332,102,Aetna,Commercial,93.84,92,,percent of total billed charges,,
"A1At Proteotype S/Z, Lc-Ms/Ms, S (Mayo)OutsideLaboratory",,82542,CPT,Facility,Outpatient,,,90,102,86.7,29.2332,102,Aetna,Medicare Advantage,49.98,49,,percent of total billed charges,,
"A1At Proteotype S/Z, Lc-Ms/Ms, S (Mayo)OutsideLaboratory",,82542,CPT,Facility,Inpatient,,,90,102,86.7,29.2332,102,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"A1At Proteotype S/Z, Lc-Ms/Ms, S (Mayo)OutsideLaboratory",,82542,CPT,Facility,Both,,,90,102,86.7,29.2332,102,Aetna,PPO,94.86,93,,percent of total billed charges,,
"A1At Proteotype S/Z, Lc-Ms/Ms, S (Mayo)OutsideLaboratory",,82542,CPT,Facility,Both,,,90,102,86.7,29.2332,102,America's PPO,America's PPO,97.9506,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"A1At Proteotype S/Z, Lc-Ms/Ms, S (Mayo)OutsideLaboratory",,82542,CPT,Facility,Both,,,90,102,86.7,29.2332,102,BlueCross BlueShield Minnesota, Federal Employee Program,100.368,98.4,,percent of total billed charges,,
"A1At Proteotype S/Z, Lc-Ms/Ms, S (Mayo)OutsideLaboratory",,82542,CPT,Facility,Both,,,90,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,102,100,,percent of total billed charges,,
"A1At Proteotype S/Z, Lc-Ms/Ms, S (Mayo)OutsideLaboratory",,82542,CPT,Facility,Both,,,90,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,High Value Network Plan,91.8,90,,percent of total billed charges,,
"A1At Proteotype S/Z, Lc-Ms/Ms, S (Mayo)OutsideLaboratory",,82542,CPT,Facility,Outpatient,,,90,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,Medicare Advantage,49.98,49,,percent of total billed charges,,
"A1At Proteotype S/Z, Lc-Ms/Ms, S (Mayo)OutsideLaboratory",,82542,CPT,Facility,Inpatient,,,90,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"A1At Proteotype S/Z, Lc-Ms/Ms, S (Mayo)OutsideLaboratory",,82542,CPT,Facility,Both,,,90,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,90.3414,88.57,,percent of total billed charges,,
"A1At Proteotype S/Z, Lc-Ms/Ms, S (Mayo)OutsideLaboratory",,82542,CPT,Facility,Both,,,90,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,29.2332,28.66,,percent of total billed charges,,
"A1At Proteotype S/Z, Lc-Ms/Ms, S (Mayo)OutsideLaboratory",,82542,CPT,Facility,Outpatient,,,90,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),49.98,49,,percent of total billed charges,,
"A1At Proteotype S/Z, Lc-Ms/Ms, S (Mayo)OutsideLaboratory",,82542,CPT,Facility,Inpatient,,,90,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"A1At Proteotype S/Z, Lc-Ms/Ms, S (Mayo)OutsideLaboratory",,82542,CPT,Facility,Both,,,90,102,86.7,29.2332,102,CorVel,Worker's Compensation,102,100,,percent of total billed charges,,
"A1At Proteotype S/Z, Lc-Ms/Ms, S (Mayo)OutsideLaboratory",,82542,CPT,Facility,Both,,,90,102,86.7,29.2332,102,First Health Group Corporation,First Health Network,98.94,97,,percent of total billed charges,,
"A1At Proteotype S/Z, Lc-Ms/Ms, S (Mayo)OutsideLaboratory",,82542,CPT,Facility,Both,,,90,102,86.7,29.2332,102,"Health Partners, Inc.",Commercial,96.492,94.6,,percent of total billed charges,,
"A1At Proteotype S/Z, Lc-Ms/Ms, S (Mayo)OutsideLaboratory",,82542,CPT,Facility,Outpatient,,,90,102,86.7,29.2332,102,"Health Partners, Inc.",Medicare Advantage,49.98,49,,percent of total billed charges,,
"A1At Proteotype S/Z, Lc-Ms/Ms, S (Mayo)OutsideLaboratory",,82542,CPT,Facility,Inpatient,,,90,102,86.7,29.2332,102,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"A1At Proteotype S/Z, Lc-Ms/Ms, S (Mayo)OutsideLaboratory",,82542,CPT,Facility,Both,,,90,102,86.7,29.2332,102,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),61.2,60,,percent of total billed charges,,
"A1At Proteotype S/Z, Lc-Ms/Ms, S (Mayo)OutsideLaboratory",,82542,CPT,Facility,Both,,,90,102,86.7,29.2332,102,"Health Partners, Inc.",State of Minnesota Advantage Program,83.13,81.5,,percent of total billed charges,,
"A1At Proteotype S/Z, Lc-Ms/Ms, S (Mayo)OutsideLaboratory",,82542,CPT,Facility,Both,,,90,102,86.7,29.2332,102,"Health Partners, Inc.",State Public Programs,51,50,,percent of total billed charges,,
"A1At Proteotype S/Z, Lc-Ms/Ms, S (Mayo)OutsideLaboratory",,82542,CPT,Facility,Both,,,90,102,86.7,29.2332,102,Humana Insurance Company,Commercial PPO,96.9,95,,percent of total billed charges,,
"A1At Proteotype S/Z, Lc-Ms/Ms, S (Mayo)OutsideLaboratory",,82542,CPT,Facility,Outpatient,,,90,102,86.7,29.2332,102,Humana Insurance Company,Medicare PPO,49.98,49,,percent of total billed charges,,
"A1At Proteotype S/Z, Lc-Ms/Ms, S (Mayo)OutsideLaboratory",,82542,CPT,Facility,Inpatient,,,90,102,86.7,29.2332,102,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"A1At Proteotype S/Z, Lc-Ms/Ms, S (Mayo)OutsideLaboratory",,82542,CPT,Facility,Both,,,90,102,86.7,29.2332,102,Medica,Individual & Family,101.082,99.1,,percent of total billed charges,,
"A1At Proteotype S/Z, Lc-Ms/Ms, S (Mayo)OutsideLaboratory",,82542,CPT,Facility,Outpatient,,,90,102,86.7,29.2332,102,Medica,Medica Advantage Solution,50.796,49.8,,percent of total billed charges,,
"A1At Proteotype S/Z, Lc-Ms/Ms, S (Mayo)OutsideLaboratory",,82542,CPT,Facility,Inpatient,,,90,102,86.7,29.2332,102,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"A1At Proteotype S/Z, Lc-Ms/Ms, S (Mayo)OutsideLaboratory",,82542,CPT,Facility,Outpatient,,,90,102,86.7,29.2332,102,Medica,Medical Assistance,45.492,44.6,,percent of total billed charges,,
"A1At Proteotype S/Z, Lc-Ms/Ms, S (Mayo)OutsideLaboratory",,82542,CPT,Facility,Inpatient,,,90,102,86.7,29.2332,102,Medica,Medical Assistance,,,,,Included in per diem rate,
"A1At Proteotype S/Z, Lc-Ms/Ms, S (Mayo)OutsideLaboratory",,82542,CPT,Facility,Outpatient,,,90,102,86.7,29.2332,102,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,50.796,49.8,,percent of total billed charges,,
"A1At Proteotype S/Z, Lc-Ms/Ms, S (Mayo)OutsideLaboratory",,82542,CPT,Facility,Inpatient,,,90,102,86.7,29.2332,102,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"A1At Proteotype S/Z, Lc-Ms/Ms, S (Mayo)OutsideLaboratory",,82542,CPT,Facility,Both,,,90,102,86.7,29.2332,102,"Multiplan, Inc.","Multiplan, Inc.",95.88,94,,percent of total billed charges,,
"A1At Proteotype S/Z, Lc-Ms/Ms, S (Mayo)OutsideLaboratory",,82542,CPT,Facility,Outpatient,,,90,102,86.7,29.2332,102,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,88.128,86.4,,percent of total billed charges,,
"A1At Proteotype S/Z, Lc-Ms/Ms, S (Mayo)OutsideLaboratory",,82542,CPT,Facility,Inpatient,,,90,102,86.7,29.2332,102,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"A1At Proteotype S/Z, Lc-Ms/Ms, S (Mayo)OutsideLaboratory",,82542,CPT,Facility,Both,,,90,102,86.7,29.2332,102,"Preferred One Administrative Services, INC.",PPO,100.572,98.6,,percent of total billed charges,,
"A1At Proteotype S/Z, Lc-Ms/Ms, S (Mayo)OutsideLaboratory",,82542,CPT,Facility,Outpatient,,,90,102,86.7,29.2332,102,PrimeWest Health,Minnesota Senior Health Options (MSHO),52.479,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"A1At Proteotype S/Z, Lc-Ms/Ms, S (Mayo)OutsideLaboratory",,82542,CPT,Facility,Inpatient,,,90,102,86.7,29.2332,102,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"A1At Proteotype S/Z, Lc-Ms/Ms, S (Mayo)OutsideLaboratory",,82542,CPT,Facility,Outpatient,,,90,102,86.7,29.2332,102,PrimeWest Health,MinnesotaCare,52.3872,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"A1At Proteotype S/Z, Lc-Ms/Ms, S (Mayo)OutsideLaboratory",,82542,CPT,Facility,Inpatient,,,90,102,86.7,29.2332,102,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"A1At Proteotype S/Z, Lc-Ms/Ms, S (Mayo)OutsideLaboratory",,82542,CPT,Facility,Both,,,90,102,86.7,29.2332,102,Sanford Health Plan,Sanford Health Plan,93.84,92,,percent of total billed charges,,
"A1At Proteotype S/Z, Lc-Ms/Ms, S (Mayo)OutsideLaboratory",,82542,CPT,Facility,Outpatient,,,90,102,86.7,29.2332,102,"UCare Health, Inc.",Individual & Family Plan,57.477,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"A1At Proteotype S/Z, Lc-Ms/Ms, S (Mayo)OutsideLaboratory",,82542,CPT,Facility,Inpatient,,,90,102,86.7,29.2332,102,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"A1At Proteotype S/Z, Lc-Ms/Ms, S (Mayo)OutsideLaboratory",,82542,CPT,Facility,Outpatient,,,90,102,86.7,29.2332,102,"UCare Health, Inc.",Medical Assistance,51.4794,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"A1At Proteotype S/Z, Lc-Ms/Ms, S (Mayo)OutsideLaboratory",,82542,CPT,Facility,Inpatient,,,90,102,86.7,29.2332,102,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"A1At Proteotype S/Z, Lc-Ms/Ms, S (Mayo)OutsideLaboratory",,82542,CPT,Facility,Outpatient,,,90,102,86.7,29.2332,102,"UCare Health, Inc.",Medicare Advantage,51.4794,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"A1At Proteotype S/Z, Lc-Ms/Ms, S (Mayo)OutsideLaboratory",,82542,CPT,Facility,Inpatient,,,90,102,86.7,29.2332,102,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"A1At Proteotype S/Z, Lc-Ms/Ms, S (Mayo)OutsideLaboratory",,82542,CPT,Facility,Outpatient,,,90,102,86.7,29.2332,102,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),51.4794,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"A1At Proteotype S/Z, Lc-Ms/Ms, S (Mayo)OutsideLaboratory",,82542,CPT,Facility,Inpatient,,,90,102,86.7,29.2332,102,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"A1At Proteotype S/Z, Lc-Ms/Ms, S (Mayo)OutsideLaboratory",,82542,CPT,Facility,Both,,,90,102,86.7,29.2332,102,UnitedHealthcare,Individual & Family,95.88,94,,percent of total billed charges,,
"A1At Proteotype S/Z, Lc-Ms/Ms, S (Mayo)OutsideLaboratory",,82542,CPT,Facility,Outpatient,,,90,102,86.7,29.2332,102,UnitedHealthcare,Medicare Advantage,49.98,49,,percent of total billed charges,,
"A1At Proteotype S/Z, Lc-Ms/Ms, S (Mayo)OutsideLaboratory",,82542,CPT,Facility,Inpatient,,,90,102,86.7,29.2332,102,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"A1At Proteotype S/Z, Lc-Ms/Ms, S (Mayo)OutsideLaboratory",,82542,CPT,Facility,Outpatient,,,90,102,86.7,29.2332,102,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,48.96,48,,percent of total billed charges,,100% of DHS outpatient percentage
"A1At Proteotype S/Z, Lc-Ms/Ms, S (Mayo)OutsideLaboratory",,82542,CPT,Facility,Inpatient,,,90,102,86.7,29.2332,102,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Bile Acids, Fractionated And Tot, S (Mayo)OutsideLaboratory",,82542,CPT,Facility,Both,,,90,133,113.05,38.1178,133,Aetna,Commercial,122.36,92,,percent of total billed charges,,
"Bile Acids, Fractionated And Tot, S (Mayo)OutsideLaboratory",,82542,CPT,Facility,Outpatient,,,90,133,113.05,38.1178,133,Aetna,Medicare Advantage,65.17,49,,percent of total billed charges,,
"Bile Acids, Fractionated And Tot, S (Mayo)OutsideLaboratory",,82542,CPT,Facility,Inpatient,,,90,133,113.05,38.1178,133,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Bile Acids, Fractionated And Tot, S (Mayo)OutsideLaboratory",,82542,CPT,Facility,Both,,,90,133,113.05,38.1178,133,Aetna,PPO,123.69,93,,percent of total billed charges,,
"Bile Acids, Fractionated And Tot, S (Mayo)OutsideLaboratory",,82542,CPT,Facility,Both,,,90,133,113.05,38.1178,133,America's PPO,America's PPO,127.7199,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Bile Acids, Fractionated And Tot, S (Mayo)OutsideLaboratory",,82542,CPT,Facility,Both,,,90,133,113.05,38.1178,133,BlueCross BlueShield Minnesota, Federal Employee Program,130.872,98.4,,percent of total billed charges,,
"Bile Acids, Fractionated And Tot, S (Mayo)OutsideLaboratory",,82542,CPT,Facility,Both,,,90,133,113.05,38.1178,133,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,133,100,,percent of total billed charges,,
"Bile Acids, Fractionated And Tot, S (Mayo)OutsideLaboratory",,82542,CPT,Facility,Both,,,90,133,113.05,38.1178,133,BlueCross BlueShield Minnesota,High Value Network Plan,119.7,90,,percent of total billed charges,,
"Bile Acids, Fractionated And Tot, S (Mayo)OutsideLaboratory",,82542,CPT,Facility,Outpatient,,,90,133,113.05,38.1178,133,BlueCross BlueShield Minnesota,Medicare Advantage,65.17,49,,percent of total billed charges,,
"Bile Acids, Fractionated And Tot, S (Mayo)OutsideLaboratory",,82542,CPT,Facility,Inpatient,,,90,133,113.05,38.1178,133,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Bile Acids, Fractionated And Tot, S (Mayo)OutsideLaboratory",,82542,CPT,Facility,Both,,,90,133,113.05,38.1178,133,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,117.7981,88.57,,percent of total billed charges,,
"Bile Acids, Fractionated And Tot, S (Mayo)OutsideLaboratory",,82542,CPT,Facility,Both,,,90,133,113.05,38.1178,133,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,38.1178,28.66,,percent of total billed charges,,
"Bile Acids, Fractionated And Tot, S (Mayo)OutsideLaboratory",,82542,CPT,Facility,Outpatient,,,90,133,113.05,38.1178,133,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),65.17,49,,percent of total billed charges,,
"Bile Acids, Fractionated And Tot, S (Mayo)OutsideLaboratory",,82542,CPT,Facility,Inpatient,,,90,133,113.05,38.1178,133,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Bile Acids, Fractionated And Tot, S (Mayo)OutsideLaboratory",,82542,CPT,Facility,Both,,,90,133,113.05,38.1178,133,CorVel,Worker's Compensation,133,100,,percent of total billed charges,,
"Bile Acids, Fractionated And Tot, S (Mayo)OutsideLaboratory",,82542,CPT,Facility,Both,,,90,133,113.05,38.1178,133,First Health Group Corporation,First Health Network,129.01,97,,percent of total billed charges,,
"Bile Acids, Fractionated And Tot, S (Mayo)OutsideLaboratory",,82542,CPT,Facility,Both,,,90,133,113.05,38.1178,133,"Health Partners, Inc.",Commercial,125.818,94.6,,percent of total billed charges,,
"Bile Acids, Fractionated And Tot, S (Mayo)OutsideLaboratory",,82542,CPT,Facility,Outpatient,,,90,133,113.05,38.1178,133,"Health Partners, Inc.",Medicare Advantage,65.17,49,,percent of total billed charges,,
"Bile Acids, Fractionated And Tot, S (Mayo)OutsideLaboratory",,82542,CPT,Facility,Inpatient,,,90,133,113.05,38.1178,133,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Bile Acids, Fractionated And Tot, S (Mayo)OutsideLaboratory",,82542,CPT,Facility,Both,,,90,133,113.05,38.1178,133,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),79.8,60,,percent of total billed charges,,
"Bile Acids, Fractionated And Tot, S (Mayo)OutsideLaboratory",,82542,CPT,Facility,Both,,,90,133,113.05,38.1178,133,"Health Partners, Inc.",State of Minnesota Advantage Program,108.395,81.5,,percent of total billed charges,,
"Bile Acids, Fractionated And Tot, S (Mayo)OutsideLaboratory",,82542,CPT,Facility,Both,,,90,133,113.05,38.1178,133,"Health Partners, Inc.",State Public Programs,66.5,50,,percent of total billed charges,,
"Bile Acids, Fractionated And Tot, S (Mayo)OutsideLaboratory",,82542,CPT,Facility,Both,,,90,133,113.05,38.1178,133,Humana Insurance Company,Commercial PPO,126.35,95,,percent of total billed charges,,
"Bile Acids, Fractionated And Tot, S (Mayo)OutsideLaboratory",,82542,CPT,Facility,Outpatient,,,90,133,113.05,38.1178,133,Humana Insurance Company,Medicare PPO,65.17,49,,percent of total billed charges,,
"Bile Acids, Fractionated And Tot, S (Mayo)OutsideLaboratory",,82542,CPT,Facility,Inpatient,,,90,133,113.05,38.1178,133,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Bile Acids, Fractionated And Tot, S (Mayo)OutsideLaboratory",,82542,CPT,Facility,Both,,,90,133,113.05,38.1178,133,Medica,Individual & Family,131.803,99.1,,percent of total billed charges,,
"Bile Acids, Fractionated And Tot, S (Mayo)OutsideLaboratory",,82542,CPT,Facility,Outpatient,,,90,133,113.05,38.1178,133,Medica,Medica Advantage Solution,66.234,49.8,,percent of total billed charges,,
"Bile Acids, Fractionated And Tot, S (Mayo)OutsideLaboratory",,82542,CPT,Facility,Inpatient,,,90,133,113.05,38.1178,133,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Bile Acids, Fractionated And Tot, S (Mayo)OutsideLaboratory",,82542,CPT,Facility,Outpatient,,,90,133,113.05,38.1178,133,Medica,Medical Assistance,59.318,44.6,,percent of total billed charges,,
"Bile Acids, Fractionated And Tot, S (Mayo)OutsideLaboratory",,82542,CPT,Facility,Inpatient,,,90,133,113.05,38.1178,133,Medica,Medical Assistance,,,,,Included in per diem rate,
"Bile Acids, Fractionated And Tot, S (Mayo)OutsideLaboratory",,82542,CPT,Facility,Outpatient,,,90,133,113.05,38.1178,133,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,66.234,49.8,,percent of total billed charges,,
"Bile Acids, Fractionated And Tot, S (Mayo)OutsideLaboratory",,82542,CPT,Facility,Inpatient,,,90,133,113.05,38.1178,133,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Bile Acids, Fractionated And Tot, S (Mayo)OutsideLaboratory",,82542,CPT,Facility,Both,,,90,133,113.05,38.1178,133,"Multiplan, Inc.","Multiplan, Inc.",125.02,94,,percent of total billed charges,,
"Bile Acids, Fractionated And Tot, S (Mayo)OutsideLaboratory",,82542,CPT,Facility,Outpatient,,,90,133,113.05,38.1178,133,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,114.912,86.4,,percent of total billed charges,,
"Bile Acids, Fractionated And Tot, S (Mayo)OutsideLaboratory",,82542,CPT,Facility,Inpatient,,,90,133,113.05,38.1178,133,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Bile Acids, Fractionated And Tot, S (Mayo)OutsideLaboratory",,82542,CPT,Facility,Both,,,90,133,113.05,38.1178,133,"Preferred One Administrative Services, INC.",PPO,131.138,98.6,,percent of total billed charges,,
"Bile Acids, Fractionated And Tot, S (Mayo)OutsideLaboratory",,82542,CPT,Facility,Outpatient,,,90,133,113.05,38.1178,133,PrimeWest Health,Minnesota Senior Health Options (MSHO),68.4285,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Bile Acids, Fractionated And Tot, S (Mayo)OutsideLaboratory",,82542,CPT,Facility,Inpatient,,,90,133,113.05,38.1178,133,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Bile Acids, Fractionated And Tot, S (Mayo)OutsideLaboratory",,82542,CPT,Facility,Outpatient,,,90,133,113.05,38.1178,133,PrimeWest Health,MinnesotaCare,68.3088,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Bile Acids, Fractionated And Tot, S (Mayo)OutsideLaboratory",,82542,CPT,Facility,Inpatient,,,90,133,113.05,38.1178,133,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Bile Acids, Fractionated And Tot, S (Mayo)OutsideLaboratory",,82542,CPT,Facility,Both,,,90,133,113.05,38.1178,133,Sanford Health Plan,Sanford Health Plan,122.36,92,,percent of total billed charges,,
"Bile Acids, Fractionated And Tot, S (Mayo)OutsideLaboratory",,82542,CPT,Facility,Outpatient,,,90,133,113.05,38.1178,133,"UCare Health, Inc.",Individual & Family Plan,74.9455,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Bile Acids, Fractionated And Tot, S (Mayo)OutsideLaboratory",,82542,CPT,Facility,Inpatient,,,90,133,113.05,38.1178,133,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Bile Acids, Fractionated And Tot, S (Mayo)OutsideLaboratory",,82542,CPT,Facility,Outpatient,,,90,133,113.05,38.1178,133,"UCare Health, Inc.",Medical Assistance,67.1251,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Bile Acids, Fractionated And Tot, S (Mayo)OutsideLaboratory",,82542,CPT,Facility,Inpatient,,,90,133,113.05,38.1178,133,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Bile Acids, Fractionated And Tot, S (Mayo)OutsideLaboratory",,82542,CPT,Facility,Outpatient,,,90,133,113.05,38.1178,133,"UCare Health, Inc.",Medicare Advantage,67.1251,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Bile Acids, Fractionated And Tot, S (Mayo)OutsideLaboratory",,82542,CPT,Facility,Inpatient,,,90,133,113.05,38.1178,133,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Bile Acids, Fractionated And Tot, S (Mayo)OutsideLaboratory",,82542,CPT,Facility,Outpatient,,,90,133,113.05,38.1178,133,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),67.1251,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Bile Acids, Fractionated And Tot, S (Mayo)OutsideLaboratory",,82542,CPT,Facility,Inpatient,,,90,133,113.05,38.1178,133,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Bile Acids, Fractionated And Tot, S (Mayo)OutsideLaboratory",,82542,CPT,Facility,Both,,,90,133,113.05,38.1178,133,UnitedHealthcare,Individual & Family,125.02,94,,percent of total billed charges,,
"Bile Acids, Fractionated And Tot, S (Mayo)OutsideLaboratory",,82542,CPT,Facility,Outpatient,,,90,133,113.05,38.1178,133,UnitedHealthcare,Medicare Advantage,65.17,49,,percent of total billed charges,,
"Bile Acids, Fractionated And Tot, S (Mayo)OutsideLaboratory",,82542,CPT,Facility,Inpatient,,,90,133,113.05,38.1178,133,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Bile Acids, Fractionated And Tot, S (Mayo)OutsideLaboratory",,82542,CPT,Facility,Outpatient,,,90,133,113.05,38.1178,133,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,63.84,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Bile Acids, Fractionated And Tot, S (Mayo)OutsideLaboratory",,82542,CPT,Facility,Inpatient,,,90,133,113.05,38.1178,133,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Column Chromatography, Inc Mass Spectrometry (Mayo)OutsideLaboratory",,82542,CPT,Facility,Both,,,90,77,65.45,22.0682,77,Aetna,Commercial,70.84,92,,percent of total billed charges,,
"Column Chromatography, Inc Mass Spectrometry (Mayo)OutsideLaboratory",,82542,CPT,Facility,Outpatient,,,90,77,65.45,22.0682,77,Aetna,Medicare Advantage,37.73,49,,percent of total billed charges,,
"Column Chromatography, Inc Mass Spectrometry (Mayo)OutsideLaboratory",,82542,CPT,Facility,Inpatient,,,90,77,65.45,22.0682,77,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Column Chromatography, Inc Mass Spectrometry (Mayo)OutsideLaboratory",,82542,CPT,Facility,Both,,,90,77,65.45,22.0682,77,Aetna,PPO,71.61,93,,percent of total billed charges,,
"Column Chromatography, Inc Mass Spectrometry (Mayo)OutsideLaboratory",,82542,CPT,Facility,Both,,,90,77,65.45,22.0682,77,America's PPO,America's PPO,73.9431,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Column Chromatography, Inc Mass Spectrometry (Mayo)OutsideLaboratory",,82542,CPT,Facility,Both,,,90,77,65.45,22.0682,77,BlueCross BlueShield Minnesota, Federal Employee Program,75.768,98.4,,percent of total billed charges,,
"Column Chromatography, Inc Mass Spectrometry (Mayo)OutsideLaboratory",,82542,CPT,Facility,Both,,,90,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,77,100,,percent of total billed charges,,
"Column Chromatography, Inc Mass Spectrometry (Mayo)OutsideLaboratory",,82542,CPT,Facility,Both,,,90,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,High Value Network Plan,69.3,90,,percent of total billed charges,,
"Column Chromatography, Inc Mass Spectrometry (Mayo)OutsideLaboratory",,82542,CPT,Facility,Outpatient,,,90,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,Medicare Advantage,37.73,49,,percent of total billed charges,,
"Column Chromatography, Inc Mass Spectrometry (Mayo)OutsideLaboratory",,82542,CPT,Facility,Inpatient,,,90,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Column Chromatography, Inc Mass Spectrometry (Mayo)OutsideLaboratory",,82542,CPT,Facility,Both,,,90,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,68.1989,88.57,,percent of total billed charges,,
"Column Chromatography, Inc Mass Spectrometry (Mayo)OutsideLaboratory",,82542,CPT,Facility,Both,,,90,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,22.0682,28.66,,percent of total billed charges,,
"Column Chromatography, Inc Mass Spectrometry (Mayo)OutsideLaboratory",,82542,CPT,Facility,Outpatient,,,90,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),37.73,49,,percent of total billed charges,,
"Column Chromatography, Inc Mass Spectrometry (Mayo)OutsideLaboratory",,82542,CPT,Facility,Inpatient,,,90,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Column Chromatography, Inc Mass Spectrometry (Mayo)OutsideLaboratory",,82542,CPT,Facility,Both,,,90,77,65.45,22.0682,77,CorVel,Worker's Compensation,77,100,,percent of total billed charges,,
"Column Chromatography, Inc Mass Spectrometry (Mayo)OutsideLaboratory",,82542,CPT,Facility,Both,,,90,77,65.45,22.0682,77,First Health Group Corporation,First Health Network,74.69,97,,percent of total billed charges,,
"Column Chromatography, Inc Mass Spectrometry (Mayo)OutsideLaboratory",,82542,CPT,Facility,Both,,,90,77,65.45,22.0682,77,"Health Partners, Inc.",Commercial,72.842,94.6,,percent of total billed charges,,
"Column Chromatography, Inc Mass Spectrometry (Mayo)OutsideLaboratory",,82542,CPT,Facility,Outpatient,,,90,77,65.45,22.0682,77,"Health Partners, Inc.",Medicare Advantage,37.73,49,,percent of total billed charges,,
"Column Chromatography, Inc Mass Spectrometry (Mayo)OutsideLaboratory",,82542,CPT,Facility,Inpatient,,,90,77,65.45,22.0682,77,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Column Chromatography, Inc Mass Spectrometry (Mayo)OutsideLaboratory",,82542,CPT,Facility,Both,,,90,77,65.45,22.0682,77,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),46.2,60,,percent of total billed charges,,
"Column Chromatography, Inc Mass Spectrometry (Mayo)OutsideLaboratory",,82542,CPT,Facility,Both,,,90,77,65.45,22.0682,77,"Health Partners, Inc.",State of Minnesota Advantage Program,62.755,81.5,,percent of total billed charges,,
"Column Chromatography, Inc Mass Spectrometry (Mayo)OutsideLaboratory",,82542,CPT,Facility,Both,,,90,77,65.45,22.0682,77,"Health Partners, Inc.",State Public Programs,38.5,50,,percent of total billed charges,,
"Column Chromatography, Inc Mass Spectrometry (Mayo)OutsideLaboratory",,82542,CPT,Facility,Both,,,90,77,65.45,22.0682,77,Humana Insurance Company,Commercial PPO,73.15,95,,percent of total billed charges,,
"Column Chromatography, Inc Mass Spectrometry (Mayo)OutsideLaboratory",,82542,CPT,Facility,Outpatient,,,90,77,65.45,22.0682,77,Humana Insurance Company,Medicare PPO,37.73,49,,percent of total billed charges,,
"Column Chromatography, Inc Mass Spectrometry (Mayo)OutsideLaboratory",,82542,CPT,Facility,Inpatient,,,90,77,65.45,22.0682,77,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Column Chromatography, Inc Mass Spectrometry (Mayo)OutsideLaboratory",,82542,CPT,Facility,Both,,,90,77,65.45,22.0682,77,Medica,Individual & Family,76.307,99.1,,percent of total billed charges,,
"Column Chromatography, Inc Mass Spectrometry (Mayo)OutsideLaboratory",,82542,CPT,Facility,Outpatient,,,90,77,65.45,22.0682,77,Medica,Medica Advantage Solution,38.346,49.8,,percent of total billed charges,,
"Column Chromatography, Inc Mass Spectrometry (Mayo)OutsideLaboratory",,82542,CPT,Facility,Inpatient,,,90,77,65.45,22.0682,77,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Column Chromatography, Inc Mass Spectrometry (Mayo)OutsideLaboratory",,82542,CPT,Facility,Outpatient,,,90,77,65.45,22.0682,77,Medica,Medical Assistance,34.342,44.6,,percent of total billed charges,,
"Column Chromatography, Inc Mass Spectrometry (Mayo)OutsideLaboratory",,82542,CPT,Facility,Inpatient,,,90,77,65.45,22.0682,77,Medica,Medical Assistance,,,,,Included in per diem rate,
"Column Chromatography, Inc Mass Spectrometry (Mayo)OutsideLaboratory",,82542,CPT,Facility,Outpatient,,,90,77,65.45,22.0682,77,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,38.346,49.8,,percent of total billed charges,,
"Column Chromatography, Inc Mass Spectrometry (Mayo)OutsideLaboratory",,82542,CPT,Facility,Inpatient,,,90,77,65.45,22.0682,77,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Column Chromatography, Inc Mass Spectrometry (Mayo)OutsideLaboratory",,82542,CPT,Facility,Both,,,90,77,65.45,22.0682,77,"Multiplan, Inc.","Multiplan, Inc.",72.38,94,,percent of total billed charges,,
"Column Chromatography, Inc Mass Spectrometry (Mayo)OutsideLaboratory",,82542,CPT,Facility,Outpatient,,,90,77,65.45,22.0682,77,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,66.528,86.4,,percent of total billed charges,,
"Column Chromatography, Inc Mass Spectrometry (Mayo)OutsideLaboratory",,82542,CPT,Facility,Inpatient,,,90,77,65.45,22.0682,77,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Column Chromatography, Inc Mass Spectrometry (Mayo)OutsideLaboratory",,82542,CPT,Facility,Both,,,90,77,65.45,22.0682,77,"Preferred One Administrative Services, INC.",PPO,75.922,98.6,,percent of total billed charges,,
"Column Chromatography, Inc Mass Spectrometry (Mayo)OutsideLaboratory",,82542,CPT,Facility,Outpatient,,,90,77,65.45,22.0682,77,PrimeWest Health,Minnesota Senior Health Options (MSHO),39.6165,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Column Chromatography, Inc Mass Spectrometry (Mayo)OutsideLaboratory",,82542,CPT,Facility,Inpatient,,,90,77,65.45,22.0682,77,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Column Chromatography, Inc Mass Spectrometry (Mayo)OutsideLaboratory",,82542,CPT,Facility,Outpatient,,,90,77,65.45,22.0682,77,PrimeWest Health,MinnesotaCare,39.5472,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Column Chromatography, Inc Mass Spectrometry (Mayo)OutsideLaboratory",,82542,CPT,Facility,Inpatient,,,90,77,65.45,22.0682,77,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Column Chromatography, Inc Mass Spectrometry (Mayo)OutsideLaboratory",,82542,CPT,Facility,Both,,,90,77,65.45,22.0682,77,Sanford Health Plan,Sanford Health Plan,70.84,92,,percent of total billed charges,,
"Column Chromatography, Inc Mass Spectrometry (Mayo)OutsideLaboratory",,82542,CPT,Facility,Outpatient,,,90,77,65.45,22.0682,77,"UCare Health, Inc.",Individual & Family Plan,43.3895,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Column Chromatography, Inc Mass Spectrometry (Mayo)OutsideLaboratory",,82542,CPT,Facility,Inpatient,,,90,77,65.45,22.0682,77,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Column Chromatography, Inc Mass Spectrometry (Mayo)OutsideLaboratory",,82542,CPT,Facility,Outpatient,,,90,77,65.45,22.0682,77,"UCare Health, Inc.",Medical Assistance,38.8619,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Column Chromatography, Inc Mass Spectrometry (Mayo)OutsideLaboratory",,82542,CPT,Facility,Inpatient,,,90,77,65.45,22.0682,77,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Column Chromatography, Inc Mass Spectrometry (Mayo)OutsideLaboratory",,82542,CPT,Facility,Outpatient,,,90,77,65.45,22.0682,77,"UCare Health, Inc.",Medicare Advantage,38.8619,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Column Chromatography, Inc Mass Spectrometry (Mayo)OutsideLaboratory",,82542,CPT,Facility,Inpatient,,,90,77,65.45,22.0682,77,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Column Chromatography, Inc Mass Spectrometry (Mayo)OutsideLaboratory",,82542,CPT,Facility,Outpatient,,,90,77,65.45,22.0682,77,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),38.8619,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Column Chromatography, Inc Mass Spectrometry (Mayo)OutsideLaboratory",,82542,CPT,Facility,Inpatient,,,90,77,65.45,22.0682,77,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Column Chromatography, Inc Mass Spectrometry (Mayo)OutsideLaboratory",,82542,CPT,Facility,Both,,,90,77,65.45,22.0682,77,UnitedHealthcare,Individual & Family,72.38,94,,percent of total billed charges,,
"Column Chromatography, Inc Mass Spectrometry (Mayo)OutsideLaboratory",,82542,CPT,Facility,Outpatient,,,90,77,65.45,22.0682,77,UnitedHealthcare,Medicare Advantage,37.73,49,,percent of total billed charges,,
"Column Chromatography, Inc Mass Spectrometry (Mayo)OutsideLaboratory",,82542,CPT,Facility,Inpatient,,,90,77,65.45,22.0682,77,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Column Chromatography, Inc Mass Spectrometry (Mayo)OutsideLaboratory",,82542,CPT,Facility,Outpatient,,,90,77,65.45,22.0682,77,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,36.96,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Column Chromatography, Inc Mass Spectrometry (Mayo)OutsideLaboratory",,82542,CPT,Facility,Inpatient,,,90,77,65.45,22.0682,77,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Porphyrins, Fractionation, Plasma (Reflex Only) (Mayo)OutsideLaboratory",,82542,CPT,Facility,Both,,,90,144,122.4,41.2704,144,Aetna,Commercial,132.48,92,,percent of total billed charges,,
"Porphyrins, Fractionation, Plasma (Reflex Only) (Mayo)OutsideLaboratory",,82542,CPT,Facility,Outpatient,,,90,144,122.4,41.2704,144,Aetna,Medicare Advantage,70.56,49,,percent of total billed charges,,
"Porphyrins, Fractionation, Plasma (Reflex Only) (Mayo)OutsideLaboratory",,82542,CPT,Facility,Inpatient,,,90,144,122.4,41.2704,144,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Porphyrins, Fractionation, Plasma (Reflex Only) (Mayo)OutsideLaboratory",,82542,CPT,Facility,Both,,,90,144,122.4,41.2704,144,Aetna,PPO,133.92,93,,percent of total billed charges,,
"Porphyrins, Fractionation, Plasma (Reflex Only) (Mayo)OutsideLaboratory",,82542,CPT,Facility,Both,,,90,144,122.4,41.2704,144,America's PPO,America's PPO,138.2832,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Porphyrins, Fractionation, Plasma (Reflex Only) (Mayo)OutsideLaboratory",,82542,CPT,Facility,Both,,,90,144,122.4,41.2704,144,BlueCross BlueShield Minnesota, Federal Employee Program,141.696,98.4,,percent of total billed charges,,
"Porphyrins, Fractionation, Plasma (Reflex Only) (Mayo)OutsideLaboratory",,82542,CPT,Facility,Both,,,90,144,122.4,41.2704,144,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,144,100,,percent of total billed charges,,
"Porphyrins, Fractionation, Plasma (Reflex Only) (Mayo)OutsideLaboratory",,82542,CPT,Facility,Both,,,90,144,122.4,41.2704,144,BlueCross BlueShield Minnesota,High Value Network Plan,129.6,90,,percent of total billed charges,,
"Porphyrins, Fractionation, Plasma (Reflex Only) (Mayo)OutsideLaboratory",,82542,CPT,Facility,Outpatient,,,90,144,122.4,41.2704,144,BlueCross BlueShield Minnesota,Medicare Advantage,70.56,49,,percent of total billed charges,,
"Porphyrins, Fractionation, Plasma (Reflex Only) (Mayo)OutsideLaboratory",,82542,CPT,Facility,Inpatient,,,90,144,122.4,41.2704,144,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Porphyrins, Fractionation, Plasma (Reflex Only) (Mayo)OutsideLaboratory",,82542,CPT,Facility,Both,,,90,144,122.4,41.2704,144,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,127.5408,88.57,,percent of total billed charges,,
"Porphyrins, Fractionation, Plasma (Reflex Only) (Mayo)OutsideLaboratory",,82542,CPT,Facility,Both,,,90,144,122.4,41.2704,144,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,41.2704,28.66,,percent of total billed charges,,
"Porphyrins, Fractionation, Plasma (Reflex Only) (Mayo)OutsideLaboratory",,82542,CPT,Facility,Outpatient,,,90,144,122.4,41.2704,144,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),70.56,49,,percent of total billed charges,,
"Porphyrins, Fractionation, Plasma (Reflex Only) (Mayo)OutsideLaboratory",,82542,CPT,Facility,Inpatient,,,90,144,122.4,41.2704,144,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Porphyrins, Fractionation, Plasma (Reflex Only) (Mayo)OutsideLaboratory",,82542,CPT,Facility,Both,,,90,144,122.4,41.2704,144,CorVel,Worker's Compensation,144,100,,percent of total billed charges,,
"Porphyrins, Fractionation, Plasma (Reflex Only) (Mayo)OutsideLaboratory",,82542,CPT,Facility,Both,,,90,144,122.4,41.2704,144,First Health Group Corporation,First Health Network,139.68,97,,percent of total billed charges,,
"Porphyrins, Fractionation, Plasma (Reflex Only) (Mayo)OutsideLaboratory",,82542,CPT,Facility,Both,,,90,144,122.4,41.2704,144,"Health Partners, Inc.",Commercial,136.224,94.6,,percent of total billed charges,,
"Porphyrins, Fractionation, Plasma (Reflex Only) (Mayo)OutsideLaboratory",,82542,CPT,Facility,Outpatient,,,90,144,122.4,41.2704,144,"Health Partners, Inc.",Medicare Advantage,70.56,49,,percent of total billed charges,,
"Porphyrins, Fractionation, Plasma (Reflex Only) (Mayo)OutsideLaboratory",,82542,CPT,Facility,Inpatient,,,90,144,122.4,41.2704,144,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Porphyrins, Fractionation, Plasma (Reflex Only) (Mayo)OutsideLaboratory",,82542,CPT,Facility,Both,,,90,144,122.4,41.2704,144,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),86.4,60,,percent of total billed charges,,
"Porphyrins, Fractionation, Plasma (Reflex Only) (Mayo)OutsideLaboratory",,82542,CPT,Facility,Both,,,90,144,122.4,41.2704,144,"Health Partners, Inc.",State of Minnesota Advantage Program,117.36,81.5,,percent of total billed charges,,
"Porphyrins, Fractionation, Plasma (Reflex Only) (Mayo)OutsideLaboratory",,82542,CPT,Facility,Both,,,90,144,122.4,41.2704,144,"Health Partners, Inc.",State Public Programs,72,50,,percent of total billed charges,,
"Porphyrins, Fractionation, Plasma (Reflex Only) (Mayo)OutsideLaboratory",,82542,CPT,Facility,Both,,,90,144,122.4,41.2704,144,Humana Insurance Company,Commercial PPO,136.8,95,,percent of total billed charges,,
"Porphyrins, Fractionation, Plasma (Reflex Only) (Mayo)OutsideLaboratory",,82542,CPT,Facility,Outpatient,,,90,144,122.4,41.2704,144,Humana Insurance Company,Medicare PPO,70.56,49,,percent of total billed charges,,
"Porphyrins, Fractionation, Plasma (Reflex Only) (Mayo)OutsideLaboratory",,82542,CPT,Facility,Inpatient,,,90,144,122.4,41.2704,144,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Porphyrins, Fractionation, Plasma (Reflex Only) (Mayo)OutsideLaboratory",,82542,CPT,Facility,Both,,,90,144,122.4,41.2704,144,Medica,Individual & Family,142.704,99.1,,percent of total billed charges,,
"Porphyrins, Fractionation, Plasma (Reflex Only) (Mayo)OutsideLaboratory",,82542,CPT,Facility,Outpatient,,,90,144,122.4,41.2704,144,Medica,Medica Advantage Solution,71.712,49.8,,percent of total billed charges,,
"Porphyrins, Fractionation, Plasma (Reflex Only) (Mayo)OutsideLaboratory",,82542,CPT,Facility,Inpatient,,,90,144,122.4,41.2704,144,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Porphyrins, Fractionation, Plasma (Reflex Only) (Mayo)OutsideLaboratory",,82542,CPT,Facility,Outpatient,,,90,144,122.4,41.2704,144,Medica,Medical Assistance,64.224,44.6,,percent of total billed charges,,
"Porphyrins, Fractionation, Plasma (Reflex Only) (Mayo)OutsideLaboratory",,82542,CPT,Facility,Inpatient,,,90,144,122.4,41.2704,144,Medica,Medical Assistance,,,,,Included in per diem rate,
"Porphyrins, Fractionation, Plasma (Reflex Only) (Mayo)OutsideLaboratory",,82542,CPT,Facility,Outpatient,,,90,144,122.4,41.2704,144,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,71.712,49.8,,percent of total billed charges,,
"Porphyrins, Fractionation, Plasma (Reflex Only) (Mayo)OutsideLaboratory",,82542,CPT,Facility,Inpatient,,,90,144,122.4,41.2704,144,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Porphyrins, Fractionation, Plasma (Reflex Only) (Mayo)OutsideLaboratory",,82542,CPT,Facility,Both,,,90,144,122.4,41.2704,144,"Multiplan, Inc.","Multiplan, Inc.",135.36,94,,percent of total billed charges,,
"Porphyrins, Fractionation, Plasma (Reflex Only) (Mayo)OutsideLaboratory",,82542,CPT,Facility,Outpatient,,,90,144,122.4,41.2704,144,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,124.416,86.4,,percent of total billed charges,,
"Porphyrins, Fractionation, Plasma (Reflex Only) (Mayo)OutsideLaboratory",,82542,CPT,Facility,Inpatient,,,90,144,122.4,41.2704,144,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Porphyrins, Fractionation, Plasma (Reflex Only) (Mayo)OutsideLaboratory",,82542,CPT,Facility,Both,,,90,144,122.4,41.2704,144,"Preferred One Administrative Services, INC.",PPO,141.984,98.6,,percent of total billed charges,,
"Porphyrins, Fractionation, Plasma (Reflex Only) (Mayo)OutsideLaboratory",,82542,CPT,Facility,Outpatient,,,90,144,122.4,41.2704,144,PrimeWest Health,Minnesota Senior Health Options (MSHO),74.088,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Porphyrins, Fractionation, Plasma (Reflex Only) (Mayo)OutsideLaboratory",,82542,CPT,Facility,Inpatient,,,90,144,122.4,41.2704,144,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Porphyrins, Fractionation, Plasma (Reflex Only) (Mayo)OutsideLaboratory",,82542,CPT,Facility,Outpatient,,,90,144,122.4,41.2704,144,PrimeWest Health,MinnesotaCare,73.9584,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Porphyrins, Fractionation, Plasma (Reflex Only) (Mayo)OutsideLaboratory",,82542,CPT,Facility,Inpatient,,,90,144,122.4,41.2704,144,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Porphyrins, Fractionation, Plasma (Reflex Only) (Mayo)OutsideLaboratory",,82542,CPT,Facility,Both,,,90,144,122.4,41.2704,144,Sanford Health Plan,Sanford Health Plan,132.48,92,,percent of total billed charges,,
"Porphyrins, Fractionation, Plasma (Reflex Only) (Mayo)OutsideLaboratory",,82542,CPT,Facility,Outpatient,,,90,144,122.4,41.2704,144,"UCare Health, Inc.",Individual & Family Plan,81.144,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Porphyrins, Fractionation, Plasma (Reflex Only) (Mayo)OutsideLaboratory",,82542,CPT,Facility,Inpatient,,,90,144,122.4,41.2704,144,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Porphyrins, Fractionation, Plasma (Reflex Only) (Mayo)OutsideLaboratory",,82542,CPT,Facility,Outpatient,,,90,144,122.4,41.2704,144,"UCare Health, Inc.",Medical Assistance,72.6768,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Porphyrins, Fractionation, Plasma (Reflex Only) (Mayo)OutsideLaboratory",,82542,CPT,Facility,Inpatient,,,90,144,122.4,41.2704,144,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Porphyrins, Fractionation, Plasma (Reflex Only) (Mayo)OutsideLaboratory",,82542,CPT,Facility,Outpatient,,,90,144,122.4,41.2704,144,"UCare Health, Inc.",Medicare Advantage,72.6768,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Porphyrins, Fractionation, Plasma (Reflex Only) (Mayo)OutsideLaboratory",,82542,CPT,Facility,Inpatient,,,90,144,122.4,41.2704,144,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Porphyrins, Fractionation, Plasma (Reflex Only) (Mayo)OutsideLaboratory",,82542,CPT,Facility,Outpatient,,,90,144,122.4,41.2704,144,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),72.6768,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Porphyrins, Fractionation, Plasma (Reflex Only) (Mayo)OutsideLaboratory",,82542,CPT,Facility,Inpatient,,,90,144,122.4,41.2704,144,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Porphyrins, Fractionation, Plasma (Reflex Only) (Mayo)OutsideLaboratory",,82542,CPT,Facility,Both,,,90,144,122.4,41.2704,144,UnitedHealthcare,Individual & Family,135.36,94,,percent of total billed charges,,
"Porphyrins, Fractionation, Plasma (Reflex Only) (Mayo)OutsideLaboratory",,82542,CPT,Facility,Outpatient,,,90,144,122.4,41.2704,144,UnitedHealthcare,Medicare Advantage,70.56,49,,percent of total billed charges,,
"Porphyrins, Fractionation, Plasma (Reflex Only) (Mayo)OutsideLaboratory",,82542,CPT,Facility,Inpatient,,,90,144,122.4,41.2704,144,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Porphyrins, Fractionation, Plasma (Reflex Only) (Mayo)OutsideLaboratory",,82542,CPT,Facility,Outpatient,,,90,144,122.4,41.2704,144,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,69.12,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Porphyrins, Fractionation, Plasma (Reflex Only) (Mayo)OutsideLaboratory",,82542,CPT,Facility,Inpatient,,,90,144,122.4,41.2704,144,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Pyridoxic Acid, P (Mayo)OutsideLaboratory",,82542,CPT,Facility,Both,,,90,163,138.55,46.7158,163,Aetna,Commercial,149.96,92,,percent of total billed charges,,
"Pyridoxic Acid, P (Mayo)OutsideLaboratory",,82542,CPT,Facility,Outpatient,,,90,163,138.55,46.7158,163,Aetna,Medicare Advantage,79.87,49,,percent of total billed charges,,
"Pyridoxic Acid, P (Mayo)OutsideLaboratory",,82542,CPT,Facility,Inpatient,,,90,163,138.55,46.7158,163,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Pyridoxic Acid, P (Mayo)OutsideLaboratory",,82542,CPT,Facility,Both,,,90,163,138.55,46.7158,163,Aetna,PPO,151.59,93,,percent of total billed charges,,
"Pyridoxic Acid, P (Mayo)OutsideLaboratory",,82542,CPT,Facility,Both,,,90,163,138.55,46.7158,163,America's PPO,America's PPO,156.5289,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Pyridoxic Acid, P (Mayo)OutsideLaboratory",,82542,CPT,Facility,Both,,,90,163,138.55,46.7158,163,BlueCross BlueShield Minnesota, Federal Employee Program,160.392,98.4,,percent of total billed charges,,
"Pyridoxic Acid, P (Mayo)OutsideLaboratory",,82542,CPT,Facility,Both,,,90,163,138.55,46.7158,163,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,163,100,,percent of total billed charges,,
"Pyridoxic Acid, P (Mayo)OutsideLaboratory",,82542,CPT,Facility,Both,,,90,163,138.55,46.7158,163,BlueCross BlueShield Minnesota,High Value Network Plan,146.7,90,,percent of total billed charges,,
"Pyridoxic Acid, P (Mayo)OutsideLaboratory",,82542,CPT,Facility,Outpatient,,,90,163,138.55,46.7158,163,BlueCross BlueShield Minnesota,Medicare Advantage,79.87,49,,percent of total billed charges,,
"Pyridoxic Acid, P (Mayo)OutsideLaboratory",,82542,CPT,Facility,Inpatient,,,90,163,138.55,46.7158,163,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Pyridoxic Acid, P (Mayo)OutsideLaboratory",,82542,CPT,Facility,Both,,,90,163,138.55,46.7158,163,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,144.3691,88.57,,percent of total billed charges,,
"Pyridoxic Acid, P (Mayo)OutsideLaboratory",,82542,CPT,Facility,Both,,,90,163,138.55,46.7158,163,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,46.7158,28.66,,percent of total billed charges,,
"Pyridoxic Acid, P (Mayo)OutsideLaboratory",,82542,CPT,Facility,Outpatient,,,90,163,138.55,46.7158,163,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),79.87,49,,percent of total billed charges,,
"Pyridoxic Acid, P (Mayo)OutsideLaboratory",,82542,CPT,Facility,Inpatient,,,90,163,138.55,46.7158,163,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Pyridoxic Acid, P (Mayo)OutsideLaboratory",,82542,CPT,Facility,Both,,,90,163,138.55,46.7158,163,CorVel,Worker's Compensation,163,100,,percent of total billed charges,,
"Pyridoxic Acid, P (Mayo)OutsideLaboratory",,82542,CPT,Facility,Both,,,90,163,138.55,46.7158,163,First Health Group Corporation,First Health Network,158.11,97,,percent of total billed charges,,
"Pyridoxic Acid, P (Mayo)OutsideLaboratory",,82542,CPT,Facility,Both,,,90,163,138.55,46.7158,163,"Health Partners, Inc.",Commercial,154.198,94.6,,percent of total billed charges,,
"Pyridoxic Acid, P (Mayo)OutsideLaboratory",,82542,CPT,Facility,Outpatient,,,90,163,138.55,46.7158,163,"Health Partners, Inc.",Medicare Advantage,79.87,49,,percent of total billed charges,,
"Pyridoxic Acid, P (Mayo)OutsideLaboratory",,82542,CPT,Facility,Inpatient,,,90,163,138.55,46.7158,163,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Pyridoxic Acid, P (Mayo)OutsideLaboratory",,82542,CPT,Facility,Both,,,90,163,138.55,46.7158,163,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),97.8,60,,percent of total billed charges,,
"Pyridoxic Acid, P (Mayo)OutsideLaboratory",,82542,CPT,Facility,Both,,,90,163,138.55,46.7158,163,"Health Partners, Inc.",State of Minnesota Advantage Program,132.845,81.5,,percent of total billed charges,,
"Pyridoxic Acid, P (Mayo)OutsideLaboratory",,82542,CPT,Facility,Both,,,90,163,138.55,46.7158,163,"Health Partners, Inc.",State Public Programs,81.5,50,,percent of total billed charges,,
"Pyridoxic Acid, P (Mayo)OutsideLaboratory",,82542,CPT,Facility,Both,,,90,163,138.55,46.7158,163,Humana Insurance Company,Commercial PPO,154.85,95,,percent of total billed charges,,
"Pyridoxic Acid, P (Mayo)OutsideLaboratory",,82542,CPT,Facility,Outpatient,,,90,163,138.55,46.7158,163,Humana Insurance Company,Medicare PPO,79.87,49,,percent of total billed charges,,
"Pyridoxic Acid, P (Mayo)OutsideLaboratory",,82542,CPT,Facility,Inpatient,,,90,163,138.55,46.7158,163,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Pyridoxic Acid, P (Mayo)OutsideLaboratory",,82542,CPT,Facility,Both,,,90,163,138.55,46.7158,163,Medica,Individual & Family,161.533,99.1,,percent of total billed charges,,
"Pyridoxic Acid, P (Mayo)OutsideLaboratory",,82542,CPT,Facility,Outpatient,,,90,163,138.55,46.7158,163,Medica,Medica Advantage Solution,81.174,49.8,,percent of total billed charges,,
"Pyridoxic Acid, P (Mayo)OutsideLaboratory",,82542,CPT,Facility,Inpatient,,,90,163,138.55,46.7158,163,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Pyridoxic Acid, P (Mayo)OutsideLaboratory",,82542,CPT,Facility,Outpatient,,,90,163,138.55,46.7158,163,Medica,Medical Assistance,72.698,44.6,,percent of total billed charges,,
"Pyridoxic Acid, P (Mayo)OutsideLaboratory",,82542,CPT,Facility,Inpatient,,,90,163,138.55,46.7158,163,Medica,Medical Assistance,,,,,Included in per diem rate,
"Pyridoxic Acid, P (Mayo)OutsideLaboratory",,82542,CPT,Facility,Outpatient,,,90,163,138.55,46.7158,163,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,81.174,49.8,,percent of total billed charges,,
"Pyridoxic Acid, P (Mayo)OutsideLaboratory",,82542,CPT,Facility,Inpatient,,,90,163,138.55,46.7158,163,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Pyridoxic Acid, P (Mayo)OutsideLaboratory",,82542,CPT,Facility,Both,,,90,163,138.55,46.7158,163,"Multiplan, Inc.","Multiplan, Inc.",153.22,94,,percent of total billed charges,,
"Pyridoxic Acid, P (Mayo)OutsideLaboratory",,82542,CPT,Facility,Outpatient,,,90,163,138.55,46.7158,163,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,140.832,86.4,,percent of total billed charges,,
"Pyridoxic Acid, P (Mayo)OutsideLaboratory",,82542,CPT,Facility,Inpatient,,,90,163,138.55,46.7158,163,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Pyridoxic Acid, P (Mayo)OutsideLaboratory",,82542,CPT,Facility,Both,,,90,163,138.55,46.7158,163,"Preferred One Administrative Services, INC.",PPO,160.718,98.6,,percent of total billed charges,,
"Pyridoxic Acid, P (Mayo)OutsideLaboratory",,82542,CPT,Facility,Outpatient,,,90,163,138.55,46.7158,163,PrimeWest Health,Minnesota Senior Health Options (MSHO),83.8635,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Pyridoxic Acid, P (Mayo)OutsideLaboratory",,82542,CPT,Facility,Inpatient,,,90,163,138.55,46.7158,163,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Pyridoxic Acid, P (Mayo)OutsideLaboratory",,82542,CPT,Facility,Outpatient,,,90,163,138.55,46.7158,163,PrimeWest Health,MinnesotaCare,83.7168,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Pyridoxic Acid, P (Mayo)OutsideLaboratory",,82542,CPT,Facility,Inpatient,,,90,163,138.55,46.7158,163,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Pyridoxic Acid, P (Mayo)OutsideLaboratory",,82542,CPT,Facility,Both,,,90,163,138.55,46.7158,163,Sanford Health Plan,Sanford Health Plan,149.96,92,,percent of total billed charges,,
"Pyridoxic Acid, P (Mayo)OutsideLaboratory",,82542,CPT,Facility,Outpatient,,,90,163,138.55,46.7158,163,"UCare Health, Inc.",Individual & Family Plan,91.8505,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Pyridoxic Acid, P (Mayo)OutsideLaboratory",,82542,CPT,Facility,Inpatient,,,90,163,138.55,46.7158,163,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Pyridoxic Acid, P (Mayo)OutsideLaboratory",,82542,CPT,Facility,Outpatient,,,90,163,138.55,46.7158,163,"UCare Health, Inc.",Medical Assistance,82.2661,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Pyridoxic Acid, P (Mayo)OutsideLaboratory",,82542,CPT,Facility,Inpatient,,,90,163,138.55,46.7158,163,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Pyridoxic Acid, P (Mayo)OutsideLaboratory",,82542,CPT,Facility,Outpatient,,,90,163,138.55,46.7158,163,"UCare Health, Inc.",Medicare Advantage,82.2661,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Pyridoxic Acid, P (Mayo)OutsideLaboratory",,82542,CPT,Facility,Inpatient,,,90,163,138.55,46.7158,163,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Pyridoxic Acid, P (Mayo)OutsideLaboratory",,82542,CPT,Facility,Outpatient,,,90,163,138.55,46.7158,163,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),82.2661,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Pyridoxic Acid, P (Mayo)OutsideLaboratory",,82542,CPT,Facility,Inpatient,,,90,163,138.55,46.7158,163,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Pyridoxic Acid, P (Mayo)OutsideLaboratory",,82542,CPT,Facility,Both,,,90,163,138.55,46.7158,163,UnitedHealthcare,Individual & Family,153.22,94,,percent of total billed charges,,
"Pyridoxic Acid, P (Mayo)OutsideLaboratory",,82542,CPT,Facility,Outpatient,,,90,163,138.55,46.7158,163,UnitedHealthcare,Medicare Advantage,79.87,49,,percent of total billed charges,,
"Pyridoxic Acid, P (Mayo)OutsideLaboratory",,82542,CPT,Facility,Inpatient,,,90,163,138.55,46.7158,163,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Pyridoxic Acid, P (Mayo)OutsideLaboratory",,82542,CPT,Facility,Outpatient,,,90,163,138.55,46.7158,163,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,78.24,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Pyridoxic Acid, P (Mayo)OutsideLaboratory",,82542,CPT,Facility,Inpatient,,,90,163,138.55,46.7158,163,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Smith-Lemli-Opitz Scrn, P (Mayo)OutsideLaboratory",,82542,CPT,Facility,Both,,,90,163,138.55,46.7158,163,Aetna,Commercial,149.96,92,,percent of total billed charges,,
"Smith-Lemli-Opitz Scrn, P (Mayo)OutsideLaboratory",,82542,CPT,Facility,Outpatient,,,90,163,138.55,46.7158,163,Aetna,Medicare Advantage,79.87,49,,percent of total billed charges,,
"Smith-Lemli-Opitz Scrn, P (Mayo)OutsideLaboratory",,82542,CPT,Facility,Inpatient,,,90,163,138.55,46.7158,163,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Smith-Lemli-Opitz Scrn, P (Mayo)OutsideLaboratory",,82542,CPT,Facility,Both,,,90,163,138.55,46.7158,163,Aetna,PPO,151.59,93,,percent of total billed charges,,
"Smith-Lemli-Opitz Scrn, P (Mayo)OutsideLaboratory",,82542,CPT,Facility,Both,,,90,163,138.55,46.7158,163,America's PPO,America's PPO,156.5289,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Smith-Lemli-Opitz Scrn, P (Mayo)OutsideLaboratory",,82542,CPT,Facility,Both,,,90,163,138.55,46.7158,163,BlueCross BlueShield Minnesota, Federal Employee Program,160.392,98.4,,percent of total billed charges,,
"Smith-Lemli-Opitz Scrn, P (Mayo)OutsideLaboratory",,82542,CPT,Facility,Both,,,90,163,138.55,46.7158,163,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,163,100,,percent of total billed charges,,
"Smith-Lemli-Opitz Scrn, P (Mayo)OutsideLaboratory",,82542,CPT,Facility,Both,,,90,163,138.55,46.7158,163,BlueCross BlueShield Minnesota,High Value Network Plan,146.7,90,,percent of total billed charges,,
"Smith-Lemli-Opitz Scrn, P (Mayo)OutsideLaboratory",,82542,CPT,Facility,Outpatient,,,90,163,138.55,46.7158,163,BlueCross BlueShield Minnesota,Medicare Advantage,79.87,49,,percent of total billed charges,,
"Smith-Lemli-Opitz Scrn, P (Mayo)OutsideLaboratory",,82542,CPT,Facility,Inpatient,,,90,163,138.55,46.7158,163,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Smith-Lemli-Opitz Scrn, P (Mayo)OutsideLaboratory",,82542,CPT,Facility,Both,,,90,163,138.55,46.7158,163,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,144.3691,88.57,,percent of total billed charges,,
"Smith-Lemli-Opitz Scrn, P (Mayo)OutsideLaboratory",,82542,CPT,Facility,Both,,,90,163,138.55,46.7158,163,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,46.7158,28.66,,percent of total billed charges,,
"Smith-Lemli-Opitz Scrn, P (Mayo)OutsideLaboratory",,82542,CPT,Facility,Outpatient,,,90,163,138.55,46.7158,163,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),79.87,49,,percent of total billed charges,,
"Smith-Lemli-Opitz Scrn, P (Mayo)OutsideLaboratory",,82542,CPT,Facility,Inpatient,,,90,163,138.55,46.7158,163,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Smith-Lemli-Opitz Scrn, P (Mayo)OutsideLaboratory",,82542,CPT,Facility,Both,,,90,163,138.55,46.7158,163,CorVel,Worker's Compensation,163,100,,percent of total billed charges,,
"Smith-Lemli-Opitz Scrn, P (Mayo)OutsideLaboratory",,82542,CPT,Facility,Both,,,90,163,138.55,46.7158,163,First Health Group Corporation,First Health Network,158.11,97,,percent of total billed charges,,
"Smith-Lemli-Opitz Scrn, P (Mayo)OutsideLaboratory",,82542,CPT,Facility,Both,,,90,163,138.55,46.7158,163,"Health Partners, Inc.",Commercial,154.198,94.6,,percent of total billed charges,,
"Smith-Lemli-Opitz Scrn, P (Mayo)OutsideLaboratory",,82542,CPT,Facility,Outpatient,,,90,163,138.55,46.7158,163,"Health Partners, Inc.",Medicare Advantage,79.87,49,,percent of total billed charges,,
"Smith-Lemli-Opitz Scrn, P (Mayo)OutsideLaboratory",,82542,CPT,Facility,Inpatient,,,90,163,138.55,46.7158,163,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Smith-Lemli-Opitz Scrn, P (Mayo)OutsideLaboratory",,82542,CPT,Facility,Both,,,90,163,138.55,46.7158,163,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),97.8,60,,percent of total billed charges,,
"Smith-Lemli-Opitz Scrn, P (Mayo)OutsideLaboratory",,82542,CPT,Facility,Both,,,90,163,138.55,46.7158,163,"Health Partners, Inc.",State of Minnesota Advantage Program,132.845,81.5,,percent of total billed charges,,
"Smith-Lemli-Opitz Scrn, P (Mayo)OutsideLaboratory",,82542,CPT,Facility,Both,,,90,163,138.55,46.7158,163,"Health Partners, Inc.",State Public Programs,81.5,50,,percent of total billed charges,,
"Smith-Lemli-Opitz Scrn, P (Mayo)OutsideLaboratory",,82542,CPT,Facility,Both,,,90,163,138.55,46.7158,163,Humana Insurance Company,Commercial PPO,154.85,95,,percent of total billed charges,,
"Smith-Lemli-Opitz Scrn, P (Mayo)OutsideLaboratory",,82542,CPT,Facility,Outpatient,,,90,163,138.55,46.7158,163,Humana Insurance Company,Medicare PPO,79.87,49,,percent of total billed charges,,
"Smith-Lemli-Opitz Scrn, P (Mayo)OutsideLaboratory",,82542,CPT,Facility,Inpatient,,,90,163,138.55,46.7158,163,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Smith-Lemli-Opitz Scrn, P (Mayo)OutsideLaboratory",,82542,CPT,Facility,Both,,,90,163,138.55,46.7158,163,Medica,Individual & Family,161.533,99.1,,percent of total billed charges,,
"Smith-Lemli-Opitz Scrn, P (Mayo)OutsideLaboratory",,82542,CPT,Facility,Outpatient,,,90,163,138.55,46.7158,163,Medica,Medica Advantage Solution,81.174,49.8,,percent of total billed charges,,
"Smith-Lemli-Opitz Scrn, P (Mayo)OutsideLaboratory",,82542,CPT,Facility,Inpatient,,,90,163,138.55,46.7158,163,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Smith-Lemli-Opitz Scrn, P (Mayo)OutsideLaboratory",,82542,CPT,Facility,Outpatient,,,90,163,138.55,46.7158,163,Medica,Medical Assistance,72.698,44.6,,percent of total billed charges,,
"Smith-Lemli-Opitz Scrn, P (Mayo)OutsideLaboratory",,82542,CPT,Facility,Inpatient,,,90,163,138.55,46.7158,163,Medica,Medical Assistance,,,,,Included in per diem rate,
"Smith-Lemli-Opitz Scrn, P (Mayo)OutsideLaboratory",,82542,CPT,Facility,Outpatient,,,90,163,138.55,46.7158,163,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,81.174,49.8,,percent of total billed charges,,
"Smith-Lemli-Opitz Scrn, P (Mayo)OutsideLaboratory",,82542,CPT,Facility,Inpatient,,,90,163,138.55,46.7158,163,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Smith-Lemli-Opitz Scrn, P (Mayo)OutsideLaboratory",,82542,CPT,Facility,Both,,,90,163,138.55,46.7158,163,"Multiplan, Inc.","Multiplan, Inc.",153.22,94,,percent of total billed charges,,
"Smith-Lemli-Opitz Scrn, P (Mayo)OutsideLaboratory",,82542,CPT,Facility,Outpatient,,,90,163,138.55,46.7158,163,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,140.832,86.4,,percent of total billed charges,,
"Smith-Lemli-Opitz Scrn, P (Mayo)OutsideLaboratory",,82542,CPT,Facility,Inpatient,,,90,163,138.55,46.7158,163,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Smith-Lemli-Opitz Scrn, P (Mayo)OutsideLaboratory",,82542,CPT,Facility,Both,,,90,163,138.55,46.7158,163,"Preferred One Administrative Services, INC.",PPO,160.718,98.6,,percent of total billed charges,,
"Smith-Lemli-Opitz Scrn, P (Mayo)OutsideLaboratory",,82542,CPT,Facility,Outpatient,,,90,163,138.55,46.7158,163,PrimeWest Health,Minnesota Senior Health Options (MSHO),83.8635,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Smith-Lemli-Opitz Scrn, P (Mayo)OutsideLaboratory",,82542,CPT,Facility,Inpatient,,,90,163,138.55,46.7158,163,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Smith-Lemli-Opitz Scrn, P (Mayo)OutsideLaboratory",,82542,CPT,Facility,Outpatient,,,90,163,138.55,46.7158,163,PrimeWest Health,MinnesotaCare,83.7168,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Smith-Lemli-Opitz Scrn, P (Mayo)OutsideLaboratory",,82542,CPT,Facility,Inpatient,,,90,163,138.55,46.7158,163,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Smith-Lemli-Opitz Scrn, P (Mayo)OutsideLaboratory",,82542,CPT,Facility,Both,,,90,163,138.55,46.7158,163,Sanford Health Plan,Sanford Health Plan,149.96,92,,percent of total billed charges,,
"Smith-Lemli-Opitz Scrn, P (Mayo)OutsideLaboratory",,82542,CPT,Facility,Outpatient,,,90,163,138.55,46.7158,163,"UCare Health, Inc.",Individual & Family Plan,91.8505,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Smith-Lemli-Opitz Scrn, P (Mayo)OutsideLaboratory",,82542,CPT,Facility,Inpatient,,,90,163,138.55,46.7158,163,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Smith-Lemli-Opitz Scrn, P (Mayo)OutsideLaboratory",,82542,CPT,Facility,Outpatient,,,90,163,138.55,46.7158,163,"UCare Health, Inc.",Medical Assistance,82.2661,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Smith-Lemli-Opitz Scrn, P (Mayo)OutsideLaboratory",,82542,CPT,Facility,Inpatient,,,90,163,138.55,46.7158,163,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Smith-Lemli-Opitz Scrn, P (Mayo)OutsideLaboratory",,82542,CPT,Facility,Outpatient,,,90,163,138.55,46.7158,163,"UCare Health, Inc.",Medicare Advantage,82.2661,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Smith-Lemli-Opitz Scrn, P (Mayo)OutsideLaboratory",,82542,CPT,Facility,Inpatient,,,90,163,138.55,46.7158,163,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Smith-Lemli-Opitz Scrn, P (Mayo)OutsideLaboratory",,82542,CPT,Facility,Outpatient,,,90,163,138.55,46.7158,163,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),82.2661,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Smith-Lemli-Opitz Scrn, P (Mayo)OutsideLaboratory",,82542,CPT,Facility,Inpatient,,,90,163,138.55,46.7158,163,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Smith-Lemli-Opitz Scrn, P (Mayo)OutsideLaboratory",,82542,CPT,Facility,Both,,,90,163,138.55,46.7158,163,UnitedHealthcare,Individual & Family,153.22,94,,percent of total billed charges,,
"Smith-Lemli-Opitz Scrn, P (Mayo)OutsideLaboratory",,82542,CPT,Facility,Outpatient,,,90,163,138.55,46.7158,163,UnitedHealthcare,Medicare Advantage,79.87,49,,percent of total billed charges,,
"Smith-Lemli-Opitz Scrn, P (Mayo)OutsideLaboratory",,82542,CPT,Facility,Inpatient,,,90,163,138.55,46.7158,163,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Smith-Lemli-Opitz Scrn, P (Mayo)OutsideLaboratory",,82542,CPT,Facility,Outpatient,,,90,163,138.55,46.7158,163,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,78.24,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Smith-Lemli-Opitz Scrn, P (Mayo)OutsideLaboratory",,82542,CPT,Facility,Inpatient,,,90,163,138.55,46.7158,163,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Creatine Kinase Isoenzyme Reflex, S (Mayo)OutsideLaboratory",,82550,CPT,Facility,Both,,,90,51,43.35,14.6166,51,Aetna,Commercial,46.92,92,,percent of total billed charges,,
"Creatine Kinase Isoenzyme Reflex, S (Mayo)OutsideLaboratory",,82550,CPT,Facility,Outpatient,,,90,51,43.35,14.6166,51,Aetna,Medicare Advantage,24.99,49,,percent of total billed charges,,
"Creatine Kinase Isoenzyme Reflex, S (Mayo)OutsideLaboratory",,82550,CPT,Facility,Inpatient,,,90,51,43.35,14.6166,51,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Creatine Kinase Isoenzyme Reflex, S (Mayo)OutsideLaboratory",,82550,CPT,Facility,Both,,,90,51,43.35,14.6166,51,Aetna,PPO,47.43,93,,percent of total billed charges,,
"Creatine Kinase Isoenzyme Reflex, S (Mayo)OutsideLaboratory",,82550,CPT,Facility,Both,,,90,51,43.35,14.6166,51,America's PPO,America's PPO,48.9753,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Creatine Kinase Isoenzyme Reflex, S (Mayo)OutsideLaboratory",,82550,CPT,Facility,Both,,,90,51,43.35,14.6166,51,BlueCross BlueShield Minnesota, Federal Employee Program,50.184,98.4,,percent of total billed charges,,
"Creatine Kinase Isoenzyme Reflex, S (Mayo)OutsideLaboratory",,82550,CPT,Facility,Both,,,90,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,51,100,,percent of total billed charges,,
"Creatine Kinase Isoenzyme Reflex, S (Mayo)OutsideLaboratory",,82550,CPT,Facility,Both,,,90,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,High Value Network Plan,45.9,90,,percent of total billed charges,,
"Creatine Kinase Isoenzyme Reflex, S (Mayo)OutsideLaboratory",,82550,CPT,Facility,Outpatient,,,90,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,Medicare Advantage,24.99,49,,percent of total billed charges,,
"Creatine Kinase Isoenzyme Reflex, S (Mayo)OutsideLaboratory",,82550,CPT,Facility,Inpatient,,,90,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Creatine Kinase Isoenzyme Reflex, S (Mayo)OutsideLaboratory",,82550,CPT,Facility,Both,,,90,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,45.1707,88.57,,percent of total billed charges,,
"Creatine Kinase Isoenzyme Reflex, S (Mayo)OutsideLaboratory",,82550,CPT,Facility,Both,,,90,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,14.6166,28.66,,percent of total billed charges,,
"Creatine Kinase Isoenzyme Reflex, S (Mayo)OutsideLaboratory",,82550,CPT,Facility,Outpatient,,,90,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),24.99,49,,percent of total billed charges,,
"Creatine Kinase Isoenzyme Reflex, S (Mayo)OutsideLaboratory",,82550,CPT,Facility,Inpatient,,,90,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Creatine Kinase Isoenzyme Reflex, S (Mayo)OutsideLaboratory",,82550,CPT,Facility,Both,,,90,51,43.35,14.6166,51,CorVel,Worker's Compensation,51,100,,percent of total billed charges,,
"Creatine Kinase Isoenzyme Reflex, S (Mayo)OutsideLaboratory",,82550,CPT,Facility,Both,,,90,51,43.35,14.6166,51,First Health Group Corporation,First Health Network,49.47,97,,percent of total billed charges,,
"Creatine Kinase Isoenzyme Reflex, S (Mayo)OutsideLaboratory",,82550,CPT,Facility,Both,,,90,51,43.35,14.6166,51,"Health Partners, Inc.",Commercial,48.246,94.6,,percent of total billed charges,,
"Creatine Kinase Isoenzyme Reflex, S (Mayo)OutsideLaboratory",,82550,CPT,Facility,Outpatient,,,90,51,43.35,14.6166,51,"Health Partners, Inc.",Medicare Advantage,24.99,49,,percent of total billed charges,,
"Creatine Kinase Isoenzyme Reflex, S (Mayo)OutsideLaboratory",,82550,CPT,Facility,Inpatient,,,90,51,43.35,14.6166,51,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Creatine Kinase Isoenzyme Reflex, S (Mayo)OutsideLaboratory",,82550,CPT,Facility,Both,,,90,51,43.35,14.6166,51,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),30.6,60,,percent of total billed charges,,
"Creatine Kinase Isoenzyme Reflex, S (Mayo)OutsideLaboratory",,82550,CPT,Facility,Both,,,90,51,43.35,14.6166,51,"Health Partners, Inc.",State of Minnesota Advantage Program,41.565,81.5,,percent of total billed charges,,
"Creatine Kinase Isoenzyme Reflex, S (Mayo)OutsideLaboratory",,82550,CPT,Facility,Both,,,90,51,43.35,14.6166,51,"Health Partners, Inc.",State Public Programs,25.5,50,,percent of total billed charges,,
"Creatine Kinase Isoenzyme Reflex, S (Mayo)OutsideLaboratory",,82550,CPT,Facility,Both,,,90,51,43.35,14.6166,51,Humana Insurance Company,Commercial PPO,48.45,95,,percent of total billed charges,,
"Creatine Kinase Isoenzyme Reflex, S (Mayo)OutsideLaboratory",,82550,CPT,Facility,Outpatient,,,90,51,43.35,14.6166,51,Humana Insurance Company,Medicare PPO,24.99,49,,percent of total billed charges,,
"Creatine Kinase Isoenzyme Reflex, S (Mayo)OutsideLaboratory",,82550,CPT,Facility,Inpatient,,,90,51,43.35,14.6166,51,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Creatine Kinase Isoenzyme Reflex, S (Mayo)OutsideLaboratory",,82550,CPT,Facility,Both,,,90,51,43.35,14.6166,51,Medica,Individual & Family,50.541,99.1,,percent of total billed charges,,
"Creatine Kinase Isoenzyme Reflex, S (Mayo)OutsideLaboratory",,82550,CPT,Facility,Outpatient,,,90,51,43.35,14.6166,51,Medica,Medica Advantage Solution,25.398,49.8,,percent of total billed charges,,
"Creatine Kinase Isoenzyme Reflex, S (Mayo)OutsideLaboratory",,82550,CPT,Facility,Inpatient,,,90,51,43.35,14.6166,51,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Creatine Kinase Isoenzyme Reflex, S (Mayo)OutsideLaboratory",,82550,CPT,Facility,Outpatient,,,90,51,43.35,14.6166,51,Medica,Medical Assistance,22.746,44.6,,percent of total billed charges,,
"Creatine Kinase Isoenzyme Reflex, S (Mayo)OutsideLaboratory",,82550,CPT,Facility,Inpatient,,,90,51,43.35,14.6166,51,Medica,Medical Assistance,,,,,Included in per diem rate,
"Creatine Kinase Isoenzyme Reflex, S (Mayo)OutsideLaboratory",,82550,CPT,Facility,Outpatient,,,90,51,43.35,14.6166,51,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,25.398,49.8,,percent of total billed charges,,
"Creatine Kinase Isoenzyme Reflex, S (Mayo)OutsideLaboratory",,82550,CPT,Facility,Inpatient,,,90,51,43.35,14.6166,51,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Creatine Kinase Isoenzyme Reflex, S (Mayo)OutsideLaboratory",,82550,CPT,Facility,Both,,,90,51,43.35,14.6166,51,"Multiplan, Inc.","Multiplan, Inc.",47.94,94,,percent of total billed charges,,
"Creatine Kinase Isoenzyme Reflex, S (Mayo)OutsideLaboratory",,82550,CPT,Facility,Outpatient,,,90,51,43.35,14.6166,51,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,44.064,86.4,,percent of total billed charges,,
"Creatine Kinase Isoenzyme Reflex, S (Mayo)OutsideLaboratory",,82550,CPT,Facility,Inpatient,,,90,51,43.35,14.6166,51,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Creatine Kinase Isoenzyme Reflex, S (Mayo)OutsideLaboratory",,82550,CPT,Facility,Both,,,90,51,43.35,14.6166,51,"Preferred One Administrative Services, INC.",PPO,50.286,98.6,,percent of total billed charges,,
"Creatine Kinase Isoenzyme Reflex, S (Mayo)OutsideLaboratory",,82550,CPT,Facility,Outpatient,,,90,51,43.35,14.6166,51,PrimeWest Health,Minnesota Senior Health Options (MSHO),26.2395,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Creatine Kinase Isoenzyme Reflex, S (Mayo)OutsideLaboratory",,82550,CPT,Facility,Inpatient,,,90,51,43.35,14.6166,51,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Creatine Kinase Isoenzyme Reflex, S (Mayo)OutsideLaboratory",,82550,CPT,Facility,Outpatient,,,90,51,43.35,14.6166,51,PrimeWest Health,MinnesotaCare,26.1936,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Creatine Kinase Isoenzyme Reflex, S (Mayo)OutsideLaboratory",,82550,CPT,Facility,Inpatient,,,90,51,43.35,14.6166,51,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Creatine Kinase Isoenzyme Reflex, S (Mayo)OutsideLaboratory",,82550,CPT,Facility,Both,,,90,51,43.35,14.6166,51,Sanford Health Plan,Sanford Health Plan,46.92,92,,percent of total billed charges,,
"Creatine Kinase Isoenzyme Reflex, S (Mayo)OutsideLaboratory",,82550,CPT,Facility,Outpatient,,,90,51,43.35,14.6166,51,"UCare Health, Inc.",Individual & Family Plan,28.7385,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Creatine Kinase Isoenzyme Reflex, S (Mayo)OutsideLaboratory",,82550,CPT,Facility,Inpatient,,,90,51,43.35,14.6166,51,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Creatine Kinase Isoenzyme Reflex, S (Mayo)OutsideLaboratory",,82550,CPT,Facility,Outpatient,,,90,51,43.35,14.6166,51,"UCare Health, Inc.",Medical Assistance,25.7397,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Creatine Kinase Isoenzyme Reflex, S (Mayo)OutsideLaboratory",,82550,CPT,Facility,Inpatient,,,90,51,43.35,14.6166,51,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Creatine Kinase Isoenzyme Reflex, S (Mayo)OutsideLaboratory",,82550,CPT,Facility,Outpatient,,,90,51,43.35,14.6166,51,"UCare Health, Inc.",Medicare Advantage,25.7397,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Creatine Kinase Isoenzyme Reflex, S (Mayo)OutsideLaboratory",,82550,CPT,Facility,Inpatient,,,90,51,43.35,14.6166,51,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Creatine Kinase Isoenzyme Reflex, S (Mayo)OutsideLaboratory",,82550,CPT,Facility,Outpatient,,,90,51,43.35,14.6166,51,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),25.7397,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Creatine Kinase Isoenzyme Reflex, S (Mayo)OutsideLaboratory",,82550,CPT,Facility,Inpatient,,,90,51,43.35,14.6166,51,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Creatine Kinase Isoenzyme Reflex, S (Mayo)OutsideLaboratory",,82550,CPT,Facility,Both,,,90,51,43.35,14.6166,51,UnitedHealthcare,Individual & Family,47.94,94,,percent of total billed charges,,
"Creatine Kinase Isoenzyme Reflex, S (Mayo)OutsideLaboratory",,82550,CPT,Facility,Outpatient,,,90,51,43.35,14.6166,51,UnitedHealthcare,Medicare Advantage,24.99,49,,percent of total billed charges,,
"Creatine Kinase Isoenzyme Reflex, S (Mayo)OutsideLaboratory",,82550,CPT,Facility,Inpatient,,,90,51,43.35,14.6166,51,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Creatine Kinase Isoenzyme Reflex, S (Mayo)OutsideLaboratory",,82550,CPT,Facility,Outpatient,,,90,51,43.35,14.6166,51,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,24.48,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Creatine Kinase Isoenzyme Reflex, S (Mayo)OutsideLaboratory",,82550,CPT,Facility,Inpatient,,,90,51,43.35,14.6166,51,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Ck Isoenzymes (Mayo)OutsideLaboratory,,82552,CPT,Facility,Both,,,90,326,277.1,93.4316,326,Aetna,Commercial,299.92,92,,percent of total billed charges,,
Ck Isoenzymes (Mayo)OutsideLaboratory,,82552,CPT,Facility,Outpatient,,,90,326,277.1,93.4316,326,Aetna,Medicare Advantage,159.74,49,,percent of total billed charges,,
Ck Isoenzymes (Mayo)OutsideLaboratory,,82552,CPT,Facility,Inpatient,,,90,326,277.1,93.4316,326,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Ck Isoenzymes (Mayo)OutsideLaboratory,,82552,CPT,Facility,Both,,,90,326,277.1,93.4316,326,Aetna,PPO,303.18,93,,percent of total billed charges,,
Ck Isoenzymes (Mayo)OutsideLaboratory,,82552,CPT,Facility,Both,,,90,326,277.1,93.4316,326,America's PPO,America's PPO,313.0578,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Ck Isoenzymes (Mayo)OutsideLaboratory,,82552,CPT,Facility,Both,,,90,326,277.1,93.4316,326,BlueCross BlueShield Minnesota, Federal Employee Program,320.784,98.4,,percent of total billed charges,,
Ck Isoenzymes (Mayo)OutsideLaboratory,,82552,CPT,Facility,Both,,,90,326,277.1,93.4316,326,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,326,100,,percent of total billed charges,,
Ck Isoenzymes (Mayo)OutsideLaboratory,,82552,CPT,Facility,Both,,,90,326,277.1,93.4316,326,BlueCross BlueShield Minnesota,High Value Network Plan,293.4,90,,percent of total billed charges,,
Ck Isoenzymes (Mayo)OutsideLaboratory,,82552,CPT,Facility,Outpatient,,,90,326,277.1,93.4316,326,BlueCross BlueShield Minnesota,Medicare Advantage,159.74,49,,percent of total billed charges,,
Ck Isoenzymes (Mayo)OutsideLaboratory,,82552,CPT,Facility,Inpatient,,,90,326,277.1,93.4316,326,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Ck Isoenzymes (Mayo)OutsideLaboratory,,82552,CPT,Facility,Both,,,90,326,277.1,93.4316,326,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,288.7382,88.57,,percent of total billed charges,,
Ck Isoenzymes (Mayo)OutsideLaboratory,,82552,CPT,Facility,Both,,,90,326,277.1,93.4316,326,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,93.4316,28.66,,percent of total billed charges,,
Ck Isoenzymes (Mayo)OutsideLaboratory,,82552,CPT,Facility,Outpatient,,,90,326,277.1,93.4316,326,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),159.74,49,,percent of total billed charges,,
Ck Isoenzymes (Mayo)OutsideLaboratory,,82552,CPT,Facility,Inpatient,,,90,326,277.1,93.4316,326,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Ck Isoenzymes (Mayo)OutsideLaboratory,,82552,CPT,Facility,Both,,,90,326,277.1,93.4316,326,CorVel,Worker's Compensation,326,100,,percent of total billed charges,,
Ck Isoenzymes (Mayo)OutsideLaboratory,,82552,CPT,Facility,Both,,,90,326,277.1,93.4316,326,First Health Group Corporation,First Health Network,316.22,97,,percent of total billed charges,,
Ck Isoenzymes (Mayo)OutsideLaboratory,,82552,CPT,Facility,Both,,,90,326,277.1,93.4316,326,"Health Partners, Inc.",Commercial,308.396,94.6,,percent of total billed charges,,
Ck Isoenzymes (Mayo)OutsideLaboratory,,82552,CPT,Facility,Outpatient,,,90,326,277.1,93.4316,326,"Health Partners, Inc.",Medicare Advantage,159.74,49,,percent of total billed charges,,
Ck Isoenzymes (Mayo)OutsideLaboratory,,82552,CPT,Facility,Inpatient,,,90,326,277.1,93.4316,326,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ck Isoenzymes (Mayo)OutsideLaboratory,,82552,CPT,Facility,Both,,,90,326,277.1,93.4316,326,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),195.6,60,,percent of total billed charges,,
Ck Isoenzymes (Mayo)OutsideLaboratory,,82552,CPT,Facility,Both,,,90,326,277.1,93.4316,326,"Health Partners, Inc.",State of Minnesota Advantage Program,265.69,81.5,,percent of total billed charges,,
Ck Isoenzymes (Mayo)OutsideLaboratory,,82552,CPT,Facility,Both,,,90,326,277.1,93.4316,326,"Health Partners, Inc.",State Public Programs,163,50,,percent of total billed charges,,
Ck Isoenzymes (Mayo)OutsideLaboratory,,82552,CPT,Facility,Both,,,90,326,277.1,93.4316,326,Humana Insurance Company,Commercial PPO,309.7,95,,percent of total billed charges,,
Ck Isoenzymes (Mayo)OutsideLaboratory,,82552,CPT,Facility,Outpatient,,,90,326,277.1,93.4316,326,Humana Insurance Company,Medicare PPO,159.74,49,,percent of total billed charges,,
Ck Isoenzymes (Mayo)OutsideLaboratory,,82552,CPT,Facility,Inpatient,,,90,326,277.1,93.4316,326,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Ck Isoenzymes (Mayo)OutsideLaboratory,,82552,CPT,Facility,Both,,,90,326,277.1,93.4316,326,Medica,Individual & Family,323.066,99.1,,percent of total billed charges,,
Ck Isoenzymes (Mayo)OutsideLaboratory,,82552,CPT,Facility,Outpatient,,,90,326,277.1,93.4316,326,Medica,Medica Advantage Solution,162.348,49.8,,percent of total billed charges,,
Ck Isoenzymes (Mayo)OutsideLaboratory,,82552,CPT,Facility,Inpatient,,,90,326,277.1,93.4316,326,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Ck Isoenzymes (Mayo)OutsideLaboratory,,82552,CPT,Facility,Outpatient,,,90,326,277.1,93.4316,326,Medica,Medical Assistance,145.396,44.6,,percent of total billed charges,,
Ck Isoenzymes (Mayo)OutsideLaboratory,,82552,CPT,Facility,Inpatient,,,90,326,277.1,93.4316,326,Medica,Medical Assistance,,,,,Included in per diem rate,
Ck Isoenzymes (Mayo)OutsideLaboratory,,82552,CPT,Facility,Outpatient,,,90,326,277.1,93.4316,326,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,162.348,49.8,,percent of total billed charges,,
Ck Isoenzymes (Mayo)OutsideLaboratory,,82552,CPT,Facility,Inpatient,,,90,326,277.1,93.4316,326,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Ck Isoenzymes (Mayo)OutsideLaboratory,,82552,CPT,Facility,Both,,,90,326,277.1,93.4316,326,"Multiplan, Inc.","Multiplan, Inc.",306.44,94,,percent of total billed charges,,
Ck Isoenzymes (Mayo)OutsideLaboratory,,82552,CPT,Facility,Outpatient,,,90,326,277.1,93.4316,326,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,281.664,86.4,,percent of total billed charges,,
Ck Isoenzymes (Mayo)OutsideLaboratory,,82552,CPT,Facility,Inpatient,,,90,326,277.1,93.4316,326,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Ck Isoenzymes (Mayo)OutsideLaboratory,,82552,CPT,Facility,Both,,,90,326,277.1,93.4316,326,"Preferred One Administrative Services, INC.",PPO,321.436,98.6,,percent of total billed charges,,
Ck Isoenzymes (Mayo)OutsideLaboratory,,82552,CPT,Facility,Outpatient,,,90,326,277.1,93.4316,326,PrimeWest Health,Minnesota Senior Health Options (MSHO),167.727,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Ck Isoenzymes (Mayo)OutsideLaboratory,,82552,CPT,Facility,Inpatient,,,90,326,277.1,93.4316,326,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ck Isoenzymes (Mayo)OutsideLaboratory,,82552,CPT,Facility,Outpatient,,,90,326,277.1,93.4316,326,PrimeWest Health,MinnesotaCare,167.4336,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Ck Isoenzymes (Mayo)OutsideLaboratory,,82552,CPT,Facility,Inpatient,,,90,326,277.1,93.4316,326,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Ck Isoenzymes (Mayo)OutsideLaboratory,,82552,CPT,Facility,Both,,,90,326,277.1,93.4316,326,Sanford Health Plan,Sanford Health Plan,299.92,92,,percent of total billed charges,,
Ck Isoenzymes (Mayo)OutsideLaboratory,,82552,CPT,Facility,Outpatient,,,90,326,277.1,93.4316,326,"UCare Health, Inc.",Individual & Family Plan,183.701,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Ck Isoenzymes (Mayo)OutsideLaboratory,,82552,CPT,Facility,Inpatient,,,90,326,277.1,93.4316,326,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Ck Isoenzymes (Mayo)OutsideLaboratory,,82552,CPT,Facility,Outpatient,,,90,326,277.1,93.4316,326,"UCare Health, Inc.",Medical Assistance,164.5322,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ck Isoenzymes (Mayo)OutsideLaboratory,,82552,CPT,Facility,Inpatient,,,90,326,277.1,93.4316,326,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Ck Isoenzymes (Mayo)OutsideLaboratory,,82552,CPT,Facility,Outpatient,,,90,326,277.1,93.4316,326,"UCare Health, Inc.",Medicare Advantage,164.5322,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ck Isoenzymes (Mayo)OutsideLaboratory,,82552,CPT,Facility,Inpatient,,,90,326,277.1,93.4316,326,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ck Isoenzymes (Mayo)OutsideLaboratory,,82552,CPT,Facility,Outpatient,,,90,326,277.1,93.4316,326,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),164.5322,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ck Isoenzymes (Mayo)OutsideLaboratory,,82552,CPT,Facility,Inpatient,,,90,326,277.1,93.4316,326,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ck Isoenzymes (Mayo)OutsideLaboratory,,82552,CPT,Facility,Both,,,90,326,277.1,93.4316,326,UnitedHealthcare,Individual & Family,306.44,94,,percent of total billed charges,,
Ck Isoenzymes (Mayo)OutsideLaboratory,,82552,CPT,Facility,Outpatient,,,90,326,277.1,93.4316,326,UnitedHealthcare,Medicare Advantage,159.74,49,,percent of total billed charges,,
Ck Isoenzymes (Mayo)OutsideLaboratory,,82552,CPT,Facility,Inpatient,,,90,326,277.1,93.4316,326,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Ck Isoenzymes (Mayo)OutsideLaboratory,,82552,CPT,Facility,Outpatient,,,90,326,277.1,93.4316,326,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,156.48,48,,percent of total billed charges,,100% of DHS outpatient percentage
Ck Isoenzymes (Mayo)OutsideLaboratory,,82552,CPT,Facility,Inpatient,,,90,326,277.1,93.4316,326,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Cryoglobulin, S (Mayo)OutsideLaboratory",,82595,CPT,Facility,Both,,,90,63,53.55,18.0558,63,Aetna,Commercial,57.96,92,,percent of total billed charges,,
"Cryoglobulin, S (Mayo)OutsideLaboratory",,82595,CPT,Facility,Outpatient,,,90,63,53.55,18.0558,63,Aetna,Medicare Advantage,30.87,49,,percent of total billed charges,,
"Cryoglobulin, S (Mayo)OutsideLaboratory",,82595,CPT,Facility,Inpatient,,,90,63,53.55,18.0558,63,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Cryoglobulin, S (Mayo)OutsideLaboratory",,82595,CPT,Facility,Both,,,90,63,53.55,18.0558,63,Aetna,PPO,58.59,93,,percent of total billed charges,,
"Cryoglobulin, S (Mayo)OutsideLaboratory",,82595,CPT,Facility,Both,,,90,63,53.55,18.0558,63,America's PPO,America's PPO,60.4989,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Cryoglobulin, S (Mayo)OutsideLaboratory",,82595,CPT,Facility,Both,,,90,63,53.55,18.0558,63,BlueCross BlueShield Minnesota, Federal Employee Program,61.992,98.4,,percent of total billed charges,,
"Cryoglobulin, S (Mayo)OutsideLaboratory",,82595,CPT,Facility,Both,,,90,63,53.55,18.0558,63,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,63,100,,percent of total billed charges,,
"Cryoglobulin, S (Mayo)OutsideLaboratory",,82595,CPT,Facility,Both,,,90,63,53.55,18.0558,63,BlueCross BlueShield Minnesota,High Value Network Plan,56.7,90,,percent of total billed charges,,
"Cryoglobulin, S (Mayo)OutsideLaboratory",,82595,CPT,Facility,Outpatient,,,90,63,53.55,18.0558,63,BlueCross BlueShield Minnesota,Medicare Advantage,30.87,49,,percent of total billed charges,,
"Cryoglobulin, S (Mayo)OutsideLaboratory",,82595,CPT,Facility,Inpatient,,,90,63,53.55,18.0558,63,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Cryoglobulin, S (Mayo)OutsideLaboratory",,82595,CPT,Facility,Both,,,90,63,53.55,18.0558,63,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,55.7991,88.57,,percent of total billed charges,,
"Cryoglobulin, S (Mayo)OutsideLaboratory",,82595,CPT,Facility,Both,,,90,63,53.55,18.0558,63,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,18.0558,28.66,,percent of total billed charges,,
"Cryoglobulin, S (Mayo)OutsideLaboratory",,82595,CPT,Facility,Outpatient,,,90,63,53.55,18.0558,63,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),30.87,49,,percent of total billed charges,,
"Cryoglobulin, S (Mayo)OutsideLaboratory",,82595,CPT,Facility,Inpatient,,,90,63,53.55,18.0558,63,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Cryoglobulin, S (Mayo)OutsideLaboratory",,82595,CPT,Facility,Both,,,90,63,53.55,18.0558,63,CorVel,Worker's Compensation,63,100,,percent of total billed charges,,
"Cryoglobulin, S (Mayo)OutsideLaboratory",,82595,CPT,Facility,Both,,,90,63,53.55,18.0558,63,First Health Group Corporation,First Health Network,61.11,97,,percent of total billed charges,,
"Cryoglobulin, S (Mayo)OutsideLaboratory",,82595,CPT,Facility,Both,,,90,63,53.55,18.0558,63,"Health Partners, Inc.",Commercial,59.598,94.6,,percent of total billed charges,,
"Cryoglobulin, S (Mayo)OutsideLaboratory",,82595,CPT,Facility,Outpatient,,,90,63,53.55,18.0558,63,"Health Partners, Inc.",Medicare Advantage,30.87,49,,percent of total billed charges,,
"Cryoglobulin, S (Mayo)OutsideLaboratory",,82595,CPT,Facility,Inpatient,,,90,63,53.55,18.0558,63,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Cryoglobulin, S (Mayo)OutsideLaboratory",,82595,CPT,Facility,Both,,,90,63,53.55,18.0558,63,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),37.8,60,,percent of total billed charges,,
"Cryoglobulin, S (Mayo)OutsideLaboratory",,82595,CPT,Facility,Both,,,90,63,53.55,18.0558,63,"Health Partners, Inc.",State of Minnesota Advantage Program,51.345,81.5,,percent of total billed charges,,
"Cryoglobulin, S (Mayo)OutsideLaboratory",,82595,CPT,Facility,Both,,,90,63,53.55,18.0558,63,"Health Partners, Inc.",State Public Programs,31.5,50,,percent of total billed charges,,
"Cryoglobulin, S (Mayo)OutsideLaboratory",,82595,CPT,Facility,Both,,,90,63,53.55,18.0558,63,Humana Insurance Company,Commercial PPO,59.85,95,,percent of total billed charges,,
"Cryoglobulin, S (Mayo)OutsideLaboratory",,82595,CPT,Facility,Outpatient,,,90,63,53.55,18.0558,63,Humana Insurance Company,Medicare PPO,30.87,49,,percent of total billed charges,,
"Cryoglobulin, S (Mayo)OutsideLaboratory",,82595,CPT,Facility,Inpatient,,,90,63,53.55,18.0558,63,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Cryoglobulin, S (Mayo)OutsideLaboratory",,82595,CPT,Facility,Both,,,90,63,53.55,18.0558,63,Medica,Individual & Family,62.433,99.1,,percent of total billed charges,,
"Cryoglobulin, S (Mayo)OutsideLaboratory",,82595,CPT,Facility,Outpatient,,,90,63,53.55,18.0558,63,Medica,Medica Advantage Solution,31.374,49.8,,percent of total billed charges,,
"Cryoglobulin, S (Mayo)OutsideLaboratory",,82595,CPT,Facility,Inpatient,,,90,63,53.55,18.0558,63,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Cryoglobulin, S (Mayo)OutsideLaboratory",,82595,CPT,Facility,Outpatient,,,90,63,53.55,18.0558,63,Medica,Medical Assistance,28.098,44.6,,percent of total billed charges,,
"Cryoglobulin, S (Mayo)OutsideLaboratory",,82595,CPT,Facility,Inpatient,,,90,63,53.55,18.0558,63,Medica,Medical Assistance,,,,,Included in per diem rate,
"Cryoglobulin, S (Mayo)OutsideLaboratory",,82595,CPT,Facility,Outpatient,,,90,63,53.55,18.0558,63,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,31.374,49.8,,percent of total billed charges,,
"Cryoglobulin, S (Mayo)OutsideLaboratory",,82595,CPT,Facility,Inpatient,,,90,63,53.55,18.0558,63,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Cryoglobulin, S (Mayo)OutsideLaboratory",,82595,CPT,Facility,Both,,,90,63,53.55,18.0558,63,"Multiplan, Inc.","Multiplan, Inc.",59.22,94,,percent of total billed charges,,
"Cryoglobulin, S (Mayo)OutsideLaboratory",,82595,CPT,Facility,Outpatient,,,90,63,53.55,18.0558,63,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,54.432,86.4,,percent of total billed charges,,
"Cryoglobulin, S (Mayo)OutsideLaboratory",,82595,CPT,Facility,Inpatient,,,90,63,53.55,18.0558,63,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Cryoglobulin, S (Mayo)OutsideLaboratory",,82595,CPT,Facility,Both,,,90,63,53.55,18.0558,63,"Preferred One Administrative Services, INC.",PPO,62.118,98.6,,percent of total billed charges,,
"Cryoglobulin, S (Mayo)OutsideLaboratory",,82595,CPT,Facility,Outpatient,,,90,63,53.55,18.0558,63,PrimeWest Health,Minnesota Senior Health Options (MSHO),32.4135,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Cryoglobulin, S (Mayo)OutsideLaboratory",,82595,CPT,Facility,Inpatient,,,90,63,53.55,18.0558,63,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Cryoglobulin, S (Mayo)OutsideLaboratory",,82595,CPT,Facility,Outpatient,,,90,63,53.55,18.0558,63,PrimeWest Health,MinnesotaCare,32.3568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Cryoglobulin, S (Mayo)OutsideLaboratory",,82595,CPT,Facility,Inpatient,,,90,63,53.55,18.0558,63,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Cryoglobulin, S (Mayo)OutsideLaboratory",,82595,CPT,Facility,Both,,,90,63,53.55,18.0558,63,Sanford Health Plan,Sanford Health Plan,57.96,92,,percent of total billed charges,,
"Cryoglobulin, S (Mayo)OutsideLaboratory",,82595,CPT,Facility,Outpatient,,,90,63,53.55,18.0558,63,"UCare Health, Inc.",Individual & Family Plan,35.5005,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Cryoglobulin, S (Mayo)OutsideLaboratory",,82595,CPT,Facility,Inpatient,,,90,63,53.55,18.0558,63,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Cryoglobulin, S (Mayo)OutsideLaboratory",,82595,CPT,Facility,Outpatient,,,90,63,53.55,18.0558,63,"UCare Health, Inc.",Medical Assistance,31.7961,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Cryoglobulin, S (Mayo)OutsideLaboratory",,82595,CPT,Facility,Inpatient,,,90,63,53.55,18.0558,63,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Cryoglobulin, S (Mayo)OutsideLaboratory",,82595,CPT,Facility,Outpatient,,,90,63,53.55,18.0558,63,"UCare Health, Inc.",Medicare Advantage,31.7961,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Cryoglobulin, S (Mayo)OutsideLaboratory",,82595,CPT,Facility,Inpatient,,,90,63,53.55,18.0558,63,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Cryoglobulin, S (Mayo)OutsideLaboratory",,82595,CPT,Facility,Outpatient,,,90,63,53.55,18.0558,63,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),31.7961,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Cryoglobulin, S (Mayo)OutsideLaboratory",,82595,CPT,Facility,Inpatient,,,90,63,53.55,18.0558,63,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Cryoglobulin, S (Mayo)OutsideLaboratory",,82595,CPT,Facility,Both,,,90,63,53.55,18.0558,63,UnitedHealthcare,Individual & Family,59.22,94,,percent of total billed charges,,
"Cryoglobulin, S (Mayo)OutsideLaboratory",,82595,CPT,Facility,Outpatient,,,90,63,53.55,18.0558,63,UnitedHealthcare,Medicare Advantage,30.87,49,,percent of total billed charges,,
"Cryoglobulin, S (Mayo)OutsideLaboratory",,82595,CPT,Facility,Inpatient,,,90,63,53.55,18.0558,63,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Cryoglobulin, S (Mayo)OutsideLaboratory",,82595,CPT,Facility,Outpatient,,,90,63,53.55,18.0558,63,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,30.24,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Cryoglobulin, S (Mayo)OutsideLaboratory",,82595,CPT,Facility,Inpatient,,,90,63,53.55,18.0558,63,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Dehydroepiandrosterone, S (Mayo)OutsideLaboratory",,82626,CPT,Facility,Both,,,90,168,142.8,48.1488,168,Aetna,Commercial,154.56,92,,percent of total billed charges,,
"Dehydroepiandrosterone, S (Mayo)OutsideLaboratory",,82626,CPT,Facility,Outpatient,,,90,168,142.8,48.1488,168,Aetna,Medicare Advantage,82.32,49,,percent of total billed charges,,
"Dehydroepiandrosterone, S (Mayo)OutsideLaboratory",,82626,CPT,Facility,Inpatient,,,90,168,142.8,48.1488,168,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Dehydroepiandrosterone, S (Mayo)OutsideLaboratory",,82626,CPT,Facility,Both,,,90,168,142.8,48.1488,168,Aetna,PPO,156.24,93,,percent of total billed charges,,
"Dehydroepiandrosterone, S (Mayo)OutsideLaboratory",,82626,CPT,Facility,Both,,,90,168,142.8,48.1488,168,America's PPO,America's PPO,161.3304,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Dehydroepiandrosterone, S (Mayo)OutsideLaboratory",,82626,CPT,Facility,Both,,,90,168,142.8,48.1488,168,BlueCross BlueShield Minnesota, Federal Employee Program,165.312,98.4,,percent of total billed charges,,
"Dehydroepiandrosterone, S (Mayo)OutsideLaboratory",,82626,CPT,Facility,Both,,,90,168,142.8,48.1488,168,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,168,100,,percent of total billed charges,,
"Dehydroepiandrosterone, S (Mayo)OutsideLaboratory",,82626,CPT,Facility,Both,,,90,168,142.8,48.1488,168,BlueCross BlueShield Minnesota,High Value Network Plan,151.2,90,,percent of total billed charges,,
"Dehydroepiandrosterone, S (Mayo)OutsideLaboratory",,82626,CPT,Facility,Outpatient,,,90,168,142.8,48.1488,168,BlueCross BlueShield Minnesota,Medicare Advantage,82.32,49,,percent of total billed charges,,
"Dehydroepiandrosterone, S (Mayo)OutsideLaboratory",,82626,CPT,Facility,Inpatient,,,90,168,142.8,48.1488,168,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Dehydroepiandrosterone, S (Mayo)OutsideLaboratory",,82626,CPT,Facility,Both,,,90,168,142.8,48.1488,168,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,148.7976,88.57,,percent of total billed charges,,
"Dehydroepiandrosterone, S (Mayo)OutsideLaboratory",,82626,CPT,Facility,Both,,,90,168,142.8,48.1488,168,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,48.1488,28.66,,percent of total billed charges,,
"Dehydroepiandrosterone, S (Mayo)OutsideLaboratory",,82626,CPT,Facility,Outpatient,,,90,168,142.8,48.1488,168,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),82.32,49,,percent of total billed charges,,
"Dehydroepiandrosterone, S (Mayo)OutsideLaboratory",,82626,CPT,Facility,Inpatient,,,90,168,142.8,48.1488,168,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Dehydroepiandrosterone, S (Mayo)OutsideLaboratory",,82626,CPT,Facility,Both,,,90,168,142.8,48.1488,168,CorVel,Worker's Compensation,168,100,,percent of total billed charges,,
"Dehydroepiandrosterone, S (Mayo)OutsideLaboratory",,82626,CPT,Facility,Both,,,90,168,142.8,48.1488,168,First Health Group Corporation,First Health Network,162.96,97,,percent of total billed charges,,
"Dehydroepiandrosterone, S (Mayo)OutsideLaboratory",,82626,CPT,Facility,Both,,,90,168,142.8,48.1488,168,"Health Partners, Inc.",Commercial,158.928,94.6,,percent of total billed charges,,
"Dehydroepiandrosterone, S (Mayo)OutsideLaboratory",,82626,CPT,Facility,Outpatient,,,90,168,142.8,48.1488,168,"Health Partners, Inc.",Medicare Advantage,82.32,49,,percent of total billed charges,,
"Dehydroepiandrosterone, S (Mayo)OutsideLaboratory",,82626,CPT,Facility,Inpatient,,,90,168,142.8,48.1488,168,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Dehydroepiandrosterone, S (Mayo)OutsideLaboratory",,82626,CPT,Facility,Both,,,90,168,142.8,48.1488,168,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),100.8,60,,percent of total billed charges,,
"Dehydroepiandrosterone, S (Mayo)OutsideLaboratory",,82626,CPT,Facility,Both,,,90,168,142.8,48.1488,168,"Health Partners, Inc.",State of Minnesota Advantage Program,136.92,81.5,,percent of total billed charges,,
"Dehydroepiandrosterone, S (Mayo)OutsideLaboratory",,82626,CPT,Facility,Both,,,90,168,142.8,48.1488,168,"Health Partners, Inc.",State Public Programs,84,50,,percent of total billed charges,,
"Dehydroepiandrosterone, S (Mayo)OutsideLaboratory",,82626,CPT,Facility,Both,,,90,168,142.8,48.1488,168,Humana Insurance Company,Commercial PPO,159.6,95,,percent of total billed charges,,
"Dehydroepiandrosterone, S (Mayo)OutsideLaboratory",,82626,CPT,Facility,Outpatient,,,90,168,142.8,48.1488,168,Humana Insurance Company,Medicare PPO,82.32,49,,percent of total billed charges,,
"Dehydroepiandrosterone, S (Mayo)OutsideLaboratory",,82626,CPT,Facility,Inpatient,,,90,168,142.8,48.1488,168,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Dehydroepiandrosterone, S (Mayo)OutsideLaboratory",,82626,CPT,Facility,Both,,,90,168,142.8,48.1488,168,Medica,Individual & Family,166.488,99.1,,percent of total billed charges,,
"Dehydroepiandrosterone, S (Mayo)OutsideLaboratory",,82626,CPT,Facility,Outpatient,,,90,168,142.8,48.1488,168,Medica,Medica Advantage Solution,83.664,49.8,,percent of total billed charges,,
"Dehydroepiandrosterone, S (Mayo)OutsideLaboratory",,82626,CPT,Facility,Inpatient,,,90,168,142.8,48.1488,168,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Dehydroepiandrosterone, S (Mayo)OutsideLaboratory",,82626,CPT,Facility,Outpatient,,,90,168,142.8,48.1488,168,Medica,Medical Assistance,74.928,44.6,,percent of total billed charges,,
"Dehydroepiandrosterone, S (Mayo)OutsideLaboratory",,82626,CPT,Facility,Inpatient,,,90,168,142.8,48.1488,168,Medica,Medical Assistance,,,,,Included in per diem rate,
"Dehydroepiandrosterone, S (Mayo)OutsideLaboratory",,82626,CPT,Facility,Outpatient,,,90,168,142.8,48.1488,168,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,83.664,49.8,,percent of total billed charges,,
"Dehydroepiandrosterone, S (Mayo)OutsideLaboratory",,82626,CPT,Facility,Inpatient,,,90,168,142.8,48.1488,168,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Dehydroepiandrosterone, S (Mayo)OutsideLaboratory",,82626,CPT,Facility,Both,,,90,168,142.8,48.1488,168,"Multiplan, Inc.","Multiplan, Inc.",157.92,94,,percent of total billed charges,,
"Dehydroepiandrosterone, S (Mayo)OutsideLaboratory",,82626,CPT,Facility,Outpatient,,,90,168,142.8,48.1488,168,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,145.152,86.4,,percent of total billed charges,,
"Dehydroepiandrosterone, S (Mayo)OutsideLaboratory",,82626,CPT,Facility,Inpatient,,,90,168,142.8,48.1488,168,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Dehydroepiandrosterone, S (Mayo)OutsideLaboratory",,82626,CPT,Facility,Both,,,90,168,142.8,48.1488,168,"Preferred One Administrative Services, INC.",PPO,165.648,98.6,,percent of total billed charges,,
"Dehydroepiandrosterone, S (Mayo)OutsideLaboratory",,82626,CPT,Facility,Outpatient,,,90,168,142.8,48.1488,168,PrimeWest Health,Minnesota Senior Health Options (MSHO),86.436,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Dehydroepiandrosterone, S (Mayo)OutsideLaboratory",,82626,CPT,Facility,Inpatient,,,90,168,142.8,48.1488,168,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Dehydroepiandrosterone, S (Mayo)OutsideLaboratory",,82626,CPT,Facility,Outpatient,,,90,168,142.8,48.1488,168,PrimeWest Health,MinnesotaCare,86.2848,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Dehydroepiandrosterone, S (Mayo)OutsideLaboratory",,82626,CPT,Facility,Inpatient,,,90,168,142.8,48.1488,168,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Dehydroepiandrosterone, S (Mayo)OutsideLaboratory",,82626,CPT,Facility,Both,,,90,168,142.8,48.1488,168,Sanford Health Plan,Sanford Health Plan,154.56,92,,percent of total billed charges,,
"Dehydroepiandrosterone, S (Mayo)OutsideLaboratory",,82626,CPT,Facility,Outpatient,,,90,168,142.8,48.1488,168,"UCare Health, Inc.",Individual & Family Plan,94.668,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Dehydroepiandrosterone, S (Mayo)OutsideLaboratory",,82626,CPT,Facility,Inpatient,,,90,168,142.8,48.1488,168,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Dehydroepiandrosterone, S (Mayo)OutsideLaboratory",,82626,CPT,Facility,Outpatient,,,90,168,142.8,48.1488,168,"UCare Health, Inc.",Medical Assistance,84.7896,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Dehydroepiandrosterone, S (Mayo)OutsideLaboratory",,82626,CPT,Facility,Inpatient,,,90,168,142.8,48.1488,168,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Dehydroepiandrosterone, S (Mayo)OutsideLaboratory",,82626,CPT,Facility,Outpatient,,,90,168,142.8,48.1488,168,"UCare Health, Inc.",Medicare Advantage,84.7896,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Dehydroepiandrosterone, S (Mayo)OutsideLaboratory",,82626,CPT,Facility,Inpatient,,,90,168,142.8,48.1488,168,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Dehydroepiandrosterone, S (Mayo)OutsideLaboratory",,82626,CPT,Facility,Outpatient,,,90,168,142.8,48.1488,168,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),84.7896,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Dehydroepiandrosterone, S (Mayo)OutsideLaboratory",,82626,CPT,Facility,Inpatient,,,90,168,142.8,48.1488,168,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Dehydroepiandrosterone, S (Mayo)OutsideLaboratory",,82626,CPT,Facility,Both,,,90,168,142.8,48.1488,168,UnitedHealthcare,Individual & Family,157.92,94,,percent of total billed charges,,
"Dehydroepiandrosterone, S (Mayo)OutsideLaboratory",,82626,CPT,Facility,Outpatient,,,90,168,142.8,48.1488,168,UnitedHealthcare,Medicare Advantage,82.32,49,,percent of total billed charges,,
"Dehydroepiandrosterone, S (Mayo)OutsideLaboratory",,82626,CPT,Facility,Inpatient,,,90,168,142.8,48.1488,168,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Dehydroepiandrosterone, S (Mayo)OutsideLaboratory",,82626,CPT,Facility,Outpatient,,,90,168,142.8,48.1488,168,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,80.64,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Dehydroepiandrosterone, S (Mayo)OutsideLaboratory",,82626,CPT,Facility,Inpatient,,,90,168,142.8,48.1488,168,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Dehydroepiandrosterone Sulfate, S (Mayo)OutsideLaboratory",,82627,CPT,Facility,Both,,,90,153,130.05,43.8498,153,Aetna,Commercial,140.76,92,,percent of total billed charges,,
"Dehydroepiandrosterone Sulfate, S (Mayo)OutsideLaboratory",,82627,CPT,Facility,Outpatient,,,90,153,130.05,43.8498,153,Aetna,Medicare Advantage,74.97,49,,percent of total billed charges,,
"Dehydroepiandrosterone Sulfate, S (Mayo)OutsideLaboratory",,82627,CPT,Facility,Inpatient,,,90,153,130.05,43.8498,153,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Dehydroepiandrosterone Sulfate, S (Mayo)OutsideLaboratory",,82627,CPT,Facility,Both,,,90,153,130.05,43.8498,153,Aetna,PPO,142.29,93,,percent of total billed charges,,
"Dehydroepiandrosterone Sulfate, S (Mayo)OutsideLaboratory",,82627,CPT,Facility,Both,,,90,153,130.05,43.8498,153,America's PPO,America's PPO,146.9259,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Dehydroepiandrosterone Sulfate, S (Mayo)OutsideLaboratory",,82627,CPT,Facility,Both,,,90,153,130.05,43.8498,153,BlueCross BlueShield Minnesota, Federal Employee Program,150.552,98.4,,percent of total billed charges,,
"Dehydroepiandrosterone Sulfate, S (Mayo)OutsideLaboratory",,82627,CPT,Facility,Both,,,90,153,130.05,43.8498,153,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,153,100,,percent of total billed charges,,
"Dehydroepiandrosterone Sulfate, S (Mayo)OutsideLaboratory",,82627,CPT,Facility,Both,,,90,153,130.05,43.8498,153,BlueCross BlueShield Minnesota,High Value Network Plan,137.7,90,,percent of total billed charges,,
"Dehydroepiandrosterone Sulfate, S (Mayo)OutsideLaboratory",,82627,CPT,Facility,Outpatient,,,90,153,130.05,43.8498,153,BlueCross BlueShield Minnesota,Medicare Advantage,74.97,49,,percent of total billed charges,,
"Dehydroepiandrosterone Sulfate, S (Mayo)OutsideLaboratory",,82627,CPT,Facility,Inpatient,,,90,153,130.05,43.8498,153,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Dehydroepiandrosterone Sulfate, S (Mayo)OutsideLaboratory",,82627,CPT,Facility,Both,,,90,153,130.05,43.8498,153,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,135.5121,88.57,,percent of total billed charges,,
"Dehydroepiandrosterone Sulfate, S (Mayo)OutsideLaboratory",,82627,CPT,Facility,Both,,,90,153,130.05,43.8498,153,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,43.8498,28.66,,percent of total billed charges,,
"Dehydroepiandrosterone Sulfate, S (Mayo)OutsideLaboratory",,82627,CPT,Facility,Outpatient,,,90,153,130.05,43.8498,153,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),74.97,49,,percent of total billed charges,,
"Dehydroepiandrosterone Sulfate, S (Mayo)OutsideLaboratory",,82627,CPT,Facility,Inpatient,,,90,153,130.05,43.8498,153,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Dehydroepiandrosterone Sulfate, S (Mayo)OutsideLaboratory",,82627,CPT,Facility,Both,,,90,153,130.05,43.8498,153,CorVel,Worker's Compensation,153,100,,percent of total billed charges,,
"Dehydroepiandrosterone Sulfate, S (Mayo)OutsideLaboratory",,82627,CPT,Facility,Both,,,90,153,130.05,43.8498,153,First Health Group Corporation,First Health Network,148.41,97,,percent of total billed charges,,
"Dehydroepiandrosterone Sulfate, S (Mayo)OutsideLaboratory",,82627,CPT,Facility,Both,,,90,153,130.05,43.8498,153,"Health Partners, Inc.",Commercial,144.738,94.6,,percent of total billed charges,,
"Dehydroepiandrosterone Sulfate, S (Mayo)OutsideLaboratory",,82627,CPT,Facility,Outpatient,,,90,153,130.05,43.8498,153,"Health Partners, Inc.",Medicare Advantage,74.97,49,,percent of total billed charges,,
"Dehydroepiandrosterone Sulfate, S (Mayo)OutsideLaboratory",,82627,CPT,Facility,Inpatient,,,90,153,130.05,43.8498,153,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Dehydroepiandrosterone Sulfate, S (Mayo)OutsideLaboratory",,82627,CPT,Facility,Both,,,90,153,130.05,43.8498,153,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),91.8,60,,percent of total billed charges,,
"Dehydroepiandrosterone Sulfate, S (Mayo)OutsideLaboratory",,82627,CPT,Facility,Both,,,90,153,130.05,43.8498,153,"Health Partners, Inc.",State of Minnesota Advantage Program,124.695,81.5,,percent of total billed charges,,
"Dehydroepiandrosterone Sulfate, S (Mayo)OutsideLaboratory",,82627,CPT,Facility,Both,,,90,153,130.05,43.8498,153,"Health Partners, Inc.",State Public Programs,76.5,50,,percent of total billed charges,,
"Dehydroepiandrosterone Sulfate, S (Mayo)OutsideLaboratory",,82627,CPT,Facility,Both,,,90,153,130.05,43.8498,153,Humana Insurance Company,Commercial PPO,145.35,95,,percent of total billed charges,,
"Dehydroepiandrosterone Sulfate, S (Mayo)OutsideLaboratory",,82627,CPT,Facility,Outpatient,,,90,153,130.05,43.8498,153,Humana Insurance Company,Medicare PPO,74.97,49,,percent of total billed charges,,
"Dehydroepiandrosterone Sulfate, S (Mayo)OutsideLaboratory",,82627,CPT,Facility,Inpatient,,,90,153,130.05,43.8498,153,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Dehydroepiandrosterone Sulfate, S (Mayo)OutsideLaboratory",,82627,CPT,Facility,Both,,,90,153,130.05,43.8498,153,Medica,Individual & Family,151.623,99.1,,percent of total billed charges,,
"Dehydroepiandrosterone Sulfate, S (Mayo)OutsideLaboratory",,82627,CPT,Facility,Outpatient,,,90,153,130.05,43.8498,153,Medica,Medica Advantage Solution,76.194,49.8,,percent of total billed charges,,
"Dehydroepiandrosterone Sulfate, S (Mayo)OutsideLaboratory",,82627,CPT,Facility,Inpatient,,,90,153,130.05,43.8498,153,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Dehydroepiandrosterone Sulfate, S (Mayo)OutsideLaboratory",,82627,CPT,Facility,Outpatient,,,90,153,130.05,43.8498,153,Medica,Medical Assistance,68.238,44.6,,percent of total billed charges,,
"Dehydroepiandrosterone Sulfate, S (Mayo)OutsideLaboratory",,82627,CPT,Facility,Inpatient,,,90,153,130.05,43.8498,153,Medica,Medical Assistance,,,,,Included in per diem rate,
"Dehydroepiandrosterone Sulfate, S (Mayo)OutsideLaboratory",,82627,CPT,Facility,Outpatient,,,90,153,130.05,43.8498,153,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,76.194,49.8,,percent of total billed charges,,
"Dehydroepiandrosterone Sulfate, S (Mayo)OutsideLaboratory",,82627,CPT,Facility,Inpatient,,,90,153,130.05,43.8498,153,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Dehydroepiandrosterone Sulfate, S (Mayo)OutsideLaboratory",,82627,CPT,Facility,Both,,,90,153,130.05,43.8498,153,"Multiplan, Inc.","Multiplan, Inc.",143.82,94,,percent of total billed charges,,
"Dehydroepiandrosterone Sulfate, S (Mayo)OutsideLaboratory",,82627,CPT,Facility,Outpatient,,,90,153,130.05,43.8498,153,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,132.192,86.4,,percent of total billed charges,,
"Dehydroepiandrosterone Sulfate, S (Mayo)OutsideLaboratory",,82627,CPT,Facility,Inpatient,,,90,153,130.05,43.8498,153,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Dehydroepiandrosterone Sulfate, S (Mayo)OutsideLaboratory",,82627,CPT,Facility,Both,,,90,153,130.05,43.8498,153,"Preferred One Administrative Services, INC.",PPO,150.858,98.6,,percent of total billed charges,,
"Dehydroepiandrosterone Sulfate, S (Mayo)OutsideLaboratory",,82627,CPT,Facility,Outpatient,,,90,153,130.05,43.8498,153,PrimeWest Health,Minnesota Senior Health Options (MSHO),78.7185,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Dehydroepiandrosterone Sulfate, S (Mayo)OutsideLaboratory",,82627,CPT,Facility,Inpatient,,,90,153,130.05,43.8498,153,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Dehydroepiandrosterone Sulfate, S (Mayo)OutsideLaboratory",,82627,CPT,Facility,Outpatient,,,90,153,130.05,43.8498,153,PrimeWest Health,MinnesotaCare,78.5808,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Dehydroepiandrosterone Sulfate, S (Mayo)OutsideLaboratory",,82627,CPT,Facility,Inpatient,,,90,153,130.05,43.8498,153,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Dehydroepiandrosterone Sulfate, S (Mayo)OutsideLaboratory",,82627,CPT,Facility,Both,,,90,153,130.05,43.8498,153,Sanford Health Plan,Sanford Health Plan,140.76,92,,percent of total billed charges,,
"Dehydroepiandrosterone Sulfate, S (Mayo)OutsideLaboratory",,82627,CPT,Facility,Outpatient,,,90,153,130.05,43.8498,153,"UCare Health, Inc.",Individual & Family Plan,86.2155,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Dehydroepiandrosterone Sulfate, S (Mayo)OutsideLaboratory",,82627,CPT,Facility,Inpatient,,,90,153,130.05,43.8498,153,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Dehydroepiandrosterone Sulfate, S (Mayo)OutsideLaboratory",,82627,CPT,Facility,Outpatient,,,90,153,130.05,43.8498,153,"UCare Health, Inc.",Medical Assistance,77.2191,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Dehydroepiandrosterone Sulfate, S (Mayo)OutsideLaboratory",,82627,CPT,Facility,Inpatient,,,90,153,130.05,43.8498,153,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Dehydroepiandrosterone Sulfate, S (Mayo)OutsideLaboratory",,82627,CPT,Facility,Outpatient,,,90,153,130.05,43.8498,153,"UCare Health, Inc.",Medicare Advantage,77.2191,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Dehydroepiandrosterone Sulfate, S (Mayo)OutsideLaboratory",,82627,CPT,Facility,Inpatient,,,90,153,130.05,43.8498,153,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Dehydroepiandrosterone Sulfate, S (Mayo)OutsideLaboratory",,82627,CPT,Facility,Outpatient,,,90,153,130.05,43.8498,153,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),77.2191,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Dehydroepiandrosterone Sulfate, S (Mayo)OutsideLaboratory",,82627,CPT,Facility,Inpatient,,,90,153,130.05,43.8498,153,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Dehydroepiandrosterone Sulfate, S (Mayo)OutsideLaboratory",,82627,CPT,Facility,Both,,,90,153,130.05,43.8498,153,UnitedHealthcare,Individual & Family,143.82,94,,percent of total billed charges,,
"Dehydroepiandrosterone Sulfate, S (Mayo)OutsideLaboratory",,82627,CPT,Facility,Outpatient,,,90,153,130.05,43.8498,153,UnitedHealthcare,Medicare Advantage,74.97,49,,percent of total billed charges,,
"Dehydroepiandrosterone Sulfate, S (Mayo)OutsideLaboratory",,82627,CPT,Facility,Inpatient,,,90,153,130.05,43.8498,153,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Dehydroepiandrosterone Sulfate, S (Mayo)OutsideLaboratory",,82627,CPT,Facility,Outpatient,,,90,153,130.05,43.8498,153,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,73.44,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Dehydroepiandrosterone Sulfate, S (Mayo)OutsideLaboratory",,82627,CPT,Facility,Inpatient,,,90,153,130.05,43.8498,153,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Dihydrotestosterone, S (Mayo)OutsideLaboratory",,82642,CPT,Facility,Both,,,90,219,186.15,62.7654,219,Aetna,Commercial,201.48,92,,percent of total billed charges,,
"Dihydrotestosterone, S (Mayo)OutsideLaboratory",,82642,CPT,Facility,Outpatient,,,90,219,186.15,62.7654,219,Aetna,Medicare Advantage,107.31,49,,percent of total billed charges,,
"Dihydrotestosterone, S (Mayo)OutsideLaboratory",,82642,CPT,Facility,Inpatient,,,90,219,186.15,62.7654,219,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Dihydrotestosterone, S (Mayo)OutsideLaboratory",,82642,CPT,Facility,Both,,,90,219,186.15,62.7654,219,Aetna,PPO,203.67,93,,percent of total billed charges,,
"Dihydrotestosterone, S (Mayo)OutsideLaboratory",,82642,CPT,Facility,Both,,,90,219,186.15,62.7654,219,America's PPO,America's PPO,210.3057,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Dihydrotestosterone, S (Mayo)OutsideLaboratory",,82642,CPT,Facility,Both,,,90,219,186.15,62.7654,219,BlueCross BlueShield Minnesota, Federal Employee Program,215.496,98.4,,percent of total billed charges,,
"Dihydrotestosterone, S (Mayo)OutsideLaboratory",,82642,CPT,Facility,Both,,,90,219,186.15,62.7654,219,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,219,100,,percent of total billed charges,,
"Dihydrotestosterone, S (Mayo)OutsideLaboratory",,82642,CPT,Facility,Both,,,90,219,186.15,62.7654,219,BlueCross BlueShield Minnesota,High Value Network Plan,197.1,90,,percent of total billed charges,,
"Dihydrotestosterone, S (Mayo)OutsideLaboratory",,82642,CPT,Facility,Outpatient,,,90,219,186.15,62.7654,219,BlueCross BlueShield Minnesota,Medicare Advantage,107.31,49,,percent of total billed charges,,
"Dihydrotestosterone, S (Mayo)OutsideLaboratory",,82642,CPT,Facility,Inpatient,,,90,219,186.15,62.7654,219,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Dihydrotestosterone, S (Mayo)OutsideLaboratory",,82642,CPT,Facility,Both,,,90,219,186.15,62.7654,219,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,193.9683,88.57,,percent of total billed charges,,
"Dihydrotestosterone, S (Mayo)OutsideLaboratory",,82642,CPT,Facility,Both,,,90,219,186.15,62.7654,219,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,62.7654,28.66,,percent of total billed charges,,
"Dihydrotestosterone, S (Mayo)OutsideLaboratory",,82642,CPT,Facility,Outpatient,,,90,219,186.15,62.7654,219,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),107.31,49,,percent of total billed charges,,
"Dihydrotestosterone, S (Mayo)OutsideLaboratory",,82642,CPT,Facility,Inpatient,,,90,219,186.15,62.7654,219,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Dihydrotestosterone, S (Mayo)OutsideLaboratory",,82642,CPT,Facility,Both,,,90,219,186.15,62.7654,219,CorVel,Worker's Compensation,219,100,,percent of total billed charges,,
"Dihydrotestosterone, S (Mayo)OutsideLaboratory",,82642,CPT,Facility,Both,,,90,219,186.15,62.7654,219,First Health Group Corporation,First Health Network,212.43,97,,percent of total billed charges,,
"Dihydrotestosterone, S (Mayo)OutsideLaboratory",,82642,CPT,Facility,Both,,,90,219,186.15,62.7654,219,"Health Partners, Inc.",Commercial,207.174,94.6,,percent of total billed charges,,
"Dihydrotestosterone, S (Mayo)OutsideLaboratory",,82642,CPT,Facility,Outpatient,,,90,219,186.15,62.7654,219,"Health Partners, Inc.",Medicare Advantage,107.31,49,,percent of total billed charges,,
"Dihydrotestosterone, S (Mayo)OutsideLaboratory",,82642,CPT,Facility,Inpatient,,,90,219,186.15,62.7654,219,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Dihydrotestosterone, S (Mayo)OutsideLaboratory",,82642,CPT,Facility,Both,,,90,219,186.15,62.7654,219,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),131.4,60,,percent of total billed charges,,
"Dihydrotestosterone, S (Mayo)OutsideLaboratory",,82642,CPT,Facility,Both,,,90,219,186.15,62.7654,219,"Health Partners, Inc.",State of Minnesota Advantage Program,178.485,81.5,,percent of total billed charges,,
"Dihydrotestosterone, S (Mayo)OutsideLaboratory",,82642,CPT,Facility,Both,,,90,219,186.15,62.7654,219,"Health Partners, Inc.",State Public Programs,109.5,50,,percent of total billed charges,,
"Dihydrotestosterone, S (Mayo)OutsideLaboratory",,82642,CPT,Facility,Both,,,90,219,186.15,62.7654,219,Humana Insurance Company,Commercial PPO,208.05,95,,percent of total billed charges,,
"Dihydrotestosterone, S (Mayo)OutsideLaboratory",,82642,CPT,Facility,Outpatient,,,90,219,186.15,62.7654,219,Humana Insurance Company,Medicare PPO,107.31,49,,percent of total billed charges,,
"Dihydrotestosterone, S (Mayo)OutsideLaboratory",,82642,CPT,Facility,Inpatient,,,90,219,186.15,62.7654,219,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Dihydrotestosterone, S (Mayo)OutsideLaboratory",,82642,CPT,Facility,Both,,,90,219,186.15,62.7654,219,Medica,Individual & Family,217.029,99.1,,percent of total billed charges,,
"Dihydrotestosterone, S (Mayo)OutsideLaboratory",,82642,CPT,Facility,Outpatient,,,90,219,186.15,62.7654,219,Medica,Medica Advantage Solution,109.062,49.8,,percent of total billed charges,,
"Dihydrotestosterone, S (Mayo)OutsideLaboratory",,82642,CPT,Facility,Inpatient,,,90,219,186.15,62.7654,219,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Dihydrotestosterone, S (Mayo)OutsideLaboratory",,82642,CPT,Facility,Outpatient,,,90,219,186.15,62.7654,219,Medica,Medical Assistance,97.674,44.6,,percent of total billed charges,,
"Dihydrotestosterone, S (Mayo)OutsideLaboratory",,82642,CPT,Facility,Inpatient,,,90,219,186.15,62.7654,219,Medica,Medical Assistance,,,,,Included in per diem rate,
"Dihydrotestosterone, S (Mayo)OutsideLaboratory",,82642,CPT,Facility,Outpatient,,,90,219,186.15,62.7654,219,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,109.062,49.8,,percent of total billed charges,,
"Dihydrotestosterone, S (Mayo)OutsideLaboratory",,82642,CPT,Facility,Inpatient,,,90,219,186.15,62.7654,219,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Dihydrotestosterone, S (Mayo)OutsideLaboratory",,82642,CPT,Facility,Both,,,90,219,186.15,62.7654,219,"Multiplan, Inc.","Multiplan, Inc.",205.86,94,,percent of total billed charges,,
"Dihydrotestosterone, S (Mayo)OutsideLaboratory",,82642,CPT,Facility,Outpatient,,,90,219,186.15,62.7654,219,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,189.216,86.4,,percent of total billed charges,,
"Dihydrotestosterone, S (Mayo)OutsideLaboratory",,82642,CPT,Facility,Inpatient,,,90,219,186.15,62.7654,219,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Dihydrotestosterone, S (Mayo)OutsideLaboratory",,82642,CPT,Facility,Both,,,90,219,186.15,62.7654,219,"Preferred One Administrative Services, INC.",PPO,215.934,98.6,,percent of total billed charges,,
"Dihydrotestosterone, S (Mayo)OutsideLaboratory",,82642,CPT,Facility,Outpatient,,,90,219,186.15,62.7654,219,PrimeWest Health,Minnesota Senior Health Options (MSHO),112.6755,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Dihydrotestosterone, S (Mayo)OutsideLaboratory",,82642,CPT,Facility,Inpatient,,,90,219,186.15,62.7654,219,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Dihydrotestosterone, S (Mayo)OutsideLaboratory",,82642,CPT,Facility,Outpatient,,,90,219,186.15,62.7654,219,PrimeWest Health,MinnesotaCare,112.4784,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Dihydrotestosterone, S (Mayo)OutsideLaboratory",,82642,CPT,Facility,Inpatient,,,90,219,186.15,62.7654,219,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Dihydrotestosterone, S (Mayo)OutsideLaboratory",,82642,CPT,Facility,Both,,,90,219,186.15,62.7654,219,Sanford Health Plan,Sanford Health Plan,201.48,92,,percent of total billed charges,,
"Dihydrotestosterone, S (Mayo)OutsideLaboratory",,82642,CPT,Facility,Outpatient,,,90,219,186.15,62.7654,219,"UCare Health, Inc.",Individual & Family Plan,123.4065,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Dihydrotestosterone, S (Mayo)OutsideLaboratory",,82642,CPT,Facility,Inpatient,,,90,219,186.15,62.7654,219,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Dihydrotestosterone, S (Mayo)OutsideLaboratory",,82642,CPT,Facility,Outpatient,,,90,219,186.15,62.7654,219,"UCare Health, Inc.",Medical Assistance,110.5293,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Dihydrotestosterone, S (Mayo)OutsideLaboratory",,82642,CPT,Facility,Inpatient,,,90,219,186.15,62.7654,219,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Dihydrotestosterone, S (Mayo)OutsideLaboratory",,82642,CPT,Facility,Outpatient,,,90,219,186.15,62.7654,219,"UCare Health, Inc.",Medicare Advantage,110.5293,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Dihydrotestosterone, S (Mayo)OutsideLaboratory",,82642,CPT,Facility,Inpatient,,,90,219,186.15,62.7654,219,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Dihydrotestosterone, S (Mayo)OutsideLaboratory",,82642,CPT,Facility,Outpatient,,,90,219,186.15,62.7654,219,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),110.5293,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Dihydrotestosterone, S (Mayo)OutsideLaboratory",,82642,CPT,Facility,Inpatient,,,90,219,186.15,62.7654,219,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Dihydrotestosterone, S (Mayo)OutsideLaboratory",,82642,CPT,Facility,Both,,,90,219,186.15,62.7654,219,UnitedHealthcare,Individual & Family,205.86,94,,percent of total billed charges,,
"Dihydrotestosterone, S (Mayo)OutsideLaboratory",,82642,CPT,Facility,Outpatient,,,90,219,186.15,62.7654,219,UnitedHealthcare,Medicare Advantage,107.31,49,,percent of total billed charges,,
"Dihydrotestosterone, S (Mayo)OutsideLaboratory",,82642,CPT,Facility,Inpatient,,,90,219,186.15,62.7654,219,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Dihydrotestosterone, S (Mayo)OutsideLaboratory",,82642,CPT,Facility,Outpatient,,,90,219,186.15,62.7654,219,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,105.12,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Dihydrotestosterone, S (Mayo)OutsideLaboratory",,82642,CPT,Facility,Inpatient,,,90,219,186.15,62.7654,219,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"1,25-Dihydroxyvitamin D, S (Mayo)OutsideLaboratory",,82652,CPT,Facility,Both,,,90,191,162.35,54.7406,191,Aetna,Commercial,175.72,92,,percent of total billed charges,,
"1,25-Dihydroxyvitamin D, S (Mayo)OutsideLaboratory",,82652,CPT,Facility,Outpatient,,,90,191,162.35,54.7406,191,Aetna,Medicare Advantage,93.59,49,,percent of total billed charges,,
"1,25-Dihydroxyvitamin D, S (Mayo)OutsideLaboratory",,82652,CPT,Facility,Inpatient,,,90,191,162.35,54.7406,191,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"1,25-Dihydroxyvitamin D, S (Mayo)OutsideLaboratory",,82652,CPT,Facility,Both,,,90,191,162.35,54.7406,191,Aetna,PPO,177.63,93,,percent of total billed charges,,
"1,25-Dihydroxyvitamin D, S (Mayo)OutsideLaboratory",,82652,CPT,Facility,Both,,,90,191,162.35,54.7406,191,America's PPO,America's PPO,183.4173,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"1,25-Dihydroxyvitamin D, S (Mayo)OutsideLaboratory",,82652,CPT,Facility,Both,,,90,191,162.35,54.7406,191,BlueCross BlueShield Minnesota, Federal Employee Program,187.944,98.4,,percent of total billed charges,,
"1,25-Dihydroxyvitamin D, S (Mayo)OutsideLaboratory",,82652,CPT,Facility,Both,,,90,191,162.35,54.7406,191,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,191,100,,percent of total billed charges,,
"1,25-Dihydroxyvitamin D, S (Mayo)OutsideLaboratory",,82652,CPT,Facility,Both,,,90,191,162.35,54.7406,191,BlueCross BlueShield Minnesota,High Value Network Plan,171.9,90,,percent of total billed charges,,
"1,25-Dihydroxyvitamin D, S (Mayo)OutsideLaboratory",,82652,CPT,Facility,Outpatient,,,90,191,162.35,54.7406,191,BlueCross BlueShield Minnesota,Medicare Advantage,93.59,49,,percent of total billed charges,,
"1,25-Dihydroxyvitamin D, S (Mayo)OutsideLaboratory",,82652,CPT,Facility,Inpatient,,,90,191,162.35,54.7406,191,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"1,25-Dihydroxyvitamin D, S (Mayo)OutsideLaboratory",,82652,CPT,Facility,Both,,,90,191,162.35,54.7406,191,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,169.1687,88.57,,percent of total billed charges,,
"1,25-Dihydroxyvitamin D, S (Mayo)OutsideLaboratory",,82652,CPT,Facility,Both,,,90,191,162.35,54.7406,191,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,54.7406,28.66,,percent of total billed charges,,
"1,25-Dihydroxyvitamin D, S (Mayo)OutsideLaboratory",,82652,CPT,Facility,Outpatient,,,90,191,162.35,54.7406,191,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),93.59,49,,percent of total billed charges,,
"1,25-Dihydroxyvitamin D, S (Mayo)OutsideLaboratory",,82652,CPT,Facility,Inpatient,,,90,191,162.35,54.7406,191,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"1,25-Dihydroxyvitamin D, S (Mayo)OutsideLaboratory",,82652,CPT,Facility,Both,,,90,191,162.35,54.7406,191,CorVel,Worker's Compensation,191,100,,percent of total billed charges,,
"1,25-Dihydroxyvitamin D, S (Mayo)OutsideLaboratory",,82652,CPT,Facility,Both,,,90,191,162.35,54.7406,191,First Health Group Corporation,First Health Network,185.27,97,,percent of total billed charges,,
"1,25-Dihydroxyvitamin D, S (Mayo)OutsideLaboratory",,82652,CPT,Facility,Both,,,90,191,162.35,54.7406,191,"Health Partners, Inc.",Commercial,180.686,94.6,,percent of total billed charges,,
"1,25-Dihydroxyvitamin D, S (Mayo)OutsideLaboratory",,82652,CPT,Facility,Outpatient,,,90,191,162.35,54.7406,191,"Health Partners, Inc.",Medicare Advantage,93.59,49,,percent of total billed charges,,
"1,25-Dihydroxyvitamin D, S (Mayo)OutsideLaboratory",,82652,CPT,Facility,Inpatient,,,90,191,162.35,54.7406,191,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"1,25-Dihydroxyvitamin D, S (Mayo)OutsideLaboratory",,82652,CPT,Facility,Both,,,90,191,162.35,54.7406,191,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),114.6,60,,percent of total billed charges,,
"1,25-Dihydroxyvitamin D, S (Mayo)OutsideLaboratory",,82652,CPT,Facility,Both,,,90,191,162.35,54.7406,191,"Health Partners, Inc.",State of Minnesota Advantage Program,155.665,81.5,,percent of total billed charges,,
"1,25-Dihydroxyvitamin D, S (Mayo)OutsideLaboratory",,82652,CPT,Facility,Both,,,90,191,162.35,54.7406,191,"Health Partners, Inc.",State Public Programs,95.5,50,,percent of total billed charges,,
"1,25-Dihydroxyvitamin D, S (Mayo)OutsideLaboratory",,82652,CPT,Facility,Both,,,90,191,162.35,54.7406,191,Humana Insurance Company,Commercial PPO,181.45,95,,percent of total billed charges,,
"1,25-Dihydroxyvitamin D, S (Mayo)OutsideLaboratory",,82652,CPT,Facility,Outpatient,,,90,191,162.35,54.7406,191,Humana Insurance Company,Medicare PPO,93.59,49,,percent of total billed charges,,
"1,25-Dihydroxyvitamin D, S (Mayo)OutsideLaboratory",,82652,CPT,Facility,Inpatient,,,90,191,162.35,54.7406,191,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"1,25-Dihydroxyvitamin D, S (Mayo)OutsideLaboratory",,82652,CPT,Facility,Both,,,90,191,162.35,54.7406,191,Medica,Individual & Family,189.281,99.1,,percent of total billed charges,,
"1,25-Dihydroxyvitamin D, S (Mayo)OutsideLaboratory",,82652,CPT,Facility,Outpatient,,,90,191,162.35,54.7406,191,Medica,Medica Advantage Solution,95.118,49.8,,percent of total billed charges,,
"1,25-Dihydroxyvitamin D, S (Mayo)OutsideLaboratory",,82652,CPT,Facility,Inpatient,,,90,191,162.35,54.7406,191,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"1,25-Dihydroxyvitamin D, S (Mayo)OutsideLaboratory",,82652,CPT,Facility,Outpatient,,,90,191,162.35,54.7406,191,Medica,Medical Assistance,85.186,44.6,,percent of total billed charges,,
"1,25-Dihydroxyvitamin D, S (Mayo)OutsideLaboratory",,82652,CPT,Facility,Inpatient,,,90,191,162.35,54.7406,191,Medica,Medical Assistance,,,,,Included in per diem rate,
"1,25-Dihydroxyvitamin D, S (Mayo)OutsideLaboratory",,82652,CPT,Facility,Outpatient,,,90,191,162.35,54.7406,191,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,95.118,49.8,,percent of total billed charges,,
"1,25-Dihydroxyvitamin D, S (Mayo)OutsideLaboratory",,82652,CPT,Facility,Inpatient,,,90,191,162.35,54.7406,191,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"1,25-Dihydroxyvitamin D, S (Mayo)OutsideLaboratory",,82652,CPT,Facility,Both,,,90,191,162.35,54.7406,191,"Multiplan, Inc.","Multiplan, Inc.",179.54,94,,percent of total billed charges,,
"1,25-Dihydroxyvitamin D, S (Mayo)OutsideLaboratory",,82652,CPT,Facility,Outpatient,,,90,191,162.35,54.7406,191,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,165.024,86.4,,percent of total billed charges,,
"1,25-Dihydroxyvitamin D, S (Mayo)OutsideLaboratory",,82652,CPT,Facility,Inpatient,,,90,191,162.35,54.7406,191,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"1,25-Dihydroxyvitamin D, S (Mayo)OutsideLaboratory",,82652,CPT,Facility,Both,,,90,191,162.35,54.7406,191,"Preferred One Administrative Services, INC.",PPO,188.326,98.6,,percent of total billed charges,,
"1,25-Dihydroxyvitamin D, S (Mayo)OutsideLaboratory",,82652,CPT,Facility,Outpatient,,,90,191,162.35,54.7406,191,PrimeWest Health,Minnesota Senior Health Options (MSHO),98.2695,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"1,25-Dihydroxyvitamin D, S (Mayo)OutsideLaboratory",,82652,CPT,Facility,Inpatient,,,90,191,162.35,54.7406,191,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"1,25-Dihydroxyvitamin D, S (Mayo)OutsideLaboratory",,82652,CPT,Facility,Outpatient,,,90,191,162.35,54.7406,191,PrimeWest Health,MinnesotaCare,98.0976,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"1,25-Dihydroxyvitamin D, S (Mayo)OutsideLaboratory",,82652,CPT,Facility,Inpatient,,,90,191,162.35,54.7406,191,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"1,25-Dihydroxyvitamin D, S (Mayo)OutsideLaboratory",,82652,CPT,Facility,Both,,,90,191,162.35,54.7406,191,Sanford Health Plan,Sanford Health Plan,175.72,92,,percent of total billed charges,,
"1,25-Dihydroxyvitamin D, S (Mayo)OutsideLaboratory",,82652,CPT,Facility,Outpatient,,,90,191,162.35,54.7406,191,"UCare Health, Inc.",Individual & Family Plan,107.6285,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"1,25-Dihydroxyvitamin D, S (Mayo)OutsideLaboratory",,82652,CPT,Facility,Inpatient,,,90,191,162.35,54.7406,191,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"1,25-Dihydroxyvitamin D, S (Mayo)OutsideLaboratory",,82652,CPT,Facility,Outpatient,,,90,191,162.35,54.7406,191,"UCare Health, Inc.",Medical Assistance,96.3977,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"1,25-Dihydroxyvitamin D, S (Mayo)OutsideLaboratory",,82652,CPT,Facility,Inpatient,,,90,191,162.35,54.7406,191,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"1,25-Dihydroxyvitamin D, S (Mayo)OutsideLaboratory",,82652,CPT,Facility,Outpatient,,,90,191,162.35,54.7406,191,"UCare Health, Inc.",Medicare Advantage,96.3977,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"1,25-Dihydroxyvitamin D, S (Mayo)OutsideLaboratory",,82652,CPT,Facility,Inpatient,,,90,191,162.35,54.7406,191,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"1,25-Dihydroxyvitamin D, S (Mayo)OutsideLaboratory",,82652,CPT,Facility,Outpatient,,,90,191,162.35,54.7406,191,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),96.3977,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"1,25-Dihydroxyvitamin D, S (Mayo)OutsideLaboratory",,82652,CPT,Facility,Inpatient,,,90,191,162.35,54.7406,191,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"1,25-Dihydroxyvitamin D, S (Mayo)OutsideLaboratory",,82652,CPT,Facility,Both,,,90,191,162.35,54.7406,191,UnitedHealthcare,Individual & Family,179.54,94,,percent of total billed charges,,
"1,25-Dihydroxyvitamin D, S (Mayo)OutsideLaboratory",,82652,CPT,Facility,Outpatient,,,90,191,162.35,54.7406,191,UnitedHealthcare,Medicare Advantage,93.59,49,,percent of total billed charges,,
"1,25-Dihydroxyvitamin D, S (Mayo)OutsideLaboratory",,82652,CPT,Facility,Inpatient,,,90,191,162.35,54.7406,191,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"1,25-Dihydroxyvitamin D, S (Mayo)OutsideLaboratory",,82652,CPT,Facility,Outpatient,,,90,191,162.35,54.7406,191,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,91.68,48,,percent of total billed charges,,100% of DHS outpatient percentage
"1,25-Dihydroxyvitamin D, S (Mayo)OutsideLaboratory",,82652,CPT,Facility,Inpatient,,,90,191,162.35,54.7406,191,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Pancreatic Elastase (Mayo)OutsideLaboratory,,82653,CPT,Facility,Both,,,90,214,181.9,61.3324,214,Aetna,Commercial,196.88,92,,percent of total billed charges,,
Pancreatic Elastase (Mayo)OutsideLaboratory,,82653,CPT,Facility,Outpatient,,,90,214,181.9,61.3324,214,Aetna,Medicare Advantage,104.86,49,,percent of total billed charges,,
Pancreatic Elastase (Mayo)OutsideLaboratory,,82653,CPT,Facility,Inpatient,,,90,214,181.9,61.3324,214,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Pancreatic Elastase (Mayo)OutsideLaboratory,,82653,CPT,Facility,Both,,,90,214,181.9,61.3324,214,Aetna,PPO,199.02,93,,percent of total billed charges,,
Pancreatic Elastase (Mayo)OutsideLaboratory,,82653,CPT,Facility,Both,,,90,214,181.9,61.3324,214,America's PPO,America's PPO,205.5042,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Pancreatic Elastase (Mayo)OutsideLaboratory,,82653,CPT,Facility,Both,,,90,214,181.9,61.3324,214,BlueCross BlueShield Minnesota, Federal Employee Program,210.576,98.4,,percent of total billed charges,,
Pancreatic Elastase (Mayo)OutsideLaboratory,,82653,CPT,Facility,Both,,,90,214,181.9,61.3324,214,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,214,100,,percent of total billed charges,,
Pancreatic Elastase (Mayo)OutsideLaboratory,,82653,CPT,Facility,Both,,,90,214,181.9,61.3324,214,BlueCross BlueShield Minnesota,High Value Network Plan,192.6,90,,percent of total billed charges,,
Pancreatic Elastase (Mayo)OutsideLaboratory,,82653,CPT,Facility,Outpatient,,,90,214,181.9,61.3324,214,BlueCross BlueShield Minnesota,Medicare Advantage,104.86,49,,percent of total billed charges,,
Pancreatic Elastase (Mayo)OutsideLaboratory,,82653,CPT,Facility,Inpatient,,,90,214,181.9,61.3324,214,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Pancreatic Elastase (Mayo)OutsideLaboratory,,82653,CPT,Facility,Both,,,90,214,181.9,61.3324,214,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,189.5398,88.57,,percent of total billed charges,,
Pancreatic Elastase (Mayo)OutsideLaboratory,,82653,CPT,Facility,Both,,,90,214,181.9,61.3324,214,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,61.3324,28.66,,percent of total billed charges,,
Pancreatic Elastase (Mayo)OutsideLaboratory,,82653,CPT,Facility,Outpatient,,,90,214,181.9,61.3324,214,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),104.86,49,,percent of total billed charges,,
Pancreatic Elastase (Mayo)OutsideLaboratory,,82653,CPT,Facility,Inpatient,,,90,214,181.9,61.3324,214,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Pancreatic Elastase (Mayo)OutsideLaboratory,,82653,CPT,Facility,Both,,,90,214,181.9,61.3324,214,CorVel,Worker's Compensation,214,100,,percent of total billed charges,,
Pancreatic Elastase (Mayo)OutsideLaboratory,,82653,CPT,Facility,Both,,,90,214,181.9,61.3324,214,First Health Group Corporation,First Health Network,207.58,97,,percent of total billed charges,,
Pancreatic Elastase (Mayo)OutsideLaboratory,,82653,CPT,Facility,Both,,,90,214,181.9,61.3324,214,"Health Partners, Inc.",Commercial,202.444,94.6,,percent of total billed charges,,
Pancreatic Elastase (Mayo)OutsideLaboratory,,82653,CPT,Facility,Outpatient,,,90,214,181.9,61.3324,214,"Health Partners, Inc.",Medicare Advantage,104.86,49,,percent of total billed charges,,
Pancreatic Elastase (Mayo)OutsideLaboratory,,82653,CPT,Facility,Inpatient,,,90,214,181.9,61.3324,214,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Pancreatic Elastase (Mayo)OutsideLaboratory,,82653,CPT,Facility,Both,,,90,214,181.9,61.3324,214,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),128.4,60,,percent of total billed charges,,
Pancreatic Elastase (Mayo)OutsideLaboratory,,82653,CPT,Facility,Both,,,90,214,181.9,61.3324,214,"Health Partners, Inc.",State of Minnesota Advantage Program,174.41,81.5,,percent of total billed charges,,
Pancreatic Elastase (Mayo)OutsideLaboratory,,82653,CPT,Facility,Both,,,90,214,181.9,61.3324,214,"Health Partners, Inc.",State Public Programs,107,50,,percent of total billed charges,,
Pancreatic Elastase (Mayo)OutsideLaboratory,,82653,CPT,Facility,Both,,,90,214,181.9,61.3324,214,Humana Insurance Company,Commercial PPO,203.3,95,,percent of total billed charges,,
Pancreatic Elastase (Mayo)OutsideLaboratory,,82653,CPT,Facility,Outpatient,,,90,214,181.9,61.3324,214,Humana Insurance Company,Medicare PPO,104.86,49,,percent of total billed charges,,
Pancreatic Elastase (Mayo)OutsideLaboratory,,82653,CPT,Facility,Inpatient,,,90,214,181.9,61.3324,214,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Pancreatic Elastase (Mayo)OutsideLaboratory,,82653,CPT,Facility,Both,,,90,214,181.9,61.3324,214,Medica,Individual & Family,212.074,99.1,,percent of total billed charges,,
Pancreatic Elastase (Mayo)OutsideLaboratory,,82653,CPT,Facility,Outpatient,,,90,214,181.9,61.3324,214,Medica,Medica Advantage Solution,106.572,49.8,,percent of total billed charges,,
Pancreatic Elastase (Mayo)OutsideLaboratory,,82653,CPT,Facility,Inpatient,,,90,214,181.9,61.3324,214,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Pancreatic Elastase (Mayo)OutsideLaboratory,,82653,CPT,Facility,Outpatient,,,90,214,181.9,61.3324,214,Medica,Medical Assistance,95.444,44.6,,percent of total billed charges,,
Pancreatic Elastase (Mayo)OutsideLaboratory,,82653,CPT,Facility,Inpatient,,,90,214,181.9,61.3324,214,Medica,Medical Assistance,,,,,Included in per diem rate,
Pancreatic Elastase (Mayo)OutsideLaboratory,,82653,CPT,Facility,Outpatient,,,90,214,181.9,61.3324,214,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,106.572,49.8,,percent of total billed charges,,
Pancreatic Elastase (Mayo)OutsideLaboratory,,82653,CPT,Facility,Inpatient,,,90,214,181.9,61.3324,214,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Pancreatic Elastase (Mayo)OutsideLaboratory,,82653,CPT,Facility,Both,,,90,214,181.9,61.3324,214,"Multiplan, Inc.","Multiplan, Inc.",201.16,94,,percent of total billed charges,,
Pancreatic Elastase (Mayo)OutsideLaboratory,,82653,CPT,Facility,Outpatient,,,90,214,181.9,61.3324,214,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,184.896,86.4,,percent of total billed charges,,
Pancreatic Elastase (Mayo)OutsideLaboratory,,82653,CPT,Facility,Inpatient,,,90,214,181.9,61.3324,214,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Pancreatic Elastase (Mayo)OutsideLaboratory,,82653,CPT,Facility,Both,,,90,214,181.9,61.3324,214,"Preferred One Administrative Services, INC.",PPO,211.004,98.6,,percent of total billed charges,,
Pancreatic Elastase (Mayo)OutsideLaboratory,,82653,CPT,Facility,Outpatient,,,90,214,181.9,61.3324,214,PrimeWest Health,Minnesota Senior Health Options (MSHO),110.103,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Pancreatic Elastase (Mayo)OutsideLaboratory,,82653,CPT,Facility,Inpatient,,,90,214,181.9,61.3324,214,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Pancreatic Elastase (Mayo)OutsideLaboratory,,82653,CPT,Facility,Outpatient,,,90,214,181.9,61.3324,214,PrimeWest Health,MinnesotaCare,109.9104,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Pancreatic Elastase (Mayo)OutsideLaboratory,,82653,CPT,Facility,Inpatient,,,90,214,181.9,61.3324,214,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Pancreatic Elastase (Mayo)OutsideLaboratory,,82653,CPT,Facility,Both,,,90,214,181.9,61.3324,214,Sanford Health Plan,Sanford Health Plan,196.88,92,,percent of total billed charges,,
Pancreatic Elastase (Mayo)OutsideLaboratory,,82653,CPT,Facility,Outpatient,,,90,214,181.9,61.3324,214,"UCare Health, Inc.",Individual & Family Plan,120.589,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Pancreatic Elastase (Mayo)OutsideLaboratory,,82653,CPT,Facility,Inpatient,,,90,214,181.9,61.3324,214,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Pancreatic Elastase (Mayo)OutsideLaboratory,,82653,CPT,Facility,Outpatient,,,90,214,181.9,61.3324,214,"UCare Health, Inc.",Medical Assistance,108.0058,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Pancreatic Elastase (Mayo)OutsideLaboratory,,82653,CPT,Facility,Inpatient,,,90,214,181.9,61.3324,214,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Pancreatic Elastase (Mayo)OutsideLaboratory,,82653,CPT,Facility,Outpatient,,,90,214,181.9,61.3324,214,"UCare Health, Inc.",Medicare Advantage,108.0058,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Pancreatic Elastase (Mayo)OutsideLaboratory,,82653,CPT,Facility,Inpatient,,,90,214,181.9,61.3324,214,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Pancreatic Elastase (Mayo)OutsideLaboratory,,82653,CPT,Facility,Outpatient,,,90,214,181.9,61.3324,214,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),108.0058,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Pancreatic Elastase (Mayo)OutsideLaboratory,,82653,CPT,Facility,Inpatient,,,90,214,181.9,61.3324,214,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Pancreatic Elastase (Mayo)OutsideLaboratory,,82653,CPT,Facility,Both,,,90,214,181.9,61.3324,214,UnitedHealthcare,Individual & Family,201.16,94,,percent of total billed charges,,
Pancreatic Elastase (Mayo)OutsideLaboratory,,82653,CPT,Facility,Outpatient,,,90,214,181.9,61.3324,214,UnitedHealthcare,Medicare Advantage,104.86,49,,percent of total billed charges,,
Pancreatic Elastase (Mayo)OutsideLaboratory,,82653,CPT,Facility,Inpatient,,,90,214,181.9,61.3324,214,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Pancreatic Elastase (Mayo)OutsideLaboratory,,82653,CPT,Facility,Outpatient,,,90,214,181.9,61.3324,214,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,102.72,48,,percent of total billed charges,,100% of DHS outpatient percentage
Pancreatic Elastase (Mayo)OutsideLaboratory,,82653,CPT,Facility,Inpatient,,,90,214,181.9,61.3324,214,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Erythropoietin (Epo), S (Mayo)OutsideLaboratory",,82668,CPT,Facility,Both,,,90,191,162.35,54.7406,191,Aetna,Commercial,175.72,92,,percent of total billed charges,,
"Erythropoietin (Epo), S (Mayo)OutsideLaboratory",,82668,CPT,Facility,Outpatient,,,90,191,162.35,54.7406,191,Aetna,Medicare Advantage,93.59,49,,percent of total billed charges,,
"Erythropoietin (Epo), S (Mayo)OutsideLaboratory",,82668,CPT,Facility,Inpatient,,,90,191,162.35,54.7406,191,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Erythropoietin (Epo), S (Mayo)OutsideLaboratory",,82668,CPT,Facility,Both,,,90,191,162.35,54.7406,191,Aetna,PPO,177.63,93,,percent of total billed charges,,
"Erythropoietin (Epo), S (Mayo)OutsideLaboratory",,82668,CPT,Facility,Both,,,90,191,162.35,54.7406,191,America's PPO,America's PPO,183.4173,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Erythropoietin (Epo), S (Mayo)OutsideLaboratory",,82668,CPT,Facility,Both,,,90,191,162.35,54.7406,191,BlueCross BlueShield Minnesota, Federal Employee Program,187.944,98.4,,percent of total billed charges,,
"Erythropoietin (Epo), S (Mayo)OutsideLaboratory",,82668,CPT,Facility,Both,,,90,191,162.35,54.7406,191,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,191,100,,percent of total billed charges,,
"Erythropoietin (Epo), S (Mayo)OutsideLaboratory",,82668,CPT,Facility,Both,,,90,191,162.35,54.7406,191,BlueCross BlueShield Minnesota,High Value Network Plan,171.9,90,,percent of total billed charges,,
"Erythropoietin (Epo), S (Mayo)OutsideLaboratory",,82668,CPT,Facility,Outpatient,,,90,191,162.35,54.7406,191,BlueCross BlueShield Minnesota,Medicare Advantage,93.59,49,,percent of total billed charges,,
"Erythropoietin (Epo), S (Mayo)OutsideLaboratory",,82668,CPT,Facility,Inpatient,,,90,191,162.35,54.7406,191,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Erythropoietin (Epo), S (Mayo)OutsideLaboratory",,82668,CPT,Facility,Both,,,90,191,162.35,54.7406,191,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,169.1687,88.57,,percent of total billed charges,,
"Erythropoietin (Epo), S (Mayo)OutsideLaboratory",,82668,CPT,Facility,Both,,,90,191,162.35,54.7406,191,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,54.7406,28.66,,percent of total billed charges,,
"Erythropoietin (Epo), S (Mayo)OutsideLaboratory",,82668,CPT,Facility,Outpatient,,,90,191,162.35,54.7406,191,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),93.59,49,,percent of total billed charges,,
"Erythropoietin (Epo), S (Mayo)OutsideLaboratory",,82668,CPT,Facility,Inpatient,,,90,191,162.35,54.7406,191,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Erythropoietin (Epo), S (Mayo)OutsideLaboratory",,82668,CPT,Facility,Both,,,90,191,162.35,54.7406,191,CorVel,Worker's Compensation,191,100,,percent of total billed charges,,
"Erythropoietin (Epo), S (Mayo)OutsideLaboratory",,82668,CPT,Facility,Both,,,90,191,162.35,54.7406,191,First Health Group Corporation,First Health Network,185.27,97,,percent of total billed charges,,
"Erythropoietin (Epo), S (Mayo)OutsideLaboratory",,82668,CPT,Facility,Both,,,90,191,162.35,54.7406,191,"Health Partners, Inc.",Commercial,180.686,94.6,,percent of total billed charges,,
"Erythropoietin (Epo), S (Mayo)OutsideLaboratory",,82668,CPT,Facility,Outpatient,,,90,191,162.35,54.7406,191,"Health Partners, Inc.",Medicare Advantage,93.59,49,,percent of total billed charges,,
"Erythropoietin (Epo), S (Mayo)OutsideLaboratory",,82668,CPT,Facility,Inpatient,,,90,191,162.35,54.7406,191,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Erythropoietin (Epo), S (Mayo)OutsideLaboratory",,82668,CPT,Facility,Both,,,90,191,162.35,54.7406,191,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),114.6,60,,percent of total billed charges,,
"Erythropoietin (Epo), S (Mayo)OutsideLaboratory",,82668,CPT,Facility,Both,,,90,191,162.35,54.7406,191,"Health Partners, Inc.",State of Minnesota Advantage Program,155.665,81.5,,percent of total billed charges,,
"Erythropoietin (Epo), S (Mayo)OutsideLaboratory",,82668,CPT,Facility,Both,,,90,191,162.35,54.7406,191,"Health Partners, Inc.",State Public Programs,95.5,50,,percent of total billed charges,,
"Erythropoietin (Epo), S (Mayo)OutsideLaboratory",,82668,CPT,Facility,Both,,,90,191,162.35,54.7406,191,Humana Insurance Company,Commercial PPO,181.45,95,,percent of total billed charges,,
"Erythropoietin (Epo), S (Mayo)OutsideLaboratory",,82668,CPT,Facility,Outpatient,,,90,191,162.35,54.7406,191,Humana Insurance Company,Medicare PPO,93.59,49,,percent of total billed charges,,
"Erythropoietin (Epo), S (Mayo)OutsideLaboratory",,82668,CPT,Facility,Inpatient,,,90,191,162.35,54.7406,191,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Erythropoietin (Epo), S (Mayo)OutsideLaboratory",,82668,CPT,Facility,Both,,,90,191,162.35,54.7406,191,Medica,Individual & Family,189.281,99.1,,percent of total billed charges,,
"Erythropoietin (Epo), S (Mayo)OutsideLaboratory",,82668,CPT,Facility,Outpatient,,,90,191,162.35,54.7406,191,Medica,Medica Advantage Solution,95.118,49.8,,percent of total billed charges,,
"Erythropoietin (Epo), S (Mayo)OutsideLaboratory",,82668,CPT,Facility,Inpatient,,,90,191,162.35,54.7406,191,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Erythropoietin (Epo), S (Mayo)OutsideLaboratory",,82668,CPT,Facility,Outpatient,,,90,191,162.35,54.7406,191,Medica,Medical Assistance,85.186,44.6,,percent of total billed charges,,
"Erythropoietin (Epo), S (Mayo)OutsideLaboratory",,82668,CPT,Facility,Inpatient,,,90,191,162.35,54.7406,191,Medica,Medical Assistance,,,,,Included in per diem rate,
"Erythropoietin (Epo), S (Mayo)OutsideLaboratory",,82668,CPT,Facility,Outpatient,,,90,191,162.35,54.7406,191,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,95.118,49.8,,percent of total billed charges,,
"Erythropoietin (Epo), S (Mayo)OutsideLaboratory",,82668,CPT,Facility,Inpatient,,,90,191,162.35,54.7406,191,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Erythropoietin (Epo), S (Mayo)OutsideLaboratory",,82668,CPT,Facility,Both,,,90,191,162.35,54.7406,191,"Multiplan, Inc.","Multiplan, Inc.",179.54,94,,percent of total billed charges,,
"Erythropoietin (Epo), S (Mayo)OutsideLaboratory",,82668,CPT,Facility,Outpatient,,,90,191,162.35,54.7406,191,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,165.024,86.4,,percent of total billed charges,,
"Erythropoietin (Epo), S (Mayo)OutsideLaboratory",,82668,CPT,Facility,Inpatient,,,90,191,162.35,54.7406,191,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Erythropoietin (Epo), S (Mayo)OutsideLaboratory",,82668,CPT,Facility,Both,,,90,191,162.35,54.7406,191,"Preferred One Administrative Services, INC.",PPO,188.326,98.6,,percent of total billed charges,,
"Erythropoietin (Epo), S (Mayo)OutsideLaboratory",,82668,CPT,Facility,Outpatient,,,90,191,162.35,54.7406,191,PrimeWest Health,Minnesota Senior Health Options (MSHO),98.2695,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Erythropoietin (Epo), S (Mayo)OutsideLaboratory",,82668,CPT,Facility,Inpatient,,,90,191,162.35,54.7406,191,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Erythropoietin (Epo), S (Mayo)OutsideLaboratory",,82668,CPT,Facility,Outpatient,,,90,191,162.35,54.7406,191,PrimeWest Health,MinnesotaCare,98.0976,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Erythropoietin (Epo), S (Mayo)OutsideLaboratory",,82668,CPT,Facility,Inpatient,,,90,191,162.35,54.7406,191,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Erythropoietin (Epo), S (Mayo)OutsideLaboratory",,82668,CPT,Facility,Both,,,90,191,162.35,54.7406,191,Sanford Health Plan,Sanford Health Plan,175.72,92,,percent of total billed charges,,
"Erythropoietin (Epo), S (Mayo)OutsideLaboratory",,82668,CPT,Facility,Outpatient,,,90,191,162.35,54.7406,191,"UCare Health, Inc.",Individual & Family Plan,107.6285,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Erythropoietin (Epo), S (Mayo)OutsideLaboratory",,82668,CPT,Facility,Inpatient,,,90,191,162.35,54.7406,191,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Erythropoietin (Epo), S (Mayo)OutsideLaboratory",,82668,CPT,Facility,Outpatient,,,90,191,162.35,54.7406,191,"UCare Health, Inc.",Medical Assistance,96.3977,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Erythropoietin (Epo), S (Mayo)OutsideLaboratory",,82668,CPT,Facility,Inpatient,,,90,191,162.35,54.7406,191,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Erythropoietin (Epo), S (Mayo)OutsideLaboratory",,82668,CPT,Facility,Outpatient,,,90,191,162.35,54.7406,191,"UCare Health, Inc.",Medicare Advantage,96.3977,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Erythropoietin (Epo), S (Mayo)OutsideLaboratory",,82668,CPT,Facility,Inpatient,,,90,191,162.35,54.7406,191,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Erythropoietin (Epo), S (Mayo)OutsideLaboratory",,82668,CPT,Facility,Outpatient,,,90,191,162.35,54.7406,191,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),96.3977,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Erythropoietin (Epo), S (Mayo)OutsideLaboratory",,82668,CPT,Facility,Inpatient,,,90,191,162.35,54.7406,191,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Erythropoietin (Epo), S (Mayo)OutsideLaboratory",,82668,CPT,Facility,Both,,,90,191,162.35,54.7406,191,UnitedHealthcare,Individual & Family,179.54,94,,percent of total billed charges,,
"Erythropoietin (Epo), S (Mayo)OutsideLaboratory",,82668,CPT,Facility,Outpatient,,,90,191,162.35,54.7406,191,UnitedHealthcare,Medicare Advantage,93.59,49,,percent of total billed charges,,
"Erythropoietin (Epo), S (Mayo)OutsideLaboratory",,82668,CPT,Facility,Inpatient,,,90,191,162.35,54.7406,191,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Erythropoietin (Epo), S (Mayo)OutsideLaboratory",,82668,CPT,Facility,Outpatient,,,90,191,162.35,54.7406,191,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,91.68,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Erythropoietin (Epo), S (Mayo)OutsideLaboratory",,82668,CPT,Facility,Inpatient,,,90,191,162.35,54.7406,191,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Estradiol; Total, Mass Spectrometry, S (Mayo)OutsideLaboratory",,82670,CPT,Facility,Both,,,90,162,137.7,46.4292,162,Aetna,Commercial,149.04,92,,percent of total billed charges,,
"Estradiol; Total, Mass Spectrometry, S (Mayo)OutsideLaboratory",,82670,CPT,Facility,Outpatient,,,90,162,137.7,46.4292,162,Aetna,Medicare Advantage,79.38,49,,percent of total billed charges,,
"Estradiol; Total, Mass Spectrometry, S (Mayo)OutsideLaboratory",,82670,CPT,Facility,Inpatient,,,90,162,137.7,46.4292,162,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Estradiol; Total, Mass Spectrometry, S (Mayo)OutsideLaboratory",,82670,CPT,Facility,Both,,,90,162,137.7,46.4292,162,Aetna,PPO,150.66,93,,percent of total billed charges,,
"Estradiol; Total, Mass Spectrometry, S (Mayo)OutsideLaboratory",,82670,CPT,Facility,Both,,,90,162,137.7,46.4292,162,America's PPO,America's PPO,155.5686,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Estradiol; Total, Mass Spectrometry, S (Mayo)OutsideLaboratory",,82670,CPT,Facility,Both,,,90,162,137.7,46.4292,162,BlueCross BlueShield Minnesota, Federal Employee Program,159.408,98.4,,percent of total billed charges,,
"Estradiol; Total, Mass Spectrometry, S (Mayo)OutsideLaboratory",,82670,CPT,Facility,Both,,,90,162,137.7,46.4292,162,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,162,100,,percent of total billed charges,,
"Estradiol; Total, Mass Spectrometry, S (Mayo)OutsideLaboratory",,82670,CPT,Facility,Both,,,90,162,137.7,46.4292,162,BlueCross BlueShield Minnesota,High Value Network Plan,145.8,90,,percent of total billed charges,,
"Estradiol; Total, Mass Spectrometry, S (Mayo)OutsideLaboratory",,82670,CPT,Facility,Outpatient,,,90,162,137.7,46.4292,162,BlueCross BlueShield Minnesota,Medicare Advantage,79.38,49,,percent of total billed charges,,
"Estradiol; Total, Mass Spectrometry, S (Mayo)OutsideLaboratory",,82670,CPT,Facility,Inpatient,,,90,162,137.7,46.4292,162,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Estradiol; Total, Mass Spectrometry, S (Mayo)OutsideLaboratory",,82670,CPT,Facility,Both,,,90,162,137.7,46.4292,162,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,143.4834,88.57,,percent of total billed charges,,
"Estradiol; Total, Mass Spectrometry, S (Mayo)OutsideLaboratory",,82670,CPT,Facility,Both,,,90,162,137.7,46.4292,162,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,46.4292,28.66,,percent of total billed charges,,
"Estradiol; Total, Mass Spectrometry, S (Mayo)OutsideLaboratory",,82670,CPT,Facility,Outpatient,,,90,162,137.7,46.4292,162,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),79.38,49,,percent of total billed charges,,
"Estradiol; Total, Mass Spectrometry, S (Mayo)OutsideLaboratory",,82670,CPT,Facility,Inpatient,,,90,162,137.7,46.4292,162,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Estradiol; Total, Mass Spectrometry, S (Mayo)OutsideLaboratory",,82670,CPT,Facility,Both,,,90,162,137.7,46.4292,162,CorVel,Worker's Compensation,162,100,,percent of total billed charges,,
"Estradiol; Total, Mass Spectrometry, S (Mayo)OutsideLaboratory",,82670,CPT,Facility,Both,,,90,162,137.7,46.4292,162,First Health Group Corporation,First Health Network,157.14,97,,percent of total billed charges,,
"Estradiol; Total, Mass Spectrometry, S (Mayo)OutsideLaboratory",,82670,CPT,Facility,Both,,,90,162,137.7,46.4292,162,"Health Partners, Inc.",Commercial,153.252,94.6,,percent of total billed charges,,
"Estradiol; Total, Mass Spectrometry, S (Mayo)OutsideLaboratory",,82670,CPT,Facility,Outpatient,,,90,162,137.7,46.4292,162,"Health Partners, Inc.",Medicare Advantage,79.38,49,,percent of total billed charges,,
"Estradiol; Total, Mass Spectrometry, S (Mayo)OutsideLaboratory",,82670,CPT,Facility,Inpatient,,,90,162,137.7,46.4292,162,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Estradiol; Total, Mass Spectrometry, S (Mayo)OutsideLaboratory",,82670,CPT,Facility,Both,,,90,162,137.7,46.4292,162,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),97.2,60,,percent of total billed charges,,
"Estradiol; Total, Mass Spectrometry, S (Mayo)OutsideLaboratory",,82670,CPT,Facility,Both,,,90,162,137.7,46.4292,162,"Health Partners, Inc.",State of Minnesota Advantage Program,132.03,81.5,,percent of total billed charges,,
"Estradiol; Total, Mass Spectrometry, S (Mayo)OutsideLaboratory",,82670,CPT,Facility,Both,,,90,162,137.7,46.4292,162,"Health Partners, Inc.",State Public Programs,81,50,,percent of total billed charges,,
"Estradiol; Total, Mass Spectrometry, S (Mayo)OutsideLaboratory",,82670,CPT,Facility,Both,,,90,162,137.7,46.4292,162,Humana Insurance Company,Commercial PPO,153.9,95,,percent of total billed charges,,
"Estradiol; Total, Mass Spectrometry, S (Mayo)OutsideLaboratory",,82670,CPT,Facility,Outpatient,,,90,162,137.7,46.4292,162,Humana Insurance Company,Medicare PPO,79.38,49,,percent of total billed charges,,
"Estradiol; Total, Mass Spectrometry, S (Mayo)OutsideLaboratory",,82670,CPT,Facility,Inpatient,,,90,162,137.7,46.4292,162,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Estradiol; Total, Mass Spectrometry, S (Mayo)OutsideLaboratory",,82670,CPT,Facility,Both,,,90,162,137.7,46.4292,162,Medica,Individual & Family,160.542,99.1,,percent of total billed charges,,
"Estradiol; Total, Mass Spectrometry, S (Mayo)OutsideLaboratory",,82670,CPT,Facility,Outpatient,,,90,162,137.7,46.4292,162,Medica,Medica Advantage Solution,80.676,49.8,,percent of total billed charges,,
"Estradiol; Total, Mass Spectrometry, S (Mayo)OutsideLaboratory",,82670,CPT,Facility,Inpatient,,,90,162,137.7,46.4292,162,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Estradiol; Total, Mass Spectrometry, S (Mayo)OutsideLaboratory",,82670,CPT,Facility,Outpatient,,,90,162,137.7,46.4292,162,Medica,Medical Assistance,72.252,44.6,,percent of total billed charges,,
"Estradiol; Total, Mass Spectrometry, S (Mayo)OutsideLaboratory",,82670,CPT,Facility,Inpatient,,,90,162,137.7,46.4292,162,Medica,Medical Assistance,,,,,Included in per diem rate,
"Estradiol; Total, Mass Spectrometry, S (Mayo)OutsideLaboratory",,82670,CPT,Facility,Outpatient,,,90,162,137.7,46.4292,162,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,80.676,49.8,,percent of total billed charges,,
"Estradiol; Total, Mass Spectrometry, S (Mayo)OutsideLaboratory",,82670,CPT,Facility,Inpatient,,,90,162,137.7,46.4292,162,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Estradiol; Total, Mass Spectrometry, S (Mayo)OutsideLaboratory",,82670,CPT,Facility,Both,,,90,162,137.7,46.4292,162,"Multiplan, Inc.","Multiplan, Inc.",152.28,94,,percent of total billed charges,,
"Estradiol; Total, Mass Spectrometry, S (Mayo)OutsideLaboratory",,82670,CPT,Facility,Outpatient,,,90,162,137.7,46.4292,162,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,139.968,86.4,,percent of total billed charges,,
"Estradiol; Total, Mass Spectrometry, S (Mayo)OutsideLaboratory",,82670,CPT,Facility,Inpatient,,,90,162,137.7,46.4292,162,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Estradiol; Total, Mass Spectrometry, S (Mayo)OutsideLaboratory",,82670,CPT,Facility,Both,,,90,162,137.7,46.4292,162,"Preferred One Administrative Services, INC.",PPO,159.732,98.6,,percent of total billed charges,,
"Estradiol; Total, Mass Spectrometry, S (Mayo)OutsideLaboratory",,82670,CPT,Facility,Outpatient,,,90,162,137.7,46.4292,162,PrimeWest Health,Minnesota Senior Health Options (MSHO),83.349,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Estradiol; Total, Mass Spectrometry, S (Mayo)OutsideLaboratory",,82670,CPT,Facility,Inpatient,,,90,162,137.7,46.4292,162,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Estradiol; Total, Mass Spectrometry, S (Mayo)OutsideLaboratory",,82670,CPT,Facility,Outpatient,,,90,162,137.7,46.4292,162,PrimeWest Health,MinnesotaCare,83.2032,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Estradiol; Total, Mass Spectrometry, S (Mayo)OutsideLaboratory",,82670,CPT,Facility,Inpatient,,,90,162,137.7,46.4292,162,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Estradiol; Total, Mass Spectrometry, S (Mayo)OutsideLaboratory",,82670,CPT,Facility,Both,,,90,162,137.7,46.4292,162,Sanford Health Plan,Sanford Health Plan,149.04,92,,percent of total billed charges,,
"Estradiol; Total, Mass Spectrometry, S (Mayo)OutsideLaboratory",,82670,CPT,Facility,Outpatient,,,90,162,137.7,46.4292,162,"UCare Health, Inc.",Individual & Family Plan,91.287,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Estradiol; Total, Mass Spectrometry, S (Mayo)OutsideLaboratory",,82670,CPT,Facility,Inpatient,,,90,162,137.7,46.4292,162,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Estradiol; Total, Mass Spectrometry, S (Mayo)OutsideLaboratory",,82670,CPT,Facility,Outpatient,,,90,162,137.7,46.4292,162,"UCare Health, Inc.",Medical Assistance,81.7614,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Estradiol; Total, Mass Spectrometry, S (Mayo)OutsideLaboratory",,82670,CPT,Facility,Inpatient,,,90,162,137.7,46.4292,162,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Estradiol; Total, Mass Spectrometry, S (Mayo)OutsideLaboratory",,82670,CPT,Facility,Outpatient,,,90,162,137.7,46.4292,162,"UCare Health, Inc.",Medicare Advantage,81.7614,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Estradiol; Total, Mass Spectrometry, S (Mayo)OutsideLaboratory",,82670,CPT,Facility,Inpatient,,,90,162,137.7,46.4292,162,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Estradiol; Total, Mass Spectrometry, S (Mayo)OutsideLaboratory",,82670,CPT,Facility,Outpatient,,,90,162,137.7,46.4292,162,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),81.7614,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Estradiol; Total, Mass Spectrometry, S (Mayo)OutsideLaboratory",,82670,CPT,Facility,Inpatient,,,90,162,137.7,46.4292,162,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Estradiol; Total, Mass Spectrometry, S (Mayo)OutsideLaboratory",,82670,CPT,Facility,Both,,,90,162,137.7,46.4292,162,UnitedHealthcare,Individual & Family,152.28,94,,percent of total billed charges,,
"Estradiol; Total, Mass Spectrometry, S (Mayo)OutsideLaboratory",,82670,CPT,Facility,Outpatient,,,90,162,137.7,46.4292,162,UnitedHealthcare,Medicare Advantage,79.38,49,,percent of total billed charges,,
"Estradiol; Total, Mass Spectrometry, S (Mayo)OutsideLaboratory",,82670,CPT,Facility,Inpatient,,,90,162,137.7,46.4292,162,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Estradiol; Total, Mass Spectrometry, S (Mayo)OutsideLaboratory",,82670,CPT,Facility,Outpatient,,,90,162,137.7,46.4292,162,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,77.76,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Estradiol; Total, Mass Spectrometry, S (Mayo)OutsideLaboratory",,82670,CPT,Facility,Inpatient,,,90,162,137.7,46.4292,162,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Estrogens, E1+E2, Fractionated, S (Mayo)OutsideLaboratory",,82671,CPT,Facility,Both,,,90,82,69.7,23.5012,82,Aetna,Commercial,75.44,92,,percent of total billed charges,,
"Estrogens, E1+E2, Fractionated, S (Mayo)OutsideLaboratory",,82671,CPT,Facility,Outpatient,,,90,82,69.7,23.5012,82,Aetna,Medicare Advantage,40.18,49,,percent of total billed charges,,
"Estrogens, E1+E2, Fractionated, S (Mayo)OutsideLaboratory",,82671,CPT,Facility,Inpatient,,,90,82,69.7,23.5012,82,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Estrogens, E1+E2, Fractionated, S (Mayo)OutsideLaboratory",,82671,CPT,Facility,Both,,,90,82,69.7,23.5012,82,Aetna,PPO,76.26,93,,percent of total billed charges,,
"Estrogens, E1+E2, Fractionated, S (Mayo)OutsideLaboratory",,82671,CPT,Facility,Both,,,90,82,69.7,23.5012,82,America's PPO,America's PPO,78.7446,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Estrogens, E1+E2, Fractionated, S (Mayo)OutsideLaboratory",,82671,CPT,Facility,Both,,,90,82,69.7,23.5012,82,BlueCross BlueShield Minnesota, Federal Employee Program,80.688,98.4,,percent of total billed charges,,
"Estrogens, E1+E2, Fractionated, S (Mayo)OutsideLaboratory",,82671,CPT,Facility,Both,,,90,82,69.7,23.5012,82,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,82,100,,percent of total billed charges,,
"Estrogens, E1+E2, Fractionated, S (Mayo)OutsideLaboratory",,82671,CPT,Facility,Both,,,90,82,69.7,23.5012,82,BlueCross BlueShield Minnesota,High Value Network Plan,73.8,90,,percent of total billed charges,,
"Estrogens, E1+E2, Fractionated, S (Mayo)OutsideLaboratory",,82671,CPT,Facility,Outpatient,,,90,82,69.7,23.5012,82,BlueCross BlueShield Minnesota,Medicare Advantage,40.18,49,,percent of total billed charges,,
"Estrogens, E1+E2, Fractionated, S (Mayo)OutsideLaboratory",,82671,CPT,Facility,Inpatient,,,90,82,69.7,23.5012,82,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Estrogens, E1+E2, Fractionated, S (Mayo)OutsideLaboratory",,82671,CPT,Facility,Both,,,90,82,69.7,23.5012,82,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,72.6274,88.57,,percent of total billed charges,,
"Estrogens, E1+E2, Fractionated, S (Mayo)OutsideLaboratory",,82671,CPT,Facility,Both,,,90,82,69.7,23.5012,82,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,23.5012,28.66,,percent of total billed charges,,
"Estrogens, E1+E2, Fractionated, S (Mayo)OutsideLaboratory",,82671,CPT,Facility,Outpatient,,,90,82,69.7,23.5012,82,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),40.18,49,,percent of total billed charges,,
"Estrogens, E1+E2, Fractionated, S (Mayo)OutsideLaboratory",,82671,CPT,Facility,Inpatient,,,90,82,69.7,23.5012,82,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Estrogens, E1+E2, Fractionated, S (Mayo)OutsideLaboratory",,82671,CPT,Facility,Both,,,90,82,69.7,23.5012,82,CorVel,Worker's Compensation,82,100,,percent of total billed charges,,
"Estrogens, E1+E2, Fractionated, S (Mayo)OutsideLaboratory",,82671,CPT,Facility,Both,,,90,82,69.7,23.5012,82,First Health Group Corporation,First Health Network,79.54,97,,percent of total billed charges,,
"Estrogens, E1+E2, Fractionated, S (Mayo)OutsideLaboratory",,82671,CPT,Facility,Both,,,90,82,69.7,23.5012,82,"Health Partners, Inc.",Commercial,77.572,94.6,,percent of total billed charges,,
"Estrogens, E1+E2, Fractionated, S (Mayo)OutsideLaboratory",,82671,CPT,Facility,Outpatient,,,90,82,69.7,23.5012,82,"Health Partners, Inc.",Medicare Advantage,40.18,49,,percent of total billed charges,,
"Estrogens, E1+E2, Fractionated, S (Mayo)OutsideLaboratory",,82671,CPT,Facility,Inpatient,,,90,82,69.7,23.5012,82,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Estrogens, E1+E2, Fractionated, S (Mayo)OutsideLaboratory",,82671,CPT,Facility,Both,,,90,82,69.7,23.5012,82,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),49.2,60,,percent of total billed charges,,
"Estrogens, E1+E2, Fractionated, S (Mayo)OutsideLaboratory",,82671,CPT,Facility,Both,,,90,82,69.7,23.5012,82,"Health Partners, Inc.",State of Minnesota Advantage Program,66.83,81.5,,percent of total billed charges,,
"Estrogens, E1+E2, Fractionated, S (Mayo)OutsideLaboratory",,82671,CPT,Facility,Both,,,90,82,69.7,23.5012,82,"Health Partners, Inc.",State Public Programs,41,50,,percent of total billed charges,,
"Estrogens, E1+E2, Fractionated, S (Mayo)OutsideLaboratory",,82671,CPT,Facility,Both,,,90,82,69.7,23.5012,82,Humana Insurance Company,Commercial PPO,77.9,95,,percent of total billed charges,,
"Estrogens, E1+E2, Fractionated, S (Mayo)OutsideLaboratory",,82671,CPT,Facility,Outpatient,,,90,82,69.7,23.5012,82,Humana Insurance Company,Medicare PPO,40.18,49,,percent of total billed charges,,
"Estrogens, E1+E2, Fractionated, S (Mayo)OutsideLaboratory",,82671,CPT,Facility,Inpatient,,,90,82,69.7,23.5012,82,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Estrogens, E1+E2, Fractionated, S (Mayo)OutsideLaboratory",,82671,CPT,Facility,Both,,,90,82,69.7,23.5012,82,Medica,Individual & Family,81.262,99.1,,percent of total billed charges,,
"Estrogens, E1+E2, Fractionated, S (Mayo)OutsideLaboratory",,82671,CPT,Facility,Outpatient,,,90,82,69.7,23.5012,82,Medica,Medica Advantage Solution,40.836,49.8,,percent of total billed charges,,
"Estrogens, E1+E2, Fractionated, S (Mayo)OutsideLaboratory",,82671,CPT,Facility,Inpatient,,,90,82,69.7,23.5012,82,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Estrogens, E1+E2, Fractionated, S (Mayo)OutsideLaboratory",,82671,CPT,Facility,Outpatient,,,90,82,69.7,23.5012,82,Medica,Medical Assistance,36.572,44.6,,percent of total billed charges,,
"Estrogens, E1+E2, Fractionated, S (Mayo)OutsideLaboratory",,82671,CPT,Facility,Inpatient,,,90,82,69.7,23.5012,82,Medica,Medical Assistance,,,,,Included in per diem rate,
"Estrogens, E1+E2, Fractionated, S (Mayo)OutsideLaboratory",,82671,CPT,Facility,Outpatient,,,90,82,69.7,23.5012,82,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,40.836,49.8,,percent of total billed charges,,
"Estrogens, E1+E2, Fractionated, S (Mayo)OutsideLaboratory",,82671,CPT,Facility,Inpatient,,,90,82,69.7,23.5012,82,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Estrogens, E1+E2, Fractionated, S (Mayo)OutsideLaboratory",,82671,CPT,Facility,Both,,,90,82,69.7,23.5012,82,"Multiplan, Inc.","Multiplan, Inc.",77.08,94,,percent of total billed charges,,
"Estrogens, E1+E2, Fractionated, S (Mayo)OutsideLaboratory",,82671,CPT,Facility,Outpatient,,,90,82,69.7,23.5012,82,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,70.848,86.4,,percent of total billed charges,,
"Estrogens, E1+E2, Fractionated, S (Mayo)OutsideLaboratory",,82671,CPT,Facility,Inpatient,,,90,82,69.7,23.5012,82,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Estrogens, E1+E2, Fractionated, S (Mayo)OutsideLaboratory",,82671,CPT,Facility,Both,,,90,82,69.7,23.5012,82,"Preferred One Administrative Services, INC.",PPO,80.852,98.6,,percent of total billed charges,,
"Estrogens, E1+E2, Fractionated, S (Mayo)OutsideLaboratory",,82671,CPT,Facility,Outpatient,,,90,82,69.7,23.5012,82,PrimeWest Health,Minnesota Senior Health Options (MSHO),42.189,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Estrogens, E1+E2, Fractionated, S (Mayo)OutsideLaboratory",,82671,CPT,Facility,Inpatient,,,90,82,69.7,23.5012,82,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Estrogens, E1+E2, Fractionated, S (Mayo)OutsideLaboratory",,82671,CPT,Facility,Outpatient,,,90,82,69.7,23.5012,82,PrimeWest Health,MinnesotaCare,42.1152,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Estrogens, E1+E2, Fractionated, S (Mayo)OutsideLaboratory",,82671,CPT,Facility,Inpatient,,,90,82,69.7,23.5012,82,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Estrogens, E1+E2, Fractionated, S (Mayo)OutsideLaboratory",,82671,CPT,Facility,Both,,,90,82,69.7,23.5012,82,Sanford Health Plan,Sanford Health Plan,75.44,92,,percent of total billed charges,,
"Estrogens, E1+E2, Fractionated, S (Mayo)OutsideLaboratory",,82671,CPT,Facility,Outpatient,,,90,82,69.7,23.5012,82,"UCare Health, Inc.",Individual & Family Plan,46.207,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Estrogens, E1+E2, Fractionated, S (Mayo)OutsideLaboratory",,82671,CPT,Facility,Inpatient,,,90,82,69.7,23.5012,82,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Estrogens, E1+E2, Fractionated, S (Mayo)OutsideLaboratory",,82671,CPT,Facility,Outpatient,,,90,82,69.7,23.5012,82,"UCare Health, Inc.",Medical Assistance,41.3854,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Estrogens, E1+E2, Fractionated, S (Mayo)OutsideLaboratory",,82671,CPT,Facility,Inpatient,,,90,82,69.7,23.5012,82,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Estrogens, E1+E2, Fractionated, S (Mayo)OutsideLaboratory",,82671,CPT,Facility,Outpatient,,,90,82,69.7,23.5012,82,"UCare Health, Inc.",Medicare Advantage,41.3854,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Estrogens, E1+E2, Fractionated, S (Mayo)OutsideLaboratory",,82671,CPT,Facility,Inpatient,,,90,82,69.7,23.5012,82,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Estrogens, E1+E2, Fractionated, S (Mayo)OutsideLaboratory",,82671,CPT,Facility,Outpatient,,,90,82,69.7,23.5012,82,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),41.3854,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Estrogens, E1+E2, Fractionated, S (Mayo)OutsideLaboratory",,82671,CPT,Facility,Inpatient,,,90,82,69.7,23.5012,82,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Estrogens, E1+E2, Fractionated, S (Mayo)OutsideLaboratory",,82671,CPT,Facility,Both,,,90,82,69.7,23.5012,82,UnitedHealthcare,Individual & Family,77.08,94,,percent of total billed charges,,
"Estrogens, E1+E2, Fractionated, S (Mayo)OutsideLaboratory",,82671,CPT,Facility,Outpatient,,,90,82,69.7,23.5012,82,UnitedHealthcare,Medicare Advantage,40.18,49,,percent of total billed charges,,
"Estrogens, E1+E2, Fractionated, S (Mayo)OutsideLaboratory",,82671,CPT,Facility,Inpatient,,,90,82,69.7,23.5012,82,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Estrogens, E1+E2, Fractionated, S (Mayo)OutsideLaboratory",,82671,CPT,Facility,Outpatient,,,90,82,69.7,23.5012,82,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,39.36,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Estrogens, E1+E2, Fractionated, S (Mayo)OutsideLaboratory",,82671,CPT,Facility,Inpatient,,,90,82,69.7,23.5012,82,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Fat, F (Mayo)OutsideLaboratory",,82710,CPT,Facility,Both,,,90,131,111.35,37.5446,131,Aetna,Commercial,120.52,92,,percent of total billed charges,,
"Fat, F (Mayo)OutsideLaboratory",,82710,CPT,Facility,Outpatient,,,90,131,111.35,37.5446,131,Aetna,Medicare Advantage,64.19,49,,percent of total billed charges,,
"Fat, F (Mayo)OutsideLaboratory",,82710,CPT,Facility,Inpatient,,,90,131,111.35,37.5446,131,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Fat, F (Mayo)OutsideLaboratory",,82710,CPT,Facility,Both,,,90,131,111.35,37.5446,131,Aetna,PPO,121.83,93,,percent of total billed charges,,
"Fat, F (Mayo)OutsideLaboratory",,82710,CPT,Facility,Both,,,90,131,111.35,37.5446,131,America's PPO,America's PPO,125.7993,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Fat, F (Mayo)OutsideLaboratory",,82710,CPT,Facility,Both,,,90,131,111.35,37.5446,131,BlueCross BlueShield Minnesota, Federal Employee Program,128.904,98.4,,percent of total billed charges,,
"Fat, F (Mayo)OutsideLaboratory",,82710,CPT,Facility,Both,,,90,131,111.35,37.5446,131,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,131,100,,percent of total billed charges,,
"Fat, F (Mayo)OutsideLaboratory",,82710,CPT,Facility,Both,,,90,131,111.35,37.5446,131,BlueCross BlueShield Minnesota,High Value Network Plan,117.9,90,,percent of total billed charges,,
"Fat, F (Mayo)OutsideLaboratory",,82710,CPT,Facility,Outpatient,,,90,131,111.35,37.5446,131,BlueCross BlueShield Minnesota,Medicare Advantage,64.19,49,,percent of total billed charges,,
"Fat, F (Mayo)OutsideLaboratory",,82710,CPT,Facility,Inpatient,,,90,131,111.35,37.5446,131,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Fat, F (Mayo)OutsideLaboratory",,82710,CPT,Facility,Both,,,90,131,111.35,37.5446,131,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,116.0267,88.57,,percent of total billed charges,,
"Fat, F (Mayo)OutsideLaboratory",,82710,CPT,Facility,Both,,,90,131,111.35,37.5446,131,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,37.5446,28.66,,percent of total billed charges,,
"Fat, F (Mayo)OutsideLaboratory",,82710,CPT,Facility,Outpatient,,,90,131,111.35,37.5446,131,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),64.19,49,,percent of total billed charges,,
"Fat, F (Mayo)OutsideLaboratory",,82710,CPT,Facility,Inpatient,,,90,131,111.35,37.5446,131,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Fat, F (Mayo)OutsideLaboratory",,82710,CPT,Facility,Both,,,90,131,111.35,37.5446,131,CorVel,Worker's Compensation,131,100,,percent of total billed charges,,
"Fat, F (Mayo)OutsideLaboratory",,82710,CPT,Facility,Both,,,90,131,111.35,37.5446,131,First Health Group Corporation,First Health Network,127.07,97,,percent of total billed charges,,
"Fat, F (Mayo)OutsideLaboratory",,82710,CPT,Facility,Both,,,90,131,111.35,37.5446,131,"Health Partners, Inc.",Commercial,123.926,94.6,,percent of total billed charges,,
"Fat, F (Mayo)OutsideLaboratory",,82710,CPT,Facility,Outpatient,,,90,131,111.35,37.5446,131,"Health Partners, Inc.",Medicare Advantage,64.19,49,,percent of total billed charges,,
"Fat, F (Mayo)OutsideLaboratory",,82710,CPT,Facility,Inpatient,,,90,131,111.35,37.5446,131,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Fat, F (Mayo)OutsideLaboratory",,82710,CPT,Facility,Both,,,90,131,111.35,37.5446,131,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),78.6,60,,percent of total billed charges,,
"Fat, F (Mayo)OutsideLaboratory",,82710,CPT,Facility,Both,,,90,131,111.35,37.5446,131,"Health Partners, Inc.",State of Minnesota Advantage Program,106.765,81.5,,percent of total billed charges,,
"Fat, F (Mayo)OutsideLaboratory",,82710,CPT,Facility,Both,,,90,131,111.35,37.5446,131,"Health Partners, Inc.",State Public Programs,65.5,50,,percent of total billed charges,,
"Fat, F (Mayo)OutsideLaboratory",,82710,CPT,Facility,Both,,,90,131,111.35,37.5446,131,Humana Insurance Company,Commercial PPO,124.45,95,,percent of total billed charges,,
"Fat, F (Mayo)OutsideLaboratory",,82710,CPT,Facility,Outpatient,,,90,131,111.35,37.5446,131,Humana Insurance Company,Medicare PPO,64.19,49,,percent of total billed charges,,
"Fat, F (Mayo)OutsideLaboratory",,82710,CPT,Facility,Inpatient,,,90,131,111.35,37.5446,131,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Fat, F (Mayo)OutsideLaboratory",,82710,CPT,Facility,Both,,,90,131,111.35,37.5446,131,Medica,Individual & Family,129.821,99.1,,percent of total billed charges,,
"Fat, F (Mayo)OutsideLaboratory",,82710,CPT,Facility,Outpatient,,,90,131,111.35,37.5446,131,Medica,Medica Advantage Solution,65.238,49.8,,percent of total billed charges,,
"Fat, F (Mayo)OutsideLaboratory",,82710,CPT,Facility,Inpatient,,,90,131,111.35,37.5446,131,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Fat, F (Mayo)OutsideLaboratory",,82710,CPT,Facility,Outpatient,,,90,131,111.35,37.5446,131,Medica,Medical Assistance,58.426,44.6,,percent of total billed charges,,
"Fat, F (Mayo)OutsideLaboratory",,82710,CPT,Facility,Inpatient,,,90,131,111.35,37.5446,131,Medica,Medical Assistance,,,,,Included in per diem rate,
"Fat, F (Mayo)OutsideLaboratory",,82710,CPT,Facility,Outpatient,,,90,131,111.35,37.5446,131,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,65.238,49.8,,percent of total billed charges,,
"Fat, F (Mayo)OutsideLaboratory",,82710,CPT,Facility,Inpatient,,,90,131,111.35,37.5446,131,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Fat, F (Mayo)OutsideLaboratory",,82710,CPT,Facility,Both,,,90,131,111.35,37.5446,131,"Multiplan, Inc.","Multiplan, Inc.",123.14,94,,percent of total billed charges,,
"Fat, F (Mayo)OutsideLaboratory",,82710,CPT,Facility,Outpatient,,,90,131,111.35,37.5446,131,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,113.184,86.4,,percent of total billed charges,,
"Fat, F (Mayo)OutsideLaboratory",,82710,CPT,Facility,Inpatient,,,90,131,111.35,37.5446,131,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Fat, F (Mayo)OutsideLaboratory",,82710,CPT,Facility,Both,,,90,131,111.35,37.5446,131,"Preferred One Administrative Services, INC.",PPO,129.166,98.6,,percent of total billed charges,,
"Fat, F (Mayo)OutsideLaboratory",,82710,CPT,Facility,Outpatient,,,90,131,111.35,37.5446,131,PrimeWest Health,Minnesota Senior Health Options (MSHO),67.3995,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Fat, F (Mayo)OutsideLaboratory",,82710,CPT,Facility,Inpatient,,,90,131,111.35,37.5446,131,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Fat, F (Mayo)OutsideLaboratory",,82710,CPT,Facility,Outpatient,,,90,131,111.35,37.5446,131,PrimeWest Health,MinnesotaCare,67.2816,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Fat, F (Mayo)OutsideLaboratory",,82710,CPT,Facility,Inpatient,,,90,131,111.35,37.5446,131,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Fat, F (Mayo)OutsideLaboratory",,82710,CPT,Facility,Both,,,90,131,111.35,37.5446,131,Sanford Health Plan,Sanford Health Plan,120.52,92,,percent of total billed charges,,
"Fat, F (Mayo)OutsideLaboratory",,82710,CPT,Facility,Outpatient,,,90,131,111.35,37.5446,131,"UCare Health, Inc.",Individual & Family Plan,73.8185,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Fat, F (Mayo)OutsideLaboratory",,82710,CPT,Facility,Inpatient,,,90,131,111.35,37.5446,131,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Fat, F (Mayo)OutsideLaboratory",,82710,CPT,Facility,Outpatient,,,90,131,111.35,37.5446,131,"UCare Health, Inc.",Medical Assistance,66.1157,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Fat, F (Mayo)OutsideLaboratory",,82710,CPT,Facility,Inpatient,,,90,131,111.35,37.5446,131,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Fat, F (Mayo)OutsideLaboratory",,82710,CPT,Facility,Outpatient,,,90,131,111.35,37.5446,131,"UCare Health, Inc.",Medicare Advantage,66.1157,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Fat, F (Mayo)OutsideLaboratory",,82710,CPT,Facility,Inpatient,,,90,131,111.35,37.5446,131,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Fat, F (Mayo)OutsideLaboratory",,82710,CPT,Facility,Outpatient,,,90,131,111.35,37.5446,131,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),66.1157,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Fat, F (Mayo)OutsideLaboratory",,82710,CPT,Facility,Inpatient,,,90,131,111.35,37.5446,131,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Fat, F (Mayo)OutsideLaboratory",,82710,CPT,Facility,Both,,,90,131,111.35,37.5446,131,UnitedHealthcare,Individual & Family,123.14,94,,percent of total billed charges,,
"Fat, F (Mayo)OutsideLaboratory",,82710,CPT,Facility,Outpatient,,,90,131,111.35,37.5446,131,UnitedHealthcare,Medicare Advantage,64.19,49,,percent of total billed charges,,
"Fat, F (Mayo)OutsideLaboratory",,82710,CPT,Facility,Inpatient,,,90,131,111.35,37.5446,131,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Fat, F (Mayo)OutsideLaboratory",,82710,CPT,Facility,Outpatient,,,90,131,111.35,37.5446,131,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,62.88,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Fat, F (Mayo)OutsideLaboratory",,82710,CPT,Facility,Inpatient,,,90,131,111.35,37.5446,131,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Total Galactose (Mdh)OutsideLaboratory,,82760,CPT,Facility,Both,,,90,27,22.95,7.7382,27,Aetna,Commercial,24.84,92,,percent of total billed charges,,
Total Galactose (Mdh)OutsideLaboratory,,82760,CPT,Facility,Outpatient,,,90,27,22.95,7.7382,27,Aetna,Medicare Advantage,13.23,49,,percent of total billed charges,,
Total Galactose (Mdh)OutsideLaboratory,,82760,CPT,Facility,Inpatient,,,90,27,22.95,7.7382,27,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Total Galactose (Mdh)OutsideLaboratory,,82760,CPT,Facility,Both,,,90,27,22.95,7.7382,27,Aetna,PPO,25.11,93,,percent of total billed charges,,
Total Galactose (Mdh)OutsideLaboratory,,82760,CPT,Facility,Both,,,90,27,22.95,7.7382,27,America's PPO,America's PPO,25.9281,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Total Galactose (Mdh)OutsideLaboratory,,82760,CPT,Facility,Both,,,90,27,22.95,7.7382,27,BlueCross BlueShield Minnesota, Federal Employee Program,26.568,98.4,,percent of total billed charges,,
Total Galactose (Mdh)OutsideLaboratory,,82760,CPT,Facility,Both,,,90,27,22.95,7.7382,27,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,27,100,,percent of total billed charges,,
Total Galactose (Mdh)OutsideLaboratory,,82760,CPT,Facility,Both,,,90,27,22.95,7.7382,27,BlueCross BlueShield Minnesota,High Value Network Plan,24.3,90,,percent of total billed charges,,
Total Galactose (Mdh)OutsideLaboratory,,82760,CPT,Facility,Outpatient,,,90,27,22.95,7.7382,27,BlueCross BlueShield Minnesota,Medicare Advantage,13.23,49,,percent of total billed charges,,
Total Galactose (Mdh)OutsideLaboratory,,82760,CPT,Facility,Inpatient,,,90,27,22.95,7.7382,27,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Total Galactose (Mdh)OutsideLaboratory,,82760,CPT,Facility,Both,,,90,27,22.95,7.7382,27,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,23.9139,88.57,,percent of total billed charges,,
Total Galactose (Mdh)OutsideLaboratory,,82760,CPT,Facility,Both,,,90,27,22.95,7.7382,27,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,7.7382,28.66,,percent of total billed charges,,
Total Galactose (Mdh)OutsideLaboratory,,82760,CPT,Facility,Outpatient,,,90,27,22.95,7.7382,27,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),13.23,49,,percent of total billed charges,,
Total Galactose (Mdh)OutsideLaboratory,,82760,CPT,Facility,Inpatient,,,90,27,22.95,7.7382,27,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Total Galactose (Mdh)OutsideLaboratory,,82760,CPT,Facility,Both,,,90,27,22.95,7.7382,27,CorVel,Worker's Compensation,27,100,,percent of total billed charges,,
Total Galactose (Mdh)OutsideLaboratory,,82760,CPT,Facility,Both,,,90,27,22.95,7.7382,27,First Health Group Corporation,First Health Network,26.19,97,,percent of total billed charges,,
Total Galactose (Mdh)OutsideLaboratory,,82760,CPT,Facility,Both,,,90,27,22.95,7.7382,27,"Health Partners, Inc.",Commercial,25.542,94.6,,percent of total billed charges,,
Total Galactose (Mdh)OutsideLaboratory,,82760,CPT,Facility,Outpatient,,,90,27,22.95,7.7382,27,"Health Partners, Inc.",Medicare Advantage,13.23,49,,percent of total billed charges,,
Total Galactose (Mdh)OutsideLaboratory,,82760,CPT,Facility,Inpatient,,,90,27,22.95,7.7382,27,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Total Galactose (Mdh)OutsideLaboratory,,82760,CPT,Facility,Both,,,90,27,22.95,7.7382,27,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),16.2,60,,percent of total billed charges,,
Total Galactose (Mdh)OutsideLaboratory,,82760,CPT,Facility,Both,,,90,27,22.95,7.7382,27,"Health Partners, Inc.",State of Minnesota Advantage Program,22.005,81.5,,percent of total billed charges,,
Total Galactose (Mdh)OutsideLaboratory,,82760,CPT,Facility,Both,,,90,27,22.95,7.7382,27,"Health Partners, Inc.",State Public Programs,13.5,50,,percent of total billed charges,,
Total Galactose (Mdh)OutsideLaboratory,,82760,CPT,Facility,Both,,,90,27,22.95,7.7382,27,Humana Insurance Company,Commercial PPO,25.65,95,,percent of total billed charges,,
Total Galactose (Mdh)OutsideLaboratory,,82760,CPT,Facility,Outpatient,,,90,27,22.95,7.7382,27,Humana Insurance Company,Medicare PPO,13.23,49,,percent of total billed charges,,
Total Galactose (Mdh)OutsideLaboratory,,82760,CPT,Facility,Inpatient,,,90,27,22.95,7.7382,27,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Total Galactose (Mdh)OutsideLaboratory,,82760,CPT,Facility,Both,,,90,27,22.95,7.7382,27,Medica,Individual & Family,26.757,99.1,,percent of total billed charges,,
Total Galactose (Mdh)OutsideLaboratory,,82760,CPT,Facility,Outpatient,,,90,27,22.95,7.7382,27,Medica,Medica Advantage Solution,13.446,49.8,,percent of total billed charges,,
Total Galactose (Mdh)OutsideLaboratory,,82760,CPT,Facility,Inpatient,,,90,27,22.95,7.7382,27,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Total Galactose (Mdh)OutsideLaboratory,,82760,CPT,Facility,Outpatient,,,90,27,22.95,7.7382,27,Medica,Medical Assistance,12.042,44.6,,percent of total billed charges,,
Total Galactose (Mdh)OutsideLaboratory,,82760,CPT,Facility,Inpatient,,,90,27,22.95,7.7382,27,Medica,Medical Assistance,,,,,Included in per diem rate,
Total Galactose (Mdh)OutsideLaboratory,,82760,CPT,Facility,Outpatient,,,90,27,22.95,7.7382,27,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,13.446,49.8,,percent of total billed charges,,
Total Galactose (Mdh)OutsideLaboratory,,82760,CPT,Facility,Inpatient,,,90,27,22.95,7.7382,27,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Total Galactose (Mdh)OutsideLaboratory,,82760,CPT,Facility,Both,,,90,27,22.95,7.7382,27,"Multiplan, Inc.","Multiplan, Inc.",25.38,94,,percent of total billed charges,,
Total Galactose (Mdh)OutsideLaboratory,,82760,CPT,Facility,Outpatient,,,90,27,22.95,7.7382,27,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,23.328,86.4,,percent of total billed charges,,
Total Galactose (Mdh)OutsideLaboratory,,82760,CPT,Facility,Inpatient,,,90,27,22.95,7.7382,27,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Total Galactose (Mdh)OutsideLaboratory,,82760,CPT,Facility,Both,,,90,27,22.95,7.7382,27,"Preferred One Administrative Services, INC.",PPO,26.622,98.6,,percent of total billed charges,,
Total Galactose (Mdh)OutsideLaboratory,,82760,CPT,Facility,Outpatient,,,90,27,22.95,7.7382,27,PrimeWest Health,Minnesota Senior Health Options (MSHO),13.8915,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Total Galactose (Mdh)OutsideLaboratory,,82760,CPT,Facility,Inpatient,,,90,27,22.95,7.7382,27,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Total Galactose (Mdh)OutsideLaboratory,,82760,CPT,Facility,Outpatient,,,90,27,22.95,7.7382,27,PrimeWest Health,MinnesotaCare,13.8672,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Total Galactose (Mdh)OutsideLaboratory,,82760,CPT,Facility,Inpatient,,,90,27,22.95,7.7382,27,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Total Galactose (Mdh)OutsideLaboratory,,82760,CPT,Facility,Both,,,90,27,22.95,7.7382,27,Sanford Health Plan,Sanford Health Plan,24.84,92,,percent of total billed charges,,
Total Galactose (Mdh)OutsideLaboratory,,82760,CPT,Facility,Outpatient,,,90,27,22.95,7.7382,27,"UCare Health, Inc.",Individual & Family Plan,15.2145,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Total Galactose (Mdh)OutsideLaboratory,,82760,CPT,Facility,Inpatient,,,90,27,22.95,7.7382,27,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Total Galactose (Mdh)OutsideLaboratory,,82760,CPT,Facility,Outpatient,,,90,27,22.95,7.7382,27,"UCare Health, Inc.",Medical Assistance,13.6269,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Total Galactose (Mdh)OutsideLaboratory,,82760,CPT,Facility,Inpatient,,,90,27,22.95,7.7382,27,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Total Galactose (Mdh)OutsideLaboratory,,82760,CPT,Facility,Outpatient,,,90,27,22.95,7.7382,27,"UCare Health, Inc.",Medicare Advantage,13.6269,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Total Galactose (Mdh)OutsideLaboratory,,82760,CPT,Facility,Inpatient,,,90,27,22.95,7.7382,27,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Total Galactose (Mdh)OutsideLaboratory,,82760,CPT,Facility,Outpatient,,,90,27,22.95,7.7382,27,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),13.6269,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Total Galactose (Mdh)OutsideLaboratory,,82760,CPT,Facility,Inpatient,,,90,27,22.95,7.7382,27,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Total Galactose (Mdh)OutsideLaboratory,,82760,CPT,Facility,Both,,,90,27,22.95,7.7382,27,UnitedHealthcare,Individual & Family,25.38,94,,percent of total billed charges,,
Total Galactose (Mdh)OutsideLaboratory,,82760,CPT,Facility,Outpatient,,,90,27,22.95,7.7382,27,UnitedHealthcare,Medicare Advantage,13.23,49,,percent of total billed charges,,
Total Galactose (Mdh)OutsideLaboratory,,82760,CPT,Facility,Inpatient,,,90,27,22.95,7.7382,27,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Total Galactose (Mdh)OutsideLaboratory,,82760,CPT,Facility,Outpatient,,,90,27,22.95,7.7382,27,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,12.96,48,,percent of total billed charges,,100% of DHS outpatient percentage
Total Galactose (Mdh)OutsideLaboratory,,82760,CPT,Facility,Inpatient,,,90,27,22.95,7.7382,27,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Galactose - 1 Phosphate Uridyl Transferase, Screen (Mdh)OutsideLaboratory",,82776,CPT,Facility,Both,,,90,27,22.95,7.7382,27,Aetna,Commercial,24.84,92,,percent of total billed charges,,
"Galactose - 1 Phosphate Uridyl Transferase, Screen (Mdh)OutsideLaboratory",,82776,CPT,Facility,Outpatient,,,90,27,22.95,7.7382,27,Aetna,Medicare Advantage,13.23,49,,percent of total billed charges,,
"Galactose - 1 Phosphate Uridyl Transferase, Screen (Mdh)OutsideLaboratory",,82776,CPT,Facility,Inpatient,,,90,27,22.95,7.7382,27,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Galactose - 1 Phosphate Uridyl Transferase, Screen (Mdh)OutsideLaboratory",,82776,CPT,Facility,Both,,,90,27,22.95,7.7382,27,Aetna,PPO,25.11,93,,percent of total billed charges,,
"Galactose - 1 Phosphate Uridyl Transferase, Screen (Mdh)OutsideLaboratory",,82776,CPT,Facility,Both,,,90,27,22.95,7.7382,27,America's PPO,America's PPO,25.9281,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Galactose - 1 Phosphate Uridyl Transferase, Screen (Mdh)OutsideLaboratory",,82776,CPT,Facility,Both,,,90,27,22.95,7.7382,27,BlueCross BlueShield Minnesota, Federal Employee Program,26.568,98.4,,percent of total billed charges,,
"Galactose - 1 Phosphate Uridyl Transferase, Screen (Mdh)OutsideLaboratory",,82776,CPT,Facility,Both,,,90,27,22.95,7.7382,27,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,27,100,,percent of total billed charges,,
"Galactose - 1 Phosphate Uridyl Transferase, Screen (Mdh)OutsideLaboratory",,82776,CPT,Facility,Both,,,90,27,22.95,7.7382,27,BlueCross BlueShield Minnesota,High Value Network Plan,24.3,90,,percent of total billed charges,,
"Galactose - 1 Phosphate Uridyl Transferase, Screen (Mdh)OutsideLaboratory",,82776,CPT,Facility,Outpatient,,,90,27,22.95,7.7382,27,BlueCross BlueShield Minnesota,Medicare Advantage,13.23,49,,percent of total billed charges,,
"Galactose - 1 Phosphate Uridyl Transferase, Screen (Mdh)OutsideLaboratory",,82776,CPT,Facility,Inpatient,,,90,27,22.95,7.7382,27,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Galactose - 1 Phosphate Uridyl Transferase, Screen (Mdh)OutsideLaboratory",,82776,CPT,Facility,Both,,,90,27,22.95,7.7382,27,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,23.9139,88.57,,percent of total billed charges,,
"Galactose - 1 Phosphate Uridyl Transferase, Screen (Mdh)OutsideLaboratory",,82776,CPT,Facility,Both,,,90,27,22.95,7.7382,27,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,7.7382,28.66,,percent of total billed charges,,
"Galactose - 1 Phosphate Uridyl Transferase, Screen (Mdh)OutsideLaboratory",,82776,CPT,Facility,Outpatient,,,90,27,22.95,7.7382,27,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),13.23,49,,percent of total billed charges,,
"Galactose - 1 Phosphate Uridyl Transferase, Screen (Mdh)OutsideLaboratory",,82776,CPT,Facility,Inpatient,,,90,27,22.95,7.7382,27,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Galactose - 1 Phosphate Uridyl Transferase, Screen (Mdh)OutsideLaboratory",,82776,CPT,Facility,Both,,,90,27,22.95,7.7382,27,CorVel,Worker's Compensation,27,100,,percent of total billed charges,,
"Galactose - 1 Phosphate Uridyl Transferase, Screen (Mdh)OutsideLaboratory",,82776,CPT,Facility,Both,,,90,27,22.95,7.7382,27,First Health Group Corporation,First Health Network,26.19,97,,percent of total billed charges,,
"Galactose - 1 Phosphate Uridyl Transferase, Screen (Mdh)OutsideLaboratory",,82776,CPT,Facility,Both,,,90,27,22.95,7.7382,27,"Health Partners, Inc.",Commercial,25.542,94.6,,percent of total billed charges,,
"Galactose - 1 Phosphate Uridyl Transferase, Screen (Mdh)OutsideLaboratory",,82776,CPT,Facility,Outpatient,,,90,27,22.95,7.7382,27,"Health Partners, Inc.",Medicare Advantage,13.23,49,,percent of total billed charges,,
"Galactose - 1 Phosphate Uridyl Transferase, Screen (Mdh)OutsideLaboratory",,82776,CPT,Facility,Inpatient,,,90,27,22.95,7.7382,27,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Galactose - 1 Phosphate Uridyl Transferase, Screen (Mdh)OutsideLaboratory",,82776,CPT,Facility,Both,,,90,27,22.95,7.7382,27,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),16.2,60,,percent of total billed charges,,
"Galactose - 1 Phosphate Uridyl Transferase, Screen (Mdh)OutsideLaboratory",,82776,CPT,Facility,Both,,,90,27,22.95,7.7382,27,"Health Partners, Inc.",State of Minnesota Advantage Program,22.005,81.5,,percent of total billed charges,,
"Galactose - 1 Phosphate Uridyl Transferase, Screen (Mdh)OutsideLaboratory",,82776,CPT,Facility,Both,,,90,27,22.95,7.7382,27,"Health Partners, Inc.",State Public Programs,13.5,50,,percent of total billed charges,,
"Galactose - 1 Phosphate Uridyl Transferase, Screen (Mdh)OutsideLaboratory",,82776,CPT,Facility,Both,,,90,27,22.95,7.7382,27,Humana Insurance Company,Commercial PPO,25.65,95,,percent of total billed charges,,
"Galactose - 1 Phosphate Uridyl Transferase, Screen (Mdh)OutsideLaboratory",,82776,CPT,Facility,Outpatient,,,90,27,22.95,7.7382,27,Humana Insurance Company,Medicare PPO,13.23,49,,percent of total billed charges,,
"Galactose - 1 Phosphate Uridyl Transferase, Screen (Mdh)OutsideLaboratory",,82776,CPT,Facility,Inpatient,,,90,27,22.95,7.7382,27,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Galactose - 1 Phosphate Uridyl Transferase, Screen (Mdh)OutsideLaboratory",,82776,CPT,Facility,Both,,,90,27,22.95,7.7382,27,Medica,Individual & Family,26.757,99.1,,percent of total billed charges,,
"Galactose - 1 Phosphate Uridyl Transferase, Screen (Mdh)OutsideLaboratory",,82776,CPT,Facility,Outpatient,,,90,27,22.95,7.7382,27,Medica,Medica Advantage Solution,13.446,49.8,,percent of total billed charges,,
"Galactose - 1 Phosphate Uridyl Transferase, Screen (Mdh)OutsideLaboratory",,82776,CPT,Facility,Inpatient,,,90,27,22.95,7.7382,27,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Galactose - 1 Phosphate Uridyl Transferase, Screen (Mdh)OutsideLaboratory",,82776,CPT,Facility,Outpatient,,,90,27,22.95,7.7382,27,Medica,Medical Assistance,12.042,44.6,,percent of total billed charges,,
"Galactose - 1 Phosphate Uridyl Transferase, Screen (Mdh)OutsideLaboratory",,82776,CPT,Facility,Inpatient,,,90,27,22.95,7.7382,27,Medica,Medical Assistance,,,,,Included in per diem rate,
"Galactose - 1 Phosphate Uridyl Transferase, Screen (Mdh)OutsideLaboratory",,82776,CPT,Facility,Outpatient,,,90,27,22.95,7.7382,27,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,13.446,49.8,,percent of total billed charges,,
"Galactose - 1 Phosphate Uridyl Transferase, Screen (Mdh)OutsideLaboratory",,82776,CPT,Facility,Inpatient,,,90,27,22.95,7.7382,27,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Galactose - 1 Phosphate Uridyl Transferase, Screen (Mdh)OutsideLaboratory",,82776,CPT,Facility,Both,,,90,27,22.95,7.7382,27,"Multiplan, Inc.","Multiplan, Inc.",25.38,94,,percent of total billed charges,,
"Galactose - 1 Phosphate Uridyl Transferase, Screen (Mdh)OutsideLaboratory",,82776,CPT,Facility,Outpatient,,,90,27,22.95,7.7382,27,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,23.328,86.4,,percent of total billed charges,,
"Galactose - 1 Phosphate Uridyl Transferase, Screen (Mdh)OutsideLaboratory",,82776,CPT,Facility,Inpatient,,,90,27,22.95,7.7382,27,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Galactose - 1 Phosphate Uridyl Transferase, Screen (Mdh)OutsideLaboratory",,82776,CPT,Facility,Both,,,90,27,22.95,7.7382,27,"Preferred One Administrative Services, INC.",PPO,26.622,98.6,,percent of total billed charges,,
"Galactose - 1 Phosphate Uridyl Transferase, Screen (Mdh)OutsideLaboratory",,82776,CPT,Facility,Outpatient,,,90,27,22.95,7.7382,27,PrimeWest Health,Minnesota Senior Health Options (MSHO),13.8915,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Galactose - 1 Phosphate Uridyl Transferase, Screen (Mdh)OutsideLaboratory",,82776,CPT,Facility,Inpatient,,,90,27,22.95,7.7382,27,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Galactose - 1 Phosphate Uridyl Transferase, Screen (Mdh)OutsideLaboratory",,82776,CPT,Facility,Outpatient,,,90,27,22.95,7.7382,27,PrimeWest Health,MinnesotaCare,13.8672,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Galactose - 1 Phosphate Uridyl Transferase, Screen (Mdh)OutsideLaboratory",,82776,CPT,Facility,Inpatient,,,90,27,22.95,7.7382,27,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Galactose - 1 Phosphate Uridyl Transferase, Screen (Mdh)OutsideLaboratory",,82776,CPT,Facility,Both,,,90,27,22.95,7.7382,27,Sanford Health Plan,Sanford Health Plan,24.84,92,,percent of total billed charges,,
"Galactose - 1 Phosphate Uridyl Transferase, Screen (Mdh)OutsideLaboratory",,82776,CPT,Facility,Outpatient,,,90,27,22.95,7.7382,27,"UCare Health, Inc.",Individual & Family Plan,15.2145,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Galactose - 1 Phosphate Uridyl Transferase, Screen (Mdh)OutsideLaboratory",,82776,CPT,Facility,Inpatient,,,90,27,22.95,7.7382,27,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Galactose - 1 Phosphate Uridyl Transferase, Screen (Mdh)OutsideLaboratory",,82776,CPT,Facility,Outpatient,,,90,27,22.95,7.7382,27,"UCare Health, Inc.",Medical Assistance,13.6269,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Galactose - 1 Phosphate Uridyl Transferase, Screen (Mdh)OutsideLaboratory",,82776,CPT,Facility,Inpatient,,,90,27,22.95,7.7382,27,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Galactose - 1 Phosphate Uridyl Transferase, Screen (Mdh)OutsideLaboratory",,82776,CPT,Facility,Outpatient,,,90,27,22.95,7.7382,27,"UCare Health, Inc.",Medicare Advantage,13.6269,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Galactose - 1 Phosphate Uridyl Transferase, Screen (Mdh)OutsideLaboratory",,82776,CPT,Facility,Inpatient,,,90,27,22.95,7.7382,27,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Galactose - 1 Phosphate Uridyl Transferase, Screen (Mdh)OutsideLaboratory",,82776,CPT,Facility,Outpatient,,,90,27,22.95,7.7382,27,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),13.6269,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Galactose - 1 Phosphate Uridyl Transferase, Screen (Mdh)OutsideLaboratory",,82776,CPT,Facility,Inpatient,,,90,27,22.95,7.7382,27,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Galactose - 1 Phosphate Uridyl Transferase, Screen (Mdh)OutsideLaboratory",,82776,CPT,Facility,Both,,,90,27,22.95,7.7382,27,UnitedHealthcare,Individual & Family,25.38,94,,percent of total billed charges,,
"Galactose - 1 Phosphate Uridyl Transferase, Screen (Mdh)OutsideLaboratory",,82776,CPT,Facility,Outpatient,,,90,27,22.95,7.7382,27,UnitedHealthcare,Medicare Advantage,13.23,49,,percent of total billed charges,,
"Galactose - 1 Phosphate Uridyl Transferase, Screen (Mdh)OutsideLaboratory",,82776,CPT,Facility,Inpatient,,,90,27,22.95,7.7382,27,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Galactose - 1 Phosphate Uridyl Transferase, Screen (Mdh)OutsideLaboratory",,82776,CPT,Facility,Outpatient,,,90,27,22.95,7.7382,27,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,12.96,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Galactose - 1 Phosphate Uridyl Transferase, Screen (Mdh)OutsideLaboratory",,82776,CPT,Facility,Inpatient,,,90,27,22.95,7.7382,27,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Celiac Disease Serology Cascade (Mayo)OutsideLaboratory,,82784,CPT,Facility,Both,,,90,154,130.9,44.1364,154,Aetna,Commercial,141.68,92,,percent of total billed charges,,
Celiac Disease Serology Cascade (Mayo)OutsideLaboratory,,82784,CPT,Facility,Outpatient,,,90,154,130.9,44.1364,154,Aetna,Medicare Advantage,75.46,49,,percent of total billed charges,,
Celiac Disease Serology Cascade (Mayo)OutsideLaboratory,,82784,CPT,Facility,Inpatient,,,90,154,130.9,44.1364,154,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Celiac Disease Serology Cascade (Mayo)OutsideLaboratory,,82784,CPT,Facility,Both,,,90,154,130.9,44.1364,154,Aetna,PPO,143.22,93,,percent of total billed charges,,
Celiac Disease Serology Cascade (Mayo)OutsideLaboratory,,82784,CPT,Facility,Both,,,90,154,130.9,44.1364,154,America's PPO,America's PPO,147.8862,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Celiac Disease Serology Cascade (Mayo)OutsideLaboratory,,82784,CPT,Facility,Both,,,90,154,130.9,44.1364,154,BlueCross BlueShield Minnesota, Federal Employee Program,151.536,98.4,,percent of total billed charges,,
Celiac Disease Serology Cascade (Mayo)OutsideLaboratory,,82784,CPT,Facility,Both,,,90,154,130.9,44.1364,154,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,154,100,,percent of total billed charges,,
Celiac Disease Serology Cascade (Mayo)OutsideLaboratory,,82784,CPT,Facility,Both,,,90,154,130.9,44.1364,154,BlueCross BlueShield Minnesota,High Value Network Plan,138.6,90,,percent of total billed charges,,
Celiac Disease Serology Cascade (Mayo)OutsideLaboratory,,82784,CPT,Facility,Outpatient,,,90,154,130.9,44.1364,154,BlueCross BlueShield Minnesota,Medicare Advantage,75.46,49,,percent of total billed charges,,
Celiac Disease Serology Cascade (Mayo)OutsideLaboratory,,82784,CPT,Facility,Inpatient,,,90,154,130.9,44.1364,154,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Celiac Disease Serology Cascade (Mayo)OutsideLaboratory,,82784,CPT,Facility,Both,,,90,154,130.9,44.1364,154,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,136.3978,88.57,,percent of total billed charges,,
Celiac Disease Serology Cascade (Mayo)OutsideLaboratory,,82784,CPT,Facility,Both,,,90,154,130.9,44.1364,154,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,44.1364,28.66,,percent of total billed charges,,
Celiac Disease Serology Cascade (Mayo)OutsideLaboratory,,82784,CPT,Facility,Outpatient,,,90,154,130.9,44.1364,154,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),75.46,49,,percent of total billed charges,,
Celiac Disease Serology Cascade (Mayo)OutsideLaboratory,,82784,CPT,Facility,Inpatient,,,90,154,130.9,44.1364,154,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Celiac Disease Serology Cascade (Mayo)OutsideLaboratory,,82784,CPT,Facility,Both,,,90,154,130.9,44.1364,154,CorVel,Worker's Compensation,154,100,,percent of total billed charges,,
Celiac Disease Serology Cascade (Mayo)OutsideLaboratory,,82784,CPT,Facility,Both,,,90,154,130.9,44.1364,154,First Health Group Corporation,First Health Network,149.38,97,,percent of total billed charges,,
Celiac Disease Serology Cascade (Mayo)OutsideLaboratory,,82784,CPT,Facility,Both,,,90,154,130.9,44.1364,154,"Health Partners, Inc.",Commercial,145.684,94.6,,percent of total billed charges,,
Celiac Disease Serology Cascade (Mayo)OutsideLaboratory,,82784,CPT,Facility,Outpatient,,,90,154,130.9,44.1364,154,"Health Partners, Inc.",Medicare Advantage,75.46,49,,percent of total billed charges,,
Celiac Disease Serology Cascade (Mayo)OutsideLaboratory,,82784,CPT,Facility,Inpatient,,,90,154,130.9,44.1364,154,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Celiac Disease Serology Cascade (Mayo)OutsideLaboratory,,82784,CPT,Facility,Both,,,90,154,130.9,44.1364,154,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),92.4,60,,percent of total billed charges,,
Celiac Disease Serology Cascade (Mayo)OutsideLaboratory,,82784,CPT,Facility,Both,,,90,154,130.9,44.1364,154,"Health Partners, Inc.",State of Minnesota Advantage Program,125.51,81.5,,percent of total billed charges,,
Celiac Disease Serology Cascade (Mayo)OutsideLaboratory,,82784,CPT,Facility,Both,,,90,154,130.9,44.1364,154,"Health Partners, Inc.",State Public Programs,77,50,,percent of total billed charges,,
Celiac Disease Serology Cascade (Mayo)OutsideLaboratory,,82784,CPT,Facility,Both,,,90,154,130.9,44.1364,154,Humana Insurance Company,Commercial PPO,146.3,95,,percent of total billed charges,,
Celiac Disease Serology Cascade (Mayo)OutsideLaboratory,,82784,CPT,Facility,Outpatient,,,90,154,130.9,44.1364,154,Humana Insurance Company,Medicare PPO,75.46,49,,percent of total billed charges,,
Celiac Disease Serology Cascade (Mayo)OutsideLaboratory,,82784,CPT,Facility,Inpatient,,,90,154,130.9,44.1364,154,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Celiac Disease Serology Cascade (Mayo)OutsideLaboratory,,82784,CPT,Facility,Both,,,90,154,130.9,44.1364,154,Medica,Individual & Family,152.614,99.1,,percent of total billed charges,,
Celiac Disease Serology Cascade (Mayo)OutsideLaboratory,,82784,CPT,Facility,Outpatient,,,90,154,130.9,44.1364,154,Medica,Medica Advantage Solution,76.692,49.8,,percent of total billed charges,,
Celiac Disease Serology Cascade (Mayo)OutsideLaboratory,,82784,CPT,Facility,Inpatient,,,90,154,130.9,44.1364,154,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Celiac Disease Serology Cascade (Mayo)OutsideLaboratory,,82784,CPT,Facility,Outpatient,,,90,154,130.9,44.1364,154,Medica,Medical Assistance,68.684,44.6,,percent of total billed charges,,
Celiac Disease Serology Cascade (Mayo)OutsideLaboratory,,82784,CPT,Facility,Inpatient,,,90,154,130.9,44.1364,154,Medica,Medical Assistance,,,,,Included in per diem rate,
Celiac Disease Serology Cascade (Mayo)OutsideLaboratory,,82784,CPT,Facility,Outpatient,,,90,154,130.9,44.1364,154,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,76.692,49.8,,percent of total billed charges,,
Celiac Disease Serology Cascade (Mayo)OutsideLaboratory,,82784,CPT,Facility,Inpatient,,,90,154,130.9,44.1364,154,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Celiac Disease Serology Cascade (Mayo)OutsideLaboratory,,82784,CPT,Facility,Both,,,90,154,130.9,44.1364,154,"Multiplan, Inc.","Multiplan, Inc.",144.76,94,,percent of total billed charges,,
Celiac Disease Serology Cascade (Mayo)OutsideLaboratory,,82784,CPT,Facility,Outpatient,,,90,154,130.9,44.1364,154,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,133.056,86.4,,percent of total billed charges,,
Celiac Disease Serology Cascade (Mayo)OutsideLaboratory,,82784,CPT,Facility,Inpatient,,,90,154,130.9,44.1364,154,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Celiac Disease Serology Cascade (Mayo)OutsideLaboratory,,82784,CPT,Facility,Both,,,90,154,130.9,44.1364,154,"Preferred One Administrative Services, INC.",PPO,151.844,98.6,,percent of total billed charges,,
Celiac Disease Serology Cascade (Mayo)OutsideLaboratory,,82784,CPT,Facility,Outpatient,,,90,154,130.9,44.1364,154,PrimeWest Health,Minnesota Senior Health Options (MSHO),79.233,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Celiac Disease Serology Cascade (Mayo)OutsideLaboratory,,82784,CPT,Facility,Inpatient,,,90,154,130.9,44.1364,154,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Celiac Disease Serology Cascade (Mayo)OutsideLaboratory,,82784,CPT,Facility,Outpatient,,,90,154,130.9,44.1364,154,PrimeWest Health,MinnesotaCare,79.0944,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Celiac Disease Serology Cascade (Mayo)OutsideLaboratory,,82784,CPT,Facility,Inpatient,,,90,154,130.9,44.1364,154,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Celiac Disease Serology Cascade (Mayo)OutsideLaboratory,,82784,CPT,Facility,Both,,,90,154,130.9,44.1364,154,Sanford Health Plan,Sanford Health Plan,141.68,92,,percent of total billed charges,,
Celiac Disease Serology Cascade (Mayo)OutsideLaboratory,,82784,CPT,Facility,Outpatient,,,90,154,130.9,44.1364,154,"UCare Health, Inc.",Individual & Family Plan,86.779,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Celiac Disease Serology Cascade (Mayo)OutsideLaboratory,,82784,CPT,Facility,Inpatient,,,90,154,130.9,44.1364,154,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Celiac Disease Serology Cascade (Mayo)OutsideLaboratory,,82784,CPT,Facility,Outpatient,,,90,154,130.9,44.1364,154,"UCare Health, Inc.",Medical Assistance,77.7238,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Celiac Disease Serology Cascade (Mayo)OutsideLaboratory,,82784,CPT,Facility,Inpatient,,,90,154,130.9,44.1364,154,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Celiac Disease Serology Cascade (Mayo)OutsideLaboratory,,82784,CPT,Facility,Outpatient,,,90,154,130.9,44.1364,154,"UCare Health, Inc.",Medicare Advantage,77.7238,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Celiac Disease Serology Cascade (Mayo)OutsideLaboratory,,82784,CPT,Facility,Inpatient,,,90,154,130.9,44.1364,154,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Celiac Disease Serology Cascade (Mayo)OutsideLaboratory,,82784,CPT,Facility,Outpatient,,,90,154,130.9,44.1364,154,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),77.7238,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Celiac Disease Serology Cascade (Mayo)OutsideLaboratory,,82784,CPT,Facility,Inpatient,,,90,154,130.9,44.1364,154,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Celiac Disease Serology Cascade (Mayo)OutsideLaboratory,,82784,CPT,Facility,Both,,,90,154,130.9,44.1364,154,UnitedHealthcare,Individual & Family,144.76,94,,percent of total billed charges,,
Celiac Disease Serology Cascade (Mayo)OutsideLaboratory,,82784,CPT,Facility,Outpatient,,,90,154,130.9,44.1364,154,UnitedHealthcare,Medicare Advantage,75.46,49,,percent of total billed charges,,
Celiac Disease Serology Cascade (Mayo)OutsideLaboratory,,82784,CPT,Facility,Inpatient,,,90,154,130.9,44.1364,154,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Celiac Disease Serology Cascade (Mayo)OutsideLaboratory,,82784,CPT,Facility,Outpatient,,,90,154,130.9,44.1364,154,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,73.92,48,,percent of total billed charges,,100% of DHS outpatient percentage
Celiac Disease Serology Cascade (Mayo)OutsideLaboratory,,82784,CPT,Facility,Inpatient,,,90,154,130.9,44.1364,154,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Igg Subclasses, S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Both,,,90,72,61.2,20.6352,72,Aetna,Commercial,66.24,92,,percent of total billed charges,,
"Igg Subclasses, S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Outpatient,,,90,72,61.2,20.6352,72,Aetna,Medicare Advantage,35.28,49,,percent of total billed charges,,
"Igg Subclasses, S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Inpatient,,,90,72,61.2,20.6352,72,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Igg Subclasses, S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Both,,,90,72,61.2,20.6352,72,Aetna,PPO,66.96,93,,percent of total billed charges,,
"Igg Subclasses, S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Both,,,90,72,61.2,20.6352,72,America's PPO,America's PPO,69.1416,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Igg Subclasses, S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Both,,,90,72,61.2,20.6352,72,BlueCross BlueShield Minnesota, Federal Employee Program,70.848,98.4,,percent of total billed charges,,
"Igg Subclasses, S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Both,,,90,72,61.2,20.6352,72,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,72,100,,percent of total billed charges,,
"Igg Subclasses, S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Both,,,90,72,61.2,20.6352,72,BlueCross BlueShield Minnesota,High Value Network Plan,64.8,90,,percent of total billed charges,,
"Igg Subclasses, S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Outpatient,,,90,72,61.2,20.6352,72,BlueCross BlueShield Minnesota,Medicare Advantage,35.28,49,,percent of total billed charges,,
"Igg Subclasses, S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Inpatient,,,90,72,61.2,20.6352,72,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Igg Subclasses, S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Both,,,90,72,61.2,20.6352,72,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,63.7704,88.57,,percent of total billed charges,,
"Igg Subclasses, S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Both,,,90,72,61.2,20.6352,72,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,20.6352,28.66,,percent of total billed charges,,
"Igg Subclasses, S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Outpatient,,,90,72,61.2,20.6352,72,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),35.28,49,,percent of total billed charges,,
"Igg Subclasses, S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Inpatient,,,90,72,61.2,20.6352,72,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Igg Subclasses, S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Both,,,90,72,61.2,20.6352,72,CorVel,Worker's Compensation,72,100,,percent of total billed charges,,
"Igg Subclasses, S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Both,,,90,72,61.2,20.6352,72,First Health Group Corporation,First Health Network,69.84,97,,percent of total billed charges,,
"Igg Subclasses, S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Both,,,90,72,61.2,20.6352,72,"Health Partners, Inc.",Commercial,68.112,94.6,,percent of total billed charges,,
"Igg Subclasses, S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Outpatient,,,90,72,61.2,20.6352,72,"Health Partners, Inc.",Medicare Advantage,35.28,49,,percent of total billed charges,,
"Igg Subclasses, S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Inpatient,,,90,72,61.2,20.6352,72,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Igg Subclasses, S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Both,,,90,72,61.2,20.6352,72,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),43.2,60,,percent of total billed charges,,
"Igg Subclasses, S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Both,,,90,72,61.2,20.6352,72,"Health Partners, Inc.",State of Minnesota Advantage Program,58.68,81.5,,percent of total billed charges,,
"Igg Subclasses, S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Both,,,90,72,61.2,20.6352,72,"Health Partners, Inc.",State Public Programs,36,50,,percent of total billed charges,,
"Igg Subclasses, S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Both,,,90,72,61.2,20.6352,72,Humana Insurance Company,Commercial PPO,68.4,95,,percent of total billed charges,,
"Igg Subclasses, S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Outpatient,,,90,72,61.2,20.6352,72,Humana Insurance Company,Medicare PPO,35.28,49,,percent of total billed charges,,
"Igg Subclasses, S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Inpatient,,,90,72,61.2,20.6352,72,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Igg Subclasses, S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Both,,,90,72,61.2,20.6352,72,Medica,Individual & Family,71.352,99.1,,percent of total billed charges,,
"Igg Subclasses, S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Outpatient,,,90,72,61.2,20.6352,72,Medica,Medica Advantage Solution,35.856,49.8,,percent of total billed charges,,
"Igg Subclasses, S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Inpatient,,,90,72,61.2,20.6352,72,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Igg Subclasses, S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Outpatient,,,90,72,61.2,20.6352,72,Medica,Medical Assistance,32.112,44.6,,percent of total billed charges,,
"Igg Subclasses, S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Inpatient,,,90,72,61.2,20.6352,72,Medica,Medical Assistance,,,,,Included in per diem rate,
"Igg Subclasses, S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Outpatient,,,90,72,61.2,20.6352,72,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,35.856,49.8,,percent of total billed charges,,
"Igg Subclasses, S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Inpatient,,,90,72,61.2,20.6352,72,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Igg Subclasses, S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Both,,,90,72,61.2,20.6352,72,"Multiplan, Inc.","Multiplan, Inc.",67.68,94,,percent of total billed charges,,
"Igg Subclasses, S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Outpatient,,,90,72,61.2,20.6352,72,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,62.208,86.4,,percent of total billed charges,,
"Igg Subclasses, S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Inpatient,,,90,72,61.2,20.6352,72,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Igg Subclasses, S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Both,,,90,72,61.2,20.6352,72,"Preferred One Administrative Services, INC.",PPO,70.992,98.6,,percent of total billed charges,,
"Igg Subclasses, S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Outpatient,,,90,72,61.2,20.6352,72,PrimeWest Health,Minnesota Senior Health Options (MSHO),37.044,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Igg Subclasses, S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Inpatient,,,90,72,61.2,20.6352,72,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Igg Subclasses, S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Outpatient,,,90,72,61.2,20.6352,72,PrimeWest Health,MinnesotaCare,36.9792,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Igg Subclasses, S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Inpatient,,,90,72,61.2,20.6352,72,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Igg Subclasses, S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Both,,,90,72,61.2,20.6352,72,Sanford Health Plan,Sanford Health Plan,66.24,92,,percent of total billed charges,,
"Igg Subclasses, S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Outpatient,,,90,72,61.2,20.6352,72,"UCare Health, Inc.",Individual & Family Plan,40.572,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Igg Subclasses, S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Inpatient,,,90,72,61.2,20.6352,72,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Igg Subclasses, S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Outpatient,,,90,72,61.2,20.6352,72,"UCare Health, Inc.",Medical Assistance,36.3384,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Igg Subclasses, S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Inpatient,,,90,72,61.2,20.6352,72,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Igg Subclasses, S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Outpatient,,,90,72,61.2,20.6352,72,"UCare Health, Inc.",Medicare Advantage,36.3384,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Igg Subclasses, S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Inpatient,,,90,72,61.2,20.6352,72,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Igg Subclasses, S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Outpatient,,,90,72,61.2,20.6352,72,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),36.3384,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Igg Subclasses, S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Inpatient,,,90,72,61.2,20.6352,72,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Igg Subclasses, S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Both,,,90,72,61.2,20.6352,72,UnitedHealthcare,Individual & Family,67.68,94,,percent of total billed charges,,
"Igg Subclasses, S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Outpatient,,,90,72,61.2,20.6352,72,UnitedHealthcare,Medicare Advantage,35.28,49,,percent of total billed charges,,
"Igg Subclasses, S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Inpatient,,,90,72,61.2,20.6352,72,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Igg Subclasses, S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Outpatient,,,90,72,61.2,20.6352,72,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,34.56,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Igg Subclasses, S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Inpatient,,,90,72,61.2,20.6352,72,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Immunoglobulin A (Iga), S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Both,,,90,66,56.1,18.9156,66,Aetna,Commercial,60.72,92,,percent of total billed charges,,
"Immunoglobulin A (Iga), S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Outpatient,,,90,66,56.1,18.9156,66,Aetna,Medicare Advantage,32.34,49,,percent of total billed charges,,
"Immunoglobulin A (Iga), S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Inpatient,,,90,66,56.1,18.9156,66,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Immunoglobulin A (Iga), S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Both,,,90,66,56.1,18.9156,66,Aetna,PPO,61.38,93,,percent of total billed charges,,
"Immunoglobulin A (Iga), S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Both,,,90,66,56.1,18.9156,66,America's PPO,America's PPO,63.3798,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Immunoglobulin A (Iga), S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Both,,,90,66,56.1,18.9156,66,BlueCross BlueShield Minnesota, Federal Employee Program,64.944,98.4,,percent of total billed charges,,
"Immunoglobulin A (Iga), S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Both,,,90,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,66,100,,percent of total billed charges,,
"Immunoglobulin A (Iga), S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Both,,,90,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,High Value Network Plan,59.4,90,,percent of total billed charges,,
"Immunoglobulin A (Iga), S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Outpatient,,,90,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,Medicare Advantage,32.34,49,,percent of total billed charges,,
"Immunoglobulin A (Iga), S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Inpatient,,,90,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Immunoglobulin A (Iga), S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Both,,,90,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,58.4562,88.57,,percent of total billed charges,,
"Immunoglobulin A (Iga), S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Both,,,90,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,18.9156,28.66,,percent of total billed charges,,
"Immunoglobulin A (Iga), S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Outpatient,,,90,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),32.34,49,,percent of total billed charges,,
"Immunoglobulin A (Iga), S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Inpatient,,,90,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Immunoglobulin A (Iga), S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Both,,,90,66,56.1,18.9156,66,CorVel,Worker's Compensation,66,100,,percent of total billed charges,,
"Immunoglobulin A (Iga), S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Both,,,90,66,56.1,18.9156,66,First Health Group Corporation,First Health Network,64.02,97,,percent of total billed charges,,
"Immunoglobulin A (Iga), S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Both,,,90,66,56.1,18.9156,66,"Health Partners, Inc.",Commercial,62.436,94.6,,percent of total billed charges,,
"Immunoglobulin A (Iga), S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Outpatient,,,90,66,56.1,18.9156,66,"Health Partners, Inc.",Medicare Advantage,32.34,49,,percent of total billed charges,,
"Immunoglobulin A (Iga), S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Inpatient,,,90,66,56.1,18.9156,66,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Immunoglobulin A (Iga), S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Both,,,90,66,56.1,18.9156,66,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),39.6,60,,percent of total billed charges,,
"Immunoglobulin A (Iga), S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Both,,,90,66,56.1,18.9156,66,"Health Partners, Inc.",State of Minnesota Advantage Program,53.79,81.5,,percent of total billed charges,,
"Immunoglobulin A (Iga), S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Both,,,90,66,56.1,18.9156,66,"Health Partners, Inc.",State Public Programs,33,50,,percent of total billed charges,,
"Immunoglobulin A (Iga), S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Both,,,90,66,56.1,18.9156,66,Humana Insurance Company,Commercial PPO,62.7,95,,percent of total billed charges,,
"Immunoglobulin A (Iga), S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Outpatient,,,90,66,56.1,18.9156,66,Humana Insurance Company,Medicare PPO,32.34,49,,percent of total billed charges,,
"Immunoglobulin A (Iga), S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Inpatient,,,90,66,56.1,18.9156,66,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Immunoglobulin A (Iga), S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Both,,,90,66,56.1,18.9156,66,Medica,Individual & Family,65.406,99.1,,percent of total billed charges,,
"Immunoglobulin A (Iga), S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Outpatient,,,90,66,56.1,18.9156,66,Medica,Medica Advantage Solution,32.868,49.8,,percent of total billed charges,,
"Immunoglobulin A (Iga), S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Inpatient,,,90,66,56.1,18.9156,66,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Immunoglobulin A (Iga), S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Outpatient,,,90,66,56.1,18.9156,66,Medica,Medical Assistance,29.436,44.6,,percent of total billed charges,,
"Immunoglobulin A (Iga), S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Inpatient,,,90,66,56.1,18.9156,66,Medica,Medical Assistance,,,,,Included in per diem rate,
"Immunoglobulin A (Iga), S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Outpatient,,,90,66,56.1,18.9156,66,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,32.868,49.8,,percent of total billed charges,,
"Immunoglobulin A (Iga), S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Inpatient,,,90,66,56.1,18.9156,66,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Immunoglobulin A (Iga), S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Both,,,90,66,56.1,18.9156,66,"Multiplan, Inc.","Multiplan, Inc.",62.04,94,,percent of total billed charges,,
"Immunoglobulin A (Iga), S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Outpatient,,,90,66,56.1,18.9156,66,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,57.024,86.4,,percent of total billed charges,,
"Immunoglobulin A (Iga), S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Inpatient,,,90,66,56.1,18.9156,66,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Immunoglobulin A (Iga), S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Both,,,90,66,56.1,18.9156,66,"Preferred One Administrative Services, INC.",PPO,65.076,98.6,,percent of total billed charges,,
"Immunoglobulin A (Iga), S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Outpatient,,,90,66,56.1,18.9156,66,PrimeWest Health,Minnesota Senior Health Options (MSHO),33.957,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Immunoglobulin A (Iga), S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Inpatient,,,90,66,56.1,18.9156,66,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Immunoglobulin A (Iga), S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Outpatient,,,90,66,56.1,18.9156,66,PrimeWest Health,MinnesotaCare,33.8976,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Immunoglobulin A (Iga), S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Inpatient,,,90,66,56.1,18.9156,66,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Immunoglobulin A (Iga), S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Both,,,90,66,56.1,18.9156,66,Sanford Health Plan,Sanford Health Plan,60.72,92,,percent of total billed charges,,
"Immunoglobulin A (Iga), S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Outpatient,,,90,66,56.1,18.9156,66,"UCare Health, Inc.",Individual & Family Plan,37.191,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Immunoglobulin A (Iga), S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Inpatient,,,90,66,56.1,18.9156,66,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Immunoglobulin A (Iga), S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Outpatient,,,90,66,56.1,18.9156,66,"UCare Health, Inc.",Medical Assistance,33.3102,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Immunoglobulin A (Iga), S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Inpatient,,,90,66,56.1,18.9156,66,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Immunoglobulin A (Iga), S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Outpatient,,,90,66,56.1,18.9156,66,"UCare Health, Inc.",Medicare Advantage,33.3102,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Immunoglobulin A (Iga), S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Inpatient,,,90,66,56.1,18.9156,66,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Immunoglobulin A (Iga), S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Outpatient,,,90,66,56.1,18.9156,66,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),33.3102,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Immunoglobulin A (Iga), S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Inpatient,,,90,66,56.1,18.9156,66,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Immunoglobulin A (Iga), S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Both,,,90,66,56.1,18.9156,66,UnitedHealthcare,Individual & Family,62.04,94,,percent of total billed charges,,
"Immunoglobulin A (Iga), S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Outpatient,,,90,66,56.1,18.9156,66,UnitedHealthcare,Medicare Advantage,32.34,49,,percent of total billed charges,,
"Immunoglobulin A (Iga), S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Inpatient,,,90,66,56.1,18.9156,66,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Immunoglobulin A (Iga), S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Outpatient,,,90,66,56.1,18.9156,66,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,31.68,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Immunoglobulin A (Iga), S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Inpatient,,,90,66,56.1,18.9156,66,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Immunoglobulin G (Igg), S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Both,,,90,66,56.1,18.9156,66,Aetna,Commercial,60.72,92,,percent of total billed charges,,
"Immunoglobulin G (Igg), S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Outpatient,,,90,66,56.1,18.9156,66,Aetna,Medicare Advantage,32.34,49,,percent of total billed charges,,
"Immunoglobulin G (Igg), S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Inpatient,,,90,66,56.1,18.9156,66,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Immunoglobulin G (Igg), S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Both,,,90,66,56.1,18.9156,66,Aetna,PPO,61.38,93,,percent of total billed charges,,
"Immunoglobulin G (Igg), S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Both,,,90,66,56.1,18.9156,66,America's PPO,America's PPO,63.3798,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Immunoglobulin G (Igg), S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Both,,,90,66,56.1,18.9156,66,BlueCross BlueShield Minnesota, Federal Employee Program,64.944,98.4,,percent of total billed charges,,
"Immunoglobulin G (Igg), S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Both,,,90,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,66,100,,percent of total billed charges,,
"Immunoglobulin G (Igg), S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Both,,,90,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,High Value Network Plan,59.4,90,,percent of total billed charges,,
"Immunoglobulin G (Igg), S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Outpatient,,,90,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,Medicare Advantage,32.34,49,,percent of total billed charges,,
"Immunoglobulin G (Igg), S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Inpatient,,,90,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Immunoglobulin G (Igg), S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Both,,,90,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,58.4562,88.57,,percent of total billed charges,,
"Immunoglobulin G (Igg), S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Both,,,90,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,18.9156,28.66,,percent of total billed charges,,
"Immunoglobulin G (Igg), S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Outpatient,,,90,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),32.34,49,,percent of total billed charges,,
"Immunoglobulin G (Igg), S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Inpatient,,,90,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Immunoglobulin G (Igg), S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Both,,,90,66,56.1,18.9156,66,CorVel,Worker's Compensation,66,100,,percent of total billed charges,,
"Immunoglobulin G (Igg), S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Both,,,90,66,56.1,18.9156,66,First Health Group Corporation,First Health Network,64.02,97,,percent of total billed charges,,
"Immunoglobulin G (Igg), S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Both,,,90,66,56.1,18.9156,66,"Health Partners, Inc.",Commercial,62.436,94.6,,percent of total billed charges,,
"Immunoglobulin G (Igg), S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Outpatient,,,90,66,56.1,18.9156,66,"Health Partners, Inc.",Medicare Advantage,32.34,49,,percent of total billed charges,,
"Immunoglobulin G (Igg), S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Inpatient,,,90,66,56.1,18.9156,66,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Immunoglobulin G (Igg), S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Both,,,90,66,56.1,18.9156,66,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),39.6,60,,percent of total billed charges,,
"Immunoglobulin G (Igg), S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Both,,,90,66,56.1,18.9156,66,"Health Partners, Inc.",State of Minnesota Advantage Program,53.79,81.5,,percent of total billed charges,,
"Immunoglobulin G (Igg), S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Both,,,90,66,56.1,18.9156,66,"Health Partners, Inc.",State Public Programs,33,50,,percent of total billed charges,,
"Immunoglobulin G (Igg), S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Both,,,90,66,56.1,18.9156,66,Humana Insurance Company,Commercial PPO,62.7,95,,percent of total billed charges,,
"Immunoglobulin G (Igg), S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Outpatient,,,90,66,56.1,18.9156,66,Humana Insurance Company,Medicare PPO,32.34,49,,percent of total billed charges,,
"Immunoglobulin G (Igg), S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Inpatient,,,90,66,56.1,18.9156,66,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Immunoglobulin G (Igg), S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Both,,,90,66,56.1,18.9156,66,Medica,Individual & Family,65.406,99.1,,percent of total billed charges,,
"Immunoglobulin G (Igg), S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Outpatient,,,90,66,56.1,18.9156,66,Medica,Medica Advantage Solution,32.868,49.8,,percent of total billed charges,,
"Immunoglobulin G (Igg), S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Inpatient,,,90,66,56.1,18.9156,66,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Immunoglobulin G (Igg), S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Outpatient,,,90,66,56.1,18.9156,66,Medica,Medical Assistance,29.436,44.6,,percent of total billed charges,,
"Immunoglobulin G (Igg), S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Inpatient,,,90,66,56.1,18.9156,66,Medica,Medical Assistance,,,,,Included in per diem rate,
"Immunoglobulin G (Igg), S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Outpatient,,,90,66,56.1,18.9156,66,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,32.868,49.8,,percent of total billed charges,,
"Immunoglobulin G (Igg), S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Inpatient,,,90,66,56.1,18.9156,66,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Immunoglobulin G (Igg), S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Both,,,90,66,56.1,18.9156,66,"Multiplan, Inc.","Multiplan, Inc.",62.04,94,,percent of total billed charges,,
"Immunoglobulin G (Igg), S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Outpatient,,,90,66,56.1,18.9156,66,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,57.024,86.4,,percent of total billed charges,,
"Immunoglobulin G (Igg), S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Inpatient,,,90,66,56.1,18.9156,66,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Immunoglobulin G (Igg), S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Both,,,90,66,56.1,18.9156,66,"Preferred One Administrative Services, INC.",PPO,65.076,98.6,,percent of total billed charges,,
"Immunoglobulin G (Igg), S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Outpatient,,,90,66,56.1,18.9156,66,PrimeWest Health,Minnesota Senior Health Options (MSHO),33.957,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Immunoglobulin G (Igg), S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Inpatient,,,90,66,56.1,18.9156,66,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Immunoglobulin G (Igg), S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Outpatient,,,90,66,56.1,18.9156,66,PrimeWest Health,MinnesotaCare,33.8976,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Immunoglobulin G (Igg), S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Inpatient,,,90,66,56.1,18.9156,66,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Immunoglobulin G (Igg), S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Both,,,90,66,56.1,18.9156,66,Sanford Health Plan,Sanford Health Plan,60.72,92,,percent of total billed charges,,
"Immunoglobulin G (Igg), S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Outpatient,,,90,66,56.1,18.9156,66,"UCare Health, Inc.",Individual & Family Plan,37.191,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Immunoglobulin G (Igg), S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Inpatient,,,90,66,56.1,18.9156,66,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Immunoglobulin G (Igg), S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Outpatient,,,90,66,56.1,18.9156,66,"UCare Health, Inc.",Medical Assistance,33.3102,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Immunoglobulin G (Igg), S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Inpatient,,,90,66,56.1,18.9156,66,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Immunoglobulin G (Igg), S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Outpatient,,,90,66,56.1,18.9156,66,"UCare Health, Inc.",Medicare Advantage,33.3102,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Immunoglobulin G (Igg), S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Inpatient,,,90,66,56.1,18.9156,66,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Immunoglobulin G (Igg), S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Outpatient,,,90,66,56.1,18.9156,66,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),33.3102,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Immunoglobulin G (Igg), S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Inpatient,,,90,66,56.1,18.9156,66,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Immunoglobulin G (Igg), S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Both,,,90,66,56.1,18.9156,66,UnitedHealthcare,Individual & Family,62.04,94,,percent of total billed charges,,
"Immunoglobulin G (Igg), S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Outpatient,,,90,66,56.1,18.9156,66,UnitedHealthcare,Medicare Advantage,32.34,49,,percent of total billed charges,,
"Immunoglobulin G (Igg), S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Inpatient,,,90,66,56.1,18.9156,66,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Immunoglobulin G (Igg), S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Outpatient,,,90,66,56.1,18.9156,66,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,31.68,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Immunoglobulin G (Igg), S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Inpatient,,,90,66,56.1,18.9156,66,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Immunoglobulin M (Igm), S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Both,,,90,66,56.1,18.9156,66,Aetna,Commercial,60.72,92,,percent of total billed charges,,
"Immunoglobulin M (Igm), S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Outpatient,,,90,66,56.1,18.9156,66,Aetna,Medicare Advantage,32.34,49,,percent of total billed charges,,
"Immunoglobulin M (Igm), S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Inpatient,,,90,66,56.1,18.9156,66,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Immunoglobulin M (Igm), S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Both,,,90,66,56.1,18.9156,66,Aetna,PPO,61.38,93,,percent of total billed charges,,
"Immunoglobulin M (Igm), S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Both,,,90,66,56.1,18.9156,66,America's PPO,America's PPO,63.3798,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Immunoglobulin M (Igm), S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Both,,,90,66,56.1,18.9156,66,BlueCross BlueShield Minnesota, Federal Employee Program,64.944,98.4,,percent of total billed charges,,
"Immunoglobulin M (Igm), S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Both,,,90,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,66,100,,percent of total billed charges,,
"Immunoglobulin M (Igm), S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Both,,,90,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,High Value Network Plan,59.4,90,,percent of total billed charges,,
"Immunoglobulin M (Igm), S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Outpatient,,,90,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,Medicare Advantage,32.34,49,,percent of total billed charges,,
"Immunoglobulin M (Igm), S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Inpatient,,,90,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Immunoglobulin M (Igm), S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Both,,,90,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,58.4562,88.57,,percent of total billed charges,,
"Immunoglobulin M (Igm), S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Both,,,90,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,18.9156,28.66,,percent of total billed charges,,
"Immunoglobulin M (Igm), S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Outpatient,,,90,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),32.34,49,,percent of total billed charges,,
"Immunoglobulin M (Igm), S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Inpatient,,,90,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Immunoglobulin M (Igm), S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Both,,,90,66,56.1,18.9156,66,CorVel,Worker's Compensation,66,100,,percent of total billed charges,,
"Immunoglobulin M (Igm), S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Both,,,90,66,56.1,18.9156,66,First Health Group Corporation,First Health Network,64.02,97,,percent of total billed charges,,
"Immunoglobulin M (Igm), S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Both,,,90,66,56.1,18.9156,66,"Health Partners, Inc.",Commercial,62.436,94.6,,percent of total billed charges,,
"Immunoglobulin M (Igm), S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Outpatient,,,90,66,56.1,18.9156,66,"Health Partners, Inc.",Medicare Advantage,32.34,49,,percent of total billed charges,,
"Immunoglobulin M (Igm), S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Inpatient,,,90,66,56.1,18.9156,66,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Immunoglobulin M (Igm), S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Both,,,90,66,56.1,18.9156,66,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),39.6,60,,percent of total billed charges,,
"Immunoglobulin M (Igm), S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Both,,,90,66,56.1,18.9156,66,"Health Partners, Inc.",State of Minnesota Advantage Program,53.79,81.5,,percent of total billed charges,,
"Immunoglobulin M (Igm), S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Both,,,90,66,56.1,18.9156,66,"Health Partners, Inc.",State Public Programs,33,50,,percent of total billed charges,,
"Immunoglobulin M (Igm), S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Both,,,90,66,56.1,18.9156,66,Humana Insurance Company,Commercial PPO,62.7,95,,percent of total billed charges,,
"Immunoglobulin M (Igm), S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Outpatient,,,90,66,56.1,18.9156,66,Humana Insurance Company,Medicare PPO,32.34,49,,percent of total billed charges,,
"Immunoglobulin M (Igm), S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Inpatient,,,90,66,56.1,18.9156,66,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Immunoglobulin M (Igm), S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Both,,,90,66,56.1,18.9156,66,Medica,Individual & Family,65.406,99.1,,percent of total billed charges,,
"Immunoglobulin M (Igm), S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Outpatient,,,90,66,56.1,18.9156,66,Medica,Medica Advantage Solution,32.868,49.8,,percent of total billed charges,,
"Immunoglobulin M (Igm), S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Inpatient,,,90,66,56.1,18.9156,66,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Immunoglobulin M (Igm), S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Outpatient,,,90,66,56.1,18.9156,66,Medica,Medical Assistance,29.436,44.6,,percent of total billed charges,,
"Immunoglobulin M (Igm), S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Inpatient,,,90,66,56.1,18.9156,66,Medica,Medical Assistance,,,,,Included in per diem rate,
"Immunoglobulin M (Igm), S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Outpatient,,,90,66,56.1,18.9156,66,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,32.868,49.8,,percent of total billed charges,,
"Immunoglobulin M (Igm), S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Inpatient,,,90,66,56.1,18.9156,66,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Immunoglobulin M (Igm), S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Both,,,90,66,56.1,18.9156,66,"Multiplan, Inc.","Multiplan, Inc.",62.04,94,,percent of total billed charges,,
"Immunoglobulin M (Igm), S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Outpatient,,,90,66,56.1,18.9156,66,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,57.024,86.4,,percent of total billed charges,,
"Immunoglobulin M (Igm), S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Inpatient,,,90,66,56.1,18.9156,66,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Immunoglobulin M (Igm), S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Both,,,90,66,56.1,18.9156,66,"Preferred One Administrative Services, INC.",PPO,65.076,98.6,,percent of total billed charges,,
"Immunoglobulin M (Igm), S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Outpatient,,,90,66,56.1,18.9156,66,PrimeWest Health,Minnesota Senior Health Options (MSHO),33.957,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Immunoglobulin M (Igm), S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Inpatient,,,90,66,56.1,18.9156,66,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Immunoglobulin M (Igm), S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Outpatient,,,90,66,56.1,18.9156,66,PrimeWest Health,MinnesotaCare,33.8976,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Immunoglobulin M (Igm), S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Inpatient,,,90,66,56.1,18.9156,66,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Immunoglobulin M (Igm), S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Both,,,90,66,56.1,18.9156,66,Sanford Health Plan,Sanford Health Plan,60.72,92,,percent of total billed charges,,
"Immunoglobulin M (Igm), S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Outpatient,,,90,66,56.1,18.9156,66,"UCare Health, Inc.",Individual & Family Plan,37.191,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Immunoglobulin M (Igm), S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Inpatient,,,90,66,56.1,18.9156,66,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Immunoglobulin M (Igm), S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Outpatient,,,90,66,56.1,18.9156,66,"UCare Health, Inc.",Medical Assistance,33.3102,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Immunoglobulin M (Igm), S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Inpatient,,,90,66,56.1,18.9156,66,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Immunoglobulin M (Igm), S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Outpatient,,,90,66,56.1,18.9156,66,"UCare Health, Inc.",Medicare Advantage,33.3102,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Immunoglobulin M (Igm), S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Inpatient,,,90,66,56.1,18.9156,66,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Immunoglobulin M (Igm), S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Outpatient,,,90,66,56.1,18.9156,66,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),33.3102,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Immunoglobulin M (Igm), S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Inpatient,,,90,66,56.1,18.9156,66,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Immunoglobulin M (Igm), S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Both,,,90,66,56.1,18.9156,66,UnitedHealthcare,Individual & Family,62.04,94,,percent of total billed charges,,
"Immunoglobulin M (Igm), S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Outpatient,,,90,66,56.1,18.9156,66,UnitedHealthcare,Medicare Advantage,32.34,49,,percent of total billed charges,,
"Immunoglobulin M (Igm), S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Inpatient,,,90,66,56.1,18.9156,66,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Immunoglobulin M (Igm), S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Outpatient,,,90,66,56.1,18.9156,66,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,31.68,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Immunoglobulin M (Igm), S (Mayo)OutsideLaboratory",,82784,CPT,Facility,Inpatient,,,90,66,56.1,18.9156,66,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Immunoglobulin, Iga (Mayo)OutsideLaboratory",,82784,CPT,Facility,Both,,,90,66,56.1,18.9156,66,Aetna,Commercial,60.72,92,,percent of total billed charges,,
"Immunoglobulin, Iga (Mayo)OutsideLaboratory",,82784,CPT,Facility,Outpatient,,,90,66,56.1,18.9156,66,Aetna,Medicare Advantage,32.34,49,,percent of total billed charges,,
"Immunoglobulin, Iga (Mayo)OutsideLaboratory",,82784,CPT,Facility,Inpatient,,,90,66,56.1,18.9156,66,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Immunoglobulin, Iga (Mayo)OutsideLaboratory",,82784,CPT,Facility,Both,,,90,66,56.1,18.9156,66,Aetna,PPO,61.38,93,,percent of total billed charges,,
"Immunoglobulin, Iga (Mayo)OutsideLaboratory",,82784,CPT,Facility,Both,,,90,66,56.1,18.9156,66,America's PPO,America's PPO,63.3798,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Immunoglobulin, Iga (Mayo)OutsideLaboratory",,82784,CPT,Facility,Both,,,90,66,56.1,18.9156,66,BlueCross BlueShield Minnesota, Federal Employee Program,64.944,98.4,,percent of total billed charges,,
"Immunoglobulin, Iga (Mayo)OutsideLaboratory",,82784,CPT,Facility,Both,,,90,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,66,100,,percent of total billed charges,,
"Immunoglobulin, Iga (Mayo)OutsideLaboratory",,82784,CPT,Facility,Both,,,90,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,High Value Network Plan,59.4,90,,percent of total billed charges,,
"Immunoglobulin, Iga (Mayo)OutsideLaboratory",,82784,CPT,Facility,Outpatient,,,90,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,Medicare Advantage,32.34,49,,percent of total billed charges,,
"Immunoglobulin, Iga (Mayo)OutsideLaboratory",,82784,CPT,Facility,Inpatient,,,90,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Immunoglobulin, Iga (Mayo)OutsideLaboratory",,82784,CPT,Facility,Both,,,90,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,58.4562,88.57,,percent of total billed charges,,
"Immunoglobulin, Iga (Mayo)OutsideLaboratory",,82784,CPT,Facility,Both,,,90,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,18.9156,28.66,,percent of total billed charges,,
"Immunoglobulin, Iga (Mayo)OutsideLaboratory",,82784,CPT,Facility,Outpatient,,,90,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),32.34,49,,percent of total billed charges,,
"Immunoglobulin, Iga (Mayo)OutsideLaboratory",,82784,CPT,Facility,Inpatient,,,90,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Immunoglobulin, Iga (Mayo)OutsideLaboratory",,82784,CPT,Facility,Both,,,90,66,56.1,18.9156,66,CorVel,Worker's Compensation,66,100,,percent of total billed charges,,
"Immunoglobulin, Iga (Mayo)OutsideLaboratory",,82784,CPT,Facility,Both,,,90,66,56.1,18.9156,66,First Health Group Corporation,First Health Network,64.02,97,,percent of total billed charges,,
"Immunoglobulin, Iga (Mayo)OutsideLaboratory",,82784,CPT,Facility,Both,,,90,66,56.1,18.9156,66,"Health Partners, Inc.",Commercial,62.436,94.6,,percent of total billed charges,,
"Immunoglobulin, Iga (Mayo)OutsideLaboratory",,82784,CPT,Facility,Outpatient,,,90,66,56.1,18.9156,66,"Health Partners, Inc.",Medicare Advantage,32.34,49,,percent of total billed charges,,
"Immunoglobulin, Iga (Mayo)OutsideLaboratory",,82784,CPT,Facility,Inpatient,,,90,66,56.1,18.9156,66,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Immunoglobulin, Iga (Mayo)OutsideLaboratory",,82784,CPT,Facility,Both,,,90,66,56.1,18.9156,66,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),39.6,60,,percent of total billed charges,,
"Immunoglobulin, Iga (Mayo)OutsideLaboratory",,82784,CPT,Facility,Both,,,90,66,56.1,18.9156,66,"Health Partners, Inc.",State of Minnesota Advantage Program,53.79,81.5,,percent of total billed charges,,
"Immunoglobulin, Iga (Mayo)OutsideLaboratory",,82784,CPT,Facility,Both,,,90,66,56.1,18.9156,66,"Health Partners, Inc.",State Public Programs,33,50,,percent of total billed charges,,
"Immunoglobulin, Iga (Mayo)OutsideLaboratory",,82784,CPT,Facility,Both,,,90,66,56.1,18.9156,66,Humana Insurance Company,Commercial PPO,62.7,95,,percent of total billed charges,,
"Immunoglobulin, Iga (Mayo)OutsideLaboratory",,82784,CPT,Facility,Outpatient,,,90,66,56.1,18.9156,66,Humana Insurance Company,Medicare PPO,32.34,49,,percent of total billed charges,,
"Immunoglobulin, Iga (Mayo)OutsideLaboratory",,82784,CPT,Facility,Inpatient,,,90,66,56.1,18.9156,66,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Immunoglobulin, Iga (Mayo)OutsideLaboratory",,82784,CPT,Facility,Both,,,90,66,56.1,18.9156,66,Medica,Individual & Family,65.406,99.1,,percent of total billed charges,,
"Immunoglobulin, Iga (Mayo)OutsideLaboratory",,82784,CPT,Facility,Outpatient,,,90,66,56.1,18.9156,66,Medica,Medica Advantage Solution,32.868,49.8,,percent of total billed charges,,
"Immunoglobulin, Iga (Mayo)OutsideLaboratory",,82784,CPT,Facility,Inpatient,,,90,66,56.1,18.9156,66,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Immunoglobulin, Iga (Mayo)OutsideLaboratory",,82784,CPT,Facility,Outpatient,,,90,66,56.1,18.9156,66,Medica,Medical Assistance,29.436,44.6,,percent of total billed charges,,
"Immunoglobulin, Iga (Mayo)OutsideLaboratory",,82784,CPT,Facility,Inpatient,,,90,66,56.1,18.9156,66,Medica,Medical Assistance,,,,,Included in per diem rate,
"Immunoglobulin, Iga (Mayo)OutsideLaboratory",,82784,CPT,Facility,Outpatient,,,90,66,56.1,18.9156,66,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,32.868,49.8,,percent of total billed charges,,
"Immunoglobulin, Iga (Mayo)OutsideLaboratory",,82784,CPT,Facility,Inpatient,,,90,66,56.1,18.9156,66,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Immunoglobulin, Iga (Mayo)OutsideLaboratory",,82784,CPT,Facility,Both,,,90,66,56.1,18.9156,66,"Multiplan, Inc.","Multiplan, Inc.",62.04,94,,percent of total billed charges,,
"Immunoglobulin, Iga (Mayo)OutsideLaboratory",,82784,CPT,Facility,Outpatient,,,90,66,56.1,18.9156,66,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,57.024,86.4,,percent of total billed charges,,
"Immunoglobulin, Iga (Mayo)OutsideLaboratory",,82784,CPT,Facility,Inpatient,,,90,66,56.1,18.9156,66,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Immunoglobulin, Iga (Mayo)OutsideLaboratory",,82784,CPT,Facility,Both,,,90,66,56.1,18.9156,66,"Preferred One Administrative Services, INC.",PPO,65.076,98.6,,percent of total billed charges,,
"Immunoglobulin, Iga (Mayo)OutsideLaboratory",,82784,CPT,Facility,Outpatient,,,90,66,56.1,18.9156,66,PrimeWest Health,Minnesota Senior Health Options (MSHO),33.957,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Immunoglobulin, Iga (Mayo)OutsideLaboratory",,82784,CPT,Facility,Inpatient,,,90,66,56.1,18.9156,66,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Immunoglobulin, Iga (Mayo)OutsideLaboratory",,82784,CPT,Facility,Outpatient,,,90,66,56.1,18.9156,66,PrimeWest Health,MinnesotaCare,33.8976,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Immunoglobulin, Iga (Mayo)OutsideLaboratory",,82784,CPT,Facility,Inpatient,,,90,66,56.1,18.9156,66,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Immunoglobulin, Iga (Mayo)OutsideLaboratory",,82784,CPT,Facility,Both,,,90,66,56.1,18.9156,66,Sanford Health Plan,Sanford Health Plan,60.72,92,,percent of total billed charges,,
"Immunoglobulin, Iga (Mayo)OutsideLaboratory",,82784,CPT,Facility,Outpatient,,,90,66,56.1,18.9156,66,"UCare Health, Inc.",Individual & Family Plan,37.191,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Immunoglobulin, Iga (Mayo)OutsideLaboratory",,82784,CPT,Facility,Inpatient,,,90,66,56.1,18.9156,66,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Immunoglobulin, Iga (Mayo)OutsideLaboratory",,82784,CPT,Facility,Outpatient,,,90,66,56.1,18.9156,66,"UCare Health, Inc.",Medical Assistance,33.3102,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Immunoglobulin, Iga (Mayo)OutsideLaboratory",,82784,CPT,Facility,Inpatient,,,90,66,56.1,18.9156,66,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Immunoglobulin, Iga (Mayo)OutsideLaboratory",,82784,CPT,Facility,Outpatient,,,90,66,56.1,18.9156,66,"UCare Health, Inc.",Medicare Advantage,33.3102,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Immunoglobulin, Iga (Mayo)OutsideLaboratory",,82784,CPT,Facility,Inpatient,,,90,66,56.1,18.9156,66,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Immunoglobulin, Iga (Mayo)OutsideLaboratory",,82784,CPT,Facility,Outpatient,,,90,66,56.1,18.9156,66,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),33.3102,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Immunoglobulin, Iga (Mayo)OutsideLaboratory",,82784,CPT,Facility,Inpatient,,,90,66,56.1,18.9156,66,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Immunoglobulin, Iga (Mayo)OutsideLaboratory",,82784,CPT,Facility,Both,,,90,66,56.1,18.9156,66,UnitedHealthcare,Individual & Family,62.04,94,,percent of total billed charges,,
"Immunoglobulin, Iga (Mayo)OutsideLaboratory",,82784,CPT,Facility,Outpatient,,,90,66,56.1,18.9156,66,UnitedHealthcare,Medicare Advantage,32.34,49,,percent of total billed charges,,
"Immunoglobulin, Iga (Mayo)OutsideLaboratory",,82784,CPT,Facility,Inpatient,,,90,66,56.1,18.9156,66,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Immunoglobulin, Iga (Mayo)OutsideLaboratory",,82784,CPT,Facility,Outpatient,,,90,66,56.1,18.9156,66,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,31.68,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Immunoglobulin, Iga (Mayo)OutsideLaboratory",,82784,CPT,Facility,Inpatient,,,90,66,56.1,18.9156,66,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Immunoglobulin, Igg (Mayo)OutsideLaboratory",,82784,CPT,Facility,Both,,,90,66,56.1,18.9156,66,Aetna,Commercial,60.72,92,,percent of total billed charges,,
"Immunoglobulin, Igg (Mayo)OutsideLaboratory",,82784,CPT,Facility,Outpatient,,,90,66,56.1,18.9156,66,Aetna,Medicare Advantage,32.34,49,,percent of total billed charges,,
"Immunoglobulin, Igg (Mayo)OutsideLaboratory",,82784,CPT,Facility,Inpatient,,,90,66,56.1,18.9156,66,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Immunoglobulin, Igg (Mayo)OutsideLaboratory",,82784,CPT,Facility,Both,,,90,66,56.1,18.9156,66,Aetna,PPO,61.38,93,,percent of total billed charges,,
"Immunoglobulin, Igg (Mayo)OutsideLaboratory",,82784,CPT,Facility,Both,,,90,66,56.1,18.9156,66,America's PPO,America's PPO,63.3798,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Immunoglobulin, Igg (Mayo)OutsideLaboratory",,82784,CPT,Facility,Both,,,90,66,56.1,18.9156,66,BlueCross BlueShield Minnesota, Federal Employee Program,64.944,98.4,,percent of total billed charges,,
"Immunoglobulin, Igg (Mayo)OutsideLaboratory",,82784,CPT,Facility,Both,,,90,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,66,100,,percent of total billed charges,,
"Immunoglobulin, Igg (Mayo)OutsideLaboratory",,82784,CPT,Facility,Both,,,90,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,High Value Network Plan,59.4,90,,percent of total billed charges,,
"Immunoglobulin, Igg (Mayo)OutsideLaboratory",,82784,CPT,Facility,Outpatient,,,90,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,Medicare Advantage,32.34,49,,percent of total billed charges,,
"Immunoglobulin, Igg (Mayo)OutsideLaboratory",,82784,CPT,Facility,Inpatient,,,90,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Immunoglobulin, Igg (Mayo)OutsideLaboratory",,82784,CPT,Facility,Both,,,90,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,58.4562,88.57,,percent of total billed charges,,
"Immunoglobulin, Igg (Mayo)OutsideLaboratory",,82784,CPT,Facility,Both,,,90,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,18.9156,28.66,,percent of total billed charges,,
"Immunoglobulin, Igg (Mayo)OutsideLaboratory",,82784,CPT,Facility,Outpatient,,,90,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),32.34,49,,percent of total billed charges,,
"Immunoglobulin, Igg (Mayo)OutsideLaboratory",,82784,CPT,Facility,Inpatient,,,90,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Immunoglobulin, Igg (Mayo)OutsideLaboratory",,82784,CPT,Facility,Both,,,90,66,56.1,18.9156,66,CorVel,Worker's Compensation,66,100,,percent of total billed charges,,
"Immunoglobulin, Igg (Mayo)OutsideLaboratory",,82784,CPT,Facility,Both,,,90,66,56.1,18.9156,66,First Health Group Corporation,First Health Network,64.02,97,,percent of total billed charges,,
"Immunoglobulin, Igg (Mayo)OutsideLaboratory",,82784,CPT,Facility,Both,,,90,66,56.1,18.9156,66,"Health Partners, Inc.",Commercial,62.436,94.6,,percent of total billed charges,,
"Immunoglobulin, Igg (Mayo)OutsideLaboratory",,82784,CPT,Facility,Outpatient,,,90,66,56.1,18.9156,66,"Health Partners, Inc.",Medicare Advantage,32.34,49,,percent of total billed charges,,
"Immunoglobulin, Igg (Mayo)OutsideLaboratory",,82784,CPT,Facility,Inpatient,,,90,66,56.1,18.9156,66,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Immunoglobulin, Igg (Mayo)OutsideLaboratory",,82784,CPT,Facility,Both,,,90,66,56.1,18.9156,66,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),39.6,60,,percent of total billed charges,,
"Immunoglobulin, Igg (Mayo)OutsideLaboratory",,82784,CPT,Facility,Both,,,90,66,56.1,18.9156,66,"Health Partners, Inc.",State of Minnesota Advantage Program,53.79,81.5,,percent of total billed charges,,
"Immunoglobulin, Igg (Mayo)OutsideLaboratory",,82784,CPT,Facility,Both,,,90,66,56.1,18.9156,66,"Health Partners, Inc.",State Public Programs,33,50,,percent of total billed charges,,
"Immunoglobulin, Igg (Mayo)OutsideLaboratory",,82784,CPT,Facility,Both,,,90,66,56.1,18.9156,66,Humana Insurance Company,Commercial PPO,62.7,95,,percent of total billed charges,,
"Immunoglobulin, Igg (Mayo)OutsideLaboratory",,82784,CPT,Facility,Outpatient,,,90,66,56.1,18.9156,66,Humana Insurance Company,Medicare PPO,32.34,49,,percent of total billed charges,,
"Immunoglobulin, Igg (Mayo)OutsideLaboratory",,82784,CPT,Facility,Inpatient,,,90,66,56.1,18.9156,66,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Immunoglobulin, Igg (Mayo)OutsideLaboratory",,82784,CPT,Facility,Both,,,90,66,56.1,18.9156,66,Medica,Individual & Family,65.406,99.1,,percent of total billed charges,,
"Immunoglobulin, Igg (Mayo)OutsideLaboratory",,82784,CPT,Facility,Outpatient,,,90,66,56.1,18.9156,66,Medica,Medica Advantage Solution,32.868,49.8,,percent of total billed charges,,
"Immunoglobulin, Igg (Mayo)OutsideLaboratory",,82784,CPT,Facility,Inpatient,,,90,66,56.1,18.9156,66,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Immunoglobulin, Igg (Mayo)OutsideLaboratory",,82784,CPT,Facility,Outpatient,,,90,66,56.1,18.9156,66,Medica,Medical Assistance,29.436,44.6,,percent of total billed charges,,
"Immunoglobulin, Igg (Mayo)OutsideLaboratory",,82784,CPT,Facility,Inpatient,,,90,66,56.1,18.9156,66,Medica,Medical Assistance,,,,,Included in per diem rate,
"Immunoglobulin, Igg (Mayo)OutsideLaboratory",,82784,CPT,Facility,Outpatient,,,90,66,56.1,18.9156,66,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,32.868,49.8,,percent of total billed charges,,
"Immunoglobulin, Igg (Mayo)OutsideLaboratory",,82784,CPT,Facility,Inpatient,,,90,66,56.1,18.9156,66,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Immunoglobulin, Igg (Mayo)OutsideLaboratory",,82784,CPT,Facility,Both,,,90,66,56.1,18.9156,66,"Multiplan, Inc.","Multiplan, Inc.",62.04,94,,percent of total billed charges,,
"Immunoglobulin, Igg (Mayo)OutsideLaboratory",,82784,CPT,Facility,Outpatient,,,90,66,56.1,18.9156,66,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,57.024,86.4,,percent of total billed charges,,
"Immunoglobulin, Igg (Mayo)OutsideLaboratory",,82784,CPT,Facility,Inpatient,,,90,66,56.1,18.9156,66,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Immunoglobulin, Igg (Mayo)OutsideLaboratory",,82784,CPT,Facility,Both,,,90,66,56.1,18.9156,66,"Preferred One Administrative Services, INC.",PPO,65.076,98.6,,percent of total billed charges,,
"Immunoglobulin, Igg (Mayo)OutsideLaboratory",,82784,CPT,Facility,Outpatient,,,90,66,56.1,18.9156,66,PrimeWest Health,Minnesota Senior Health Options (MSHO),33.957,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Immunoglobulin, Igg (Mayo)OutsideLaboratory",,82784,CPT,Facility,Inpatient,,,90,66,56.1,18.9156,66,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Immunoglobulin, Igg (Mayo)OutsideLaboratory",,82784,CPT,Facility,Outpatient,,,90,66,56.1,18.9156,66,PrimeWest Health,MinnesotaCare,33.8976,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Immunoglobulin, Igg (Mayo)OutsideLaboratory",,82784,CPT,Facility,Inpatient,,,90,66,56.1,18.9156,66,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Immunoglobulin, Igg (Mayo)OutsideLaboratory",,82784,CPT,Facility,Both,,,90,66,56.1,18.9156,66,Sanford Health Plan,Sanford Health Plan,60.72,92,,percent of total billed charges,,
"Immunoglobulin, Igg (Mayo)OutsideLaboratory",,82784,CPT,Facility,Outpatient,,,90,66,56.1,18.9156,66,"UCare Health, Inc.",Individual & Family Plan,37.191,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Immunoglobulin, Igg (Mayo)OutsideLaboratory",,82784,CPT,Facility,Inpatient,,,90,66,56.1,18.9156,66,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Immunoglobulin, Igg (Mayo)OutsideLaboratory",,82784,CPT,Facility,Outpatient,,,90,66,56.1,18.9156,66,"UCare Health, Inc.",Medical Assistance,33.3102,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Immunoglobulin, Igg (Mayo)OutsideLaboratory",,82784,CPT,Facility,Inpatient,,,90,66,56.1,18.9156,66,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Immunoglobulin, Igg (Mayo)OutsideLaboratory",,82784,CPT,Facility,Outpatient,,,90,66,56.1,18.9156,66,"UCare Health, Inc.",Medicare Advantage,33.3102,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Immunoglobulin, Igg (Mayo)OutsideLaboratory",,82784,CPT,Facility,Inpatient,,,90,66,56.1,18.9156,66,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Immunoglobulin, Igg (Mayo)OutsideLaboratory",,82784,CPT,Facility,Outpatient,,,90,66,56.1,18.9156,66,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),33.3102,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Immunoglobulin, Igg (Mayo)OutsideLaboratory",,82784,CPT,Facility,Inpatient,,,90,66,56.1,18.9156,66,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Immunoglobulin, Igg (Mayo)OutsideLaboratory",,82784,CPT,Facility,Both,,,90,66,56.1,18.9156,66,UnitedHealthcare,Individual & Family,62.04,94,,percent of total billed charges,,
"Immunoglobulin, Igg (Mayo)OutsideLaboratory",,82784,CPT,Facility,Outpatient,,,90,66,56.1,18.9156,66,UnitedHealthcare,Medicare Advantage,32.34,49,,percent of total billed charges,,
"Immunoglobulin, Igg (Mayo)OutsideLaboratory",,82784,CPT,Facility,Inpatient,,,90,66,56.1,18.9156,66,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Immunoglobulin, Igg (Mayo)OutsideLaboratory",,82784,CPT,Facility,Outpatient,,,90,66,56.1,18.9156,66,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,31.68,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Immunoglobulin, Igg (Mayo)OutsideLaboratory",,82784,CPT,Facility,Inpatient,,,90,66,56.1,18.9156,66,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Immunoglobulin Subclasses (Mayo)OutsideLaboratory,,82787,CPT,Facility,Both,,,90,39,33.15,11.1774,39,Aetna,Commercial,35.88,92,,percent of total billed charges,,
Immunoglobulin Subclasses (Mayo)OutsideLaboratory,,82787,CPT,Facility,Outpatient,,,90,39,33.15,11.1774,39,Aetna,Medicare Advantage,19.11,49,,percent of total billed charges,,
Immunoglobulin Subclasses (Mayo)OutsideLaboratory,,82787,CPT,Facility,Inpatient,,,90,39,33.15,11.1774,39,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Immunoglobulin Subclasses (Mayo)OutsideLaboratory,,82787,CPT,Facility,Both,,,90,39,33.15,11.1774,39,Aetna,PPO,36.27,93,,percent of total billed charges,,
Immunoglobulin Subclasses (Mayo)OutsideLaboratory,,82787,CPT,Facility,Both,,,90,39,33.15,11.1774,39,America's PPO,America's PPO,37.4517,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Immunoglobulin Subclasses (Mayo)OutsideLaboratory,,82787,CPT,Facility,Both,,,90,39,33.15,11.1774,39,BlueCross BlueShield Minnesota, Federal Employee Program,38.376,98.4,,percent of total billed charges,,
Immunoglobulin Subclasses (Mayo)OutsideLaboratory,,82787,CPT,Facility,Both,,,90,39,33.15,11.1774,39,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,39,100,,percent of total billed charges,,
Immunoglobulin Subclasses (Mayo)OutsideLaboratory,,82787,CPT,Facility,Both,,,90,39,33.15,11.1774,39,BlueCross BlueShield Minnesota,High Value Network Plan,35.1,90,,percent of total billed charges,,
Immunoglobulin Subclasses (Mayo)OutsideLaboratory,,82787,CPT,Facility,Outpatient,,,90,39,33.15,11.1774,39,BlueCross BlueShield Minnesota,Medicare Advantage,19.11,49,,percent of total billed charges,,
Immunoglobulin Subclasses (Mayo)OutsideLaboratory,,82787,CPT,Facility,Inpatient,,,90,39,33.15,11.1774,39,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Immunoglobulin Subclasses (Mayo)OutsideLaboratory,,82787,CPT,Facility,Both,,,90,39,33.15,11.1774,39,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,34.5423,88.57,,percent of total billed charges,,
Immunoglobulin Subclasses (Mayo)OutsideLaboratory,,82787,CPT,Facility,Both,,,90,39,33.15,11.1774,39,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,11.1774,28.66,,percent of total billed charges,,
Immunoglobulin Subclasses (Mayo)OutsideLaboratory,,82787,CPT,Facility,Outpatient,,,90,39,33.15,11.1774,39,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),19.11,49,,percent of total billed charges,,
Immunoglobulin Subclasses (Mayo)OutsideLaboratory,,82787,CPT,Facility,Inpatient,,,90,39,33.15,11.1774,39,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Immunoglobulin Subclasses (Mayo)OutsideLaboratory,,82787,CPT,Facility,Both,,,90,39,33.15,11.1774,39,CorVel,Worker's Compensation,39,100,,percent of total billed charges,,
Immunoglobulin Subclasses (Mayo)OutsideLaboratory,,82787,CPT,Facility,Both,,,90,39,33.15,11.1774,39,First Health Group Corporation,First Health Network,37.83,97,,percent of total billed charges,,
Immunoglobulin Subclasses (Mayo)OutsideLaboratory,,82787,CPT,Facility,Both,,,90,39,33.15,11.1774,39,"Health Partners, Inc.",Commercial,36.894,94.6,,percent of total billed charges,,
Immunoglobulin Subclasses (Mayo)OutsideLaboratory,,82787,CPT,Facility,Outpatient,,,90,39,33.15,11.1774,39,"Health Partners, Inc.",Medicare Advantage,19.11,49,,percent of total billed charges,,
Immunoglobulin Subclasses (Mayo)OutsideLaboratory,,82787,CPT,Facility,Inpatient,,,90,39,33.15,11.1774,39,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Immunoglobulin Subclasses (Mayo)OutsideLaboratory,,82787,CPT,Facility,Both,,,90,39,33.15,11.1774,39,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),23.4,60,,percent of total billed charges,,
Immunoglobulin Subclasses (Mayo)OutsideLaboratory,,82787,CPT,Facility,Both,,,90,39,33.15,11.1774,39,"Health Partners, Inc.",State of Minnesota Advantage Program,31.785,81.5,,percent of total billed charges,,
Immunoglobulin Subclasses (Mayo)OutsideLaboratory,,82787,CPT,Facility,Both,,,90,39,33.15,11.1774,39,"Health Partners, Inc.",State Public Programs,19.5,50,,percent of total billed charges,,
Immunoglobulin Subclasses (Mayo)OutsideLaboratory,,82787,CPT,Facility,Both,,,90,39,33.15,11.1774,39,Humana Insurance Company,Commercial PPO,37.05,95,,percent of total billed charges,,
Immunoglobulin Subclasses (Mayo)OutsideLaboratory,,82787,CPT,Facility,Outpatient,,,90,39,33.15,11.1774,39,Humana Insurance Company,Medicare PPO,19.11,49,,percent of total billed charges,,
Immunoglobulin Subclasses (Mayo)OutsideLaboratory,,82787,CPT,Facility,Inpatient,,,90,39,33.15,11.1774,39,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Immunoglobulin Subclasses (Mayo)OutsideLaboratory,,82787,CPT,Facility,Both,,,90,39,33.15,11.1774,39,Medica,Individual & Family,38.649,99.1,,percent of total billed charges,,
Immunoglobulin Subclasses (Mayo)OutsideLaboratory,,82787,CPT,Facility,Outpatient,,,90,39,33.15,11.1774,39,Medica,Medica Advantage Solution,19.422,49.8,,percent of total billed charges,,
Immunoglobulin Subclasses (Mayo)OutsideLaboratory,,82787,CPT,Facility,Inpatient,,,90,39,33.15,11.1774,39,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Immunoglobulin Subclasses (Mayo)OutsideLaboratory,,82787,CPT,Facility,Outpatient,,,90,39,33.15,11.1774,39,Medica,Medical Assistance,17.394,44.6,,percent of total billed charges,,
Immunoglobulin Subclasses (Mayo)OutsideLaboratory,,82787,CPT,Facility,Inpatient,,,90,39,33.15,11.1774,39,Medica,Medical Assistance,,,,,Included in per diem rate,
Immunoglobulin Subclasses (Mayo)OutsideLaboratory,,82787,CPT,Facility,Outpatient,,,90,39,33.15,11.1774,39,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,19.422,49.8,,percent of total billed charges,,
Immunoglobulin Subclasses (Mayo)OutsideLaboratory,,82787,CPT,Facility,Inpatient,,,90,39,33.15,11.1774,39,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Immunoglobulin Subclasses (Mayo)OutsideLaboratory,,82787,CPT,Facility,Both,,,90,39,33.15,11.1774,39,"Multiplan, Inc.","Multiplan, Inc.",36.66,94,,percent of total billed charges,,
Immunoglobulin Subclasses (Mayo)OutsideLaboratory,,82787,CPT,Facility,Outpatient,,,90,39,33.15,11.1774,39,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,33.696,86.4,,percent of total billed charges,,
Immunoglobulin Subclasses (Mayo)OutsideLaboratory,,82787,CPT,Facility,Inpatient,,,90,39,33.15,11.1774,39,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Immunoglobulin Subclasses (Mayo)OutsideLaboratory,,82787,CPT,Facility,Both,,,90,39,33.15,11.1774,39,"Preferred One Administrative Services, INC.",PPO,38.454,98.6,,percent of total billed charges,,
Immunoglobulin Subclasses (Mayo)OutsideLaboratory,,82787,CPT,Facility,Outpatient,,,90,39,33.15,11.1774,39,PrimeWest Health,Minnesota Senior Health Options (MSHO),20.0655,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Immunoglobulin Subclasses (Mayo)OutsideLaboratory,,82787,CPT,Facility,Inpatient,,,90,39,33.15,11.1774,39,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Immunoglobulin Subclasses (Mayo)OutsideLaboratory,,82787,CPT,Facility,Outpatient,,,90,39,33.15,11.1774,39,PrimeWest Health,MinnesotaCare,20.0304,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Immunoglobulin Subclasses (Mayo)OutsideLaboratory,,82787,CPT,Facility,Inpatient,,,90,39,33.15,11.1774,39,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Immunoglobulin Subclasses (Mayo)OutsideLaboratory,,82787,CPT,Facility,Both,,,90,39,33.15,11.1774,39,Sanford Health Plan,Sanford Health Plan,35.88,92,,percent of total billed charges,,
Immunoglobulin Subclasses (Mayo)OutsideLaboratory,,82787,CPT,Facility,Outpatient,,,90,39,33.15,11.1774,39,"UCare Health, Inc.",Individual & Family Plan,21.9765,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Immunoglobulin Subclasses (Mayo)OutsideLaboratory,,82787,CPT,Facility,Inpatient,,,90,39,33.15,11.1774,39,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Immunoglobulin Subclasses (Mayo)OutsideLaboratory,,82787,CPT,Facility,Outpatient,,,90,39,33.15,11.1774,39,"UCare Health, Inc.",Medical Assistance,19.6833,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Immunoglobulin Subclasses (Mayo)OutsideLaboratory,,82787,CPT,Facility,Inpatient,,,90,39,33.15,11.1774,39,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Immunoglobulin Subclasses (Mayo)OutsideLaboratory,,82787,CPT,Facility,Outpatient,,,90,39,33.15,11.1774,39,"UCare Health, Inc.",Medicare Advantage,19.6833,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Immunoglobulin Subclasses (Mayo)OutsideLaboratory,,82787,CPT,Facility,Inpatient,,,90,39,33.15,11.1774,39,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Immunoglobulin Subclasses (Mayo)OutsideLaboratory,,82787,CPT,Facility,Outpatient,,,90,39,33.15,11.1774,39,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),19.6833,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Immunoglobulin Subclasses (Mayo)OutsideLaboratory,,82787,CPT,Facility,Inpatient,,,90,39,33.15,11.1774,39,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Immunoglobulin Subclasses (Mayo)OutsideLaboratory,,82787,CPT,Facility,Both,,,90,39,33.15,11.1774,39,UnitedHealthcare,Individual & Family,36.66,94,,percent of total billed charges,,
Immunoglobulin Subclasses (Mayo)OutsideLaboratory,,82787,CPT,Facility,Outpatient,,,90,39,33.15,11.1774,39,UnitedHealthcare,Medicare Advantage,19.11,49,,percent of total billed charges,,
Immunoglobulin Subclasses (Mayo)OutsideLaboratory,,82787,CPT,Facility,Inpatient,,,90,39,33.15,11.1774,39,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Immunoglobulin Subclasses (Mayo)OutsideLaboratory,,82787,CPT,Facility,Outpatient,,,90,39,33.15,11.1774,39,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,18.72,48,,percent of total billed charges,,100% of DHS outpatient percentage
Immunoglobulin Subclasses (Mayo)OutsideLaboratory,,82787,CPT,Facility,Inpatient,,,90,39,33.15,11.1774,39,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Glucagon, P (Mayo)OutsideLaboratory",,82943,CPT,Facility,Both,,,90,124,105.4,35.5384,124,Aetna,Commercial,114.08,92,,percent of total billed charges,,
"Glucagon, P (Mayo)OutsideLaboratory",,82943,CPT,Facility,Outpatient,,,90,124,105.4,35.5384,124,Aetna,Medicare Advantage,60.76,49,,percent of total billed charges,,
"Glucagon, P (Mayo)OutsideLaboratory",,82943,CPT,Facility,Inpatient,,,90,124,105.4,35.5384,124,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Glucagon, P (Mayo)OutsideLaboratory",,82943,CPT,Facility,Both,,,90,124,105.4,35.5384,124,Aetna,PPO,115.32,93,,percent of total billed charges,,
"Glucagon, P (Mayo)OutsideLaboratory",,82943,CPT,Facility,Both,,,90,124,105.4,35.5384,124,America's PPO,America's PPO,119.0772,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Glucagon, P (Mayo)OutsideLaboratory",,82943,CPT,Facility,Both,,,90,124,105.4,35.5384,124,BlueCross BlueShield Minnesota, Federal Employee Program,122.016,98.4,,percent of total billed charges,,
"Glucagon, P (Mayo)OutsideLaboratory",,82943,CPT,Facility,Both,,,90,124,105.4,35.5384,124,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,124,100,,percent of total billed charges,,
"Glucagon, P (Mayo)OutsideLaboratory",,82943,CPT,Facility,Both,,,90,124,105.4,35.5384,124,BlueCross BlueShield Minnesota,High Value Network Plan,111.6,90,,percent of total billed charges,,
"Glucagon, P (Mayo)OutsideLaboratory",,82943,CPT,Facility,Outpatient,,,90,124,105.4,35.5384,124,BlueCross BlueShield Minnesota,Medicare Advantage,60.76,49,,percent of total billed charges,,
"Glucagon, P (Mayo)OutsideLaboratory",,82943,CPT,Facility,Inpatient,,,90,124,105.4,35.5384,124,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Glucagon, P (Mayo)OutsideLaboratory",,82943,CPT,Facility,Both,,,90,124,105.4,35.5384,124,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,109.8268,88.57,,percent of total billed charges,,
"Glucagon, P (Mayo)OutsideLaboratory",,82943,CPT,Facility,Both,,,90,124,105.4,35.5384,124,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,35.5384,28.66,,percent of total billed charges,,
"Glucagon, P (Mayo)OutsideLaboratory",,82943,CPT,Facility,Outpatient,,,90,124,105.4,35.5384,124,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),60.76,49,,percent of total billed charges,,
"Glucagon, P (Mayo)OutsideLaboratory",,82943,CPT,Facility,Inpatient,,,90,124,105.4,35.5384,124,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Glucagon, P (Mayo)OutsideLaboratory",,82943,CPT,Facility,Both,,,90,124,105.4,35.5384,124,CorVel,Worker's Compensation,124,100,,percent of total billed charges,,
"Glucagon, P (Mayo)OutsideLaboratory",,82943,CPT,Facility,Both,,,90,124,105.4,35.5384,124,First Health Group Corporation,First Health Network,120.28,97,,percent of total billed charges,,
"Glucagon, P (Mayo)OutsideLaboratory",,82943,CPT,Facility,Both,,,90,124,105.4,35.5384,124,"Health Partners, Inc.",Commercial,117.304,94.6,,percent of total billed charges,,
"Glucagon, P (Mayo)OutsideLaboratory",,82943,CPT,Facility,Outpatient,,,90,124,105.4,35.5384,124,"Health Partners, Inc.",Medicare Advantage,60.76,49,,percent of total billed charges,,
"Glucagon, P (Mayo)OutsideLaboratory",,82943,CPT,Facility,Inpatient,,,90,124,105.4,35.5384,124,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Glucagon, P (Mayo)OutsideLaboratory",,82943,CPT,Facility,Both,,,90,124,105.4,35.5384,124,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),74.4,60,,percent of total billed charges,,
"Glucagon, P (Mayo)OutsideLaboratory",,82943,CPT,Facility,Both,,,90,124,105.4,35.5384,124,"Health Partners, Inc.",State of Minnesota Advantage Program,101.06,81.5,,percent of total billed charges,,
"Glucagon, P (Mayo)OutsideLaboratory",,82943,CPT,Facility,Both,,,90,124,105.4,35.5384,124,"Health Partners, Inc.",State Public Programs,62,50,,percent of total billed charges,,
"Glucagon, P (Mayo)OutsideLaboratory",,82943,CPT,Facility,Both,,,90,124,105.4,35.5384,124,Humana Insurance Company,Commercial PPO,117.8,95,,percent of total billed charges,,
"Glucagon, P (Mayo)OutsideLaboratory",,82943,CPT,Facility,Outpatient,,,90,124,105.4,35.5384,124,Humana Insurance Company,Medicare PPO,60.76,49,,percent of total billed charges,,
"Glucagon, P (Mayo)OutsideLaboratory",,82943,CPT,Facility,Inpatient,,,90,124,105.4,35.5384,124,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Glucagon, P (Mayo)OutsideLaboratory",,82943,CPT,Facility,Both,,,90,124,105.4,35.5384,124,Medica,Individual & Family,122.884,99.1,,percent of total billed charges,,
"Glucagon, P (Mayo)OutsideLaboratory",,82943,CPT,Facility,Outpatient,,,90,124,105.4,35.5384,124,Medica,Medica Advantage Solution,61.752,49.8,,percent of total billed charges,,
"Glucagon, P (Mayo)OutsideLaboratory",,82943,CPT,Facility,Inpatient,,,90,124,105.4,35.5384,124,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Glucagon, P (Mayo)OutsideLaboratory",,82943,CPT,Facility,Outpatient,,,90,124,105.4,35.5384,124,Medica,Medical Assistance,55.304,44.6,,percent of total billed charges,,
"Glucagon, P (Mayo)OutsideLaboratory",,82943,CPT,Facility,Inpatient,,,90,124,105.4,35.5384,124,Medica,Medical Assistance,,,,,Included in per diem rate,
"Glucagon, P (Mayo)OutsideLaboratory",,82943,CPT,Facility,Outpatient,,,90,124,105.4,35.5384,124,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,61.752,49.8,,percent of total billed charges,,
"Glucagon, P (Mayo)OutsideLaboratory",,82943,CPT,Facility,Inpatient,,,90,124,105.4,35.5384,124,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Glucagon, P (Mayo)OutsideLaboratory",,82943,CPT,Facility,Both,,,90,124,105.4,35.5384,124,"Multiplan, Inc.","Multiplan, Inc.",116.56,94,,percent of total billed charges,,
"Glucagon, P (Mayo)OutsideLaboratory",,82943,CPT,Facility,Outpatient,,,90,124,105.4,35.5384,124,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,107.136,86.4,,percent of total billed charges,,
"Glucagon, P (Mayo)OutsideLaboratory",,82943,CPT,Facility,Inpatient,,,90,124,105.4,35.5384,124,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Glucagon, P (Mayo)OutsideLaboratory",,82943,CPT,Facility,Both,,,90,124,105.4,35.5384,124,"Preferred One Administrative Services, INC.",PPO,122.264,98.6,,percent of total billed charges,,
"Glucagon, P (Mayo)OutsideLaboratory",,82943,CPT,Facility,Outpatient,,,90,124,105.4,35.5384,124,PrimeWest Health,Minnesota Senior Health Options (MSHO),63.798,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Glucagon, P (Mayo)OutsideLaboratory",,82943,CPT,Facility,Inpatient,,,90,124,105.4,35.5384,124,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Glucagon, P (Mayo)OutsideLaboratory",,82943,CPT,Facility,Outpatient,,,90,124,105.4,35.5384,124,PrimeWest Health,MinnesotaCare,63.6864,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Glucagon, P (Mayo)OutsideLaboratory",,82943,CPT,Facility,Inpatient,,,90,124,105.4,35.5384,124,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Glucagon, P (Mayo)OutsideLaboratory",,82943,CPT,Facility,Both,,,90,124,105.4,35.5384,124,Sanford Health Plan,Sanford Health Plan,114.08,92,,percent of total billed charges,,
"Glucagon, P (Mayo)OutsideLaboratory",,82943,CPT,Facility,Outpatient,,,90,124,105.4,35.5384,124,"UCare Health, Inc.",Individual & Family Plan,69.874,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Glucagon, P (Mayo)OutsideLaboratory",,82943,CPT,Facility,Inpatient,,,90,124,105.4,35.5384,124,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Glucagon, P (Mayo)OutsideLaboratory",,82943,CPT,Facility,Outpatient,,,90,124,105.4,35.5384,124,"UCare Health, Inc.",Medical Assistance,62.5828,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Glucagon, P (Mayo)OutsideLaboratory",,82943,CPT,Facility,Inpatient,,,90,124,105.4,35.5384,124,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Glucagon, P (Mayo)OutsideLaboratory",,82943,CPT,Facility,Outpatient,,,90,124,105.4,35.5384,124,"UCare Health, Inc.",Medicare Advantage,62.5828,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Glucagon, P (Mayo)OutsideLaboratory",,82943,CPT,Facility,Inpatient,,,90,124,105.4,35.5384,124,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Glucagon, P (Mayo)OutsideLaboratory",,82943,CPT,Facility,Outpatient,,,90,124,105.4,35.5384,124,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),62.5828,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Glucagon, P (Mayo)OutsideLaboratory",,82943,CPT,Facility,Inpatient,,,90,124,105.4,35.5384,124,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Glucagon, P (Mayo)OutsideLaboratory",,82943,CPT,Facility,Both,,,90,124,105.4,35.5384,124,UnitedHealthcare,Individual & Family,116.56,94,,percent of total billed charges,,
"Glucagon, P (Mayo)OutsideLaboratory",,82943,CPT,Facility,Outpatient,,,90,124,105.4,35.5384,124,UnitedHealthcare,Medicare Advantage,60.76,49,,percent of total billed charges,,
"Glucagon, P (Mayo)OutsideLaboratory",,82943,CPT,Facility,Inpatient,,,90,124,105.4,35.5384,124,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Glucagon, P (Mayo)OutsideLaboratory",,82943,CPT,Facility,Outpatient,,,90,124,105.4,35.5384,124,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,59.52,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Glucagon, P (Mayo)OutsideLaboratory",,82943,CPT,Facility,Inpatient,,,90,124,105.4,35.5384,124,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"G-6-Pd, Qn, Rbc (Mayo)OutsideLaboratory",,82955,CPT,Facility,Both,,,90,129,109.65,36.9714,129,Aetna,Commercial,118.68,92,,percent of total billed charges,,
"G-6-Pd, Qn, Rbc (Mayo)OutsideLaboratory",,82955,CPT,Facility,Outpatient,,,90,129,109.65,36.9714,129,Aetna,Medicare Advantage,63.21,49,,percent of total billed charges,,
"G-6-Pd, Qn, Rbc (Mayo)OutsideLaboratory",,82955,CPT,Facility,Inpatient,,,90,129,109.65,36.9714,129,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"G-6-Pd, Qn, Rbc (Mayo)OutsideLaboratory",,82955,CPT,Facility,Both,,,90,129,109.65,36.9714,129,Aetna,PPO,119.97,93,,percent of total billed charges,,
"G-6-Pd, Qn, Rbc (Mayo)OutsideLaboratory",,82955,CPT,Facility,Both,,,90,129,109.65,36.9714,129,America's PPO,America's PPO,123.8787,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"G-6-Pd, Qn, Rbc (Mayo)OutsideLaboratory",,82955,CPT,Facility,Both,,,90,129,109.65,36.9714,129,BlueCross BlueShield Minnesota, Federal Employee Program,126.936,98.4,,percent of total billed charges,,
"G-6-Pd, Qn, Rbc (Mayo)OutsideLaboratory",,82955,CPT,Facility,Both,,,90,129,109.65,36.9714,129,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,129,100,,percent of total billed charges,,
"G-6-Pd, Qn, Rbc (Mayo)OutsideLaboratory",,82955,CPT,Facility,Both,,,90,129,109.65,36.9714,129,BlueCross BlueShield Minnesota,High Value Network Plan,116.1,90,,percent of total billed charges,,
"G-6-Pd, Qn, Rbc (Mayo)OutsideLaboratory",,82955,CPT,Facility,Outpatient,,,90,129,109.65,36.9714,129,BlueCross BlueShield Minnesota,Medicare Advantage,63.21,49,,percent of total billed charges,,
"G-6-Pd, Qn, Rbc (Mayo)OutsideLaboratory",,82955,CPT,Facility,Inpatient,,,90,129,109.65,36.9714,129,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"G-6-Pd, Qn, Rbc (Mayo)OutsideLaboratory",,82955,CPT,Facility,Both,,,90,129,109.65,36.9714,129,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,114.2553,88.57,,percent of total billed charges,,
"G-6-Pd, Qn, Rbc (Mayo)OutsideLaboratory",,82955,CPT,Facility,Both,,,90,129,109.65,36.9714,129,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,36.9714,28.66,,percent of total billed charges,,
"G-6-Pd, Qn, Rbc (Mayo)OutsideLaboratory",,82955,CPT,Facility,Outpatient,,,90,129,109.65,36.9714,129,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),63.21,49,,percent of total billed charges,,
"G-6-Pd, Qn, Rbc (Mayo)OutsideLaboratory",,82955,CPT,Facility,Inpatient,,,90,129,109.65,36.9714,129,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"G-6-Pd, Qn, Rbc (Mayo)OutsideLaboratory",,82955,CPT,Facility,Both,,,90,129,109.65,36.9714,129,CorVel,Worker's Compensation,129,100,,percent of total billed charges,,
"G-6-Pd, Qn, Rbc (Mayo)OutsideLaboratory",,82955,CPT,Facility,Both,,,90,129,109.65,36.9714,129,First Health Group Corporation,First Health Network,125.13,97,,percent of total billed charges,,
"G-6-Pd, Qn, Rbc (Mayo)OutsideLaboratory",,82955,CPT,Facility,Both,,,90,129,109.65,36.9714,129,"Health Partners, Inc.",Commercial,122.034,94.6,,percent of total billed charges,,
"G-6-Pd, Qn, Rbc (Mayo)OutsideLaboratory",,82955,CPT,Facility,Outpatient,,,90,129,109.65,36.9714,129,"Health Partners, Inc.",Medicare Advantage,63.21,49,,percent of total billed charges,,
"G-6-Pd, Qn, Rbc (Mayo)OutsideLaboratory",,82955,CPT,Facility,Inpatient,,,90,129,109.65,36.9714,129,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"G-6-Pd, Qn, Rbc (Mayo)OutsideLaboratory",,82955,CPT,Facility,Both,,,90,129,109.65,36.9714,129,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),77.4,60,,percent of total billed charges,,
"G-6-Pd, Qn, Rbc (Mayo)OutsideLaboratory",,82955,CPT,Facility,Both,,,90,129,109.65,36.9714,129,"Health Partners, Inc.",State of Minnesota Advantage Program,105.135,81.5,,percent of total billed charges,,
"G-6-Pd, Qn, Rbc (Mayo)OutsideLaboratory",,82955,CPT,Facility,Both,,,90,129,109.65,36.9714,129,"Health Partners, Inc.",State Public Programs,64.5,50,,percent of total billed charges,,
"G-6-Pd, Qn, Rbc (Mayo)OutsideLaboratory",,82955,CPT,Facility,Both,,,90,129,109.65,36.9714,129,Humana Insurance Company,Commercial PPO,122.55,95,,percent of total billed charges,,
"G-6-Pd, Qn, Rbc (Mayo)OutsideLaboratory",,82955,CPT,Facility,Outpatient,,,90,129,109.65,36.9714,129,Humana Insurance Company,Medicare PPO,63.21,49,,percent of total billed charges,,
"G-6-Pd, Qn, Rbc (Mayo)OutsideLaboratory",,82955,CPT,Facility,Inpatient,,,90,129,109.65,36.9714,129,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"G-6-Pd, Qn, Rbc (Mayo)OutsideLaboratory",,82955,CPT,Facility,Both,,,90,129,109.65,36.9714,129,Medica,Individual & Family,127.839,99.1,,percent of total billed charges,,
"G-6-Pd, Qn, Rbc (Mayo)OutsideLaboratory",,82955,CPT,Facility,Outpatient,,,90,129,109.65,36.9714,129,Medica,Medica Advantage Solution,64.242,49.8,,percent of total billed charges,,
"G-6-Pd, Qn, Rbc (Mayo)OutsideLaboratory",,82955,CPT,Facility,Inpatient,,,90,129,109.65,36.9714,129,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"G-6-Pd, Qn, Rbc (Mayo)OutsideLaboratory",,82955,CPT,Facility,Outpatient,,,90,129,109.65,36.9714,129,Medica,Medical Assistance,57.534,44.6,,percent of total billed charges,,
"G-6-Pd, Qn, Rbc (Mayo)OutsideLaboratory",,82955,CPT,Facility,Inpatient,,,90,129,109.65,36.9714,129,Medica,Medical Assistance,,,,,Included in per diem rate,
"G-6-Pd, Qn, Rbc (Mayo)OutsideLaboratory",,82955,CPT,Facility,Outpatient,,,90,129,109.65,36.9714,129,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,64.242,49.8,,percent of total billed charges,,
"G-6-Pd, Qn, Rbc (Mayo)OutsideLaboratory",,82955,CPT,Facility,Inpatient,,,90,129,109.65,36.9714,129,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"G-6-Pd, Qn, Rbc (Mayo)OutsideLaboratory",,82955,CPT,Facility,Both,,,90,129,109.65,36.9714,129,"Multiplan, Inc.","Multiplan, Inc.",121.26,94,,percent of total billed charges,,
"G-6-Pd, Qn, Rbc (Mayo)OutsideLaboratory",,82955,CPT,Facility,Outpatient,,,90,129,109.65,36.9714,129,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,111.456,86.4,,percent of total billed charges,,
"G-6-Pd, Qn, Rbc (Mayo)OutsideLaboratory",,82955,CPT,Facility,Inpatient,,,90,129,109.65,36.9714,129,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"G-6-Pd, Qn, Rbc (Mayo)OutsideLaboratory",,82955,CPT,Facility,Both,,,90,129,109.65,36.9714,129,"Preferred One Administrative Services, INC.",PPO,127.194,98.6,,percent of total billed charges,,
"G-6-Pd, Qn, Rbc (Mayo)OutsideLaboratory",,82955,CPT,Facility,Outpatient,,,90,129,109.65,36.9714,129,PrimeWest Health,Minnesota Senior Health Options (MSHO),66.3705,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"G-6-Pd, Qn, Rbc (Mayo)OutsideLaboratory",,82955,CPT,Facility,Inpatient,,,90,129,109.65,36.9714,129,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"G-6-Pd, Qn, Rbc (Mayo)OutsideLaboratory",,82955,CPT,Facility,Outpatient,,,90,129,109.65,36.9714,129,PrimeWest Health,MinnesotaCare,66.2544,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"G-6-Pd, Qn, Rbc (Mayo)OutsideLaboratory",,82955,CPT,Facility,Inpatient,,,90,129,109.65,36.9714,129,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"G-6-Pd, Qn, Rbc (Mayo)OutsideLaboratory",,82955,CPT,Facility,Both,,,90,129,109.65,36.9714,129,Sanford Health Plan,Sanford Health Plan,118.68,92,,percent of total billed charges,,
"G-6-Pd, Qn, Rbc (Mayo)OutsideLaboratory",,82955,CPT,Facility,Outpatient,,,90,129,109.65,36.9714,129,"UCare Health, Inc.",Individual & Family Plan,72.6915,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"G-6-Pd, Qn, Rbc (Mayo)OutsideLaboratory",,82955,CPT,Facility,Inpatient,,,90,129,109.65,36.9714,129,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"G-6-Pd, Qn, Rbc (Mayo)OutsideLaboratory",,82955,CPT,Facility,Outpatient,,,90,129,109.65,36.9714,129,"UCare Health, Inc.",Medical Assistance,65.1063,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"G-6-Pd, Qn, Rbc (Mayo)OutsideLaboratory",,82955,CPT,Facility,Inpatient,,,90,129,109.65,36.9714,129,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"G-6-Pd, Qn, Rbc (Mayo)OutsideLaboratory",,82955,CPT,Facility,Outpatient,,,90,129,109.65,36.9714,129,"UCare Health, Inc.",Medicare Advantage,65.1063,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"G-6-Pd, Qn, Rbc (Mayo)OutsideLaboratory",,82955,CPT,Facility,Inpatient,,,90,129,109.65,36.9714,129,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"G-6-Pd, Qn, Rbc (Mayo)OutsideLaboratory",,82955,CPT,Facility,Outpatient,,,90,129,109.65,36.9714,129,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),65.1063,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"G-6-Pd, Qn, Rbc (Mayo)OutsideLaboratory",,82955,CPT,Facility,Inpatient,,,90,129,109.65,36.9714,129,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"G-6-Pd, Qn, Rbc (Mayo)OutsideLaboratory",,82955,CPT,Facility,Both,,,90,129,109.65,36.9714,129,UnitedHealthcare,Individual & Family,121.26,94,,percent of total billed charges,,
"G-6-Pd, Qn, Rbc (Mayo)OutsideLaboratory",,82955,CPT,Facility,Outpatient,,,90,129,109.65,36.9714,129,UnitedHealthcare,Medicare Advantage,63.21,49,,percent of total billed charges,,
"G-6-Pd, Qn, Rbc (Mayo)OutsideLaboratory",,82955,CPT,Facility,Inpatient,,,90,129,109.65,36.9714,129,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"G-6-Pd, Qn, Rbc (Mayo)OutsideLaboratory",,82955,CPT,Facility,Outpatient,,,90,129,109.65,36.9714,129,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,61.92,48,,percent of total billed charges,,100% of DHS outpatient percentage
"G-6-Pd, Qn, Rbc (Mayo)OutsideLaboratory",,82955,CPT,Facility,Inpatient,,,90,129,109.65,36.9714,129,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Growth Hormone, S (Mayo)OutsideLaboratory",,83003,CPT,Facility,Both,,,90,82,69.7,23.5012,82,Aetna,Commercial,75.44,92,,percent of total billed charges,,
"Growth Hormone, S (Mayo)OutsideLaboratory",,83003,CPT,Facility,Outpatient,,,90,82,69.7,23.5012,82,Aetna,Medicare Advantage,40.18,49,,percent of total billed charges,,
"Growth Hormone, S (Mayo)OutsideLaboratory",,83003,CPT,Facility,Inpatient,,,90,82,69.7,23.5012,82,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Growth Hormone, S (Mayo)OutsideLaboratory",,83003,CPT,Facility,Both,,,90,82,69.7,23.5012,82,Aetna,PPO,76.26,93,,percent of total billed charges,,
"Growth Hormone, S (Mayo)OutsideLaboratory",,83003,CPT,Facility,Both,,,90,82,69.7,23.5012,82,America's PPO,America's PPO,78.7446,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Growth Hormone, S (Mayo)OutsideLaboratory",,83003,CPT,Facility,Both,,,90,82,69.7,23.5012,82,BlueCross BlueShield Minnesota, Federal Employee Program,80.688,98.4,,percent of total billed charges,,
"Growth Hormone, S (Mayo)OutsideLaboratory",,83003,CPT,Facility,Both,,,90,82,69.7,23.5012,82,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,82,100,,percent of total billed charges,,
"Growth Hormone, S (Mayo)OutsideLaboratory",,83003,CPT,Facility,Both,,,90,82,69.7,23.5012,82,BlueCross BlueShield Minnesota,High Value Network Plan,73.8,90,,percent of total billed charges,,
"Growth Hormone, S (Mayo)OutsideLaboratory",,83003,CPT,Facility,Outpatient,,,90,82,69.7,23.5012,82,BlueCross BlueShield Minnesota,Medicare Advantage,40.18,49,,percent of total billed charges,,
"Growth Hormone, S (Mayo)OutsideLaboratory",,83003,CPT,Facility,Inpatient,,,90,82,69.7,23.5012,82,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Growth Hormone, S (Mayo)OutsideLaboratory",,83003,CPT,Facility,Both,,,90,82,69.7,23.5012,82,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,72.6274,88.57,,percent of total billed charges,,
"Growth Hormone, S (Mayo)OutsideLaboratory",,83003,CPT,Facility,Both,,,90,82,69.7,23.5012,82,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,23.5012,28.66,,percent of total billed charges,,
"Growth Hormone, S (Mayo)OutsideLaboratory",,83003,CPT,Facility,Outpatient,,,90,82,69.7,23.5012,82,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),40.18,49,,percent of total billed charges,,
"Growth Hormone, S (Mayo)OutsideLaboratory",,83003,CPT,Facility,Inpatient,,,90,82,69.7,23.5012,82,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Growth Hormone, S (Mayo)OutsideLaboratory",,83003,CPT,Facility,Both,,,90,82,69.7,23.5012,82,CorVel,Worker's Compensation,82,100,,percent of total billed charges,,
"Growth Hormone, S (Mayo)OutsideLaboratory",,83003,CPT,Facility,Both,,,90,82,69.7,23.5012,82,First Health Group Corporation,First Health Network,79.54,97,,percent of total billed charges,,
"Growth Hormone, S (Mayo)OutsideLaboratory",,83003,CPT,Facility,Both,,,90,82,69.7,23.5012,82,"Health Partners, Inc.",Commercial,77.572,94.6,,percent of total billed charges,,
"Growth Hormone, S (Mayo)OutsideLaboratory",,83003,CPT,Facility,Outpatient,,,90,82,69.7,23.5012,82,"Health Partners, Inc.",Medicare Advantage,40.18,49,,percent of total billed charges,,
"Growth Hormone, S (Mayo)OutsideLaboratory",,83003,CPT,Facility,Inpatient,,,90,82,69.7,23.5012,82,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Growth Hormone, S (Mayo)OutsideLaboratory",,83003,CPT,Facility,Both,,,90,82,69.7,23.5012,82,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),49.2,60,,percent of total billed charges,,
"Growth Hormone, S (Mayo)OutsideLaboratory",,83003,CPT,Facility,Both,,,90,82,69.7,23.5012,82,"Health Partners, Inc.",State of Minnesota Advantage Program,66.83,81.5,,percent of total billed charges,,
"Growth Hormone, S (Mayo)OutsideLaboratory",,83003,CPT,Facility,Both,,,90,82,69.7,23.5012,82,"Health Partners, Inc.",State Public Programs,41,50,,percent of total billed charges,,
"Growth Hormone, S (Mayo)OutsideLaboratory",,83003,CPT,Facility,Both,,,90,82,69.7,23.5012,82,Humana Insurance Company,Commercial PPO,77.9,95,,percent of total billed charges,,
"Growth Hormone, S (Mayo)OutsideLaboratory",,83003,CPT,Facility,Outpatient,,,90,82,69.7,23.5012,82,Humana Insurance Company,Medicare PPO,40.18,49,,percent of total billed charges,,
"Growth Hormone, S (Mayo)OutsideLaboratory",,83003,CPT,Facility,Inpatient,,,90,82,69.7,23.5012,82,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Growth Hormone, S (Mayo)OutsideLaboratory",,83003,CPT,Facility,Both,,,90,82,69.7,23.5012,82,Medica,Individual & Family,81.262,99.1,,percent of total billed charges,,
"Growth Hormone, S (Mayo)OutsideLaboratory",,83003,CPT,Facility,Outpatient,,,90,82,69.7,23.5012,82,Medica,Medica Advantage Solution,40.836,49.8,,percent of total billed charges,,
"Growth Hormone, S (Mayo)OutsideLaboratory",,83003,CPT,Facility,Inpatient,,,90,82,69.7,23.5012,82,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Growth Hormone, S (Mayo)OutsideLaboratory",,83003,CPT,Facility,Outpatient,,,90,82,69.7,23.5012,82,Medica,Medical Assistance,36.572,44.6,,percent of total billed charges,,
"Growth Hormone, S (Mayo)OutsideLaboratory",,83003,CPT,Facility,Inpatient,,,90,82,69.7,23.5012,82,Medica,Medical Assistance,,,,,Included in per diem rate,
"Growth Hormone, S (Mayo)OutsideLaboratory",,83003,CPT,Facility,Outpatient,,,90,82,69.7,23.5012,82,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,40.836,49.8,,percent of total billed charges,,
"Growth Hormone, S (Mayo)OutsideLaboratory",,83003,CPT,Facility,Inpatient,,,90,82,69.7,23.5012,82,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Growth Hormone, S (Mayo)OutsideLaboratory",,83003,CPT,Facility,Both,,,90,82,69.7,23.5012,82,"Multiplan, Inc.","Multiplan, Inc.",77.08,94,,percent of total billed charges,,
"Growth Hormone, S (Mayo)OutsideLaboratory",,83003,CPT,Facility,Outpatient,,,90,82,69.7,23.5012,82,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,70.848,86.4,,percent of total billed charges,,
"Growth Hormone, S (Mayo)OutsideLaboratory",,83003,CPT,Facility,Inpatient,,,90,82,69.7,23.5012,82,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Growth Hormone, S (Mayo)OutsideLaboratory",,83003,CPT,Facility,Both,,,90,82,69.7,23.5012,82,"Preferred One Administrative Services, INC.",PPO,80.852,98.6,,percent of total billed charges,,
"Growth Hormone, S (Mayo)OutsideLaboratory",,83003,CPT,Facility,Outpatient,,,90,82,69.7,23.5012,82,PrimeWest Health,Minnesota Senior Health Options (MSHO),42.189,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Growth Hormone, S (Mayo)OutsideLaboratory",,83003,CPT,Facility,Inpatient,,,90,82,69.7,23.5012,82,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Growth Hormone, S (Mayo)OutsideLaboratory",,83003,CPT,Facility,Outpatient,,,90,82,69.7,23.5012,82,PrimeWest Health,MinnesotaCare,42.1152,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Growth Hormone, S (Mayo)OutsideLaboratory",,83003,CPT,Facility,Inpatient,,,90,82,69.7,23.5012,82,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Growth Hormone, S (Mayo)OutsideLaboratory",,83003,CPT,Facility,Both,,,90,82,69.7,23.5012,82,Sanford Health Plan,Sanford Health Plan,75.44,92,,percent of total billed charges,,
"Growth Hormone, S (Mayo)OutsideLaboratory",,83003,CPT,Facility,Outpatient,,,90,82,69.7,23.5012,82,"UCare Health, Inc.",Individual & Family Plan,46.207,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Growth Hormone, S (Mayo)OutsideLaboratory",,83003,CPT,Facility,Inpatient,,,90,82,69.7,23.5012,82,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Growth Hormone, S (Mayo)OutsideLaboratory",,83003,CPT,Facility,Outpatient,,,90,82,69.7,23.5012,82,"UCare Health, Inc.",Medical Assistance,41.3854,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Growth Hormone, S (Mayo)OutsideLaboratory",,83003,CPT,Facility,Inpatient,,,90,82,69.7,23.5012,82,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Growth Hormone, S (Mayo)OutsideLaboratory",,83003,CPT,Facility,Outpatient,,,90,82,69.7,23.5012,82,"UCare Health, Inc.",Medicare Advantage,41.3854,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Growth Hormone, S (Mayo)OutsideLaboratory",,83003,CPT,Facility,Inpatient,,,90,82,69.7,23.5012,82,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Growth Hormone, S (Mayo)OutsideLaboratory",,83003,CPT,Facility,Outpatient,,,90,82,69.7,23.5012,82,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),41.3854,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Growth Hormone, S (Mayo)OutsideLaboratory",,83003,CPT,Facility,Inpatient,,,90,82,69.7,23.5012,82,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Growth Hormone, S (Mayo)OutsideLaboratory",,83003,CPT,Facility,Both,,,90,82,69.7,23.5012,82,UnitedHealthcare,Individual & Family,77.08,94,,percent of total billed charges,,
"Growth Hormone, S (Mayo)OutsideLaboratory",,83003,CPT,Facility,Outpatient,,,90,82,69.7,23.5012,82,UnitedHealthcare,Medicare Advantage,40.18,49,,percent of total billed charges,,
"Growth Hormone, S (Mayo)OutsideLaboratory",,83003,CPT,Facility,Inpatient,,,90,82,69.7,23.5012,82,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Growth Hormone, S (Mayo)OutsideLaboratory",,83003,CPT,Facility,Outpatient,,,90,82,69.7,23.5012,82,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,39.36,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Growth Hormone, S (Mayo)OutsideLaboratory",,83003,CPT,Facility,Inpatient,,,90,82,69.7,23.5012,82,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Haptoglobin, S (Mayo)OutsideLaboratory",,83010,CPT,Facility,Both,,,90,96,81.6,27.5136,96,Aetna,Commercial,88.32,92,,percent of total billed charges,,
"Haptoglobin, S (Mayo)OutsideLaboratory",,83010,CPT,Facility,Outpatient,,,90,96,81.6,27.5136,96,Aetna,Medicare Advantage,47.04,49,,percent of total billed charges,,
"Haptoglobin, S (Mayo)OutsideLaboratory",,83010,CPT,Facility,Inpatient,,,90,96,81.6,27.5136,96,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Haptoglobin, S (Mayo)OutsideLaboratory",,83010,CPT,Facility,Both,,,90,96,81.6,27.5136,96,Aetna,PPO,89.28,93,,percent of total billed charges,,
"Haptoglobin, S (Mayo)OutsideLaboratory",,83010,CPT,Facility,Both,,,90,96,81.6,27.5136,96,America's PPO,America's PPO,92.1888,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Haptoglobin, S (Mayo)OutsideLaboratory",,83010,CPT,Facility,Both,,,90,96,81.6,27.5136,96,BlueCross BlueShield Minnesota, Federal Employee Program,94.464,98.4,,percent of total billed charges,,
"Haptoglobin, S (Mayo)OutsideLaboratory",,83010,CPT,Facility,Both,,,90,96,81.6,27.5136,96,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,96,100,,percent of total billed charges,,
"Haptoglobin, S (Mayo)OutsideLaboratory",,83010,CPT,Facility,Both,,,90,96,81.6,27.5136,96,BlueCross BlueShield Minnesota,High Value Network Plan,86.4,90,,percent of total billed charges,,
"Haptoglobin, S (Mayo)OutsideLaboratory",,83010,CPT,Facility,Outpatient,,,90,96,81.6,27.5136,96,BlueCross BlueShield Minnesota,Medicare Advantage,47.04,49,,percent of total billed charges,,
"Haptoglobin, S (Mayo)OutsideLaboratory",,83010,CPT,Facility,Inpatient,,,90,96,81.6,27.5136,96,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Haptoglobin, S (Mayo)OutsideLaboratory",,83010,CPT,Facility,Both,,,90,96,81.6,27.5136,96,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,85.0272,88.57,,percent of total billed charges,,
"Haptoglobin, S (Mayo)OutsideLaboratory",,83010,CPT,Facility,Both,,,90,96,81.6,27.5136,96,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,27.5136,28.66,,percent of total billed charges,,
"Haptoglobin, S (Mayo)OutsideLaboratory",,83010,CPT,Facility,Outpatient,,,90,96,81.6,27.5136,96,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),47.04,49,,percent of total billed charges,,
"Haptoglobin, S (Mayo)OutsideLaboratory",,83010,CPT,Facility,Inpatient,,,90,96,81.6,27.5136,96,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Haptoglobin, S (Mayo)OutsideLaboratory",,83010,CPT,Facility,Both,,,90,96,81.6,27.5136,96,CorVel,Worker's Compensation,96,100,,percent of total billed charges,,
"Haptoglobin, S (Mayo)OutsideLaboratory",,83010,CPT,Facility,Both,,,90,96,81.6,27.5136,96,First Health Group Corporation,First Health Network,93.12,97,,percent of total billed charges,,
"Haptoglobin, S (Mayo)OutsideLaboratory",,83010,CPT,Facility,Both,,,90,96,81.6,27.5136,96,"Health Partners, Inc.",Commercial,90.816,94.6,,percent of total billed charges,,
"Haptoglobin, S (Mayo)OutsideLaboratory",,83010,CPT,Facility,Outpatient,,,90,96,81.6,27.5136,96,"Health Partners, Inc.",Medicare Advantage,47.04,49,,percent of total billed charges,,
"Haptoglobin, S (Mayo)OutsideLaboratory",,83010,CPT,Facility,Inpatient,,,90,96,81.6,27.5136,96,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Haptoglobin, S (Mayo)OutsideLaboratory",,83010,CPT,Facility,Both,,,90,96,81.6,27.5136,96,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),57.6,60,,percent of total billed charges,,
"Haptoglobin, S (Mayo)OutsideLaboratory",,83010,CPT,Facility,Both,,,90,96,81.6,27.5136,96,"Health Partners, Inc.",State of Minnesota Advantage Program,78.24,81.5,,percent of total billed charges,,
"Haptoglobin, S (Mayo)OutsideLaboratory",,83010,CPT,Facility,Both,,,90,96,81.6,27.5136,96,"Health Partners, Inc.",State Public Programs,48,50,,percent of total billed charges,,
"Haptoglobin, S (Mayo)OutsideLaboratory",,83010,CPT,Facility,Both,,,90,96,81.6,27.5136,96,Humana Insurance Company,Commercial PPO,91.2,95,,percent of total billed charges,,
"Haptoglobin, S (Mayo)OutsideLaboratory",,83010,CPT,Facility,Outpatient,,,90,96,81.6,27.5136,96,Humana Insurance Company,Medicare PPO,47.04,49,,percent of total billed charges,,
"Haptoglobin, S (Mayo)OutsideLaboratory",,83010,CPT,Facility,Inpatient,,,90,96,81.6,27.5136,96,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Haptoglobin, S (Mayo)OutsideLaboratory",,83010,CPT,Facility,Both,,,90,96,81.6,27.5136,96,Medica,Individual & Family,95.136,99.1,,percent of total billed charges,,
"Haptoglobin, S (Mayo)OutsideLaboratory",,83010,CPT,Facility,Outpatient,,,90,96,81.6,27.5136,96,Medica,Medica Advantage Solution,47.808,49.8,,percent of total billed charges,,
"Haptoglobin, S (Mayo)OutsideLaboratory",,83010,CPT,Facility,Inpatient,,,90,96,81.6,27.5136,96,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Haptoglobin, S (Mayo)OutsideLaboratory",,83010,CPT,Facility,Outpatient,,,90,96,81.6,27.5136,96,Medica,Medical Assistance,42.816,44.6,,percent of total billed charges,,
"Haptoglobin, S (Mayo)OutsideLaboratory",,83010,CPT,Facility,Inpatient,,,90,96,81.6,27.5136,96,Medica,Medical Assistance,,,,,Included in per diem rate,
"Haptoglobin, S (Mayo)OutsideLaboratory",,83010,CPT,Facility,Outpatient,,,90,96,81.6,27.5136,96,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,47.808,49.8,,percent of total billed charges,,
"Haptoglobin, S (Mayo)OutsideLaboratory",,83010,CPT,Facility,Inpatient,,,90,96,81.6,27.5136,96,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Haptoglobin, S (Mayo)OutsideLaboratory",,83010,CPT,Facility,Both,,,90,96,81.6,27.5136,96,"Multiplan, Inc.","Multiplan, Inc.",90.24,94,,percent of total billed charges,,
"Haptoglobin, S (Mayo)OutsideLaboratory",,83010,CPT,Facility,Outpatient,,,90,96,81.6,27.5136,96,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,82.944,86.4,,percent of total billed charges,,
"Haptoglobin, S (Mayo)OutsideLaboratory",,83010,CPT,Facility,Inpatient,,,90,96,81.6,27.5136,96,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Haptoglobin, S (Mayo)OutsideLaboratory",,83010,CPT,Facility,Both,,,90,96,81.6,27.5136,96,"Preferred One Administrative Services, INC.",PPO,94.656,98.6,,percent of total billed charges,,
"Haptoglobin, S (Mayo)OutsideLaboratory",,83010,CPT,Facility,Outpatient,,,90,96,81.6,27.5136,96,PrimeWest Health,Minnesota Senior Health Options (MSHO),49.392,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Haptoglobin, S (Mayo)OutsideLaboratory",,83010,CPT,Facility,Inpatient,,,90,96,81.6,27.5136,96,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Haptoglobin, S (Mayo)OutsideLaboratory",,83010,CPT,Facility,Outpatient,,,90,96,81.6,27.5136,96,PrimeWest Health,MinnesotaCare,49.3056,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Haptoglobin, S (Mayo)OutsideLaboratory",,83010,CPT,Facility,Inpatient,,,90,96,81.6,27.5136,96,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Haptoglobin, S (Mayo)OutsideLaboratory",,83010,CPT,Facility,Both,,,90,96,81.6,27.5136,96,Sanford Health Plan,Sanford Health Plan,88.32,92,,percent of total billed charges,,
"Haptoglobin, S (Mayo)OutsideLaboratory",,83010,CPT,Facility,Outpatient,,,90,96,81.6,27.5136,96,"UCare Health, Inc.",Individual & Family Plan,54.096,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Haptoglobin, S (Mayo)OutsideLaboratory",,83010,CPT,Facility,Inpatient,,,90,96,81.6,27.5136,96,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Haptoglobin, S (Mayo)OutsideLaboratory",,83010,CPT,Facility,Outpatient,,,90,96,81.6,27.5136,96,"UCare Health, Inc.",Medical Assistance,48.4512,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Haptoglobin, S (Mayo)OutsideLaboratory",,83010,CPT,Facility,Inpatient,,,90,96,81.6,27.5136,96,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Haptoglobin, S (Mayo)OutsideLaboratory",,83010,CPT,Facility,Outpatient,,,90,96,81.6,27.5136,96,"UCare Health, Inc.",Medicare Advantage,48.4512,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Haptoglobin, S (Mayo)OutsideLaboratory",,83010,CPT,Facility,Inpatient,,,90,96,81.6,27.5136,96,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Haptoglobin, S (Mayo)OutsideLaboratory",,83010,CPT,Facility,Outpatient,,,90,96,81.6,27.5136,96,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),48.4512,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Haptoglobin, S (Mayo)OutsideLaboratory",,83010,CPT,Facility,Inpatient,,,90,96,81.6,27.5136,96,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Haptoglobin, S (Mayo)OutsideLaboratory",,83010,CPT,Facility,Both,,,90,96,81.6,27.5136,96,UnitedHealthcare,Individual & Family,90.24,94,,percent of total billed charges,,
"Haptoglobin, S (Mayo)OutsideLaboratory",,83010,CPT,Facility,Outpatient,,,90,96,81.6,27.5136,96,UnitedHealthcare,Medicare Advantage,47.04,49,,percent of total billed charges,,
"Haptoglobin, S (Mayo)OutsideLaboratory",,83010,CPT,Facility,Inpatient,,,90,96,81.6,27.5136,96,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Haptoglobin, S (Mayo)OutsideLaboratory",,83010,CPT,Facility,Outpatient,,,90,96,81.6,27.5136,96,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,46.08,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Haptoglobin, S (Mayo)OutsideLaboratory",,83010,CPT,Facility,Inpatient,,,90,96,81.6,27.5136,96,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
H. Pylori C Urea Breath Test (Mayo)OutsideLaboratory,,83013,CPT,Facility,Both,,,90,310,263.5,88.846,310,Aetna,Commercial,285.2,92,,percent of total billed charges,,
H. Pylori C Urea Breath Test (Mayo)OutsideLaboratory,,83013,CPT,Facility,Outpatient,,,90,310,263.5,88.846,310,Aetna,Medicare Advantage,151.9,49,,percent of total billed charges,,
H. Pylori C Urea Breath Test (Mayo)OutsideLaboratory,,83013,CPT,Facility,Inpatient,,,90,310,263.5,88.846,310,Aetna,Medicare Advantage,,,,,Included in per diem rate,
H. Pylori C Urea Breath Test (Mayo)OutsideLaboratory,,83013,CPT,Facility,Both,,,90,310,263.5,88.846,310,Aetna,PPO,288.3,93,,percent of total billed charges,,
H. Pylori C Urea Breath Test (Mayo)OutsideLaboratory,,83013,CPT,Facility,Both,,,90,310,263.5,88.846,310,America's PPO,America's PPO,297.693,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
H. Pylori C Urea Breath Test (Mayo)OutsideLaboratory,,83013,CPT,Facility,Both,,,90,310,263.5,88.846,310,BlueCross BlueShield Minnesota, Federal Employee Program,305.04,98.4,,percent of total billed charges,,
H. Pylori C Urea Breath Test (Mayo)OutsideLaboratory,,83013,CPT,Facility,Both,,,90,310,263.5,88.846,310,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,310,100,,percent of total billed charges,,
H. Pylori C Urea Breath Test (Mayo)OutsideLaboratory,,83013,CPT,Facility,Both,,,90,310,263.5,88.846,310,BlueCross BlueShield Minnesota,High Value Network Plan,279,90,,percent of total billed charges,,
H. Pylori C Urea Breath Test (Mayo)OutsideLaboratory,,83013,CPT,Facility,Outpatient,,,90,310,263.5,88.846,310,BlueCross BlueShield Minnesota,Medicare Advantage,151.9,49,,percent of total billed charges,,
H. Pylori C Urea Breath Test (Mayo)OutsideLaboratory,,83013,CPT,Facility,Inpatient,,,90,310,263.5,88.846,310,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
H. Pylori C Urea Breath Test (Mayo)OutsideLaboratory,,83013,CPT,Facility,Both,,,90,310,263.5,88.846,310,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,274.567,88.57,,percent of total billed charges,,
H. Pylori C Urea Breath Test (Mayo)OutsideLaboratory,,83013,CPT,Facility,Both,,,90,310,263.5,88.846,310,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,88.846,28.66,,percent of total billed charges,,
H. Pylori C Urea Breath Test (Mayo)OutsideLaboratory,,83013,CPT,Facility,Outpatient,,,90,310,263.5,88.846,310,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),151.9,49,,percent of total billed charges,,
H. Pylori C Urea Breath Test (Mayo)OutsideLaboratory,,83013,CPT,Facility,Inpatient,,,90,310,263.5,88.846,310,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
H. Pylori C Urea Breath Test (Mayo)OutsideLaboratory,,83013,CPT,Facility,Both,,,90,310,263.5,88.846,310,CorVel,Worker's Compensation,310,100,,percent of total billed charges,,
H. Pylori C Urea Breath Test (Mayo)OutsideLaboratory,,83013,CPT,Facility,Both,,,90,310,263.5,88.846,310,First Health Group Corporation,First Health Network,300.7,97,,percent of total billed charges,,
H. Pylori C Urea Breath Test (Mayo)OutsideLaboratory,,83013,CPT,Facility,Both,,,90,310,263.5,88.846,310,"Health Partners, Inc.",Commercial,293.26,94.6,,percent of total billed charges,,
H. Pylori C Urea Breath Test (Mayo)OutsideLaboratory,,83013,CPT,Facility,Outpatient,,,90,310,263.5,88.846,310,"Health Partners, Inc.",Medicare Advantage,151.9,49,,percent of total billed charges,,
H. Pylori C Urea Breath Test (Mayo)OutsideLaboratory,,83013,CPT,Facility,Inpatient,,,90,310,263.5,88.846,310,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
H. Pylori C Urea Breath Test (Mayo)OutsideLaboratory,,83013,CPT,Facility,Both,,,90,310,263.5,88.846,310,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),186,60,,percent of total billed charges,,
H. Pylori C Urea Breath Test (Mayo)OutsideLaboratory,,83013,CPT,Facility,Both,,,90,310,263.5,88.846,310,"Health Partners, Inc.",State of Minnesota Advantage Program,252.65,81.5,,percent of total billed charges,,
H. Pylori C Urea Breath Test (Mayo)OutsideLaboratory,,83013,CPT,Facility,Both,,,90,310,263.5,88.846,310,"Health Partners, Inc.",State Public Programs,155,50,,percent of total billed charges,,
H. Pylori C Urea Breath Test (Mayo)OutsideLaboratory,,83013,CPT,Facility,Both,,,90,310,263.5,88.846,310,Humana Insurance Company,Commercial PPO,294.5,95,,percent of total billed charges,,
H. Pylori C Urea Breath Test (Mayo)OutsideLaboratory,,83013,CPT,Facility,Outpatient,,,90,310,263.5,88.846,310,Humana Insurance Company,Medicare PPO,151.9,49,,percent of total billed charges,,
H. Pylori C Urea Breath Test (Mayo)OutsideLaboratory,,83013,CPT,Facility,Inpatient,,,90,310,263.5,88.846,310,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
H. Pylori C Urea Breath Test (Mayo)OutsideLaboratory,,83013,CPT,Facility,Both,,,90,310,263.5,88.846,310,Medica,Individual & Family,307.21,99.1,,percent of total billed charges,,
H. Pylori C Urea Breath Test (Mayo)OutsideLaboratory,,83013,CPT,Facility,Outpatient,,,90,310,263.5,88.846,310,Medica,Medica Advantage Solution,154.38,49.8,,percent of total billed charges,,
H. Pylori C Urea Breath Test (Mayo)OutsideLaboratory,,83013,CPT,Facility,Inpatient,,,90,310,263.5,88.846,310,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
H. Pylori C Urea Breath Test (Mayo)OutsideLaboratory,,83013,CPT,Facility,Outpatient,,,90,310,263.5,88.846,310,Medica,Medical Assistance,138.26,44.6,,percent of total billed charges,,
H. Pylori C Urea Breath Test (Mayo)OutsideLaboratory,,83013,CPT,Facility,Inpatient,,,90,310,263.5,88.846,310,Medica,Medical Assistance,,,,,Included in per diem rate,
H. Pylori C Urea Breath Test (Mayo)OutsideLaboratory,,83013,CPT,Facility,Outpatient,,,90,310,263.5,88.846,310,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,154.38,49.8,,percent of total billed charges,,
H. Pylori C Urea Breath Test (Mayo)OutsideLaboratory,,83013,CPT,Facility,Inpatient,,,90,310,263.5,88.846,310,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
H. Pylori C Urea Breath Test (Mayo)OutsideLaboratory,,83013,CPT,Facility,Both,,,90,310,263.5,88.846,310,"Multiplan, Inc.","Multiplan, Inc.",291.4,94,,percent of total billed charges,,
H. Pylori C Urea Breath Test (Mayo)OutsideLaboratory,,83013,CPT,Facility,Outpatient,,,90,310,263.5,88.846,310,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,267.84,86.4,,percent of total billed charges,,
H. Pylori C Urea Breath Test (Mayo)OutsideLaboratory,,83013,CPT,Facility,Inpatient,,,90,310,263.5,88.846,310,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
H. Pylori C Urea Breath Test (Mayo)OutsideLaboratory,,83013,CPT,Facility,Both,,,90,310,263.5,88.846,310,"Preferred One Administrative Services, INC.",PPO,305.66,98.6,,percent of total billed charges,,
H. Pylori C Urea Breath Test (Mayo)OutsideLaboratory,,83013,CPT,Facility,Outpatient,,,90,310,263.5,88.846,310,PrimeWest Health,Minnesota Senior Health Options (MSHO),159.495,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
H. Pylori C Urea Breath Test (Mayo)OutsideLaboratory,,83013,CPT,Facility,Inpatient,,,90,310,263.5,88.846,310,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
H. Pylori C Urea Breath Test (Mayo)OutsideLaboratory,,83013,CPT,Facility,Outpatient,,,90,310,263.5,88.846,310,PrimeWest Health,MinnesotaCare,159.216,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
H. Pylori C Urea Breath Test (Mayo)OutsideLaboratory,,83013,CPT,Facility,Inpatient,,,90,310,263.5,88.846,310,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
H. Pylori C Urea Breath Test (Mayo)OutsideLaboratory,,83013,CPT,Facility,Both,,,90,310,263.5,88.846,310,Sanford Health Plan,Sanford Health Plan,285.2,92,,percent of total billed charges,,
H. Pylori C Urea Breath Test (Mayo)OutsideLaboratory,,83013,CPT,Facility,Outpatient,,,90,310,263.5,88.846,310,"UCare Health, Inc.",Individual & Family Plan,174.685,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
H. Pylori C Urea Breath Test (Mayo)OutsideLaboratory,,83013,CPT,Facility,Inpatient,,,90,310,263.5,88.846,310,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
H. Pylori C Urea Breath Test (Mayo)OutsideLaboratory,,83013,CPT,Facility,Outpatient,,,90,310,263.5,88.846,310,"UCare Health, Inc.",Medical Assistance,156.457,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
H. Pylori C Urea Breath Test (Mayo)OutsideLaboratory,,83013,CPT,Facility,Inpatient,,,90,310,263.5,88.846,310,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
H. Pylori C Urea Breath Test (Mayo)OutsideLaboratory,,83013,CPT,Facility,Outpatient,,,90,310,263.5,88.846,310,"UCare Health, Inc.",Medicare Advantage,156.457,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
H. Pylori C Urea Breath Test (Mayo)OutsideLaboratory,,83013,CPT,Facility,Inpatient,,,90,310,263.5,88.846,310,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
H. Pylori C Urea Breath Test (Mayo)OutsideLaboratory,,83013,CPT,Facility,Outpatient,,,90,310,263.5,88.846,310,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),156.457,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
H. Pylori C Urea Breath Test (Mayo)OutsideLaboratory,,83013,CPT,Facility,Inpatient,,,90,310,263.5,88.846,310,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
H. Pylori C Urea Breath Test (Mayo)OutsideLaboratory,,83013,CPT,Facility,Both,,,90,310,263.5,88.846,310,UnitedHealthcare,Individual & Family,291.4,94,,percent of total billed charges,,
H. Pylori C Urea Breath Test (Mayo)OutsideLaboratory,,83013,CPT,Facility,Outpatient,,,90,310,263.5,88.846,310,UnitedHealthcare,Medicare Advantage,151.9,49,,percent of total billed charges,,
H. Pylori C Urea Breath Test (Mayo)OutsideLaboratory,,83013,CPT,Facility,Inpatient,,,90,310,263.5,88.846,310,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
H. Pylori C Urea Breath Test (Mayo)OutsideLaboratory,,83013,CPT,Facility,Outpatient,,,90,310,263.5,88.846,310,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,148.8,48,,percent of total billed charges,,100% of DHS outpatient percentage
H. Pylori C Urea Breath Test (Mayo)OutsideLaboratory,,83013,CPT,Facility,Inpatient,,,90,310,263.5,88.846,310,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Cobalt, S (Mayo)OutsideLaboratory",,83018,CPT,Facility,Both,,,90,145,123.25,41.557,145,Aetna,Commercial,133.4,92,,percent of total billed charges,,
"Cobalt, S (Mayo)OutsideLaboratory",,83018,CPT,Facility,Outpatient,,,90,145,123.25,41.557,145,Aetna,Medicare Advantage,71.05,49,,percent of total billed charges,,
"Cobalt, S (Mayo)OutsideLaboratory",,83018,CPT,Facility,Inpatient,,,90,145,123.25,41.557,145,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Cobalt, S (Mayo)OutsideLaboratory",,83018,CPT,Facility,Both,,,90,145,123.25,41.557,145,Aetna,PPO,134.85,93,,percent of total billed charges,,
"Cobalt, S (Mayo)OutsideLaboratory",,83018,CPT,Facility,Both,,,90,145,123.25,41.557,145,America's PPO,America's PPO,139.2435,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Cobalt, S (Mayo)OutsideLaboratory",,83018,CPT,Facility,Both,,,90,145,123.25,41.557,145,BlueCross BlueShield Minnesota, Federal Employee Program,142.68,98.4,,percent of total billed charges,,
"Cobalt, S (Mayo)OutsideLaboratory",,83018,CPT,Facility,Both,,,90,145,123.25,41.557,145,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,145,100,,percent of total billed charges,,
"Cobalt, S (Mayo)OutsideLaboratory",,83018,CPT,Facility,Both,,,90,145,123.25,41.557,145,BlueCross BlueShield Minnesota,High Value Network Plan,130.5,90,,percent of total billed charges,,
"Cobalt, S (Mayo)OutsideLaboratory",,83018,CPT,Facility,Outpatient,,,90,145,123.25,41.557,145,BlueCross BlueShield Minnesota,Medicare Advantage,71.05,49,,percent of total billed charges,,
"Cobalt, S (Mayo)OutsideLaboratory",,83018,CPT,Facility,Inpatient,,,90,145,123.25,41.557,145,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Cobalt, S (Mayo)OutsideLaboratory",,83018,CPT,Facility,Both,,,90,145,123.25,41.557,145,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,128.4265,88.57,,percent of total billed charges,,
"Cobalt, S (Mayo)OutsideLaboratory",,83018,CPT,Facility,Both,,,90,145,123.25,41.557,145,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,41.557,28.66,,percent of total billed charges,,
"Cobalt, S (Mayo)OutsideLaboratory",,83018,CPT,Facility,Outpatient,,,90,145,123.25,41.557,145,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),71.05,49,,percent of total billed charges,,
"Cobalt, S (Mayo)OutsideLaboratory",,83018,CPT,Facility,Inpatient,,,90,145,123.25,41.557,145,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Cobalt, S (Mayo)OutsideLaboratory",,83018,CPT,Facility,Both,,,90,145,123.25,41.557,145,CorVel,Worker's Compensation,145,100,,percent of total billed charges,,
"Cobalt, S (Mayo)OutsideLaboratory",,83018,CPT,Facility,Both,,,90,145,123.25,41.557,145,First Health Group Corporation,First Health Network,140.65,97,,percent of total billed charges,,
"Cobalt, S (Mayo)OutsideLaboratory",,83018,CPT,Facility,Both,,,90,145,123.25,41.557,145,"Health Partners, Inc.",Commercial,137.17,94.6,,percent of total billed charges,,
"Cobalt, S (Mayo)OutsideLaboratory",,83018,CPT,Facility,Outpatient,,,90,145,123.25,41.557,145,"Health Partners, Inc.",Medicare Advantage,71.05,49,,percent of total billed charges,,
"Cobalt, S (Mayo)OutsideLaboratory",,83018,CPT,Facility,Inpatient,,,90,145,123.25,41.557,145,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Cobalt, S (Mayo)OutsideLaboratory",,83018,CPT,Facility,Both,,,90,145,123.25,41.557,145,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),87,60,,percent of total billed charges,,
"Cobalt, S (Mayo)OutsideLaboratory",,83018,CPT,Facility,Both,,,90,145,123.25,41.557,145,"Health Partners, Inc.",State of Minnesota Advantage Program,118.175,81.5,,percent of total billed charges,,
"Cobalt, S (Mayo)OutsideLaboratory",,83018,CPT,Facility,Both,,,90,145,123.25,41.557,145,"Health Partners, Inc.",State Public Programs,72.5,50,,percent of total billed charges,,
"Cobalt, S (Mayo)OutsideLaboratory",,83018,CPT,Facility,Both,,,90,145,123.25,41.557,145,Humana Insurance Company,Commercial PPO,137.75,95,,percent of total billed charges,,
"Cobalt, S (Mayo)OutsideLaboratory",,83018,CPT,Facility,Outpatient,,,90,145,123.25,41.557,145,Humana Insurance Company,Medicare PPO,71.05,49,,percent of total billed charges,,
"Cobalt, S (Mayo)OutsideLaboratory",,83018,CPT,Facility,Inpatient,,,90,145,123.25,41.557,145,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Cobalt, S (Mayo)OutsideLaboratory",,83018,CPT,Facility,Both,,,90,145,123.25,41.557,145,Medica,Individual & Family,143.695,99.1,,percent of total billed charges,,
"Cobalt, S (Mayo)OutsideLaboratory",,83018,CPT,Facility,Outpatient,,,90,145,123.25,41.557,145,Medica,Medica Advantage Solution,72.21,49.8,,percent of total billed charges,,
"Cobalt, S (Mayo)OutsideLaboratory",,83018,CPT,Facility,Inpatient,,,90,145,123.25,41.557,145,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Cobalt, S (Mayo)OutsideLaboratory",,83018,CPT,Facility,Outpatient,,,90,145,123.25,41.557,145,Medica,Medical Assistance,64.67,44.6,,percent of total billed charges,,
"Cobalt, S (Mayo)OutsideLaboratory",,83018,CPT,Facility,Inpatient,,,90,145,123.25,41.557,145,Medica,Medical Assistance,,,,,Included in per diem rate,
"Cobalt, S (Mayo)OutsideLaboratory",,83018,CPT,Facility,Outpatient,,,90,145,123.25,41.557,145,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,72.21,49.8,,percent of total billed charges,,
"Cobalt, S (Mayo)OutsideLaboratory",,83018,CPT,Facility,Inpatient,,,90,145,123.25,41.557,145,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Cobalt, S (Mayo)OutsideLaboratory",,83018,CPT,Facility,Both,,,90,145,123.25,41.557,145,"Multiplan, Inc.","Multiplan, Inc.",136.3,94,,percent of total billed charges,,
"Cobalt, S (Mayo)OutsideLaboratory",,83018,CPT,Facility,Outpatient,,,90,145,123.25,41.557,145,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,125.28,86.4,,percent of total billed charges,,
"Cobalt, S (Mayo)OutsideLaboratory",,83018,CPT,Facility,Inpatient,,,90,145,123.25,41.557,145,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Cobalt, S (Mayo)OutsideLaboratory",,83018,CPT,Facility,Both,,,90,145,123.25,41.557,145,"Preferred One Administrative Services, INC.",PPO,142.97,98.6,,percent of total billed charges,,
"Cobalt, S (Mayo)OutsideLaboratory",,83018,CPT,Facility,Outpatient,,,90,145,123.25,41.557,145,PrimeWest Health,Minnesota Senior Health Options (MSHO),74.6025,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Cobalt, S (Mayo)OutsideLaboratory",,83018,CPT,Facility,Inpatient,,,90,145,123.25,41.557,145,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Cobalt, S (Mayo)OutsideLaboratory",,83018,CPT,Facility,Outpatient,,,90,145,123.25,41.557,145,PrimeWest Health,MinnesotaCare,74.472,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Cobalt, S (Mayo)OutsideLaboratory",,83018,CPT,Facility,Inpatient,,,90,145,123.25,41.557,145,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Cobalt, S (Mayo)OutsideLaboratory",,83018,CPT,Facility,Both,,,90,145,123.25,41.557,145,Sanford Health Plan,Sanford Health Plan,133.4,92,,percent of total billed charges,,
"Cobalt, S (Mayo)OutsideLaboratory",,83018,CPT,Facility,Outpatient,,,90,145,123.25,41.557,145,"UCare Health, Inc.",Individual & Family Plan,81.7075,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Cobalt, S (Mayo)OutsideLaboratory",,83018,CPT,Facility,Inpatient,,,90,145,123.25,41.557,145,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Cobalt, S (Mayo)OutsideLaboratory",,83018,CPT,Facility,Outpatient,,,90,145,123.25,41.557,145,"UCare Health, Inc.",Medical Assistance,73.1815,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Cobalt, S (Mayo)OutsideLaboratory",,83018,CPT,Facility,Inpatient,,,90,145,123.25,41.557,145,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Cobalt, S (Mayo)OutsideLaboratory",,83018,CPT,Facility,Outpatient,,,90,145,123.25,41.557,145,"UCare Health, Inc.",Medicare Advantage,73.1815,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Cobalt, S (Mayo)OutsideLaboratory",,83018,CPT,Facility,Inpatient,,,90,145,123.25,41.557,145,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Cobalt, S (Mayo)OutsideLaboratory",,83018,CPT,Facility,Outpatient,,,90,145,123.25,41.557,145,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),73.1815,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Cobalt, S (Mayo)OutsideLaboratory",,83018,CPT,Facility,Inpatient,,,90,145,123.25,41.557,145,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Cobalt, S (Mayo)OutsideLaboratory",,83018,CPT,Facility,Both,,,90,145,123.25,41.557,145,UnitedHealthcare,Individual & Family,136.3,94,,percent of total billed charges,,
"Cobalt, S (Mayo)OutsideLaboratory",,83018,CPT,Facility,Outpatient,,,90,145,123.25,41.557,145,UnitedHealthcare,Medicare Advantage,71.05,49,,percent of total billed charges,,
"Cobalt, S (Mayo)OutsideLaboratory",,83018,CPT,Facility,Inpatient,,,90,145,123.25,41.557,145,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Cobalt, S (Mayo)OutsideLaboratory",,83018,CPT,Facility,Outpatient,,,90,145,123.25,41.557,145,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,69.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Cobalt, S (Mayo)OutsideLaboratory",,83018,CPT,Facility,Inpatient,,,90,145,123.25,41.557,145,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Hemoglobin Fractionation & Quant, Electrophoresis (Mayo)OutsideLaboratory",,83020,CPT,Facility,Both,,,90,115,97.75,32.959,115,Aetna,Commercial,105.8,92,,percent of total billed charges,,
"Hemoglobin Fractionation & Quant, Electrophoresis (Mayo)OutsideLaboratory",,83020,CPT,Facility,Outpatient,,,90,115,97.75,32.959,115,Aetna,Medicare Advantage,56.35,49,,percent of total billed charges,,
"Hemoglobin Fractionation & Quant, Electrophoresis (Mayo)OutsideLaboratory",,83020,CPT,Facility,Inpatient,,,90,115,97.75,32.959,115,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Hemoglobin Fractionation & Quant, Electrophoresis (Mayo)OutsideLaboratory",,83020,CPT,Facility,Both,,,90,115,97.75,32.959,115,Aetna,PPO,106.95,93,,percent of total billed charges,,
"Hemoglobin Fractionation & Quant, Electrophoresis (Mayo)OutsideLaboratory",,83020,CPT,Facility,Both,,,90,115,97.75,32.959,115,America's PPO,America's PPO,110.4345,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Hemoglobin Fractionation & Quant, Electrophoresis (Mayo)OutsideLaboratory",,83020,CPT,Facility,Both,,,90,115,97.75,32.959,115,BlueCross BlueShield Minnesota, Federal Employee Program,113.16,98.4,,percent of total billed charges,,
"Hemoglobin Fractionation & Quant, Electrophoresis (Mayo)OutsideLaboratory",,83020,CPT,Facility,Both,,,90,115,97.75,32.959,115,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,115,100,,percent of total billed charges,,
"Hemoglobin Fractionation & Quant, Electrophoresis (Mayo)OutsideLaboratory",,83020,CPT,Facility,Both,,,90,115,97.75,32.959,115,BlueCross BlueShield Minnesota,High Value Network Plan,103.5,90,,percent of total billed charges,,
"Hemoglobin Fractionation & Quant, Electrophoresis (Mayo)OutsideLaboratory",,83020,CPT,Facility,Outpatient,,,90,115,97.75,32.959,115,BlueCross BlueShield Minnesota,Medicare Advantage,56.35,49,,percent of total billed charges,,
"Hemoglobin Fractionation & Quant, Electrophoresis (Mayo)OutsideLaboratory",,83020,CPT,Facility,Inpatient,,,90,115,97.75,32.959,115,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Hemoglobin Fractionation & Quant, Electrophoresis (Mayo)OutsideLaboratory",,83020,CPT,Facility,Both,,,90,115,97.75,32.959,115,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,101.8555,88.57,,percent of total billed charges,,
"Hemoglobin Fractionation & Quant, Electrophoresis (Mayo)OutsideLaboratory",,83020,CPT,Facility,Both,,,90,115,97.75,32.959,115,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,32.959,28.66,,percent of total billed charges,,
"Hemoglobin Fractionation & Quant, Electrophoresis (Mayo)OutsideLaboratory",,83020,CPT,Facility,Outpatient,,,90,115,97.75,32.959,115,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),56.35,49,,percent of total billed charges,,
"Hemoglobin Fractionation & Quant, Electrophoresis (Mayo)OutsideLaboratory",,83020,CPT,Facility,Inpatient,,,90,115,97.75,32.959,115,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Hemoglobin Fractionation & Quant, Electrophoresis (Mayo)OutsideLaboratory",,83020,CPT,Facility,Both,,,90,115,97.75,32.959,115,CorVel,Worker's Compensation,115,100,,percent of total billed charges,,
"Hemoglobin Fractionation & Quant, Electrophoresis (Mayo)OutsideLaboratory",,83020,CPT,Facility,Both,,,90,115,97.75,32.959,115,First Health Group Corporation,First Health Network,111.55,97,,percent of total billed charges,,
"Hemoglobin Fractionation & Quant, Electrophoresis (Mayo)OutsideLaboratory",,83020,CPT,Facility,Both,,,90,115,97.75,32.959,115,"Health Partners, Inc.",Commercial,108.79,94.6,,percent of total billed charges,,
"Hemoglobin Fractionation & Quant, Electrophoresis (Mayo)OutsideLaboratory",,83020,CPT,Facility,Outpatient,,,90,115,97.75,32.959,115,"Health Partners, Inc.",Medicare Advantage,56.35,49,,percent of total billed charges,,
"Hemoglobin Fractionation & Quant, Electrophoresis (Mayo)OutsideLaboratory",,83020,CPT,Facility,Inpatient,,,90,115,97.75,32.959,115,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Hemoglobin Fractionation & Quant, Electrophoresis (Mayo)OutsideLaboratory",,83020,CPT,Facility,Both,,,90,115,97.75,32.959,115,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),69,60,,percent of total billed charges,,
"Hemoglobin Fractionation & Quant, Electrophoresis (Mayo)OutsideLaboratory",,83020,CPT,Facility,Both,,,90,115,97.75,32.959,115,"Health Partners, Inc.",State of Minnesota Advantage Program,93.725,81.5,,percent of total billed charges,,
"Hemoglobin Fractionation & Quant, Electrophoresis (Mayo)OutsideLaboratory",,83020,CPT,Facility,Both,,,90,115,97.75,32.959,115,"Health Partners, Inc.",State Public Programs,57.5,50,,percent of total billed charges,,
"Hemoglobin Fractionation & Quant, Electrophoresis (Mayo)OutsideLaboratory",,83020,CPT,Facility,Both,,,90,115,97.75,32.959,115,Humana Insurance Company,Commercial PPO,109.25,95,,percent of total billed charges,,
"Hemoglobin Fractionation & Quant, Electrophoresis (Mayo)OutsideLaboratory",,83020,CPT,Facility,Outpatient,,,90,115,97.75,32.959,115,Humana Insurance Company,Medicare PPO,56.35,49,,percent of total billed charges,,
"Hemoglobin Fractionation & Quant, Electrophoresis (Mayo)OutsideLaboratory",,83020,CPT,Facility,Inpatient,,,90,115,97.75,32.959,115,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Hemoglobin Fractionation & Quant, Electrophoresis (Mayo)OutsideLaboratory",,83020,CPT,Facility,Both,,,90,115,97.75,32.959,115,Medica,Individual & Family,113.965,99.1,,percent of total billed charges,,
"Hemoglobin Fractionation & Quant, Electrophoresis (Mayo)OutsideLaboratory",,83020,CPT,Facility,Outpatient,,,90,115,97.75,32.959,115,Medica,Medica Advantage Solution,57.27,49.8,,percent of total billed charges,,
"Hemoglobin Fractionation & Quant, Electrophoresis (Mayo)OutsideLaboratory",,83020,CPT,Facility,Inpatient,,,90,115,97.75,32.959,115,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Hemoglobin Fractionation & Quant, Electrophoresis (Mayo)OutsideLaboratory",,83020,CPT,Facility,Outpatient,,,90,115,97.75,32.959,115,Medica,Medical Assistance,51.29,44.6,,percent of total billed charges,,
"Hemoglobin Fractionation & Quant, Electrophoresis (Mayo)OutsideLaboratory",,83020,CPT,Facility,Inpatient,,,90,115,97.75,32.959,115,Medica,Medical Assistance,,,,,Included in per diem rate,
"Hemoglobin Fractionation & Quant, Electrophoresis (Mayo)OutsideLaboratory",,83020,CPT,Facility,Outpatient,,,90,115,97.75,32.959,115,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,57.27,49.8,,percent of total billed charges,,
"Hemoglobin Fractionation & Quant, Electrophoresis (Mayo)OutsideLaboratory",,83020,CPT,Facility,Inpatient,,,90,115,97.75,32.959,115,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Hemoglobin Fractionation & Quant, Electrophoresis (Mayo)OutsideLaboratory",,83020,CPT,Facility,Both,,,90,115,97.75,32.959,115,"Multiplan, Inc.","Multiplan, Inc.",108.1,94,,percent of total billed charges,,
"Hemoglobin Fractionation & Quant, Electrophoresis (Mayo)OutsideLaboratory",,83020,CPT,Facility,Outpatient,,,90,115,97.75,32.959,115,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,99.36,86.4,,percent of total billed charges,,
"Hemoglobin Fractionation & Quant, Electrophoresis (Mayo)OutsideLaboratory",,83020,CPT,Facility,Inpatient,,,90,115,97.75,32.959,115,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Hemoglobin Fractionation & Quant, Electrophoresis (Mayo)OutsideLaboratory",,83020,CPT,Facility,Both,,,90,115,97.75,32.959,115,"Preferred One Administrative Services, INC.",PPO,113.39,98.6,,percent of total billed charges,,
"Hemoglobin Fractionation & Quant, Electrophoresis (Mayo)OutsideLaboratory",,83020,CPT,Facility,Outpatient,,,90,115,97.75,32.959,115,PrimeWest Health,Minnesota Senior Health Options (MSHO),59.1675,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Hemoglobin Fractionation & Quant, Electrophoresis (Mayo)OutsideLaboratory",,83020,CPT,Facility,Inpatient,,,90,115,97.75,32.959,115,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Hemoglobin Fractionation & Quant, Electrophoresis (Mayo)OutsideLaboratory",,83020,CPT,Facility,Outpatient,,,90,115,97.75,32.959,115,PrimeWest Health,MinnesotaCare,59.064,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Hemoglobin Fractionation & Quant, Electrophoresis (Mayo)OutsideLaboratory",,83020,CPT,Facility,Inpatient,,,90,115,97.75,32.959,115,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Hemoglobin Fractionation & Quant, Electrophoresis (Mayo)OutsideLaboratory",,83020,CPT,Facility,Both,,,90,115,97.75,32.959,115,Sanford Health Plan,Sanford Health Plan,105.8,92,,percent of total billed charges,,
"Hemoglobin Fractionation & Quant, Electrophoresis (Mayo)OutsideLaboratory",,83020,CPT,Facility,Outpatient,,,90,115,97.75,32.959,115,"UCare Health, Inc.",Individual & Family Plan,64.8025,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Hemoglobin Fractionation & Quant, Electrophoresis (Mayo)OutsideLaboratory",,83020,CPT,Facility,Inpatient,,,90,115,97.75,32.959,115,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Hemoglobin Fractionation & Quant, Electrophoresis (Mayo)OutsideLaboratory",,83020,CPT,Facility,Outpatient,,,90,115,97.75,32.959,115,"UCare Health, Inc.",Medical Assistance,58.0405,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Hemoglobin Fractionation & Quant, Electrophoresis (Mayo)OutsideLaboratory",,83020,CPT,Facility,Inpatient,,,90,115,97.75,32.959,115,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Hemoglobin Fractionation & Quant, Electrophoresis (Mayo)OutsideLaboratory",,83020,CPT,Facility,Outpatient,,,90,115,97.75,32.959,115,"UCare Health, Inc.",Medicare Advantage,58.0405,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Hemoglobin Fractionation & Quant, Electrophoresis (Mayo)OutsideLaboratory",,83020,CPT,Facility,Inpatient,,,90,115,97.75,32.959,115,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Hemoglobin Fractionation & Quant, Electrophoresis (Mayo)OutsideLaboratory",,83020,CPT,Facility,Outpatient,,,90,115,97.75,32.959,115,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),58.0405,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Hemoglobin Fractionation & Quant, Electrophoresis (Mayo)OutsideLaboratory",,83020,CPT,Facility,Inpatient,,,90,115,97.75,32.959,115,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Hemoglobin Fractionation & Quant, Electrophoresis (Mayo)OutsideLaboratory",,83020,CPT,Facility,Both,,,90,115,97.75,32.959,115,UnitedHealthcare,Individual & Family,108.1,94,,percent of total billed charges,,
"Hemoglobin Fractionation & Quant, Electrophoresis (Mayo)OutsideLaboratory",,83020,CPT,Facility,Outpatient,,,90,115,97.75,32.959,115,UnitedHealthcare,Medicare Advantage,56.35,49,,percent of total billed charges,,
"Hemoglobin Fractionation & Quant, Electrophoresis (Mayo)OutsideLaboratory",,83020,CPT,Facility,Inpatient,,,90,115,97.75,32.959,115,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Hemoglobin Fractionation & Quant, Electrophoresis (Mayo)OutsideLaboratory",,83020,CPT,Facility,Outpatient,,,90,115,97.75,32.959,115,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,55.2,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Hemoglobin Fractionation & Quant, Electrophoresis (Mayo)OutsideLaboratory",,83020,CPT,Facility,Inpatient,,,90,115,97.75,32.959,115,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Hgb Electrophoresis Cascade (Mdh)OutsideLaboratory,,83020,CPT,Facility,Both,,,90,34,28.9,9.7444,34,Aetna,Commercial,31.28,92,,percent of total billed charges,,
Hgb Electrophoresis Cascade (Mdh)OutsideLaboratory,,83020,CPT,Facility,Outpatient,,,90,34,28.9,9.7444,34,Aetna,Medicare Advantage,16.66,49,,percent of total billed charges,,
Hgb Electrophoresis Cascade (Mdh)OutsideLaboratory,,83020,CPT,Facility,Inpatient,,,90,34,28.9,9.7444,34,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Hgb Electrophoresis Cascade (Mdh)OutsideLaboratory,,83020,CPT,Facility,Both,,,90,34,28.9,9.7444,34,Aetna,PPO,31.62,93,,percent of total billed charges,,
Hgb Electrophoresis Cascade (Mdh)OutsideLaboratory,,83020,CPT,Facility,Both,,,90,34,28.9,9.7444,34,America's PPO,America's PPO,32.6502,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Hgb Electrophoresis Cascade (Mdh)OutsideLaboratory,,83020,CPT,Facility,Both,,,90,34,28.9,9.7444,34,BlueCross BlueShield Minnesota, Federal Employee Program,33.456,98.4,,percent of total billed charges,,
Hgb Electrophoresis Cascade (Mdh)OutsideLaboratory,,83020,CPT,Facility,Both,,,90,34,28.9,9.7444,34,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,34,100,,percent of total billed charges,,
Hgb Electrophoresis Cascade (Mdh)OutsideLaboratory,,83020,CPT,Facility,Both,,,90,34,28.9,9.7444,34,BlueCross BlueShield Minnesota,High Value Network Plan,30.6,90,,percent of total billed charges,,
Hgb Electrophoresis Cascade (Mdh)OutsideLaboratory,,83020,CPT,Facility,Outpatient,,,90,34,28.9,9.7444,34,BlueCross BlueShield Minnesota,Medicare Advantage,16.66,49,,percent of total billed charges,,
Hgb Electrophoresis Cascade (Mdh)OutsideLaboratory,,83020,CPT,Facility,Inpatient,,,90,34,28.9,9.7444,34,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Hgb Electrophoresis Cascade (Mdh)OutsideLaboratory,,83020,CPT,Facility,Both,,,90,34,28.9,9.7444,34,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,30.1138,88.57,,percent of total billed charges,,
Hgb Electrophoresis Cascade (Mdh)OutsideLaboratory,,83020,CPT,Facility,Both,,,90,34,28.9,9.7444,34,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,9.7444,28.66,,percent of total billed charges,,
Hgb Electrophoresis Cascade (Mdh)OutsideLaboratory,,83020,CPT,Facility,Outpatient,,,90,34,28.9,9.7444,34,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),16.66,49,,percent of total billed charges,,
Hgb Electrophoresis Cascade (Mdh)OutsideLaboratory,,83020,CPT,Facility,Inpatient,,,90,34,28.9,9.7444,34,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Hgb Electrophoresis Cascade (Mdh)OutsideLaboratory,,83020,CPT,Facility,Both,,,90,34,28.9,9.7444,34,CorVel,Worker's Compensation,34,100,,percent of total billed charges,,
Hgb Electrophoresis Cascade (Mdh)OutsideLaboratory,,83020,CPT,Facility,Both,,,90,34,28.9,9.7444,34,First Health Group Corporation,First Health Network,32.98,97,,percent of total billed charges,,
Hgb Electrophoresis Cascade (Mdh)OutsideLaboratory,,83020,CPT,Facility,Both,,,90,34,28.9,9.7444,34,"Health Partners, Inc.",Commercial,32.164,94.6,,percent of total billed charges,,
Hgb Electrophoresis Cascade (Mdh)OutsideLaboratory,,83020,CPT,Facility,Outpatient,,,90,34,28.9,9.7444,34,"Health Partners, Inc.",Medicare Advantage,16.66,49,,percent of total billed charges,,
Hgb Electrophoresis Cascade (Mdh)OutsideLaboratory,,83020,CPT,Facility,Inpatient,,,90,34,28.9,9.7444,34,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Hgb Electrophoresis Cascade (Mdh)OutsideLaboratory,,83020,CPT,Facility,Both,,,90,34,28.9,9.7444,34,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),20.4,60,,percent of total billed charges,,
Hgb Electrophoresis Cascade (Mdh)OutsideLaboratory,,83020,CPT,Facility,Both,,,90,34,28.9,9.7444,34,"Health Partners, Inc.",State of Minnesota Advantage Program,27.71,81.5,,percent of total billed charges,,
Hgb Electrophoresis Cascade (Mdh)OutsideLaboratory,,83020,CPT,Facility,Both,,,90,34,28.9,9.7444,34,"Health Partners, Inc.",State Public Programs,17,50,,percent of total billed charges,,
Hgb Electrophoresis Cascade (Mdh)OutsideLaboratory,,83020,CPT,Facility,Both,,,90,34,28.9,9.7444,34,Humana Insurance Company,Commercial PPO,32.3,95,,percent of total billed charges,,
Hgb Electrophoresis Cascade (Mdh)OutsideLaboratory,,83020,CPT,Facility,Outpatient,,,90,34,28.9,9.7444,34,Humana Insurance Company,Medicare PPO,16.66,49,,percent of total billed charges,,
Hgb Electrophoresis Cascade (Mdh)OutsideLaboratory,,83020,CPT,Facility,Inpatient,,,90,34,28.9,9.7444,34,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Hgb Electrophoresis Cascade (Mdh)OutsideLaboratory,,83020,CPT,Facility,Both,,,90,34,28.9,9.7444,34,Medica,Individual & Family,33.694,99.1,,percent of total billed charges,,
Hgb Electrophoresis Cascade (Mdh)OutsideLaboratory,,83020,CPT,Facility,Outpatient,,,90,34,28.9,9.7444,34,Medica,Medica Advantage Solution,16.932,49.8,,percent of total billed charges,,
Hgb Electrophoresis Cascade (Mdh)OutsideLaboratory,,83020,CPT,Facility,Inpatient,,,90,34,28.9,9.7444,34,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Hgb Electrophoresis Cascade (Mdh)OutsideLaboratory,,83020,CPT,Facility,Outpatient,,,90,34,28.9,9.7444,34,Medica,Medical Assistance,15.164,44.6,,percent of total billed charges,,
Hgb Electrophoresis Cascade (Mdh)OutsideLaboratory,,83020,CPT,Facility,Inpatient,,,90,34,28.9,9.7444,34,Medica,Medical Assistance,,,,,Included in per diem rate,
Hgb Electrophoresis Cascade (Mdh)OutsideLaboratory,,83020,CPT,Facility,Outpatient,,,90,34,28.9,9.7444,34,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,16.932,49.8,,percent of total billed charges,,
Hgb Electrophoresis Cascade (Mdh)OutsideLaboratory,,83020,CPT,Facility,Inpatient,,,90,34,28.9,9.7444,34,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Hgb Electrophoresis Cascade (Mdh)OutsideLaboratory,,83020,CPT,Facility,Both,,,90,34,28.9,9.7444,34,"Multiplan, Inc.","Multiplan, Inc.",31.96,94,,percent of total billed charges,,
Hgb Electrophoresis Cascade (Mdh)OutsideLaboratory,,83020,CPT,Facility,Outpatient,,,90,34,28.9,9.7444,34,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,29.376,86.4,,percent of total billed charges,,
Hgb Electrophoresis Cascade (Mdh)OutsideLaboratory,,83020,CPT,Facility,Inpatient,,,90,34,28.9,9.7444,34,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Hgb Electrophoresis Cascade (Mdh)OutsideLaboratory,,83020,CPT,Facility,Both,,,90,34,28.9,9.7444,34,"Preferred One Administrative Services, INC.",PPO,33.524,98.6,,percent of total billed charges,,
Hgb Electrophoresis Cascade (Mdh)OutsideLaboratory,,83020,CPT,Facility,Outpatient,,,90,34,28.9,9.7444,34,PrimeWest Health,Minnesota Senior Health Options (MSHO),17.493,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Hgb Electrophoresis Cascade (Mdh)OutsideLaboratory,,83020,CPT,Facility,Inpatient,,,90,34,28.9,9.7444,34,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Hgb Electrophoresis Cascade (Mdh)OutsideLaboratory,,83020,CPT,Facility,Outpatient,,,90,34,28.9,9.7444,34,PrimeWest Health,MinnesotaCare,17.4624,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Hgb Electrophoresis Cascade (Mdh)OutsideLaboratory,,83020,CPT,Facility,Inpatient,,,90,34,28.9,9.7444,34,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Hgb Electrophoresis Cascade (Mdh)OutsideLaboratory,,83020,CPT,Facility,Both,,,90,34,28.9,9.7444,34,Sanford Health Plan,Sanford Health Plan,31.28,92,,percent of total billed charges,,
Hgb Electrophoresis Cascade (Mdh)OutsideLaboratory,,83020,CPT,Facility,Outpatient,,,90,34,28.9,9.7444,34,"UCare Health, Inc.",Individual & Family Plan,19.159,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Hgb Electrophoresis Cascade (Mdh)OutsideLaboratory,,83020,CPT,Facility,Inpatient,,,90,34,28.9,9.7444,34,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Hgb Electrophoresis Cascade (Mdh)OutsideLaboratory,,83020,CPT,Facility,Outpatient,,,90,34,28.9,9.7444,34,"UCare Health, Inc.",Medical Assistance,17.1598,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Hgb Electrophoresis Cascade (Mdh)OutsideLaboratory,,83020,CPT,Facility,Inpatient,,,90,34,28.9,9.7444,34,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Hgb Electrophoresis Cascade (Mdh)OutsideLaboratory,,83020,CPT,Facility,Outpatient,,,90,34,28.9,9.7444,34,"UCare Health, Inc.",Medicare Advantage,17.1598,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Hgb Electrophoresis Cascade (Mdh)OutsideLaboratory,,83020,CPT,Facility,Inpatient,,,90,34,28.9,9.7444,34,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Hgb Electrophoresis Cascade (Mdh)OutsideLaboratory,,83020,CPT,Facility,Outpatient,,,90,34,28.9,9.7444,34,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),17.1598,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Hgb Electrophoresis Cascade (Mdh)OutsideLaboratory,,83020,CPT,Facility,Inpatient,,,90,34,28.9,9.7444,34,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Hgb Electrophoresis Cascade (Mdh)OutsideLaboratory,,83020,CPT,Facility,Both,,,90,34,28.9,9.7444,34,UnitedHealthcare,Individual & Family,31.96,94,,percent of total billed charges,,
Hgb Electrophoresis Cascade (Mdh)OutsideLaboratory,,83020,CPT,Facility,Outpatient,,,90,34,28.9,9.7444,34,UnitedHealthcare,Medicare Advantage,16.66,49,,percent of total billed charges,,
Hgb Electrophoresis Cascade (Mdh)OutsideLaboratory,,83020,CPT,Facility,Inpatient,,,90,34,28.9,9.7444,34,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Hgb Electrophoresis Cascade (Mdh)OutsideLaboratory,,83020,CPT,Facility,Outpatient,,,90,34,28.9,9.7444,34,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,16.32,48,,percent of total billed charges,,100% of DHS outpatient percentage
Hgb Electrophoresis Cascade (Mdh)OutsideLaboratory,,83020,CPT,Facility,Inpatient,,,90,34,28.9,9.7444,34,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
A2 & F Hemoglobin (Mayo)OutsideLaboratory,,83021,CPT,Facility,Both,,,90,115,97.75,32.959,115,Aetna,Commercial,105.8,92,,percent of total billed charges,,
A2 & F Hemoglobin (Mayo)OutsideLaboratory,,83021,CPT,Facility,Outpatient,,,90,115,97.75,32.959,115,Aetna,Medicare Advantage,56.35,49,,percent of total billed charges,,
A2 & F Hemoglobin (Mayo)OutsideLaboratory,,83021,CPT,Facility,Inpatient,,,90,115,97.75,32.959,115,Aetna,Medicare Advantage,,,,,Included in per diem rate,
A2 & F Hemoglobin (Mayo)OutsideLaboratory,,83021,CPT,Facility,Both,,,90,115,97.75,32.959,115,Aetna,PPO,106.95,93,,percent of total billed charges,,
A2 & F Hemoglobin (Mayo)OutsideLaboratory,,83021,CPT,Facility,Both,,,90,115,97.75,32.959,115,America's PPO,America's PPO,110.4345,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
A2 & F Hemoglobin (Mayo)OutsideLaboratory,,83021,CPT,Facility,Both,,,90,115,97.75,32.959,115,BlueCross BlueShield Minnesota, Federal Employee Program,113.16,98.4,,percent of total billed charges,,
A2 & F Hemoglobin (Mayo)OutsideLaboratory,,83021,CPT,Facility,Both,,,90,115,97.75,32.959,115,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,115,100,,percent of total billed charges,,
A2 & F Hemoglobin (Mayo)OutsideLaboratory,,83021,CPT,Facility,Both,,,90,115,97.75,32.959,115,BlueCross BlueShield Minnesota,High Value Network Plan,103.5,90,,percent of total billed charges,,
A2 & F Hemoglobin (Mayo)OutsideLaboratory,,83021,CPT,Facility,Outpatient,,,90,115,97.75,32.959,115,BlueCross BlueShield Minnesota,Medicare Advantage,56.35,49,,percent of total billed charges,,
A2 & F Hemoglobin (Mayo)OutsideLaboratory,,83021,CPT,Facility,Inpatient,,,90,115,97.75,32.959,115,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
A2 & F Hemoglobin (Mayo)OutsideLaboratory,,83021,CPT,Facility,Both,,,90,115,97.75,32.959,115,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,101.8555,88.57,,percent of total billed charges,,
A2 & F Hemoglobin (Mayo)OutsideLaboratory,,83021,CPT,Facility,Both,,,90,115,97.75,32.959,115,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,32.959,28.66,,percent of total billed charges,,
A2 & F Hemoglobin (Mayo)OutsideLaboratory,,83021,CPT,Facility,Outpatient,,,90,115,97.75,32.959,115,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),56.35,49,,percent of total billed charges,,
A2 & F Hemoglobin (Mayo)OutsideLaboratory,,83021,CPT,Facility,Inpatient,,,90,115,97.75,32.959,115,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
A2 & F Hemoglobin (Mayo)OutsideLaboratory,,83021,CPT,Facility,Both,,,90,115,97.75,32.959,115,CorVel,Worker's Compensation,115,100,,percent of total billed charges,,
A2 & F Hemoglobin (Mayo)OutsideLaboratory,,83021,CPT,Facility,Both,,,90,115,97.75,32.959,115,First Health Group Corporation,First Health Network,111.55,97,,percent of total billed charges,,
A2 & F Hemoglobin (Mayo)OutsideLaboratory,,83021,CPT,Facility,Both,,,90,115,97.75,32.959,115,"Health Partners, Inc.",Commercial,108.79,94.6,,percent of total billed charges,,
A2 & F Hemoglobin (Mayo)OutsideLaboratory,,83021,CPT,Facility,Outpatient,,,90,115,97.75,32.959,115,"Health Partners, Inc.",Medicare Advantage,56.35,49,,percent of total billed charges,,
A2 & F Hemoglobin (Mayo)OutsideLaboratory,,83021,CPT,Facility,Inpatient,,,90,115,97.75,32.959,115,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
A2 & F Hemoglobin (Mayo)OutsideLaboratory,,83021,CPT,Facility,Both,,,90,115,97.75,32.959,115,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),69,60,,percent of total billed charges,,
A2 & F Hemoglobin (Mayo)OutsideLaboratory,,83021,CPT,Facility,Both,,,90,115,97.75,32.959,115,"Health Partners, Inc.",State of Minnesota Advantage Program,93.725,81.5,,percent of total billed charges,,
A2 & F Hemoglobin (Mayo)OutsideLaboratory,,83021,CPT,Facility,Both,,,90,115,97.75,32.959,115,"Health Partners, Inc.",State Public Programs,57.5,50,,percent of total billed charges,,
A2 & F Hemoglobin (Mayo)OutsideLaboratory,,83021,CPT,Facility,Both,,,90,115,97.75,32.959,115,Humana Insurance Company,Commercial PPO,109.25,95,,percent of total billed charges,,
A2 & F Hemoglobin (Mayo)OutsideLaboratory,,83021,CPT,Facility,Outpatient,,,90,115,97.75,32.959,115,Humana Insurance Company,Medicare PPO,56.35,49,,percent of total billed charges,,
A2 & F Hemoglobin (Mayo)OutsideLaboratory,,83021,CPT,Facility,Inpatient,,,90,115,97.75,32.959,115,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
A2 & F Hemoglobin (Mayo)OutsideLaboratory,,83021,CPT,Facility,Both,,,90,115,97.75,32.959,115,Medica,Individual & Family,113.965,99.1,,percent of total billed charges,,
A2 & F Hemoglobin (Mayo)OutsideLaboratory,,83021,CPT,Facility,Outpatient,,,90,115,97.75,32.959,115,Medica,Medica Advantage Solution,57.27,49.8,,percent of total billed charges,,
A2 & F Hemoglobin (Mayo)OutsideLaboratory,,83021,CPT,Facility,Inpatient,,,90,115,97.75,32.959,115,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
A2 & F Hemoglobin (Mayo)OutsideLaboratory,,83021,CPT,Facility,Outpatient,,,90,115,97.75,32.959,115,Medica,Medical Assistance,51.29,44.6,,percent of total billed charges,,
A2 & F Hemoglobin (Mayo)OutsideLaboratory,,83021,CPT,Facility,Inpatient,,,90,115,97.75,32.959,115,Medica,Medical Assistance,,,,,Included in per diem rate,
A2 & F Hemoglobin (Mayo)OutsideLaboratory,,83021,CPT,Facility,Outpatient,,,90,115,97.75,32.959,115,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,57.27,49.8,,percent of total billed charges,,
A2 & F Hemoglobin (Mayo)OutsideLaboratory,,83021,CPT,Facility,Inpatient,,,90,115,97.75,32.959,115,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
A2 & F Hemoglobin (Mayo)OutsideLaboratory,,83021,CPT,Facility,Both,,,90,115,97.75,32.959,115,"Multiplan, Inc.","Multiplan, Inc.",108.1,94,,percent of total billed charges,,
A2 & F Hemoglobin (Mayo)OutsideLaboratory,,83021,CPT,Facility,Outpatient,,,90,115,97.75,32.959,115,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,99.36,86.4,,percent of total billed charges,,
A2 & F Hemoglobin (Mayo)OutsideLaboratory,,83021,CPT,Facility,Inpatient,,,90,115,97.75,32.959,115,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
A2 & F Hemoglobin (Mayo)OutsideLaboratory,,83021,CPT,Facility,Both,,,90,115,97.75,32.959,115,"Preferred One Administrative Services, INC.",PPO,113.39,98.6,,percent of total billed charges,,
A2 & F Hemoglobin (Mayo)OutsideLaboratory,,83021,CPT,Facility,Outpatient,,,90,115,97.75,32.959,115,PrimeWest Health,Minnesota Senior Health Options (MSHO),59.1675,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
A2 & F Hemoglobin (Mayo)OutsideLaboratory,,83021,CPT,Facility,Inpatient,,,90,115,97.75,32.959,115,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
A2 & F Hemoglobin (Mayo)OutsideLaboratory,,83021,CPT,Facility,Outpatient,,,90,115,97.75,32.959,115,PrimeWest Health,MinnesotaCare,59.064,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
A2 & F Hemoglobin (Mayo)OutsideLaboratory,,83021,CPT,Facility,Inpatient,,,90,115,97.75,32.959,115,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
A2 & F Hemoglobin (Mayo)OutsideLaboratory,,83021,CPT,Facility,Both,,,90,115,97.75,32.959,115,Sanford Health Plan,Sanford Health Plan,105.8,92,,percent of total billed charges,,
A2 & F Hemoglobin (Mayo)OutsideLaboratory,,83021,CPT,Facility,Outpatient,,,90,115,97.75,32.959,115,"UCare Health, Inc.",Individual & Family Plan,64.8025,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
A2 & F Hemoglobin (Mayo)OutsideLaboratory,,83021,CPT,Facility,Inpatient,,,90,115,97.75,32.959,115,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
A2 & F Hemoglobin (Mayo)OutsideLaboratory,,83021,CPT,Facility,Outpatient,,,90,115,97.75,32.959,115,"UCare Health, Inc.",Medical Assistance,58.0405,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
A2 & F Hemoglobin (Mayo)OutsideLaboratory,,83021,CPT,Facility,Inpatient,,,90,115,97.75,32.959,115,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
A2 & F Hemoglobin (Mayo)OutsideLaboratory,,83021,CPT,Facility,Outpatient,,,90,115,97.75,32.959,115,"UCare Health, Inc.",Medicare Advantage,58.0405,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
A2 & F Hemoglobin (Mayo)OutsideLaboratory,,83021,CPT,Facility,Inpatient,,,90,115,97.75,32.959,115,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
A2 & F Hemoglobin (Mayo)OutsideLaboratory,,83021,CPT,Facility,Outpatient,,,90,115,97.75,32.959,115,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),58.0405,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
A2 & F Hemoglobin (Mayo)OutsideLaboratory,,83021,CPT,Facility,Inpatient,,,90,115,97.75,32.959,115,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
A2 & F Hemoglobin (Mayo)OutsideLaboratory,,83021,CPT,Facility,Both,,,90,115,97.75,32.959,115,UnitedHealthcare,Individual & Family,108.1,94,,percent of total billed charges,,
A2 & F Hemoglobin (Mayo)OutsideLaboratory,,83021,CPT,Facility,Outpatient,,,90,115,97.75,32.959,115,UnitedHealthcare,Medicare Advantage,56.35,49,,percent of total billed charges,,
A2 & F Hemoglobin (Mayo)OutsideLaboratory,,83021,CPT,Facility,Inpatient,,,90,115,97.75,32.959,115,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
A2 & F Hemoglobin (Mayo)OutsideLaboratory,,83021,CPT,Facility,Outpatient,,,90,115,97.75,32.959,115,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,55.2,48,,percent of total billed charges,,100% of DHS outpatient percentage
A2 & F Hemoglobin (Mayo)OutsideLaboratory,,83021,CPT,Facility,Inpatient,,,90,115,97.75,32.959,115,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
A2 Hemoglobin (Mdh)OutsideLaboratory,,83021,CPT,Facility,Both,,,90,115,97.75,32.959,115,Aetna,Commercial,105.8,92,,percent of total billed charges,,
A2 Hemoglobin (Mdh)OutsideLaboratory,,83021,CPT,Facility,Outpatient,,,90,115,97.75,32.959,115,Aetna,Medicare Advantage,56.35,49,,percent of total billed charges,,
A2 Hemoglobin (Mdh)OutsideLaboratory,,83021,CPT,Facility,Inpatient,,,90,115,97.75,32.959,115,Aetna,Medicare Advantage,,,,,Included in per diem rate,
A2 Hemoglobin (Mdh)OutsideLaboratory,,83021,CPT,Facility,Both,,,90,115,97.75,32.959,115,Aetna,PPO,106.95,93,,percent of total billed charges,,
A2 Hemoglobin (Mdh)OutsideLaboratory,,83021,CPT,Facility,Both,,,90,115,97.75,32.959,115,America's PPO,America's PPO,110.4345,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
A2 Hemoglobin (Mdh)OutsideLaboratory,,83021,CPT,Facility,Both,,,90,115,97.75,32.959,115,BlueCross BlueShield Minnesota, Federal Employee Program,113.16,98.4,,percent of total billed charges,,
A2 Hemoglobin (Mdh)OutsideLaboratory,,83021,CPT,Facility,Both,,,90,115,97.75,32.959,115,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,115,100,,percent of total billed charges,,
A2 Hemoglobin (Mdh)OutsideLaboratory,,83021,CPT,Facility,Both,,,90,115,97.75,32.959,115,BlueCross BlueShield Minnesota,High Value Network Plan,103.5,90,,percent of total billed charges,,
A2 Hemoglobin (Mdh)OutsideLaboratory,,83021,CPT,Facility,Outpatient,,,90,115,97.75,32.959,115,BlueCross BlueShield Minnesota,Medicare Advantage,56.35,49,,percent of total billed charges,,
A2 Hemoglobin (Mdh)OutsideLaboratory,,83021,CPT,Facility,Inpatient,,,90,115,97.75,32.959,115,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
A2 Hemoglobin (Mdh)OutsideLaboratory,,83021,CPT,Facility,Both,,,90,115,97.75,32.959,115,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,101.8555,88.57,,percent of total billed charges,,
A2 Hemoglobin (Mdh)OutsideLaboratory,,83021,CPT,Facility,Both,,,90,115,97.75,32.959,115,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,32.959,28.66,,percent of total billed charges,,
A2 Hemoglobin (Mdh)OutsideLaboratory,,83021,CPT,Facility,Outpatient,,,90,115,97.75,32.959,115,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),56.35,49,,percent of total billed charges,,
A2 Hemoglobin (Mdh)OutsideLaboratory,,83021,CPT,Facility,Inpatient,,,90,115,97.75,32.959,115,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
A2 Hemoglobin (Mdh)OutsideLaboratory,,83021,CPT,Facility,Both,,,90,115,97.75,32.959,115,CorVel,Worker's Compensation,115,100,,percent of total billed charges,,
A2 Hemoglobin (Mdh)OutsideLaboratory,,83021,CPT,Facility,Both,,,90,115,97.75,32.959,115,First Health Group Corporation,First Health Network,111.55,97,,percent of total billed charges,,
A2 Hemoglobin (Mdh)OutsideLaboratory,,83021,CPT,Facility,Both,,,90,115,97.75,32.959,115,"Health Partners, Inc.",Commercial,108.79,94.6,,percent of total billed charges,,
A2 Hemoglobin (Mdh)OutsideLaboratory,,83021,CPT,Facility,Outpatient,,,90,115,97.75,32.959,115,"Health Partners, Inc.",Medicare Advantage,56.35,49,,percent of total billed charges,,
A2 Hemoglobin (Mdh)OutsideLaboratory,,83021,CPT,Facility,Inpatient,,,90,115,97.75,32.959,115,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
A2 Hemoglobin (Mdh)OutsideLaboratory,,83021,CPT,Facility,Both,,,90,115,97.75,32.959,115,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),69,60,,percent of total billed charges,,
A2 Hemoglobin (Mdh)OutsideLaboratory,,83021,CPT,Facility,Both,,,90,115,97.75,32.959,115,"Health Partners, Inc.",State of Minnesota Advantage Program,93.725,81.5,,percent of total billed charges,,
A2 Hemoglobin (Mdh)OutsideLaboratory,,83021,CPT,Facility,Both,,,90,115,97.75,32.959,115,"Health Partners, Inc.",State Public Programs,57.5,50,,percent of total billed charges,,
A2 Hemoglobin (Mdh)OutsideLaboratory,,83021,CPT,Facility,Both,,,90,115,97.75,32.959,115,Humana Insurance Company,Commercial PPO,109.25,95,,percent of total billed charges,,
A2 Hemoglobin (Mdh)OutsideLaboratory,,83021,CPT,Facility,Outpatient,,,90,115,97.75,32.959,115,Humana Insurance Company,Medicare PPO,56.35,49,,percent of total billed charges,,
A2 Hemoglobin (Mdh)OutsideLaboratory,,83021,CPT,Facility,Inpatient,,,90,115,97.75,32.959,115,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
A2 Hemoglobin (Mdh)OutsideLaboratory,,83021,CPT,Facility,Both,,,90,115,97.75,32.959,115,Medica,Individual & Family,113.965,99.1,,percent of total billed charges,,
A2 Hemoglobin (Mdh)OutsideLaboratory,,83021,CPT,Facility,Outpatient,,,90,115,97.75,32.959,115,Medica,Medica Advantage Solution,57.27,49.8,,percent of total billed charges,,
A2 Hemoglobin (Mdh)OutsideLaboratory,,83021,CPT,Facility,Inpatient,,,90,115,97.75,32.959,115,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
A2 Hemoglobin (Mdh)OutsideLaboratory,,83021,CPT,Facility,Outpatient,,,90,115,97.75,32.959,115,Medica,Medical Assistance,51.29,44.6,,percent of total billed charges,,
A2 Hemoglobin (Mdh)OutsideLaboratory,,83021,CPT,Facility,Inpatient,,,90,115,97.75,32.959,115,Medica,Medical Assistance,,,,,Included in per diem rate,
A2 Hemoglobin (Mdh)OutsideLaboratory,,83021,CPT,Facility,Outpatient,,,90,115,97.75,32.959,115,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,57.27,49.8,,percent of total billed charges,,
A2 Hemoglobin (Mdh)OutsideLaboratory,,83021,CPT,Facility,Inpatient,,,90,115,97.75,32.959,115,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
A2 Hemoglobin (Mdh)OutsideLaboratory,,83021,CPT,Facility,Both,,,90,115,97.75,32.959,115,"Multiplan, Inc.","Multiplan, Inc.",108.1,94,,percent of total billed charges,,
A2 Hemoglobin (Mdh)OutsideLaboratory,,83021,CPT,Facility,Outpatient,,,90,115,97.75,32.959,115,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,99.36,86.4,,percent of total billed charges,,
A2 Hemoglobin (Mdh)OutsideLaboratory,,83021,CPT,Facility,Inpatient,,,90,115,97.75,32.959,115,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
A2 Hemoglobin (Mdh)OutsideLaboratory,,83021,CPT,Facility,Both,,,90,115,97.75,32.959,115,"Preferred One Administrative Services, INC.",PPO,113.39,98.6,,percent of total billed charges,,
A2 Hemoglobin (Mdh)OutsideLaboratory,,83021,CPT,Facility,Outpatient,,,90,115,97.75,32.959,115,PrimeWest Health,Minnesota Senior Health Options (MSHO),59.1675,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
A2 Hemoglobin (Mdh)OutsideLaboratory,,83021,CPT,Facility,Inpatient,,,90,115,97.75,32.959,115,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
A2 Hemoglobin (Mdh)OutsideLaboratory,,83021,CPT,Facility,Outpatient,,,90,115,97.75,32.959,115,PrimeWest Health,MinnesotaCare,59.064,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
A2 Hemoglobin (Mdh)OutsideLaboratory,,83021,CPT,Facility,Inpatient,,,90,115,97.75,32.959,115,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
A2 Hemoglobin (Mdh)OutsideLaboratory,,83021,CPT,Facility,Both,,,90,115,97.75,32.959,115,Sanford Health Plan,Sanford Health Plan,105.8,92,,percent of total billed charges,,
A2 Hemoglobin (Mdh)OutsideLaboratory,,83021,CPT,Facility,Outpatient,,,90,115,97.75,32.959,115,"UCare Health, Inc.",Individual & Family Plan,64.8025,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
A2 Hemoglobin (Mdh)OutsideLaboratory,,83021,CPT,Facility,Inpatient,,,90,115,97.75,32.959,115,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
A2 Hemoglobin (Mdh)OutsideLaboratory,,83021,CPT,Facility,Outpatient,,,90,115,97.75,32.959,115,"UCare Health, Inc.",Medical Assistance,58.0405,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
A2 Hemoglobin (Mdh)OutsideLaboratory,,83021,CPT,Facility,Inpatient,,,90,115,97.75,32.959,115,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
A2 Hemoglobin (Mdh)OutsideLaboratory,,83021,CPT,Facility,Outpatient,,,90,115,97.75,32.959,115,"UCare Health, Inc.",Medicare Advantage,58.0405,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
A2 Hemoglobin (Mdh)OutsideLaboratory,,83021,CPT,Facility,Inpatient,,,90,115,97.75,32.959,115,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
A2 Hemoglobin (Mdh)OutsideLaboratory,,83021,CPT,Facility,Outpatient,,,90,115,97.75,32.959,115,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),58.0405,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
A2 Hemoglobin (Mdh)OutsideLaboratory,,83021,CPT,Facility,Inpatient,,,90,115,97.75,32.959,115,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
A2 Hemoglobin (Mdh)OutsideLaboratory,,83021,CPT,Facility,Both,,,90,115,97.75,32.959,115,UnitedHealthcare,Individual & Family,108.1,94,,percent of total billed charges,,
A2 Hemoglobin (Mdh)OutsideLaboratory,,83021,CPT,Facility,Outpatient,,,90,115,97.75,32.959,115,UnitedHealthcare,Medicare Advantage,56.35,49,,percent of total billed charges,,
A2 Hemoglobin (Mdh)OutsideLaboratory,,83021,CPT,Facility,Inpatient,,,90,115,97.75,32.959,115,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
A2 Hemoglobin (Mdh)OutsideLaboratory,,83021,CPT,Facility,Outpatient,,,90,115,97.75,32.959,115,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,55.2,48,,percent of total billed charges,,100% of DHS outpatient percentage
A2 Hemoglobin (Mdh)OutsideLaboratory,,83021,CPT,Facility,Inpatient,,,90,115,97.75,32.959,115,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Hemoglobin Fractionation & Quant, Chromatography (Mayo)OutsideLaboratory",,83021,CPT,Facility,Both,,,90,115,97.75,32.959,115,Aetna,Commercial,105.8,92,,percent of total billed charges,,
"Hemoglobin Fractionation & Quant, Chromatography (Mayo)OutsideLaboratory",,83021,CPT,Facility,Outpatient,,,90,115,97.75,32.959,115,Aetna,Medicare Advantage,56.35,49,,percent of total billed charges,,
"Hemoglobin Fractionation & Quant, Chromatography (Mayo)OutsideLaboratory",,83021,CPT,Facility,Inpatient,,,90,115,97.75,32.959,115,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Hemoglobin Fractionation & Quant, Chromatography (Mayo)OutsideLaboratory",,83021,CPT,Facility,Both,,,90,115,97.75,32.959,115,Aetna,PPO,106.95,93,,percent of total billed charges,,
"Hemoglobin Fractionation & Quant, Chromatography (Mayo)OutsideLaboratory",,83021,CPT,Facility,Both,,,90,115,97.75,32.959,115,America's PPO,America's PPO,110.4345,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Hemoglobin Fractionation & Quant, Chromatography (Mayo)OutsideLaboratory",,83021,CPT,Facility,Both,,,90,115,97.75,32.959,115,BlueCross BlueShield Minnesota, Federal Employee Program,113.16,98.4,,percent of total billed charges,,
"Hemoglobin Fractionation & Quant, Chromatography (Mayo)OutsideLaboratory",,83021,CPT,Facility,Both,,,90,115,97.75,32.959,115,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,115,100,,percent of total billed charges,,
"Hemoglobin Fractionation & Quant, Chromatography (Mayo)OutsideLaboratory",,83021,CPT,Facility,Both,,,90,115,97.75,32.959,115,BlueCross BlueShield Minnesota,High Value Network Plan,103.5,90,,percent of total billed charges,,
"Hemoglobin Fractionation & Quant, Chromatography (Mayo)OutsideLaboratory",,83021,CPT,Facility,Outpatient,,,90,115,97.75,32.959,115,BlueCross BlueShield Minnesota,Medicare Advantage,56.35,49,,percent of total billed charges,,
"Hemoglobin Fractionation & Quant, Chromatography (Mayo)OutsideLaboratory",,83021,CPT,Facility,Inpatient,,,90,115,97.75,32.959,115,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Hemoglobin Fractionation & Quant, Chromatography (Mayo)OutsideLaboratory",,83021,CPT,Facility,Both,,,90,115,97.75,32.959,115,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,101.8555,88.57,,percent of total billed charges,,
"Hemoglobin Fractionation & Quant, Chromatography (Mayo)OutsideLaboratory",,83021,CPT,Facility,Both,,,90,115,97.75,32.959,115,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,32.959,28.66,,percent of total billed charges,,
"Hemoglobin Fractionation & Quant, Chromatography (Mayo)OutsideLaboratory",,83021,CPT,Facility,Outpatient,,,90,115,97.75,32.959,115,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),56.35,49,,percent of total billed charges,,
"Hemoglobin Fractionation & Quant, Chromatography (Mayo)OutsideLaboratory",,83021,CPT,Facility,Inpatient,,,90,115,97.75,32.959,115,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Hemoglobin Fractionation & Quant, Chromatography (Mayo)OutsideLaboratory",,83021,CPT,Facility,Both,,,90,115,97.75,32.959,115,CorVel,Worker's Compensation,115,100,,percent of total billed charges,,
"Hemoglobin Fractionation & Quant, Chromatography (Mayo)OutsideLaboratory",,83021,CPT,Facility,Both,,,90,115,97.75,32.959,115,First Health Group Corporation,First Health Network,111.55,97,,percent of total billed charges,,
"Hemoglobin Fractionation & Quant, Chromatography (Mayo)OutsideLaboratory",,83021,CPT,Facility,Both,,,90,115,97.75,32.959,115,"Health Partners, Inc.",Commercial,108.79,94.6,,percent of total billed charges,,
"Hemoglobin Fractionation & Quant, Chromatography (Mayo)OutsideLaboratory",,83021,CPT,Facility,Outpatient,,,90,115,97.75,32.959,115,"Health Partners, Inc.",Medicare Advantage,56.35,49,,percent of total billed charges,,
"Hemoglobin Fractionation & Quant, Chromatography (Mayo)OutsideLaboratory",,83021,CPT,Facility,Inpatient,,,90,115,97.75,32.959,115,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Hemoglobin Fractionation & Quant, Chromatography (Mayo)OutsideLaboratory",,83021,CPT,Facility,Both,,,90,115,97.75,32.959,115,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),69,60,,percent of total billed charges,,
"Hemoglobin Fractionation & Quant, Chromatography (Mayo)OutsideLaboratory",,83021,CPT,Facility,Both,,,90,115,97.75,32.959,115,"Health Partners, Inc.",State of Minnesota Advantage Program,93.725,81.5,,percent of total billed charges,,
"Hemoglobin Fractionation & Quant, Chromatography (Mayo)OutsideLaboratory",,83021,CPT,Facility,Both,,,90,115,97.75,32.959,115,"Health Partners, Inc.",State Public Programs,57.5,50,,percent of total billed charges,,
"Hemoglobin Fractionation & Quant, Chromatography (Mayo)OutsideLaboratory",,83021,CPT,Facility,Both,,,90,115,97.75,32.959,115,Humana Insurance Company,Commercial PPO,109.25,95,,percent of total billed charges,,
"Hemoglobin Fractionation & Quant, Chromatography (Mayo)OutsideLaboratory",,83021,CPT,Facility,Outpatient,,,90,115,97.75,32.959,115,Humana Insurance Company,Medicare PPO,56.35,49,,percent of total billed charges,,
"Hemoglobin Fractionation & Quant, Chromatography (Mayo)OutsideLaboratory",,83021,CPT,Facility,Inpatient,,,90,115,97.75,32.959,115,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Hemoglobin Fractionation & Quant, Chromatography (Mayo)OutsideLaboratory",,83021,CPT,Facility,Both,,,90,115,97.75,32.959,115,Medica,Individual & Family,113.965,99.1,,percent of total billed charges,,
"Hemoglobin Fractionation & Quant, Chromatography (Mayo)OutsideLaboratory",,83021,CPT,Facility,Outpatient,,,90,115,97.75,32.959,115,Medica,Medica Advantage Solution,57.27,49.8,,percent of total billed charges,,
"Hemoglobin Fractionation & Quant, Chromatography (Mayo)OutsideLaboratory",,83021,CPT,Facility,Inpatient,,,90,115,97.75,32.959,115,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Hemoglobin Fractionation & Quant, Chromatography (Mayo)OutsideLaboratory",,83021,CPT,Facility,Outpatient,,,90,115,97.75,32.959,115,Medica,Medical Assistance,51.29,44.6,,percent of total billed charges,,
"Hemoglobin Fractionation & Quant, Chromatography (Mayo)OutsideLaboratory",,83021,CPT,Facility,Inpatient,,,90,115,97.75,32.959,115,Medica,Medical Assistance,,,,,Included in per diem rate,
"Hemoglobin Fractionation & Quant, Chromatography (Mayo)OutsideLaboratory",,83021,CPT,Facility,Outpatient,,,90,115,97.75,32.959,115,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,57.27,49.8,,percent of total billed charges,,
"Hemoglobin Fractionation & Quant, Chromatography (Mayo)OutsideLaboratory",,83021,CPT,Facility,Inpatient,,,90,115,97.75,32.959,115,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Hemoglobin Fractionation & Quant, Chromatography (Mayo)OutsideLaboratory",,83021,CPT,Facility,Both,,,90,115,97.75,32.959,115,"Multiplan, Inc.","Multiplan, Inc.",108.1,94,,percent of total billed charges,,
"Hemoglobin Fractionation & Quant, Chromatography (Mayo)OutsideLaboratory",,83021,CPT,Facility,Outpatient,,,90,115,97.75,32.959,115,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,99.36,86.4,,percent of total billed charges,,
"Hemoglobin Fractionation & Quant, Chromatography (Mayo)OutsideLaboratory",,83021,CPT,Facility,Inpatient,,,90,115,97.75,32.959,115,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Hemoglobin Fractionation & Quant, Chromatography (Mayo)OutsideLaboratory",,83021,CPT,Facility,Both,,,90,115,97.75,32.959,115,"Preferred One Administrative Services, INC.",PPO,113.39,98.6,,percent of total billed charges,,
"Hemoglobin Fractionation & Quant, Chromatography (Mayo)OutsideLaboratory",,83021,CPT,Facility,Outpatient,,,90,115,97.75,32.959,115,PrimeWest Health,Minnesota Senior Health Options (MSHO),59.1675,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Hemoglobin Fractionation & Quant, Chromatography (Mayo)OutsideLaboratory",,83021,CPT,Facility,Inpatient,,,90,115,97.75,32.959,115,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Hemoglobin Fractionation & Quant, Chromatography (Mayo)OutsideLaboratory",,83021,CPT,Facility,Outpatient,,,90,115,97.75,32.959,115,PrimeWest Health,MinnesotaCare,59.064,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Hemoglobin Fractionation & Quant, Chromatography (Mayo)OutsideLaboratory",,83021,CPT,Facility,Inpatient,,,90,115,97.75,32.959,115,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Hemoglobin Fractionation & Quant, Chromatography (Mayo)OutsideLaboratory",,83021,CPT,Facility,Both,,,90,115,97.75,32.959,115,Sanford Health Plan,Sanford Health Plan,105.8,92,,percent of total billed charges,,
"Hemoglobin Fractionation & Quant, Chromatography (Mayo)OutsideLaboratory",,83021,CPT,Facility,Outpatient,,,90,115,97.75,32.959,115,"UCare Health, Inc.",Individual & Family Plan,64.8025,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Hemoglobin Fractionation & Quant, Chromatography (Mayo)OutsideLaboratory",,83021,CPT,Facility,Inpatient,,,90,115,97.75,32.959,115,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Hemoglobin Fractionation & Quant, Chromatography (Mayo)OutsideLaboratory",,83021,CPT,Facility,Outpatient,,,90,115,97.75,32.959,115,"UCare Health, Inc.",Medical Assistance,58.0405,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Hemoglobin Fractionation & Quant, Chromatography (Mayo)OutsideLaboratory",,83021,CPT,Facility,Inpatient,,,90,115,97.75,32.959,115,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Hemoglobin Fractionation & Quant, Chromatography (Mayo)OutsideLaboratory",,83021,CPT,Facility,Outpatient,,,90,115,97.75,32.959,115,"UCare Health, Inc.",Medicare Advantage,58.0405,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Hemoglobin Fractionation & Quant, Chromatography (Mayo)OutsideLaboratory",,83021,CPT,Facility,Inpatient,,,90,115,97.75,32.959,115,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Hemoglobin Fractionation & Quant, Chromatography (Mayo)OutsideLaboratory",,83021,CPT,Facility,Outpatient,,,90,115,97.75,32.959,115,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),58.0405,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Hemoglobin Fractionation & Quant, Chromatography (Mayo)OutsideLaboratory",,83021,CPT,Facility,Inpatient,,,90,115,97.75,32.959,115,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Hemoglobin Fractionation & Quant, Chromatography (Mayo)OutsideLaboratory",,83021,CPT,Facility,Both,,,90,115,97.75,32.959,115,UnitedHealthcare,Individual & Family,108.1,94,,percent of total billed charges,,
"Hemoglobin Fractionation & Quant, Chromatography (Mayo)OutsideLaboratory",,83021,CPT,Facility,Outpatient,,,90,115,97.75,32.959,115,UnitedHealthcare,Medicare Advantage,56.35,49,,percent of total billed charges,,
"Hemoglobin Fractionation & Quant, Chromatography (Mayo)OutsideLaboratory",,83021,CPT,Facility,Inpatient,,,90,115,97.75,32.959,115,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Hemoglobin Fractionation & Quant, Chromatography (Mayo)OutsideLaboratory",,83021,CPT,Facility,Outpatient,,,90,115,97.75,32.959,115,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,55.2,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Hemoglobin Fractionation & Quant, Chromatography (Mayo)OutsideLaboratory",,83021,CPT,Facility,Inpatient,,,90,115,97.75,32.959,115,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Homocysteine, Total, P (Mayo)OutsideLaboratory",,83090,CPT,Facility,Both,,,90,78,66.3,22.3548,78,Aetna,Commercial,71.76,92,,percent of total billed charges,,
"Homocysteine, Total, P (Mayo)OutsideLaboratory",,83090,CPT,Facility,Outpatient,,,90,78,66.3,22.3548,78,Aetna,Medicare Advantage,38.22,49,,percent of total billed charges,,
"Homocysteine, Total, P (Mayo)OutsideLaboratory",,83090,CPT,Facility,Inpatient,,,90,78,66.3,22.3548,78,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Homocysteine, Total, P (Mayo)OutsideLaboratory",,83090,CPT,Facility,Both,,,90,78,66.3,22.3548,78,Aetna,PPO,72.54,93,,percent of total billed charges,,
"Homocysteine, Total, P (Mayo)OutsideLaboratory",,83090,CPT,Facility,Both,,,90,78,66.3,22.3548,78,America's PPO,America's PPO,74.9034,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Homocysteine, Total, P (Mayo)OutsideLaboratory",,83090,CPT,Facility,Both,,,90,78,66.3,22.3548,78,BlueCross BlueShield Minnesota, Federal Employee Program,76.752,98.4,,percent of total billed charges,,
"Homocysteine, Total, P (Mayo)OutsideLaboratory",,83090,CPT,Facility,Both,,,90,78,66.3,22.3548,78,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,78,100,,percent of total billed charges,,
"Homocysteine, Total, P (Mayo)OutsideLaboratory",,83090,CPT,Facility,Both,,,90,78,66.3,22.3548,78,BlueCross BlueShield Minnesota,High Value Network Plan,70.2,90,,percent of total billed charges,,
"Homocysteine, Total, P (Mayo)OutsideLaboratory",,83090,CPT,Facility,Outpatient,,,90,78,66.3,22.3548,78,BlueCross BlueShield Minnesota,Medicare Advantage,38.22,49,,percent of total billed charges,,
"Homocysteine, Total, P (Mayo)OutsideLaboratory",,83090,CPT,Facility,Inpatient,,,90,78,66.3,22.3548,78,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Homocysteine, Total, P (Mayo)OutsideLaboratory",,83090,CPT,Facility,Both,,,90,78,66.3,22.3548,78,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,69.0846,88.57,,percent of total billed charges,,
"Homocysteine, Total, P (Mayo)OutsideLaboratory",,83090,CPT,Facility,Both,,,90,78,66.3,22.3548,78,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,22.3548,28.66,,percent of total billed charges,,
"Homocysteine, Total, P (Mayo)OutsideLaboratory",,83090,CPT,Facility,Outpatient,,,90,78,66.3,22.3548,78,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),38.22,49,,percent of total billed charges,,
"Homocysteine, Total, P (Mayo)OutsideLaboratory",,83090,CPT,Facility,Inpatient,,,90,78,66.3,22.3548,78,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Homocysteine, Total, P (Mayo)OutsideLaboratory",,83090,CPT,Facility,Both,,,90,78,66.3,22.3548,78,CorVel,Worker's Compensation,78,100,,percent of total billed charges,,
"Homocysteine, Total, P (Mayo)OutsideLaboratory",,83090,CPT,Facility,Both,,,90,78,66.3,22.3548,78,First Health Group Corporation,First Health Network,75.66,97,,percent of total billed charges,,
"Homocysteine, Total, P (Mayo)OutsideLaboratory",,83090,CPT,Facility,Both,,,90,78,66.3,22.3548,78,"Health Partners, Inc.",Commercial,73.788,94.6,,percent of total billed charges,,
"Homocysteine, Total, P (Mayo)OutsideLaboratory",,83090,CPT,Facility,Outpatient,,,90,78,66.3,22.3548,78,"Health Partners, Inc.",Medicare Advantage,38.22,49,,percent of total billed charges,,
"Homocysteine, Total, P (Mayo)OutsideLaboratory",,83090,CPT,Facility,Inpatient,,,90,78,66.3,22.3548,78,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Homocysteine, Total, P (Mayo)OutsideLaboratory",,83090,CPT,Facility,Both,,,90,78,66.3,22.3548,78,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),46.8,60,,percent of total billed charges,,
"Homocysteine, Total, P (Mayo)OutsideLaboratory",,83090,CPT,Facility,Both,,,90,78,66.3,22.3548,78,"Health Partners, Inc.",State of Minnesota Advantage Program,63.57,81.5,,percent of total billed charges,,
"Homocysteine, Total, P (Mayo)OutsideLaboratory",,83090,CPT,Facility,Both,,,90,78,66.3,22.3548,78,"Health Partners, Inc.",State Public Programs,39,50,,percent of total billed charges,,
"Homocysteine, Total, P (Mayo)OutsideLaboratory",,83090,CPT,Facility,Both,,,90,78,66.3,22.3548,78,Humana Insurance Company,Commercial PPO,74.1,95,,percent of total billed charges,,
"Homocysteine, Total, P (Mayo)OutsideLaboratory",,83090,CPT,Facility,Outpatient,,,90,78,66.3,22.3548,78,Humana Insurance Company,Medicare PPO,38.22,49,,percent of total billed charges,,
"Homocysteine, Total, P (Mayo)OutsideLaboratory",,83090,CPT,Facility,Inpatient,,,90,78,66.3,22.3548,78,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Homocysteine, Total, P (Mayo)OutsideLaboratory",,83090,CPT,Facility,Both,,,90,78,66.3,22.3548,78,Medica,Individual & Family,77.298,99.1,,percent of total billed charges,,
"Homocysteine, Total, P (Mayo)OutsideLaboratory",,83090,CPT,Facility,Outpatient,,,90,78,66.3,22.3548,78,Medica,Medica Advantage Solution,38.844,49.8,,percent of total billed charges,,
"Homocysteine, Total, P (Mayo)OutsideLaboratory",,83090,CPT,Facility,Inpatient,,,90,78,66.3,22.3548,78,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Homocysteine, Total, P (Mayo)OutsideLaboratory",,83090,CPT,Facility,Outpatient,,,90,78,66.3,22.3548,78,Medica,Medical Assistance,34.788,44.6,,percent of total billed charges,,
"Homocysteine, Total, P (Mayo)OutsideLaboratory",,83090,CPT,Facility,Inpatient,,,90,78,66.3,22.3548,78,Medica,Medical Assistance,,,,,Included in per diem rate,
"Homocysteine, Total, P (Mayo)OutsideLaboratory",,83090,CPT,Facility,Outpatient,,,90,78,66.3,22.3548,78,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,38.844,49.8,,percent of total billed charges,,
"Homocysteine, Total, P (Mayo)OutsideLaboratory",,83090,CPT,Facility,Inpatient,,,90,78,66.3,22.3548,78,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Homocysteine, Total, P (Mayo)OutsideLaboratory",,83090,CPT,Facility,Both,,,90,78,66.3,22.3548,78,"Multiplan, Inc.","Multiplan, Inc.",73.32,94,,percent of total billed charges,,
"Homocysteine, Total, P (Mayo)OutsideLaboratory",,83090,CPT,Facility,Outpatient,,,90,78,66.3,22.3548,78,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,67.392,86.4,,percent of total billed charges,,
"Homocysteine, Total, P (Mayo)OutsideLaboratory",,83090,CPT,Facility,Inpatient,,,90,78,66.3,22.3548,78,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Homocysteine, Total, P (Mayo)OutsideLaboratory",,83090,CPT,Facility,Both,,,90,78,66.3,22.3548,78,"Preferred One Administrative Services, INC.",PPO,76.908,98.6,,percent of total billed charges,,
"Homocysteine, Total, P (Mayo)OutsideLaboratory",,83090,CPT,Facility,Outpatient,,,90,78,66.3,22.3548,78,PrimeWest Health,Minnesota Senior Health Options (MSHO),40.131,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Homocysteine, Total, P (Mayo)OutsideLaboratory",,83090,CPT,Facility,Inpatient,,,90,78,66.3,22.3548,78,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Homocysteine, Total, P (Mayo)OutsideLaboratory",,83090,CPT,Facility,Outpatient,,,90,78,66.3,22.3548,78,PrimeWest Health,MinnesotaCare,40.0608,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Homocysteine, Total, P (Mayo)OutsideLaboratory",,83090,CPT,Facility,Inpatient,,,90,78,66.3,22.3548,78,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Homocysteine, Total, P (Mayo)OutsideLaboratory",,83090,CPT,Facility,Both,,,90,78,66.3,22.3548,78,Sanford Health Plan,Sanford Health Plan,71.76,92,,percent of total billed charges,,
"Homocysteine, Total, P (Mayo)OutsideLaboratory",,83090,CPT,Facility,Outpatient,,,90,78,66.3,22.3548,78,"UCare Health, Inc.",Individual & Family Plan,43.953,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Homocysteine, Total, P (Mayo)OutsideLaboratory",,83090,CPT,Facility,Inpatient,,,90,78,66.3,22.3548,78,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Homocysteine, Total, P (Mayo)OutsideLaboratory",,83090,CPT,Facility,Outpatient,,,90,78,66.3,22.3548,78,"UCare Health, Inc.",Medical Assistance,39.3666,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Homocysteine, Total, P (Mayo)OutsideLaboratory",,83090,CPT,Facility,Inpatient,,,90,78,66.3,22.3548,78,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Homocysteine, Total, P (Mayo)OutsideLaboratory",,83090,CPT,Facility,Outpatient,,,90,78,66.3,22.3548,78,"UCare Health, Inc.",Medicare Advantage,39.3666,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Homocysteine, Total, P (Mayo)OutsideLaboratory",,83090,CPT,Facility,Inpatient,,,90,78,66.3,22.3548,78,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Homocysteine, Total, P (Mayo)OutsideLaboratory",,83090,CPT,Facility,Outpatient,,,90,78,66.3,22.3548,78,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),39.3666,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Homocysteine, Total, P (Mayo)OutsideLaboratory",,83090,CPT,Facility,Inpatient,,,90,78,66.3,22.3548,78,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Homocysteine, Total, P (Mayo)OutsideLaboratory",,83090,CPT,Facility,Both,,,90,78,66.3,22.3548,78,UnitedHealthcare,Individual & Family,73.32,94,,percent of total billed charges,,
"Homocysteine, Total, P (Mayo)OutsideLaboratory",,83090,CPT,Facility,Outpatient,,,90,78,66.3,22.3548,78,UnitedHealthcare,Medicare Advantage,38.22,49,,percent of total billed charges,,
"Homocysteine, Total, P (Mayo)OutsideLaboratory",,83090,CPT,Facility,Inpatient,,,90,78,66.3,22.3548,78,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Homocysteine, Total, P (Mayo)OutsideLaboratory",,83090,CPT,Facility,Outpatient,,,90,78,66.3,22.3548,78,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,37.44,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Homocysteine, Total, P (Mayo)OutsideLaboratory",,83090,CPT,Facility,Inpatient,,,90,78,66.3,22.3548,78,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Homocysteine, Total, S (Mayo)OutsideLaboratory",,83090,CPT,Facility,Both,,,90,76,64.6,21.7816,76,Aetna,Commercial,69.92,92,,percent of total billed charges,,
"Homocysteine, Total, S (Mayo)OutsideLaboratory",,83090,CPT,Facility,Outpatient,,,90,76,64.6,21.7816,76,Aetna,Medicare Advantage,37.24,49,,percent of total billed charges,,
"Homocysteine, Total, S (Mayo)OutsideLaboratory",,83090,CPT,Facility,Inpatient,,,90,76,64.6,21.7816,76,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Homocysteine, Total, S (Mayo)OutsideLaboratory",,83090,CPT,Facility,Both,,,90,76,64.6,21.7816,76,Aetna,PPO,70.68,93,,percent of total billed charges,,
"Homocysteine, Total, S (Mayo)OutsideLaboratory",,83090,CPT,Facility,Both,,,90,76,64.6,21.7816,76,America's PPO,America's PPO,72.9828,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Homocysteine, Total, S (Mayo)OutsideLaboratory",,83090,CPT,Facility,Both,,,90,76,64.6,21.7816,76,BlueCross BlueShield Minnesota, Federal Employee Program,74.784,98.4,,percent of total billed charges,,
"Homocysteine, Total, S (Mayo)OutsideLaboratory",,83090,CPT,Facility,Both,,,90,76,64.6,21.7816,76,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,76,100,,percent of total billed charges,,
"Homocysteine, Total, S (Mayo)OutsideLaboratory",,83090,CPT,Facility,Both,,,90,76,64.6,21.7816,76,BlueCross BlueShield Minnesota,High Value Network Plan,68.4,90,,percent of total billed charges,,
"Homocysteine, Total, S (Mayo)OutsideLaboratory",,83090,CPT,Facility,Outpatient,,,90,76,64.6,21.7816,76,BlueCross BlueShield Minnesota,Medicare Advantage,37.24,49,,percent of total billed charges,,
"Homocysteine, Total, S (Mayo)OutsideLaboratory",,83090,CPT,Facility,Inpatient,,,90,76,64.6,21.7816,76,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Homocysteine, Total, S (Mayo)OutsideLaboratory",,83090,CPT,Facility,Both,,,90,76,64.6,21.7816,76,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,67.3132,88.57,,percent of total billed charges,,
"Homocysteine, Total, S (Mayo)OutsideLaboratory",,83090,CPT,Facility,Both,,,90,76,64.6,21.7816,76,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,21.7816,28.66,,percent of total billed charges,,
"Homocysteine, Total, S (Mayo)OutsideLaboratory",,83090,CPT,Facility,Outpatient,,,90,76,64.6,21.7816,76,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),37.24,49,,percent of total billed charges,,
"Homocysteine, Total, S (Mayo)OutsideLaboratory",,83090,CPT,Facility,Inpatient,,,90,76,64.6,21.7816,76,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Homocysteine, Total, S (Mayo)OutsideLaboratory",,83090,CPT,Facility,Both,,,90,76,64.6,21.7816,76,CorVel,Worker's Compensation,76,100,,percent of total billed charges,,
"Homocysteine, Total, S (Mayo)OutsideLaboratory",,83090,CPT,Facility,Both,,,90,76,64.6,21.7816,76,First Health Group Corporation,First Health Network,73.72,97,,percent of total billed charges,,
"Homocysteine, Total, S (Mayo)OutsideLaboratory",,83090,CPT,Facility,Both,,,90,76,64.6,21.7816,76,"Health Partners, Inc.",Commercial,71.896,94.6,,percent of total billed charges,,
"Homocysteine, Total, S (Mayo)OutsideLaboratory",,83090,CPT,Facility,Outpatient,,,90,76,64.6,21.7816,76,"Health Partners, Inc.",Medicare Advantage,37.24,49,,percent of total billed charges,,
"Homocysteine, Total, S (Mayo)OutsideLaboratory",,83090,CPT,Facility,Inpatient,,,90,76,64.6,21.7816,76,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Homocysteine, Total, S (Mayo)OutsideLaboratory",,83090,CPT,Facility,Both,,,90,76,64.6,21.7816,76,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),45.6,60,,percent of total billed charges,,
"Homocysteine, Total, S (Mayo)OutsideLaboratory",,83090,CPT,Facility,Both,,,90,76,64.6,21.7816,76,"Health Partners, Inc.",State of Minnesota Advantage Program,61.94,81.5,,percent of total billed charges,,
"Homocysteine, Total, S (Mayo)OutsideLaboratory",,83090,CPT,Facility,Both,,,90,76,64.6,21.7816,76,"Health Partners, Inc.",State Public Programs,38,50,,percent of total billed charges,,
"Homocysteine, Total, S (Mayo)OutsideLaboratory",,83090,CPT,Facility,Both,,,90,76,64.6,21.7816,76,Humana Insurance Company,Commercial PPO,72.2,95,,percent of total billed charges,,
"Homocysteine, Total, S (Mayo)OutsideLaboratory",,83090,CPT,Facility,Outpatient,,,90,76,64.6,21.7816,76,Humana Insurance Company,Medicare PPO,37.24,49,,percent of total billed charges,,
"Homocysteine, Total, S (Mayo)OutsideLaboratory",,83090,CPT,Facility,Inpatient,,,90,76,64.6,21.7816,76,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Homocysteine, Total, S (Mayo)OutsideLaboratory",,83090,CPT,Facility,Both,,,90,76,64.6,21.7816,76,Medica,Individual & Family,75.316,99.1,,percent of total billed charges,,
"Homocysteine, Total, S (Mayo)OutsideLaboratory",,83090,CPT,Facility,Outpatient,,,90,76,64.6,21.7816,76,Medica,Medica Advantage Solution,37.848,49.8,,percent of total billed charges,,
"Homocysteine, Total, S (Mayo)OutsideLaboratory",,83090,CPT,Facility,Inpatient,,,90,76,64.6,21.7816,76,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Homocysteine, Total, S (Mayo)OutsideLaboratory",,83090,CPT,Facility,Outpatient,,,90,76,64.6,21.7816,76,Medica,Medical Assistance,33.896,44.6,,percent of total billed charges,,
"Homocysteine, Total, S (Mayo)OutsideLaboratory",,83090,CPT,Facility,Inpatient,,,90,76,64.6,21.7816,76,Medica,Medical Assistance,,,,,Included in per diem rate,
"Homocysteine, Total, S (Mayo)OutsideLaboratory",,83090,CPT,Facility,Outpatient,,,90,76,64.6,21.7816,76,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,37.848,49.8,,percent of total billed charges,,
"Homocysteine, Total, S (Mayo)OutsideLaboratory",,83090,CPT,Facility,Inpatient,,,90,76,64.6,21.7816,76,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Homocysteine, Total, S (Mayo)OutsideLaboratory",,83090,CPT,Facility,Both,,,90,76,64.6,21.7816,76,"Multiplan, Inc.","Multiplan, Inc.",71.44,94,,percent of total billed charges,,
"Homocysteine, Total, S (Mayo)OutsideLaboratory",,83090,CPT,Facility,Outpatient,,,90,76,64.6,21.7816,76,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,65.664,86.4,,percent of total billed charges,,
"Homocysteine, Total, S (Mayo)OutsideLaboratory",,83090,CPT,Facility,Inpatient,,,90,76,64.6,21.7816,76,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Homocysteine, Total, S (Mayo)OutsideLaboratory",,83090,CPT,Facility,Both,,,90,76,64.6,21.7816,76,"Preferred One Administrative Services, INC.",PPO,74.936,98.6,,percent of total billed charges,,
"Homocysteine, Total, S (Mayo)OutsideLaboratory",,83090,CPT,Facility,Outpatient,,,90,76,64.6,21.7816,76,PrimeWest Health,Minnesota Senior Health Options (MSHO),39.102,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Homocysteine, Total, S (Mayo)OutsideLaboratory",,83090,CPT,Facility,Inpatient,,,90,76,64.6,21.7816,76,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Homocysteine, Total, S (Mayo)OutsideLaboratory",,83090,CPT,Facility,Outpatient,,,90,76,64.6,21.7816,76,PrimeWest Health,MinnesotaCare,39.0336,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Homocysteine, Total, S (Mayo)OutsideLaboratory",,83090,CPT,Facility,Inpatient,,,90,76,64.6,21.7816,76,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Homocysteine, Total, S (Mayo)OutsideLaboratory",,83090,CPT,Facility,Both,,,90,76,64.6,21.7816,76,Sanford Health Plan,Sanford Health Plan,69.92,92,,percent of total billed charges,,
"Homocysteine, Total, S (Mayo)OutsideLaboratory",,83090,CPT,Facility,Outpatient,,,90,76,64.6,21.7816,76,"UCare Health, Inc.",Individual & Family Plan,42.826,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Homocysteine, Total, S (Mayo)OutsideLaboratory",,83090,CPT,Facility,Inpatient,,,90,76,64.6,21.7816,76,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Homocysteine, Total, S (Mayo)OutsideLaboratory",,83090,CPT,Facility,Outpatient,,,90,76,64.6,21.7816,76,"UCare Health, Inc.",Medical Assistance,38.3572,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Homocysteine, Total, S (Mayo)OutsideLaboratory",,83090,CPT,Facility,Inpatient,,,90,76,64.6,21.7816,76,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Homocysteine, Total, S (Mayo)OutsideLaboratory",,83090,CPT,Facility,Outpatient,,,90,76,64.6,21.7816,76,"UCare Health, Inc.",Medicare Advantage,38.3572,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Homocysteine, Total, S (Mayo)OutsideLaboratory",,83090,CPT,Facility,Inpatient,,,90,76,64.6,21.7816,76,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Homocysteine, Total, S (Mayo)OutsideLaboratory",,83090,CPT,Facility,Outpatient,,,90,76,64.6,21.7816,76,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),38.3572,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Homocysteine, Total, S (Mayo)OutsideLaboratory",,83090,CPT,Facility,Inpatient,,,90,76,64.6,21.7816,76,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Homocysteine, Total, S (Mayo)OutsideLaboratory",,83090,CPT,Facility,Both,,,90,76,64.6,21.7816,76,UnitedHealthcare,Individual & Family,71.44,94,,percent of total billed charges,,
"Homocysteine, Total, S (Mayo)OutsideLaboratory",,83090,CPT,Facility,Outpatient,,,90,76,64.6,21.7816,76,UnitedHealthcare,Medicare Advantage,37.24,49,,percent of total billed charges,,
"Homocysteine, Total, S (Mayo)OutsideLaboratory",,83090,CPT,Facility,Inpatient,,,90,76,64.6,21.7816,76,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Homocysteine, Total, S (Mayo)OutsideLaboratory",,83090,CPT,Facility,Outpatient,,,90,76,64.6,21.7816,76,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,36.48,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Homocysteine, Total, S (Mayo)OutsideLaboratory",,83090,CPT,Facility,Inpatient,,,90,76,64.6,21.7816,76,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Homovanillic Acid (Hva), Random, U (Mayo)OutsideLaboratory",,83150,CPT,Facility,Both,,,90,119,101.15,34.1054,119,Aetna,Commercial,109.48,92,,percent of total billed charges,,
"Homovanillic Acid (Hva), Random, U (Mayo)OutsideLaboratory",,83150,CPT,Facility,Outpatient,,,90,119,101.15,34.1054,119,Aetna,Medicare Advantage,58.31,49,,percent of total billed charges,,
"Homovanillic Acid (Hva), Random, U (Mayo)OutsideLaboratory",,83150,CPT,Facility,Inpatient,,,90,119,101.15,34.1054,119,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Homovanillic Acid (Hva), Random, U (Mayo)OutsideLaboratory",,83150,CPT,Facility,Both,,,90,119,101.15,34.1054,119,Aetna,PPO,110.67,93,,percent of total billed charges,,
"Homovanillic Acid (Hva), Random, U (Mayo)OutsideLaboratory",,83150,CPT,Facility,Both,,,90,119,101.15,34.1054,119,America's PPO,America's PPO,114.2757,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Homovanillic Acid (Hva), Random, U (Mayo)OutsideLaboratory",,83150,CPT,Facility,Both,,,90,119,101.15,34.1054,119,BlueCross BlueShield Minnesota, Federal Employee Program,117.096,98.4,,percent of total billed charges,,
"Homovanillic Acid (Hva), Random, U (Mayo)OutsideLaboratory",,83150,CPT,Facility,Both,,,90,119,101.15,34.1054,119,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,119,100,,percent of total billed charges,,
"Homovanillic Acid (Hva), Random, U (Mayo)OutsideLaboratory",,83150,CPT,Facility,Both,,,90,119,101.15,34.1054,119,BlueCross BlueShield Minnesota,High Value Network Plan,107.1,90,,percent of total billed charges,,
"Homovanillic Acid (Hva), Random, U (Mayo)OutsideLaboratory",,83150,CPT,Facility,Outpatient,,,90,119,101.15,34.1054,119,BlueCross BlueShield Minnesota,Medicare Advantage,58.31,49,,percent of total billed charges,,
"Homovanillic Acid (Hva), Random, U (Mayo)OutsideLaboratory",,83150,CPT,Facility,Inpatient,,,90,119,101.15,34.1054,119,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Homovanillic Acid (Hva), Random, U (Mayo)OutsideLaboratory",,83150,CPT,Facility,Both,,,90,119,101.15,34.1054,119,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,105.3983,88.57,,percent of total billed charges,,
"Homovanillic Acid (Hva), Random, U (Mayo)OutsideLaboratory",,83150,CPT,Facility,Both,,,90,119,101.15,34.1054,119,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,34.1054,28.66,,percent of total billed charges,,
"Homovanillic Acid (Hva), Random, U (Mayo)OutsideLaboratory",,83150,CPT,Facility,Outpatient,,,90,119,101.15,34.1054,119,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),58.31,49,,percent of total billed charges,,
"Homovanillic Acid (Hva), Random, U (Mayo)OutsideLaboratory",,83150,CPT,Facility,Inpatient,,,90,119,101.15,34.1054,119,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Homovanillic Acid (Hva), Random, U (Mayo)OutsideLaboratory",,83150,CPT,Facility,Both,,,90,119,101.15,34.1054,119,CorVel,Worker's Compensation,119,100,,percent of total billed charges,,
"Homovanillic Acid (Hva), Random, U (Mayo)OutsideLaboratory",,83150,CPT,Facility,Both,,,90,119,101.15,34.1054,119,First Health Group Corporation,First Health Network,115.43,97,,percent of total billed charges,,
"Homovanillic Acid (Hva), Random, U (Mayo)OutsideLaboratory",,83150,CPT,Facility,Both,,,90,119,101.15,34.1054,119,"Health Partners, Inc.",Commercial,112.574,94.6,,percent of total billed charges,,
"Homovanillic Acid (Hva), Random, U (Mayo)OutsideLaboratory",,83150,CPT,Facility,Outpatient,,,90,119,101.15,34.1054,119,"Health Partners, Inc.",Medicare Advantage,58.31,49,,percent of total billed charges,,
"Homovanillic Acid (Hva), Random, U (Mayo)OutsideLaboratory",,83150,CPT,Facility,Inpatient,,,90,119,101.15,34.1054,119,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Homovanillic Acid (Hva), Random, U (Mayo)OutsideLaboratory",,83150,CPT,Facility,Both,,,90,119,101.15,34.1054,119,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),71.4,60,,percent of total billed charges,,
"Homovanillic Acid (Hva), Random, U (Mayo)OutsideLaboratory",,83150,CPT,Facility,Both,,,90,119,101.15,34.1054,119,"Health Partners, Inc.",State of Minnesota Advantage Program,96.985,81.5,,percent of total billed charges,,
"Homovanillic Acid (Hva), Random, U (Mayo)OutsideLaboratory",,83150,CPT,Facility,Both,,,90,119,101.15,34.1054,119,"Health Partners, Inc.",State Public Programs,59.5,50,,percent of total billed charges,,
"Homovanillic Acid (Hva), Random, U (Mayo)OutsideLaboratory",,83150,CPT,Facility,Both,,,90,119,101.15,34.1054,119,Humana Insurance Company,Commercial PPO,113.05,95,,percent of total billed charges,,
"Homovanillic Acid (Hva), Random, U (Mayo)OutsideLaboratory",,83150,CPT,Facility,Outpatient,,,90,119,101.15,34.1054,119,Humana Insurance Company,Medicare PPO,58.31,49,,percent of total billed charges,,
"Homovanillic Acid (Hva), Random, U (Mayo)OutsideLaboratory",,83150,CPT,Facility,Inpatient,,,90,119,101.15,34.1054,119,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Homovanillic Acid (Hva), Random, U (Mayo)OutsideLaboratory",,83150,CPT,Facility,Both,,,90,119,101.15,34.1054,119,Medica,Individual & Family,117.929,99.1,,percent of total billed charges,,
"Homovanillic Acid (Hva), Random, U (Mayo)OutsideLaboratory",,83150,CPT,Facility,Outpatient,,,90,119,101.15,34.1054,119,Medica,Medica Advantage Solution,59.262,49.8,,percent of total billed charges,,
"Homovanillic Acid (Hva), Random, U (Mayo)OutsideLaboratory",,83150,CPT,Facility,Inpatient,,,90,119,101.15,34.1054,119,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Homovanillic Acid (Hva), Random, U (Mayo)OutsideLaboratory",,83150,CPT,Facility,Outpatient,,,90,119,101.15,34.1054,119,Medica,Medical Assistance,53.074,44.6,,percent of total billed charges,,
"Homovanillic Acid (Hva), Random, U (Mayo)OutsideLaboratory",,83150,CPT,Facility,Inpatient,,,90,119,101.15,34.1054,119,Medica,Medical Assistance,,,,,Included in per diem rate,
"Homovanillic Acid (Hva), Random, U (Mayo)OutsideLaboratory",,83150,CPT,Facility,Outpatient,,,90,119,101.15,34.1054,119,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,59.262,49.8,,percent of total billed charges,,
"Homovanillic Acid (Hva), Random, U (Mayo)OutsideLaboratory",,83150,CPT,Facility,Inpatient,,,90,119,101.15,34.1054,119,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Homovanillic Acid (Hva), Random, U (Mayo)OutsideLaboratory",,83150,CPT,Facility,Both,,,90,119,101.15,34.1054,119,"Multiplan, Inc.","Multiplan, Inc.",111.86,94,,percent of total billed charges,,
"Homovanillic Acid (Hva), Random, U (Mayo)OutsideLaboratory",,83150,CPT,Facility,Outpatient,,,90,119,101.15,34.1054,119,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,102.816,86.4,,percent of total billed charges,,
"Homovanillic Acid (Hva), Random, U (Mayo)OutsideLaboratory",,83150,CPT,Facility,Inpatient,,,90,119,101.15,34.1054,119,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Homovanillic Acid (Hva), Random, U (Mayo)OutsideLaboratory",,83150,CPT,Facility,Both,,,90,119,101.15,34.1054,119,"Preferred One Administrative Services, INC.",PPO,117.334,98.6,,percent of total billed charges,,
"Homovanillic Acid (Hva), Random, U (Mayo)OutsideLaboratory",,83150,CPT,Facility,Outpatient,,,90,119,101.15,34.1054,119,PrimeWest Health,Minnesota Senior Health Options (MSHO),61.2255,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Homovanillic Acid (Hva), Random, U (Mayo)OutsideLaboratory",,83150,CPT,Facility,Inpatient,,,90,119,101.15,34.1054,119,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Homovanillic Acid (Hva), Random, U (Mayo)OutsideLaboratory",,83150,CPT,Facility,Outpatient,,,90,119,101.15,34.1054,119,PrimeWest Health,MinnesotaCare,61.1184,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Homovanillic Acid (Hva), Random, U (Mayo)OutsideLaboratory",,83150,CPT,Facility,Inpatient,,,90,119,101.15,34.1054,119,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Homovanillic Acid (Hva), Random, U (Mayo)OutsideLaboratory",,83150,CPT,Facility,Both,,,90,119,101.15,34.1054,119,Sanford Health Plan,Sanford Health Plan,109.48,92,,percent of total billed charges,,
"Homovanillic Acid (Hva), Random, U (Mayo)OutsideLaboratory",,83150,CPT,Facility,Outpatient,,,90,119,101.15,34.1054,119,"UCare Health, Inc.",Individual & Family Plan,67.0565,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Homovanillic Acid (Hva), Random, U (Mayo)OutsideLaboratory",,83150,CPT,Facility,Inpatient,,,90,119,101.15,34.1054,119,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Homovanillic Acid (Hva), Random, U (Mayo)OutsideLaboratory",,83150,CPT,Facility,Outpatient,,,90,119,101.15,34.1054,119,"UCare Health, Inc.",Medical Assistance,60.0593,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Homovanillic Acid (Hva), Random, U (Mayo)OutsideLaboratory",,83150,CPT,Facility,Inpatient,,,90,119,101.15,34.1054,119,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Homovanillic Acid (Hva), Random, U (Mayo)OutsideLaboratory",,83150,CPT,Facility,Outpatient,,,90,119,101.15,34.1054,119,"UCare Health, Inc.",Medicare Advantage,60.0593,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Homovanillic Acid (Hva), Random, U (Mayo)OutsideLaboratory",,83150,CPT,Facility,Inpatient,,,90,119,101.15,34.1054,119,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Homovanillic Acid (Hva), Random, U (Mayo)OutsideLaboratory",,83150,CPT,Facility,Outpatient,,,90,119,101.15,34.1054,119,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),60.0593,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Homovanillic Acid (Hva), Random, U (Mayo)OutsideLaboratory",,83150,CPT,Facility,Inpatient,,,90,119,101.15,34.1054,119,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Homovanillic Acid (Hva), Random, U (Mayo)OutsideLaboratory",,83150,CPT,Facility,Both,,,90,119,101.15,34.1054,119,UnitedHealthcare,Individual & Family,111.86,94,,percent of total billed charges,,
"Homovanillic Acid (Hva), Random, U (Mayo)OutsideLaboratory",,83150,CPT,Facility,Outpatient,,,90,119,101.15,34.1054,119,UnitedHealthcare,Medicare Advantage,58.31,49,,percent of total billed charges,,
"Homovanillic Acid (Hva), Random, U (Mayo)OutsideLaboratory",,83150,CPT,Facility,Inpatient,,,90,119,101.15,34.1054,119,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Homovanillic Acid (Hva), Random, U (Mayo)OutsideLaboratory",,83150,CPT,Facility,Outpatient,,,90,119,101.15,34.1054,119,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,57.12,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Homovanillic Acid (Hva), Random, U (Mayo)OutsideLaboratory",,83150,CPT,Facility,Inpatient,,,90,119,101.15,34.1054,119,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Hydroxyindolacetic Acid, 5-(Hiaa) (Mayo)OutsideLaboratory",,83497,CPT,Facility,Both,,,90,75,63.75,21.495,75,Aetna,Commercial,69,92,,percent of total billed charges,,
"Hydroxyindolacetic Acid, 5-(Hiaa) (Mayo)OutsideLaboratory",,83497,CPT,Facility,Outpatient,,,90,75,63.75,21.495,75,Aetna,Medicare Advantage,36.75,49,,percent of total billed charges,,
"Hydroxyindolacetic Acid, 5-(Hiaa) (Mayo)OutsideLaboratory",,83497,CPT,Facility,Inpatient,,,90,75,63.75,21.495,75,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Hydroxyindolacetic Acid, 5-(Hiaa) (Mayo)OutsideLaboratory",,83497,CPT,Facility,Both,,,90,75,63.75,21.495,75,Aetna,PPO,69.75,93,,percent of total billed charges,,
"Hydroxyindolacetic Acid, 5-(Hiaa) (Mayo)OutsideLaboratory",,83497,CPT,Facility,Both,,,90,75,63.75,21.495,75,America's PPO,America's PPO,72.0225,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Hydroxyindolacetic Acid, 5-(Hiaa) (Mayo)OutsideLaboratory",,83497,CPT,Facility,Both,,,90,75,63.75,21.495,75,BlueCross BlueShield Minnesota, Federal Employee Program,73.8,98.4,,percent of total billed charges,,
"Hydroxyindolacetic Acid, 5-(Hiaa) (Mayo)OutsideLaboratory",,83497,CPT,Facility,Both,,,90,75,63.75,21.495,75,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,75,100,,percent of total billed charges,,
"Hydroxyindolacetic Acid, 5-(Hiaa) (Mayo)OutsideLaboratory",,83497,CPT,Facility,Both,,,90,75,63.75,21.495,75,BlueCross BlueShield Minnesota,High Value Network Plan,67.5,90,,percent of total billed charges,,
"Hydroxyindolacetic Acid, 5-(Hiaa) (Mayo)OutsideLaboratory",,83497,CPT,Facility,Outpatient,,,90,75,63.75,21.495,75,BlueCross BlueShield Minnesota,Medicare Advantage,36.75,49,,percent of total billed charges,,
"Hydroxyindolacetic Acid, 5-(Hiaa) (Mayo)OutsideLaboratory",,83497,CPT,Facility,Inpatient,,,90,75,63.75,21.495,75,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Hydroxyindolacetic Acid, 5-(Hiaa) (Mayo)OutsideLaboratory",,83497,CPT,Facility,Both,,,90,75,63.75,21.495,75,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,66.4275,88.57,,percent of total billed charges,,
"Hydroxyindolacetic Acid, 5-(Hiaa) (Mayo)OutsideLaboratory",,83497,CPT,Facility,Both,,,90,75,63.75,21.495,75,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,21.495,28.66,,percent of total billed charges,,
"Hydroxyindolacetic Acid, 5-(Hiaa) (Mayo)OutsideLaboratory",,83497,CPT,Facility,Outpatient,,,90,75,63.75,21.495,75,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),36.75,49,,percent of total billed charges,,
"Hydroxyindolacetic Acid, 5-(Hiaa) (Mayo)OutsideLaboratory",,83497,CPT,Facility,Inpatient,,,90,75,63.75,21.495,75,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Hydroxyindolacetic Acid, 5-(Hiaa) (Mayo)OutsideLaboratory",,83497,CPT,Facility,Both,,,90,75,63.75,21.495,75,CorVel,Worker's Compensation,75,100,,percent of total billed charges,,
"Hydroxyindolacetic Acid, 5-(Hiaa) (Mayo)OutsideLaboratory",,83497,CPT,Facility,Both,,,90,75,63.75,21.495,75,First Health Group Corporation,First Health Network,72.75,97,,percent of total billed charges,,
"Hydroxyindolacetic Acid, 5-(Hiaa) (Mayo)OutsideLaboratory",,83497,CPT,Facility,Both,,,90,75,63.75,21.495,75,"Health Partners, Inc.",Commercial,70.95,94.6,,percent of total billed charges,,
"Hydroxyindolacetic Acid, 5-(Hiaa) (Mayo)OutsideLaboratory",,83497,CPT,Facility,Outpatient,,,90,75,63.75,21.495,75,"Health Partners, Inc.",Medicare Advantage,36.75,49,,percent of total billed charges,,
"Hydroxyindolacetic Acid, 5-(Hiaa) (Mayo)OutsideLaboratory",,83497,CPT,Facility,Inpatient,,,90,75,63.75,21.495,75,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Hydroxyindolacetic Acid, 5-(Hiaa) (Mayo)OutsideLaboratory",,83497,CPT,Facility,Both,,,90,75,63.75,21.495,75,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),45,60,,percent of total billed charges,,
"Hydroxyindolacetic Acid, 5-(Hiaa) (Mayo)OutsideLaboratory",,83497,CPT,Facility,Both,,,90,75,63.75,21.495,75,"Health Partners, Inc.",State of Minnesota Advantage Program,61.125,81.5,,percent of total billed charges,,
"Hydroxyindolacetic Acid, 5-(Hiaa) (Mayo)OutsideLaboratory",,83497,CPT,Facility,Both,,,90,75,63.75,21.495,75,"Health Partners, Inc.",State Public Programs,37.5,50,,percent of total billed charges,,
"Hydroxyindolacetic Acid, 5-(Hiaa) (Mayo)OutsideLaboratory",,83497,CPT,Facility,Both,,,90,75,63.75,21.495,75,Humana Insurance Company,Commercial PPO,71.25,95,,percent of total billed charges,,
"Hydroxyindolacetic Acid, 5-(Hiaa) (Mayo)OutsideLaboratory",,83497,CPT,Facility,Outpatient,,,90,75,63.75,21.495,75,Humana Insurance Company,Medicare PPO,36.75,49,,percent of total billed charges,,
"Hydroxyindolacetic Acid, 5-(Hiaa) (Mayo)OutsideLaboratory",,83497,CPT,Facility,Inpatient,,,90,75,63.75,21.495,75,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Hydroxyindolacetic Acid, 5-(Hiaa) (Mayo)OutsideLaboratory",,83497,CPT,Facility,Both,,,90,75,63.75,21.495,75,Medica,Individual & Family,74.325,99.1,,percent of total billed charges,,
"Hydroxyindolacetic Acid, 5-(Hiaa) (Mayo)OutsideLaboratory",,83497,CPT,Facility,Outpatient,,,90,75,63.75,21.495,75,Medica,Medica Advantage Solution,37.35,49.8,,percent of total billed charges,,
"Hydroxyindolacetic Acid, 5-(Hiaa) (Mayo)OutsideLaboratory",,83497,CPT,Facility,Inpatient,,,90,75,63.75,21.495,75,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Hydroxyindolacetic Acid, 5-(Hiaa) (Mayo)OutsideLaboratory",,83497,CPT,Facility,Outpatient,,,90,75,63.75,21.495,75,Medica,Medical Assistance,33.45,44.6,,percent of total billed charges,,
"Hydroxyindolacetic Acid, 5-(Hiaa) (Mayo)OutsideLaboratory",,83497,CPT,Facility,Inpatient,,,90,75,63.75,21.495,75,Medica,Medical Assistance,,,,,Included in per diem rate,
"Hydroxyindolacetic Acid, 5-(Hiaa) (Mayo)OutsideLaboratory",,83497,CPT,Facility,Outpatient,,,90,75,63.75,21.495,75,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,37.35,49.8,,percent of total billed charges,,
"Hydroxyindolacetic Acid, 5-(Hiaa) (Mayo)OutsideLaboratory",,83497,CPT,Facility,Inpatient,,,90,75,63.75,21.495,75,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Hydroxyindolacetic Acid, 5-(Hiaa) (Mayo)OutsideLaboratory",,83497,CPT,Facility,Both,,,90,75,63.75,21.495,75,"Multiplan, Inc.","Multiplan, Inc.",70.5,94,,percent of total billed charges,,
"Hydroxyindolacetic Acid, 5-(Hiaa) (Mayo)OutsideLaboratory",,83497,CPT,Facility,Outpatient,,,90,75,63.75,21.495,75,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,64.8,86.4,,percent of total billed charges,,
"Hydroxyindolacetic Acid, 5-(Hiaa) (Mayo)OutsideLaboratory",,83497,CPT,Facility,Inpatient,,,90,75,63.75,21.495,75,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Hydroxyindolacetic Acid, 5-(Hiaa) (Mayo)OutsideLaboratory",,83497,CPT,Facility,Both,,,90,75,63.75,21.495,75,"Preferred One Administrative Services, INC.",PPO,73.95,98.6,,percent of total billed charges,,
"Hydroxyindolacetic Acid, 5-(Hiaa) (Mayo)OutsideLaboratory",,83497,CPT,Facility,Outpatient,,,90,75,63.75,21.495,75,PrimeWest Health,Minnesota Senior Health Options (MSHO),38.5875,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Hydroxyindolacetic Acid, 5-(Hiaa) (Mayo)OutsideLaboratory",,83497,CPT,Facility,Inpatient,,,90,75,63.75,21.495,75,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Hydroxyindolacetic Acid, 5-(Hiaa) (Mayo)OutsideLaboratory",,83497,CPT,Facility,Outpatient,,,90,75,63.75,21.495,75,PrimeWest Health,MinnesotaCare,38.52,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Hydroxyindolacetic Acid, 5-(Hiaa) (Mayo)OutsideLaboratory",,83497,CPT,Facility,Inpatient,,,90,75,63.75,21.495,75,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Hydroxyindolacetic Acid, 5-(Hiaa) (Mayo)OutsideLaboratory",,83497,CPT,Facility,Both,,,90,75,63.75,21.495,75,Sanford Health Plan,Sanford Health Plan,69,92,,percent of total billed charges,,
"Hydroxyindolacetic Acid, 5-(Hiaa) (Mayo)OutsideLaboratory",,83497,CPT,Facility,Outpatient,,,90,75,63.75,21.495,75,"UCare Health, Inc.",Individual & Family Plan,42.2625,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Hydroxyindolacetic Acid, 5-(Hiaa) (Mayo)OutsideLaboratory",,83497,CPT,Facility,Inpatient,,,90,75,63.75,21.495,75,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Hydroxyindolacetic Acid, 5-(Hiaa) (Mayo)OutsideLaboratory",,83497,CPT,Facility,Outpatient,,,90,75,63.75,21.495,75,"UCare Health, Inc.",Medical Assistance,37.8525,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Hydroxyindolacetic Acid, 5-(Hiaa) (Mayo)OutsideLaboratory",,83497,CPT,Facility,Inpatient,,,90,75,63.75,21.495,75,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Hydroxyindolacetic Acid, 5-(Hiaa) (Mayo)OutsideLaboratory",,83497,CPT,Facility,Outpatient,,,90,75,63.75,21.495,75,"UCare Health, Inc.",Medicare Advantage,37.8525,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Hydroxyindolacetic Acid, 5-(Hiaa) (Mayo)OutsideLaboratory",,83497,CPT,Facility,Inpatient,,,90,75,63.75,21.495,75,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Hydroxyindolacetic Acid, 5-(Hiaa) (Mayo)OutsideLaboratory",,83497,CPT,Facility,Outpatient,,,90,75,63.75,21.495,75,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),37.8525,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Hydroxyindolacetic Acid, 5-(Hiaa) (Mayo)OutsideLaboratory",,83497,CPT,Facility,Inpatient,,,90,75,63.75,21.495,75,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Hydroxyindolacetic Acid, 5-(Hiaa) (Mayo)OutsideLaboratory",,83497,CPT,Facility,Both,,,90,75,63.75,21.495,75,UnitedHealthcare,Individual & Family,70.5,94,,percent of total billed charges,,
"Hydroxyindolacetic Acid, 5-(Hiaa) (Mayo)OutsideLaboratory",,83497,CPT,Facility,Outpatient,,,90,75,63.75,21.495,75,UnitedHealthcare,Medicare Advantage,36.75,49,,percent of total billed charges,,
"Hydroxyindolacetic Acid, 5-(Hiaa) (Mayo)OutsideLaboratory",,83497,CPT,Facility,Inpatient,,,90,75,63.75,21.495,75,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Hydroxyindolacetic Acid, 5-(Hiaa) (Mayo)OutsideLaboratory",,83497,CPT,Facility,Outpatient,,,90,75,63.75,21.495,75,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,36,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Hydroxyindolacetic Acid, 5-(Hiaa) (Mayo)OutsideLaboratory",,83497,CPT,Facility,Inpatient,,,90,75,63.75,21.495,75,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"17-Hydroxyprogesterone, S (Mayo)OutsideLaboratory",,83498,CPT,Facility,Both,,,90,61,51.85,17.4826,61,Aetna,Commercial,56.12,92,,percent of total billed charges,,
"17-Hydroxyprogesterone, S (Mayo)OutsideLaboratory",,83498,CPT,Facility,Outpatient,,,90,61,51.85,17.4826,61,Aetna,Medicare Advantage,29.89,49,,percent of total billed charges,,
"17-Hydroxyprogesterone, S (Mayo)OutsideLaboratory",,83498,CPT,Facility,Inpatient,,,90,61,51.85,17.4826,61,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"17-Hydroxyprogesterone, S (Mayo)OutsideLaboratory",,83498,CPT,Facility,Both,,,90,61,51.85,17.4826,61,Aetna,PPO,56.73,93,,percent of total billed charges,,
"17-Hydroxyprogesterone, S (Mayo)OutsideLaboratory",,83498,CPT,Facility,Both,,,90,61,51.85,17.4826,61,America's PPO,America's PPO,58.5783,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"17-Hydroxyprogesterone, S (Mayo)OutsideLaboratory",,83498,CPT,Facility,Both,,,90,61,51.85,17.4826,61,BlueCross BlueShield Minnesota, Federal Employee Program,60.024,98.4,,percent of total billed charges,,
"17-Hydroxyprogesterone, S (Mayo)OutsideLaboratory",,83498,CPT,Facility,Both,,,90,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,61,100,,percent of total billed charges,,
"17-Hydroxyprogesterone, S (Mayo)OutsideLaboratory",,83498,CPT,Facility,Both,,,90,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,High Value Network Plan,54.9,90,,percent of total billed charges,,
"17-Hydroxyprogesterone, S (Mayo)OutsideLaboratory",,83498,CPT,Facility,Outpatient,,,90,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,Medicare Advantage,29.89,49,,percent of total billed charges,,
"17-Hydroxyprogesterone, S (Mayo)OutsideLaboratory",,83498,CPT,Facility,Inpatient,,,90,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"17-Hydroxyprogesterone, S (Mayo)OutsideLaboratory",,83498,CPT,Facility,Both,,,90,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,54.0277,88.57,,percent of total billed charges,,
"17-Hydroxyprogesterone, S (Mayo)OutsideLaboratory",,83498,CPT,Facility,Both,,,90,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,17.4826,28.66,,percent of total billed charges,,
"17-Hydroxyprogesterone, S (Mayo)OutsideLaboratory",,83498,CPT,Facility,Outpatient,,,90,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),29.89,49,,percent of total billed charges,,
"17-Hydroxyprogesterone, S (Mayo)OutsideLaboratory",,83498,CPT,Facility,Inpatient,,,90,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"17-Hydroxyprogesterone, S (Mayo)OutsideLaboratory",,83498,CPT,Facility,Both,,,90,61,51.85,17.4826,61,CorVel,Worker's Compensation,61,100,,percent of total billed charges,,
"17-Hydroxyprogesterone, S (Mayo)OutsideLaboratory",,83498,CPT,Facility,Both,,,90,61,51.85,17.4826,61,First Health Group Corporation,First Health Network,59.17,97,,percent of total billed charges,,
"17-Hydroxyprogesterone, S (Mayo)OutsideLaboratory",,83498,CPT,Facility,Both,,,90,61,51.85,17.4826,61,"Health Partners, Inc.",Commercial,57.706,94.6,,percent of total billed charges,,
"17-Hydroxyprogesterone, S (Mayo)OutsideLaboratory",,83498,CPT,Facility,Outpatient,,,90,61,51.85,17.4826,61,"Health Partners, Inc.",Medicare Advantage,29.89,49,,percent of total billed charges,,
"17-Hydroxyprogesterone, S (Mayo)OutsideLaboratory",,83498,CPT,Facility,Inpatient,,,90,61,51.85,17.4826,61,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"17-Hydroxyprogesterone, S (Mayo)OutsideLaboratory",,83498,CPT,Facility,Both,,,90,61,51.85,17.4826,61,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),36.6,60,,percent of total billed charges,,
"17-Hydroxyprogesterone, S (Mayo)OutsideLaboratory",,83498,CPT,Facility,Both,,,90,61,51.85,17.4826,61,"Health Partners, Inc.",State of Minnesota Advantage Program,49.715,81.5,,percent of total billed charges,,
"17-Hydroxyprogesterone, S (Mayo)OutsideLaboratory",,83498,CPT,Facility,Both,,,90,61,51.85,17.4826,61,"Health Partners, Inc.",State Public Programs,30.5,50,,percent of total billed charges,,
"17-Hydroxyprogesterone, S (Mayo)OutsideLaboratory",,83498,CPT,Facility,Both,,,90,61,51.85,17.4826,61,Humana Insurance Company,Commercial PPO,57.95,95,,percent of total billed charges,,
"17-Hydroxyprogesterone, S (Mayo)OutsideLaboratory",,83498,CPT,Facility,Outpatient,,,90,61,51.85,17.4826,61,Humana Insurance Company,Medicare PPO,29.89,49,,percent of total billed charges,,
"17-Hydroxyprogesterone, S (Mayo)OutsideLaboratory",,83498,CPT,Facility,Inpatient,,,90,61,51.85,17.4826,61,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"17-Hydroxyprogesterone, S (Mayo)OutsideLaboratory",,83498,CPT,Facility,Both,,,90,61,51.85,17.4826,61,Medica,Individual & Family,60.451,99.1,,percent of total billed charges,,
"17-Hydroxyprogesterone, S (Mayo)OutsideLaboratory",,83498,CPT,Facility,Outpatient,,,90,61,51.85,17.4826,61,Medica,Medica Advantage Solution,30.378,49.8,,percent of total billed charges,,
"17-Hydroxyprogesterone, S (Mayo)OutsideLaboratory",,83498,CPT,Facility,Inpatient,,,90,61,51.85,17.4826,61,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"17-Hydroxyprogesterone, S (Mayo)OutsideLaboratory",,83498,CPT,Facility,Outpatient,,,90,61,51.85,17.4826,61,Medica,Medical Assistance,27.206,44.6,,percent of total billed charges,,
"17-Hydroxyprogesterone, S (Mayo)OutsideLaboratory",,83498,CPT,Facility,Inpatient,,,90,61,51.85,17.4826,61,Medica,Medical Assistance,,,,,Included in per diem rate,
"17-Hydroxyprogesterone, S (Mayo)OutsideLaboratory",,83498,CPT,Facility,Outpatient,,,90,61,51.85,17.4826,61,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,30.378,49.8,,percent of total billed charges,,
"17-Hydroxyprogesterone, S (Mayo)OutsideLaboratory",,83498,CPT,Facility,Inpatient,,,90,61,51.85,17.4826,61,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"17-Hydroxyprogesterone, S (Mayo)OutsideLaboratory",,83498,CPT,Facility,Both,,,90,61,51.85,17.4826,61,"Multiplan, Inc.","Multiplan, Inc.",57.34,94,,percent of total billed charges,,
"17-Hydroxyprogesterone, S (Mayo)OutsideLaboratory",,83498,CPT,Facility,Outpatient,,,90,61,51.85,17.4826,61,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,52.704,86.4,,percent of total billed charges,,
"17-Hydroxyprogesterone, S (Mayo)OutsideLaboratory",,83498,CPT,Facility,Inpatient,,,90,61,51.85,17.4826,61,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"17-Hydroxyprogesterone, S (Mayo)OutsideLaboratory",,83498,CPT,Facility,Both,,,90,61,51.85,17.4826,61,"Preferred One Administrative Services, INC.",PPO,60.146,98.6,,percent of total billed charges,,
"17-Hydroxyprogesterone, S (Mayo)OutsideLaboratory",,83498,CPT,Facility,Outpatient,,,90,61,51.85,17.4826,61,PrimeWest Health,Minnesota Senior Health Options (MSHO),31.3845,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"17-Hydroxyprogesterone, S (Mayo)OutsideLaboratory",,83498,CPT,Facility,Inpatient,,,90,61,51.85,17.4826,61,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"17-Hydroxyprogesterone, S (Mayo)OutsideLaboratory",,83498,CPT,Facility,Outpatient,,,90,61,51.85,17.4826,61,PrimeWest Health,MinnesotaCare,31.3296,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"17-Hydroxyprogesterone, S (Mayo)OutsideLaboratory",,83498,CPT,Facility,Inpatient,,,90,61,51.85,17.4826,61,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"17-Hydroxyprogesterone, S (Mayo)OutsideLaboratory",,83498,CPT,Facility,Both,,,90,61,51.85,17.4826,61,Sanford Health Plan,Sanford Health Plan,56.12,92,,percent of total billed charges,,
"17-Hydroxyprogesterone, S (Mayo)OutsideLaboratory",,83498,CPT,Facility,Outpatient,,,90,61,51.85,17.4826,61,"UCare Health, Inc.",Individual & Family Plan,34.3735,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"17-Hydroxyprogesterone, S (Mayo)OutsideLaboratory",,83498,CPT,Facility,Inpatient,,,90,61,51.85,17.4826,61,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"17-Hydroxyprogesterone, S (Mayo)OutsideLaboratory",,83498,CPT,Facility,Outpatient,,,90,61,51.85,17.4826,61,"UCare Health, Inc.",Medical Assistance,30.7867,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"17-Hydroxyprogesterone, S (Mayo)OutsideLaboratory",,83498,CPT,Facility,Inpatient,,,90,61,51.85,17.4826,61,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"17-Hydroxyprogesterone, S (Mayo)OutsideLaboratory",,83498,CPT,Facility,Outpatient,,,90,61,51.85,17.4826,61,"UCare Health, Inc.",Medicare Advantage,30.7867,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"17-Hydroxyprogesterone, S (Mayo)OutsideLaboratory",,83498,CPT,Facility,Inpatient,,,90,61,51.85,17.4826,61,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"17-Hydroxyprogesterone, S (Mayo)OutsideLaboratory",,83498,CPT,Facility,Outpatient,,,90,61,51.85,17.4826,61,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),30.7867,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"17-Hydroxyprogesterone, S (Mayo)OutsideLaboratory",,83498,CPT,Facility,Inpatient,,,90,61,51.85,17.4826,61,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"17-Hydroxyprogesterone, S (Mayo)OutsideLaboratory",,83498,CPT,Facility,Both,,,90,61,51.85,17.4826,61,UnitedHealthcare,Individual & Family,57.34,94,,percent of total billed charges,,
"17-Hydroxyprogesterone, S (Mayo)OutsideLaboratory",,83498,CPT,Facility,Outpatient,,,90,61,51.85,17.4826,61,UnitedHealthcare,Medicare Advantage,29.89,49,,percent of total billed charges,,
"17-Hydroxyprogesterone, S (Mayo)OutsideLaboratory",,83498,CPT,Facility,Inpatient,,,90,61,51.85,17.4826,61,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"17-Hydroxyprogesterone, S (Mayo)OutsideLaboratory",,83498,CPT,Facility,Outpatient,,,90,61,51.85,17.4826,61,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,29.28,48,,percent of total billed charges,,100% of DHS outpatient percentage
"17-Hydroxyprogesterone, S (Mayo)OutsideLaboratory",,83498,CPT,Facility,Inpatient,,,90,61,51.85,17.4826,61,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Hydroxyprogestero 17-D (Mdh)OutsideLaboratory,,83498,CPT,Facility,Both,,,90,52,44.2,14.9032,52,Aetna,Commercial,47.84,92,,percent of total billed charges,,
Hydroxyprogestero 17-D (Mdh)OutsideLaboratory,,83498,CPT,Facility,Outpatient,,,90,52,44.2,14.9032,52,Aetna,Medicare Advantage,25.48,49,,percent of total billed charges,,
Hydroxyprogestero 17-D (Mdh)OutsideLaboratory,,83498,CPT,Facility,Inpatient,,,90,52,44.2,14.9032,52,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Hydroxyprogestero 17-D (Mdh)OutsideLaboratory,,83498,CPT,Facility,Both,,,90,52,44.2,14.9032,52,Aetna,PPO,48.36,93,,percent of total billed charges,,
Hydroxyprogestero 17-D (Mdh)OutsideLaboratory,,83498,CPT,Facility,Both,,,90,52,44.2,14.9032,52,America's PPO,America's PPO,49.9356,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Hydroxyprogestero 17-D (Mdh)OutsideLaboratory,,83498,CPT,Facility,Both,,,90,52,44.2,14.9032,52,BlueCross BlueShield Minnesota, Federal Employee Program,51.168,98.4,,percent of total billed charges,,
Hydroxyprogestero 17-D (Mdh)OutsideLaboratory,,83498,CPT,Facility,Both,,,90,52,44.2,14.9032,52,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,52,100,,percent of total billed charges,,
Hydroxyprogestero 17-D (Mdh)OutsideLaboratory,,83498,CPT,Facility,Both,,,90,52,44.2,14.9032,52,BlueCross BlueShield Minnesota,High Value Network Plan,46.8,90,,percent of total billed charges,,
Hydroxyprogestero 17-D (Mdh)OutsideLaboratory,,83498,CPT,Facility,Outpatient,,,90,52,44.2,14.9032,52,BlueCross BlueShield Minnesota,Medicare Advantage,25.48,49,,percent of total billed charges,,
Hydroxyprogestero 17-D (Mdh)OutsideLaboratory,,83498,CPT,Facility,Inpatient,,,90,52,44.2,14.9032,52,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Hydroxyprogestero 17-D (Mdh)OutsideLaboratory,,83498,CPT,Facility,Both,,,90,52,44.2,14.9032,52,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,46.0564,88.57,,percent of total billed charges,,
Hydroxyprogestero 17-D (Mdh)OutsideLaboratory,,83498,CPT,Facility,Both,,,90,52,44.2,14.9032,52,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,14.9032,28.66,,percent of total billed charges,,
Hydroxyprogestero 17-D (Mdh)OutsideLaboratory,,83498,CPT,Facility,Outpatient,,,90,52,44.2,14.9032,52,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),25.48,49,,percent of total billed charges,,
Hydroxyprogestero 17-D (Mdh)OutsideLaboratory,,83498,CPT,Facility,Inpatient,,,90,52,44.2,14.9032,52,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Hydroxyprogestero 17-D (Mdh)OutsideLaboratory,,83498,CPT,Facility,Both,,,90,52,44.2,14.9032,52,CorVel,Worker's Compensation,52,100,,percent of total billed charges,,
Hydroxyprogestero 17-D (Mdh)OutsideLaboratory,,83498,CPT,Facility,Both,,,90,52,44.2,14.9032,52,First Health Group Corporation,First Health Network,50.44,97,,percent of total billed charges,,
Hydroxyprogestero 17-D (Mdh)OutsideLaboratory,,83498,CPT,Facility,Both,,,90,52,44.2,14.9032,52,"Health Partners, Inc.",Commercial,49.192,94.6,,percent of total billed charges,,
Hydroxyprogestero 17-D (Mdh)OutsideLaboratory,,83498,CPT,Facility,Outpatient,,,90,52,44.2,14.9032,52,"Health Partners, Inc.",Medicare Advantage,25.48,49,,percent of total billed charges,,
Hydroxyprogestero 17-D (Mdh)OutsideLaboratory,,83498,CPT,Facility,Inpatient,,,90,52,44.2,14.9032,52,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Hydroxyprogestero 17-D (Mdh)OutsideLaboratory,,83498,CPT,Facility,Both,,,90,52,44.2,14.9032,52,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),31.2,60,,percent of total billed charges,,
Hydroxyprogestero 17-D (Mdh)OutsideLaboratory,,83498,CPT,Facility,Both,,,90,52,44.2,14.9032,52,"Health Partners, Inc.",State of Minnesota Advantage Program,42.38,81.5,,percent of total billed charges,,
Hydroxyprogestero 17-D (Mdh)OutsideLaboratory,,83498,CPT,Facility,Both,,,90,52,44.2,14.9032,52,"Health Partners, Inc.",State Public Programs,26,50,,percent of total billed charges,,
Hydroxyprogestero 17-D (Mdh)OutsideLaboratory,,83498,CPT,Facility,Both,,,90,52,44.2,14.9032,52,Humana Insurance Company,Commercial PPO,49.4,95,,percent of total billed charges,,
Hydroxyprogestero 17-D (Mdh)OutsideLaboratory,,83498,CPT,Facility,Outpatient,,,90,52,44.2,14.9032,52,Humana Insurance Company,Medicare PPO,25.48,49,,percent of total billed charges,,
Hydroxyprogestero 17-D (Mdh)OutsideLaboratory,,83498,CPT,Facility,Inpatient,,,90,52,44.2,14.9032,52,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Hydroxyprogestero 17-D (Mdh)OutsideLaboratory,,83498,CPT,Facility,Both,,,90,52,44.2,14.9032,52,Medica,Individual & Family,51.532,99.1,,percent of total billed charges,,
Hydroxyprogestero 17-D (Mdh)OutsideLaboratory,,83498,CPT,Facility,Outpatient,,,90,52,44.2,14.9032,52,Medica,Medica Advantage Solution,25.896,49.8,,percent of total billed charges,,
Hydroxyprogestero 17-D (Mdh)OutsideLaboratory,,83498,CPT,Facility,Inpatient,,,90,52,44.2,14.9032,52,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Hydroxyprogestero 17-D (Mdh)OutsideLaboratory,,83498,CPT,Facility,Outpatient,,,90,52,44.2,14.9032,52,Medica,Medical Assistance,23.192,44.6,,percent of total billed charges,,
Hydroxyprogestero 17-D (Mdh)OutsideLaboratory,,83498,CPT,Facility,Inpatient,,,90,52,44.2,14.9032,52,Medica,Medical Assistance,,,,,Included in per diem rate,
Hydroxyprogestero 17-D (Mdh)OutsideLaboratory,,83498,CPT,Facility,Outpatient,,,90,52,44.2,14.9032,52,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,25.896,49.8,,percent of total billed charges,,
Hydroxyprogestero 17-D (Mdh)OutsideLaboratory,,83498,CPT,Facility,Inpatient,,,90,52,44.2,14.9032,52,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Hydroxyprogestero 17-D (Mdh)OutsideLaboratory,,83498,CPT,Facility,Both,,,90,52,44.2,14.9032,52,"Multiplan, Inc.","Multiplan, Inc.",48.88,94,,percent of total billed charges,,
Hydroxyprogestero 17-D (Mdh)OutsideLaboratory,,83498,CPT,Facility,Outpatient,,,90,52,44.2,14.9032,52,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,44.928,86.4,,percent of total billed charges,,
Hydroxyprogestero 17-D (Mdh)OutsideLaboratory,,83498,CPT,Facility,Inpatient,,,90,52,44.2,14.9032,52,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Hydroxyprogestero 17-D (Mdh)OutsideLaboratory,,83498,CPT,Facility,Both,,,90,52,44.2,14.9032,52,"Preferred One Administrative Services, INC.",PPO,51.272,98.6,,percent of total billed charges,,
Hydroxyprogestero 17-D (Mdh)OutsideLaboratory,,83498,CPT,Facility,Outpatient,,,90,52,44.2,14.9032,52,PrimeWest Health,Minnesota Senior Health Options (MSHO),26.754,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Hydroxyprogestero 17-D (Mdh)OutsideLaboratory,,83498,CPT,Facility,Inpatient,,,90,52,44.2,14.9032,52,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Hydroxyprogestero 17-D (Mdh)OutsideLaboratory,,83498,CPT,Facility,Outpatient,,,90,52,44.2,14.9032,52,PrimeWest Health,MinnesotaCare,26.7072,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Hydroxyprogestero 17-D (Mdh)OutsideLaboratory,,83498,CPT,Facility,Inpatient,,,90,52,44.2,14.9032,52,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Hydroxyprogestero 17-D (Mdh)OutsideLaboratory,,83498,CPT,Facility,Both,,,90,52,44.2,14.9032,52,Sanford Health Plan,Sanford Health Plan,47.84,92,,percent of total billed charges,,
Hydroxyprogestero 17-D (Mdh)OutsideLaboratory,,83498,CPT,Facility,Outpatient,,,90,52,44.2,14.9032,52,"UCare Health, Inc.",Individual & Family Plan,29.302,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Hydroxyprogestero 17-D (Mdh)OutsideLaboratory,,83498,CPT,Facility,Inpatient,,,90,52,44.2,14.9032,52,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Hydroxyprogestero 17-D (Mdh)OutsideLaboratory,,83498,CPT,Facility,Outpatient,,,90,52,44.2,14.9032,52,"UCare Health, Inc.",Medical Assistance,26.2444,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Hydroxyprogestero 17-D (Mdh)OutsideLaboratory,,83498,CPT,Facility,Inpatient,,,90,52,44.2,14.9032,52,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Hydroxyprogestero 17-D (Mdh)OutsideLaboratory,,83498,CPT,Facility,Outpatient,,,90,52,44.2,14.9032,52,"UCare Health, Inc.",Medicare Advantage,26.2444,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Hydroxyprogestero 17-D (Mdh)OutsideLaboratory,,83498,CPT,Facility,Inpatient,,,90,52,44.2,14.9032,52,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Hydroxyprogestero 17-D (Mdh)OutsideLaboratory,,83498,CPT,Facility,Outpatient,,,90,52,44.2,14.9032,52,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),26.2444,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Hydroxyprogestero 17-D (Mdh)OutsideLaboratory,,83498,CPT,Facility,Inpatient,,,90,52,44.2,14.9032,52,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Hydroxyprogestero 17-D (Mdh)OutsideLaboratory,,83498,CPT,Facility,Both,,,90,52,44.2,14.9032,52,UnitedHealthcare,Individual & Family,48.88,94,,percent of total billed charges,,
Hydroxyprogestero 17-D (Mdh)OutsideLaboratory,,83498,CPT,Facility,Outpatient,,,90,52,44.2,14.9032,52,UnitedHealthcare,Medicare Advantage,25.48,49,,percent of total billed charges,,
Hydroxyprogestero 17-D (Mdh)OutsideLaboratory,,83498,CPT,Facility,Inpatient,,,90,52,44.2,14.9032,52,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Hydroxyprogestero 17-D (Mdh)OutsideLaboratory,,83498,CPT,Facility,Outpatient,,,90,52,44.2,14.9032,52,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,24.96,48,,percent of total billed charges,,100% of DHS outpatient percentage
Hydroxyprogestero 17-D (Mdh)OutsideLaboratory,,83498,CPT,Facility,Inpatient,,,90,52,44.2,14.9032,52,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Anca Panel For Vasculitis, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Both,,,90,116,98.6,33.2456,116,Aetna,Commercial,106.72,92,,percent of total billed charges,,
"Anca Panel For Vasculitis, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Outpatient,,,90,116,98.6,33.2456,116,Aetna,Medicare Advantage,56.84,49,,percent of total billed charges,,
"Anca Panel For Vasculitis, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Inpatient,,,90,116,98.6,33.2456,116,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Anca Panel For Vasculitis, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Both,,,90,116,98.6,33.2456,116,Aetna,PPO,107.88,93,,percent of total billed charges,,
"Anca Panel For Vasculitis, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Both,,,90,116,98.6,33.2456,116,America's PPO,America's PPO,111.3948,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Anca Panel For Vasculitis, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Both,,,90,116,98.6,33.2456,116,BlueCross BlueShield Minnesota, Federal Employee Program,114.144,98.4,,percent of total billed charges,,
"Anca Panel For Vasculitis, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Both,,,90,116,98.6,33.2456,116,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,116,100,,percent of total billed charges,,
"Anca Panel For Vasculitis, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Both,,,90,116,98.6,33.2456,116,BlueCross BlueShield Minnesota,High Value Network Plan,104.4,90,,percent of total billed charges,,
"Anca Panel For Vasculitis, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Outpatient,,,90,116,98.6,33.2456,116,BlueCross BlueShield Minnesota,Medicare Advantage,56.84,49,,percent of total billed charges,,
"Anca Panel For Vasculitis, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Inpatient,,,90,116,98.6,33.2456,116,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Anca Panel For Vasculitis, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Both,,,90,116,98.6,33.2456,116,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,102.7412,88.57,,percent of total billed charges,,
"Anca Panel For Vasculitis, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Both,,,90,116,98.6,33.2456,116,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,33.2456,28.66,,percent of total billed charges,,
"Anca Panel For Vasculitis, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Outpatient,,,90,116,98.6,33.2456,116,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),56.84,49,,percent of total billed charges,,
"Anca Panel For Vasculitis, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Inpatient,,,90,116,98.6,33.2456,116,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Anca Panel For Vasculitis, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Both,,,90,116,98.6,33.2456,116,CorVel,Worker's Compensation,116,100,,percent of total billed charges,,
"Anca Panel For Vasculitis, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Both,,,90,116,98.6,33.2456,116,First Health Group Corporation,First Health Network,112.52,97,,percent of total billed charges,,
"Anca Panel For Vasculitis, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Both,,,90,116,98.6,33.2456,116,"Health Partners, Inc.",Commercial,109.736,94.6,,percent of total billed charges,,
"Anca Panel For Vasculitis, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Outpatient,,,90,116,98.6,33.2456,116,"Health Partners, Inc.",Medicare Advantage,56.84,49,,percent of total billed charges,,
"Anca Panel For Vasculitis, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Inpatient,,,90,116,98.6,33.2456,116,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Anca Panel For Vasculitis, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Both,,,90,116,98.6,33.2456,116,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),69.6,60,,percent of total billed charges,,
"Anca Panel For Vasculitis, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Both,,,90,116,98.6,33.2456,116,"Health Partners, Inc.",State of Minnesota Advantage Program,94.54,81.5,,percent of total billed charges,,
"Anca Panel For Vasculitis, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Both,,,90,116,98.6,33.2456,116,"Health Partners, Inc.",State Public Programs,58,50,,percent of total billed charges,,
"Anca Panel For Vasculitis, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Both,,,90,116,98.6,33.2456,116,Humana Insurance Company,Commercial PPO,110.2,95,,percent of total billed charges,,
"Anca Panel For Vasculitis, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Outpatient,,,90,116,98.6,33.2456,116,Humana Insurance Company,Medicare PPO,56.84,49,,percent of total billed charges,,
"Anca Panel For Vasculitis, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Inpatient,,,90,116,98.6,33.2456,116,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Anca Panel For Vasculitis, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Both,,,90,116,98.6,33.2456,116,Medica,Individual & Family,114.956,99.1,,percent of total billed charges,,
"Anca Panel For Vasculitis, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Outpatient,,,90,116,98.6,33.2456,116,Medica,Medica Advantage Solution,57.768,49.8,,percent of total billed charges,,
"Anca Panel For Vasculitis, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Inpatient,,,90,116,98.6,33.2456,116,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Anca Panel For Vasculitis, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Outpatient,,,90,116,98.6,33.2456,116,Medica,Medical Assistance,51.736,44.6,,percent of total billed charges,,
"Anca Panel For Vasculitis, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Inpatient,,,90,116,98.6,33.2456,116,Medica,Medical Assistance,,,,,Included in per diem rate,
"Anca Panel For Vasculitis, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Outpatient,,,90,116,98.6,33.2456,116,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,57.768,49.8,,percent of total billed charges,,
"Anca Panel For Vasculitis, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Inpatient,,,90,116,98.6,33.2456,116,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Anca Panel For Vasculitis, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Both,,,90,116,98.6,33.2456,116,"Multiplan, Inc.","Multiplan, Inc.",109.04,94,,percent of total billed charges,,
"Anca Panel For Vasculitis, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Outpatient,,,90,116,98.6,33.2456,116,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,100.224,86.4,,percent of total billed charges,,
"Anca Panel For Vasculitis, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Inpatient,,,90,116,98.6,33.2456,116,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Anca Panel For Vasculitis, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Both,,,90,116,98.6,33.2456,116,"Preferred One Administrative Services, INC.",PPO,114.376,98.6,,percent of total billed charges,,
"Anca Panel For Vasculitis, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Outpatient,,,90,116,98.6,33.2456,116,PrimeWest Health,Minnesota Senior Health Options (MSHO),59.682,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Anca Panel For Vasculitis, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Inpatient,,,90,116,98.6,33.2456,116,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Anca Panel For Vasculitis, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Outpatient,,,90,116,98.6,33.2456,116,PrimeWest Health,MinnesotaCare,59.5776,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Anca Panel For Vasculitis, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Inpatient,,,90,116,98.6,33.2456,116,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Anca Panel For Vasculitis, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Both,,,90,116,98.6,33.2456,116,Sanford Health Plan,Sanford Health Plan,106.72,92,,percent of total billed charges,,
"Anca Panel For Vasculitis, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Outpatient,,,90,116,98.6,33.2456,116,"UCare Health, Inc.",Individual & Family Plan,65.366,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Anca Panel For Vasculitis, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Inpatient,,,90,116,98.6,33.2456,116,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Anca Panel For Vasculitis, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Outpatient,,,90,116,98.6,33.2456,116,"UCare Health, Inc.",Medical Assistance,58.5452,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Anca Panel For Vasculitis, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Inpatient,,,90,116,98.6,33.2456,116,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Anca Panel For Vasculitis, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Outpatient,,,90,116,98.6,33.2456,116,"UCare Health, Inc.",Medicare Advantage,58.5452,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Anca Panel For Vasculitis, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Inpatient,,,90,116,98.6,33.2456,116,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Anca Panel For Vasculitis, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Outpatient,,,90,116,98.6,33.2456,116,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),58.5452,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Anca Panel For Vasculitis, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Inpatient,,,90,116,98.6,33.2456,116,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Anca Panel For Vasculitis, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Both,,,90,116,98.6,33.2456,116,UnitedHealthcare,Individual & Family,109.04,94,,percent of total billed charges,,
"Anca Panel For Vasculitis, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Outpatient,,,90,116,98.6,33.2456,116,UnitedHealthcare,Medicare Advantage,56.84,49,,percent of total billed charges,,
"Anca Panel For Vasculitis, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Inpatient,,,90,116,98.6,33.2456,116,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Anca Panel For Vasculitis, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Outpatient,,,90,116,98.6,33.2456,116,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,55.68,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Anca Panel For Vasculitis, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Inpatient,,,90,116,98.6,33.2456,116,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Centromere Ab, Igg, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Both,,,90,133,113.05,38.1178,133,Aetna,Commercial,122.36,92,,percent of total billed charges,,
"Centromere Ab, Igg, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Outpatient,,,90,133,113.05,38.1178,133,Aetna,Medicare Advantage,65.17,49,,percent of total billed charges,,
"Centromere Ab, Igg, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Inpatient,,,90,133,113.05,38.1178,133,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Centromere Ab, Igg, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Both,,,90,133,113.05,38.1178,133,Aetna,PPO,123.69,93,,percent of total billed charges,,
"Centromere Ab, Igg, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Both,,,90,133,113.05,38.1178,133,America's PPO,America's PPO,127.7199,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Centromere Ab, Igg, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Both,,,90,133,113.05,38.1178,133,BlueCross BlueShield Minnesota, Federal Employee Program,130.872,98.4,,percent of total billed charges,,
"Centromere Ab, Igg, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Both,,,90,133,113.05,38.1178,133,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,133,100,,percent of total billed charges,,
"Centromere Ab, Igg, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Both,,,90,133,113.05,38.1178,133,BlueCross BlueShield Minnesota,High Value Network Plan,119.7,90,,percent of total billed charges,,
"Centromere Ab, Igg, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Outpatient,,,90,133,113.05,38.1178,133,BlueCross BlueShield Minnesota,Medicare Advantage,65.17,49,,percent of total billed charges,,
"Centromere Ab, Igg, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Inpatient,,,90,133,113.05,38.1178,133,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Centromere Ab, Igg, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Both,,,90,133,113.05,38.1178,133,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,117.7981,88.57,,percent of total billed charges,,
"Centromere Ab, Igg, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Both,,,90,133,113.05,38.1178,133,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,38.1178,28.66,,percent of total billed charges,,
"Centromere Ab, Igg, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Outpatient,,,90,133,113.05,38.1178,133,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),65.17,49,,percent of total billed charges,,
"Centromere Ab, Igg, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Inpatient,,,90,133,113.05,38.1178,133,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Centromere Ab, Igg, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Both,,,90,133,113.05,38.1178,133,CorVel,Worker's Compensation,133,100,,percent of total billed charges,,
"Centromere Ab, Igg, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Both,,,90,133,113.05,38.1178,133,First Health Group Corporation,First Health Network,129.01,97,,percent of total billed charges,,
"Centromere Ab, Igg, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Both,,,90,133,113.05,38.1178,133,"Health Partners, Inc.",Commercial,125.818,94.6,,percent of total billed charges,,
"Centromere Ab, Igg, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Outpatient,,,90,133,113.05,38.1178,133,"Health Partners, Inc.",Medicare Advantage,65.17,49,,percent of total billed charges,,
"Centromere Ab, Igg, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Inpatient,,,90,133,113.05,38.1178,133,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Centromere Ab, Igg, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Both,,,90,133,113.05,38.1178,133,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),79.8,60,,percent of total billed charges,,
"Centromere Ab, Igg, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Both,,,90,133,113.05,38.1178,133,"Health Partners, Inc.",State of Minnesota Advantage Program,108.395,81.5,,percent of total billed charges,,
"Centromere Ab, Igg, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Both,,,90,133,113.05,38.1178,133,"Health Partners, Inc.",State Public Programs,66.5,50,,percent of total billed charges,,
"Centromere Ab, Igg, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Both,,,90,133,113.05,38.1178,133,Humana Insurance Company,Commercial PPO,126.35,95,,percent of total billed charges,,
"Centromere Ab, Igg, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Outpatient,,,90,133,113.05,38.1178,133,Humana Insurance Company,Medicare PPO,65.17,49,,percent of total billed charges,,
"Centromere Ab, Igg, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Inpatient,,,90,133,113.05,38.1178,133,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Centromere Ab, Igg, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Both,,,90,133,113.05,38.1178,133,Medica,Individual & Family,131.803,99.1,,percent of total billed charges,,
"Centromere Ab, Igg, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Outpatient,,,90,133,113.05,38.1178,133,Medica,Medica Advantage Solution,66.234,49.8,,percent of total billed charges,,
"Centromere Ab, Igg, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Inpatient,,,90,133,113.05,38.1178,133,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Centromere Ab, Igg, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Outpatient,,,90,133,113.05,38.1178,133,Medica,Medical Assistance,59.318,44.6,,percent of total billed charges,,
"Centromere Ab, Igg, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Inpatient,,,90,133,113.05,38.1178,133,Medica,Medical Assistance,,,,,Included in per diem rate,
"Centromere Ab, Igg, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Outpatient,,,90,133,113.05,38.1178,133,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,66.234,49.8,,percent of total billed charges,,
"Centromere Ab, Igg, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Inpatient,,,90,133,113.05,38.1178,133,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Centromere Ab, Igg, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Both,,,90,133,113.05,38.1178,133,"Multiplan, Inc.","Multiplan, Inc.",125.02,94,,percent of total billed charges,,
"Centromere Ab, Igg, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Outpatient,,,90,133,113.05,38.1178,133,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,114.912,86.4,,percent of total billed charges,,
"Centromere Ab, Igg, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Inpatient,,,90,133,113.05,38.1178,133,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Centromere Ab, Igg, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Both,,,90,133,113.05,38.1178,133,"Preferred One Administrative Services, INC.",PPO,131.138,98.6,,percent of total billed charges,,
"Centromere Ab, Igg, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Outpatient,,,90,133,113.05,38.1178,133,PrimeWest Health,Minnesota Senior Health Options (MSHO),68.4285,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Centromere Ab, Igg, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Inpatient,,,90,133,113.05,38.1178,133,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Centromere Ab, Igg, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Outpatient,,,90,133,113.05,38.1178,133,PrimeWest Health,MinnesotaCare,68.3088,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Centromere Ab, Igg, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Inpatient,,,90,133,113.05,38.1178,133,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Centromere Ab, Igg, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Both,,,90,133,113.05,38.1178,133,Sanford Health Plan,Sanford Health Plan,122.36,92,,percent of total billed charges,,
"Centromere Ab, Igg, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Outpatient,,,90,133,113.05,38.1178,133,"UCare Health, Inc.",Individual & Family Plan,74.9455,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Centromere Ab, Igg, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Inpatient,,,90,133,113.05,38.1178,133,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Centromere Ab, Igg, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Outpatient,,,90,133,113.05,38.1178,133,"UCare Health, Inc.",Medical Assistance,67.1251,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Centromere Ab, Igg, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Inpatient,,,90,133,113.05,38.1178,133,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Centromere Ab, Igg, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Outpatient,,,90,133,113.05,38.1178,133,"UCare Health, Inc.",Medicare Advantage,67.1251,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Centromere Ab, Igg, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Inpatient,,,90,133,113.05,38.1178,133,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Centromere Ab, Igg, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Outpatient,,,90,133,113.05,38.1178,133,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),67.1251,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Centromere Ab, Igg, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Inpatient,,,90,133,113.05,38.1178,133,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Centromere Ab, Igg, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Both,,,90,133,113.05,38.1178,133,UnitedHealthcare,Individual & Family,125.02,94,,percent of total billed charges,,
"Centromere Ab, Igg, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Outpatient,,,90,133,113.05,38.1178,133,UnitedHealthcare,Medicare Advantage,65.17,49,,percent of total billed charges,,
"Centromere Ab, Igg, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Inpatient,,,90,133,113.05,38.1178,133,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Centromere Ab, Igg, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Outpatient,,,90,133,113.05,38.1178,133,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,63.84,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Centromere Ab, Igg, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Inpatient,,,90,133,113.05,38.1178,133,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Glomerular Basement Membrane Igg Ab (Mayo)OutsideLaboratory,,83516,CPT,Facility,Both,,,90,106,90.1,30.3796,106,Aetna,Commercial,97.52,92,,percent of total billed charges,,
Glomerular Basement Membrane Igg Ab (Mayo)OutsideLaboratory,,83516,CPT,Facility,Outpatient,,,90,106,90.1,30.3796,106,Aetna,Medicare Advantage,51.94,49,,percent of total billed charges,,
Glomerular Basement Membrane Igg Ab (Mayo)OutsideLaboratory,,83516,CPT,Facility,Inpatient,,,90,106,90.1,30.3796,106,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Glomerular Basement Membrane Igg Ab (Mayo)OutsideLaboratory,,83516,CPT,Facility,Both,,,90,106,90.1,30.3796,106,Aetna,PPO,98.58,93,,percent of total billed charges,,
Glomerular Basement Membrane Igg Ab (Mayo)OutsideLaboratory,,83516,CPT,Facility,Both,,,90,106,90.1,30.3796,106,America's PPO,America's PPO,101.7918,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Glomerular Basement Membrane Igg Ab (Mayo)OutsideLaboratory,,83516,CPT,Facility,Both,,,90,106,90.1,30.3796,106,BlueCross BlueShield Minnesota, Federal Employee Program,104.304,98.4,,percent of total billed charges,,
Glomerular Basement Membrane Igg Ab (Mayo)OutsideLaboratory,,83516,CPT,Facility,Both,,,90,106,90.1,30.3796,106,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,106,100,,percent of total billed charges,,
Glomerular Basement Membrane Igg Ab (Mayo)OutsideLaboratory,,83516,CPT,Facility,Both,,,90,106,90.1,30.3796,106,BlueCross BlueShield Minnesota,High Value Network Plan,95.4,90,,percent of total billed charges,,
Glomerular Basement Membrane Igg Ab (Mayo)OutsideLaboratory,,83516,CPT,Facility,Outpatient,,,90,106,90.1,30.3796,106,BlueCross BlueShield Minnesota,Medicare Advantage,51.94,49,,percent of total billed charges,,
Glomerular Basement Membrane Igg Ab (Mayo)OutsideLaboratory,,83516,CPT,Facility,Inpatient,,,90,106,90.1,30.3796,106,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Glomerular Basement Membrane Igg Ab (Mayo)OutsideLaboratory,,83516,CPT,Facility,Both,,,90,106,90.1,30.3796,106,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,93.8842,88.57,,percent of total billed charges,,
Glomerular Basement Membrane Igg Ab (Mayo)OutsideLaboratory,,83516,CPT,Facility,Both,,,90,106,90.1,30.3796,106,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,30.3796,28.66,,percent of total billed charges,,
Glomerular Basement Membrane Igg Ab (Mayo)OutsideLaboratory,,83516,CPT,Facility,Outpatient,,,90,106,90.1,30.3796,106,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),51.94,49,,percent of total billed charges,,
Glomerular Basement Membrane Igg Ab (Mayo)OutsideLaboratory,,83516,CPT,Facility,Inpatient,,,90,106,90.1,30.3796,106,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Glomerular Basement Membrane Igg Ab (Mayo)OutsideLaboratory,,83516,CPT,Facility,Both,,,90,106,90.1,30.3796,106,CorVel,Worker's Compensation,106,100,,percent of total billed charges,,
Glomerular Basement Membrane Igg Ab (Mayo)OutsideLaboratory,,83516,CPT,Facility,Both,,,90,106,90.1,30.3796,106,First Health Group Corporation,First Health Network,102.82,97,,percent of total billed charges,,
Glomerular Basement Membrane Igg Ab (Mayo)OutsideLaboratory,,83516,CPT,Facility,Both,,,90,106,90.1,30.3796,106,"Health Partners, Inc.",Commercial,100.276,94.6,,percent of total billed charges,,
Glomerular Basement Membrane Igg Ab (Mayo)OutsideLaboratory,,83516,CPT,Facility,Outpatient,,,90,106,90.1,30.3796,106,"Health Partners, Inc.",Medicare Advantage,51.94,49,,percent of total billed charges,,
Glomerular Basement Membrane Igg Ab (Mayo)OutsideLaboratory,,83516,CPT,Facility,Inpatient,,,90,106,90.1,30.3796,106,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Glomerular Basement Membrane Igg Ab (Mayo)OutsideLaboratory,,83516,CPT,Facility,Both,,,90,106,90.1,30.3796,106,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),63.6,60,,percent of total billed charges,,
Glomerular Basement Membrane Igg Ab (Mayo)OutsideLaboratory,,83516,CPT,Facility,Both,,,90,106,90.1,30.3796,106,"Health Partners, Inc.",State of Minnesota Advantage Program,86.39,81.5,,percent of total billed charges,,
Glomerular Basement Membrane Igg Ab (Mayo)OutsideLaboratory,,83516,CPT,Facility,Both,,,90,106,90.1,30.3796,106,"Health Partners, Inc.",State Public Programs,53,50,,percent of total billed charges,,
Glomerular Basement Membrane Igg Ab (Mayo)OutsideLaboratory,,83516,CPT,Facility,Both,,,90,106,90.1,30.3796,106,Humana Insurance Company,Commercial PPO,100.7,95,,percent of total billed charges,,
Glomerular Basement Membrane Igg Ab (Mayo)OutsideLaboratory,,83516,CPT,Facility,Outpatient,,,90,106,90.1,30.3796,106,Humana Insurance Company,Medicare PPO,51.94,49,,percent of total billed charges,,
Glomerular Basement Membrane Igg Ab (Mayo)OutsideLaboratory,,83516,CPT,Facility,Inpatient,,,90,106,90.1,30.3796,106,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Glomerular Basement Membrane Igg Ab (Mayo)OutsideLaboratory,,83516,CPT,Facility,Both,,,90,106,90.1,30.3796,106,Medica,Individual & Family,105.046,99.1,,percent of total billed charges,,
Glomerular Basement Membrane Igg Ab (Mayo)OutsideLaboratory,,83516,CPT,Facility,Outpatient,,,90,106,90.1,30.3796,106,Medica,Medica Advantage Solution,52.788,49.8,,percent of total billed charges,,
Glomerular Basement Membrane Igg Ab (Mayo)OutsideLaboratory,,83516,CPT,Facility,Inpatient,,,90,106,90.1,30.3796,106,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Glomerular Basement Membrane Igg Ab (Mayo)OutsideLaboratory,,83516,CPT,Facility,Outpatient,,,90,106,90.1,30.3796,106,Medica,Medical Assistance,47.276,44.6,,percent of total billed charges,,
Glomerular Basement Membrane Igg Ab (Mayo)OutsideLaboratory,,83516,CPT,Facility,Inpatient,,,90,106,90.1,30.3796,106,Medica,Medical Assistance,,,,,Included in per diem rate,
Glomerular Basement Membrane Igg Ab (Mayo)OutsideLaboratory,,83516,CPT,Facility,Outpatient,,,90,106,90.1,30.3796,106,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,52.788,49.8,,percent of total billed charges,,
Glomerular Basement Membrane Igg Ab (Mayo)OutsideLaboratory,,83516,CPT,Facility,Inpatient,,,90,106,90.1,30.3796,106,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Glomerular Basement Membrane Igg Ab (Mayo)OutsideLaboratory,,83516,CPT,Facility,Both,,,90,106,90.1,30.3796,106,"Multiplan, Inc.","Multiplan, Inc.",99.64,94,,percent of total billed charges,,
Glomerular Basement Membrane Igg Ab (Mayo)OutsideLaboratory,,83516,CPT,Facility,Outpatient,,,90,106,90.1,30.3796,106,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,91.584,86.4,,percent of total billed charges,,
Glomerular Basement Membrane Igg Ab (Mayo)OutsideLaboratory,,83516,CPT,Facility,Inpatient,,,90,106,90.1,30.3796,106,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Glomerular Basement Membrane Igg Ab (Mayo)OutsideLaboratory,,83516,CPT,Facility,Both,,,90,106,90.1,30.3796,106,"Preferred One Administrative Services, INC.",PPO,104.516,98.6,,percent of total billed charges,,
Glomerular Basement Membrane Igg Ab (Mayo)OutsideLaboratory,,83516,CPT,Facility,Outpatient,,,90,106,90.1,30.3796,106,PrimeWest Health,Minnesota Senior Health Options (MSHO),54.537,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Glomerular Basement Membrane Igg Ab (Mayo)OutsideLaboratory,,83516,CPT,Facility,Inpatient,,,90,106,90.1,30.3796,106,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Glomerular Basement Membrane Igg Ab (Mayo)OutsideLaboratory,,83516,CPT,Facility,Outpatient,,,90,106,90.1,30.3796,106,PrimeWest Health,MinnesotaCare,54.4416,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Glomerular Basement Membrane Igg Ab (Mayo)OutsideLaboratory,,83516,CPT,Facility,Inpatient,,,90,106,90.1,30.3796,106,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Glomerular Basement Membrane Igg Ab (Mayo)OutsideLaboratory,,83516,CPT,Facility,Both,,,90,106,90.1,30.3796,106,Sanford Health Plan,Sanford Health Plan,97.52,92,,percent of total billed charges,,
Glomerular Basement Membrane Igg Ab (Mayo)OutsideLaboratory,,83516,CPT,Facility,Outpatient,,,90,106,90.1,30.3796,106,"UCare Health, Inc.",Individual & Family Plan,59.731,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Glomerular Basement Membrane Igg Ab (Mayo)OutsideLaboratory,,83516,CPT,Facility,Inpatient,,,90,106,90.1,30.3796,106,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Glomerular Basement Membrane Igg Ab (Mayo)OutsideLaboratory,,83516,CPT,Facility,Outpatient,,,90,106,90.1,30.3796,106,"UCare Health, Inc.",Medical Assistance,53.4982,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Glomerular Basement Membrane Igg Ab (Mayo)OutsideLaboratory,,83516,CPT,Facility,Inpatient,,,90,106,90.1,30.3796,106,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Glomerular Basement Membrane Igg Ab (Mayo)OutsideLaboratory,,83516,CPT,Facility,Outpatient,,,90,106,90.1,30.3796,106,"UCare Health, Inc.",Medicare Advantage,53.4982,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Glomerular Basement Membrane Igg Ab (Mayo)OutsideLaboratory,,83516,CPT,Facility,Inpatient,,,90,106,90.1,30.3796,106,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Glomerular Basement Membrane Igg Ab (Mayo)OutsideLaboratory,,83516,CPT,Facility,Outpatient,,,90,106,90.1,30.3796,106,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),53.4982,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Glomerular Basement Membrane Igg Ab (Mayo)OutsideLaboratory,,83516,CPT,Facility,Inpatient,,,90,106,90.1,30.3796,106,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Glomerular Basement Membrane Igg Ab (Mayo)OutsideLaboratory,,83516,CPT,Facility,Both,,,90,106,90.1,30.3796,106,UnitedHealthcare,Individual & Family,99.64,94,,percent of total billed charges,,
Glomerular Basement Membrane Igg Ab (Mayo)OutsideLaboratory,,83516,CPT,Facility,Outpatient,,,90,106,90.1,30.3796,106,UnitedHealthcare,Medicare Advantage,51.94,49,,percent of total billed charges,,
Glomerular Basement Membrane Igg Ab (Mayo)OutsideLaboratory,,83516,CPT,Facility,Inpatient,,,90,106,90.1,30.3796,106,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Glomerular Basement Membrane Igg Ab (Mayo)OutsideLaboratory,,83516,CPT,Facility,Outpatient,,,90,106,90.1,30.3796,106,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,50.88,48,,percent of total billed charges,,100% of DHS outpatient percentage
Glomerular Basement Membrane Igg Ab (Mayo)OutsideLaboratory,,83516,CPT,Facility,Inpatient,,,90,106,90.1,30.3796,106,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Histone Autoantibodies, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Both,,,90,164,139.4,47.0024,164,Aetna,Commercial,150.88,92,,percent of total billed charges,,
"Histone Autoantibodies, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Outpatient,,,90,164,139.4,47.0024,164,Aetna,Medicare Advantage,80.36,49,,percent of total billed charges,,
"Histone Autoantibodies, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Inpatient,,,90,164,139.4,47.0024,164,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Histone Autoantibodies, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Both,,,90,164,139.4,47.0024,164,Aetna,PPO,152.52,93,,percent of total billed charges,,
"Histone Autoantibodies, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Both,,,90,164,139.4,47.0024,164,America's PPO,America's PPO,157.4892,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Histone Autoantibodies, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Both,,,90,164,139.4,47.0024,164,BlueCross BlueShield Minnesota, Federal Employee Program,161.376,98.4,,percent of total billed charges,,
"Histone Autoantibodies, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Both,,,90,164,139.4,47.0024,164,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,164,100,,percent of total billed charges,,
"Histone Autoantibodies, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Both,,,90,164,139.4,47.0024,164,BlueCross BlueShield Minnesota,High Value Network Plan,147.6,90,,percent of total billed charges,,
"Histone Autoantibodies, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Outpatient,,,90,164,139.4,47.0024,164,BlueCross BlueShield Minnesota,Medicare Advantage,80.36,49,,percent of total billed charges,,
"Histone Autoantibodies, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Inpatient,,,90,164,139.4,47.0024,164,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Histone Autoantibodies, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Both,,,90,164,139.4,47.0024,164,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,145.2548,88.57,,percent of total billed charges,,
"Histone Autoantibodies, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Both,,,90,164,139.4,47.0024,164,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,47.0024,28.66,,percent of total billed charges,,
"Histone Autoantibodies, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Outpatient,,,90,164,139.4,47.0024,164,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),80.36,49,,percent of total billed charges,,
"Histone Autoantibodies, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Inpatient,,,90,164,139.4,47.0024,164,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Histone Autoantibodies, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Both,,,90,164,139.4,47.0024,164,CorVel,Worker's Compensation,164,100,,percent of total billed charges,,
"Histone Autoantibodies, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Both,,,90,164,139.4,47.0024,164,First Health Group Corporation,First Health Network,159.08,97,,percent of total billed charges,,
"Histone Autoantibodies, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Both,,,90,164,139.4,47.0024,164,"Health Partners, Inc.",Commercial,155.144,94.6,,percent of total billed charges,,
"Histone Autoantibodies, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Outpatient,,,90,164,139.4,47.0024,164,"Health Partners, Inc.",Medicare Advantage,80.36,49,,percent of total billed charges,,
"Histone Autoantibodies, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Inpatient,,,90,164,139.4,47.0024,164,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Histone Autoantibodies, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Both,,,90,164,139.4,47.0024,164,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),98.4,60,,percent of total billed charges,,
"Histone Autoantibodies, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Both,,,90,164,139.4,47.0024,164,"Health Partners, Inc.",State of Minnesota Advantage Program,133.66,81.5,,percent of total billed charges,,
"Histone Autoantibodies, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Both,,,90,164,139.4,47.0024,164,"Health Partners, Inc.",State Public Programs,82,50,,percent of total billed charges,,
"Histone Autoantibodies, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Both,,,90,164,139.4,47.0024,164,Humana Insurance Company,Commercial PPO,155.8,95,,percent of total billed charges,,
"Histone Autoantibodies, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Outpatient,,,90,164,139.4,47.0024,164,Humana Insurance Company,Medicare PPO,80.36,49,,percent of total billed charges,,
"Histone Autoantibodies, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Inpatient,,,90,164,139.4,47.0024,164,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Histone Autoantibodies, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Both,,,90,164,139.4,47.0024,164,Medica,Individual & Family,162.524,99.1,,percent of total billed charges,,
"Histone Autoantibodies, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Outpatient,,,90,164,139.4,47.0024,164,Medica,Medica Advantage Solution,81.672,49.8,,percent of total billed charges,,
"Histone Autoantibodies, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Inpatient,,,90,164,139.4,47.0024,164,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Histone Autoantibodies, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Outpatient,,,90,164,139.4,47.0024,164,Medica,Medical Assistance,73.144,44.6,,percent of total billed charges,,
"Histone Autoantibodies, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Inpatient,,,90,164,139.4,47.0024,164,Medica,Medical Assistance,,,,,Included in per diem rate,
"Histone Autoantibodies, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Outpatient,,,90,164,139.4,47.0024,164,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,81.672,49.8,,percent of total billed charges,,
"Histone Autoantibodies, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Inpatient,,,90,164,139.4,47.0024,164,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Histone Autoantibodies, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Both,,,90,164,139.4,47.0024,164,"Multiplan, Inc.","Multiplan, Inc.",154.16,94,,percent of total billed charges,,
"Histone Autoantibodies, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Outpatient,,,90,164,139.4,47.0024,164,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,141.696,86.4,,percent of total billed charges,,
"Histone Autoantibodies, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Inpatient,,,90,164,139.4,47.0024,164,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Histone Autoantibodies, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Both,,,90,164,139.4,47.0024,164,"Preferred One Administrative Services, INC.",PPO,161.704,98.6,,percent of total billed charges,,
"Histone Autoantibodies, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Outpatient,,,90,164,139.4,47.0024,164,PrimeWest Health,Minnesota Senior Health Options (MSHO),84.378,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Histone Autoantibodies, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Inpatient,,,90,164,139.4,47.0024,164,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Histone Autoantibodies, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Outpatient,,,90,164,139.4,47.0024,164,PrimeWest Health,MinnesotaCare,84.2304,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Histone Autoantibodies, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Inpatient,,,90,164,139.4,47.0024,164,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Histone Autoantibodies, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Both,,,90,164,139.4,47.0024,164,Sanford Health Plan,Sanford Health Plan,150.88,92,,percent of total billed charges,,
"Histone Autoantibodies, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Outpatient,,,90,164,139.4,47.0024,164,"UCare Health, Inc.",Individual & Family Plan,92.414,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Histone Autoantibodies, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Inpatient,,,90,164,139.4,47.0024,164,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Histone Autoantibodies, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Outpatient,,,90,164,139.4,47.0024,164,"UCare Health, Inc.",Medical Assistance,82.7708,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Histone Autoantibodies, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Inpatient,,,90,164,139.4,47.0024,164,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Histone Autoantibodies, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Outpatient,,,90,164,139.4,47.0024,164,"UCare Health, Inc.",Medicare Advantage,82.7708,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Histone Autoantibodies, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Inpatient,,,90,164,139.4,47.0024,164,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Histone Autoantibodies, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Outpatient,,,90,164,139.4,47.0024,164,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),82.7708,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Histone Autoantibodies, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Inpatient,,,90,164,139.4,47.0024,164,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Histone Autoantibodies, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Both,,,90,164,139.4,47.0024,164,UnitedHealthcare,Individual & Family,154.16,94,,percent of total billed charges,,
"Histone Autoantibodies, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Outpatient,,,90,164,139.4,47.0024,164,UnitedHealthcare,Medicare Advantage,80.36,49,,percent of total billed charges,,
"Histone Autoantibodies, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Inpatient,,,90,164,139.4,47.0024,164,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Histone Autoantibodies, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Outpatient,,,90,164,139.4,47.0024,164,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,78.72,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Histone Autoantibodies, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Inpatient,,,90,164,139.4,47.0024,164,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Immunoassay (Mdh)OutsideLaboratory,,83516,CPT,Facility,Both,,,90,49,41.65,14.0434,49,Aetna,Commercial,45.08,92,,percent of total billed charges,,
Immunoassay (Mdh)OutsideLaboratory,,83516,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,Aetna,Medicare Advantage,24.01,49,,percent of total billed charges,,
Immunoassay (Mdh)OutsideLaboratory,,83516,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Immunoassay (Mdh)OutsideLaboratory,,83516,CPT,Facility,Both,,,90,49,41.65,14.0434,49,Aetna,PPO,45.57,93,,percent of total billed charges,,
Immunoassay (Mdh)OutsideLaboratory,,83516,CPT,Facility,Both,,,90,49,41.65,14.0434,49,America's PPO,America's PPO,47.0547,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Immunoassay (Mdh)OutsideLaboratory,,83516,CPT,Facility,Both,,,90,49,41.65,14.0434,49,BlueCross BlueShield Minnesota, Federal Employee Program,48.216,98.4,,percent of total billed charges,,
Immunoassay (Mdh)OutsideLaboratory,,83516,CPT,Facility,Both,,,90,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,49,100,,percent of total billed charges,,
Immunoassay (Mdh)OutsideLaboratory,,83516,CPT,Facility,Both,,,90,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,High Value Network Plan,44.1,90,,percent of total billed charges,,
Immunoassay (Mdh)OutsideLaboratory,,83516,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Medicare Advantage,24.01,49,,percent of total billed charges,,
Immunoassay (Mdh)OutsideLaboratory,,83516,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Immunoassay (Mdh)OutsideLaboratory,,83516,CPT,Facility,Both,,,90,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,43.3993,88.57,,percent of total billed charges,,
Immunoassay (Mdh)OutsideLaboratory,,83516,CPT,Facility,Both,,,90,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,14.0434,28.66,,percent of total billed charges,,
Immunoassay (Mdh)OutsideLaboratory,,83516,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),24.01,49,,percent of total billed charges,,
Immunoassay (Mdh)OutsideLaboratory,,83516,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Immunoassay (Mdh)OutsideLaboratory,,83516,CPT,Facility,Both,,,90,49,41.65,14.0434,49,CorVel,Worker's Compensation,49,100,,percent of total billed charges,,
Immunoassay (Mdh)OutsideLaboratory,,83516,CPT,Facility,Both,,,90,49,41.65,14.0434,49,First Health Group Corporation,First Health Network,47.53,97,,percent of total billed charges,,
Immunoassay (Mdh)OutsideLaboratory,,83516,CPT,Facility,Both,,,90,49,41.65,14.0434,49,"Health Partners, Inc.",Commercial,46.354,94.6,,percent of total billed charges,,
Immunoassay (Mdh)OutsideLaboratory,,83516,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,"Health Partners, Inc.",Medicare Advantage,24.01,49,,percent of total billed charges,,
Immunoassay (Mdh)OutsideLaboratory,,83516,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Immunoassay (Mdh)OutsideLaboratory,,83516,CPT,Facility,Both,,,90,49,41.65,14.0434,49,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),29.4,60,,percent of total billed charges,,
Immunoassay (Mdh)OutsideLaboratory,,83516,CPT,Facility,Both,,,90,49,41.65,14.0434,49,"Health Partners, Inc.",State of Minnesota Advantage Program,39.935,81.5,,percent of total billed charges,,
Immunoassay (Mdh)OutsideLaboratory,,83516,CPT,Facility,Both,,,90,49,41.65,14.0434,49,"Health Partners, Inc.",State Public Programs,24.5,50,,percent of total billed charges,,
Immunoassay (Mdh)OutsideLaboratory,,83516,CPT,Facility,Both,,,90,49,41.65,14.0434,49,Humana Insurance Company,Commercial PPO,46.55,95,,percent of total billed charges,,
Immunoassay (Mdh)OutsideLaboratory,,83516,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,Humana Insurance Company,Medicare PPO,24.01,49,,percent of total billed charges,,
Immunoassay (Mdh)OutsideLaboratory,,83516,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Immunoassay (Mdh)OutsideLaboratory,,83516,CPT,Facility,Both,,,90,49,41.65,14.0434,49,Medica,Individual & Family,48.559,99.1,,percent of total billed charges,,
Immunoassay (Mdh)OutsideLaboratory,,83516,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,Medica,Medica Advantage Solution,24.402,49.8,,percent of total billed charges,,
Immunoassay (Mdh)OutsideLaboratory,,83516,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Immunoassay (Mdh)OutsideLaboratory,,83516,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,Medica,Medical Assistance,21.854,44.6,,percent of total billed charges,,
Immunoassay (Mdh)OutsideLaboratory,,83516,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,Medica,Medical Assistance,,,,,Included in per diem rate,
Immunoassay (Mdh)OutsideLaboratory,,83516,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,24.402,49.8,,percent of total billed charges,,
Immunoassay (Mdh)OutsideLaboratory,,83516,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Immunoassay (Mdh)OutsideLaboratory,,83516,CPT,Facility,Both,,,90,49,41.65,14.0434,49,"Multiplan, Inc.","Multiplan, Inc.",46.06,94,,percent of total billed charges,,
Immunoassay (Mdh)OutsideLaboratory,,83516,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,42.336,86.4,,percent of total billed charges,,
Immunoassay (Mdh)OutsideLaboratory,,83516,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Immunoassay (Mdh)OutsideLaboratory,,83516,CPT,Facility,Both,,,90,49,41.65,14.0434,49,"Preferred One Administrative Services, INC.",PPO,48.314,98.6,,percent of total billed charges,,
Immunoassay (Mdh)OutsideLaboratory,,83516,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,PrimeWest Health,Minnesota Senior Health Options (MSHO),25.2105,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Immunoassay (Mdh)OutsideLaboratory,,83516,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Immunoassay (Mdh)OutsideLaboratory,,83516,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,PrimeWest Health,MinnesotaCare,25.1664,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Immunoassay (Mdh)OutsideLaboratory,,83516,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Immunoassay (Mdh)OutsideLaboratory,,83516,CPT,Facility,Both,,,90,49,41.65,14.0434,49,Sanford Health Plan,Sanford Health Plan,45.08,92,,percent of total billed charges,,
Immunoassay (Mdh)OutsideLaboratory,,83516,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,"UCare Health, Inc.",Individual & Family Plan,27.6115,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Immunoassay (Mdh)OutsideLaboratory,,83516,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Immunoassay (Mdh)OutsideLaboratory,,83516,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,"UCare Health, Inc.",Medical Assistance,24.7303,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Immunoassay (Mdh)OutsideLaboratory,,83516,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Immunoassay (Mdh)OutsideLaboratory,,83516,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,"UCare Health, Inc.",Medicare Advantage,24.7303,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Immunoassay (Mdh)OutsideLaboratory,,83516,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Immunoassay (Mdh)OutsideLaboratory,,83516,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),24.7303,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Immunoassay (Mdh)OutsideLaboratory,,83516,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Immunoassay (Mdh)OutsideLaboratory,,83516,CPT,Facility,Both,,,90,49,41.65,14.0434,49,UnitedHealthcare,Individual & Family,46.06,94,,percent of total billed charges,,
Immunoassay (Mdh)OutsideLaboratory,,83516,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,UnitedHealthcare,Medicare Advantage,24.01,49,,percent of total billed charges,,
Immunoassay (Mdh)OutsideLaboratory,,83516,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Immunoassay (Mdh)OutsideLaboratory,,83516,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,23.52,48,,percent of total billed charges,,100% of DHS outpatient percentage
Immunoassay (Mdh)OutsideLaboratory,,83516,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Immunoassay Qual For Cf (Mayo)OutsideLaboratory,,83516,CPT,Facility,Both,,,90,49,41.65,14.0434,49,Aetna,Commercial,45.08,92,,percent of total billed charges,,
Immunoassay Qual For Cf (Mayo)OutsideLaboratory,,83516,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,Aetna,Medicare Advantage,24.01,49,,percent of total billed charges,,
Immunoassay Qual For Cf (Mayo)OutsideLaboratory,,83516,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Immunoassay Qual For Cf (Mayo)OutsideLaboratory,,83516,CPT,Facility,Both,,,90,49,41.65,14.0434,49,Aetna,PPO,45.57,93,,percent of total billed charges,,
Immunoassay Qual For Cf (Mayo)OutsideLaboratory,,83516,CPT,Facility,Both,,,90,49,41.65,14.0434,49,America's PPO,America's PPO,47.0547,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Immunoassay Qual For Cf (Mayo)OutsideLaboratory,,83516,CPT,Facility,Both,,,90,49,41.65,14.0434,49,BlueCross BlueShield Minnesota, Federal Employee Program,48.216,98.4,,percent of total billed charges,,
Immunoassay Qual For Cf (Mayo)OutsideLaboratory,,83516,CPT,Facility,Both,,,90,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,49,100,,percent of total billed charges,,
Immunoassay Qual For Cf (Mayo)OutsideLaboratory,,83516,CPT,Facility,Both,,,90,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,High Value Network Plan,44.1,90,,percent of total billed charges,,
Immunoassay Qual For Cf (Mayo)OutsideLaboratory,,83516,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Medicare Advantage,24.01,49,,percent of total billed charges,,
Immunoassay Qual For Cf (Mayo)OutsideLaboratory,,83516,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Immunoassay Qual For Cf (Mayo)OutsideLaboratory,,83516,CPT,Facility,Both,,,90,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,43.3993,88.57,,percent of total billed charges,,
Immunoassay Qual For Cf (Mayo)OutsideLaboratory,,83516,CPT,Facility,Both,,,90,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,14.0434,28.66,,percent of total billed charges,,
Immunoassay Qual For Cf (Mayo)OutsideLaboratory,,83516,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),24.01,49,,percent of total billed charges,,
Immunoassay Qual For Cf (Mayo)OutsideLaboratory,,83516,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Immunoassay Qual For Cf (Mayo)OutsideLaboratory,,83516,CPT,Facility,Both,,,90,49,41.65,14.0434,49,CorVel,Worker's Compensation,49,100,,percent of total billed charges,,
Immunoassay Qual For Cf (Mayo)OutsideLaboratory,,83516,CPT,Facility,Both,,,90,49,41.65,14.0434,49,First Health Group Corporation,First Health Network,47.53,97,,percent of total billed charges,,
Immunoassay Qual For Cf (Mayo)OutsideLaboratory,,83516,CPT,Facility,Both,,,90,49,41.65,14.0434,49,"Health Partners, Inc.",Commercial,46.354,94.6,,percent of total billed charges,,
Immunoassay Qual For Cf (Mayo)OutsideLaboratory,,83516,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,"Health Partners, Inc.",Medicare Advantage,24.01,49,,percent of total billed charges,,
Immunoassay Qual For Cf (Mayo)OutsideLaboratory,,83516,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Immunoassay Qual For Cf (Mayo)OutsideLaboratory,,83516,CPT,Facility,Both,,,90,49,41.65,14.0434,49,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),29.4,60,,percent of total billed charges,,
Immunoassay Qual For Cf (Mayo)OutsideLaboratory,,83516,CPT,Facility,Both,,,90,49,41.65,14.0434,49,"Health Partners, Inc.",State of Minnesota Advantage Program,39.935,81.5,,percent of total billed charges,,
Immunoassay Qual For Cf (Mayo)OutsideLaboratory,,83516,CPT,Facility,Both,,,90,49,41.65,14.0434,49,"Health Partners, Inc.",State Public Programs,24.5,50,,percent of total billed charges,,
Immunoassay Qual For Cf (Mayo)OutsideLaboratory,,83516,CPT,Facility,Both,,,90,49,41.65,14.0434,49,Humana Insurance Company,Commercial PPO,46.55,95,,percent of total billed charges,,
Immunoassay Qual For Cf (Mayo)OutsideLaboratory,,83516,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,Humana Insurance Company,Medicare PPO,24.01,49,,percent of total billed charges,,
Immunoassay Qual For Cf (Mayo)OutsideLaboratory,,83516,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Immunoassay Qual For Cf (Mayo)OutsideLaboratory,,83516,CPT,Facility,Both,,,90,49,41.65,14.0434,49,Medica,Individual & Family,48.559,99.1,,percent of total billed charges,,
Immunoassay Qual For Cf (Mayo)OutsideLaboratory,,83516,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,Medica,Medica Advantage Solution,24.402,49.8,,percent of total billed charges,,
Immunoassay Qual For Cf (Mayo)OutsideLaboratory,,83516,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Immunoassay Qual For Cf (Mayo)OutsideLaboratory,,83516,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,Medica,Medical Assistance,21.854,44.6,,percent of total billed charges,,
Immunoassay Qual For Cf (Mayo)OutsideLaboratory,,83516,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,Medica,Medical Assistance,,,,,Included in per diem rate,
Immunoassay Qual For Cf (Mayo)OutsideLaboratory,,83516,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,24.402,49.8,,percent of total billed charges,,
Immunoassay Qual For Cf (Mayo)OutsideLaboratory,,83516,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Immunoassay Qual For Cf (Mayo)OutsideLaboratory,,83516,CPT,Facility,Both,,,90,49,41.65,14.0434,49,"Multiplan, Inc.","Multiplan, Inc.",46.06,94,,percent of total billed charges,,
Immunoassay Qual For Cf (Mayo)OutsideLaboratory,,83516,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,42.336,86.4,,percent of total billed charges,,
Immunoassay Qual For Cf (Mayo)OutsideLaboratory,,83516,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Immunoassay Qual For Cf (Mayo)OutsideLaboratory,,83516,CPT,Facility,Both,,,90,49,41.65,14.0434,49,"Preferred One Administrative Services, INC.",PPO,48.314,98.6,,percent of total billed charges,,
Immunoassay Qual For Cf (Mayo)OutsideLaboratory,,83516,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,PrimeWest Health,Minnesota Senior Health Options (MSHO),25.2105,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Immunoassay Qual For Cf (Mayo)OutsideLaboratory,,83516,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Immunoassay Qual For Cf (Mayo)OutsideLaboratory,,83516,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,PrimeWest Health,MinnesotaCare,25.1664,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Immunoassay Qual For Cf (Mayo)OutsideLaboratory,,83516,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Immunoassay Qual For Cf (Mayo)OutsideLaboratory,,83516,CPT,Facility,Both,,,90,49,41.65,14.0434,49,Sanford Health Plan,Sanford Health Plan,45.08,92,,percent of total billed charges,,
Immunoassay Qual For Cf (Mayo)OutsideLaboratory,,83516,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,"UCare Health, Inc.",Individual & Family Plan,27.6115,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Immunoassay Qual For Cf (Mayo)OutsideLaboratory,,83516,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Immunoassay Qual For Cf (Mayo)OutsideLaboratory,,83516,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,"UCare Health, Inc.",Medical Assistance,24.7303,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Immunoassay Qual For Cf (Mayo)OutsideLaboratory,,83516,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Immunoassay Qual For Cf (Mayo)OutsideLaboratory,,83516,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,"UCare Health, Inc.",Medicare Advantage,24.7303,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Immunoassay Qual For Cf (Mayo)OutsideLaboratory,,83516,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Immunoassay Qual For Cf (Mayo)OutsideLaboratory,,83516,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),24.7303,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Immunoassay Qual For Cf (Mayo)OutsideLaboratory,,83516,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Immunoassay Qual For Cf (Mayo)OutsideLaboratory,,83516,CPT,Facility,Both,,,90,49,41.65,14.0434,49,UnitedHealthcare,Individual & Family,46.06,94,,percent of total billed charges,,
Immunoassay Qual For Cf (Mayo)OutsideLaboratory,,83516,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,UnitedHealthcare,Medicare Advantage,24.01,49,,percent of total billed charges,,
Immunoassay Qual For Cf (Mayo)OutsideLaboratory,,83516,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Immunoassay Qual For Cf (Mayo)OutsideLaboratory,,83516,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,23.52,48,,percent of total billed charges,,100% of DHS outpatient percentage
Immunoassay Qual For Cf (Mayo)OutsideLaboratory,,83516,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Myeloperoxidase Ab, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Both,,,90,111,94.35,31.8126,111,Aetna,Commercial,102.12,92,,percent of total billed charges,,
"Myeloperoxidase Ab, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Outpatient,,,90,111,94.35,31.8126,111,Aetna,Medicare Advantage,54.39,49,,percent of total billed charges,,
"Myeloperoxidase Ab, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Inpatient,,,90,111,94.35,31.8126,111,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Myeloperoxidase Ab, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Both,,,90,111,94.35,31.8126,111,Aetna,PPO,103.23,93,,percent of total billed charges,,
"Myeloperoxidase Ab, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Both,,,90,111,94.35,31.8126,111,America's PPO,America's PPO,106.5933,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Myeloperoxidase Ab, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Both,,,90,111,94.35,31.8126,111,BlueCross BlueShield Minnesota, Federal Employee Program,109.224,98.4,,percent of total billed charges,,
"Myeloperoxidase Ab, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Both,,,90,111,94.35,31.8126,111,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,111,100,,percent of total billed charges,,
"Myeloperoxidase Ab, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Both,,,90,111,94.35,31.8126,111,BlueCross BlueShield Minnesota,High Value Network Plan,99.9,90,,percent of total billed charges,,
"Myeloperoxidase Ab, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Outpatient,,,90,111,94.35,31.8126,111,BlueCross BlueShield Minnesota,Medicare Advantage,54.39,49,,percent of total billed charges,,
"Myeloperoxidase Ab, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Inpatient,,,90,111,94.35,31.8126,111,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Myeloperoxidase Ab, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Both,,,90,111,94.35,31.8126,111,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,98.3127,88.57,,percent of total billed charges,,
"Myeloperoxidase Ab, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Both,,,90,111,94.35,31.8126,111,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,31.8126,28.66,,percent of total billed charges,,
"Myeloperoxidase Ab, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Outpatient,,,90,111,94.35,31.8126,111,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),54.39,49,,percent of total billed charges,,
"Myeloperoxidase Ab, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Inpatient,,,90,111,94.35,31.8126,111,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Myeloperoxidase Ab, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Both,,,90,111,94.35,31.8126,111,CorVel,Worker's Compensation,111,100,,percent of total billed charges,,
"Myeloperoxidase Ab, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Both,,,90,111,94.35,31.8126,111,First Health Group Corporation,First Health Network,107.67,97,,percent of total billed charges,,
"Myeloperoxidase Ab, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Both,,,90,111,94.35,31.8126,111,"Health Partners, Inc.",Commercial,105.006,94.6,,percent of total billed charges,,
"Myeloperoxidase Ab, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Outpatient,,,90,111,94.35,31.8126,111,"Health Partners, Inc.",Medicare Advantage,54.39,49,,percent of total billed charges,,
"Myeloperoxidase Ab, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Inpatient,,,90,111,94.35,31.8126,111,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Myeloperoxidase Ab, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Both,,,90,111,94.35,31.8126,111,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),66.6,60,,percent of total billed charges,,
"Myeloperoxidase Ab, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Both,,,90,111,94.35,31.8126,111,"Health Partners, Inc.",State of Minnesota Advantage Program,90.465,81.5,,percent of total billed charges,,
"Myeloperoxidase Ab, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Both,,,90,111,94.35,31.8126,111,"Health Partners, Inc.",State Public Programs,55.5,50,,percent of total billed charges,,
"Myeloperoxidase Ab, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Both,,,90,111,94.35,31.8126,111,Humana Insurance Company,Commercial PPO,105.45,95,,percent of total billed charges,,
"Myeloperoxidase Ab, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Outpatient,,,90,111,94.35,31.8126,111,Humana Insurance Company,Medicare PPO,54.39,49,,percent of total billed charges,,
"Myeloperoxidase Ab, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Inpatient,,,90,111,94.35,31.8126,111,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Myeloperoxidase Ab, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Both,,,90,111,94.35,31.8126,111,Medica,Individual & Family,110.001,99.1,,percent of total billed charges,,
"Myeloperoxidase Ab, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Outpatient,,,90,111,94.35,31.8126,111,Medica,Medica Advantage Solution,55.278,49.8,,percent of total billed charges,,
"Myeloperoxidase Ab, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Inpatient,,,90,111,94.35,31.8126,111,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Myeloperoxidase Ab, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Outpatient,,,90,111,94.35,31.8126,111,Medica,Medical Assistance,49.506,44.6,,percent of total billed charges,,
"Myeloperoxidase Ab, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Inpatient,,,90,111,94.35,31.8126,111,Medica,Medical Assistance,,,,,Included in per diem rate,
"Myeloperoxidase Ab, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Outpatient,,,90,111,94.35,31.8126,111,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,55.278,49.8,,percent of total billed charges,,
"Myeloperoxidase Ab, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Inpatient,,,90,111,94.35,31.8126,111,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Myeloperoxidase Ab, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Both,,,90,111,94.35,31.8126,111,"Multiplan, Inc.","Multiplan, Inc.",104.34,94,,percent of total billed charges,,
"Myeloperoxidase Ab, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Outpatient,,,90,111,94.35,31.8126,111,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,95.904,86.4,,percent of total billed charges,,
"Myeloperoxidase Ab, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Inpatient,,,90,111,94.35,31.8126,111,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Myeloperoxidase Ab, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Both,,,90,111,94.35,31.8126,111,"Preferred One Administrative Services, INC.",PPO,109.446,98.6,,percent of total billed charges,,
"Myeloperoxidase Ab, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Outpatient,,,90,111,94.35,31.8126,111,PrimeWest Health,Minnesota Senior Health Options (MSHO),57.1095,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Myeloperoxidase Ab, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Inpatient,,,90,111,94.35,31.8126,111,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Myeloperoxidase Ab, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Outpatient,,,90,111,94.35,31.8126,111,PrimeWest Health,MinnesotaCare,57.0096,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Myeloperoxidase Ab, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Inpatient,,,90,111,94.35,31.8126,111,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Myeloperoxidase Ab, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Both,,,90,111,94.35,31.8126,111,Sanford Health Plan,Sanford Health Plan,102.12,92,,percent of total billed charges,,
"Myeloperoxidase Ab, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Outpatient,,,90,111,94.35,31.8126,111,"UCare Health, Inc.",Individual & Family Plan,62.5485,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Myeloperoxidase Ab, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Inpatient,,,90,111,94.35,31.8126,111,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Myeloperoxidase Ab, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Outpatient,,,90,111,94.35,31.8126,111,"UCare Health, Inc.",Medical Assistance,56.0217,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Myeloperoxidase Ab, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Inpatient,,,90,111,94.35,31.8126,111,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Myeloperoxidase Ab, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Outpatient,,,90,111,94.35,31.8126,111,"UCare Health, Inc.",Medicare Advantage,56.0217,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Myeloperoxidase Ab, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Inpatient,,,90,111,94.35,31.8126,111,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Myeloperoxidase Ab, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Outpatient,,,90,111,94.35,31.8126,111,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),56.0217,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Myeloperoxidase Ab, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Inpatient,,,90,111,94.35,31.8126,111,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Myeloperoxidase Ab, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Both,,,90,111,94.35,31.8126,111,UnitedHealthcare,Individual & Family,104.34,94,,percent of total billed charges,,
"Myeloperoxidase Ab, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Outpatient,,,90,111,94.35,31.8126,111,UnitedHealthcare,Medicare Advantage,54.39,49,,percent of total billed charges,,
"Myeloperoxidase Ab, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Inpatient,,,90,111,94.35,31.8126,111,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Myeloperoxidase Ab, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Outpatient,,,90,111,94.35,31.8126,111,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,53.28,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Myeloperoxidase Ab, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Inpatient,,,90,111,94.35,31.8126,111,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Parietal Cell Ab, Igg, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Both,,,90,111,94.35,31.8126,111,Aetna,Commercial,102.12,92,,percent of total billed charges,,
"Parietal Cell Ab, Igg, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Outpatient,,,90,111,94.35,31.8126,111,Aetna,Medicare Advantage,54.39,49,,percent of total billed charges,,
"Parietal Cell Ab, Igg, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Inpatient,,,90,111,94.35,31.8126,111,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Parietal Cell Ab, Igg, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Both,,,90,111,94.35,31.8126,111,Aetna,PPO,103.23,93,,percent of total billed charges,,
"Parietal Cell Ab, Igg, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Both,,,90,111,94.35,31.8126,111,America's PPO,America's PPO,106.5933,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Parietal Cell Ab, Igg, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Both,,,90,111,94.35,31.8126,111,BlueCross BlueShield Minnesota, Federal Employee Program,109.224,98.4,,percent of total billed charges,,
"Parietal Cell Ab, Igg, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Both,,,90,111,94.35,31.8126,111,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,111,100,,percent of total billed charges,,
"Parietal Cell Ab, Igg, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Both,,,90,111,94.35,31.8126,111,BlueCross BlueShield Minnesota,High Value Network Plan,99.9,90,,percent of total billed charges,,
"Parietal Cell Ab, Igg, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Outpatient,,,90,111,94.35,31.8126,111,BlueCross BlueShield Minnesota,Medicare Advantage,54.39,49,,percent of total billed charges,,
"Parietal Cell Ab, Igg, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Inpatient,,,90,111,94.35,31.8126,111,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Parietal Cell Ab, Igg, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Both,,,90,111,94.35,31.8126,111,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,98.3127,88.57,,percent of total billed charges,,
"Parietal Cell Ab, Igg, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Both,,,90,111,94.35,31.8126,111,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,31.8126,28.66,,percent of total billed charges,,
"Parietal Cell Ab, Igg, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Outpatient,,,90,111,94.35,31.8126,111,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),54.39,49,,percent of total billed charges,,
"Parietal Cell Ab, Igg, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Inpatient,,,90,111,94.35,31.8126,111,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Parietal Cell Ab, Igg, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Both,,,90,111,94.35,31.8126,111,CorVel,Worker's Compensation,111,100,,percent of total billed charges,,
"Parietal Cell Ab, Igg, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Both,,,90,111,94.35,31.8126,111,First Health Group Corporation,First Health Network,107.67,97,,percent of total billed charges,,
"Parietal Cell Ab, Igg, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Both,,,90,111,94.35,31.8126,111,"Health Partners, Inc.",Commercial,105.006,94.6,,percent of total billed charges,,
"Parietal Cell Ab, Igg, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Outpatient,,,90,111,94.35,31.8126,111,"Health Partners, Inc.",Medicare Advantage,54.39,49,,percent of total billed charges,,
"Parietal Cell Ab, Igg, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Inpatient,,,90,111,94.35,31.8126,111,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Parietal Cell Ab, Igg, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Both,,,90,111,94.35,31.8126,111,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),66.6,60,,percent of total billed charges,,
"Parietal Cell Ab, Igg, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Both,,,90,111,94.35,31.8126,111,"Health Partners, Inc.",State of Minnesota Advantage Program,90.465,81.5,,percent of total billed charges,,
"Parietal Cell Ab, Igg, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Both,,,90,111,94.35,31.8126,111,"Health Partners, Inc.",State Public Programs,55.5,50,,percent of total billed charges,,
"Parietal Cell Ab, Igg, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Both,,,90,111,94.35,31.8126,111,Humana Insurance Company,Commercial PPO,105.45,95,,percent of total billed charges,,
"Parietal Cell Ab, Igg, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Outpatient,,,90,111,94.35,31.8126,111,Humana Insurance Company,Medicare PPO,54.39,49,,percent of total billed charges,,
"Parietal Cell Ab, Igg, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Inpatient,,,90,111,94.35,31.8126,111,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Parietal Cell Ab, Igg, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Both,,,90,111,94.35,31.8126,111,Medica,Individual & Family,110.001,99.1,,percent of total billed charges,,
"Parietal Cell Ab, Igg, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Outpatient,,,90,111,94.35,31.8126,111,Medica,Medica Advantage Solution,55.278,49.8,,percent of total billed charges,,
"Parietal Cell Ab, Igg, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Inpatient,,,90,111,94.35,31.8126,111,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Parietal Cell Ab, Igg, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Outpatient,,,90,111,94.35,31.8126,111,Medica,Medical Assistance,49.506,44.6,,percent of total billed charges,,
"Parietal Cell Ab, Igg, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Inpatient,,,90,111,94.35,31.8126,111,Medica,Medical Assistance,,,,,Included in per diem rate,
"Parietal Cell Ab, Igg, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Outpatient,,,90,111,94.35,31.8126,111,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,55.278,49.8,,percent of total billed charges,,
"Parietal Cell Ab, Igg, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Inpatient,,,90,111,94.35,31.8126,111,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Parietal Cell Ab, Igg, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Both,,,90,111,94.35,31.8126,111,"Multiplan, Inc.","Multiplan, Inc.",104.34,94,,percent of total billed charges,,
"Parietal Cell Ab, Igg, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Outpatient,,,90,111,94.35,31.8126,111,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,95.904,86.4,,percent of total billed charges,,
"Parietal Cell Ab, Igg, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Inpatient,,,90,111,94.35,31.8126,111,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Parietal Cell Ab, Igg, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Both,,,90,111,94.35,31.8126,111,"Preferred One Administrative Services, INC.",PPO,109.446,98.6,,percent of total billed charges,,
"Parietal Cell Ab, Igg, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Outpatient,,,90,111,94.35,31.8126,111,PrimeWest Health,Minnesota Senior Health Options (MSHO),57.1095,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Parietal Cell Ab, Igg, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Inpatient,,,90,111,94.35,31.8126,111,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Parietal Cell Ab, Igg, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Outpatient,,,90,111,94.35,31.8126,111,PrimeWest Health,MinnesotaCare,57.0096,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Parietal Cell Ab, Igg, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Inpatient,,,90,111,94.35,31.8126,111,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Parietal Cell Ab, Igg, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Both,,,90,111,94.35,31.8126,111,Sanford Health Plan,Sanford Health Plan,102.12,92,,percent of total billed charges,,
"Parietal Cell Ab, Igg, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Outpatient,,,90,111,94.35,31.8126,111,"UCare Health, Inc.",Individual & Family Plan,62.5485,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Parietal Cell Ab, Igg, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Inpatient,,,90,111,94.35,31.8126,111,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Parietal Cell Ab, Igg, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Outpatient,,,90,111,94.35,31.8126,111,"UCare Health, Inc.",Medical Assistance,56.0217,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Parietal Cell Ab, Igg, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Inpatient,,,90,111,94.35,31.8126,111,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Parietal Cell Ab, Igg, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Outpatient,,,90,111,94.35,31.8126,111,"UCare Health, Inc.",Medicare Advantage,56.0217,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Parietal Cell Ab, Igg, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Inpatient,,,90,111,94.35,31.8126,111,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Parietal Cell Ab, Igg, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Outpatient,,,90,111,94.35,31.8126,111,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),56.0217,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Parietal Cell Ab, Igg, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Inpatient,,,90,111,94.35,31.8126,111,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Parietal Cell Ab, Igg, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Both,,,90,111,94.35,31.8126,111,UnitedHealthcare,Individual & Family,104.34,94,,percent of total billed charges,,
"Parietal Cell Ab, Igg, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Outpatient,,,90,111,94.35,31.8126,111,UnitedHealthcare,Medicare Advantage,54.39,49,,percent of total billed charges,,
"Parietal Cell Ab, Igg, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Inpatient,,,90,111,94.35,31.8126,111,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Parietal Cell Ab, Igg, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Outpatient,,,90,111,94.35,31.8126,111,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,53.28,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Parietal Cell Ab, Igg, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Inpatient,,,90,111,94.35,31.8126,111,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Proteinase 3 Ab (Pr3), S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Both,,,90,100,85,28.66,100,Aetna,Commercial,92,92,,percent of total billed charges,,
"Proteinase 3 Ab (Pr3), S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Outpatient,,,90,100,85,28.66,100,Aetna,Medicare Advantage,49,49,,percent of total billed charges,,
"Proteinase 3 Ab (Pr3), S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Inpatient,,,90,100,85,28.66,100,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Proteinase 3 Ab (Pr3), S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Both,,,90,100,85,28.66,100,Aetna,PPO,93,93,,percent of total billed charges,,
"Proteinase 3 Ab (Pr3), S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Both,,,90,100,85,28.66,100,America's PPO,America's PPO,96.03,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Proteinase 3 Ab (Pr3), S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Both,,,90,100,85,28.66,100,BlueCross BlueShield Minnesota, Federal Employee Program,98.4,98.4,,percent of total billed charges,,
"Proteinase 3 Ab (Pr3), S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Both,,,90,100,85,28.66,100,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,100,100,,percent of total billed charges,,
"Proteinase 3 Ab (Pr3), S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Both,,,90,100,85,28.66,100,BlueCross BlueShield Minnesota,High Value Network Plan,90,90,,percent of total billed charges,,
"Proteinase 3 Ab (Pr3), S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Outpatient,,,90,100,85,28.66,100,BlueCross BlueShield Minnesota,Medicare Advantage,49,49,,percent of total billed charges,,
"Proteinase 3 Ab (Pr3), S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Inpatient,,,90,100,85,28.66,100,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Proteinase 3 Ab (Pr3), S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Both,,,90,100,85,28.66,100,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,88.57,88.57,,percent of total billed charges,,
"Proteinase 3 Ab (Pr3), S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Both,,,90,100,85,28.66,100,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,28.66,28.66,,percent of total billed charges,,
"Proteinase 3 Ab (Pr3), S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Outpatient,,,90,100,85,28.66,100,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),49,49,,percent of total billed charges,,
"Proteinase 3 Ab (Pr3), S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Inpatient,,,90,100,85,28.66,100,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Proteinase 3 Ab (Pr3), S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Both,,,90,100,85,28.66,100,CorVel,Worker's Compensation,100,100,,percent of total billed charges,,
"Proteinase 3 Ab (Pr3), S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Both,,,90,100,85,28.66,100,First Health Group Corporation,First Health Network,97,97,,percent of total billed charges,,
"Proteinase 3 Ab (Pr3), S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Both,,,90,100,85,28.66,100,"Health Partners, Inc.",Commercial,94.6,94.6,,percent of total billed charges,,
"Proteinase 3 Ab (Pr3), S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Outpatient,,,90,100,85,28.66,100,"Health Partners, Inc.",Medicare Advantage,49,49,,percent of total billed charges,,
"Proteinase 3 Ab (Pr3), S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Inpatient,,,90,100,85,28.66,100,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Proteinase 3 Ab (Pr3), S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Both,,,90,100,85,28.66,100,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),60,60,,percent of total billed charges,,
"Proteinase 3 Ab (Pr3), S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Both,,,90,100,85,28.66,100,"Health Partners, Inc.",State of Minnesota Advantage Program,81.5,81.5,,percent of total billed charges,,
"Proteinase 3 Ab (Pr3), S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Both,,,90,100,85,28.66,100,"Health Partners, Inc.",State Public Programs,50,50,,percent of total billed charges,,
"Proteinase 3 Ab (Pr3), S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Both,,,90,100,85,28.66,100,Humana Insurance Company,Commercial PPO,95,95,,percent of total billed charges,,
"Proteinase 3 Ab (Pr3), S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Outpatient,,,90,100,85,28.66,100,Humana Insurance Company,Medicare PPO,49,49,,percent of total billed charges,,
"Proteinase 3 Ab (Pr3), S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Inpatient,,,90,100,85,28.66,100,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Proteinase 3 Ab (Pr3), S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Both,,,90,100,85,28.66,100,Medica,Individual & Family,99.1,99.1,,percent of total billed charges,,
"Proteinase 3 Ab (Pr3), S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Outpatient,,,90,100,85,28.66,100,Medica,Medica Advantage Solution,49.8,49.8,,percent of total billed charges,,
"Proteinase 3 Ab (Pr3), S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Inpatient,,,90,100,85,28.66,100,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Proteinase 3 Ab (Pr3), S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Outpatient,,,90,100,85,28.66,100,Medica,Medical Assistance,44.6,44.6,,percent of total billed charges,,
"Proteinase 3 Ab (Pr3), S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Inpatient,,,90,100,85,28.66,100,Medica,Medical Assistance,,,,,Included in per diem rate,
"Proteinase 3 Ab (Pr3), S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Outpatient,,,90,100,85,28.66,100,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,49.8,49.8,,percent of total billed charges,,
"Proteinase 3 Ab (Pr3), S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Inpatient,,,90,100,85,28.66,100,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Proteinase 3 Ab (Pr3), S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Both,,,90,100,85,28.66,100,"Multiplan, Inc.","Multiplan, Inc.",94,94,,percent of total billed charges,,
"Proteinase 3 Ab (Pr3), S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Outpatient,,,90,100,85,28.66,100,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,86.4,86.4,,percent of total billed charges,,
"Proteinase 3 Ab (Pr3), S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Inpatient,,,90,100,85,28.66,100,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Proteinase 3 Ab (Pr3), S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Both,,,90,100,85,28.66,100,"Preferred One Administrative Services, INC.",PPO,98.6,98.6,,percent of total billed charges,,
"Proteinase 3 Ab (Pr3), S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Outpatient,,,90,100,85,28.66,100,PrimeWest Health,Minnesota Senior Health Options (MSHO),51.45,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Proteinase 3 Ab (Pr3), S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Inpatient,,,90,100,85,28.66,100,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Proteinase 3 Ab (Pr3), S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Outpatient,,,90,100,85,28.66,100,PrimeWest Health,MinnesotaCare,51.36,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Proteinase 3 Ab (Pr3), S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Inpatient,,,90,100,85,28.66,100,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Proteinase 3 Ab (Pr3), S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Both,,,90,100,85,28.66,100,Sanford Health Plan,Sanford Health Plan,92,92,,percent of total billed charges,,
"Proteinase 3 Ab (Pr3), S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Outpatient,,,90,100,85,28.66,100,"UCare Health, Inc.",Individual & Family Plan,56.35,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Proteinase 3 Ab (Pr3), S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Inpatient,,,90,100,85,28.66,100,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Proteinase 3 Ab (Pr3), S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Outpatient,,,90,100,85,28.66,100,"UCare Health, Inc.",Medical Assistance,50.47,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Proteinase 3 Ab (Pr3), S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Inpatient,,,90,100,85,28.66,100,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Proteinase 3 Ab (Pr3), S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Outpatient,,,90,100,85,28.66,100,"UCare Health, Inc.",Medicare Advantage,50.47,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Proteinase 3 Ab (Pr3), S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Inpatient,,,90,100,85,28.66,100,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Proteinase 3 Ab (Pr3), S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Outpatient,,,90,100,85,28.66,100,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),50.47,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Proteinase 3 Ab (Pr3), S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Inpatient,,,90,100,85,28.66,100,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Proteinase 3 Ab (Pr3), S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Both,,,90,100,85,28.66,100,UnitedHealthcare,Individual & Family,94,94,,percent of total billed charges,,
"Proteinase 3 Ab (Pr3), S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Outpatient,,,90,100,85,28.66,100,UnitedHealthcare,Medicare Advantage,49,49,,percent of total billed charges,,
"Proteinase 3 Ab (Pr3), S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Inpatient,,,90,100,85,28.66,100,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Proteinase 3 Ab (Pr3), S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Outpatient,,,90,100,85,28.66,100,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,48,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Proteinase 3 Ab (Pr3), S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Inpatient,,,90,100,85,28.66,100,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Ribosome P Ab, Igg, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Both,,,90,131,111.35,37.5446,131,Aetna,Commercial,120.52,92,,percent of total billed charges,,
"Ribosome P Ab, Igg, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Outpatient,,,90,131,111.35,37.5446,131,Aetna,Medicare Advantage,64.19,49,,percent of total billed charges,,
"Ribosome P Ab, Igg, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Inpatient,,,90,131,111.35,37.5446,131,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Ribosome P Ab, Igg, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Both,,,90,131,111.35,37.5446,131,Aetna,PPO,121.83,93,,percent of total billed charges,,
"Ribosome P Ab, Igg, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Both,,,90,131,111.35,37.5446,131,America's PPO,America's PPO,125.7993,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Ribosome P Ab, Igg, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Both,,,90,131,111.35,37.5446,131,BlueCross BlueShield Minnesota, Federal Employee Program,128.904,98.4,,percent of total billed charges,,
"Ribosome P Ab, Igg, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Both,,,90,131,111.35,37.5446,131,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,131,100,,percent of total billed charges,,
"Ribosome P Ab, Igg, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Both,,,90,131,111.35,37.5446,131,BlueCross BlueShield Minnesota,High Value Network Plan,117.9,90,,percent of total billed charges,,
"Ribosome P Ab, Igg, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Outpatient,,,90,131,111.35,37.5446,131,BlueCross BlueShield Minnesota,Medicare Advantage,64.19,49,,percent of total billed charges,,
"Ribosome P Ab, Igg, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Inpatient,,,90,131,111.35,37.5446,131,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Ribosome P Ab, Igg, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Both,,,90,131,111.35,37.5446,131,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,116.0267,88.57,,percent of total billed charges,,
"Ribosome P Ab, Igg, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Both,,,90,131,111.35,37.5446,131,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,37.5446,28.66,,percent of total billed charges,,
"Ribosome P Ab, Igg, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Outpatient,,,90,131,111.35,37.5446,131,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),64.19,49,,percent of total billed charges,,
"Ribosome P Ab, Igg, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Inpatient,,,90,131,111.35,37.5446,131,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Ribosome P Ab, Igg, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Both,,,90,131,111.35,37.5446,131,CorVel,Worker's Compensation,131,100,,percent of total billed charges,,
"Ribosome P Ab, Igg, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Both,,,90,131,111.35,37.5446,131,First Health Group Corporation,First Health Network,127.07,97,,percent of total billed charges,,
"Ribosome P Ab, Igg, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Both,,,90,131,111.35,37.5446,131,"Health Partners, Inc.",Commercial,123.926,94.6,,percent of total billed charges,,
"Ribosome P Ab, Igg, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Outpatient,,,90,131,111.35,37.5446,131,"Health Partners, Inc.",Medicare Advantage,64.19,49,,percent of total billed charges,,
"Ribosome P Ab, Igg, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Inpatient,,,90,131,111.35,37.5446,131,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Ribosome P Ab, Igg, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Both,,,90,131,111.35,37.5446,131,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),78.6,60,,percent of total billed charges,,
"Ribosome P Ab, Igg, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Both,,,90,131,111.35,37.5446,131,"Health Partners, Inc.",State of Minnesota Advantage Program,106.765,81.5,,percent of total billed charges,,
"Ribosome P Ab, Igg, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Both,,,90,131,111.35,37.5446,131,"Health Partners, Inc.",State Public Programs,65.5,50,,percent of total billed charges,,
"Ribosome P Ab, Igg, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Both,,,90,131,111.35,37.5446,131,Humana Insurance Company,Commercial PPO,124.45,95,,percent of total billed charges,,
"Ribosome P Ab, Igg, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Outpatient,,,90,131,111.35,37.5446,131,Humana Insurance Company,Medicare PPO,64.19,49,,percent of total billed charges,,
"Ribosome P Ab, Igg, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Inpatient,,,90,131,111.35,37.5446,131,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Ribosome P Ab, Igg, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Both,,,90,131,111.35,37.5446,131,Medica,Individual & Family,129.821,99.1,,percent of total billed charges,,
"Ribosome P Ab, Igg, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Outpatient,,,90,131,111.35,37.5446,131,Medica,Medica Advantage Solution,65.238,49.8,,percent of total billed charges,,
"Ribosome P Ab, Igg, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Inpatient,,,90,131,111.35,37.5446,131,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Ribosome P Ab, Igg, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Outpatient,,,90,131,111.35,37.5446,131,Medica,Medical Assistance,58.426,44.6,,percent of total billed charges,,
"Ribosome P Ab, Igg, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Inpatient,,,90,131,111.35,37.5446,131,Medica,Medical Assistance,,,,,Included in per diem rate,
"Ribosome P Ab, Igg, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Outpatient,,,90,131,111.35,37.5446,131,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,65.238,49.8,,percent of total billed charges,,
"Ribosome P Ab, Igg, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Inpatient,,,90,131,111.35,37.5446,131,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Ribosome P Ab, Igg, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Both,,,90,131,111.35,37.5446,131,"Multiplan, Inc.","Multiplan, Inc.",123.14,94,,percent of total billed charges,,
"Ribosome P Ab, Igg, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Outpatient,,,90,131,111.35,37.5446,131,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,113.184,86.4,,percent of total billed charges,,
"Ribosome P Ab, Igg, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Inpatient,,,90,131,111.35,37.5446,131,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Ribosome P Ab, Igg, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Both,,,90,131,111.35,37.5446,131,"Preferred One Administrative Services, INC.",PPO,129.166,98.6,,percent of total billed charges,,
"Ribosome P Ab, Igg, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Outpatient,,,90,131,111.35,37.5446,131,PrimeWest Health,Minnesota Senior Health Options (MSHO),67.3995,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Ribosome P Ab, Igg, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Inpatient,,,90,131,111.35,37.5446,131,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Ribosome P Ab, Igg, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Outpatient,,,90,131,111.35,37.5446,131,PrimeWest Health,MinnesotaCare,67.2816,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Ribosome P Ab, Igg, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Inpatient,,,90,131,111.35,37.5446,131,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Ribosome P Ab, Igg, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Both,,,90,131,111.35,37.5446,131,Sanford Health Plan,Sanford Health Plan,120.52,92,,percent of total billed charges,,
"Ribosome P Ab, Igg, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Outpatient,,,90,131,111.35,37.5446,131,"UCare Health, Inc.",Individual & Family Plan,73.8185,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Ribosome P Ab, Igg, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Inpatient,,,90,131,111.35,37.5446,131,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Ribosome P Ab, Igg, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Outpatient,,,90,131,111.35,37.5446,131,"UCare Health, Inc.",Medical Assistance,66.1157,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Ribosome P Ab, Igg, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Inpatient,,,90,131,111.35,37.5446,131,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Ribosome P Ab, Igg, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Outpatient,,,90,131,111.35,37.5446,131,"UCare Health, Inc.",Medicare Advantage,66.1157,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Ribosome P Ab, Igg, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Inpatient,,,90,131,111.35,37.5446,131,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Ribosome P Ab, Igg, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Outpatient,,,90,131,111.35,37.5446,131,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),66.1157,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Ribosome P Ab, Igg, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Inpatient,,,90,131,111.35,37.5446,131,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Ribosome P Ab, Igg, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Both,,,90,131,111.35,37.5446,131,UnitedHealthcare,Individual & Family,123.14,94,,percent of total billed charges,,
"Ribosome P Ab, Igg, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Outpatient,,,90,131,111.35,37.5446,131,UnitedHealthcare,Medicare Advantage,64.19,49,,percent of total billed charges,,
"Ribosome P Ab, Igg, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Inpatient,,,90,131,111.35,37.5446,131,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Ribosome P Ab, Igg, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Outpatient,,,90,131,111.35,37.5446,131,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,62.88,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Ribosome P Ab, Igg, S (Mayo)OutsideLaboratory",,83516,CPT,Facility,Inpatient,,,90,131,111.35,37.5446,131,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Musk Autoantibody, S (Mayo)OutsideLaboratory",,83519,CPT,Facility,Both,,,90,1040,884,298.064,1040,Aetna,Commercial,956.8,92,,percent of total billed charges,,
"Musk Autoantibody, S (Mayo)OutsideLaboratory",,83519,CPT,Facility,Outpatient,,,90,1040,884,298.064,1040,Aetna,Medicare Advantage,509.6,49,,percent of total billed charges,,
"Musk Autoantibody, S (Mayo)OutsideLaboratory",,83519,CPT,Facility,Inpatient,,,90,1040,884,298.064,1040,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Musk Autoantibody, S (Mayo)OutsideLaboratory",,83519,CPT,Facility,Both,,,90,1040,884,298.064,1040,Aetna,PPO,967.2,93,,percent of total billed charges,,
"Musk Autoantibody, S (Mayo)OutsideLaboratory",,83519,CPT,Facility,Both,,,90,1040,884,298.064,1040,America's PPO,America's PPO,998.712,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Musk Autoantibody, S (Mayo)OutsideLaboratory",,83519,CPT,Facility,Both,,,90,1040,884,298.064,1040,BlueCross BlueShield Minnesota, Federal Employee Program,1023.36,98.4,,percent of total billed charges,,
"Musk Autoantibody, S (Mayo)OutsideLaboratory",,83519,CPT,Facility,Both,,,90,1040,884,298.064,1040,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1040,100,,percent of total billed charges,,
"Musk Autoantibody, S (Mayo)OutsideLaboratory",,83519,CPT,Facility,Both,,,90,1040,884,298.064,1040,BlueCross BlueShield Minnesota,High Value Network Plan,936,90,,percent of total billed charges,,
"Musk Autoantibody, S (Mayo)OutsideLaboratory",,83519,CPT,Facility,Outpatient,,,90,1040,884,298.064,1040,BlueCross BlueShield Minnesota,Medicare Advantage,509.6,49,,percent of total billed charges,,
"Musk Autoantibody, S (Mayo)OutsideLaboratory",,83519,CPT,Facility,Inpatient,,,90,1040,884,298.064,1040,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Musk Autoantibody, S (Mayo)OutsideLaboratory",,83519,CPT,Facility,Both,,,90,1040,884,298.064,1040,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,921.128,88.57,,percent of total billed charges,,
"Musk Autoantibody, S (Mayo)OutsideLaboratory",,83519,CPT,Facility,Both,,,90,1040,884,298.064,1040,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,298.064,28.66,,percent of total billed charges,,
"Musk Autoantibody, S (Mayo)OutsideLaboratory",,83519,CPT,Facility,Outpatient,,,90,1040,884,298.064,1040,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),509.6,49,,percent of total billed charges,,
"Musk Autoantibody, S (Mayo)OutsideLaboratory",,83519,CPT,Facility,Inpatient,,,90,1040,884,298.064,1040,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Musk Autoantibody, S (Mayo)OutsideLaboratory",,83519,CPT,Facility,Both,,,90,1040,884,298.064,1040,CorVel,Worker's Compensation,1040,100,,percent of total billed charges,,
"Musk Autoantibody, S (Mayo)OutsideLaboratory",,83519,CPT,Facility,Both,,,90,1040,884,298.064,1040,First Health Group Corporation,First Health Network,1008.8,97,,percent of total billed charges,,
"Musk Autoantibody, S (Mayo)OutsideLaboratory",,83519,CPT,Facility,Both,,,90,1040,884,298.064,1040,"Health Partners, Inc.",Commercial,983.84,94.6,,percent of total billed charges,,
"Musk Autoantibody, S (Mayo)OutsideLaboratory",,83519,CPT,Facility,Outpatient,,,90,1040,884,298.064,1040,"Health Partners, Inc.",Medicare Advantage,509.6,49,,percent of total billed charges,,
"Musk Autoantibody, S (Mayo)OutsideLaboratory",,83519,CPT,Facility,Inpatient,,,90,1040,884,298.064,1040,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Musk Autoantibody, S (Mayo)OutsideLaboratory",,83519,CPT,Facility,Both,,,90,1040,884,298.064,1040,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),624,60,,percent of total billed charges,,
"Musk Autoantibody, S (Mayo)OutsideLaboratory",,83519,CPT,Facility,Both,,,90,1040,884,298.064,1040,"Health Partners, Inc.",State of Minnesota Advantage Program,847.6,81.5,,percent of total billed charges,,
"Musk Autoantibody, S (Mayo)OutsideLaboratory",,83519,CPT,Facility,Both,,,90,1040,884,298.064,1040,"Health Partners, Inc.",State Public Programs,520,50,,percent of total billed charges,,
"Musk Autoantibody, S (Mayo)OutsideLaboratory",,83519,CPT,Facility,Both,,,90,1040,884,298.064,1040,Humana Insurance Company,Commercial PPO,988,95,,percent of total billed charges,,
"Musk Autoantibody, S (Mayo)OutsideLaboratory",,83519,CPT,Facility,Outpatient,,,90,1040,884,298.064,1040,Humana Insurance Company,Medicare PPO,509.6,49,,percent of total billed charges,,
"Musk Autoantibody, S (Mayo)OutsideLaboratory",,83519,CPT,Facility,Inpatient,,,90,1040,884,298.064,1040,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Musk Autoantibody, S (Mayo)OutsideLaboratory",,83519,CPT,Facility,Both,,,90,1040,884,298.064,1040,Medica,Individual & Family,1030.64,99.1,,percent of total billed charges,,
"Musk Autoantibody, S (Mayo)OutsideLaboratory",,83519,CPT,Facility,Outpatient,,,90,1040,884,298.064,1040,Medica,Medica Advantage Solution,517.92,49.8,,percent of total billed charges,,
"Musk Autoantibody, S (Mayo)OutsideLaboratory",,83519,CPT,Facility,Inpatient,,,90,1040,884,298.064,1040,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Musk Autoantibody, S (Mayo)OutsideLaboratory",,83519,CPT,Facility,Outpatient,,,90,1040,884,298.064,1040,Medica,Medical Assistance,463.84,44.6,,percent of total billed charges,,
"Musk Autoantibody, S (Mayo)OutsideLaboratory",,83519,CPT,Facility,Inpatient,,,90,1040,884,298.064,1040,Medica,Medical Assistance,,,,,Included in per diem rate,
"Musk Autoantibody, S (Mayo)OutsideLaboratory",,83519,CPT,Facility,Outpatient,,,90,1040,884,298.064,1040,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,517.92,49.8,,percent of total billed charges,,
"Musk Autoantibody, S (Mayo)OutsideLaboratory",,83519,CPT,Facility,Inpatient,,,90,1040,884,298.064,1040,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Musk Autoantibody, S (Mayo)OutsideLaboratory",,83519,CPT,Facility,Both,,,90,1040,884,298.064,1040,"Multiplan, Inc.","Multiplan, Inc.",977.6,94,,percent of total billed charges,,
"Musk Autoantibody, S (Mayo)OutsideLaboratory",,83519,CPT,Facility,Outpatient,,,90,1040,884,298.064,1040,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,898.56,86.4,,percent of total billed charges,,
"Musk Autoantibody, S (Mayo)OutsideLaboratory",,83519,CPT,Facility,Inpatient,,,90,1040,884,298.064,1040,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Musk Autoantibody, S (Mayo)OutsideLaboratory",,83519,CPT,Facility,Both,,,90,1040,884,298.064,1040,"Preferred One Administrative Services, INC.",PPO,1025.44,98.6,,percent of total billed charges,,
"Musk Autoantibody, S (Mayo)OutsideLaboratory",,83519,CPT,Facility,Outpatient,,,90,1040,884,298.064,1040,PrimeWest Health,Minnesota Senior Health Options (MSHO),535.08,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Musk Autoantibody, S (Mayo)OutsideLaboratory",,83519,CPT,Facility,Inpatient,,,90,1040,884,298.064,1040,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Musk Autoantibody, S (Mayo)OutsideLaboratory",,83519,CPT,Facility,Outpatient,,,90,1040,884,298.064,1040,PrimeWest Health,MinnesotaCare,534.144,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Musk Autoantibody, S (Mayo)OutsideLaboratory",,83519,CPT,Facility,Inpatient,,,90,1040,884,298.064,1040,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Musk Autoantibody, S (Mayo)OutsideLaboratory",,83519,CPT,Facility,Both,,,90,1040,884,298.064,1040,Sanford Health Plan,Sanford Health Plan,956.8,92,,percent of total billed charges,,
"Musk Autoantibody, S (Mayo)OutsideLaboratory",,83519,CPT,Facility,Outpatient,,,90,1040,884,298.064,1040,"UCare Health, Inc.",Individual & Family Plan,586.04,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Musk Autoantibody, S (Mayo)OutsideLaboratory",,83519,CPT,Facility,Inpatient,,,90,1040,884,298.064,1040,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Musk Autoantibody, S (Mayo)OutsideLaboratory",,83519,CPT,Facility,Outpatient,,,90,1040,884,298.064,1040,"UCare Health, Inc.",Medical Assistance,524.888,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Musk Autoantibody, S (Mayo)OutsideLaboratory",,83519,CPT,Facility,Inpatient,,,90,1040,884,298.064,1040,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Musk Autoantibody, S (Mayo)OutsideLaboratory",,83519,CPT,Facility,Outpatient,,,90,1040,884,298.064,1040,"UCare Health, Inc.",Medicare Advantage,524.888,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Musk Autoantibody, S (Mayo)OutsideLaboratory",,83519,CPT,Facility,Inpatient,,,90,1040,884,298.064,1040,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Musk Autoantibody, S (Mayo)OutsideLaboratory",,83519,CPT,Facility,Outpatient,,,90,1040,884,298.064,1040,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),524.888,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Musk Autoantibody, S (Mayo)OutsideLaboratory",,83519,CPT,Facility,Inpatient,,,90,1040,884,298.064,1040,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Musk Autoantibody, S (Mayo)OutsideLaboratory",,83519,CPT,Facility,Both,,,90,1040,884,298.064,1040,UnitedHealthcare,Individual & Family,977.6,94,,percent of total billed charges,,
"Musk Autoantibody, S (Mayo)OutsideLaboratory",,83519,CPT,Facility,Outpatient,,,90,1040,884,298.064,1040,UnitedHealthcare,Medicare Advantage,509.6,49,,percent of total billed charges,,
"Musk Autoantibody, S (Mayo)OutsideLaboratory",,83519,CPT,Facility,Inpatient,,,90,1040,884,298.064,1040,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Musk Autoantibody, S (Mayo)OutsideLaboratory",,83519,CPT,Facility,Outpatient,,,90,1040,884,298.064,1040,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,499.2,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Musk Autoantibody, S (Mayo)OutsideLaboratory",,83519,CPT,Facility,Inpatient,,,90,1040,884,298.064,1040,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Anti-Adalimumab Antibody (Mayo)OutsideLaboratory,,83520,CPT,Facility,Both,,,90,163,138.55,46.7158,163,Aetna,Commercial,149.96,92,,percent of total billed charges,,
Anti-Adalimumab Antibody (Mayo)OutsideLaboratory,,83520,CPT,Facility,Outpatient,,,90,163,138.55,46.7158,163,Aetna,Medicare Advantage,79.87,49,,percent of total billed charges,,
Anti-Adalimumab Antibody (Mayo)OutsideLaboratory,,83520,CPT,Facility,Inpatient,,,90,163,138.55,46.7158,163,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Anti-Adalimumab Antibody (Mayo)OutsideLaboratory,,83520,CPT,Facility,Both,,,90,163,138.55,46.7158,163,Aetna,PPO,151.59,93,,percent of total billed charges,,
Anti-Adalimumab Antibody (Mayo)OutsideLaboratory,,83520,CPT,Facility,Both,,,90,163,138.55,46.7158,163,America's PPO,America's PPO,156.5289,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Anti-Adalimumab Antibody (Mayo)OutsideLaboratory,,83520,CPT,Facility,Both,,,90,163,138.55,46.7158,163,BlueCross BlueShield Minnesota, Federal Employee Program,160.392,98.4,,percent of total billed charges,,
Anti-Adalimumab Antibody (Mayo)OutsideLaboratory,,83520,CPT,Facility,Both,,,90,163,138.55,46.7158,163,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,163,100,,percent of total billed charges,,
Anti-Adalimumab Antibody (Mayo)OutsideLaboratory,,83520,CPT,Facility,Both,,,90,163,138.55,46.7158,163,BlueCross BlueShield Minnesota,High Value Network Plan,146.7,90,,percent of total billed charges,,
Anti-Adalimumab Antibody (Mayo)OutsideLaboratory,,83520,CPT,Facility,Outpatient,,,90,163,138.55,46.7158,163,BlueCross BlueShield Minnesota,Medicare Advantage,79.87,49,,percent of total billed charges,,
Anti-Adalimumab Antibody (Mayo)OutsideLaboratory,,83520,CPT,Facility,Inpatient,,,90,163,138.55,46.7158,163,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Anti-Adalimumab Antibody (Mayo)OutsideLaboratory,,83520,CPT,Facility,Both,,,90,163,138.55,46.7158,163,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,144.3691,88.57,,percent of total billed charges,,
Anti-Adalimumab Antibody (Mayo)OutsideLaboratory,,83520,CPT,Facility,Both,,,90,163,138.55,46.7158,163,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,46.7158,28.66,,percent of total billed charges,,
Anti-Adalimumab Antibody (Mayo)OutsideLaboratory,,83520,CPT,Facility,Outpatient,,,90,163,138.55,46.7158,163,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),79.87,49,,percent of total billed charges,,
Anti-Adalimumab Antibody (Mayo)OutsideLaboratory,,83520,CPT,Facility,Inpatient,,,90,163,138.55,46.7158,163,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Anti-Adalimumab Antibody (Mayo)OutsideLaboratory,,83520,CPT,Facility,Both,,,90,163,138.55,46.7158,163,CorVel,Worker's Compensation,163,100,,percent of total billed charges,,
Anti-Adalimumab Antibody (Mayo)OutsideLaboratory,,83520,CPT,Facility,Both,,,90,163,138.55,46.7158,163,First Health Group Corporation,First Health Network,158.11,97,,percent of total billed charges,,
Anti-Adalimumab Antibody (Mayo)OutsideLaboratory,,83520,CPT,Facility,Both,,,90,163,138.55,46.7158,163,"Health Partners, Inc.",Commercial,154.198,94.6,,percent of total billed charges,,
Anti-Adalimumab Antibody (Mayo)OutsideLaboratory,,83520,CPT,Facility,Outpatient,,,90,163,138.55,46.7158,163,"Health Partners, Inc.",Medicare Advantage,79.87,49,,percent of total billed charges,,
Anti-Adalimumab Antibody (Mayo)OutsideLaboratory,,83520,CPT,Facility,Inpatient,,,90,163,138.55,46.7158,163,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Anti-Adalimumab Antibody (Mayo)OutsideLaboratory,,83520,CPT,Facility,Both,,,90,163,138.55,46.7158,163,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),97.8,60,,percent of total billed charges,,
Anti-Adalimumab Antibody (Mayo)OutsideLaboratory,,83520,CPT,Facility,Both,,,90,163,138.55,46.7158,163,"Health Partners, Inc.",State of Minnesota Advantage Program,132.845,81.5,,percent of total billed charges,,
Anti-Adalimumab Antibody (Mayo)OutsideLaboratory,,83520,CPT,Facility,Both,,,90,163,138.55,46.7158,163,"Health Partners, Inc.",State Public Programs,81.5,50,,percent of total billed charges,,
Anti-Adalimumab Antibody (Mayo)OutsideLaboratory,,83520,CPT,Facility,Both,,,90,163,138.55,46.7158,163,Humana Insurance Company,Commercial PPO,154.85,95,,percent of total billed charges,,
Anti-Adalimumab Antibody (Mayo)OutsideLaboratory,,83520,CPT,Facility,Outpatient,,,90,163,138.55,46.7158,163,Humana Insurance Company,Medicare PPO,79.87,49,,percent of total billed charges,,
Anti-Adalimumab Antibody (Mayo)OutsideLaboratory,,83520,CPT,Facility,Inpatient,,,90,163,138.55,46.7158,163,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Anti-Adalimumab Antibody (Mayo)OutsideLaboratory,,83520,CPT,Facility,Both,,,90,163,138.55,46.7158,163,Medica,Individual & Family,161.533,99.1,,percent of total billed charges,,
Anti-Adalimumab Antibody (Mayo)OutsideLaboratory,,83520,CPT,Facility,Outpatient,,,90,163,138.55,46.7158,163,Medica,Medica Advantage Solution,81.174,49.8,,percent of total billed charges,,
Anti-Adalimumab Antibody (Mayo)OutsideLaboratory,,83520,CPT,Facility,Inpatient,,,90,163,138.55,46.7158,163,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Anti-Adalimumab Antibody (Mayo)OutsideLaboratory,,83520,CPT,Facility,Outpatient,,,90,163,138.55,46.7158,163,Medica,Medical Assistance,72.698,44.6,,percent of total billed charges,,
Anti-Adalimumab Antibody (Mayo)OutsideLaboratory,,83520,CPT,Facility,Inpatient,,,90,163,138.55,46.7158,163,Medica,Medical Assistance,,,,,Included in per diem rate,
Anti-Adalimumab Antibody (Mayo)OutsideLaboratory,,83520,CPT,Facility,Outpatient,,,90,163,138.55,46.7158,163,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,81.174,49.8,,percent of total billed charges,,
Anti-Adalimumab Antibody (Mayo)OutsideLaboratory,,83520,CPT,Facility,Inpatient,,,90,163,138.55,46.7158,163,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Anti-Adalimumab Antibody (Mayo)OutsideLaboratory,,83520,CPT,Facility,Both,,,90,163,138.55,46.7158,163,"Multiplan, Inc.","Multiplan, Inc.",153.22,94,,percent of total billed charges,,
Anti-Adalimumab Antibody (Mayo)OutsideLaboratory,,83520,CPT,Facility,Outpatient,,,90,163,138.55,46.7158,163,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,140.832,86.4,,percent of total billed charges,,
Anti-Adalimumab Antibody (Mayo)OutsideLaboratory,,83520,CPT,Facility,Inpatient,,,90,163,138.55,46.7158,163,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Anti-Adalimumab Antibody (Mayo)OutsideLaboratory,,83520,CPT,Facility,Both,,,90,163,138.55,46.7158,163,"Preferred One Administrative Services, INC.",PPO,160.718,98.6,,percent of total billed charges,,
Anti-Adalimumab Antibody (Mayo)OutsideLaboratory,,83520,CPT,Facility,Outpatient,,,90,163,138.55,46.7158,163,PrimeWest Health,Minnesota Senior Health Options (MSHO),83.8635,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Anti-Adalimumab Antibody (Mayo)OutsideLaboratory,,83520,CPT,Facility,Inpatient,,,90,163,138.55,46.7158,163,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Anti-Adalimumab Antibody (Mayo)OutsideLaboratory,,83520,CPT,Facility,Outpatient,,,90,163,138.55,46.7158,163,PrimeWest Health,MinnesotaCare,83.7168,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Anti-Adalimumab Antibody (Mayo)OutsideLaboratory,,83520,CPT,Facility,Inpatient,,,90,163,138.55,46.7158,163,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Anti-Adalimumab Antibody (Mayo)OutsideLaboratory,,83520,CPT,Facility,Both,,,90,163,138.55,46.7158,163,Sanford Health Plan,Sanford Health Plan,149.96,92,,percent of total billed charges,,
Anti-Adalimumab Antibody (Mayo)OutsideLaboratory,,83520,CPT,Facility,Outpatient,,,90,163,138.55,46.7158,163,"UCare Health, Inc.",Individual & Family Plan,91.8505,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Anti-Adalimumab Antibody (Mayo)OutsideLaboratory,,83520,CPT,Facility,Inpatient,,,90,163,138.55,46.7158,163,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Anti-Adalimumab Antibody (Mayo)OutsideLaboratory,,83520,CPT,Facility,Outpatient,,,90,163,138.55,46.7158,163,"UCare Health, Inc.",Medical Assistance,82.2661,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Anti-Adalimumab Antibody (Mayo)OutsideLaboratory,,83520,CPT,Facility,Inpatient,,,90,163,138.55,46.7158,163,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Anti-Adalimumab Antibody (Mayo)OutsideLaboratory,,83520,CPT,Facility,Outpatient,,,90,163,138.55,46.7158,163,"UCare Health, Inc.",Medicare Advantage,82.2661,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Anti-Adalimumab Antibody (Mayo)OutsideLaboratory,,83520,CPT,Facility,Inpatient,,,90,163,138.55,46.7158,163,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Anti-Adalimumab Antibody (Mayo)OutsideLaboratory,,83520,CPT,Facility,Outpatient,,,90,163,138.55,46.7158,163,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),82.2661,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Anti-Adalimumab Antibody (Mayo)OutsideLaboratory,,83520,CPT,Facility,Inpatient,,,90,163,138.55,46.7158,163,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Anti-Adalimumab Antibody (Mayo)OutsideLaboratory,,83520,CPT,Facility,Both,,,90,163,138.55,46.7158,163,UnitedHealthcare,Individual & Family,153.22,94,,percent of total billed charges,,
Anti-Adalimumab Antibody (Mayo)OutsideLaboratory,,83520,CPT,Facility,Outpatient,,,90,163,138.55,46.7158,163,UnitedHealthcare,Medicare Advantage,79.87,49,,percent of total billed charges,,
Anti-Adalimumab Antibody (Mayo)OutsideLaboratory,,83520,CPT,Facility,Inpatient,,,90,163,138.55,46.7158,163,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Anti-Adalimumab Antibody (Mayo)OutsideLaboratory,,83520,CPT,Facility,Outpatient,,,90,163,138.55,46.7158,163,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,78.24,48,,percent of total billed charges,,100% of DHS outpatient percentage
Anti-Adalimumab Antibody (Mayo)OutsideLaboratory,,83520,CPT,Facility,Inpatient,,,90,163,138.55,46.7158,163,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Antimullerian Hormone, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Both,,,90,236,200.6,67.6376,236,Aetna,Commercial,217.12,92,,percent of total billed charges,,
"Antimullerian Hormone, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Outpatient,,,90,236,200.6,67.6376,236,Aetna,Medicare Advantage,115.64,49,,percent of total billed charges,,
"Antimullerian Hormone, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Inpatient,,,90,236,200.6,67.6376,236,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Antimullerian Hormone, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Both,,,90,236,200.6,67.6376,236,Aetna,PPO,219.48,93,,percent of total billed charges,,
"Antimullerian Hormone, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Both,,,90,236,200.6,67.6376,236,America's PPO,America's PPO,226.6308,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Antimullerian Hormone, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Both,,,90,236,200.6,67.6376,236,BlueCross BlueShield Minnesota, Federal Employee Program,232.224,98.4,,percent of total billed charges,,
"Antimullerian Hormone, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Both,,,90,236,200.6,67.6376,236,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,236,100,,percent of total billed charges,,
"Antimullerian Hormone, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Both,,,90,236,200.6,67.6376,236,BlueCross BlueShield Minnesota,High Value Network Plan,212.4,90,,percent of total billed charges,,
"Antimullerian Hormone, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Outpatient,,,90,236,200.6,67.6376,236,BlueCross BlueShield Minnesota,Medicare Advantage,115.64,49,,percent of total billed charges,,
"Antimullerian Hormone, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Inpatient,,,90,236,200.6,67.6376,236,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Antimullerian Hormone, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Both,,,90,236,200.6,67.6376,236,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,209.0252,88.57,,percent of total billed charges,,
"Antimullerian Hormone, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Both,,,90,236,200.6,67.6376,236,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,67.6376,28.66,,percent of total billed charges,,
"Antimullerian Hormone, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Outpatient,,,90,236,200.6,67.6376,236,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),115.64,49,,percent of total billed charges,,
"Antimullerian Hormone, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Inpatient,,,90,236,200.6,67.6376,236,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Antimullerian Hormone, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Both,,,90,236,200.6,67.6376,236,CorVel,Worker's Compensation,236,100,,percent of total billed charges,,
"Antimullerian Hormone, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Both,,,90,236,200.6,67.6376,236,First Health Group Corporation,First Health Network,228.92,97,,percent of total billed charges,,
"Antimullerian Hormone, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Both,,,90,236,200.6,67.6376,236,"Health Partners, Inc.",Commercial,223.256,94.6,,percent of total billed charges,,
"Antimullerian Hormone, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Outpatient,,,90,236,200.6,67.6376,236,"Health Partners, Inc.",Medicare Advantage,115.64,49,,percent of total billed charges,,
"Antimullerian Hormone, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Inpatient,,,90,236,200.6,67.6376,236,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Antimullerian Hormone, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Both,,,90,236,200.6,67.6376,236,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),141.6,60,,percent of total billed charges,,
"Antimullerian Hormone, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Both,,,90,236,200.6,67.6376,236,"Health Partners, Inc.",State of Minnesota Advantage Program,192.34,81.5,,percent of total billed charges,,
"Antimullerian Hormone, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Both,,,90,236,200.6,67.6376,236,"Health Partners, Inc.",State Public Programs,118,50,,percent of total billed charges,,
"Antimullerian Hormone, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Both,,,90,236,200.6,67.6376,236,Humana Insurance Company,Commercial PPO,224.2,95,,percent of total billed charges,,
"Antimullerian Hormone, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Outpatient,,,90,236,200.6,67.6376,236,Humana Insurance Company,Medicare PPO,115.64,49,,percent of total billed charges,,
"Antimullerian Hormone, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Inpatient,,,90,236,200.6,67.6376,236,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Antimullerian Hormone, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Both,,,90,236,200.6,67.6376,236,Medica,Individual & Family,233.876,99.1,,percent of total billed charges,,
"Antimullerian Hormone, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Outpatient,,,90,236,200.6,67.6376,236,Medica,Medica Advantage Solution,117.528,49.8,,percent of total billed charges,,
"Antimullerian Hormone, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Inpatient,,,90,236,200.6,67.6376,236,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Antimullerian Hormone, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Outpatient,,,90,236,200.6,67.6376,236,Medica,Medical Assistance,105.256,44.6,,percent of total billed charges,,
"Antimullerian Hormone, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Inpatient,,,90,236,200.6,67.6376,236,Medica,Medical Assistance,,,,,Included in per diem rate,
"Antimullerian Hormone, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Outpatient,,,90,236,200.6,67.6376,236,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,117.528,49.8,,percent of total billed charges,,
"Antimullerian Hormone, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Inpatient,,,90,236,200.6,67.6376,236,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Antimullerian Hormone, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Both,,,90,236,200.6,67.6376,236,"Multiplan, Inc.","Multiplan, Inc.",221.84,94,,percent of total billed charges,,
"Antimullerian Hormone, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Outpatient,,,90,236,200.6,67.6376,236,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,203.904,86.4,,percent of total billed charges,,
"Antimullerian Hormone, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Inpatient,,,90,236,200.6,67.6376,236,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Antimullerian Hormone, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Both,,,90,236,200.6,67.6376,236,"Preferred One Administrative Services, INC.",PPO,232.696,98.6,,percent of total billed charges,,
"Antimullerian Hormone, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Outpatient,,,90,236,200.6,67.6376,236,PrimeWest Health,Minnesota Senior Health Options (MSHO),121.422,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Antimullerian Hormone, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Inpatient,,,90,236,200.6,67.6376,236,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Antimullerian Hormone, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Outpatient,,,90,236,200.6,67.6376,236,PrimeWest Health,MinnesotaCare,121.2096,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Antimullerian Hormone, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Inpatient,,,90,236,200.6,67.6376,236,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Antimullerian Hormone, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Both,,,90,236,200.6,67.6376,236,Sanford Health Plan,Sanford Health Plan,217.12,92,,percent of total billed charges,,
"Antimullerian Hormone, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Outpatient,,,90,236,200.6,67.6376,236,"UCare Health, Inc.",Individual & Family Plan,132.986,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Antimullerian Hormone, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Inpatient,,,90,236,200.6,67.6376,236,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Antimullerian Hormone, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Outpatient,,,90,236,200.6,67.6376,236,"UCare Health, Inc.",Medical Assistance,119.1092,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Antimullerian Hormone, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Inpatient,,,90,236,200.6,67.6376,236,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Antimullerian Hormone, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Outpatient,,,90,236,200.6,67.6376,236,"UCare Health, Inc.",Medicare Advantage,119.1092,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Antimullerian Hormone, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Inpatient,,,90,236,200.6,67.6376,236,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Antimullerian Hormone, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Outpatient,,,90,236,200.6,67.6376,236,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),119.1092,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Antimullerian Hormone, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Inpatient,,,90,236,200.6,67.6376,236,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Antimullerian Hormone, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Both,,,90,236,200.6,67.6376,236,UnitedHealthcare,Individual & Family,221.84,94,,percent of total billed charges,,
"Antimullerian Hormone, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Outpatient,,,90,236,200.6,67.6376,236,UnitedHealthcare,Medicare Advantage,115.64,49,,percent of total billed charges,,
"Antimullerian Hormone, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Inpatient,,,90,236,200.6,67.6376,236,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Antimullerian Hormone, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Outpatient,,,90,236,200.6,67.6376,236,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,113.28,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Antimullerian Hormone, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Inpatient,,,90,236,200.6,67.6376,236,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"C1 Esterase Inhib, Functional (Mayo)OutsideLaboratory",,83520,CPT,Facility,Both,,,90,117,99.45,33.5322,117,Aetna,Commercial,107.64,92,,percent of total billed charges,,
"C1 Esterase Inhib, Functional (Mayo)OutsideLaboratory",,83520,CPT,Facility,Outpatient,,,90,117,99.45,33.5322,117,Aetna,Medicare Advantage,57.33,49,,percent of total billed charges,,
"C1 Esterase Inhib, Functional (Mayo)OutsideLaboratory",,83520,CPT,Facility,Inpatient,,,90,117,99.45,33.5322,117,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"C1 Esterase Inhib, Functional (Mayo)OutsideLaboratory",,83520,CPT,Facility,Both,,,90,117,99.45,33.5322,117,Aetna,PPO,108.81,93,,percent of total billed charges,,
"C1 Esterase Inhib, Functional (Mayo)OutsideLaboratory",,83520,CPT,Facility,Both,,,90,117,99.45,33.5322,117,America's PPO,America's PPO,112.3551,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"C1 Esterase Inhib, Functional (Mayo)OutsideLaboratory",,83520,CPT,Facility,Both,,,90,117,99.45,33.5322,117,BlueCross BlueShield Minnesota, Federal Employee Program,115.128,98.4,,percent of total billed charges,,
"C1 Esterase Inhib, Functional (Mayo)OutsideLaboratory",,83520,CPT,Facility,Both,,,90,117,99.45,33.5322,117,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,117,100,,percent of total billed charges,,
"C1 Esterase Inhib, Functional (Mayo)OutsideLaboratory",,83520,CPT,Facility,Both,,,90,117,99.45,33.5322,117,BlueCross BlueShield Minnesota,High Value Network Plan,105.3,90,,percent of total billed charges,,
"C1 Esterase Inhib, Functional (Mayo)OutsideLaboratory",,83520,CPT,Facility,Outpatient,,,90,117,99.45,33.5322,117,BlueCross BlueShield Minnesota,Medicare Advantage,57.33,49,,percent of total billed charges,,
"C1 Esterase Inhib, Functional (Mayo)OutsideLaboratory",,83520,CPT,Facility,Inpatient,,,90,117,99.45,33.5322,117,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"C1 Esterase Inhib, Functional (Mayo)OutsideLaboratory",,83520,CPT,Facility,Both,,,90,117,99.45,33.5322,117,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,103.6269,88.57,,percent of total billed charges,,
"C1 Esterase Inhib, Functional (Mayo)OutsideLaboratory",,83520,CPT,Facility,Both,,,90,117,99.45,33.5322,117,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,33.5322,28.66,,percent of total billed charges,,
"C1 Esterase Inhib, Functional (Mayo)OutsideLaboratory",,83520,CPT,Facility,Outpatient,,,90,117,99.45,33.5322,117,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),57.33,49,,percent of total billed charges,,
"C1 Esterase Inhib, Functional (Mayo)OutsideLaboratory",,83520,CPT,Facility,Inpatient,,,90,117,99.45,33.5322,117,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"C1 Esterase Inhib, Functional (Mayo)OutsideLaboratory",,83520,CPT,Facility,Both,,,90,117,99.45,33.5322,117,CorVel,Worker's Compensation,117,100,,percent of total billed charges,,
"C1 Esterase Inhib, Functional (Mayo)OutsideLaboratory",,83520,CPT,Facility,Both,,,90,117,99.45,33.5322,117,First Health Group Corporation,First Health Network,113.49,97,,percent of total billed charges,,
"C1 Esterase Inhib, Functional (Mayo)OutsideLaboratory",,83520,CPT,Facility,Both,,,90,117,99.45,33.5322,117,"Health Partners, Inc.",Commercial,110.682,94.6,,percent of total billed charges,,
"C1 Esterase Inhib, Functional (Mayo)OutsideLaboratory",,83520,CPT,Facility,Outpatient,,,90,117,99.45,33.5322,117,"Health Partners, Inc.",Medicare Advantage,57.33,49,,percent of total billed charges,,
"C1 Esterase Inhib, Functional (Mayo)OutsideLaboratory",,83520,CPT,Facility,Inpatient,,,90,117,99.45,33.5322,117,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"C1 Esterase Inhib, Functional (Mayo)OutsideLaboratory",,83520,CPT,Facility,Both,,,90,117,99.45,33.5322,117,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),70.2,60,,percent of total billed charges,,
"C1 Esterase Inhib, Functional (Mayo)OutsideLaboratory",,83520,CPT,Facility,Both,,,90,117,99.45,33.5322,117,"Health Partners, Inc.",State of Minnesota Advantage Program,95.355,81.5,,percent of total billed charges,,
"C1 Esterase Inhib, Functional (Mayo)OutsideLaboratory",,83520,CPT,Facility,Both,,,90,117,99.45,33.5322,117,"Health Partners, Inc.",State Public Programs,58.5,50,,percent of total billed charges,,
"C1 Esterase Inhib, Functional (Mayo)OutsideLaboratory",,83520,CPT,Facility,Both,,,90,117,99.45,33.5322,117,Humana Insurance Company,Commercial PPO,111.15,95,,percent of total billed charges,,
"C1 Esterase Inhib, Functional (Mayo)OutsideLaboratory",,83520,CPT,Facility,Outpatient,,,90,117,99.45,33.5322,117,Humana Insurance Company,Medicare PPO,57.33,49,,percent of total billed charges,,
"C1 Esterase Inhib, Functional (Mayo)OutsideLaboratory",,83520,CPT,Facility,Inpatient,,,90,117,99.45,33.5322,117,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"C1 Esterase Inhib, Functional (Mayo)OutsideLaboratory",,83520,CPT,Facility,Both,,,90,117,99.45,33.5322,117,Medica,Individual & Family,115.947,99.1,,percent of total billed charges,,
"C1 Esterase Inhib, Functional (Mayo)OutsideLaboratory",,83520,CPT,Facility,Outpatient,,,90,117,99.45,33.5322,117,Medica,Medica Advantage Solution,58.266,49.8,,percent of total billed charges,,
"C1 Esterase Inhib, Functional (Mayo)OutsideLaboratory",,83520,CPT,Facility,Inpatient,,,90,117,99.45,33.5322,117,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"C1 Esterase Inhib, Functional (Mayo)OutsideLaboratory",,83520,CPT,Facility,Outpatient,,,90,117,99.45,33.5322,117,Medica,Medical Assistance,52.182,44.6,,percent of total billed charges,,
"C1 Esterase Inhib, Functional (Mayo)OutsideLaboratory",,83520,CPT,Facility,Inpatient,,,90,117,99.45,33.5322,117,Medica,Medical Assistance,,,,,Included in per diem rate,
"C1 Esterase Inhib, Functional (Mayo)OutsideLaboratory",,83520,CPT,Facility,Outpatient,,,90,117,99.45,33.5322,117,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,58.266,49.8,,percent of total billed charges,,
"C1 Esterase Inhib, Functional (Mayo)OutsideLaboratory",,83520,CPT,Facility,Inpatient,,,90,117,99.45,33.5322,117,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"C1 Esterase Inhib, Functional (Mayo)OutsideLaboratory",,83520,CPT,Facility,Both,,,90,117,99.45,33.5322,117,"Multiplan, Inc.","Multiplan, Inc.",109.98,94,,percent of total billed charges,,
"C1 Esterase Inhib, Functional (Mayo)OutsideLaboratory",,83520,CPT,Facility,Outpatient,,,90,117,99.45,33.5322,117,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,101.088,86.4,,percent of total billed charges,,
"C1 Esterase Inhib, Functional (Mayo)OutsideLaboratory",,83520,CPT,Facility,Inpatient,,,90,117,99.45,33.5322,117,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"C1 Esterase Inhib, Functional (Mayo)OutsideLaboratory",,83520,CPT,Facility,Both,,,90,117,99.45,33.5322,117,"Preferred One Administrative Services, INC.",PPO,115.362,98.6,,percent of total billed charges,,
"C1 Esterase Inhib, Functional (Mayo)OutsideLaboratory",,83520,CPT,Facility,Outpatient,,,90,117,99.45,33.5322,117,PrimeWest Health,Minnesota Senior Health Options (MSHO),60.1965,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"C1 Esterase Inhib, Functional (Mayo)OutsideLaboratory",,83520,CPT,Facility,Inpatient,,,90,117,99.45,33.5322,117,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"C1 Esterase Inhib, Functional (Mayo)OutsideLaboratory",,83520,CPT,Facility,Outpatient,,,90,117,99.45,33.5322,117,PrimeWest Health,MinnesotaCare,60.0912,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"C1 Esterase Inhib, Functional (Mayo)OutsideLaboratory",,83520,CPT,Facility,Inpatient,,,90,117,99.45,33.5322,117,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"C1 Esterase Inhib, Functional (Mayo)OutsideLaboratory",,83520,CPT,Facility,Both,,,90,117,99.45,33.5322,117,Sanford Health Plan,Sanford Health Plan,107.64,92,,percent of total billed charges,,
"C1 Esterase Inhib, Functional (Mayo)OutsideLaboratory",,83520,CPT,Facility,Outpatient,,,90,117,99.45,33.5322,117,"UCare Health, Inc.",Individual & Family Plan,65.9295,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"C1 Esterase Inhib, Functional (Mayo)OutsideLaboratory",,83520,CPT,Facility,Inpatient,,,90,117,99.45,33.5322,117,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"C1 Esterase Inhib, Functional (Mayo)OutsideLaboratory",,83520,CPT,Facility,Outpatient,,,90,117,99.45,33.5322,117,"UCare Health, Inc.",Medical Assistance,59.0499,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"C1 Esterase Inhib, Functional (Mayo)OutsideLaboratory",,83520,CPT,Facility,Inpatient,,,90,117,99.45,33.5322,117,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"C1 Esterase Inhib, Functional (Mayo)OutsideLaboratory",,83520,CPT,Facility,Outpatient,,,90,117,99.45,33.5322,117,"UCare Health, Inc.",Medicare Advantage,59.0499,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"C1 Esterase Inhib, Functional (Mayo)OutsideLaboratory",,83520,CPT,Facility,Inpatient,,,90,117,99.45,33.5322,117,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"C1 Esterase Inhib, Functional (Mayo)OutsideLaboratory",,83520,CPT,Facility,Outpatient,,,90,117,99.45,33.5322,117,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),59.0499,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"C1 Esterase Inhib, Functional (Mayo)OutsideLaboratory",,83520,CPT,Facility,Inpatient,,,90,117,99.45,33.5322,117,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"C1 Esterase Inhib, Functional (Mayo)OutsideLaboratory",,83520,CPT,Facility,Both,,,90,117,99.45,33.5322,117,UnitedHealthcare,Individual & Family,109.98,94,,percent of total billed charges,,
"C1 Esterase Inhib, Functional (Mayo)OutsideLaboratory",,83520,CPT,Facility,Outpatient,,,90,117,99.45,33.5322,117,UnitedHealthcare,Medicare Advantage,57.33,49,,percent of total billed charges,,
"C1 Esterase Inhib, Functional (Mayo)OutsideLaboratory",,83520,CPT,Facility,Inpatient,,,90,117,99.45,33.5322,117,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"C1 Esterase Inhib, Functional (Mayo)OutsideLaboratory",,83520,CPT,Facility,Outpatient,,,90,117,99.45,33.5322,117,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,56.16,48,,percent of total billed charges,,100% of DHS outpatient percentage
"C1 Esterase Inhib, Functional (Mayo)OutsideLaboratory",,83520,CPT,Facility,Inpatient,,,90,117,99.45,33.5322,117,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Igfbp-3, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Both,,,90,87,73.95,24.9342,87,Aetna,Commercial,80.04,92,,percent of total billed charges,,
"Igfbp-3, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Outpatient,,,90,87,73.95,24.9342,87,Aetna,Medicare Advantage,42.63,49,,percent of total billed charges,,
"Igfbp-3, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Inpatient,,,90,87,73.95,24.9342,87,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Igfbp-3, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Both,,,90,87,73.95,24.9342,87,Aetna,PPO,80.91,93,,percent of total billed charges,,
"Igfbp-3, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Both,,,90,87,73.95,24.9342,87,America's PPO,America's PPO,83.5461,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Igfbp-3, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Both,,,90,87,73.95,24.9342,87,BlueCross BlueShield Minnesota, Federal Employee Program,85.608,98.4,,percent of total billed charges,,
"Igfbp-3, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Both,,,90,87,73.95,24.9342,87,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,87,100,,percent of total billed charges,,
"Igfbp-3, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Both,,,90,87,73.95,24.9342,87,BlueCross BlueShield Minnesota,High Value Network Plan,78.3,90,,percent of total billed charges,,
"Igfbp-3, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Outpatient,,,90,87,73.95,24.9342,87,BlueCross BlueShield Minnesota,Medicare Advantage,42.63,49,,percent of total billed charges,,
"Igfbp-3, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Inpatient,,,90,87,73.95,24.9342,87,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Igfbp-3, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Both,,,90,87,73.95,24.9342,87,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,77.0559,88.57,,percent of total billed charges,,
"Igfbp-3, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Both,,,90,87,73.95,24.9342,87,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,24.9342,28.66,,percent of total billed charges,,
"Igfbp-3, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Outpatient,,,90,87,73.95,24.9342,87,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),42.63,49,,percent of total billed charges,,
"Igfbp-3, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Inpatient,,,90,87,73.95,24.9342,87,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Igfbp-3, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Both,,,90,87,73.95,24.9342,87,CorVel,Worker's Compensation,87,100,,percent of total billed charges,,
"Igfbp-3, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Both,,,90,87,73.95,24.9342,87,First Health Group Corporation,First Health Network,84.39,97,,percent of total billed charges,,
"Igfbp-3, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Both,,,90,87,73.95,24.9342,87,"Health Partners, Inc.",Commercial,82.302,94.6,,percent of total billed charges,,
"Igfbp-3, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Outpatient,,,90,87,73.95,24.9342,87,"Health Partners, Inc.",Medicare Advantage,42.63,49,,percent of total billed charges,,
"Igfbp-3, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Inpatient,,,90,87,73.95,24.9342,87,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Igfbp-3, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Both,,,90,87,73.95,24.9342,87,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),52.2,60,,percent of total billed charges,,
"Igfbp-3, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Both,,,90,87,73.95,24.9342,87,"Health Partners, Inc.",State of Minnesota Advantage Program,70.905,81.5,,percent of total billed charges,,
"Igfbp-3, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Both,,,90,87,73.95,24.9342,87,"Health Partners, Inc.",State Public Programs,43.5,50,,percent of total billed charges,,
"Igfbp-3, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Both,,,90,87,73.95,24.9342,87,Humana Insurance Company,Commercial PPO,82.65,95,,percent of total billed charges,,
"Igfbp-3, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Outpatient,,,90,87,73.95,24.9342,87,Humana Insurance Company,Medicare PPO,42.63,49,,percent of total billed charges,,
"Igfbp-3, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Inpatient,,,90,87,73.95,24.9342,87,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Igfbp-3, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Both,,,90,87,73.95,24.9342,87,Medica,Individual & Family,86.217,99.1,,percent of total billed charges,,
"Igfbp-3, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Outpatient,,,90,87,73.95,24.9342,87,Medica,Medica Advantage Solution,43.326,49.8,,percent of total billed charges,,
"Igfbp-3, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Inpatient,,,90,87,73.95,24.9342,87,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Igfbp-3, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Outpatient,,,90,87,73.95,24.9342,87,Medica,Medical Assistance,38.802,44.6,,percent of total billed charges,,
"Igfbp-3, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Inpatient,,,90,87,73.95,24.9342,87,Medica,Medical Assistance,,,,,Included in per diem rate,
"Igfbp-3, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Outpatient,,,90,87,73.95,24.9342,87,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,43.326,49.8,,percent of total billed charges,,
"Igfbp-3, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Inpatient,,,90,87,73.95,24.9342,87,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Igfbp-3, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Both,,,90,87,73.95,24.9342,87,"Multiplan, Inc.","Multiplan, Inc.",81.78,94,,percent of total billed charges,,
"Igfbp-3, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Outpatient,,,90,87,73.95,24.9342,87,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,75.168,86.4,,percent of total billed charges,,
"Igfbp-3, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Inpatient,,,90,87,73.95,24.9342,87,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Igfbp-3, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Both,,,90,87,73.95,24.9342,87,"Preferred One Administrative Services, INC.",PPO,85.782,98.6,,percent of total billed charges,,
"Igfbp-3, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Outpatient,,,90,87,73.95,24.9342,87,PrimeWest Health,Minnesota Senior Health Options (MSHO),44.7615,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Igfbp-3, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Inpatient,,,90,87,73.95,24.9342,87,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Igfbp-3, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Outpatient,,,90,87,73.95,24.9342,87,PrimeWest Health,MinnesotaCare,44.6832,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Igfbp-3, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Inpatient,,,90,87,73.95,24.9342,87,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Igfbp-3, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Both,,,90,87,73.95,24.9342,87,Sanford Health Plan,Sanford Health Plan,80.04,92,,percent of total billed charges,,
"Igfbp-3, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Outpatient,,,90,87,73.95,24.9342,87,"UCare Health, Inc.",Individual & Family Plan,49.0245,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Igfbp-3, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Inpatient,,,90,87,73.95,24.9342,87,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Igfbp-3, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Outpatient,,,90,87,73.95,24.9342,87,"UCare Health, Inc.",Medical Assistance,43.9089,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Igfbp-3, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Inpatient,,,90,87,73.95,24.9342,87,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Igfbp-3, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Outpatient,,,90,87,73.95,24.9342,87,"UCare Health, Inc.",Medicare Advantage,43.9089,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Igfbp-3, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Inpatient,,,90,87,73.95,24.9342,87,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Igfbp-3, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Outpatient,,,90,87,73.95,24.9342,87,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),43.9089,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Igfbp-3, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Inpatient,,,90,87,73.95,24.9342,87,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Igfbp-3, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Both,,,90,87,73.95,24.9342,87,UnitedHealthcare,Individual & Family,81.78,94,,percent of total billed charges,,
"Igfbp-3, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Outpatient,,,90,87,73.95,24.9342,87,UnitedHealthcare,Medicare Advantage,42.63,49,,percent of total billed charges,,
"Igfbp-3, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Inpatient,,,90,87,73.95,24.9342,87,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Igfbp-3, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Outpatient,,,90,87,73.95,24.9342,87,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,41.76,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Igfbp-3, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Inpatient,,,90,87,73.95,24.9342,87,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Immunoassay Quant Nos Nonab (Mayo)OutsideLaboratory,,83520,CPT,Facility,Both,,,90,122,103.7,34.9652,122,Aetna,Commercial,112.24,92,,percent of total billed charges,,
Immunoassay Quant Nos Nonab (Mayo)OutsideLaboratory,,83520,CPT,Facility,Outpatient,,,90,122,103.7,34.9652,122,Aetna,Medicare Advantage,59.78,49,,percent of total billed charges,,
Immunoassay Quant Nos Nonab (Mayo)OutsideLaboratory,,83520,CPT,Facility,Inpatient,,,90,122,103.7,34.9652,122,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Immunoassay Quant Nos Nonab (Mayo)OutsideLaboratory,,83520,CPT,Facility,Both,,,90,122,103.7,34.9652,122,Aetna,PPO,113.46,93,,percent of total billed charges,,
Immunoassay Quant Nos Nonab (Mayo)OutsideLaboratory,,83520,CPT,Facility,Both,,,90,122,103.7,34.9652,122,America's PPO,America's PPO,117.1566,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Immunoassay Quant Nos Nonab (Mayo)OutsideLaboratory,,83520,CPT,Facility,Both,,,90,122,103.7,34.9652,122,BlueCross BlueShield Minnesota, Federal Employee Program,120.048,98.4,,percent of total billed charges,,
Immunoassay Quant Nos Nonab (Mayo)OutsideLaboratory,,83520,CPT,Facility,Both,,,90,122,103.7,34.9652,122,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,122,100,,percent of total billed charges,,
Immunoassay Quant Nos Nonab (Mayo)OutsideLaboratory,,83520,CPT,Facility,Both,,,90,122,103.7,34.9652,122,BlueCross BlueShield Minnesota,High Value Network Plan,109.8,90,,percent of total billed charges,,
Immunoassay Quant Nos Nonab (Mayo)OutsideLaboratory,,83520,CPT,Facility,Outpatient,,,90,122,103.7,34.9652,122,BlueCross BlueShield Minnesota,Medicare Advantage,59.78,49,,percent of total billed charges,,
Immunoassay Quant Nos Nonab (Mayo)OutsideLaboratory,,83520,CPT,Facility,Inpatient,,,90,122,103.7,34.9652,122,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Immunoassay Quant Nos Nonab (Mayo)OutsideLaboratory,,83520,CPT,Facility,Both,,,90,122,103.7,34.9652,122,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,108.0554,88.57,,percent of total billed charges,,
Immunoassay Quant Nos Nonab (Mayo)OutsideLaboratory,,83520,CPT,Facility,Both,,,90,122,103.7,34.9652,122,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,34.9652,28.66,,percent of total billed charges,,
Immunoassay Quant Nos Nonab (Mayo)OutsideLaboratory,,83520,CPT,Facility,Outpatient,,,90,122,103.7,34.9652,122,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),59.78,49,,percent of total billed charges,,
Immunoassay Quant Nos Nonab (Mayo)OutsideLaboratory,,83520,CPT,Facility,Inpatient,,,90,122,103.7,34.9652,122,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Immunoassay Quant Nos Nonab (Mayo)OutsideLaboratory,,83520,CPT,Facility,Both,,,90,122,103.7,34.9652,122,CorVel,Worker's Compensation,122,100,,percent of total billed charges,,
Immunoassay Quant Nos Nonab (Mayo)OutsideLaboratory,,83520,CPT,Facility,Both,,,90,122,103.7,34.9652,122,First Health Group Corporation,First Health Network,118.34,97,,percent of total billed charges,,
Immunoassay Quant Nos Nonab (Mayo)OutsideLaboratory,,83520,CPT,Facility,Both,,,90,122,103.7,34.9652,122,"Health Partners, Inc.",Commercial,115.412,94.6,,percent of total billed charges,,
Immunoassay Quant Nos Nonab (Mayo)OutsideLaboratory,,83520,CPT,Facility,Outpatient,,,90,122,103.7,34.9652,122,"Health Partners, Inc.",Medicare Advantage,59.78,49,,percent of total billed charges,,
Immunoassay Quant Nos Nonab (Mayo)OutsideLaboratory,,83520,CPT,Facility,Inpatient,,,90,122,103.7,34.9652,122,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Immunoassay Quant Nos Nonab (Mayo)OutsideLaboratory,,83520,CPT,Facility,Both,,,90,122,103.7,34.9652,122,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),73.2,60,,percent of total billed charges,,
Immunoassay Quant Nos Nonab (Mayo)OutsideLaboratory,,83520,CPT,Facility,Both,,,90,122,103.7,34.9652,122,"Health Partners, Inc.",State of Minnesota Advantage Program,99.43,81.5,,percent of total billed charges,,
Immunoassay Quant Nos Nonab (Mayo)OutsideLaboratory,,83520,CPT,Facility,Both,,,90,122,103.7,34.9652,122,"Health Partners, Inc.",State Public Programs,61,50,,percent of total billed charges,,
Immunoassay Quant Nos Nonab (Mayo)OutsideLaboratory,,83520,CPT,Facility,Both,,,90,122,103.7,34.9652,122,Humana Insurance Company,Commercial PPO,115.9,95,,percent of total billed charges,,
Immunoassay Quant Nos Nonab (Mayo)OutsideLaboratory,,83520,CPT,Facility,Outpatient,,,90,122,103.7,34.9652,122,Humana Insurance Company,Medicare PPO,59.78,49,,percent of total billed charges,,
Immunoassay Quant Nos Nonab (Mayo)OutsideLaboratory,,83520,CPT,Facility,Inpatient,,,90,122,103.7,34.9652,122,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Immunoassay Quant Nos Nonab (Mayo)OutsideLaboratory,,83520,CPT,Facility,Both,,,90,122,103.7,34.9652,122,Medica,Individual & Family,120.902,99.1,,percent of total billed charges,,
Immunoassay Quant Nos Nonab (Mayo)OutsideLaboratory,,83520,CPT,Facility,Outpatient,,,90,122,103.7,34.9652,122,Medica,Medica Advantage Solution,60.756,49.8,,percent of total billed charges,,
Immunoassay Quant Nos Nonab (Mayo)OutsideLaboratory,,83520,CPT,Facility,Inpatient,,,90,122,103.7,34.9652,122,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Immunoassay Quant Nos Nonab (Mayo)OutsideLaboratory,,83520,CPT,Facility,Outpatient,,,90,122,103.7,34.9652,122,Medica,Medical Assistance,54.412,44.6,,percent of total billed charges,,
Immunoassay Quant Nos Nonab (Mayo)OutsideLaboratory,,83520,CPT,Facility,Inpatient,,,90,122,103.7,34.9652,122,Medica,Medical Assistance,,,,,Included in per diem rate,
Immunoassay Quant Nos Nonab (Mayo)OutsideLaboratory,,83520,CPT,Facility,Outpatient,,,90,122,103.7,34.9652,122,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,60.756,49.8,,percent of total billed charges,,
Immunoassay Quant Nos Nonab (Mayo)OutsideLaboratory,,83520,CPT,Facility,Inpatient,,,90,122,103.7,34.9652,122,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Immunoassay Quant Nos Nonab (Mayo)OutsideLaboratory,,83520,CPT,Facility,Both,,,90,122,103.7,34.9652,122,"Multiplan, Inc.","Multiplan, Inc.",114.68,94,,percent of total billed charges,,
Immunoassay Quant Nos Nonab (Mayo)OutsideLaboratory,,83520,CPT,Facility,Outpatient,,,90,122,103.7,34.9652,122,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,105.408,86.4,,percent of total billed charges,,
Immunoassay Quant Nos Nonab (Mayo)OutsideLaboratory,,83520,CPT,Facility,Inpatient,,,90,122,103.7,34.9652,122,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Immunoassay Quant Nos Nonab (Mayo)OutsideLaboratory,,83520,CPT,Facility,Both,,,90,122,103.7,34.9652,122,"Preferred One Administrative Services, INC.",PPO,120.292,98.6,,percent of total billed charges,,
Immunoassay Quant Nos Nonab (Mayo)OutsideLaboratory,,83520,CPT,Facility,Outpatient,,,90,122,103.7,34.9652,122,PrimeWest Health,Minnesota Senior Health Options (MSHO),62.769,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Immunoassay Quant Nos Nonab (Mayo)OutsideLaboratory,,83520,CPT,Facility,Inpatient,,,90,122,103.7,34.9652,122,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Immunoassay Quant Nos Nonab (Mayo)OutsideLaboratory,,83520,CPT,Facility,Outpatient,,,90,122,103.7,34.9652,122,PrimeWest Health,MinnesotaCare,62.6592,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Immunoassay Quant Nos Nonab (Mayo)OutsideLaboratory,,83520,CPT,Facility,Inpatient,,,90,122,103.7,34.9652,122,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Immunoassay Quant Nos Nonab (Mayo)OutsideLaboratory,,83520,CPT,Facility,Both,,,90,122,103.7,34.9652,122,Sanford Health Plan,Sanford Health Plan,112.24,92,,percent of total billed charges,,
Immunoassay Quant Nos Nonab (Mayo)OutsideLaboratory,,83520,CPT,Facility,Outpatient,,,90,122,103.7,34.9652,122,"UCare Health, Inc.",Individual & Family Plan,68.747,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Immunoassay Quant Nos Nonab (Mayo)OutsideLaboratory,,83520,CPT,Facility,Inpatient,,,90,122,103.7,34.9652,122,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Immunoassay Quant Nos Nonab (Mayo)OutsideLaboratory,,83520,CPT,Facility,Outpatient,,,90,122,103.7,34.9652,122,"UCare Health, Inc.",Medical Assistance,61.5734,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Immunoassay Quant Nos Nonab (Mayo)OutsideLaboratory,,83520,CPT,Facility,Inpatient,,,90,122,103.7,34.9652,122,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Immunoassay Quant Nos Nonab (Mayo)OutsideLaboratory,,83520,CPT,Facility,Outpatient,,,90,122,103.7,34.9652,122,"UCare Health, Inc.",Medicare Advantage,61.5734,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Immunoassay Quant Nos Nonab (Mayo)OutsideLaboratory,,83520,CPT,Facility,Inpatient,,,90,122,103.7,34.9652,122,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Immunoassay Quant Nos Nonab (Mayo)OutsideLaboratory,,83520,CPT,Facility,Outpatient,,,90,122,103.7,34.9652,122,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),61.5734,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Immunoassay Quant Nos Nonab (Mayo)OutsideLaboratory,,83520,CPT,Facility,Inpatient,,,90,122,103.7,34.9652,122,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Immunoassay Quant Nos Nonab (Mayo)OutsideLaboratory,,83520,CPT,Facility,Both,,,90,122,103.7,34.9652,122,UnitedHealthcare,Individual & Family,114.68,94,,percent of total billed charges,,
Immunoassay Quant Nos Nonab (Mayo)OutsideLaboratory,,83520,CPT,Facility,Outpatient,,,90,122,103.7,34.9652,122,UnitedHealthcare,Medicare Advantage,59.78,49,,percent of total billed charges,,
Immunoassay Quant Nos Nonab (Mayo)OutsideLaboratory,,83520,CPT,Facility,Inpatient,,,90,122,103.7,34.9652,122,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Immunoassay Quant Nos Nonab (Mayo)OutsideLaboratory,,83520,CPT,Facility,Outpatient,,,90,122,103.7,34.9652,122,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,58.56,48,,percent of total billed charges,,100% of DHS outpatient percentage
Immunoassay Quant Nos Nonab (Mayo)OutsideLaboratory,,83520,CPT,Facility,Inpatient,,,90,122,103.7,34.9652,122,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Thyrotropin Receptor Ab, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Both,,,90,192,163.2,55.0272,192,Aetna,Commercial,176.64,92,,percent of total billed charges,,
"Thyrotropin Receptor Ab, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Outpatient,,,90,192,163.2,55.0272,192,Aetna,Medicare Advantage,94.08,49,,percent of total billed charges,,
"Thyrotropin Receptor Ab, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Inpatient,,,90,192,163.2,55.0272,192,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Thyrotropin Receptor Ab, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Both,,,90,192,163.2,55.0272,192,Aetna,PPO,178.56,93,,percent of total billed charges,,
"Thyrotropin Receptor Ab, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Both,,,90,192,163.2,55.0272,192,America's PPO,America's PPO,184.3776,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Thyrotropin Receptor Ab, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Both,,,90,192,163.2,55.0272,192,BlueCross BlueShield Minnesota, Federal Employee Program,188.928,98.4,,percent of total billed charges,,
"Thyrotropin Receptor Ab, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Both,,,90,192,163.2,55.0272,192,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,192,100,,percent of total billed charges,,
"Thyrotropin Receptor Ab, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Both,,,90,192,163.2,55.0272,192,BlueCross BlueShield Minnesota,High Value Network Plan,172.8,90,,percent of total billed charges,,
"Thyrotropin Receptor Ab, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Outpatient,,,90,192,163.2,55.0272,192,BlueCross BlueShield Minnesota,Medicare Advantage,94.08,49,,percent of total billed charges,,
"Thyrotropin Receptor Ab, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Inpatient,,,90,192,163.2,55.0272,192,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Thyrotropin Receptor Ab, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Both,,,90,192,163.2,55.0272,192,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,170.0544,88.57,,percent of total billed charges,,
"Thyrotropin Receptor Ab, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Both,,,90,192,163.2,55.0272,192,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,55.0272,28.66,,percent of total billed charges,,
"Thyrotropin Receptor Ab, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Outpatient,,,90,192,163.2,55.0272,192,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),94.08,49,,percent of total billed charges,,
"Thyrotropin Receptor Ab, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Inpatient,,,90,192,163.2,55.0272,192,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Thyrotropin Receptor Ab, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Both,,,90,192,163.2,55.0272,192,CorVel,Worker's Compensation,192,100,,percent of total billed charges,,
"Thyrotropin Receptor Ab, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Both,,,90,192,163.2,55.0272,192,First Health Group Corporation,First Health Network,186.24,97,,percent of total billed charges,,
"Thyrotropin Receptor Ab, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Both,,,90,192,163.2,55.0272,192,"Health Partners, Inc.",Commercial,181.632,94.6,,percent of total billed charges,,
"Thyrotropin Receptor Ab, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Outpatient,,,90,192,163.2,55.0272,192,"Health Partners, Inc.",Medicare Advantage,94.08,49,,percent of total billed charges,,
"Thyrotropin Receptor Ab, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Inpatient,,,90,192,163.2,55.0272,192,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Thyrotropin Receptor Ab, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Both,,,90,192,163.2,55.0272,192,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),115.2,60,,percent of total billed charges,,
"Thyrotropin Receptor Ab, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Both,,,90,192,163.2,55.0272,192,"Health Partners, Inc.",State of Minnesota Advantage Program,156.48,81.5,,percent of total billed charges,,
"Thyrotropin Receptor Ab, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Both,,,90,192,163.2,55.0272,192,"Health Partners, Inc.",State Public Programs,96,50,,percent of total billed charges,,
"Thyrotropin Receptor Ab, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Both,,,90,192,163.2,55.0272,192,Humana Insurance Company,Commercial PPO,182.4,95,,percent of total billed charges,,
"Thyrotropin Receptor Ab, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Outpatient,,,90,192,163.2,55.0272,192,Humana Insurance Company,Medicare PPO,94.08,49,,percent of total billed charges,,
"Thyrotropin Receptor Ab, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Inpatient,,,90,192,163.2,55.0272,192,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Thyrotropin Receptor Ab, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Both,,,90,192,163.2,55.0272,192,Medica,Individual & Family,190.272,99.1,,percent of total billed charges,,
"Thyrotropin Receptor Ab, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Outpatient,,,90,192,163.2,55.0272,192,Medica,Medica Advantage Solution,95.616,49.8,,percent of total billed charges,,
"Thyrotropin Receptor Ab, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Inpatient,,,90,192,163.2,55.0272,192,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Thyrotropin Receptor Ab, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Outpatient,,,90,192,163.2,55.0272,192,Medica,Medical Assistance,85.632,44.6,,percent of total billed charges,,
"Thyrotropin Receptor Ab, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Inpatient,,,90,192,163.2,55.0272,192,Medica,Medical Assistance,,,,,Included in per diem rate,
"Thyrotropin Receptor Ab, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Outpatient,,,90,192,163.2,55.0272,192,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,95.616,49.8,,percent of total billed charges,,
"Thyrotropin Receptor Ab, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Inpatient,,,90,192,163.2,55.0272,192,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Thyrotropin Receptor Ab, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Both,,,90,192,163.2,55.0272,192,"Multiplan, Inc.","Multiplan, Inc.",180.48,94,,percent of total billed charges,,
"Thyrotropin Receptor Ab, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Outpatient,,,90,192,163.2,55.0272,192,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,165.888,86.4,,percent of total billed charges,,
"Thyrotropin Receptor Ab, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Inpatient,,,90,192,163.2,55.0272,192,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Thyrotropin Receptor Ab, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Both,,,90,192,163.2,55.0272,192,"Preferred One Administrative Services, INC.",PPO,189.312,98.6,,percent of total billed charges,,
"Thyrotropin Receptor Ab, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Outpatient,,,90,192,163.2,55.0272,192,PrimeWest Health,Minnesota Senior Health Options (MSHO),98.784,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Thyrotropin Receptor Ab, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Inpatient,,,90,192,163.2,55.0272,192,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Thyrotropin Receptor Ab, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Outpatient,,,90,192,163.2,55.0272,192,PrimeWest Health,MinnesotaCare,98.6112,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Thyrotropin Receptor Ab, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Inpatient,,,90,192,163.2,55.0272,192,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Thyrotropin Receptor Ab, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Both,,,90,192,163.2,55.0272,192,Sanford Health Plan,Sanford Health Plan,176.64,92,,percent of total billed charges,,
"Thyrotropin Receptor Ab, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Outpatient,,,90,192,163.2,55.0272,192,"UCare Health, Inc.",Individual & Family Plan,108.192,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Thyrotropin Receptor Ab, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Inpatient,,,90,192,163.2,55.0272,192,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Thyrotropin Receptor Ab, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Outpatient,,,90,192,163.2,55.0272,192,"UCare Health, Inc.",Medical Assistance,96.9024,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Thyrotropin Receptor Ab, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Inpatient,,,90,192,163.2,55.0272,192,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Thyrotropin Receptor Ab, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Outpatient,,,90,192,163.2,55.0272,192,"UCare Health, Inc.",Medicare Advantage,96.9024,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Thyrotropin Receptor Ab, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Inpatient,,,90,192,163.2,55.0272,192,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Thyrotropin Receptor Ab, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Outpatient,,,90,192,163.2,55.0272,192,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),96.9024,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Thyrotropin Receptor Ab, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Inpatient,,,90,192,163.2,55.0272,192,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Thyrotropin Receptor Ab, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Both,,,90,192,163.2,55.0272,192,UnitedHealthcare,Individual & Family,180.48,94,,percent of total billed charges,,
"Thyrotropin Receptor Ab, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Outpatient,,,90,192,163.2,55.0272,192,UnitedHealthcare,Medicare Advantage,94.08,49,,percent of total billed charges,,
"Thyrotropin Receptor Ab, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Inpatient,,,90,192,163.2,55.0272,192,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Thyrotropin Receptor Ab, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Outpatient,,,90,192,163.2,55.0272,192,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,92.16,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Thyrotropin Receptor Ab, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Inpatient,,,90,192,163.2,55.0272,192,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Tryptase, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Both,,,90,192,163.2,55.0272,192,Aetna,Commercial,176.64,92,,percent of total billed charges,,
"Tryptase, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Outpatient,,,90,192,163.2,55.0272,192,Aetna,Medicare Advantage,94.08,49,,percent of total billed charges,,
"Tryptase, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Inpatient,,,90,192,163.2,55.0272,192,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Tryptase, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Both,,,90,192,163.2,55.0272,192,Aetna,PPO,178.56,93,,percent of total billed charges,,
"Tryptase, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Both,,,90,192,163.2,55.0272,192,America's PPO,America's PPO,184.3776,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Tryptase, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Both,,,90,192,163.2,55.0272,192,BlueCross BlueShield Minnesota, Federal Employee Program,188.928,98.4,,percent of total billed charges,,
"Tryptase, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Both,,,90,192,163.2,55.0272,192,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,192,100,,percent of total billed charges,,
"Tryptase, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Both,,,90,192,163.2,55.0272,192,BlueCross BlueShield Minnesota,High Value Network Plan,172.8,90,,percent of total billed charges,,
"Tryptase, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Outpatient,,,90,192,163.2,55.0272,192,BlueCross BlueShield Minnesota,Medicare Advantage,94.08,49,,percent of total billed charges,,
"Tryptase, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Inpatient,,,90,192,163.2,55.0272,192,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Tryptase, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Both,,,90,192,163.2,55.0272,192,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,170.0544,88.57,,percent of total billed charges,,
"Tryptase, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Both,,,90,192,163.2,55.0272,192,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,55.0272,28.66,,percent of total billed charges,,
"Tryptase, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Outpatient,,,90,192,163.2,55.0272,192,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),94.08,49,,percent of total billed charges,,
"Tryptase, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Inpatient,,,90,192,163.2,55.0272,192,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Tryptase, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Both,,,90,192,163.2,55.0272,192,CorVel,Worker's Compensation,192,100,,percent of total billed charges,,
"Tryptase, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Both,,,90,192,163.2,55.0272,192,First Health Group Corporation,First Health Network,186.24,97,,percent of total billed charges,,
"Tryptase, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Both,,,90,192,163.2,55.0272,192,"Health Partners, Inc.",Commercial,181.632,94.6,,percent of total billed charges,,
"Tryptase, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Outpatient,,,90,192,163.2,55.0272,192,"Health Partners, Inc.",Medicare Advantage,94.08,49,,percent of total billed charges,,
"Tryptase, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Inpatient,,,90,192,163.2,55.0272,192,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Tryptase, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Both,,,90,192,163.2,55.0272,192,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),115.2,60,,percent of total billed charges,,
"Tryptase, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Both,,,90,192,163.2,55.0272,192,"Health Partners, Inc.",State of Minnesota Advantage Program,156.48,81.5,,percent of total billed charges,,
"Tryptase, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Both,,,90,192,163.2,55.0272,192,"Health Partners, Inc.",State Public Programs,96,50,,percent of total billed charges,,
"Tryptase, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Both,,,90,192,163.2,55.0272,192,Humana Insurance Company,Commercial PPO,182.4,95,,percent of total billed charges,,
"Tryptase, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Outpatient,,,90,192,163.2,55.0272,192,Humana Insurance Company,Medicare PPO,94.08,49,,percent of total billed charges,,
"Tryptase, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Inpatient,,,90,192,163.2,55.0272,192,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Tryptase, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Both,,,90,192,163.2,55.0272,192,Medica,Individual & Family,190.272,99.1,,percent of total billed charges,,
"Tryptase, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Outpatient,,,90,192,163.2,55.0272,192,Medica,Medica Advantage Solution,95.616,49.8,,percent of total billed charges,,
"Tryptase, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Inpatient,,,90,192,163.2,55.0272,192,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Tryptase, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Outpatient,,,90,192,163.2,55.0272,192,Medica,Medical Assistance,85.632,44.6,,percent of total billed charges,,
"Tryptase, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Inpatient,,,90,192,163.2,55.0272,192,Medica,Medical Assistance,,,,,Included in per diem rate,
"Tryptase, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Outpatient,,,90,192,163.2,55.0272,192,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,95.616,49.8,,percent of total billed charges,,
"Tryptase, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Inpatient,,,90,192,163.2,55.0272,192,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Tryptase, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Both,,,90,192,163.2,55.0272,192,"Multiplan, Inc.","Multiplan, Inc.",180.48,94,,percent of total billed charges,,
"Tryptase, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Outpatient,,,90,192,163.2,55.0272,192,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,165.888,86.4,,percent of total billed charges,,
"Tryptase, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Inpatient,,,90,192,163.2,55.0272,192,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Tryptase, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Both,,,90,192,163.2,55.0272,192,"Preferred One Administrative Services, INC.",PPO,189.312,98.6,,percent of total billed charges,,
"Tryptase, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Outpatient,,,90,192,163.2,55.0272,192,PrimeWest Health,Minnesota Senior Health Options (MSHO),98.784,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Tryptase, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Inpatient,,,90,192,163.2,55.0272,192,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Tryptase, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Outpatient,,,90,192,163.2,55.0272,192,PrimeWest Health,MinnesotaCare,98.6112,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Tryptase, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Inpatient,,,90,192,163.2,55.0272,192,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Tryptase, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Both,,,90,192,163.2,55.0272,192,Sanford Health Plan,Sanford Health Plan,176.64,92,,percent of total billed charges,,
"Tryptase, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Outpatient,,,90,192,163.2,55.0272,192,"UCare Health, Inc.",Individual & Family Plan,108.192,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Tryptase, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Inpatient,,,90,192,163.2,55.0272,192,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Tryptase, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Outpatient,,,90,192,163.2,55.0272,192,"UCare Health, Inc.",Medical Assistance,96.9024,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Tryptase, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Inpatient,,,90,192,163.2,55.0272,192,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Tryptase, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Outpatient,,,90,192,163.2,55.0272,192,"UCare Health, Inc.",Medicare Advantage,96.9024,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Tryptase, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Inpatient,,,90,192,163.2,55.0272,192,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Tryptase, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Outpatient,,,90,192,163.2,55.0272,192,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),96.9024,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Tryptase, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Inpatient,,,90,192,163.2,55.0272,192,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Tryptase, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Both,,,90,192,163.2,55.0272,192,UnitedHealthcare,Individual & Family,180.48,94,,percent of total billed charges,,
"Tryptase, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Outpatient,,,90,192,163.2,55.0272,192,UnitedHealthcare,Medicare Advantage,94.08,49,,percent of total billed charges,,
"Tryptase, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Inpatient,,,90,192,163.2,55.0272,192,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Tryptase, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Outpatient,,,90,192,163.2,55.0272,192,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,92.16,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Tryptase, S (Mayo)OutsideLaboratory",,83520,CPT,Facility,Inpatient,,,90,192,163.2,55.0272,192,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Insulin, S (Mayo)OutsideLaboratory",,83525,CPT,Facility,Both,,,90,89,75.65,25.5074,89,Aetna,Commercial,81.88,92,,percent of total billed charges,,
"Insulin, S (Mayo)OutsideLaboratory",,83525,CPT,Facility,Outpatient,,,90,89,75.65,25.5074,89,Aetna,Medicare Advantage,43.61,49,,percent of total billed charges,,
"Insulin, S (Mayo)OutsideLaboratory",,83525,CPT,Facility,Inpatient,,,90,89,75.65,25.5074,89,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Insulin, S (Mayo)OutsideLaboratory",,83525,CPT,Facility,Both,,,90,89,75.65,25.5074,89,Aetna,PPO,82.77,93,,percent of total billed charges,,
"Insulin, S (Mayo)OutsideLaboratory",,83525,CPT,Facility,Both,,,90,89,75.65,25.5074,89,America's PPO,America's PPO,85.4667,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Insulin, S (Mayo)OutsideLaboratory",,83525,CPT,Facility,Both,,,90,89,75.65,25.5074,89,BlueCross BlueShield Minnesota, Federal Employee Program,87.576,98.4,,percent of total billed charges,,
"Insulin, S (Mayo)OutsideLaboratory",,83525,CPT,Facility,Both,,,90,89,75.65,25.5074,89,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,89,100,,percent of total billed charges,,
"Insulin, S (Mayo)OutsideLaboratory",,83525,CPT,Facility,Both,,,90,89,75.65,25.5074,89,BlueCross BlueShield Minnesota,High Value Network Plan,80.1,90,,percent of total billed charges,,
"Insulin, S (Mayo)OutsideLaboratory",,83525,CPT,Facility,Outpatient,,,90,89,75.65,25.5074,89,BlueCross BlueShield Minnesota,Medicare Advantage,43.61,49,,percent of total billed charges,,
"Insulin, S (Mayo)OutsideLaboratory",,83525,CPT,Facility,Inpatient,,,90,89,75.65,25.5074,89,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Insulin, S (Mayo)OutsideLaboratory",,83525,CPT,Facility,Both,,,90,89,75.65,25.5074,89,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,78.8273,88.57,,percent of total billed charges,,
"Insulin, S (Mayo)OutsideLaboratory",,83525,CPT,Facility,Both,,,90,89,75.65,25.5074,89,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,25.5074,28.66,,percent of total billed charges,,
"Insulin, S (Mayo)OutsideLaboratory",,83525,CPT,Facility,Outpatient,,,90,89,75.65,25.5074,89,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),43.61,49,,percent of total billed charges,,
"Insulin, S (Mayo)OutsideLaboratory",,83525,CPT,Facility,Inpatient,,,90,89,75.65,25.5074,89,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Insulin, S (Mayo)OutsideLaboratory",,83525,CPT,Facility,Both,,,90,89,75.65,25.5074,89,CorVel,Worker's Compensation,89,100,,percent of total billed charges,,
"Insulin, S (Mayo)OutsideLaboratory",,83525,CPT,Facility,Both,,,90,89,75.65,25.5074,89,First Health Group Corporation,First Health Network,86.33,97,,percent of total billed charges,,
"Insulin, S (Mayo)OutsideLaboratory",,83525,CPT,Facility,Both,,,90,89,75.65,25.5074,89,"Health Partners, Inc.",Commercial,84.194,94.6,,percent of total billed charges,,
"Insulin, S (Mayo)OutsideLaboratory",,83525,CPT,Facility,Outpatient,,,90,89,75.65,25.5074,89,"Health Partners, Inc.",Medicare Advantage,43.61,49,,percent of total billed charges,,
"Insulin, S (Mayo)OutsideLaboratory",,83525,CPT,Facility,Inpatient,,,90,89,75.65,25.5074,89,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Insulin, S (Mayo)OutsideLaboratory",,83525,CPT,Facility,Both,,,90,89,75.65,25.5074,89,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),53.4,60,,percent of total billed charges,,
"Insulin, S (Mayo)OutsideLaboratory",,83525,CPT,Facility,Both,,,90,89,75.65,25.5074,89,"Health Partners, Inc.",State of Minnesota Advantage Program,72.535,81.5,,percent of total billed charges,,
"Insulin, S (Mayo)OutsideLaboratory",,83525,CPT,Facility,Both,,,90,89,75.65,25.5074,89,"Health Partners, Inc.",State Public Programs,44.5,50,,percent of total billed charges,,
"Insulin, S (Mayo)OutsideLaboratory",,83525,CPT,Facility,Both,,,90,89,75.65,25.5074,89,Humana Insurance Company,Commercial PPO,84.55,95,,percent of total billed charges,,
"Insulin, S (Mayo)OutsideLaboratory",,83525,CPT,Facility,Outpatient,,,90,89,75.65,25.5074,89,Humana Insurance Company,Medicare PPO,43.61,49,,percent of total billed charges,,
"Insulin, S (Mayo)OutsideLaboratory",,83525,CPT,Facility,Inpatient,,,90,89,75.65,25.5074,89,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Insulin, S (Mayo)OutsideLaboratory",,83525,CPT,Facility,Both,,,90,89,75.65,25.5074,89,Medica,Individual & Family,88.199,99.1,,percent of total billed charges,,
"Insulin, S (Mayo)OutsideLaboratory",,83525,CPT,Facility,Outpatient,,,90,89,75.65,25.5074,89,Medica,Medica Advantage Solution,44.322,49.8,,percent of total billed charges,,
"Insulin, S (Mayo)OutsideLaboratory",,83525,CPT,Facility,Inpatient,,,90,89,75.65,25.5074,89,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Insulin, S (Mayo)OutsideLaboratory",,83525,CPT,Facility,Outpatient,,,90,89,75.65,25.5074,89,Medica,Medical Assistance,39.694,44.6,,percent of total billed charges,,
"Insulin, S (Mayo)OutsideLaboratory",,83525,CPT,Facility,Inpatient,,,90,89,75.65,25.5074,89,Medica,Medical Assistance,,,,,Included in per diem rate,
"Insulin, S (Mayo)OutsideLaboratory",,83525,CPT,Facility,Outpatient,,,90,89,75.65,25.5074,89,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,44.322,49.8,,percent of total billed charges,,
"Insulin, S (Mayo)OutsideLaboratory",,83525,CPT,Facility,Inpatient,,,90,89,75.65,25.5074,89,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Insulin, S (Mayo)OutsideLaboratory",,83525,CPT,Facility,Both,,,90,89,75.65,25.5074,89,"Multiplan, Inc.","Multiplan, Inc.",83.66,94,,percent of total billed charges,,
"Insulin, S (Mayo)OutsideLaboratory",,83525,CPT,Facility,Outpatient,,,90,89,75.65,25.5074,89,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,76.896,86.4,,percent of total billed charges,,
"Insulin, S (Mayo)OutsideLaboratory",,83525,CPT,Facility,Inpatient,,,90,89,75.65,25.5074,89,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Insulin, S (Mayo)OutsideLaboratory",,83525,CPT,Facility,Both,,,90,89,75.65,25.5074,89,"Preferred One Administrative Services, INC.",PPO,87.754,98.6,,percent of total billed charges,,
"Insulin, S (Mayo)OutsideLaboratory",,83525,CPT,Facility,Outpatient,,,90,89,75.65,25.5074,89,PrimeWest Health,Minnesota Senior Health Options (MSHO),45.7905,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Insulin, S (Mayo)OutsideLaboratory",,83525,CPT,Facility,Inpatient,,,90,89,75.65,25.5074,89,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Insulin, S (Mayo)OutsideLaboratory",,83525,CPT,Facility,Outpatient,,,90,89,75.65,25.5074,89,PrimeWest Health,MinnesotaCare,45.7104,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Insulin, S (Mayo)OutsideLaboratory",,83525,CPT,Facility,Inpatient,,,90,89,75.65,25.5074,89,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Insulin, S (Mayo)OutsideLaboratory",,83525,CPT,Facility,Both,,,90,89,75.65,25.5074,89,Sanford Health Plan,Sanford Health Plan,81.88,92,,percent of total billed charges,,
"Insulin, S (Mayo)OutsideLaboratory",,83525,CPT,Facility,Outpatient,,,90,89,75.65,25.5074,89,"UCare Health, Inc.",Individual & Family Plan,50.1515,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Insulin, S (Mayo)OutsideLaboratory",,83525,CPT,Facility,Inpatient,,,90,89,75.65,25.5074,89,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Insulin, S (Mayo)OutsideLaboratory",,83525,CPT,Facility,Outpatient,,,90,89,75.65,25.5074,89,"UCare Health, Inc.",Medical Assistance,44.9183,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Insulin, S (Mayo)OutsideLaboratory",,83525,CPT,Facility,Inpatient,,,90,89,75.65,25.5074,89,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Insulin, S (Mayo)OutsideLaboratory",,83525,CPT,Facility,Outpatient,,,90,89,75.65,25.5074,89,"UCare Health, Inc.",Medicare Advantage,44.9183,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Insulin, S (Mayo)OutsideLaboratory",,83525,CPT,Facility,Inpatient,,,90,89,75.65,25.5074,89,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Insulin, S (Mayo)OutsideLaboratory",,83525,CPT,Facility,Outpatient,,,90,89,75.65,25.5074,89,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),44.9183,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Insulin, S (Mayo)OutsideLaboratory",,83525,CPT,Facility,Inpatient,,,90,89,75.65,25.5074,89,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Insulin, S (Mayo)OutsideLaboratory",,83525,CPT,Facility,Both,,,90,89,75.65,25.5074,89,UnitedHealthcare,Individual & Family,83.66,94,,percent of total billed charges,,
"Insulin, S (Mayo)OutsideLaboratory",,83525,CPT,Facility,Outpatient,,,90,89,75.65,25.5074,89,UnitedHealthcare,Medicare Advantage,43.61,49,,percent of total billed charges,,
"Insulin, S (Mayo)OutsideLaboratory",,83525,CPT,Facility,Inpatient,,,90,89,75.65,25.5074,89,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Insulin, S (Mayo)OutsideLaboratory",,83525,CPT,Facility,Outpatient,,,90,89,75.65,25.5074,89,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,42.72,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Insulin, S (Mayo)OutsideLaboratory",,83525,CPT,Facility,Inpatient,,,90,89,75.65,25.5074,89,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Lactic Dehydrogenase (Mayo)OutsideLaboratory,,83615,CPT,Facility,Both,,,90,66,56.1,18.9156,66,Aetna,Commercial,60.72,92,,percent of total billed charges,,
Lactic Dehydrogenase (Mayo)OutsideLaboratory,,83615,CPT,Facility,Outpatient,,,90,66,56.1,18.9156,66,Aetna,Medicare Advantage,32.34,49,,percent of total billed charges,,
Lactic Dehydrogenase (Mayo)OutsideLaboratory,,83615,CPT,Facility,Inpatient,,,90,66,56.1,18.9156,66,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Lactic Dehydrogenase (Mayo)OutsideLaboratory,,83615,CPT,Facility,Both,,,90,66,56.1,18.9156,66,Aetna,PPO,61.38,93,,percent of total billed charges,,
Lactic Dehydrogenase (Mayo)OutsideLaboratory,,83615,CPT,Facility,Both,,,90,66,56.1,18.9156,66,America's PPO,America's PPO,63.3798,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Lactic Dehydrogenase (Mayo)OutsideLaboratory,,83615,CPT,Facility,Both,,,90,66,56.1,18.9156,66,BlueCross BlueShield Minnesota, Federal Employee Program,64.944,98.4,,percent of total billed charges,,
Lactic Dehydrogenase (Mayo)OutsideLaboratory,,83615,CPT,Facility,Both,,,90,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,66,100,,percent of total billed charges,,
Lactic Dehydrogenase (Mayo)OutsideLaboratory,,83615,CPT,Facility,Both,,,90,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,High Value Network Plan,59.4,90,,percent of total billed charges,,
Lactic Dehydrogenase (Mayo)OutsideLaboratory,,83615,CPT,Facility,Outpatient,,,90,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,Medicare Advantage,32.34,49,,percent of total billed charges,,
Lactic Dehydrogenase (Mayo)OutsideLaboratory,,83615,CPT,Facility,Inpatient,,,90,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Lactic Dehydrogenase (Mayo)OutsideLaboratory,,83615,CPT,Facility,Both,,,90,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,58.4562,88.57,,percent of total billed charges,,
Lactic Dehydrogenase (Mayo)OutsideLaboratory,,83615,CPT,Facility,Both,,,90,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,18.9156,28.66,,percent of total billed charges,,
Lactic Dehydrogenase (Mayo)OutsideLaboratory,,83615,CPT,Facility,Outpatient,,,90,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),32.34,49,,percent of total billed charges,,
Lactic Dehydrogenase (Mayo)OutsideLaboratory,,83615,CPT,Facility,Inpatient,,,90,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Lactic Dehydrogenase (Mayo)OutsideLaboratory,,83615,CPT,Facility,Both,,,90,66,56.1,18.9156,66,CorVel,Worker's Compensation,66,100,,percent of total billed charges,,
Lactic Dehydrogenase (Mayo)OutsideLaboratory,,83615,CPT,Facility,Both,,,90,66,56.1,18.9156,66,First Health Group Corporation,First Health Network,64.02,97,,percent of total billed charges,,
Lactic Dehydrogenase (Mayo)OutsideLaboratory,,83615,CPT,Facility,Both,,,90,66,56.1,18.9156,66,"Health Partners, Inc.",Commercial,62.436,94.6,,percent of total billed charges,,
Lactic Dehydrogenase (Mayo)OutsideLaboratory,,83615,CPT,Facility,Outpatient,,,90,66,56.1,18.9156,66,"Health Partners, Inc.",Medicare Advantage,32.34,49,,percent of total billed charges,,
Lactic Dehydrogenase (Mayo)OutsideLaboratory,,83615,CPT,Facility,Inpatient,,,90,66,56.1,18.9156,66,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Lactic Dehydrogenase (Mayo)OutsideLaboratory,,83615,CPT,Facility,Both,,,90,66,56.1,18.9156,66,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),39.6,60,,percent of total billed charges,,
Lactic Dehydrogenase (Mayo)OutsideLaboratory,,83615,CPT,Facility,Both,,,90,66,56.1,18.9156,66,"Health Partners, Inc.",State of Minnesota Advantage Program,53.79,81.5,,percent of total billed charges,,
Lactic Dehydrogenase (Mayo)OutsideLaboratory,,83615,CPT,Facility,Both,,,90,66,56.1,18.9156,66,"Health Partners, Inc.",State Public Programs,33,50,,percent of total billed charges,,
Lactic Dehydrogenase (Mayo)OutsideLaboratory,,83615,CPT,Facility,Both,,,90,66,56.1,18.9156,66,Humana Insurance Company,Commercial PPO,62.7,95,,percent of total billed charges,,
Lactic Dehydrogenase (Mayo)OutsideLaboratory,,83615,CPT,Facility,Outpatient,,,90,66,56.1,18.9156,66,Humana Insurance Company,Medicare PPO,32.34,49,,percent of total billed charges,,
Lactic Dehydrogenase (Mayo)OutsideLaboratory,,83615,CPT,Facility,Inpatient,,,90,66,56.1,18.9156,66,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Lactic Dehydrogenase (Mayo)OutsideLaboratory,,83615,CPT,Facility,Both,,,90,66,56.1,18.9156,66,Medica,Individual & Family,65.406,99.1,,percent of total billed charges,,
Lactic Dehydrogenase (Mayo)OutsideLaboratory,,83615,CPT,Facility,Outpatient,,,90,66,56.1,18.9156,66,Medica,Medica Advantage Solution,32.868,49.8,,percent of total billed charges,,
Lactic Dehydrogenase (Mayo)OutsideLaboratory,,83615,CPT,Facility,Inpatient,,,90,66,56.1,18.9156,66,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Lactic Dehydrogenase (Mayo)OutsideLaboratory,,83615,CPT,Facility,Outpatient,,,90,66,56.1,18.9156,66,Medica,Medical Assistance,29.436,44.6,,percent of total billed charges,,
Lactic Dehydrogenase (Mayo)OutsideLaboratory,,83615,CPT,Facility,Inpatient,,,90,66,56.1,18.9156,66,Medica,Medical Assistance,,,,,Included in per diem rate,
Lactic Dehydrogenase (Mayo)OutsideLaboratory,,83615,CPT,Facility,Outpatient,,,90,66,56.1,18.9156,66,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,32.868,49.8,,percent of total billed charges,,
Lactic Dehydrogenase (Mayo)OutsideLaboratory,,83615,CPT,Facility,Inpatient,,,90,66,56.1,18.9156,66,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Lactic Dehydrogenase (Mayo)OutsideLaboratory,,83615,CPT,Facility,Both,,,90,66,56.1,18.9156,66,"Multiplan, Inc.","Multiplan, Inc.",62.04,94,,percent of total billed charges,,
Lactic Dehydrogenase (Mayo)OutsideLaboratory,,83615,CPT,Facility,Outpatient,,,90,66,56.1,18.9156,66,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,57.024,86.4,,percent of total billed charges,,
Lactic Dehydrogenase (Mayo)OutsideLaboratory,,83615,CPT,Facility,Inpatient,,,90,66,56.1,18.9156,66,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Lactic Dehydrogenase (Mayo)OutsideLaboratory,,83615,CPT,Facility,Both,,,90,66,56.1,18.9156,66,"Preferred One Administrative Services, INC.",PPO,65.076,98.6,,percent of total billed charges,,
Lactic Dehydrogenase (Mayo)OutsideLaboratory,,83615,CPT,Facility,Outpatient,,,90,66,56.1,18.9156,66,PrimeWest Health,Minnesota Senior Health Options (MSHO),33.957,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Lactic Dehydrogenase (Mayo)OutsideLaboratory,,83615,CPT,Facility,Inpatient,,,90,66,56.1,18.9156,66,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Lactic Dehydrogenase (Mayo)OutsideLaboratory,,83615,CPT,Facility,Outpatient,,,90,66,56.1,18.9156,66,PrimeWest Health,MinnesotaCare,33.8976,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Lactic Dehydrogenase (Mayo)OutsideLaboratory,,83615,CPT,Facility,Inpatient,,,90,66,56.1,18.9156,66,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Lactic Dehydrogenase (Mayo)OutsideLaboratory,,83615,CPT,Facility,Both,,,90,66,56.1,18.9156,66,Sanford Health Plan,Sanford Health Plan,60.72,92,,percent of total billed charges,,
Lactic Dehydrogenase (Mayo)OutsideLaboratory,,83615,CPT,Facility,Outpatient,,,90,66,56.1,18.9156,66,"UCare Health, Inc.",Individual & Family Plan,37.191,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Lactic Dehydrogenase (Mayo)OutsideLaboratory,,83615,CPT,Facility,Inpatient,,,90,66,56.1,18.9156,66,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Lactic Dehydrogenase (Mayo)OutsideLaboratory,,83615,CPT,Facility,Outpatient,,,90,66,56.1,18.9156,66,"UCare Health, Inc.",Medical Assistance,33.3102,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Lactic Dehydrogenase (Mayo)OutsideLaboratory,,83615,CPT,Facility,Inpatient,,,90,66,56.1,18.9156,66,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Lactic Dehydrogenase (Mayo)OutsideLaboratory,,83615,CPT,Facility,Outpatient,,,90,66,56.1,18.9156,66,"UCare Health, Inc.",Medicare Advantage,33.3102,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Lactic Dehydrogenase (Mayo)OutsideLaboratory,,83615,CPT,Facility,Inpatient,,,90,66,56.1,18.9156,66,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Lactic Dehydrogenase (Mayo)OutsideLaboratory,,83615,CPT,Facility,Outpatient,,,90,66,56.1,18.9156,66,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),33.3102,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Lactic Dehydrogenase (Mayo)OutsideLaboratory,,83615,CPT,Facility,Inpatient,,,90,66,56.1,18.9156,66,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Lactic Dehydrogenase (Mayo)OutsideLaboratory,,83615,CPT,Facility,Both,,,90,66,56.1,18.9156,66,UnitedHealthcare,Individual & Family,62.04,94,,percent of total billed charges,,
Lactic Dehydrogenase (Mayo)OutsideLaboratory,,83615,CPT,Facility,Outpatient,,,90,66,56.1,18.9156,66,UnitedHealthcare,Medicare Advantage,32.34,49,,percent of total billed charges,,
Lactic Dehydrogenase (Mayo)OutsideLaboratory,,83615,CPT,Facility,Inpatient,,,90,66,56.1,18.9156,66,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Lactic Dehydrogenase (Mayo)OutsideLaboratory,,83615,CPT,Facility,Outpatient,,,90,66,56.1,18.9156,66,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,31.68,48,,percent of total billed charges,,100% of DHS outpatient percentage
Lactic Dehydrogenase (Mayo)OutsideLaboratory,,83615,CPT,Facility,Inpatient,,,90,66,56.1,18.9156,66,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Lead (Mayo)OutsideLaboratory,,83655,CPT,Facility,Both,,,90,90,76.5,25.794,90,Aetna,Commercial,82.8,92,,percent of total billed charges,,
Lead (Mayo)OutsideLaboratory,,83655,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,Aetna,Medicare Advantage,44.1,49,,percent of total billed charges,,
Lead (Mayo)OutsideLaboratory,,83655,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Lead (Mayo)OutsideLaboratory,,83655,CPT,Facility,Both,,,90,90,76.5,25.794,90,Aetna,PPO,83.7,93,,percent of total billed charges,,
Lead (Mayo)OutsideLaboratory,,83655,CPT,Facility,Both,,,90,90,76.5,25.794,90,America's PPO,America's PPO,86.427,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Lead (Mayo)OutsideLaboratory,,83655,CPT,Facility,Both,,,90,90,76.5,25.794,90,BlueCross BlueShield Minnesota, Federal Employee Program,88.56,98.4,,percent of total billed charges,,
Lead (Mayo)OutsideLaboratory,,83655,CPT,Facility,Both,,,90,90,76.5,25.794,90,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,90,100,,percent of total billed charges,,
Lead (Mayo)OutsideLaboratory,,83655,CPT,Facility,Both,,,90,90,76.5,25.794,90,BlueCross BlueShield Minnesota,High Value Network Plan,81,90,,percent of total billed charges,,
Lead (Mayo)OutsideLaboratory,,83655,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,BlueCross BlueShield Minnesota,Medicare Advantage,44.1,49,,percent of total billed charges,,
Lead (Mayo)OutsideLaboratory,,83655,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Lead (Mayo)OutsideLaboratory,,83655,CPT,Facility,Both,,,90,90,76.5,25.794,90,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,79.713,88.57,,percent of total billed charges,,
Lead (Mayo)OutsideLaboratory,,83655,CPT,Facility,Both,,,90,90,76.5,25.794,90,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,25.794,28.66,,percent of total billed charges,,
Lead (Mayo)OutsideLaboratory,,83655,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),44.1,49,,percent of total billed charges,,
Lead (Mayo)OutsideLaboratory,,83655,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Lead (Mayo)OutsideLaboratory,,83655,CPT,Facility,Both,,,90,90,76.5,25.794,90,CorVel,Worker's Compensation,90,100,,percent of total billed charges,,
Lead (Mayo)OutsideLaboratory,,83655,CPT,Facility,Both,,,90,90,76.5,25.794,90,First Health Group Corporation,First Health Network,87.3,97,,percent of total billed charges,,
Lead (Mayo)OutsideLaboratory,,83655,CPT,Facility,Both,,,90,90,76.5,25.794,90,"Health Partners, Inc.",Commercial,85.14,94.6,,percent of total billed charges,,
Lead (Mayo)OutsideLaboratory,,83655,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,"Health Partners, Inc.",Medicare Advantage,44.1,49,,percent of total billed charges,,
Lead (Mayo)OutsideLaboratory,,83655,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Lead (Mayo)OutsideLaboratory,,83655,CPT,Facility,Both,,,90,90,76.5,25.794,90,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),54,60,,percent of total billed charges,,
Lead (Mayo)OutsideLaboratory,,83655,CPT,Facility,Both,,,90,90,76.5,25.794,90,"Health Partners, Inc.",State of Minnesota Advantage Program,73.35,81.5,,percent of total billed charges,,
Lead (Mayo)OutsideLaboratory,,83655,CPT,Facility,Both,,,90,90,76.5,25.794,90,"Health Partners, Inc.",State Public Programs,45,50,,percent of total billed charges,,
Lead (Mayo)OutsideLaboratory,,83655,CPT,Facility,Both,,,90,90,76.5,25.794,90,Humana Insurance Company,Commercial PPO,85.5,95,,percent of total billed charges,,
Lead (Mayo)OutsideLaboratory,,83655,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,Humana Insurance Company,Medicare PPO,44.1,49,,percent of total billed charges,,
Lead (Mayo)OutsideLaboratory,,83655,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Lead (Mayo)OutsideLaboratory,,83655,CPT,Facility,Both,,,90,90,76.5,25.794,90,Medica,Individual & Family,89.19,99.1,,percent of total billed charges,,
Lead (Mayo)OutsideLaboratory,,83655,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,Medica,Medica Advantage Solution,44.82,49.8,,percent of total billed charges,,
Lead (Mayo)OutsideLaboratory,,83655,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Lead (Mayo)OutsideLaboratory,,83655,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,Medica,Medical Assistance,40.14,44.6,,percent of total billed charges,,
Lead (Mayo)OutsideLaboratory,,83655,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,Medica,Medical Assistance,,,,,Included in per diem rate,
Lead (Mayo)OutsideLaboratory,,83655,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,44.82,49.8,,percent of total billed charges,,
Lead (Mayo)OutsideLaboratory,,83655,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Lead (Mayo)OutsideLaboratory,,83655,CPT,Facility,Both,,,90,90,76.5,25.794,90,"Multiplan, Inc.","Multiplan, Inc.",84.6,94,,percent of total billed charges,,
Lead (Mayo)OutsideLaboratory,,83655,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,77.76,86.4,,percent of total billed charges,,
Lead (Mayo)OutsideLaboratory,,83655,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Lead (Mayo)OutsideLaboratory,,83655,CPT,Facility,Both,,,90,90,76.5,25.794,90,"Preferred One Administrative Services, INC.",PPO,88.74,98.6,,percent of total billed charges,,
Lead (Mayo)OutsideLaboratory,,83655,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,PrimeWest Health,Minnesota Senior Health Options (MSHO),46.305,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Lead (Mayo)OutsideLaboratory,,83655,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Lead (Mayo)OutsideLaboratory,,83655,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,PrimeWest Health,MinnesotaCare,46.224,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Lead (Mayo)OutsideLaboratory,,83655,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Lead (Mayo)OutsideLaboratory,,83655,CPT,Facility,Both,,,90,90,76.5,25.794,90,Sanford Health Plan,Sanford Health Plan,82.8,92,,percent of total billed charges,,
Lead (Mayo)OutsideLaboratory,,83655,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,"UCare Health, Inc.",Individual & Family Plan,50.715,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Lead (Mayo)OutsideLaboratory,,83655,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Lead (Mayo)OutsideLaboratory,,83655,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,"UCare Health, Inc.",Medical Assistance,45.423,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Lead (Mayo)OutsideLaboratory,,83655,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Lead (Mayo)OutsideLaboratory,,83655,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,"UCare Health, Inc.",Medicare Advantage,45.423,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Lead (Mayo)OutsideLaboratory,,83655,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Lead (Mayo)OutsideLaboratory,,83655,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),45.423,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Lead (Mayo)OutsideLaboratory,,83655,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Lead (Mayo)OutsideLaboratory,,83655,CPT,Facility,Both,,,90,90,76.5,25.794,90,UnitedHealthcare,Individual & Family,84.6,94,,percent of total billed charges,,
Lead (Mayo)OutsideLaboratory,,83655,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,UnitedHealthcare,Medicare Advantage,44.1,49,,percent of total billed charges,,
Lead (Mayo)OutsideLaboratory,,83655,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Lead (Mayo)OutsideLaboratory,,83655,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,43.2,48,,percent of total billed charges,,100% of DHS outpatient percentage
Lead (Mayo)OutsideLaboratory,,83655,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Lipoprotein (A), S (Mayo)OutsideLaboratory",,83695,CPT,Facility,Both,,,90,105,89.25,30.093,105,Aetna,Commercial,96.6,92,,percent of total billed charges,,
"Lipoprotein (A), S (Mayo)OutsideLaboratory",,83695,CPT,Facility,Outpatient,,,90,105,89.25,30.093,105,Aetna,Medicare Advantage,51.45,49,,percent of total billed charges,,
"Lipoprotein (A), S (Mayo)OutsideLaboratory",,83695,CPT,Facility,Inpatient,,,90,105,89.25,30.093,105,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Lipoprotein (A), S (Mayo)OutsideLaboratory",,83695,CPT,Facility,Both,,,90,105,89.25,30.093,105,Aetna,PPO,97.65,93,,percent of total billed charges,,
"Lipoprotein (A), S (Mayo)OutsideLaboratory",,83695,CPT,Facility,Both,,,90,105,89.25,30.093,105,America's PPO,America's PPO,100.8315,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Lipoprotein (A), S (Mayo)OutsideLaboratory",,83695,CPT,Facility,Both,,,90,105,89.25,30.093,105,BlueCross BlueShield Minnesota, Federal Employee Program,103.32,98.4,,percent of total billed charges,,
"Lipoprotein (A), S (Mayo)OutsideLaboratory",,83695,CPT,Facility,Both,,,90,105,89.25,30.093,105,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,105,100,,percent of total billed charges,,
"Lipoprotein (A), S (Mayo)OutsideLaboratory",,83695,CPT,Facility,Both,,,90,105,89.25,30.093,105,BlueCross BlueShield Minnesota,High Value Network Plan,94.5,90,,percent of total billed charges,,
"Lipoprotein (A), S (Mayo)OutsideLaboratory",,83695,CPT,Facility,Outpatient,,,90,105,89.25,30.093,105,BlueCross BlueShield Minnesota,Medicare Advantage,51.45,49,,percent of total billed charges,,
"Lipoprotein (A), S (Mayo)OutsideLaboratory",,83695,CPT,Facility,Inpatient,,,90,105,89.25,30.093,105,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Lipoprotein (A), S (Mayo)OutsideLaboratory",,83695,CPT,Facility,Both,,,90,105,89.25,30.093,105,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,92.9985,88.57,,percent of total billed charges,,
"Lipoprotein (A), S (Mayo)OutsideLaboratory",,83695,CPT,Facility,Both,,,90,105,89.25,30.093,105,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,30.093,28.66,,percent of total billed charges,,
"Lipoprotein (A), S (Mayo)OutsideLaboratory",,83695,CPT,Facility,Outpatient,,,90,105,89.25,30.093,105,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),51.45,49,,percent of total billed charges,,
"Lipoprotein (A), S (Mayo)OutsideLaboratory",,83695,CPT,Facility,Inpatient,,,90,105,89.25,30.093,105,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Lipoprotein (A), S (Mayo)OutsideLaboratory",,83695,CPT,Facility,Both,,,90,105,89.25,30.093,105,CorVel,Worker's Compensation,105,100,,percent of total billed charges,,
"Lipoprotein (A), S (Mayo)OutsideLaboratory",,83695,CPT,Facility,Both,,,90,105,89.25,30.093,105,First Health Group Corporation,First Health Network,101.85,97,,percent of total billed charges,,
"Lipoprotein (A), S (Mayo)OutsideLaboratory",,83695,CPT,Facility,Both,,,90,105,89.25,30.093,105,"Health Partners, Inc.",Commercial,99.33,94.6,,percent of total billed charges,,
"Lipoprotein (A), S (Mayo)OutsideLaboratory",,83695,CPT,Facility,Outpatient,,,90,105,89.25,30.093,105,"Health Partners, Inc.",Medicare Advantage,51.45,49,,percent of total billed charges,,
"Lipoprotein (A), S (Mayo)OutsideLaboratory",,83695,CPT,Facility,Inpatient,,,90,105,89.25,30.093,105,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Lipoprotein (A), S (Mayo)OutsideLaboratory",,83695,CPT,Facility,Both,,,90,105,89.25,30.093,105,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),63,60,,percent of total billed charges,,
"Lipoprotein (A), S (Mayo)OutsideLaboratory",,83695,CPT,Facility,Both,,,90,105,89.25,30.093,105,"Health Partners, Inc.",State of Minnesota Advantage Program,85.575,81.5,,percent of total billed charges,,
"Lipoprotein (A), S (Mayo)OutsideLaboratory",,83695,CPT,Facility,Both,,,90,105,89.25,30.093,105,"Health Partners, Inc.",State Public Programs,52.5,50,,percent of total billed charges,,
"Lipoprotein (A), S (Mayo)OutsideLaboratory",,83695,CPT,Facility,Both,,,90,105,89.25,30.093,105,Humana Insurance Company,Commercial PPO,99.75,95,,percent of total billed charges,,
"Lipoprotein (A), S (Mayo)OutsideLaboratory",,83695,CPT,Facility,Outpatient,,,90,105,89.25,30.093,105,Humana Insurance Company,Medicare PPO,51.45,49,,percent of total billed charges,,
"Lipoprotein (A), S (Mayo)OutsideLaboratory",,83695,CPT,Facility,Inpatient,,,90,105,89.25,30.093,105,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Lipoprotein (A), S (Mayo)OutsideLaboratory",,83695,CPT,Facility,Both,,,90,105,89.25,30.093,105,Medica,Individual & Family,104.055,99.1,,percent of total billed charges,,
"Lipoprotein (A), S (Mayo)OutsideLaboratory",,83695,CPT,Facility,Outpatient,,,90,105,89.25,30.093,105,Medica,Medica Advantage Solution,52.29,49.8,,percent of total billed charges,,
"Lipoprotein (A), S (Mayo)OutsideLaboratory",,83695,CPT,Facility,Inpatient,,,90,105,89.25,30.093,105,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Lipoprotein (A), S (Mayo)OutsideLaboratory",,83695,CPT,Facility,Outpatient,,,90,105,89.25,30.093,105,Medica,Medical Assistance,46.83,44.6,,percent of total billed charges,,
"Lipoprotein (A), S (Mayo)OutsideLaboratory",,83695,CPT,Facility,Inpatient,,,90,105,89.25,30.093,105,Medica,Medical Assistance,,,,,Included in per diem rate,
"Lipoprotein (A), S (Mayo)OutsideLaboratory",,83695,CPT,Facility,Outpatient,,,90,105,89.25,30.093,105,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,52.29,49.8,,percent of total billed charges,,
"Lipoprotein (A), S (Mayo)OutsideLaboratory",,83695,CPT,Facility,Inpatient,,,90,105,89.25,30.093,105,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Lipoprotein (A), S (Mayo)OutsideLaboratory",,83695,CPT,Facility,Both,,,90,105,89.25,30.093,105,"Multiplan, Inc.","Multiplan, Inc.",98.7,94,,percent of total billed charges,,
"Lipoprotein (A), S (Mayo)OutsideLaboratory",,83695,CPT,Facility,Outpatient,,,90,105,89.25,30.093,105,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,90.72,86.4,,percent of total billed charges,,
"Lipoprotein (A), S (Mayo)OutsideLaboratory",,83695,CPT,Facility,Inpatient,,,90,105,89.25,30.093,105,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Lipoprotein (A), S (Mayo)OutsideLaboratory",,83695,CPT,Facility,Both,,,90,105,89.25,30.093,105,"Preferred One Administrative Services, INC.",PPO,103.53,98.6,,percent of total billed charges,,
"Lipoprotein (A), S (Mayo)OutsideLaboratory",,83695,CPT,Facility,Outpatient,,,90,105,89.25,30.093,105,PrimeWest Health,Minnesota Senior Health Options (MSHO),54.0225,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Lipoprotein (A), S (Mayo)OutsideLaboratory",,83695,CPT,Facility,Inpatient,,,90,105,89.25,30.093,105,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Lipoprotein (A), S (Mayo)OutsideLaboratory",,83695,CPT,Facility,Outpatient,,,90,105,89.25,30.093,105,PrimeWest Health,MinnesotaCare,53.928,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Lipoprotein (A), S (Mayo)OutsideLaboratory",,83695,CPT,Facility,Inpatient,,,90,105,89.25,30.093,105,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Lipoprotein (A), S (Mayo)OutsideLaboratory",,83695,CPT,Facility,Both,,,90,105,89.25,30.093,105,Sanford Health Plan,Sanford Health Plan,96.6,92,,percent of total billed charges,,
"Lipoprotein (A), S (Mayo)OutsideLaboratory",,83695,CPT,Facility,Outpatient,,,90,105,89.25,30.093,105,"UCare Health, Inc.",Individual & Family Plan,59.1675,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Lipoprotein (A), S (Mayo)OutsideLaboratory",,83695,CPT,Facility,Inpatient,,,90,105,89.25,30.093,105,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Lipoprotein (A), S (Mayo)OutsideLaboratory",,83695,CPT,Facility,Outpatient,,,90,105,89.25,30.093,105,"UCare Health, Inc.",Medical Assistance,52.9935,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Lipoprotein (A), S (Mayo)OutsideLaboratory",,83695,CPT,Facility,Inpatient,,,90,105,89.25,30.093,105,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Lipoprotein (A), S (Mayo)OutsideLaboratory",,83695,CPT,Facility,Outpatient,,,90,105,89.25,30.093,105,"UCare Health, Inc.",Medicare Advantage,52.9935,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Lipoprotein (A), S (Mayo)OutsideLaboratory",,83695,CPT,Facility,Inpatient,,,90,105,89.25,30.093,105,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Lipoprotein (A), S (Mayo)OutsideLaboratory",,83695,CPT,Facility,Outpatient,,,90,105,89.25,30.093,105,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),52.9935,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Lipoprotein (A), S (Mayo)OutsideLaboratory",,83695,CPT,Facility,Inpatient,,,90,105,89.25,30.093,105,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Lipoprotein (A), S (Mayo)OutsideLaboratory",,83695,CPT,Facility,Both,,,90,105,89.25,30.093,105,UnitedHealthcare,Individual & Family,98.7,94,,percent of total billed charges,,
"Lipoprotein (A), S (Mayo)OutsideLaboratory",,83695,CPT,Facility,Outpatient,,,90,105,89.25,30.093,105,UnitedHealthcare,Medicare Advantage,51.45,49,,percent of total billed charges,,
"Lipoprotein (A), S (Mayo)OutsideLaboratory",,83695,CPT,Facility,Inpatient,,,90,105,89.25,30.093,105,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Lipoprotein (A), S (Mayo)OutsideLaboratory",,83695,CPT,Facility,Outpatient,,,90,105,89.25,30.093,105,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,50.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Lipoprotein (A), S (Mayo)OutsideLaboratory",,83695,CPT,Facility,Inpatient,,,90,105,89.25,30.093,105,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Magnesium (Mayo)OutsideLaboratory,,83735,CPT,Facility,Both,,,90,90,76.5,25.794,90,Aetna,Commercial,82.8,92,,percent of total billed charges,,
Magnesium (Mayo)OutsideLaboratory,,83735,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,Aetna,Medicare Advantage,44.1,49,,percent of total billed charges,,
Magnesium (Mayo)OutsideLaboratory,,83735,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Magnesium (Mayo)OutsideLaboratory,,83735,CPT,Facility,Both,,,90,90,76.5,25.794,90,Aetna,PPO,83.7,93,,percent of total billed charges,,
Magnesium (Mayo)OutsideLaboratory,,83735,CPT,Facility,Both,,,90,90,76.5,25.794,90,America's PPO,America's PPO,86.427,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Magnesium (Mayo)OutsideLaboratory,,83735,CPT,Facility,Both,,,90,90,76.5,25.794,90,BlueCross BlueShield Minnesota, Federal Employee Program,88.56,98.4,,percent of total billed charges,,
Magnesium (Mayo)OutsideLaboratory,,83735,CPT,Facility,Both,,,90,90,76.5,25.794,90,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,90,100,,percent of total billed charges,,
Magnesium (Mayo)OutsideLaboratory,,83735,CPT,Facility,Both,,,90,90,76.5,25.794,90,BlueCross BlueShield Minnesota,High Value Network Plan,81,90,,percent of total billed charges,,
Magnesium (Mayo)OutsideLaboratory,,83735,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,BlueCross BlueShield Minnesota,Medicare Advantage,44.1,49,,percent of total billed charges,,
Magnesium (Mayo)OutsideLaboratory,,83735,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Magnesium (Mayo)OutsideLaboratory,,83735,CPT,Facility,Both,,,90,90,76.5,25.794,90,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,79.713,88.57,,percent of total billed charges,,
Magnesium (Mayo)OutsideLaboratory,,83735,CPT,Facility,Both,,,90,90,76.5,25.794,90,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,25.794,28.66,,percent of total billed charges,,
Magnesium (Mayo)OutsideLaboratory,,83735,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),44.1,49,,percent of total billed charges,,
Magnesium (Mayo)OutsideLaboratory,,83735,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Magnesium (Mayo)OutsideLaboratory,,83735,CPT,Facility,Both,,,90,90,76.5,25.794,90,CorVel,Worker's Compensation,90,100,,percent of total billed charges,,
Magnesium (Mayo)OutsideLaboratory,,83735,CPT,Facility,Both,,,90,90,76.5,25.794,90,First Health Group Corporation,First Health Network,87.3,97,,percent of total billed charges,,
Magnesium (Mayo)OutsideLaboratory,,83735,CPT,Facility,Both,,,90,90,76.5,25.794,90,"Health Partners, Inc.",Commercial,85.14,94.6,,percent of total billed charges,,
Magnesium (Mayo)OutsideLaboratory,,83735,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,"Health Partners, Inc.",Medicare Advantage,44.1,49,,percent of total billed charges,,
Magnesium (Mayo)OutsideLaboratory,,83735,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Magnesium (Mayo)OutsideLaboratory,,83735,CPT,Facility,Both,,,90,90,76.5,25.794,90,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),54,60,,percent of total billed charges,,
Magnesium (Mayo)OutsideLaboratory,,83735,CPT,Facility,Both,,,90,90,76.5,25.794,90,"Health Partners, Inc.",State of Minnesota Advantage Program,73.35,81.5,,percent of total billed charges,,
Magnesium (Mayo)OutsideLaboratory,,83735,CPT,Facility,Both,,,90,90,76.5,25.794,90,"Health Partners, Inc.",State Public Programs,45,50,,percent of total billed charges,,
Magnesium (Mayo)OutsideLaboratory,,83735,CPT,Facility,Both,,,90,90,76.5,25.794,90,Humana Insurance Company,Commercial PPO,85.5,95,,percent of total billed charges,,
Magnesium (Mayo)OutsideLaboratory,,83735,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,Humana Insurance Company,Medicare PPO,44.1,49,,percent of total billed charges,,
Magnesium (Mayo)OutsideLaboratory,,83735,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Magnesium (Mayo)OutsideLaboratory,,83735,CPT,Facility,Both,,,90,90,76.5,25.794,90,Medica,Individual & Family,89.19,99.1,,percent of total billed charges,,
Magnesium (Mayo)OutsideLaboratory,,83735,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,Medica,Medica Advantage Solution,44.82,49.8,,percent of total billed charges,,
Magnesium (Mayo)OutsideLaboratory,,83735,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Magnesium (Mayo)OutsideLaboratory,,83735,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,Medica,Medical Assistance,40.14,44.6,,percent of total billed charges,,
Magnesium (Mayo)OutsideLaboratory,,83735,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,Medica,Medical Assistance,,,,,Included in per diem rate,
Magnesium (Mayo)OutsideLaboratory,,83735,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,44.82,49.8,,percent of total billed charges,,
Magnesium (Mayo)OutsideLaboratory,,83735,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Magnesium (Mayo)OutsideLaboratory,,83735,CPT,Facility,Both,,,90,90,76.5,25.794,90,"Multiplan, Inc.","Multiplan, Inc.",84.6,94,,percent of total billed charges,,
Magnesium (Mayo)OutsideLaboratory,,83735,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,77.76,86.4,,percent of total billed charges,,
Magnesium (Mayo)OutsideLaboratory,,83735,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Magnesium (Mayo)OutsideLaboratory,,83735,CPT,Facility,Both,,,90,90,76.5,25.794,90,"Preferred One Administrative Services, INC.",PPO,88.74,98.6,,percent of total billed charges,,
Magnesium (Mayo)OutsideLaboratory,,83735,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,PrimeWest Health,Minnesota Senior Health Options (MSHO),46.305,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Magnesium (Mayo)OutsideLaboratory,,83735,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Magnesium (Mayo)OutsideLaboratory,,83735,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,PrimeWest Health,MinnesotaCare,46.224,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Magnesium (Mayo)OutsideLaboratory,,83735,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Magnesium (Mayo)OutsideLaboratory,,83735,CPT,Facility,Both,,,90,90,76.5,25.794,90,Sanford Health Plan,Sanford Health Plan,82.8,92,,percent of total billed charges,,
Magnesium (Mayo)OutsideLaboratory,,83735,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,"UCare Health, Inc.",Individual & Family Plan,50.715,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Magnesium (Mayo)OutsideLaboratory,,83735,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Magnesium (Mayo)OutsideLaboratory,,83735,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,"UCare Health, Inc.",Medical Assistance,45.423,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Magnesium (Mayo)OutsideLaboratory,,83735,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Magnesium (Mayo)OutsideLaboratory,,83735,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,"UCare Health, Inc.",Medicare Advantage,45.423,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Magnesium (Mayo)OutsideLaboratory,,83735,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Magnesium (Mayo)OutsideLaboratory,,83735,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),45.423,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Magnesium (Mayo)OutsideLaboratory,,83735,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Magnesium (Mayo)OutsideLaboratory,,83735,CPT,Facility,Both,,,90,90,76.5,25.794,90,UnitedHealthcare,Individual & Family,84.6,94,,percent of total billed charges,,
Magnesium (Mayo)OutsideLaboratory,,83735,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,UnitedHealthcare,Medicare Advantage,44.1,49,,percent of total billed charges,,
Magnesium (Mayo)OutsideLaboratory,,83735,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Magnesium (Mayo)OutsideLaboratory,,83735,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,43.2,48,,percent of total billed charges,,100% of DHS outpatient percentage
Magnesium (Mayo)OutsideLaboratory,,83735,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Magnesium, Random (Mayo)OutsideLaboratory",,83735,CPT,Facility,Both,,,90,90,76.5,25.794,90,Aetna,Commercial,82.8,92,,percent of total billed charges,,
"Magnesium, Random (Mayo)OutsideLaboratory",,83735,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,Aetna,Medicare Advantage,44.1,49,,percent of total billed charges,,
"Magnesium, Random (Mayo)OutsideLaboratory",,83735,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Magnesium, Random (Mayo)OutsideLaboratory",,83735,CPT,Facility,Both,,,90,90,76.5,25.794,90,Aetna,PPO,83.7,93,,percent of total billed charges,,
"Magnesium, Random (Mayo)OutsideLaboratory",,83735,CPT,Facility,Both,,,90,90,76.5,25.794,90,America's PPO,America's PPO,86.427,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Magnesium, Random (Mayo)OutsideLaboratory",,83735,CPT,Facility,Both,,,90,90,76.5,25.794,90,BlueCross BlueShield Minnesota, Federal Employee Program,88.56,98.4,,percent of total billed charges,,
"Magnesium, Random (Mayo)OutsideLaboratory",,83735,CPT,Facility,Both,,,90,90,76.5,25.794,90,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,90,100,,percent of total billed charges,,
"Magnesium, Random (Mayo)OutsideLaboratory",,83735,CPT,Facility,Both,,,90,90,76.5,25.794,90,BlueCross BlueShield Minnesota,High Value Network Plan,81,90,,percent of total billed charges,,
"Magnesium, Random (Mayo)OutsideLaboratory",,83735,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,BlueCross BlueShield Minnesota,Medicare Advantage,44.1,49,,percent of total billed charges,,
"Magnesium, Random (Mayo)OutsideLaboratory",,83735,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Magnesium, Random (Mayo)OutsideLaboratory",,83735,CPT,Facility,Both,,,90,90,76.5,25.794,90,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,79.713,88.57,,percent of total billed charges,,
"Magnesium, Random (Mayo)OutsideLaboratory",,83735,CPT,Facility,Both,,,90,90,76.5,25.794,90,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,25.794,28.66,,percent of total billed charges,,
"Magnesium, Random (Mayo)OutsideLaboratory",,83735,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),44.1,49,,percent of total billed charges,,
"Magnesium, Random (Mayo)OutsideLaboratory",,83735,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Magnesium, Random (Mayo)OutsideLaboratory",,83735,CPT,Facility,Both,,,90,90,76.5,25.794,90,CorVel,Worker's Compensation,90,100,,percent of total billed charges,,
"Magnesium, Random (Mayo)OutsideLaboratory",,83735,CPT,Facility,Both,,,90,90,76.5,25.794,90,First Health Group Corporation,First Health Network,87.3,97,,percent of total billed charges,,
"Magnesium, Random (Mayo)OutsideLaboratory",,83735,CPT,Facility,Both,,,90,90,76.5,25.794,90,"Health Partners, Inc.",Commercial,85.14,94.6,,percent of total billed charges,,
"Magnesium, Random (Mayo)OutsideLaboratory",,83735,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,"Health Partners, Inc.",Medicare Advantage,44.1,49,,percent of total billed charges,,
"Magnesium, Random (Mayo)OutsideLaboratory",,83735,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Magnesium, Random (Mayo)OutsideLaboratory",,83735,CPT,Facility,Both,,,90,90,76.5,25.794,90,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),54,60,,percent of total billed charges,,
"Magnesium, Random (Mayo)OutsideLaboratory",,83735,CPT,Facility,Both,,,90,90,76.5,25.794,90,"Health Partners, Inc.",State of Minnesota Advantage Program,73.35,81.5,,percent of total billed charges,,
"Magnesium, Random (Mayo)OutsideLaboratory",,83735,CPT,Facility,Both,,,90,90,76.5,25.794,90,"Health Partners, Inc.",State Public Programs,45,50,,percent of total billed charges,,
"Magnesium, Random (Mayo)OutsideLaboratory",,83735,CPT,Facility,Both,,,90,90,76.5,25.794,90,Humana Insurance Company,Commercial PPO,85.5,95,,percent of total billed charges,,
"Magnesium, Random (Mayo)OutsideLaboratory",,83735,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,Humana Insurance Company,Medicare PPO,44.1,49,,percent of total billed charges,,
"Magnesium, Random (Mayo)OutsideLaboratory",,83735,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Magnesium, Random (Mayo)OutsideLaboratory",,83735,CPT,Facility,Both,,,90,90,76.5,25.794,90,Medica,Individual & Family,89.19,99.1,,percent of total billed charges,,
"Magnesium, Random (Mayo)OutsideLaboratory",,83735,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,Medica,Medica Advantage Solution,44.82,49.8,,percent of total billed charges,,
"Magnesium, Random (Mayo)OutsideLaboratory",,83735,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Magnesium, Random (Mayo)OutsideLaboratory",,83735,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,Medica,Medical Assistance,40.14,44.6,,percent of total billed charges,,
"Magnesium, Random (Mayo)OutsideLaboratory",,83735,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,Medica,Medical Assistance,,,,,Included in per diem rate,
"Magnesium, Random (Mayo)OutsideLaboratory",,83735,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,44.82,49.8,,percent of total billed charges,,
"Magnesium, Random (Mayo)OutsideLaboratory",,83735,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Magnesium, Random (Mayo)OutsideLaboratory",,83735,CPT,Facility,Both,,,90,90,76.5,25.794,90,"Multiplan, Inc.","Multiplan, Inc.",84.6,94,,percent of total billed charges,,
"Magnesium, Random (Mayo)OutsideLaboratory",,83735,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,77.76,86.4,,percent of total billed charges,,
"Magnesium, Random (Mayo)OutsideLaboratory",,83735,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Magnesium, Random (Mayo)OutsideLaboratory",,83735,CPT,Facility,Both,,,90,90,76.5,25.794,90,"Preferred One Administrative Services, INC.",PPO,88.74,98.6,,percent of total billed charges,,
"Magnesium, Random (Mayo)OutsideLaboratory",,83735,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,PrimeWest Health,Minnesota Senior Health Options (MSHO),46.305,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Magnesium, Random (Mayo)OutsideLaboratory",,83735,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Magnesium, Random (Mayo)OutsideLaboratory",,83735,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,PrimeWest Health,MinnesotaCare,46.224,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Magnesium, Random (Mayo)OutsideLaboratory",,83735,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Magnesium, Random (Mayo)OutsideLaboratory",,83735,CPT,Facility,Both,,,90,90,76.5,25.794,90,Sanford Health Plan,Sanford Health Plan,82.8,92,,percent of total billed charges,,
"Magnesium, Random (Mayo)OutsideLaboratory",,83735,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,"UCare Health, Inc.",Individual & Family Plan,50.715,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Magnesium, Random (Mayo)OutsideLaboratory",,83735,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Magnesium, Random (Mayo)OutsideLaboratory",,83735,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,"UCare Health, Inc.",Medical Assistance,45.423,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Magnesium, Random (Mayo)OutsideLaboratory",,83735,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Magnesium, Random (Mayo)OutsideLaboratory",,83735,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,"UCare Health, Inc.",Medicare Advantage,45.423,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Magnesium, Random (Mayo)OutsideLaboratory",,83735,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Magnesium, Random (Mayo)OutsideLaboratory",,83735,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),45.423,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Magnesium, Random (Mayo)OutsideLaboratory",,83735,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Magnesium, Random (Mayo)OutsideLaboratory",,83735,CPT,Facility,Both,,,90,90,76.5,25.794,90,UnitedHealthcare,Individual & Family,84.6,94,,percent of total billed charges,,
"Magnesium, Random (Mayo)OutsideLaboratory",,83735,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,UnitedHealthcare,Medicare Advantage,44.1,49,,percent of total billed charges,,
"Magnesium, Random (Mayo)OutsideLaboratory",,83735,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Magnesium, Random (Mayo)OutsideLaboratory",,83735,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,43.2,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Magnesium, Random (Mayo)OutsideLaboratory",,83735,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Iodine, 24 Hr, U (Mayo)OutsideLaboratory",,83789,CPT,Facility,Both,,,90,99,84.15,28.3734,99,Aetna,Commercial,91.08,92,,percent of total billed charges,,
"Iodine, 24 Hr, U (Mayo)OutsideLaboratory",,83789,CPT,Facility,Outpatient,,,90,99,84.15,28.3734,99,Aetna,Medicare Advantage,48.51,49,,percent of total billed charges,,
"Iodine, 24 Hr, U (Mayo)OutsideLaboratory",,83789,CPT,Facility,Inpatient,,,90,99,84.15,28.3734,99,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Iodine, 24 Hr, U (Mayo)OutsideLaboratory",,83789,CPT,Facility,Both,,,90,99,84.15,28.3734,99,Aetna,PPO,92.07,93,,percent of total billed charges,,
"Iodine, 24 Hr, U (Mayo)OutsideLaboratory",,83789,CPT,Facility,Both,,,90,99,84.15,28.3734,99,America's PPO,America's PPO,95.0697,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Iodine, 24 Hr, U (Mayo)OutsideLaboratory",,83789,CPT,Facility,Both,,,90,99,84.15,28.3734,99,BlueCross BlueShield Minnesota, Federal Employee Program,97.416,98.4,,percent of total billed charges,,
"Iodine, 24 Hr, U (Mayo)OutsideLaboratory",,83789,CPT,Facility,Both,,,90,99,84.15,28.3734,99,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,99,100,,percent of total billed charges,,
"Iodine, 24 Hr, U (Mayo)OutsideLaboratory",,83789,CPT,Facility,Both,,,90,99,84.15,28.3734,99,BlueCross BlueShield Minnesota,High Value Network Plan,89.1,90,,percent of total billed charges,,
"Iodine, 24 Hr, U (Mayo)OutsideLaboratory",,83789,CPT,Facility,Outpatient,,,90,99,84.15,28.3734,99,BlueCross BlueShield Minnesota,Medicare Advantage,48.51,49,,percent of total billed charges,,
"Iodine, 24 Hr, U (Mayo)OutsideLaboratory",,83789,CPT,Facility,Inpatient,,,90,99,84.15,28.3734,99,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Iodine, 24 Hr, U (Mayo)OutsideLaboratory",,83789,CPT,Facility,Both,,,90,99,84.15,28.3734,99,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,87.6843,88.57,,percent of total billed charges,,
"Iodine, 24 Hr, U (Mayo)OutsideLaboratory",,83789,CPT,Facility,Both,,,90,99,84.15,28.3734,99,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,28.3734,28.66,,percent of total billed charges,,
"Iodine, 24 Hr, U (Mayo)OutsideLaboratory",,83789,CPT,Facility,Outpatient,,,90,99,84.15,28.3734,99,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),48.51,49,,percent of total billed charges,,
"Iodine, 24 Hr, U (Mayo)OutsideLaboratory",,83789,CPT,Facility,Inpatient,,,90,99,84.15,28.3734,99,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Iodine, 24 Hr, U (Mayo)OutsideLaboratory",,83789,CPT,Facility,Both,,,90,99,84.15,28.3734,99,CorVel,Worker's Compensation,99,100,,percent of total billed charges,,
"Iodine, 24 Hr, U (Mayo)OutsideLaboratory",,83789,CPT,Facility,Both,,,90,99,84.15,28.3734,99,First Health Group Corporation,First Health Network,96.03,97,,percent of total billed charges,,
"Iodine, 24 Hr, U (Mayo)OutsideLaboratory",,83789,CPT,Facility,Both,,,90,99,84.15,28.3734,99,"Health Partners, Inc.",Commercial,93.654,94.6,,percent of total billed charges,,
"Iodine, 24 Hr, U (Mayo)OutsideLaboratory",,83789,CPT,Facility,Outpatient,,,90,99,84.15,28.3734,99,"Health Partners, Inc.",Medicare Advantage,48.51,49,,percent of total billed charges,,
"Iodine, 24 Hr, U (Mayo)OutsideLaboratory",,83789,CPT,Facility,Inpatient,,,90,99,84.15,28.3734,99,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Iodine, 24 Hr, U (Mayo)OutsideLaboratory",,83789,CPT,Facility,Both,,,90,99,84.15,28.3734,99,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),59.4,60,,percent of total billed charges,,
"Iodine, 24 Hr, U (Mayo)OutsideLaboratory",,83789,CPT,Facility,Both,,,90,99,84.15,28.3734,99,"Health Partners, Inc.",State of Minnesota Advantage Program,80.685,81.5,,percent of total billed charges,,
"Iodine, 24 Hr, U (Mayo)OutsideLaboratory",,83789,CPT,Facility,Both,,,90,99,84.15,28.3734,99,"Health Partners, Inc.",State Public Programs,49.5,50,,percent of total billed charges,,
"Iodine, 24 Hr, U (Mayo)OutsideLaboratory",,83789,CPT,Facility,Both,,,90,99,84.15,28.3734,99,Humana Insurance Company,Commercial PPO,94.05,95,,percent of total billed charges,,
"Iodine, 24 Hr, U (Mayo)OutsideLaboratory",,83789,CPT,Facility,Outpatient,,,90,99,84.15,28.3734,99,Humana Insurance Company,Medicare PPO,48.51,49,,percent of total billed charges,,
"Iodine, 24 Hr, U (Mayo)OutsideLaboratory",,83789,CPT,Facility,Inpatient,,,90,99,84.15,28.3734,99,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Iodine, 24 Hr, U (Mayo)OutsideLaboratory",,83789,CPT,Facility,Both,,,90,99,84.15,28.3734,99,Medica,Individual & Family,98.109,99.1,,percent of total billed charges,,
"Iodine, 24 Hr, U (Mayo)OutsideLaboratory",,83789,CPT,Facility,Outpatient,,,90,99,84.15,28.3734,99,Medica,Medica Advantage Solution,49.302,49.8,,percent of total billed charges,,
"Iodine, 24 Hr, U (Mayo)OutsideLaboratory",,83789,CPT,Facility,Inpatient,,,90,99,84.15,28.3734,99,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Iodine, 24 Hr, U (Mayo)OutsideLaboratory",,83789,CPT,Facility,Outpatient,,,90,99,84.15,28.3734,99,Medica,Medical Assistance,44.154,44.6,,percent of total billed charges,,
"Iodine, 24 Hr, U (Mayo)OutsideLaboratory",,83789,CPT,Facility,Inpatient,,,90,99,84.15,28.3734,99,Medica,Medical Assistance,,,,,Included in per diem rate,
"Iodine, 24 Hr, U (Mayo)OutsideLaboratory",,83789,CPT,Facility,Outpatient,,,90,99,84.15,28.3734,99,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,49.302,49.8,,percent of total billed charges,,
"Iodine, 24 Hr, U (Mayo)OutsideLaboratory",,83789,CPT,Facility,Inpatient,,,90,99,84.15,28.3734,99,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Iodine, 24 Hr, U (Mayo)OutsideLaboratory",,83789,CPT,Facility,Both,,,90,99,84.15,28.3734,99,"Multiplan, Inc.","Multiplan, Inc.",93.06,94,,percent of total billed charges,,
"Iodine, 24 Hr, U (Mayo)OutsideLaboratory",,83789,CPT,Facility,Outpatient,,,90,99,84.15,28.3734,99,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,85.536,86.4,,percent of total billed charges,,
"Iodine, 24 Hr, U (Mayo)OutsideLaboratory",,83789,CPT,Facility,Inpatient,,,90,99,84.15,28.3734,99,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Iodine, 24 Hr, U (Mayo)OutsideLaboratory",,83789,CPT,Facility,Both,,,90,99,84.15,28.3734,99,"Preferred One Administrative Services, INC.",PPO,97.614,98.6,,percent of total billed charges,,
"Iodine, 24 Hr, U (Mayo)OutsideLaboratory",,83789,CPT,Facility,Outpatient,,,90,99,84.15,28.3734,99,PrimeWest Health,Minnesota Senior Health Options (MSHO),50.9355,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Iodine, 24 Hr, U (Mayo)OutsideLaboratory",,83789,CPT,Facility,Inpatient,,,90,99,84.15,28.3734,99,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Iodine, 24 Hr, U (Mayo)OutsideLaboratory",,83789,CPT,Facility,Outpatient,,,90,99,84.15,28.3734,99,PrimeWest Health,MinnesotaCare,50.8464,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Iodine, 24 Hr, U (Mayo)OutsideLaboratory",,83789,CPT,Facility,Inpatient,,,90,99,84.15,28.3734,99,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Iodine, 24 Hr, U (Mayo)OutsideLaboratory",,83789,CPT,Facility,Both,,,90,99,84.15,28.3734,99,Sanford Health Plan,Sanford Health Plan,91.08,92,,percent of total billed charges,,
"Iodine, 24 Hr, U (Mayo)OutsideLaboratory",,83789,CPT,Facility,Outpatient,,,90,99,84.15,28.3734,99,"UCare Health, Inc.",Individual & Family Plan,55.7865,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Iodine, 24 Hr, U (Mayo)OutsideLaboratory",,83789,CPT,Facility,Inpatient,,,90,99,84.15,28.3734,99,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Iodine, 24 Hr, U (Mayo)OutsideLaboratory",,83789,CPT,Facility,Outpatient,,,90,99,84.15,28.3734,99,"UCare Health, Inc.",Medical Assistance,49.9653,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Iodine, 24 Hr, U (Mayo)OutsideLaboratory",,83789,CPT,Facility,Inpatient,,,90,99,84.15,28.3734,99,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Iodine, 24 Hr, U (Mayo)OutsideLaboratory",,83789,CPT,Facility,Outpatient,,,90,99,84.15,28.3734,99,"UCare Health, Inc.",Medicare Advantage,49.9653,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Iodine, 24 Hr, U (Mayo)OutsideLaboratory",,83789,CPT,Facility,Inpatient,,,90,99,84.15,28.3734,99,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Iodine, 24 Hr, U (Mayo)OutsideLaboratory",,83789,CPT,Facility,Outpatient,,,90,99,84.15,28.3734,99,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),49.9653,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Iodine, 24 Hr, U (Mayo)OutsideLaboratory",,83789,CPT,Facility,Inpatient,,,90,99,84.15,28.3734,99,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Iodine, 24 Hr, U (Mayo)OutsideLaboratory",,83789,CPT,Facility,Both,,,90,99,84.15,28.3734,99,UnitedHealthcare,Individual & Family,93.06,94,,percent of total billed charges,,
"Iodine, 24 Hr, U (Mayo)OutsideLaboratory",,83789,CPT,Facility,Outpatient,,,90,99,84.15,28.3734,99,UnitedHealthcare,Medicare Advantage,48.51,49,,percent of total billed charges,,
"Iodine, 24 Hr, U (Mayo)OutsideLaboratory",,83789,CPT,Facility,Inpatient,,,90,99,84.15,28.3734,99,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Iodine, 24 Hr, U (Mayo)OutsideLaboratory",,83789,CPT,Facility,Outpatient,,,90,99,84.15,28.3734,99,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,47.52,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Iodine, 24 Hr, U (Mayo)OutsideLaboratory",,83789,CPT,Facility,Inpatient,,,90,99,84.15,28.3734,99,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Tandem Mass Spectrometry (Mdh)OutsideLaboratory,,83789,CPT,Facility,Both,,,90,34,28.9,9.7444,34,Aetna,Commercial,31.28,92,,percent of total billed charges,,
Tandem Mass Spectrometry (Mdh)OutsideLaboratory,,83789,CPT,Facility,Outpatient,,,90,34,28.9,9.7444,34,Aetna,Medicare Advantage,16.66,49,,percent of total billed charges,,
Tandem Mass Spectrometry (Mdh)OutsideLaboratory,,83789,CPT,Facility,Inpatient,,,90,34,28.9,9.7444,34,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Tandem Mass Spectrometry (Mdh)OutsideLaboratory,,83789,CPT,Facility,Both,,,90,34,28.9,9.7444,34,Aetna,PPO,31.62,93,,percent of total billed charges,,
Tandem Mass Spectrometry (Mdh)OutsideLaboratory,,83789,CPT,Facility,Both,,,90,34,28.9,9.7444,34,America's PPO,America's PPO,32.6502,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Tandem Mass Spectrometry (Mdh)OutsideLaboratory,,83789,CPT,Facility,Both,,,90,34,28.9,9.7444,34,BlueCross BlueShield Minnesota, Federal Employee Program,33.456,98.4,,percent of total billed charges,,
Tandem Mass Spectrometry (Mdh)OutsideLaboratory,,83789,CPT,Facility,Both,,,90,34,28.9,9.7444,34,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,34,100,,percent of total billed charges,,
Tandem Mass Spectrometry (Mdh)OutsideLaboratory,,83789,CPT,Facility,Both,,,90,34,28.9,9.7444,34,BlueCross BlueShield Minnesota,High Value Network Plan,30.6,90,,percent of total billed charges,,
Tandem Mass Spectrometry (Mdh)OutsideLaboratory,,83789,CPT,Facility,Outpatient,,,90,34,28.9,9.7444,34,BlueCross BlueShield Minnesota,Medicare Advantage,16.66,49,,percent of total billed charges,,
Tandem Mass Spectrometry (Mdh)OutsideLaboratory,,83789,CPT,Facility,Inpatient,,,90,34,28.9,9.7444,34,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Tandem Mass Spectrometry (Mdh)OutsideLaboratory,,83789,CPT,Facility,Both,,,90,34,28.9,9.7444,34,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,30.1138,88.57,,percent of total billed charges,,
Tandem Mass Spectrometry (Mdh)OutsideLaboratory,,83789,CPT,Facility,Both,,,90,34,28.9,9.7444,34,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,9.7444,28.66,,percent of total billed charges,,
Tandem Mass Spectrometry (Mdh)OutsideLaboratory,,83789,CPT,Facility,Outpatient,,,90,34,28.9,9.7444,34,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),16.66,49,,percent of total billed charges,,
Tandem Mass Spectrometry (Mdh)OutsideLaboratory,,83789,CPT,Facility,Inpatient,,,90,34,28.9,9.7444,34,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Tandem Mass Spectrometry (Mdh)OutsideLaboratory,,83789,CPT,Facility,Both,,,90,34,28.9,9.7444,34,CorVel,Worker's Compensation,34,100,,percent of total billed charges,,
Tandem Mass Spectrometry (Mdh)OutsideLaboratory,,83789,CPT,Facility,Both,,,90,34,28.9,9.7444,34,First Health Group Corporation,First Health Network,32.98,97,,percent of total billed charges,,
Tandem Mass Spectrometry (Mdh)OutsideLaboratory,,83789,CPT,Facility,Both,,,90,34,28.9,9.7444,34,"Health Partners, Inc.",Commercial,32.164,94.6,,percent of total billed charges,,
Tandem Mass Spectrometry (Mdh)OutsideLaboratory,,83789,CPT,Facility,Outpatient,,,90,34,28.9,9.7444,34,"Health Partners, Inc.",Medicare Advantage,16.66,49,,percent of total billed charges,,
Tandem Mass Spectrometry (Mdh)OutsideLaboratory,,83789,CPT,Facility,Inpatient,,,90,34,28.9,9.7444,34,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Tandem Mass Spectrometry (Mdh)OutsideLaboratory,,83789,CPT,Facility,Both,,,90,34,28.9,9.7444,34,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),20.4,60,,percent of total billed charges,,
Tandem Mass Spectrometry (Mdh)OutsideLaboratory,,83789,CPT,Facility,Both,,,90,34,28.9,9.7444,34,"Health Partners, Inc.",State of Minnesota Advantage Program,27.71,81.5,,percent of total billed charges,,
Tandem Mass Spectrometry (Mdh)OutsideLaboratory,,83789,CPT,Facility,Both,,,90,34,28.9,9.7444,34,"Health Partners, Inc.",State Public Programs,17,50,,percent of total billed charges,,
Tandem Mass Spectrometry (Mdh)OutsideLaboratory,,83789,CPT,Facility,Both,,,90,34,28.9,9.7444,34,Humana Insurance Company,Commercial PPO,32.3,95,,percent of total billed charges,,
Tandem Mass Spectrometry (Mdh)OutsideLaboratory,,83789,CPT,Facility,Outpatient,,,90,34,28.9,9.7444,34,Humana Insurance Company,Medicare PPO,16.66,49,,percent of total billed charges,,
Tandem Mass Spectrometry (Mdh)OutsideLaboratory,,83789,CPT,Facility,Inpatient,,,90,34,28.9,9.7444,34,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Tandem Mass Spectrometry (Mdh)OutsideLaboratory,,83789,CPT,Facility,Both,,,90,34,28.9,9.7444,34,Medica,Individual & Family,33.694,99.1,,percent of total billed charges,,
Tandem Mass Spectrometry (Mdh)OutsideLaboratory,,83789,CPT,Facility,Outpatient,,,90,34,28.9,9.7444,34,Medica,Medica Advantage Solution,16.932,49.8,,percent of total billed charges,,
Tandem Mass Spectrometry (Mdh)OutsideLaboratory,,83789,CPT,Facility,Inpatient,,,90,34,28.9,9.7444,34,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Tandem Mass Spectrometry (Mdh)OutsideLaboratory,,83789,CPT,Facility,Outpatient,,,90,34,28.9,9.7444,34,Medica,Medical Assistance,15.164,44.6,,percent of total billed charges,,
Tandem Mass Spectrometry (Mdh)OutsideLaboratory,,83789,CPT,Facility,Inpatient,,,90,34,28.9,9.7444,34,Medica,Medical Assistance,,,,,Included in per diem rate,
Tandem Mass Spectrometry (Mdh)OutsideLaboratory,,83789,CPT,Facility,Outpatient,,,90,34,28.9,9.7444,34,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,16.932,49.8,,percent of total billed charges,,
Tandem Mass Spectrometry (Mdh)OutsideLaboratory,,83789,CPT,Facility,Inpatient,,,90,34,28.9,9.7444,34,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Tandem Mass Spectrometry (Mdh)OutsideLaboratory,,83789,CPT,Facility,Both,,,90,34,28.9,9.7444,34,"Multiplan, Inc.","Multiplan, Inc.",31.96,94,,percent of total billed charges,,
Tandem Mass Spectrometry (Mdh)OutsideLaboratory,,83789,CPT,Facility,Outpatient,,,90,34,28.9,9.7444,34,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,29.376,86.4,,percent of total billed charges,,
Tandem Mass Spectrometry (Mdh)OutsideLaboratory,,83789,CPT,Facility,Inpatient,,,90,34,28.9,9.7444,34,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Tandem Mass Spectrometry (Mdh)OutsideLaboratory,,83789,CPT,Facility,Both,,,90,34,28.9,9.7444,34,"Preferred One Administrative Services, INC.",PPO,33.524,98.6,,percent of total billed charges,,
Tandem Mass Spectrometry (Mdh)OutsideLaboratory,,83789,CPT,Facility,Outpatient,,,90,34,28.9,9.7444,34,PrimeWest Health,Minnesota Senior Health Options (MSHO),17.493,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Tandem Mass Spectrometry (Mdh)OutsideLaboratory,,83789,CPT,Facility,Inpatient,,,90,34,28.9,9.7444,34,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Tandem Mass Spectrometry (Mdh)OutsideLaboratory,,83789,CPT,Facility,Outpatient,,,90,34,28.9,9.7444,34,PrimeWest Health,MinnesotaCare,17.4624,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Tandem Mass Spectrometry (Mdh)OutsideLaboratory,,83789,CPT,Facility,Inpatient,,,90,34,28.9,9.7444,34,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Tandem Mass Spectrometry (Mdh)OutsideLaboratory,,83789,CPT,Facility,Both,,,90,34,28.9,9.7444,34,Sanford Health Plan,Sanford Health Plan,31.28,92,,percent of total billed charges,,
Tandem Mass Spectrometry (Mdh)OutsideLaboratory,,83789,CPT,Facility,Outpatient,,,90,34,28.9,9.7444,34,"UCare Health, Inc.",Individual & Family Plan,19.159,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Tandem Mass Spectrometry (Mdh)OutsideLaboratory,,83789,CPT,Facility,Inpatient,,,90,34,28.9,9.7444,34,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Tandem Mass Spectrometry (Mdh)OutsideLaboratory,,83789,CPT,Facility,Outpatient,,,90,34,28.9,9.7444,34,"UCare Health, Inc.",Medical Assistance,17.1598,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Tandem Mass Spectrometry (Mdh)OutsideLaboratory,,83789,CPT,Facility,Inpatient,,,90,34,28.9,9.7444,34,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Tandem Mass Spectrometry (Mdh)OutsideLaboratory,,83789,CPT,Facility,Outpatient,,,90,34,28.9,9.7444,34,"UCare Health, Inc.",Medicare Advantage,17.1598,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Tandem Mass Spectrometry (Mdh)OutsideLaboratory,,83789,CPT,Facility,Inpatient,,,90,34,28.9,9.7444,34,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Tandem Mass Spectrometry (Mdh)OutsideLaboratory,,83789,CPT,Facility,Outpatient,,,90,34,28.9,9.7444,34,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),17.1598,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Tandem Mass Spectrometry (Mdh)OutsideLaboratory,,83789,CPT,Facility,Inpatient,,,90,34,28.9,9.7444,34,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Tandem Mass Spectrometry (Mdh)OutsideLaboratory,,83789,CPT,Facility,Both,,,90,34,28.9,9.7444,34,UnitedHealthcare,Individual & Family,31.96,94,,percent of total billed charges,,
Tandem Mass Spectrometry (Mdh)OutsideLaboratory,,83789,CPT,Facility,Outpatient,,,90,34,28.9,9.7444,34,UnitedHealthcare,Medicare Advantage,16.66,49,,percent of total billed charges,,
Tandem Mass Spectrometry (Mdh)OutsideLaboratory,,83789,CPT,Facility,Inpatient,,,90,34,28.9,9.7444,34,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Tandem Mass Spectrometry (Mdh)OutsideLaboratory,,83789,CPT,Facility,Outpatient,,,90,34,28.9,9.7444,34,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,16.32,48,,percent of total billed charges,,100% of DHS outpatient percentage
Tandem Mass Spectrometry (Mdh)OutsideLaboratory,,83789,CPT,Facility,Inpatient,,,90,34,28.9,9.7444,34,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Mercury (Mayo)OutsideLaboratory,,83825,CPT,Facility,Both,,,90,122,103.7,34.9652,122,Aetna,Commercial,112.24,92,,percent of total billed charges,,
Mercury (Mayo)OutsideLaboratory,,83825,CPT,Facility,Outpatient,,,90,122,103.7,34.9652,122,Aetna,Medicare Advantage,59.78,49,,percent of total billed charges,,
Mercury (Mayo)OutsideLaboratory,,83825,CPT,Facility,Inpatient,,,90,122,103.7,34.9652,122,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Mercury (Mayo)OutsideLaboratory,,83825,CPT,Facility,Both,,,90,122,103.7,34.9652,122,Aetna,PPO,113.46,93,,percent of total billed charges,,
Mercury (Mayo)OutsideLaboratory,,83825,CPT,Facility,Both,,,90,122,103.7,34.9652,122,America's PPO,America's PPO,117.1566,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Mercury (Mayo)OutsideLaboratory,,83825,CPT,Facility,Both,,,90,122,103.7,34.9652,122,BlueCross BlueShield Minnesota, Federal Employee Program,120.048,98.4,,percent of total billed charges,,
Mercury (Mayo)OutsideLaboratory,,83825,CPT,Facility,Both,,,90,122,103.7,34.9652,122,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,122,100,,percent of total billed charges,,
Mercury (Mayo)OutsideLaboratory,,83825,CPT,Facility,Both,,,90,122,103.7,34.9652,122,BlueCross BlueShield Minnesota,High Value Network Plan,109.8,90,,percent of total billed charges,,
Mercury (Mayo)OutsideLaboratory,,83825,CPT,Facility,Outpatient,,,90,122,103.7,34.9652,122,BlueCross BlueShield Minnesota,Medicare Advantage,59.78,49,,percent of total billed charges,,
Mercury (Mayo)OutsideLaboratory,,83825,CPT,Facility,Inpatient,,,90,122,103.7,34.9652,122,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Mercury (Mayo)OutsideLaboratory,,83825,CPT,Facility,Both,,,90,122,103.7,34.9652,122,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,108.0554,88.57,,percent of total billed charges,,
Mercury (Mayo)OutsideLaboratory,,83825,CPT,Facility,Both,,,90,122,103.7,34.9652,122,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,34.9652,28.66,,percent of total billed charges,,
Mercury (Mayo)OutsideLaboratory,,83825,CPT,Facility,Outpatient,,,90,122,103.7,34.9652,122,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),59.78,49,,percent of total billed charges,,
Mercury (Mayo)OutsideLaboratory,,83825,CPT,Facility,Inpatient,,,90,122,103.7,34.9652,122,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Mercury (Mayo)OutsideLaboratory,,83825,CPT,Facility,Both,,,90,122,103.7,34.9652,122,CorVel,Worker's Compensation,122,100,,percent of total billed charges,,
Mercury (Mayo)OutsideLaboratory,,83825,CPT,Facility,Both,,,90,122,103.7,34.9652,122,First Health Group Corporation,First Health Network,118.34,97,,percent of total billed charges,,
Mercury (Mayo)OutsideLaboratory,,83825,CPT,Facility,Both,,,90,122,103.7,34.9652,122,"Health Partners, Inc.",Commercial,115.412,94.6,,percent of total billed charges,,
Mercury (Mayo)OutsideLaboratory,,83825,CPT,Facility,Outpatient,,,90,122,103.7,34.9652,122,"Health Partners, Inc.",Medicare Advantage,59.78,49,,percent of total billed charges,,
Mercury (Mayo)OutsideLaboratory,,83825,CPT,Facility,Inpatient,,,90,122,103.7,34.9652,122,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mercury (Mayo)OutsideLaboratory,,83825,CPT,Facility,Both,,,90,122,103.7,34.9652,122,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),73.2,60,,percent of total billed charges,,
Mercury (Mayo)OutsideLaboratory,,83825,CPT,Facility,Both,,,90,122,103.7,34.9652,122,"Health Partners, Inc.",State of Minnesota Advantage Program,99.43,81.5,,percent of total billed charges,,
Mercury (Mayo)OutsideLaboratory,,83825,CPT,Facility,Both,,,90,122,103.7,34.9652,122,"Health Partners, Inc.",State Public Programs,61,50,,percent of total billed charges,,
Mercury (Mayo)OutsideLaboratory,,83825,CPT,Facility,Both,,,90,122,103.7,34.9652,122,Humana Insurance Company,Commercial PPO,115.9,95,,percent of total billed charges,,
Mercury (Mayo)OutsideLaboratory,,83825,CPT,Facility,Outpatient,,,90,122,103.7,34.9652,122,Humana Insurance Company,Medicare PPO,59.78,49,,percent of total billed charges,,
Mercury (Mayo)OutsideLaboratory,,83825,CPT,Facility,Inpatient,,,90,122,103.7,34.9652,122,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Mercury (Mayo)OutsideLaboratory,,83825,CPT,Facility,Both,,,90,122,103.7,34.9652,122,Medica,Individual & Family,120.902,99.1,,percent of total billed charges,,
Mercury (Mayo)OutsideLaboratory,,83825,CPT,Facility,Outpatient,,,90,122,103.7,34.9652,122,Medica,Medica Advantage Solution,60.756,49.8,,percent of total billed charges,,
Mercury (Mayo)OutsideLaboratory,,83825,CPT,Facility,Inpatient,,,90,122,103.7,34.9652,122,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Mercury (Mayo)OutsideLaboratory,,83825,CPT,Facility,Outpatient,,,90,122,103.7,34.9652,122,Medica,Medical Assistance,54.412,44.6,,percent of total billed charges,,
Mercury (Mayo)OutsideLaboratory,,83825,CPT,Facility,Inpatient,,,90,122,103.7,34.9652,122,Medica,Medical Assistance,,,,,Included in per diem rate,
Mercury (Mayo)OutsideLaboratory,,83825,CPT,Facility,Outpatient,,,90,122,103.7,34.9652,122,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,60.756,49.8,,percent of total billed charges,,
Mercury (Mayo)OutsideLaboratory,,83825,CPT,Facility,Inpatient,,,90,122,103.7,34.9652,122,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Mercury (Mayo)OutsideLaboratory,,83825,CPT,Facility,Both,,,90,122,103.7,34.9652,122,"Multiplan, Inc.","Multiplan, Inc.",114.68,94,,percent of total billed charges,,
Mercury (Mayo)OutsideLaboratory,,83825,CPT,Facility,Outpatient,,,90,122,103.7,34.9652,122,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,105.408,86.4,,percent of total billed charges,,
Mercury (Mayo)OutsideLaboratory,,83825,CPT,Facility,Inpatient,,,90,122,103.7,34.9652,122,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Mercury (Mayo)OutsideLaboratory,,83825,CPT,Facility,Both,,,90,122,103.7,34.9652,122,"Preferred One Administrative Services, INC.",PPO,120.292,98.6,,percent of total billed charges,,
Mercury (Mayo)OutsideLaboratory,,83825,CPT,Facility,Outpatient,,,90,122,103.7,34.9652,122,PrimeWest Health,Minnesota Senior Health Options (MSHO),62.769,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Mercury (Mayo)OutsideLaboratory,,83825,CPT,Facility,Inpatient,,,90,122,103.7,34.9652,122,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mercury (Mayo)OutsideLaboratory,,83825,CPT,Facility,Outpatient,,,90,122,103.7,34.9652,122,PrimeWest Health,MinnesotaCare,62.6592,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Mercury (Mayo)OutsideLaboratory,,83825,CPT,Facility,Inpatient,,,90,122,103.7,34.9652,122,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Mercury (Mayo)OutsideLaboratory,,83825,CPT,Facility,Both,,,90,122,103.7,34.9652,122,Sanford Health Plan,Sanford Health Plan,112.24,92,,percent of total billed charges,,
Mercury (Mayo)OutsideLaboratory,,83825,CPT,Facility,Outpatient,,,90,122,103.7,34.9652,122,"UCare Health, Inc.",Individual & Family Plan,68.747,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Mercury (Mayo)OutsideLaboratory,,83825,CPT,Facility,Inpatient,,,90,122,103.7,34.9652,122,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Mercury (Mayo)OutsideLaboratory,,83825,CPT,Facility,Outpatient,,,90,122,103.7,34.9652,122,"UCare Health, Inc.",Medical Assistance,61.5734,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mercury (Mayo)OutsideLaboratory,,83825,CPT,Facility,Inpatient,,,90,122,103.7,34.9652,122,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Mercury (Mayo)OutsideLaboratory,,83825,CPT,Facility,Outpatient,,,90,122,103.7,34.9652,122,"UCare Health, Inc.",Medicare Advantage,61.5734,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mercury (Mayo)OutsideLaboratory,,83825,CPT,Facility,Inpatient,,,90,122,103.7,34.9652,122,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mercury (Mayo)OutsideLaboratory,,83825,CPT,Facility,Outpatient,,,90,122,103.7,34.9652,122,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),61.5734,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mercury (Mayo)OutsideLaboratory,,83825,CPT,Facility,Inpatient,,,90,122,103.7,34.9652,122,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mercury (Mayo)OutsideLaboratory,,83825,CPT,Facility,Both,,,90,122,103.7,34.9652,122,UnitedHealthcare,Individual & Family,114.68,94,,percent of total billed charges,,
Mercury (Mayo)OutsideLaboratory,,83825,CPT,Facility,Outpatient,,,90,122,103.7,34.9652,122,UnitedHealthcare,Medicare Advantage,59.78,49,,percent of total billed charges,,
Mercury (Mayo)OutsideLaboratory,,83825,CPT,Facility,Inpatient,,,90,122,103.7,34.9652,122,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Mercury (Mayo)OutsideLaboratory,,83825,CPT,Facility,Outpatient,,,90,122,103.7,34.9652,122,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,58.56,48,,percent of total billed charges,,100% of DHS outpatient percentage
Mercury (Mayo)OutsideLaboratory,,83825,CPT,Facility,Inpatient,,,90,122,103.7,34.9652,122,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Mercury, B (Mayo)OutsideLaboratory",,83825,CPT,Facility,Both,,,90,122,103.7,34.9652,122,Aetna,Commercial,112.24,92,,percent of total billed charges,,
"Mercury, B (Mayo)OutsideLaboratory",,83825,CPT,Facility,Outpatient,,,90,122,103.7,34.9652,122,Aetna,Medicare Advantage,59.78,49,,percent of total billed charges,,
"Mercury, B (Mayo)OutsideLaboratory",,83825,CPT,Facility,Inpatient,,,90,122,103.7,34.9652,122,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Mercury, B (Mayo)OutsideLaboratory",,83825,CPT,Facility,Both,,,90,122,103.7,34.9652,122,Aetna,PPO,113.46,93,,percent of total billed charges,,
"Mercury, B (Mayo)OutsideLaboratory",,83825,CPT,Facility,Both,,,90,122,103.7,34.9652,122,America's PPO,America's PPO,117.1566,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Mercury, B (Mayo)OutsideLaboratory",,83825,CPT,Facility,Both,,,90,122,103.7,34.9652,122,BlueCross BlueShield Minnesota, Federal Employee Program,120.048,98.4,,percent of total billed charges,,
"Mercury, B (Mayo)OutsideLaboratory",,83825,CPT,Facility,Both,,,90,122,103.7,34.9652,122,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,122,100,,percent of total billed charges,,
"Mercury, B (Mayo)OutsideLaboratory",,83825,CPT,Facility,Both,,,90,122,103.7,34.9652,122,BlueCross BlueShield Minnesota,High Value Network Plan,109.8,90,,percent of total billed charges,,
"Mercury, B (Mayo)OutsideLaboratory",,83825,CPT,Facility,Outpatient,,,90,122,103.7,34.9652,122,BlueCross BlueShield Minnesota,Medicare Advantage,59.78,49,,percent of total billed charges,,
"Mercury, B (Mayo)OutsideLaboratory",,83825,CPT,Facility,Inpatient,,,90,122,103.7,34.9652,122,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Mercury, B (Mayo)OutsideLaboratory",,83825,CPT,Facility,Both,,,90,122,103.7,34.9652,122,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,108.0554,88.57,,percent of total billed charges,,
"Mercury, B (Mayo)OutsideLaboratory",,83825,CPT,Facility,Both,,,90,122,103.7,34.9652,122,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,34.9652,28.66,,percent of total billed charges,,
"Mercury, B (Mayo)OutsideLaboratory",,83825,CPT,Facility,Outpatient,,,90,122,103.7,34.9652,122,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),59.78,49,,percent of total billed charges,,
"Mercury, B (Mayo)OutsideLaboratory",,83825,CPT,Facility,Inpatient,,,90,122,103.7,34.9652,122,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Mercury, B (Mayo)OutsideLaboratory",,83825,CPT,Facility,Both,,,90,122,103.7,34.9652,122,CorVel,Worker's Compensation,122,100,,percent of total billed charges,,
"Mercury, B (Mayo)OutsideLaboratory",,83825,CPT,Facility,Both,,,90,122,103.7,34.9652,122,First Health Group Corporation,First Health Network,118.34,97,,percent of total billed charges,,
"Mercury, B (Mayo)OutsideLaboratory",,83825,CPT,Facility,Both,,,90,122,103.7,34.9652,122,"Health Partners, Inc.",Commercial,115.412,94.6,,percent of total billed charges,,
"Mercury, B (Mayo)OutsideLaboratory",,83825,CPT,Facility,Outpatient,,,90,122,103.7,34.9652,122,"Health Partners, Inc.",Medicare Advantage,59.78,49,,percent of total billed charges,,
"Mercury, B (Mayo)OutsideLaboratory",,83825,CPT,Facility,Inpatient,,,90,122,103.7,34.9652,122,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Mercury, B (Mayo)OutsideLaboratory",,83825,CPT,Facility,Both,,,90,122,103.7,34.9652,122,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),73.2,60,,percent of total billed charges,,
"Mercury, B (Mayo)OutsideLaboratory",,83825,CPT,Facility,Both,,,90,122,103.7,34.9652,122,"Health Partners, Inc.",State of Minnesota Advantage Program,99.43,81.5,,percent of total billed charges,,
"Mercury, B (Mayo)OutsideLaboratory",,83825,CPT,Facility,Both,,,90,122,103.7,34.9652,122,"Health Partners, Inc.",State Public Programs,61,50,,percent of total billed charges,,
"Mercury, B (Mayo)OutsideLaboratory",,83825,CPT,Facility,Both,,,90,122,103.7,34.9652,122,Humana Insurance Company,Commercial PPO,115.9,95,,percent of total billed charges,,
"Mercury, B (Mayo)OutsideLaboratory",,83825,CPT,Facility,Outpatient,,,90,122,103.7,34.9652,122,Humana Insurance Company,Medicare PPO,59.78,49,,percent of total billed charges,,
"Mercury, B (Mayo)OutsideLaboratory",,83825,CPT,Facility,Inpatient,,,90,122,103.7,34.9652,122,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Mercury, B (Mayo)OutsideLaboratory",,83825,CPT,Facility,Both,,,90,122,103.7,34.9652,122,Medica,Individual & Family,120.902,99.1,,percent of total billed charges,,
"Mercury, B (Mayo)OutsideLaboratory",,83825,CPT,Facility,Outpatient,,,90,122,103.7,34.9652,122,Medica,Medica Advantage Solution,60.756,49.8,,percent of total billed charges,,
"Mercury, B (Mayo)OutsideLaboratory",,83825,CPT,Facility,Inpatient,,,90,122,103.7,34.9652,122,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Mercury, B (Mayo)OutsideLaboratory",,83825,CPT,Facility,Outpatient,,,90,122,103.7,34.9652,122,Medica,Medical Assistance,54.412,44.6,,percent of total billed charges,,
"Mercury, B (Mayo)OutsideLaboratory",,83825,CPT,Facility,Inpatient,,,90,122,103.7,34.9652,122,Medica,Medical Assistance,,,,,Included in per diem rate,
"Mercury, B (Mayo)OutsideLaboratory",,83825,CPT,Facility,Outpatient,,,90,122,103.7,34.9652,122,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,60.756,49.8,,percent of total billed charges,,
"Mercury, B (Mayo)OutsideLaboratory",,83825,CPT,Facility,Inpatient,,,90,122,103.7,34.9652,122,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Mercury, B (Mayo)OutsideLaboratory",,83825,CPT,Facility,Both,,,90,122,103.7,34.9652,122,"Multiplan, Inc.","Multiplan, Inc.",114.68,94,,percent of total billed charges,,
"Mercury, B (Mayo)OutsideLaboratory",,83825,CPT,Facility,Outpatient,,,90,122,103.7,34.9652,122,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,105.408,86.4,,percent of total billed charges,,
"Mercury, B (Mayo)OutsideLaboratory",,83825,CPT,Facility,Inpatient,,,90,122,103.7,34.9652,122,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Mercury, B (Mayo)OutsideLaboratory",,83825,CPT,Facility,Both,,,90,122,103.7,34.9652,122,"Preferred One Administrative Services, INC.",PPO,120.292,98.6,,percent of total billed charges,,
"Mercury, B (Mayo)OutsideLaboratory",,83825,CPT,Facility,Outpatient,,,90,122,103.7,34.9652,122,PrimeWest Health,Minnesota Senior Health Options (MSHO),62.769,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Mercury, B (Mayo)OutsideLaboratory",,83825,CPT,Facility,Inpatient,,,90,122,103.7,34.9652,122,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Mercury, B (Mayo)OutsideLaboratory",,83825,CPT,Facility,Outpatient,,,90,122,103.7,34.9652,122,PrimeWest Health,MinnesotaCare,62.6592,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Mercury, B (Mayo)OutsideLaboratory",,83825,CPT,Facility,Inpatient,,,90,122,103.7,34.9652,122,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Mercury, B (Mayo)OutsideLaboratory",,83825,CPT,Facility,Both,,,90,122,103.7,34.9652,122,Sanford Health Plan,Sanford Health Plan,112.24,92,,percent of total billed charges,,
"Mercury, B (Mayo)OutsideLaboratory",,83825,CPT,Facility,Outpatient,,,90,122,103.7,34.9652,122,"UCare Health, Inc.",Individual & Family Plan,68.747,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Mercury, B (Mayo)OutsideLaboratory",,83825,CPT,Facility,Inpatient,,,90,122,103.7,34.9652,122,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Mercury, B (Mayo)OutsideLaboratory",,83825,CPT,Facility,Outpatient,,,90,122,103.7,34.9652,122,"UCare Health, Inc.",Medical Assistance,61.5734,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Mercury, B (Mayo)OutsideLaboratory",,83825,CPT,Facility,Inpatient,,,90,122,103.7,34.9652,122,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Mercury, B (Mayo)OutsideLaboratory",,83825,CPT,Facility,Outpatient,,,90,122,103.7,34.9652,122,"UCare Health, Inc.",Medicare Advantage,61.5734,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Mercury, B (Mayo)OutsideLaboratory",,83825,CPT,Facility,Inpatient,,,90,122,103.7,34.9652,122,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Mercury, B (Mayo)OutsideLaboratory",,83825,CPT,Facility,Outpatient,,,90,122,103.7,34.9652,122,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),61.5734,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Mercury, B (Mayo)OutsideLaboratory",,83825,CPT,Facility,Inpatient,,,90,122,103.7,34.9652,122,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Mercury, B (Mayo)OutsideLaboratory",,83825,CPT,Facility,Both,,,90,122,103.7,34.9652,122,UnitedHealthcare,Individual & Family,114.68,94,,percent of total billed charges,,
"Mercury, B (Mayo)OutsideLaboratory",,83825,CPT,Facility,Outpatient,,,90,122,103.7,34.9652,122,UnitedHealthcare,Medicare Advantage,59.78,49,,percent of total billed charges,,
"Mercury, B (Mayo)OutsideLaboratory",,83825,CPT,Facility,Inpatient,,,90,122,103.7,34.9652,122,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Mercury, B (Mayo)OutsideLaboratory",,83825,CPT,Facility,Outpatient,,,90,122,103.7,34.9652,122,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,58.56,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Mercury, B (Mayo)OutsideLaboratory",,83825,CPT,Facility,Inpatient,,,90,122,103.7,34.9652,122,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Metanephrines, Fract., Free, P (Mayo)OutsideLaboratory",,83835,CPT,Facility,Both,,,90,232,197.2,66.4912,232,Aetna,Commercial,213.44,92,,percent of total billed charges,,
"Metanephrines, Fract., Free, P (Mayo)OutsideLaboratory",,83835,CPT,Facility,Outpatient,,,90,232,197.2,66.4912,232,Aetna,Medicare Advantage,113.68,49,,percent of total billed charges,,
"Metanephrines, Fract., Free, P (Mayo)OutsideLaboratory",,83835,CPT,Facility,Inpatient,,,90,232,197.2,66.4912,232,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Metanephrines, Fract., Free, P (Mayo)OutsideLaboratory",,83835,CPT,Facility,Both,,,90,232,197.2,66.4912,232,Aetna,PPO,215.76,93,,percent of total billed charges,,
"Metanephrines, Fract., Free, P (Mayo)OutsideLaboratory",,83835,CPT,Facility,Both,,,90,232,197.2,66.4912,232,America's PPO,America's PPO,222.7896,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Metanephrines, Fract., Free, P (Mayo)OutsideLaboratory",,83835,CPT,Facility,Both,,,90,232,197.2,66.4912,232,BlueCross BlueShield Minnesota, Federal Employee Program,228.288,98.4,,percent of total billed charges,,
"Metanephrines, Fract., Free, P (Mayo)OutsideLaboratory",,83835,CPT,Facility,Both,,,90,232,197.2,66.4912,232,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,232,100,,percent of total billed charges,,
"Metanephrines, Fract., Free, P (Mayo)OutsideLaboratory",,83835,CPT,Facility,Both,,,90,232,197.2,66.4912,232,BlueCross BlueShield Minnesota,High Value Network Plan,208.8,90,,percent of total billed charges,,
"Metanephrines, Fract., Free, P (Mayo)OutsideLaboratory",,83835,CPT,Facility,Outpatient,,,90,232,197.2,66.4912,232,BlueCross BlueShield Minnesota,Medicare Advantage,113.68,49,,percent of total billed charges,,
"Metanephrines, Fract., Free, P (Mayo)OutsideLaboratory",,83835,CPT,Facility,Inpatient,,,90,232,197.2,66.4912,232,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Metanephrines, Fract., Free, P (Mayo)OutsideLaboratory",,83835,CPT,Facility,Both,,,90,232,197.2,66.4912,232,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,205.4824,88.57,,percent of total billed charges,,
"Metanephrines, Fract., Free, P (Mayo)OutsideLaboratory",,83835,CPT,Facility,Both,,,90,232,197.2,66.4912,232,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,66.4912,28.66,,percent of total billed charges,,
"Metanephrines, Fract., Free, P (Mayo)OutsideLaboratory",,83835,CPT,Facility,Outpatient,,,90,232,197.2,66.4912,232,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),113.68,49,,percent of total billed charges,,
"Metanephrines, Fract., Free, P (Mayo)OutsideLaboratory",,83835,CPT,Facility,Inpatient,,,90,232,197.2,66.4912,232,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Metanephrines, Fract., Free, P (Mayo)OutsideLaboratory",,83835,CPT,Facility,Both,,,90,232,197.2,66.4912,232,CorVel,Worker's Compensation,232,100,,percent of total billed charges,,
"Metanephrines, Fract., Free, P (Mayo)OutsideLaboratory",,83835,CPT,Facility,Both,,,90,232,197.2,66.4912,232,First Health Group Corporation,First Health Network,225.04,97,,percent of total billed charges,,
"Metanephrines, Fract., Free, P (Mayo)OutsideLaboratory",,83835,CPT,Facility,Both,,,90,232,197.2,66.4912,232,"Health Partners, Inc.",Commercial,219.472,94.6,,percent of total billed charges,,
"Metanephrines, Fract., Free, P (Mayo)OutsideLaboratory",,83835,CPT,Facility,Outpatient,,,90,232,197.2,66.4912,232,"Health Partners, Inc.",Medicare Advantage,113.68,49,,percent of total billed charges,,
"Metanephrines, Fract., Free, P (Mayo)OutsideLaboratory",,83835,CPT,Facility,Inpatient,,,90,232,197.2,66.4912,232,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Metanephrines, Fract., Free, P (Mayo)OutsideLaboratory",,83835,CPT,Facility,Both,,,90,232,197.2,66.4912,232,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),139.2,60,,percent of total billed charges,,
"Metanephrines, Fract., Free, P (Mayo)OutsideLaboratory",,83835,CPT,Facility,Both,,,90,232,197.2,66.4912,232,"Health Partners, Inc.",State of Minnesota Advantage Program,189.08,81.5,,percent of total billed charges,,
"Metanephrines, Fract., Free, P (Mayo)OutsideLaboratory",,83835,CPT,Facility,Both,,,90,232,197.2,66.4912,232,"Health Partners, Inc.",State Public Programs,116,50,,percent of total billed charges,,
"Metanephrines, Fract., Free, P (Mayo)OutsideLaboratory",,83835,CPT,Facility,Both,,,90,232,197.2,66.4912,232,Humana Insurance Company,Commercial PPO,220.4,95,,percent of total billed charges,,
"Metanephrines, Fract., Free, P (Mayo)OutsideLaboratory",,83835,CPT,Facility,Outpatient,,,90,232,197.2,66.4912,232,Humana Insurance Company,Medicare PPO,113.68,49,,percent of total billed charges,,
"Metanephrines, Fract., Free, P (Mayo)OutsideLaboratory",,83835,CPT,Facility,Inpatient,,,90,232,197.2,66.4912,232,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Metanephrines, Fract., Free, P (Mayo)OutsideLaboratory",,83835,CPT,Facility,Both,,,90,232,197.2,66.4912,232,Medica,Individual & Family,229.912,99.1,,percent of total billed charges,,
"Metanephrines, Fract., Free, P (Mayo)OutsideLaboratory",,83835,CPT,Facility,Outpatient,,,90,232,197.2,66.4912,232,Medica,Medica Advantage Solution,115.536,49.8,,percent of total billed charges,,
"Metanephrines, Fract., Free, P (Mayo)OutsideLaboratory",,83835,CPT,Facility,Inpatient,,,90,232,197.2,66.4912,232,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Metanephrines, Fract., Free, P (Mayo)OutsideLaboratory",,83835,CPT,Facility,Outpatient,,,90,232,197.2,66.4912,232,Medica,Medical Assistance,103.472,44.6,,percent of total billed charges,,
"Metanephrines, Fract., Free, P (Mayo)OutsideLaboratory",,83835,CPT,Facility,Inpatient,,,90,232,197.2,66.4912,232,Medica,Medical Assistance,,,,,Included in per diem rate,
"Metanephrines, Fract., Free, P (Mayo)OutsideLaboratory",,83835,CPT,Facility,Outpatient,,,90,232,197.2,66.4912,232,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,115.536,49.8,,percent of total billed charges,,
"Metanephrines, Fract., Free, P (Mayo)OutsideLaboratory",,83835,CPT,Facility,Inpatient,,,90,232,197.2,66.4912,232,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Metanephrines, Fract., Free, P (Mayo)OutsideLaboratory",,83835,CPT,Facility,Both,,,90,232,197.2,66.4912,232,"Multiplan, Inc.","Multiplan, Inc.",218.08,94,,percent of total billed charges,,
"Metanephrines, Fract., Free, P (Mayo)OutsideLaboratory",,83835,CPT,Facility,Outpatient,,,90,232,197.2,66.4912,232,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,200.448,86.4,,percent of total billed charges,,
"Metanephrines, Fract., Free, P (Mayo)OutsideLaboratory",,83835,CPT,Facility,Inpatient,,,90,232,197.2,66.4912,232,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Metanephrines, Fract., Free, P (Mayo)OutsideLaboratory",,83835,CPT,Facility,Both,,,90,232,197.2,66.4912,232,"Preferred One Administrative Services, INC.",PPO,228.752,98.6,,percent of total billed charges,,
"Metanephrines, Fract., Free, P (Mayo)OutsideLaboratory",,83835,CPT,Facility,Outpatient,,,90,232,197.2,66.4912,232,PrimeWest Health,Minnesota Senior Health Options (MSHO),119.364,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Metanephrines, Fract., Free, P (Mayo)OutsideLaboratory",,83835,CPT,Facility,Inpatient,,,90,232,197.2,66.4912,232,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Metanephrines, Fract., Free, P (Mayo)OutsideLaboratory",,83835,CPT,Facility,Outpatient,,,90,232,197.2,66.4912,232,PrimeWest Health,MinnesotaCare,119.1552,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Metanephrines, Fract., Free, P (Mayo)OutsideLaboratory",,83835,CPT,Facility,Inpatient,,,90,232,197.2,66.4912,232,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Metanephrines, Fract., Free, P (Mayo)OutsideLaboratory",,83835,CPT,Facility,Both,,,90,232,197.2,66.4912,232,Sanford Health Plan,Sanford Health Plan,213.44,92,,percent of total billed charges,,
"Metanephrines, Fract., Free, P (Mayo)OutsideLaboratory",,83835,CPT,Facility,Outpatient,,,90,232,197.2,66.4912,232,"UCare Health, Inc.",Individual & Family Plan,130.732,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Metanephrines, Fract., Free, P (Mayo)OutsideLaboratory",,83835,CPT,Facility,Inpatient,,,90,232,197.2,66.4912,232,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Metanephrines, Fract., Free, P (Mayo)OutsideLaboratory",,83835,CPT,Facility,Outpatient,,,90,232,197.2,66.4912,232,"UCare Health, Inc.",Medical Assistance,117.0904,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Metanephrines, Fract., Free, P (Mayo)OutsideLaboratory",,83835,CPT,Facility,Inpatient,,,90,232,197.2,66.4912,232,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Metanephrines, Fract., Free, P (Mayo)OutsideLaboratory",,83835,CPT,Facility,Outpatient,,,90,232,197.2,66.4912,232,"UCare Health, Inc.",Medicare Advantage,117.0904,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Metanephrines, Fract., Free, P (Mayo)OutsideLaboratory",,83835,CPT,Facility,Inpatient,,,90,232,197.2,66.4912,232,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Metanephrines, Fract., Free, P (Mayo)OutsideLaboratory",,83835,CPT,Facility,Outpatient,,,90,232,197.2,66.4912,232,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),117.0904,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Metanephrines, Fract., Free, P (Mayo)OutsideLaboratory",,83835,CPT,Facility,Inpatient,,,90,232,197.2,66.4912,232,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Metanephrines, Fract., Free, P (Mayo)OutsideLaboratory",,83835,CPT,Facility,Both,,,90,232,197.2,66.4912,232,UnitedHealthcare,Individual & Family,218.08,94,,percent of total billed charges,,
"Metanephrines, Fract., Free, P (Mayo)OutsideLaboratory",,83835,CPT,Facility,Outpatient,,,90,232,197.2,66.4912,232,UnitedHealthcare,Medicare Advantage,113.68,49,,percent of total billed charges,,
"Metanephrines, Fract., Free, P (Mayo)OutsideLaboratory",,83835,CPT,Facility,Inpatient,,,90,232,197.2,66.4912,232,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Metanephrines, Fract., Free, P (Mayo)OutsideLaboratory",,83835,CPT,Facility,Outpatient,,,90,232,197.2,66.4912,232,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,111.36,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Metanephrines, Fract., Free, P (Mayo)OutsideLaboratory",,83835,CPT,Facility,Inpatient,,,90,232,197.2,66.4912,232,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Metanephrines, Fract., Random, U (Mayo)OutsideLaboratory",,83835,CPT,Facility,Both,,,90,232,197.2,66.4912,232,Aetna,Commercial,213.44,92,,percent of total billed charges,,
"Metanephrines, Fract., Random, U (Mayo)OutsideLaboratory",,83835,CPT,Facility,Outpatient,,,90,232,197.2,66.4912,232,Aetna,Medicare Advantage,113.68,49,,percent of total billed charges,,
"Metanephrines, Fract., Random, U (Mayo)OutsideLaboratory",,83835,CPT,Facility,Inpatient,,,90,232,197.2,66.4912,232,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Metanephrines, Fract., Random, U (Mayo)OutsideLaboratory",,83835,CPT,Facility,Both,,,90,232,197.2,66.4912,232,Aetna,PPO,215.76,93,,percent of total billed charges,,
"Metanephrines, Fract., Random, U (Mayo)OutsideLaboratory",,83835,CPT,Facility,Both,,,90,232,197.2,66.4912,232,America's PPO,America's PPO,222.7896,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Metanephrines, Fract., Random, U (Mayo)OutsideLaboratory",,83835,CPT,Facility,Both,,,90,232,197.2,66.4912,232,BlueCross BlueShield Minnesota, Federal Employee Program,228.288,98.4,,percent of total billed charges,,
"Metanephrines, Fract., Random, U (Mayo)OutsideLaboratory",,83835,CPT,Facility,Both,,,90,232,197.2,66.4912,232,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,232,100,,percent of total billed charges,,
"Metanephrines, Fract., Random, U (Mayo)OutsideLaboratory",,83835,CPT,Facility,Both,,,90,232,197.2,66.4912,232,BlueCross BlueShield Minnesota,High Value Network Plan,208.8,90,,percent of total billed charges,,
"Metanephrines, Fract., Random, U (Mayo)OutsideLaboratory",,83835,CPT,Facility,Outpatient,,,90,232,197.2,66.4912,232,BlueCross BlueShield Minnesota,Medicare Advantage,113.68,49,,percent of total billed charges,,
"Metanephrines, Fract., Random, U (Mayo)OutsideLaboratory",,83835,CPT,Facility,Inpatient,,,90,232,197.2,66.4912,232,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Metanephrines, Fract., Random, U (Mayo)OutsideLaboratory",,83835,CPT,Facility,Both,,,90,232,197.2,66.4912,232,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,205.4824,88.57,,percent of total billed charges,,
"Metanephrines, Fract., Random, U (Mayo)OutsideLaboratory",,83835,CPT,Facility,Both,,,90,232,197.2,66.4912,232,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,66.4912,28.66,,percent of total billed charges,,
"Metanephrines, Fract., Random, U (Mayo)OutsideLaboratory",,83835,CPT,Facility,Outpatient,,,90,232,197.2,66.4912,232,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),113.68,49,,percent of total billed charges,,
"Metanephrines, Fract., Random, U (Mayo)OutsideLaboratory",,83835,CPT,Facility,Inpatient,,,90,232,197.2,66.4912,232,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Metanephrines, Fract., Random, U (Mayo)OutsideLaboratory",,83835,CPT,Facility,Both,,,90,232,197.2,66.4912,232,CorVel,Worker's Compensation,232,100,,percent of total billed charges,,
"Metanephrines, Fract., Random, U (Mayo)OutsideLaboratory",,83835,CPT,Facility,Both,,,90,232,197.2,66.4912,232,First Health Group Corporation,First Health Network,225.04,97,,percent of total billed charges,,
"Metanephrines, Fract., Random, U (Mayo)OutsideLaboratory",,83835,CPT,Facility,Both,,,90,232,197.2,66.4912,232,"Health Partners, Inc.",Commercial,219.472,94.6,,percent of total billed charges,,
"Metanephrines, Fract., Random, U (Mayo)OutsideLaboratory",,83835,CPT,Facility,Outpatient,,,90,232,197.2,66.4912,232,"Health Partners, Inc.",Medicare Advantage,113.68,49,,percent of total billed charges,,
"Metanephrines, Fract., Random, U (Mayo)OutsideLaboratory",,83835,CPT,Facility,Inpatient,,,90,232,197.2,66.4912,232,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Metanephrines, Fract., Random, U (Mayo)OutsideLaboratory",,83835,CPT,Facility,Both,,,90,232,197.2,66.4912,232,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),139.2,60,,percent of total billed charges,,
"Metanephrines, Fract., Random, U (Mayo)OutsideLaboratory",,83835,CPT,Facility,Both,,,90,232,197.2,66.4912,232,"Health Partners, Inc.",State of Minnesota Advantage Program,189.08,81.5,,percent of total billed charges,,
"Metanephrines, Fract., Random, U (Mayo)OutsideLaboratory",,83835,CPT,Facility,Both,,,90,232,197.2,66.4912,232,"Health Partners, Inc.",State Public Programs,116,50,,percent of total billed charges,,
"Metanephrines, Fract., Random, U (Mayo)OutsideLaboratory",,83835,CPT,Facility,Both,,,90,232,197.2,66.4912,232,Humana Insurance Company,Commercial PPO,220.4,95,,percent of total billed charges,,
"Metanephrines, Fract., Random, U (Mayo)OutsideLaboratory",,83835,CPT,Facility,Outpatient,,,90,232,197.2,66.4912,232,Humana Insurance Company,Medicare PPO,113.68,49,,percent of total billed charges,,
"Metanephrines, Fract., Random, U (Mayo)OutsideLaboratory",,83835,CPT,Facility,Inpatient,,,90,232,197.2,66.4912,232,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Metanephrines, Fract., Random, U (Mayo)OutsideLaboratory",,83835,CPT,Facility,Both,,,90,232,197.2,66.4912,232,Medica,Individual & Family,229.912,99.1,,percent of total billed charges,,
"Metanephrines, Fract., Random, U (Mayo)OutsideLaboratory",,83835,CPT,Facility,Outpatient,,,90,232,197.2,66.4912,232,Medica,Medica Advantage Solution,115.536,49.8,,percent of total billed charges,,
"Metanephrines, Fract., Random, U (Mayo)OutsideLaboratory",,83835,CPT,Facility,Inpatient,,,90,232,197.2,66.4912,232,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Metanephrines, Fract., Random, U (Mayo)OutsideLaboratory",,83835,CPT,Facility,Outpatient,,,90,232,197.2,66.4912,232,Medica,Medical Assistance,103.472,44.6,,percent of total billed charges,,
"Metanephrines, Fract., Random, U (Mayo)OutsideLaboratory",,83835,CPT,Facility,Inpatient,,,90,232,197.2,66.4912,232,Medica,Medical Assistance,,,,,Included in per diem rate,
"Metanephrines, Fract., Random, U (Mayo)OutsideLaboratory",,83835,CPT,Facility,Outpatient,,,90,232,197.2,66.4912,232,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,115.536,49.8,,percent of total billed charges,,
"Metanephrines, Fract., Random, U (Mayo)OutsideLaboratory",,83835,CPT,Facility,Inpatient,,,90,232,197.2,66.4912,232,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Metanephrines, Fract., Random, U (Mayo)OutsideLaboratory",,83835,CPT,Facility,Both,,,90,232,197.2,66.4912,232,"Multiplan, Inc.","Multiplan, Inc.",218.08,94,,percent of total billed charges,,
"Metanephrines, Fract., Random, U (Mayo)OutsideLaboratory",,83835,CPT,Facility,Outpatient,,,90,232,197.2,66.4912,232,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,200.448,86.4,,percent of total billed charges,,
"Metanephrines, Fract., Random, U (Mayo)OutsideLaboratory",,83835,CPT,Facility,Inpatient,,,90,232,197.2,66.4912,232,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Metanephrines, Fract., Random, U (Mayo)OutsideLaboratory",,83835,CPT,Facility,Both,,,90,232,197.2,66.4912,232,"Preferred One Administrative Services, INC.",PPO,228.752,98.6,,percent of total billed charges,,
"Metanephrines, Fract., Random, U (Mayo)OutsideLaboratory",,83835,CPT,Facility,Outpatient,,,90,232,197.2,66.4912,232,PrimeWest Health,Minnesota Senior Health Options (MSHO),119.364,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Metanephrines, Fract., Random, U (Mayo)OutsideLaboratory",,83835,CPT,Facility,Inpatient,,,90,232,197.2,66.4912,232,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Metanephrines, Fract., Random, U (Mayo)OutsideLaboratory",,83835,CPT,Facility,Outpatient,,,90,232,197.2,66.4912,232,PrimeWest Health,MinnesotaCare,119.1552,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Metanephrines, Fract., Random, U (Mayo)OutsideLaboratory",,83835,CPT,Facility,Inpatient,,,90,232,197.2,66.4912,232,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Metanephrines, Fract., Random, U (Mayo)OutsideLaboratory",,83835,CPT,Facility,Both,,,90,232,197.2,66.4912,232,Sanford Health Plan,Sanford Health Plan,213.44,92,,percent of total billed charges,,
"Metanephrines, Fract., Random, U (Mayo)OutsideLaboratory",,83835,CPT,Facility,Outpatient,,,90,232,197.2,66.4912,232,"UCare Health, Inc.",Individual & Family Plan,130.732,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Metanephrines, Fract., Random, U (Mayo)OutsideLaboratory",,83835,CPT,Facility,Inpatient,,,90,232,197.2,66.4912,232,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Metanephrines, Fract., Random, U (Mayo)OutsideLaboratory",,83835,CPT,Facility,Outpatient,,,90,232,197.2,66.4912,232,"UCare Health, Inc.",Medical Assistance,117.0904,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Metanephrines, Fract., Random, U (Mayo)OutsideLaboratory",,83835,CPT,Facility,Inpatient,,,90,232,197.2,66.4912,232,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Metanephrines, Fract., Random, U (Mayo)OutsideLaboratory",,83835,CPT,Facility,Outpatient,,,90,232,197.2,66.4912,232,"UCare Health, Inc.",Medicare Advantage,117.0904,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Metanephrines, Fract., Random, U (Mayo)OutsideLaboratory",,83835,CPT,Facility,Inpatient,,,90,232,197.2,66.4912,232,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Metanephrines, Fract., Random, U (Mayo)OutsideLaboratory",,83835,CPT,Facility,Outpatient,,,90,232,197.2,66.4912,232,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),117.0904,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Metanephrines, Fract., Random, U (Mayo)OutsideLaboratory",,83835,CPT,Facility,Inpatient,,,90,232,197.2,66.4912,232,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Metanephrines, Fract., Random, U (Mayo)OutsideLaboratory",,83835,CPT,Facility,Both,,,90,232,197.2,66.4912,232,UnitedHealthcare,Individual & Family,218.08,94,,percent of total billed charges,,
"Metanephrines, Fract., Random, U (Mayo)OutsideLaboratory",,83835,CPT,Facility,Outpatient,,,90,232,197.2,66.4912,232,UnitedHealthcare,Medicare Advantage,113.68,49,,percent of total billed charges,,
"Metanephrines, Fract., Random, U (Mayo)OutsideLaboratory",,83835,CPT,Facility,Inpatient,,,90,232,197.2,66.4912,232,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Metanephrines, Fract., Random, U (Mayo)OutsideLaboratory",,83835,CPT,Facility,Outpatient,,,90,232,197.2,66.4912,232,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,111.36,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Metanephrines, Fract., Random, U (Mayo)OutsideLaboratory",,83835,CPT,Facility,Inpatient,,,90,232,197.2,66.4912,232,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Metanephrines, Fractionated, 24H, U (Mayo)OutsideLaboratory",,83835,CPT,Facility,Both,,,90,232,197.2,66.4912,232,Aetna,Commercial,213.44,92,,percent of total billed charges,,
"Metanephrines, Fractionated, 24H, U (Mayo)OutsideLaboratory",,83835,CPT,Facility,Outpatient,,,90,232,197.2,66.4912,232,Aetna,Medicare Advantage,113.68,49,,percent of total billed charges,,
"Metanephrines, Fractionated, 24H, U (Mayo)OutsideLaboratory",,83835,CPT,Facility,Inpatient,,,90,232,197.2,66.4912,232,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Metanephrines, Fractionated, 24H, U (Mayo)OutsideLaboratory",,83835,CPT,Facility,Both,,,90,232,197.2,66.4912,232,Aetna,PPO,215.76,93,,percent of total billed charges,,
"Metanephrines, Fractionated, 24H, U (Mayo)OutsideLaboratory",,83835,CPT,Facility,Both,,,90,232,197.2,66.4912,232,America's PPO,America's PPO,222.7896,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Metanephrines, Fractionated, 24H, U (Mayo)OutsideLaboratory",,83835,CPT,Facility,Both,,,90,232,197.2,66.4912,232,BlueCross BlueShield Minnesota, Federal Employee Program,228.288,98.4,,percent of total billed charges,,
"Metanephrines, Fractionated, 24H, U (Mayo)OutsideLaboratory",,83835,CPT,Facility,Both,,,90,232,197.2,66.4912,232,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,232,100,,percent of total billed charges,,
"Metanephrines, Fractionated, 24H, U (Mayo)OutsideLaboratory",,83835,CPT,Facility,Both,,,90,232,197.2,66.4912,232,BlueCross BlueShield Minnesota,High Value Network Plan,208.8,90,,percent of total billed charges,,
"Metanephrines, Fractionated, 24H, U (Mayo)OutsideLaboratory",,83835,CPT,Facility,Outpatient,,,90,232,197.2,66.4912,232,BlueCross BlueShield Minnesota,Medicare Advantage,113.68,49,,percent of total billed charges,,
"Metanephrines, Fractionated, 24H, U (Mayo)OutsideLaboratory",,83835,CPT,Facility,Inpatient,,,90,232,197.2,66.4912,232,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Metanephrines, Fractionated, 24H, U (Mayo)OutsideLaboratory",,83835,CPT,Facility,Both,,,90,232,197.2,66.4912,232,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,205.4824,88.57,,percent of total billed charges,,
"Metanephrines, Fractionated, 24H, U (Mayo)OutsideLaboratory",,83835,CPT,Facility,Both,,,90,232,197.2,66.4912,232,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,66.4912,28.66,,percent of total billed charges,,
"Metanephrines, Fractionated, 24H, U (Mayo)OutsideLaboratory",,83835,CPT,Facility,Outpatient,,,90,232,197.2,66.4912,232,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),113.68,49,,percent of total billed charges,,
"Metanephrines, Fractionated, 24H, U (Mayo)OutsideLaboratory",,83835,CPT,Facility,Inpatient,,,90,232,197.2,66.4912,232,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Metanephrines, Fractionated, 24H, U (Mayo)OutsideLaboratory",,83835,CPT,Facility,Both,,,90,232,197.2,66.4912,232,CorVel,Worker's Compensation,232,100,,percent of total billed charges,,
"Metanephrines, Fractionated, 24H, U (Mayo)OutsideLaboratory",,83835,CPT,Facility,Both,,,90,232,197.2,66.4912,232,First Health Group Corporation,First Health Network,225.04,97,,percent of total billed charges,,
"Metanephrines, Fractionated, 24H, U (Mayo)OutsideLaboratory",,83835,CPT,Facility,Both,,,90,232,197.2,66.4912,232,"Health Partners, Inc.",Commercial,219.472,94.6,,percent of total billed charges,,
"Metanephrines, Fractionated, 24H, U (Mayo)OutsideLaboratory",,83835,CPT,Facility,Outpatient,,,90,232,197.2,66.4912,232,"Health Partners, Inc.",Medicare Advantage,113.68,49,,percent of total billed charges,,
"Metanephrines, Fractionated, 24H, U (Mayo)OutsideLaboratory",,83835,CPT,Facility,Inpatient,,,90,232,197.2,66.4912,232,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Metanephrines, Fractionated, 24H, U (Mayo)OutsideLaboratory",,83835,CPT,Facility,Both,,,90,232,197.2,66.4912,232,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),139.2,60,,percent of total billed charges,,
"Metanephrines, Fractionated, 24H, U (Mayo)OutsideLaboratory",,83835,CPT,Facility,Both,,,90,232,197.2,66.4912,232,"Health Partners, Inc.",State of Minnesota Advantage Program,189.08,81.5,,percent of total billed charges,,
"Metanephrines, Fractionated, 24H, U (Mayo)OutsideLaboratory",,83835,CPT,Facility,Both,,,90,232,197.2,66.4912,232,"Health Partners, Inc.",State Public Programs,116,50,,percent of total billed charges,,
"Metanephrines, Fractionated, 24H, U (Mayo)OutsideLaboratory",,83835,CPT,Facility,Both,,,90,232,197.2,66.4912,232,Humana Insurance Company,Commercial PPO,220.4,95,,percent of total billed charges,,
"Metanephrines, Fractionated, 24H, U (Mayo)OutsideLaboratory",,83835,CPT,Facility,Outpatient,,,90,232,197.2,66.4912,232,Humana Insurance Company,Medicare PPO,113.68,49,,percent of total billed charges,,
"Metanephrines, Fractionated, 24H, U (Mayo)OutsideLaboratory",,83835,CPT,Facility,Inpatient,,,90,232,197.2,66.4912,232,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Metanephrines, Fractionated, 24H, U (Mayo)OutsideLaboratory",,83835,CPT,Facility,Both,,,90,232,197.2,66.4912,232,Medica,Individual & Family,229.912,99.1,,percent of total billed charges,,
"Metanephrines, Fractionated, 24H, U (Mayo)OutsideLaboratory",,83835,CPT,Facility,Outpatient,,,90,232,197.2,66.4912,232,Medica,Medica Advantage Solution,115.536,49.8,,percent of total billed charges,,
"Metanephrines, Fractionated, 24H, U (Mayo)OutsideLaboratory",,83835,CPT,Facility,Inpatient,,,90,232,197.2,66.4912,232,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Metanephrines, Fractionated, 24H, U (Mayo)OutsideLaboratory",,83835,CPT,Facility,Outpatient,,,90,232,197.2,66.4912,232,Medica,Medical Assistance,103.472,44.6,,percent of total billed charges,,
"Metanephrines, Fractionated, 24H, U (Mayo)OutsideLaboratory",,83835,CPT,Facility,Inpatient,,,90,232,197.2,66.4912,232,Medica,Medical Assistance,,,,,Included in per diem rate,
"Metanephrines, Fractionated, 24H, U (Mayo)OutsideLaboratory",,83835,CPT,Facility,Outpatient,,,90,232,197.2,66.4912,232,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,115.536,49.8,,percent of total billed charges,,
"Metanephrines, Fractionated, 24H, U (Mayo)OutsideLaboratory",,83835,CPT,Facility,Inpatient,,,90,232,197.2,66.4912,232,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Metanephrines, Fractionated, 24H, U (Mayo)OutsideLaboratory",,83835,CPT,Facility,Both,,,90,232,197.2,66.4912,232,"Multiplan, Inc.","Multiplan, Inc.",218.08,94,,percent of total billed charges,,
"Metanephrines, Fractionated, 24H, U (Mayo)OutsideLaboratory",,83835,CPT,Facility,Outpatient,,,90,232,197.2,66.4912,232,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,200.448,86.4,,percent of total billed charges,,
"Metanephrines, Fractionated, 24H, U (Mayo)OutsideLaboratory",,83835,CPT,Facility,Inpatient,,,90,232,197.2,66.4912,232,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Metanephrines, Fractionated, 24H, U (Mayo)OutsideLaboratory",,83835,CPT,Facility,Both,,,90,232,197.2,66.4912,232,"Preferred One Administrative Services, INC.",PPO,228.752,98.6,,percent of total billed charges,,
"Metanephrines, Fractionated, 24H, U (Mayo)OutsideLaboratory",,83835,CPT,Facility,Outpatient,,,90,232,197.2,66.4912,232,PrimeWest Health,Minnesota Senior Health Options (MSHO),119.364,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Metanephrines, Fractionated, 24H, U (Mayo)OutsideLaboratory",,83835,CPT,Facility,Inpatient,,,90,232,197.2,66.4912,232,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Metanephrines, Fractionated, 24H, U (Mayo)OutsideLaboratory",,83835,CPT,Facility,Outpatient,,,90,232,197.2,66.4912,232,PrimeWest Health,MinnesotaCare,119.1552,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Metanephrines, Fractionated, 24H, U (Mayo)OutsideLaboratory",,83835,CPT,Facility,Inpatient,,,90,232,197.2,66.4912,232,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Metanephrines, Fractionated, 24H, U (Mayo)OutsideLaboratory",,83835,CPT,Facility,Both,,,90,232,197.2,66.4912,232,Sanford Health Plan,Sanford Health Plan,213.44,92,,percent of total billed charges,,
"Metanephrines, Fractionated, 24H, U (Mayo)OutsideLaboratory",,83835,CPT,Facility,Outpatient,,,90,232,197.2,66.4912,232,"UCare Health, Inc.",Individual & Family Plan,130.732,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Metanephrines, Fractionated, 24H, U (Mayo)OutsideLaboratory",,83835,CPT,Facility,Inpatient,,,90,232,197.2,66.4912,232,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Metanephrines, Fractionated, 24H, U (Mayo)OutsideLaboratory",,83835,CPT,Facility,Outpatient,,,90,232,197.2,66.4912,232,"UCare Health, Inc.",Medical Assistance,117.0904,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Metanephrines, Fractionated, 24H, U (Mayo)OutsideLaboratory",,83835,CPT,Facility,Inpatient,,,90,232,197.2,66.4912,232,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Metanephrines, Fractionated, 24H, U (Mayo)OutsideLaboratory",,83835,CPT,Facility,Outpatient,,,90,232,197.2,66.4912,232,"UCare Health, Inc.",Medicare Advantage,117.0904,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Metanephrines, Fractionated, 24H, U (Mayo)OutsideLaboratory",,83835,CPT,Facility,Inpatient,,,90,232,197.2,66.4912,232,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Metanephrines, Fractionated, 24H, U (Mayo)OutsideLaboratory",,83835,CPT,Facility,Outpatient,,,90,232,197.2,66.4912,232,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),117.0904,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Metanephrines, Fractionated, 24H, U (Mayo)OutsideLaboratory",,83835,CPT,Facility,Inpatient,,,90,232,197.2,66.4912,232,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Metanephrines, Fractionated, 24H, U (Mayo)OutsideLaboratory",,83835,CPT,Facility,Both,,,90,232,197.2,66.4912,232,UnitedHealthcare,Individual & Family,218.08,94,,percent of total billed charges,,
"Metanephrines, Fractionated, 24H, U (Mayo)OutsideLaboratory",,83835,CPT,Facility,Outpatient,,,90,232,197.2,66.4912,232,UnitedHealthcare,Medicare Advantage,113.68,49,,percent of total billed charges,,
"Metanephrines, Fractionated, 24H, U (Mayo)OutsideLaboratory",,83835,CPT,Facility,Inpatient,,,90,232,197.2,66.4912,232,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Metanephrines, Fractionated, 24H, U (Mayo)OutsideLaboratory",,83835,CPT,Facility,Outpatient,,,90,232,197.2,66.4912,232,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,111.36,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Metanephrines, Fractionated, 24H, U (Mayo)OutsideLaboratory",,83835,CPT,Facility,Inpatient,,,90,232,197.2,66.4912,232,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Myoglobin, S (Mayo)OutsideLaboratory",,83874,CPT,Facility,Both,,,90,110,93.5,31.526,110,Aetna,Commercial,101.2,92,,percent of total billed charges,,
"Myoglobin, S (Mayo)OutsideLaboratory",,83874,CPT,Facility,Outpatient,,,90,110,93.5,31.526,110,Aetna,Medicare Advantage,53.9,49,,percent of total billed charges,,
"Myoglobin, S (Mayo)OutsideLaboratory",,83874,CPT,Facility,Inpatient,,,90,110,93.5,31.526,110,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Myoglobin, S (Mayo)OutsideLaboratory",,83874,CPT,Facility,Both,,,90,110,93.5,31.526,110,Aetna,PPO,102.3,93,,percent of total billed charges,,
"Myoglobin, S (Mayo)OutsideLaboratory",,83874,CPT,Facility,Both,,,90,110,93.5,31.526,110,America's PPO,America's PPO,105.633,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Myoglobin, S (Mayo)OutsideLaboratory",,83874,CPT,Facility,Both,,,90,110,93.5,31.526,110,BlueCross BlueShield Minnesota, Federal Employee Program,108.24,98.4,,percent of total billed charges,,
"Myoglobin, S (Mayo)OutsideLaboratory",,83874,CPT,Facility,Both,,,90,110,93.5,31.526,110,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,110,100,,percent of total billed charges,,
"Myoglobin, S (Mayo)OutsideLaboratory",,83874,CPT,Facility,Both,,,90,110,93.5,31.526,110,BlueCross BlueShield Minnesota,High Value Network Plan,99,90,,percent of total billed charges,,
"Myoglobin, S (Mayo)OutsideLaboratory",,83874,CPT,Facility,Outpatient,,,90,110,93.5,31.526,110,BlueCross BlueShield Minnesota,Medicare Advantage,53.9,49,,percent of total billed charges,,
"Myoglobin, S (Mayo)OutsideLaboratory",,83874,CPT,Facility,Inpatient,,,90,110,93.5,31.526,110,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Myoglobin, S (Mayo)OutsideLaboratory",,83874,CPT,Facility,Both,,,90,110,93.5,31.526,110,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,97.427,88.57,,percent of total billed charges,,
"Myoglobin, S (Mayo)OutsideLaboratory",,83874,CPT,Facility,Both,,,90,110,93.5,31.526,110,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,31.526,28.66,,percent of total billed charges,,
"Myoglobin, S (Mayo)OutsideLaboratory",,83874,CPT,Facility,Outpatient,,,90,110,93.5,31.526,110,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),53.9,49,,percent of total billed charges,,
"Myoglobin, S (Mayo)OutsideLaboratory",,83874,CPT,Facility,Inpatient,,,90,110,93.5,31.526,110,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Myoglobin, S (Mayo)OutsideLaboratory",,83874,CPT,Facility,Both,,,90,110,93.5,31.526,110,CorVel,Worker's Compensation,110,100,,percent of total billed charges,,
"Myoglobin, S (Mayo)OutsideLaboratory",,83874,CPT,Facility,Both,,,90,110,93.5,31.526,110,First Health Group Corporation,First Health Network,106.7,97,,percent of total billed charges,,
"Myoglobin, S (Mayo)OutsideLaboratory",,83874,CPT,Facility,Both,,,90,110,93.5,31.526,110,"Health Partners, Inc.",Commercial,104.06,94.6,,percent of total billed charges,,
"Myoglobin, S (Mayo)OutsideLaboratory",,83874,CPT,Facility,Outpatient,,,90,110,93.5,31.526,110,"Health Partners, Inc.",Medicare Advantage,53.9,49,,percent of total billed charges,,
"Myoglobin, S (Mayo)OutsideLaboratory",,83874,CPT,Facility,Inpatient,,,90,110,93.5,31.526,110,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Myoglobin, S (Mayo)OutsideLaboratory",,83874,CPT,Facility,Both,,,90,110,93.5,31.526,110,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),66,60,,percent of total billed charges,,
"Myoglobin, S (Mayo)OutsideLaboratory",,83874,CPT,Facility,Both,,,90,110,93.5,31.526,110,"Health Partners, Inc.",State of Minnesota Advantage Program,89.65,81.5,,percent of total billed charges,,
"Myoglobin, S (Mayo)OutsideLaboratory",,83874,CPT,Facility,Both,,,90,110,93.5,31.526,110,"Health Partners, Inc.",State Public Programs,55,50,,percent of total billed charges,,
"Myoglobin, S (Mayo)OutsideLaboratory",,83874,CPT,Facility,Both,,,90,110,93.5,31.526,110,Humana Insurance Company,Commercial PPO,104.5,95,,percent of total billed charges,,
"Myoglobin, S (Mayo)OutsideLaboratory",,83874,CPT,Facility,Outpatient,,,90,110,93.5,31.526,110,Humana Insurance Company,Medicare PPO,53.9,49,,percent of total billed charges,,
"Myoglobin, S (Mayo)OutsideLaboratory",,83874,CPT,Facility,Inpatient,,,90,110,93.5,31.526,110,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Myoglobin, S (Mayo)OutsideLaboratory",,83874,CPT,Facility,Both,,,90,110,93.5,31.526,110,Medica,Individual & Family,109.01,99.1,,percent of total billed charges,,
"Myoglobin, S (Mayo)OutsideLaboratory",,83874,CPT,Facility,Outpatient,,,90,110,93.5,31.526,110,Medica,Medica Advantage Solution,54.78,49.8,,percent of total billed charges,,
"Myoglobin, S (Mayo)OutsideLaboratory",,83874,CPT,Facility,Inpatient,,,90,110,93.5,31.526,110,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Myoglobin, S (Mayo)OutsideLaboratory",,83874,CPT,Facility,Outpatient,,,90,110,93.5,31.526,110,Medica,Medical Assistance,49.06,44.6,,percent of total billed charges,,
"Myoglobin, S (Mayo)OutsideLaboratory",,83874,CPT,Facility,Inpatient,,,90,110,93.5,31.526,110,Medica,Medical Assistance,,,,,Included in per diem rate,
"Myoglobin, S (Mayo)OutsideLaboratory",,83874,CPT,Facility,Outpatient,,,90,110,93.5,31.526,110,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,54.78,49.8,,percent of total billed charges,,
"Myoglobin, S (Mayo)OutsideLaboratory",,83874,CPT,Facility,Inpatient,,,90,110,93.5,31.526,110,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Myoglobin, S (Mayo)OutsideLaboratory",,83874,CPT,Facility,Both,,,90,110,93.5,31.526,110,"Multiplan, Inc.","Multiplan, Inc.",103.4,94,,percent of total billed charges,,
"Myoglobin, S (Mayo)OutsideLaboratory",,83874,CPT,Facility,Outpatient,,,90,110,93.5,31.526,110,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,95.04,86.4,,percent of total billed charges,,
"Myoglobin, S (Mayo)OutsideLaboratory",,83874,CPT,Facility,Inpatient,,,90,110,93.5,31.526,110,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Myoglobin, S (Mayo)OutsideLaboratory",,83874,CPT,Facility,Both,,,90,110,93.5,31.526,110,"Preferred One Administrative Services, INC.",PPO,108.46,98.6,,percent of total billed charges,,
"Myoglobin, S (Mayo)OutsideLaboratory",,83874,CPT,Facility,Outpatient,,,90,110,93.5,31.526,110,PrimeWest Health,Minnesota Senior Health Options (MSHO),56.595,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Myoglobin, S (Mayo)OutsideLaboratory",,83874,CPT,Facility,Inpatient,,,90,110,93.5,31.526,110,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Myoglobin, S (Mayo)OutsideLaboratory",,83874,CPT,Facility,Outpatient,,,90,110,93.5,31.526,110,PrimeWest Health,MinnesotaCare,56.496,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Myoglobin, S (Mayo)OutsideLaboratory",,83874,CPT,Facility,Inpatient,,,90,110,93.5,31.526,110,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Myoglobin, S (Mayo)OutsideLaboratory",,83874,CPT,Facility,Both,,,90,110,93.5,31.526,110,Sanford Health Plan,Sanford Health Plan,101.2,92,,percent of total billed charges,,
"Myoglobin, S (Mayo)OutsideLaboratory",,83874,CPT,Facility,Outpatient,,,90,110,93.5,31.526,110,"UCare Health, Inc.",Individual & Family Plan,61.985,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Myoglobin, S (Mayo)OutsideLaboratory",,83874,CPT,Facility,Inpatient,,,90,110,93.5,31.526,110,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Myoglobin, S (Mayo)OutsideLaboratory",,83874,CPT,Facility,Outpatient,,,90,110,93.5,31.526,110,"UCare Health, Inc.",Medical Assistance,55.517,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Myoglobin, S (Mayo)OutsideLaboratory",,83874,CPT,Facility,Inpatient,,,90,110,93.5,31.526,110,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Myoglobin, S (Mayo)OutsideLaboratory",,83874,CPT,Facility,Outpatient,,,90,110,93.5,31.526,110,"UCare Health, Inc.",Medicare Advantage,55.517,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Myoglobin, S (Mayo)OutsideLaboratory",,83874,CPT,Facility,Inpatient,,,90,110,93.5,31.526,110,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Myoglobin, S (Mayo)OutsideLaboratory",,83874,CPT,Facility,Outpatient,,,90,110,93.5,31.526,110,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),55.517,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Myoglobin, S (Mayo)OutsideLaboratory",,83874,CPT,Facility,Inpatient,,,90,110,93.5,31.526,110,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Myoglobin, S (Mayo)OutsideLaboratory",,83874,CPT,Facility,Both,,,90,110,93.5,31.526,110,UnitedHealthcare,Individual & Family,103.4,94,,percent of total billed charges,,
"Myoglobin, S (Mayo)OutsideLaboratory",,83874,CPT,Facility,Outpatient,,,90,110,93.5,31.526,110,UnitedHealthcare,Medicare Advantage,53.9,49,,percent of total billed charges,,
"Myoglobin, S (Mayo)OutsideLaboratory",,83874,CPT,Facility,Inpatient,,,90,110,93.5,31.526,110,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Myoglobin, S (Mayo)OutsideLaboratory",,83874,CPT,Facility,Outpatient,,,90,110,93.5,31.526,110,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,52.8,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Myoglobin, S (Mayo)OutsideLaboratory",,83874,CPT,Facility,Inpatient,,,90,110,93.5,31.526,110,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Myoglobin, U (Mayo)OutsideLaboratory",,83874,CPT,Facility,Both,,,90,110,93.5,31.526,110,Aetna,Commercial,101.2,92,,percent of total billed charges,,
"Myoglobin, U (Mayo)OutsideLaboratory",,83874,CPT,Facility,Outpatient,,,90,110,93.5,31.526,110,Aetna,Medicare Advantage,53.9,49,,percent of total billed charges,,
"Myoglobin, U (Mayo)OutsideLaboratory",,83874,CPT,Facility,Inpatient,,,90,110,93.5,31.526,110,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Myoglobin, U (Mayo)OutsideLaboratory",,83874,CPT,Facility,Both,,,90,110,93.5,31.526,110,Aetna,PPO,102.3,93,,percent of total billed charges,,
"Myoglobin, U (Mayo)OutsideLaboratory",,83874,CPT,Facility,Both,,,90,110,93.5,31.526,110,America's PPO,America's PPO,105.633,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Myoglobin, U (Mayo)OutsideLaboratory",,83874,CPT,Facility,Both,,,90,110,93.5,31.526,110,BlueCross BlueShield Minnesota, Federal Employee Program,108.24,98.4,,percent of total billed charges,,
"Myoglobin, U (Mayo)OutsideLaboratory",,83874,CPT,Facility,Both,,,90,110,93.5,31.526,110,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,110,100,,percent of total billed charges,,
"Myoglobin, U (Mayo)OutsideLaboratory",,83874,CPT,Facility,Both,,,90,110,93.5,31.526,110,BlueCross BlueShield Minnesota,High Value Network Plan,99,90,,percent of total billed charges,,
"Myoglobin, U (Mayo)OutsideLaboratory",,83874,CPT,Facility,Outpatient,,,90,110,93.5,31.526,110,BlueCross BlueShield Minnesota,Medicare Advantage,53.9,49,,percent of total billed charges,,
"Myoglobin, U (Mayo)OutsideLaboratory",,83874,CPT,Facility,Inpatient,,,90,110,93.5,31.526,110,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Myoglobin, U (Mayo)OutsideLaboratory",,83874,CPT,Facility,Both,,,90,110,93.5,31.526,110,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,97.427,88.57,,percent of total billed charges,,
"Myoglobin, U (Mayo)OutsideLaboratory",,83874,CPT,Facility,Both,,,90,110,93.5,31.526,110,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,31.526,28.66,,percent of total billed charges,,
"Myoglobin, U (Mayo)OutsideLaboratory",,83874,CPT,Facility,Outpatient,,,90,110,93.5,31.526,110,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),53.9,49,,percent of total billed charges,,
"Myoglobin, U (Mayo)OutsideLaboratory",,83874,CPT,Facility,Inpatient,,,90,110,93.5,31.526,110,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Myoglobin, U (Mayo)OutsideLaboratory",,83874,CPT,Facility,Both,,,90,110,93.5,31.526,110,CorVel,Worker's Compensation,110,100,,percent of total billed charges,,
"Myoglobin, U (Mayo)OutsideLaboratory",,83874,CPT,Facility,Both,,,90,110,93.5,31.526,110,First Health Group Corporation,First Health Network,106.7,97,,percent of total billed charges,,
"Myoglobin, U (Mayo)OutsideLaboratory",,83874,CPT,Facility,Both,,,90,110,93.5,31.526,110,"Health Partners, Inc.",Commercial,104.06,94.6,,percent of total billed charges,,
"Myoglobin, U (Mayo)OutsideLaboratory",,83874,CPT,Facility,Outpatient,,,90,110,93.5,31.526,110,"Health Partners, Inc.",Medicare Advantage,53.9,49,,percent of total billed charges,,
"Myoglobin, U (Mayo)OutsideLaboratory",,83874,CPT,Facility,Inpatient,,,90,110,93.5,31.526,110,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Myoglobin, U (Mayo)OutsideLaboratory",,83874,CPT,Facility,Both,,,90,110,93.5,31.526,110,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),66,60,,percent of total billed charges,,
"Myoglobin, U (Mayo)OutsideLaboratory",,83874,CPT,Facility,Both,,,90,110,93.5,31.526,110,"Health Partners, Inc.",State of Minnesota Advantage Program,89.65,81.5,,percent of total billed charges,,
"Myoglobin, U (Mayo)OutsideLaboratory",,83874,CPT,Facility,Both,,,90,110,93.5,31.526,110,"Health Partners, Inc.",State Public Programs,55,50,,percent of total billed charges,,
"Myoglobin, U (Mayo)OutsideLaboratory",,83874,CPT,Facility,Both,,,90,110,93.5,31.526,110,Humana Insurance Company,Commercial PPO,104.5,95,,percent of total billed charges,,
"Myoglobin, U (Mayo)OutsideLaboratory",,83874,CPT,Facility,Outpatient,,,90,110,93.5,31.526,110,Humana Insurance Company,Medicare PPO,53.9,49,,percent of total billed charges,,
"Myoglobin, U (Mayo)OutsideLaboratory",,83874,CPT,Facility,Inpatient,,,90,110,93.5,31.526,110,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Myoglobin, U (Mayo)OutsideLaboratory",,83874,CPT,Facility,Both,,,90,110,93.5,31.526,110,Medica,Individual & Family,109.01,99.1,,percent of total billed charges,,
"Myoglobin, U (Mayo)OutsideLaboratory",,83874,CPT,Facility,Outpatient,,,90,110,93.5,31.526,110,Medica,Medica Advantage Solution,54.78,49.8,,percent of total billed charges,,
"Myoglobin, U (Mayo)OutsideLaboratory",,83874,CPT,Facility,Inpatient,,,90,110,93.5,31.526,110,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Myoglobin, U (Mayo)OutsideLaboratory",,83874,CPT,Facility,Outpatient,,,90,110,93.5,31.526,110,Medica,Medical Assistance,49.06,44.6,,percent of total billed charges,,
"Myoglobin, U (Mayo)OutsideLaboratory",,83874,CPT,Facility,Inpatient,,,90,110,93.5,31.526,110,Medica,Medical Assistance,,,,,Included in per diem rate,
"Myoglobin, U (Mayo)OutsideLaboratory",,83874,CPT,Facility,Outpatient,,,90,110,93.5,31.526,110,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,54.78,49.8,,percent of total billed charges,,
"Myoglobin, U (Mayo)OutsideLaboratory",,83874,CPT,Facility,Inpatient,,,90,110,93.5,31.526,110,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Myoglobin, U (Mayo)OutsideLaboratory",,83874,CPT,Facility,Both,,,90,110,93.5,31.526,110,"Multiplan, Inc.","Multiplan, Inc.",103.4,94,,percent of total billed charges,,
"Myoglobin, U (Mayo)OutsideLaboratory",,83874,CPT,Facility,Outpatient,,,90,110,93.5,31.526,110,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,95.04,86.4,,percent of total billed charges,,
"Myoglobin, U (Mayo)OutsideLaboratory",,83874,CPT,Facility,Inpatient,,,90,110,93.5,31.526,110,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Myoglobin, U (Mayo)OutsideLaboratory",,83874,CPT,Facility,Both,,,90,110,93.5,31.526,110,"Preferred One Administrative Services, INC.",PPO,108.46,98.6,,percent of total billed charges,,
"Myoglobin, U (Mayo)OutsideLaboratory",,83874,CPT,Facility,Outpatient,,,90,110,93.5,31.526,110,PrimeWest Health,Minnesota Senior Health Options (MSHO),56.595,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Myoglobin, U (Mayo)OutsideLaboratory",,83874,CPT,Facility,Inpatient,,,90,110,93.5,31.526,110,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Myoglobin, U (Mayo)OutsideLaboratory",,83874,CPT,Facility,Outpatient,,,90,110,93.5,31.526,110,PrimeWest Health,MinnesotaCare,56.496,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Myoglobin, U (Mayo)OutsideLaboratory",,83874,CPT,Facility,Inpatient,,,90,110,93.5,31.526,110,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Myoglobin, U (Mayo)OutsideLaboratory",,83874,CPT,Facility,Both,,,90,110,93.5,31.526,110,Sanford Health Plan,Sanford Health Plan,101.2,92,,percent of total billed charges,,
"Myoglobin, U (Mayo)OutsideLaboratory",,83874,CPT,Facility,Outpatient,,,90,110,93.5,31.526,110,"UCare Health, Inc.",Individual & Family Plan,61.985,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Myoglobin, U (Mayo)OutsideLaboratory",,83874,CPT,Facility,Inpatient,,,90,110,93.5,31.526,110,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Myoglobin, U (Mayo)OutsideLaboratory",,83874,CPT,Facility,Outpatient,,,90,110,93.5,31.526,110,"UCare Health, Inc.",Medical Assistance,55.517,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Myoglobin, U (Mayo)OutsideLaboratory",,83874,CPT,Facility,Inpatient,,,90,110,93.5,31.526,110,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Myoglobin, U (Mayo)OutsideLaboratory",,83874,CPT,Facility,Outpatient,,,90,110,93.5,31.526,110,"UCare Health, Inc.",Medicare Advantage,55.517,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Myoglobin, U (Mayo)OutsideLaboratory",,83874,CPT,Facility,Inpatient,,,90,110,93.5,31.526,110,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Myoglobin, U (Mayo)OutsideLaboratory",,83874,CPT,Facility,Outpatient,,,90,110,93.5,31.526,110,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),55.517,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Myoglobin, U (Mayo)OutsideLaboratory",,83874,CPT,Facility,Inpatient,,,90,110,93.5,31.526,110,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Myoglobin, U (Mayo)OutsideLaboratory",,83874,CPT,Facility,Both,,,90,110,93.5,31.526,110,UnitedHealthcare,Individual & Family,103.4,94,,percent of total billed charges,,
"Myoglobin, U (Mayo)OutsideLaboratory",,83874,CPT,Facility,Outpatient,,,90,110,93.5,31.526,110,UnitedHealthcare,Medicare Advantage,53.9,49,,percent of total billed charges,,
"Myoglobin, U (Mayo)OutsideLaboratory",,83874,CPT,Facility,Inpatient,,,90,110,93.5,31.526,110,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Myoglobin, U (Mayo)OutsideLaboratory",,83874,CPT,Facility,Outpatient,,,90,110,93.5,31.526,110,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,52.8,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Myoglobin, U (Mayo)OutsideLaboratory",,83874,CPT,Facility,Inpatient,,,90,110,93.5,31.526,110,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Nt-Pro Bnp, S (Mayo)OutsideLaboratory",,83880,CPT,Facility,Both,,,90,184,156.4,52.7344,184,Aetna,Commercial,169.28,92,,percent of total billed charges,,
"Nt-Pro Bnp, S (Mayo)OutsideLaboratory",,83880,CPT,Facility,Outpatient,,,90,184,156.4,52.7344,184,Aetna,Medicare Advantage,90.16,49,,percent of total billed charges,,
"Nt-Pro Bnp, S (Mayo)OutsideLaboratory",,83880,CPT,Facility,Inpatient,,,90,184,156.4,52.7344,184,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Nt-Pro Bnp, S (Mayo)OutsideLaboratory",,83880,CPT,Facility,Both,,,90,184,156.4,52.7344,184,Aetna,PPO,171.12,93,,percent of total billed charges,,
"Nt-Pro Bnp, S (Mayo)OutsideLaboratory",,83880,CPT,Facility,Both,,,90,184,156.4,52.7344,184,America's PPO,America's PPO,176.6952,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Nt-Pro Bnp, S (Mayo)OutsideLaboratory",,83880,CPT,Facility,Both,,,90,184,156.4,52.7344,184,BlueCross BlueShield Minnesota, Federal Employee Program,181.056,98.4,,percent of total billed charges,,
"Nt-Pro Bnp, S (Mayo)OutsideLaboratory",,83880,CPT,Facility,Both,,,90,184,156.4,52.7344,184,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,184,100,,percent of total billed charges,,
"Nt-Pro Bnp, S (Mayo)OutsideLaboratory",,83880,CPT,Facility,Both,,,90,184,156.4,52.7344,184,BlueCross BlueShield Minnesota,High Value Network Plan,165.6,90,,percent of total billed charges,,
"Nt-Pro Bnp, S (Mayo)OutsideLaboratory",,83880,CPT,Facility,Outpatient,,,90,184,156.4,52.7344,184,BlueCross BlueShield Minnesota,Medicare Advantage,90.16,49,,percent of total billed charges,,
"Nt-Pro Bnp, S (Mayo)OutsideLaboratory",,83880,CPT,Facility,Inpatient,,,90,184,156.4,52.7344,184,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Nt-Pro Bnp, S (Mayo)OutsideLaboratory",,83880,CPT,Facility,Both,,,90,184,156.4,52.7344,184,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,162.9688,88.57,,percent of total billed charges,,
"Nt-Pro Bnp, S (Mayo)OutsideLaboratory",,83880,CPT,Facility,Both,,,90,184,156.4,52.7344,184,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,52.7344,28.66,,percent of total billed charges,,
"Nt-Pro Bnp, S (Mayo)OutsideLaboratory",,83880,CPT,Facility,Outpatient,,,90,184,156.4,52.7344,184,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),90.16,49,,percent of total billed charges,,
"Nt-Pro Bnp, S (Mayo)OutsideLaboratory",,83880,CPT,Facility,Inpatient,,,90,184,156.4,52.7344,184,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Nt-Pro Bnp, S (Mayo)OutsideLaboratory",,83880,CPT,Facility,Both,,,90,184,156.4,52.7344,184,CorVel,Worker's Compensation,184,100,,percent of total billed charges,,
"Nt-Pro Bnp, S (Mayo)OutsideLaboratory",,83880,CPT,Facility,Both,,,90,184,156.4,52.7344,184,First Health Group Corporation,First Health Network,178.48,97,,percent of total billed charges,,
"Nt-Pro Bnp, S (Mayo)OutsideLaboratory",,83880,CPT,Facility,Both,,,90,184,156.4,52.7344,184,"Health Partners, Inc.",Commercial,174.064,94.6,,percent of total billed charges,,
"Nt-Pro Bnp, S (Mayo)OutsideLaboratory",,83880,CPT,Facility,Outpatient,,,90,184,156.4,52.7344,184,"Health Partners, Inc.",Medicare Advantage,90.16,49,,percent of total billed charges,,
"Nt-Pro Bnp, S (Mayo)OutsideLaboratory",,83880,CPT,Facility,Inpatient,,,90,184,156.4,52.7344,184,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Nt-Pro Bnp, S (Mayo)OutsideLaboratory",,83880,CPT,Facility,Both,,,90,184,156.4,52.7344,184,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),110.4,60,,percent of total billed charges,,
"Nt-Pro Bnp, S (Mayo)OutsideLaboratory",,83880,CPT,Facility,Both,,,90,184,156.4,52.7344,184,"Health Partners, Inc.",State of Minnesota Advantage Program,149.96,81.5,,percent of total billed charges,,
"Nt-Pro Bnp, S (Mayo)OutsideLaboratory",,83880,CPT,Facility,Both,,,90,184,156.4,52.7344,184,"Health Partners, Inc.",State Public Programs,92,50,,percent of total billed charges,,
"Nt-Pro Bnp, S (Mayo)OutsideLaboratory",,83880,CPT,Facility,Both,,,90,184,156.4,52.7344,184,Humana Insurance Company,Commercial PPO,174.8,95,,percent of total billed charges,,
"Nt-Pro Bnp, S (Mayo)OutsideLaboratory",,83880,CPT,Facility,Outpatient,,,90,184,156.4,52.7344,184,Humana Insurance Company,Medicare PPO,90.16,49,,percent of total billed charges,,
"Nt-Pro Bnp, S (Mayo)OutsideLaboratory",,83880,CPT,Facility,Inpatient,,,90,184,156.4,52.7344,184,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Nt-Pro Bnp, S (Mayo)OutsideLaboratory",,83880,CPT,Facility,Both,,,90,184,156.4,52.7344,184,Medica,Individual & Family,182.344,99.1,,percent of total billed charges,,
"Nt-Pro Bnp, S (Mayo)OutsideLaboratory",,83880,CPT,Facility,Outpatient,,,90,184,156.4,52.7344,184,Medica,Medica Advantage Solution,91.632,49.8,,percent of total billed charges,,
"Nt-Pro Bnp, S (Mayo)OutsideLaboratory",,83880,CPT,Facility,Inpatient,,,90,184,156.4,52.7344,184,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Nt-Pro Bnp, S (Mayo)OutsideLaboratory",,83880,CPT,Facility,Outpatient,,,90,184,156.4,52.7344,184,Medica,Medical Assistance,82.064,44.6,,percent of total billed charges,,
"Nt-Pro Bnp, S (Mayo)OutsideLaboratory",,83880,CPT,Facility,Inpatient,,,90,184,156.4,52.7344,184,Medica,Medical Assistance,,,,,Included in per diem rate,
"Nt-Pro Bnp, S (Mayo)OutsideLaboratory",,83880,CPT,Facility,Outpatient,,,90,184,156.4,52.7344,184,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,91.632,49.8,,percent of total billed charges,,
"Nt-Pro Bnp, S (Mayo)OutsideLaboratory",,83880,CPT,Facility,Inpatient,,,90,184,156.4,52.7344,184,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Nt-Pro Bnp, S (Mayo)OutsideLaboratory",,83880,CPT,Facility,Both,,,90,184,156.4,52.7344,184,"Multiplan, Inc.","Multiplan, Inc.",172.96,94,,percent of total billed charges,,
"Nt-Pro Bnp, S (Mayo)OutsideLaboratory",,83880,CPT,Facility,Outpatient,,,90,184,156.4,52.7344,184,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,158.976,86.4,,percent of total billed charges,,
"Nt-Pro Bnp, S (Mayo)OutsideLaboratory",,83880,CPT,Facility,Inpatient,,,90,184,156.4,52.7344,184,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Nt-Pro Bnp, S (Mayo)OutsideLaboratory",,83880,CPT,Facility,Both,,,90,184,156.4,52.7344,184,"Preferred One Administrative Services, INC.",PPO,181.424,98.6,,percent of total billed charges,,
"Nt-Pro Bnp, S (Mayo)OutsideLaboratory",,83880,CPT,Facility,Outpatient,,,90,184,156.4,52.7344,184,PrimeWest Health,Minnesota Senior Health Options (MSHO),94.668,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Nt-Pro Bnp, S (Mayo)OutsideLaboratory",,83880,CPT,Facility,Inpatient,,,90,184,156.4,52.7344,184,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Nt-Pro Bnp, S (Mayo)OutsideLaboratory",,83880,CPT,Facility,Outpatient,,,90,184,156.4,52.7344,184,PrimeWest Health,MinnesotaCare,94.5024,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Nt-Pro Bnp, S (Mayo)OutsideLaboratory",,83880,CPT,Facility,Inpatient,,,90,184,156.4,52.7344,184,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Nt-Pro Bnp, S (Mayo)OutsideLaboratory",,83880,CPT,Facility,Both,,,90,184,156.4,52.7344,184,Sanford Health Plan,Sanford Health Plan,169.28,92,,percent of total billed charges,,
"Nt-Pro Bnp, S (Mayo)OutsideLaboratory",,83880,CPT,Facility,Outpatient,,,90,184,156.4,52.7344,184,"UCare Health, Inc.",Individual & Family Plan,103.684,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Nt-Pro Bnp, S (Mayo)OutsideLaboratory",,83880,CPT,Facility,Inpatient,,,90,184,156.4,52.7344,184,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Nt-Pro Bnp, S (Mayo)OutsideLaboratory",,83880,CPT,Facility,Outpatient,,,90,184,156.4,52.7344,184,"UCare Health, Inc.",Medical Assistance,92.8648,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Nt-Pro Bnp, S (Mayo)OutsideLaboratory",,83880,CPT,Facility,Inpatient,,,90,184,156.4,52.7344,184,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Nt-Pro Bnp, S (Mayo)OutsideLaboratory",,83880,CPT,Facility,Outpatient,,,90,184,156.4,52.7344,184,"UCare Health, Inc.",Medicare Advantage,92.8648,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Nt-Pro Bnp, S (Mayo)OutsideLaboratory",,83880,CPT,Facility,Inpatient,,,90,184,156.4,52.7344,184,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Nt-Pro Bnp, S (Mayo)OutsideLaboratory",,83880,CPT,Facility,Outpatient,,,90,184,156.4,52.7344,184,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),92.8648,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Nt-Pro Bnp, S (Mayo)OutsideLaboratory",,83880,CPT,Facility,Inpatient,,,90,184,156.4,52.7344,184,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Nt-Pro Bnp, S (Mayo)OutsideLaboratory",,83880,CPT,Facility,Both,,,90,184,156.4,52.7344,184,UnitedHealthcare,Individual & Family,172.96,94,,percent of total billed charges,,
"Nt-Pro Bnp, S (Mayo)OutsideLaboratory",,83880,CPT,Facility,Outpatient,,,90,184,156.4,52.7344,184,UnitedHealthcare,Medicare Advantage,90.16,49,,percent of total billed charges,,
"Nt-Pro Bnp, S (Mayo)OutsideLaboratory",,83880,CPT,Facility,Inpatient,,,90,184,156.4,52.7344,184,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Nt-Pro Bnp, S (Mayo)OutsideLaboratory",,83880,CPT,Facility,Outpatient,,,90,184,156.4,52.7344,184,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,88.32,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Nt-Pro Bnp, S (Mayo)OutsideLaboratory",,83880,CPT,Facility,Inpatient,,,90,184,156.4,52.7344,184,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"C1 Esterase Inhibitor Antigen, S (Mayo)OutsideLaboratory",,83883,CPT,Facility,Both,,,90,375,318.75,107.475,375,Aetna,Commercial,345,92,,percent of total billed charges,,
"C1 Esterase Inhibitor Antigen, S (Mayo)OutsideLaboratory",,83883,CPT,Facility,Outpatient,,,90,375,318.75,107.475,375,Aetna,Medicare Advantage,183.75,49,,percent of total billed charges,,
"C1 Esterase Inhibitor Antigen, S (Mayo)OutsideLaboratory",,83883,CPT,Facility,Inpatient,,,90,375,318.75,107.475,375,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"C1 Esterase Inhibitor Antigen, S (Mayo)OutsideLaboratory",,83883,CPT,Facility,Both,,,90,375,318.75,107.475,375,Aetna,PPO,348.75,93,,percent of total billed charges,,
"C1 Esterase Inhibitor Antigen, S (Mayo)OutsideLaboratory",,83883,CPT,Facility,Both,,,90,375,318.75,107.475,375,America's PPO,America's PPO,360.1125,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"C1 Esterase Inhibitor Antigen, S (Mayo)OutsideLaboratory",,83883,CPT,Facility,Both,,,90,375,318.75,107.475,375,BlueCross BlueShield Minnesota, Federal Employee Program,369,98.4,,percent of total billed charges,,
"C1 Esterase Inhibitor Antigen, S (Mayo)OutsideLaboratory",,83883,CPT,Facility,Both,,,90,375,318.75,107.475,375,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,375,100,,percent of total billed charges,,
"C1 Esterase Inhibitor Antigen, S (Mayo)OutsideLaboratory",,83883,CPT,Facility,Both,,,90,375,318.75,107.475,375,BlueCross BlueShield Minnesota,High Value Network Plan,337.5,90,,percent of total billed charges,,
"C1 Esterase Inhibitor Antigen, S (Mayo)OutsideLaboratory",,83883,CPT,Facility,Outpatient,,,90,375,318.75,107.475,375,BlueCross BlueShield Minnesota,Medicare Advantage,183.75,49,,percent of total billed charges,,
"C1 Esterase Inhibitor Antigen, S (Mayo)OutsideLaboratory",,83883,CPT,Facility,Inpatient,,,90,375,318.75,107.475,375,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"C1 Esterase Inhibitor Antigen, S (Mayo)OutsideLaboratory",,83883,CPT,Facility,Both,,,90,375,318.75,107.475,375,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,332.1375,88.57,,percent of total billed charges,,
"C1 Esterase Inhibitor Antigen, S (Mayo)OutsideLaboratory",,83883,CPT,Facility,Both,,,90,375,318.75,107.475,375,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,107.475,28.66,,percent of total billed charges,,
"C1 Esterase Inhibitor Antigen, S (Mayo)OutsideLaboratory",,83883,CPT,Facility,Outpatient,,,90,375,318.75,107.475,375,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),183.75,49,,percent of total billed charges,,
"C1 Esterase Inhibitor Antigen, S (Mayo)OutsideLaboratory",,83883,CPT,Facility,Inpatient,,,90,375,318.75,107.475,375,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"C1 Esterase Inhibitor Antigen, S (Mayo)OutsideLaboratory",,83883,CPT,Facility,Both,,,90,375,318.75,107.475,375,CorVel,Worker's Compensation,375,100,,percent of total billed charges,,
"C1 Esterase Inhibitor Antigen, S (Mayo)OutsideLaboratory",,83883,CPT,Facility,Both,,,90,375,318.75,107.475,375,First Health Group Corporation,First Health Network,363.75,97,,percent of total billed charges,,
"C1 Esterase Inhibitor Antigen, S (Mayo)OutsideLaboratory",,83883,CPT,Facility,Both,,,90,375,318.75,107.475,375,"Health Partners, Inc.",Commercial,354.75,94.6,,percent of total billed charges,,
"C1 Esterase Inhibitor Antigen, S (Mayo)OutsideLaboratory",,83883,CPT,Facility,Outpatient,,,90,375,318.75,107.475,375,"Health Partners, Inc.",Medicare Advantage,183.75,49,,percent of total billed charges,,
"C1 Esterase Inhibitor Antigen, S (Mayo)OutsideLaboratory",,83883,CPT,Facility,Inpatient,,,90,375,318.75,107.475,375,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"C1 Esterase Inhibitor Antigen, S (Mayo)OutsideLaboratory",,83883,CPT,Facility,Both,,,90,375,318.75,107.475,375,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),225,60,,percent of total billed charges,,
"C1 Esterase Inhibitor Antigen, S (Mayo)OutsideLaboratory",,83883,CPT,Facility,Both,,,90,375,318.75,107.475,375,"Health Partners, Inc.",State of Minnesota Advantage Program,305.625,81.5,,percent of total billed charges,,
"C1 Esterase Inhibitor Antigen, S (Mayo)OutsideLaboratory",,83883,CPT,Facility,Both,,,90,375,318.75,107.475,375,"Health Partners, Inc.",State Public Programs,187.5,50,,percent of total billed charges,,
"C1 Esterase Inhibitor Antigen, S (Mayo)OutsideLaboratory",,83883,CPT,Facility,Both,,,90,375,318.75,107.475,375,Humana Insurance Company,Commercial PPO,356.25,95,,percent of total billed charges,,
"C1 Esterase Inhibitor Antigen, S (Mayo)OutsideLaboratory",,83883,CPT,Facility,Outpatient,,,90,375,318.75,107.475,375,Humana Insurance Company,Medicare PPO,183.75,49,,percent of total billed charges,,
"C1 Esterase Inhibitor Antigen, S (Mayo)OutsideLaboratory",,83883,CPT,Facility,Inpatient,,,90,375,318.75,107.475,375,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"C1 Esterase Inhibitor Antigen, S (Mayo)OutsideLaboratory",,83883,CPT,Facility,Both,,,90,375,318.75,107.475,375,Medica,Individual & Family,371.625,99.1,,percent of total billed charges,,
"C1 Esterase Inhibitor Antigen, S (Mayo)OutsideLaboratory",,83883,CPT,Facility,Outpatient,,,90,375,318.75,107.475,375,Medica,Medica Advantage Solution,186.75,49.8,,percent of total billed charges,,
"C1 Esterase Inhibitor Antigen, S (Mayo)OutsideLaboratory",,83883,CPT,Facility,Inpatient,,,90,375,318.75,107.475,375,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"C1 Esterase Inhibitor Antigen, S (Mayo)OutsideLaboratory",,83883,CPT,Facility,Outpatient,,,90,375,318.75,107.475,375,Medica,Medical Assistance,167.25,44.6,,percent of total billed charges,,
"C1 Esterase Inhibitor Antigen, S (Mayo)OutsideLaboratory",,83883,CPT,Facility,Inpatient,,,90,375,318.75,107.475,375,Medica,Medical Assistance,,,,,Included in per diem rate,
"C1 Esterase Inhibitor Antigen, S (Mayo)OutsideLaboratory",,83883,CPT,Facility,Outpatient,,,90,375,318.75,107.475,375,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,186.75,49.8,,percent of total billed charges,,
"C1 Esterase Inhibitor Antigen, S (Mayo)OutsideLaboratory",,83883,CPT,Facility,Inpatient,,,90,375,318.75,107.475,375,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"C1 Esterase Inhibitor Antigen, S (Mayo)OutsideLaboratory",,83883,CPT,Facility,Both,,,90,375,318.75,107.475,375,"Multiplan, Inc.","Multiplan, Inc.",352.5,94,,percent of total billed charges,,
"C1 Esterase Inhibitor Antigen, S (Mayo)OutsideLaboratory",,83883,CPT,Facility,Outpatient,,,90,375,318.75,107.475,375,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,324,86.4,,percent of total billed charges,,
"C1 Esterase Inhibitor Antigen, S (Mayo)OutsideLaboratory",,83883,CPT,Facility,Inpatient,,,90,375,318.75,107.475,375,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"C1 Esterase Inhibitor Antigen, S (Mayo)OutsideLaboratory",,83883,CPT,Facility,Both,,,90,375,318.75,107.475,375,"Preferred One Administrative Services, INC.",PPO,369.75,98.6,,percent of total billed charges,,
"C1 Esterase Inhibitor Antigen, S (Mayo)OutsideLaboratory",,83883,CPT,Facility,Outpatient,,,90,375,318.75,107.475,375,PrimeWest Health,Minnesota Senior Health Options (MSHO),192.9375,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"C1 Esterase Inhibitor Antigen, S (Mayo)OutsideLaboratory",,83883,CPT,Facility,Inpatient,,,90,375,318.75,107.475,375,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"C1 Esterase Inhibitor Antigen, S (Mayo)OutsideLaboratory",,83883,CPT,Facility,Outpatient,,,90,375,318.75,107.475,375,PrimeWest Health,MinnesotaCare,192.6,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"C1 Esterase Inhibitor Antigen, S (Mayo)OutsideLaboratory",,83883,CPT,Facility,Inpatient,,,90,375,318.75,107.475,375,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"C1 Esterase Inhibitor Antigen, S (Mayo)OutsideLaboratory",,83883,CPT,Facility,Both,,,90,375,318.75,107.475,375,Sanford Health Plan,Sanford Health Plan,345,92,,percent of total billed charges,,
"C1 Esterase Inhibitor Antigen, S (Mayo)OutsideLaboratory",,83883,CPT,Facility,Outpatient,,,90,375,318.75,107.475,375,"UCare Health, Inc.",Individual & Family Plan,211.3125,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"C1 Esterase Inhibitor Antigen, S (Mayo)OutsideLaboratory",,83883,CPT,Facility,Inpatient,,,90,375,318.75,107.475,375,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"C1 Esterase Inhibitor Antigen, S (Mayo)OutsideLaboratory",,83883,CPT,Facility,Outpatient,,,90,375,318.75,107.475,375,"UCare Health, Inc.",Medical Assistance,189.2625,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"C1 Esterase Inhibitor Antigen, S (Mayo)OutsideLaboratory",,83883,CPT,Facility,Inpatient,,,90,375,318.75,107.475,375,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"C1 Esterase Inhibitor Antigen, S (Mayo)OutsideLaboratory",,83883,CPT,Facility,Outpatient,,,90,375,318.75,107.475,375,"UCare Health, Inc.",Medicare Advantage,189.2625,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"C1 Esterase Inhibitor Antigen, S (Mayo)OutsideLaboratory",,83883,CPT,Facility,Inpatient,,,90,375,318.75,107.475,375,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"C1 Esterase Inhibitor Antigen, S (Mayo)OutsideLaboratory",,83883,CPT,Facility,Outpatient,,,90,375,318.75,107.475,375,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),189.2625,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"C1 Esterase Inhibitor Antigen, S (Mayo)OutsideLaboratory",,83883,CPT,Facility,Inpatient,,,90,375,318.75,107.475,375,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"C1 Esterase Inhibitor Antigen, S (Mayo)OutsideLaboratory",,83883,CPT,Facility,Both,,,90,375,318.75,107.475,375,UnitedHealthcare,Individual & Family,352.5,94,,percent of total billed charges,,
"C1 Esterase Inhibitor Antigen, S (Mayo)OutsideLaboratory",,83883,CPT,Facility,Outpatient,,,90,375,318.75,107.475,375,UnitedHealthcare,Medicare Advantage,183.75,49,,percent of total billed charges,,
"C1 Esterase Inhibitor Antigen, S (Mayo)OutsideLaboratory",,83883,CPT,Facility,Inpatient,,,90,375,318.75,107.475,375,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"C1 Esterase Inhibitor Antigen, S (Mayo)OutsideLaboratory",,83883,CPT,Facility,Outpatient,,,90,375,318.75,107.475,375,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,180,48,,percent of total billed charges,,100% of DHS outpatient percentage
"C1 Esterase Inhibitor Antigen, S (Mayo)OutsideLaboratory",,83883,CPT,Facility,Inpatient,,,90,375,318.75,107.475,375,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Immunoglobulin Total Light Chains,U (Mayo)OutsideLaboratory",,83883,CPT,Facility,Both,,,90,151,128.35,43.2766,151,Aetna,Commercial,138.92,92,,percent of total billed charges,,
"Immunoglobulin Total Light Chains,U (Mayo)OutsideLaboratory",,83883,CPT,Facility,Outpatient,,,90,151,128.35,43.2766,151,Aetna,Medicare Advantage,73.99,49,,percent of total billed charges,,
"Immunoglobulin Total Light Chains,U (Mayo)OutsideLaboratory",,83883,CPT,Facility,Inpatient,,,90,151,128.35,43.2766,151,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Immunoglobulin Total Light Chains,U (Mayo)OutsideLaboratory",,83883,CPT,Facility,Both,,,90,151,128.35,43.2766,151,Aetna,PPO,140.43,93,,percent of total billed charges,,
"Immunoglobulin Total Light Chains,U (Mayo)OutsideLaboratory",,83883,CPT,Facility,Both,,,90,151,128.35,43.2766,151,America's PPO,America's PPO,145.0053,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Immunoglobulin Total Light Chains,U (Mayo)OutsideLaboratory",,83883,CPT,Facility,Both,,,90,151,128.35,43.2766,151,BlueCross BlueShield Minnesota, Federal Employee Program,148.584,98.4,,percent of total billed charges,,
"Immunoglobulin Total Light Chains,U (Mayo)OutsideLaboratory",,83883,CPT,Facility,Both,,,90,151,128.35,43.2766,151,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,151,100,,percent of total billed charges,,
"Immunoglobulin Total Light Chains,U (Mayo)OutsideLaboratory",,83883,CPT,Facility,Both,,,90,151,128.35,43.2766,151,BlueCross BlueShield Minnesota,High Value Network Plan,135.9,90,,percent of total billed charges,,
"Immunoglobulin Total Light Chains,U (Mayo)OutsideLaboratory",,83883,CPT,Facility,Outpatient,,,90,151,128.35,43.2766,151,BlueCross BlueShield Minnesota,Medicare Advantage,73.99,49,,percent of total billed charges,,
"Immunoglobulin Total Light Chains,U (Mayo)OutsideLaboratory",,83883,CPT,Facility,Inpatient,,,90,151,128.35,43.2766,151,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Immunoglobulin Total Light Chains,U (Mayo)OutsideLaboratory",,83883,CPT,Facility,Both,,,90,151,128.35,43.2766,151,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,133.7407,88.57,,percent of total billed charges,,
"Immunoglobulin Total Light Chains,U (Mayo)OutsideLaboratory",,83883,CPT,Facility,Both,,,90,151,128.35,43.2766,151,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,43.2766,28.66,,percent of total billed charges,,
"Immunoglobulin Total Light Chains,U (Mayo)OutsideLaboratory",,83883,CPT,Facility,Outpatient,,,90,151,128.35,43.2766,151,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),73.99,49,,percent of total billed charges,,
"Immunoglobulin Total Light Chains,U (Mayo)OutsideLaboratory",,83883,CPT,Facility,Inpatient,,,90,151,128.35,43.2766,151,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Immunoglobulin Total Light Chains,U (Mayo)OutsideLaboratory",,83883,CPT,Facility,Both,,,90,151,128.35,43.2766,151,CorVel,Worker's Compensation,151,100,,percent of total billed charges,,
"Immunoglobulin Total Light Chains,U (Mayo)OutsideLaboratory",,83883,CPT,Facility,Both,,,90,151,128.35,43.2766,151,First Health Group Corporation,First Health Network,146.47,97,,percent of total billed charges,,
"Immunoglobulin Total Light Chains,U (Mayo)OutsideLaboratory",,83883,CPT,Facility,Both,,,90,151,128.35,43.2766,151,"Health Partners, Inc.",Commercial,142.846,94.6,,percent of total billed charges,,
"Immunoglobulin Total Light Chains,U (Mayo)OutsideLaboratory",,83883,CPT,Facility,Outpatient,,,90,151,128.35,43.2766,151,"Health Partners, Inc.",Medicare Advantage,73.99,49,,percent of total billed charges,,
"Immunoglobulin Total Light Chains,U (Mayo)OutsideLaboratory",,83883,CPT,Facility,Inpatient,,,90,151,128.35,43.2766,151,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Immunoglobulin Total Light Chains,U (Mayo)OutsideLaboratory",,83883,CPT,Facility,Both,,,90,151,128.35,43.2766,151,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),90.6,60,,percent of total billed charges,,
"Immunoglobulin Total Light Chains,U (Mayo)OutsideLaboratory",,83883,CPT,Facility,Both,,,90,151,128.35,43.2766,151,"Health Partners, Inc.",State of Minnesota Advantage Program,123.065,81.5,,percent of total billed charges,,
"Immunoglobulin Total Light Chains,U (Mayo)OutsideLaboratory",,83883,CPT,Facility,Both,,,90,151,128.35,43.2766,151,"Health Partners, Inc.",State Public Programs,75.5,50,,percent of total billed charges,,
"Immunoglobulin Total Light Chains,U (Mayo)OutsideLaboratory",,83883,CPT,Facility,Both,,,90,151,128.35,43.2766,151,Humana Insurance Company,Commercial PPO,143.45,95,,percent of total billed charges,,
"Immunoglobulin Total Light Chains,U (Mayo)OutsideLaboratory",,83883,CPT,Facility,Outpatient,,,90,151,128.35,43.2766,151,Humana Insurance Company,Medicare PPO,73.99,49,,percent of total billed charges,,
"Immunoglobulin Total Light Chains,U (Mayo)OutsideLaboratory",,83883,CPT,Facility,Inpatient,,,90,151,128.35,43.2766,151,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Immunoglobulin Total Light Chains,U (Mayo)OutsideLaboratory",,83883,CPT,Facility,Both,,,90,151,128.35,43.2766,151,Medica,Individual & Family,149.641,99.1,,percent of total billed charges,,
"Immunoglobulin Total Light Chains,U (Mayo)OutsideLaboratory",,83883,CPT,Facility,Outpatient,,,90,151,128.35,43.2766,151,Medica,Medica Advantage Solution,75.198,49.8,,percent of total billed charges,,
"Immunoglobulin Total Light Chains,U (Mayo)OutsideLaboratory",,83883,CPT,Facility,Inpatient,,,90,151,128.35,43.2766,151,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Immunoglobulin Total Light Chains,U (Mayo)OutsideLaboratory",,83883,CPT,Facility,Outpatient,,,90,151,128.35,43.2766,151,Medica,Medical Assistance,67.346,44.6,,percent of total billed charges,,
"Immunoglobulin Total Light Chains,U (Mayo)OutsideLaboratory",,83883,CPT,Facility,Inpatient,,,90,151,128.35,43.2766,151,Medica,Medical Assistance,,,,,Included in per diem rate,
"Immunoglobulin Total Light Chains,U (Mayo)OutsideLaboratory",,83883,CPT,Facility,Outpatient,,,90,151,128.35,43.2766,151,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,75.198,49.8,,percent of total billed charges,,
"Immunoglobulin Total Light Chains,U (Mayo)OutsideLaboratory",,83883,CPT,Facility,Inpatient,,,90,151,128.35,43.2766,151,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Immunoglobulin Total Light Chains,U (Mayo)OutsideLaboratory",,83883,CPT,Facility,Both,,,90,151,128.35,43.2766,151,"Multiplan, Inc.","Multiplan, Inc.",141.94,94,,percent of total billed charges,,
"Immunoglobulin Total Light Chains,U (Mayo)OutsideLaboratory",,83883,CPT,Facility,Outpatient,,,90,151,128.35,43.2766,151,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,130.464,86.4,,percent of total billed charges,,
"Immunoglobulin Total Light Chains,U (Mayo)OutsideLaboratory",,83883,CPT,Facility,Inpatient,,,90,151,128.35,43.2766,151,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Immunoglobulin Total Light Chains,U (Mayo)OutsideLaboratory",,83883,CPT,Facility,Both,,,90,151,128.35,43.2766,151,"Preferred One Administrative Services, INC.",PPO,148.886,98.6,,percent of total billed charges,,
"Immunoglobulin Total Light Chains,U (Mayo)OutsideLaboratory",,83883,CPT,Facility,Outpatient,,,90,151,128.35,43.2766,151,PrimeWest Health,Minnesota Senior Health Options (MSHO),77.6895,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Immunoglobulin Total Light Chains,U (Mayo)OutsideLaboratory",,83883,CPT,Facility,Inpatient,,,90,151,128.35,43.2766,151,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Immunoglobulin Total Light Chains,U (Mayo)OutsideLaboratory",,83883,CPT,Facility,Outpatient,,,90,151,128.35,43.2766,151,PrimeWest Health,MinnesotaCare,77.5536,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Immunoglobulin Total Light Chains,U (Mayo)OutsideLaboratory",,83883,CPT,Facility,Inpatient,,,90,151,128.35,43.2766,151,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Immunoglobulin Total Light Chains,U (Mayo)OutsideLaboratory",,83883,CPT,Facility,Both,,,90,151,128.35,43.2766,151,Sanford Health Plan,Sanford Health Plan,138.92,92,,percent of total billed charges,,
"Immunoglobulin Total Light Chains,U (Mayo)OutsideLaboratory",,83883,CPT,Facility,Outpatient,,,90,151,128.35,43.2766,151,"UCare Health, Inc.",Individual & Family Plan,85.0885,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Immunoglobulin Total Light Chains,U (Mayo)OutsideLaboratory",,83883,CPT,Facility,Inpatient,,,90,151,128.35,43.2766,151,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Immunoglobulin Total Light Chains,U (Mayo)OutsideLaboratory",,83883,CPT,Facility,Outpatient,,,90,151,128.35,43.2766,151,"UCare Health, Inc.",Medical Assistance,76.2097,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Immunoglobulin Total Light Chains,U (Mayo)OutsideLaboratory",,83883,CPT,Facility,Inpatient,,,90,151,128.35,43.2766,151,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Immunoglobulin Total Light Chains,U (Mayo)OutsideLaboratory",,83883,CPT,Facility,Outpatient,,,90,151,128.35,43.2766,151,"UCare Health, Inc.",Medicare Advantage,76.2097,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Immunoglobulin Total Light Chains,U (Mayo)OutsideLaboratory",,83883,CPT,Facility,Inpatient,,,90,151,128.35,43.2766,151,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Immunoglobulin Total Light Chains,U (Mayo)OutsideLaboratory",,83883,CPT,Facility,Outpatient,,,90,151,128.35,43.2766,151,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),76.2097,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Immunoglobulin Total Light Chains,U (Mayo)OutsideLaboratory",,83883,CPT,Facility,Inpatient,,,90,151,128.35,43.2766,151,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Immunoglobulin Total Light Chains,U (Mayo)OutsideLaboratory",,83883,CPT,Facility,Both,,,90,151,128.35,43.2766,151,UnitedHealthcare,Individual & Family,141.94,94,,percent of total billed charges,,
"Immunoglobulin Total Light Chains,U (Mayo)OutsideLaboratory",,83883,CPT,Facility,Outpatient,,,90,151,128.35,43.2766,151,UnitedHealthcare,Medicare Advantage,73.99,49,,percent of total billed charges,,
"Immunoglobulin Total Light Chains,U (Mayo)OutsideLaboratory",,83883,CPT,Facility,Inpatient,,,90,151,128.35,43.2766,151,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Immunoglobulin Total Light Chains,U (Mayo)OutsideLaboratory",,83883,CPT,Facility,Outpatient,,,90,151,128.35,43.2766,151,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,72.48,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Immunoglobulin Total Light Chains,U (Mayo)OutsideLaboratory",,83883,CPT,Facility,Inpatient,,,90,151,128.35,43.2766,151,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Nephelometry, Each Analyte, Not Elsewhere Specified (Mayo)OutsideLaboratory",,83883,CPT,Facility,Both,,,90,572,486.2,163.9352,572,Aetna,Commercial,526.24,92,,percent of total billed charges,,
"Nephelometry, Each Analyte, Not Elsewhere Specified (Mayo)OutsideLaboratory",,83883,CPT,Facility,Outpatient,,,90,572,486.2,163.9352,572,Aetna,Medicare Advantage,280.28,49,,percent of total billed charges,,
"Nephelometry, Each Analyte, Not Elsewhere Specified (Mayo)OutsideLaboratory",,83883,CPT,Facility,Inpatient,,,90,572,486.2,163.9352,572,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Nephelometry, Each Analyte, Not Elsewhere Specified (Mayo)OutsideLaboratory",,83883,CPT,Facility,Both,,,90,572,486.2,163.9352,572,Aetna,PPO,531.96,93,,percent of total billed charges,,
"Nephelometry, Each Analyte, Not Elsewhere Specified (Mayo)OutsideLaboratory",,83883,CPT,Facility,Both,,,90,572,486.2,163.9352,572,America's PPO,America's PPO,549.2916,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Nephelometry, Each Analyte, Not Elsewhere Specified (Mayo)OutsideLaboratory",,83883,CPT,Facility,Both,,,90,572,486.2,163.9352,572,BlueCross BlueShield Minnesota, Federal Employee Program,562.848,98.4,,percent of total billed charges,,
"Nephelometry, Each Analyte, Not Elsewhere Specified (Mayo)OutsideLaboratory",,83883,CPT,Facility,Both,,,90,572,486.2,163.9352,572,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,572,100,,percent of total billed charges,,
"Nephelometry, Each Analyte, Not Elsewhere Specified (Mayo)OutsideLaboratory",,83883,CPT,Facility,Both,,,90,572,486.2,163.9352,572,BlueCross BlueShield Minnesota,High Value Network Plan,514.8,90,,percent of total billed charges,,
"Nephelometry, Each Analyte, Not Elsewhere Specified (Mayo)OutsideLaboratory",,83883,CPT,Facility,Outpatient,,,90,572,486.2,163.9352,572,BlueCross BlueShield Minnesota,Medicare Advantage,280.28,49,,percent of total billed charges,,
"Nephelometry, Each Analyte, Not Elsewhere Specified (Mayo)OutsideLaboratory",,83883,CPT,Facility,Inpatient,,,90,572,486.2,163.9352,572,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Nephelometry, Each Analyte, Not Elsewhere Specified (Mayo)OutsideLaboratory",,83883,CPT,Facility,Both,,,90,572,486.2,163.9352,572,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,506.6204,88.57,,percent of total billed charges,,
"Nephelometry, Each Analyte, Not Elsewhere Specified (Mayo)OutsideLaboratory",,83883,CPT,Facility,Both,,,90,572,486.2,163.9352,572,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,163.9352,28.66,,percent of total billed charges,,
"Nephelometry, Each Analyte, Not Elsewhere Specified (Mayo)OutsideLaboratory",,83883,CPT,Facility,Outpatient,,,90,572,486.2,163.9352,572,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),280.28,49,,percent of total billed charges,,
"Nephelometry, Each Analyte, Not Elsewhere Specified (Mayo)OutsideLaboratory",,83883,CPT,Facility,Inpatient,,,90,572,486.2,163.9352,572,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Nephelometry, Each Analyte, Not Elsewhere Specified (Mayo)OutsideLaboratory",,83883,CPT,Facility,Both,,,90,572,486.2,163.9352,572,CorVel,Worker's Compensation,572,100,,percent of total billed charges,,
"Nephelometry, Each Analyte, Not Elsewhere Specified (Mayo)OutsideLaboratory",,83883,CPT,Facility,Both,,,90,572,486.2,163.9352,572,First Health Group Corporation,First Health Network,554.84,97,,percent of total billed charges,,
"Nephelometry, Each Analyte, Not Elsewhere Specified (Mayo)OutsideLaboratory",,83883,CPT,Facility,Both,,,90,572,486.2,163.9352,572,"Health Partners, Inc.",Commercial,541.112,94.6,,percent of total billed charges,,
"Nephelometry, Each Analyte, Not Elsewhere Specified (Mayo)OutsideLaboratory",,83883,CPT,Facility,Outpatient,,,90,572,486.2,163.9352,572,"Health Partners, Inc.",Medicare Advantage,280.28,49,,percent of total billed charges,,
"Nephelometry, Each Analyte, Not Elsewhere Specified (Mayo)OutsideLaboratory",,83883,CPT,Facility,Inpatient,,,90,572,486.2,163.9352,572,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Nephelometry, Each Analyte, Not Elsewhere Specified (Mayo)OutsideLaboratory",,83883,CPT,Facility,Both,,,90,572,486.2,163.9352,572,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),343.2,60,,percent of total billed charges,,
"Nephelometry, Each Analyte, Not Elsewhere Specified (Mayo)OutsideLaboratory",,83883,CPT,Facility,Both,,,90,572,486.2,163.9352,572,"Health Partners, Inc.",State of Minnesota Advantage Program,466.18,81.5,,percent of total billed charges,,
"Nephelometry, Each Analyte, Not Elsewhere Specified (Mayo)OutsideLaboratory",,83883,CPT,Facility,Both,,,90,572,486.2,163.9352,572,"Health Partners, Inc.",State Public Programs,286,50,,percent of total billed charges,,
"Nephelometry, Each Analyte, Not Elsewhere Specified (Mayo)OutsideLaboratory",,83883,CPT,Facility,Both,,,90,572,486.2,163.9352,572,Humana Insurance Company,Commercial PPO,543.4,95,,percent of total billed charges,,
"Nephelometry, Each Analyte, Not Elsewhere Specified (Mayo)OutsideLaboratory",,83883,CPT,Facility,Outpatient,,,90,572,486.2,163.9352,572,Humana Insurance Company,Medicare PPO,280.28,49,,percent of total billed charges,,
"Nephelometry, Each Analyte, Not Elsewhere Specified (Mayo)OutsideLaboratory",,83883,CPT,Facility,Inpatient,,,90,572,486.2,163.9352,572,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Nephelometry, Each Analyte, Not Elsewhere Specified (Mayo)OutsideLaboratory",,83883,CPT,Facility,Both,,,90,572,486.2,163.9352,572,Medica,Individual & Family,566.852,99.1,,percent of total billed charges,,
"Nephelometry, Each Analyte, Not Elsewhere Specified (Mayo)OutsideLaboratory",,83883,CPT,Facility,Outpatient,,,90,572,486.2,163.9352,572,Medica,Medica Advantage Solution,284.856,49.8,,percent of total billed charges,,
"Nephelometry, Each Analyte, Not Elsewhere Specified (Mayo)OutsideLaboratory",,83883,CPT,Facility,Inpatient,,,90,572,486.2,163.9352,572,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Nephelometry, Each Analyte, Not Elsewhere Specified (Mayo)OutsideLaboratory",,83883,CPT,Facility,Outpatient,,,90,572,486.2,163.9352,572,Medica,Medical Assistance,255.112,44.6,,percent of total billed charges,,
"Nephelometry, Each Analyte, Not Elsewhere Specified (Mayo)OutsideLaboratory",,83883,CPT,Facility,Inpatient,,,90,572,486.2,163.9352,572,Medica,Medical Assistance,,,,,Included in per diem rate,
"Nephelometry, Each Analyte, Not Elsewhere Specified (Mayo)OutsideLaboratory",,83883,CPT,Facility,Outpatient,,,90,572,486.2,163.9352,572,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,284.856,49.8,,percent of total billed charges,,
"Nephelometry, Each Analyte, Not Elsewhere Specified (Mayo)OutsideLaboratory",,83883,CPT,Facility,Inpatient,,,90,572,486.2,163.9352,572,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Nephelometry, Each Analyte, Not Elsewhere Specified (Mayo)OutsideLaboratory",,83883,CPT,Facility,Both,,,90,572,486.2,163.9352,572,"Multiplan, Inc.","Multiplan, Inc.",537.68,94,,percent of total billed charges,,
"Nephelometry, Each Analyte, Not Elsewhere Specified (Mayo)OutsideLaboratory",,83883,CPT,Facility,Outpatient,,,90,572,486.2,163.9352,572,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,494.208,86.4,,percent of total billed charges,,
"Nephelometry, Each Analyte, Not Elsewhere Specified (Mayo)OutsideLaboratory",,83883,CPT,Facility,Inpatient,,,90,572,486.2,163.9352,572,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Nephelometry, Each Analyte, Not Elsewhere Specified (Mayo)OutsideLaboratory",,83883,CPT,Facility,Both,,,90,572,486.2,163.9352,572,"Preferred One Administrative Services, INC.",PPO,563.992,98.6,,percent of total billed charges,,
"Nephelometry, Each Analyte, Not Elsewhere Specified (Mayo)OutsideLaboratory",,83883,CPT,Facility,Outpatient,,,90,572,486.2,163.9352,572,PrimeWest Health,Minnesota Senior Health Options (MSHO),294.294,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Nephelometry, Each Analyte, Not Elsewhere Specified (Mayo)OutsideLaboratory",,83883,CPT,Facility,Inpatient,,,90,572,486.2,163.9352,572,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Nephelometry, Each Analyte, Not Elsewhere Specified (Mayo)OutsideLaboratory",,83883,CPT,Facility,Outpatient,,,90,572,486.2,163.9352,572,PrimeWest Health,MinnesotaCare,293.7792,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Nephelometry, Each Analyte, Not Elsewhere Specified (Mayo)OutsideLaboratory",,83883,CPT,Facility,Inpatient,,,90,572,486.2,163.9352,572,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Nephelometry, Each Analyte, Not Elsewhere Specified (Mayo)OutsideLaboratory",,83883,CPT,Facility,Both,,,90,572,486.2,163.9352,572,Sanford Health Plan,Sanford Health Plan,526.24,92,,percent of total billed charges,,
"Nephelometry, Each Analyte, Not Elsewhere Specified (Mayo)OutsideLaboratory",,83883,CPT,Facility,Outpatient,,,90,572,486.2,163.9352,572,"UCare Health, Inc.",Individual & Family Plan,322.322,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Nephelometry, Each Analyte, Not Elsewhere Specified (Mayo)OutsideLaboratory",,83883,CPT,Facility,Inpatient,,,90,572,486.2,163.9352,572,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Nephelometry, Each Analyte, Not Elsewhere Specified (Mayo)OutsideLaboratory",,83883,CPT,Facility,Outpatient,,,90,572,486.2,163.9352,572,"UCare Health, Inc.",Medical Assistance,288.6884,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Nephelometry, Each Analyte, Not Elsewhere Specified (Mayo)OutsideLaboratory",,83883,CPT,Facility,Inpatient,,,90,572,486.2,163.9352,572,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Nephelometry, Each Analyte, Not Elsewhere Specified (Mayo)OutsideLaboratory",,83883,CPT,Facility,Outpatient,,,90,572,486.2,163.9352,572,"UCare Health, Inc.",Medicare Advantage,288.6884,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Nephelometry, Each Analyte, Not Elsewhere Specified (Mayo)OutsideLaboratory",,83883,CPT,Facility,Inpatient,,,90,572,486.2,163.9352,572,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Nephelometry, Each Analyte, Not Elsewhere Specified (Mayo)OutsideLaboratory",,83883,CPT,Facility,Outpatient,,,90,572,486.2,163.9352,572,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),288.6884,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Nephelometry, Each Analyte, Not Elsewhere Specified (Mayo)OutsideLaboratory",,83883,CPT,Facility,Inpatient,,,90,572,486.2,163.9352,572,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Nephelometry, Each Analyte, Not Elsewhere Specified (Mayo)OutsideLaboratory",,83883,CPT,Facility,Both,,,90,572,486.2,163.9352,572,UnitedHealthcare,Individual & Family,537.68,94,,percent of total billed charges,,
"Nephelometry, Each Analyte, Not Elsewhere Specified (Mayo)OutsideLaboratory",,83883,CPT,Facility,Outpatient,,,90,572,486.2,163.9352,572,UnitedHealthcare,Medicare Advantage,280.28,49,,percent of total billed charges,,
"Nephelometry, Each Analyte, Not Elsewhere Specified (Mayo)OutsideLaboratory",,83883,CPT,Facility,Inpatient,,,90,572,486.2,163.9352,572,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Nephelometry, Each Analyte, Not Elsewhere Specified (Mayo)OutsideLaboratory",,83883,CPT,Facility,Outpatient,,,90,572,486.2,163.9352,572,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,274.56,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Nephelometry, Each Analyte, Not Elsewhere Specified (Mayo)OutsideLaboratory",,83883,CPT,Facility,Inpatient,,,90,572,486.2,163.9352,572,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
5' Nucleotidase (Mayo)OutsideLaboratory,,83915,CPT,Facility,Both,,,90,184,156.4,52.7344,184,Aetna,Commercial,169.28,92,,percent of total billed charges,,
5' Nucleotidase (Mayo)OutsideLaboratory,,83915,CPT,Facility,Outpatient,,,90,184,156.4,52.7344,184,Aetna,Medicare Advantage,90.16,49,,percent of total billed charges,,
5' Nucleotidase (Mayo)OutsideLaboratory,,83915,CPT,Facility,Inpatient,,,90,184,156.4,52.7344,184,Aetna,Medicare Advantage,,,,,Included in per diem rate,
5' Nucleotidase (Mayo)OutsideLaboratory,,83915,CPT,Facility,Both,,,90,184,156.4,52.7344,184,Aetna,PPO,171.12,93,,percent of total billed charges,,
5' Nucleotidase (Mayo)OutsideLaboratory,,83915,CPT,Facility,Both,,,90,184,156.4,52.7344,184,America's PPO,America's PPO,176.6952,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
5' Nucleotidase (Mayo)OutsideLaboratory,,83915,CPT,Facility,Both,,,90,184,156.4,52.7344,184,BlueCross BlueShield Minnesota, Federal Employee Program,181.056,98.4,,percent of total billed charges,,
5' Nucleotidase (Mayo)OutsideLaboratory,,83915,CPT,Facility,Both,,,90,184,156.4,52.7344,184,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,184,100,,percent of total billed charges,,
5' Nucleotidase (Mayo)OutsideLaboratory,,83915,CPT,Facility,Both,,,90,184,156.4,52.7344,184,BlueCross BlueShield Minnesota,High Value Network Plan,165.6,90,,percent of total billed charges,,
5' Nucleotidase (Mayo)OutsideLaboratory,,83915,CPT,Facility,Outpatient,,,90,184,156.4,52.7344,184,BlueCross BlueShield Minnesota,Medicare Advantage,90.16,49,,percent of total billed charges,,
5' Nucleotidase (Mayo)OutsideLaboratory,,83915,CPT,Facility,Inpatient,,,90,184,156.4,52.7344,184,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
5' Nucleotidase (Mayo)OutsideLaboratory,,83915,CPT,Facility,Both,,,90,184,156.4,52.7344,184,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,162.9688,88.57,,percent of total billed charges,,
5' Nucleotidase (Mayo)OutsideLaboratory,,83915,CPT,Facility,Both,,,90,184,156.4,52.7344,184,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,52.7344,28.66,,percent of total billed charges,,
5' Nucleotidase (Mayo)OutsideLaboratory,,83915,CPT,Facility,Outpatient,,,90,184,156.4,52.7344,184,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),90.16,49,,percent of total billed charges,,
5' Nucleotidase (Mayo)OutsideLaboratory,,83915,CPT,Facility,Inpatient,,,90,184,156.4,52.7344,184,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
5' Nucleotidase (Mayo)OutsideLaboratory,,83915,CPT,Facility,Both,,,90,184,156.4,52.7344,184,CorVel,Worker's Compensation,184,100,,percent of total billed charges,,
5' Nucleotidase (Mayo)OutsideLaboratory,,83915,CPT,Facility,Both,,,90,184,156.4,52.7344,184,First Health Group Corporation,First Health Network,178.48,97,,percent of total billed charges,,
5' Nucleotidase (Mayo)OutsideLaboratory,,83915,CPT,Facility,Both,,,90,184,156.4,52.7344,184,"Health Partners, Inc.",Commercial,174.064,94.6,,percent of total billed charges,,
5' Nucleotidase (Mayo)OutsideLaboratory,,83915,CPT,Facility,Outpatient,,,90,184,156.4,52.7344,184,"Health Partners, Inc.",Medicare Advantage,90.16,49,,percent of total billed charges,,
5' Nucleotidase (Mayo)OutsideLaboratory,,83915,CPT,Facility,Inpatient,,,90,184,156.4,52.7344,184,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
5' Nucleotidase (Mayo)OutsideLaboratory,,83915,CPT,Facility,Both,,,90,184,156.4,52.7344,184,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),110.4,60,,percent of total billed charges,,
5' Nucleotidase (Mayo)OutsideLaboratory,,83915,CPT,Facility,Both,,,90,184,156.4,52.7344,184,"Health Partners, Inc.",State of Minnesota Advantage Program,149.96,81.5,,percent of total billed charges,,
5' Nucleotidase (Mayo)OutsideLaboratory,,83915,CPT,Facility,Both,,,90,184,156.4,52.7344,184,"Health Partners, Inc.",State Public Programs,92,50,,percent of total billed charges,,
5' Nucleotidase (Mayo)OutsideLaboratory,,83915,CPT,Facility,Both,,,90,184,156.4,52.7344,184,Humana Insurance Company,Commercial PPO,174.8,95,,percent of total billed charges,,
5' Nucleotidase (Mayo)OutsideLaboratory,,83915,CPT,Facility,Outpatient,,,90,184,156.4,52.7344,184,Humana Insurance Company,Medicare PPO,90.16,49,,percent of total billed charges,,
5' Nucleotidase (Mayo)OutsideLaboratory,,83915,CPT,Facility,Inpatient,,,90,184,156.4,52.7344,184,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
5' Nucleotidase (Mayo)OutsideLaboratory,,83915,CPT,Facility,Both,,,90,184,156.4,52.7344,184,Medica,Individual & Family,182.344,99.1,,percent of total billed charges,,
5' Nucleotidase (Mayo)OutsideLaboratory,,83915,CPT,Facility,Outpatient,,,90,184,156.4,52.7344,184,Medica,Medica Advantage Solution,91.632,49.8,,percent of total billed charges,,
5' Nucleotidase (Mayo)OutsideLaboratory,,83915,CPT,Facility,Inpatient,,,90,184,156.4,52.7344,184,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
5' Nucleotidase (Mayo)OutsideLaboratory,,83915,CPT,Facility,Outpatient,,,90,184,156.4,52.7344,184,Medica,Medical Assistance,82.064,44.6,,percent of total billed charges,,
5' Nucleotidase (Mayo)OutsideLaboratory,,83915,CPT,Facility,Inpatient,,,90,184,156.4,52.7344,184,Medica,Medical Assistance,,,,,Included in per diem rate,
5' Nucleotidase (Mayo)OutsideLaboratory,,83915,CPT,Facility,Outpatient,,,90,184,156.4,52.7344,184,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,91.632,49.8,,percent of total billed charges,,
5' Nucleotidase (Mayo)OutsideLaboratory,,83915,CPT,Facility,Inpatient,,,90,184,156.4,52.7344,184,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
5' Nucleotidase (Mayo)OutsideLaboratory,,83915,CPT,Facility,Both,,,90,184,156.4,52.7344,184,"Multiplan, Inc.","Multiplan, Inc.",172.96,94,,percent of total billed charges,,
5' Nucleotidase (Mayo)OutsideLaboratory,,83915,CPT,Facility,Outpatient,,,90,184,156.4,52.7344,184,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,158.976,86.4,,percent of total billed charges,,
5' Nucleotidase (Mayo)OutsideLaboratory,,83915,CPT,Facility,Inpatient,,,90,184,156.4,52.7344,184,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
5' Nucleotidase (Mayo)OutsideLaboratory,,83915,CPT,Facility,Both,,,90,184,156.4,52.7344,184,"Preferred One Administrative Services, INC.",PPO,181.424,98.6,,percent of total billed charges,,
5' Nucleotidase (Mayo)OutsideLaboratory,,83915,CPT,Facility,Outpatient,,,90,184,156.4,52.7344,184,PrimeWest Health,Minnesota Senior Health Options (MSHO),94.668,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
5' Nucleotidase (Mayo)OutsideLaboratory,,83915,CPT,Facility,Inpatient,,,90,184,156.4,52.7344,184,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
5' Nucleotidase (Mayo)OutsideLaboratory,,83915,CPT,Facility,Outpatient,,,90,184,156.4,52.7344,184,PrimeWest Health,MinnesotaCare,94.5024,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
5' Nucleotidase (Mayo)OutsideLaboratory,,83915,CPT,Facility,Inpatient,,,90,184,156.4,52.7344,184,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
5' Nucleotidase (Mayo)OutsideLaboratory,,83915,CPT,Facility,Both,,,90,184,156.4,52.7344,184,Sanford Health Plan,Sanford Health Plan,169.28,92,,percent of total billed charges,,
5' Nucleotidase (Mayo)OutsideLaboratory,,83915,CPT,Facility,Outpatient,,,90,184,156.4,52.7344,184,"UCare Health, Inc.",Individual & Family Plan,103.684,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
5' Nucleotidase (Mayo)OutsideLaboratory,,83915,CPT,Facility,Inpatient,,,90,184,156.4,52.7344,184,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
5' Nucleotidase (Mayo)OutsideLaboratory,,83915,CPT,Facility,Outpatient,,,90,184,156.4,52.7344,184,"UCare Health, Inc.",Medical Assistance,92.8648,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
5' Nucleotidase (Mayo)OutsideLaboratory,,83915,CPT,Facility,Inpatient,,,90,184,156.4,52.7344,184,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
5' Nucleotidase (Mayo)OutsideLaboratory,,83915,CPT,Facility,Outpatient,,,90,184,156.4,52.7344,184,"UCare Health, Inc.",Medicare Advantage,92.8648,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
5' Nucleotidase (Mayo)OutsideLaboratory,,83915,CPT,Facility,Inpatient,,,90,184,156.4,52.7344,184,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
5' Nucleotidase (Mayo)OutsideLaboratory,,83915,CPT,Facility,Outpatient,,,90,184,156.4,52.7344,184,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),92.8648,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
5' Nucleotidase (Mayo)OutsideLaboratory,,83915,CPT,Facility,Inpatient,,,90,184,156.4,52.7344,184,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
5' Nucleotidase (Mayo)OutsideLaboratory,,83915,CPT,Facility,Both,,,90,184,156.4,52.7344,184,UnitedHealthcare,Individual & Family,172.96,94,,percent of total billed charges,,
5' Nucleotidase (Mayo)OutsideLaboratory,,83915,CPT,Facility,Outpatient,,,90,184,156.4,52.7344,184,UnitedHealthcare,Medicare Advantage,90.16,49,,percent of total billed charges,,
5' Nucleotidase (Mayo)OutsideLaboratory,,83915,CPT,Facility,Inpatient,,,90,184,156.4,52.7344,184,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
5' Nucleotidase (Mayo)OutsideLaboratory,,83915,CPT,Facility,Outpatient,,,90,184,156.4,52.7344,184,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,88.32,48,,percent of total billed charges,,100% of DHS outpatient percentage
5' Nucleotidase (Mayo)OutsideLaboratory,,83915,CPT,Facility,Inpatient,,,90,184,156.4,52.7344,184,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Organic Acids Scrn, U (Mayo)OutsideLaboratory",,83919,CPT,Facility,Both,,,90,122,103.7,34.9652,122,Aetna,Commercial,112.24,92,,percent of total billed charges,,
"Organic Acids Scrn, U (Mayo)OutsideLaboratory",,83919,CPT,Facility,Outpatient,,,90,122,103.7,34.9652,122,Aetna,Medicare Advantage,59.78,49,,percent of total billed charges,,
"Organic Acids Scrn, U (Mayo)OutsideLaboratory",,83919,CPT,Facility,Inpatient,,,90,122,103.7,34.9652,122,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Organic Acids Scrn, U (Mayo)OutsideLaboratory",,83919,CPT,Facility,Both,,,90,122,103.7,34.9652,122,Aetna,PPO,113.46,93,,percent of total billed charges,,
"Organic Acids Scrn, U (Mayo)OutsideLaboratory",,83919,CPT,Facility,Both,,,90,122,103.7,34.9652,122,America's PPO,America's PPO,117.1566,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Organic Acids Scrn, U (Mayo)OutsideLaboratory",,83919,CPT,Facility,Both,,,90,122,103.7,34.9652,122,BlueCross BlueShield Minnesota, Federal Employee Program,120.048,98.4,,percent of total billed charges,,
"Organic Acids Scrn, U (Mayo)OutsideLaboratory",,83919,CPT,Facility,Both,,,90,122,103.7,34.9652,122,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,122,100,,percent of total billed charges,,
"Organic Acids Scrn, U (Mayo)OutsideLaboratory",,83919,CPT,Facility,Both,,,90,122,103.7,34.9652,122,BlueCross BlueShield Minnesota,High Value Network Plan,109.8,90,,percent of total billed charges,,
"Organic Acids Scrn, U (Mayo)OutsideLaboratory",,83919,CPT,Facility,Outpatient,,,90,122,103.7,34.9652,122,BlueCross BlueShield Minnesota,Medicare Advantage,59.78,49,,percent of total billed charges,,
"Organic Acids Scrn, U (Mayo)OutsideLaboratory",,83919,CPT,Facility,Inpatient,,,90,122,103.7,34.9652,122,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Organic Acids Scrn, U (Mayo)OutsideLaboratory",,83919,CPT,Facility,Both,,,90,122,103.7,34.9652,122,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,108.0554,88.57,,percent of total billed charges,,
"Organic Acids Scrn, U (Mayo)OutsideLaboratory",,83919,CPT,Facility,Both,,,90,122,103.7,34.9652,122,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,34.9652,28.66,,percent of total billed charges,,
"Organic Acids Scrn, U (Mayo)OutsideLaboratory",,83919,CPT,Facility,Outpatient,,,90,122,103.7,34.9652,122,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),59.78,49,,percent of total billed charges,,
"Organic Acids Scrn, U (Mayo)OutsideLaboratory",,83919,CPT,Facility,Inpatient,,,90,122,103.7,34.9652,122,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Organic Acids Scrn, U (Mayo)OutsideLaboratory",,83919,CPT,Facility,Both,,,90,122,103.7,34.9652,122,CorVel,Worker's Compensation,122,100,,percent of total billed charges,,
"Organic Acids Scrn, U (Mayo)OutsideLaboratory",,83919,CPT,Facility,Both,,,90,122,103.7,34.9652,122,First Health Group Corporation,First Health Network,118.34,97,,percent of total billed charges,,
"Organic Acids Scrn, U (Mayo)OutsideLaboratory",,83919,CPT,Facility,Both,,,90,122,103.7,34.9652,122,"Health Partners, Inc.",Commercial,115.412,94.6,,percent of total billed charges,,
"Organic Acids Scrn, U (Mayo)OutsideLaboratory",,83919,CPT,Facility,Outpatient,,,90,122,103.7,34.9652,122,"Health Partners, Inc.",Medicare Advantage,59.78,49,,percent of total billed charges,,
"Organic Acids Scrn, U (Mayo)OutsideLaboratory",,83919,CPT,Facility,Inpatient,,,90,122,103.7,34.9652,122,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Organic Acids Scrn, U (Mayo)OutsideLaboratory",,83919,CPT,Facility,Both,,,90,122,103.7,34.9652,122,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),73.2,60,,percent of total billed charges,,
"Organic Acids Scrn, U (Mayo)OutsideLaboratory",,83919,CPT,Facility,Both,,,90,122,103.7,34.9652,122,"Health Partners, Inc.",State of Minnesota Advantage Program,99.43,81.5,,percent of total billed charges,,
"Organic Acids Scrn, U (Mayo)OutsideLaboratory",,83919,CPT,Facility,Both,,,90,122,103.7,34.9652,122,"Health Partners, Inc.",State Public Programs,61,50,,percent of total billed charges,,
"Organic Acids Scrn, U (Mayo)OutsideLaboratory",,83919,CPT,Facility,Both,,,90,122,103.7,34.9652,122,Humana Insurance Company,Commercial PPO,115.9,95,,percent of total billed charges,,
"Organic Acids Scrn, U (Mayo)OutsideLaboratory",,83919,CPT,Facility,Outpatient,,,90,122,103.7,34.9652,122,Humana Insurance Company,Medicare PPO,59.78,49,,percent of total billed charges,,
"Organic Acids Scrn, U (Mayo)OutsideLaboratory",,83919,CPT,Facility,Inpatient,,,90,122,103.7,34.9652,122,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Organic Acids Scrn, U (Mayo)OutsideLaboratory",,83919,CPT,Facility,Both,,,90,122,103.7,34.9652,122,Medica,Individual & Family,120.902,99.1,,percent of total billed charges,,
"Organic Acids Scrn, U (Mayo)OutsideLaboratory",,83919,CPT,Facility,Outpatient,,,90,122,103.7,34.9652,122,Medica,Medica Advantage Solution,60.756,49.8,,percent of total billed charges,,
"Organic Acids Scrn, U (Mayo)OutsideLaboratory",,83919,CPT,Facility,Inpatient,,,90,122,103.7,34.9652,122,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Organic Acids Scrn, U (Mayo)OutsideLaboratory",,83919,CPT,Facility,Outpatient,,,90,122,103.7,34.9652,122,Medica,Medical Assistance,54.412,44.6,,percent of total billed charges,,
"Organic Acids Scrn, U (Mayo)OutsideLaboratory",,83919,CPT,Facility,Inpatient,,,90,122,103.7,34.9652,122,Medica,Medical Assistance,,,,,Included in per diem rate,
"Organic Acids Scrn, U (Mayo)OutsideLaboratory",,83919,CPT,Facility,Outpatient,,,90,122,103.7,34.9652,122,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,60.756,49.8,,percent of total billed charges,,
"Organic Acids Scrn, U (Mayo)OutsideLaboratory",,83919,CPT,Facility,Inpatient,,,90,122,103.7,34.9652,122,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Organic Acids Scrn, U (Mayo)OutsideLaboratory",,83919,CPT,Facility,Both,,,90,122,103.7,34.9652,122,"Multiplan, Inc.","Multiplan, Inc.",114.68,94,,percent of total billed charges,,
"Organic Acids Scrn, U (Mayo)OutsideLaboratory",,83919,CPT,Facility,Outpatient,,,90,122,103.7,34.9652,122,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,105.408,86.4,,percent of total billed charges,,
"Organic Acids Scrn, U (Mayo)OutsideLaboratory",,83919,CPT,Facility,Inpatient,,,90,122,103.7,34.9652,122,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Organic Acids Scrn, U (Mayo)OutsideLaboratory",,83919,CPT,Facility,Both,,,90,122,103.7,34.9652,122,"Preferred One Administrative Services, INC.",PPO,120.292,98.6,,percent of total billed charges,,
"Organic Acids Scrn, U (Mayo)OutsideLaboratory",,83919,CPT,Facility,Outpatient,,,90,122,103.7,34.9652,122,PrimeWest Health,Minnesota Senior Health Options (MSHO),62.769,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Organic Acids Scrn, U (Mayo)OutsideLaboratory",,83919,CPT,Facility,Inpatient,,,90,122,103.7,34.9652,122,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Organic Acids Scrn, U (Mayo)OutsideLaboratory",,83919,CPT,Facility,Outpatient,,,90,122,103.7,34.9652,122,PrimeWest Health,MinnesotaCare,62.6592,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Organic Acids Scrn, U (Mayo)OutsideLaboratory",,83919,CPT,Facility,Inpatient,,,90,122,103.7,34.9652,122,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Organic Acids Scrn, U (Mayo)OutsideLaboratory",,83919,CPT,Facility,Both,,,90,122,103.7,34.9652,122,Sanford Health Plan,Sanford Health Plan,112.24,92,,percent of total billed charges,,
"Organic Acids Scrn, U (Mayo)OutsideLaboratory",,83919,CPT,Facility,Outpatient,,,90,122,103.7,34.9652,122,"UCare Health, Inc.",Individual & Family Plan,68.747,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Organic Acids Scrn, U (Mayo)OutsideLaboratory",,83919,CPT,Facility,Inpatient,,,90,122,103.7,34.9652,122,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Organic Acids Scrn, U (Mayo)OutsideLaboratory",,83919,CPT,Facility,Outpatient,,,90,122,103.7,34.9652,122,"UCare Health, Inc.",Medical Assistance,61.5734,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Organic Acids Scrn, U (Mayo)OutsideLaboratory",,83919,CPT,Facility,Inpatient,,,90,122,103.7,34.9652,122,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Organic Acids Scrn, U (Mayo)OutsideLaboratory",,83919,CPT,Facility,Outpatient,,,90,122,103.7,34.9652,122,"UCare Health, Inc.",Medicare Advantage,61.5734,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Organic Acids Scrn, U (Mayo)OutsideLaboratory",,83919,CPT,Facility,Inpatient,,,90,122,103.7,34.9652,122,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Organic Acids Scrn, U (Mayo)OutsideLaboratory",,83919,CPT,Facility,Outpatient,,,90,122,103.7,34.9652,122,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),61.5734,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Organic Acids Scrn, U (Mayo)OutsideLaboratory",,83919,CPT,Facility,Inpatient,,,90,122,103.7,34.9652,122,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Organic Acids Scrn, U (Mayo)OutsideLaboratory",,83919,CPT,Facility,Both,,,90,122,103.7,34.9652,122,UnitedHealthcare,Individual & Family,114.68,94,,percent of total billed charges,,
"Organic Acids Scrn, U (Mayo)OutsideLaboratory",,83919,CPT,Facility,Outpatient,,,90,122,103.7,34.9652,122,UnitedHealthcare,Medicare Advantage,59.78,49,,percent of total billed charges,,
"Organic Acids Scrn, U (Mayo)OutsideLaboratory",,83919,CPT,Facility,Inpatient,,,90,122,103.7,34.9652,122,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Organic Acids Scrn, U (Mayo)OutsideLaboratory",,83919,CPT,Facility,Outpatient,,,90,122,103.7,34.9652,122,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,58.56,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Organic Acids Scrn, U (Mayo)OutsideLaboratory",,83919,CPT,Facility,Inpatient,,,90,122,103.7,34.9652,122,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Methylmalonic Acid, Qn, P (Mayo)OutsideLaboratory",,83921,CPT,Facility,Both,,,90,112,95.2,32.0992,112,Aetna,Commercial,103.04,92,,percent of total billed charges,,
"Methylmalonic Acid, Qn, P (Mayo)OutsideLaboratory",,83921,CPT,Facility,Outpatient,,,90,112,95.2,32.0992,112,Aetna,Medicare Advantage,54.88,49,,percent of total billed charges,,
"Methylmalonic Acid, Qn, P (Mayo)OutsideLaboratory",,83921,CPT,Facility,Inpatient,,,90,112,95.2,32.0992,112,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Methylmalonic Acid, Qn, P (Mayo)OutsideLaboratory",,83921,CPT,Facility,Both,,,90,112,95.2,32.0992,112,Aetna,PPO,104.16,93,,percent of total billed charges,,
"Methylmalonic Acid, Qn, P (Mayo)OutsideLaboratory",,83921,CPT,Facility,Both,,,90,112,95.2,32.0992,112,America's PPO,America's PPO,107.5536,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Methylmalonic Acid, Qn, P (Mayo)OutsideLaboratory",,83921,CPT,Facility,Both,,,90,112,95.2,32.0992,112,BlueCross BlueShield Minnesota, Federal Employee Program,110.208,98.4,,percent of total billed charges,,
"Methylmalonic Acid, Qn, P (Mayo)OutsideLaboratory",,83921,CPT,Facility,Both,,,90,112,95.2,32.0992,112,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,112,100,,percent of total billed charges,,
"Methylmalonic Acid, Qn, P (Mayo)OutsideLaboratory",,83921,CPT,Facility,Both,,,90,112,95.2,32.0992,112,BlueCross BlueShield Minnesota,High Value Network Plan,100.8,90,,percent of total billed charges,,
"Methylmalonic Acid, Qn, P (Mayo)OutsideLaboratory",,83921,CPT,Facility,Outpatient,,,90,112,95.2,32.0992,112,BlueCross BlueShield Minnesota,Medicare Advantage,54.88,49,,percent of total billed charges,,
"Methylmalonic Acid, Qn, P (Mayo)OutsideLaboratory",,83921,CPT,Facility,Inpatient,,,90,112,95.2,32.0992,112,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Methylmalonic Acid, Qn, P (Mayo)OutsideLaboratory",,83921,CPT,Facility,Both,,,90,112,95.2,32.0992,112,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,99.1984,88.57,,percent of total billed charges,,
"Methylmalonic Acid, Qn, P (Mayo)OutsideLaboratory",,83921,CPT,Facility,Both,,,90,112,95.2,32.0992,112,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,32.0992,28.66,,percent of total billed charges,,
"Methylmalonic Acid, Qn, P (Mayo)OutsideLaboratory",,83921,CPT,Facility,Outpatient,,,90,112,95.2,32.0992,112,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),54.88,49,,percent of total billed charges,,
"Methylmalonic Acid, Qn, P (Mayo)OutsideLaboratory",,83921,CPT,Facility,Inpatient,,,90,112,95.2,32.0992,112,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Methylmalonic Acid, Qn, P (Mayo)OutsideLaboratory",,83921,CPT,Facility,Both,,,90,112,95.2,32.0992,112,CorVel,Worker's Compensation,112,100,,percent of total billed charges,,
"Methylmalonic Acid, Qn, P (Mayo)OutsideLaboratory",,83921,CPT,Facility,Both,,,90,112,95.2,32.0992,112,First Health Group Corporation,First Health Network,108.64,97,,percent of total billed charges,,
"Methylmalonic Acid, Qn, P (Mayo)OutsideLaboratory",,83921,CPT,Facility,Both,,,90,112,95.2,32.0992,112,"Health Partners, Inc.",Commercial,105.952,94.6,,percent of total billed charges,,
"Methylmalonic Acid, Qn, P (Mayo)OutsideLaboratory",,83921,CPT,Facility,Outpatient,,,90,112,95.2,32.0992,112,"Health Partners, Inc.",Medicare Advantage,54.88,49,,percent of total billed charges,,
"Methylmalonic Acid, Qn, P (Mayo)OutsideLaboratory",,83921,CPT,Facility,Inpatient,,,90,112,95.2,32.0992,112,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Methylmalonic Acid, Qn, P (Mayo)OutsideLaboratory",,83921,CPT,Facility,Both,,,90,112,95.2,32.0992,112,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),67.2,60,,percent of total billed charges,,
"Methylmalonic Acid, Qn, P (Mayo)OutsideLaboratory",,83921,CPT,Facility,Both,,,90,112,95.2,32.0992,112,"Health Partners, Inc.",State of Minnesota Advantage Program,91.28,81.5,,percent of total billed charges,,
"Methylmalonic Acid, Qn, P (Mayo)OutsideLaboratory",,83921,CPT,Facility,Both,,,90,112,95.2,32.0992,112,"Health Partners, Inc.",State Public Programs,56,50,,percent of total billed charges,,
"Methylmalonic Acid, Qn, P (Mayo)OutsideLaboratory",,83921,CPT,Facility,Both,,,90,112,95.2,32.0992,112,Humana Insurance Company,Commercial PPO,106.4,95,,percent of total billed charges,,
"Methylmalonic Acid, Qn, P (Mayo)OutsideLaboratory",,83921,CPT,Facility,Outpatient,,,90,112,95.2,32.0992,112,Humana Insurance Company,Medicare PPO,54.88,49,,percent of total billed charges,,
"Methylmalonic Acid, Qn, P (Mayo)OutsideLaboratory",,83921,CPT,Facility,Inpatient,,,90,112,95.2,32.0992,112,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Methylmalonic Acid, Qn, P (Mayo)OutsideLaboratory",,83921,CPT,Facility,Both,,,90,112,95.2,32.0992,112,Medica,Individual & Family,110.992,99.1,,percent of total billed charges,,
"Methylmalonic Acid, Qn, P (Mayo)OutsideLaboratory",,83921,CPT,Facility,Outpatient,,,90,112,95.2,32.0992,112,Medica,Medica Advantage Solution,55.776,49.8,,percent of total billed charges,,
"Methylmalonic Acid, Qn, P (Mayo)OutsideLaboratory",,83921,CPT,Facility,Inpatient,,,90,112,95.2,32.0992,112,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Methylmalonic Acid, Qn, P (Mayo)OutsideLaboratory",,83921,CPT,Facility,Outpatient,,,90,112,95.2,32.0992,112,Medica,Medical Assistance,49.952,44.6,,percent of total billed charges,,
"Methylmalonic Acid, Qn, P (Mayo)OutsideLaboratory",,83921,CPT,Facility,Inpatient,,,90,112,95.2,32.0992,112,Medica,Medical Assistance,,,,,Included in per diem rate,
"Methylmalonic Acid, Qn, P (Mayo)OutsideLaboratory",,83921,CPT,Facility,Outpatient,,,90,112,95.2,32.0992,112,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,55.776,49.8,,percent of total billed charges,,
"Methylmalonic Acid, Qn, P (Mayo)OutsideLaboratory",,83921,CPT,Facility,Inpatient,,,90,112,95.2,32.0992,112,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Methylmalonic Acid, Qn, P (Mayo)OutsideLaboratory",,83921,CPT,Facility,Both,,,90,112,95.2,32.0992,112,"Multiplan, Inc.","Multiplan, Inc.",105.28,94,,percent of total billed charges,,
"Methylmalonic Acid, Qn, P (Mayo)OutsideLaboratory",,83921,CPT,Facility,Outpatient,,,90,112,95.2,32.0992,112,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,96.768,86.4,,percent of total billed charges,,
"Methylmalonic Acid, Qn, P (Mayo)OutsideLaboratory",,83921,CPT,Facility,Inpatient,,,90,112,95.2,32.0992,112,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Methylmalonic Acid, Qn, P (Mayo)OutsideLaboratory",,83921,CPT,Facility,Both,,,90,112,95.2,32.0992,112,"Preferred One Administrative Services, INC.",PPO,110.432,98.6,,percent of total billed charges,,
"Methylmalonic Acid, Qn, P (Mayo)OutsideLaboratory",,83921,CPT,Facility,Outpatient,,,90,112,95.2,32.0992,112,PrimeWest Health,Minnesota Senior Health Options (MSHO),57.624,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Methylmalonic Acid, Qn, P (Mayo)OutsideLaboratory",,83921,CPT,Facility,Inpatient,,,90,112,95.2,32.0992,112,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Methylmalonic Acid, Qn, P (Mayo)OutsideLaboratory",,83921,CPT,Facility,Outpatient,,,90,112,95.2,32.0992,112,PrimeWest Health,MinnesotaCare,57.5232,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Methylmalonic Acid, Qn, P (Mayo)OutsideLaboratory",,83921,CPT,Facility,Inpatient,,,90,112,95.2,32.0992,112,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Methylmalonic Acid, Qn, P (Mayo)OutsideLaboratory",,83921,CPT,Facility,Both,,,90,112,95.2,32.0992,112,Sanford Health Plan,Sanford Health Plan,103.04,92,,percent of total billed charges,,
"Methylmalonic Acid, Qn, P (Mayo)OutsideLaboratory",,83921,CPT,Facility,Outpatient,,,90,112,95.2,32.0992,112,"UCare Health, Inc.",Individual & Family Plan,63.112,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Methylmalonic Acid, Qn, P (Mayo)OutsideLaboratory",,83921,CPT,Facility,Inpatient,,,90,112,95.2,32.0992,112,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Methylmalonic Acid, Qn, P (Mayo)OutsideLaboratory",,83921,CPT,Facility,Outpatient,,,90,112,95.2,32.0992,112,"UCare Health, Inc.",Medical Assistance,56.5264,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Methylmalonic Acid, Qn, P (Mayo)OutsideLaboratory",,83921,CPT,Facility,Inpatient,,,90,112,95.2,32.0992,112,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Methylmalonic Acid, Qn, P (Mayo)OutsideLaboratory",,83921,CPT,Facility,Outpatient,,,90,112,95.2,32.0992,112,"UCare Health, Inc.",Medicare Advantage,56.5264,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Methylmalonic Acid, Qn, P (Mayo)OutsideLaboratory",,83921,CPT,Facility,Inpatient,,,90,112,95.2,32.0992,112,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Methylmalonic Acid, Qn, P (Mayo)OutsideLaboratory",,83921,CPT,Facility,Outpatient,,,90,112,95.2,32.0992,112,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),56.5264,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Methylmalonic Acid, Qn, P (Mayo)OutsideLaboratory",,83921,CPT,Facility,Inpatient,,,90,112,95.2,32.0992,112,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Methylmalonic Acid, Qn, P (Mayo)OutsideLaboratory",,83921,CPT,Facility,Both,,,90,112,95.2,32.0992,112,UnitedHealthcare,Individual & Family,105.28,94,,percent of total billed charges,,
"Methylmalonic Acid, Qn, P (Mayo)OutsideLaboratory",,83921,CPT,Facility,Outpatient,,,90,112,95.2,32.0992,112,UnitedHealthcare,Medicare Advantage,54.88,49,,percent of total billed charges,,
"Methylmalonic Acid, Qn, P (Mayo)OutsideLaboratory",,83921,CPT,Facility,Inpatient,,,90,112,95.2,32.0992,112,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Methylmalonic Acid, Qn, P (Mayo)OutsideLaboratory",,83921,CPT,Facility,Outpatient,,,90,112,95.2,32.0992,112,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,53.76,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Methylmalonic Acid, Qn, P (Mayo)OutsideLaboratory",,83921,CPT,Facility,Inpatient,,,90,112,95.2,32.0992,112,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Methylmalonic Acid, Qn, S (Mayo)OutsideLaboratory",,83921,CPT,Facility,Both,,,90,75,63.75,21.495,75,Aetna,Commercial,69,92,,percent of total billed charges,,
"Methylmalonic Acid, Qn, S (Mayo)OutsideLaboratory",,83921,CPT,Facility,Outpatient,,,90,75,63.75,21.495,75,Aetna,Medicare Advantage,36.75,49,,percent of total billed charges,,
"Methylmalonic Acid, Qn, S (Mayo)OutsideLaboratory",,83921,CPT,Facility,Inpatient,,,90,75,63.75,21.495,75,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Methylmalonic Acid, Qn, S (Mayo)OutsideLaboratory",,83921,CPT,Facility,Both,,,90,75,63.75,21.495,75,Aetna,PPO,69.75,93,,percent of total billed charges,,
"Methylmalonic Acid, Qn, S (Mayo)OutsideLaboratory",,83921,CPT,Facility,Both,,,90,75,63.75,21.495,75,America's PPO,America's PPO,72.0225,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Methylmalonic Acid, Qn, S (Mayo)OutsideLaboratory",,83921,CPT,Facility,Both,,,90,75,63.75,21.495,75,BlueCross BlueShield Minnesota, Federal Employee Program,73.8,98.4,,percent of total billed charges,,
"Methylmalonic Acid, Qn, S (Mayo)OutsideLaboratory",,83921,CPT,Facility,Both,,,90,75,63.75,21.495,75,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,75,100,,percent of total billed charges,,
"Methylmalonic Acid, Qn, S (Mayo)OutsideLaboratory",,83921,CPT,Facility,Both,,,90,75,63.75,21.495,75,BlueCross BlueShield Minnesota,High Value Network Plan,67.5,90,,percent of total billed charges,,
"Methylmalonic Acid, Qn, S (Mayo)OutsideLaboratory",,83921,CPT,Facility,Outpatient,,,90,75,63.75,21.495,75,BlueCross BlueShield Minnesota,Medicare Advantage,36.75,49,,percent of total billed charges,,
"Methylmalonic Acid, Qn, S (Mayo)OutsideLaboratory",,83921,CPT,Facility,Inpatient,,,90,75,63.75,21.495,75,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Methylmalonic Acid, Qn, S (Mayo)OutsideLaboratory",,83921,CPT,Facility,Both,,,90,75,63.75,21.495,75,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,66.4275,88.57,,percent of total billed charges,,
"Methylmalonic Acid, Qn, S (Mayo)OutsideLaboratory",,83921,CPT,Facility,Both,,,90,75,63.75,21.495,75,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,21.495,28.66,,percent of total billed charges,,
"Methylmalonic Acid, Qn, S (Mayo)OutsideLaboratory",,83921,CPT,Facility,Outpatient,,,90,75,63.75,21.495,75,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),36.75,49,,percent of total billed charges,,
"Methylmalonic Acid, Qn, S (Mayo)OutsideLaboratory",,83921,CPT,Facility,Inpatient,,,90,75,63.75,21.495,75,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Methylmalonic Acid, Qn, S (Mayo)OutsideLaboratory",,83921,CPT,Facility,Both,,,90,75,63.75,21.495,75,CorVel,Worker's Compensation,75,100,,percent of total billed charges,,
"Methylmalonic Acid, Qn, S (Mayo)OutsideLaboratory",,83921,CPT,Facility,Both,,,90,75,63.75,21.495,75,First Health Group Corporation,First Health Network,72.75,97,,percent of total billed charges,,
"Methylmalonic Acid, Qn, S (Mayo)OutsideLaboratory",,83921,CPT,Facility,Both,,,90,75,63.75,21.495,75,"Health Partners, Inc.",Commercial,70.95,94.6,,percent of total billed charges,,
"Methylmalonic Acid, Qn, S (Mayo)OutsideLaboratory",,83921,CPT,Facility,Outpatient,,,90,75,63.75,21.495,75,"Health Partners, Inc.",Medicare Advantage,36.75,49,,percent of total billed charges,,
"Methylmalonic Acid, Qn, S (Mayo)OutsideLaboratory",,83921,CPT,Facility,Inpatient,,,90,75,63.75,21.495,75,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Methylmalonic Acid, Qn, S (Mayo)OutsideLaboratory",,83921,CPT,Facility,Both,,,90,75,63.75,21.495,75,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),45,60,,percent of total billed charges,,
"Methylmalonic Acid, Qn, S (Mayo)OutsideLaboratory",,83921,CPT,Facility,Both,,,90,75,63.75,21.495,75,"Health Partners, Inc.",State of Minnesota Advantage Program,61.125,81.5,,percent of total billed charges,,
"Methylmalonic Acid, Qn, S (Mayo)OutsideLaboratory",,83921,CPT,Facility,Both,,,90,75,63.75,21.495,75,"Health Partners, Inc.",State Public Programs,37.5,50,,percent of total billed charges,,
"Methylmalonic Acid, Qn, S (Mayo)OutsideLaboratory",,83921,CPT,Facility,Both,,,90,75,63.75,21.495,75,Humana Insurance Company,Commercial PPO,71.25,95,,percent of total billed charges,,
"Methylmalonic Acid, Qn, S (Mayo)OutsideLaboratory",,83921,CPT,Facility,Outpatient,,,90,75,63.75,21.495,75,Humana Insurance Company,Medicare PPO,36.75,49,,percent of total billed charges,,
"Methylmalonic Acid, Qn, S (Mayo)OutsideLaboratory",,83921,CPT,Facility,Inpatient,,,90,75,63.75,21.495,75,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Methylmalonic Acid, Qn, S (Mayo)OutsideLaboratory",,83921,CPT,Facility,Both,,,90,75,63.75,21.495,75,Medica,Individual & Family,74.325,99.1,,percent of total billed charges,,
"Methylmalonic Acid, Qn, S (Mayo)OutsideLaboratory",,83921,CPT,Facility,Outpatient,,,90,75,63.75,21.495,75,Medica,Medica Advantage Solution,37.35,49.8,,percent of total billed charges,,
"Methylmalonic Acid, Qn, S (Mayo)OutsideLaboratory",,83921,CPT,Facility,Inpatient,,,90,75,63.75,21.495,75,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Methylmalonic Acid, Qn, S (Mayo)OutsideLaboratory",,83921,CPT,Facility,Outpatient,,,90,75,63.75,21.495,75,Medica,Medical Assistance,33.45,44.6,,percent of total billed charges,,
"Methylmalonic Acid, Qn, S (Mayo)OutsideLaboratory",,83921,CPT,Facility,Inpatient,,,90,75,63.75,21.495,75,Medica,Medical Assistance,,,,,Included in per diem rate,
"Methylmalonic Acid, Qn, S (Mayo)OutsideLaboratory",,83921,CPT,Facility,Outpatient,,,90,75,63.75,21.495,75,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,37.35,49.8,,percent of total billed charges,,
"Methylmalonic Acid, Qn, S (Mayo)OutsideLaboratory",,83921,CPT,Facility,Inpatient,,,90,75,63.75,21.495,75,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Methylmalonic Acid, Qn, S (Mayo)OutsideLaboratory",,83921,CPT,Facility,Both,,,90,75,63.75,21.495,75,"Multiplan, Inc.","Multiplan, Inc.",70.5,94,,percent of total billed charges,,
"Methylmalonic Acid, Qn, S (Mayo)OutsideLaboratory",,83921,CPT,Facility,Outpatient,,,90,75,63.75,21.495,75,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,64.8,86.4,,percent of total billed charges,,
"Methylmalonic Acid, Qn, S (Mayo)OutsideLaboratory",,83921,CPT,Facility,Inpatient,,,90,75,63.75,21.495,75,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Methylmalonic Acid, Qn, S (Mayo)OutsideLaboratory",,83921,CPT,Facility,Both,,,90,75,63.75,21.495,75,"Preferred One Administrative Services, INC.",PPO,73.95,98.6,,percent of total billed charges,,
"Methylmalonic Acid, Qn, S (Mayo)OutsideLaboratory",,83921,CPT,Facility,Outpatient,,,90,75,63.75,21.495,75,PrimeWest Health,Minnesota Senior Health Options (MSHO),38.5875,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Methylmalonic Acid, Qn, S (Mayo)OutsideLaboratory",,83921,CPT,Facility,Inpatient,,,90,75,63.75,21.495,75,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Methylmalonic Acid, Qn, S (Mayo)OutsideLaboratory",,83921,CPT,Facility,Outpatient,,,90,75,63.75,21.495,75,PrimeWest Health,MinnesotaCare,38.52,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Methylmalonic Acid, Qn, S (Mayo)OutsideLaboratory",,83921,CPT,Facility,Inpatient,,,90,75,63.75,21.495,75,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Methylmalonic Acid, Qn, S (Mayo)OutsideLaboratory",,83921,CPT,Facility,Both,,,90,75,63.75,21.495,75,Sanford Health Plan,Sanford Health Plan,69,92,,percent of total billed charges,,
"Methylmalonic Acid, Qn, S (Mayo)OutsideLaboratory",,83921,CPT,Facility,Outpatient,,,90,75,63.75,21.495,75,"UCare Health, Inc.",Individual & Family Plan,42.2625,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Methylmalonic Acid, Qn, S (Mayo)OutsideLaboratory",,83921,CPT,Facility,Inpatient,,,90,75,63.75,21.495,75,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Methylmalonic Acid, Qn, S (Mayo)OutsideLaboratory",,83921,CPT,Facility,Outpatient,,,90,75,63.75,21.495,75,"UCare Health, Inc.",Medical Assistance,37.8525,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Methylmalonic Acid, Qn, S (Mayo)OutsideLaboratory",,83921,CPT,Facility,Inpatient,,,90,75,63.75,21.495,75,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Methylmalonic Acid, Qn, S (Mayo)OutsideLaboratory",,83921,CPT,Facility,Outpatient,,,90,75,63.75,21.495,75,"UCare Health, Inc.",Medicare Advantage,37.8525,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Methylmalonic Acid, Qn, S (Mayo)OutsideLaboratory",,83921,CPT,Facility,Inpatient,,,90,75,63.75,21.495,75,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Methylmalonic Acid, Qn, S (Mayo)OutsideLaboratory",,83921,CPT,Facility,Outpatient,,,90,75,63.75,21.495,75,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),37.8525,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Methylmalonic Acid, Qn, S (Mayo)OutsideLaboratory",,83921,CPT,Facility,Inpatient,,,90,75,63.75,21.495,75,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Methylmalonic Acid, Qn, S (Mayo)OutsideLaboratory",,83921,CPT,Facility,Both,,,90,75,63.75,21.495,75,UnitedHealthcare,Individual & Family,70.5,94,,percent of total billed charges,,
"Methylmalonic Acid, Qn, S (Mayo)OutsideLaboratory",,83921,CPT,Facility,Outpatient,,,90,75,63.75,21.495,75,UnitedHealthcare,Medicare Advantage,36.75,49,,percent of total billed charges,,
"Methylmalonic Acid, Qn, S (Mayo)OutsideLaboratory",,83921,CPT,Facility,Inpatient,,,90,75,63.75,21.495,75,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Methylmalonic Acid, Qn, S (Mayo)OutsideLaboratory",,83921,CPT,Facility,Outpatient,,,90,75,63.75,21.495,75,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,36,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Methylmalonic Acid, Qn, S (Mayo)OutsideLaboratory",,83921,CPT,Facility,Inpatient,,,90,75,63.75,21.495,75,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Osmolality, U (Mayo)OutsideLaboratory",,83935,CPT,Facility,Both,,,90,90,76.5,25.794,90,Aetna,Commercial,82.8,92,,percent of total billed charges,,
"Osmolality, U (Mayo)OutsideLaboratory",,83935,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,Aetna,Medicare Advantage,44.1,49,,percent of total billed charges,,
"Osmolality, U (Mayo)OutsideLaboratory",,83935,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Osmolality, U (Mayo)OutsideLaboratory",,83935,CPT,Facility,Both,,,90,90,76.5,25.794,90,Aetna,PPO,83.7,93,,percent of total billed charges,,
"Osmolality, U (Mayo)OutsideLaboratory",,83935,CPT,Facility,Both,,,90,90,76.5,25.794,90,America's PPO,America's PPO,86.427,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Osmolality, U (Mayo)OutsideLaboratory",,83935,CPT,Facility,Both,,,90,90,76.5,25.794,90,BlueCross BlueShield Minnesota, Federal Employee Program,88.56,98.4,,percent of total billed charges,,
"Osmolality, U (Mayo)OutsideLaboratory",,83935,CPT,Facility,Both,,,90,90,76.5,25.794,90,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,90,100,,percent of total billed charges,,
"Osmolality, U (Mayo)OutsideLaboratory",,83935,CPT,Facility,Both,,,90,90,76.5,25.794,90,BlueCross BlueShield Minnesota,High Value Network Plan,81,90,,percent of total billed charges,,
"Osmolality, U (Mayo)OutsideLaboratory",,83935,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,BlueCross BlueShield Minnesota,Medicare Advantage,44.1,49,,percent of total billed charges,,
"Osmolality, U (Mayo)OutsideLaboratory",,83935,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Osmolality, U (Mayo)OutsideLaboratory",,83935,CPT,Facility,Both,,,90,90,76.5,25.794,90,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,79.713,88.57,,percent of total billed charges,,
"Osmolality, U (Mayo)OutsideLaboratory",,83935,CPT,Facility,Both,,,90,90,76.5,25.794,90,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,25.794,28.66,,percent of total billed charges,,
"Osmolality, U (Mayo)OutsideLaboratory",,83935,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),44.1,49,,percent of total billed charges,,
"Osmolality, U (Mayo)OutsideLaboratory",,83935,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Osmolality, U (Mayo)OutsideLaboratory",,83935,CPT,Facility,Both,,,90,90,76.5,25.794,90,CorVel,Worker's Compensation,90,100,,percent of total billed charges,,
"Osmolality, U (Mayo)OutsideLaboratory",,83935,CPT,Facility,Both,,,90,90,76.5,25.794,90,First Health Group Corporation,First Health Network,87.3,97,,percent of total billed charges,,
"Osmolality, U (Mayo)OutsideLaboratory",,83935,CPT,Facility,Both,,,90,90,76.5,25.794,90,"Health Partners, Inc.",Commercial,85.14,94.6,,percent of total billed charges,,
"Osmolality, U (Mayo)OutsideLaboratory",,83935,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,"Health Partners, Inc.",Medicare Advantage,44.1,49,,percent of total billed charges,,
"Osmolality, U (Mayo)OutsideLaboratory",,83935,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Osmolality, U (Mayo)OutsideLaboratory",,83935,CPT,Facility,Both,,,90,90,76.5,25.794,90,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),54,60,,percent of total billed charges,,
"Osmolality, U (Mayo)OutsideLaboratory",,83935,CPT,Facility,Both,,,90,90,76.5,25.794,90,"Health Partners, Inc.",State of Minnesota Advantage Program,73.35,81.5,,percent of total billed charges,,
"Osmolality, U (Mayo)OutsideLaboratory",,83935,CPT,Facility,Both,,,90,90,76.5,25.794,90,"Health Partners, Inc.",State Public Programs,45,50,,percent of total billed charges,,
"Osmolality, U (Mayo)OutsideLaboratory",,83935,CPT,Facility,Both,,,90,90,76.5,25.794,90,Humana Insurance Company,Commercial PPO,85.5,95,,percent of total billed charges,,
"Osmolality, U (Mayo)OutsideLaboratory",,83935,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,Humana Insurance Company,Medicare PPO,44.1,49,,percent of total billed charges,,
"Osmolality, U (Mayo)OutsideLaboratory",,83935,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Osmolality, U (Mayo)OutsideLaboratory",,83935,CPT,Facility,Both,,,90,90,76.5,25.794,90,Medica,Individual & Family,89.19,99.1,,percent of total billed charges,,
"Osmolality, U (Mayo)OutsideLaboratory",,83935,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,Medica,Medica Advantage Solution,44.82,49.8,,percent of total billed charges,,
"Osmolality, U (Mayo)OutsideLaboratory",,83935,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Osmolality, U (Mayo)OutsideLaboratory",,83935,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,Medica,Medical Assistance,40.14,44.6,,percent of total billed charges,,
"Osmolality, U (Mayo)OutsideLaboratory",,83935,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,Medica,Medical Assistance,,,,,Included in per diem rate,
"Osmolality, U (Mayo)OutsideLaboratory",,83935,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,44.82,49.8,,percent of total billed charges,,
"Osmolality, U (Mayo)OutsideLaboratory",,83935,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Osmolality, U (Mayo)OutsideLaboratory",,83935,CPT,Facility,Both,,,90,90,76.5,25.794,90,"Multiplan, Inc.","Multiplan, Inc.",84.6,94,,percent of total billed charges,,
"Osmolality, U (Mayo)OutsideLaboratory",,83935,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,77.76,86.4,,percent of total billed charges,,
"Osmolality, U (Mayo)OutsideLaboratory",,83935,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Osmolality, U (Mayo)OutsideLaboratory",,83935,CPT,Facility,Both,,,90,90,76.5,25.794,90,"Preferred One Administrative Services, INC.",PPO,88.74,98.6,,percent of total billed charges,,
"Osmolality, U (Mayo)OutsideLaboratory",,83935,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,PrimeWest Health,Minnesota Senior Health Options (MSHO),46.305,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Osmolality, U (Mayo)OutsideLaboratory",,83935,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Osmolality, U (Mayo)OutsideLaboratory",,83935,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,PrimeWest Health,MinnesotaCare,46.224,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Osmolality, U (Mayo)OutsideLaboratory",,83935,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Osmolality, U (Mayo)OutsideLaboratory",,83935,CPT,Facility,Both,,,90,90,76.5,25.794,90,Sanford Health Plan,Sanford Health Plan,82.8,92,,percent of total billed charges,,
"Osmolality, U (Mayo)OutsideLaboratory",,83935,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,"UCare Health, Inc.",Individual & Family Plan,50.715,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Osmolality, U (Mayo)OutsideLaboratory",,83935,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Osmolality, U (Mayo)OutsideLaboratory",,83935,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,"UCare Health, Inc.",Medical Assistance,45.423,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Osmolality, U (Mayo)OutsideLaboratory",,83935,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Osmolality, U (Mayo)OutsideLaboratory",,83935,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,"UCare Health, Inc.",Medicare Advantage,45.423,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Osmolality, U (Mayo)OutsideLaboratory",,83935,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Osmolality, U (Mayo)OutsideLaboratory",,83935,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),45.423,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Osmolality, U (Mayo)OutsideLaboratory",,83935,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Osmolality, U (Mayo)OutsideLaboratory",,83935,CPT,Facility,Both,,,90,90,76.5,25.794,90,UnitedHealthcare,Individual & Family,84.6,94,,percent of total billed charges,,
"Osmolality, U (Mayo)OutsideLaboratory",,83935,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,UnitedHealthcare,Medicare Advantage,44.1,49,,percent of total billed charges,,
"Osmolality, U (Mayo)OutsideLaboratory",,83935,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Osmolality, U (Mayo)OutsideLaboratory",,83935,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,43.2,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Osmolality, U (Mayo)OutsideLaboratory",,83935,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Osmolality, Urine; Uosmu (Mayo)OutsideLaboratory",,83935,CPT,Facility,Both,,,90,90,76.5,25.794,90,Aetna,Commercial,82.8,92,,percent of total billed charges,,
"Osmolality, Urine; Uosmu (Mayo)OutsideLaboratory",,83935,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,Aetna,Medicare Advantage,44.1,49,,percent of total billed charges,,
"Osmolality, Urine; Uosmu (Mayo)OutsideLaboratory",,83935,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Osmolality, Urine; Uosmu (Mayo)OutsideLaboratory",,83935,CPT,Facility,Both,,,90,90,76.5,25.794,90,Aetna,PPO,83.7,93,,percent of total billed charges,,
"Osmolality, Urine; Uosmu (Mayo)OutsideLaboratory",,83935,CPT,Facility,Both,,,90,90,76.5,25.794,90,America's PPO,America's PPO,86.427,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Osmolality, Urine; Uosmu (Mayo)OutsideLaboratory",,83935,CPT,Facility,Both,,,90,90,76.5,25.794,90,BlueCross BlueShield Minnesota, Federal Employee Program,88.56,98.4,,percent of total billed charges,,
"Osmolality, Urine; Uosmu (Mayo)OutsideLaboratory",,83935,CPT,Facility,Both,,,90,90,76.5,25.794,90,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,90,100,,percent of total billed charges,,
"Osmolality, Urine; Uosmu (Mayo)OutsideLaboratory",,83935,CPT,Facility,Both,,,90,90,76.5,25.794,90,BlueCross BlueShield Minnesota,High Value Network Plan,81,90,,percent of total billed charges,,
"Osmolality, Urine; Uosmu (Mayo)OutsideLaboratory",,83935,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,BlueCross BlueShield Minnesota,Medicare Advantage,44.1,49,,percent of total billed charges,,
"Osmolality, Urine; Uosmu (Mayo)OutsideLaboratory",,83935,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Osmolality, Urine; Uosmu (Mayo)OutsideLaboratory",,83935,CPT,Facility,Both,,,90,90,76.5,25.794,90,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,79.713,88.57,,percent of total billed charges,,
"Osmolality, Urine; Uosmu (Mayo)OutsideLaboratory",,83935,CPT,Facility,Both,,,90,90,76.5,25.794,90,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,25.794,28.66,,percent of total billed charges,,
"Osmolality, Urine; Uosmu (Mayo)OutsideLaboratory",,83935,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),44.1,49,,percent of total billed charges,,
"Osmolality, Urine; Uosmu (Mayo)OutsideLaboratory",,83935,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Osmolality, Urine; Uosmu (Mayo)OutsideLaboratory",,83935,CPT,Facility,Both,,,90,90,76.5,25.794,90,CorVel,Worker's Compensation,90,100,,percent of total billed charges,,
"Osmolality, Urine; Uosmu (Mayo)OutsideLaboratory",,83935,CPT,Facility,Both,,,90,90,76.5,25.794,90,First Health Group Corporation,First Health Network,87.3,97,,percent of total billed charges,,
"Osmolality, Urine; Uosmu (Mayo)OutsideLaboratory",,83935,CPT,Facility,Both,,,90,90,76.5,25.794,90,"Health Partners, Inc.",Commercial,85.14,94.6,,percent of total billed charges,,
"Osmolality, Urine; Uosmu (Mayo)OutsideLaboratory",,83935,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,"Health Partners, Inc.",Medicare Advantage,44.1,49,,percent of total billed charges,,
"Osmolality, Urine; Uosmu (Mayo)OutsideLaboratory",,83935,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Osmolality, Urine; Uosmu (Mayo)OutsideLaboratory",,83935,CPT,Facility,Both,,,90,90,76.5,25.794,90,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),54,60,,percent of total billed charges,,
"Osmolality, Urine; Uosmu (Mayo)OutsideLaboratory",,83935,CPT,Facility,Both,,,90,90,76.5,25.794,90,"Health Partners, Inc.",State of Minnesota Advantage Program,73.35,81.5,,percent of total billed charges,,
"Osmolality, Urine; Uosmu (Mayo)OutsideLaboratory",,83935,CPT,Facility,Both,,,90,90,76.5,25.794,90,"Health Partners, Inc.",State Public Programs,45,50,,percent of total billed charges,,
"Osmolality, Urine; Uosmu (Mayo)OutsideLaboratory",,83935,CPT,Facility,Both,,,90,90,76.5,25.794,90,Humana Insurance Company,Commercial PPO,85.5,95,,percent of total billed charges,,
"Osmolality, Urine; Uosmu (Mayo)OutsideLaboratory",,83935,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,Humana Insurance Company,Medicare PPO,44.1,49,,percent of total billed charges,,
"Osmolality, Urine; Uosmu (Mayo)OutsideLaboratory",,83935,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Osmolality, Urine; Uosmu (Mayo)OutsideLaboratory",,83935,CPT,Facility,Both,,,90,90,76.5,25.794,90,Medica,Individual & Family,89.19,99.1,,percent of total billed charges,,
"Osmolality, Urine; Uosmu (Mayo)OutsideLaboratory",,83935,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,Medica,Medica Advantage Solution,44.82,49.8,,percent of total billed charges,,
"Osmolality, Urine; Uosmu (Mayo)OutsideLaboratory",,83935,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Osmolality, Urine; Uosmu (Mayo)OutsideLaboratory",,83935,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,Medica,Medical Assistance,40.14,44.6,,percent of total billed charges,,
"Osmolality, Urine; Uosmu (Mayo)OutsideLaboratory",,83935,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,Medica,Medical Assistance,,,,,Included in per diem rate,
"Osmolality, Urine; Uosmu (Mayo)OutsideLaboratory",,83935,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,44.82,49.8,,percent of total billed charges,,
"Osmolality, Urine; Uosmu (Mayo)OutsideLaboratory",,83935,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Osmolality, Urine; Uosmu (Mayo)OutsideLaboratory",,83935,CPT,Facility,Both,,,90,90,76.5,25.794,90,"Multiplan, Inc.","Multiplan, Inc.",84.6,94,,percent of total billed charges,,
"Osmolality, Urine; Uosmu (Mayo)OutsideLaboratory",,83935,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,77.76,86.4,,percent of total billed charges,,
"Osmolality, Urine; Uosmu (Mayo)OutsideLaboratory",,83935,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Osmolality, Urine; Uosmu (Mayo)OutsideLaboratory",,83935,CPT,Facility,Both,,,90,90,76.5,25.794,90,"Preferred One Administrative Services, INC.",PPO,88.74,98.6,,percent of total billed charges,,
"Osmolality, Urine; Uosmu (Mayo)OutsideLaboratory",,83935,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,PrimeWest Health,Minnesota Senior Health Options (MSHO),46.305,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Osmolality, Urine; Uosmu (Mayo)OutsideLaboratory",,83935,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Osmolality, Urine; Uosmu (Mayo)OutsideLaboratory",,83935,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,PrimeWest Health,MinnesotaCare,46.224,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Osmolality, Urine; Uosmu (Mayo)OutsideLaboratory",,83935,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Osmolality, Urine; Uosmu (Mayo)OutsideLaboratory",,83935,CPT,Facility,Both,,,90,90,76.5,25.794,90,Sanford Health Plan,Sanford Health Plan,82.8,92,,percent of total billed charges,,
"Osmolality, Urine; Uosmu (Mayo)OutsideLaboratory",,83935,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,"UCare Health, Inc.",Individual & Family Plan,50.715,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Osmolality, Urine; Uosmu (Mayo)OutsideLaboratory",,83935,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Osmolality, Urine; Uosmu (Mayo)OutsideLaboratory",,83935,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,"UCare Health, Inc.",Medical Assistance,45.423,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Osmolality, Urine; Uosmu (Mayo)OutsideLaboratory",,83935,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Osmolality, Urine; Uosmu (Mayo)OutsideLaboratory",,83935,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,"UCare Health, Inc.",Medicare Advantage,45.423,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Osmolality, Urine; Uosmu (Mayo)OutsideLaboratory",,83935,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Osmolality, Urine; Uosmu (Mayo)OutsideLaboratory",,83935,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),45.423,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Osmolality, Urine; Uosmu (Mayo)OutsideLaboratory",,83935,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Osmolality, Urine; Uosmu (Mayo)OutsideLaboratory",,83935,CPT,Facility,Both,,,90,90,76.5,25.794,90,UnitedHealthcare,Individual & Family,84.6,94,,percent of total billed charges,,
"Osmolality, Urine; Uosmu (Mayo)OutsideLaboratory",,83935,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,UnitedHealthcare,Medicare Advantage,44.1,49,,percent of total billed charges,,
"Osmolality, Urine; Uosmu (Mayo)OutsideLaboratory",,83935,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Osmolality, Urine; Uosmu (Mayo)OutsideLaboratory",,83935,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,43.2,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Osmolality, Urine; Uosmu (Mayo)OutsideLaboratory",,83935,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Osteocalcin, S (Mayo)OutsideLaboratory",,83937,CPT,Facility,Both,,,90,163,138.55,46.7158,163,Aetna,Commercial,149.96,92,,percent of total billed charges,,
"Osteocalcin, S (Mayo)OutsideLaboratory",,83937,CPT,Facility,Outpatient,,,90,163,138.55,46.7158,163,Aetna,Medicare Advantage,79.87,49,,percent of total billed charges,,
"Osteocalcin, S (Mayo)OutsideLaboratory",,83937,CPT,Facility,Inpatient,,,90,163,138.55,46.7158,163,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Osteocalcin, S (Mayo)OutsideLaboratory",,83937,CPT,Facility,Both,,,90,163,138.55,46.7158,163,Aetna,PPO,151.59,93,,percent of total billed charges,,
"Osteocalcin, S (Mayo)OutsideLaboratory",,83937,CPT,Facility,Both,,,90,163,138.55,46.7158,163,America's PPO,America's PPO,156.5289,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Osteocalcin, S (Mayo)OutsideLaboratory",,83937,CPT,Facility,Both,,,90,163,138.55,46.7158,163,BlueCross BlueShield Minnesota, Federal Employee Program,160.392,98.4,,percent of total billed charges,,
"Osteocalcin, S (Mayo)OutsideLaboratory",,83937,CPT,Facility,Both,,,90,163,138.55,46.7158,163,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,163,100,,percent of total billed charges,,
"Osteocalcin, S (Mayo)OutsideLaboratory",,83937,CPT,Facility,Both,,,90,163,138.55,46.7158,163,BlueCross BlueShield Minnesota,High Value Network Plan,146.7,90,,percent of total billed charges,,
"Osteocalcin, S (Mayo)OutsideLaboratory",,83937,CPT,Facility,Outpatient,,,90,163,138.55,46.7158,163,BlueCross BlueShield Minnesota,Medicare Advantage,79.87,49,,percent of total billed charges,,
"Osteocalcin, S (Mayo)OutsideLaboratory",,83937,CPT,Facility,Inpatient,,,90,163,138.55,46.7158,163,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Osteocalcin, S (Mayo)OutsideLaboratory",,83937,CPT,Facility,Both,,,90,163,138.55,46.7158,163,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,144.3691,88.57,,percent of total billed charges,,
"Osteocalcin, S (Mayo)OutsideLaboratory",,83937,CPT,Facility,Both,,,90,163,138.55,46.7158,163,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,46.7158,28.66,,percent of total billed charges,,
"Osteocalcin, S (Mayo)OutsideLaboratory",,83937,CPT,Facility,Outpatient,,,90,163,138.55,46.7158,163,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),79.87,49,,percent of total billed charges,,
"Osteocalcin, S (Mayo)OutsideLaboratory",,83937,CPT,Facility,Inpatient,,,90,163,138.55,46.7158,163,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Osteocalcin, S (Mayo)OutsideLaboratory",,83937,CPT,Facility,Both,,,90,163,138.55,46.7158,163,CorVel,Worker's Compensation,163,100,,percent of total billed charges,,
"Osteocalcin, S (Mayo)OutsideLaboratory",,83937,CPT,Facility,Both,,,90,163,138.55,46.7158,163,First Health Group Corporation,First Health Network,158.11,97,,percent of total billed charges,,
"Osteocalcin, S (Mayo)OutsideLaboratory",,83937,CPT,Facility,Both,,,90,163,138.55,46.7158,163,"Health Partners, Inc.",Commercial,154.198,94.6,,percent of total billed charges,,
"Osteocalcin, S (Mayo)OutsideLaboratory",,83937,CPT,Facility,Outpatient,,,90,163,138.55,46.7158,163,"Health Partners, Inc.",Medicare Advantage,79.87,49,,percent of total billed charges,,
"Osteocalcin, S (Mayo)OutsideLaboratory",,83937,CPT,Facility,Inpatient,,,90,163,138.55,46.7158,163,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Osteocalcin, S (Mayo)OutsideLaboratory",,83937,CPT,Facility,Both,,,90,163,138.55,46.7158,163,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),97.8,60,,percent of total billed charges,,
"Osteocalcin, S (Mayo)OutsideLaboratory",,83937,CPT,Facility,Both,,,90,163,138.55,46.7158,163,"Health Partners, Inc.",State of Minnesota Advantage Program,132.845,81.5,,percent of total billed charges,,
"Osteocalcin, S (Mayo)OutsideLaboratory",,83937,CPT,Facility,Both,,,90,163,138.55,46.7158,163,"Health Partners, Inc.",State Public Programs,81.5,50,,percent of total billed charges,,
"Osteocalcin, S (Mayo)OutsideLaboratory",,83937,CPT,Facility,Both,,,90,163,138.55,46.7158,163,Humana Insurance Company,Commercial PPO,154.85,95,,percent of total billed charges,,
"Osteocalcin, S (Mayo)OutsideLaboratory",,83937,CPT,Facility,Outpatient,,,90,163,138.55,46.7158,163,Humana Insurance Company,Medicare PPO,79.87,49,,percent of total billed charges,,
"Osteocalcin, S (Mayo)OutsideLaboratory",,83937,CPT,Facility,Inpatient,,,90,163,138.55,46.7158,163,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Osteocalcin, S (Mayo)OutsideLaboratory",,83937,CPT,Facility,Both,,,90,163,138.55,46.7158,163,Medica,Individual & Family,161.533,99.1,,percent of total billed charges,,
"Osteocalcin, S (Mayo)OutsideLaboratory",,83937,CPT,Facility,Outpatient,,,90,163,138.55,46.7158,163,Medica,Medica Advantage Solution,81.174,49.8,,percent of total billed charges,,
"Osteocalcin, S (Mayo)OutsideLaboratory",,83937,CPT,Facility,Inpatient,,,90,163,138.55,46.7158,163,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Osteocalcin, S (Mayo)OutsideLaboratory",,83937,CPT,Facility,Outpatient,,,90,163,138.55,46.7158,163,Medica,Medical Assistance,72.698,44.6,,percent of total billed charges,,
"Osteocalcin, S (Mayo)OutsideLaboratory",,83937,CPT,Facility,Inpatient,,,90,163,138.55,46.7158,163,Medica,Medical Assistance,,,,,Included in per diem rate,
"Osteocalcin, S (Mayo)OutsideLaboratory",,83937,CPT,Facility,Outpatient,,,90,163,138.55,46.7158,163,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,81.174,49.8,,percent of total billed charges,,
"Osteocalcin, S (Mayo)OutsideLaboratory",,83937,CPT,Facility,Inpatient,,,90,163,138.55,46.7158,163,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Osteocalcin, S (Mayo)OutsideLaboratory",,83937,CPT,Facility,Both,,,90,163,138.55,46.7158,163,"Multiplan, Inc.","Multiplan, Inc.",153.22,94,,percent of total billed charges,,
"Osteocalcin, S (Mayo)OutsideLaboratory",,83937,CPT,Facility,Outpatient,,,90,163,138.55,46.7158,163,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,140.832,86.4,,percent of total billed charges,,
"Osteocalcin, S (Mayo)OutsideLaboratory",,83937,CPT,Facility,Inpatient,,,90,163,138.55,46.7158,163,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Osteocalcin, S (Mayo)OutsideLaboratory",,83937,CPT,Facility,Both,,,90,163,138.55,46.7158,163,"Preferred One Administrative Services, INC.",PPO,160.718,98.6,,percent of total billed charges,,
"Osteocalcin, S (Mayo)OutsideLaboratory",,83937,CPT,Facility,Outpatient,,,90,163,138.55,46.7158,163,PrimeWest Health,Minnesota Senior Health Options (MSHO),83.8635,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Osteocalcin, S (Mayo)OutsideLaboratory",,83937,CPT,Facility,Inpatient,,,90,163,138.55,46.7158,163,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Osteocalcin, S (Mayo)OutsideLaboratory",,83937,CPT,Facility,Outpatient,,,90,163,138.55,46.7158,163,PrimeWest Health,MinnesotaCare,83.7168,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Osteocalcin, S (Mayo)OutsideLaboratory",,83937,CPT,Facility,Inpatient,,,90,163,138.55,46.7158,163,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Osteocalcin, S (Mayo)OutsideLaboratory",,83937,CPT,Facility,Both,,,90,163,138.55,46.7158,163,Sanford Health Plan,Sanford Health Plan,149.96,92,,percent of total billed charges,,
"Osteocalcin, S (Mayo)OutsideLaboratory",,83937,CPT,Facility,Outpatient,,,90,163,138.55,46.7158,163,"UCare Health, Inc.",Individual & Family Plan,91.8505,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Osteocalcin, S (Mayo)OutsideLaboratory",,83937,CPT,Facility,Inpatient,,,90,163,138.55,46.7158,163,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Osteocalcin, S (Mayo)OutsideLaboratory",,83937,CPT,Facility,Outpatient,,,90,163,138.55,46.7158,163,"UCare Health, Inc.",Medical Assistance,82.2661,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Osteocalcin, S (Mayo)OutsideLaboratory",,83937,CPT,Facility,Inpatient,,,90,163,138.55,46.7158,163,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Osteocalcin, S (Mayo)OutsideLaboratory",,83937,CPT,Facility,Outpatient,,,90,163,138.55,46.7158,163,"UCare Health, Inc.",Medicare Advantage,82.2661,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Osteocalcin, S (Mayo)OutsideLaboratory",,83937,CPT,Facility,Inpatient,,,90,163,138.55,46.7158,163,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Osteocalcin, S (Mayo)OutsideLaboratory",,83937,CPT,Facility,Outpatient,,,90,163,138.55,46.7158,163,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),82.2661,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Osteocalcin, S (Mayo)OutsideLaboratory",,83937,CPT,Facility,Inpatient,,,90,163,138.55,46.7158,163,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Osteocalcin, S (Mayo)OutsideLaboratory",,83937,CPT,Facility,Both,,,90,163,138.55,46.7158,163,UnitedHealthcare,Individual & Family,153.22,94,,percent of total billed charges,,
"Osteocalcin, S (Mayo)OutsideLaboratory",,83937,CPT,Facility,Outpatient,,,90,163,138.55,46.7158,163,UnitedHealthcare,Medicare Advantage,79.87,49,,percent of total billed charges,,
"Osteocalcin, S (Mayo)OutsideLaboratory",,83937,CPT,Facility,Inpatient,,,90,163,138.55,46.7158,163,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Osteocalcin, S (Mayo)OutsideLaboratory",,83937,CPT,Facility,Outpatient,,,90,163,138.55,46.7158,163,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,78.24,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Osteocalcin, S (Mayo)OutsideLaboratory",,83937,CPT,Facility,Inpatient,,,90,163,138.55,46.7158,163,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Oxalate, U (Mayo)OutsideLaboratory",,83945,CPT,Facility,Both,,,90,88,74.8,25.2208,88,Aetna,Commercial,80.96,92,,percent of total billed charges,,
"Oxalate, U (Mayo)OutsideLaboratory",,83945,CPT,Facility,Outpatient,,,90,88,74.8,25.2208,88,Aetna,Medicare Advantage,43.12,49,,percent of total billed charges,,
"Oxalate, U (Mayo)OutsideLaboratory",,83945,CPT,Facility,Inpatient,,,90,88,74.8,25.2208,88,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Oxalate, U (Mayo)OutsideLaboratory",,83945,CPT,Facility,Both,,,90,88,74.8,25.2208,88,Aetna,PPO,81.84,93,,percent of total billed charges,,
"Oxalate, U (Mayo)OutsideLaboratory",,83945,CPT,Facility,Both,,,90,88,74.8,25.2208,88,America's PPO,America's PPO,84.5064,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Oxalate, U (Mayo)OutsideLaboratory",,83945,CPT,Facility,Both,,,90,88,74.8,25.2208,88,BlueCross BlueShield Minnesota, Federal Employee Program,86.592,98.4,,percent of total billed charges,,
"Oxalate, U (Mayo)OutsideLaboratory",,83945,CPT,Facility,Both,,,90,88,74.8,25.2208,88,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,88,100,,percent of total billed charges,,
"Oxalate, U (Mayo)OutsideLaboratory",,83945,CPT,Facility,Both,,,90,88,74.8,25.2208,88,BlueCross BlueShield Minnesota,High Value Network Plan,79.2,90,,percent of total billed charges,,
"Oxalate, U (Mayo)OutsideLaboratory",,83945,CPT,Facility,Outpatient,,,90,88,74.8,25.2208,88,BlueCross BlueShield Minnesota,Medicare Advantage,43.12,49,,percent of total billed charges,,
"Oxalate, U (Mayo)OutsideLaboratory",,83945,CPT,Facility,Inpatient,,,90,88,74.8,25.2208,88,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Oxalate, U (Mayo)OutsideLaboratory",,83945,CPT,Facility,Both,,,90,88,74.8,25.2208,88,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,77.9416,88.57,,percent of total billed charges,,
"Oxalate, U (Mayo)OutsideLaboratory",,83945,CPT,Facility,Both,,,90,88,74.8,25.2208,88,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,25.2208,28.66,,percent of total billed charges,,
"Oxalate, U (Mayo)OutsideLaboratory",,83945,CPT,Facility,Outpatient,,,90,88,74.8,25.2208,88,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),43.12,49,,percent of total billed charges,,
"Oxalate, U (Mayo)OutsideLaboratory",,83945,CPT,Facility,Inpatient,,,90,88,74.8,25.2208,88,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Oxalate, U (Mayo)OutsideLaboratory",,83945,CPT,Facility,Both,,,90,88,74.8,25.2208,88,CorVel,Worker's Compensation,88,100,,percent of total billed charges,,
"Oxalate, U (Mayo)OutsideLaboratory",,83945,CPT,Facility,Both,,,90,88,74.8,25.2208,88,First Health Group Corporation,First Health Network,85.36,97,,percent of total billed charges,,
"Oxalate, U (Mayo)OutsideLaboratory",,83945,CPT,Facility,Both,,,90,88,74.8,25.2208,88,"Health Partners, Inc.",Commercial,83.248,94.6,,percent of total billed charges,,
"Oxalate, U (Mayo)OutsideLaboratory",,83945,CPT,Facility,Outpatient,,,90,88,74.8,25.2208,88,"Health Partners, Inc.",Medicare Advantage,43.12,49,,percent of total billed charges,,
"Oxalate, U (Mayo)OutsideLaboratory",,83945,CPT,Facility,Inpatient,,,90,88,74.8,25.2208,88,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Oxalate, U (Mayo)OutsideLaboratory",,83945,CPT,Facility,Both,,,90,88,74.8,25.2208,88,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),52.8,60,,percent of total billed charges,,
"Oxalate, U (Mayo)OutsideLaboratory",,83945,CPT,Facility,Both,,,90,88,74.8,25.2208,88,"Health Partners, Inc.",State of Minnesota Advantage Program,71.72,81.5,,percent of total billed charges,,
"Oxalate, U (Mayo)OutsideLaboratory",,83945,CPT,Facility,Both,,,90,88,74.8,25.2208,88,"Health Partners, Inc.",State Public Programs,44,50,,percent of total billed charges,,
"Oxalate, U (Mayo)OutsideLaboratory",,83945,CPT,Facility,Both,,,90,88,74.8,25.2208,88,Humana Insurance Company,Commercial PPO,83.6,95,,percent of total billed charges,,
"Oxalate, U (Mayo)OutsideLaboratory",,83945,CPT,Facility,Outpatient,,,90,88,74.8,25.2208,88,Humana Insurance Company,Medicare PPO,43.12,49,,percent of total billed charges,,
"Oxalate, U (Mayo)OutsideLaboratory",,83945,CPT,Facility,Inpatient,,,90,88,74.8,25.2208,88,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Oxalate, U (Mayo)OutsideLaboratory",,83945,CPT,Facility,Both,,,90,88,74.8,25.2208,88,Medica,Individual & Family,87.208,99.1,,percent of total billed charges,,
"Oxalate, U (Mayo)OutsideLaboratory",,83945,CPT,Facility,Outpatient,,,90,88,74.8,25.2208,88,Medica,Medica Advantage Solution,43.824,49.8,,percent of total billed charges,,
"Oxalate, U (Mayo)OutsideLaboratory",,83945,CPT,Facility,Inpatient,,,90,88,74.8,25.2208,88,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Oxalate, U (Mayo)OutsideLaboratory",,83945,CPT,Facility,Outpatient,,,90,88,74.8,25.2208,88,Medica,Medical Assistance,39.248,44.6,,percent of total billed charges,,
"Oxalate, U (Mayo)OutsideLaboratory",,83945,CPT,Facility,Inpatient,,,90,88,74.8,25.2208,88,Medica,Medical Assistance,,,,,Included in per diem rate,
"Oxalate, U (Mayo)OutsideLaboratory",,83945,CPT,Facility,Outpatient,,,90,88,74.8,25.2208,88,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,43.824,49.8,,percent of total billed charges,,
"Oxalate, U (Mayo)OutsideLaboratory",,83945,CPT,Facility,Inpatient,,,90,88,74.8,25.2208,88,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Oxalate, U (Mayo)OutsideLaboratory",,83945,CPT,Facility,Both,,,90,88,74.8,25.2208,88,"Multiplan, Inc.","Multiplan, Inc.",82.72,94,,percent of total billed charges,,
"Oxalate, U (Mayo)OutsideLaboratory",,83945,CPT,Facility,Outpatient,,,90,88,74.8,25.2208,88,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,76.032,86.4,,percent of total billed charges,,
"Oxalate, U (Mayo)OutsideLaboratory",,83945,CPT,Facility,Inpatient,,,90,88,74.8,25.2208,88,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Oxalate, U (Mayo)OutsideLaboratory",,83945,CPT,Facility,Both,,,90,88,74.8,25.2208,88,"Preferred One Administrative Services, INC.",PPO,86.768,98.6,,percent of total billed charges,,
"Oxalate, U (Mayo)OutsideLaboratory",,83945,CPT,Facility,Outpatient,,,90,88,74.8,25.2208,88,PrimeWest Health,Minnesota Senior Health Options (MSHO),45.276,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Oxalate, U (Mayo)OutsideLaboratory",,83945,CPT,Facility,Inpatient,,,90,88,74.8,25.2208,88,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Oxalate, U (Mayo)OutsideLaboratory",,83945,CPT,Facility,Outpatient,,,90,88,74.8,25.2208,88,PrimeWest Health,MinnesotaCare,45.1968,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Oxalate, U (Mayo)OutsideLaboratory",,83945,CPT,Facility,Inpatient,,,90,88,74.8,25.2208,88,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Oxalate, U (Mayo)OutsideLaboratory",,83945,CPT,Facility,Both,,,90,88,74.8,25.2208,88,Sanford Health Plan,Sanford Health Plan,80.96,92,,percent of total billed charges,,
"Oxalate, U (Mayo)OutsideLaboratory",,83945,CPT,Facility,Outpatient,,,90,88,74.8,25.2208,88,"UCare Health, Inc.",Individual & Family Plan,49.588,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Oxalate, U (Mayo)OutsideLaboratory",,83945,CPT,Facility,Inpatient,,,90,88,74.8,25.2208,88,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Oxalate, U (Mayo)OutsideLaboratory",,83945,CPT,Facility,Outpatient,,,90,88,74.8,25.2208,88,"UCare Health, Inc.",Medical Assistance,44.4136,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Oxalate, U (Mayo)OutsideLaboratory",,83945,CPT,Facility,Inpatient,,,90,88,74.8,25.2208,88,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Oxalate, U (Mayo)OutsideLaboratory",,83945,CPT,Facility,Outpatient,,,90,88,74.8,25.2208,88,"UCare Health, Inc.",Medicare Advantage,44.4136,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Oxalate, U (Mayo)OutsideLaboratory",,83945,CPT,Facility,Inpatient,,,90,88,74.8,25.2208,88,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Oxalate, U (Mayo)OutsideLaboratory",,83945,CPT,Facility,Outpatient,,,90,88,74.8,25.2208,88,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),44.4136,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Oxalate, U (Mayo)OutsideLaboratory",,83945,CPT,Facility,Inpatient,,,90,88,74.8,25.2208,88,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Oxalate, U (Mayo)OutsideLaboratory",,83945,CPT,Facility,Both,,,90,88,74.8,25.2208,88,UnitedHealthcare,Individual & Family,82.72,94,,percent of total billed charges,,
"Oxalate, U (Mayo)OutsideLaboratory",,83945,CPT,Facility,Outpatient,,,90,88,74.8,25.2208,88,UnitedHealthcare,Medicare Advantage,43.12,49,,percent of total billed charges,,
"Oxalate, U (Mayo)OutsideLaboratory",,83945,CPT,Facility,Inpatient,,,90,88,74.8,25.2208,88,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Oxalate, U (Mayo)OutsideLaboratory",,83945,CPT,Facility,Outpatient,,,90,88,74.8,25.2208,88,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,42.24,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Oxalate, U (Mayo)OutsideLaboratory",,83945,CPT,Facility,Inpatient,,,90,88,74.8,25.2208,88,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Ph, Body Fluid (Mayo)OutsideLaboratory",,83986,CPT,Facility,Both,,,90,47,39.95,13.4702,47,Aetna,Commercial,43.24,92,,percent of total billed charges,,
"Ph, Body Fluid (Mayo)OutsideLaboratory",,83986,CPT,Facility,Outpatient,,,90,47,39.95,13.4702,47,Aetna,Medicare Advantage,23.03,49,,percent of total billed charges,,
"Ph, Body Fluid (Mayo)OutsideLaboratory",,83986,CPT,Facility,Inpatient,,,90,47,39.95,13.4702,47,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Ph, Body Fluid (Mayo)OutsideLaboratory",,83986,CPT,Facility,Both,,,90,47,39.95,13.4702,47,Aetna,PPO,43.71,93,,percent of total billed charges,,
"Ph, Body Fluid (Mayo)OutsideLaboratory",,83986,CPT,Facility,Both,,,90,47,39.95,13.4702,47,America's PPO,America's PPO,45.1341,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Ph, Body Fluid (Mayo)OutsideLaboratory",,83986,CPT,Facility,Both,,,90,47,39.95,13.4702,47,BlueCross BlueShield Minnesota, Federal Employee Program,46.248,98.4,,percent of total billed charges,,
"Ph, Body Fluid (Mayo)OutsideLaboratory",,83986,CPT,Facility,Both,,,90,47,39.95,13.4702,47,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,47,100,,percent of total billed charges,,
"Ph, Body Fluid (Mayo)OutsideLaboratory",,83986,CPT,Facility,Both,,,90,47,39.95,13.4702,47,BlueCross BlueShield Minnesota,High Value Network Plan,42.3,90,,percent of total billed charges,,
"Ph, Body Fluid (Mayo)OutsideLaboratory",,83986,CPT,Facility,Outpatient,,,90,47,39.95,13.4702,47,BlueCross BlueShield Minnesota,Medicare Advantage,23.03,49,,percent of total billed charges,,
"Ph, Body Fluid (Mayo)OutsideLaboratory",,83986,CPT,Facility,Inpatient,,,90,47,39.95,13.4702,47,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Ph, Body Fluid (Mayo)OutsideLaboratory",,83986,CPT,Facility,Both,,,90,47,39.95,13.4702,47,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,41.6279,88.57,,percent of total billed charges,,
"Ph, Body Fluid (Mayo)OutsideLaboratory",,83986,CPT,Facility,Both,,,90,47,39.95,13.4702,47,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,13.4702,28.66,,percent of total billed charges,,
"Ph, Body Fluid (Mayo)OutsideLaboratory",,83986,CPT,Facility,Outpatient,,,90,47,39.95,13.4702,47,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),23.03,49,,percent of total billed charges,,
"Ph, Body Fluid (Mayo)OutsideLaboratory",,83986,CPT,Facility,Inpatient,,,90,47,39.95,13.4702,47,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Ph, Body Fluid (Mayo)OutsideLaboratory",,83986,CPT,Facility,Both,,,90,47,39.95,13.4702,47,CorVel,Worker's Compensation,47,100,,percent of total billed charges,,
"Ph, Body Fluid (Mayo)OutsideLaboratory",,83986,CPT,Facility,Both,,,90,47,39.95,13.4702,47,First Health Group Corporation,First Health Network,45.59,97,,percent of total billed charges,,
"Ph, Body Fluid (Mayo)OutsideLaboratory",,83986,CPT,Facility,Both,,,90,47,39.95,13.4702,47,"Health Partners, Inc.",Commercial,44.462,94.6,,percent of total billed charges,,
"Ph, Body Fluid (Mayo)OutsideLaboratory",,83986,CPT,Facility,Outpatient,,,90,47,39.95,13.4702,47,"Health Partners, Inc.",Medicare Advantage,23.03,49,,percent of total billed charges,,
"Ph, Body Fluid (Mayo)OutsideLaboratory",,83986,CPT,Facility,Inpatient,,,90,47,39.95,13.4702,47,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Ph, Body Fluid (Mayo)OutsideLaboratory",,83986,CPT,Facility,Both,,,90,47,39.95,13.4702,47,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),28.2,60,,percent of total billed charges,,
"Ph, Body Fluid (Mayo)OutsideLaboratory",,83986,CPT,Facility,Both,,,90,47,39.95,13.4702,47,"Health Partners, Inc.",State of Minnesota Advantage Program,38.305,81.5,,percent of total billed charges,,
"Ph, Body Fluid (Mayo)OutsideLaboratory",,83986,CPT,Facility,Both,,,90,47,39.95,13.4702,47,"Health Partners, Inc.",State Public Programs,23.5,50,,percent of total billed charges,,
"Ph, Body Fluid (Mayo)OutsideLaboratory",,83986,CPT,Facility,Both,,,90,47,39.95,13.4702,47,Humana Insurance Company,Commercial PPO,44.65,95,,percent of total billed charges,,
"Ph, Body Fluid (Mayo)OutsideLaboratory",,83986,CPT,Facility,Outpatient,,,90,47,39.95,13.4702,47,Humana Insurance Company,Medicare PPO,23.03,49,,percent of total billed charges,,
"Ph, Body Fluid (Mayo)OutsideLaboratory",,83986,CPT,Facility,Inpatient,,,90,47,39.95,13.4702,47,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Ph, Body Fluid (Mayo)OutsideLaboratory",,83986,CPT,Facility,Both,,,90,47,39.95,13.4702,47,Medica,Individual & Family,46.577,99.1,,percent of total billed charges,,
"Ph, Body Fluid (Mayo)OutsideLaboratory",,83986,CPT,Facility,Outpatient,,,90,47,39.95,13.4702,47,Medica,Medica Advantage Solution,23.406,49.8,,percent of total billed charges,,
"Ph, Body Fluid (Mayo)OutsideLaboratory",,83986,CPT,Facility,Inpatient,,,90,47,39.95,13.4702,47,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Ph, Body Fluid (Mayo)OutsideLaboratory",,83986,CPT,Facility,Outpatient,,,90,47,39.95,13.4702,47,Medica,Medical Assistance,20.962,44.6,,percent of total billed charges,,
"Ph, Body Fluid (Mayo)OutsideLaboratory",,83986,CPT,Facility,Inpatient,,,90,47,39.95,13.4702,47,Medica,Medical Assistance,,,,,Included in per diem rate,
"Ph, Body Fluid (Mayo)OutsideLaboratory",,83986,CPT,Facility,Outpatient,,,90,47,39.95,13.4702,47,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,23.406,49.8,,percent of total billed charges,,
"Ph, Body Fluid (Mayo)OutsideLaboratory",,83986,CPT,Facility,Inpatient,,,90,47,39.95,13.4702,47,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Ph, Body Fluid (Mayo)OutsideLaboratory",,83986,CPT,Facility,Both,,,90,47,39.95,13.4702,47,"Multiplan, Inc.","Multiplan, Inc.",44.18,94,,percent of total billed charges,,
"Ph, Body Fluid (Mayo)OutsideLaboratory",,83986,CPT,Facility,Outpatient,,,90,47,39.95,13.4702,47,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,40.608,86.4,,percent of total billed charges,,
"Ph, Body Fluid (Mayo)OutsideLaboratory",,83986,CPT,Facility,Inpatient,,,90,47,39.95,13.4702,47,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Ph, Body Fluid (Mayo)OutsideLaboratory",,83986,CPT,Facility,Both,,,90,47,39.95,13.4702,47,"Preferred One Administrative Services, INC.",PPO,46.342,98.6,,percent of total billed charges,,
"Ph, Body Fluid (Mayo)OutsideLaboratory",,83986,CPT,Facility,Outpatient,,,90,47,39.95,13.4702,47,PrimeWest Health,Minnesota Senior Health Options (MSHO),24.1815,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Ph, Body Fluid (Mayo)OutsideLaboratory",,83986,CPT,Facility,Inpatient,,,90,47,39.95,13.4702,47,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Ph, Body Fluid (Mayo)OutsideLaboratory",,83986,CPT,Facility,Outpatient,,,90,47,39.95,13.4702,47,PrimeWest Health,MinnesotaCare,24.1392,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Ph, Body Fluid (Mayo)OutsideLaboratory",,83986,CPT,Facility,Inpatient,,,90,47,39.95,13.4702,47,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Ph, Body Fluid (Mayo)OutsideLaboratory",,83986,CPT,Facility,Both,,,90,47,39.95,13.4702,47,Sanford Health Plan,Sanford Health Plan,43.24,92,,percent of total billed charges,,
"Ph, Body Fluid (Mayo)OutsideLaboratory",,83986,CPT,Facility,Outpatient,,,90,47,39.95,13.4702,47,"UCare Health, Inc.",Individual & Family Plan,26.4845,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Ph, Body Fluid (Mayo)OutsideLaboratory",,83986,CPT,Facility,Inpatient,,,90,47,39.95,13.4702,47,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Ph, Body Fluid (Mayo)OutsideLaboratory",,83986,CPT,Facility,Outpatient,,,90,47,39.95,13.4702,47,"UCare Health, Inc.",Medical Assistance,23.7209,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Ph, Body Fluid (Mayo)OutsideLaboratory",,83986,CPT,Facility,Inpatient,,,90,47,39.95,13.4702,47,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Ph, Body Fluid (Mayo)OutsideLaboratory",,83986,CPT,Facility,Outpatient,,,90,47,39.95,13.4702,47,"UCare Health, Inc.",Medicare Advantage,23.7209,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Ph, Body Fluid (Mayo)OutsideLaboratory",,83986,CPT,Facility,Inpatient,,,90,47,39.95,13.4702,47,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Ph, Body Fluid (Mayo)OutsideLaboratory",,83986,CPT,Facility,Outpatient,,,90,47,39.95,13.4702,47,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),23.7209,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Ph, Body Fluid (Mayo)OutsideLaboratory",,83986,CPT,Facility,Inpatient,,,90,47,39.95,13.4702,47,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Ph, Body Fluid (Mayo)OutsideLaboratory",,83986,CPT,Facility,Both,,,90,47,39.95,13.4702,47,UnitedHealthcare,Individual & Family,44.18,94,,percent of total billed charges,,
"Ph, Body Fluid (Mayo)OutsideLaboratory",,83986,CPT,Facility,Outpatient,,,90,47,39.95,13.4702,47,UnitedHealthcare,Medicare Advantage,23.03,49,,percent of total billed charges,,
"Ph, Body Fluid (Mayo)OutsideLaboratory",,83986,CPT,Facility,Inpatient,,,90,47,39.95,13.4702,47,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Ph, Body Fluid (Mayo)OutsideLaboratory",,83986,CPT,Facility,Outpatient,,,90,47,39.95,13.4702,47,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,22.56,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Ph, Body Fluid (Mayo)OutsideLaboratory",,83986,CPT,Facility,Inpatient,,,90,47,39.95,13.4702,47,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Ph, Body Fluid, 24 Hr Supersaturation (Mayo)OutsideLaboratory",,83986,CPT,Facility,Both,,,90,47,39.95,13.4702,47,Aetna,Commercial,43.24,92,,percent of total billed charges,,
"Ph, Body Fluid, 24 Hr Supersaturation (Mayo)OutsideLaboratory",,83986,CPT,Facility,Outpatient,,,90,47,39.95,13.4702,47,Aetna,Medicare Advantage,23.03,49,,percent of total billed charges,,
"Ph, Body Fluid, 24 Hr Supersaturation (Mayo)OutsideLaboratory",,83986,CPT,Facility,Inpatient,,,90,47,39.95,13.4702,47,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Ph, Body Fluid, 24 Hr Supersaturation (Mayo)OutsideLaboratory",,83986,CPT,Facility,Both,,,90,47,39.95,13.4702,47,Aetna,PPO,43.71,93,,percent of total billed charges,,
"Ph, Body Fluid, 24 Hr Supersaturation (Mayo)OutsideLaboratory",,83986,CPT,Facility,Both,,,90,47,39.95,13.4702,47,America's PPO,America's PPO,45.1341,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Ph, Body Fluid, 24 Hr Supersaturation (Mayo)OutsideLaboratory",,83986,CPT,Facility,Both,,,90,47,39.95,13.4702,47,BlueCross BlueShield Minnesota, Federal Employee Program,46.248,98.4,,percent of total billed charges,,
"Ph, Body Fluid, 24 Hr Supersaturation (Mayo)OutsideLaboratory",,83986,CPT,Facility,Both,,,90,47,39.95,13.4702,47,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,47,100,,percent of total billed charges,,
"Ph, Body Fluid, 24 Hr Supersaturation (Mayo)OutsideLaboratory",,83986,CPT,Facility,Both,,,90,47,39.95,13.4702,47,BlueCross BlueShield Minnesota,High Value Network Plan,42.3,90,,percent of total billed charges,,
"Ph, Body Fluid, 24 Hr Supersaturation (Mayo)OutsideLaboratory",,83986,CPT,Facility,Outpatient,,,90,47,39.95,13.4702,47,BlueCross BlueShield Minnesota,Medicare Advantage,23.03,49,,percent of total billed charges,,
"Ph, Body Fluid, 24 Hr Supersaturation (Mayo)OutsideLaboratory",,83986,CPT,Facility,Inpatient,,,90,47,39.95,13.4702,47,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Ph, Body Fluid, 24 Hr Supersaturation (Mayo)OutsideLaboratory",,83986,CPT,Facility,Both,,,90,47,39.95,13.4702,47,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,41.6279,88.57,,percent of total billed charges,,
"Ph, Body Fluid, 24 Hr Supersaturation (Mayo)OutsideLaboratory",,83986,CPT,Facility,Both,,,90,47,39.95,13.4702,47,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,13.4702,28.66,,percent of total billed charges,,
"Ph, Body Fluid, 24 Hr Supersaturation (Mayo)OutsideLaboratory",,83986,CPT,Facility,Outpatient,,,90,47,39.95,13.4702,47,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),23.03,49,,percent of total billed charges,,
"Ph, Body Fluid, 24 Hr Supersaturation (Mayo)OutsideLaboratory",,83986,CPT,Facility,Inpatient,,,90,47,39.95,13.4702,47,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Ph, Body Fluid, 24 Hr Supersaturation (Mayo)OutsideLaboratory",,83986,CPT,Facility,Both,,,90,47,39.95,13.4702,47,CorVel,Worker's Compensation,47,100,,percent of total billed charges,,
"Ph, Body Fluid, 24 Hr Supersaturation (Mayo)OutsideLaboratory",,83986,CPT,Facility,Both,,,90,47,39.95,13.4702,47,First Health Group Corporation,First Health Network,45.59,97,,percent of total billed charges,,
"Ph, Body Fluid, 24 Hr Supersaturation (Mayo)OutsideLaboratory",,83986,CPT,Facility,Both,,,90,47,39.95,13.4702,47,"Health Partners, Inc.",Commercial,44.462,94.6,,percent of total billed charges,,
"Ph, Body Fluid, 24 Hr Supersaturation (Mayo)OutsideLaboratory",,83986,CPT,Facility,Outpatient,,,90,47,39.95,13.4702,47,"Health Partners, Inc.",Medicare Advantage,23.03,49,,percent of total billed charges,,
"Ph, Body Fluid, 24 Hr Supersaturation (Mayo)OutsideLaboratory",,83986,CPT,Facility,Inpatient,,,90,47,39.95,13.4702,47,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Ph, Body Fluid, 24 Hr Supersaturation (Mayo)OutsideLaboratory",,83986,CPT,Facility,Both,,,90,47,39.95,13.4702,47,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),28.2,60,,percent of total billed charges,,
"Ph, Body Fluid, 24 Hr Supersaturation (Mayo)OutsideLaboratory",,83986,CPT,Facility,Both,,,90,47,39.95,13.4702,47,"Health Partners, Inc.",State of Minnesota Advantage Program,38.305,81.5,,percent of total billed charges,,
"Ph, Body Fluid, 24 Hr Supersaturation (Mayo)OutsideLaboratory",,83986,CPT,Facility,Both,,,90,47,39.95,13.4702,47,"Health Partners, Inc.",State Public Programs,23.5,50,,percent of total billed charges,,
"Ph, Body Fluid, 24 Hr Supersaturation (Mayo)OutsideLaboratory",,83986,CPT,Facility,Both,,,90,47,39.95,13.4702,47,Humana Insurance Company,Commercial PPO,44.65,95,,percent of total billed charges,,
"Ph, Body Fluid, 24 Hr Supersaturation (Mayo)OutsideLaboratory",,83986,CPT,Facility,Outpatient,,,90,47,39.95,13.4702,47,Humana Insurance Company,Medicare PPO,23.03,49,,percent of total billed charges,,
"Ph, Body Fluid, 24 Hr Supersaturation (Mayo)OutsideLaboratory",,83986,CPT,Facility,Inpatient,,,90,47,39.95,13.4702,47,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Ph, Body Fluid, 24 Hr Supersaturation (Mayo)OutsideLaboratory",,83986,CPT,Facility,Both,,,90,47,39.95,13.4702,47,Medica,Individual & Family,46.577,99.1,,percent of total billed charges,,
"Ph, Body Fluid, 24 Hr Supersaturation (Mayo)OutsideLaboratory",,83986,CPT,Facility,Outpatient,,,90,47,39.95,13.4702,47,Medica,Medica Advantage Solution,23.406,49.8,,percent of total billed charges,,
"Ph, Body Fluid, 24 Hr Supersaturation (Mayo)OutsideLaboratory",,83986,CPT,Facility,Inpatient,,,90,47,39.95,13.4702,47,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Ph, Body Fluid, 24 Hr Supersaturation (Mayo)OutsideLaboratory",,83986,CPT,Facility,Outpatient,,,90,47,39.95,13.4702,47,Medica,Medical Assistance,20.962,44.6,,percent of total billed charges,,
"Ph, Body Fluid, 24 Hr Supersaturation (Mayo)OutsideLaboratory",,83986,CPT,Facility,Inpatient,,,90,47,39.95,13.4702,47,Medica,Medical Assistance,,,,,Included in per diem rate,
"Ph, Body Fluid, 24 Hr Supersaturation (Mayo)OutsideLaboratory",,83986,CPT,Facility,Outpatient,,,90,47,39.95,13.4702,47,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,23.406,49.8,,percent of total billed charges,,
"Ph, Body Fluid, 24 Hr Supersaturation (Mayo)OutsideLaboratory",,83986,CPT,Facility,Inpatient,,,90,47,39.95,13.4702,47,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Ph, Body Fluid, 24 Hr Supersaturation (Mayo)OutsideLaboratory",,83986,CPT,Facility,Both,,,90,47,39.95,13.4702,47,"Multiplan, Inc.","Multiplan, Inc.",44.18,94,,percent of total billed charges,,
"Ph, Body Fluid, 24 Hr Supersaturation (Mayo)OutsideLaboratory",,83986,CPT,Facility,Outpatient,,,90,47,39.95,13.4702,47,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,40.608,86.4,,percent of total billed charges,,
"Ph, Body Fluid, 24 Hr Supersaturation (Mayo)OutsideLaboratory",,83986,CPT,Facility,Inpatient,,,90,47,39.95,13.4702,47,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Ph, Body Fluid, 24 Hr Supersaturation (Mayo)OutsideLaboratory",,83986,CPT,Facility,Both,,,90,47,39.95,13.4702,47,"Preferred One Administrative Services, INC.",PPO,46.342,98.6,,percent of total billed charges,,
"Ph, Body Fluid, 24 Hr Supersaturation (Mayo)OutsideLaboratory",,83986,CPT,Facility,Outpatient,,,90,47,39.95,13.4702,47,PrimeWest Health,Minnesota Senior Health Options (MSHO),24.1815,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Ph, Body Fluid, 24 Hr Supersaturation (Mayo)OutsideLaboratory",,83986,CPT,Facility,Inpatient,,,90,47,39.95,13.4702,47,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Ph, Body Fluid, 24 Hr Supersaturation (Mayo)OutsideLaboratory",,83986,CPT,Facility,Outpatient,,,90,47,39.95,13.4702,47,PrimeWest Health,MinnesotaCare,24.1392,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Ph, Body Fluid, 24 Hr Supersaturation (Mayo)OutsideLaboratory",,83986,CPT,Facility,Inpatient,,,90,47,39.95,13.4702,47,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Ph, Body Fluid, 24 Hr Supersaturation (Mayo)OutsideLaboratory",,83986,CPT,Facility,Both,,,90,47,39.95,13.4702,47,Sanford Health Plan,Sanford Health Plan,43.24,92,,percent of total billed charges,,
"Ph, Body Fluid, 24 Hr Supersaturation (Mayo)OutsideLaboratory",,83986,CPT,Facility,Outpatient,,,90,47,39.95,13.4702,47,"UCare Health, Inc.",Individual & Family Plan,26.4845,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Ph, Body Fluid, 24 Hr Supersaturation (Mayo)OutsideLaboratory",,83986,CPT,Facility,Inpatient,,,90,47,39.95,13.4702,47,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Ph, Body Fluid, 24 Hr Supersaturation (Mayo)OutsideLaboratory",,83986,CPT,Facility,Outpatient,,,90,47,39.95,13.4702,47,"UCare Health, Inc.",Medical Assistance,23.7209,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Ph, Body Fluid, 24 Hr Supersaturation (Mayo)OutsideLaboratory",,83986,CPT,Facility,Inpatient,,,90,47,39.95,13.4702,47,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Ph, Body Fluid, 24 Hr Supersaturation (Mayo)OutsideLaboratory",,83986,CPT,Facility,Outpatient,,,90,47,39.95,13.4702,47,"UCare Health, Inc.",Medicare Advantage,23.7209,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Ph, Body Fluid, 24 Hr Supersaturation (Mayo)OutsideLaboratory",,83986,CPT,Facility,Inpatient,,,90,47,39.95,13.4702,47,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Ph, Body Fluid, 24 Hr Supersaturation (Mayo)OutsideLaboratory",,83986,CPT,Facility,Outpatient,,,90,47,39.95,13.4702,47,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),23.7209,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Ph, Body Fluid, 24 Hr Supersaturation (Mayo)OutsideLaboratory",,83986,CPT,Facility,Inpatient,,,90,47,39.95,13.4702,47,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Ph, Body Fluid, 24 Hr Supersaturation (Mayo)OutsideLaboratory",,83986,CPT,Facility,Both,,,90,47,39.95,13.4702,47,UnitedHealthcare,Individual & Family,44.18,94,,percent of total billed charges,,
"Ph, Body Fluid, 24 Hr Supersaturation (Mayo)OutsideLaboratory",,83986,CPT,Facility,Outpatient,,,90,47,39.95,13.4702,47,UnitedHealthcare,Medicare Advantage,23.03,49,,percent of total billed charges,,
"Ph, Body Fluid, 24 Hr Supersaturation (Mayo)OutsideLaboratory",,83986,CPT,Facility,Inpatient,,,90,47,39.95,13.4702,47,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Ph, Body Fluid, 24 Hr Supersaturation (Mayo)OutsideLaboratory",,83986,CPT,Facility,Outpatient,,,90,47,39.95,13.4702,47,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,22.56,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Ph, Body Fluid, 24 Hr Supersaturation (Mayo)OutsideLaboratory",,83986,CPT,Facility,Inpatient,,,90,47,39.95,13.4702,47,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Calprotectin, F (Mayo)OutsideLaboratory",,83993,CPT,Facility,Both,,,90,349,296.65,100.0234,349,Aetna,Commercial,321.08,92,,percent of total billed charges,,
"Calprotectin, F (Mayo)OutsideLaboratory",,83993,CPT,Facility,Outpatient,,,90,349,296.65,100.0234,349,Aetna,Medicare Advantage,171.01,49,,percent of total billed charges,,
"Calprotectin, F (Mayo)OutsideLaboratory",,83993,CPT,Facility,Inpatient,,,90,349,296.65,100.0234,349,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Calprotectin, F (Mayo)OutsideLaboratory",,83993,CPT,Facility,Both,,,90,349,296.65,100.0234,349,Aetna,PPO,324.57,93,,percent of total billed charges,,
"Calprotectin, F (Mayo)OutsideLaboratory",,83993,CPT,Facility,Both,,,90,349,296.65,100.0234,349,America's PPO,America's PPO,335.1447,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Calprotectin, F (Mayo)OutsideLaboratory",,83993,CPT,Facility,Both,,,90,349,296.65,100.0234,349,BlueCross BlueShield Minnesota, Federal Employee Program,343.416,98.4,,percent of total billed charges,,
"Calprotectin, F (Mayo)OutsideLaboratory",,83993,CPT,Facility,Both,,,90,349,296.65,100.0234,349,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,349,100,,percent of total billed charges,,
"Calprotectin, F (Mayo)OutsideLaboratory",,83993,CPT,Facility,Both,,,90,349,296.65,100.0234,349,BlueCross BlueShield Minnesota,High Value Network Plan,314.1,90,,percent of total billed charges,,
"Calprotectin, F (Mayo)OutsideLaboratory",,83993,CPT,Facility,Outpatient,,,90,349,296.65,100.0234,349,BlueCross BlueShield Minnesota,Medicare Advantage,171.01,49,,percent of total billed charges,,
"Calprotectin, F (Mayo)OutsideLaboratory",,83993,CPT,Facility,Inpatient,,,90,349,296.65,100.0234,349,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Calprotectin, F (Mayo)OutsideLaboratory",,83993,CPT,Facility,Both,,,90,349,296.65,100.0234,349,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,309.1093,88.57,,percent of total billed charges,,
"Calprotectin, F (Mayo)OutsideLaboratory",,83993,CPT,Facility,Both,,,90,349,296.65,100.0234,349,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,100.0234,28.66,,percent of total billed charges,,
"Calprotectin, F (Mayo)OutsideLaboratory",,83993,CPT,Facility,Outpatient,,,90,349,296.65,100.0234,349,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),171.01,49,,percent of total billed charges,,
"Calprotectin, F (Mayo)OutsideLaboratory",,83993,CPT,Facility,Inpatient,,,90,349,296.65,100.0234,349,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Calprotectin, F (Mayo)OutsideLaboratory",,83993,CPT,Facility,Both,,,90,349,296.65,100.0234,349,CorVel,Worker's Compensation,349,100,,percent of total billed charges,,
"Calprotectin, F (Mayo)OutsideLaboratory",,83993,CPT,Facility,Both,,,90,349,296.65,100.0234,349,First Health Group Corporation,First Health Network,338.53,97,,percent of total billed charges,,
"Calprotectin, F (Mayo)OutsideLaboratory",,83993,CPT,Facility,Both,,,90,349,296.65,100.0234,349,"Health Partners, Inc.",Commercial,330.154,94.6,,percent of total billed charges,,
"Calprotectin, F (Mayo)OutsideLaboratory",,83993,CPT,Facility,Outpatient,,,90,349,296.65,100.0234,349,"Health Partners, Inc.",Medicare Advantage,171.01,49,,percent of total billed charges,,
"Calprotectin, F (Mayo)OutsideLaboratory",,83993,CPT,Facility,Inpatient,,,90,349,296.65,100.0234,349,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Calprotectin, F (Mayo)OutsideLaboratory",,83993,CPT,Facility,Both,,,90,349,296.65,100.0234,349,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),209.4,60,,percent of total billed charges,,
"Calprotectin, F (Mayo)OutsideLaboratory",,83993,CPT,Facility,Both,,,90,349,296.65,100.0234,349,"Health Partners, Inc.",State of Minnesota Advantage Program,284.435,81.5,,percent of total billed charges,,
"Calprotectin, F (Mayo)OutsideLaboratory",,83993,CPT,Facility,Both,,,90,349,296.65,100.0234,349,"Health Partners, Inc.",State Public Programs,174.5,50,,percent of total billed charges,,
"Calprotectin, F (Mayo)OutsideLaboratory",,83993,CPT,Facility,Both,,,90,349,296.65,100.0234,349,Humana Insurance Company,Commercial PPO,331.55,95,,percent of total billed charges,,
"Calprotectin, F (Mayo)OutsideLaboratory",,83993,CPT,Facility,Outpatient,,,90,349,296.65,100.0234,349,Humana Insurance Company,Medicare PPO,171.01,49,,percent of total billed charges,,
"Calprotectin, F (Mayo)OutsideLaboratory",,83993,CPT,Facility,Inpatient,,,90,349,296.65,100.0234,349,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Calprotectin, F (Mayo)OutsideLaboratory",,83993,CPT,Facility,Both,,,90,349,296.65,100.0234,349,Medica,Individual & Family,345.859,99.1,,percent of total billed charges,,
"Calprotectin, F (Mayo)OutsideLaboratory",,83993,CPT,Facility,Outpatient,,,90,349,296.65,100.0234,349,Medica,Medica Advantage Solution,173.802,49.8,,percent of total billed charges,,
"Calprotectin, F (Mayo)OutsideLaboratory",,83993,CPT,Facility,Inpatient,,,90,349,296.65,100.0234,349,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Calprotectin, F (Mayo)OutsideLaboratory",,83993,CPT,Facility,Outpatient,,,90,349,296.65,100.0234,349,Medica,Medical Assistance,155.654,44.6,,percent of total billed charges,,
"Calprotectin, F (Mayo)OutsideLaboratory",,83993,CPT,Facility,Inpatient,,,90,349,296.65,100.0234,349,Medica,Medical Assistance,,,,,Included in per diem rate,
"Calprotectin, F (Mayo)OutsideLaboratory",,83993,CPT,Facility,Outpatient,,,90,349,296.65,100.0234,349,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,173.802,49.8,,percent of total billed charges,,
"Calprotectin, F (Mayo)OutsideLaboratory",,83993,CPT,Facility,Inpatient,,,90,349,296.65,100.0234,349,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Calprotectin, F (Mayo)OutsideLaboratory",,83993,CPT,Facility,Both,,,90,349,296.65,100.0234,349,"Multiplan, Inc.","Multiplan, Inc.",328.06,94,,percent of total billed charges,,
"Calprotectin, F (Mayo)OutsideLaboratory",,83993,CPT,Facility,Outpatient,,,90,349,296.65,100.0234,349,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,301.536,86.4,,percent of total billed charges,,
"Calprotectin, F (Mayo)OutsideLaboratory",,83993,CPT,Facility,Inpatient,,,90,349,296.65,100.0234,349,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Calprotectin, F (Mayo)OutsideLaboratory",,83993,CPT,Facility,Both,,,90,349,296.65,100.0234,349,"Preferred One Administrative Services, INC.",PPO,344.114,98.6,,percent of total billed charges,,
"Calprotectin, F (Mayo)OutsideLaboratory",,83993,CPT,Facility,Outpatient,,,90,349,296.65,100.0234,349,PrimeWest Health,Minnesota Senior Health Options (MSHO),179.5605,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Calprotectin, F (Mayo)OutsideLaboratory",,83993,CPT,Facility,Inpatient,,,90,349,296.65,100.0234,349,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Calprotectin, F (Mayo)OutsideLaboratory",,83993,CPT,Facility,Outpatient,,,90,349,296.65,100.0234,349,PrimeWest Health,MinnesotaCare,179.2464,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Calprotectin, F (Mayo)OutsideLaboratory",,83993,CPT,Facility,Inpatient,,,90,349,296.65,100.0234,349,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Calprotectin, F (Mayo)OutsideLaboratory",,83993,CPT,Facility,Both,,,90,349,296.65,100.0234,349,Sanford Health Plan,Sanford Health Plan,321.08,92,,percent of total billed charges,,
"Calprotectin, F (Mayo)OutsideLaboratory",,83993,CPT,Facility,Outpatient,,,90,349,296.65,100.0234,349,"UCare Health, Inc.",Individual & Family Plan,196.6615,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Calprotectin, F (Mayo)OutsideLaboratory",,83993,CPT,Facility,Inpatient,,,90,349,296.65,100.0234,349,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Calprotectin, F (Mayo)OutsideLaboratory",,83993,CPT,Facility,Outpatient,,,90,349,296.65,100.0234,349,"UCare Health, Inc.",Medical Assistance,176.1403,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Calprotectin, F (Mayo)OutsideLaboratory",,83993,CPT,Facility,Inpatient,,,90,349,296.65,100.0234,349,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Calprotectin, F (Mayo)OutsideLaboratory",,83993,CPT,Facility,Outpatient,,,90,349,296.65,100.0234,349,"UCare Health, Inc.",Medicare Advantage,176.1403,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Calprotectin, F (Mayo)OutsideLaboratory",,83993,CPT,Facility,Inpatient,,,90,349,296.65,100.0234,349,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Calprotectin, F (Mayo)OutsideLaboratory",,83993,CPT,Facility,Outpatient,,,90,349,296.65,100.0234,349,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),176.1403,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Calprotectin, F (Mayo)OutsideLaboratory",,83993,CPT,Facility,Inpatient,,,90,349,296.65,100.0234,349,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Calprotectin, F (Mayo)OutsideLaboratory",,83993,CPT,Facility,Both,,,90,349,296.65,100.0234,349,UnitedHealthcare,Individual & Family,328.06,94,,percent of total billed charges,,
"Calprotectin, F (Mayo)OutsideLaboratory",,83993,CPT,Facility,Outpatient,,,90,349,296.65,100.0234,349,UnitedHealthcare,Medicare Advantage,171.01,49,,percent of total billed charges,,
"Calprotectin, F (Mayo)OutsideLaboratory",,83993,CPT,Facility,Inpatient,,,90,349,296.65,100.0234,349,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Calprotectin, F (Mayo)OutsideLaboratory",,83993,CPT,Facility,Outpatient,,,90,349,296.65,100.0234,349,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,167.52,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Calprotectin, F (Mayo)OutsideLaboratory",,83993,CPT,Facility,Inpatient,,,90,349,296.65,100.0234,349,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Alkaline Phosphatase-Mml (Mayo)OutsideLaboratory,,84075,CPT,Facility,Both,,,90,108,91.8,30.9528,108,Aetna,Commercial,99.36,92,,percent of total billed charges,,
Alkaline Phosphatase-Mml (Mayo)OutsideLaboratory,,84075,CPT,Facility,Outpatient,,,90,108,91.8,30.9528,108,Aetna,Medicare Advantage,52.92,49,,percent of total billed charges,,
Alkaline Phosphatase-Mml (Mayo)OutsideLaboratory,,84075,CPT,Facility,Inpatient,,,90,108,91.8,30.9528,108,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Alkaline Phosphatase-Mml (Mayo)OutsideLaboratory,,84075,CPT,Facility,Both,,,90,108,91.8,30.9528,108,Aetna,PPO,100.44,93,,percent of total billed charges,,
Alkaline Phosphatase-Mml (Mayo)OutsideLaboratory,,84075,CPT,Facility,Both,,,90,108,91.8,30.9528,108,America's PPO,America's PPO,103.7124,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Alkaline Phosphatase-Mml (Mayo)OutsideLaboratory,,84075,CPT,Facility,Both,,,90,108,91.8,30.9528,108,BlueCross BlueShield Minnesota, Federal Employee Program,106.272,98.4,,percent of total billed charges,,
Alkaline Phosphatase-Mml (Mayo)OutsideLaboratory,,84075,CPT,Facility,Both,,,90,108,91.8,30.9528,108,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,108,100,,percent of total billed charges,,
Alkaline Phosphatase-Mml (Mayo)OutsideLaboratory,,84075,CPT,Facility,Both,,,90,108,91.8,30.9528,108,BlueCross BlueShield Minnesota,High Value Network Plan,97.2,90,,percent of total billed charges,,
Alkaline Phosphatase-Mml (Mayo)OutsideLaboratory,,84075,CPT,Facility,Outpatient,,,90,108,91.8,30.9528,108,BlueCross BlueShield Minnesota,Medicare Advantage,52.92,49,,percent of total billed charges,,
Alkaline Phosphatase-Mml (Mayo)OutsideLaboratory,,84075,CPT,Facility,Inpatient,,,90,108,91.8,30.9528,108,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Alkaline Phosphatase-Mml (Mayo)OutsideLaboratory,,84075,CPT,Facility,Both,,,90,108,91.8,30.9528,108,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,95.6556,88.57,,percent of total billed charges,,
Alkaline Phosphatase-Mml (Mayo)OutsideLaboratory,,84075,CPT,Facility,Both,,,90,108,91.8,30.9528,108,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,30.9528,28.66,,percent of total billed charges,,
Alkaline Phosphatase-Mml (Mayo)OutsideLaboratory,,84075,CPT,Facility,Outpatient,,,90,108,91.8,30.9528,108,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),52.92,49,,percent of total billed charges,,
Alkaline Phosphatase-Mml (Mayo)OutsideLaboratory,,84075,CPT,Facility,Inpatient,,,90,108,91.8,30.9528,108,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Alkaline Phosphatase-Mml (Mayo)OutsideLaboratory,,84075,CPT,Facility,Both,,,90,108,91.8,30.9528,108,CorVel,Worker's Compensation,108,100,,percent of total billed charges,,
Alkaline Phosphatase-Mml (Mayo)OutsideLaboratory,,84075,CPT,Facility,Both,,,90,108,91.8,30.9528,108,First Health Group Corporation,First Health Network,104.76,97,,percent of total billed charges,,
Alkaline Phosphatase-Mml (Mayo)OutsideLaboratory,,84075,CPT,Facility,Both,,,90,108,91.8,30.9528,108,"Health Partners, Inc.",Commercial,102.168,94.6,,percent of total billed charges,,
Alkaline Phosphatase-Mml (Mayo)OutsideLaboratory,,84075,CPT,Facility,Outpatient,,,90,108,91.8,30.9528,108,"Health Partners, Inc.",Medicare Advantage,52.92,49,,percent of total billed charges,,
Alkaline Phosphatase-Mml (Mayo)OutsideLaboratory,,84075,CPT,Facility,Inpatient,,,90,108,91.8,30.9528,108,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Alkaline Phosphatase-Mml (Mayo)OutsideLaboratory,,84075,CPT,Facility,Both,,,90,108,91.8,30.9528,108,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),64.8,60,,percent of total billed charges,,
Alkaline Phosphatase-Mml (Mayo)OutsideLaboratory,,84075,CPT,Facility,Both,,,90,108,91.8,30.9528,108,"Health Partners, Inc.",State of Minnesota Advantage Program,88.02,81.5,,percent of total billed charges,,
Alkaline Phosphatase-Mml (Mayo)OutsideLaboratory,,84075,CPT,Facility,Both,,,90,108,91.8,30.9528,108,"Health Partners, Inc.",State Public Programs,54,50,,percent of total billed charges,,
Alkaline Phosphatase-Mml (Mayo)OutsideLaboratory,,84075,CPT,Facility,Both,,,90,108,91.8,30.9528,108,Humana Insurance Company,Commercial PPO,102.6,95,,percent of total billed charges,,
Alkaline Phosphatase-Mml (Mayo)OutsideLaboratory,,84075,CPT,Facility,Outpatient,,,90,108,91.8,30.9528,108,Humana Insurance Company,Medicare PPO,52.92,49,,percent of total billed charges,,
Alkaline Phosphatase-Mml (Mayo)OutsideLaboratory,,84075,CPT,Facility,Inpatient,,,90,108,91.8,30.9528,108,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Alkaline Phosphatase-Mml (Mayo)OutsideLaboratory,,84075,CPT,Facility,Both,,,90,108,91.8,30.9528,108,Medica,Individual & Family,107.028,99.1,,percent of total billed charges,,
Alkaline Phosphatase-Mml (Mayo)OutsideLaboratory,,84075,CPT,Facility,Outpatient,,,90,108,91.8,30.9528,108,Medica,Medica Advantage Solution,53.784,49.8,,percent of total billed charges,,
Alkaline Phosphatase-Mml (Mayo)OutsideLaboratory,,84075,CPT,Facility,Inpatient,,,90,108,91.8,30.9528,108,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Alkaline Phosphatase-Mml (Mayo)OutsideLaboratory,,84075,CPT,Facility,Outpatient,,,90,108,91.8,30.9528,108,Medica,Medical Assistance,48.168,44.6,,percent of total billed charges,,
Alkaline Phosphatase-Mml (Mayo)OutsideLaboratory,,84075,CPT,Facility,Inpatient,,,90,108,91.8,30.9528,108,Medica,Medical Assistance,,,,,Included in per diem rate,
Alkaline Phosphatase-Mml (Mayo)OutsideLaboratory,,84075,CPT,Facility,Outpatient,,,90,108,91.8,30.9528,108,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,53.784,49.8,,percent of total billed charges,,
Alkaline Phosphatase-Mml (Mayo)OutsideLaboratory,,84075,CPT,Facility,Inpatient,,,90,108,91.8,30.9528,108,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Alkaline Phosphatase-Mml (Mayo)OutsideLaboratory,,84075,CPT,Facility,Both,,,90,108,91.8,30.9528,108,"Multiplan, Inc.","Multiplan, Inc.",101.52,94,,percent of total billed charges,,
Alkaline Phosphatase-Mml (Mayo)OutsideLaboratory,,84075,CPT,Facility,Outpatient,,,90,108,91.8,30.9528,108,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,93.312,86.4,,percent of total billed charges,,
Alkaline Phosphatase-Mml (Mayo)OutsideLaboratory,,84075,CPT,Facility,Inpatient,,,90,108,91.8,30.9528,108,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Alkaline Phosphatase-Mml (Mayo)OutsideLaboratory,,84075,CPT,Facility,Both,,,90,108,91.8,30.9528,108,"Preferred One Administrative Services, INC.",PPO,106.488,98.6,,percent of total billed charges,,
Alkaline Phosphatase-Mml (Mayo)OutsideLaboratory,,84075,CPT,Facility,Outpatient,,,90,108,91.8,30.9528,108,PrimeWest Health,Minnesota Senior Health Options (MSHO),55.566,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Alkaline Phosphatase-Mml (Mayo)OutsideLaboratory,,84075,CPT,Facility,Inpatient,,,90,108,91.8,30.9528,108,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Alkaline Phosphatase-Mml (Mayo)OutsideLaboratory,,84075,CPT,Facility,Outpatient,,,90,108,91.8,30.9528,108,PrimeWest Health,MinnesotaCare,55.4688,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Alkaline Phosphatase-Mml (Mayo)OutsideLaboratory,,84075,CPT,Facility,Inpatient,,,90,108,91.8,30.9528,108,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Alkaline Phosphatase-Mml (Mayo)OutsideLaboratory,,84075,CPT,Facility,Both,,,90,108,91.8,30.9528,108,Sanford Health Plan,Sanford Health Plan,99.36,92,,percent of total billed charges,,
Alkaline Phosphatase-Mml (Mayo)OutsideLaboratory,,84075,CPT,Facility,Outpatient,,,90,108,91.8,30.9528,108,"UCare Health, Inc.",Individual & Family Plan,60.858,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Alkaline Phosphatase-Mml (Mayo)OutsideLaboratory,,84075,CPT,Facility,Inpatient,,,90,108,91.8,30.9528,108,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Alkaline Phosphatase-Mml (Mayo)OutsideLaboratory,,84075,CPT,Facility,Outpatient,,,90,108,91.8,30.9528,108,"UCare Health, Inc.",Medical Assistance,54.5076,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Alkaline Phosphatase-Mml (Mayo)OutsideLaboratory,,84075,CPT,Facility,Inpatient,,,90,108,91.8,30.9528,108,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Alkaline Phosphatase-Mml (Mayo)OutsideLaboratory,,84075,CPT,Facility,Outpatient,,,90,108,91.8,30.9528,108,"UCare Health, Inc.",Medicare Advantage,54.5076,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Alkaline Phosphatase-Mml (Mayo)OutsideLaboratory,,84075,CPT,Facility,Inpatient,,,90,108,91.8,30.9528,108,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Alkaline Phosphatase-Mml (Mayo)OutsideLaboratory,,84075,CPT,Facility,Outpatient,,,90,108,91.8,30.9528,108,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),54.5076,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Alkaline Phosphatase-Mml (Mayo)OutsideLaboratory,,84075,CPT,Facility,Inpatient,,,90,108,91.8,30.9528,108,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Alkaline Phosphatase-Mml (Mayo)OutsideLaboratory,,84075,CPT,Facility,Both,,,90,108,91.8,30.9528,108,UnitedHealthcare,Individual & Family,101.52,94,,percent of total billed charges,,
Alkaline Phosphatase-Mml (Mayo)OutsideLaboratory,,84075,CPT,Facility,Outpatient,,,90,108,91.8,30.9528,108,UnitedHealthcare,Medicare Advantage,52.92,49,,percent of total billed charges,,
Alkaline Phosphatase-Mml (Mayo)OutsideLaboratory,,84075,CPT,Facility,Inpatient,,,90,108,91.8,30.9528,108,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Alkaline Phosphatase-Mml (Mayo)OutsideLaboratory,,84075,CPT,Facility,Outpatient,,,90,108,91.8,30.9528,108,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,51.84,48,,percent of total billed charges,,100% of DHS outpatient percentage
Alkaline Phosphatase-Mml (Mayo)OutsideLaboratory,,84075,CPT,Facility,Inpatient,,,90,108,91.8,30.9528,108,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Alkaline Phosphatase, Isoenzymes, S (Mayo)OutsideLaboratory",,84080,CPT,Facility,Both,,,90,204,173.4,58.4664,204,Aetna,Commercial,187.68,92,,percent of total billed charges,,
"Alkaline Phosphatase, Isoenzymes, S (Mayo)OutsideLaboratory",,84080,CPT,Facility,Outpatient,,,90,204,173.4,58.4664,204,Aetna,Medicare Advantage,99.96,49,,percent of total billed charges,,
"Alkaline Phosphatase, Isoenzymes, S (Mayo)OutsideLaboratory",,84080,CPT,Facility,Inpatient,,,90,204,173.4,58.4664,204,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Alkaline Phosphatase, Isoenzymes, S (Mayo)OutsideLaboratory",,84080,CPT,Facility,Both,,,90,204,173.4,58.4664,204,Aetna,PPO,189.72,93,,percent of total billed charges,,
"Alkaline Phosphatase, Isoenzymes, S (Mayo)OutsideLaboratory",,84080,CPT,Facility,Both,,,90,204,173.4,58.4664,204,America's PPO,America's PPO,195.9012,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Alkaline Phosphatase, Isoenzymes, S (Mayo)OutsideLaboratory",,84080,CPT,Facility,Both,,,90,204,173.4,58.4664,204,BlueCross BlueShield Minnesota, Federal Employee Program,200.736,98.4,,percent of total billed charges,,
"Alkaline Phosphatase, Isoenzymes, S (Mayo)OutsideLaboratory",,84080,CPT,Facility,Both,,,90,204,173.4,58.4664,204,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,204,100,,percent of total billed charges,,
"Alkaline Phosphatase, Isoenzymes, S (Mayo)OutsideLaboratory",,84080,CPT,Facility,Both,,,90,204,173.4,58.4664,204,BlueCross BlueShield Minnesota,High Value Network Plan,183.6,90,,percent of total billed charges,,
"Alkaline Phosphatase, Isoenzymes, S (Mayo)OutsideLaboratory",,84080,CPT,Facility,Outpatient,,,90,204,173.4,58.4664,204,BlueCross BlueShield Minnesota,Medicare Advantage,99.96,49,,percent of total billed charges,,
"Alkaline Phosphatase, Isoenzymes, S (Mayo)OutsideLaboratory",,84080,CPT,Facility,Inpatient,,,90,204,173.4,58.4664,204,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Alkaline Phosphatase, Isoenzymes, S (Mayo)OutsideLaboratory",,84080,CPT,Facility,Both,,,90,204,173.4,58.4664,204,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,180.6828,88.57,,percent of total billed charges,,
"Alkaline Phosphatase, Isoenzymes, S (Mayo)OutsideLaboratory",,84080,CPT,Facility,Both,,,90,204,173.4,58.4664,204,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,58.4664,28.66,,percent of total billed charges,,
"Alkaline Phosphatase, Isoenzymes, S (Mayo)OutsideLaboratory",,84080,CPT,Facility,Outpatient,,,90,204,173.4,58.4664,204,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),99.96,49,,percent of total billed charges,,
"Alkaline Phosphatase, Isoenzymes, S (Mayo)OutsideLaboratory",,84080,CPT,Facility,Inpatient,,,90,204,173.4,58.4664,204,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Alkaline Phosphatase, Isoenzymes, S (Mayo)OutsideLaboratory",,84080,CPT,Facility,Both,,,90,204,173.4,58.4664,204,CorVel,Worker's Compensation,204,100,,percent of total billed charges,,
"Alkaline Phosphatase, Isoenzymes, S (Mayo)OutsideLaboratory",,84080,CPT,Facility,Both,,,90,204,173.4,58.4664,204,First Health Group Corporation,First Health Network,197.88,97,,percent of total billed charges,,
"Alkaline Phosphatase, Isoenzymes, S (Mayo)OutsideLaboratory",,84080,CPT,Facility,Both,,,90,204,173.4,58.4664,204,"Health Partners, Inc.",Commercial,192.984,94.6,,percent of total billed charges,,
"Alkaline Phosphatase, Isoenzymes, S (Mayo)OutsideLaboratory",,84080,CPT,Facility,Outpatient,,,90,204,173.4,58.4664,204,"Health Partners, Inc.",Medicare Advantage,99.96,49,,percent of total billed charges,,
"Alkaline Phosphatase, Isoenzymes, S (Mayo)OutsideLaboratory",,84080,CPT,Facility,Inpatient,,,90,204,173.4,58.4664,204,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Alkaline Phosphatase, Isoenzymes, S (Mayo)OutsideLaboratory",,84080,CPT,Facility,Both,,,90,204,173.4,58.4664,204,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),122.4,60,,percent of total billed charges,,
"Alkaline Phosphatase, Isoenzymes, S (Mayo)OutsideLaboratory",,84080,CPT,Facility,Both,,,90,204,173.4,58.4664,204,"Health Partners, Inc.",State of Minnesota Advantage Program,166.26,81.5,,percent of total billed charges,,
"Alkaline Phosphatase, Isoenzymes, S (Mayo)OutsideLaboratory",,84080,CPT,Facility,Both,,,90,204,173.4,58.4664,204,"Health Partners, Inc.",State Public Programs,102,50,,percent of total billed charges,,
"Alkaline Phosphatase, Isoenzymes, S (Mayo)OutsideLaboratory",,84080,CPT,Facility,Both,,,90,204,173.4,58.4664,204,Humana Insurance Company,Commercial PPO,193.8,95,,percent of total billed charges,,
"Alkaline Phosphatase, Isoenzymes, S (Mayo)OutsideLaboratory",,84080,CPT,Facility,Outpatient,,,90,204,173.4,58.4664,204,Humana Insurance Company,Medicare PPO,99.96,49,,percent of total billed charges,,
"Alkaline Phosphatase, Isoenzymes, S (Mayo)OutsideLaboratory",,84080,CPT,Facility,Inpatient,,,90,204,173.4,58.4664,204,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Alkaline Phosphatase, Isoenzymes, S (Mayo)OutsideLaboratory",,84080,CPT,Facility,Both,,,90,204,173.4,58.4664,204,Medica,Individual & Family,202.164,99.1,,percent of total billed charges,,
"Alkaline Phosphatase, Isoenzymes, S (Mayo)OutsideLaboratory",,84080,CPT,Facility,Outpatient,,,90,204,173.4,58.4664,204,Medica,Medica Advantage Solution,101.592,49.8,,percent of total billed charges,,
"Alkaline Phosphatase, Isoenzymes, S (Mayo)OutsideLaboratory",,84080,CPT,Facility,Inpatient,,,90,204,173.4,58.4664,204,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Alkaline Phosphatase, Isoenzymes, S (Mayo)OutsideLaboratory",,84080,CPT,Facility,Outpatient,,,90,204,173.4,58.4664,204,Medica,Medical Assistance,90.984,44.6,,percent of total billed charges,,
"Alkaline Phosphatase, Isoenzymes, S (Mayo)OutsideLaboratory",,84080,CPT,Facility,Inpatient,,,90,204,173.4,58.4664,204,Medica,Medical Assistance,,,,,Included in per diem rate,
"Alkaline Phosphatase, Isoenzymes, S (Mayo)OutsideLaboratory",,84080,CPT,Facility,Outpatient,,,90,204,173.4,58.4664,204,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,101.592,49.8,,percent of total billed charges,,
"Alkaline Phosphatase, Isoenzymes, S (Mayo)OutsideLaboratory",,84080,CPT,Facility,Inpatient,,,90,204,173.4,58.4664,204,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Alkaline Phosphatase, Isoenzymes, S (Mayo)OutsideLaboratory",,84080,CPT,Facility,Both,,,90,204,173.4,58.4664,204,"Multiplan, Inc.","Multiplan, Inc.",191.76,94,,percent of total billed charges,,
"Alkaline Phosphatase, Isoenzymes, S (Mayo)OutsideLaboratory",,84080,CPT,Facility,Outpatient,,,90,204,173.4,58.4664,204,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,176.256,86.4,,percent of total billed charges,,
"Alkaline Phosphatase, Isoenzymes, S (Mayo)OutsideLaboratory",,84080,CPT,Facility,Inpatient,,,90,204,173.4,58.4664,204,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Alkaline Phosphatase, Isoenzymes, S (Mayo)OutsideLaboratory",,84080,CPT,Facility,Both,,,90,204,173.4,58.4664,204,"Preferred One Administrative Services, INC.",PPO,201.144,98.6,,percent of total billed charges,,
"Alkaline Phosphatase, Isoenzymes, S (Mayo)OutsideLaboratory",,84080,CPT,Facility,Outpatient,,,90,204,173.4,58.4664,204,PrimeWest Health,Minnesota Senior Health Options (MSHO),104.958,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Alkaline Phosphatase, Isoenzymes, S (Mayo)OutsideLaboratory",,84080,CPT,Facility,Inpatient,,,90,204,173.4,58.4664,204,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Alkaline Phosphatase, Isoenzymes, S (Mayo)OutsideLaboratory",,84080,CPT,Facility,Outpatient,,,90,204,173.4,58.4664,204,PrimeWest Health,MinnesotaCare,104.7744,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Alkaline Phosphatase, Isoenzymes, S (Mayo)OutsideLaboratory",,84080,CPT,Facility,Inpatient,,,90,204,173.4,58.4664,204,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Alkaline Phosphatase, Isoenzymes, S (Mayo)OutsideLaboratory",,84080,CPT,Facility,Both,,,90,204,173.4,58.4664,204,Sanford Health Plan,Sanford Health Plan,187.68,92,,percent of total billed charges,,
"Alkaline Phosphatase, Isoenzymes, S (Mayo)OutsideLaboratory",,84080,CPT,Facility,Outpatient,,,90,204,173.4,58.4664,204,"UCare Health, Inc.",Individual & Family Plan,114.954,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Alkaline Phosphatase, Isoenzymes, S (Mayo)OutsideLaboratory",,84080,CPT,Facility,Inpatient,,,90,204,173.4,58.4664,204,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Alkaline Phosphatase, Isoenzymes, S (Mayo)OutsideLaboratory",,84080,CPT,Facility,Outpatient,,,90,204,173.4,58.4664,204,"UCare Health, Inc.",Medical Assistance,102.9588,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Alkaline Phosphatase, Isoenzymes, S (Mayo)OutsideLaboratory",,84080,CPT,Facility,Inpatient,,,90,204,173.4,58.4664,204,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Alkaline Phosphatase, Isoenzymes, S (Mayo)OutsideLaboratory",,84080,CPT,Facility,Outpatient,,,90,204,173.4,58.4664,204,"UCare Health, Inc.",Medicare Advantage,102.9588,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Alkaline Phosphatase, Isoenzymes, S (Mayo)OutsideLaboratory",,84080,CPT,Facility,Inpatient,,,90,204,173.4,58.4664,204,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Alkaline Phosphatase, Isoenzymes, S (Mayo)OutsideLaboratory",,84080,CPT,Facility,Outpatient,,,90,204,173.4,58.4664,204,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),102.9588,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Alkaline Phosphatase, Isoenzymes, S (Mayo)OutsideLaboratory",,84080,CPT,Facility,Inpatient,,,90,204,173.4,58.4664,204,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Alkaline Phosphatase, Isoenzymes, S (Mayo)OutsideLaboratory",,84080,CPT,Facility,Both,,,90,204,173.4,58.4664,204,UnitedHealthcare,Individual & Family,191.76,94,,percent of total billed charges,,
"Alkaline Phosphatase, Isoenzymes, S (Mayo)OutsideLaboratory",,84080,CPT,Facility,Outpatient,,,90,204,173.4,58.4664,204,UnitedHealthcare,Medicare Advantage,99.96,49,,percent of total billed charges,,
"Alkaline Phosphatase, Isoenzymes, S (Mayo)OutsideLaboratory",,84080,CPT,Facility,Inpatient,,,90,204,173.4,58.4664,204,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Alkaline Phosphatase, Isoenzymes, S (Mayo)OutsideLaboratory",,84080,CPT,Facility,Outpatient,,,90,204,173.4,58.4664,204,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,97.92,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Alkaline Phosphatase, Isoenzymes, S (Mayo)OutsideLaboratory",,84080,CPT,Facility,Inpatient,,,90,204,173.4,58.4664,204,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Phosphorus Inorganic; Urine (Mayo)OutsideLaboratory,,84105,CPT,Facility,Both,,,90,35,29.75,10.031,35,Aetna,Commercial,32.2,92,,percent of total billed charges,,
Phosphorus Inorganic; Urine (Mayo)OutsideLaboratory,,84105,CPT,Facility,Outpatient,,,90,35,29.75,10.031,35,Aetna,Medicare Advantage,17.15,49,,percent of total billed charges,,
Phosphorus Inorganic; Urine (Mayo)OutsideLaboratory,,84105,CPT,Facility,Inpatient,,,90,35,29.75,10.031,35,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Phosphorus Inorganic; Urine (Mayo)OutsideLaboratory,,84105,CPT,Facility,Both,,,90,35,29.75,10.031,35,Aetna,PPO,32.55,93,,percent of total billed charges,,
Phosphorus Inorganic; Urine (Mayo)OutsideLaboratory,,84105,CPT,Facility,Both,,,90,35,29.75,10.031,35,America's PPO,America's PPO,33.6105,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Phosphorus Inorganic; Urine (Mayo)OutsideLaboratory,,84105,CPT,Facility,Both,,,90,35,29.75,10.031,35,BlueCross BlueShield Minnesota, Federal Employee Program,34.44,98.4,,percent of total billed charges,,
Phosphorus Inorganic; Urine (Mayo)OutsideLaboratory,,84105,CPT,Facility,Both,,,90,35,29.75,10.031,35,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,35,100,,percent of total billed charges,,
Phosphorus Inorganic; Urine (Mayo)OutsideLaboratory,,84105,CPT,Facility,Both,,,90,35,29.75,10.031,35,BlueCross BlueShield Minnesota,High Value Network Plan,31.5,90,,percent of total billed charges,,
Phosphorus Inorganic; Urine (Mayo)OutsideLaboratory,,84105,CPT,Facility,Outpatient,,,90,35,29.75,10.031,35,BlueCross BlueShield Minnesota,Medicare Advantage,17.15,49,,percent of total billed charges,,
Phosphorus Inorganic; Urine (Mayo)OutsideLaboratory,,84105,CPT,Facility,Inpatient,,,90,35,29.75,10.031,35,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Phosphorus Inorganic; Urine (Mayo)OutsideLaboratory,,84105,CPT,Facility,Both,,,90,35,29.75,10.031,35,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,30.9995,88.57,,percent of total billed charges,,
Phosphorus Inorganic; Urine (Mayo)OutsideLaboratory,,84105,CPT,Facility,Both,,,90,35,29.75,10.031,35,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,10.031,28.66,,percent of total billed charges,,
Phosphorus Inorganic; Urine (Mayo)OutsideLaboratory,,84105,CPT,Facility,Outpatient,,,90,35,29.75,10.031,35,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),17.15,49,,percent of total billed charges,,
Phosphorus Inorganic; Urine (Mayo)OutsideLaboratory,,84105,CPT,Facility,Inpatient,,,90,35,29.75,10.031,35,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Phosphorus Inorganic; Urine (Mayo)OutsideLaboratory,,84105,CPT,Facility,Both,,,90,35,29.75,10.031,35,CorVel,Worker's Compensation,35,100,,percent of total billed charges,,
Phosphorus Inorganic; Urine (Mayo)OutsideLaboratory,,84105,CPT,Facility,Both,,,90,35,29.75,10.031,35,First Health Group Corporation,First Health Network,33.95,97,,percent of total billed charges,,
Phosphorus Inorganic; Urine (Mayo)OutsideLaboratory,,84105,CPT,Facility,Both,,,90,35,29.75,10.031,35,"Health Partners, Inc.",Commercial,33.11,94.6,,percent of total billed charges,,
Phosphorus Inorganic; Urine (Mayo)OutsideLaboratory,,84105,CPT,Facility,Outpatient,,,90,35,29.75,10.031,35,"Health Partners, Inc.",Medicare Advantage,17.15,49,,percent of total billed charges,,
Phosphorus Inorganic; Urine (Mayo)OutsideLaboratory,,84105,CPT,Facility,Inpatient,,,90,35,29.75,10.031,35,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Phosphorus Inorganic; Urine (Mayo)OutsideLaboratory,,84105,CPT,Facility,Both,,,90,35,29.75,10.031,35,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),21,60,,percent of total billed charges,,
Phosphorus Inorganic; Urine (Mayo)OutsideLaboratory,,84105,CPT,Facility,Both,,,90,35,29.75,10.031,35,"Health Partners, Inc.",State of Minnesota Advantage Program,28.525,81.5,,percent of total billed charges,,
Phosphorus Inorganic; Urine (Mayo)OutsideLaboratory,,84105,CPT,Facility,Both,,,90,35,29.75,10.031,35,"Health Partners, Inc.",State Public Programs,17.5,50,,percent of total billed charges,,
Phosphorus Inorganic; Urine (Mayo)OutsideLaboratory,,84105,CPT,Facility,Both,,,90,35,29.75,10.031,35,Humana Insurance Company,Commercial PPO,33.25,95,,percent of total billed charges,,
Phosphorus Inorganic; Urine (Mayo)OutsideLaboratory,,84105,CPT,Facility,Outpatient,,,90,35,29.75,10.031,35,Humana Insurance Company,Medicare PPO,17.15,49,,percent of total billed charges,,
Phosphorus Inorganic; Urine (Mayo)OutsideLaboratory,,84105,CPT,Facility,Inpatient,,,90,35,29.75,10.031,35,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Phosphorus Inorganic; Urine (Mayo)OutsideLaboratory,,84105,CPT,Facility,Both,,,90,35,29.75,10.031,35,Medica,Individual & Family,34.685,99.1,,percent of total billed charges,,
Phosphorus Inorganic; Urine (Mayo)OutsideLaboratory,,84105,CPT,Facility,Outpatient,,,90,35,29.75,10.031,35,Medica,Medica Advantage Solution,17.43,49.8,,percent of total billed charges,,
Phosphorus Inorganic; Urine (Mayo)OutsideLaboratory,,84105,CPT,Facility,Inpatient,,,90,35,29.75,10.031,35,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Phosphorus Inorganic; Urine (Mayo)OutsideLaboratory,,84105,CPT,Facility,Outpatient,,,90,35,29.75,10.031,35,Medica,Medical Assistance,15.61,44.6,,percent of total billed charges,,
Phosphorus Inorganic; Urine (Mayo)OutsideLaboratory,,84105,CPT,Facility,Inpatient,,,90,35,29.75,10.031,35,Medica,Medical Assistance,,,,,Included in per diem rate,
Phosphorus Inorganic; Urine (Mayo)OutsideLaboratory,,84105,CPT,Facility,Outpatient,,,90,35,29.75,10.031,35,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,17.43,49.8,,percent of total billed charges,,
Phosphorus Inorganic; Urine (Mayo)OutsideLaboratory,,84105,CPT,Facility,Inpatient,,,90,35,29.75,10.031,35,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Phosphorus Inorganic; Urine (Mayo)OutsideLaboratory,,84105,CPT,Facility,Both,,,90,35,29.75,10.031,35,"Multiplan, Inc.","Multiplan, Inc.",32.9,94,,percent of total billed charges,,
Phosphorus Inorganic; Urine (Mayo)OutsideLaboratory,,84105,CPT,Facility,Outpatient,,,90,35,29.75,10.031,35,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,30.24,86.4,,percent of total billed charges,,
Phosphorus Inorganic; Urine (Mayo)OutsideLaboratory,,84105,CPT,Facility,Inpatient,,,90,35,29.75,10.031,35,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Phosphorus Inorganic; Urine (Mayo)OutsideLaboratory,,84105,CPT,Facility,Both,,,90,35,29.75,10.031,35,"Preferred One Administrative Services, INC.",PPO,34.51,98.6,,percent of total billed charges,,
Phosphorus Inorganic; Urine (Mayo)OutsideLaboratory,,84105,CPT,Facility,Outpatient,,,90,35,29.75,10.031,35,PrimeWest Health,Minnesota Senior Health Options (MSHO),18.0075,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Phosphorus Inorganic; Urine (Mayo)OutsideLaboratory,,84105,CPT,Facility,Inpatient,,,90,35,29.75,10.031,35,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Phosphorus Inorganic; Urine (Mayo)OutsideLaboratory,,84105,CPT,Facility,Outpatient,,,90,35,29.75,10.031,35,PrimeWest Health,MinnesotaCare,17.976,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Phosphorus Inorganic; Urine (Mayo)OutsideLaboratory,,84105,CPT,Facility,Inpatient,,,90,35,29.75,10.031,35,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Phosphorus Inorganic; Urine (Mayo)OutsideLaboratory,,84105,CPT,Facility,Both,,,90,35,29.75,10.031,35,Sanford Health Plan,Sanford Health Plan,32.2,92,,percent of total billed charges,,
Phosphorus Inorganic; Urine (Mayo)OutsideLaboratory,,84105,CPT,Facility,Outpatient,,,90,35,29.75,10.031,35,"UCare Health, Inc.",Individual & Family Plan,19.7225,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Phosphorus Inorganic; Urine (Mayo)OutsideLaboratory,,84105,CPT,Facility,Inpatient,,,90,35,29.75,10.031,35,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Phosphorus Inorganic; Urine (Mayo)OutsideLaboratory,,84105,CPT,Facility,Outpatient,,,90,35,29.75,10.031,35,"UCare Health, Inc.",Medical Assistance,17.6645,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Phosphorus Inorganic; Urine (Mayo)OutsideLaboratory,,84105,CPT,Facility,Inpatient,,,90,35,29.75,10.031,35,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Phosphorus Inorganic; Urine (Mayo)OutsideLaboratory,,84105,CPT,Facility,Outpatient,,,90,35,29.75,10.031,35,"UCare Health, Inc.",Medicare Advantage,17.6645,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Phosphorus Inorganic; Urine (Mayo)OutsideLaboratory,,84105,CPT,Facility,Inpatient,,,90,35,29.75,10.031,35,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Phosphorus Inorganic; Urine (Mayo)OutsideLaboratory,,84105,CPT,Facility,Outpatient,,,90,35,29.75,10.031,35,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),17.6645,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Phosphorus Inorganic; Urine (Mayo)OutsideLaboratory,,84105,CPT,Facility,Inpatient,,,90,35,29.75,10.031,35,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Phosphorus Inorganic; Urine (Mayo)OutsideLaboratory,,84105,CPT,Facility,Both,,,90,35,29.75,10.031,35,UnitedHealthcare,Individual & Family,32.9,94,,percent of total billed charges,,
Phosphorus Inorganic; Urine (Mayo)OutsideLaboratory,,84105,CPT,Facility,Outpatient,,,90,35,29.75,10.031,35,UnitedHealthcare,Medicare Advantage,17.15,49,,percent of total billed charges,,
Phosphorus Inorganic; Urine (Mayo)OutsideLaboratory,,84105,CPT,Facility,Inpatient,,,90,35,29.75,10.031,35,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Phosphorus Inorganic; Urine (Mayo)OutsideLaboratory,,84105,CPT,Facility,Outpatient,,,90,35,29.75,10.031,35,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,16.8,48,,percent of total billed charges,,100% of DHS outpatient percentage
Phosphorus Inorganic; Urine (Mayo)OutsideLaboratory,,84105,CPT,Facility,Inpatient,,,90,35,29.75,10.031,35,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Phosphorus, U (Mayo)OutsideLaboratory",,84105,CPT,Facility,Both,,,90,35,29.75,10.031,35,Aetna,Commercial,32.2,92,,percent of total billed charges,,
"Phosphorus, U (Mayo)OutsideLaboratory",,84105,CPT,Facility,Outpatient,,,90,35,29.75,10.031,35,Aetna,Medicare Advantage,17.15,49,,percent of total billed charges,,
"Phosphorus, U (Mayo)OutsideLaboratory",,84105,CPT,Facility,Inpatient,,,90,35,29.75,10.031,35,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Phosphorus, U (Mayo)OutsideLaboratory",,84105,CPT,Facility,Both,,,90,35,29.75,10.031,35,Aetna,PPO,32.55,93,,percent of total billed charges,,
"Phosphorus, U (Mayo)OutsideLaboratory",,84105,CPT,Facility,Both,,,90,35,29.75,10.031,35,America's PPO,America's PPO,33.6105,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Phosphorus, U (Mayo)OutsideLaboratory",,84105,CPT,Facility,Both,,,90,35,29.75,10.031,35,BlueCross BlueShield Minnesota, Federal Employee Program,34.44,98.4,,percent of total billed charges,,
"Phosphorus, U (Mayo)OutsideLaboratory",,84105,CPT,Facility,Both,,,90,35,29.75,10.031,35,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,35,100,,percent of total billed charges,,
"Phosphorus, U (Mayo)OutsideLaboratory",,84105,CPT,Facility,Both,,,90,35,29.75,10.031,35,BlueCross BlueShield Minnesota,High Value Network Plan,31.5,90,,percent of total billed charges,,
"Phosphorus, U (Mayo)OutsideLaboratory",,84105,CPT,Facility,Outpatient,,,90,35,29.75,10.031,35,BlueCross BlueShield Minnesota,Medicare Advantage,17.15,49,,percent of total billed charges,,
"Phosphorus, U (Mayo)OutsideLaboratory",,84105,CPT,Facility,Inpatient,,,90,35,29.75,10.031,35,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Phosphorus, U (Mayo)OutsideLaboratory",,84105,CPT,Facility,Both,,,90,35,29.75,10.031,35,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,30.9995,88.57,,percent of total billed charges,,
"Phosphorus, U (Mayo)OutsideLaboratory",,84105,CPT,Facility,Both,,,90,35,29.75,10.031,35,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,10.031,28.66,,percent of total billed charges,,
"Phosphorus, U (Mayo)OutsideLaboratory",,84105,CPT,Facility,Outpatient,,,90,35,29.75,10.031,35,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),17.15,49,,percent of total billed charges,,
"Phosphorus, U (Mayo)OutsideLaboratory",,84105,CPT,Facility,Inpatient,,,90,35,29.75,10.031,35,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Phosphorus, U (Mayo)OutsideLaboratory",,84105,CPT,Facility,Both,,,90,35,29.75,10.031,35,CorVel,Worker's Compensation,35,100,,percent of total billed charges,,
"Phosphorus, U (Mayo)OutsideLaboratory",,84105,CPT,Facility,Both,,,90,35,29.75,10.031,35,First Health Group Corporation,First Health Network,33.95,97,,percent of total billed charges,,
"Phosphorus, U (Mayo)OutsideLaboratory",,84105,CPT,Facility,Both,,,90,35,29.75,10.031,35,"Health Partners, Inc.",Commercial,33.11,94.6,,percent of total billed charges,,
"Phosphorus, U (Mayo)OutsideLaboratory",,84105,CPT,Facility,Outpatient,,,90,35,29.75,10.031,35,"Health Partners, Inc.",Medicare Advantage,17.15,49,,percent of total billed charges,,
"Phosphorus, U (Mayo)OutsideLaboratory",,84105,CPT,Facility,Inpatient,,,90,35,29.75,10.031,35,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Phosphorus, U (Mayo)OutsideLaboratory",,84105,CPT,Facility,Both,,,90,35,29.75,10.031,35,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),21,60,,percent of total billed charges,,
"Phosphorus, U (Mayo)OutsideLaboratory",,84105,CPT,Facility,Both,,,90,35,29.75,10.031,35,"Health Partners, Inc.",State of Minnesota Advantage Program,28.525,81.5,,percent of total billed charges,,
"Phosphorus, U (Mayo)OutsideLaboratory",,84105,CPT,Facility,Both,,,90,35,29.75,10.031,35,"Health Partners, Inc.",State Public Programs,17.5,50,,percent of total billed charges,,
"Phosphorus, U (Mayo)OutsideLaboratory",,84105,CPT,Facility,Both,,,90,35,29.75,10.031,35,Humana Insurance Company,Commercial PPO,33.25,95,,percent of total billed charges,,
"Phosphorus, U (Mayo)OutsideLaboratory",,84105,CPT,Facility,Outpatient,,,90,35,29.75,10.031,35,Humana Insurance Company,Medicare PPO,17.15,49,,percent of total billed charges,,
"Phosphorus, U (Mayo)OutsideLaboratory",,84105,CPT,Facility,Inpatient,,,90,35,29.75,10.031,35,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Phosphorus, U (Mayo)OutsideLaboratory",,84105,CPT,Facility,Both,,,90,35,29.75,10.031,35,Medica,Individual & Family,34.685,99.1,,percent of total billed charges,,
"Phosphorus, U (Mayo)OutsideLaboratory",,84105,CPT,Facility,Outpatient,,,90,35,29.75,10.031,35,Medica,Medica Advantage Solution,17.43,49.8,,percent of total billed charges,,
"Phosphorus, U (Mayo)OutsideLaboratory",,84105,CPT,Facility,Inpatient,,,90,35,29.75,10.031,35,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Phosphorus, U (Mayo)OutsideLaboratory",,84105,CPT,Facility,Outpatient,,,90,35,29.75,10.031,35,Medica,Medical Assistance,15.61,44.6,,percent of total billed charges,,
"Phosphorus, U (Mayo)OutsideLaboratory",,84105,CPT,Facility,Inpatient,,,90,35,29.75,10.031,35,Medica,Medical Assistance,,,,,Included in per diem rate,
"Phosphorus, U (Mayo)OutsideLaboratory",,84105,CPT,Facility,Outpatient,,,90,35,29.75,10.031,35,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,17.43,49.8,,percent of total billed charges,,
"Phosphorus, U (Mayo)OutsideLaboratory",,84105,CPT,Facility,Inpatient,,,90,35,29.75,10.031,35,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Phosphorus, U (Mayo)OutsideLaboratory",,84105,CPT,Facility,Both,,,90,35,29.75,10.031,35,"Multiplan, Inc.","Multiplan, Inc.",32.9,94,,percent of total billed charges,,
"Phosphorus, U (Mayo)OutsideLaboratory",,84105,CPT,Facility,Outpatient,,,90,35,29.75,10.031,35,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,30.24,86.4,,percent of total billed charges,,
"Phosphorus, U (Mayo)OutsideLaboratory",,84105,CPT,Facility,Inpatient,,,90,35,29.75,10.031,35,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Phosphorus, U (Mayo)OutsideLaboratory",,84105,CPT,Facility,Both,,,90,35,29.75,10.031,35,"Preferred One Administrative Services, INC.",PPO,34.51,98.6,,percent of total billed charges,,
"Phosphorus, U (Mayo)OutsideLaboratory",,84105,CPT,Facility,Outpatient,,,90,35,29.75,10.031,35,PrimeWest Health,Minnesota Senior Health Options (MSHO),18.0075,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Phosphorus, U (Mayo)OutsideLaboratory",,84105,CPT,Facility,Inpatient,,,90,35,29.75,10.031,35,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Phosphorus, U (Mayo)OutsideLaboratory",,84105,CPT,Facility,Outpatient,,,90,35,29.75,10.031,35,PrimeWest Health,MinnesotaCare,17.976,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Phosphorus, U (Mayo)OutsideLaboratory",,84105,CPT,Facility,Inpatient,,,90,35,29.75,10.031,35,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Phosphorus, U (Mayo)OutsideLaboratory",,84105,CPT,Facility,Both,,,90,35,29.75,10.031,35,Sanford Health Plan,Sanford Health Plan,32.2,92,,percent of total billed charges,,
"Phosphorus, U (Mayo)OutsideLaboratory",,84105,CPT,Facility,Outpatient,,,90,35,29.75,10.031,35,"UCare Health, Inc.",Individual & Family Plan,19.7225,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Phosphorus, U (Mayo)OutsideLaboratory",,84105,CPT,Facility,Inpatient,,,90,35,29.75,10.031,35,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Phosphorus, U (Mayo)OutsideLaboratory",,84105,CPT,Facility,Outpatient,,,90,35,29.75,10.031,35,"UCare Health, Inc.",Medical Assistance,17.6645,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Phosphorus, U (Mayo)OutsideLaboratory",,84105,CPT,Facility,Inpatient,,,90,35,29.75,10.031,35,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Phosphorus, U (Mayo)OutsideLaboratory",,84105,CPT,Facility,Outpatient,,,90,35,29.75,10.031,35,"UCare Health, Inc.",Medicare Advantage,17.6645,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Phosphorus, U (Mayo)OutsideLaboratory",,84105,CPT,Facility,Inpatient,,,90,35,29.75,10.031,35,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Phosphorus, U (Mayo)OutsideLaboratory",,84105,CPT,Facility,Outpatient,,,90,35,29.75,10.031,35,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),17.6645,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Phosphorus, U (Mayo)OutsideLaboratory",,84105,CPT,Facility,Inpatient,,,90,35,29.75,10.031,35,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Phosphorus, U (Mayo)OutsideLaboratory",,84105,CPT,Facility,Both,,,90,35,29.75,10.031,35,UnitedHealthcare,Individual & Family,32.9,94,,percent of total billed charges,,
"Phosphorus, U (Mayo)OutsideLaboratory",,84105,CPT,Facility,Outpatient,,,90,35,29.75,10.031,35,UnitedHealthcare,Medicare Advantage,17.15,49,,percent of total billed charges,,
"Phosphorus, U (Mayo)OutsideLaboratory",,84105,CPT,Facility,Inpatient,,,90,35,29.75,10.031,35,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Phosphorus, U (Mayo)OutsideLaboratory",,84105,CPT,Facility,Outpatient,,,90,35,29.75,10.031,35,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,16.8,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Phosphorus, U (Mayo)OutsideLaboratory",,84105,CPT,Facility,Inpatient,,,90,35,29.75,10.031,35,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Hemoquant, F (Mayo)OutsideLaboratory",,84126,CPT,Facility,Both,,,90,145,123.25,41.557,145,Aetna,Commercial,133.4,92,,percent of total billed charges,,
"Hemoquant, F (Mayo)OutsideLaboratory",,84126,CPT,Facility,Outpatient,,,90,145,123.25,41.557,145,Aetna,Medicare Advantage,71.05,49,,percent of total billed charges,,
"Hemoquant, F (Mayo)OutsideLaboratory",,84126,CPT,Facility,Inpatient,,,90,145,123.25,41.557,145,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Hemoquant, F (Mayo)OutsideLaboratory",,84126,CPT,Facility,Both,,,90,145,123.25,41.557,145,Aetna,PPO,134.85,93,,percent of total billed charges,,
"Hemoquant, F (Mayo)OutsideLaboratory",,84126,CPT,Facility,Both,,,90,145,123.25,41.557,145,America's PPO,America's PPO,139.2435,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Hemoquant, F (Mayo)OutsideLaboratory",,84126,CPT,Facility,Both,,,90,145,123.25,41.557,145,BlueCross BlueShield Minnesota, Federal Employee Program,142.68,98.4,,percent of total billed charges,,
"Hemoquant, F (Mayo)OutsideLaboratory",,84126,CPT,Facility,Both,,,90,145,123.25,41.557,145,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,145,100,,percent of total billed charges,,
"Hemoquant, F (Mayo)OutsideLaboratory",,84126,CPT,Facility,Both,,,90,145,123.25,41.557,145,BlueCross BlueShield Minnesota,High Value Network Plan,130.5,90,,percent of total billed charges,,
"Hemoquant, F (Mayo)OutsideLaboratory",,84126,CPT,Facility,Outpatient,,,90,145,123.25,41.557,145,BlueCross BlueShield Minnesota,Medicare Advantage,71.05,49,,percent of total billed charges,,
"Hemoquant, F (Mayo)OutsideLaboratory",,84126,CPT,Facility,Inpatient,,,90,145,123.25,41.557,145,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Hemoquant, F (Mayo)OutsideLaboratory",,84126,CPT,Facility,Both,,,90,145,123.25,41.557,145,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,128.4265,88.57,,percent of total billed charges,,
"Hemoquant, F (Mayo)OutsideLaboratory",,84126,CPT,Facility,Both,,,90,145,123.25,41.557,145,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,41.557,28.66,,percent of total billed charges,,
"Hemoquant, F (Mayo)OutsideLaboratory",,84126,CPT,Facility,Outpatient,,,90,145,123.25,41.557,145,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),71.05,49,,percent of total billed charges,,
"Hemoquant, F (Mayo)OutsideLaboratory",,84126,CPT,Facility,Inpatient,,,90,145,123.25,41.557,145,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Hemoquant, F (Mayo)OutsideLaboratory",,84126,CPT,Facility,Both,,,90,145,123.25,41.557,145,CorVel,Worker's Compensation,145,100,,percent of total billed charges,,
"Hemoquant, F (Mayo)OutsideLaboratory",,84126,CPT,Facility,Both,,,90,145,123.25,41.557,145,First Health Group Corporation,First Health Network,140.65,97,,percent of total billed charges,,
"Hemoquant, F (Mayo)OutsideLaboratory",,84126,CPT,Facility,Both,,,90,145,123.25,41.557,145,"Health Partners, Inc.",Commercial,137.17,94.6,,percent of total billed charges,,
"Hemoquant, F (Mayo)OutsideLaboratory",,84126,CPT,Facility,Outpatient,,,90,145,123.25,41.557,145,"Health Partners, Inc.",Medicare Advantage,71.05,49,,percent of total billed charges,,
"Hemoquant, F (Mayo)OutsideLaboratory",,84126,CPT,Facility,Inpatient,,,90,145,123.25,41.557,145,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Hemoquant, F (Mayo)OutsideLaboratory",,84126,CPT,Facility,Both,,,90,145,123.25,41.557,145,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),87,60,,percent of total billed charges,,
"Hemoquant, F (Mayo)OutsideLaboratory",,84126,CPT,Facility,Both,,,90,145,123.25,41.557,145,"Health Partners, Inc.",State of Minnesota Advantage Program,118.175,81.5,,percent of total billed charges,,
"Hemoquant, F (Mayo)OutsideLaboratory",,84126,CPT,Facility,Both,,,90,145,123.25,41.557,145,"Health Partners, Inc.",State Public Programs,72.5,50,,percent of total billed charges,,
"Hemoquant, F (Mayo)OutsideLaboratory",,84126,CPT,Facility,Both,,,90,145,123.25,41.557,145,Humana Insurance Company,Commercial PPO,137.75,95,,percent of total billed charges,,
"Hemoquant, F (Mayo)OutsideLaboratory",,84126,CPT,Facility,Outpatient,,,90,145,123.25,41.557,145,Humana Insurance Company,Medicare PPO,71.05,49,,percent of total billed charges,,
"Hemoquant, F (Mayo)OutsideLaboratory",,84126,CPT,Facility,Inpatient,,,90,145,123.25,41.557,145,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Hemoquant, F (Mayo)OutsideLaboratory",,84126,CPT,Facility,Both,,,90,145,123.25,41.557,145,Medica,Individual & Family,143.695,99.1,,percent of total billed charges,,
"Hemoquant, F (Mayo)OutsideLaboratory",,84126,CPT,Facility,Outpatient,,,90,145,123.25,41.557,145,Medica,Medica Advantage Solution,72.21,49.8,,percent of total billed charges,,
"Hemoquant, F (Mayo)OutsideLaboratory",,84126,CPT,Facility,Inpatient,,,90,145,123.25,41.557,145,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Hemoquant, F (Mayo)OutsideLaboratory",,84126,CPT,Facility,Outpatient,,,90,145,123.25,41.557,145,Medica,Medical Assistance,64.67,44.6,,percent of total billed charges,,
"Hemoquant, F (Mayo)OutsideLaboratory",,84126,CPT,Facility,Inpatient,,,90,145,123.25,41.557,145,Medica,Medical Assistance,,,,,Included in per diem rate,
"Hemoquant, F (Mayo)OutsideLaboratory",,84126,CPT,Facility,Outpatient,,,90,145,123.25,41.557,145,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,72.21,49.8,,percent of total billed charges,,
"Hemoquant, F (Mayo)OutsideLaboratory",,84126,CPT,Facility,Inpatient,,,90,145,123.25,41.557,145,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Hemoquant, F (Mayo)OutsideLaboratory",,84126,CPT,Facility,Both,,,90,145,123.25,41.557,145,"Multiplan, Inc.","Multiplan, Inc.",136.3,94,,percent of total billed charges,,
"Hemoquant, F (Mayo)OutsideLaboratory",,84126,CPT,Facility,Outpatient,,,90,145,123.25,41.557,145,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,125.28,86.4,,percent of total billed charges,,
"Hemoquant, F (Mayo)OutsideLaboratory",,84126,CPT,Facility,Inpatient,,,90,145,123.25,41.557,145,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Hemoquant, F (Mayo)OutsideLaboratory",,84126,CPT,Facility,Both,,,90,145,123.25,41.557,145,"Preferred One Administrative Services, INC.",PPO,142.97,98.6,,percent of total billed charges,,
"Hemoquant, F (Mayo)OutsideLaboratory",,84126,CPT,Facility,Outpatient,,,90,145,123.25,41.557,145,PrimeWest Health,Minnesota Senior Health Options (MSHO),74.6025,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Hemoquant, F (Mayo)OutsideLaboratory",,84126,CPT,Facility,Inpatient,,,90,145,123.25,41.557,145,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Hemoquant, F (Mayo)OutsideLaboratory",,84126,CPT,Facility,Outpatient,,,90,145,123.25,41.557,145,PrimeWest Health,MinnesotaCare,74.472,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Hemoquant, F (Mayo)OutsideLaboratory",,84126,CPT,Facility,Inpatient,,,90,145,123.25,41.557,145,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Hemoquant, F (Mayo)OutsideLaboratory",,84126,CPT,Facility,Both,,,90,145,123.25,41.557,145,Sanford Health Plan,Sanford Health Plan,133.4,92,,percent of total billed charges,,
"Hemoquant, F (Mayo)OutsideLaboratory",,84126,CPT,Facility,Outpatient,,,90,145,123.25,41.557,145,"UCare Health, Inc.",Individual & Family Plan,81.7075,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Hemoquant, F (Mayo)OutsideLaboratory",,84126,CPT,Facility,Inpatient,,,90,145,123.25,41.557,145,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Hemoquant, F (Mayo)OutsideLaboratory",,84126,CPT,Facility,Outpatient,,,90,145,123.25,41.557,145,"UCare Health, Inc.",Medical Assistance,73.1815,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Hemoquant, F (Mayo)OutsideLaboratory",,84126,CPT,Facility,Inpatient,,,90,145,123.25,41.557,145,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Hemoquant, F (Mayo)OutsideLaboratory",,84126,CPT,Facility,Outpatient,,,90,145,123.25,41.557,145,"UCare Health, Inc.",Medicare Advantage,73.1815,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Hemoquant, F (Mayo)OutsideLaboratory",,84126,CPT,Facility,Inpatient,,,90,145,123.25,41.557,145,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Hemoquant, F (Mayo)OutsideLaboratory",,84126,CPT,Facility,Outpatient,,,90,145,123.25,41.557,145,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),73.1815,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Hemoquant, F (Mayo)OutsideLaboratory",,84126,CPT,Facility,Inpatient,,,90,145,123.25,41.557,145,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Hemoquant, F (Mayo)OutsideLaboratory",,84126,CPT,Facility,Both,,,90,145,123.25,41.557,145,UnitedHealthcare,Individual & Family,136.3,94,,percent of total billed charges,,
"Hemoquant, F (Mayo)OutsideLaboratory",,84126,CPT,Facility,Outpatient,,,90,145,123.25,41.557,145,UnitedHealthcare,Medicare Advantage,71.05,49,,percent of total billed charges,,
"Hemoquant, F (Mayo)OutsideLaboratory",,84126,CPT,Facility,Inpatient,,,90,145,123.25,41.557,145,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Hemoquant, F (Mayo)OutsideLaboratory",,84126,CPT,Facility,Outpatient,,,90,145,123.25,41.557,145,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,69.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Hemoquant, F (Mayo)OutsideLaboratory",,84126,CPT,Facility,Inpatient,,,90,145,123.25,41.557,145,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Prealbumin (Pab), S (Mayo)OutsideLaboratory",,84134,CPT,Facility,Both,,,90,86,73.1,24.6476,86,Aetna,Commercial,79.12,92,,percent of total billed charges,,
"Prealbumin (Pab), S (Mayo)OutsideLaboratory",,84134,CPT,Facility,Outpatient,,,90,86,73.1,24.6476,86,Aetna,Medicare Advantage,42.14,49,,percent of total billed charges,,
"Prealbumin (Pab), S (Mayo)OutsideLaboratory",,84134,CPT,Facility,Inpatient,,,90,86,73.1,24.6476,86,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Prealbumin (Pab), S (Mayo)OutsideLaboratory",,84134,CPT,Facility,Both,,,90,86,73.1,24.6476,86,Aetna,PPO,79.98,93,,percent of total billed charges,,
"Prealbumin (Pab), S (Mayo)OutsideLaboratory",,84134,CPT,Facility,Both,,,90,86,73.1,24.6476,86,America's PPO,America's PPO,82.5858,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Prealbumin (Pab), S (Mayo)OutsideLaboratory",,84134,CPT,Facility,Both,,,90,86,73.1,24.6476,86,BlueCross BlueShield Minnesota, Federal Employee Program,84.624,98.4,,percent of total billed charges,,
"Prealbumin (Pab), S (Mayo)OutsideLaboratory",,84134,CPT,Facility,Both,,,90,86,73.1,24.6476,86,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,86,100,,percent of total billed charges,,
"Prealbumin (Pab), S (Mayo)OutsideLaboratory",,84134,CPT,Facility,Both,,,90,86,73.1,24.6476,86,BlueCross BlueShield Minnesota,High Value Network Plan,77.4,90,,percent of total billed charges,,
"Prealbumin (Pab), S (Mayo)OutsideLaboratory",,84134,CPT,Facility,Outpatient,,,90,86,73.1,24.6476,86,BlueCross BlueShield Minnesota,Medicare Advantage,42.14,49,,percent of total billed charges,,
"Prealbumin (Pab), S (Mayo)OutsideLaboratory",,84134,CPT,Facility,Inpatient,,,90,86,73.1,24.6476,86,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Prealbumin (Pab), S (Mayo)OutsideLaboratory",,84134,CPT,Facility,Both,,,90,86,73.1,24.6476,86,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,76.1702,88.57,,percent of total billed charges,,
"Prealbumin (Pab), S (Mayo)OutsideLaboratory",,84134,CPT,Facility,Both,,,90,86,73.1,24.6476,86,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,24.6476,28.66,,percent of total billed charges,,
"Prealbumin (Pab), S (Mayo)OutsideLaboratory",,84134,CPT,Facility,Outpatient,,,90,86,73.1,24.6476,86,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),42.14,49,,percent of total billed charges,,
"Prealbumin (Pab), S (Mayo)OutsideLaboratory",,84134,CPT,Facility,Inpatient,,,90,86,73.1,24.6476,86,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Prealbumin (Pab), S (Mayo)OutsideLaboratory",,84134,CPT,Facility,Both,,,90,86,73.1,24.6476,86,CorVel,Worker's Compensation,86,100,,percent of total billed charges,,
"Prealbumin (Pab), S (Mayo)OutsideLaboratory",,84134,CPT,Facility,Both,,,90,86,73.1,24.6476,86,First Health Group Corporation,First Health Network,83.42,97,,percent of total billed charges,,
"Prealbumin (Pab), S (Mayo)OutsideLaboratory",,84134,CPT,Facility,Both,,,90,86,73.1,24.6476,86,"Health Partners, Inc.",Commercial,81.356,94.6,,percent of total billed charges,,
"Prealbumin (Pab), S (Mayo)OutsideLaboratory",,84134,CPT,Facility,Outpatient,,,90,86,73.1,24.6476,86,"Health Partners, Inc.",Medicare Advantage,42.14,49,,percent of total billed charges,,
"Prealbumin (Pab), S (Mayo)OutsideLaboratory",,84134,CPT,Facility,Inpatient,,,90,86,73.1,24.6476,86,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Prealbumin (Pab), S (Mayo)OutsideLaboratory",,84134,CPT,Facility,Both,,,90,86,73.1,24.6476,86,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),51.6,60,,percent of total billed charges,,
"Prealbumin (Pab), S (Mayo)OutsideLaboratory",,84134,CPT,Facility,Both,,,90,86,73.1,24.6476,86,"Health Partners, Inc.",State of Minnesota Advantage Program,70.09,81.5,,percent of total billed charges,,
"Prealbumin (Pab), S (Mayo)OutsideLaboratory",,84134,CPT,Facility,Both,,,90,86,73.1,24.6476,86,"Health Partners, Inc.",State Public Programs,43,50,,percent of total billed charges,,
"Prealbumin (Pab), S (Mayo)OutsideLaboratory",,84134,CPT,Facility,Both,,,90,86,73.1,24.6476,86,Humana Insurance Company,Commercial PPO,81.7,95,,percent of total billed charges,,
"Prealbumin (Pab), S (Mayo)OutsideLaboratory",,84134,CPT,Facility,Outpatient,,,90,86,73.1,24.6476,86,Humana Insurance Company,Medicare PPO,42.14,49,,percent of total billed charges,,
"Prealbumin (Pab), S (Mayo)OutsideLaboratory",,84134,CPT,Facility,Inpatient,,,90,86,73.1,24.6476,86,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Prealbumin (Pab), S (Mayo)OutsideLaboratory",,84134,CPT,Facility,Both,,,90,86,73.1,24.6476,86,Medica,Individual & Family,85.226,99.1,,percent of total billed charges,,
"Prealbumin (Pab), S (Mayo)OutsideLaboratory",,84134,CPT,Facility,Outpatient,,,90,86,73.1,24.6476,86,Medica,Medica Advantage Solution,42.828,49.8,,percent of total billed charges,,
"Prealbumin (Pab), S (Mayo)OutsideLaboratory",,84134,CPT,Facility,Inpatient,,,90,86,73.1,24.6476,86,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Prealbumin (Pab), S (Mayo)OutsideLaboratory",,84134,CPT,Facility,Outpatient,,,90,86,73.1,24.6476,86,Medica,Medical Assistance,38.356,44.6,,percent of total billed charges,,
"Prealbumin (Pab), S (Mayo)OutsideLaboratory",,84134,CPT,Facility,Inpatient,,,90,86,73.1,24.6476,86,Medica,Medical Assistance,,,,,Included in per diem rate,
"Prealbumin (Pab), S (Mayo)OutsideLaboratory",,84134,CPT,Facility,Outpatient,,,90,86,73.1,24.6476,86,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,42.828,49.8,,percent of total billed charges,,
"Prealbumin (Pab), S (Mayo)OutsideLaboratory",,84134,CPT,Facility,Inpatient,,,90,86,73.1,24.6476,86,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Prealbumin (Pab), S (Mayo)OutsideLaboratory",,84134,CPT,Facility,Both,,,90,86,73.1,24.6476,86,"Multiplan, Inc.","Multiplan, Inc.",80.84,94,,percent of total billed charges,,
"Prealbumin (Pab), S (Mayo)OutsideLaboratory",,84134,CPT,Facility,Outpatient,,,90,86,73.1,24.6476,86,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,74.304,86.4,,percent of total billed charges,,
"Prealbumin (Pab), S (Mayo)OutsideLaboratory",,84134,CPT,Facility,Inpatient,,,90,86,73.1,24.6476,86,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Prealbumin (Pab), S (Mayo)OutsideLaboratory",,84134,CPT,Facility,Both,,,90,86,73.1,24.6476,86,"Preferred One Administrative Services, INC.",PPO,84.796,98.6,,percent of total billed charges,,
"Prealbumin (Pab), S (Mayo)OutsideLaboratory",,84134,CPT,Facility,Outpatient,,,90,86,73.1,24.6476,86,PrimeWest Health,Minnesota Senior Health Options (MSHO),44.247,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Prealbumin (Pab), S (Mayo)OutsideLaboratory",,84134,CPT,Facility,Inpatient,,,90,86,73.1,24.6476,86,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Prealbumin (Pab), S (Mayo)OutsideLaboratory",,84134,CPT,Facility,Outpatient,,,90,86,73.1,24.6476,86,PrimeWest Health,MinnesotaCare,44.1696,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Prealbumin (Pab), S (Mayo)OutsideLaboratory",,84134,CPT,Facility,Inpatient,,,90,86,73.1,24.6476,86,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Prealbumin (Pab), S (Mayo)OutsideLaboratory",,84134,CPT,Facility,Both,,,90,86,73.1,24.6476,86,Sanford Health Plan,Sanford Health Plan,79.12,92,,percent of total billed charges,,
"Prealbumin (Pab), S (Mayo)OutsideLaboratory",,84134,CPT,Facility,Outpatient,,,90,86,73.1,24.6476,86,"UCare Health, Inc.",Individual & Family Plan,48.461,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Prealbumin (Pab), S (Mayo)OutsideLaboratory",,84134,CPT,Facility,Inpatient,,,90,86,73.1,24.6476,86,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Prealbumin (Pab), S (Mayo)OutsideLaboratory",,84134,CPT,Facility,Outpatient,,,90,86,73.1,24.6476,86,"UCare Health, Inc.",Medical Assistance,43.4042,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Prealbumin (Pab), S (Mayo)OutsideLaboratory",,84134,CPT,Facility,Inpatient,,,90,86,73.1,24.6476,86,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Prealbumin (Pab), S (Mayo)OutsideLaboratory",,84134,CPT,Facility,Outpatient,,,90,86,73.1,24.6476,86,"UCare Health, Inc.",Medicare Advantage,43.4042,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Prealbumin (Pab), S (Mayo)OutsideLaboratory",,84134,CPT,Facility,Inpatient,,,90,86,73.1,24.6476,86,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Prealbumin (Pab), S (Mayo)OutsideLaboratory",,84134,CPT,Facility,Outpatient,,,90,86,73.1,24.6476,86,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),43.4042,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Prealbumin (Pab), S (Mayo)OutsideLaboratory",,84134,CPT,Facility,Inpatient,,,90,86,73.1,24.6476,86,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Prealbumin (Pab), S (Mayo)OutsideLaboratory",,84134,CPT,Facility,Both,,,90,86,73.1,24.6476,86,UnitedHealthcare,Individual & Family,80.84,94,,percent of total billed charges,,
"Prealbumin (Pab), S (Mayo)OutsideLaboratory",,84134,CPT,Facility,Outpatient,,,90,86,73.1,24.6476,86,UnitedHealthcare,Medicare Advantage,42.14,49,,percent of total billed charges,,
"Prealbumin (Pab), S (Mayo)OutsideLaboratory",,84134,CPT,Facility,Inpatient,,,90,86,73.1,24.6476,86,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Prealbumin (Pab), S (Mayo)OutsideLaboratory",,84134,CPT,Facility,Outpatient,,,90,86,73.1,24.6476,86,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,41.28,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Prealbumin (Pab), S (Mayo)OutsideLaboratory",,84134,CPT,Facility,Inpatient,,,90,86,73.1,24.6476,86,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Progesterone, S (Mayo)OutsideLaboratory",,84144,CPT,Facility,Both,,,90,107,90.95,30.6662,107,Aetna,Commercial,98.44,92,,percent of total billed charges,,
"Progesterone, S (Mayo)OutsideLaboratory",,84144,CPT,Facility,Outpatient,,,90,107,90.95,30.6662,107,Aetna,Medicare Advantage,52.43,49,,percent of total billed charges,,
"Progesterone, S (Mayo)OutsideLaboratory",,84144,CPT,Facility,Inpatient,,,90,107,90.95,30.6662,107,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Progesterone, S (Mayo)OutsideLaboratory",,84144,CPT,Facility,Both,,,90,107,90.95,30.6662,107,Aetna,PPO,99.51,93,,percent of total billed charges,,
"Progesterone, S (Mayo)OutsideLaboratory",,84144,CPT,Facility,Both,,,90,107,90.95,30.6662,107,America's PPO,America's PPO,102.7521,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Progesterone, S (Mayo)OutsideLaboratory",,84144,CPT,Facility,Both,,,90,107,90.95,30.6662,107,BlueCross BlueShield Minnesota, Federal Employee Program,105.288,98.4,,percent of total billed charges,,
"Progesterone, S (Mayo)OutsideLaboratory",,84144,CPT,Facility,Both,,,90,107,90.95,30.6662,107,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,107,100,,percent of total billed charges,,
"Progesterone, S (Mayo)OutsideLaboratory",,84144,CPT,Facility,Both,,,90,107,90.95,30.6662,107,BlueCross BlueShield Minnesota,High Value Network Plan,96.3,90,,percent of total billed charges,,
"Progesterone, S (Mayo)OutsideLaboratory",,84144,CPT,Facility,Outpatient,,,90,107,90.95,30.6662,107,BlueCross BlueShield Minnesota,Medicare Advantage,52.43,49,,percent of total billed charges,,
"Progesterone, S (Mayo)OutsideLaboratory",,84144,CPT,Facility,Inpatient,,,90,107,90.95,30.6662,107,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Progesterone, S (Mayo)OutsideLaboratory",,84144,CPT,Facility,Both,,,90,107,90.95,30.6662,107,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,94.7699,88.57,,percent of total billed charges,,
"Progesterone, S (Mayo)OutsideLaboratory",,84144,CPT,Facility,Both,,,90,107,90.95,30.6662,107,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,30.6662,28.66,,percent of total billed charges,,
"Progesterone, S (Mayo)OutsideLaboratory",,84144,CPT,Facility,Outpatient,,,90,107,90.95,30.6662,107,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),52.43,49,,percent of total billed charges,,
"Progesterone, S (Mayo)OutsideLaboratory",,84144,CPT,Facility,Inpatient,,,90,107,90.95,30.6662,107,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Progesterone, S (Mayo)OutsideLaboratory",,84144,CPT,Facility,Both,,,90,107,90.95,30.6662,107,CorVel,Worker's Compensation,107,100,,percent of total billed charges,,
"Progesterone, S (Mayo)OutsideLaboratory",,84144,CPT,Facility,Both,,,90,107,90.95,30.6662,107,First Health Group Corporation,First Health Network,103.79,97,,percent of total billed charges,,
"Progesterone, S (Mayo)OutsideLaboratory",,84144,CPT,Facility,Both,,,90,107,90.95,30.6662,107,"Health Partners, Inc.",Commercial,101.222,94.6,,percent of total billed charges,,
"Progesterone, S (Mayo)OutsideLaboratory",,84144,CPT,Facility,Outpatient,,,90,107,90.95,30.6662,107,"Health Partners, Inc.",Medicare Advantage,52.43,49,,percent of total billed charges,,
"Progesterone, S (Mayo)OutsideLaboratory",,84144,CPT,Facility,Inpatient,,,90,107,90.95,30.6662,107,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Progesterone, S (Mayo)OutsideLaboratory",,84144,CPT,Facility,Both,,,90,107,90.95,30.6662,107,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),64.2,60,,percent of total billed charges,,
"Progesterone, S (Mayo)OutsideLaboratory",,84144,CPT,Facility,Both,,,90,107,90.95,30.6662,107,"Health Partners, Inc.",State of Minnesota Advantage Program,87.205,81.5,,percent of total billed charges,,
"Progesterone, S (Mayo)OutsideLaboratory",,84144,CPT,Facility,Both,,,90,107,90.95,30.6662,107,"Health Partners, Inc.",State Public Programs,53.5,50,,percent of total billed charges,,
"Progesterone, S (Mayo)OutsideLaboratory",,84144,CPT,Facility,Both,,,90,107,90.95,30.6662,107,Humana Insurance Company,Commercial PPO,101.65,95,,percent of total billed charges,,
"Progesterone, S (Mayo)OutsideLaboratory",,84144,CPT,Facility,Outpatient,,,90,107,90.95,30.6662,107,Humana Insurance Company,Medicare PPO,52.43,49,,percent of total billed charges,,
"Progesterone, S (Mayo)OutsideLaboratory",,84144,CPT,Facility,Inpatient,,,90,107,90.95,30.6662,107,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Progesterone, S (Mayo)OutsideLaboratory",,84144,CPT,Facility,Both,,,90,107,90.95,30.6662,107,Medica,Individual & Family,106.037,99.1,,percent of total billed charges,,
"Progesterone, S (Mayo)OutsideLaboratory",,84144,CPT,Facility,Outpatient,,,90,107,90.95,30.6662,107,Medica,Medica Advantage Solution,53.286,49.8,,percent of total billed charges,,
"Progesterone, S (Mayo)OutsideLaboratory",,84144,CPT,Facility,Inpatient,,,90,107,90.95,30.6662,107,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Progesterone, S (Mayo)OutsideLaboratory",,84144,CPT,Facility,Outpatient,,,90,107,90.95,30.6662,107,Medica,Medical Assistance,47.722,44.6,,percent of total billed charges,,
"Progesterone, S (Mayo)OutsideLaboratory",,84144,CPT,Facility,Inpatient,,,90,107,90.95,30.6662,107,Medica,Medical Assistance,,,,,Included in per diem rate,
"Progesterone, S (Mayo)OutsideLaboratory",,84144,CPT,Facility,Outpatient,,,90,107,90.95,30.6662,107,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,53.286,49.8,,percent of total billed charges,,
"Progesterone, S (Mayo)OutsideLaboratory",,84144,CPT,Facility,Inpatient,,,90,107,90.95,30.6662,107,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Progesterone, S (Mayo)OutsideLaboratory",,84144,CPT,Facility,Both,,,90,107,90.95,30.6662,107,"Multiplan, Inc.","Multiplan, Inc.",100.58,94,,percent of total billed charges,,
"Progesterone, S (Mayo)OutsideLaboratory",,84144,CPT,Facility,Outpatient,,,90,107,90.95,30.6662,107,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,92.448,86.4,,percent of total billed charges,,
"Progesterone, S (Mayo)OutsideLaboratory",,84144,CPT,Facility,Inpatient,,,90,107,90.95,30.6662,107,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Progesterone, S (Mayo)OutsideLaboratory",,84144,CPT,Facility,Both,,,90,107,90.95,30.6662,107,"Preferred One Administrative Services, INC.",PPO,105.502,98.6,,percent of total billed charges,,
"Progesterone, S (Mayo)OutsideLaboratory",,84144,CPT,Facility,Outpatient,,,90,107,90.95,30.6662,107,PrimeWest Health,Minnesota Senior Health Options (MSHO),55.0515,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Progesterone, S (Mayo)OutsideLaboratory",,84144,CPT,Facility,Inpatient,,,90,107,90.95,30.6662,107,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Progesterone, S (Mayo)OutsideLaboratory",,84144,CPT,Facility,Outpatient,,,90,107,90.95,30.6662,107,PrimeWest Health,MinnesotaCare,54.9552,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Progesterone, S (Mayo)OutsideLaboratory",,84144,CPT,Facility,Inpatient,,,90,107,90.95,30.6662,107,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Progesterone, S (Mayo)OutsideLaboratory",,84144,CPT,Facility,Both,,,90,107,90.95,30.6662,107,Sanford Health Plan,Sanford Health Plan,98.44,92,,percent of total billed charges,,
"Progesterone, S (Mayo)OutsideLaboratory",,84144,CPT,Facility,Outpatient,,,90,107,90.95,30.6662,107,"UCare Health, Inc.",Individual & Family Plan,60.2945,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Progesterone, S (Mayo)OutsideLaboratory",,84144,CPT,Facility,Inpatient,,,90,107,90.95,30.6662,107,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Progesterone, S (Mayo)OutsideLaboratory",,84144,CPT,Facility,Outpatient,,,90,107,90.95,30.6662,107,"UCare Health, Inc.",Medical Assistance,54.0029,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Progesterone, S (Mayo)OutsideLaboratory",,84144,CPT,Facility,Inpatient,,,90,107,90.95,30.6662,107,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Progesterone, S (Mayo)OutsideLaboratory",,84144,CPT,Facility,Outpatient,,,90,107,90.95,30.6662,107,"UCare Health, Inc.",Medicare Advantage,54.0029,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Progesterone, S (Mayo)OutsideLaboratory",,84144,CPT,Facility,Inpatient,,,90,107,90.95,30.6662,107,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Progesterone, S (Mayo)OutsideLaboratory",,84144,CPT,Facility,Outpatient,,,90,107,90.95,30.6662,107,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),54.0029,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Progesterone, S (Mayo)OutsideLaboratory",,84144,CPT,Facility,Inpatient,,,90,107,90.95,30.6662,107,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Progesterone, S (Mayo)OutsideLaboratory",,84144,CPT,Facility,Both,,,90,107,90.95,30.6662,107,UnitedHealthcare,Individual & Family,100.58,94,,percent of total billed charges,,
"Progesterone, S (Mayo)OutsideLaboratory",,84144,CPT,Facility,Outpatient,,,90,107,90.95,30.6662,107,UnitedHealthcare,Medicare Advantage,52.43,49,,percent of total billed charges,,
"Progesterone, S (Mayo)OutsideLaboratory",,84144,CPT,Facility,Inpatient,,,90,107,90.95,30.6662,107,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Progesterone, S (Mayo)OutsideLaboratory",,84144,CPT,Facility,Outpatient,,,90,107,90.95,30.6662,107,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,51.36,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Progesterone, S (Mayo)OutsideLaboratory",,84144,CPT,Facility,Inpatient,,,90,107,90.95,30.6662,107,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Macroprolactin, S (Mayo)OutsideLaboratory",,84146,CPT,Facility,Both,,,90,149,126.65,42.7034,149,Aetna,Commercial,137.08,92,,percent of total billed charges,,
"Macroprolactin, S (Mayo)OutsideLaboratory",,84146,CPT,Facility,Outpatient,,,90,149,126.65,42.7034,149,Aetna,Medicare Advantage,73.01,49,,percent of total billed charges,,
"Macroprolactin, S (Mayo)OutsideLaboratory",,84146,CPT,Facility,Inpatient,,,90,149,126.65,42.7034,149,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Macroprolactin, S (Mayo)OutsideLaboratory",,84146,CPT,Facility,Both,,,90,149,126.65,42.7034,149,Aetna,PPO,138.57,93,,percent of total billed charges,,
"Macroprolactin, S (Mayo)OutsideLaboratory",,84146,CPT,Facility,Both,,,90,149,126.65,42.7034,149,America's PPO,America's PPO,143.0847,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Macroprolactin, S (Mayo)OutsideLaboratory",,84146,CPT,Facility,Both,,,90,149,126.65,42.7034,149,BlueCross BlueShield Minnesota, Federal Employee Program,146.616,98.4,,percent of total billed charges,,
"Macroprolactin, S (Mayo)OutsideLaboratory",,84146,CPT,Facility,Both,,,90,149,126.65,42.7034,149,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,149,100,,percent of total billed charges,,
"Macroprolactin, S (Mayo)OutsideLaboratory",,84146,CPT,Facility,Both,,,90,149,126.65,42.7034,149,BlueCross BlueShield Minnesota,High Value Network Plan,134.1,90,,percent of total billed charges,,
"Macroprolactin, S (Mayo)OutsideLaboratory",,84146,CPT,Facility,Outpatient,,,90,149,126.65,42.7034,149,BlueCross BlueShield Minnesota,Medicare Advantage,73.01,49,,percent of total billed charges,,
"Macroprolactin, S (Mayo)OutsideLaboratory",,84146,CPT,Facility,Inpatient,,,90,149,126.65,42.7034,149,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Macroprolactin, S (Mayo)OutsideLaboratory",,84146,CPT,Facility,Both,,,90,149,126.65,42.7034,149,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,131.9693,88.57,,percent of total billed charges,,
"Macroprolactin, S (Mayo)OutsideLaboratory",,84146,CPT,Facility,Both,,,90,149,126.65,42.7034,149,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,42.7034,28.66,,percent of total billed charges,,
"Macroprolactin, S (Mayo)OutsideLaboratory",,84146,CPT,Facility,Outpatient,,,90,149,126.65,42.7034,149,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),73.01,49,,percent of total billed charges,,
"Macroprolactin, S (Mayo)OutsideLaboratory",,84146,CPT,Facility,Inpatient,,,90,149,126.65,42.7034,149,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Macroprolactin, S (Mayo)OutsideLaboratory",,84146,CPT,Facility,Both,,,90,149,126.65,42.7034,149,CorVel,Worker's Compensation,149,100,,percent of total billed charges,,
"Macroprolactin, S (Mayo)OutsideLaboratory",,84146,CPT,Facility,Both,,,90,149,126.65,42.7034,149,First Health Group Corporation,First Health Network,144.53,97,,percent of total billed charges,,
"Macroprolactin, S (Mayo)OutsideLaboratory",,84146,CPT,Facility,Both,,,90,149,126.65,42.7034,149,"Health Partners, Inc.",Commercial,140.954,94.6,,percent of total billed charges,,
"Macroprolactin, S (Mayo)OutsideLaboratory",,84146,CPT,Facility,Outpatient,,,90,149,126.65,42.7034,149,"Health Partners, Inc.",Medicare Advantage,73.01,49,,percent of total billed charges,,
"Macroprolactin, S (Mayo)OutsideLaboratory",,84146,CPT,Facility,Inpatient,,,90,149,126.65,42.7034,149,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Macroprolactin, S (Mayo)OutsideLaboratory",,84146,CPT,Facility,Both,,,90,149,126.65,42.7034,149,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),89.4,60,,percent of total billed charges,,
"Macroprolactin, S (Mayo)OutsideLaboratory",,84146,CPT,Facility,Both,,,90,149,126.65,42.7034,149,"Health Partners, Inc.",State of Minnesota Advantage Program,121.435,81.5,,percent of total billed charges,,
"Macroprolactin, S (Mayo)OutsideLaboratory",,84146,CPT,Facility,Both,,,90,149,126.65,42.7034,149,"Health Partners, Inc.",State Public Programs,74.5,50,,percent of total billed charges,,
"Macroprolactin, S (Mayo)OutsideLaboratory",,84146,CPT,Facility,Both,,,90,149,126.65,42.7034,149,Humana Insurance Company,Commercial PPO,141.55,95,,percent of total billed charges,,
"Macroprolactin, S (Mayo)OutsideLaboratory",,84146,CPT,Facility,Outpatient,,,90,149,126.65,42.7034,149,Humana Insurance Company,Medicare PPO,73.01,49,,percent of total billed charges,,
"Macroprolactin, S (Mayo)OutsideLaboratory",,84146,CPT,Facility,Inpatient,,,90,149,126.65,42.7034,149,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Macroprolactin, S (Mayo)OutsideLaboratory",,84146,CPT,Facility,Both,,,90,149,126.65,42.7034,149,Medica,Individual & Family,147.659,99.1,,percent of total billed charges,,
"Macroprolactin, S (Mayo)OutsideLaboratory",,84146,CPT,Facility,Outpatient,,,90,149,126.65,42.7034,149,Medica,Medica Advantage Solution,74.202,49.8,,percent of total billed charges,,
"Macroprolactin, S (Mayo)OutsideLaboratory",,84146,CPT,Facility,Inpatient,,,90,149,126.65,42.7034,149,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Macroprolactin, S (Mayo)OutsideLaboratory",,84146,CPT,Facility,Outpatient,,,90,149,126.65,42.7034,149,Medica,Medical Assistance,66.454,44.6,,percent of total billed charges,,
"Macroprolactin, S (Mayo)OutsideLaboratory",,84146,CPT,Facility,Inpatient,,,90,149,126.65,42.7034,149,Medica,Medical Assistance,,,,,Included in per diem rate,
"Macroprolactin, S (Mayo)OutsideLaboratory",,84146,CPT,Facility,Outpatient,,,90,149,126.65,42.7034,149,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,74.202,49.8,,percent of total billed charges,,
"Macroprolactin, S (Mayo)OutsideLaboratory",,84146,CPT,Facility,Inpatient,,,90,149,126.65,42.7034,149,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Macroprolactin, S (Mayo)OutsideLaboratory",,84146,CPT,Facility,Both,,,90,149,126.65,42.7034,149,"Multiplan, Inc.","Multiplan, Inc.",140.06,94,,percent of total billed charges,,
"Macroprolactin, S (Mayo)OutsideLaboratory",,84146,CPT,Facility,Outpatient,,,90,149,126.65,42.7034,149,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,128.736,86.4,,percent of total billed charges,,
"Macroprolactin, S (Mayo)OutsideLaboratory",,84146,CPT,Facility,Inpatient,,,90,149,126.65,42.7034,149,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Macroprolactin, S (Mayo)OutsideLaboratory",,84146,CPT,Facility,Both,,,90,149,126.65,42.7034,149,"Preferred One Administrative Services, INC.",PPO,146.914,98.6,,percent of total billed charges,,
"Macroprolactin, S (Mayo)OutsideLaboratory",,84146,CPT,Facility,Outpatient,,,90,149,126.65,42.7034,149,PrimeWest Health,Minnesota Senior Health Options (MSHO),76.6605,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Macroprolactin, S (Mayo)OutsideLaboratory",,84146,CPT,Facility,Inpatient,,,90,149,126.65,42.7034,149,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Macroprolactin, S (Mayo)OutsideLaboratory",,84146,CPT,Facility,Outpatient,,,90,149,126.65,42.7034,149,PrimeWest Health,MinnesotaCare,76.5264,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Macroprolactin, S (Mayo)OutsideLaboratory",,84146,CPT,Facility,Inpatient,,,90,149,126.65,42.7034,149,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Macroprolactin, S (Mayo)OutsideLaboratory",,84146,CPT,Facility,Both,,,90,149,126.65,42.7034,149,Sanford Health Plan,Sanford Health Plan,137.08,92,,percent of total billed charges,,
"Macroprolactin, S (Mayo)OutsideLaboratory",,84146,CPT,Facility,Outpatient,,,90,149,126.65,42.7034,149,"UCare Health, Inc.",Individual & Family Plan,83.9615,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Macroprolactin, S (Mayo)OutsideLaboratory",,84146,CPT,Facility,Inpatient,,,90,149,126.65,42.7034,149,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Macroprolactin, S (Mayo)OutsideLaboratory",,84146,CPT,Facility,Outpatient,,,90,149,126.65,42.7034,149,"UCare Health, Inc.",Medical Assistance,75.2003,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Macroprolactin, S (Mayo)OutsideLaboratory",,84146,CPT,Facility,Inpatient,,,90,149,126.65,42.7034,149,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Macroprolactin, S (Mayo)OutsideLaboratory",,84146,CPT,Facility,Outpatient,,,90,149,126.65,42.7034,149,"UCare Health, Inc.",Medicare Advantage,75.2003,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Macroprolactin, S (Mayo)OutsideLaboratory",,84146,CPT,Facility,Inpatient,,,90,149,126.65,42.7034,149,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Macroprolactin, S (Mayo)OutsideLaboratory",,84146,CPT,Facility,Outpatient,,,90,149,126.65,42.7034,149,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),75.2003,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Macroprolactin, S (Mayo)OutsideLaboratory",,84146,CPT,Facility,Inpatient,,,90,149,126.65,42.7034,149,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Macroprolactin, S (Mayo)OutsideLaboratory",,84146,CPT,Facility,Both,,,90,149,126.65,42.7034,149,UnitedHealthcare,Individual & Family,140.06,94,,percent of total billed charges,,
"Macroprolactin, S (Mayo)OutsideLaboratory",,84146,CPT,Facility,Outpatient,,,90,149,126.65,42.7034,149,UnitedHealthcare,Medicare Advantage,73.01,49,,percent of total billed charges,,
"Macroprolactin, S (Mayo)OutsideLaboratory",,84146,CPT,Facility,Inpatient,,,90,149,126.65,42.7034,149,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Macroprolactin, S (Mayo)OutsideLaboratory",,84146,CPT,Facility,Outpatient,,,90,149,126.65,42.7034,149,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,71.52,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Macroprolactin, S (Mayo)OutsideLaboratory",,84146,CPT,Facility,Inpatient,,,90,149,126.65,42.7034,149,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Prostate Specific Antigen (Psa); Free (Mayo)OutsideLaboratory,,84154,CPT,Facility,Both,,,90,102,86.7,29.2332,102,Aetna,Commercial,93.84,92,,percent of total billed charges,,
Prostate Specific Antigen (Psa); Free (Mayo)OutsideLaboratory,,84154,CPT,Facility,Outpatient,,,90,102,86.7,29.2332,102,Aetna,Medicare Advantage,49.98,49,,percent of total billed charges,,
Prostate Specific Antigen (Psa); Free (Mayo)OutsideLaboratory,,84154,CPT,Facility,Inpatient,,,90,102,86.7,29.2332,102,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Prostate Specific Antigen (Psa); Free (Mayo)OutsideLaboratory,,84154,CPT,Facility,Both,,,90,102,86.7,29.2332,102,Aetna,PPO,94.86,93,,percent of total billed charges,,
Prostate Specific Antigen (Psa); Free (Mayo)OutsideLaboratory,,84154,CPT,Facility,Both,,,90,102,86.7,29.2332,102,America's PPO,America's PPO,97.9506,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Prostate Specific Antigen (Psa); Free (Mayo)OutsideLaboratory,,84154,CPT,Facility,Both,,,90,102,86.7,29.2332,102,BlueCross BlueShield Minnesota, Federal Employee Program,100.368,98.4,,percent of total billed charges,,
Prostate Specific Antigen (Psa); Free (Mayo)OutsideLaboratory,,84154,CPT,Facility,Both,,,90,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,102,100,,percent of total billed charges,,
Prostate Specific Antigen (Psa); Free (Mayo)OutsideLaboratory,,84154,CPT,Facility,Both,,,90,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,High Value Network Plan,91.8,90,,percent of total billed charges,,
Prostate Specific Antigen (Psa); Free (Mayo)OutsideLaboratory,,84154,CPT,Facility,Outpatient,,,90,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,Medicare Advantage,49.98,49,,percent of total billed charges,,
Prostate Specific Antigen (Psa); Free (Mayo)OutsideLaboratory,,84154,CPT,Facility,Inpatient,,,90,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Prostate Specific Antigen (Psa); Free (Mayo)OutsideLaboratory,,84154,CPT,Facility,Both,,,90,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,90.3414,88.57,,percent of total billed charges,,
Prostate Specific Antigen (Psa); Free (Mayo)OutsideLaboratory,,84154,CPT,Facility,Both,,,90,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,29.2332,28.66,,percent of total billed charges,,
Prostate Specific Antigen (Psa); Free (Mayo)OutsideLaboratory,,84154,CPT,Facility,Outpatient,,,90,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),49.98,49,,percent of total billed charges,,
Prostate Specific Antigen (Psa); Free (Mayo)OutsideLaboratory,,84154,CPT,Facility,Inpatient,,,90,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Prostate Specific Antigen (Psa); Free (Mayo)OutsideLaboratory,,84154,CPT,Facility,Both,,,90,102,86.7,29.2332,102,CorVel,Worker's Compensation,102,100,,percent of total billed charges,,
Prostate Specific Antigen (Psa); Free (Mayo)OutsideLaboratory,,84154,CPT,Facility,Both,,,90,102,86.7,29.2332,102,First Health Group Corporation,First Health Network,98.94,97,,percent of total billed charges,,
Prostate Specific Antigen (Psa); Free (Mayo)OutsideLaboratory,,84154,CPT,Facility,Both,,,90,102,86.7,29.2332,102,"Health Partners, Inc.",Commercial,96.492,94.6,,percent of total billed charges,,
Prostate Specific Antigen (Psa); Free (Mayo)OutsideLaboratory,,84154,CPT,Facility,Outpatient,,,90,102,86.7,29.2332,102,"Health Partners, Inc.",Medicare Advantage,49.98,49,,percent of total billed charges,,
Prostate Specific Antigen (Psa); Free (Mayo)OutsideLaboratory,,84154,CPT,Facility,Inpatient,,,90,102,86.7,29.2332,102,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Prostate Specific Antigen (Psa); Free (Mayo)OutsideLaboratory,,84154,CPT,Facility,Both,,,90,102,86.7,29.2332,102,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),61.2,60,,percent of total billed charges,,
Prostate Specific Antigen (Psa); Free (Mayo)OutsideLaboratory,,84154,CPT,Facility,Both,,,90,102,86.7,29.2332,102,"Health Partners, Inc.",State of Minnesota Advantage Program,83.13,81.5,,percent of total billed charges,,
Prostate Specific Antigen (Psa); Free (Mayo)OutsideLaboratory,,84154,CPT,Facility,Both,,,90,102,86.7,29.2332,102,"Health Partners, Inc.",State Public Programs,51,50,,percent of total billed charges,,
Prostate Specific Antigen (Psa); Free (Mayo)OutsideLaboratory,,84154,CPT,Facility,Both,,,90,102,86.7,29.2332,102,Humana Insurance Company,Commercial PPO,96.9,95,,percent of total billed charges,,
Prostate Specific Antigen (Psa); Free (Mayo)OutsideLaboratory,,84154,CPT,Facility,Outpatient,,,90,102,86.7,29.2332,102,Humana Insurance Company,Medicare PPO,49.98,49,,percent of total billed charges,,
Prostate Specific Antigen (Psa); Free (Mayo)OutsideLaboratory,,84154,CPT,Facility,Inpatient,,,90,102,86.7,29.2332,102,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Prostate Specific Antigen (Psa); Free (Mayo)OutsideLaboratory,,84154,CPT,Facility,Both,,,90,102,86.7,29.2332,102,Medica,Individual & Family,101.082,99.1,,percent of total billed charges,,
Prostate Specific Antigen (Psa); Free (Mayo)OutsideLaboratory,,84154,CPT,Facility,Outpatient,,,90,102,86.7,29.2332,102,Medica,Medica Advantage Solution,50.796,49.8,,percent of total billed charges,,
Prostate Specific Antigen (Psa); Free (Mayo)OutsideLaboratory,,84154,CPT,Facility,Inpatient,,,90,102,86.7,29.2332,102,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Prostate Specific Antigen (Psa); Free (Mayo)OutsideLaboratory,,84154,CPT,Facility,Outpatient,,,90,102,86.7,29.2332,102,Medica,Medical Assistance,45.492,44.6,,percent of total billed charges,,
Prostate Specific Antigen (Psa); Free (Mayo)OutsideLaboratory,,84154,CPT,Facility,Inpatient,,,90,102,86.7,29.2332,102,Medica,Medical Assistance,,,,,Included in per diem rate,
Prostate Specific Antigen (Psa); Free (Mayo)OutsideLaboratory,,84154,CPT,Facility,Outpatient,,,90,102,86.7,29.2332,102,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,50.796,49.8,,percent of total billed charges,,
Prostate Specific Antigen (Psa); Free (Mayo)OutsideLaboratory,,84154,CPT,Facility,Inpatient,,,90,102,86.7,29.2332,102,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Prostate Specific Antigen (Psa); Free (Mayo)OutsideLaboratory,,84154,CPT,Facility,Both,,,90,102,86.7,29.2332,102,"Multiplan, Inc.","Multiplan, Inc.",95.88,94,,percent of total billed charges,,
Prostate Specific Antigen (Psa); Free (Mayo)OutsideLaboratory,,84154,CPT,Facility,Outpatient,,,90,102,86.7,29.2332,102,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,88.128,86.4,,percent of total billed charges,,
Prostate Specific Antigen (Psa); Free (Mayo)OutsideLaboratory,,84154,CPT,Facility,Inpatient,,,90,102,86.7,29.2332,102,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Prostate Specific Antigen (Psa); Free (Mayo)OutsideLaboratory,,84154,CPT,Facility,Both,,,90,102,86.7,29.2332,102,"Preferred One Administrative Services, INC.",PPO,100.572,98.6,,percent of total billed charges,,
Prostate Specific Antigen (Psa); Free (Mayo)OutsideLaboratory,,84154,CPT,Facility,Outpatient,,,90,102,86.7,29.2332,102,PrimeWest Health,Minnesota Senior Health Options (MSHO),52.479,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Prostate Specific Antigen (Psa); Free (Mayo)OutsideLaboratory,,84154,CPT,Facility,Inpatient,,,90,102,86.7,29.2332,102,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Prostate Specific Antigen (Psa); Free (Mayo)OutsideLaboratory,,84154,CPT,Facility,Outpatient,,,90,102,86.7,29.2332,102,PrimeWest Health,MinnesotaCare,52.3872,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Prostate Specific Antigen (Psa); Free (Mayo)OutsideLaboratory,,84154,CPT,Facility,Inpatient,,,90,102,86.7,29.2332,102,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Prostate Specific Antigen (Psa); Free (Mayo)OutsideLaboratory,,84154,CPT,Facility,Both,,,90,102,86.7,29.2332,102,Sanford Health Plan,Sanford Health Plan,93.84,92,,percent of total billed charges,,
Prostate Specific Antigen (Psa); Free (Mayo)OutsideLaboratory,,84154,CPT,Facility,Outpatient,,,90,102,86.7,29.2332,102,"UCare Health, Inc.",Individual & Family Plan,57.477,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Prostate Specific Antigen (Psa); Free (Mayo)OutsideLaboratory,,84154,CPT,Facility,Inpatient,,,90,102,86.7,29.2332,102,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Prostate Specific Antigen (Psa); Free (Mayo)OutsideLaboratory,,84154,CPT,Facility,Outpatient,,,90,102,86.7,29.2332,102,"UCare Health, Inc.",Medical Assistance,51.4794,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Prostate Specific Antigen (Psa); Free (Mayo)OutsideLaboratory,,84154,CPT,Facility,Inpatient,,,90,102,86.7,29.2332,102,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Prostate Specific Antigen (Psa); Free (Mayo)OutsideLaboratory,,84154,CPT,Facility,Outpatient,,,90,102,86.7,29.2332,102,"UCare Health, Inc.",Medicare Advantage,51.4794,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Prostate Specific Antigen (Psa); Free (Mayo)OutsideLaboratory,,84154,CPT,Facility,Inpatient,,,90,102,86.7,29.2332,102,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Prostate Specific Antigen (Psa); Free (Mayo)OutsideLaboratory,,84154,CPT,Facility,Outpatient,,,90,102,86.7,29.2332,102,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),51.4794,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Prostate Specific Antigen (Psa); Free (Mayo)OutsideLaboratory,,84154,CPT,Facility,Inpatient,,,90,102,86.7,29.2332,102,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Prostate Specific Antigen (Psa); Free (Mayo)OutsideLaboratory,,84154,CPT,Facility,Both,,,90,102,86.7,29.2332,102,UnitedHealthcare,Individual & Family,95.88,94,,percent of total billed charges,,
Prostate Specific Antigen (Psa); Free (Mayo)OutsideLaboratory,,84154,CPT,Facility,Outpatient,,,90,102,86.7,29.2332,102,UnitedHealthcare,Medicare Advantage,49.98,49,,percent of total billed charges,,
Prostate Specific Antigen (Psa); Free (Mayo)OutsideLaboratory,,84154,CPT,Facility,Inpatient,,,90,102,86.7,29.2332,102,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Prostate Specific Antigen (Psa); Free (Mayo)OutsideLaboratory,,84154,CPT,Facility,Outpatient,,,90,102,86.7,29.2332,102,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,48.96,48,,percent of total billed charges,,100% of DHS outpatient percentage
Prostate Specific Antigen (Psa); Free (Mayo)OutsideLaboratory,,84154,CPT,Facility,Inpatient,,,90,102,86.7,29.2332,102,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Protein, Total, Except By Refractometry, S (Mayo)OutsideLaboratory",,84155,CPT,Facility,Both,,,90,103,87.55,29.5198,103,Aetna,Commercial,94.76,92,,percent of total billed charges,,
"Protein, Total, Except By Refractometry, S (Mayo)OutsideLaboratory",,84155,CPT,Facility,Outpatient,,,90,103,87.55,29.5198,103,Aetna,Medicare Advantage,50.47,49,,percent of total billed charges,,
"Protein, Total, Except By Refractometry, S (Mayo)OutsideLaboratory",,84155,CPT,Facility,Inpatient,,,90,103,87.55,29.5198,103,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Protein, Total, Except By Refractometry, S (Mayo)OutsideLaboratory",,84155,CPT,Facility,Both,,,90,103,87.55,29.5198,103,Aetna,PPO,95.79,93,,percent of total billed charges,,
"Protein, Total, Except By Refractometry, S (Mayo)OutsideLaboratory",,84155,CPT,Facility,Both,,,90,103,87.55,29.5198,103,America's PPO,America's PPO,98.9109,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Protein, Total, Except By Refractometry, S (Mayo)OutsideLaboratory",,84155,CPT,Facility,Both,,,90,103,87.55,29.5198,103,BlueCross BlueShield Minnesota, Federal Employee Program,101.352,98.4,,percent of total billed charges,,
"Protein, Total, Except By Refractometry, S (Mayo)OutsideLaboratory",,84155,CPT,Facility,Both,,,90,103,87.55,29.5198,103,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,103,100,,percent of total billed charges,,
"Protein, Total, Except By Refractometry, S (Mayo)OutsideLaboratory",,84155,CPT,Facility,Both,,,90,103,87.55,29.5198,103,BlueCross BlueShield Minnesota,High Value Network Plan,92.7,90,,percent of total billed charges,,
"Protein, Total, Except By Refractometry, S (Mayo)OutsideLaboratory",,84155,CPT,Facility,Outpatient,,,90,103,87.55,29.5198,103,BlueCross BlueShield Minnesota,Medicare Advantage,50.47,49,,percent of total billed charges,,
"Protein, Total, Except By Refractometry, S (Mayo)OutsideLaboratory",,84155,CPT,Facility,Inpatient,,,90,103,87.55,29.5198,103,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Protein, Total, Except By Refractometry, S (Mayo)OutsideLaboratory",,84155,CPT,Facility,Both,,,90,103,87.55,29.5198,103,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,91.2271,88.57,,percent of total billed charges,,
"Protein, Total, Except By Refractometry, S (Mayo)OutsideLaboratory",,84155,CPT,Facility,Both,,,90,103,87.55,29.5198,103,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,29.5198,28.66,,percent of total billed charges,,
"Protein, Total, Except By Refractometry, S (Mayo)OutsideLaboratory",,84155,CPT,Facility,Outpatient,,,90,103,87.55,29.5198,103,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),50.47,49,,percent of total billed charges,,
"Protein, Total, Except By Refractometry, S (Mayo)OutsideLaboratory",,84155,CPT,Facility,Inpatient,,,90,103,87.55,29.5198,103,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Protein, Total, Except By Refractometry, S (Mayo)OutsideLaboratory",,84155,CPT,Facility,Both,,,90,103,87.55,29.5198,103,CorVel,Worker's Compensation,103,100,,percent of total billed charges,,
"Protein, Total, Except By Refractometry, S (Mayo)OutsideLaboratory",,84155,CPT,Facility,Both,,,90,103,87.55,29.5198,103,First Health Group Corporation,First Health Network,99.91,97,,percent of total billed charges,,
"Protein, Total, Except By Refractometry, S (Mayo)OutsideLaboratory",,84155,CPT,Facility,Both,,,90,103,87.55,29.5198,103,"Health Partners, Inc.",Commercial,97.438,94.6,,percent of total billed charges,,
"Protein, Total, Except By Refractometry, S (Mayo)OutsideLaboratory",,84155,CPT,Facility,Outpatient,,,90,103,87.55,29.5198,103,"Health Partners, Inc.",Medicare Advantage,50.47,49,,percent of total billed charges,,
"Protein, Total, Except By Refractometry, S (Mayo)OutsideLaboratory",,84155,CPT,Facility,Inpatient,,,90,103,87.55,29.5198,103,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Protein, Total, Except By Refractometry, S (Mayo)OutsideLaboratory",,84155,CPT,Facility,Both,,,90,103,87.55,29.5198,103,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),61.8,60,,percent of total billed charges,,
"Protein, Total, Except By Refractometry, S (Mayo)OutsideLaboratory",,84155,CPT,Facility,Both,,,90,103,87.55,29.5198,103,"Health Partners, Inc.",State of Minnesota Advantage Program,83.945,81.5,,percent of total billed charges,,
"Protein, Total, Except By Refractometry, S (Mayo)OutsideLaboratory",,84155,CPT,Facility,Both,,,90,103,87.55,29.5198,103,"Health Partners, Inc.",State Public Programs,51.5,50,,percent of total billed charges,,
"Protein, Total, Except By Refractometry, S (Mayo)OutsideLaboratory",,84155,CPT,Facility,Both,,,90,103,87.55,29.5198,103,Humana Insurance Company,Commercial PPO,97.85,95,,percent of total billed charges,,
"Protein, Total, Except By Refractometry, S (Mayo)OutsideLaboratory",,84155,CPT,Facility,Outpatient,,,90,103,87.55,29.5198,103,Humana Insurance Company,Medicare PPO,50.47,49,,percent of total billed charges,,
"Protein, Total, Except By Refractometry, S (Mayo)OutsideLaboratory",,84155,CPT,Facility,Inpatient,,,90,103,87.55,29.5198,103,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Protein, Total, Except By Refractometry, S (Mayo)OutsideLaboratory",,84155,CPT,Facility,Both,,,90,103,87.55,29.5198,103,Medica,Individual & Family,102.073,99.1,,percent of total billed charges,,
"Protein, Total, Except By Refractometry, S (Mayo)OutsideLaboratory",,84155,CPT,Facility,Outpatient,,,90,103,87.55,29.5198,103,Medica,Medica Advantage Solution,51.294,49.8,,percent of total billed charges,,
"Protein, Total, Except By Refractometry, S (Mayo)OutsideLaboratory",,84155,CPT,Facility,Inpatient,,,90,103,87.55,29.5198,103,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Protein, Total, Except By Refractometry, S (Mayo)OutsideLaboratory",,84155,CPT,Facility,Outpatient,,,90,103,87.55,29.5198,103,Medica,Medical Assistance,45.938,44.6,,percent of total billed charges,,
"Protein, Total, Except By Refractometry, S (Mayo)OutsideLaboratory",,84155,CPT,Facility,Inpatient,,,90,103,87.55,29.5198,103,Medica,Medical Assistance,,,,,Included in per diem rate,
"Protein, Total, Except By Refractometry, S (Mayo)OutsideLaboratory",,84155,CPT,Facility,Outpatient,,,90,103,87.55,29.5198,103,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,51.294,49.8,,percent of total billed charges,,
"Protein, Total, Except By Refractometry, S (Mayo)OutsideLaboratory",,84155,CPT,Facility,Inpatient,,,90,103,87.55,29.5198,103,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Protein, Total, Except By Refractometry, S (Mayo)OutsideLaboratory",,84155,CPT,Facility,Both,,,90,103,87.55,29.5198,103,"Multiplan, Inc.","Multiplan, Inc.",96.82,94,,percent of total billed charges,,
"Protein, Total, Except By Refractometry, S (Mayo)OutsideLaboratory",,84155,CPT,Facility,Outpatient,,,90,103,87.55,29.5198,103,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,88.992,86.4,,percent of total billed charges,,
"Protein, Total, Except By Refractometry, S (Mayo)OutsideLaboratory",,84155,CPT,Facility,Inpatient,,,90,103,87.55,29.5198,103,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Protein, Total, Except By Refractometry, S (Mayo)OutsideLaboratory",,84155,CPT,Facility,Both,,,90,103,87.55,29.5198,103,"Preferred One Administrative Services, INC.",PPO,101.558,98.6,,percent of total billed charges,,
"Protein, Total, Except By Refractometry, S (Mayo)OutsideLaboratory",,84155,CPT,Facility,Outpatient,,,90,103,87.55,29.5198,103,PrimeWest Health,Minnesota Senior Health Options (MSHO),52.9935,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Protein, Total, Except By Refractometry, S (Mayo)OutsideLaboratory",,84155,CPT,Facility,Inpatient,,,90,103,87.55,29.5198,103,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Protein, Total, Except By Refractometry, S (Mayo)OutsideLaboratory",,84155,CPT,Facility,Outpatient,,,90,103,87.55,29.5198,103,PrimeWest Health,MinnesotaCare,52.9008,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Protein, Total, Except By Refractometry, S (Mayo)OutsideLaboratory",,84155,CPT,Facility,Inpatient,,,90,103,87.55,29.5198,103,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Protein, Total, Except By Refractometry, S (Mayo)OutsideLaboratory",,84155,CPT,Facility,Both,,,90,103,87.55,29.5198,103,Sanford Health Plan,Sanford Health Plan,94.76,92,,percent of total billed charges,,
"Protein, Total, Except By Refractometry, S (Mayo)OutsideLaboratory",,84155,CPT,Facility,Outpatient,,,90,103,87.55,29.5198,103,"UCare Health, Inc.",Individual & Family Plan,58.0405,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Protein, Total, Except By Refractometry, S (Mayo)OutsideLaboratory",,84155,CPT,Facility,Inpatient,,,90,103,87.55,29.5198,103,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Protein, Total, Except By Refractometry, S (Mayo)OutsideLaboratory",,84155,CPT,Facility,Outpatient,,,90,103,87.55,29.5198,103,"UCare Health, Inc.",Medical Assistance,51.9841,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Protein, Total, Except By Refractometry, S (Mayo)OutsideLaboratory",,84155,CPT,Facility,Inpatient,,,90,103,87.55,29.5198,103,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Protein, Total, Except By Refractometry, S (Mayo)OutsideLaboratory",,84155,CPT,Facility,Outpatient,,,90,103,87.55,29.5198,103,"UCare Health, Inc.",Medicare Advantage,51.9841,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Protein, Total, Except By Refractometry, S (Mayo)OutsideLaboratory",,84155,CPT,Facility,Inpatient,,,90,103,87.55,29.5198,103,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Protein, Total, Except By Refractometry, S (Mayo)OutsideLaboratory",,84155,CPT,Facility,Outpatient,,,90,103,87.55,29.5198,103,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),51.9841,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Protein, Total, Except By Refractometry, S (Mayo)OutsideLaboratory",,84155,CPT,Facility,Inpatient,,,90,103,87.55,29.5198,103,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Protein, Total, Except By Refractometry, S (Mayo)OutsideLaboratory",,84155,CPT,Facility,Both,,,90,103,87.55,29.5198,103,UnitedHealthcare,Individual & Family,96.82,94,,percent of total billed charges,,
"Protein, Total, Except By Refractometry, S (Mayo)OutsideLaboratory",,84155,CPT,Facility,Outpatient,,,90,103,87.55,29.5198,103,UnitedHealthcare,Medicare Advantage,50.47,49,,percent of total billed charges,,
"Protein, Total, Except By Refractometry, S (Mayo)OutsideLaboratory",,84155,CPT,Facility,Inpatient,,,90,103,87.55,29.5198,103,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Protein, Total, Except By Refractometry, S (Mayo)OutsideLaboratory",,84155,CPT,Facility,Outpatient,,,90,103,87.55,29.5198,103,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,49.44,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Protein, Total, Except By Refractometry, S (Mayo)OutsideLaboratory",,84155,CPT,Facility,Inpatient,,,90,103,87.55,29.5198,103,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Protein Total (Mayo)OutsideLaboratory,,84156,CPT,Facility,Both,,,90,60,51,17.196,60,Aetna,Commercial,55.2,92,,percent of total billed charges,,
Protein Total (Mayo)OutsideLaboratory,,84156,CPT,Facility,Outpatient,,,90,60,51,17.196,60,Aetna,Medicare Advantage,29.4,49,,percent of total billed charges,,
Protein Total (Mayo)OutsideLaboratory,,84156,CPT,Facility,Inpatient,,,90,60,51,17.196,60,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Protein Total (Mayo)OutsideLaboratory,,84156,CPT,Facility,Both,,,90,60,51,17.196,60,Aetna,PPO,55.8,93,,percent of total billed charges,,
Protein Total (Mayo)OutsideLaboratory,,84156,CPT,Facility,Both,,,90,60,51,17.196,60,America's PPO,America's PPO,57.618,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Protein Total (Mayo)OutsideLaboratory,,84156,CPT,Facility,Both,,,90,60,51,17.196,60,BlueCross BlueShield Minnesota, Federal Employee Program,59.04,98.4,,percent of total billed charges,,
Protein Total (Mayo)OutsideLaboratory,,84156,CPT,Facility,Both,,,90,60,51,17.196,60,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,60,100,,percent of total billed charges,,
Protein Total (Mayo)OutsideLaboratory,,84156,CPT,Facility,Both,,,90,60,51,17.196,60,BlueCross BlueShield Minnesota,High Value Network Plan,54,90,,percent of total billed charges,,
Protein Total (Mayo)OutsideLaboratory,,84156,CPT,Facility,Outpatient,,,90,60,51,17.196,60,BlueCross BlueShield Minnesota,Medicare Advantage,29.4,49,,percent of total billed charges,,
Protein Total (Mayo)OutsideLaboratory,,84156,CPT,Facility,Inpatient,,,90,60,51,17.196,60,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Protein Total (Mayo)OutsideLaboratory,,84156,CPT,Facility,Both,,,90,60,51,17.196,60,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,53.142,88.57,,percent of total billed charges,,
Protein Total (Mayo)OutsideLaboratory,,84156,CPT,Facility,Both,,,90,60,51,17.196,60,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,17.196,28.66,,percent of total billed charges,,
Protein Total (Mayo)OutsideLaboratory,,84156,CPT,Facility,Outpatient,,,90,60,51,17.196,60,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),29.4,49,,percent of total billed charges,,
Protein Total (Mayo)OutsideLaboratory,,84156,CPT,Facility,Inpatient,,,90,60,51,17.196,60,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Protein Total (Mayo)OutsideLaboratory,,84156,CPT,Facility,Both,,,90,60,51,17.196,60,CorVel,Worker's Compensation,60,100,,percent of total billed charges,,
Protein Total (Mayo)OutsideLaboratory,,84156,CPT,Facility,Both,,,90,60,51,17.196,60,First Health Group Corporation,First Health Network,58.2,97,,percent of total billed charges,,
Protein Total (Mayo)OutsideLaboratory,,84156,CPT,Facility,Both,,,90,60,51,17.196,60,"Health Partners, Inc.",Commercial,56.76,94.6,,percent of total billed charges,,
Protein Total (Mayo)OutsideLaboratory,,84156,CPT,Facility,Outpatient,,,90,60,51,17.196,60,"Health Partners, Inc.",Medicare Advantage,29.4,49,,percent of total billed charges,,
Protein Total (Mayo)OutsideLaboratory,,84156,CPT,Facility,Inpatient,,,90,60,51,17.196,60,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Protein Total (Mayo)OutsideLaboratory,,84156,CPT,Facility,Both,,,90,60,51,17.196,60,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),36,60,,percent of total billed charges,,
Protein Total (Mayo)OutsideLaboratory,,84156,CPT,Facility,Both,,,90,60,51,17.196,60,"Health Partners, Inc.",State of Minnesota Advantage Program,48.9,81.5,,percent of total billed charges,,
Protein Total (Mayo)OutsideLaboratory,,84156,CPT,Facility,Both,,,90,60,51,17.196,60,"Health Partners, Inc.",State Public Programs,30,50,,percent of total billed charges,,
Protein Total (Mayo)OutsideLaboratory,,84156,CPT,Facility,Both,,,90,60,51,17.196,60,Humana Insurance Company,Commercial PPO,57,95,,percent of total billed charges,,
Protein Total (Mayo)OutsideLaboratory,,84156,CPT,Facility,Outpatient,,,90,60,51,17.196,60,Humana Insurance Company,Medicare PPO,29.4,49,,percent of total billed charges,,
Protein Total (Mayo)OutsideLaboratory,,84156,CPT,Facility,Inpatient,,,90,60,51,17.196,60,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Protein Total (Mayo)OutsideLaboratory,,84156,CPT,Facility,Both,,,90,60,51,17.196,60,Medica,Individual & Family,59.46,99.1,,percent of total billed charges,,
Protein Total (Mayo)OutsideLaboratory,,84156,CPT,Facility,Outpatient,,,90,60,51,17.196,60,Medica,Medica Advantage Solution,29.88,49.8,,percent of total billed charges,,
Protein Total (Mayo)OutsideLaboratory,,84156,CPT,Facility,Inpatient,,,90,60,51,17.196,60,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Protein Total (Mayo)OutsideLaboratory,,84156,CPT,Facility,Outpatient,,,90,60,51,17.196,60,Medica,Medical Assistance,26.76,44.6,,percent of total billed charges,,
Protein Total (Mayo)OutsideLaboratory,,84156,CPT,Facility,Inpatient,,,90,60,51,17.196,60,Medica,Medical Assistance,,,,,Included in per diem rate,
Protein Total (Mayo)OutsideLaboratory,,84156,CPT,Facility,Outpatient,,,90,60,51,17.196,60,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,29.88,49.8,,percent of total billed charges,,
Protein Total (Mayo)OutsideLaboratory,,84156,CPT,Facility,Inpatient,,,90,60,51,17.196,60,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Protein Total (Mayo)OutsideLaboratory,,84156,CPT,Facility,Both,,,90,60,51,17.196,60,"Multiplan, Inc.","Multiplan, Inc.",56.4,94,,percent of total billed charges,,
Protein Total (Mayo)OutsideLaboratory,,84156,CPT,Facility,Outpatient,,,90,60,51,17.196,60,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,51.84,86.4,,percent of total billed charges,,
Protein Total (Mayo)OutsideLaboratory,,84156,CPT,Facility,Inpatient,,,90,60,51,17.196,60,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Protein Total (Mayo)OutsideLaboratory,,84156,CPT,Facility,Both,,,90,60,51,17.196,60,"Preferred One Administrative Services, INC.",PPO,59.16,98.6,,percent of total billed charges,,
Protein Total (Mayo)OutsideLaboratory,,84156,CPT,Facility,Outpatient,,,90,60,51,17.196,60,PrimeWest Health,Minnesota Senior Health Options (MSHO),30.87,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Protein Total (Mayo)OutsideLaboratory,,84156,CPT,Facility,Inpatient,,,90,60,51,17.196,60,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Protein Total (Mayo)OutsideLaboratory,,84156,CPT,Facility,Outpatient,,,90,60,51,17.196,60,PrimeWest Health,MinnesotaCare,30.816,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Protein Total (Mayo)OutsideLaboratory,,84156,CPT,Facility,Inpatient,,,90,60,51,17.196,60,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Protein Total (Mayo)OutsideLaboratory,,84156,CPT,Facility,Both,,,90,60,51,17.196,60,Sanford Health Plan,Sanford Health Plan,55.2,92,,percent of total billed charges,,
Protein Total (Mayo)OutsideLaboratory,,84156,CPT,Facility,Outpatient,,,90,60,51,17.196,60,"UCare Health, Inc.",Individual & Family Plan,33.81,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Protein Total (Mayo)OutsideLaboratory,,84156,CPT,Facility,Inpatient,,,90,60,51,17.196,60,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Protein Total (Mayo)OutsideLaboratory,,84156,CPT,Facility,Outpatient,,,90,60,51,17.196,60,"UCare Health, Inc.",Medical Assistance,30.282,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Protein Total (Mayo)OutsideLaboratory,,84156,CPT,Facility,Inpatient,,,90,60,51,17.196,60,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Protein Total (Mayo)OutsideLaboratory,,84156,CPT,Facility,Outpatient,,,90,60,51,17.196,60,"UCare Health, Inc.",Medicare Advantage,30.282,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Protein Total (Mayo)OutsideLaboratory,,84156,CPT,Facility,Inpatient,,,90,60,51,17.196,60,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Protein Total (Mayo)OutsideLaboratory,,84156,CPT,Facility,Outpatient,,,90,60,51,17.196,60,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),30.282,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Protein Total (Mayo)OutsideLaboratory,,84156,CPT,Facility,Inpatient,,,90,60,51,17.196,60,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Protein Total (Mayo)OutsideLaboratory,,84156,CPT,Facility,Both,,,90,60,51,17.196,60,UnitedHealthcare,Individual & Family,56.4,94,,percent of total billed charges,,
Protein Total (Mayo)OutsideLaboratory,,84156,CPT,Facility,Outpatient,,,90,60,51,17.196,60,UnitedHealthcare,Medicare Advantage,29.4,49,,percent of total billed charges,,
Protein Total (Mayo)OutsideLaboratory,,84156,CPT,Facility,Inpatient,,,90,60,51,17.196,60,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Protein Total (Mayo)OutsideLaboratory,,84156,CPT,Facility,Outpatient,,,90,60,51,17.196,60,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,28.8,48,,percent of total billed charges,,100% of DHS outpatient percentage
Protein Total (Mayo)OutsideLaboratory,,84156,CPT,Facility,Inpatient,,,90,60,51,17.196,60,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Pyridoxal 5-Phosphate, P (Mayo)OutsideLaboratory",,84207,CPT,Facility,Both,,,90,94,79.9,26.9404,94,Aetna,Commercial,86.48,92,,percent of total billed charges,,
"Pyridoxal 5-Phosphate, P (Mayo)OutsideLaboratory",,84207,CPT,Facility,Outpatient,,,90,94,79.9,26.9404,94,Aetna,Medicare Advantage,46.06,49,,percent of total billed charges,,
"Pyridoxal 5-Phosphate, P (Mayo)OutsideLaboratory",,84207,CPT,Facility,Inpatient,,,90,94,79.9,26.9404,94,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Pyridoxal 5-Phosphate, P (Mayo)OutsideLaboratory",,84207,CPT,Facility,Both,,,90,94,79.9,26.9404,94,Aetna,PPO,87.42,93,,percent of total billed charges,,
"Pyridoxal 5-Phosphate, P (Mayo)OutsideLaboratory",,84207,CPT,Facility,Both,,,90,94,79.9,26.9404,94,America's PPO,America's PPO,90.2682,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Pyridoxal 5-Phosphate, P (Mayo)OutsideLaboratory",,84207,CPT,Facility,Both,,,90,94,79.9,26.9404,94,BlueCross BlueShield Minnesota, Federal Employee Program,92.496,98.4,,percent of total billed charges,,
"Pyridoxal 5-Phosphate, P (Mayo)OutsideLaboratory",,84207,CPT,Facility,Both,,,90,94,79.9,26.9404,94,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,94,100,,percent of total billed charges,,
"Pyridoxal 5-Phosphate, P (Mayo)OutsideLaboratory",,84207,CPT,Facility,Both,,,90,94,79.9,26.9404,94,BlueCross BlueShield Minnesota,High Value Network Plan,84.6,90,,percent of total billed charges,,
"Pyridoxal 5-Phosphate, P (Mayo)OutsideLaboratory",,84207,CPT,Facility,Outpatient,,,90,94,79.9,26.9404,94,BlueCross BlueShield Minnesota,Medicare Advantage,46.06,49,,percent of total billed charges,,
"Pyridoxal 5-Phosphate, P (Mayo)OutsideLaboratory",,84207,CPT,Facility,Inpatient,,,90,94,79.9,26.9404,94,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Pyridoxal 5-Phosphate, P (Mayo)OutsideLaboratory",,84207,CPT,Facility,Both,,,90,94,79.9,26.9404,94,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,83.2558,88.57,,percent of total billed charges,,
"Pyridoxal 5-Phosphate, P (Mayo)OutsideLaboratory",,84207,CPT,Facility,Both,,,90,94,79.9,26.9404,94,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,26.9404,28.66,,percent of total billed charges,,
"Pyridoxal 5-Phosphate, P (Mayo)OutsideLaboratory",,84207,CPT,Facility,Outpatient,,,90,94,79.9,26.9404,94,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),46.06,49,,percent of total billed charges,,
"Pyridoxal 5-Phosphate, P (Mayo)OutsideLaboratory",,84207,CPT,Facility,Inpatient,,,90,94,79.9,26.9404,94,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Pyridoxal 5-Phosphate, P (Mayo)OutsideLaboratory",,84207,CPT,Facility,Both,,,90,94,79.9,26.9404,94,CorVel,Worker's Compensation,94,100,,percent of total billed charges,,
"Pyridoxal 5-Phosphate, P (Mayo)OutsideLaboratory",,84207,CPT,Facility,Both,,,90,94,79.9,26.9404,94,First Health Group Corporation,First Health Network,91.18,97,,percent of total billed charges,,
"Pyridoxal 5-Phosphate, P (Mayo)OutsideLaboratory",,84207,CPT,Facility,Both,,,90,94,79.9,26.9404,94,"Health Partners, Inc.",Commercial,88.924,94.6,,percent of total billed charges,,
"Pyridoxal 5-Phosphate, P (Mayo)OutsideLaboratory",,84207,CPT,Facility,Outpatient,,,90,94,79.9,26.9404,94,"Health Partners, Inc.",Medicare Advantage,46.06,49,,percent of total billed charges,,
"Pyridoxal 5-Phosphate, P (Mayo)OutsideLaboratory",,84207,CPT,Facility,Inpatient,,,90,94,79.9,26.9404,94,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Pyridoxal 5-Phosphate, P (Mayo)OutsideLaboratory",,84207,CPT,Facility,Both,,,90,94,79.9,26.9404,94,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),56.4,60,,percent of total billed charges,,
"Pyridoxal 5-Phosphate, P (Mayo)OutsideLaboratory",,84207,CPT,Facility,Both,,,90,94,79.9,26.9404,94,"Health Partners, Inc.",State of Minnesota Advantage Program,76.61,81.5,,percent of total billed charges,,
"Pyridoxal 5-Phosphate, P (Mayo)OutsideLaboratory",,84207,CPT,Facility,Both,,,90,94,79.9,26.9404,94,"Health Partners, Inc.",State Public Programs,47,50,,percent of total billed charges,,
"Pyridoxal 5-Phosphate, P (Mayo)OutsideLaboratory",,84207,CPT,Facility,Both,,,90,94,79.9,26.9404,94,Humana Insurance Company,Commercial PPO,89.3,95,,percent of total billed charges,,
"Pyridoxal 5-Phosphate, P (Mayo)OutsideLaboratory",,84207,CPT,Facility,Outpatient,,,90,94,79.9,26.9404,94,Humana Insurance Company,Medicare PPO,46.06,49,,percent of total billed charges,,
"Pyridoxal 5-Phosphate, P (Mayo)OutsideLaboratory",,84207,CPT,Facility,Inpatient,,,90,94,79.9,26.9404,94,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Pyridoxal 5-Phosphate, P (Mayo)OutsideLaboratory",,84207,CPT,Facility,Both,,,90,94,79.9,26.9404,94,Medica,Individual & Family,93.154,99.1,,percent of total billed charges,,
"Pyridoxal 5-Phosphate, P (Mayo)OutsideLaboratory",,84207,CPT,Facility,Outpatient,,,90,94,79.9,26.9404,94,Medica,Medica Advantage Solution,46.812,49.8,,percent of total billed charges,,
"Pyridoxal 5-Phosphate, P (Mayo)OutsideLaboratory",,84207,CPT,Facility,Inpatient,,,90,94,79.9,26.9404,94,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Pyridoxal 5-Phosphate, P (Mayo)OutsideLaboratory",,84207,CPT,Facility,Outpatient,,,90,94,79.9,26.9404,94,Medica,Medical Assistance,41.924,44.6,,percent of total billed charges,,
"Pyridoxal 5-Phosphate, P (Mayo)OutsideLaboratory",,84207,CPT,Facility,Inpatient,,,90,94,79.9,26.9404,94,Medica,Medical Assistance,,,,,Included in per diem rate,
"Pyridoxal 5-Phosphate, P (Mayo)OutsideLaboratory",,84207,CPT,Facility,Outpatient,,,90,94,79.9,26.9404,94,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,46.812,49.8,,percent of total billed charges,,
"Pyridoxal 5-Phosphate, P (Mayo)OutsideLaboratory",,84207,CPT,Facility,Inpatient,,,90,94,79.9,26.9404,94,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Pyridoxal 5-Phosphate, P (Mayo)OutsideLaboratory",,84207,CPT,Facility,Both,,,90,94,79.9,26.9404,94,"Multiplan, Inc.","Multiplan, Inc.",88.36,94,,percent of total billed charges,,
"Pyridoxal 5-Phosphate, P (Mayo)OutsideLaboratory",,84207,CPT,Facility,Outpatient,,,90,94,79.9,26.9404,94,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,81.216,86.4,,percent of total billed charges,,
"Pyridoxal 5-Phosphate, P (Mayo)OutsideLaboratory",,84207,CPT,Facility,Inpatient,,,90,94,79.9,26.9404,94,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Pyridoxal 5-Phosphate, P (Mayo)OutsideLaboratory",,84207,CPT,Facility,Both,,,90,94,79.9,26.9404,94,"Preferred One Administrative Services, INC.",PPO,92.684,98.6,,percent of total billed charges,,
"Pyridoxal 5-Phosphate, P (Mayo)OutsideLaboratory",,84207,CPT,Facility,Outpatient,,,90,94,79.9,26.9404,94,PrimeWest Health,Minnesota Senior Health Options (MSHO),48.363,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Pyridoxal 5-Phosphate, P (Mayo)OutsideLaboratory",,84207,CPT,Facility,Inpatient,,,90,94,79.9,26.9404,94,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Pyridoxal 5-Phosphate, P (Mayo)OutsideLaboratory",,84207,CPT,Facility,Outpatient,,,90,94,79.9,26.9404,94,PrimeWest Health,MinnesotaCare,48.2784,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Pyridoxal 5-Phosphate, P (Mayo)OutsideLaboratory",,84207,CPT,Facility,Inpatient,,,90,94,79.9,26.9404,94,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Pyridoxal 5-Phosphate, P (Mayo)OutsideLaboratory",,84207,CPT,Facility,Both,,,90,94,79.9,26.9404,94,Sanford Health Plan,Sanford Health Plan,86.48,92,,percent of total billed charges,,
"Pyridoxal 5-Phosphate, P (Mayo)OutsideLaboratory",,84207,CPT,Facility,Outpatient,,,90,94,79.9,26.9404,94,"UCare Health, Inc.",Individual & Family Plan,52.969,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Pyridoxal 5-Phosphate, P (Mayo)OutsideLaboratory",,84207,CPT,Facility,Inpatient,,,90,94,79.9,26.9404,94,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Pyridoxal 5-Phosphate, P (Mayo)OutsideLaboratory",,84207,CPT,Facility,Outpatient,,,90,94,79.9,26.9404,94,"UCare Health, Inc.",Medical Assistance,47.4418,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Pyridoxal 5-Phosphate, P (Mayo)OutsideLaboratory",,84207,CPT,Facility,Inpatient,,,90,94,79.9,26.9404,94,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Pyridoxal 5-Phosphate, P (Mayo)OutsideLaboratory",,84207,CPT,Facility,Outpatient,,,90,94,79.9,26.9404,94,"UCare Health, Inc.",Medicare Advantage,47.4418,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Pyridoxal 5-Phosphate, P (Mayo)OutsideLaboratory",,84207,CPT,Facility,Inpatient,,,90,94,79.9,26.9404,94,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Pyridoxal 5-Phosphate, P (Mayo)OutsideLaboratory",,84207,CPT,Facility,Outpatient,,,90,94,79.9,26.9404,94,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),47.4418,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Pyridoxal 5-Phosphate, P (Mayo)OutsideLaboratory",,84207,CPT,Facility,Inpatient,,,90,94,79.9,26.9404,94,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Pyridoxal 5-Phosphate, P (Mayo)OutsideLaboratory",,84207,CPT,Facility,Both,,,90,94,79.9,26.9404,94,UnitedHealthcare,Individual & Family,88.36,94,,percent of total billed charges,,
"Pyridoxal 5-Phosphate, P (Mayo)OutsideLaboratory",,84207,CPT,Facility,Outpatient,,,90,94,79.9,26.9404,94,UnitedHealthcare,Medicare Advantage,46.06,49,,percent of total billed charges,,
"Pyridoxal 5-Phosphate, P (Mayo)OutsideLaboratory",,84207,CPT,Facility,Inpatient,,,90,94,79.9,26.9404,94,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Pyridoxal 5-Phosphate, P (Mayo)OutsideLaboratory",,84207,CPT,Facility,Outpatient,,,90,94,79.9,26.9404,94,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,45.12,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Pyridoxal 5-Phosphate, P (Mayo)OutsideLaboratory",,84207,CPT,Facility,Inpatient,,,90,94,79.9,26.9404,94,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Pyridoxal Phosphate (Vitamin B-6) (Mayo)OutsideLaboratory,,84207,CPT,Facility,Both,,,90,94,79.9,26.9404,94,Aetna,Commercial,86.48,92,,percent of total billed charges,,
Pyridoxal Phosphate (Vitamin B-6) (Mayo)OutsideLaboratory,,84207,CPT,Facility,Outpatient,,,90,94,79.9,26.9404,94,Aetna,Medicare Advantage,46.06,49,,percent of total billed charges,,
Pyridoxal Phosphate (Vitamin B-6) (Mayo)OutsideLaboratory,,84207,CPT,Facility,Inpatient,,,90,94,79.9,26.9404,94,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Pyridoxal Phosphate (Vitamin B-6) (Mayo)OutsideLaboratory,,84207,CPT,Facility,Both,,,90,94,79.9,26.9404,94,Aetna,PPO,87.42,93,,percent of total billed charges,,
Pyridoxal Phosphate (Vitamin B-6) (Mayo)OutsideLaboratory,,84207,CPT,Facility,Both,,,90,94,79.9,26.9404,94,America's PPO,America's PPO,90.2682,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Pyridoxal Phosphate (Vitamin B-6) (Mayo)OutsideLaboratory,,84207,CPT,Facility,Both,,,90,94,79.9,26.9404,94,BlueCross BlueShield Minnesota, Federal Employee Program,92.496,98.4,,percent of total billed charges,,
Pyridoxal Phosphate (Vitamin B-6) (Mayo)OutsideLaboratory,,84207,CPT,Facility,Both,,,90,94,79.9,26.9404,94,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,94,100,,percent of total billed charges,,
Pyridoxal Phosphate (Vitamin B-6) (Mayo)OutsideLaboratory,,84207,CPT,Facility,Both,,,90,94,79.9,26.9404,94,BlueCross BlueShield Minnesota,High Value Network Plan,84.6,90,,percent of total billed charges,,
Pyridoxal Phosphate (Vitamin B-6) (Mayo)OutsideLaboratory,,84207,CPT,Facility,Outpatient,,,90,94,79.9,26.9404,94,BlueCross BlueShield Minnesota,Medicare Advantage,46.06,49,,percent of total billed charges,,
Pyridoxal Phosphate (Vitamin B-6) (Mayo)OutsideLaboratory,,84207,CPT,Facility,Inpatient,,,90,94,79.9,26.9404,94,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Pyridoxal Phosphate (Vitamin B-6) (Mayo)OutsideLaboratory,,84207,CPT,Facility,Both,,,90,94,79.9,26.9404,94,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,83.2558,88.57,,percent of total billed charges,,
Pyridoxal Phosphate (Vitamin B-6) (Mayo)OutsideLaboratory,,84207,CPT,Facility,Both,,,90,94,79.9,26.9404,94,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,26.9404,28.66,,percent of total billed charges,,
Pyridoxal Phosphate (Vitamin B-6) (Mayo)OutsideLaboratory,,84207,CPT,Facility,Outpatient,,,90,94,79.9,26.9404,94,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),46.06,49,,percent of total billed charges,,
Pyridoxal Phosphate (Vitamin B-6) (Mayo)OutsideLaboratory,,84207,CPT,Facility,Inpatient,,,90,94,79.9,26.9404,94,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Pyridoxal Phosphate (Vitamin B-6) (Mayo)OutsideLaboratory,,84207,CPT,Facility,Both,,,90,94,79.9,26.9404,94,CorVel,Worker's Compensation,94,100,,percent of total billed charges,,
Pyridoxal Phosphate (Vitamin B-6) (Mayo)OutsideLaboratory,,84207,CPT,Facility,Both,,,90,94,79.9,26.9404,94,First Health Group Corporation,First Health Network,91.18,97,,percent of total billed charges,,
Pyridoxal Phosphate (Vitamin B-6) (Mayo)OutsideLaboratory,,84207,CPT,Facility,Both,,,90,94,79.9,26.9404,94,"Health Partners, Inc.",Commercial,88.924,94.6,,percent of total billed charges,,
Pyridoxal Phosphate (Vitamin B-6) (Mayo)OutsideLaboratory,,84207,CPT,Facility,Outpatient,,,90,94,79.9,26.9404,94,"Health Partners, Inc.",Medicare Advantage,46.06,49,,percent of total billed charges,,
Pyridoxal Phosphate (Vitamin B-6) (Mayo)OutsideLaboratory,,84207,CPT,Facility,Inpatient,,,90,94,79.9,26.9404,94,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Pyridoxal Phosphate (Vitamin B-6) (Mayo)OutsideLaboratory,,84207,CPT,Facility,Both,,,90,94,79.9,26.9404,94,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),56.4,60,,percent of total billed charges,,
Pyridoxal Phosphate (Vitamin B-6) (Mayo)OutsideLaboratory,,84207,CPT,Facility,Both,,,90,94,79.9,26.9404,94,"Health Partners, Inc.",State of Minnesota Advantage Program,76.61,81.5,,percent of total billed charges,,
Pyridoxal Phosphate (Vitamin B-6) (Mayo)OutsideLaboratory,,84207,CPT,Facility,Both,,,90,94,79.9,26.9404,94,"Health Partners, Inc.",State Public Programs,47,50,,percent of total billed charges,,
Pyridoxal Phosphate (Vitamin B-6) (Mayo)OutsideLaboratory,,84207,CPT,Facility,Both,,,90,94,79.9,26.9404,94,Humana Insurance Company,Commercial PPO,89.3,95,,percent of total billed charges,,
Pyridoxal Phosphate (Vitamin B-6) (Mayo)OutsideLaboratory,,84207,CPT,Facility,Outpatient,,,90,94,79.9,26.9404,94,Humana Insurance Company,Medicare PPO,46.06,49,,percent of total billed charges,,
Pyridoxal Phosphate (Vitamin B-6) (Mayo)OutsideLaboratory,,84207,CPT,Facility,Inpatient,,,90,94,79.9,26.9404,94,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Pyridoxal Phosphate (Vitamin B-6) (Mayo)OutsideLaboratory,,84207,CPT,Facility,Both,,,90,94,79.9,26.9404,94,Medica,Individual & Family,93.154,99.1,,percent of total billed charges,,
Pyridoxal Phosphate (Vitamin B-6) (Mayo)OutsideLaboratory,,84207,CPT,Facility,Outpatient,,,90,94,79.9,26.9404,94,Medica,Medica Advantage Solution,46.812,49.8,,percent of total billed charges,,
Pyridoxal Phosphate (Vitamin B-6) (Mayo)OutsideLaboratory,,84207,CPT,Facility,Inpatient,,,90,94,79.9,26.9404,94,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Pyridoxal Phosphate (Vitamin B-6) (Mayo)OutsideLaboratory,,84207,CPT,Facility,Outpatient,,,90,94,79.9,26.9404,94,Medica,Medical Assistance,41.924,44.6,,percent of total billed charges,,
Pyridoxal Phosphate (Vitamin B-6) (Mayo)OutsideLaboratory,,84207,CPT,Facility,Inpatient,,,90,94,79.9,26.9404,94,Medica,Medical Assistance,,,,,Included in per diem rate,
Pyridoxal Phosphate (Vitamin B-6) (Mayo)OutsideLaboratory,,84207,CPT,Facility,Outpatient,,,90,94,79.9,26.9404,94,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,46.812,49.8,,percent of total billed charges,,
Pyridoxal Phosphate (Vitamin B-6) (Mayo)OutsideLaboratory,,84207,CPT,Facility,Inpatient,,,90,94,79.9,26.9404,94,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Pyridoxal Phosphate (Vitamin B-6) (Mayo)OutsideLaboratory,,84207,CPT,Facility,Both,,,90,94,79.9,26.9404,94,"Multiplan, Inc.","Multiplan, Inc.",88.36,94,,percent of total billed charges,,
Pyridoxal Phosphate (Vitamin B-6) (Mayo)OutsideLaboratory,,84207,CPT,Facility,Outpatient,,,90,94,79.9,26.9404,94,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,81.216,86.4,,percent of total billed charges,,
Pyridoxal Phosphate (Vitamin B-6) (Mayo)OutsideLaboratory,,84207,CPT,Facility,Inpatient,,,90,94,79.9,26.9404,94,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Pyridoxal Phosphate (Vitamin B-6) (Mayo)OutsideLaboratory,,84207,CPT,Facility,Both,,,90,94,79.9,26.9404,94,"Preferred One Administrative Services, INC.",PPO,92.684,98.6,,percent of total billed charges,,
Pyridoxal Phosphate (Vitamin B-6) (Mayo)OutsideLaboratory,,84207,CPT,Facility,Outpatient,,,90,94,79.9,26.9404,94,PrimeWest Health,Minnesota Senior Health Options (MSHO),48.363,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Pyridoxal Phosphate (Vitamin B-6) (Mayo)OutsideLaboratory,,84207,CPT,Facility,Inpatient,,,90,94,79.9,26.9404,94,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Pyridoxal Phosphate (Vitamin B-6) (Mayo)OutsideLaboratory,,84207,CPT,Facility,Outpatient,,,90,94,79.9,26.9404,94,PrimeWest Health,MinnesotaCare,48.2784,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Pyridoxal Phosphate (Vitamin B-6) (Mayo)OutsideLaboratory,,84207,CPT,Facility,Inpatient,,,90,94,79.9,26.9404,94,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Pyridoxal Phosphate (Vitamin B-6) (Mayo)OutsideLaboratory,,84207,CPT,Facility,Both,,,90,94,79.9,26.9404,94,Sanford Health Plan,Sanford Health Plan,86.48,92,,percent of total billed charges,,
Pyridoxal Phosphate (Vitamin B-6) (Mayo)OutsideLaboratory,,84207,CPT,Facility,Outpatient,,,90,94,79.9,26.9404,94,"UCare Health, Inc.",Individual & Family Plan,52.969,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Pyridoxal Phosphate (Vitamin B-6) (Mayo)OutsideLaboratory,,84207,CPT,Facility,Inpatient,,,90,94,79.9,26.9404,94,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Pyridoxal Phosphate (Vitamin B-6) (Mayo)OutsideLaboratory,,84207,CPT,Facility,Outpatient,,,90,94,79.9,26.9404,94,"UCare Health, Inc.",Medical Assistance,47.4418,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Pyridoxal Phosphate (Vitamin B-6) (Mayo)OutsideLaboratory,,84207,CPT,Facility,Inpatient,,,90,94,79.9,26.9404,94,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Pyridoxal Phosphate (Vitamin B-6) (Mayo)OutsideLaboratory,,84207,CPT,Facility,Outpatient,,,90,94,79.9,26.9404,94,"UCare Health, Inc.",Medicare Advantage,47.4418,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Pyridoxal Phosphate (Vitamin B-6) (Mayo)OutsideLaboratory,,84207,CPT,Facility,Inpatient,,,90,94,79.9,26.9404,94,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Pyridoxal Phosphate (Vitamin B-6) (Mayo)OutsideLaboratory,,84207,CPT,Facility,Outpatient,,,90,94,79.9,26.9404,94,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),47.4418,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Pyridoxal Phosphate (Vitamin B-6) (Mayo)OutsideLaboratory,,84207,CPT,Facility,Inpatient,,,90,94,79.9,26.9404,94,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Pyridoxal Phosphate (Vitamin B-6) (Mayo)OutsideLaboratory,,84207,CPT,Facility,Both,,,90,94,79.9,26.9404,94,UnitedHealthcare,Individual & Family,88.36,94,,percent of total billed charges,,
Pyridoxal Phosphate (Vitamin B-6) (Mayo)OutsideLaboratory,,84207,CPT,Facility,Outpatient,,,90,94,79.9,26.9404,94,UnitedHealthcare,Medicare Advantage,46.06,49,,percent of total billed charges,,
Pyridoxal Phosphate (Vitamin B-6) (Mayo)OutsideLaboratory,,84207,CPT,Facility,Inpatient,,,90,94,79.9,26.9404,94,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Pyridoxal Phosphate (Vitamin B-6) (Mayo)OutsideLaboratory,,84207,CPT,Facility,Outpatient,,,90,94,79.9,26.9404,94,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,45.12,48,,percent of total billed charges,,100% of DHS outpatient percentage
Pyridoxal Phosphate (Vitamin B-6) (Mayo)OutsideLaboratory,,84207,CPT,Facility,Inpatient,,,90,94,79.9,26.9404,94,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Renin Activity, P (Mayo)OutsideLaboratory",,84244,CPT,Facility,Both,,,90,105,89.25,30.093,105,Aetna,Commercial,96.6,92,,percent of total billed charges,,
"Renin Activity, P (Mayo)OutsideLaboratory",,84244,CPT,Facility,Outpatient,,,90,105,89.25,30.093,105,Aetna,Medicare Advantage,51.45,49,,percent of total billed charges,,
"Renin Activity, P (Mayo)OutsideLaboratory",,84244,CPT,Facility,Inpatient,,,90,105,89.25,30.093,105,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Renin Activity, P (Mayo)OutsideLaboratory",,84244,CPT,Facility,Both,,,90,105,89.25,30.093,105,Aetna,PPO,97.65,93,,percent of total billed charges,,
"Renin Activity, P (Mayo)OutsideLaboratory",,84244,CPT,Facility,Both,,,90,105,89.25,30.093,105,America's PPO,America's PPO,100.8315,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Renin Activity, P (Mayo)OutsideLaboratory",,84244,CPT,Facility,Both,,,90,105,89.25,30.093,105,BlueCross BlueShield Minnesota, Federal Employee Program,103.32,98.4,,percent of total billed charges,,
"Renin Activity, P (Mayo)OutsideLaboratory",,84244,CPT,Facility,Both,,,90,105,89.25,30.093,105,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,105,100,,percent of total billed charges,,
"Renin Activity, P (Mayo)OutsideLaboratory",,84244,CPT,Facility,Both,,,90,105,89.25,30.093,105,BlueCross BlueShield Minnesota,High Value Network Plan,94.5,90,,percent of total billed charges,,
"Renin Activity, P (Mayo)OutsideLaboratory",,84244,CPT,Facility,Outpatient,,,90,105,89.25,30.093,105,BlueCross BlueShield Minnesota,Medicare Advantage,51.45,49,,percent of total billed charges,,
"Renin Activity, P (Mayo)OutsideLaboratory",,84244,CPT,Facility,Inpatient,,,90,105,89.25,30.093,105,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Renin Activity, P (Mayo)OutsideLaboratory",,84244,CPT,Facility,Both,,,90,105,89.25,30.093,105,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,92.9985,88.57,,percent of total billed charges,,
"Renin Activity, P (Mayo)OutsideLaboratory",,84244,CPT,Facility,Both,,,90,105,89.25,30.093,105,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,30.093,28.66,,percent of total billed charges,,
"Renin Activity, P (Mayo)OutsideLaboratory",,84244,CPT,Facility,Outpatient,,,90,105,89.25,30.093,105,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),51.45,49,,percent of total billed charges,,
"Renin Activity, P (Mayo)OutsideLaboratory",,84244,CPT,Facility,Inpatient,,,90,105,89.25,30.093,105,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Renin Activity, P (Mayo)OutsideLaboratory",,84244,CPT,Facility,Both,,,90,105,89.25,30.093,105,CorVel,Worker's Compensation,105,100,,percent of total billed charges,,
"Renin Activity, P (Mayo)OutsideLaboratory",,84244,CPT,Facility,Both,,,90,105,89.25,30.093,105,First Health Group Corporation,First Health Network,101.85,97,,percent of total billed charges,,
"Renin Activity, P (Mayo)OutsideLaboratory",,84244,CPT,Facility,Both,,,90,105,89.25,30.093,105,"Health Partners, Inc.",Commercial,99.33,94.6,,percent of total billed charges,,
"Renin Activity, P (Mayo)OutsideLaboratory",,84244,CPT,Facility,Outpatient,,,90,105,89.25,30.093,105,"Health Partners, Inc.",Medicare Advantage,51.45,49,,percent of total billed charges,,
"Renin Activity, P (Mayo)OutsideLaboratory",,84244,CPT,Facility,Inpatient,,,90,105,89.25,30.093,105,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Renin Activity, P (Mayo)OutsideLaboratory",,84244,CPT,Facility,Both,,,90,105,89.25,30.093,105,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),63,60,,percent of total billed charges,,
"Renin Activity, P (Mayo)OutsideLaboratory",,84244,CPT,Facility,Both,,,90,105,89.25,30.093,105,"Health Partners, Inc.",State of Minnesota Advantage Program,85.575,81.5,,percent of total billed charges,,
"Renin Activity, P (Mayo)OutsideLaboratory",,84244,CPT,Facility,Both,,,90,105,89.25,30.093,105,"Health Partners, Inc.",State Public Programs,52.5,50,,percent of total billed charges,,
"Renin Activity, P (Mayo)OutsideLaboratory",,84244,CPT,Facility,Both,,,90,105,89.25,30.093,105,Humana Insurance Company,Commercial PPO,99.75,95,,percent of total billed charges,,
"Renin Activity, P (Mayo)OutsideLaboratory",,84244,CPT,Facility,Outpatient,,,90,105,89.25,30.093,105,Humana Insurance Company,Medicare PPO,51.45,49,,percent of total billed charges,,
"Renin Activity, P (Mayo)OutsideLaboratory",,84244,CPT,Facility,Inpatient,,,90,105,89.25,30.093,105,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Renin Activity, P (Mayo)OutsideLaboratory",,84244,CPT,Facility,Both,,,90,105,89.25,30.093,105,Medica,Individual & Family,104.055,99.1,,percent of total billed charges,,
"Renin Activity, P (Mayo)OutsideLaboratory",,84244,CPT,Facility,Outpatient,,,90,105,89.25,30.093,105,Medica,Medica Advantage Solution,52.29,49.8,,percent of total billed charges,,
"Renin Activity, P (Mayo)OutsideLaboratory",,84244,CPT,Facility,Inpatient,,,90,105,89.25,30.093,105,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Renin Activity, P (Mayo)OutsideLaboratory",,84244,CPT,Facility,Outpatient,,,90,105,89.25,30.093,105,Medica,Medical Assistance,46.83,44.6,,percent of total billed charges,,
"Renin Activity, P (Mayo)OutsideLaboratory",,84244,CPT,Facility,Inpatient,,,90,105,89.25,30.093,105,Medica,Medical Assistance,,,,,Included in per diem rate,
"Renin Activity, P (Mayo)OutsideLaboratory",,84244,CPT,Facility,Outpatient,,,90,105,89.25,30.093,105,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,52.29,49.8,,percent of total billed charges,,
"Renin Activity, P (Mayo)OutsideLaboratory",,84244,CPT,Facility,Inpatient,,,90,105,89.25,30.093,105,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Renin Activity, P (Mayo)OutsideLaboratory",,84244,CPT,Facility,Both,,,90,105,89.25,30.093,105,"Multiplan, Inc.","Multiplan, Inc.",98.7,94,,percent of total billed charges,,
"Renin Activity, P (Mayo)OutsideLaboratory",,84244,CPT,Facility,Outpatient,,,90,105,89.25,30.093,105,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,90.72,86.4,,percent of total billed charges,,
"Renin Activity, P (Mayo)OutsideLaboratory",,84244,CPT,Facility,Inpatient,,,90,105,89.25,30.093,105,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Renin Activity, P (Mayo)OutsideLaboratory",,84244,CPT,Facility,Both,,,90,105,89.25,30.093,105,"Preferred One Administrative Services, INC.",PPO,103.53,98.6,,percent of total billed charges,,
"Renin Activity, P (Mayo)OutsideLaboratory",,84244,CPT,Facility,Outpatient,,,90,105,89.25,30.093,105,PrimeWest Health,Minnesota Senior Health Options (MSHO),54.0225,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Renin Activity, P (Mayo)OutsideLaboratory",,84244,CPT,Facility,Inpatient,,,90,105,89.25,30.093,105,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Renin Activity, P (Mayo)OutsideLaboratory",,84244,CPT,Facility,Outpatient,,,90,105,89.25,30.093,105,PrimeWest Health,MinnesotaCare,53.928,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Renin Activity, P (Mayo)OutsideLaboratory",,84244,CPT,Facility,Inpatient,,,90,105,89.25,30.093,105,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Renin Activity, P (Mayo)OutsideLaboratory",,84244,CPT,Facility,Both,,,90,105,89.25,30.093,105,Sanford Health Plan,Sanford Health Plan,96.6,92,,percent of total billed charges,,
"Renin Activity, P (Mayo)OutsideLaboratory",,84244,CPT,Facility,Outpatient,,,90,105,89.25,30.093,105,"UCare Health, Inc.",Individual & Family Plan,59.1675,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Renin Activity, P (Mayo)OutsideLaboratory",,84244,CPT,Facility,Inpatient,,,90,105,89.25,30.093,105,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Renin Activity, P (Mayo)OutsideLaboratory",,84244,CPT,Facility,Outpatient,,,90,105,89.25,30.093,105,"UCare Health, Inc.",Medical Assistance,52.9935,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Renin Activity, P (Mayo)OutsideLaboratory",,84244,CPT,Facility,Inpatient,,,90,105,89.25,30.093,105,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Renin Activity, P (Mayo)OutsideLaboratory",,84244,CPT,Facility,Outpatient,,,90,105,89.25,30.093,105,"UCare Health, Inc.",Medicare Advantage,52.9935,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Renin Activity, P (Mayo)OutsideLaboratory",,84244,CPT,Facility,Inpatient,,,90,105,89.25,30.093,105,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Renin Activity, P (Mayo)OutsideLaboratory",,84244,CPT,Facility,Outpatient,,,90,105,89.25,30.093,105,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),52.9935,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Renin Activity, P (Mayo)OutsideLaboratory",,84244,CPT,Facility,Inpatient,,,90,105,89.25,30.093,105,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Renin Activity, P (Mayo)OutsideLaboratory",,84244,CPT,Facility,Both,,,90,105,89.25,30.093,105,UnitedHealthcare,Individual & Family,98.7,94,,percent of total billed charges,,
"Renin Activity, P (Mayo)OutsideLaboratory",,84244,CPT,Facility,Outpatient,,,90,105,89.25,30.093,105,UnitedHealthcare,Medicare Advantage,51.45,49,,percent of total billed charges,,
"Renin Activity, P (Mayo)OutsideLaboratory",,84244,CPT,Facility,Inpatient,,,90,105,89.25,30.093,105,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Renin Activity, P (Mayo)OutsideLaboratory",,84244,CPT,Facility,Outpatient,,,90,105,89.25,30.093,105,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,50.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Renin Activity, P (Mayo)OutsideLaboratory",,84244,CPT,Facility,Inpatient,,,90,105,89.25,30.093,105,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Riboflavin (Vitamin B2), P (Mayo)OutsideLaboratory",,84252,CPT,Facility,Both,,,90,102,86.7,29.2332,102,Aetna,Commercial,93.84,92,,percent of total billed charges,,
"Riboflavin (Vitamin B2), P (Mayo)OutsideLaboratory",,84252,CPT,Facility,Outpatient,,,90,102,86.7,29.2332,102,Aetna,Medicare Advantage,49.98,49,,percent of total billed charges,,
"Riboflavin (Vitamin B2), P (Mayo)OutsideLaboratory",,84252,CPT,Facility,Inpatient,,,90,102,86.7,29.2332,102,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Riboflavin (Vitamin B2), P (Mayo)OutsideLaboratory",,84252,CPT,Facility,Both,,,90,102,86.7,29.2332,102,Aetna,PPO,94.86,93,,percent of total billed charges,,
"Riboflavin (Vitamin B2), P (Mayo)OutsideLaboratory",,84252,CPT,Facility,Both,,,90,102,86.7,29.2332,102,America's PPO,America's PPO,97.9506,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Riboflavin (Vitamin B2), P (Mayo)OutsideLaboratory",,84252,CPT,Facility,Both,,,90,102,86.7,29.2332,102,BlueCross BlueShield Minnesota, Federal Employee Program,100.368,98.4,,percent of total billed charges,,
"Riboflavin (Vitamin B2), P (Mayo)OutsideLaboratory",,84252,CPT,Facility,Both,,,90,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,102,100,,percent of total billed charges,,
"Riboflavin (Vitamin B2), P (Mayo)OutsideLaboratory",,84252,CPT,Facility,Both,,,90,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,High Value Network Plan,91.8,90,,percent of total billed charges,,
"Riboflavin (Vitamin B2), P (Mayo)OutsideLaboratory",,84252,CPT,Facility,Outpatient,,,90,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,Medicare Advantage,49.98,49,,percent of total billed charges,,
"Riboflavin (Vitamin B2), P (Mayo)OutsideLaboratory",,84252,CPT,Facility,Inpatient,,,90,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Riboflavin (Vitamin B2), P (Mayo)OutsideLaboratory",,84252,CPT,Facility,Both,,,90,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,90.3414,88.57,,percent of total billed charges,,
"Riboflavin (Vitamin B2), P (Mayo)OutsideLaboratory",,84252,CPT,Facility,Both,,,90,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,29.2332,28.66,,percent of total billed charges,,
"Riboflavin (Vitamin B2), P (Mayo)OutsideLaboratory",,84252,CPT,Facility,Outpatient,,,90,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),49.98,49,,percent of total billed charges,,
"Riboflavin (Vitamin B2), P (Mayo)OutsideLaboratory",,84252,CPT,Facility,Inpatient,,,90,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Riboflavin (Vitamin B2), P (Mayo)OutsideLaboratory",,84252,CPT,Facility,Both,,,90,102,86.7,29.2332,102,CorVel,Worker's Compensation,102,100,,percent of total billed charges,,
"Riboflavin (Vitamin B2), P (Mayo)OutsideLaboratory",,84252,CPT,Facility,Both,,,90,102,86.7,29.2332,102,First Health Group Corporation,First Health Network,98.94,97,,percent of total billed charges,,
"Riboflavin (Vitamin B2), P (Mayo)OutsideLaboratory",,84252,CPT,Facility,Both,,,90,102,86.7,29.2332,102,"Health Partners, Inc.",Commercial,96.492,94.6,,percent of total billed charges,,
"Riboflavin (Vitamin B2), P (Mayo)OutsideLaboratory",,84252,CPT,Facility,Outpatient,,,90,102,86.7,29.2332,102,"Health Partners, Inc.",Medicare Advantage,49.98,49,,percent of total billed charges,,
"Riboflavin (Vitamin B2), P (Mayo)OutsideLaboratory",,84252,CPT,Facility,Inpatient,,,90,102,86.7,29.2332,102,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Riboflavin (Vitamin B2), P (Mayo)OutsideLaboratory",,84252,CPT,Facility,Both,,,90,102,86.7,29.2332,102,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),61.2,60,,percent of total billed charges,,
"Riboflavin (Vitamin B2), P (Mayo)OutsideLaboratory",,84252,CPT,Facility,Both,,,90,102,86.7,29.2332,102,"Health Partners, Inc.",State of Minnesota Advantage Program,83.13,81.5,,percent of total billed charges,,
"Riboflavin (Vitamin B2), P (Mayo)OutsideLaboratory",,84252,CPT,Facility,Both,,,90,102,86.7,29.2332,102,"Health Partners, Inc.",State Public Programs,51,50,,percent of total billed charges,,
"Riboflavin (Vitamin B2), P (Mayo)OutsideLaboratory",,84252,CPT,Facility,Both,,,90,102,86.7,29.2332,102,Humana Insurance Company,Commercial PPO,96.9,95,,percent of total billed charges,,
"Riboflavin (Vitamin B2), P (Mayo)OutsideLaboratory",,84252,CPT,Facility,Outpatient,,,90,102,86.7,29.2332,102,Humana Insurance Company,Medicare PPO,49.98,49,,percent of total billed charges,,
"Riboflavin (Vitamin B2), P (Mayo)OutsideLaboratory",,84252,CPT,Facility,Inpatient,,,90,102,86.7,29.2332,102,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Riboflavin (Vitamin B2), P (Mayo)OutsideLaboratory",,84252,CPT,Facility,Both,,,90,102,86.7,29.2332,102,Medica,Individual & Family,101.082,99.1,,percent of total billed charges,,
"Riboflavin (Vitamin B2), P (Mayo)OutsideLaboratory",,84252,CPT,Facility,Outpatient,,,90,102,86.7,29.2332,102,Medica,Medica Advantage Solution,50.796,49.8,,percent of total billed charges,,
"Riboflavin (Vitamin B2), P (Mayo)OutsideLaboratory",,84252,CPT,Facility,Inpatient,,,90,102,86.7,29.2332,102,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Riboflavin (Vitamin B2), P (Mayo)OutsideLaboratory",,84252,CPT,Facility,Outpatient,,,90,102,86.7,29.2332,102,Medica,Medical Assistance,45.492,44.6,,percent of total billed charges,,
"Riboflavin (Vitamin B2), P (Mayo)OutsideLaboratory",,84252,CPT,Facility,Inpatient,,,90,102,86.7,29.2332,102,Medica,Medical Assistance,,,,,Included in per diem rate,
"Riboflavin (Vitamin B2), P (Mayo)OutsideLaboratory",,84252,CPT,Facility,Outpatient,,,90,102,86.7,29.2332,102,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,50.796,49.8,,percent of total billed charges,,
"Riboflavin (Vitamin B2), P (Mayo)OutsideLaboratory",,84252,CPT,Facility,Inpatient,,,90,102,86.7,29.2332,102,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Riboflavin (Vitamin B2), P (Mayo)OutsideLaboratory",,84252,CPT,Facility,Both,,,90,102,86.7,29.2332,102,"Multiplan, Inc.","Multiplan, Inc.",95.88,94,,percent of total billed charges,,
"Riboflavin (Vitamin B2), P (Mayo)OutsideLaboratory",,84252,CPT,Facility,Outpatient,,,90,102,86.7,29.2332,102,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,88.128,86.4,,percent of total billed charges,,
"Riboflavin (Vitamin B2), P (Mayo)OutsideLaboratory",,84252,CPT,Facility,Inpatient,,,90,102,86.7,29.2332,102,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Riboflavin (Vitamin B2), P (Mayo)OutsideLaboratory",,84252,CPT,Facility,Both,,,90,102,86.7,29.2332,102,"Preferred One Administrative Services, INC.",PPO,100.572,98.6,,percent of total billed charges,,
"Riboflavin (Vitamin B2), P (Mayo)OutsideLaboratory",,84252,CPT,Facility,Outpatient,,,90,102,86.7,29.2332,102,PrimeWest Health,Minnesota Senior Health Options (MSHO),52.479,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Riboflavin (Vitamin B2), P (Mayo)OutsideLaboratory",,84252,CPT,Facility,Inpatient,,,90,102,86.7,29.2332,102,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Riboflavin (Vitamin B2), P (Mayo)OutsideLaboratory",,84252,CPT,Facility,Outpatient,,,90,102,86.7,29.2332,102,PrimeWest Health,MinnesotaCare,52.3872,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Riboflavin (Vitamin B2), P (Mayo)OutsideLaboratory",,84252,CPT,Facility,Inpatient,,,90,102,86.7,29.2332,102,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Riboflavin (Vitamin B2), P (Mayo)OutsideLaboratory",,84252,CPT,Facility,Both,,,90,102,86.7,29.2332,102,Sanford Health Plan,Sanford Health Plan,93.84,92,,percent of total billed charges,,
"Riboflavin (Vitamin B2), P (Mayo)OutsideLaboratory",,84252,CPT,Facility,Outpatient,,,90,102,86.7,29.2332,102,"UCare Health, Inc.",Individual & Family Plan,57.477,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Riboflavin (Vitamin B2), P (Mayo)OutsideLaboratory",,84252,CPT,Facility,Inpatient,,,90,102,86.7,29.2332,102,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Riboflavin (Vitamin B2), P (Mayo)OutsideLaboratory",,84252,CPT,Facility,Outpatient,,,90,102,86.7,29.2332,102,"UCare Health, Inc.",Medical Assistance,51.4794,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Riboflavin (Vitamin B2), P (Mayo)OutsideLaboratory",,84252,CPT,Facility,Inpatient,,,90,102,86.7,29.2332,102,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Riboflavin (Vitamin B2), P (Mayo)OutsideLaboratory",,84252,CPT,Facility,Outpatient,,,90,102,86.7,29.2332,102,"UCare Health, Inc.",Medicare Advantage,51.4794,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Riboflavin (Vitamin B2), P (Mayo)OutsideLaboratory",,84252,CPT,Facility,Inpatient,,,90,102,86.7,29.2332,102,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Riboflavin (Vitamin B2), P (Mayo)OutsideLaboratory",,84252,CPT,Facility,Outpatient,,,90,102,86.7,29.2332,102,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),51.4794,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Riboflavin (Vitamin B2), P (Mayo)OutsideLaboratory",,84252,CPT,Facility,Inpatient,,,90,102,86.7,29.2332,102,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Riboflavin (Vitamin B2), P (Mayo)OutsideLaboratory",,84252,CPT,Facility,Both,,,90,102,86.7,29.2332,102,UnitedHealthcare,Individual & Family,95.88,94,,percent of total billed charges,,
"Riboflavin (Vitamin B2), P (Mayo)OutsideLaboratory",,84252,CPT,Facility,Outpatient,,,90,102,86.7,29.2332,102,UnitedHealthcare,Medicare Advantage,49.98,49,,percent of total billed charges,,
"Riboflavin (Vitamin B2), P (Mayo)OutsideLaboratory",,84252,CPT,Facility,Inpatient,,,90,102,86.7,29.2332,102,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Riboflavin (Vitamin B2), P (Mayo)OutsideLaboratory",,84252,CPT,Facility,Outpatient,,,90,102,86.7,29.2332,102,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,48.96,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Riboflavin (Vitamin B2), P (Mayo)OutsideLaboratory",,84252,CPT,Facility,Inpatient,,,90,102,86.7,29.2332,102,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Igf-1, Lc/Ms, S (Mayo)OutsideLaboratory",,84305,CPT,Facility,Both,,,90,87,73.95,24.9342,87,Aetna,Commercial,80.04,92,,percent of total billed charges,,
"Igf-1, Lc/Ms, S (Mayo)OutsideLaboratory",,84305,CPT,Facility,Outpatient,,,90,87,73.95,24.9342,87,Aetna,Medicare Advantage,42.63,49,,percent of total billed charges,,
"Igf-1, Lc/Ms, S (Mayo)OutsideLaboratory",,84305,CPT,Facility,Inpatient,,,90,87,73.95,24.9342,87,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Igf-1, Lc/Ms, S (Mayo)OutsideLaboratory",,84305,CPT,Facility,Both,,,90,87,73.95,24.9342,87,Aetna,PPO,80.91,93,,percent of total billed charges,,
"Igf-1, Lc/Ms, S (Mayo)OutsideLaboratory",,84305,CPT,Facility,Both,,,90,87,73.95,24.9342,87,America's PPO,America's PPO,83.5461,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Igf-1, Lc/Ms, S (Mayo)OutsideLaboratory",,84305,CPT,Facility,Both,,,90,87,73.95,24.9342,87,BlueCross BlueShield Minnesota, Federal Employee Program,85.608,98.4,,percent of total billed charges,,
"Igf-1, Lc/Ms, S (Mayo)OutsideLaboratory",,84305,CPT,Facility,Both,,,90,87,73.95,24.9342,87,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,87,100,,percent of total billed charges,,
"Igf-1, Lc/Ms, S (Mayo)OutsideLaboratory",,84305,CPT,Facility,Both,,,90,87,73.95,24.9342,87,BlueCross BlueShield Minnesota,High Value Network Plan,78.3,90,,percent of total billed charges,,
"Igf-1, Lc/Ms, S (Mayo)OutsideLaboratory",,84305,CPT,Facility,Outpatient,,,90,87,73.95,24.9342,87,BlueCross BlueShield Minnesota,Medicare Advantage,42.63,49,,percent of total billed charges,,
"Igf-1, Lc/Ms, S (Mayo)OutsideLaboratory",,84305,CPT,Facility,Inpatient,,,90,87,73.95,24.9342,87,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Igf-1, Lc/Ms, S (Mayo)OutsideLaboratory",,84305,CPT,Facility,Both,,,90,87,73.95,24.9342,87,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,77.0559,88.57,,percent of total billed charges,,
"Igf-1, Lc/Ms, S (Mayo)OutsideLaboratory",,84305,CPT,Facility,Both,,,90,87,73.95,24.9342,87,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,24.9342,28.66,,percent of total billed charges,,
"Igf-1, Lc/Ms, S (Mayo)OutsideLaboratory",,84305,CPT,Facility,Outpatient,,,90,87,73.95,24.9342,87,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),42.63,49,,percent of total billed charges,,
"Igf-1, Lc/Ms, S (Mayo)OutsideLaboratory",,84305,CPT,Facility,Inpatient,,,90,87,73.95,24.9342,87,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Igf-1, Lc/Ms, S (Mayo)OutsideLaboratory",,84305,CPT,Facility,Both,,,90,87,73.95,24.9342,87,CorVel,Worker's Compensation,87,100,,percent of total billed charges,,
"Igf-1, Lc/Ms, S (Mayo)OutsideLaboratory",,84305,CPT,Facility,Both,,,90,87,73.95,24.9342,87,First Health Group Corporation,First Health Network,84.39,97,,percent of total billed charges,,
"Igf-1, Lc/Ms, S (Mayo)OutsideLaboratory",,84305,CPT,Facility,Both,,,90,87,73.95,24.9342,87,"Health Partners, Inc.",Commercial,82.302,94.6,,percent of total billed charges,,
"Igf-1, Lc/Ms, S (Mayo)OutsideLaboratory",,84305,CPT,Facility,Outpatient,,,90,87,73.95,24.9342,87,"Health Partners, Inc.",Medicare Advantage,42.63,49,,percent of total billed charges,,
"Igf-1, Lc/Ms, S (Mayo)OutsideLaboratory",,84305,CPT,Facility,Inpatient,,,90,87,73.95,24.9342,87,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Igf-1, Lc/Ms, S (Mayo)OutsideLaboratory",,84305,CPT,Facility,Both,,,90,87,73.95,24.9342,87,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),52.2,60,,percent of total billed charges,,
"Igf-1, Lc/Ms, S (Mayo)OutsideLaboratory",,84305,CPT,Facility,Both,,,90,87,73.95,24.9342,87,"Health Partners, Inc.",State of Minnesota Advantage Program,70.905,81.5,,percent of total billed charges,,
"Igf-1, Lc/Ms, S (Mayo)OutsideLaboratory",,84305,CPT,Facility,Both,,,90,87,73.95,24.9342,87,"Health Partners, Inc.",State Public Programs,43.5,50,,percent of total billed charges,,
"Igf-1, Lc/Ms, S (Mayo)OutsideLaboratory",,84305,CPT,Facility,Both,,,90,87,73.95,24.9342,87,Humana Insurance Company,Commercial PPO,82.65,95,,percent of total billed charges,,
"Igf-1, Lc/Ms, S (Mayo)OutsideLaboratory",,84305,CPT,Facility,Outpatient,,,90,87,73.95,24.9342,87,Humana Insurance Company,Medicare PPO,42.63,49,,percent of total billed charges,,
"Igf-1, Lc/Ms, S (Mayo)OutsideLaboratory",,84305,CPT,Facility,Inpatient,,,90,87,73.95,24.9342,87,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Igf-1, Lc/Ms, S (Mayo)OutsideLaboratory",,84305,CPT,Facility,Both,,,90,87,73.95,24.9342,87,Medica,Individual & Family,86.217,99.1,,percent of total billed charges,,
"Igf-1, Lc/Ms, S (Mayo)OutsideLaboratory",,84305,CPT,Facility,Outpatient,,,90,87,73.95,24.9342,87,Medica,Medica Advantage Solution,43.326,49.8,,percent of total billed charges,,
"Igf-1, Lc/Ms, S (Mayo)OutsideLaboratory",,84305,CPT,Facility,Inpatient,,,90,87,73.95,24.9342,87,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Igf-1, Lc/Ms, S (Mayo)OutsideLaboratory",,84305,CPT,Facility,Outpatient,,,90,87,73.95,24.9342,87,Medica,Medical Assistance,38.802,44.6,,percent of total billed charges,,
"Igf-1, Lc/Ms, S (Mayo)OutsideLaboratory",,84305,CPT,Facility,Inpatient,,,90,87,73.95,24.9342,87,Medica,Medical Assistance,,,,,Included in per diem rate,
"Igf-1, Lc/Ms, S (Mayo)OutsideLaboratory",,84305,CPT,Facility,Outpatient,,,90,87,73.95,24.9342,87,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,43.326,49.8,,percent of total billed charges,,
"Igf-1, Lc/Ms, S (Mayo)OutsideLaboratory",,84305,CPT,Facility,Inpatient,,,90,87,73.95,24.9342,87,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Igf-1, Lc/Ms, S (Mayo)OutsideLaboratory",,84305,CPT,Facility,Both,,,90,87,73.95,24.9342,87,"Multiplan, Inc.","Multiplan, Inc.",81.78,94,,percent of total billed charges,,
"Igf-1, Lc/Ms, S (Mayo)OutsideLaboratory",,84305,CPT,Facility,Outpatient,,,90,87,73.95,24.9342,87,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,75.168,86.4,,percent of total billed charges,,
"Igf-1, Lc/Ms, S (Mayo)OutsideLaboratory",,84305,CPT,Facility,Inpatient,,,90,87,73.95,24.9342,87,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Igf-1, Lc/Ms, S (Mayo)OutsideLaboratory",,84305,CPT,Facility,Both,,,90,87,73.95,24.9342,87,"Preferred One Administrative Services, INC.",PPO,85.782,98.6,,percent of total billed charges,,
"Igf-1, Lc/Ms, S (Mayo)OutsideLaboratory",,84305,CPT,Facility,Outpatient,,,90,87,73.95,24.9342,87,PrimeWest Health,Minnesota Senior Health Options (MSHO),44.7615,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Igf-1, Lc/Ms, S (Mayo)OutsideLaboratory",,84305,CPT,Facility,Inpatient,,,90,87,73.95,24.9342,87,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Igf-1, Lc/Ms, S (Mayo)OutsideLaboratory",,84305,CPT,Facility,Outpatient,,,90,87,73.95,24.9342,87,PrimeWest Health,MinnesotaCare,44.6832,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Igf-1, Lc/Ms, S (Mayo)OutsideLaboratory",,84305,CPT,Facility,Inpatient,,,90,87,73.95,24.9342,87,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Igf-1, Lc/Ms, S (Mayo)OutsideLaboratory",,84305,CPT,Facility,Both,,,90,87,73.95,24.9342,87,Sanford Health Plan,Sanford Health Plan,80.04,92,,percent of total billed charges,,
"Igf-1, Lc/Ms, S (Mayo)OutsideLaboratory",,84305,CPT,Facility,Outpatient,,,90,87,73.95,24.9342,87,"UCare Health, Inc.",Individual & Family Plan,49.0245,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Igf-1, Lc/Ms, S (Mayo)OutsideLaboratory",,84305,CPT,Facility,Inpatient,,,90,87,73.95,24.9342,87,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Igf-1, Lc/Ms, S (Mayo)OutsideLaboratory",,84305,CPT,Facility,Outpatient,,,90,87,73.95,24.9342,87,"UCare Health, Inc.",Medical Assistance,43.9089,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Igf-1, Lc/Ms, S (Mayo)OutsideLaboratory",,84305,CPT,Facility,Inpatient,,,90,87,73.95,24.9342,87,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Igf-1, Lc/Ms, S (Mayo)OutsideLaboratory",,84305,CPT,Facility,Outpatient,,,90,87,73.95,24.9342,87,"UCare Health, Inc.",Medicare Advantage,43.9089,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Igf-1, Lc/Ms, S (Mayo)OutsideLaboratory",,84305,CPT,Facility,Inpatient,,,90,87,73.95,24.9342,87,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Igf-1, Lc/Ms, S (Mayo)OutsideLaboratory",,84305,CPT,Facility,Outpatient,,,90,87,73.95,24.9342,87,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),43.9089,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Igf-1, Lc/Ms, S (Mayo)OutsideLaboratory",,84305,CPT,Facility,Inpatient,,,90,87,73.95,24.9342,87,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Igf-1, Lc/Ms, S (Mayo)OutsideLaboratory",,84305,CPT,Facility,Both,,,90,87,73.95,24.9342,87,UnitedHealthcare,Individual & Family,81.78,94,,percent of total billed charges,,
"Igf-1, Lc/Ms, S (Mayo)OutsideLaboratory",,84305,CPT,Facility,Outpatient,,,90,87,73.95,24.9342,87,UnitedHealthcare,Medicare Advantage,42.63,49,,percent of total billed charges,,
"Igf-1, Lc/Ms, S (Mayo)OutsideLaboratory",,84305,CPT,Facility,Inpatient,,,90,87,73.95,24.9342,87,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Igf-1, Lc/Ms, S (Mayo)OutsideLaboratory",,84305,CPT,Facility,Outpatient,,,90,87,73.95,24.9342,87,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,41.76,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Igf-1, Lc/Ms, S (Mayo)OutsideLaboratory",,84305,CPT,Facility,Inpatient,,,90,87,73.95,24.9342,87,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Porphyrins, Total, P (Mayo)OutsideLaboratory",,84311,CPT,Facility,Both,,,90,144,122.4,41.2704,144,Aetna,Commercial,132.48,92,,percent of total billed charges,,
"Porphyrins, Total, P (Mayo)OutsideLaboratory",,84311,CPT,Facility,Outpatient,,,90,144,122.4,41.2704,144,Aetna,Medicare Advantage,70.56,49,,percent of total billed charges,,
"Porphyrins, Total, P (Mayo)OutsideLaboratory",,84311,CPT,Facility,Inpatient,,,90,144,122.4,41.2704,144,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Porphyrins, Total, P (Mayo)OutsideLaboratory",,84311,CPT,Facility,Both,,,90,144,122.4,41.2704,144,Aetna,PPO,133.92,93,,percent of total billed charges,,
"Porphyrins, Total, P (Mayo)OutsideLaboratory",,84311,CPT,Facility,Both,,,90,144,122.4,41.2704,144,America's PPO,America's PPO,138.2832,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Porphyrins, Total, P (Mayo)OutsideLaboratory",,84311,CPT,Facility,Both,,,90,144,122.4,41.2704,144,BlueCross BlueShield Minnesota, Federal Employee Program,141.696,98.4,,percent of total billed charges,,
"Porphyrins, Total, P (Mayo)OutsideLaboratory",,84311,CPT,Facility,Both,,,90,144,122.4,41.2704,144,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,144,100,,percent of total billed charges,,
"Porphyrins, Total, P (Mayo)OutsideLaboratory",,84311,CPT,Facility,Both,,,90,144,122.4,41.2704,144,BlueCross BlueShield Minnesota,High Value Network Plan,129.6,90,,percent of total billed charges,,
"Porphyrins, Total, P (Mayo)OutsideLaboratory",,84311,CPT,Facility,Outpatient,,,90,144,122.4,41.2704,144,BlueCross BlueShield Minnesota,Medicare Advantage,70.56,49,,percent of total billed charges,,
"Porphyrins, Total, P (Mayo)OutsideLaboratory",,84311,CPT,Facility,Inpatient,,,90,144,122.4,41.2704,144,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Porphyrins, Total, P (Mayo)OutsideLaboratory",,84311,CPT,Facility,Both,,,90,144,122.4,41.2704,144,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,127.5408,88.57,,percent of total billed charges,,
"Porphyrins, Total, P (Mayo)OutsideLaboratory",,84311,CPT,Facility,Both,,,90,144,122.4,41.2704,144,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,41.2704,28.66,,percent of total billed charges,,
"Porphyrins, Total, P (Mayo)OutsideLaboratory",,84311,CPT,Facility,Outpatient,,,90,144,122.4,41.2704,144,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),70.56,49,,percent of total billed charges,,
"Porphyrins, Total, P (Mayo)OutsideLaboratory",,84311,CPT,Facility,Inpatient,,,90,144,122.4,41.2704,144,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Porphyrins, Total, P (Mayo)OutsideLaboratory",,84311,CPT,Facility,Both,,,90,144,122.4,41.2704,144,CorVel,Worker's Compensation,144,100,,percent of total billed charges,,
"Porphyrins, Total, P (Mayo)OutsideLaboratory",,84311,CPT,Facility,Both,,,90,144,122.4,41.2704,144,First Health Group Corporation,First Health Network,139.68,97,,percent of total billed charges,,
"Porphyrins, Total, P (Mayo)OutsideLaboratory",,84311,CPT,Facility,Both,,,90,144,122.4,41.2704,144,"Health Partners, Inc.",Commercial,136.224,94.6,,percent of total billed charges,,
"Porphyrins, Total, P (Mayo)OutsideLaboratory",,84311,CPT,Facility,Outpatient,,,90,144,122.4,41.2704,144,"Health Partners, Inc.",Medicare Advantage,70.56,49,,percent of total billed charges,,
"Porphyrins, Total, P (Mayo)OutsideLaboratory",,84311,CPT,Facility,Inpatient,,,90,144,122.4,41.2704,144,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Porphyrins, Total, P (Mayo)OutsideLaboratory",,84311,CPT,Facility,Both,,,90,144,122.4,41.2704,144,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),86.4,60,,percent of total billed charges,,
"Porphyrins, Total, P (Mayo)OutsideLaboratory",,84311,CPT,Facility,Both,,,90,144,122.4,41.2704,144,"Health Partners, Inc.",State of Minnesota Advantage Program,117.36,81.5,,percent of total billed charges,,
"Porphyrins, Total, P (Mayo)OutsideLaboratory",,84311,CPT,Facility,Both,,,90,144,122.4,41.2704,144,"Health Partners, Inc.",State Public Programs,72,50,,percent of total billed charges,,
"Porphyrins, Total, P (Mayo)OutsideLaboratory",,84311,CPT,Facility,Both,,,90,144,122.4,41.2704,144,Humana Insurance Company,Commercial PPO,136.8,95,,percent of total billed charges,,
"Porphyrins, Total, P (Mayo)OutsideLaboratory",,84311,CPT,Facility,Outpatient,,,90,144,122.4,41.2704,144,Humana Insurance Company,Medicare PPO,70.56,49,,percent of total billed charges,,
"Porphyrins, Total, P (Mayo)OutsideLaboratory",,84311,CPT,Facility,Inpatient,,,90,144,122.4,41.2704,144,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Porphyrins, Total, P (Mayo)OutsideLaboratory",,84311,CPT,Facility,Both,,,90,144,122.4,41.2704,144,Medica,Individual & Family,142.704,99.1,,percent of total billed charges,,
"Porphyrins, Total, P (Mayo)OutsideLaboratory",,84311,CPT,Facility,Outpatient,,,90,144,122.4,41.2704,144,Medica,Medica Advantage Solution,71.712,49.8,,percent of total billed charges,,
"Porphyrins, Total, P (Mayo)OutsideLaboratory",,84311,CPT,Facility,Inpatient,,,90,144,122.4,41.2704,144,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Porphyrins, Total, P (Mayo)OutsideLaboratory",,84311,CPT,Facility,Outpatient,,,90,144,122.4,41.2704,144,Medica,Medical Assistance,64.224,44.6,,percent of total billed charges,,
"Porphyrins, Total, P (Mayo)OutsideLaboratory",,84311,CPT,Facility,Inpatient,,,90,144,122.4,41.2704,144,Medica,Medical Assistance,,,,,Included in per diem rate,
"Porphyrins, Total, P (Mayo)OutsideLaboratory",,84311,CPT,Facility,Outpatient,,,90,144,122.4,41.2704,144,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,71.712,49.8,,percent of total billed charges,,
"Porphyrins, Total, P (Mayo)OutsideLaboratory",,84311,CPT,Facility,Inpatient,,,90,144,122.4,41.2704,144,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Porphyrins, Total, P (Mayo)OutsideLaboratory",,84311,CPT,Facility,Both,,,90,144,122.4,41.2704,144,"Multiplan, Inc.","Multiplan, Inc.",135.36,94,,percent of total billed charges,,
"Porphyrins, Total, P (Mayo)OutsideLaboratory",,84311,CPT,Facility,Outpatient,,,90,144,122.4,41.2704,144,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,124.416,86.4,,percent of total billed charges,,
"Porphyrins, Total, P (Mayo)OutsideLaboratory",,84311,CPT,Facility,Inpatient,,,90,144,122.4,41.2704,144,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Porphyrins, Total, P (Mayo)OutsideLaboratory",,84311,CPT,Facility,Both,,,90,144,122.4,41.2704,144,"Preferred One Administrative Services, INC.",PPO,141.984,98.6,,percent of total billed charges,,
"Porphyrins, Total, P (Mayo)OutsideLaboratory",,84311,CPT,Facility,Outpatient,,,90,144,122.4,41.2704,144,PrimeWest Health,Minnesota Senior Health Options (MSHO),74.088,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Porphyrins, Total, P (Mayo)OutsideLaboratory",,84311,CPT,Facility,Inpatient,,,90,144,122.4,41.2704,144,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Porphyrins, Total, P (Mayo)OutsideLaboratory",,84311,CPT,Facility,Outpatient,,,90,144,122.4,41.2704,144,PrimeWest Health,MinnesotaCare,73.9584,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Porphyrins, Total, P (Mayo)OutsideLaboratory",,84311,CPT,Facility,Inpatient,,,90,144,122.4,41.2704,144,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Porphyrins, Total, P (Mayo)OutsideLaboratory",,84311,CPT,Facility,Both,,,90,144,122.4,41.2704,144,Sanford Health Plan,Sanford Health Plan,132.48,92,,percent of total billed charges,,
"Porphyrins, Total, P (Mayo)OutsideLaboratory",,84311,CPT,Facility,Outpatient,,,90,144,122.4,41.2704,144,"UCare Health, Inc.",Individual & Family Plan,81.144,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Porphyrins, Total, P (Mayo)OutsideLaboratory",,84311,CPT,Facility,Inpatient,,,90,144,122.4,41.2704,144,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Porphyrins, Total, P (Mayo)OutsideLaboratory",,84311,CPT,Facility,Outpatient,,,90,144,122.4,41.2704,144,"UCare Health, Inc.",Medical Assistance,72.6768,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Porphyrins, Total, P (Mayo)OutsideLaboratory",,84311,CPT,Facility,Inpatient,,,90,144,122.4,41.2704,144,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Porphyrins, Total, P (Mayo)OutsideLaboratory",,84311,CPT,Facility,Outpatient,,,90,144,122.4,41.2704,144,"UCare Health, Inc.",Medicare Advantage,72.6768,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Porphyrins, Total, P (Mayo)OutsideLaboratory",,84311,CPT,Facility,Inpatient,,,90,144,122.4,41.2704,144,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Porphyrins, Total, P (Mayo)OutsideLaboratory",,84311,CPT,Facility,Outpatient,,,90,144,122.4,41.2704,144,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),72.6768,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Porphyrins, Total, P (Mayo)OutsideLaboratory",,84311,CPT,Facility,Inpatient,,,90,144,122.4,41.2704,144,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Porphyrins, Total, P (Mayo)OutsideLaboratory",,84311,CPT,Facility,Both,,,90,144,122.4,41.2704,144,UnitedHealthcare,Individual & Family,135.36,94,,percent of total billed charges,,
"Porphyrins, Total, P (Mayo)OutsideLaboratory",,84311,CPT,Facility,Outpatient,,,90,144,122.4,41.2704,144,UnitedHealthcare,Medicare Advantage,70.56,49,,percent of total billed charges,,
"Porphyrins, Total, P (Mayo)OutsideLaboratory",,84311,CPT,Facility,Inpatient,,,90,144,122.4,41.2704,144,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Porphyrins, Total, P (Mayo)OutsideLaboratory",,84311,CPT,Facility,Outpatient,,,90,144,122.4,41.2704,144,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,69.12,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Porphyrins, Total, P (Mayo)OutsideLaboratory",,84311,CPT,Facility,Inpatient,,,90,144,122.4,41.2704,144,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Sulfate (Mayo)OutsideLaboratory,,84392,CPT,Facility,Both,,,90,39,33.15,11.1774,39,Aetna,Commercial,35.88,92,,percent of total billed charges,,
Sulfate (Mayo)OutsideLaboratory,,84392,CPT,Facility,Outpatient,,,90,39,33.15,11.1774,39,Aetna,Medicare Advantage,19.11,49,,percent of total billed charges,,
Sulfate (Mayo)OutsideLaboratory,,84392,CPT,Facility,Inpatient,,,90,39,33.15,11.1774,39,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Sulfate (Mayo)OutsideLaboratory,,84392,CPT,Facility,Both,,,90,39,33.15,11.1774,39,Aetna,PPO,36.27,93,,percent of total billed charges,,
Sulfate (Mayo)OutsideLaboratory,,84392,CPT,Facility,Both,,,90,39,33.15,11.1774,39,America's PPO,America's PPO,37.4517,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Sulfate (Mayo)OutsideLaboratory,,84392,CPT,Facility,Both,,,90,39,33.15,11.1774,39,BlueCross BlueShield Minnesota, Federal Employee Program,38.376,98.4,,percent of total billed charges,,
Sulfate (Mayo)OutsideLaboratory,,84392,CPT,Facility,Both,,,90,39,33.15,11.1774,39,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,39,100,,percent of total billed charges,,
Sulfate (Mayo)OutsideLaboratory,,84392,CPT,Facility,Both,,,90,39,33.15,11.1774,39,BlueCross BlueShield Minnesota,High Value Network Plan,35.1,90,,percent of total billed charges,,
Sulfate (Mayo)OutsideLaboratory,,84392,CPT,Facility,Outpatient,,,90,39,33.15,11.1774,39,BlueCross BlueShield Minnesota,Medicare Advantage,19.11,49,,percent of total billed charges,,
Sulfate (Mayo)OutsideLaboratory,,84392,CPT,Facility,Inpatient,,,90,39,33.15,11.1774,39,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Sulfate (Mayo)OutsideLaboratory,,84392,CPT,Facility,Both,,,90,39,33.15,11.1774,39,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,34.5423,88.57,,percent of total billed charges,,
Sulfate (Mayo)OutsideLaboratory,,84392,CPT,Facility,Both,,,90,39,33.15,11.1774,39,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,11.1774,28.66,,percent of total billed charges,,
Sulfate (Mayo)OutsideLaboratory,,84392,CPT,Facility,Outpatient,,,90,39,33.15,11.1774,39,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),19.11,49,,percent of total billed charges,,
Sulfate (Mayo)OutsideLaboratory,,84392,CPT,Facility,Inpatient,,,90,39,33.15,11.1774,39,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Sulfate (Mayo)OutsideLaboratory,,84392,CPT,Facility,Both,,,90,39,33.15,11.1774,39,CorVel,Worker's Compensation,39,100,,percent of total billed charges,,
Sulfate (Mayo)OutsideLaboratory,,84392,CPT,Facility,Both,,,90,39,33.15,11.1774,39,First Health Group Corporation,First Health Network,37.83,97,,percent of total billed charges,,
Sulfate (Mayo)OutsideLaboratory,,84392,CPT,Facility,Both,,,90,39,33.15,11.1774,39,"Health Partners, Inc.",Commercial,36.894,94.6,,percent of total billed charges,,
Sulfate (Mayo)OutsideLaboratory,,84392,CPT,Facility,Outpatient,,,90,39,33.15,11.1774,39,"Health Partners, Inc.",Medicare Advantage,19.11,49,,percent of total billed charges,,
Sulfate (Mayo)OutsideLaboratory,,84392,CPT,Facility,Inpatient,,,90,39,33.15,11.1774,39,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sulfate (Mayo)OutsideLaboratory,,84392,CPT,Facility,Both,,,90,39,33.15,11.1774,39,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),23.4,60,,percent of total billed charges,,
Sulfate (Mayo)OutsideLaboratory,,84392,CPT,Facility,Both,,,90,39,33.15,11.1774,39,"Health Partners, Inc.",State of Minnesota Advantage Program,31.785,81.5,,percent of total billed charges,,
Sulfate (Mayo)OutsideLaboratory,,84392,CPT,Facility,Both,,,90,39,33.15,11.1774,39,"Health Partners, Inc.",State Public Programs,19.5,50,,percent of total billed charges,,
Sulfate (Mayo)OutsideLaboratory,,84392,CPT,Facility,Both,,,90,39,33.15,11.1774,39,Humana Insurance Company,Commercial PPO,37.05,95,,percent of total billed charges,,
Sulfate (Mayo)OutsideLaboratory,,84392,CPT,Facility,Outpatient,,,90,39,33.15,11.1774,39,Humana Insurance Company,Medicare PPO,19.11,49,,percent of total billed charges,,
Sulfate (Mayo)OutsideLaboratory,,84392,CPT,Facility,Inpatient,,,90,39,33.15,11.1774,39,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Sulfate (Mayo)OutsideLaboratory,,84392,CPT,Facility,Both,,,90,39,33.15,11.1774,39,Medica,Individual & Family,38.649,99.1,,percent of total billed charges,,
Sulfate (Mayo)OutsideLaboratory,,84392,CPT,Facility,Outpatient,,,90,39,33.15,11.1774,39,Medica,Medica Advantage Solution,19.422,49.8,,percent of total billed charges,,
Sulfate (Mayo)OutsideLaboratory,,84392,CPT,Facility,Inpatient,,,90,39,33.15,11.1774,39,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Sulfate (Mayo)OutsideLaboratory,,84392,CPT,Facility,Outpatient,,,90,39,33.15,11.1774,39,Medica,Medical Assistance,17.394,44.6,,percent of total billed charges,,
Sulfate (Mayo)OutsideLaboratory,,84392,CPT,Facility,Inpatient,,,90,39,33.15,11.1774,39,Medica,Medical Assistance,,,,,Included in per diem rate,
Sulfate (Mayo)OutsideLaboratory,,84392,CPT,Facility,Outpatient,,,90,39,33.15,11.1774,39,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,19.422,49.8,,percent of total billed charges,,
Sulfate (Mayo)OutsideLaboratory,,84392,CPT,Facility,Inpatient,,,90,39,33.15,11.1774,39,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Sulfate (Mayo)OutsideLaboratory,,84392,CPT,Facility,Both,,,90,39,33.15,11.1774,39,"Multiplan, Inc.","Multiplan, Inc.",36.66,94,,percent of total billed charges,,
Sulfate (Mayo)OutsideLaboratory,,84392,CPT,Facility,Outpatient,,,90,39,33.15,11.1774,39,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,33.696,86.4,,percent of total billed charges,,
Sulfate (Mayo)OutsideLaboratory,,84392,CPT,Facility,Inpatient,,,90,39,33.15,11.1774,39,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Sulfate (Mayo)OutsideLaboratory,,84392,CPT,Facility,Both,,,90,39,33.15,11.1774,39,"Preferred One Administrative Services, INC.",PPO,38.454,98.6,,percent of total billed charges,,
Sulfate (Mayo)OutsideLaboratory,,84392,CPT,Facility,Outpatient,,,90,39,33.15,11.1774,39,PrimeWest Health,Minnesota Senior Health Options (MSHO),20.0655,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Sulfate (Mayo)OutsideLaboratory,,84392,CPT,Facility,Inpatient,,,90,39,33.15,11.1774,39,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sulfate (Mayo)OutsideLaboratory,,84392,CPT,Facility,Outpatient,,,90,39,33.15,11.1774,39,PrimeWest Health,MinnesotaCare,20.0304,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Sulfate (Mayo)OutsideLaboratory,,84392,CPT,Facility,Inpatient,,,90,39,33.15,11.1774,39,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Sulfate (Mayo)OutsideLaboratory,,84392,CPT,Facility,Both,,,90,39,33.15,11.1774,39,Sanford Health Plan,Sanford Health Plan,35.88,92,,percent of total billed charges,,
Sulfate (Mayo)OutsideLaboratory,,84392,CPT,Facility,Outpatient,,,90,39,33.15,11.1774,39,"UCare Health, Inc.",Individual & Family Plan,21.9765,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Sulfate (Mayo)OutsideLaboratory,,84392,CPT,Facility,Inpatient,,,90,39,33.15,11.1774,39,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Sulfate (Mayo)OutsideLaboratory,,84392,CPT,Facility,Outpatient,,,90,39,33.15,11.1774,39,"UCare Health, Inc.",Medical Assistance,19.6833,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sulfate (Mayo)OutsideLaboratory,,84392,CPT,Facility,Inpatient,,,90,39,33.15,11.1774,39,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Sulfate (Mayo)OutsideLaboratory,,84392,CPT,Facility,Outpatient,,,90,39,33.15,11.1774,39,"UCare Health, Inc.",Medicare Advantage,19.6833,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sulfate (Mayo)OutsideLaboratory,,84392,CPT,Facility,Inpatient,,,90,39,33.15,11.1774,39,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sulfate (Mayo)OutsideLaboratory,,84392,CPT,Facility,Outpatient,,,90,39,33.15,11.1774,39,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),19.6833,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sulfate (Mayo)OutsideLaboratory,,84392,CPT,Facility,Inpatient,,,90,39,33.15,11.1774,39,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sulfate (Mayo)OutsideLaboratory,,84392,CPT,Facility,Both,,,90,39,33.15,11.1774,39,UnitedHealthcare,Individual & Family,36.66,94,,percent of total billed charges,,
Sulfate (Mayo)OutsideLaboratory,,84392,CPT,Facility,Outpatient,,,90,39,33.15,11.1774,39,UnitedHealthcare,Medicare Advantage,19.11,49,,percent of total billed charges,,
Sulfate (Mayo)OutsideLaboratory,,84392,CPT,Facility,Inpatient,,,90,39,33.15,11.1774,39,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Sulfate (Mayo)OutsideLaboratory,,84392,CPT,Facility,Outpatient,,,90,39,33.15,11.1774,39,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,18.72,48,,percent of total billed charges,,100% of DHS outpatient percentage
Sulfate (Mayo)OutsideLaboratory,,84392,CPT,Facility,Inpatient,,,90,39,33.15,11.1774,39,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Testosterone Free (Mayo)OutsideLaboratory,,84402,CPT,Facility,Both,,,90,167,141.95,47.8622,167,Aetna,Commercial,153.64,92,,percent of total billed charges,,
Testosterone Free (Mayo)OutsideLaboratory,,84402,CPT,Facility,Outpatient,,,90,167,141.95,47.8622,167,Aetna,Medicare Advantage,81.83,49,,percent of total billed charges,,
Testosterone Free (Mayo)OutsideLaboratory,,84402,CPT,Facility,Inpatient,,,90,167,141.95,47.8622,167,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Testosterone Free (Mayo)OutsideLaboratory,,84402,CPT,Facility,Both,,,90,167,141.95,47.8622,167,Aetna,PPO,155.31,93,,percent of total billed charges,,
Testosterone Free (Mayo)OutsideLaboratory,,84402,CPT,Facility,Both,,,90,167,141.95,47.8622,167,America's PPO,America's PPO,160.3701,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Testosterone Free (Mayo)OutsideLaboratory,,84402,CPT,Facility,Both,,,90,167,141.95,47.8622,167,BlueCross BlueShield Minnesota, Federal Employee Program,164.328,98.4,,percent of total billed charges,,
Testosterone Free (Mayo)OutsideLaboratory,,84402,CPT,Facility,Both,,,90,167,141.95,47.8622,167,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,167,100,,percent of total billed charges,,
Testosterone Free (Mayo)OutsideLaboratory,,84402,CPT,Facility,Both,,,90,167,141.95,47.8622,167,BlueCross BlueShield Minnesota,High Value Network Plan,150.3,90,,percent of total billed charges,,
Testosterone Free (Mayo)OutsideLaboratory,,84402,CPT,Facility,Outpatient,,,90,167,141.95,47.8622,167,BlueCross BlueShield Minnesota,Medicare Advantage,81.83,49,,percent of total billed charges,,
Testosterone Free (Mayo)OutsideLaboratory,,84402,CPT,Facility,Inpatient,,,90,167,141.95,47.8622,167,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Testosterone Free (Mayo)OutsideLaboratory,,84402,CPT,Facility,Both,,,90,167,141.95,47.8622,167,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,147.9119,88.57,,percent of total billed charges,,
Testosterone Free (Mayo)OutsideLaboratory,,84402,CPT,Facility,Both,,,90,167,141.95,47.8622,167,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,47.8622,28.66,,percent of total billed charges,,
Testosterone Free (Mayo)OutsideLaboratory,,84402,CPT,Facility,Outpatient,,,90,167,141.95,47.8622,167,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),81.83,49,,percent of total billed charges,,
Testosterone Free (Mayo)OutsideLaboratory,,84402,CPT,Facility,Inpatient,,,90,167,141.95,47.8622,167,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Testosterone Free (Mayo)OutsideLaboratory,,84402,CPT,Facility,Both,,,90,167,141.95,47.8622,167,CorVel,Worker's Compensation,167,100,,percent of total billed charges,,
Testosterone Free (Mayo)OutsideLaboratory,,84402,CPT,Facility,Both,,,90,167,141.95,47.8622,167,First Health Group Corporation,First Health Network,161.99,97,,percent of total billed charges,,
Testosterone Free (Mayo)OutsideLaboratory,,84402,CPT,Facility,Both,,,90,167,141.95,47.8622,167,"Health Partners, Inc.",Commercial,157.982,94.6,,percent of total billed charges,,
Testosterone Free (Mayo)OutsideLaboratory,,84402,CPT,Facility,Outpatient,,,90,167,141.95,47.8622,167,"Health Partners, Inc.",Medicare Advantage,81.83,49,,percent of total billed charges,,
Testosterone Free (Mayo)OutsideLaboratory,,84402,CPT,Facility,Inpatient,,,90,167,141.95,47.8622,167,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Testosterone Free (Mayo)OutsideLaboratory,,84402,CPT,Facility,Both,,,90,167,141.95,47.8622,167,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),100.2,60,,percent of total billed charges,,
Testosterone Free (Mayo)OutsideLaboratory,,84402,CPT,Facility,Both,,,90,167,141.95,47.8622,167,"Health Partners, Inc.",State of Minnesota Advantage Program,136.105,81.5,,percent of total billed charges,,
Testosterone Free (Mayo)OutsideLaboratory,,84402,CPT,Facility,Both,,,90,167,141.95,47.8622,167,"Health Partners, Inc.",State Public Programs,83.5,50,,percent of total billed charges,,
Testosterone Free (Mayo)OutsideLaboratory,,84402,CPT,Facility,Both,,,90,167,141.95,47.8622,167,Humana Insurance Company,Commercial PPO,158.65,95,,percent of total billed charges,,
Testosterone Free (Mayo)OutsideLaboratory,,84402,CPT,Facility,Outpatient,,,90,167,141.95,47.8622,167,Humana Insurance Company,Medicare PPO,81.83,49,,percent of total billed charges,,
Testosterone Free (Mayo)OutsideLaboratory,,84402,CPT,Facility,Inpatient,,,90,167,141.95,47.8622,167,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Testosterone Free (Mayo)OutsideLaboratory,,84402,CPT,Facility,Both,,,90,167,141.95,47.8622,167,Medica,Individual & Family,165.497,99.1,,percent of total billed charges,,
Testosterone Free (Mayo)OutsideLaboratory,,84402,CPT,Facility,Outpatient,,,90,167,141.95,47.8622,167,Medica,Medica Advantage Solution,83.166,49.8,,percent of total billed charges,,
Testosterone Free (Mayo)OutsideLaboratory,,84402,CPT,Facility,Inpatient,,,90,167,141.95,47.8622,167,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Testosterone Free (Mayo)OutsideLaboratory,,84402,CPT,Facility,Outpatient,,,90,167,141.95,47.8622,167,Medica,Medical Assistance,74.482,44.6,,percent of total billed charges,,
Testosterone Free (Mayo)OutsideLaboratory,,84402,CPT,Facility,Inpatient,,,90,167,141.95,47.8622,167,Medica,Medical Assistance,,,,,Included in per diem rate,
Testosterone Free (Mayo)OutsideLaboratory,,84402,CPT,Facility,Outpatient,,,90,167,141.95,47.8622,167,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,83.166,49.8,,percent of total billed charges,,
Testosterone Free (Mayo)OutsideLaboratory,,84402,CPT,Facility,Inpatient,,,90,167,141.95,47.8622,167,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Testosterone Free (Mayo)OutsideLaboratory,,84402,CPT,Facility,Both,,,90,167,141.95,47.8622,167,"Multiplan, Inc.","Multiplan, Inc.",156.98,94,,percent of total billed charges,,
Testosterone Free (Mayo)OutsideLaboratory,,84402,CPT,Facility,Outpatient,,,90,167,141.95,47.8622,167,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,144.288,86.4,,percent of total billed charges,,
Testosterone Free (Mayo)OutsideLaboratory,,84402,CPT,Facility,Inpatient,,,90,167,141.95,47.8622,167,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Testosterone Free (Mayo)OutsideLaboratory,,84402,CPT,Facility,Both,,,90,167,141.95,47.8622,167,"Preferred One Administrative Services, INC.",PPO,164.662,98.6,,percent of total billed charges,,
Testosterone Free (Mayo)OutsideLaboratory,,84402,CPT,Facility,Outpatient,,,90,167,141.95,47.8622,167,PrimeWest Health,Minnesota Senior Health Options (MSHO),85.9215,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Testosterone Free (Mayo)OutsideLaboratory,,84402,CPT,Facility,Inpatient,,,90,167,141.95,47.8622,167,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Testosterone Free (Mayo)OutsideLaboratory,,84402,CPT,Facility,Outpatient,,,90,167,141.95,47.8622,167,PrimeWest Health,MinnesotaCare,85.7712,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Testosterone Free (Mayo)OutsideLaboratory,,84402,CPT,Facility,Inpatient,,,90,167,141.95,47.8622,167,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Testosterone Free (Mayo)OutsideLaboratory,,84402,CPT,Facility,Both,,,90,167,141.95,47.8622,167,Sanford Health Plan,Sanford Health Plan,153.64,92,,percent of total billed charges,,
Testosterone Free (Mayo)OutsideLaboratory,,84402,CPT,Facility,Outpatient,,,90,167,141.95,47.8622,167,"UCare Health, Inc.",Individual & Family Plan,94.1045,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Testosterone Free (Mayo)OutsideLaboratory,,84402,CPT,Facility,Inpatient,,,90,167,141.95,47.8622,167,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Testosterone Free (Mayo)OutsideLaboratory,,84402,CPT,Facility,Outpatient,,,90,167,141.95,47.8622,167,"UCare Health, Inc.",Medical Assistance,84.2849,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Testosterone Free (Mayo)OutsideLaboratory,,84402,CPT,Facility,Inpatient,,,90,167,141.95,47.8622,167,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Testosterone Free (Mayo)OutsideLaboratory,,84402,CPT,Facility,Outpatient,,,90,167,141.95,47.8622,167,"UCare Health, Inc.",Medicare Advantage,84.2849,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Testosterone Free (Mayo)OutsideLaboratory,,84402,CPT,Facility,Inpatient,,,90,167,141.95,47.8622,167,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Testosterone Free (Mayo)OutsideLaboratory,,84402,CPT,Facility,Outpatient,,,90,167,141.95,47.8622,167,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),84.2849,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Testosterone Free (Mayo)OutsideLaboratory,,84402,CPT,Facility,Inpatient,,,90,167,141.95,47.8622,167,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Testosterone Free (Mayo)OutsideLaboratory,,84402,CPT,Facility,Both,,,90,167,141.95,47.8622,167,UnitedHealthcare,Individual & Family,156.98,94,,percent of total billed charges,,
Testosterone Free (Mayo)OutsideLaboratory,,84402,CPT,Facility,Outpatient,,,90,167,141.95,47.8622,167,UnitedHealthcare,Medicare Advantage,81.83,49,,percent of total billed charges,,
Testosterone Free (Mayo)OutsideLaboratory,,84402,CPT,Facility,Inpatient,,,90,167,141.95,47.8622,167,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Testosterone Free (Mayo)OutsideLaboratory,,84402,CPT,Facility,Outpatient,,,90,167,141.95,47.8622,167,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,80.16,48,,percent of total billed charges,,100% of DHS outpatient percentage
Testosterone Free (Mayo)OutsideLaboratory,,84402,CPT,Facility,Inpatient,,,90,167,141.95,47.8622,167,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Testosterone, Total, S (Mayo)OutsideLaboratory",,84403,CPT,Facility,Both,,,90,84,71.4,24.0744,84,Aetna,Commercial,77.28,92,,percent of total billed charges,,
"Testosterone, Total, S (Mayo)OutsideLaboratory",,84403,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,Aetna,Medicare Advantage,41.16,49,,percent of total billed charges,,
"Testosterone, Total, S (Mayo)OutsideLaboratory",,84403,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Testosterone, Total, S (Mayo)OutsideLaboratory",,84403,CPT,Facility,Both,,,90,84,71.4,24.0744,84,Aetna,PPO,78.12,93,,percent of total billed charges,,
"Testosterone, Total, S (Mayo)OutsideLaboratory",,84403,CPT,Facility,Both,,,90,84,71.4,24.0744,84,America's PPO,America's PPO,80.6652,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Testosterone, Total, S (Mayo)OutsideLaboratory",,84403,CPT,Facility,Both,,,90,84,71.4,24.0744,84,BlueCross BlueShield Minnesota, Federal Employee Program,82.656,98.4,,percent of total billed charges,,
"Testosterone, Total, S (Mayo)OutsideLaboratory",,84403,CPT,Facility,Both,,,90,84,71.4,24.0744,84,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,84,100,,percent of total billed charges,,
"Testosterone, Total, S (Mayo)OutsideLaboratory",,84403,CPT,Facility,Both,,,90,84,71.4,24.0744,84,BlueCross BlueShield Minnesota,High Value Network Plan,75.6,90,,percent of total billed charges,,
"Testosterone, Total, S (Mayo)OutsideLaboratory",,84403,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,BlueCross BlueShield Minnesota,Medicare Advantage,41.16,49,,percent of total billed charges,,
"Testosterone, Total, S (Mayo)OutsideLaboratory",,84403,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Testosterone, Total, S (Mayo)OutsideLaboratory",,84403,CPT,Facility,Both,,,90,84,71.4,24.0744,84,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,74.3988,88.57,,percent of total billed charges,,
"Testosterone, Total, S (Mayo)OutsideLaboratory",,84403,CPT,Facility,Both,,,90,84,71.4,24.0744,84,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,24.0744,28.66,,percent of total billed charges,,
"Testosterone, Total, S (Mayo)OutsideLaboratory",,84403,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),41.16,49,,percent of total billed charges,,
"Testosterone, Total, S (Mayo)OutsideLaboratory",,84403,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Testosterone, Total, S (Mayo)OutsideLaboratory",,84403,CPT,Facility,Both,,,90,84,71.4,24.0744,84,CorVel,Worker's Compensation,84,100,,percent of total billed charges,,
"Testosterone, Total, S (Mayo)OutsideLaboratory",,84403,CPT,Facility,Both,,,90,84,71.4,24.0744,84,First Health Group Corporation,First Health Network,81.48,97,,percent of total billed charges,,
"Testosterone, Total, S (Mayo)OutsideLaboratory",,84403,CPT,Facility,Both,,,90,84,71.4,24.0744,84,"Health Partners, Inc.",Commercial,79.464,94.6,,percent of total billed charges,,
"Testosterone, Total, S (Mayo)OutsideLaboratory",,84403,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,"Health Partners, Inc.",Medicare Advantage,41.16,49,,percent of total billed charges,,
"Testosterone, Total, S (Mayo)OutsideLaboratory",,84403,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Testosterone, Total, S (Mayo)OutsideLaboratory",,84403,CPT,Facility,Both,,,90,84,71.4,24.0744,84,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),50.4,60,,percent of total billed charges,,
"Testosterone, Total, S (Mayo)OutsideLaboratory",,84403,CPT,Facility,Both,,,90,84,71.4,24.0744,84,"Health Partners, Inc.",State of Minnesota Advantage Program,68.46,81.5,,percent of total billed charges,,
"Testosterone, Total, S (Mayo)OutsideLaboratory",,84403,CPT,Facility,Both,,,90,84,71.4,24.0744,84,"Health Partners, Inc.",State Public Programs,42,50,,percent of total billed charges,,
"Testosterone, Total, S (Mayo)OutsideLaboratory",,84403,CPT,Facility,Both,,,90,84,71.4,24.0744,84,Humana Insurance Company,Commercial PPO,79.8,95,,percent of total billed charges,,
"Testosterone, Total, S (Mayo)OutsideLaboratory",,84403,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,Humana Insurance Company,Medicare PPO,41.16,49,,percent of total billed charges,,
"Testosterone, Total, S (Mayo)OutsideLaboratory",,84403,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Testosterone, Total, S (Mayo)OutsideLaboratory",,84403,CPT,Facility,Both,,,90,84,71.4,24.0744,84,Medica,Individual & Family,83.244,99.1,,percent of total billed charges,,
"Testosterone, Total, S (Mayo)OutsideLaboratory",,84403,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,Medica,Medica Advantage Solution,41.832,49.8,,percent of total billed charges,,
"Testosterone, Total, S (Mayo)OutsideLaboratory",,84403,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Testosterone, Total, S (Mayo)OutsideLaboratory",,84403,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,Medica,Medical Assistance,37.464,44.6,,percent of total billed charges,,
"Testosterone, Total, S (Mayo)OutsideLaboratory",,84403,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,Medica,Medical Assistance,,,,,Included in per diem rate,
"Testosterone, Total, S (Mayo)OutsideLaboratory",,84403,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,41.832,49.8,,percent of total billed charges,,
"Testosterone, Total, S (Mayo)OutsideLaboratory",,84403,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Testosterone, Total, S (Mayo)OutsideLaboratory",,84403,CPT,Facility,Both,,,90,84,71.4,24.0744,84,"Multiplan, Inc.","Multiplan, Inc.",78.96,94,,percent of total billed charges,,
"Testosterone, Total, S (Mayo)OutsideLaboratory",,84403,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,72.576,86.4,,percent of total billed charges,,
"Testosterone, Total, S (Mayo)OutsideLaboratory",,84403,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Testosterone, Total, S (Mayo)OutsideLaboratory",,84403,CPT,Facility,Both,,,90,84,71.4,24.0744,84,"Preferred One Administrative Services, INC.",PPO,82.824,98.6,,percent of total billed charges,,
"Testosterone, Total, S (Mayo)OutsideLaboratory",,84403,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,PrimeWest Health,Minnesota Senior Health Options (MSHO),43.218,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Testosterone, Total, S (Mayo)OutsideLaboratory",,84403,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Testosterone, Total, S (Mayo)OutsideLaboratory",,84403,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,PrimeWest Health,MinnesotaCare,43.1424,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Testosterone, Total, S (Mayo)OutsideLaboratory",,84403,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Testosterone, Total, S (Mayo)OutsideLaboratory",,84403,CPT,Facility,Both,,,90,84,71.4,24.0744,84,Sanford Health Plan,Sanford Health Plan,77.28,92,,percent of total billed charges,,
"Testosterone, Total, S (Mayo)OutsideLaboratory",,84403,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,"UCare Health, Inc.",Individual & Family Plan,47.334,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Testosterone, Total, S (Mayo)OutsideLaboratory",,84403,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Testosterone, Total, S (Mayo)OutsideLaboratory",,84403,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,"UCare Health, Inc.",Medical Assistance,42.3948,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Testosterone, Total, S (Mayo)OutsideLaboratory",,84403,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Testosterone, Total, S (Mayo)OutsideLaboratory",,84403,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,"UCare Health, Inc.",Medicare Advantage,42.3948,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Testosterone, Total, S (Mayo)OutsideLaboratory",,84403,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Testosterone, Total, S (Mayo)OutsideLaboratory",,84403,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),42.3948,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Testosterone, Total, S (Mayo)OutsideLaboratory",,84403,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Testosterone, Total, S (Mayo)OutsideLaboratory",,84403,CPT,Facility,Both,,,90,84,71.4,24.0744,84,UnitedHealthcare,Individual & Family,78.96,94,,percent of total billed charges,,
"Testosterone, Total, S (Mayo)OutsideLaboratory",,84403,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,UnitedHealthcare,Medicare Advantage,41.16,49,,percent of total billed charges,,
"Testosterone, Total, S (Mayo)OutsideLaboratory",,84403,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Testosterone, Total, S (Mayo)OutsideLaboratory",,84403,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,40.32,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Testosterone, Total, S (Mayo)OutsideLaboratory",,84403,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Testosterone; Total, S (Mayo)OutsideLaboratory",,84403,CPT,Facility,Both,,,90,214,181.9,61.3324,214,Aetna,Commercial,196.88,92,,percent of total billed charges,,
"Testosterone; Total, S (Mayo)OutsideLaboratory",,84403,CPT,Facility,Outpatient,,,90,214,181.9,61.3324,214,Aetna,Medicare Advantage,104.86,49,,percent of total billed charges,,
"Testosterone; Total, S (Mayo)OutsideLaboratory",,84403,CPT,Facility,Inpatient,,,90,214,181.9,61.3324,214,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Testosterone; Total, S (Mayo)OutsideLaboratory",,84403,CPT,Facility,Both,,,90,214,181.9,61.3324,214,Aetna,PPO,199.02,93,,percent of total billed charges,,
"Testosterone; Total, S (Mayo)OutsideLaboratory",,84403,CPT,Facility,Both,,,90,214,181.9,61.3324,214,America's PPO,America's PPO,205.5042,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Testosterone; Total, S (Mayo)OutsideLaboratory",,84403,CPT,Facility,Both,,,90,214,181.9,61.3324,214,BlueCross BlueShield Minnesota, Federal Employee Program,210.576,98.4,,percent of total billed charges,,
"Testosterone; Total, S (Mayo)OutsideLaboratory",,84403,CPT,Facility,Both,,,90,214,181.9,61.3324,214,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,214,100,,percent of total billed charges,,
"Testosterone; Total, S (Mayo)OutsideLaboratory",,84403,CPT,Facility,Both,,,90,214,181.9,61.3324,214,BlueCross BlueShield Minnesota,High Value Network Plan,192.6,90,,percent of total billed charges,,
"Testosterone; Total, S (Mayo)OutsideLaboratory",,84403,CPT,Facility,Outpatient,,,90,214,181.9,61.3324,214,BlueCross BlueShield Minnesota,Medicare Advantage,104.86,49,,percent of total billed charges,,
"Testosterone; Total, S (Mayo)OutsideLaboratory",,84403,CPT,Facility,Inpatient,,,90,214,181.9,61.3324,214,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Testosterone; Total, S (Mayo)OutsideLaboratory",,84403,CPT,Facility,Both,,,90,214,181.9,61.3324,214,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,189.5398,88.57,,percent of total billed charges,,
"Testosterone; Total, S (Mayo)OutsideLaboratory",,84403,CPT,Facility,Both,,,90,214,181.9,61.3324,214,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,61.3324,28.66,,percent of total billed charges,,
"Testosterone; Total, S (Mayo)OutsideLaboratory",,84403,CPT,Facility,Outpatient,,,90,214,181.9,61.3324,214,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),104.86,49,,percent of total billed charges,,
"Testosterone; Total, S (Mayo)OutsideLaboratory",,84403,CPT,Facility,Inpatient,,,90,214,181.9,61.3324,214,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Testosterone; Total, S (Mayo)OutsideLaboratory",,84403,CPT,Facility,Both,,,90,214,181.9,61.3324,214,CorVel,Worker's Compensation,214,100,,percent of total billed charges,,
"Testosterone; Total, S (Mayo)OutsideLaboratory",,84403,CPT,Facility,Both,,,90,214,181.9,61.3324,214,First Health Group Corporation,First Health Network,207.58,97,,percent of total billed charges,,
"Testosterone; Total, S (Mayo)OutsideLaboratory",,84403,CPT,Facility,Both,,,90,214,181.9,61.3324,214,"Health Partners, Inc.",Commercial,202.444,94.6,,percent of total billed charges,,
"Testosterone; Total, S (Mayo)OutsideLaboratory",,84403,CPT,Facility,Outpatient,,,90,214,181.9,61.3324,214,"Health Partners, Inc.",Medicare Advantage,104.86,49,,percent of total billed charges,,
"Testosterone; Total, S (Mayo)OutsideLaboratory",,84403,CPT,Facility,Inpatient,,,90,214,181.9,61.3324,214,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Testosterone; Total, S (Mayo)OutsideLaboratory",,84403,CPT,Facility,Both,,,90,214,181.9,61.3324,214,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),128.4,60,,percent of total billed charges,,
"Testosterone; Total, S (Mayo)OutsideLaboratory",,84403,CPT,Facility,Both,,,90,214,181.9,61.3324,214,"Health Partners, Inc.",State of Minnesota Advantage Program,174.41,81.5,,percent of total billed charges,,
"Testosterone; Total, S (Mayo)OutsideLaboratory",,84403,CPT,Facility,Both,,,90,214,181.9,61.3324,214,"Health Partners, Inc.",State Public Programs,107,50,,percent of total billed charges,,
"Testosterone; Total, S (Mayo)OutsideLaboratory",,84403,CPT,Facility,Both,,,90,214,181.9,61.3324,214,Humana Insurance Company,Commercial PPO,203.3,95,,percent of total billed charges,,
"Testosterone; Total, S (Mayo)OutsideLaboratory",,84403,CPT,Facility,Outpatient,,,90,214,181.9,61.3324,214,Humana Insurance Company,Medicare PPO,104.86,49,,percent of total billed charges,,
"Testosterone; Total, S (Mayo)OutsideLaboratory",,84403,CPT,Facility,Inpatient,,,90,214,181.9,61.3324,214,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Testosterone; Total, S (Mayo)OutsideLaboratory",,84403,CPT,Facility,Both,,,90,214,181.9,61.3324,214,Medica,Individual & Family,212.074,99.1,,percent of total billed charges,,
"Testosterone; Total, S (Mayo)OutsideLaboratory",,84403,CPT,Facility,Outpatient,,,90,214,181.9,61.3324,214,Medica,Medica Advantage Solution,106.572,49.8,,percent of total billed charges,,
"Testosterone; Total, S (Mayo)OutsideLaboratory",,84403,CPT,Facility,Inpatient,,,90,214,181.9,61.3324,214,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Testosterone; Total, S (Mayo)OutsideLaboratory",,84403,CPT,Facility,Outpatient,,,90,214,181.9,61.3324,214,Medica,Medical Assistance,95.444,44.6,,percent of total billed charges,,
"Testosterone; Total, S (Mayo)OutsideLaboratory",,84403,CPT,Facility,Inpatient,,,90,214,181.9,61.3324,214,Medica,Medical Assistance,,,,,Included in per diem rate,
"Testosterone; Total, S (Mayo)OutsideLaboratory",,84403,CPT,Facility,Outpatient,,,90,214,181.9,61.3324,214,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,106.572,49.8,,percent of total billed charges,,
"Testosterone; Total, S (Mayo)OutsideLaboratory",,84403,CPT,Facility,Inpatient,,,90,214,181.9,61.3324,214,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Testosterone; Total, S (Mayo)OutsideLaboratory",,84403,CPT,Facility,Both,,,90,214,181.9,61.3324,214,"Multiplan, Inc.","Multiplan, Inc.",201.16,94,,percent of total billed charges,,
"Testosterone; Total, S (Mayo)OutsideLaboratory",,84403,CPT,Facility,Outpatient,,,90,214,181.9,61.3324,214,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,184.896,86.4,,percent of total billed charges,,
"Testosterone; Total, S (Mayo)OutsideLaboratory",,84403,CPT,Facility,Inpatient,,,90,214,181.9,61.3324,214,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Testosterone; Total, S (Mayo)OutsideLaboratory",,84403,CPT,Facility,Both,,,90,214,181.9,61.3324,214,"Preferred One Administrative Services, INC.",PPO,211.004,98.6,,percent of total billed charges,,
"Testosterone; Total, S (Mayo)OutsideLaboratory",,84403,CPT,Facility,Outpatient,,,90,214,181.9,61.3324,214,PrimeWest Health,Minnesota Senior Health Options (MSHO),110.103,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Testosterone; Total, S (Mayo)OutsideLaboratory",,84403,CPT,Facility,Inpatient,,,90,214,181.9,61.3324,214,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Testosterone; Total, S (Mayo)OutsideLaboratory",,84403,CPT,Facility,Outpatient,,,90,214,181.9,61.3324,214,PrimeWest Health,MinnesotaCare,109.9104,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Testosterone; Total, S (Mayo)OutsideLaboratory",,84403,CPT,Facility,Inpatient,,,90,214,181.9,61.3324,214,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Testosterone; Total, S (Mayo)OutsideLaboratory",,84403,CPT,Facility,Both,,,90,214,181.9,61.3324,214,Sanford Health Plan,Sanford Health Plan,196.88,92,,percent of total billed charges,,
"Testosterone; Total, S (Mayo)OutsideLaboratory",,84403,CPT,Facility,Outpatient,,,90,214,181.9,61.3324,214,"UCare Health, Inc.",Individual & Family Plan,120.589,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Testosterone; Total, S (Mayo)OutsideLaboratory",,84403,CPT,Facility,Inpatient,,,90,214,181.9,61.3324,214,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Testosterone; Total, S (Mayo)OutsideLaboratory",,84403,CPT,Facility,Outpatient,,,90,214,181.9,61.3324,214,"UCare Health, Inc.",Medical Assistance,108.0058,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Testosterone; Total, S (Mayo)OutsideLaboratory",,84403,CPT,Facility,Inpatient,,,90,214,181.9,61.3324,214,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Testosterone; Total, S (Mayo)OutsideLaboratory",,84403,CPT,Facility,Outpatient,,,90,214,181.9,61.3324,214,"UCare Health, Inc.",Medicare Advantage,108.0058,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Testosterone; Total, S (Mayo)OutsideLaboratory",,84403,CPT,Facility,Inpatient,,,90,214,181.9,61.3324,214,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Testosterone; Total, S (Mayo)OutsideLaboratory",,84403,CPT,Facility,Outpatient,,,90,214,181.9,61.3324,214,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),108.0058,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Testosterone; Total, S (Mayo)OutsideLaboratory",,84403,CPT,Facility,Inpatient,,,90,214,181.9,61.3324,214,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Testosterone; Total, S (Mayo)OutsideLaboratory",,84403,CPT,Facility,Both,,,90,214,181.9,61.3324,214,UnitedHealthcare,Individual & Family,201.16,94,,percent of total billed charges,,
"Testosterone; Total, S (Mayo)OutsideLaboratory",,84403,CPT,Facility,Outpatient,,,90,214,181.9,61.3324,214,UnitedHealthcare,Medicare Advantage,104.86,49,,percent of total billed charges,,
"Testosterone; Total, S (Mayo)OutsideLaboratory",,84403,CPT,Facility,Inpatient,,,90,214,181.9,61.3324,214,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Testosterone; Total, S (Mayo)OutsideLaboratory",,84403,CPT,Facility,Outpatient,,,90,214,181.9,61.3324,214,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,102.72,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Testosterone; Total, S (Mayo)OutsideLaboratory",,84403,CPT,Facility,Inpatient,,,90,214,181.9,61.3324,214,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Testosterone Bioavail, S (Mayo)OutsideLaboratory",,84410,CPT,Facility,Both,,,90,94,79.9,26.9404,94,Aetna,Commercial,86.48,92,,percent of total billed charges,,
"Testosterone Bioavail, S (Mayo)OutsideLaboratory",,84410,CPT,Facility,Outpatient,,,90,94,79.9,26.9404,94,Aetna,Medicare Advantage,46.06,49,,percent of total billed charges,,
"Testosterone Bioavail, S (Mayo)OutsideLaboratory",,84410,CPT,Facility,Inpatient,,,90,94,79.9,26.9404,94,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Testosterone Bioavail, S (Mayo)OutsideLaboratory",,84410,CPT,Facility,Both,,,90,94,79.9,26.9404,94,Aetna,PPO,87.42,93,,percent of total billed charges,,
"Testosterone Bioavail, S (Mayo)OutsideLaboratory",,84410,CPT,Facility,Both,,,90,94,79.9,26.9404,94,America's PPO,America's PPO,90.2682,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Testosterone Bioavail, S (Mayo)OutsideLaboratory",,84410,CPT,Facility,Both,,,90,94,79.9,26.9404,94,BlueCross BlueShield Minnesota, Federal Employee Program,92.496,98.4,,percent of total billed charges,,
"Testosterone Bioavail, S (Mayo)OutsideLaboratory",,84410,CPT,Facility,Both,,,90,94,79.9,26.9404,94,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,94,100,,percent of total billed charges,,
"Testosterone Bioavail, S (Mayo)OutsideLaboratory",,84410,CPT,Facility,Both,,,90,94,79.9,26.9404,94,BlueCross BlueShield Minnesota,High Value Network Plan,84.6,90,,percent of total billed charges,,
"Testosterone Bioavail, S (Mayo)OutsideLaboratory",,84410,CPT,Facility,Outpatient,,,90,94,79.9,26.9404,94,BlueCross BlueShield Minnesota,Medicare Advantage,46.06,49,,percent of total billed charges,,
"Testosterone Bioavail, S (Mayo)OutsideLaboratory",,84410,CPT,Facility,Inpatient,,,90,94,79.9,26.9404,94,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Testosterone Bioavail, S (Mayo)OutsideLaboratory",,84410,CPT,Facility,Both,,,90,94,79.9,26.9404,94,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,83.2558,88.57,,percent of total billed charges,,
"Testosterone Bioavail, S (Mayo)OutsideLaboratory",,84410,CPT,Facility,Both,,,90,94,79.9,26.9404,94,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,26.9404,28.66,,percent of total billed charges,,
"Testosterone Bioavail, S (Mayo)OutsideLaboratory",,84410,CPT,Facility,Outpatient,,,90,94,79.9,26.9404,94,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),46.06,49,,percent of total billed charges,,
"Testosterone Bioavail, S (Mayo)OutsideLaboratory",,84410,CPT,Facility,Inpatient,,,90,94,79.9,26.9404,94,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Testosterone Bioavail, S (Mayo)OutsideLaboratory",,84410,CPT,Facility,Both,,,90,94,79.9,26.9404,94,CorVel,Worker's Compensation,94,100,,percent of total billed charges,,
"Testosterone Bioavail, S (Mayo)OutsideLaboratory",,84410,CPT,Facility,Both,,,90,94,79.9,26.9404,94,First Health Group Corporation,First Health Network,91.18,97,,percent of total billed charges,,
"Testosterone Bioavail, S (Mayo)OutsideLaboratory",,84410,CPT,Facility,Both,,,90,94,79.9,26.9404,94,"Health Partners, Inc.",Commercial,88.924,94.6,,percent of total billed charges,,
"Testosterone Bioavail, S (Mayo)OutsideLaboratory",,84410,CPT,Facility,Outpatient,,,90,94,79.9,26.9404,94,"Health Partners, Inc.",Medicare Advantage,46.06,49,,percent of total billed charges,,
"Testosterone Bioavail, S (Mayo)OutsideLaboratory",,84410,CPT,Facility,Inpatient,,,90,94,79.9,26.9404,94,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Testosterone Bioavail, S (Mayo)OutsideLaboratory",,84410,CPT,Facility,Both,,,90,94,79.9,26.9404,94,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),56.4,60,,percent of total billed charges,,
"Testosterone Bioavail, S (Mayo)OutsideLaboratory",,84410,CPT,Facility,Both,,,90,94,79.9,26.9404,94,"Health Partners, Inc.",State of Minnesota Advantage Program,76.61,81.5,,percent of total billed charges,,
"Testosterone Bioavail, S (Mayo)OutsideLaboratory",,84410,CPT,Facility,Both,,,90,94,79.9,26.9404,94,"Health Partners, Inc.",State Public Programs,47,50,,percent of total billed charges,,
"Testosterone Bioavail, S (Mayo)OutsideLaboratory",,84410,CPT,Facility,Both,,,90,94,79.9,26.9404,94,Humana Insurance Company,Commercial PPO,89.3,95,,percent of total billed charges,,
"Testosterone Bioavail, S (Mayo)OutsideLaboratory",,84410,CPT,Facility,Outpatient,,,90,94,79.9,26.9404,94,Humana Insurance Company,Medicare PPO,46.06,49,,percent of total billed charges,,
"Testosterone Bioavail, S (Mayo)OutsideLaboratory",,84410,CPT,Facility,Inpatient,,,90,94,79.9,26.9404,94,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Testosterone Bioavail, S (Mayo)OutsideLaboratory",,84410,CPT,Facility,Both,,,90,94,79.9,26.9404,94,Medica,Individual & Family,93.154,99.1,,percent of total billed charges,,
"Testosterone Bioavail, S (Mayo)OutsideLaboratory",,84410,CPT,Facility,Outpatient,,,90,94,79.9,26.9404,94,Medica,Medica Advantage Solution,46.812,49.8,,percent of total billed charges,,
"Testosterone Bioavail, S (Mayo)OutsideLaboratory",,84410,CPT,Facility,Inpatient,,,90,94,79.9,26.9404,94,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Testosterone Bioavail, S (Mayo)OutsideLaboratory",,84410,CPT,Facility,Outpatient,,,90,94,79.9,26.9404,94,Medica,Medical Assistance,41.924,44.6,,percent of total billed charges,,
"Testosterone Bioavail, S (Mayo)OutsideLaboratory",,84410,CPT,Facility,Inpatient,,,90,94,79.9,26.9404,94,Medica,Medical Assistance,,,,,Included in per diem rate,
"Testosterone Bioavail, S (Mayo)OutsideLaboratory",,84410,CPT,Facility,Outpatient,,,90,94,79.9,26.9404,94,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,46.812,49.8,,percent of total billed charges,,
"Testosterone Bioavail, S (Mayo)OutsideLaboratory",,84410,CPT,Facility,Inpatient,,,90,94,79.9,26.9404,94,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Testosterone Bioavail, S (Mayo)OutsideLaboratory",,84410,CPT,Facility,Both,,,90,94,79.9,26.9404,94,"Multiplan, Inc.","Multiplan, Inc.",88.36,94,,percent of total billed charges,,
"Testosterone Bioavail, S (Mayo)OutsideLaboratory",,84410,CPT,Facility,Outpatient,,,90,94,79.9,26.9404,94,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,81.216,86.4,,percent of total billed charges,,
"Testosterone Bioavail, S (Mayo)OutsideLaboratory",,84410,CPT,Facility,Inpatient,,,90,94,79.9,26.9404,94,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Testosterone Bioavail, S (Mayo)OutsideLaboratory",,84410,CPT,Facility,Both,,,90,94,79.9,26.9404,94,"Preferred One Administrative Services, INC.",PPO,92.684,98.6,,percent of total billed charges,,
"Testosterone Bioavail, S (Mayo)OutsideLaboratory",,84410,CPT,Facility,Outpatient,,,90,94,79.9,26.9404,94,PrimeWest Health,Minnesota Senior Health Options (MSHO),48.363,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Testosterone Bioavail, S (Mayo)OutsideLaboratory",,84410,CPT,Facility,Inpatient,,,90,94,79.9,26.9404,94,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Testosterone Bioavail, S (Mayo)OutsideLaboratory",,84410,CPT,Facility,Outpatient,,,90,94,79.9,26.9404,94,PrimeWest Health,MinnesotaCare,48.2784,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Testosterone Bioavail, S (Mayo)OutsideLaboratory",,84410,CPT,Facility,Inpatient,,,90,94,79.9,26.9404,94,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Testosterone Bioavail, S (Mayo)OutsideLaboratory",,84410,CPT,Facility,Both,,,90,94,79.9,26.9404,94,Sanford Health Plan,Sanford Health Plan,86.48,92,,percent of total billed charges,,
"Testosterone Bioavail, S (Mayo)OutsideLaboratory",,84410,CPT,Facility,Outpatient,,,90,94,79.9,26.9404,94,"UCare Health, Inc.",Individual & Family Plan,52.969,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Testosterone Bioavail, S (Mayo)OutsideLaboratory",,84410,CPT,Facility,Inpatient,,,90,94,79.9,26.9404,94,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Testosterone Bioavail, S (Mayo)OutsideLaboratory",,84410,CPT,Facility,Outpatient,,,90,94,79.9,26.9404,94,"UCare Health, Inc.",Medical Assistance,47.4418,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Testosterone Bioavail, S (Mayo)OutsideLaboratory",,84410,CPT,Facility,Inpatient,,,90,94,79.9,26.9404,94,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Testosterone Bioavail, S (Mayo)OutsideLaboratory",,84410,CPT,Facility,Outpatient,,,90,94,79.9,26.9404,94,"UCare Health, Inc.",Medicare Advantage,47.4418,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Testosterone Bioavail, S (Mayo)OutsideLaboratory",,84410,CPT,Facility,Inpatient,,,90,94,79.9,26.9404,94,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Testosterone Bioavail, S (Mayo)OutsideLaboratory",,84410,CPT,Facility,Outpatient,,,90,94,79.9,26.9404,94,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),47.4418,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Testosterone Bioavail, S (Mayo)OutsideLaboratory",,84410,CPT,Facility,Inpatient,,,90,94,79.9,26.9404,94,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Testosterone Bioavail, S (Mayo)OutsideLaboratory",,84410,CPT,Facility,Both,,,90,94,79.9,26.9404,94,UnitedHealthcare,Individual & Family,88.36,94,,percent of total billed charges,,
"Testosterone Bioavail, S (Mayo)OutsideLaboratory",,84410,CPT,Facility,Outpatient,,,90,94,79.9,26.9404,94,UnitedHealthcare,Medicare Advantage,46.06,49,,percent of total billed charges,,
"Testosterone Bioavail, S (Mayo)OutsideLaboratory",,84410,CPT,Facility,Inpatient,,,90,94,79.9,26.9404,94,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Testosterone Bioavail, S (Mayo)OutsideLaboratory",,84410,CPT,Facility,Outpatient,,,90,94,79.9,26.9404,94,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,45.12,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Testosterone Bioavail, S (Mayo)OutsideLaboratory",,84410,CPT,Facility,Inpatient,,,90,94,79.9,26.9404,94,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Thiamin (Vitamin B1), Wb (Mayo)OutsideLaboratory",,84425,CPT,Facility,Both,,,90,214,181.9,61.3324,214,Aetna,Commercial,196.88,92,,percent of total billed charges,,
"Thiamin (Vitamin B1), Wb (Mayo)OutsideLaboratory",,84425,CPT,Facility,Outpatient,,,90,214,181.9,61.3324,214,Aetna,Medicare Advantage,104.86,49,,percent of total billed charges,,
"Thiamin (Vitamin B1), Wb (Mayo)OutsideLaboratory",,84425,CPT,Facility,Inpatient,,,90,214,181.9,61.3324,214,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Thiamin (Vitamin B1), Wb (Mayo)OutsideLaboratory",,84425,CPT,Facility,Both,,,90,214,181.9,61.3324,214,Aetna,PPO,199.02,93,,percent of total billed charges,,
"Thiamin (Vitamin B1), Wb (Mayo)OutsideLaboratory",,84425,CPT,Facility,Both,,,90,214,181.9,61.3324,214,America's PPO,America's PPO,205.5042,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Thiamin (Vitamin B1), Wb (Mayo)OutsideLaboratory",,84425,CPT,Facility,Both,,,90,214,181.9,61.3324,214,BlueCross BlueShield Minnesota, Federal Employee Program,210.576,98.4,,percent of total billed charges,,
"Thiamin (Vitamin B1), Wb (Mayo)OutsideLaboratory",,84425,CPT,Facility,Both,,,90,214,181.9,61.3324,214,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,214,100,,percent of total billed charges,,
"Thiamin (Vitamin B1), Wb (Mayo)OutsideLaboratory",,84425,CPT,Facility,Both,,,90,214,181.9,61.3324,214,BlueCross BlueShield Minnesota,High Value Network Plan,192.6,90,,percent of total billed charges,,
"Thiamin (Vitamin B1), Wb (Mayo)OutsideLaboratory",,84425,CPT,Facility,Outpatient,,,90,214,181.9,61.3324,214,BlueCross BlueShield Minnesota,Medicare Advantage,104.86,49,,percent of total billed charges,,
"Thiamin (Vitamin B1), Wb (Mayo)OutsideLaboratory",,84425,CPT,Facility,Inpatient,,,90,214,181.9,61.3324,214,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Thiamin (Vitamin B1), Wb (Mayo)OutsideLaboratory",,84425,CPT,Facility,Both,,,90,214,181.9,61.3324,214,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,189.5398,88.57,,percent of total billed charges,,
"Thiamin (Vitamin B1), Wb (Mayo)OutsideLaboratory",,84425,CPT,Facility,Both,,,90,214,181.9,61.3324,214,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,61.3324,28.66,,percent of total billed charges,,
"Thiamin (Vitamin B1), Wb (Mayo)OutsideLaboratory",,84425,CPT,Facility,Outpatient,,,90,214,181.9,61.3324,214,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),104.86,49,,percent of total billed charges,,
"Thiamin (Vitamin B1), Wb (Mayo)OutsideLaboratory",,84425,CPT,Facility,Inpatient,,,90,214,181.9,61.3324,214,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Thiamin (Vitamin B1), Wb (Mayo)OutsideLaboratory",,84425,CPT,Facility,Both,,,90,214,181.9,61.3324,214,CorVel,Worker's Compensation,214,100,,percent of total billed charges,,
"Thiamin (Vitamin B1), Wb (Mayo)OutsideLaboratory",,84425,CPT,Facility,Both,,,90,214,181.9,61.3324,214,First Health Group Corporation,First Health Network,207.58,97,,percent of total billed charges,,
"Thiamin (Vitamin B1), Wb (Mayo)OutsideLaboratory",,84425,CPT,Facility,Both,,,90,214,181.9,61.3324,214,"Health Partners, Inc.",Commercial,202.444,94.6,,percent of total billed charges,,
"Thiamin (Vitamin B1), Wb (Mayo)OutsideLaboratory",,84425,CPT,Facility,Outpatient,,,90,214,181.9,61.3324,214,"Health Partners, Inc.",Medicare Advantage,104.86,49,,percent of total billed charges,,
"Thiamin (Vitamin B1), Wb (Mayo)OutsideLaboratory",,84425,CPT,Facility,Inpatient,,,90,214,181.9,61.3324,214,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Thiamin (Vitamin B1), Wb (Mayo)OutsideLaboratory",,84425,CPT,Facility,Both,,,90,214,181.9,61.3324,214,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),128.4,60,,percent of total billed charges,,
"Thiamin (Vitamin B1), Wb (Mayo)OutsideLaboratory",,84425,CPT,Facility,Both,,,90,214,181.9,61.3324,214,"Health Partners, Inc.",State of Minnesota Advantage Program,174.41,81.5,,percent of total billed charges,,
"Thiamin (Vitamin B1), Wb (Mayo)OutsideLaboratory",,84425,CPT,Facility,Both,,,90,214,181.9,61.3324,214,"Health Partners, Inc.",State Public Programs,107,50,,percent of total billed charges,,
"Thiamin (Vitamin B1), Wb (Mayo)OutsideLaboratory",,84425,CPT,Facility,Both,,,90,214,181.9,61.3324,214,Humana Insurance Company,Commercial PPO,203.3,95,,percent of total billed charges,,
"Thiamin (Vitamin B1), Wb (Mayo)OutsideLaboratory",,84425,CPT,Facility,Outpatient,,,90,214,181.9,61.3324,214,Humana Insurance Company,Medicare PPO,104.86,49,,percent of total billed charges,,
"Thiamin (Vitamin B1), Wb (Mayo)OutsideLaboratory",,84425,CPT,Facility,Inpatient,,,90,214,181.9,61.3324,214,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Thiamin (Vitamin B1), Wb (Mayo)OutsideLaboratory",,84425,CPT,Facility,Both,,,90,214,181.9,61.3324,214,Medica,Individual & Family,212.074,99.1,,percent of total billed charges,,
"Thiamin (Vitamin B1), Wb (Mayo)OutsideLaboratory",,84425,CPT,Facility,Outpatient,,,90,214,181.9,61.3324,214,Medica,Medica Advantage Solution,106.572,49.8,,percent of total billed charges,,
"Thiamin (Vitamin B1), Wb (Mayo)OutsideLaboratory",,84425,CPT,Facility,Inpatient,,,90,214,181.9,61.3324,214,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Thiamin (Vitamin B1), Wb (Mayo)OutsideLaboratory",,84425,CPT,Facility,Outpatient,,,90,214,181.9,61.3324,214,Medica,Medical Assistance,95.444,44.6,,percent of total billed charges,,
"Thiamin (Vitamin B1), Wb (Mayo)OutsideLaboratory",,84425,CPT,Facility,Inpatient,,,90,214,181.9,61.3324,214,Medica,Medical Assistance,,,,,Included in per diem rate,
"Thiamin (Vitamin B1), Wb (Mayo)OutsideLaboratory",,84425,CPT,Facility,Outpatient,,,90,214,181.9,61.3324,214,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,106.572,49.8,,percent of total billed charges,,
"Thiamin (Vitamin B1), Wb (Mayo)OutsideLaboratory",,84425,CPT,Facility,Inpatient,,,90,214,181.9,61.3324,214,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Thiamin (Vitamin B1), Wb (Mayo)OutsideLaboratory",,84425,CPT,Facility,Both,,,90,214,181.9,61.3324,214,"Multiplan, Inc.","Multiplan, Inc.",201.16,94,,percent of total billed charges,,
"Thiamin (Vitamin B1), Wb (Mayo)OutsideLaboratory",,84425,CPT,Facility,Outpatient,,,90,214,181.9,61.3324,214,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,184.896,86.4,,percent of total billed charges,,
"Thiamin (Vitamin B1), Wb (Mayo)OutsideLaboratory",,84425,CPT,Facility,Inpatient,,,90,214,181.9,61.3324,214,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Thiamin (Vitamin B1), Wb (Mayo)OutsideLaboratory",,84425,CPT,Facility,Both,,,90,214,181.9,61.3324,214,"Preferred One Administrative Services, INC.",PPO,211.004,98.6,,percent of total billed charges,,
"Thiamin (Vitamin B1), Wb (Mayo)OutsideLaboratory",,84425,CPT,Facility,Outpatient,,,90,214,181.9,61.3324,214,PrimeWest Health,Minnesota Senior Health Options (MSHO),110.103,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Thiamin (Vitamin B1), Wb (Mayo)OutsideLaboratory",,84425,CPT,Facility,Inpatient,,,90,214,181.9,61.3324,214,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Thiamin (Vitamin B1), Wb (Mayo)OutsideLaboratory",,84425,CPT,Facility,Outpatient,,,90,214,181.9,61.3324,214,PrimeWest Health,MinnesotaCare,109.9104,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Thiamin (Vitamin B1), Wb (Mayo)OutsideLaboratory",,84425,CPT,Facility,Inpatient,,,90,214,181.9,61.3324,214,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Thiamin (Vitamin B1), Wb (Mayo)OutsideLaboratory",,84425,CPT,Facility,Both,,,90,214,181.9,61.3324,214,Sanford Health Plan,Sanford Health Plan,196.88,92,,percent of total billed charges,,
"Thiamin (Vitamin B1), Wb (Mayo)OutsideLaboratory",,84425,CPT,Facility,Outpatient,,,90,214,181.9,61.3324,214,"UCare Health, Inc.",Individual & Family Plan,120.589,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Thiamin (Vitamin B1), Wb (Mayo)OutsideLaboratory",,84425,CPT,Facility,Inpatient,,,90,214,181.9,61.3324,214,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Thiamin (Vitamin B1), Wb (Mayo)OutsideLaboratory",,84425,CPT,Facility,Outpatient,,,90,214,181.9,61.3324,214,"UCare Health, Inc.",Medical Assistance,108.0058,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Thiamin (Vitamin B1), Wb (Mayo)OutsideLaboratory",,84425,CPT,Facility,Inpatient,,,90,214,181.9,61.3324,214,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Thiamin (Vitamin B1), Wb (Mayo)OutsideLaboratory",,84425,CPT,Facility,Outpatient,,,90,214,181.9,61.3324,214,"UCare Health, Inc.",Medicare Advantage,108.0058,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Thiamin (Vitamin B1), Wb (Mayo)OutsideLaboratory",,84425,CPT,Facility,Inpatient,,,90,214,181.9,61.3324,214,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Thiamin (Vitamin B1), Wb (Mayo)OutsideLaboratory",,84425,CPT,Facility,Outpatient,,,90,214,181.9,61.3324,214,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),108.0058,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Thiamin (Vitamin B1), Wb (Mayo)OutsideLaboratory",,84425,CPT,Facility,Inpatient,,,90,214,181.9,61.3324,214,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Thiamin (Vitamin B1), Wb (Mayo)OutsideLaboratory",,84425,CPT,Facility,Both,,,90,214,181.9,61.3324,214,UnitedHealthcare,Individual & Family,201.16,94,,percent of total billed charges,,
"Thiamin (Vitamin B1), Wb (Mayo)OutsideLaboratory",,84425,CPT,Facility,Outpatient,,,90,214,181.9,61.3324,214,UnitedHealthcare,Medicare Advantage,104.86,49,,percent of total billed charges,,
"Thiamin (Vitamin B1), Wb (Mayo)OutsideLaboratory",,84425,CPT,Facility,Inpatient,,,90,214,181.9,61.3324,214,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Thiamin (Vitamin B1), Wb (Mayo)OutsideLaboratory",,84425,CPT,Facility,Outpatient,,,90,214,181.9,61.3324,214,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,102.72,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Thiamin (Vitamin B1), Wb (Mayo)OutsideLaboratory",,84425,CPT,Facility,Inpatient,,,90,214,181.9,61.3324,214,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Thyroglobulin Tumor Marker (Mayo)OutsideLaboratory,,84432,CPT,Facility,Both,,,90,92,78.2,26.3672,92,Aetna,Commercial,84.64,92,,percent of total billed charges,,
Thyroglobulin Tumor Marker (Mayo)OutsideLaboratory,,84432,CPT,Facility,Outpatient,,,90,92,78.2,26.3672,92,Aetna,Medicare Advantage,45.08,49,,percent of total billed charges,,
Thyroglobulin Tumor Marker (Mayo)OutsideLaboratory,,84432,CPT,Facility,Inpatient,,,90,92,78.2,26.3672,92,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Thyroglobulin Tumor Marker (Mayo)OutsideLaboratory,,84432,CPT,Facility,Both,,,90,92,78.2,26.3672,92,Aetna,PPO,85.56,93,,percent of total billed charges,,
Thyroglobulin Tumor Marker (Mayo)OutsideLaboratory,,84432,CPT,Facility,Both,,,90,92,78.2,26.3672,92,America's PPO,America's PPO,88.3476,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Thyroglobulin Tumor Marker (Mayo)OutsideLaboratory,,84432,CPT,Facility,Both,,,90,92,78.2,26.3672,92,BlueCross BlueShield Minnesota, Federal Employee Program,90.528,98.4,,percent of total billed charges,,
Thyroglobulin Tumor Marker (Mayo)OutsideLaboratory,,84432,CPT,Facility,Both,,,90,92,78.2,26.3672,92,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,92,100,,percent of total billed charges,,
Thyroglobulin Tumor Marker (Mayo)OutsideLaboratory,,84432,CPT,Facility,Both,,,90,92,78.2,26.3672,92,BlueCross BlueShield Minnesota,High Value Network Plan,82.8,90,,percent of total billed charges,,
Thyroglobulin Tumor Marker (Mayo)OutsideLaboratory,,84432,CPT,Facility,Outpatient,,,90,92,78.2,26.3672,92,BlueCross BlueShield Minnesota,Medicare Advantage,45.08,49,,percent of total billed charges,,
Thyroglobulin Tumor Marker (Mayo)OutsideLaboratory,,84432,CPT,Facility,Inpatient,,,90,92,78.2,26.3672,92,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Thyroglobulin Tumor Marker (Mayo)OutsideLaboratory,,84432,CPT,Facility,Both,,,90,92,78.2,26.3672,92,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,81.4844,88.57,,percent of total billed charges,,
Thyroglobulin Tumor Marker (Mayo)OutsideLaboratory,,84432,CPT,Facility,Both,,,90,92,78.2,26.3672,92,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,26.3672,28.66,,percent of total billed charges,,
Thyroglobulin Tumor Marker (Mayo)OutsideLaboratory,,84432,CPT,Facility,Outpatient,,,90,92,78.2,26.3672,92,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),45.08,49,,percent of total billed charges,,
Thyroglobulin Tumor Marker (Mayo)OutsideLaboratory,,84432,CPT,Facility,Inpatient,,,90,92,78.2,26.3672,92,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Thyroglobulin Tumor Marker (Mayo)OutsideLaboratory,,84432,CPT,Facility,Both,,,90,92,78.2,26.3672,92,CorVel,Worker's Compensation,92,100,,percent of total billed charges,,
Thyroglobulin Tumor Marker (Mayo)OutsideLaboratory,,84432,CPT,Facility,Both,,,90,92,78.2,26.3672,92,First Health Group Corporation,First Health Network,89.24,97,,percent of total billed charges,,
Thyroglobulin Tumor Marker (Mayo)OutsideLaboratory,,84432,CPT,Facility,Both,,,90,92,78.2,26.3672,92,"Health Partners, Inc.",Commercial,87.032,94.6,,percent of total billed charges,,
Thyroglobulin Tumor Marker (Mayo)OutsideLaboratory,,84432,CPT,Facility,Outpatient,,,90,92,78.2,26.3672,92,"Health Partners, Inc.",Medicare Advantage,45.08,49,,percent of total billed charges,,
Thyroglobulin Tumor Marker (Mayo)OutsideLaboratory,,84432,CPT,Facility,Inpatient,,,90,92,78.2,26.3672,92,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Thyroglobulin Tumor Marker (Mayo)OutsideLaboratory,,84432,CPT,Facility,Both,,,90,92,78.2,26.3672,92,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),55.2,60,,percent of total billed charges,,
Thyroglobulin Tumor Marker (Mayo)OutsideLaboratory,,84432,CPT,Facility,Both,,,90,92,78.2,26.3672,92,"Health Partners, Inc.",State of Minnesota Advantage Program,74.98,81.5,,percent of total billed charges,,
Thyroglobulin Tumor Marker (Mayo)OutsideLaboratory,,84432,CPT,Facility,Both,,,90,92,78.2,26.3672,92,"Health Partners, Inc.",State Public Programs,46,50,,percent of total billed charges,,
Thyroglobulin Tumor Marker (Mayo)OutsideLaboratory,,84432,CPT,Facility,Both,,,90,92,78.2,26.3672,92,Humana Insurance Company,Commercial PPO,87.4,95,,percent of total billed charges,,
Thyroglobulin Tumor Marker (Mayo)OutsideLaboratory,,84432,CPT,Facility,Outpatient,,,90,92,78.2,26.3672,92,Humana Insurance Company,Medicare PPO,45.08,49,,percent of total billed charges,,
Thyroglobulin Tumor Marker (Mayo)OutsideLaboratory,,84432,CPT,Facility,Inpatient,,,90,92,78.2,26.3672,92,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Thyroglobulin Tumor Marker (Mayo)OutsideLaboratory,,84432,CPT,Facility,Both,,,90,92,78.2,26.3672,92,Medica,Individual & Family,91.172,99.1,,percent of total billed charges,,
Thyroglobulin Tumor Marker (Mayo)OutsideLaboratory,,84432,CPT,Facility,Outpatient,,,90,92,78.2,26.3672,92,Medica,Medica Advantage Solution,45.816,49.8,,percent of total billed charges,,
Thyroglobulin Tumor Marker (Mayo)OutsideLaboratory,,84432,CPT,Facility,Inpatient,,,90,92,78.2,26.3672,92,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Thyroglobulin Tumor Marker (Mayo)OutsideLaboratory,,84432,CPT,Facility,Outpatient,,,90,92,78.2,26.3672,92,Medica,Medical Assistance,41.032,44.6,,percent of total billed charges,,
Thyroglobulin Tumor Marker (Mayo)OutsideLaboratory,,84432,CPT,Facility,Inpatient,,,90,92,78.2,26.3672,92,Medica,Medical Assistance,,,,,Included in per diem rate,
Thyroglobulin Tumor Marker (Mayo)OutsideLaboratory,,84432,CPT,Facility,Outpatient,,,90,92,78.2,26.3672,92,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,45.816,49.8,,percent of total billed charges,,
Thyroglobulin Tumor Marker (Mayo)OutsideLaboratory,,84432,CPT,Facility,Inpatient,,,90,92,78.2,26.3672,92,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Thyroglobulin Tumor Marker (Mayo)OutsideLaboratory,,84432,CPT,Facility,Both,,,90,92,78.2,26.3672,92,"Multiplan, Inc.","Multiplan, Inc.",86.48,94,,percent of total billed charges,,
Thyroglobulin Tumor Marker (Mayo)OutsideLaboratory,,84432,CPT,Facility,Outpatient,,,90,92,78.2,26.3672,92,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,79.488,86.4,,percent of total billed charges,,
Thyroglobulin Tumor Marker (Mayo)OutsideLaboratory,,84432,CPT,Facility,Inpatient,,,90,92,78.2,26.3672,92,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Thyroglobulin Tumor Marker (Mayo)OutsideLaboratory,,84432,CPT,Facility,Both,,,90,92,78.2,26.3672,92,"Preferred One Administrative Services, INC.",PPO,90.712,98.6,,percent of total billed charges,,
Thyroglobulin Tumor Marker (Mayo)OutsideLaboratory,,84432,CPT,Facility,Outpatient,,,90,92,78.2,26.3672,92,PrimeWest Health,Minnesota Senior Health Options (MSHO),47.334,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Thyroglobulin Tumor Marker (Mayo)OutsideLaboratory,,84432,CPT,Facility,Inpatient,,,90,92,78.2,26.3672,92,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Thyroglobulin Tumor Marker (Mayo)OutsideLaboratory,,84432,CPT,Facility,Outpatient,,,90,92,78.2,26.3672,92,PrimeWest Health,MinnesotaCare,47.2512,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Thyroglobulin Tumor Marker (Mayo)OutsideLaboratory,,84432,CPT,Facility,Inpatient,,,90,92,78.2,26.3672,92,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Thyroglobulin Tumor Marker (Mayo)OutsideLaboratory,,84432,CPT,Facility,Both,,,90,92,78.2,26.3672,92,Sanford Health Plan,Sanford Health Plan,84.64,92,,percent of total billed charges,,
Thyroglobulin Tumor Marker (Mayo)OutsideLaboratory,,84432,CPT,Facility,Outpatient,,,90,92,78.2,26.3672,92,"UCare Health, Inc.",Individual & Family Plan,51.842,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Thyroglobulin Tumor Marker (Mayo)OutsideLaboratory,,84432,CPT,Facility,Inpatient,,,90,92,78.2,26.3672,92,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Thyroglobulin Tumor Marker (Mayo)OutsideLaboratory,,84432,CPT,Facility,Outpatient,,,90,92,78.2,26.3672,92,"UCare Health, Inc.",Medical Assistance,46.4324,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Thyroglobulin Tumor Marker (Mayo)OutsideLaboratory,,84432,CPT,Facility,Inpatient,,,90,92,78.2,26.3672,92,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Thyroglobulin Tumor Marker (Mayo)OutsideLaboratory,,84432,CPT,Facility,Outpatient,,,90,92,78.2,26.3672,92,"UCare Health, Inc.",Medicare Advantage,46.4324,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Thyroglobulin Tumor Marker (Mayo)OutsideLaboratory,,84432,CPT,Facility,Inpatient,,,90,92,78.2,26.3672,92,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Thyroglobulin Tumor Marker (Mayo)OutsideLaboratory,,84432,CPT,Facility,Outpatient,,,90,92,78.2,26.3672,92,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),46.4324,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Thyroglobulin Tumor Marker (Mayo)OutsideLaboratory,,84432,CPT,Facility,Inpatient,,,90,92,78.2,26.3672,92,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Thyroglobulin Tumor Marker (Mayo)OutsideLaboratory,,84432,CPT,Facility,Both,,,90,92,78.2,26.3672,92,UnitedHealthcare,Individual & Family,86.48,94,,percent of total billed charges,,
Thyroglobulin Tumor Marker (Mayo)OutsideLaboratory,,84432,CPT,Facility,Outpatient,,,90,92,78.2,26.3672,92,UnitedHealthcare,Medicare Advantage,45.08,49,,percent of total billed charges,,
Thyroglobulin Tumor Marker (Mayo)OutsideLaboratory,,84432,CPT,Facility,Inpatient,,,90,92,78.2,26.3672,92,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Thyroglobulin Tumor Marker (Mayo)OutsideLaboratory,,84432,CPT,Facility,Outpatient,,,90,92,78.2,26.3672,92,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,44.16,48,,percent of total billed charges,,100% of DHS outpatient percentage
Thyroglobulin Tumor Marker (Mayo)OutsideLaboratory,,84432,CPT,Facility,Inpatient,,,90,92,78.2,26.3672,92,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Thyroglobulin, Tumor Marker (Mayo)OutsideLaboratory",,84432,CPT,Facility,Both,,,90,102,86.7,29.2332,102,Aetna,Commercial,93.84,92,,percent of total billed charges,,
"Thyroglobulin, Tumor Marker (Mayo)OutsideLaboratory",,84432,CPT,Facility,Outpatient,,,90,102,86.7,29.2332,102,Aetna,Medicare Advantage,49.98,49,,percent of total billed charges,,
"Thyroglobulin, Tumor Marker (Mayo)OutsideLaboratory",,84432,CPT,Facility,Inpatient,,,90,102,86.7,29.2332,102,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Thyroglobulin, Tumor Marker (Mayo)OutsideLaboratory",,84432,CPT,Facility,Both,,,90,102,86.7,29.2332,102,Aetna,PPO,94.86,93,,percent of total billed charges,,
"Thyroglobulin, Tumor Marker (Mayo)OutsideLaboratory",,84432,CPT,Facility,Both,,,90,102,86.7,29.2332,102,America's PPO,America's PPO,97.9506,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Thyroglobulin, Tumor Marker (Mayo)OutsideLaboratory",,84432,CPT,Facility,Both,,,90,102,86.7,29.2332,102,BlueCross BlueShield Minnesota, Federal Employee Program,100.368,98.4,,percent of total billed charges,,
"Thyroglobulin, Tumor Marker (Mayo)OutsideLaboratory",,84432,CPT,Facility,Both,,,90,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,102,100,,percent of total billed charges,,
"Thyroglobulin, Tumor Marker (Mayo)OutsideLaboratory",,84432,CPT,Facility,Both,,,90,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,High Value Network Plan,91.8,90,,percent of total billed charges,,
"Thyroglobulin, Tumor Marker (Mayo)OutsideLaboratory",,84432,CPT,Facility,Outpatient,,,90,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,Medicare Advantage,49.98,49,,percent of total billed charges,,
"Thyroglobulin, Tumor Marker (Mayo)OutsideLaboratory",,84432,CPT,Facility,Inpatient,,,90,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Thyroglobulin, Tumor Marker (Mayo)OutsideLaboratory",,84432,CPT,Facility,Both,,,90,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,90.3414,88.57,,percent of total billed charges,,
"Thyroglobulin, Tumor Marker (Mayo)OutsideLaboratory",,84432,CPT,Facility,Both,,,90,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,29.2332,28.66,,percent of total billed charges,,
"Thyroglobulin, Tumor Marker (Mayo)OutsideLaboratory",,84432,CPT,Facility,Outpatient,,,90,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),49.98,49,,percent of total billed charges,,
"Thyroglobulin, Tumor Marker (Mayo)OutsideLaboratory",,84432,CPT,Facility,Inpatient,,,90,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Thyroglobulin, Tumor Marker (Mayo)OutsideLaboratory",,84432,CPT,Facility,Both,,,90,102,86.7,29.2332,102,CorVel,Worker's Compensation,102,100,,percent of total billed charges,,
"Thyroglobulin, Tumor Marker (Mayo)OutsideLaboratory",,84432,CPT,Facility,Both,,,90,102,86.7,29.2332,102,First Health Group Corporation,First Health Network,98.94,97,,percent of total billed charges,,
"Thyroglobulin, Tumor Marker (Mayo)OutsideLaboratory",,84432,CPT,Facility,Both,,,90,102,86.7,29.2332,102,"Health Partners, Inc.",Commercial,96.492,94.6,,percent of total billed charges,,
"Thyroglobulin, Tumor Marker (Mayo)OutsideLaboratory",,84432,CPT,Facility,Outpatient,,,90,102,86.7,29.2332,102,"Health Partners, Inc.",Medicare Advantage,49.98,49,,percent of total billed charges,,
"Thyroglobulin, Tumor Marker (Mayo)OutsideLaboratory",,84432,CPT,Facility,Inpatient,,,90,102,86.7,29.2332,102,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Thyroglobulin, Tumor Marker (Mayo)OutsideLaboratory",,84432,CPT,Facility,Both,,,90,102,86.7,29.2332,102,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),61.2,60,,percent of total billed charges,,
"Thyroglobulin, Tumor Marker (Mayo)OutsideLaboratory",,84432,CPT,Facility,Both,,,90,102,86.7,29.2332,102,"Health Partners, Inc.",State of Minnesota Advantage Program,83.13,81.5,,percent of total billed charges,,
"Thyroglobulin, Tumor Marker (Mayo)OutsideLaboratory",,84432,CPT,Facility,Both,,,90,102,86.7,29.2332,102,"Health Partners, Inc.",State Public Programs,51,50,,percent of total billed charges,,
"Thyroglobulin, Tumor Marker (Mayo)OutsideLaboratory",,84432,CPT,Facility,Both,,,90,102,86.7,29.2332,102,Humana Insurance Company,Commercial PPO,96.9,95,,percent of total billed charges,,
"Thyroglobulin, Tumor Marker (Mayo)OutsideLaboratory",,84432,CPT,Facility,Outpatient,,,90,102,86.7,29.2332,102,Humana Insurance Company,Medicare PPO,49.98,49,,percent of total billed charges,,
"Thyroglobulin, Tumor Marker (Mayo)OutsideLaboratory",,84432,CPT,Facility,Inpatient,,,90,102,86.7,29.2332,102,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Thyroglobulin, Tumor Marker (Mayo)OutsideLaboratory",,84432,CPT,Facility,Both,,,90,102,86.7,29.2332,102,Medica,Individual & Family,101.082,99.1,,percent of total billed charges,,
"Thyroglobulin, Tumor Marker (Mayo)OutsideLaboratory",,84432,CPT,Facility,Outpatient,,,90,102,86.7,29.2332,102,Medica,Medica Advantage Solution,50.796,49.8,,percent of total billed charges,,
"Thyroglobulin, Tumor Marker (Mayo)OutsideLaboratory",,84432,CPT,Facility,Inpatient,,,90,102,86.7,29.2332,102,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Thyroglobulin, Tumor Marker (Mayo)OutsideLaboratory",,84432,CPT,Facility,Outpatient,,,90,102,86.7,29.2332,102,Medica,Medical Assistance,45.492,44.6,,percent of total billed charges,,
"Thyroglobulin, Tumor Marker (Mayo)OutsideLaboratory",,84432,CPT,Facility,Inpatient,,,90,102,86.7,29.2332,102,Medica,Medical Assistance,,,,,Included in per diem rate,
"Thyroglobulin, Tumor Marker (Mayo)OutsideLaboratory",,84432,CPT,Facility,Outpatient,,,90,102,86.7,29.2332,102,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,50.796,49.8,,percent of total billed charges,,
"Thyroglobulin, Tumor Marker (Mayo)OutsideLaboratory",,84432,CPT,Facility,Inpatient,,,90,102,86.7,29.2332,102,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Thyroglobulin, Tumor Marker (Mayo)OutsideLaboratory",,84432,CPT,Facility,Both,,,90,102,86.7,29.2332,102,"Multiplan, Inc.","Multiplan, Inc.",95.88,94,,percent of total billed charges,,
"Thyroglobulin, Tumor Marker (Mayo)OutsideLaboratory",,84432,CPT,Facility,Outpatient,,,90,102,86.7,29.2332,102,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,88.128,86.4,,percent of total billed charges,,
"Thyroglobulin, Tumor Marker (Mayo)OutsideLaboratory",,84432,CPT,Facility,Inpatient,,,90,102,86.7,29.2332,102,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Thyroglobulin, Tumor Marker (Mayo)OutsideLaboratory",,84432,CPT,Facility,Both,,,90,102,86.7,29.2332,102,"Preferred One Administrative Services, INC.",PPO,100.572,98.6,,percent of total billed charges,,
"Thyroglobulin, Tumor Marker (Mayo)OutsideLaboratory",,84432,CPT,Facility,Outpatient,,,90,102,86.7,29.2332,102,PrimeWest Health,Minnesota Senior Health Options (MSHO),52.479,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Thyroglobulin, Tumor Marker (Mayo)OutsideLaboratory",,84432,CPT,Facility,Inpatient,,,90,102,86.7,29.2332,102,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Thyroglobulin, Tumor Marker (Mayo)OutsideLaboratory",,84432,CPT,Facility,Outpatient,,,90,102,86.7,29.2332,102,PrimeWest Health,MinnesotaCare,52.3872,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Thyroglobulin, Tumor Marker (Mayo)OutsideLaboratory",,84432,CPT,Facility,Inpatient,,,90,102,86.7,29.2332,102,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Thyroglobulin, Tumor Marker (Mayo)OutsideLaboratory",,84432,CPT,Facility,Both,,,90,102,86.7,29.2332,102,Sanford Health Plan,Sanford Health Plan,93.84,92,,percent of total billed charges,,
"Thyroglobulin, Tumor Marker (Mayo)OutsideLaboratory",,84432,CPT,Facility,Outpatient,,,90,102,86.7,29.2332,102,"UCare Health, Inc.",Individual & Family Plan,57.477,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Thyroglobulin, Tumor Marker (Mayo)OutsideLaboratory",,84432,CPT,Facility,Inpatient,,,90,102,86.7,29.2332,102,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Thyroglobulin, Tumor Marker (Mayo)OutsideLaboratory",,84432,CPT,Facility,Outpatient,,,90,102,86.7,29.2332,102,"UCare Health, Inc.",Medical Assistance,51.4794,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Thyroglobulin, Tumor Marker (Mayo)OutsideLaboratory",,84432,CPT,Facility,Inpatient,,,90,102,86.7,29.2332,102,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Thyroglobulin, Tumor Marker (Mayo)OutsideLaboratory",,84432,CPT,Facility,Outpatient,,,90,102,86.7,29.2332,102,"UCare Health, Inc.",Medicare Advantage,51.4794,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Thyroglobulin, Tumor Marker (Mayo)OutsideLaboratory",,84432,CPT,Facility,Inpatient,,,90,102,86.7,29.2332,102,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Thyroglobulin, Tumor Marker (Mayo)OutsideLaboratory",,84432,CPT,Facility,Outpatient,,,90,102,86.7,29.2332,102,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),51.4794,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Thyroglobulin, Tumor Marker (Mayo)OutsideLaboratory",,84432,CPT,Facility,Inpatient,,,90,102,86.7,29.2332,102,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Thyroglobulin, Tumor Marker (Mayo)OutsideLaboratory",,84432,CPT,Facility,Both,,,90,102,86.7,29.2332,102,UnitedHealthcare,Individual & Family,95.88,94,,percent of total billed charges,,
"Thyroglobulin, Tumor Marker (Mayo)OutsideLaboratory",,84432,CPT,Facility,Outpatient,,,90,102,86.7,29.2332,102,UnitedHealthcare,Medicare Advantage,49.98,49,,percent of total billed charges,,
"Thyroglobulin, Tumor Marker (Mayo)OutsideLaboratory",,84432,CPT,Facility,Inpatient,,,90,102,86.7,29.2332,102,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Thyroglobulin, Tumor Marker (Mayo)OutsideLaboratory",,84432,CPT,Facility,Outpatient,,,90,102,86.7,29.2332,102,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,48.96,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Thyroglobulin, Tumor Marker (Mayo)OutsideLaboratory",,84432,CPT,Facility,Inpatient,,,90,102,86.7,29.2332,102,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Thyroxine Binding Globulin, S (Mayo)OutsideLaboratory",,84442,CPT,Facility,Both,,,90,150,127.5,42.99,150,Aetna,Commercial,138,92,,percent of total billed charges,,
"Thyroxine Binding Globulin, S (Mayo)OutsideLaboratory",,84442,CPT,Facility,Outpatient,,,90,150,127.5,42.99,150,Aetna,Medicare Advantage,73.5,49,,percent of total billed charges,,
"Thyroxine Binding Globulin, S (Mayo)OutsideLaboratory",,84442,CPT,Facility,Inpatient,,,90,150,127.5,42.99,150,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Thyroxine Binding Globulin, S (Mayo)OutsideLaboratory",,84442,CPT,Facility,Both,,,90,150,127.5,42.99,150,Aetna,PPO,139.5,93,,percent of total billed charges,,
"Thyroxine Binding Globulin, S (Mayo)OutsideLaboratory",,84442,CPT,Facility,Both,,,90,150,127.5,42.99,150,America's PPO,America's PPO,144.045,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Thyroxine Binding Globulin, S (Mayo)OutsideLaboratory",,84442,CPT,Facility,Both,,,90,150,127.5,42.99,150,BlueCross BlueShield Minnesota, Federal Employee Program,147.6,98.4,,percent of total billed charges,,
"Thyroxine Binding Globulin, S (Mayo)OutsideLaboratory",,84442,CPT,Facility,Both,,,90,150,127.5,42.99,150,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,150,100,,percent of total billed charges,,
"Thyroxine Binding Globulin, S (Mayo)OutsideLaboratory",,84442,CPT,Facility,Both,,,90,150,127.5,42.99,150,BlueCross BlueShield Minnesota,High Value Network Plan,135,90,,percent of total billed charges,,
"Thyroxine Binding Globulin, S (Mayo)OutsideLaboratory",,84442,CPT,Facility,Outpatient,,,90,150,127.5,42.99,150,BlueCross BlueShield Minnesota,Medicare Advantage,73.5,49,,percent of total billed charges,,
"Thyroxine Binding Globulin, S (Mayo)OutsideLaboratory",,84442,CPT,Facility,Inpatient,,,90,150,127.5,42.99,150,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Thyroxine Binding Globulin, S (Mayo)OutsideLaboratory",,84442,CPT,Facility,Both,,,90,150,127.5,42.99,150,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,132.855,88.57,,percent of total billed charges,,
"Thyroxine Binding Globulin, S (Mayo)OutsideLaboratory",,84442,CPT,Facility,Both,,,90,150,127.5,42.99,150,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,42.99,28.66,,percent of total billed charges,,
"Thyroxine Binding Globulin, S (Mayo)OutsideLaboratory",,84442,CPT,Facility,Outpatient,,,90,150,127.5,42.99,150,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),73.5,49,,percent of total billed charges,,
"Thyroxine Binding Globulin, S (Mayo)OutsideLaboratory",,84442,CPT,Facility,Inpatient,,,90,150,127.5,42.99,150,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Thyroxine Binding Globulin, S (Mayo)OutsideLaboratory",,84442,CPT,Facility,Both,,,90,150,127.5,42.99,150,CorVel,Worker's Compensation,150,100,,percent of total billed charges,,
"Thyroxine Binding Globulin, S (Mayo)OutsideLaboratory",,84442,CPT,Facility,Both,,,90,150,127.5,42.99,150,First Health Group Corporation,First Health Network,145.5,97,,percent of total billed charges,,
"Thyroxine Binding Globulin, S (Mayo)OutsideLaboratory",,84442,CPT,Facility,Both,,,90,150,127.5,42.99,150,"Health Partners, Inc.",Commercial,141.9,94.6,,percent of total billed charges,,
"Thyroxine Binding Globulin, S (Mayo)OutsideLaboratory",,84442,CPT,Facility,Outpatient,,,90,150,127.5,42.99,150,"Health Partners, Inc.",Medicare Advantage,73.5,49,,percent of total billed charges,,
"Thyroxine Binding Globulin, S (Mayo)OutsideLaboratory",,84442,CPT,Facility,Inpatient,,,90,150,127.5,42.99,150,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Thyroxine Binding Globulin, S (Mayo)OutsideLaboratory",,84442,CPT,Facility,Both,,,90,150,127.5,42.99,150,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),90,60,,percent of total billed charges,,
"Thyroxine Binding Globulin, S (Mayo)OutsideLaboratory",,84442,CPT,Facility,Both,,,90,150,127.5,42.99,150,"Health Partners, Inc.",State of Minnesota Advantage Program,122.25,81.5,,percent of total billed charges,,
"Thyroxine Binding Globulin, S (Mayo)OutsideLaboratory",,84442,CPT,Facility,Both,,,90,150,127.5,42.99,150,"Health Partners, Inc.",State Public Programs,75,50,,percent of total billed charges,,
"Thyroxine Binding Globulin, S (Mayo)OutsideLaboratory",,84442,CPT,Facility,Both,,,90,150,127.5,42.99,150,Humana Insurance Company,Commercial PPO,142.5,95,,percent of total billed charges,,
"Thyroxine Binding Globulin, S (Mayo)OutsideLaboratory",,84442,CPT,Facility,Outpatient,,,90,150,127.5,42.99,150,Humana Insurance Company,Medicare PPO,73.5,49,,percent of total billed charges,,
"Thyroxine Binding Globulin, S (Mayo)OutsideLaboratory",,84442,CPT,Facility,Inpatient,,,90,150,127.5,42.99,150,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Thyroxine Binding Globulin, S (Mayo)OutsideLaboratory",,84442,CPT,Facility,Both,,,90,150,127.5,42.99,150,Medica,Individual & Family,148.65,99.1,,percent of total billed charges,,
"Thyroxine Binding Globulin, S (Mayo)OutsideLaboratory",,84442,CPT,Facility,Outpatient,,,90,150,127.5,42.99,150,Medica,Medica Advantage Solution,74.7,49.8,,percent of total billed charges,,
"Thyroxine Binding Globulin, S (Mayo)OutsideLaboratory",,84442,CPT,Facility,Inpatient,,,90,150,127.5,42.99,150,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Thyroxine Binding Globulin, S (Mayo)OutsideLaboratory",,84442,CPT,Facility,Outpatient,,,90,150,127.5,42.99,150,Medica,Medical Assistance,66.9,44.6,,percent of total billed charges,,
"Thyroxine Binding Globulin, S (Mayo)OutsideLaboratory",,84442,CPT,Facility,Inpatient,,,90,150,127.5,42.99,150,Medica,Medical Assistance,,,,,Included in per diem rate,
"Thyroxine Binding Globulin, S (Mayo)OutsideLaboratory",,84442,CPT,Facility,Outpatient,,,90,150,127.5,42.99,150,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,74.7,49.8,,percent of total billed charges,,
"Thyroxine Binding Globulin, S (Mayo)OutsideLaboratory",,84442,CPT,Facility,Inpatient,,,90,150,127.5,42.99,150,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Thyroxine Binding Globulin, S (Mayo)OutsideLaboratory",,84442,CPT,Facility,Both,,,90,150,127.5,42.99,150,"Multiplan, Inc.","Multiplan, Inc.",141,94,,percent of total billed charges,,
"Thyroxine Binding Globulin, S (Mayo)OutsideLaboratory",,84442,CPT,Facility,Outpatient,,,90,150,127.5,42.99,150,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,129.6,86.4,,percent of total billed charges,,
"Thyroxine Binding Globulin, S (Mayo)OutsideLaboratory",,84442,CPT,Facility,Inpatient,,,90,150,127.5,42.99,150,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Thyroxine Binding Globulin, S (Mayo)OutsideLaboratory",,84442,CPT,Facility,Both,,,90,150,127.5,42.99,150,"Preferred One Administrative Services, INC.",PPO,147.9,98.6,,percent of total billed charges,,
"Thyroxine Binding Globulin, S (Mayo)OutsideLaboratory",,84442,CPT,Facility,Outpatient,,,90,150,127.5,42.99,150,PrimeWest Health,Minnesota Senior Health Options (MSHO),77.175,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Thyroxine Binding Globulin, S (Mayo)OutsideLaboratory",,84442,CPT,Facility,Inpatient,,,90,150,127.5,42.99,150,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Thyroxine Binding Globulin, S (Mayo)OutsideLaboratory",,84442,CPT,Facility,Outpatient,,,90,150,127.5,42.99,150,PrimeWest Health,MinnesotaCare,77.04,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Thyroxine Binding Globulin, S (Mayo)OutsideLaboratory",,84442,CPT,Facility,Inpatient,,,90,150,127.5,42.99,150,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Thyroxine Binding Globulin, S (Mayo)OutsideLaboratory",,84442,CPT,Facility,Both,,,90,150,127.5,42.99,150,Sanford Health Plan,Sanford Health Plan,138,92,,percent of total billed charges,,
"Thyroxine Binding Globulin, S (Mayo)OutsideLaboratory",,84442,CPT,Facility,Outpatient,,,90,150,127.5,42.99,150,"UCare Health, Inc.",Individual & Family Plan,84.525,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Thyroxine Binding Globulin, S (Mayo)OutsideLaboratory",,84442,CPT,Facility,Inpatient,,,90,150,127.5,42.99,150,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Thyroxine Binding Globulin, S (Mayo)OutsideLaboratory",,84442,CPT,Facility,Outpatient,,,90,150,127.5,42.99,150,"UCare Health, Inc.",Medical Assistance,75.705,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Thyroxine Binding Globulin, S (Mayo)OutsideLaboratory",,84442,CPT,Facility,Inpatient,,,90,150,127.5,42.99,150,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Thyroxine Binding Globulin, S (Mayo)OutsideLaboratory",,84442,CPT,Facility,Outpatient,,,90,150,127.5,42.99,150,"UCare Health, Inc.",Medicare Advantage,75.705,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Thyroxine Binding Globulin, S (Mayo)OutsideLaboratory",,84442,CPT,Facility,Inpatient,,,90,150,127.5,42.99,150,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Thyroxine Binding Globulin, S (Mayo)OutsideLaboratory",,84442,CPT,Facility,Outpatient,,,90,150,127.5,42.99,150,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),75.705,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Thyroxine Binding Globulin, S (Mayo)OutsideLaboratory",,84442,CPT,Facility,Inpatient,,,90,150,127.5,42.99,150,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Thyroxine Binding Globulin, S (Mayo)OutsideLaboratory",,84442,CPT,Facility,Both,,,90,150,127.5,42.99,150,UnitedHealthcare,Individual & Family,141,94,,percent of total billed charges,,
"Thyroxine Binding Globulin, S (Mayo)OutsideLaboratory",,84442,CPT,Facility,Outpatient,,,90,150,127.5,42.99,150,UnitedHealthcare,Medicare Advantage,73.5,49,,percent of total billed charges,,
"Thyroxine Binding Globulin, S (Mayo)OutsideLaboratory",,84442,CPT,Facility,Inpatient,,,90,150,127.5,42.99,150,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Thyroxine Binding Globulin, S (Mayo)OutsideLaboratory",,84442,CPT,Facility,Outpatient,,,90,150,127.5,42.99,150,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,72,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Thyroxine Binding Globulin, S (Mayo)OutsideLaboratory",,84442,CPT,Facility,Inpatient,,,90,150,127.5,42.99,150,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Thyroid Stimulating Hormone (Mdh)OutsideLaboratory,,84443,CPT,Facility,Both,,,90,34,28.9,9.7444,34,Aetna,Commercial,31.28,92,,percent of total billed charges,,
Thyroid Stimulating Hormone (Mdh)OutsideLaboratory,,84443,CPT,Facility,Outpatient,,,90,34,28.9,9.7444,34,Aetna,Medicare Advantage,16.66,49,,percent of total billed charges,,
Thyroid Stimulating Hormone (Mdh)OutsideLaboratory,,84443,CPT,Facility,Inpatient,,,90,34,28.9,9.7444,34,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Thyroid Stimulating Hormone (Mdh)OutsideLaboratory,,84443,CPT,Facility,Both,,,90,34,28.9,9.7444,34,Aetna,PPO,31.62,93,,percent of total billed charges,,
Thyroid Stimulating Hormone (Mdh)OutsideLaboratory,,84443,CPT,Facility,Both,,,90,34,28.9,9.7444,34,America's PPO,America's PPO,32.6502,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Thyroid Stimulating Hormone (Mdh)OutsideLaboratory,,84443,CPT,Facility,Both,,,90,34,28.9,9.7444,34,BlueCross BlueShield Minnesota, Federal Employee Program,33.456,98.4,,percent of total billed charges,,
Thyroid Stimulating Hormone (Mdh)OutsideLaboratory,,84443,CPT,Facility,Both,,,90,34,28.9,9.7444,34,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,34,100,,percent of total billed charges,,
Thyroid Stimulating Hormone (Mdh)OutsideLaboratory,,84443,CPT,Facility,Both,,,90,34,28.9,9.7444,34,BlueCross BlueShield Minnesota,High Value Network Plan,30.6,90,,percent of total billed charges,,
Thyroid Stimulating Hormone (Mdh)OutsideLaboratory,,84443,CPT,Facility,Outpatient,,,90,34,28.9,9.7444,34,BlueCross BlueShield Minnesota,Medicare Advantage,16.66,49,,percent of total billed charges,,
Thyroid Stimulating Hormone (Mdh)OutsideLaboratory,,84443,CPT,Facility,Inpatient,,,90,34,28.9,9.7444,34,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Thyroid Stimulating Hormone (Mdh)OutsideLaboratory,,84443,CPT,Facility,Both,,,90,34,28.9,9.7444,34,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,30.1138,88.57,,percent of total billed charges,,
Thyroid Stimulating Hormone (Mdh)OutsideLaboratory,,84443,CPT,Facility,Both,,,90,34,28.9,9.7444,34,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,9.7444,28.66,,percent of total billed charges,,
Thyroid Stimulating Hormone (Mdh)OutsideLaboratory,,84443,CPT,Facility,Outpatient,,,90,34,28.9,9.7444,34,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),16.66,49,,percent of total billed charges,,
Thyroid Stimulating Hormone (Mdh)OutsideLaboratory,,84443,CPT,Facility,Inpatient,,,90,34,28.9,9.7444,34,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Thyroid Stimulating Hormone (Mdh)OutsideLaboratory,,84443,CPT,Facility,Both,,,90,34,28.9,9.7444,34,CorVel,Worker's Compensation,34,100,,percent of total billed charges,,
Thyroid Stimulating Hormone (Mdh)OutsideLaboratory,,84443,CPT,Facility,Both,,,90,34,28.9,9.7444,34,First Health Group Corporation,First Health Network,32.98,97,,percent of total billed charges,,
Thyroid Stimulating Hormone (Mdh)OutsideLaboratory,,84443,CPT,Facility,Both,,,90,34,28.9,9.7444,34,"Health Partners, Inc.",Commercial,32.164,94.6,,percent of total billed charges,,
Thyroid Stimulating Hormone (Mdh)OutsideLaboratory,,84443,CPT,Facility,Outpatient,,,90,34,28.9,9.7444,34,"Health Partners, Inc.",Medicare Advantage,16.66,49,,percent of total billed charges,,
Thyroid Stimulating Hormone (Mdh)OutsideLaboratory,,84443,CPT,Facility,Inpatient,,,90,34,28.9,9.7444,34,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Thyroid Stimulating Hormone (Mdh)OutsideLaboratory,,84443,CPT,Facility,Both,,,90,34,28.9,9.7444,34,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),20.4,60,,percent of total billed charges,,
Thyroid Stimulating Hormone (Mdh)OutsideLaboratory,,84443,CPT,Facility,Both,,,90,34,28.9,9.7444,34,"Health Partners, Inc.",State of Minnesota Advantage Program,27.71,81.5,,percent of total billed charges,,
Thyroid Stimulating Hormone (Mdh)OutsideLaboratory,,84443,CPT,Facility,Both,,,90,34,28.9,9.7444,34,"Health Partners, Inc.",State Public Programs,17,50,,percent of total billed charges,,
Thyroid Stimulating Hormone (Mdh)OutsideLaboratory,,84443,CPT,Facility,Both,,,90,34,28.9,9.7444,34,Humana Insurance Company,Commercial PPO,32.3,95,,percent of total billed charges,,
Thyroid Stimulating Hormone (Mdh)OutsideLaboratory,,84443,CPT,Facility,Outpatient,,,90,34,28.9,9.7444,34,Humana Insurance Company,Medicare PPO,16.66,49,,percent of total billed charges,,
Thyroid Stimulating Hormone (Mdh)OutsideLaboratory,,84443,CPT,Facility,Inpatient,,,90,34,28.9,9.7444,34,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Thyroid Stimulating Hormone (Mdh)OutsideLaboratory,,84443,CPT,Facility,Both,,,90,34,28.9,9.7444,34,Medica,Individual & Family,33.694,99.1,,percent of total billed charges,,
Thyroid Stimulating Hormone (Mdh)OutsideLaboratory,,84443,CPT,Facility,Outpatient,,,90,34,28.9,9.7444,34,Medica,Medica Advantage Solution,16.932,49.8,,percent of total billed charges,,
Thyroid Stimulating Hormone (Mdh)OutsideLaboratory,,84443,CPT,Facility,Inpatient,,,90,34,28.9,9.7444,34,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Thyroid Stimulating Hormone (Mdh)OutsideLaboratory,,84443,CPT,Facility,Outpatient,,,90,34,28.9,9.7444,34,Medica,Medical Assistance,15.164,44.6,,percent of total billed charges,,
Thyroid Stimulating Hormone (Mdh)OutsideLaboratory,,84443,CPT,Facility,Inpatient,,,90,34,28.9,9.7444,34,Medica,Medical Assistance,,,,,Included in per diem rate,
Thyroid Stimulating Hormone (Mdh)OutsideLaboratory,,84443,CPT,Facility,Outpatient,,,90,34,28.9,9.7444,34,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,16.932,49.8,,percent of total billed charges,,
Thyroid Stimulating Hormone (Mdh)OutsideLaboratory,,84443,CPT,Facility,Inpatient,,,90,34,28.9,9.7444,34,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Thyroid Stimulating Hormone (Mdh)OutsideLaboratory,,84443,CPT,Facility,Both,,,90,34,28.9,9.7444,34,"Multiplan, Inc.","Multiplan, Inc.",31.96,94,,percent of total billed charges,,
Thyroid Stimulating Hormone (Mdh)OutsideLaboratory,,84443,CPT,Facility,Outpatient,,,90,34,28.9,9.7444,34,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,29.376,86.4,,percent of total billed charges,,
Thyroid Stimulating Hormone (Mdh)OutsideLaboratory,,84443,CPT,Facility,Inpatient,,,90,34,28.9,9.7444,34,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Thyroid Stimulating Hormone (Mdh)OutsideLaboratory,,84443,CPT,Facility,Both,,,90,34,28.9,9.7444,34,"Preferred One Administrative Services, INC.",PPO,33.524,98.6,,percent of total billed charges,,
Thyroid Stimulating Hormone (Mdh)OutsideLaboratory,,84443,CPT,Facility,Outpatient,,,90,34,28.9,9.7444,34,PrimeWest Health,Minnesota Senior Health Options (MSHO),17.493,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Thyroid Stimulating Hormone (Mdh)OutsideLaboratory,,84443,CPT,Facility,Inpatient,,,90,34,28.9,9.7444,34,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Thyroid Stimulating Hormone (Mdh)OutsideLaboratory,,84443,CPT,Facility,Outpatient,,,90,34,28.9,9.7444,34,PrimeWest Health,MinnesotaCare,17.4624,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Thyroid Stimulating Hormone (Mdh)OutsideLaboratory,,84443,CPT,Facility,Inpatient,,,90,34,28.9,9.7444,34,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Thyroid Stimulating Hormone (Mdh)OutsideLaboratory,,84443,CPT,Facility,Both,,,90,34,28.9,9.7444,34,Sanford Health Plan,Sanford Health Plan,31.28,92,,percent of total billed charges,,
Thyroid Stimulating Hormone (Mdh)OutsideLaboratory,,84443,CPT,Facility,Outpatient,,,90,34,28.9,9.7444,34,"UCare Health, Inc.",Individual & Family Plan,19.159,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Thyroid Stimulating Hormone (Mdh)OutsideLaboratory,,84443,CPT,Facility,Inpatient,,,90,34,28.9,9.7444,34,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Thyroid Stimulating Hormone (Mdh)OutsideLaboratory,,84443,CPT,Facility,Outpatient,,,90,34,28.9,9.7444,34,"UCare Health, Inc.",Medical Assistance,17.1598,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Thyroid Stimulating Hormone (Mdh)OutsideLaboratory,,84443,CPT,Facility,Inpatient,,,90,34,28.9,9.7444,34,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Thyroid Stimulating Hormone (Mdh)OutsideLaboratory,,84443,CPT,Facility,Outpatient,,,90,34,28.9,9.7444,34,"UCare Health, Inc.",Medicare Advantage,17.1598,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Thyroid Stimulating Hormone (Mdh)OutsideLaboratory,,84443,CPT,Facility,Inpatient,,,90,34,28.9,9.7444,34,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Thyroid Stimulating Hormone (Mdh)OutsideLaboratory,,84443,CPT,Facility,Outpatient,,,90,34,28.9,9.7444,34,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),17.1598,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Thyroid Stimulating Hormone (Mdh)OutsideLaboratory,,84443,CPT,Facility,Inpatient,,,90,34,28.9,9.7444,34,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Thyroid Stimulating Hormone (Mdh)OutsideLaboratory,,84443,CPT,Facility,Both,,,90,34,28.9,9.7444,34,UnitedHealthcare,Individual & Family,31.96,94,,percent of total billed charges,,
Thyroid Stimulating Hormone (Mdh)OutsideLaboratory,,84443,CPT,Facility,Outpatient,,,90,34,28.9,9.7444,34,UnitedHealthcare,Medicare Advantage,16.66,49,,percent of total billed charges,,
Thyroid Stimulating Hormone (Mdh)OutsideLaboratory,,84443,CPT,Facility,Inpatient,,,90,34,28.9,9.7444,34,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Thyroid Stimulating Hormone (Mdh)OutsideLaboratory,,84443,CPT,Facility,Outpatient,,,90,34,28.9,9.7444,34,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,16.32,48,,percent of total billed charges,,100% of DHS outpatient percentage
Thyroid Stimulating Hormone (Mdh)OutsideLaboratory,,84443,CPT,Facility,Inpatient,,,90,34,28.9,9.7444,34,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Thyroid-Stimulating Immunoglob, S (Mayo)OutsideLaboratory",,84445,CPT,Facility,Both,,,90,214,181.9,61.3324,214,Aetna,Commercial,196.88,92,,percent of total billed charges,,
"Thyroid-Stimulating Immunoglob, S (Mayo)OutsideLaboratory",,84445,CPT,Facility,Outpatient,,,90,214,181.9,61.3324,214,Aetna,Medicare Advantage,104.86,49,,percent of total billed charges,,
"Thyroid-Stimulating Immunoglob, S (Mayo)OutsideLaboratory",,84445,CPT,Facility,Inpatient,,,90,214,181.9,61.3324,214,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Thyroid-Stimulating Immunoglob, S (Mayo)OutsideLaboratory",,84445,CPT,Facility,Both,,,90,214,181.9,61.3324,214,Aetna,PPO,199.02,93,,percent of total billed charges,,
"Thyroid-Stimulating Immunoglob, S (Mayo)OutsideLaboratory",,84445,CPT,Facility,Both,,,90,214,181.9,61.3324,214,America's PPO,America's PPO,205.5042,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Thyroid-Stimulating Immunoglob, S (Mayo)OutsideLaboratory",,84445,CPT,Facility,Both,,,90,214,181.9,61.3324,214,BlueCross BlueShield Minnesota, Federal Employee Program,210.576,98.4,,percent of total billed charges,,
"Thyroid-Stimulating Immunoglob, S (Mayo)OutsideLaboratory",,84445,CPT,Facility,Both,,,90,214,181.9,61.3324,214,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,214,100,,percent of total billed charges,,
"Thyroid-Stimulating Immunoglob, S (Mayo)OutsideLaboratory",,84445,CPT,Facility,Both,,,90,214,181.9,61.3324,214,BlueCross BlueShield Minnesota,High Value Network Plan,192.6,90,,percent of total billed charges,,
"Thyroid-Stimulating Immunoglob, S (Mayo)OutsideLaboratory",,84445,CPT,Facility,Outpatient,,,90,214,181.9,61.3324,214,BlueCross BlueShield Minnesota,Medicare Advantage,104.86,49,,percent of total billed charges,,
"Thyroid-Stimulating Immunoglob, S (Mayo)OutsideLaboratory",,84445,CPT,Facility,Inpatient,,,90,214,181.9,61.3324,214,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Thyroid-Stimulating Immunoglob, S (Mayo)OutsideLaboratory",,84445,CPT,Facility,Both,,,90,214,181.9,61.3324,214,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,189.5398,88.57,,percent of total billed charges,,
"Thyroid-Stimulating Immunoglob, S (Mayo)OutsideLaboratory",,84445,CPT,Facility,Both,,,90,214,181.9,61.3324,214,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,61.3324,28.66,,percent of total billed charges,,
"Thyroid-Stimulating Immunoglob, S (Mayo)OutsideLaboratory",,84445,CPT,Facility,Outpatient,,,90,214,181.9,61.3324,214,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),104.86,49,,percent of total billed charges,,
"Thyroid-Stimulating Immunoglob, S (Mayo)OutsideLaboratory",,84445,CPT,Facility,Inpatient,,,90,214,181.9,61.3324,214,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Thyroid-Stimulating Immunoglob, S (Mayo)OutsideLaboratory",,84445,CPT,Facility,Both,,,90,214,181.9,61.3324,214,CorVel,Worker's Compensation,214,100,,percent of total billed charges,,
"Thyroid-Stimulating Immunoglob, S (Mayo)OutsideLaboratory",,84445,CPT,Facility,Both,,,90,214,181.9,61.3324,214,First Health Group Corporation,First Health Network,207.58,97,,percent of total billed charges,,
"Thyroid-Stimulating Immunoglob, S (Mayo)OutsideLaboratory",,84445,CPT,Facility,Both,,,90,214,181.9,61.3324,214,"Health Partners, Inc.",Commercial,202.444,94.6,,percent of total billed charges,,
"Thyroid-Stimulating Immunoglob, S (Mayo)OutsideLaboratory",,84445,CPT,Facility,Outpatient,,,90,214,181.9,61.3324,214,"Health Partners, Inc.",Medicare Advantage,104.86,49,,percent of total billed charges,,
"Thyroid-Stimulating Immunoglob, S (Mayo)OutsideLaboratory",,84445,CPT,Facility,Inpatient,,,90,214,181.9,61.3324,214,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Thyroid-Stimulating Immunoglob, S (Mayo)OutsideLaboratory",,84445,CPT,Facility,Both,,,90,214,181.9,61.3324,214,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),128.4,60,,percent of total billed charges,,
"Thyroid-Stimulating Immunoglob, S (Mayo)OutsideLaboratory",,84445,CPT,Facility,Both,,,90,214,181.9,61.3324,214,"Health Partners, Inc.",State of Minnesota Advantage Program,174.41,81.5,,percent of total billed charges,,
"Thyroid-Stimulating Immunoglob, S (Mayo)OutsideLaboratory",,84445,CPT,Facility,Both,,,90,214,181.9,61.3324,214,"Health Partners, Inc.",State Public Programs,107,50,,percent of total billed charges,,
"Thyroid-Stimulating Immunoglob, S (Mayo)OutsideLaboratory",,84445,CPT,Facility,Both,,,90,214,181.9,61.3324,214,Humana Insurance Company,Commercial PPO,203.3,95,,percent of total billed charges,,
"Thyroid-Stimulating Immunoglob, S (Mayo)OutsideLaboratory",,84445,CPT,Facility,Outpatient,,,90,214,181.9,61.3324,214,Humana Insurance Company,Medicare PPO,104.86,49,,percent of total billed charges,,
"Thyroid-Stimulating Immunoglob, S (Mayo)OutsideLaboratory",,84445,CPT,Facility,Inpatient,,,90,214,181.9,61.3324,214,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Thyroid-Stimulating Immunoglob, S (Mayo)OutsideLaboratory",,84445,CPT,Facility,Both,,,90,214,181.9,61.3324,214,Medica,Individual & Family,212.074,99.1,,percent of total billed charges,,
"Thyroid-Stimulating Immunoglob, S (Mayo)OutsideLaboratory",,84445,CPT,Facility,Outpatient,,,90,214,181.9,61.3324,214,Medica,Medica Advantage Solution,106.572,49.8,,percent of total billed charges,,
"Thyroid-Stimulating Immunoglob, S (Mayo)OutsideLaboratory",,84445,CPT,Facility,Inpatient,,,90,214,181.9,61.3324,214,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Thyroid-Stimulating Immunoglob, S (Mayo)OutsideLaboratory",,84445,CPT,Facility,Outpatient,,,90,214,181.9,61.3324,214,Medica,Medical Assistance,95.444,44.6,,percent of total billed charges,,
"Thyroid-Stimulating Immunoglob, S (Mayo)OutsideLaboratory",,84445,CPT,Facility,Inpatient,,,90,214,181.9,61.3324,214,Medica,Medical Assistance,,,,,Included in per diem rate,
"Thyroid-Stimulating Immunoglob, S (Mayo)OutsideLaboratory",,84445,CPT,Facility,Outpatient,,,90,214,181.9,61.3324,214,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,106.572,49.8,,percent of total billed charges,,
"Thyroid-Stimulating Immunoglob, S (Mayo)OutsideLaboratory",,84445,CPT,Facility,Inpatient,,,90,214,181.9,61.3324,214,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Thyroid-Stimulating Immunoglob, S (Mayo)OutsideLaboratory",,84445,CPT,Facility,Both,,,90,214,181.9,61.3324,214,"Multiplan, Inc.","Multiplan, Inc.",201.16,94,,percent of total billed charges,,
"Thyroid-Stimulating Immunoglob, S (Mayo)OutsideLaboratory",,84445,CPT,Facility,Outpatient,,,90,214,181.9,61.3324,214,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,184.896,86.4,,percent of total billed charges,,
"Thyroid-Stimulating Immunoglob, S (Mayo)OutsideLaboratory",,84445,CPT,Facility,Inpatient,,,90,214,181.9,61.3324,214,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Thyroid-Stimulating Immunoglob, S (Mayo)OutsideLaboratory",,84445,CPT,Facility,Both,,,90,214,181.9,61.3324,214,"Preferred One Administrative Services, INC.",PPO,211.004,98.6,,percent of total billed charges,,
"Thyroid-Stimulating Immunoglob, S (Mayo)OutsideLaboratory",,84445,CPT,Facility,Outpatient,,,90,214,181.9,61.3324,214,PrimeWest Health,Minnesota Senior Health Options (MSHO),110.103,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Thyroid-Stimulating Immunoglob, S (Mayo)OutsideLaboratory",,84445,CPT,Facility,Inpatient,,,90,214,181.9,61.3324,214,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Thyroid-Stimulating Immunoglob, S (Mayo)OutsideLaboratory",,84445,CPT,Facility,Outpatient,,,90,214,181.9,61.3324,214,PrimeWest Health,MinnesotaCare,109.9104,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Thyroid-Stimulating Immunoglob, S (Mayo)OutsideLaboratory",,84445,CPT,Facility,Inpatient,,,90,214,181.9,61.3324,214,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Thyroid-Stimulating Immunoglob, S (Mayo)OutsideLaboratory",,84445,CPT,Facility,Both,,,90,214,181.9,61.3324,214,Sanford Health Plan,Sanford Health Plan,196.88,92,,percent of total billed charges,,
"Thyroid-Stimulating Immunoglob, S (Mayo)OutsideLaboratory",,84445,CPT,Facility,Outpatient,,,90,214,181.9,61.3324,214,"UCare Health, Inc.",Individual & Family Plan,120.589,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Thyroid-Stimulating Immunoglob, S (Mayo)OutsideLaboratory",,84445,CPT,Facility,Inpatient,,,90,214,181.9,61.3324,214,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Thyroid-Stimulating Immunoglob, S (Mayo)OutsideLaboratory",,84445,CPT,Facility,Outpatient,,,90,214,181.9,61.3324,214,"UCare Health, Inc.",Medical Assistance,108.0058,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Thyroid-Stimulating Immunoglob, S (Mayo)OutsideLaboratory",,84445,CPT,Facility,Inpatient,,,90,214,181.9,61.3324,214,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Thyroid-Stimulating Immunoglob, S (Mayo)OutsideLaboratory",,84445,CPT,Facility,Outpatient,,,90,214,181.9,61.3324,214,"UCare Health, Inc.",Medicare Advantage,108.0058,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Thyroid-Stimulating Immunoglob, S (Mayo)OutsideLaboratory",,84445,CPT,Facility,Inpatient,,,90,214,181.9,61.3324,214,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Thyroid-Stimulating Immunoglob, S (Mayo)OutsideLaboratory",,84445,CPT,Facility,Outpatient,,,90,214,181.9,61.3324,214,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),108.0058,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Thyroid-Stimulating Immunoglob, S (Mayo)OutsideLaboratory",,84445,CPT,Facility,Inpatient,,,90,214,181.9,61.3324,214,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Thyroid-Stimulating Immunoglob, S (Mayo)OutsideLaboratory",,84445,CPT,Facility,Both,,,90,214,181.9,61.3324,214,UnitedHealthcare,Individual & Family,201.16,94,,percent of total billed charges,,
"Thyroid-Stimulating Immunoglob, S (Mayo)OutsideLaboratory",,84445,CPT,Facility,Outpatient,,,90,214,181.9,61.3324,214,UnitedHealthcare,Medicare Advantage,104.86,49,,percent of total billed charges,,
"Thyroid-Stimulating Immunoglob, S (Mayo)OutsideLaboratory",,84445,CPT,Facility,Inpatient,,,90,214,181.9,61.3324,214,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Thyroid-Stimulating Immunoglob, S (Mayo)OutsideLaboratory",,84445,CPT,Facility,Outpatient,,,90,214,181.9,61.3324,214,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,102.72,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Thyroid-Stimulating Immunoglob, S (Mayo)OutsideLaboratory",,84445,CPT,Facility,Inpatient,,,90,214,181.9,61.3324,214,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Vitamin E, S (Mayo)OutsideLaboratory",,84446,CPT,Facility,Both,,,90,118,100.3,33.8188,118,Aetna,Commercial,108.56,92,,percent of total billed charges,,
"Vitamin E, S (Mayo)OutsideLaboratory",,84446,CPT,Facility,Outpatient,,,90,118,100.3,33.8188,118,Aetna,Medicare Advantage,57.82,49,,percent of total billed charges,,
"Vitamin E, S (Mayo)OutsideLaboratory",,84446,CPT,Facility,Inpatient,,,90,118,100.3,33.8188,118,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Vitamin E, S (Mayo)OutsideLaboratory",,84446,CPT,Facility,Both,,,90,118,100.3,33.8188,118,Aetna,PPO,109.74,93,,percent of total billed charges,,
"Vitamin E, S (Mayo)OutsideLaboratory",,84446,CPT,Facility,Both,,,90,118,100.3,33.8188,118,America's PPO,America's PPO,113.3154,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Vitamin E, S (Mayo)OutsideLaboratory",,84446,CPT,Facility,Both,,,90,118,100.3,33.8188,118,BlueCross BlueShield Minnesota, Federal Employee Program,116.112,98.4,,percent of total billed charges,,
"Vitamin E, S (Mayo)OutsideLaboratory",,84446,CPT,Facility,Both,,,90,118,100.3,33.8188,118,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,118,100,,percent of total billed charges,,
"Vitamin E, S (Mayo)OutsideLaboratory",,84446,CPT,Facility,Both,,,90,118,100.3,33.8188,118,BlueCross BlueShield Minnesota,High Value Network Plan,106.2,90,,percent of total billed charges,,
"Vitamin E, S (Mayo)OutsideLaboratory",,84446,CPT,Facility,Outpatient,,,90,118,100.3,33.8188,118,BlueCross BlueShield Minnesota,Medicare Advantage,57.82,49,,percent of total billed charges,,
"Vitamin E, S (Mayo)OutsideLaboratory",,84446,CPT,Facility,Inpatient,,,90,118,100.3,33.8188,118,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Vitamin E, S (Mayo)OutsideLaboratory",,84446,CPT,Facility,Both,,,90,118,100.3,33.8188,118,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,104.5126,88.57,,percent of total billed charges,,
"Vitamin E, S (Mayo)OutsideLaboratory",,84446,CPT,Facility,Both,,,90,118,100.3,33.8188,118,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,33.8188,28.66,,percent of total billed charges,,
"Vitamin E, S (Mayo)OutsideLaboratory",,84446,CPT,Facility,Outpatient,,,90,118,100.3,33.8188,118,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),57.82,49,,percent of total billed charges,,
"Vitamin E, S (Mayo)OutsideLaboratory",,84446,CPT,Facility,Inpatient,,,90,118,100.3,33.8188,118,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Vitamin E, S (Mayo)OutsideLaboratory",,84446,CPT,Facility,Both,,,90,118,100.3,33.8188,118,CorVel,Worker's Compensation,118,100,,percent of total billed charges,,
"Vitamin E, S (Mayo)OutsideLaboratory",,84446,CPT,Facility,Both,,,90,118,100.3,33.8188,118,First Health Group Corporation,First Health Network,114.46,97,,percent of total billed charges,,
"Vitamin E, S (Mayo)OutsideLaboratory",,84446,CPT,Facility,Both,,,90,118,100.3,33.8188,118,"Health Partners, Inc.",Commercial,111.628,94.6,,percent of total billed charges,,
"Vitamin E, S (Mayo)OutsideLaboratory",,84446,CPT,Facility,Outpatient,,,90,118,100.3,33.8188,118,"Health Partners, Inc.",Medicare Advantage,57.82,49,,percent of total billed charges,,
"Vitamin E, S (Mayo)OutsideLaboratory",,84446,CPT,Facility,Inpatient,,,90,118,100.3,33.8188,118,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Vitamin E, S (Mayo)OutsideLaboratory",,84446,CPT,Facility,Both,,,90,118,100.3,33.8188,118,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),70.8,60,,percent of total billed charges,,
"Vitamin E, S (Mayo)OutsideLaboratory",,84446,CPT,Facility,Both,,,90,118,100.3,33.8188,118,"Health Partners, Inc.",State of Minnesota Advantage Program,96.17,81.5,,percent of total billed charges,,
"Vitamin E, S (Mayo)OutsideLaboratory",,84446,CPT,Facility,Both,,,90,118,100.3,33.8188,118,"Health Partners, Inc.",State Public Programs,59,50,,percent of total billed charges,,
"Vitamin E, S (Mayo)OutsideLaboratory",,84446,CPT,Facility,Both,,,90,118,100.3,33.8188,118,Humana Insurance Company,Commercial PPO,112.1,95,,percent of total billed charges,,
"Vitamin E, S (Mayo)OutsideLaboratory",,84446,CPT,Facility,Outpatient,,,90,118,100.3,33.8188,118,Humana Insurance Company,Medicare PPO,57.82,49,,percent of total billed charges,,
"Vitamin E, S (Mayo)OutsideLaboratory",,84446,CPT,Facility,Inpatient,,,90,118,100.3,33.8188,118,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Vitamin E, S (Mayo)OutsideLaboratory",,84446,CPT,Facility,Both,,,90,118,100.3,33.8188,118,Medica,Individual & Family,116.938,99.1,,percent of total billed charges,,
"Vitamin E, S (Mayo)OutsideLaboratory",,84446,CPT,Facility,Outpatient,,,90,118,100.3,33.8188,118,Medica,Medica Advantage Solution,58.764,49.8,,percent of total billed charges,,
"Vitamin E, S (Mayo)OutsideLaboratory",,84446,CPT,Facility,Inpatient,,,90,118,100.3,33.8188,118,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Vitamin E, S (Mayo)OutsideLaboratory",,84446,CPT,Facility,Outpatient,,,90,118,100.3,33.8188,118,Medica,Medical Assistance,52.628,44.6,,percent of total billed charges,,
"Vitamin E, S (Mayo)OutsideLaboratory",,84446,CPT,Facility,Inpatient,,,90,118,100.3,33.8188,118,Medica,Medical Assistance,,,,,Included in per diem rate,
"Vitamin E, S (Mayo)OutsideLaboratory",,84446,CPT,Facility,Outpatient,,,90,118,100.3,33.8188,118,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,58.764,49.8,,percent of total billed charges,,
"Vitamin E, S (Mayo)OutsideLaboratory",,84446,CPT,Facility,Inpatient,,,90,118,100.3,33.8188,118,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Vitamin E, S (Mayo)OutsideLaboratory",,84446,CPT,Facility,Both,,,90,118,100.3,33.8188,118,"Multiplan, Inc.","Multiplan, Inc.",110.92,94,,percent of total billed charges,,
"Vitamin E, S (Mayo)OutsideLaboratory",,84446,CPT,Facility,Outpatient,,,90,118,100.3,33.8188,118,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,101.952,86.4,,percent of total billed charges,,
"Vitamin E, S (Mayo)OutsideLaboratory",,84446,CPT,Facility,Inpatient,,,90,118,100.3,33.8188,118,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Vitamin E, S (Mayo)OutsideLaboratory",,84446,CPT,Facility,Both,,,90,118,100.3,33.8188,118,"Preferred One Administrative Services, INC.",PPO,116.348,98.6,,percent of total billed charges,,
"Vitamin E, S (Mayo)OutsideLaboratory",,84446,CPT,Facility,Outpatient,,,90,118,100.3,33.8188,118,PrimeWest Health,Minnesota Senior Health Options (MSHO),60.711,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Vitamin E, S (Mayo)OutsideLaboratory",,84446,CPT,Facility,Inpatient,,,90,118,100.3,33.8188,118,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Vitamin E, S (Mayo)OutsideLaboratory",,84446,CPT,Facility,Outpatient,,,90,118,100.3,33.8188,118,PrimeWest Health,MinnesotaCare,60.6048,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Vitamin E, S (Mayo)OutsideLaboratory",,84446,CPT,Facility,Inpatient,,,90,118,100.3,33.8188,118,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Vitamin E, S (Mayo)OutsideLaboratory",,84446,CPT,Facility,Both,,,90,118,100.3,33.8188,118,Sanford Health Plan,Sanford Health Plan,108.56,92,,percent of total billed charges,,
"Vitamin E, S (Mayo)OutsideLaboratory",,84446,CPT,Facility,Outpatient,,,90,118,100.3,33.8188,118,"UCare Health, Inc.",Individual & Family Plan,66.493,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Vitamin E, S (Mayo)OutsideLaboratory",,84446,CPT,Facility,Inpatient,,,90,118,100.3,33.8188,118,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Vitamin E, S (Mayo)OutsideLaboratory",,84446,CPT,Facility,Outpatient,,,90,118,100.3,33.8188,118,"UCare Health, Inc.",Medical Assistance,59.5546,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Vitamin E, S (Mayo)OutsideLaboratory",,84446,CPT,Facility,Inpatient,,,90,118,100.3,33.8188,118,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Vitamin E, S (Mayo)OutsideLaboratory",,84446,CPT,Facility,Outpatient,,,90,118,100.3,33.8188,118,"UCare Health, Inc.",Medicare Advantage,59.5546,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Vitamin E, S (Mayo)OutsideLaboratory",,84446,CPT,Facility,Inpatient,,,90,118,100.3,33.8188,118,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Vitamin E, S (Mayo)OutsideLaboratory",,84446,CPT,Facility,Outpatient,,,90,118,100.3,33.8188,118,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),59.5546,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Vitamin E, S (Mayo)OutsideLaboratory",,84446,CPT,Facility,Inpatient,,,90,118,100.3,33.8188,118,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Vitamin E, S (Mayo)OutsideLaboratory",,84446,CPT,Facility,Both,,,90,118,100.3,33.8188,118,UnitedHealthcare,Individual & Family,110.92,94,,percent of total billed charges,,
"Vitamin E, S (Mayo)OutsideLaboratory",,84446,CPT,Facility,Outpatient,,,90,118,100.3,33.8188,118,UnitedHealthcare,Medicare Advantage,57.82,49,,percent of total billed charges,,
"Vitamin E, S (Mayo)OutsideLaboratory",,84446,CPT,Facility,Inpatient,,,90,118,100.3,33.8188,118,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Vitamin E, S (Mayo)OutsideLaboratory",,84446,CPT,Facility,Outpatient,,,90,118,100.3,33.8188,118,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,56.64,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Vitamin E, S (Mayo)OutsideLaboratory",,84446,CPT,Facility,Inpatient,,,90,118,100.3,33.8188,118,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"T3 (Triiodothyronine), Total, S (Mayo)OutsideLaboratory",,84480,CPT,Facility,Both,,,90,69,58.65,19.7754,69,Aetna,Commercial,63.48,92,,percent of total billed charges,,
"T3 (Triiodothyronine), Total, S (Mayo)OutsideLaboratory",,84480,CPT,Facility,Outpatient,,,90,69,58.65,19.7754,69,Aetna,Medicare Advantage,33.81,49,,percent of total billed charges,,
"T3 (Triiodothyronine), Total, S (Mayo)OutsideLaboratory",,84480,CPT,Facility,Inpatient,,,90,69,58.65,19.7754,69,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"T3 (Triiodothyronine), Total, S (Mayo)OutsideLaboratory",,84480,CPT,Facility,Both,,,90,69,58.65,19.7754,69,Aetna,PPO,64.17,93,,percent of total billed charges,,
"T3 (Triiodothyronine), Total, S (Mayo)OutsideLaboratory",,84480,CPT,Facility,Both,,,90,69,58.65,19.7754,69,America's PPO,America's PPO,66.2607,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"T3 (Triiodothyronine), Total, S (Mayo)OutsideLaboratory",,84480,CPT,Facility,Both,,,90,69,58.65,19.7754,69,BlueCross BlueShield Minnesota, Federal Employee Program,67.896,98.4,,percent of total billed charges,,
"T3 (Triiodothyronine), Total, S (Mayo)OutsideLaboratory",,84480,CPT,Facility,Both,,,90,69,58.65,19.7754,69,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,69,100,,percent of total billed charges,,
"T3 (Triiodothyronine), Total, S (Mayo)OutsideLaboratory",,84480,CPT,Facility,Both,,,90,69,58.65,19.7754,69,BlueCross BlueShield Minnesota,High Value Network Plan,62.1,90,,percent of total billed charges,,
"T3 (Triiodothyronine), Total, S (Mayo)OutsideLaboratory",,84480,CPT,Facility,Outpatient,,,90,69,58.65,19.7754,69,BlueCross BlueShield Minnesota,Medicare Advantage,33.81,49,,percent of total billed charges,,
"T3 (Triiodothyronine), Total, S (Mayo)OutsideLaboratory",,84480,CPT,Facility,Inpatient,,,90,69,58.65,19.7754,69,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"T3 (Triiodothyronine), Total, S (Mayo)OutsideLaboratory",,84480,CPT,Facility,Both,,,90,69,58.65,19.7754,69,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,61.1133,88.57,,percent of total billed charges,,
"T3 (Triiodothyronine), Total, S (Mayo)OutsideLaboratory",,84480,CPT,Facility,Both,,,90,69,58.65,19.7754,69,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,19.7754,28.66,,percent of total billed charges,,
"T3 (Triiodothyronine), Total, S (Mayo)OutsideLaboratory",,84480,CPT,Facility,Outpatient,,,90,69,58.65,19.7754,69,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),33.81,49,,percent of total billed charges,,
"T3 (Triiodothyronine), Total, S (Mayo)OutsideLaboratory",,84480,CPT,Facility,Inpatient,,,90,69,58.65,19.7754,69,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"T3 (Triiodothyronine), Total, S (Mayo)OutsideLaboratory",,84480,CPT,Facility,Both,,,90,69,58.65,19.7754,69,CorVel,Worker's Compensation,69,100,,percent of total billed charges,,
"T3 (Triiodothyronine), Total, S (Mayo)OutsideLaboratory",,84480,CPT,Facility,Both,,,90,69,58.65,19.7754,69,First Health Group Corporation,First Health Network,66.93,97,,percent of total billed charges,,
"T3 (Triiodothyronine), Total, S (Mayo)OutsideLaboratory",,84480,CPT,Facility,Both,,,90,69,58.65,19.7754,69,"Health Partners, Inc.",Commercial,65.274,94.6,,percent of total billed charges,,
"T3 (Triiodothyronine), Total, S (Mayo)OutsideLaboratory",,84480,CPT,Facility,Outpatient,,,90,69,58.65,19.7754,69,"Health Partners, Inc.",Medicare Advantage,33.81,49,,percent of total billed charges,,
"T3 (Triiodothyronine), Total, S (Mayo)OutsideLaboratory",,84480,CPT,Facility,Inpatient,,,90,69,58.65,19.7754,69,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"T3 (Triiodothyronine), Total, S (Mayo)OutsideLaboratory",,84480,CPT,Facility,Both,,,90,69,58.65,19.7754,69,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),41.4,60,,percent of total billed charges,,
"T3 (Triiodothyronine), Total, S (Mayo)OutsideLaboratory",,84480,CPT,Facility,Both,,,90,69,58.65,19.7754,69,"Health Partners, Inc.",State of Minnesota Advantage Program,56.235,81.5,,percent of total billed charges,,
"T3 (Triiodothyronine), Total, S (Mayo)OutsideLaboratory",,84480,CPT,Facility,Both,,,90,69,58.65,19.7754,69,"Health Partners, Inc.",State Public Programs,34.5,50,,percent of total billed charges,,
"T3 (Triiodothyronine), Total, S (Mayo)OutsideLaboratory",,84480,CPT,Facility,Both,,,90,69,58.65,19.7754,69,Humana Insurance Company,Commercial PPO,65.55,95,,percent of total billed charges,,
"T3 (Triiodothyronine), Total, S (Mayo)OutsideLaboratory",,84480,CPT,Facility,Outpatient,,,90,69,58.65,19.7754,69,Humana Insurance Company,Medicare PPO,33.81,49,,percent of total billed charges,,
"T3 (Triiodothyronine), Total, S (Mayo)OutsideLaboratory",,84480,CPT,Facility,Inpatient,,,90,69,58.65,19.7754,69,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"T3 (Triiodothyronine), Total, S (Mayo)OutsideLaboratory",,84480,CPT,Facility,Both,,,90,69,58.65,19.7754,69,Medica,Individual & Family,68.379,99.1,,percent of total billed charges,,
"T3 (Triiodothyronine), Total, S (Mayo)OutsideLaboratory",,84480,CPT,Facility,Outpatient,,,90,69,58.65,19.7754,69,Medica,Medica Advantage Solution,34.362,49.8,,percent of total billed charges,,
"T3 (Triiodothyronine), Total, S (Mayo)OutsideLaboratory",,84480,CPT,Facility,Inpatient,,,90,69,58.65,19.7754,69,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"T3 (Triiodothyronine), Total, S (Mayo)OutsideLaboratory",,84480,CPT,Facility,Outpatient,,,90,69,58.65,19.7754,69,Medica,Medical Assistance,30.774,44.6,,percent of total billed charges,,
"T3 (Triiodothyronine), Total, S (Mayo)OutsideLaboratory",,84480,CPT,Facility,Inpatient,,,90,69,58.65,19.7754,69,Medica,Medical Assistance,,,,,Included in per diem rate,
"T3 (Triiodothyronine), Total, S (Mayo)OutsideLaboratory",,84480,CPT,Facility,Outpatient,,,90,69,58.65,19.7754,69,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,34.362,49.8,,percent of total billed charges,,
"T3 (Triiodothyronine), Total, S (Mayo)OutsideLaboratory",,84480,CPT,Facility,Inpatient,,,90,69,58.65,19.7754,69,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"T3 (Triiodothyronine), Total, S (Mayo)OutsideLaboratory",,84480,CPT,Facility,Both,,,90,69,58.65,19.7754,69,"Multiplan, Inc.","Multiplan, Inc.",64.86,94,,percent of total billed charges,,
"T3 (Triiodothyronine), Total, S (Mayo)OutsideLaboratory",,84480,CPT,Facility,Outpatient,,,90,69,58.65,19.7754,69,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,59.616,86.4,,percent of total billed charges,,
"T3 (Triiodothyronine), Total, S (Mayo)OutsideLaboratory",,84480,CPT,Facility,Inpatient,,,90,69,58.65,19.7754,69,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"T3 (Triiodothyronine), Total, S (Mayo)OutsideLaboratory",,84480,CPT,Facility,Both,,,90,69,58.65,19.7754,69,"Preferred One Administrative Services, INC.",PPO,68.034,98.6,,percent of total billed charges,,
"T3 (Triiodothyronine), Total, S (Mayo)OutsideLaboratory",,84480,CPT,Facility,Outpatient,,,90,69,58.65,19.7754,69,PrimeWest Health,Minnesota Senior Health Options (MSHO),35.5005,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"T3 (Triiodothyronine), Total, S (Mayo)OutsideLaboratory",,84480,CPT,Facility,Inpatient,,,90,69,58.65,19.7754,69,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"T3 (Triiodothyronine), Total, S (Mayo)OutsideLaboratory",,84480,CPT,Facility,Outpatient,,,90,69,58.65,19.7754,69,PrimeWest Health,MinnesotaCare,35.4384,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"T3 (Triiodothyronine), Total, S (Mayo)OutsideLaboratory",,84480,CPT,Facility,Inpatient,,,90,69,58.65,19.7754,69,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"T3 (Triiodothyronine), Total, S (Mayo)OutsideLaboratory",,84480,CPT,Facility,Both,,,90,69,58.65,19.7754,69,Sanford Health Plan,Sanford Health Plan,63.48,92,,percent of total billed charges,,
"T3 (Triiodothyronine), Total, S (Mayo)OutsideLaboratory",,84480,CPT,Facility,Outpatient,,,90,69,58.65,19.7754,69,"UCare Health, Inc.",Individual & Family Plan,38.8815,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"T3 (Triiodothyronine), Total, S (Mayo)OutsideLaboratory",,84480,CPT,Facility,Inpatient,,,90,69,58.65,19.7754,69,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"T3 (Triiodothyronine), Total, S (Mayo)OutsideLaboratory",,84480,CPT,Facility,Outpatient,,,90,69,58.65,19.7754,69,"UCare Health, Inc.",Medical Assistance,34.8243,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"T3 (Triiodothyronine), Total, S (Mayo)OutsideLaboratory",,84480,CPT,Facility,Inpatient,,,90,69,58.65,19.7754,69,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"T3 (Triiodothyronine), Total, S (Mayo)OutsideLaboratory",,84480,CPT,Facility,Outpatient,,,90,69,58.65,19.7754,69,"UCare Health, Inc.",Medicare Advantage,34.8243,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"T3 (Triiodothyronine), Total, S (Mayo)OutsideLaboratory",,84480,CPT,Facility,Inpatient,,,90,69,58.65,19.7754,69,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"T3 (Triiodothyronine), Total, S (Mayo)OutsideLaboratory",,84480,CPT,Facility,Outpatient,,,90,69,58.65,19.7754,69,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),34.8243,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"T3 (Triiodothyronine), Total, S (Mayo)OutsideLaboratory",,84480,CPT,Facility,Inpatient,,,90,69,58.65,19.7754,69,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"T3 (Triiodothyronine), Total, S (Mayo)OutsideLaboratory",,84480,CPT,Facility,Both,,,90,69,58.65,19.7754,69,UnitedHealthcare,Individual & Family,64.86,94,,percent of total billed charges,,
"T3 (Triiodothyronine), Total, S (Mayo)OutsideLaboratory",,84480,CPT,Facility,Outpatient,,,90,69,58.65,19.7754,69,UnitedHealthcare,Medicare Advantage,33.81,49,,percent of total billed charges,,
"T3 (Triiodothyronine), Total, S (Mayo)OutsideLaboratory",,84480,CPT,Facility,Inpatient,,,90,69,58.65,19.7754,69,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"T3 (Triiodothyronine), Total, S (Mayo)OutsideLaboratory",,84480,CPT,Facility,Outpatient,,,90,69,58.65,19.7754,69,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,33.12,48,,percent of total billed charges,,100% of DHS outpatient percentage
"T3 (Triiodothyronine), Total, S (Mayo)OutsideLaboratory",,84480,CPT,Facility,Inpatient,,,90,69,58.65,19.7754,69,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"T3 (Triiodothyronine), Reverse, S (Mayo)OutsideLaboratory",,84482,CPT,Facility,Both,,,90,185,157.25,53.021,185,Aetna,Commercial,170.2,92,,percent of total billed charges,,
"T3 (Triiodothyronine), Reverse, S (Mayo)OutsideLaboratory",,84482,CPT,Facility,Outpatient,,,90,185,157.25,53.021,185,Aetna,Medicare Advantage,90.65,49,,percent of total billed charges,,
"T3 (Triiodothyronine), Reverse, S (Mayo)OutsideLaboratory",,84482,CPT,Facility,Inpatient,,,90,185,157.25,53.021,185,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"T3 (Triiodothyronine), Reverse, S (Mayo)OutsideLaboratory",,84482,CPT,Facility,Both,,,90,185,157.25,53.021,185,Aetna,PPO,172.05,93,,percent of total billed charges,,
"T3 (Triiodothyronine), Reverse, S (Mayo)OutsideLaboratory",,84482,CPT,Facility,Both,,,90,185,157.25,53.021,185,America's PPO,America's PPO,177.6555,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"T3 (Triiodothyronine), Reverse, S (Mayo)OutsideLaboratory",,84482,CPT,Facility,Both,,,90,185,157.25,53.021,185,BlueCross BlueShield Minnesota, Federal Employee Program,182.04,98.4,,percent of total billed charges,,
"T3 (Triiodothyronine), Reverse, S (Mayo)OutsideLaboratory",,84482,CPT,Facility,Both,,,90,185,157.25,53.021,185,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,185,100,,percent of total billed charges,,
"T3 (Triiodothyronine), Reverse, S (Mayo)OutsideLaboratory",,84482,CPT,Facility,Both,,,90,185,157.25,53.021,185,BlueCross BlueShield Minnesota,High Value Network Plan,166.5,90,,percent of total billed charges,,
"T3 (Triiodothyronine), Reverse, S (Mayo)OutsideLaboratory",,84482,CPT,Facility,Outpatient,,,90,185,157.25,53.021,185,BlueCross BlueShield Minnesota,Medicare Advantage,90.65,49,,percent of total billed charges,,
"T3 (Triiodothyronine), Reverse, S (Mayo)OutsideLaboratory",,84482,CPT,Facility,Inpatient,,,90,185,157.25,53.021,185,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"T3 (Triiodothyronine), Reverse, S (Mayo)OutsideLaboratory",,84482,CPT,Facility,Both,,,90,185,157.25,53.021,185,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,163.8545,88.57,,percent of total billed charges,,
"T3 (Triiodothyronine), Reverse, S (Mayo)OutsideLaboratory",,84482,CPT,Facility,Both,,,90,185,157.25,53.021,185,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,53.021,28.66,,percent of total billed charges,,
"T3 (Triiodothyronine), Reverse, S (Mayo)OutsideLaboratory",,84482,CPT,Facility,Outpatient,,,90,185,157.25,53.021,185,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),90.65,49,,percent of total billed charges,,
"T3 (Triiodothyronine), Reverse, S (Mayo)OutsideLaboratory",,84482,CPT,Facility,Inpatient,,,90,185,157.25,53.021,185,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"T3 (Triiodothyronine), Reverse, S (Mayo)OutsideLaboratory",,84482,CPT,Facility,Both,,,90,185,157.25,53.021,185,CorVel,Worker's Compensation,185,100,,percent of total billed charges,,
"T3 (Triiodothyronine), Reverse, S (Mayo)OutsideLaboratory",,84482,CPT,Facility,Both,,,90,185,157.25,53.021,185,First Health Group Corporation,First Health Network,179.45,97,,percent of total billed charges,,
"T3 (Triiodothyronine), Reverse, S (Mayo)OutsideLaboratory",,84482,CPT,Facility,Both,,,90,185,157.25,53.021,185,"Health Partners, Inc.",Commercial,175.01,94.6,,percent of total billed charges,,
"T3 (Triiodothyronine), Reverse, S (Mayo)OutsideLaboratory",,84482,CPT,Facility,Outpatient,,,90,185,157.25,53.021,185,"Health Partners, Inc.",Medicare Advantage,90.65,49,,percent of total billed charges,,
"T3 (Triiodothyronine), Reverse, S (Mayo)OutsideLaboratory",,84482,CPT,Facility,Inpatient,,,90,185,157.25,53.021,185,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"T3 (Triiodothyronine), Reverse, S (Mayo)OutsideLaboratory",,84482,CPT,Facility,Both,,,90,185,157.25,53.021,185,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),111,60,,percent of total billed charges,,
"T3 (Triiodothyronine), Reverse, S (Mayo)OutsideLaboratory",,84482,CPT,Facility,Both,,,90,185,157.25,53.021,185,"Health Partners, Inc.",State of Minnesota Advantage Program,150.775,81.5,,percent of total billed charges,,
"T3 (Triiodothyronine), Reverse, S (Mayo)OutsideLaboratory",,84482,CPT,Facility,Both,,,90,185,157.25,53.021,185,"Health Partners, Inc.",State Public Programs,92.5,50,,percent of total billed charges,,
"T3 (Triiodothyronine), Reverse, S (Mayo)OutsideLaboratory",,84482,CPT,Facility,Both,,,90,185,157.25,53.021,185,Humana Insurance Company,Commercial PPO,175.75,95,,percent of total billed charges,,
"T3 (Triiodothyronine), Reverse, S (Mayo)OutsideLaboratory",,84482,CPT,Facility,Outpatient,,,90,185,157.25,53.021,185,Humana Insurance Company,Medicare PPO,90.65,49,,percent of total billed charges,,
"T3 (Triiodothyronine), Reverse, S (Mayo)OutsideLaboratory",,84482,CPT,Facility,Inpatient,,,90,185,157.25,53.021,185,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"T3 (Triiodothyronine), Reverse, S (Mayo)OutsideLaboratory",,84482,CPT,Facility,Both,,,90,185,157.25,53.021,185,Medica,Individual & Family,183.335,99.1,,percent of total billed charges,,
"T3 (Triiodothyronine), Reverse, S (Mayo)OutsideLaboratory",,84482,CPT,Facility,Outpatient,,,90,185,157.25,53.021,185,Medica,Medica Advantage Solution,92.13,49.8,,percent of total billed charges,,
"T3 (Triiodothyronine), Reverse, S (Mayo)OutsideLaboratory",,84482,CPT,Facility,Inpatient,,,90,185,157.25,53.021,185,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"T3 (Triiodothyronine), Reverse, S (Mayo)OutsideLaboratory",,84482,CPT,Facility,Outpatient,,,90,185,157.25,53.021,185,Medica,Medical Assistance,82.51,44.6,,percent of total billed charges,,
"T3 (Triiodothyronine), Reverse, S (Mayo)OutsideLaboratory",,84482,CPT,Facility,Inpatient,,,90,185,157.25,53.021,185,Medica,Medical Assistance,,,,,Included in per diem rate,
"T3 (Triiodothyronine), Reverse, S (Mayo)OutsideLaboratory",,84482,CPT,Facility,Outpatient,,,90,185,157.25,53.021,185,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,92.13,49.8,,percent of total billed charges,,
"T3 (Triiodothyronine), Reverse, S (Mayo)OutsideLaboratory",,84482,CPT,Facility,Inpatient,,,90,185,157.25,53.021,185,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"T3 (Triiodothyronine), Reverse, S (Mayo)OutsideLaboratory",,84482,CPT,Facility,Both,,,90,185,157.25,53.021,185,"Multiplan, Inc.","Multiplan, Inc.",173.9,94,,percent of total billed charges,,
"T3 (Triiodothyronine), Reverse, S (Mayo)OutsideLaboratory",,84482,CPT,Facility,Outpatient,,,90,185,157.25,53.021,185,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,159.84,86.4,,percent of total billed charges,,
"T3 (Triiodothyronine), Reverse, S (Mayo)OutsideLaboratory",,84482,CPT,Facility,Inpatient,,,90,185,157.25,53.021,185,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"T3 (Triiodothyronine), Reverse, S (Mayo)OutsideLaboratory",,84482,CPT,Facility,Both,,,90,185,157.25,53.021,185,"Preferred One Administrative Services, INC.",PPO,182.41,98.6,,percent of total billed charges,,
"T3 (Triiodothyronine), Reverse, S (Mayo)OutsideLaboratory",,84482,CPT,Facility,Outpatient,,,90,185,157.25,53.021,185,PrimeWest Health,Minnesota Senior Health Options (MSHO),95.1825,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"T3 (Triiodothyronine), Reverse, S (Mayo)OutsideLaboratory",,84482,CPT,Facility,Inpatient,,,90,185,157.25,53.021,185,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"T3 (Triiodothyronine), Reverse, S (Mayo)OutsideLaboratory",,84482,CPT,Facility,Outpatient,,,90,185,157.25,53.021,185,PrimeWest Health,MinnesotaCare,95.016,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"T3 (Triiodothyronine), Reverse, S (Mayo)OutsideLaboratory",,84482,CPT,Facility,Inpatient,,,90,185,157.25,53.021,185,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"T3 (Triiodothyronine), Reverse, S (Mayo)OutsideLaboratory",,84482,CPT,Facility,Both,,,90,185,157.25,53.021,185,Sanford Health Plan,Sanford Health Plan,170.2,92,,percent of total billed charges,,
"T3 (Triiodothyronine), Reverse, S (Mayo)OutsideLaboratory",,84482,CPT,Facility,Outpatient,,,90,185,157.25,53.021,185,"UCare Health, Inc.",Individual & Family Plan,104.2475,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"T3 (Triiodothyronine), Reverse, S (Mayo)OutsideLaboratory",,84482,CPT,Facility,Inpatient,,,90,185,157.25,53.021,185,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"T3 (Triiodothyronine), Reverse, S (Mayo)OutsideLaboratory",,84482,CPT,Facility,Outpatient,,,90,185,157.25,53.021,185,"UCare Health, Inc.",Medical Assistance,93.3695,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"T3 (Triiodothyronine), Reverse, S (Mayo)OutsideLaboratory",,84482,CPT,Facility,Inpatient,,,90,185,157.25,53.021,185,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"T3 (Triiodothyronine), Reverse, S (Mayo)OutsideLaboratory",,84482,CPT,Facility,Outpatient,,,90,185,157.25,53.021,185,"UCare Health, Inc.",Medicare Advantage,93.3695,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"T3 (Triiodothyronine), Reverse, S (Mayo)OutsideLaboratory",,84482,CPT,Facility,Inpatient,,,90,185,157.25,53.021,185,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"T3 (Triiodothyronine), Reverse, S (Mayo)OutsideLaboratory",,84482,CPT,Facility,Outpatient,,,90,185,157.25,53.021,185,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),93.3695,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"T3 (Triiodothyronine), Reverse, S (Mayo)OutsideLaboratory",,84482,CPT,Facility,Inpatient,,,90,185,157.25,53.021,185,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"T3 (Triiodothyronine), Reverse, S (Mayo)OutsideLaboratory",,84482,CPT,Facility,Both,,,90,185,157.25,53.021,185,UnitedHealthcare,Individual & Family,173.9,94,,percent of total billed charges,,
"T3 (Triiodothyronine), Reverse, S (Mayo)OutsideLaboratory",,84482,CPT,Facility,Outpatient,,,90,185,157.25,53.021,185,UnitedHealthcare,Medicare Advantage,90.65,49,,percent of total billed charges,,
"T3 (Triiodothyronine), Reverse, S (Mayo)OutsideLaboratory",,84482,CPT,Facility,Inpatient,,,90,185,157.25,53.021,185,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"T3 (Triiodothyronine), Reverse, S (Mayo)OutsideLaboratory",,84482,CPT,Facility,Outpatient,,,90,185,157.25,53.021,185,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,88.8,48,,percent of total billed charges,,100% of DHS outpatient percentage
"T3 (Triiodothyronine), Reverse, S (Mayo)OutsideLaboratory",,84482,CPT,Facility,Inpatient,,,90,185,157.25,53.021,185,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Urea, Random, U (Mayo)OutsideLaboratory",,84540,CPT,Facility,Both,,,90,56,47.6,16.0496,56,Aetna,Commercial,51.52,92,,percent of total billed charges,,
"Urea, Random, U (Mayo)OutsideLaboratory",,84540,CPT,Facility,Outpatient,,,90,56,47.6,16.0496,56,Aetna,Medicare Advantage,27.44,49,,percent of total billed charges,,
"Urea, Random, U (Mayo)OutsideLaboratory",,84540,CPT,Facility,Inpatient,,,90,56,47.6,16.0496,56,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Urea, Random, U (Mayo)OutsideLaboratory",,84540,CPT,Facility,Both,,,90,56,47.6,16.0496,56,Aetna,PPO,52.08,93,,percent of total billed charges,,
"Urea, Random, U (Mayo)OutsideLaboratory",,84540,CPT,Facility,Both,,,90,56,47.6,16.0496,56,America's PPO,America's PPO,53.7768,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Urea, Random, U (Mayo)OutsideLaboratory",,84540,CPT,Facility,Both,,,90,56,47.6,16.0496,56,BlueCross BlueShield Minnesota, Federal Employee Program,55.104,98.4,,percent of total billed charges,,
"Urea, Random, U (Mayo)OutsideLaboratory",,84540,CPT,Facility,Both,,,90,56,47.6,16.0496,56,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,56,100,,percent of total billed charges,,
"Urea, Random, U (Mayo)OutsideLaboratory",,84540,CPT,Facility,Both,,,90,56,47.6,16.0496,56,BlueCross BlueShield Minnesota,High Value Network Plan,50.4,90,,percent of total billed charges,,
"Urea, Random, U (Mayo)OutsideLaboratory",,84540,CPT,Facility,Outpatient,,,90,56,47.6,16.0496,56,BlueCross BlueShield Minnesota,Medicare Advantage,27.44,49,,percent of total billed charges,,
"Urea, Random, U (Mayo)OutsideLaboratory",,84540,CPT,Facility,Inpatient,,,90,56,47.6,16.0496,56,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Urea, Random, U (Mayo)OutsideLaboratory",,84540,CPT,Facility,Both,,,90,56,47.6,16.0496,56,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,49.5992,88.57,,percent of total billed charges,,
"Urea, Random, U (Mayo)OutsideLaboratory",,84540,CPT,Facility,Both,,,90,56,47.6,16.0496,56,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,16.0496,28.66,,percent of total billed charges,,
"Urea, Random, U (Mayo)OutsideLaboratory",,84540,CPT,Facility,Outpatient,,,90,56,47.6,16.0496,56,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),27.44,49,,percent of total billed charges,,
"Urea, Random, U (Mayo)OutsideLaboratory",,84540,CPT,Facility,Inpatient,,,90,56,47.6,16.0496,56,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Urea, Random, U (Mayo)OutsideLaboratory",,84540,CPT,Facility,Both,,,90,56,47.6,16.0496,56,CorVel,Worker's Compensation,56,100,,percent of total billed charges,,
"Urea, Random, U (Mayo)OutsideLaboratory",,84540,CPT,Facility,Both,,,90,56,47.6,16.0496,56,First Health Group Corporation,First Health Network,54.32,97,,percent of total billed charges,,
"Urea, Random, U (Mayo)OutsideLaboratory",,84540,CPT,Facility,Both,,,90,56,47.6,16.0496,56,"Health Partners, Inc.",Commercial,52.976,94.6,,percent of total billed charges,,
"Urea, Random, U (Mayo)OutsideLaboratory",,84540,CPT,Facility,Outpatient,,,90,56,47.6,16.0496,56,"Health Partners, Inc.",Medicare Advantage,27.44,49,,percent of total billed charges,,
"Urea, Random, U (Mayo)OutsideLaboratory",,84540,CPT,Facility,Inpatient,,,90,56,47.6,16.0496,56,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Urea, Random, U (Mayo)OutsideLaboratory",,84540,CPT,Facility,Both,,,90,56,47.6,16.0496,56,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),33.6,60,,percent of total billed charges,,
"Urea, Random, U (Mayo)OutsideLaboratory",,84540,CPT,Facility,Both,,,90,56,47.6,16.0496,56,"Health Partners, Inc.",State of Minnesota Advantage Program,45.64,81.5,,percent of total billed charges,,
"Urea, Random, U (Mayo)OutsideLaboratory",,84540,CPT,Facility,Both,,,90,56,47.6,16.0496,56,"Health Partners, Inc.",State Public Programs,28,50,,percent of total billed charges,,
"Urea, Random, U (Mayo)OutsideLaboratory",,84540,CPT,Facility,Both,,,90,56,47.6,16.0496,56,Humana Insurance Company,Commercial PPO,53.2,95,,percent of total billed charges,,
"Urea, Random, U (Mayo)OutsideLaboratory",,84540,CPT,Facility,Outpatient,,,90,56,47.6,16.0496,56,Humana Insurance Company,Medicare PPO,27.44,49,,percent of total billed charges,,
"Urea, Random, U (Mayo)OutsideLaboratory",,84540,CPT,Facility,Inpatient,,,90,56,47.6,16.0496,56,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Urea, Random, U (Mayo)OutsideLaboratory",,84540,CPT,Facility,Both,,,90,56,47.6,16.0496,56,Medica,Individual & Family,55.496,99.1,,percent of total billed charges,,
"Urea, Random, U (Mayo)OutsideLaboratory",,84540,CPT,Facility,Outpatient,,,90,56,47.6,16.0496,56,Medica,Medica Advantage Solution,27.888,49.8,,percent of total billed charges,,
"Urea, Random, U (Mayo)OutsideLaboratory",,84540,CPT,Facility,Inpatient,,,90,56,47.6,16.0496,56,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Urea, Random, U (Mayo)OutsideLaboratory",,84540,CPT,Facility,Outpatient,,,90,56,47.6,16.0496,56,Medica,Medical Assistance,24.976,44.6,,percent of total billed charges,,
"Urea, Random, U (Mayo)OutsideLaboratory",,84540,CPT,Facility,Inpatient,,,90,56,47.6,16.0496,56,Medica,Medical Assistance,,,,,Included in per diem rate,
"Urea, Random, U (Mayo)OutsideLaboratory",,84540,CPT,Facility,Outpatient,,,90,56,47.6,16.0496,56,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,27.888,49.8,,percent of total billed charges,,
"Urea, Random, U (Mayo)OutsideLaboratory",,84540,CPT,Facility,Inpatient,,,90,56,47.6,16.0496,56,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Urea, Random, U (Mayo)OutsideLaboratory",,84540,CPT,Facility,Both,,,90,56,47.6,16.0496,56,"Multiplan, Inc.","Multiplan, Inc.",52.64,94,,percent of total billed charges,,
"Urea, Random, U (Mayo)OutsideLaboratory",,84540,CPT,Facility,Outpatient,,,90,56,47.6,16.0496,56,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,48.384,86.4,,percent of total billed charges,,
"Urea, Random, U (Mayo)OutsideLaboratory",,84540,CPT,Facility,Inpatient,,,90,56,47.6,16.0496,56,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Urea, Random, U (Mayo)OutsideLaboratory",,84540,CPT,Facility,Both,,,90,56,47.6,16.0496,56,"Preferred One Administrative Services, INC.",PPO,55.216,98.6,,percent of total billed charges,,
"Urea, Random, U (Mayo)OutsideLaboratory",,84540,CPT,Facility,Outpatient,,,90,56,47.6,16.0496,56,PrimeWest Health,Minnesota Senior Health Options (MSHO),28.812,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Urea, Random, U (Mayo)OutsideLaboratory",,84540,CPT,Facility,Inpatient,,,90,56,47.6,16.0496,56,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Urea, Random, U (Mayo)OutsideLaboratory",,84540,CPT,Facility,Outpatient,,,90,56,47.6,16.0496,56,PrimeWest Health,MinnesotaCare,28.7616,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Urea, Random, U (Mayo)OutsideLaboratory",,84540,CPT,Facility,Inpatient,,,90,56,47.6,16.0496,56,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Urea, Random, U (Mayo)OutsideLaboratory",,84540,CPT,Facility,Both,,,90,56,47.6,16.0496,56,Sanford Health Plan,Sanford Health Plan,51.52,92,,percent of total billed charges,,
"Urea, Random, U (Mayo)OutsideLaboratory",,84540,CPT,Facility,Outpatient,,,90,56,47.6,16.0496,56,"UCare Health, Inc.",Individual & Family Plan,31.556,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Urea, Random, U (Mayo)OutsideLaboratory",,84540,CPT,Facility,Inpatient,,,90,56,47.6,16.0496,56,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Urea, Random, U (Mayo)OutsideLaboratory",,84540,CPT,Facility,Outpatient,,,90,56,47.6,16.0496,56,"UCare Health, Inc.",Medical Assistance,28.2632,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Urea, Random, U (Mayo)OutsideLaboratory",,84540,CPT,Facility,Inpatient,,,90,56,47.6,16.0496,56,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Urea, Random, U (Mayo)OutsideLaboratory",,84540,CPT,Facility,Outpatient,,,90,56,47.6,16.0496,56,"UCare Health, Inc.",Medicare Advantage,28.2632,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Urea, Random, U (Mayo)OutsideLaboratory",,84540,CPT,Facility,Inpatient,,,90,56,47.6,16.0496,56,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Urea, Random, U (Mayo)OutsideLaboratory",,84540,CPT,Facility,Outpatient,,,90,56,47.6,16.0496,56,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),28.2632,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Urea, Random, U (Mayo)OutsideLaboratory",,84540,CPT,Facility,Inpatient,,,90,56,47.6,16.0496,56,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Urea, Random, U (Mayo)OutsideLaboratory",,84540,CPT,Facility,Both,,,90,56,47.6,16.0496,56,UnitedHealthcare,Individual & Family,52.64,94,,percent of total billed charges,,
"Urea, Random, U (Mayo)OutsideLaboratory",,84540,CPT,Facility,Outpatient,,,90,56,47.6,16.0496,56,UnitedHealthcare,Medicare Advantage,27.44,49,,percent of total billed charges,,
"Urea, Random, U (Mayo)OutsideLaboratory",,84540,CPT,Facility,Inpatient,,,90,56,47.6,16.0496,56,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Urea, Random, U (Mayo)OutsideLaboratory",,84540,CPT,Facility,Outpatient,,,90,56,47.6,16.0496,56,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,26.88,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Urea, Random, U (Mayo)OutsideLaboratory",,84540,CPT,Facility,Inpatient,,,90,56,47.6,16.0496,56,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Uric Acid, Random, U (Mayo)OutsideLaboratory",,84560,CPT,Facility,Both,,,90,61,51.85,17.4826,61,Aetna,Commercial,56.12,92,,percent of total billed charges,,
"Uric Acid, Random, U (Mayo)OutsideLaboratory",,84560,CPT,Facility,Outpatient,,,90,61,51.85,17.4826,61,Aetna,Medicare Advantage,29.89,49,,percent of total billed charges,,
"Uric Acid, Random, U (Mayo)OutsideLaboratory",,84560,CPT,Facility,Inpatient,,,90,61,51.85,17.4826,61,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Uric Acid, Random, U (Mayo)OutsideLaboratory",,84560,CPT,Facility,Both,,,90,61,51.85,17.4826,61,Aetna,PPO,56.73,93,,percent of total billed charges,,
"Uric Acid, Random, U (Mayo)OutsideLaboratory",,84560,CPT,Facility,Both,,,90,61,51.85,17.4826,61,America's PPO,America's PPO,58.5783,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Uric Acid, Random, U (Mayo)OutsideLaboratory",,84560,CPT,Facility,Both,,,90,61,51.85,17.4826,61,BlueCross BlueShield Minnesota, Federal Employee Program,60.024,98.4,,percent of total billed charges,,
"Uric Acid, Random, U (Mayo)OutsideLaboratory",,84560,CPT,Facility,Both,,,90,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,61,100,,percent of total billed charges,,
"Uric Acid, Random, U (Mayo)OutsideLaboratory",,84560,CPT,Facility,Both,,,90,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,High Value Network Plan,54.9,90,,percent of total billed charges,,
"Uric Acid, Random, U (Mayo)OutsideLaboratory",,84560,CPT,Facility,Outpatient,,,90,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,Medicare Advantage,29.89,49,,percent of total billed charges,,
"Uric Acid, Random, U (Mayo)OutsideLaboratory",,84560,CPT,Facility,Inpatient,,,90,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Uric Acid, Random, U (Mayo)OutsideLaboratory",,84560,CPT,Facility,Both,,,90,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,54.0277,88.57,,percent of total billed charges,,
"Uric Acid, Random, U (Mayo)OutsideLaboratory",,84560,CPT,Facility,Both,,,90,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,17.4826,28.66,,percent of total billed charges,,
"Uric Acid, Random, U (Mayo)OutsideLaboratory",,84560,CPT,Facility,Outpatient,,,90,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),29.89,49,,percent of total billed charges,,
"Uric Acid, Random, U (Mayo)OutsideLaboratory",,84560,CPT,Facility,Inpatient,,,90,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Uric Acid, Random, U (Mayo)OutsideLaboratory",,84560,CPT,Facility,Both,,,90,61,51.85,17.4826,61,CorVel,Worker's Compensation,61,100,,percent of total billed charges,,
"Uric Acid, Random, U (Mayo)OutsideLaboratory",,84560,CPT,Facility,Both,,,90,61,51.85,17.4826,61,First Health Group Corporation,First Health Network,59.17,97,,percent of total billed charges,,
"Uric Acid, Random, U (Mayo)OutsideLaboratory",,84560,CPT,Facility,Both,,,90,61,51.85,17.4826,61,"Health Partners, Inc.",Commercial,57.706,94.6,,percent of total billed charges,,
"Uric Acid, Random, U (Mayo)OutsideLaboratory",,84560,CPT,Facility,Outpatient,,,90,61,51.85,17.4826,61,"Health Partners, Inc.",Medicare Advantage,29.89,49,,percent of total billed charges,,
"Uric Acid, Random, U (Mayo)OutsideLaboratory",,84560,CPT,Facility,Inpatient,,,90,61,51.85,17.4826,61,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Uric Acid, Random, U (Mayo)OutsideLaboratory",,84560,CPT,Facility,Both,,,90,61,51.85,17.4826,61,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),36.6,60,,percent of total billed charges,,
"Uric Acid, Random, U (Mayo)OutsideLaboratory",,84560,CPT,Facility,Both,,,90,61,51.85,17.4826,61,"Health Partners, Inc.",State of Minnesota Advantage Program,49.715,81.5,,percent of total billed charges,,
"Uric Acid, Random, U (Mayo)OutsideLaboratory",,84560,CPT,Facility,Both,,,90,61,51.85,17.4826,61,"Health Partners, Inc.",State Public Programs,30.5,50,,percent of total billed charges,,
"Uric Acid, Random, U (Mayo)OutsideLaboratory",,84560,CPT,Facility,Both,,,90,61,51.85,17.4826,61,Humana Insurance Company,Commercial PPO,57.95,95,,percent of total billed charges,,
"Uric Acid, Random, U (Mayo)OutsideLaboratory",,84560,CPT,Facility,Outpatient,,,90,61,51.85,17.4826,61,Humana Insurance Company,Medicare PPO,29.89,49,,percent of total billed charges,,
"Uric Acid, Random, U (Mayo)OutsideLaboratory",,84560,CPT,Facility,Inpatient,,,90,61,51.85,17.4826,61,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Uric Acid, Random, U (Mayo)OutsideLaboratory",,84560,CPT,Facility,Both,,,90,61,51.85,17.4826,61,Medica,Individual & Family,60.451,99.1,,percent of total billed charges,,
"Uric Acid, Random, U (Mayo)OutsideLaboratory",,84560,CPT,Facility,Outpatient,,,90,61,51.85,17.4826,61,Medica,Medica Advantage Solution,30.378,49.8,,percent of total billed charges,,
"Uric Acid, Random, U (Mayo)OutsideLaboratory",,84560,CPT,Facility,Inpatient,,,90,61,51.85,17.4826,61,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Uric Acid, Random, U (Mayo)OutsideLaboratory",,84560,CPT,Facility,Outpatient,,,90,61,51.85,17.4826,61,Medica,Medical Assistance,27.206,44.6,,percent of total billed charges,,
"Uric Acid, Random, U (Mayo)OutsideLaboratory",,84560,CPT,Facility,Inpatient,,,90,61,51.85,17.4826,61,Medica,Medical Assistance,,,,,Included in per diem rate,
"Uric Acid, Random, U (Mayo)OutsideLaboratory",,84560,CPT,Facility,Outpatient,,,90,61,51.85,17.4826,61,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,30.378,49.8,,percent of total billed charges,,
"Uric Acid, Random, U (Mayo)OutsideLaboratory",,84560,CPT,Facility,Inpatient,,,90,61,51.85,17.4826,61,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Uric Acid, Random, U (Mayo)OutsideLaboratory",,84560,CPT,Facility,Both,,,90,61,51.85,17.4826,61,"Multiplan, Inc.","Multiplan, Inc.",57.34,94,,percent of total billed charges,,
"Uric Acid, Random, U (Mayo)OutsideLaboratory",,84560,CPT,Facility,Outpatient,,,90,61,51.85,17.4826,61,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,52.704,86.4,,percent of total billed charges,,
"Uric Acid, Random, U (Mayo)OutsideLaboratory",,84560,CPT,Facility,Inpatient,,,90,61,51.85,17.4826,61,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Uric Acid, Random, U (Mayo)OutsideLaboratory",,84560,CPT,Facility,Both,,,90,61,51.85,17.4826,61,"Preferred One Administrative Services, INC.",PPO,60.146,98.6,,percent of total billed charges,,
"Uric Acid, Random, U (Mayo)OutsideLaboratory",,84560,CPT,Facility,Outpatient,,,90,61,51.85,17.4826,61,PrimeWest Health,Minnesota Senior Health Options (MSHO),31.3845,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Uric Acid, Random, U (Mayo)OutsideLaboratory",,84560,CPT,Facility,Inpatient,,,90,61,51.85,17.4826,61,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Uric Acid, Random, U (Mayo)OutsideLaboratory",,84560,CPT,Facility,Outpatient,,,90,61,51.85,17.4826,61,PrimeWest Health,MinnesotaCare,31.3296,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Uric Acid, Random, U (Mayo)OutsideLaboratory",,84560,CPT,Facility,Inpatient,,,90,61,51.85,17.4826,61,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Uric Acid, Random, U (Mayo)OutsideLaboratory",,84560,CPT,Facility,Both,,,90,61,51.85,17.4826,61,Sanford Health Plan,Sanford Health Plan,56.12,92,,percent of total billed charges,,
"Uric Acid, Random, U (Mayo)OutsideLaboratory",,84560,CPT,Facility,Outpatient,,,90,61,51.85,17.4826,61,"UCare Health, Inc.",Individual & Family Plan,34.3735,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Uric Acid, Random, U (Mayo)OutsideLaboratory",,84560,CPT,Facility,Inpatient,,,90,61,51.85,17.4826,61,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Uric Acid, Random, U (Mayo)OutsideLaboratory",,84560,CPT,Facility,Outpatient,,,90,61,51.85,17.4826,61,"UCare Health, Inc.",Medical Assistance,30.7867,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Uric Acid, Random, U (Mayo)OutsideLaboratory",,84560,CPT,Facility,Inpatient,,,90,61,51.85,17.4826,61,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Uric Acid, Random, U (Mayo)OutsideLaboratory",,84560,CPT,Facility,Outpatient,,,90,61,51.85,17.4826,61,"UCare Health, Inc.",Medicare Advantage,30.7867,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Uric Acid, Random, U (Mayo)OutsideLaboratory",,84560,CPT,Facility,Inpatient,,,90,61,51.85,17.4826,61,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Uric Acid, Random, U (Mayo)OutsideLaboratory",,84560,CPT,Facility,Outpatient,,,90,61,51.85,17.4826,61,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),30.7867,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Uric Acid, Random, U (Mayo)OutsideLaboratory",,84560,CPT,Facility,Inpatient,,,90,61,51.85,17.4826,61,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Uric Acid, Random, U (Mayo)OutsideLaboratory",,84560,CPT,Facility,Both,,,90,61,51.85,17.4826,61,UnitedHealthcare,Individual & Family,57.34,94,,percent of total billed charges,,
"Uric Acid, Random, U (Mayo)OutsideLaboratory",,84560,CPT,Facility,Outpatient,,,90,61,51.85,17.4826,61,UnitedHealthcare,Medicare Advantage,29.89,49,,percent of total billed charges,,
"Uric Acid, Random, U (Mayo)OutsideLaboratory",,84560,CPT,Facility,Inpatient,,,90,61,51.85,17.4826,61,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Uric Acid, Random, U (Mayo)OutsideLaboratory",,84560,CPT,Facility,Outpatient,,,90,61,51.85,17.4826,61,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,29.28,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Uric Acid, Random, U (Mayo)OutsideLaboratory",,84560,CPT,Facility,Inpatient,,,90,61,51.85,17.4826,61,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Vitamin A, S (Mayo)OutsideLaboratory",,84590,CPT,Facility,Both,,,90,104,88.4,29.8064,104,Aetna,Commercial,95.68,92,,percent of total billed charges,,
"Vitamin A, S (Mayo)OutsideLaboratory",,84590,CPT,Facility,Outpatient,,,90,104,88.4,29.8064,104,Aetna,Medicare Advantage,50.96,49,,percent of total billed charges,,
"Vitamin A, S (Mayo)OutsideLaboratory",,84590,CPT,Facility,Inpatient,,,90,104,88.4,29.8064,104,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Vitamin A, S (Mayo)OutsideLaboratory",,84590,CPT,Facility,Both,,,90,104,88.4,29.8064,104,Aetna,PPO,96.72,93,,percent of total billed charges,,
"Vitamin A, S (Mayo)OutsideLaboratory",,84590,CPT,Facility,Both,,,90,104,88.4,29.8064,104,America's PPO,America's PPO,99.8712,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Vitamin A, S (Mayo)OutsideLaboratory",,84590,CPT,Facility,Both,,,90,104,88.4,29.8064,104,BlueCross BlueShield Minnesota, Federal Employee Program,102.336,98.4,,percent of total billed charges,,
"Vitamin A, S (Mayo)OutsideLaboratory",,84590,CPT,Facility,Both,,,90,104,88.4,29.8064,104,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,104,100,,percent of total billed charges,,
"Vitamin A, S (Mayo)OutsideLaboratory",,84590,CPT,Facility,Both,,,90,104,88.4,29.8064,104,BlueCross BlueShield Minnesota,High Value Network Plan,93.6,90,,percent of total billed charges,,
"Vitamin A, S (Mayo)OutsideLaboratory",,84590,CPT,Facility,Outpatient,,,90,104,88.4,29.8064,104,BlueCross BlueShield Minnesota,Medicare Advantage,50.96,49,,percent of total billed charges,,
"Vitamin A, S (Mayo)OutsideLaboratory",,84590,CPT,Facility,Inpatient,,,90,104,88.4,29.8064,104,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Vitamin A, S (Mayo)OutsideLaboratory",,84590,CPT,Facility,Both,,,90,104,88.4,29.8064,104,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,92.1128,88.57,,percent of total billed charges,,
"Vitamin A, S (Mayo)OutsideLaboratory",,84590,CPT,Facility,Both,,,90,104,88.4,29.8064,104,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,29.8064,28.66,,percent of total billed charges,,
"Vitamin A, S (Mayo)OutsideLaboratory",,84590,CPT,Facility,Outpatient,,,90,104,88.4,29.8064,104,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),50.96,49,,percent of total billed charges,,
"Vitamin A, S (Mayo)OutsideLaboratory",,84590,CPT,Facility,Inpatient,,,90,104,88.4,29.8064,104,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Vitamin A, S (Mayo)OutsideLaboratory",,84590,CPT,Facility,Both,,,90,104,88.4,29.8064,104,CorVel,Worker's Compensation,104,100,,percent of total billed charges,,
"Vitamin A, S (Mayo)OutsideLaboratory",,84590,CPT,Facility,Both,,,90,104,88.4,29.8064,104,First Health Group Corporation,First Health Network,100.88,97,,percent of total billed charges,,
"Vitamin A, S (Mayo)OutsideLaboratory",,84590,CPT,Facility,Both,,,90,104,88.4,29.8064,104,"Health Partners, Inc.",Commercial,98.384,94.6,,percent of total billed charges,,
"Vitamin A, S (Mayo)OutsideLaboratory",,84590,CPT,Facility,Outpatient,,,90,104,88.4,29.8064,104,"Health Partners, Inc.",Medicare Advantage,50.96,49,,percent of total billed charges,,
"Vitamin A, S (Mayo)OutsideLaboratory",,84590,CPT,Facility,Inpatient,,,90,104,88.4,29.8064,104,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Vitamin A, S (Mayo)OutsideLaboratory",,84590,CPT,Facility,Both,,,90,104,88.4,29.8064,104,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),62.4,60,,percent of total billed charges,,
"Vitamin A, S (Mayo)OutsideLaboratory",,84590,CPT,Facility,Both,,,90,104,88.4,29.8064,104,"Health Partners, Inc.",State of Minnesota Advantage Program,84.76,81.5,,percent of total billed charges,,
"Vitamin A, S (Mayo)OutsideLaboratory",,84590,CPT,Facility,Both,,,90,104,88.4,29.8064,104,"Health Partners, Inc.",State Public Programs,52,50,,percent of total billed charges,,
"Vitamin A, S (Mayo)OutsideLaboratory",,84590,CPT,Facility,Both,,,90,104,88.4,29.8064,104,Humana Insurance Company,Commercial PPO,98.8,95,,percent of total billed charges,,
"Vitamin A, S (Mayo)OutsideLaboratory",,84590,CPT,Facility,Outpatient,,,90,104,88.4,29.8064,104,Humana Insurance Company,Medicare PPO,50.96,49,,percent of total billed charges,,
"Vitamin A, S (Mayo)OutsideLaboratory",,84590,CPT,Facility,Inpatient,,,90,104,88.4,29.8064,104,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Vitamin A, S (Mayo)OutsideLaboratory",,84590,CPT,Facility,Both,,,90,104,88.4,29.8064,104,Medica,Individual & Family,103.064,99.1,,percent of total billed charges,,
"Vitamin A, S (Mayo)OutsideLaboratory",,84590,CPT,Facility,Outpatient,,,90,104,88.4,29.8064,104,Medica,Medica Advantage Solution,51.792,49.8,,percent of total billed charges,,
"Vitamin A, S (Mayo)OutsideLaboratory",,84590,CPT,Facility,Inpatient,,,90,104,88.4,29.8064,104,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Vitamin A, S (Mayo)OutsideLaboratory",,84590,CPT,Facility,Outpatient,,,90,104,88.4,29.8064,104,Medica,Medical Assistance,46.384,44.6,,percent of total billed charges,,
"Vitamin A, S (Mayo)OutsideLaboratory",,84590,CPT,Facility,Inpatient,,,90,104,88.4,29.8064,104,Medica,Medical Assistance,,,,,Included in per diem rate,
"Vitamin A, S (Mayo)OutsideLaboratory",,84590,CPT,Facility,Outpatient,,,90,104,88.4,29.8064,104,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,51.792,49.8,,percent of total billed charges,,
"Vitamin A, S (Mayo)OutsideLaboratory",,84590,CPT,Facility,Inpatient,,,90,104,88.4,29.8064,104,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Vitamin A, S (Mayo)OutsideLaboratory",,84590,CPT,Facility,Both,,,90,104,88.4,29.8064,104,"Multiplan, Inc.","Multiplan, Inc.",97.76,94,,percent of total billed charges,,
"Vitamin A, S (Mayo)OutsideLaboratory",,84590,CPT,Facility,Outpatient,,,90,104,88.4,29.8064,104,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,89.856,86.4,,percent of total billed charges,,
"Vitamin A, S (Mayo)OutsideLaboratory",,84590,CPT,Facility,Inpatient,,,90,104,88.4,29.8064,104,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Vitamin A, S (Mayo)OutsideLaboratory",,84590,CPT,Facility,Both,,,90,104,88.4,29.8064,104,"Preferred One Administrative Services, INC.",PPO,102.544,98.6,,percent of total billed charges,,
"Vitamin A, S (Mayo)OutsideLaboratory",,84590,CPT,Facility,Outpatient,,,90,104,88.4,29.8064,104,PrimeWest Health,Minnesota Senior Health Options (MSHO),53.508,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Vitamin A, S (Mayo)OutsideLaboratory",,84590,CPT,Facility,Inpatient,,,90,104,88.4,29.8064,104,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Vitamin A, S (Mayo)OutsideLaboratory",,84590,CPT,Facility,Outpatient,,,90,104,88.4,29.8064,104,PrimeWest Health,MinnesotaCare,53.4144,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Vitamin A, S (Mayo)OutsideLaboratory",,84590,CPT,Facility,Inpatient,,,90,104,88.4,29.8064,104,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Vitamin A, S (Mayo)OutsideLaboratory",,84590,CPT,Facility,Both,,,90,104,88.4,29.8064,104,Sanford Health Plan,Sanford Health Plan,95.68,92,,percent of total billed charges,,
"Vitamin A, S (Mayo)OutsideLaboratory",,84590,CPT,Facility,Outpatient,,,90,104,88.4,29.8064,104,"UCare Health, Inc.",Individual & Family Plan,58.604,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Vitamin A, S (Mayo)OutsideLaboratory",,84590,CPT,Facility,Inpatient,,,90,104,88.4,29.8064,104,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Vitamin A, S (Mayo)OutsideLaboratory",,84590,CPT,Facility,Outpatient,,,90,104,88.4,29.8064,104,"UCare Health, Inc.",Medical Assistance,52.4888,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Vitamin A, S (Mayo)OutsideLaboratory",,84590,CPT,Facility,Inpatient,,,90,104,88.4,29.8064,104,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Vitamin A, S (Mayo)OutsideLaboratory",,84590,CPT,Facility,Outpatient,,,90,104,88.4,29.8064,104,"UCare Health, Inc.",Medicare Advantage,52.4888,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Vitamin A, S (Mayo)OutsideLaboratory",,84590,CPT,Facility,Inpatient,,,90,104,88.4,29.8064,104,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Vitamin A, S (Mayo)OutsideLaboratory",,84590,CPT,Facility,Outpatient,,,90,104,88.4,29.8064,104,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),52.4888,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Vitamin A, S (Mayo)OutsideLaboratory",,84590,CPT,Facility,Inpatient,,,90,104,88.4,29.8064,104,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Vitamin A, S (Mayo)OutsideLaboratory",,84590,CPT,Facility,Both,,,90,104,88.4,29.8064,104,UnitedHealthcare,Individual & Family,97.76,94,,percent of total billed charges,,
"Vitamin A, S (Mayo)OutsideLaboratory",,84590,CPT,Facility,Outpatient,,,90,104,88.4,29.8064,104,UnitedHealthcare,Medicare Advantage,50.96,49,,percent of total billed charges,,
"Vitamin A, S (Mayo)OutsideLaboratory",,84590,CPT,Facility,Inpatient,,,90,104,88.4,29.8064,104,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Vitamin A, S (Mayo)OutsideLaboratory",,84590,CPT,Facility,Outpatient,,,90,104,88.4,29.8064,104,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,49.92,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Vitamin A, S (Mayo)OutsideLaboratory",,84590,CPT,Facility,Inpatient,,,90,104,88.4,29.8064,104,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Vitamin K1, S (Mayo)OutsideLaboratory",,84597,CPT,Facility,Both,,,90,187,158.95,53.5942,187,Aetna,Commercial,172.04,92,,percent of total billed charges,,
"Vitamin K1, S (Mayo)OutsideLaboratory",,84597,CPT,Facility,Outpatient,,,90,187,158.95,53.5942,187,Aetna,Medicare Advantage,91.63,49,,percent of total billed charges,,
"Vitamin K1, S (Mayo)OutsideLaboratory",,84597,CPT,Facility,Inpatient,,,90,187,158.95,53.5942,187,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Vitamin K1, S (Mayo)OutsideLaboratory",,84597,CPT,Facility,Both,,,90,187,158.95,53.5942,187,Aetna,PPO,173.91,93,,percent of total billed charges,,
"Vitamin K1, S (Mayo)OutsideLaboratory",,84597,CPT,Facility,Both,,,90,187,158.95,53.5942,187,America's PPO,America's PPO,179.5761,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Vitamin K1, S (Mayo)OutsideLaboratory",,84597,CPT,Facility,Both,,,90,187,158.95,53.5942,187,BlueCross BlueShield Minnesota, Federal Employee Program,184.008,98.4,,percent of total billed charges,,
"Vitamin K1, S (Mayo)OutsideLaboratory",,84597,CPT,Facility,Both,,,90,187,158.95,53.5942,187,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,187,100,,percent of total billed charges,,
"Vitamin K1, S (Mayo)OutsideLaboratory",,84597,CPT,Facility,Both,,,90,187,158.95,53.5942,187,BlueCross BlueShield Minnesota,High Value Network Plan,168.3,90,,percent of total billed charges,,
"Vitamin K1, S (Mayo)OutsideLaboratory",,84597,CPT,Facility,Outpatient,,,90,187,158.95,53.5942,187,BlueCross BlueShield Minnesota,Medicare Advantage,91.63,49,,percent of total billed charges,,
"Vitamin K1, S (Mayo)OutsideLaboratory",,84597,CPT,Facility,Inpatient,,,90,187,158.95,53.5942,187,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Vitamin K1, S (Mayo)OutsideLaboratory",,84597,CPT,Facility,Both,,,90,187,158.95,53.5942,187,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,165.6259,88.57,,percent of total billed charges,,
"Vitamin K1, S (Mayo)OutsideLaboratory",,84597,CPT,Facility,Both,,,90,187,158.95,53.5942,187,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,53.5942,28.66,,percent of total billed charges,,
"Vitamin K1, S (Mayo)OutsideLaboratory",,84597,CPT,Facility,Outpatient,,,90,187,158.95,53.5942,187,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),91.63,49,,percent of total billed charges,,
"Vitamin K1, S (Mayo)OutsideLaboratory",,84597,CPT,Facility,Inpatient,,,90,187,158.95,53.5942,187,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Vitamin K1, S (Mayo)OutsideLaboratory",,84597,CPT,Facility,Both,,,90,187,158.95,53.5942,187,CorVel,Worker's Compensation,187,100,,percent of total billed charges,,
"Vitamin K1, S (Mayo)OutsideLaboratory",,84597,CPT,Facility,Both,,,90,187,158.95,53.5942,187,First Health Group Corporation,First Health Network,181.39,97,,percent of total billed charges,,
"Vitamin K1, S (Mayo)OutsideLaboratory",,84597,CPT,Facility,Both,,,90,187,158.95,53.5942,187,"Health Partners, Inc.",Commercial,176.902,94.6,,percent of total billed charges,,
"Vitamin K1, S (Mayo)OutsideLaboratory",,84597,CPT,Facility,Outpatient,,,90,187,158.95,53.5942,187,"Health Partners, Inc.",Medicare Advantage,91.63,49,,percent of total billed charges,,
"Vitamin K1, S (Mayo)OutsideLaboratory",,84597,CPT,Facility,Inpatient,,,90,187,158.95,53.5942,187,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Vitamin K1, S (Mayo)OutsideLaboratory",,84597,CPT,Facility,Both,,,90,187,158.95,53.5942,187,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),112.2,60,,percent of total billed charges,,
"Vitamin K1, S (Mayo)OutsideLaboratory",,84597,CPT,Facility,Both,,,90,187,158.95,53.5942,187,"Health Partners, Inc.",State of Minnesota Advantage Program,152.405,81.5,,percent of total billed charges,,
"Vitamin K1, S (Mayo)OutsideLaboratory",,84597,CPT,Facility,Both,,,90,187,158.95,53.5942,187,"Health Partners, Inc.",State Public Programs,93.5,50,,percent of total billed charges,,
"Vitamin K1, S (Mayo)OutsideLaboratory",,84597,CPT,Facility,Both,,,90,187,158.95,53.5942,187,Humana Insurance Company,Commercial PPO,177.65,95,,percent of total billed charges,,
"Vitamin K1, S (Mayo)OutsideLaboratory",,84597,CPT,Facility,Outpatient,,,90,187,158.95,53.5942,187,Humana Insurance Company,Medicare PPO,91.63,49,,percent of total billed charges,,
"Vitamin K1, S (Mayo)OutsideLaboratory",,84597,CPT,Facility,Inpatient,,,90,187,158.95,53.5942,187,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Vitamin K1, S (Mayo)OutsideLaboratory",,84597,CPT,Facility,Both,,,90,187,158.95,53.5942,187,Medica,Individual & Family,185.317,99.1,,percent of total billed charges,,
"Vitamin K1, S (Mayo)OutsideLaboratory",,84597,CPT,Facility,Outpatient,,,90,187,158.95,53.5942,187,Medica,Medica Advantage Solution,93.126,49.8,,percent of total billed charges,,
"Vitamin K1, S (Mayo)OutsideLaboratory",,84597,CPT,Facility,Inpatient,,,90,187,158.95,53.5942,187,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Vitamin K1, S (Mayo)OutsideLaboratory",,84597,CPT,Facility,Outpatient,,,90,187,158.95,53.5942,187,Medica,Medical Assistance,83.402,44.6,,percent of total billed charges,,
"Vitamin K1, S (Mayo)OutsideLaboratory",,84597,CPT,Facility,Inpatient,,,90,187,158.95,53.5942,187,Medica,Medical Assistance,,,,,Included in per diem rate,
"Vitamin K1, S (Mayo)OutsideLaboratory",,84597,CPT,Facility,Outpatient,,,90,187,158.95,53.5942,187,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,93.126,49.8,,percent of total billed charges,,
"Vitamin K1, S (Mayo)OutsideLaboratory",,84597,CPT,Facility,Inpatient,,,90,187,158.95,53.5942,187,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Vitamin K1, S (Mayo)OutsideLaboratory",,84597,CPT,Facility,Both,,,90,187,158.95,53.5942,187,"Multiplan, Inc.","Multiplan, Inc.",175.78,94,,percent of total billed charges,,
"Vitamin K1, S (Mayo)OutsideLaboratory",,84597,CPT,Facility,Outpatient,,,90,187,158.95,53.5942,187,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,161.568,86.4,,percent of total billed charges,,
"Vitamin K1, S (Mayo)OutsideLaboratory",,84597,CPT,Facility,Inpatient,,,90,187,158.95,53.5942,187,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Vitamin K1, S (Mayo)OutsideLaboratory",,84597,CPT,Facility,Both,,,90,187,158.95,53.5942,187,"Preferred One Administrative Services, INC.",PPO,184.382,98.6,,percent of total billed charges,,
"Vitamin K1, S (Mayo)OutsideLaboratory",,84597,CPT,Facility,Outpatient,,,90,187,158.95,53.5942,187,PrimeWest Health,Minnesota Senior Health Options (MSHO),96.2115,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Vitamin K1, S (Mayo)OutsideLaboratory",,84597,CPT,Facility,Inpatient,,,90,187,158.95,53.5942,187,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Vitamin K1, S (Mayo)OutsideLaboratory",,84597,CPT,Facility,Outpatient,,,90,187,158.95,53.5942,187,PrimeWest Health,MinnesotaCare,96.0432,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Vitamin K1, S (Mayo)OutsideLaboratory",,84597,CPT,Facility,Inpatient,,,90,187,158.95,53.5942,187,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Vitamin K1, S (Mayo)OutsideLaboratory",,84597,CPT,Facility,Both,,,90,187,158.95,53.5942,187,Sanford Health Plan,Sanford Health Plan,172.04,92,,percent of total billed charges,,
"Vitamin K1, S (Mayo)OutsideLaboratory",,84597,CPT,Facility,Outpatient,,,90,187,158.95,53.5942,187,"UCare Health, Inc.",Individual & Family Plan,105.3745,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Vitamin K1, S (Mayo)OutsideLaboratory",,84597,CPT,Facility,Inpatient,,,90,187,158.95,53.5942,187,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Vitamin K1, S (Mayo)OutsideLaboratory",,84597,CPT,Facility,Outpatient,,,90,187,158.95,53.5942,187,"UCare Health, Inc.",Medical Assistance,94.3789,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Vitamin K1, S (Mayo)OutsideLaboratory",,84597,CPT,Facility,Inpatient,,,90,187,158.95,53.5942,187,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Vitamin K1, S (Mayo)OutsideLaboratory",,84597,CPT,Facility,Outpatient,,,90,187,158.95,53.5942,187,"UCare Health, Inc.",Medicare Advantage,94.3789,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Vitamin K1, S (Mayo)OutsideLaboratory",,84597,CPT,Facility,Inpatient,,,90,187,158.95,53.5942,187,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Vitamin K1, S (Mayo)OutsideLaboratory",,84597,CPT,Facility,Outpatient,,,90,187,158.95,53.5942,187,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),94.3789,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Vitamin K1, S (Mayo)OutsideLaboratory",,84597,CPT,Facility,Inpatient,,,90,187,158.95,53.5942,187,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Vitamin K1, S (Mayo)OutsideLaboratory",,84597,CPT,Facility,Both,,,90,187,158.95,53.5942,187,UnitedHealthcare,Individual & Family,175.78,94,,percent of total billed charges,,
"Vitamin K1, S (Mayo)OutsideLaboratory",,84597,CPT,Facility,Outpatient,,,90,187,158.95,53.5942,187,UnitedHealthcare,Medicare Advantage,91.63,49,,percent of total billed charges,,
"Vitamin K1, S (Mayo)OutsideLaboratory",,84597,CPT,Facility,Inpatient,,,90,187,158.95,53.5942,187,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Vitamin K1, S (Mayo)OutsideLaboratory",,84597,CPT,Facility,Outpatient,,,90,187,158.95,53.5942,187,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,89.76,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Vitamin K1, S (Mayo)OutsideLaboratory",,84597,CPT,Facility,Inpatient,,,90,187,158.95,53.5942,187,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Zinc, S (Mayo)OutsideLaboratory",,84630,CPT,Facility,Both,,,90,90,76.5,25.794,90,Aetna,Commercial,82.8,92,,percent of total billed charges,,
"Zinc, S (Mayo)OutsideLaboratory",,84630,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,Aetna,Medicare Advantage,44.1,49,,percent of total billed charges,,
"Zinc, S (Mayo)OutsideLaboratory",,84630,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Zinc, S (Mayo)OutsideLaboratory",,84630,CPT,Facility,Both,,,90,90,76.5,25.794,90,Aetna,PPO,83.7,93,,percent of total billed charges,,
"Zinc, S (Mayo)OutsideLaboratory",,84630,CPT,Facility,Both,,,90,90,76.5,25.794,90,America's PPO,America's PPO,86.427,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Zinc, S (Mayo)OutsideLaboratory",,84630,CPT,Facility,Both,,,90,90,76.5,25.794,90,BlueCross BlueShield Minnesota, Federal Employee Program,88.56,98.4,,percent of total billed charges,,
"Zinc, S (Mayo)OutsideLaboratory",,84630,CPT,Facility,Both,,,90,90,76.5,25.794,90,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,90,100,,percent of total billed charges,,
"Zinc, S (Mayo)OutsideLaboratory",,84630,CPT,Facility,Both,,,90,90,76.5,25.794,90,BlueCross BlueShield Minnesota,High Value Network Plan,81,90,,percent of total billed charges,,
"Zinc, S (Mayo)OutsideLaboratory",,84630,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,BlueCross BlueShield Minnesota,Medicare Advantage,44.1,49,,percent of total billed charges,,
"Zinc, S (Mayo)OutsideLaboratory",,84630,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Zinc, S (Mayo)OutsideLaboratory",,84630,CPT,Facility,Both,,,90,90,76.5,25.794,90,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,79.713,88.57,,percent of total billed charges,,
"Zinc, S (Mayo)OutsideLaboratory",,84630,CPT,Facility,Both,,,90,90,76.5,25.794,90,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,25.794,28.66,,percent of total billed charges,,
"Zinc, S (Mayo)OutsideLaboratory",,84630,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),44.1,49,,percent of total billed charges,,
"Zinc, S (Mayo)OutsideLaboratory",,84630,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Zinc, S (Mayo)OutsideLaboratory",,84630,CPT,Facility,Both,,,90,90,76.5,25.794,90,CorVel,Worker's Compensation,90,100,,percent of total billed charges,,
"Zinc, S (Mayo)OutsideLaboratory",,84630,CPT,Facility,Both,,,90,90,76.5,25.794,90,First Health Group Corporation,First Health Network,87.3,97,,percent of total billed charges,,
"Zinc, S (Mayo)OutsideLaboratory",,84630,CPT,Facility,Both,,,90,90,76.5,25.794,90,"Health Partners, Inc.",Commercial,85.14,94.6,,percent of total billed charges,,
"Zinc, S (Mayo)OutsideLaboratory",,84630,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,"Health Partners, Inc.",Medicare Advantage,44.1,49,,percent of total billed charges,,
"Zinc, S (Mayo)OutsideLaboratory",,84630,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Zinc, S (Mayo)OutsideLaboratory",,84630,CPT,Facility,Both,,,90,90,76.5,25.794,90,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),54,60,,percent of total billed charges,,
"Zinc, S (Mayo)OutsideLaboratory",,84630,CPT,Facility,Both,,,90,90,76.5,25.794,90,"Health Partners, Inc.",State of Minnesota Advantage Program,73.35,81.5,,percent of total billed charges,,
"Zinc, S (Mayo)OutsideLaboratory",,84630,CPT,Facility,Both,,,90,90,76.5,25.794,90,"Health Partners, Inc.",State Public Programs,45,50,,percent of total billed charges,,
"Zinc, S (Mayo)OutsideLaboratory",,84630,CPT,Facility,Both,,,90,90,76.5,25.794,90,Humana Insurance Company,Commercial PPO,85.5,95,,percent of total billed charges,,
"Zinc, S (Mayo)OutsideLaboratory",,84630,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,Humana Insurance Company,Medicare PPO,44.1,49,,percent of total billed charges,,
"Zinc, S (Mayo)OutsideLaboratory",,84630,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Zinc, S (Mayo)OutsideLaboratory",,84630,CPT,Facility,Both,,,90,90,76.5,25.794,90,Medica,Individual & Family,89.19,99.1,,percent of total billed charges,,
"Zinc, S (Mayo)OutsideLaboratory",,84630,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,Medica,Medica Advantage Solution,44.82,49.8,,percent of total billed charges,,
"Zinc, S (Mayo)OutsideLaboratory",,84630,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Zinc, S (Mayo)OutsideLaboratory",,84630,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,Medica,Medical Assistance,40.14,44.6,,percent of total billed charges,,
"Zinc, S (Mayo)OutsideLaboratory",,84630,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,Medica,Medical Assistance,,,,,Included in per diem rate,
"Zinc, S (Mayo)OutsideLaboratory",,84630,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,44.82,49.8,,percent of total billed charges,,
"Zinc, S (Mayo)OutsideLaboratory",,84630,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Zinc, S (Mayo)OutsideLaboratory",,84630,CPT,Facility,Both,,,90,90,76.5,25.794,90,"Multiplan, Inc.","Multiplan, Inc.",84.6,94,,percent of total billed charges,,
"Zinc, S (Mayo)OutsideLaboratory",,84630,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,77.76,86.4,,percent of total billed charges,,
"Zinc, S (Mayo)OutsideLaboratory",,84630,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Zinc, S (Mayo)OutsideLaboratory",,84630,CPT,Facility,Both,,,90,90,76.5,25.794,90,"Preferred One Administrative Services, INC.",PPO,88.74,98.6,,percent of total billed charges,,
"Zinc, S (Mayo)OutsideLaboratory",,84630,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,PrimeWest Health,Minnesota Senior Health Options (MSHO),46.305,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Zinc, S (Mayo)OutsideLaboratory",,84630,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Zinc, S (Mayo)OutsideLaboratory",,84630,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,PrimeWest Health,MinnesotaCare,46.224,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Zinc, S (Mayo)OutsideLaboratory",,84630,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Zinc, S (Mayo)OutsideLaboratory",,84630,CPT,Facility,Both,,,90,90,76.5,25.794,90,Sanford Health Plan,Sanford Health Plan,82.8,92,,percent of total billed charges,,
"Zinc, S (Mayo)OutsideLaboratory",,84630,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,"UCare Health, Inc.",Individual & Family Plan,50.715,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Zinc, S (Mayo)OutsideLaboratory",,84630,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Zinc, S (Mayo)OutsideLaboratory",,84630,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,"UCare Health, Inc.",Medical Assistance,45.423,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Zinc, S (Mayo)OutsideLaboratory",,84630,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Zinc, S (Mayo)OutsideLaboratory",,84630,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,"UCare Health, Inc.",Medicare Advantage,45.423,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Zinc, S (Mayo)OutsideLaboratory",,84630,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Zinc, S (Mayo)OutsideLaboratory",,84630,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),45.423,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Zinc, S (Mayo)OutsideLaboratory",,84630,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Zinc, S (Mayo)OutsideLaboratory",,84630,CPT,Facility,Both,,,90,90,76.5,25.794,90,UnitedHealthcare,Individual & Family,84.6,94,,percent of total billed charges,,
"Zinc, S (Mayo)OutsideLaboratory",,84630,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,UnitedHealthcare,Medicare Advantage,44.1,49,,percent of total billed charges,,
"Zinc, S (Mayo)OutsideLaboratory",,84630,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Zinc, S (Mayo)OutsideLaboratory",,84630,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,43.2,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Zinc, S (Mayo)OutsideLaboratory",,84630,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"C-Peptide, S (Mayo)OutsideLaboratory",,84681,CPT,Facility,Both,,,90,185,157.25,53.021,185,Aetna,Commercial,170.2,92,,percent of total billed charges,,
"C-Peptide, S (Mayo)OutsideLaboratory",,84681,CPT,Facility,Outpatient,,,90,185,157.25,53.021,185,Aetna,Medicare Advantage,90.65,49,,percent of total billed charges,,
"C-Peptide, S (Mayo)OutsideLaboratory",,84681,CPT,Facility,Inpatient,,,90,185,157.25,53.021,185,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"C-Peptide, S (Mayo)OutsideLaboratory",,84681,CPT,Facility,Both,,,90,185,157.25,53.021,185,Aetna,PPO,172.05,93,,percent of total billed charges,,
"C-Peptide, S (Mayo)OutsideLaboratory",,84681,CPT,Facility,Both,,,90,185,157.25,53.021,185,America's PPO,America's PPO,177.6555,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"C-Peptide, S (Mayo)OutsideLaboratory",,84681,CPT,Facility,Both,,,90,185,157.25,53.021,185,BlueCross BlueShield Minnesota, Federal Employee Program,182.04,98.4,,percent of total billed charges,,
"C-Peptide, S (Mayo)OutsideLaboratory",,84681,CPT,Facility,Both,,,90,185,157.25,53.021,185,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,185,100,,percent of total billed charges,,
"C-Peptide, S (Mayo)OutsideLaboratory",,84681,CPT,Facility,Both,,,90,185,157.25,53.021,185,BlueCross BlueShield Minnesota,High Value Network Plan,166.5,90,,percent of total billed charges,,
"C-Peptide, S (Mayo)OutsideLaboratory",,84681,CPT,Facility,Outpatient,,,90,185,157.25,53.021,185,BlueCross BlueShield Minnesota,Medicare Advantage,90.65,49,,percent of total billed charges,,
"C-Peptide, S (Mayo)OutsideLaboratory",,84681,CPT,Facility,Inpatient,,,90,185,157.25,53.021,185,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"C-Peptide, S (Mayo)OutsideLaboratory",,84681,CPT,Facility,Both,,,90,185,157.25,53.021,185,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,163.8545,88.57,,percent of total billed charges,,
"C-Peptide, S (Mayo)OutsideLaboratory",,84681,CPT,Facility,Both,,,90,185,157.25,53.021,185,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,53.021,28.66,,percent of total billed charges,,
"C-Peptide, S (Mayo)OutsideLaboratory",,84681,CPT,Facility,Outpatient,,,90,185,157.25,53.021,185,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),90.65,49,,percent of total billed charges,,
"C-Peptide, S (Mayo)OutsideLaboratory",,84681,CPT,Facility,Inpatient,,,90,185,157.25,53.021,185,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"C-Peptide, S (Mayo)OutsideLaboratory",,84681,CPT,Facility,Both,,,90,185,157.25,53.021,185,CorVel,Worker's Compensation,185,100,,percent of total billed charges,,
"C-Peptide, S (Mayo)OutsideLaboratory",,84681,CPT,Facility,Both,,,90,185,157.25,53.021,185,First Health Group Corporation,First Health Network,179.45,97,,percent of total billed charges,,
"C-Peptide, S (Mayo)OutsideLaboratory",,84681,CPT,Facility,Both,,,90,185,157.25,53.021,185,"Health Partners, Inc.",Commercial,175.01,94.6,,percent of total billed charges,,
"C-Peptide, S (Mayo)OutsideLaboratory",,84681,CPT,Facility,Outpatient,,,90,185,157.25,53.021,185,"Health Partners, Inc.",Medicare Advantage,90.65,49,,percent of total billed charges,,
"C-Peptide, S (Mayo)OutsideLaboratory",,84681,CPT,Facility,Inpatient,,,90,185,157.25,53.021,185,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"C-Peptide, S (Mayo)OutsideLaboratory",,84681,CPT,Facility,Both,,,90,185,157.25,53.021,185,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),111,60,,percent of total billed charges,,
"C-Peptide, S (Mayo)OutsideLaboratory",,84681,CPT,Facility,Both,,,90,185,157.25,53.021,185,"Health Partners, Inc.",State of Minnesota Advantage Program,150.775,81.5,,percent of total billed charges,,
"C-Peptide, S (Mayo)OutsideLaboratory",,84681,CPT,Facility,Both,,,90,185,157.25,53.021,185,"Health Partners, Inc.",State Public Programs,92.5,50,,percent of total billed charges,,
"C-Peptide, S (Mayo)OutsideLaboratory",,84681,CPT,Facility,Both,,,90,185,157.25,53.021,185,Humana Insurance Company,Commercial PPO,175.75,95,,percent of total billed charges,,
"C-Peptide, S (Mayo)OutsideLaboratory",,84681,CPT,Facility,Outpatient,,,90,185,157.25,53.021,185,Humana Insurance Company,Medicare PPO,90.65,49,,percent of total billed charges,,
"C-Peptide, S (Mayo)OutsideLaboratory",,84681,CPT,Facility,Inpatient,,,90,185,157.25,53.021,185,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"C-Peptide, S (Mayo)OutsideLaboratory",,84681,CPT,Facility,Both,,,90,185,157.25,53.021,185,Medica,Individual & Family,183.335,99.1,,percent of total billed charges,,
"C-Peptide, S (Mayo)OutsideLaboratory",,84681,CPT,Facility,Outpatient,,,90,185,157.25,53.021,185,Medica,Medica Advantage Solution,92.13,49.8,,percent of total billed charges,,
"C-Peptide, S (Mayo)OutsideLaboratory",,84681,CPT,Facility,Inpatient,,,90,185,157.25,53.021,185,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"C-Peptide, S (Mayo)OutsideLaboratory",,84681,CPT,Facility,Outpatient,,,90,185,157.25,53.021,185,Medica,Medical Assistance,82.51,44.6,,percent of total billed charges,,
"C-Peptide, S (Mayo)OutsideLaboratory",,84681,CPT,Facility,Inpatient,,,90,185,157.25,53.021,185,Medica,Medical Assistance,,,,,Included in per diem rate,
"C-Peptide, S (Mayo)OutsideLaboratory",,84681,CPT,Facility,Outpatient,,,90,185,157.25,53.021,185,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,92.13,49.8,,percent of total billed charges,,
"C-Peptide, S (Mayo)OutsideLaboratory",,84681,CPT,Facility,Inpatient,,,90,185,157.25,53.021,185,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"C-Peptide, S (Mayo)OutsideLaboratory",,84681,CPT,Facility,Both,,,90,185,157.25,53.021,185,"Multiplan, Inc.","Multiplan, Inc.",173.9,94,,percent of total billed charges,,
"C-Peptide, S (Mayo)OutsideLaboratory",,84681,CPT,Facility,Outpatient,,,90,185,157.25,53.021,185,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,159.84,86.4,,percent of total billed charges,,
"C-Peptide, S (Mayo)OutsideLaboratory",,84681,CPT,Facility,Inpatient,,,90,185,157.25,53.021,185,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"C-Peptide, S (Mayo)OutsideLaboratory",,84681,CPT,Facility,Both,,,90,185,157.25,53.021,185,"Preferred One Administrative Services, INC.",PPO,182.41,98.6,,percent of total billed charges,,
"C-Peptide, S (Mayo)OutsideLaboratory",,84681,CPT,Facility,Outpatient,,,90,185,157.25,53.021,185,PrimeWest Health,Minnesota Senior Health Options (MSHO),95.1825,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"C-Peptide, S (Mayo)OutsideLaboratory",,84681,CPT,Facility,Inpatient,,,90,185,157.25,53.021,185,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"C-Peptide, S (Mayo)OutsideLaboratory",,84681,CPT,Facility,Outpatient,,,90,185,157.25,53.021,185,PrimeWest Health,MinnesotaCare,95.016,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"C-Peptide, S (Mayo)OutsideLaboratory",,84681,CPT,Facility,Inpatient,,,90,185,157.25,53.021,185,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"C-Peptide, S (Mayo)OutsideLaboratory",,84681,CPT,Facility,Both,,,90,185,157.25,53.021,185,Sanford Health Plan,Sanford Health Plan,170.2,92,,percent of total billed charges,,
"C-Peptide, S (Mayo)OutsideLaboratory",,84681,CPT,Facility,Outpatient,,,90,185,157.25,53.021,185,"UCare Health, Inc.",Individual & Family Plan,104.2475,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"C-Peptide, S (Mayo)OutsideLaboratory",,84681,CPT,Facility,Inpatient,,,90,185,157.25,53.021,185,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"C-Peptide, S (Mayo)OutsideLaboratory",,84681,CPT,Facility,Outpatient,,,90,185,157.25,53.021,185,"UCare Health, Inc.",Medical Assistance,93.3695,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"C-Peptide, S (Mayo)OutsideLaboratory",,84681,CPT,Facility,Inpatient,,,90,185,157.25,53.021,185,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"C-Peptide, S (Mayo)OutsideLaboratory",,84681,CPT,Facility,Outpatient,,,90,185,157.25,53.021,185,"UCare Health, Inc.",Medicare Advantage,93.3695,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"C-Peptide, S (Mayo)OutsideLaboratory",,84681,CPT,Facility,Inpatient,,,90,185,157.25,53.021,185,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"C-Peptide, S (Mayo)OutsideLaboratory",,84681,CPT,Facility,Outpatient,,,90,185,157.25,53.021,185,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),93.3695,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"C-Peptide, S (Mayo)OutsideLaboratory",,84681,CPT,Facility,Inpatient,,,90,185,157.25,53.021,185,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"C-Peptide, S (Mayo)OutsideLaboratory",,84681,CPT,Facility,Both,,,90,185,157.25,53.021,185,UnitedHealthcare,Individual & Family,173.9,94,,percent of total billed charges,,
"C-Peptide, S (Mayo)OutsideLaboratory",,84681,CPT,Facility,Outpatient,,,90,185,157.25,53.021,185,UnitedHealthcare,Medicare Advantage,90.65,49,,percent of total billed charges,,
"C-Peptide, S (Mayo)OutsideLaboratory",,84681,CPT,Facility,Inpatient,,,90,185,157.25,53.021,185,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"C-Peptide, S (Mayo)OutsideLaboratory",,84681,CPT,Facility,Outpatient,,,90,185,157.25,53.021,185,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,88.8,48,,percent of total billed charges,,100% of DHS outpatient percentage
"C-Peptide, S (Mayo)OutsideLaboratory",,84681,CPT,Facility,Inpatient,,,90,185,157.25,53.021,185,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Beta-Hcg, Quantitative, S (Mayo)OutsideLaboratory",,84702,CPT,Facility,Both,,,90,168,142.8,48.1488,168,Aetna,Commercial,154.56,92,,percent of total billed charges,,
"Beta-Hcg, Quantitative, S (Mayo)OutsideLaboratory",,84702,CPT,Facility,Outpatient,,,90,168,142.8,48.1488,168,Aetna,Medicare Advantage,82.32,49,,percent of total billed charges,,
"Beta-Hcg, Quantitative, S (Mayo)OutsideLaboratory",,84702,CPT,Facility,Inpatient,,,90,168,142.8,48.1488,168,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Beta-Hcg, Quantitative, S (Mayo)OutsideLaboratory",,84702,CPT,Facility,Both,,,90,168,142.8,48.1488,168,Aetna,PPO,156.24,93,,percent of total billed charges,,
"Beta-Hcg, Quantitative, S (Mayo)OutsideLaboratory",,84702,CPT,Facility,Both,,,90,168,142.8,48.1488,168,America's PPO,America's PPO,161.3304,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Beta-Hcg, Quantitative, S (Mayo)OutsideLaboratory",,84702,CPT,Facility,Both,,,90,168,142.8,48.1488,168,BlueCross BlueShield Minnesota, Federal Employee Program,165.312,98.4,,percent of total billed charges,,
"Beta-Hcg, Quantitative, S (Mayo)OutsideLaboratory",,84702,CPT,Facility,Both,,,90,168,142.8,48.1488,168,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,168,100,,percent of total billed charges,,
"Beta-Hcg, Quantitative, S (Mayo)OutsideLaboratory",,84702,CPT,Facility,Both,,,90,168,142.8,48.1488,168,BlueCross BlueShield Minnesota,High Value Network Plan,151.2,90,,percent of total billed charges,,
"Beta-Hcg, Quantitative, S (Mayo)OutsideLaboratory",,84702,CPT,Facility,Outpatient,,,90,168,142.8,48.1488,168,BlueCross BlueShield Minnesota,Medicare Advantage,82.32,49,,percent of total billed charges,,
"Beta-Hcg, Quantitative, S (Mayo)OutsideLaboratory",,84702,CPT,Facility,Inpatient,,,90,168,142.8,48.1488,168,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Beta-Hcg, Quantitative, S (Mayo)OutsideLaboratory",,84702,CPT,Facility,Both,,,90,168,142.8,48.1488,168,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,148.7976,88.57,,percent of total billed charges,,
"Beta-Hcg, Quantitative, S (Mayo)OutsideLaboratory",,84702,CPT,Facility,Both,,,90,168,142.8,48.1488,168,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,48.1488,28.66,,percent of total billed charges,,
"Beta-Hcg, Quantitative, S (Mayo)OutsideLaboratory",,84702,CPT,Facility,Outpatient,,,90,168,142.8,48.1488,168,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),82.32,49,,percent of total billed charges,,
"Beta-Hcg, Quantitative, S (Mayo)OutsideLaboratory",,84702,CPT,Facility,Inpatient,,,90,168,142.8,48.1488,168,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Beta-Hcg, Quantitative, S (Mayo)OutsideLaboratory",,84702,CPT,Facility,Both,,,90,168,142.8,48.1488,168,CorVel,Worker's Compensation,168,100,,percent of total billed charges,,
"Beta-Hcg, Quantitative, S (Mayo)OutsideLaboratory",,84702,CPT,Facility,Both,,,90,168,142.8,48.1488,168,First Health Group Corporation,First Health Network,162.96,97,,percent of total billed charges,,
"Beta-Hcg, Quantitative, S (Mayo)OutsideLaboratory",,84702,CPT,Facility,Both,,,90,168,142.8,48.1488,168,"Health Partners, Inc.",Commercial,158.928,94.6,,percent of total billed charges,,
"Beta-Hcg, Quantitative, S (Mayo)OutsideLaboratory",,84702,CPT,Facility,Outpatient,,,90,168,142.8,48.1488,168,"Health Partners, Inc.",Medicare Advantage,82.32,49,,percent of total billed charges,,
"Beta-Hcg, Quantitative, S (Mayo)OutsideLaboratory",,84702,CPT,Facility,Inpatient,,,90,168,142.8,48.1488,168,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Beta-Hcg, Quantitative, S (Mayo)OutsideLaboratory",,84702,CPT,Facility,Both,,,90,168,142.8,48.1488,168,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),100.8,60,,percent of total billed charges,,
"Beta-Hcg, Quantitative, S (Mayo)OutsideLaboratory",,84702,CPT,Facility,Both,,,90,168,142.8,48.1488,168,"Health Partners, Inc.",State of Minnesota Advantage Program,136.92,81.5,,percent of total billed charges,,
"Beta-Hcg, Quantitative, S (Mayo)OutsideLaboratory",,84702,CPT,Facility,Both,,,90,168,142.8,48.1488,168,"Health Partners, Inc.",State Public Programs,84,50,,percent of total billed charges,,
"Beta-Hcg, Quantitative, S (Mayo)OutsideLaboratory",,84702,CPT,Facility,Both,,,90,168,142.8,48.1488,168,Humana Insurance Company,Commercial PPO,159.6,95,,percent of total billed charges,,
"Beta-Hcg, Quantitative, S (Mayo)OutsideLaboratory",,84702,CPT,Facility,Outpatient,,,90,168,142.8,48.1488,168,Humana Insurance Company,Medicare PPO,82.32,49,,percent of total billed charges,,
"Beta-Hcg, Quantitative, S (Mayo)OutsideLaboratory",,84702,CPT,Facility,Inpatient,,,90,168,142.8,48.1488,168,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Beta-Hcg, Quantitative, S (Mayo)OutsideLaboratory",,84702,CPT,Facility,Both,,,90,168,142.8,48.1488,168,Medica,Individual & Family,166.488,99.1,,percent of total billed charges,,
"Beta-Hcg, Quantitative, S (Mayo)OutsideLaboratory",,84702,CPT,Facility,Outpatient,,,90,168,142.8,48.1488,168,Medica,Medica Advantage Solution,83.664,49.8,,percent of total billed charges,,
"Beta-Hcg, Quantitative, S (Mayo)OutsideLaboratory",,84702,CPT,Facility,Inpatient,,,90,168,142.8,48.1488,168,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Beta-Hcg, Quantitative, S (Mayo)OutsideLaboratory",,84702,CPT,Facility,Outpatient,,,90,168,142.8,48.1488,168,Medica,Medical Assistance,74.928,44.6,,percent of total billed charges,,
"Beta-Hcg, Quantitative, S (Mayo)OutsideLaboratory",,84702,CPT,Facility,Inpatient,,,90,168,142.8,48.1488,168,Medica,Medical Assistance,,,,,Included in per diem rate,
"Beta-Hcg, Quantitative, S (Mayo)OutsideLaboratory",,84702,CPT,Facility,Outpatient,,,90,168,142.8,48.1488,168,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,83.664,49.8,,percent of total billed charges,,
"Beta-Hcg, Quantitative, S (Mayo)OutsideLaboratory",,84702,CPT,Facility,Inpatient,,,90,168,142.8,48.1488,168,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Beta-Hcg, Quantitative, S (Mayo)OutsideLaboratory",,84702,CPT,Facility,Both,,,90,168,142.8,48.1488,168,"Multiplan, Inc.","Multiplan, Inc.",157.92,94,,percent of total billed charges,,
"Beta-Hcg, Quantitative, S (Mayo)OutsideLaboratory",,84702,CPT,Facility,Outpatient,,,90,168,142.8,48.1488,168,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,145.152,86.4,,percent of total billed charges,,
"Beta-Hcg, Quantitative, S (Mayo)OutsideLaboratory",,84702,CPT,Facility,Inpatient,,,90,168,142.8,48.1488,168,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Beta-Hcg, Quantitative, S (Mayo)OutsideLaboratory",,84702,CPT,Facility,Both,,,90,168,142.8,48.1488,168,"Preferred One Administrative Services, INC.",PPO,165.648,98.6,,percent of total billed charges,,
"Beta-Hcg, Quantitative, S (Mayo)OutsideLaboratory",,84702,CPT,Facility,Outpatient,,,90,168,142.8,48.1488,168,PrimeWest Health,Minnesota Senior Health Options (MSHO),86.436,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Beta-Hcg, Quantitative, S (Mayo)OutsideLaboratory",,84702,CPT,Facility,Inpatient,,,90,168,142.8,48.1488,168,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Beta-Hcg, Quantitative, S (Mayo)OutsideLaboratory",,84702,CPT,Facility,Outpatient,,,90,168,142.8,48.1488,168,PrimeWest Health,MinnesotaCare,86.2848,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Beta-Hcg, Quantitative, S (Mayo)OutsideLaboratory",,84702,CPT,Facility,Inpatient,,,90,168,142.8,48.1488,168,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Beta-Hcg, Quantitative, S (Mayo)OutsideLaboratory",,84702,CPT,Facility,Both,,,90,168,142.8,48.1488,168,Sanford Health Plan,Sanford Health Plan,154.56,92,,percent of total billed charges,,
"Beta-Hcg, Quantitative, S (Mayo)OutsideLaboratory",,84702,CPT,Facility,Outpatient,,,90,168,142.8,48.1488,168,"UCare Health, Inc.",Individual & Family Plan,94.668,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Beta-Hcg, Quantitative, S (Mayo)OutsideLaboratory",,84702,CPT,Facility,Inpatient,,,90,168,142.8,48.1488,168,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Beta-Hcg, Quantitative, S (Mayo)OutsideLaboratory",,84702,CPT,Facility,Outpatient,,,90,168,142.8,48.1488,168,"UCare Health, Inc.",Medical Assistance,84.7896,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Beta-Hcg, Quantitative, S (Mayo)OutsideLaboratory",,84702,CPT,Facility,Inpatient,,,90,168,142.8,48.1488,168,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Beta-Hcg, Quantitative, S (Mayo)OutsideLaboratory",,84702,CPT,Facility,Outpatient,,,90,168,142.8,48.1488,168,"UCare Health, Inc.",Medicare Advantage,84.7896,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Beta-Hcg, Quantitative, S (Mayo)OutsideLaboratory",,84702,CPT,Facility,Inpatient,,,90,168,142.8,48.1488,168,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Beta-Hcg, Quantitative, S (Mayo)OutsideLaboratory",,84702,CPT,Facility,Outpatient,,,90,168,142.8,48.1488,168,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),84.7896,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Beta-Hcg, Quantitative, S (Mayo)OutsideLaboratory",,84702,CPT,Facility,Inpatient,,,90,168,142.8,48.1488,168,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Beta-Hcg, Quantitative, S (Mayo)OutsideLaboratory",,84702,CPT,Facility,Both,,,90,168,142.8,48.1488,168,UnitedHealthcare,Individual & Family,157.92,94,,percent of total billed charges,,
"Beta-Hcg, Quantitative, S (Mayo)OutsideLaboratory",,84702,CPT,Facility,Outpatient,,,90,168,142.8,48.1488,168,UnitedHealthcare,Medicare Advantage,82.32,49,,percent of total billed charges,,
"Beta-Hcg, Quantitative, S (Mayo)OutsideLaboratory",,84702,CPT,Facility,Inpatient,,,90,168,142.8,48.1488,168,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Beta-Hcg, Quantitative, S (Mayo)OutsideLaboratory",,84702,CPT,Facility,Outpatient,,,90,168,142.8,48.1488,168,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,80.64,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Beta-Hcg, Quantitative, S (Mayo)OutsideLaboratory",,84702,CPT,Facility,Inpatient,,,90,168,142.8,48.1488,168,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Coag Factor Ii Assay, P (Mayo)OutsideLaboratory",,85210,CPT,Facility,Both,,,90,179,152.15,51.3014,179,Aetna,Commercial,164.68,92,,percent of total billed charges,,
"Coag Factor Ii Assay, P (Mayo)OutsideLaboratory",,85210,CPT,Facility,Outpatient,,,90,179,152.15,51.3014,179,Aetna,Medicare Advantage,87.71,49,,percent of total billed charges,,
"Coag Factor Ii Assay, P (Mayo)OutsideLaboratory",,85210,CPT,Facility,Inpatient,,,90,179,152.15,51.3014,179,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Coag Factor Ii Assay, P (Mayo)OutsideLaboratory",,85210,CPT,Facility,Both,,,90,179,152.15,51.3014,179,Aetna,PPO,166.47,93,,percent of total billed charges,,
"Coag Factor Ii Assay, P (Mayo)OutsideLaboratory",,85210,CPT,Facility,Both,,,90,179,152.15,51.3014,179,America's PPO,America's PPO,171.8937,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Coag Factor Ii Assay, P (Mayo)OutsideLaboratory",,85210,CPT,Facility,Both,,,90,179,152.15,51.3014,179,BlueCross BlueShield Minnesota, Federal Employee Program,176.136,98.4,,percent of total billed charges,,
"Coag Factor Ii Assay, P (Mayo)OutsideLaboratory",,85210,CPT,Facility,Both,,,90,179,152.15,51.3014,179,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,179,100,,percent of total billed charges,,
"Coag Factor Ii Assay, P (Mayo)OutsideLaboratory",,85210,CPT,Facility,Both,,,90,179,152.15,51.3014,179,BlueCross BlueShield Minnesota,High Value Network Plan,161.1,90,,percent of total billed charges,,
"Coag Factor Ii Assay, P (Mayo)OutsideLaboratory",,85210,CPT,Facility,Outpatient,,,90,179,152.15,51.3014,179,BlueCross BlueShield Minnesota,Medicare Advantage,87.71,49,,percent of total billed charges,,
"Coag Factor Ii Assay, P (Mayo)OutsideLaboratory",,85210,CPT,Facility,Inpatient,,,90,179,152.15,51.3014,179,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Coag Factor Ii Assay, P (Mayo)OutsideLaboratory",,85210,CPT,Facility,Both,,,90,179,152.15,51.3014,179,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,158.5403,88.57,,percent of total billed charges,,
"Coag Factor Ii Assay, P (Mayo)OutsideLaboratory",,85210,CPT,Facility,Both,,,90,179,152.15,51.3014,179,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,51.3014,28.66,,percent of total billed charges,,
"Coag Factor Ii Assay, P (Mayo)OutsideLaboratory",,85210,CPT,Facility,Outpatient,,,90,179,152.15,51.3014,179,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),87.71,49,,percent of total billed charges,,
"Coag Factor Ii Assay, P (Mayo)OutsideLaboratory",,85210,CPT,Facility,Inpatient,,,90,179,152.15,51.3014,179,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Coag Factor Ii Assay, P (Mayo)OutsideLaboratory",,85210,CPT,Facility,Both,,,90,179,152.15,51.3014,179,CorVel,Worker's Compensation,179,100,,percent of total billed charges,,
"Coag Factor Ii Assay, P (Mayo)OutsideLaboratory",,85210,CPT,Facility,Both,,,90,179,152.15,51.3014,179,First Health Group Corporation,First Health Network,173.63,97,,percent of total billed charges,,
"Coag Factor Ii Assay, P (Mayo)OutsideLaboratory",,85210,CPT,Facility,Both,,,90,179,152.15,51.3014,179,"Health Partners, Inc.",Commercial,169.334,94.6,,percent of total billed charges,,
"Coag Factor Ii Assay, P (Mayo)OutsideLaboratory",,85210,CPT,Facility,Outpatient,,,90,179,152.15,51.3014,179,"Health Partners, Inc.",Medicare Advantage,87.71,49,,percent of total billed charges,,
"Coag Factor Ii Assay, P (Mayo)OutsideLaboratory",,85210,CPT,Facility,Inpatient,,,90,179,152.15,51.3014,179,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Coag Factor Ii Assay, P (Mayo)OutsideLaboratory",,85210,CPT,Facility,Both,,,90,179,152.15,51.3014,179,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),107.4,60,,percent of total billed charges,,
"Coag Factor Ii Assay, P (Mayo)OutsideLaboratory",,85210,CPT,Facility,Both,,,90,179,152.15,51.3014,179,"Health Partners, Inc.",State of Minnesota Advantage Program,145.885,81.5,,percent of total billed charges,,
"Coag Factor Ii Assay, P (Mayo)OutsideLaboratory",,85210,CPT,Facility,Both,,,90,179,152.15,51.3014,179,"Health Partners, Inc.",State Public Programs,89.5,50,,percent of total billed charges,,
"Coag Factor Ii Assay, P (Mayo)OutsideLaboratory",,85210,CPT,Facility,Both,,,90,179,152.15,51.3014,179,Humana Insurance Company,Commercial PPO,170.05,95,,percent of total billed charges,,
"Coag Factor Ii Assay, P (Mayo)OutsideLaboratory",,85210,CPT,Facility,Outpatient,,,90,179,152.15,51.3014,179,Humana Insurance Company,Medicare PPO,87.71,49,,percent of total billed charges,,
"Coag Factor Ii Assay, P (Mayo)OutsideLaboratory",,85210,CPT,Facility,Inpatient,,,90,179,152.15,51.3014,179,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Coag Factor Ii Assay, P (Mayo)OutsideLaboratory",,85210,CPT,Facility,Both,,,90,179,152.15,51.3014,179,Medica,Individual & Family,177.389,99.1,,percent of total billed charges,,
"Coag Factor Ii Assay, P (Mayo)OutsideLaboratory",,85210,CPT,Facility,Outpatient,,,90,179,152.15,51.3014,179,Medica,Medica Advantage Solution,89.142,49.8,,percent of total billed charges,,
"Coag Factor Ii Assay, P (Mayo)OutsideLaboratory",,85210,CPT,Facility,Inpatient,,,90,179,152.15,51.3014,179,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Coag Factor Ii Assay, P (Mayo)OutsideLaboratory",,85210,CPT,Facility,Outpatient,,,90,179,152.15,51.3014,179,Medica,Medical Assistance,79.834,44.6,,percent of total billed charges,,
"Coag Factor Ii Assay, P (Mayo)OutsideLaboratory",,85210,CPT,Facility,Inpatient,,,90,179,152.15,51.3014,179,Medica,Medical Assistance,,,,,Included in per diem rate,
"Coag Factor Ii Assay, P (Mayo)OutsideLaboratory",,85210,CPT,Facility,Outpatient,,,90,179,152.15,51.3014,179,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,89.142,49.8,,percent of total billed charges,,
"Coag Factor Ii Assay, P (Mayo)OutsideLaboratory",,85210,CPT,Facility,Inpatient,,,90,179,152.15,51.3014,179,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Coag Factor Ii Assay, P (Mayo)OutsideLaboratory",,85210,CPT,Facility,Both,,,90,179,152.15,51.3014,179,"Multiplan, Inc.","Multiplan, Inc.",168.26,94,,percent of total billed charges,,
"Coag Factor Ii Assay, P (Mayo)OutsideLaboratory",,85210,CPT,Facility,Outpatient,,,90,179,152.15,51.3014,179,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,154.656,86.4,,percent of total billed charges,,
"Coag Factor Ii Assay, P (Mayo)OutsideLaboratory",,85210,CPT,Facility,Inpatient,,,90,179,152.15,51.3014,179,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Coag Factor Ii Assay, P (Mayo)OutsideLaboratory",,85210,CPT,Facility,Both,,,90,179,152.15,51.3014,179,"Preferred One Administrative Services, INC.",PPO,176.494,98.6,,percent of total billed charges,,
"Coag Factor Ii Assay, P (Mayo)OutsideLaboratory",,85210,CPT,Facility,Outpatient,,,90,179,152.15,51.3014,179,PrimeWest Health,Minnesota Senior Health Options (MSHO),92.0955,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Coag Factor Ii Assay, P (Mayo)OutsideLaboratory",,85210,CPT,Facility,Inpatient,,,90,179,152.15,51.3014,179,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Coag Factor Ii Assay, P (Mayo)OutsideLaboratory",,85210,CPT,Facility,Outpatient,,,90,179,152.15,51.3014,179,PrimeWest Health,MinnesotaCare,91.9344,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Coag Factor Ii Assay, P (Mayo)OutsideLaboratory",,85210,CPT,Facility,Inpatient,,,90,179,152.15,51.3014,179,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Coag Factor Ii Assay, P (Mayo)OutsideLaboratory",,85210,CPT,Facility,Both,,,90,179,152.15,51.3014,179,Sanford Health Plan,Sanford Health Plan,164.68,92,,percent of total billed charges,,
"Coag Factor Ii Assay, P (Mayo)OutsideLaboratory",,85210,CPT,Facility,Outpatient,,,90,179,152.15,51.3014,179,"UCare Health, Inc.",Individual & Family Plan,100.8665,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Coag Factor Ii Assay, P (Mayo)OutsideLaboratory",,85210,CPT,Facility,Inpatient,,,90,179,152.15,51.3014,179,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Coag Factor Ii Assay, P (Mayo)OutsideLaboratory",,85210,CPT,Facility,Outpatient,,,90,179,152.15,51.3014,179,"UCare Health, Inc.",Medical Assistance,90.3413,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Coag Factor Ii Assay, P (Mayo)OutsideLaboratory",,85210,CPT,Facility,Inpatient,,,90,179,152.15,51.3014,179,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Coag Factor Ii Assay, P (Mayo)OutsideLaboratory",,85210,CPT,Facility,Outpatient,,,90,179,152.15,51.3014,179,"UCare Health, Inc.",Medicare Advantage,90.3413,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Coag Factor Ii Assay, P (Mayo)OutsideLaboratory",,85210,CPT,Facility,Inpatient,,,90,179,152.15,51.3014,179,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Coag Factor Ii Assay, P (Mayo)OutsideLaboratory",,85210,CPT,Facility,Outpatient,,,90,179,152.15,51.3014,179,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),90.3413,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Coag Factor Ii Assay, P (Mayo)OutsideLaboratory",,85210,CPT,Facility,Inpatient,,,90,179,152.15,51.3014,179,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Coag Factor Ii Assay, P (Mayo)OutsideLaboratory",,85210,CPT,Facility,Both,,,90,179,152.15,51.3014,179,UnitedHealthcare,Individual & Family,168.26,94,,percent of total billed charges,,
"Coag Factor Ii Assay, P (Mayo)OutsideLaboratory",,85210,CPT,Facility,Outpatient,,,90,179,152.15,51.3014,179,UnitedHealthcare,Medicare Advantage,87.71,49,,percent of total billed charges,,
"Coag Factor Ii Assay, P (Mayo)OutsideLaboratory",,85210,CPT,Facility,Inpatient,,,90,179,152.15,51.3014,179,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Coag Factor Ii Assay, P (Mayo)OutsideLaboratory",,85210,CPT,Facility,Outpatient,,,90,179,152.15,51.3014,179,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,85.92,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Coag Factor Ii Assay, P (Mayo)OutsideLaboratory",,85210,CPT,Facility,Inpatient,,,90,179,152.15,51.3014,179,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Coag Factor Vii Assay, P (Mayo)OutsideLaboratory",,85230,CPT,Facility,Both,,,90,179,152.15,51.3014,179,Aetna,Commercial,164.68,92,,percent of total billed charges,,
"Coag Factor Vii Assay, P (Mayo)OutsideLaboratory",,85230,CPT,Facility,Outpatient,,,90,179,152.15,51.3014,179,Aetna,Medicare Advantage,87.71,49,,percent of total billed charges,,
"Coag Factor Vii Assay, P (Mayo)OutsideLaboratory",,85230,CPT,Facility,Inpatient,,,90,179,152.15,51.3014,179,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Coag Factor Vii Assay, P (Mayo)OutsideLaboratory",,85230,CPT,Facility,Both,,,90,179,152.15,51.3014,179,Aetna,PPO,166.47,93,,percent of total billed charges,,
"Coag Factor Vii Assay, P (Mayo)OutsideLaboratory",,85230,CPT,Facility,Both,,,90,179,152.15,51.3014,179,America's PPO,America's PPO,171.8937,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Coag Factor Vii Assay, P (Mayo)OutsideLaboratory",,85230,CPT,Facility,Both,,,90,179,152.15,51.3014,179,BlueCross BlueShield Minnesota, Federal Employee Program,176.136,98.4,,percent of total billed charges,,
"Coag Factor Vii Assay, P (Mayo)OutsideLaboratory",,85230,CPT,Facility,Both,,,90,179,152.15,51.3014,179,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,179,100,,percent of total billed charges,,
"Coag Factor Vii Assay, P (Mayo)OutsideLaboratory",,85230,CPT,Facility,Both,,,90,179,152.15,51.3014,179,BlueCross BlueShield Minnesota,High Value Network Plan,161.1,90,,percent of total billed charges,,
"Coag Factor Vii Assay, P (Mayo)OutsideLaboratory",,85230,CPT,Facility,Outpatient,,,90,179,152.15,51.3014,179,BlueCross BlueShield Minnesota,Medicare Advantage,87.71,49,,percent of total billed charges,,
"Coag Factor Vii Assay, P (Mayo)OutsideLaboratory",,85230,CPT,Facility,Inpatient,,,90,179,152.15,51.3014,179,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Coag Factor Vii Assay, P (Mayo)OutsideLaboratory",,85230,CPT,Facility,Both,,,90,179,152.15,51.3014,179,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,158.5403,88.57,,percent of total billed charges,,
"Coag Factor Vii Assay, P (Mayo)OutsideLaboratory",,85230,CPT,Facility,Both,,,90,179,152.15,51.3014,179,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,51.3014,28.66,,percent of total billed charges,,
"Coag Factor Vii Assay, P (Mayo)OutsideLaboratory",,85230,CPT,Facility,Outpatient,,,90,179,152.15,51.3014,179,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),87.71,49,,percent of total billed charges,,
"Coag Factor Vii Assay, P (Mayo)OutsideLaboratory",,85230,CPT,Facility,Inpatient,,,90,179,152.15,51.3014,179,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Coag Factor Vii Assay, P (Mayo)OutsideLaboratory",,85230,CPT,Facility,Both,,,90,179,152.15,51.3014,179,CorVel,Worker's Compensation,179,100,,percent of total billed charges,,
"Coag Factor Vii Assay, P (Mayo)OutsideLaboratory",,85230,CPT,Facility,Both,,,90,179,152.15,51.3014,179,First Health Group Corporation,First Health Network,173.63,97,,percent of total billed charges,,
"Coag Factor Vii Assay, P (Mayo)OutsideLaboratory",,85230,CPT,Facility,Both,,,90,179,152.15,51.3014,179,"Health Partners, Inc.",Commercial,169.334,94.6,,percent of total billed charges,,
"Coag Factor Vii Assay, P (Mayo)OutsideLaboratory",,85230,CPT,Facility,Outpatient,,,90,179,152.15,51.3014,179,"Health Partners, Inc.",Medicare Advantage,87.71,49,,percent of total billed charges,,
"Coag Factor Vii Assay, P (Mayo)OutsideLaboratory",,85230,CPT,Facility,Inpatient,,,90,179,152.15,51.3014,179,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Coag Factor Vii Assay, P (Mayo)OutsideLaboratory",,85230,CPT,Facility,Both,,,90,179,152.15,51.3014,179,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),107.4,60,,percent of total billed charges,,
"Coag Factor Vii Assay, P (Mayo)OutsideLaboratory",,85230,CPT,Facility,Both,,,90,179,152.15,51.3014,179,"Health Partners, Inc.",State of Minnesota Advantage Program,145.885,81.5,,percent of total billed charges,,
"Coag Factor Vii Assay, P (Mayo)OutsideLaboratory",,85230,CPT,Facility,Both,,,90,179,152.15,51.3014,179,"Health Partners, Inc.",State Public Programs,89.5,50,,percent of total billed charges,,
"Coag Factor Vii Assay, P (Mayo)OutsideLaboratory",,85230,CPT,Facility,Both,,,90,179,152.15,51.3014,179,Humana Insurance Company,Commercial PPO,170.05,95,,percent of total billed charges,,
"Coag Factor Vii Assay, P (Mayo)OutsideLaboratory",,85230,CPT,Facility,Outpatient,,,90,179,152.15,51.3014,179,Humana Insurance Company,Medicare PPO,87.71,49,,percent of total billed charges,,
"Coag Factor Vii Assay, P (Mayo)OutsideLaboratory",,85230,CPT,Facility,Inpatient,,,90,179,152.15,51.3014,179,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Coag Factor Vii Assay, P (Mayo)OutsideLaboratory",,85230,CPT,Facility,Both,,,90,179,152.15,51.3014,179,Medica,Individual & Family,177.389,99.1,,percent of total billed charges,,
"Coag Factor Vii Assay, P (Mayo)OutsideLaboratory",,85230,CPT,Facility,Outpatient,,,90,179,152.15,51.3014,179,Medica,Medica Advantage Solution,89.142,49.8,,percent of total billed charges,,
"Coag Factor Vii Assay, P (Mayo)OutsideLaboratory",,85230,CPT,Facility,Inpatient,,,90,179,152.15,51.3014,179,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Coag Factor Vii Assay, P (Mayo)OutsideLaboratory",,85230,CPT,Facility,Outpatient,,,90,179,152.15,51.3014,179,Medica,Medical Assistance,79.834,44.6,,percent of total billed charges,,
"Coag Factor Vii Assay, P (Mayo)OutsideLaboratory",,85230,CPT,Facility,Inpatient,,,90,179,152.15,51.3014,179,Medica,Medical Assistance,,,,,Included in per diem rate,
"Coag Factor Vii Assay, P (Mayo)OutsideLaboratory",,85230,CPT,Facility,Outpatient,,,90,179,152.15,51.3014,179,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,89.142,49.8,,percent of total billed charges,,
"Coag Factor Vii Assay, P (Mayo)OutsideLaboratory",,85230,CPT,Facility,Inpatient,,,90,179,152.15,51.3014,179,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Coag Factor Vii Assay, P (Mayo)OutsideLaboratory",,85230,CPT,Facility,Both,,,90,179,152.15,51.3014,179,"Multiplan, Inc.","Multiplan, Inc.",168.26,94,,percent of total billed charges,,
"Coag Factor Vii Assay, P (Mayo)OutsideLaboratory",,85230,CPT,Facility,Outpatient,,,90,179,152.15,51.3014,179,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,154.656,86.4,,percent of total billed charges,,
"Coag Factor Vii Assay, P (Mayo)OutsideLaboratory",,85230,CPT,Facility,Inpatient,,,90,179,152.15,51.3014,179,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Coag Factor Vii Assay, P (Mayo)OutsideLaboratory",,85230,CPT,Facility,Both,,,90,179,152.15,51.3014,179,"Preferred One Administrative Services, INC.",PPO,176.494,98.6,,percent of total billed charges,,
"Coag Factor Vii Assay, P (Mayo)OutsideLaboratory",,85230,CPT,Facility,Outpatient,,,90,179,152.15,51.3014,179,PrimeWest Health,Minnesota Senior Health Options (MSHO),92.0955,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Coag Factor Vii Assay, P (Mayo)OutsideLaboratory",,85230,CPT,Facility,Inpatient,,,90,179,152.15,51.3014,179,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Coag Factor Vii Assay, P (Mayo)OutsideLaboratory",,85230,CPT,Facility,Outpatient,,,90,179,152.15,51.3014,179,PrimeWest Health,MinnesotaCare,91.9344,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Coag Factor Vii Assay, P (Mayo)OutsideLaboratory",,85230,CPT,Facility,Inpatient,,,90,179,152.15,51.3014,179,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Coag Factor Vii Assay, P (Mayo)OutsideLaboratory",,85230,CPT,Facility,Both,,,90,179,152.15,51.3014,179,Sanford Health Plan,Sanford Health Plan,164.68,92,,percent of total billed charges,,
"Coag Factor Vii Assay, P (Mayo)OutsideLaboratory",,85230,CPT,Facility,Outpatient,,,90,179,152.15,51.3014,179,"UCare Health, Inc.",Individual & Family Plan,100.8665,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Coag Factor Vii Assay, P (Mayo)OutsideLaboratory",,85230,CPT,Facility,Inpatient,,,90,179,152.15,51.3014,179,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Coag Factor Vii Assay, P (Mayo)OutsideLaboratory",,85230,CPT,Facility,Outpatient,,,90,179,152.15,51.3014,179,"UCare Health, Inc.",Medical Assistance,90.3413,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Coag Factor Vii Assay, P (Mayo)OutsideLaboratory",,85230,CPT,Facility,Inpatient,,,90,179,152.15,51.3014,179,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Coag Factor Vii Assay, P (Mayo)OutsideLaboratory",,85230,CPT,Facility,Outpatient,,,90,179,152.15,51.3014,179,"UCare Health, Inc.",Medicare Advantage,90.3413,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Coag Factor Vii Assay, P (Mayo)OutsideLaboratory",,85230,CPT,Facility,Inpatient,,,90,179,152.15,51.3014,179,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Coag Factor Vii Assay, P (Mayo)OutsideLaboratory",,85230,CPT,Facility,Outpatient,,,90,179,152.15,51.3014,179,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),90.3413,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Coag Factor Vii Assay, P (Mayo)OutsideLaboratory",,85230,CPT,Facility,Inpatient,,,90,179,152.15,51.3014,179,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Coag Factor Vii Assay, P (Mayo)OutsideLaboratory",,85230,CPT,Facility,Both,,,90,179,152.15,51.3014,179,UnitedHealthcare,Individual & Family,168.26,94,,percent of total billed charges,,
"Coag Factor Vii Assay, P (Mayo)OutsideLaboratory",,85230,CPT,Facility,Outpatient,,,90,179,152.15,51.3014,179,UnitedHealthcare,Medicare Advantage,87.71,49,,percent of total billed charges,,
"Coag Factor Vii Assay, P (Mayo)OutsideLaboratory",,85230,CPT,Facility,Inpatient,,,90,179,152.15,51.3014,179,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Coag Factor Vii Assay, P (Mayo)OutsideLaboratory",,85230,CPT,Facility,Outpatient,,,90,179,152.15,51.3014,179,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,85.92,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Coag Factor Vii Assay, P (Mayo)OutsideLaboratory",,85230,CPT,Facility,Inpatient,,,90,179,152.15,51.3014,179,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Clotting; Factor Viii (Ahg), 1-Stage (Mayo)OutsideLaboratory",,85240,CPT,Facility,Both,,,90,155,131.75,44.423,155,Aetna,Commercial,142.6,92,,percent of total billed charges,,
"Clotting; Factor Viii (Ahg), 1-Stage (Mayo)OutsideLaboratory",,85240,CPT,Facility,Outpatient,,,90,155,131.75,44.423,155,Aetna,Medicare Advantage,75.95,49,,percent of total billed charges,,
"Clotting; Factor Viii (Ahg), 1-Stage (Mayo)OutsideLaboratory",,85240,CPT,Facility,Inpatient,,,90,155,131.75,44.423,155,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Clotting; Factor Viii (Ahg), 1-Stage (Mayo)OutsideLaboratory",,85240,CPT,Facility,Both,,,90,155,131.75,44.423,155,Aetna,PPO,144.15,93,,percent of total billed charges,,
"Clotting; Factor Viii (Ahg), 1-Stage (Mayo)OutsideLaboratory",,85240,CPT,Facility,Both,,,90,155,131.75,44.423,155,America's PPO,America's PPO,148.8465,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Clotting; Factor Viii (Ahg), 1-Stage (Mayo)OutsideLaboratory",,85240,CPT,Facility,Both,,,90,155,131.75,44.423,155,BlueCross BlueShield Minnesota, Federal Employee Program,152.52,98.4,,percent of total billed charges,,
"Clotting; Factor Viii (Ahg), 1-Stage (Mayo)OutsideLaboratory",,85240,CPT,Facility,Both,,,90,155,131.75,44.423,155,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,155,100,,percent of total billed charges,,
"Clotting; Factor Viii (Ahg), 1-Stage (Mayo)OutsideLaboratory",,85240,CPT,Facility,Both,,,90,155,131.75,44.423,155,BlueCross BlueShield Minnesota,High Value Network Plan,139.5,90,,percent of total billed charges,,
"Clotting; Factor Viii (Ahg), 1-Stage (Mayo)OutsideLaboratory",,85240,CPT,Facility,Outpatient,,,90,155,131.75,44.423,155,BlueCross BlueShield Minnesota,Medicare Advantage,75.95,49,,percent of total billed charges,,
"Clotting; Factor Viii (Ahg), 1-Stage (Mayo)OutsideLaboratory",,85240,CPT,Facility,Inpatient,,,90,155,131.75,44.423,155,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Clotting; Factor Viii (Ahg), 1-Stage (Mayo)OutsideLaboratory",,85240,CPT,Facility,Both,,,90,155,131.75,44.423,155,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,137.2835,88.57,,percent of total billed charges,,
"Clotting; Factor Viii (Ahg), 1-Stage (Mayo)OutsideLaboratory",,85240,CPT,Facility,Both,,,90,155,131.75,44.423,155,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,44.423,28.66,,percent of total billed charges,,
"Clotting; Factor Viii (Ahg), 1-Stage (Mayo)OutsideLaboratory",,85240,CPT,Facility,Outpatient,,,90,155,131.75,44.423,155,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),75.95,49,,percent of total billed charges,,
"Clotting; Factor Viii (Ahg), 1-Stage (Mayo)OutsideLaboratory",,85240,CPT,Facility,Inpatient,,,90,155,131.75,44.423,155,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Clotting; Factor Viii (Ahg), 1-Stage (Mayo)OutsideLaboratory",,85240,CPT,Facility,Both,,,90,155,131.75,44.423,155,CorVel,Worker's Compensation,155,100,,percent of total billed charges,,
"Clotting; Factor Viii (Ahg), 1-Stage (Mayo)OutsideLaboratory",,85240,CPT,Facility,Both,,,90,155,131.75,44.423,155,First Health Group Corporation,First Health Network,150.35,97,,percent of total billed charges,,
"Clotting; Factor Viii (Ahg), 1-Stage (Mayo)OutsideLaboratory",,85240,CPT,Facility,Both,,,90,155,131.75,44.423,155,"Health Partners, Inc.",Commercial,146.63,94.6,,percent of total billed charges,,
"Clotting; Factor Viii (Ahg), 1-Stage (Mayo)OutsideLaboratory",,85240,CPT,Facility,Outpatient,,,90,155,131.75,44.423,155,"Health Partners, Inc.",Medicare Advantage,75.95,49,,percent of total billed charges,,
"Clotting; Factor Viii (Ahg), 1-Stage (Mayo)OutsideLaboratory",,85240,CPT,Facility,Inpatient,,,90,155,131.75,44.423,155,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Clotting; Factor Viii (Ahg), 1-Stage (Mayo)OutsideLaboratory",,85240,CPT,Facility,Both,,,90,155,131.75,44.423,155,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),93,60,,percent of total billed charges,,
"Clotting; Factor Viii (Ahg), 1-Stage (Mayo)OutsideLaboratory",,85240,CPT,Facility,Both,,,90,155,131.75,44.423,155,"Health Partners, Inc.",State of Minnesota Advantage Program,126.325,81.5,,percent of total billed charges,,
"Clotting; Factor Viii (Ahg), 1-Stage (Mayo)OutsideLaboratory",,85240,CPT,Facility,Both,,,90,155,131.75,44.423,155,"Health Partners, Inc.",State Public Programs,77.5,50,,percent of total billed charges,,
"Clotting; Factor Viii (Ahg), 1-Stage (Mayo)OutsideLaboratory",,85240,CPT,Facility,Both,,,90,155,131.75,44.423,155,Humana Insurance Company,Commercial PPO,147.25,95,,percent of total billed charges,,
"Clotting; Factor Viii (Ahg), 1-Stage (Mayo)OutsideLaboratory",,85240,CPT,Facility,Outpatient,,,90,155,131.75,44.423,155,Humana Insurance Company,Medicare PPO,75.95,49,,percent of total billed charges,,
"Clotting; Factor Viii (Ahg), 1-Stage (Mayo)OutsideLaboratory",,85240,CPT,Facility,Inpatient,,,90,155,131.75,44.423,155,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Clotting; Factor Viii (Ahg), 1-Stage (Mayo)OutsideLaboratory",,85240,CPT,Facility,Both,,,90,155,131.75,44.423,155,Medica,Individual & Family,153.605,99.1,,percent of total billed charges,,
"Clotting; Factor Viii (Ahg), 1-Stage (Mayo)OutsideLaboratory",,85240,CPT,Facility,Outpatient,,,90,155,131.75,44.423,155,Medica,Medica Advantage Solution,77.19,49.8,,percent of total billed charges,,
"Clotting; Factor Viii (Ahg), 1-Stage (Mayo)OutsideLaboratory",,85240,CPT,Facility,Inpatient,,,90,155,131.75,44.423,155,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Clotting; Factor Viii (Ahg), 1-Stage (Mayo)OutsideLaboratory",,85240,CPT,Facility,Outpatient,,,90,155,131.75,44.423,155,Medica,Medical Assistance,69.13,44.6,,percent of total billed charges,,
"Clotting; Factor Viii (Ahg), 1-Stage (Mayo)OutsideLaboratory",,85240,CPT,Facility,Inpatient,,,90,155,131.75,44.423,155,Medica,Medical Assistance,,,,,Included in per diem rate,
"Clotting; Factor Viii (Ahg), 1-Stage (Mayo)OutsideLaboratory",,85240,CPT,Facility,Outpatient,,,90,155,131.75,44.423,155,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,77.19,49.8,,percent of total billed charges,,
"Clotting; Factor Viii (Ahg), 1-Stage (Mayo)OutsideLaboratory",,85240,CPT,Facility,Inpatient,,,90,155,131.75,44.423,155,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Clotting; Factor Viii (Ahg), 1-Stage (Mayo)OutsideLaboratory",,85240,CPT,Facility,Both,,,90,155,131.75,44.423,155,"Multiplan, Inc.","Multiplan, Inc.",145.7,94,,percent of total billed charges,,
"Clotting; Factor Viii (Ahg), 1-Stage (Mayo)OutsideLaboratory",,85240,CPT,Facility,Outpatient,,,90,155,131.75,44.423,155,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,133.92,86.4,,percent of total billed charges,,
"Clotting; Factor Viii (Ahg), 1-Stage (Mayo)OutsideLaboratory",,85240,CPT,Facility,Inpatient,,,90,155,131.75,44.423,155,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Clotting; Factor Viii (Ahg), 1-Stage (Mayo)OutsideLaboratory",,85240,CPT,Facility,Both,,,90,155,131.75,44.423,155,"Preferred One Administrative Services, INC.",PPO,152.83,98.6,,percent of total billed charges,,
"Clotting; Factor Viii (Ahg), 1-Stage (Mayo)OutsideLaboratory",,85240,CPT,Facility,Outpatient,,,90,155,131.75,44.423,155,PrimeWest Health,Minnesota Senior Health Options (MSHO),79.7475,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Clotting; Factor Viii (Ahg), 1-Stage (Mayo)OutsideLaboratory",,85240,CPT,Facility,Inpatient,,,90,155,131.75,44.423,155,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Clotting; Factor Viii (Ahg), 1-Stage (Mayo)OutsideLaboratory",,85240,CPT,Facility,Outpatient,,,90,155,131.75,44.423,155,PrimeWest Health,MinnesotaCare,79.608,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Clotting; Factor Viii (Ahg), 1-Stage (Mayo)OutsideLaboratory",,85240,CPT,Facility,Inpatient,,,90,155,131.75,44.423,155,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Clotting; Factor Viii (Ahg), 1-Stage (Mayo)OutsideLaboratory",,85240,CPT,Facility,Both,,,90,155,131.75,44.423,155,Sanford Health Plan,Sanford Health Plan,142.6,92,,percent of total billed charges,,
"Clotting; Factor Viii (Ahg), 1-Stage (Mayo)OutsideLaboratory",,85240,CPT,Facility,Outpatient,,,90,155,131.75,44.423,155,"UCare Health, Inc.",Individual & Family Plan,87.3425,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Clotting; Factor Viii (Ahg), 1-Stage (Mayo)OutsideLaboratory",,85240,CPT,Facility,Inpatient,,,90,155,131.75,44.423,155,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Clotting; Factor Viii (Ahg), 1-Stage (Mayo)OutsideLaboratory",,85240,CPT,Facility,Outpatient,,,90,155,131.75,44.423,155,"UCare Health, Inc.",Medical Assistance,78.2285,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Clotting; Factor Viii (Ahg), 1-Stage (Mayo)OutsideLaboratory",,85240,CPT,Facility,Inpatient,,,90,155,131.75,44.423,155,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Clotting; Factor Viii (Ahg), 1-Stage (Mayo)OutsideLaboratory",,85240,CPT,Facility,Outpatient,,,90,155,131.75,44.423,155,"UCare Health, Inc.",Medicare Advantage,78.2285,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Clotting; Factor Viii (Ahg), 1-Stage (Mayo)OutsideLaboratory",,85240,CPT,Facility,Inpatient,,,90,155,131.75,44.423,155,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Clotting; Factor Viii (Ahg), 1-Stage (Mayo)OutsideLaboratory",,85240,CPT,Facility,Outpatient,,,90,155,131.75,44.423,155,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),78.2285,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Clotting; Factor Viii (Ahg), 1-Stage (Mayo)OutsideLaboratory",,85240,CPT,Facility,Inpatient,,,90,155,131.75,44.423,155,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Clotting; Factor Viii (Ahg), 1-Stage (Mayo)OutsideLaboratory",,85240,CPT,Facility,Both,,,90,155,131.75,44.423,155,UnitedHealthcare,Individual & Family,145.7,94,,percent of total billed charges,,
"Clotting; Factor Viii (Ahg), 1-Stage (Mayo)OutsideLaboratory",,85240,CPT,Facility,Outpatient,,,90,155,131.75,44.423,155,UnitedHealthcare,Medicare Advantage,75.95,49,,percent of total billed charges,,
"Clotting; Factor Viii (Ahg), 1-Stage (Mayo)OutsideLaboratory",,85240,CPT,Facility,Inpatient,,,90,155,131.75,44.423,155,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Clotting; Factor Viii (Ahg), 1-Stage (Mayo)OutsideLaboratory",,85240,CPT,Facility,Outpatient,,,90,155,131.75,44.423,155,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,74.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Clotting; Factor Viii (Ahg), 1-Stage (Mayo)OutsideLaboratory",,85240,CPT,Facility,Inpatient,,,90,155,131.75,44.423,155,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Clotting; Factor Viii, 1-Stage (Mayo)OutsideLaboratory",,85240,CPT,Facility,Both,,,90,155,131.75,44.423,155,Aetna,Commercial,142.6,92,,percent of total billed charges,,
"Clotting; Factor Viii, 1-Stage (Mayo)OutsideLaboratory",,85240,CPT,Facility,Outpatient,,,90,155,131.75,44.423,155,Aetna,Medicare Advantage,75.95,49,,percent of total billed charges,,
"Clotting; Factor Viii, 1-Stage (Mayo)OutsideLaboratory",,85240,CPT,Facility,Inpatient,,,90,155,131.75,44.423,155,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Clotting; Factor Viii, 1-Stage (Mayo)OutsideLaboratory",,85240,CPT,Facility,Both,,,90,155,131.75,44.423,155,Aetna,PPO,144.15,93,,percent of total billed charges,,
"Clotting; Factor Viii, 1-Stage (Mayo)OutsideLaboratory",,85240,CPT,Facility,Both,,,90,155,131.75,44.423,155,America's PPO,America's PPO,148.8465,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Clotting; Factor Viii, 1-Stage (Mayo)OutsideLaboratory",,85240,CPT,Facility,Both,,,90,155,131.75,44.423,155,BlueCross BlueShield Minnesota, Federal Employee Program,152.52,98.4,,percent of total billed charges,,
"Clotting; Factor Viii, 1-Stage (Mayo)OutsideLaboratory",,85240,CPT,Facility,Both,,,90,155,131.75,44.423,155,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,155,100,,percent of total billed charges,,
"Clotting; Factor Viii, 1-Stage (Mayo)OutsideLaboratory",,85240,CPT,Facility,Both,,,90,155,131.75,44.423,155,BlueCross BlueShield Minnesota,High Value Network Plan,139.5,90,,percent of total billed charges,,
"Clotting; Factor Viii, 1-Stage (Mayo)OutsideLaboratory",,85240,CPT,Facility,Outpatient,,,90,155,131.75,44.423,155,BlueCross BlueShield Minnesota,Medicare Advantage,75.95,49,,percent of total billed charges,,
"Clotting; Factor Viii, 1-Stage (Mayo)OutsideLaboratory",,85240,CPT,Facility,Inpatient,,,90,155,131.75,44.423,155,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Clotting; Factor Viii, 1-Stage (Mayo)OutsideLaboratory",,85240,CPT,Facility,Both,,,90,155,131.75,44.423,155,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,137.2835,88.57,,percent of total billed charges,,
"Clotting; Factor Viii, 1-Stage (Mayo)OutsideLaboratory",,85240,CPT,Facility,Both,,,90,155,131.75,44.423,155,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,44.423,28.66,,percent of total billed charges,,
"Clotting; Factor Viii, 1-Stage (Mayo)OutsideLaboratory",,85240,CPT,Facility,Outpatient,,,90,155,131.75,44.423,155,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),75.95,49,,percent of total billed charges,,
"Clotting; Factor Viii, 1-Stage (Mayo)OutsideLaboratory",,85240,CPT,Facility,Inpatient,,,90,155,131.75,44.423,155,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Clotting; Factor Viii, 1-Stage (Mayo)OutsideLaboratory",,85240,CPT,Facility,Both,,,90,155,131.75,44.423,155,CorVel,Worker's Compensation,155,100,,percent of total billed charges,,
"Clotting; Factor Viii, 1-Stage (Mayo)OutsideLaboratory",,85240,CPT,Facility,Both,,,90,155,131.75,44.423,155,First Health Group Corporation,First Health Network,150.35,97,,percent of total billed charges,,
"Clotting; Factor Viii, 1-Stage (Mayo)OutsideLaboratory",,85240,CPT,Facility,Both,,,90,155,131.75,44.423,155,"Health Partners, Inc.",Commercial,146.63,94.6,,percent of total billed charges,,
"Clotting; Factor Viii, 1-Stage (Mayo)OutsideLaboratory",,85240,CPT,Facility,Outpatient,,,90,155,131.75,44.423,155,"Health Partners, Inc.",Medicare Advantage,75.95,49,,percent of total billed charges,,
"Clotting; Factor Viii, 1-Stage (Mayo)OutsideLaboratory",,85240,CPT,Facility,Inpatient,,,90,155,131.75,44.423,155,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Clotting; Factor Viii, 1-Stage (Mayo)OutsideLaboratory",,85240,CPT,Facility,Both,,,90,155,131.75,44.423,155,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),93,60,,percent of total billed charges,,
"Clotting; Factor Viii, 1-Stage (Mayo)OutsideLaboratory",,85240,CPT,Facility,Both,,,90,155,131.75,44.423,155,"Health Partners, Inc.",State of Minnesota Advantage Program,126.325,81.5,,percent of total billed charges,,
"Clotting; Factor Viii, 1-Stage (Mayo)OutsideLaboratory",,85240,CPT,Facility,Both,,,90,155,131.75,44.423,155,"Health Partners, Inc.",State Public Programs,77.5,50,,percent of total billed charges,,
"Clotting; Factor Viii, 1-Stage (Mayo)OutsideLaboratory",,85240,CPT,Facility,Both,,,90,155,131.75,44.423,155,Humana Insurance Company,Commercial PPO,147.25,95,,percent of total billed charges,,
"Clotting; Factor Viii, 1-Stage (Mayo)OutsideLaboratory",,85240,CPT,Facility,Outpatient,,,90,155,131.75,44.423,155,Humana Insurance Company,Medicare PPO,75.95,49,,percent of total billed charges,,
"Clotting; Factor Viii, 1-Stage (Mayo)OutsideLaboratory",,85240,CPT,Facility,Inpatient,,,90,155,131.75,44.423,155,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Clotting; Factor Viii, 1-Stage (Mayo)OutsideLaboratory",,85240,CPT,Facility,Both,,,90,155,131.75,44.423,155,Medica,Individual & Family,153.605,99.1,,percent of total billed charges,,
"Clotting; Factor Viii, 1-Stage (Mayo)OutsideLaboratory",,85240,CPT,Facility,Outpatient,,,90,155,131.75,44.423,155,Medica,Medica Advantage Solution,77.19,49.8,,percent of total billed charges,,
"Clotting; Factor Viii, 1-Stage (Mayo)OutsideLaboratory",,85240,CPT,Facility,Inpatient,,,90,155,131.75,44.423,155,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Clotting; Factor Viii, 1-Stage (Mayo)OutsideLaboratory",,85240,CPT,Facility,Outpatient,,,90,155,131.75,44.423,155,Medica,Medical Assistance,69.13,44.6,,percent of total billed charges,,
"Clotting; Factor Viii, 1-Stage (Mayo)OutsideLaboratory",,85240,CPT,Facility,Inpatient,,,90,155,131.75,44.423,155,Medica,Medical Assistance,,,,,Included in per diem rate,
"Clotting; Factor Viii, 1-Stage (Mayo)OutsideLaboratory",,85240,CPT,Facility,Outpatient,,,90,155,131.75,44.423,155,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,77.19,49.8,,percent of total billed charges,,
"Clotting; Factor Viii, 1-Stage (Mayo)OutsideLaboratory",,85240,CPT,Facility,Inpatient,,,90,155,131.75,44.423,155,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Clotting; Factor Viii, 1-Stage (Mayo)OutsideLaboratory",,85240,CPT,Facility,Both,,,90,155,131.75,44.423,155,"Multiplan, Inc.","Multiplan, Inc.",145.7,94,,percent of total billed charges,,
"Clotting; Factor Viii, 1-Stage (Mayo)OutsideLaboratory",,85240,CPT,Facility,Outpatient,,,90,155,131.75,44.423,155,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,133.92,86.4,,percent of total billed charges,,
"Clotting; Factor Viii, 1-Stage (Mayo)OutsideLaboratory",,85240,CPT,Facility,Inpatient,,,90,155,131.75,44.423,155,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Clotting; Factor Viii, 1-Stage (Mayo)OutsideLaboratory",,85240,CPT,Facility,Both,,,90,155,131.75,44.423,155,"Preferred One Administrative Services, INC.",PPO,152.83,98.6,,percent of total billed charges,,
"Clotting; Factor Viii, 1-Stage (Mayo)OutsideLaboratory",,85240,CPT,Facility,Outpatient,,,90,155,131.75,44.423,155,PrimeWest Health,Minnesota Senior Health Options (MSHO),79.7475,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Clotting; Factor Viii, 1-Stage (Mayo)OutsideLaboratory",,85240,CPT,Facility,Inpatient,,,90,155,131.75,44.423,155,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Clotting; Factor Viii, 1-Stage (Mayo)OutsideLaboratory",,85240,CPT,Facility,Outpatient,,,90,155,131.75,44.423,155,PrimeWest Health,MinnesotaCare,79.608,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Clotting; Factor Viii, 1-Stage (Mayo)OutsideLaboratory",,85240,CPT,Facility,Inpatient,,,90,155,131.75,44.423,155,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Clotting; Factor Viii, 1-Stage (Mayo)OutsideLaboratory",,85240,CPT,Facility,Both,,,90,155,131.75,44.423,155,Sanford Health Plan,Sanford Health Plan,142.6,92,,percent of total billed charges,,
"Clotting; Factor Viii, 1-Stage (Mayo)OutsideLaboratory",,85240,CPT,Facility,Outpatient,,,90,155,131.75,44.423,155,"UCare Health, Inc.",Individual & Family Plan,87.3425,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Clotting; Factor Viii, 1-Stage (Mayo)OutsideLaboratory",,85240,CPT,Facility,Inpatient,,,90,155,131.75,44.423,155,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Clotting; Factor Viii, 1-Stage (Mayo)OutsideLaboratory",,85240,CPT,Facility,Outpatient,,,90,155,131.75,44.423,155,"UCare Health, Inc.",Medical Assistance,78.2285,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Clotting; Factor Viii, 1-Stage (Mayo)OutsideLaboratory",,85240,CPT,Facility,Inpatient,,,90,155,131.75,44.423,155,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Clotting; Factor Viii, 1-Stage (Mayo)OutsideLaboratory",,85240,CPT,Facility,Outpatient,,,90,155,131.75,44.423,155,"UCare Health, Inc.",Medicare Advantage,78.2285,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Clotting; Factor Viii, 1-Stage (Mayo)OutsideLaboratory",,85240,CPT,Facility,Inpatient,,,90,155,131.75,44.423,155,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Clotting; Factor Viii, 1-Stage (Mayo)OutsideLaboratory",,85240,CPT,Facility,Outpatient,,,90,155,131.75,44.423,155,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),78.2285,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Clotting; Factor Viii, 1-Stage (Mayo)OutsideLaboratory",,85240,CPT,Facility,Inpatient,,,90,155,131.75,44.423,155,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Clotting; Factor Viii, 1-Stage (Mayo)OutsideLaboratory",,85240,CPT,Facility,Both,,,90,155,131.75,44.423,155,UnitedHealthcare,Individual & Family,145.7,94,,percent of total billed charges,,
"Clotting; Factor Viii, 1-Stage (Mayo)OutsideLaboratory",,85240,CPT,Facility,Outpatient,,,90,155,131.75,44.423,155,UnitedHealthcare,Medicare Advantage,75.95,49,,percent of total billed charges,,
"Clotting; Factor Viii, 1-Stage (Mayo)OutsideLaboratory",,85240,CPT,Facility,Inpatient,,,90,155,131.75,44.423,155,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Clotting; Factor Viii, 1-Stage (Mayo)OutsideLaboratory",,85240,CPT,Facility,Outpatient,,,90,155,131.75,44.423,155,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,74.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Clotting; Factor Viii, 1-Stage (Mayo)OutsideLaboratory",,85240,CPT,Facility,Inpatient,,,90,155,131.75,44.423,155,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Coag Factor Viii Activity Assay, P (Mayo)OutsideLaboratory",,85240,CPT,Facility,Both,,,90,155,131.75,44.423,155,Aetna,Commercial,142.6,92,,percent of total billed charges,,
"Coag Factor Viii Activity Assay, P (Mayo)OutsideLaboratory",,85240,CPT,Facility,Outpatient,,,90,155,131.75,44.423,155,Aetna,Medicare Advantage,75.95,49,,percent of total billed charges,,
"Coag Factor Viii Activity Assay, P (Mayo)OutsideLaboratory",,85240,CPT,Facility,Inpatient,,,90,155,131.75,44.423,155,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Coag Factor Viii Activity Assay, P (Mayo)OutsideLaboratory",,85240,CPT,Facility,Both,,,90,155,131.75,44.423,155,Aetna,PPO,144.15,93,,percent of total billed charges,,
"Coag Factor Viii Activity Assay, P (Mayo)OutsideLaboratory",,85240,CPT,Facility,Both,,,90,155,131.75,44.423,155,America's PPO,America's PPO,148.8465,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Coag Factor Viii Activity Assay, P (Mayo)OutsideLaboratory",,85240,CPT,Facility,Both,,,90,155,131.75,44.423,155,BlueCross BlueShield Minnesota, Federal Employee Program,152.52,98.4,,percent of total billed charges,,
"Coag Factor Viii Activity Assay, P (Mayo)OutsideLaboratory",,85240,CPT,Facility,Both,,,90,155,131.75,44.423,155,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,155,100,,percent of total billed charges,,
"Coag Factor Viii Activity Assay, P (Mayo)OutsideLaboratory",,85240,CPT,Facility,Both,,,90,155,131.75,44.423,155,BlueCross BlueShield Minnesota,High Value Network Plan,139.5,90,,percent of total billed charges,,
"Coag Factor Viii Activity Assay, P (Mayo)OutsideLaboratory",,85240,CPT,Facility,Outpatient,,,90,155,131.75,44.423,155,BlueCross BlueShield Minnesota,Medicare Advantage,75.95,49,,percent of total billed charges,,
"Coag Factor Viii Activity Assay, P (Mayo)OutsideLaboratory",,85240,CPT,Facility,Inpatient,,,90,155,131.75,44.423,155,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Coag Factor Viii Activity Assay, P (Mayo)OutsideLaboratory",,85240,CPT,Facility,Both,,,90,155,131.75,44.423,155,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,137.2835,88.57,,percent of total billed charges,,
"Coag Factor Viii Activity Assay, P (Mayo)OutsideLaboratory",,85240,CPT,Facility,Both,,,90,155,131.75,44.423,155,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,44.423,28.66,,percent of total billed charges,,
"Coag Factor Viii Activity Assay, P (Mayo)OutsideLaboratory",,85240,CPT,Facility,Outpatient,,,90,155,131.75,44.423,155,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),75.95,49,,percent of total billed charges,,
"Coag Factor Viii Activity Assay, P (Mayo)OutsideLaboratory",,85240,CPT,Facility,Inpatient,,,90,155,131.75,44.423,155,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Coag Factor Viii Activity Assay, P (Mayo)OutsideLaboratory",,85240,CPT,Facility,Both,,,90,155,131.75,44.423,155,CorVel,Worker's Compensation,155,100,,percent of total billed charges,,
"Coag Factor Viii Activity Assay, P (Mayo)OutsideLaboratory",,85240,CPT,Facility,Both,,,90,155,131.75,44.423,155,First Health Group Corporation,First Health Network,150.35,97,,percent of total billed charges,,
"Coag Factor Viii Activity Assay, P (Mayo)OutsideLaboratory",,85240,CPT,Facility,Both,,,90,155,131.75,44.423,155,"Health Partners, Inc.",Commercial,146.63,94.6,,percent of total billed charges,,
"Coag Factor Viii Activity Assay, P (Mayo)OutsideLaboratory",,85240,CPT,Facility,Outpatient,,,90,155,131.75,44.423,155,"Health Partners, Inc.",Medicare Advantage,75.95,49,,percent of total billed charges,,
"Coag Factor Viii Activity Assay, P (Mayo)OutsideLaboratory",,85240,CPT,Facility,Inpatient,,,90,155,131.75,44.423,155,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Coag Factor Viii Activity Assay, P (Mayo)OutsideLaboratory",,85240,CPT,Facility,Both,,,90,155,131.75,44.423,155,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),93,60,,percent of total billed charges,,
"Coag Factor Viii Activity Assay, P (Mayo)OutsideLaboratory",,85240,CPT,Facility,Both,,,90,155,131.75,44.423,155,"Health Partners, Inc.",State of Minnesota Advantage Program,126.325,81.5,,percent of total billed charges,,
"Coag Factor Viii Activity Assay, P (Mayo)OutsideLaboratory",,85240,CPT,Facility,Both,,,90,155,131.75,44.423,155,"Health Partners, Inc.",State Public Programs,77.5,50,,percent of total billed charges,,
"Coag Factor Viii Activity Assay, P (Mayo)OutsideLaboratory",,85240,CPT,Facility,Both,,,90,155,131.75,44.423,155,Humana Insurance Company,Commercial PPO,147.25,95,,percent of total billed charges,,
"Coag Factor Viii Activity Assay, P (Mayo)OutsideLaboratory",,85240,CPT,Facility,Outpatient,,,90,155,131.75,44.423,155,Humana Insurance Company,Medicare PPO,75.95,49,,percent of total billed charges,,
"Coag Factor Viii Activity Assay, P (Mayo)OutsideLaboratory",,85240,CPT,Facility,Inpatient,,,90,155,131.75,44.423,155,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Coag Factor Viii Activity Assay, P (Mayo)OutsideLaboratory",,85240,CPT,Facility,Both,,,90,155,131.75,44.423,155,Medica,Individual & Family,153.605,99.1,,percent of total billed charges,,
"Coag Factor Viii Activity Assay, P (Mayo)OutsideLaboratory",,85240,CPT,Facility,Outpatient,,,90,155,131.75,44.423,155,Medica,Medica Advantage Solution,77.19,49.8,,percent of total billed charges,,
"Coag Factor Viii Activity Assay, P (Mayo)OutsideLaboratory",,85240,CPT,Facility,Inpatient,,,90,155,131.75,44.423,155,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Coag Factor Viii Activity Assay, P (Mayo)OutsideLaboratory",,85240,CPT,Facility,Outpatient,,,90,155,131.75,44.423,155,Medica,Medical Assistance,69.13,44.6,,percent of total billed charges,,
"Coag Factor Viii Activity Assay, P (Mayo)OutsideLaboratory",,85240,CPT,Facility,Inpatient,,,90,155,131.75,44.423,155,Medica,Medical Assistance,,,,,Included in per diem rate,
"Coag Factor Viii Activity Assay, P (Mayo)OutsideLaboratory",,85240,CPT,Facility,Outpatient,,,90,155,131.75,44.423,155,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,77.19,49.8,,percent of total billed charges,,
"Coag Factor Viii Activity Assay, P (Mayo)OutsideLaboratory",,85240,CPT,Facility,Inpatient,,,90,155,131.75,44.423,155,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Coag Factor Viii Activity Assay, P (Mayo)OutsideLaboratory",,85240,CPT,Facility,Both,,,90,155,131.75,44.423,155,"Multiplan, Inc.","Multiplan, Inc.",145.7,94,,percent of total billed charges,,
"Coag Factor Viii Activity Assay, P (Mayo)OutsideLaboratory",,85240,CPT,Facility,Outpatient,,,90,155,131.75,44.423,155,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,133.92,86.4,,percent of total billed charges,,
"Coag Factor Viii Activity Assay, P (Mayo)OutsideLaboratory",,85240,CPT,Facility,Inpatient,,,90,155,131.75,44.423,155,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Coag Factor Viii Activity Assay, P (Mayo)OutsideLaboratory",,85240,CPT,Facility,Both,,,90,155,131.75,44.423,155,"Preferred One Administrative Services, INC.",PPO,152.83,98.6,,percent of total billed charges,,
"Coag Factor Viii Activity Assay, P (Mayo)OutsideLaboratory",,85240,CPT,Facility,Outpatient,,,90,155,131.75,44.423,155,PrimeWest Health,Minnesota Senior Health Options (MSHO),79.7475,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Coag Factor Viii Activity Assay, P (Mayo)OutsideLaboratory",,85240,CPT,Facility,Inpatient,,,90,155,131.75,44.423,155,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Coag Factor Viii Activity Assay, P (Mayo)OutsideLaboratory",,85240,CPT,Facility,Outpatient,,,90,155,131.75,44.423,155,PrimeWest Health,MinnesotaCare,79.608,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Coag Factor Viii Activity Assay, P (Mayo)OutsideLaboratory",,85240,CPT,Facility,Inpatient,,,90,155,131.75,44.423,155,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Coag Factor Viii Activity Assay, P (Mayo)OutsideLaboratory",,85240,CPT,Facility,Both,,,90,155,131.75,44.423,155,Sanford Health Plan,Sanford Health Plan,142.6,92,,percent of total billed charges,,
"Coag Factor Viii Activity Assay, P (Mayo)OutsideLaboratory",,85240,CPT,Facility,Outpatient,,,90,155,131.75,44.423,155,"UCare Health, Inc.",Individual & Family Plan,87.3425,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Coag Factor Viii Activity Assay, P (Mayo)OutsideLaboratory",,85240,CPT,Facility,Inpatient,,,90,155,131.75,44.423,155,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Coag Factor Viii Activity Assay, P (Mayo)OutsideLaboratory",,85240,CPT,Facility,Outpatient,,,90,155,131.75,44.423,155,"UCare Health, Inc.",Medical Assistance,78.2285,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Coag Factor Viii Activity Assay, P (Mayo)OutsideLaboratory",,85240,CPT,Facility,Inpatient,,,90,155,131.75,44.423,155,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Coag Factor Viii Activity Assay, P (Mayo)OutsideLaboratory",,85240,CPT,Facility,Outpatient,,,90,155,131.75,44.423,155,"UCare Health, Inc.",Medicare Advantage,78.2285,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Coag Factor Viii Activity Assay, P (Mayo)OutsideLaboratory",,85240,CPT,Facility,Inpatient,,,90,155,131.75,44.423,155,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Coag Factor Viii Activity Assay, P (Mayo)OutsideLaboratory",,85240,CPT,Facility,Outpatient,,,90,155,131.75,44.423,155,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),78.2285,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Coag Factor Viii Activity Assay, P (Mayo)OutsideLaboratory",,85240,CPT,Facility,Inpatient,,,90,155,131.75,44.423,155,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Coag Factor Viii Activity Assay, P (Mayo)OutsideLaboratory",,85240,CPT,Facility,Both,,,90,155,131.75,44.423,155,UnitedHealthcare,Individual & Family,145.7,94,,percent of total billed charges,,
"Coag Factor Viii Activity Assay, P (Mayo)OutsideLaboratory",,85240,CPT,Facility,Outpatient,,,90,155,131.75,44.423,155,UnitedHealthcare,Medicare Advantage,75.95,49,,percent of total billed charges,,
"Coag Factor Viii Activity Assay, P (Mayo)OutsideLaboratory",,85240,CPT,Facility,Inpatient,,,90,155,131.75,44.423,155,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Coag Factor Viii Activity Assay, P (Mayo)OutsideLaboratory",,85240,CPT,Facility,Outpatient,,,90,155,131.75,44.423,155,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,74.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Coag Factor Viii Activity Assay, P (Mayo)OutsideLaboratory",,85240,CPT,Facility,Inpatient,,,90,155,131.75,44.423,155,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Ristocetin Cofactor (Mayo)OutsideLaboratory,,85245,CPT,Facility,Both,,,90,98,83.3,28.0868,98,Aetna,Commercial,90.16,92,,percent of total billed charges,,
Ristocetin Cofactor (Mayo)OutsideLaboratory,,85245,CPT,Facility,Outpatient,,,90,98,83.3,28.0868,98,Aetna,Medicare Advantage,48.02,49,,percent of total billed charges,,
Ristocetin Cofactor (Mayo)OutsideLaboratory,,85245,CPT,Facility,Inpatient,,,90,98,83.3,28.0868,98,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Ristocetin Cofactor (Mayo)OutsideLaboratory,,85245,CPT,Facility,Both,,,90,98,83.3,28.0868,98,Aetna,PPO,91.14,93,,percent of total billed charges,,
Ristocetin Cofactor (Mayo)OutsideLaboratory,,85245,CPT,Facility,Both,,,90,98,83.3,28.0868,98,America's PPO,America's PPO,94.1094,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Ristocetin Cofactor (Mayo)OutsideLaboratory,,85245,CPT,Facility,Both,,,90,98,83.3,28.0868,98,BlueCross BlueShield Minnesota, Federal Employee Program,96.432,98.4,,percent of total billed charges,,
Ristocetin Cofactor (Mayo)OutsideLaboratory,,85245,CPT,Facility,Both,,,90,98,83.3,28.0868,98,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,98,100,,percent of total billed charges,,
Ristocetin Cofactor (Mayo)OutsideLaboratory,,85245,CPT,Facility,Both,,,90,98,83.3,28.0868,98,BlueCross BlueShield Minnesota,High Value Network Plan,88.2,90,,percent of total billed charges,,
Ristocetin Cofactor (Mayo)OutsideLaboratory,,85245,CPT,Facility,Outpatient,,,90,98,83.3,28.0868,98,BlueCross BlueShield Minnesota,Medicare Advantage,48.02,49,,percent of total billed charges,,
Ristocetin Cofactor (Mayo)OutsideLaboratory,,85245,CPT,Facility,Inpatient,,,90,98,83.3,28.0868,98,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Ristocetin Cofactor (Mayo)OutsideLaboratory,,85245,CPT,Facility,Both,,,90,98,83.3,28.0868,98,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,86.7986,88.57,,percent of total billed charges,,
Ristocetin Cofactor (Mayo)OutsideLaboratory,,85245,CPT,Facility,Both,,,90,98,83.3,28.0868,98,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,28.0868,28.66,,percent of total billed charges,,
Ristocetin Cofactor (Mayo)OutsideLaboratory,,85245,CPT,Facility,Outpatient,,,90,98,83.3,28.0868,98,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),48.02,49,,percent of total billed charges,,
Ristocetin Cofactor (Mayo)OutsideLaboratory,,85245,CPT,Facility,Inpatient,,,90,98,83.3,28.0868,98,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Ristocetin Cofactor (Mayo)OutsideLaboratory,,85245,CPT,Facility,Both,,,90,98,83.3,28.0868,98,CorVel,Worker's Compensation,98,100,,percent of total billed charges,,
Ristocetin Cofactor (Mayo)OutsideLaboratory,,85245,CPT,Facility,Both,,,90,98,83.3,28.0868,98,First Health Group Corporation,First Health Network,95.06,97,,percent of total billed charges,,
Ristocetin Cofactor (Mayo)OutsideLaboratory,,85245,CPT,Facility,Both,,,90,98,83.3,28.0868,98,"Health Partners, Inc.",Commercial,92.708,94.6,,percent of total billed charges,,
Ristocetin Cofactor (Mayo)OutsideLaboratory,,85245,CPT,Facility,Outpatient,,,90,98,83.3,28.0868,98,"Health Partners, Inc.",Medicare Advantage,48.02,49,,percent of total billed charges,,
Ristocetin Cofactor (Mayo)OutsideLaboratory,,85245,CPT,Facility,Inpatient,,,90,98,83.3,28.0868,98,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ristocetin Cofactor (Mayo)OutsideLaboratory,,85245,CPT,Facility,Both,,,90,98,83.3,28.0868,98,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),58.8,60,,percent of total billed charges,,
Ristocetin Cofactor (Mayo)OutsideLaboratory,,85245,CPT,Facility,Both,,,90,98,83.3,28.0868,98,"Health Partners, Inc.",State of Minnesota Advantage Program,79.87,81.5,,percent of total billed charges,,
Ristocetin Cofactor (Mayo)OutsideLaboratory,,85245,CPT,Facility,Both,,,90,98,83.3,28.0868,98,"Health Partners, Inc.",State Public Programs,49,50,,percent of total billed charges,,
Ristocetin Cofactor (Mayo)OutsideLaboratory,,85245,CPT,Facility,Both,,,90,98,83.3,28.0868,98,Humana Insurance Company,Commercial PPO,93.1,95,,percent of total billed charges,,
Ristocetin Cofactor (Mayo)OutsideLaboratory,,85245,CPT,Facility,Outpatient,,,90,98,83.3,28.0868,98,Humana Insurance Company,Medicare PPO,48.02,49,,percent of total billed charges,,
Ristocetin Cofactor (Mayo)OutsideLaboratory,,85245,CPT,Facility,Inpatient,,,90,98,83.3,28.0868,98,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Ristocetin Cofactor (Mayo)OutsideLaboratory,,85245,CPT,Facility,Both,,,90,98,83.3,28.0868,98,Medica,Individual & Family,97.118,99.1,,percent of total billed charges,,
Ristocetin Cofactor (Mayo)OutsideLaboratory,,85245,CPT,Facility,Outpatient,,,90,98,83.3,28.0868,98,Medica,Medica Advantage Solution,48.804,49.8,,percent of total billed charges,,
Ristocetin Cofactor (Mayo)OutsideLaboratory,,85245,CPT,Facility,Inpatient,,,90,98,83.3,28.0868,98,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Ristocetin Cofactor (Mayo)OutsideLaboratory,,85245,CPT,Facility,Outpatient,,,90,98,83.3,28.0868,98,Medica,Medical Assistance,43.708,44.6,,percent of total billed charges,,
Ristocetin Cofactor (Mayo)OutsideLaboratory,,85245,CPT,Facility,Inpatient,,,90,98,83.3,28.0868,98,Medica,Medical Assistance,,,,,Included in per diem rate,
Ristocetin Cofactor (Mayo)OutsideLaboratory,,85245,CPT,Facility,Outpatient,,,90,98,83.3,28.0868,98,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,48.804,49.8,,percent of total billed charges,,
Ristocetin Cofactor (Mayo)OutsideLaboratory,,85245,CPT,Facility,Inpatient,,,90,98,83.3,28.0868,98,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Ristocetin Cofactor (Mayo)OutsideLaboratory,,85245,CPT,Facility,Both,,,90,98,83.3,28.0868,98,"Multiplan, Inc.","Multiplan, Inc.",92.12,94,,percent of total billed charges,,
Ristocetin Cofactor (Mayo)OutsideLaboratory,,85245,CPT,Facility,Outpatient,,,90,98,83.3,28.0868,98,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,84.672,86.4,,percent of total billed charges,,
Ristocetin Cofactor (Mayo)OutsideLaboratory,,85245,CPT,Facility,Inpatient,,,90,98,83.3,28.0868,98,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Ristocetin Cofactor (Mayo)OutsideLaboratory,,85245,CPT,Facility,Both,,,90,98,83.3,28.0868,98,"Preferred One Administrative Services, INC.",PPO,96.628,98.6,,percent of total billed charges,,
Ristocetin Cofactor (Mayo)OutsideLaboratory,,85245,CPT,Facility,Outpatient,,,90,98,83.3,28.0868,98,PrimeWest Health,Minnesota Senior Health Options (MSHO),50.421,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Ristocetin Cofactor (Mayo)OutsideLaboratory,,85245,CPT,Facility,Inpatient,,,90,98,83.3,28.0868,98,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ristocetin Cofactor (Mayo)OutsideLaboratory,,85245,CPT,Facility,Outpatient,,,90,98,83.3,28.0868,98,PrimeWest Health,MinnesotaCare,50.3328,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Ristocetin Cofactor (Mayo)OutsideLaboratory,,85245,CPT,Facility,Inpatient,,,90,98,83.3,28.0868,98,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Ristocetin Cofactor (Mayo)OutsideLaboratory,,85245,CPT,Facility,Both,,,90,98,83.3,28.0868,98,Sanford Health Plan,Sanford Health Plan,90.16,92,,percent of total billed charges,,
Ristocetin Cofactor (Mayo)OutsideLaboratory,,85245,CPT,Facility,Outpatient,,,90,98,83.3,28.0868,98,"UCare Health, Inc.",Individual & Family Plan,55.223,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Ristocetin Cofactor (Mayo)OutsideLaboratory,,85245,CPT,Facility,Inpatient,,,90,98,83.3,28.0868,98,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Ristocetin Cofactor (Mayo)OutsideLaboratory,,85245,CPT,Facility,Outpatient,,,90,98,83.3,28.0868,98,"UCare Health, Inc.",Medical Assistance,49.4606,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ristocetin Cofactor (Mayo)OutsideLaboratory,,85245,CPT,Facility,Inpatient,,,90,98,83.3,28.0868,98,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Ristocetin Cofactor (Mayo)OutsideLaboratory,,85245,CPT,Facility,Outpatient,,,90,98,83.3,28.0868,98,"UCare Health, Inc.",Medicare Advantage,49.4606,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ristocetin Cofactor (Mayo)OutsideLaboratory,,85245,CPT,Facility,Inpatient,,,90,98,83.3,28.0868,98,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ristocetin Cofactor (Mayo)OutsideLaboratory,,85245,CPT,Facility,Outpatient,,,90,98,83.3,28.0868,98,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),49.4606,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ristocetin Cofactor (Mayo)OutsideLaboratory,,85245,CPT,Facility,Inpatient,,,90,98,83.3,28.0868,98,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ristocetin Cofactor (Mayo)OutsideLaboratory,,85245,CPT,Facility,Both,,,90,98,83.3,28.0868,98,UnitedHealthcare,Individual & Family,92.12,94,,percent of total billed charges,,
Ristocetin Cofactor (Mayo)OutsideLaboratory,,85245,CPT,Facility,Outpatient,,,90,98,83.3,28.0868,98,UnitedHealthcare,Medicare Advantage,48.02,49,,percent of total billed charges,,
Ristocetin Cofactor (Mayo)OutsideLaboratory,,85245,CPT,Facility,Inpatient,,,90,98,83.3,28.0868,98,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Ristocetin Cofactor (Mayo)OutsideLaboratory,,85245,CPT,Facility,Outpatient,,,90,98,83.3,28.0868,98,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,47.04,48,,percent of total billed charges,,100% of DHS outpatient percentage
Ristocetin Cofactor (Mayo)OutsideLaboratory,,85245,CPT,Facility,Inpatient,,,90,98,83.3,28.0868,98,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Clotting; Factor Viii, Vw Factor Antigen (Mayo)OutsideLaboratory",,85246,CPT,Facility,Both,,,90,155,131.75,44.423,155,Aetna,Commercial,142.6,92,,percent of total billed charges,,
"Clotting; Factor Viii, Vw Factor Antigen (Mayo)OutsideLaboratory",,85246,CPT,Facility,Outpatient,,,90,155,131.75,44.423,155,Aetna,Medicare Advantage,75.95,49,,percent of total billed charges,,
"Clotting; Factor Viii, Vw Factor Antigen (Mayo)OutsideLaboratory",,85246,CPT,Facility,Inpatient,,,90,155,131.75,44.423,155,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Clotting; Factor Viii, Vw Factor Antigen (Mayo)OutsideLaboratory",,85246,CPT,Facility,Both,,,90,155,131.75,44.423,155,Aetna,PPO,144.15,93,,percent of total billed charges,,
"Clotting; Factor Viii, Vw Factor Antigen (Mayo)OutsideLaboratory",,85246,CPT,Facility,Both,,,90,155,131.75,44.423,155,America's PPO,America's PPO,148.8465,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Clotting; Factor Viii, Vw Factor Antigen (Mayo)OutsideLaboratory",,85246,CPT,Facility,Both,,,90,155,131.75,44.423,155,BlueCross BlueShield Minnesota, Federal Employee Program,152.52,98.4,,percent of total billed charges,,
"Clotting; Factor Viii, Vw Factor Antigen (Mayo)OutsideLaboratory",,85246,CPT,Facility,Both,,,90,155,131.75,44.423,155,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,155,100,,percent of total billed charges,,
"Clotting; Factor Viii, Vw Factor Antigen (Mayo)OutsideLaboratory",,85246,CPT,Facility,Both,,,90,155,131.75,44.423,155,BlueCross BlueShield Minnesota,High Value Network Plan,139.5,90,,percent of total billed charges,,
"Clotting; Factor Viii, Vw Factor Antigen (Mayo)OutsideLaboratory",,85246,CPT,Facility,Outpatient,,,90,155,131.75,44.423,155,BlueCross BlueShield Minnesota,Medicare Advantage,75.95,49,,percent of total billed charges,,
"Clotting; Factor Viii, Vw Factor Antigen (Mayo)OutsideLaboratory",,85246,CPT,Facility,Inpatient,,,90,155,131.75,44.423,155,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Clotting; Factor Viii, Vw Factor Antigen (Mayo)OutsideLaboratory",,85246,CPT,Facility,Both,,,90,155,131.75,44.423,155,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,137.2835,88.57,,percent of total billed charges,,
"Clotting; Factor Viii, Vw Factor Antigen (Mayo)OutsideLaboratory",,85246,CPT,Facility,Both,,,90,155,131.75,44.423,155,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,44.423,28.66,,percent of total billed charges,,
"Clotting; Factor Viii, Vw Factor Antigen (Mayo)OutsideLaboratory",,85246,CPT,Facility,Outpatient,,,90,155,131.75,44.423,155,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),75.95,49,,percent of total billed charges,,
"Clotting; Factor Viii, Vw Factor Antigen (Mayo)OutsideLaboratory",,85246,CPT,Facility,Inpatient,,,90,155,131.75,44.423,155,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Clotting; Factor Viii, Vw Factor Antigen (Mayo)OutsideLaboratory",,85246,CPT,Facility,Both,,,90,155,131.75,44.423,155,CorVel,Worker's Compensation,155,100,,percent of total billed charges,,
"Clotting; Factor Viii, Vw Factor Antigen (Mayo)OutsideLaboratory",,85246,CPT,Facility,Both,,,90,155,131.75,44.423,155,First Health Group Corporation,First Health Network,150.35,97,,percent of total billed charges,,
"Clotting; Factor Viii, Vw Factor Antigen (Mayo)OutsideLaboratory",,85246,CPT,Facility,Both,,,90,155,131.75,44.423,155,"Health Partners, Inc.",Commercial,146.63,94.6,,percent of total billed charges,,
"Clotting; Factor Viii, Vw Factor Antigen (Mayo)OutsideLaboratory",,85246,CPT,Facility,Outpatient,,,90,155,131.75,44.423,155,"Health Partners, Inc.",Medicare Advantage,75.95,49,,percent of total billed charges,,
"Clotting; Factor Viii, Vw Factor Antigen (Mayo)OutsideLaboratory",,85246,CPT,Facility,Inpatient,,,90,155,131.75,44.423,155,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Clotting; Factor Viii, Vw Factor Antigen (Mayo)OutsideLaboratory",,85246,CPT,Facility,Both,,,90,155,131.75,44.423,155,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),93,60,,percent of total billed charges,,
"Clotting; Factor Viii, Vw Factor Antigen (Mayo)OutsideLaboratory",,85246,CPT,Facility,Both,,,90,155,131.75,44.423,155,"Health Partners, Inc.",State of Minnesota Advantage Program,126.325,81.5,,percent of total billed charges,,
"Clotting; Factor Viii, Vw Factor Antigen (Mayo)OutsideLaboratory",,85246,CPT,Facility,Both,,,90,155,131.75,44.423,155,"Health Partners, Inc.",State Public Programs,77.5,50,,percent of total billed charges,,
"Clotting; Factor Viii, Vw Factor Antigen (Mayo)OutsideLaboratory",,85246,CPT,Facility,Both,,,90,155,131.75,44.423,155,Humana Insurance Company,Commercial PPO,147.25,95,,percent of total billed charges,,
"Clotting; Factor Viii, Vw Factor Antigen (Mayo)OutsideLaboratory",,85246,CPT,Facility,Outpatient,,,90,155,131.75,44.423,155,Humana Insurance Company,Medicare PPO,75.95,49,,percent of total billed charges,,
"Clotting; Factor Viii, Vw Factor Antigen (Mayo)OutsideLaboratory",,85246,CPT,Facility,Inpatient,,,90,155,131.75,44.423,155,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Clotting; Factor Viii, Vw Factor Antigen (Mayo)OutsideLaboratory",,85246,CPT,Facility,Both,,,90,155,131.75,44.423,155,Medica,Individual & Family,153.605,99.1,,percent of total billed charges,,
"Clotting; Factor Viii, Vw Factor Antigen (Mayo)OutsideLaboratory",,85246,CPT,Facility,Outpatient,,,90,155,131.75,44.423,155,Medica,Medica Advantage Solution,77.19,49.8,,percent of total billed charges,,
"Clotting; Factor Viii, Vw Factor Antigen (Mayo)OutsideLaboratory",,85246,CPT,Facility,Inpatient,,,90,155,131.75,44.423,155,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Clotting; Factor Viii, Vw Factor Antigen (Mayo)OutsideLaboratory",,85246,CPT,Facility,Outpatient,,,90,155,131.75,44.423,155,Medica,Medical Assistance,69.13,44.6,,percent of total billed charges,,
"Clotting; Factor Viii, Vw Factor Antigen (Mayo)OutsideLaboratory",,85246,CPT,Facility,Inpatient,,,90,155,131.75,44.423,155,Medica,Medical Assistance,,,,,Included in per diem rate,
"Clotting; Factor Viii, Vw Factor Antigen (Mayo)OutsideLaboratory",,85246,CPT,Facility,Outpatient,,,90,155,131.75,44.423,155,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,77.19,49.8,,percent of total billed charges,,
"Clotting; Factor Viii, Vw Factor Antigen (Mayo)OutsideLaboratory",,85246,CPT,Facility,Inpatient,,,90,155,131.75,44.423,155,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Clotting; Factor Viii, Vw Factor Antigen (Mayo)OutsideLaboratory",,85246,CPT,Facility,Both,,,90,155,131.75,44.423,155,"Multiplan, Inc.","Multiplan, Inc.",145.7,94,,percent of total billed charges,,
"Clotting; Factor Viii, Vw Factor Antigen (Mayo)OutsideLaboratory",,85246,CPT,Facility,Outpatient,,,90,155,131.75,44.423,155,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,133.92,86.4,,percent of total billed charges,,
"Clotting; Factor Viii, Vw Factor Antigen (Mayo)OutsideLaboratory",,85246,CPT,Facility,Inpatient,,,90,155,131.75,44.423,155,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Clotting; Factor Viii, Vw Factor Antigen (Mayo)OutsideLaboratory",,85246,CPT,Facility,Both,,,90,155,131.75,44.423,155,"Preferred One Administrative Services, INC.",PPO,152.83,98.6,,percent of total billed charges,,
"Clotting; Factor Viii, Vw Factor Antigen (Mayo)OutsideLaboratory",,85246,CPT,Facility,Outpatient,,,90,155,131.75,44.423,155,PrimeWest Health,Minnesota Senior Health Options (MSHO),79.7475,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Clotting; Factor Viii, Vw Factor Antigen (Mayo)OutsideLaboratory",,85246,CPT,Facility,Inpatient,,,90,155,131.75,44.423,155,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Clotting; Factor Viii, Vw Factor Antigen (Mayo)OutsideLaboratory",,85246,CPT,Facility,Outpatient,,,90,155,131.75,44.423,155,PrimeWest Health,MinnesotaCare,79.608,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Clotting; Factor Viii, Vw Factor Antigen (Mayo)OutsideLaboratory",,85246,CPT,Facility,Inpatient,,,90,155,131.75,44.423,155,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Clotting; Factor Viii, Vw Factor Antigen (Mayo)OutsideLaboratory",,85246,CPT,Facility,Both,,,90,155,131.75,44.423,155,Sanford Health Plan,Sanford Health Plan,142.6,92,,percent of total billed charges,,
"Clotting; Factor Viii, Vw Factor Antigen (Mayo)OutsideLaboratory",,85246,CPT,Facility,Outpatient,,,90,155,131.75,44.423,155,"UCare Health, Inc.",Individual & Family Plan,87.3425,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Clotting; Factor Viii, Vw Factor Antigen (Mayo)OutsideLaboratory",,85246,CPT,Facility,Inpatient,,,90,155,131.75,44.423,155,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Clotting; Factor Viii, Vw Factor Antigen (Mayo)OutsideLaboratory",,85246,CPT,Facility,Outpatient,,,90,155,131.75,44.423,155,"UCare Health, Inc.",Medical Assistance,78.2285,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Clotting; Factor Viii, Vw Factor Antigen (Mayo)OutsideLaboratory",,85246,CPT,Facility,Inpatient,,,90,155,131.75,44.423,155,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Clotting; Factor Viii, Vw Factor Antigen (Mayo)OutsideLaboratory",,85246,CPT,Facility,Outpatient,,,90,155,131.75,44.423,155,"UCare Health, Inc.",Medicare Advantage,78.2285,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Clotting; Factor Viii, Vw Factor Antigen (Mayo)OutsideLaboratory",,85246,CPT,Facility,Inpatient,,,90,155,131.75,44.423,155,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Clotting; Factor Viii, Vw Factor Antigen (Mayo)OutsideLaboratory",,85246,CPT,Facility,Outpatient,,,90,155,131.75,44.423,155,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),78.2285,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Clotting; Factor Viii, Vw Factor Antigen (Mayo)OutsideLaboratory",,85246,CPT,Facility,Inpatient,,,90,155,131.75,44.423,155,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Clotting; Factor Viii, Vw Factor Antigen (Mayo)OutsideLaboratory",,85246,CPT,Facility,Both,,,90,155,131.75,44.423,155,UnitedHealthcare,Individual & Family,145.7,94,,percent of total billed charges,,
"Clotting; Factor Viii, Vw Factor Antigen (Mayo)OutsideLaboratory",,85246,CPT,Facility,Outpatient,,,90,155,131.75,44.423,155,UnitedHealthcare,Medicare Advantage,75.95,49,,percent of total billed charges,,
"Clotting; Factor Viii, Vw Factor Antigen (Mayo)OutsideLaboratory",,85246,CPT,Facility,Inpatient,,,90,155,131.75,44.423,155,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Clotting; Factor Viii, Vw Factor Antigen (Mayo)OutsideLaboratory",,85246,CPT,Facility,Outpatient,,,90,155,131.75,44.423,155,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,74.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Clotting; Factor Viii, Vw Factor Antigen (Mayo)OutsideLaboratory",,85246,CPT,Facility,Inpatient,,,90,155,131.75,44.423,155,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Coag Factor Ix Assay, P (Mayo)OutsideLaboratory",,85250,CPT,Facility,Both,,,90,176,149.6,50.4416,176,Aetna,Commercial,161.92,92,,percent of total billed charges,,
"Coag Factor Ix Assay, P (Mayo)OutsideLaboratory",,85250,CPT,Facility,Outpatient,,,90,176,149.6,50.4416,176,Aetna,Medicare Advantage,86.24,49,,percent of total billed charges,,
"Coag Factor Ix Assay, P (Mayo)OutsideLaboratory",,85250,CPT,Facility,Inpatient,,,90,176,149.6,50.4416,176,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Coag Factor Ix Assay, P (Mayo)OutsideLaboratory",,85250,CPT,Facility,Both,,,90,176,149.6,50.4416,176,Aetna,PPO,163.68,93,,percent of total billed charges,,
"Coag Factor Ix Assay, P (Mayo)OutsideLaboratory",,85250,CPT,Facility,Both,,,90,176,149.6,50.4416,176,America's PPO,America's PPO,169.0128,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Coag Factor Ix Assay, P (Mayo)OutsideLaboratory",,85250,CPT,Facility,Both,,,90,176,149.6,50.4416,176,BlueCross BlueShield Minnesota, Federal Employee Program,173.184,98.4,,percent of total billed charges,,
"Coag Factor Ix Assay, P (Mayo)OutsideLaboratory",,85250,CPT,Facility,Both,,,90,176,149.6,50.4416,176,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,176,100,,percent of total billed charges,,
"Coag Factor Ix Assay, P (Mayo)OutsideLaboratory",,85250,CPT,Facility,Both,,,90,176,149.6,50.4416,176,BlueCross BlueShield Minnesota,High Value Network Plan,158.4,90,,percent of total billed charges,,
"Coag Factor Ix Assay, P (Mayo)OutsideLaboratory",,85250,CPT,Facility,Outpatient,,,90,176,149.6,50.4416,176,BlueCross BlueShield Minnesota,Medicare Advantage,86.24,49,,percent of total billed charges,,
"Coag Factor Ix Assay, P (Mayo)OutsideLaboratory",,85250,CPT,Facility,Inpatient,,,90,176,149.6,50.4416,176,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Coag Factor Ix Assay, P (Mayo)OutsideLaboratory",,85250,CPT,Facility,Both,,,90,176,149.6,50.4416,176,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,155.8832,88.57,,percent of total billed charges,,
"Coag Factor Ix Assay, P (Mayo)OutsideLaboratory",,85250,CPT,Facility,Both,,,90,176,149.6,50.4416,176,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,50.4416,28.66,,percent of total billed charges,,
"Coag Factor Ix Assay, P (Mayo)OutsideLaboratory",,85250,CPT,Facility,Outpatient,,,90,176,149.6,50.4416,176,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),86.24,49,,percent of total billed charges,,
"Coag Factor Ix Assay, P (Mayo)OutsideLaboratory",,85250,CPT,Facility,Inpatient,,,90,176,149.6,50.4416,176,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Coag Factor Ix Assay, P (Mayo)OutsideLaboratory",,85250,CPT,Facility,Both,,,90,176,149.6,50.4416,176,CorVel,Worker's Compensation,176,100,,percent of total billed charges,,
"Coag Factor Ix Assay, P (Mayo)OutsideLaboratory",,85250,CPT,Facility,Both,,,90,176,149.6,50.4416,176,First Health Group Corporation,First Health Network,170.72,97,,percent of total billed charges,,
"Coag Factor Ix Assay, P (Mayo)OutsideLaboratory",,85250,CPT,Facility,Both,,,90,176,149.6,50.4416,176,"Health Partners, Inc.",Commercial,166.496,94.6,,percent of total billed charges,,
"Coag Factor Ix Assay, P (Mayo)OutsideLaboratory",,85250,CPT,Facility,Outpatient,,,90,176,149.6,50.4416,176,"Health Partners, Inc.",Medicare Advantage,86.24,49,,percent of total billed charges,,
"Coag Factor Ix Assay, P (Mayo)OutsideLaboratory",,85250,CPT,Facility,Inpatient,,,90,176,149.6,50.4416,176,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Coag Factor Ix Assay, P (Mayo)OutsideLaboratory",,85250,CPT,Facility,Both,,,90,176,149.6,50.4416,176,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),105.6,60,,percent of total billed charges,,
"Coag Factor Ix Assay, P (Mayo)OutsideLaboratory",,85250,CPT,Facility,Both,,,90,176,149.6,50.4416,176,"Health Partners, Inc.",State of Minnesota Advantage Program,143.44,81.5,,percent of total billed charges,,
"Coag Factor Ix Assay, P (Mayo)OutsideLaboratory",,85250,CPT,Facility,Both,,,90,176,149.6,50.4416,176,"Health Partners, Inc.",State Public Programs,88,50,,percent of total billed charges,,
"Coag Factor Ix Assay, P (Mayo)OutsideLaboratory",,85250,CPT,Facility,Both,,,90,176,149.6,50.4416,176,Humana Insurance Company,Commercial PPO,167.2,95,,percent of total billed charges,,
"Coag Factor Ix Assay, P (Mayo)OutsideLaboratory",,85250,CPT,Facility,Outpatient,,,90,176,149.6,50.4416,176,Humana Insurance Company,Medicare PPO,86.24,49,,percent of total billed charges,,
"Coag Factor Ix Assay, P (Mayo)OutsideLaboratory",,85250,CPT,Facility,Inpatient,,,90,176,149.6,50.4416,176,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Coag Factor Ix Assay, P (Mayo)OutsideLaboratory",,85250,CPT,Facility,Both,,,90,176,149.6,50.4416,176,Medica,Individual & Family,174.416,99.1,,percent of total billed charges,,
"Coag Factor Ix Assay, P (Mayo)OutsideLaboratory",,85250,CPT,Facility,Outpatient,,,90,176,149.6,50.4416,176,Medica,Medica Advantage Solution,87.648,49.8,,percent of total billed charges,,
"Coag Factor Ix Assay, P (Mayo)OutsideLaboratory",,85250,CPT,Facility,Inpatient,,,90,176,149.6,50.4416,176,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Coag Factor Ix Assay, P (Mayo)OutsideLaboratory",,85250,CPT,Facility,Outpatient,,,90,176,149.6,50.4416,176,Medica,Medical Assistance,78.496,44.6,,percent of total billed charges,,
"Coag Factor Ix Assay, P (Mayo)OutsideLaboratory",,85250,CPT,Facility,Inpatient,,,90,176,149.6,50.4416,176,Medica,Medical Assistance,,,,,Included in per diem rate,
"Coag Factor Ix Assay, P (Mayo)OutsideLaboratory",,85250,CPT,Facility,Outpatient,,,90,176,149.6,50.4416,176,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,87.648,49.8,,percent of total billed charges,,
"Coag Factor Ix Assay, P (Mayo)OutsideLaboratory",,85250,CPT,Facility,Inpatient,,,90,176,149.6,50.4416,176,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Coag Factor Ix Assay, P (Mayo)OutsideLaboratory",,85250,CPT,Facility,Both,,,90,176,149.6,50.4416,176,"Multiplan, Inc.","Multiplan, Inc.",165.44,94,,percent of total billed charges,,
"Coag Factor Ix Assay, P (Mayo)OutsideLaboratory",,85250,CPT,Facility,Outpatient,,,90,176,149.6,50.4416,176,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,152.064,86.4,,percent of total billed charges,,
"Coag Factor Ix Assay, P (Mayo)OutsideLaboratory",,85250,CPT,Facility,Inpatient,,,90,176,149.6,50.4416,176,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Coag Factor Ix Assay, P (Mayo)OutsideLaboratory",,85250,CPT,Facility,Both,,,90,176,149.6,50.4416,176,"Preferred One Administrative Services, INC.",PPO,173.536,98.6,,percent of total billed charges,,
"Coag Factor Ix Assay, P (Mayo)OutsideLaboratory",,85250,CPT,Facility,Outpatient,,,90,176,149.6,50.4416,176,PrimeWest Health,Minnesota Senior Health Options (MSHO),90.552,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Coag Factor Ix Assay, P (Mayo)OutsideLaboratory",,85250,CPT,Facility,Inpatient,,,90,176,149.6,50.4416,176,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Coag Factor Ix Assay, P (Mayo)OutsideLaboratory",,85250,CPT,Facility,Outpatient,,,90,176,149.6,50.4416,176,PrimeWest Health,MinnesotaCare,90.3936,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Coag Factor Ix Assay, P (Mayo)OutsideLaboratory",,85250,CPT,Facility,Inpatient,,,90,176,149.6,50.4416,176,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Coag Factor Ix Assay, P (Mayo)OutsideLaboratory",,85250,CPT,Facility,Both,,,90,176,149.6,50.4416,176,Sanford Health Plan,Sanford Health Plan,161.92,92,,percent of total billed charges,,
"Coag Factor Ix Assay, P (Mayo)OutsideLaboratory",,85250,CPT,Facility,Outpatient,,,90,176,149.6,50.4416,176,"UCare Health, Inc.",Individual & Family Plan,99.176,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Coag Factor Ix Assay, P (Mayo)OutsideLaboratory",,85250,CPT,Facility,Inpatient,,,90,176,149.6,50.4416,176,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Coag Factor Ix Assay, P (Mayo)OutsideLaboratory",,85250,CPT,Facility,Outpatient,,,90,176,149.6,50.4416,176,"UCare Health, Inc.",Medical Assistance,88.8272,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Coag Factor Ix Assay, P (Mayo)OutsideLaboratory",,85250,CPT,Facility,Inpatient,,,90,176,149.6,50.4416,176,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Coag Factor Ix Assay, P (Mayo)OutsideLaboratory",,85250,CPT,Facility,Outpatient,,,90,176,149.6,50.4416,176,"UCare Health, Inc.",Medicare Advantage,88.8272,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Coag Factor Ix Assay, P (Mayo)OutsideLaboratory",,85250,CPT,Facility,Inpatient,,,90,176,149.6,50.4416,176,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Coag Factor Ix Assay, P (Mayo)OutsideLaboratory",,85250,CPT,Facility,Outpatient,,,90,176,149.6,50.4416,176,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),88.8272,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Coag Factor Ix Assay, P (Mayo)OutsideLaboratory",,85250,CPT,Facility,Inpatient,,,90,176,149.6,50.4416,176,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Coag Factor Ix Assay, P (Mayo)OutsideLaboratory",,85250,CPT,Facility,Both,,,90,176,149.6,50.4416,176,UnitedHealthcare,Individual & Family,165.44,94,,percent of total billed charges,,
"Coag Factor Ix Assay, P (Mayo)OutsideLaboratory",,85250,CPT,Facility,Outpatient,,,90,176,149.6,50.4416,176,UnitedHealthcare,Medicare Advantage,86.24,49,,percent of total billed charges,,
"Coag Factor Ix Assay, P (Mayo)OutsideLaboratory",,85250,CPT,Facility,Inpatient,,,90,176,149.6,50.4416,176,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Coag Factor Ix Assay, P (Mayo)OutsideLaboratory",,85250,CPT,Facility,Outpatient,,,90,176,149.6,50.4416,176,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,84.48,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Coag Factor Ix Assay, P (Mayo)OutsideLaboratory",,85250,CPT,Facility,Inpatient,,,90,176,149.6,50.4416,176,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Coag Factor X Assay, P (Mayo)OutsideLaboratory",,85260,CPT,Facility,Both,,,90,145,123.25,41.557,145,Aetna,Commercial,133.4,92,,percent of total billed charges,,
"Coag Factor X Assay, P (Mayo)OutsideLaboratory",,85260,CPT,Facility,Outpatient,,,90,145,123.25,41.557,145,Aetna,Medicare Advantage,71.05,49,,percent of total billed charges,,
"Coag Factor X Assay, P (Mayo)OutsideLaboratory",,85260,CPT,Facility,Inpatient,,,90,145,123.25,41.557,145,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Coag Factor X Assay, P (Mayo)OutsideLaboratory",,85260,CPT,Facility,Both,,,90,145,123.25,41.557,145,Aetna,PPO,134.85,93,,percent of total billed charges,,
"Coag Factor X Assay, P (Mayo)OutsideLaboratory",,85260,CPT,Facility,Both,,,90,145,123.25,41.557,145,America's PPO,America's PPO,139.2435,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Coag Factor X Assay, P (Mayo)OutsideLaboratory",,85260,CPT,Facility,Both,,,90,145,123.25,41.557,145,BlueCross BlueShield Minnesota, Federal Employee Program,142.68,98.4,,percent of total billed charges,,
"Coag Factor X Assay, P (Mayo)OutsideLaboratory",,85260,CPT,Facility,Both,,,90,145,123.25,41.557,145,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,145,100,,percent of total billed charges,,
"Coag Factor X Assay, P (Mayo)OutsideLaboratory",,85260,CPT,Facility,Both,,,90,145,123.25,41.557,145,BlueCross BlueShield Minnesota,High Value Network Plan,130.5,90,,percent of total billed charges,,
"Coag Factor X Assay, P (Mayo)OutsideLaboratory",,85260,CPT,Facility,Outpatient,,,90,145,123.25,41.557,145,BlueCross BlueShield Minnesota,Medicare Advantage,71.05,49,,percent of total billed charges,,
"Coag Factor X Assay, P (Mayo)OutsideLaboratory",,85260,CPT,Facility,Inpatient,,,90,145,123.25,41.557,145,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Coag Factor X Assay, P (Mayo)OutsideLaboratory",,85260,CPT,Facility,Both,,,90,145,123.25,41.557,145,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,128.4265,88.57,,percent of total billed charges,,
"Coag Factor X Assay, P (Mayo)OutsideLaboratory",,85260,CPT,Facility,Both,,,90,145,123.25,41.557,145,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,41.557,28.66,,percent of total billed charges,,
"Coag Factor X Assay, P (Mayo)OutsideLaboratory",,85260,CPT,Facility,Outpatient,,,90,145,123.25,41.557,145,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),71.05,49,,percent of total billed charges,,
"Coag Factor X Assay, P (Mayo)OutsideLaboratory",,85260,CPT,Facility,Inpatient,,,90,145,123.25,41.557,145,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Coag Factor X Assay, P (Mayo)OutsideLaboratory",,85260,CPT,Facility,Both,,,90,145,123.25,41.557,145,CorVel,Worker's Compensation,145,100,,percent of total billed charges,,
"Coag Factor X Assay, P (Mayo)OutsideLaboratory",,85260,CPT,Facility,Both,,,90,145,123.25,41.557,145,First Health Group Corporation,First Health Network,140.65,97,,percent of total billed charges,,
"Coag Factor X Assay, P (Mayo)OutsideLaboratory",,85260,CPT,Facility,Both,,,90,145,123.25,41.557,145,"Health Partners, Inc.",Commercial,137.17,94.6,,percent of total billed charges,,
"Coag Factor X Assay, P (Mayo)OutsideLaboratory",,85260,CPT,Facility,Outpatient,,,90,145,123.25,41.557,145,"Health Partners, Inc.",Medicare Advantage,71.05,49,,percent of total billed charges,,
"Coag Factor X Assay, P (Mayo)OutsideLaboratory",,85260,CPT,Facility,Inpatient,,,90,145,123.25,41.557,145,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Coag Factor X Assay, P (Mayo)OutsideLaboratory",,85260,CPT,Facility,Both,,,90,145,123.25,41.557,145,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),87,60,,percent of total billed charges,,
"Coag Factor X Assay, P (Mayo)OutsideLaboratory",,85260,CPT,Facility,Both,,,90,145,123.25,41.557,145,"Health Partners, Inc.",State of Minnesota Advantage Program,118.175,81.5,,percent of total billed charges,,
"Coag Factor X Assay, P (Mayo)OutsideLaboratory",,85260,CPT,Facility,Both,,,90,145,123.25,41.557,145,"Health Partners, Inc.",State Public Programs,72.5,50,,percent of total billed charges,,
"Coag Factor X Assay, P (Mayo)OutsideLaboratory",,85260,CPT,Facility,Both,,,90,145,123.25,41.557,145,Humana Insurance Company,Commercial PPO,137.75,95,,percent of total billed charges,,
"Coag Factor X Assay, P (Mayo)OutsideLaboratory",,85260,CPT,Facility,Outpatient,,,90,145,123.25,41.557,145,Humana Insurance Company,Medicare PPO,71.05,49,,percent of total billed charges,,
"Coag Factor X Assay, P (Mayo)OutsideLaboratory",,85260,CPT,Facility,Inpatient,,,90,145,123.25,41.557,145,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Coag Factor X Assay, P (Mayo)OutsideLaboratory",,85260,CPT,Facility,Both,,,90,145,123.25,41.557,145,Medica,Individual & Family,143.695,99.1,,percent of total billed charges,,
"Coag Factor X Assay, P (Mayo)OutsideLaboratory",,85260,CPT,Facility,Outpatient,,,90,145,123.25,41.557,145,Medica,Medica Advantage Solution,72.21,49.8,,percent of total billed charges,,
"Coag Factor X Assay, P (Mayo)OutsideLaboratory",,85260,CPT,Facility,Inpatient,,,90,145,123.25,41.557,145,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Coag Factor X Assay, P (Mayo)OutsideLaboratory",,85260,CPT,Facility,Outpatient,,,90,145,123.25,41.557,145,Medica,Medical Assistance,64.67,44.6,,percent of total billed charges,,
"Coag Factor X Assay, P (Mayo)OutsideLaboratory",,85260,CPT,Facility,Inpatient,,,90,145,123.25,41.557,145,Medica,Medical Assistance,,,,,Included in per diem rate,
"Coag Factor X Assay, P (Mayo)OutsideLaboratory",,85260,CPT,Facility,Outpatient,,,90,145,123.25,41.557,145,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,72.21,49.8,,percent of total billed charges,,
"Coag Factor X Assay, P (Mayo)OutsideLaboratory",,85260,CPT,Facility,Inpatient,,,90,145,123.25,41.557,145,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Coag Factor X Assay, P (Mayo)OutsideLaboratory",,85260,CPT,Facility,Both,,,90,145,123.25,41.557,145,"Multiplan, Inc.","Multiplan, Inc.",136.3,94,,percent of total billed charges,,
"Coag Factor X Assay, P (Mayo)OutsideLaboratory",,85260,CPT,Facility,Outpatient,,,90,145,123.25,41.557,145,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,125.28,86.4,,percent of total billed charges,,
"Coag Factor X Assay, P (Mayo)OutsideLaboratory",,85260,CPT,Facility,Inpatient,,,90,145,123.25,41.557,145,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Coag Factor X Assay, P (Mayo)OutsideLaboratory",,85260,CPT,Facility,Both,,,90,145,123.25,41.557,145,"Preferred One Administrative Services, INC.",PPO,142.97,98.6,,percent of total billed charges,,
"Coag Factor X Assay, P (Mayo)OutsideLaboratory",,85260,CPT,Facility,Outpatient,,,90,145,123.25,41.557,145,PrimeWest Health,Minnesota Senior Health Options (MSHO),74.6025,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Coag Factor X Assay, P (Mayo)OutsideLaboratory",,85260,CPT,Facility,Inpatient,,,90,145,123.25,41.557,145,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Coag Factor X Assay, P (Mayo)OutsideLaboratory",,85260,CPT,Facility,Outpatient,,,90,145,123.25,41.557,145,PrimeWest Health,MinnesotaCare,74.472,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Coag Factor X Assay, P (Mayo)OutsideLaboratory",,85260,CPT,Facility,Inpatient,,,90,145,123.25,41.557,145,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Coag Factor X Assay, P (Mayo)OutsideLaboratory",,85260,CPT,Facility,Both,,,90,145,123.25,41.557,145,Sanford Health Plan,Sanford Health Plan,133.4,92,,percent of total billed charges,,
"Coag Factor X Assay, P (Mayo)OutsideLaboratory",,85260,CPT,Facility,Outpatient,,,90,145,123.25,41.557,145,"UCare Health, Inc.",Individual & Family Plan,81.7075,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Coag Factor X Assay, P (Mayo)OutsideLaboratory",,85260,CPT,Facility,Inpatient,,,90,145,123.25,41.557,145,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Coag Factor X Assay, P (Mayo)OutsideLaboratory",,85260,CPT,Facility,Outpatient,,,90,145,123.25,41.557,145,"UCare Health, Inc.",Medical Assistance,73.1815,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Coag Factor X Assay, P (Mayo)OutsideLaboratory",,85260,CPT,Facility,Inpatient,,,90,145,123.25,41.557,145,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Coag Factor X Assay, P (Mayo)OutsideLaboratory",,85260,CPT,Facility,Outpatient,,,90,145,123.25,41.557,145,"UCare Health, Inc.",Medicare Advantage,73.1815,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Coag Factor X Assay, P (Mayo)OutsideLaboratory",,85260,CPT,Facility,Inpatient,,,90,145,123.25,41.557,145,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Coag Factor X Assay, P (Mayo)OutsideLaboratory",,85260,CPT,Facility,Outpatient,,,90,145,123.25,41.557,145,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),73.1815,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Coag Factor X Assay, P (Mayo)OutsideLaboratory",,85260,CPT,Facility,Inpatient,,,90,145,123.25,41.557,145,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Coag Factor X Assay, P (Mayo)OutsideLaboratory",,85260,CPT,Facility,Both,,,90,145,123.25,41.557,145,UnitedHealthcare,Individual & Family,136.3,94,,percent of total billed charges,,
"Coag Factor X Assay, P (Mayo)OutsideLaboratory",,85260,CPT,Facility,Outpatient,,,90,145,123.25,41.557,145,UnitedHealthcare,Medicare Advantage,71.05,49,,percent of total billed charges,,
"Coag Factor X Assay, P (Mayo)OutsideLaboratory",,85260,CPT,Facility,Inpatient,,,90,145,123.25,41.557,145,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Coag Factor X Assay, P (Mayo)OutsideLaboratory",,85260,CPT,Facility,Outpatient,,,90,145,123.25,41.557,145,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,69.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Coag Factor X Assay, P (Mayo)OutsideLaboratory",,85260,CPT,Facility,Inpatient,,,90,145,123.25,41.557,145,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Coag Factor Xi Assay, P (Mayo)OutsideLaboratory",,85270,CPT,Facility,Both,,,90,189,160.65,54.1674,189,Aetna,Commercial,173.88,92,,percent of total billed charges,,
"Coag Factor Xi Assay, P (Mayo)OutsideLaboratory",,85270,CPT,Facility,Outpatient,,,90,189,160.65,54.1674,189,Aetna,Medicare Advantage,92.61,49,,percent of total billed charges,,
"Coag Factor Xi Assay, P (Mayo)OutsideLaboratory",,85270,CPT,Facility,Inpatient,,,90,189,160.65,54.1674,189,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Coag Factor Xi Assay, P (Mayo)OutsideLaboratory",,85270,CPT,Facility,Both,,,90,189,160.65,54.1674,189,Aetna,PPO,175.77,93,,percent of total billed charges,,
"Coag Factor Xi Assay, P (Mayo)OutsideLaboratory",,85270,CPT,Facility,Both,,,90,189,160.65,54.1674,189,America's PPO,America's PPO,181.4967,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Coag Factor Xi Assay, P (Mayo)OutsideLaboratory",,85270,CPT,Facility,Both,,,90,189,160.65,54.1674,189,BlueCross BlueShield Minnesota, Federal Employee Program,185.976,98.4,,percent of total billed charges,,
"Coag Factor Xi Assay, P (Mayo)OutsideLaboratory",,85270,CPT,Facility,Both,,,90,189,160.65,54.1674,189,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,189,100,,percent of total billed charges,,
"Coag Factor Xi Assay, P (Mayo)OutsideLaboratory",,85270,CPT,Facility,Both,,,90,189,160.65,54.1674,189,BlueCross BlueShield Minnesota,High Value Network Plan,170.1,90,,percent of total billed charges,,
"Coag Factor Xi Assay, P (Mayo)OutsideLaboratory",,85270,CPT,Facility,Outpatient,,,90,189,160.65,54.1674,189,BlueCross BlueShield Minnesota,Medicare Advantage,92.61,49,,percent of total billed charges,,
"Coag Factor Xi Assay, P (Mayo)OutsideLaboratory",,85270,CPT,Facility,Inpatient,,,90,189,160.65,54.1674,189,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Coag Factor Xi Assay, P (Mayo)OutsideLaboratory",,85270,CPT,Facility,Both,,,90,189,160.65,54.1674,189,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,167.3973,88.57,,percent of total billed charges,,
"Coag Factor Xi Assay, P (Mayo)OutsideLaboratory",,85270,CPT,Facility,Both,,,90,189,160.65,54.1674,189,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,54.1674,28.66,,percent of total billed charges,,
"Coag Factor Xi Assay, P (Mayo)OutsideLaboratory",,85270,CPT,Facility,Outpatient,,,90,189,160.65,54.1674,189,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),92.61,49,,percent of total billed charges,,
"Coag Factor Xi Assay, P (Mayo)OutsideLaboratory",,85270,CPT,Facility,Inpatient,,,90,189,160.65,54.1674,189,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Coag Factor Xi Assay, P (Mayo)OutsideLaboratory",,85270,CPT,Facility,Both,,,90,189,160.65,54.1674,189,CorVel,Worker's Compensation,189,100,,percent of total billed charges,,
"Coag Factor Xi Assay, P (Mayo)OutsideLaboratory",,85270,CPT,Facility,Both,,,90,189,160.65,54.1674,189,First Health Group Corporation,First Health Network,183.33,97,,percent of total billed charges,,
"Coag Factor Xi Assay, P (Mayo)OutsideLaboratory",,85270,CPT,Facility,Both,,,90,189,160.65,54.1674,189,"Health Partners, Inc.",Commercial,178.794,94.6,,percent of total billed charges,,
"Coag Factor Xi Assay, P (Mayo)OutsideLaboratory",,85270,CPT,Facility,Outpatient,,,90,189,160.65,54.1674,189,"Health Partners, Inc.",Medicare Advantage,92.61,49,,percent of total billed charges,,
"Coag Factor Xi Assay, P (Mayo)OutsideLaboratory",,85270,CPT,Facility,Inpatient,,,90,189,160.65,54.1674,189,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Coag Factor Xi Assay, P (Mayo)OutsideLaboratory",,85270,CPT,Facility,Both,,,90,189,160.65,54.1674,189,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),113.4,60,,percent of total billed charges,,
"Coag Factor Xi Assay, P (Mayo)OutsideLaboratory",,85270,CPT,Facility,Both,,,90,189,160.65,54.1674,189,"Health Partners, Inc.",State of Minnesota Advantage Program,154.035,81.5,,percent of total billed charges,,
"Coag Factor Xi Assay, P (Mayo)OutsideLaboratory",,85270,CPT,Facility,Both,,,90,189,160.65,54.1674,189,"Health Partners, Inc.",State Public Programs,94.5,50,,percent of total billed charges,,
"Coag Factor Xi Assay, P (Mayo)OutsideLaboratory",,85270,CPT,Facility,Both,,,90,189,160.65,54.1674,189,Humana Insurance Company,Commercial PPO,179.55,95,,percent of total billed charges,,
"Coag Factor Xi Assay, P (Mayo)OutsideLaboratory",,85270,CPT,Facility,Outpatient,,,90,189,160.65,54.1674,189,Humana Insurance Company,Medicare PPO,92.61,49,,percent of total billed charges,,
"Coag Factor Xi Assay, P (Mayo)OutsideLaboratory",,85270,CPT,Facility,Inpatient,,,90,189,160.65,54.1674,189,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Coag Factor Xi Assay, P (Mayo)OutsideLaboratory",,85270,CPT,Facility,Both,,,90,189,160.65,54.1674,189,Medica,Individual & Family,187.299,99.1,,percent of total billed charges,,
"Coag Factor Xi Assay, P (Mayo)OutsideLaboratory",,85270,CPT,Facility,Outpatient,,,90,189,160.65,54.1674,189,Medica,Medica Advantage Solution,94.122,49.8,,percent of total billed charges,,
"Coag Factor Xi Assay, P (Mayo)OutsideLaboratory",,85270,CPT,Facility,Inpatient,,,90,189,160.65,54.1674,189,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Coag Factor Xi Assay, P (Mayo)OutsideLaboratory",,85270,CPT,Facility,Outpatient,,,90,189,160.65,54.1674,189,Medica,Medical Assistance,84.294,44.6,,percent of total billed charges,,
"Coag Factor Xi Assay, P (Mayo)OutsideLaboratory",,85270,CPT,Facility,Inpatient,,,90,189,160.65,54.1674,189,Medica,Medical Assistance,,,,,Included in per diem rate,
"Coag Factor Xi Assay, P (Mayo)OutsideLaboratory",,85270,CPT,Facility,Outpatient,,,90,189,160.65,54.1674,189,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,94.122,49.8,,percent of total billed charges,,
"Coag Factor Xi Assay, P (Mayo)OutsideLaboratory",,85270,CPT,Facility,Inpatient,,,90,189,160.65,54.1674,189,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Coag Factor Xi Assay, P (Mayo)OutsideLaboratory",,85270,CPT,Facility,Both,,,90,189,160.65,54.1674,189,"Multiplan, Inc.","Multiplan, Inc.",177.66,94,,percent of total billed charges,,
"Coag Factor Xi Assay, P (Mayo)OutsideLaboratory",,85270,CPT,Facility,Outpatient,,,90,189,160.65,54.1674,189,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,163.296,86.4,,percent of total billed charges,,
"Coag Factor Xi Assay, P (Mayo)OutsideLaboratory",,85270,CPT,Facility,Inpatient,,,90,189,160.65,54.1674,189,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Coag Factor Xi Assay, P (Mayo)OutsideLaboratory",,85270,CPT,Facility,Both,,,90,189,160.65,54.1674,189,"Preferred One Administrative Services, INC.",PPO,186.354,98.6,,percent of total billed charges,,
"Coag Factor Xi Assay, P (Mayo)OutsideLaboratory",,85270,CPT,Facility,Outpatient,,,90,189,160.65,54.1674,189,PrimeWest Health,Minnesota Senior Health Options (MSHO),97.2405,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Coag Factor Xi Assay, P (Mayo)OutsideLaboratory",,85270,CPT,Facility,Inpatient,,,90,189,160.65,54.1674,189,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Coag Factor Xi Assay, P (Mayo)OutsideLaboratory",,85270,CPT,Facility,Outpatient,,,90,189,160.65,54.1674,189,PrimeWest Health,MinnesotaCare,97.0704,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Coag Factor Xi Assay, P (Mayo)OutsideLaboratory",,85270,CPT,Facility,Inpatient,,,90,189,160.65,54.1674,189,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Coag Factor Xi Assay, P (Mayo)OutsideLaboratory",,85270,CPT,Facility,Both,,,90,189,160.65,54.1674,189,Sanford Health Plan,Sanford Health Plan,173.88,92,,percent of total billed charges,,
"Coag Factor Xi Assay, P (Mayo)OutsideLaboratory",,85270,CPT,Facility,Outpatient,,,90,189,160.65,54.1674,189,"UCare Health, Inc.",Individual & Family Plan,106.5015,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Coag Factor Xi Assay, P (Mayo)OutsideLaboratory",,85270,CPT,Facility,Inpatient,,,90,189,160.65,54.1674,189,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Coag Factor Xi Assay, P (Mayo)OutsideLaboratory",,85270,CPT,Facility,Outpatient,,,90,189,160.65,54.1674,189,"UCare Health, Inc.",Medical Assistance,95.3883,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Coag Factor Xi Assay, P (Mayo)OutsideLaboratory",,85270,CPT,Facility,Inpatient,,,90,189,160.65,54.1674,189,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Coag Factor Xi Assay, P (Mayo)OutsideLaboratory",,85270,CPT,Facility,Outpatient,,,90,189,160.65,54.1674,189,"UCare Health, Inc.",Medicare Advantage,95.3883,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Coag Factor Xi Assay, P (Mayo)OutsideLaboratory",,85270,CPT,Facility,Inpatient,,,90,189,160.65,54.1674,189,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Coag Factor Xi Assay, P (Mayo)OutsideLaboratory",,85270,CPT,Facility,Outpatient,,,90,189,160.65,54.1674,189,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),95.3883,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Coag Factor Xi Assay, P (Mayo)OutsideLaboratory",,85270,CPT,Facility,Inpatient,,,90,189,160.65,54.1674,189,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Coag Factor Xi Assay, P (Mayo)OutsideLaboratory",,85270,CPT,Facility,Both,,,90,189,160.65,54.1674,189,UnitedHealthcare,Individual & Family,177.66,94,,percent of total billed charges,,
"Coag Factor Xi Assay, P (Mayo)OutsideLaboratory",,85270,CPT,Facility,Outpatient,,,90,189,160.65,54.1674,189,UnitedHealthcare,Medicare Advantage,92.61,49,,percent of total billed charges,,
"Coag Factor Xi Assay, P (Mayo)OutsideLaboratory",,85270,CPT,Facility,Inpatient,,,90,189,160.65,54.1674,189,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Coag Factor Xi Assay, P (Mayo)OutsideLaboratory",,85270,CPT,Facility,Outpatient,,,90,189,160.65,54.1674,189,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,90.72,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Coag Factor Xi Assay, P (Mayo)OutsideLaboratory",,85270,CPT,Facility,Inpatient,,,90,189,160.65,54.1674,189,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Coag Factor Xii Assay, P (Mayo)OutsideLaboratory",,85280,CPT,Facility,Both,,,90,144,122.4,41.2704,144,Aetna,Commercial,132.48,92,,percent of total billed charges,,
"Coag Factor Xii Assay, P (Mayo)OutsideLaboratory",,85280,CPT,Facility,Outpatient,,,90,144,122.4,41.2704,144,Aetna,Medicare Advantage,70.56,49,,percent of total billed charges,,
"Coag Factor Xii Assay, P (Mayo)OutsideLaboratory",,85280,CPT,Facility,Inpatient,,,90,144,122.4,41.2704,144,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Coag Factor Xii Assay, P (Mayo)OutsideLaboratory",,85280,CPT,Facility,Both,,,90,144,122.4,41.2704,144,Aetna,PPO,133.92,93,,percent of total billed charges,,
"Coag Factor Xii Assay, P (Mayo)OutsideLaboratory",,85280,CPT,Facility,Both,,,90,144,122.4,41.2704,144,America's PPO,America's PPO,138.2832,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Coag Factor Xii Assay, P (Mayo)OutsideLaboratory",,85280,CPT,Facility,Both,,,90,144,122.4,41.2704,144,BlueCross BlueShield Minnesota, Federal Employee Program,141.696,98.4,,percent of total billed charges,,
"Coag Factor Xii Assay, P (Mayo)OutsideLaboratory",,85280,CPT,Facility,Both,,,90,144,122.4,41.2704,144,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,144,100,,percent of total billed charges,,
"Coag Factor Xii Assay, P (Mayo)OutsideLaboratory",,85280,CPT,Facility,Both,,,90,144,122.4,41.2704,144,BlueCross BlueShield Minnesota,High Value Network Plan,129.6,90,,percent of total billed charges,,
"Coag Factor Xii Assay, P (Mayo)OutsideLaboratory",,85280,CPT,Facility,Outpatient,,,90,144,122.4,41.2704,144,BlueCross BlueShield Minnesota,Medicare Advantage,70.56,49,,percent of total billed charges,,
"Coag Factor Xii Assay, P (Mayo)OutsideLaboratory",,85280,CPT,Facility,Inpatient,,,90,144,122.4,41.2704,144,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Coag Factor Xii Assay, P (Mayo)OutsideLaboratory",,85280,CPT,Facility,Both,,,90,144,122.4,41.2704,144,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,127.5408,88.57,,percent of total billed charges,,
"Coag Factor Xii Assay, P (Mayo)OutsideLaboratory",,85280,CPT,Facility,Both,,,90,144,122.4,41.2704,144,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,41.2704,28.66,,percent of total billed charges,,
"Coag Factor Xii Assay, P (Mayo)OutsideLaboratory",,85280,CPT,Facility,Outpatient,,,90,144,122.4,41.2704,144,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),70.56,49,,percent of total billed charges,,
"Coag Factor Xii Assay, P (Mayo)OutsideLaboratory",,85280,CPT,Facility,Inpatient,,,90,144,122.4,41.2704,144,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Coag Factor Xii Assay, P (Mayo)OutsideLaboratory",,85280,CPT,Facility,Both,,,90,144,122.4,41.2704,144,CorVel,Worker's Compensation,144,100,,percent of total billed charges,,
"Coag Factor Xii Assay, P (Mayo)OutsideLaboratory",,85280,CPT,Facility,Both,,,90,144,122.4,41.2704,144,First Health Group Corporation,First Health Network,139.68,97,,percent of total billed charges,,
"Coag Factor Xii Assay, P (Mayo)OutsideLaboratory",,85280,CPT,Facility,Both,,,90,144,122.4,41.2704,144,"Health Partners, Inc.",Commercial,136.224,94.6,,percent of total billed charges,,
"Coag Factor Xii Assay, P (Mayo)OutsideLaboratory",,85280,CPT,Facility,Outpatient,,,90,144,122.4,41.2704,144,"Health Partners, Inc.",Medicare Advantage,70.56,49,,percent of total billed charges,,
"Coag Factor Xii Assay, P (Mayo)OutsideLaboratory",,85280,CPT,Facility,Inpatient,,,90,144,122.4,41.2704,144,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Coag Factor Xii Assay, P (Mayo)OutsideLaboratory",,85280,CPT,Facility,Both,,,90,144,122.4,41.2704,144,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),86.4,60,,percent of total billed charges,,
"Coag Factor Xii Assay, P (Mayo)OutsideLaboratory",,85280,CPT,Facility,Both,,,90,144,122.4,41.2704,144,"Health Partners, Inc.",State of Minnesota Advantage Program,117.36,81.5,,percent of total billed charges,,
"Coag Factor Xii Assay, P (Mayo)OutsideLaboratory",,85280,CPT,Facility,Both,,,90,144,122.4,41.2704,144,"Health Partners, Inc.",State Public Programs,72,50,,percent of total billed charges,,
"Coag Factor Xii Assay, P (Mayo)OutsideLaboratory",,85280,CPT,Facility,Both,,,90,144,122.4,41.2704,144,Humana Insurance Company,Commercial PPO,136.8,95,,percent of total billed charges,,
"Coag Factor Xii Assay, P (Mayo)OutsideLaboratory",,85280,CPT,Facility,Outpatient,,,90,144,122.4,41.2704,144,Humana Insurance Company,Medicare PPO,70.56,49,,percent of total billed charges,,
"Coag Factor Xii Assay, P (Mayo)OutsideLaboratory",,85280,CPT,Facility,Inpatient,,,90,144,122.4,41.2704,144,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Coag Factor Xii Assay, P (Mayo)OutsideLaboratory",,85280,CPT,Facility,Both,,,90,144,122.4,41.2704,144,Medica,Individual & Family,142.704,99.1,,percent of total billed charges,,
"Coag Factor Xii Assay, P (Mayo)OutsideLaboratory",,85280,CPT,Facility,Outpatient,,,90,144,122.4,41.2704,144,Medica,Medica Advantage Solution,71.712,49.8,,percent of total billed charges,,
"Coag Factor Xii Assay, P (Mayo)OutsideLaboratory",,85280,CPT,Facility,Inpatient,,,90,144,122.4,41.2704,144,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Coag Factor Xii Assay, P (Mayo)OutsideLaboratory",,85280,CPT,Facility,Outpatient,,,90,144,122.4,41.2704,144,Medica,Medical Assistance,64.224,44.6,,percent of total billed charges,,
"Coag Factor Xii Assay, P (Mayo)OutsideLaboratory",,85280,CPT,Facility,Inpatient,,,90,144,122.4,41.2704,144,Medica,Medical Assistance,,,,,Included in per diem rate,
"Coag Factor Xii Assay, P (Mayo)OutsideLaboratory",,85280,CPT,Facility,Outpatient,,,90,144,122.4,41.2704,144,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,71.712,49.8,,percent of total billed charges,,
"Coag Factor Xii Assay, P (Mayo)OutsideLaboratory",,85280,CPT,Facility,Inpatient,,,90,144,122.4,41.2704,144,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Coag Factor Xii Assay, P (Mayo)OutsideLaboratory",,85280,CPT,Facility,Both,,,90,144,122.4,41.2704,144,"Multiplan, Inc.","Multiplan, Inc.",135.36,94,,percent of total billed charges,,
"Coag Factor Xii Assay, P (Mayo)OutsideLaboratory",,85280,CPT,Facility,Outpatient,,,90,144,122.4,41.2704,144,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,124.416,86.4,,percent of total billed charges,,
"Coag Factor Xii Assay, P (Mayo)OutsideLaboratory",,85280,CPT,Facility,Inpatient,,,90,144,122.4,41.2704,144,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Coag Factor Xii Assay, P (Mayo)OutsideLaboratory",,85280,CPT,Facility,Both,,,90,144,122.4,41.2704,144,"Preferred One Administrative Services, INC.",PPO,141.984,98.6,,percent of total billed charges,,
"Coag Factor Xii Assay, P (Mayo)OutsideLaboratory",,85280,CPT,Facility,Outpatient,,,90,144,122.4,41.2704,144,PrimeWest Health,Minnesota Senior Health Options (MSHO),74.088,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Coag Factor Xii Assay, P (Mayo)OutsideLaboratory",,85280,CPT,Facility,Inpatient,,,90,144,122.4,41.2704,144,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Coag Factor Xii Assay, P (Mayo)OutsideLaboratory",,85280,CPT,Facility,Outpatient,,,90,144,122.4,41.2704,144,PrimeWest Health,MinnesotaCare,73.9584,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Coag Factor Xii Assay, P (Mayo)OutsideLaboratory",,85280,CPT,Facility,Inpatient,,,90,144,122.4,41.2704,144,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Coag Factor Xii Assay, P (Mayo)OutsideLaboratory",,85280,CPT,Facility,Both,,,90,144,122.4,41.2704,144,Sanford Health Plan,Sanford Health Plan,132.48,92,,percent of total billed charges,,
"Coag Factor Xii Assay, P (Mayo)OutsideLaboratory",,85280,CPT,Facility,Outpatient,,,90,144,122.4,41.2704,144,"UCare Health, Inc.",Individual & Family Plan,81.144,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Coag Factor Xii Assay, P (Mayo)OutsideLaboratory",,85280,CPT,Facility,Inpatient,,,90,144,122.4,41.2704,144,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Coag Factor Xii Assay, P (Mayo)OutsideLaboratory",,85280,CPT,Facility,Outpatient,,,90,144,122.4,41.2704,144,"UCare Health, Inc.",Medical Assistance,72.6768,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Coag Factor Xii Assay, P (Mayo)OutsideLaboratory",,85280,CPT,Facility,Inpatient,,,90,144,122.4,41.2704,144,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Coag Factor Xii Assay, P (Mayo)OutsideLaboratory",,85280,CPT,Facility,Outpatient,,,90,144,122.4,41.2704,144,"UCare Health, Inc.",Medicare Advantage,72.6768,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Coag Factor Xii Assay, P (Mayo)OutsideLaboratory",,85280,CPT,Facility,Inpatient,,,90,144,122.4,41.2704,144,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Coag Factor Xii Assay, P (Mayo)OutsideLaboratory",,85280,CPT,Facility,Outpatient,,,90,144,122.4,41.2704,144,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),72.6768,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Coag Factor Xii Assay, P (Mayo)OutsideLaboratory",,85280,CPT,Facility,Inpatient,,,90,144,122.4,41.2704,144,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Coag Factor Xii Assay, P (Mayo)OutsideLaboratory",,85280,CPT,Facility,Both,,,90,144,122.4,41.2704,144,UnitedHealthcare,Individual & Family,135.36,94,,percent of total billed charges,,
"Coag Factor Xii Assay, P (Mayo)OutsideLaboratory",,85280,CPT,Facility,Outpatient,,,90,144,122.4,41.2704,144,UnitedHealthcare,Medicare Advantage,70.56,49,,percent of total billed charges,,
"Coag Factor Xii Assay, P (Mayo)OutsideLaboratory",,85280,CPT,Facility,Inpatient,,,90,144,122.4,41.2704,144,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Coag Factor Xii Assay, P (Mayo)OutsideLaboratory",,85280,CPT,Facility,Outpatient,,,90,144,122.4,41.2704,144,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,69.12,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Coag Factor Xii Assay, P (Mayo)OutsideLaboratory",,85280,CPT,Facility,Inpatient,,,90,144,122.4,41.2704,144,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Antithrombin Activity (Mayo)OutsideLaboratory,,85300,CPT,Facility,Both,,,90,92,78.2,26.3672,92,Aetna,Commercial,84.64,92,,percent of total billed charges,,
Antithrombin Activity (Mayo)OutsideLaboratory,,85300,CPT,Facility,Outpatient,,,90,92,78.2,26.3672,92,Aetna,Medicare Advantage,45.08,49,,percent of total billed charges,,
Antithrombin Activity (Mayo)OutsideLaboratory,,85300,CPT,Facility,Inpatient,,,90,92,78.2,26.3672,92,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Antithrombin Activity (Mayo)OutsideLaboratory,,85300,CPT,Facility,Both,,,90,92,78.2,26.3672,92,Aetna,PPO,85.56,93,,percent of total billed charges,,
Antithrombin Activity (Mayo)OutsideLaboratory,,85300,CPT,Facility,Both,,,90,92,78.2,26.3672,92,America's PPO,America's PPO,88.3476,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Antithrombin Activity (Mayo)OutsideLaboratory,,85300,CPT,Facility,Both,,,90,92,78.2,26.3672,92,BlueCross BlueShield Minnesota, Federal Employee Program,90.528,98.4,,percent of total billed charges,,
Antithrombin Activity (Mayo)OutsideLaboratory,,85300,CPT,Facility,Both,,,90,92,78.2,26.3672,92,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,92,100,,percent of total billed charges,,
Antithrombin Activity (Mayo)OutsideLaboratory,,85300,CPT,Facility,Both,,,90,92,78.2,26.3672,92,BlueCross BlueShield Minnesota,High Value Network Plan,82.8,90,,percent of total billed charges,,
Antithrombin Activity (Mayo)OutsideLaboratory,,85300,CPT,Facility,Outpatient,,,90,92,78.2,26.3672,92,BlueCross BlueShield Minnesota,Medicare Advantage,45.08,49,,percent of total billed charges,,
Antithrombin Activity (Mayo)OutsideLaboratory,,85300,CPT,Facility,Inpatient,,,90,92,78.2,26.3672,92,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Antithrombin Activity (Mayo)OutsideLaboratory,,85300,CPT,Facility,Both,,,90,92,78.2,26.3672,92,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,81.4844,88.57,,percent of total billed charges,,
Antithrombin Activity (Mayo)OutsideLaboratory,,85300,CPT,Facility,Both,,,90,92,78.2,26.3672,92,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,26.3672,28.66,,percent of total billed charges,,
Antithrombin Activity (Mayo)OutsideLaboratory,,85300,CPT,Facility,Outpatient,,,90,92,78.2,26.3672,92,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),45.08,49,,percent of total billed charges,,
Antithrombin Activity (Mayo)OutsideLaboratory,,85300,CPT,Facility,Inpatient,,,90,92,78.2,26.3672,92,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Antithrombin Activity (Mayo)OutsideLaboratory,,85300,CPT,Facility,Both,,,90,92,78.2,26.3672,92,CorVel,Worker's Compensation,92,100,,percent of total billed charges,,
Antithrombin Activity (Mayo)OutsideLaboratory,,85300,CPT,Facility,Both,,,90,92,78.2,26.3672,92,First Health Group Corporation,First Health Network,89.24,97,,percent of total billed charges,,
Antithrombin Activity (Mayo)OutsideLaboratory,,85300,CPT,Facility,Both,,,90,92,78.2,26.3672,92,"Health Partners, Inc.",Commercial,87.032,94.6,,percent of total billed charges,,
Antithrombin Activity (Mayo)OutsideLaboratory,,85300,CPT,Facility,Outpatient,,,90,92,78.2,26.3672,92,"Health Partners, Inc.",Medicare Advantage,45.08,49,,percent of total billed charges,,
Antithrombin Activity (Mayo)OutsideLaboratory,,85300,CPT,Facility,Inpatient,,,90,92,78.2,26.3672,92,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Antithrombin Activity (Mayo)OutsideLaboratory,,85300,CPT,Facility,Both,,,90,92,78.2,26.3672,92,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),55.2,60,,percent of total billed charges,,
Antithrombin Activity (Mayo)OutsideLaboratory,,85300,CPT,Facility,Both,,,90,92,78.2,26.3672,92,"Health Partners, Inc.",State of Minnesota Advantage Program,74.98,81.5,,percent of total billed charges,,
Antithrombin Activity (Mayo)OutsideLaboratory,,85300,CPT,Facility,Both,,,90,92,78.2,26.3672,92,"Health Partners, Inc.",State Public Programs,46,50,,percent of total billed charges,,
Antithrombin Activity (Mayo)OutsideLaboratory,,85300,CPT,Facility,Both,,,90,92,78.2,26.3672,92,Humana Insurance Company,Commercial PPO,87.4,95,,percent of total billed charges,,
Antithrombin Activity (Mayo)OutsideLaboratory,,85300,CPT,Facility,Outpatient,,,90,92,78.2,26.3672,92,Humana Insurance Company,Medicare PPO,45.08,49,,percent of total billed charges,,
Antithrombin Activity (Mayo)OutsideLaboratory,,85300,CPT,Facility,Inpatient,,,90,92,78.2,26.3672,92,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Antithrombin Activity (Mayo)OutsideLaboratory,,85300,CPT,Facility,Both,,,90,92,78.2,26.3672,92,Medica,Individual & Family,91.172,99.1,,percent of total billed charges,,
Antithrombin Activity (Mayo)OutsideLaboratory,,85300,CPT,Facility,Outpatient,,,90,92,78.2,26.3672,92,Medica,Medica Advantage Solution,45.816,49.8,,percent of total billed charges,,
Antithrombin Activity (Mayo)OutsideLaboratory,,85300,CPT,Facility,Inpatient,,,90,92,78.2,26.3672,92,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Antithrombin Activity (Mayo)OutsideLaboratory,,85300,CPT,Facility,Outpatient,,,90,92,78.2,26.3672,92,Medica,Medical Assistance,41.032,44.6,,percent of total billed charges,,
Antithrombin Activity (Mayo)OutsideLaboratory,,85300,CPT,Facility,Inpatient,,,90,92,78.2,26.3672,92,Medica,Medical Assistance,,,,,Included in per diem rate,
Antithrombin Activity (Mayo)OutsideLaboratory,,85300,CPT,Facility,Outpatient,,,90,92,78.2,26.3672,92,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,45.816,49.8,,percent of total billed charges,,
Antithrombin Activity (Mayo)OutsideLaboratory,,85300,CPT,Facility,Inpatient,,,90,92,78.2,26.3672,92,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Antithrombin Activity (Mayo)OutsideLaboratory,,85300,CPT,Facility,Both,,,90,92,78.2,26.3672,92,"Multiplan, Inc.","Multiplan, Inc.",86.48,94,,percent of total billed charges,,
Antithrombin Activity (Mayo)OutsideLaboratory,,85300,CPT,Facility,Outpatient,,,90,92,78.2,26.3672,92,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,79.488,86.4,,percent of total billed charges,,
Antithrombin Activity (Mayo)OutsideLaboratory,,85300,CPT,Facility,Inpatient,,,90,92,78.2,26.3672,92,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Antithrombin Activity (Mayo)OutsideLaboratory,,85300,CPT,Facility,Both,,,90,92,78.2,26.3672,92,"Preferred One Administrative Services, INC.",PPO,90.712,98.6,,percent of total billed charges,,
Antithrombin Activity (Mayo)OutsideLaboratory,,85300,CPT,Facility,Outpatient,,,90,92,78.2,26.3672,92,PrimeWest Health,Minnesota Senior Health Options (MSHO),47.334,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Antithrombin Activity (Mayo)OutsideLaboratory,,85300,CPT,Facility,Inpatient,,,90,92,78.2,26.3672,92,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Antithrombin Activity (Mayo)OutsideLaboratory,,85300,CPT,Facility,Outpatient,,,90,92,78.2,26.3672,92,PrimeWest Health,MinnesotaCare,47.2512,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Antithrombin Activity (Mayo)OutsideLaboratory,,85300,CPT,Facility,Inpatient,,,90,92,78.2,26.3672,92,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Antithrombin Activity (Mayo)OutsideLaboratory,,85300,CPT,Facility,Both,,,90,92,78.2,26.3672,92,Sanford Health Plan,Sanford Health Plan,84.64,92,,percent of total billed charges,,
Antithrombin Activity (Mayo)OutsideLaboratory,,85300,CPT,Facility,Outpatient,,,90,92,78.2,26.3672,92,"UCare Health, Inc.",Individual & Family Plan,51.842,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Antithrombin Activity (Mayo)OutsideLaboratory,,85300,CPT,Facility,Inpatient,,,90,92,78.2,26.3672,92,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Antithrombin Activity (Mayo)OutsideLaboratory,,85300,CPT,Facility,Outpatient,,,90,92,78.2,26.3672,92,"UCare Health, Inc.",Medical Assistance,46.4324,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Antithrombin Activity (Mayo)OutsideLaboratory,,85300,CPT,Facility,Inpatient,,,90,92,78.2,26.3672,92,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Antithrombin Activity (Mayo)OutsideLaboratory,,85300,CPT,Facility,Outpatient,,,90,92,78.2,26.3672,92,"UCare Health, Inc.",Medicare Advantage,46.4324,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Antithrombin Activity (Mayo)OutsideLaboratory,,85300,CPT,Facility,Inpatient,,,90,92,78.2,26.3672,92,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Antithrombin Activity (Mayo)OutsideLaboratory,,85300,CPT,Facility,Outpatient,,,90,92,78.2,26.3672,92,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),46.4324,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Antithrombin Activity (Mayo)OutsideLaboratory,,85300,CPT,Facility,Inpatient,,,90,92,78.2,26.3672,92,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Antithrombin Activity (Mayo)OutsideLaboratory,,85300,CPT,Facility,Both,,,90,92,78.2,26.3672,92,UnitedHealthcare,Individual & Family,86.48,94,,percent of total billed charges,,
Antithrombin Activity (Mayo)OutsideLaboratory,,85300,CPT,Facility,Outpatient,,,90,92,78.2,26.3672,92,UnitedHealthcare,Medicare Advantage,45.08,49,,percent of total billed charges,,
Antithrombin Activity (Mayo)OutsideLaboratory,,85300,CPT,Facility,Inpatient,,,90,92,78.2,26.3672,92,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Antithrombin Activity (Mayo)OutsideLaboratory,,85300,CPT,Facility,Outpatient,,,90,92,78.2,26.3672,92,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,44.16,48,,percent of total billed charges,,100% of DHS outpatient percentage
Antithrombin Activity (Mayo)OutsideLaboratory,,85300,CPT,Facility,Inpatient,,,90,92,78.2,26.3672,92,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Clotting Inhibitors Or Anticoagulants; Antithrombin Iii, Activity (Mayo)OutsideLaboratory",,85300,CPT,Facility,Both,,,90,92,78.2,26.3672,92,Aetna,Commercial,84.64,92,,percent of total billed charges,,
"Clotting Inhibitors Or Anticoagulants; Antithrombin Iii, Activity (Mayo)OutsideLaboratory",,85300,CPT,Facility,Outpatient,,,90,92,78.2,26.3672,92,Aetna,Medicare Advantage,45.08,49,,percent of total billed charges,,
"Clotting Inhibitors Or Anticoagulants; Antithrombin Iii, Activity (Mayo)OutsideLaboratory",,85300,CPT,Facility,Inpatient,,,90,92,78.2,26.3672,92,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Clotting Inhibitors Or Anticoagulants; Antithrombin Iii, Activity (Mayo)OutsideLaboratory",,85300,CPT,Facility,Both,,,90,92,78.2,26.3672,92,Aetna,PPO,85.56,93,,percent of total billed charges,,
"Clotting Inhibitors Or Anticoagulants; Antithrombin Iii, Activity (Mayo)OutsideLaboratory",,85300,CPT,Facility,Both,,,90,92,78.2,26.3672,92,America's PPO,America's PPO,88.3476,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Clotting Inhibitors Or Anticoagulants; Antithrombin Iii, Activity (Mayo)OutsideLaboratory",,85300,CPT,Facility,Both,,,90,92,78.2,26.3672,92,BlueCross BlueShield Minnesota, Federal Employee Program,90.528,98.4,,percent of total billed charges,,
"Clotting Inhibitors Or Anticoagulants; Antithrombin Iii, Activity (Mayo)OutsideLaboratory",,85300,CPT,Facility,Both,,,90,92,78.2,26.3672,92,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,92,100,,percent of total billed charges,,
"Clotting Inhibitors Or Anticoagulants; Antithrombin Iii, Activity (Mayo)OutsideLaboratory",,85300,CPT,Facility,Both,,,90,92,78.2,26.3672,92,BlueCross BlueShield Minnesota,High Value Network Plan,82.8,90,,percent of total billed charges,,
"Clotting Inhibitors Or Anticoagulants; Antithrombin Iii, Activity (Mayo)OutsideLaboratory",,85300,CPT,Facility,Outpatient,,,90,92,78.2,26.3672,92,BlueCross BlueShield Minnesota,Medicare Advantage,45.08,49,,percent of total billed charges,,
"Clotting Inhibitors Or Anticoagulants; Antithrombin Iii, Activity (Mayo)OutsideLaboratory",,85300,CPT,Facility,Inpatient,,,90,92,78.2,26.3672,92,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Clotting Inhibitors Or Anticoagulants; Antithrombin Iii, Activity (Mayo)OutsideLaboratory",,85300,CPT,Facility,Both,,,90,92,78.2,26.3672,92,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,81.4844,88.57,,percent of total billed charges,,
"Clotting Inhibitors Or Anticoagulants; Antithrombin Iii, Activity (Mayo)OutsideLaboratory",,85300,CPT,Facility,Both,,,90,92,78.2,26.3672,92,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,26.3672,28.66,,percent of total billed charges,,
"Clotting Inhibitors Or Anticoagulants; Antithrombin Iii, Activity (Mayo)OutsideLaboratory",,85300,CPT,Facility,Outpatient,,,90,92,78.2,26.3672,92,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),45.08,49,,percent of total billed charges,,
"Clotting Inhibitors Or Anticoagulants; Antithrombin Iii, Activity (Mayo)OutsideLaboratory",,85300,CPT,Facility,Inpatient,,,90,92,78.2,26.3672,92,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Clotting Inhibitors Or Anticoagulants; Antithrombin Iii, Activity (Mayo)OutsideLaboratory",,85300,CPT,Facility,Both,,,90,92,78.2,26.3672,92,CorVel,Worker's Compensation,92,100,,percent of total billed charges,,
"Clotting Inhibitors Or Anticoagulants; Antithrombin Iii, Activity (Mayo)OutsideLaboratory",,85300,CPT,Facility,Both,,,90,92,78.2,26.3672,92,First Health Group Corporation,First Health Network,89.24,97,,percent of total billed charges,,
"Clotting Inhibitors Or Anticoagulants; Antithrombin Iii, Activity (Mayo)OutsideLaboratory",,85300,CPT,Facility,Both,,,90,92,78.2,26.3672,92,"Health Partners, Inc.",Commercial,87.032,94.6,,percent of total billed charges,,
"Clotting Inhibitors Or Anticoagulants; Antithrombin Iii, Activity (Mayo)OutsideLaboratory",,85300,CPT,Facility,Outpatient,,,90,92,78.2,26.3672,92,"Health Partners, Inc.",Medicare Advantage,45.08,49,,percent of total billed charges,,
"Clotting Inhibitors Or Anticoagulants; Antithrombin Iii, Activity (Mayo)OutsideLaboratory",,85300,CPT,Facility,Inpatient,,,90,92,78.2,26.3672,92,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Clotting Inhibitors Or Anticoagulants; Antithrombin Iii, Activity (Mayo)OutsideLaboratory",,85300,CPT,Facility,Both,,,90,92,78.2,26.3672,92,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),55.2,60,,percent of total billed charges,,
"Clotting Inhibitors Or Anticoagulants; Antithrombin Iii, Activity (Mayo)OutsideLaboratory",,85300,CPT,Facility,Both,,,90,92,78.2,26.3672,92,"Health Partners, Inc.",State of Minnesota Advantage Program,74.98,81.5,,percent of total billed charges,,
"Clotting Inhibitors Or Anticoagulants; Antithrombin Iii, Activity (Mayo)OutsideLaboratory",,85300,CPT,Facility,Both,,,90,92,78.2,26.3672,92,"Health Partners, Inc.",State Public Programs,46,50,,percent of total billed charges,,
"Clotting Inhibitors Or Anticoagulants; Antithrombin Iii, Activity (Mayo)OutsideLaboratory",,85300,CPT,Facility,Both,,,90,92,78.2,26.3672,92,Humana Insurance Company,Commercial PPO,87.4,95,,percent of total billed charges,,
"Clotting Inhibitors Or Anticoagulants; Antithrombin Iii, Activity (Mayo)OutsideLaboratory",,85300,CPT,Facility,Outpatient,,,90,92,78.2,26.3672,92,Humana Insurance Company,Medicare PPO,45.08,49,,percent of total billed charges,,
"Clotting Inhibitors Or Anticoagulants; Antithrombin Iii, Activity (Mayo)OutsideLaboratory",,85300,CPT,Facility,Inpatient,,,90,92,78.2,26.3672,92,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Clotting Inhibitors Or Anticoagulants; Antithrombin Iii, Activity (Mayo)OutsideLaboratory",,85300,CPT,Facility,Both,,,90,92,78.2,26.3672,92,Medica,Individual & Family,91.172,99.1,,percent of total billed charges,,
"Clotting Inhibitors Or Anticoagulants; Antithrombin Iii, Activity (Mayo)OutsideLaboratory",,85300,CPT,Facility,Outpatient,,,90,92,78.2,26.3672,92,Medica,Medica Advantage Solution,45.816,49.8,,percent of total billed charges,,
"Clotting Inhibitors Or Anticoagulants; Antithrombin Iii, Activity (Mayo)OutsideLaboratory",,85300,CPT,Facility,Inpatient,,,90,92,78.2,26.3672,92,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Clotting Inhibitors Or Anticoagulants; Antithrombin Iii, Activity (Mayo)OutsideLaboratory",,85300,CPT,Facility,Outpatient,,,90,92,78.2,26.3672,92,Medica,Medical Assistance,41.032,44.6,,percent of total billed charges,,
"Clotting Inhibitors Or Anticoagulants; Antithrombin Iii, Activity (Mayo)OutsideLaboratory",,85300,CPT,Facility,Inpatient,,,90,92,78.2,26.3672,92,Medica,Medical Assistance,,,,,Included in per diem rate,
"Clotting Inhibitors Or Anticoagulants; Antithrombin Iii, Activity (Mayo)OutsideLaboratory",,85300,CPT,Facility,Outpatient,,,90,92,78.2,26.3672,92,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,45.816,49.8,,percent of total billed charges,,
"Clotting Inhibitors Or Anticoagulants; Antithrombin Iii, Activity (Mayo)OutsideLaboratory",,85300,CPT,Facility,Inpatient,,,90,92,78.2,26.3672,92,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Clotting Inhibitors Or Anticoagulants; Antithrombin Iii, Activity (Mayo)OutsideLaboratory",,85300,CPT,Facility,Both,,,90,92,78.2,26.3672,92,"Multiplan, Inc.","Multiplan, Inc.",86.48,94,,percent of total billed charges,,
"Clotting Inhibitors Or Anticoagulants; Antithrombin Iii, Activity (Mayo)OutsideLaboratory",,85300,CPT,Facility,Outpatient,,,90,92,78.2,26.3672,92,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,79.488,86.4,,percent of total billed charges,,
"Clotting Inhibitors Or Anticoagulants; Antithrombin Iii, Activity (Mayo)OutsideLaboratory",,85300,CPT,Facility,Inpatient,,,90,92,78.2,26.3672,92,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Clotting Inhibitors Or Anticoagulants; Antithrombin Iii, Activity (Mayo)OutsideLaboratory",,85300,CPT,Facility,Both,,,90,92,78.2,26.3672,92,"Preferred One Administrative Services, INC.",PPO,90.712,98.6,,percent of total billed charges,,
"Clotting Inhibitors Or Anticoagulants; Antithrombin Iii, Activity (Mayo)OutsideLaboratory",,85300,CPT,Facility,Outpatient,,,90,92,78.2,26.3672,92,PrimeWest Health,Minnesota Senior Health Options (MSHO),47.334,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Clotting Inhibitors Or Anticoagulants; Antithrombin Iii, Activity (Mayo)OutsideLaboratory",,85300,CPT,Facility,Inpatient,,,90,92,78.2,26.3672,92,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Clotting Inhibitors Or Anticoagulants; Antithrombin Iii, Activity (Mayo)OutsideLaboratory",,85300,CPT,Facility,Outpatient,,,90,92,78.2,26.3672,92,PrimeWest Health,MinnesotaCare,47.2512,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Clotting Inhibitors Or Anticoagulants; Antithrombin Iii, Activity (Mayo)OutsideLaboratory",,85300,CPT,Facility,Inpatient,,,90,92,78.2,26.3672,92,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Clotting Inhibitors Or Anticoagulants; Antithrombin Iii, Activity (Mayo)OutsideLaboratory",,85300,CPT,Facility,Both,,,90,92,78.2,26.3672,92,Sanford Health Plan,Sanford Health Plan,84.64,92,,percent of total billed charges,,
"Clotting Inhibitors Or Anticoagulants; Antithrombin Iii, Activity (Mayo)OutsideLaboratory",,85300,CPT,Facility,Outpatient,,,90,92,78.2,26.3672,92,"UCare Health, Inc.",Individual & Family Plan,51.842,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Clotting Inhibitors Or Anticoagulants; Antithrombin Iii, Activity (Mayo)OutsideLaboratory",,85300,CPT,Facility,Inpatient,,,90,92,78.2,26.3672,92,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Clotting Inhibitors Or Anticoagulants; Antithrombin Iii, Activity (Mayo)OutsideLaboratory",,85300,CPT,Facility,Outpatient,,,90,92,78.2,26.3672,92,"UCare Health, Inc.",Medical Assistance,46.4324,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Clotting Inhibitors Or Anticoagulants; Antithrombin Iii, Activity (Mayo)OutsideLaboratory",,85300,CPT,Facility,Inpatient,,,90,92,78.2,26.3672,92,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Clotting Inhibitors Or Anticoagulants; Antithrombin Iii, Activity (Mayo)OutsideLaboratory",,85300,CPT,Facility,Outpatient,,,90,92,78.2,26.3672,92,"UCare Health, Inc.",Medicare Advantage,46.4324,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Clotting Inhibitors Or Anticoagulants; Antithrombin Iii, Activity (Mayo)OutsideLaboratory",,85300,CPT,Facility,Inpatient,,,90,92,78.2,26.3672,92,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Clotting Inhibitors Or Anticoagulants; Antithrombin Iii, Activity (Mayo)OutsideLaboratory",,85300,CPT,Facility,Outpatient,,,90,92,78.2,26.3672,92,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),46.4324,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Clotting Inhibitors Or Anticoagulants; Antithrombin Iii, Activity (Mayo)OutsideLaboratory",,85300,CPT,Facility,Inpatient,,,90,92,78.2,26.3672,92,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Clotting Inhibitors Or Anticoagulants; Antithrombin Iii, Activity (Mayo)OutsideLaboratory",,85300,CPT,Facility,Both,,,90,92,78.2,26.3672,92,UnitedHealthcare,Individual & Family,86.48,94,,percent of total billed charges,,
"Clotting Inhibitors Or Anticoagulants; Antithrombin Iii, Activity (Mayo)OutsideLaboratory",,85300,CPT,Facility,Outpatient,,,90,92,78.2,26.3672,92,UnitedHealthcare,Medicare Advantage,45.08,49,,percent of total billed charges,,
"Clotting Inhibitors Or Anticoagulants; Antithrombin Iii, Activity (Mayo)OutsideLaboratory",,85300,CPT,Facility,Inpatient,,,90,92,78.2,26.3672,92,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Clotting Inhibitors Or Anticoagulants; Antithrombin Iii, Activity (Mayo)OutsideLaboratory",,85300,CPT,Facility,Outpatient,,,90,92,78.2,26.3672,92,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,44.16,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Clotting Inhibitors Or Anticoagulants; Antithrombin Iii, Activity (Mayo)OutsideLaboratory",,85300,CPT,Facility,Inpatient,,,90,92,78.2,26.3672,92,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Clotting Inhibitors Or Anticoagulants; Protein C, Activity (Mayo)OutsideLaboratory",,85303,CPT,Facility,Both,,,90,93,79.05,26.6538,93,Aetna,Commercial,85.56,92,,percent of total billed charges,,
"Clotting Inhibitors Or Anticoagulants; Protein C, Activity (Mayo)OutsideLaboratory",,85303,CPT,Facility,Outpatient,,,90,93,79.05,26.6538,93,Aetna,Medicare Advantage,45.57,49,,percent of total billed charges,,
"Clotting Inhibitors Or Anticoagulants; Protein C, Activity (Mayo)OutsideLaboratory",,85303,CPT,Facility,Inpatient,,,90,93,79.05,26.6538,93,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Clotting Inhibitors Or Anticoagulants; Protein C, Activity (Mayo)OutsideLaboratory",,85303,CPT,Facility,Both,,,90,93,79.05,26.6538,93,Aetna,PPO,86.49,93,,percent of total billed charges,,
"Clotting Inhibitors Or Anticoagulants; Protein C, Activity (Mayo)OutsideLaboratory",,85303,CPT,Facility,Both,,,90,93,79.05,26.6538,93,America's PPO,America's PPO,89.3079,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Clotting Inhibitors Or Anticoagulants; Protein C, Activity (Mayo)OutsideLaboratory",,85303,CPT,Facility,Both,,,90,93,79.05,26.6538,93,BlueCross BlueShield Minnesota, Federal Employee Program,91.512,98.4,,percent of total billed charges,,
"Clotting Inhibitors Or Anticoagulants; Protein C, Activity (Mayo)OutsideLaboratory",,85303,CPT,Facility,Both,,,90,93,79.05,26.6538,93,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,93,100,,percent of total billed charges,,
"Clotting Inhibitors Or Anticoagulants; Protein C, Activity (Mayo)OutsideLaboratory",,85303,CPT,Facility,Both,,,90,93,79.05,26.6538,93,BlueCross BlueShield Minnesota,High Value Network Plan,83.7,90,,percent of total billed charges,,
"Clotting Inhibitors Or Anticoagulants; Protein C, Activity (Mayo)OutsideLaboratory",,85303,CPT,Facility,Outpatient,,,90,93,79.05,26.6538,93,BlueCross BlueShield Minnesota,Medicare Advantage,45.57,49,,percent of total billed charges,,
"Clotting Inhibitors Or Anticoagulants; Protein C, Activity (Mayo)OutsideLaboratory",,85303,CPT,Facility,Inpatient,,,90,93,79.05,26.6538,93,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Clotting Inhibitors Or Anticoagulants; Protein C, Activity (Mayo)OutsideLaboratory",,85303,CPT,Facility,Both,,,90,93,79.05,26.6538,93,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,82.3701,88.57,,percent of total billed charges,,
"Clotting Inhibitors Or Anticoagulants; Protein C, Activity (Mayo)OutsideLaboratory",,85303,CPT,Facility,Both,,,90,93,79.05,26.6538,93,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,26.6538,28.66,,percent of total billed charges,,
"Clotting Inhibitors Or Anticoagulants; Protein C, Activity (Mayo)OutsideLaboratory",,85303,CPT,Facility,Outpatient,,,90,93,79.05,26.6538,93,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),45.57,49,,percent of total billed charges,,
"Clotting Inhibitors Or Anticoagulants; Protein C, Activity (Mayo)OutsideLaboratory",,85303,CPT,Facility,Inpatient,,,90,93,79.05,26.6538,93,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Clotting Inhibitors Or Anticoagulants; Protein C, Activity (Mayo)OutsideLaboratory",,85303,CPT,Facility,Both,,,90,93,79.05,26.6538,93,CorVel,Worker's Compensation,93,100,,percent of total billed charges,,
"Clotting Inhibitors Or Anticoagulants; Protein C, Activity (Mayo)OutsideLaboratory",,85303,CPT,Facility,Both,,,90,93,79.05,26.6538,93,First Health Group Corporation,First Health Network,90.21,97,,percent of total billed charges,,
"Clotting Inhibitors Or Anticoagulants; Protein C, Activity (Mayo)OutsideLaboratory",,85303,CPT,Facility,Both,,,90,93,79.05,26.6538,93,"Health Partners, Inc.",Commercial,87.978,94.6,,percent of total billed charges,,
"Clotting Inhibitors Or Anticoagulants; Protein C, Activity (Mayo)OutsideLaboratory",,85303,CPT,Facility,Outpatient,,,90,93,79.05,26.6538,93,"Health Partners, Inc.",Medicare Advantage,45.57,49,,percent of total billed charges,,
"Clotting Inhibitors Or Anticoagulants; Protein C, Activity (Mayo)OutsideLaboratory",,85303,CPT,Facility,Inpatient,,,90,93,79.05,26.6538,93,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Clotting Inhibitors Or Anticoagulants; Protein C, Activity (Mayo)OutsideLaboratory",,85303,CPT,Facility,Both,,,90,93,79.05,26.6538,93,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),55.8,60,,percent of total billed charges,,
"Clotting Inhibitors Or Anticoagulants; Protein C, Activity (Mayo)OutsideLaboratory",,85303,CPT,Facility,Both,,,90,93,79.05,26.6538,93,"Health Partners, Inc.",State of Minnesota Advantage Program,75.795,81.5,,percent of total billed charges,,
"Clotting Inhibitors Or Anticoagulants; Protein C, Activity (Mayo)OutsideLaboratory",,85303,CPT,Facility,Both,,,90,93,79.05,26.6538,93,"Health Partners, Inc.",State Public Programs,46.5,50,,percent of total billed charges,,
"Clotting Inhibitors Or Anticoagulants; Protein C, Activity (Mayo)OutsideLaboratory",,85303,CPT,Facility,Both,,,90,93,79.05,26.6538,93,Humana Insurance Company,Commercial PPO,88.35,95,,percent of total billed charges,,
"Clotting Inhibitors Or Anticoagulants; Protein C, Activity (Mayo)OutsideLaboratory",,85303,CPT,Facility,Outpatient,,,90,93,79.05,26.6538,93,Humana Insurance Company,Medicare PPO,45.57,49,,percent of total billed charges,,
"Clotting Inhibitors Or Anticoagulants; Protein C, Activity (Mayo)OutsideLaboratory",,85303,CPT,Facility,Inpatient,,,90,93,79.05,26.6538,93,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Clotting Inhibitors Or Anticoagulants; Protein C, Activity (Mayo)OutsideLaboratory",,85303,CPT,Facility,Both,,,90,93,79.05,26.6538,93,Medica,Individual & Family,92.163,99.1,,percent of total billed charges,,
"Clotting Inhibitors Or Anticoagulants; Protein C, Activity (Mayo)OutsideLaboratory",,85303,CPT,Facility,Outpatient,,,90,93,79.05,26.6538,93,Medica,Medica Advantage Solution,46.314,49.8,,percent of total billed charges,,
"Clotting Inhibitors Or Anticoagulants; Protein C, Activity (Mayo)OutsideLaboratory",,85303,CPT,Facility,Inpatient,,,90,93,79.05,26.6538,93,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Clotting Inhibitors Or Anticoagulants; Protein C, Activity (Mayo)OutsideLaboratory",,85303,CPT,Facility,Outpatient,,,90,93,79.05,26.6538,93,Medica,Medical Assistance,41.478,44.6,,percent of total billed charges,,
"Clotting Inhibitors Or Anticoagulants; Protein C, Activity (Mayo)OutsideLaboratory",,85303,CPT,Facility,Inpatient,,,90,93,79.05,26.6538,93,Medica,Medical Assistance,,,,,Included in per diem rate,
"Clotting Inhibitors Or Anticoagulants; Protein C, Activity (Mayo)OutsideLaboratory",,85303,CPT,Facility,Outpatient,,,90,93,79.05,26.6538,93,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,46.314,49.8,,percent of total billed charges,,
"Clotting Inhibitors Or Anticoagulants; Protein C, Activity (Mayo)OutsideLaboratory",,85303,CPT,Facility,Inpatient,,,90,93,79.05,26.6538,93,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Clotting Inhibitors Or Anticoagulants; Protein C, Activity (Mayo)OutsideLaboratory",,85303,CPT,Facility,Both,,,90,93,79.05,26.6538,93,"Multiplan, Inc.","Multiplan, Inc.",87.42,94,,percent of total billed charges,,
"Clotting Inhibitors Or Anticoagulants; Protein C, Activity (Mayo)OutsideLaboratory",,85303,CPT,Facility,Outpatient,,,90,93,79.05,26.6538,93,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,80.352,86.4,,percent of total billed charges,,
"Clotting Inhibitors Or Anticoagulants; Protein C, Activity (Mayo)OutsideLaboratory",,85303,CPT,Facility,Inpatient,,,90,93,79.05,26.6538,93,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Clotting Inhibitors Or Anticoagulants; Protein C, Activity (Mayo)OutsideLaboratory",,85303,CPT,Facility,Both,,,90,93,79.05,26.6538,93,"Preferred One Administrative Services, INC.",PPO,91.698,98.6,,percent of total billed charges,,
"Clotting Inhibitors Or Anticoagulants; Protein C, Activity (Mayo)OutsideLaboratory",,85303,CPT,Facility,Outpatient,,,90,93,79.05,26.6538,93,PrimeWest Health,Minnesota Senior Health Options (MSHO),47.8485,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Clotting Inhibitors Or Anticoagulants; Protein C, Activity (Mayo)OutsideLaboratory",,85303,CPT,Facility,Inpatient,,,90,93,79.05,26.6538,93,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Clotting Inhibitors Or Anticoagulants; Protein C, Activity (Mayo)OutsideLaboratory",,85303,CPT,Facility,Outpatient,,,90,93,79.05,26.6538,93,PrimeWest Health,MinnesotaCare,47.7648,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Clotting Inhibitors Or Anticoagulants; Protein C, Activity (Mayo)OutsideLaboratory",,85303,CPT,Facility,Inpatient,,,90,93,79.05,26.6538,93,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Clotting Inhibitors Or Anticoagulants; Protein C, Activity (Mayo)OutsideLaboratory",,85303,CPT,Facility,Both,,,90,93,79.05,26.6538,93,Sanford Health Plan,Sanford Health Plan,85.56,92,,percent of total billed charges,,
"Clotting Inhibitors Or Anticoagulants; Protein C, Activity (Mayo)OutsideLaboratory",,85303,CPT,Facility,Outpatient,,,90,93,79.05,26.6538,93,"UCare Health, Inc.",Individual & Family Plan,52.4055,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Clotting Inhibitors Or Anticoagulants; Protein C, Activity (Mayo)OutsideLaboratory",,85303,CPT,Facility,Inpatient,,,90,93,79.05,26.6538,93,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Clotting Inhibitors Or Anticoagulants; Protein C, Activity (Mayo)OutsideLaboratory",,85303,CPT,Facility,Outpatient,,,90,93,79.05,26.6538,93,"UCare Health, Inc.",Medical Assistance,46.9371,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Clotting Inhibitors Or Anticoagulants; Protein C, Activity (Mayo)OutsideLaboratory",,85303,CPT,Facility,Inpatient,,,90,93,79.05,26.6538,93,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Clotting Inhibitors Or Anticoagulants; Protein C, Activity (Mayo)OutsideLaboratory",,85303,CPT,Facility,Outpatient,,,90,93,79.05,26.6538,93,"UCare Health, Inc.",Medicare Advantage,46.9371,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Clotting Inhibitors Or Anticoagulants; Protein C, Activity (Mayo)OutsideLaboratory",,85303,CPT,Facility,Inpatient,,,90,93,79.05,26.6538,93,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Clotting Inhibitors Or Anticoagulants; Protein C, Activity (Mayo)OutsideLaboratory",,85303,CPT,Facility,Outpatient,,,90,93,79.05,26.6538,93,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),46.9371,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Clotting Inhibitors Or Anticoagulants; Protein C, Activity (Mayo)OutsideLaboratory",,85303,CPT,Facility,Inpatient,,,90,93,79.05,26.6538,93,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Clotting Inhibitors Or Anticoagulants; Protein C, Activity (Mayo)OutsideLaboratory",,85303,CPT,Facility,Both,,,90,93,79.05,26.6538,93,UnitedHealthcare,Individual & Family,87.42,94,,percent of total billed charges,,
"Clotting Inhibitors Or Anticoagulants; Protein C, Activity (Mayo)OutsideLaboratory",,85303,CPT,Facility,Outpatient,,,90,93,79.05,26.6538,93,UnitedHealthcare,Medicare Advantage,45.57,49,,percent of total billed charges,,
"Clotting Inhibitors Or Anticoagulants; Protein C, Activity (Mayo)OutsideLaboratory",,85303,CPT,Facility,Inpatient,,,90,93,79.05,26.6538,93,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Clotting Inhibitors Or Anticoagulants; Protein C, Activity (Mayo)OutsideLaboratory",,85303,CPT,Facility,Outpatient,,,90,93,79.05,26.6538,93,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,44.64,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Clotting Inhibitors Or Anticoagulants; Protein C, Activity (Mayo)OutsideLaboratory",,85303,CPT,Facility,Inpatient,,,90,93,79.05,26.6538,93,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Protein C Activity, P (Mayo)OutsideLaboratory",,85303,CPT,Facility,Both,,,90,93,79.05,26.6538,93,Aetna,Commercial,85.56,92,,percent of total billed charges,,
"Protein C Activity, P (Mayo)OutsideLaboratory",,85303,CPT,Facility,Outpatient,,,90,93,79.05,26.6538,93,Aetna,Medicare Advantage,45.57,49,,percent of total billed charges,,
"Protein C Activity, P (Mayo)OutsideLaboratory",,85303,CPT,Facility,Inpatient,,,90,93,79.05,26.6538,93,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Protein C Activity, P (Mayo)OutsideLaboratory",,85303,CPT,Facility,Both,,,90,93,79.05,26.6538,93,Aetna,PPO,86.49,93,,percent of total billed charges,,
"Protein C Activity, P (Mayo)OutsideLaboratory",,85303,CPT,Facility,Both,,,90,93,79.05,26.6538,93,America's PPO,America's PPO,89.3079,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Protein C Activity, P (Mayo)OutsideLaboratory",,85303,CPT,Facility,Both,,,90,93,79.05,26.6538,93,BlueCross BlueShield Minnesota, Federal Employee Program,91.512,98.4,,percent of total billed charges,,
"Protein C Activity, P (Mayo)OutsideLaboratory",,85303,CPT,Facility,Both,,,90,93,79.05,26.6538,93,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,93,100,,percent of total billed charges,,
"Protein C Activity, P (Mayo)OutsideLaboratory",,85303,CPT,Facility,Both,,,90,93,79.05,26.6538,93,BlueCross BlueShield Minnesota,High Value Network Plan,83.7,90,,percent of total billed charges,,
"Protein C Activity, P (Mayo)OutsideLaboratory",,85303,CPT,Facility,Outpatient,,,90,93,79.05,26.6538,93,BlueCross BlueShield Minnesota,Medicare Advantage,45.57,49,,percent of total billed charges,,
"Protein C Activity, P (Mayo)OutsideLaboratory",,85303,CPT,Facility,Inpatient,,,90,93,79.05,26.6538,93,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Protein C Activity, P (Mayo)OutsideLaboratory",,85303,CPT,Facility,Both,,,90,93,79.05,26.6538,93,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,82.3701,88.57,,percent of total billed charges,,
"Protein C Activity, P (Mayo)OutsideLaboratory",,85303,CPT,Facility,Both,,,90,93,79.05,26.6538,93,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,26.6538,28.66,,percent of total billed charges,,
"Protein C Activity, P (Mayo)OutsideLaboratory",,85303,CPT,Facility,Outpatient,,,90,93,79.05,26.6538,93,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),45.57,49,,percent of total billed charges,,
"Protein C Activity, P (Mayo)OutsideLaboratory",,85303,CPT,Facility,Inpatient,,,90,93,79.05,26.6538,93,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Protein C Activity, P (Mayo)OutsideLaboratory",,85303,CPT,Facility,Both,,,90,93,79.05,26.6538,93,CorVel,Worker's Compensation,93,100,,percent of total billed charges,,
"Protein C Activity, P (Mayo)OutsideLaboratory",,85303,CPT,Facility,Both,,,90,93,79.05,26.6538,93,First Health Group Corporation,First Health Network,90.21,97,,percent of total billed charges,,
"Protein C Activity, P (Mayo)OutsideLaboratory",,85303,CPT,Facility,Both,,,90,93,79.05,26.6538,93,"Health Partners, Inc.",Commercial,87.978,94.6,,percent of total billed charges,,
"Protein C Activity, P (Mayo)OutsideLaboratory",,85303,CPT,Facility,Outpatient,,,90,93,79.05,26.6538,93,"Health Partners, Inc.",Medicare Advantage,45.57,49,,percent of total billed charges,,
"Protein C Activity, P (Mayo)OutsideLaboratory",,85303,CPT,Facility,Inpatient,,,90,93,79.05,26.6538,93,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Protein C Activity, P (Mayo)OutsideLaboratory",,85303,CPT,Facility,Both,,,90,93,79.05,26.6538,93,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),55.8,60,,percent of total billed charges,,
"Protein C Activity, P (Mayo)OutsideLaboratory",,85303,CPT,Facility,Both,,,90,93,79.05,26.6538,93,"Health Partners, Inc.",State of Minnesota Advantage Program,75.795,81.5,,percent of total billed charges,,
"Protein C Activity, P (Mayo)OutsideLaboratory",,85303,CPT,Facility,Both,,,90,93,79.05,26.6538,93,"Health Partners, Inc.",State Public Programs,46.5,50,,percent of total billed charges,,
"Protein C Activity, P (Mayo)OutsideLaboratory",,85303,CPT,Facility,Both,,,90,93,79.05,26.6538,93,Humana Insurance Company,Commercial PPO,88.35,95,,percent of total billed charges,,
"Protein C Activity, P (Mayo)OutsideLaboratory",,85303,CPT,Facility,Outpatient,,,90,93,79.05,26.6538,93,Humana Insurance Company,Medicare PPO,45.57,49,,percent of total billed charges,,
"Protein C Activity, P (Mayo)OutsideLaboratory",,85303,CPT,Facility,Inpatient,,,90,93,79.05,26.6538,93,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Protein C Activity, P (Mayo)OutsideLaboratory",,85303,CPT,Facility,Both,,,90,93,79.05,26.6538,93,Medica,Individual & Family,92.163,99.1,,percent of total billed charges,,
"Protein C Activity, P (Mayo)OutsideLaboratory",,85303,CPT,Facility,Outpatient,,,90,93,79.05,26.6538,93,Medica,Medica Advantage Solution,46.314,49.8,,percent of total billed charges,,
"Protein C Activity, P (Mayo)OutsideLaboratory",,85303,CPT,Facility,Inpatient,,,90,93,79.05,26.6538,93,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Protein C Activity, P (Mayo)OutsideLaboratory",,85303,CPT,Facility,Outpatient,,,90,93,79.05,26.6538,93,Medica,Medical Assistance,41.478,44.6,,percent of total billed charges,,
"Protein C Activity, P (Mayo)OutsideLaboratory",,85303,CPT,Facility,Inpatient,,,90,93,79.05,26.6538,93,Medica,Medical Assistance,,,,,Included in per diem rate,
"Protein C Activity, P (Mayo)OutsideLaboratory",,85303,CPT,Facility,Outpatient,,,90,93,79.05,26.6538,93,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,46.314,49.8,,percent of total billed charges,,
"Protein C Activity, P (Mayo)OutsideLaboratory",,85303,CPT,Facility,Inpatient,,,90,93,79.05,26.6538,93,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Protein C Activity, P (Mayo)OutsideLaboratory",,85303,CPT,Facility,Both,,,90,93,79.05,26.6538,93,"Multiplan, Inc.","Multiplan, Inc.",87.42,94,,percent of total billed charges,,
"Protein C Activity, P (Mayo)OutsideLaboratory",,85303,CPT,Facility,Outpatient,,,90,93,79.05,26.6538,93,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,80.352,86.4,,percent of total billed charges,,
"Protein C Activity, P (Mayo)OutsideLaboratory",,85303,CPT,Facility,Inpatient,,,90,93,79.05,26.6538,93,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Protein C Activity, P (Mayo)OutsideLaboratory",,85303,CPT,Facility,Both,,,90,93,79.05,26.6538,93,"Preferred One Administrative Services, INC.",PPO,91.698,98.6,,percent of total billed charges,,
"Protein C Activity, P (Mayo)OutsideLaboratory",,85303,CPT,Facility,Outpatient,,,90,93,79.05,26.6538,93,PrimeWest Health,Minnesota Senior Health Options (MSHO),47.8485,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Protein C Activity, P (Mayo)OutsideLaboratory",,85303,CPT,Facility,Inpatient,,,90,93,79.05,26.6538,93,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Protein C Activity, P (Mayo)OutsideLaboratory",,85303,CPT,Facility,Outpatient,,,90,93,79.05,26.6538,93,PrimeWest Health,MinnesotaCare,47.7648,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Protein C Activity, P (Mayo)OutsideLaboratory",,85303,CPT,Facility,Inpatient,,,90,93,79.05,26.6538,93,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Protein C Activity, P (Mayo)OutsideLaboratory",,85303,CPT,Facility,Both,,,90,93,79.05,26.6538,93,Sanford Health Plan,Sanford Health Plan,85.56,92,,percent of total billed charges,,
"Protein C Activity, P (Mayo)OutsideLaboratory",,85303,CPT,Facility,Outpatient,,,90,93,79.05,26.6538,93,"UCare Health, Inc.",Individual & Family Plan,52.4055,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Protein C Activity, P (Mayo)OutsideLaboratory",,85303,CPT,Facility,Inpatient,,,90,93,79.05,26.6538,93,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Protein C Activity, P (Mayo)OutsideLaboratory",,85303,CPT,Facility,Outpatient,,,90,93,79.05,26.6538,93,"UCare Health, Inc.",Medical Assistance,46.9371,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Protein C Activity, P (Mayo)OutsideLaboratory",,85303,CPT,Facility,Inpatient,,,90,93,79.05,26.6538,93,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Protein C Activity, P (Mayo)OutsideLaboratory",,85303,CPT,Facility,Outpatient,,,90,93,79.05,26.6538,93,"UCare Health, Inc.",Medicare Advantage,46.9371,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Protein C Activity, P (Mayo)OutsideLaboratory",,85303,CPT,Facility,Inpatient,,,90,93,79.05,26.6538,93,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Protein C Activity, P (Mayo)OutsideLaboratory",,85303,CPT,Facility,Outpatient,,,90,93,79.05,26.6538,93,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),46.9371,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Protein C Activity, P (Mayo)OutsideLaboratory",,85303,CPT,Facility,Inpatient,,,90,93,79.05,26.6538,93,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Protein C Activity, P (Mayo)OutsideLaboratory",,85303,CPT,Facility,Both,,,90,93,79.05,26.6538,93,UnitedHealthcare,Individual & Family,87.42,94,,percent of total billed charges,,
"Protein C Activity, P (Mayo)OutsideLaboratory",,85303,CPT,Facility,Outpatient,,,90,93,79.05,26.6538,93,UnitedHealthcare,Medicare Advantage,45.57,49,,percent of total billed charges,,
"Protein C Activity, P (Mayo)OutsideLaboratory",,85303,CPT,Facility,Inpatient,,,90,93,79.05,26.6538,93,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Protein C Activity, P (Mayo)OutsideLaboratory",,85303,CPT,Facility,Outpatient,,,90,93,79.05,26.6538,93,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,44.64,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Protein C Activity, P (Mayo)OutsideLaboratory",,85303,CPT,Facility,Inpatient,,,90,93,79.05,26.6538,93,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Clotting Inhibitors Or Anticoagulants; Protein S, Free (Mayo)OutsideLaboratory",,85306,CPT,Facility,Both,,,90,111,94.35,31.8126,111,Aetna,Commercial,102.12,92,,percent of total billed charges,,
"Clotting Inhibitors Or Anticoagulants; Protein S, Free (Mayo)OutsideLaboratory",,85306,CPT,Facility,Outpatient,,,90,111,94.35,31.8126,111,Aetna,Medicare Advantage,54.39,49,,percent of total billed charges,,
"Clotting Inhibitors Or Anticoagulants; Protein S, Free (Mayo)OutsideLaboratory",,85306,CPT,Facility,Inpatient,,,90,111,94.35,31.8126,111,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Clotting Inhibitors Or Anticoagulants; Protein S, Free (Mayo)OutsideLaboratory",,85306,CPT,Facility,Both,,,90,111,94.35,31.8126,111,Aetna,PPO,103.23,93,,percent of total billed charges,,
"Clotting Inhibitors Or Anticoagulants; Protein S, Free (Mayo)OutsideLaboratory",,85306,CPT,Facility,Both,,,90,111,94.35,31.8126,111,America's PPO,America's PPO,106.5933,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Clotting Inhibitors Or Anticoagulants; Protein S, Free (Mayo)OutsideLaboratory",,85306,CPT,Facility,Both,,,90,111,94.35,31.8126,111,BlueCross BlueShield Minnesota, Federal Employee Program,109.224,98.4,,percent of total billed charges,,
"Clotting Inhibitors Or Anticoagulants; Protein S, Free (Mayo)OutsideLaboratory",,85306,CPT,Facility,Both,,,90,111,94.35,31.8126,111,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,111,100,,percent of total billed charges,,
"Clotting Inhibitors Or Anticoagulants; Protein S, Free (Mayo)OutsideLaboratory",,85306,CPT,Facility,Both,,,90,111,94.35,31.8126,111,BlueCross BlueShield Minnesota,High Value Network Plan,99.9,90,,percent of total billed charges,,
"Clotting Inhibitors Or Anticoagulants; Protein S, Free (Mayo)OutsideLaboratory",,85306,CPT,Facility,Outpatient,,,90,111,94.35,31.8126,111,BlueCross BlueShield Minnesota,Medicare Advantage,54.39,49,,percent of total billed charges,,
"Clotting Inhibitors Or Anticoagulants; Protein S, Free (Mayo)OutsideLaboratory",,85306,CPT,Facility,Inpatient,,,90,111,94.35,31.8126,111,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Clotting Inhibitors Or Anticoagulants; Protein S, Free (Mayo)OutsideLaboratory",,85306,CPT,Facility,Both,,,90,111,94.35,31.8126,111,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,98.3127,88.57,,percent of total billed charges,,
"Clotting Inhibitors Or Anticoagulants; Protein S, Free (Mayo)OutsideLaboratory",,85306,CPT,Facility,Both,,,90,111,94.35,31.8126,111,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,31.8126,28.66,,percent of total billed charges,,
"Clotting Inhibitors Or Anticoagulants; Protein S, Free (Mayo)OutsideLaboratory",,85306,CPT,Facility,Outpatient,,,90,111,94.35,31.8126,111,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),54.39,49,,percent of total billed charges,,
"Clotting Inhibitors Or Anticoagulants; Protein S, Free (Mayo)OutsideLaboratory",,85306,CPT,Facility,Inpatient,,,90,111,94.35,31.8126,111,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Clotting Inhibitors Or Anticoagulants; Protein S, Free (Mayo)OutsideLaboratory",,85306,CPT,Facility,Both,,,90,111,94.35,31.8126,111,CorVel,Worker's Compensation,111,100,,percent of total billed charges,,
"Clotting Inhibitors Or Anticoagulants; Protein S, Free (Mayo)OutsideLaboratory",,85306,CPT,Facility,Both,,,90,111,94.35,31.8126,111,First Health Group Corporation,First Health Network,107.67,97,,percent of total billed charges,,
"Clotting Inhibitors Or Anticoagulants; Protein S, Free (Mayo)OutsideLaboratory",,85306,CPT,Facility,Both,,,90,111,94.35,31.8126,111,"Health Partners, Inc.",Commercial,105.006,94.6,,percent of total billed charges,,
"Clotting Inhibitors Or Anticoagulants; Protein S, Free (Mayo)OutsideLaboratory",,85306,CPT,Facility,Outpatient,,,90,111,94.35,31.8126,111,"Health Partners, Inc.",Medicare Advantage,54.39,49,,percent of total billed charges,,
"Clotting Inhibitors Or Anticoagulants; Protein S, Free (Mayo)OutsideLaboratory",,85306,CPT,Facility,Inpatient,,,90,111,94.35,31.8126,111,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Clotting Inhibitors Or Anticoagulants; Protein S, Free (Mayo)OutsideLaboratory",,85306,CPT,Facility,Both,,,90,111,94.35,31.8126,111,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),66.6,60,,percent of total billed charges,,
"Clotting Inhibitors Or Anticoagulants; Protein S, Free (Mayo)OutsideLaboratory",,85306,CPT,Facility,Both,,,90,111,94.35,31.8126,111,"Health Partners, Inc.",State of Minnesota Advantage Program,90.465,81.5,,percent of total billed charges,,
"Clotting Inhibitors Or Anticoagulants; Protein S, Free (Mayo)OutsideLaboratory",,85306,CPT,Facility,Both,,,90,111,94.35,31.8126,111,"Health Partners, Inc.",State Public Programs,55.5,50,,percent of total billed charges,,
"Clotting Inhibitors Or Anticoagulants; Protein S, Free (Mayo)OutsideLaboratory",,85306,CPT,Facility,Both,,,90,111,94.35,31.8126,111,Humana Insurance Company,Commercial PPO,105.45,95,,percent of total billed charges,,
"Clotting Inhibitors Or Anticoagulants; Protein S, Free (Mayo)OutsideLaboratory",,85306,CPT,Facility,Outpatient,,,90,111,94.35,31.8126,111,Humana Insurance Company,Medicare PPO,54.39,49,,percent of total billed charges,,
"Clotting Inhibitors Or Anticoagulants; Protein S, Free (Mayo)OutsideLaboratory",,85306,CPT,Facility,Inpatient,,,90,111,94.35,31.8126,111,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Clotting Inhibitors Or Anticoagulants; Protein S, Free (Mayo)OutsideLaboratory",,85306,CPT,Facility,Both,,,90,111,94.35,31.8126,111,Medica,Individual & Family,110.001,99.1,,percent of total billed charges,,
"Clotting Inhibitors Or Anticoagulants; Protein S, Free (Mayo)OutsideLaboratory",,85306,CPT,Facility,Outpatient,,,90,111,94.35,31.8126,111,Medica,Medica Advantage Solution,55.278,49.8,,percent of total billed charges,,
"Clotting Inhibitors Or Anticoagulants; Protein S, Free (Mayo)OutsideLaboratory",,85306,CPT,Facility,Inpatient,,,90,111,94.35,31.8126,111,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Clotting Inhibitors Or Anticoagulants; Protein S, Free (Mayo)OutsideLaboratory",,85306,CPT,Facility,Outpatient,,,90,111,94.35,31.8126,111,Medica,Medical Assistance,49.506,44.6,,percent of total billed charges,,
"Clotting Inhibitors Or Anticoagulants; Protein S, Free (Mayo)OutsideLaboratory",,85306,CPT,Facility,Inpatient,,,90,111,94.35,31.8126,111,Medica,Medical Assistance,,,,,Included in per diem rate,
"Clotting Inhibitors Or Anticoagulants; Protein S, Free (Mayo)OutsideLaboratory",,85306,CPT,Facility,Outpatient,,,90,111,94.35,31.8126,111,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,55.278,49.8,,percent of total billed charges,,
"Clotting Inhibitors Or Anticoagulants; Protein S, Free (Mayo)OutsideLaboratory",,85306,CPT,Facility,Inpatient,,,90,111,94.35,31.8126,111,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Clotting Inhibitors Or Anticoagulants; Protein S, Free (Mayo)OutsideLaboratory",,85306,CPT,Facility,Both,,,90,111,94.35,31.8126,111,"Multiplan, Inc.","Multiplan, Inc.",104.34,94,,percent of total billed charges,,
"Clotting Inhibitors Or Anticoagulants; Protein S, Free (Mayo)OutsideLaboratory",,85306,CPT,Facility,Outpatient,,,90,111,94.35,31.8126,111,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,95.904,86.4,,percent of total billed charges,,
"Clotting Inhibitors Or Anticoagulants; Protein S, Free (Mayo)OutsideLaboratory",,85306,CPT,Facility,Inpatient,,,90,111,94.35,31.8126,111,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Clotting Inhibitors Or Anticoagulants; Protein S, Free (Mayo)OutsideLaboratory",,85306,CPT,Facility,Both,,,90,111,94.35,31.8126,111,"Preferred One Administrative Services, INC.",PPO,109.446,98.6,,percent of total billed charges,,
"Clotting Inhibitors Or Anticoagulants; Protein S, Free (Mayo)OutsideLaboratory",,85306,CPT,Facility,Outpatient,,,90,111,94.35,31.8126,111,PrimeWest Health,Minnesota Senior Health Options (MSHO),57.1095,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Clotting Inhibitors Or Anticoagulants; Protein S, Free (Mayo)OutsideLaboratory",,85306,CPT,Facility,Inpatient,,,90,111,94.35,31.8126,111,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Clotting Inhibitors Or Anticoagulants; Protein S, Free (Mayo)OutsideLaboratory",,85306,CPT,Facility,Outpatient,,,90,111,94.35,31.8126,111,PrimeWest Health,MinnesotaCare,57.0096,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Clotting Inhibitors Or Anticoagulants; Protein S, Free (Mayo)OutsideLaboratory",,85306,CPT,Facility,Inpatient,,,90,111,94.35,31.8126,111,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Clotting Inhibitors Or Anticoagulants; Protein S, Free (Mayo)OutsideLaboratory",,85306,CPT,Facility,Both,,,90,111,94.35,31.8126,111,Sanford Health Plan,Sanford Health Plan,102.12,92,,percent of total billed charges,,
"Clotting Inhibitors Or Anticoagulants; Protein S, Free (Mayo)OutsideLaboratory",,85306,CPT,Facility,Outpatient,,,90,111,94.35,31.8126,111,"UCare Health, Inc.",Individual & Family Plan,62.5485,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Clotting Inhibitors Or Anticoagulants; Protein S, Free (Mayo)OutsideLaboratory",,85306,CPT,Facility,Inpatient,,,90,111,94.35,31.8126,111,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Clotting Inhibitors Or Anticoagulants; Protein S, Free (Mayo)OutsideLaboratory",,85306,CPT,Facility,Outpatient,,,90,111,94.35,31.8126,111,"UCare Health, Inc.",Medical Assistance,56.0217,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Clotting Inhibitors Or Anticoagulants; Protein S, Free (Mayo)OutsideLaboratory",,85306,CPT,Facility,Inpatient,,,90,111,94.35,31.8126,111,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Clotting Inhibitors Or Anticoagulants; Protein S, Free (Mayo)OutsideLaboratory",,85306,CPT,Facility,Outpatient,,,90,111,94.35,31.8126,111,"UCare Health, Inc.",Medicare Advantage,56.0217,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Clotting Inhibitors Or Anticoagulants; Protein S, Free (Mayo)OutsideLaboratory",,85306,CPT,Facility,Inpatient,,,90,111,94.35,31.8126,111,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Clotting Inhibitors Or Anticoagulants; Protein S, Free (Mayo)OutsideLaboratory",,85306,CPT,Facility,Outpatient,,,90,111,94.35,31.8126,111,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),56.0217,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Clotting Inhibitors Or Anticoagulants; Protein S, Free (Mayo)OutsideLaboratory",,85306,CPT,Facility,Inpatient,,,90,111,94.35,31.8126,111,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Clotting Inhibitors Or Anticoagulants; Protein S, Free (Mayo)OutsideLaboratory",,85306,CPT,Facility,Both,,,90,111,94.35,31.8126,111,UnitedHealthcare,Individual & Family,104.34,94,,percent of total billed charges,,
"Clotting Inhibitors Or Anticoagulants; Protein S, Free (Mayo)OutsideLaboratory",,85306,CPT,Facility,Outpatient,,,90,111,94.35,31.8126,111,UnitedHealthcare,Medicare Advantage,54.39,49,,percent of total billed charges,,
"Clotting Inhibitors Or Anticoagulants; Protein S, Free (Mayo)OutsideLaboratory",,85306,CPT,Facility,Inpatient,,,90,111,94.35,31.8126,111,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Clotting Inhibitors Or Anticoagulants; Protein S, Free (Mayo)OutsideLaboratory",,85306,CPT,Facility,Outpatient,,,90,111,94.35,31.8126,111,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,53.28,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Clotting Inhibitors Or Anticoagulants; Protein S, Free (Mayo)OutsideLaboratory",,85306,CPT,Facility,Inpatient,,,90,111,94.35,31.8126,111,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Protein S Activity, P (Mayo)OutsideLaboratory",,85306,CPT,Facility,Both,,,90,111,94.35,31.8126,111,Aetna,Commercial,102.12,92,,percent of total billed charges,,
"Protein S Activity, P (Mayo)OutsideLaboratory",,85306,CPT,Facility,Outpatient,,,90,111,94.35,31.8126,111,Aetna,Medicare Advantage,54.39,49,,percent of total billed charges,,
"Protein S Activity, P (Mayo)OutsideLaboratory",,85306,CPT,Facility,Inpatient,,,90,111,94.35,31.8126,111,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Protein S Activity, P (Mayo)OutsideLaboratory",,85306,CPT,Facility,Both,,,90,111,94.35,31.8126,111,Aetna,PPO,103.23,93,,percent of total billed charges,,
"Protein S Activity, P (Mayo)OutsideLaboratory",,85306,CPT,Facility,Both,,,90,111,94.35,31.8126,111,America's PPO,America's PPO,106.5933,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Protein S Activity, P (Mayo)OutsideLaboratory",,85306,CPT,Facility,Both,,,90,111,94.35,31.8126,111,BlueCross BlueShield Minnesota, Federal Employee Program,109.224,98.4,,percent of total billed charges,,
"Protein S Activity, P (Mayo)OutsideLaboratory",,85306,CPT,Facility,Both,,,90,111,94.35,31.8126,111,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,111,100,,percent of total billed charges,,
"Protein S Activity, P (Mayo)OutsideLaboratory",,85306,CPT,Facility,Both,,,90,111,94.35,31.8126,111,BlueCross BlueShield Minnesota,High Value Network Plan,99.9,90,,percent of total billed charges,,
"Protein S Activity, P (Mayo)OutsideLaboratory",,85306,CPT,Facility,Outpatient,,,90,111,94.35,31.8126,111,BlueCross BlueShield Minnesota,Medicare Advantage,54.39,49,,percent of total billed charges,,
"Protein S Activity, P (Mayo)OutsideLaboratory",,85306,CPT,Facility,Inpatient,,,90,111,94.35,31.8126,111,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Protein S Activity, P (Mayo)OutsideLaboratory",,85306,CPT,Facility,Both,,,90,111,94.35,31.8126,111,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,98.3127,88.57,,percent of total billed charges,,
"Protein S Activity, P (Mayo)OutsideLaboratory",,85306,CPT,Facility,Both,,,90,111,94.35,31.8126,111,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,31.8126,28.66,,percent of total billed charges,,
"Protein S Activity, P (Mayo)OutsideLaboratory",,85306,CPT,Facility,Outpatient,,,90,111,94.35,31.8126,111,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),54.39,49,,percent of total billed charges,,
"Protein S Activity, P (Mayo)OutsideLaboratory",,85306,CPT,Facility,Inpatient,,,90,111,94.35,31.8126,111,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Protein S Activity, P (Mayo)OutsideLaboratory",,85306,CPT,Facility,Both,,,90,111,94.35,31.8126,111,CorVel,Worker's Compensation,111,100,,percent of total billed charges,,
"Protein S Activity, P (Mayo)OutsideLaboratory",,85306,CPT,Facility,Both,,,90,111,94.35,31.8126,111,First Health Group Corporation,First Health Network,107.67,97,,percent of total billed charges,,
"Protein S Activity, P (Mayo)OutsideLaboratory",,85306,CPT,Facility,Both,,,90,111,94.35,31.8126,111,"Health Partners, Inc.",Commercial,105.006,94.6,,percent of total billed charges,,
"Protein S Activity, P (Mayo)OutsideLaboratory",,85306,CPT,Facility,Outpatient,,,90,111,94.35,31.8126,111,"Health Partners, Inc.",Medicare Advantage,54.39,49,,percent of total billed charges,,
"Protein S Activity, P (Mayo)OutsideLaboratory",,85306,CPT,Facility,Inpatient,,,90,111,94.35,31.8126,111,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Protein S Activity, P (Mayo)OutsideLaboratory",,85306,CPT,Facility,Both,,,90,111,94.35,31.8126,111,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),66.6,60,,percent of total billed charges,,
"Protein S Activity, P (Mayo)OutsideLaboratory",,85306,CPT,Facility,Both,,,90,111,94.35,31.8126,111,"Health Partners, Inc.",State of Minnesota Advantage Program,90.465,81.5,,percent of total billed charges,,
"Protein S Activity, P (Mayo)OutsideLaboratory",,85306,CPT,Facility,Both,,,90,111,94.35,31.8126,111,"Health Partners, Inc.",State Public Programs,55.5,50,,percent of total billed charges,,
"Protein S Activity, P (Mayo)OutsideLaboratory",,85306,CPT,Facility,Both,,,90,111,94.35,31.8126,111,Humana Insurance Company,Commercial PPO,105.45,95,,percent of total billed charges,,
"Protein S Activity, P (Mayo)OutsideLaboratory",,85306,CPT,Facility,Outpatient,,,90,111,94.35,31.8126,111,Humana Insurance Company,Medicare PPO,54.39,49,,percent of total billed charges,,
"Protein S Activity, P (Mayo)OutsideLaboratory",,85306,CPT,Facility,Inpatient,,,90,111,94.35,31.8126,111,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Protein S Activity, P (Mayo)OutsideLaboratory",,85306,CPT,Facility,Both,,,90,111,94.35,31.8126,111,Medica,Individual & Family,110.001,99.1,,percent of total billed charges,,
"Protein S Activity, P (Mayo)OutsideLaboratory",,85306,CPT,Facility,Outpatient,,,90,111,94.35,31.8126,111,Medica,Medica Advantage Solution,55.278,49.8,,percent of total billed charges,,
"Protein S Activity, P (Mayo)OutsideLaboratory",,85306,CPT,Facility,Inpatient,,,90,111,94.35,31.8126,111,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Protein S Activity, P (Mayo)OutsideLaboratory",,85306,CPT,Facility,Outpatient,,,90,111,94.35,31.8126,111,Medica,Medical Assistance,49.506,44.6,,percent of total billed charges,,
"Protein S Activity, P (Mayo)OutsideLaboratory",,85306,CPT,Facility,Inpatient,,,90,111,94.35,31.8126,111,Medica,Medical Assistance,,,,,Included in per diem rate,
"Protein S Activity, P (Mayo)OutsideLaboratory",,85306,CPT,Facility,Outpatient,,,90,111,94.35,31.8126,111,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,55.278,49.8,,percent of total billed charges,,
"Protein S Activity, P (Mayo)OutsideLaboratory",,85306,CPT,Facility,Inpatient,,,90,111,94.35,31.8126,111,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Protein S Activity, P (Mayo)OutsideLaboratory",,85306,CPT,Facility,Both,,,90,111,94.35,31.8126,111,"Multiplan, Inc.","Multiplan, Inc.",104.34,94,,percent of total billed charges,,
"Protein S Activity, P (Mayo)OutsideLaboratory",,85306,CPT,Facility,Outpatient,,,90,111,94.35,31.8126,111,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,95.904,86.4,,percent of total billed charges,,
"Protein S Activity, P (Mayo)OutsideLaboratory",,85306,CPT,Facility,Inpatient,,,90,111,94.35,31.8126,111,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Protein S Activity, P (Mayo)OutsideLaboratory",,85306,CPT,Facility,Both,,,90,111,94.35,31.8126,111,"Preferred One Administrative Services, INC.",PPO,109.446,98.6,,percent of total billed charges,,
"Protein S Activity, P (Mayo)OutsideLaboratory",,85306,CPT,Facility,Outpatient,,,90,111,94.35,31.8126,111,PrimeWest Health,Minnesota Senior Health Options (MSHO),57.1095,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Protein S Activity, P (Mayo)OutsideLaboratory",,85306,CPT,Facility,Inpatient,,,90,111,94.35,31.8126,111,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Protein S Activity, P (Mayo)OutsideLaboratory",,85306,CPT,Facility,Outpatient,,,90,111,94.35,31.8126,111,PrimeWest Health,MinnesotaCare,57.0096,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Protein S Activity, P (Mayo)OutsideLaboratory",,85306,CPT,Facility,Inpatient,,,90,111,94.35,31.8126,111,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Protein S Activity, P (Mayo)OutsideLaboratory",,85306,CPT,Facility,Both,,,90,111,94.35,31.8126,111,Sanford Health Plan,Sanford Health Plan,102.12,92,,percent of total billed charges,,
"Protein S Activity, P (Mayo)OutsideLaboratory",,85306,CPT,Facility,Outpatient,,,90,111,94.35,31.8126,111,"UCare Health, Inc.",Individual & Family Plan,62.5485,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Protein S Activity, P (Mayo)OutsideLaboratory",,85306,CPT,Facility,Inpatient,,,90,111,94.35,31.8126,111,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Protein S Activity, P (Mayo)OutsideLaboratory",,85306,CPT,Facility,Outpatient,,,90,111,94.35,31.8126,111,"UCare Health, Inc.",Medical Assistance,56.0217,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Protein S Activity, P (Mayo)OutsideLaboratory",,85306,CPT,Facility,Inpatient,,,90,111,94.35,31.8126,111,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Protein S Activity, P (Mayo)OutsideLaboratory",,85306,CPT,Facility,Outpatient,,,90,111,94.35,31.8126,111,"UCare Health, Inc.",Medicare Advantage,56.0217,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Protein S Activity, P (Mayo)OutsideLaboratory",,85306,CPT,Facility,Inpatient,,,90,111,94.35,31.8126,111,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Protein S Activity, P (Mayo)OutsideLaboratory",,85306,CPT,Facility,Outpatient,,,90,111,94.35,31.8126,111,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),56.0217,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Protein S Activity, P (Mayo)OutsideLaboratory",,85306,CPT,Facility,Inpatient,,,90,111,94.35,31.8126,111,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Protein S Activity, P (Mayo)OutsideLaboratory",,85306,CPT,Facility,Both,,,90,111,94.35,31.8126,111,UnitedHealthcare,Individual & Family,104.34,94,,percent of total billed charges,,
"Protein S Activity, P (Mayo)OutsideLaboratory",,85306,CPT,Facility,Outpatient,,,90,111,94.35,31.8126,111,UnitedHealthcare,Medicare Advantage,54.39,49,,percent of total billed charges,,
"Protein S Activity, P (Mayo)OutsideLaboratory",,85306,CPT,Facility,Inpatient,,,90,111,94.35,31.8126,111,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Protein S Activity, P (Mayo)OutsideLaboratory",,85306,CPT,Facility,Outpatient,,,90,111,94.35,31.8126,111,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,53.28,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Protein S Activity, P (Mayo)OutsideLaboratory",,85306,CPT,Facility,Inpatient,,,90,111,94.35,31.8126,111,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Protein S Ag, P (Mayo)OutsideLaboratory",,85306,CPT,Facility,Both,,,90,111,94.35,31.8126,111,Aetna,Commercial,102.12,92,,percent of total billed charges,,
"Protein S Ag, P (Mayo)OutsideLaboratory",,85306,CPT,Facility,Outpatient,,,90,111,94.35,31.8126,111,Aetna,Medicare Advantage,54.39,49,,percent of total billed charges,,
"Protein S Ag, P (Mayo)OutsideLaboratory",,85306,CPT,Facility,Inpatient,,,90,111,94.35,31.8126,111,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Protein S Ag, P (Mayo)OutsideLaboratory",,85306,CPT,Facility,Both,,,90,111,94.35,31.8126,111,Aetna,PPO,103.23,93,,percent of total billed charges,,
"Protein S Ag, P (Mayo)OutsideLaboratory",,85306,CPT,Facility,Both,,,90,111,94.35,31.8126,111,America's PPO,America's PPO,106.5933,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Protein S Ag, P (Mayo)OutsideLaboratory",,85306,CPT,Facility,Both,,,90,111,94.35,31.8126,111,BlueCross BlueShield Minnesota, Federal Employee Program,109.224,98.4,,percent of total billed charges,,
"Protein S Ag, P (Mayo)OutsideLaboratory",,85306,CPT,Facility,Both,,,90,111,94.35,31.8126,111,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,111,100,,percent of total billed charges,,
"Protein S Ag, P (Mayo)OutsideLaboratory",,85306,CPT,Facility,Both,,,90,111,94.35,31.8126,111,BlueCross BlueShield Minnesota,High Value Network Plan,99.9,90,,percent of total billed charges,,
"Protein S Ag, P (Mayo)OutsideLaboratory",,85306,CPT,Facility,Outpatient,,,90,111,94.35,31.8126,111,BlueCross BlueShield Minnesota,Medicare Advantage,54.39,49,,percent of total billed charges,,
"Protein S Ag, P (Mayo)OutsideLaboratory",,85306,CPT,Facility,Inpatient,,,90,111,94.35,31.8126,111,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Protein S Ag, P (Mayo)OutsideLaboratory",,85306,CPT,Facility,Both,,,90,111,94.35,31.8126,111,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,98.3127,88.57,,percent of total billed charges,,
"Protein S Ag, P (Mayo)OutsideLaboratory",,85306,CPT,Facility,Both,,,90,111,94.35,31.8126,111,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,31.8126,28.66,,percent of total billed charges,,
"Protein S Ag, P (Mayo)OutsideLaboratory",,85306,CPT,Facility,Outpatient,,,90,111,94.35,31.8126,111,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),54.39,49,,percent of total billed charges,,
"Protein S Ag, P (Mayo)OutsideLaboratory",,85306,CPT,Facility,Inpatient,,,90,111,94.35,31.8126,111,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Protein S Ag, P (Mayo)OutsideLaboratory",,85306,CPT,Facility,Both,,,90,111,94.35,31.8126,111,CorVel,Worker's Compensation,111,100,,percent of total billed charges,,
"Protein S Ag, P (Mayo)OutsideLaboratory",,85306,CPT,Facility,Both,,,90,111,94.35,31.8126,111,First Health Group Corporation,First Health Network,107.67,97,,percent of total billed charges,,
"Protein S Ag, P (Mayo)OutsideLaboratory",,85306,CPT,Facility,Both,,,90,111,94.35,31.8126,111,"Health Partners, Inc.",Commercial,105.006,94.6,,percent of total billed charges,,
"Protein S Ag, P (Mayo)OutsideLaboratory",,85306,CPT,Facility,Outpatient,,,90,111,94.35,31.8126,111,"Health Partners, Inc.",Medicare Advantage,54.39,49,,percent of total billed charges,,
"Protein S Ag, P (Mayo)OutsideLaboratory",,85306,CPT,Facility,Inpatient,,,90,111,94.35,31.8126,111,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Protein S Ag, P (Mayo)OutsideLaboratory",,85306,CPT,Facility,Both,,,90,111,94.35,31.8126,111,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),66.6,60,,percent of total billed charges,,
"Protein S Ag, P (Mayo)OutsideLaboratory",,85306,CPT,Facility,Both,,,90,111,94.35,31.8126,111,"Health Partners, Inc.",State of Minnesota Advantage Program,90.465,81.5,,percent of total billed charges,,
"Protein S Ag, P (Mayo)OutsideLaboratory",,85306,CPT,Facility,Both,,,90,111,94.35,31.8126,111,"Health Partners, Inc.",State Public Programs,55.5,50,,percent of total billed charges,,
"Protein S Ag, P (Mayo)OutsideLaboratory",,85306,CPT,Facility,Both,,,90,111,94.35,31.8126,111,Humana Insurance Company,Commercial PPO,105.45,95,,percent of total billed charges,,
"Protein S Ag, P (Mayo)OutsideLaboratory",,85306,CPT,Facility,Outpatient,,,90,111,94.35,31.8126,111,Humana Insurance Company,Medicare PPO,54.39,49,,percent of total billed charges,,
"Protein S Ag, P (Mayo)OutsideLaboratory",,85306,CPT,Facility,Inpatient,,,90,111,94.35,31.8126,111,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Protein S Ag, P (Mayo)OutsideLaboratory",,85306,CPT,Facility,Both,,,90,111,94.35,31.8126,111,Medica,Individual & Family,110.001,99.1,,percent of total billed charges,,
"Protein S Ag, P (Mayo)OutsideLaboratory",,85306,CPT,Facility,Outpatient,,,90,111,94.35,31.8126,111,Medica,Medica Advantage Solution,55.278,49.8,,percent of total billed charges,,
"Protein S Ag, P (Mayo)OutsideLaboratory",,85306,CPT,Facility,Inpatient,,,90,111,94.35,31.8126,111,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Protein S Ag, P (Mayo)OutsideLaboratory",,85306,CPT,Facility,Outpatient,,,90,111,94.35,31.8126,111,Medica,Medical Assistance,49.506,44.6,,percent of total billed charges,,
"Protein S Ag, P (Mayo)OutsideLaboratory",,85306,CPT,Facility,Inpatient,,,90,111,94.35,31.8126,111,Medica,Medical Assistance,,,,,Included in per diem rate,
"Protein S Ag, P (Mayo)OutsideLaboratory",,85306,CPT,Facility,Outpatient,,,90,111,94.35,31.8126,111,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,55.278,49.8,,percent of total billed charges,,
"Protein S Ag, P (Mayo)OutsideLaboratory",,85306,CPT,Facility,Inpatient,,,90,111,94.35,31.8126,111,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Protein S Ag, P (Mayo)OutsideLaboratory",,85306,CPT,Facility,Both,,,90,111,94.35,31.8126,111,"Multiplan, Inc.","Multiplan, Inc.",104.34,94,,percent of total billed charges,,
"Protein S Ag, P (Mayo)OutsideLaboratory",,85306,CPT,Facility,Outpatient,,,90,111,94.35,31.8126,111,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,95.904,86.4,,percent of total billed charges,,
"Protein S Ag, P (Mayo)OutsideLaboratory",,85306,CPT,Facility,Inpatient,,,90,111,94.35,31.8126,111,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Protein S Ag, P (Mayo)OutsideLaboratory",,85306,CPT,Facility,Both,,,90,111,94.35,31.8126,111,"Preferred One Administrative Services, INC.",PPO,109.446,98.6,,percent of total billed charges,,
"Protein S Ag, P (Mayo)OutsideLaboratory",,85306,CPT,Facility,Outpatient,,,90,111,94.35,31.8126,111,PrimeWest Health,Minnesota Senior Health Options (MSHO),57.1095,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Protein S Ag, P (Mayo)OutsideLaboratory",,85306,CPT,Facility,Inpatient,,,90,111,94.35,31.8126,111,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Protein S Ag, P (Mayo)OutsideLaboratory",,85306,CPT,Facility,Outpatient,,,90,111,94.35,31.8126,111,PrimeWest Health,MinnesotaCare,57.0096,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Protein S Ag, P (Mayo)OutsideLaboratory",,85306,CPT,Facility,Inpatient,,,90,111,94.35,31.8126,111,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Protein S Ag, P (Mayo)OutsideLaboratory",,85306,CPT,Facility,Both,,,90,111,94.35,31.8126,111,Sanford Health Plan,Sanford Health Plan,102.12,92,,percent of total billed charges,,
"Protein S Ag, P (Mayo)OutsideLaboratory",,85306,CPT,Facility,Outpatient,,,90,111,94.35,31.8126,111,"UCare Health, Inc.",Individual & Family Plan,62.5485,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Protein S Ag, P (Mayo)OutsideLaboratory",,85306,CPT,Facility,Inpatient,,,90,111,94.35,31.8126,111,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Protein S Ag, P (Mayo)OutsideLaboratory",,85306,CPT,Facility,Outpatient,,,90,111,94.35,31.8126,111,"UCare Health, Inc.",Medical Assistance,56.0217,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Protein S Ag, P (Mayo)OutsideLaboratory",,85306,CPT,Facility,Inpatient,,,90,111,94.35,31.8126,111,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Protein S Ag, P (Mayo)OutsideLaboratory",,85306,CPT,Facility,Outpatient,,,90,111,94.35,31.8126,111,"UCare Health, Inc.",Medicare Advantage,56.0217,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Protein S Ag, P (Mayo)OutsideLaboratory",,85306,CPT,Facility,Inpatient,,,90,111,94.35,31.8126,111,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Protein S Ag, P (Mayo)OutsideLaboratory",,85306,CPT,Facility,Outpatient,,,90,111,94.35,31.8126,111,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),56.0217,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Protein S Ag, P (Mayo)OutsideLaboratory",,85306,CPT,Facility,Inpatient,,,90,111,94.35,31.8126,111,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Protein S Ag, P (Mayo)OutsideLaboratory",,85306,CPT,Facility,Both,,,90,111,94.35,31.8126,111,UnitedHealthcare,Individual & Family,104.34,94,,percent of total billed charges,,
"Protein S Ag, P (Mayo)OutsideLaboratory",,85306,CPT,Facility,Outpatient,,,90,111,94.35,31.8126,111,UnitedHealthcare,Medicare Advantage,54.39,49,,percent of total billed charges,,
"Protein S Ag, P (Mayo)OutsideLaboratory",,85306,CPT,Facility,Inpatient,,,90,111,94.35,31.8126,111,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Protein S Ag, P (Mayo)OutsideLaboratory",,85306,CPT,Facility,Outpatient,,,90,111,94.35,31.8126,111,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,53.28,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Protein S Ag, P (Mayo)OutsideLaboratory",,85306,CPT,Facility,Inpatient,,,90,111,94.35,31.8126,111,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Activated Protein C (Apc) Resistance Assay (Mayo)OutsideLaboratory,,85307,CPT,Facility,Both,,,90,51,43.35,14.6166,51,Aetna,Commercial,46.92,92,,percent of total billed charges,,
Activated Protein C (Apc) Resistance Assay (Mayo)OutsideLaboratory,,85307,CPT,Facility,Outpatient,,,90,51,43.35,14.6166,51,Aetna,Medicare Advantage,24.99,49,,percent of total billed charges,,
Activated Protein C (Apc) Resistance Assay (Mayo)OutsideLaboratory,,85307,CPT,Facility,Inpatient,,,90,51,43.35,14.6166,51,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Activated Protein C (Apc) Resistance Assay (Mayo)OutsideLaboratory,,85307,CPT,Facility,Both,,,90,51,43.35,14.6166,51,Aetna,PPO,47.43,93,,percent of total billed charges,,
Activated Protein C (Apc) Resistance Assay (Mayo)OutsideLaboratory,,85307,CPT,Facility,Both,,,90,51,43.35,14.6166,51,America's PPO,America's PPO,48.9753,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Activated Protein C (Apc) Resistance Assay (Mayo)OutsideLaboratory,,85307,CPT,Facility,Both,,,90,51,43.35,14.6166,51,BlueCross BlueShield Minnesota, Federal Employee Program,50.184,98.4,,percent of total billed charges,,
Activated Protein C (Apc) Resistance Assay (Mayo)OutsideLaboratory,,85307,CPT,Facility,Both,,,90,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,51,100,,percent of total billed charges,,
Activated Protein C (Apc) Resistance Assay (Mayo)OutsideLaboratory,,85307,CPT,Facility,Both,,,90,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,High Value Network Plan,45.9,90,,percent of total billed charges,,
Activated Protein C (Apc) Resistance Assay (Mayo)OutsideLaboratory,,85307,CPT,Facility,Outpatient,,,90,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,Medicare Advantage,24.99,49,,percent of total billed charges,,
Activated Protein C (Apc) Resistance Assay (Mayo)OutsideLaboratory,,85307,CPT,Facility,Inpatient,,,90,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Activated Protein C (Apc) Resistance Assay (Mayo)OutsideLaboratory,,85307,CPT,Facility,Both,,,90,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,45.1707,88.57,,percent of total billed charges,,
Activated Protein C (Apc) Resistance Assay (Mayo)OutsideLaboratory,,85307,CPT,Facility,Both,,,90,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,14.6166,28.66,,percent of total billed charges,,
Activated Protein C (Apc) Resistance Assay (Mayo)OutsideLaboratory,,85307,CPT,Facility,Outpatient,,,90,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),24.99,49,,percent of total billed charges,,
Activated Protein C (Apc) Resistance Assay (Mayo)OutsideLaboratory,,85307,CPT,Facility,Inpatient,,,90,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Activated Protein C (Apc) Resistance Assay (Mayo)OutsideLaboratory,,85307,CPT,Facility,Both,,,90,51,43.35,14.6166,51,CorVel,Worker's Compensation,51,100,,percent of total billed charges,,
Activated Protein C (Apc) Resistance Assay (Mayo)OutsideLaboratory,,85307,CPT,Facility,Both,,,90,51,43.35,14.6166,51,First Health Group Corporation,First Health Network,49.47,97,,percent of total billed charges,,
Activated Protein C (Apc) Resistance Assay (Mayo)OutsideLaboratory,,85307,CPT,Facility,Both,,,90,51,43.35,14.6166,51,"Health Partners, Inc.",Commercial,48.246,94.6,,percent of total billed charges,,
Activated Protein C (Apc) Resistance Assay (Mayo)OutsideLaboratory,,85307,CPT,Facility,Outpatient,,,90,51,43.35,14.6166,51,"Health Partners, Inc.",Medicare Advantage,24.99,49,,percent of total billed charges,,
Activated Protein C (Apc) Resistance Assay (Mayo)OutsideLaboratory,,85307,CPT,Facility,Inpatient,,,90,51,43.35,14.6166,51,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Activated Protein C (Apc) Resistance Assay (Mayo)OutsideLaboratory,,85307,CPT,Facility,Both,,,90,51,43.35,14.6166,51,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),30.6,60,,percent of total billed charges,,
Activated Protein C (Apc) Resistance Assay (Mayo)OutsideLaboratory,,85307,CPT,Facility,Both,,,90,51,43.35,14.6166,51,"Health Partners, Inc.",State of Minnesota Advantage Program,41.565,81.5,,percent of total billed charges,,
Activated Protein C (Apc) Resistance Assay (Mayo)OutsideLaboratory,,85307,CPT,Facility,Both,,,90,51,43.35,14.6166,51,"Health Partners, Inc.",State Public Programs,25.5,50,,percent of total billed charges,,
Activated Protein C (Apc) Resistance Assay (Mayo)OutsideLaboratory,,85307,CPT,Facility,Both,,,90,51,43.35,14.6166,51,Humana Insurance Company,Commercial PPO,48.45,95,,percent of total billed charges,,
Activated Protein C (Apc) Resistance Assay (Mayo)OutsideLaboratory,,85307,CPT,Facility,Outpatient,,,90,51,43.35,14.6166,51,Humana Insurance Company,Medicare PPO,24.99,49,,percent of total billed charges,,
Activated Protein C (Apc) Resistance Assay (Mayo)OutsideLaboratory,,85307,CPT,Facility,Inpatient,,,90,51,43.35,14.6166,51,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Activated Protein C (Apc) Resistance Assay (Mayo)OutsideLaboratory,,85307,CPT,Facility,Both,,,90,51,43.35,14.6166,51,Medica,Individual & Family,50.541,99.1,,percent of total billed charges,,
Activated Protein C (Apc) Resistance Assay (Mayo)OutsideLaboratory,,85307,CPT,Facility,Outpatient,,,90,51,43.35,14.6166,51,Medica,Medica Advantage Solution,25.398,49.8,,percent of total billed charges,,
Activated Protein C (Apc) Resistance Assay (Mayo)OutsideLaboratory,,85307,CPT,Facility,Inpatient,,,90,51,43.35,14.6166,51,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Activated Protein C (Apc) Resistance Assay (Mayo)OutsideLaboratory,,85307,CPT,Facility,Outpatient,,,90,51,43.35,14.6166,51,Medica,Medical Assistance,22.746,44.6,,percent of total billed charges,,
Activated Protein C (Apc) Resistance Assay (Mayo)OutsideLaboratory,,85307,CPT,Facility,Inpatient,,,90,51,43.35,14.6166,51,Medica,Medical Assistance,,,,,Included in per diem rate,
Activated Protein C (Apc) Resistance Assay (Mayo)OutsideLaboratory,,85307,CPT,Facility,Outpatient,,,90,51,43.35,14.6166,51,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,25.398,49.8,,percent of total billed charges,,
Activated Protein C (Apc) Resistance Assay (Mayo)OutsideLaboratory,,85307,CPT,Facility,Inpatient,,,90,51,43.35,14.6166,51,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Activated Protein C (Apc) Resistance Assay (Mayo)OutsideLaboratory,,85307,CPT,Facility,Both,,,90,51,43.35,14.6166,51,"Multiplan, Inc.","Multiplan, Inc.",47.94,94,,percent of total billed charges,,
Activated Protein C (Apc) Resistance Assay (Mayo)OutsideLaboratory,,85307,CPT,Facility,Outpatient,,,90,51,43.35,14.6166,51,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,44.064,86.4,,percent of total billed charges,,
Activated Protein C (Apc) Resistance Assay (Mayo)OutsideLaboratory,,85307,CPT,Facility,Inpatient,,,90,51,43.35,14.6166,51,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Activated Protein C (Apc) Resistance Assay (Mayo)OutsideLaboratory,,85307,CPT,Facility,Both,,,90,51,43.35,14.6166,51,"Preferred One Administrative Services, INC.",PPO,50.286,98.6,,percent of total billed charges,,
Activated Protein C (Apc) Resistance Assay (Mayo)OutsideLaboratory,,85307,CPT,Facility,Outpatient,,,90,51,43.35,14.6166,51,PrimeWest Health,Minnesota Senior Health Options (MSHO),26.2395,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Activated Protein C (Apc) Resistance Assay (Mayo)OutsideLaboratory,,85307,CPT,Facility,Inpatient,,,90,51,43.35,14.6166,51,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Activated Protein C (Apc) Resistance Assay (Mayo)OutsideLaboratory,,85307,CPT,Facility,Outpatient,,,90,51,43.35,14.6166,51,PrimeWest Health,MinnesotaCare,26.1936,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Activated Protein C (Apc) Resistance Assay (Mayo)OutsideLaboratory,,85307,CPT,Facility,Inpatient,,,90,51,43.35,14.6166,51,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Activated Protein C (Apc) Resistance Assay (Mayo)OutsideLaboratory,,85307,CPT,Facility,Both,,,90,51,43.35,14.6166,51,Sanford Health Plan,Sanford Health Plan,46.92,92,,percent of total billed charges,,
Activated Protein C (Apc) Resistance Assay (Mayo)OutsideLaboratory,,85307,CPT,Facility,Outpatient,,,90,51,43.35,14.6166,51,"UCare Health, Inc.",Individual & Family Plan,28.7385,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Activated Protein C (Apc) Resistance Assay (Mayo)OutsideLaboratory,,85307,CPT,Facility,Inpatient,,,90,51,43.35,14.6166,51,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Activated Protein C (Apc) Resistance Assay (Mayo)OutsideLaboratory,,85307,CPT,Facility,Outpatient,,,90,51,43.35,14.6166,51,"UCare Health, Inc.",Medical Assistance,25.7397,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Activated Protein C (Apc) Resistance Assay (Mayo)OutsideLaboratory,,85307,CPT,Facility,Inpatient,,,90,51,43.35,14.6166,51,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Activated Protein C (Apc) Resistance Assay (Mayo)OutsideLaboratory,,85307,CPT,Facility,Outpatient,,,90,51,43.35,14.6166,51,"UCare Health, Inc.",Medicare Advantage,25.7397,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Activated Protein C (Apc) Resistance Assay (Mayo)OutsideLaboratory,,85307,CPT,Facility,Inpatient,,,90,51,43.35,14.6166,51,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Activated Protein C (Apc) Resistance Assay (Mayo)OutsideLaboratory,,85307,CPT,Facility,Outpatient,,,90,51,43.35,14.6166,51,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),25.7397,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Activated Protein C (Apc) Resistance Assay (Mayo)OutsideLaboratory,,85307,CPT,Facility,Inpatient,,,90,51,43.35,14.6166,51,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Activated Protein C (Apc) Resistance Assay (Mayo)OutsideLaboratory,,85307,CPT,Facility,Both,,,90,51,43.35,14.6166,51,UnitedHealthcare,Individual & Family,47.94,94,,percent of total billed charges,,
Activated Protein C (Apc) Resistance Assay (Mayo)OutsideLaboratory,,85307,CPT,Facility,Outpatient,,,90,51,43.35,14.6166,51,UnitedHealthcare,Medicare Advantage,24.99,49,,percent of total billed charges,,
Activated Protein C (Apc) Resistance Assay (Mayo)OutsideLaboratory,,85307,CPT,Facility,Inpatient,,,90,51,43.35,14.6166,51,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Activated Protein C (Apc) Resistance Assay (Mayo)OutsideLaboratory,,85307,CPT,Facility,Outpatient,,,90,51,43.35,14.6166,51,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,24.48,48,,percent of total billed charges,,100% of DHS outpatient percentage
Activated Protein C (Apc) Resistance Assay (Mayo)OutsideLaboratory,,85307,CPT,Facility,Inpatient,,,90,51,43.35,14.6166,51,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Activated Protein Resistance V, P (Mayo)OutsideLaboratory",,85307,CPT,Facility,Both,,,90,51,43.35,14.6166,51,Aetna,Commercial,46.92,92,,percent of total billed charges,,
"Activated Protein Resistance V, P (Mayo)OutsideLaboratory",,85307,CPT,Facility,Outpatient,,,90,51,43.35,14.6166,51,Aetna,Medicare Advantage,24.99,49,,percent of total billed charges,,
"Activated Protein Resistance V, P (Mayo)OutsideLaboratory",,85307,CPT,Facility,Inpatient,,,90,51,43.35,14.6166,51,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Activated Protein Resistance V, P (Mayo)OutsideLaboratory",,85307,CPT,Facility,Both,,,90,51,43.35,14.6166,51,Aetna,PPO,47.43,93,,percent of total billed charges,,
"Activated Protein Resistance V, P (Mayo)OutsideLaboratory",,85307,CPT,Facility,Both,,,90,51,43.35,14.6166,51,America's PPO,America's PPO,48.9753,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Activated Protein Resistance V, P (Mayo)OutsideLaboratory",,85307,CPT,Facility,Both,,,90,51,43.35,14.6166,51,BlueCross BlueShield Minnesota, Federal Employee Program,50.184,98.4,,percent of total billed charges,,
"Activated Protein Resistance V, P (Mayo)OutsideLaboratory",,85307,CPT,Facility,Both,,,90,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,51,100,,percent of total billed charges,,
"Activated Protein Resistance V, P (Mayo)OutsideLaboratory",,85307,CPT,Facility,Both,,,90,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,High Value Network Plan,45.9,90,,percent of total billed charges,,
"Activated Protein Resistance V, P (Mayo)OutsideLaboratory",,85307,CPT,Facility,Outpatient,,,90,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,Medicare Advantage,24.99,49,,percent of total billed charges,,
"Activated Protein Resistance V, P (Mayo)OutsideLaboratory",,85307,CPT,Facility,Inpatient,,,90,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Activated Protein Resistance V, P (Mayo)OutsideLaboratory",,85307,CPT,Facility,Both,,,90,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,45.1707,88.57,,percent of total billed charges,,
"Activated Protein Resistance V, P (Mayo)OutsideLaboratory",,85307,CPT,Facility,Both,,,90,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,14.6166,28.66,,percent of total billed charges,,
"Activated Protein Resistance V, P (Mayo)OutsideLaboratory",,85307,CPT,Facility,Outpatient,,,90,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),24.99,49,,percent of total billed charges,,
"Activated Protein Resistance V, P (Mayo)OutsideLaboratory",,85307,CPT,Facility,Inpatient,,,90,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Activated Protein Resistance V, P (Mayo)OutsideLaboratory",,85307,CPT,Facility,Both,,,90,51,43.35,14.6166,51,CorVel,Worker's Compensation,51,100,,percent of total billed charges,,
"Activated Protein Resistance V, P (Mayo)OutsideLaboratory",,85307,CPT,Facility,Both,,,90,51,43.35,14.6166,51,First Health Group Corporation,First Health Network,49.47,97,,percent of total billed charges,,
"Activated Protein Resistance V, P (Mayo)OutsideLaboratory",,85307,CPT,Facility,Both,,,90,51,43.35,14.6166,51,"Health Partners, Inc.",Commercial,48.246,94.6,,percent of total billed charges,,
"Activated Protein Resistance V, P (Mayo)OutsideLaboratory",,85307,CPT,Facility,Outpatient,,,90,51,43.35,14.6166,51,"Health Partners, Inc.",Medicare Advantage,24.99,49,,percent of total billed charges,,
"Activated Protein Resistance V, P (Mayo)OutsideLaboratory",,85307,CPT,Facility,Inpatient,,,90,51,43.35,14.6166,51,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Activated Protein Resistance V, P (Mayo)OutsideLaboratory",,85307,CPT,Facility,Both,,,90,51,43.35,14.6166,51,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),30.6,60,,percent of total billed charges,,
"Activated Protein Resistance V, P (Mayo)OutsideLaboratory",,85307,CPT,Facility,Both,,,90,51,43.35,14.6166,51,"Health Partners, Inc.",State of Minnesota Advantage Program,41.565,81.5,,percent of total billed charges,,
"Activated Protein Resistance V, P (Mayo)OutsideLaboratory",,85307,CPT,Facility,Both,,,90,51,43.35,14.6166,51,"Health Partners, Inc.",State Public Programs,25.5,50,,percent of total billed charges,,
"Activated Protein Resistance V, P (Mayo)OutsideLaboratory",,85307,CPT,Facility,Both,,,90,51,43.35,14.6166,51,Humana Insurance Company,Commercial PPO,48.45,95,,percent of total billed charges,,
"Activated Protein Resistance V, P (Mayo)OutsideLaboratory",,85307,CPT,Facility,Outpatient,,,90,51,43.35,14.6166,51,Humana Insurance Company,Medicare PPO,24.99,49,,percent of total billed charges,,
"Activated Protein Resistance V, P (Mayo)OutsideLaboratory",,85307,CPT,Facility,Inpatient,,,90,51,43.35,14.6166,51,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Activated Protein Resistance V, P (Mayo)OutsideLaboratory",,85307,CPT,Facility,Both,,,90,51,43.35,14.6166,51,Medica,Individual & Family,50.541,99.1,,percent of total billed charges,,
"Activated Protein Resistance V, P (Mayo)OutsideLaboratory",,85307,CPT,Facility,Outpatient,,,90,51,43.35,14.6166,51,Medica,Medica Advantage Solution,25.398,49.8,,percent of total billed charges,,
"Activated Protein Resistance V, P (Mayo)OutsideLaboratory",,85307,CPT,Facility,Inpatient,,,90,51,43.35,14.6166,51,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Activated Protein Resistance V, P (Mayo)OutsideLaboratory",,85307,CPT,Facility,Outpatient,,,90,51,43.35,14.6166,51,Medica,Medical Assistance,22.746,44.6,,percent of total billed charges,,
"Activated Protein Resistance V, P (Mayo)OutsideLaboratory",,85307,CPT,Facility,Inpatient,,,90,51,43.35,14.6166,51,Medica,Medical Assistance,,,,,Included in per diem rate,
"Activated Protein Resistance V, P (Mayo)OutsideLaboratory",,85307,CPT,Facility,Outpatient,,,90,51,43.35,14.6166,51,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,25.398,49.8,,percent of total billed charges,,
"Activated Protein Resistance V, P (Mayo)OutsideLaboratory",,85307,CPT,Facility,Inpatient,,,90,51,43.35,14.6166,51,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Activated Protein Resistance V, P (Mayo)OutsideLaboratory",,85307,CPT,Facility,Both,,,90,51,43.35,14.6166,51,"Multiplan, Inc.","Multiplan, Inc.",47.94,94,,percent of total billed charges,,
"Activated Protein Resistance V, P (Mayo)OutsideLaboratory",,85307,CPT,Facility,Outpatient,,,90,51,43.35,14.6166,51,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,44.064,86.4,,percent of total billed charges,,
"Activated Protein Resistance V, P (Mayo)OutsideLaboratory",,85307,CPT,Facility,Inpatient,,,90,51,43.35,14.6166,51,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Activated Protein Resistance V, P (Mayo)OutsideLaboratory",,85307,CPT,Facility,Both,,,90,51,43.35,14.6166,51,"Preferred One Administrative Services, INC.",PPO,50.286,98.6,,percent of total billed charges,,
"Activated Protein Resistance V, P (Mayo)OutsideLaboratory",,85307,CPT,Facility,Outpatient,,,90,51,43.35,14.6166,51,PrimeWest Health,Minnesota Senior Health Options (MSHO),26.2395,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Activated Protein Resistance V, P (Mayo)OutsideLaboratory",,85307,CPT,Facility,Inpatient,,,90,51,43.35,14.6166,51,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Activated Protein Resistance V, P (Mayo)OutsideLaboratory",,85307,CPT,Facility,Outpatient,,,90,51,43.35,14.6166,51,PrimeWest Health,MinnesotaCare,26.1936,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Activated Protein Resistance V, P (Mayo)OutsideLaboratory",,85307,CPT,Facility,Inpatient,,,90,51,43.35,14.6166,51,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Activated Protein Resistance V, P (Mayo)OutsideLaboratory",,85307,CPT,Facility,Both,,,90,51,43.35,14.6166,51,Sanford Health Plan,Sanford Health Plan,46.92,92,,percent of total billed charges,,
"Activated Protein Resistance V, P (Mayo)OutsideLaboratory",,85307,CPT,Facility,Outpatient,,,90,51,43.35,14.6166,51,"UCare Health, Inc.",Individual & Family Plan,28.7385,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Activated Protein Resistance V, P (Mayo)OutsideLaboratory",,85307,CPT,Facility,Inpatient,,,90,51,43.35,14.6166,51,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Activated Protein Resistance V, P (Mayo)OutsideLaboratory",,85307,CPT,Facility,Outpatient,,,90,51,43.35,14.6166,51,"UCare Health, Inc.",Medical Assistance,25.7397,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Activated Protein Resistance V, P (Mayo)OutsideLaboratory",,85307,CPT,Facility,Inpatient,,,90,51,43.35,14.6166,51,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Activated Protein Resistance V, P (Mayo)OutsideLaboratory",,85307,CPT,Facility,Outpatient,,,90,51,43.35,14.6166,51,"UCare Health, Inc.",Medicare Advantage,25.7397,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Activated Protein Resistance V, P (Mayo)OutsideLaboratory",,85307,CPT,Facility,Inpatient,,,90,51,43.35,14.6166,51,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Activated Protein Resistance V, P (Mayo)OutsideLaboratory",,85307,CPT,Facility,Outpatient,,,90,51,43.35,14.6166,51,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),25.7397,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Activated Protein Resistance V, P (Mayo)OutsideLaboratory",,85307,CPT,Facility,Inpatient,,,90,51,43.35,14.6166,51,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Activated Protein Resistance V, P (Mayo)OutsideLaboratory",,85307,CPT,Facility,Both,,,90,51,43.35,14.6166,51,UnitedHealthcare,Individual & Family,47.94,94,,percent of total billed charges,,
"Activated Protein Resistance V, P (Mayo)OutsideLaboratory",,85307,CPT,Facility,Outpatient,,,90,51,43.35,14.6166,51,UnitedHealthcare,Medicare Advantage,24.99,49,,percent of total billed charges,,
"Activated Protein Resistance V, P (Mayo)OutsideLaboratory",,85307,CPT,Facility,Inpatient,,,90,51,43.35,14.6166,51,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Activated Protein Resistance V, P (Mayo)OutsideLaboratory",,85307,CPT,Facility,Outpatient,,,90,51,43.35,14.6166,51,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,24.48,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Activated Protein Resistance V, P (Mayo)OutsideLaboratory",,85307,CPT,Facility,Inpatient,,,90,51,43.35,14.6166,51,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Soluble Fibrin Monomer (Mayo)OutsideLaboratory,,85366,CPT,Facility,Both,,,90,236,200.6,67.6376,236,Aetna,Commercial,217.12,92,,percent of total billed charges,,
Soluble Fibrin Monomer (Mayo)OutsideLaboratory,,85366,CPT,Facility,Outpatient,,,90,236,200.6,67.6376,236,Aetna,Medicare Advantage,115.64,49,,percent of total billed charges,,
Soluble Fibrin Monomer (Mayo)OutsideLaboratory,,85366,CPT,Facility,Inpatient,,,90,236,200.6,67.6376,236,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Soluble Fibrin Monomer (Mayo)OutsideLaboratory,,85366,CPT,Facility,Both,,,90,236,200.6,67.6376,236,Aetna,PPO,219.48,93,,percent of total billed charges,,
Soluble Fibrin Monomer (Mayo)OutsideLaboratory,,85366,CPT,Facility,Both,,,90,236,200.6,67.6376,236,America's PPO,America's PPO,226.6308,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Soluble Fibrin Monomer (Mayo)OutsideLaboratory,,85366,CPT,Facility,Both,,,90,236,200.6,67.6376,236,BlueCross BlueShield Minnesota, Federal Employee Program,232.224,98.4,,percent of total billed charges,,
Soluble Fibrin Monomer (Mayo)OutsideLaboratory,,85366,CPT,Facility,Both,,,90,236,200.6,67.6376,236,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,236,100,,percent of total billed charges,,
Soluble Fibrin Monomer (Mayo)OutsideLaboratory,,85366,CPT,Facility,Both,,,90,236,200.6,67.6376,236,BlueCross BlueShield Minnesota,High Value Network Plan,212.4,90,,percent of total billed charges,,
Soluble Fibrin Monomer (Mayo)OutsideLaboratory,,85366,CPT,Facility,Outpatient,,,90,236,200.6,67.6376,236,BlueCross BlueShield Minnesota,Medicare Advantage,115.64,49,,percent of total billed charges,,
Soluble Fibrin Monomer (Mayo)OutsideLaboratory,,85366,CPT,Facility,Inpatient,,,90,236,200.6,67.6376,236,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Soluble Fibrin Monomer (Mayo)OutsideLaboratory,,85366,CPT,Facility,Both,,,90,236,200.6,67.6376,236,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,209.0252,88.57,,percent of total billed charges,,
Soluble Fibrin Monomer (Mayo)OutsideLaboratory,,85366,CPT,Facility,Both,,,90,236,200.6,67.6376,236,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,67.6376,28.66,,percent of total billed charges,,
Soluble Fibrin Monomer (Mayo)OutsideLaboratory,,85366,CPT,Facility,Outpatient,,,90,236,200.6,67.6376,236,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),115.64,49,,percent of total billed charges,,
Soluble Fibrin Monomer (Mayo)OutsideLaboratory,,85366,CPT,Facility,Inpatient,,,90,236,200.6,67.6376,236,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Soluble Fibrin Monomer (Mayo)OutsideLaboratory,,85366,CPT,Facility,Both,,,90,236,200.6,67.6376,236,CorVel,Worker's Compensation,236,100,,percent of total billed charges,,
Soluble Fibrin Monomer (Mayo)OutsideLaboratory,,85366,CPT,Facility,Both,,,90,236,200.6,67.6376,236,First Health Group Corporation,First Health Network,228.92,97,,percent of total billed charges,,
Soluble Fibrin Monomer (Mayo)OutsideLaboratory,,85366,CPT,Facility,Both,,,90,236,200.6,67.6376,236,"Health Partners, Inc.",Commercial,223.256,94.6,,percent of total billed charges,,
Soluble Fibrin Monomer (Mayo)OutsideLaboratory,,85366,CPT,Facility,Outpatient,,,90,236,200.6,67.6376,236,"Health Partners, Inc.",Medicare Advantage,115.64,49,,percent of total billed charges,,
Soluble Fibrin Monomer (Mayo)OutsideLaboratory,,85366,CPT,Facility,Inpatient,,,90,236,200.6,67.6376,236,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Soluble Fibrin Monomer (Mayo)OutsideLaboratory,,85366,CPT,Facility,Both,,,90,236,200.6,67.6376,236,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),141.6,60,,percent of total billed charges,,
Soluble Fibrin Monomer (Mayo)OutsideLaboratory,,85366,CPT,Facility,Both,,,90,236,200.6,67.6376,236,"Health Partners, Inc.",State of Minnesota Advantage Program,192.34,81.5,,percent of total billed charges,,
Soluble Fibrin Monomer (Mayo)OutsideLaboratory,,85366,CPT,Facility,Both,,,90,236,200.6,67.6376,236,"Health Partners, Inc.",State Public Programs,118,50,,percent of total billed charges,,
Soluble Fibrin Monomer (Mayo)OutsideLaboratory,,85366,CPT,Facility,Both,,,90,236,200.6,67.6376,236,Humana Insurance Company,Commercial PPO,224.2,95,,percent of total billed charges,,
Soluble Fibrin Monomer (Mayo)OutsideLaboratory,,85366,CPT,Facility,Outpatient,,,90,236,200.6,67.6376,236,Humana Insurance Company,Medicare PPO,115.64,49,,percent of total billed charges,,
Soluble Fibrin Monomer (Mayo)OutsideLaboratory,,85366,CPT,Facility,Inpatient,,,90,236,200.6,67.6376,236,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Soluble Fibrin Monomer (Mayo)OutsideLaboratory,,85366,CPT,Facility,Both,,,90,236,200.6,67.6376,236,Medica,Individual & Family,233.876,99.1,,percent of total billed charges,,
Soluble Fibrin Monomer (Mayo)OutsideLaboratory,,85366,CPT,Facility,Outpatient,,,90,236,200.6,67.6376,236,Medica,Medica Advantage Solution,117.528,49.8,,percent of total billed charges,,
Soluble Fibrin Monomer (Mayo)OutsideLaboratory,,85366,CPT,Facility,Inpatient,,,90,236,200.6,67.6376,236,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Soluble Fibrin Monomer (Mayo)OutsideLaboratory,,85366,CPT,Facility,Outpatient,,,90,236,200.6,67.6376,236,Medica,Medical Assistance,105.256,44.6,,percent of total billed charges,,
Soluble Fibrin Monomer (Mayo)OutsideLaboratory,,85366,CPT,Facility,Inpatient,,,90,236,200.6,67.6376,236,Medica,Medical Assistance,,,,,Included in per diem rate,
Soluble Fibrin Monomer (Mayo)OutsideLaboratory,,85366,CPT,Facility,Outpatient,,,90,236,200.6,67.6376,236,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,117.528,49.8,,percent of total billed charges,,
Soluble Fibrin Monomer (Mayo)OutsideLaboratory,,85366,CPT,Facility,Inpatient,,,90,236,200.6,67.6376,236,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Soluble Fibrin Monomer (Mayo)OutsideLaboratory,,85366,CPT,Facility,Both,,,90,236,200.6,67.6376,236,"Multiplan, Inc.","Multiplan, Inc.",221.84,94,,percent of total billed charges,,
Soluble Fibrin Monomer (Mayo)OutsideLaboratory,,85366,CPT,Facility,Outpatient,,,90,236,200.6,67.6376,236,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,203.904,86.4,,percent of total billed charges,,
Soluble Fibrin Monomer (Mayo)OutsideLaboratory,,85366,CPT,Facility,Inpatient,,,90,236,200.6,67.6376,236,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Soluble Fibrin Monomer (Mayo)OutsideLaboratory,,85366,CPT,Facility,Both,,,90,236,200.6,67.6376,236,"Preferred One Administrative Services, INC.",PPO,232.696,98.6,,percent of total billed charges,,
Soluble Fibrin Monomer (Mayo)OutsideLaboratory,,85366,CPT,Facility,Outpatient,,,90,236,200.6,67.6376,236,PrimeWest Health,Minnesota Senior Health Options (MSHO),121.422,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Soluble Fibrin Monomer (Mayo)OutsideLaboratory,,85366,CPT,Facility,Inpatient,,,90,236,200.6,67.6376,236,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Soluble Fibrin Monomer (Mayo)OutsideLaboratory,,85366,CPT,Facility,Outpatient,,,90,236,200.6,67.6376,236,PrimeWest Health,MinnesotaCare,121.2096,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Soluble Fibrin Monomer (Mayo)OutsideLaboratory,,85366,CPT,Facility,Inpatient,,,90,236,200.6,67.6376,236,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Soluble Fibrin Monomer (Mayo)OutsideLaboratory,,85366,CPT,Facility,Both,,,90,236,200.6,67.6376,236,Sanford Health Plan,Sanford Health Plan,217.12,92,,percent of total billed charges,,
Soluble Fibrin Monomer (Mayo)OutsideLaboratory,,85366,CPT,Facility,Outpatient,,,90,236,200.6,67.6376,236,"UCare Health, Inc.",Individual & Family Plan,132.986,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Soluble Fibrin Monomer (Mayo)OutsideLaboratory,,85366,CPT,Facility,Inpatient,,,90,236,200.6,67.6376,236,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Soluble Fibrin Monomer (Mayo)OutsideLaboratory,,85366,CPT,Facility,Outpatient,,,90,236,200.6,67.6376,236,"UCare Health, Inc.",Medical Assistance,119.1092,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Soluble Fibrin Monomer (Mayo)OutsideLaboratory,,85366,CPT,Facility,Inpatient,,,90,236,200.6,67.6376,236,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Soluble Fibrin Monomer (Mayo)OutsideLaboratory,,85366,CPT,Facility,Outpatient,,,90,236,200.6,67.6376,236,"UCare Health, Inc.",Medicare Advantage,119.1092,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Soluble Fibrin Monomer (Mayo)OutsideLaboratory,,85366,CPT,Facility,Inpatient,,,90,236,200.6,67.6376,236,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Soluble Fibrin Monomer (Mayo)OutsideLaboratory,,85366,CPT,Facility,Outpatient,,,90,236,200.6,67.6376,236,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),119.1092,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Soluble Fibrin Monomer (Mayo)OutsideLaboratory,,85366,CPT,Facility,Inpatient,,,90,236,200.6,67.6376,236,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Soluble Fibrin Monomer (Mayo)OutsideLaboratory,,85366,CPT,Facility,Both,,,90,236,200.6,67.6376,236,UnitedHealthcare,Individual & Family,221.84,94,,percent of total billed charges,,
Soluble Fibrin Monomer (Mayo)OutsideLaboratory,,85366,CPT,Facility,Outpatient,,,90,236,200.6,67.6376,236,UnitedHealthcare,Medicare Advantage,115.64,49,,percent of total billed charges,,
Soluble Fibrin Monomer (Mayo)OutsideLaboratory,,85366,CPT,Facility,Inpatient,,,90,236,200.6,67.6376,236,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Soluble Fibrin Monomer (Mayo)OutsideLaboratory,,85366,CPT,Facility,Outpatient,,,90,236,200.6,67.6376,236,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,113.28,48,,percent of total billed charges,,100% of DHS outpatient percentage
Soluble Fibrin Monomer (Mayo)OutsideLaboratory,,85366,CPT,Facility,Inpatient,,,90,236,200.6,67.6376,236,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"D Dimer, Quantitative (Mayo)OutsideLaboratory",,85379,CPT,Facility,Both,,,90,168,142.8,48.1488,168,Aetna,Commercial,154.56,92,,percent of total billed charges,,
"D Dimer, Quantitative (Mayo)OutsideLaboratory",,85379,CPT,Facility,Outpatient,,,90,168,142.8,48.1488,168,Aetna,Medicare Advantage,82.32,49,,percent of total billed charges,,
"D Dimer, Quantitative (Mayo)OutsideLaboratory",,85379,CPT,Facility,Inpatient,,,90,168,142.8,48.1488,168,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"D Dimer, Quantitative (Mayo)OutsideLaboratory",,85379,CPT,Facility,Both,,,90,168,142.8,48.1488,168,Aetna,PPO,156.24,93,,percent of total billed charges,,
"D Dimer, Quantitative (Mayo)OutsideLaboratory",,85379,CPT,Facility,Both,,,90,168,142.8,48.1488,168,America's PPO,America's PPO,161.3304,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"D Dimer, Quantitative (Mayo)OutsideLaboratory",,85379,CPT,Facility,Both,,,90,168,142.8,48.1488,168,BlueCross BlueShield Minnesota, Federal Employee Program,165.312,98.4,,percent of total billed charges,,
"D Dimer, Quantitative (Mayo)OutsideLaboratory",,85379,CPT,Facility,Both,,,90,168,142.8,48.1488,168,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,168,100,,percent of total billed charges,,
"D Dimer, Quantitative (Mayo)OutsideLaboratory",,85379,CPT,Facility,Both,,,90,168,142.8,48.1488,168,BlueCross BlueShield Minnesota,High Value Network Plan,151.2,90,,percent of total billed charges,,
"D Dimer, Quantitative (Mayo)OutsideLaboratory",,85379,CPT,Facility,Outpatient,,,90,168,142.8,48.1488,168,BlueCross BlueShield Minnesota,Medicare Advantage,82.32,49,,percent of total billed charges,,
"D Dimer, Quantitative (Mayo)OutsideLaboratory",,85379,CPT,Facility,Inpatient,,,90,168,142.8,48.1488,168,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"D Dimer, Quantitative (Mayo)OutsideLaboratory",,85379,CPT,Facility,Both,,,90,168,142.8,48.1488,168,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,148.7976,88.57,,percent of total billed charges,,
"D Dimer, Quantitative (Mayo)OutsideLaboratory",,85379,CPT,Facility,Both,,,90,168,142.8,48.1488,168,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,48.1488,28.66,,percent of total billed charges,,
"D Dimer, Quantitative (Mayo)OutsideLaboratory",,85379,CPT,Facility,Outpatient,,,90,168,142.8,48.1488,168,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),82.32,49,,percent of total billed charges,,
"D Dimer, Quantitative (Mayo)OutsideLaboratory",,85379,CPT,Facility,Inpatient,,,90,168,142.8,48.1488,168,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"D Dimer, Quantitative (Mayo)OutsideLaboratory",,85379,CPT,Facility,Both,,,90,168,142.8,48.1488,168,CorVel,Worker's Compensation,168,100,,percent of total billed charges,,
"D Dimer, Quantitative (Mayo)OutsideLaboratory",,85379,CPT,Facility,Both,,,90,168,142.8,48.1488,168,First Health Group Corporation,First Health Network,162.96,97,,percent of total billed charges,,
"D Dimer, Quantitative (Mayo)OutsideLaboratory",,85379,CPT,Facility,Both,,,90,168,142.8,48.1488,168,"Health Partners, Inc.",Commercial,158.928,94.6,,percent of total billed charges,,
"D Dimer, Quantitative (Mayo)OutsideLaboratory",,85379,CPT,Facility,Outpatient,,,90,168,142.8,48.1488,168,"Health Partners, Inc.",Medicare Advantage,82.32,49,,percent of total billed charges,,
"D Dimer, Quantitative (Mayo)OutsideLaboratory",,85379,CPT,Facility,Inpatient,,,90,168,142.8,48.1488,168,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"D Dimer, Quantitative (Mayo)OutsideLaboratory",,85379,CPT,Facility,Both,,,90,168,142.8,48.1488,168,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),100.8,60,,percent of total billed charges,,
"D Dimer, Quantitative (Mayo)OutsideLaboratory",,85379,CPT,Facility,Both,,,90,168,142.8,48.1488,168,"Health Partners, Inc.",State of Minnesota Advantage Program,136.92,81.5,,percent of total billed charges,,
"D Dimer, Quantitative (Mayo)OutsideLaboratory",,85379,CPT,Facility,Both,,,90,168,142.8,48.1488,168,"Health Partners, Inc.",State Public Programs,84,50,,percent of total billed charges,,
"D Dimer, Quantitative (Mayo)OutsideLaboratory",,85379,CPT,Facility,Both,,,90,168,142.8,48.1488,168,Humana Insurance Company,Commercial PPO,159.6,95,,percent of total billed charges,,
"D Dimer, Quantitative (Mayo)OutsideLaboratory",,85379,CPT,Facility,Outpatient,,,90,168,142.8,48.1488,168,Humana Insurance Company,Medicare PPO,82.32,49,,percent of total billed charges,,
"D Dimer, Quantitative (Mayo)OutsideLaboratory",,85379,CPT,Facility,Inpatient,,,90,168,142.8,48.1488,168,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"D Dimer, Quantitative (Mayo)OutsideLaboratory",,85379,CPT,Facility,Both,,,90,168,142.8,48.1488,168,Medica,Individual & Family,166.488,99.1,,percent of total billed charges,,
"D Dimer, Quantitative (Mayo)OutsideLaboratory",,85379,CPT,Facility,Outpatient,,,90,168,142.8,48.1488,168,Medica,Medica Advantage Solution,83.664,49.8,,percent of total billed charges,,
"D Dimer, Quantitative (Mayo)OutsideLaboratory",,85379,CPT,Facility,Inpatient,,,90,168,142.8,48.1488,168,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"D Dimer, Quantitative (Mayo)OutsideLaboratory",,85379,CPT,Facility,Outpatient,,,90,168,142.8,48.1488,168,Medica,Medical Assistance,74.928,44.6,,percent of total billed charges,,
"D Dimer, Quantitative (Mayo)OutsideLaboratory",,85379,CPT,Facility,Inpatient,,,90,168,142.8,48.1488,168,Medica,Medical Assistance,,,,,Included in per diem rate,
"D Dimer, Quantitative (Mayo)OutsideLaboratory",,85379,CPT,Facility,Outpatient,,,90,168,142.8,48.1488,168,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,83.664,49.8,,percent of total billed charges,,
"D Dimer, Quantitative (Mayo)OutsideLaboratory",,85379,CPT,Facility,Inpatient,,,90,168,142.8,48.1488,168,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"D Dimer, Quantitative (Mayo)OutsideLaboratory",,85379,CPT,Facility,Both,,,90,168,142.8,48.1488,168,"Multiplan, Inc.","Multiplan, Inc.",157.92,94,,percent of total billed charges,,
"D Dimer, Quantitative (Mayo)OutsideLaboratory",,85379,CPT,Facility,Outpatient,,,90,168,142.8,48.1488,168,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,145.152,86.4,,percent of total billed charges,,
"D Dimer, Quantitative (Mayo)OutsideLaboratory",,85379,CPT,Facility,Inpatient,,,90,168,142.8,48.1488,168,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"D Dimer, Quantitative (Mayo)OutsideLaboratory",,85379,CPT,Facility,Both,,,90,168,142.8,48.1488,168,"Preferred One Administrative Services, INC.",PPO,165.648,98.6,,percent of total billed charges,,
"D Dimer, Quantitative (Mayo)OutsideLaboratory",,85379,CPT,Facility,Outpatient,,,90,168,142.8,48.1488,168,PrimeWest Health,Minnesota Senior Health Options (MSHO),86.436,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"D Dimer, Quantitative (Mayo)OutsideLaboratory",,85379,CPT,Facility,Inpatient,,,90,168,142.8,48.1488,168,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"D Dimer, Quantitative (Mayo)OutsideLaboratory",,85379,CPT,Facility,Outpatient,,,90,168,142.8,48.1488,168,PrimeWest Health,MinnesotaCare,86.2848,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"D Dimer, Quantitative (Mayo)OutsideLaboratory",,85379,CPT,Facility,Inpatient,,,90,168,142.8,48.1488,168,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"D Dimer, Quantitative (Mayo)OutsideLaboratory",,85379,CPT,Facility,Both,,,90,168,142.8,48.1488,168,Sanford Health Plan,Sanford Health Plan,154.56,92,,percent of total billed charges,,
"D Dimer, Quantitative (Mayo)OutsideLaboratory",,85379,CPT,Facility,Outpatient,,,90,168,142.8,48.1488,168,"UCare Health, Inc.",Individual & Family Plan,94.668,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"D Dimer, Quantitative (Mayo)OutsideLaboratory",,85379,CPT,Facility,Inpatient,,,90,168,142.8,48.1488,168,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"D Dimer, Quantitative (Mayo)OutsideLaboratory",,85379,CPT,Facility,Outpatient,,,90,168,142.8,48.1488,168,"UCare Health, Inc.",Medical Assistance,84.7896,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"D Dimer, Quantitative (Mayo)OutsideLaboratory",,85379,CPT,Facility,Inpatient,,,90,168,142.8,48.1488,168,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"D Dimer, Quantitative (Mayo)OutsideLaboratory",,85379,CPT,Facility,Outpatient,,,90,168,142.8,48.1488,168,"UCare Health, Inc.",Medicare Advantage,84.7896,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"D Dimer, Quantitative (Mayo)OutsideLaboratory",,85379,CPT,Facility,Inpatient,,,90,168,142.8,48.1488,168,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"D Dimer, Quantitative (Mayo)OutsideLaboratory",,85379,CPT,Facility,Outpatient,,,90,168,142.8,48.1488,168,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),84.7896,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"D Dimer, Quantitative (Mayo)OutsideLaboratory",,85379,CPT,Facility,Inpatient,,,90,168,142.8,48.1488,168,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"D Dimer, Quantitative (Mayo)OutsideLaboratory",,85379,CPT,Facility,Both,,,90,168,142.8,48.1488,168,UnitedHealthcare,Individual & Family,157.92,94,,percent of total billed charges,,
"D Dimer, Quantitative (Mayo)OutsideLaboratory",,85379,CPT,Facility,Outpatient,,,90,168,142.8,48.1488,168,UnitedHealthcare,Medicare Advantage,82.32,49,,percent of total billed charges,,
"D Dimer, Quantitative (Mayo)OutsideLaboratory",,85379,CPT,Facility,Inpatient,,,90,168,142.8,48.1488,168,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"D Dimer, Quantitative (Mayo)OutsideLaboratory",,85379,CPT,Facility,Outpatient,,,90,168,142.8,48.1488,168,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,80.64,48,,percent of total billed charges,,100% of DHS outpatient percentage
"D Dimer, Quantitative (Mayo)OutsideLaboratory",,85379,CPT,Facility,Inpatient,,,90,168,142.8,48.1488,168,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
D-Dimer (Mayo)OutsideLaboratory,,85379,CPT,Facility,Both,,,90,168,142.8,48.1488,168,Aetna,Commercial,154.56,92,,percent of total billed charges,,
D-Dimer (Mayo)OutsideLaboratory,,85379,CPT,Facility,Outpatient,,,90,168,142.8,48.1488,168,Aetna,Medicare Advantage,82.32,49,,percent of total billed charges,,
D-Dimer (Mayo)OutsideLaboratory,,85379,CPT,Facility,Inpatient,,,90,168,142.8,48.1488,168,Aetna,Medicare Advantage,,,,,Included in per diem rate,
D-Dimer (Mayo)OutsideLaboratory,,85379,CPT,Facility,Both,,,90,168,142.8,48.1488,168,Aetna,PPO,156.24,93,,percent of total billed charges,,
D-Dimer (Mayo)OutsideLaboratory,,85379,CPT,Facility,Both,,,90,168,142.8,48.1488,168,America's PPO,America's PPO,161.3304,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
D-Dimer (Mayo)OutsideLaboratory,,85379,CPT,Facility,Both,,,90,168,142.8,48.1488,168,BlueCross BlueShield Minnesota, Federal Employee Program,165.312,98.4,,percent of total billed charges,,
D-Dimer (Mayo)OutsideLaboratory,,85379,CPT,Facility,Both,,,90,168,142.8,48.1488,168,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,168,100,,percent of total billed charges,,
D-Dimer (Mayo)OutsideLaboratory,,85379,CPT,Facility,Both,,,90,168,142.8,48.1488,168,BlueCross BlueShield Minnesota,High Value Network Plan,151.2,90,,percent of total billed charges,,
D-Dimer (Mayo)OutsideLaboratory,,85379,CPT,Facility,Outpatient,,,90,168,142.8,48.1488,168,BlueCross BlueShield Minnesota,Medicare Advantage,82.32,49,,percent of total billed charges,,
D-Dimer (Mayo)OutsideLaboratory,,85379,CPT,Facility,Inpatient,,,90,168,142.8,48.1488,168,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
D-Dimer (Mayo)OutsideLaboratory,,85379,CPT,Facility,Both,,,90,168,142.8,48.1488,168,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,148.7976,88.57,,percent of total billed charges,,
D-Dimer (Mayo)OutsideLaboratory,,85379,CPT,Facility,Both,,,90,168,142.8,48.1488,168,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,48.1488,28.66,,percent of total billed charges,,
D-Dimer (Mayo)OutsideLaboratory,,85379,CPT,Facility,Outpatient,,,90,168,142.8,48.1488,168,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),82.32,49,,percent of total billed charges,,
D-Dimer (Mayo)OutsideLaboratory,,85379,CPT,Facility,Inpatient,,,90,168,142.8,48.1488,168,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
D-Dimer (Mayo)OutsideLaboratory,,85379,CPT,Facility,Both,,,90,168,142.8,48.1488,168,CorVel,Worker's Compensation,168,100,,percent of total billed charges,,
D-Dimer (Mayo)OutsideLaboratory,,85379,CPT,Facility,Both,,,90,168,142.8,48.1488,168,First Health Group Corporation,First Health Network,162.96,97,,percent of total billed charges,,
D-Dimer (Mayo)OutsideLaboratory,,85379,CPT,Facility,Both,,,90,168,142.8,48.1488,168,"Health Partners, Inc.",Commercial,158.928,94.6,,percent of total billed charges,,
D-Dimer (Mayo)OutsideLaboratory,,85379,CPT,Facility,Outpatient,,,90,168,142.8,48.1488,168,"Health Partners, Inc.",Medicare Advantage,82.32,49,,percent of total billed charges,,
D-Dimer (Mayo)OutsideLaboratory,,85379,CPT,Facility,Inpatient,,,90,168,142.8,48.1488,168,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
D-Dimer (Mayo)OutsideLaboratory,,85379,CPT,Facility,Both,,,90,168,142.8,48.1488,168,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),100.8,60,,percent of total billed charges,,
D-Dimer (Mayo)OutsideLaboratory,,85379,CPT,Facility,Both,,,90,168,142.8,48.1488,168,"Health Partners, Inc.",State of Minnesota Advantage Program,136.92,81.5,,percent of total billed charges,,
D-Dimer (Mayo)OutsideLaboratory,,85379,CPT,Facility,Both,,,90,168,142.8,48.1488,168,"Health Partners, Inc.",State Public Programs,84,50,,percent of total billed charges,,
D-Dimer (Mayo)OutsideLaboratory,,85379,CPT,Facility,Both,,,90,168,142.8,48.1488,168,Humana Insurance Company,Commercial PPO,159.6,95,,percent of total billed charges,,
D-Dimer (Mayo)OutsideLaboratory,,85379,CPT,Facility,Outpatient,,,90,168,142.8,48.1488,168,Humana Insurance Company,Medicare PPO,82.32,49,,percent of total billed charges,,
D-Dimer (Mayo)OutsideLaboratory,,85379,CPT,Facility,Inpatient,,,90,168,142.8,48.1488,168,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
D-Dimer (Mayo)OutsideLaboratory,,85379,CPT,Facility,Both,,,90,168,142.8,48.1488,168,Medica,Individual & Family,166.488,99.1,,percent of total billed charges,,
D-Dimer (Mayo)OutsideLaboratory,,85379,CPT,Facility,Outpatient,,,90,168,142.8,48.1488,168,Medica,Medica Advantage Solution,83.664,49.8,,percent of total billed charges,,
D-Dimer (Mayo)OutsideLaboratory,,85379,CPT,Facility,Inpatient,,,90,168,142.8,48.1488,168,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
D-Dimer (Mayo)OutsideLaboratory,,85379,CPT,Facility,Outpatient,,,90,168,142.8,48.1488,168,Medica,Medical Assistance,74.928,44.6,,percent of total billed charges,,
D-Dimer (Mayo)OutsideLaboratory,,85379,CPT,Facility,Inpatient,,,90,168,142.8,48.1488,168,Medica,Medical Assistance,,,,,Included in per diem rate,
D-Dimer (Mayo)OutsideLaboratory,,85379,CPT,Facility,Outpatient,,,90,168,142.8,48.1488,168,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,83.664,49.8,,percent of total billed charges,,
D-Dimer (Mayo)OutsideLaboratory,,85379,CPT,Facility,Inpatient,,,90,168,142.8,48.1488,168,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
D-Dimer (Mayo)OutsideLaboratory,,85379,CPT,Facility,Both,,,90,168,142.8,48.1488,168,"Multiplan, Inc.","Multiplan, Inc.",157.92,94,,percent of total billed charges,,
D-Dimer (Mayo)OutsideLaboratory,,85379,CPT,Facility,Outpatient,,,90,168,142.8,48.1488,168,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,145.152,86.4,,percent of total billed charges,,
D-Dimer (Mayo)OutsideLaboratory,,85379,CPT,Facility,Inpatient,,,90,168,142.8,48.1488,168,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
D-Dimer (Mayo)OutsideLaboratory,,85379,CPT,Facility,Both,,,90,168,142.8,48.1488,168,"Preferred One Administrative Services, INC.",PPO,165.648,98.6,,percent of total billed charges,,
D-Dimer (Mayo)OutsideLaboratory,,85379,CPT,Facility,Outpatient,,,90,168,142.8,48.1488,168,PrimeWest Health,Minnesota Senior Health Options (MSHO),86.436,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
D-Dimer (Mayo)OutsideLaboratory,,85379,CPT,Facility,Inpatient,,,90,168,142.8,48.1488,168,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
D-Dimer (Mayo)OutsideLaboratory,,85379,CPT,Facility,Outpatient,,,90,168,142.8,48.1488,168,PrimeWest Health,MinnesotaCare,86.2848,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
D-Dimer (Mayo)OutsideLaboratory,,85379,CPT,Facility,Inpatient,,,90,168,142.8,48.1488,168,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
D-Dimer (Mayo)OutsideLaboratory,,85379,CPT,Facility,Both,,,90,168,142.8,48.1488,168,Sanford Health Plan,Sanford Health Plan,154.56,92,,percent of total billed charges,,
D-Dimer (Mayo)OutsideLaboratory,,85379,CPT,Facility,Outpatient,,,90,168,142.8,48.1488,168,"UCare Health, Inc.",Individual & Family Plan,94.668,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
D-Dimer (Mayo)OutsideLaboratory,,85379,CPT,Facility,Inpatient,,,90,168,142.8,48.1488,168,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
D-Dimer (Mayo)OutsideLaboratory,,85379,CPT,Facility,Outpatient,,,90,168,142.8,48.1488,168,"UCare Health, Inc.",Medical Assistance,84.7896,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
D-Dimer (Mayo)OutsideLaboratory,,85379,CPT,Facility,Inpatient,,,90,168,142.8,48.1488,168,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
D-Dimer (Mayo)OutsideLaboratory,,85379,CPT,Facility,Outpatient,,,90,168,142.8,48.1488,168,"UCare Health, Inc.",Medicare Advantage,84.7896,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
D-Dimer (Mayo)OutsideLaboratory,,85379,CPT,Facility,Inpatient,,,90,168,142.8,48.1488,168,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
D-Dimer (Mayo)OutsideLaboratory,,85379,CPT,Facility,Outpatient,,,90,168,142.8,48.1488,168,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),84.7896,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
D-Dimer (Mayo)OutsideLaboratory,,85379,CPT,Facility,Inpatient,,,90,168,142.8,48.1488,168,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
D-Dimer (Mayo)OutsideLaboratory,,85379,CPT,Facility,Both,,,90,168,142.8,48.1488,168,UnitedHealthcare,Individual & Family,157.92,94,,percent of total billed charges,,
D-Dimer (Mayo)OutsideLaboratory,,85379,CPT,Facility,Outpatient,,,90,168,142.8,48.1488,168,UnitedHealthcare,Medicare Advantage,82.32,49,,percent of total billed charges,,
D-Dimer (Mayo)OutsideLaboratory,,85379,CPT,Facility,Inpatient,,,90,168,142.8,48.1488,168,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
D-Dimer (Mayo)OutsideLaboratory,,85379,CPT,Facility,Outpatient,,,90,168,142.8,48.1488,168,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,80.64,48,,percent of total billed charges,,100% of DHS outpatient percentage
D-Dimer (Mayo)OutsideLaboratory,,85379,CPT,Facility,Inpatient,,,90,168,142.8,48.1488,168,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
D-Dimer Quant. (Mayo)OutsideLaboratory,,85379,CPT,Facility,Both,,,90,168,142.8,48.1488,168,Aetna,Commercial,154.56,92,,percent of total billed charges,,
D-Dimer Quant. (Mayo)OutsideLaboratory,,85379,CPT,Facility,Outpatient,,,90,168,142.8,48.1488,168,Aetna,Medicare Advantage,82.32,49,,percent of total billed charges,,
D-Dimer Quant. (Mayo)OutsideLaboratory,,85379,CPT,Facility,Inpatient,,,90,168,142.8,48.1488,168,Aetna,Medicare Advantage,,,,,Included in per diem rate,
D-Dimer Quant. (Mayo)OutsideLaboratory,,85379,CPT,Facility,Both,,,90,168,142.8,48.1488,168,Aetna,PPO,156.24,93,,percent of total billed charges,,
D-Dimer Quant. (Mayo)OutsideLaboratory,,85379,CPT,Facility,Both,,,90,168,142.8,48.1488,168,America's PPO,America's PPO,161.3304,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
D-Dimer Quant. (Mayo)OutsideLaboratory,,85379,CPT,Facility,Both,,,90,168,142.8,48.1488,168,BlueCross BlueShield Minnesota, Federal Employee Program,165.312,98.4,,percent of total billed charges,,
D-Dimer Quant. (Mayo)OutsideLaboratory,,85379,CPT,Facility,Both,,,90,168,142.8,48.1488,168,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,168,100,,percent of total billed charges,,
D-Dimer Quant. (Mayo)OutsideLaboratory,,85379,CPT,Facility,Both,,,90,168,142.8,48.1488,168,BlueCross BlueShield Minnesota,High Value Network Plan,151.2,90,,percent of total billed charges,,
D-Dimer Quant. (Mayo)OutsideLaboratory,,85379,CPT,Facility,Outpatient,,,90,168,142.8,48.1488,168,BlueCross BlueShield Minnesota,Medicare Advantage,82.32,49,,percent of total billed charges,,
D-Dimer Quant. (Mayo)OutsideLaboratory,,85379,CPT,Facility,Inpatient,,,90,168,142.8,48.1488,168,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
D-Dimer Quant. (Mayo)OutsideLaboratory,,85379,CPT,Facility,Both,,,90,168,142.8,48.1488,168,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,148.7976,88.57,,percent of total billed charges,,
D-Dimer Quant. (Mayo)OutsideLaboratory,,85379,CPT,Facility,Both,,,90,168,142.8,48.1488,168,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,48.1488,28.66,,percent of total billed charges,,
D-Dimer Quant. (Mayo)OutsideLaboratory,,85379,CPT,Facility,Outpatient,,,90,168,142.8,48.1488,168,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),82.32,49,,percent of total billed charges,,
D-Dimer Quant. (Mayo)OutsideLaboratory,,85379,CPT,Facility,Inpatient,,,90,168,142.8,48.1488,168,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
D-Dimer Quant. (Mayo)OutsideLaboratory,,85379,CPT,Facility,Both,,,90,168,142.8,48.1488,168,CorVel,Worker's Compensation,168,100,,percent of total billed charges,,
D-Dimer Quant. (Mayo)OutsideLaboratory,,85379,CPT,Facility,Both,,,90,168,142.8,48.1488,168,First Health Group Corporation,First Health Network,162.96,97,,percent of total billed charges,,
D-Dimer Quant. (Mayo)OutsideLaboratory,,85379,CPT,Facility,Both,,,90,168,142.8,48.1488,168,"Health Partners, Inc.",Commercial,158.928,94.6,,percent of total billed charges,,
D-Dimer Quant. (Mayo)OutsideLaboratory,,85379,CPT,Facility,Outpatient,,,90,168,142.8,48.1488,168,"Health Partners, Inc.",Medicare Advantage,82.32,49,,percent of total billed charges,,
D-Dimer Quant. (Mayo)OutsideLaboratory,,85379,CPT,Facility,Inpatient,,,90,168,142.8,48.1488,168,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
D-Dimer Quant. (Mayo)OutsideLaboratory,,85379,CPT,Facility,Both,,,90,168,142.8,48.1488,168,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),100.8,60,,percent of total billed charges,,
D-Dimer Quant. (Mayo)OutsideLaboratory,,85379,CPT,Facility,Both,,,90,168,142.8,48.1488,168,"Health Partners, Inc.",State of Minnesota Advantage Program,136.92,81.5,,percent of total billed charges,,
D-Dimer Quant. (Mayo)OutsideLaboratory,,85379,CPT,Facility,Both,,,90,168,142.8,48.1488,168,"Health Partners, Inc.",State Public Programs,84,50,,percent of total billed charges,,
D-Dimer Quant. (Mayo)OutsideLaboratory,,85379,CPT,Facility,Both,,,90,168,142.8,48.1488,168,Humana Insurance Company,Commercial PPO,159.6,95,,percent of total billed charges,,
D-Dimer Quant. (Mayo)OutsideLaboratory,,85379,CPT,Facility,Outpatient,,,90,168,142.8,48.1488,168,Humana Insurance Company,Medicare PPO,82.32,49,,percent of total billed charges,,
D-Dimer Quant. (Mayo)OutsideLaboratory,,85379,CPT,Facility,Inpatient,,,90,168,142.8,48.1488,168,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
D-Dimer Quant. (Mayo)OutsideLaboratory,,85379,CPT,Facility,Both,,,90,168,142.8,48.1488,168,Medica,Individual & Family,166.488,99.1,,percent of total billed charges,,
D-Dimer Quant. (Mayo)OutsideLaboratory,,85379,CPT,Facility,Outpatient,,,90,168,142.8,48.1488,168,Medica,Medica Advantage Solution,83.664,49.8,,percent of total billed charges,,
D-Dimer Quant. (Mayo)OutsideLaboratory,,85379,CPT,Facility,Inpatient,,,90,168,142.8,48.1488,168,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
D-Dimer Quant. (Mayo)OutsideLaboratory,,85379,CPT,Facility,Outpatient,,,90,168,142.8,48.1488,168,Medica,Medical Assistance,74.928,44.6,,percent of total billed charges,,
D-Dimer Quant. (Mayo)OutsideLaboratory,,85379,CPT,Facility,Inpatient,,,90,168,142.8,48.1488,168,Medica,Medical Assistance,,,,,Included in per diem rate,
D-Dimer Quant. (Mayo)OutsideLaboratory,,85379,CPT,Facility,Outpatient,,,90,168,142.8,48.1488,168,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,83.664,49.8,,percent of total billed charges,,
D-Dimer Quant. (Mayo)OutsideLaboratory,,85379,CPT,Facility,Inpatient,,,90,168,142.8,48.1488,168,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
D-Dimer Quant. (Mayo)OutsideLaboratory,,85379,CPT,Facility,Both,,,90,168,142.8,48.1488,168,"Multiplan, Inc.","Multiplan, Inc.",157.92,94,,percent of total billed charges,,
D-Dimer Quant. (Mayo)OutsideLaboratory,,85379,CPT,Facility,Outpatient,,,90,168,142.8,48.1488,168,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,145.152,86.4,,percent of total billed charges,,
D-Dimer Quant. (Mayo)OutsideLaboratory,,85379,CPT,Facility,Inpatient,,,90,168,142.8,48.1488,168,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
D-Dimer Quant. (Mayo)OutsideLaboratory,,85379,CPT,Facility,Both,,,90,168,142.8,48.1488,168,"Preferred One Administrative Services, INC.",PPO,165.648,98.6,,percent of total billed charges,,
D-Dimer Quant. (Mayo)OutsideLaboratory,,85379,CPT,Facility,Outpatient,,,90,168,142.8,48.1488,168,PrimeWest Health,Minnesota Senior Health Options (MSHO),86.436,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
D-Dimer Quant. (Mayo)OutsideLaboratory,,85379,CPT,Facility,Inpatient,,,90,168,142.8,48.1488,168,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
D-Dimer Quant. (Mayo)OutsideLaboratory,,85379,CPT,Facility,Outpatient,,,90,168,142.8,48.1488,168,PrimeWest Health,MinnesotaCare,86.2848,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
D-Dimer Quant. (Mayo)OutsideLaboratory,,85379,CPT,Facility,Inpatient,,,90,168,142.8,48.1488,168,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
D-Dimer Quant. (Mayo)OutsideLaboratory,,85379,CPT,Facility,Both,,,90,168,142.8,48.1488,168,Sanford Health Plan,Sanford Health Plan,154.56,92,,percent of total billed charges,,
D-Dimer Quant. (Mayo)OutsideLaboratory,,85379,CPT,Facility,Outpatient,,,90,168,142.8,48.1488,168,"UCare Health, Inc.",Individual & Family Plan,94.668,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
D-Dimer Quant. (Mayo)OutsideLaboratory,,85379,CPT,Facility,Inpatient,,,90,168,142.8,48.1488,168,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
D-Dimer Quant. (Mayo)OutsideLaboratory,,85379,CPT,Facility,Outpatient,,,90,168,142.8,48.1488,168,"UCare Health, Inc.",Medical Assistance,84.7896,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
D-Dimer Quant. (Mayo)OutsideLaboratory,,85379,CPT,Facility,Inpatient,,,90,168,142.8,48.1488,168,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
D-Dimer Quant. (Mayo)OutsideLaboratory,,85379,CPT,Facility,Outpatient,,,90,168,142.8,48.1488,168,"UCare Health, Inc.",Medicare Advantage,84.7896,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
D-Dimer Quant. (Mayo)OutsideLaboratory,,85379,CPT,Facility,Inpatient,,,90,168,142.8,48.1488,168,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
D-Dimer Quant. (Mayo)OutsideLaboratory,,85379,CPT,Facility,Outpatient,,,90,168,142.8,48.1488,168,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),84.7896,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
D-Dimer Quant. (Mayo)OutsideLaboratory,,85379,CPT,Facility,Inpatient,,,90,168,142.8,48.1488,168,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
D-Dimer Quant. (Mayo)OutsideLaboratory,,85379,CPT,Facility,Both,,,90,168,142.8,48.1488,168,UnitedHealthcare,Individual & Family,157.92,94,,percent of total billed charges,,
D-Dimer Quant. (Mayo)OutsideLaboratory,,85379,CPT,Facility,Outpatient,,,90,168,142.8,48.1488,168,UnitedHealthcare,Medicare Advantage,82.32,49,,percent of total billed charges,,
D-Dimer Quant. (Mayo)OutsideLaboratory,,85379,CPT,Facility,Inpatient,,,90,168,142.8,48.1488,168,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
D-Dimer Quant. (Mayo)OutsideLaboratory,,85379,CPT,Facility,Outpatient,,,90,168,142.8,48.1488,168,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,80.64,48,,percent of total billed charges,,100% of DHS outpatient percentage
D-Dimer Quant. (Mayo)OutsideLaboratory,,85379,CPT,Facility,Inpatient,,,90,168,142.8,48.1488,168,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
D-Dimer Quantitative (Mayo)OutsideLaboratory,,85379,CPT,Facility,Both,,,90,168,142.8,48.1488,168,Aetna,Commercial,154.56,92,,percent of total billed charges,,
D-Dimer Quantitative (Mayo)OutsideLaboratory,,85379,CPT,Facility,Outpatient,,,90,168,142.8,48.1488,168,Aetna,Medicare Advantage,82.32,49,,percent of total billed charges,,
D-Dimer Quantitative (Mayo)OutsideLaboratory,,85379,CPT,Facility,Inpatient,,,90,168,142.8,48.1488,168,Aetna,Medicare Advantage,,,,,Included in per diem rate,
D-Dimer Quantitative (Mayo)OutsideLaboratory,,85379,CPT,Facility,Both,,,90,168,142.8,48.1488,168,Aetna,PPO,156.24,93,,percent of total billed charges,,
D-Dimer Quantitative (Mayo)OutsideLaboratory,,85379,CPT,Facility,Both,,,90,168,142.8,48.1488,168,America's PPO,America's PPO,161.3304,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
D-Dimer Quantitative (Mayo)OutsideLaboratory,,85379,CPT,Facility,Both,,,90,168,142.8,48.1488,168,BlueCross BlueShield Minnesota, Federal Employee Program,165.312,98.4,,percent of total billed charges,,
D-Dimer Quantitative (Mayo)OutsideLaboratory,,85379,CPT,Facility,Both,,,90,168,142.8,48.1488,168,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,168,100,,percent of total billed charges,,
D-Dimer Quantitative (Mayo)OutsideLaboratory,,85379,CPT,Facility,Both,,,90,168,142.8,48.1488,168,BlueCross BlueShield Minnesota,High Value Network Plan,151.2,90,,percent of total billed charges,,
D-Dimer Quantitative (Mayo)OutsideLaboratory,,85379,CPT,Facility,Outpatient,,,90,168,142.8,48.1488,168,BlueCross BlueShield Minnesota,Medicare Advantage,82.32,49,,percent of total billed charges,,
D-Dimer Quantitative (Mayo)OutsideLaboratory,,85379,CPT,Facility,Inpatient,,,90,168,142.8,48.1488,168,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
D-Dimer Quantitative (Mayo)OutsideLaboratory,,85379,CPT,Facility,Both,,,90,168,142.8,48.1488,168,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,148.7976,88.57,,percent of total billed charges,,
D-Dimer Quantitative (Mayo)OutsideLaboratory,,85379,CPT,Facility,Both,,,90,168,142.8,48.1488,168,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,48.1488,28.66,,percent of total billed charges,,
D-Dimer Quantitative (Mayo)OutsideLaboratory,,85379,CPT,Facility,Outpatient,,,90,168,142.8,48.1488,168,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),82.32,49,,percent of total billed charges,,
D-Dimer Quantitative (Mayo)OutsideLaboratory,,85379,CPT,Facility,Inpatient,,,90,168,142.8,48.1488,168,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
D-Dimer Quantitative (Mayo)OutsideLaboratory,,85379,CPT,Facility,Both,,,90,168,142.8,48.1488,168,CorVel,Worker's Compensation,168,100,,percent of total billed charges,,
D-Dimer Quantitative (Mayo)OutsideLaboratory,,85379,CPT,Facility,Both,,,90,168,142.8,48.1488,168,First Health Group Corporation,First Health Network,162.96,97,,percent of total billed charges,,
D-Dimer Quantitative (Mayo)OutsideLaboratory,,85379,CPT,Facility,Both,,,90,168,142.8,48.1488,168,"Health Partners, Inc.",Commercial,158.928,94.6,,percent of total billed charges,,
D-Dimer Quantitative (Mayo)OutsideLaboratory,,85379,CPT,Facility,Outpatient,,,90,168,142.8,48.1488,168,"Health Partners, Inc.",Medicare Advantage,82.32,49,,percent of total billed charges,,
D-Dimer Quantitative (Mayo)OutsideLaboratory,,85379,CPT,Facility,Inpatient,,,90,168,142.8,48.1488,168,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
D-Dimer Quantitative (Mayo)OutsideLaboratory,,85379,CPT,Facility,Both,,,90,168,142.8,48.1488,168,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),100.8,60,,percent of total billed charges,,
D-Dimer Quantitative (Mayo)OutsideLaboratory,,85379,CPT,Facility,Both,,,90,168,142.8,48.1488,168,"Health Partners, Inc.",State of Minnesota Advantage Program,136.92,81.5,,percent of total billed charges,,
D-Dimer Quantitative (Mayo)OutsideLaboratory,,85379,CPT,Facility,Both,,,90,168,142.8,48.1488,168,"Health Partners, Inc.",State Public Programs,84,50,,percent of total billed charges,,
D-Dimer Quantitative (Mayo)OutsideLaboratory,,85379,CPT,Facility,Both,,,90,168,142.8,48.1488,168,Humana Insurance Company,Commercial PPO,159.6,95,,percent of total billed charges,,
D-Dimer Quantitative (Mayo)OutsideLaboratory,,85379,CPT,Facility,Outpatient,,,90,168,142.8,48.1488,168,Humana Insurance Company,Medicare PPO,82.32,49,,percent of total billed charges,,
D-Dimer Quantitative (Mayo)OutsideLaboratory,,85379,CPT,Facility,Inpatient,,,90,168,142.8,48.1488,168,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
D-Dimer Quantitative (Mayo)OutsideLaboratory,,85379,CPT,Facility,Both,,,90,168,142.8,48.1488,168,Medica,Individual & Family,166.488,99.1,,percent of total billed charges,,
D-Dimer Quantitative (Mayo)OutsideLaboratory,,85379,CPT,Facility,Outpatient,,,90,168,142.8,48.1488,168,Medica,Medica Advantage Solution,83.664,49.8,,percent of total billed charges,,
D-Dimer Quantitative (Mayo)OutsideLaboratory,,85379,CPT,Facility,Inpatient,,,90,168,142.8,48.1488,168,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
D-Dimer Quantitative (Mayo)OutsideLaboratory,,85379,CPT,Facility,Outpatient,,,90,168,142.8,48.1488,168,Medica,Medical Assistance,74.928,44.6,,percent of total billed charges,,
D-Dimer Quantitative (Mayo)OutsideLaboratory,,85379,CPT,Facility,Inpatient,,,90,168,142.8,48.1488,168,Medica,Medical Assistance,,,,,Included in per diem rate,
D-Dimer Quantitative (Mayo)OutsideLaboratory,,85379,CPT,Facility,Outpatient,,,90,168,142.8,48.1488,168,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,83.664,49.8,,percent of total billed charges,,
D-Dimer Quantitative (Mayo)OutsideLaboratory,,85379,CPT,Facility,Inpatient,,,90,168,142.8,48.1488,168,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
D-Dimer Quantitative (Mayo)OutsideLaboratory,,85379,CPT,Facility,Both,,,90,168,142.8,48.1488,168,"Multiplan, Inc.","Multiplan, Inc.",157.92,94,,percent of total billed charges,,
D-Dimer Quantitative (Mayo)OutsideLaboratory,,85379,CPT,Facility,Outpatient,,,90,168,142.8,48.1488,168,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,145.152,86.4,,percent of total billed charges,,
D-Dimer Quantitative (Mayo)OutsideLaboratory,,85379,CPT,Facility,Inpatient,,,90,168,142.8,48.1488,168,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
D-Dimer Quantitative (Mayo)OutsideLaboratory,,85379,CPT,Facility,Both,,,90,168,142.8,48.1488,168,"Preferred One Administrative Services, INC.",PPO,165.648,98.6,,percent of total billed charges,,
D-Dimer Quantitative (Mayo)OutsideLaboratory,,85379,CPT,Facility,Outpatient,,,90,168,142.8,48.1488,168,PrimeWest Health,Minnesota Senior Health Options (MSHO),86.436,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
D-Dimer Quantitative (Mayo)OutsideLaboratory,,85379,CPT,Facility,Inpatient,,,90,168,142.8,48.1488,168,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
D-Dimer Quantitative (Mayo)OutsideLaboratory,,85379,CPT,Facility,Outpatient,,,90,168,142.8,48.1488,168,PrimeWest Health,MinnesotaCare,86.2848,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
D-Dimer Quantitative (Mayo)OutsideLaboratory,,85379,CPT,Facility,Inpatient,,,90,168,142.8,48.1488,168,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
D-Dimer Quantitative (Mayo)OutsideLaboratory,,85379,CPT,Facility,Both,,,90,168,142.8,48.1488,168,Sanford Health Plan,Sanford Health Plan,154.56,92,,percent of total billed charges,,
D-Dimer Quantitative (Mayo)OutsideLaboratory,,85379,CPT,Facility,Outpatient,,,90,168,142.8,48.1488,168,"UCare Health, Inc.",Individual & Family Plan,94.668,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
D-Dimer Quantitative (Mayo)OutsideLaboratory,,85379,CPT,Facility,Inpatient,,,90,168,142.8,48.1488,168,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
D-Dimer Quantitative (Mayo)OutsideLaboratory,,85379,CPT,Facility,Outpatient,,,90,168,142.8,48.1488,168,"UCare Health, Inc.",Medical Assistance,84.7896,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
D-Dimer Quantitative (Mayo)OutsideLaboratory,,85379,CPT,Facility,Inpatient,,,90,168,142.8,48.1488,168,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
D-Dimer Quantitative (Mayo)OutsideLaboratory,,85379,CPT,Facility,Outpatient,,,90,168,142.8,48.1488,168,"UCare Health, Inc.",Medicare Advantage,84.7896,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
D-Dimer Quantitative (Mayo)OutsideLaboratory,,85379,CPT,Facility,Inpatient,,,90,168,142.8,48.1488,168,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
D-Dimer Quantitative (Mayo)OutsideLaboratory,,85379,CPT,Facility,Outpatient,,,90,168,142.8,48.1488,168,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),84.7896,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
D-Dimer Quantitative (Mayo)OutsideLaboratory,,85379,CPT,Facility,Inpatient,,,90,168,142.8,48.1488,168,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
D-Dimer Quantitative (Mayo)OutsideLaboratory,,85379,CPT,Facility,Both,,,90,168,142.8,48.1488,168,UnitedHealthcare,Individual & Family,157.92,94,,percent of total billed charges,,
D-Dimer Quantitative (Mayo)OutsideLaboratory,,85379,CPT,Facility,Outpatient,,,90,168,142.8,48.1488,168,UnitedHealthcare,Medicare Advantage,82.32,49,,percent of total billed charges,,
D-Dimer Quantitative (Mayo)OutsideLaboratory,,85379,CPT,Facility,Inpatient,,,90,168,142.8,48.1488,168,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
D-Dimer Quantitative (Mayo)OutsideLaboratory,,85379,CPT,Facility,Outpatient,,,90,168,142.8,48.1488,168,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,80.64,48,,percent of total billed charges,,100% of DHS outpatient percentage
D-Dimer Quantitative (Mayo)OutsideLaboratory,,85379,CPT,Facility,Inpatient,,,90,168,142.8,48.1488,168,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Fibrinogen (Mayo)OutsideLaboratory,,85384,CPT,Facility,Both,,,90,84,71.4,24.0744,84,Aetna,Commercial,77.28,92,,percent of total billed charges,,
Fibrinogen (Mayo)OutsideLaboratory,,85384,CPT,Facility,Both,,,90,84,71.4,24.0744,84,Aetna,Commercial,77.28,92,,percent of total billed charges,,
Fibrinogen (Mayo)OutsideLaboratory,,85384,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,Aetna,Medicare Advantage,41.16,49,,percent of total billed charges,,
Fibrinogen (Mayo)OutsideLaboratory,,85384,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,Aetna,Medicare Advantage,41.16,49,,percent of total billed charges,,
Fibrinogen (Mayo)OutsideLaboratory,,85384,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Fibrinogen (Mayo)OutsideLaboratory,,85384,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Fibrinogen (Mayo)OutsideLaboratory,,85384,CPT,Facility,Both,,,90,84,71.4,24.0744,84,Aetna,PPO,78.12,93,,percent of total billed charges,,
Fibrinogen (Mayo)OutsideLaboratory,,85384,CPT,Facility,Both,,,90,84,71.4,24.0744,84,Aetna,PPO,78.12,93,,percent of total billed charges,,
Fibrinogen (Mayo)OutsideLaboratory,,85384,CPT,Facility,Both,,,90,84,71.4,24.0744,84,America's PPO,America's PPO,80.6652,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Fibrinogen (Mayo)OutsideLaboratory,,85384,CPT,Facility,Both,,,90,84,71.4,24.0744,84,America's PPO,America's PPO,80.6652,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Fibrinogen (Mayo)OutsideLaboratory,,85384,CPT,Facility,Both,,,90,84,71.4,24.0744,84,BlueCross BlueShield Minnesota, Federal Employee Program,82.656,98.4,,percent of total billed charges,,
Fibrinogen (Mayo)OutsideLaboratory,,85384,CPT,Facility,Both,,,90,84,71.4,24.0744,84,BlueCross BlueShield Minnesota, Federal Employee Program,82.656,98.4,,percent of total billed charges,,
Fibrinogen (Mayo)OutsideLaboratory,,85384,CPT,Facility,Both,,,90,84,71.4,24.0744,84,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,84,100,,percent of total billed charges,,
Fibrinogen (Mayo)OutsideLaboratory,,85384,CPT,Facility,Both,,,90,84,71.4,24.0744,84,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,84,100,,percent of total billed charges,,
Fibrinogen (Mayo)OutsideLaboratory,,85384,CPT,Facility,Both,,,90,84,71.4,24.0744,84,BlueCross BlueShield Minnesota,High Value Network Plan,75.6,90,,percent of total billed charges,,
Fibrinogen (Mayo)OutsideLaboratory,,85384,CPT,Facility,Both,,,90,84,71.4,24.0744,84,BlueCross BlueShield Minnesota,High Value Network Plan,75.6,90,,percent of total billed charges,,
Fibrinogen (Mayo)OutsideLaboratory,,85384,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,BlueCross BlueShield Minnesota,Medicare Advantage,41.16,49,,percent of total billed charges,,
Fibrinogen (Mayo)OutsideLaboratory,,85384,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,BlueCross BlueShield Minnesota,Medicare Advantage,41.16,49,,percent of total billed charges,,
Fibrinogen (Mayo)OutsideLaboratory,,85384,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Fibrinogen (Mayo)OutsideLaboratory,,85384,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Fibrinogen (Mayo)OutsideLaboratory,,85384,CPT,Facility,Both,,,90,84,71.4,24.0744,84,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,74.3988,88.57,,percent of total billed charges,,
Fibrinogen (Mayo)OutsideLaboratory,,85384,CPT,Facility,Both,,,90,84,71.4,24.0744,84,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,74.3988,88.57,,percent of total billed charges,,
Fibrinogen (Mayo)OutsideLaboratory,,85384,CPT,Facility,Both,,,90,84,71.4,24.0744,84,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,24.0744,28.66,,percent of total billed charges,,
Fibrinogen (Mayo)OutsideLaboratory,,85384,CPT,Facility,Both,,,90,84,71.4,24.0744,84,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,24.0744,28.66,,percent of total billed charges,,
Fibrinogen (Mayo)OutsideLaboratory,,85384,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),41.16,49,,percent of total billed charges,,
Fibrinogen (Mayo)OutsideLaboratory,,85384,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),41.16,49,,percent of total billed charges,,
Fibrinogen (Mayo)OutsideLaboratory,,85384,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Fibrinogen (Mayo)OutsideLaboratory,,85384,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Fibrinogen (Mayo)OutsideLaboratory,,85384,CPT,Facility,Both,,,90,84,71.4,24.0744,84,CorVel,Worker's Compensation,84,100,,percent of total billed charges,,
Fibrinogen (Mayo)OutsideLaboratory,,85384,CPT,Facility,Both,,,90,84,71.4,24.0744,84,CorVel,Worker's Compensation,84,100,,percent of total billed charges,,
Fibrinogen (Mayo)OutsideLaboratory,,85384,CPT,Facility,Both,,,90,84,71.4,24.0744,84,First Health Group Corporation,First Health Network,81.48,97,,percent of total billed charges,,
Fibrinogen (Mayo)OutsideLaboratory,,85384,CPT,Facility,Both,,,90,84,71.4,24.0744,84,First Health Group Corporation,First Health Network,81.48,97,,percent of total billed charges,,
Fibrinogen (Mayo)OutsideLaboratory,,85384,CPT,Facility,Both,,,90,84,71.4,24.0744,84,"Health Partners, Inc.",Commercial,79.464,94.6,,percent of total billed charges,,
Fibrinogen (Mayo)OutsideLaboratory,,85384,CPT,Facility,Both,,,90,84,71.4,24.0744,84,"Health Partners, Inc.",Commercial,79.464,94.6,,percent of total billed charges,,
Fibrinogen (Mayo)OutsideLaboratory,,85384,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,"Health Partners, Inc.",Medicare Advantage,41.16,49,,percent of total billed charges,,
Fibrinogen (Mayo)OutsideLaboratory,,85384,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,"Health Partners, Inc.",Medicare Advantage,41.16,49,,percent of total billed charges,,
Fibrinogen (Mayo)OutsideLaboratory,,85384,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Fibrinogen (Mayo)OutsideLaboratory,,85384,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Fibrinogen (Mayo)OutsideLaboratory,,85384,CPT,Facility,Both,,,90,84,71.4,24.0744,84,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),50.4,60,,percent of total billed charges,,
Fibrinogen (Mayo)OutsideLaboratory,,85384,CPT,Facility,Both,,,90,84,71.4,24.0744,84,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),50.4,60,,percent of total billed charges,,
Fibrinogen (Mayo)OutsideLaboratory,,85384,CPT,Facility,Both,,,90,84,71.4,24.0744,84,"Health Partners, Inc.",State of Minnesota Advantage Program,68.46,81.5,,percent of total billed charges,,
Fibrinogen (Mayo)OutsideLaboratory,,85384,CPT,Facility,Both,,,90,84,71.4,24.0744,84,"Health Partners, Inc.",State of Minnesota Advantage Program,68.46,81.5,,percent of total billed charges,,
Fibrinogen (Mayo)OutsideLaboratory,,85384,CPT,Facility,Both,,,90,84,71.4,24.0744,84,"Health Partners, Inc.",State Public Programs,42,50,,percent of total billed charges,,
Fibrinogen (Mayo)OutsideLaboratory,,85384,CPT,Facility,Both,,,90,84,71.4,24.0744,84,"Health Partners, Inc.",State Public Programs,42,50,,percent of total billed charges,,
Fibrinogen (Mayo)OutsideLaboratory,,85384,CPT,Facility,Both,,,90,84,71.4,24.0744,84,Humana Insurance Company,Commercial PPO,79.8,95,,percent of total billed charges,,
Fibrinogen (Mayo)OutsideLaboratory,,85384,CPT,Facility,Both,,,90,84,71.4,24.0744,84,Humana Insurance Company,Commercial PPO,79.8,95,,percent of total billed charges,,
Fibrinogen (Mayo)OutsideLaboratory,,85384,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,Humana Insurance Company,Medicare PPO,41.16,49,,percent of total billed charges,,
Fibrinogen (Mayo)OutsideLaboratory,,85384,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,Humana Insurance Company,Medicare PPO,41.16,49,,percent of total billed charges,,
Fibrinogen (Mayo)OutsideLaboratory,,85384,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Fibrinogen (Mayo)OutsideLaboratory,,85384,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Fibrinogen (Mayo)OutsideLaboratory,,85384,CPT,Facility,Both,,,90,84,71.4,24.0744,84,Medica,Individual & Family,83.244,99.1,,percent of total billed charges,,
Fibrinogen (Mayo)OutsideLaboratory,,85384,CPT,Facility,Both,,,90,84,71.4,24.0744,84,Medica,Individual & Family,83.244,99.1,,percent of total billed charges,,
Fibrinogen (Mayo)OutsideLaboratory,,85384,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,Medica,Medica Advantage Solution,41.832,49.8,,percent of total billed charges,,
Fibrinogen (Mayo)OutsideLaboratory,,85384,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,Medica,Medica Advantage Solution,41.832,49.8,,percent of total billed charges,,
Fibrinogen (Mayo)OutsideLaboratory,,85384,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Fibrinogen (Mayo)OutsideLaboratory,,85384,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Fibrinogen (Mayo)OutsideLaboratory,,85384,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,Medica,Medical Assistance,37.464,44.6,,percent of total billed charges,,
Fibrinogen (Mayo)OutsideLaboratory,,85384,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,Medica,Medical Assistance,37.464,44.6,,percent of total billed charges,,
Fibrinogen (Mayo)OutsideLaboratory,,85384,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,Medica,Medical Assistance,,,,,Included in per diem rate,
Fibrinogen (Mayo)OutsideLaboratory,,85384,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,Medica,Medical Assistance,,,,,Included in per diem rate,
Fibrinogen (Mayo)OutsideLaboratory,,85384,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,41.832,49.8,,percent of total billed charges,,
Fibrinogen (Mayo)OutsideLaboratory,,85384,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,41.832,49.8,,percent of total billed charges,,
Fibrinogen (Mayo)OutsideLaboratory,,85384,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Fibrinogen (Mayo)OutsideLaboratory,,85384,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Fibrinogen (Mayo)OutsideLaboratory,,85384,CPT,Facility,Both,,,90,84,71.4,24.0744,84,"Multiplan, Inc.","Multiplan, Inc.",78.96,94,,percent of total billed charges,,
Fibrinogen (Mayo)OutsideLaboratory,,85384,CPT,Facility,Both,,,90,84,71.4,24.0744,84,"Multiplan, Inc.","Multiplan, Inc.",78.96,94,,percent of total billed charges,,
Fibrinogen (Mayo)OutsideLaboratory,,85384,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,72.576,86.4,,percent of total billed charges,,
Fibrinogen (Mayo)OutsideLaboratory,,85384,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,72.576,86.4,,percent of total billed charges,,
Fibrinogen (Mayo)OutsideLaboratory,,85384,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Fibrinogen (Mayo)OutsideLaboratory,,85384,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Fibrinogen (Mayo)OutsideLaboratory,,85384,CPT,Facility,Both,,,90,84,71.4,24.0744,84,"Preferred One Administrative Services, INC.",PPO,82.824,98.6,,percent of total billed charges,,
Fibrinogen (Mayo)OutsideLaboratory,,85384,CPT,Facility,Both,,,90,84,71.4,24.0744,84,"Preferred One Administrative Services, INC.",PPO,82.824,98.6,,percent of total billed charges,,
Fibrinogen (Mayo)OutsideLaboratory,,85384,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,PrimeWest Health,Minnesota Senior Health Options (MSHO),43.218,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Fibrinogen (Mayo)OutsideLaboratory,,85384,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,PrimeWest Health,Minnesota Senior Health Options (MSHO),43.218,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Fibrinogen (Mayo)OutsideLaboratory,,85384,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Fibrinogen (Mayo)OutsideLaboratory,,85384,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Fibrinogen (Mayo)OutsideLaboratory,,85384,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,PrimeWest Health,MinnesotaCare,43.1424,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Fibrinogen (Mayo)OutsideLaboratory,,85384,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,PrimeWest Health,MinnesotaCare,43.1424,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Fibrinogen (Mayo)OutsideLaboratory,,85384,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Fibrinogen (Mayo)OutsideLaboratory,,85384,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Fibrinogen (Mayo)OutsideLaboratory,,85384,CPT,Facility,Both,,,90,84,71.4,24.0744,84,Sanford Health Plan,Sanford Health Plan,77.28,92,,percent of total billed charges,,
Fibrinogen (Mayo)OutsideLaboratory,,85384,CPT,Facility,Both,,,90,84,71.4,24.0744,84,Sanford Health Plan,Sanford Health Plan,77.28,92,,percent of total billed charges,,
Fibrinogen (Mayo)OutsideLaboratory,,85384,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,"UCare Health, Inc.",Individual & Family Plan,47.334,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Fibrinogen (Mayo)OutsideLaboratory,,85384,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,"UCare Health, Inc.",Individual & Family Plan,47.334,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Fibrinogen (Mayo)OutsideLaboratory,,85384,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Fibrinogen (Mayo)OutsideLaboratory,,85384,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Fibrinogen (Mayo)OutsideLaboratory,,85384,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,"UCare Health, Inc.",Medical Assistance,42.3948,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Fibrinogen (Mayo)OutsideLaboratory,,85384,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,"UCare Health, Inc.",Medical Assistance,42.3948,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Fibrinogen (Mayo)OutsideLaboratory,,85384,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Fibrinogen (Mayo)OutsideLaboratory,,85384,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Fibrinogen (Mayo)OutsideLaboratory,,85384,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,"UCare Health, Inc.",Medicare Advantage,42.3948,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Fibrinogen (Mayo)OutsideLaboratory,,85384,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,"UCare Health, Inc.",Medicare Advantage,42.3948,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Fibrinogen (Mayo)OutsideLaboratory,,85384,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Fibrinogen (Mayo)OutsideLaboratory,,85384,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Fibrinogen (Mayo)OutsideLaboratory,,85384,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),42.3948,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Fibrinogen (Mayo)OutsideLaboratory,,85384,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),42.3948,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Fibrinogen (Mayo)OutsideLaboratory,,85384,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Fibrinogen (Mayo)OutsideLaboratory,,85384,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Fibrinogen (Mayo)OutsideLaboratory,,85384,CPT,Facility,Both,,,90,84,71.4,24.0744,84,UnitedHealthcare,Individual & Family,78.96,94,,percent of total billed charges,,
Fibrinogen (Mayo)OutsideLaboratory,,85384,CPT,Facility,Both,,,90,84,71.4,24.0744,84,UnitedHealthcare,Individual & Family,78.96,94,,percent of total billed charges,,
Fibrinogen (Mayo)OutsideLaboratory,,85384,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,UnitedHealthcare,Medicare Advantage,41.16,49,,percent of total billed charges,,
Fibrinogen (Mayo)OutsideLaboratory,,85384,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,UnitedHealthcare,Medicare Advantage,41.16,49,,percent of total billed charges,,
Fibrinogen (Mayo)OutsideLaboratory,,85384,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Fibrinogen (Mayo)OutsideLaboratory,,85384,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Fibrinogen (Mayo)OutsideLaboratory,,85384,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,40.32,48,,percent of total billed charges,,100% of DHS outpatient percentage
Fibrinogen (Mayo)OutsideLaboratory,,85384,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,40.32,48,,percent of total billed charges,,100% of DHS outpatient percentage
Fibrinogen (Mayo)OutsideLaboratory,,85384,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Fibrinogen (Mayo)OutsideLaboratory,,85384,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Fibrinogen, P (Mayo)OutsideLaboratory",,85384,CPT,Facility,Both,,,90,84,71.4,24.0744,84,Aetna,Commercial,77.28,92,,percent of total billed charges,,
"Fibrinogen, P (Mayo)OutsideLaboratory",,85384,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,Aetna,Medicare Advantage,41.16,49,,percent of total billed charges,,
"Fibrinogen, P (Mayo)OutsideLaboratory",,85384,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Fibrinogen, P (Mayo)OutsideLaboratory",,85384,CPT,Facility,Both,,,90,84,71.4,24.0744,84,Aetna,PPO,78.12,93,,percent of total billed charges,,
"Fibrinogen, P (Mayo)OutsideLaboratory",,85384,CPT,Facility,Both,,,90,84,71.4,24.0744,84,America's PPO,America's PPO,80.6652,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Fibrinogen, P (Mayo)OutsideLaboratory",,85384,CPT,Facility,Both,,,90,84,71.4,24.0744,84,BlueCross BlueShield Minnesota, Federal Employee Program,82.656,98.4,,percent of total billed charges,,
"Fibrinogen, P (Mayo)OutsideLaboratory",,85384,CPT,Facility,Both,,,90,84,71.4,24.0744,84,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,84,100,,percent of total billed charges,,
"Fibrinogen, P (Mayo)OutsideLaboratory",,85384,CPT,Facility,Both,,,90,84,71.4,24.0744,84,BlueCross BlueShield Minnesota,High Value Network Plan,75.6,90,,percent of total billed charges,,
"Fibrinogen, P (Mayo)OutsideLaboratory",,85384,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,BlueCross BlueShield Minnesota,Medicare Advantage,41.16,49,,percent of total billed charges,,
"Fibrinogen, P (Mayo)OutsideLaboratory",,85384,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Fibrinogen, P (Mayo)OutsideLaboratory",,85384,CPT,Facility,Both,,,90,84,71.4,24.0744,84,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,74.3988,88.57,,percent of total billed charges,,
"Fibrinogen, P (Mayo)OutsideLaboratory",,85384,CPT,Facility,Both,,,90,84,71.4,24.0744,84,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,24.0744,28.66,,percent of total billed charges,,
"Fibrinogen, P (Mayo)OutsideLaboratory",,85384,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),41.16,49,,percent of total billed charges,,
"Fibrinogen, P (Mayo)OutsideLaboratory",,85384,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Fibrinogen, P (Mayo)OutsideLaboratory",,85384,CPT,Facility,Both,,,90,84,71.4,24.0744,84,CorVel,Worker's Compensation,84,100,,percent of total billed charges,,
"Fibrinogen, P (Mayo)OutsideLaboratory",,85384,CPT,Facility,Both,,,90,84,71.4,24.0744,84,First Health Group Corporation,First Health Network,81.48,97,,percent of total billed charges,,
"Fibrinogen, P (Mayo)OutsideLaboratory",,85384,CPT,Facility,Both,,,90,84,71.4,24.0744,84,"Health Partners, Inc.",Commercial,79.464,94.6,,percent of total billed charges,,
"Fibrinogen, P (Mayo)OutsideLaboratory",,85384,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,"Health Partners, Inc.",Medicare Advantage,41.16,49,,percent of total billed charges,,
"Fibrinogen, P (Mayo)OutsideLaboratory",,85384,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Fibrinogen, P (Mayo)OutsideLaboratory",,85384,CPT,Facility,Both,,,90,84,71.4,24.0744,84,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),50.4,60,,percent of total billed charges,,
"Fibrinogen, P (Mayo)OutsideLaboratory",,85384,CPT,Facility,Both,,,90,84,71.4,24.0744,84,"Health Partners, Inc.",State of Minnesota Advantage Program,68.46,81.5,,percent of total billed charges,,
"Fibrinogen, P (Mayo)OutsideLaboratory",,85384,CPT,Facility,Both,,,90,84,71.4,24.0744,84,"Health Partners, Inc.",State Public Programs,42,50,,percent of total billed charges,,
"Fibrinogen, P (Mayo)OutsideLaboratory",,85384,CPT,Facility,Both,,,90,84,71.4,24.0744,84,Humana Insurance Company,Commercial PPO,79.8,95,,percent of total billed charges,,
"Fibrinogen, P (Mayo)OutsideLaboratory",,85384,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,Humana Insurance Company,Medicare PPO,41.16,49,,percent of total billed charges,,
"Fibrinogen, P (Mayo)OutsideLaboratory",,85384,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Fibrinogen, P (Mayo)OutsideLaboratory",,85384,CPT,Facility,Both,,,90,84,71.4,24.0744,84,Medica,Individual & Family,83.244,99.1,,percent of total billed charges,,
"Fibrinogen, P (Mayo)OutsideLaboratory",,85384,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,Medica,Medica Advantage Solution,41.832,49.8,,percent of total billed charges,,
"Fibrinogen, P (Mayo)OutsideLaboratory",,85384,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Fibrinogen, P (Mayo)OutsideLaboratory",,85384,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,Medica,Medical Assistance,37.464,44.6,,percent of total billed charges,,
"Fibrinogen, P (Mayo)OutsideLaboratory",,85384,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,Medica,Medical Assistance,,,,,Included in per diem rate,
"Fibrinogen, P (Mayo)OutsideLaboratory",,85384,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,41.832,49.8,,percent of total billed charges,,
"Fibrinogen, P (Mayo)OutsideLaboratory",,85384,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Fibrinogen, P (Mayo)OutsideLaboratory",,85384,CPT,Facility,Both,,,90,84,71.4,24.0744,84,"Multiplan, Inc.","Multiplan, Inc.",78.96,94,,percent of total billed charges,,
"Fibrinogen, P (Mayo)OutsideLaboratory",,85384,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,72.576,86.4,,percent of total billed charges,,
"Fibrinogen, P (Mayo)OutsideLaboratory",,85384,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Fibrinogen, P (Mayo)OutsideLaboratory",,85384,CPT,Facility,Both,,,90,84,71.4,24.0744,84,"Preferred One Administrative Services, INC.",PPO,82.824,98.6,,percent of total billed charges,,
"Fibrinogen, P (Mayo)OutsideLaboratory",,85384,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,PrimeWest Health,Minnesota Senior Health Options (MSHO),43.218,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Fibrinogen, P (Mayo)OutsideLaboratory",,85384,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Fibrinogen, P (Mayo)OutsideLaboratory",,85384,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,PrimeWest Health,MinnesotaCare,43.1424,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Fibrinogen, P (Mayo)OutsideLaboratory",,85384,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Fibrinogen, P (Mayo)OutsideLaboratory",,85384,CPT,Facility,Both,,,90,84,71.4,24.0744,84,Sanford Health Plan,Sanford Health Plan,77.28,92,,percent of total billed charges,,
"Fibrinogen, P (Mayo)OutsideLaboratory",,85384,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,"UCare Health, Inc.",Individual & Family Plan,47.334,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Fibrinogen, P (Mayo)OutsideLaboratory",,85384,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Fibrinogen, P (Mayo)OutsideLaboratory",,85384,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,"UCare Health, Inc.",Medical Assistance,42.3948,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Fibrinogen, P (Mayo)OutsideLaboratory",,85384,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Fibrinogen, P (Mayo)OutsideLaboratory",,85384,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,"UCare Health, Inc.",Medicare Advantage,42.3948,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Fibrinogen, P (Mayo)OutsideLaboratory",,85384,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Fibrinogen, P (Mayo)OutsideLaboratory",,85384,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),42.3948,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Fibrinogen, P (Mayo)OutsideLaboratory",,85384,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Fibrinogen, P (Mayo)OutsideLaboratory",,85384,CPT,Facility,Both,,,90,84,71.4,24.0744,84,UnitedHealthcare,Individual & Family,78.96,94,,percent of total billed charges,,
"Fibrinogen, P (Mayo)OutsideLaboratory",,85384,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,UnitedHealthcare,Medicare Advantage,41.16,49,,percent of total billed charges,,
"Fibrinogen, P (Mayo)OutsideLaboratory",,85384,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Fibrinogen, P (Mayo)OutsideLaboratory",,85384,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,40.32,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Fibrinogen, P (Mayo)OutsideLaboratory",,85384,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Fibrinogen; Activity (Mayo)OutsideLaboratory,,85384,CPT,Facility,Both,,,90,84,71.4,24.0744,84,Aetna,Commercial,77.28,92,,percent of total billed charges,,
Fibrinogen; Activity (Mayo)OutsideLaboratory,,85384,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,Aetna,Medicare Advantage,41.16,49,,percent of total billed charges,,
Fibrinogen; Activity (Mayo)OutsideLaboratory,,85384,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Fibrinogen; Activity (Mayo)OutsideLaboratory,,85384,CPT,Facility,Both,,,90,84,71.4,24.0744,84,Aetna,PPO,78.12,93,,percent of total billed charges,,
Fibrinogen; Activity (Mayo)OutsideLaboratory,,85384,CPT,Facility,Both,,,90,84,71.4,24.0744,84,America's PPO,America's PPO,80.6652,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Fibrinogen; Activity (Mayo)OutsideLaboratory,,85384,CPT,Facility,Both,,,90,84,71.4,24.0744,84,BlueCross BlueShield Minnesota, Federal Employee Program,82.656,98.4,,percent of total billed charges,,
Fibrinogen; Activity (Mayo)OutsideLaboratory,,85384,CPT,Facility,Both,,,90,84,71.4,24.0744,84,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,84,100,,percent of total billed charges,,
Fibrinogen; Activity (Mayo)OutsideLaboratory,,85384,CPT,Facility,Both,,,90,84,71.4,24.0744,84,BlueCross BlueShield Minnesota,High Value Network Plan,75.6,90,,percent of total billed charges,,
Fibrinogen; Activity (Mayo)OutsideLaboratory,,85384,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,BlueCross BlueShield Minnesota,Medicare Advantage,41.16,49,,percent of total billed charges,,
Fibrinogen; Activity (Mayo)OutsideLaboratory,,85384,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Fibrinogen; Activity (Mayo)OutsideLaboratory,,85384,CPT,Facility,Both,,,90,84,71.4,24.0744,84,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,74.3988,88.57,,percent of total billed charges,,
Fibrinogen; Activity (Mayo)OutsideLaboratory,,85384,CPT,Facility,Both,,,90,84,71.4,24.0744,84,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,24.0744,28.66,,percent of total billed charges,,
Fibrinogen; Activity (Mayo)OutsideLaboratory,,85384,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),41.16,49,,percent of total billed charges,,
Fibrinogen; Activity (Mayo)OutsideLaboratory,,85384,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Fibrinogen; Activity (Mayo)OutsideLaboratory,,85384,CPT,Facility,Both,,,90,84,71.4,24.0744,84,CorVel,Worker's Compensation,84,100,,percent of total billed charges,,
Fibrinogen; Activity (Mayo)OutsideLaboratory,,85384,CPT,Facility,Both,,,90,84,71.4,24.0744,84,First Health Group Corporation,First Health Network,81.48,97,,percent of total billed charges,,
Fibrinogen; Activity (Mayo)OutsideLaboratory,,85384,CPT,Facility,Both,,,90,84,71.4,24.0744,84,"Health Partners, Inc.",Commercial,79.464,94.6,,percent of total billed charges,,
Fibrinogen; Activity (Mayo)OutsideLaboratory,,85384,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,"Health Partners, Inc.",Medicare Advantage,41.16,49,,percent of total billed charges,,
Fibrinogen; Activity (Mayo)OutsideLaboratory,,85384,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Fibrinogen; Activity (Mayo)OutsideLaboratory,,85384,CPT,Facility,Both,,,90,84,71.4,24.0744,84,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),50.4,60,,percent of total billed charges,,
Fibrinogen; Activity (Mayo)OutsideLaboratory,,85384,CPT,Facility,Both,,,90,84,71.4,24.0744,84,"Health Partners, Inc.",State of Minnesota Advantage Program,68.46,81.5,,percent of total billed charges,,
Fibrinogen; Activity (Mayo)OutsideLaboratory,,85384,CPT,Facility,Both,,,90,84,71.4,24.0744,84,"Health Partners, Inc.",State Public Programs,42,50,,percent of total billed charges,,
Fibrinogen; Activity (Mayo)OutsideLaboratory,,85384,CPT,Facility,Both,,,90,84,71.4,24.0744,84,Humana Insurance Company,Commercial PPO,79.8,95,,percent of total billed charges,,
Fibrinogen; Activity (Mayo)OutsideLaboratory,,85384,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,Humana Insurance Company,Medicare PPO,41.16,49,,percent of total billed charges,,
Fibrinogen; Activity (Mayo)OutsideLaboratory,,85384,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Fibrinogen; Activity (Mayo)OutsideLaboratory,,85384,CPT,Facility,Both,,,90,84,71.4,24.0744,84,Medica,Individual & Family,83.244,99.1,,percent of total billed charges,,
Fibrinogen; Activity (Mayo)OutsideLaboratory,,85384,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,Medica,Medica Advantage Solution,41.832,49.8,,percent of total billed charges,,
Fibrinogen; Activity (Mayo)OutsideLaboratory,,85384,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Fibrinogen; Activity (Mayo)OutsideLaboratory,,85384,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,Medica,Medical Assistance,37.464,44.6,,percent of total billed charges,,
Fibrinogen; Activity (Mayo)OutsideLaboratory,,85384,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,Medica,Medical Assistance,,,,,Included in per diem rate,
Fibrinogen; Activity (Mayo)OutsideLaboratory,,85384,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,41.832,49.8,,percent of total billed charges,,
Fibrinogen; Activity (Mayo)OutsideLaboratory,,85384,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Fibrinogen; Activity (Mayo)OutsideLaboratory,,85384,CPT,Facility,Both,,,90,84,71.4,24.0744,84,"Multiplan, Inc.","Multiplan, Inc.",78.96,94,,percent of total billed charges,,
Fibrinogen; Activity (Mayo)OutsideLaboratory,,85384,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,72.576,86.4,,percent of total billed charges,,
Fibrinogen; Activity (Mayo)OutsideLaboratory,,85384,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Fibrinogen; Activity (Mayo)OutsideLaboratory,,85384,CPT,Facility,Both,,,90,84,71.4,24.0744,84,"Preferred One Administrative Services, INC.",PPO,82.824,98.6,,percent of total billed charges,,
Fibrinogen; Activity (Mayo)OutsideLaboratory,,85384,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,PrimeWest Health,Minnesota Senior Health Options (MSHO),43.218,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Fibrinogen; Activity (Mayo)OutsideLaboratory,,85384,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Fibrinogen; Activity (Mayo)OutsideLaboratory,,85384,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,PrimeWest Health,MinnesotaCare,43.1424,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Fibrinogen; Activity (Mayo)OutsideLaboratory,,85384,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Fibrinogen; Activity (Mayo)OutsideLaboratory,,85384,CPT,Facility,Both,,,90,84,71.4,24.0744,84,Sanford Health Plan,Sanford Health Plan,77.28,92,,percent of total billed charges,,
Fibrinogen; Activity (Mayo)OutsideLaboratory,,85384,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,"UCare Health, Inc.",Individual & Family Plan,47.334,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Fibrinogen; Activity (Mayo)OutsideLaboratory,,85384,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Fibrinogen; Activity (Mayo)OutsideLaboratory,,85384,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,"UCare Health, Inc.",Medical Assistance,42.3948,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Fibrinogen; Activity (Mayo)OutsideLaboratory,,85384,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Fibrinogen; Activity (Mayo)OutsideLaboratory,,85384,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,"UCare Health, Inc.",Medicare Advantage,42.3948,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Fibrinogen; Activity (Mayo)OutsideLaboratory,,85384,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Fibrinogen; Activity (Mayo)OutsideLaboratory,,85384,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),42.3948,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Fibrinogen; Activity (Mayo)OutsideLaboratory,,85384,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Fibrinogen; Activity (Mayo)OutsideLaboratory,,85384,CPT,Facility,Both,,,90,84,71.4,24.0744,84,UnitedHealthcare,Individual & Family,78.96,94,,percent of total billed charges,,
Fibrinogen; Activity (Mayo)OutsideLaboratory,,85384,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,UnitedHealthcare,Medicare Advantage,41.16,49,,percent of total billed charges,,
Fibrinogen; Activity (Mayo)OutsideLaboratory,,85384,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Fibrinogen; Activity (Mayo)OutsideLaboratory,,85384,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,40.32,48,,percent of total billed charges,,100% of DHS outpatient percentage
Fibrinogen; Activity (Mayo)OutsideLaboratory,,85384,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Coagulopathy Screen, Interp And Report (Mayo)OutsideLaboratory",,85390,CPT,Facility,Both,,,90,109,92.65,31.2394,109,Aetna,Commercial,100.28,92,,percent of total billed charges,,
"Coagulopathy Screen, Interp And Report (Mayo)OutsideLaboratory",,85390,CPT,Facility,Outpatient,,,90,109,92.65,31.2394,109,Aetna,Medicare Advantage,53.41,49,,percent of total billed charges,,
"Coagulopathy Screen, Interp And Report (Mayo)OutsideLaboratory",,85390,CPT,Facility,Inpatient,,,90,109,92.65,31.2394,109,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Coagulopathy Screen, Interp And Report (Mayo)OutsideLaboratory",,85390,CPT,Facility,Both,,,90,109,92.65,31.2394,109,Aetna,PPO,101.37,93,,percent of total billed charges,,
"Coagulopathy Screen, Interp And Report (Mayo)OutsideLaboratory",,85390,CPT,Facility,Both,,,90,109,92.65,31.2394,109,America's PPO,America's PPO,104.6727,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Coagulopathy Screen, Interp And Report (Mayo)OutsideLaboratory",,85390,CPT,Facility,Both,,,90,109,92.65,31.2394,109,BlueCross BlueShield Minnesota, Federal Employee Program,107.256,98.4,,percent of total billed charges,,
"Coagulopathy Screen, Interp And Report (Mayo)OutsideLaboratory",,85390,CPT,Facility,Both,,,90,109,92.65,31.2394,109,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,109,100,,percent of total billed charges,,
"Coagulopathy Screen, Interp And Report (Mayo)OutsideLaboratory",,85390,CPT,Facility,Both,,,90,109,92.65,31.2394,109,BlueCross BlueShield Minnesota,High Value Network Plan,98.1,90,,percent of total billed charges,,
"Coagulopathy Screen, Interp And Report (Mayo)OutsideLaboratory",,85390,CPT,Facility,Outpatient,,,90,109,92.65,31.2394,109,BlueCross BlueShield Minnesota,Medicare Advantage,53.41,49,,percent of total billed charges,,
"Coagulopathy Screen, Interp And Report (Mayo)OutsideLaboratory",,85390,CPT,Facility,Inpatient,,,90,109,92.65,31.2394,109,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Coagulopathy Screen, Interp And Report (Mayo)OutsideLaboratory",,85390,CPT,Facility,Both,,,90,109,92.65,31.2394,109,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,96.5413,88.57,,percent of total billed charges,,
"Coagulopathy Screen, Interp And Report (Mayo)OutsideLaboratory",,85390,CPT,Facility,Both,,,90,109,92.65,31.2394,109,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,31.2394,28.66,,percent of total billed charges,,
"Coagulopathy Screen, Interp And Report (Mayo)OutsideLaboratory",,85390,CPT,Facility,Outpatient,,,90,109,92.65,31.2394,109,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),53.41,49,,percent of total billed charges,,
"Coagulopathy Screen, Interp And Report (Mayo)OutsideLaboratory",,85390,CPT,Facility,Inpatient,,,90,109,92.65,31.2394,109,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Coagulopathy Screen, Interp And Report (Mayo)OutsideLaboratory",,85390,CPT,Facility,Both,,,90,109,92.65,31.2394,109,CorVel,Worker's Compensation,109,100,,percent of total billed charges,,
"Coagulopathy Screen, Interp And Report (Mayo)OutsideLaboratory",,85390,CPT,Facility,Both,,,90,109,92.65,31.2394,109,First Health Group Corporation,First Health Network,105.73,97,,percent of total billed charges,,
"Coagulopathy Screen, Interp And Report (Mayo)OutsideLaboratory",,85390,CPT,Facility,Both,,,90,109,92.65,31.2394,109,"Health Partners, Inc.",Commercial,103.114,94.6,,percent of total billed charges,,
"Coagulopathy Screen, Interp And Report (Mayo)OutsideLaboratory",,85390,CPT,Facility,Outpatient,,,90,109,92.65,31.2394,109,"Health Partners, Inc.",Medicare Advantage,53.41,49,,percent of total billed charges,,
"Coagulopathy Screen, Interp And Report (Mayo)OutsideLaboratory",,85390,CPT,Facility,Inpatient,,,90,109,92.65,31.2394,109,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Coagulopathy Screen, Interp And Report (Mayo)OutsideLaboratory",,85390,CPT,Facility,Both,,,90,109,92.65,31.2394,109,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),65.4,60,,percent of total billed charges,,
"Coagulopathy Screen, Interp And Report (Mayo)OutsideLaboratory",,85390,CPT,Facility,Both,,,90,109,92.65,31.2394,109,"Health Partners, Inc.",State of Minnesota Advantage Program,88.835,81.5,,percent of total billed charges,,
"Coagulopathy Screen, Interp And Report (Mayo)OutsideLaboratory",,85390,CPT,Facility,Both,,,90,109,92.65,31.2394,109,"Health Partners, Inc.",State Public Programs,54.5,50,,percent of total billed charges,,
"Coagulopathy Screen, Interp And Report (Mayo)OutsideLaboratory",,85390,CPT,Facility,Both,,,90,109,92.65,31.2394,109,Humana Insurance Company,Commercial PPO,103.55,95,,percent of total billed charges,,
"Coagulopathy Screen, Interp And Report (Mayo)OutsideLaboratory",,85390,CPT,Facility,Outpatient,,,90,109,92.65,31.2394,109,Humana Insurance Company,Medicare PPO,53.41,49,,percent of total billed charges,,
"Coagulopathy Screen, Interp And Report (Mayo)OutsideLaboratory",,85390,CPT,Facility,Inpatient,,,90,109,92.65,31.2394,109,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Coagulopathy Screen, Interp And Report (Mayo)OutsideLaboratory",,85390,CPT,Facility,Both,,,90,109,92.65,31.2394,109,Medica,Individual & Family,108.019,99.1,,percent of total billed charges,,
"Coagulopathy Screen, Interp And Report (Mayo)OutsideLaboratory",,85390,CPT,Facility,Outpatient,,,90,109,92.65,31.2394,109,Medica,Medica Advantage Solution,54.282,49.8,,percent of total billed charges,,
"Coagulopathy Screen, Interp And Report (Mayo)OutsideLaboratory",,85390,CPT,Facility,Inpatient,,,90,109,92.65,31.2394,109,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Coagulopathy Screen, Interp And Report (Mayo)OutsideLaboratory",,85390,CPT,Facility,Outpatient,,,90,109,92.65,31.2394,109,Medica,Medical Assistance,48.614,44.6,,percent of total billed charges,,
"Coagulopathy Screen, Interp And Report (Mayo)OutsideLaboratory",,85390,CPT,Facility,Inpatient,,,90,109,92.65,31.2394,109,Medica,Medical Assistance,,,,,Included in per diem rate,
"Coagulopathy Screen, Interp And Report (Mayo)OutsideLaboratory",,85390,CPT,Facility,Outpatient,,,90,109,92.65,31.2394,109,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,54.282,49.8,,percent of total billed charges,,
"Coagulopathy Screen, Interp And Report (Mayo)OutsideLaboratory",,85390,CPT,Facility,Inpatient,,,90,109,92.65,31.2394,109,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Coagulopathy Screen, Interp And Report (Mayo)OutsideLaboratory",,85390,CPT,Facility,Both,,,90,109,92.65,31.2394,109,"Multiplan, Inc.","Multiplan, Inc.",102.46,94,,percent of total billed charges,,
"Coagulopathy Screen, Interp And Report (Mayo)OutsideLaboratory",,85390,CPT,Facility,Outpatient,,,90,109,92.65,31.2394,109,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,94.176,86.4,,percent of total billed charges,,
"Coagulopathy Screen, Interp And Report (Mayo)OutsideLaboratory",,85390,CPT,Facility,Inpatient,,,90,109,92.65,31.2394,109,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Coagulopathy Screen, Interp And Report (Mayo)OutsideLaboratory",,85390,CPT,Facility,Both,,,90,109,92.65,31.2394,109,"Preferred One Administrative Services, INC.",PPO,107.474,98.6,,percent of total billed charges,,
"Coagulopathy Screen, Interp And Report (Mayo)OutsideLaboratory",,85390,CPT,Facility,Outpatient,,,90,109,92.65,31.2394,109,PrimeWest Health,Minnesota Senior Health Options (MSHO),56.0805,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Coagulopathy Screen, Interp And Report (Mayo)OutsideLaboratory",,85390,CPT,Facility,Inpatient,,,90,109,92.65,31.2394,109,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Coagulopathy Screen, Interp And Report (Mayo)OutsideLaboratory",,85390,CPT,Facility,Outpatient,,,90,109,92.65,31.2394,109,PrimeWest Health,MinnesotaCare,55.9824,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Coagulopathy Screen, Interp And Report (Mayo)OutsideLaboratory",,85390,CPT,Facility,Inpatient,,,90,109,92.65,31.2394,109,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Coagulopathy Screen, Interp And Report (Mayo)OutsideLaboratory",,85390,CPT,Facility,Both,,,90,109,92.65,31.2394,109,Sanford Health Plan,Sanford Health Plan,100.28,92,,percent of total billed charges,,
"Coagulopathy Screen, Interp And Report (Mayo)OutsideLaboratory",,85390,CPT,Facility,Outpatient,,,90,109,92.65,31.2394,109,"UCare Health, Inc.",Individual & Family Plan,61.4215,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Coagulopathy Screen, Interp And Report (Mayo)OutsideLaboratory",,85390,CPT,Facility,Inpatient,,,90,109,92.65,31.2394,109,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Coagulopathy Screen, Interp And Report (Mayo)OutsideLaboratory",,85390,CPT,Facility,Outpatient,,,90,109,92.65,31.2394,109,"UCare Health, Inc.",Medical Assistance,55.0123,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Coagulopathy Screen, Interp And Report (Mayo)OutsideLaboratory",,85390,CPT,Facility,Inpatient,,,90,109,92.65,31.2394,109,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Coagulopathy Screen, Interp And Report (Mayo)OutsideLaboratory",,85390,CPT,Facility,Outpatient,,,90,109,92.65,31.2394,109,"UCare Health, Inc.",Medicare Advantage,55.0123,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Coagulopathy Screen, Interp And Report (Mayo)OutsideLaboratory",,85390,CPT,Facility,Inpatient,,,90,109,92.65,31.2394,109,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Coagulopathy Screen, Interp And Report (Mayo)OutsideLaboratory",,85390,CPT,Facility,Outpatient,,,90,109,92.65,31.2394,109,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),55.0123,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Coagulopathy Screen, Interp And Report (Mayo)OutsideLaboratory",,85390,CPT,Facility,Inpatient,,,90,109,92.65,31.2394,109,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Coagulopathy Screen, Interp And Report (Mayo)OutsideLaboratory",,85390,CPT,Facility,Both,,,90,109,92.65,31.2394,109,UnitedHealthcare,Individual & Family,102.46,94,,percent of total billed charges,,
"Coagulopathy Screen, Interp And Report (Mayo)OutsideLaboratory",,85390,CPT,Facility,Outpatient,,,90,109,92.65,31.2394,109,UnitedHealthcare,Medicare Advantage,53.41,49,,percent of total billed charges,,
"Coagulopathy Screen, Interp And Report (Mayo)OutsideLaboratory",,85390,CPT,Facility,Inpatient,,,90,109,92.65,31.2394,109,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Coagulopathy Screen, Interp And Report (Mayo)OutsideLaboratory",,85390,CPT,Facility,Outpatient,,,90,109,92.65,31.2394,109,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,52.32,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Coagulopathy Screen, Interp And Report (Mayo)OutsideLaboratory",,85390,CPT,Facility,Inpatient,,,90,109,92.65,31.2394,109,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Fibrinolysins Or Coagulopathy Screen, I&R (Mayo)OutsideLaboratory",,85390,CPT,Facility,Both,,,90,109,92.65,31.2394,109,Aetna,Commercial,100.28,92,,percent of total billed charges,,
"Fibrinolysins Or Coagulopathy Screen, I&R (Mayo)OutsideLaboratory",,85390,CPT,Facility,Outpatient,,,90,109,92.65,31.2394,109,Aetna,Medicare Advantage,53.41,49,,percent of total billed charges,,
"Fibrinolysins Or Coagulopathy Screen, I&R (Mayo)OutsideLaboratory",,85390,CPT,Facility,Inpatient,,,90,109,92.65,31.2394,109,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Fibrinolysins Or Coagulopathy Screen, I&R (Mayo)OutsideLaboratory",,85390,CPT,Facility,Both,,,90,109,92.65,31.2394,109,Aetna,PPO,101.37,93,,percent of total billed charges,,
"Fibrinolysins Or Coagulopathy Screen, I&R (Mayo)OutsideLaboratory",,85390,CPT,Facility,Both,,,90,109,92.65,31.2394,109,America's PPO,America's PPO,104.6727,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Fibrinolysins Or Coagulopathy Screen, I&R (Mayo)OutsideLaboratory",,85390,CPT,Facility,Both,,,90,109,92.65,31.2394,109,BlueCross BlueShield Minnesota, Federal Employee Program,107.256,98.4,,percent of total billed charges,,
"Fibrinolysins Or Coagulopathy Screen, I&R (Mayo)OutsideLaboratory",,85390,CPT,Facility,Both,,,90,109,92.65,31.2394,109,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,109,100,,percent of total billed charges,,
"Fibrinolysins Or Coagulopathy Screen, I&R (Mayo)OutsideLaboratory",,85390,CPT,Facility,Both,,,90,109,92.65,31.2394,109,BlueCross BlueShield Minnesota,High Value Network Plan,98.1,90,,percent of total billed charges,,
"Fibrinolysins Or Coagulopathy Screen, I&R (Mayo)OutsideLaboratory",,85390,CPT,Facility,Outpatient,,,90,109,92.65,31.2394,109,BlueCross BlueShield Minnesota,Medicare Advantage,53.41,49,,percent of total billed charges,,
"Fibrinolysins Or Coagulopathy Screen, I&R (Mayo)OutsideLaboratory",,85390,CPT,Facility,Inpatient,,,90,109,92.65,31.2394,109,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Fibrinolysins Or Coagulopathy Screen, I&R (Mayo)OutsideLaboratory",,85390,CPT,Facility,Both,,,90,109,92.65,31.2394,109,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,96.5413,88.57,,percent of total billed charges,,
"Fibrinolysins Or Coagulopathy Screen, I&R (Mayo)OutsideLaboratory",,85390,CPT,Facility,Both,,,90,109,92.65,31.2394,109,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,31.2394,28.66,,percent of total billed charges,,
"Fibrinolysins Or Coagulopathy Screen, I&R (Mayo)OutsideLaboratory",,85390,CPT,Facility,Outpatient,,,90,109,92.65,31.2394,109,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),53.41,49,,percent of total billed charges,,
"Fibrinolysins Or Coagulopathy Screen, I&R (Mayo)OutsideLaboratory",,85390,CPT,Facility,Inpatient,,,90,109,92.65,31.2394,109,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Fibrinolysins Or Coagulopathy Screen, I&R (Mayo)OutsideLaboratory",,85390,CPT,Facility,Both,,,90,109,92.65,31.2394,109,CorVel,Worker's Compensation,109,100,,percent of total billed charges,,
"Fibrinolysins Or Coagulopathy Screen, I&R (Mayo)OutsideLaboratory",,85390,CPT,Facility,Both,,,90,109,92.65,31.2394,109,First Health Group Corporation,First Health Network,105.73,97,,percent of total billed charges,,
"Fibrinolysins Or Coagulopathy Screen, I&R (Mayo)OutsideLaboratory",,85390,CPT,Facility,Both,,,90,109,92.65,31.2394,109,"Health Partners, Inc.",Commercial,103.114,94.6,,percent of total billed charges,,
"Fibrinolysins Or Coagulopathy Screen, I&R (Mayo)OutsideLaboratory",,85390,CPT,Facility,Outpatient,,,90,109,92.65,31.2394,109,"Health Partners, Inc.",Medicare Advantage,53.41,49,,percent of total billed charges,,
"Fibrinolysins Or Coagulopathy Screen, I&R (Mayo)OutsideLaboratory",,85390,CPT,Facility,Inpatient,,,90,109,92.65,31.2394,109,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Fibrinolysins Or Coagulopathy Screen, I&R (Mayo)OutsideLaboratory",,85390,CPT,Facility,Both,,,90,109,92.65,31.2394,109,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),65.4,60,,percent of total billed charges,,
"Fibrinolysins Or Coagulopathy Screen, I&R (Mayo)OutsideLaboratory",,85390,CPT,Facility,Both,,,90,109,92.65,31.2394,109,"Health Partners, Inc.",State of Minnesota Advantage Program,88.835,81.5,,percent of total billed charges,,
"Fibrinolysins Or Coagulopathy Screen, I&R (Mayo)OutsideLaboratory",,85390,CPT,Facility,Both,,,90,109,92.65,31.2394,109,"Health Partners, Inc.",State Public Programs,54.5,50,,percent of total billed charges,,
"Fibrinolysins Or Coagulopathy Screen, I&R (Mayo)OutsideLaboratory",,85390,CPT,Facility,Both,,,90,109,92.65,31.2394,109,Humana Insurance Company,Commercial PPO,103.55,95,,percent of total billed charges,,
"Fibrinolysins Or Coagulopathy Screen, I&R (Mayo)OutsideLaboratory",,85390,CPT,Facility,Outpatient,,,90,109,92.65,31.2394,109,Humana Insurance Company,Medicare PPO,53.41,49,,percent of total billed charges,,
"Fibrinolysins Or Coagulopathy Screen, I&R (Mayo)OutsideLaboratory",,85390,CPT,Facility,Inpatient,,,90,109,92.65,31.2394,109,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Fibrinolysins Or Coagulopathy Screen, I&R (Mayo)OutsideLaboratory",,85390,CPT,Facility,Both,,,90,109,92.65,31.2394,109,Medica,Individual & Family,108.019,99.1,,percent of total billed charges,,
"Fibrinolysins Or Coagulopathy Screen, I&R (Mayo)OutsideLaboratory",,85390,CPT,Facility,Outpatient,,,90,109,92.65,31.2394,109,Medica,Medica Advantage Solution,54.282,49.8,,percent of total billed charges,,
"Fibrinolysins Or Coagulopathy Screen, I&R (Mayo)OutsideLaboratory",,85390,CPT,Facility,Inpatient,,,90,109,92.65,31.2394,109,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Fibrinolysins Or Coagulopathy Screen, I&R (Mayo)OutsideLaboratory",,85390,CPT,Facility,Outpatient,,,90,109,92.65,31.2394,109,Medica,Medical Assistance,48.614,44.6,,percent of total billed charges,,
"Fibrinolysins Or Coagulopathy Screen, I&R (Mayo)OutsideLaboratory",,85390,CPT,Facility,Inpatient,,,90,109,92.65,31.2394,109,Medica,Medical Assistance,,,,,Included in per diem rate,
"Fibrinolysins Or Coagulopathy Screen, I&R (Mayo)OutsideLaboratory",,85390,CPT,Facility,Outpatient,,,90,109,92.65,31.2394,109,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,54.282,49.8,,percent of total billed charges,,
"Fibrinolysins Or Coagulopathy Screen, I&R (Mayo)OutsideLaboratory",,85390,CPT,Facility,Inpatient,,,90,109,92.65,31.2394,109,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Fibrinolysins Or Coagulopathy Screen, I&R (Mayo)OutsideLaboratory",,85390,CPT,Facility,Both,,,90,109,92.65,31.2394,109,"Multiplan, Inc.","Multiplan, Inc.",102.46,94,,percent of total billed charges,,
"Fibrinolysins Or Coagulopathy Screen, I&R (Mayo)OutsideLaboratory",,85390,CPT,Facility,Outpatient,,,90,109,92.65,31.2394,109,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,94.176,86.4,,percent of total billed charges,,
"Fibrinolysins Or Coagulopathy Screen, I&R (Mayo)OutsideLaboratory",,85390,CPT,Facility,Inpatient,,,90,109,92.65,31.2394,109,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Fibrinolysins Or Coagulopathy Screen, I&R (Mayo)OutsideLaboratory",,85390,CPT,Facility,Both,,,90,109,92.65,31.2394,109,"Preferred One Administrative Services, INC.",PPO,107.474,98.6,,percent of total billed charges,,
"Fibrinolysins Or Coagulopathy Screen, I&R (Mayo)OutsideLaboratory",,85390,CPT,Facility,Outpatient,,,90,109,92.65,31.2394,109,PrimeWest Health,Minnesota Senior Health Options (MSHO),56.0805,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Fibrinolysins Or Coagulopathy Screen, I&R (Mayo)OutsideLaboratory",,85390,CPT,Facility,Inpatient,,,90,109,92.65,31.2394,109,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Fibrinolysins Or Coagulopathy Screen, I&R (Mayo)OutsideLaboratory",,85390,CPT,Facility,Outpatient,,,90,109,92.65,31.2394,109,PrimeWest Health,MinnesotaCare,55.9824,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Fibrinolysins Or Coagulopathy Screen, I&R (Mayo)OutsideLaboratory",,85390,CPT,Facility,Inpatient,,,90,109,92.65,31.2394,109,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Fibrinolysins Or Coagulopathy Screen, I&R (Mayo)OutsideLaboratory",,85390,CPT,Facility,Both,,,90,109,92.65,31.2394,109,Sanford Health Plan,Sanford Health Plan,100.28,92,,percent of total billed charges,,
"Fibrinolysins Or Coagulopathy Screen, I&R (Mayo)OutsideLaboratory",,85390,CPT,Facility,Outpatient,,,90,109,92.65,31.2394,109,"UCare Health, Inc.",Individual & Family Plan,61.4215,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Fibrinolysins Or Coagulopathy Screen, I&R (Mayo)OutsideLaboratory",,85390,CPT,Facility,Inpatient,,,90,109,92.65,31.2394,109,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Fibrinolysins Or Coagulopathy Screen, I&R (Mayo)OutsideLaboratory",,85390,CPT,Facility,Outpatient,,,90,109,92.65,31.2394,109,"UCare Health, Inc.",Medical Assistance,55.0123,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Fibrinolysins Or Coagulopathy Screen, I&R (Mayo)OutsideLaboratory",,85390,CPT,Facility,Inpatient,,,90,109,92.65,31.2394,109,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Fibrinolysins Or Coagulopathy Screen, I&R (Mayo)OutsideLaboratory",,85390,CPT,Facility,Outpatient,,,90,109,92.65,31.2394,109,"UCare Health, Inc.",Medicare Advantage,55.0123,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Fibrinolysins Or Coagulopathy Screen, I&R (Mayo)OutsideLaboratory",,85390,CPT,Facility,Inpatient,,,90,109,92.65,31.2394,109,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Fibrinolysins Or Coagulopathy Screen, I&R (Mayo)OutsideLaboratory",,85390,CPT,Facility,Outpatient,,,90,109,92.65,31.2394,109,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),55.0123,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Fibrinolysins Or Coagulopathy Screen, I&R (Mayo)OutsideLaboratory",,85390,CPT,Facility,Inpatient,,,90,109,92.65,31.2394,109,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Fibrinolysins Or Coagulopathy Screen, I&R (Mayo)OutsideLaboratory",,85390,CPT,Facility,Both,,,90,109,92.65,31.2394,109,UnitedHealthcare,Individual & Family,102.46,94,,percent of total billed charges,,
"Fibrinolysins Or Coagulopathy Screen, I&R (Mayo)OutsideLaboratory",,85390,CPT,Facility,Outpatient,,,90,109,92.65,31.2394,109,UnitedHealthcare,Medicare Advantage,53.41,49,,percent of total billed charges,,
"Fibrinolysins Or Coagulopathy Screen, I&R (Mayo)OutsideLaboratory",,85390,CPT,Facility,Inpatient,,,90,109,92.65,31.2394,109,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Fibrinolysins Or Coagulopathy Screen, I&R (Mayo)OutsideLaboratory",,85390,CPT,Facility,Outpatient,,,90,109,92.65,31.2394,109,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,52.32,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Fibrinolysins Or Coagulopathy Screen, I&R (Mayo)OutsideLaboratory",,85390,CPT,Facility,Inpatient,,,90,109,92.65,31.2394,109,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Fibrinolysins Or Coagulopathy Screen, Interpretation And Report (Mayo)OutsideLaboratory",,85390,CPT,Facility,Both,,,90,109,92.65,31.2394,109,Aetna,Commercial,100.28,92,,percent of total billed charges,,
"Fibrinolysins Or Coagulopathy Screen, Interpretation And Report (Mayo)OutsideLaboratory",,85390,CPT,Facility,Outpatient,,,90,109,92.65,31.2394,109,Aetna,Medicare Advantage,53.41,49,,percent of total billed charges,,
"Fibrinolysins Or Coagulopathy Screen, Interpretation And Report (Mayo)OutsideLaboratory",,85390,CPT,Facility,Inpatient,,,90,109,92.65,31.2394,109,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Fibrinolysins Or Coagulopathy Screen, Interpretation And Report (Mayo)OutsideLaboratory",,85390,CPT,Facility,Both,,,90,109,92.65,31.2394,109,Aetna,PPO,101.37,93,,percent of total billed charges,,
"Fibrinolysins Or Coagulopathy Screen, Interpretation And Report (Mayo)OutsideLaboratory",,85390,CPT,Facility,Both,,,90,109,92.65,31.2394,109,America's PPO,America's PPO,104.6727,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Fibrinolysins Or Coagulopathy Screen, Interpretation And Report (Mayo)OutsideLaboratory",,85390,CPT,Facility,Both,,,90,109,92.65,31.2394,109,BlueCross BlueShield Minnesota, Federal Employee Program,107.256,98.4,,percent of total billed charges,,
"Fibrinolysins Or Coagulopathy Screen, Interpretation And Report (Mayo)OutsideLaboratory",,85390,CPT,Facility,Both,,,90,109,92.65,31.2394,109,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,109,100,,percent of total billed charges,,
"Fibrinolysins Or Coagulopathy Screen, Interpretation And Report (Mayo)OutsideLaboratory",,85390,CPT,Facility,Both,,,90,109,92.65,31.2394,109,BlueCross BlueShield Minnesota,High Value Network Plan,98.1,90,,percent of total billed charges,,
"Fibrinolysins Or Coagulopathy Screen, Interpretation And Report (Mayo)OutsideLaboratory",,85390,CPT,Facility,Outpatient,,,90,109,92.65,31.2394,109,BlueCross BlueShield Minnesota,Medicare Advantage,53.41,49,,percent of total billed charges,,
"Fibrinolysins Or Coagulopathy Screen, Interpretation And Report (Mayo)OutsideLaboratory",,85390,CPT,Facility,Inpatient,,,90,109,92.65,31.2394,109,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Fibrinolysins Or Coagulopathy Screen, Interpretation And Report (Mayo)OutsideLaboratory",,85390,CPT,Facility,Both,,,90,109,92.65,31.2394,109,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,96.5413,88.57,,percent of total billed charges,,
"Fibrinolysins Or Coagulopathy Screen, Interpretation And Report (Mayo)OutsideLaboratory",,85390,CPT,Facility,Both,,,90,109,92.65,31.2394,109,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,31.2394,28.66,,percent of total billed charges,,
"Fibrinolysins Or Coagulopathy Screen, Interpretation And Report (Mayo)OutsideLaboratory",,85390,CPT,Facility,Outpatient,,,90,109,92.65,31.2394,109,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),53.41,49,,percent of total billed charges,,
"Fibrinolysins Or Coagulopathy Screen, Interpretation And Report (Mayo)OutsideLaboratory",,85390,CPT,Facility,Inpatient,,,90,109,92.65,31.2394,109,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Fibrinolysins Or Coagulopathy Screen, Interpretation And Report (Mayo)OutsideLaboratory",,85390,CPT,Facility,Both,,,90,109,92.65,31.2394,109,CorVel,Worker's Compensation,109,100,,percent of total billed charges,,
"Fibrinolysins Or Coagulopathy Screen, Interpretation And Report (Mayo)OutsideLaboratory",,85390,CPT,Facility,Both,,,90,109,92.65,31.2394,109,First Health Group Corporation,First Health Network,105.73,97,,percent of total billed charges,,
"Fibrinolysins Or Coagulopathy Screen, Interpretation And Report (Mayo)OutsideLaboratory",,85390,CPT,Facility,Both,,,90,109,92.65,31.2394,109,"Health Partners, Inc.",Commercial,103.114,94.6,,percent of total billed charges,,
"Fibrinolysins Or Coagulopathy Screen, Interpretation And Report (Mayo)OutsideLaboratory",,85390,CPT,Facility,Outpatient,,,90,109,92.65,31.2394,109,"Health Partners, Inc.",Medicare Advantage,53.41,49,,percent of total billed charges,,
"Fibrinolysins Or Coagulopathy Screen, Interpretation And Report (Mayo)OutsideLaboratory",,85390,CPT,Facility,Inpatient,,,90,109,92.65,31.2394,109,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Fibrinolysins Or Coagulopathy Screen, Interpretation And Report (Mayo)OutsideLaboratory",,85390,CPT,Facility,Both,,,90,109,92.65,31.2394,109,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),65.4,60,,percent of total billed charges,,
"Fibrinolysins Or Coagulopathy Screen, Interpretation And Report (Mayo)OutsideLaboratory",,85390,CPT,Facility,Both,,,90,109,92.65,31.2394,109,"Health Partners, Inc.",State of Minnesota Advantage Program,88.835,81.5,,percent of total billed charges,,
"Fibrinolysins Or Coagulopathy Screen, Interpretation And Report (Mayo)OutsideLaboratory",,85390,CPT,Facility,Both,,,90,109,92.65,31.2394,109,"Health Partners, Inc.",State Public Programs,54.5,50,,percent of total billed charges,,
"Fibrinolysins Or Coagulopathy Screen, Interpretation And Report (Mayo)OutsideLaboratory",,85390,CPT,Facility,Both,,,90,109,92.65,31.2394,109,Humana Insurance Company,Commercial PPO,103.55,95,,percent of total billed charges,,
"Fibrinolysins Or Coagulopathy Screen, Interpretation And Report (Mayo)OutsideLaboratory",,85390,CPT,Facility,Outpatient,,,90,109,92.65,31.2394,109,Humana Insurance Company,Medicare PPO,53.41,49,,percent of total billed charges,,
"Fibrinolysins Or Coagulopathy Screen, Interpretation And Report (Mayo)OutsideLaboratory",,85390,CPT,Facility,Inpatient,,,90,109,92.65,31.2394,109,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Fibrinolysins Or Coagulopathy Screen, Interpretation And Report (Mayo)OutsideLaboratory",,85390,CPT,Facility,Both,,,90,109,92.65,31.2394,109,Medica,Individual & Family,108.019,99.1,,percent of total billed charges,,
"Fibrinolysins Or Coagulopathy Screen, Interpretation And Report (Mayo)OutsideLaboratory",,85390,CPT,Facility,Outpatient,,,90,109,92.65,31.2394,109,Medica,Medica Advantage Solution,54.282,49.8,,percent of total billed charges,,
"Fibrinolysins Or Coagulopathy Screen, Interpretation And Report (Mayo)OutsideLaboratory",,85390,CPT,Facility,Inpatient,,,90,109,92.65,31.2394,109,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Fibrinolysins Or Coagulopathy Screen, Interpretation And Report (Mayo)OutsideLaboratory",,85390,CPT,Facility,Outpatient,,,90,109,92.65,31.2394,109,Medica,Medical Assistance,48.614,44.6,,percent of total billed charges,,
"Fibrinolysins Or Coagulopathy Screen, Interpretation And Report (Mayo)OutsideLaboratory",,85390,CPT,Facility,Inpatient,,,90,109,92.65,31.2394,109,Medica,Medical Assistance,,,,,Included in per diem rate,
"Fibrinolysins Or Coagulopathy Screen, Interpretation And Report (Mayo)OutsideLaboratory",,85390,CPT,Facility,Outpatient,,,90,109,92.65,31.2394,109,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,54.282,49.8,,percent of total billed charges,,
"Fibrinolysins Or Coagulopathy Screen, Interpretation And Report (Mayo)OutsideLaboratory",,85390,CPT,Facility,Inpatient,,,90,109,92.65,31.2394,109,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Fibrinolysins Or Coagulopathy Screen, Interpretation And Report (Mayo)OutsideLaboratory",,85390,CPT,Facility,Both,,,90,109,92.65,31.2394,109,"Multiplan, Inc.","Multiplan, Inc.",102.46,94,,percent of total billed charges,,
"Fibrinolysins Or Coagulopathy Screen, Interpretation And Report (Mayo)OutsideLaboratory",,85390,CPT,Facility,Outpatient,,,90,109,92.65,31.2394,109,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,94.176,86.4,,percent of total billed charges,,
"Fibrinolysins Or Coagulopathy Screen, Interpretation And Report (Mayo)OutsideLaboratory",,85390,CPT,Facility,Inpatient,,,90,109,92.65,31.2394,109,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Fibrinolysins Or Coagulopathy Screen, Interpretation And Report (Mayo)OutsideLaboratory",,85390,CPT,Facility,Both,,,90,109,92.65,31.2394,109,"Preferred One Administrative Services, INC.",PPO,107.474,98.6,,percent of total billed charges,,
"Fibrinolysins Or Coagulopathy Screen, Interpretation And Report (Mayo)OutsideLaboratory",,85390,CPT,Facility,Outpatient,,,90,109,92.65,31.2394,109,PrimeWest Health,Minnesota Senior Health Options (MSHO),56.0805,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Fibrinolysins Or Coagulopathy Screen, Interpretation And Report (Mayo)OutsideLaboratory",,85390,CPT,Facility,Inpatient,,,90,109,92.65,31.2394,109,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Fibrinolysins Or Coagulopathy Screen, Interpretation And Report (Mayo)OutsideLaboratory",,85390,CPT,Facility,Outpatient,,,90,109,92.65,31.2394,109,PrimeWest Health,MinnesotaCare,55.9824,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Fibrinolysins Or Coagulopathy Screen, Interpretation And Report (Mayo)OutsideLaboratory",,85390,CPT,Facility,Inpatient,,,90,109,92.65,31.2394,109,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Fibrinolysins Or Coagulopathy Screen, Interpretation And Report (Mayo)OutsideLaboratory",,85390,CPT,Facility,Both,,,90,109,92.65,31.2394,109,Sanford Health Plan,Sanford Health Plan,100.28,92,,percent of total billed charges,,
"Fibrinolysins Or Coagulopathy Screen, Interpretation And Report (Mayo)OutsideLaboratory",,85390,CPT,Facility,Outpatient,,,90,109,92.65,31.2394,109,"UCare Health, Inc.",Individual & Family Plan,61.4215,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Fibrinolysins Or Coagulopathy Screen, Interpretation And Report (Mayo)OutsideLaboratory",,85390,CPT,Facility,Inpatient,,,90,109,92.65,31.2394,109,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Fibrinolysins Or Coagulopathy Screen, Interpretation And Report (Mayo)OutsideLaboratory",,85390,CPT,Facility,Outpatient,,,90,109,92.65,31.2394,109,"UCare Health, Inc.",Medical Assistance,55.0123,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Fibrinolysins Or Coagulopathy Screen, Interpretation And Report (Mayo)OutsideLaboratory",,85390,CPT,Facility,Inpatient,,,90,109,92.65,31.2394,109,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Fibrinolysins Or Coagulopathy Screen, Interpretation And Report (Mayo)OutsideLaboratory",,85390,CPT,Facility,Outpatient,,,90,109,92.65,31.2394,109,"UCare Health, Inc.",Medicare Advantage,55.0123,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Fibrinolysins Or Coagulopathy Screen, Interpretation And Report (Mayo)OutsideLaboratory",,85390,CPT,Facility,Inpatient,,,90,109,92.65,31.2394,109,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Fibrinolysins Or Coagulopathy Screen, Interpretation And Report (Mayo)OutsideLaboratory",,85390,CPT,Facility,Outpatient,,,90,109,92.65,31.2394,109,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),55.0123,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Fibrinolysins Or Coagulopathy Screen, Interpretation And Report (Mayo)OutsideLaboratory",,85390,CPT,Facility,Inpatient,,,90,109,92.65,31.2394,109,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Fibrinolysins Or Coagulopathy Screen, Interpretation And Report (Mayo)OutsideLaboratory",,85390,CPT,Facility,Both,,,90,109,92.65,31.2394,109,UnitedHealthcare,Individual & Family,102.46,94,,percent of total billed charges,,
"Fibrinolysins Or Coagulopathy Screen, Interpretation And Report (Mayo)OutsideLaboratory",,85390,CPT,Facility,Outpatient,,,90,109,92.65,31.2394,109,UnitedHealthcare,Medicare Advantage,53.41,49,,percent of total billed charges,,
"Fibrinolysins Or Coagulopathy Screen, Interpretation And Report (Mayo)OutsideLaboratory",,85390,CPT,Facility,Inpatient,,,90,109,92.65,31.2394,109,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Fibrinolysins Or Coagulopathy Screen, Interpretation And Report (Mayo)OutsideLaboratory",,85390,CPT,Facility,Outpatient,,,90,109,92.65,31.2394,109,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,52.32,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Fibrinolysins Or Coagulopathy Screen, Interpretation And Report (Mayo)OutsideLaboratory",,85390,CPT,Facility,Inpatient,,,90,109,92.65,31.2394,109,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Fibrinolysins/Coagulopathy Screen Interp&Repor (Mayo)OutsideLaboratory,,85390,CPT,Facility,Both,,,90,109,92.65,31.2394,109,Aetna,Commercial,100.28,92,,percent of total billed charges,,
Fibrinolysins/Coagulopathy Screen Interp&Repor (Mayo)OutsideLaboratory,,85390,CPT,Facility,Outpatient,,,90,109,92.65,31.2394,109,Aetna,Medicare Advantage,53.41,49,,percent of total billed charges,,
Fibrinolysins/Coagulopathy Screen Interp&Repor (Mayo)OutsideLaboratory,,85390,CPT,Facility,Inpatient,,,90,109,92.65,31.2394,109,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Fibrinolysins/Coagulopathy Screen Interp&Repor (Mayo)OutsideLaboratory,,85390,CPT,Facility,Both,,,90,109,92.65,31.2394,109,Aetna,PPO,101.37,93,,percent of total billed charges,,
Fibrinolysins/Coagulopathy Screen Interp&Repor (Mayo)OutsideLaboratory,,85390,CPT,Facility,Both,,,90,109,92.65,31.2394,109,America's PPO,America's PPO,104.6727,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Fibrinolysins/Coagulopathy Screen Interp&Repor (Mayo)OutsideLaboratory,,85390,CPT,Facility,Both,,,90,109,92.65,31.2394,109,BlueCross BlueShield Minnesota, Federal Employee Program,107.256,98.4,,percent of total billed charges,,
Fibrinolysins/Coagulopathy Screen Interp&Repor (Mayo)OutsideLaboratory,,85390,CPT,Facility,Both,,,90,109,92.65,31.2394,109,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,109,100,,percent of total billed charges,,
Fibrinolysins/Coagulopathy Screen Interp&Repor (Mayo)OutsideLaboratory,,85390,CPT,Facility,Both,,,90,109,92.65,31.2394,109,BlueCross BlueShield Minnesota,High Value Network Plan,98.1,90,,percent of total billed charges,,
Fibrinolysins/Coagulopathy Screen Interp&Repor (Mayo)OutsideLaboratory,,85390,CPT,Facility,Outpatient,,,90,109,92.65,31.2394,109,BlueCross BlueShield Minnesota,Medicare Advantage,53.41,49,,percent of total billed charges,,
Fibrinolysins/Coagulopathy Screen Interp&Repor (Mayo)OutsideLaboratory,,85390,CPT,Facility,Inpatient,,,90,109,92.65,31.2394,109,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Fibrinolysins/Coagulopathy Screen Interp&Repor (Mayo)OutsideLaboratory,,85390,CPT,Facility,Both,,,90,109,92.65,31.2394,109,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,96.5413,88.57,,percent of total billed charges,,
Fibrinolysins/Coagulopathy Screen Interp&Repor (Mayo)OutsideLaboratory,,85390,CPT,Facility,Both,,,90,109,92.65,31.2394,109,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,31.2394,28.66,,percent of total billed charges,,
Fibrinolysins/Coagulopathy Screen Interp&Repor (Mayo)OutsideLaboratory,,85390,CPT,Facility,Outpatient,,,90,109,92.65,31.2394,109,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),53.41,49,,percent of total billed charges,,
Fibrinolysins/Coagulopathy Screen Interp&Repor (Mayo)OutsideLaboratory,,85390,CPT,Facility,Inpatient,,,90,109,92.65,31.2394,109,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Fibrinolysins/Coagulopathy Screen Interp&Repor (Mayo)OutsideLaboratory,,85390,CPT,Facility,Both,,,90,109,92.65,31.2394,109,CorVel,Worker's Compensation,109,100,,percent of total billed charges,,
Fibrinolysins/Coagulopathy Screen Interp&Repor (Mayo)OutsideLaboratory,,85390,CPT,Facility,Both,,,90,109,92.65,31.2394,109,First Health Group Corporation,First Health Network,105.73,97,,percent of total billed charges,,
Fibrinolysins/Coagulopathy Screen Interp&Repor (Mayo)OutsideLaboratory,,85390,CPT,Facility,Both,,,90,109,92.65,31.2394,109,"Health Partners, Inc.",Commercial,103.114,94.6,,percent of total billed charges,,
Fibrinolysins/Coagulopathy Screen Interp&Repor (Mayo)OutsideLaboratory,,85390,CPT,Facility,Outpatient,,,90,109,92.65,31.2394,109,"Health Partners, Inc.",Medicare Advantage,53.41,49,,percent of total billed charges,,
Fibrinolysins/Coagulopathy Screen Interp&Repor (Mayo)OutsideLaboratory,,85390,CPT,Facility,Inpatient,,,90,109,92.65,31.2394,109,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Fibrinolysins/Coagulopathy Screen Interp&Repor (Mayo)OutsideLaboratory,,85390,CPT,Facility,Both,,,90,109,92.65,31.2394,109,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),65.4,60,,percent of total billed charges,,
Fibrinolysins/Coagulopathy Screen Interp&Repor (Mayo)OutsideLaboratory,,85390,CPT,Facility,Both,,,90,109,92.65,31.2394,109,"Health Partners, Inc.",State of Minnesota Advantage Program,88.835,81.5,,percent of total billed charges,,
Fibrinolysins/Coagulopathy Screen Interp&Repor (Mayo)OutsideLaboratory,,85390,CPT,Facility,Both,,,90,109,92.65,31.2394,109,"Health Partners, Inc.",State Public Programs,54.5,50,,percent of total billed charges,,
Fibrinolysins/Coagulopathy Screen Interp&Repor (Mayo)OutsideLaboratory,,85390,CPT,Facility,Both,,,90,109,92.65,31.2394,109,Humana Insurance Company,Commercial PPO,103.55,95,,percent of total billed charges,,
Fibrinolysins/Coagulopathy Screen Interp&Repor (Mayo)OutsideLaboratory,,85390,CPT,Facility,Outpatient,,,90,109,92.65,31.2394,109,Humana Insurance Company,Medicare PPO,53.41,49,,percent of total billed charges,,
Fibrinolysins/Coagulopathy Screen Interp&Repor (Mayo)OutsideLaboratory,,85390,CPT,Facility,Inpatient,,,90,109,92.65,31.2394,109,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Fibrinolysins/Coagulopathy Screen Interp&Repor (Mayo)OutsideLaboratory,,85390,CPT,Facility,Both,,,90,109,92.65,31.2394,109,Medica,Individual & Family,108.019,99.1,,percent of total billed charges,,
Fibrinolysins/Coagulopathy Screen Interp&Repor (Mayo)OutsideLaboratory,,85390,CPT,Facility,Outpatient,,,90,109,92.65,31.2394,109,Medica,Medica Advantage Solution,54.282,49.8,,percent of total billed charges,,
Fibrinolysins/Coagulopathy Screen Interp&Repor (Mayo)OutsideLaboratory,,85390,CPT,Facility,Inpatient,,,90,109,92.65,31.2394,109,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Fibrinolysins/Coagulopathy Screen Interp&Repor (Mayo)OutsideLaboratory,,85390,CPT,Facility,Outpatient,,,90,109,92.65,31.2394,109,Medica,Medical Assistance,48.614,44.6,,percent of total billed charges,,
Fibrinolysins/Coagulopathy Screen Interp&Repor (Mayo)OutsideLaboratory,,85390,CPT,Facility,Inpatient,,,90,109,92.65,31.2394,109,Medica,Medical Assistance,,,,,Included in per diem rate,
Fibrinolysins/Coagulopathy Screen Interp&Repor (Mayo)OutsideLaboratory,,85390,CPT,Facility,Outpatient,,,90,109,92.65,31.2394,109,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,54.282,49.8,,percent of total billed charges,,
Fibrinolysins/Coagulopathy Screen Interp&Repor (Mayo)OutsideLaboratory,,85390,CPT,Facility,Inpatient,,,90,109,92.65,31.2394,109,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Fibrinolysins/Coagulopathy Screen Interp&Repor (Mayo)OutsideLaboratory,,85390,CPT,Facility,Both,,,90,109,92.65,31.2394,109,"Multiplan, Inc.","Multiplan, Inc.",102.46,94,,percent of total billed charges,,
Fibrinolysins/Coagulopathy Screen Interp&Repor (Mayo)OutsideLaboratory,,85390,CPT,Facility,Outpatient,,,90,109,92.65,31.2394,109,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,94.176,86.4,,percent of total billed charges,,
Fibrinolysins/Coagulopathy Screen Interp&Repor (Mayo)OutsideLaboratory,,85390,CPT,Facility,Inpatient,,,90,109,92.65,31.2394,109,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Fibrinolysins/Coagulopathy Screen Interp&Repor (Mayo)OutsideLaboratory,,85390,CPT,Facility,Both,,,90,109,92.65,31.2394,109,"Preferred One Administrative Services, INC.",PPO,107.474,98.6,,percent of total billed charges,,
Fibrinolysins/Coagulopathy Screen Interp&Repor (Mayo)OutsideLaboratory,,85390,CPT,Facility,Outpatient,,,90,109,92.65,31.2394,109,PrimeWest Health,Minnesota Senior Health Options (MSHO),56.0805,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Fibrinolysins/Coagulopathy Screen Interp&Repor (Mayo)OutsideLaboratory,,85390,CPT,Facility,Inpatient,,,90,109,92.65,31.2394,109,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Fibrinolysins/Coagulopathy Screen Interp&Repor (Mayo)OutsideLaboratory,,85390,CPT,Facility,Outpatient,,,90,109,92.65,31.2394,109,PrimeWest Health,MinnesotaCare,55.9824,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Fibrinolysins/Coagulopathy Screen Interp&Repor (Mayo)OutsideLaboratory,,85390,CPT,Facility,Inpatient,,,90,109,92.65,31.2394,109,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Fibrinolysins/Coagulopathy Screen Interp&Repor (Mayo)OutsideLaboratory,,85390,CPT,Facility,Both,,,90,109,92.65,31.2394,109,Sanford Health Plan,Sanford Health Plan,100.28,92,,percent of total billed charges,,
Fibrinolysins/Coagulopathy Screen Interp&Repor (Mayo)OutsideLaboratory,,85390,CPT,Facility,Outpatient,,,90,109,92.65,31.2394,109,"UCare Health, Inc.",Individual & Family Plan,61.4215,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Fibrinolysins/Coagulopathy Screen Interp&Repor (Mayo)OutsideLaboratory,,85390,CPT,Facility,Inpatient,,,90,109,92.65,31.2394,109,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Fibrinolysins/Coagulopathy Screen Interp&Repor (Mayo)OutsideLaboratory,,85390,CPT,Facility,Outpatient,,,90,109,92.65,31.2394,109,"UCare Health, Inc.",Medical Assistance,55.0123,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Fibrinolysins/Coagulopathy Screen Interp&Repor (Mayo)OutsideLaboratory,,85390,CPT,Facility,Inpatient,,,90,109,92.65,31.2394,109,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Fibrinolysins/Coagulopathy Screen Interp&Repor (Mayo)OutsideLaboratory,,85390,CPT,Facility,Outpatient,,,90,109,92.65,31.2394,109,"UCare Health, Inc.",Medicare Advantage,55.0123,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Fibrinolysins/Coagulopathy Screen Interp&Repor (Mayo)OutsideLaboratory,,85390,CPT,Facility,Inpatient,,,90,109,92.65,31.2394,109,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Fibrinolysins/Coagulopathy Screen Interp&Repor (Mayo)OutsideLaboratory,,85390,CPT,Facility,Outpatient,,,90,109,92.65,31.2394,109,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),55.0123,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Fibrinolysins/Coagulopathy Screen Interp&Repor (Mayo)OutsideLaboratory,,85390,CPT,Facility,Inpatient,,,90,109,92.65,31.2394,109,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Fibrinolysins/Coagulopathy Screen Interp&Repor (Mayo)OutsideLaboratory,,85390,CPT,Facility,Both,,,90,109,92.65,31.2394,109,UnitedHealthcare,Individual & Family,102.46,94,,percent of total billed charges,,
Fibrinolysins/Coagulopathy Screen Interp&Repor (Mayo)OutsideLaboratory,,85390,CPT,Facility,Outpatient,,,90,109,92.65,31.2394,109,UnitedHealthcare,Medicare Advantage,53.41,49,,percent of total billed charges,,
Fibrinolysins/Coagulopathy Screen Interp&Repor (Mayo)OutsideLaboratory,,85390,CPT,Facility,Inpatient,,,90,109,92.65,31.2394,109,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Fibrinolysins/Coagulopathy Screen Interp&Repor (Mayo)OutsideLaboratory,,85390,CPT,Facility,Outpatient,,,90,109,92.65,31.2394,109,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,52.32,48,,percent of total billed charges,,100% of DHS outpatient percentage
Fibrinolysins/Coagulopathy Screen Interp&Repor (Mayo)OutsideLaboratory,,85390,CPT,Facility,Inpatient,,,90,109,92.65,31.2394,109,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Special Coagulation Interpretation (Mayo)OutsideLaboratory,,85390,CPT,Facility,Both,,,90,109,92.65,31.2394,109,Aetna,Commercial,100.28,92,,percent of total billed charges,,
Special Coagulation Interpretation (Mayo)OutsideLaboratory,,85390,CPT,Facility,Outpatient,,,90,109,92.65,31.2394,109,Aetna,Medicare Advantage,53.41,49,,percent of total billed charges,,
Special Coagulation Interpretation (Mayo)OutsideLaboratory,,85390,CPT,Facility,Inpatient,,,90,109,92.65,31.2394,109,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Special Coagulation Interpretation (Mayo)OutsideLaboratory,,85390,CPT,Facility,Both,,,90,109,92.65,31.2394,109,Aetna,PPO,101.37,93,,percent of total billed charges,,
Special Coagulation Interpretation (Mayo)OutsideLaboratory,,85390,CPT,Facility,Both,,,90,109,92.65,31.2394,109,America's PPO,America's PPO,104.6727,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Special Coagulation Interpretation (Mayo)OutsideLaboratory,,85390,CPT,Facility,Both,,,90,109,92.65,31.2394,109,BlueCross BlueShield Minnesota, Federal Employee Program,107.256,98.4,,percent of total billed charges,,
Special Coagulation Interpretation (Mayo)OutsideLaboratory,,85390,CPT,Facility,Both,,,90,109,92.65,31.2394,109,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,109,100,,percent of total billed charges,,
Special Coagulation Interpretation (Mayo)OutsideLaboratory,,85390,CPT,Facility,Both,,,90,109,92.65,31.2394,109,BlueCross BlueShield Minnesota,High Value Network Plan,98.1,90,,percent of total billed charges,,
Special Coagulation Interpretation (Mayo)OutsideLaboratory,,85390,CPT,Facility,Outpatient,,,90,109,92.65,31.2394,109,BlueCross BlueShield Minnesota,Medicare Advantage,53.41,49,,percent of total billed charges,,
Special Coagulation Interpretation (Mayo)OutsideLaboratory,,85390,CPT,Facility,Inpatient,,,90,109,92.65,31.2394,109,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Special Coagulation Interpretation (Mayo)OutsideLaboratory,,85390,CPT,Facility,Both,,,90,109,92.65,31.2394,109,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,96.5413,88.57,,percent of total billed charges,,
Special Coagulation Interpretation (Mayo)OutsideLaboratory,,85390,CPT,Facility,Both,,,90,109,92.65,31.2394,109,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,31.2394,28.66,,percent of total billed charges,,
Special Coagulation Interpretation (Mayo)OutsideLaboratory,,85390,CPT,Facility,Outpatient,,,90,109,92.65,31.2394,109,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),53.41,49,,percent of total billed charges,,
Special Coagulation Interpretation (Mayo)OutsideLaboratory,,85390,CPT,Facility,Inpatient,,,90,109,92.65,31.2394,109,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Special Coagulation Interpretation (Mayo)OutsideLaboratory,,85390,CPT,Facility,Both,,,90,109,92.65,31.2394,109,CorVel,Worker's Compensation,109,100,,percent of total billed charges,,
Special Coagulation Interpretation (Mayo)OutsideLaboratory,,85390,CPT,Facility,Both,,,90,109,92.65,31.2394,109,First Health Group Corporation,First Health Network,105.73,97,,percent of total billed charges,,
Special Coagulation Interpretation (Mayo)OutsideLaboratory,,85390,CPT,Facility,Both,,,90,109,92.65,31.2394,109,"Health Partners, Inc.",Commercial,103.114,94.6,,percent of total billed charges,,
Special Coagulation Interpretation (Mayo)OutsideLaboratory,,85390,CPT,Facility,Outpatient,,,90,109,92.65,31.2394,109,"Health Partners, Inc.",Medicare Advantage,53.41,49,,percent of total billed charges,,
Special Coagulation Interpretation (Mayo)OutsideLaboratory,,85390,CPT,Facility,Inpatient,,,90,109,92.65,31.2394,109,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Special Coagulation Interpretation (Mayo)OutsideLaboratory,,85390,CPT,Facility,Both,,,90,109,92.65,31.2394,109,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),65.4,60,,percent of total billed charges,,
Special Coagulation Interpretation (Mayo)OutsideLaboratory,,85390,CPT,Facility,Both,,,90,109,92.65,31.2394,109,"Health Partners, Inc.",State of Minnesota Advantage Program,88.835,81.5,,percent of total billed charges,,
Special Coagulation Interpretation (Mayo)OutsideLaboratory,,85390,CPT,Facility,Both,,,90,109,92.65,31.2394,109,"Health Partners, Inc.",State Public Programs,54.5,50,,percent of total billed charges,,
Special Coagulation Interpretation (Mayo)OutsideLaboratory,,85390,CPT,Facility,Both,,,90,109,92.65,31.2394,109,Humana Insurance Company,Commercial PPO,103.55,95,,percent of total billed charges,,
Special Coagulation Interpretation (Mayo)OutsideLaboratory,,85390,CPT,Facility,Outpatient,,,90,109,92.65,31.2394,109,Humana Insurance Company,Medicare PPO,53.41,49,,percent of total billed charges,,
Special Coagulation Interpretation (Mayo)OutsideLaboratory,,85390,CPT,Facility,Inpatient,,,90,109,92.65,31.2394,109,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Special Coagulation Interpretation (Mayo)OutsideLaboratory,,85390,CPT,Facility,Both,,,90,109,92.65,31.2394,109,Medica,Individual & Family,108.019,99.1,,percent of total billed charges,,
Special Coagulation Interpretation (Mayo)OutsideLaboratory,,85390,CPT,Facility,Outpatient,,,90,109,92.65,31.2394,109,Medica,Medica Advantage Solution,54.282,49.8,,percent of total billed charges,,
Special Coagulation Interpretation (Mayo)OutsideLaboratory,,85390,CPT,Facility,Inpatient,,,90,109,92.65,31.2394,109,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Special Coagulation Interpretation (Mayo)OutsideLaboratory,,85390,CPT,Facility,Outpatient,,,90,109,92.65,31.2394,109,Medica,Medical Assistance,48.614,44.6,,percent of total billed charges,,
Special Coagulation Interpretation (Mayo)OutsideLaboratory,,85390,CPT,Facility,Inpatient,,,90,109,92.65,31.2394,109,Medica,Medical Assistance,,,,,Included in per diem rate,
Special Coagulation Interpretation (Mayo)OutsideLaboratory,,85390,CPT,Facility,Outpatient,,,90,109,92.65,31.2394,109,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,54.282,49.8,,percent of total billed charges,,
Special Coagulation Interpretation (Mayo)OutsideLaboratory,,85390,CPT,Facility,Inpatient,,,90,109,92.65,31.2394,109,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Special Coagulation Interpretation (Mayo)OutsideLaboratory,,85390,CPT,Facility,Both,,,90,109,92.65,31.2394,109,"Multiplan, Inc.","Multiplan, Inc.",102.46,94,,percent of total billed charges,,
Special Coagulation Interpretation (Mayo)OutsideLaboratory,,85390,CPT,Facility,Outpatient,,,90,109,92.65,31.2394,109,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,94.176,86.4,,percent of total billed charges,,
Special Coagulation Interpretation (Mayo)OutsideLaboratory,,85390,CPT,Facility,Inpatient,,,90,109,92.65,31.2394,109,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Special Coagulation Interpretation (Mayo)OutsideLaboratory,,85390,CPT,Facility,Both,,,90,109,92.65,31.2394,109,"Preferred One Administrative Services, INC.",PPO,107.474,98.6,,percent of total billed charges,,
Special Coagulation Interpretation (Mayo)OutsideLaboratory,,85390,CPT,Facility,Outpatient,,,90,109,92.65,31.2394,109,PrimeWest Health,Minnesota Senior Health Options (MSHO),56.0805,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Special Coagulation Interpretation (Mayo)OutsideLaboratory,,85390,CPT,Facility,Inpatient,,,90,109,92.65,31.2394,109,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Special Coagulation Interpretation (Mayo)OutsideLaboratory,,85390,CPT,Facility,Outpatient,,,90,109,92.65,31.2394,109,PrimeWest Health,MinnesotaCare,55.9824,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Special Coagulation Interpretation (Mayo)OutsideLaboratory,,85390,CPT,Facility,Inpatient,,,90,109,92.65,31.2394,109,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Special Coagulation Interpretation (Mayo)OutsideLaboratory,,85390,CPT,Facility,Both,,,90,109,92.65,31.2394,109,Sanford Health Plan,Sanford Health Plan,100.28,92,,percent of total billed charges,,
Special Coagulation Interpretation (Mayo)OutsideLaboratory,,85390,CPT,Facility,Outpatient,,,90,109,92.65,31.2394,109,"UCare Health, Inc.",Individual & Family Plan,61.4215,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Special Coagulation Interpretation (Mayo)OutsideLaboratory,,85390,CPT,Facility,Inpatient,,,90,109,92.65,31.2394,109,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Special Coagulation Interpretation (Mayo)OutsideLaboratory,,85390,CPT,Facility,Outpatient,,,90,109,92.65,31.2394,109,"UCare Health, Inc.",Medical Assistance,55.0123,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Special Coagulation Interpretation (Mayo)OutsideLaboratory,,85390,CPT,Facility,Inpatient,,,90,109,92.65,31.2394,109,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Special Coagulation Interpretation (Mayo)OutsideLaboratory,,85390,CPT,Facility,Outpatient,,,90,109,92.65,31.2394,109,"UCare Health, Inc.",Medicare Advantage,55.0123,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Special Coagulation Interpretation (Mayo)OutsideLaboratory,,85390,CPT,Facility,Inpatient,,,90,109,92.65,31.2394,109,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Special Coagulation Interpretation (Mayo)OutsideLaboratory,,85390,CPT,Facility,Outpatient,,,90,109,92.65,31.2394,109,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),55.0123,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Special Coagulation Interpretation (Mayo)OutsideLaboratory,,85390,CPT,Facility,Inpatient,,,90,109,92.65,31.2394,109,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Special Coagulation Interpretation (Mayo)OutsideLaboratory,,85390,CPT,Facility,Both,,,90,109,92.65,31.2394,109,UnitedHealthcare,Individual & Family,102.46,94,,percent of total billed charges,,
Special Coagulation Interpretation (Mayo)OutsideLaboratory,,85390,CPT,Facility,Outpatient,,,90,109,92.65,31.2394,109,UnitedHealthcare,Medicare Advantage,53.41,49,,percent of total billed charges,,
Special Coagulation Interpretation (Mayo)OutsideLaboratory,,85390,CPT,Facility,Inpatient,,,90,109,92.65,31.2394,109,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Special Coagulation Interpretation (Mayo)OutsideLaboratory,,85390,CPT,Facility,Outpatient,,,90,109,92.65,31.2394,109,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,52.32,48,,percent of total billed charges,,100% of DHS outpatient percentage
Special Coagulation Interpretation (Mayo)OutsideLaboratory,,85390,CPT,Facility,Inpatient,,,90,109,92.65,31.2394,109,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Von Willebrand Disease Tech Interp, (Mayo)OutsideLaboratory",,85390,CPT,Facility,Both,,,90,302,256.7,86.5532,302,Aetna,Commercial,277.84,92,,percent of total billed charges,,
"Von Willebrand Disease Tech Interp, (Mayo)OutsideLaboratory",,85390,CPT,Facility,Outpatient,,,90,302,256.7,86.5532,302,Aetna,Medicare Advantage,147.98,49,,percent of total billed charges,,
"Von Willebrand Disease Tech Interp, (Mayo)OutsideLaboratory",,85390,CPT,Facility,Inpatient,,,90,302,256.7,86.5532,302,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Von Willebrand Disease Tech Interp, (Mayo)OutsideLaboratory",,85390,CPT,Facility,Both,,,90,302,256.7,86.5532,302,Aetna,PPO,280.86,93,,percent of total billed charges,,
"Von Willebrand Disease Tech Interp, (Mayo)OutsideLaboratory",,85390,CPT,Facility,Both,,,90,302,256.7,86.5532,302,America's PPO,America's PPO,290.0106,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Von Willebrand Disease Tech Interp, (Mayo)OutsideLaboratory",,85390,CPT,Facility,Both,,,90,302,256.7,86.5532,302,BlueCross BlueShield Minnesota, Federal Employee Program,297.168,98.4,,percent of total billed charges,,
"Von Willebrand Disease Tech Interp, (Mayo)OutsideLaboratory",,85390,CPT,Facility,Both,,,90,302,256.7,86.5532,302,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,302,100,,percent of total billed charges,,
"Von Willebrand Disease Tech Interp, (Mayo)OutsideLaboratory",,85390,CPT,Facility,Both,,,90,302,256.7,86.5532,302,BlueCross BlueShield Minnesota,High Value Network Plan,271.8,90,,percent of total billed charges,,
"Von Willebrand Disease Tech Interp, (Mayo)OutsideLaboratory",,85390,CPT,Facility,Outpatient,,,90,302,256.7,86.5532,302,BlueCross BlueShield Minnesota,Medicare Advantage,147.98,49,,percent of total billed charges,,
"Von Willebrand Disease Tech Interp, (Mayo)OutsideLaboratory",,85390,CPT,Facility,Inpatient,,,90,302,256.7,86.5532,302,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Von Willebrand Disease Tech Interp, (Mayo)OutsideLaboratory",,85390,CPT,Facility,Both,,,90,302,256.7,86.5532,302,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,267.4814,88.57,,percent of total billed charges,,
"Von Willebrand Disease Tech Interp, (Mayo)OutsideLaboratory",,85390,CPT,Facility,Both,,,90,302,256.7,86.5532,302,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,86.5532,28.66,,percent of total billed charges,,
"Von Willebrand Disease Tech Interp, (Mayo)OutsideLaboratory",,85390,CPT,Facility,Outpatient,,,90,302,256.7,86.5532,302,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),147.98,49,,percent of total billed charges,,
"Von Willebrand Disease Tech Interp, (Mayo)OutsideLaboratory",,85390,CPT,Facility,Inpatient,,,90,302,256.7,86.5532,302,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Von Willebrand Disease Tech Interp, (Mayo)OutsideLaboratory",,85390,CPT,Facility,Both,,,90,302,256.7,86.5532,302,CorVel,Worker's Compensation,302,100,,percent of total billed charges,,
"Von Willebrand Disease Tech Interp, (Mayo)OutsideLaboratory",,85390,CPT,Facility,Both,,,90,302,256.7,86.5532,302,First Health Group Corporation,First Health Network,292.94,97,,percent of total billed charges,,
"Von Willebrand Disease Tech Interp, (Mayo)OutsideLaboratory",,85390,CPT,Facility,Both,,,90,302,256.7,86.5532,302,"Health Partners, Inc.",Commercial,285.692,94.6,,percent of total billed charges,,
"Von Willebrand Disease Tech Interp, (Mayo)OutsideLaboratory",,85390,CPT,Facility,Outpatient,,,90,302,256.7,86.5532,302,"Health Partners, Inc.",Medicare Advantage,147.98,49,,percent of total billed charges,,
"Von Willebrand Disease Tech Interp, (Mayo)OutsideLaboratory",,85390,CPT,Facility,Inpatient,,,90,302,256.7,86.5532,302,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Von Willebrand Disease Tech Interp, (Mayo)OutsideLaboratory",,85390,CPT,Facility,Both,,,90,302,256.7,86.5532,302,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),181.2,60,,percent of total billed charges,,
"Von Willebrand Disease Tech Interp, (Mayo)OutsideLaboratory",,85390,CPT,Facility,Both,,,90,302,256.7,86.5532,302,"Health Partners, Inc.",State of Minnesota Advantage Program,246.13,81.5,,percent of total billed charges,,
"Von Willebrand Disease Tech Interp, (Mayo)OutsideLaboratory",,85390,CPT,Facility,Both,,,90,302,256.7,86.5532,302,"Health Partners, Inc.",State Public Programs,151,50,,percent of total billed charges,,
"Von Willebrand Disease Tech Interp, (Mayo)OutsideLaboratory",,85390,CPT,Facility,Both,,,90,302,256.7,86.5532,302,Humana Insurance Company,Commercial PPO,286.9,95,,percent of total billed charges,,
"Von Willebrand Disease Tech Interp, (Mayo)OutsideLaboratory",,85390,CPT,Facility,Outpatient,,,90,302,256.7,86.5532,302,Humana Insurance Company,Medicare PPO,147.98,49,,percent of total billed charges,,
"Von Willebrand Disease Tech Interp, (Mayo)OutsideLaboratory",,85390,CPT,Facility,Inpatient,,,90,302,256.7,86.5532,302,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Von Willebrand Disease Tech Interp, (Mayo)OutsideLaboratory",,85390,CPT,Facility,Both,,,90,302,256.7,86.5532,302,Medica,Individual & Family,299.282,99.1,,percent of total billed charges,,
"Von Willebrand Disease Tech Interp, (Mayo)OutsideLaboratory",,85390,CPT,Facility,Outpatient,,,90,302,256.7,86.5532,302,Medica,Medica Advantage Solution,150.396,49.8,,percent of total billed charges,,
"Von Willebrand Disease Tech Interp, (Mayo)OutsideLaboratory",,85390,CPT,Facility,Inpatient,,,90,302,256.7,86.5532,302,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Von Willebrand Disease Tech Interp, (Mayo)OutsideLaboratory",,85390,CPT,Facility,Outpatient,,,90,302,256.7,86.5532,302,Medica,Medical Assistance,134.692,44.6,,percent of total billed charges,,
"Von Willebrand Disease Tech Interp, (Mayo)OutsideLaboratory",,85390,CPT,Facility,Inpatient,,,90,302,256.7,86.5532,302,Medica,Medical Assistance,,,,,Included in per diem rate,
"Von Willebrand Disease Tech Interp, (Mayo)OutsideLaboratory",,85390,CPT,Facility,Outpatient,,,90,302,256.7,86.5532,302,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,150.396,49.8,,percent of total billed charges,,
"Von Willebrand Disease Tech Interp, (Mayo)OutsideLaboratory",,85390,CPT,Facility,Inpatient,,,90,302,256.7,86.5532,302,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Von Willebrand Disease Tech Interp, (Mayo)OutsideLaboratory",,85390,CPT,Facility,Both,,,90,302,256.7,86.5532,302,"Multiplan, Inc.","Multiplan, Inc.",283.88,94,,percent of total billed charges,,
"Von Willebrand Disease Tech Interp, (Mayo)OutsideLaboratory",,85390,CPT,Facility,Outpatient,,,90,302,256.7,86.5532,302,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,260.928,86.4,,percent of total billed charges,,
"Von Willebrand Disease Tech Interp, (Mayo)OutsideLaboratory",,85390,CPT,Facility,Inpatient,,,90,302,256.7,86.5532,302,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Von Willebrand Disease Tech Interp, (Mayo)OutsideLaboratory",,85390,CPT,Facility,Both,,,90,302,256.7,86.5532,302,"Preferred One Administrative Services, INC.",PPO,297.772,98.6,,percent of total billed charges,,
"Von Willebrand Disease Tech Interp, (Mayo)OutsideLaboratory",,85390,CPT,Facility,Outpatient,,,90,302,256.7,86.5532,302,PrimeWest Health,Minnesota Senior Health Options (MSHO),155.379,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Von Willebrand Disease Tech Interp, (Mayo)OutsideLaboratory",,85390,CPT,Facility,Inpatient,,,90,302,256.7,86.5532,302,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Von Willebrand Disease Tech Interp, (Mayo)OutsideLaboratory",,85390,CPT,Facility,Outpatient,,,90,302,256.7,86.5532,302,PrimeWest Health,MinnesotaCare,155.1072,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Von Willebrand Disease Tech Interp, (Mayo)OutsideLaboratory",,85390,CPT,Facility,Inpatient,,,90,302,256.7,86.5532,302,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Von Willebrand Disease Tech Interp, (Mayo)OutsideLaboratory",,85390,CPT,Facility,Both,,,90,302,256.7,86.5532,302,Sanford Health Plan,Sanford Health Plan,277.84,92,,percent of total billed charges,,
"Von Willebrand Disease Tech Interp, (Mayo)OutsideLaboratory",,85390,CPT,Facility,Outpatient,,,90,302,256.7,86.5532,302,"UCare Health, Inc.",Individual & Family Plan,170.177,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Von Willebrand Disease Tech Interp, (Mayo)OutsideLaboratory",,85390,CPT,Facility,Inpatient,,,90,302,256.7,86.5532,302,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Von Willebrand Disease Tech Interp, (Mayo)OutsideLaboratory",,85390,CPT,Facility,Outpatient,,,90,302,256.7,86.5532,302,"UCare Health, Inc.",Medical Assistance,152.4194,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Von Willebrand Disease Tech Interp, (Mayo)OutsideLaboratory",,85390,CPT,Facility,Inpatient,,,90,302,256.7,86.5532,302,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Von Willebrand Disease Tech Interp, (Mayo)OutsideLaboratory",,85390,CPT,Facility,Outpatient,,,90,302,256.7,86.5532,302,"UCare Health, Inc.",Medicare Advantage,152.4194,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Von Willebrand Disease Tech Interp, (Mayo)OutsideLaboratory",,85390,CPT,Facility,Inpatient,,,90,302,256.7,86.5532,302,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Von Willebrand Disease Tech Interp, (Mayo)OutsideLaboratory",,85390,CPT,Facility,Outpatient,,,90,302,256.7,86.5532,302,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),152.4194,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Von Willebrand Disease Tech Interp, (Mayo)OutsideLaboratory",,85390,CPT,Facility,Inpatient,,,90,302,256.7,86.5532,302,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Von Willebrand Disease Tech Interp, (Mayo)OutsideLaboratory",,85390,CPT,Facility,Both,,,90,302,256.7,86.5532,302,UnitedHealthcare,Individual & Family,283.88,94,,percent of total billed charges,,
"Von Willebrand Disease Tech Interp, (Mayo)OutsideLaboratory",,85390,CPT,Facility,Outpatient,,,90,302,256.7,86.5532,302,UnitedHealthcare,Medicare Advantage,147.98,49,,percent of total billed charges,,
"Von Willebrand Disease Tech Interp, (Mayo)OutsideLaboratory",,85390,CPT,Facility,Inpatient,,,90,302,256.7,86.5532,302,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Von Willebrand Disease Tech Interp, (Mayo)OutsideLaboratory",,85390,CPT,Facility,Outpatient,,,90,302,256.7,86.5532,302,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,144.96,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Von Willebrand Disease Tech Interp, (Mayo)OutsideLaboratory",,85390,CPT,Facility,Inpatient,,,90,302,256.7,86.5532,302,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Von Willebrand Prof (Mayo)OutsideLaboratory,,85397,CPT,Facility,Both,,,90,292,248.2,83.6872,292,Aetna,Commercial,268.64,92,,percent of total billed charges,,
Von Willebrand Prof (Mayo)OutsideLaboratory,,85397,CPT,Facility,Outpatient,,,90,292,248.2,83.6872,292,Aetna,Medicare Advantage,143.08,49,,percent of total billed charges,,
Von Willebrand Prof (Mayo)OutsideLaboratory,,85397,CPT,Facility,Inpatient,,,90,292,248.2,83.6872,292,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Von Willebrand Prof (Mayo)OutsideLaboratory,,85397,CPT,Facility,Both,,,90,292,248.2,83.6872,292,Aetna,PPO,271.56,93,,percent of total billed charges,,
Von Willebrand Prof (Mayo)OutsideLaboratory,,85397,CPT,Facility,Both,,,90,292,248.2,83.6872,292,America's PPO,America's PPO,280.4076,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Von Willebrand Prof (Mayo)OutsideLaboratory,,85397,CPT,Facility,Both,,,90,292,248.2,83.6872,292,BlueCross BlueShield Minnesota, Federal Employee Program,287.328,98.4,,percent of total billed charges,,
Von Willebrand Prof (Mayo)OutsideLaboratory,,85397,CPT,Facility,Both,,,90,292,248.2,83.6872,292,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,292,100,,percent of total billed charges,,
Von Willebrand Prof (Mayo)OutsideLaboratory,,85397,CPT,Facility,Both,,,90,292,248.2,83.6872,292,BlueCross BlueShield Minnesota,High Value Network Plan,262.8,90,,percent of total billed charges,,
Von Willebrand Prof (Mayo)OutsideLaboratory,,85397,CPT,Facility,Outpatient,,,90,292,248.2,83.6872,292,BlueCross BlueShield Minnesota,Medicare Advantage,143.08,49,,percent of total billed charges,,
Von Willebrand Prof (Mayo)OutsideLaboratory,,85397,CPT,Facility,Inpatient,,,90,292,248.2,83.6872,292,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Von Willebrand Prof (Mayo)OutsideLaboratory,,85397,CPT,Facility,Both,,,90,292,248.2,83.6872,292,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,258.6244,88.57,,percent of total billed charges,,
Von Willebrand Prof (Mayo)OutsideLaboratory,,85397,CPT,Facility,Both,,,90,292,248.2,83.6872,292,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,83.6872,28.66,,percent of total billed charges,,
Von Willebrand Prof (Mayo)OutsideLaboratory,,85397,CPT,Facility,Outpatient,,,90,292,248.2,83.6872,292,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),143.08,49,,percent of total billed charges,,
Von Willebrand Prof (Mayo)OutsideLaboratory,,85397,CPT,Facility,Inpatient,,,90,292,248.2,83.6872,292,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Von Willebrand Prof (Mayo)OutsideLaboratory,,85397,CPT,Facility,Both,,,90,292,248.2,83.6872,292,CorVel,Worker's Compensation,292,100,,percent of total billed charges,,
Von Willebrand Prof (Mayo)OutsideLaboratory,,85397,CPT,Facility,Both,,,90,292,248.2,83.6872,292,First Health Group Corporation,First Health Network,283.24,97,,percent of total billed charges,,
Von Willebrand Prof (Mayo)OutsideLaboratory,,85397,CPT,Facility,Both,,,90,292,248.2,83.6872,292,"Health Partners, Inc.",Commercial,276.232,94.6,,percent of total billed charges,,
Von Willebrand Prof (Mayo)OutsideLaboratory,,85397,CPT,Facility,Outpatient,,,90,292,248.2,83.6872,292,"Health Partners, Inc.",Medicare Advantage,143.08,49,,percent of total billed charges,,
Von Willebrand Prof (Mayo)OutsideLaboratory,,85397,CPT,Facility,Inpatient,,,90,292,248.2,83.6872,292,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Von Willebrand Prof (Mayo)OutsideLaboratory,,85397,CPT,Facility,Both,,,90,292,248.2,83.6872,292,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),175.2,60,,percent of total billed charges,,
Von Willebrand Prof (Mayo)OutsideLaboratory,,85397,CPT,Facility,Both,,,90,292,248.2,83.6872,292,"Health Partners, Inc.",State of Minnesota Advantage Program,237.98,81.5,,percent of total billed charges,,
Von Willebrand Prof (Mayo)OutsideLaboratory,,85397,CPT,Facility,Both,,,90,292,248.2,83.6872,292,"Health Partners, Inc.",State Public Programs,146,50,,percent of total billed charges,,
Von Willebrand Prof (Mayo)OutsideLaboratory,,85397,CPT,Facility,Both,,,90,292,248.2,83.6872,292,Humana Insurance Company,Commercial PPO,277.4,95,,percent of total billed charges,,
Von Willebrand Prof (Mayo)OutsideLaboratory,,85397,CPT,Facility,Outpatient,,,90,292,248.2,83.6872,292,Humana Insurance Company,Medicare PPO,143.08,49,,percent of total billed charges,,
Von Willebrand Prof (Mayo)OutsideLaboratory,,85397,CPT,Facility,Inpatient,,,90,292,248.2,83.6872,292,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Von Willebrand Prof (Mayo)OutsideLaboratory,,85397,CPT,Facility,Both,,,90,292,248.2,83.6872,292,Medica,Individual & Family,289.372,99.1,,percent of total billed charges,,
Von Willebrand Prof (Mayo)OutsideLaboratory,,85397,CPT,Facility,Outpatient,,,90,292,248.2,83.6872,292,Medica,Medica Advantage Solution,145.416,49.8,,percent of total billed charges,,
Von Willebrand Prof (Mayo)OutsideLaboratory,,85397,CPT,Facility,Inpatient,,,90,292,248.2,83.6872,292,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Von Willebrand Prof (Mayo)OutsideLaboratory,,85397,CPT,Facility,Outpatient,,,90,292,248.2,83.6872,292,Medica,Medical Assistance,130.232,44.6,,percent of total billed charges,,
Von Willebrand Prof (Mayo)OutsideLaboratory,,85397,CPT,Facility,Inpatient,,,90,292,248.2,83.6872,292,Medica,Medical Assistance,,,,,Included in per diem rate,
Von Willebrand Prof (Mayo)OutsideLaboratory,,85397,CPT,Facility,Outpatient,,,90,292,248.2,83.6872,292,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,145.416,49.8,,percent of total billed charges,,
Von Willebrand Prof (Mayo)OutsideLaboratory,,85397,CPT,Facility,Inpatient,,,90,292,248.2,83.6872,292,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Von Willebrand Prof (Mayo)OutsideLaboratory,,85397,CPT,Facility,Both,,,90,292,248.2,83.6872,292,"Multiplan, Inc.","Multiplan, Inc.",274.48,94,,percent of total billed charges,,
Von Willebrand Prof (Mayo)OutsideLaboratory,,85397,CPT,Facility,Outpatient,,,90,292,248.2,83.6872,292,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,252.288,86.4,,percent of total billed charges,,
Von Willebrand Prof (Mayo)OutsideLaboratory,,85397,CPT,Facility,Inpatient,,,90,292,248.2,83.6872,292,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Von Willebrand Prof (Mayo)OutsideLaboratory,,85397,CPT,Facility,Both,,,90,292,248.2,83.6872,292,"Preferred One Administrative Services, INC.",PPO,287.912,98.6,,percent of total billed charges,,
Von Willebrand Prof (Mayo)OutsideLaboratory,,85397,CPT,Facility,Outpatient,,,90,292,248.2,83.6872,292,PrimeWest Health,Minnesota Senior Health Options (MSHO),150.234,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Von Willebrand Prof (Mayo)OutsideLaboratory,,85397,CPT,Facility,Inpatient,,,90,292,248.2,83.6872,292,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Von Willebrand Prof (Mayo)OutsideLaboratory,,85397,CPT,Facility,Outpatient,,,90,292,248.2,83.6872,292,PrimeWest Health,MinnesotaCare,149.9712,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Von Willebrand Prof (Mayo)OutsideLaboratory,,85397,CPT,Facility,Inpatient,,,90,292,248.2,83.6872,292,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Von Willebrand Prof (Mayo)OutsideLaboratory,,85397,CPT,Facility,Both,,,90,292,248.2,83.6872,292,Sanford Health Plan,Sanford Health Plan,268.64,92,,percent of total billed charges,,
Von Willebrand Prof (Mayo)OutsideLaboratory,,85397,CPT,Facility,Outpatient,,,90,292,248.2,83.6872,292,"UCare Health, Inc.",Individual & Family Plan,164.542,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Von Willebrand Prof (Mayo)OutsideLaboratory,,85397,CPT,Facility,Inpatient,,,90,292,248.2,83.6872,292,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Von Willebrand Prof (Mayo)OutsideLaboratory,,85397,CPT,Facility,Outpatient,,,90,292,248.2,83.6872,292,"UCare Health, Inc.",Medical Assistance,147.3724,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Von Willebrand Prof (Mayo)OutsideLaboratory,,85397,CPT,Facility,Inpatient,,,90,292,248.2,83.6872,292,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Von Willebrand Prof (Mayo)OutsideLaboratory,,85397,CPT,Facility,Outpatient,,,90,292,248.2,83.6872,292,"UCare Health, Inc.",Medicare Advantage,147.3724,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Von Willebrand Prof (Mayo)OutsideLaboratory,,85397,CPT,Facility,Inpatient,,,90,292,248.2,83.6872,292,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Von Willebrand Prof (Mayo)OutsideLaboratory,,85397,CPT,Facility,Outpatient,,,90,292,248.2,83.6872,292,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),147.3724,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Von Willebrand Prof (Mayo)OutsideLaboratory,,85397,CPT,Facility,Inpatient,,,90,292,248.2,83.6872,292,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Von Willebrand Prof (Mayo)OutsideLaboratory,,85397,CPT,Facility,Both,,,90,292,248.2,83.6872,292,UnitedHealthcare,Individual & Family,274.48,94,,percent of total billed charges,,
Von Willebrand Prof (Mayo)OutsideLaboratory,,85397,CPT,Facility,Outpatient,,,90,292,248.2,83.6872,292,UnitedHealthcare,Medicare Advantage,143.08,49,,percent of total billed charges,,
Von Willebrand Prof (Mayo)OutsideLaboratory,,85397,CPT,Facility,Inpatient,,,90,292,248.2,83.6872,292,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Von Willebrand Prof (Mayo)OutsideLaboratory,,85397,CPT,Facility,Outpatient,,,90,292,248.2,83.6872,292,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,140.16,48,,percent of total billed charges,,100% of DHS outpatient percentage
Von Willebrand Prof (Mayo)OutsideLaboratory,,85397,CPT,Facility,Inpatient,,,90,292,248.2,83.6872,292,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Prothrombin Time (Albld) (Mayo)OutsideLaboratory,,85610,CPT,Facility,Both,,,90,60,51,17.196,60,Aetna,Commercial,55.2,92,,percent of total billed charges,,
Prothrombin Time (Albld) (Mayo)OutsideLaboratory,,85610,CPT,Facility,Outpatient,,,90,60,51,17.196,60,Aetna,Medicare Advantage,29.4,49,,percent of total billed charges,,
Prothrombin Time (Albld) (Mayo)OutsideLaboratory,,85610,CPT,Facility,Inpatient,,,90,60,51,17.196,60,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Prothrombin Time (Albld) (Mayo)OutsideLaboratory,,85610,CPT,Facility,Both,,,90,60,51,17.196,60,Aetna,PPO,55.8,93,,percent of total billed charges,,
Prothrombin Time (Albld) (Mayo)OutsideLaboratory,,85610,CPT,Facility,Both,,,90,60,51,17.196,60,America's PPO,America's PPO,57.618,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Prothrombin Time (Albld) (Mayo)OutsideLaboratory,,85610,CPT,Facility,Both,,,90,60,51,17.196,60,BlueCross BlueShield Minnesota, Federal Employee Program,59.04,98.4,,percent of total billed charges,,
Prothrombin Time (Albld) (Mayo)OutsideLaboratory,,85610,CPT,Facility,Both,,,90,60,51,17.196,60,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,60,100,,percent of total billed charges,,
Prothrombin Time (Albld) (Mayo)OutsideLaboratory,,85610,CPT,Facility,Both,,,90,60,51,17.196,60,BlueCross BlueShield Minnesota,High Value Network Plan,54,90,,percent of total billed charges,,
Prothrombin Time (Albld) (Mayo)OutsideLaboratory,,85610,CPT,Facility,Outpatient,,,90,60,51,17.196,60,BlueCross BlueShield Minnesota,Medicare Advantage,29.4,49,,percent of total billed charges,,
Prothrombin Time (Albld) (Mayo)OutsideLaboratory,,85610,CPT,Facility,Inpatient,,,90,60,51,17.196,60,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Prothrombin Time (Albld) (Mayo)OutsideLaboratory,,85610,CPT,Facility,Both,,,90,60,51,17.196,60,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,53.142,88.57,,percent of total billed charges,,
Prothrombin Time (Albld) (Mayo)OutsideLaboratory,,85610,CPT,Facility,Both,,,90,60,51,17.196,60,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,17.196,28.66,,percent of total billed charges,,
Prothrombin Time (Albld) (Mayo)OutsideLaboratory,,85610,CPT,Facility,Outpatient,,,90,60,51,17.196,60,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),29.4,49,,percent of total billed charges,,
Prothrombin Time (Albld) (Mayo)OutsideLaboratory,,85610,CPT,Facility,Inpatient,,,90,60,51,17.196,60,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Prothrombin Time (Albld) (Mayo)OutsideLaboratory,,85610,CPT,Facility,Both,,,90,60,51,17.196,60,CorVel,Worker's Compensation,60,100,,percent of total billed charges,,
Prothrombin Time (Albld) (Mayo)OutsideLaboratory,,85610,CPT,Facility,Both,,,90,60,51,17.196,60,First Health Group Corporation,First Health Network,58.2,97,,percent of total billed charges,,
Prothrombin Time (Albld) (Mayo)OutsideLaboratory,,85610,CPT,Facility,Both,,,90,60,51,17.196,60,"Health Partners, Inc.",Commercial,56.76,94.6,,percent of total billed charges,,
Prothrombin Time (Albld) (Mayo)OutsideLaboratory,,85610,CPT,Facility,Outpatient,,,90,60,51,17.196,60,"Health Partners, Inc.",Medicare Advantage,29.4,49,,percent of total billed charges,,
Prothrombin Time (Albld) (Mayo)OutsideLaboratory,,85610,CPT,Facility,Inpatient,,,90,60,51,17.196,60,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Prothrombin Time (Albld) (Mayo)OutsideLaboratory,,85610,CPT,Facility,Both,,,90,60,51,17.196,60,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),36,60,,percent of total billed charges,,
Prothrombin Time (Albld) (Mayo)OutsideLaboratory,,85610,CPT,Facility,Both,,,90,60,51,17.196,60,"Health Partners, Inc.",State of Minnesota Advantage Program,48.9,81.5,,percent of total billed charges,,
Prothrombin Time (Albld) (Mayo)OutsideLaboratory,,85610,CPT,Facility,Both,,,90,60,51,17.196,60,"Health Partners, Inc.",State Public Programs,30,50,,percent of total billed charges,,
Prothrombin Time (Albld) (Mayo)OutsideLaboratory,,85610,CPT,Facility,Both,,,90,60,51,17.196,60,Humana Insurance Company,Commercial PPO,57,95,,percent of total billed charges,,
Prothrombin Time (Albld) (Mayo)OutsideLaboratory,,85610,CPT,Facility,Outpatient,,,90,60,51,17.196,60,Humana Insurance Company,Medicare PPO,29.4,49,,percent of total billed charges,,
Prothrombin Time (Albld) (Mayo)OutsideLaboratory,,85610,CPT,Facility,Inpatient,,,90,60,51,17.196,60,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Prothrombin Time (Albld) (Mayo)OutsideLaboratory,,85610,CPT,Facility,Both,,,90,60,51,17.196,60,Medica,Individual & Family,59.46,99.1,,percent of total billed charges,,
Prothrombin Time (Albld) (Mayo)OutsideLaboratory,,85610,CPT,Facility,Outpatient,,,90,60,51,17.196,60,Medica,Medica Advantage Solution,29.88,49.8,,percent of total billed charges,,
Prothrombin Time (Albld) (Mayo)OutsideLaboratory,,85610,CPT,Facility,Inpatient,,,90,60,51,17.196,60,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Prothrombin Time (Albld) (Mayo)OutsideLaboratory,,85610,CPT,Facility,Outpatient,,,90,60,51,17.196,60,Medica,Medical Assistance,26.76,44.6,,percent of total billed charges,,
Prothrombin Time (Albld) (Mayo)OutsideLaboratory,,85610,CPT,Facility,Inpatient,,,90,60,51,17.196,60,Medica,Medical Assistance,,,,,Included in per diem rate,
Prothrombin Time (Albld) (Mayo)OutsideLaboratory,,85610,CPT,Facility,Outpatient,,,90,60,51,17.196,60,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,29.88,49.8,,percent of total billed charges,,
Prothrombin Time (Albld) (Mayo)OutsideLaboratory,,85610,CPT,Facility,Inpatient,,,90,60,51,17.196,60,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Prothrombin Time (Albld) (Mayo)OutsideLaboratory,,85610,CPT,Facility,Both,,,90,60,51,17.196,60,"Multiplan, Inc.","Multiplan, Inc.",56.4,94,,percent of total billed charges,,
Prothrombin Time (Albld) (Mayo)OutsideLaboratory,,85610,CPT,Facility,Outpatient,,,90,60,51,17.196,60,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,51.84,86.4,,percent of total billed charges,,
Prothrombin Time (Albld) (Mayo)OutsideLaboratory,,85610,CPT,Facility,Inpatient,,,90,60,51,17.196,60,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Prothrombin Time (Albld) (Mayo)OutsideLaboratory,,85610,CPT,Facility,Both,,,90,60,51,17.196,60,"Preferred One Administrative Services, INC.",PPO,59.16,98.6,,percent of total billed charges,,
Prothrombin Time (Albld) (Mayo)OutsideLaboratory,,85610,CPT,Facility,Outpatient,,,90,60,51,17.196,60,PrimeWest Health,Minnesota Senior Health Options (MSHO),30.87,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Prothrombin Time (Albld) (Mayo)OutsideLaboratory,,85610,CPT,Facility,Inpatient,,,90,60,51,17.196,60,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Prothrombin Time (Albld) (Mayo)OutsideLaboratory,,85610,CPT,Facility,Outpatient,,,90,60,51,17.196,60,PrimeWest Health,MinnesotaCare,30.816,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Prothrombin Time (Albld) (Mayo)OutsideLaboratory,,85610,CPT,Facility,Inpatient,,,90,60,51,17.196,60,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Prothrombin Time (Albld) (Mayo)OutsideLaboratory,,85610,CPT,Facility,Both,,,90,60,51,17.196,60,Sanford Health Plan,Sanford Health Plan,55.2,92,,percent of total billed charges,,
Prothrombin Time (Albld) (Mayo)OutsideLaboratory,,85610,CPT,Facility,Outpatient,,,90,60,51,17.196,60,"UCare Health, Inc.",Individual & Family Plan,33.81,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Prothrombin Time (Albld) (Mayo)OutsideLaboratory,,85610,CPT,Facility,Inpatient,,,90,60,51,17.196,60,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Prothrombin Time (Albld) (Mayo)OutsideLaboratory,,85610,CPT,Facility,Outpatient,,,90,60,51,17.196,60,"UCare Health, Inc.",Medical Assistance,30.282,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Prothrombin Time (Albld) (Mayo)OutsideLaboratory,,85610,CPT,Facility,Inpatient,,,90,60,51,17.196,60,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Prothrombin Time (Albld) (Mayo)OutsideLaboratory,,85610,CPT,Facility,Outpatient,,,90,60,51,17.196,60,"UCare Health, Inc.",Medicare Advantage,30.282,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Prothrombin Time (Albld) (Mayo)OutsideLaboratory,,85610,CPT,Facility,Inpatient,,,90,60,51,17.196,60,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Prothrombin Time (Albld) (Mayo)OutsideLaboratory,,85610,CPT,Facility,Outpatient,,,90,60,51,17.196,60,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),30.282,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Prothrombin Time (Albld) (Mayo)OutsideLaboratory,,85610,CPT,Facility,Inpatient,,,90,60,51,17.196,60,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Prothrombin Time (Albld) (Mayo)OutsideLaboratory,,85610,CPT,Facility,Both,,,90,60,51,17.196,60,UnitedHealthcare,Individual & Family,56.4,94,,percent of total billed charges,,
Prothrombin Time (Albld) (Mayo)OutsideLaboratory,,85610,CPT,Facility,Outpatient,,,90,60,51,17.196,60,UnitedHealthcare,Medicare Advantage,29.4,49,,percent of total billed charges,,
Prothrombin Time (Albld) (Mayo)OutsideLaboratory,,85610,CPT,Facility,Inpatient,,,90,60,51,17.196,60,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Prothrombin Time (Albld) (Mayo)OutsideLaboratory,,85610,CPT,Facility,Outpatient,,,90,60,51,17.196,60,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,28.8,48,,percent of total billed charges,,100% of DHS outpatient percentage
Prothrombin Time (Albld) (Mayo)OutsideLaboratory,,85610,CPT,Facility,Inpatient,,,90,60,51,17.196,60,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Prothrombin Time (Mayo)OutsideLaboratory,,85610,CPT,Facility,Both,,,90,60,51,17.196,60,Aetna,Commercial,55.2,92,,percent of total billed charges,,
Prothrombin Time (Mayo)OutsideLaboratory,,85610,CPT,Facility,Both,,,90,60,51,17.196,60,Aetna,Commercial,55.2,92,,percent of total billed charges,,
Prothrombin Time (Mayo)OutsideLaboratory,,85610,CPT,Facility,Both,,,90,53,45.05,15.1898,53,Aetna,Commercial,48.76,92,,percent of total billed charges,,
Prothrombin Time (Mayo)OutsideLaboratory,,85610,CPT,Facility,Outpatient,,,90,60,51,17.196,60,Aetna,Medicare Advantage,29.4,49,,percent of total billed charges,,
Prothrombin Time (Mayo)OutsideLaboratory,,85610,CPT,Facility,Outpatient,,,90,60,51,17.196,60,Aetna,Medicare Advantage,29.4,49,,percent of total billed charges,,
Prothrombin Time (Mayo)OutsideLaboratory,,85610,CPT,Facility,Outpatient,,,90,53,45.05,15.1898,53,Aetna,Medicare Advantage,25.97,49,,percent of total billed charges,,
Prothrombin Time (Mayo)OutsideLaboratory,,85610,CPT,Facility,Inpatient,,,90,60,51,17.196,60,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Prothrombin Time (Mayo)OutsideLaboratory,,85610,CPT,Facility,Inpatient,,,90,60,51,17.196,60,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Prothrombin Time (Mayo)OutsideLaboratory,,85610,CPT,Facility,Inpatient,,,90,53,45.05,15.1898,53,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Prothrombin Time (Mayo)OutsideLaboratory,,85610,CPT,Facility,Both,,,90,60,51,17.196,60,Aetna,PPO,55.8,93,,percent of total billed charges,,
Prothrombin Time (Mayo)OutsideLaboratory,,85610,CPT,Facility,Both,,,90,60,51,17.196,60,Aetna,PPO,55.8,93,,percent of total billed charges,,
Prothrombin Time (Mayo)OutsideLaboratory,,85610,CPT,Facility,Both,,,90,53,45.05,15.1898,53,Aetna,PPO,49.29,93,,percent of total billed charges,,
Prothrombin Time (Mayo)OutsideLaboratory,,85610,CPT,Facility,Both,,,90,60,51,17.196,60,America's PPO,America's PPO,57.618,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Prothrombin Time (Mayo)OutsideLaboratory,,85610,CPT,Facility,Both,,,90,60,51,17.196,60,America's PPO,America's PPO,57.618,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Prothrombin Time (Mayo)OutsideLaboratory,,85610,CPT,Facility,Both,,,90,53,45.05,15.1898,53,America's PPO,America's PPO,50.8959,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Prothrombin Time (Mayo)OutsideLaboratory,,85610,CPT,Facility,Both,,,90,60,51,17.196,60,BlueCross BlueShield Minnesota, Federal Employee Program,59.04,98.4,,percent of total billed charges,,
Prothrombin Time (Mayo)OutsideLaboratory,,85610,CPT,Facility,Both,,,90,60,51,17.196,60,BlueCross BlueShield Minnesota, Federal Employee Program,59.04,98.4,,percent of total billed charges,,
Prothrombin Time (Mayo)OutsideLaboratory,,85610,CPT,Facility,Both,,,90,53,45.05,15.1898,53,BlueCross BlueShield Minnesota, Federal Employee Program,52.152,98.4,,percent of total billed charges,,
Prothrombin Time (Mayo)OutsideLaboratory,,85610,CPT,Facility,Both,,,90,60,51,17.196,60,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,60,100,,percent of total billed charges,,
Prothrombin Time (Mayo)OutsideLaboratory,,85610,CPT,Facility,Both,,,90,60,51,17.196,60,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,60,100,,percent of total billed charges,,
Prothrombin Time (Mayo)OutsideLaboratory,,85610,CPT,Facility,Both,,,90,53,45.05,15.1898,53,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,53,100,,percent of total billed charges,,
Prothrombin Time (Mayo)OutsideLaboratory,,85610,CPT,Facility,Both,,,90,60,51,17.196,60,BlueCross BlueShield Minnesota,High Value Network Plan,54,90,,percent of total billed charges,,
Prothrombin Time (Mayo)OutsideLaboratory,,85610,CPT,Facility,Both,,,90,60,51,17.196,60,BlueCross BlueShield Minnesota,High Value Network Plan,54,90,,percent of total billed charges,,
Prothrombin Time (Mayo)OutsideLaboratory,,85610,CPT,Facility,Both,,,90,53,45.05,15.1898,53,BlueCross BlueShield Minnesota,High Value Network Plan,47.7,90,,percent of total billed charges,,
Prothrombin Time (Mayo)OutsideLaboratory,,85610,CPT,Facility,Outpatient,,,90,60,51,17.196,60,BlueCross BlueShield Minnesota,Medicare Advantage,29.4,49,,percent of total billed charges,,
Prothrombin Time (Mayo)OutsideLaboratory,,85610,CPT,Facility,Outpatient,,,90,60,51,17.196,60,BlueCross BlueShield Minnesota,Medicare Advantage,29.4,49,,percent of total billed charges,,
Prothrombin Time (Mayo)OutsideLaboratory,,85610,CPT,Facility,Outpatient,,,90,53,45.05,15.1898,53,BlueCross BlueShield Minnesota,Medicare Advantage,25.97,49,,percent of total billed charges,,
Prothrombin Time (Mayo)OutsideLaboratory,,85610,CPT,Facility,Inpatient,,,90,60,51,17.196,60,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Prothrombin Time (Mayo)OutsideLaboratory,,85610,CPT,Facility,Inpatient,,,90,60,51,17.196,60,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Prothrombin Time (Mayo)OutsideLaboratory,,85610,CPT,Facility,Inpatient,,,90,53,45.05,15.1898,53,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Prothrombin Time (Mayo)OutsideLaboratory,,85610,CPT,Facility,Both,,,90,60,51,17.196,60,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,53.142,88.57,,percent of total billed charges,,
Prothrombin Time (Mayo)OutsideLaboratory,,85610,CPT,Facility,Both,,,90,60,51,17.196,60,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,53.142,88.57,,percent of total billed charges,,
Prothrombin Time (Mayo)OutsideLaboratory,,85610,CPT,Facility,Both,,,90,53,45.05,15.1898,53,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,46.9421,88.57,,percent of total billed charges,,
Prothrombin Time (Mayo)OutsideLaboratory,,85610,CPT,Facility,Both,,,90,60,51,17.196,60,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,17.196,28.66,,percent of total billed charges,,
Prothrombin Time (Mayo)OutsideLaboratory,,85610,CPT,Facility,Both,,,90,60,51,17.196,60,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,17.196,28.66,,percent of total billed charges,,
Prothrombin Time (Mayo)OutsideLaboratory,,85610,CPT,Facility,Both,,,90,53,45.05,15.1898,53,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,15.1898,28.66,,percent of total billed charges,,
Prothrombin Time (Mayo)OutsideLaboratory,,85610,CPT,Facility,Outpatient,,,90,60,51,17.196,60,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),29.4,49,,percent of total billed charges,,
Prothrombin Time (Mayo)OutsideLaboratory,,85610,CPT,Facility,Outpatient,,,90,60,51,17.196,60,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),29.4,49,,percent of total billed charges,,
Prothrombin Time (Mayo)OutsideLaboratory,,85610,CPT,Facility,Outpatient,,,90,53,45.05,15.1898,53,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),25.97,49,,percent of total billed charges,,
Prothrombin Time (Mayo)OutsideLaboratory,,85610,CPT,Facility,Inpatient,,,90,60,51,17.196,60,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Prothrombin Time (Mayo)OutsideLaboratory,,85610,CPT,Facility,Inpatient,,,90,60,51,17.196,60,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Prothrombin Time (Mayo)OutsideLaboratory,,85610,CPT,Facility,Inpatient,,,90,53,45.05,15.1898,53,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Prothrombin Time (Mayo)OutsideLaboratory,,85610,CPT,Facility,Both,,,90,60,51,17.196,60,CorVel,Worker's Compensation,60,100,,percent of total billed charges,,
Prothrombin Time (Mayo)OutsideLaboratory,,85610,CPT,Facility,Both,,,90,60,51,17.196,60,CorVel,Worker's Compensation,60,100,,percent of total billed charges,,
Prothrombin Time (Mayo)OutsideLaboratory,,85610,CPT,Facility,Both,,,90,53,45.05,15.1898,53,CorVel,Worker's Compensation,53,100,,percent of total billed charges,,
Prothrombin Time (Mayo)OutsideLaboratory,,85610,CPT,Facility,Both,,,90,60,51,17.196,60,First Health Group Corporation,First Health Network,58.2,97,,percent of total billed charges,,
Prothrombin Time (Mayo)OutsideLaboratory,,85610,CPT,Facility,Both,,,90,60,51,17.196,60,First Health Group Corporation,First Health Network,58.2,97,,percent of total billed charges,,
Prothrombin Time (Mayo)OutsideLaboratory,,85610,CPT,Facility,Both,,,90,53,45.05,15.1898,53,First Health Group Corporation,First Health Network,51.41,97,,percent of total billed charges,,
Prothrombin Time (Mayo)OutsideLaboratory,,85610,CPT,Facility,Both,,,90,60,51,17.196,60,"Health Partners, Inc.",Commercial,56.76,94.6,,percent of total billed charges,,
Prothrombin Time (Mayo)OutsideLaboratory,,85610,CPT,Facility,Both,,,90,60,51,17.196,60,"Health Partners, Inc.",Commercial,56.76,94.6,,percent of total billed charges,,
Prothrombin Time (Mayo)OutsideLaboratory,,85610,CPT,Facility,Both,,,90,53,45.05,15.1898,53,"Health Partners, Inc.",Commercial,50.138,94.6,,percent of total billed charges,,
Prothrombin Time (Mayo)OutsideLaboratory,,85610,CPT,Facility,Outpatient,,,90,60,51,17.196,60,"Health Partners, Inc.",Medicare Advantage,29.4,49,,percent of total billed charges,,
Prothrombin Time (Mayo)OutsideLaboratory,,85610,CPT,Facility,Outpatient,,,90,60,51,17.196,60,"Health Partners, Inc.",Medicare Advantage,29.4,49,,percent of total billed charges,,
Prothrombin Time (Mayo)OutsideLaboratory,,85610,CPT,Facility,Outpatient,,,90,53,45.05,15.1898,53,"Health Partners, Inc.",Medicare Advantage,25.97,49,,percent of total billed charges,,
Prothrombin Time (Mayo)OutsideLaboratory,,85610,CPT,Facility,Inpatient,,,90,60,51,17.196,60,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Prothrombin Time (Mayo)OutsideLaboratory,,85610,CPT,Facility,Inpatient,,,90,60,51,17.196,60,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Prothrombin Time (Mayo)OutsideLaboratory,,85610,CPT,Facility,Inpatient,,,90,53,45.05,15.1898,53,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Prothrombin Time (Mayo)OutsideLaboratory,,85610,CPT,Facility,Both,,,90,60,51,17.196,60,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),36,60,,percent of total billed charges,,
Prothrombin Time (Mayo)OutsideLaboratory,,85610,CPT,Facility,Both,,,90,60,51,17.196,60,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),36,60,,percent of total billed charges,,
Prothrombin Time (Mayo)OutsideLaboratory,,85610,CPT,Facility,Both,,,90,53,45.05,15.1898,53,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),31.8,60,,percent of total billed charges,,
Prothrombin Time (Mayo)OutsideLaboratory,,85610,CPT,Facility,Both,,,90,60,51,17.196,60,"Health Partners, Inc.",State of Minnesota Advantage Program,48.9,81.5,,percent of total billed charges,,
Prothrombin Time (Mayo)OutsideLaboratory,,85610,CPT,Facility,Both,,,90,60,51,17.196,60,"Health Partners, Inc.",State of Minnesota Advantage Program,48.9,81.5,,percent of total billed charges,,
Prothrombin Time (Mayo)OutsideLaboratory,,85610,CPT,Facility,Both,,,90,53,45.05,15.1898,53,"Health Partners, Inc.",State of Minnesota Advantage Program,43.195,81.5,,percent of total billed charges,,
Prothrombin Time (Mayo)OutsideLaboratory,,85610,CPT,Facility,Both,,,90,60,51,17.196,60,"Health Partners, Inc.",State Public Programs,30,50,,percent of total billed charges,,
Prothrombin Time (Mayo)OutsideLaboratory,,85610,CPT,Facility,Both,,,90,60,51,17.196,60,"Health Partners, Inc.",State Public Programs,30,50,,percent of total billed charges,,
Prothrombin Time (Mayo)OutsideLaboratory,,85610,CPT,Facility,Both,,,90,53,45.05,15.1898,53,"Health Partners, Inc.",State Public Programs,26.5,50,,percent of total billed charges,,
Prothrombin Time (Mayo)OutsideLaboratory,,85610,CPT,Facility,Both,,,90,60,51,17.196,60,Humana Insurance Company,Commercial PPO,57,95,,percent of total billed charges,,
Prothrombin Time (Mayo)OutsideLaboratory,,85610,CPT,Facility,Both,,,90,60,51,17.196,60,Humana Insurance Company,Commercial PPO,57,95,,percent of total billed charges,,
Prothrombin Time (Mayo)OutsideLaboratory,,85610,CPT,Facility,Both,,,90,53,45.05,15.1898,53,Humana Insurance Company,Commercial PPO,50.35,95,,percent of total billed charges,,
Prothrombin Time (Mayo)OutsideLaboratory,,85610,CPT,Facility,Outpatient,,,90,60,51,17.196,60,Humana Insurance Company,Medicare PPO,29.4,49,,percent of total billed charges,,
Prothrombin Time (Mayo)OutsideLaboratory,,85610,CPT,Facility,Outpatient,,,90,60,51,17.196,60,Humana Insurance Company,Medicare PPO,29.4,49,,percent of total billed charges,,
Prothrombin Time (Mayo)OutsideLaboratory,,85610,CPT,Facility,Outpatient,,,90,53,45.05,15.1898,53,Humana Insurance Company,Medicare PPO,25.97,49,,percent of total billed charges,,
Prothrombin Time (Mayo)OutsideLaboratory,,85610,CPT,Facility,Inpatient,,,90,60,51,17.196,60,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Prothrombin Time (Mayo)OutsideLaboratory,,85610,CPT,Facility,Inpatient,,,90,60,51,17.196,60,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Prothrombin Time (Mayo)OutsideLaboratory,,85610,CPT,Facility,Inpatient,,,90,53,45.05,15.1898,53,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Prothrombin Time (Mayo)OutsideLaboratory,,85610,CPT,Facility,Both,,,90,60,51,17.196,60,Medica,Individual & Family,59.46,99.1,,percent of total billed charges,,
Prothrombin Time (Mayo)OutsideLaboratory,,85610,CPT,Facility,Both,,,90,60,51,17.196,60,Medica,Individual & Family,59.46,99.1,,percent of total billed charges,,
Prothrombin Time (Mayo)OutsideLaboratory,,85610,CPT,Facility,Both,,,90,53,45.05,15.1898,53,Medica,Individual & Family,52.523,99.1,,percent of total billed charges,,
Prothrombin Time (Mayo)OutsideLaboratory,,85610,CPT,Facility,Outpatient,,,90,60,51,17.196,60,Medica,Medica Advantage Solution,29.88,49.8,,percent of total billed charges,,
Prothrombin Time (Mayo)OutsideLaboratory,,85610,CPT,Facility,Outpatient,,,90,60,51,17.196,60,Medica,Medica Advantage Solution,29.88,49.8,,percent of total billed charges,,
Prothrombin Time (Mayo)OutsideLaboratory,,85610,CPT,Facility,Outpatient,,,90,53,45.05,15.1898,53,Medica,Medica Advantage Solution,26.394,49.8,,percent of total billed charges,,
Prothrombin Time (Mayo)OutsideLaboratory,,85610,CPT,Facility,Inpatient,,,90,60,51,17.196,60,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Prothrombin Time (Mayo)OutsideLaboratory,,85610,CPT,Facility,Inpatient,,,90,60,51,17.196,60,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Prothrombin Time (Mayo)OutsideLaboratory,,85610,CPT,Facility,Inpatient,,,90,53,45.05,15.1898,53,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Prothrombin Time (Mayo)OutsideLaboratory,,85610,CPT,Facility,Outpatient,,,90,60,51,17.196,60,Medica,Medical Assistance,26.76,44.6,,percent of total billed charges,,
Prothrombin Time (Mayo)OutsideLaboratory,,85610,CPT,Facility,Outpatient,,,90,60,51,17.196,60,Medica,Medical Assistance,26.76,44.6,,percent of total billed charges,,
Prothrombin Time (Mayo)OutsideLaboratory,,85610,CPT,Facility,Outpatient,,,90,53,45.05,15.1898,53,Medica,Medical Assistance,23.638,44.6,,percent of total billed charges,,
Prothrombin Time (Mayo)OutsideLaboratory,,85610,CPT,Facility,Inpatient,,,90,60,51,17.196,60,Medica,Medical Assistance,,,,,Included in per diem rate,
Prothrombin Time (Mayo)OutsideLaboratory,,85610,CPT,Facility,Inpatient,,,90,60,51,17.196,60,Medica,Medical Assistance,,,,,Included in per diem rate,
Prothrombin Time (Mayo)OutsideLaboratory,,85610,CPT,Facility,Inpatient,,,90,53,45.05,15.1898,53,Medica,Medical Assistance,,,,,Included in per diem rate,
Prothrombin Time (Mayo)OutsideLaboratory,,85610,CPT,Facility,Outpatient,,,90,60,51,17.196,60,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,29.88,49.8,,percent of total billed charges,,
Prothrombin Time (Mayo)OutsideLaboratory,,85610,CPT,Facility,Outpatient,,,90,60,51,17.196,60,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,29.88,49.8,,percent of total billed charges,,
Prothrombin Time (Mayo)OutsideLaboratory,,85610,CPT,Facility,Outpatient,,,90,53,45.05,15.1898,53,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,26.394,49.8,,percent of total billed charges,,
Prothrombin Time (Mayo)OutsideLaboratory,,85610,CPT,Facility,Inpatient,,,90,60,51,17.196,60,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Prothrombin Time (Mayo)OutsideLaboratory,,85610,CPT,Facility,Inpatient,,,90,60,51,17.196,60,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Prothrombin Time (Mayo)OutsideLaboratory,,85610,CPT,Facility,Inpatient,,,90,53,45.05,15.1898,53,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Prothrombin Time (Mayo)OutsideLaboratory,,85610,CPT,Facility,Both,,,90,60,51,17.196,60,"Multiplan, Inc.","Multiplan, Inc.",56.4,94,,percent of total billed charges,,
Prothrombin Time (Mayo)OutsideLaboratory,,85610,CPT,Facility,Both,,,90,60,51,17.196,60,"Multiplan, Inc.","Multiplan, Inc.",56.4,94,,percent of total billed charges,,
Prothrombin Time (Mayo)OutsideLaboratory,,85610,CPT,Facility,Both,,,90,53,45.05,15.1898,53,"Multiplan, Inc.","Multiplan, Inc.",49.82,94,,percent of total billed charges,,
Prothrombin Time (Mayo)OutsideLaboratory,,85610,CPT,Facility,Outpatient,,,90,60,51,17.196,60,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,51.84,86.4,,percent of total billed charges,,
Prothrombin Time (Mayo)OutsideLaboratory,,85610,CPT,Facility,Outpatient,,,90,60,51,17.196,60,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,51.84,86.4,,percent of total billed charges,,
Prothrombin Time (Mayo)OutsideLaboratory,,85610,CPT,Facility,Outpatient,,,90,53,45.05,15.1898,53,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,45.792,86.4,,percent of total billed charges,,
Prothrombin Time (Mayo)OutsideLaboratory,,85610,CPT,Facility,Inpatient,,,90,60,51,17.196,60,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Prothrombin Time (Mayo)OutsideLaboratory,,85610,CPT,Facility,Inpatient,,,90,60,51,17.196,60,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Prothrombin Time (Mayo)OutsideLaboratory,,85610,CPT,Facility,Inpatient,,,90,53,45.05,15.1898,53,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Prothrombin Time (Mayo)OutsideLaboratory,,85610,CPT,Facility,Both,,,90,60,51,17.196,60,"Preferred One Administrative Services, INC.",PPO,59.16,98.6,,percent of total billed charges,,
Prothrombin Time (Mayo)OutsideLaboratory,,85610,CPT,Facility,Both,,,90,60,51,17.196,60,"Preferred One Administrative Services, INC.",PPO,59.16,98.6,,percent of total billed charges,,
Prothrombin Time (Mayo)OutsideLaboratory,,85610,CPT,Facility,Both,,,90,53,45.05,15.1898,53,"Preferred One Administrative Services, INC.",PPO,52.258,98.6,,percent of total billed charges,,
Prothrombin Time (Mayo)OutsideLaboratory,,85610,CPT,Facility,Outpatient,,,90,60,51,17.196,60,PrimeWest Health,Minnesota Senior Health Options (MSHO),30.87,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Prothrombin Time (Mayo)OutsideLaboratory,,85610,CPT,Facility,Outpatient,,,90,60,51,17.196,60,PrimeWest Health,Minnesota Senior Health Options (MSHO),30.87,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Prothrombin Time (Mayo)OutsideLaboratory,,85610,CPT,Facility,Outpatient,,,90,53,45.05,15.1898,53,PrimeWest Health,Minnesota Senior Health Options (MSHO),27.2685,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Prothrombin Time (Mayo)OutsideLaboratory,,85610,CPT,Facility,Inpatient,,,90,60,51,17.196,60,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Prothrombin Time (Mayo)OutsideLaboratory,,85610,CPT,Facility,Inpatient,,,90,60,51,17.196,60,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Prothrombin Time (Mayo)OutsideLaboratory,,85610,CPT,Facility,Inpatient,,,90,53,45.05,15.1898,53,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Prothrombin Time (Mayo)OutsideLaboratory,,85610,CPT,Facility,Outpatient,,,90,60,51,17.196,60,PrimeWest Health,MinnesotaCare,30.816,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Prothrombin Time (Mayo)OutsideLaboratory,,85610,CPT,Facility,Outpatient,,,90,60,51,17.196,60,PrimeWest Health,MinnesotaCare,30.816,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Prothrombin Time (Mayo)OutsideLaboratory,,85610,CPT,Facility,Outpatient,,,90,53,45.05,15.1898,53,PrimeWest Health,MinnesotaCare,27.2208,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Prothrombin Time (Mayo)OutsideLaboratory,,85610,CPT,Facility,Inpatient,,,90,60,51,17.196,60,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Prothrombin Time (Mayo)OutsideLaboratory,,85610,CPT,Facility,Inpatient,,,90,60,51,17.196,60,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Prothrombin Time (Mayo)OutsideLaboratory,,85610,CPT,Facility,Inpatient,,,90,53,45.05,15.1898,53,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Prothrombin Time (Mayo)OutsideLaboratory,,85610,CPT,Facility,Both,,,90,60,51,17.196,60,Sanford Health Plan,Sanford Health Plan,55.2,92,,percent of total billed charges,,
Prothrombin Time (Mayo)OutsideLaboratory,,85610,CPT,Facility,Both,,,90,60,51,17.196,60,Sanford Health Plan,Sanford Health Plan,55.2,92,,percent of total billed charges,,
Prothrombin Time (Mayo)OutsideLaboratory,,85610,CPT,Facility,Both,,,90,53,45.05,15.1898,53,Sanford Health Plan,Sanford Health Plan,48.76,92,,percent of total billed charges,,
Prothrombin Time (Mayo)OutsideLaboratory,,85610,CPT,Facility,Outpatient,,,90,60,51,17.196,60,"UCare Health, Inc.",Individual & Family Plan,33.81,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Prothrombin Time (Mayo)OutsideLaboratory,,85610,CPT,Facility,Outpatient,,,90,60,51,17.196,60,"UCare Health, Inc.",Individual & Family Plan,33.81,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Prothrombin Time (Mayo)OutsideLaboratory,,85610,CPT,Facility,Outpatient,,,90,53,45.05,15.1898,53,"UCare Health, Inc.",Individual & Family Plan,29.8655,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Prothrombin Time (Mayo)OutsideLaboratory,,85610,CPT,Facility,Inpatient,,,90,60,51,17.196,60,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Prothrombin Time (Mayo)OutsideLaboratory,,85610,CPT,Facility,Inpatient,,,90,60,51,17.196,60,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Prothrombin Time (Mayo)OutsideLaboratory,,85610,CPT,Facility,Inpatient,,,90,53,45.05,15.1898,53,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Prothrombin Time (Mayo)OutsideLaboratory,,85610,CPT,Facility,Outpatient,,,90,60,51,17.196,60,"UCare Health, Inc.",Medical Assistance,30.282,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Prothrombin Time (Mayo)OutsideLaboratory,,85610,CPT,Facility,Outpatient,,,90,60,51,17.196,60,"UCare Health, Inc.",Medical Assistance,30.282,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Prothrombin Time (Mayo)OutsideLaboratory,,85610,CPT,Facility,Outpatient,,,90,53,45.05,15.1898,53,"UCare Health, Inc.",Medical Assistance,26.7491,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Prothrombin Time (Mayo)OutsideLaboratory,,85610,CPT,Facility,Inpatient,,,90,60,51,17.196,60,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Prothrombin Time (Mayo)OutsideLaboratory,,85610,CPT,Facility,Inpatient,,,90,60,51,17.196,60,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Prothrombin Time (Mayo)OutsideLaboratory,,85610,CPT,Facility,Inpatient,,,90,53,45.05,15.1898,53,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Prothrombin Time (Mayo)OutsideLaboratory,,85610,CPT,Facility,Outpatient,,,90,60,51,17.196,60,"UCare Health, Inc.",Medicare Advantage,30.282,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Prothrombin Time (Mayo)OutsideLaboratory,,85610,CPT,Facility,Outpatient,,,90,60,51,17.196,60,"UCare Health, Inc.",Medicare Advantage,30.282,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Prothrombin Time (Mayo)OutsideLaboratory,,85610,CPT,Facility,Outpatient,,,90,53,45.05,15.1898,53,"UCare Health, Inc.",Medicare Advantage,26.7491,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Prothrombin Time (Mayo)OutsideLaboratory,,85610,CPT,Facility,Inpatient,,,90,60,51,17.196,60,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Prothrombin Time (Mayo)OutsideLaboratory,,85610,CPT,Facility,Inpatient,,,90,60,51,17.196,60,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Prothrombin Time (Mayo)OutsideLaboratory,,85610,CPT,Facility,Inpatient,,,90,53,45.05,15.1898,53,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Prothrombin Time (Mayo)OutsideLaboratory,,85610,CPT,Facility,Outpatient,,,90,60,51,17.196,60,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),30.282,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Prothrombin Time (Mayo)OutsideLaboratory,,85610,CPT,Facility,Outpatient,,,90,60,51,17.196,60,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),30.282,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Prothrombin Time (Mayo)OutsideLaboratory,,85610,CPT,Facility,Outpatient,,,90,53,45.05,15.1898,53,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),26.7491,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Prothrombin Time (Mayo)OutsideLaboratory,,85610,CPT,Facility,Inpatient,,,90,60,51,17.196,60,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Prothrombin Time (Mayo)OutsideLaboratory,,85610,CPT,Facility,Inpatient,,,90,60,51,17.196,60,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Prothrombin Time (Mayo)OutsideLaboratory,,85610,CPT,Facility,Inpatient,,,90,53,45.05,15.1898,53,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Prothrombin Time (Mayo)OutsideLaboratory,,85610,CPT,Facility,Both,,,90,60,51,17.196,60,UnitedHealthcare,Individual & Family,56.4,94,,percent of total billed charges,,
Prothrombin Time (Mayo)OutsideLaboratory,,85610,CPT,Facility,Both,,,90,60,51,17.196,60,UnitedHealthcare,Individual & Family,56.4,94,,percent of total billed charges,,
Prothrombin Time (Mayo)OutsideLaboratory,,85610,CPT,Facility,Both,,,90,53,45.05,15.1898,53,UnitedHealthcare,Individual & Family,49.82,94,,percent of total billed charges,,
Prothrombin Time (Mayo)OutsideLaboratory,,85610,CPT,Facility,Outpatient,,,90,60,51,17.196,60,UnitedHealthcare,Medicare Advantage,29.4,49,,percent of total billed charges,,
Prothrombin Time (Mayo)OutsideLaboratory,,85610,CPT,Facility,Outpatient,,,90,60,51,17.196,60,UnitedHealthcare,Medicare Advantage,29.4,49,,percent of total billed charges,,
Prothrombin Time (Mayo)OutsideLaboratory,,85610,CPT,Facility,Outpatient,,,90,53,45.05,15.1898,53,UnitedHealthcare,Medicare Advantage,25.97,49,,percent of total billed charges,,
Prothrombin Time (Mayo)OutsideLaboratory,,85610,CPT,Facility,Inpatient,,,90,60,51,17.196,60,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Prothrombin Time (Mayo)OutsideLaboratory,,85610,CPT,Facility,Inpatient,,,90,60,51,17.196,60,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Prothrombin Time (Mayo)OutsideLaboratory,,85610,CPT,Facility,Inpatient,,,90,53,45.05,15.1898,53,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Prothrombin Time (Mayo)OutsideLaboratory,,85610,CPT,Facility,Outpatient,,,90,60,51,17.196,60,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,28.8,48,,percent of total billed charges,,100% of DHS outpatient percentage
Prothrombin Time (Mayo)OutsideLaboratory,,85610,CPT,Facility,Outpatient,,,90,60,51,17.196,60,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,28.8,48,,percent of total billed charges,,100% of DHS outpatient percentage
Prothrombin Time (Mayo)OutsideLaboratory,,85610,CPT,Facility,Outpatient,,,90,53,45.05,15.1898,53,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,25.44,48,,percent of total billed charges,,100% of DHS outpatient percentage
Prothrombin Time (Mayo)OutsideLaboratory,,85610,CPT,Facility,Inpatient,,,90,60,51,17.196,60,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Prothrombin Time (Mayo)OutsideLaboratory,,85610,CPT,Facility,Inpatient,,,90,60,51,17.196,60,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Prothrombin Time (Mayo)OutsideLaboratory,,85610,CPT,Facility,Inpatient,,,90,53,45.05,15.1898,53,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Drvvt Confirmation (Mayo)OutsideLaboratory,,85613,CPT,Facility,Both,,,90,247,209.95,70.7902,247,Aetna,Commercial,227.24,92,,percent of total billed charges,,
Drvvt Confirmation (Mayo)OutsideLaboratory,,85613,CPT,Facility,Outpatient,,,90,247,209.95,70.7902,247,Aetna,Medicare Advantage,121.03,49,,percent of total billed charges,,
Drvvt Confirmation (Mayo)OutsideLaboratory,,85613,CPT,Facility,Inpatient,,,90,247,209.95,70.7902,247,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Drvvt Confirmation (Mayo)OutsideLaboratory,,85613,CPT,Facility,Both,,,90,247,209.95,70.7902,247,Aetna,PPO,229.71,93,,percent of total billed charges,,
Drvvt Confirmation (Mayo)OutsideLaboratory,,85613,CPT,Facility,Both,,,90,247,209.95,70.7902,247,America's PPO,America's PPO,237.1941,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Drvvt Confirmation (Mayo)OutsideLaboratory,,85613,CPT,Facility,Both,,,90,247,209.95,70.7902,247,BlueCross BlueShield Minnesota, Federal Employee Program,243.048,98.4,,percent of total billed charges,,
Drvvt Confirmation (Mayo)OutsideLaboratory,,85613,CPT,Facility,Both,,,90,247,209.95,70.7902,247,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,247,100,,percent of total billed charges,,
Drvvt Confirmation (Mayo)OutsideLaboratory,,85613,CPT,Facility,Both,,,90,247,209.95,70.7902,247,BlueCross BlueShield Minnesota,High Value Network Plan,222.3,90,,percent of total billed charges,,
Drvvt Confirmation (Mayo)OutsideLaboratory,,85613,CPT,Facility,Outpatient,,,90,247,209.95,70.7902,247,BlueCross BlueShield Minnesota,Medicare Advantage,121.03,49,,percent of total billed charges,,
Drvvt Confirmation (Mayo)OutsideLaboratory,,85613,CPT,Facility,Inpatient,,,90,247,209.95,70.7902,247,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Drvvt Confirmation (Mayo)OutsideLaboratory,,85613,CPT,Facility,Both,,,90,247,209.95,70.7902,247,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,218.7679,88.57,,percent of total billed charges,,
Drvvt Confirmation (Mayo)OutsideLaboratory,,85613,CPT,Facility,Both,,,90,247,209.95,70.7902,247,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,70.7902,28.66,,percent of total billed charges,,
Drvvt Confirmation (Mayo)OutsideLaboratory,,85613,CPT,Facility,Outpatient,,,90,247,209.95,70.7902,247,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),121.03,49,,percent of total billed charges,,
Drvvt Confirmation (Mayo)OutsideLaboratory,,85613,CPT,Facility,Inpatient,,,90,247,209.95,70.7902,247,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Drvvt Confirmation (Mayo)OutsideLaboratory,,85613,CPT,Facility,Both,,,90,247,209.95,70.7902,247,CorVel,Worker's Compensation,247,100,,percent of total billed charges,,
Drvvt Confirmation (Mayo)OutsideLaboratory,,85613,CPT,Facility,Both,,,90,247,209.95,70.7902,247,First Health Group Corporation,First Health Network,239.59,97,,percent of total billed charges,,
Drvvt Confirmation (Mayo)OutsideLaboratory,,85613,CPT,Facility,Both,,,90,247,209.95,70.7902,247,"Health Partners, Inc.",Commercial,233.662,94.6,,percent of total billed charges,,
Drvvt Confirmation (Mayo)OutsideLaboratory,,85613,CPT,Facility,Outpatient,,,90,247,209.95,70.7902,247,"Health Partners, Inc.",Medicare Advantage,121.03,49,,percent of total billed charges,,
Drvvt Confirmation (Mayo)OutsideLaboratory,,85613,CPT,Facility,Inpatient,,,90,247,209.95,70.7902,247,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Drvvt Confirmation (Mayo)OutsideLaboratory,,85613,CPT,Facility,Both,,,90,247,209.95,70.7902,247,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),148.2,60,,percent of total billed charges,,
Drvvt Confirmation (Mayo)OutsideLaboratory,,85613,CPT,Facility,Both,,,90,247,209.95,70.7902,247,"Health Partners, Inc.",State of Minnesota Advantage Program,201.305,81.5,,percent of total billed charges,,
Drvvt Confirmation (Mayo)OutsideLaboratory,,85613,CPT,Facility,Both,,,90,247,209.95,70.7902,247,"Health Partners, Inc.",State Public Programs,123.5,50,,percent of total billed charges,,
Drvvt Confirmation (Mayo)OutsideLaboratory,,85613,CPT,Facility,Both,,,90,247,209.95,70.7902,247,Humana Insurance Company,Commercial PPO,234.65,95,,percent of total billed charges,,
Drvvt Confirmation (Mayo)OutsideLaboratory,,85613,CPT,Facility,Outpatient,,,90,247,209.95,70.7902,247,Humana Insurance Company,Medicare PPO,121.03,49,,percent of total billed charges,,
Drvvt Confirmation (Mayo)OutsideLaboratory,,85613,CPT,Facility,Inpatient,,,90,247,209.95,70.7902,247,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Drvvt Confirmation (Mayo)OutsideLaboratory,,85613,CPT,Facility,Both,,,90,247,209.95,70.7902,247,Medica,Individual & Family,244.777,99.1,,percent of total billed charges,,
Drvvt Confirmation (Mayo)OutsideLaboratory,,85613,CPT,Facility,Outpatient,,,90,247,209.95,70.7902,247,Medica,Medica Advantage Solution,123.006,49.8,,percent of total billed charges,,
Drvvt Confirmation (Mayo)OutsideLaboratory,,85613,CPT,Facility,Inpatient,,,90,247,209.95,70.7902,247,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Drvvt Confirmation (Mayo)OutsideLaboratory,,85613,CPT,Facility,Outpatient,,,90,247,209.95,70.7902,247,Medica,Medical Assistance,110.162,44.6,,percent of total billed charges,,
Drvvt Confirmation (Mayo)OutsideLaboratory,,85613,CPT,Facility,Inpatient,,,90,247,209.95,70.7902,247,Medica,Medical Assistance,,,,,Included in per diem rate,
Drvvt Confirmation (Mayo)OutsideLaboratory,,85613,CPT,Facility,Outpatient,,,90,247,209.95,70.7902,247,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,123.006,49.8,,percent of total billed charges,,
Drvvt Confirmation (Mayo)OutsideLaboratory,,85613,CPT,Facility,Inpatient,,,90,247,209.95,70.7902,247,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Drvvt Confirmation (Mayo)OutsideLaboratory,,85613,CPT,Facility,Both,,,90,247,209.95,70.7902,247,"Multiplan, Inc.","Multiplan, Inc.",232.18,94,,percent of total billed charges,,
Drvvt Confirmation (Mayo)OutsideLaboratory,,85613,CPT,Facility,Outpatient,,,90,247,209.95,70.7902,247,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,213.408,86.4,,percent of total billed charges,,
Drvvt Confirmation (Mayo)OutsideLaboratory,,85613,CPT,Facility,Inpatient,,,90,247,209.95,70.7902,247,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Drvvt Confirmation (Mayo)OutsideLaboratory,,85613,CPT,Facility,Both,,,90,247,209.95,70.7902,247,"Preferred One Administrative Services, INC.",PPO,243.542,98.6,,percent of total billed charges,,
Drvvt Confirmation (Mayo)OutsideLaboratory,,85613,CPT,Facility,Outpatient,,,90,247,209.95,70.7902,247,PrimeWest Health,Minnesota Senior Health Options (MSHO),127.0815,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Drvvt Confirmation (Mayo)OutsideLaboratory,,85613,CPT,Facility,Inpatient,,,90,247,209.95,70.7902,247,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Drvvt Confirmation (Mayo)OutsideLaboratory,,85613,CPT,Facility,Outpatient,,,90,247,209.95,70.7902,247,PrimeWest Health,MinnesotaCare,126.8592,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Drvvt Confirmation (Mayo)OutsideLaboratory,,85613,CPT,Facility,Inpatient,,,90,247,209.95,70.7902,247,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Drvvt Confirmation (Mayo)OutsideLaboratory,,85613,CPT,Facility,Both,,,90,247,209.95,70.7902,247,Sanford Health Plan,Sanford Health Plan,227.24,92,,percent of total billed charges,,
Drvvt Confirmation (Mayo)OutsideLaboratory,,85613,CPT,Facility,Outpatient,,,90,247,209.95,70.7902,247,"UCare Health, Inc.",Individual & Family Plan,139.1845,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Drvvt Confirmation (Mayo)OutsideLaboratory,,85613,CPT,Facility,Inpatient,,,90,247,209.95,70.7902,247,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Drvvt Confirmation (Mayo)OutsideLaboratory,,85613,CPT,Facility,Outpatient,,,90,247,209.95,70.7902,247,"UCare Health, Inc.",Medical Assistance,124.6609,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Drvvt Confirmation (Mayo)OutsideLaboratory,,85613,CPT,Facility,Inpatient,,,90,247,209.95,70.7902,247,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Drvvt Confirmation (Mayo)OutsideLaboratory,,85613,CPT,Facility,Outpatient,,,90,247,209.95,70.7902,247,"UCare Health, Inc.",Medicare Advantage,124.6609,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Drvvt Confirmation (Mayo)OutsideLaboratory,,85613,CPT,Facility,Inpatient,,,90,247,209.95,70.7902,247,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Drvvt Confirmation (Mayo)OutsideLaboratory,,85613,CPT,Facility,Outpatient,,,90,247,209.95,70.7902,247,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),124.6609,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Drvvt Confirmation (Mayo)OutsideLaboratory,,85613,CPT,Facility,Inpatient,,,90,247,209.95,70.7902,247,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Drvvt Confirmation (Mayo)OutsideLaboratory,,85613,CPT,Facility,Both,,,90,247,209.95,70.7902,247,UnitedHealthcare,Individual & Family,232.18,94,,percent of total billed charges,,
Drvvt Confirmation (Mayo)OutsideLaboratory,,85613,CPT,Facility,Outpatient,,,90,247,209.95,70.7902,247,UnitedHealthcare,Medicare Advantage,121.03,49,,percent of total billed charges,,
Drvvt Confirmation (Mayo)OutsideLaboratory,,85613,CPT,Facility,Inpatient,,,90,247,209.95,70.7902,247,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Drvvt Confirmation (Mayo)OutsideLaboratory,,85613,CPT,Facility,Outpatient,,,90,247,209.95,70.7902,247,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,118.56,48,,percent of total billed charges,,100% of DHS outpatient percentage
Drvvt Confirmation (Mayo)OutsideLaboratory,,85613,CPT,Facility,Inpatient,,,90,247,209.95,70.7902,247,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Drvvt Mix (Mayo)OutsideLaboratory,,85613,CPT,Facility,Both,,,90,70,59.5,20.062,70,Aetna,Commercial,64.4,92,,percent of total billed charges,,
Drvvt Mix (Mayo)OutsideLaboratory,,85613,CPT,Facility,Outpatient,,,90,70,59.5,20.062,70,Aetna,Medicare Advantage,34.3,49,,percent of total billed charges,,
Drvvt Mix (Mayo)OutsideLaboratory,,85613,CPT,Facility,Inpatient,,,90,70,59.5,20.062,70,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Drvvt Mix (Mayo)OutsideLaboratory,,85613,CPT,Facility,Both,,,90,70,59.5,20.062,70,Aetna,PPO,65.1,93,,percent of total billed charges,,
Drvvt Mix (Mayo)OutsideLaboratory,,85613,CPT,Facility,Both,,,90,70,59.5,20.062,70,America's PPO,America's PPO,67.221,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Drvvt Mix (Mayo)OutsideLaboratory,,85613,CPT,Facility,Both,,,90,70,59.5,20.062,70,BlueCross BlueShield Minnesota, Federal Employee Program,68.88,98.4,,percent of total billed charges,,
Drvvt Mix (Mayo)OutsideLaboratory,,85613,CPT,Facility,Both,,,90,70,59.5,20.062,70,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,70,100,,percent of total billed charges,,
Drvvt Mix (Mayo)OutsideLaboratory,,85613,CPT,Facility,Both,,,90,70,59.5,20.062,70,BlueCross BlueShield Minnesota,High Value Network Plan,63,90,,percent of total billed charges,,
Drvvt Mix (Mayo)OutsideLaboratory,,85613,CPT,Facility,Outpatient,,,90,70,59.5,20.062,70,BlueCross BlueShield Minnesota,Medicare Advantage,34.3,49,,percent of total billed charges,,
Drvvt Mix (Mayo)OutsideLaboratory,,85613,CPT,Facility,Inpatient,,,90,70,59.5,20.062,70,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Drvvt Mix (Mayo)OutsideLaboratory,,85613,CPT,Facility,Both,,,90,70,59.5,20.062,70,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,61.999,88.57,,percent of total billed charges,,
Drvvt Mix (Mayo)OutsideLaboratory,,85613,CPT,Facility,Both,,,90,70,59.5,20.062,70,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,20.062,28.66,,percent of total billed charges,,
Drvvt Mix (Mayo)OutsideLaboratory,,85613,CPT,Facility,Outpatient,,,90,70,59.5,20.062,70,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),34.3,49,,percent of total billed charges,,
Drvvt Mix (Mayo)OutsideLaboratory,,85613,CPT,Facility,Inpatient,,,90,70,59.5,20.062,70,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Drvvt Mix (Mayo)OutsideLaboratory,,85613,CPT,Facility,Both,,,90,70,59.5,20.062,70,CorVel,Worker's Compensation,70,100,,percent of total billed charges,,
Drvvt Mix (Mayo)OutsideLaboratory,,85613,CPT,Facility,Both,,,90,70,59.5,20.062,70,First Health Group Corporation,First Health Network,67.9,97,,percent of total billed charges,,
Drvvt Mix (Mayo)OutsideLaboratory,,85613,CPT,Facility,Both,,,90,70,59.5,20.062,70,"Health Partners, Inc.",Commercial,66.22,94.6,,percent of total billed charges,,
Drvvt Mix (Mayo)OutsideLaboratory,,85613,CPT,Facility,Outpatient,,,90,70,59.5,20.062,70,"Health Partners, Inc.",Medicare Advantage,34.3,49,,percent of total billed charges,,
Drvvt Mix (Mayo)OutsideLaboratory,,85613,CPT,Facility,Inpatient,,,90,70,59.5,20.062,70,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Drvvt Mix (Mayo)OutsideLaboratory,,85613,CPT,Facility,Both,,,90,70,59.5,20.062,70,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),42,60,,percent of total billed charges,,
Drvvt Mix (Mayo)OutsideLaboratory,,85613,CPT,Facility,Both,,,90,70,59.5,20.062,70,"Health Partners, Inc.",State of Minnesota Advantage Program,57.05,81.5,,percent of total billed charges,,
Drvvt Mix (Mayo)OutsideLaboratory,,85613,CPT,Facility,Both,,,90,70,59.5,20.062,70,"Health Partners, Inc.",State Public Programs,35,50,,percent of total billed charges,,
Drvvt Mix (Mayo)OutsideLaboratory,,85613,CPT,Facility,Both,,,90,70,59.5,20.062,70,Humana Insurance Company,Commercial PPO,66.5,95,,percent of total billed charges,,
Drvvt Mix (Mayo)OutsideLaboratory,,85613,CPT,Facility,Outpatient,,,90,70,59.5,20.062,70,Humana Insurance Company,Medicare PPO,34.3,49,,percent of total billed charges,,
Drvvt Mix (Mayo)OutsideLaboratory,,85613,CPT,Facility,Inpatient,,,90,70,59.5,20.062,70,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Drvvt Mix (Mayo)OutsideLaboratory,,85613,CPT,Facility,Both,,,90,70,59.5,20.062,70,Medica,Individual & Family,69.37,99.1,,percent of total billed charges,,
Drvvt Mix (Mayo)OutsideLaboratory,,85613,CPT,Facility,Outpatient,,,90,70,59.5,20.062,70,Medica,Medica Advantage Solution,34.86,49.8,,percent of total billed charges,,
Drvvt Mix (Mayo)OutsideLaboratory,,85613,CPT,Facility,Inpatient,,,90,70,59.5,20.062,70,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Drvvt Mix (Mayo)OutsideLaboratory,,85613,CPT,Facility,Outpatient,,,90,70,59.5,20.062,70,Medica,Medical Assistance,31.22,44.6,,percent of total billed charges,,
Drvvt Mix (Mayo)OutsideLaboratory,,85613,CPT,Facility,Inpatient,,,90,70,59.5,20.062,70,Medica,Medical Assistance,,,,,Included in per diem rate,
Drvvt Mix (Mayo)OutsideLaboratory,,85613,CPT,Facility,Outpatient,,,90,70,59.5,20.062,70,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,34.86,49.8,,percent of total billed charges,,
Drvvt Mix (Mayo)OutsideLaboratory,,85613,CPT,Facility,Inpatient,,,90,70,59.5,20.062,70,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Drvvt Mix (Mayo)OutsideLaboratory,,85613,CPT,Facility,Both,,,90,70,59.5,20.062,70,"Multiplan, Inc.","Multiplan, Inc.",65.8,94,,percent of total billed charges,,
Drvvt Mix (Mayo)OutsideLaboratory,,85613,CPT,Facility,Outpatient,,,90,70,59.5,20.062,70,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,60.48,86.4,,percent of total billed charges,,
Drvvt Mix (Mayo)OutsideLaboratory,,85613,CPT,Facility,Inpatient,,,90,70,59.5,20.062,70,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Drvvt Mix (Mayo)OutsideLaboratory,,85613,CPT,Facility,Both,,,90,70,59.5,20.062,70,"Preferred One Administrative Services, INC.",PPO,69.02,98.6,,percent of total billed charges,,
Drvvt Mix (Mayo)OutsideLaboratory,,85613,CPT,Facility,Outpatient,,,90,70,59.5,20.062,70,PrimeWest Health,Minnesota Senior Health Options (MSHO),36.015,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Drvvt Mix (Mayo)OutsideLaboratory,,85613,CPT,Facility,Inpatient,,,90,70,59.5,20.062,70,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Drvvt Mix (Mayo)OutsideLaboratory,,85613,CPT,Facility,Outpatient,,,90,70,59.5,20.062,70,PrimeWest Health,MinnesotaCare,35.952,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Drvvt Mix (Mayo)OutsideLaboratory,,85613,CPT,Facility,Inpatient,,,90,70,59.5,20.062,70,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Drvvt Mix (Mayo)OutsideLaboratory,,85613,CPT,Facility,Both,,,90,70,59.5,20.062,70,Sanford Health Plan,Sanford Health Plan,64.4,92,,percent of total billed charges,,
Drvvt Mix (Mayo)OutsideLaboratory,,85613,CPT,Facility,Outpatient,,,90,70,59.5,20.062,70,"UCare Health, Inc.",Individual & Family Plan,39.445,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Drvvt Mix (Mayo)OutsideLaboratory,,85613,CPT,Facility,Inpatient,,,90,70,59.5,20.062,70,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Drvvt Mix (Mayo)OutsideLaboratory,,85613,CPT,Facility,Outpatient,,,90,70,59.5,20.062,70,"UCare Health, Inc.",Medical Assistance,35.329,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Drvvt Mix (Mayo)OutsideLaboratory,,85613,CPT,Facility,Inpatient,,,90,70,59.5,20.062,70,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Drvvt Mix (Mayo)OutsideLaboratory,,85613,CPT,Facility,Outpatient,,,90,70,59.5,20.062,70,"UCare Health, Inc.",Medicare Advantage,35.329,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Drvvt Mix (Mayo)OutsideLaboratory,,85613,CPT,Facility,Inpatient,,,90,70,59.5,20.062,70,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Drvvt Mix (Mayo)OutsideLaboratory,,85613,CPT,Facility,Outpatient,,,90,70,59.5,20.062,70,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),35.329,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Drvvt Mix (Mayo)OutsideLaboratory,,85613,CPT,Facility,Inpatient,,,90,70,59.5,20.062,70,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Drvvt Mix (Mayo)OutsideLaboratory,,85613,CPT,Facility,Both,,,90,70,59.5,20.062,70,UnitedHealthcare,Individual & Family,65.8,94,,percent of total billed charges,,
Drvvt Mix (Mayo)OutsideLaboratory,,85613,CPT,Facility,Outpatient,,,90,70,59.5,20.062,70,UnitedHealthcare,Medicare Advantage,34.3,49,,percent of total billed charges,,
Drvvt Mix (Mayo)OutsideLaboratory,,85613,CPT,Facility,Inpatient,,,90,70,59.5,20.062,70,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Drvvt Mix (Mayo)OutsideLaboratory,,85613,CPT,Facility,Outpatient,,,90,70,59.5,20.062,70,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,33.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
Drvvt Mix (Mayo)OutsideLaboratory,,85613,CPT,Facility,Inpatient,,,90,70,59.5,20.062,70,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Russell Viper Venom Time (Includes Venom); Diluted (Mayo)OutsideLaboratory,,85613,CPT,Facility,Both,,,90,247,209.95,70.7902,247,Aetna,Commercial,227.24,92,,percent of total billed charges,,
Russell Viper Venom Time (Includes Venom); Diluted (Mayo)OutsideLaboratory,,85613,CPT,Facility,Outpatient,,,90,247,209.95,70.7902,247,Aetna,Medicare Advantage,121.03,49,,percent of total billed charges,,
Russell Viper Venom Time (Includes Venom); Diluted (Mayo)OutsideLaboratory,,85613,CPT,Facility,Inpatient,,,90,247,209.95,70.7902,247,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Russell Viper Venom Time (Includes Venom); Diluted (Mayo)OutsideLaboratory,,85613,CPT,Facility,Both,,,90,247,209.95,70.7902,247,Aetna,PPO,229.71,93,,percent of total billed charges,,
Russell Viper Venom Time (Includes Venom); Diluted (Mayo)OutsideLaboratory,,85613,CPT,Facility,Both,,,90,247,209.95,70.7902,247,America's PPO,America's PPO,237.1941,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Russell Viper Venom Time (Includes Venom); Diluted (Mayo)OutsideLaboratory,,85613,CPT,Facility,Both,,,90,247,209.95,70.7902,247,BlueCross BlueShield Minnesota, Federal Employee Program,243.048,98.4,,percent of total billed charges,,
Russell Viper Venom Time (Includes Venom); Diluted (Mayo)OutsideLaboratory,,85613,CPT,Facility,Both,,,90,247,209.95,70.7902,247,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,247,100,,percent of total billed charges,,
Russell Viper Venom Time (Includes Venom); Diluted (Mayo)OutsideLaboratory,,85613,CPT,Facility,Both,,,90,247,209.95,70.7902,247,BlueCross BlueShield Minnesota,High Value Network Plan,222.3,90,,percent of total billed charges,,
Russell Viper Venom Time (Includes Venom); Diluted (Mayo)OutsideLaboratory,,85613,CPT,Facility,Outpatient,,,90,247,209.95,70.7902,247,BlueCross BlueShield Minnesota,Medicare Advantage,121.03,49,,percent of total billed charges,,
Russell Viper Venom Time (Includes Venom); Diluted (Mayo)OutsideLaboratory,,85613,CPT,Facility,Inpatient,,,90,247,209.95,70.7902,247,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Russell Viper Venom Time (Includes Venom); Diluted (Mayo)OutsideLaboratory,,85613,CPT,Facility,Both,,,90,247,209.95,70.7902,247,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,218.7679,88.57,,percent of total billed charges,,
Russell Viper Venom Time (Includes Venom); Diluted (Mayo)OutsideLaboratory,,85613,CPT,Facility,Both,,,90,247,209.95,70.7902,247,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,70.7902,28.66,,percent of total billed charges,,
Russell Viper Venom Time (Includes Venom); Diluted (Mayo)OutsideLaboratory,,85613,CPT,Facility,Outpatient,,,90,247,209.95,70.7902,247,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),121.03,49,,percent of total billed charges,,
Russell Viper Venom Time (Includes Venom); Diluted (Mayo)OutsideLaboratory,,85613,CPT,Facility,Inpatient,,,90,247,209.95,70.7902,247,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Russell Viper Venom Time (Includes Venom); Diluted (Mayo)OutsideLaboratory,,85613,CPT,Facility,Both,,,90,247,209.95,70.7902,247,CorVel,Worker's Compensation,247,100,,percent of total billed charges,,
Russell Viper Venom Time (Includes Venom); Diluted (Mayo)OutsideLaboratory,,85613,CPT,Facility,Both,,,90,247,209.95,70.7902,247,First Health Group Corporation,First Health Network,239.59,97,,percent of total billed charges,,
Russell Viper Venom Time (Includes Venom); Diluted (Mayo)OutsideLaboratory,,85613,CPT,Facility,Both,,,90,247,209.95,70.7902,247,"Health Partners, Inc.",Commercial,233.662,94.6,,percent of total billed charges,,
Russell Viper Venom Time (Includes Venom); Diluted (Mayo)OutsideLaboratory,,85613,CPT,Facility,Outpatient,,,90,247,209.95,70.7902,247,"Health Partners, Inc.",Medicare Advantage,121.03,49,,percent of total billed charges,,
Russell Viper Venom Time (Includes Venom); Diluted (Mayo)OutsideLaboratory,,85613,CPT,Facility,Inpatient,,,90,247,209.95,70.7902,247,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Russell Viper Venom Time (Includes Venom); Diluted (Mayo)OutsideLaboratory,,85613,CPT,Facility,Both,,,90,247,209.95,70.7902,247,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),148.2,60,,percent of total billed charges,,
Russell Viper Venom Time (Includes Venom); Diluted (Mayo)OutsideLaboratory,,85613,CPT,Facility,Both,,,90,247,209.95,70.7902,247,"Health Partners, Inc.",State of Minnesota Advantage Program,201.305,81.5,,percent of total billed charges,,
Russell Viper Venom Time (Includes Venom); Diluted (Mayo)OutsideLaboratory,,85613,CPT,Facility,Both,,,90,247,209.95,70.7902,247,"Health Partners, Inc.",State Public Programs,123.5,50,,percent of total billed charges,,
Russell Viper Venom Time (Includes Venom); Diluted (Mayo)OutsideLaboratory,,85613,CPT,Facility,Both,,,90,247,209.95,70.7902,247,Humana Insurance Company,Commercial PPO,234.65,95,,percent of total billed charges,,
Russell Viper Venom Time (Includes Venom); Diluted (Mayo)OutsideLaboratory,,85613,CPT,Facility,Outpatient,,,90,247,209.95,70.7902,247,Humana Insurance Company,Medicare PPO,121.03,49,,percent of total billed charges,,
Russell Viper Venom Time (Includes Venom); Diluted (Mayo)OutsideLaboratory,,85613,CPT,Facility,Inpatient,,,90,247,209.95,70.7902,247,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Russell Viper Venom Time (Includes Venom); Diluted (Mayo)OutsideLaboratory,,85613,CPT,Facility,Both,,,90,247,209.95,70.7902,247,Medica,Individual & Family,244.777,99.1,,percent of total billed charges,,
Russell Viper Venom Time (Includes Venom); Diluted (Mayo)OutsideLaboratory,,85613,CPT,Facility,Outpatient,,,90,247,209.95,70.7902,247,Medica,Medica Advantage Solution,123.006,49.8,,percent of total billed charges,,
Russell Viper Venom Time (Includes Venom); Diluted (Mayo)OutsideLaboratory,,85613,CPT,Facility,Inpatient,,,90,247,209.95,70.7902,247,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Russell Viper Venom Time (Includes Venom); Diluted (Mayo)OutsideLaboratory,,85613,CPT,Facility,Outpatient,,,90,247,209.95,70.7902,247,Medica,Medical Assistance,110.162,44.6,,percent of total billed charges,,
Russell Viper Venom Time (Includes Venom); Diluted (Mayo)OutsideLaboratory,,85613,CPT,Facility,Inpatient,,,90,247,209.95,70.7902,247,Medica,Medical Assistance,,,,,Included in per diem rate,
Russell Viper Venom Time (Includes Venom); Diluted (Mayo)OutsideLaboratory,,85613,CPT,Facility,Outpatient,,,90,247,209.95,70.7902,247,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,123.006,49.8,,percent of total billed charges,,
Russell Viper Venom Time (Includes Venom); Diluted (Mayo)OutsideLaboratory,,85613,CPT,Facility,Inpatient,,,90,247,209.95,70.7902,247,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Russell Viper Venom Time (Includes Venom); Diluted (Mayo)OutsideLaboratory,,85613,CPT,Facility,Both,,,90,247,209.95,70.7902,247,"Multiplan, Inc.","Multiplan, Inc.",232.18,94,,percent of total billed charges,,
Russell Viper Venom Time (Includes Venom); Diluted (Mayo)OutsideLaboratory,,85613,CPT,Facility,Outpatient,,,90,247,209.95,70.7902,247,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,213.408,86.4,,percent of total billed charges,,
Russell Viper Venom Time (Includes Venom); Diluted (Mayo)OutsideLaboratory,,85613,CPT,Facility,Inpatient,,,90,247,209.95,70.7902,247,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Russell Viper Venom Time (Includes Venom); Diluted (Mayo)OutsideLaboratory,,85613,CPT,Facility,Both,,,90,247,209.95,70.7902,247,"Preferred One Administrative Services, INC.",PPO,243.542,98.6,,percent of total billed charges,,
Russell Viper Venom Time (Includes Venom); Diluted (Mayo)OutsideLaboratory,,85613,CPT,Facility,Outpatient,,,90,247,209.95,70.7902,247,PrimeWest Health,Minnesota Senior Health Options (MSHO),127.0815,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Russell Viper Venom Time (Includes Venom); Diluted (Mayo)OutsideLaboratory,,85613,CPT,Facility,Inpatient,,,90,247,209.95,70.7902,247,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Russell Viper Venom Time (Includes Venom); Diluted (Mayo)OutsideLaboratory,,85613,CPT,Facility,Outpatient,,,90,247,209.95,70.7902,247,PrimeWest Health,MinnesotaCare,126.8592,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Russell Viper Venom Time (Includes Venom); Diluted (Mayo)OutsideLaboratory,,85613,CPT,Facility,Inpatient,,,90,247,209.95,70.7902,247,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Russell Viper Venom Time (Includes Venom); Diluted (Mayo)OutsideLaboratory,,85613,CPT,Facility,Both,,,90,247,209.95,70.7902,247,Sanford Health Plan,Sanford Health Plan,227.24,92,,percent of total billed charges,,
Russell Viper Venom Time (Includes Venom); Diluted (Mayo)OutsideLaboratory,,85613,CPT,Facility,Outpatient,,,90,247,209.95,70.7902,247,"UCare Health, Inc.",Individual & Family Plan,139.1845,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Russell Viper Venom Time (Includes Venom); Diluted (Mayo)OutsideLaboratory,,85613,CPT,Facility,Inpatient,,,90,247,209.95,70.7902,247,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Russell Viper Venom Time (Includes Venom); Diluted (Mayo)OutsideLaboratory,,85613,CPT,Facility,Outpatient,,,90,247,209.95,70.7902,247,"UCare Health, Inc.",Medical Assistance,124.6609,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Russell Viper Venom Time (Includes Venom); Diluted (Mayo)OutsideLaboratory,,85613,CPT,Facility,Inpatient,,,90,247,209.95,70.7902,247,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Russell Viper Venom Time (Includes Venom); Diluted (Mayo)OutsideLaboratory,,85613,CPT,Facility,Outpatient,,,90,247,209.95,70.7902,247,"UCare Health, Inc.",Medicare Advantage,124.6609,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Russell Viper Venom Time (Includes Venom); Diluted (Mayo)OutsideLaboratory,,85613,CPT,Facility,Inpatient,,,90,247,209.95,70.7902,247,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Russell Viper Venom Time (Includes Venom); Diluted (Mayo)OutsideLaboratory,,85613,CPT,Facility,Outpatient,,,90,247,209.95,70.7902,247,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),124.6609,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Russell Viper Venom Time (Includes Venom); Diluted (Mayo)OutsideLaboratory,,85613,CPT,Facility,Inpatient,,,90,247,209.95,70.7902,247,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Russell Viper Venom Time (Includes Venom); Diluted (Mayo)OutsideLaboratory,,85613,CPT,Facility,Both,,,90,247,209.95,70.7902,247,UnitedHealthcare,Individual & Family,232.18,94,,percent of total billed charges,,
Russell Viper Venom Time (Includes Venom); Diluted (Mayo)OutsideLaboratory,,85613,CPT,Facility,Outpatient,,,90,247,209.95,70.7902,247,UnitedHealthcare,Medicare Advantage,121.03,49,,percent of total billed charges,,
Russell Viper Venom Time (Includes Venom); Diluted (Mayo)OutsideLaboratory,,85613,CPT,Facility,Inpatient,,,90,247,209.95,70.7902,247,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Russell Viper Venom Time (Includes Venom); Diluted (Mayo)OutsideLaboratory,,85613,CPT,Facility,Outpatient,,,90,247,209.95,70.7902,247,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,118.56,48,,percent of total billed charges,,100% of DHS outpatient percentage
Russell Viper Venom Time (Includes Venom); Diluted (Mayo)OutsideLaboratory,,85613,CPT,Facility,Inpatient,,,90,247,209.95,70.7902,247,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Russell Viper Venom Time Diluted (Mayo)OutsideLaboratory,,85613,CPT,Facility,Both,,,90,247,209.95,70.7902,247,Aetna,Commercial,227.24,92,,percent of total billed charges,,
Russell Viper Venom Time Diluted (Mayo)OutsideLaboratory,,85613,CPT,Facility,Outpatient,,,90,247,209.95,70.7902,247,Aetna,Medicare Advantage,121.03,49,,percent of total billed charges,,
Russell Viper Venom Time Diluted (Mayo)OutsideLaboratory,,85613,CPT,Facility,Inpatient,,,90,247,209.95,70.7902,247,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Russell Viper Venom Time Diluted (Mayo)OutsideLaboratory,,85613,CPT,Facility,Both,,,90,247,209.95,70.7902,247,Aetna,PPO,229.71,93,,percent of total billed charges,,
Russell Viper Venom Time Diluted (Mayo)OutsideLaboratory,,85613,CPT,Facility,Both,,,90,247,209.95,70.7902,247,America's PPO,America's PPO,237.1941,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Russell Viper Venom Time Diluted (Mayo)OutsideLaboratory,,85613,CPT,Facility,Both,,,90,247,209.95,70.7902,247,BlueCross BlueShield Minnesota, Federal Employee Program,243.048,98.4,,percent of total billed charges,,
Russell Viper Venom Time Diluted (Mayo)OutsideLaboratory,,85613,CPT,Facility,Both,,,90,247,209.95,70.7902,247,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,247,100,,percent of total billed charges,,
Russell Viper Venom Time Diluted (Mayo)OutsideLaboratory,,85613,CPT,Facility,Both,,,90,247,209.95,70.7902,247,BlueCross BlueShield Minnesota,High Value Network Plan,222.3,90,,percent of total billed charges,,
Russell Viper Venom Time Diluted (Mayo)OutsideLaboratory,,85613,CPT,Facility,Outpatient,,,90,247,209.95,70.7902,247,BlueCross BlueShield Minnesota,Medicare Advantage,121.03,49,,percent of total billed charges,,
Russell Viper Venom Time Diluted (Mayo)OutsideLaboratory,,85613,CPT,Facility,Inpatient,,,90,247,209.95,70.7902,247,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Russell Viper Venom Time Diluted (Mayo)OutsideLaboratory,,85613,CPT,Facility,Both,,,90,247,209.95,70.7902,247,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,218.7679,88.57,,percent of total billed charges,,
Russell Viper Venom Time Diluted (Mayo)OutsideLaboratory,,85613,CPT,Facility,Both,,,90,247,209.95,70.7902,247,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,70.7902,28.66,,percent of total billed charges,,
Russell Viper Venom Time Diluted (Mayo)OutsideLaboratory,,85613,CPT,Facility,Outpatient,,,90,247,209.95,70.7902,247,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),121.03,49,,percent of total billed charges,,
Russell Viper Venom Time Diluted (Mayo)OutsideLaboratory,,85613,CPT,Facility,Inpatient,,,90,247,209.95,70.7902,247,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Russell Viper Venom Time Diluted (Mayo)OutsideLaboratory,,85613,CPT,Facility,Both,,,90,247,209.95,70.7902,247,CorVel,Worker's Compensation,247,100,,percent of total billed charges,,
Russell Viper Venom Time Diluted (Mayo)OutsideLaboratory,,85613,CPT,Facility,Both,,,90,247,209.95,70.7902,247,First Health Group Corporation,First Health Network,239.59,97,,percent of total billed charges,,
Russell Viper Venom Time Diluted (Mayo)OutsideLaboratory,,85613,CPT,Facility,Both,,,90,247,209.95,70.7902,247,"Health Partners, Inc.",Commercial,233.662,94.6,,percent of total billed charges,,
Russell Viper Venom Time Diluted (Mayo)OutsideLaboratory,,85613,CPT,Facility,Outpatient,,,90,247,209.95,70.7902,247,"Health Partners, Inc.",Medicare Advantage,121.03,49,,percent of total billed charges,,
Russell Viper Venom Time Diluted (Mayo)OutsideLaboratory,,85613,CPT,Facility,Inpatient,,,90,247,209.95,70.7902,247,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Russell Viper Venom Time Diluted (Mayo)OutsideLaboratory,,85613,CPT,Facility,Both,,,90,247,209.95,70.7902,247,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),148.2,60,,percent of total billed charges,,
Russell Viper Venom Time Diluted (Mayo)OutsideLaboratory,,85613,CPT,Facility,Both,,,90,247,209.95,70.7902,247,"Health Partners, Inc.",State of Minnesota Advantage Program,201.305,81.5,,percent of total billed charges,,
Russell Viper Venom Time Diluted (Mayo)OutsideLaboratory,,85613,CPT,Facility,Both,,,90,247,209.95,70.7902,247,"Health Partners, Inc.",State Public Programs,123.5,50,,percent of total billed charges,,
Russell Viper Venom Time Diluted (Mayo)OutsideLaboratory,,85613,CPT,Facility,Both,,,90,247,209.95,70.7902,247,Humana Insurance Company,Commercial PPO,234.65,95,,percent of total billed charges,,
Russell Viper Venom Time Diluted (Mayo)OutsideLaboratory,,85613,CPT,Facility,Outpatient,,,90,247,209.95,70.7902,247,Humana Insurance Company,Medicare PPO,121.03,49,,percent of total billed charges,,
Russell Viper Venom Time Diluted (Mayo)OutsideLaboratory,,85613,CPT,Facility,Inpatient,,,90,247,209.95,70.7902,247,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Russell Viper Venom Time Diluted (Mayo)OutsideLaboratory,,85613,CPT,Facility,Both,,,90,247,209.95,70.7902,247,Medica,Individual & Family,244.777,99.1,,percent of total billed charges,,
Russell Viper Venom Time Diluted (Mayo)OutsideLaboratory,,85613,CPT,Facility,Outpatient,,,90,247,209.95,70.7902,247,Medica,Medica Advantage Solution,123.006,49.8,,percent of total billed charges,,
Russell Viper Venom Time Diluted (Mayo)OutsideLaboratory,,85613,CPT,Facility,Inpatient,,,90,247,209.95,70.7902,247,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Russell Viper Venom Time Diluted (Mayo)OutsideLaboratory,,85613,CPT,Facility,Outpatient,,,90,247,209.95,70.7902,247,Medica,Medical Assistance,110.162,44.6,,percent of total billed charges,,
Russell Viper Venom Time Diluted (Mayo)OutsideLaboratory,,85613,CPT,Facility,Inpatient,,,90,247,209.95,70.7902,247,Medica,Medical Assistance,,,,,Included in per diem rate,
Russell Viper Venom Time Diluted (Mayo)OutsideLaboratory,,85613,CPT,Facility,Outpatient,,,90,247,209.95,70.7902,247,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,123.006,49.8,,percent of total billed charges,,
Russell Viper Venom Time Diluted (Mayo)OutsideLaboratory,,85613,CPT,Facility,Inpatient,,,90,247,209.95,70.7902,247,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Russell Viper Venom Time Diluted (Mayo)OutsideLaboratory,,85613,CPT,Facility,Both,,,90,247,209.95,70.7902,247,"Multiplan, Inc.","Multiplan, Inc.",232.18,94,,percent of total billed charges,,
Russell Viper Venom Time Diluted (Mayo)OutsideLaboratory,,85613,CPT,Facility,Outpatient,,,90,247,209.95,70.7902,247,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,213.408,86.4,,percent of total billed charges,,
Russell Viper Venom Time Diluted (Mayo)OutsideLaboratory,,85613,CPT,Facility,Inpatient,,,90,247,209.95,70.7902,247,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Russell Viper Venom Time Diluted (Mayo)OutsideLaboratory,,85613,CPT,Facility,Both,,,90,247,209.95,70.7902,247,"Preferred One Administrative Services, INC.",PPO,243.542,98.6,,percent of total billed charges,,
Russell Viper Venom Time Diluted (Mayo)OutsideLaboratory,,85613,CPT,Facility,Outpatient,,,90,247,209.95,70.7902,247,PrimeWest Health,Minnesota Senior Health Options (MSHO),127.0815,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Russell Viper Venom Time Diluted (Mayo)OutsideLaboratory,,85613,CPT,Facility,Inpatient,,,90,247,209.95,70.7902,247,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Russell Viper Venom Time Diluted (Mayo)OutsideLaboratory,,85613,CPT,Facility,Outpatient,,,90,247,209.95,70.7902,247,PrimeWest Health,MinnesotaCare,126.8592,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Russell Viper Venom Time Diluted (Mayo)OutsideLaboratory,,85613,CPT,Facility,Inpatient,,,90,247,209.95,70.7902,247,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Russell Viper Venom Time Diluted (Mayo)OutsideLaboratory,,85613,CPT,Facility,Both,,,90,247,209.95,70.7902,247,Sanford Health Plan,Sanford Health Plan,227.24,92,,percent of total billed charges,,
Russell Viper Venom Time Diluted (Mayo)OutsideLaboratory,,85613,CPT,Facility,Outpatient,,,90,247,209.95,70.7902,247,"UCare Health, Inc.",Individual & Family Plan,139.1845,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Russell Viper Venom Time Diluted (Mayo)OutsideLaboratory,,85613,CPT,Facility,Inpatient,,,90,247,209.95,70.7902,247,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Russell Viper Venom Time Diluted (Mayo)OutsideLaboratory,,85613,CPT,Facility,Outpatient,,,90,247,209.95,70.7902,247,"UCare Health, Inc.",Medical Assistance,124.6609,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Russell Viper Venom Time Diluted (Mayo)OutsideLaboratory,,85613,CPT,Facility,Inpatient,,,90,247,209.95,70.7902,247,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Russell Viper Venom Time Diluted (Mayo)OutsideLaboratory,,85613,CPT,Facility,Outpatient,,,90,247,209.95,70.7902,247,"UCare Health, Inc.",Medicare Advantage,124.6609,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Russell Viper Venom Time Diluted (Mayo)OutsideLaboratory,,85613,CPT,Facility,Inpatient,,,90,247,209.95,70.7902,247,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Russell Viper Venom Time Diluted (Mayo)OutsideLaboratory,,85613,CPT,Facility,Outpatient,,,90,247,209.95,70.7902,247,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),124.6609,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Russell Viper Venom Time Diluted (Mayo)OutsideLaboratory,,85613,CPT,Facility,Inpatient,,,90,247,209.95,70.7902,247,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Russell Viper Venom Time Diluted (Mayo)OutsideLaboratory,,85613,CPT,Facility,Both,,,90,247,209.95,70.7902,247,UnitedHealthcare,Individual & Family,232.18,94,,percent of total billed charges,,
Russell Viper Venom Time Diluted (Mayo)OutsideLaboratory,,85613,CPT,Facility,Outpatient,,,90,247,209.95,70.7902,247,UnitedHealthcare,Medicare Advantage,121.03,49,,percent of total billed charges,,
Russell Viper Venom Time Diluted (Mayo)OutsideLaboratory,,85613,CPT,Facility,Inpatient,,,90,247,209.95,70.7902,247,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Russell Viper Venom Time Diluted (Mayo)OutsideLaboratory,,85613,CPT,Facility,Outpatient,,,90,247,209.95,70.7902,247,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,118.56,48,,percent of total billed charges,,100% of DHS outpatient percentage
Russell Viper Venom Time Diluted (Mayo)OutsideLaboratory,,85613,CPT,Facility,Inpatient,,,90,247,209.95,70.7902,247,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Sickling Of Rbc, Reduction (Mayo)OutsideLaboratory",,85660,CPT,Facility,Both,,,90,132,112.2,37.8312,132,Aetna,Commercial,121.44,92,,percent of total billed charges,,
"Sickling Of Rbc, Reduction (Mayo)OutsideLaboratory",,85660,CPT,Facility,Outpatient,,,90,132,112.2,37.8312,132,Aetna,Medicare Advantage,64.68,49,,percent of total billed charges,,
"Sickling Of Rbc, Reduction (Mayo)OutsideLaboratory",,85660,CPT,Facility,Inpatient,,,90,132,112.2,37.8312,132,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Sickling Of Rbc, Reduction (Mayo)OutsideLaboratory",,85660,CPT,Facility,Both,,,90,132,112.2,37.8312,132,Aetna,PPO,122.76,93,,percent of total billed charges,,
"Sickling Of Rbc, Reduction (Mayo)OutsideLaboratory",,85660,CPT,Facility,Both,,,90,132,112.2,37.8312,132,America's PPO,America's PPO,126.7596,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Sickling Of Rbc, Reduction (Mayo)OutsideLaboratory",,85660,CPT,Facility,Both,,,90,132,112.2,37.8312,132,BlueCross BlueShield Minnesota, Federal Employee Program,129.888,98.4,,percent of total billed charges,,
"Sickling Of Rbc, Reduction (Mayo)OutsideLaboratory",,85660,CPT,Facility,Both,,,90,132,112.2,37.8312,132,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,132,100,,percent of total billed charges,,
"Sickling Of Rbc, Reduction (Mayo)OutsideLaboratory",,85660,CPT,Facility,Both,,,90,132,112.2,37.8312,132,BlueCross BlueShield Minnesota,High Value Network Plan,118.8,90,,percent of total billed charges,,
"Sickling Of Rbc, Reduction (Mayo)OutsideLaboratory",,85660,CPT,Facility,Outpatient,,,90,132,112.2,37.8312,132,BlueCross BlueShield Minnesota,Medicare Advantage,64.68,49,,percent of total billed charges,,
"Sickling Of Rbc, Reduction (Mayo)OutsideLaboratory",,85660,CPT,Facility,Inpatient,,,90,132,112.2,37.8312,132,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Sickling Of Rbc, Reduction (Mayo)OutsideLaboratory",,85660,CPT,Facility,Both,,,90,132,112.2,37.8312,132,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,116.9124,88.57,,percent of total billed charges,,
"Sickling Of Rbc, Reduction (Mayo)OutsideLaboratory",,85660,CPT,Facility,Both,,,90,132,112.2,37.8312,132,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,37.8312,28.66,,percent of total billed charges,,
"Sickling Of Rbc, Reduction (Mayo)OutsideLaboratory",,85660,CPT,Facility,Outpatient,,,90,132,112.2,37.8312,132,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),64.68,49,,percent of total billed charges,,
"Sickling Of Rbc, Reduction (Mayo)OutsideLaboratory",,85660,CPT,Facility,Inpatient,,,90,132,112.2,37.8312,132,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Sickling Of Rbc, Reduction (Mayo)OutsideLaboratory",,85660,CPT,Facility,Both,,,90,132,112.2,37.8312,132,CorVel,Worker's Compensation,132,100,,percent of total billed charges,,
"Sickling Of Rbc, Reduction (Mayo)OutsideLaboratory",,85660,CPT,Facility,Both,,,90,132,112.2,37.8312,132,First Health Group Corporation,First Health Network,128.04,97,,percent of total billed charges,,
"Sickling Of Rbc, Reduction (Mayo)OutsideLaboratory",,85660,CPT,Facility,Both,,,90,132,112.2,37.8312,132,"Health Partners, Inc.",Commercial,124.872,94.6,,percent of total billed charges,,
"Sickling Of Rbc, Reduction (Mayo)OutsideLaboratory",,85660,CPT,Facility,Outpatient,,,90,132,112.2,37.8312,132,"Health Partners, Inc.",Medicare Advantage,64.68,49,,percent of total billed charges,,
"Sickling Of Rbc, Reduction (Mayo)OutsideLaboratory",,85660,CPT,Facility,Inpatient,,,90,132,112.2,37.8312,132,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Sickling Of Rbc, Reduction (Mayo)OutsideLaboratory",,85660,CPT,Facility,Both,,,90,132,112.2,37.8312,132,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),79.2,60,,percent of total billed charges,,
"Sickling Of Rbc, Reduction (Mayo)OutsideLaboratory",,85660,CPT,Facility,Both,,,90,132,112.2,37.8312,132,"Health Partners, Inc.",State of Minnesota Advantage Program,107.58,81.5,,percent of total billed charges,,
"Sickling Of Rbc, Reduction (Mayo)OutsideLaboratory",,85660,CPT,Facility,Both,,,90,132,112.2,37.8312,132,"Health Partners, Inc.",State Public Programs,66,50,,percent of total billed charges,,
"Sickling Of Rbc, Reduction (Mayo)OutsideLaboratory",,85660,CPT,Facility,Both,,,90,132,112.2,37.8312,132,Humana Insurance Company,Commercial PPO,125.4,95,,percent of total billed charges,,
"Sickling Of Rbc, Reduction (Mayo)OutsideLaboratory",,85660,CPT,Facility,Outpatient,,,90,132,112.2,37.8312,132,Humana Insurance Company,Medicare PPO,64.68,49,,percent of total billed charges,,
"Sickling Of Rbc, Reduction (Mayo)OutsideLaboratory",,85660,CPT,Facility,Inpatient,,,90,132,112.2,37.8312,132,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Sickling Of Rbc, Reduction (Mayo)OutsideLaboratory",,85660,CPT,Facility,Both,,,90,132,112.2,37.8312,132,Medica,Individual & Family,130.812,99.1,,percent of total billed charges,,
"Sickling Of Rbc, Reduction (Mayo)OutsideLaboratory",,85660,CPT,Facility,Outpatient,,,90,132,112.2,37.8312,132,Medica,Medica Advantage Solution,65.736,49.8,,percent of total billed charges,,
"Sickling Of Rbc, Reduction (Mayo)OutsideLaboratory",,85660,CPT,Facility,Inpatient,,,90,132,112.2,37.8312,132,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Sickling Of Rbc, Reduction (Mayo)OutsideLaboratory",,85660,CPT,Facility,Outpatient,,,90,132,112.2,37.8312,132,Medica,Medical Assistance,58.872,44.6,,percent of total billed charges,,
"Sickling Of Rbc, Reduction (Mayo)OutsideLaboratory",,85660,CPT,Facility,Inpatient,,,90,132,112.2,37.8312,132,Medica,Medical Assistance,,,,,Included in per diem rate,
"Sickling Of Rbc, Reduction (Mayo)OutsideLaboratory",,85660,CPT,Facility,Outpatient,,,90,132,112.2,37.8312,132,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,65.736,49.8,,percent of total billed charges,,
"Sickling Of Rbc, Reduction (Mayo)OutsideLaboratory",,85660,CPT,Facility,Inpatient,,,90,132,112.2,37.8312,132,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Sickling Of Rbc, Reduction (Mayo)OutsideLaboratory",,85660,CPT,Facility,Both,,,90,132,112.2,37.8312,132,"Multiplan, Inc.","Multiplan, Inc.",124.08,94,,percent of total billed charges,,
"Sickling Of Rbc, Reduction (Mayo)OutsideLaboratory",,85660,CPT,Facility,Outpatient,,,90,132,112.2,37.8312,132,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,114.048,86.4,,percent of total billed charges,,
"Sickling Of Rbc, Reduction (Mayo)OutsideLaboratory",,85660,CPT,Facility,Inpatient,,,90,132,112.2,37.8312,132,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Sickling Of Rbc, Reduction (Mayo)OutsideLaboratory",,85660,CPT,Facility,Both,,,90,132,112.2,37.8312,132,"Preferred One Administrative Services, INC.",PPO,130.152,98.6,,percent of total billed charges,,
"Sickling Of Rbc, Reduction (Mayo)OutsideLaboratory",,85660,CPT,Facility,Outpatient,,,90,132,112.2,37.8312,132,PrimeWest Health,Minnesota Senior Health Options (MSHO),67.914,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Sickling Of Rbc, Reduction (Mayo)OutsideLaboratory",,85660,CPT,Facility,Inpatient,,,90,132,112.2,37.8312,132,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Sickling Of Rbc, Reduction (Mayo)OutsideLaboratory",,85660,CPT,Facility,Outpatient,,,90,132,112.2,37.8312,132,PrimeWest Health,MinnesotaCare,67.7952,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Sickling Of Rbc, Reduction (Mayo)OutsideLaboratory",,85660,CPT,Facility,Inpatient,,,90,132,112.2,37.8312,132,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Sickling Of Rbc, Reduction (Mayo)OutsideLaboratory",,85660,CPT,Facility,Both,,,90,132,112.2,37.8312,132,Sanford Health Plan,Sanford Health Plan,121.44,92,,percent of total billed charges,,
"Sickling Of Rbc, Reduction (Mayo)OutsideLaboratory",,85660,CPT,Facility,Outpatient,,,90,132,112.2,37.8312,132,"UCare Health, Inc.",Individual & Family Plan,74.382,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Sickling Of Rbc, Reduction (Mayo)OutsideLaboratory",,85660,CPT,Facility,Inpatient,,,90,132,112.2,37.8312,132,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Sickling Of Rbc, Reduction (Mayo)OutsideLaboratory",,85660,CPT,Facility,Outpatient,,,90,132,112.2,37.8312,132,"UCare Health, Inc.",Medical Assistance,66.6204,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Sickling Of Rbc, Reduction (Mayo)OutsideLaboratory",,85660,CPT,Facility,Inpatient,,,90,132,112.2,37.8312,132,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Sickling Of Rbc, Reduction (Mayo)OutsideLaboratory",,85660,CPT,Facility,Outpatient,,,90,132,112.2,37.8312,132,"UCare Health, Inc.",Medicare Advantage,66.6204,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Sickling Of Rbc, Reduction (Mayo)OutsideLaboratory",,85660,CPT,Facility,Inpatient,,,90,132,112.2,37.8312,132,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Sickling Of Rbc, Reduction (Mayo)OutsideLaboratory",,85660,CPT,Facility,Outpatient,,,90,132,112.2,37.8312,132,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),66.6204,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Sickling Of Rbc, Reduction (Mayo)OutsideLaboratory",,85660,CPT,Facility,Inpatient,,,90,132,112.2,37.8312,132,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Sickling Of Rbc, Reduction (Mayo)OutsideLaboratory",,85660,CPT,Facility,Both,,,90,132,112.2,37.8312,132,UnitedHealthcare,Individual & Family,124.08,94,,percent of total billed charges,,
"Sickling Of Rbc, Reduction (Mayo)OutsideLaboratory",,85660,CPT,Facility,Outpatient,,,90,132,112.2,37.8312,132,UnitedHealthcare,Medicare Advantage,64.68,49,,percent of total billed charges,,
"Sickling Of Rbc, Reduction (Mayo)OutsideLaboratory",,85660,CPT,Facility,Inpatient,,,90,132,112.2,37.8312,132,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Sickling Of Rbc, Reduction (Mayo)OutsideLaboratory",,85660,CPT,Facility,Outpatient,,,90,132,112.2,37.8312,132,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,63.36,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Sickling Of Rbc, Reduction (Mayo)OutsideLaboratory",,85660,CPT,Facility,Inpatient,,,90,132,112.2,37.8312,132,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Thrombin Time (Bovine), P (Mayo)OutsideLaboratory",,85670,CPT,Facility,Both,,,90,121,102.85,34.6786,121,Aetna,Commercial,111.32,92,,percent of total billed charges,,
"Thrombin Time (Bovine), P (Mayo)OutsideLaboratory",,85670,CPT,Facility,Outpatient,,,90,121,102.85,34.6786,121,Aetna,Medicare Advantage,59.29,49,,percent of total billed charges,,
"Thrombin Time (Bovine), P (Mayo)OutsideLaboratory",,85670,CPT,Facility,Inpatient,,,90,121,102.85,34.6786,121,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Thrombin Time (Bovine), P (Mayo)OutsideLaboratory",,85670,CPT,Facility,Both,,,90,121,102.85,34.6786,121,Aetna,PPO,112.53,93,,percent of total billed charges,,
"Thrombin Time (Bovine), P (Mayo)OutsideLaboratory",,85670,CPT,Facility,Both,,,90,121,102.85,34.6786,121,America's PPO,America's PPO,116.1963,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Thrombin Time (Bovine), P (Mayo)OutsideLaboratory",,85670,CPT,Facility,Both,,,90,121,102.85,34.6786,121,BlueCross BlueShield Minnesota, Federal Employee Program,119.064,98.4,,percent of total billed charges,,
"Thrombin Time (Bovine), P (Mayo)OutsideLaboratory",,85670,CPT,Facility,Both,,,90,121,102.85,34.6786,121,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,121,100,,percent of total billed charges,,
"Thrombin Time (Bovine), P (Mayo)OutsideLaboratory",,85670,CPT,Facility,Both,,,90,121,102.85,34.6786,121,BlueCross BlueShield Minnesota,High Value Network Plan,108.9,90,,percent of total billed charges,,
"Thrombin Time (Bovine), P (Mayo)OutsideLaboratory",,85670,CPT,Facility,Outpatient,,,90,121,102.85,34.6786,121,BlueCross BlueShield Minnesota,Medicare Advantage,59.29,49,,percent of total billed charges,,
"Thrombin Time (Bovine), P (Mayo)OutsideLaboratory",,85670,CPT,Facility,Inpatient,,,90,121,102.85,34.6786,121,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Thrombin Time (Bovine), P (Mayo)OutsideLaboratory",,85670,CPT,Facility,Both,,,90,121,102.85,34.6786,121,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,107.1697,88.57,,percent of total billed charges,,
"Thrombin Time (Bovine), P (Mayo)OutsideLaboratory",,85670,CPT,Facility,Both,,,90,121,102.85,34.6786,121,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,34.6786,28.66,,percent of total billed charges,,
"Thrombin Time (Bovine), P (Mayo)OutsideLaboratory",,85670,CPT,Facility,Outpatient,,,90,121,102.85,34.6786,121,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),59.29,49,,percent of total billed charges,,
"Thrombin Time (Bovine), P (Mayo)OutsideLaboratory",,85670,CPT,Facility,Inpatient,,,90,121,102.85,34.6786,121,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Thrombin Time (Bovine), P (Mayo)OutsideLaboratory",,85670,CPT,Facility,Both,,,90,121,102.85,34.6786,121,CorVel,Worker's Compensation,121,100,,percent of total billed charges,,
"Thrombin Time (Bovine), P (Mayo)OutsideLaboratory",,85670,CPT,Facility,Both,,,90,121,102.85,34.6786,121,First Health Group Corporation,First Health Network,117.37,97,,percent of total billed charges,,
"Thrombin Time (Bovine), P (Mayo)OutsideLaboratory",,85670,CPT,Facility,Both,,,90,121,102.85,34.6786,121,"Health Partners, Inc.",Commercial,114.466,94.6,,percent of total billed charges,,
"Thrombin Time (Bovine), P (Mayo)OutsideLaboratory",,85670,CPT,Facility,Outpatient,,,90,121,102.85,34.6786,121,"Health Partners, Inc.",Medicare Advantage,59.29,49,,percent of total billed charges,,
"Thrombin Time (Bovine), P (Mayo)OutsideLaboratory",,85670,CPT,Facility,Inpatient,,,90,121,102.85,34.6786,121,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Thrombin Time (Bovine), P (Mayo)OutsideLaboratory",,85670,CPT,Facility,Both,,,90,121,102.85,34.6786,121,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),72.6,60,,percent of total billed charges,,
"Thrombin Time (Bovine), P (Mayo)OutsideLaboratory",,85670,CPT,Facility,Both,,,90,121,102.85,34.6786,121,"Health Partners, Inc.",State of Minnesota Advantage Program,98.615,81.5,,percent of total billed charges,,
"Thrombin Time (Bovine), P (Mayo)OutsideLaboratory",,85670,CPT,Facility,Both,,,90,121,102.85,34.6786,121,"Health Partners, Inc.",State Public Programs,60.5,50,,percent of total billed charges,,
"Thrombin Time (Bovine), P (Mayo)OutsideLaboratory",,85670,CPT,Facility,Both,,,90,121,102.85,34.6786,121,Humana Insurance Company,Commercial PPO,114.95,95,,percent of total billed charges,,
"Thrombin Time (Bovine), P (Mayo)OutsideLaboratory",,85670,CPT,Facility,Outpatient,,,90,121,102.85,34.6786,121,Humana Insurance Company,Medicare PPO,59.29,49,,percent of total billed charges,,
"Thrombin Time (Bovine), P (Mayo)OutsideLaboratory",,85670,CPT,Facility,Inpatient,,,90,121,102.85,34.6786,121,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Thrombin Time (Bovine), P (Mayo)OutsideLaboratory",,85670,CPT,Facility,Both,,,90,121,102.85,34.6786,121,Medica,Individual & Family,119.911,99.1,,percent of total billed charges,,
"Thrombin Time (Bovine), P (Mayo)OutsideLaboratory",,85670,CPT,Facility,Outpatient,,,90,121,102.85,34.6786,121,Medica,Medica Advantage Solution,60.258,49.8,,percent of total billed charges,,
"Thrombin Time (Bovine), P (Mayo)OutsideLaboratory",,85670,CPT,Facility,Inpatient,,,90,121,102.85,34.6786,121,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Thrombin Time (Bovine), P (Mayo)OutsideLaboratory",,85670,CPT,Facility,Outpatient,,,90,121,102.85,34.6786,121,Medica,Medical Assistance,53.966,44.6,,percent of total billed charges,,
"Thrombin Time (Bovine), P (Mayo)OutsideLaboratory",,85670,CPT,Facility,Inpatient,,,90,121,102.85,34.6786,121,Medica,Medical Assistance,,,,,Included in per diem rate,
"Thrombin Time (Bovine), P (Mayo)OutsideLaboratory",,85670,CPT,Facility,Outpatient,,,90,121,102.85,34.6786,121,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,60.258,49.8,,percent of total billed charges,,
"Thrombin Time (Bovine), P (Mayo)OutsideLaboratory",,85670,CPT,Facility,Inpatient,,,90,121,102.85,34.6786,121,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Thrombin Time (Bovine), P (Mayo)OutsideLaboratory",,85670,CPT,Facility,Both,,,90,121,102.85,34.6786,121,"Multiplan, Inc.","Multiplan, Inc.",113.74,94,,percent of total billed charges,,
"Thrombin Time (Bovine), P (Mayo)OutsideLaboratory",,85670,CPT,Facility,Outpatient,,,90,121,102.85,34.6786,121,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,104.544,86.4,,percent of total billed charges,,
"Thrombin Time (Bovine), P (Mayo)OutsideLaboratory",,85670,CPT,Facility,Inpatient,,,90,121,102.85,34.6786,121,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Thrombin Time (Bovine), P (Mayo)OutsideLaboratory",,85670,CPT,Facility,Both,,,90,121,102.85,34.6786,121,"Preferred One Administrative Services, INC.",PPO,119.306,98.6,,percent of total billed charges,,
"Thrombin Time (Bovine), P (Mayo)OutsideLaboratory",,85670,CPT,Facility,Outpatient,,,90,121,102.85,34.6786,121,PrimeWest Health,Minnesota Senior Health Options (MSHO),62.2545,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Thrombin Time (Bovine), P (Mayo)OutsideLaboratory",,85670,CPT,Facility,Inpatient,,,90,121,102.85,34.6786,121,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Thrombin Time (Bovine), P (Mayo)OutsideLaboratory",,85670,CPT,Facility,Outpatient,,,90,121,102.85,34.6786,121,PrimeWest Health,MinnesotaCare,62.1456,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Thrombin Time (Bovine), P (Mayo)OutsideLaboratory",,85670,CPT,Facility,Inpatient,,,90,121,102.85,34.6786,121,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Thrombin Time (Bovine), P (Mayo)OutsideLaboratory",,85670,CPT,Facility,Both,,,90,121,102.85,34.6786,121,Sanford Health Plan,Sanford Health Plan,111.32,92,,percent of total billed charges,,
"Thrombin Time (Bovine), P (Mayo)OutsideLaboratory",,85670,CPT,Facility,Outpatient,,,90,121,102.85,34.6786,121,"UCare Health, Inc.",Individual & Family Plan,68.1835,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Thrombin Time (Bovine), P (Mayo)OutsideLaboratory",,85670,CPT,Facility,Inpatient,,,90,121,102.85,34.6786,121,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Thrombin Time (Bovine), P (Mayo)OutsideLaboratory",,85670,CPT,Facility,Outpatient,,,90,121,102.85,34.6786,121,"UCare Health, Inc.",Medical Assistance,61.0687,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Thrombin Time (Bovine), P (Mayo)OutsideLaboratory",,85670,CPT,Facility,Inpatient,,,90,121,102.85,34.6786,121,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Thrombin Time (Bovine), P (Mayo)OutsideLaboratory",,85670,CPT,Facility,Outpatient,,,90,121,102.85,34.6786,121,"UCare Health, Inc.",Medicare Advantage,61.0687,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Thrombin Time (Bovine), P (Mayo)OutsideLaboratory",,85670,CPT,Facility,Inpatient,,,90,121,102.85,34.6786,121,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Thrombin Time (Bovine), P (Mayo)OutsideLaboratory",,85670,CPT,Facility,Outpatient,,,90,121,102.85,34.6786,121,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),61.0687,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Thrombin Time (Bovine), P (Mayo)OutsideLaboratory",,85670,CPT,Facility,Inpatient,,,90,121,102.85,34.6786,121,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Thrombin Time (Bovine), P (Mayo)OutsideLaboratory",,85670,CPT,Facility,Both,,,90,121,102.85,34.6786,121,UnitedHealthcare,Individual & Family,113.74,94,,percent of total billed charges,,
"Thrombin Time (Bovine), P (Mayo)OutsideLaboratory",,85670,CPT,Facility,Outpatient,,,90,121,102.85,34.6786,121,UnitedHealthcare,Medicare Advantage,59.29,49,,percent of total billed charges,,
"Thrombin Time (Bovine), P (Mayo)OutsideLaboratory",,85670,CPT,Facility,Inpatient,,,90,121,102.85,34.6786,121,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Thrombin Time (Bovine), P (Mayo)OutsideLaboratory",,85670,CPT,Facility,Outpatient,,,90,121,102.85,34.6786,121,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,58.08,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Thrombin Time (Bovine), P (Mayo)OutsideLaboratory",,85670,CPT,Facility,Inpatient,,,90,121,102.85,34.6786,121,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Thrombin Time, Plasma (Mayo)OutsideLaboratory",,85670,CPT,Facility,Both,,,90,121,102.85,34.6786,121,Aetna,Commercial,111.32,92,,percent of total billed charges,,
"Thrombin Time, Plasma (Mayo)OutsideLaboratory",,85670,CPT,Facility,Outpatient,,,90,121,102.85,34.6786,121,Aetna,Medicare Advantage,59.29,49,,percent of total billed charges,,
"Thrombin Time, Plasma (Mayo)OutsideLaboratory",,85670,CPT,Facility,Inpatient,,,90,121,102.85,34.6786,121,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Thrombin Time, Plasma (Mayo)OutsideLaboratory",,85670,CPT,Facility,Both,,,90,121,102.85,34.6786,121,Aetna,PPO,112.53,93,,percent of total billed charges,,
"Thrombin Time, Plasma (Mayo)OutsideLaboratory",,85670,CPT,Facility,Both,,,90,121,102.85,34.6786,121,America's PPO,America's PPO,116.1963,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Thrombin Time, Plasma (Mayo)OutsideLaboratory",,85670,CPT,Facility,Both,,,90,121,102.85,34.6786,121,BlueCross BlueShield Minnesota, Federal Employee Program,119.064,98.4,,percent of total billed charges,,
"Thrombin Time, Plasma (Mayo)OutsideLaboratory",,85670,CPT,Facility,Both,,,90,121,102.85,34.6786,121,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,121,100,,percent of total billed charges,,
"Thrombin Time, Plasma (Mayo)OutsideLaboratory",,85670,CPT,Facility,Both,,,90,121,102.85,34.6786,121,BlueCross BlueShield Minnesota,High Value Network Plan,108.9,90,,percent of total billed charges,,
"Thrombin Time, Plasma (Mayo)OutsideLaboratory",,85670,CPT,Facility,Outpatient,,,90,121,102.85,34.6786,121,BlueCross BlueShield Minnesota,Medicare Advantage,59.29,49,,percent of total billed charges,,
"Thrombin Time, Plasma (Mayo)OutsideLaboratory",,85670,CPT,Facility,Inpatient,,,90,121,102.85,34.6786,121,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Thrombin Time, Plasma (Mayo)OutsideLaboratory",,85670,CPT,Facility,Both,,,90,121,102.85,34.6786,121,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,107.1697,88.57,,percent of total billed charges,,
"Thrombin Time, Plasma (Mayo)OutsideLaboratory",,85670,CPT,Facility,Both,,,90,121,102.85,34.6786,121,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,34.6786,28.66,,percent of total billed charges,,
"Thrombin Time, Plasma (Mayo)OutsideLaboratory",,85670,CPT,Facility,Outpatient,,,90,121,102.85,34.6786,121,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),59.29,49,,percent of total billed charges,,
"Thrombin Time, Plasma (Mayo)OutsideLaboratory",,85670,CPT,Facility,Inpatient,,,90,121,102.85,34.6786,121,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Thrombin Time, Plasma (Mayo)OutsideLaboratory",,85670,CPT,Facility,Both,,,90,121,102.85,34.6786,121,CorVel,Worker's Compensation,121,100,,percent of total billed charges,,
"Thrombin Time, Plasma (Mayo)OutsideLaboratory",,85670,CPT,Facility,Both,,,90,121,102.85,34.6786,121,First Health Group Corporation,First Health Network,117.37,97,,percent of total billed charges,,
"Thrombin Time, Plasma (Mayo)OutsideLaboratory",,85670,CPT,Facility,Both,,,90,121,102.85,34.6786,121,"Health Partners, Inc.",Commercial,114.466,94.6,,percent of total billed charges,,
"Thrombin Time, Plasma (Mayo)OutsideLaboratory",,85670,CPT,Facility,Outpatient,,,90,121,102.85,34.6786,121,"Health Partners, Inc.",Medicare Advantage,59.29,49,,percent of total billed charges,,
"Thrombin Time, Plasma (Mayo)OutsideLaboratory",,85670,CPT,Facility,Inpatient,,,90,121,102.85,34.6786,121,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Thrombin Time, Plasma (Mayo)OutsideLaboratory",,85670,CPT,Facility,Both,,,90,121,102.85,34.6786,121,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),72.6,60,,percent of total billed charges,,
"Thrombin Time, Plasma (Mayo)OutsideLaboratory",,85670,CPT,Facility,Both,,,90,121,102.85,34.6786,121,"Health Partners, Inc.",State of Minnesota Advantage Program,98.615,81.5,,percent of total billed charges,,
"Thrombin Time, Plasma (Mayo)OutsideLaboratory",,85670,CPT,Facility,Both,,,90,121,102.85,34.6786,121,"Health Partners, Inc.",State Public Programs,60.5,50,,percent of total billed charges,,
"Thrombin Time, Plasma (Mayo)OutsideLaboratory",,85670,CPT,Facility,Both,,,90,121,102.85,34.6786,121,Humana Insurance Company,Commercial PPO,114.95,95,,percent of total billed charges,,
"Thrombin Time, Plasma (Mayo)OutsideLaboratory",,85670,CPT,Facility,Outpatient,,,90,121,102.85,34.6786,121,Humana Insurance Company,Medicare PPO,59.29,49,,percent of total billed charges,,
"Thrombin Time, Plasma (Mayo)OutsideLaboratory",,85670,CPT,Facility,Inpatient,,,90,121,102.85,34.6786,121,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Thrombin Time, Plasma (Mayo)OutsideLaboratory",,85670,CPT,Facility,Both,,,90,121,102.85,34.6786,121,Medica,Individual & Family,119.911,99.1,,percent of total billed charges,,
"Thrombin Time, Plasma (Mayo)OutsideLaboratory",,85670,CPT,Facility,Outpatient,,,90,121,102.85,34.6786,121,Medica,Medica Advantage Solution,60.258,49.8,,percent of total billed charges,,
"Thrombin Time, Plasma (Mayo)OutsideLaboratory",,85670,CPT,Facility,Inpatient,,,90,121,102.85,34.6786,121,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Thrombin Time, Plasma (Mayo)OutsideLaboratory",,85670,CPT,Facility,Outpatient,,,90,121,102.85,34.6786,121,Medica,Medical Assistance,53.966,44.6,,percent of total billed charges,,
"Thrombin Time, Plasma (Mayo)OutsideLaboratory",,85670,CPT,Facility,Inpatient,,,90,121,102.85,34.6786,121,Medica,Medical Assistance,,,,,Included in per diem rate,
"Thrombin Time, Plasma (Mayo)OutsideLaboratory",,85670,CPT,Facility,Outpatient,,,90,121,102.85,34.6786,121,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,60.258,49.8,,percent of total billed charges,,
"Thrombin Time, Plasma (Mayo)OutsideLaboratory",,85670,CPT,Facility,Inpatient,,,90,121,102.85,34.6786,121,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Thrombin Time, Plasma (Mayo)OutsideLaboratory",,85670,CPT,Facility,Both,,,90,121,102.85,34.6786,121,"Multiplan, Inc.","Multiplan, Inc.",113.74,94,,percent of total billed charges,,
"Thrombin Time, Plasma (Mayo)OutsideLaboratory",,85670,CPT,Facility,Outpatient,,,90,121,102.85,34.6786,121,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,104.544,86.4,,percent of total billed charges,,
"Thrombin Time, Plasma (Mayo)OutsideLaboratory",,85670,CPT,Facility,Inpatient,,,90,121,102.85,34.6786,121,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Thrombin Time, Plasma (Mayo)OutsideLaboratory",,85670,CPT,Facility,Both,,,90,121,102.85,34.6786,121,"Preferred One Administrative Services, INC.",PPO,119.306,98.6,,percent of total billed charges,,
"Thrombin Time, Plasma (Mayo)OutsideLaboratory",,85670,CPT,Facility,Outpatient,,,90,121,102.85,34.6786,121,PrimeWest Health,Minnesota Senior Health Options (MSHO),62.2545,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Thrombin Time, Plasma (Mayo)OutsideLaboratory",,85670,CPT,Facility,Inpatient,,,90,121,102.85,34.6786,121,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Thrombin Time, Plasma (Mayo)OutsideLaboratory",,85670,CPT,Facility,Outpatient,,,90,121,102.85,34.6786,121,PrimeWest Health,MinnesotaCare,62.1456,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Thrombin Time, Plasma (Mayo)OutsideLaboratory",,85670,CPT,Facility,Inpatient,,,90,121,102.85,34.6786,121,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Thrombin Time, Plasma (Mayo)OutsideLaboratory",,85670,CPT,Facility,Both,,,90,121,102.85,34.6786,121,Sanford Health Plan,Sanford Health Plan,111.32,92,,percent of total billed charges,,
"Thrombin Time, Plasma (Mayo)OutsideLaboratory",,85670,CPT,Facility,Outpatient,,,90,121,102.85,34.6786,121,"UCare Health, Inc.",Individual & Family Plan,68.1835,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Thrombin Time, Plasma (Mayo)OutsideLaboratory",,85670,CPT,Facility,Inpatient,,,90,121,102.85,34.6786,121,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Thrombin Time, Plasma (Mayo)OutsideLaboratory",,85670,CPT,Facility,Outpatient,,,90,121,102.85,34.6786,121,"UCare Health, Inc.",Medical Assistance,61.0687,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Thrombin Time, Plasma (Mayo)OutsideLaboratory",,85670,CPT,Facility,Inpatient,,,90,121,102.85,34.6786,121,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Thrombin Time, Plasma (Mayo)OutsideLaboratory",,85670,CPT,Facility,Outpatient,,,90,121,102.85,34.6786,121,"UCare Health, Inc.",Medicare Advantage,61.0687,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Thrombin Time, Plasma (Mayo)OutsideLaboratory",,85670,CPT,Facility,Inpatient,,,90,121,102.85,34.6786,121,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Thrombin Time, Plasma (Mayo)OutsideLaboratory",,85670,CPT,Facility,Outpatient,,,90,121,102.85,34.6786,121,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),61.0687,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Thrombin Time, Plasma (Mayo)OutsideLaboratory",,85670,CPT,Facility,Inpatient,,,90,121,102.85,34.6786,121,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Thrombin Time, Plasma (Mayo)OutsideLaboratory",,85670,CPT,Facility,Both,,,90,121,102.85,34.6786,121,UnitedHealthcare,Individual & Family,113.74,94,,percent of total billed charges,,
"Thrombin Time, Plasma (Mayo)OutsideLaboratory",,85670,CPT,Facility,Outpatient,,,90,121,102.85,34.6786,121,UnitedHealthcare,Medicare Advantage,59.29,49,,percent of total billed charges,,
"Thrombin Time, Plasma (Mayo)OutsideLaboratory",,85670,CPT,Facility,Inpatient,,,90,121,102.85,34.6786,121,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Thrombin Time, Plasma (Mayo)OutsideLaboratory",,85670,CPT,Facility,Outpatient,,,90,121,102.85,34.6786,121,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,58.08,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Thrombin Time, Plasma (Mayo)OutsideLaboratory",,85670,CPT,Facility,Inpatient,,,90,121,102.85,34.6786,121,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Thrombin Time; Plasma (Mayo)OutsideLaboratory,,85670,CPT,Facility,Both,,,90,121,102.85,34.6786,121,Aetna,Commercial,111.32,92,,percent of total billed charges,,
Thrombin Time; Plasma (Mayo)OutsideLaboratory,,85670,CPT,Facility,Both,,,90,121,102.85,34.6786,121,Aetna,Commercial,111.32,92,,percent of total billed charges,,
Thrombin Time; Plasma (Mayo)OutsideLaboratory,,85670,CPT,Facility,Outpatient,,,90,121,102.85,34.6786,121,Aetna,Medicare Advantage,59.29,49,,percent of total billed charges,,
Thrombin Time; Plasma (Mayo)OutsideLaboratory,,85670,CPT,Facility,Outpatient,,,90,121,102.85,34.6786,121,Aetna,Medicare Advantage,59.29,49,,percent of total billed charges,,
Thrombin Time; Plasma (Mayo)OutsideLaboratory,,85670,CPT,Facility,Inpatient,,,90,121,102.85,34.6786,121,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Thrombin Time; Plasma (Mayo)OutsideLaboratory,,85670,CPT,Facility,Inpatient,,,90,121,102.85,34.6786,121,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Thrombin Time; Plasma (Mayo)OutsideLaboratory,,85670,CPT,Facility,Both,,,90,121,102.85,34.6786,121,Aetna,PPO,112.53,93,,percent of total billed charges,,
Thrombin Time; Plasma (Mayo)OutsideLaboratory,,85670,CPT,Facility,Both,,,90,121,102.85,34.6786,121,Aetna,PPO,112.53,93,,percent of total billed charges,,
Thrombin Time; Plasma (Mayo)OutsideLaboratory,,85670,CPT,Facility,Both,,,90,121,102.85,34.6786,121,America's PPO,America's PPO,116.1963,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Thrombin Time; Plasma (Mayo)OutsideLaboratory,,85670,CPT,Facility,Both,,,90,121,102.85,34.6786,121,America's PPO,America's PPO,116.1963,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Thrombin Time; Plasma (Mayo)OutsideLaboratory,,85670,CPT,Facility,Both,,,90,121,102.85,34.6786,121,BlueCross BlueShield Minnesota, Federal Employee Program,119.064,98.4,,percent of total billed charges,,
Thrombin Time; Plasma (Mayo)OutsideLaboratory,,85670,CPT,Facility,Both,,,90,121,102.85,34.6786,121,BlueCross BlueShield Minnesota, Federal Employee Program,119.064,98.4,,percent of total billed charges,,
Thrombin Time; Plasma (Mayo)OutsideLaboratory,,85670,CPT,Facility,Both,,,90,121,102.85,34.6786,121,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,121,100,,percent of total billed charges,,
Thrombin Time; Plasma (Mayo)OutsideLaboratory,,85670,CPT,Facility,Both,,,90,121,102.85,34.6786,121,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,121,100,,percent of total billed charges,,
Thrombin Time; Plasma (Mayo)OutsideLaboratory,,85670,CPT,Facility,Both,,,90,121,102.85,34.6786,121,BlueCross BlueShield Minnesota,High Value Network Plan,108.9,90,,percent of total billed charges,,
Thrombin Time; Plasma (Mayo)OutsideLaboratory,,85670,CPT,Facility,Both,,,90,121,102.85,34.6786,121,BlueCross BlueShield Minnesota,High Value Network Plan,108.9,90,,percent of total billed charges,,
Thrombin Time; Plasma (Mayo)OutsideLaboratory,,85670,CPT,Facility,Outpatient,,,90,121,102.85,34.6786,121,BlueCross BlueShield Minnesota,Medicare Advantage,59.29,49,,percent of total billed charges,,
Thrombin Time; Plasma (Mayo)OutsideLaboratory,,85670,CPT,Facility,Outpatient,,,90,121,102.85,34.6786,121,BlueCross BlueShield Minnesota,Medicare Advantage,59.29,49,,percent of total billed charges,,
Thrombin Time; Plasma (Mayo)OutsideLaboratory,,85670,CPT,Facility,Inpatient,,,90,121,102.85,34.6786,121,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Thrombin Time; Plasma (Mayo)OutsideLaboratory,,85670,CPT,Facility,Inpatient,,,90,121,102.85,34.6786,121,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Thrombin Time; Plasma (Mayo)OutsideLaboratory,,85670,CPT,Facility,Both,,,90,121,102.85,34.6786,121,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,107.1697,88.57,,percent of total billed charges,,
Thrombin Time; Plasma (Mayo)OutsideLaboratory,,85670,CPT,Facility,Both,,,90,121,102.85,34.6786,121,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,107.1697,88.57,,percent of total billed charges,,
Thrombin Time; Plasma (Mayo)OutsideLaboratory,,85670,CPT,Facility,Both,,,90,121,102.85,34.6786,121,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,34.6786,28.66,,percent of total billed charges,,
Thrombin Time; Plasma (Mayo)OutsideLaboratory,,85670,CPT,Facility,Both,,,90,121,102.85,34.6786,121,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,34.6786,28.66,,percent of total billed charges,,
Thrombin Time; Plasma (Mayo)OutsideLaboratory,,85670,CPT,Facility,Outpatient,,,90,121,102.85,34.6786,121,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),59.29,49,,percent of total billed charges,,
Thrombin Time; Plasma (Mayo)OutsideLaboratory,,85670,CPT,Facility,Outpatient,,,90,121,102.85,34.6786,121,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),59.29,49,,percent of total billed charges,,
Thrombin Time; Plasma (Mayo)OutsideLaboratory,,85670,CPT,Facility,Inpatient,,,90,121,102.85,34.6786,121,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Thrombin Time; Plasma (Mayo)OutsideLaboratory,,85670,CPT,Facility,Inpatient,,,90,121,102.85,34.6786,121,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Thrombin Time; Plasma (Mayo)OutsideLaboratory,,85670,CPT,Facility,Both,,,90,121,102.85,34.6786,121,CorVel,Worker's Compensation,121,100,,percent of total billed charges,,
Thrombin Time; Plasma (Mayo)OutsideLaboratory,,85670,CPT,Facility,Both,,,90,121,102.85,34.6786,121,CorVel,Worker's Compensation,121,100,,percent of total billed charges,,
Thrombin Time; Plasma (Mayo)OutsideLaboratory,,85670,CPT,Facility,Both,,,90,121,102.85,34.6786,121,First Health Group Corporation,First Health Network,117.37,97,,percent of total billed charges,,
Thrombin Time; Plasma (Mayo)OutsideLaboratory,,85670,CPT,Facility,Both,,,90,121,102.85,34.6786,121,First Health Group Corporation,First Health Network,117.37,97,,percent of total billed charges,,
Thrombin Time; Plasma (Mayo)OutsideLaboratory,,85670,CPT,Facility,Both,,,90,121,102.85,34.6786,121,"Health Partners, Inc.",Commercial,114.466,94.6,,percent of total billed charges,,
Thrombin Time; Plasma (Mayo)OutsideLaboratory,,85670,CPT,Facility,Both,,,90,121,102.85,34.6786,121,"Health Partners, Inc.",Commercial,114.466,94.6,,percent of total billed charges,,
Thrombin Time; Plasma (Mayo)OutsideLaboratory,,85670,CPT,Facility,Outpatient,,,90,121,102.85,34.6786,121,"Health Partners, Inc.",Medicare Advantage,59.29,49,,percent of total billed charges,,
Thrombin Time; Plasma (Mayo)OutsideLaboratory,,85670,CPT,Facility,Outpatient,,,90,121,102.85,34.6786,121,"Health Partners, Inc.",Medicare Advantage,59.29,49,,percent of total billed charges,,
Thrombin Time; Plasma (Mayo)OutsideLaboratory,,85670,CPT,Facility,Inpatient,,,90,121,102.85,34.6786,121,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Thrombin Time; Plasma (Mayo)OutsideLaboratory,,85670,CPT,Facility,Inpatient,,,90,121,102.85,34.6786,121,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Thrombin Time; Plasma (Mayo)OutsideLaboratory,,85670,CPT,Facility,Both,,,90,121,102.85,34.6786,121,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),72.6,60,,percent of total billed charges,,
Thrombin Time; Plasma (Mayo)OutsideLaboratory,,85670,CPT,Facility,Both,,,90,121,102.85,34.6786,121,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),72.6,60,,percent of total billed charges,,
Thrombin Time; Plasma (Mayo)OutsideLaboratory,,85670,CPT,Facility,Both,,,90,121,102.85,34.6786,121,"Health Partners, Inc.",State of Minnesota Advantage Program,98.615,81.5,,percent of total billed charges,,
Thrombin Time; Plasma (Mayo)OutsideLaboratory,,85670,CPT,Facility,Both,,,90,121,102.85,34.6786,121,"Health Partners, Inc.",State of Minnesota Advantage Program,98.615,81.5,,percent of total billed charges,,
Thrombin Time; Plasma (Mayo)OutsideLaboratory,,85670,CPT,Facility,Both,,,90,121,102.85,34.6786,121,"Health Partners, Inc.",State Public Programs,60.5,50,,percent of total billed charges,,
Thrombin Time; Plasma (Mayo)OutsideLaboratory,,85670,CPT,Facility,Both,,,90,121,102.85,34.6786,121,"Health Partners, Inc.",State Public Programs,60.5,50,,percent of total billed charges,,
Thrombin Time; Plasma (Mayo)OutsideLaboratory,,85670,CPT,Facility,Both,,,90,121,102.85,34.6786,121,Humana Insurance Company,Commercial PPO,114.95,95,,percent of total billed charges,,
Thrombin Time; Plasma (Mayo)OutsideLaboratory,,85670,CPT,Facility,Both,,,90,121,102.85,34.6786,121,Humana Insurance Company,Commercial PPO,114.95,95,,percent of total billed charges,,
Thrombin Time; Plasma (Mayo)OutsideLaboratory,,85670,CPT,Facility,Outpatient,,,90,121,102.85,34.6786,121,Humana Insurance Company,Medicare PPO,59.29,49,,percent of total billed charges,,
Thrombin Time; Plasma (Mayo)OutsideLaboratory,,85670,CPT,Facility,Outpatient,,,90,121,102.85,34.6786,121,Humana Insurance Company,Medicare PPO,59.29,49,,percent of total billed charges,,
Thrombin Time; Plasma (Mayo)OutsideLaboratory,,85670,CPT,Facility,Inpatient,,,90,121,102.85,34.6786,121,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Thrombin Time; Plasma (Mayo)OutsideLaboratory,,85670,CPT,Facility,Inpatient,,,90,121,102.85,34.6786,121,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Thrombin Time; Plasma (Mayo)OutsideLaboratory,,85670,CPT,Facility,Both,,,90,121,102.85,34.6786,121,Medica,Individual & Family,119.911,99.1,,percent of total billed charges,,
Thrombin Time; Plasma (Mayo)OutsideLaboratory,,85670,CPT,Facility,Both,,,90,121,102.85,34.6786,121,Medica,Individual & Family,119.911,99.1,,percent of total billed charges,,
Thrombin Time; Plasma (Mayo)OutsideLaboratory,,85670,CPT,Facility,Outpatient,,,90,121,102.85,34.6786,121,Medica,Medica Advantage Solution,60.258,49.8,,percent of total billed charges,,
Thrombin Time; Plasma (Mayo)OutsideLaboratory,,85670,CPT,Facility,Outpatient,,,90,121,102.85,34.6786,121,Medica,Medica Advantage Solution,60.258,49.8,,percent of total billed charges,,
Thrombin Time; Plasma (Mayo)OutsideLaboratory,,85670,CPT,Facility,Inpatient,,,90,121,102.85,34.6786,121,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Thrombin Time; Plasma (Mayo)OutsideLaboratory,,85670,CPT,Facility,Inpatient,,,90,121,102.85,34.6786,121,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Thrombin Time; Plasma (Mayo)OutsideLaboratory,,85670,CPT,Facility,Outpatient,,,90,121,102.85,34.6786,121,Medica,Medical Assistance,53.966,44.6,,percent of total billed charges,,
Thrombin Time; Plasma (Mayo)OutsideLaboratory,,85670,CPT,Facility,Outpatient,,,90,121,102.85,34.6786,121,Medica,Medical Assistance,53.966,44.6,,percent of total billed charges,,
Thrombin Time; Plasma (Mayo)OutsideLaboratory,,85670,CPT,Facility,Inpatient,,,90,121,102.85,34.6786,121,Medica,Medical Assistance,,,,,Included in per diem rate,
Thrombin Time; Plasma (Mayo)OutsideLaboratory,,85670,CPT,Facility,Inpatient,,,90,121,102.85,34.6786,121,Medica,Medical Assistance,,,,,Included in per diem rate,
Thrombin Time; Plasma (Mayo)OutsideLaboratory,,85670,CPT,Facility,Outpatient,,,90,121,102.85,34.6786,121,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,60.258,49.8,,percent of total billed charges,,
Thrombin Time; Plasma (Mayo)OutsideLaboratory,,85670,CPT,Facility,Outpatient,,,90,121,102.85,34.6786,121,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,60.258,49.8,,percent of total billed charges,,
Thrombin Time; Plasma (Mayo)OutsideLaboratory,,85670,CPT,Facility,Inpatient,,,90,121,102.85,34.6786,121,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Thrombin Time; Plasma (Mayo)OutsideLaboratory,,85670,CPT,Facility,Inpatient,,,90,121,102.85,34.6786,121,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Thrombin Time; Plasma (Mayo)OutsideLaboratory,,85670,CPT,Facility,Both,,,90,121,102.85,34.6786,121,"Multiplan, Inc.","Multiplan, Inc.",113.74,94,,percent of total billed charges,,
Thrombin Time; Plasma (Mayo)OutsideLaboratory,,85670,CPT,Facility,Both,,,90,121,102.85,34.6786,121,"Multiplan, Inc.","Multiplan, Inc.",113.74,94,,percent of total billed charges,,
Thrombin Time; Plasma (Mayo)OutsideLaboratory,,85670,CPT,Facility,Outpatient,,,90,121,102.85,34.6786,121,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,104.544,86.4,,percent of total billed charges,,
Thrombin Time; Plasma (Mayo)OutsideLaboratory,,85670,CPT,Facility,Outpatient,,,90,121,102.85,34.6786,121,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,104.544,86.4,,percent of total billed charges,,
Thrombin Time; Plasma (Mayo)OutsideLaboratory,,85670,CPT,Facility,Inpatient,,,90,121,102.85,34.6786,121,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Thrombin Time; Plasma (Mayo)OutsideLaboratory,,85670,CPT,Facility,Inpatient,,,90,121,102.85,34.6786,121,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Thrombin Time; Plasma (Mayo)OutsideLaboratory,,85670,CPT,Facility,Both,,,90,121,102.85,34.6786,121,"Preferred One Administrative Services, INC.",PPO,119.306,98.6,,percent of total billed charges,,
Thrombin Time; Plasma (Mayo)OutsideLaboratory,,85670,CPT,Facility,Both,,,90,121,102.85,34.6786,121,"Preferred One Administrative Services, INC.",PPO,119.306,98.6,,percent of total billed charges,,
Thrombin Time; Plasma (Mayo)OutsideLaboratory,,85670,CPT,Facility,Outpatient,,,90,121,102.85,34.6786,121,PrimeWest Health,Minnesota Senior Health Options (MSHO),62.2545,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Thrombin Time; Plasma (Mayo)OutsideLaboratory,,85670,CPT,Facility,Outpatient,,,90,121,102.85,34.6786,121,PrimeWest Health,Minnesota Senior Health Options (MSHO),62.2545,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Thrombin Time; Plasma (Mayo)OutsideLaboratory,,85670,CPT,Facility,Inpatient,,,90,121,102.85,34.6786,121,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Thrombin Time; Plasma (Mayo)OutsideLaboratory,,85670,CPT,Facility,Inpatient,,,90,121,102.85,34.6786,121,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Thrombin Time; Plasma (Mayo)OutsideLaboratory,,85670,CPT,Facility,Outpatient,,,90,121,102.85,34.6786,121,PrimeWest Health,MinnesotaCare,62.1456,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Thrombin Time; Plasma (Mayo)OutsideLaboratory,,85670,CPT,Facility,Outpatient,,,90,121,102.85,34.6786,121,PrimeWest Health,MinnesotaCare,62.1456,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Thrombin Time; Plasma (Mayo)OutsideLaboratory,,85670,CPT,Facility,Inpatient,,,90,121,102.85,34.6786,121,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Thrombin Time; Plasma (Mayo)OutsideLaboratory,,85670,CPT,Facility,Inpatient,,,90,121,102.85,34.6786,121,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Thrombin Time; Plasma (Mayo)OutsideLaboratory,,85670,CPT,Facility,Both,,,90,121,102.85,34.6786,121,Sanford Health Plan,Sanford Health Plan,111.32,92,,percent of total billed charges,,
Thrombin Time; Plasma (Mayo)OutsideLaboratory,,85670,CPT,Facility,Both,,,90,121,102.85,34.6786,121,Sanford Health Plan,Sanford Health Plan,111.32,92,,percent of total billed charges,,
Thrombin Time; Plasma (Mayo)OutsideLaboratory,,85670,CPT,Facility,Outpatient,,,90,121,102.85,34.6786,121,"UCare Health, Inc.",Individual & Family Plan,68.1835,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Thrombin Time; Plasma (Mayo)OutsideLaboratory,,85670,CPT,Facility,Outpatient,,,90,121,102.85,34.6786,121,"UCare Health, Inc.",Individual & Family Plan,68.1835,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Thrombin Time; Plasma (Mayo)OutsideLaboratory,,85670,CPT,Facility,Inpatient,,,90,121,102.85,34.6786,121,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Thrombin Time; Plasma (Mayo)OutsideLaboratory,,85670,CPT,Facility,Inpatient,,,90,121,102.85,34.6786,121,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Thrombin Time; Plasma (Mayo)OutsideLaboratory,,85670,CPT,Facility,Outpatient,,,90,121,102.85,34.6786,121,"UCare Health, Inc.",Medical Assistance,61.0687,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Thrombin Time; Plasma (Mayo)OutsideLaboratory,,85670,CPT,Facility,Outpatient,,,90,121,102.85,34.6786,121,"UCare Health, Inc.",Medical Assistance,61.0687,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Thrombin Time; Plasma (Mayo)OutsideLaboratory,,85670,CPT,Facility,Inpatient,,,90,121,102.85,34.6786,121,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Thrombin Time; Plasma (Mayo)OutsideLaboratory,,85670,CPT,Facility,Inpatient,,,90,121,102.85,34.6786,121,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Thrombin Time; Plasma (Mayo)OutsideLaboratory,,85670,CPT,Facility,Outpatient,,,90,121,102.85,34.6786,121,"UCare Health, Inc.",Medicare Advantage,61.0687,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Thrombin Time; Plasma (Mayo)OutsideLaboratory,,85670,CPT,Facility,Outpatient,,,90,121,102.85,34.6786,121,"UCare Health, Inc.",Medicare Advantage,61.0687,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Thrombin Time; Plasma (Mayo)OutsideLaboratory,,85670,CPT,Facility,Inpatient,,,90,121,102.85,34.6786,121,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Thrombin Time; Plasma (Mayo)OutsideLaboratory,,85670,CPT,Facility,Inpatient,,,90,121,102.85,34.6786,121,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Thrombin Time; Plasma (Mayo)OutsideLaboratory,,85670,CPT,Facility,Outpatient,,,90,121,102.85,34.6786,121,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),61.0687,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Thrombin Time; Plasma (Mayo)OutsideLaboratory,,85670,CPT,Facility,Outpatient,,,90,121,102.85,34.6786,121,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),61.0687,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Thrombin Time; Plasma (Mayo)OutsideLaboratory,,85670,CPT,Facility,Inpatient,,,90,121,102.85,34.6786,121,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Thrombin Time; Plasma (Mayo)OutsideLaboratory,,85670,CPT,Facility,Inpatient,,,90,121,102.85,34.6786,121,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Thrombin Time; Plasma (Mayo)OutsideLaboratory,,85670,CPT,Facility,Both,,,90,121,102.85,34.6786,121,UnitedHealthcare,Individual & Family,113.74,94,,percent of total billed charges,,
Thrombin Time; Plasma (Mayo)OutsideLaboratory,,85670,CPT,Facility,Both,,,90,121,102.85,34.6786,121,UnitedHealthcare,Individual & Family,113.74,94,,percent of total billed charges,,
Thrombin Time; Plasma (Mayo)OutsideLaboratory,,85670,CPT,Facility,Outpatient,,,90,121,102.85,34.6786,121,UnitedHealthcare,Medicare Advantage,59.29,49,,percent of total billed charges,,
Thrombin Time; Plasma (Mayo)OutsideLaboratory,,85670,CPT,Facility,Outpatient,,,90,121,102.85,34.6786,121,UnitedHealthcare,Medicare Advantage,59.29,49,,percent of total billed charges,,
Thrombin Time; Plasma (Mayo)OutsideLaboratory,,85670,CPT,Facility,Inpatient,,,90,121,102.85,34.6786,121,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Thrombin Time; Plasma (Mayo)OutsideLaboratory,,85670,CPT,Facility,Inpatient,,,90,121,102.85,34.6786,121,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Thrombin Time; Plasma (Mayo)OutsideLaboratory,,85670,CPT,Facility,Outpatient,,,90,121,102.85,34.6786,121,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,58.08,48,,percent of total billed charges,,100% of DHS outpatient percentage
Thrombin Time; Plasma (Mayo)OutsideLaboratory,,85670,CPT,Facility,Outpatient,,,90,121,102.85,34.6786,121,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,58.08,48,,percent of total billed charges,,100% of DHS outpatient percentage
Thrombin Time; Plasma (Mayo)OutsideLaboratory,,85670,CPT,Facility,Inpatient,,,90,121,102.85,34.6786,121,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Thrombin Time; Plasma (Mayo)OutsideLaboratory,,85670,CPT,Facility,Inpatient,,,90,121,102.85,34.6786,121,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Lupus Anticoag; Thromboplastin Time, Partial; Plasma Or Whole Blood (Mayo)OutsideLaboratory",,85730,CPT,Facility,Both,,,90,108,91.8,30.9528,108,Aetna,Commercial,99.36,92,,percent of total billed charges,,
"Lupus Anticoag; Thromboplastin Time, Partial; Plasma Or Whole Blood (Mayo)OutsideLaboratory",,85730,CPT,Facility,Outpatient,,,90,108,91.8,30.9528,108,Aetna,Medicare Advantage,52.92,49,,percent of total billed charges,,
"Lupus Anticoag; Thromboplastin Time, Partial; Plasma Or Whole Blood (Mayo)OutsideLaboratory",,85730,CPT,Facility,Inpatient,,,90,108,91.8,30.9528,108,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Lupus Anticoag; Thromboplastin Time, Partial; Plasma Or Whole Blood (Mayo)OutsideLaboratory",,85730,CPT,Facility,Both,,,90,108,91.8,30.9528,108,Aetna,PPO,100.44,93,,percent of total billed charges,,
"Lupus Anticoag; Thromboplastin Time, Partial; Plasma Or Whole Blood (Mayo)OutsideLaboratory",,85730,CPT,Facility,Both,,,90,108,91.8,30.9528,108,America's PPO,America's PPO,103.7124,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Lupus Anticoag; Thromboplastin Time, Partial; Plasma Or Whole Blood (Mayo)OutsideLaboratory",,85730,CPT,Facility,Both,,,90,108,91.8,30.9528,108,BlueCross BlueShield Minnesota, Federal Employee Program,106.272,98.4,,percent of total billed charges,,
"Lupus Anticoag; Thromboplastin Time, Partial; Plasma Or Whole Blood (Mayo)OutsideLaboratory",,85730,CPT,Facility,Both,,,90,108,91.8,30.9528,108,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,108,100,,percent of total billed charges,,
"Lupus Anticoag; Thromboplastin Time, Partial; Plasma Or Whole Blood (Mayo)OutsideLaboratory",,85730,CPT,Facility,Both,,,90,108,91.8,30.9528,108,BlueCross BlueShield Minnesota,High Value Network Plan,97.2,90,,percent of total billed charges,,
"Lupus Anticoag; Thromboplastin Time, Partial; Plasma Or Whole Blood (Mayo)OutsideLaboratory",,85730,CPT,Facility,Outpatient,,,90,108,91.8,30.9528,108,BlueCross BlueShield Minnesota,Medicare Advantage,52.92,49,,percent of total billed charges,,
"Lupus Anticoag; Thromboplastin Time, Partial; Plasma Or Whole Blood (Mayo)OutsideLaboratory",,85730,CPT,Facility,Inpatient,,,90,108,91.8,30.9528,108,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Lupus Anticoag; Thromboplastin Time, Partial; Plasma Or Whole Blood (Mayo)OutsideLaboratory",,85730,CPT,Facility,Both,,,90,108,91.8,30.9528,108,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,95.6556,88.57,,percent of total billed charges,,
"Lupus Anticoag; Thromboplastin Time, Partial; Plasma Or Whole Blood (Mayo)OutsideLaboratory",,85730,CPT,Facility,Both,,,90,108,91.8,30.9528,108,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,30.9528,28.66,,percent of total billed charges,,
"Lupus Anticoag; Thromboplastin Time, Partial; Plasma Or Whole Blood (Mayo)OutsideLaboratory",,85730,CPT,Facility,Outpatient,,,90,108,91.8,30.9528,108,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),52.92,49,,percent of total billed charges,,
"Lupus Anticoag; Thromboplastin Time, Partial; Plasma Or Whole Blood (Mayo)OutsideLaboratory",,85730,CPT,Facility,Inpatient,,,90,108,91.8,30.9528,108,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Lupus Anticoag; Thromboplastin Time, Partial; Plasma Or Whole Blood (Mayo)OutsideLaboratory",,85730,CPT,Facility,Both,,,90,108,91.8,30.9528,108,CorVel,Worker's Compensation,108,100,,percent of total billed charges,,
"Lupus Anticoag; Thromboplastin Time, Partial; Plasma Or Whole Blood (Mayo)OutsideLaboratory",,85730,CPT,Facility,Both,,,90,108,91.8,30.9528,108,First Health Group Corporation,First Health Network,104.76,97,,percent of total billed charges,,
"Lupus Anticoag; Thromboplastin Time, Partial; Plasma Or Whole Blood (Mayo)OutsideLaboratory",,85730,CPT,Facility,Both,,,90,108,91.8,30.9528,108,"Health Partners, Inc.",Commercial,102.168,94.6,,percent of total billed charges,,
"Lupus Anticoag; Thromboplastin Time, Partial; Plasma Or Whole Blood (Mayo)OutsideLaboratory",,85730,CPT,Facility,Outpatient,,,90,108,91.8,30.9528,108,"Health Partners, Inc.",Medicare Advantage,52.92,49,,percent of total billed charges,,
"Lupus Anticoag; Thromboplastin Time, Partial; Plasma Or Whole Blood (Mayo)OutsideLaboratory",,85730,CPT,Facility,Inpatient,,,90,108,91.8,30.9528,108,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Lupus Anticoag; Thromboplastin Time, Partial; Plasma Or Whole Blood (Mayo)OutsideLaboratory",,85730,CPT,Facility,Both,,,90,108,91.8,30.9528,108,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),64.8,60,,percent of total billed charges,,
"Lupus Anticoag; Thromboplastin Time, Partial; Plasma Or Whole Blood (Mayo)OutsideLaboratory",,85730,CPT,Facility,Both,,,90,108,91.8,30.9528,108,"Health Partners, Inc.",State of Minnesota Advantage Program,88.02,81.5,,percent of total billed charges,,
"Lupus Anticoag; Thromboplastin Time, Partial; Plasma Or Whole Blood (Mayo)OutsideLaboratory",,85730,CPT,Facility,Both,,,90,108,91.8,30.9528,108,"Health Partners, Inc.",State Public Programs,54,50,,percent of total billed charges,,
"Lupus Anticoag; Thromboplastin Time, Partial; Plasma Or Whole Blood (Mayo)OutsideLaboratory",,85730,CPT,Facility,Both,,,90,108,91.8,30.9528,108,Humana Insurance Company,Commercial PPO,102.6,95,,percent of total billed charges,,
"Lupus Anticoag; Thromboplastin Time, Partial; Plasma Or Whole Blood (Mayo)OutsideLaboratory",,85730,CPT,Facility,Outpatient,,,90,108,91.8,30.9528,108,Humana Insurance Company,Medicare PPO,52.92,49,,percent of total billed charges,,
"Lupus Anticoag; Thromboplastin Time, Partial; Plasma Or Whole Blood (Mayo)OutsideLaboratory",,85730,CPT,Facility,Inpatient,,,90,108,91.8,30.9528,108,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Lupus Anticoag; Thromboplastin Time, Partial; Plasma Or Whole Blood (Mayo)OutsideLaboratory",,85730,CPT,Facility,Both,,,90,108,91.8,30.9528,108,Medica,Individual & Family,107.028,99.1,,percent of total billed charges,,
"Lupus Anticoag; Thromboplastin Time, Partial; Plasma Or Whole Blood (Mayo)OutsideLaboratory",,85730,CPT,Facility,Outpatient,,,90,108,91.8,30.9528,108,Medica,Medica Advantage Solution,53.784,49.8,,percent of total billed charges,,
"Lupus Anticoag; Thromboplastin Time, Partial; Plasma Or Whole Blood (Mayo)OutsideLaboratory",,85730,CPT,Facility,Inpatient,,,90,108,91.8,30.9528,108,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Lupus Anticoag; Thromboplastin Time, Partial; Plasma Or Whole Blood (Mayo)OutsideLaboratory",,85730,CPT,Facility,Outpatient,,,90,108,91.8,30.9528,108,Medica,Medical Assistance,48.168,44.6,,percent of total billed charges,,
"Lupus Anticoag; Thromboplastin Time, Partial; Plasma Or Whole Blood (Mayo)OutsideLaboratory",,85730,CPT,Facility,Inpatient,,,90,108,91.8,30.9528,108,Medica,Medical Assistance,,,,,Included in per diem rate,
"Lupus Anticoag; Thromboplastin Time, Partial; Plasma Or Whole Blood (Mayo)OutsideLaboratory",,85730,CPT,Facility,Outpatient,,,90,108,91.8,30.9528,108,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,53.784,49.8,,percent of total billed charges,,
"Lupus Anticoag; Thromboplastin Time, Partial; Plasma Or Whole Blood (Mayo)OutsideLaboratory",,85730,CPT,Facility,Inpatient,,,90,108,91.8,30.9528,108,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Lupus Anticoag; Thromboplastin Time, Partial; Plasma Or Whole Blood (Mayo)OutsideLaboratory",,85730,CPT,Facility,Both,,,90,108,91.8,30.9528,108,"Multiplan, Inc.","Multiplan, Inc.",101.52,94,,percent of total billed charges,,
"Lupus Anticoag; Thromboplastin Time, Partial; Plasma Or Whole Blood (Mayo)OutsideLaboratory",,85730,CPT,Facility,Outpatient,,,90,108,91.8,30.9528,108,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,93.312,86.4,,percent of total billed charges,,
"Lupus Anticoag; Thromboplastin Time, Partial; Plasma Or Whole Blood (Mayo)OutsideLaboratory",,85730,CPT,Facility,Inpatient,,,90,108,91.8,30.9528,108,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Lupus Anticoag; Thromboplastin Time, Partial; Plasma Or Whole Blood (Mayo)OutsideLaboratory",,85730,CPT,Facility,Both,,,90,108,91.8,30.9528,108,"Preferred One Administrative Services, INC.",PPO,106.488,98.6,,percent of total billed charges,,
"Lupus Anticoag; Thromboplastin Time, Partial; Plasma Or Whole Blood (Mayo)OutsideLaboratory",,85730,CPT,Facility,Outpatient,,,90,108,91.8,30.9528,108,PrimeWest Health,Minnesota Senior Health Options (MSHO),55.566,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Lupus Anticoag; Thromboplastin Time, Partial; Plasma Or Whole Blood (Mayo)OutsideLaboratory",,85730,CPT,Facility,Inpatient,,,90,108,91.8,30.9528,108,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Lupus Anticoag; Thromboplastin Time, Partial; Plasma Or Whole Blood (Mayo)OutsideLaboratory",,85730,CPT,Facility,Outpatient,,,90,108,91.8,30.9528,108,PrimeWest Health,MinnesotaCare,55.4688,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Lupus Anticoag; Thromboplastin Time, Partial; Plasma Or Whole Blood (Mayo)OutsideLaboratory",,85730,CPT,Facility,Inpatient,,,90,108,91.8,30.9528,108,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Lupus Anticoag; Thromboplastin Time, Partial; Plasma Or Whole Blood (Mayo)OutsideLaboratory",,85730,CPT,Facility,Both,,,90,108,91.8,30.9528,108,Sanford Health Plan,Sanford Health Plan,99.36,92,,percent of total billed charges,,
"Lupus Anticoag; Thromboplastin Time, Partial; Plasma Or Whole Blood (Mayo)OutsideLaboratory",,85730,CPT,Facility,Outpatient,,,90,108,91.8,30.9528,108,"UCare Health, Inc.",Individual & Family Plan,60.858,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Lupus Anticoag; Thromboplastin Time, Partial; Plasma Or Whole Blood (Mayo)OutsideLaboratory",,85730,CPT,Facility,Inpatient,,,90,108,91.8,30.9528,108,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Lupus Anticoag; Thromboplastin Time, Partial; Plasma Or Whole Blood (Mayo)OutsideLaboratory",,85730,CPT,Facility,Outpatient,,,90,108,91.8,30.9528,108,"UCare Health, Inc.",Medical Assistance,54.5076,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Lupus Anticoag; Thromboplastin Time, Partial; Plasma Or Whole Blood (Mayo)OutsideLaboratory",,85730,CPT,Facility,Inpatient,,,90,108,91.8,30.9528,108,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Lupus Anticoag; Thromboplastin Time, Partial; Plasma Or Whole Blood (Mayo)OutsideLaboratory",,85730,CPT,Facility,Outpatient,,,90,108,91.8,30.9528,108,"UCare Health, Inc.",Medicare Advantage,54.5076,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Lupus Anticoag; Thromboplastin Time, Partial; Plasma Or Whole Blood (Mayo)OutsideLaboratory",,85730,CPT,Facility,Inpatient,,,90,108,91.8,30.9528,108,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Lupus Anticoag; Thromboplastin Time, Partial; Plasma Or Whole Blood (Mayo)OutsideLaboratory",,85730,CPT,Facility,Outpatient,,,90,108,91.8,30.9528,108,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),54.5076,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Lupus Anticoag; Thromboplastin Time, Partial; Plasma Or Whole Blood (Mayo)OutsideLaboratory",,85730,CPT,Facility,Inpatient,,,90,108,91.8,30.9528,108,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Lupus Anticoag; Thromboplastin Time, Partial; Plasma Or Whole Blood (Mayo)OutsideLaboratory",,85730,CPT,Facility,Both,,,90,108,91.8,30.9528,108,UnitedHealthcare,Individual & Family,101.52,94,,percent of total billed charges,,
"Lupus Anticoag; Thromboplastin Time, Partial; Plasma Or Whole Blood (Mayo)OutsideLaboratory",,85730,CPT,Facility,Outpatient,,,90,108,91.8,30.9528,108,UnitedHealthcare,Medicare Advantage,52.92,49,,percent of total billed charges,,
"Lupus Anticoag; Thromboplastin Time, Partial; Plasma Or Whole Blood (Mayo)OutsideLaboratory",,85730,CPT,Facility,Inpatient,,,90,108,91.8,30.9528,108,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Lupus Anticoag; Thromboplastin Time, Partial; Plasma Or Whole Blood (Mayo)OutsideLaboratory",,85730,CPT,Facility,Outpatient,,,90,108,91.8,30.9528,108,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,51.84,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Lupus Anticoag; Thromboplastin Time, Partial; Plasma Or Whole Blood (Mayo)OutsideLaboratory",,85730,CPT,Facility,Inpatient,,,90,108,91.8,30.9528,108,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Thromboplastin Time, Partial (Mayo)OutsideLaboratory",,85730,CPT,Facility,Both,,,90,108,91.8,30.9528,108,Aetna,Commercial,99.36,92,,percent of total billed charges,,
"Thromboplastin Time, Partial (Mayo)OutsideLaboratory",,85730,CPT,Facility,Outpatient,,,90,108,91.8,30.9528,108,Aetna,Medicare Advantage,52.92,49,,percent of total billed charges,,
"Thromboplastin Time, Partial (Mayo)OutsideLaboratory",,85730,CPT,Facility,Inpatient,,,90,108,91.8,30.9528,108,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Thromboplastin Time, Partial (Mayo)OutsideLaboratory",,85730,CPT,Facility,Both,,,90,108,91.8,30.9528,108,Aetna,PPO,100.44,93,,percent of total billed charges,,
"Thromboplastin Time, Partial (Mayo)OutsideLaboratory",,85730,CPT,Facility,Both,,,90,108,91.8,30.9528,108,America's PPO,America's PPO,103.7124,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Thromboplastin Time, Partial (Mayo)OutsideLaboratory",,85730,CPT,Facility,Both,,,90,108,91.8,30.9528,108,BlueCross BlueShield Minnesota, Federal Employee Program,106.272,98.4,,percent of total billed charges,,
"Thromboplastin Time, Partial (Mayo)OutsideLaboratory",,85730,CPT,Facility,Both,,,90,108,91.8,30.9528,108,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,108,100,,percent of total billed charges,,
"Thromboplastin Time, Partial (Mayo)OutsideLaboratory",,85730,CPT,Facility,Both,,,90,108,91.8,30.9528,108,BlueCross BlueShield Minnesota,High Value Network Plan,97.2,90,,percent of total billed charges,,
"Thromboplastin Time, Partial (Mayo)OutsideLaboratory",,85730,CPT,Facility,Outpatient,,,90,108,91.8,30.9528,108,BlueCross BlueShield Minnesota,Medicare Advantage,52.92,49,,percent of total billed charges,,
"Thromboplastin Time, Partial (Mayo)OutsideLaboratory",,85730,CPT,Facility,Inpatient,,,90,108,91.8,30.9528,108,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Thromboplastin Time, Partial (Mayo)OutsideLaboratory",,85730,CPT,Facility,Both,,,90,108,91.8,30.9528,108,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,95.6556,88.57,,percent of total billed charges,,
"Thromboplastin Time, Partial (Mayo)OutsideLaboratory",,85730,CPT,Facility,Both,,,90,108,91.8,30.9528,108,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,30.9528,28.66,,percent of total billed charges,,
"Thromboplastin Time, Partial (Mayo)OutsideLaboratory",,85730,CPT,Facility,Outpatient,,,90,108,91.8,30.9528,108,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),52.92,49,,percent of total billed charges,,
"Thromboplastin Time, Partial (Mayo)OutsideLaboratory",,85730,CPT,Facility,Inpatient,,,90,108,91.8,30.9528,108,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Thromboplastin Time, Partial (Mayo)OutsideLaboratory",,85730,CPT,Facility,Both,,,90,108,91.8,30.9528,108,CorVel,Worker's Compensation,108,100,,percent of total billed charges,,
"Thromboplastin Time, Partial (Mayo)OutsideLaboratory",,85730,CPT,Facility,Both,,,90,108,91.8,30.9528,108,First Health Group Corporation,First Health Network,104.76,97,,percent of total billed charges,,
"Thromboplastin Time, Partial (Mayo)OutsideLaboratory",,85730,CPT,Facility,Both,,,90,108,91.8,30.9528,108,"Health Partners, Inc.",Commercial,102.168,94.6,,percent of total billed charges,,
"Thromboplastin Time, Partial (Mayo)OutsideLaboratory",,85730,CPT,Facility,Outpatient,,,90,108,91.8,30.9528,108,"Health Partners, Inc.",Medicare Advantage,52.92,49,,percent of total billed charges,,
"Thromboplastin Time, Partial (Mayo)OutsideLaboratory",,85730,CPT,Facility,Inpatient,,,90,108,91.8,30.9528,108,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Thromboplastin Time, Partial (Mayo)OutsideLaboratory",,85730,CPT,Facility,Both,,,90,108,91.8,30.9528,108,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),64.8,60,,percent of total billed charges,,
"Thromboplastin Time, Partial (Mayo)OutsideLaboratory",,85730,CPT,Facility,Both,,,90,108,91.8,30.9528,108,"Health Partners, Inc.",State of Minnesota Advantage Program,88.02,81.5,,percent of total billed charges,,
"Thromboplastin Time, Partial (Mayo)OutsideLaboratory",,85730,CPT,Facility,Both,,,90,108,91.8,30.9528,108,"Health Partners, Inc.",State Public Programs,54,50,,percent of total billed charges,,
"Thromboplastin Time, Partial (Mayo)OutsideLaboratory",,85730,CPT,Facility,Both,,,90,108,91.8,30.9528,108,Humana Insurance Company,Commercial PPO,102.6,95,,percent of total billed charges,,
"Thromboplastin Time, Partial (Mayo)OutsideLaboratory",,85730,CPT,Facility,Outpatient,,,90,108,91.8,30.9528,108,Humana Insurance Company,Medicare PPO,52.92,49,,percent of total billed charges,,
"Thromboplastin Time, Partial (Mayo)OutsideLaboratory",,85730,CPT,Facility,Inpatient,,,90,108,91.8,30.9528,108,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Thromboplastin Time, Partial (Mayo)OutsideLaboratory",,85730,CPT,Facility,Both,,,90,108,91.8,30.9528,108,Medica,Individual & Family,107.028,99.1,,percent of total billed charges,,
"Thromboplastin Time, Partial (Mayo)OutsideLaboratory",,85730,CPT,Facility,Outpatient,,,90,108,91.8,30.9528,108,Medica,Medica Advantage Solution,53.784,49.8,,percent of total billed charges,,
"Thromboplastin Time, Partial (Mayo)OutsideLaboratory",,85730,CPT,Facility,Inpatient,,,90,108,91.8,30.9528,108,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Thromboplastin Time, Partial (Mayo)OutsideLaboratory",,85730,CPT,Facility,Outpatient,,,90,108,91.8,30.9528,108,Medica,Medical Assistance,48.168,44.6,,percent of total billed charges,,
"Thromboplastin Time, Partial (Mayo)OutsideLaboratory",,85730,CPT,Facility,Inpatient,,,90,108,91.8,30.9528,108,Medica,Medical Assistance,,,,,Included in per diem rate,
"Thromboplastin Time, Partial (Mayo)OutsideLaboratory",,85730,CPT,Facility,Outpatient,,,90,108,91.8,30.9528,108,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,53.784,49.8,,percent of total billed charges,,
"Thromboplastin Time, Partial (Mayo)OutsideLaboratory",,85730,CPT,Facility,Inpatient,,,90,108,91.8,30.9528,108,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Thromboplastin Time, Partial (Mayo)OutsideLaboratory",,85730,CPT,Facility,Both,,,90,108,91.8,30.9528,108,"Multiplan, Inc.","Multiplan, Inc.",101.52,94,,percent of total billed charges,,
"Thromboplastin Time, Partial (Mayo)OutsideLaboratory",,85730,CPT,Facility,Outpatient,,,90,108,91.8,30.9528,108,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,93.312,86.4,,percent of total billed charges,,
"Thromboplastin Time, Partial (Mayo)OutsideLaboratory",,85730,CPT,Facility,Inpatient,,,90,108,91.8,30.9528,108,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Thromboplastin Time, Partial (Mayo)OutsideLaboratory",,85730,CPT,Facility,Both,,,90,108,91.8,30.9528,108,"Preferred One Administrative Services, INC.",PPO,106.488,98.6,,percent of total billed charges,,
"Thromboplastin Time, Partial (Mayo)OutsideLaboratory",,85730,CPT,Facility,Outpatient,,,90,108,91.8,30.9528,108,PrimeWest Health,Minnesota Senior Health Options (MSHO),55.566,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Thromboplastin Time, Partial (Mayo)OutsideLaboratory",,85730,CPT,Facility,Inpatient,,,90,108,91.8,30.9528,108,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Thromboplastin Time, Partial (Mayo)OutsideLaboratory",,85730,CPT,Facility,Outpatient,,,90,108,91.8,30.9528,108,PrimeWest Health,MinnesotaCare,55.4688,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Thromboplastin Time, Partial (Mayo)OutsideLaboratory",,85730,CPT,Facility,Inpatient,,,90,108,91.8,30.9528,108,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Thromboplastin Time, Partial (Mayo)OutsideLaboratory",,85730,CPT,Facility,Both,,,90,108,91.8,30.9528,108,Sanford Health Plan,Sanford Health Plan,99.36,92,,percent of total billed charges,,
"Thromboplastin Time, Partial (Mayo)OutsideLaboratory",,85730,CPT,Facility,Outpatient,,,90,108,91.8,30.9528,108,"UCare Health, Inc.",Individual & Family Plan,60.858,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Thromboplastin Time, Partial (Mayo)OutsideLaboratory",,85730,CPT,Facility,Inpatient,,,90,108,91.8,30.9528,108,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Thromboplastin Time, Partial (Mayo)OutsideLaboratory",,85730,CPT,Facility,Outpatient,,,90,108,91.8,30.9528,108,"UCare Health, Inc.",Medical Assistance,54.5076,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Thromboplastin Time, Partial (Mayo)OutsideLaboratory",,85730,CPT,Facility,Inpatient,,,90,108,91.8,30.9528,108,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Thromboplastin Time, Partial (Mayo)OutsideLaboratory",,85730,CPT,Facility,Outpatient,,,90,108,91.8,30.9528,108,"UCare Health, Inc.",Medicare Advantage,54.5076,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Thromboplastin Time, Partial (Mayo)OutsideLaboratory",,85730,CPT,Facility,Inpatient,,,90,108,91.8,30.9528,108,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Thromboplastin Time, Partial (Mayo)OutsideLaboratory",,85730,CPT,Facility,Outpatient,,,90,108,91.8,30.9528,108,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),54.5076,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Thromboplastin Time, Partial (Mayo)OutsideLaboratory",,85730,CPT,Facility,Inpatient,,,90,108,91.8,30.9528,108,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Thromboplastin Time, Partial (Mayo)OutsideLaboratory",,85730,CPT,Facility,Both,,,90,108,91.8,30.9528,108,UnitedHealthcare,Individual & Family,101.52,94,,percent of total billed charges,,
"Thromboplastin Time, Partial (Mayo)OutsideLaboratory",,85730,CPT,Facility,Outpatient,,,90,108,91.8,30.9528,108,UnitedHealthcare,Medicare Advantage,52.92,49,,percent of total billed charges,,
"Thromboplastin Time, Partial (Mayo)OutsideLaboratory",,85730,CPT,Facility,Inpatient,,,90,108,91.8,30.9528,108,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Thromboplastin Time, Partial (Mayo)OutsideLaboratory",,85730,CPT,Facility,Outpatient,,,90,108,91.8,30.9528,108,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,51.84,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Thromboplastin Time, Partial (Mayo)OutsideLaboratory",,85730,CPT,Facility,Inpatient,,,90,108,91.8,30.9528,108,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Thromboplastin Time, Partial (Ptt); Plasma Or Whole Blood (Mayo)OutsideLaboratory",,85730,CPT,Facility,Both,,,90,108,91.8,30.9528,108,Aetna,Commercial,99.36,92,,percent of total billed charges,,
"Thromboplastin Time, Partial (Ptt); Plasma Or Whole Blood (Mayo)OutsideLaboratory",,85730,CPT,Facility,Outpatient,,,90,108,91.8,30.9528,108,Aetna,Medicare Advantage,52.92,49,,percent of total billed charges,,
"Thromboplastin Time, Partial (Ptt); Plasma Or Whole Blood (Mayo)OutsideLaboratory",,85730,CPT,Facility,Inpatient,,,90,108,91.8,30.9528,108,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Thromboplastin Time, Partial (Ptt); Plasma Or Whole Blood (Mayo)OutsideLaboratory",,85730,CPT,Facility,Both,,,90,108,91.8,30.9528,108,Aetna,PPO,100.44,93,,percent of total billed charges,,
"Thromboplastin Time, Partial (Ptt); Plasma Or Whole Blood (Mayo)OutsideLaboratory",,85730,CPT,Facility,Both,,,90,108,91.8,30.9528,108,America's PPO,America's PPO,103.7124,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Thromboplastin Time, Partial (Ptt); Plasma Or Whole Blood (Mayo)OutsideLaboratory",,85730,CPT,Facility,Both,,,90,108,91.8,30.9528,108,BlueCross BlueShield Minnesota, Federal Employee Program,106.272,98.4,,percent of total billed charges,,
"Thromboplastin Time, Partial (Ptt); Plasma Or Whole Blood (Mayo)OutsideLaboratory",,85730,CPT,Facility,Both,,,90,108,91.8,30.9528,108,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,108,100,,percent of total billed charges,,
"Thromboplastin Time, Partial (Ptt); Plasma Or Whole Blood (Mayo)OutsideLaboratory",,85730,CPT,Facility,Both,,,90,108,91.8,30.9528,108,BlueCross BlueShield Minnesota,High Value Network Plan,97.2,90,,percent of total billed charges,,
"Thromboplastin Time, Partial (Ptt); Plasma Or Whole Blood (Mayo)OutsideLaboratory",,85730,CPT,Facility,Outpatient,,,90,108,91.8,30.9528,108,BlueCross BlueShield Minnesota,Medicare Advantage,52.92,49,,percent of total billed charges,,
"Thromboplastin Time, Partial (Ptt); Plasma Or Whole Blood (Mayo)OutsideLaboratory",,85730,CPT,Facility,Inpatient,,,90,108,91.8,30.9528,108,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Thromboplastin Time, Partial (Ptt); Plasma Or Whole Blood (Mayo)OutsideLaboratory",,85730,CPT,Facility,Both,,,90,108,91.8,30.9528,108,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,95.6556,88.57,,percent of total billed charges,,
"Thromboplastin Time, Partial (Ptt); Plasma Or Whole Blood (Mayo)OutsideLaboratory",,85730,CPT,Facility,Both,,,90,108,91.8,30.9528,108,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,30.9528,28.66,,percent of total billed charges,,
"Thromboplastin Time, Partial (Ptt); Plasma Or Whole Blood (Mayo)OutsideLaboratory",,85730,CPT,Facility,Outpatient,,,90,108,91.8,30.9528,108,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),52.92,49,,percent of total billed charges,,
"Thromboplastin Time, Partial (Ptt); Plasma Or Whole Blood (Mayo)OutsideLaboratory",,85730,CPT,Facility,Inpatient,,,90,108,91.8,30.9528,108,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Thromboplastin Time, Partial (Ptt); Plasma Or Whole Blood (Mayo)OutsideLaboratory",,85730,CPT,Facility,Both,,,90,108,91.8,30.9528,108,CorVel,Worker's Compensation,108,100,,percent of total billed charges,,
"Thromboplastin Time, Partial (Ptt); Plasma Or Whole Blood (Mayo)OutsideLaboratory",,85730,CPT,Facility,Both,,,90,108,91.8,30.9528,108,First Health Group Corporation,First Health Network,104.76,97,,percent of total billed charges,,
"Thromboplastin Time, Partial (Ptt); Plasma Or Whole Blood (Mayo)OutsideLaboratory",,85730,CPT,Facility,Both,,,90,108,91.8,30.9528,108,"Health Partners, Inc.",Commercial,102.168,94.6,,percent of total billed charges,,
"Thromboplastin Time, Partial (Ptt); Plasma Or Whole Blood (Mayo)OutsideLaboratory",,85730,CPT,Facility,Outpatient,,,90,108,91.8,30.9528,108,"Health Partners, Inc.",Medicare Advantage,52.92,49,,percent of total billed charges,,
"Thromboplastin Time, Partial (Ptt); Plasma Or Whole Blood (Mayo)OutsideLaboratory",,85730,CPT,Facility,Inpatient,,,90,108,91.8,30.9528,108,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Thromboplastin Time, Partial (Ptt); Plasma Or Whole Blood (Mayo)OutsideLaboratory",,85730,CPT,Facility,Both,,,90,108,91.8,30.9528,108,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),64.8,60,,percent of total billed charges,,
"Thromboplastin Time, Partial (Ptt); Plasma Or Whole Blood (Mayo)OutsideLaboratory",,85730,CPT,Facility,Both,,,90,108,91.8,30.9528,108,"Health Partners, Inc.",State of Minnesota Advantage Program,88.02,81.5,,percent of total billed charges,,
"Thromboplastin Time, Partial (Ptt); Plasma Or Whole Blood (Mayo)OutsideLaboratory",,85730,CPT,Facility,Both,,,90,108,91.8,30.9528,108,"Health Partners, Inc.",State Public Programs,54,50,,percent of total billed charges,,
"Thromboplastin Time, Partial (Ptt); Plasma Or Whole Blood (Mayo)OutsideLaboratory",,85730,CPT,Facility,Both,,,90,108,91.8,30.9528,108,Humana Insurance Company,Commercial PPO,102.6,95,,percent of total billed charges,,
"Thromboplastin Time, Partial (Ptt); Plasma Or Whole Blood (Mayo)OutsideLaboratory",,85730,CPT,Facility,Outpatient,,,90,108,91.8,30.9528,108,Humana Insurance Company,Medicare PPO,52.92,49,,percent of total billed charges,,
"Thromboplastin Time, Partial (Ptt); Plasma Or Whole Blood (Mayo)OutsideLaboratory",,85730,CPT,Facility,Inpatient,,,90,108,91.8,30.9528,108,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Thromboplastin Time, Partial (Ptt); Plasma Or Whole Blood (Mayo)OutsideLaboratory",,85730,CPT,Facility,Both,,,90,108,91.8,30.9528,108,Medica,Individual & Family,107.028,99.1,,percent of total billed charges,,
"Thromboplastin Time, Partial (Ptt); Plasma Or Whole Blood (Mayo)OutsideLaboratory",,85730,CPT,Facility,Outpatient,,,90,108,91.8,30.9528,108,Medica,Medica Advantage Solution,53.784,49.8,,percent of total billed charges,,
"Thromboplastin Time, Partial (Ptt); Plasma Or Whole Blood (Mayo)OutsideLaboratory",,85730,CPT,Facility,Inpatient,,,90,108,91.8,30.9528,108,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Thromboplastin Time, Partial (Ptt); Plasma Or Whole Blood (Mayo)OutsideLaboratory",,85730,CPT,Facility,Outpatient,,,90,108,91.8,30.9528,108,Medica,Medical Assistance,48.168,44.6,,percent of total billed charges,,
"Thromboplastin Time, Partial (Ptt); Plasma Or Whole Blood (Mayo)OutsideLaboratory",,85730,CPT,Facility,Inpatient,,,90,108,91.8,30.9528,108,Medica,Medical Assistance,,,,,Included in per diem rate,
"Thromboplastin Time, Partial (Ptt); Plasma Or Whole Blood (Mayo)OutsideLaboratory",,85730,CPT,Facility,Outpatient,,,90,108,91.8,30.9528,108,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,53.784,49.8,,percent of total billed charges,,
"Thromboplastin Time, Partial (Ptt); Plasma Or Whole Blood (Mayo)OutsideLaboratory",,85730,CPT,Facility,Inpatient,,,90,108,91.8,30.9528,108,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Thromboplastin Time, Partial (Ptt); Plasma Or Whole Blood (Mayo)OutsideLaboratory",,85730,CPT,Facility,Both,,,90,108,91.8,30.9528,108,"Multiplan, Inc.","Multiplan, Inc.",101.52,94,,percent of total billed charges,,
"Thromboplastin Time, Partial (Ptt); Plasma Or Whole Blood (Mayo)OutsideLaboratory",,85730,CPT,Facility,Outpatient,,,90,108,91.8,30.9528,108,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,93.312,86.4,,percent of total billed charges,,
"Thromboplastin Time, Partial (Ptt); Plasma Or Whole Blood (Mayo)OutsideLaboratory",,85730,CPT,Facility,Inpatient,,,90,108,91.8,30.9528,108,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Thromboplastin Time, Partial (Ptt); Plasma Or Whole Blood (Mayo)OutsideLaboratory",,85730,CPT,Facility,Both,,,90,108,91.8,30.9528,108,"Preferred One Administrative Services, INC.",PPO,106.488,98.6,,percent of total billed charges,,
"Thromboplastin Time, Partial (Ptt); Plasma Or Whole Blood (Mayo)OutsideLaboratory",,85730,CPT,Facility,Outpatient,,,90,108,91.8,30.9528,108,PrimeWest Health,Minnesota Senior Health Options (MSHO),55.566,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Thromboplastin Time, Partial (Ptt); Plasma Or Whole Blood (Mayo)OutsideLaboratory",,85730,CPT,Facility,Inpatient,,,90,108,91.8,30.9528,108,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Thromboplastin Time, Partial (Ptt); Plasma Or Whole Blood (Mayo)OutsideLaboratory",,85730,CPT,Facility,Outpatient,,,90,108,91.8,30.9528,108,PrimeWest Health,MinnesotaCare,55.4688,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Thromboplastin Time, Partial (Ptt); Plasma Or Whole Blood (Mayo)OutsideLaboratory",,85730,CPT,Facility,Inpatient,,,90,108,91.8,30.9528,108,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Thromboplastin Time, Partial (Ptt); Plasma Or Whole Blood (Mayo)OutsideLaboratory",,85730,CPT,Facility,Both,,,90,108,91.8,30.9528,108,Sanford Health Plan,Sanford Health Plan,99.36,92,,percent of total billed charges,,
"Thromboplastin Time, Partial (Ptt); Plasma Or Whole Blood (Mayo)OutsideLaboratory",,85730,CPT,Facility,Outpatient,,,90,108,91.8,30.9528,108,"UCare Health, Inc.",Individual & Family Plan,60.858,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Thromboplastin Time, Partial (Ptt); Plasma Or Whole Blood (Mayo)OutsideLaboratory",,85730,CPT,Facility,Inpatient,,,90,108,91.8,30.9528,108,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Thromboplastin Time, Partial (Ptt); Plasma Or Whole Blood (Mayo)OutsideLaboratory",,85730,CPT,Facility,Outpatient,,,90,108,91.8,30.9528,108,"UCare Health, Inc.",Medical Assistance,54.5076,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Thromboplastin Time, Partial (Ptt); Plasma Or Whole Blood (Mayo)OutsideLaboratory",,85730,CPT,Facility,Inpatient,,,90,108,91.8,30.9528,108,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Thromboplastin Time, Partial (Ptt); Plasma Or Whole Blood (Mayo)OutsideLaboratory",,85730,CPT,Facility,Outpatient,,,90,108,91.8,30.9528,108,"UCare Health, Inc.",Medicare Advantage,54.5076,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Thromboplastin Time, Partial (Ptt); Plasma Or Whole Blood (Mayo)OutsideLaboratory",,85730,CPT,Facility,Inpatient,,,90,108,91.8,30.9528,108,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Thromboplastin Time, Partial (Ptt); Plasma Or Whole Blood (Mayo)OutsideLaboratory",,85730,CPT,Facility,Outpatient,,,90,108,91.8,30.9528,108,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),54.5076,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Thromboplastin Time, Partial (Ptt); Plasma Or Whole Blood (Mayo)OutsideLaboratory",,85730,CPT,Facility,Inpatient,,,90,108,91.8,30.9528,108,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Thromboplastin Time, Partial (Ptt); Plasma Or Whole Blood (Mayo)OutsideLaboratory",,85730,CPT,Facility,Both,,,90,108,91.8,30.9528,108,UnitedHealthcare,Individual & Family,101.52,94,,percent of total billed charges,,
"Thromboplastin Time, Partial (Ptt); Plasma Or Whole Blood (Mayo)OutsideLaboratory",,85730,CPT,Facility,Outpatient,,,90,108,91.8,30.9528,108,UnitedHealthcare,Medicare Advantage,52.92,49,,percent of total billed charges,,
"Thromboplastin Time, Partial (Ptt); Plasma Or Whole Blood (Mayo)OutsideLaboratory",,85730,CPT,Facility,Inpatient,,,90,108,91.8,30.9528,108,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Thromboplastin Time, Partial (Ptt); Plasma Or Whole Blood (Mayo)OutsideLaboratory",,85730,CPT,Facility,Outpatient,,,90,108,91.8,30.9528,108,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,51.84,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Thromboplastin Time, Partial (Ptt); Plasma Or Whole Blood (Mayo)OutsideLaboratory",,85730,CPT,Facility,Inpatient,,,90,108,91.8,30.9528,108,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Thromboplastin Time, Partial; Plasma Or Whole Blood (Mayo)OutsideLaboratory",,85730,CPT,Facility,Both,,,90,108,91.8,30.9528,108,Aetna,Commercial,99.36,92,,percent of total billed charges,,
"Thromboplastin Time, Partial; Plasma Or Whole Blood (Mayo)OutsideLaboratory",,85730,CPT,Facility,Outpatient,,,90,108,91.8,30.9528,108,Aetna,Medicare Advantage,52.92,49,,percent of total billed charges,,
"Thromboplastin Time, Partial; Plasma Or Whole Blood (Mayo)OutsideLaboratory",,85730,CPT,Facility,Inpatient,,,90,108,91.8,30.9528,108,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Thromboplastin Time, Partial; Plasma Or Whole Blood (Mayo)OutsideLaboratory",,85730,CPT,Facility,Both,,,90,108,91.8,30.9528,108,Aetna,PPO,100.44,93,,percent of total billed charges,,
"Thromboplastin Time, Partial; Plasma Or Whole Blood (Mayo)OutsideLaboratory",,85730,CPT,Facility,Both,,,90,108,91.8,30.9528,108,America's PPO,America's PPO,103.7124,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Thromboplastin Time, Partial; Plasma Or Whole Blood (Mayo)OutsideLaboratory",,85730,CPT,Facility,Both,,,90,108,91.8,30.9528,108,BlueCross BlueShield Minnesota, Federal Employee Program,106.272,98.4,,percent of total billed charges,,
"Thromboplastin Time, Partial; Plasma Or Whole Blood (Mayo)OutsideLaboratory",,85730,CPT,Facility,Both,,,90,108,91.8,30.9528,108,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,108,100,,percent of total billed charges,,
"Thromboplastin Time, Partial; Plasma Or Whole Blood (Mayo)OutsideLaboratory",,85730,CPT,Facility,Both,,,90,108,91.8,30.9528,108,BlueCross BlueShield Minnesota,High Value Network Plan,97.2,90,,percent of total billed charges,,
"Thromboplastin Time, Partial; Plasma Or Whole Blood (Mayo)OutsideLaboratory",,85730,CPT,Facility,Outpatient,,,90,108,91.8,30.9528,108,BlueCross BlueShield Minnesota,Medicare Advantage,52.92,49,,percent of total billed charges,,
"Thromboplastin Time, Partial; Plasma Or Whole Blood (Mayo)OutsideLaboratory",,85730,CPT,Facility,Inpatient,,,90,108,91.8,30.9528,108,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Thromboplastin Time, Partial; Plasma Or Whole Blood (Mayo)OutsideLaboratory",,85730,CPT,Facility,Both,,,90,108,91.8,30.9528,108,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,95.6556,88.57,,percent of total billed charges,,
"Thromboplastin Time, Partial; Plasma Or Whole Blood (Mayo)OutsideLaboratory",,85730,CPT,Facility,Both,,,90,108,91.8,30.9528,108,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,30.9528,28.66,,percent of total billed charges,,
"Thromboplastin Time, Partial; Plasma Or Whole Blood (Mayo)OutsideLaboratory",,85730,CPT,Facility,Outpatient,,,90,108,91.8,30.9528,108,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),52.92,49,,percent of total billed charges,,
"Thromboplastin Time, Partial; Plasma Or Whole Blood (Mayo)OutsideLaboratory",,85730,CPT,Facility,Inpatient,,,90,108,91.8,30.9528,108,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Thromboplastin Time, Partial; Plasma Or Whole Blood (Mayo)OutsideLaboratory",,85730,CPT,Facility,Both,,,90,108,91.8,30.9528,108,CorVel,Worker's Compensation,108,100,,percent of total billed charges,,
"Thromboplastin Time, Partial; Plasma Or Whole Blood (Mayo)OutsideLaboratory",,85730,CPT,Facility,Both,,,90,108,91.8,30.9528,108,First Health Group Corporation,First Health Network,104.76,97,,percent of total billed charges,,
"Thromboplastin Time, Partial; Plasma Or Whole Blood (Mayo)OutsideLaboratory",,85730,CPT,Facility,Both,,,90,108,91.8,30.9528,108,"Health Partners, Inc.",Commercial,102.168,94.6,,percent of total billed charges,,
"Thromboplastin Time, Partial; Plasma Or Whole Blood (Mayo)OutsideLaboratory",,85730,CPT,Facility,Outpatient,,,90,108,91.8,30.9528,108,"Health Partners, Inc.",Medicare Advantage,52.92,49,,percent of total billed charges,,
"Thromboplastin Time, Partial; Plasma Or Whole Blood (Mayo)OutsideLaboratory",,85730,CPT,Facility,Inpatient,,,90,108,91.8,30.9528,108,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Thromboplastin Time, Partial; Plasma Or Whole Blood (Mayo)OutsideLaboratory",,85730,CPT,Facility,Both,,,90,108,91.8,30.9528,108,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),64.8,60,,percent of total billed charges,,
"Thromboplastin Time, Partial; Plasma Or Whole Blood (Mayo)OutsideLaboratory",,85730,CPT,Facility,Both,,,90,108,91.8,30.9528,108,"Health Partners, Inc.",State of Minnesota Advantage Program,88.02,81.5,,percent of total billed charges,,
"Thromboplastin Time, Partial; Plasma Or Whole Blood (Mayo)OutsideLaboratory",,85730,CPT,Facility,Both,,,90,108,91.8,30.9528,108,"Health Partners, Inc.",State Public Programs,54,50,,percent of total billed charges,,
"Thromboplastin Time, Partial; Plasma Or Whole Blood (Mayo)OutsideLaboratory",,85730,CPT,Facility,Both,,,90,108,91.8,30.9528,108,Humana Insurance Company,Commercial PPO,102.6,95,,percent of total billed charges,,
"Thromboplastin Time, Partial; Plasma Or Whole Blood (Mayo)OutsideLaboratory",,85730,CPT,Facility,Outpatient,,,90,108,91.8,30.9528,108,Humana Insurance Company,Medicare PPO,52.92,49,,percent of total billed charges,,
"Thromboplastin Time, Partial; Plasma Or Whole Blood (Mayo)OutsideLaboratory",,85730,CPT,Facility,Inpatient,,,90,108,91.8,30.9528,108,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Thromboplastin Time, Partial; Plasma Or Whole Blood (Mayo)OutsideLaboratory",,85730,CPT,Facility,Both,,,90,108,91.8,30.9528,108,Medica,Individual & Family,107.028,99.1,,percent of total billed charges,,
"Thromboplastin Time, Partial; Plasma Or Whole Blood (Mayo)OutsideLaboratory",,85730,CPT,Facility,Outpatient,,,90,108,91.8,30.9528,108,Medica,Medica Advantage Solution,53.784,49.8,,percent of total billed charges,,
"Thromboplastin Time, Partial; Plasma Or Whole Blood (Mayo)OutsideLaboratory",,85730,CPT,Facility,Inpatient,,,90,108,91.8,30.9528,108,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Thromboplastin Time, Partial; Plasma Or Whole Blood (Mayo)OutsideLaboratory",,85730,CPT,Facility,Outpatient,,,90,108,91.8,30.9528,108,Medica,Medical Assistance,48.168,44.6,,percent of total billed charges,,
"Thromboplastin Time, Partial; Plasma Or Whole Blood (Mayo)OutsideLaboratory",,85730,CPT,Facility,Inpatient,,,90,108,91.8,30.9528,108,Medica,Medical Assistance,,,,,Included in per diem rate,
"Thromboplastin Time, Partial; Plasma Or Whole Blood (Mayo)OutsideLaboratory",,85730,CPT,Facility,Outpatient,,,90,108,91.8,30.9528,108,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,53.784,49.8,,percent of total billed charges,,
"Thromboplastin Time, Partial; Plasma Or Whole Blood (Mayo)OutsideLaboratory",,85730,CPT,Facility,Inpatient,,,90,108,91.8,30.9528,108,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Thromboplastin Time, Partial; Plasma Or Whole Blood (Mayo)OutsideLaboratory",,85730,CPT,Facility,Both,,,90,108,91.8,30.9528,108,"Multiplan, Inc.","Multiplan, Inc.",101.52,94,,percent of total billed charges,,
"Thromboplastin Time, Partial; Plasma Or Whole Blood (Mayo)OutsideLaboratory",,85730,CPT,Facility,Outpatient,,,90,108,91.8,30.9528,108,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,93.312,86.4,,percent of total billed charges,,
"Thromboplastin Time, Partial; Plasma Or Whole Blood (Mayo)OutsideLaboratory",,85730,CPT,Facility,Inpatient,,,90,108,91.8,30.9528,108,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Thromboplastin Time, Partial; Plasma Or Whole Blood (Mayo)OutsideLaboratory",,85730,CPT,Facility,Both,,,90,108,91.8,30.9528,108,"Preferred One Administrative Services, INC.",PPO,106.488,98.6,,percent of total billed charges,,
"Thromboplastin Time, Partial; Plasma Or Whole Blood (Mayo)OutsideLaboratory",,85730,CPT,Facility,Outpatient,,,90,108,91.8,30.9528,108,PrimeWest Health,Minnesota Senior Health Options (MSHO),55.566,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Thromboplastin Time, Partial; Plasma Or Whole Blood (Mayo)OutsideLaboratory",,85730,CPT,Facility,Inpatient,,,90,108,91.8,30.9528,108,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Thromboplastin Time, Partial; Plasma Or Whole Blood (Mayo)OutsideLaboratory",,85730,CPT,Facility,Outpatient,,,90,108,91.8,30.9528,108,PrimeWest Health,MinnesotaCare,55.4688,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Thromboplastin Time, Partial; Plasma Or Whole Blood (Mayo)OutsideLaboratory",,85730,CPT,Facility,Inpatient,,,90,108,91.8,30.9528,108,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Thromboplastin Time, Partial; Plasma Or Whole Blood (Mayo)OutsideLaboratory",,85730,CPT,Facility,Both,,,90,108,91.8,30.9528,108,Sanford Health Plan,Sanford Health Plan,99.36,92,,percent of total billed charges,,
"Thromboplastin Time, Partial; Plasma Or Whole Blood (Mayo)OutsideLaboratory",,85730,CPT,Facility,Outpatient,,,90,108,91.8,30.9528,108,"UCare Health, Inc.",Individual & Family Plan,60.858,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Thromboplastin Time, Partial; Plasma Or Whole Blood (Mayo)OutsideLaboratory",,85730,CPT,Facility,Inpatient,,,90,108,91.8,30.9528,108,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Thromboplastin Time, Partial; Plasma Or Whole Blood (Mayo)OutsideLaboratory",,85730,CPT,Facility,Outpatient,,,90,108,91.8,30.9528,108,"UCare Health, Inc.",Medical Assistance,54.5076,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Thromboplastin Time, Partial; Plasma Or Whole Blood (Mayo)OutsideLaboratory",,85730,CPT,Facility,Inpatient,,,90,108,91.8,30.9528,108,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Thromboplastin Time, Partial; Plasma Or Whole Blood (Mayo)OutsideLaboratory",,85730,CPT,Facility,Outpatient,,,90,108,91.8,30.9528,108,"UCare Health, Inc.",Medicare Advantage,54.5076,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Thromboplastin Time, Partial; Plasma Or Whole Blood (Mayo)OutsideLaboratory",,85730,CPT,Facility,Inpatient,,,90,108,91.8,30.9528,108,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Thromboplastin Time, Partial; Plasma Or Whole Blood (Mayo)OutsideLaboratory",,85730,CPT,Facility,Outpatient,,,90,108,91.8,30.9528,108,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),54.5076,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Thromboplastin Time, Partial; Plasma Or Whole Blood (Mayo)OutsideLaboratory",,85730,CPT,Facility,Inpatient,,,90,108,91.8,30.9528,108,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Thromboplastin Time, Partial; Plasma Or Whole Blood (Mayo)OutsideLaboratory",,85730,CPT,Facility,Both,,,90,108,91.8,30.9528,108,UnitedHealthcare,Individual & Family,101.52,94,,percent of total billed charges,,
"Thromboplastin Time, Partial; Plasma Or Whole Blood (Mayo)OutsideLaboratory",,85730,CPT,Facility,Outpatient,,,90,108,91.8,30.9528,108,UnitedHealthcare,Medicare Advantage,52.92,49,,percent of total billed charges,,
"Thromboplastin Time, Partial; Plasma Or Whole Blood (Mayo)OutsideLaboratory",,85730,CPT,Facility,Inpatient,,,90,108,91.8,30.9528,108,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Thromboplastin Time, Partial; Plasma Or Whole Blood (Mayo)OutsideLaboratory",,85730,CPT,Facility,Outpatient,,,90,108,91.8,30.9528,108,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,51.84,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Thromboplastin Time, Partial; Plasma Or Whole Blood (Mayo)OutsideLaboratory",,85730,CPT,Facility,Inpatient,,,90,108,91.8,30.9528,108,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Viscosity, S (Mayo)OutsideLaboratory",,85810,CPT,Facility,Both,,,90,148,125.8,42.4168,148,Aetna,Commercial,136.16,92,,percent of total billed charges,,
"Viscosity, S (Mayo)OutsideLaboratory",,85810,CPT,Facility,Outpatient,,,90,148,125.8,42.4168,148,Aetna,Medicare Advantage,72.52,49,,percent of total billed charges,,
"Viscosity, S (Mayo)OutsideLaboratory",,85810,CPT,Facility,Inpatient,,,90,148,125.8,42.4168,148,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Viscosity, S (Mayo)OutsideLaboratory",,85810,CPT,Facility,Both,,,90,148,125.8,42.4168,148,Aetna,PPO,137.64,93,,percent of total billed charges,,
"Viscosity, S (Mayo)OutsideLaboratory",,85810,CPT,Facility,Both,,,90,148,125.8,42.4168,148,America's PPO,America's PPO,142.1244,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Viscosity, S (Mayo)OutsideLaboratory",,85810,CPT,Facility,Both,,,90,148,125.8,42.4168,148,BlueCross BlueShield Minnesota, Federal Employee Program,145.632,98.4,,percent of total billed charges,,
"Viscosity, S (Mayo)OutsideLaboratory",,85810,CPT,Facility,Both,,,90,148,125.8,42.4168,148,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,148,100,,percent of total billed charges,,
"Viscosity, S (Mayo)OutsideLaboratory",,85810,CPT,Facility,Both,,,90,148,125.8,42.4168,148,BlueCross BlueShield Minnesota,High Value Network Plan,133.2,90,,percent of total billed charges,,
"Viscosity, S (Mayo)OutsideLaboratory",,85810,CPT,Facility,Outpatient,,,90,148,125.8,42.4168,148,BlueCross BlueShield Minnesota,Medicare Advantage,72.52,49,,percent of total billed charges,,
"Viscosity, S (Mayo)OutsideLaboratory",,85810,CPT,Facility,Inpatient,,,90,148,125.8,42.4168,148,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Viscosity, S (Mayo)OutsideLaboratory",,85810,CPT,Facility,Both,,,90,148,125.8,42.4168,148,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,131.0836,88.57,,percent of total billed charges,,
"Viscosity, S (Mayo)OutsideLaboratory",,85810,CPT,Facility,Both,,,90,148,125.8,42.4168,148,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,42.4168,28.66,,percent of total billed charges,,
"Viscosity, S (Mayo)OutsideLaboratory",,85810,CPT,Facility,Outpatient,,,90,148,125.8,42.4168,148,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),72.52,49,,percent of total billed charges,,
"Viscosity, S (Mayo)OutsideLaboratory",,85810,CPT,Facility,Inpatient,,,90,148,125.8,42.4168,148,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Viscosity, S (Mayo)OutsideLaboratory",,85810,CPT,Facility,Both,,,90,148,125.8,42.4168,148,CorVel,Worker's Compensation,148,100,,percent of total billed charges,,
"Viscosity, S (Mayo)OutsideLaboratory",,85810,CPT,Facility,Both,,,90,148,125.8,42.4168,148,First Health Group Corporation,First Health Network,143.56,97,,percent of total billed charges,,
"Viscosity, S (Mayo)OutsideLaboratory",,85810,CPT,Facility,Both,,,90,148,125.8,42.4168,148,"Health Partners, Inc.",Commercial,140.008,94.6,,percent of total billed charges,,
"Viscosity, S (Mayo)OutsideLaboratory",,85810,CPT,Facility,Outpatient,,,90,148,125.8,42.4168,148,"Health Partners, Inc.",Medicare Advantage,72.52,49,,percent of total billed charges,,
"Viscosity, S (Mayo)OutsideLaboratory",,85810,CPT,Facility,Inpatient,,,90,148,125.8,42.4168,148,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Viscosity, S (Mayo)OutsideLaboratory",,85810,CPT,Facility,Both,,,90,148,125.8,42.4168,148,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),88.8,60,,percent of total billed charges,,
"Viscosity, S (Mayo)OutsideLaboratory",,85810,CPT,Facility,Both,,,90,148,125.8,42.4168,148,"Health Partners, Inc.",State of Minnesota Advantage Program,120.62,81.5,,percent of total billed charges,,
"Viscosity, S (Mayo)OutsideLaboratory",,85810,CPT,Facility,Both,,,90,148,125.8,42.4168,148,"Health Partners, Inc.",State Public Programs,74,50,,percent of total billed charges,,
"Viscosity, S (Mayo)OutsideLaboratory",,85810,CPT,Facility,Both,,,90,148,125.8,42.4168,148,Humana Insurance Company,Commercial PPO,140.6,95,,percent of total billed charges,,
"Viscosity, S (Mayo)OutsideLaboratory",,85810,CPT,Facility,Outpatient,,,90,148,125.8,42.4168,148,Humana Insurance Company,Medicare PPO,72.52,49,,percent of total billed charges,,
"Viscosity, S (Mayo)OutsideLaboratory",,85810,CPT,Facility,Inpatient,,,90,148,125.8,42.4168,148,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Viscosity, S (Mayo)OutsideLaboratory",,85810,CPT,Facility,Both,,,90,148,125.8,42.4168,148,Medica,Individual & Family,146.668,99.1,,percent of total billed charges,,
"Viscosity, S (Mayo)OutsideLaboratory",,85810,CPT,Facility,Outpatient,,,90,148,125.8,42.4168,148,Medica,Medica Advantage Solution,73.704,49.8,,percent of total billed charges,,
"Viscosity, S (Mayo)OutsideLaboratory",,85810,CPT,Facility,Inpatient,,,90,148,125.8,42.4168,148,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Viscosity, S (Mayo)OutsideLaboratory",,85810,CPT,Facility,Outpatient,,,90,148,125.8,42.4168,148,Medica,Medical Assistance,66.008,44.6,,percent of total billed charges,,
"Viscosity, S (Mayo)OutsideLaboratory",,85810,CPT,Facility,Inpatient,,,90,148,125.8,42.4168,148,Medica,Medical Assistance,,,,,Included in per diem rate,
"Viscosity, S (Mayo)OutsideLaboratory",,85810,CPT,Facility,Outpatient,,,90,148,125.8,42.4168,148,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,73.704,49.8,,percent of total billed charges,,
"Viscosity, S (Mayo)OutsideLaboratory",,85810,CPT,Facility,Inpatient,,,90,148,125.8,42.4168,148,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Viscosity, S (Mayo)OutsideLaboratory",,85810,CPT,Facility,Both,,,90,148,125.8,42.4168,148,"Multiplan, Inc.","Multiplan, Inc.",139.12,94,,percent of total billed charges,,
"Viscosity, S (Mayo)OutsideLaboratory",,85810,CPT,Facility,Outpatient,,,90,148,125.8,42.4168,148,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,127.872,86.4,,percent of total billed charges,,
"Viscosity, S (Mayo)OutsideLaboratory",,85810,CPT,Facility,Inpatient,,,90,148,125.8,42.4168,148,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Viscosity, S (Mayo)OutsideLaboratory",,85810,CPT,Facility,Both,,,90,148,125.8,42.4168,148,"Preferred One Administrative Services, INC.",PPO,145.928,98.6,,percent of total billed charges,,
"Viscosity, S (Mayo)OutsideLaboratory",,85810,CPT,Facility,Outpatient,,,90,148,125.8,42.4168,148,PrimeWest Health,Minnesota Senior Health Options (MSHO),76.146,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Viscosity, S (Mayo)OutsideLaboratory",,85810,CPT,Facility,Inpatient,,,90,148,125.8,42.4168,148,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Viscosity, S (Mayo)OutsideLaboratory",,85810,CPT,Facility,Outpatient,,,90,148,125.8,42.4168,148,PrimeWest Health,MinnesotaCare,76.0128,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Viscosity, S (Mayo)OutsideLaboratory",,85810,CPT,Facility,Inpatient,,,90,148,125.8,42.4168,148,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Viscosity, S (Mayo)OutsideLaboratory",,85810,CPT,Facility,Both,,,90,148,125.8,42.4168,148,Sanford Health Plan,Sanford Health Plan,136.16,92,,percent of total billed charges,,
"Viscosity, S (Mayo)OutsideLaboratory",,85810,CPT,Facility,Outpatient,,,90,148,125.8,42.4168,148,"UCare Health, Inc.",Individual & Family Plan,83.398,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Viscosity, S (Mayo)OutsideLaboratory",,85810,CPT,Facility,Inpatient,,,90,148,125.8,42.4168,148,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Viscosity, S (Mayo)OutsideLaboratory",,85810,CPT,Facility,Outpatient,,,90,148,125.8,42.4168,148,"UCare Health, Inc.",Medical Assistance,74.6956,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Viscosity, S (Mayo)OutsideLaboratory",,85810,CPT,Facility,Inpatient,,,90,148,125.8,42.4168,148,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Viscosity, S (Mayo)OutsideLaboratory",,85810,CPT,Facility,Outpatient,,,90,148,125.8,42.4168,148,"UCare Health, Inc.",Medicare Advantage,74.6956,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Viscosity, S (Mayo)OutsideLaboratory",,85810,CPT,Facility,Inpatient,,,90,148,125.8,42.4168,148,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Viscosity, S (Mayo)OutsideLaboratory",,85810,CPT,Facility,Outpatient,,,90,148,125.8,42.4168,148,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),74.6956,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Viscosity, S (Mayo)OutsideLaboratory",,85810,CPT,Facility,Inpatient,,,90,148,125.8,42.4168,148,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Viscosity, S (Mayo)OutsideLaboratory",,85810,CPT,Facility,Both,,,90,148,125.8,42.4168,148,UnitedHealthcare,Individual & Family,139.12,94,,percent of total billed charges,,
"Viscosity, S (Mayo)OutsideLaboratory",,85810,CPT,Facility,Outpatient,,,90,148,125.8,42.4168,148,UnitedHealthcare,Medicare Advantage,72.52,49,,percent of total billed charges,,
"Viscosity, S (Mayo)OutsideLaboratory",,85810,CPT,Facility,Inpatient,,,90,148,125.8,42.4168,148,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Viscosity, S (Mayo)OutsideLaboratory",,85810,CPT,Facility,Outpatient,,,90,148,125.8,42.4168,148,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,71.04,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Viscosity, S (Mayo)OutsideLaboratory",,85810,CPT,Facility,Inpatient,,,90,148,125.8,42.4168,148,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Allergen (Dairy And Grain Profile) (Mayo)OutsideLaboratory,,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Aetna,Commercial,42.32,92,,percent of total billed charges,,
Allergen (Dairy And Grain Profile) (Mayo)OutsideLaboratory,,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Aetna,Medicare Advantage,22.54,49,,percent of total billed charges,,
Allergen (Dairy And Grain Profile) (Mayo)OutsideLaboratory,,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Allergen (Dairy And Grain Profile) (Mayo)OutsideLaboratory,,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Aetna,PPO,42.78,93,,percent of total billed charges,,
Allergen (Dairy And Grain Profile) (Mayo)OutsideLaboratory,,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,America's PPO,America's PPO,44.1738,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Allergen (Dairy And Grain Profile) (Mayo)OutsideLaboratory,,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota, Federal Employee Program,45.264,98.4,,percent of total billed charges,,
Allergen (Dairy And Grain Profile) (Mayo)OutsideLaboratory,,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,46,100,,percent of total billed charges,,
Allergen (Dairy And Grain Profile) (Mayo)OutsideLaboratory,,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,High Value Network Plan,41.4,90,,percent of total billed charges,,
Allergen (Dairy And Grain Profile) (Mayo)OutsideLaboratory,,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Medicare Advantage,22.54,49,,percent of total billed charges,,
Allergen (Dairy And Grain Profile) (Mayo)OutsideLaboratory,,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Allergen (Dairy And Grain Profile) (Mayo)OutsideLaboratory,,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,40.7422,88.57,,percent of total billed charges,,
Allergen (Dairy And Grain Profile) (Mayo)OutsideLaboratory,,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,13.1836,28.66,,percent of total billed charges,,
Allergen (Dairy And Grain Profile) (Mayo)OutsideLaboratory,,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),22.54,49,,percent of total billed charges,,
Allergen (Dairy And Grain Profile) (Mayo)OutsideLaboratory,,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Allergen (Dairy And Grain Profile) (Mayo)OutsideLaboratory,,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,CorVel,Worker's Compensation,46,100,,percent of total billed charges,,
Allergen (Dairy And Grain Profile) (Mayo)OutsideLaboratory,,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,First Health Group Corporation,First Health Network,44.62,97,,percent of total billed charges,,
Allergen (Dairy And Grain Profile) (Mayo)OutsideLaboratory,,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Commercial,43.516,94.6,,percent of total billed charges,,
Allergen (Dairy And Grain Profile) (Mayo)OutsideLaboratory,,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Medicare Advantage,22.54,49,,percent of total billed charges,,
Allergen (Dairy And Grain Profile) (Mayo)OutsideLaboratory,,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Allergen (Dairy And Grain Profile) (Mayo)OutsideLaboratory,,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),27.6,60,,percent of total billed charges,,
Allergen (Dairy And Grain Profile) (Mayo)OutsideLaboratory,,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",State of Minnesota Advantage Program,37.49,81.5,,percent of total billed charges,,
Allergen (Dairy And Grain Profile) (Mayo)OutsideLaboratory,,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",State Public Programs,23,50,,percent of total billed charges,,
Allergen (Dairy And Grain Profile) (Mayo)OutsideLaboratory,,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Humana Insurance Company,Commercial PPO,43.7,95,,percent of total billed charges,,
Allergen (Dairy And Grain Profile) (Mayo)OutsideLaboratory,,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Humana Insurance Company,Medicare PPO,22.54,49,,percent of total billed charges,,
Allergen (Dairy And Grain Profile) (Mayo)OutsideLaboratory,,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Allergen (Dairy And Grain Profile) (Mayo)OutsideLaboratory,,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Medica,Individual & Family,45.586,99.1,,percent of total billed charges,,
Allergen (Dairy And Grain Profile) (Mayo)OutsideLaboratory,,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Medica,Medica Advantage Solution,22.908,49.8,,percent of total billed charges,,
Allergen (Dairy And Grain Profile) (Mayo)OutsideLaboratory,,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Allergen (Dairy And Grain Profile) (Mayo)OutsideLaboratory,,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Medica,Medical Assistance,20.516,44.6,,percent of total billed charges,,
Allergen (Dairy And Grain Profile) (Mayo)OutsideLaboratory,,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Medica,Medical Assistance,,,,,Included in per diem rate,
Allergen (Dairy And Grain Profile) (Mayo)OutsideLaboratory,,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,22.908,49.8,,percent of total billed charges,,
Allergen (Dairy And Grain Profile) (Mayo)OutsideLaboratory,,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Allergen (Dairy And Grain Profile) (Mayo)OutsideLaboratory,,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Multiplan, Inc.","Multiplan, Inc.",43.24,94,,percent of total billed charges,,
Allergen (Dairy And Grain Profile) (Mayo)OutsideLaboratory,,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,39.744,86.4,,percent of total billed charges,,
Allergen (Dairy And Grain Profile) (Mayo)OutsideLaboratory,,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Allergen (Dairy And Grain Profile) (Mayo)OutsideLaboratory,,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PPO,45.356,98.6,,percent of total billed charges,,
Allergen (Dairy And Grain Profile) (Mayo)OutsideLaboratory,,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,Minnesota Senior Health Options (MSHO),23.667,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Allergen (Dairy And Grain Profile) (Mayo)OutsideLaboratory,,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Allergen (Dairy And Grain Profile) (Mayo)OutsideLaboratory,,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,MinnesotaCare,23.6256,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Allergen (Dairy And Grain Profile) (Mayo)OutsideLaboratory,,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Allergen (Dairy And Grain Profile) (Mayo)OutsideLaboratory,,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Sanford Health Plan,Sanford Health Plan,42.32,92,,percent of total billed charges,,
Allergen (Dairy And Grain Profile) (Mayo)OutsideLaboratory,,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Individual & Family Plan,25.921,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Allergen (Dairy And Grain Profile) (Mayo)OutsideLaboratory,,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Allergen (Dairy And Grain Profile) (Mayo)OutsideLaboratory,,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medical Assistance,23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Allergen (Dairy And Grain Profile) (Mayo)OutsideLaboratory,,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Allergen (Dairy And Grain Profile) (Mayo)OutsideLaboratory,,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medicare Advantage,23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Allergen (Dairy And Grain Profile) (Mayo)OutsideLaboratory,,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Allergen (Dairy And Grain Profile) (Mayo)OutsideLaboratory,,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Allergen (Dairy And Grain Profile) (Mayo)OutsideLaboratory,,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Allergen (Dairy And Grain Profile) (Mayo)OutsideLaboratory,,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,UnitedHealthcare,Individual & Family,43.24,94,,percent of total billed charges,,
Allergen (Dairy And Grain Profile) (Mayo)OutsideLaboratory,,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Medicare Advantage,22.54,49,,percent of total billed charges,,
Allergen (Dairy And Grain Profile) (Mayo)OutsideLaboratory,,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Allergen (Dairy And Grain Profile) (Mayo)OutsideLaboratory,,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,22.08,48,,percent of total billed charges,,100% of DHS outpatient percentage
Allergen (Dairy And Grain Profile) (Mayo)OutsideLaboratory,,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Almond, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Aetna,Commercial,42.32,92,,percent of total billed charges,,
"Almond, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Aetna,Medicare Advantage,22.54,49,,percent of total billed charges,,
"Almond, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Almond, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Aetna,PPO,42.78,93,,percent of total billed charges,,
"Almond, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,America's PPO,America's PPO,44.1738,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Almond, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota, Federal Employee Program,45.264,98.4,,percent of total billed charges,,
"Almond, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,46,100,,percent of total billed charges,,
"Almond, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,High Value Network Plan,41.4,90,,percent of total billed charges,,
"Almond, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Medicare Advantage,22.54,49,,percent of total billed charges,,
"Almond, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Almond, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,40.7422,88.57,,percent of total billed charges,,
"Almond, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,13.1836,28.66,,percent of total billed charges,,
"Almond, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),22.54,49,,percent of total billed charges,,
"Almond, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Almond, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,CorVel,Worker's Compensation,46,100,,percent of total billed charges,,
"Almond, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,First Health Group Corporation,First Health Network,44.62,97,,percent of total billed charges,,
"Almond, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Commercial,43.516,94.6,,percent of total billed charges,,
"Almond, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Medicare Advantage,22.54,49,,percent of total billed charges,,
"Almond, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Almond, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),27.6,60,,percent of total billed charges,,
"Almond, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",State of Minnesota Advantage Program,37.49,81.5,,percent of total billed charges,,
"Almond, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",State Public Programs,23,50,,percent of total billed charges,,
"Almond, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Humana Insurance Company,Commercial PPO,43.7,95,,percent of total billed charges,,
"Almond, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Humana Insurance Company,Medicare PPO,22.54,49,,percent of total billed charges,,
"Almond, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Almond, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Medica,Individual & Family,45.586,99.1,,percent of total billed charges,,
"Almond, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Medica,Medica Advantage Solution,22.908,49.8,,percent of total billed charges,,
"Almond, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Almond, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Medica,Medical Assistance,20.516,44.6,,percent of total billed charges,,
"Almond, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Medica,Medical Assistance,,,,,Included in per diem rate,
"Almond, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,22.908,49.8,,percent of total billed charges,,
"Almond, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Almond, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Multiplan, Inc.","Multiplan, Inc.",43.24,94,,percent of total billed charges,,
"Almond, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,39.744,86.4,,percent of total billed charges,,
"Almond, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Almond, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PPO,45.356,98.6,,percent of total billed charges,,
"Almond, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,Minnesota Senior Health Options (MSHO),23.667,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Almond, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Almond, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,MinnesotaCare,23.6256,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Almond, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Almond, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Sanford Health Plan,Sanford Health Plan,42.32,92,,percent of total billed charges,,
"Almond, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Individual & Family Plan,25.921,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Almond, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Almond, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medical Assistance,23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Almond, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Almond, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medicare Advantage,23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Almond, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Almond, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Almond, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Almond, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,UnitedHealthcare,Individual & Family,43.24,94,,percent of total billed charges,,
"Almond, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Medicare Advantage,22.54,49,,percent of total billed charges,,
"Almond, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Almond, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,22.08,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Almond, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Alternaria Tenuis, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Aetna,Commercial,42.32,92,,percent of total billed charges,,
"Alternaria Tenuis, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Aetna,Medicare Advantage,22.54,49,,percent of total billed charges,,
"Alternaria Tenuis, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Alternaria Tenuis, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Aetna,PPO,42.78,93,,percent of total billed charges,,
"Alternaria Tenuis, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,America's PPO,America's PPO,44.1738,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Alternaria Tenuis, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota, Federal Employee Program,45.264,98.4,,percent of total billed charges,,
"Alternaria Tenuis, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,46,100,,percent of total billed charges,,
"Alternaria Tenuis, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,High Value Network Plan,41.4,90,,percent of total billed charges,,
"Alternaria Tenuis, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Medicare Advantage,22.54,49,,percent of total billed charges,,
"Alternaria Tenuis, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Alternaria Tenuis, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,40.7422,88.57,,percent of total billed charges,,
"Alternaria Tenuis, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,13.1836,28.66,,percent of total billed charges,,
"Alternaria Tenuis, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),22.54,49,,percent of total billed charges,,
"Alternaria Tenuis, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Alternaria Tenuis, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,CorVel,Worker's Compensation,46,100,,percent of total billed charges,,
"Alternaria Tenuis, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,First Health Group Corporation,First Health Network,44.62,97,,percent of total billed charges,,
"Alternaria Tenuis, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Commercial,43.516,94.6,,percent of total billed charges,,
"Alternaria Tenuis, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Medicare Advantage,22.54,49,,percent of total billed charges,,
"Alternaria Tenuis, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Alternaria Tenuis, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),27.6,60,,percent of total billed charges,,
"Alternaria Tenuis, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",State of Minnesota Advantage Program,37.49,81.5,,percent of total billed charges,,
"Alternaria Tenuis, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",State Public Programs,23,50,,percent of total billed charges,,
"Alternaria Tenuis, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Humana Insurance Company,Commercial PPO,43.7,95,,percent of total billed charges,,
"Alternaria Tenuis, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Humana Insurance Company,Medicare PPO,22.54,49,,percent of total billed charges,,
"Alternaria Tenuis, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Alternaria Tenuis, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Medica,Individual & Family,45.586,99.1,,percent of total billed charges,,
"Alternaria Tenuis, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Medica,Medica Advantage Solution,22.908,49.8,,percent of total billed charges,,
"Alternaria Tenuis, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Alternaria Tenuis, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Medica,Medical Assistance,20.516,44.6,,percent of total billed charges,,
"Alternaria Tenuis, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Medica,Medical Assistance,,,,,Included in per diem rate,
"Alternaria Tenuis, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,22.908,49.8,,percent of total billed charges,,
"Alternaria Tenuis, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Alternaria Tenuis, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Multiplan, Inc.","Multiplan, Inc.",43.24,94,,percent of total billed charges,,
"Alternaria Tenuis, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,39.744,86.4,,percent of total billed charges,,
"Alternaria Tenuis, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Alternaria Tenuis, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PPO,45.356,98.6,,percent of total billed charges,,
"Alternaria Tenuis, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,Minnesota Senior Health Options (MSHO),23.667,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Alternaria Tenuis, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Alternaria Tenuis, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,MinnesotaCare,23.6256,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Alternaria Tenuis, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Alternaria Tenuis, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Sanford Health Plan,Sanford Health Plan,42.32,92,,percent of total billed charges,,
"Alternaria Tenuis, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Individual & Family Plan,25.921,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Alternaria Tenuis, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Alternaria Tenuis, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medical Assistance,23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Alternaria Tenuis, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Alternaria Tenuis, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medicare Advantage,23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Alternaria Tenuis, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Alternaria Tenuis, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Alternaria Tenuis, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Alternaria Tenuis, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,UnitedHealthcare,Individual & Family,43.24,94,,percent of total billed charges,,
"Alternaria Tenuis, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Medicare Advantage,22.54,49,,percent of total billed charges,,
"Alternaria Tenuis, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Alternaria Tenuis, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,22.08,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Alternaria Tenuis, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Aspergillus Fumigatus, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Aetna,Commercial,42.32,92,,percent of total billed charges,,
"Aspergillus Fumigatus, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Aetna,Medicare Advantage,22.54,49,,percent of total billed charges,,
"Aspergillus Fumigatus, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Aspergillus Fumigatus, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Aetna,PPO,42.78,93,,percent of total billed charges,,
"Aspergillus Fumigatus, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,America's PPO,America's PPO,44.1738,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Aspergillus Fumigatus, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota, Federal Employee Program,45.264,98.4,,percent of total billed charges,,
"Aspergillus Fumigatus, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,46,100,,percent of total billed charges,,
"Aspergillus Fumigatus, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,High Value Network Plan,41.4,90,,percent of total billed charges,,
"Aspergillus Fumigatus, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Medicare Advantage,22.54,49,,percent of total billed charges,,
"Aspergillus Fumigatus, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Aspergillus Fumigatus, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,40.7422,88.57,,percent of total billed charges,,
"Aspergillus Fumigatus, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,13.1836,28.66,,percent of total billed charges,,
"Aspergillus Fumigatus, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),22.54,49,,percent of total billed charges,,
"Aspergillus Fumigatus, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Aspergillus Fumigatus, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,CorVel,Worker's Compensation,46,100,,percent of total billed charges,,
"Aspergillus Fumigatus, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,First Health Group Corporation,First Health Network,44.62,97,,percent of total billed charges,,
"Aspergillus Fumigatus, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Commercial,43.516,94.6,,percent of total billed charges,,
"Aspergillus Fumigatus, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Medicare Advantage,22.54,49,,percent of total billed charges,,
"Aspergillus Fumigatus, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Aspergillus Fumigatus, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),27.6,60,,percent of total billed charges,,
"Aspergillus Fumigatus, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",State of Minnesota Advantage Program,37.49,81.5,,percent of total billed charges,,
"Aspergillus Fumigatus, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",State Public Programs,23,50,,percent of total billed charges,,
"Aspergillus Fumigatus, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Humana Insurance Company,Commercial PPO,43.7,95,,percent of total billed charges,,
"Aspergillus Fumigatus, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Humana Insurance Company,Medicare PPO,22.54,49,,percent of total billed charges,,
"Aspergillus Fumigatus, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Aspergillus Fumigatus, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Medica,Individual & Family,45.586,99.1,,percent of total billed charges,,
"Aspergillus Fumigatus, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Medica,Medica Advantage Solution,22.908,49.8,,percent of total billed charges,,
"Aspergillus Fumigatus, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Aspergillus Fumigatus, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Medica,Medical Assistance,20.516,44.6,,percent of total billed charges,,
"Aspergillus Fumigatus, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Medica,Medical Assistance,,,,,Included in per diem rate,
"Aspergillus Fumigatus, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,22.908,49.8,,percent of total billed charges,,
"Aspergillus Fumigatus, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Aspergillus Fumigatus, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Multiplan, Inc.","Multiplan, Inc.",43.24,94,,percent of total billed charges,,
"Aspergillus Fumigatus, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,39.744,86.4,,percent of total billed charges,,
"Aspergillus Fumigatus, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Aspergillus Fumigatus, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PPO,45.356,98.6,,percent of total billed charges,,
"Aspergillus Fumigatus, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,Minnesota Senior Health Options (MSHO),23.667,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Aspergillus Fumigatus, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Aspergillus Fumigatus, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,MinnesotaCare,23.6256,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Aspergillus Fumigatus, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Aspergillus Fumigatus, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Sanford Health Plan,Sanford Health Plan,42.32,92,,percent of total billed charges,,
"Aspergillus Fumigatus, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Individual & Family Plan,25.921,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Aspergillus Fumigatus, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Aspergillus Fumigatus, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medical Assistance,23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Aspergillus Fumigatus, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Aspergillus Fumigatus, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medicare Advantage,23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Aspergillus Fumigatus, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Aspergillus Fumigatus, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Aspergillus Fumigatus, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Aspergillus Fumigatus, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,UnitedHealthcare,Individual & Family,43.24,94,,percent of total billed charges,,
"Aspergillus Fumigatus, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Medicare Advantage,22.54,49,,percent of total billed charges,,
"Aspergillus Fumigatus, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Aspergillus Fumigatus, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,22.08,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Aspergillus Fumigatus, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Bermuda Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Aetna,Commercial,42.32,92,,percent of total billed charges,,
"Bermuda Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Aetna,Medicare Advantage,22.54,49,,percent of total billed charges,,
"Bermuda Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Bermuda Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Aetna,PPO,42.78,93,,percent of total billed charges,,
"Bermuda Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,America's PPO,America's PPO,44.1738,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Bermuda Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota, Federal Employee Program,45.264,98.4,,percent of total billed charges,,
"Bermuda Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,46,100,,percent of total billed charges,,
"Bermuda Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,High Value Network Plan,41.4,90,,percent of total billed charges,,
"Bermuda Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Medicare Advantage,22.54,49,,percent of total billed charges,,
"Bermuda Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Bermuda Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,40.7422,88.57,,percent of total billed charges,,
"Bermuda Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,13.1836,28.66,,percent of total billed charges,,
"Bermuda Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),22.54,49,,percent of total billed charges,,
"Bermuda Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Bermuda Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,CorVel,Worker's Compensation,46,100,,percent of total billed charges,,
"Bermuda Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,First Health Group Corporation,First Health Network,44.62,97,,percent of total billed charges,,
"Bermuda Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Commercial,43.516,94.6,,percent of total billed charges,,
"Bermuda Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Medicare Advantage,22.54,49,,percent of total billed charges,,
"Bermuda Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Bermuda Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),27.6,60,,percent of total billed charges,,
"Bermuda Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",State of Minnesota Advantage Program,37.49,81.5,,percent of total billed charges,,
"Bermuda Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",State Public Programs,23,50,,percent of total billed charges,,
"Bermuda Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Humana Insurance Company,Commercial PPO,43.7,95,,percent of total billed charges,,
"Bermuda Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Humana Insurance Company,Medicare PPO,22.54,49,,percent of total billed charges,,
"Bermuda Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Bermuda Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Medica,Individual & Family,45.586,99.1,,percent of total billed charges,,
"Bermuda Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Medica,Medica Advantage Solution,22.908,49.8,,percent of total billed charges,,
"Bermuda Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Bermuda Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Medica,Medical Assistance,20.516,44.6,,percent of total billed charges,,
"Bermuda Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Medica,Medical Assistance,,,,,Included in per diem rate,
"Bermuda Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,22.908,49.8,,percent of total billed charges,,
"Bermuda Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Bermuda Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Multiplan, Inc.","Multiplan, Inc.",43.24,94,,percent of total billed charges,,
"Bermuda Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,39.744,86.4,,percent of total billed charges,,
"Bermuda Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Bermuda Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PPO,45.356,98.6,,percent of total billed charges,,
"Bermuda Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,Minnesota Senior Health Options (MSHO),23.667,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Bermuda Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Bermuda Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,MinnesotaCare,23.6256,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Bermuda Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Bermuda Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Sanford Health Plan,Sanford Health Plan,42.32,92,,percent of total billed charges,,
"Bermuda Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Individual & Family Plan,25.921,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Bermuda Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Bermuda Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medical Assistance,23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Bermuda Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Bermuda Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medicare Advantage,23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Bermuda Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Bermuda Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Bermuda Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Bermuda Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,UnitedHealthcare,Individual & Family,43.24,94,,percent of total billed charges,,
"Bermuda Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Medicare Advantage,22.54,49,,percent of total billed charges,,
"Bermuda Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Bermuda Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,22.08,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Bermuda Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Cashew, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,47,39.95,13.4702,47,Aetna,Commercial,43.24,92,,percent of total billed charges,,
"Cashew, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,47,39.95,13.4702,47,Aetna,Medicare Advantage,23.03,49,,percent of total billed charges,,
"Cashew, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,47,39.95,13.4702,47,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Cashew, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,47,39.95,13.4702,47,Aetna,PPO,43.71,93,,percent of total billed charges,,
"Cashew, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,47,39.95,13.4702,47,America's PPO,America's PPO,45.1341,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Cashew, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,47,39.95,13.4702,47,BlueCross BlueShield Minnesota, Federal Employee Program,46.248,98.4,,percent of total billed charges,,
"Cashew, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,47,39.95,13.4702,47,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,47,100,,percent of total billed charges,,
"Cashew, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,47,39.95,13.4702,47,BlueCross BlueShield Minnesota,High Value Network Plan,42.3,90,,percent of total billed charges,,
"Cashew, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,47,39.95,13.4702,47,BlueCross BlueShield Minnesota,Medicare Advantage,23.03,49,,percent of total billed charges,,
"Cashew, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,47,39.95,13.4702,47,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Cashew, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,47,39.95,13.4702,47,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,41.6279,88.57,,percent of total billed charges,,
"Cashew, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,47,39.95,13.4702,47,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,13.4702,28.66,,percent of total billed charges,,
"Cashew, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,47,39.95,13.4702,47,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),23.03,49,,percent of total billed charges,,
"Cashew, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,47,39.95,13.4702,47,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Cashew, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,47,39.95,13.4702,47,CorVel,Worker's Compensation,47,100,,percent of total billed charges,,
"Cashew, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,47,39.95,13.4702,47,First Health Group Corporation,First Health Network,45.59,97,,percent of total billed charges,,
"Cashew, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,47,39.95,13.4702,47,"Health Partners, Inc.",Commercial,44.462,94.6,,percent of total billed charges,,
"Cashew, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,47,39.95,13.4702,47,"Health Partners, Inc.",Medicare Advantage,23.03,49,,percent of total billed charges,,
"Cashew, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,47,39.95,13.4702,47,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Cashew, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,47,39.95,13.4702,47,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),28.2,60,,percent of total billed charges,,
"Cashew, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,47,39.95,13.4702,47,"Health Partners, Inc.",State of Minnesota Advantage Program,38.305,81.5,,percent of total billed charges,,
"Cashew, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,47,39.95,13.4702,47,"Health Partners, Inc.",State Public Programs,23.5,50,,percent of total billed charges,,
"Cashew, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,47,39.95,13.4702,47,Humana Insurance Company,Commercial PPO,44.65,95,,percent of total billed charges,,
"Cashew, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,47,39.95,13.4702,47,Humana Insurance Company,Medicare PPO,23.03,49,,percent of total billed charges,,
"Cashew, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,47,39.95,13.4702,47,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Cashew, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,47,39.95,13.4702,47,Medica,Individual & Family,46.577,99.1,,percent of total billed charges,,
"Cashew, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,47,39.95,13.4702,47,Medica,Medica Advantage Solution,23.406,49.8,,percent of total billed charges,,
"Cashew, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,47,39.95,13.4702,47,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Cashew, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,47,39.95,13.4702,47,Medica,Medical Assistance,20.962,44.6,,percent of total billed charges,,
"Cashew, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,47,39.95,13.4702,47,Medica,Medical Assistance,,,,,Included in per diem rate,
"Cashew, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,47,39.95,13.4702,47,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,23.406,49.8,,percent of total billed charges,,
"Cashew, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,47,39.95,13.4702,47,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Cashew, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,47,39.95,13.4702,47,"Multiplan, Inc.","Multiplan, Inc.",44.18,94,,percent of total billed charges,,
"Cashew, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,47,39.95,13.4702,47,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,40.608,86.4,,percent of total billed charges,,
"Cashew, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,47,39.95,13.4702,47,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Cashew, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,47,39.95,13.4702,47,"Preferred One Administrative Services, INC.",PPO,46.342,98.6,,percent of total billed charges,,
"Cashew, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,47,39.95,13.4702,47,PrimeWest Health,Minnesota Senior Health Options (MSHO),24.1815,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Cashew, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,47,39.95,13.4702,47,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Cashew, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,47,39.95,13.4702,47,PrimeWest Health,MinnesotaCare,24.1392,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Cashew, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,47,39.95,13.4702,47,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Cashew, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,47,39.95,13.4702,47,Sanford Health Plan,Sanford Health Plan,43.24,92,,percent of total billed charges,,
"Cashew, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,47,39.95,13.4702,47,"UCare Health, Inc.",Individual & Family Plan,26.4845,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Cashew, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,47,39.95,13.4702,47,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Cashew, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,47,39.95,13.4702,47,"UCare Health, Inc.",Medical Assistance,23.7209,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Cashew, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,47,39.95,13.4702,47,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Cashew, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,47,39.95,13.4702,47,"UCare Health, Inc.",Medicare Advantage,23.7209,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Cashew, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,47,39.95,13.4702,47,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Cashew, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,47,39.95,13.4702,47,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),23.7209,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Cashew, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,47,39.95,13.4702,47,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Cashew, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,47,39.95,13.4702,47,UnitedHealthcare,Individual & Family,44.18,94,,percent of total billed charges,,
"Cashew, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,47,39.95,13.4702,47,UnitedHealthcare,Medicare Advantage,23.03,49,,percent of total billed charges,,
"Cashew, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,47,39.95,13.4702,47,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Cashew, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,47,39.95,13.4702,47,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,22.56,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Cashew, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,47,39.95,13.4702,47,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Cat Epithelium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Aetna,Commercial,42.32,92,,percent of total billed charges,,
"Cat Epithelium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Aetna,Medicare Advantage,22.54,49,,percent of total billed charges,,
"Cat Epithelium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Cat Epithelium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Aetna,PPO,42.78,93,,percent of total billed charges,,
"Cat Epithelium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,America's PPO,America's PPO,44.1738,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Cat Epithelium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota, Federal Employee Program,45.264,98.4,,percent of total billed charges,,
"Cat Epithelium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,46,100,,percent of total billed charges,,
"Cat Epithelium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,High Value Network Plan,41.4,90,,percent of total billed charges,,
"Cat Epithelium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Medicare Advantage,22.54,49,,percent of total billed charges,,
"Cat Epithelium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Cat Epithelium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,40.7422,88.57,,percent of total billed charges,,
"Cat Epithelium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,13.1836,28.66,,percent of total billed charges,,
"Cat Epithelium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),22.54,49,,percent of total billed charges,,
"Cat Epithelium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Cat Epithelium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,CorVel,Worker's Compensation,46,100,,percent of total billed charges,,
"Cat Epithelium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,First Health Group Corporation,First Health Network,44.62,97,,percent of total billed charges,,
"Cat Epithelium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Commercial,43.516,94.6,,percent of total billed charges,,
"Cat Epithelium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Medicare Advantage,22.54,49,,percent of total billed charges,,
"Cat Epithelium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Cat Epithelium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),27.6,60,,percent of total billed charges,,
"Cat Epithelium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",State of Minnesota Advantage Program,37.49,81.5,,percent of total billed charges,,
"Cat Epithelium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",State Public Programs,23,50,,percent of total billed charges,,
"Cat Epithelium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Humana Insurance Company,Commercial PPO,43.7,95,,percent of total billed charges,,
"Cat Epithelium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Humana Insurance Company,Medicare PPO,22.54,49,,percent of total billed charges,,
"Cat Epithelium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Cat Epithelium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Medica,Individual & Family,45.586,99.1,,percent of total billed charges,,
"Cat Epithelium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Medica,Medica Advantage Solution,22.908,49.8,,percent of total billed charges,,
"Cat Epithelium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Cat Epithelium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Medica,Medical Assistance,20.516,44.6,,percent of total billed charges,,
"Cat Epithelium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Medica,Medical Assistance,,,,,Included in per diem rate,
"Cat Epithelium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,22.908,49.8,,percent of total billed charges,,
"Cat Epithelium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Cat Epithelium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Multiplan, Inc.","Multiplan, Inc.",43.24,94,,percent of total billed charges,,
"Cat Epithelium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,39.744,86.4,,percent of total billed charges,,
"Cat Epithelium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Cat Epithelium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PPO,45.356,98.6,,percent of total billed charges,,
"Cat Epithelium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,Minnesota Senior Health Options (MSHO),23.667,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Cat Epithelium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Cat Epithelium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,MinnesotaCare,23.6256,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Cat Epithelium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Cat Epithelium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Sanford Health Plan,Sanford Health Plan,42.32,92,,percent of total billed charges,,
"Cat Epithelium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Individual & Family Plan,25.921,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Cat Epithelium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Cat Epithelium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medical Assistance,23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Cat Epithelium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Cat Epithelium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medicare Advantage,23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Cat Epithelium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Cat Epithelium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Cat Epithelium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Cat Epithelium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,UnitedHealthcare,Individual & Family,43.24,94,,percent of total billed charges,,
"Cat Epithelium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Medicare Advantage,22.54,49,,percent of total billed charges,,
"Cat Epithelium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Cat Epithelium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,22.08,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Cat Epithelium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Cladosporium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Aetna,Commercial,42.32,92,,percent of total billed charges,,
"Cladosporium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Aetna,Medicare Advantage,22.54,49,,percent of total billed charges,,
"Cladosporium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Cladosporium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Aetna,PPO,42.78,93,,percent of total billed charges,,
"Cladosporium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,America's PPO,America's PPO,44.1738,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Cladosporium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota, Federal Employee Program,45.264,98.4,,percent of total billed charges,,
"Cladosporium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,46,100,,percent of total billed charges,,
"Cladosporium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,High Value Network Plan,41.4,90,,percent of total billed charges,,
"Cladosporium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Medicare Advantage,22.54,49,,percent of total billed charges,,
"Cladosporium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Cladosporium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,40.7422,88.57,,percent of total billed charges,,
"Cladosporium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,13.1836,28.66,,percent of total billed charges,,
"Cladosporium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),22.54,49,,percent of total billed charges,,
"Cladosporium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Cladosporium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,CorVel,Worker's Compensation,46,100,,percent of total billed charges,,
"Cladosporium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,First Health Group Corporation,First Health Network,44.62,97,,percent of total billed charges,,
"Cladosporium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Commercial,43.516,94.6,,percent of total billed charges,,
"Cladosporium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Medicare Advantage,22.54,49,,percent of total billed charges,,
"Cladosporium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Cladosporium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),27.6,60,,percent of total billed charges,,
"Cladosporium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",State of Minnesota Advantage Program,37.49,81.5,,percent of total billed charges,,
"Cladosporium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",State Public Programs,23,50,,percent of total billed charges,,
"Cladosporium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Humana Insurance Company,Commercial PPO,43.7,95,,percent of total billed charges,,
"Cladosporium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Humana Insurance Company,Medicare PPO,22.54,49,,percent of total billed charges,,
"Cladosporium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Cladosporium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Medica,Individual & Family,45.586,99.1,,percent of total billed charges,,
"Cladosporium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Medica,Medica Advantage Solution,22.908,49.8,,percent of total billed charges,,
"Cladosporium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Cladosporium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Medica,Medical Assistance,20.516,44.6,,percent of total billed charges,,
"Cladosporium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Medica,Medical Assistance,,,,,Included in per diem rate,
"Cladosporium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,22.908,49.8,,percent of total billed charges,,
"Cladosporium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Cladosporium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Multiplan, Inc.","Multiplan, Inc.",43.24,94,,percent of total billed charges,,
"Cladosporium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,39.744,86.4,,percent of total billed charges,,
"Cladosporium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Cladosporium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PPO,45.356,98.6,,percent of total billed charges,,
"Cladosporium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,Minnesota Senior Health Options (MSHO),23.667,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Cladosporium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Cladosporium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,MinnesotaCare,23.6256,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Cladosporium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Cladosporium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Sanford Health Plan,Sanford Health Plan,42.32,92,,percent of total billed charges,,
"Cladosporium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Individual & Family Plan,25.921,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Cladosporium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Cladosporium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medical Assistance,23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Cladosporium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Cladosporium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medicare Advantage,23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Cladosporium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Cladosporium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Cladosporium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Cladosporium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,UnitedHealthcare,Individual & Family,43.24,94,,percent of total billed charges,,
"Cladosporium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Medicare Advantage,22.54,49,,percent of total billed charges,,
"Cladosporium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Cladosporium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,22.08,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Cladosporium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Clam, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,Aetna,Commercial,45.08,92,,percent of total billed charges,,
"Clam, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,Aetna,Medicare Advantage,24.01,49,,percent of total billed charges,,
"Clam, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Clam, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,Aetna,PPO,45.57,93,,percent of total billed charges,,
"Clam, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,America's PPO,America's PPO,47.0547,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Clam, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,BlueCross BlueShield Minnesota, Federal Employee Program,48.216,98.4,,percent of total billed charges,,
"Clam, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,49,100,,percent of total billed charges,,
"Clam, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,High Value Network Plan,44.1,90,,percent of total billed charges,,
"Clam, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Medicare Advantage,24.01,49,,percent of total billed charges,,
"Clam, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Clam, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,43.3993,88.57,,percent of total billed charges,,
"Clam, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,14.0434,28.66,,percent of total billed charges,,
"Clam, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),24.01,49,,percent of total billed charges,,
"Clam, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Clam, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,CorVel,Worker's Compensation,49,100,,percent of total billed charges,,
"Clam, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,First Health Group Corporation,First Health Network,47.53,97,,percent of total billed charges,,
"Clam, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,"Health Partners, Inc.",Commercial,46.354,94.6,,percent of total billed charges,,
"Clam, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,"Health Partners, Inc.",Medicare Advantage,24.01,49,,percent of total billed charges,,
"Clam, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Clam, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),29.4,60,,percent of total billed charges,,
"Clam, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,"Health Partners, Inc.",State of Minnesota Advantage Program,39.935,81.5,,percent of total billed charges,,
"Clam, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,"Health Partners, Inc.",State Public Programs,24.5,50,,percent of total billed charges,,
"Clam, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,Humana Insurance Company,Commercial PPO,46.55,95,,percent of total billed charges,,
"Clam, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,Humana Insurance Company,Medicare PPO,24.01,49,,percent of total billed charges,,
"Clam, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Clam, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,Medica,Individual & Family,48.559,99.1,,percent of total billed charges,,
"Clam, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,Medica,Medica Advantage Solution,24.402,49.8,,percent of total billed charges,,
"Clam, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Clam, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,Medica,Medical Assistance,21.854,44.6,,percent of total billed charges,,
"Clam, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,Medica,Medical Assistance,,,,,Included in per diem rate,
"Clam, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,24.402,49.8,,percent of total billed charges,,
"Clam, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Clam, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,"Multiplan, Inc.","Multiplan, Inc.",46.06,94,,percent of total billed charges,,
"Clam, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,42.336,86.4,,percent of total billed charges,,
"Clam, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Clam, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,"Preferred One Administrative Services, INC.",PPO,48.314,98.6,,percent of total billed charges,,
"Clam, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,PrimeWest Health,Minnesota Senior Health Options (MSHO),25.2105,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Clam, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Clam, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,PrimeWest Health,MinnesotaCare,25.1664,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Clam, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Clam, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,Sanford Health Plan,Sanford Health Plan,45.08,92,,percent of total billed charges,,
"Clam, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,"UCare Health, Inc.",Individual & Family Plan,27.6115,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Clam, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Clam, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,"UCare Health, Inc.",Medical Assistance,24.7303,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Clam, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Clam, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,"UCare Health, Inc.",Medicare Advantage,24.7303,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Clam, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Clam, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),24.7303,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Clam, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Clam, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,UnitedHealthcare,Individual & Family,46.06,94,,percent of total billed charges,,
"Clam, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,UnitedHealthcare,Medicare Advantage,24.01,49,,percent of total billed charges,,
"Clam, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Clam, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,23.52,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Clam, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Cockroach, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Aetna,Commercial,42.32,92,,percent of total billed charges,,
"Cockroach, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Aetna,Medicare Advantage,22.54,49,,percent of total billed charges,,
"Cockroach, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Cockroach, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Aetna,PPO,42.78,93,,percent of total billed charges,,
"Cockroach, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,America's PPO,America's PPO,44.1738,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Cockroach, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota, Federal Employee Program,45.264,98.4,,percent of total billed charges,,
"Cockroach, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,46,100,,percent of total billed charges,,
"Cockroach, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,High Value Network Plan,41.4,90,,percent of total billed charges,,
"Cockroach, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Medicare Advantage,22.54,49,,percent of total billed charges,,
"Cockroach, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Cockroach, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,40.7422,88.57,,percent of total billed charges,,
"Cockroach, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,13.1836,28.66,,percent of total billed charges,,
"Cockroach, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),22.54,49,,percent of total billed charges,,
"Cockroach, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Cockroach, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,CorVel,Worker's Compensation,46,100,,percent of total billed charges,,
"Cockroach, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,First Health Group Corporation,First Health Network,44.62,97,,percent of total billed charges,,
"Cockroach, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Commercial,43.516,94.6,,percent of total billed charges,,
"Cockroach, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Medicare Advantage,22.54,49,,percent of total billed charges,,
"Cockroach, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Cockroach, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),27.6,60,,percent of total billed charges,,
"Cockroach, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",State of Minnesota Advantage Program,37.49,81.5,,percent of total billed charges,,
"Cockroach, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",State Public Programs,23,50,,percent of total billed charges,,
"Cockroach, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Humana Insurance Company,Commercial PPO,43.7,95,,percent of total billed charges,,
"Cockroach, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Humana Insurance Company,Medicare PPO,22.54,49,,percent of total billed charges,,
"Cockroach, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Cockroach, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Medica,Individual & Family,45.586,99.1,,percent of total billed charges,,
"Cockroach, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Medica,Medica Advantage Solution,22.908,49.8,,percent of total billed charges,,
"Cockroach, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Cockroach, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Medica,Medical Assistance,20.516,44.6,,percent of total billed charges,,
"Cockroach, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Medica,Medical Assistance,,,,,Included in per diem rate,
"Cockroach, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,22.908,49.8,,percent of total billed charges,,
"Cockroach, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Cockroach, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Multiplan, Inc.","Multiplan, Inc.",43.24,94,,percent of total billed charges,,
"Cockroach, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,39.744,86.4,,percent of total billed charges,,
"Cockroach, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Cockroach, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PPO,45.356,98.6,,percent of total billed charges,,
"Cockroach, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,Minnesota Senior Health Options (MSHO),23.667,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Cockroach, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Cockroach, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,MinnesotaCare,23.6256,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Cockroach, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Cockroach, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Sanford Health Plan,Sanford Health Plan,42.32,92,,percent of total billed charges,,
"Cockroach, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Individual & Family Plan,25.921,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Cockroach, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Cockroach, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medical Assistance,23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Cockroach, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Cockroach, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medicare Advantage,23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Cockroach, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Cockroach, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Cockroach, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Cockroach, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,UnitedHealthcare,Individual & Family,43.24,94,,percent of total billed charges,,
"Cockroach, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Medicare Advantage,22.54,49,,percent of total billed charges,,
"Cockroach, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Cockroach, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,22.08,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Cockroach, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Corn Pollen, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Aetna,Commercial,42.32,92,,percent of total billed charges,,
"Corn Pollen, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Aetna,Medicare Advantage,22.54,49,,percent of total billed charges,,
"Corn Pollen, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Corn Pollen, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Aetna,PPO,42.78,93,,percent of total billed charges,,
"Corn Pollen, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,America's PPO,America's PPO,44.1738,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Corn Pollen, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota, Federal Employee Program,45.264,98.4,,percent of total billed charges,,
"Corn Pollen, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,46,100,,percent of total billed charges,,
"Corn Pollen, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,High Value Network Plan,41.4,90,,percent of total billed charges,,
"Corn Pollen, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Medicare Advantage,22.54,49,,percent of total billed charges,,
"Corn Pollen, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Corn Pollen, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,40.7422,88.57,,percent of total billed charges,,
"Corn Pollen, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,13.1836,28.66,,percent of total billed charges,,
"Corn Pollen, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),22.54,49,,percent of total billed charges,,
"Corn Pollen, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Corn Pollen, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,CorVel,Worker's Compensation,46,100,,percent of total billed charges,,
"Corn Pollen, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,First Health Group Corporation,First Health Network,44.62,97,,percent of total billed charges,,
"Corn Pollen, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Commercial,43.516,94.6,,percent of total billed charges,,
"Corn Pollen, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Medicare Advantage,22.54,49,,percent of total billed charges,,
"Corn Pollen, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Corn Pollen, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),27.6,60,,percent of total billed charges,,
"Corn Pollen, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",State of Minnesota Advantage Program,37.49,81.5,,percent of total billed charges,,
"Corn Pollen, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",State Public Programs,23,50,,percent of total billed charges,,
"Corn Pollen, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Humana Insurance Company,Commercial PPO,43.7,95,,percent of total billed charges,,
"Corn Pollen, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Humana Insurance Company,Medicare PPO,22.54,49,,percent of total billed charges,,
"Corn Pollen, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Corn Pollen, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Medica,Individual & Family,45.586,99.1,,percent of total billed charges,,
"Corn Pollen, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Medica,Medica Advantage Solution,22.908,49.8,,percent of total billed charges,,
"Corn Pollen, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Corn Pollen, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Medica,Medical Assistance,20.516,44.6,,percent of total billed charges,,
"Corn Pollen, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Medica,Medical Assistance,,,,,Included in per diem rate,
"Corn Pollen, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,22.908,49.8,,percent of total billed charges,,
"Corn Pollen, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Corn Pollen, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Multiplan, Inc.","Multiplan, Inc.",43.24,94,,percent of total billed charges,,
"Corn Pollen, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,39.744,86.4,,percent of total billed charges,,
"Corn Pollen, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Corn Pollen, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PPO,45.356,98.6,,percent of total billed charges,,
"Corn Pollen, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,Minnesota Senior Health Options (MSHO),23.667,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Corn Pollen, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Corn Pollen, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,MinnesotaCare,23.6256,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Corn Pollen, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Corn Pollen, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Sanford Health Plan,Sanford Health Plan,42.32,92,,percent of total billed charges,,
"Corn Pollen, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Individual & Family Plan,25.921,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Corn Pollen, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Corn Pollen, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medical Assistance,23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Corn Pollen, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Corn Pollen, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medicare Advantage,23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Corn Pollen, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Corn Pollen, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Corn Pollen, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Corn Pollen, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,UnitedHealthcare,Individual & Family,43.24,94,,percent of total billed charges,,
"Corn Pollen, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Medicare Advantage,22.54,49,,percent of total billed charges,,
"Corn Pollen, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Corn Pollen, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,22.08,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Corn Pollen, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Corn-Food, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,50,42.5,14.33,50,Aetna,Commercial,46,92,,percent of total billed charges,,
"Corn-Food, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,50,42.5,14.33,50,Aetna,Medicare Advantage,24.5,49,,percent of total billed charges,,
"Corn-Food, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,50,42.5,14.33,50,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Corn-Food, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,50,42.5,14.33,50,Aetna,PPO,46.5,93,,percent of total billed charges,,
"Corn-Food, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,50,42.5,14.33,50,America's PPO,America's PPO,48.015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Corn-Food, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,50,42.5,14.33,50,BlueCross BlueShield Minnesota, Federal Employee Program,49.2,98.4,,percent of total billed charges,,
"Corn-Food, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,50,42.5,14.33,50,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,50,100,,percent of total billed charges,,
"Corn-Food, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,50,42.5,14.33,50,BlueCross BlueShield Minnesota,High Value Network Plan,45,90,,percent of total billed charges,,
"Corn-Food, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,50,42.5,14.33,50,BlueCross BlueShield Minnesota,Medicare Advantage,24.5,49,,percent of total billed charges,,
"Corn-Food, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,50,42.5,14.33,50,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Corn-Food, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,50,42.5,14.33,50,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,44.285,88.57,,percent of total billed charges,,
"Corn-Food, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,50,42.5,14.33,50,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,14.33,28.66,,percent of total billed charges,,
"Corn-Food, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,50,42.5,14.33,50,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),24.5,49,,percent of total billed charges,,
"Corn-Food, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,50,42.5,14.33,50,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Corn-Food, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,50,42.5,14.33,50,CorVel,Worker's Compensation,50,100,,percent of total billed charges,,
"Corn-Food, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,50,42.5,14.33,50,First Health Group Corporation,First Health Network,48.5,97,,percent of total billed charges,,
"Corn-Food, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,50,42.5,14.33,50,"Health Partners, Inc.",Commercial,47.3,94.6,,percent of total billed charges,,
"Corn-Food, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,50,42.5,14.33,50,"Health Partners, Inc.",Medicare Advantage,24.5,49,,percent of total billed charges,,
"Corn-Food, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,50,42.5,14.33,50,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Corn-Food, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,50,42.5,14.33,50,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),30,60,,percent of total billed charges,,
"Corn-Food, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,50,42.5,14.33,50,"Health Partners, Inc.",State of Minnesota Advantage Program,40.75,81.5,,percent of total billed charges,,
"Corn-Food, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,50,42.5,14.33,50,"Health Partners, Inc.",State Public Programs,25,50,,percent of total billed charges,,
"Corn-Food, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,50,42.5,14.33,50,Humana Insurance Company,Commercial PPO,47.5,95,,percent of total billed charges,,
"Corn-Food, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,50,42.5,14.33,50,Humana Insurance Company,Medicare PPO,24.5,49,,percent of total billed charges,,
"Corn-Food, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,50,42.5,14.33,50,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Corn-Food, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,50,42.5,14.33,50,Medica,Individual & Family,49.55,99.1,,percent of total billed charges,,
"Corn-Food, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,50,42.5,14.33,50,Medica,Medica Advantage Solution,24.9,49.8,,percent of total billed charges,,
"Corn-Food, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,50,42.5,14.33,50,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Corn-Food, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,50,42.5,14.33,50,Medica,Medical Assistance,22.3,44.6,,percent of total billed charges,,
"Corn-Food, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,50,42.5,14.33,50,Medica,Medical Assistance,,,,,Included in per diem rate,
"Corn-Food, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,50,42.5,14.33,50,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,24.9,49.8,,percent of total billed charges,,
"Corn-Food, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,50,42.5,14.33,50,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Corn-Food, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,50,42.5,14.33,50,"Multiplan, Inc.","Multiplan, Inc.",47,94,,percent of total billed charges,,
"Corn-Food, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,50,42.5,14.33,50,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,43.2,86.4,,percent of total billed charges,,
"Corn-Food, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,50,42.5,14.33,50,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Corn-Food, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,50,42.5,14.33,50,"Preferred One Administrative Services, INC.",PPO,49.3,98.6,,percent of total billed charges,,
"Corn-Food, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,50,42.5,14.33,50,PrimeWest Health,Minnesota Senior Health Options (MSHO),25.725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Corn-Food, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,50,42.5,14.33,50,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Corn-Food, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,50,42.5,14.33,50,PrimeWest Health,MinnesotaCare,25.68,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Corn-Food, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,50,42.5,14.33,50,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Corn-Food, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,50,42.5,14.33,50,Sanford Health Plan,Sanford Health Plan,46,92,,percent of total billed charges,,
"Corn-Food, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,50,42.5,14.33,50,"UCare Health, Inc.",Individual & Family Plan,28.175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Corn-Food, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,50,42.5,14.33,50,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Corn-Food, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,50,42.5,14.33,50,"UCare Health, Inc.",Medical Assistance,25.235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Corn-Food, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,50,42.5,14.33,50,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Corn-Food, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,50,42.5,14.33,50,"UCare Health, Inc.",Medicare Advantage,25.235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Corn-Food, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,50,42.5,14.33,50,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Corn-Food, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,50,42.5,14.33,50,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),25.235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Corn-Food, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,50,42.5,14.33,50,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Corn-Food, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,50,42.5,14.33,50,UnitedHealthcare,Individual & Family,47,94,,percent of total billed charges,,
"Corn-Food, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,50,42.5,14.33,50,UnitedHealthcare,Medicare Advantage,24.5,49,,percent of total billed charges,,
"Corn-Food, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,50,42.5,14.33,50,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Corn-Food, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,50,42.5,14.33,50,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,24,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Corn-Food, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,50,42.5,14.33,50,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Cottonwood, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Aetna,Commercial,42.32,92,,percent of total billed charges,,
"Cottonwood, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Aetna,Medicare Advantage,22.54,49,,percent of total billed charges,,
"Cottonwood, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Cottonwood, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Aetna,PPO,42.78,93,,percent of total billed charges,,
"Cottonwood, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,America's PPO,America's PPO,44.1738,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Cottonwood, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota, Federal Employee Program,45.264,98.4,,percent of total billed charges,,
"Cottonwood, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,46,100,,percent of total billed charges,,
"Cottonwood, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,High Value Network Plan,41.4,90,,percent of total billed charges,,
"Cottonwood, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Medicare Advantage,22.54,49,,percent of total billed charges,,
"Cottonwood, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Cottonwood, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,40.7422,88.57,,percent of total billed charges,,
"Cottonwood, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,13.1836,28.66,,percent of total billed charges,,
"Cottonwood, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),22.54,49,,percent of total billed charges,,
"Cottonwood, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Cottonwood, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,CorVel,Worker's Compensation,46,100,,percent of total billed charges,,
"Cottonwood, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,First Health Group Corporation,First Health Network,44.62,97,,percent of total billed charges,,
"Cottonwood, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Commercial,43.516,94.6,,percent of total billed charges,,
"Cottonwood, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Medicare Advantage,22.54,49,,percent of total billed charges,,
"Cottonwood, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Cottonwood, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),27.6,60,,percent of total billed charges,,
"Cottonwood, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",State of Minnesota Advantage Program,37.49,81.5,,percent of total billed charges,,
"Cottonwood, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",State Public Programs,23,50,,percent of total billed charges,,
"Cottonwood, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Humana Insurance Company,Commercial PPO,43.7,95,,percent of total billed charges,,
"Cottonwood, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Humana Insurance Company,Medicare PPO,22.54,49,,percent of total billed charges,,
"Cottonwood, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Cottonwood, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Medica,Individual & Family,45.586,99.1,,percent of total billed charges,,
"Cottonwood, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Medica,Medica Advantage Solution,22.908,49.8,,percent of total billed charges,,
"Cottonwood, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Cottonwood, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Medica,Medical Assistance,20.516,44.6,,percent of total billed charges,,
"Cottonwood, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Medica,Medical Assistance,,,,,Included in per diem rate,
"Cottonwood, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,22.908,49.8,,percent of total billed charges,,
"Cottonwood, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Cottonwood, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Multiplan, Inc.","Multiplan, Inc.",43.24,94,,percent of total billed charges,,
"Cottonwood, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,39.744,86.4,,percent of total billed charges,,
"Cottonwood, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Cottonwood, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PPO,45.356,98.6,,percent of total billed charges,,
"Cottonwood, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,Minnesota Senior Health Options (MSHO),23.667,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Cottonwood, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Cottonwood, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,MinnesotaCare,23.6256,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Cottonwood, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Cottonwood, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Sanford Health Plan,Sanford Health Plan,42.32,92,,percent of total billed charges,,
"Cottonwood, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Individual & Family Plan,25.921,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Cottonwood, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Cottonwood, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medical Assistance,23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Cottonwood, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Cottonwood, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medicare Advantage,23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Cottonwood, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Cottonwood, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Cottonwood, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Cottonwood, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,UnitedHealthcare,Individual & Family,43.24,94,,percent of total billed charges,,
"Cottonwood, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Medicare Advantage,22.54,49,,percent of total billed charges,,
"Cottonwood, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Cottonwood, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,22.08,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Cottonwood, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Cow Epithelium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,Aetna,Commercial,45.08,92,,percent of total billed charges,,
"Cow Epithelium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,Aetna,Medicare Advantage,24.01,49,,percent of total billed charges,,
"Cow Epithelium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Cow Epithelium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,Aetna,PPO,45.57,93,,percent of total billed charges,,
"Cow Epithelium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,America's PPO,America's PPO,47.0547,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Cow Epithelium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,BlueCross BlueShield Minnesota, Federal Employee Program,48.216,98.4,,percent of total billed charges,,
"Cow Epithelium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,49,100,,percent of total billed charges,,
"Cow Epithelium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,High Value Network Plan,44.1,90,,percent of total billed charges,,
"Cow Epithelium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Medicare Advantage,24.01,49,,percent of total billed charges,,
"Cow Epithelium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Cow Epithelium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,43.3993,88.57,,percent of total billed charges,,
"Cow Epithelium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,14.0434,28.66,,percent of total billed charges,,
"Cow Epithelium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),24.01,49,,percent of total billed charges,,
"Cow Epithelium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Cow Epithelium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,CorVel,Worker's Compensation,49,100,,percent of total billed charges,,
"Cow Epithelium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,First Health Group Corporation,First Health Network,47.53,97,,percent of total billed charges,,
"Cow Epithelium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,"Health Partners, Inc.",Commercial,46.354,94.6,,percent of total billed charges,,
"Cow Epithelium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,"Health Partners, Inc.",Medicare Advantage,24.01,49,,percent of total billed charges,,
"Cow Epithelium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Cow Epithelium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),29.4,60,,percent of total billed charges,,
"Cow Epithelium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,"Health Partners, Inc.",State of Minnesota Advantage Program,39.935,81.5,,percent of total billed charges,,
"Cow Epithelium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,"Health Partners, Inc.",State Public Programs,24.5,50,,percent of total billed charges,,
"Cow Epithelium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,Humana Insurance Company,Commercial PPO,46.55,95,,percent of total billed charges,,
"Cow Epithelium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,Humana Insurance Company,Medicare PPO,24.01,49,,percent of total billed charges,,
"Cow Epithelium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Cow Epithelium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,Medica,Individual & Family,48.559,99.1,,percent of total billed charges,,
"Cow Epithelium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,Medica,Medica Advantage Solution,24.402,49.8,,percent of total billed charges,,
"Cow Epithelium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Cow Epithelium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,Medica,Medical Assistance,21.854,44.6,,percent of total billed charges,,
"Cow Epithelium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,Medica,Medical Assistance,,,,,Included in per diem rate,
"Cow Epithelium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,24.402,49.8,,percent of total billed charges,,
"Cow Epithelium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Cow Epithelium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,"Multiplan, Inc.","Multiplan, Inc.",46.06,94,,percent of total billed charges,,
"Cow Epithelium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,42.336,86.4,,percent of total billed charges,,
"Cow Epithelium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Cow Epithelium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,"Preferred One Administrative Services, INC.",PPO,48.314,98.6,,percent of total billed charges,,
"Cow Epithelium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,PrimeWest Health,Minnesota Senior Health Options (MSHO),25.2105,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Cow Epithelium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Cow Epithelium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,PrimeWest Health,MinnesotaCare,25.1664,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Cow Epithelium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Cow Epithelium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,Sanford Health Plan,Sanford Health Plan,45.08,92,,percent of total billed charges,,
"Cow Epithelium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,"UCare Health, Inc.",Individual & Family Plan,27.6115,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Cow Epithelium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Cow Epithelium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,"UCare Health, Inc.",Medical Assistance,24.7303,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Cow Epithelium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Cow Epithelium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,"UCare Health, Inc.",Medicare Advantage,24.7303,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Cow Epithelium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Cow Epithelium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),24.7303,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Cow Epithelium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Cow Epithelium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,UnitedHealthcare,Individual & Family,46.06,94,,percent of total billed charges,,
"Cow Epithelium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,UnitedHealthcare,Medicare Advantage,24.01,49,,percent of total billed charges,,
"Cow Epithelium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Cow Epithelium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,23.52,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Cow Epithelium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Crab, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,Aetna,Commercial,45.08,92,,percent of total billed charges,,
"Crab, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,Aetna,Medicare Advantage,24.01,49,,percent of total billed charges,,
"Crab, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Crab, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,Aetna,PPO,45.57,93,,percent of total billed charges,,
"Crab, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,America's PPO,America's PPO,47.0547,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Crab, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,BlueCross BlueShield Minnesota, Federal Employee Program,48.216,98.4,,percent of total billed charges,,
"Crab, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,49,100,,percent of total billed charges,,
"Crab, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,High Value Network Plan,44.1,90,,percent of total billed charges,,
"Crab, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Medicare Advantage,24.01,49,,percent of total billed charges,,
"Crab, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Crab, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,43.3993,88.57,,percent of total billed charges,,
"Crab, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,14.0434,28.66,,percent of total billed charges,,
"Crab, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),24.01,49,,percent of total billed charges,,
"Crab, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Crab, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,CorVel,Worker's Compensation,49,100,,percent of total billed charges,,
"Crab, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,First Health Group Corporation,First Health Network,47.53,97,,percent of total billed charges,,
"Crab, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,"Health Partners, Inc.",Commercial,46.354,94.6,,percent of total billed charges,,
"Crab, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,"Health Partners, Inc.",Medicare Advantage,24.01,49,,percent of total billed charges,,
"Crab, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Crab, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),29.4,60,,percent of total billed charges,,
"Crab, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,"Health Partners, Inc.",State of Minnesota Advantage Program,39.935,81.5,,percent of total billed charges,,
"Crab, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,"Health Partners, Inc.",State Public Programs,24.5,50,,percent of total billed charges,,
"Crab, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,Humana Insurance Company,Commercial PPO,46.55,95,,percent of total billed charges,,
"Crab, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,Humana Insurance Company,Medicare PPO,24.01,49,,percent of total billed charges,,
"Crab, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Crab, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,Medica,Individual & Family,48.559,99.1,,percent of total billed charges,,
"Crab, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,Medica,Medica Advantage Solution,24.402,49.8,,percent of total billed charges,,
"Crab, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Crab, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,Medica,Medical Assistance,21.854,44.6,,percent of total billed charges,,
"Crab, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,Medica,Medical Assistance,,,,,Included in per diem rate,
"Crab, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,24.402,49.8,,percent of total billed charges,,
"Crab, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Crab, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,"Multiplan, Inc.","Multiplan, Inc.",46.06,94,,percent of total billed charges,,
"Crab, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,42.336,86.4,,percent of total billed charges,,
"Crab, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Crab, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,"Preferred One Administrative Services, INC.",PPO,48.314,98.6,,percent of total billed charges,,
"Crab, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,PrimeWest Health,Minnesota Senior Health Options (MSHO),25.2105,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Crab, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Crab, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,PrimeWest Health,MinnesotaCare,25.1664,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Crab, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Crab, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,Sanford Health Plan,Sanford Health Plan,45.08,92,,percent of total billed charges,,
"Crab, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,"UCare Health, Inc.",Individual & Family Plan,27.6115,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Crab, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Crab, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,"UCare Health, Inc.",Medical Assistance,24.7303,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Crab, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Crab, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,"UCare Health, Inc.",Medicare Advantage,24.7303,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Crab, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Crab, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),24.7303,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Crab, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Crab, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,UnitedHealthcare,Individual & Family,46.06,94,,percent of total billed charges,,
"Crab, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,UnitedHealthcare,Medicare Advantage,24.01,49,,percent of total billed charges,,
"Crab, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Crab, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,23.52,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Crab, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Crayfish, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,50,42.5,14.33,50,Aetna,Commercial,46,92,,percent of total billed charges,,
"Crayfish, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,50,42.5,14.33,50,Aetna,Medicare Advantage,24.5,49,,percent of total billed charges,,
"Crayfish, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,50,42.5,14.33,50,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Crayfish, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,50,42.5,14.33,50,Aetna,PPO,46.5,93,,percent of total billed charges,,
"Crayfish, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,50,42.5,14.33,50,America's PPO,America's PPO,48.015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Crayfish, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,50,42.5,14.33,50,BlueCross BlueShield Minnesota, Federal Employee Program,49.2,98.4,,percent of total billed charges,,
"Crayfish, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,50,42.5,14.33,50,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,50,100,,percent of total billed charges,,
"Crayfish, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,50,42.5,14.33,50,BlueCross BlueShield Minnesota,High Value Network Plan,45,90,,percent of total billed charges,,
"Crayfish, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,50,42.5,14.33,50,BlueCross BlueShield Minnesota,Medicare Advantage,24.5,49,,percent of total billed charges,,
"Crayfish, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,50,42.5,14.33,50,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Crayfish, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,50,42.5,14.33,50,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,44.285,88.57,,percent of total billed charges,,
"Crayfish, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,50,42.5,14.33,50,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,14.33,28.66,,percent of total billed charges,,
"Crayfish, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,50,42.5,14.33,50,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),24.5,49,,percent of total billed charges,,
"Crayfish, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,50,42.5,14.33,50,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Crayfish, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,50,42.5,14.33,50,CorVel,Worker's Compensation,50,100,,percent of total billed charges,,
"Crayfish, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,50,42.5,14.33,50,First Health Group Corporation,First Health Network,48.5,97,,percent of total billed charges,,
"Crayfish, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,50,42.5,14.33,50,"Health Partners, Inc.",Commercial,47.3,94.6,,percent of total billed charges,,
"Crayfish, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,50,42.5,14.33,50,"Health Partners, Inc.",Medicare Advantage,24.5,49,,percent of total billed charges,,
"Crayfish, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,50,42.5,14.33,50,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Crayfish, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,50,42.5,14.33,50,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),30,60,,percent of total billed charges,,
"Crayfish, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,50,42.5,14.33,50,"Health Partners, Inc.",State of Minnesota Advantage Program,40.75,81.5,,percent of total billed charges,,
"Crayfish, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,50,42.5,14.33,50,"Health Partners, Inc.",State Public Programs,25,50,,percent of total billed charges,,
"Crayfish, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,50,42.5,14.33,50,Humana Insurance Company,Commercial PPO,47.5,95,,percent of total billed charges,,
"Crayfish, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,50,42.5,14.33,50,Humana Insurance Company,Medicare PPO,24.5,49,,percent of total billed charges,,
"Crayfish, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,50,42.5,14.33,50,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Crayfish, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,50,42.5,14.33,50,Medica,Individual & Family,49.55,99.1,,percent of total billed charges,,
"Crayfish, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,50,42.5,14.33,50,Medica,Medica Advantage Solution,24.9,49.8,,percent of total billed charges,,
"Crayfish, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,50,42.5,14.33,50,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Crayfish, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,50,42.5,14.33,50,Medica,Medical Assistance,22.3,44.6,,percent of total billed charges,,
"Crayfish, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,50,42.5,14.33,50,Medica,Medical Assistance,,,,,Included in per diem rate,
"Crayfish, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,50,42.5,14.33,50,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,24.9,49.8,,percent of total billed charges,,
"Crayfish, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,50,42.5,14.33,50,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Crayfish, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,50,42.5,14.33,50,"Multiplan, Inc.","Multiplan, Inc.",47,94,,percent of total billed charges,,
"Crayfish, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,50,42.5,14.33,50,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,43.2,86.4,,percent of total billed charges,,
"Crayfish, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,50,42.5,14.33,50,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Crayfish, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,50,42.5,14.33,50,"Preferred One Administrative Services, INC.",PPO,49.3,98.6,,percent of total billed charges,,
"Crayfish, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,50,42.5,14.33,50,PrimeWest Health,Minnesota Senior Health Options (MSHO),25.725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Crayfish, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,50,42.5,14.33,50,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Crayfish, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,50,42.5,14.33,50,PrimeWest Health,MinnesotaCare,25.68,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Crayfish, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,50,42.5,14.33,50,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Crayfish, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,50,42.5,14.33,50,Sanford Health Plan,Sanford Health Plan,46,92,,percent of total billed charges,,
"Crayfish, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,50,42.5,14.33,50,"UCare Health, Inc.",Individual & Family Plan,28.175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Crayfish, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,50,42.5,14.33,50,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Crayfish, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,50,42.5,14.33,50,"UCare Health, Inc.",Medical Assistance,25.235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Crayfish, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,50,42.5,14.33,50,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Crayfish, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,50,42.5,14.33,50,"UCare Health, Inc.",Medicare Advantage,25.235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Crayfish, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,50,42.5,14.33,50,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Crayfish, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,50,42.5,14.33,50,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),25.235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Crayfish, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,50,42.5,14.33,50,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Crayfish, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,50,42.5,14.33,50,UnitedHealthcare,Individual & Family,47,94,,percent of total billed charges,,
"Crayfish, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,50,42.5,14.33,50,UnitedHealthcare,Medicare Advantage,24.5,49,,percent of total billed charges,,
"Crayfish, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,50,42.5,14.33,50,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Crayfish, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,50,42.5,14.33,50,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,24,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Crayfish, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,50,42.5,14.33,50,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Dog Dander, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Aetna,Commercial,42.32,92,,percent of total billed charges,,
"Dog Dander, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Aetna,Medicare Advantage,22.54,49,,percent of total billed charges,,
"Dog Dander, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Dog Dander, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Aetna,PPO,42.78,93,,percent of total billed charges,,
"Dog Dander, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,America's PPO,America's PPO,44.1738,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Dog Dander, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota, Federal Employee Program,45.264,98.4,,percent of total billed charges,,
"Dog Dander, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,46,100,,percent of total billed charges,,
"Dog Dander, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,High Value Network Plan,41.4,90,,percent of total billed charges,,
"Dog Dander, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Medicare Advantage,22.54,49,,percent of total billed charges,,
"Dog Dander, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Dog Dander, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,40.7422,88.57,,percent of total billed charges,,
"Dog Dander, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,13.1836,28.66,,percent of total billed charges,,
"Dog Dander, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),22.54,49,,percent of total billed charges,,
"Dog Dander, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Dog Dander, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,CorVel,Worker's Compensation,46,100,,percent of total billed charges,,
"Dog Dander, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,First Health Group Corporation,First Health Network,44.62,97,,percent of total billed charges,,
"Dog Dander, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Commercial,43.516,94.6,,percent of total billed charges,,
"Dog Dander, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Medicare Advantage,22.54,49,,percent of total billed charges,,
"Dog Dander, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Dog Dander, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),27.6,60,,percent of total billed charges,,
"Dog Dander, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",State of Minnesota Advantage Program,37.49,81.5,,percent of total billed charges,,
"Dog Dander, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",State Public Programs,23,50,,percent of total billed charges,,
"Dog Dander, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Humana Insurance Company,Commercial PPO,43.7,95,,percent of total billed charges,,
"Dog Dander, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Humana Insurance Company,Medicare PPO,22.54,49,,percent of total billed charges,,
"Dog Dander, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Dog Dander, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Medica,Individual & Family,45.586,99.1,,percent of total billed charges,,
"Dog Dander, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Medica,Medica Advantage Solution,22.908,49.8,,percent of total billed charges,,
"Dog Dander, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Dog Dander, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Medica,Medical Assistance,20.516,44.6,,percent of total billed charges,,
"Dog Dander, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Medica,Medical Assistance,,,,,Included in per diem rate,
"Dog Dander, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,22.908,49.8,,percent of total billed charges,,
"Dog Dander, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Dog Dander, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Multiplan, Inc.","Multiplan, Inc.",43.24,94,,percent of total billed charges,,
"Dog Dander, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,39.744,86.4,,percent of total billed charges,,
"Dog Dander, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Dog Dander, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PPO,45.356,98.6,,percent of total billed charges,,
"Dog Dander, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,Minnesota Senior Health Options (MSHO),23.667,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Dog Dander, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Dog Dander, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,MinnesotaCare,23.6256,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Dog Dander, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Dog Dander, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Sanford Health Plan,Sanford Health Plan,42.32,92,,percent of total billed charges,,
"Dog Dander, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Individual & Family Plan,25.921,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Dog Dander, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Dog Dander, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medical Assistance,23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Dog Dander, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Dog Dander, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medicare Advantage,23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Dog Dander, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Dog Dander, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Dog Dander, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Dog Dander, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,UnitedHealthcare,Individual & Family,43.24,94,,percent of total billed charges,,
"Dog Dander, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Medicare Advantage,22.54,49,,percent of total billed charges,,
"Dog Dander, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Dog Dander, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,22.08,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Dog Dander, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Egg White, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,Aetna,Commercial,45.08,92,,percent of total billed charges,,
"Egg White, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,Aetna,Medicare Advantage,24.01,49,,percent of total billed charges,,
"Egg White, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Egg White, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,Aetna,PPO,45.57,93,,percent of total billed charges,,
"Egg White, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,America's PPO,America's PPO,47.0547,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Egg White, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,BlueCross BlueShield Minnesota, Federal Employee Program,48.216,98.4,,percent of total billed charges,,
"Egg White, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,49,100,,percent of total billed charges,,
"Egg White, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,High Value Network Plan,44.1,90,,percent of total billed charges,,
"Egg White, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Medicare Advantage,24.01,49,,percent of total billed charges,,
"Egg White, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Egg White, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,43.3993,88.57,,percent of total billed charges,,
"Egg White, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,14.0434,28.66,,percent of total billed charges,,
"Egg White, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),24.01,49,,percent of total billed charges,,
"Egg White, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Egg White, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,CorVel,Worker's Compensation,49,100,,percent of total billed charges,,
"Egg White, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,First Health Group Corporation,First Health Network,47.53,97,,percent of total billed charges,,
"Egg White, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,"Health Partners, Inc.",Commercial,46.354,94.6,,percent of total billed charges,,
"Egg White, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,"Health Partners, Inc.",Medicare Advantage,24.01,49,,percent of total billed charges,,
"Egg White, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Egg White, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),29.4,60,,percent of total billed charges,,
"Egg White, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,"Health Partners, Inc.",State of Minnesota Advantage Program,39.935,81.5,,percent of total billed charges,,
"Egg White, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,"Health Partners, Inc.",State Public Programs,24.5,50,,percent of total billed charges,,
"Egg White, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,Humana Insurance Company,Commercial PPO,46.55,95,,percent of total billed charges,,
"Egg White, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,Humana Insurance Company,Medicare PPO,24.01,49,,percent of total billed charges,,
"Egg White, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Egg White, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,Medica,Individual & Family,48.559,99.1,,percent of total billed charges,,
"Egg White, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,Medica,Medica Advantage Solution,24.402,49.8,,percent of total billed charges,,
"Egg White, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Egg White, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,Medica,Medical Assistance,21.854,44.6,,percent of total billed charges,,
"Egg White, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,Medica,Medical Assistance,,,,,Included in per diem rate,
"Egg White, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,24.402,49.8,,percent of total billed charges,,
"Egg White, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Egg White, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,"Multiplan, Inc.","Multiplan, Inc.",46.06,94,,percent of total billed charges,,
"Egg White, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,42.336,86.4,,percent of total billed charges,,
"Egg White, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Egg White, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,"Preferred One Administrative Services, INC.",PPO,48.314,98.6,,percent of total billed charges,,
"Egg White, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,PrimeWest Health,Minnesota Senior Health Options (MSHO),25.2105,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Egg White, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Egg White, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,PrimeWest Health,MinnesotaCare,25.1664,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Egg White, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Egg White, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,Sanford Health Plan,Sanford Health Plan,45.08,92,,percent of total billed charges,,
"Egg White, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,"UCare Health, Inc.",Individual & Family Plan,27.6115,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Egg White, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Egg White, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,"UCare Health, Inc.",Medical Assistance,24.7303,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Egg White, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Egg White, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,"UCare Health, Inc.",Medicare Advantage,24.7303,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Egg White, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Egg White, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),24.7303,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Egg White, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Egg White, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,UnitedHealthcare,Individual & Family,46.06,94,,percent of total billed charges,,
"Egg White, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,UnitedHealthcare,Medicare Advantage,24.01,49,,percent of total billed charges,,
"Egg White, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Egg White, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,23.52,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Egg White, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Elm, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Aetna,Commercial,42.32,92,,percent of total billed charges,,
"Elm, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Aetna,Medicare Advantage,22.54,49,,percent of total billed charges,,
"Elm, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Elm, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Aetna,PPO,42.78,93,,percent of total billed charges,,
"Elm, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,America's PPO,America's PPO,44.1738,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Elm, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota, Federal Employee Program,45.264,98.4,,percent of total billed charges,,
"Elm, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,46,100,,percent of total billed charges,,
"Elm, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,High Value Network Plan,41.4,90,,percent of total billed charges,,
"Elm, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Medicare Advantage,22.54,49,,percent of total billed charges,,
"Elm, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Elm, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,40.7422,88.57,,percent of total billed charges,,
"Elm, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,13.1836,28.66,,percent of total billed charges,,
"Elm, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),22.54,49,,percent of total billed charges,,
"Elm, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Elm, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,CorVel,Worker's Compensation,46,100,,percent of total billed charges,,
"Elm, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,First Health Group Corporation,First Health Network,44.62,97,,percent of total billed charges,,
"Elm, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Commercial,43.516,94.6,,percent of total billed charges,,
"Elm, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Medicare Advantage,22.54,49,,percent of total billed charges,,
"Elm, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Elm, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),27.6,60,,percent of total billed charges,,
"Elm, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",State of Minnesota Advantage Program,37.49,81.5,,percent of total billed charges,,
"Elm, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",State Public Programs,23,50,,percent of total billed charges,,
"Elm, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Humana Insurance Company,Commercial PPO,43.7,95,,percent of total billed charges,,
"Elm, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Humana Insurance Company,Medicare PPO,22.54,49,,percent of total billed charges,,
"Elm, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Elm, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Medica,Individual & Family,45.586,99.1,,percent of total billed charges,,
"Elm, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Medica,Medica Advantage Solution,22.908,49.8,,percent of total billed charges,,
"Elm, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Elm, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Medica,Medical Assistance,20.516,44.6,,percent of total billed charges,,
"Elm, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Medica,Medical Assistance,,,,,Included in per diem rate,
"Elm, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,22.908,49.8,,percent of total billed charges,,
"Elm, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Elm, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Multiplan, Inc.","Multiplan, Inc.",43.24,94,,percent of total billed charges,,
"Elm, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,39.744,86.4,,percent of total billed charges,,
"Elm, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Elm, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PPO,45.356,98.6,,percent of total billed charges,,
"Elm, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,Minnesota Senior Health Options (MSHO),23.667,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Elm, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Elm, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,MinnesotaCare,23.6256,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Elm, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Elm, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Sanford Health Plan,Sanford Health Plan,42.32,92,,percent of total billed charges,,
"Elm, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Individual & Family Plan,25.921,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Elm, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Elm, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medical Assistance,23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Elm, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Elm, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medicare Advantage,23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Elm, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Elm, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Elm, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Elm, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,UnitedHealthcare,Individual & Family,43.24,94,,percent of total billed charges,,
"Elm, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Medicare Advantage,22.54,49,,percent of total billed charges,,
"Elm, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Elm, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,22.08,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Elm, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"English Plantain, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Aetna,Commercial,42.32,92,,percent of total billed charges,,
"English Plantain, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Aetna,Medicare Advantage,22.54,49,,percent of total billed charges,,
"English Plantain, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"English Plantain, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Aetna,PPO,42.78,93,,percent of total billed charges,,
"English Plantain, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,America's PPO,America's PPO,44.1738,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"English Plantain, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota, Federal Employee Program,45.264,98.4,,percent of total billed charges,,
"English Plantain, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,46,100,,percent of total billed charges,,
"English Plantain, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,High Value Network Plan,41.4,90,,percent of total billed charges,,
"English Plantain, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Medicare Advantage,22.54,49,,percent of total billed charges,,
"English Plantain, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"English Plantain, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,40.7422,88.57,,percent of total billed charges,,
"English Plantain, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,13.1836,28.66,,percent of total billed charges,,
"English Plantain, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),22.54,49,,percent of total billed charges,,
"English Plantain, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"English Plantain, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,CorVel,Worker's Compensation,46,100,,percent of total billed charges,,
"English Plantain, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,First Health Group Corporation,First Health Network,44.62,97,,percent of total billed charges,,
"English Plantain, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Commercial,43.516,94.6,,percent of total billed charges,,
"English Plantain, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Medicare Advantage,22.54,49,,percent of total billed charges,,
"English Plantain, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"English Plantain, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),27.6,60,,percent of total billed charges,,
"English Plantain, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",State of Minnesota Advantage Program,37.49,81.5,,percent of total billed charges,,
"English Plantain, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",State Public Programs,23,50,,percent of total billed charges,,
"English Plantain, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Humana Insurance Company,Commercial PPO,43.7,95,,percent of total billed charges,,
"English Plantain, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Humana Insurance Company,Medicare PPO,22.54,49,,percent of total billed charges,,
"English Plantain, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"English Plantain, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Medica,Individual & Family,45.586,99.1,,percent of total billed charges,,
"English Plantain, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Medica,Medica Advantage Solution,22.908,49.8,,percent of total billed charges,,
"English Plantain, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"English Plantain, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Medica,Medical Assistance,20.516,44.6,,percent of total billed charges,,
"English Plantain, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Medica,Medical Assistance,,,,,Included in per diem rate,
"English Plantain, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,22.908,49.8,,percent of total billed charges,,
"English Plantain, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"English Plantain, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Multiplan, Inc.","Multiplan, Inc.",43.24,94,,percent of total billed charges,,
"English Plantain, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,39.744,86.4,,percent of total billed charges,,
"English Plantain, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"English Plantain, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PPO,45.356,98.6,,percent of total billed charges,,
"English Plantain, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,Minnesota Senior Health Options (MSHO),23.667,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"English Plantain, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"English Plantain, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,MinnesotaCare,23.6256,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"English Plantain, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"English Plantain, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Sanford Health Plan,Sanford Health Plan,42.32,92,,percent of total billed charges,,
"English Plantain, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Individual & Family Plan,25.921,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"English Plantain, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"English Plantain, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medical Assistance,23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"English Plantain, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"English Plantain, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medicare Advantage,23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"English Plantain, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"English Plantain, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"English Plantain, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"English Plantain, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,UnitedHealthcare,Individual & Family,43.24,94,,percent of total billed charges,,
"English Plantain, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Medicare Advantage,22.54,49,,percent of total billed charges,,
"English Plantain, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"English Plantain, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,22.08,48,,percent of total billed charges,,100% of DHS outpatient percentage
"English Plantain, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Food Panel (Mayo)OutsideLaboratory,,86003,CPT,Facility,Both,,,90,82,69.7,23.5012,82,Aetna,Commercial,75.44,92,,percent of total billed charges,,
Food Panel (Mayo)OutsideLaboratory,,86003,CPT,Facility,Outpatient,,,90,82,69.7,23.5012,82,Aetna,Medicare Advantage,40.18,49,,percent of total billed charges,,
Food Panel (Mayo)OutsideLaboratory,,86003,CPT,Facility,Inpatient,,,90,82,69.7,23.5012,82,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Food Panel (Mayo)OutsideLaboratory,,86003,CPT,Facility,Both,,,90,82,69.7,23.5012,82,Aetna,PPO,76.26,93,,percent of total billed charges,,
Food Panel (Mayo)OutsideLaboratory,,86003,CPT,Facility,Both,,,90,82,69.7,23.5012,82,America's PPO,America's PPO,78.7446,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Food Panel (Mayo)OutsideLaboratory,,86003,CPT,Facility,Both,,,90,82,69.7,23.5012,82,BlueCross BlueShield Minnesota, Federal Employee Program,80.688,98.4,,percent of total billed charges,,
Food Panel (Mayo)OutsideLaboratory,,86003,CPT,Facility,Both,,,90,82,69.7,23.5012,82,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,82,100,,percent of total billed charges,,
Food Panel (Mayo)OutsideLaboratory,,86003,CPT,Facility,Both,,,90,82,69.7,23.5012,82,BlueCross BlueShield Minnesota,High Value Network Plan,73.8,90,,percent of total billed charges,,
Food Panel (Mayo)OutsideLaboratory,,86003,CPT,Facility,Outpatient,,,90,82,69.7,23.5012,82,BlueCross BlueShield Minnesota,Medicare Advantage,40.18,49,,percent of total billed charges,,
Food Panel (Mayo)OutsideLaboratory,,86003,CPT,Facility,Inpatient,,,90,82,69.7,23.5012,82,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Food Panel (Mayo)OutsideLaboratory,,86003,CPT,Facility,Both,,,90,82,69.7,23.5012,82,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,72.6274,88.57,,percent of total billed charges,,
Food Panel (Mayo)OutsideLaboratory,,86003,CPT,Facility,Both,,,90,82,69.7,23.5012,82,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,23.5012,28.66,,percent of total billed charges,,
Food Panel (Mayo)OutsideLaboratory,,86003,CPT,Facility,Outpatient,,,90,82,69.7,23.5012,82,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),40.18,49,,percent of total billed charges,,
Food Panel (Mayo)OutsideLaboratory,,86003,CPT,Facility,Inpatient,,,90,82,69.7,23.5012,82,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Food Panel (Mayo)OutsideLaboratory,,86003,CPT,Facility,Both,,,90,82,69.7,23.5012,82,CorVel,Worker's Compensation,82,100,,percent of total billed charges,,
Food Panel (Mayo)OutsideLaboratory,,86003,CPT,Facility,Both,,,90,82,69.7,23.5012,82,First Health Group Corporation,First Health Network,79.54,97,,percent of total billed charges,,
Food Panel (Mayo)OutsideLaboratory,,86003,CPT,Facility,Both,,,90,82,69.7,23.5012,82,"Health Partners, Inc.",Commercial,77.572,94.6,,percent of total billed charges,,
Food Panel (Mayo)OutsideLaboratory,,86003,CPT,Facility,Outpatient,,,90,82,69.7,23.5012,82,"Health Partners, Inc.",Medicare Advantage,40.18,49,,percent of total billed charges,,
Food Panel (Mayo)OutsideLaboratory,,86003,CPT,Facility,Inpatient,,,90,82,69.7,23.5012,82,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Food Panel (Mayo)OutsideLaboratory,,86003,CPT,Facility,Both,,,90,82,69.7,23.5012,82,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),49.2,60,,percent of total billed charges,,
Food Panel (Mayo)OutsideLaboratory,,86003,CPT,Facility,Both,,,90,82,69.7,23.5012,82,"Health Partners, Inc.",State of Minnesota Advantage Program,66.83,81.5,,percent of total billed charges,,
Food Panel (Mayo)OutsideLaboratory,,86003,CPT,Facility,Both,,,90,82,69.7,23.5012,82,"Health Partners, Inc.",State Public Programs,41,50,,percent of total billed charges,,
Food Panel (Mayo)OutsideLaboratory,,86003,CPT,Facility,Both,,,90,82,69.7,23.5012,82,Humana Insurance Company,Commercial PPO,77.9,95,,percent of total billed charges,,
Food Panel (Mayo)OutsideLaboratory,,86003,CPT,Facility,Outpatient,,,90,82,69.7,23.5012,82,Humana Insurance Company,Medicare PPO,40.18,49,,percent of total billed charges,,
Food Panel (Mayo)OutsideLaboratory,,86003,CPT,Facility,Inpatient,,,90,82,69.7,23.5012,82,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Food Panel (Mayo)OutsideLaboratory,,86003,CPT,Facility,Both,,,90,82,69.7,23.5012,82,Medica,Individual & Family,81.262,99.1,,percent of total billed charges,,
Food Panel (Mayo)OutsideLaboratory,,86003,CPT,Facility,Outpatient,,,90,82,69.7,23.5012,82,Medica,Medica Advantage Solution,40.836,49.8,,percent of total billed charges,,
Food Panel (Mayo)OutsideLaboratory,,86003,CPT,Facility,Inpatient,,,90,82,69.7,23.5012,82,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Food Panel (Mayo)OutsideLaboratory,,86003,CPT,Facility,Outpatient,,,90,82,69.7,23.5012,82,Medica,Medical Assistance,36.572,44.6,,percent of total billed charges,,
Food Panel (Mayo)OutsideLaboratory,,86003,CPT,Facility,Inpatient,,,90,82,69.7,23.5012,82,Medica,Medical Assistance,,,,,Included in per diem rate,
Food Panel (Mayo)OutsideLaboratory,,86003,CPT,Facility,Outpatient,,,90,82,69.7,23.5012,82,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,40.836,49.8,,percent of total billed charges,,
Food Panel (Mayo)OutsideLaboratory,,86003,CPT,Facility,Inpatient,,,90,82,69.7,23.5012,82,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Food Panel (Mayo)OutsideLaboratory,,86003,CPT,Facility,Both,,,90,82,69.7,23.5012,82,"Multiplan, Inc.","Multiplan, Inc.",77.08,94,,percent of total billed charges,,
Food Panel (Mayo)OutsideLaboratory,,86003,CPT,Facility,Outpatient,,,90,82,69.7,23.5012,82,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,70.848,86.4,,percent of total billed charges,,
Food Panel (Mayo)OutsideLaboratory,,86003,CPT,Facility,Inpatient,,,90,82,69.7,23.5012,82,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Food Panel (Mayo)OutsideLaboratory,,86003,CPT,Facility,Both,,,90,82,69.7,23.5012,82,"Preferred One Administrative Services, INC.",PPO,80.852,98.6,,percent of total billed charges,,
Food Panel (Mayo)OutsideLaboratory,,86003,CPT,Facility,Outpatient,,,90,82,69.7,23.5012,82,PrimeWest Health,Minnesota Senior Health Options (MSHO),42.189,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Food Panel (Mayo)OutsideLaboratory,,86003,CPT,Facility,Inpatient,,,90,82,69.7,23.5012,82,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Food Panel (Mayo)OutsideLaboratory,,86003,CPT,Facility,Outpatient,,,90,82,69.7,23.5012,82,PrimeWest Health,MinnesotaCare,42.1152,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Food Panel (Mayo)OutsideLaboratory,,86003,CPT,Facility,Inpatient,,,90,82,69.7,23.5012,82,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Food Panel (Mayo)OutsideLaboratory,,86003,CPT,Facility,Both,,,90,82,69.7,23.5012,82,Sanford Health Plan,Sanford Health Plan,75.44,92,,percent of total billed charges,,
Food Panel (Mayo)OutsideLaboratory,,86003,CPT,Facility,Outpatient,,,90,82,69.7,23.5012,82,"UCare Health, Inc.",Individual & Family Plan,46.207,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Food Panel (Mayo)OutsideLaboratory,,86003,CPT,Facility,Inpatient,,,90,82,69.7,23.5012,82,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Food Panel (Mayo)OutsideLaboratory,,86003,CPT,Facility,Outpatient,,,90,82,69.7,23.5012,82,"UCare Health, Inc.",Medical Assistance,41.3854,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Food Panel (Mayo)OutsideLaboratory,,86003,CPT,Facility,Inpatient,,,90,82,69.7,23.5012,82,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Food Panel (Mayo)OutsideLaboratory,,86003,CPT,Facility,Outpatient,,,90,82,69.7,23.5012,82,"UCare Health, Inc.",Medicare Advantage,41.3854,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Food Panel (Mayo)OutsideLaboratory,,86003,CPT,Facility,Inpatient,,,90,82,69.7,23.5012,82,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Food Panel (Mayo)OutsideLaboratory,,86003,CPT,Facility,Outpatient,,,90,82,69.7,23.5012,82,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),41.3854,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Food Panel (Mayo)OutsideLaboratory,,86003,CPT,Facility,Inpatient,,,90,82,69.7,23.5012,82,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Food Panel (Mayo)OutsideLaboratory,,86003,CPT,Facility,Both,,,90,82,69.7,23.5012,82,UnitedHealthcare,Individual & Family,77.08,94,,percent of total billed charges,,
Food Panel (Mayo)OutsideLaboratory,,86003,CPT,Facility,Outpatient,,,90,82,69.7,23.5012,82,UnitedHealthcare,Medicare Advantage,40.18,49,,percent of total billed charges,,
Food Panel (Mayo)OutsideLaboratory,,86003,CPT,Facility,Inpatient,,,90,82,69.7,23.5012,82,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Food Panel (Mayo)OutsideLaboratory,,86003,CPT,Facility,Outpatient,,,90,82,69.7,23.5012,82,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,39.36,48,,percent of total billed charges,,100% of DHS outpatient percentage
Food Panel (Mayo)OutsideLaboratory,,86003,CPT,Facility,Inpatient,,,90,82,69.7,23.5012,82,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Food-Nut Panel # 1 (Mayo)OutsideLaboratory,,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Aetna,Commercial,42.32,92,,percent of total billed charges,,
Food-Nut Panel # 1 (Mayo)OutsideLaboratory,,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Aetna,Medicare Advantage,22.54,49,,percent of total billed charges,,
Food-Nut Panel # 1 (Mayo)OutsideLaboratory,,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Food-Nut Panel # 1 (Mayo)OutsideLaboratory,,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Aetna,PPO,42.78,93,,percent of total billed charges,,
Food-Nut Panel # 1 (Mayo)OutsideLaboratory,,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,America's PPO,America's PPO,44.1738,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Food-Nut Panel # 1 (Mayo)OutsideLaboratory,,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota, Federal Employee Program,45.264,98.4,,percent of total billed charges,,
Food-Nut Panel # 1 (Mayo)OutsideLaboratory,,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,46,100,,percent of total billed charges,,
Food-Nut Panel # 1 (Mayo)OutsideLaboratory,,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,High Value Network Plan,41.4,90,,percent of total billed charges,,
Food-Nut Panel # 1 (Mayo)OutsideLaboratory,,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Medicare Advantage,22.54,49,,percent of total billed charges,,
Food-Nut Panel # 1 (Mayo)OutsideLaboratory,,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Food-Nut Panel # 1 (Mayo)OutsideLaboratory,,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,40.7422,88.57,,percent of total billed charges,,
Food-Nut Panel # 1 (Mayo)OutsideLaboratory,,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,13.1836,28.66,,percent of total billed charges,,
Food-Nut Panel # 1 (Mayo)OutsideLaboratory,,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),22.54,49,,percent of total billed charges,,
Food-Nut Panel # 1 (Mayo)OutsideLaboratory,,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Food-Nut Panel # 1 (Mayo)OutsideLaboratory,,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,CorVel,Worker's Compensation,46,100,,percent of total billed charges,,
Food-Nut Panel # 1 (Mayo)OutsideLaboratory,,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,First Health Group Corporation,First Health Network,44.62,97,,percent of total billed charges,,
Food-Nut Panel # 1 (Mayo)OutsideLaboratory,,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Commercial,43.516,94.6,,percent of total billed charges,,
Food-Nut Panel # 1 (Mayo)OutsideLaboratory,,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Medicare Advantage,22.54,49,,percent of total billed charges,,
Food-Nut Panel # 1 (Mayo)OutsideLaboratory,,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Food-Nut Panel # 1 (Mayo)OutsideLaboratory,,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),27.6,60,,percent of total billed charges,,
Food-Nut Panel # 1 (Mayo)OutsideLaboratory,,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",State of Minnesota Advantage Program,37.49,81.5,,percent of total billed charges,,
Food-Nut Panel # 1 (Mayo)OutsideLaboratory,,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",State Public Programs,23,50,,percent of total billed charges,,
Food-Nut Panel # 1 (Mayo)OutsideLaboratory,,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Humana Insurance Company,Commercial PPO,43.7,95,,percent of total billed charges,,
Food-Nut Panel # 1 (Mayo)OutsideLaboratory,,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Humana Insurance Company,Medicare PPO,22.54,49,,percent of total billed charges,,
Food-Nut Panel # 1 (Mayo)OutsideLaboratory,,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Food-Nut Panel # 1 (Mayo)OutsideLaboratory,,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Medica,Individual & Family,45.586,99.1,,percent of total billed charges,,
Food-Nut Panel # 1 (Mayo)OutsideLaboratory,,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Medica,Medica Advantage Solution,22.908,49.8,,percent of total billed charges,,
Food-Nut Panel # 1 (Mayo)OutsideLaboratory,,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Food-Nut Panel # 1 (Mayo)OutsideLaboratory,,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Medica,Medical Assistance,20.516,44.6,,percent of total billed charges,,
Food-Nut Panel # 1 (Mayo)OutsideLaboratory,,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Medica,Medical Assistance,,,,,Included in per diem rate,
Food-Nut Panel # 1 (Mayo)OutsideLaboratory,,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,22.908,49.8,,percent of total billed charges,,
Food-Nut Panel # 1 (Mayo)OutsideLaboratory,,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Food-Nut Panel # 1 (Mayo)OutsideLaboratory,,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Multiplan, Inc.","Multiplan, Inc.",43.24,94,,percent of total billed charges,,
Food-Nut Panel # 1 (Mayo)OutsideLaboratory,,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,39.744,86.4,,percent of total billed charges,,
Food-Nut Panel # 1 (Mayo)OutsideLaboratory,,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Food-Nut Panel # 1 (Mayo)OutsideLaboratory,,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PPO,45.356,98.6,,percent of total billed charges,,
Food-Nut Panel # 1 (Mayo)OutsideLaboratory,,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,Minnesota Senior Health Options (MSHO),23.667,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Food-Nut Panel # 1 (Mayo)OutsideLaboratory,,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Food-Nut Panel # 1 (Mayo)OutsideLaboratory,,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,MinnesotaCare,23.6256,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Food-Nut Panel # 1 (Mayo)OutsideLaboratory,,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Food-Nut Panel # 1 (Mayo)OutsideLaboratory,,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Sanford Health Plan,Sanford Health Plan,42.32,92,,percent of total billed charges,,
Food-Nut Panel # 1 (Mayo)OutsideLaboratory,,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Individual & Family Plan,25.921,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Food-Nut Panel # 1 (Mayo)OutsideLaboratory,,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Food-Nut Panel # 1 (Mayo)OutsideLaboratory,,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medical Assistance,23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Food-Nut Panel # 1 (Mayo)OutsideLaboratory,,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Food-Nut Panel # 1 (Mayo)OutsideLaboratory,,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medicare Advantage,23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Food-Nut Panel # 1 (Mayo)OutsideLaboratory,,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Food-Nut Panel # 1 (Mayo)OutsideLaboratory,,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Food-Nut Panel # 1 (Mayo)OutsideLaboratory,,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Food-Nut Panel # 1 (Mayo)OutsideLaboratory,,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,UnitedHealthcare,Individual & Family,43.24,94,,percent of total billed charges,,
Food-Nut Panel # 1 (Mayo)OutsideLaboratory,,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Medicare Advantage,22.54,49,,percent of total billed charges,,
Food-Nut Panel # 1 (Mayo)OutsideLaboratory,,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Food-Nut Panel # 1 (Mayo)OutsideLaboratory,,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,22.08,48,,percent of total billed charges,,100% of DHS outpatient percentage
Food-Nut Panel # 1 (Mayo)OutsideLaboratory,,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Food-Nut Panel # 2 (Mayo)OutsideLaboratory,,86003,CPT,Facility,Both,,,90,82,69.7,23.5012,82,Aetna,Commercial,75.44,92,,percent of total billed charges,,
Food-Nut Panel # 2 (Mayo)OutsideLaboratory,,86003,CPT,Facility,Outpatient,,,90,82,69.7,23.5012,82,Aetna,Medicare Advantage,40.18,49,,percent of total billed charges,,
Food-Nut Panel # 2 (Mayo)OutsideLaboratory,,86003,CPT,Facility,Inpatient,,,90,82,69.7,23.5012,82,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Food-Nut Panel # 2 (Mayo)OutsideLaboratory,,86003,CPT,Facility,Both,,,90,82,69.7,23.5012,82,Aetna,PPO,76.26,93,,percent of total billed charges,,
Food-Nut Panel # 2 (Mayo)OutsideLaboratory,,86003,CPT,Facility,Both,,,90,82,69.7,23.5012,82,America's PPO,America's PPO,78.7446,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Food-Nut Panel # 2 (Mayo)OutsideLaboratory,,86003,CPT,Facility,Both,,,90,82,69.7,23.5012,82,BlueCross BlueShield Minnesota, Federal Employee Program,80.688,98.4,,percent of total billed charges,,
Food-Nut Panel # 2 (Mayo)OutsideLaboratory,,86003,CPT,Facility,Both,,,90,82,69.7,23.5012,82,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,82,100,,percent of total billed charges,,
Food-Nut Panel # 2 (Mayo)OutsideLaboratory,,86003,CPT,Facility,Both,,,90,82,69.7,23.5012,82,BlueCross BlueShield Minnesota,High Value Network Plan,73.8,90,,percent of total billed charges,,
Food-Nut Panel # 2 (Mayo)OutsideLaboratory,,86003,CPT,Facility,Outpatient,,,90,82,69.7,23.5012,82,BlueCross BlueShield Minnesota,Medicare Advantage,40.18,49,,percent of total billed charges,,
Food-Nut Panel # 2 (Mayo)OutsideLaboratory,,86003,CPT,Facility,Inpatient,,,90,82,69.7,23.5012,82,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Food-Nut Panel # 2 (Mayo)OutsideLaboratory,,86003,CPT,Facility,Both,,,90,82,69.7,23.5012,82,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,72.6274,88.57,,percent of total billed charges,,
Food-Nut Panel # 2 (Mayo)OutsideLaboratory,,86003,CPT,Facility,Both,,,90,82,69.7,23.5012,82,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,23.5012,28.66,,percent of total billed charges,,
Food-Nut Panel # 2 (Mayo)OutsideLaboratory,,86003,CPT,Facility,Outpatient,,,90,82,69.7,23.5012,82,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),40.18,49,,percent of total billed charges,,
Food-Nut Panel # 2 (Mayo)OutsideLaboratory,,86003,CPT,Facility,Inpatient,,,90,82,69.7,23.5012,82,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Food-Nut Panel # 2 (Mayo)OutsideLaboratory,,86003,CPT,Facility,Both,,,90,82,69.7,23.5012,82,CorVel,Worker's Compensation,82,100,,percent of total billed charges,,
Food-Nut Panel # 2 (Mayo)OutsideLaboratory,,86003,CPT,Facility,Both,,,90,82,69.7,23.5012,82,First Health Group Corporation,First Health Network,79.54,97,,percent of total billed charges,,
Food-Nut Panel # 2 (Mayo)OutsideLaboratory,,86003,CPT,Facility,Both,,,90,82,69.7,23.5012,82,"Health Partners, Inc.",Commercial,77.572,94.6,,percent of total billed charges,,
Food-Nut Panel # 2 (Mayo)OutsideLaboratory,,86003,CPT,Facility,Outpatient,,,90,82,69.7,23.5012,82,"Health Partners, Inc.",Medicare Advantage,40.18,49,,percent of total billed charges,,
Food-Nut Panel # 2 (Mayo)OutsideLaboratory,,86003,CPT,Facility,Inpatient,,,90,82,69.7,23.5012,82,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Food-Nut Panel # 2 (Mayo)OutsideLaboratory,,86003,CPT,Facility,Both,,,90,82,69.7,23.5012,82,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),49.2,60,,percent of total billed charges,,
Food-Nut Panel # 2 (Mayo)OutsideLaboratory,,86003,CPT,Facility,Both,,,90,82,69.7,23.5012,82,"Health Partners, Inc.",State of Minnesota Advantage Program,66.83,81.5,,percent of total billed charges,,
Food-Nut Panel # 2 (Mayo)OutsideLaboratory,,86003,CPT,Facility,Both,,,90,82,69.7,23.5012,82,"Health Partners, Inc.",State Public Programs,41,50,,percent of total billed charges,,
Food-Nut Panel # 2 (Mayo)OutsideLaboratory,,86003,CPT,Facility,Both,,,90,82,69.7,23.5012,82,Humana Insurance Company,Commercial PPO,77.9,95,,percent of total billed charges,,
Food-Nut Panel # 2 (Mayo)OutsideLaboratory,,86003,CPT,Facility,Outpatient,,,90,82,69.7,23.5012,82,Humana Insurance Company,Medicare PPO,40.18,49,,percent of total billed charges,,
Food-Nut Panel # 2 (Mayo)OutsideLaboratory,,86003,CPT,Facility,Inpatient,,,90,82,69.7,23.5012,82,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Food-Nut Panel # 2 (Mayo)OutsideLaboratory,,86003,CPT,Facility,Both,,,90,82,69.7,23.5012,82,Medica,Individual & Family,81.262,99.1,,percent of total billed charges,,
Food-Nut Panel # 2 (Mayo)OutsideLaboratory,,86003,CPT,Facility,Outpatient,,,90,82,69.7,23.5012,82,Medica,Medica Advantage Solution,40.836,49.8,,percent of total billed charges,,
Food-Nut Panel # 2 (Mayo)OutsideLaboratory,,86003,CPT,Facility,Inpatient,,,90,82,69.7,23.5012,82,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Food-Nut Panel # 2 (Mayo)OutsideLaboratory,,86003,CPT,Facility,Outpatient,,,90,82,69.7,23.5012,82,Medica,Medical Assistance,36.572,44.6,,percent of total billed charges,,
Food-Nut Panel # 2 (Mayo)OutsideLaboratory,,86003,CPT,Facility,Inpatient,,,90,82,69.7,23.5012,82,Medica,Medical Assistance,,,,,Included in per diem rate,
Food-Nut Panel # 2 (Mayo)OutsideLaboratory,,86003,CPT,Facility,Outpatient,,,90,82,69.7,23.5012,82,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,40.836,49.8,,percent of total billed charges,,
Food-Nut Panel # 2 (Mayo)OutsideLaboratory,,86003,CPT,Facility,Inpatient,,,90,82,69.7,23.5012,82,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Food-Nut Panel # 2 (Mayo)OutsideLaboratory,,86003,CPT,Facility,Both,,,90,82,69.7,23.5012,82,"Multiplan, Inc.","Multiplan, Inc.",77.08,94,,percent of total billed charges,,
Food-Nut Panel # 2 (Mayo)OutsideLaboratory,,86003,CPT,Facility,Outpatient,,,90,82,69.7,23.5012,82,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,70.848,86.4,,percent of total billed charges,,
Food-Nut Panel # 2 (Mayo)OutsideLaboratory,,86003,CPT,Facility,Inpatient,,,90,82,69.7,23.5012,82,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Food-Nut Panel # 2 (Mayo)OutsideLaboratory,,86003,CPT,Facility,Both,,,90,82,69.7,23.5012,82,"Preferred One Administrative Services, INC.",PPO,80.852,98.6,,percent of total billed charges,,
Food-Nut Panel # 2 (Mayo)OutsideLaboratory,,86003,CPT,Facility,Outpatient,,,90,82,69.7,23.5012,82,PrimeWest Health,Minnesota Senior Health Options (MSHO),42.189,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Food-Nut Panel # 2 (Mayo)OutsideLaboratory,,86003,CPT,Facility,Inpatient,,,90,82,69.7,23.5012,82,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Food-Nut Panel # 2 (Mayo)OutsideLaboratory,,86003,CPT,Facility,Outpatient,,,90,82,69.7,23.5012,82,PrimeWest Health,MinnesotaCare,42.1152,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Food-Nut Panel # 2 (Mayo)OutsideLaboratory,,86003,CPT,Facility,Inpatient,,,90,82,69.7,23.5012,82,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Food-Nut Panel # 2 (Mayo)OutsideLaboratory,,86003,CPT,Facility,Both,,,90,82,69.7,23.5012,82,Sanford Health Plan,Sanford Health Plan,75.44,92,,percent of total billed charges,,
Food-Nut Panel # 2 (Mayo)OutsideLaboratory,,86003,CPT,Facility,Outpatient,,,90,82,69.7,23.5012,82,"UCare Health, Inc.",Individual & Family Plan,46.207,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Food-Nut Panel # 2 (Mayo)OutsideLaboratory,,86003,CPT,Facility,Inpatient,,,90,82,69.7,23.5012,82,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Food-Nut Panel # 2 (Mayo)OutsideLaboratory,,86003,CPT,Facility,Outpatient,,,90,82,69.7,23.5012,82,"UCare Health, Inc.",Medical Assistance,41.3854,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Food-Nut Panel # 2 (Mayo)OutsideLaboratory,,86003,CPT,Facility,Inpatient,,,90,82,69.7,23.5012,82,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Food-Nut Panel # 2 (Mayo)OutsideLaboratory,,86003,CPT,Facility,Outpatient,,,90,82,69.7,23.5012,82,"UCare Health, Inc.",Medicare Advantage,41.3854,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Food-Nut Panel # 2 (Mayo)OutsideLaboratory,,86003,CPT,Facility,Inpatient,,,90,82,69.7,23.5012,82,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Food-Nut Panel # 2 (Mayo)OutsideLaboratory,,86003,CPT,Facility,Outpatient,,,90,82,69.7,23.5012,82,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),41.3854,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Food-Nut Panel # 2 (Mayo)OutsideLaboratory,,86003,CPT,Facility,Inpatient,,,90,82,69.7,23.5012,82,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Food-Nut Panel # 2 (Mayo)OutsideLaboratory,,86003,CPT,Facility,Both,,,90,82,69.7,23.5012,82,UnitedHealthcare,Individual & Family,77.08,94,,percent of total billed charges,,
Food-Nut Panel # 2 (Mayo)OutsideLaboratory,,86003,CPT,Facility,Outpatient,,,90,82,69.7,23.5012,82,UnitedHealthcare,Medicare Advantage,40.18,49,,percent of total billed charges,,
Food-Nut Panel # 2 (Mayo)OutsideLaboratory,,86003,CPT,Facility,Inpatient,,,90,82,69.7,23.5012,82,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Food-Nut Panel # 2 (Mayo)OutsideLaboratory,,86003,CPT,Facility,Outpatient,,,90,82,69.7,23.5012,82,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,39.36,48,,percent of total billed charges,,100% of DHS outpatient percentage
Food-Nut Panel # 2 (Mayo)OutsideLaboratory,,86003,CPT,Facility,Inpatient,,,90,82,69.7,23.5012,82,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Food-Seafood Panel (Mayo)OutsideLaboratory,,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Aetna,Commercial,42.32,92,,percent of total billed charges,,
Food-Seafood Panel (Mayo)OutsideLaboratory,,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Aetna,Medicare Advantage,22.54,49,,percent of total billed charges,,
Food-Seafood Panel (Mayo)OutsideLaboratory,,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Food-Seafood Panel (Mayo)OutsideLaboratory,,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Aetna,PPO,42.78,93,,percent of total billed charges,,
Food-Seafood Panel (Mayo)OutsideLaboratory,,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,America's PPO,America's PPO,44.1738,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Food-Seafood Panel (Mayo)OutsideLaboratory,,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota, Federal Employee Program,45.264,98.4,,percent of total billed charges,,
Food-Seafood Panel (Mayo)OutsideLaboratory,,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,46,100,,percent of total billed charges,,
Food-Seafood Panel (Mayo)OutsideLaboratory,,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,High Value Network Plan,41.4,90,,percent of total billed charges,,
Food-Seafood Panel (Mayo)OutsideLaboratory,,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Medicare Advantage,22.54,49,,percent of total billed charges,,
Food-Seafood Panel (Mayo)OutsideLaboratory,,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Food-Seafood Panel (Mayo)OutsideLaboratory,,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,40.7422,88.57,,percent of total billed charges,,
Food-Seafood Panel (Mayo)OutsideLaboratory,,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,13.1836,28.66,,percent of total billed charges,,
Food-Seafood Panel (Mayo)OutsideLaboratory,,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),22.54,49,,percent of total billed charges,,
Food-Seafood Panel (Mayo)OutsideLaboratory,,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Food-Seafood Panel (Mayo)OutsideLaboratory,,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,CorVel,Worker's Compensation,46,100,,percent of total billed charges,,
Food-Seafood Panel (Mayo)OutsideLaboratory,,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,First Health Group Corporation,First Health Network,44.62,97,,percent of total billed charges,,
Food-Seafood Panel (Mayo)OutsideLaboratory,,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Commercial,43.516,94.6,,percent of total billed charges,,
Food-Seafood Panel (Mayo)OutsideLaboratory,,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Medicare Advantage,22.54,49,,percent of total billed charges,,
Food-Seafood Panel (Mayo)OutsideLaboratory,,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Food-Seafood Panel (Mayo)OutsideLaboratory,,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),27.6,60,,percent of total billed charges,,
Food-Seafood Panel (Mayo)OutsideLaboratory,,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",State of Minnesota Advantage Program,37.49,81.5,,percent of total billed charges,,
Food-Seafood Panel (Mayo)OutsideLaboratory,,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",State Public Programs,23,50,,percent of total billed charges,,
Food-Seafood Panel (Mayo)OutsideLaboratory,,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Humana Insurance Company,Commercial PPO,43.7,95,,percent of total billed charges,,
Food-Seafood Panel (Mayo)OutsideLaboratory,,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Humana Insurance Company,Medicare PPO,22.54,49,,percent of total billed charges,,
Food-Seafood Panel (Mayo)OutsideLaboratory,,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Food-Seafood Panel (Mayo)OutsideLaboratory,,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Medica,Individual & Family,45.586,99.1,,percent of total billed charges,,
Food-Seafood Panel (Mayo)OutsideLaboratory,,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Medica,Medica Advantage Solution,22.908,49.8,,percent of total billed charges,,
Food-Seafood Panel (Mayo)OutsideLaboratory,,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Food-Seafood Panel (Mayo)OutsideLaboratory,,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Medica,Medical Assistance,20.516,44.6,,percent of total billed charges,,
Food-Seafood Panel (Mayo)OutsideLaboratory,,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Medica,Medical Assistance,,,,,Included in per diem rate,
Food-Seafood Panel (Mayo)OutsideLaboratory,,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,22.908,49.8,,percent of total billed charges,,
Food-Seafood Panel (Mayo)OutsideLaboratory,,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Food-Seafood Panel (Mayo)OutsideLaboratory,,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Multiplan, Inc.","Multiplan, Inc.",43.24,94,,percent of total billed charges,,
Food-Seafood Panel (Mayo)OutsideLaboratory,,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,39.744,86.4,,percent of total billed charges,,
Food-Seafood Panel (Mayo)OutsideLaboratory,,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Food-Seafood Panel (Mayo)OutsideLaboratory,,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PPO,45.356,98.6,,percent of total billed charges,,
Food-Seafood Panel (Mayo)OutsideLaboratory,,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,Minnesota Senior Health Options (MSHO),23.667,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Food-Seafood Panel (Mayo)OutsideLaboratory,,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Food-Seafood Panel (Mayo)OutsideLaboratory,,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,MinnesotaCare,23.6256,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Food-Seafood Panel (Mayo)OutsideLaboratory,,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Food-Seafood Panel (Mayo)OutsideLaboratory,,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Sanford Health Plan,Sanford Health Plan,42.32,92,,percent of total billed charges,,
Food-Seafood Panel (Mayo)OutsideLaboratory,,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Individual & Family Plan,25.921,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Food-Seafood Panel (Mayo)OutsideLaboratory,,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Food-Seafood Panel (Mayo)OutsideLaboratory,,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medical Assistance,23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Food-Seafood Panel (Mayo)OutsideLaboratory,,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Food-Seafood Panel (Mayo)OutsideLaboratory,,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medicare Advantage,23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Food-Seafood Panel (Mayo)OutsideLaboratory,,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Food-Seafood Panel (Mayo)OutsideLaboratory,,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Food-Seafood Panel (Mayo)OutsideLaboratory,,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Food-Seafood Panel (Mayo)OutsideLaboratory,,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,UnitedHealthcare,Individual & Family,43.24,94,,percent of total billed charges,,
Food-Seafood Panel (Mayo)OutsideLaboratory,,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Medicare Advantage,22.54,49,,percent of total billed charges,,
Food-Seafood Panel (Mayo)OutsideLaboratory,,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Food-Seafood Panel (Mayo)OutsideLaboratory,,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,22.08,48,,percent of total billed charges,,100% of DHS outpatient percentage
Food-Seafood Panel (Mayo)OutsideLaboratory,,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Gluten, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,56,47.6,16.0496,56,Aetna,Commercial,51.52,92,,percent of total billed charges,,
"Gluten, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,56,47.6,16.0496,56,Aetna,Medicare Advantage,27.44,49,,percent of total billed charges,,
"Gluten, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,56,47.6,16.0496,56,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Gluten, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,56,47.6,16.0496,56,Aetna,PPO,52.08,93,,percent of total billed charges,,
"Gluten, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,56,47.6,16.0496,56,America's PPO,America's PPO,53.7768,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Gluten, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,56,47.6,16.0496,56,BlueCross BlueShield Minnesota, Federal Employee Program,55.104,98.4,,percent of total billed charges,,
"Gluten, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,56,47.6,16.0496,56,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,56,100,,percent of total billed charges,,
"Gluten, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,56,47.6,16.0496,56,BlueCross BlueShield Minnesota,High Value Network Plan,50.4,90,,percent of total billed charges,,
"Gluten, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,56,47.6,16.0496,56,BlueCross BlueShield Minnesota,Medicare Advantage,27.44,49,,percent of total billed charges,,
"Gluten, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,56,47.6,16.0496,56,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Gluten, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,56,47.6,16.0496,56,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,49.5992,88.57,,percent of total billed charges,,
"Gluten, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,56,47.6,16.0496,56,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,16.0496,28.66,,percent of total billed charges,,
"Gluten, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,56,47.6,16.0496,56,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),27.44,49,,percent of total billed charges,,
"Gluten, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,56,47.6,16.0496,56,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Gluten, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,56,47.6,16.0496,56,CorVel,Worker's Compensation,56,100,,percent of total billed charges,,
"Gluten, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,56,47.6,16.0496,56,First Health Group Corporation,First Health Network,54.32,97,,percent of total billed charges,,
"Gluten, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,56,47.6,16.0496,56,"Health Partners, Inc.",Commercial,52.976,94.6,,percent of total billed charges,,
"Gluten, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,56,47.6,16.0496,56,"Health Partners, Inc.",Medicare Advantage,27.44,49,,percent of total billed charges,,
"Gluten, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,56,47.6,16.0496,56,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Gluten, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,56,47.6,16.0496,56,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),33.6,60,,percent of total billed charges,,
"Gluten, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,56,47.6,16.0496,56,"Health Partners, Inc.",State of Minnesota Advantage Program,45.64,81.5,,percent of total billed charges,,
"Gluten, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,56,47.6,16.0496,56,"Health Partners, Inc.",State Public Programs,28,50,,percent of total billed charges,,
"Gluten, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,56,47.6,16.0496,56,Humana Insurance Company,Commercial PPO,53.2,95,,percent of total billed charges,,
"Gluten, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,56,47.6,16.0496,56,Humana Insurance Company,Medicare PPO,27.44,49,,percent of total billed charges,,
"Gluten, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,56,47.6,16.0496,56,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Gluten, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,56,47.6,16.0496,56,Medica,Individual & Family,55.496,99.1,,percent of total billed charges,,
"Gluten, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,56,47.6,16.0496,56,Medica,Medica Advantage Solution,27.888,49.8,,percent of total billed charges,,
"Gluten, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,56,47.6,16.0496,56,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Gluten, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,56,47.6,16.0496,56,Medica,Medical Assistance,24.976,44.6,,percent of total billed charges,,
"Gluten, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,56,47.6,16.0496,56,Medica,Medical Assistance,,,,,Included in per diem rate,
"Gluten, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,56,47.6,16.0496,56,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,27.888,49.8,,percent of total billed charges,,
"Gluten, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,56,47.6,16.0496,56,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Gluten, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,56,47.6,16.0496,56,"Multiplan, Inc.","Multiplan, Inc.",52.64,94,,percent of total billed charges,,
"Gluten, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,56,47.6,16.0496,56,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,48.384,86.4,,percent of total billed charges,,
"Gluten, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,56,47.6,16.0496,56,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Gluten, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,56,47.6,16.0496,56,"Preferred One Administrative Services, INC.",PPO,55.216,98.6,,percent of total billed charges,,
"Gluten, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,56,47.6,16.0496,56,PrimeWest Health,Minnesota Senior Health Options (MSHO),28.812,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Gluten, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,56,47.6,16.0496,56,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Gluten, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,56,47.6,16.0496,56,PrimeWest Health,MinnesotaCare,28.7616,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Gluten, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,56,47.6,16.0496,56,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Gluten, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,56,47.6,16.0496,56,Sanford Health Plan,Sanford Health Plan,51.52,92,,percent of total billed charges,,
"Gluten, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,56,47.6,16.0496,56,"UCare Health, Inc.",Individual & Family Plan,31.556,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Gluten, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,56,47.6,16.0496,56,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Gluten, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,56,47.6,16.0496,56,"UCare Health, Inc.",Medical Assistance,28.2632,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Gluten, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,56,47.6,16.0496,56,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Gluten, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,56,47.6,16.0496,56,"UCare Health, Inc.",Medicare Advantage,28.2632,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Gluten, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,56,47.6,16.0496,56,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Gluten, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,56,47.6,16.0496,56,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),28.2632,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Gluten, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,56,47.6,16.0496,56,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Gluten, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,56,47.6,16.0496,56,UnitedHealthcare,Individual & Family,52.64,94,,percent of total billed charges,,
"Gluten, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,56,47.6,16.0496,56,UnitedHealthcare,Medicare Advantage,27.44,49,,percent of total billed charges,,
"Gluten, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,56,47.6,16.0496,56,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Gluten, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,56,47.6,16.0496,56,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,26.88,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Gluten, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,56,47.6,16.0496,56,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Grass Panel # 1 (Mayo)OutsideLaboratory,,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Aetna,Commercial,42.32,92,,percent of total billed charges,,
Grass Panel # 1 (Mayo)OutsideLaboratory,,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Aetna,Medicare Advantage,22.54,49,,percent of total billed charges,,
Grass Panel # 1 (Mayo)OutsideLaboratory,,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Grass Panel # 1 (Mayo)OutsideLaboratory,,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Aetna,PPO,42.78,93,,percent of total billed charges,,
Grass Panel # 1 (Mayo)OutsideLaboratory,,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,America's PPO,America's PPO,44.1738,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Grass Panel # 1 (Mayo)OutsideLaboratory,,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota, Federal Employee Program,45.264,98.4,,percent of total billed charges,,
Grass Panel # 1 (Mayo)OutsideLaboratory,,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,46,100,,percent of total billed charges,,
Grass Panel # 1 (Mayo)OutsideLaboratory,,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,High Value Network Plan,41.4,90,,percent of total billed charges,,
Grass Panel # 1 (Mayo)OutsideLaboratory,,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Medicare Advantage,22.54,49,,percent of total billed charges,,
Grass Panel # 1 (Mayo)OutsideLaboratory,,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Grass Panel # 1 (Mayo)OutsideLaboratory,,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,40.7422,88.57,,percent of total billed charges,,
Grass Panel # 1 (Mayo)OutsideLaboratory,,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,13.1836,28.66,,percent of total billed charges,,
Grass Panel # 1 (Mayo)OutsideLaboratory,,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),22.54,49,,percent of total billed charges,,
Grass Panel # 1 (Mayo)OutsideLaboratory,,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Grass Panel # 1 (Mayo)OutsideLaboratory,,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,CorVel,Worker's Compensation,46,100,,percent of total billed charges,,
Grass Panel # 1 (Mayo)OutsideLaboratory,,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,First Health Group Corporation,First Health Network,44.62,97,,percent of total billed charges,,
Grass Panel # 1 (Mayo)OutsideLaboratory,,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Commercial,43.516,94.6,,percent of total billed charges,,
Grass Panel # 1 (Mayo)OutsideLaboratory,,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Medicare Advantage,22.54,49,,percent of total billed charges,,
Grass Panel # 1 (Mayo)OutsideLaboratory,,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Grass Panel # 1 (Mayo)OutsideLaboratory,,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),27.6,60,,percent of total billed charges,,
Grass Panel # 1 (Mayo)OutsideLaboratory,,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",State of Minnesota Advantage Program,37.49,81.5,,percent of total billed charges,,
Grass Panel # 1 (Mayo)OutsideLaboratory,,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",State Public Programs,23,50,,percent of total billed charges,,
Grass Panel # 1 (Mayo)OutsideLaboratory,,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Humana Insurance Company,Commercial PPO,43.7,95,,percent of total billed charges,,
Grass Panel # 1 (Mayo)OutsideLaboratory,,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Humana Insurance Company,Medicare PPO,22.54,49,,percent of total billed charges,,
Grass Panel # 1 (Mayo)OutsideLaboratory,,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Grass Panel # 1 (Mayo)OutsideLaboratory,,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Medica,Individual & Family,45.586,99.1,,percent of total billed charges,,
Grass Panel # 1 (Mayo)OutsideLaboratory,,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Medica,Medica Advantage Solution,22.908,49.8,,percent of total billed charges,,
Grass Panel # 1 (Mayo)OutsideLaboratory,,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Grass Panel # 1 (Mayo)OutsideLaboratory,,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Medica,Medical Assistance,20.516,44.6,,percent of total billed charges,,
Grass Panel # 1 (Mayo)OutsideLaboratory,,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Medica,Medical Assistance,,,,,Included in per diem rate,
Grass Panel # 1 (Mayo)OutsideLaboratory,,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,22.908,49.8,,percent of total billed charges,,
Grass Panel # 1 (Mayo)OutsideLaboratory,,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Grass Panel # 1 (Mayo)OutsideLaboratory,,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Multiplan, Inc.","Multiplan, Inc.",43.24,94,,percent of total billed charges,,
Grass Panel # 1 (Mayo)OutsideLaboratory,,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,39.744,86.4,,percent of total billed charges,,
Grass Panel # 1 (Mayo)OutsideLaboratory,,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Grass Panel # 1 (Mayo)OutsideLaboratory,,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PPO,45.356,98.6,,percent of total billed charges,,
Grass Panel # 1 (Mayo)OutsideLaboratory,,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,Minnesota Senior Health Options (MSHO),23.667,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Grass Panel # 1 (Mayo)OutsideLaboratory,,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Grass Panel # 1 (Mayo)OutsideLaboratory,,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,MinnesotaCare,23.6256,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Grass Panel # 1 (Mayo)OutsideLaboratory,,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Grass Panel # 1 (Mayo)OutsideLaboratory,,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Sanford Health Plan,Sanford Health Plan,42.32,92,,percent of total billed charges,,
Grass Panel # 1 (Mayo)OutsideLaboratory,,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Individual & Family Plan,25.921,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Grass Panel # 1 (Mayo)OutsideLaboratory,,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Grass Panel # 1 (Mayo)OutsideLaboratory,,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medical Assistance,23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Grass Panel # 1 (Mayo)OutsideLaboratory,,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Grass Panel # 1 (Mayo)OutsideLaboratory,,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medicare Advantage,23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Grass Panel # 1 (Mayo)OutsideLaboratory,,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Grass Panel # 1 (Mayo)OutsideLaboratory,,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Grass Panel # 1 (Mayo)OutsideLaboratory,,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Grass Panel # 1 (Mayo)OutsideLaboratory,,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,UnitedHealthcare,Individual & Family,43.24,94,,percent of total billed charges,,
Grass Panel # 1 (Mayo)OutsideLaboratory,,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Medicare Advantage,22.54,49,,percent of total billed charges,,
Grass Panel # 1 (Mayo)OutsideLaboratory,,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Grass Panel # 1 (Mayo)OutsideLaboratory,,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,22.08,48,,percent of total billed charges,,100% of DHS outpatient percentage
Grass Panel # 1 (Mayo)OutsideLaboratory,,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Horse Dander, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Aetna,Commercial,42.32,92,,percent of total billed charges,,
"Horse Dander, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Aetna,Medicare Advantage,22.54,49,,percent of total billed charges,,
"Horse Dander, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Horse Dander, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Aetna,PPO,42.78,93,,percent of total billed charges,,
"Horse Dander, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,America's PPO,America's PPO,44.1738,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Horse Dander, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota, Federal Employee Program,45.264,98.4,,percent of total billed charges,,
"Horse Dander, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,46,100,,percent of total billed charges,,
"Horse Dander, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,High Value Network Plan,41.4,90,,percent of total billed charges,,
"Horse Dander, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Medicare Advantage,22.54,49,,percent of total billed charges,,
"Horse Dander, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Horse Dander, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,40.7422,88.57,,percent of total billed charges,,
"Horse Dander, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,13.1836,28.66,,percent of total billed charges,,
"Horse Dander, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),22.54,49,,percent of total billed charges,,
"Horse Dander, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Horse Dander, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,CorVel,Worker's Compensation,46,100,,percent of total billed charges,,
"Horse Dander, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,First Health Group Corporation,First Health Network,44.62,97,,percent of total billed charges,,
"Horse Dander, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Commercial,43.516,94.6,,percent of total billed charges,,
"Horse Dander, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Medicare Advantage,22.54,49,,percent of total billed charges,,
"Horse Dander, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Horse Dander, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),27.6,60,,percent of total billed charges,,
"Horse Dander, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",State of Minnesota Advantage Program,37.49,81.5,,percent of total billed charges,,
"Horse Dander, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",State Public Programs,23,50,,percent of total billed charges,,
"Horse Dander, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Humana Insurance Company,Commercial PPO,43.7,95,,percent of total billed charges,,
"Horse Dander, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Humana Insurance Company,Medicare PPO,22.54,49,,percent of total billed charges,,
"Horse Dander, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Horse Dander, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Medica,Individual & Family,45.586,99.1,,percent of total billed charges,,
"Horse Dander, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Medica,Medica Advantage Solution,22.908,49.8,,percent of total billed charges,,
"Horse Dander, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Horse Dander, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Medica,Medical Assistance,20.516,44.6,,percent of total billed charges,,
"Horse Dander, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Medica,Medical Assistance,,,,,Included in per diem rate,
"Horse Dander, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,22.908,49.8,,percent of total billed charges,,
"Horse Dander, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Horse Dander, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Multiplan, Inc.","Multiplan, Inc.",43.24,94,,percent of total billed charges,,
"Horse Dander, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,39.744,86.4,,percent of total billed charges,,
"Horse Dander, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Horse Dander, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PPO,45.356,98.6,,percent of total billed charges,,
"Horse Dander, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,Minnesota Senior Health Options (MSHO),23.667,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Horse Dander, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Horse Dander, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,MinnesotaCare,23.6256,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Horse Dander, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Horse Dander, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Sanford Health Plan,Sanford Health Plan,42.32,92,,percent of total billed charges,,
"Horse Dander, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Individual & Family Plan,25.921,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Horse Dander, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Horse Dander, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medical Assistance,23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Horse Dander, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Horse Dander, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medicare Advantage,23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Horse Dander, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Horse Dander, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Horse Dander, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Horse Dander, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,UnitedHealthcare,Individual & Family,43.24,94,,percent of total billed charges,,
"Horse Dander, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Medicare Advantage,22.54,49,,percent of total billed charges,,
"Horse Dander, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Horse Dander, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,22.08,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Horse Dander, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"House Dust Mites/D.F., Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Aetna,Commercial,42.32,92,,percent of total billed charges,,
"House Dust Mites/D.F., Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Aetna,Medicare Advantage,22.54,49,,percent of total billed charges,,
"House Dust Mites/D.F., Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"House Dust Mites/D.F., Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Aetna,PPO,42.78,93,,percent of total billed charges,,
"House Dust Mites/D.F., Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,America's PPO,America's PPO,44.1738,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"House Dust Mites/D.F., Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota, Federal Employee Program,45.264,98.4,,percent of total billed charges,,
"House Dust Mites/D.F., Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,46,100,,percent of total billed charges,,
"House Dust Mites/D.F., Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,High Value Network Plan,41.4,90,,percent of total billed charges,,
"House Dust Mites/D.F., Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Medicare Advantage,22.54,49,,percent of total billed charges,,
"House Dust Mites/D.F., Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"House Dust Mites/D.F., Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,40.7422,88.57,,percent of total billed charges,,
"House Dust Mites/D.F., Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,13.1836,28.66,,percent of total billed charges,,
"House Dust Mites/D.F., Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),22.54,49,,percent of total billed charges,,
"House Dust Mites/D.F., Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"House Dust Mites/D.F., Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,CorVel,Worker's Compensation,46,100,,percent of total billed charges,,
"House Dust Mites/D.F., Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,First Health Group Corporation,First Health Network,44.62,97,,percent of total billed charges,,
"House Dust Mites/D.F., Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Commercial,43.516,94.6,,percent of total billed charges,,
"House Dust Mites/D.F., Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Medicare Advantage,22.54,49,,percent of total billed charges,,
"House Dust Mites/D.F., Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"House Dust Mites/D.F., Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),27.6,60,,percent of total billed charges,,
"House Dust Mites/D.F., Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",State of Minnesota Advantage Program,37.49,81.5,,percent of total billed charges,,
"House Dust Mites/D.F., Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",State Public Programs,23,50,,percent of total billed charges,,
"House Dust Mites/D.F., Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Humana Insurance Company,Commercial PPO,43.7,95,,percent of total billed charges,,
"House Dust Mites/D.F., Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Humana Insurance Company,Medicare PPO,22.54,49,,percent of total billed charges,,
"House Dust Mites/D.F., Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"House Dust Mites/D.F., Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Medica,Individual & Family,45.586,99.1,,percent of total billed charges,,
"House Dust Mites/D.F., Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Medica,Medica Advantage Solution,22.908,49.8,,percent of total billed charges,,
"House Dust Mites/D.F., Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"House Dust Mites/D.F., Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Medica,Medical Assistance,20.516,44.6,,percent of total billed charges,,
"House Dust Mites/D.F., Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Medica,Medical Assistance,,,,,Included in per diem rate,
"House Dust Mites/D.F., Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,22.908,49.8,,percent of total billed charges,,
"House Dust Mites/D.F., Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"House Dust Mites/D.F., Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Multiplan, Inc.","Multiplan, Inc.",43.24,94,,percent of total billed charges,,
"House Dust Mites/D.F., Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,39.744,86.4,,percent of total billed charges,,
"House Dust Mites/D.F., Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"House Dust Mites/D.F., Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PPO,45.356,98.6,,percent of total billed charges,,
"House Dust Mites/D.F., Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,Minnesota Senior Health Options (MSHO),23.667,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"House Dust Mites/D.F., Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"House Dust Mites/D.F., Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,MinnesotaCare,23.6256,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"House Dust Mites/D.F., Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"House Dust Mites/D.F., Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Sanford Health Plan,Sanford Health Plan,42.32,92,,percent of total billed charges,,
"House Dust Mites/D.F., Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Individual & Family Plan,25.921,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"House Dust Mites/D.F., Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"House Dust Mites/D.F., Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medical Assistance,23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"House Dust Mites/D.F., Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"House Dust Mites/D.F., Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medicare Advantage,23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"House Dust Mites/D.F., Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"House Dust Mites/D.F., Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"House Dust Mites/D.F., Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"House Dust Mites/D.F., Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,UnitedHealthcare,Individual & Family,43.24,94,,percent of total billed charges,,
"House Dust Mites/D.F., Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Medicare Advantage,22.54,49,,percent of total billed charges,,
"House Dust Mites/D.F., Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"House Dust Mites/D.F., Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,22.08,48,,percent of total billed charges,,100% of DHS outpatient percentage
"House Dust Mites/D.F., Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"House Dust Mites/D.P., Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Aetna,Commercial,42.32,92,,percent of total billed charges,,
"House Dust Mites/D.P., Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Aetna,Medicare Advantage,22.54,49,,percent of total billed charges,,
"House Dust Mites/D.P., Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"House Dust Mites/D.P., Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Aetna,PPO,42.78,93,,percent of total billed charges,,
"House Dust Mites/D.P., Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,America's PPO,America's PPO,44.1738,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"House Dust Mites/D.P., Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota, Federal Employee Program,45.264,98.4,,percent of total billed charges,,
"House Dust Mites/D.P., Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,46,100,,percent of total billed charges,,
"House Dust Mites/D.P., Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,High Value Network Plan,41.4,90,,percent of total billed charges,,
"House Dust Mites/D.P., Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Medicare Advantage,22.54,49,,percent of total billed charges,,
"House Dust Mites/D.P., Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"House Dust Mites/D.P., Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,40.7422,88.57,,percent of total billed charges,,
"House Dust Mites/D.P., Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,13.1836,28.66,,percent of total billed charges,,
"House Dust Mites/D.P., Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),22.54,49,,percent of total billed charges,,
"House Dust Mites/D.P., Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"House Dust Mites/D.P., Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,CorVel,Worker's Compensation,46,100,,percent of total billed charges,,
"House Dust Mites/D.P., Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,First Health Group Corporation,First Health Network,44.62,97,,percent of total billed charges,,
"House Dust Mites/D.P., Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Commercial,43.516,94.6,,percent of total billed charges,,
"House Dust Mites/D.P., Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Medicare Advantage,22.54,49,,percent of total billed charges,,
"House Dust Mites/D.P., Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"House Dust Mites/D.P., Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),27.6,60,,percent of total billed charges,,
"House Dust Mites/D.P., Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",State of Minnesota Advantage Program,37.49,81.5,,percent of total billed charges,,
"House Dust Mites/D.P., Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",State Public Programs,23,50,,percent of total billed charges,,
"House Dust Mites/D.P., Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Humana Insurance Company,Commercial PPO,43.7,95,,percent of total billed charges,,
"House Dust Mites/D.P., Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Humana Insurance Company,Medicare PPO,22.54,49,,percent of total billed charges,,
"House Dust Mites/D.P., Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"House Dust Mites/D.P., Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Medica,Individual & Family,45.586,99.1,,percent of total billed charges,,
"House Dust Mites/D.P., Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Medica,Medica Advantage Solution,22.908,49.8,,percent of total billed charges,,
"House Dust Mites/D.P., Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"House Dust Mites/D.P., Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Medica,Medical Assistance,20.516,44.6,,percent of total billed charges,,
"House Dust Mites/D.P., Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Medica,Medical Assistance,,,,,Included in per diem rate,
"House Dust Mites/D.P., Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,22.908,49.8,,percent of total billed charges,,
"House Dust Mites/D.P., Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"House Dust Mites/D.P., Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Multiplan, Inc.","Multiplan, Inc.",43.24,94,,percent of total billed charges,,
"House Dust Mites/D.P., Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,39.744,86.4,,percent of total billed charges,,
"House Dust Mites/D.P., Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"House Dust Mites/D.P., Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PPO,45.356,98.6,,percent of total billed charges,,
"House Dust Mites/D.P., Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,Minnesota Senior Health Options (MSHO),23.667,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"House Dust Mites/D.P., Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"House Dust Mites/D.P., Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,MinnesotaCare,23.6256,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"House Dust Mites/D.P., Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"House Dust Mites/D.P., Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Sanford Health Plan,Sanford Health Plan,42.32,92,,percent of total billed charges,,
"House Dust Mites/D.P., Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Individual & Family Plan,25.921,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"House Dust Mites/D.P., Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"House Dust Mites/D.P., Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medical Assistance,23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"House Dust Mites/D.P., Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"House Dust Mites/D.P., Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medicare Advantage,23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"House Dust Mites/D.P., Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"House Dust Mites/D.P., Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"House Dust Mites/D.P., Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"House Dust Mites/D.P., Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,UnitedHealthcare,Individual & Family,43.24,94,,percent of total billed charges,,
"House Dust Mites/D.P., Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Medicare Advantage,22.54,49,,percent of total billed charges,,
"House Dust Mites/D.P., Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"House Dust Mites/D.P., Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,22.08,48,,percent of total billed charges,,100% of DHS outpatient percentage
"House Dust Mites/D.P., Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
House Dust Panel (Mayo)OutsideLaboratory,,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Aetna,Commercial,42.32,92,,percent of total billed charges,,
House Dust Panel (Mayo)OutsideLaboratory,,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Aetna,Medicare Advantage,22.54,49,,percent of total billed charges,,
House Dust Panel (Mayo)OutsideLaboratory,,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Aetna,Medicare Advantage,,,,,Included in per diem rate,
House Dust Panel (Mayo)OutsideLaboratory,,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Aetna,PPO,42.78,93,,percent of total billed charges,,
House Dust Panel (Mayo)OutsideLaboratory,,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,America's PPO,America's PPO,44.1738,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
House Dust Panel (Mayo)OutsideLaboratory,,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota, Federal Employee Program,45.264,98.4,,percent of total billed charges,,
House Dust Panel (Mayo)OutsideLaboratory,,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,46,100,,percent of total billed charges,,
House Dust Panel (Mayo)OutsideLaboratory,,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,High Value Network Plan,41.4,90,,percent of total billed charges,,
House Dust Panel (Mayo)OutsideLaboratory,,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Medicare Advantage,22.54,49,,percent of total billed charges,,
House Dust Panel (Mayo)OutsideLaboratory,,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
House Dust Panel (Mayo)OutsideLaboratory,,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,40.7422,88.57,,percent of total billed charges,,
House Dust Panel (Mayo)OutsideLaboratory,,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,13.1836,28.66,,percent of total billed charges,,
House Dust Panel (Mayo)OutsideLaboratory,,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),22.54,49,,percent of total billed charges,,
House Dust Panel (Mayo)OutsideLaboratory,,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
House Dust Panel (Mayo)OutsideLaboratory,,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,CorVel,Worker's Compensation,46,100,,percent of total billed charges,,
House Dust Panel (Mayo)OutsideLaboratory,,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,First Health Group Corporation,First Health Network,44.62,97,,percent of total billed charges,,
House Dust Panel (Mayo)OutsideLaboratory,,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Commercial,43.516,94.6,,percent of total billed charges,,
House Dust Panel (Mayo)OutsideLaboratory,,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Medicare Advantage,22.54,49,,percent of total billed charges,,
House Dust Panel (Mayo)OutsideLaboratory,,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
House Dust Panel (Mayo)OutsideLaboratory,,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),27.6,60,,percent of total billed charges,,
House Dust Panel (Mayo)OutsideLaboratory,,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",State of Minnesota Advantage Program,37.49,81.5,,percent of total billed charges,,
House Dust Panel (Mayo)OutsideLaboratory,,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",State Public Programs,23,50,,percent of total billed charges,,
House Dust Panel (Mayo)OutsideLaboratory,,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Humana Insurance Company,Commercial PPO,43.7,95,,percent of total billed charges,,
House Dust Panel (Mayo)OutsideLaboratory,,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Humana Insurance Company,Medicare PPO,22.54,49,,percent of total billed charges,,
House Dust Panel (Mayo)OutsideLaboratory,,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
House Dust Panel (Mayo)OutsideLaboratory,,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Medica,Individual & Family,45.586,99.1,,percent of total billed charges,,
House Dust Panel (Mayo)OutsideLaboratory,,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Medica,Medica Advantage Solution,22.908,49.8,,percent of total billed charges,,
House Dust Panel (Mayo)OutsideLaboratory,,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
House Dust Panel (Mayo)OutsideLaboratory,,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Medica,Medical Assistance,20.516,44.6,,percent of total billed charges,,
House Dust Panel (Mayo)OutsideLaboratory,,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Medica,Medical Assistance,,,,,Included in per diem rate,
House Dust Panel (Mayo)OutsideLaboratory,,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,22.908,49.8,,percent of total billed charges,,
House Dust Panel (Mayo)OutsideLaboratory,,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
House Dust Panel (Mayo)OutsideLaboratory,,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Multiplan, Inc.","Multiplan, Inc.",43.24,94,,percent of total billed charges,,
House Dust Panel (Mayo)OutsideLaboratory,,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,39.744,86.4,,percent of total billed charges,,
House Dust Panel (Mayo)OutsideLaboratory,,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
House Dust Panel (Mayo)OutsideLaboratory,,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PPO,45.356,98.6,,percent of total billed charges,,
House Dust Panel (Mayo)OutsideLaboratory,,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,Minnesota Senior Health Options (MSHO),23.667,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
House Dust Panel (Mayo)OutsideLaboratory,,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
House Dust Panel (Mayo)OutsideLaboratory,,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,MinnesotaCare,23.6256,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
House Dust Panel (Mayo)OutsideLaboratory,,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
House Dust Panel (Mayo)OutsideLaboratory,,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Sanford Health Plan,Sanford Health Plan,42.32,92,,percent of total billed charges,,
House Dust Panel (Mayo)OutsideLaboratory,,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Individual & Family Plan,25.921,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
House Dust Panel (Mayo)OutsideLaboratory,,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
House Dust Panel (Mayo)OutsideLaboratory,,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medical Assistance,23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
House Dust Panel (Mayo)OutsideLaboratory,,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
House Dust Panel (Mayo)OutsideLaboratory,,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medicare Advantage,23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
House Dust Panel (Mayo)OutsideLaboratory,,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
House Dust Panel (Mayo)OutsideLaboratory,,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
House Dust Panel (Mayo)OutsideLaboratory,,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
House Dust Panel (Mayo)OutsideLaboratory,,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,UnitedHealthcare,Individual & Family,43.24,94,,percent of total billed charges,,
House Dust Panel (Mayo)OutsideLaboratory,,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Medicare Advantage,22.54,49,,percent of total billed charges,,
House Dust Panel (Mayo)OutsideLaboratory,,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
House Dust Panel (Mayo)OutsideLaboratory,,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,22.08,48,,percent of total billed charges,,100% of DHS outpatient percentage
House Dust Panel (Mayo)OutsideLaboratory,,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"House Dust/Greer Lab, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Aetna,Commercial,42.32,92,,percent of total billed charges,,
"House Dust/Greer Lab, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Aetna,Medicare Advantage,22.54,49,,percent of total billed charges,,
"House Dust/Greer Lab, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"House Dust/Greer Lab, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Aetna,PPO,42.78,93,,percent of total billed charges,,
"House Dust/Greer Lab, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,America's PPO,America's PPO,44.1738,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"House Dust/Greer Lab, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota, Federal Employee Program,45.264,98.4,,percent of total billed charges,,
"House Dust/Greer Lab, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,46,100,,percent of total billed charges,,
"House Dust/Greer Lab, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,High Value Network Plan,41.4,90,,percent of total billed charges,,
"House Dust/Greer Lab, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Medicare Advantage,22.54,49,,percent of total billed charges,,
"House Dust/Greer Lab, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"House Dust/Greer Lab, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,40.7422,88.57,,percent of total billed charges,,
"House Dust/Greer Lab, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,13.1836,28.66,,percent of total billed charges,,
"House Dust/Greer Lab, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),22.54,49,,percent of total billed charges,,
"House Dust/Greer Lab, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"House Dust/Greer Lab, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,CorVel,Worker's Compensation,46,100,,percent of total billed charges,,
"House Dust/Greer Lab, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,First Health Group Corporation,First Health Network,44.62,97,,percent of total billed charges,,
"House Dust/Greer Lab, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Commercial,43.516,94.6,,percent of total billed charges,,
"House Dust/Greer Lab, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Medicare Advantage,22.54,49,,percent of total billed charges,,
"House Dust/Greer Lab, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"House Dust/Greer Lab, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),27.6,60,,percent of total billed charges,,
"House Dust/Greer Lab, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",State of Minnesota Advantage Program,37.49,81.5,,percent of total billed charges,,
"House Dust/Greer Lab, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",State Public Programs,23,50,,percent of total billed charges,,
"House Dust/Greer Lab, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Humana Insurance Company,Commercial PPO,43.7,95,,percent of total billed charges,,
"House Dust/Greer Lab, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Humana Insurance Company,Medicare PPO,22.54,49,,percent of total billed charges,,
"House Dust/Greer Lab, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"House Dust/Greer Lab, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Medica,Individual & Family,45.586,99.1,,percent of total billed charges,,
"House Dust/Greer Lab, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Medica,Medica Advantage Solution,22.908,49.8,,percent of total billed charges,,
"House Dust/Greer Lab, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"House Dust/Greer Lab, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Medica,Medical Assistance,20.516,44.6,,percent of total billed charges,,
"House Dust/Greer Lab, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Medica,Medical Assistance,,,,,Included in per diem rate,
"House Dust/Greer Lab, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,22.908,49.8,,percent of total billed charges,,
"House Dust/Greer Lab, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"House Dust/Greer Lab, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Multiplan, Inc.","Multiplan, Inc.",43.24,94,,percent of total billed charges,,
"House Dust/Greer Lab, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,39.744,86.4,,percent of total billed charges,,
"House Dust/Greer Lab, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"House Dust/Greer Lab, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PPO,45.356,98.6,,percent of total billed charges,,
"House Dust/Greer Lab, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,Minnesota Senior Health Options (MSHO),23.667,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"House Dust/Greer Lab, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"House Dust/Greer Lab, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,MinnesotaCare,23.6256,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"House Dust/Greer Lab, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"House Dust/Greer Lab, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Sanford Health Plan,Sanford Health Plan,42.32,92,,percent of total billed charges,,
"House Dust/Greer Lab, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Individual & Family Plan,25.921,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"House Dust/Greer Lab, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"House Dust/Greer Lab, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medical Assistance,23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"House Dust/Greer Lab, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"House Dust/Greer Lab, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medicare Advantage,23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"House Dust/Greer Lab, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"House Dust/Greer Lab, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"House Dust/Greer Lab, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"House Dust/Greer Lab, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,UnitedHealthcare,Individual & Family,43.24,94,,percent of total billed charges,,
"House Dust/Greer Lab, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Medicare Advantage,22.54,49,,percent of total billed charges,,
"House Dust/Greer Lab, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"House Dust/Greer Lab, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,22.08,48,,percent of total billed charges,,100% of DHS outpatient percentage
"House Dust/Greer Lab, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"House Dust/H-S Lab, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Aetna,Commercial,42.32,92,,percent of total billed charges,,
"House Dust/H-S Lab, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Aetna,Medicare Advantage,22.54,49,,percent of total billed charges,,
"House Dust/H-S Lab, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"House Dust/H-S Lab, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Aetna,PPO,42.78,93,,percent of total billed charges,,
"House Dust/H-S Lab, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,America's PPO,America's PPO,44.1738,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"House Dust/H-S Lab, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota, Federal Employee Program,45.264,98.4,,percent of total billed charges,,
"House Dust/H-S Lab, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,46,100,,percent of total billed charges,,
"House Dust/H-S Lab, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,High Value Network Plan,41.4,90,,percent of total billed charges,,
"House Dust/H-S Lab, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Medicare Advantage,22.54,49,,percent of total billed charges,,
"House Dust/H-S Lab, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"House Dust/H-S Lab, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,40.7422,88.57,,percent of total billed charges,,
"House Dust/H-S Lab, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,13.1836,28.66,,percent of total billed charges,,
"House Dust/H-S Lab, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),22.54,49,,percent of total billed charges,,
"House Dust/H-S Lab, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"House Dust/H-S Lab, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,CorVel,Worker's Compensation,46,100,,percent of total billed charges,,
"House Dust/H-S Lab, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,First Health Group Corporation,First Health Network,44.62,97,,percent of total billed charges,,
"House Dust/H-S Lab, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Commercial,43.516,94.6,,percent of total billed charges,,
"House Dust/H-S Lab, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Medicare Advantage,22.54,49,,percent of total billed charges,,
"House Dust/H-S Lab, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"House Dust/H-S Lab, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),27.6,60,,percent of total billed charges,,
"House Dust/H-S Lab, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",State of Minnesota Advantage Program,37.49,81.5,,percent of total billed charges,,
"House Dust/H-S Lab, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",State Public Programs,23,50,,percent of total billed charges,,
"House Dust/H-S Lab, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Humana Insurance Company,Commercial PPO,43.7,95,,percent of total billed charges,,
"House Dust/H-S Lab, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Humana Insurance Company,Medicare PPO,22.54,49,,percent of total billed charges,,
"House Dust/H-S Lab, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"House Dust/H-S Lab, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Medica,Individual & Family,45.586,99.1,,percent of total billed charges,,
"House Dust/H-S Lab, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Medica,Medica Advantage Solution,22.908,49.8,,percent of total billed charges,,
"House Dust/H-S Lab, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"House Dust/H-S Lab, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Medica,Medical Assistance,20.516,44.6,,percent of total billed charges,,
"House Dust/H-S Lab, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Medica,Medical Assistance,,,,,Included in per diem rate,
"House Dust/H-S Lab, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,22.908,49.8,,percent of total billed charges,,
"House Dust/H-S Lab, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"House Dust/H-S Lab, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Multiplan, Inc.","Multiplan, Inc.",43.24,94,,percent of total billed charges,,
"House Dust/H-S Lab, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,39.744,86.4,,percent of total billed charges,,
"House Dust/H-S Lab, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"House Dust/H-S Lab, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PPO,45.356,98.6,,percent of total billed charges,,
"House Dust/H-S Lab, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,Minnesota Senior Health Options (MSHO),23.667,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"House Dust/H-S Lab, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"House Dust/H-S Lab, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,MinnesotaCare,23.6256,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"House Dust/H-S Lab, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"House Dust/H-S Lab, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Sanford Health Plan,Sanford Health Plan,42.32,92,,percent of total billed charges,,
"House Dust/H-S Lab, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Individual & Family Plan,25.921,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"House Dust/H-S Lab, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"House Dust/H-S Lab, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medical Assistance,23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"House Dust/H-S Lab, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"House Dust/H-S Lab, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medicare Advantage,23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"House Dust/H-S Lab, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"House Dust/H-S Lab, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"House Dust/H-S Lab, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"House Dust/H-S Lab, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,UnitedHealthcare,Individual & Family,43.24,94,,percent of total billed charges,,
"House Dust/H-S Lab, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Medicare Advantage,22.54,49,,percent of total billed charges,,
"House Dust/H-S Lab, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"House Dust/H-S Lab, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,22.08,48,,percent of total billed charges,,100% of DHS outpatient percentage
"House Dust/H-S Lab, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"June Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Aetna,Commercial,42.32,92,,percent of total billed charges,,
"June Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Aetna,Medicare Advantage,22.54,49,,percent of total billed charges,,
"June Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"June Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Aetna,PPO,42.78,93,,percent of total billed charges,,
"June Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,America's PPO,America's PPO,44.1738,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"June Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota, Federal Employee Program,45.264,98.4,,percent of total billed charges,,
"June Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,46,100,,percent of total billed charges,,
"June Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,High Value Network Plan,41.4,90,,percent of total billed charges,,
"June Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Medicare Advantage,22.54,49,,percent of total billed charges,,
"June Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"June Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,40.7422,88.57,,percent of total billed charges,,
"June Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,13.1836,28.66,,percent of total billed charges,,
"June Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),22.54,49,,percent of total billed charges,,
"June Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"June Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,CorVel,Worker's Compensation,46,100,,percent of total billed charges,,
"June Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,First Health Group Corporation,First Health Network,44.62,97,,percent of total billed charges,,
"June Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Commercial,43.516,94.6,,percent of total billed charges,,
"June Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Medicare Advantage,22.54,49,,percent of total billed charges,,
"June Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"June Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),27.6,60,,percent of total billed charges,,
"June Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",State of Minnesota Advantage Program,37.49,81.5,,percent of total billed charges,,
"June Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",State Public Programs,23,50,,percent of total billed charges,,
"June Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Humana Insurance Company,Commercial PPO,43.7,95,,percent of total billed charges,,
"June Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Humana Insurance Company,Medicare PPO,22.54,49,,percent of total billed charges,,
"June Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"June Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Medica,Individual & Family,45.586,99.1,,percent of total billed charges,,
"June Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Medica,Medica Advantage Solution,22.908,49.8,,percent of total billed charges,,
"June Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"June Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Medica,Medical Assistance,20.516,44.6,,percent of total billed charges,,
"June Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Medica,Medical Assistance,,,,,Included in per diem rate,
"June Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,22.908,49.8,,percent of total billed charges,,
"June Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"June Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Multiplan, Inc.","Multiplan, Inc.",43.24,94,,percent of total billed charges,,
"June Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,39.744,86.4,,percent of total billed charges,,
"June Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"June Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PPO,45.356,98.6,,percent of total billed charges,,
"June Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,Minnesota Senior Health Options (MSHO),23.667,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"June Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"June Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,MinnesotaCare,23.6256,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"June Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"June Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Sanford Health Plan,Sanford Health Plan,42.32,92,,percent of total billed charges,,
"June Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Individual & Family Plan,25.921,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"June Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"June Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medical Assistance,23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"June Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"June Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medicare Advantage,23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"June Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"June Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"June Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"June Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,UnitedHealthcare,Individual & Family,43.24,94,,percent of total billed charges,,
"June Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Medicare Advantage,22.54,49,,percent of total billed charges,,
"June Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"June Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,22.08,48,,percent of total billed charges,,100% of DHS outpatient percentage
"June Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Kiwi Fruit, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,Aetna,Commercial,45.08,92,,percent of total billed charges,,
"Kiwi Fruit, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,Aetna,Medicare Advantage,24.01,49,,percent of total billed charges,,
"Kiwi Fruit, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Kiwi Fruit, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,Aetna,PPO,45.57,93,,percent of total billed charges,,
"Kiwi Fruit, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,America's PPO,America's PPO,47.0547,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Kiwi Fruit, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,BlueCross BlueShield Minnesota, Federal Employee Program,48.216,98.4,,percent of total billed charges,,
"Kiwi Fruit, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,49,100,,percent of total billed charges,,
"Kiwi Fruit, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,High Value Network Plan,44.1,90,,percent of total billed charges,,
"Kiwi Fruit, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Medicare Advantage,24.01,49,,percent of total billed charges,,
"Kiwi Fruit, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Kiwi Fruit, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,43.3993,88.57,,percent of total billed charges,,
"Kiwi Fruit, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,14.0434,28.66,,percent of total billed charges,,
"Kiwi Fruit, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),24.01,49,,percent of total billed charges,,
"Kiwi Fruit, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Kiwi Fruit, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,CorVel,Worker's Compensation,49,100,,percent of total billed charges,,
"Kiwi Fruit, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,First Health Group Corporation,First Health Network,47.53,97,,percent of total billed charges,,
"Kiwi Fruit, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,"Health Partners, Inc.",Commercial,46.354,94.6,,percent of total billed charges,,
"Kiwi Fruit, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,"Health Partners, Inc.",Medicare Advantage,24.01,49,,percent of total billed charges,,
"Kiwi Fruit, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Kiwi Fruit, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),29.4,60,,percent of total billed charges,,
"Kiwi Fruit, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,"Health Partners, Inc.",State of Minnesota Advantage Program,39.935,81.5,,percent of total billed charges,,
"Kiwi Fruit, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,"Health Partners, Inc.",State Public Programs,24.5,50,,percent of total billed charges,,
"Kiwi Fruit, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,Humana Insurance Company,Commercial PPO,46.55,95,,percent of total billed charges,,
"Kiwi Fruit, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,Humana Insurance Company,Medicare PPO,24.01,49,,percent of total billed charges,,
"Kiwi Fruit, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Kiwi Fruit, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,Medica,Individual & Family,48.559,99.1,,percent of total billed charges,,
"Kiwi Fruit, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,Medica,Medica Advantage Solution,24.402,49.8,,percent of total billed charges,,
"Kiwi Fruit, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Kiwi Fruit, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,Medica,Medical Assistance,21.854,44.6,,percent of total billed charges,,
"Kiwi Fruit, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,Medica,Medical Assistance,,,,,Included in per diem rate,
"Kiwi Fruit, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,24.402,49.8,,percent of total billed charges,,
"Kiwi Fruit, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Kiwi Fruit, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,"Multiplan, Inc.","Multiplan, Inc.",46.06,94,,percent of total billed charges,,
"Kiwi Fruit, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,42.336,86.4,,percent of total billed charges,,
"Kiwi Fruit, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Kiwi Fruit, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,"Preferred One Administrative Services, INC.",PPO,48.314,98.6,,percent of total billed charges,,
"Kiwi Fruit, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,PrimeWest Health,Minnesota Senior Health Options (MSHO),25.2105,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Kiwi Fruit, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Kiwi Fruit, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,PrimeWest Health,MinnesotaCare,25.1664,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Kiwi Fruit, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Kiwi Fruit, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,Sanford Health Plan,Sanford Health Plan,45.08,92,,percent of total billed charges,,
"Kiwi Fruit, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,"UCare Health, Inc.",Individual & Family Plan,27.6115,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Kiwi Fruit, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Kiwi Fruit, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,"UCare Health, Inc.",Medical Assistance,24.7303,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Kiwi Fruit, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Kiwi Fruit, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,"UCare Health, Inc.",Medicare Advantage,24.7303,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Kiwi Fruit, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Kiwi Fruit, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),24.7303,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Kiwi Fruit, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Kiwi Fruit, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,UnitedHealthcare,Individual & Family,46.06,94,,percent of total billed charges,,
"Kiwi Fruit, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,UnitedHealthcare,Medicare Advantage,24.01,49,,percent of total billed charges,,
"Kiwi Fruit, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Kiwi Fruit, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,23.52,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Kiwi Fruit, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Lambs Quarter, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Aetna,Commercial,42.32,92,,percent of total billed charges,,
"Lambs Quarter, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Aetna,Medicare Advantage,22.54,49,,percent of total billed charges,,
"Lambs Quarter, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Lambs Quarter, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Aetna,PPO,42.78,93,,percent of total billed charges,,
"Lambs Quarter, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,America's PPO,America's PPO,44.1738,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Lambs Quarter, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota, Federal Employee Program,45.264,98.4,,percent of total billed charges,,
"Lambs Quarter, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,46,100,,percent of total billed charges,,
"Lambs Quarter, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,High Value Network Plan,41.4,90,,percent of total billed charges,,
"Lambs Quarter, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Medicare Advantage,22.54,49,,percent of total billed charges,,
"Lambs Quarter, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Lambs Quarter, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,40.7422,88.57,,percent of total billed charges,,
"Lambs Quarter, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,13.1836,28.66,,percent of total billed charges,,
"Lambs Quarter, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),22.54,49,,percent of total billed charges,,
"Lambs Quarter, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Lambs Quarter, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,CorVel,Worker's Compensation,46,100,,percent of total billed charges,,
"Lambs Quarter, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,First Health Group Corporation,First Health Network,44.62,97,,percent of total billed charges,,
"Lambs Quarter, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Commercial,43.516,94.6,,percent of total billed charges,,
"Lambs Quarter, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Medicare Advantage,22.54,49,,percent of total billed charges,,
"Lambs Quarter, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Lambs Quarter, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),27.6,60,,percent of total billed charges,,
"Lambs Quarter, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",State of Minnesota Advantage Program,37.49,81.5,,percent of total billed charges,,
"Lambs Quarter, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",State Public Programs,23,50,,percent of total billed charges,,
"Lambs Quarter, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Humana Insurance Company,Commercial PPO,43.7,95,,percent of total billed charges,,
"Lambs Quarter, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Humana Insurance Company,Medicare PPO,22.54,49,,percent of total billed charges,,
"Lambs Quarter, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Lambs Quarter, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Medica,Individual & Family,45.586,99.1,,percent of total billed charges,,
"Lambs Quarter, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Medica,Medica Advantage Solution,22.908,49.8,,percent of total billed charges,,
"Lambs Quarter, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Lambs Quarter, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Medica,Medical Assistance,20.516,44.6,,percent of total billed charges,,
"Lambs Quarter, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Medica,Medical Assistance,,,,,Included in per diem rate,
"Lambs Quarter, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,22.908,49.8,,percent of total billed charges,,
"Lambs Quarter, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Lambs Quarter, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Multiplan, Inc.","Multiplan, Inc.",43.24,94,,percent of total billed charges,,
"Lambs Quarter, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,39.744,86.4,,percent of total billed charges,,
"Lambs Quarter, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Lambs Quarter, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PPO,45.356,98.6,,percent of total billed charges,,
"Lambs Quarter, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,Minnesota Senior Health Options (MSHO),23.667,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Lambs Quarter, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Lambs Quarter, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,MinnesotaCare,23.6256,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Lambs Quarter, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Lambs Quarter, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Sanford Health Plan,Sanford Health Plan,42.32,92,,percent of total billed charges,,
"Lambs Quarter, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Individual & Family Plan,25.921,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Lambs Quarter, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Lambs Quarter, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medical Assistance,23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Lambs Quarter, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Lambs Quarter, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medicare Advantage,23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Lambs Quarter, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Lambs Quarter, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Lambs Quarter, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Lambs Quarter, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,UnitedHealthcare,Individual & Family,43.24,94,,percent of total billed charges,,
"Lambs Quarter, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Medicare Advantage,22.54,49,,percent of total billed charges,,
"Lambs Quarter, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Lambs Quarter, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,22.08,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Lambs Quarter, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Lobster, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,Aetna,Commercial,45.08,92,,percent of total billed charges,,
"Lobster, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,Aetna,Medicare Advantage,24.01,49,,percent of total billed charges,,
"Lobster, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Lobster, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,Aetna,PPO,45.57,93,,percent of total billed charges,,
"Lobster, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,America's PPO,America's PPO,47.0547,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Lobster, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,BlueCross BlueShield Minnesota, Federal Employee Program,48.216,98.4,,percent of total billed charges,,
"Lobster, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,49,100,,percent of total billed charges,,
"Lobster, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,High Value Network Plan,44.1,90,,percent of total billed charges,,
"Lobster, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Medicare Advantage,24.01,49,,percent of total billed charges,,
"Lobster, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Lobster, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,43.3993,88.57,,percent of total billed charges,,
"Lobster, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,14.0434,28.66,,percent of total billed charges,,
"Lobster, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),24.01,49,,percent of total billed charges,,
"Lobster, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Lobster, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,CorVel,Worker's Compensation,49,100,,percent of total billed charges,,
"Lobster, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,First Health Group Corporation,First Health Network,47.53,97,,percent of total billed charges,,
"Lobster, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,"Health Partners, Inc.",Commercial,46.354,94.6,,percent of total billed charges,,
"Lobster, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,"Health Partners, Inc.",Medicare Advantage,24.01,49,,percent of total billed charges,,
"Lobster, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Lobster, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),29.4,60,,percent of total billed charges,,
"Lobster, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,"Health Partners, Inc.",State of Minnesota Advantage Program,39.935,81.5,,percent of total billed charges,,
"Lobster, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,"Health Partners, Inc.",State Public Programs,24.5,50,,percent of total billed charges,,
"Lobster, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,Humana Insurance Company,Commercial PPO,46.55,95,,percent of total billed charges,,
"Lobster, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,Humana Insurance Company,Medicare PPO,24.01,49,,percent of total billed charges,,
"Lobster, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Lobster, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,Medica,Individual & Family,48.559,99.1,,percent of total billed charges,,
"Lobster, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,Medica,Medica Advantage Solution,24.402,49.8,,percent of total billed charges,,
"Lobster, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Lobster, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,Medica,Medical Assistance,21.854,44.6,,percent of total billed charges,,
"Lobster, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,Medica,Medical Assistance,,,,,Included in per diem rate,
"Lobster, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,24.402,49.8,,percent of total billed charges,,
"Lobster, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Lobster, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,"Multiplan, Inc.","Multiplan, Inc.",46.06,94,,percent of total billed charges,,
"Lobster, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,42.336,86.4,,percent of total billed charges,,
"Lobster, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Lobster, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,"Preferred One Administrative Services, INC.",PPO,48.314,98.6,,percent of total billed charges,,
"Lobster, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,PrimeWest Health,Minnesota Senior Health Options (MSHO),25.2105,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Lobster, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Lobster, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,PrimeWest Health,MinnesotaCare,25.1664,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Lobster, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Lobster, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,Sanford Health Plan,Sanford Health Plan,45.08,92,,percent of total billed charges,,
"Lobster, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,"UCare Health, Inc.",Individual & Family Plan,27.6115,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Lobster, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Lobster, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,"UCare Health, Inc.",Medical Assistance,24.7303,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Lobster, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Lobster, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,"UCare Health, Inc.",Medicare Advantage,24.7303,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Lobster, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Lobster, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),24.7303,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Lobster, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Lobster, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,UnitedHealthcare,Individual & Family,46.06,94,,percent of total billed charges,,
"Lobster, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,UnitedHealthcare,Medicare Advantage,24.01,49,,percent of total billed charges,,
"Lobster, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Lobster, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,23.52,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Lobster, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Maple, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Aetna,Commercial,42.32,92,,percent of total billed charges,,
"Maple, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Aetna,Medicare Advantage,22.54,49,,percent of total billed charges,,
"Maple, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Maple, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Aetna,PPO,42.78,93,,percent of total billed charges,,
"Maple, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,America's PPO,America's PPO,44.1738,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Maple, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota, Federal Employee Program,45.264,98.4,,percent of total billed charges,,
"Maple, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,46,100,,percent of total billed charges,,
"Maple, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,High Value Network Plan,41.4,90,,percent of total billed charges,,
"Maple, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Medicare Advantage,22.54,49,,percent of total billed charges,,
"Maple, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Maple, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,40.7422,88.57,,percent of total billed charges,,
"Maple, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,13.1836,28.66,,percent of total billed charges,,
"Maple, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),22.54,49,,percent of total billed charges,,
"Maple, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Maple, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,CorVel,Worker's Compensation,46,100,,percent of total billed charges,,
"Maple, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,First Health Group Corporation,First Health Network,44.62,97,,percent of total billed charges,,
"Maple, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Commercial,43.516,94.6,,percent of total billed charges,,
"Maple, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Medicare Advantage,22.54,49,,percent of total billed charges,,
"Maple, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Maple, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),27.6,60,,percent of total billed charges,,
"Maple, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",State of Minnesota Advantage Program,37.49,81.5,,percent of total billed charges,,
"Maple, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",State Public Programs,23,50,,percent of total billed charges,,
"Maple, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Humana Insurance Company,Commercial PPO,43.7,95,,percent of total billed charges,,
"Maple, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Humana Insurance Company,Medicare PPO,22.54,49,,percent of total billed charges,,
"Maple, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Maple, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Medica,Individual & Family,45.586,99.1,,percent of total billed charges,,
"Maple, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Medica,Medica Advantage Solution,22.908,49.8,,percent of total billed charges,,
"Maple, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Maple, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Medica,Medical Assistance,20.516,44.6,,percent of total billed charges,,
"Maple, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Medica,Medical Assistance,,,,,Included in per diem rate,
"Maple, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,22.908,49.8,,percent of total billed charges,,
"Maple, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Maple, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Multiplan, Inc.","Multiplan, Inc.",43.24,94,,percent of total billed charges,,
"Maple, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,39.744,86.4,,percent of total billed charges,,
"Maple, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Maple, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PPO,45.356,98.6,,percent of total billed charges,,
"Maple, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,Minnesota Senior Health Options (MSHO),23.667,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Maple, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Maple, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,MinnesotaCare,23.6256,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Maple, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Maple, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Sanford Health Plan,Sanford Health Plan,42.32,92,,percent of total billed charges,,
"Maple, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Individual & Family Plan,25.921,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Maple, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Maple, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medical Assistance,23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Maple, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Maple, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medicare Advantage,23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Maple, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Maple, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Maple, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Maple, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,UnitedHealthcare,Individual & Family,43.24,94,,percent of total billed charges,,
"Maple, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Medicare Advantage,22.54,49,,percent of total billed charges,,
"Maple, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Maple, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,22.08,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Maple, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Milk, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Aetna,Commercial,42.32,92,,percent of total billed charges,,
"Milk, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Aetna,Medicare Advantage,22.54,49,,percent of total billed charges,,
"Milk, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Milk, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Aetna,PPO,42.78,93,,percent of total billed charges,,
"Milk, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,America's PPO,America's PPO,44.1738,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Milk, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota, Federal Employee Program,45.264,98.4,,percent of total billed charges,,
"Milk, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,46,100,,percent of total billed charges,,
"Milk, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,High Value Network Plan,41.4,90,,percent of total billed charges,,
"Milk, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Medicare Advantage,22.54,49,,percent of total billed charges,,
"Milk, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Milk, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,40.7422,88.57,,percent of total billed charges,,
"Milk, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,13.1836,28.66,,percent of total billed charges,,
"Milk, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),22.54,49,,percent of total billed charges,,
"Milk, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Milk, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,CorVel,Worker's Compensation,46,100,,percent of total billed charges,,
"Milk, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,First Health Group Corporation,First Health Network,44.62,97,,percent of total billed charges,,
"Milk, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Commercial,43.516,94.6,,percent of total billed charges,,
"Milk, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Medicare Advantage,22.54,49,,percent of total billed charges,,
"Milk, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Milk, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),27.6,60,,percent of total billed charges,,
"Milk, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",State of Minnesota Advantage Program,37.49,81.5,,percent of total billed charges,,
"Milk, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",State Public Programs,23,50,,percent of total billed charges,,
"Milk, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Humana Insurance Company,Commercial PPO,43.7,95,,percent of total billed charges,,
"Milk, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Humana Insurance Company,Medicare PPO,22.54,49,,percent of total billed charges,,
"Milk, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Milk, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Medica,Individual & Family,45.586,99.1,,percent of total billed charges,,
"Milk, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Medica,Medica Advantage Solution,22.908,49.8,,percent of total billed charges,,
"Milk, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Milk, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Medica,Medical Assistance,20.516,44.6,,percent of total billed charges,,
"Milk, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Medica,Medical Assistance,,,,,Included in per diem rate,
"Milk, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,22.908,49.8,,percent of total billed charges,,
"Milk, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Milk, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Multiplan, Inc.","Multiplan, Inc.",43.24,94,,percent of total billed charges,,
"Milk, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,39.744,86.4,,percent of total billed charges,,
"Milk, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Milk, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PPO,45.356,98.6,,percent of total billed charges,,
"Milk, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,Minnesota Senior Health Options (MSHO),23.667,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Milk, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Milk, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,MinnesotaCare,23.6256,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Milk, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Milk, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Sanford Health Plan,Sanford Health Plan,42.32,92,,percent of total billed charges,,
"Milk, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Individual & Family Plan,25.921,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Milk, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Milk, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medical Assistance,23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Milk, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Milk, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medicare Advantage,23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Milk, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Milk, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Milk, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Milk, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,UnitedHealthcare,Individual & Family,43.24,94,,percent of total billed charges,,
"Milk, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Medicare Advantage,22.54,49,,percent of total billed charges,,
"Milk, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Milk, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,22.08,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Milk, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Mountain Cedar, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Aetna,Commercial,42.32,92,,percent of total billed charges,,
"Mountain Cedar, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Aetna,Medicare Advantage,22.54,49,,percent of total billed charges,,
"Mountain Cedar, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Mountain Cedar, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Aetna,PPO,42.78,93,,percent of total billed charges,,
"Mountain Cedar, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,America's PPO,America's PPO,44.1738,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Mountain Cedar, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota, Federal Employee Program,45.264,98.4,,percent of total billed charges,,
"Mountain Cedar, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,46,100,,percent of total billed charges,,
"Mountain Cedar, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,High Value Network Plan,41.4,90,,percent of total billed charges,,
"Mountain Cedar, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Medicare Advantage,22.54,49,,percent of total billed charges,,
"Mountain Cedar, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Mountain Cedar, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,40.7422,88.57,,percent of total billed charges,,
"Mountain Cedar, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,13.1836,28.66,,percent of total billed charges,,
"Mountain Cedar, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),22.54,49,,percent of total billed charges,,
"Mountain Cedar, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Mountain Cedar, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,CorVel,Worker's Compensation,46,100,,percent of total billed charges,,
"Mountain Cedar, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,First Health Group Corporation,First Health Network,44.62,97,,percent of total billed charges,,
"Mountain Cedar, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Commercial,43.516,94.6,,percent of total billed charges,,
"Mountain Cedar, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Medicare Advantage,22.54,49,,percent of total billed charges,,
"Mountain Cedar, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Mountain Cedar, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),27.6,60,,percent of total billed charges,,
"Mountain Cedar, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",State of Minnesota Advantage Program,37.49,81.5,,percent of total billed charges,,
"Mountain Cedar, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",State Public Programs,23,50,,percent of total billed charges,,
"Mountain Cedar, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Humana Insurance Company,Commercial PPO,43.7,95,,percent of total billed charges,,
"Mountain Cedar, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Humana Insurance Company,Medicare PPO,22.54,49,,percent of total billed charges,,
"Mountain Cedar, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Mountain Cedar, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Medica,Individual & Family,45.586,99.1,,percent of total billed charges,,
"Mountain Cedar, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Medica,Medica Advantage Solution,22.908,49.8,,percent of total billed charges,,
"Mountain Cedar, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Mountain Cedar, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Medica,Medical Assistance,20.516,44.6,,percent of total billed charges,,
"Mountain Cedar, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Medica,Medical Assistance,,,,,Included in per diem rate,
"Mountain Cedar, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,22.908,49.8,,percent of total billed charges,,
"Mountain Cedar, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Mountain Cedar, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Multiplan, Inc.","Multiplan, Inc.",43.24,94,,percent of total billed charges,,
"Mountain Cedar, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,39.744,86.4,,percent of total billed charges,,
"Mountain Cedar, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Mountain Cedar, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PPO,45.356,98.6,,percent of total billed charges,,
"Mountain Cedar, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,Minnesota Senior Health Options (MSHO),23.667,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Mountain Cedar, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Mountain Cedar, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,MinnesotaCare,23.6256,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Mountain Cedar, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Mountain Cedar, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Sanford Health Plan,Sanford Health Plan,42.32,92,,percent of total billed charges,,
"Mountain Cedar, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Individual & Family Plan,25.921,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Mountain Cedar, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Mountain Cedar, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medical Assistance,23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Mountain Cedar, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Mountain Cedar, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medicare Advantage,23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Mountain Cedar, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Mountain Cedar, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Mountain Cedar, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Mountain Cedar, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,UnitedHealthcare,Individual & Family,43.24,94,,percent of total billed charges,,
"Mountain Cedar, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Medicare Advantage,22.54,49,,percent of total billed charges,,
"Mountain Cedar, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Mountain Cedar, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,22.08,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Mountain Cedar, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Mulberry Tree, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Aetna,Commercial,42.32,92,,percent of total billed charges,,
"Mulberry Tree, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Aetna,Medicare Advantage,22.54,49,,percent of total billed charges,,
"Mulberry Tree, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Mulberry Tree, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Aetna,PPO,42.78,93,,percent of total billed charges,,
"Mulberry Tree, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,America's PPO,America's PPO,44.1738,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Mulberry Tree, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota, Federal Employee Program,45.264,98.4,,percent of total billed charges,,
"Mulberry Tree, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,46,100,,percent of total billed charges,,
"Mulberry Tree, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,High Value Network Plan,41.4,90,,percent of total billed charges,,
"Mulberry Tree, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Medicare Advantage,22.54,49,,percent of total billed charges,,
"Mulberry Tree, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Mulberry Tree, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,40.7422,88.57,,percent of total billed charges,,
"Mulberry Tree, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,13.1836,28.66,,percent of total billed charges,,
"Mulberry Tree, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),22.54,49,,percent of total billed charges,,
"Mulberry Tree, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Mulberry Tree, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,CorVel,Worker's Compensation,46,100,,percent of total billed charges,,
"Mulberry Tree, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,First Health Group Corporation,First Health Network,44.62,97,,percent of total billed charges,,
"Mulberry Tree, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Commercial,43.516,94.6,,percent of total billed charges,,
"Mulberry Tree, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Medicare Advantage,22.54,49,,percent of total billed charges,,
"Mulberry Tree, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Mulberry Tree, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),27.6,60,,percent of total billed charges,,
"Mulberry Tree, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",State of Minnesota Advantage Program,37.49,81.5,,percent of total billed charges,,
"Mulberry Tree, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",State Public Programs,23,50,,percent of total billed charges,,
"Mulberry Tree, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Humana Insurance Company,Commercial PPO,43.7,95,,percent of total billed charges,,
"Mulberry Tree, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Humana Insurance Company,Medicare PPO,22.54,49,,percent of total billed charges,,
"Mulberry Tree, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Mulberry Tree, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Medica,Individual & Family,45.586,99.1,,percent of total billed charges,,
"Mulberry Tree, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Medica,Medica Advantage Solution,22.908,49.8,,percent of total billed charges,,
"Mulberry Tree, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Mulberry Tree, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Medica,Medical Assistance,20.516,44.6,,percent of total billed charges,,
"Mulberry Tree, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Medica,Medical Assistance,,,,,Included in per diem rate,
"Mulberry Tree, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,22.908,49.8,,percent of total billed charges,,
"Mulberry Tree, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Mulberry Tree, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Multiplan, Inc.","Multiplan, Inc.",43.24,94,,percent of total billed charges,,
"Mulberry Tree, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,39.744,86.4,,percent of total billed charges,,
"Mulberry Tree, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Mulberry Tree, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PPO,45.356,98.6,,percent of total billed charges,,
"Mulberry Tree, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,Minnesota Senior Health Options (MSHO),23.667,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Mulberry Tree, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Mulberry Tree, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,MinnesotaCare,23.6256,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Mulberry Tree, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Mulberry Tree, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Sanford Health Plan,Sanford Health Plan,42.32,92,,percent of total billed charges,,
"Mulberry Tree, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Individual & Family Plan,25.921,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Mulberry Tree, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Mulberry Tree, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medical Assistance,23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Mulberry Tree, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Mulberry Tree, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medicare Advantage,23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Mulberry Tree, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Mulberry Tree, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Mulberry Tree, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Mulberry Tree, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,UnitedHealthcare,Individual & Family,43.24,94,,percent of total billed charges,,
"Mulberry Tree, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Medicare Advantage,22.54,49,,percent of total billed charges,,
"Mulberry Tree, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Mulberry Tree, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,22.08,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Mulberry Tree, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Nettle, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Aetna,Commercial,42.32,92,,percent of total billed charges,,
"Nettle, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Aetna,Medicare Advantage,22.54,49,,percent of total billed charges,,
"Nettle, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Nettle, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Aetna,PPO,42.78,93,,percent of total billed charges,,
"Nettle, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,America's PPO,America's PPO,44.1738,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Nettle, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota, Federal Employee Program,45.264,98.4,,percent of total billed charges,,
"Nettle, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,46,100,,percent of total billed charges,,
"Nettle, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,High Value Network Plan,41.4,90,,percent of total billed charges,,
"Nettle, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Medicare Advantage,22.54,49,,percent of total billed charges,,
"Nettle, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Nettle, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,40.7422,88.57,,percent of total billed charges,,
"Nettle, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,13.1836,28.66,,percent of total billed charges,,
"Nettle, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),22.54,49,,percent of total billed charges,,
"Nettle, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Nettle, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,CorVel,Worker's Compensation,46,100,,percent of total billed charges,,
"Nettle, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,First Health Group Corporation,First Health Network,44.62,97,,percent of total billed charges,,
"Nettle, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Commercial,43.516,94.6,,percent of total billed charges,,
"Nettle, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Medicare Advantage,22.54,49,,percent of total billed charges,,
"Nettle, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Nettle, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),27.6,60,,percent of total billed charges,,
"Nettle, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",State of Minnesota Advantage Program,37.49,81.5,,percent of total billed charges,,
"Nettle, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",State Public Programs,23,50,,percent of total billed charges,,
"Nettle, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Humana Insurance Company,Commercial PPO,43.7,95,,percent of total billed charges,,
"Nettle, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Humana Insurance Company,Medicare PPO,22.54,49,,percent of total billed charges,,
"Nettle, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Nettle, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Medica,Individual & Family,45.586,99.1,,percent of total billed charges,,
"Nettle, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Medica,Medica Advantage Solution,22.908,49.8,,percent of total billed charges,,
"Nettle, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Nettle, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Medica,Medical Assistance,20.516,44.6,,percent of total billed charges,,
"Nettle, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Medica,Medical Assistance,,,,,Included in per diem rate,
"Nettle, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,22.908,49.8,,percent of total billed charges,,
"Nettle, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Nettle, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Multiplan, Inc.","Multiplan, Inc.",43.24,94,,percent of total billed charges,,
"Nettle, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,39.744,86.4,,percent of total billed charges,,
"Nettle, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Nettle, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PPO,45.356,98.6,,percent of total billed charges,,
"Nettle, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,Minnesota Senior Health Options (MSHO),23.667,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Nettle, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Nettle, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,MinnesotaCare,23.6256,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Nettle, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Nettle, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Sanford Health Plan,Sanford Health Plan,42.32,92,,percent of total billed charges,,
"Nettle, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Individual & Family Plan,25.921,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Nettle, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Nettle, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medical Assistance,23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Nettle, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Nettle, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medicare Advantage,23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Nettle, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Nettle, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Nettle, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Nettle, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,UnitedHealthcare,Individual & Family,43.24,94,,percent of total billed charges,,
"Nettle, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Medicare Advantage,22.54,49,,percent of total billed charges,,
"Nettle, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Nettle, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,22.08,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Nettle, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Oak, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Aetna,Commercial,42.32,92,,percent of total billed charges,,
"Oak, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Aetna,Medicare Advantage,22.54,49,,percent of total billed charges,,
"Oak, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Oak, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Aetna,PPO,42.78,93,,percent of total billed charges,,
"Oak, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,America's PPO,America's PPO,44.1738,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Oak, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota, Federal Employee Program,45.264,98.4,,percent of total billed charges,,
"Oak, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,46,100,,percent of total billed charges,,
"Oak, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,High Value Network Plan,41.4,90,,percent of total billed charges,,
"Oak, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Medicare Advantage,22.54,49,,percent of total billed charges,,
"Oak, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Oak, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,40.7422,88.57,,percent of total billed charges,,
"Oak, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,13.1836,28.66,,percent of total billed charges,,
"Oak, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),22.54,49,,percent of total billed charges,,
"Oak, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Oak, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,CorVel,Worker's Compensation,46,100,,percent of total billed charges,,
"Oak, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,First Health Group Corporation,First Health Network,44.62,97,,percent of total billed charges,,
"Oak, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Commercial,43.516,94.6,,percent of total billed charges,,
"Oak, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Medicare Advantage,22.54,49,,percent of total billed charges,,
"Oak, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Oak, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),27.6,60,,percent of total billed charges,,
"Oak, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",State of Minnesota Advantage Program,37.49,81.5,,percent of total billed charges,,
"Oak, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",State Public Programs,23,50,,percent of total billed charges,,
"Oak, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Humana Insurance Company,Commercial PPO,43.7,95,,percent of total billed charges,,
"Oak, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Humana Insurance Company,Medicare PPO,22.54,49,,percent of total billed charges,,
"Oak, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Oak, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Medica,Individual & Family,45.586,99.1,,percent of total billed charges,,
"Oak, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Medica,Medica Advantage Solution,22.908,49.8,,percent of total billed charges,,
"Oak, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Oak, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Medica,Medical Assistance,20.516,44.6,,percent of total billed charges,,
"Oak, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Medica,Medical Assistance,,,,,Included in per diem rate,
"Oak, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,22.908,49.8,,percent of total billed charges,,
"Oak, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Oak, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Multiplan, Inc.","Multiplan, Inc.",43.24,94,,percent of total billed charges,,
"Oak, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,39.744,86.4,,percent of total billed charges,,
"Oak, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Oak, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PPO,45.356,98.6,,percent of total billed charges,,
"Oak, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,Minnesota Senior Health Options (MSHO),23.667,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Oak, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Oak, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,MinnesotaCare,23.6256,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Oak, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Oak, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Sanford Health Plan,Sanford Health Plan,42.32,92,,percent of total billed charges,,
"Oak, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Individual & Family Plan,25.921,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Oak, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Oak, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medical Assistance,23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Oak, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Oak, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medicare Advantage,23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Oak, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Oak, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Oak, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Oak, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,UnitedHealthcare,Individual & Family,43.24,94,,percent of total billed charges,,
"Oak, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Medicare Advantage,22.54,49,,percent of total billed charges,,
"Oak, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Oak, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,22.08,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Oak, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Oyster, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,Aetna,Commercial,45.08,92,,percent of total billed charges,,
"Oyster, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,Aetna,Medicare Advantage,24.01,49,,percent of total billed charges,,
"Oyster, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Oyster, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,Aetna,PPO,45.57,93,,percent of total billed charges,,
"Oyster, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,America's PPO,America's PPO,47.0547,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Oyster, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,BlueCross BlueShield Minnesota, Federal Employee Program,48.216,98.4,,percent of total billed charges,,
"Oyster, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,49,100,,percent of total billed charges,,
"Oyster, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,High Value Network Plan,44.1,90,,percent of total billed charges,,
"Oyster, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Medicare Advantage,24.01,49,,percent of total billed charges,,
"Oyster, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Oyster, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,43.3993,88.57,,percent of total billed charges,,
"Oyster, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,14.0434,28.66,,percent of total billed charges,,
"Oyster, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),24.01,49,,percent of total billed charges,,
"Oyster, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Oyster, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,CorVel,Worker's Compensation,49,100,,percent of total billed charges,,
"Oyster, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,First Health Group Corporation,First Health Network,47.53,97,,percent of total billed charges,,
"Oyster, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,"Health Partners, Inc.",Commercial,46.354,94.6,,percent of total billed charges,,
"Oyster, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,"Health Partners, Inc.",Medicare Advantage,24.01,49,,percent of total billed charges,,
"Oyster, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Oyster, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),29.4,60,,percent of total billed charges,,
"Oyster, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,"Health Partners, Inc.",State of Minnesota Advantage Program,39.935,81.5,,percent of total billed charges,,
"Oyster, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,"Health Partners, Inc.",State Public Programs,24.5,50,,percent of total billed charges,,
"Oyster, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,Humana Insurance Company,Commercial PPO,46.55,95,,percent of total billed charges,,
"Oyster, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,Humana Insurance Company,Medicare PPO,24.01,49,,percent of total billed charges,,
"Oyster, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Oyster, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,Medica,Individual & Family,48.559,99.1,,percent of total billed charges,,
"Oyster, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,Medica,Medica Advantage Solution,24.402,49.8,,percent of total billed charges,,
"Oyster, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Oyster, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,Medica,Medical Assistance,21.854,44.6,,percent of total billed charges,,
"Oyster, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,Medica,Medical Assistance,,,,,Included in per diem rate,
"Oyster, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,24.402,49.8,,percent of total billed charges,,
"Oyster, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Oyster, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,"Multiplan, Inc.","Multiplan, Inc.",46.06,94,,percent of total billed charges,,
"Oyster, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,42.336,86.4,,percent of total billed charges,,
"Oyster, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Oyster, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,"Preferred One Administrative Services, INC.",PPO,48.314,98.6,,percent of total billed charges,,
"Oyster, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,PrimeWest Health,Minnesota Senior Health Options (MSHO),25.2105,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Oyster, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Oyster, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,PrimeWest Health,MinnesotaCare,25.1664,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Oyster, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Oyster, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,Sanford Health Plan,Sanford Health Plan,45.08,92,,percent of total billed charges,,
"Oyster, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,"UCare Health, Inc.",Individual & Family Plan,27.6115,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Oyster, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Oyster, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,"UCare Health, Inc.",Medical Assistance,24.7303,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Oyster, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Oyster, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,"UCare Health, Inc.",Medicare Advantage,24.7303,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Oyster, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Oyster, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),24.7303,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Oyster, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Oyster, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,UnitedHealthcare,Individual & Family,46.06,94,,percent of total billed charges,,
"Oyster, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,UnitedHealthcare,Medicare Advantage,24.01,49,,percent of total billed charges,,
"Oyster, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Oyster, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,23.52,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Oyster, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Peanut Component Reflex, S (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Aetna,Commercial,42.32,92,,percent of total billed charges,,
"Peanut Component Reflex, S (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Aetna,Medicare Advantage,22.54,49,,percent of total billed charges,,
"Peanut Component Reflex, S (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Peanut Component Reflex, S (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Aetna,PPO,42.78,93,,percent of total billed charges,,
"Peanut Component Reflex, S (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,America's PPO,America's PPO,44.1738,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Peanut Component Reflex, S (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota, Federal Employee Program,45.264,98.4,,percent of total billed charges,,
"Peanut Component Reflex, S (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,46,100,,percent of total billed charges,,
"Peanut Component Reflex, S (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,High Value Network Plan,41.4,90,,percent of total billed charges,,
"Peanut Component Reflex, S (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Medicare Advantage,22.54,49,,percent of total billed charges,,
"Peanut Component Reflex, S (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Peanut Component Reflex, S (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,40.7422,88.57,,percent of total billed charges,,
"Peanut Component Reflex, S (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,13.1836,28.66,,percent of total billed charges,,
"Peanut Component Reflex, S (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),22.54,49,,percent of total billed charges,,
"Peanut Component Reflex, S (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Peanut Component Reflex, S (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,CorVel,Worker's Compensation,46,100,,percent of total billed charges,,
"Peanut Component Reflex, S (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,First Health Group Corporation,First Health Network,44.62,97,,percent of total billed charges,,
"Peanut Component Reflex, S (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Commercial,43.516,94.6,,percent of total billed charges,,
"Peanut Component Reflex, S (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Medicare Advantage,22.54,49,,percent of total billed charges,,
"Peanut Component Reflex, S (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Peanut Component Reflex, S (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),27.6,60,,percent of total billed charges,,
"Peanut Component Reflex, S (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",State of Minnesota Advantage Program,37.49,81.5,,percent of total billed charges,,
"Peanut Component Reflex, S (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",State Public Programs,23,50,,percent of total billed charges,,
"Peanut Component Reflex, S (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Humana Insurance Company,Commercial PPO,43.7,95,,percent of total billed charges,,
"Peanut Component Reflex, S (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Humana Insurance Company,Medicare PPO,22.54,49,,percent of total billed charges,,
"Peanut Component Reflex, S (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Peanut Component Reflex, S (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Medica,Individual & Family,45.586,99.1,,percent of total billed charges,,
"Peanut Component Reflex, S (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Medica,Medica Advantage Solution,22.908,49.8,,percent of total billed charges,,
"Peanut Component Reflex, S (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Peanut Component Reflex, S (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Medica,Medical Assistance,20.516,44.6,,percent of total billed charges,,
"Peanut Component Reflex, S (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Medica,Medical Assistance,,,,,Included in per diem rate,
"Peanut Component Reflex, S (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,22.908,49.8,,percent of total billed charges,,
"Peanut Component Reflex, S (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Peanut Component Reflex, S (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Multiplan, Inc.","Multiplan, Inc.",43.24,94,,percent of total billed charges,,
"Peanut Component Reflex, S (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,39.744,86.4,,percent of total billed charges,,
"Peanut Component Reflex, S (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Peanut Component Reflex, S (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PPO,45.356,98.6,,percent of total billed charges,,
"Peanut Component Reflex, S (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,Minnesota Senior Health Options (MSHO),23.667,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Peanut Component Reflex, S (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Peanut Component Reflex, S (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,MinnesotaCare,23.6256,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Peanut Component Reflex, S (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Peanut Component Reflex, S (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Sanford Health Plan,Sanford Health Plan,42.32,92,,percent of total billed charges,,
"Peanut Component Reflex, S (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Individual & Family Plan,25.921,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Peanut Component Reflex, S (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Peanut Component Reflex, S (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medical Assistance,23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Peanut Component Reflex, S (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Peanut Component Reflex, S (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medicare Advantage,23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Peanut Component Reflex, S (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Peanut Component Reflex, S (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Peanut Component Reflex, S (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Peanut Component Reflex, S (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,UnitedHealthcare,Individual & Family,43.24,94,,percent of total billed charges,,
"Peanut Component Reflex, S (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Medicare Advantage,22.54,49,,percent of total billed charges,,
"Peanut Component Reflex, S (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Peanut Component Reflex, S (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,22.08,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Peanut Component Reflex, S (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Penicillium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Aetna,Commercial,42.32,92,,percent of total billed charges,,
"Penicillium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Aetna,Medicare Advantage,22.54,49,,percent of total billed charges,,
"Penicillium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Penicillium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Aetna,PPO,42.78,93,,percent of total billed charges,,
"Penicillium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,America's PPO,America's PPO,44.1738,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Penicillium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota, Federal Employee Program,45.264,98.4,,percent of total billed charges,,
"Penicillium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,46,100,,percent of total billed charges,,
"Penicillium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,High Value Network Plan,41.4,90,,percent of total billed charges,,
"Penicillium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Medicare Advantage,22.54,49,,percent of total billed charges,,
"Penicillium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Penicillium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,40.7422,88.57,,percent of total billed charges,,
"Penicillium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,13.1836,28.66,,percent of total billed charges,,
"Penicillium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),22.54,49,,percent of total billed charges,,
"Penicillium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Penicillium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,CorVel,Worker's Compensation,46,100,,percent of total billed charges,,
"Penicillium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,First Health Group Corporation,First Health Network,44.62,97,,percent of total billed charges,,
"Penicillium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Commercial,43.516,94.6,,percent of total billed charges,,
"Penicillium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Medicare Advantage,22.54,49,,percent of total billed charges,,
"Penicillium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Penicillium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),27.6,60,,percent of total billed charges,,
"Penicillium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",State of Minnesota Advantage Program,37.49,81.5,,percent of total billed charges,,
"Penicillium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",State Public Programs,23,50,,percent of total billed charges,,
"Penicillium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Humana Insurance Company,Commercial PPO,43.7,95,,percent of total billed charges,,
"Penicillium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Humana Insurance Company,Medicare PPO,22.54,49,,percent of total billed charges,,
"Penicillium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Penicillium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Medica,Individual & Family,45.586,99.1,,percent of total billed charges,,
"Penicillium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Medica,Medica Advantage Solution,22.908,49.8,,percent of total billed charges,,
"Penicillium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Penicillium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Medica,Medical Assistance,20.516,44.6,,percent of total billed charges,,
"Penicillium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Medica,Medical Assistance,,,,,Included in per diem rate,
"Penicillium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,22.908,49.8,,percent of total billed charges,,
"Penicillium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Penicillium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Multiplan, Inc.","Multiplan, Inc.",43.24,94,,percent of total billed charges,,
"Penicillium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,39.744,86.4,,percent of total billed charges,,
"Penicillium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Penicillium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PPO,45.356,98.6,,percent of total billed charges,,
"Penicillium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,Minnesota Senior Health Options (MSHO),23.667,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Penicillium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Penicillium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,MinnesotaCare,23.6256,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Penicillium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Penicillium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Sanford Health Plan,Sanford Health Plan,42.32,92,,percent of total billed charges,,
"Penicillium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Individual & Family Plan,25.921,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Penicillium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Penicillium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medical Assistance,23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Penicillium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Penicillium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medicare Advantage,23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Penicillium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Penicillium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Penicillium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Penicillium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,UnitedHealthcare,Individual & Family,43.24,94,,percent of total billed charges,,
"Penicillium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Medicare Advantage,22.54,49,,percent of total billed charges,,
"Penicillium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Penicillium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,22.08,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Penicillium, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Rough Marshelder, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Aetna,Commercial,42.32,92,,percent of total billed charges,,
"Rough Marshelder, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Aetna,Medicare Advantage,22.54,49,,percent of total billed charges,,
"Rough Marshelder, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Rough Marshelder, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Aetna,PPO,42.78,93,,percent of total billed charges,,
"Rough Marshelder, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,America's PPO,America's PPO,44.1738,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Rough Marshelder, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota, Federal Employee Program,45.264,98.4,,percent of total billed charges,,
"Rough Marshelder, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,46,100,,percent of total billed charges,,
"Rough Marshelder, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,High Value Network Plan,41.4,90,,percent of total billed charges,,
"Rough Marshelder, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Medicare Advantage,22.54,49,,percent of total billed charges,,
"Rough Marshelder, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Rough Marshelder, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,40.7422,88.57,,percent of total billed charges,,
"Rough Marshelder, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,13.1836,28.66,,percent of total billed charges,,
"Rough Marshelder, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),22.54,49,,percent of total billed charges,,
"Rough Marshelder, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Rough Marshelder, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,CorVel,Worker's Compensation,46,100,,percent of total billed charges,,
"Rough Marshelder, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,First Health Group Corporation,First Health Network,44.62,97,,percent of total billed charges,,
"Rough Marshelder, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Commercial,43.516,94.6,,percent of total billed charges,,
"Rough Marshelder, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Medicare Advantage,22.54,49,,percent of total billed charges,,
"Rough Marshelder, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Rough Marshelder, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),27.6,60,,percent of total billed charges,,
"Rough Marshelder, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",State of Minnesota Advantage Program,37.49,81.5,,percent of total billed charges,,
"Rough Marshelder, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",State Public Programs,23,50,,percent of total billed charges,,
"Rough Marshelder, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Humana Insurance Company,Commercial PPO,43.7,95,,percent of total billed charges,,
"Rough Marshelder, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Humana Insurance Company,Medicare PPO,22.54,49,,percent of total billed charges,,
"Rough Marshelder, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Rough Marshelder, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Medica,Individual & Family,45.586,99.1,,percent of total billed charges,,
"Rough Marshelder, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Medica,Medica Advantage Solution,22.908,49.8,,percent of total billed charges,,
"Rough Marshelder, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Rough Marshelder, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Medica,Medical Assistance,20.516,44.6,,percent of total billed charges,,
"Rough Marshelder, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Medica,Medical Assistance,,,,,Included in per diem rate,
"Rough Marshelder, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,22.908,49.8,,percent of total billed charges,,
"Rough Marshelder, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Rough Marshelder, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Multiplan, Inc.","Multiplan, Inc.",43.24,94,,percent of total billed charges,,
"Rough Marshelder, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,39.744,86.4,,percent of total billed charges,,
"Rough Marshelder, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Rough Marshelder, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PPO,45.356,98.6,,percent of total billed charges,,
"Rough Marshelder, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,Minnesota Senior Health Options (MSHO),23.667,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Rough Marshelder, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Rough Marshelder, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,MinnesotaCare,23.6256,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Rough Marshelder, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Rough Marshelder, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Sanford Health Plan,Sanford Health Plan,42.32,92,,percent of total billed charges,,
"Rough Marshelder, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Individual & Family Plan,25.921,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Rough Marshelder, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Rough Marshelder, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medical Assistance,23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Rough Marshelder, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Rough Marshelder, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medicare Advantage,23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Rough Marshelder, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Rough Marshelder, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Rough Marshelder, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Rough Marshelder, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,UnitedHealthcare,Individual & Family,43.24,94,,percent of total billed charges,,
"Rough Marshelder, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Medicare Advantage,22.54,49,,percent of total billed charges,,
"Rough Marshelder, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Rough Marshelder, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,22.08,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Rough Marshelder, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Russian Thistle, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Aetna,Commercial,42.32,92,,percent of total billed charges,,
"Russian Thistle, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Aetna,Medicare Advantage,22.54,49,,percent of total billed charges,,
"Russian Thistle, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Russian Thistle, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Aetna,PPO,42.78,93,,percent of total billed charges,,
"Russian Thistle, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,America's PPO,America's PPO,44.1738,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Russian Thistle, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota, Federal Employee Program,45.264,98.4,,percent of total billed charges,,
"Russian Thistle, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,46,100,,percent of total billed charges,,
"Russian Thistle, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,High Value Network Plan,41.4,90,,percent of total billed charges,,
"Russian Thistle, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Medicare Advantage,22.54,49,,percent of total billed charges,,
"Russian Thistle, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Russian Thistle, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,40.7422,88.57,,percent of total billed charges,,
"Russian Thistle, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,13.1836,28.66,,percent of total billed charges,,
"Russian Thistle, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),22.54,49,,percent of total billed charges,,
"Russian Thistle, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Russian Thistle, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,CorVel,Worker's Compensation,46,100,,percent of total billed charges,,
"Russian Thistle, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,First Health Group Corporation,First Health Network,44.62,97,,percent of total billed charges,,
"Russian Thistle, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Commercial,43.516,94.6,,percent of total billed charges,,
"Russian Thistle, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Medicare Advantage,22.54,49,,percent of total billed charges,,
"Russian Thistle, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Russian Thistle, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),27.6,60,,percent of total billed charges,,
"Russian Thistle, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",State of Minnesota Advantage Program,37.49,81.5,,percent of total billed charges,,
"Russian Thistle, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",State Public Programs,23,50,,percent of total billed charges,,
"Russian Thistle, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Humana Insurance Company,Commercial PPO,43.7,95,,percent of total billed charges,,
"Russian Thistle, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Humana Insurance Company,Medicare PPO,22.54,49,,percent of total billed charges,,
"Russian Thistle, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Russian Thistle, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Medica,Individual & Family,45.586,99.1,,percent of total billed charges,,
"Russian Thistle, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Medica,Medica Advantage Solution,22.908,49.8,,percent of total billed charges,,
"Russian Thistle, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Russian Thistle, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Medica,Medical Assistance,20.516,44.6,,percent of total billed charges,,
"Russian Thistle, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Medica,Medical Assistance,,,,,Included in per diem rate,
"Russian Thistle, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,22.908,49.8,,percent of total billed charges,,
"Russian Thistle, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Russian Thistle, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Multiplan, Inc.","Multiplan, Inc.",43.24,94,,percent of total billed charges,,
"Russian Thistle, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,39.744,86.4,,percent of total billed charges,,
"Russian Thistle, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Russian Thistle, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PPO,45.356,98.6,,percent of total billed charges,,
"Russian Thistle, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,Minnesota Senior Health Options (MSHO),23.667,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Russian Thistle, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Russian Thistle, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,MinnesotaCare,23.6256,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Russian Thistle, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Russian Thistle, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Sanford Health Plan,Sanford Health Plan,42.32,92,,percent of total billed charges,,
"Russian Thistle, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Individual & Family Plan,25.921,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Russian Thistle, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Russian Thistle, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medical Assistance,23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Russian Thistle, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Russian Thistle, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medicare Advantage,23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Russian Thistle, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Russian Thistle, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Russian Thistle, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Russian Thistle, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,UnitedHealthcare,Individual & Family,43.24,94,,percent of total billed charges,,
"Russian Thistle, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Medicare Advantage,22.54,49,,percent of total billed charges,,
"Russian Thistle, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Russian Thistle, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,22.08,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Russian Thistle, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Rye Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Aetna,Commercial,42.32,92,,percent of total billed charges,,
"Rye Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Aetna,Medicare Advantage,22.54,49,,percent of total billed charges,,
"Rye Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Rye Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Aetna,PPO,42.78,93,,percent of total billed charges,,
"Rye Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,America's PPO,America's PPO,44.1738,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Rye Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota, Federal Employee Program,45.264,98.4,,percent of total billed charges,,
"Rye Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,46,100,,percent of total billed charges,,
"Rye Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,High Value Network Plan,41.4,90,,percent of total billed charges,,
"Rye Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Medicare Advantage,22.54,49,,percent of total billed charges,,
"Rye Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Rye Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,40.7422,88.57,,percent of total billed charges,,
"Rye Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,13.1836,28.66,,percent of total billed charges,,
"Rye Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),22.54,49,,percent of total billed charges,,
"Rye Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Rye Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,CorVel,Worker's Compensation,46,100,,percent of total billed charges,,
"Rye Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,First Health Group Corporation,First Health Network,44.62,97,,percent of total billed charges,,
"Rye Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Commercial,43.516,94.6,,percent of total billed charges,,
"Rye Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Medicare Advantage,22.54,49,,percent of total billed charges,,
"Rye Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Rye Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),27.6,60,,percent of total billed charges,,
"Rye Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",State of Minnesota Advantage Program,37.49,81.5,,percent of total billed charges,,
"Rye Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",State Public Programs,23,50,,percent of total billed charges,,
"Rye Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Humana Insurance Company,Commercial PPO,43.7,95,,percent of total billed charges,,
"Rye Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Humana Insurance Company,Medicare PPO,22.54,49,,percent of total billed charges,,
"Rye Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Rye Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Medica,Individual & Family,45.586,99.1,,percent of total billed charges,,
"Rye Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Medica,Medica Advantage Solution,22.908,49.8,,percent of total billed charges,,
"Rye Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Rye Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Medica,Medical Assistance,20.516,44.6,,percent of total billed charges,,
"Rye Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Medica,Medical Assistance,,,,,Included in per diem rate,
"Rye Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,22.908,49.8,,percent of total billed charges,,
"Rye Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Rye Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Multiplan, Inc.","Multiplan, Inc.",43.24,94,,percent of total billed charges,,
"Rye Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,39.744,86.4,,percent of total billed charges,,
"Rye Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Rye Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PPO,45.356,98.6,,percent of total billed charges,,
"Rye Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,Minnesota Senior Health Options (MSHO),23.667,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Rye Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Rye Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,MinnesotaCare,23.6256,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Rye Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Rye Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Sanford Health Plan,Sanford Health Plan,42.32,92,,percent of total billed charges,,
"Rye Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Individual & Family Plan,25.921,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Rye Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Rye Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medical Assistance,23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Rye Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Rye Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medicare Advantage,23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Rye Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Rye Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Rye Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Rye Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,UnitedHealthcare,Individual & Family,43.24,94,,percent of total billed charges,,
"Rye Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Medicare Advantage,22.54,49,,percent of total billed charges,,
"Rye Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Rye Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,22.08,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Rye Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Short Ragweed, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Aetna,Commercial,42.32,92,,percent of total billed charges,,
"Short Ragweed, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Aetna,Medicare Advantage,22.54,49,,percent of total billed charges,,
"Short Ragweed, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Short Ragweed, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Aetna,PPO,42.78,93,,percent of total billed charges,,
"Short Ragweed, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,America's PPO,America's PPO,44.1738,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Short Ragweed, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota, Federal Employee Program,45.264,98.4,,percent of total billed charges,,
"Short Ragweed, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,46,100,,percent of total billed charges,,
"Short Ragweed, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,High Value Network Plan,41.4,90,,percent of total billed charges,,
"Short Ragweed, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Medicare Advantage,22.54,49,,percent of total billed charges,,
"Short Ragweed, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Short Ragweed, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,40.7422,88.57,,percent of total billed charges,,
"Short Ragweed, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,13.1836,28.66,,percent of total billed charges,,
"Short Ragweed, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),22.54,49,,percent of total billed charges,,
"Short Ragweed, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Short Ragweed, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,CorVel,Worker's Compensation,46,100,,percent of total billed charges,,
"Short Ragweed, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,First Health Group Corporation,First Health Network,44.62,97,,percent of total billed charges,,
"Short Ragweed, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Commercial,43.516,94.6,,percent of total billed charges,,
"Short Ragweed, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Medicare Advantage,22.54,49,,percent of total billed charges,,
"Short Ragweed, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Short Ragweed, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),27.6,60,,percent of total billed charges,,
"Short Ragweed, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",State of Minnesota Advantage Program,37.49,81.5,,percent of total billed charges,,
"Short Ragweed, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",State Public Programs,23,50,,percent of total billed charges,,
"Short Ragweed, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Humana Insurance Company,Commercial PPO,43.7,95,,percent of total billed charges,,
"Short Ragweed, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Humana Insurance Company,Medicare PPO,22.54,49,,percent of total billed charges,,
"Short Ragweed, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Short Ragweed, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Medica,Individual & Family,45.586,99.1,,percent of total billed charges,,
"Short Ragweed, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Medica,Medica Advantage Solution,22.908,49.8,,percent of total billed charges,,
"Short Ragweed, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Short Ragweed, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Medica,Medical Assistance,20.516,44.6,,percent of total billed charges,,
"Short Ragweed, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Medica,Medical Assistance,,,,,Included in per diem rate,
"Short Ragweed, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,22.908,49.8,,percent of total billed charges,,
"Short Ragweed, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Short Ragweed, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Multiplan, Inc.","Multiplan, Inc.",43.24,94,,percent of total billed charges,,
"Short Ragweed, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,39.744,86.4,,percent of total billed charges,,
"Short Ragweed, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Short Ragweed, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PPO,45.356,98.6,,percent of total billed charges,,
"Short Ragweed, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,Minnesota Senior Health Options (MSHO),23.667,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Short Ragweed, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Short Ragweed, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,MinnesotaCare,23.6256,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Short Ragweed, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Short Ragweed, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Sanford Health Plan,Sanford Health Plan,42.32,92,,percent of total billed charges,,
"Short Ragweed, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Individual & Family Plan,25.921,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Short Ragweed, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Short Ragweed, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medical Assistance,23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Short Ragweed, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Short Ragweed, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medicare Advantage,23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Short Ragweed, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Short Ragweed, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Short Ragweed, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Short Ragweed, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,UnitedHealthcare,Individual & Family,43.24,94,,percent of total billed charges,,
"Short Ragweed, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Medicare Advantage,22.54,49,,percent of total billed charges,,
"Short Ragweed, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Short Ragweed, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,22.08,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Short Ragweed, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Shrimp, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,Aetna,Commercial,45.08,92,,percent of total billed charges,,
"Shrimp, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,Aetna,Medicare Advantage,24.01,49,,percent of total billed charges,,
"Shrimp, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Shrimp, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,Aetna,PPO,45.57,93,,percent of total billed charges,,
"Shrimp, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,America's PPO,America's PPO,47.0547,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Shrimp, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,BlueCross BlueShield Minnesota, Federal Employee Program,48.216,98.4,,percent of total billed charges,,
"Shrimp, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,49,100,,percent of total billed charges,,
"Shrimp, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,High Value Network Plan,44.1,90,,percent of total billed charges,,
"Shrimp, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Medicare Advantage,24.01,49,,percent of total billed charges,,
"Shrimp, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Shrimp, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,43.3993,88.57,,percent of total billed charges,,
"Shrimp, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,14.0434,28.66,,percent of total billed charges,,
"Shrimp, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),24.01,49,,percent of total billed charges,,
"Shrimp, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Shrimp, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,CorVel,Worker's Compensation,49,100,,percent of total billed charges,,
"Shrimp, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,First Health Group Corporation,First Health Network,47.53,97,,percent of total billed charges,,
"Shrimp, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,"Health Partners, Inc.",Commercial,46.354,94.6,,percent of total billed charges,,
"Shrimp, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,"Health Partners, Inc.",Medicare Advantage,24.01,49,,percent of total billed charges,,
"Shrimp, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Shrimp, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),29.4,60,,percent of total billed charges,,
"Shrimp, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,"Health Partners, Inc.",State of Minnesota Advantage Program,39.935,81.5,,percent of total billed charges,,
"Shrimp, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,"Health Partners, Inc.",State Public Programs,24.5,50,,percent of total billed charges,,
"Shrimp, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,Humana Insurance Company,Commercial PPO,46.55,95,,percent of total billed charges,,
"Shrimp, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,Humana Insurance Company,Medicare PPO,24.01,49,,percent of total billed charges,,
"Shrimp, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Shrimp, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,Medica,Individual & Family,48.559,99.1,,percent of total billed charges,,
"Shrimp, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,Medica,Medica Advantage Solution,24.402,49.8,,percent of total billed charges,,
"Shrimp, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Shrimp, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,Medica,Medical Assistance,21.854,44.6,,percent of total billed charges,,
"Shrimp, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,Medica,Medical Assistance,,,,,Included in per diem rate,
"Shrimp, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,24.402,49.8,,percent of total billed charges,,
"Shrimp, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Shrimp, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,"Multiplan, Inc.","Multiplan, Inc.",46.06,94,,percent of total billed charges,,
"Shrimp, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,42.336,86.4,,percent of total billed charges,,
"Shrimp, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Shrimp, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,"Preferred One Administrative Services, INC.",PPO,48.314,98.6,,percent of total billed charges,,
"Shrimp, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,PrimeWest Health,Minnesota Senior Health Options (MSHO),25.2105,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Shrimp, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Shrimp, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,PrimeWest Health,MinnesotaCare,25.1664,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Shrimp, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Shrimp, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,Sanford Health Plan,Sanford Health Plan,45.08,92,,percent of total billed charges,,
"Shrimp, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,"UCare Health, Inc.",Individual & Family Plan,27.6115,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Shrimp, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Shrimp, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,"UCare Health, Inc.",Medical Assistance,24.7303,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Shrimp, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Shrimp, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,"UCare Health, Inc.",Medicare Advantage,24.7303,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Shrimp, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Shrimp, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),24.7303,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Shrimp, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Shrimp, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,UnitedHealthcare,Individual & Family,46.06,94,,percent of total billed charges,,
"Shrimp, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,UnitedHealthcare,Medicare Advantage,24.01,49,,percent of total billed charges,,
"Shrimp, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Shrimp, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,23.52,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Shrimp, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Silver Birch, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Aetna,Commercial,42.32,92,,percent of total billed charges,,
"Silver Birch, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Aetna,Medicare Advantage,22.54,49,,percent of total billed charges,,
"Silver Birch, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Silver Birch, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Aetna,PPO,42.78,93,,percent of total billed charges,,
"Silver Birch, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,America's PPO,America's PPO,44.1738,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Silver Birch, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota, Federal Employee Program,45.264,98.4,,percent of total billed charges,,
"Silver Birch, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,46,100,,percent of total billed charges,,
"Silver Birch, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,High Value Network Plan,41.4,90,,percent of total billed charges,,
"Silver Birch, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Medicare Advantage,22.54,49,,percent of total billed charges,,
"Silver Birch, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Silver Birch, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,40.7422,88.57,,percent of total billed charges,,
"Silver Birch, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,13.1836,28.66,,percent of total billed charges,,
"Silver Birch, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),22.54,49,,percent of total billed charges,,
"Silver Birch, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Silver Birch, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,CorVel,Worker's Compensation,46,100,,percent of total billed charges,,
"Silver Birch, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,First Health Group Corporation,First Health Network,44.62,97,,percent of total billed charges,,
"Silver Birch, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Commercial,43.516,94.6,,percent of total billed charges,,
"Silver Birch, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Medicare Advantage,22.54,49,,percent of total billed charges,,
"Silver Birch, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Silver Birch, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),27.6,60,,percent of total billed charges,,
"Silver Birch, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",State of Minnesota Advantage Program,37.49,81.5,,percent of total billed charges,,
"Silver Birch, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",State Public Programs,23,50,,percent of total billed charges,,
"Silver Birch, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Humana Insurance Company,Commercial PPO,43.7,95,,percent of total billed charges,,
"Silver Birch, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Humana Insurance Company,Medicare PPO,22.54,49,,percent of total billed charges,,
"Silver Birch, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Silver Birch, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Medica,Individual & Family,45.586,99.1,,percent of total billed charges,,
"Silver Birch, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Medica,Medica Advantage Solution,22.908,49.8,,percent of total billed charges,,
"Silver Birch, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Silver Birch, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Medica,Medical Assistance,20.516,44.6,,percent of total billed charges,,
"Silver Birch, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Medica,Medical Assistance,,,,,Included in per diem rate,
"Silver Birch, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,22.908,49.8,,percent of total billed charges,,
"Silver Birch, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Silver Birch, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Multiplan, Inc.","Multiplan, Inc.",43.24,94,,percent of total billed charges,,
"Silver Birch, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,39.744,86.4,,percent of total billed charges,,
"Silver Birch, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Silver Birch, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PPO,45.356,98.6,,percent of total billed charges,,
"Silver Birch, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,Minnesota Senior Health Options (MSHO),23.667,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Silver Birch, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Silver Birch, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,MinnesotaCare,23.6256,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Silver Birch, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Silver Birch, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Sanford Health Plan,Sanford Health Plan,42.32,92,,percent of total billed charges,,
"Silver Birch, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Individual & Family Plan,25.921,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Silver Birch, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Silver Birch, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medical Assistance,23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Silver Birch, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Silver Birch, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medicare Advantage,23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Silver Birch, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Silver Birch, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Silver Birch, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Silver Birch, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,UnitedHealthcare,Individual & Family,43.24,94,,percent of total billed charges,,
"Silver Birch, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Medicare Advantage,22.54,49,,percent of total billed charges,,
"Silver Birch, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Silver Birch, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,22.08,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Silver Birch, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Soybean, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,Aetna,Commercial,45.08,92,,percent of total billed charges,,
"Soybean, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,Aetna,Medicare Advantage,24.01,49,,percent of total billed charges,,
"Soybean, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Soybean, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,Aetna,PPO,45.57,93,,percent of total billed charges,,
"Soybean, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,America's PPO,America's PPO,47.0547,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Soybean, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,BlueCross BlueShield Minnesota, Federal Employee Program,48.216,98.4,,percent of total billed charges,,
"Soybean, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,49,100,,percent of total billed charges,,
"Soybean, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,High Value Network Plan,44.1,90,,percent of total billed charges,,
"Soybean, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Medicare Advantage,24.01,49,,percent of total billed charges,,
"Soybean, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Soybean, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,43.3993,88.57,,percent of total billed charges,,
"Soybean, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,14.0434,28.66,,percent of total billed charges,,
"Soybean, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),24.01,49,,percent of total billed charges,,
"Soybean, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Soybean, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,CorVel,Worker's Compensation,49,100,,percent of total billed charges,,
"Soybean, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,First Health Group Corporation,First Health Network,47.53,97,,percent of total billed charges,,
"Soybean, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,"Health Partners, Inc.",Commercial,46.354,94.6,,percent of total billed charges,,
"Soybean, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,"Health Partners, Inc.",Medicare Advantage,24.01,49,,percent of total billed charges,,
"Soybean, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Soybean, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),29.4,60,,percent of total billed charges,,
"Soybean, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,"Health Partners, Inc.",State of Minnesota Advantage Program,39.935,81.5,,percent of total billed charges,,
"Soybean, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,"Health Partners, Inc.",State Public Programs,24.5,50,,percent of total billed charges,,
"Soybean, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,Humana Insurance Company,Commercial PPO,46.55,95,,percent of total billed charges,,
"Soybean, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,Humana Insurance Company,Medicare PPO,24.01,49,,percent of total billed charges,,
"Soybean, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Soybean, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,Medica,Individual & Family,48.559,99.1,,percent of total billed charges,,
"Soybean, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,Medica,Medica Advantage Solution,24.402,49.8,,percent of total billed charges,,
"Soybean, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Soybean, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,Medica,Medical Assistance,21.854,44.6,,percent of total billed charges,,
"Soybean, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,Medica,Medical Assistance,,,,,Included in per diem rate,
"Soybean, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,24.402,49.8,,percent of total billed charges,,
"Soybean, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Soybean, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,"Multiplan, Inc.","Multiplan, Inc.",46.06,94,,percent of total billed charges,,
"Soybean, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,42.336,86.4,,percent of total billed charges,,
"Soybean, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Soybean, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,"Preferred One Administrative Services, INC.",PPO,48.314,98.6,,percent of total billed charges,,
"Soybean, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,PrimeWest Health,Minnesota Senior Health Options (MSHO),25.2105,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Soybean, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Soybean, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,PrimeWest Health,MinnesotaCare,25.1664,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Soybean, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Soybean, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,Sanford Health Plan,Sanford Health Plan,45.08,92,,percent of total billed charges,,
"Soybean, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,"UCare Health, Inc.",Individual & Family Plan,27.6115,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Soybean, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Soybean, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,"UCare Health, Inc.",Medical Assistance,24.7303,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Soybean, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Soybean, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,"UCare Health, Inc.",Medicare Advantage,24.7303,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Soybean, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Soybean, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),24.7303,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Soybean, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Soybean, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,UnitedHealthcare,Individual & Family,46.06,94,,percent of total billed charges,,
"Soybean, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,UnitedHealthcare,Medicare Advantage,24.01,49,,percent of total billed charges,,
"Soybean, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Soybean, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,23.52,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Soybean, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Timothy Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Aetna,Commercial,42.32,92,,percent of total billed charges,,
"Timothy Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Aetna,Medicare Advantage,22.54,49,,percent of total billed charges,,
"Timothy Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Timothy Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Aetna,PPO,42.78,93,,percent of total billed charges,,
"Timothy Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,America's PPO,America's PPO,44.1738,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Timothy Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota, Federal Employee Program,45.264,98.4,,percent of total billed charges,,
"Timothy Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,46,100,,percent of total billed charges,,
"Timothy Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,High Value Network Plan,41.4,90,,percent of total billed charges,,
"Timothy Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Medicare Advantage,22.54,49,,percent of total billed charges,,
"Timothy Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Timothy Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,40.7422,88.57,,percent of total billed charges,,
"Timothy Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,13.1836,28.66,,percent of total billed charges,,
"Timothy Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),22.54,49,,percent of total billed charges,,
"Timothy Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Timothy Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,CorVel,Worker's Compensation,46,100,,percent of total billed charges,,
"Timothy Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,First Health Group Corporation,First Health Network,44.62,97,,percent of total billed charges,,
"Timothy Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Commercial,43.516,94.6,,percent of total billed charges,,
"Timothy Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Medicare Advantage,22.54,49,,percent of total billed charges,,
"Timothy Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Timothy Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),27.6,60,,percent of total billed charges,,
"Timothy Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",State of Minnesota Advantage Program,37.49,81.5,,percent of total billed charges,,
"Timothy Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",State Public Programs,23,50,,percent of total billed charges,,
"Timothy Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Humana Insurance Company,Commercial PPO,43.7,95,,percent of total billed charges,,
"Timothy Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Humana Insurance Company,Medicare PPO,22.54,49,,percent of total billed charges,,
"Timothy Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Timothy Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Medica,Individual & Family,45.586,99.1,,percent of total billed charges,,
"Timothy Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Medica,Medica Advantage Solution,22.908,49.8,,percent of total billed charges,,
"Timothy Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Timothy Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Medica,Medical Assistance,20.516,44.6,,percent of total billed charges,,
"Timothy Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Medica,Medical Assistance,,,,,Included in per diem rate,
"Timothy Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,22.908,49.8,,percent of total billed charges,,
"Timothy Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Timothy Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Multiplan, Inc.","Multiplan, Inc.",43.24,94,,percent of total billed charges,,
"Timothy Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,39.744,86.4,,percent of total billed charges,,
"Timothy Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Timothy Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PPO,45.356,98.6,,percent of total billed charges,,
"Timothy Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,Minnesota Senior Health Options (MSHO),23.667,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Timothy Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Timothy Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,MinnesotaCare,23.6256,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Timothy Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Timothy Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Sanford Health Plan,Sanford Health Plan,42.32,92,,percent of total billed charges,,
"Timothy Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Individual & Family Plan,25.921,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Timothy Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Timothy Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medical Assistance,23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Timothy Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Timothy Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medicare Advantage,23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Timothy Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Timothy Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Timothy Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Timothy Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,UnitedHealthcare,Individual & Family,43.24,94,,percent of total billed charges,,
"Timothy Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Medicare Advantage,22.54,49,,percent of total billed charges,,
"Timothy Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Timothy Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,22.08,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Timothy Grass, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Wheat, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,Aetna,Commercial,45.08,92,,percent of total billed charges,,
"Wheat, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,Aetna,Medicare Advantage,24.01,49,,percent of total billed charges,,
"Wheat, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Wheat, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,Aetna,PPO,45.57,93,,percent of total billed charges,,
"Wheat, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,America's PPO,America's PPO,47.0547,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Wheat, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,BlueCross BlueShield Minnesota, Federal Employee Program,48.216,98.4,,percent of total billed charges,,
"Wheat, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,49,100,,percent of total billed charges,,
"Wheat, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,High Value Network Plan,44.1,90,,percent of total billed charges,,
"Wheat, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Medicare Advantage,24.01,49,,percent of total billed charges,,
"Wheat, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Wheat, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,43.3993,88.57,,percent of total billed charges,,
"Wheat, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,14.0434,28.66,,percent of total billed charges,,
"Wheat, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),24.01,49,,percent of total billed charges,,
"Wheat, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Wheat, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,CorVel,Worker's Compensation,49,100,,percent of total billed charges,,
"Wheat, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,First Health Group Corporation,First Health Network,47.53,97,,percent of total billed charges,,
"Wheat, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,"Health Partners, Inc.",Commercial,46.354,94.6,,percent of total billed charges,,
"Wheat, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,"Health Partners, Inc.",Medicare Advantage,24.01,49,,percent of total billed charges,,
"Wheat, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Wheat, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),29.4,60,,percent of total billed charges,,
"Wheat, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,"Health Partners, Inc.",State of Minnesota Advantage Program,39.935,81.5,,percent of total billed charges,,
"Wheat, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,"Health Partners, Inc.",State Public Programs,24.5,50,,percent of total billed charges,,
"Wheat, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,Humana Insurance Company,Commercial PPO,46.55,95,,percent of total billed charges,,
"Wheat, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,Humana Insurance Company,Medicare PPO,24.01,49,,percent of total billed charges,,
"Wheat, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Wheat, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,Medica,Individual & Family,48.559,99.1,,percent of total billed charges,,
"Wheat, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,Medica,Medica Advantage Solution,24.402,49.8,,percent of total billed charges,,
"Wheat, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Wheat, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,Medica,Medical Assistance,21.854,44.6,,percent of total billed charges,,
"Wheat, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,Medica,Medical Assistance,,,,,Included in per diem rate,
"Wheat, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,24.402,49.8,,percent of total billed charges,,
"Wheat, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Wheat, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,"Multiplan, Inc.","Multiplan, Inc.",46.06,94,,percent of total billed charges,,
"Wheat, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,42.336,86.4,,percent of total billed charges,,
"Wheat, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Wheat, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,"Preferred One Administrative Services, INC.",PPO,48.314,98.6,,percent of total billed charges,,
"Wheat, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,PrimeWest Health,Minnesota Senior Health Options (MSHO),25.2105,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Wheat, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Wheat, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,PrimeWest Health,MinnesotaCare,25.1664,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Wheat, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Wheat, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,Sanford Health Plan,Sanford Health Plan,45.08,92,,percent of total billed charges,,
"Wheat, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,"UCare Health, Inc.",Individual & Family Plan,27.6115,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Wheat, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Wheat, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,"UCare Health, Inc.",Medical Assistance,24.7303,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Wheat, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Wheat, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,"UCare Health, Inc.",Medicare Advantage,24.7303,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Wheat, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Wheat, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),24.7303,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Wheat, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Wheat, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,49,41.65,14.0434,49,UnitedHealthcare,Individual & Family,46.06,94,,percent of total billed charges,,
"Wheat, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,UnitedHealthcare,Medicare Advantage,24.01,49,,percent of total billed charges,,
"Wheat, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Wheat, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,23.52,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Wheat, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"White Ash, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Aetna,Commercial,42.32,92,,percent of total billed charges,,
"White Ash, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Aetna,Medicare Advantage,22.54,49,,percent of total billed charges,,
"White Ash, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"White Ash, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Aetna,PPO,42.78,93,,percent of total billed charges,,
"White Ash, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,America's PPO,America's PPO,44.1738,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"White Ash, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota, Federal Employee Program,45.264,98.4,,percent of total billed charges,,
"White Ash, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,46,100,,percent of total billed charges,,
"White Ash, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,High Value Network Plan,41.4,90,,percent of total billed charges,,
"White Ash, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Medicare Advantage,22.54,49,,percent of total billed charges,,
"White Ash, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"White Ash, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,40.7422,88.57,,percent of total billed charges,,
"White Ash, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,13.1836,28.66,,percent of total billed charges,,
"White Ash, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),22.54,49,,percent of total billed charges,,
"White Ash, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"White Ash, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,CorVel,Worker's Compensation,46,100,,percent of total billed charges,,
"White Ash, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,First Health Group Corporation,First Health Network,44.62,97,,percent of total billed charges,,
"White Ash, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Commercial,43.516,94.6,,percent of total billed charges,,
"White Ash, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Medicare Advantage,22.54,49,,percent of total billed charges,,
"White Ash, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"White Ash, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),27.6,60,,percent of total billed charges,,
"White Ash, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",State of Minnesota Advantage Program,37.49,81.5,,percent of total billed charges,,
"White Ash, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",State Public Programs,23,50,,percent of total billed charges,,
"White Ash, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Humana Insurance Company,Commercial PPO,43.7,95,,percent of total billed charges,,
"White Ash, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Humana Insurance Company,Medicare PPO,22.54,49,,percent of total billed charges,,
"White Ash, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"White Ash, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Medica,Individual & Family,45.586,99.1,,percent of total billed charges,,
"White Ash, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Medica,Medica Advantage Solution,22.908,49.8,,percent of total billed charges,,
"White Ash, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"White Ash, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Medica,Medical Assistance,20.516,44.6,,percent of total billed charges,,
"White Ash, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Medica,Medical Assistance,,,,,Included in per diem rate,
"White Ash, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,22.908,49.8,,percent of total billed charges,,
"White Ash, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"White Ash, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Multiplan, Inc.","Multiplan, Inc.",43.24,94,,percent of total billed charges,,
"White Ash, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,39.744,86.4,,percent of total billed charges,,
"White Ash, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"White Ash, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PPO,45.356,98.6,,percent of total billed charges,,
"White Ash, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,Minnesota Senior Health Options (MSHO),23.667,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"White Ash, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"White Ash, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,MinnesotaCare,23.6256,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"White Ash, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"White Ash, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Sanford Health Plan,Sanford Health Plan,42.32,92,,percent of total billed charges,,
"White Ash, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Individual & Family Plan,25.921,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"White Ash, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"White Ash, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medical Assistance,23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"White Ash, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"White Ash, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medicare Advantage,23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"White Ash, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"White Ash, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"White Ash, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"White Ash, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Both,,,90,46,39.1,13.1836,46,UnitedHealthcare,Individual & Family,43.24,94,,percent of total billed charges,,
"White Ash, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Medicare Advantage,22.54,49,,percent of total billed charges,,
"White Ash, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"White Ash, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,22.08,48,,percent of total billed charges,,100% of DHS outpatient percentage
"White Ash, Ige (Mayo)OutsideLaboratory",,86003,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Peanut Components (Mayo)OutsideLaboratory,,86008,CPT,Facility,Both,,,90,485,412.25,139.001,485,Aetna,Commercial,446.2,92,,percent of total billed charges,,
Peanut Components (Mayo)OutsideLaboratory,,86008,CPT,Facility,Outpatient,,,90,485,412.25,139.001,485,Aetna,Medicare Advantage,237.65,49,,percent of total billed charges,,
Peanut Components (Mayo)OutsideLaboratory,,86008,CPT,Facility,Inpatient,,,90,485,412.25,139.001,485,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Peanut Components (Mayo)OutsideLaboratory,,86008,CPT,Facility,Both,,,90,485,412.25,139.001,485,Aetna,PPO,451.05,93,,percent of total billed charges,,
Peanut Components (Mayo)OutsideLaboratory,,86008,CPT,Facility,Both,,,90,485,412.25,139.001,485,America's PPO,America's PPO,465.7455,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Peanut Components (Mayo)OutsideLaboratory,,86008,CPT,Facility,Both,,,90,485,412.25,139.001,485,BlueCross BlueShield Minnesota, Federal Employee Program,477.24,98.4,,percent of total billed charges,,
Peanut Components (Mayo)OutsideLaboratory,,86008,CPT,Facility,Both,,,90,485,412.25,139.001,485,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,485,100,,percent of total billed charges,,
Peanut Components (Mayo)OutsideLaboratory,,86008,CPT,Facility,Both,,,90,485,412.25,139.001,485,BlueCross BlueShield Minnesota,High Value Network Plan,436.5,90,,percent of total billed charges,,
Peanut Components (Mayo)OutsideLaboratory,,86008,CPT,Facility,Outpatient,,,90,485,412.25,139.001,485,BlueCross BlueShield Minnesota,Medicare Advantage,237.65,49,,percent of total billed charges,,
Peanut Components (Mayo)OutsideLaboratory,,86008,CPT,Facility,Inpatient,,,90,485,412.25,139.001,485,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Peanut Components (Mayo)OutsideLaboratory,,86008,CPT,Facility,Both,,,90,485,412.25,139.001,485,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,429.5645,88.57,,percent of total billed charges,,
Peanut Components (Mayo)OutsideLaboratory,,86008,CPT,Facility,Both,,,90,485,412.25,139.001,485,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,139.001,28.66,,percent of total billed charges,,
Peanut Components (Mayo)OutsideLaboratory,,86008,CPT,Facility,Outpatient,,,90,485,412.25,139.001,485,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),237.65,49,,percent of total billed charges,,
Peanut Components (Mayo)OutsideLaboratory,,86008,CPT,Facility,Inpatient,,,90,485,412.25,139.001,485,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Peanut Components (Mayo)OutsideLaboratory,,86008,CPT,Facility,Both,,,90,485,412.25,139.001,485,CorVel,Worker's Compensation,485,100,,percent of total billed charges,,
Peanut Components (Mayo)OutsideLaboratory,,86008,CPT,Facility,Both,,,90,485,412.25,139.001,485,First Health Group Corporation,First Health Network,470.45,97,,percent of total billed charges,,
Peanut Components (Mayo)OutsideLaboratory,,86008,CPT,Facility,Both,,,90,485,412.25,139.001,485,"Health Partners, Inc.",Commercial,458.81,94.6,,percent of total billed charges,,
Peanut Components (Mayo)OutsideLaboratory,,86008,CPT,Facility,Outpatient,,,90,485,412.25,139.001,485,"Health Partners, Inc.",Medicare Advantage,237.65,49,,percent of total billed charges,,
Peanut Components (Mayo)OutsideLaboratory,,86008,CPT,Facility,Inpatient,,,90,485,412.25,139.001,485,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Peanut Components (Mayo)OutsideLaboratory,,86008,CPT,Facility,Both,,,90,485,412.25,139.001,485,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),291,60,,percent of total billed charges,,
Peanut Components (Mayo)OutsideLaboratory,,86008,CPT,Facility,Both,,,90,485,412.25,139.001,485,"Health Partners, Inc.",State of Minnesota Advantage Program,395.275,81.5,,percent of total billed charges,,
Peanut Components (Mayo)OutsideLaboratory,,86008,CPT,Facility,Both,,,90,485,412.25,139.001,485,"Health Partners, Inc.",State Public Programs,242.5,50,,percent of total billed charges,,
Peanut Components (Mayo)OutsideLaboratory,,86008,CPT,Facility,Both,,,90,485,412.25,139.001,485,Humana Insurance Company,Commercial PPO,460.75,95,,percent of total billed charges,,
Peanut Components (Mayo)OutsideLaboratory,,86008,CPT,Facility,Outpatient,,,90,485,412.25,139.001,485,Humana Insurance Company,Medicare PPO,237.65,49,,percent of total billed charges,,
Peanut Components (Mayo)OutsideLaboratory,,86008,CPT,Facility,Inpatient,,,90,485,412.25,139.001,485,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Peanut Components (Mayo)OutsideLaboratory,,86008,CPT,Facility,Both,,,90,485,412.25,139.001,485,Medica,Individual & Family,480.635,99.1,,percent of total billed charges,,
Peanut Components (Mayo)OutsideLaboratory,,86008,CPT,Facility,Outpatient,,,90,485,412.25,139.001,485,Medica,Medica Advantage Solution,241.53,49.8,,percent of total billed charges,,
Peanut Components (Mayo)OutsideLaboratory,,86008,CPT,Facility,Inpatient,,,90,485,412.25,139.001,485,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Peanut Components (Mayo)OutsideLaboratory,,86008,CPT,Facility,Outpatient,,,90,485,412.25,139.001,485,Medica,Medical Assistance,216.31,44.6,,percent of total billed charges,,
Peanut Components (Mayo)OutsideLaboratory,,86008,CPT,Facility,Inpatient,,,90,485,412.25,139.001,485,Medica,Medical Assistance,,,,,Included in per diem rate,
Peanut Components (Mayo)OutsideLaboratory,,86008,CPT,Facility,Outpatient,,,90,485,412.25,139.001,485,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,241.53,49.8,,percent of total billed charges,,
Peanut Components (Mayo)OutsideLaboratory,,86008,CPT,Facility,Inpatient,,,90,485,412.25,139.001,485,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Peanut Components (Mayo)OutsideLaboratory,,86008,CPT,Facility,Both,,,90,485,412.25,139.001,485,"Multiplan, Inc.","Multiplan, Inc.",455.9,94,,percent of total billed charges,,
Peanut Components (Mayo)OutsideLaboratory,,86008,CPT,Facility,Outpatient,,,90,485,412.25,139.001,485,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,419.04,86.4,,percent of total billed charges,,
Peanut Components (Mayo)OutsideLaboratory,,86008,CPT,Facility,Inpatient,,,90,485,412.25,139.001,485,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Peanut Components (Mayo)OutsideLaboratory,,86008,CPT,Facility,Both,,,90,485,412.25,139.001,485,"Preferred One Administrative Services, INC.",PPO,478.21,98.6,,percent of total billed charges,,
Peanut Components (Mayo)OutsideLaboratory,,86008,CPT,Facility,Outpatient,,,90,485,412.25,139.001,485,PrimeWest Health,Minnesota Senior Health Options (MSHO),249.5325,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Peanut Components (Mayo)OutsideLaboratory,,86008,CPT,Facility,Inpatient,,,90,485,412.25,139.001,485,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Peanut Components (Mayo)OutsideLaboratory,,86008,CPT,Facility,Outpatient,,,90,485,412.25,139.001,485,PrimeWest Health,MinnesotaCare,249.096,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Peanut Components (Mayo)OutsideLaboratory,,86008,CPT,Facility,Inpatient,,,90,485,412.25,139.001,485,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Peanut Components (Mayo)OutsideLaboratory,,86008,CPT,Facility,Both,,,90,485,412.25,139.001,485,Sanford Health Plan,Sanford Health Plan,446.2,92,,percent of total billed charges,,
Peanut Components (Mayo)OutsideLaboratory,,86008,CPT,Facility,Outpatient,,,90,485,412.25,139.001,485,"UCare Health, Inc.",Individual & Family Plan,273.2975,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Peanut Components (Mayo)OutsideLaboratory,,86008,CPT,Facility,Inpatient,,,90,485,412.25,139.001,485,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Peanut Components (Mayo)OutsideLaboratory,,86008,CPT,Facility,Outpatient,,,90,485,412.25,139.001,485,"UCare Health, Inc.",Medical Assistance,244.7795,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Peanut Components (Mayo)OutsideLaboratory,,86008,CPT,Facility,Inpatient,,,90,485,412.25,139.001,485,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Peanut Components (Mayo)OutsideLaboratory,,86008,CPT,Facility,Outpatient,,,90,485,412.25,139.001,485,"UCare Health, Inc.",Medicare Advantage,244.7795,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Peanut Components (Mayo)OutsideLaboratory,,86008,CPT,Facility,Inpatient,,,90,485,412.25,139.001,485,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Peanut Components (Mayo)OutsideLaboratory,,86008,CPT,Facility,Outpatient,,,90,485,412.25,139.001,485,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),244.7795,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Peanut Components (Mayo)OutsideLaboratory,,86008,CPT,Facility,Inpatient,,,90,485,412.25,139.001,485,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Peanut Components (Mayo)OutsideLaboratory,,86008,CPT,Facility,Both,,,90,485,412.25,139.001,485,UnitedHealthcare,Individual & Family,455.9,94,,percent of total billed charges,,
Peanut Components (Mayo)OutsideLaboratory,,86008,CPT,Facility,Outpatient,,,90,485,412.25,139.001,485,UnitedHealthcare,Medicare Advantage,237.65,49,,percent of total billed charges,,
Peanut Components (Mayo)OutsideLaboratory,,86008,CPT,Facility,Inpatient,,,90,485,412.25,139.001,485,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Peanut Components (Mayo)OutsideLaboratory,,86008,CPT,Facility,Outpatient,,,90,485,412.25,139.001,485,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,232.8,48,,percent of total billed charges,,100% of DHS outpatient percentage
Peanut Components (Mayo)OutsideLaboratory,,86008,CPT,Facility,Inpatient,,,90,485,412.25,139.001,485,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Actin Smooth Muscle Antibody Each (Mayo)OutsideLaboratory,,86015,CPT,Facility,Both,,,90,122,103.7,34.9652,122,Aetna,Commercial,112.24,92,,percent of total billed charges,,
Actin Smooth Muscle Antibody Each (Mayo)OutsideLaboratory,,86015,CPT,Facility,Outpatient,,,90,122,103.7,34.9652,122,Aetna,Medicare Advantage,59.78,49,,percent of total billed charges,,
Actin Smooth Muscle Antibody Each (Mayo)OutsideLaboratory,,86015,CPT,Facility,Inpatient,,,90,122,103.7,34.9652,122,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Actin Smooth Muscle Antibody Each (Mayo)OutsideLaboratory,,86015,CPT,Facility,Both,,,90,122,103.7,34.9652,122,Aetna,PPO,113.46,93,,percent of total billed charges,,
Actin Smooth Muscle Antibody Each (Mayo)OutsideLaboratory,,86015,CPT,Facility,Both,,,90,122,103.7,34.9652,122,America's PPO,America's PPO,117.1566,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Actin Smooth Muscle Antibody Each (Mayo)OutsideLaboratory,,86015,CPT,Facility,Both,,,90,122,103.7,34.9652,122,BlueCross BlueShield Minnesota, Federal Employee Program,120.048,98.4,,percent of total billed charges,,
Actin Smooth Muscle Antibody Each (Mayo)OutsideLaboratory,,86015,CPT,Facility,Both,,,90,122,103.7,34.9652,122,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,122,100,,percent of total billed charges,,
Actin Smooth Muscle Antibody Each (Mayo)OutsideLaboratory,,86015,CPT,Facility,Both,,,90,122,103.7,34.9652,122,BlueCross BlueShield Minnesota,High Value Network Plan,109.8,90,,percent of total billed charges,,
Actin Smooth Muscle Antibody Each (Mayo)OutsideLaboratory,,86015,CPT,Facility,Outpatient,,,90,122,103.7,34.9652,122,BlueCross BlueShield Minnesota,Medicare Advantage,59.78,49,,percent of total billed charges,,
Actin Smooth Muscle Antibody Each (Mayo)OutsideLaboratory,,86015,CPT,Facility,Inpatient,,,90,122,103.7,34.9652,122,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Actin Smooth Muscle Antibody Each (Mayo)OutsideLaboratory,,86015,CPT,Facility,Both,,,90,122,103.7,34.9652,122,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,108.0554,88.57,,percent of total billed charges,,
Actin Smooth Muscle Antibody Each (Mayo)OutsideLaboratory,,86015,CPT,Facility,Both,,,90,122,103.7,34.9652,122,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,34.9652,28.66,,percent of total billed charges,,
Actin Smooth Muscle Antibody Each (Mayo)OutsideLaboratory,,86015,CPT,Facility,Outpatient,,,90,122,103.7,34.9652,122,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),59.78,49,,percent of total billed charges,,
Actin Smooth Muscle Antibody Each (Mayo)OutsideLaboratory,,86015,CPT,Facility,Inpatient,,,90,122,103.7,34.9652,122,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Actin Smooth Muscle Antibody Each (Mayo)OutsideLaboratory,,86015,CPT,Facility,Both,,,90,122,103.7,34.9652,122,CorVel,Worker's Compensation,122,100,,percent of total billed charges,,
Actin Smooth Muscle Antibody Each (Mayo)OutsideLaboratory,,86015,CPT,Facility,Both,,,90,122,103.7,34.9652,122,First Health Group Corporation,First Health Network,118.34,97,,percent of total billed charges,,
Actin Smooth Muscle Antibody Each (Mayo)OutsideLaboratory,,86015,CPT,Facility,Both,,,90,122,103.7,34.9652,122,"Health Partners, Inc.",Commercial,115.412,94.6,,percent of total billed charges,,
Actin Smooth Muscle Antibody Each (Mayo)OutsideLaboratory,,86015,CPT,Facility,Outpatient,,,90,122,103.7,34.9652,122,"Health Partners, Inc.",Medicare Advantage,59.78,49,,percent of total billed charges,,
Actin Smooth Muscle Antibody Each (Mayo)OutsideLaboratory,,86015,CPT,Facility,Inpatient,,,90,122,103.7,34.9652,122,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Actin Smooth Muscle Antibody Each (Mayo)OutsideLaboratory,,86015,CPT,Facility,Both,,,90,122,103.7,34.9652,122,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),73.2,60,,percent of total billed charges,,
Actin Smooth Muscle Antibody Each (Mayo)OutsideLaboratory,,86015,CPT,Facility,Both,,,90,122,103.7,34.9652,122,"Health Partners, Inc.",State of Minnesota Advantage Program,99.43,81.5,,percent of total billed charges,,
Actin Smooth Muscle Antibody Each (Mayo)OutsideLaboratory,,86015,CPT,Facility,Both,,,90,122,103.7,34.9652,122,"Health Partners, Inc.",State Public Programs,61,50,,percent of total billed charges,,
Actin Smooth Muscle Antibody Each (Mayo)OutsideLaboratory,,86015,CPT,Facility,Both,,,90,122,103.7,34.9652,122,Humana Insurance Company,Commercial PPO,115.9,95,,percent of total billed charges,,
Actin Smooth Muscle Antibody Each (Mayo)OutsideLaboratory,,86015,CPT,Facility,Outpatient,,,90,122,103.7,34.9652,122,Humana Insurance Company,Medicare PPO,59.78,49,,percent of total billed charges,,
Actin Smooth Muscle Antibody Each (Mayo)OutsideLaboratory,,86015,CPT,Facility,Inpatient,,,90,122,103.7,34.9652,122,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Actin Smooth Muscle Antibody Each (Mayo)OutsideLaboratory,,86015,CPT,Facility,Both,,,90,122,103.7,34.9652,122,Medica,Individual & Family,120.902,99.1,,percent of total billed charges,,
Actin Smooth Muscle Antibody Each (Mayo)OutsideLaboratory,,86015,CPT,Facility,Outpatient,,,90,122,103.7,34.9652,122,Medica,Medica Advantage Solution,60.756,49.8,,percent of total billed charges,,
Actin Smooth Muscle Antibody Each (Mayo)OutsideLaboratory,,86015,CPT,Facility,Inpatient,,,90,122,103.7,34.9652,122,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Actin Smooth Muscle Antibody Each (Mayo)OutsideLaboratory,,86015,CPT,Facility,Outpatient,,,90,122,103.7,34.9652,122,Medica,Medical Assistance,54.412,44.6,,percent of total billed charges,,
Actin Smooth Muscle Antibody Each (Mayo)OutsideLaboratory,,86015,CPT,Facility,Inpatient,,,90,122,103.7,34.9652,122,Medica,Medical Assistance,,,,,Included in per diem rate,
Actin Smooth Muscle Antibody Each (Mayo)OutsideLaboratory,,86015,CPT,Facility,Outpatient,,,90,122,103.7,34.9652,122,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,60.756,49.8,,percent of total billed charges,,
Actin Smooth Muscle Antibody Each (Mayo)OutsideLaboratory,,86015,CPT,Facility,Inpatient,,,90,122,103.7,34.9652,122,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Actin Smooth Muscle Antibody Each (Mayo)OutsideLaboratory,,86015,CPT,Facility,Both,,,90,122,103.7,34.9652,122,"Multiplan, Inc.","Multiplan, Inc.",114.68,94,,percent of total billed charges,,
Actin Smooth Muscle Antibody Each (Mayo)OutsideLaboratory,,86015,CPT,Facility,Outpatient,,,90,122,103.7,34.9652,122,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,105.408,86.4,,percent of total billed charges,,
Actin Smooth Muscle Antibody Each (Mayo)OutsideLaboratory,,86015,CPT,Facility,Inpatient,,,90,122,103.7,34.9652,122,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Actin Smooth Muscle Antibody Each (Mayo)OutsideLaboratory,,86015,CPT,Facility,Both,,,90,122,103.7,34.9652,122,"Preferred One Administrative Services, INC.",PPO,120.292,98.6,,percent of total billed charges,,
Actin Smooth Muscle Antibody Each (Mayo)OutsideLaboratory,,86015,CPT,Facility,Outpatient,,,90,122,103.7,34.9652,122,PrimeWest Health,Minnesota Senior Health Options (MSHO),62.769,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Actin Smooth Muscle Antibody Each (Mayo)OutsideLaboratory,,86015,CPT,Facility,Inpatient,,,90,122,103.7,34.9652,122,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Actin Smooth Muscle Antibody Each (Mayo)OutsideLaboratory,,86015,CPT,Facility,Outpatient,,,90,122,103.7,34.9652,122,PrimeWest Health,MinnesotaCare,62.6592,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Actin Smooth Muscle Antibody Each (Mayo)OutsideLaboratory,,86015,CPT,Facility,Inpatient,,,90,122,103.7,34.9652,122,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Actin Smooth Muscle Antibody Each (Mayo)OutsideLaboratory,,86015,CPT,Facility,Both,,,90,122,103.7,34.9652,122,Sanford Health Plan,Sanford Health Plan,112.24,92,,percent of total billed charges,,
Actin Smooth Muscle Antibody Each (Mayo)OutsideLaboratory,,86015,CPT,Facility,Outpatient,,,90,122,103.7,34.9652,122,"UCare Health, Inc.",Individual & Family Plan,68.747,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Actin Smooth Muscle Antibody Each (Mayo)OutsideLaboratory,,86015,CPT,Facility,Inpatient,,,90,122,103.7,34.9652,122,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Actin Smooth Muscle Antibody Each (Mayo)OutsideLaboratory,,86015,CPT,Facility,Outpatient,,,90,122,103.7,34.9652,122,"UCare Health, Inc.",Medical Assistance,61.5734,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Actin Smooth Muscle Antibody Each (Mayo)OutsideLaboratory,,86015,CPT,Facility,Inpatient,,,90,122,103.7,34.9652,122,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Actin Smooth Muscle Antibody Each (Mayo)OutsideLaboratory,,86015,CPT,Facility,Outpatient,,,90,122,103.7,34.9652,122,"UCare Health, Inc.",Medicare Advantage,61.5734,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Actin Smooth Muscle Antibody Each (Mayo)OutsideLaboratory,,86015,CPT,Facility,Inpatient,,,90,122,103.7,34.9652,122,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Actin Smooth Muscle Antibody Each (Mayo)OutsideLaboratory,,86015,CPT,Facility,Outpatient,,,90,122,103.7,34.9652,122,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),61.5734,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Actin Smooth Muscle Antibody Each (Mayo)OutsideLaboratory,,86015,CPT,Facility,Inpatient,,,90,122,103.7,34.9652,122,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Actin Smooth Muscle Antibody Each (Mayo)OutsideLaboratory,,86015,CPT,Facility,Both,,,90,122,103.7,34.9652,122,UnitedHealthcare,Individual & Family,114.68,94,,percent of total billed charges,,
Actin Smooth Muscle Antibody Each (Mayo)OutsideLaboratory,,86015,CPT,Facility,Outpatient,,,90,122,103.7,34.9652,122,UnitedHealthcare,Medicare Advantage,59.78,49,,percent of total billed charges,,
Actin Smooth Muscle Antibody Each (Mayo)OutsideLaboratory,,86015,CPT,Facility,Inpatient,,,90,122,103.7,34.9652,122,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Actin Smooth Muscle Antibody Each (Mayo)OutsideLaboratory,,86015,CPT,Facility,Outpatient,,,90,122,103.7,34.9652,122,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,58.56,48,,percent of total billed charges,,100% of DHS outpatient percentage
Actin Smooth Muscle Antibody Each (Mayo)OutsideLaboratory,,86015,CPT,Facility,Inpatient,,,90,122,103.7,34.9652,122,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Anti-Smooth Muscle Ab (Mayo)OutsideLaboratory,,86015,CPT,Facility,Both,,,90,47,39.95,13.4702,47,Aetna,Commercial,43.24,92,,percent of total billed charges,,
Anti-Smooth Muscle Ab (Mayo)OutsideLaboratory,,86015,CPT,Facility,Outpatient,,,90,47,39.95,13.4702,47,Aetna,Medicare Advantage,23.03,49,,percent of total billed charges,,
Anti-Smooth Muscle Ab (Mayo)OutsideLaboratory,,86015,CPT,Facility,Inpatient,,,90,47,39.95,13.4702,47,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Anti-Smooth Muscle Ab (Mayo)OutsideLaboratory,,86015,CPT,Facility,Both,,,90,47,39.95,13.4702,47,Aetna,PPO,43.71,93,,percent of total billed charges,,
Anti-Smooth Muscle Ab (Mayo)OutsideLaboratory,,86015,CPT,Facility,Both,,,90,47,39.95,13.4702,47,America's PPO,America's PPO,45.1341,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Anti-Smooth Muscle Ab (Mayo)OutsideLaboratory,,86015,CPT,Facility,Both,,,90,47,39.95,13.4702,47,BlueCross BlueShield Minnesota, Federal Employee Program,46.248,98.4,,percent of total billed charges,,
Anti-Smooth Muscle Ab (Mayo)OutsideLaboratory,,86015,CPT,Facility,Both,,,90,47,39.95,13.4702,47,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,47,100,,percent of total billed charges,,
Anti-Smooth Muscle Ab (Mayo)OutsideLaboratory,,86015,CPT,Facility,Both,,,90,47,39.95,13.4702,47,BlueCross BlueShield Minnesota,High Value Network Plan,42.3,90,,percent of total billed charges,,
Anti-Smooth Muscle Ab (Mayo)OutsideLaboratory,,86015,CPT,Facility,Outpatient,,,90,47,39.95,13.4702,47,BlueCross BlueShield Minnesota,Medicare Advantage,23.03,49,,percent of total billed charges,,
Anti-Smooth Muscle Ab (Mayo)OutsideLaboratory,,86015,CPT,Facility,Inpatient,,,90,47,39.95,13.4702,47,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Anti-Smooth Muscle Ab (Mayo)OutsideLaboratory,,86015,CPT,Facility,Both,,,90,47,39.95,13.4702,47,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,41.6279,88.57,,percent of total billed charges,,
Anti-Smooth Muscle Ab (Mayo)OutsideLaboratory,,86015,CPT,Facility,Both,,,90,47,39.95,13.4702,47,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,13.4702,28.66,,percent of total billed charges,,
Anti-Smooth Muscle Ab (Mayo)OutsideLaboratory,,86015,CPT,Facility,Outpatient,,,90,47,39.95,13.4702,47,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),23.03,49,,percent of total billed charges,,
Anti-Smooth Muscle Ab (Mayo)OutsideLaboratory,,86015,CPT,Facility,Inpatient,,,90,47,39.95,13.4702,47,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Anti-Smooth Muscle Ab (Mayo)OutsideLaboratory,,86015,CPT,Facility,Both,,,90,47,39.95,13.4702,47,CorVel,Worker's Compensation,47,100,,percent of total billed charges,,
Anti-Smooth Muscle Ab (Mayo)OutsideLaboratory,,86015,CPT,Facility,Both,,,90,47,39.95,13.4702,47,First Health Group Corporation,First Health Network,45.59,97,,percent of total billed charges,,
Anti-Smooth Muscle Ab (Mayo)OutsideLaboratory,,86015,CPT,Facility,Both,,,90,47,39.95,13.4702,47,"Health Partners, Inc.",Commercial,44.462,94.6,,percent of total billed charges,,
Anti-Smooth Muscle Ab (Mayo)OutsideLaboratory,,86015,CPT,Facility,Outpatient,,,90,47,39.95,13.4702,47,"Health Partners, Inc.",Medicare Advantage,23.03,49,,percent of total billed charges,,
Anti-Smooth Muscle Ab (Mayo)OutsideLaboratory,,86015,CPT,Facility,Inpatient,,,90,47,39.95,13.4702,47,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Anti-Smooth Muscle Ab (Mayo)OutsideLaboratory,,86015,CPT,Facility,Both,,,90,47,39.95,13.4702,47,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),28.2,60,,percent of total billed charges,,
Anti-Smooth Muscle Ab (Mayo)OutsideLaboratory,,86015,CPT,Facility,Both,,,90,47,39.95,13.4702,47,"Health Partners, Inc.",State of Minnesota Advantage Program,38.305,81.5,,percent of total billed charges,,
Anti-Smooth Muscle Ab (Mayo)OutsideLaboratory,,86015,CPT,Facility,Both,,,90,47,39.95,13.4702,47,"Health Partners, Inc.",State Public Programs,23.5,50,,percent of total billed charges,,
Anti-Smooth Muscle Ab (Mayo)OutsideLaboratory,,86015,CPT,Facility,Both,,,90,47,39.95,13.4702,47,Humana Insurance Company,Commercial PPO,44.65,95,,percent of total billed charges,,
Anti-Smooth Muscle Ab (Mayo)OutsideLaboratory,,86015,CPT,Facility,Outpatient,,,90,47,39.95,13.4702,47,Humana Insurance Company,Medicare PPO,23.03,49,,percent of total billed charges,,
Anti-Smooth Muscle Ab (Mayo)OutsideLaboratory,,86015,CPT,Facility,Inpatient,,,90,47,39.95,13.4702,47,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Anti-Smooth Muscle Ab (Mayo)OutsideLaboratory,,86015,CPT,Facility,Both,,,90,47,39.95,13.4702,47,Medica,Individual & Family,46.577,99.1,,percent of total billed charges,,
Anti-Smooth Muscle Ab (Mayo)OutsideLaboratory,,86015,CPT,Facility,Outpatient,,,90,47,39.95,13.4702,47,Medica,Medica Advantage Solution,23.406,49.8,,percent of total billed charges,,
Anti-Smooth Muscle Ab (Mayo)OutsideLaboratory,,86015,CPT,Facility,Inpatient,,,90,47,39.95,13.4702,47,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Anti-Smooth Muscle Ab (Mayo)OutsideLaboratory,,86015,CPT,Facility,Outpatient,,,90,47,39.95,13.4702,47,Medica,Medical Assistance,20.962,44.6,,percent of total billed charges,,
Anti-Smooth Muscle Ab (Mayo)OutsideLaboratory,,86015,CPT,Facility,Inpatient,,,90,47,39.95,13.4702,47,Medica,Medical Assistance,,,,,Included in per diem rate,
Anti-Smooth Muscle Ab (Mayo)OutsideLaboratory,,86015,CPT,Facility,Outpatient,,,90,47,39.95,13.4702,47,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,23.406,49.8,,percent of total billed charges,,
Anti-Smooth Muscle Ab (Mayo)OutsideLaboratory,,86015,CPT,Facility,Inpatient,,,90,47,39.95,13.4702,47,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Anti-Smooth Muscle Ab (Mayo)OutsideLaboratory,,86015,CPT,Facility,Both,,,90,47,39.95,13.4702,47,"Multiplan, Inc.","Multiplan, Inc.",44.18,94,,percent of total billed charges,,
Anti-Smooth Muscle Ab (Mayo)OutsideLaboratory,,86015,CPT,Facility,Outpatient,,,90,47,39.95,13.4702,47,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,40.608,86.4,,percent of total billed charges,,
Anti-Smooth Muscle Ab (Mayo)OutsideLaboratory,,86015,CPT,Facility,Inpatient,,,90,47,39.95,13.4702,47,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Anti-Smooth Muscle Ab (Mayo)OutsideLaboratory,,86015,CPT,Facility,Both,,,90,47,39.95,13.4702,47,"Preferred One Administrative Services, INC.",PPO,46.342,98.6,,percent of total billed charges,,
Anti-Smooth Muscle Ab (Mayo)OutsideLaboratory,,86015,CPT,Facility,Outpatient,,,90,47,39.95,13.4702,47,PrimeWest Health,Minnesota Senior Health Options (MSHO),24.1815,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Anti-Smooth Muscle Ab (Mayo)OutsideLaboratory,,86015,CPT,Facility,Inpatient,,,90,47,39.95,13.4702,47,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Anti-Smooth Muscle Ab (Mayo)OutsideLaboratory,,86015,CPT,Facility,Outpatient,,,90,47,39.95,13.4702,47,PrimeWest Health,MinnesotaCare,24.1392,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Anti-Smooth Muscle Ab (Mayo)OutsideLaboratory,,86015,CPT,Facility,Inpatient,,,90,47,39.95,13.4702,47,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Anti-Smooth Muscle Ab (Mayo)OutsideLaboratory,,86015,CPT,Facility,Both,,,90,47,39.95,13.4702,47,Sanford Health Plan,Sanford Health Plan,43.24,92,,percent of total billed charges,,
Anti-Smooth Muscle Ab (Mayo)OutsideLaboratory,,86015,CPT,Facility,Outpatient,,,90,47,39.95,13.4702,47,"UCare Health, Inc.",Individual & Family Plan,26.4845,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Anti-Smooth Muscle Ab (Mayo)OutsideLaboratory,,86015,CPT,Facility,Inpatient,,,90,47,39.95,13.4702,47,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Anti-Smooth Muscle Ab (Mayo)OutsideLaboratory,,86015,CPT,Facility,Outpatient,,,90,47,39.95,13.4702,47,"UCare Health, Inc.",Medical Assistance,23.7209,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Anti-Smooth Muscle Ab (Mayo)OutsideLaboratory,,86015,CPT,Facility,Inpatient,,,90,47,39.95,13.4702,47,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Anti-Smooth Muscle Ab (Mayo)OutsideLaboratory,,86015,CPT,Facility,Outpatient,,,90,47,39.95,13.4702,47,"UCare Health, Inc.",Medicare Advantage,23.7209,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Anti-Smooth Muscle Ab (Mayo)OutsideLaboratory,,86015,CPT,Facility,Inpatient,,,90,47,39.95,13.4702,47,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Anti-Smooth Muscle Ab (Mayo)OutsideLaboratory,,86015,CPT,Facility,Outpatient,,,90,47,39.95,13.4702,47,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),23.7209,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Anti-Smooth Muscle Ab (Mayo)OutsideLaboratory,,86015,CPT,Facility,Inpatient,,,90,47,39.95,13.4702,47,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Anti-Smooth Muscle Ab (Mayo)OutsideLaboratory,,86015,CPT,Facility,Both,,,90,47,39.95,13.4702,47,UnitedHealthcare,Individual & Family,44.18,94,,percent of total billed charges,,
Anti-Smooth Muscle Ab (Mayo)OutsideLaboratory,,86015,CPT,Facility,Outpatient,,,90,47,39.95,13.4702,47,UnitedHealthcare,Medicare Advantage,23.03,49,,percent of total billed charges,,
Anti-Smooth Muscle Ab (Mayo)OutsideLaboratory,,86015,CPT,Facility,Inpatient,,,90,47,39.95,13.4702,47,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Anti-Smooth Muscle Ab (Mayo)OutsideLaboratory,,86015,CPT,Facility,Outpatient,,,90,47,39.95,13.4702,47,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,22.56,48,,percent of total billed charges,,100% of DHS outpatient percentage
Anti-Smooth Muscle Ab (Mayo)OutsideLaboratory,,86015,CPT,Facility,Inpatient,,,90,47,39.95,13.4702,47,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Cytoplasmic Neutrophilic Ab, S (Mayo)OutsideLaboratory",,86036,CPT,Facility,Both,,,90,162,137.7,46.4292,162,Aetna,Commercial,149.04,92,,percent of total billed charges,,
"Cytoplasmic Neutrophilic Ab, S (Mayo)OutsideLaboratory",,86036,CPT,Facility,Outpatient,,,90,162,137.7,46.4292,162,Aetna,Medicare Advantage,79.38,49,,percent of total billed charges,,
"Cytoplasmic Neutrophilic Ab, S (Mayo)OutsideLaboratory",,86036,CPT,Facility,Inpatient,,,90,162,137.7,46.4292,162,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Cytoplasmic Neutrophilic Ab, S (Mayo)OutsideLaboratory",,86036,CPT,Facility,Both,,,90,162,137.7,46.4292,162,Aetna,PPO,150.66,93,,percent of total billed charges,,
"Cytoplasmic Neutrophilic Ab, S (Mayo)OutsideLaboratory",,86036,CPT,Facility,Both,,,90,162,137.7,46.4292,162,America's PPO,America's PPO,155.5686,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Cytoplasmic Neutrophilic Ab, S (Mayo)OutsideLaboratory",,86036,CPT,Facility,Both,,,90,162,137.7,46.4292,162,BlueCross BlueShield Minnesota, Federal Employee Program,159.408,98.4,,percent of total billed charges,,
"Cytoplasmic Neutrophilic Ab, S (Mayo)OutsideLaboratory",,86036,CPT,Facility,Both,,,90,162,137.7,46.4292,162,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,162,100,,percent of total billed charges,,
"Cytoplasmic Neutrophilic Ab, S (Mayo)OutsideLaboratory",,86036,CPT,Facility,Both,,,90,162,137.7,46.4292,162,BlueCross BlueShield Minnesota,High Value Network Plan,145.8,90,,percent of total billed charges,,
"Cytoplasmic Neutrophilic Ab, S (Mayo)OutsideLaboratory",,86036,CPT,Facility,Outpatient,,,90,162,137.7,46.4292,162,BlueCross BlueShield Minnesota,Medicare Advantage,79.38,49,,percent of total billed charges,,
"Cytoplasmic Neutrophilic Ab, S (Mayo)OutsideLaboratory",,86036,CPT,Facility,Inpatient,,,90,162,137.7,46.4292,162,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Cytoplasmic Neutrophilic Ab, S (Mayo)OutsideLaboratory",,86036,CPT,Facility,Both,,,90,162,137.7,46.4292,162,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,143.4834,88.57,,percent of total billed charges,,
"Cytoplasmic Neutrophilic Ab, S (Mayo)OutsideLaboratory",,86036,CPT,Facility,Both,,,90,162,137.7,46.4292,162,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,46.4292,28.66,,percent of total billed charges,,
"Cytoplasmic Neutrophilic Ab, S (Mayo)OutsideLaboratory",,86036,CPT,Facility,Outpatient,,,90,162,137.7,46.4292,162,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),79.38,49,,percent of total billed charges,,
"Cytoplasmic Neutrophilic Ab, S (Mayo)OutsideLaboratory",,86036,CPT,Facility,Inpatient,,,90,162,137.7,46.4292,162,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Cytoplasmic Neutrophilic Ab, S (Mayo)OutsideLaboratory",,86036,CPT,Facility,Both,,,90,162,137.7,46.4292,162,CorVel,Worker's Compensation,162,100,,percent of total billed charges,,
"Cytoplasmic Neutrophilic Ab, S (Mayo)OutsideLaboratory",,86036,CPT,Facility,Both,,,90,162,137.7,46.4292,162,First Health Group Corporation,First Health Network,157.14,97,,percent of total billed charges,,
"Cytoplasmic Neutrophilic Ab, S (Mayo)OutsideLaboratory",,86036,CPT,Facility,Both,,,90,162,137.7,46.4292,162,"Health Partners, Inc.",Commercial,153.252,94.6,,percent of total billed charges,,
"Cytoplasmic Neutrophilic Ab, S (Mayo)OutsideLaboratory",,86036,CPT,Facility,Outpatient,,,90,162,137.7,46.4292,162,"Health Partners, Inc.",Medicare Advantage,79.38,49,,percent of total billed charges,,
"Cytoplasmic Neutrophilic Ab, S (Mayo)OutsideLaboratory",,86036,CPT,Facility,Inpatient,,,90,162,137.7,46.4292,162,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Cytoplasmic Neutrophilic Ab, S (Mayo)OutsideLaboratory",,86036,CPT,Facility,Both,,,90,162,137.7,46.4292,162,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),97.2,60,,percent of total billed charges,,
"Cytoplasmic Neutrophilic Ab, S (Mayo)OutsideLaboratory",,86036,CPT,Facility,Both,,,90,162,137.7,46.4292,162,"Health Partners, Inc.",State of Minnesota Advantage Program,132.03,81.5,,percent of total billed charges,,
"Cytoplasmic Neutrophilic Ab, S (Mayo)OutsideLaboratory",,86036,CPT,Facility,Both,,,90,162,137.7,46.4292,162,"Health Partners, Inc.",State Public Programs,81,50,,percent of total billed charges,,
"Cytoplasmic Neutrophilic Ab, S (Mayo)OutsideLaboratory",,86036,CPT,Facility,Both,,,90,162,137.7,46.4292,162,Humana Insurance Company,Commercial PPO,153.9,95,,percent of total billed charges,,
"Cytoplasmic Neutrophilic Ab, S (Mayo)OutsideLaboratory",,86036,CPT,Facility,Outpatient,,,90,162,137.7,46.4292,162,Humana Insurance Company,Medicare PPO,79.38,49,,percent of total billed charges,,
"Cytoplasmic Neutrophilic Ab, S (Mayo)OutsideLaboratory",,86036,CPT,Facility,Inpatient,,,90,162,137.7,46.4292,162,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Cytoplasmic Neutrophilic Ab, S (Mayo)OutsideLaboratory",,86036,CPT,Facility,Both,,,90,162,137.7,46.4292,162,Medica,Individual & Family,160.542,99.1,,percent of total billed charges,,
"Cytoplasmic Neutrophilic Ab, S (Mayo)OutsideLaboratory",,86036,CPT,Facility,Outpatient,,,90,162,137.7,46.4292,162,Medica,Medica Advantage Solution,80.676,49.8,,percent of total billed charges,,
"Cytoplasmic Neutrophilic Ab, S (Mayo)OutsideLaboratory",,86036,CPT,Facility,Inpatient,,,90,162,137.7,46.4292,162,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Cytoplasmic Neutrophilic Ab, S (Mayo)OutsideLaboratory",,86036,CPT,Facility,Outpatient,,,90,162,137.7,46.4292,162,Medica,Medical Assistance,72.252,44.6,,percent of total billed charges,,
"Cytoplasmic Neutrophilic Ab, S (Mayo)OutsideLaboratory",,86036,CPT,Facility,Inpatient,,,90,162,137.7,46.4292,162,Medica,Medical Assistance,,,,,Included in per diem rate,
"Cytoplasmic Neutrophilic Ab, S (Mayo)OutsideLaboratory",,86036,CPT,Facility,Outpatient,,,90,162,137.7,46.4292,162,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,80.676,49.8,,percent of total billed charges,,
"Cytoplasmic Neutrophilic Ab, S (Mayo)OutsideLaboratory",,86036,CPT,Facility,Inpatient,,,90,162,137.7,46.4292,162,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Cytoplasmic Neutrophilic Ab, S (Mayo)OutsideLaboratory",,86036,CPT,Facility,Both,,,90,162,137.7,46.4292,162,"Multiplan, Inc.","Multiplan, Inc.",152.28,94,,percent of total billed charges,,
"Cytoplasmic Neutrophilic Ab, S (Mayo)OutsideLaboratory",,86036,CPT,Facility,Outpatient,,,90,162,137.7,46.4292,162,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,139.968,86.4,,percent of total billed charges,,
"Cytoplasmic Neutrophilic Ab, S (Mayo)OutsideLaboratory",,86036,CPT,Facility,Inpatient,,,90,162,137.7,46.4292,162,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Cytoplasmic Neutrophilic Ab, S (Mayo)OutsideLaboratory",,86036,CPT,Facility,Both,,,90,162,137.7,46.4292,162,"Preferred One Administrative Services, INC.",PPO,159.732,98.6,,percent of total billed charges,,
"Cytoplasmic Neutrophilic Ab, S (Mayo)OutsideLaboratory",,86036,CPT,Facility,Outpatient,,,90,162,137.7,46.4292,162,PrimeWest Health,Minnesota Senior Health Options (MSHO),83.349,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Cytoplasmic Neutrophilic Ab, S (Mayo)OutsideLaboratory",,86036,CPT,Facility,Inpatient,,,90,162,137.7,46.4292,162,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Cytoplasmic Neutrophilic Ab, S (Mayo)OutsideLaboratory",,86036,CPT,Facility,Outpatient,,,90,162,137.7,46.4292,162,PrimeWest Health,MinnesotaCare,83.2032,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Cytoplasmic Neutrophilic Ab, S (Mayo)OutsideLaboratory",,86036,CPT,Facility,Inpatient,,,90,162,137.7,46.4292,162,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Cytoplasmic Neutrophilic Ab, S (Mayo)OutsideLaboratory",,86036,CPT,Facility,Both,,,90,162,137.7,46.4292,162,Sanford Health Plan,Sanford Health Plan,149.04,92,,percent of total billed charges,,
"Cytoplasmic Neutrophilic Ab, S (Mayo)OutsideLaboratory",,86036,CPT,Facility,Outpatient,,,90,162,137.7,46.4292,162,"UCare Health, Inc.",Individual & Family Plan,91.287,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Cytoplasmic Neutrophilic Ab, S (Mayo)OutsideLaboratory",,86036,CPT,Facility,Inpatient,,,90,162,137.7,46.4292,162,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Cytoplasmic Neutrophilic Ab, S (Mayo)OutsideLaboratory",,86036,CPT,Facility,Outpatient,,,90,162,137.7,46.4292,162,"UCare Health, Inc.",Medical Assistance,81.7614,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Cytoplasmic Neutrophilic Ab, S (Mayo)OutsideLaboratory",,86036,CPT,Facility,Inpatient,,,90,162,137.7,46.4292,162,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Cytoplasmic Neutrophilic Ab, S (Mayo)OutsideLaboratory",,86036,CPT,Facility,Outpatient,,,90,162,137.7,46.4292,162,"UCare Health, Inc.",Medicare Advantage,81.7614,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Cytoplasmic Neutrophilic Ab, S (Mayo)OutsideLaboratory",,86036,CPT,Facility,Inpatient,,,90,162,137.7,46.4292,162,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Cytoplasmic Neutrophilic Ab, S (Mayo)OutsideLaboratory",,86036,CPT,Facility,Outpatient,,,90,162,137.7,46.4292,162,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),81.7614,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Cytoplasmic Neutrophilic Ab, S (Mayo)OutsideLaboratory",,86036,CPT,Facility,Inpatient,,,90,162,137.7,46.4292,162,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Cytoplasmic Neutrophilic Ab, S (Mayo)OutsideLaboratory",,86036,CPT,Facility,Both,,,90,162,137.7,46.4292,162,UnitedHealthcare,Individual & Family,152.28,94,,percent of total billed charges,,
"Cytoplasmic Neutrophilic Ab, S (Mayo)OutsideLaboratory",,86036,CPT,Facility,Outpatient,,,90,162,137.7,46.4292,162,UnitedHealthcare,Medicare Advantage,79.38,49,,percent of total billed charges,,
"Cytoplasmic Neutrophilic Ab, S (Mayo)OutsideLaboratory",,86036,CPT,Facility,Inpatient,,,90,162,137.7,46.4292,162,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Cytoplasmic Neutrophilic Ab, S (Mayo)OutsideLaboratory",,86036,CPT,Facility,Outpatient,,,90,162,137.7,46.4292,162,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,77.76,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Cytoplasmic Neutrophilic Ab, S (Mayo)OutsideLaboratory",,86036,CPT,Facility,Inpatient,,,90,162,137.7,46.4292,162,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Connective Tissue Disease Cascade,S (Mayo)OutsideLaboratory",,86038,CPT,Facility,Both,,,90,201,170.85,57.6066,201,Aetna,Commercial,184.92,92,,percent of total billed charges,,
"Connective Tissue Disease Cascade,S (Mayo)OutsideLaboratory",,86038,CPT,Facility,Outpatient,,,90,201,170.85,57.6066,201,Aetna,Medicare Advantage,98.49,49,,percent of total billed charges,,
"Connective Tissue Disease Cascade,S (Mayo)OutsideLaboratory",,86038,CPT,Facility,Inpatient,,,90,201,170.85,57.6066,201,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Connective Tissue Disease Cascade,S (Mayo)OutsideLaboratory",,86038,CPT,Facility,Both,,,90,201,170.85,57.6066,201,Aetna,PPO,186.93,93,,percent of total billed charges,,
"Connective Tissue Disease Cascade,S (Mayo)OutsideLaboratory",,86038,CPT,Facility,Both,,,90,201,170.85,57.6066,201,America's PPO,America's PPO,193.0203,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Connective Tissue Disease Cascade,S (Mayo)OutsideLaboratory",,86038,CPT,Facility,Both,,,90,201,170.85,57.6066,201,BlueCross BlueShield Minnesota, Federal Employee Program,197.784,98.4,,percent of total billed charges,,
"Connective Tissue Disease Cascade,S (Mayo)OutsideLaboratory",,86038,CPT,Facility,Both,,,90,201,170.85,57.6066,201,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,201,100,,percent of total billed charges,,
"Connective Tissue Disease Cascade,S (Mayo)OutsideLaboratory",,86038,CPT,Facility,Both,,,90,201,170.85,57.6066,201,BlueCross BlueShield Minnesota,High Value Network Plan,180.9,90,,percent of total billed charges,,
"Connective Tissue Disease Cascade,S (Mayo)OutsideLaboratory",,86038,CPT,Facility,Outpatient,,,90,201,170.85,57.6066,201,BlueCross BlueShield Minnesota,Medicare Advantage,98.49,49,,percent of total billed charges,,
"Connective Tissue Disease Cascade,S (Mayo)OutsideLaboratory",,86038,CPT,Facility,Inpatient,,,90,201,170.85,57.6066,201,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Connective Tissue Disease Cascade,S (Mayo)OutsideLaboratory",,86038,CPT,Facility,Both,,,90,201,170.85,57.6066,201,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,178.0257,88.57,,percent of total billed charges,,
"Connective Tissue Disease Cascade,S (Mayo)OutsideLaboratory",,86038,CPT,Facility,Both,,,90,201,170.85,57.6066,201,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,57.6066,28.66,,percent of total billed charges,,
"Connective Tissue Disease Cascade,S (Mayo)OutsideLaboratory",,86038,CPT,Facility,Outpatient,,,90,201,170.85,57.6066,201,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),98.49,49,,percent of total billed charges,,
"Connective Tissue Disease Cascade,S (Mayo)OutsideLaboratory",,86038,CPT,Facility,Inpatient,,,90,201,170.85,57.6066,201,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Connective Tissue Disease Cascade,S (Mayo)OutsideLaboratory",,86038,CPT,Facility,Both,,,90,201,170.85,57.6066,201,CorVel,Worker's Compensation,201,100,,percent of total billed charges,,
"Connective Tissue Disease Cascade,S (Mayo)OutsideLaboratory",,86038,CPT,Facility,Both,,,90,201,170.85,57.6066,201,First Health Group Corporation,First Health Network,194.97,97,,percent of total billed charges,,
"Connective Tissue Disease Cascade,S (Mayo)OutsideLaboratory",,86038,CPT,Facility,Both,,,90,201,170.85,57.6066,201,"Health Partners, Inc.",Commercial,190.146,94.6,,percent of total billed charges,,
"Connective Tissue Disease Cascade,S (Mayo)OutsideLaboratory",,86038,CPT,Facility,Outpatient,,,90,201,170.85,57.6066,201,"Health Partners, Inc.",Medicare Advantage,98.49,49,,percent of total billed charges,,
"Connective Tissue Disease Cascade,S (Mayo)OutsideLaboratory",,86038,CPT,Facility,Inpatient,,,90,201,170.85,57.6066,201,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Connective Tissue Disease Cascade,S (Mayo)OutsideLaboratory",,86038,CPT,Facility,Both,,,90,201,170.85,57.6066,201,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),120.6,60,,percent of total billed charges,,
"Connective Tissue Disease Cascade,S (Mayo)OutsideLaboratory",,86038,CPT,Facility,Both,,,90,201,170.85,57.6066,201,"Health Partners, Inc.",State of Minnesota Advantage Program,163.815,81.5,,percent of total billed charges,,
"Connective Tissue Disease Cascade,S (Mayo)OutsideLaboratory",,86038,CPT,Facility,Both,,,90,201,170.85,57.6066,201,"Health Partners, Inc.",State Public Programs,100.5,50,,percent of total billed charges,,
"Connective Tissue Disease Cascade,S (Mayo)OutsideLaboratory",,86038,CPT,Facility,Both,,,90,201,170.85,57.6066,201,Humana Insurance Company,Commercial PPO,190.95,95,,percent of total billed charges,,
"Connective Tissue Disease Cascade,S (Mayo)OutsideLaboratory",,86038,CPT,Facility,Outpatient,,,90,201,170.85,57.6066,201,Humana Insurance Company,Medicare PPO,98.49,49,,percent of total billed charges,,
"Connective Tissue Disease Cascade,S (Mayo)OutsideLaboratory",,86038,CPT,Facility,Inpatient,,,90,201,170.85,57.6066,201,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Connective Tissue Disease Cascade,S (Mayo)OutsideLaboratory",,86038,CPT,Facility,Both,,,90,201,170.85,57.6066,201,Medica,Individual & Family,199.191,99.1,,percent of total billed charges,,
"Connective Tissue Disease Cascade,S (Mayo)OutsideLaboratory",,86038,CPT,Facility,Outpatient,,,90,201,170.85,57.6066,201,Medica,Medica Advantage Solution,100.098,49.8,,percent of total billed charges,,
"Connective Tissue Disease Cascade,S (Mayo)OutsideLaboratory",,86038,CPT,Facility,Inpatient,,,90,201,170.85,57.6066,201,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Connective Tissue Disease Cascade,S (Mayo)OutsideLaboratory",,86038,CPT,Facility,Outpatient,,,90,201,170.85,57.6066,201,Medica,Medical Assistance,89.646,44.6,,percent of total billed charges,,
"Connective Tissue Disease Cascade,S (Mayo)OutsideLaboratory",,86038,CPT,Facility,Inpatient,,,90,201,170.85,57.6066,201,Medica,Medical Assistance,,,,,Included in per diem rate,
"Connective Tissue Disease Cascade,S (Mayo)OutsideLaboratory",,86038,CPT,Facility,Outpatient,,,90,201,170.85,57.6066,201,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,100.098,49.8,,percent of total billed charges,,
"Connective Tissue Disease Cascade,S (Mayo)OutsideLaboratory",,86038,CPT,Facility,Inpatient,,,90,201,170.85,57.6066,201,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Connective Tissue Disease Cascade,S (Mayo)OutsideLaboratory",,86038,CPT,Facility,Both,,,90,201,170.85,57.6066,201,"Multiplan, Inc.","Multiplan, Inc.",188.94,94,,percent of total billed charges,,
"Connective Tissue Disease Cascade,S (Mayo)OutsideLaboratory",,86038,CPT,Facility,Outpatient,,,90,201,170.85,57.6066,201,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,173.664,86.4,,percent of total billed charges,,
"Connective Tissue Disease Cascade,S (Mayo)OutsideLaboratory",,86038,CPT,Facility,Inpatient,,,90,201,170.85,57.6066,201,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Connective Tissue Disease Cascade,S (Mayo)OutsideLaboratory",,86038,CPT,Facility,Both,,,90,201,170.85,57.6066,201,"Preferred One Administrative Services, INC.",PPO,198.186,98.6,,percent of total billed charges,,
"Connective Tissue Disease Cascade,S (Mayo)OutsideLaboratory",,86038,CPT,Facility,Outpatient,,,90,201,170.85,57.6066,201,PrimeWest Health,Minnesota Senior Health Options (MSHO),103.4145,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Connective Tissue Disease Cascade,S (Mayo)OutsideLaboratory",,86038,CPT,Facility,Inpatient,,,90,201,170.85,57.6066,201,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Connective Tissue Disease Cascade,S (Mayo)OutsideLaboratory",,86038,CPT,Facility,Outpatient,,,90,201,170.85,57.6066,201,PrimeWest Health,MinnesotaCare,103.2336,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Connective Tissue Disease Cascade,S (Mayo)OutsideLaboratory",,86038,CPT,Facility,Inpatient,,,90,201,170.85,57.6066,201,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Connective Tissue Disease Cascade,S (Mayo)OutsideLaboratory",,86038,CPT,Facility,Both,,,90,201,170.85,57.6066,201,Sanford Health Plan,Sanford Health Plan,184.92,92,,percent of total billed charges,,
"Connective Tissue Disease Cascade,S (Mayo)OutsideLaboratory",,86038,CPT,Facility,Outpatient,,,90,201,170.85,57.6066,201,"UCare Health, Inc.",Individual & Family Plan,113.2635,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Connective Tissue Disease Cascade,S (Mayo)OutsideLaboratory",,86038,CPT,Facility,Inpatient,,,90,201,170.85,57.6066,201,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Connective Tissue Disease Cascade,S (Mayo)OutsideLaboratory",,86038,CPT,Facility,Outpatient,,,90,201,170.85,57.6066,201,"UCare Health, Inc.",Medical Assistance,101.4447,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Connective Tissue Disease Cascade,S (Mayo)OutsideLaboratory",,86038,CPT,Facility,Inpatient,,,90,201,170.85,57.6066,201,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Connective Tissue Disease Cascade,S (Mayo)OutsideLaboratory",,86038,CPT,Facility,Outpatient,,,90,201,170.85,57.6066,201,"UCare Health, Inc.",Medicare Advantage,101.4447,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Connective Tissue Disease Cascade,S (Mayo)OutsideLaboratory",,86038,CPT,Facility,Inpatient,,,90,201,170.85,57.6066,201,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Connective Tissue Disease Cascade,S (Mayo)OutsideLaboratory",,86038,CPT,Facility,Outpatient,,,90,201,170.85,57.6066,201,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),101.4447,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Connective Tissue Disease Cascade,S (Mayo)OutsideLaboratory",,86038,CPT,Facility,Inpatient,,,90,201,170.85,57.6066,201,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Connective Tissue Disease Cascade,S (Mayo)OutsideLaboratory",,86038,CPT,Facility,Both,,,90,201,170.85,57.6066,201,UnitedHealthcare,Individual & Family,188.94,94,,percent of total billed charges,,
"Connective Tissue Disease Cascade,S (Mayo)OutsideLaboratory",,86038,CPT,Facility,Outpatient,,,90,201,170.85,57.6066,201,UnitedHealthcare,Medicare Advantage,98.49,49,,percent of total billed charges,,
"Connective Tissue Disease Cascade,S (Mayo)OutsideLaboratory",,86038,CPT,Facility,Inpatient,,,90,201,170.85,57.6066,201,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Connective Tissue Disease Cascade,S (Mayo)OutsideLaboratory",,86038,CPT,Facility,Outpatient,,,90,201,170.85,57.6066,201,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,96.48,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Connective Tissue Disease Cascade,S (Mayo)OutsideLaboratory",,86038,CPT,Facility,Inpatient,,,90,201,170.85,57.6066,201,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
C-Reactive Protein (Mayo)OutsideLaboratory,,86140,CPT,Facility,Both,,,90,104,88.4,29.8064,104,Aetna,Commercial,95.68,92,,percent of total billed charges,,
C-Reactive Protein (Mayo)OutsideLaboratory,,86140,CPT,Facility,Outpatient,,,90,104,88.4,29.8064,104,Aetna,Medicare Advantage,50.96,49,,percent of total billed charges,,
C-Reactive Protein (Mayo)OutsideLaboratory,,86140,CPT,Facility,Inpatient,,,90,104,88.4,29.8064,104,Aetna,Medicare Advantage,,,,,Included in per diem rate,
C-Reactive Protein (Mayo)OutsideLaboratory,,86140,CPT,Facility,Both,,,90,104,88.4,29.8064,104,Aetna,PPO,96.72,93,,percent of total billed charges,,
C-Reactive Protein (Mayo)OutsideLaboratory,,86140,CPT,Facility,Both,,,90,104,88.4,29.8064,104,America's PPO,America's PPO,99.8712,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
C-Reactive Protein (Mayo)OutsideLaboratory,,86140,CPT,Facility,Both,,,90,104,88.4,29.8064,104,BlueCross BlueShield Minnesota, Federal Employee Program,102.336,98.4,,percent of total billed charges,,
C-Reactive Protein (Mayo)OutsideLaboratory,,86140,CPT,Facility,Both,,,90,104,88.4,29.8064,104,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,104,100,,percent of total billed charges,,
C-Reactive Protein (Mayo)OutsideLaboratory,,86140,CPT,Facility,Both,,,90,104,88.4,29.8064,104,BlueCross BlueShield Minnesota,High Value Network Plan,93.6,90,,percent of total billed charges,,
C-Reactive Protein (Mayo)OutsideLaboratory,,86140,CPT,Facility,Outpatient,,,90,104,88.4,29.8064,104,BlueCross BlueShield Minnesota,Medicare Advantage,50.96,49,,percent of total billed charges,,
C-Reactive Protein (Mayo)OutsideLaboratory,,86140,CPT,Facility,Inpatient,,,90,104,88.4,29.8064,104,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
C-Reactive Protein (Mayo)OutsideLaboratory,,86140,CPT,Facility,Both,,,90,104,88.4,29.8064,104,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,92.1128,88.57,,percent of total billed charges,,
C-Reactive Protein (Mayo)OutsideLaboratory,,86140,CPT,Facility,Both,,,90,104,88.4,29.8064,104,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,29.8064,28.66,,percent of total billed charges,,
C-Reactive Protein (Mayo)OutsideLaboratory,,86140,CPT,Facility,Outpatient,,,90,104,88.4,29.8064,104,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),50.96,49,,percent of total billed charges,,
C-Reactive Protein (Mayo)OutsideLaboratory,,86140,CPT,Facility,Inpatient,,,90,104,88.4,29.8064,104,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
C-Reactive Protein (Mayo)OutsideLaboratory,,86140,CPT,Facility,Both,,,90,104,88.4,29.8064,104,CorVel,Worker's Compensation,104,100,,percent of total billed charges,,
C-Reactive Protein (Mayo)OutsideLaboratory,,86140,CPT,Facility,Both,,,90,104,88.4,29.8064,104,First Health Group Corporation,First Health Network,100.88,97,,percent of total billed charges,,
C-Reactive Protein (Mayo)OutsideLaboratory,,86140,CPT,Facility,Both,,,90,104,88.4,29.8064,104,"Health Partners, Inc.",Commercial,98.384,94.6,,percent of total billed charges,,
C-Reactive Protein (Mayo)OutsideLaboratory,,86140,CPT,Facility,Outpatient,,,90,104,88.4,29.8064,104,"Health Partners, Inc.",Medicare Advantage,50.96,49,,percent of total billed charges,,
C-Reactive Protein (Mayo)OutsideLaboratory,,86140,CPT,Facility,Inpatient,,,90,104,88.4,29.8064,104,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
C-Reactive Protein (Mayo)OutsideLaboratory,,86140,CPT,Facility,Both,,,90,104,88.4,29.8064,104,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),62.4,60,,percent of total billed charges,,
C-Reactive Protein (Mayo)OutsideLaboratory,,86140,CPT,Facility,Both,,,90,104,88.4,29.8064,104,"Health Partners, Inc.",State of Minnesota Advantage Program,84.76,81.5,,percent of total billed charges,,
C-Reactive Protein (Mayo)OutsideLaboratory,,86140,CPT,Facility,Both,,,90,104,88.4,29.8064,104,"Health Partners, Inc.",State Public Programs,52,50,,percent of total billed charges,,
C-Reactive Protein (Mayo)OutsideLaboratory,,86140,CPT,Facility,Both,,,90,104,88.4,29.8064,104,Humana Insurance Company,Commercial PPO,98.8,95,,percent of total billed charges,,
C-Reactive Protein (Mayo)OutsideLaboratory,,86140,CPT,Facility,Outpatient,,,90,104,88.4,29.8064,104,Humana Insurance Company,Medicare PPO,50.96,49,,percent of total billed charges,,
C-Reactive Protein (Mayo)OutsideLaboratory,,86140,CPT,Facility,Inpatient,,,90,104,88.4,29.8064,104,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
C-Reactive Protein (Mayo)OutsideLaboratory,,86140,CPT,Facility,Both,,,90,104,88.4,29.8064,104,Medica,Individual & Family,103.064,99.1,,percent of total billed charges,,
C-Reactive Protein (Mayo)OutsideLaboratory,,86140,CPT,Facility,Outpatient,,,90,104,88.4,29.8064,104,Medica,Medica Advantage Solution,51.792,49.8,,percent of total billed charges,,
C-Reactive Protein (Mayo)OutsideLaboratory,,86140,CPT,Facility,Inpatient,,,90,104,88.4,29.8064,104,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
C-Reactive Protein (Mayo)OutsideLaboratory,,86140,CPT,Facility,Outpatient,,,90,104,88.4,29.8064,104,Medica,Medical Assistance,46.384,44.6,,percent of total billed charges,,
C-Reactive Protein (Mayo)OutsideLaboratory,,86140,CPT,Facility,Inpatient,,,90,104,88.4,29.8064,104,Medica,Medical Assistance,,,,,Included in per diem rate,
C-Reactive Protein (Mayo)OutsideLaboratory,,86140,CPT,Facility,Outpatient,,,90,104,88.4,29.8064,104,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,51.792,49.8,,percent of total billed charges,,
C-Reactive Protein (Mayo)OutsideLaboratory,,86140,CPT,Facility,Inpatient,,,90,104,88.4,29.8064,104,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
C-Reactive Protein (Mayo)OutsideLaboratory,,86140,CPT,Facility,Both,,,90,104,88.4,29.8064,104,"Multiplan, Inc.","Multiplan, Inc.",97.76,94,,percent of total billed charges,,
C-Reactive Protein (Mayo)OutsideLaboratory,,86140,CPT,Facility,Outpatient,,,90,104,88.4,29.8064,104,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,89.856,86.4,,percent of total billed charges,,
C-Reactive Protein (Mayo)OutsideLaboratory,,86140,CPT,Facility,Inpatient,,,90,104,88.4,29.8064,104,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
C-Reactive Protein (Mayo)OutsideLaboratory,,86140,CPT,Facility,Both,,,90,104,88.4,29.8064,104,"Preferred One Administrative Services, INC.",PPO,102.544,98.6,,percent of total billed charges,,
C-Reactive Protein (Mayo)OutsideLaboratory,,86140,CPT,Facility,Outpatient,,,90,104,88.4,29.8064,104,PrimeWest Health,Minnesota Senior Health Options (MSHO),53.508,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
C-Reactive Protein (Mayo)OutsideLaboratory,,86140,CPT,Facility,Inpatient,,,90,104,88.4,29.8064,104,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
C-Reactive Protein (Mayo)OutsideLaboratory,,86140,CPT,Facility,Outpatient,,,90,104,88.4,29.8064,104,PrimeWest Health,MinnesotaCare,53.4144,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
C-Reactive Protein (Mayo)OutsideLaboratory,,86140,CPT,Facility,Inpatient,,,90,104,88.4,29.8064,104,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
C-Reactive Protein (Mayo)OutsideLaboratory,,86140,CPT,Facility,Both,,,90,104,88.4,29.8064,104,Sanford Health Plan,Sanford Health Plan,95.68,92,,percent of total billed charges,,
C-Reactive Protein (Mayo)OutsideLaboratory,,86140,CPT,Facility,Outpatient,,,90,104,88.4,29.8064,104,"UCare Health, Inc.",Individual & Family Plan,58.604,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
C-Reactive Protein (Mayo)OutsideLaboratory,,86140,CPT,Facility,Inpatient,,,90,104,88.4,29.8064,104,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
C-Reactive Protein (Mayo)OutsideLaboratory,,86140,CPT,Facility,Outpatient,,,90,104,88.4,29.8064,104,"UCare Health, Inc.",Medical Assistance,52.4888,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
C-Reactive Protein (Mayo)OutsideLaboratory,,86140,CPT,Facility,Inpatient,,,90,104,88.4,29.8064,104,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
C-Reactive Protein (Mayo)OutsideLaboratory,,86140,CPT,Facility,Outpatient,,,90,104,88.4,29.8064,104,"UCare Health, Inc.",Medicare Advantage,52.4888,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
C-Reactive Protein (Mayo)OutsideLaboratory,,86140,CPT,Facility,Inpatient,,,90,104,88.4,29.8064,104,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
C-Reactive Protein (Mayo)OutsideLaboratory,,86140,CPT,Facility,Outpatient,,,90,104,88.4,29.8064,104,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),52.4888,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
C-Reactive Protein (Mayo)OutsideLaboratory,,86140,CPT,Facility,Inpatient,,,90,104,88.4,29.8064,104,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
C-Reactive Protein (Mayo)OutsideLaboratory,,86140,CPT,Facility,Both,,,90,104,88.4,29.8064,104,UnitedHealthcare,Individual & Family,97.76,94,,percent of total billed charges,,
C-Reactive Protein (Mayo)OutsideLaboratory,,86140,CPT,Facility,Outpatient,,,90,104,88.4,29.8064,104,UnitedHealthcare,Medicare Advantage,50.96,49,,percent of total billed charges,,
C-Reactive Protein (Mayo)OutsideLaboratory,,86140,CPT,Facility,Inpatient,,,90,104,88.4,29.8064,104,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
C-Reactive Protein (Mayo)OutsideLaboratory,,86140,CPT,Facility,Outpatient,,,90,104,88.4,29.8064,104,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,49.92,48,,percent of total billed charges,,100% of DHS outpatient percentage
C-Reactive Protein (Mayo)OutsideLaboratory,,86140,CPT,Facility,Inpatient,,,90,104,88.4,29.8064,104,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Beta 2 Gp1 Ab, Igm/Igg, S (Mayo)OutsideLaboratory",,86146,CPT,Facility,Both,,,90,61,51.85,17.4826,61,Aetna,Commercial,56.12,92,,percent of total billed charges,,
"Beta 2 Gp1 Ab, Igm/Igg, S (Mayo)OutsideLaboratory",,86146,CPT,Facility,Outpatient,,,90,61,51.85,17.4826,61,Aetna,Medicare Advantage,29.89,49,,percent of total billed charges,,
"Beta 2 Gp1 Ab, Igm/Igg, S (Mayo)OutsideLaboratory",,86146,CPT,Facility,Inpatient,,,90,61,51.85,17.4826,61,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Beta 2 Gp1 Ab, Igm/Igg, S (Mayo)OutsideLaboratory",,86146,CPT,Facility,Both,,,90,61,51.85,17.4826,61,Aetna,PPO,56.73,93,,percent of total billed charges,,
"Beta 2 Gp1 Ab, Igm/Igg, S (Mayo)OutsideLaboratory",,86146,CPT,Facility,Both,,,90,61,51.85,17.4826,61,America's PPO,America's PPO,58.5783,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Beta 2 Gp1 Ab, Igm/Igg, S (Mayo)OutsideLaboratory",,86146,CPT,Facility,Both,,,90,61,51.85,17.4826,61,BlueCross BlueShield Minnesota, Federal Employee Program,60.024,98.4,,percent of total billed charges,,
"Beta 2 Gp1 Ab, Igm/Igg, S (Mayo)OutsideLaboratory",,86146,CPT,Facility,Both,,,90,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,61,100,,percent of total billed charges,,
"Beta 2 Gp1 Ab, Igm/Igg, S (Mayo)OutsideLaboratory",,86146,CPT,Facility,Both,,,90,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,High Value Network Plan,54.9,90,,percent of total billed charges,,
"Beta 2 Gp1 Ab, Igm/Igg, S (Mayo)OutsideLaboratory",,86146,CPT,Facility,Outpatient,,,90,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,Medicare Advantage,29.89,49,,percent of total billed charges,,
"Beta 2 Gp1 Ab, Igm/Igg, S (Mayo)OutsideLaboratory",,86146,CPT,Facility,Inpatient,,,90,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Beta 2 Gp1 Ab, Igm/Igg, S (Mayo)OutsideLaboratory",,86146,CPT,Facility,Both,,,90,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,54.0277,88.57,,percent of total billed charges,,
"Beta 2 Gp1 Ab, Igm/Igg, S (Mayo)OutsideLaboratory",,86146,CPT,Facility,Both,,,90,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,17.4826,28.66,,percent of total billed charges,,
"Beta 2 Gp1 Ab, Igm/Igg, S (Mayo)OutsideLaboratory",,86146,CPT,Facility,Outpatient,,,90,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),29.89,49,,percent of total billed charges,,
"Beta 2 Gp1 Ab, Igm/Igg, S (Mayo)OutsideLaboratory",,86146,CPT,Facility,Inpatient,,,90,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Beta 2 Gp1 Ab, Igm/Igg, S (Mayo)OutsideLaboratory",,86146,CPT,Facility,Both,,,90,61,51.85,17.4826,61,CorVel,Worker's Compensation,61,100,,percent of total billed charges,,
"Beta 2 Gp1 Ab, Igm/Igg, S (Mayo)OutsideLaboratory",,86146,CPT,Facility,Both,,,90,61,51.85,17.4826,61,First Health Group Corporation,First Health Network,59.17,97,,percent of total billed charges,,
"Beta 2 Gp1 Ab, Igm/Igg, S (Mayo)OutsideLaboratory",,86146,CPT,Facility,Both,,,90,61,51.85,17.4826,61,"Health Partners, Inc.",Commercial,57.706,94.6,,percent of total billed charges,,
"Beta 2 Gp1 Ab, Igm/Igg, S (Mayo)OutsideLaboratory",,86146,CPT,Facility,Outpatient,,,90,61,51.85,17.4826,61,"Health Partners, Inc.",Medicare Advantage,29.89,49,,percent of total billed charges,,
"Beta 2 Gp1 Ab, Igm/Igg, S (Mayo)OutsideLaboratory",,86146,CPT,Facility,Inpatient,,,90,61,51.85,17.4826,61,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Beta 2 Gp1 Ab, Igm/Igg, S (Mayo)OutsideLaboratory",,86146,CPT,Facility,Both,,,90,61,51.85,17.4826,61,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),36.6,60,,percent of total billed charges,,
"Beta 2 Gp1 Ab, Igm/Igg, S (Mayo)OutsideLaboratory",,86146,CPT,Facility,Both,,,90,61,51.85,17.4826,61,"Health Partners, Inc.",State of Minnesota Advantage Program,49.715,81.5,,percent of total billed charges,,
"Beta 2 Gp1 Ab, Igm/Igg, S (Mayo)OutsideLaboratory",,86146,CPT,Facility,Both,,,90,61,51.85,17.4826,61,"Health Partners, Inc.",State Public Programs,30.5,50,,percent of total billed charges,,
"Beta 2 Gp1 Ab, Igm/Igg, S (Mayo)OutsideLaboratory",,86146,CPT,Facility,Both,,,90,61,51.85,17.4826,61,Humana Insurance Company,Commercial PPO,57.95,95,,percent of total billed charges,,
"Beta 2 Gp1 Ab, Igm/Igg, S (Mayo)OutsideLaboratory",,86146,CPT,Facility,Outpatient,,,90,61,51.85,17.4826,61,Humana Insurance Company,Medicare PPO,29.89,49,,percent of total billed charges,,
"Beta 2 Gp1 Ab, Igm/Igg, S (Mayo)OutsideLaboratory",,86146,CPT,Facility,Inpatient,,,90,61,51.85,17.4826,61,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Beta 2 Gp1 Ab, Igm/Igg, S (Mayo)OutsideLaboratory",,86146,CPT,Facility,Both,,,90,61,51.85,17.4826,61,Medica,Individual & Family,60.451,99.1,,percent of total billed charges,,
"Beta 2 Gp1 Ab, Igm/Igg, S (Mayo)OutsideLaboratory",,86146,CPT,Facility,Outpatient,,,90,61,51.85,17.4826,61,Medica,Medica Advantage Solution,30.378,49.8,,percent of total billed charges,,
"Beta 2 Gp1 Ab, Igm/Igg, S (Mayo)OutsideLaboratory",,86146,CPT,Facility,Inpatient,,,90,61,51.85,17.4826,61,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Beta 2 Gp1 Ab, Igm/Igg, S (Mayo)OutsideLaboratory",,86146,CPT,Facility,Outpatient,,,90,61,51.85,17.4826,61,Medica,Medical Assistance,27.206,44.6,,percent of total billed charges,,
"Beta 2 Gp1 Ab, Igm/Igg, S (Mayo)OutsideLaboratory",,86146,CPT,Facility,Inpatient,,,90,61,51.85,17.4826,61,Medica,Medical Assistance,,,,,Included in per diem rate,
"Beta 2 Gp1 Ab, Igm/Igg, S (Mayo)OutsideLaboratory",,86146,CPT,Facility,Outpatient,,,90,61,51.85,17.4826,61,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,30.378,49.8,,percent of total billed charges,,
"Beta 2 Gp1 Ab, Igm/Igg, S (Mayo)OutsideLaboratory",,86146,CPT,Facility,Inpatient,,,90,61,51.85,17.4826,61,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Beta 2 Gp1 Ab, Igm/Igg, S (Mayo)OutsideLaboratory",,86146,CPT,Facility,Both,,,90,61,51.85,17.4826,61,"Multiplan, Inc.","Multiplan, Inc.",57.34,94,,percent of total billed charges,,
"Beta 2 Gp1 Ab, Igm/Igg, S (Mayo)OutsideLaboratory",,86146,CPT,Facility,Outpatient,,,90,61,51.85,17.4826,61,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,52.704,86.4,,percent of total billed charges,,
"Beta 2 Gp1 Ab, Igm/Igg, S (Mayo)OutsideLaboratory",,86146,CPT,Facility,Inpatient,,,90,61,51.85,17.4826,61,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Beta 2 Gp1 Ab, Igm/Igg, S (Mayo)OutsideLaboratory",,86146,CPT,Facility,Both,,,90,61,51.85,17.4826,61,"Preferred One Administrative Services, INC.",PPO,60.146,98.6,,percent of total billed charges,,
"Beta 2 Gp1 Ab, Igm/Igg, S (Mayo)OutsideLaboratory",,86146,CPT,Facility,Outpatient,,,90,61,51.85,17.4826,61,PrimeWest Health,Minnesota Senior Health Options (MSHO),31.3845,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Beta 2 Gp1 Ab, Igm/Igg, S (Mayo)OutsideLaboratory",,86146,CPT,Facility,Inpatient,,,90,61,51.85,17.4826,61,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Beta 2 Gp1 Ab, Igm/Igg, S (Mayo)OutsideLaboratory",,86146,CPT,Facility,Outpatient,,,90,61,51.85,17.4826,61,PrimeWest Health,MinnesotaCare,31.3296,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Beta 2 Gp1 Ab, Igm/Igg, S (Mayo)OutsideLaboratory",,86146,CPT,Facility,Inpatient,,,90,61,51.85,17.4826,61,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Beta 2 Gp1 Ab, Igm/Igg, S (Mayo)OutsideLaboratory",,86146,CPT,Facility,Both,,,90,61,51.85,17.4826,61,Sanford Health Plan,Sanford Health Plan,56.12,92,,percent of total billed charges,,
"Beta 2 Gp1 Ab, Igm/Igg, S (Mayo)OutsideLaboratory",,86146,CPT,Facility,Outpatient,,,90,61,51.85,17.4826,61,"UCare Health, Inc.",Individual & Family Plan,34.3735,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Beta 2 Gp1 Ab, Igm/Igg, S (Mayo)OutsideLaboratory",,86146,CPT,Facility,Inpatient,,,90,61,51.85,17.4826,61,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Beta 2 Gp1 Ab, Igm/Igg, S (Mayo)OutsideLaboratory",,86146,CPT,Facility,Outpatient,,,90,61,51.85,17.4826,61,"UCare Health, Inc.",Medical Assistance,30.7867,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Beta 2 Gp1 Ab, Igm/Igg, S (Mayo)OutsideLaboratory",,86146,CPT,Facility,Inpatient,,,90,61,51.85,17.4826,61,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Beta 2 Gp1 Ab, Igm/Igg, S (Mayo)OutsideLaboratory",,86146,CPT,Facility,Outpatient,,,90,61,51.85,17.4826,61,"UCare Health, Inc.",Medicare Advantage,30.7867,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Beta 2 Gp1 Ab, Igm/Igg, S (Mayo)OutsideLaboratory",,86146,CPT,Facility,Inpatient,,,90,61,51.85,17.4826,61,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Beta 2 Gp1 Ab, Igm/Igg, S (Mayo)OutsideLaboratory",,86146,CPT,Facility,Outpatient,,,90,61,51.85,17.4826,61,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),30.7867,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Beta 2 Gp1 Ab, Igm/Igg, S (Mayo)OutsideLaboratory",,86146,CPT,Facility,Inpatient,,,90,61,51.85,17.4826,61,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Beta 2 Gp1 Ab, Igm/Igg, S (Mayo)OutsideLaboratory",,86146,CPT,Facility,Both,,,90,61,51.85,17.4826,61,UnitedHealthcare,Individual & Family,57.34,94,,percent of total billed charges,,
"Beta 2 Gp1 Ab, Igm/Igg, S (Mayo)OutsideLaboratory",,86146,CPT,Facility,Outpatient,,,90,61,51.85,17.4826,61,UnitedHealthcare,Medicare Advantage,29.89,49,,percent of total billed charges,,
"Beta 2 Gp1 Ab, Igm/Igg, S (Mayo)OutsideLaboratory",,86146,CPT,Facility,Inpatient,,,90,61,51.85,17.4826,61,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Beta 2 Gp1 Ab, Igm/Igg, S (Mayo)OutsideLaboratory",,86146,CPT,Facility,Outpatient,,,90,61,51.85,17.4826,61,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,29.28,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Beta 2 Gp1 Ab, Igm/Igg, S (Mayo)OutsideLaboratory",,86146,CPT,Facility,Inpatient,,,90,61,51.85,17.4826,61,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Cardiolipin Aby Igm (Mayo)OutsideLaboratory,,86147,CPT,Facility,Both,,,90,65,55.25,18.629,65,Aetna,Commercial,59.8,92,,percent of total billed charges,,
Cardiolipin Aby Igm (Mayo)OutsideLaboratory,,86147,CPT,Facility,Outpatient,,,90,65,55.25,18.629,65,Aetna,Medicare Advantage,31.85,49,,percent of total billed charges,,
Cardiolipin Aby Igm (Mayo)OutsideLaboratory,,86147,CPT,Facility,Inpatient,,,90,65,55.25,18.629,65,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Cardiolipin Aby Igm (Mayo)OutsideLaboratory,,86147,CPT,Facility,Both,,,90,65,55.25,18.629,65,Aetna,PPO,60.45,93,,percent of total billed charges,,
Cardiolipin Aby Igm (Mayo)OutsideLaboratory,,86147,CPT,Facility,Both,,,90,65,55.25,18.629,65,America's PPO,America's PPO,62.4195,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Cardiolipin Aby Igm (Mayo)OutsideLaboratory,,86147,CPT,Facility,Both,,,90,65,55.25,18.629,65,BlueCross BlueShield Minnesota, Federal Employee Program,63.96,98.4,,percent of total billed charges,,
Cardiolipin Aby Igm (Mayo)OutsideLaboratory,,86147,CPT,Facility,Both,,,90,65,55.25,18.629,65,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,65,100,,percent of total billed charges,,
Cardiolipin Aby Igm (Mayo)OutsideLaboratory,,86147,CPT,Facility,Both,,,90,65,55.25,18.629,65,BlueCross BlueShield Minnesota,High Value Network Plan,58.5,90,,percent of total billed charges,,
Cardiolipin Aby Igm (Mayo)OutsideLaboratory,,86147,CPT,Facility,Outpatient,,,90,65,55.25,18.629,65,BlueCross BlueShield Minnesota,Medicare Advantage,31.85,49,,percent of total billed charges,,
Cardiolipin Aby Igm (Mayo)OutsideLaboratory,,86147,CPT,Facility,Inpatient,,,90,65,55.25,18.629,65,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Cardiolipin Aby Igm (Mayo)OutsideLaboratory,,86147,CPT,Facility,Both,,,90,65,55.25,18.629,65,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,57.5705,88.57,,percent of total billed charges,,
Cardiolipin Aby Igm (Mayo)OutsideLaboratory,,86147,CPT,Facility,Both,,,90,65,55.25,18.629,65,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,18.629,28.66,,percent of total billed charges,,
Cardiolipin Aby Igm (Mayo)OutsideLaboratory,,86147,CPT,Facility,Outpatient,,,90,65,55.25,18.629,65,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),31.85,49,,percent of total billed charges,,
Cardiolipin Aby Igm (Mayo)OutsideLaboratory,,86147,CPT,Facility,Inpatient,,,90,65,55.25,18.629,65,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Cardiolipin Aby Igm (Mayo)OutsideLaboratory,,86147,CPT,Facility,Both,,,90,65,55.25,18.629,65,CorVel,Worker's Compensation,65,100,,percent of total billed charges,,
Cardiolipin Aby Igm (Mayo)OutsideLaboratory,,86147,CPT,Facility,Both,,,90,65,55.25,18.629,65,First Health Group Corporation,First Health Network,63.05,97,,percent of total billed charges,,
Cardiolipin Aby Igm (Mayo)OutsideLaboratory,,86147,CPT,Facility,Both,,,90,65,55.25,18.629,65,"Health Partners, Inc.",Commercial,61.49,94.6,,percent of total billed charges,,
Cardiolipin Aby Igm (Mayo)OutsideLaboratory,,86147,CPT,Facility,Outpatient,,,90,65,55.25,18.629,65,"Health Partners, Inc.",Medicare Advantage,31.85,49,,percent of total billed charges,,
Cardiolipin Aby Igm (Mayo)OutsideLaboratory,,86147,CPT,Facility,Inpatient,,,90,65,55.25,18.629,65,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Cardiolipin Aby Igm (Mayo)OutsideLaboratory,,86147,CPT,Facility,Both,,,90,65,55.25,18.629,65,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),39,60,,percent of total billed charges,,
Cardiolipin Aby Igm (Mayo)OutsideLaboratory,,86147,CPT,Facility,Both,,,90,65,55.25,18.629,65,"Health Partners, Inc.",State of Minnesota Advantage Program,52.975,81.5,,percent of total billed charges,,
Cardiolipin Aby Igm (Mayo)OutsideLaboratory,,86147,CPT,Facility,Both,,,90,65,55.25,18.629,65,"Health Partners, Inc.",State Public Programs,32.5,50,,percent of total billed charges,,
Cardiolipin Aby Igm (Mayo)OutsideLaboratory,,86147,CPT,Facility,Both,,,90,65,55.25,18.629,65,Humana Insurance Company,Commercial PPO,61.75,95,,percent of total billed charges,,
Cardiolipin Aby Igm (Mayo)OutsideLaboratory,,86147,CPT,Facility,Outpatient,,,90,65,55.25,18.629,65,Humana Insurance Company,Medicare PPO,31.85,49,,percent of total billed charges,,
Cardiolipin Aby Igm (Mayo)OutsideLaboratory,,86147,CPT,Facility,Inpatient,,,90,65,55.25,18.629,65,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Cardiolipin Aby Igm (Mayo)OutsideLaboratory,,86147,CPT,Facility,Both,,,90,65,55.25,18.629,65,Medica,Individual & Family,64.415,99.1,,percent of total billed charges,,
Cardiolipin Aby Igm (Mayo)OutsideLaboratory,,86147,CPT,Facility,Outpatient,,,90,65,55.25,18.629,65,Medica,Medica Advantage Solution,32.37,49.8,,percent of total billed charges,,
Cardiolipin Aby Igm (Mayo)OutsideLaboratory,,86147,CPT,Facility,Inpatient,,,90,65,55.25,18.629,65,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Cardiolipin Aby Igm (Mayo)OutsideLaboratory,,86147,CPT,Facility,Outpatient,,,90,65,55.25,18.629,65,Medica,Medical Assistance,28.99,44.6,,percent of total billed charges,,
Cardiolipin Aby Igm (Mayo)OutsideLaboratory,,86147,CPT,Facility,Inpatient,,,90,65,55.25,18.629,65,Medica,Medical Assistance,,,,,Included in per diem rate,
Cardiolipin Aby Igm (Mayo)OutsideLaboratory,,86147,CPT,Facility,Outpatient,,,90,65,55.25,18.629,65,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,32.37,49.8,,percent of total billed charges,,
Cardiolipin Aby Igm (Mayo)OutsideLaboratory,,86147,CPT,Facility,Inpatient,,,90,65,55.25,18.629,65,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Cardiolipin Aby Igm (Mayo)OutsideLaboratory,,86147,CPT,Facility,Both,,,90,65,55.25,18.629,65,"Multiplan, Inc.","Multiplan, Inc.",61.1,94,,percent of total billed charges,,
Cardiolipin Aby Igm (Mayo)OutsideLaboratory,,86147,CPT,Facility,Outpatient,,,90,65,55.25,18.629,65,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,56.16,86.4,,percent of total billed charges,,
Cardiolipin Aby Igm (Mayo)OutsideLaboratory,,86147,CPT,Facility,Inpatient,,,90,65,55.25,18.629,65,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Cardiolipin Aby Igm (Mayo)OutsideLaboratory,,86147,CPT,Facility,Both,,,90,65,55.25,18.629,65,"Preferred One Administrative Services, INC.",PPO,64.09,98.6,,percent of total billed charges,,
Cardiolipin Aby Igm (Mayo)OutsideLaboratory,,86147,CPT,Facility,Outpatient,,,90,65,55.25,18.629,65,PrimeWest Health,Minnesota Senior Health Options (MSHO),33.4425,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Cardiolipin Aby Igm (Mayo)OutsideLaboratory,,86147,CPT,Facility,Inpatient,,,90,65,55.25,18.629,65,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Cardiolipin Aby Igm (Mayo)OutsideLaboratory,,86147,CPT,Facility,Outpatient,,,90,65,55.25,18.629,65,PrimeWest Health,MinnesotaCare,33.384,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Cardiolipin Aby Igm (Mayo)OutsideLaboratory,,86147,CPT,Facility,Inpatient,,,90,65,55.25,18.629,65,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Cardiolipin Aby Igm (Mayo)OutsideLaboratory,,86147,CPT,Facility,Both,,,90,65,55.25,18.629,65,Sanford Health Plan,Sanford Health Plan,59.8,92,,percent of total billed charges,,
Cardiolipin Aby Igm (Mayo)OutsideLaboratory,,86147,CPT,Facility,Outpatient,,,90,65,55.25,18.629,65,"UCare Health, Inc.",Individual & Family Plan,36.6275,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Cardiolipin Aby Igm (Mayo)OutsideLaboratory,,86147,CPT,Facility,Inpatient,,,90,65,55.25,18.629,65,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Cardiolipin Aby Igm (Mayo)OutsideLaboratory,,86147,CPT,Facility,Outpatient,,,90,65,55.25,18.629,65,"UCare Health, Inc.",Medical Assistance,32.8055,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Cardiolipin Aby Igm (Mayo)OutsideLaboratory,,86147,CPT,Facility,Inpatient,,,90,65,55.25,18.629,65,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Cardiolipin Aby Igm (Mayo)OutsideLaboratory,,86147,CPT,Facility,Outpatient,,,90,65,55.25,18.629,65,"UCare Health, Inc.",Medicare Advantage,32.8055,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Cardiolipin Aby Igm (Mayo)OutsideLaboratory,,86147,CPT,Facility,Inpatient,,,90,65,55.25,18.629,65,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Cardiolipin Aby Igm (Mayo)OutsideLaboratory,,86147,CPT,Facility,Outpatient,,,90,65,55.25,18.629,65,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),32.8055,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Cardiolipin Aby Igm (Mayo)OutsideLaboratory,,86147,CPT,Facility,Inpatient,,,90,65,55.25,18.629,65,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Cardiolipin Aby Igm (Mayo)OutsideLaboratory,,86147,CPT,Facility,Both,,,90,65,55.25,18.629,65,UnitedHealthcare,Individual & Family,61.1,94,,percent of total billed charges,,
Cardiolipin Aby Igm (Mayo)OutsideLaboratory,,86147,CPT,Facility,Outpatient,,,90,65,55.25,18.629,65,UnitedHealthcare,Medicare Advantage,31.85,49,,percent of total billed charges,,
Cardiolipin Aby Igm (Mayo)OutsideLaboratory,,86147,CPT,Facility,Inpatient,,,90,65,55.25,18.629,65,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Cardiolipin Aby Igm (Mayo)OutsideLaboratory,,86147,CPT,Facility,Outpatient,,,90,65,55.25,18.629,65,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,31.2,48,,percent of total billed charges,,100% of DHS outpatient percentage
Cardiolipin Aby Igm (Mayo)OutsideLaboratory,,86147,CPT,Facility,Inpatient,,,90,65,55.25,18.629,65,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Phospholip Ab (Cardiolip) Igm/Igg (Mayo)OutsideLaboratory,,86147,CPT,Facility,Both,,,90,84,71.4,24.0744,84,Aetna,Commercial,77.28,92,,percent of total billed charges,,
Phospholip Ab (Cardiolip) Igm/Igg (Mayo)OutsideLaboratory,,86147,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,Aetna,Medicare Advantage,41.16,49,,percent of total billed charges,,
Phospholip Ab (Cardiolip) Igm/Igg (Mayo)OutsideLaboratory,,86147,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Phospholip Ab (Cardiolip) Igm/Igg (Mayo)OutsideLaboratory,,86147,CPT,Facility,Both,,,90,84,71.4,24.0744,84,Aetna,PPO,78.12,93,,percent of total billed charges,,
Phospholip Ab (Cardiolip) Igm/Igg (Mayo)OutsideLaboratory,,86147,CPT,Facility,Both,,,90,84,71.4,24.0744,84,America's PPO,America's PPO,80.6652,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Phospholip Ab (Cardiolip) Igm/Igg (Mayo)OutsideLaboratory,,86147,CPT,Facility,Both,,,90,84,71.4,24.0744,84,BlueCross BlueShield Minnesota, Federal Employee Program,82.656,98.4,,percent of total billed charges,,
Phospholip Ab (Cardiolip) Igm/Igg (Mayo)OutsideLaboratory,,86147,CPT,Facility,Both,,,90,84,71.4,24.0744,84,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,84,100,,percent of total billed charges,,
Phospholip Ab (Cardiolip) Igm/Igg (Mayo)OutsideLaboratory,,86147,CPT,Facility,Both,,,90,84,71.4,24.0744,84,BlueCross BlueShield Minnesota,High Value Network Plan,75.6,90,,percent of total billed charges,,
Phospholip Ab (Cardiolip) Igm/Igg (Mayo)OutsideLaboratory,,86147,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,BlueCross BlueShield Minnesota,Medicare Advantage,41.16,49,,percent of total billed charges,,
Phospholip Ab (Cardiolip) Igm/Igg (Mayo)OutsideLaboratory,,86147,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Phospholip Ab (Cardiolip) Igm/Igg (Mayo)OutsideLaboratory,,86147,CPT,Facility,Both,,,90,84,71.4,24.0744,84,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,74.3988,88.57,,percent of total billed charges,,
Phospholip Ab (Cardiolip) Igm/Igg (Mayo)OutsideLaboratory,,86147,CPT,Facility,Both,,,90,84,71.4,24.0744,84,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,24.0744,28.66,,percent of total billed charges,,
Phospholip Ab (Cardiolip) Igm/Igg (Mayo)OutsideLaboratory,,86147,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),41.16,49,,percent of total billed charges,,
Phospholip Ab (Cardiolip) Igm/Igg (Mayo)OutsideLaboratory,,86147,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Phospholip Ab (Cardiolip) Igm/Igg (Mayo)OutsideLaboratory,,86147,CPT,Facility,Both,,,90,84,71.4,24.0744,84,CorVel,Worker's Compensation,84,100,,percent of total billed charges,,
Phospholip Ab (Cardiolip) Igm/Igg (Mayo)OutsideLaboratory,,86147,CPT,Facility,Both,,,90,84,71.4,24.0744,84,First Health Group Corporation,First Health Network,81.48,97,,percent of total billed charges,,
Phospholip Ab (Cardiolip) Igm/Igg (Mayo)OutsideLaboratory,,86147,CPT,Facility,Both,,,90,84,71.4,24.0744,84,"Health Partners, Inc.",Commercial,79.464,94.6,,percent of total billed charges,,
Phospholip Ab (Cardiolip) Igm/Igg (Mayo)OutsideLaboratory,,86147,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,"Health Partners, Inc.",Medicare Advantage,41.16,49,,percent of total billed charges,,
Phospholip Ab (Cardiolip) Igm/Igg (Mayo)OutsideLaboratory,,86147,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Phospholip Ab (Cardiolip) Igm/Igg (Mayo)OutsideLaboratory,,86147,CPT,Facility,Both,,,90,84,71.4,24.0744,84,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),50.4,60,,percent of total billed charges,,
Phospholip Ab (Cardiolip) Igm/Igg (Mayo)OutsideLaboratory,,86147,CPT,Facility,Both,,,90,84,71.4,24.0744,84,"Health Partners, Inc.",State of Minnesota Advantage Program,68.46,81.5,,percent of total billed charges,,
Phospholip Ab (Cardiolip) Igm/Igg (Mayo)OutsideLaboratory,,86147,CPT,Facility,Both,,,90,84,71.4,24.0744,84,"Health Partners, Inc.",State Public Programs,42,50,,percent of total billed charges,,
Phospholip Ab (Cardiolip) Igm/Igg (Mayo)OutsideLaboratory,,86147,CPT,Facility,Both,,,90,84,71.4,24.0744,84,Humana Insurance Company,Commercial PPO,79.8,95,,percent of total billed charges,,
Phospholip Ab (Cardiolip) Igm/Igg (Mayo)OutsideLaboratory,,86147,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,Humana Insurance Company,Medicare PPO,41.16,49,,percent of total billed charges,,
Phospholip Ab (Cardiolip) Igm/Igg (Mayo)OutsideLaboratory,,86147,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Phospholip Ab (Cardiolip) Igm/Igg (Mayo)OutsideLaboratory,,86147,CPT,Facility,Both,,,90,84,71.4,24.0744,84,Medica,Individual & Family,83.244,99.1,,percent of total billed charges,,
Phospholip Ab (Cardiolip) Igm/Igg (Mayo)OutsideLaboratory,,86147,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,Medica,Medica Advantage Solution,41.832,49.8,,percent of total billed charges,,
Phospholip Ab (Cardiolip) Igm/Igg (Mayo)OutsideLaboratory,,86147,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Phospholip Ab (Cardiolip) Igm/Igg (Mayo)OutsideLaboratory,,86147,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,Medica,Medical Assistance,37.464,44.6,,percent of total billed charges,,
Phospholip Ab (Cardiolip) Igm/Igg (Mayo)OutsideLaboratory,,86147,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,Medica,Medical Assistance,,,,,Included in per diem rate,
Phospholip Ab (Cardiolip) Igm/Igg (Mayo)OutsideLaboratory,,86147,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,41.832,49.8,,percent of total billed charges,,
Phospholip Ab (Cardiolip) Igm/Igg (Mayo)OutsideLaboratory,,86147,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Phospholip Ab (Cardiolip) Igm/Igg (Mayo)OutsideLaboratory,,86147,CPT,Facility,Both,,,90,84,71.4,24.0744,84,"Multiplan, Inc.","Multiplan, Inc.",78.96,94,,percent of total billed charges,,
Phospholip Ab (Cardiolip) Igm/Igg (Mayo)OutsideLaboratory,,86147,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,72.576,86.4,,percent of total billed charges,,
Phospholip Ab (Cardiolip) Igm/Igg (Mayo)OutsideLaboratory,,86147,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Phospholip Ab (Cardiolip) Igm/Igg (Mayo)OutsideLaboratory,,86147,CPT,Facility,Both,,,90,84,71.4,24.0744,84,"Preferred One Administrative Services, INC.",PPO,82.824,98.6,,percent of total billed charges,,
Phospholip Ab (Cardiolip) Igm/Igg (Mayo)OutsideLaboratory,,86147,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,PrimeWest Health,Minnesota Senior Health Options (MSHO),43.218,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Phospholip Ab (Cardiolip) Igm/Igg (Mayo)OutsideLaboratory,,86147,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Phospholip Ab (Cardiolip) Igm/Igg (Mayo)OutsideLaboratory,,86147,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,PrimeWest Health,MinnesotaCare,43.1424,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Phospholip Ab (Cardiolip) Igm/Igg (Mayo)OutsideLaboratory,,86147,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Phospholip Ab (Cardiolip) Igm/Igg (Mayo)OutsideLaboratory,,86147,CPT,Facility,Both,,,90,84,71.4,24.0744,84,Sanford Health Plan,Sanford Health Plan,77.28,92,,percent of total billed charges,,
Phospholip Ab (Cardiolip) Igm/Igg (Mayo)OutsideLaboratory,,86147,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,"UCare Health, Inc.",Individual & Family Plan,47.334,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Phospholip Ab (Cardiolip) Igm/Igg (Mayo)OutsideLaboratory,,86147,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Phospholip Ab (Cardiolip) Igm/Igg (Mayo)OutsideLaboratory,,86147,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,"UCare Health, Inc.",Medical Assistance,42.3948,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Phospholip Ab (Cardiolip) Igm/Igg (Mayo)OutsideLaboratory,,86147,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Phospholip Ab (Cardiolip) Igm/Igg (Mayo)OutsideLaboratory,,86147,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,"UCare Health, Inc.",Medicare Advantage,42.3948,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Phospholip Ab (Cardiolip) Igm/Igg (Mayo)OutsideLaboratory,,86147,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Phospholip Ab (Cardiolip) Igm/Igg (Mayo)OutsideLaboratory,,86147,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),42.3948,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Phospholip Ab (Cardiolip) Igm/Igg (Mayo)OutsideLaboratory,,86147,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Phospholip Ab (Cardiolip) Igm/Igg (Mayo)OutsideLaboratory,,86147,CPT,Facility,Both,,,90,84,71.4,24.0744,84,UnitedHealthcare,Individual & Family,78.96,94,,percent of total billed charges,,
Phospholip Ab (Cardiolip) Igm/Igg (Mayo)OutsideLaboratory,,86147,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,UnitedHealthcare,Medicare Advantage,41.16,49,,percent of total billed charges,,
Phospholip Ab (Cardiolip) Igm/Igg (Mayo)OutsideLaboratory,,86147,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Phospholip Ab (Cardiolip) Igm/Igg (Mayo)OutsideLaboratory,,86147,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,40.32,48,,percent of total billed charges,,100% of DHS outpatient percentage
Phospholip Ab (Cardiolip) Igm/Igg (Mayo)OutsideLaboratory,,86147,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Phospholipid Ab Iga, S (Mayo)OutsideLaboratory",,86147,CPT,Facility,Both,,,90,53,45.05,15.1898,53,Aetna,Commercial,48.76,92,,percent of total billed charges,,
"Phospholipid Ab Iga, S (Mayo)OutsideLaboratory",,86147,CPT,Facility,Outpatient,,,90,53,45.05,15.1898,53,Aetna,Medicare Advantage,25.97,49,,percent of total billed charges,,
"Phospholipid Ab Iga, S (Mayo)OutsideLaboratory",,86147,CPT,Facility,Inpatient,,,90,53,45.05,15.1898,53,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Phospholipid Ab Iga, S (Mayo)OutsideLaboratory",,86147,CPT,Facility,Both,,,90,53,45.05,15.1898,53,Aetna,PPO,49.29,93,,percent of total billed charges,,
"Phospholipid Ab Iga, S (Mayo)OutsideLaboratory",,86147,CPT,Facility,Both,,,90,53,45.05,15.1898,53,America's PPO,America's PPO,50.8959,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Phospholipid Ab Iga, S (Mayo)OutsideLaboratory",,86147,CPT,Facility,Both,,,90,53,45.05,15.1898,53,BlueCross BlueShield Minnesota, Federal Employee Program,52.152,98.4,,percent of total billed charges,,
"Phospholipid Ab Iga, S (Mayo)OutsideLaboratory",,86147,CPT,Facility,Both,,,90,53,45.05,15.1898,53,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,53,100,,percent of total billed charges,,
"Phospholipid Ab Iga, S (Mayo)OutsideLaboratory",,86147,CPT,Facility,Both,,,90,53,45.05,15.1898,53,BlueCross BlueShield Minnesota,High Value Network Plan,47.7,90,,percent of total billed charges,,
"Phospholipid Ab Iga, S (Mayo)OutsideLaboratory",,86147,CPT,Facility,Outpatient,,,90,53,45.05,15.1898,53,BlueCross BlueShield Minnesota,Medicare Advantage,25.97,49,,percent of total billed charges,,
"Phospholipid Ab Iga, S (Mayo)OutsideLaboratory",,86147,CPT,Facility,Inpatient,,,90,53,45.05,15.1898,53,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Phospholipid Ab Iga, S (Mayo)OutsideLaboratory",,86147,CPT,Facility,Both,,,90,53,45.05,15.1898,53,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,46.9421,88.57,,percent of total billed charges,,
"Phospholipid Ab Iga, S (Mayo)OutsideLaboratory",,86147,CPT,Facility,Both,,,90,53,45.05,15.1898,53,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,15.1898,28.66,,percent of total billed charges,,
"Phospholipid Ab Iga, S (Mayo)OutsideLaboratory",,86147,CPT,Facility,Outpatient,,,90,53,45.05,15.1898,53,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),25.97,49,,percent of total billed charges,,
"Phospholipid Ab Iga, S (Mayo)OutsideLaboratory",,86147,CPT,Facility,Inpatient,,,90,53,45.05,15.1898,53,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Phospholipid Ab Iga, S (Mayo)OutsideLaboratory",,86147,CPT,Facility,Both,,,90,53,45.05,15.1898,53,CorVel,Worker's Compensation,53,100,,percent of total billed charges,,
"Phospholipid Ab Iga, S (Mayo)OutsideLaboratory",,86147,CPT,Facility,Both,,,90,53,45.05,15.1898,53,First Health Group Corporation,First Health Network,51.41,97,,percent of total billed charges,,
"Phospholipid Ab Iga, S (Mayo)OutsideLaboratory",,86147,CPT,Facility,Both,,,90,53,45.05,15.1898,53,"Health Partners, Inc.",Commercial,50.138,94.6,,percent of total billed charges,,
"Phospholipid Ab Iga, S (Mayo)OutsideLaboratory",,86147,CPT,Facility,Outpatient,,,90,53,45.05,15.1898,53,"Health Partners, Inc.",Medicare Advantage,25.97,49,,percent of total billed charges,,
"Phospholipid Ab Iga, S (Mayo)OutsideLaboratory",,86147,CPT,Facility,Inpatient,,,90,53,45.05,15.1898,53,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Phospholipid Ab Iga, S (Mayo)OutsideLaboratory",,86147,CPT,Facility,Both,,,90,53,45.05,15.1898,53,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),31.8,60,,percent of total billed charges,,
"Phospholipid Ab Iga, S (Mayo)OutsideLaboratory",,86147,CPT,Facility,Both,,,90,53,45.05,15.1898,53,"Health Partners, Inc.",State of Minnesota Advantage Program,43.195,81.5,,percent of total billed charges,,
"Phospholipid Ab Iga, S (Mayo)OutsideLaboratory",,86147,CPT,Facility,Both,,,90,53,45.05,15.1898,53,"Health Partners, Inc.",State Public Programs,26.5,50,,percent of total billed charges,,
"Phospholipid Ab Iga, S (Mayo)OutsideLaboratory",,86147,CPT,Facility,Both,,,90,53,45.05,15.1898,53,Humana Insurance Company,Commercial PPO,50.35,95,,percent of total billed charges,,
"Phospholipid Ab Iga, S (Mayo)OutsideLaboratory",,86147,CPT,Facility,Outpatient,,,90,53,45.05,15.1898,53,Humana Insurance Company,Medicare PPO,25.97,49,,percent of total billed charges,,
"Phospholipid Ab Iga, S (Mayo)OutsideLaboratory",,86147,CPT,Facility,Inpatient,,,90,53,45.05,15.1898,53,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Phospholipid Ab Iga, S (Mayo)OutsideLaboratory",,86147,CPT,Facility,Both,,,90,53,45.05,15.1898,53,Medica,Individual & Family,52.523,99.1,,percent of total billed charges,,
"Phospholipid Ab Iga, S (Mayo)OutsideLaboratory",,86147,CPT,Facility,Outpatient,,,90,53,45.05,15.1898,53,Medica,Medica Advantage Solution,26.394,49.8,,percent of total billed charges,,
"Phospholipid Ab Iga, S (Mayo)OutsideLaboratory",,86147,CPT,Facility,Inpatient,,,90,53,45.05,15.1898,53,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Phospholipid Ab Iga, S (Mayo)OutsideLaboratory",,86147,CPT,Facility,Outpatient,,,90,53,45.05,15.1898,53,Medica,Medical Assistance,23.638,44.6,,percent of total billed charges,,
"Phospholipid Ab Iga, S (Mayo)OutsideLaboratory",,86147,CPT,Facility,Inpatient,,,90,53,45.05,15.1898,53,Medica,Medical Assistance,,,,,Included in per diem rate,
"Phospholipid Ab Iga, S (Mayo)OutsideLaboratory",,86147,CPT,Facility,Outpatient,,,90,53,45.05,15.1898,53,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,26.394,49.8,,percent of total billed charges,,
"Phospholipid Ab Iga, S (Mayo)OutsideLaboratory",,86147,CPT,Facility,Inpatient,,,90,53,45.05,15.1898,53,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Phospholipid Ab Iga, S (Mayo)OutsideLaboratory",,86147,CPT,Facility,Both,,,90,53,45.05,15.1898,53,"Multiplan, Inc.","Multiplan, Inc.",49.82,94,,percent of total billed charges,,
"Phospholipid Ab Iga, S (Mayo)OutsideLaboratory",,86147,CPT,Facility,Outpatient,,,90,53,45.05,15.1898,53,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,45.792,86.4,,percent of total billed charges,,
"Phospholipid Ab Iga, S (Mayo)OutsideLaboratory",,86147,CPT,Facility,Inpatient,,,90,53,45.05,15.1898,53,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Phospholipid Ab Iga, S (Mayo)OutsideLaboratory",,86147,CPT,Facility,Both,,,90,53,45.05,15.1898,53,"Preferred One Administrative Services, INC.",PPO,52.258,98.6,,percent of total billed charges,,
"Phospholipid Ab Iga, S (Mayo)OutsideLaboratory",,86147,CPT,Facility,Outpatient,,,90,53,45.05,15.1898,53,PrimeWest Health,Minnesota Senior Health Options (MSHO),27.2685,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Phospholipid Ab Iga, S (Mayo)OutsideLaboratory",,86147,CPT,Facility,Inpatient,,,90,53,45.05,15.1898,53,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Phospholipid Ab Iga, S (Mayo)OutsideLaboratory",,86147,CPT,Facility,Outpatient,,,90,53,45.05,15.1898,53,PrimeWest Health,MinnesotaCare,27.2208,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Phospholipid Ab Iga, S (Mayo)OutsideLaboratory",,86147,CPT,Facility,Inpatient,,,90,53,45.05,15.1898,53,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Phospholipid Ab Iga, S (Mayo)OutsideLaboratory",,86147,CPT,Facility,Both,,,90,53,45.05,15.1898,53,Sanford Health Plan,Sanford Health Plan,48.76,92,,percent of total billed charges,,
"Phospholipid Ab Iga, S (Mayo)OutsideLaboratory",,86147,CPT,Facility,Outpatient,,,90,53,45.05,15.1898,53,"UCare Health, Inc.",Individual & Family Plan,29.8655,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Phospholipid Ab Iga, S (Mayo)OutsideLaboratory",,86147,CPT,Facility,Inpatient,,,90,53,45.05,15.1898,53,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Phospholipid Ab Iga, S (Mayo)OutsideLaboratory",,86147,CPT,Facility,Outpatient,,,90,53,45.05,15.1898,53,"UCare Health, Inc.",Medical Assistance,26.7491,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Phospholipid Ab Iga, S (Mayo)OutsideLaboratory",,86147,CPT,Facility,Inpatient,,,90,53,45.05,15.1898,53,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Phospholipid Ab Iga, S (Mayo)OutsideLaboratory",,86147,CPT,Facility,Outpatient,,,90,53,45.05,15.1898,53,"UCare Health, Inc.",Medicare Advantage,26.7491,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Phospholipid Ab Iga, S (Mayo)OutsideLaboratory",,86147,CPT,Facility,Inpatient,,,90,53,45.05,15.1898,53,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Phospholipid Ab Iga, S (Mayo)OutsideLaboratory",,86147,CPT,Facility,Outpatient,,,90,53,45.05,15.1898,53,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),26.7491,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Phospholipid Ab Iga, S (Mayo)OutsideLaboratory",,86147,CPT,Facility,Inpatient,,,90,53,45.05,15.1898,53,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Phospholipid Ab Iga, S (Mayo)OutsideLaboratory",,86147,CPT,Facility,Both,,,90,53,45.05,15.1898,53,UnitedHealthcare,Individual & Family,49.82,94,,percent of total billed charges,,
"Phospholipid Ab Iga, S (Mayo)OutsideLaboratory",,86147,CPT,Facility,Outpatient,,,90,53,45.05,15.1898,53,UnitedHealthcare,Medicare Advantage,25.97,49,,percent of total billed charges,,
"Phospholipid Ab Iga, S (Mayo)OutsideLaboratory",,86147,CPT,Facility,Inpatient,,,90,53,45.05,15.1898,53,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Phospholipid Ab Iga, S (Mayo)OutsideLaboratory",,86147,CPT,Facility,Outpatient,,,90,53,45.05,15.1898,53,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,25.44,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Phospholipid Ab Iga, S (Mayo)OutsideLaboratory",,86147,CPT,Facility,Inpatient,,,90,53,45.05,15.1898,53,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Cold Agglutinin Titer (Mayo)OutsideLaboratory,,86157,CPT,Facility,Both,,,90,63,53.55,18.0558,63,Aetna,Commercial,57.96,92,,percent of total billed charges,,
Cold Agglutinin Titer (Mayo)OutsideLaboratory,,86157,CPT,Facility,Outpatient,,,90,63,53.55,18.0558,63,Aetna,Medicare Advantage,30.87,49,,percent of total billed charges,,
Cold Agglutinin Titer (Mayo)OutsideLaboratory,,86157,CPT,Facility,Inpatient,,,90,63,53.55,18.0558,63,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Cold Agglutinin Titer (Mayo)OutsideLaboratory,,86157,CPT,Facility,Both,,,90,63,53.55,18.0558,63,Aetna,PPO,58.59,93,,percent of total billed charges,,
Cold Agglutinin Titer (Mayo)OutsideLaboratory,,86157,CPT,Facility,Both,,,90,63,53.55,18.0558,63,America's PPO,America's PPO,60.4989,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Cold Agglutinin Titer (Mayo)OutsideLaboratory,,86157,CPT,Facility,Both,,,90,63,53.55,18.0558,63,BlueCross BlueShield Minnesota, Federal Employee Program,61.992,98.4,,percent of total billed charges,,
Cold Agglutinin Titer (Mayo)OutsideLaboratory,,86157,CPT,Facility,Both,,,90,63,53.55,18.0558,63,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,63,100,,percent of total billed charges,,
Cold Agglutinin Titer (Mayo)OutsideLaboratory,,86157,CPT,Facility,Both,,,90,63,53.55,18.0558,63,BlueCross BlueShield Minnesota,High Value Network Plan,56.7,90,,percent of total billed charges,,
Cold Agglutinin Titer (Mayo)OutsideLaboratory,,86157,CPT,Facility,Outpatient,,,90,63,53.55,18.0558,63,BlueCross BlueShield Minnesota,Medicare Advantage,30.87,49,,percent of total billed charges,,
Cold Agglutinin Titer (Mayo)OutsideLaboratory,,86157,CPT,Facility,Inpatient,,,90,63,53.55,18.0558,63,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Cold Agglutinin Titer (Mayo)OutsideLaboratory,,86157,CPT,Facility,Both,,,90,63,53.55,18.0558,63,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,55.7991,88.57,,percent of total billed charges,,
Cold Agglutinin Titer (Mayo)OutsideLaboratory,,86157,CPT,Facility,Both,,,90,63,53.55,18.0558,63,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,18.0558,28.66,,percent of total billed charges,,
Cold Agglutinin Titer (Mayo)OutsideLaboratory,,86157,CPT,Facility,Outpatient,,,90,63,53.55,18.0558,63,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),30.87,49,,percent of total billed charges,,
Cold Agglutinin Titer (Mayo)OutsideLaboratory,,86157,CPT,Facility,Inpatient,,,90,63,53.55,18.0558,63,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Cold Agglutinin Titer (Mayo)OutsideLaboratory,,86157,CPT,Facility,Both,,,90,63,53.55,18.0558,63,CorVel,Worker's Compensation,63,100,,percent of total billed charges,,
Cold Agglutinin Titer (Mayo)OutsideLaboratory,,86157,CPT,Facility,Both,,,90,63,53.55,18.0558,63,First Health Group Corporation,First Health Network,61.11,97,,percent of total billed charges,,
Cold Agglutinin Titer (Mayo)OutsideLaboratory,,86157,CPT,Facility,Both,,,90,63,53.55,18.0558,63,"Health Partners, Inc.",Commercial,59.598,94.6,,percent of total billed charges,,
Cold Agglutinin Titer (Mayo)OutsideLaboratory,,86157,CPT,Facility,Outpatient,,,90,63,53.55,18.0558,63,"Health Partners, Inc.",Medicare Advantage,30.87,49,,percent of total billed charges,,
Cold Agglutinin Titer (Mayo)OutsideLaboratory,,86157,CPT,Facility,Inpatient,,,90,63,53.55,18.0558,63,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Cold Agglutinin Titer (Mayo)OutsideLaboratory,,86157,CPT,Facility,Both,,,90,63,53.55,18.0558,63,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),37.8,60,,percent of total billed charges,,
Cold Agglutinin Titer (Mayo)OutsideLaboratory,,86157,CPT,Facility,Both,,,90,63,53.55,18.0558,63,"Health Partners, Inc.",State of Minnesota Advantage Program,51.345,81.5,,percent of total billed charges,,
Cold Agglutinin Titer (Mayo)OutsideLaboratory,,86157,CPT,Facility,Both,,,90,63,53.55,18.0558,63,"Health Partners, Inc.",State Public Programs,31.5,50,,percent of total billed charges,,
Cold Agglutinin Titer (Mayo)OutsideLaboratory,,86157,CPT,Facility,Both,,,90,63,53.55,18.0558,63,Humana Insurance Company,Commercial PPO,59.85,95,,percent of total billed charges,,
Cold Agglutinin Titer (Mayo)OutsideLaboratory,,86157,CPT,Facility,Outpatient,,,90,63,53.55,18.0558,63,Humana Insurance Company,Medicare PPO,30.87,49,,percent of total billed charges,,
Cold Agglutinin Titer (Mayo)OutsideLaboratory,,86157,CPT,Facility,Inpatient,,,90,63,53.55,18.0558,63,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Cold Agglutinin Titer (Mayo)OutsideLaboratory,,86157,CPT,Facility,Both,,,90,63,53.55,18.0558,63,Medica,Individual & Family,62.433,99.1,,percent of total billed charges,,
Cold Agglutinin Titer (Mayo)OutsideLaboratory,,86157,CPT,Facility,Outpatient,,,90,63,53.55,18.0558,63,Medica,Medica Advantage Solution,31.374,49.8,,percent of total billed charges,,
Cold Agglutinin Titer (Mayo)OutsideLaboratory,,86157,CPT,Facility,Inpatient,,,90,63,53.55,18.0558,63,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Cold Agglutinin Titer (Mayo)OutsideLaboratory,,86157,CPT,Facility,Outpatient,,,90,63,53.55,18.0558,63,Medica,Medical Assistance,28.098,44.6,,percent of total billed charges,,
Cold Agglutinin Titer (Mayo)OutsideLaboratory,,86157,CPT,Facility,Inpatient,,,90,63,53.55,18.0558,63,Medica,Medical Assistance,,,,,Included in per diem rate,
Cold Agglutinin Titer (Mayo)OutsideLaboratory,,86157,CPT,Facility,Outpatient,,,90,63,53.55,18.0558,63,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,31.374,49.8,,percent of total billed charges,,
Cold Agglutinin Titer (Mayo)OutsideLaboratory,,86157,CPT,Facility,Inpatient,,,90,63,53.55,18.0558,63,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Cold Agglutinin Titer (Mayo)OutsideLaboratory,,86157,CPT,Facility,Both,,,90,63,53.55,18.0558,63,"Multiplan, Inc.","Multiplan, Inc.",59.22,94,,percent of total billed charges,,
Cold Agglutinin Titer (Mayo)OutsideLaboratory,,86157,CPT,Facility,Outpatient,,,90,63,53.55,18.0558,63,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,54.432,86.4,,percent of total billed charges,,
Cold Agglutinin Titer (Mayo)OutsideLaboratory,,86157,CPT,Facility,Inpatient,,,90,63,53.55,18.0558,63,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Cold Agglutinin Titer (Mayo)OutsideLaboratory,,86157,CPT,Facility,Both,,,90,63,53.55,18.0558,63,"Preferred One Administrative Services, INC.",PPO,62.118,98.6,,percent of total billed charges,,
Cold Agglutinin Titer (Mayo)OutsideLaboratory,,86157,CPT,Facility,Outpatient,,,90,63,53.55,18.0558,63,PrimeWest Health,Minnesota Senior Health Options (MSHO),32.4135,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Cold Agglutinin Titer (Mayo)OutsideLaboratory,,86157,CPT,Facility,Inpatient,,,90,63,53.55,18.0558,63,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Cold Agglutinin Titer (Mayo)OutsideLaboratory,,86157,CPT,Facility,Outpatient,,,90,63,53.55,18.0558,63,PrimeWest Health,MinnesotaCare,32.3568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Cold Agglutinin Titer (Mayo)OutsideLaboratory,,86157,CPT,Facility,Inpatient,,,90,63,53.55,18.0558,63,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Cold Agglutinin Titer (Mayo)OutsideLaboratory,,86157,CPT,Facility,Both,,,90,63,53.55,18.0558,63,Sanford Health Plan,Sanford Health Plan,57.96,92,,percent of total billed charges,,
Cold Agglutinin Titer (Mayo)OutsideLaboratory,,86157,CPT,Facility,Outpatient,,,90,63,53.55,18.0558,63,"UCare Health, Inc.",Individual & Family Plan,35.5005,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Cold Agglutinin Titer (Mayo)OutsideLaboratory,,86157,CPT,Facility,Inpatient,,,90,63,53.55,18.0558,63,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Cold Agglutinin Titer (Mayo)OutsideLaboratory,,86157,CPT,Facility,Outpatient,,,90,63,53.55,18.0558,63,"UCare Health, Inc.",Medical Assistance,31.7961,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Cold Agglutinin Titer (Mayo)OutsideLaboratory,,86157,CPT,Facility,Inpatient,,,90,63,53.55,18.0558,63,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Cold Agglutinin Titer (Mayo)OutsideLaboratory,,86157,CPT,Facility,Outpatient,,,90,63,53.55,18.0558,63,"UCare Health, Inc.",Medicare Advantage,31.7961,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Cold Agglutinin Titer (Mayo)OutsideLaboratory,,86157,CPT,Facility,Inpatient,,,90,63,53.55,18.0558,63,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Cold Agglutinin Titer (Mayo)OutsideLaboratory,,86157,CPT,Facility,Outpatient,,,90,63,53.55,18.0558,63,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),31.7961,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Cold Agglutinin Titer (Mayo)OutsideLaboratory,,86157,CPT,Facility,Inpatient,,,90,63,53.55,18.0558,63,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Cold Agglutinin Titer (Mayo)OutsideLaboratory,,86157,CPT,Facility,Both,,,90,63,53.55,18.0558,63,UnitedHealthcare,Individual & Family,59.22,94,,percent of total billed charges,,
Cold Agglutinin Titer (Mayo)OutsideLaboratory,,86157,CPT,Facility,Outpatient,,,90,63,53.55,18.0558,63,UnitedHealthcare,Medicare Advantage,30.87,49,,percent of total billed charges,,
Cold Agglutinin Titer (Mayo)OutsideLaboratory,,86157,CPT,Facility,Inpatient,,,90,63,53.55,18.0558,63,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Cold Agglutinin Titer (Mayo)OutsideLaboratory,,86157,CPT,Facility,Outpatient,,,90,63,53.55,18.0558,63,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,30.24,48,,percent of total billed charges,,100% of DHS outpatient percentage
Cold Agglutinin Titer (Mayo)OutsideLaboratory,,86157,CPT,Facility,Inpatient,,,90,63,53.55,18.0558,63,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Complement C1Q, S (Mayo)OutsideLaboratory",,86160,CPT,Facility,Both,,,90,220,187,63.052,220,Aetna,Commercial,202.4,92,,percent of total billed charges,,
"Complement C1Q, S (Mayo)OutsideLaboratory",,86160,CPT,Facility,Outpatient,,,90,220,187,63.052,220,Aetna,Medicare Advantage,107.8,49,,percent of total billed charges,,
"Complement C1Q, S (Mayo)OutsideLaboratory",,86160,CPT,Facility,Inpatient,,,90,220,187,63.052,220,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Complement C1Q, S (Mayo)OutsideLaboratory",,86160,CPT,Facility,Both,,,90,220,187,63.052,220,Aetna,PPO,204.6,93,,percent of total billed charges,,
"Complement C1Q, S (Mayo)OutsideLaboratory",,86160,CPT,Facility,Both,,,90,220,187,63.052,220,America's PPO,America's PPO,211.266,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Complement C1Q, S (Mayo)OutsideLaboratory",,86160,CPT,Facility,Both,,,90,220,187,63.052,220,BlueCross BlueShield Minnesota, Federal Employee Program,216.48,98.4,,percent of total billed charges,,
"Complement C1Q, S (Mayo)OutsideLaboratory",,86160,CPT,Facility,Both,,,90,220,187,63.052,220,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,220,100,,percent of total billed charges,,
"Complement C1Q, S (Mayo)OutsideLaboratory",,86160,CPT,Facility,Both,,,90,220,187,63.052,220,BlueCross BlueShield Minnesota,High Value Network Plan,198,90,,percent of total billed charges,,
"Complement C1Q, S (Mayo)OutsideLaboratory",,86160,CPT,Facility,Outpatient,,,90,220,187,63.052,220,BlueCross BlueShield Minnesota,Medicare Advantage,107.8,49,,percent of total billed charges,,
"Complement C1Q, S (Mayo)OutsideLaboratory",,86160,CPT,Facility,Inpatient,,,90,220,187,63.052,220,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Complement C1Q, S (Mayo)OutsideLaboratory",,86160,CPT,Facility,Both,,,90,220,187,63.052,220,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,194.854,88.57,,percent of total billed charges,,
"Complement C1Q, S (Mayo)OutsideLaboratory",,86160,CPT,Facility,Both,,,90,220,187,63.052,220,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,63.052,28.66,,percent of total billed charges,,
"Complement C1Q, S (Mayo)OutsideLaboratory",,86160,CPT,Facility,Outpatient,,,90,220,187,63.052,220,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),107.8,49,,percent of total billed charges,,
"Complement C1Q, S (Mayo)OutsideLaboratory",,86160,CPT,Facility,Inpatient,,,90,220,187,63.052,220,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Complement C1Q, S (Mayo)OutsideLaboratory",,86160,CPT,Facility,Both,,,90,220,187,63.052,220,CorVel,Worker's Compensation,220,100,,percent of total billed charges,,
"Complement C1Q, S (Mayo)OutsideLaboratory",,86160,CPT,Facility,Both,,,90,220,187,63.052,220,First Health Group Corporation,First Health Network,213.4,97,,percent of total billed charges,,
"Complement C1Q, S (Mayo)OutsideLaboratory",,86160,CPT,Facility,Both,,,90,220,187,63.052,220,"Health Partners, Inc.",Commercial,208.12,94.6,,percent of total billed charges,,
"Complement C1Q, S (Mayo)OutsideLaboratory",,86160,CPT,Facility,Outpatient,,,90,220,187,63.052,220,"Health Partners, Inc.",Medicare Advantage,107.8,49,,percent of total billed charges,,
"Complement C1Q, S (Mayo)OutsideLaboratory",,86160,CPT,Facility,Inpatient,,,90,220,187,63.052,220,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Complement C1Q, S (Mayo)OutsideLaboratory",,86160,CPT,Facility,Both,,,90,220,187,63.052,220,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),132,60,,percent of total billed charges,,
"Complement C1Q, S (Mayo)OutsideLaboratory",,86160,CPT,Facility,Both,,,90,220,187,63.052,220,"Health Partners, Inc.",State of Minnesota Advantage Program,179.3,81.5,,percent of total billed charges,,
"Complement C1Q, S (Mayo)OutsideLaboratory",,86160,CPT,Facility,Both,,,90,220,187,63.052,220,"Health Partners, Inc.",State Public Programs,110,50,,percent of total billed charges,,
"Complement C1Q, S (Mayo)OutsideLaboratory",,86160,CPT,Facility,Both,,,90,220,187,63.052,220,Humana Insurance Company,Commercial PPO,209,95,,percent of total billed charges,,
"Complement C1Q, S (Mayo)OutsideLaboratory",,86160,CPT,Facility,Outpatient,,,90,220,187,63.052,220,Humana Insurance Company,Medicare PPO,107.8,49,,percent of total billed charges,,
"Complement C1Q, S (Mayo)OutsideLaboratory",,86160,CPT,Facility,Inpatient,,,90,220,187,63.052,220,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Complement C1Q, S (Mayo)OutsideLaboratory",,86160,CPT,Facility,Both,,,90,220,187,63.052,220,Medica,Individual & Family,218.02,99.1,,percent of total billed charges,,
"Complement C1Q, S (Mayo)OutsideLaboratory",,86160,CPT,Facility,Outpatient,,,90,220,187,63.052,220,Medica,Medica Advantage Solution,109.56,49.8,,percent of total billed charges,,
"Complement C1Q, S (Mayo)OutsideLaboratory",,86160,CPT,Facility,Inpatient,,,90,220,187,63.052,220,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Complement C1Q, S (Mayo)OutsideLaboratory",,86160,CPT,Facility,Outpatient,,,90,220,187,63.052,220,Medica,Medical Assistance,98.12,44.6,,percent of total billed charges,,
"Complement C1Q, S (Mayo)OutsideLaboratory",,86160,CPT,Facility,Inpatient,,,90,220,187,63.052,220,Medica,Medical Assistance,,,,,Included in per diem rate,
"Complement C1Q, S (Mayo)OutsideLaboratory",,86160,CPT,Facility,Outpatient,,,90,220,187,63.052,220,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,109.56,49.8,,percent of total billed charges,,
"Complement C1Q, S (Mayo)OutsideLaboratory",,86160,CPT,Facility,Inpatient,,,90,220,187,63.052,220,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Complement C1Q, S (Mayo)OutsideLaboratory",,86160,CPT,Facility,Both,,,90,220,187,63.052,220,"Multiplan, Inc.","Multiplan, Inc.",206.8,94,,percent of total billed charges,,
"Complement C1Q, S (Mayo)OutsideLaboratory",,86160,CPT,Facility,Outpatient,,,90,220,187,63.052,220,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,190.08,86.4,,percent of total billed charges,,
"Complement C1Q, S (Mayo)OutsideLaboratory",,86160,CPT,Facility,Inpatient,,,90,220,187,63.052,220,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Complement C1Q, S (Mayo)OutsideLaboratory",,86160,CPT,Facility,Both,,,90,220,187,63.052,220,"Preferred One Administrative Services, INC.",PPO,216.92,98.6,,percent of total billed charges,,
"Complement C1Q, S (Mayo)OutsideLaboratory",,86160,CPT,Facility,Outpatient,,,90,220,187,63.052,220,PrimeWest Health,Minnesota Senior Health Options (MSHO),113.19,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Complement C1Q, S (Mayo)OutsideLaboratory",,86160,CPT,Facility,Inpatient,,,90,220,187,63.052,220,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Complement C1Q, S (Mayo)OutsideLaboratory",,86160,CPT,Facility,Outpatient,,,90,220,187,63.052,220,PrimeWest Health,MinnesotaCare,112.992,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Complement C1Q, S (Mayo)OutsideLaboratory",,86160,CPT,Facility,Inpatient,,,90,220,187,63.052,220,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Complement C1Q, S (Mayo)OutsideLaboratory",,86160,CPT,Facility,Both,,,90,220,187,63.052,220,Sanford Health Plan,Sanford Health Plan,202.4,92,,percent of total billed charges,,
"Complement C1Q, S (Mayo)OutsideLaboratory",,86160,CPT,Facility,Outpatient,,,90,220,187,63.052,220,"UCare Health, Inc.",Individual & Family Plan,123.97,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Complement C1Q, S (Mayo)OutsideLaboratory",,86160,CPT,Facility,Inpatient,,,90,220,187,63.052,220,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Complement C1Q, S (Mayo)OutsideLaboratory",,86160,CPT,Facility,Outpatient,,,90,220,187,63.052,220,"UCare Health, Inc.",Medical Assistance,111.034,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Complement C1Q, S (Mayo)OutsideLaboratory",,86160,CPT,Facility,Inpatient,,,90,220,187,63.052,220,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Complement C1Q, S (Mayo)OutsideLaboratory",,86160,CPT,Facility,Outpatient,,,90,220,187,63.052,220,"UCare Health, Inc.",Medicare Advantage,111.034,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Complement C1Q, S (Mayo)OutsideLaboratory",,86160,CPT,Facility,Inpatient,,,90,220,187,63.052,220,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Complement C1Q, S (Mayo)OutsideLaboratory",,86160,CPT,Facility,Outpatient,,,90,220,187,63.052,220,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),111.034,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Complement C1Q, S (Mayo)OutsideLaboratory",,86160,CPT,Facility,Inpatient,,,90,220,187,63.052,220,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Complement C1Q, S (Mayo)OutsideLaboratory",,86160,CPT,Facility,Both,,,90,220,187,63.052,220,UnitedHealthcare,Individual & Family,206.8,94,,percent of total billed charges,,
"Complement C1Q, S (Mayo)OutsideLaboratory",,86160,CPT,Facility,Outpatient,,,90,220,187,63.052,220,UnitedHealthcare,Medicare Advantage,107.8,49,,percent of total billed charges,,
"Complement C1Q, S (Mayo)OutsideLaboratory",,86160,CPT,Facility,Inpatient,,,90,220,187,63.052,220,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Complement C1Q, S (Mayo)OutsideLaboratory",,86160,CPT,Facility,Outpatient,,,90,220,187,63.052,220,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,105.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Complement C1Q, S (Mayo)OutsideLaboratory",,86160,CPT,Facility,Inpatient,,,90,220,187,63.052,220,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Complement C3, S (Mayo)OutsideLaboratory",,86160,CPT,Facility,Both,,,90,84,71.4,24.0744,84,Aetna,Commercial,77.28,92,,percent of total billed charges,,
"Complement C3, S (Mayo)OutsideLaboratory",,86160,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,Aetna,Medicare Advantage,41.16,49,,percent of total billed charges,,
"Complement C3, S (Mayo)OutsideLaboratory",,86160,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Complement C3, S (Mayo)OutsideLaboratory",,86160,CPT,Facility,Both,,,90,84,71.4,24.0744,84,Aetna,PPO,78.12,93,,percent of total billed charges,,
"Complement C3, S (Mayo)OutsideLaboratory",,86160,CPT,Facility,Both,,,90,84,71.4,24.0744,84,America's PPO,America's PPO,80.6652,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Complement C3, S (Mayo)OutsideLaboratory",,86160,CPT,Facility,Both,,,90,84,71.4,24.0744,84,BlueCross BlueShield Minnesota, Federal Employee Program,82.656,98.4,,percent of total billed charges,,
"Complement C3, S (Mayo)OutsideLaboratory",,86160,CPT,Facility,Both,,,90,84,71.4,24.0744,84,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,84,100,,percent of total billed charges,,
"Complement C3, S (Mayo)OutsideLaboratory",,86160,CPT,Facility,Both,,,90,84,71.4,24.0744,84,BlueCross BlueShield Minnesota,High Value Network Plan,75.6,90,,percent of total billed charges,,
"Complement C3, S (Mayo)OutsideLaboratory",,86160,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,BlueCross BlueShield Minnesota,Medicare Advantage,41.16,49,,percent of total billed charges,,
"Complement C3, S (Mayo)OutsideLaboratory",,86160,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Complement C3, S (Mayo)OutsideLaboratory",,86160,CPT,Facility,Both,,,90,84,71.4,24.0744,84,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,74.3988,88.57,,percent of total billed charges,,
"Complement C3, S (Mayo)OutsideLaboratory",,86160,CPT,Facility,Both,,,90,84,71.4,24.0744,84,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,24.0744,28.66,,percent of total billed charges,,
"Complement C3, S (Mayo)OutsideLaboratory",,86160,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),41.16,49,,percent of total billed charges,,
"Complement C3, S (Mayo)OutsideLaboratory",,86160,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Complement C3, S (Mayo)OutsideLaboratory",,86160,CPT,Facility,Both,,,90,84,71.4,24.0744,84,CorVel,Worker's Compensation,84,100,,percent of total billed charges,,
"Complement C3, S (Mayo)OutsideLaboratory",,86160,CPT,Facility,Both,,,90,84,71.4,24.0744,84,First Health Group Corporation,First Health Network,81.48,97,,percent of total billed charges,,
"Complement C3, S (Mayo)OutsideLaboratory",,86160,CPT,Facility,Both,,,90,84,71.4,24.0744,84,"Health Partners, Inc.",Commercial,79.464,94.6,,percent of total billed charges,,
"Complement C3, S (Mayo)OutsideLaboratory",,86160,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,"Health Partners, Inc.",Medicare Advantage,41.16,49,,percent of total billed charges,,
"Complement C3, S (Mayo)OutsideLaboratory",,86160,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Complement C3, S (Mayo)OutsideLaboratory",,86160,CPT,Facility,Both,,,90,84,71.4,24.0744,84,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),50.4,60,,percent of total billed charges,,
"Complement C3, S (Mayo)OutsideLaboratory",,86160,CPT,Facility,Both,,,90,84,71.4,24.0744,84,"Health Partners, Inc.",State of Minnesota Advantage Program,68.46,81.5,,percent of total billed charges,,
"Complement C3, S (Mayo)OutsideLaboratory",,86160,CPT,Facility,Both,,,90,84,71.4,24.0744,84,"Health Partners, Inc.",State Public Programs,42,50,,percent of total billed charges,,
"Complement C3, S (Mayo)OutsideLaboratory",,86160,CPT,Facility,Both,,,90,84,71.4,24.0744,84,Humana Insurance Company,Commercial PPO,79.8,95,,percent of total billed charges,,
"Complement C3, S (Mayo)OutsideLaboratory",,86160,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,Humana Insurance Company,Medicare PPO,41.16,49,,percent of total billed charges,,
"Complement C3, S (Mayo)OutsideLaboratory",,86160,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Complement C3, S (Mayo)OutsideLaboratory",,86160,CPT,Facility,Both,,,90,84,71.4,24.0744,84,Medica,Individual & Family,83.244,99.1,,percent of total billed charges,,
"Complement C3, S (Mayo)OutsideLaboratory",,86160,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,Medica,Medica Advantage Solution,41.832,49.8,,percent of total billed charges,,
"Complement C3, S (Mayo)OutsideLaboratory",,86160,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Complement C3, S (Mayo)OutsideLaboratory",,86160,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,Medica,Medical Assistance,37.464,44.6,,percent of total billed charges,,
"Complement C3, S (Mayo)OutsideLaboratory",,86160,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,Medica,Medical Assistance,,,,,Included in per diem rate,
"Complement C3, S (Mayo)OutsideLaboratory",,86160,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,41.832,49.8,,percent of total billed charges,,
"Complement C3, S (Mayo)OutsideLaboratory",,86160,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Complement C3, S (Mayo)OutsideLaboratory",,86160,CPT,Facility,Both,,,90,84,71.4,24.0744,84,"Multiplan, Inc.","Multiplan, Inc.",78.96,94,,percent of total billed charges,,
"Complement C3, S (Mayo)OutsideLaboratory",,86160,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,72.576,86.4,,percent of total billed charges,,
"Complement C3, S (Mayo)OutsideLaboratory",,86160,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Complement C3, S (Mayo)OutsideLaboratory",,86160,CPT,Facility,Both,,,90,84,71.4,24.0744,84,"Preferred One Administrative Services, INC.",PPO,82.824,98.6,,percent of total billed charges,,
"Complement C3, S (Mayo)OutsideLaboratory",,86160,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,PrimeWest Health,Minnesota Senior Health Options (MSHO),43.218,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Complement C3, S (Mayo)OutsideLaboratory",,86160,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Complement C3, S (Mayo)OutsideLaboratory",,86160,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,PrimeWest Health,MinnesotaCare,43.1424,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Complement C3, S (Mayo)OutsideLaboratory",,86160,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Complement C3, S (Mayo)OutsideLaboratory",,86160,CPT,Facility,Both,,,90,84,71.4,24.0744,84,Sanford Health Plan,Sanford Health Plan,77.28,92,,percent of total billed charges,,
"Complement C3, S (Mayo)OutsideLaboratory",,86160,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,"UCare Health, Inc.",Individual & Family Plan,47.334,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Complement C3, S (Mayo)OutsideLaboratory",,86160,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Complement C3, S (Mayo)OutsideLaboratory",,86160,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,"UCare Health, Inc.",Medical Assistance,42.3948,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Complement C3, S (Mayo)OutsideLaboratory",,86160,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Complement C3, S (Mayo)OutsideLaboratory",,86160,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,"UCare Health, Inc.",Medicare Advantage,42.3948,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Complement C3, S (Mayo)OutsideLaboratory",,86160,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Complement C3, S (Mayo)OutsideLaboratory",,86160,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),42.3948,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Complement C3, S (Mayo)OutsideLaboratory",,86160,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Complement C3, S (Mayo)OutsideLaboratory",,86160,CPT,Facility,Both,,,90,84,71.4,24.0744,84,UnitedHealthcare,Individual & Family,78.96,94,,percent of total billed charges,,
"Complement C3, S (Mayo)OutsideLaboratory",,86160,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,UnitedHealthcare,Medicare Advantage,41.16,49,,percent of total billed charges,,
"Complement C3, S (Mayo)OutsideLaboratory",,86160,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Complement C3, S (Mayo)OutsideLaboratory",,86160,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,40.32,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Complement C3, S (Mayo)OutsideLaboratory",,86160,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Complement C4, S (Mayo)OutsideLaboratory",,86160,CPT,Facility,Both,,,90,81,68.85,23.2146,81,Aetna,Commercial,74.52,92,,percent of total billed charges,,
"Complement C4, S (Mayo)OutsideLaboratory",,86160,CPT,Facility,Outpatient,,,90,81,68.85,23.2146,81,Aetna,Medicare Advantage,39.69,49,,percent of total billed charges,,
"Complement C4, S (Mayo)OutsideLaboratory",,86160,CPT,Facility,Inpatient,,,90,81,68.85,23.2146,81,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Complement C4, S (Mayo)OutsideLaboratory",,86160,CPT,Facility,Both,,,90,81,68.85,23.2146,81,Aetna,PPO,75.33,93,,percent of total billed charges,,
"Complement C4, S (Mayo)OutsideLaboratory",,86160,CPT,Facility,Both,,,90,81,68.85,23.2146,81,America's PPO,America's PPO,77.7843,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Complement C4, S (Mayo)OutsideLaboratory",,86160,CPT,Facility,Both,,,90,81,68.85,23.2146,81,BlueCross BlueShield Minnesota, Federal Employee Program,79.704,98.4,,percent of total billed charges,,
"Complement C4, S (Mayo)OutsideLaboratory",,86160,CPT,Facility,Both,,,90,81,68.85,23.2146,81,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,81,100,,percent of total billed charges,,
"Complement C4, S (Mayo)OutsideLaboratory",,86160,CPT,Facility,Both,,,90,81,68.85,23.2146,81,BlueCross BlueShield Minnesota,High Value Network Plan,72.9,90,,percent of total billed charges,,
"Complement C4, S (Mayo)OutsideLaboratory",,86160,CPT,Facility,Outpatient,,,90,81,68.85,23.2146,81,BlueCross BlueShield Minnesota,Medicare Advantage,39.69,49,,percent of total billed charges,,
"Complement C4, S (Mayo)OutsideLaboratory",,86160,CPT,Facility,Inpatient,,,90,81,68.85,23.2146,81,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Complement C4, S (Mayo)OutsideLaboratory",,86160,CPT,Facility,Both,,,90,81,68.85,23.2146,81,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,71.7417,88.57,,percent of total billed charges,,
"Complement C4, S (Mayo)OutsideLaboratory",,86160,CPT,Facility,Both,,,90,81,68.85,23.2146,81,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,23.2146,28.66,,percent of total billed charges,,
"Complement C4, S (Mayo)OutsideLaboratory",,86160,CPT,Facility,Outpatient,,,90,81,68.85,23.2146,81,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),39.69,49,,percent of total billed charges,,
"Complement C4, S (Mayo)OutsideLaboratory",,86160,CPT,Facility,Inpatient,,,90,81,68.85,23.2146,81,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Complement C4, S (Mayo)OutsideLaboratory",,86160,CPT,Facility,Both,,,90,81,68.85,23.2146,81,CorVel,Worker's Compensation,81,100,,percent of total billed charges,,
"Complement C4, S (Mayo)OutsideLaboratory",,86160,CPT,Facility,Both,,,90,81,68.85,23.2146,81,First Health Group Corporation,First Health Network,78.57,97,,percent of total billed charges,,
"Complement C4, S (Mayo)OutsideLaboratory",,86160,CPT,Facility,Both,,,90,81,68.85,23.2146,81,"Health Partners, Inc.",Commercial,76.626,94.6,,percent of total billed charges,,
"Complement C4, S (Mayo)OutsideLaboratory",,86160,CPT,Facility,Outpatient,,,90,81,68.85,23.2146,81,"Health Partners, Inc.",Medicare Advantage,39.69,49,,percent of total billed charges,,
"Complement C4, S (Mayo)OutsideLaboratory",,86160,CPT,Facility,Inpatient,,,90,81,68.85,23.2146,81,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Complement C4, S (Mayo)OutsideLaboratory",,86160,CPT,Facility,Both,,,90,81,68.85,23.2146,81,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),48.6,60,,percent of total billed charges,,
"Complement C4, S (Mayo)OutsideLaboratory",,86160,CPT,Facility,Both,,,90,81,68.85,23.2146,81,"Health Partners, Inc.",State of Minnesota Advantage Program,66.015,81.5,,percent of total billed charges,,
"Complement C4, S (Mayo)OutsideLaboratory",,86160,CPT,Facility,Both,,,90,81,68.85,23.2146,81,"Health Partners, Inc.",State Public Programs,40.5,50,,percent of total billed charges,,
"Complement C4, S (Mayo)OutsideLaboratory",,86160,CPT,Facility,Both,,,90,81,68.85,23.2146,81,Humana Insurance Company,Commercial PPO,76.95,95,,percent of total billed charges,,
"Complement C4, S (Mayo)OutsideLaboratory",,86160,CPT,Facility,Outpatient,,,90,81,68.85,23.2146,81,Humana Insurance Company,Medicare PPO,39.69,49,,percent of total billed charges,,
"Complement C4, S (Mayo)OutsideLaboratory",,86160,CPT,Facility,Inpatient,,,90,81,68.85,23.2146,81,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Complement C4, S (Mayo)OutsideLaboratory",,86160,CPT,Facility,Both,,,90,81,68.85,23.2146,81,Medica,Individual & Family,80.271,99.1,,percent of total billed charges,,
"Complement C4, S (Mayo)OutsideLaboratory",,86160,CPT,Facility,Outpatient,,,90,81,68.85,23.2146,81,Medica,Medica Advantage Solution,40.338,49.8,,percent of total billed charges,,
"Complement C4, S (Mayo)OutsideLaboratory",,86160,CPT,Facility,Inpatient,,,90,81,68.85,23.2146,81,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Complement C4, S (Mayo)OutsideLaboratory",,86160,CPT,Facility,Outpatient,,,90,81,68.85,23.2146,81,Medica,Medical Assistance,36.126,44.6,,percent of total billed charges,,
"Complement C4, S (Mayo)OutsideLaboratory",,86160,CPT,Facility,Inpatient,,,90,81,68.85,23.2146,81,Medica,Medical Assistance,,,,,Included in per diem rate,
"Complement C4, S (Mayo)OutsideLaboratory",,86160,CPT,Facility,Outpatient,,,90,81,68.85,23.2146,81,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,40.338,49.8,,percent of total billed charges,,
"Complement C4, S (Mayo)OutsideLaboratory",,86160,CPT,Facility,Inpatient,,,90,81,68.85,23.2146,81,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Complement C4, S (Mayo)OutsideLaboratory",,86160,CPT,Facility,Both,,,90,81,68.85,23.2146,81,"Multiplan, Inc.","Multiplan, Inc.",76.14,94,,percent of total billed charges,,
"Complement C4, S (Mayo)OutsideLaboratory",,86160,CPT,Facility,Outpatient,,,90,81,68.85,23.2146,81,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,69.984,86.4,,percent of total billed charges,,
"Complement C4, S (Mayo)OutsideLaboratory",,86160,CPT,Facility,Inpatient,,,90,81,68.85,23.2146,81,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Complement C4, S (Mayo)OutsideLaboratory",,86160,CPT,Facility,Both,,,90,81,68.85,23.2146,81,"Preferred One Administrative Services, INC.",PPO,79.866,98.6,,percent of total billed charges,,
"Complement C4, S (Mayo)OutsideLaboratory",,86160,CPT,Facility,Outpatient,,,90,81,68.85,23.2146,81,PrimeWest Health,Minnesota Senior Health Options (MSHO),41.6745,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Complement C4, S (Mayo)OutsideLaboratory",,86160,CPT,Facility,Inpatient,,,90,81,68.85,23.2146,81,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Complement C4, S (Mayo)OutsideLaboratory",,86160,CPT,Facility,Outpatient,,,90,81,68.85,23.2146,81,PrimeWest Health,MinnesotaCare,41.6016,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Complement C4, S (Mayo)OutsideLaboratory",,86160,CPT,Facility,Inpatient,,,90,81,68.85,23.2146,81,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Complement C4, S (Mayo)OutsideLaboratory",,86160,CPT,Facility,Both,,,90,81,68.85,23.2146,81,Sanford Health Plan,Sanford Health Plan,74.52,92,,percent of total billed charges,,
"Complement C4, S (Mayo)OutsideLaboratory",,86160,CPT,Facility,Outpatient,,,90,81,68.85,23.2146,81,"UCare Health, Inc.",Individual & Family Plan,45.6435,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Complement C4, S (Mayo)OutsideLaboratory",,86160,CPT,Facility,Inpatient,,,90,81,68.85,23.2146,81,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Complement C4, S (Mayo)OutsideLaboratory",,86160,CPT,Facility,Outpatient,,,90,81,68.85,23.2146,81,"UCare Health, Inc.",Medical Assistance,40.8807,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Complement C4, S (Mayo)OutsideLaboratory",,86160,CPT,Facility,Inpatient,,,90,81,68.85,23.2146,81,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Complement C4, S (Mayo)OutsideLaboratory",,86160,CPT,Facility,Outpatient,,,90,81,68.85,23.2146,81,"UCare Health, Inc.",Medicare Advantage,40.8807,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Complement C4, S (Mayo)OutsideLaboratory",,86160,CPT,Facility,Inpatient,,,90,81,68.85,23.2146,81,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Complement C4, S (Mayo)OutsideLaboratory",,86160,CPT,Facility,Outpatient,,,90,81,68.85,23.2146,81,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),40.8807,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Complement C4, S (Mayo)OutsideLaboratory",,86160,CPT,Facility,Inpatient,,,90,81,68.85,23.2146,81,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Complement C4, S (Mayo)OutsideLaboratory",,86160,CPT,Facility,Both,,,90,81,68.85,23.2146,81,UnitedHealthcare,Individual & Family,76.14,94,,percent of total billed charges,,
"Complement C4, S (Mayo)OutsideLaboratory",,86160,CPT,Facility,Outpatient,,,90,81,68.85,23.2146,81,UnitedHealthcare,Medicare Advantage,39.69,49,,percent of total billed charges,,
"Complement C4, S (Mayo)OutsideLaboratory",,86160,CPT,Facility,Inpatient,,,90,81,68.85,23.2146,81,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Complement C4, S (Mayo)OutsideLaboratory",,86160,CPT,Facility,Outpatient,,,90,81,68.85,23.2146,81,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,38.88,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Complement C4, S (Mayo)OutsideLaboratory",,86160,CPT,Facility,Inpatient,,,90,81,68.85,23.2146,81,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"C8 Complement, Functional, S (Mayo)OutsideLaboratory",,86161,CPT,Facility,Both,,,90,163,138.55,46.7158,163,Aetna,Commercial,149.96,92,,percent of total billed charges,,
"C8 Complement, Functional, S (Mayo)OutsideLaboratory",,86161,CPT,Facility,Outpatient,,,90,163,138.55,46.7158,163,Aetna,Medicare Advantage,79.87,49,,percent of total billed charges,,
"C8 Complement, Functional, S (Mayo)OutsideLaboratory",,86161,CPT,Facility,Inpatient,,,90,163,138.55,46.7158,163,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"C8 Complement, Functional, S (Mayo)OutsideLaboratory",,86161,CPT,Facility,Both,,,90,163,138.55,46.7158,163,Aetna,PPO,151.59,93,,percent of total billed charges,,
"C8 Complement, Functional, S (Mayo)OutsideLaboratory",,86161,CPT,Facility,Both,,,90,163,138.55,46.7158,163,America's PPO,America's PPO,156.5289,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"C8 Complement, Functional, S (Mayo)OutsideLaboratory",,86161,CPT,Facility,Both,,,90,163,138.55,46.7158,163,BlueCross BlueShield Minnesota, Federal Employee Program,160.392,98.4,,percent of total billed charges,,
"C8 Complement, Functional, S (Mayo)OutsideLaboratory",,86161,CPT,Facility,Both,,,90,163,138.55,46.7158,163,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,163,100,,percent of total billed charges,,
"C8 Complement, Functional, S (Mayo)OutsideLaboratory",,86161,CPT,Facility,Both,,,90,163,138.55,46.7158,163,BlueCross BlueShield Minnesota,High Value Network Plan,146.7,90,,percent of total billed charges,,
"C8 Complement, Functional, S (Mayo)OutsideLaboratory",,86161,CPT,Facility,Outpatient,,,90,163,138.55,46.7158,163,BlueCross BlueShield Minnesota,Medicare Advantage,79.87,49,,percent of total billed charges,,
"C8 Complement, Functional, S (Mayo)OutsideLaboratory",,86161,CPT,Facility,Inpatient,,,90,163,138.55,46.7158,163,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"C8 Complement, Functional, S (Mayo)OutsideLaboratory",,86161,CPT,Facility,Both,,,90,163,138.55,46.7158,163,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,144.3691,88.57,,percent of total billed charges,,
"C8 Complement, Functional, S (Mayo)OutsideLaboratory",,86161,CPT,Facility,Both,,,90,163,138.55,46.7158,163,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,46.7158,28.66,,percent of total billed charges,,
"C8 Complement, Functional, S (Mayo)OutsideLaboratory",,86161,CPT,Facility,Outpatient,,,90,163,138.55,46.7158,163,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),79.87,49,,percent of total billed charges,,
"C8 Complement, Functional, S (Mayo)OutsideLaboratory",,86161,CPT,Facility,Inpatient,,,90,163,138.55,46.7158,163,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"C8 Complement, Functional, S (Mayo)OutsideLaboratory",,86161,CPT,Facility,Both,,,90,163,138.55,46.7158,163,CorVel,Worker's Compensation,163,100,,percent of total billed charges,,
"C8 Complement, Functional, S (Mayo)OutsideLaboratory",,86161,CPT,Facility,Both,,,90,163,138.55,46.7158,163,First Health Group Corporation,First Health Network,158.11,97,,percent of total billed charges,,
"C8 Complement, Functional, S (Mayo)OutsideLaboratory",,86161,CPT,Facility,Both,,,90,163,138.55,46.7158,163,"Health Partners, Inc.",Commercial,154.198,94.6,,percent of total billed charges,,
"C8 Complement, Functional, S (Mayo)OutsideLaboratory",,86161,CPT,Facility,Outpatient,,,90,163,138.55,46.7158,163,"Health Partners, Inc.",Medicare Advantage,79.87,49,,percent of total billed charges,,
"C8 Complement, Functional, S (Mayo)OutsideLaboratory",,86161,CPT,Facility,Inpatient,,,90,163,138.55,46.7158,163,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"C8 Complement, Functional, S (Mayo)OutsideLaboratory",,86161,CPT,Facility,Both,,,90,163,138.55,46.7158,163,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),97.8,60,,percent of total billed charges,,
"C8 Complement, Functional, S (Mayo)OutsideLaboratory",,86161,CPT,Facility,Both,,,90,163,138.55,46.7158,163,"Health Partners, Inc.",State of Minnesota Advantage Program,132.845,81.5,,percent of total billed charges,,
"C8 Complement, Functional, S (Mayo)OutsideLaboratory",,86161,CPT,Facility,Both,,,90,163,138.55,46.7158,163,"Health Partners, Inc.",State Public Programs,81.5,50,,percent of total billed charges,,
"C8 Complement, Functional, S (Mayo)OutsideLaboratory",,86161,CPT,Facility,Both,,,90,163,138.55,46.7158,163,Humana Insurance Company,Commercial PPO,154.85,95,,percent of total billed charges,,
"C8 Complement, Functional, S (Mayo)OutsideLaboratory",,86161,CPT,Facility,Outpatient,,,90,163,138.55,46.7158,163,Humana Insurance Company,Medicare PPO,79.87,49,,percent of total billed charges,,
"C8 Complement, Functional, S (Mayo)OutsideLaboratory",,86161,CPT,Facility,Inpatient,,,90,163,138.55,46.7158,163,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"C8 Complement, Functional, S (Mayo)OutsideLaboratory",,86161,CPT,Facility,Both,,,90,163,138.55,46.7158,163,Medica,Individual & Family,161.533,99.1,,percent of total billed charges,,
"C8 Complement, Functional, S (Mayo)OutsideLaboratory",,86161,CPT,Facility,Outpatient,,,90,163,138.55,46.7158,163,Medica,Medica Advantage Solution,81.174,49.8,,percent of total billed charges,,
"C8 Complement, Functional, S (Mayo)OutsideLaboratory",,86161,CPT,Facility,Inpatient,,,90,163,138.55,46.7158,163,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"C8 Complement, Functional, S (Mayo)OutsideLaboratory",,86161,CPT,Facility,Outpatient,,,90,163,138.55,46.7158,163,Medica,Medical Assistance,72.698,44.6,,percent of total billed charges,,
"C8 Complement, Functional, S (Mayo)OutsideLaboratory",,86161,CPT,Facility,Inpatient,,,90,163,138.55,46.7158,163,Medica,Medical Assistance,,,,,Included in per diem rate,
"C8 Complement, Functional, S (Mayo)OutsideLaboratory",,86161,CPT,Facility,Outpatient,,,90,163,138.55,46.7158,163,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,81.174,49.8,,percent of total billed charges,,
"C8 Complement, Functional, S (Mayo)OutsideLaboratory",,86161,CPT,Facility,Inpatient,,,90,163,138.55,46.7158,163,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"C8 Complement, Functional, S (Mayo)OutsideLaboratory",,86161,CPT,Facility,Both,,,90,163,138.55,46.7158,163,"Multiplan, Inc.","Multiplan, Inc.",153.22,94,,percent of total billed charges,,
"C8 Complement, Functional, S (Mayo)OutsideLaboratory",,86161,CPT,Facility,Outpatient,,,90,163,138.55,46.7158,163,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,140.832,86.4,,percent of total billed charges,,
"C8 Complement, Functional, S (Mayo)OutsideLaboratory",,86161,CPT,Facility,Inpatient,,,90,163,138.55,46.7158,163,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"C8 Complement, Functional, S (Mayo)OutsideLaboratory",,86161,CPT,Facility,Both,,,90,163,138.55,46.7158,163,"Preferred One Administrative Services, INC.",PPO,160.718,98.6,,percent of total billed charges,,
"C8 Complement, Functional, S (Mayo)OutsideLaboratory",,86161,CPT,Facility,Outpatient,,,90,163,138.55,46.7158,163,PrimeWest Health,Minnesota Senior Health Options (MSHO),83.8635,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"C8 Complement, Functional, S (Mayo)OutsideLaboratory",,86161,CPT,Facility,Inpatient,,,90,163,138.55,46.7158,163,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"C8 Complement, Functional, S (Mayo)OutsideLaboratory",,86161,CPT,Facility,Outpatient,,,90,163,138.55,46.7158,163,PrimeWest Health,MinnesotaCare,83.7168,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"C8 Complement, Functional, S (Mayo)OutsideLaboratory",,86161,CPT,Facility,Inpatient,,,90,163,138.55,46.7158,163,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"C8 Complement, Functional, S (Mayo)OutsideLaboratory",,86161,CPT,Facility,Both,,,90,163,138.55,46.7158,163,Sanford Health Plan,Sanford Health Plan,149.96,92,,percent of total billed charges,,
"C8 Complement, Functional, S (Mayo)OutsideLaboratory",,86161,CPT,Facility,Outpatient,,,90,163,138.55,46.7158,163,"UCare Health, Inc.",Individual & Family Plan,91.8505,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"C8 Complement, Functional, S (Mayo)OutsideLaboratory",,86161,CPT,Facility,Inpatient,,,90,163,138.55,46.7158,163,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"C8 Complement, Functional, S (Mayo)OutsideLaboratory",,86161,CPT,Facility,Outpatient,,,90,163,138.55,46.7158,163,"UCare Health, Inc.",Medical Assistance,82.2661,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"C8 Complement, Functional, S (Mayo)OutsideLaboratory",,86161,CPT,Facility,Inpatient,,,90,163,138.55,46.7158,163,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"C8 Complement, Functional, S (Mayo)OutsideLaboratory",,86161,CPT,Facility,Outpatient,,,90,163,138.55,46.7158,163,"UCare Health, Inc.",Medicare Advantage,82.2661,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"C8 Complement, Functional, S (Mayo)OutsideLaboratory",,86161,CPT,Facility,Inpatient,,,90,163,138.55,46.7158,163,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"C8 Complement, Functional, S (Mayo)OutsideLaboratory",,86161,CPT,Facility,Outpatient,,,90,163,138.55,46.7158,163,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),82.2661,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"C8 Complement, Functional, S (Mayo)OutsideLaboratory",,86161,CPT,Facility,Inpatient,,,90,163,138.55,46.7158,163,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"C8 Complement, Functional, S (Mayo)OutsideLaboratory",,86161,CPT,Facility,Both,,,90,163,138.55,46.7158,163,UnitedHealthcare,Individual & Family,153.22,94,,percent of total billed charges,,
"C8 Complement, Functional, S (Mayo)OutsideLaboratory",,86161,CPT,Facility,Outpatient,,,90,163,138.55,46.7158,163,UnitedHealthcare,Medicare Advantage,79.87,49,,percent of total billed charges,,
"C8 Complement, Functional, S (Mayo)OutsideLaboratory",,86161,CPT,Facility,Inpatient,,,90,163,138.55,46.7158,163,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"C8 Complement, Functional, S (Mayo)OutsideLaboratory",,86161,CPT,Facility,Outpatient,,,90,163,138.55,46.7158,163,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,78.24,48,,percent of total billed charges,,100% of DHS outpatient percentage
"C8 Complement, Functional, S (Mayo)OutsideLaboratory",,86161,CPT,Facility,Inpatient,,,90,163,138.55,46.7158,163,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Complement, Alternate Path, Func, S (Mayo)OutsideLaboratory",,86161,CPT,Facility,Both,,,90,163,138.55,46.7158,163,Aetna,Commercial,149.96,92,,percent of total billed charges,,
"Complement, Alternate Path, Func, S (Mayo)OutsideLaboratory",,86161,CPT,Facility,Outpatient,,,90,163,138.55,46.7158,163,Aetna,Medicare Advantage,79.87,49,,percent of total billed charges,,
"Complement, Alternate Path, Func, S (Mayo)OutsideLaboratory",,86161,CPT,Facility,Inpatient,,,90,163,138.55,46.7158,163,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Complement, Alternate Path, Func, S (Mayo)OutsideLaboratory",,86161,CPT,Facility,Both,,,90,163,138.55,46.7158,163,Aetna,PPO,151.59,93,,percent of total billed charges,,
"Complement, Alternate Path, Func, S (Mayo)OutsideLaboratory",,86161,CPT,Facility,Both,,,90,163,138.55,46.7158,163,America's PPO,America's PPO,156.5289,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Complement, Alternate Path, Func, S (Mayo)OutsideLaboratory",,86161,CPT,Facility,Both,,,90,163,138.55,46.7158,163,BlueCross BlueShield Minnesota, Federal Employee Program,160.392,98.4,,percent of total billed charges,,
"Complement, Alternate Path, Func, S (Mayo)OutsideLaboratory",,86161,CPT,Facility,Both,,,90,163,138.55,46.7158,163,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,163,100,,percent of total billed charges,,
"Complement, Alternate Path, Func, S (Mayo)OutsideLaboratory",,86161,CPT,Facility,Both,,,90,163,138.55,46.7158,163,BlueCross BlueShield Minnesota,High Value Network Plan,146.7,90,,percent of total billed charges,,
"Complement, Alternate Path, Func, S (Mayo)OutsideLaboratory",,86161,CPT,Facility,Outpatient,,,90,163,138.55,46.7158,163,BlueCross BlueShield Minnesota,Medicare Advantage,79.87,49,,percent of total billed charges,,
"Complement, Alternate Path, Func, S (Mayo)OutsideLaboratory",,86161,CPT,Facility,Inpatient,,,90,163,138.55,46.7158,163,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Complement, Alternate Path, Func, S (Mayo)OutsideLaboratory",,86161,CPT,Facility,Both,,,90,163,138.55,46.7158,163,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,144.3691,88.57,,percent of total billed charges,,
"Complement, Alternate Path, Func, S (Mayo)OutsideLaboratory",,86161,CPT,Facility,Both,,,90,163,138.55,46.7158,163,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,46.7158,28.66,,percent of total billed charges,,
"Complement, Alternate Path, Func, S (Mayo)OutsideLaboratory",,86161,CPT,Facility,Outpatient,,,90,163,138.55,46.7158,163,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),79.87,49,,percent of total billed charges,,
"Complement, Alternate Path, Func, S (Mayo)OutsideLaboratory",,86161,CPT,Facility,Inpatient,,,90,163,138.55,46.7158,163,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Complement, Alternate Path, Func, S (Mayo)OutsideLaboratory",,86161,CPT,Facility,Both,,,90,163,138.55,46.7158,163,CorVel,Worker's Compensation,163,100,,percent of total billed charges,,
"Complement, Alternate Path, Func, S (Mayo)OutsideLaboratory",,86161,CPT,Facility,Both,,,90,163,138.55,46.7158,163,First Health Group Corporation,First Health Network,158.11,97,,percent of total billed charges,,
"Complement, Alternate Path, Func, S (Mayo)OutsideLaboratory",,86161,CPT,Facility,Both,,,90,163,138.55,46.7158,163,"Health Partners, Inc.",Commercial,154.198,94.6,,percent of total billed charges,,
"Complement, Alternate Path, Func, S (Mayo)OutsideLaboratory",,86161,CPT,Facility,Outpatient,,,90,163,138.55,46.7158,163,"Health Partners, Inc.",Medicare Advantage,79.87,49,,percent of total billed charges,,
"Complement, Alternate Path, Func, S (Mayo)OutsideLaboratory",,86161,CPT,Facility,Inpatient,,,90,163,138.55,46.7158,163,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Complement, Alternate Path, Func, S (Mayo)OutsideLaboratory",,86161,CPT,Facility,Both,,,90,163,138.55,46.7158,163,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),97.8,60,,percent of total billed charges,,
"Complement, Alternate Path, Func, S (Mayo)OutsideLaboratory",,86161,CPT,Facility,Both,,,90,163,138.55,46.7158,163,"Health Partners, Inc.",State of Minnesota Advantage Program,132.845,81.5,,percent of total billed charges,,
"Complement, Alternate Path, Func, S (Mayo)OutsideLaboratory",,86161,CPT,Facility,Both,,,90,163,138.55,46.7158,163,"Health Partners, Inc.",State Public Programs,81.5,50,,percent of total billed charges,,
"Complement, Alternate Path, Func, S (Mayo)OutsideLaboratory",,86161,CPT,Facility,Both,,,90,163,138.55,46.7158,163,Humana Insurance Company,Commercial PPO,154.85,95,,percent of total billed charges,,
"Complement, Alternate Path, Func, S (Mayo)OutsideLaboratory",,86161,CPT,Facility,Outpatient,,,90,163,138.55,46.7158,163,Humana Insurance Company,Medicare PPO,79.87,49,,percent of total billed charges,,
"Complement, Alternate Path, Func, S (Mayo)OutsideLaboratory",,86161,CPT,Facility,Inpatient,,,90,163,138.55,46.7158,163,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Complement, Alternate Path, Func, S (Mayo)OutsideLaboratory",,86161,CPT,Facility,Both,,,90,163,138.55,46.7158,163,Medica,Individual & Family,161.533,99.1,,percent of total billed charges,,
"Complement, Alternate Path, Func, S (Mayo)OutsideLaboratory",,86161,CPT,Facility,Outpatient,,,90,163,138.55,46.7158,163,Medica,Medica Advantage Solution,81.174,49.8,,percent of total billed charges,,
"Complement, Alternate Path, Func, S (Mayo)OutsideLaboratory",,86161,CPT,Facility,Inpatient,,,90,163,138.55,46.7158,163,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Complement, Alternate Path, Func, S (Mayo)OutsideLaboratory",,86161,CPT,Facility,Outpatient,,,90,163,138.55,46.7158,163,Medica,Medical Assistance,72.698,44.6,,percent of total billed charges,,
"Complement, Alternate Path, Func, S (Mayo)OutsideLaboratory",,86161,CPT,Facility,Inpatient,,,90,163,138.55,46.7158,163,Medica,Medical Assistance,,,,,Included in per diem rate,
"Complement, Alternate Path, Func, S (Mayo)OutsideLaboratory",,86161,CPT,Facility,Outpatient,,,90,163,138.55,46.7158,163,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,81.174,49.8,,percent of total billed charges,,
"Complement, Alternate Path, Func, S (Mayo)OutsideLaboratory",,86161,CPT,Facility,Inpatient,,,90,163,138.55,46.7158,163,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Complement, Alternate Path, Func, S (Mayo)OutsideLaboratory",,86161,CPT,Facility,Both,,,90,163,138.55,46.7158,163,"Multiplan, Inc.","Multiplan, Inc.",153.22,94,,percent of total billed charges,,
"Complement, Alternate Path, Func, S (Mayo)OutsideLaboratory",,86161,CPT,Facility,Outpatient,,,90,163,138.55,46.7158,163,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,140.832,86.4,,percent of total billed charges,,
"Complement, Alternate Path, Func, S (Mayo)OutsideLaboratory",,86161,CPT,Facility,Inpatient,,,90,163,138.55,46.7158,163,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Complement, Alternate Path, Func, S (Mayo)OutsideLaboratory",,86161,CPT,Facility,Both,,,90,163,138.55,46.7158,163,"Preferred One Administrative Services, INC.",PPO,160.718,98.6,,percent of total billed charges,,
"Complement, Alternate Path, Func, S (Mayo)OutsideLaboratory",,86161,CPT,Facility,Outpatient,,,90,163,138.55,46.7158,163,PrimeWest Health,Minnesota Senior Health Options (MSHO),83.8635,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Complement, Alternate Path, Func, S (Mayo)OutsideLaboratory",,86161,CPT,Facility,Inpatient,,,90,163,138.55,46.7158,163,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Complement, Alternate Path, Func, S (Mayo)OutsideLaboratory",,86161,CPT,Facility,Outpatient,,,90,163,138.55,46.7158,163,PrimeWest Health,MinnesotaCare,83.7168,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Complement, Alternate Path, Func, S (Mayo)OutsideLaboratory",,86161,CPT,Facility,Inpatient,,,90,163,138.55,46.7158,163,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Complement, Alternate Path, Func, S (Mayo)OutsideLaboratory",,86161,CPT,Facility,Both,,,90,163,138.55,46.7158,163,Sanford Health Plan,Sanford Health Plan,149.96,92,,percent of total billed charges,,
"Complement, Alternate Path, Func, S (Mayo)OutsideLaboratory",,86161,CPT,Facility,Outpatient,,,90,163,138.55,46.7158,163,"UCare Health, Inc.",Individual & Family Plan,91.8505,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Complement, Alternate Path, Func, S (Mayo)OutsideLaboratory",,86161,CPT,Facility,Inpatient,,,90,163,138.55,46.7158,163,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Complement, Alternate Path, Func, S (Mayo)OutsideLaboratory",,86161,CPT,Facility,Outpatient,,,90,163,138.55,46.7158,163,"UCare Health, Inc.",Medical Assistance,82.2661,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Complement, Alternate Path, Func, S (Mayo)OutsideLaboratory",,86161,CPT,Facility,Inpatient,,,90,163,138.55,46.7158,163,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Complement, Alternate Path, Func, S (Mayo)OutsideLaboratory",,86161,CPT,Facility,Outpatient,,,90,163,138.55,46.7158,163,"UCare Health, Inc.",Medicare Advantage,82.2661,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Complement, Alternate Path, Func, S (Mayo)OutsideLaboratory",,86161,CPT,Facility,Inpatient,,,90,163,138.55,46.7158,163,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Complement, Alternate Path, Func, S (Mayo)OutsideLaboratory",,86161,CPT,Facility,Outpatient,,,90,163,138.55,46.7158,163,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),82.2661,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Complement, Alternate Path, Func, S (Mayo)OutsideLaboratory",,86161,CPT,Facility,Inpatient,,,90,163,138.55,46.7158,163,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Complement, Alternate Path, Func, S (Mayo)OutsideLaboratory",,86161,CPT,Facility,Both,,,90,163,138.55,46.7158,163,UnitedHealthcare,Individual & Family,153.22,94,,percent of total billed charges,,
"Complement, Alternate Path, Func, S (Mayo)OutsideLaboratory",,86161,CPT,Facility,Outpatient,,,90,163,138.55,46.7158,163,UnitedHealthcare,Medicare Advantage,79.87,49,,percent of total billed charges,,
"Complement, Alternate Path, Func, S (Mayo)OutsideLaboratory",,86161,CPT,Facility,Inpatient,,,90,163,138.55,46.7158,163,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Complement, Alternate Path, Func, S (Mayo)OutsideLaboratory",,86161,CPT,Facility,Outpatient,,,90,163,138.55,46.7158,163,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,78.24,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Complement, Alternate Path, Func, S (Mayo)OutsideLaboratory",,86161,CPT,Facility,Inpatient,,,90,163,138.55,46.7158,163,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Complement, Total, S (Mayo)OutsideLaboratory",,86162,CPT,Facility,Both,,,90,143,121.55,40.9838,143,Aetna,Commercial,131.56,92,,percent of total billed charges,,
"Complement, Total, S (Mayo)OutsideLaboratory",,86162,CPT,Facility,Outpatient,,,90,143,121.55,40.9838,143,Aetna,Medicare Advantage,70.07,49,,percent of total billed charges,,
"Complement, Total, S (Mayo)OutsideLaboratory",,86162,CPT,Facility,Inpatient,,,90,143,121.55,40.9838,143,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Complement, Total, S (Mayo)OutsideLaboratory",,86162,CPT,Facility,Both,,,90,143,121.55,40.9838,143,Aetna,PPO,132.99,93,,percent of total billed charges,,
"Complement, Total, S (Mayo)OutsideLaboratory",,86162,CPT,Facility,Both,,,90,143,121.55,40.9838,143,America's PPO,America's PPO,137.3229,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Complement, Total, S (Mayo)OutsideLaboratory",,86162,CPT,Facility,Both,,,90,143,121.55,40.9838,143,BlueCross BlueShield Minnesota, Federal Employee Program,140.712,98.4,,percent of total billed charges,,
"Complement, Total, S (Mayo)OutsideLaboratory",,86162,CPT,Facility,Both,,,90,143,121.55,40.9838,143,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,143,100,,percent of total billed charges,,
"Complement, Total, S (Mayo)OutsideLaboratory",,86162,CPT,Facility,Both,,,90,143,121.55,40.9838,143,BlueCross BlueShield Minnesota,High Value Network Plan,128.7,90,,percent of total billed charges,,
"Complement, Total, S (Mayo)OutsideLaboratory",,86162,CPT,Facility,Outpatient,,,90,143,121.55,40.9838,143,BlueCross BlueShield Minnesota,Medicare Advantage,70.07,49,,percent of total billed charges,,
"Complement, Total, S (Mayo)OutsideLaboratory",,86162,CPT,Facility,Inpatient,,,90,143,121.55,40.9838,143,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Complement, Total, S (Mayo)OutsideLaboratory",,86162,CPT,Facility,Both,,,90,143,121.55,40.9838,143,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,126.6551,88.57,,percent of total billed charges,,
"Complement, Total, S (Mayo)OutsideLaboratory",,86162,CPT,Facility,Both,,,90,143,121.55,40.9838,143,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,40.9838,28.66,,percent of total billed charges,,
"Complement, Total, S (Mayo)OutsideLaboratory",,86162,CPT,Facility,Outpatient,,,90,143,121.55,40.9838,143,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),70.07,49,,percent of total billed charges,,
"Complement, Total, S (Mayo)OutsideLaboratory",,86162,CPT,Facility,Inpatient,,,90,143,121.55,40.9838,143,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Complement, Total, S (Mayo)OutsideLaboratory",,86162,CPT,Facility,Both,,,90,143,121.55,40.9838,143,CorVel,Worker's Compensation,143,100,,percent of total billed charges,,
"Complement, Total, S (Mayo)OutsideLaboratory",,86162,CPT,Facility,Both,,,90,143,121.55,40.9838,143,First Health Group Corporation,First Health Network,138.71,97,,percent of total billed charges,,
"Complement, Total, S (Mayo)OutsideLaboratory",,86162,CPT,Facility,Both,,,90,143,121.55,40.9838,143,"Health Partners, Inc.",Commercial,135.278,94.6,,percent of total billed charges,,
"Complement, Total, S (Mayo)OutsideLaboratory",,86162,CPT,Facility,Outpatient,,,90,143,121.55,40.9838,143,"Health Partners, Inc.",Medicare Advantage,70.07,49,,percent of total billed charges,,
"Complement, Total, S (Mayo)OutsideLaboratory",,86162,CPT,Facility,Inpatient,,,90,143,121.55,40.9838,143,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Complement, Total, S (Mayo)OutsideLaboratory",,86162,CPT,Facility,Both,,,90,143,121.55,40.9838,143,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),85.8,60,,percent of total billed charges,,
"Complement, Total, S (Mayo)OutsideLaboratory",,86162,CPT,Facility,Both,,,90,143,121.55,40.9838,143,"Health Partners, Inc.",State of Minnesota Advantage Program,116.545,81.5,,percent of total billed charges,,
"Complement, Total, S (Mayo)OutsideLaboratory",,86162,CPT,Facility,Both,,,90,143,121.55,40.9838,143,"Health Partners, Inc.",State Public Programs,71.5,50,,percent of total billed charges,,
"Complement, Total, S (Mayo)OutsideLaboratory",,86162,CPT,Facility,Both,,,90,143,121.55,40.9838,143,Humana Insurance Company,Commercial PPO,135.85,95,,percent of total billed charges,,
"Complement, Total, S (Mayo)OutsideLaboratory",,86162,CPT,Facility,Outpatient,,,90,143,121.55,40.9838,143,Humana Insurance Company,Medicare PPO,70.07,49,,percent of total billed charges,,
"Complement, Total, S (Mayo)OutsideLaboratory",,86162,CPT,Facility,Inpatient,,,90,143,121.55,40.9838,143,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Complement, Total, S (Mayo)OutsideLaboratory",,86162,CPT,Facility,Both,,,90,143,121.55,40.9838,143,Medica,Individual & Family,141.713,99.1,,percent of total billed charges,,
"Complement, Total, S (Mayo)OutsideLaboratory",,86162,CPT,Facility,Outpatient,,,90,143,121.55,40.9838,143,Medica,Medica Advantage Solution,71.214,49.8,,percent of total billed charges,,
"Complement, Total, S (Mayo)OutsideLaboratory",,86162,CPT,Facility,Inpatient,,,90,143,121.55,40.9838,143,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Complement, Total, S (Mayo)OutsideLaboratory",,86162,CPT,Facility,Outpatient,,,90,143,121.55,40.9838,143,Medica,Medical Assistance,63.778,44.6,,percent of total billed charges,,
"Complement, Total, S (Mayo)OutsideLaboratory",,86162,CPT,Facility,Inpatient,,,90,143,121.55,40.9838,143,Medica,Medical Assistance,,,,,Included in per diem rate,
"Complement, Total, S (Mayo)OutsideLaboratory",,86162,CPT,Facility,Outpatient,,,90,143,121.55,40.9838,143,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,71.214,49.8,,percent of total billed charges,,
"Complement, Total, S (Mayo)OutsideLaboratory",,86162,CPT,Facility,Inpatient,,,90,143,121.55,40.9838,143,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Complement, Total, S (Mayo)OutsideLaboratory",,86162,CPT,Facility,Both,,,90,143,121.55,40.9838,143,"Multiplan, Inc.","Multiplan, Inc.",134.42,94,,percent of total billed charges,,
"Complement, Total, S (Mayo)OutsideLaboratory",,86162,CPT,Facility,Outpatient,,,90,143,121.55,40.9838,143,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,123.552,86.4,,percent of total billed charges,,
"Complement, Total, S (Mayo)OutsideLaboratory",,86162,CPT,Facility,Inpatient,,,90,143,121.55,40.9838,143,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Complement, Total, S (Mayo)OutsideLaboratory",,86162,CPT,Facility,Both,,,90,143,121.55,40.9838,143,"Preferred One Administrative Services, INC.",PPO,140.998,98.6,,percent of total billed charges,,
"Complement, Total, S (Mayo)OutsideLaboratory",,86162,CPT,Facility,Outpatient,,,90,143,121.55,40.9838,143,PrimeWest Health,Minnesota Senior Health Options (MSHO),73.5735,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Complement, Total, S (Mayo)OutsideLaboratory",,86162,CPT,Facility,Inpatient,,,90,143,121.55,40.9838,143,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Complement, Total, S (Mayo)OutsideLaboratory",,86162,CPT,Facility,Outpatient,,,90,143,121.55,40.9838,143,PrimeWest Health,MinnesotaCare,73.4448,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Complement, Total, S (Mayo)OutsideLaboratory",,86162,CPT,Facility,Inpatient,,,90,143,121.55,40.9838,143,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Complement, Total, S (Mayo)OutsideLaboratory",,86162,CPT,Facility,Both,,,90,143,121.55,40.9838,143,Sanford Health Plan,Sanford Health Plan,131.56,92,,percent of total billed charges,,
"Complement, Total, S (Mayo)OutsideLaboratory",,86162,CPT,Facility,Outpatient,,,90,143,121.55,40.9838,143,"UCare Health, Inc.",Individual & Family Plan,80.5805,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Complement, Total, S (Mayo)OutsideLaboratory",,86162,CPT,Facility,Inpatient,,,90,143,121.55,40.9838,143,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Complement, Total, S (Mayo)OutsideLaboratory",,86162,CPT,Facility,Outpatient,,,90,143,121.55,40.9838,143,"UCare Health, Inc.",Medical Assistance,72.1721,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Complement, Total, S (Mayo)OutsideLaboratory",,86162,CPT,Facility,Inpatient,,,90,143,121.55,40.9838,143,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Complement, Total, S (Mayo)OutsideLaboratory",,86162,CPT,Facility,Outpatient,,,90,143,121.55,40.9838,143,"UCare Health, Inc.",Medicare Advantage,72.1721,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Complement, Total, S (Mayo)OutsideLaboratory",,86162,CPT,Facility,Inpatient,,,90,143,121.55,40.9838,143,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Complement, Total, S (Mayo)OutsideLaboratory",,86162,CPT,Facility,Outpatient,,,90,143,121.55,40.9838,143,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),72.1721,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Complement, Total, S (Mayo)OutsideLaboratory",,86162,CPT,Facility,Inpatient,,,90,143,121.55,40.9838,143,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Complement, Total, S (Mayo)OutsideLaboratory",,86162,CPT,Facility,Both,,,90,143,121.55,40.9838,143,UnitedHealthcare,Individual & Family,134.42,94,,percent of total billed charges,,
"Complement, Total, S (Mayo)OutsideLaboratory",,86162,CPT,Facility,Outpatient,,,90,143,121.55,40.9838,143,UnitedHealthcare,Medicare Advantage,70.07,49,,percent of total billed charges,,
"Complement, Total, S (Mayo)OutsideLaboratory",,86162,CPT,Facility,Inpatient,,,90,143,121.55,40.9838,143,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Complement, Total, S (Mayo)OutsideLaboratory",,86162,CPT,Facility,Outpatient,,,90,143,121.55,40.9838,143,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,68.64,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Complement, Total, S (Mayo)OutsideLaboratory",,86162,CPT,Facility,Inpatient,,,90,143,121.55,40.9838,143,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Cyclic Citrullinated Peptide Ab, S (Mayo)OutsideLaboratory",,86200,CPT,Facility,Both,,,90,122,103.7,34.9652,122,Aetna,Commercial,112.24,92,,percent of total billed charges,,
"Cyclic Citrullinated Peptide Ab, S (Mayo)OutsideLaboratory",,86200,CPT,Facility,Outpatient,,,90,122,103.7,34.9652,122,Aetna,Medicare Advantage,59.78,49,,percent of total billed charges,,
"Cyclic Citrullinated Peptide Ab, S (Mayo)OutsideLaboratory",,86200,CPT,Facility,Inpatient,,,90,122,103.7,34.9652,122,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Cyclic Citrullinated Peptide Ab, S (Mayo)OutsideLaboratory",,86200,CPT,Facility,Both,,,90,122,103.7,34.9652,122,Aetna,PPO,113.46,93,,percent of total billed charges,,
"Cyclic Citrullinated Peptide Ab, S (Mayo)OutsideLaboratory",,86200,CPT,Facility,Both,,,90,122,103.7,34.9652,122,America's PPO,America's PPO,117.1566,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Cyclic Citrullinated Peptide Ab, S (Mayo)OutsideLaboratory",,86200,CPT,Facility,Both,,,90,122,103.7,34.9652,122,BlueCross BlueShield Minnesota, Federal Employee Program,120.048,98.4,,percent of total billed charges,,
"Cyclic Citrullinated Peptide Ab, S (Mayo)OutsideLaboratory",,86200,CPT,Facility,Both,,,90,122,103.7,34.9652,122,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,122,100,,percent of total billed charges,,
"Cyclic Citrullinated Peptide Ab, S (Mayo)OutsideLaboratory",,86200,CPT,Facility,Both,,,90,122,103.7,34.9652,122,BlueCross BlueShield Minnesota,High Value Network Plan,109.8,90,,percent of total billed charges,,
"Cyclic Citrullinated Peptide Ab, S (Mayo)OutsideLaboratory",,86200,CPT,Facility,Outpatient,,,90,122,103.7,34.9652,122,BlueCross BlueShield Minnesota,Medicare Advantage,59.78,49,,percent of total billed charges,,
"Cyclic Citrullinated Peptide Ab, S (Mayo)OutsideLaboratory",,86200,CPT,Facility,Inpatient,,,90,122,103.7,34.9652,122,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Cyclic Citrullinated Peptide Ab, S (Mayo)OutsideLaboratory",,86200,CPT,Facility,Both,,,90,122,103.7,34.9652,122,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,108.0554,88.57,,percent of total billed charges,,
"Cyclic Citrullinated Peptide Ab, S (Mayo)OutsideLaboratory",,86200,CPT,Facility,Both,,,90,122,103.7,34.9652,122,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,34.9652,28.66,,percent of total billed charges,,
"Cyclic Citrullinated Peptide Ab, S (Mayo)OutsideLaboratory",,86200,CPT,Facility,Outpatient,,,90,122,103.7,34.9652,122,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),59.78,49,,percent of total billed charges,,
"Cyclic Citrullinated Peptide Ab, S (Mayo)OutsideLaboratory",,86200,CPT,Facility,Inpatient,,,90,122,103.7,34.9652,122,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Cyclic Citrullinated Peptide Ab, S (Mayo)OutsideLaboratory",,86200,CPT,Facility,Both,,,90,122,103.7,34.9652,122,CorVel,Worker's Compensation,122,100,,percent of total billed charges,,
"Cyclic Citrullinated Peptide Ab, S (Mayo)OutsideLaboratory",,86200,CPT,Facility,Both,,,90,122,103.7,34.9652,122,First Health Group Corporation,First Health Network,118.34,97,,percent of total billed charges,,
"Cyclic Citrullinated Peptide Ab, S (Mayo)OutsideLaboratory",,86200,CPT,Facility,Both,,,90,122,103.7,34.9652,122,"Health Partners, Inc.",Commercial,115.412,94.6,,percent of total billed charges,,
"Cyclic Citrullinated Peptide Ab, S (Mayo)OutsideLaboratory",,86200,CPT,Facility,Outpatient,,,90,122,103.7,34.9652,122,"Health Partners, Inc.",Medicare Advantage,59.78,49,,percent of total billed charges,,
"Cyclic Citrullinated Peptide Ab, S (Mayo)OutsideLaboratory",,86200,CPT,Facility,Inpatient,,,90,122,103.7,34.9652,122,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Cyclic Citrullinated Peptide Ab, S (Mayo)OutsideLaboratory",,86200,CPT,Facility,Both,,,90,122,103.7,34.9652,122,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),73.2,60,,percent of total billed charges,,
"Cyclic Citrullinated Peptide Ab, S (Mayo)OutsideLaboratory",,86200,CPT,Facility,Both,,,90,122,103.7,34.9652,122,"Health Partners, Inc.",State of Minnesota Advantage Program,99.43,81.5,,percent of total billed charges,,
"Cyclic Citrullinated Peptide Ab, S (Mayo)OutsideLaboratory",,86200,CPT,Facility,Both,,,90,122,103.7,34.9652,122,"Health Partners, Inc.",State Public Programs,61,50,,percent of total billed charges,,
"Cyclic Citrullinated Peptide Ab, S (Mayo)OutsideLaboratory",,86200,CPT,Facility,Both,,,90,122,103.7,34.9652,122,Humana Insurance Company,Commercial PPO,115.9,95,,percent of total billed charges,,
"Cyclic Citrullinated Peptide Ab, S (Mayo)OutsideLaboratory",,86200,CPT,Facility,Outpatient,,,90,122,103.7,34.9652,122,Humana Insurance Company,Medicare PPO,59.78,49,,percent of total billed charges,,
"Cyclic Citrullinated Peptide Ab, S (Mayo)OutsideLaboratory",,86200,CPT,Facility,Inpatient,,,90,122,103.7,34.9652,122,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Cyclic Citrullinated Peptide Ab, S (Mayo)OutsideLaboratory",,86200,CPT,Facility,Both,,,90,122,103.7,34.9652,122,Medica,Individual & Family,120.902,99.1,,percent of total billed charges,,
"Cyclic Citrullinated Peptide Ab, S (Mayo)OutsideLaboratory",,86200,CPT,Facility,Outpatient,,,90,122,103.7,34.9652,122,Medica,Medica Advantage Solution,60.756,49.8,,percent of total billed charges,,
"Cyclic Citrullinated Peptide Ab, S (Mayo)OutsideLaboratory",,86200,CPT,Facility,Inpatient,,,90,122,103.7,34.9652,122,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Cyclic Citrullinated Peptide Ab, S (Mayo)OutsideLaboratory",,86200,CPT,Facility,Outpatient,,,90,122,103.7,34.9652,122,Medica,Medical Assistance,54.412,44.6,,percent of total billed charges,,
"Cyclic Citrullinated Peptide Ab, S (Mayo)OutsideLaboratory",,86200,CPT,Facility,Inpatient,,,90,122,103.7,34.9652,122,Medica,Medical Assistance,,,,,Included in per diem rate,
"Cyclic Citrullinated Peptide Ab, S (Mayo)OutsideLaboratory",,86200,CPT,Facility,Outpatient,,,90,122,103.7,34.9652,122,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,60.756,49.8,,percent of total billed charges,,
"Cyclic Citrullinated Peptide Ab, S (Mayo)OutsideLaboratory",,86200,CPT,Facility,Inpatient,,,90,122,103.7,34.9652,122,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Cyclic Citrullinated Peptide Ab, S (Mayo)OutsideLaboratory",,86200,CPT,Facility,Both,,,90,122,103.7,34.9652,122,"Multiplan, Inc.","Multiplan, Inc.",114.68,94,,percent of total billed charges,,
"Cyclic Citrullinated Peptide Ab, S (Mayo)OutsideLaboratory",,86200,CPT,Facility,Outpatient,,,90,122,103.7,34.9652,122,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,105.408,86.4,,percent of total billed charges,,
"Cyclic Citrullinated Peptide Ab, S (Mayo)OutsideLaboratory",,86200,CPT,Facility,Inpatient,,,90,122,103.7,34.9652,122,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Cyclic Citrullinated Peptide Ab, S (Mayo)OutsideLaboratory",,86200,CPT,Facility,Both,,,90,122,103.7,34.9652,122,"Preferred One Administrative Services, INC.",PPO,120.292,98.6,,percent of total billed charges,,
"Cyclic Citrullinated Peptide Ab, S (Mayo)OutsideLaboratory",,86200,CPT,Facility,Outpatient,,,90,122,103.7,34.9652,122,PrimeWest Health,Minnesota Senior Health Options (MSHO),62.769,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Cyclic Citrullinated Peptide Ab, S (Mayo)OutsideLaboratory",,86200,CPT,Facility,Inpatient,,,90,122,103.7,34.9652,122,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Cyclic Citrullinated Peptide Ab, S (Mayo)OutsideLaboratory",,86200,CPT,Facility,Outpatient,,,90,122,103.7,34.9652,122,PrimeWest Health,MinnesotaCare,62.6592,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Cyclic Citrullinated Peptide Ab, S (Mayo)OutsideLaboratory",,86200,CPT,Facility,Inpatient,,,90,122,103.7,34.9652,122,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Cyclic Citrullinated Peptide Ab, S (Mayo)OutsideLaboratory",,86200,CPT,Facility,Both,,,90,122,103.7,34.9652,122,Sanford Health Plan,Sanford Health Plan,112.24,92,,percent of total billed charges,,
"Cyclic Citrullinated Peptide Ab, S (Mayo)OutsideLaboratory",,86200,CPT,Facility,Outpatient,,,90,122,103.7,34.9652,122,"UCare Health, Inc.",Individual & Family Plan,68.747,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Cyclic Citrullinated Peptide Ab, S (Mayo)OutsideLaboratory",,86200,CPT,Facility,Inpatient,,,90,122,103.7,34.9652,122,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Cyclic Citrullinated Peptide Ab, S (Mayo)OutsideLaboratory",,86200,CPT,Facility,Outpatient,,,90,122,103.7,34.9652,122,"UCare Health, Inc.",Medical Assistance,61.5734,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Cyclic Citrullinated Peptide Ab, S (Mayo)OutsideLaboratory",,86200,CPT,Facility,Inpatient,,,90,122,103.7,34.9652,122,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Cyclic Citrullinated Peptide Ab, S (Mayo)OutsideLaboratory",,86200,CPT,Facility,Outpatient,,,90,122,103.7,34.9652,122,"UCare Health, Inc.",Medicare Advantage,61.5734,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Cyclic Citrullinated Peptide Ab, S (Mayo)OutsideLaboratory",,86200,CPT,Facility,Inpatient,,,90,122,103.7,34.9652,122,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Cyclic Citrullinated Peptide Ab, S (Mayo)OutsideLaboratory",,86200,CPT,Facility,Outpatient,,,90,122,103.7,34.9652,122,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),61.5734,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Cyclic Citrullinated Peptide Ab, S (Mayo)OutsideLaboratory",,86200,CPT,Facility,Inpatient,,,90,122,103.7,34.9652,122,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Cyclic Citrullinated Peptide Ab, S (Mayo)OutsideLaboratory",,86200,CPT,Facility,Both,,,90,122,103.7,34.9652,122,UnitedHealthcare,Individual & Family,114.68,94,,percent of total billed charges,,
"Cyclic Citrullinated Peptide Ab, S (Mayo)OutsideLaboratory",,86200,CPT,Facility,Outpatient,,,90,122,103.7,34.9652,122,UnitedHealthcare,Medicare Advantage,59.78,49,,percent of total billed charges,,
"Cyclic Citrullinated Peptide Ab, S (Mayo)OutsideLaboratory",,86200,CPT,Facility,Inpatient,,,90,122,103.7,34.9652,122,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Cyclic Citrullinated Peptide Ab, S (Mayo)OutsideLaboratory",,86200,CPT,Facility,Outpatient,,,90,122,103.7,34.9652,122,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,58.56,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Cyclic Citrullinated Peptide Ab, S (Mayo)OutsideLaboratory",,86200,CPT,Facility,Inpatient,,,90,122,103.7,34.9652,122,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Streptococcal Antibodies Profile (Mayo)OutsideLaboratory,,86215,CPT,Facility,Both,,,90,61,51.85,17.4826,61,Aetna,Commercial,56.12,92,,percent of total billed charges,,
Streptococcal Antibodies Profile (Mayo)OutsideLaboratory,,86215,CPT,Facility,Outpatient,,,90,61,51.85,17.4826,61,Aetna,Medicare Advantage,29.89,49,,percent of total billed charges,,
Streptococcal Antibodies Profile (Mayo)OutsideLaboratory,,86215,CPT,Facility,Inpatient,,,90,61,51.85,17.4826,61,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Streptococcal Antibodies Profile (Mayo)OutsideLaboratory,,86215,CPT,Facility,Both,,,90,61,51.85,17.4826,61,Aetna,PPO,56.73,93,,percent of total billed charges,,
Streptococcal Antibodies Profile (Mayo)OutsideLaboratory,,86215,CPT,Facility,Both,,,90,61,51.85,17.4826,61,America's PPO,America's PPO,58.5783,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Streptococcal Antibodies Profile (Mayo)OutsideLaboratory,,86215,CPT,Facility,Both,,,90,61,51.85,17.4826,61,BlueCross BlueShield Minnesota, Federal Employee Program,60.024,98.4,,percent of total billed charges,,
Streptococcal Antibodies Profile (Mayo)OutsideLaboratory,,86215,CPT,Facility,Both,,,90,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,61,100,,percent of total billed charges,,
Streptococcal Antibodies Profile (Mayo)OutsideLaboratory,,86215,CPT,Facility,Both,,,90,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,High Value Network Plan,54.9,90,,percent of total billed charges,,
Streptococcal Antibodies Profile (Mayo)OutsideLaboratory,,86215,CPT,Facility,Outpatient,,,90,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,Medicare Advantage,29.89,49,,percent of total billed charges,,
Streptococcal Antibodies Profile (Mayo)OutsideLaboratory,,86215,CPT,Facility,Inpatient,,,90,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Streptococcal Antibodies Profile (Mayo)OutsideLaboratory,,86215,CPT,Facility,Both,,,90,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,54.0277,88.57,,percent of total billed charges,,
Streptococcal Antibodies Profile (Mayo)OutsideLaboratory,,86215,CPT,Facility,Both,,,90,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,17.4826,28.66,,percent of total billed charges,,
Streptococcal Antibodies Profile (Mayo)OutsideLaboratory,,86215,CPT,Facility,Outpatient,,,90,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),29.89,49,,percent of total billed charges,,
Streptococcal Antibodies Profile (Mayo)OutsideLaboratory,,86215,CPT,Facility,Inpatient,,,90,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Streptococcal Antibodies Profile (Mayo)OutsideLaboratory,,86215,CPT,Facility,Both,,,90,61,51.85,17.4826,61,CorVel,Worker's Compensation,61,100,,percent of total billed charges,,
Streptococcal Antibodies Profile (Mayo)OutsideLaboratory,,86215,CPT,Facility,Both,,,90,61,51.85,17.4826,61,First Health Group Corporation,First Health Network,59.17,97,,percent of total billed charges,,
Streptococcal Antibodies Profile (Mayo)OutsideLaboratory,,86215,CPT,Facility,Both,,,90,61,51.85,17.4826,61,"Health Partners, Inc.",Commercial,57.706,94.6,,percent of total billed charges,,
Streptococcal Antibodies Profile (Mayo)OutsideLaboratory,,86215,CPT,Facility,Outpatient,,,90,61,51.85,17.4826,61,"Health Partners, Inc.",Medicare Advantage,29.89,49,,percent of total billed charges,,
Streptococcal Antibodies Profile (Mayo)OutsideLaboratory,,86215,CPT,Facility,Inpatient,,,90,61,51.85,17.4826,61,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Streptococcal Antibodies Profile (Mayo)OutsideLaboratory,,86215,CPT,Facility,Both,,,90,61,51.85,17.4826,61,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),36.6,60,,percent of total billed charges,,
Streptococcal Antibodies Profile (Mayo)OutsideLaboratory,,86215,CPT,Facility,Both,,,90,61,51.85,17.4826,61,"Health Partners, Inc.",State of Minnesota Advantage Program,49.715,81.5,,percent of total billed charges,,
Streptococcal Antibodies Profile (Mayo)OutsideLaboratory,,86215,CPT,Facility,Both,,,90,61,51.85,17.4826,61,"Health Partners, Inc.",State Public Programs,30.5,50,,percent of total billed charges,,
Streptococcal Antibodies Profile (Mayo)OutsideLaboratory,,86215,CPT,Facility,Both,,,90,61,51.85,17.4826,61,Humana Insurance Company,Commercial PPO,57.95,95,,percent of total billed charges,,
Streptococcal Antibodies Profile (Mayo)OutsideLaboratory,,86215,CPT,Facility,Outpatient,,,90,61,51.85,17.4826,61,Humana Insurance Company,Medicare PPO,29.89,49,,percent of total billed charges,,
Streptococcal Antibodies Profile (Mayo)OutsideLaboratory,,86215,CPT,Facility,Inpatient,,,90,61,51.85,17.4826,61,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Streptococcal Antibodies Profile (Mayo)OutsideLaboratory,,86215,CPT,Facility,Both,,,90,61,51.85,17.4826,61,Medica,Individual & Family,60.451,99.1,,percent of total billed charges,,
Streptococcal Antibodies Profile (Mayo)OutsideLaboratory,,86215,CPT,Facility,Outpatient,,,90,61,51.85,17.4826,61,Medica,Medica Advantage Solution,30.378,49.8,,percent of total billed charges,,
Streptococcal Antibodies Profile (Mayo)OutsideLaboratory,,86215,CPT,Facility,Inpatient,,,90,61,51.85,17.4826,61,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Streptococcal Antibodies Profile (Mayo)OutsideLaboratory,,86215,CPT,Facility,Outpatient,,,90,61,51.85,17.4826,61,Medica,Medical Assistance,27.206,44.6,,percent of total billed charges,,
Streptococcal Antibodies Profile (Mayo)OutsideLaboratory,,86215,CPT,Facility,Inpatient,,,90,61,51.85,17.4826,61,Medica,Medical Assistance,,,,,Included in per diem rate,
Streptococcal Antibodies Profile (Mayo)OutsideLaboratory,,86215,CPT,Facility,Outpatient,,,90,61,51.85,17.4826,61,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,30.378,49.8,,percent of total billed charges,,
Streptococcal Antibodies Profile (Mayo)OutsideLaboratory,,86215,CPT,Facility,Inpatient,,,90,61,51.85,17.4826,61,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Streptococcal Antibodies Profile (Mayo)OutsideLaboratory,,86215,CPT,Facility,Both,,,90,61,51.85,17.4826,61,"Multiplan, Inc.","Multiplan, Inc.",57.34,94,,percent of total billed charges,,
Streptococcal Antibodies Profile (Mayo)OutsideLaboratory,,86215,CPT,Facility,Outpatient,,,90,61,51.85,17.4826,61,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,52.704,86.4,,percent of total billed charges,,
Streptococcal Antibodies Profile (Mayo)OutsideLaboratory,,86215,CPT,Facility,Inpatient,,,90,61,51.85,17.4826,61,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Streptococcal Antibodies Profile (Mayo)OutsideLaboratory,,86215,CPT,Facility,Both,,,90,61,51.85,17.4826,61,"Preferred One Administrative Services, INC.",PPO,60.146,98.6,,percent of total billed charges,,
Streptococcal Antibodies Profile (Mayo)OutsideLaboratory,,86215,CPT,Facility,Outpatient,,,90,61,51.85,17.4826,61,PrimeWest Health,Minnesota Senior Health Options (MSHO),31.3845,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Streptococcal Antibodies Profile (Mayo)OutsideLaboratory,,86215,CPT,Facility,Inpatient,,,90,61,51.85,17.4826,61,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Streptococcal Antibodies Profile (Mayo)OutsideLaboratory,,86215,CPT,Facility,Outpatient,,,90,61,51.85,17.4826,61,PrimeWest Health,MinnesotaCare,31.3296,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Streptococcal Antibodies Profile (Mayo)OutsideLaboratory,,86215,CPT,Facility,Inpatient,,,90,61,51.85,17.4826,61,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Streptococcal Antibodies Profile (Mayo)OutsideLaboratory,,86215,CPT,Facility,Both,,,90,61,51.85,17.4826,61,Sanford Health Plan,Sanford Health Plan,56.12,92,,percent of total billed charges,,
Streptococcal Antibodies Profile (Mayo)OutsideLaboratory,,86215,CPT,Facility,Outpatient,,,90,61,51.85,17.4826,61,"UCare Health, Inc.",Individual & Family Plan,34.3735,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Streptococcal Antibodies Profile (Mayo)OutsideLaboratory,,86215,CPT,Facility,Inpatient,,,90,61,51.85,17.4826,61,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Streptococcal Antibodies Profile (Mayo)OutsideLaboratory,,86215,CPT,Facility,Outpatient,,,90,61,51.85,17.4826,61,"UCare Health, Inc.",Medical Assistance,30.7867,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Streptococcal Antibodies Profile (Mayo)OutsideLaboratory,,86215,CPT,Facility,Inpatient,,,90,61,51.85,17.4826,61,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Streptococcal Antibodies Profile (Mayo)OutsideLaboratory,,86215,CPT,Facility,Outpatient,,,90,61,51.85,17.4826,61,"UCare Health, Inc.",Medicare Advantage,30.7867,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Streptococcal Antibodies Profile (Mayo)OutsideLaboratory,,86215,CPT,Facility,Inpatient,,,90,61,51.85,17.4826,61,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Streptococcal Antibodies Profile (Mayo)OutsideLaboratory,,86215,CPT,Facility,Outpatient,,,90,61,51.85,17.4826,61,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),30.7867,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Streptococcal Antibodies Profile (Mayo)OutsideLaboratory,,86215,CPT,Facility,Inpatient,,,90,61,51.85,17.4826,61,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Streptococcal Antibodies Profile (Mayo)OutsideLaboratory,,86215,CPT,Facility,Both,,,90,61,51.85,17.4826,61,UnitedHealthcare,Individual & Family,57.34,94,,percent of total billed charges,,
Streptococcal Antibodies Profile (Mayo)OutsideLaboratory,,86215,CPT,Facility,Outpatient,,,90,61,51.85,17.4826,61,UnitedHealthcare,Medicare Advantage,29.89,49,,percent of total billed charges,,
Streptococcal Antibodies Profile (Mayo)OutsideLaboratory,,86215,CPT,Facility,Inpatient,,,90,61,51.85,17.4826,61,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Streptococcal Antibodies Profile (Mayo)OutsideLaboratory,,86215,CPT,Facility,Outpatient,,,90,61,51.85,17.4826,61,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,29.28,48,,percent of total billed charges,,100% of DHS outpatient percentage
Streptococcal Antibodies Profile (Mayo)OutsideLaboratory,,86215,CPT,Facility,Inpatient,,,90,61,51.85,17.4826,61,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Dna Double-Stranded Ab, Igg, S (Mayo)OutsideLaboratory",,86225,CPT,Facility,Both,,,90,195,165.75,55.887,195,Aetna,Commercial,179.4,92,,percent of total billed charges,,
"Dna Double-Stranded Ab, Igg, S (Mayo)OutsideLaboratory",,86225,CPT,Facility,Outpatient,,,90,195,165.75,55.887,195,Aetna,Medicare Advantage,95.55,49,,percent of total billed charges,,
"Dna Double-Stranded Ab, Igg, S (Mayo)OutsideLaboratory",,86225,CPT,Facility,Inpatient,,,90,195,165.75,55.887,195,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Dna Double-Stranded Ab, Igg, S (Mayo)OutsideLaboratory",,86225,CPT,Facility,Both,,,90,195,165.75,55.887,195,Aetna,PPO,181.35,93,,percent of total billed charges,,
"Dna Double-Stranded Ab, Igg, S (Mayo)OutsideLaboratory",,86225,CPT,Facility,Both,,,90,195,165.75,55.887,195,America's PPO,America's PPO,187.2585,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Dna Double-Stranded Ab, Igg, S (Mayo)OutsideLaboratory",,86225,CPT,Facility,Both,,,90,195,165.75,55.887,195,BlueCross BlueShield Minnesota, Federal Employee Program,191.88,98.4,,percent of total billed charges,,
"Dna Double-Stranded Ab, Igg, S (Mayo)OutsideLaboratory",,86225,CPT,Facility,Both,,,90,195,165.75,55.887,195,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,195,100,,percent of total billed charges,,
"Dna Double-Stranded Ab, Igg, S (Mayo)OutsideLaboratory",,86225,CPT,Facility,Both,,,90,195,165.75,55.887,195,BlueCross BlueShield Minnesota,High Value Network Plan,175.5,90,,percent of total billed charges,,
"Dna Double-Stranded Ab, Igg, S (Mayo)OutsideLaboratory",,86225,CPT,Facility,Outpatient,,,90,195,165.75,55.887,195,BlueCross BlueShield Minnesota,Medicare Advantage,95.55,49,,percent of total billed charges,,
"Dna Double-Stranded Ab, Igg, S (Mayo)OutsideLaboratory",,86225,CPT,Facility,Inpatient,,,90,195,165.75,55.887,195,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Dna Double-Stranded Ab, Igg, S (Mayo)OutsideLaboratory",,86225,CPT,Facility,Both,,,90,195,165.75,55.887,195,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,172.7115,88.57,,percent of total billed charges,,
"Dna Double-Stranded Ab, Igg, S (Mayo)OutsideLaboratory",,86225,CPT,Facility,Both,,,90,195,165.75,55.887,195,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,55.887,28.66,,percent of total billed charges,,
"Dna Double-Stranded Ab, Igg, S (Mayo)OutsideLaboratory",,86225,CPT,Facility,Outpatient,,,90,195,165.75,55.887,195,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),95.55,49,,percent of total billed charges,,
"Dna Double-Stranded Ab, Igg, S (Mayo)OutsideLaboratory",,86225,CPT,Facility,Inpatient,,,90,195,165.75,55.887,195,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Dna Double-Stranded Ab, Igg, S (Mayo)OutsideLaboratory",,86225,CPT,Facility,Both,,,90,195,165.75,55.887,195,CorVel,Worker's Compensation,195,100,,percent of total billed charges,,
"Dna Double-Stranded Ab, Igg, S (Mayo)OutsideLaboratory",,86225,CPT,Facility,Both,,,90,195,165.75,55.887,195,First Health Group Corporation,First Health Network,189.15,97,,percent of total billed charges,,
"Dna Double-Stranded Ab, Igg, S (Mayo)OutsideLaboratory",,86225,CPT,Facility,Both,,,90,195,165.75,55.887,195,"Health Partners, Inc.",Commercial,184.47,94.6,,percent of total billed charges,,
"Dna Double-Stranded Ab, Igg, S (Mayo)OutsideLaboratory",,86225,CPT,Facility,Outpatient,,,90,195,165.75,55.887,195,"Health Partners, Inc.",Medicare Advantage,95.55,49,,percent of total billed charges,,
"Dna Double-Stranded Ab, Igg, S (Mayo)OutsideLaboratory",,86225,CPT,Facility,Inpatient,,,90,195,165.75,55.887,195,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Dna Double-Stranded Ab, Igg, S (Mayo)OutsideLaboratory",,86225,CPT,Facility,Both,,,90,195,165.75,55.887,195,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),117,60,,percent of total billed charges,,
"Dna Double-Stranded Ab, Igg, S (Mayo)OutsideLaboratory",,86225,CPT,Facility,Both,,,90,195,165.75,55.887,195,"Health Partners, Inc.",State of Minnesota Advantage Program,158.925,81.5,,percent of total billed charges,,
"Dna Double-Stranded Ab, Igg, S (Mayo)OutsideLaboratory",,86225,CPT,Facility,Both,,,90,195,165.75,55.887,195,"Health Partners, Inc.",State Public Programs,97.5,50,,percent of total billed charges,,
"Dna Double-Stranded Ab, Igg, S (Mayo)OutsideLaboratory",,86225,CPT,Facility,Both,,,90,195,165.75,55.887,195,Humana Insurance Company,Commercial PPO,185.25,95,,percent of total billed charges,,
"Dna Double-Stranded Ab, Igg, S (Mayo)OutsideLaboratory",,86225,CPT,Facility,Outpatient,,,90,195,165.75,55.887,195,Humana Insurance Company,Medicare PPO,95.55,49,,percent of total billed charges,,
"Dna Double-Stranded Ab, Igg, S (Mayo)OutsideLaboratory",,86225,CPT,Facility,Inpatient,,,90,195,165.75,55.887,195,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Dna Double-Stranded Ab, Igg, S (Mayo)OutsideLaboratory",,86225,CPT,Facility,Both,,,90,195,165.75,55.887,195,Medica,Individual & Family,193.245,99.1,,percent of total billed charges,,
"Dna Double-Stranded Ab, Igg, S (Mayo)OutsideLaboratory",,86225,CPT,Facility,Outpatient,,,90,195,165.75,55.887,195,Medica,Medica Advantage Solution,97.11,49.8,,percent of total billed charges,,
"Dna Double-Stranded Ab, Igg, S (Mayo)OutsideLaboratory",,86225,CPT,Facility,Inpatient,,,90,195,165.75,55.887,195,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Dna Double-Stranded Ab, Igg, S (Mayo)OutsideLaboratory",,86225,CPT,Facility,Outpatient,,,90,195,165.75,55.887,195,Medica,Medical Assistance,86.97,44.6,,percent of total billed charges,,
"Dna Double-Stranded Ab, Igg, S (Mayo)OutsideLaboratory",,86225,CPT,Facility,Inpatient,,,90,195,165.75,55.887,195,Medica,Medical Assistance,,,,,Included in per diem rate,
"Dna Double-Stranded Ab, Igg, S (Mayo)OutsideLaboratory",,86225,CPT,Facility,Outpatient,,,90,195,165.75,55.887,195,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,97.11,49.8,,percent of total billed charges,,
"Dna Double-Stranded Ab, Igg, S (Mayo)OutsideLaboratory",,86225,CPT,Facility,Inpatient,,,90,195,165.75,55.887,195,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Dna Double-Stranded Ab, Igg, S (Mayo)OutsideLaboratory",,86225,CPT,Facility,Both,,,90,195,165.75,55.887,195,"Multiplan, Inc.","Multiplan, Inc.",183.3,94,,percent of total billed charges,,
"Dna Double-Stranded Ab, Igg, S (Mayo)OutsideLaboratory",,86225,CPT,Facility,Outpatient,,,90,195,165.75,55.887,195,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,168.48,86.4,,percent of total billed charges,,
"Dna Double-Stranded Ab, Igg, S (Mayo)OutsideLaboratory",,86225,CPT,Facility,Inpatient,,,90,195,165.75,55.887,195,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Dna Double-Stranded Ab, Igg, S (Mayo)OutsideLaboratory",,86225,CPT,Facility,Both,,,90,195,165.75,55.887,195,"Preferred One Administrative Services, INC.",PPO,192.27,98.6,,percent of total billed charges,,
"Dna Double-Stranded Ab, Igg, S (Mayo)OutsideLaboratory",,86225,CPT,Facility,Outpatient,,,90,195,165.75,55.887,195,PrimeWest Health,Minnesota Senior Health Options (MSHO),100.3275,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Dna Double-Stranded Ab, Igg, S (Mayo)OutsideLaboratory",,86225,CPT,Facility,Inpatient,,,90,195,165.75,55.887,195,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Dna Double-Stranded Ab, Igg, S (Mayo)OutsideLaboratory",,86225,CPT,Facility,Outpatient,,,90,195,165.75,55.887,195,PrimeWest Health,MinnesotaCare,100.152,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Dna Double-Stranded Ab, Igg, S (Mayo)OutsideLaboratory",,86225,CPT,Facility,Inpatient,,,90,195,165.75,55.887,195,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Dna Double-Stranded Ab, Igg, S (Mayo)OutsideLaboratory",,86225,CPT,Facility,Both,,,90,195,165.75,55.887,195,Sanford Health Plan,Sanford Health Plan,179.4,92,,percent of total billed charges,,
"Dna Double-Stranded Ab, Igg, S (Mayo)OutsideLaboratory",,86225,CPT,Facility,Outpatient,,,90,195,165.75,55.887,195,"UCare Health, Inc.",Individual & Family Plan,109.8825,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Dna Double-Stranded Ab, Igg, S (Mayo)OutsideLaboratory",,86225,CPT,Facility,Inpatient,,,90,195,165.75,55.887,195,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Dna Double-Stranded Ab, Igg, S (Mayo)OutsideLaboratory",,86225,CPT,Facility,Outpatient,,,90,195,165.75,55.887,195,"UCare Health, Inc.",Medical Assistance,98.4165,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Dna Double-Stranded Ab, Igg, S (Mayo)OutsideLaboratory",,86225,CPT,Facility,Inpatient,,,90,195,165.75,55.887,195,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Dna Double-Stranded Ab, Igg, S (Mayo)OutsideLaboratory",,86225,CPT,Facility,Outpatient,,,90,195,165.75,55.887,195,"UCare Health, Inc.",Medicare Advantage,98.4165,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Dna Double-Stranded Ab, Igg, S (Mayo)OutsideLaboratory",,86225,CPT,Facility,Inpatient,,,90,195,165.75,55.887,195,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Dna Double-Stranded Ab, Igg, S (Mayo)OutsideLaboratory",,86225,CPT,Facility,Outpatient,,,90,195,165.75,55.887,195,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),98.4165,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Dna Double-Stranded Ab, Igg, S (Mayo)OutsideLaboratory",,86225,CPT,Facility,Inpatient,,,90,195,165.75,55.887,195,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Dna Double-Stranded Ab, Igg, S (Mayo)OutsideLaboratory",,86225,CPT,Facility,Both,,,90,195,165.75,55.887,195,UnitedHealthcare,Individual & Family,183.3,94,,percent of total billed charges,,
"Dna Double-Stranded Ab, Igg, S (Mayo)OutsideLaboratory",,86225,CPT,Facility,Outpatient,,,90,195,165.75,55.887,195,UnitedHealthcare,Medicare Advantage,95.55,49,,percent of total billed charges,,
"Dna Double-Stranded Ab, Igg, S (Mayo)OutsideLaboratory",,86225,CPT,Facility,Inpatient,,,90,195,165.75,55.887,195,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Dna Double-Stranded Ab, Igg, S (Mayo)OutsideLaboratory",,86225,CPT,Facility,Outpatient,,,90,195,165.75,55.887,195,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,93.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Dna Double-Stranded Ab, Igg, S (Mayo)OutsideLaboratory",,86225,CPT,Facility,Inpatient,,,90,195,165.75,55.887,195,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Dsdna Ab With Reflex, Igg, S (Mayo)OutsideLaboratory",,86225,CPT,Facility,Both,,,90,90,76.5,25.794,90,Aetna,Commercial,82.8,92,,percent of total billed charges,,
"Dsdna Ab With Reflex, Igg, S (Mayo)OutsideLaboratory",,86225,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,Aetna,Medicare Advantage,44.1,49,,percent of total billed charges,,
"Dsdna Ab With Reflex, Igg, S (Mayo)OutsideLaboratory",,86225,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Dsdna Ab With Reflex, Igg, S (Mayo)OutsideLaboratory",,86225,CPT,Facility,Both,,,90,90,76.5,25.794,90,Aetna,PPO,83.7,93,,percent of total billed charges,,
"Dsdna Ab With Reflex, Igg, S (Mayo)OutsideLaboratory",,86225,CPT,Facility,Both,,,90,90,76.5,25.794,90,America's PPO,America's PPO,86.427,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Dsdna Ab With Reflex, Igg, S (Mayo)OutsideLaboratory",,86225,CPT,Facility,Both,,,90,90,76.5,25.794,90,BlueCross BlueShield Minnesota, Federal Employee Program,88.56,98.4,,percent of total billed charges,,
"Dsdna Ab With Reflex, Igg, S (Mayo)OutsideLaboratory",,86225,CPT,Facility,Both,,,90,90,76.5,25.794,90,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,90,100,,percent of total billed charges,,
"Dsdna Ab With Reflex, Igg, S (Mayo)OutsideLaboratory",,86225,CPT,Facility,Both,,,90,90,76.5,25.794,90,BlueCross BlueShield Minnesota,High Value Network Plan,81,90,,percent of total billed charges,,
"Dsdna Ab With Reflex, Igg, S (Mayo)OutsideLaboratory",,86225,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,BlueCross BlueShield Minnesota,Medicare Advantage,44.1,49,,percent of total billed charges,,
"Dsdna Ab With Reflex, Igg, S (Mayo)OutsideLaboratory",,86225,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Dsdna Ab With Reflex, Igg, S (Mayo)OutsideLaboratory",,86225,CPT,Facility,Both,,,90,90,76.5,25.794,90,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,79.713,88.57,,percent of total billed charges,,
"Dsdna Ab With Reflex, Igg, S (Mayo)OutsideLaboratory",,86225,CPT,Facility,Both,,,90,90,76.5,25.794,90,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,25.794,28.66,,percent of total billed charges,,
"Dsdna Ab With Reflex, Igg, S (Mayo)OutsideLaboratory",,86225,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),44.1,49,,percent of total billed charges,,
"Dsdna Ab With Reflex, Igg, S (Mayo)OutsideLaboratory",,86225,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Dsdna Ab With Reflex, Igg, S (Mayo)OutsideLaboratory",,86225,CPT,Facility,Both,,,90,90,76.5,25.794,90,CorVel,Worker's Compensation,90,100,,percent of total billed charges,,
"Dsdna Ab With Reflex, Igg, S (Mayo)OutsideLaboratory",,86225,CPT,Facility,Both,,,90,90,76.5,25.794,90,First Health Group Corporation,First Health Network,87.3,97,,percent of total billed charges,,
"Dsdna Ab With Reflex, Igg, S (Mayo)OutsideLaboratory",,86225,CPT,Facility,Both,,,90,90,76.5,25.794,90,"Health Partners, Inc.",Commercial,85.14,94.6,,percent of total billed charges,,
"Dsdna Ab With Reflex, Igg, S (Mayo)OutsideLaboratory",,86225,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,"Health Partners, Inc.",Medicare Advantage,44.1,49,,percent of total billed charges,,
"Dsdna Ab With Reflex, Igg, S (Mayo)OutsideLaboratory",,86225,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Dsdna Ab With Reflex, Igg, S (Mayo)OutsideLaboratory",,86225,CPT,Facility,Both,,,90,90,76.5,25.794,90,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),54,60,,percent of total billed charges,,
"Dsdna Ab With Reflex, Igg, S (Mayo)OutsideLaboratory",,86225,CPT,Facility,Both,,,90,90,76.5,25.794,90,"Health Partners, Inc.",State of Minnesota Advantage Program,73.35,81.5,,percent of total billed charges,,
"Dsdna Ab With Reflex, Igg, S (Mayo)OutsideLaboratory",,86225,CPT,Facility,Both,,,90,90,76.5,25.794,90,"Health Partners, Inc.",State Public Programs,45,50,,percent of total billed charges,,
"Dsdna Ab With Reflex, Igg, S (Mayo)OutsideLaboratory",,86225,CPT,Facility,Both,,,90,90,76.5,25.794,90,Humana Insurance Company,Commercial PPO,85.5,95,,percent of total billed charges,,
"Dsdna Ab With Reflex, Igg, S (Mayo)OutsideLaboratory",,86225,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,Humana Insurance Company,Medicare PPO,44.1,49,,percent of total billed charges,,
"Dsdna Ab With Reflex, Igg, S (Mayo)OutsideLaboratory",,86225,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Dsdna Ab With Reflex, Igg, S (Mayo)OutsideLaboratory",,86225,CPT,Facility,Both,,,90,90,76.5,25.794,90,Medica,Individual & Family,89.19,99.1,,percent of total billed charges,,
"Dsdna Ab With Reflex, Igg, S (Mayo)OutsideLaboratory",,86225,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,Medica,Medica Advantage Solution,44.82,49.8,,percent of total billed charges,,
"Dsdna Ab With Reflex, Igg, S (Mayo)OutsideLaboratory",,86225,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Dsdna Ab With Reflex, Igg, S (Mayo)OutsideLaboratory",,86225,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,Medica,Medical Assistance,40.14,44.6,,percent of total billed charges,,
"Dsdna Ab With Reflex, Igg, S (Mayo)OutsideLaboratory",,86225,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,Medica,Medical Assistance,,,,,Included in per diem rate,
"Dsdna Ab With Reflex, Igg, S (Mayo)OutsideLaboratory",,86225,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,44.82,49.8,,percent of total billed charges,,
"Dsdna Ab With Reflex, Igg, S (Mayo)OutsideLaboratory",,86225,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Dsdna Ab With Reflex, Igg, S (Mayo)OutsideLaboratory",,86225,CPT,Facility,Both,,,90,90,76.5,25.794,90,"Multiplan, Inc.","Multiplan, Inc.",84.6,94,,percent of total billed charges,,
"Dsdna Ab With Reflex, Igg, S (Mayo)OutsideLaboratory",,86225,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,77.76,86.4,,percent of total billed charges,,
"Dsdna Ab With Reflex, Igg, S (Mayo)OutsideLaboratory",,86225,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Dsdna Ab With Reflex, Igg, S (Mayo)OutsideLaboratory",,86225,CPT,Facility,Both,,,90,90,76.5,25.794,90,"Preferred One Administrative Services, INC.",PPO,88.74,98.6,,percent of total billed charges,,
"Dsdna Ab With Reflex, Igg, S (Mayo)OutsideLaboratory",,86225,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,PrimeWest Health,Minnesota Senior Health Options (MSHO),46.305,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Dsdna Ab With Reflex, Igg, S (Mayo)OutsideLaboratory",,86225,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Dsdna Ab With Reflex, Igg, S (Mayo)OutsideLaboratory",,86225,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,PrimeWest Health,MinnesotaCare,46.224,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Dsdna Ab With Reflex, Igg, S (Mayo)OutsideLaboratory",,86225,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Dsdna Ab With Reflex, Igg, S (Mayo)OutsideLaboratory",,86225,CPT,Facility,Both,,,90,90,76.5,25.794,90,Sanford Health Plan,Sanford Health Plan,82.8,92,,percent of total billed charges,,
"Dsdna Ab With Reflex, Igg, S (Mayo)OutsideLaboratory",,86225,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,"UCare Health, Inc.",Individual & Family Plan,50.715,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Dsdna Ab With Reflex, Igg, S (Mayo)OutsideLaboratory",,86225,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Dsdna Ab With Reflex, Igg, S (Mayo)OutsideLaboratory",,86225,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,"UCare Health, Inc.",Medical Assistance,45.423,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Dsdna Ab With Reflex, Igg, S (Mayo)OutsideLaboratory",,86225,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Dsdna Ab With Reflex, Igg, S (Mayo)OutsideLaboratory",,86225,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,"UCare Health, Inc.",Medicare Advantage,45.423,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Dsdna Ab With Reflex, Igg, S (Mayo)OutsideLaboratory",,86225,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Dsdna Ab With Reflex, Igg, S (Mayo)OutsideLaboratory",,86225,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),45.423,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Dsdna Ab With Reflex, Igg, S (Mayo)OutsideLaboratory",,86225,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Dsdna Ab With Reflex, Igg, S (Mayo)OutsideLaboratory",,86225,CPT,Facility,Both,,,90,90,76.5,25.794,90,UnitedHealthcare,Individual & Family,84.6,94,,percent of total billed charges,,
"Dsdna Ab With Reflex, Igg, S (Mayo)OutsideLaboratory",,86225,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,UnitedHealthcare,Medicare Advantage,44.1,49,,percent of total billed charges,,
"Dsdna Ab With Reflex, Igg, S (Mayo)OutsideLaboratory",,86225,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Dsdna Ab With Reflex, Igg, S (Mayo)OutsideLaboratory",,86225,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,43.2,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Dsdna Ab With Reflex, Igg, S (Mayo)OutsideLaboratory",,86225,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Endomysial Abs, S Iga (Mayo)OutsideLaboratory",,86231,CPT,Facility,Both,,,90,196,166.6,56.1736,196,Aetna,Commercial,180.32,92,,percent of total billed charges,,
"Endomysial Abs, S Iga (Mayo)OutsideLaboratory",,86231,CPT,Facility,Outpatient,,,90,196,166.6,56.1736,196,Aetna,Medicare Advantage,96.04,49,,percent of total billed charges,,
"Endomysial Abs, S Iga (Mayo)OutsideLaboratory",,86231,CPT,Facility,Inpatient,,,90,196,166.6,56.1736,196,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Endomysial Abs, S Iga (Mayo)OutsideLaboratory",,86231,CPT,Facility,Both,,,90,196,166.6,56.1736,196,Aetna,PPO,182.28,93,,percent of total billed charges,,
"Endomysial Abs, S Iga (Mayo)OutsideLaboratory",,86231,CPT,Facility,Both,,,90,196,166.6,56.1736,196,America's PPO,America's PPO,188.2188,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Endomysial Abs, S Iga (Mayo)OutsideLaboratory",,86231,CPT,Facility,Both,,,90,196,166.6,56.1736,196,BlueCross BlueShield Minnesota, Federal Employee Program,192.864,98.4,,percent of total billed charges,,
"Endomysial Abs, S Iga (Mayo)OutsideLaboratory",,86231,CPT,Facility,Both,,,90,196,166.6,56.1736,196,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,196,100,,percent of total billed charges,,
"Endomysial Abs, S Iga (Mayo)OutsideLaboratory",,86231,CPT,Facility,Both,,,90,196,166.6,56.1736,196,BlueCross BlueShield Minnesota,High Value Network Plan,176.4,90,,percent of total billed charges,,
"Endomysial Abs, S Iga (Mayo)OutsideLaboratory",,86231,CPT,Facility,Outpatient,,,90,196,166.6,56.1736,196,BlueCross BlueShield Minnesota,Medicare Advantage,96.04,49,,percent of total billed charges,,
"Endomysial Abs, S Iga (Mayo)OutsideLaboratory",,86231,CPT,Facility,Inpatient,,,90,196,166.6,56.1736,196,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Endomysial Abs, S Iga (Mayo)OutsideLaboratory",,86231,CPT,Facility,Both,,,90,196,166.6,56.1736,196,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,173.5972,88.57,,percent of total billed charges,,
"Endomysial Abs, S Iga (Mayo)OutsideLaboratory",,86231,CPT,Facility,Both,,,90,196,166.6,56.1736,196,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,56.1736,28.66,,percent of total billed charges,,
"Endomysial Abs, S Iga (Mayo)OutsideLaboratory",,86231,CPT,Facility,Outpatient,,,90,196,166.6,56.1736,196,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),96.04,49,,percent of total billed charges,,
"Endomysial Abs, S Iga (Mayo)OutsideLaboratory",,86231,CPT,Facility,Inpatient,,,90,196,166.6,56.1736,196,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Endomysial Abs, S Iga (Mayo)OutsideLaboratory",,86231,CPT,Facility,Both,,,90,196,166.6,56.1736,196,CorVel,Worker's Compensation,196,100,,percent of total billed charges,,
"Endomysial Abs, S Iga (Mayo)OutsideLaboratory",,86231,CPT,Facility,Both,,,90,196,166.6,56.1736,196,First Health Group Corporation,First Health Network,190.12,97,,percent of total billed charges,,
"Endomysial Abs, S Iga (Mayo)OutsideLaboratory",,86231,CPT,Facility,Both,,,90,196,166.6,56.1736,196,"Health Partners, Inc.",Commercial,185.416,94.6,,percent of total billed charges,,
"Endomysial Abs, S Iga (Mayo)OutsideLaboratory",,86231,CPT,Facility,Outpatient,,,90,196,166.6,56.1736,196,"Health Partners, Inc.",Medicare Advantage,96.04,49,,percent of total billed charges,,
"Endomysial Abs, S Iga (Mayo)OutsideLaboratory",,86231,CPT,Facility,Inpatient,,,90,196,166.6,56.1736,196,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Endomysial Abs, S Iga (Mayo)OutsideLaboratory",,86231,CPT,Facility,Both,,,90,196,166.6,56.1736,196,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),117.6,60,,percent of total billed charges,,
"Endomysial Abs, S Iga (Mayo)OutsideLaboratory",,86231,CPT,Facility,Both,,,90,196,166.6,56.1736,196,"Health Partners, Inc.",State of Minnesota Advantage Program,159.74,81.5,,percent of total billed charges,,
"Endomysial Abs, S Iga (Mayo)OutsideLaboratory",,86231,CPT,Facility,Both,,,90,196,166.6,56.1736,196,"Health Partners, Inc.",State Public Programs,98,50,,percent of total billed charges,,
"Endomysial Abs, S Iga (Mayo)OutsideLaboratory",,86231,CPT,Facility,Both,,,90,196,166.6,56.1736,196,Humana Insurance Company,Commercial PPO,186.2,95,,percent of total billed charges,,
"Endomysial Abs, S Iga (Mayo)OutsideLaboratory",,86231,CPT,Facility,Outpatient,,,90,196,166.6,56.1736,196,Humana Insurance Company,Medicare PPO,96.04,49,,percent of total billed charges,,
"Endomysial Abs, S Iga (Mayo)OutsideLaboratory",,86231,CPT,Facility,Inpatient,,,90,196,166.6,56.1736,196,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Endomysial Abs, S Iga (Mayo)OutsideLaboratory",,86231,CPT,Facility,Both,,,90,196,166.6,56.1736,196,Medica,Individual & Family,194.236,99.1,,percent of total billed charges,,
"Endomysial Abs, S Iga (Mayo)OutsideLaboratory",,86231,CPT,Facility,Outpatient,,,90,196,166.6,56.1736,196,Medica,Medica Advantage Solution,97.608,49.8,,percent of total billed charges,,
"Endomysial Abs, S Iga (Mayo)OutsideLaboratory",,86231,CPT,Facility,Inpatient,,,90,196,166.6,56.1736,196,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Endomysial Abs, S Iga (Mayo)OutsideLaboratory",,86231,CPT,Facility,Outpatient,,,90,196,166.6,56.1736,196,Medica,Medical Assistance,87.416,44.6,,percent of total billed charges,,
"Endomysial Abs, S Iga (Mayo)OutsideLaboratory",,86231,CPT,Facility,Inpatient,,,90,196,166.6,56.1736,196,Medica,Medical Assistance,,,,,Included in per diem rate,
"Endomysial Abs, S Iga (Mayo)OutsideLaboratory",,86231,CPT,Facility,Outpatient,,,90,196,166.6,56.1736,196,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,97.608,49.8,,percent of total billed charges,,
"Endomysial Abs, S Iga (Mayo)OutsideLaboratory",,86231,CPT,Facility,Inpatient,,,90,196,166.6,56.1736,196,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Endomysial Abs, S Iga (Mayo)OutsideLaboratory",,86231,CPT,Facility,Both,,,90,196,166.6,56.1736,196,"Multiplan, Inc.","Multiplan, Inc.",184.24,94,,percent of total billed charges,,
"Endomysial Abs, S Iga (Mayo)OutsideLaboratory",,86231,CPT,Facility,Outpatient,,,90,196,166.6,56.1736,196,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,169.344,86.4,,percent of total billed charges,,
"Endomysial Abs, S Iga (Mayo)OutsideLaboratory",,86231,CPT,Facility,Inpatient,,,90,196,166.6,56.1736,196,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Endomysial Abs, S Iga (Mayo)OutsideLaboratory",,86231,CPT,Facility,Both,,,90,196,166.6,56.1736,196,"Preferred One Administrative Services, INC.",PPO,193.256,98.6,,percent of total billed charges,,
"Endomysial Abs, S Iga (Mayo)OutsideLaboratory",,86231,CPT,Facility,Outpatient,,,90,196,166.6,56.1736,196,PrimeWest Health,Minnesota Senior Health Options (MSHO),100.842,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Endomysial Abs, S Iga (Mayo)OutsideLaboratory",,86231,CPT,Facility,Inpatient,,,90,196,166.6,56.1736,196,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Endomysial Abs, S Iga (Mayo)OutsideLaboratory",,86231,CPT,Facility,Outpatient,,,90,196,166.6,56.1736,196,PrimeWest Health,MinnesotaCare,100.6656,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Endomysial Abs, S Iga (Mayo)OutsideLaboratory",,86231,CPT,Facility,Inpatient,,,90,196,166.6,56.1736,196,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Endomysial Abs, S Iga (Mayo)OutsideLaboratory",,86231,CPT,Facility,Both,,,90,196,166.6,56.1736,196,Sanford Health Plan,Sanford Health Plan,180.32,92,,percent of total billed charges,,
"Endomysial Abs, S Iga (Mayo)OutsideLaboratory",,86231,CPT,Facility,Outpatient,,,90,196,166.6,56.1736,196,"UCare Health, Inc.",Individual & Family Plan,110.446,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Endomysial Abs, S Iga (Mayo)OutsideLaboratory",,86231,CPT,Facility,Inpatient,,,90,196,166.6,56.1736,196,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Endomysial Abs, S Iga (Mayo)OutsideLaboratory",,86231,CPT,Facility,Outpatient,,,90,196,166.6,56.1736,196,"UCare Health, Inc.",Medical Assistance,98.9212,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Endomysial Abs, S Iga (Mayo)OutsideLaboratory",,86231,CPT,Facility,Inpatient,,,90,196,166.6,56.1736,196,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Endomysial Abs, S Iga (Mayo)OutsideLaboratory",,86231,CPT,Facility,Outpatient,,,90,196,166.6,56.1736,196,"UCare Health, Inc.",Medicare Advantage,98.9212,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Endomysial Abs, S Iga (Mayo)OutsideLaboratory",,86231,CPT,Facility,Inpatient,,,90,196,166.6,56.1736,196,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Endomysial Abs, S Iga (Mayo)OutsideLaboratory",,86231,CPT,Facility,Outpatient,,,90,196,166.6,56.1736,196,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),98.9212,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Endomysial Abs, S Iga (Mayo)OutsideLaboratory",,86231,CPT,Facility,Inpatient,,,90,196,166.6,56.1736,196,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Endomysial Abs, S Iga (Mayo)OutsideLaboratory",,86231,CPT,Facility,Both,,,90,196,166.6,56.1736,196,UnitedHealthcare,Individual & Family,184.24,94,,percent of total billed charges,,
"Endomysial Abs, S Iga (Mayo)OutsideLaboratory",,86231,CPT,Facility,Outpatient,,,90,196,166.6,56.1736,196,UnitedHealthcare,Medicare Advantage,96.04,49,,percent of total billed charges,,
"Endomysial Abs, S Iga (Mayo)OutsideLaboratory",,86231,CPT,Facility,Inpatient,,,90,196,166.6,56.1736,196,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Endomysial Abs, S Iga (Mayo)OutsideLaboratory",,86231,CPT,Facility,Outpatient,,,90,196,166.6,56.1736,196,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,94.08,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Endomysial Abs, S Iga (Mayo)OutsideLaboratory",,86231,CPT,Facility,Inpatient,,,90,196,166.6,56.1736,196,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Ab To Extractable Nuclear Ag Eval,S (Mayo)OutsideLaboratory",,86235,CPT,Facility,Both,,,90,27,22.95,7.7382,27,Aetna,Commercial,24.84,92,,percent of total billed charges,,
"Ab To Extractable Nuclear Ag Eval,S (Mayo)OutsideLaboratory",,86235,CPT,Facility,Outpatient,,,90,27,22.95,7.7382,27,Aetna,Medicare Advantage,13.23,49,,percent of total billed charges,,
"Ab To Extractable Nuclear Ag Eval,S (Mayo)OutsideLaboratory",,86235,CPT,Facility,Inpatient,,,90,27,22.95,7.7382,27,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Ab To Extractable Nuclear Ag Eval,S (Mayo)OutsideLaboratory",,86235,CPT,Facility,Both,,,90,27,22.95,7.7382,27,Aetna,PPO,25.11,93,,percent of total billed charges,,
"Ab To Extractable Nuclear Ag Eval,S (Mayo)OutsideLaboratory",,86235,CPT,Facility,Both,,,90,27,22.95,7.7382,27,America's PPO,America's PPO,25.9281,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Ab To Extractable Nuclear Ag Eval,S (Mayo)OutsideLaboratory",,86235,CPT,Facility,Both,,,90,27,22.95,7.7382,27,BlueCross BlueShield Minnesota, Federal Employee Program,26.568,98.4,,percent of total billed charges,,
"Ab To Extractable Nuclear Ag Eval,S (Mayo)OutsideLaboratory",,86235,CPT,Facility,Both,,,90,27,22.95,7.7382,27,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,27,100,,percent of total billed charges,,
"Ab To Extractable Nuclear Ag Eval,S (Mayo)OutsideLaboratory",,86235,CPT,Facility,Both,,,90,27,22.95,7.7382,27,BlueCross BlueShield Minnesota,High Value Network Plan,24.3,90,,percent of total billed charges,,
"Ab To Extractable Nuclear Ag Eval,S (Mayo)OutsideLaboratory",,86235,CPT,Facility,Outpatient,,,90,27,22.95,7.7382,27,BlueCross BlueShield Minnesota,Medicare Advantage,13.23,49,,percent of total billed charges,,
"Ab To Extractable Nuclear Ag Eval,S (Mayo)OutsideLaboratory",,86235,CPT,Facility,Inpatient,,,90,27,22.95,7.7382,27,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Ab To Extractable Nuclear Ag Eval,S (Mayo)OutsideLaboratory",,86235,CPT,Facility,Both,,,90,27,22.95,7.7382,27,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,23.9139,88.57,,percent of total billed charges,,
"Ab To Extractable Nuclear Ag Eval,S (Mayo)OutsideLaboratory",,86235,CPT,Facility,Both,,,90,27,22.95,7.7382,27,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,7.7382,28.66,,percent of total billed charges,,
"Ab To Extractable Nuclear Ag Eval,S (Mayo)OutsideLaboratory",,86235,CPT,Facility,Outpatient,,,90,27,22.95,7.7382,27,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),13.23,49,,percent of total billed charges,,
"Ab To Extractable Nuclear Ag Eval,S (Mayo)OutsideLaboratory",,86235,CPT,Facility,Inpatient,,,90,27,22.95,7.7382,27,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Ab To Extractable Nuclear Ag Eval,S (Mayo)OutsideLaboratory",,86235,CPT,Facility,Both,,,90,27,22.95,7.7382,27,CorVel,Worker's Compensation,27,100,,percent of total billed charges,,
"Ab To Extractable Nuclear Ag Eval,S (Mayo)OutsideLaboratory",,86235,CPT,Facility,Both,,,90,27,22.95,7.7382,27,First Health Group Corporation,First Health Network,26.19,97,,percent of total billed charges,,
"Ab To Extractable Nuclear Ag Eval,S (Mayo)OutsideLaboratory",,86235,CPT,Facility,Both,,,90,27,22.95,7.7382,27,"Health Partners, Inc.",Commercial,25.542,94.6,,percent of total billed charges,,
"Ab To Extractable Nuclear Ag Eval,S (Mayo)OutsideLaboratory",,86235,CPT,Facility,Outpatient,,,90,27,22.95,7.7382,27,"Health Partners, Inc.",Medicare Advantage,13.23,49,,percent of total billed charges,,
"Ab To Extractable Nuclear Ag Eval,S (Mayo)OutsideLaboratory",,86235,CPT,Facility,Inpatient,,,90,27,22.95,7.7382,27,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Ab To Extractable Nuclear Ag Eval,S (Mayo)OutsideLaboratory",,86235,CPT,Facility,Both,,,90,27,22.95,7.7382,27,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),16.2,60,,percent of total billed charges,,
"Ab To Extractable Nuclear Ag Eval,S (Mayo)OutsideLaboratory",,86235,CPT,Facility,Both,,,90,27,22.95,7.7382,27,"Health Partners, Inc.",State of Minnesota Advantage Program,22.005,81.5,,percent of total billed charges,,
"Ab To Extractable Nuclear Ag Eval,S (Mayo)OutsideLaboratory",,86235,CPT,Facility,Both,,,90,27,22.95,7.7382,27,"Health Partners, Inc.",State Public Programs,13.5,50,,percent of total billed charges,,
"Ab To Extractable Nuclear Ag Eval,S (Mayo)OutsideLaboratory",,86235,CPT,Facility,Both,,,90,27,22.95,7.7382,27,Humana Insurance Company,Commercial PPO,25.65,95,,percent of total billed charges,,
"Ab To Extractable Nuclear Ag Eval,S (Mayo)OutsideLaboratory",,86235,CPT,Facility,Outpatient,,,90,27,22.95,7.7382,27,Humana Insurance Company,Medicare PPO,13.23,49,,percent of total billed charges,,
"Ab To Extractable Nuclear Ag Eval,S (Mayo)OutsideLaboratory",,86235,CPT,Facility,Inpatient,,,90,27,22.95,7.7382,27,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Ab To Extractable Nuclear Ag Eval,S (Mayo)OutsideLaboratory",,86235,CPT,Facility,Both,,,90,27,22.95,7.7382,27,Medica,Individual & Family,26.757,99.1,,percent of total billed charges,,
"Ab To Extractable Nuclear Ag Eval,S (Mayo)OutsideLaboratory",,86235,CPT,Facility,Outpatient,,,90,27,22.95,7.7382,27,Medica,Medica Advantage Solution,13.446,49.8,,percent of total billed charges,,
"Ab To Extractable Nuclear Ag Eval,S (Mayo)OutsideLaboratory",,86235,CPT,Facility,Inpatient,,,90,27,22.95,7.7382,27,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Ab To Extractable Nuclear Ag Eval,S (Mayo)OutsideLaboratory",,86235,CPT,Facility,Outpatient,,,90,27,22.95,7.7382,27,Medica,Medical Assistance,12.042,44.6,,percent of total billed charges,,
"Ab To Extractable Nuclear Ag Eval,S (Mayo)OutsideLaboratory",,86235,CPT,Facility,Inpatient,,,90,27,22.95,7.7382,27,Medica,Medical Assistance,,,,,Included in per diem rate,
"Ab To Extractable Nuclear Ag Eval,S (Mayo)OutsideLaboratory",,86235,CPT,Facility,Outpatient,,,90,27,22.95,7.7382,27,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,13.446,49.8,,percent of total billed charges,,
"Ab To Extractable Nuclear Ag Eval,S (Mayo)OutsideLaboratory",,86235,CPT,Facility,Inpatient,,,90,27,22.95,7.7382,27,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Ab To Extractable Nuclear Ag Eval,S (Mayo)OutsideLaboratory",,86235,CPT,Facility,Both,,,90,27,22.95,7.7382,27,"Multiplan, Inc.","Multiplan, Inc.",25.38,94,,percent of total billed charges,,
"Ab To Extractable Nuclear Ag Eval,S (Mayo)OutsideLaboratory",,86235,CPT,Facility,Outpatient,,,90,27,22.95,7.7382,27,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,23.328,86.4,,percent of total billed charges,,
"Ab To Extractable Nuclear Ag Eval,S (Mayo)OutsideLaboratory",,86235,CPT,Facility,Inpatient,,,90,27,22.95,7.7382,27,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Ab To Extractable Nuclear Ag Eval,S (Mayo)OutsideLaboratory",,86235,CPT,Facility,Both,,,90,27,22.95,7.7382,27,"Preferred One Administrative Services, INC.",PPO,26.622,98.6,,percent of total billed charges,,
"Ab To Extractable Nuclear Ag Eval,S (Mayo)OutsideLaboratory",,86235,CPT,Facility,Outpatient,,,90,27,22.95,7.7382,27,PrimeWest Health,Minnesota Senior Health Options (MSHO),13.8915,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Ab To Extractable Nuclear Ag Eval,S (Mayo)OutsideLaboratory",,86235,CPT,Facility,Inpatient,,,90,27,22.95,7.7382,27,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Ab To Extractable Nuclear Ag Eval,S (Mayo)OutsideLaboratory",,86235,CPT,Facility,Outpatient,,,90,27,22.95,7.7382,27,PrimeWest Health,MinnesotaCare,13.8672,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Ab To Extractable Nuclear Ag Eval,S (Mayo)OutsideLaboratory",,86235,CPT,Facility,Inpatient,,,90,27,22.95,7.7382,27,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Ab To Extractable Nuclear Ag Eval,S (Mayo)OutsideLaboratory",,86235,CPT,Facility,Both,,,90,27,22.95,7.7382,27,Sanford Health Plan,Sanford Health Plan,24.84,92,,percent of total billed charges,,
"Ab To Extractable Nuclear Ag Eval,S (Mayo)OutsideLaboratory",,86235,CPT,Facility,Outpatient,,,90,27,22.95,7.7382,27,"UCare Health, Inc.",Individual & Family Plan,15.2145,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Ab To Extractable Nuclear Ag Eval,S (Mayo)OutsideLaboratory",,86235,CPT,Facility,Inpatient,,,90,27,22.95,7.7382,27,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Ab To Extractable Nuclear Ag Eval,S (Mayo)OutsideLaboratory",,86235,CPT,Facility,Outpatient,,,90,27,22.95,7.7382,27,"UCare Health, Inc.",Medical Assistance,13.6269,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Ab To Extractable Nuclear Ag Eval,S (Mayo)OutsideLaboratory",,86235,CPT,Facility,Inpatient,,,90,27,22.95,7.7382,27,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Ab To Extractable Nuclear Ag Eval,S (Mayo)OutsideLaboratory",,86235,CPT,Facility,Outpatient,,,90,27,22.95,7.7382,27,"UCare Health, Inc.",Medicare Advantage,13.6269,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Ab To Extractable Nuclear Ag Eval,S (Mayo)OutsideLaboratory",,86235,CPT,Facility,Inpatient,,,90,27,22.95,7.7382,27,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Ab To Extractable Nuclear Ag Eval,S (Mayo)OutsideLaboratory",,86235,CPT,Facility,Outpatient,,,90,27,22.95,7.7382,27,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),13.6269,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Ab To Extractable Nuclear Ag Eval,S (Mayo)OutsideLaboratory",,86235,CPT,Facility,Inpatient,,,90,27,22.95,7.7382,27,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Ab To Extractable Nuclear Ag Eval,S (Mayo)OutsideLaboratory",,86235,CPT,Facility,Both,,,90,27,22.95,7.7382,27,UnitedHealthcare,Individual & Family,25.38,94,,percent of total billed charges,,
"Ab To Extractable Nuclear Ag Eval,S (Mayo)OutsideLaboratory",,86235,CPT,Facility,Outpatient,,,90,27,22.95,7.7382,27,UnitedHealthcare,Medicare Advantage,13.23,49,,percent of total billed charges,,
"Ab To Extractable Nuclear Ag Eval,S (Mayo)OutsideLaboratory",,86235,CPT,Facility,Inpatient,,,90,27,22.95,7.7382,27,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Ab To Extractable Nuclear Ag Eval,S (Mayo)OutsideLaboratory",,86235,CPT,Facility,Outpatient,,,90,27,22.95,7.7382,27,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,12.96,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Ab To Extractable Nuclear Ag Eval,S (Mayo)OutsideLaboratory",,86235,CPT,Facility,Inpatient,,,90,27,22.95,7.7382,27,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Ss-A/Ro Ab, Igg, S (Mayo)OutsideLaboratory",,86235,CPT,Facility,Both,,,90,159,135.15,45.5694,159,Aetna,Commercial,146.28,92,,percent of total billed charges,,
"Ss-A/Ro Ab, Igg, S (Mayo)OutsideLaboratory",,86235,CPT,Facility,Outpatient,,,90,159,135.15,45.5694,159,Aetna,Medicare Advantage,77.91,49,,percent of total billed charges,,
"Ss-A/Ro Ab, Igg, S (Mayo)OutsideLaboratory",,86235,CPT,Facility,Inpatient,,,90,159,135.15,45.5694,159,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Ss-A/Ro Ab, Igg, S (Mayo)OutsideLaboratory",,86235,CPT,Facility,Both,,,90,159,135.15,45.5694,159,Aetna,PPO,147.87,93,,percent of total billed charges,,
"Ss-A/Ro Ab, Igg, S (Mayo)OutsideLaboratory",,86235,CPT,Facility,Both,,,90,159,135.15,45.5694,159,America's PPO,America's PPO,152.6877,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Ss-A/Ro Ab, Igg, S (Mayo)OutsideLaboratory",,86235,CPT,Facility,Both,,,90,159,135.15,45.5694,159,BlueCross BlueShield Minnesota, Federal Employee Program,156.456,98.4,,percent of total billed charges,,
"Ss-A/Ro Ab, Igg, S (Mayo)OutsideLaboratory",,86235,CPT,Facility,Both,,,90,159,135.15,45.5694,159,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,159,100,,percent of total billed charges,,
"Ss-A/Ro Ab, Igg, S (Mayo)OutsideLaboratory",,86235,CPT,Facility,Both,,,90,159,135.15,45.5694,159,BlueCross BlueShield Minnesota,High Value Network Plan,143.1,90,,percent of total billed charges,,
"Ss-A/Ro Ab, Igg, S (Mayo)OutsideLaboratory",,86235,CPT,Facility,Outpatient,,,90,159,135.15,45.5694,159,BlueCross BlueShield Minnesota,Medicare Advantage,77.91,49,,percent of total billed charges,,
"Ss-A/Ro Ab, Igg, S (Mayo)OutsideLaboratory",,86235,CPT,Facility,Inpatient,,,90,159,135.15,45.5694,159,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Ss-A/Ro Ab, Igg, S (Mayo)OutsideLaboratory",,86235,CPT,Facility,Both,,,90,159,135.15,45.5694,159,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,140.8263,88.57,,percent of total billed charges,,
"Ss-A/Ro Ab, Igg, S (Mayo)OutsideLaboratory",,86235,CPT,Facility,Both,,,90,159,135.15,45.5694,159,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,45.5694,28.66,,percent of total billed charges,,
"Ss-A/Ro Ab, Igg, S (Mayo)OutsideLaboratory",,86235,CPT,Facility,Outpatient,,,90,159,135.15,45.5694,159,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),77.91,49,,percent of total billed charges,,
"Ss-A/Ro Ab, Igg, S (Mayo)OutsideLaboratory",,86235,CPT,Facility,Inpatient,,,90,159,135.15,45.5694,159,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Ss-A/Ro Ab, Igg, S (Mayo)OutsideLaboratory",,86235,CPT,Facility,Both,,,90,159,135.15,45.5694,159,CorVel,Worker's Compensation,159,100,,percent of total billed charges,,
"Ss-A/Ro Ab, Igg, S (Mayo)OutsideLaboratory",,86235,CPT,Facility,Both,,,90,159,135.15,45.5694,159,First Health Group Corporation,First Health Network,154.23,97,,percent of total billed charges,,
"Ss-A/Ro Ab, Igg, S (Mayo)OutsideLaboratory",,86235,CPT,Facility,Both,,,90,159,135.15,45.5694,159,"Health Partners, Inc.",Commercial,150.414,94.6,,percent of total billed charges,,
"Ss-A/Ro Ab, Igg, S (Mayo)OutsideLaboratory",,86235,CPT,Facility,Outpatient,,,90,159,135.15,45.5694,159,"Health Partners, Inc.",Medicare Advantage,77.91,49,,percent of total billed charges,,
"Ss-A/Ro Ab, Igg, S (Mayo)OutsideLaboratory",,86235,CPT,Facility,Inpatient,,,90,159,135.15,45.5694,159,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Ss-A/Ro Ab, Igg, S (Mayo)OutsideLaboratory",,86235,CPT,Facility,Both,,,90,159,135.15,45.5694,159,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),95.4,60,,percent of total billed charges,,
"Ss-A/Ro Ab, Igg, S (Mayo)OutsideLaboratory",,86235,CPT,Facility,Both,,,90,159,135.15,45.5694,159,"Health Partners, Inc.",State of Minnesota Advantage Program,129.585,81.5,,percent of total billed charges,,
"Ss-A/Ro Ab, Igg, S (Mayo)OutsideLaboratory",,86235,CPT,Facility,Both,,,90,159,135.15,45.5694,159,"Health Partners, Inc.",State Public Programs,79.5,50,,percent of total billed charges,,
"Ss-A/Ro Ab, Igg, S (Mayo)OutsideLaboratory",,86235,CPT,Facility,Both,,,90,159,135.15,45.5694,159,Humana Insurance Company,Commercial PPO,151.05,95,,percent of total billed charges,,
"Ss-A/Ro Ab, Igg, S (Mayo)OutsideLaboratory",,86235,CPT,Facility,Outpatient,,,90,159,135.15,45.5694,159,Humana Insurance Company,Medicare PPO,77.91,49,,percent of total billed charges,,
"Ss-A/Ro Ab, Igg, S (Mayo)OutsideLaboratory",,86235,CPT,Facility,Inpatient,,,90,159,135.15,45.5694,159,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Ss-A/Ro Ab, Igg, S (Mayo)OutsideLaboratory",,86235,CPT,Facility,Both,,,90,159,135.15,45.5694,159,Medica,Individual & Family,157.569,99.1,,percent of total billed charges,,
"Ss-A/Ro Ab, Igg, S (Mayo)OutsideLaboratory",,86235,CPT,Facility,Outpatient,,,90,159,135.15,45.5694,159,Medica,Medica Advantage Solution,79.182,49.8,,percent of total billed charges,,
"Ss-A/Ro Ab, Igg, S (Mayo)OutsideLaboratory",,86235,CPT,Facility,Inpatient,,,90,159,135.15,45.5694,159,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Ss-A/Ro Ab, Igg, S (Mayo)OutsideLaboratory",,86235,CPT,Facility,Outpatient,,,90,159,135.15,45.5694,159,Medica,Medical Assistance,70.914,44.6,,percent of total billed charges,,
"Ss-A/Ro Ab, Igg, S (Mayo)OutsideLaboratory",,86235,CPT,Facility,Inpatient,,,90,159,135.15,45.5694,159,Medica,Medical Assistance,,,,,Included in per diem rate,
"Ss-A/Ro Ab, Igg, S (Mayo)OutsideLaboratory",,86235,CPT,Facility,Outpatient,,,90,159,135.15,45.5694,159,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,79.182,49.8,,percent of total billed charges,,
"Ss-A/Ro Ab, Igg, S (Mayo)OutsideLaboratory",,86235,CPT,Facility,Inpatient,,,90,159,135.15,45.5694,159,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Ss-A/Ro Ab, Igg, S (Mayo)OutsideLaboratory",,86235,CPT,Facility,Both,,,90,159,135.15,45.5694,159,"Multiplan, Inc.","Multiplan, Inc.",149.46,94,,percent of total billed charges,,
"Ss-A/Ro Ab, Igg, S (Mayo)OutsideLaboratory",,86235,CPT,Facility,Outpatient,,,90,159,135.15,45.5694,159,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,137.376,86.4,,percent of total billed charges,,
"Ss-A/Ro Ab, Igg, S (Mayo)OutsideLaboratory",,86235,CPT,Facility,Inpatient,,,90,159,135.15,45.5694,159,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Ss-A/Ro Ab, Igg, S (Mayo)OutsideLaboratory",,86235,CPT,Facility,Both,,,90,159,135.15,45.5694,159,"Preferred One Administrative Services, INC.",PPO,156.774,98.6,,percent of total billed charges,,
"Ss-A/Ro Ab, Igg, S (Mayo)OutsideLaboratory",,86235,CPT,Facility,Outpatient,,,90,159,135.15,45.5694,159,PrimeWest Health,Minnesota Senior Health Options (MSHO),81.8055,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Ss-A/Ro Ab, Igg, S (Mayo)OutsideLaboratory",,86235,CPT,Facility,Inpatient,,,90,159,135.15,45.5694,159,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Ss-A/Ro Ab, Igg, S (Mayo)OutsideLaboratory",,86235,CPT,Facility,Outpatient,,,90,159,135.15,45.5694,159,PrimeWest Health,MinnesotaCare,81.6624,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Ss-A/Ro Ab, Igg, S (Mayo)OutsideLaboratory",,86235,CPT,Facility,Inpatient,,,90,159,135.15,45.5694,159,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Ss-A/Ro Ab, Igg, S (Mayo)OutsideLaboratory",,86235,CPT,Facility,Both,,,90,159,135.15,45.5694,159,Sanford Health Plan,Sanford Health Plan,146.28,92,,percent of total billed charges,,
"Ss-A/Ro Ab, Igg, S (Mayo)OutsideLaboratory",,86235,CPT,Facility,Outpatient,,,90,159,135.15,45.5694,159,"UCare Health, Inc.",Individual & Family Plan,89.5965,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Ss-A/Ro Ab, Igg, S (Mayo)OutsideLaboratory",,86235,CPT,Facility,Inpatient,,,90,159,135.15,45.5694,159,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Ss-A/Ro Ab, Igg, S (Mayo)OutsideLaboratory",,86235,CPT,Facility,Outpatient,,,90,159,135.15,45.5694,159,"UCare Health, Inc.",Medical Assistance,80.2473,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Ss-A/Ro Ab, Igg, S (Mayo)OutsideLaboratory",,86235,CPT,Facility,Inpatient,,,90,159,135.15,45.5694,159,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Ss-A/Ro Ab, Igg, S (Mayo)OutsideLaboratory",,86235,CPT,Facility,Outpatient,,,90,159,135.15,45.5694,159,"UCare Health, Inc.",Medicare Advantage,80.2473,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Ss-A/Ro Ab, Igg, S (Mayo)OutsideLaboratory",,86235,CPT,Facility,Inpatient,,,90,159,135.15,45.5694,159,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Ss-A/Ro Ab, Igg, S (Mayo)OutsideLaboratory",,86235,CPT,Facility,Outpatient,,,90,159,135.15,45.5694,159,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),80.2473,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Ss-A/Ro Ab, Igg, S (Mayo)OutsideLaboratory",,86235,CPT,Facility,Inpatient,,,90,159,135.15,45.5694,159,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Ss-A/Ro Ab, Igg, S (Mayo)OutsideLaboratory",,86235,CPT,Facility,Both,,,90,159,135.15,45.5694,159,UnitedHealthcare,Individual & Family,149.46,94,,percent of total billed charges,,
"Ss-A/Ro Ab, Igg, S (Mayo)OutsideLaboratory",,86235,CPT,Facility,Outpatient,,,90,159,135.15,45.5694,159,UnitedHealthcare,Medicare Advantage,77.91,49,,percent of total billed charges,,
"Ss-A/Ro Ab, Igg, S (Mayo)OutsideLaboratory",,86235,CPT,Facility,Inpatient,,,90,159,135.15,45.5694,159,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Ss-A/Ro Ab, Igg, S (Mayo)OutsideLaboratory",,86235,CPT,Facility,Outpatient,,,90,159,135.15,45.5694,159,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,76.32,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Ss-A/Ro Ab, Igg, S (Mayo)OutsideLaboratory",,86235,CPT,Facility,Inpatient,,,90,159,135.15,45.5694,159,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Ss-B/La Ab, Igg, S (Mayo)OutsideLaboratory",,86235,CPT,Facility,Both,,,90,159,135.15,45.5694,159,Aetna,Commercial,146.28,92,,percent of total billed charges,,
"Ss-B/La Ab, Igg, S (Mayo)OutsideLaboratory",,86235,CPT,Facility,Outpatient,,,90,159,135.15,45.5694,159,Aetna,Medicare Advantage,77.91,49,,percent of total billed charges,,
"Ss-B/La Ab, Igg, S (Mayo)OutsideLaboratory",,86235,CPT,Facility,Inpatient,,,90,159,135.15,45.5694,159,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Ss-B/La Ab, Igg, S (Mayo)OutsideLaboratory",,86235,CPT,Facility,Both,,,90,159,135.15,45.5694,159,Aetna,PPO,147.87,93,,percent of total billed charges,,
"Ss-B/La Ab, Igg, S (Mayo)OutsideLaboratory",,86235,CPT,Facility,Both,,,90,159,135.15,45.5694,159,America's PPO,America's PPO,152.6877,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Ss-B/La Ab, Igg, S (Mayo)OutsideLaboratory",,86235,CPT,Facility,Both,,,90,159,135.15,45.5694,159,BlueCross BlueShield Minnesota, Federal Employee Program,156.456,98.4,,percent of total billed charges,,
"Ss-B/La Ab, Igg, S (Mayo)OutsideLaboratory",,86235,CPT,Facility,Both,,,90,159,135.15,45.5694,159,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,159,100,,percent of total billed charges,,
"Ss-B/La Ab, Igg, S (Mayo)OutsideLaboratory",,86235,CPT,Facility,Both,,,90,159,135.15,45.5694,159,BlueCross BlueShield Minnesota,High Value Network Plan,143.1,90,,percent of total billed charges,,
"Ss-B/La Ab, Igg, S (Mayo)OutsideLaboratory",,86235,CPT,Facility,Outpatient,,,90,159,135.15,45.5694,159,BlueCross BlueShield Minnesota,Medicare Advantage,77.91,49,,percent of total billed charges,,
"Ss-B/La Ab, Igg, S (Mayo)OutsideLaboratory",,86235,CPT,Facility,Inpatient,,,90,159,135.15,45.5694,159,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Ss-B/La Ab, Igg, S (Mayo)OutsideLaboratory",,86235,CPT,Facility,Both,,,90,159,135.15,45.5694,159,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,140.8263,88.57,,percent of total billed charges,,
"Ss-B/La Ab, Igg, S (Mayo)OutsideLaboratory",,86235,CPT,Facility,Both,,,90,159,135.15,45.5694,159,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,45.5694,28.66,,percent of total billed charges,,
"Ss-B/La Ab, Igg, S (Mayo)OutsideLaboratory",,86235,CPT,Facility,Outpatient,,,90,159,135.15,45.5694,159,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),77.91,49,,percent of total billed charges,,
"Ss-B/La Ab, Igg, S (Mayo)OutsideLaboratory",,86235,CPT,Facility,Inpatient,,,90,159,135.15,45.5694,159,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Ss-B/La Ab, Igg, S (Mayo)OutsideLaboratory",,86235,CPT,Facility,Both,,,90,159,135.15,45.5694,159,CorVel,Worker's Compensation,159,100,,percent of total billed charges,,
"Ss-B/La Ab, Igg, S (Mayo)OutsideLaboratory",,86235,CPT,Facility,Both,,,90,159,135.15,45.5694,159,First Health Group Corporation,First Health Network,154.23,97,,percent of total billed charges,,
"Ss-B/La Ab, Igg, S (Mayo)OutsideLaboratory",,86235,CPT,Facility,Both,,,90,159,135.15,45.5694,159,"Health Partners, Inc.",Commercial,150.414,94.6,,percent of total billed charges,,
"Ss-B/La Ab, Igg, S (Mayo)OutsideLaboratory",,86235,CPT,Facility,Outpatient,,,90,159,135.15,45.5694,159,"Health Partners, Inc.",Medicare Advantage,77.91,49,,percent of total billed charges,,
"Ss-B/La Ab, Igg, S (Mayo)OutsideLaboratory",,86235,CPT,Facility,Inpatient,,,90,159,135.15,45.5694,159,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Ss-B/La Ab, Igg, S (Mayo)OutsideLaboratory",,86235,CPT,Facility,Both,,,90,159,135.15,45.5694,159,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),95.4,60,,percent of total billed charges,,
"Ss-B/La Ab, Igg, S (Mayo)OutsideLaboratory",,86235,CPT,Facility,Both,,,90,159,135.15,45.5694,159,"Health Partners, Inc.",State of Minnesota Advantage Program,129.585,81.5,,percent of total billed charges,,
"Ss-B/La Ab, Igg, S (Mayo)OutsideLaboratory",,86235,CPT,Facility,Both,,,90,159,135.15,45.5694,159,"Health Partners, Inc.",State Public Programs,79.5,50,,percent of total billed charges,,
"Ss-B/La Ab, Igg, S (Mayo)OutsideLaboratory",,86235,CPT,Facility,Both,,,90,159,135.15,45.5694,159,Humana Insurance Company,Commercial PPO,151.05,95,,percent of total billed charges,,
"Ss-B/La Ab, Igg, S (Mayo)OutsideLaboratory",,86235,CPT,Facility,Outpatient,,,90,159,135.15,45.5694,159,Humana Insurance Company,Medicare PPO,77.91,49,,percent of total billed charges,,
"Ss-B/La Ab, Igg, S (Mayo)OutsideLaboratory",,86235,CPT,Facility,Inpatient,,,90,159,135.15,45.5694,159,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Ss-B/La Ab, Igg, S (Mayo)OutsideLaboratory",,86235,CPT,Facility,Both,,,90,159,135.15,45.5694,159,Medica,Individual & Family,157.569,99.1,,percent of total billed charges,,
"Ss-B/La Ab, Igg, S (Mayo)OutsideLaboratory",,86235,CPT,Facility,Outpatient,,,90,159,135.15,45.5694,159,Medica,Medica Advantage Solution,79.182,49.8,,percent of total billed charges,,
"Ss-B/La Ab, Igg, S (Mayo)OutsideLaboratory",,86235,CPT,Facility,Inpatient,,,90,159,135.15,45.5694,159,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Ss-B/La Ab, Igg, S (Mayo)OutsideLaboratory",,86235,CPT,Facility,Outpatient,,,90,159,135.15,45.5694,159,Medica,Medical Assistance,70.914,44.6,,percent of total billed charges,,
"Ss-B/La Ab, Igg, S (Mayo)OutsideLaboratory",,86235,CPT,Facility,Inpatient,,,90,159,135.15,45.5694,159,Medica,Medical Assistance,,,,,Included in per diem rate,
"Ss-B/La Ab, Igg, S (Mayo)OutsideLaboratory",,86235,CPT,Facility,Outpatient,,,90,159,135.15,45.5694,159,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,79.182,49.8,,percent of total billed charges,,
"Ss-B/La Ab, Igg, S (Mayo)OutsideLaboratory",,86235,CPT,Facility,Inpatient,,,90,159,135.15,45.5694,159,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Ss-B/La Ab, Igg, S (Mayo)OutsideLaboratory",,86235,CPT,Facility,Both,,,90,159,135.15,45.5694,159,"Multiplan, Inc.","Multiplan, Inc.",149.46,94,,percent of total billed charges,,
"Ss-B/La Ab, Igg, S (Mayo)OutsideLaboratory",,86235,CPT,Facility,Outpatient,,,90,159,135.15,45.5694,159,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,137.376,86.4,,percent of total billed charges,,
"Ss-B/La Ab, Igg, S (Mayo)OutsideLaboratory",,86235,CPT,Facility,Inpatient,,,90,159,135.15,45.5694,159,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Ss-B/La Ab, Igg, S (Mayo)OutsideLaboratory",,86235,CPT,Facility,Both,,,90,159,135.15,45.5694,159,"Preferred One Administrative Services, INC.",PPO,156.774,98.6,,percent of total billed charges,,
"Ss-B/La Ab, Igg, S (Mayo)OutsideLaboratory",,86235,CPT,Facility,Outpatient,,,90,159,135.15,45.5694,159,PrimeWest Health,Minnesota Senior Health Options (MSHO),81.8055,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Ss-B/La Ab, Igg, S (Mayo)OutsideLaboratory",,86235,CPT,Facility,Inpatient,,,90,159,135.15,45.5694,159,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Ss-B/La Ab, Igg, S (Mayo)OutsideLaboratory",,86235,CPT,Facility,Outpatient,,,90,159,135.15,45.5694,159,PrimeWest Health,MinnesotaCare,81.6624,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Ss-B/La Ab, Igg, S (Mayo)OutsideLaboratory",,86235,CPT,Facility,Inpatient,,,90,159,135.15,45.5694,159,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Ss-B/La Ab, Igg, S (Mayo)OutsideLaboratory",,86235,CPT,Facility,Both,,,90,159,135.15,45.5694,159,Sanford Health Plan,Sanford Health Plan,146.28,92,,percent of total billed charges,,
"Ss-B/La Ab, Igg, S (Mayo)OutsideLaboratory",,86235,CPT,Facility,Outpatient,,,90,159,135.15,45.5694,159,"UCare Health, Inc.",Individual & Family Plan,89.5965,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Ss-B/La Ab, Igg, S (Mayo)OutsideLaboratory",,86235,CPT,Facility,Inpatient,,,90,159,135.15,45.5694,159,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Ss-B/La Ab, Igg, S (Mayo)OutsideLaboratory",,86235,CPT,Facility,Outpatient,,,90,159,135.15,45.5694,159,"UCare Health, Inc.",Medical Assistance,80.2473,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Ss-B/La Ab, Igg, S (Mayo)OutsideLaboratory",,86235,CPT,Facility,Inpatient,,,90,159,135.15,45.5694,159,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Ss-B/La Ab, Igg, S (Mayo)OutsideLaboratory",,86235,CPT,Facility,Outpatient,,,90,159,135.15,45.5694,159,"UCare Health, Inc.",Medicare Advantage,80.2473,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Ss-B/La Ab, Igg, S (Mayo)OutsideLaboratory",,86235,CPT,Facility,Inpatient,,,90,159,135.15,45.5694,159,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Ss-B/La Ab, Igg, S (Mayo)OutsideLaboratory",,86235,CPT,Facility,Outpatient,,,90,159,135.15,45.5694,159,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),80.2473,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Ss-B/La Ab, Igg, S (Mayo)OutsideLaboratory",,86235,CPT,Facility,Inpatient,,,90,159,135.15,45.5694,159,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Ss-B/La Ab, Igg, S (Mayo)OutsideLaboratory",,86235,CPT,Facility,Both,,,90,159,135.15,45.5694,159,UnitedHealthcare,Individual & Family,149.46,94,,percent of total billed charges,,
"Ss-B/La Ab, Igg, S (Mayo)OutsideLaboratory",,86235,CPT,Facility,Outpatient,,,90,159,135.15,45.5694,159,UnitedHealthcare,Medicare Advantage,77.91,49,,percent of total billed charges,,
"Ss-B/La Ab, Igg, S (Mayo)OutsideLaboratory",,86235,CPT,Facility,Inpatient,,,90,159,135.15,45.5694,159,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Ss-B/La Ab, Igg, S (Mayo)OutsideLaboratory",,86235,CPT,Facility,Outpatient,,,90,159,135.15,45.5694,159,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,76.32,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Ss-B/La Ab, Igg, S (Mayo)OutsideLaboratory",,86235,CPT,Facility,Inpatient,,,90,159,135.15,45.5694,159,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Ds Dna Antibody By Crithidia If (Mayo)OutsideLaboratory,,86255,CPT,Facility,Both,,,90,195,165.75,55.887,195,Aetna,Commercial,179.4,92,,percent of total billed charges,,
Ds Dna Antibody By Crithidia If (Mayo)OutsideLaboratory,,86255,CPT,Facility,Outpatient,,,90,195,165.75,55.887,195,Aetna,Medicare Advantage,95.55,49,,percent of total billed charges,,
Ds Dna Antibody By Crithidia If (Mayo)OutsideLaboratory,,86255,CPT,Facility,Inpatient,,,90,195,165.75,55.887,195,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Ds Dna Antibody By Crithidia If (Mayo)OutsideLaboratory,,86255,CPT,Facility,Both,,,90,195,165.75,55.887,195,Aetna,PPO,181.35,93,,percent of total billed charges,,
Ds Dna Antibody By Crithidia If (Mayo)OutsideLaboratory,,86255,CPT,Facility,Both,,,90,195,165.75,55.887,195,America's PPO,America's PPO,187.2585,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Ds Dna Antibody By Crithidia If (Mayo)OutsideLaboratory,,86255,CPT,Facility,Both,,,90,195,165.75,55.887,195,BlueCross BlueShield Minnesota, Federal Employee Program,191.88,98.4,,percent of total billed charges,,
Ds Dna Antibody By Crithidia If (Mayo)OutsideLaboratory,,86255,CPT,Facility,Both,,,90,195,165.75,55.887,195,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,195,100,,percent of total billed charges,,
Ds Dna Antibody By Crithidia If (Mayo)OutsideLaboratory,,86255,CPT,Facility,Both,,,90,195,165.75,55.887,195,BlueCross BlueShield Minnesota,High Value Network Plan,175.5,90,,percent of total billed charges,,
Ds Dna Antibody By Crithidia If (Mayo)OutsideLaboratory,,86255,CPT,Facility,Outpatient,,,90,195,165.75,55.887,195,BlueCross BlueShield Minnesota,Medicare Advantage,95.55,49,,percent of total billed charges,,
Ds Dna Antibody By Crithidia If (Mayo)OutsideLaboratory,,86255,CPT,Facility,Inpatient,,,90,195,165.75,55.887,195,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Ds Dna Antibody By Crithidia If (Mayo)OutsideLaboratory,,86255,CPT,Facility,Both,,,90,195,165.75,55.887,195,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,172.7115,88.57,,percent of total billed charges,,
Ds Dna Antibody By Crithidia If (Mayo)OutsideLaboratory,,86255,CPT,Facility,Both,,,90,195,165.75,55.887,195,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,55.887,28.66,,percent of total billed charges,,
Ds Dna Antibody By Crithidia If (Mayo)OutsideLaboratory,,86255,CPT,Facility,Outpatient,,,90,195,165.75,55.887,195,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),95.55,49,,percent of total billed charges,,
Ds Dna Antibody By Crithidia If (Mayo)OutsideLaboratory,,86255,CPT,Facility,Inpatient,,,90,195,165.75,55.887,195,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Ds Dna Antibody By Crithidia If (Mayo)OutsideLaboratory,,86255,CPT,Facility,Both,,,90,195,165.75,55.887,195,CorVel,Worker's Compensation,195,100,,percent of total billed charges,,
Ds Dna Antibody By Crithidia If (Mayo)OutsideLaboratory,,86255,CPT,Facility,Both,,,90,195,165.75,55.887,195,First Health Group Corporation,First Health Network,189.15,97,,percent of total billed charges,,
Ds Dna Antibody By Crithidia If (Mayo)OutsideLaboratory,,86255,CPT,Facility,Both,,,90,195,165.75,55.887,195,"Health Partners, Inc.",Commercial,184.47,94.6,,percent of total billed charges,,
Ds Dna Antibody By Crithidia If (Mayo)OutsideLaboratory,,86255,CPT,Facility,Outpatient,,,90,195,165.75,55.887,195,"Health Partners, Inc.",Medicare Advantage,95.55,49,,percent of total billed charges,,
Ds Dna Antibody By Crithidia If (Mayo)OutsideLaboratory,,86255,CPT,Facility,Inpatient,,,90,195,165.75,55.887,195,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ds Dna Antibody By Crithidia If (Mayo)OutsideLaboratory,,86255,CPT,Facility,Both,,,90,195,165.75,55.887,195,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),117,60,,percent of total billed charges,,
Ds Dna Antibody By Crithidia If (Mayo)OutsideLaboratory,,86255,CPT,Facility,Both,,,90,195,165.75,55.887,195,"Health Partners, Inc.",State of Minnesota Advantage Program,158.925,81.5,,percent of total billed charges,,
Ds Dna Antibody By Crithidia If (Mayo)OutsideLaboratory,,86255,CPT,Facility,Both,,,90,195,165.75,55.887,195,"Health Partners, Inc.",State Public Programs,97.5,50,,percent of total billed charges,,
Ds Dna Antibody By Crithidia If (Mayo)OutsideLaboratory,,86255,CPT,Facility,Both,,,90,195,165.75,55.887,195,Humana Insurance Company,Commercial PPO,185.25,95,,percent of total billed charges,,
Ds Dna Antibody By Crithidia If (Mayo)OutsideLaboratory,,86255,CPT,Facility,Outpatient,,,90,195,165.75,55.887,195,Humana Insurance Company,Medicare PPO,95.55,49,,percent of total billed charges,,
Ds Dna Antibody By Crithidia If (Mayo)OutsideLaboratory,,86255,CPT,Facility,Inpatient,,,90,195,165.75,55.887,195,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Ds Dna Antibody By Crithidia If (Mayo)OutsideLaboratory,,86255,CPT,Facility,Both,,,90,195,165.75,55.887,195,Medica,Individual & Family,193.245,99.1,,percent of total billed charges,,
Ds Dna Antibody By Crithidia If (Mayo)OutsideLaboratory,,86255,CPT,Facility,Outpatient,,,90,195,165.75,55.887,195,Medica,Medica Advantage Solution,97.11,49.8,,percent of total billed charges,,
Ds Dna Antibody By Crithidia If (Mayo)OutsideLaboratory,,86255,CPT,Facility,Inpatient,,,90,195,165.75,55.887,195,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Ds Dna Antibody By Crithidia If (Mayo)OutsideLaboratory,,86255,CPT,Facility,Outpatient,,,90,195,165.75,55.887,195,Medica,Medical Assistance,86.97,44.6,,percent of total billed charges,,
Ds Dna Antibody By Crithidia If (Mayo)OutsideLaboratory,,86255,CPT,Facility,Inpatient,,,90,195,165.75,55.887,195,Medica,Medical Assistance,,,,,Included in per diem rate,
Ds Dna Antibody By Crithidia If (Mayo)OutsideLaboratory,,86255,CPT,Facility,Outpatient,,,90,195,165.75,55.887,195,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,97.11,49.8,,percent of total billed charges,,
Ds Dna Antibody By Crithidia If (Mayo)OutsideLaboratory,,86255,CPT,Facility,Inpatient,,,90,195,165.75,55.887,195,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Ds Dna Antibody By Crithidia If (Mayo)OutsideLaboratory,,86255,CPT,Facility,Both,,,90,195,165.75,55.887,195,"Multiplan, Inc.","Multiplan, Inc.",183.3,94,,percent of total billed charges,,
Ds Dna Antibody By Crithidia If (Mayo)OutsideLaboratory,,86255,CPT,Facility,Outpatient,,,90,195,165.75,55.887,195,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,168.48,86.4,,percent of total billed charges,,
Ds Dna Antibody By Crithidia If (Mayo)OutsideLaboratory,,86255,CPT,Facility,Inpatient,,,90,195,165.75,55.887,195,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Ds Dna Antibody By Crithidia If (Mayo)OutsideLaboratory,,86255,CPT,Facility,Both,,,90,195,165.75,55.887,195,"Preferred One Administrative Services, INC.",PPO,192.27,98.6,,percent of total billed charges,,
Ds Dna Antibody By Crithidia If (Mayo)OutsideLaboratory,,86255,CPT,Facility,Outpatient,,,90,195,165.75,55.887,195,PrimeWest Health,Minnesota Senior Health Options (MSHO),100.3275,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Ds Dna Antibody By Crithidia If (Mayo)OutsideLaboratory,,86255,CPT,Facility,Inpatient,,,90,195,165.75,55.887,195,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ds Dna Antibody By Crithidia If (Mayo)OutsideLaboratory,,86255,CPT,Facility,Outpatient,,,90,195,165.75,55.887,195,PrimeWest Health,MinnesotaCare,100.152,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Ds Dna Antibody By Crithidia If (Mayo)OutsideLaboratory,,86255,CPT,Facility,Inpatient,,,90,195,165.75,55.887,195,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Ds Dna Antibody By Crithidia If (Mayo)OutsideLaboratory,,86255,CPT,Facility,Both,,,90,195,165.75,55.887,195,Sanford Health Plan,Sanford Health Plan,179.4,92,,percent of total billed charges,,
Ds Dna Antibody By Crithidia If (Mayo)OutsideLaboratory,,86255,CPT,Facility,Outpatient,,,90,195,165.75,55.887,195,"UCare Health, Inc.",Individual & Family Plan,109.8825,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Ds Dna Antibody By Crithidia If (Mayo)OutsideLaboratory,,86255,CPT,Facility,Inpatient,,,90,195,165.75,55.887,195,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Ds Dna Antibody By Crithidia If (Mayo)OutsideLaboratory,,86255,CPT,Facility,Outpatient,,,90,195,165.75,55.887,195,"UCare Health, Inc.",Medical Assistance,98.4165,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ds Dna Antibody By Crithidia If (Mayo)OutsideLaboratory,,86255,CPT,Facility,Inpatient,,,90,195,165.75,55.887,195,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Ds Dna Antibody By Crithidia If (Mayo)OutsideLaboratory,,86255,CPT,Facility,Outpatient,,,90,195,165.75,55.887,195,"UCare Health, Inc.",Medicare Advantage,98.4165,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ds Dna Antibody By Crithidia If (Mayo)OutsideLaboratory,,86255,CPT,Facility,Inpatient,,,90,195,165.75,55.887,195,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ds Dna Antibody By Crithidia If (Mayo)OutsideLaboratory,,86255,CPT,Facility,Outpatient,,,90,195,165.75,55.887,195,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),98.4165,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ds Dna Antibody By Crithidia If (Mayo)OutsideLaboratory,,86255,CPT,Facility,Inpatient,,,90,195,165.75,55.887,195,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ds Dna Antibody By Crithidia If (Mayo)OutsideLaboratory,,86255,CPT,Facility,Both,,,90,195,165.75,55.887,195,UnitedHealthcare,Individual & Family,183.3,94,,percent of total billed charges,,
Ds Dna Antibody By Crithidia If (Mayo)OutsideLaboratory,,86255,CPT,Facility,Outpatient,,,90,195,165.75,55.887,195,UnitedHealthcare,Medicare Advantage,95.55,49,,percent of total billed charges,,
Ds Dna Antibody By Crithidia If (Mayo)OutsideLaboratory,,86255,CPT,Facility,Inpatient,,,90,195,165.75,55.887,195,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Ds Dna Antibody By Crithidia If (Mayo)OutsideLaboratory,,86255,CPT,Facility,Outpatient,,,90,195,165.75,55.887,195,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,93.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
Ds Dna Antibody By Crithidia If (Mayo)OutsideLaboratory,,86255,CPT,Facility,Inpatient,,,90,195,165.75,55.887,195,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Gliadin (Deamidated) Ab, Eval, S (Mayo)OutsideLaboratory",,86258,CPT,Facility,Both,,,90,180,153,51.588,180,Aetna,Commercial,165.6,92,,percent of total billed charges,,
"Gliadin (Deamidated) Ab, Eval, S (Mayo)OutsideLaboratory",,86258,CPT,Facility,Outpatient,,,90,180,153,51.588,180,Aetna,Medicare Advantage,88.2,49,,percent of total billed charges,,
"Gliadin (Deamidated) Ab, Eval, S (Mayo)OutsideLaboratory",,86258,CPT,Facility,Inpatient,,,90,180,153,51.588,180,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Gliadin (Deamidated) Ab, Eval, S (Mayo)OutsideLaboratory",,86258,CPT,Facility,Both,,,90,180,153,51.588,180,Aetna,PPO,167.4,93,,percent of total billed charges,,
"Gliadin (Deamidated) Ab, Eval, S (Mayo)OutsideLaboratory",,86258,CPT,Facility,Both,,,90,180,153,51.588,180,America's PPO,America's PPO,172.854,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Gliadin (Deamidated) Ab, Eval, S (Mayo)OutsideLaboratory",,86258,CPT,Facility,Both,,,90,180,153,51.588,180,BlueCross BlueShield Minnesota, Federal Employee Program,177.12,98.4,,percent of total billed charges,,
"Gliadin (Deamidated) Ab, Eval, S (Mayo)OutsideLaboratory",,86258,CPT,Facility,Both,,,90,180,153,51.588,180,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,180,100,,percent of total billed charges,,
"Gliadin (Deamidated) Ab, Eval, S (Mayo)OutsideLaboratory",,86258,CPT,Facility,Both,,,90,180,153,51.588,180,BlueCross BlueShield Minnesota,High Value Network Plan,162,90,,percent of total billed charges,,
"Gliadin (Deamidated) Ab, Eval, S (Mayo)OutsideLaboratory",,86258,CPT,Facility,Outpatient,,,90,180,153,51.588,180,BlueCross BlueShield Minnesota,Medicare Advantage,88.2,49,,percent of total billed charges,,
"Gliadin (Deamidated) Ab, Eval, S (Mayo)OutsideLaboratory",,86258,CPT,Facility,Inpatient,,,90,180,153,51.588,180,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Gliadin (Deamidated) Ab, Eval, S (Mayo)OutsideLaboratory",,86258,CPT,Facility,Both,,,90,180,153,51.588,180,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,159.426,88.57,,percent of total billed charges,,
"Gliadin (Deamidated) Ab, Eval, S (Mayo)OutsideLaboratory",,86258,CPT,Facility,Both,,,90,180,153,51.588,180,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,51.588,28.66,,percent of total billed charges,,
"Gliadin (Deamidated) Ab, Eval, S (Mayo)OutsideLaboratory",,86258,CPT,Facility,Outpatient,,,90,180,153,51.588,180,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),88.2,49,,percent of total billed charges,,
"Gliadin (Deamidated) Ab, Eval, S (Mayo)OutsideLaboratory",,86258,CPT,Facility,Inpatient,,,90,180,153,51.588,180,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Gliadin (Deamidated) Ab, Eval, S (Mayo)OutsideLaboratory",,86258,CPT,Facility,Both,,,90,180,153,51.588,180,CorVel,Worker's Compensation,180,100,,percent of total billed charges,,
"Gliadin (Deamidated) Ab, Eval, S (Mayo)OutsideLaboratory",,86258,CPT,Facility,Both,,,90,180,153,51.588,180,First Health Group Corporation,First Health Network,174.6,97,,percent of total billed charges,,
"Gliadin (Deamidated) Ab, Eval, S (Mayo)OutsideLaboratory",,86258,CPT,Facility,Both,,,90,180,153,51.588,180,"Health Partners, Inc.",Commercial,170.28,94.6,,percent of total billed charges,,
"Gliadin (Deamidated) Ab, Eval, S (Mayo)OutsideLaboratory",,86258,CPT,Facility,Outpatient,,,90,180,153,51.588,180,"Health Partners, Inc.",Medicare Advantage,88.2,49,,percent of total billed charges,,
"Gliadin (Deamidated) Ab, Eval, S (Mayo)OutsideLaboratory",,86258,CPT,Facility,Inpatient,,,90,180,153,51.588,180,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Gliadin (Deamidated) Ab, Eval, S (Mayo)OutsideLaboratory",,86258,CPT,Facility,Both,,,90,180,153,51.588,180,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),108,60,,percent of total billed charges,,
"Gliadin (Deamidated) Ab, Eval, S (Mayo)OutsideLaboratory",,86258,CPT,Facility,Both,,,90,180,153,51.588,180,"Health Partners, Inc.",State of Minnesota Advantage Program,146.7,81.5,,percent of total billed charges,,
"Gliadin (Deamidated) Ab, Eval, S (Mayo)OutsideLaboratory",,86258,CPT,Facility,Both,,,90,180,153,51.588,180,"Health Partners, Inc.",State Public Programs,90,50,,percent of total billed charges,,
"Gliadin (Deamidated) Ab, Eval, S (Mayo)OutsideLaboratory",,86258,CPT,Facility,Both,,,90,180,153,51.588,180,Humana Insurance Company,Commercial PPO,171,95,,percent of total billed charges,,
"Gliadin (Deamidated) Ab, Eval, S (Mayo)OutsideLaboratory",,86258,CPT,Facility,Outpatient,,,90,180,153,51.588,180,Humana Insurance Company,Medicare PPO,88.2,49,,percent of total billed charges,,
"Gliadin (Deamidated) Ab, Eval, S (Mayo)OutsideLaboratory",,86258,CPT,Facility,Inpatient,,,90,180,153,51.588,180,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Gliadin (Deamidated) Ab, Eval, S (Mayo)OutsideLaboratory",,86258,CPT,Facility,Both,,,90,180,153,51.588,180,Medica,Individual & Family,178.38,99.1,,percent of total billed charges,,
"Gliadin (Deamidated) Ab, Eval, S (Mayo)OutsideLaboratory",,86258,CPT,Facility,Outpatient,,,90,180,153,51.588,180,Medica,Medica Advantage Solution,89.64,49.8,,percent of total billed charges,,
"Gliadin (Deamidated) Ab, Eval, S (Mayo)OutsideLaboratory",,86258,CPT,Facility,Inpatient,,,90,180,153,51.588,180,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Gliadin (Deamidated) Ab, Eval, S (Mayo)OutsideLaboratory",,86258,CPT,Facility,Outpatient,,,90,180,153,51.588,180,Medica,Medical Assistance,80.28,44.6,,percent of total billed charges,,
"Gliadin (Deamidated) Ab, Eval, S (Mayo)OutsideLaboratory",,86258,CPT,Facility,Inpatient,,,90,180,153,51.588,180,Medica,Medical Assistance,,,,,Included in per diem rate,
"Gliadin (Deamidated) Ab, Eval, S (Mayo)OutsideLaboratory",,86258,CPT,Facility,Outpatient,,,90,180,153,51.588,180,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,89.64,49.8,,percent of total billed charges,,
"Gliadin (Deamidated) Ab, Eval, S (Mayo)OutsideLaboratory",,86258,CPT,Facility,Inpatient,,,90,180,153,51.588,180,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Gliadin (Deamidated) Ab, Eval, S (Mayo)OutsideLaboratory",,86258,CPT,Facility,Both,,,90,180,153,51.588,180,"Multiplan, Inc.","Multiplan, Inc.",169.2,94,,percent of total billed charges,,
"Gliadin (Deamidated) Ab, Eval, S (Mayo)OutsideLaboratory",,86258,CPT,Facility,Outpatient,,,90,180,153,51.588,180,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,155.52,86.4,,percent of total billed charges,,
"Gliadin (Deamidated) Ab, Eval, S (Mayo)OutsideLaboratory",,86258,CPT,Facility,Inpatient,,,90,180,153,51.588,180,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Gliadin (Deamidated) Ab, Eval, S (Mayo)OutsideLaboratory",,86258,CPT,Facility,Both,,,90,180,153,51.588,180,"Preferred One Administrative Services, INC.",PPO,177.48,98.6,,percent of total billed charges,,
"Gliadin (Deamidated) Ab, Eval, S (Mayo)OutsideLaboratory",,86258,CPT,Facility,Outpatient,,,90,180,153,51.588,180,PrimeWest Health,Minnesota Senior Health Options (MSHO),92.61,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Gliadin (Deamidated) Ab, Eval, S (Mayo)OutsideLaboratory",,86258,CPT,Facility,Inpatient,,,90,180,153,51.588,180,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Gliadin (Deamidated) Ab, Eval, S (Mayo)OutsideLaboratory",,86258,CPT,Facility,Outpatient,,,90,180,153,51.588,180,PrimeWest Health,MinnesotaCare,92.448,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Gliadin (Deamidated) Ab, Eval, S (Mayo)OutsideLaboratory",,86258,CPT,Facility,Inpatient,,,90,180,153,51.588,180,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Gliadin (Deamidated) Ab, Eval, S (Mayo)OutsideLaboratory",,86258,CPT,Facility,Both,,,90,180,153,51.588,180,Sanford Health Plan,Sanford Health Plan,165.6,92,,percent of total billed charges,,
"Gliadin (Deamidated) Ab, Eval, S (Mayo)OutsideLaboratory",,86258,CPT,Facility,Outpatient,,,90,180,153,51.588,180,"UCare Health, Inc.",Individual & Family Plan,101.43,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Gliadin (Deamidated) Ab, Eval, S (Mayo)OutsideLaboratory",,86258,CPT,Facility,Inpatient,,,90,180,153,51.588,180,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Gliadin (Deamidated) Ab, Eval, S (Mayo)OutsideLaboratory",,86258,CPT,Facility,Outpatient,,,90,180,153,51.588,180,"UCare Health, Inc.",Medical Assistance,90.846,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Gliadin (Deamidated) Ab, Eval, S (Mayo)OutsideLaboratory",,86258,CPT,Facility,Inpatient,,,90,180,153,51.588,180,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Gliadin (Deamidated) Ab, Eval, S (Mayo)OutsideLaboratory",,86258,CPT,Facility,Outpatient,,,90,180,153,51.588,180,"UCare Health, Inc.",Medicare Advantage,90.846,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Gliadin (Deamidated) Ab, Eval, S (Mayo)OutsideLaboratory",,86258,CPT,Facility,Inpatient,,,90,180,153,51.588,180,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Gliadin (Deamidated) Ab, Eval, S (Mayo)OutsideLaboratory",,86258,CPT,Facility,Outpatient,,,90,180,153,51.588,180,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),90.846,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Gliadin (Deamidated) Ab, Eval, S (Mayo)OutsideLaboratory",,86258,CPT,Facility,Inpatient,,,90,180,153,51.588,180,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Gliadin (Deamidated) Ab, Eval, S (Mayo)OutsideLaboratory",,86258,CPT,Facility,Both,,,90,180,153,51.588,180,UnitedHealthcare,Individual & Family,169.2,94,,percent of total billed charges,,
"Gliadin (Deamidated) Ab, Eval, S (Mayo)OutsideLaboratory",,86258,CPT,Facility,Outpatient,,,90,180,153,51.588,180,UnitedHealthcare,Medicare Advantage,88.2,49,,percent of total billed charges,,
"Gliadin (Deamidated) Ab, Eval, S (Mayo)OutsideLaboratory",,86258,CPT,Facility,Inpatient,,,90,180,153,51.588,180,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Gliadin (Deamidated) Ab, Eval, S (Mayo)OutsideLaboratory",,86258,CPT,Facility,Outpatient,,,90,180,153,51.588,180,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,86.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Gliadin (Deamidated) Ab, Eval, S (Mayo)OutsideLaboratory",,86258,CPT,Facility,Inpatient,,,90,180,153,51.588,180,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Gliadin (Deamidated) Ab, Iga, S (Mayo)OutsideLaboratory",,86258,CPT,Facility,Both,,,90,120,102,34.392,120,Aetna,Commercial,110.4,92,,percent of total billed charges,,
"Gliadin (Deamidated) Ab, Iga, S (Mayo)OutsideLaboratory",,86258,CPT,Facility,Outpatient,,,90,120,102,34.392,120,Aetna,Medicare Advantage,58.8,49,,percent of total billed charges,,
"Gliadin (Deamidated) Ab, Iga, S (Mayo)OutsideLaboratory",,86258,CPT,Facility,Inpatient,,,90,120,102,34.392,120,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Gliadin (Deamidated) Ab, Iga, S (Mayo)OutsideLaboratory",,86258,CPT,Facility,Both,,,90,120,102,34.392,120,Aetna,PPO,111.6,93,,percent of total billed charges,,
"Gliadin (Deamidated) Ab, Iga, S (Mayo)OutsideLaboratory",,86258,CPT,Facility,Both,,,90,120,102,34.392,120,America's PPO,America's PPO,115.236,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Gliadin (Deamidated) Ab, Iga, S (Mayo)OutsideLaboratory",,86258,CPT,Facility,Both,,,90,120,102,34.392,120,BlueCross BlueShield Minnesota, Federal Employee Program,118.08,98.4,,percent of total billed charges,,
"Gliadin (Deamidated) Ab, Iga, S (Mayo)OutsideLaboratory",,86258,CPT,Facility,Both,,,90,120,102,34.392,120,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,120,100,,percent of total billed charges,,
"Gliadin (Deamidated) Ab, Iga, S (Mayo)OutsideLaboratory",,86258,CPT,Facility,Both,,,90,120,102,34.392,120,BlueCross BlueShield Minnesota,High Value Network Plan,108,90,,percent of total billed charges,,
"Gliadin (Deamidated) Ab, Iga, S (Mayo)OutsideLaboratory",,86258,CPT,Facility,Outpatient,,,90,120,102,34.392,120,BlueCross BlueShield Minnesota,Medicare Advantage,58.8,49,,percent of total billed charges,,
"Gliadin (Deamidated) Ab, Iga, S (Mayo)OutsideLaboratory",,86258,CPT,Facility,Inpatient,,,90,120,102,34.392,120,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Gliadin (Deamidated) Ab, Iga, S (Mayo)OutsideLaboratory",,86258,CPT,Facility,Both,,,90,120,102,34.392,120,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,106.284,88.57,,percent of total billed charges,,
"Gliadin (Deamidated) Ab, Iga, S (Mayo)OutsideLaboratory",,86258,CPT,Facility,Both,,,90,120,102,34.392,120,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,34.392,28.66,,percent of total billed charges,,
"Gliadin (Deamidated) Ab, Iga, S (Mayo)OutsideLaboratory",,86258,CPT,Facility,Outpatient,,,90,120,102,34.392,120,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),58.8,49,,percent of total billed charges,,
"Gliadin (Deamidated) Ab, Iga, S (Mayo)OutsideLaboratory",,86258,CPT,Facility,Inpatient,,,90,120,102,34.392,120,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Gliadin (Deamidated) Ab, Iga, S (Mayo)OutsideLaboratory",,86258,CPT,Facility,Both,,,90,120,102,34.392,120,CorVel,Worker's Compensation,120,100,,percent of total billed charges,,
"Gliadin (Deamidated) Ab, Iga, S (Mayo)OutsideLaboratory",,86258,CPT,Facility,Both,,,90,120,102,34.392,120,First Health Group Corporation,First Health Network,116.4,97,,percent of total billed charges,,
"Gliadin (Deamidated) Ab, Iga, S (Mayo)OutsideLaboratory",,86258,CPT,Facility,Both,,,90,120,102,34.392,120,"Health Partners, Inc.",Commercial,113.52,94.6,,percent of total billed charges,,
"Gliadin (Deamidated) Ab, Iga, S (Mayo)OutsideLaboratory",,86258,CPT,Facility,Outpatient,,,90,120,102,34.392,120,"Health Partners, Inc.",Medicare Advantage,58.8,49,,percent of total billed charges,,
"Gliadin (Deamidated) Ab, Iga, S (Mayo)OutsideLaboratory",,86258,CPT,Facility,Inpatient,,,90,120,102,34.392,120,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Gliadin (Deamidated) Ab, Iga, S (Mayo)OutsideLaboratory",,86258,CPT,Facility,Both,,,90,120,102,34.392,120,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),72,60,,percent of total billed charges,,
"Gliadin (Deamidated) Ab, Iga, S (Mayo)OutsideLaboratory",,86258,CPT,Facility,Both,,,90,120,102,34.392,120,"Health Partners, Inc.",State of Minnesota Advantage Program,97.8,81.5,,percent of total billed charges,,
"Gliadin (Deamidated) Ab, Iga, S (Mayo)OutsideLaboratory",,86258,CPT,Facility,Both,,,90,120,102,34.392,120,"Health Partners, Inc.",State Public Programs,60,50,,percent of total billed charges,,
"Gliadin (Deamidated) Ab, Iga, S (Mayo)OutsideLaboratory",,86258,CPT,Facility,Both,,,90,120,102,34.392,120,Humana Insurance Company,Commercial PPO,114,95,,percent of total billed charges,,
"Gliadin (Deamidated) Ab, Iga, S (Mayo)OutsideLaboratory",,86258,CPT,Facility,Outpatient,,,90,120,102,34.392,120,Humana Insurance Company,Medicare PPO,58.8,49,,percent of total billed charges,,
"Gliadin (Deamidated) Ab, Iga, S (Mayo)OutsideLaboratory",,86258,CPT,Facility,Inpatient,,,90,120,102,34.392,120,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Gliadin (Deamidated) Ab, Iga, S (Mayo)OutsideLaboratory",,86258,CPT,Facility,Both,,,90,120,102,34.392,120,Medica,Individual & Family,118.92,99.1,,percent of total billed charges,,
"Gliadin (Deamidated) Ab, Iga, S (Mayo)OutsideLaboratory",,86258,CPT,Facility,Outpatient,,,90,120,102,34.392,120,Medica,Medica Advantage Solution,59.76,49.8,,percent of total billed charges,,
"Gliadin (Deamidated) Ab, Iga, S (Mayo)OutsideLaboratory",,86258,CPT,Facility,Inpatient,,,90,120,102,34.392,120,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Gliadin (Deamidated) Ab, Iga, S (Mayo)OutsideLaboratory",,86258,CPT,Facility,Outpatient,,,90,120,102,34.392,120,Medica,Medical Assistance,53.52,44.6,,percent of total billed charges,,
"Gliadin (Deamidated) Ab, Iga, S (Mayo)OutsideLaboratory",,86258,CPT,Facility,Inpatient,,,90,120,102,34.392,120,Medica,Medical Assistance,,,,,Included in per diem rate,
"Gliadin (Deamidated) Ab, Iga, S (Mayo)OutsideLaboratory",,86258,CPT,Facility,Outpatient,,,90,120,102,34.392,120,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,59.76,49.8,,percent of total billed charges,,
"Gliadin (Deamidated) Ab, Iga, S (Mayo)OutsideLaboratory",,86258,CPT,Facility,Inpatient,,,90,120,102,34.392,120,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Gliadin (Deamidated) Ab, Iga, S (Mayo)OutsideLaboratory",,86258,CPT,Facility,Both,,,90,120,102,34.392,120,"Multiplan, Inc.","Multiplan, Inc.",112.8,94,,percent of total billed charges,,
"Gliadin (Deamidated) Ab, Iga, S (Mayo)OutsideLaboratory",,86258,CPT,Facility,Outpatient,,,90,120,102,34.392,120,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,103.68,86.4,,percent of total billed charges,,
"Gliadin (Deamidated) Ab, Iga, S (Mayo)OutsideLaboratory",,86258,CPT,Facility,Inpatient,,,90,120,102,34.392,120,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Gliadin (Deamidated) Ab, Iga, S (Mayo)OutsideLaboratory",,86258,CPT,Facility,Both,,,90,120,102,34.392,120,"Preferred One Administrative Services, INC.",PPO,118.32,98.6,,percent of total billed charges,,
"Gliadin (Deamidated) Ab, Iga, S (Mayo)OutsideLaboratory",,86258,CPT,Facility,Outpatient,,,90,120,102,34.392,120,PrimeWest Health,Minnesota Senior Health Options (MSHO),61.74,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Gliadin (Deamidated) Ab, Iga, S (Mayo)OutsideLaboratory",,86258,CPT,Facility,Inpatient,,,90,120,102,34.392,120,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Gliadin (Deamidated) Ab, Iga, S (Mayo)OutsideLaboratory",,86258,CPT,Facility,Outpatient,,,90,120,102,34.392,120,PrimeWest Health,MinnesotaCare,61.632,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Gliadin (Deamidated) Ab, Iga, S (Mayo)OutsideLaboratory",,86258,CPT,Facility,Inpatient,,,90,120,102,34.392,120,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Gliadin (Deamidated) Ab, Iga, S (Mayo)OutsideLaboratory",,86258,CPT,Facility,Both,,,90,120,102,34.392,120,Sanford Health Plan,Sanford Health Plan,110.4,92,,percent of total billed charges,,
"Gliadin (Deamidated) Ab, Iga, S (Mayo)OutsideLaboratory",,86258,CPT,Facility,Outpatient,,,90,120,102,34.392,120,"UCare Health, Inc.",Individual & Family Plan,67.62,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Gliadin (Deamidated) Ab, Iga, S (Mayo)OutsideLaboratory",,86258,CPT,Facility,Inpatient,,,90,120,102,34.392,120,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Gliadin (Deamidated) Ab, Iga, S (Mayo)OutsideLaboratory",,86258,CPT,Facility,Outpatient,,,90,120,102,34.392,120,"UCare Health, Inc.",Medical Assistance,60.564,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Gliadin (Deamidated) Ab, Iga, S (Mayo)OutsideLaboratory",,86258,CPT,Facility,Inpatient,,,90,120,102,34.392,120,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Gliadin (Deamidated) Ab, Iga, S (Mayo)OutsideLaboratory",,86258,CPT,Facility,Outpatient,,,90,120,102,34.392,120,"UCare Health, Inc.",Medicare Advantage,60.564,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Gliadin (Deamidated) Ab, Iga, S (Mayo)OutsideLaboratory",,86258,CPT,Facility,Inpatient,,,90,120,102,34.392,120,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Gliadin (Deamidated) Ab, Iga, S (Mayo)OutsideLaboratory",,86258,CPT,Facility,Outpatient,,,90,120,102,34.392,120,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),60.564,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Gliadin (Deamidated) Ab, Iga, S (Mayo)OutsideLaboratory",,86258,CPT,Facility,Inpatient,,,90,120,102,34.392,120,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Gliadin (Deamidated) Ab, Iga, S (Mayo)OutsideLaboratory",,86258,CPT,Facility,Both,,,90,120,102,34.392,120,UnitedHealthcare,Individual & Family,112.8,94,,percent of total billed charges,,
"Gliadin (Deamidated) Ab, Iga, S (Mayo)OutsideLaboratory",,86258,CPT,Facility,Outpatient,,,90,120,102,34.392,120,UnitedHealthcare,Medicare Advantage,58.8,49,,percent of total billed charges,,
"Gliadin (Deamidated) Ab, Iga, S (Mayo)OutsideLaboratory",,86258,CPT,Facility,Inpatient,,,90,120,102,34.392,120,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Gliadin (Deamidated) Ab, Iga, S (Mayo)OutsideLaboratory",,86258,CPT,Facility,Outpatient,,,90,120,102,34.392,120,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,57.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Gliadin (Deamidated) Ab, Iga, S (Mayo)OutsideLaboratory",,86258,CPT,Facility,Inpatient,,,90,120,102,34.392,120,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Gliadin (Deamidated) Ab, Igg, S (Mayo)OutsideLaboratory",,86258,CPT,Facility,Both,,,90,120,102,34.392,120,Aetna,Commercial,110.4,92,,percent of total billed charges,,
"Gliadin (Deamidated) Ab, Igg, S (Mayo)OutsideLaboratory",,86258,CPT,Facility,Outpatient,,,90,120,102,34.392,120,Aetna,Medicare Advantage,58.8,49,,percent of total billed charges,,
"Gliadin (Deamidated) Ab, Igg, S (Mayo)OutsideLaboratory",,86258,CPT,Facility,Inpatient,,,90,120,102,34.392,120,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Gliadin (Deamidated) Ab, Igg, S (Mayo)OutsideLaboratory",,86258,CPT,Facility,Both,,,90,120,102,34.392,120,Aetna,PPO,111.6,93,,percent of total billed charges,,
"Gliadin (Deamidated) Ab, Igg, S (Mayo)OutsideLaboratory",,86258,CPT,Facility,Both,,,90,120,102,34.392,120,America's PPO,America's PPO,115.236,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Gliadin (Deamidated) Ab, Igg, S (Mayo)OutsideLaboratory",,86258,CPT,Facility,Both,,,90,120,102,34.392,120,BlueCross BlueShield Minnesota, Federal Employee Program,118.08,98.4,,percent of total billed charges,,
"Gliadin (Deamidated) Ab, Igg, S (Mayo)OutsideLaboratory",,86258,CPT,Facility,Both,,,90,120,102,34.392,120,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,120,100,,percent of total billed charges,,
"Gliadin (Deamidated) Ab, Igg, S (Mayo)OutsideLaboratory",,86258,CPT,Facility,Both,,,90,120,102,34.392,120,BlueCross BlueShield Minnesota,High Value Network Plan,108,90,,percent of total billed charges,,
"Gliadin (Deamidated) Ab, Igg, S (Mayo)OutsideLaboratory",,86258,CPT,Facility,Outpatient,,,90,120,102,34.392,120,BlueCross BlueShield Minnesota,Medicare Advantage,58.8,49,,percent of total billed charges,,
"Gliadin (Deamidated) Ab, Igg, S (Mayo)OutsideLaboratory",,86258,CPT,Facility,Inpatient,,,90,120,102,34.392,120,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Gliadin (Deamidated) Ab, Igg, S (Mayo)OutsideLaboratory",,86258,CPT,Facility,Both,,,90,120,102,34.392,120,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,106.284,88.57,,percent of total billed charges,,
"Gliadin (Deamidated) Ab, Igg, S (Mayo)OutsideLaboratory",,86258,CPT,Facility,Both,,,90,120,102,34.392,120,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,34.392,28.66,,percent of total billed charges,,
"Gliadin (Deamidated) Ab, Igg, S (Mayo)OutsideLaboratory",,86258,CPT,Facility,Outpatient,,,90,120,102,34.392,120,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),58.8,49,,percent of total billed charges,,
"Gliadin (Deamidated) Ab, Igg, S (Mayo)OutsideLaboratory",,86258,CPT,Facility,Inpatient,,,90,120,102,34.392,120,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Gliadin (Deamidated) Ab, Igg, S (Mayo)OutsideLaboratory",,86258,CPT,Facility,Both,,,90,120,102,34.392,120,CorVel,Worker's Compensation,120,100,,percent of total billed charges,,
"Gliadin (Deamidated) Ab, Igg, S (Mayo)OutsideLaboratory",,86258,CPT,Facility,Both,,,90,120,102,34.392,120,First Health Group Corporation,First Health Network,116.4,97,,percent of total billed charges,,
"Gliadin (Deamidated) Ab, Igg, S (Mayo)OutsideLaboratory",,86258,CPT,Facility,Both,,,90,120,102,34.392,120,"Health Partners, Inc.",Commercial,113.52,94.6,,percent of total billed charges,,
"Gliadin (Deamidated) Ab, Igg, S (Mayo)OutsideLaboratory",,86258,CPT,Facility,Outpatient,,,90,120,102,34.392,120,"Health Partners, Inc.",Medicare Advantage,58.8,49,,percent of total billed charges,,
"Gliadin (Deamidated) Ab, Igg, S (Mayo)OutsideLaboratory",,86258,CPT,Facility,Inpatient,,,90,120,102,34.392,120,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Gliadin (Deamidated) Ab, Igg, S (Mayo)OutsideLaboratory",,86258,CPT,Facility,Both,,,90,120,102,34.392,120,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),72,60,,percent of total billed charges,,
"Gliadin (Deamidated) Ab, Igg, S (Mayo)OutsideLaboratory",,86258,CPT,Facility,Both,,,90,120,102,34.392,120,"Health Partners, Inc.",State of Minnesota Advantage Program,97.8,81.5,,percent of total billed charges,,
"Gliadin (Deamidated) Ab, Igg, S (Mayo)OutsideLaboratory",,86258,CPT,Facility,Both,,,90,120,102,34.392,120,"Health Partners, Inc.",State Public Programs,60,50,,percent of total billed charges,,
"Gliadin (Deamidated) Ab, Igg, S (Mayo)OutsideLaboratory",,86258,CPT,Facility,Both,,,90,120,102,34.392,120,Humana Insurance Company,Commercial PPO,114,95,,percent of total billed charges,,
"Gliadin (Deamidated) Ab, Igg, S (Mayo)OutsideLaboratory",,86258,CPT,Facility,Outpatient,,,90,120,102,34.392,120,Humana Insurance Company,Medicare PPO,58.8,49,,percent of total billed charges,,
"Gliadin (Deamidated) Ab, Igg, S (Mayo)OutsideLaboratory",,86258,CPT,Facility,Inpatient,,,90,120,102,34.392,120,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Gliadin (Deamidated) Ab, Igg, S (Mayo)OutsideLaboratory",,86258,CPT,Facility,Both,,,90,120,102,34.392,120,Medica,Individual & Family,118.92,99.1,,percent of total billed charges,,
"Gliadin (Deamidated) Ab, Igg, S (Mayo)OutsideLaboratory",,86258,CPT,Facility,Outpatient,,,90,120,102,34.392,120,Medica,Medica Advantage Solution,59.76,49.8,,percent of total billed charges,,
"Gliadin (Deamidated) Ab, Igg, S (Mayo)OutsideLaboratory",,86258,CPT,Facility,Inpatient,,,90,120,102,34.392,120,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Gliadin (Deamidated) Ab, Igg, S (Mayo)OutsideLaboratory",,86258,CPT,Facility,Outpatient,,,90,120,102,34.392,120,Medica,Medical Assistance,53.52,44.6,,percent of total billed charges,,
"Gliadin (Deamidated) Ab, Igg, S (Mayo)OutsideLaboratory",,86258,CPT,Facility,Inpatient,,,90,120,102,34.392,120,Medica,Medical Assistance,,,,,Included in per diem rate,
"Gliadin (Deamidated) Ab, Igg, S (Mayo)OutsideLaboratory",,86258,CPT,Facility,Outpatient,,,90,120,102,34.392,120,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,59.76,49.8,,percent of total billed charges,,
"Gliadin (Deamidated) Ab, Igg, S (Mayo)OutsideLaboratory",,86258,CPT,Facility,Inpatient,,,90,120,102,34.392,120,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Gliadin (Deamidated) Ab, Igg, S (Mayo)OutsideLaboratory",,86258,CPT,Facility,Both,,,90,120,102,34.392,120,"Multiplan, Inc.","Multiplan, Inc.",112.8,94,,percent of total billed charges,,
"Gliadin (Deamidated) Ab, Igg, S (Mayo)OutsideLaboratory",,86258,CPT,Facility,Outpatient,,,90,120,102,34.392,120,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,103.68,86.4,,percent of total billed charges,,
"Gliadin (Deamidated) Ab, Igg, S (Mayo)OutsideLaboratory",,86258,CPT,Facility,Inpatient,,,90,120,102,34.392,120,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Gliadin (Deamidated) Ab, Igg, S (Mayo)OutsideLaboratory",,86258,CPT,Facility,Both,,,90,120,102,34.392,120,"Preferred One Administrative Services, INC.",PPO,118.32,98.6,,percent of total billed charges,,
"Gliadin (Deamidated) Ab, Igg, S (Mayo)OutsideLaboratory",,86258,CPT,Facility,Outpatient,,,90,120,102,34.392,120,PrimeWest Health,Minnesota Senior Health Options (MSHO),61.74,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Gliadin (Deamidated) Ab, Igg, S (Mayo)OutsideLaboratory",,86258,CPT,Facility,Inpatient,,,90,120,102,34.392,120,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Gliadin (Deamidated) Ab, Igg, S (Mayo)OutsideLaboratory",,86258,CPT,Facility,Outpatient,,,90,120,102,34.392,120,PrimeWest Health,MinnesotaCare,61.632,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Gliadin (Deamidated) Ab, Igg, S (Mayo)OutsideLaboratory",,86258,CPT,Facility,Inpatient,,,90,120,102,34.392,120,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Gliadin (Deamidated) Ab, Igg, S (Mayo)OutsideLaboratory",,86258,CPT,Facility,Both,,,90,120,102,34.392,120,Sanford Health Plan,Sanford Health Plan,110.4,92,,percent of total billed charges,,
"Gliadin (Deamidated) Ab, Igg, S (Mayo)OutsideLaboratory",,86258,CPT,Facility,Outpatient,,,90,120,102,34.392,120,"UCare Health, Inc.",Individual & Family Plan,67.62,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Gliadin (Deamidated) Ab, Igg, S (Mayo)OutsideLaboratory",,86258,CPT,Facility,Inpatient,,,90,120,102,34.392,120,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Gliadin (Deamidated) Ab, Igg, S (Mayo)OutsideLaboratory",,86258,CPT,Facility,Outpatient,,,90,120,102,34.392,120,"UCare Health, Inc.",Medical Assistance,60.564,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Gliadin (Deamidated) Ab, Igg, S (Mayo)OutsideLaboratory",,86258,CPT,Facility,Inpatient,,,90,120,102,34.392,120,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Gliadin (Deamidated) Ab, Igg, S (Mayo)OutsideLaboratory",,86258,CPT,Facility,Outpatient,,,90,120,102,34.392,120,"UCare Health, Inc.",Medicare Advantage,60.564,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Gliadin (Deamidated) Ab, Igg, S (Mayo)OutsideLaboratory",,86258,CPT,Facility,Inpatient,,,90,120,102,34.392,120,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Gliadin (Deamidated) Ab, Igg, S (Mayo)OutsideLaboratory",,86258,CPT,Facility,Outpatient,,,90,120,102,34.392,120,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),60.564,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Gliadin (Deamidated) Ab, Igg, S (Mayo)OutsideLaboratory",,86258,CPT,Facility,Inpatient,,,90,120,102,34.392,120,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Gliadin (Deamidated) Ab, Igg, S (Mayo)OutsideLaboratory",,86258,CPT,Facility,Both,,,90,120,102,34.392,120,UnitedHealthcare,Individual & Family,112.8,94,,percent of total billed charges,,
"Gliadin (Deamidated) Ab, Igg, S (Mayo)OutsideLaboratory",,86258,CPT,Facility,Outpatient,,,90,120,102,34.392,120,UnitedHealthcare,Medicare Advantage,58.8,49,,percent of total billed charges,,
"Gliadin (Deamidated) Ab, Igg, S (Mayo)OutsideLaboratory",,86258,CPT,Facility,Inpatient,,,90,120,102,34.392,120,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Gliadin (Deamidated) Ab, Igg, S (Mayo)OutsideLaboratory",,86258,CPT,Facility,Outpatient,,,90,120,102,34.392,120,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,57.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Gliadin (Deamidated) Ab, Igg, S (Mayo)OutsideLaboratory",,86258,CPT,Facility,Inpatient,,,90,120,102,34.392,120,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Breast Carcinoma Assoc Ag(Ca 27.29) (Mayo)OutsideLaboratory,,86300,CPT,Facility,Both,,,90,101,85.85,28.9466,101,Aetna,Commercial,92.92,92,,percent of total billed charges,,
Breast Carcinoma Assoc Ag(Ca 27.29) (Mayo)OutsideLaboratory,,86300,CPT,Facility,Outpatient,,,90,101,85.85,28.9466,101,Aetna,Medicare Advantage,49.49,49,,percent of total billed charges,,
Breast Carcinoma Assoc Ag(Ca 27.29) (Mayo)OutsideLaboratory,,86300,CPT,Facility,Inpatient,,,90,101,85.85,28.9466,101,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Breast Carcinoma Assoc Ag(Ca 27.29) (Mayo)OutsideLaboratory,,86300,CPT,Facility,Both,,,90,101,85.85,28.9466,101,Aetna,PPO,93.93,93,,percent of total billed charges,,
Breast Carcinoma Assoc Ag(Ca 27.29) (Mayo)OutsideLaboratory,,86300,CPT,Facility,Both,,,90,101,85.85,28.9466,101,America's PPO,America's PPO,96.9903,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Breast Carcinoma Assoc Ag(Ca 27.29) (Mayo)OutsideLaboratory,,86300,CPT,Facility,Both,,,90,101,85.85,28.9466,101,BlueCross BlueShield Minnesota, Federal Employee Program,99.384,98.4,,percent of total billed charges,,
Breast Carcinoma Assoc Ag(Ca 27.29) (Mayo)OutsideLaboratory,,86300,CPT,Facility,Both,,,90,101,85.85,28.9466,101,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,101,100,,percent of total billed charges,,
Breast Carcinoma Assoc Ag(Ca 27.29) (Mayo)OutsideLaboratory,,86300,CPT,Facility,Both,,,90,101,85.85,28.9466,101,BlueCross BlueShield Minnesota,High Value Network Plan,90.9,90,,percent of total billed charges,,
Breast Carcinoma Assoc Ag(Ca 27.29) (Mayo)OutsideLaboratory,,86300,CPT,Facility,Outpatient,,,90,101,85.85,28.9466,101,BlueCross BlueShield Minnesota,Medicare Advantage,49.49,49,,percent of total billed charges,,
Breast Carcinoma Assoc Ag(Ca 27.29) (Mayo)OutsideLaboratory,,86300,CPT,Facility,Inpatient,,,90,101,85.85,28.9466,101,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Breast Carcinoma Assoc Ag(Ca 27.29) (Mayo)OutsideLaboratory,,86300,CPT,Facility,Both,,,90,101,85.85,28.9466,101,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,89.4557,88.57,,percent of total billed charges,,
Breast Carcinoma Assoc Ag(Ca 27.29) (Mayo)OutsideLaboratory,,86300,CPT,Facility,Both,,,90,101,85.85,28.9466,101,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,28.9466,28.66,,percent of total billed charges,,
Breast Carcinoma Assoc Ag(Ca 27.29) (Mayo)OutsideLaboratory,,86300,CPT,Facility,Outpatient,,,90,101,85.85,28.9466,101,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),49.49,49,,percent of total billed charges,,
Breast Carcinoma Assoc Ag(Ca 27.29) (Mayo)OutsideLaboratory,,86300,CPT,Facility,Inpatient,,,90,101,85.85,28.9466,101,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Breast Carcinoma Assoc Ag(Ca 27.29) (Mayo)OutsideLaboratory,,86300,CPT,Facility,Both,,,90,101,85.85,28.9466,101,CorVel,Worker's Compensation,101,100,,percent of total billed charges,,
Breast Carcinoma Assoc Ag(Ca 27.29) (Mayo)OutsideLaboratory,,86300,CPT,Facility,Both,,,90,101,85.85,28.9466,101,First Health Group Corporation,First Health Network,97.97,97,,percent of total billed charges,,
Breast Carcinoma Assoc Ag(Ca 27.29) (Mayo)OutsideLaboratory,,86300,CPT,Facility,Both,,,90,101,85.85,28.9466,101,"Health Partners, Inc.",Commercial,95.546,94.6,,percent of total billed charges,,
Breast Carcinoma Assoc Ag(Ca 27.29) (Mayo)OutsideLaboratory,,86300,CPT,Facility,Outpatient,,,90,101,85.85,28.9466,101,"Health Partners, Inc.",Medicare Advantage,49.49,49,,percent of total billed charges,,
Breast Carcinoma Assoc Ag(Ca 27.29) (Mayo)OutsideLaboratory,,86300,CPT,Facility,Inpatient,,,90,101,85.85,28.9466,101,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Breast Carcinoma Assoc Ag(Ca 27.29) (Mayo)OutsideLaboratory,,86300,CPT,Facility,Both,,,90,101,85.85,28.9466,101,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),60.6,60,,percent of total billed charges,,
Breast Carcinoma Assoc Ag(Ca 27.29) (Mayo)OutsideLaboratory,,86300,CPT,Facility,Both,,,90,101,85.85,28.9466,101,"Health Partners, Inc.",State of Minnesota Advantage Program,82.315,81.5,,percent of total billed charges,,
Breast Carcinoma Assoc Ag(Ca 27.29) (Mayo)OutsideLaboratory,,86300,CPT,Facility,Both,,,90,101,85.85,28.9466,101,"Health Partners, Inc.",State Public Programs,50.5,50,,percent of total billed charges,,
Breast Carcinoma Assoc Ag(Ca 27.29) (Mayo)OutsideLaboratory,,86300,CPT,Facility,Both,,,90,101,85.85,28.9466,101,Humana Insurance Company,Commercial PPO,95.95,95,,percent of total billed charges,,
Breast Carcinoma Assoc Ag(Ca 27.29) (Mayo)OutsideLaboratory,,86300,CPT,Facility,Outpatient,,,90,101,85.85,28.9466,101,Humana Insurance Company,Medicare PPO,49.49,49,,percent of total billed charges,,
Breast Carcinoma Assoc Ag(Ca 27.29) (Mayo)OutsideLaboratory,,86300,CPT,Facility,Inpatient,,,90,101,85.85,28.9466,101,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Breast Carcinoma Assoc Ag(Ca 27.29) (Mayo)OutsideLaboratory,,86300,CPT,Facility,Both,,,90,101,85.85,28.9466,101,Medica,Individual & Family,100.091,99.1,,percent of total billed charges,,
Breast Carcinoma Assoc Ag(Ca 27.29) (Mayo)OutsideLaboratory,,86300,CPT,Facility,Outpatient,,,90,101,85.85,28.9466,101,Medica,Medica Advantage Solution,50.298,49.8,,percent of total billed charges,,
Breast Carcinoma Assoc Ag(Ca 27.29) (Mayo)OutsideLaboratory,,86300,CPT,Facility,Inpatient,,,90,101,85.85,28.9466,101,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Breast Carcinoma Assoc Ag(Ca 27.29) (Mayo)OutsideLaboratory,,86300,CPT,Facility,Outpatient,,,90,101,85.85,28.9466,101,Medica,Medical Assistance,45.046,44.6,,percent of total billed charges,,
Breast Carcinoma Assoc Ag(Ca 27.29) (Mayo)OutsideLaboratory,,86300,CPT,Facility,Inpatient,,,90,101,85.85,28.9466,101,Medica,Medical Assistance,,,,,Included in per diem rate,
Breast Carcinoma Assoc Ag(Ca 27.29) (Mayo)OutsideLaboratory,,86300,CPT,Facility,Outpatient,,,90,101,85.85,28.9466,101,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,50.298,49.8,,percent of total billed charges,,
Breast Carcinoma Assoc Ag(Ca 27.29) (Mayo)OutsideLaboratory,,86300,CPT,Facility,Inpatient,,,90,101,85.85,28.9466,101,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Breast Carcinoma Assoc Ag(Ca 27.29) (Mayo)OutsideLaboratory,,86300,CPT,Facility,Both,,,90,101,85.85,28.9466,101,"Multiplan, Inc.","Multiplan, Inc.",94.94,94,,percent of total billed charges,,
Breast Carcinoma Assoc Ag(Ca 27.29) (Mayo)OutsideLaboratory,,86300,CPT,Facility,Outpatient,,,90,101,85.85,28.9466,101,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,87.264,86.4,,percent of total billed charges,,
Breast Carcinoma Assoc Ag(Ca 27.29) (Mayo)OutsideLaboratory,,86300,CPT,Facility,Inpatient,,,90,101,85.85,28.9466,101,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Breast Carcinoma Assoc Ag(Ca 27.29) (Mayo)OutsideLaboratory,,86300,CPT,Facility,Both,,,90,101,85.85,28.9466,101,"Preferred One Administrative Services, INC.",PPO,99.586,98.6,,percent of total billed charges,,
Breast Carcinoma Assoc Ag(Ca 27.29) (Mayo)OutsideLaboratory,,86300,CPT,Facility,Outpatient,,,90,101,85.85,28.9466,101,PrimeWest Health,Minnesota Senior Health Options (MSHO),51.9645,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Breast Carcinoma Assoc Ag(Ca 27.29) (Mayo)OutsideLaboratory,,86300,CPT,Facility,Inpatient,,,90,101,85.85,28.9466,101,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Breast Carcinoma Assoc Ag(Ca 27.29) (Mayo)OutsideLaboratory,,86300,CPT,Facility,Outpatient,,,90,101,85.85,28.9466,101,PrimeWest Health,MinnesotaCare,51.8736,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Breast Carcinoma Assoc Ag(Ca 27.29) (Mayo)OutsideLaboratory,,86300,CPT,Facility,Inpatient,,,90,101,85.85,28.9466,101,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Breast Carcinoma Assoc Ag(Ca 27.29) (Mayo)OutsideLaboratory,,86300,CPT,Facility,Both,,,90,101,85.85,28.9466,101,Sanford Health Plan,Sanford Health Plan,92.92,92,,percent of total billed charges,,
Breast Carcinoma Assoc Ag(Ca 27.29) (Mayo)OutsideLaboratory,,86300,CPT,Facility,Outpatient,,,90,101,85.85,28.9466,101,"UCare Health, Inc.",Individual & Family Plan,56.9135,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Breast Carcinoma Assoc Ag(Ca 27.29) (Mayo)OutsideLaboratory,,86300,CPT,Facility,Inpatient,,,90,101,85.85,28.9466,101,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Breast Carcinoma Assoc Ag(Ca 27.29) (Mayo)OutsideLaboratory,,86300,CPT,Facility,Outpatient,,,90,101,85.85,28.9466,101,"UCare Health, Inc.",Medical Assistance,50.9747,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Breast Carcinoma Assoc Ag(Ca 27.29) (Mayo)OutsideLaboratory,,86300,CPT,Facility,Inpatient,,,90,101,85.85,28.9466,101,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Breast Carcinoma Assoc Ag(Ca 27.29) (Mayo)OutsideLaboratory,,86300,CPT,Facility,Outpatient,,,90,101,85.85,28.9466,101,"UCare Health, Inc.",Medicare Advantage,50.9747,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Breast Carcinoma Assoc Ag(Ca 27.29) (Mayo)OutsideLaboratory,,86300,CPT,Facility,Inpatient,,,90,101,85.85,28.9466,101,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Breast Carcinoma Assoc Ag(Ca 27.29) (Mayo)OutsideLaboratory,,86300,CPT,Facility,Outpatient,,,90,101,85.85,28.9466,101,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),50.9747,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Breast Carcinoma Assoc Ag(Ca 27.29) (Mayo)OutsideLaboratory,,86300,CPT,Facility,Inpatient,,,90,101,85.85,28.9466,101,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Breast Carcinoma Assoc Ag(Ca 27.29) (Mayo)OutsideLaboratory,,86300,CPT,Facility,Both,,,90,101,85.85,28.9466,101,UnitedHealthcare,Individual & Family,94.94,94,,percent of total billed charges,,
Breast Carcinoma Assoc Ag(Ca 27.29) (Mayo)OutsideLaboratory,,86300,CPT,Facility,Outpatient,,,90,101,85.85,28.9466,101,UnitedHealthcare,Medicare Advantage,49.49,49,,percent of total billed charges,,
Breast Carcinoma Assoc Ag(Ca 27.29) (Mayo)OutsideLaboratory,,86300,CPT,Facility,Inpatient,,,90,101,85.85,28.9466,101,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Breast Carcinoma Assoc Ag(Ca 27.29) (Mayo)OutsideLaboratory,,86300,CPT,Facility,Outpatient,,,90,101,85.85,28.9466,101,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,48.48,48,,percent of total billed charges,,100% of DHS outpatient percentage
Breast Carcinoma Assoc Ag(Ca 27.29) (Mayo)OutsideLaboratory,,86300,CPT,Facility,Inpatient,,,90,101,85.85,28.9466,101,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Cancer Ag 15-3, (Ca 15-3), S (Mayo)OutsideLaboratory",,86300,CPT,Facility,Both,,,90,138,117.3,39.5508,138,Aetna,Commercial,126.96,92,,percent of total billed charges,,
"Cancer Ag 15-3, (Ca 15-3), S (Mayo)OutsideLaboratory",,86300,CPT,Facility,Outpatient,,,90,138,117.3,39.5508,138,Aetna,Medicare Advantage,67.62,49,,percent of total billed charges,,
"Cancer Ag 15-3, (Ca 15-3), S (Mayo)OutsideLaboratory",,86300,CPT,Facility,Inpatient,,,90,138,117.3,39.5508,138,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Cancer Ag 15-3, (Ca 15-3), S (Mayo)OutsideLaboratory",,86300,CPT,Facility,Both,,,90,138,117.3,39.5508,138,Aetna,PPO,128.34,93,,percent of total billed charges,,
"Cancer Ag 15-3, (Ca 15-3), S (Mayo)OutsideLaboratory",,86300,CPT,Facility,Both,,,90,138,117.3,39.5508,138,America's PPO,America's PPO,132.5214,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Cancer Ag 15-3, (Ca 15-3), S (Mayo)OutsideLaboratory",,86300,CPT,Facility,Both,,,90,138,117.3,39.5508,138,BlueCross BlueShield Minnesota, Federal Employee Program,135.792,98.4,,percent of total billed charges,,
"Cancer Ag 15-3, (Ca 15-3), S (Mayo)OutsideLaboratory",,86300,CPT,Facility,Both,,,90,138,117.3,39.5508,138,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,138,100,,percent of total billed charges,,
"Cancer Ag 15-3, (Ca 15-3), S (Mayo)OutsideLaboratory",,86300,CPT,Facility,Both,,,90,138,117.3,39.5508,138,BlueCross BlueShield Minnesota,High Value Network Plan,124.2,90,,percent of total billed charges,,
"Cancer Ag 15-3, (Ca 15-3), S (Mayo)OutsideLaboratory",,86300,CPT,Facility,Outpatient,,,90,138,117.3,39.5508,138,BlueCross BlueShield Minnesota,Medicare Advantage,67.62,49,,percent of total billed charges,,
"Cancer Ag 15-3, (Ca 15-3), S (Mayo)OutsideLaboratory",,86300,CPT,Facility,Inpatient,,,90,138,117.3,39.5508,138,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Cancer Ag 15-3, (Ca 15-3), S (Mayo)OutsideLaboratory",,86300,CPT,Facility,Both,,,90,138,117.3,39.5508,138,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,122.2266,88.57,,percent of total billed charges,,
"Cancer Ag 15-3, (Ca 15-3), S (Mayo)OutsideLaboratory",,86300,CPT,Facility,Both,,,90,138,117.3,39.5508,138,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,39.5508,28.66,,percent of total billed charges,,
"Cancer Ag 15-3, (Ca 15-3), S (Mayo)OutsideLaboratory",,86300,CPT,Facility,Outpatient,,,90,138,117.3,39.5508,138,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),67.62,49,,percent of total billed charges,,
"Cancer Ag 15-3, (Ca 15-3), S (Mayo)OutsideLaboratory",,86300,CPT,Facility,Inpatient,,,90,138,117.3,39.5508,138,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Cancer Ag 15-3, (Ca 15-3), S (Mayo)OutsideLaboratory",,86300,CPT,Facility,Both,,,90,138,117.3,39.5508,138,CorVel,Worker's Compensation,138,100,,percent of total billed charges,,
"Cancer Ag 15-3, (Ca 15-3), S (Mayo)OutsideLaboratory",,86300,CPT,Facility,Both,,,90,138,117.3,39.5508,138,First Health Group Corporation,First Health Network,133.86,97,,percent of total billed charges,,
"Cancer Ag 15-3, (Ca 15-3), S (Mayo)OutsideLaboratory",,86300,CPT,Facility,Both,,,90,138,117.3,39.5508,138,"Health Partners, Inc.",Commercial,130.548,94.6,,percent of total billed charges,,
"Cancer Ag 15-3, (Ca 15-3), S (Mayo)OutsideLaboratory",,86300,CPT,Facility,Outpatient,,,90,138,117.3,39.5508,138,"Health Partners, Inc.",Medicare Advantage,67.62,49,,percent of total billed charges,,
"Cancer Ag 15-3, (Ca 15-3), S (Mayo)OutsideLaboratory",,86300,CPT,Facility,Inpatient,,,90,138,117.3,39.5508,138,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Cancer Ag 15-3, (Ca 15-3), S (Mayo)OutsideLaboratory",,86300,CPT,Facility,Both,,,90,138,117.3,39.5508,138,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),82.8,60,,percent of total billed charges,,
"Cancer Ag 15-3, (Ca 15-3), S (Mayo)OutsideLaboratory",,86300,CPT,Facility,Both,,,90,138,117.3,39.5508,138,"Health Partners, Inc.",State of Minnesota Advantage Program,112.47,81.5,,percent of total billed charges,,
"Cancer Ag 15-3, (Ca 15-3), S (Mayo)OutsideLaboratory",,86300,CPT,Facility,Both,,,90,138,117.3,39.5508,138,"Health Partners, Inc.",State Public Programs,69,50,,percent of total billed charges,,
"Cancer Ag 15-3, (Ca 15-3), S (Mayo)OutsideLaboratory",,86300,CPT,Facility,Both,,,90,138,117.3,39.5508,138,Humana Insurance Company,Commercial PPO,131.1,95,,percent of total billed charges,,
"Cancer Ag 15-3, (Ca 15-3), S (Mayo)OutsideLaboratory",,86300,CPT,Facility,Outpatient,,,90,138,117.3,39.5508,138,Humana Insurance Company,Medicare PPO,67.62,49,,percent of total billed charges,,
"Cancer Ag 15-3, (Ca 15-3), S (Mayo)OutsideLaboratory",,86300,CPT,Facility,Inpatient,,,90,138,117.3,39.5508,138,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Cancer Ag 15-3, (Ca 15-3), S (Mayo)OutsideLaboratory",,86300,CPT,Facility,Both,,,90,138,117.3,39.5508,138,Medica,Individual & Family,136.758,99.1,,percent of total billed charges,,
"Cancer Ag 15-3, (Ca 15-3), S (Mayo)OutsideLaboratory",,86300,CPT,Facility,Outpatient,,,90,138,117.3,39.5508,138,Medica,Medica Advantage Solution,68.724,49.8,,percent of total billed charges,,
"Cancer Ag 15-3, (Ca 15-3), S (Mayo)OutsideLaboratory",,86300,CPT,Facility,Inpatient,,,90,138,117.3,39.5508,138,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Cancer Ag 15-3, (Ca 15-3), S (Mayo)OutsideLaboratory",,86300,CPT,Facility,Outpatient,,,90,138,117.3,39.5508,138,Medica,Medical Assistance,61.548,44.6,,percent of total billed charges,,
"Cancer Ag 15-3, (Ca 15-3), S (Mayo)OutsideLaboratory",,86300,CPT,Facility,Inpatient,,,90,138,117.3,39.5508,138,Medica,Medical Assistance,,,,,Included in per diem rate,
"Cancer Ag 15-3, (Ca 15-3), S (Mayo)OutsideLaboratory",,86300,CPT,Facility,Outpatient,,,90,138,117.3,39.5508,138,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,68.724,49.8,,percent of total billed charges,,
"Cancer Ag 15-3, (Ca 15-3), S (Mayo)OutsideLaboratory",,86300,CPT,Facility,Inpatient,,,90,138,117.3,39.5508,138,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Cancer Ag 15-3, (Ca 15-3), S (Mayo)OutsideLaboratory",,86300,CPT,Facility,Both,,,90,138,117.3,39.5508,138,"Multiplan, Inc.","Multiplan, Inc.",129.72,94,,percent of total billed charges,,
"Cancer Ag 15-3, (Ca 15-3), S (Mayo)OutsideLaboratory",,86300,CPT,Facility,Outpatient,,,90,138,117.3,39.5508,138,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,119.232,86.4,,percent of total billed charges,,
"Cancer Ag 15-3, (Ca 15-3), S (Mayo)OutsideLaboratory",,86300,CPT,Facility,Inpatient,,,90,138,117.3,39.5508,138,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Cancer Ag 15-3, (Ca 15-3), S (Mayo)OutsideLaboratory",,86300,CPT,Facility,Both,,,90,138,117.3,39.5508,138,"Preferred One Administrative Services, INC.",PPO,136.068,98.6,,percent of total billed charges,,
"Cancer Ag 15-3, (Ca 15-3), S (Mayo)OutsideLaboratory",,86300,CPT,Facility,Outpatient,,,90,138,117.3,39.5508,138,PrimeWest Health,Minnesota Senior Health Options (MSHO),71.001,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Cancer Ag 15-3, (Ca 15-3), S (Mayo)OutsideLaboratory",,86300,CPT,Facility,Inpatient,,,90,138,117.3,39.5508,138,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Cancer Ag 15-3, (Ca 15-3), S (Mayo)OutsideLaboratory",,86300,CPT,Facility,Outpatient,,,90,138,117.3,39.5508,138,PrimeWest Health,MinnesotaCare,70.8768,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Cancer Ag 15-3, (Ca 15-3), S (Mayo)OutsideLaboratory",,86300,CPT,Facility,Inpatient,,,90,138,117.3,39.5508,138,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Cancer Ag 15-3, (Ca 15-3), S (Mayo)OutsideLaboratory",,86300,CPT,Facility,Both,,,90,138,117.3,39.5508,138,Sanford Health Plan,Sanford Health Plan,126.96,92,,percent of total billed charges,,
"Cancer Ag 15-3, (Ca 15-3), S (Mayo)OutsideLaboratory",,86300,CPT,Facility,Outpatient,,,90,138,117.3,39.5508,138,"UCare Health, Inc.",Individual & Family Plan,77.763,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Cancer Ag 15-3, (Ca 15-3), S (Mayo)OutsideLaboratory",,86300,CPT,Facility,Inpatient,,,90,138,117.3,39.5508,138,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Cancer Ag 15-3, (Ca 15-3), S (Mayo)OutsideLaboratory",,86300,CPT,Facility,Outpatient,,,90,138,117.3,39.5508,138,"UCare Health, Inc.",Medical Assistance,69.6486,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Cancer Ag 15-3, (Ca 15-3), S (Mayo)OutsideLaboratory",,86300,CPT,Facility,Inpatient,,,90,138,117.3,39.5508,138,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Cancer Ag 15-3, (Ca 15-3), S (Mayo)OutsideLaboratory",,86300,CPT,Facility,Outpatient,,,90,138,117.3,39.5508,138,"UCare Health, Inc.",Medicare Advantage,69.6486,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Cancer Ag 15-3, (Ca 15-3), S (Mayo)OutsideLaboratory",,86300,CPT,Facility,Inpatient,,,90,138,117.3,39.5508,138,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Cancer Ag 15-3, (Ca 15-3), S (Mayo)OutsideLaboratory",,86300,CPT,Facility,Outpatient,,,90,138,117.3,39.5508,138,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),69.6486,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Cancer Ag 15-3, (Ca 15-3), S (Mayo)OutsideLaboratory",,86300,CPT,Facility,Inpatient,,,90,138,117.3,39.5508,138,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Cancer Ag 15-3, (Ca 15-3), S (Mayo)OutsideLaboratory",,86300,CPT,Facility,Both,,,90,138,117.3,39.5508,138,UnitedHealthcare,Individual & Family,129.72,94,,percent of total billed charges,,
"Cancer Ag 15-3, (Ca 15-3), S (Mayo)OutsideLaboratory",,86300,CPT,Facility,Outpatient,,,90,138,117.3,39.5508,138,UnitedHealthcare,Medicare Advantage,67.62,49,,percent of total billed charges,,
"Cancer Ag 15-3, (Ca 15-3), S (Mayo)OutsideLaboratory",,86300,CPT,Facility,Inpatient,,,90,138,117.3,39.5508,138,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Cancer Ag 15-3, (Ca 15-3), S (Mayo)OutsideLaboratory",,86300,CPT,Facility,Outpatient,,,90,138,117.3,39.5508,138,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,66.24,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Cancer Ag 15-3, (Ca 15-3), S (Mayo)OutsideLaboratory",,86300,CPT,Facility,Inpatient,,,90,138,117.3,39.5508,138,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Carbohydrate Ag 19-9, S (Mayo)OutsideLaboratory",,86301,CPT,Facility,Both,,,90,71,60.35,20.3486,71,Aetna,Commercial,65.32,92,,percent of total billed charges,,
"Carbohydrate Ag 19-9, S (Mayo)OutsideLaboratory",,86301,CPT,Facility,Outpatient,,,90,71,60.35,20.3486,71,Aetna,Medicare Advantage,34.79,49,,percent of total billed charges,,
"Carbohydrate Ag 19-9, S (Mayo)OutsideLaboratory",,86301,CPT,Facility,Inpatient,,,90,71,60.35,20.3486,71,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Carbohydrate Ag 19-9, S (Mayo)OutsideLaboratory",,86301,CPT,Facility,Both,,,90,71,60.35,20.3486,71,Aetna,PPO,66.03,93,,percent of total billed charges,,
"Carbohydrate Ag 19-9, S (Mayo)OutsideLaboratory",,86301,CPT,Facility,Both,,,90,71,60.35,20.3486,71,America's PPO,America's PPO,68.1813,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Carbohydrate Ag 19-9, S (Mayo)OutsideLaboratory",,86301,CPT,Facility,Both,,,90,71,60.35,20.3486,71,BlueCross BlueShield Minnesota, Federal Employee Program,69.864,98.4,,percent of total billed charges,,
"Carbohydrate Ag 19-9, S (Mayo)OutsideLaboratory",,86301,CPT,Facility,Both,,,90,71,60.35,20.3486,71,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,71,100,,percent of total billed charges,,
"Carbohydrate Ag 19-9, S (Mayo)OutsideLaboratory",,86301,CPT,Facility,Both,,,90,71,60.35,20.3486,71,BlueCross BlueShield Minnesota,High Value Network Plan,63.9,90,,percent of total billed charges,,
"Carbohydrate Ag 19-9, S (Mayo)OutsideLaboratory",,86301,CPT,Facility,Outpatient,,,90,71,60.35,20.3486,71,BlueCross BlueShield Minnesota,Medicare Advantage,34.79,49,,percent of total billed charges,,
"Carbohydrate Ag 19-9, S (Mayo)OutsideLaboratory",,86301,CPT,Facility,Inpatient,,,90,71,60.35,20.3486,71,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Carbohydrate Ag 19-9, S (Mayo)OutsideLaboratory",,86301,CPT,Facility,Both,,,90,71,60.35,20.3486,71,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,62.8847,88.57,,percent of total billed charges,,
"Carbohydrate Ag 19-9, S (Mayo)OutsideLaboratory",,86301,CPT,Facility,Both,,,90,71,60.35,20.3486,71,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,20.3486,28.66,,percent of total billed charges,,
"Carbohydrate Ag 19-9, S (Mayo)OutsideLaboratory",,86301,CPT,Facility,Outpatient,,,90,71,60.35,20.3486,71,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),34.79,49,,percent of total billed charges,,
"Carbohydrate Ag 19-9, S (Mayo)OutsideLaboratory",,86301,CPT,Facility,Inpatient,,,90,71,60.35,20.3486,71,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Carbohydrate Ag 19-9, S (Mayo)OutsideLaboratory",,86301,CPT,Facility,Both,,,90,71,60.35,20.3486,71,CorVel,Worker's Compensation,71,100,,percent of total billed charges,,
"Carbohydrate Ag 19-9, S (Mayo)OutsideLaboratory",,86301,CPT,Facility,Both,,,90,71,60.35,20.3486,71,First Health Group Corporation,First Health Network,68.87,97,,percent of total billed charges,,
"Carbohydrate Ag 19-9, S (Mayo)OutsideLaboratory",,86301,CPT,Facility,Both,,,90,71,60.35,20.3486,71,"Health Partners, Inc.",Commercial,67.166,94.6,,percent of total billed charges,,
"Carbohydrate Ag 19-9, S (Mayo)OutsideLaboratory",,86301,CPT,Facility,Outpatient,,,90,71,60.35,20.3486,71,"Health Partners, Inc.",Medicare Advantage,34.79,49,,percent of total billed charges,,
"Carbohydrate Ag 19-9, S (Mayo)OutsideLaboratory",,86301,CPT,Facility,Inpatient,,,90,71,60.35,20.3486,71,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Carbohydrate Ag 19-9, S (Mayo)OutsideLaboratory",,86301,CPT,Facility,Both,,,90,71,60.35,20.3486,71,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),42.6,60,,percent of total billed charges,,
"Carbohydrate Ag 19-9, S (Mayo)OutsideLaboratory",,86301,CPT,Facility,Both,,,90,71,60.35,20.3486,71,"Health Partners, Inc.",State of Minnesota Advantage Program,57.865,81.5,,percent of total billed charges,,
"Carbohydrate Ag 19-9, S (Mayo)OutsideLaboratory",,86301,CPT,Facility,Both,,,90,71,60.35,20.3486,71,"Health Partners, Inc.",State Public Programs,35.5,50,,percent of total billed charges,,
"Carbohydrate Ag 19-9, S (Mayo)OutsideLaboratory",,86301,CPT,Facility,Both,,,90,71,60.35,20.3486,71,Humana Insurance Company,Commercial PPO,67.45,95,,percent of total billed charges,,
"Carbohydrate Ag 19-9, S (Mayo)OutsideLaboratory",,86301,CPT,Facility,Outpatient,,,90,71,60.35,20.3486,71,Humana Insurance Company,Medicare PPO,34.79,49,,percent of total billed charges,,
"Carbohydrate Ag 19-9, S (Mayo)OutsideLaboratory",,86301,CPT,Facility,Inpatient,,,90,71,60.35,20.3486,71,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Carbohydrate Ag 19-9, S (Mayo)OutsideLaboratory",,86301,CPT,Facility,Both,,,90,71,60.35,20.3486,71,Medica,Individual & Family,70.361,99.1,,percent of total billed charges,,
"Carbohydrate Ag 19-9, S (Mayo)OutsideLaboratory",,86301,CPT,Facility,Outpatient,,,90,71,60.35,20.3486,71,Medica,Medica Advantage Solution,35.358,49.8,,percent of total billed charges,,
"Carbohydrate Ag 19-9, S (Mayo)OutsideLaboratory",,86301,CPT,Facility,Inpatient,,,90,71,60.35,20.3486,71,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Carbohydrate Ag 19-9, S (Mayo)OutsideLaboratory",,86301,CPT,Facility,Outpatient,,,90,71,60.35,20.3486,71,Medica,Medical Assistance,31.666,44.6,,percent of total billed charges,,
"Carbohydrate Ag 19-9, S (Mayo)OutsideLaboratory",,86301,CPT,Facility,Inpatient,,,90,71,60.35,20.3486,71,Medica,Medical Assistance,,,,,Included in per diem rate,
"Carbohydrate Ag 19-9, S (Mayo)OutsideLaboratory",,86301,CPT,Facility,Outpatient,,,90,71,60.35,20.3486,71,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,35.358,49.8,,percent of total billed charges,,
"Carbohydrate Ag 19-9, S (Mayo)OutsideLaboratory",,86301,CPT,Facility,Inpatient,,,90,71,60.35,20.3486,71,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Carbohydrate Ag 19-9, S (Mayo)OutsideLaboratory",,86301,CPT,Facility,Both,,,90,71,60.35,20.3486,71,"Multiplan, Inc.","Multiplan, Inc.",66.74,94,,percent of total billed charges,,
"Carbohydrate Ag 19-9, S (Mayo)OutsideLaboratory",,86301,CPT,Facility,Outpatient,,,90,71,60.35,20.3486,71,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,61.344,86.4,,percent of total billed charges,,
"Carbohydrate Ag 19-9, S (Mayo)OutsideLaboratory",,86301,CPT,Facility,Inpatient,,,90,71,60.35,20.3486,71,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Carbohydrate Ag 19-9, S (Mayo)OutsideLaboratory",,86301,CPT,Facility,Both,,,90,71,60.35,20.3486,71,"Preferred One Administrative Services, INC.",PPO,70.006,98.6,,percent of total billed charges,,
"Carbohydrate Ag 19-9, S (Mayo)OutsideLaboratory",,86301,CPT,Facility,Outpatient,,,90,71,60.35,20.3486,71,PrimeWest Health,Minnesota Senior Health Options (MSHO),36.5295,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Carbohydrate Ag 19-9, S (Mayo)OutsideLaboratory",,86301,CPT,Facility,Inpatient,,,90,71,60.35,20.3486,71,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Carbohydrate Ag 19-9, S (Mayo)OutsideLaboratory",,86301,CPT,Facility,Outpatient,,,90,71,60.35,20.3486,71,PrimeWest Health,MinnesotaCare,36.4656,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Carbohydrate Ag 19-9, S (Mayo)OutsideLaboratory",,86301,CPT,Facility,Inpatient,,,90,71,60.35,20.3486,71,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Carbohydrate Ag 19-9, S (Mayo)OutsideLaboratory",,86301,CPT,Facility,Both,,,90,71,60.35,20.3486,71,Sanford Health Plan,Sanford Health Plan,65.32,92,,percent of total billed charges,,
"Carbohydrate Ag 19-9, S (Mayo)OutsideLaboratory",,86301,CPT,Facility,Outpatient,,,90,71,60.35,20.3486,71,"UCare Health, Inc.",Individual & Family Plan,40.0085,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Carbohydrate Ag 19-9, S (Mayo)OutsideLaboratory",,86301,CPT,Facility,Inpatient,,,90,71,60.35,20.3486,71,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Carbohydrate Ag 19-9, S (Mayo)OutsideLaboratory",,86301,CPT,Facility,Outpatient,,,90,71,60.35,20.3486,71,"UCare Health, Inc.",Medical Assistance,35.8337,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Carbohydrate Ag 19-9, S (Mayo)OutsideLaboratory",,86301,CPT,Facility,Inpatient,,,90,71,60.35,20.3486,71,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Carbohydrate Ag 19-9, S (Mayo)OutsideLaboratory",,86301,CPT,Facility,Outpatient,,,90,71,60.35,20.3486,71,"UCare Health, Inc.",Medicare Advantage,35.8337,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Carbohydrate Ag 19-9, S (Mayo)OutsideLaboratory",,86301,CPT,Facility,Inpatient,,,90,71,60.35,20.3486,71,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Carbohydrate Ag 19-9, S (Mayo)OutsideLaboratory",,86301,CPT,Facility,Outpatient,,,90,71,60.35,20.3486,71,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),35.8337,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Carbohydrate Ag 19-9, S (Mayo)OutsideLaboratory",,86301,CPT,Facility,Inpatient,,,90,71,60.35,20.3486,71,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Carbohydrate Ag 19-9, S (Mayo)OutsideLaboratory",,86301,CPT,Facility,Both,,,90,71,60.35,20.3486,71,UnitedHealthcare,Individual & Family,66.74,94,,percent of total billed charges,,
"Carbohydrate Ag 19-9, S (Mayo)OutsideLaboratory",,86301,CPT,Facility,Outpatient,,,90,71,60.35,20.3486,71,UnitedHealthcare,Medicare Advantage,34.79,49,,percent of total billed charges,,
"Carbohydrate Ag 19-9, S (Mayo)OutsideLaboratory",,86301,CPT,Facility,Inpatient,,,90,71,60.35,20.3486,71,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Carbohydrate Ag 19-9, S (Mayo)OutsideLaboratory",,86301,CPT,Facility,Outpatient,,,90,71,60.35,20.3486,71,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,34.08,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Carbohydrate Ag 19-9, S (Mayo)OutsideLaboratory",,86301,CPT,Facility,Inpatient,,,90,71,60.35,20.3486,71,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Immunoassay For Tumor Antigen, Other Antigen, Quantitative, Each, S (Mayo)OutsideLaboratory",,86316,CPT,Facility,Both,,,90,109,92.65,31.2394,109,Aetna,Commercial,100.28,92,,percent of total billed charges,,
"Immunoassay For Tumor Antigen, Other Antigen, Quantitative, Each, S (Mayo)OutsideLaboratory",,86316,CPT,Facility,Outpatient,,,90,109,92.65,31.2394,109,Aetna,Medicare Advantage,53.41,49,,percent of total billed charges,,
"Immunoassay For Tumor Antigen, Other Antigen, Quantitative, Each, S (Mayo)OutsideLaboratory",,86316,CPT,Facility,Inpatient,,,90,109,92.65,31.2394,109,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Immunoassay For Tumor Antigen, Other Antigen, Quantitative, Each, S (Mayo)OutsideLaboratory",,86316,CPT,Facility,Both,,,90,109,92.65,31.2394,109,Aetna,PPO,101.37,93,,percent of total billed charges,,
"Immunoassay For Tumor Antigen, Other Antigen, Quantitative, Each, S (Mayo)OutsideLaboratory",,86316,CPT,Facility,Both,,,90,109,92.65,31.2394,109,America's PPO,America's PPO,104.6727,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Immunoassay For Tumor Antigen, Other Antigen, Quantitative, Each, S (Mayo)OutsideLaboratory",,86316,CPT,Facility,Both,,,90,109,92.65,31.2394,109,BlueCross BlueShield Minnesota, Federal Employee Program,107.256,98.4,,percent of total billed charges,,
"Immunoassay For Tumor Antigen, Other Antigen, Quantitative, Each, S (Mayo)OutsideLaboratory",,86316,CPT,Facility,Both,,,90,109,92.65,31.2394,109,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,109,100,,percent of total billed charges,,
"Immunoassay For Tumor Antigen, Other Antigen, Quantitative, Each, S (Mayo)OutsideLaboratory",,86316,CPT,Facility,Both,,,90,109,92.65,31.2394,109,BlueCross BlueShield Minnesota,High Value Network Plan,98.1,90,,percent of total billed charges,,
"Immunoassay For Tumor Antigen, Other Antigen, Quantitative, Each, S (Mayo)OutsideLaboratory",,86316,CPT,Facility,Outpatient,,,90,109,92.65,31.2394,109,BlueCross BlueShield Minnesota,Medicare Advantage,53.41,49,,percent of total billed charges,,
"Immunoassay For Tumor Antigen, Other Antigen, Quantitative, Each, S (Mayo)OutsideLaboratory",,86316,CPT,Facility,Inpatient,,,90,109,92.65,31.2394,109,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Immunoassay For Tumor Antigen, Other Antigen, Quantitative, Each, S (Mayo)OutsideLaboratory",,86316,CPT,Facility,Both,,,90,109,92.65,31.2394,109,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,96.5413,88.57,,percent of total billed charges,,
"Immunoassay For Tumor Antigen, Other Antigen, Quantitative, Each, S (Mayo)OutsideLaboratory",,86316,CPT,Facility,Both,,,90,109,92.65,31.2394,109,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,31.2394,28.66,,percent of total billed charges,,
"Immunoassay For Tumor Antigen, Other Antigen, Quantitative, Each, S (Mayo)OutsideLaboratory",,86316,CPT,Facility,Outpatient,,,90,109,92.65,31.2394,109,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),53.41,49,,percent of total billed charges,,
"Immunoassay For Tumor Antigen, Other Antigen, Quantitative, Each, S (Mayo)OutsideLaboratory",,86316,CPT,Facility,Inpatient,,,90,109,92.65,31.2394,109,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Immunoassay For Tumor Antigen, Other Antigen, Quantitative, Each, S (Mayo)OutsideLaboratory",,86316,CPT,Facility,Both,,,90,109,92.65,31.2394,109,CorVel,Worker's Compensation,109,100,,percent of total billed charges,,
"Immunoassay For Tumor Antigen, Other Antigen, Quantitative, Each, S (Mayo)OutsideLaboratory",,86316,CPT,Facility,Both,,,90,109,92.65,31.2394,109,First Health Group Corporation,First Health Network,105.73,97,,percent of total billed charges,,
"Immunoassay For Tumor Antigen, Other Antigen, Quantitative, Each, S (Mayo)OutsideLaboratory",,86316,CPT,Facility,Both,,,90,109,92.65,31.2394,109,"Health Partners, Inc.",Commercial,103.114,94.6,,percent of total billed charges,,
"Immunoassay For Tumor Antigen, Other Antigen, Quantitative, Each, S (Mayo)OutsideLaboratory",,86316,CPT,Facility,Outpatient,,,90,109,92.65,31.2394,109,"Health Partners, Inc.",Medicare Advantage,53.41,49,,percent of total billed charges,,
"Immunoassay For Tumor Antigen, Other Antigen, Quantitative, Each, S (Mayo)OutsideLaboratory",,86316,CPT,Facility,Inpatient,,,90,109,92.65,31.2394,109,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Immunoassay For Tumor Antigen, Other Antigen, Quantitative, Each, S (Mayo)OutsideLaboratory",,86316,CPT,Facility,Both,,,90,109,92.65,31.2394,109,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),65.4,60,,percent of total billed charges,,
"Immunoassay For Tumor Antigen, Other Antigen, Quantitative, Each, S (Mayo)OutsideLaboratory",,86316,CPT,Facility,Both,,,90,109,92.65,31.2394,109,"Health Partners, Inc.",State of Minnesota Advantage Program,88.835,81.5,,percent of total billed charges,,
"Immunoassay For Tumor Antigen, Other Antigen, Quantitative, Each, S (Mayo)OutsideLaboratory",,86316,CPT,Facility,Both,,,90,109,92.65,31.2394,109,"Health Partners, Inc.",State Public Programs,54.5,50,,percent of total billed charges,,
"Immunoassay For Tumor Antigen, Other Antigen, Quantitative, Each, S (Mayo)OutsideLaboratory",,86316,CPT,Facility,Both,,,90,109,92.65,31.2394,109,Humana Insurance Company,Commercial PPO,103.55,95,,percent of total billed charges,,
"Immunoassay For Tumor Antigen, Other Antigen, Quantitative, Each, S (Mayo)OutsideLaboratory",,86316,CPT,Facility,Outpatient,,,90,109,92.65,31.2394,109,Humana Insurance Company,Medicare PPO,53.41,49,,percent of total billed charges,,
"Immunoassay For Tumor Antigen, Other Antigen, Quantitative, Each, S (Mayo)OutsideLaboratory",,86316,CPT,Facility,Inpatient,,,90,109,92.65,31.2394,109,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Immunoassay For Tumor Antigen, Other Antigen, Quantitative, Each, S (Mayo)OutsideLaboratory",,86316,CPT,Facility,Both,,,90,109,92.65,31.2394,109,Medica,Individual & Family,108.019,99.1,,percent of total billed charges,,
"Immunoassay For Tumor Antigen, Other Antigen, Quantitative, Each, S (Mayo)OutsideLaboratory",,86316,CPT,Facility,Outpatient,,,90,109,92.65,31.2394,109,Medica,Medica Advantage Solution,54.282,49.8,,percent of total billed charges,,
"Immunoassay For Tumor Antigen, Other Antigen, Quantitative, Each, S (Mayo)OutsideLaboratory",,86316,CPT,Facility,Inpatient,,,90,109,92.65,31.2394,109,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Immunoassay For Tumor Antigen, Other Antigen, Quantitative, Each, S (Mayo)OutsideLaboratory",,86316,CPT,Facility,Outpatient,,,90,109,92.65,31.2394,109,Medica,Medical Assistance,48.614,44.6,,percent of total billed charges,,
"Immunoassay For Tumor Antigen, Other Antigen, Quantitative, Each, S (Mayo)OutsideLaboratory",,86316,CPT,Facility,Inpatient,,,90,109,92.65,31.2394,109,Medica,Medical Assistance,,,,,Included in per diem rate,
"Immunoassay For Tumor Antigen, Other Antigen, Quantitative, Each, S (Mayo)OutsideLaboratory",,86316,CPT,Facility,Outpatient,,,90,109,92.65,31.2394,109,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,54.282,49.8,,percent of total billed charges,,
"Immunoassay For Tumor Antigen, Other Antigen, Quantitative, Each, S (Mayo)OutsideLaboratory",,86316,CPT,Facility,Inpatient,,,90,109,92.65,31.2394,109,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Immunoassay For Tumor Antigen, Other Antigen, Quantitative, Each, S (Mayo)OutsideLaboratory",,86316,CPT,Facility,Both,,,90,109,92.65,31.2394,109,"Multiplan, Inc.","Multiplan, Inc.",102.46,94,,percent of total billed charges,,
"Immunoassay For Tumor Antigen, Other Antigen, Quantitative, Each, S (Mayo)OutsideLaboratory",,86316,CPT,Facility,Outpatient,,,90,109,92.65,31.2394,109,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,94.176,86.4,,percent of total billed charges,,
"Immunoassay For Tumor Antigen, Other Antigen, Quantitative, Each, S (Mayo)OutsideLaboratory",,86316,CPT,Facility,Inpatient,,,90,109,92.65,31.2394,109,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Immunoassay For Tumor Antigen, Other Antigen, Quantitative, Each, S (Mayo)OutsideLaboratory",,86316,CPT,Facility,Both,,,90,109,92.65,31.2394,109,"Preferred One Administrative Services, INC.",PPO,107.474,98.6,,percent of total billed charges,,
"Immunoassay For Tumor Antigen, Other Antigen, Quantitative, Each, S (Mayo)OutsideLaboratory",,86316,CPT,Facility,Outpatient,,,90,109,92.65,31.2394,109,PrimeWest Health,Minnesota Senior Health Options (MSHO),56.0805,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Immunoassay For Tumor Antigen, Other Antigen, Quantitative, Each, S (Mayo)OutsideLaboratory",,86316,CPT,Facility,Inpatient,,,90,109,92.65,31.2394,109,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Immunoassay For Tumor Antigen, Other Antigen, Quantitative, Each, S (Mayo)OutsideLaboratory",,86316,CPT,Facility,Outpatient,,,90,109,92.65,31.2394,109,PrimeWest Health,MinnesotaCare,55.9824,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Immunoassay For Tumor Antigen, Other Antigen, Quantitative, Each, S (Mayo)OutsideLaboratory",,86316,CPT,Facility,Inpatient,,,90,109,92.65,31.2394,109,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Immunoassay For Tumor Antigen, Other Antigen, Quantitative, Each, S (Mayo)OutsideLaboratory",,86316,CPT,Facility,Both,,,90,109,92.65,31.2394,109,Sanford Health Plan,Sanford Health Plan,100.28,92,,percent of total billed charges,,
"Immunoassay For Tumor Antigen, Other Antigen, Quantitative, Each, S (Mayo)OutsideLaboratory",,86316,CPT,Facility,Outpatient,,,90,109,92.65,31.2394,109,"UCare Health, Inc.",Individual & Family Plan,61.4215,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Immunoassay For Tumor Antigen, Other Antigen, Quantitative, Each, S (Mayo)OutsideLaboratory",,86316,CPT,Facility,Inpatient,,,90,109,92.65,31.2394,109,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Immunoassay For Tumor Antigen, Other Antigen, Quantitative, Each, S (Mayo)OutsideLaboratory",,86316,CPT,Facility,Outpatient,,,90,109,92.65,31.2394,109,"UCare Health, Inc.",Medical Assistance,55.0123,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Immunoassay For Tumor Antigen, Other Antigen, Quantitative, Each, S (Mayo)OutsideLaboratory",,86316,CPT,Facility,Inpatient,,,90,109,92.65,31.2394,109,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Immunoassay For Tumor Antigen, Other Antigen, Quantitative, Each, S (Mayo)OutsideLaboratory",,86316,CPT,Facility,Outpatient,,,90,109,92.65,31.2394,109,"UCare Health, Inc.",Medicare Advantage,55.0123,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Immunoassay For Tumor Antigen, Other Antigen, Quantitative, Each, S (Mayo)OutsideLaboratory",,86316,CPT,Facility,Inpatient,,,90,109,92.65,31.2394,109,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Immunoassay For Tumor Antigen, Other Antigen, Quantitative, Each, S (Mayo)OutsideLaboratory",,86316,CPT,Facility,Outpatient,,,90,109,92.65,31.2394,109,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),55.0123,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Immunoassay For Tumor Antigen, Other Antigen, Quantitative, Each, S (Mayo)OutsideLaboratory",,86316,CPT,Facility,Inpatient,,,90,109,92.65,31.2394,109,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Immunoassay For Tumor Antigen, Other Antigen, Quantitative, Each, S (Mayo)OutsideLaboratory",,86316,CPT,Facility,Both,,,90,109,92.65,31.2394,109,UnitedHealthcare,Individual & Family,102.46,94,,percent of total billed charges,,
"Immunoassay For Tumor Antigen, Other Antigen, Quantitative, Each, S (Mayo)OutsideLaboratory",,86316,CPT,Facility,Outpatient,,,90,109,92.65,31.2394,109,UnitedHealthcare,Medicare Advantage,53.41,49,,percent of total billed charges,,
"Immunoassay For Tumor Antigen, Other Antigen, Quantitative, Each, S (Mayo)OutsideLaboratory",,86316,CPT,Facility,Inpatient,,,90,109,92.65,31.2394,109,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Immunoassay For Tumor Antigen, Other Antigen, Quantitative, Each, S (Mayo)OutsideLaboratory",,86316,CPT,Facility,Outpatient,,,90,109,92.65,31.2394,109,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,52.32,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Immunoassay For Tumor Antigen, Other Antigen, Quantitative, Each, S (Mayo)OutsideLaboratory",,86316,CPT,Facility,Inpatient,,,90,109,92.65,31.2394,109,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Tetanus Toxoid Igg Ab, S (Mayo)OutsideLaboratory",,86317,CPT,Facility,Both,,,90,90,76.5,25.794,90,Aetna,Commercial,82.8,92,,percent of total billed charges,,
"Tetanus Toxoid Igg Ab, S (Mayo)OutsideLaboratory",,86317,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,Aetna,Medicare Advantage,44.1,49,,percent of total billed charges,,
"Tetanus Toxoid Igg Ab, S (Mayo)OutsideLaboratory",,86317,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Tetanus Toxoid Igg Ab, S (Mayo)OutsideLaboratory",,86317,CPT,Facility,Both,,,90,90,76.5,25.794,90,Aetna,PPO,83.7,93,,percent of total billed charges,,
"Tetanus Toxoid Igg Ab, S (Mayo)OutsideLaboratory",,86317,CPT,Facility,Both,,,90,90,76.5,25.794,90,America's PPO,America's PPO,86.427,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Tetanus Toxoid Igg Ab, S (Mayo)OutsideLaboratory",,86317,CPT,Facility,Both,,,90,90,76.5,25.794,90,BlueCross BlueShield Minnesota, Federal Employee Program,88.56,98.4,,percent of total billed charges,,
"Tetanus Toxoid Igg Ab, S (Mayo)OutsideLaboratory",,86317,CPT,Facility,Both,,,90,90,76.5,25.794,90,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,90,100,,percent of total billed charges,,
"Tetanus Toxoid Igg Ab, S (Mayo)OutsideLaboratory",,86317,CPT,Facility,Both,,,90,90,76.5,25.794,90,BlueCross BlueShield Minnesota,High Value Network Plan,81,90,,percent of total billed charges,,
"Tetanus Toxoid Igg Ab, S (Mayo)OutsideLaboratory",,86317,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,BlueCross BlueShield Minnesota,Medicare Advantage,44.1,49,,percent of total billed charges,,
"Tetanus Toxoid Igg Ab, S (Mayo)OutsideLaboratory",,86317,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Tetanus Toxoid Igg Ab, S (Mayo)OutsideLaboratory",,86317,CPT,Facility,Both,,,90,90,76.5,25.794,90,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,79.713,88.57,,percent of total billed charges,,
"Tetanus Toxoid Igg Ab, S (Mayo)OutsideLaboratory",,86317,CPT,Facility,Both,,,90,90,76.5,25.794,90,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,25.794,28.66,,percent of total billed charges,,
"Tetanus Toxoid Igg Ab, S (Mayo)OutsideLaboratory",,86317,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),44.1,49,,percent of total billed charges,,
"Tetanus Toxoid Igg Ab, S (Mayo)OutsideLaboratory",,86317,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Tetanus Toxoid Igg Ab, S (Mayo)OutsideLaboratory",,86317,CPT,Facility,Both,,,90,90,76.5,25.794,90,CorVel,Worker's Compensation,90,100,,percent of total billed charges,,
"Tetanus Toxoid Igg Ab, S (Mayo)OutsideLaboratory",,86317,CPT,Facility,Both,,,90,90,76.5,25.794,90,First Health Group Corporation,First Health Network,87.3,97,,percent of total billed charges,,
"Tetanus Toxoid Igg Ab, S (Mayo)OutsideLaboratory",,86317,CPT,Facility,Both,,,90,90,76.5,25.794,90,"Health Partners, Inc.",Commercial,85.14,94.6,,percent of total billed charges,,
"Tetanus Toxoid Igg Ab, S (Mayo)OutsideLaboratory",,86317,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,"Health Partners, Inc.",Medicare Advantage,44.1,49,,percent of total billed charges,,
"Tetanus Toxoid Igg Ab, S (Mayo)OutsideLaboratory",,86317,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Tetanus Toxoid Igg Ab, S (Mayo)OutsideLaboratory",,86317,CPT,Facility,Both,,,90,90,76.5,25.794,90,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),54,60,,percent of total billed charges,,
"Tetanus Toxoid Igg Ab, S (Mayo)OutsideLaboratory",,86317,CPT,Facility,Both,,,90,90,76.5,25.794,90,"Health Partners, Inc.",State of Minnesota Advantage Program,73.35,81.5,,percent of total billed charges,,
"Tetanus Toxoid Igg Ab, S (Mayo)OutsideLaboratory",,86317,CPT,Facility,Both,,,90,90,76.5,25.794,90,"Health Partners, Inc.",State Public Programs,45,50,,percent of total billed charges,,
"Tetanus Toxoid Igg Ab, S (Mayo)OutsideLaboratory",,86317,CPT,Facility,Both,,,90,90,76.5,25.794,90,Humana Insurance Company,Commercial PPO,85.5,95,,percent of total billed charges,,
"Tetanus Toxoid Igg Ab, S (Mayo)OutsideLaboratory",,86317,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,Humana Insurance Company,Medicare PPO,44.1,49,,percent of total billed charges,,
"Tetanus Toxoid Igg Ab, S (Mayo)OutsideLaboratory",,86317,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Tetanus Toxoid Igg Ab, S (Mayo)OutsideLaboratory",,86317,CPT,Facility,Both,,,90,90,76.5,25.794,90,Medica,Individual & Family,89.19,99.1,,percent of total billed charges,,
"Tetanus Toxoid Igg Ab, S (Mayo)OutsideLaboratory",,86317,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,Medica,Medica Advantage Solution,44.82,49.8,,percent of total billed charges,,
"Tetanus Toxoid Igg Ab, S (Mayo)OutsideLaboratory",,86317,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Tetanus Toxoid Igg Ab, S (Mayo)OutsideLaboratory",,86317,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,Medica,Medical Assistance,40.14,44.6,,percent of total billed charges,,
"Tetanus Toxoid Igg Ab, S (Mayo)OutsideLaboratory",,86317,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,Medica,Medical Assistance,,,,,Included in per diem rate,
"Tetanus Toxoid Igg Ab, S (Mayo)OutsideLaboratory",,86317,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,44.82,49.8,,percent of total billed charges,,
"Tetanus Toxoid Igg Ab, S (Mayo)OutsideLaboratory",,86317,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Tetanus Toxoid Igg Ab, S (Mayo)OutsideLaboratory",,86317,CPT,Facility,Both,,,90,90,76.5,25.794,90,"Multiplan, Inc.","Multiplan, Inc.",84.6,94,,percent of total billed charges,,
"Tetanus Toxoid Igg Ab, S (Mayo)OutsideLaboratory",,86317,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,77.76,86.4,,percent of total billed charges,,
"Tetanus Toxoid Igg Ab, S (Mayo)OutsideLaboratory",,86317,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Tetanus Toxoid Igg Ab, S (Mayo)OutsideLaboratory",,86317,CPT,Facility,Both,,,90,90,76.5,25.794,90,"Preferred One Administrative Services, INC.",PPO,88.74,98.6,,percent of total billed charges,,
"Tetanus Toxoid Igg Ab, S (Mayo)OutsideLaboratory",,86317,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,PrimeWest Health,Minnesota Senior Health Options (MSHO),46.305,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Tetanus Toxoid Igg Ab, S (Mayo)OutsideLaboratory",,86317,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Tetanus Toxoid Igg Ab, S (Mayo)OutsideLaboratory",,86317,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,PrimeWest Health,MinnesotaCare,46.224,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Tetanus Toxoid Igg Ab, S (Mayo)OutsideLaboratory",,86317,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Tetanus Toxoid Igg Ab, S (Mayo)OutsideLaboratory",,86317,CPT,Facility,Both,,,90,90,76.5,25.794,90,Sanford Health Plan,Sanford Health Plan,82.8,92,,percent of total billed charges,,
"Tetanus Toxoid Igg Ab, S (Mayo)OutsideLaboratory",,86317,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,"UCare Health, Inc.",Individual & Family Plan,50.715,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Tetanus Toxoid Igg Ab, S (Mayo)OutsideLaboratory",,86317,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Tetanus Toxoid Igg Ab, S (Mayo)OutsideLaboratory",,86317,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,"UCare Health, Inc.",Medical Assistance,45.423,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Tetanus Toxoid Igg Ab, S (Mayo)OutsideLaboratory",,86317,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Tetanus Toxoid Igg Ab, S (Mayo)OutsideLaboratory",,86317,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,"UCare Health, Inc.",Medicare Advantage,45.423,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Tetanus Toxoid Igg Ab, S (Mayo)OutsideLaboratory",,86317,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Tetanus Toxoid Igg Ab, S (Mayo)OutsideLaboratory",,86317,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),45.423,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Tetanus Toxoid Igg Ab, S (Mayo)OutsideLaboratory",,86317,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Tetanus Toxoid Igg Ab, S (Mayo)OutsideLaboratory",,86317,CPT,Facility,Both,,,90,90,76.5,25.794,90,UnitedHealthcare,Individual & Family,84.6,94,,percent of total billed charges,,
"Tetanus Toxoid Igg Ab, S (Mayo)OutsideLaboratory",,86317,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,UnitedHealthcare,Medicare Advantage,44.1,49,,percent of total billed charges,,
"Tetanus Toxoid Igg Ab, S (Mayo)OutsideLaboratory",,86317,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Tetanus Toxoid Igg Ab, S (Mayo)OutsideLaboratory",,86317,CPT,Facility,Outpatient,,,90,90,76.5,25.794,90,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,43.2,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Tetanus Toxoid Igg Ab, S (Mayo)OutsideLaboratory",,86317,CPT,Facility,Inpatient,,,90,90,76.5,25.794,90,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Insulin Abs, S (Mayo)OutsideLaboratory",,86337,CPT,Facility,Both,,,90,118,100.3,33.8188,118,Aetna,Commercial,108.56,92,,percent of total billed charges,,
"Insulin Abs, S (Mayo)OutsideLaboratory",,86337,CPT,Facility,Outpatient,,,90,118,100.3,33.8188,118,Aetna,Medicare Advantage,57.82,49,,percent of total billed charges,,
"Insulin Abs, S (Mayo)OutsideLaboratory",,86337,CPT,Facility,Inpatient,,,90,118,100.3,33.8188,118,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Insulin Abs, S (Mayo)OutsideLaboratory",,86337,CPT,Facility,Both,,,90,118,100.3,33.8188,118,Aetna,PPO,109.74,93,,percent of total billed charges,,
"Insulin Abs, S (Mayo)OutsideLaboratory",,86337,CPT,Facility,Both,,,90,118,100.3,33.8188,118,America's PPO,America's PPO,113.3154,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Insulin Abs, S (Mayo)OutsideLaboratory",,86337,CPT,Facility,Both,,,90,118,100.3,33.8188,118,BlueCross BlueShield Minnesota, Federal Employee Program,116.112,98.4,,percent of total billed charges,,
"Insulin Abs, S (Mayo)OutsideLaboratory",,86337,CPT,Facility,Both,,,90,118,100.3,33.8188,118,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,118,100,,percent of total billed charges,,
"Insulin Abs, S (Mayo)OutsideLaboratory",,86337,CPT,Facility,Both,,,90,118,100.3,33.8188,118,BlueCross BlueShield Minnesota,High Value Network Plan,106.2,90,,percent of total billed charges,,
"Insulin Abs, S (Mayo)OutsideLaboratory",,86337,CPT,Facility,Outpatient,,,90,118,100.3,33.8188,118,BlueCross BlueShield Minnesota,Medicare Advantage,57.82,49,,percent of total billed charges,,
"Insulin Abs, S (Mayo)OutsideLaboratory",,86337,CPT,Facility,Inpatient,,,90,118,100.3,33.8188,118,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Insulin Abs, S (Mayo)OutsideLaboratory",,86337,CPT,Facility,Both,,,90,118,100.3,33.8188,118,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,104.5126,88.57,,percent of total billed charges,,
"Insulin Abs, S (Mayo)OutsideLaboratory",,86337,CPT,Facility,Both,,,90,118,100.3,33.8188,118,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,33.8188,28.66,,percent of total billed charges,,
"Insulin Abs, S (Mayo)OutsideLaboratory",,86337,CPT,Facility,Outpatient,,,90,118,100.3,33.8188,118,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),57.82,49,,percent of total billed charges,,
"Insulin Abs, S (Mayo)OutsideLaboratory",,86337,CPT,Facility,Inpatient,,,90,118,100.3,33.8188,118,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Insulin Abs, S (Mayo)OutsideLaboratory",,86337,CPT,Facility,Both,,,90,118,100.3,33.8188,118,CorVel,Worker's Compensation,118,100,,percent of total billed charges,,
"Insulin Abs, S (Mayo)OutsideLaboratory",,86337,CPT,Facility,Both,,,90,118,100.3,33.8188,118,First Health Group Corporation,First Health Network,114.46,97,,percent of total billed charges,,
"Insulin Abs, S (Mayo)OutsideLaboratory",,86337,CPT,Facility,Both,,,90,118,100.3,33.8188,118,"Health Partners, Inc.",Commercial,111.628,94.6,,percent of total billed charges,,
"Insulin Abs, S (Mayo)OutsideLaboratory",,86337,CPT,Facility,Outpatient,,,90,118,100.3,33.8188,118,"Health Partners, Inc.",Medicare Advantage,57.82,49,,percent of total billed charges,,
"Insulin Abs, S (Mayo)OutsideLaboratory",,86337,CPT,Facility,Inpatient,,,90,118,100.3,33.8188,118,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Insulin Abs, S (Mayo)OutsideLaboratory",,86337,CPT,Facility,Both,,,90,118,100.3,33.8188,118,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),70.8,60,,percent of total billed charges,,
"Insulin Abs, S (Mayo)OutsideLaboratory",,86337,CPT,Facility,Both,,,90,118,100.3,33.8188,118,"Health Partners, Inc.",State of Minnesota Advantage Program,96.17,81.5,,percent of total billed charges,,
"Insulin Abs, S (Mayo)OutsideLaboratory",,86337,CPT,Facility,Both,,,90,118,100.3,33.8188,118,"Health Partners, Inc.",State Public Programs,59,50,,percent of total billed charges,,
"Insulin Abs, S (Mayo)OutsideLaboratory",,86337,CPT,Facility,Both,,,90,118,100.3,33.8188,118,Humana Insurance Company,Commercial PPO,112.1,95,,percent of total billed charges,,
"Insulin Abs, S (Mayo)OutsideLaboratory",,86337,CPT,Facility,Outpatient,,,90,118,100.3,33.8188,118,Humana Insurance Company,Medicare PPO,57.82,49,,percent of total billed charges,,
"Insulin Abs, S (Mayo)OutsideLaboratory",,86337,CPT,Facility,Inpatient,,,90,118,100.3,33.8188,118,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Insulin Abs, S (Mayo)OutsideLaboratory",,86337,CPT,Facility,Both,,,90,118,100.3,33.8188,118,Medica,Individual & Family,116.938,99.1,,percent of total billed charges,,
"Insulin Abs, S (Mayo)OutsideLaboratory",,86337,CPT,Facility,Outpatient,,,90,118,100.3,33.8188,118,Medica,Medica Advantage Solution,58.764,49.8,,percent of total billed charges,,
"Insulin Abs, S (Mayo)OutsideLaboratory",,86337,CPT,Facility,Inpatient,,,90,118,100.3,33.8188,118,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Insulin Abs, S (Mayo)OutsideLaboratory",,86337,CPT,Facility,Outpatient,,,90,118,100.3,33.8188,118,Medica,Medical Assistance,52.628,44.6,,percent of total billed charges,,
"Insulin Abs, S (Mayo)OutsideLaboratory",,86337,CPT,Facility,Inpatient,,,90,118,100.3,33.8188,118,Medica,Medical Assistance,,,,,Included in per diem rate,
"Insulin Abs, S (Mayo)OutsideLaboratory",,86337,CPT,Facility,Outpatient,,,90,118,100.3,33.8188,118,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,58.764,49.8,,percent of total billed charges,,
"Insulin Abs, S (Mayo)OutsideLaboratory",,86337,CPT,Facility,Inpatient,,,90,118,100.3,33.8188,118,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Insulin Abs, S (Mayo)OutsideLaboratory",,86337,CPT,Facility,Both,,,90,118,100.3,33.8188,118,"Multiplan, Inc.","Multiplan, Inc.",110.92,94,,percent of total billed charges,,
"Insulin Abs, S (Mayo)OutsideLaboratory",,86337,CPT,Facility,Outpatient,,,90,118,100.3,33.8188,118,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,101.952,86.4,,percent of total billed charges,,
"Insulin Abs, S (Mayo)OutsideLaboratory",,86337,CPT,Facility,Inpatient,,,90,118,100.3,33.8188,118,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Insulin Abs, S (Mayo)OutsideLaboratory",,86337,CPT,Facility,Both,,,90,118,100.3,33.8188,118,"Preferred One Administrative Services, INC.",PPO,116.348,98.6,,percent of total billed charges,,
"Insulin Abs, S (Mayo)OutsideLaboratory",,86337,CPT,Facility,Outpatient,,,90,118,100.3,33.8188,118,PrimeWest Health,Minnesota Senior Health Options (MSHO),60.711,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Insulin Abs, S (Mayo)OutsideLaboratory",,86337,CPT,Facility,Inpatient,,,90,118,100.3,33.8188,118,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Insulin Abs, S (Mayo)OutsideLaboratory",,86337,CPT,Facility,Outpatient,,,90,118,100.3,33.8188,118,PrimeWest Health,MinnesotaCare,60.6048,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Insulin Abs, S (Mayo)OutsideLaboratory",,86337,CPT,Facility,Inpatient,,,90,118,100.3,33.8188,118,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Insulin Abs, S (Mayo)OutsideLaboratory",,86337,CPT,Facility,Both,,,90,118,100.3,33.8188,118,Sanford Health Plan,Sanford Health Plan,108.56,92,,percent of total billed charges,,
"Insulin Abs, S (Mayo)OutsideLaboratory",,86337,CPT,Facility,Outpatient,,,90,118,100.3,33.8188,118,"UCare Health, Inc.",Individual & Family Plan,66.493,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Insulin Abs, S (Mayo)OutsideLaboratory",,86337,CPT,Facility,Inpatient,,,90,118,100.3,33.8188,118,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Insulin Abs, S (Mayo)OutsideLaboratory",,86337,CPT,Facility,Outpatient,,,90,118,100.3,33.8188,118,"UCare Health, Inc.",Medical Assistance,59.5546,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Insulin Abs, S (Mayo)OutsideLaboratory",,86337,CPT,Facility,Inpatient,,,90,118,100.3,33.8188,118,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Insulin Abs, S (Mayo)OutsideLaboratory",,86337,CPT,Facility,Outpatient,,,90,118,100.3,33.8188,118,"UCare Health, Inc.",Medicare Advantage,59.5546,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Insulin Abs, S (Mayo)OutsideLaboratory",,86337,CPT,Facility,Inpatient,,,90,118,100.3,33.8188,118,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Insulin Abs, S (Mayo)OutsideLaboratory",,86337,CPT,Facility,Outpatient,,,90,118,100.3,33.8188,118,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),59.5546,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Insulin Abs, S (Mayo)OutsideLaboratory",,86337,CPT,Facility,Inpatient,,,90,118,100.3,33.8188,118,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Insulin Abs, S (Mayo)OutsideLaboratory",,86337,CPT,Facility,Both,,,90,118,100.3,33.8188,118,UnitedHealthcare,Individual & Family,110.92,94,,percent of total billed charges,,
"Insulin Abs, S (Mayo)OutsideLaboratory",,86337,CPT,Facility,Outpatient,,,90,118,100.3,33.8188,118,UnitedHealthcare,Medicare Advantage,57.82,49,,percent of total billed charges,,
"Insulin Abs, S (Mayo)OutsideLaboratory",,86337,CPT,Facility,Inpatient,,,90,118,100.3,33.8188,118,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Insulin Abs, S (Mayo)OutsideLaboratory",,86337,CPT,Facility,Outpatient,,,90,118,100.3,33.8188,118,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,56.64,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Insulin Abs, S (Mayo)OutsideLaboratory",,86337,CPT,Facility,Inpatient,,,90,118,100.3,33.8188,118,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Intrinsic Factor Blocking Ab, S (Mayo)OutsideLaboratory",,86340,CPT,Facility,Both,,,90,71,60.35,20.3486,71,Aetna,Commercial,65.32,92,,percent of total billed charges,,
"Intrinsic Factor Blocking Ab, S (Mayo)OutsideLaboratory",,86340,CPT,Facility,Outpatient,,,90,71,60.35,20.3486,71,Aetna,Medicare Advantage,34.79,49,,percent of total billed charges,,
"Intrinsic Factor Blocking Ab, S (Mayo)OutsideLaboratory",,86340,CPT,Facility,Inpatient,,,90,71,60.35,20.3486,71,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Intrinsic Factor Blocking Ab, S (Mayo)OutsideLaboratory",,86340,CPT,Facility,Both,,,90,71,60.35,20.3486,71,Aetna,PPO,66.03,93,,percent of total billed charges,,
"Intrinsic Factor Blocking Ab, S (Mayo)OutsideLaboratory",,86340,CPT,Facility,Both,,,90,71,60.35,20.3486,71,America's PPO,America's PPO,68.1813,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Intrinsic Factor Blocking Ab, S (Mayo)OutsideLaboratory",,86340,CPT,Facility,Both,,,90,71,60.35,20.3486,71,BlueCross BlueShield Minnesota, Federal Employee Program,69.864,98.4,,percent of total billed charges,,
"Intrinsic Factor Blocking Ab, S (Mayo)OutsideLaboratory",,86340,CPT,Facility,Both,,,90,71,60.35,20.3486,71,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,71,100,,percent of total billed charges,,
"Intrinsic Factor Blocking Ab, S (Mayo)OutsideLaboratory",,86340,CPT,Facility,Both,,,90,71,60.35,20.3486,71,BlueCross BlueShield Minnesota,High Value Network Plan,63.9,90,,percent of total billed charges,,
"Intrinsic Factor Blocking Ab, S (Mayo)OutsideLaboratory",,86340,CPT,Facility,Outpatient,,,90,71,60.35,20.3486,71,BlueCross BlueShield Minnesota,Medicare Advantage,34.79,49,,percent of total billed charges,,
"Intrinsic Factor Blocking Ab, S (Mayo)OutsideLaboratory",,86340,CPT,Facility,Inpatient,,,90,71,60.35,20.3486,71,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Intrinsic Factor Blocking Ab, S (Mayo)OutsideLaboratory",,86340,CPT,Facility,Both,,,90,71,60.35,20.3486,71,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,62.8847,88.57,,percent of total billed charges,,
"Intrinsic Factor Blocking Ab, S (Mayo)OutsideLaboratory",,86340,CPT,Facility,Both,,,90,71,60.35,20.3486,71,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,20.3486,28.66,,percent of total billed charges,,
"Intrinsic Factor Blocking Ab, S (Mayo)OutsideLaboratory",,86340,CPT,Facility,Outpatient,,,90,71,60.35,20.3486,71,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),34.79,49,,percent of total billed charges,,
"Intrinsic Factor Blocking Ab, S (Mayo)OutsideLaboratory",,86340,CPT,Facility,Inpatient,,,90,71,60.35,20.3486,71,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Intrinsic Factor Blocking Ab, S (Mayo)OutsideLaboratory",,86340,CPT,Facility,Both,,,90,71,60.35,20.3486,71,CorVel,Worker's Compensation,71,100,,percent of total billed charges,,
"Intrinsic Factor Blocking Ab, S (Mayo)OutsideLaboratory",,86340,CPT,Facility,Both,,,90,71,60.35,20.3486,71,First Health Group Corporation,First Health Network,68.87,97,,percent of total billed charges,,
"Intrinsic Factor Blocking Ab, S (Mayo)OutsideLaboratory",,86340,CPT,Facility,Both,,,90,71,60.35,20.3486,71,"Health Partners, Inc.",Commercial,67.166,94.6,,percent of total billed charges,,
"Intrinsic Factor Blocking Ab, S (Mayo)OutsideLaboratory",,86340,CPT,Facility,Outpatient,,,90,71,60.35,20.3486,71,"Health Partners, Inc.",Medicare Advantage,34.79,49,,percent of total billed charges,,
"Intrinsic Factor Blocking Ab, S (Mayo)OutsideLaboratory",,86340,CPT,Facility,Inpatient,,,90,71,60.35,20.3486,71,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Intrinsic Factor Blocking Ab, S (Mayo)OutsideLaboratory",,86340,CPT,Facility,Both,,,90,71,60.35,20.3486,71,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),42.6,60,,percent of total billed charges,,
"Intrinsic Factor Blocking Ab, S (Mayo)OutsideLaboratory",,86340,CPT,Facility,Both,,,90,71,60.35,20.3486,71,"Health Partners, Inc.",State of Minnesota Advantage Program,57.865,81.5,,percent of total billed charges,,
"Intrinsic Factor Blocking Ab, S (Mayo)OutsideLaboratory",,86340,CPT,Facility,Both,,,90,71,60.35,20.3486,71,"Health Partners, Inc.",State Public Programs,35.5,50,,percent of total billed charges,,
"Intrinsic Factor Blocking Ab, S (Mayo)OutsideLaboratory",,86340,CPT,Facility,Both,,,90,71,60.35,20.3486,71,Humana Insurance Company,Commercial PPO,67.45,95,,percent of total billed charges,,
"Intrinsic Factor Blocking Ab, S (Mayo)OutsideLaboratory",,86340,CPT,Facility,Outpatient,,,90,71,60.35,20.3486,71,Humana Insurance Company,Medicare PPO,34.79,49,,percent of total billed charges,,
"Intrinsic Factor Blocking Ab, S (Mayo)OutsideLaboratory",,86340,CPT,Facility,Inpatient,,,90,71,60.35,20.3486,71,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Intrinsic Factor Blocking Ab, S (Mayo)OutsideLaboratory",,86340,CPT,Facility,Both,,,90,71,60.35,20.3486,71,Medica,Individual & Family,70.361,99.1,,percent of total billed charges,,
"Intrinsic Factor Blocking Ab, S (Mayo)OutsideLaboratory",,86340,CPT,Facility,Outpatient,,,90,71,60.35,20.3486,71,Medica,Medica Advantage Solution,35.358,49.8,,percent of total billed charges,,
"Intrinsic Factor Blocking Ab, S (Mayo)OutsideLaboratory",,86340,CPT,Facility,Inpatient,,,90,71,60.35,20.3486,71,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Intrinsic Factor Blocking Ab, S (Mayo)OutsideLaboratory",,86340,CPT,Facility,Outpatient,,,90,71,60.35,20.3486,71,Medica,Medical Assistance,31.666,44.6,,percent of total billed charges,,
"Intrinsic Factor Blocking Ab, S (Mayo)OutsideLaboratory",,86340,CPT,Facility,Inpatient,,,90,71,60.35,20.3486,71,Medica,Medical Assistance,,,,,Included in per diem rate,
"Intrinsic Factor Blocking Ab, S (Mayo)OutsideLaboratory",,86340,CPT,Facility,Outpatient,,,90,71,60.35,20.3486,71,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,35.358,49.8,,percent of total billed charges,,
"Intrinsic Factor Blocking Ab, S (Mayo)OutsideLaboratory",,86340,CPT,Facility,Inpatient,,,90,71,60.35,20.3486,71,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Intrinsic Factor Blocking Ab, S (Mayo)OutsideLaboratory",,86340,CPT,Facility,Both,,,90,71,60.35,20.3486,71,"Multiplan, Inc.","Multiplan, Inc.",66.74,94,,percent of total billed charges,,
"Intrinsic Factor Blocking Ab, S (Mayo)OutsideLaboratory",,86340,CPT,Facility,Outpatient,,,90,71,60.35,20.3486,71,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,61.344,86.4,,percent of total billed charges,,
"Intrinsic Factor Blocking Ab, S (Mayo)OutsideLaboratory",,86340,CPT,Facility,Inpatient,,,90,71,60.35,20.3486,71,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Intrinsic Factor Blocking Ab, S (Mayo)OutsideLaboratory",,86340,CPT,Facility,Both,,,90,71,60.35,20.3486,71,"Preferred One Administrative Services, INC.",PPO,70.006,98.6,,percent of total billed charges,,
"Intrinsic Factor Blocking Ab, S (Mayo)OutsideLaboratory",,86340,CPT,Facility,Outpatient,,,90,71,60.35,20.3486,71,PrimeWest Health,Minnesota Senior Health Options (MSHO),36.5295,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Intrinsic Factor Blocking Ab, S (Mayo)OutsideLaboratory",,86340,CPT,Facility,Inpatient,,,90,71,60.35,20.3486,71,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Intrinsic Factor Blocking Ab, S (Mayo)OutsideLaboratory",,86340,CPT,Facility,Outpatient,,,90,71,60.35,20.3486,71,PrimeWest Health,MinnesotaCare,36.4656,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Intrinsic Factor Blocking Ab, S (Mayo)OutsideLaboratory",,86340,CPT,Facility,Inpatient,,,90,71,60.35,20.3486,71,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Intrinsic Factor Blocking Ab, S (Mayo)OutsideLaboratory",,86340,CPT,Facility,Both,,,90,71,60.35,20.3486,71,Sanford Health Plan,Sanford Health Plan,65.32,92,,percent of total billed charges,,
"Intrinsic Factor Blocking Ab, S (Mayo)OutsideLaboratory",,86340,CPT,Facility,Outpatient,,,90,71,60.35,20.3486,71,"UCare Health, Inc.",Individual & Family Plan,40.0085,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Intrinsic Factor Blocking Ab, S (Mayo)OutsideLaboratory",,86340,CPT,Facility,Inpatient,,,90,71,60.35,20.3486,71,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Intrinsic Factor Blocking Ab, S (Mayo)OutsideLaboratory",,86340,CPT,Facility,Outpatient,,,90,71,60.35,20.3486,71,"UCare Health, Inc.",Medical Assistance,35.8337,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Intrinsic Factor Blocking Ab, S (Mayo)OutsideLaboratory",,86340,CPT,Facility,Inpatient,,,90,71,60.35,20.3486,71,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Intrinsic Factor Blocking Ab, S (Mayo)OutsideLaboratory",,86340,CPT,Facility,Outpatient,,,90,71,60.35,20.3486,71,"UCare Health, Inc.",Medicare Advantage,35.8337,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Intrinsic Factor Blocking Ab, S (Mayo)OutsideLaboratory",,86340,CPT,Facility,Inpatient,,,90,71,60.35,20.3486,71,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Intrinsic Factor Blocking Ab, S (Mayo)OutsideLaboratory",,86340,CPT,Facility,Outpatient,,,90,71,60.35,20.3486,71,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),35.8337,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Intrinsic Factor Blocking Ab, S (Mayo)OutsideLaboratory",,86340,CPT,Facility,Inpatient,,,90,71,60.35,20.3486,71,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Intrinsic Factor Blocking Ab, S (Mayo)OutsideLaboratory",,86340,CPT,Facility,Both,,,90,71,60.35,20.3486,71,UnitedHealthcare,Individual & Family,66.74,94,,percent of total billed charges,,
"Intrinsic Factor Blocking Ab, S (Mayo)OutsideLaboratory",,86340,CPT,Facility,Outpatient,,,90,71,60.35,20.3486,71,UnitedHealthcare,Medicare Advantage,34.79,49,,percent of total billed charges,,
"Intrinsic Factor Blocking Ab, S (Mayo)OutsideLaboratory",,86340,CPT,Facility,Inpatient,,,90,71,60.35,20.3486,71,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Intrinsic Factor Blocking Ab, S (Mayo)OutsideLaboratory",,86340,CPT,Facility,Outpatient,,,90,71,60.35,20.3486,71,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,34.08,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Intrinsic Factor Blocking Ab, S (Mayo)OutsideLaboratory",,86340,CPT,Facility,Inpatient,,,90,71,60.35,20.3486,71,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
B Cells Total Count (Mayo)OutsideLaboratory,,86355,CPT,Facility,Both,,,90,61,51.85,17.4826,61,Aetna,Commercial,56.12,92,,percent of total billed charges,,
B Cells Total Count (Mayo)OutsideLaboratory,,86355,CPT,Facility,Outpatient,,,90,61,51.85,17.4826,61,Aetna,Medicare Advantage,29.89,49,,percent of total billed charges,,
B Cells Total Count (Mayo)OutsideLaboratory,,86355,CPT,Facility,Inpatient,,,90,61,51.85,17.4826,61,Aetna,Medicare Advantage,,,,,Included in per diem rate,
B Cells Total Count (Mayo)OutsideLaboratory,,86355,CPT,Facility,Both,,,90,61,51.85,17.4826,61,Aetna,PPO,56.73,93,,percent of total billed charges,,
B Cells Total Count (Mayo)OutsideLaboratory,,86355,CPT,Facility,Both,,,90,61,51.85,17.4826,61,America's PPO,America's PPO,58.5783,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
B Cells Total Count (Mayo)OutsideLaboratory,,86355,CPT,Facility,Both,,,90,61,51.85,17.4826,61,BlueCross BlueShield Minnesota, Federal Employee Program,60.024,98.4,,percent of total billed charges,,
B Cells Total Count (Mayo)OutsideLaboratory,,86355,CPT,Facility,Both,,,90,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,61,100,,percent of total billed charges,,
B Cells Total Count (Mayo)OutsideLaboratory,,86355,CPT,Facility,Both,,,90,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,High Value Network Plan,54.9,90,,percent of total billed charges,,
B Cells Total Count (Mayo)OutsideLaboratory,,86355,CPT,Facility,Outpatient,,,90,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,Medicare Advantage,29.89,49,,percent of total billed charges,,
B Cells Total Count (Mayo)OutsideLaboratory,,86355,CPT,Facility,Inpatient,,,90,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
B Cells Total Count (Mayo)OutsideLaboratory,,86355,CPT,Facility,Both,,,90,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,54.0277,88.57,,percent of total billed charges,,
B Cells Total Count (Mayo)OutsideLaboratory,,86355,CPT,Facility,Both,,,90,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,17.4826,28.66,,percent of total billed charges,,
B Cells Total Count (Mayo)OutsideLaboratory,,86355,CPT,Facility,Outpatient,,,90,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),29.89,49,,percent of total billed charges,,
B Cells Total Count (Mayo)OutsideLaboratory,,86355,CPT,Facility,Inpatient,,,90,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
B Cells Total Count (Mayo)OutsideLaboratory,,86355,CPT,Facility,Both,,,90,61,51.85,17.4826,61,CorVel,Worker's Compensation,61,100,,percent of total billed charges,,
B Cells Total Count (Mayo)OutsideLaboratory,,86355,CPT,Facility,Both,,,90,61,51.85,17.4826,61,First Health Group Corporation,First Health Network,59.17,97,,percent of total billed charges,,
B Cells Total Count (Mayo)OutsideLaboratory,,86355,CPT,Facility,Both,,,90,61,51.85,17.4826,61,"Health Partners, Inc.",Commercial,57.706,94.6,,percent of total billed charges,,
B Cells Total Count (Mayo)OutsideLaboratory,,86355,CPT,Facility,Outpatient,,,90,61,51.85,17.4826,61,"Health Partners, Inc.",Medicare Advantage,29.89,49,,percent of total billed charges,,
B Cells Total Count (Mayo)OutsideLaboratory,,86355,CPT,Facility,Inpatient,,,90,61,51.85,17.4826,61,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
B Cells Total Count (Mayo)OutsideLaboratory,,86355,CPT,Facility,Both,,,90,61,51.85,17.4826,61,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),36.6,60,,percent of total billed charges,,
B Cells Total Count (Mayo)OutsideLaboratory,,86355,CPT,Facility,Both,,,90,61,51.85,17.4826,61,"Health Partners, Inc.",State of Minnesota Advantage Program,49.715,81.5,,percent of total billed charges,,
B Cells Total Count (Mayo)OutsideLaboratory,,86355,CPT,Facility,Both,,,90,61,51.85,17.4826,61,"Health Partners, Inc.",State Public Programs,30.5,50,,percent of total billed charges,,
B Cells Total Count (Mayo)OutsideLaboratory,,86355,CPT,Facility,Both,,,90,61,51.85,17.4826,61,Humana Insurance Company,Commercial PPO,57.95,95,,percent of total billed charges,,
B Cells Total Count (Mayo)OutsideLaboratory,,86355,CPT,Facility,Outpatient,,,90,61,51.85,17.4826,61,Humana Insurance Company,Medicare PPO,29.89,49,,percent of total billed charges,,
B Cells Total Count (Mayo)OutsideLaboratory,,86355,CPT,Facility,Inpatient,,,90,61,51.85,17.4826,61,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
B Cells Total Count (Mayo)OutsideLaboratory,,86355,CPT,Facility,Both,,,90,61,51.85,17.4826,61,Medica,Individual & Family,60.451,99.1,,percent of total billed charges,,
B Cells Total Count (Mayo)OutsideLaboratory,,86355,CPT,Facility,Outpatient,,,90,61,51.85,17.4826,61,Medica,Medica Advantage Solution,30.378,49.8,,percent of total billed charges,,
B Cells Total Count (Mayo)OutsideLaboratory,,86355,CPT,Facility,Inpatient,,,90,61,51.85,17.4826,61,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
B Cells Total Count (Mayo)OutsideLaboratory,,86355,CPT,Facility,Outpatient,,,90,61,51.85,17.4826,61,Medica,Medical Assistance,27.206,44.6,,percent of total billed charges,,
B Cells Total Count (Mayo)OutsideLaboratory,,86355,CPT,Facility,Inpatient,,,90,61,51.85,17.4826,61,Medica,Medical Assistance,,,,,Included in per diem rate,
B Cells Total Count (Mayo)OutsideLaboratory,,86355,CPT,Facility,Outpatient,,,90,61,51.85,17.4826,61,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,30.378,49.8,,percent of total billed charges,,
B Cells Total Count (Mayo)OutsideLaboratory,,86355,CPT,Facility,Inpatient,,,90,61,51.85,17.4826,61,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
B Cells Total Count (Mayo)OutsideLaboratory,,86355,CPT,Facility,Both,,,90,61,51.85,17.4826,61,"Multiplan, Inc.","Multiplan, Inc.",57.34,94,,percent of total billed charges,,
B Cells Total Count (Mayo)OutsideLaboratory,,86355,CPT,Facility,Outpatient,,,90,61,51.85,17.4826,61,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,52.704,86.4,,percent of total billed charges,,
B Cells Total Count (Mayo)OutsideLaboratory,,86355,CPT,Facility,Inpatient,,,90,61,51.85,17.4826,61,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
B Cells Total Count (Mayo)OutsideLaboratory,,86355,CPT,Facility,Both,,,90,61,51.85,17.4826,61,"Preferred One Administrative Services, INC.",PPO,60.146,98.6,,percent of total billed charges,,
B Cells Total Count (Mayo)OutsideLaboratory,,86355,CPT,Facility,Outpatient,,,90,61,51.85,17.4826,61,PrimeWest Health,Minnesota Senior Health Options (MSHO),31.3845,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
B Cells Total Count (Mayo)OutsideLaboratory,,86355,CPT,Facility,Inpatient,,,90,61,51.85,17.4826,61,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
B Cells Total Count (Mayo)OutsideLaboratory,,86355,CPT,Facility,Outpatient,,,90,61,51.85,17.4826,61,PrimeWest Health,MinnesotaCare,31.3296,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
B Cells Total Count (Mayo)OutsideLaboratory,,86355,CPT,Facility,Inpatient,,,90,61,51.85,17.4826,61,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
B Cells Total Count (Mayo)OutsideLaboratory,,86355,CPT,Facility,Both,,,90,61,51.85,17.4826,61,Sanford Health Plan,Sanford Health Plan,56.12,92,,percent of total billed charges,,
B Cells Total Count (Mayo)OutsideLaboratory,,86355,CPT,Facility,Outpatient,,,90,61,51.85,17.4826,61,"UCare Health, Inc.",Individual & Family Plan,34.3735,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
B Cells Total Count (Mayo)OutsideLaboratory,,86355,CPT,Facility,Inpatient,,,90,61,51.85,17.4826,61,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
B Cells Total Count (Mayo)OutsideLaboratory,,86355,CPT,Facility,Outpatient,,,90,61,51.85,17.4826,61,"UCare Health, Inc.",Medical Assistance,30.7867,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
B Cells Total Count (Mayo)OutsideLaboratory,,86355,CPT,Facility,Inpatient,,,90,61,51.85,17.4826,61,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
B Cells Total Count (Mayo)OutsideLaboratory,,86355,CPT,Facility,Outpatient,,,90,61,51.85,17.4826,61,"UCare Health, Inc.",Medicare Advantage,30.7867,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
B Cells Total Count (Mayo)OutsideLaboratory,,86355,CPT,Facility,Inpatient,,,90,61,51.85,17.4826,61,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
B Cells Total Count (Mayo)OutsideLaboratory,,86355,CPT,Facility,Outpatient,,,90,61,51.85,17.4826,61,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),30.7867,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
B Cells Total Count (Mayo)OutsideLaboratory,,86355,CPT,Facility,Inpatient,,,90,61,51.85,17.4826,61,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
B Cells Total Count (Mayo)OutsideLaboratory,,86355,CPT,Facility,Both,,,90,61,51.85,17.4826,61,UnitedHealthcare,Individual & Family,57.34,94,,percent of total billed charges,,
B Cells Total Count (Mayo)OutsideLaboratory,,86355,CPT,Facility,Outpatient,,,90,61,51.85,17.4826,61,UnitedHealthcare,Medicare Advantage,29.89,49,,percent of total billed charges,,
B Cells Total Count (Mayo)OutsideLaboratory,,86355,CPT,Facility,Inpatient,,,90,61,51.85,17.4826,61,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
B Cells Total Count (Mayo)OutsideLaboratory,,86355,CPT,Facility,Outpatient,,,90,61,51.85,17.4826,61,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,29.28,48,,percent of total billed charges,,100% of DHS outpatient percentage
B Cells Total Count (Mayo)OutsideLaboratory,,86355,CPT,Facility,Inpatient,,,90,61,51.85,17.4826,61,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Natural Killer Cells, Total Count (Mayo)OutsideLaboratory",,86357,CPT,Facility,Both,,,90,45,38.25,12.897,45,Aetna,Commercial,41.4,92,,percent of total billed charges,,
"Natural Killer Cells, Total Count (Mayo)OutsideLaboratory",,86357,CPT,Facility,Outpatient,,,90,45,38.25,12.897,45,Aetna,Medicare Advantage,22.05,49,,percent of total billed charges,,
"Natural Killer Cells, Total Count (Mayo)OutsideLaboratory",,86357,CPT,Facility,Inpatient,,,90,45,38.25,12.897,45,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Natural Killer Cells, Total Count (Mayo)OutsideLaboratory",,86357,CPT,Facility,Both,,,90,45,38.25,12.897,45,Aetna,PPO,41.85,93,,percent of total billed charges,,
"Natural Killer Cells, Total Count (Mayo)OutsideLaboratory",,86357,CPT,Facility,Both,,,90,45,38.25,12.897,45,America's PPO,America's PPO,43.2135,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Natural Killer Cells, Total Count (Mayo)OutsideLaboratory",,86357,CPT,Facility,Both,,,90,45,38.25,12.897,45,BlueCross BlueShield Minnesota, Federal Employee Program,44.28,98.4,,percent of total billed charges,,
"Natural Killer Cells, Total Count (Mayo)OutsideLaboratory",,86357,CPT,Facility,Both,,,90,45,38.25,12.897,45,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,45,100,,percent of total billed charges,,
"Natural Killer Cells, Total Count (Mayo)OutsideLaboratory",,86357,CPT,Facility,Both,,,90,45,38.25,12.897,45,BlueCross BlueShield Minnesota,High Value Network Plan,40.5,90,,percent of total billed charges,,
"Natural Killer Cells, Total Count (Mayo)OutsideLaboratory",,86357,CPT,Facility,Outpatient,,,90,45,38.25,12.897,45,BlueCross BlueShield Minnesota,Medicare Advantage,22.05,49,,percent of total billed charges,,
"Natural Killer Cells, Total Count (Mayo)OutsideLaboratory",,86357,CPT,Facility,Inpatient,,,90,45,38.25,12.897,45,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Natural Killer Cells, Total Count (Mayo)OutsideLaboratory",,86357,CPT,Facility,Both,,,90,45,38.25,12.897,45,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,39.8565,88.57,,percent of total billed charges,,
"Natural Killer Cells, Total Count (Mayo)OutsideLaboratory",,86357,CPT,Facility,Both,,,90,45,38.25,12.897,45,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,12.897,28.66,,percent of total billed charges,,
"Natural Killer Cells, Total Count (Mayo)OutsideLaboratory",,86357,CPT,Facility,Outpatient,,,90,45,38.25,12.897,45,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),22.05,49,,percent of total billed charges,,
"Natural Killer Cells, Total Count (Mayo)OutsideLaboratory",,86357,CPT,Facility,Inpatient,,,90,45,38.25,12.897,45,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Natural Killer Cells, Total Count (Mayo)OutsideLaboratory",,86357,CPT,Facility,Both,,,90,45,38.25,12.897,45,CorVel,Worker's Compensation,45,100,,percent of total billed charges,,
"Natural Killer Cells, Total Count (Mayo)OutsideLaboratory",,86357,CPT,Facility,Both,,,90,45,38.25,12.897,45,First Health Group Corporation,First Health Network,43.65,97,,percent of total billed charges,,
"Natural Killer Cells, Total Count (Mayo)OutsideLaboratory",,86357,CPT,Facility,Both,,,90,45,38.25,12.897,45,"Health Partners, Inc.",Commercial,42.57,94.6,,percent of total billed charges,,
"Natural Killer Cells, Total Count (Mayo)OutsideLaboratory",,86357,CPT,Facility,Outpatient,,,90,45,38.25,12.897,45,"Health Partners, Inc.",Medicare Advantage,22.05,49,,percent of total billed charges,,
"Natural Killer Cells, Total Count (Mayo)OutsideLaboratory",,86357,CPT,Facility,Inpatient,,,90,45,38.25,12.897,45,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Natural Killer Cells, Total Count (Mayo)OutsideLaboratory",,86357,CPT,Facility,Both,,,90,45,38.25,12.897,45,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),27,60,,percent of total billed charges,,
"Natural Killer Cells, Total Count (Mayo)OutsideLaboratory",,86357,CPT,Facility,Both,,,90,45,38.25,12.897,45,"Health Partners, Inc.",State of Minnesota Advantage Program,36.675,81.5,,percent of total billed charges,,
"Natural Killer Cells, Total Count (Mayo)OutsideLaboratory",,86357,CPT,Facility,Both,,,90,45,38.25,12.897,45,"Health Partners, Inc.",State Public Programs,22.5,50,,percent of total billed charges,,
"Natural Killer Cells, Total Count (Mayo)OutsideLaboratory",,86357,CPT,Facility,Both,,,90,45,38.25,12.897,45,Humana Insurance Company,Commercial PPO,42.75,95,,percent of total billed charges,,
"Natural Killer Cells, Total Count (Mayo)OutsideLaboratory",,86357,CPT,Facility,Outpatient,,,90,45,38.25,12.897,45,Humana Insurance Company,Medicare PPO,22.05,49,,percent of total billed charges,,
"Natural Killer Cells, Total Count (Mayo)OutsideLaboratory",,86357,CPT,Facility,Inpatient,,,90,45,38.25,12.897,45,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Natural Killer Cells, Total Count (Mayo)OutsideLaboratory",,86357,CPT,Facility,Both,,,90,45,38.25,12.897,45,Medica,Individual & Family,44.595,99.1,,percent of total billed charges,,
"Natural Killer Cells, Total Count (Mayo)OutsideLaboratory",,86357,CPT,Facility,Outpatient,,,90,45,38.25,12.897,45,Medica,Medica Advantage Solution,22.41,49.8,,percent of total billed charges,,
"Natural Killer Cells, Total Count (Mayo)OutsideLaboratory",,86357,CPT,Facility,Inpatient,,,90,45,38.25,12.897,45,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Natural Killer Cells, Total Count (Mayo)OutsideLaboratory",,86357,CPT,Facility,Outpatient,,,90,45,38.25,12.897,45,Medica,Medical Assistance,20.07,44.6,,percent of total billed charges,,
"Natural Killer Cells, Total Count (Mayo)OutsideLaboratory",,86357,CPT,Facility,Inpatient,,,90,45,38.25,12.897,45,Medica,Medical Assistance,,,,,Included in per diem rate,
"Natural Killer Cells, Total Count (Mayo)OutsideLaboratory",,86357,CPT,Facility,Outpatient,,,90,45,38.25,12.897,45,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,22.41,49.8,,percent of total billed charges,,
"Natural Killer Cells, Total Count (Mayo)OutsideLaboratory",,86357,CPT,Facility,Inpatient,,,90,45,38.25,12.897,45,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Natural Killer Cells, Total Count (Mayo)OutsideLaboratory",,86357,CPT,Facility,Both,,,90,45,38.25,12.897,45,"Multiplan, Inc.","Multiplan, Inc.",42.3,94,,percent of total billed charges,,
"Natural Killer Cells, Total Count (Mayo)OutsideLaboratory",,86357,CPT,Facility,Outpatient,,,90,45,38.25,12.897,45,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,38.88,86.4,,percent of total billed charges,,
"Natural Killer Cells, Total Count (Mayo)OutsideLaboratory",,86357,CPT,Facility,Inpatient,,,90,45,38.25,12.897,45,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Natural Killer Cells, Total Count (Mayo)OutsideLaboratory",,86357,CPT,Facility,Both,,,90,45,38.25,12.897,45,"Preferred One Administrative Services, INC.",PPO,44.37,98.6,,percent of total billed charges,,
"Natural Killer Cells, Total Count (Mayo)OutsideLaboratory",,86357,CPT,Facility,Outpatient,,,90,45,38.25,12.897,45,PrimeWest Health,Minnesota Senior Health Options (MSHO),23.1525,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Natural Killer Cells, Total Count (Mayo)OutsideLaboratory",,86357,CPT,Facility,Inpatient,,,90,45,38.25,12.897,45,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Natural Killer Cells, Total Count (Mayo)OutsideLaboratory",,86357,CPT,Facility,Outpatient,,,90,45,38.25,12.897,45,PrimeWest Health,MinnesotaCare,23.112,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Natural Killer Cells, Total Count (Mayo)OutsideLaboratory",,86357,CPT,Facility,Inpatient,,,90,45,38.25,12.897,45,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Natural Killer Cells, Total Count (Mayo)OutsideLaboratory",,86357,CPT,Facility,Both,,,90,45,38.25,12.897,45,Sanford Health Plan,Sanford Health Plan,41.4,92,,percent of total billed charges,,
"Natural Killer Cells, Total Count (Mayo)OutsideLaboratory",,86357,CPT,Facility,Outpatient,,,90,45,38.25,12.897,45,"UCare Health, Inc.",Individual & Family Plan,25.3575,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Natural Killer Cells, Total Count (Mayo)OutsideLaboratory",,86357,CPT,Facility,Inpatient,,,90,45,38.25,12.897,45,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Natural Killer Cells, Total Count (Mayo)OutsideLaboratory",,86357,CPT,Facility,Outpatient,,,90,45,38.25,12.897,45,"UCare Health, Inc.",Medical Assistance,22.7115,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Natural Killer Cells, Total Count (Mayo)OutsideLaboratory",,86357,CPT,Facility,Inpatient,,,90,45,38.25,12.897,45,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Natural Killer Cells, Total Count (Mayo)OutsideLaboratory",,86357,CPT,Facility,Outpatient,,,90,45,38.25,12.897,45,"UCare Health, Inc.",Medicare Advantage,22.7115,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Natural Killer Cells, Total Count (Mayo)OutsideLaboratory",,86357,CPT,Facility,Inpatient,,,90,45,38.25,12.897,45,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Natural Killer Cells, Total Count (Mayo)OutsideLaboratory",,86357,CPT,Facility,Outpatient,,,90,45,38.25,12.897,45,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),22.7115,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Natural Killer Cells, Total Count (Mayo)OutsideLaboratory",,86357,CPT,Facility,Inpatient,,,90,45,38.25,12.897,45,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Natural Killer Cells, Total Count (Mayo)OutsideLaboratory",,86357,CPT,Facility,Both,,,90,45,38.25,12.897,45,UnitedHealthcare,Individual & Family,42.3,94,,percent of total billed charges,,
"Natural Killer Cells, Total Count (Mayo)OutsideLaboratory",,86357,CPT,Facility,Outpatient,,,90,45,38.25,12.897,45,UnitedHealthcare,Medicare Advantage,22.05,49,,percent of total billed charges,,
"Natural Killer Cells, Total Count (Mayo)OutsideLaboratory",,86357,CPT,Facility,Inpatient,,,90,45,38.25,12.897,45,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Natural Killer Cells, Total Count (Mayo)OutsideLaboratory",,86357,CPT,Facility,Outpatient,,,90,45,38.25,12.897,45,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,21.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Natural Killer Cells, Total Count (Mayo)OutsideLaboratory",,86357,CPT,Facility,Inpatient,,,90,45,38.25,12.897,45,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
T Cells; Total Count (Mayo)OutsideLaboratory,,86359,CPT,Facility,Both,,,90,45,38.25,12.897,45,Aetna,Commercial,41.4,92,,percent of total billed charges,,
T Cells; Total Count (Mayo)OutsideLaboratory,,86359,CPT,Facility,Outpatient,,,90,45,38.25,12.897,45,Aetna,Medicare Advantage,22.05,49,,percent of total billed charges,,
T Cells; Total Count (Mayo)OutsideLaboratory,,86359,CPT,Facility,Inpatient,,,90,45,38.25,12.897,45,Aetna,Medicare Advantage,,,,,Included in per diem rate,
T Cells; Total Count (Mayo)OutsideLaboratory,,86359,CPT,Facility,Both,,,90,45,38.25,12.897,45,Aetna,PPO,41.85,93,,percent of total billed charges,,
T Cells; Total Count (Mayo)OutsideLaboratory,,86359,CPT,Facility,Both,,,90,45,38.25,12.897,45,America's PPO,America's PPO,43.2135,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
T Cells; Total Count (Mayo)OutsideLaboratory,,86359,CPT,Facility,Both,,,90,45,38.25,12.897,45,BlueCross BlueShield Minnesota, Federal Employee Program,44.28,98.4,,percent of total billed charges,,
T Cells; Total Count (Mayo)OutsideLaboratory,,86359,CPT,Facility,Both,,,90,45,38.25,12.897,45,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,45,100,,percent of total billed charges,,
T Cells; Total Count (Mayo)OutsideLaboratory,,86359,CPT,Facility,Both,,,90,45,38.25,12.897,45,BlueCross BlueShield Minnesota,High Value Network Plan,40.5,90,,percent of total billed charges,,
T Cells; Total Count (Mayo)OutsideLaboratory,,86359,CPT,Facility,Outpatient,,,90,45,38.25,12.897,45,BlueCross BlueShield Minnesota,Medicare Advantage,22.05,49,,percent of total billed charges,,
T Cells; Total Count (Mayo)OutsideLaboratory,,86359,CPT,Facility,Inpatient,,,90,45,38.25,12.897,45,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
T Cells; Total Count (Mayo)OutsideLaboratory,,86359,CPT,Facility,Both,,,90,45,38.25,12.897,45,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,39.8565,88.57,,percent of total billed charges,,
T Cells; Total Count (Mayo)OutsideLaboratory,,86359,CPT,Facility,Both,,,90,45,38.25,12.897,45,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,12.897,28.66,,percent of total billed charges,,
T Cells; Total Count (Mayo)OutsideLaboratory,,86359,CPT,Facility,Outpatient,,,90,45,38.25,12.897,45,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),22.05,49,,percent of total billed charges,,
T Cells; Total Count (Mayo)OutsideLaboratory,,86359,CPT,Facility,Inpatient,,,90,45,38.25,12.897,45,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
T Cells; Total Count (Mayo)OutsideLaboratory,,86359,CPT,Facility,Both,,,90,45,38.25,12.897,45,CorVel,Worker's Compensation,45,100,,percent of total billed charges,,
T Cells; Total Count (Mayo)OutsideLaboratory,,86359,CPT,Facility,Both,,,90,45,38.25,12.897,45,First Health Group Corporation,First Health Network,43.65,97,,percent of total billed charges,,
T Cells; Total Count (Mayo)OutsideLaboratory,,86359,CPT,Facility,Both,,,90,45,38.25,12.897,45,"Health Partners, Inc.",Commercial,42.57,94.6,,percent of total billed charges,,
T Cells; Total Count (Mayo)OutsideLaboratory,,86359,CPT,Facility,Outpatient,,,90,45,38.25,12.897,45,"Health Partners, Inc.",Medicare Advantage,22.05,49,,percent of total billed charges,,
T Cells; Total Count (Mayo)OutsideLaboratory,,86359,CPT,Facility,Inpatient,,,90,45,38.25,12.897,45,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
T Cells; Total Count (Mayo)OutsideLaboratory,,86359,CPT,Facility,Both,,,90,45,38.25,12.897,45,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),27,60,,percent of total billed charges,,
T Cells; Total Count (Mayo)OutsideLaboratory,,86359,CPT,Facility,Both,,,90,45,38.25,12.897,45,"Health Partners, Inc.",State of Minnesota Advantage Program,36.675,81.5,,percent of total billed charges,,
T Cells; Total Count (Mayo)OutsideLaboratory,,86359,CPT,Facility,Both,,,90,45,38.25,12.897,45,"Health Partners, Inc.",State Public Programs,22.5,50,,percent of total billed charges,,
T Cells; Total Count (Mayo)OutsideLaboratory,,86359,CPT,Facility,Both,,,90,45,38.25,12.897,45,Humana Insurance Company,Commercial PPO,42.75,95,,percent of total billed charges,,
T Cells; Total Count (Mayo)OutsideLaboratory,,86359,CPT,Facility,Outpatient,,,90,45,38.25,12.897,45,Humana Insurance Company,Medicare PPO,22.05,49,,percent of total billed charges,,
T Cells; Total Count (Mayo)OutsideLaboratory,,86359,CPT,Facility,Inpatient,,,90,45,38.25,12.897,45,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
T Cells; Total Count (Mayo)OutsideLaboratory,,86359,CPT,Facility,Both,,,90,45,38.25,12.897,45,Medica,Individual & Family,44.595,99.1,,percent of total billed charges,,
T Cells; Total Count (Mayo)OutsideLaboratory,,86359,CPT,Facility,Outpatient,,,90,45,38.25,12.897,45,Medica,Medica Advantage Solution,22.41,49.8,,percent of total billed charges,,
T Cells; Total Count (Mayo)OutsideLaboratory,,86359,CPT,Facility,Inpatient,,,90,45,38.25,12.897,45,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
T Cells; Total Count (Mayo)OutsideLaboratory,,86359,CPT,Facility,Outpatient,,,90,45,38.25,12.897,45,Medica,Medical Assistance,20.07,44.6,,percent of total billed charges,,
T Cells; Total Count (Mayo)OutsideLaboratory,,86359,CPT,Facility,Inpatient,,,90,45,38.25,12.897,45,Medica,Medical Assistance,,,,,Included in per diem rate,
T Cells; Total Count (Mayo)OutsideLaboratory,,86359,CPT,Facility,Outpatient,,,90,45,38.25,12.897,45,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,22.41,49.8,,percent of total billed charges,,
T Cells; Total Count (Mayo)OutsideLaboratory,,86359,CPT,Facility,Inpatient,,,90,45,38.25,12.897,45,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
T Cells; Total Count (Mayo)OutsideLaboratory,,86359,CPT,Facility,Both,,,90,45,38.25,12.897,45,"Multiplan, Inc.","Multiplan, Inc.",42.3,94,,percent of total billed charges,,
T Cells; Total Count (Mayo)OutsideLaboratory,,86359,CPT,Facility,Outpatient,,,90,45,38.25,12.897,45,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,38.88,86.4,,percent of total billed charges,,
T Cells; Total Count (Mayo)OutsideLaboratory,,86359,CPT,Facility,Inpatient,,,90,45,38.25,12.897,45,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
T Cells; Total Count (Mayo)OutsideLaboratory,,86359,CPT,Facility,Both,,,90,45,38.25,12.897,45,"Preferred One Administrative Services, INC.",PPO,44.37,98.6,,percent of total billed charges,,
T Cells; Total Count (Mayo)OutsideLaboratory,,86359,CPT,Facility,Outpatient,,,90,45,38.25,12.897,45,PrimeWest Health,Minnesota Senior Health Options (MSHO),23.1525,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
T Cells; Total Count (Mayo)OutsideLaboratory,,86359,CPT,Facility,Inpatient,,,90,45,38.25,12.897,45,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
T Cells; Total Count (Mayo)OutsideLaboratory,,86359,CPT,Facility,Outpatient,,,90,45,38.25,12.897,45,PrimeWest Health,MinnesotaCare,23.112,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
T Cells; Total Count (Mayo)OutsideLaboratory,,86359,CPT,Facility,Inpatient,,,90,45,38.25,12.897,45,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
T Cells; Total Count (Mayo)OutsideLaboratory,,86359,CPT,Facility,Both,,,90,45,38.25,12.897,45,Sanford Health Plan,Sanford Health Plan,41.4,92,,percent of total billed charges,,
T Cells; Total Count (Mayo)OutsideLaboratory,,86359,CPT,Facility,Outpatient,,,90,45,38.25,12.897,45,"UCare Health, Inc.",Individual & Family Plan,25.3575,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
T Cells; Total Count (Mayo)OutsideLaboratory,,86359,CPT,Facility,Inpatient,,,90,45,38.25,12.897,45,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
T Cells; Total Count (Mayo)OutsideLaboratory,,86359,CPT,Facility,Outpatient,,,90,45,38.25,12.897,45,"UCare Health, Inc.",Medical Assistance,22.7115,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
T Cells; Total Count (Mayo)OutsideLaboratory,,86359,CPT,Facility,Inpatient,,,90,45,38.25,12.897,45,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
T Cells; Total Count (Mayo)OutsideLaboratory,,86359,CPT,Facility,Outpatient,,,90,45,38.25,12.897,45,"UCare Health, Inc.",Medicare Advantage,22.7115,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
T Cells; Total Count (Mayo)OutsideLaboratory,,86359,CPT,Facility,Inpatient,,,90,45,38.25,12.897,45,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
T Cells; Total Count (Mayo)OutsideLaboratory,,86359,CPT,Facility,Outpatient,,,90,45,38.25,12.897,45,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),22.7115,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
T Cells; Total Count (Mayo)OutsideLaboratory,,86359,CPT,Facility,Inpatient,,,90,45,38.25,12.897,45,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
T Cells; Total Count (Mayo)OutsideLaboratory,,86359,CPT,Facility,Both,,,90,45,38.25,12.897,45,UnitedHealthcare,Individual & Family,42.3,94,,percent of total billed charges,,
T Cells; Total Count (Mayo)OutsideLaboratory,,86359,CPT,Facility,Outpatient,,,90,45,38.25,12.897,45,UnitedHealthcare,Medicare Advantage,22.05,49,,percent of total billed charges,,
T Cells; Total Count (Mayo)OutsideLaboratory,,86359,CPT,Facility,Inpatient,,,90,45,38.25,12.897,45,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
T Cells; Total Count (Mayo)OutsideLaboratory,,86359,CPT,Facility,Outpatient,,,90,45,38.25,12.897,45,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,21.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
T Cells; Total Count (Mayo)OutsideLaboratory,,86359,CPT,Facility,Inpatient,,,90,45,38.25,12.897,45,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Qn Lymphocyte Subsets: T, B, And Nk (Mayo)OutsideLaboratory",,86360,CPT,Facility,Both,,,90,89,75.65,25.5074,89,Aetna,Commercial,81.88,92,,percent of total billed charges,,
"Qn Lymphocyte Subsets: T, B, And Nk (Mayo)OutsideLaboratory",,86360,CPT,Facility,Outpatient,,,90,89,75.65,25.5074,89,Aetna,Medicare Advantage,43.61,49,,percent of total billed charges,,
"Qn Lymphocyte Subsets: T, B, And Nk (Mayo)OutsideLaboratory",,86360,CPT,Facility,Inpatient,,,90,89,75.65,25.5074,89,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Qn Lymphocyte Subsets: T, B, And Nk (Mayo)OutsideLaboratory",,86360,CPT,Facility,Both,,,90,89,75.65,25.5074,89,Aetna,PPO,82.77,93,,percent of total billed charges,,
"Qn Lymphocyte Subsets: T, B, And Nk (Mayo)OutsideLaboratory",,86360,CPT,Facility,Both,,,90,89,75.65,25.5074,89,America's PPO,America's PPO,85.4667,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Qn Lymphocyte Subsets: T, B, And Nk (Mayo)OutsideLaboratory",,86360,CPT,Facility,Both,,,90,89,75.65,25.5074,89,BlueCross BlueShield Minnesota, Federal Employee Program,87.576,98.4,,percent of total billed charges,,
"Qn Lymphocyte Subsets: T, B, And Nk (Mayo)OutsideLaboratory",,86360,CPT,Facility,Both,,,90,89,75.65,25.5074,89,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,89,100,,percent of total billed charges,,
"Qn Lymphocyte Subsets: T, B, And Nk (Mayo)OutsideLaboratory",,86360,CPT,Facility,Both,,,90,89,75.65,25.5074,89,BlueCross BlueShield Minnesota,High Value Network Plan,80.1,90,,percent of total billed charges,,
"Qn Lymphocyte Subsets: T, B, And Nk (Mayo)OutsideLaboratory",,86360,CPT,Facility,Outpatient,,,90,89,75.65,25.5074,89,BlueCross BlueShield Minnesota,Medicare Advantage,43.61,49,,percent of total billed charges,,
"Qn Lymphocyte Subsets: T, B, And Nk (Mayo)OutsideLaboratory",,86360,CPT,Facility,Inpatient,,,90,89,75.65,25.5074,89,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Qn Lymphocyte Subsets: T, B, And Nk (Mayo)OutsideLaboratory",,86360,CPT,Facility,Both,,,90,89,75.65,25.5074,89,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,78.8273,88.57,,percent of total billed charges,,
"Qn Lymphocyte Subsets: T, B, And Nk (Mayo)OutsideLaboratory",,86360,CPT,Facility,Both,,,90,89,75.65,25.5074,89,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,25.5074,28.66,,percent of total billed charges,,
"Qn Lymphocyte Subsets: T, B, And Nk (Mayo)OutsideLaboratory",,86360,CPT,Facility,Outpatient,,,90,89,75.65,25.5074,89,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),43.61,49,,percent of total billed charges,,
"Qn Lymphocyte Subsets: T, B, And Nk (Mayo)OutsideLaboratory",,86360,CPT,Facility,Inpatient,,,90,89,75.65,25.5074,89,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Qn Lymphocyte Subsets: T, B, And Nk (Mayo)OutsideLaboratory",,86360,CPT,Facility,Both,,,90,89,75.65,25.5074,89,CorVel,Worker's Compensation,89,100,,percent of total billed charges,,
"Qn Lymphocyte Subsets: T, B, And Nk (Mayo)OutsideLaboratory",,86360,CPT,Facility,Both,,,90,89,75.65,25.5074,89,First Health Group Corporation,First Health Network,86.33,97,,percent of total billed charges,,
"Qn Lymphocyte Subsets: T, B, And Nk (Mayo)OutsideLaboratory",,86360,CPT,Facility,Both,,,90,89,75.65,25.5074,89,"Health Partners, Inc.",Commercial,84.194,94.6,,percent of total billed charges,,
"Qn Lymphocyte Subsets: T, B, And Nk (Mayo)OutsideLaboratory",,86360,CPT,Facility,Outpatient,,,90,89,75.65,25.5074,89,"Health Partners, Inc.",Medicare Advantage,43.61,49,,percent of total billed charges,,
"Qn Lymphocyte Subsets: T, B, And Nk (Mayo)OutsideLaboratory",,86360,CPT,Facility,Inpatient,,,90,89,75.65,25.5074,89,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Qn Lymphocyte Subsets: T, B, And Nk (Mayo)OutsideLaboratory",,86360,CPT,Facility,Both,,,90,89,75.65,25.5074,89,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),53.4,60,,percent of total billed charges,,
"Qn Lymphocyte Subsets: T, B, And Nk (Mayo)OutsideLaboratory",,86360,CPT,Facility,Both,,,90,89,75.65,25.5074,89,"Health Partners, Inc.",State of Minnesota Advantage Program,72.535,81.5,,percent of total billed charges,,
"Qn Lymphocyte Subsets: T, B, And Nk (Mayo)OutsideLaboratory",,86360,CPT,Facility,Both,,,90,89,75.65,25.5074,89,"Health Partners, Inc.",State Public Programs,44.5,50,,percent of total billed charges,,
"Qn Lymphocyte Subsets: T, B, And Nk (Mayo)OutsideLaboratory",,86360,CPT,Facility,Both,,,90,89,75.65,25.5074,89,Humana Insurance Company,Commercial PPO,84.55,95,,percent of total billed charges,,
"Qn Lymphocyte Subsets: T, B, And Nk (Mayo)OutsideLaboratory",,86360,CPT,Facility,Outpatient,,,90,89,75.65,25.5074,89,Humana Insurance Company,Medicare PPO,43.61,49,,percent of total billed charges,,
"Qn Lymphocyte Subsets: T, B, And Nk (Mayo)OutsideLaboratory",,86360,CPT,Facility,Inpatient,,,90,89,75.65,25.5074,89,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Qn Lymphocyte Subsets: T, B, And Nk (Mayo)OutsideLaboratory",,86360,CPT,Facility,Both,,,90,89,75.65,25.5074,89,Medica,Individual & Family,88.199,99.1,,percent of total billed charges,,
"Qn Lymphocyte Subsets: T, B, And Nk (Mayo)OutsideLaboratory",,86360,CPT,Facility,Outpatient,,,90,89,75.65,25.5074,89,Medica,Medica Advantage Solution,44.322,49.8,,percent of total billed charges,,
"Qn Lymphocyte Subsets: T, B, And Nk (Mayo)OutsideLaboratory",,86360,CPT,Facility,Inpatient,,,90,89,75.65,25.5074,89,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Qn Lymphocyte Subsets: T, B, And Nk (Mayo)OutsideLaboratory",,86360,CPT,Facility,Outpatient,,,90,89,75.65,25.5074,89,Medica,Medical Assistance,39.694,44.6,,percent of total billed charges,,
"Qn Lymphocyte Subsets: T, B, And Nk (Mayo)OutsideLaboratory",,86360,CPT,Facility,Inpatient,,,90,89,75.65,25.5074,89,Medica,Medical Assistance,,,,,Included in per diem rate,
"Qn Lymphocyte Subsets: T, B, And Nk (Mayo)OutsideLaboratory",,86360,CPT,Facility,Outpatient,,,90,89,75.65,25.5074,89,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,44.322,49.8,,percent of total billed charges,,
"Qn Lymphocyte Subsets: T, B, And Nk (Mayo)OutsideLaboratory",,86360,CPT,Facility,Inpatient,,,90,89,75.65,25.5074,89,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Qn Lymphocyte Subsets: T, B, And Nk (Mayo)OutsideLaboratory",,86360,CPT,Facility,Both,,,90,89,75.65,25.5074,89,"Multiplan, Inc.","Multiplan, Inc.",83.66,94,,percent of total billed charges,,
"Qn Lymphocyte Subsets: T, B, And Nk (Mayo)OutsideLaboratory",,86360,CPT,Facility,Outpatient,,,90,89,75.65,25.5074,89,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,76.896,86.4,,percent of total billed charges,,
"Qn Lymphocyte Subsets: T, B, And Nk (Mayo)OutsideLaboratory",,86360,CPT,Facility,Inpatient,,,90,89,75.65,25.5074,89,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Qn Lymphocyte Subsets: T, B, And Nk (Mayo)OutsideLaboratory",,86360,CPT,Facility,Both,,,90,89,75.65,25.5074,89,"Preferred One Administrative Services, INC.",PPO,87.754,98.6,,percent of total billed charges,,
"Qn Lymphocyte Subsets: T, B, And Nk (Mayo)OutsideLaboratory",,86360,CPT,Facility,Outpatient,,,90,89,75.65,25.5074,89,PrimeWest Health,Minnesota Senior Health Options (MSHO),45.7905,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Qn Lymphocyte Subsets: T, B, And Nk (Mayo)OutsideLaboratory",,86360,CPT,Facility,Inpatient,,,90,89,75.65,25.5074,89,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Qn Lymphocyte Subsets: T, B, And Nk (Mayo)OutsideLaboratory",,86360,CPT,Facility,Outpatient,,,90,89,75.65,25.5074,89,PrimeWest Health,MinnesotaCare,45.7104,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Qn Lymphocyte Subsets: T, B, And Nk (Mayo)OutsideLaboratory",,86360,CPT,Facility,Inpatient,,,90,89,75.65,25.5074,89,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Qn Lymphocyte Subsets: T, B, And Nk (Mayo)OutsideLaboratory",,86360,CPT,Facility,Both,,,90,89,75.65,25.5074,89,Sanford Health Plan,Sanford Health Plan,81.88,92,,percent of total billed charges,,
"Qn Lymphocyte Subsets: T, B, And Nk (Mayo)OutsideLaboratory",,86360,CPT,Facility,Outpatient,,,90,89,75.65,25.5074,89,"UCare Health, Inc.",Individual & Family Plan,50.1515,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Qn Lymphocyte Subsets: T, B, And Nk (Mayo)OutsideLaboratory",,86360,CPT,Facility,Inpatient,,,90,89,75.65,25.5074,89,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Qn Lymphocyte Subsets: T, B, And Nk (Mayo)OutsideLaboratory",,86360,CPT,Facility,Outpatient,,,90,89,75.65,25.5074,89,"UCare Health, Inc.",Medical Assistance,44.9183,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Qn Lymphocyte Subsets: T, B, And Nk (Mayo)OutsideLaboratory",,86360,CPT,Facility,Inpatient,,,90,89,75.65,25.5074,89,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Qn Lymphocyte Subsets: T, B, And Nk (Mayo)OutsideLaboratory",,86360,CPT,Facility,Outpatient,,,90,89,75.65,25.5074,89,"UCare Health, Inc.",Medicare Advantage,44.9183,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Qn Lymphocyte Subsets: T, B, And Nk (Mayo)OutsideLaboratory",,86360,CPT,Facility,Inpatient,,,90,89,75.65,25.5074,89,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Qn Lymphocyte Subsets: T, B, And Nk (Mayo)OutsideLaboratory",,86360,CPT,Facility,Outpatient,,,90,89,75.65,25.5074,89,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),44.9183,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Qn Lymphocyte Subsets: T, B, And Nk (Mayo)OutsideLaboratory",,86360,CPT,Facility,Inpatient,,,90,89,75.65,25.5074,89,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Qn Lymphocyte Subsets: T, B, And Nk (Mayo)OutsideLaboratory",,86360,CPT,Facility,Both,,,90,89,75.65,25.5074,89,UnitedHealthcare,Individual & Family,83.66,94,,percent of total billed charges,,
"Qn Lymphocyte Subsets: T, B, And Nk (Mayo)OutsideLaboratory",,86360,CPT,Facility,Outpatient,,,90,89,75.65,25.5074,89,UnitedHealthcare,Medicare Advantage,43.61,49,,percent of total billed charges,,
"Qn Lymphocyte Subsets: T, B, And Nk (Mayo)OutsideLaboratory",,86360,CPT,Facility,Inpatient,,,90,89,75.65,25.5074,89,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Qn Lymphocyte Subsets: T, B, And Nk (Mayo)OutsideLaboratory",,86360,CPT,Facility,Outpatient,,,90,89,75.65,25.5074,89,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,42.72,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Qn Lymphocyte Subsets: T, B, And Nk (Mayo)OutsideLaboratory",,86360,CPT,Facility,Inpatient,,,90,89,75.65,25.5074,89,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
T Cells; Absolute Cd4 & Cd8 Count Including Ratio (Mayo)OutsideLaboratory,,86360,CPT,Facility,Both,,,90,89,75.65,25.5074,89,Aetna,Commercial,81.88,92,,percent of total billed charges,,
T Cells; Absolute Cd4 & Cd8 Count Including Ratio (Mayo)OutsideLaboratory,,86360,CPT,Facility,Outpatient,,,90,89,75.65,25.5074,89,Aetna,Medicare Advantage,43.61,49,,percent of total billed charges,,
T Cells; Absolute Cd4 & Cd8 Count Including Ratio (Mayo)OutsideLaboratory,,86360,CPT,Facility,Inpatient,,,90,89,75.65,25.5074,89,Aetna,Medicare Advantage,,,,,Included in per diem rate,
T Cells; Absolute Cd4 & Cd8 Count Including Ratio (Mayo)OutsideLaboratory,,86360,CPT,Facility,Both,,,90,89,75.65,25.5074,89,Aetna,PPO,82.77,93,,percent of total billed charges,,
T Cells; Absolute Cd4 & Cd8 Count Including Ratio (Mayo)OutsideLaboratory,,86360,CPT,Facility,Both,,,90,89,75.65,25.5074,89,America's PPO,America's PPO,85.4667,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
T Cells; Absolute Cd4 & Cd8 Count Including Ratio (Mayo)OutsideLaboratory,,86360,CPT,Facility,Both,,,90,89,75.65,25.5074,89,BlueCross BlueShield Minnesota, Federal Employee Program,87.576,98.4,,percent of total billed charges,,
T Cells; Absolute Cd4 & Cd8 Count Including Ratio (Mayo)OutsideLaboratory,,86360,CPT,Facility,Both,,,90,89,75.65,25.5074,89,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,89,100,,percent of total billed charges,,
T Cells; Absolute Cd4 & Cd8 Count Including Ratio (Mayo)OutsideLaboratory,,86360,CPT,Facility,Both,,,90,89,75.65,25.5074,89,BlueCross BlueShield Minnesota,High Value Network Plan,80.1,90,,percent of total billed charges,,
T Cells; Absolute Cd4 & Cd8 Count Including Ratio (Mayo)OutsideLaboratory,,86360,CPT,Facility,Outpatient,,,90,89,75.65,25.5074,89,BlueCross BlueShield Minnesota,Medicare Advantage,43.61,49,,percent of total billed charges,,
T Cells; Absolute Cd4 & Cd8 Count Including Ratio (Mayo)OutsideLaboratory,,86360,CPT,Facility,Inpatient,,,90,89,75.65,25.5074,89,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
T Cells; Absolute Cd4 & Cd8 Count Including Ratio (Mayo)OutsideLaboratory,,86360,CPT,Facility,Both,,,90,89,75.65,25.5074,89,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,78.8273,88.57,,percent of total billed charges,,
T Cells; Absolute Cd4 & Cd8 Count Including Ratio (Mayo)OutsideLaboratory,,86360,CPT,Facility,Both,,,90,89,75.65,25.5074,89,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,25.5074,28.66,,percent of total billed charges,,
T Cells; Absolute Cd4 & Cd8 Count Including Ratio (Mayo)OutsideLaboratory,,86360,CPT,Facility,Outpatient,,,90,89,75.65,25.5074,89,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),43.61,49,,percent of total billed charges,,
T Cells; Absolute Cd4 & Cd8 Count Including Ratio (Mayo)OutsideLaboratory,,86360,CPT,Facility,Inpatient,,,90,89,75.65,25.5074,89,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
T Cells; Absolute Cd4 & Cd8 Count Including Ratio (Mayo)OutsideLaboratory,,86360,CPT,Facility,Both,,,90,89,75.65,25.5074,89,CorVel,Worker's Compensation,89,100,,percent of total billed charges,,
T Cells; Absolute Cd4 & Cd8 Count Including Ratio (Mayo)OutsideLaboratory,,86360,CPT,Facility,Both,,,90,89,75.65,25.5074,89,First Health Group Corporation,First Health Network,86.33,97,,percent of total billed charges,,
T Cells; Absolute Cd4 & Cd8 Count Including Ratio (Mayo)OutsideLaboratory,,86360,CPT,Facility,Both,,,90,89,75.65,25.5074,89,"Health Partners, Inc.",Commercial,84.194,94.6,,percent of total billed charges,,
T Cells; Absolute Cd4 & Cd8 Count Including Ratio (Mayo)OutsideLaboratory,,86360,CPT,Facility,Outpatient,,,90,89,75.65,25.5074,89,"Health Partners, Inc.",Medicare Advantage,43.61,49,,percent of total billed charges,,
T Cells; Absolute Cd4 & Cd8 Count Including Ratio (Mayo)OutsideLaboratory,,86360,CPT,Facility,Inpatient,,,90,89,75.65,25.5074,89,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
T Cells; Absolute Cd4 & Cd8 Count Including Ratio (Mayo)OutsideLaboratory,,86360,CPT,Facility,Both,,,90,89,75.65,25.5074,89,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),53.4,60,,percent of total billed charges,,
T Cells; Absolute Cd4 & Cd8 Count Including Ratio (Mayo)OutsideLaboratory,,86360,CPT,Facility,Both,,,90,89,75.65,25.5074,89,"Health Partners, Inc.",State of Minnesota Advantage Program,72.535,81.5,,percent of total billed charges,,
T Cells; Absolute Cd4 & Cd8 Count Including Ratio (Mayo)OutsideLaboratory,,86360,CPT,Facility,Both,,,90,89,75.65,25.5074,89,"Health Partners, Inc.",State Public Programs,44.5,50,,percent of total billed charges,,
T Cells; Absolute Cd4 & Cd8 Count Including Ratio (Mayo)OutsideLaboratory,,86360,CPT,Facility,Both,,,90,89,75.65,25.5074,89,Humana Insurance Company,Commercial PPO,84.55,95,,percent of total billed charges,,
T Cells; Absolute Cd4 & Cd8 Count Including Ratio (Mayo)OutsideLaboratory,,86360,CPT,Facility,Outpatient,,,90,89,75.65,25.5074,89,Humana Insurance Company,Medicare PPO,43.61,49,,percent of total billed charges,,
T Cells; Absolute Cd4 & Cd8 Count Including Ratio (Mayo)OutsideLaboratory,,86360,CPT,Facility,Inpatient,,,90,89,75.65,25.5074,89,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
T Cells; Absolute Cd4 & Cd8 Count Including Ratio (Mayo)OutsideLaboratory,,86360,CPT,Facility,Both,,,90,89,75.65,25.5074,89,Medica,Individual & Family,88.199,99.1,,percent of total billed charges,,
T Cells; Absolute Cd4 & Cd8 Count Including Ratio (Mayo)OutsideLaboratory,,86360,CPT,Facility,Outpatient,,,90,89,75.65,25.5074,89,Medica,Medica Advantage Solution,44.322,49.8,,percent of total billed charges,,
T Cells; Absolute Cd4 & Cd8 Count Including Ratio (Mayo)OutsideLaboratory,,86360,CPT,Facility,Inpatient,,,90,89,75.65,25.5074,89,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
T Cells; Absolute Cd4 & Cd8 Count Including Ratio (Mayo)OutsideLaboratory,,86360,CPT,Facility,Outpatient,,,90,89,75.65,25.5074,89,Medica,Medical Assistance,39.694,44.6,,percent of total billed charges,,
T Cells; Absolute Cd4 & Cd8 Count Including Ratio (Mayo)OutsideLaboratory,,86360,CPT,Facility,Inpatient,,,90,89,75.65,25.5074,89,Medica,Medical Assistance,,,,,Included in per diem rate,
T Cells; Absolute Cd4 & Cd8 Count Including Ratio (Mayo)OutsideLaboratory,,86360,CPT,Facility,Outpatient,,,90,89,75.65,25.5074,89,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,44.322,49.8,,percent of total billed charges,,
T Cells; Absolute Cd4 & Cd8 Count Including Ratio (Mayo)OutsideLaboratory,,86360,CPT,Facility,Inpatient,,,90,89,75.65,25.5074,89,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
T Cells; Absolute Cd4 & Cd8 Count Including Ratio (Mayo)OutsideLaboratory,,86360,CPT,Facility,Both,,,90,89,75.65,25.5074,89,"Multiplan, Inc.","Multiplan, Inc.",83.66,94,,percent of total billed charges,,
T Cells; Absolute Cd4 & Cd8 Count Including Ratio (Mayo)OutsideLaboratory,,86360,CPT,Facility,Outpatient,,,90,89,75.65,25.5074,89,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,76.896,86.4,,percent of total billed charges,,
T Cells; Absolute Cd4 & Cd8 Count Including Ratio (Mayo)OutsideLaboratory,,86360,CPT,Facility,Inpatient,,,90,89,75.65,25.5074,89,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
T Cells; Absolute Cd4 & Cd8 Count Including Ratio (Mayo)OutsideLaboratory,,86360,CPT,Facility,Both,,,90,89,75.65,25.5074,89,"Preferred One Administrative Services, INC.",PPO,87.754,98.6,,percent of total billed charges,,
T Cells; Absolute Cd4 & Cd8 Count Including Ratio (Mayo)OutsideLaboratory,,86360,CPT,Facility,Outpatient,,,90,89,75.65,25.5074,89,PrimeWest Health,Minnesota Senior Health Options (MSHO),45.7905,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
T Cells; Absolute Cd4 & Cd8 Count Including Ratio (Mayo)OutsideLaboratory,,86360,CPT,Facility,Inpatient,,,90,89,75.65,25.5074,89,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
T Cells; Absolute Cd4 & Cd8 Count Including Ratio (Mayo)OutsideLaboratory,,86360,CPT,Facility,Outpatient,,,90,89,75.65,25.5074,89,PrimeWest Health,MinnesotaCare,45.7104,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
T Cells; Absolute Cd4 & Cd8 Count Including Ratio (Mayo)OutsideLaboratory,,86360,CPT,Facility,Inpatient,,,90,89,75.65,25.5074,89,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
T Cells; Absolute Cd4 & Cd8 Count Including Ratio (Mayo)OutsideLaboratory,,86360,CPT,Facility,Both,,,90,89,75.65,25.5074,89,Sanford Health Plan,Sanford Health Plan,81.88,92,,percent of total billed charges,,
T Cells; Absolute Cd4 & Cd8 Count Including Ratio (Mayo)OutsideLaboratory,,86360,CPT,Facility,Outpatient,,,90,89,75.65,25.5074,89,"UCare Health, Inc.",Individual & Family Plan,50.1515,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
T Cells; Absolute Cd4 & Cd8 Count Including Ratio (Mayo)OutsideLaboratory,,86360,CPT,Facility,Inpatient,,,90,89,75.65,25.5074,89,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
T Cells; Absolute Cd4 & Cd8 Count Including Ratio (Mayo)OutsideLaboratory,,86360,CPT,Facility,Outpatient,,,90,89,75.65,25.5074,89,"UCare Health, Inc.",Medical Assistance,44.9183,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
T Cells; Absolute Cd4 & Cd8 Count Including Ratio (Mayo)OutsideLaboratory,,86360,CPT,Facility,Inpatient,,,90,89,75.65,25.5074,89,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
T Cells; Absolute Cd4 & Cd8 Count Including Ratio (Mayo)OutsideLaboratory,,86360,CPT,Facility,Outpatient,,,90,89,75.65,25.5074,89,"UCare Health, Inc.",Medicare Advantage,44.9183,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
T Cells; Absolute Cd4 & Cd8 Count Including Ratio (Mayo)OutsideLaboratory,,86360,CPT,Facility,Inpatient,,,90,89,75.65,25.5074,89,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
T Cells; Absolute Cd4 & Cd8 Count Including Ratio (Mayo)OutsideLaboratory,,86360,CPT,Facility,Outpatient,,,90,89,75.65,25.5074,89,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),44.9183,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
T Cells; Absolute Cd4 & Cd8 Count Including Ratio (Mayo)OutsideLaboratory,,86360,CPT,Facility,Inpatient,,,90,89,75.65,25.5074,89,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
T Cells; Absolute Cd4 & Cd8 Count Including Ratio (Mayo)OutsideLaboratory,,86360,CPT,Facility,Both,,,90,89,75.65,25.5074,89,UnitedHealthcare,Individual & Family,83.66,94,,percent of total billed charges,,
T Cells; Absolute Cd4 & Cd8 Count Including Ratio (Mayo)OutsideLaboratory,,86360,CPT,Facility,Outpatient,,,90,89,75.65,25.5074,89,UnitedHealthcare,Medicare Advantage,43.61,49,,percent of total billed charges,,
T Cells; Absolute Cd4 & Cd8 Count Including Ratio (Mayo)OutsideLaboratory,,86360,CPT,Facility,Inpatient,,,90,89,75.65,25.5074,89,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
T Cells; Absolute Cd4 & Cd8 Count Including Ratio (Mayo)OutsideLaboratory,,86360,CPT,Facility,Outpatient,,,90,89,75.65,25.5074,89,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,42.72,48,,percent of total billed charges,,100% of DHS outpatient percentage
T Cells; Absolute Cd4 & Cd8 Count Including Ratio (Mayo)OutsideLaboratory,,86360,CPT,Facility,Inpatient,,,90,89,75.65,25.5074,89,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Tissue Transglutaminase Ab, Iga, S (Mayo)OutsideLaboratory",,86364,CPT,Facility,Both,,,90,160,136,45.856,160,Aetna,Commercial,147.2,92,,percent of total billed charges,,
"Tissue Transglutaminase Ab, Iga, S (Mayo)OutsideLaboratory",,86364,CPT,Facility,Outpatient,,,90,160,136,45.856,160,Aetna,Medicare Advantage,78.4,49,,percent of total billed charges,,
"Tissue Transglutaminase Ab, Iga, S (Mayo)OutsideLaboratory",,86364,CPT,Facility,Inpatient,,,90,160,136,45.856,160,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Tissue Transglutaminase Ab, Iga, S (Mayo)OutsideLaboratory",,86364,CPT,Facility,Both,,,90,160,136,45.856,160,Aetna,PPO,148.8,93,,percent of total billed charges,,
"Tissue Transglutaminase Ab, Iga, S (Mayo)OutsideLaboratory",,86364,CPT,Facility,Both,,,90,160,136,45.856,160,America's PPO,America's PPO,153.648,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Tissue Transglutaminase Ab, Iga, S (Mayo)OutsideLaboratory",,86364,CPT,Facility,Both,,,90,160,136,45.856,160,BlueCross BlueShield Minnesota, Federal Employee Program,157.44,98.4,,percent of total billed charges,,
"Tissue Transglutaminase Ab, Iga, S (Mayo)OutsideLaboratory",,86364,CPT,Facility,Both,,,90,160,136,45.856,160,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,160,100,,percent of total billed charges,,
"Tissue Transglutaminase Ab, Iga, S (Mayo)OutsideLaboratory",,86364,CPT,Facility,Both,,,90,160,136,45.856,160,BlueCross BlueShield Minnesota,High Value Network Plan,144,90,,percent of total billed charges,,
"Tissue Transglutaminase Ab, Iga, S (Mayo)OutsideLaboratory",,86364,CPT,Facility,Outpatient,,,90,160,136,45.856,160,BlueCross BlueShield Minnesota,Medicare Advantage,78.4,49,,percent of total billed charges,,
"Tissue Transglutaminase Ab, Iga, S (Mayo)OutsideLaboratory",,86364,CPT,Facility,Inpatient,,,90,160,136,45.856,160,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Tissue Transglutaminase Ab, Iga, S (Mayo)OutsideLaboratory",,86364,CPT,Facility,Both,,,90,160,136,45.856,160,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,141.712,88.57,,percent of total billed charges,,
"Tissue Transglutaminase Ab, Iga, S (Mayo)OutsideLaboratory",,86364,CPT,Facility,Both,,,90,160,136,45.856,160,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,45.856,28.66,,percent of total billed charges,,
"Tissue Transglutaminase Ab, Iga, S (Mayo)OutsideLaboratory",,86364,CPT,Facility,Outpatient,,,90,160,136,45.856,160,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),78.4,49,,percent of total billed charges,,
"Tissue Transglutaminase Ab, Iga, S (Mayo)OutsideLaboratory",,86364,CPT,Facility,Inpatient,,,90,160,136,45.856,160,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Tissue Transglutaminase Ab, Iga, S (Mayo)OutsideLaboratory",,86364,CPT,Facility,Both,,,90,160,136,45.856,160,CorVel,Worker's Compensation,160,100,,percent of total billed charges,,
"Tissue Transglutaminase Ab, Iga, S (Mayo)OutsideLaboratory",,86364,CPT,Facility,Both,,,90,160,136,45.856,160,First Health Group Corporation,First Health Network,155.2,97,,percent of total billed charges,,
"Tissue Transglutaminase Ab, Iga, S (Mayo)OutsideLaboratory",,86364,CPT,Facility,Both,,,90,160,136,45.856,160,"Health Partners, Inc.",Commercial,151.36,94.6,,percent of total billed charges,,
"Tissue Transglutaminase Ab, Iga, S (Mayo)OutsideLaboratory",,86364,CPT,Facility,Outpatient,,,90,160,136,45.856,160,"Health Partners, Inc.",Medicare Advantage,78.4,49,,percent of total billed charges,,
"Tissue Transglutaminase Ab, Iga, S (Mayo)OutsideLaboratory",,86364,CPT,Facility,Inpatient,,,90,160,136,45.856,160,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Tissue Transglutaminase Ab, Iga, S (Mayo)OutsideLaboratory",,86364,CPT,Facility,Both,,,90,160,136,45.856,160,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),96,60,,percent of total billed charges,,
"Tissue Transglutaminase Ab, Iga, S (Mayo)OutsideLaboratory",,86364,CPT,Facility,Both,,,90,160,136,45.856,160,"Health Partners, Inc.",State of Minnesota Advantage Program,130.4,81.5,,percent of total billed charges,,
"Tissue Transglutaminase Ab, Iga, S (Mayo)OutsideLaboratory",,86364,CPT,Facility,Both,,,90,160,136,45.856,160,"Health Partners, Inc.",State Public Programs,80,50,,percent of total billed charges,,
"Tissue Transglutaminase Ab, Iga, S (Mayo)OutsideLaboratory",,86364,CPT,Facility,Both,,,90,160,136,45.856,160,Humana Insurance Company,Commercial PPO,152,95,,percent of total billed charges,,
"Tissue Transglutaminase Ab, Iga, S (Mayo)OutsideLaboratory",,86364,CPT,Facility,Outpatient,,,90,160,136,45.856,160,Humana Insurance Company,Medicare PPO,78.4,49,,percent of total billed charges,,
"Tissue Transglutaminase Ab, Iga, S (Mayo)OutsideLaboratory",,86364,CPT,Facility,Inpatient,,,90,160,136,45.856,160,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Tissue Transglutaminase Ab, Iga, S (Mayo)OutsideLaboratory",,86364,CPT,Facility,Both,,,90,160,136,45.856,160,Medica,Individual & Family,158.56,99.1,,percent of total billed charges,,
"Tissue Transglutaminase Ab, Iga, S (Mayo)OutsideLaboratory",,86364,CPT,Facility,Outpatient,,,90,160,136,45.856,160,Medica,Medica Advantage Solution,79.68,49.8,,percent of total billed charges,,
"Tissue Transglutaminase Ab, Iga, S (Mayo)OutsideLaboratory",,86364,CPT,Facility,Inpatient,,,90,160,136,45.856,160,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Tissue Transglutaminase Ab, Iga, S (Mayo)OutsideLaboratory",,86364,CPT,Facility,Outpatient,,,90,160,136,45.856,160,Medica,Medical Assistance,71.36,44.6,,percent of total billed charges,,
"Tissue Transglutaminase Ab, Iga, S (Mayo)OutsideLaboratory",,86364,CPT,Facility,Inpatient,,,90,160,136,45.856,160,Medica,Medical Assistance,,,,,Included in per diem rate,
"Tissue Transglutaminase Ab, Iga, S (Mayo)OutsideLaboratory",,86364,CPT,Facility,Outpatient,,,90,160,136,45.856,160,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,79.68,49.8,,percent of total billed charges,,
"Tissue Transglutaminase Ab, Iga, S (Mayo)OutsideLaboratory",,86364,CPT,Facility,Inpatient,,,90,160,136,45.856,160,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Tissue Transglutaminase Ab, Iga, S (Mayo)OutsideLaboratory",,86364,CPT,Facility,Both,,,90,160,136,45.856,160,"Multiplan, Inc.","Multiplan, Inc.",150.4,94,,percent of total billed charges,,
"Tissue Transglutaminase Ab, Iga, S (Mayo)OutsideLaboratory",,86364,CPT,Facility,Outpatient,,,90,160,136,45.856,160,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,138.24,86.4,,percent of total billed charges,,
"Tissue Transglutaminase Ab, Iga, S (Mayo)OutsideLaboratory",,86364,CPT,Facility,Inpatient,,,90,160,136,45.856,160,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Tissue Transglutaminase Ab, Iga, S (Mayo)OutsideLaboratory",,86364,CPT,Facility,Both,,,90,160,136,45.856,160,"Preferred One Administrative Services, INC.",PPO,157.76,98.6,,percent of total billed charges,,
"Tissue Transglutaminase Ab, Iga, S (Mayo)OutsideLaboratory",,86364,CPT,Facility,Outpatient,,,90,160,136,45.856,160,PrimeWest Health,Minnesota Senior Health Options (MSHO),82.32,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Tissue Transglutaminase Ab, Iga, S (Mayo)OutsideLaboratory",,86364,CPT,Facility,Inpatient,,,90,160,136,45.856,160,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Tissue Transglutaminase Ab, Iga, S (Mayo)OutsideLaboratory",,86364,CPT,Facility,Outpatient,,,90,160,136,45.856,160,PrimeWest Health,MinnesotaCare,82.176,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Tissue Transglutaminase Ab, Iga, S (Mayo)OutsideLaboratory",,86364,CPT,Facility,Inpatient,,,90,160,136,45.856,160,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Tissue Transglutaminase Ab, Iga, S (Mayo)OutsideLaboratory",,86364,CPT,Facility,Both,,,90,160,136,45.856,160,Sanford Health Plan,Sanford Health Plan,147.2,92,,percent of total billed charges,,
"Tissue Transglutaminase Ab, Iga, S (Mayo)OutsideLaboratory",,86364,CPT,Facility,Outpatient,,,90,160,136,45.856,160,"UCare Health, Inc.",Individual & Family Plan,90.16,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Tissue Transglutaminase Ab, Iga, S (Mayo)OutsideLaboratory",,86364,CPT,Facility,Inpatient,,,90,160,136,45.856,160,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Tissue Transglutaminase Ab, Iga, S (Mayo)OutsideLaboratory",,86364,CPT,Facility,Outpatient,,,90,160,136,45.856,160,"UCare Health, Inc.",Medical Assistance,80.752,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Tissue Transglutaminase Ab, Iga, S (Mayo)OutsideLaboratory",,86364,CPT,Facility,Inpatient,,,90,160,136,45.856,160,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Tissue Transglutaminase Ab, Iga, S (Mayo)OutsideLaboratory",,86364,CPT,Facility,Outpatient,,,90,160,136,45.856,160,"UCare Health, Inc.",Medicare Advantage,80.752,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Tissue Transglutaminase Ab, Iga, S (Mayo)OutsideLaboratory",,86364,CPT,Facility,Inpatient,,,90,160,136,45.856,160,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Tissue Transglutaminase Ab, Iga, S (Mayo)OutsideLaboratory",,86364,CPT,Facility,Outpatient,,,90,160,136,45.856,160,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),80.752,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Tissue Transglutaminase Ab, Iga, S (Mayo)OutsideLaboratory",,86364,CPT,Facility,Inpatient,,,90,160,136,45.856,160,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Tissue Transglutaminase Ab, Iga, S (Mayo)OutsideLaboratory",,86364,CPT,Facility,Both,,,90,160,136,45.856,160,UnitedHealthcare,Individual & Family,150.4,94,,percent of total billed charges,,
"Tissue Transglutaminase Ab, Iga, S (Mayo)OutsideLaboratory",,86364,CPT,Facility,Outpatient,,,90,160,136,45.856,160,UnitedHealthcare,Medicare Advantage,78.4,49,,percent of total billed charges,,
"Tissue Transglutaminase Ab, Iga, S (Mayo)OutsideLaboratory",,86364,CPT,Facility,Inpatient,,,90,160,136,45.856,160,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Tissue Transglutaminase Ab, Iga, S (Mayo)OutsideLaboratory",,86364,CPT,Facility,Outpatient,,,90,160,136,45.856,160,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,76.8,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Tissue Transglutaminase Ab, Iga, S (Mayo)OutsideLaboratory",,86364,CPT,Facility,Inpatient,,,90,160,136,45.856,160,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Tissue Transglutaminase Ab, Iga/Igg (Mayo)OutsideLaboratory",,86364,CPT,Facility,Both,,,90,238,202.3,68.2108,238,Aetna,Commercial,218.96,92,,percent of total billed charges,,
"Tissue Transglutaminase Ab, Iga/Igg (Mayo)OutsideLaboratory",,86364,CPT,Facility,Outpatient,,,90,238,202.3,68.2108,238,Aetna,Medicare Advantage,116.62,49,,percent of total billed charges,,
"Tissue Transglutaminase Ab, Iga/Igg (Mayo)OutsideLaboratory",,86364,CPT,Facility,Inpatient,,,90,238,202.3,68.2108,238,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Tissue Transglutaminase Ab, Iga/Igg (Mayo)OutsideLaboratory",,86364,CPT,Facility,Both,,,90,238,202.3,68.2108,238,Aetna,PPO,221.34,93,,percent of total billed charges,,
"Tissue Transglutaminase Ab, Iga/Igg (Mayo)OutsideLaboratory",,86364,CPT,Facility,Both,,,90,238,202.3,68.2108,238,America's PPO,America's PPO,228.5514,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Tissue Transglutaminase Ab, Iga/Igg (Mayo)OutsideLaboratory",,86364,CPT,Facility,Both,,,90,238,202.3,68.2108,238,BlueCross BlueShield Minnesota, Federal Employee Program,234.192,98.4,,percent of total billed charges,,
"Tissue Transglutaminase Ab, Iga/Igg (Mayo)OutsideLaboratory",,86364,CPT,Facility,Both,,,90,238,202.3,68.2108,238,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,238,100,,percent of total billed charges,,
"Tissue Transglutaminase Ab, Iga/Igg (Mayo)OutsideLaboratory",,86364,CPT,Facility,Both,,,90,238,202.3,68.2108,238,BlueCross BlueShield Minnesota,High Value Network Plan,214.2,90,,percent of total billed charges,,
"Tissue Transglutaminase Ab, Iga/Igg (Mayo)OutsideLaboratory",,86364,CPT,Facility,Outpatient,,,90,238,202.3,68.2108,238,BlueCross BlueShield Minnesota,Medicare Advantage,116.62,49,,percent of total billed charges,,
"Tissue Transglutaminase Ab, Iga/Igg (Mayo)OutsideLaboratory",,86364,CPT,Facility,Inpatient,,,90,238,202.3,68.2108,238,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Tissue Transglutaminase Ab, Iga/Igg (Mayo)OutsideLaboratory",,86364,CPT,Facility,Both,,,90,238,202.3,68.2108,238,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,210.7966,88.57,,percent of total billed charges,,
"Tissue Transglutaminase Ab, Iga/Igg (Mayo)OutsideLaboratory",,86364,CPT,Facility,Both,,,90,238,202.3,68.2108,238,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,68.2108,28.66,,percent of total billed charges,,
"Tissue Transglutaminase Ab, Iga/Igg (Mayo)OutsideLaboratory",,86364,CPT,Facility,Outpatient,,,90,238,202.3,68.2108,238,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),116.62,49,,percent of total billed charges,,
"Tissue Transglutaminase Ab, Iga/Igg (Mayo)OutsideLaboratory",,86364,CPT,Facility,Inpatient,,,90,238,202.3,68.2108,238,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Tissue Transglutaminase Ab, Iga/Igg (Mayo)OutsideLaboratory",,86364,CPT,Facility,Both,,,90,238,202.3,68.2108,238,CorVel,Worker's Compensation,238,100,,percent of total billed charges,,
"Tissue Transglutaminase Ab, Iga/Igg (Mayo)OutsideLaboratory",,86364,CPT,Facility,Both,,,90,238,202.3,68.2108,238,First Health Group Corporation,First Health Network,230.86,97,,percent of total billed charges,,
"Tissue Transglutaminase Ab, Iga/Igg (Mayo)OutsideLaboratory",,86364,CPT,Facility,Both,,,90,238,202.3,68.2108,238,"Health Partners, Inc.",Commercial,225.148,94.6,,percent of total billed charges,,
"Tissue Transglutaminase Ab, Iga/Igg (Mayo)OutsideLaboratory",,86364,CPT,Facility,Outpatient,,,90,238,202.3,68.2108,238,"Health Partners, Inc.",Medicare Advantage,116.62,49,,percent of total billed charges,,
"Tissue Transglutaminase Ab, Iga/Igg (Mayo)OutsideLaboratory",,86364,CPT,Facility,Inpatient,,,90,238,202.3,68.2108,238,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Tissue Transglutaminase Ab, Iga/Igg (Mayo)OutsideLaboratory",,86364,CPT,Facility,Both,,,90,238,202.3,68.2108,238,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),142.8,60,,percent of total billed charges,,
"Tissue Transglutaminase Ab, Iga/Igg (Mayo)OutsideLaboratory",,86364,CPT,Facility,Both,,,90,238,202.3,68.2108,238,"Health Partners, Inc.",State of Minnesota Advantage Program,193.97,81.5,,percent of total billed charges,,
"Tissue Transglutaminase Ab, Iga/Igg (Mayo)OutsideLaboratory",,86364,CPT,Facility,Both,,,90,238,202.3,68.2108,238,"Health Partners, Inc.",State Public Programs,119,50,,percent of total billed charges,,
"Tissue Transglutaminase Ab, Iga/Igg (Mayo)OutsideLaboratory",,86364,CPT,Facility,Both,,,90,238,202.3,68.2108,238,Humana Insurance Company,Commercial PPO,226.1,95,,percent of total billed charges,,
"Tissue Transglutaminase Ab, Iga/Igg (Mayo)OutsideLaboratory",,86364,CPT,Facility,Outpatient,,,90,238,202.3,68.2108,238,Humana Insurance Company,Medicare PPO,116.62,49,,percent of total billed charges,,
"Tissue Transglutaminase Ab, Iga/Igg (Mayo)OutsideLaboratory",,86364,CPT,Facility,Inpatient,,,90,238,202.3,68.2108,238,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Tissue Transglutaminase Ab, Iga/Igg (Mayo)OutsideLaboratory",,86364,CPT,Facility,Both,,,90,238,202.3,68.2108,238,Medica,Individual & Family,235.858,99.1,,percent of total billed charges,,
"Tissue Transglutaminase Ab, Iga/Igg (Mayo)OutsideLaboratory",,86364,CPT,Facility,Outpatient,,,90,238,202.3,68.2108,238,Medica,Medica Advantage Solution,118.524,49.8,,percent of total billed charges,,
"Tissue Transglutaminase Ab, Iga/Igg (Mayo)OutsideLaboratory",,86364,CPT,Facility,Inpatient,,,90,238,202.3,68.2108,238,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Tissue Transglutaminase Ab, Iga/Igg (Mayo)OutsideLaboratory",,86364,CPT,Facility,Outpatient,,,90,238,202.3,68.2108,238,Medica,Medical Assistance,106.148,44.6,,percent of total billed charges,,
"Tissue Transglutaminase Ab, Iga/Igg (Mayo)OutsideLaboratory",,86364,CPT,Facility,Inpatient,,,90,238,202.3,68.2108,238,Medica,Medical Assistance,,,,,Included in per diem rate,
"Tissue Transglutaminase Ab, Iga/Igg (Mayo)OutsideLaboratory",,86364,CPT,Facility,Outpatient,,,90,238,202.3,68.2108,238,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,118.524,49.8,,percent of total billed charges,,
"Tissue Transglutaminase Ab, Iga/Igg (Mayo)OutsideLaboratory",,86364,CPT,Facility,Inpatient,,,90,238,202.3,68.2108,238,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Tissue Transglutaminase Ab, Iga/Igg (Mayo)OutsideLaboratory",,86364,CPT,Facility,Both,,,90,238,202.3,68.2108,238,"Multiplan, Inc.","Multiplan, Inc.",223.72,94,,percent of total billed charges,,
"Tissue Transglutaminase Ab, Iga/Igg (Mayo)OutsideLaboratory",,86364,CPT,Facility,Outpatient,,,90,238,202.3,68.2108,238,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,205.632,86.4,,percent of total billed charges,,
"Tissue Transglutaminase Ab, Iga/Igg (Mayo)OutsideLaboratory",,86364,CPT,Facility,Inpatient,,,90,238,202.3,68.2108,238,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Tissue Transglutaminase Ab, Iga/Igg (Mayo)OutsideLaboratory",,86364,CPT,Facility,Both,,,90,238,202.3,68.2108,238,"Preferred One Administrative Services, INC.",PPO,234.668,98.6,,percent of total billed charges,,
"Tissue Transglutaminase Ab, Iga/Igg (Mayo)OutsideLaboratory",,86364,CPT,Facility,Outpatient,,,90,238,202.3,68.2108,238,PrimeWest Health,Minnesota Senior Health Options (MSHO),122.451,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Tissue Transglutaminase Ab, Iga/Igg (Mayo)OutsideLaboratory",,86364,CPT,Facility,Inpatient,,,90,238,202.3,68.2108,238,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Tissue Transglutaminase Ab, Iga/Igg (Mayo)OutsideLaboratory",,86364,CPT,Facility,Outpatient,,,90,238,202.3,68.2108,238,PrimeWest Health,MinnesotaCare,122.2368,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Tissue Transglutaminase Ab, Iga/Igg (Mayo)OutsideLaboratory",,86364,CPT,Facility,Inpatient,,,90,238,202.3,68.2108,238,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Tissue Transglutaminase Ab, Iga/Igg (Mayo)OutsideLaboratory",,86364,CPT,Facility,Both,,,90,238,202.3,68.2108,238,Sanford Health Plan,Sanford Health Plan,218.96,92,,percent of total billed charges,,
"Tissue Transglutaminase Ab, Iga/Igg (Mayo)OutsideLaboratory",,86364,CPT,Facility,Outpatient,,,90,238,202.3,68.2108,238,"UCare Health, Inc.",Individual & Family Plan,134.113,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Tissue Transglutaminase Ab, Iga/Igg (Mayo)OutsideLaboratory",,86364,CPT,Facility,Inpatient,,,90,238,202.3,68.2108,238,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Tissue Transglutaminase Ab, Iga/Igg (Mayo)OutsideLaboratory",,86364,CPT,Facility,Outpatient,,,90,238,202.3,68.2108,238,"UCare Health, Inc.",Medical Assistance,120.1186,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Tissue Transglutaminase Ab, Iga/Igg (Mayo)OutsideLaboratory",,86364,CPT,Facility,Inpatient,,,90,238,202.3,68.2108,238,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Tissue Transglutaminase Ab, Iga/Igg (Mayo)OutsideLaboratory",,86364,CPT,Facility,Outpatient,,,90,238,202.3,68.2108,238,"UCare Health, Inc.",Medicare Advantage,120.1186,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Tissue Transglutaminase Ab, Iga/Igg (Mayo)OutsideLaboratory",,86364,CPT,Facility,Inpatient,,,90,238,202.3,68.2108,238,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Tissue Transglutaminase Ab, Iga/Igg (Mayo)OutsideLaboratory",,86364,CPT,Facility,Outpatient,,,90,238,202.3,68.2108,238,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),120.1186,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Tissue Transglutaminase Ab, Iga/Igg (Mayo)OutsideLaboratory",,86364,CPT,Facility,Inpatient,,,90,238,202.3,68.2108,238,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Tissue Transglutaminase Ab, Iga/Igg (Mayo)OutsideLaboratory",,86364,CPT,Facility,Both,,,90,238,202.3,68.2108,238,UnitedHealthcare,Individual & Family,223.72,94,,percent of total billed charges,,
"Tissue Transglutaminase Ab, Iga/Igg (Mayo)OutsideLaboratory",,86364,CPT,Facility,Outpatient,,,90,238,202.3,68.2108,238,UnitedHealthcare,Medicare Advantage,116.62,49,,percent of total billed charges,,
"Tissue Transglutaminase Ab, Iga/Igg (Mayo)OutsideLaboratory",,86364,CPT,Facility,Inpatient,,,90,238,202.3,68.2108,238,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Tissue Transglutaminase Ab, Iga/Igg (Mayo)OutsideLaboratory",,86364,CPT,Facility,Outpatient,,,90,238,202.3,68.2108,238,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,114.24,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Tissue Transglutaminase Ab, Iga/Igg (Mayo)OutsideLaboratory",,86364,CPT,Facility,Inpatient,,,90,238,202.3,68.2108,238,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Tissue Transglutaminase Ab, Igg, S (Mayo)OutsideLaboratory",,86364,CPT,Facility,Both,,,90,160,136,45.856,160,Aetna,Commercial,147.2,92,,percent of total billed charges,,
"Tissue Transglutaminase Ab, Igg, S (Mayo)OutsideLaboratory",,86364,CPT,Facility,Outpatient,,,90,160,136,45.856,160,Aetna,Medicare Advantage,78.4,49,,percent of total billed charges,,
"Tissue Transglutaminase Ab, Igg, S (Mayo)OutsideLaboratory",,86364,CPT,Facility,Inpatient,,,90,160,136,45.856,160,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Tissue Transglutaminase Ab, Igg, S (Mayo)OutsideLaboratory",,86364,CPT,Facility,Both,,,90,160,136,45.856,160,Aetna,PPO,148.8,93,,percent of total billed charges,,
"Tissue Transglutaminase Ab, Igg, S (Mayo)OutsideLaboratory",,86364,CPT,Facility,Both,,,90,160,136,45.856,160,America's PPO,America's PPO,153.648,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Tissue Transglutaminase Ab, Igg, S (Mayo)OutsideLaboratory",,86364,CPT,Facility,Both,,,90,160,136,45.856,160,BlueCross BlueShield Minnesota, Federal Employee Program,157.44,98.4,,percent of total billed charges,,
"Tissue Transglutaminase Ab, Igg, S (Mayo)OutsideLaboratory",,86364,CPT,Facility,Both,,,90,160,136,45.856,160,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,160,100,,percent of total billed charges,,
"Tissue Transglutaminase Ab, Igg, S (Mayo)OutsideLaboratory",,86364,CPT,Facility,Both,,,90,160,136,45.856,160,BlueCross BlueShield Minnesota,High Value Network Plan,144,90,,percent of total billed charges,,
"Tissue Transglutaminase Ab, Igg, S (Mayo)OutsideLaboratory",,86364,CPT,Facility,Outpatient,,,90,160,136,45.856,160,BlueCross BlueShield Minnesota,Medicare Advantage,78.4,49,,percent of total billed charges,,
"Tissue Transglutaminase Ab, Igg, S (Mayo)OutsideLaboratory",,86364,CPT,Facility,Inpatient,,,90,160,136,45.856,160,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Tissue Transglutaminase Ab, Igg, S (Mayo)OutsideLaboratory",,86364,CPT,Facility,Both,,,90,160,136,45.856,160,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,141.712,88.57,,percent of total billed charges,,
"Tissue Transglutaminase Ab, Igg, S (Mayo)OutsideLaboratory",,86364,CPT,Facility,Both,,,90,160,136,45.856,160,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,45.856,28.66,,percent of total billed charges,,
"Tissue Transglutaminase Ab, Igg, S (Mayo)OutsideLaboratory",,86364,CPT,Facility,Outpatient,,,90,160,136,45.856,160,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),78.4,49,,percent of total billed charges,,
"Tissue Transglutaminase Ab, Igg, S (Mayo)OutsideLaboratory",,86364,CPT,Facility,Inpatient,,,90,160,136,45.856,160,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Tissue Transglutaminase Ab, Igg, S (Mayo)OutsideLaboratory",,86364,CPT,Facility,Both,,,90,160,136,45.856,160,CorVel,Worker's Compensation,160,100,,percent of total billed charges,,
"Tissue Transglutaminase Ab, Igg, S (Mayo)OutsideLaboratory",,86364,CPT,Facility,Both,,,90,160,136,45.856,160,First Health Group Corporation,First Health Network,155.2,97,,percent of total billed charges,,
"Tissue Transglutaminase Ab, Igg, S (Mayo)OutsideLaboratory",,86364,CPT,Facility,Both,,,90,160,136,45.856,160,"Health Partners, Inc.",Commercial,151.36,94.6,,percent of total billed charges,,
"Tissue Transglutaminase Ab, Igg, S (Mayo)OutsideLaboratory",,86364,CPT,Facility,Outpatient,,,90,160,136,45.856,160,"Health Partners, Inc.",Medicare Advantage,78.4,49,,percent of total billed charges,,
"Tissue Transglutaminase Ab, Igg, S (Mayo)OutsideLaboratory",,86364,CPT,Facility,Inpatient,,,90,160,136,45.856,160,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Tissue Transglutaminase Ab, Igg, S (Mayo)OutsideLaboratory",,86364,CPT,Facility,Both,,,90,160,136,45.856,160,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),96,60,,percent of total billed charges,,
"Tissue Transglutaminase Ab, Igg, S (Mayo)OutsideLaboratory",,86364,CPT,Facility,Both,,,90,160,136,45.856,160,"Health Partners, Inc.",State of Minnesota Advantage Program,130.4,81.5,,percent of total billed charges,,
"Tissue Transglutaminase Ab, Igg, S (Mayo)OutsideLaboratory",,86364,CPT,Facility,Both,,,90,160,136,45.856,160,"Health Partners, Inc.",State Public Programs,80,50,,percent of total billed charges,,
"Tissue Transglutaminase Ab, Igg, S (Mayo)OutsideLaboratory",,86364,CPT,Facility,Both,,,90,160,136,45.856,160,Humana Insurance Company,Commercial PPO,152,95,,percent of total billed charges,,
"Tissue Transglutaminase Ab, Igg, S (Mayo)OutsideLaboratory",,86364,CPT,Facility,Outpatient,,,90,160,136,45.856,160,Humana Insurance Company,Medicare PPO,78.4,49,,percent of total billed charges,,
"Tissue Transglutaminase Ab, Igg, S (Mayo)OutsideLaboratory",,86364,CPT,Facility,Inpatient,,,90,160,136,45.856,160,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Tissue Transglutaminase Ab, Igg, S (Mayo)OutsideLaboratory",,86364,CPT,Facility,Both,,,90,160,136,45.856,160,Medica,Individual & Family,158.56,99.1,,percent of total billed charges,,
"Tissue Transglutaminase Ab, Igg, S (Mayo)OutsideLaboratory",,86364,CPT,Facility,Outpatient,,,90,160,136,45.856,160,Medica,Medica Advantage Solution,79.68,49.8,,percent of total billed charges,,
"Tissue Transglutaminase Ab, Igg, S (Mayo)OutsideLaboratory",,86364,CPT,Facility,Inpatient,,,90,160,136,45.856,160,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Tissue Transglutaminase Ab, Igg, S (Mayo)OutsideLaboratory",,86364,CPT,Facility,Outpatient,,,90,160,136,45.856,160,Medica,Medical Assistance,71.36,44.6,,percent of total billed charges,,
"Tissue Transglutaminase Ab, Igg, S (Mayo)OutsideLaboratory",,86364,CPT,Facility,Inpatient,,,90,160,136,45.856,160,Medica,Medical Assistance,,,,,Included in per diem rate,
"Tissue Transglutaminase Ab, Igg, S (Mayo)OutsideLaboratory",,86364,CPT,Facility,Outpatient,,,90,160,136,45.856,160,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,79.68,49.8,,percent of total billed charges,,
"Tissue Transglutaminase Ab, Igg, S (Mayo)OutsideLaboratory",,86364,CPT,Facility,Inpatient,,,90,160,136,45.856,160,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Tissue Transglutaminase Ab, Igg, S (Mayo)OutsideLaboratory",,86364,CPT,Facility,Both,,,90,160,136,45.856,160,"Multiplan, Inc.","Multiplan, Inc.",150.4,94,,percent of total billed charges,,
"Tissue Transglutaminase Ab, Igg, S (Mayo)OutsideLaboratory",,86364,CPT,Facility,Outpatient,,,90,160,136,45.856,160,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,138.24,86.4,,percent of total billed charges,,
"Tissue Transglutaminase Ab, Igg, S (Mayo)OutsideLaboratory",,86364,CPT,Facility,Inpatient,,,90,160,136,45.856,160,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Tissue Transglutaminase Ab, Igg, S (Mayo)OutsideLaboratory",,86364,CPT,Facility,Both,,,90,160,136,45.856,160,"Preferred One Administrative Services, INC.",PPO,157.76,98.6,,percent of total billed charges,,
"Tissue Transglutaminase Ab, Igg, S (Mayo)OutsideLaboratory",,86364,CPT,Facility,Outpatient,,,90,160,136,45.856,160,PrimeWest Health,Minnesota Senior Health Options (MSHO),82.32,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Tissue Transglutaminase Ab, Igg, S (Mayo)OutsideLaboratory",,86364,CPT,Facility,Inpatient,,,90,160,136,45.856,160,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Tissue Transglutaminase Ab, Igg, S (Mayo)OutsideLaboratory",,86364,CPT,Facility,Outpatient,,,90,160,136,45.856,160,PrimeWest Health,MinnesotaCare,82.176,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Tissue Transglutaminase Ab, Igg, S (Mayo)OutsideLaboratory",,86364,CPT,Facility,Inpatient,,,90,160,136,45.856,160,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Tissue Transglutaminase Ab, Igg, S (Mayo)OutsideLaboratory",,86364,CPT,Facility,Both,,,90,160,136,45.856,160,Sanford Health Plan,Sanford Health Plan,147.2,92,,percent of total billed charges,,
"Tissue Transglutaminase Ab, Igg, S (Mayo)OutsideLaboratory",,86364,CPT,Facility,Outpatient,,,90,160,136,45.856,160,"UCare Health, Inc.",Individual & Family Plan,90.16,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Tissue Transglutaminase Ab, Igg, S (Mayo)OutsideLaboratory",,86364,CPT,Facility,Inpatient,,,90,160,136,45.856,160,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Tissue Transglutaminase Ab, Igg, S (Mayo)OutsideLaboratory",,86364,CPT,Facility,Outpatient,,,90,160,136,45.856,160,"UCare Health, Inc.",Medical Assistance,80.752,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Tissue Transglutaminase Ab, Igg, S (Mayo)OutsideLaboratory",,86364,CPT,Facility,Inpatient,,,90,160,136,45.856,160,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Tissue Transglutaminase Ab, Igg, S (Mayo)OutsideLaboratory",,86364,CPT,Facility,Outpatient,,,90,160,136,45.856,160,"UCare Health, Inc.",Medicare Advantage,80.752,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Tissue Transglutaminase Ab, Igg, S (Mayo)OutsideLaboratory",,86364,CPT,Facility,Inpatient,,,90,160,136,45.856,160,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Tissue Transglutaminase Ab, Igg, S (Mayo)OutsideLaboratory",,86364,CPT,Facility,Outpatient,,,90,160,136,45.856,160,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),80.752,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Tissue Transglutaminase Ab, Igg, S (Mayo)OutsideLaboratory",,86364,CPT,Facility,Inpatient,,,90,160,136,45.856,160,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Tissue Transglutaminase Ab, Igg, S (Mayo)OutsideLaboratory",,86364,CPT,Facility,Both,,,90,160,136,45.856,160,UnitedHealthcare,Individual & Family,150.4,94,,percent of total billed charges,,
"Tissue Transglutaminase Ab, Igg, S (Mayo)OutsideLaboratory",,86364,CPT,Facility,Outpatient,,,90,160,136,45.856,160,UnitedHealthcare,Medicare Advantage,78.4,49,,percent of total billed charges,,
"Tissue Transglutaminase Ab, Igg, S (Mayo)OutsideLaboratory",,86364,CPT,Facility,Inpatient,,,90,160,136,45.856,160,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Tissue Transglutaminase Ab, Igg, S (Mayo)OutsideLaboratory",,86364,CPT,Facility,Outpatient,,,90,160,136,45.856,160,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,76.8,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Tissue Transglutaminase Ab, Igg, S (Mayo)OutsideLaboratory",,86364,CPT,Facility,Inpatient,,,90,160,136,45.856,160,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Liver/Kidney Microsome Type 1 Ab, S (Mayo)OutsideLaboratory",,86376,CPT,Facility,Both,,,90,67,56.95,19.2022,67,Aetna,Commercial,61.64,92,,percent of total billed charges,,
"Liver/Kidney Microsome Type 1 Ab, S (Mayo)OutsideLaboratory",,86376,CPT,Facility,Outpatient,,,90,67,56.95,19.2022,67,Aetna,Medicare Advantage,32.83,49,,percent of total billed charges,,
"Liver/Kidney Microsome Type 1 Ab, S (Mayo)OutsideLaboratory",,86376,CPT,Facility,Inpatient,,,90,67,56.95,19.2022,67,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Liver/Kidney Microsome Type 1 Ab, S (Mayo)OutsideLaboratory",,86376,CPT,Facility,Both,,,90,67,56.95,19.2022,67,Aetna,PPO,62.31,93,,percent of total billed charges,,
"Liver/Kidney Microsome Type 1 Ab, S (Mayo)OutsideLaboratory",,86376,CPT,Facility,Both,,,90,67,56.95,19.2022,67,America's PPO,America's PPO,64.3401,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Liver/Kidney Microsome Type 1 Ab, S (Mayo)OutsideLaboratory",,86376,CPT,Facility,Both,,,90,67,56.95,19.2022,67,BlueCross BlueShield Minnesota, Federal Employee Program,65.928,98.4,,percent of total billed charges,,
"Liver/Kidney Microsome Type 1 Ab, S (Mayo)OutsideLaboratory",,86376,CPT,Facility,Both,,,90,67,56.95,19.2022,67,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,67,100,,percent of total billed charges,,
"Liver/Kidney Microsome Type 1 Ab, S (Mayo)OutsideLaboratory",,86376,CPT,Facility,Both,,,90,67,56.95,19.2022,67,BlueCross BlueShield Minnesota,High Value Network Plan,60.3,90,,percent of total billed charges,,
"Liver/Kidney Microsome Type 1 Ab, S (Mayo)OutsideLaboratory",,86376,CPT,Facility,Outpatient,,,90,67,56.95,19.2022,67,BlueCross BlueShield Minnesota,Medicare Advantage,32.83,49,,percent of total billed charges,,
"Liver/Kidney Microsome Type 1 Ab, S (Mayo)OutsideLaboratory",,86376,CPT,Facility,Inpatient,,,90,67,56.95,19.2022,67,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Liver/Kidney Microsome Type 1 Ab, S (Mayo)OutsideLaboratory",,86376,CPT,Facility,Both,,,90,67,56.95,19.2022,67,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,59.3419,88.57,,percent of total billed charges,,
"Liver/Kidney Microsome Type 1 Ab, S (Mayo)OutsideLaboratory",,86376,CPT,Facility,Both,,,90,67,56.95,19.2022,67,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,19.2022,28.66,,percent of total billed charges,,
"Liver/Kidney Microsome Type 1 Ab, S (Mayo)OutsideLaboratory",,86376,CPT,Facility,Outpatient,,,90,67,56.95,19.2022,67,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),32.83,49,,percent of total billed charges,,
"Liver/Kidney Microsome Type 1 Ab, S (Mayo)OutsideLaboratory",,86376,CPT,Facility,Inpatient,,,90,67,56.95,19.2022,67,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Liver/Kidney Microsome Type 1 Ab, S (Mayo)OutsideLaboratory",,86376,CPT,Facility,Both,,,90,67,56.95,19.2022,67,CorVel,Worker's Compensation,67,100,,percent of total billed charges,,
"Liver/Kidney Microsome Type 1 Ab, S (Mayo)OutsideLaboratory",,86376,CPT,Facility,Both,,,90,67,56.95,19.2022,67,First Health Group Corporation,First Health Network,64.99,97,,percent of total billed charges,,
"Liver/Kidney Microsome Type 1 Ab, S (Mayo)OutsideLaboratory",,86376,CPT,Facility,Both,,,90,67,56.95,19.2022,67,"Health Partners, Inc.",Commercial,63.382,94.6,,percent of total billed charges,,
"Liver/Kidney Microsome Type 1 Ab, S (Mayo)OutsideLaboratory",,86376,CPT,Facility,Outpatient,,,90,67,56.95,19.2022,67,"Health Partners, Inc.",Medicare Advantage,32.83,49,,percent of total billed charges,,
"Liver/Kidney Microsome Type 1 Ab, S (Mayo)OutsideLaboratory",,86376,CPT,Facility,Inpatient,,,90,67,56.95,19.2022,67,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Liver/Kidney Microsome Type 1 Ab, S (Mayo)OutsideLaboratory",,86376,CPT,Facility,Both,,,90,67,56.95,19.2022,67,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),40.2,60,,percent of total billed charges,,
"Liver/Kidney Microsome Type 1 Ab, S (Mayo)OutsideLaboratory",,86376,CPT,Facility,Both,,,90,67,56.95,19.2022,67,"Health Partners, Inc.",State of Minnesota Advantage Program,54.605,81.5,,percent of total billed charges,,
"Liver/Kidney Microsome Type 1 Ab, S (Mayo)OutsideLaboratory",,86376,CPT,Facility,Both,,,90,67,56.95,19.2022,67,"Health Partners, Inc.",State Public Programs,33.5,50,,percent of total billed charges,,
"Liver/Kidney Microsome Type 1 Ab, S (Mayo)OutsideLaboratory",,86376,CPT,Facility,Both,,,90,67,56.95,19.2022,67,Humana Insurance Company,Commercial PPO,63.65,95,,percent of total billed charges,,
"Liver/Kidney Microsome Type 1 Ab, S (Mayo)OutsideLaboratory",,86376,CPT,Facility,Outpatient,,,90,67,56.95,19.2022,67,Humana Insurance Company,Medicare PPO,32.83,49,,percent of total billed charges,,
"Liver/Kidney Microsome Type 1 Ab, S (Mayo)OutsideLaboratory",,86376,CPT,Facility,Inpatient,,,90,67,56.95,19.2022,67,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Liver/Kidney Microsome Type 1 Ab, S (Mayo)OutsideLaboratory",,86376,CPT,Facility,Both,,,90,67,56.95,19.2022,67,Medica,Individual & Family,66.397,99.1,,percent of total billed charges,,
"Liver/Kidney Microsome Type 1 Ab, S (Mayo)OutsideLaboratory",,86376,CPT,Facility,Outpatient,,,90,67,56.95,19.2022,67,Medica,Medica Advantage Solution,33.366,49.8,,percent of total billed charges,,
"Liver/Kidney Microsome Type 1 Ab, S (Mayo)OutsideLaboratory",,86376,CPT,Facility,Inpatient,,,90,67,56.95,19.2022,67,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Liver/Kidney Microsome Type 1 Ab, S (Mayo)OutsideLaboratory",,86376,CPT,Facility,Outpatient,,,90,67,56.95,19.2022,67,Medica,Medical Assistance,29.882,44.6,,percent of total billed charges,,
"Liver/Kidney Microsome Type 1 Ab, S (Mayo)OutsideLaboratory",,86376,CPT,Facility,Inpatient,,,90,67,56.95,19.2022,67,Medica,Medical Assistance,,,,,Included in per diem rate,
"Liver/Kidney Microsome Type 1 Ab, S (Mayo)OutsideLaboratory",,86376,CPT,Facility,Outpatient,,,90,67,56.95,19.2022,67,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,33.366,49.8,,percent of total billed charges,,
"Liver/Kidney Microsome Type 1 Ab, S (Mayo)OutsideLaboratory",,86376,CPT,Facility,Inpatient,,,90,67,56.95,19.2022,67,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Liver/Kidney Microsome Type 1 Ab, S (Mayo)OutsideLaboratory",,86376,CPT,Facility,Both,,,90,67,56.95,19.2022,67,"Multiplan, Inc.","Multiplan, Inc.",62.98,94,,percent of total billed charges,,
"Liver/Kidney Microsome Type 1 Ab, S (Mayo)OutsideLaboratory",,86376,CPT,Facility,Outpatient,,,90,67,56.95,19.2022,67,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,57.888,86.4,,percent of total billed charges,,
"Liver/Kidney Microsome Type 1 Ab, S (Mayo)OutsideLaboratory",,86376,CPT,Facility,Inpatient,,,90,67,56.95,19.2022,67,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Liver/Kidney Microsome Type 1 Ab, S (Mayo)OutsideLaboratory",,86376,CPT,Facility,Both,,,90,67,56.95,19.2022,67,"Preferred One Administrative Services, INC.",PPO,66.062,98.6,,percent of total billed charges,,
"Liver/Kidney Microsome Type 1 Ab, S (Mayo)OutsideLaboratory",,86376,CPT,Facility,Outpatient,,,90,67,56.95,19.2022,67,PrimeWest Health,Minnesota Senior Health Options (MSHO),34.4715,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Liver/Kidney Microsome Type 1 Ab, S (Mayo)OutsideLaboratory",,86376,CPT,Facility,Inpatient,,,90,67,56.95,19.2022,67,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Liver/Kidney Microsome Type 1 Ab, S (Mayo)OutsideLaboratory",,86376,CPT,Facility,Outpatient,,,90,67,56.95,19.2022,67,PrimeWest Health,MinnesotaCare,34.4112,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Liver/Kidney Microsome Type 1 Ab, S (Mayo)OutsideLaboratory",,86376,CPT,Facility,Inpatient,,,90,67,56.95,19.2022,67,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Liver/Kidney Microsome Type 1 Ab, S (Mayo)OutsideLaboratory",,86376,CPT,Facility,Both,,,90,67,56.95,19.2022,67,Sanford Health Plan,Sanford Health Plan,61.64,92,,percent of total billed charges,,
"Liver/Kidney Microsome Type 1 Ab, S (Mayo)OutsideLaboratory",,86376,CPT,Facility,Outpatient,,,90,67,56.95,19.2022,67,"UCare Health, Inc.",Individual & Family Plan,37.7545,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Liver/Kidney Microsome Type 1 Ab, S (Mayo)OutsideLaboratory",,86376,CPT,Facility,Inpatient,,,90,67,56.95,19.2022,67,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Liver/Kidney Microsome Type 1 Ab, S (Mayo)OutsideLaboratory",,86376,CPT,Facility,Outpatient,,,90,67,56.95,19.2022,67,"UCare Health, Inc.",Medical Assistance,33.8149,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Liver/Kidney Microsome Type 1 Ab, S (Mayo)OutsideLaboratory",,86376,CPT,Facility,Inpatient,,,90,67,56.95,19.2022,67,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Liver/Kidney Microsome Type 1 Ab, S (Mayo)OutsideLaboratory",,86376,CPT,Facility,Outpatient,,,90,67,56.95,19.2022,67,"UCare Health, Inc.",Medicare Advantage,33.8149,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Liver/Kidney Microsome Type 1 Ab, S (Mayo)OutsideLaboratory",,86376,CPT,Facility,Inpatient,,,90,67,56.95,19.2022,67,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Liver/Kidney Microsome Type 1 Ab, S (Mayo)OutsideLaboratory",,86376,CPT,Facility,Outpatient,,,90,67,56.95,19.2022,67,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),33.8149,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Liver/Kidney Microsome Type 1 Ab, S (Mayo)OutsideLaboratory",,86376,CPT,Facility,Inpatient,,,90,67,56.95,19.2022,67,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Liver/Kidney Microsome Type 1 Ab, S (Mayo)OutsideLaboratory",,86376,CPT,Facility,Both,,,90,67,56.95,19.2022,67,UnitedHealthcare,Individual & Family,62.98,94,,percent of total billed charges,,
"Liver/Kidney Microsome Type 1 Ab, S (Mayo)OutsideLaboratory",,86376,CPT,Facility,Outpatient,,,90,67,56.95,19.2022,67,UnitedHealthcare,Medicare Advantage,32.83,49,,percent of total billed charges,,
"Liver/Kidney Microsome Type 1 Ab, S (Mayo)OutsideLaboratory",,86376,CPT,Facility,Inpatient,,,90,67,56.95,19.2022,67,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Liver/Kidney Microsome Type 1 Ab, S (Mayo)OutsideLaboratory",,86376,CPT,Facility,Outpatient,,,90,67,56.95,19.2022,67,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,32.16,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Liver/Kidney Microsome Type 1 Ab, S (Mayo)OutsideLaboratory",,86376,CPT,Facility,Inpatient,,,90,67,56.95,19.2022,67,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Microsomal Antibodies (Eg, Thyroid Or Liver-Kidney), Each (Mayo)OutsideLaboratory",,86376,CPT,Facility,Both,,,90,136,115.6,38.9776,136,Aetna,Commercial,125.12,92,,percent of total billed charges,,
"Microsomal Antibodies (Eg, Thyroid Or Liver-Kidney), Each (Mayo)OutsideLaboratory",,86376,CPT,Facility,Outpatient,,,90,136,115.6,38.9776,136,Aetna,Medicare Advantage,66.64,49,,percent of total billed charges,,
"Microsomal Antibodies (Eg, Thyroid Or Liver-Kidney), Each (Mayo)OutsideLaboratory",,86376,CPT,Facility,Inpatient,,,90,136,115.6,38.9776,136,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Microsomal Antibodies (Eg, Thyroid Or Liver-Kidney), Each (Mayo)OutsideLaboratory",,86376,CPT,Facility,Both,,,90,136,115.6,38.9776,136,Aetna,PPO,126.48,93,,percent of total billed charges,,
"Microsomal Antibodies (Eg, Thyroid Or Liver-Kidney), Each (Mayo)OutsideLaboratory",,86376,CPT,Facility,Both,,,90,136,115.6,38.9776,136,America's PPO,America's PPO,130.6008,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Microsomal Antibodies (Eg, Thyroid Or Liver-Kidney), Each (Mayo)OutsideLaboratory",,86376,CPT,Facility,Both,,,90,136,115.6,38.9776,136,BlueCross BlueShield Minnesota, Federal Employee Program,133.824,98.4,,percent of total billed charges,,
"Microsomal Antibodies (Eg, Thyroid Or Liver-Kidney), Each (Mayo)OutsideLaboratory",,86376,CPT,Facility,Both,,,90,136,115.6,38.9776,136,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,136,100,,percent of total billed charges,,
"Microsomal Antibodies (Eg, Thyroid Or Liver-Kidney), Each (Mayo)OutsideLaboratory",,86376,CPT,Facility,Both,,,90,136,115.6,38.9776,136,BlueCross BlueShield Minnesota,High Value Network Plan,122.4,90,,percent of total billed charges,,
"Microsomal Antibodies (Eg, Thyroid Or Liver-Kidney), Each (Mayo)OutsideLaboratory",,86376,CPT,Facility,Outpatient,,,90,136,115.6,38.9776,136,BlueCross BlueShield Minnesota,Medicare Advantage,66.64,49,,percent of total billed charges,,
"Microsomal Antibodies (Eg, Thyroid Or Liver-Kidney), Each (Mayo)OutsideLaboratory",,86376,CPT,Facility,Inpatient,,,90,136,115.6,38.9776,136,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Microsomal Antibodies (Eg, Thyroid Or Liver-Kidney), Each (Mayo)OutsideLaboratory",,86376,CPT,Facility,Both,,,90,136,115.6,38.9776,136,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,120.4552,88.57,,percent of total billed charges,,
"Microsomal Antibodies (Eg, Thyroid Or Liver-Kidney), Each (Mayo)OutsideLaboratory",,86376,CPT,Facility,Both,,,90,136,115.6,38.9776,136,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,38.9776,28.66,,percent of total billed charges,,
"Microsomal Antibodies (Eg, Thyroid Or Liver-Kidney), Each (Mayo)OutsideLaboratory",,86376,CPT,Facility,Outpatient,,,90,136,115.6,38.9776,136,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),66.64,49,,percent of total billed charges,,
"Microsomal Antibodies (Eg, Thyroid Or Liver-Kidney), Each (Mayo)OutsideLaboratory",,86376,CPT,Facility,Inpatient,,,90,136,115.6,38.9776,136,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Microsomal Antibodies (Eg, Thyroid Or Liver-Kidney), Each (Mayo)OutsideLaboratory",,86376,CPT,Facility,Both,,,90,136,115.6,38.9776,136,CorVel,Worker's Compensation,136,100,,percent of total billed charges,,
"Microsomal Antibodies (Eg, Thyroid Or Liver-Kidney), Each (Mayo)OutsideLaboratory",,86376,CPT,Facility,Both,,,90,136,115.6,38.9776,136,First Health Group Corporation,First Health Network,131.92,97,,percent of total billed charges,,
"Microsomal Antibodies (Eg, Thyroid Or Liver-Kidney), Each (Mayo)OutsideLaboratory",,86376,CPT,Facility,Both,,,90,136,115.6,38.9776,136,"Health Partners, Inc.",Commercial,128.656,94.6,,percent of total billed charges,,
"Microsomal Antibodies (Eg, Thyroid Or Liver-Kidney), Each (Mayo)OutsideLaboratory",,86376,CPT,Facility,Outpatient,,,90,136,115.6,38.9776,136,"Health Partners, Inc.",Medicare Advantage,66.64,49,,percent of total billed charges,,
"Microsomal Antibodies (Eg, Thyroid Or Liver-Kidney), Each (Mayo)OutsideLaboratory",,86376,CPT,Facility,Inpatient,,,90,136,115.6,38.9776,136,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Microsomal Antibodies (Eg, Thyroid Or Liver-Kidney), Each (Mayo)OutsideLaboratory",,86376,CPT,Facility,Both,,,90,136,115.6,38.9776,136,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),81.6,60,,percent of total billed charges,,
"Microsomal Antibodies (Eg, Thyroid Or Liver-Kidney), Each (Mayo)OutsideLaboratory",,86376,CPT,Facility,Both,,,90,136,115.6,38.9776,136,"Health Partners, Inc.",State of Minnesota Advantage Program,110.84,81.5,,percent of total billed charges,,
"Microsomal Antibodies (Eg, Thyroid Or Liver-Kidney), Each (Mayo)OutsideLaboratory",,86376,CPT,Facility,Both,,,90,136,115.6,38.9776,136,"Health Partners, Inc.",State Public Programs,68,50,,percent of total billed charges,,
"Microsomal Antibodies (Eg, Thyroid Or Liver-Kidney), Each (Mayo)OutsideLaboratory",,86376,CPT,Facility,Both,,,90,136,115.6,38.9776,136,Humana Insurance Company,Commercial PPO,129.2,95,,percent of total billed charges,,
"Microsomal Antibodies (Eg, Thyroid Or Liver-Kidney), Each (Mayo)OutsideLaboratory",,86376,CPT,Facility,Outpatient,,,90,136,115.6,38.9776,136,Humana Insurance Company,Medicare PPO,66.64,49,,percent of total billed charges,,
"Microsomal Antibodies (Eg, Thyroid Or Liver-Kidney), Each (Mayo)OutsideLaboratory",,86376,CPT,Facility,Inpatient,,,90,136,115.6,38.9776,136,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Microsomal Antibodies (Eg, Thyroid Or Liver-Kidney), Each (Mayo)OutsideLaboratory",,86376,CPT,Facility,Both,,,90,136,115.6,38.9776,136,Medica,Individual & Family,134.776,99.1,,percent of total billed charges,,
"Microsomal Antibodies (Eg, Thyroid Or Liver-Kidney), Each (Mayo)OutsideLaboratory",,86376,CPT,Facility,Outpatient,,,90,136,115.6,38.9776,136,Medica,Medica Advantage Solution,67.728,49.8,,percent of total billed charges,,
"Microsomal Antibodies (Eg, Thyroid Or Liver-Kidney), Each (Mayo)OutsideLaboratory",,86376,CPT,Facility,Inpatient,,,90,136,115.6,38.9776,136,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Microsomal Antibodies (Eg, Thyroid Or Liver-Kidney), Each (Mayo)OutsideLaboratory",,86376,CPT,Facility,Outpatient,,,90,136,115.6,38.9776,136,Medica,Medical Assistance,60.656,44.6,,percent of total billed charges,,
"Microsomal Antibodies (Eg, Thyroid Or Liver-Kidney), Each (Mayo)OutsideLaboratory",,86376,CPT,Facility,Inpatient,,,90,136,115.6,38.9776,136,Medica,Medical Assistance,,,,,Included in per diem rate,
"Microsomal Antibodies (Eg, Thyroid Or Liver-Kidney), Each (Mayo)OutsideLaboratory",,86376,CPT,Facility,Outpatient,,,90,136,115.6,38.9776,136,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,67.728,49.8,,percent of total billed charges,,
"Microsomal Antibodies (Eg, Thyroid Or Liver-Kidney), Each (Mayo)OutsideLaboratory",,86376,CPT,Facility,Inpatient,,,90,136,115.6,38.9776,136,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Microsomal Antibodies (Eg, Thyroid Or Liver-Kidney), Each (Mayo)OutsideLaboratory",,86376,CPT,Facility,Both,,,90,136,115.6,38.9776,136,"Multiplan, Inc.","Multiplan, Inc.",127.84,94,,percent of total billed charges,,
"Microsomal Antibodies (Eg, Thyroid Or Liver-Kidney), Each (Mayo)OutsideLaboratory",,86376,CPT,Facility,Outpatient,,,90,136,115.6,38.9776,136,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,117.504,86.4,,percent of total billed charges,,
"Microsomal Antibodies (Eg, Thyroid Or Liver-Kidney), Each (Mayo)OutsideLaboratory",,86376,CPT,Facility,Inpatient,,,90,136,115.6,38.9776,136,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Microsomal Antibodies (Eg, Thyroid Or Liver-Kidney), Each (Mayo)OutsideLaboratory",,86376,CPT,Facility,Both,,,90,136,115.6,38.9776,136,"Preferred One Administrative Services, INC.",PPO,134.096,98.6,,percent of total billed charges,,
"Microsomal Antibodies (Eg, Thyroid Or Liver-Kidney), Each (Mayo)OutsideLaboratory",,86376,CPT,Facility,Outpatient,,,90,136,115.6,38.9776,136,PrimeWest Health,Minnesota Senior Health Options (MSHO),69.972,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Microsomal Antibodies (Eg, Thyroid Or Liver-Kidney), Each (Mayo)OutsideLaboratory",,86376,CPT,Facility,Inpatient,,,90,136,115.6,38.9776,136,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Microsomal Antibodies (Eg, Thyroid Or Liver-Kidney), Each (Mayo)OutsideLaboratory",,86376,CPT,Facility,Outpatient,,,90,136,115.6,38.9776,136,PrimeWest Health,MinnesotaCare,69.8496,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Microsomal Antibodies (Eg, Thyroid Or Liver-Kidney), Each (Mayo)OutsideLaboratory",,86376,CPT,Facility,Inpatient,,,90,136,115.6,38.9776,136,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Microsomal Antibodies (Eg, Thyroid Or Liver-Kidney), Each (Mayo)OutsideLaboratory",,86376,CPT,Facility,Both,,,90,136,115.6,38.9776,136,Sanford Health Plan,Sanford Health Plan,125.12,92,,percent of total billed charges,,
"Microsomal Antibodies (Eg, Thyroid Or Liver-Kidney), Each (Mayo)OutsideLaboratory",,86376,CPT,Facility,Outpatient,,,90,136,115.6,38.9776,136,"UCare Health, Inc.",Individual & Family Plan,76.636,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Microsomal Antibodies (Eg, Thyroid Or Liver-Kidney), Each (Mayo)OutsideLaboratory",,86376,CPT,Facility,Inpatient,,,90,136,115.6,38.9776,136,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Microsomal Antibodies (Eg, Thyroid Or Liver-Kidney), Each (Mayo)OutsideLaboratory",,86376,CPT,Facility,Outpatient,,,90,136,115.6,38.9776,136,"UCare Health, Inc.",Medical Assistance,68.6392,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Microsomal Antibodies (Eg, Thyroid Or Liver-Kidney), Each (Mayo)OutsideLaboratory",,86376,CPT,Facility,Inpatient,,,90,136,115.6,38.9776,136,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Microsomal Antibodies (Eg, Thyroid Or Liver-Kidney), Each (Mayo)OutsideLaboratory",,86376,CPT,Facility,Outpatient,,,90,136,115.6,38.9776,136,"UCare Health, Inc.",Medicare Advantage,68.6392,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Microsomal Antibodies (Eg, Thyroid Or Liver-Kidney), Each (Mayo)OutsideLaboratory",,86376,CPT,Facility,Inpatient,,,90,136,115.6,38.9776,136,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Microsomal Antibodies (Eg, Thyroid Or Liver-Kidney), Each (Mayo)OutsideLaboratory",,86376,CPT,Facility,Outpatient,,,90,136,115.6,38.9776,136,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),68.6392,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Microsomal Antibodies (Eg, Thyroid Or Liver-Kidney), Each (Mayo)OutsideLaboratory",,86376,CPT,Facility,Inpatient,,,90,136,115.6,38.9776,136,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Microsomal Antibodies (Eg, Thyroid Or Liver-Kidney), Each (Mayo)OutsideLaboratory",,86376,CPT,Facility,Both,,,90,136,115.6,38.9776,136,UnitedHealthcare,Individual & Family,127.84,94,,percent of total billed charges,,
"Microsomal Antibodies (Eg, Thyroid Or Liver-Kidney), Each (Mayo)OutsideLaboratory",,86376,CPT,Facility,Outpatient,,,90,136,115.6,38.9776,136,UnitedHealthcare,Medicare Advantage,66.64,49,,percent of total billed charges,,
"Microsomal Antibodies (Eg, Thyroid Or Liver-Kidney), Each (Mayo)OutsideLaboratory",,86376,CPT,Facility,Inpatient,,,90,136,115.6,38.9776,136,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Microsomal Antibodies (Eg, Thyroid Or Liver-Kidney), Each (Mayo)OutsideLaboratory",,86376,CPT,Facility,Outpatient,,,90,136,115.6,38.9776,136,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,65.28,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Microsomal Antibodies (Eg, Thyroid Or Liver-Kidney), Each (Mayo)OutsideLaboratory",,86376,CPT,Facility,Inpatient,,,90,136,115.6,38.9776,136,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Thyroperoxidase Ab, S (Mayo)OutsideLaboratory",,86376,CPT,Facility,Both,,,90,136,115.6,38.9776,136,Aetna,Commercial,125.12,92,,percent of total billed charges,,
"Thyroperoxidase Ab, S (Mayo)OutsideLaboratory",,86376,CPT,Facility,Outpatient,,,90,136,115.6,38.9776,136,Aetna,Medicare Advantage,66.64,49,,percent of total billed charges,,
"Thyroperoxidase Ab, S (Mayo)OutsideLaboratory",,86376,CPT,Facility,Inpatient,,,90,136,115.6,38.9776,136,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Thyroperoxidase Ab, S (Mayo)OutsideLaboratory",,86376,CPT,Facility,Both,,,90,136,115.6,38.9776,136,Aetna,PPO,126.48,93,,percent of total billed charges,,
"Thyroperoxidase Ab, S (Mayo)OutsideLaboratory",,86376,CPT,Facility,Both,,,90,136,115.6,38.9776,136,America's PPO,America's PPO,130.6008,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Thyroperoxidase Ab, S (Mayo)OutsideLaboratory",,86376,CPT,Facility,Both,,,90,136,115.6,38.9776,136,BlueCross BlueShield Minnesota, Federal Employee Program,133.824,98.4,,percent of total billed charges,,
"Thyroperoxidase Ab, S (Mayo)OutsideLaboratory",,86376,CPT,Facility,Both,,,90,136,115.6,38.9776,136,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,136,100,,percent of total billed charges,,
"Thyroperoxidase Ab, S (Mayo)OutsideLaboratory",,86376,CPT,Facility,Both,,,90,136,115.6,38.9776,136,BlueCross BlueShield Minnesota,High Value Network Plan,122.4,90,,percent of total billed charges,,
"Thyroperoxidase Ab, S (Mayo)OutsideLaboratory",,86376,CPT,Facility,Outpatient,,,90,136,115.6,38.9776,136,BlueCross BlueShield Minnesota,Medicare Advantage,66.64,49,,percent of total billed charges,,
"Thyroperoxidase Ab, S (Mayo)OutsideLaboratory",,86376,CPT,Facility,Inpatient,,,90,136,115.6,38.9776,136,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Thyroperoxidase Ab, S (Mayo)OutsideLaboratory",,86376,CPT,Facility,Both,,,90,136,115.6,38.9776,136,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,120.4552,88.57,,percent of total billed charges,,
"Thyroperoxidase Ab, S (Mayo)OutsideLaboratory",,86376,CPT,Facility,Both,,,90,136,115.6,38.9776,136,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,38.9776,28.66,,percent of total billed charges,,
"Thyroperoxidase Ab, S (Mayo)OutsideLaboratory",,86376,CPT,Facility,Outpatient,,,90,136,115.6,38.9776,136,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),66.64,49,,percent of total billed charges,,
"Thyroperoxidase Ab, S (Mayo)OutsideLaboratory",,86376,CPT,Facility,Inpatient,,,90,136,115.6,38.9776,136,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Thyroperoxidase Ab, S (Mayo)OutsideLaboratory",,86376,CPT,Facility,Both,,,90,136,115.6,38.9776,136,CorVel,Worker's Compensation,136,100,,percent of total billed charges,,
"Thyroperoxidase Ab, S (Mayo)OutsideLaboratory",,86376,CPT,Facility,Both,,,90,136,115.6,38.9776,136,First Health Group Corporation,First Health Network,131.92,97,,percent of total billed charges,,
"Thyroperoxidase Ab, S (Mayo)OutsideLaboratory",,86376,CPT,Facility,Both,,,90,136,115.6,38.9776,136,"Health Partners, Inc.",Commercial,128.656,94.6,,percent of total billed charges,,
"Thyroperoxidase Ab, S (Mayo)OutsideLaboratory",,86376,CPT,Facility,Outpatient,,,90,136,115.6,38.9776,136,"Health Partners, Inc.",Medicare Advantage,66.64,49,,percent of total billed charges,,
"Thyroperoxidase Ab, S (Mayo)OutsideLaboratory",,86376,CPT,Facility,Inpatient,,,90,136,115.6,38.9776,136,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Thyroperoxidase Ab, S (Mayo)OutsideLaboratory",,86376,CPT,Facility,Both,,,90,136,115.6,38.9776,136,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),81.6,60,,percent of total billed charges,,
"Thyroperoxidase Ab, S (Mayo)OutsideLaboratory",,86376,CPT,Facility,Both,,,90,136,115.6,38.9776,136,"Health Partners, Inc.",State of Minnesota Advantage Program,110.84,81.5,,percent of total billed charges,,
"Thyroperoxidase Ab, S (Mayo)OutsideLaboratory",,86376,CPT,Facility,Both,,,90,136,115.6,38.9776,136,"Health Partners, Inc.",State Public Programs,68,50,,percent of total billed charges,,
"Thyroperoxidase Ab, S (Mayo)OutsideLaboratory",,86376,CPT,Facility,Both,,,90,136,115.6,38.9776,136,Humana Insurance Company,Commercial PPO,129.2,95,,percent of total billed charges,,
"Thyroperoxidase Ab, S (Mayo)OutsideLaboratory",,86376,CPT,Facility,Outpatient,,,90,136,115.6,38.9776,136,Humana Insurance Company,Medicare PPO,66.64,49,,percent of total billed charges,,
"Thyroperoxidase Ab, S (Mayo)OutsideLaboratory",,86376,CPT,Facility,Inpatient,,,90,136,115.6,38.9776,136,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Thyroperoxidase Ab, S (Mayo)OutsideLaboratory",,86376,CPT,Facility,Both,,,90,136,115.6,38.9776,136,Medica,Individual & Family,134.776,99.1,,percent of total billed charges,,
"Thyroperoxidase Ab, S (Mayo)OutsideLaboratory",,86376,CPT,Facility,Outpatient,,,90,136,115.6,38.9776,136,Medica,Medica Advantage Solution,67.728,49.8,,percent of total billed charges,,
"Thyroperoxidase Ab, S (Mayo)OutsideLaboratory",,86376,CPT,Facility,Inpatient,,,90,136,115.6,38.9776,136,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Thyroperoxidase Ab, S (Mayo)OutsideLaboratory",,86376,CPT,Facility,Outpatient,,,90,136,115.6,38.9776,136,Medica,Medical Assistance,60.656,44.6,,percent of total billed charges,,
"Thyroperoxidase Ab, S (Mayo)OutsideLaboratory",,86376,CPT,Facility,Inpatient,,,90,136,115.6,38.9776,136,Medica,Medical Assistance,,,,,Included in per diem rate,
"Thyroperoxidase Ab, S (Mayo)OutsideLaboratory",,86376,CPT,Facility,Outpatient,,,90,136,115.6,38.9776,136,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,67.728,49.8,,percent of total billed charges,,
"Thyroperoxidase Ab, S (Mayo)OutsideLaboratory",,86376,CPT,Facility,Inpatient,,,90,136,115.6,38.9776,136,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Thyroperoxidase Ab, S (Mayo)OutsideLaboratory",,86376,CPT,Facility,Both,,,90,136,115.6,38.9776,136,"Multiplan, Inc.","Multiplan, Inc.",127.84,94,,percent of total billed charges,,
"Thyroperoxidase Ab, S (Mayo)OutsideLaboratory",,86376,CPT,Facility,Outpatient,,,90,136,115.6,38.9776,136,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,117.504,86.4,,percent of total billed charges,,
"Thyroperoxidase Ab, S (Mayo)OutsideLaboratory",,86376,CPT,Facility,Inpatient,,,90,136,115.6,38.9776,136,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Thyroperoxidase Ab, S (Mayo)OutsideLaboratory",,86376,CPT,Facility,Both,,,90,136,115.6,38.9776,136,"Preferred One Administrative Services, INC.",PPO,134.096,98.6,,percent of total billed charges,,
"Thyroperoxidase Ab, S (Mayo)OutsideLaboratory",,86376,CPT,Facility,Outpatient,,,90,136,115.6,38.9776,136,PrimeWest Health,Minnesota Senior Health Options (MSHO),69.972,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Thyroperoxidase Ab, S (Mayo)OutsideLaboratory",,86376,CPT,Facility,Inpatient,,,90,136,115.6,38.9776,136,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Thyroperoxidase Ab, S (Mayo)OutsideLaboratory",,86376,CPT,Facility,Outpatient,,,90,136,115.6,38.9776,136,PrimeWest Health,MinnesotaCare,69.8496,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Thyroperoxidase Ab, S (Mayo)OutsideLaboratory",,86376,CPT,Facility,Inpatient,,,90,136,115.6,38.9776,136,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Thyroperoxidase Ab, S (Mayo)OutsideLaboratory",,86376,CPT,Facility,Both,,,90,136,115.6,38.9776,136,Sanford Health Plan,Sanford Health Plan,125.12,92,,percent of total billed charges,,
"Thyroperoxidase Ab, S (Mayo)OutsideLaboratory",,86376,CPT,Facility,Outpatient,,,90,136,115.6,38.9776,136,"UCare Health, Inc.",Individual & Family Plan,76.636,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Thyroperoxidase Ab, S (Mayo)OutsideLaboratory",,86376,CPT,Facility,Inpatient,,,90,136,115.6,38.9776,136,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Thyroperoxidase Ab, S (Mayo)OutsideLaboratory",,86376,CPT,Facility,Outpatient,,,90,136,115.6,38.9776,136,"UCare Health, Inc.",Medical Assistance,68.6392,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Thyroperoxidase Ab, S (Mayo)OutsideLaboratory",,86376,CPT,Facility,Inpatient,,,90,136,115.6,38.9776,136,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Thyroperoxidase Ab, S (Mayo)OutsideLaboratory",,86376,CPT,Facility,Outpatient,,,90,136,115.6,38.9776,136,"UCare Health, Inc.",Medicare Advantage,68.6392,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Thyroperoxidase Ab, S (Mayo)OutsideLaboratory",,86376,CPT,Facility,Inpatient,,,90,136,115.6,38.9776,136,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Thyroperoxidase Ab, S (Mayo)OutsideLaboratory",,86376,CPT,Facility,Outpatient,,,90,136,115.6,38.9776,136,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),68.6392,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Thyroperoxidase Ab, S (Mayo)OutsideLaboratory",,86376,CPT,Facility,Inpatient,,,90,136,115.6,38.9776,136,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Thyroperoxidase Ab, S (Mayo)OutsideLaboratory",,86376,CPT,Facility,Both,,,90,136,115.6,38.9776,136,UnitedHealthcare,Individual & Family,127.84,94,,percent of total billed charges,,
"Thyroperoxidase Ab, S (Mayo)OutsideLaboratory",,86376,CPT,Facility,Outpatient,,,90,136,115.6,38.9776,136,UnitedHealthcare,Medicare Advantage,66.64,49,,percent of total billed charges,,
"Thyroperoxidase Ab, S (Mayo)OutsideLaboratory",,86376,CPT,Facility,Inpatient,,,90,136,115.6,38.9776,136,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Thyroperoxidase Ab, S (Mayo)OutsideLaboratory",,86376,CPT,Facility,Outpatient,,,90,136,115.6,38.9776,136,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,65.28,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Thyroperoxidase Ab, S (Mayo)OutsideLaboratory",,86376,CPT,Facility,Inpatient,,,90,136,115.6,38.9776,136,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Mitochondrial Ab, M2, S (Mayo)OutsideLaboratory",,86381,CPT,Facility,Both,,,90,43,36.55,12.3238,43,Aetna,Commercial,39.56,92,,percent of total billed charges,,
"Mitochondrial Ab, M2, S (Mayo)OutsideLaboratory",,86381,CPT,Facility,Outpatient,,,90,43,36.55,12.3238,43,Aetna,Medicare Advantage,21.07,49,,percent of total billed charges,,
"Mitochondrial Ab, M2, S (Mayo)OutsideLaboratory",,86381,CPT,Facility,Inpatient,,,90,43,36.55,12.3238,43,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Mitochondrial Ab, M2, S (Mayo)OutsideLaboratory",,86381,CPT,Facility,Both,,,90,43,36.55,12.3238,43,Aetna,PPO,39.99,93,,percent of total billed charges,,
"Mitochondrial Ab, M2, S (Mayo)OutsideLaboratory",,86381,CPT,Facility,Both,,,90,43,36.55,12.3238,43,America's PPO,America's PPO,41.2929,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Mitochondrial Ab, M2, S (Mayo)OutsideLaboratory",,86381,CPT,Facility,Both,,,90,43,36.55,12.3238,43,BlueCross BlueShield Minnesota, Federal Employee Program,42.312,98.4,,percent of total billed charges,,
"Mitochondrial Ab, M2, S (Mayo)OutsideLaboratory",,86381,CPT,Facility,Both,,,90,43,36.55,12.3238,43,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,43,100,,percent of total billed charges,,
"Mitochondrial Ab, M2, S (Mayo)OutsideLaboratory",,86381,CPT,Facility,Both,,,90,43,36.55,12.3238,43,BlueCross BlueShield Minnesota,High Value Network Plan,38.7,90,,percent of total billed charges,,
"Mitochondrial Ab, M2, S (Mayo)OutsideLaboratory",,86381,CPT,Facility,Outpatient,,,90,43,36.55,12.3238,43,BlueCross BlueShield Minnesota,Medicare Advantage,21.07,49,,percent of total billed charges,,
"Mitochondrial Ab, M2, S (Mayo)OutsideLaboratory",,86381,CPT,Facility,Inpatient,,,90,43,36.55,12.3238,43,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Mitochondrial Ab, M2, S (Mayo)OutsideLaboratory",,86381,CPT,Facility,Both,,,90,43,36.55,12.3238,43,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,38.0851,88.57,,percent of total billed charges,,
"Mitochondrial Ab, M2, S (Mayo)OutsideLaboratory",,86381,CPT,Facility,Both,,,90,43,36.55,12.3238,43,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,12.3238,28.66,,percent of total billed charges,,
"Mitochondrial Ab, M2, S (Mayo)OutsideLaboratory",,86381,CPT,Facility,Outpatient,,,90,43,36.55,12.3238,43,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),21.07,49,,percent of total billed charges,,
"Mitochondrial Ab, M2, S (Mayo)OutsideLaboratory",,86381,CPT,Facility,Inpatient,,,90,43,36.55,12.3238,43,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Mitochondrial Ab, M2, S (Mayo)OutsideLaboratory",,86381,CPT,Facility,Both,,,90,43,36.55,12.3238,43,CorVel,Worker's Compensation,43,100,,percent of total billed charges,,
"Mitochondrial Ab, M2, S (Mayo)OutsideLaboratory",,86381,CPT,Facility,Both,,,90,43,36.55,12.3238,43,First Health Group Corporation,First Health Network,41.71,97,,percent of total billed charges,,
"Mitochondrial Ab, M2, S (Mayo)OutsideLaboratory",,86381,CPT,Facility,Both,,,90,43,36.55,12.3238,43,"Health Partners, Inc.",Commercial,40.678,94.6,,percent of total billed charges,,
"Mitochondrial Ab, M2, S (Mayo)OutsideLaboratory",,86381,CPT,Facility,Outpatient,,,90,43,36.55,12.3238,43,"Health Partners, Inc.",Medicare Advantage,21.07,49,,percent of total billed charges,,
"Mitochondrial Ab, M2, S (Mayo)OutsideLaboratory",,86381,CPT,Facility,Inpatient,,,90,43,36.55,12.3238,43,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Mitochondrial Ab, M2, S (Mayo)OutsideLaboratory",,86381,CPT,Facility,Both,,,90,43,36.55,12.3238,43,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),25.8,60,,percent of total billed charges,,
"Mitochondrial Ab, M2, S (Mayo)OutsideLaboratory",,86381,CPT,Facility,Both,,,90,43,36.55,12.3238,43,"Health Partners, Inc.",State of Minnesota Advantage Program,35.045,81.5,,percent of total billed charges,,
"Mitochondrial Ab, M2, S (Mayo)OutsideLaboratory",,86381,CPT,Facility,Both,,,90,43,36.55,12.3238,43,"Health Partners, Inc.",State Public Programs,21.5,50,,percent of total billed charges,,
"Mitochondrial Ab, M2, S (Mayo)OutsideLaboratory",,86381,CPT,Facility,Both,,,90,43,36.55,12.3238,43,Humana Insurance Company,Commercial PPO,40.85,95,,percent of total billed charges,,
"Mitochondrial Ab, M2, S (Mayo)OutsideLaboratory",,86381,CPT,Facility,Outpatient,,,90,43,36.55,12.3238,43,Humana Insurance Company,Medicare PPO,21.07,49,,percent of total billed charges,,
"Mitochondrial Ab, M2, S (Mayo)OutsideLaboratory",,86381,CPT,Facility,Inpatient,,,90,43,36.55,12.3238,43,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Mitochondrial Ab, M2, S (Mayo)OutsideLaboratory",,86381,CPT,Facility,Both,,,90,43,36.55,12.3238,43,Medica,Individual & Family,42.613,99.1,,percent of total billed charges,,
"Mitochondrial Ab, M2, S (Mayo)OutsideLaboratory",,86381,CPT,Facility,Outpatient,,,90,43,36.55,12.3238,43,Medica,Medica Advantage Solution,21.414,49.8,,percent of total billed charges,,
"Mitochondrial Ab, M2, S (Mayo)OutsideLaboratory",,86381,CPT,Facility,Inpatient,,,90,43,36.55,12.3238,43,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Mitochondrial Ab, M2, S (Mayo)OutsideLaboratory",,86381,CPT,Facility,Outpatient,,,90,43,36.55,12.3238,43,Medica,Medical Assistance,19.178,44.6,,percent of total billed charges,,
"Mitochondrial Ab, M2, S (Mayo)OutsideLaboratory",,86381,CPT,Facility,Inpatient,,,90,43,36.55,12.3238,43,Medica,Medical Assistance,,,,,Included in per diem rate,
"Mitochondrial Ab, M2, S (Mayo)OutsideLaboratory",,86381,CPT,Facility,Outpatient,,,90,43,36.55,12.3238,43,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,21.414,49.8,,percent of total billed charges,,
"Mitochondrial Ab, M2, S (Mayo)OutsideLaboratory",,86381,CPT,Facility,Inpatient,,,90,43,36.55,12.3238,43,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Mitochondrial Ab, M2, S (Mayo)OutsideLaboratory",,86381,CPT,Facility,Both,,,90,43,36.55,12.3238,43,"Multiplan, Inc.","Multiplan, Inc.",40.42,94,,percent of total billed charges,,
"Mitochondrial Ab, M2, S (Mayo)OutsideLaboratory",,86381,CPT,Facility,Outpatient,,,90,43,36.55,12.3238,43,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,37.152,86.4,,percent of total billed charges,,
"Mitochondrial Ab, M2, S (Mayo)OutsideLaboratory",,86381,CPT,Facility,Inpatient,,,90,43,36.55,12.3238,43,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Mitochondrial Ab, M2, S (Mayo)OutsideLaboratory",,86381,CPT,Facility,Both,,,90,43,36.55,12.3238,43,"Preferred One Administrative Services, INC.",PPO,42.398,98.6,,percent of total billed charges,,
"Mitochondrial Ab, M2, S (Mayo)OutsideLaboratory",,86381,CPT,Facility,Outpatient,,,90,43,36.55,12.3238,43,PrimeWest Health,Minnesota Senior Health Options (MSHO),22.1235,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Mitochondrial Ab, M2, S (Mayo)OutsideLaboratory",,86381,CPT,Facility,Inpatient,,,90,43,36.55,12.3238,43,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Mitochondrial Ab, M2, S (Mayo)OutsideLaboratory",,86381,CPT,Facility,Outpatient,,,90,43,36.55,12.3238,43,PrimeWest Health,MinnesotaCare,22.0848,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Mitochondrial Ab, M2, S (Mayo)OutsideLaboratory",,86381,CPT,Facility,Inpatient,,,90,43,36.55,12.3238,43,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Mitochondrial Ab, M2, S (Mayo)OutsideLaboratory",,86381,CPT,Facility,Both,,,90,43,36.55,12.3238,43,Sanford Health Plan,Sanford Health Plan,39.56,92,,percent of total billed charges,,
"Mitochondrial Ab, M2, S (Mayo)OutsideLaboratory",,86381,CPT,Facility,Outpatient,,,90,43,36.55,12.3238,43,"UCare Health, Inc.",Individual & Family Plan,24.2305,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Mitochondrial Ab, M2, S (Mayo)OutsideLaboratory",,86381,CPT,Facility,Inpatient,,,90,43,36.55,12.3238,43,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Mitochondrial Ab, M2, S (Mayo)OutsideLaboratory",,86381,CPT,Facility,Outpatient,,,90,43,36.55,12.3238,43,"UCare Health, Inc.",Medical Assistance,21.7021,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Mitochondrial Ab, M2, S (Mayo)OutsideLaboratory",,86381,CPT,Facility,Inpatient,,,90,43,36.55,12.3238,43,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Mitochondrial Ab, M2, S (Mayo)OutsideLaboratory",,86381,CPT,Facility,Outpatient,,,90,43,36.55,12.3238,43,"UCare Health, Inc.",Medicare Advantage,21.7021,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Mitochondrial Ab, M2, S (Mayo)OutsideLaboratory",,86381,CPT,Facility,Inpatient,,,90,43,36.55,12.3238,43,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Mitochondrial Ab, M2, S (Mayo)OutsideLaboratory",,86381,CPT,Facility,Outpatient,,,90,43,36.55,12.3238,43,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),21.7021,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Mitochondrial Ab, M2, S (Mayo)OutsideLaboratory",,86381,CPT,Facility,Inpatient,,,90,43,36.55,12.3238,43,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Mitochondrial Ab, M2, S (Mayo)OutsideLaboratory",,86381,CPT,Facility,Both,,,90,43,36.55,12.3238,43,UnitedHealthcare,Individual & Family,40.42,94,,percent of total billed charges,,
"Mitochondrial Ab, M2, S (Mayo)OutsideLaboratory",,86381,CPT,Facility,Outpatient,,,90,43,36.55,12.3238,43,UnitedHealthcare,Medicare Advantage,21.07,49,,percent of total billed charges,,
"Mitochondrial Ab, M2, S (Mayo)OutsideLaboratory",,86381,CPT,Facility,Inpatient,,,90,43,36.55,12.3238,43,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Mitochondrial Ab, M2, S (Mayo)OutsideLaboratory",,86381,CPT,Facility,Outpatient,,,90,43,36.55,12.3238,43,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,20.64,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Mitochondrial Ab, M2, S (Mayo)OutsideLaboratory",,86381,CPT,Facility,Inpatient,,,90,43,36.55,12.3238,43,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Mitochondrial Antibody Each (Mayo)OutsideLaboratory,,86381,CPT,Facility,Both,,,90,101,85.85,28.9466,101,Aetna,Commercial,92.92,92,,percent of total billed charges,,
Mitochondrial Antibody Each (Mayo)OutsideLaboratory,,86381,CPT,Facility,Outpatient,,,90,101,85.85,28.9466,101,Aetna,Medicare Advantage,49.49,49,,percent of total billed charges,,
Mitochondrial Antibody Each (Mayo)OutsideLaboratory,,86381,CPT,Facility,Inpatient,,,90,101,85.85,28.9466,101,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Mitochondrial Antibody Each (Mayo)OutsideLaboratory,,86381,CPT,Facility,Both,,,90,101,85.85,28.9466,101,Aetna,PPO,93.93,93,,percent of total billed charges,,
Mitochondrial Antibody Each (Mayo)OutsideLaboratory,,86381,CPT,Facility,Both,,,90,101,85.85,28.9466,101,America's PPO,America's PPO,96.9903,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Mitochondrial Antibody Each (Mayo)OutsideLaboratory,,86381,CPT,Facility,Both,,,90,101,85.85,28.9466,101,BlueCross BlueShield Minnesota, Federal Employee Program,99.384,98.4,,percent of total billed charges,,
Mitochondrial Antibody Each (Mayo)OutsideLaboratory,,86381,CPT,Facility,Both,,,90,101,85.85,28.9466,101,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,101,100,,percent of total billed charges,,
Mitochondrial Antibody Each (Mayo)OutsideLaboratory,,86381,CPT,Facility,Both,,,90,101,85.85,28.9466,101,BlueCross BlueShield Minnesota,High Value Network Plan,90.9,90,,percent of total billed charges,,
Mitochondrial Antibody Each (Mayo)OutsideLaboratory,,86381,CPT,Facility,Outpatient,,,90,101,85.85,28.9466,101,BlueCross BlueShield Minnesota,Medicare Advantage,49.49,49,,percent of total billed charges,,
Mitochondrial Antibody Each (Mayo)OutsideLaboratory,,86381,CPT,Facility,Inpatient,,,90,101,85.85,28.9466,101,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Mitochondrial Antibody Each (Mayo)OutsideLaboratory,,86381,CPT,Facility,Both,,,90,101,85.85,28.9466,101,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,89.4557,88.57,,percent of total billed charges,,
Mitochondrial Antibody Each (Mayo)OutsideLaboratory,,86381,CPT,Facility,Both,,,90,101,85.85,28.9466,101,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,28.9466,28.66,,percent of total billed charges,,
Mitochondrial Antibody Each (Mayo)OutsideLaboratory,,86381,CPT,Facility,Outpatient,,,90,101,85.85,28.9466,101,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),49.49,49,,percent of total billed charges,,
Mitochondrial Antibody Each (Mayo)OutsideLaboratory,,86381,CPT,Facility,Inpatient,,,90,101,85.85,28.9466,101,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Mitochondrial Antibody Each (Mayo)OutsideLaboratory,,86381,CPT,Facility,Both,,,90,101,85.85,28.9466,101,CorVel,Worker's Compensation,101,100,,percent of total billed charges,,
Mitochondrial Antibody Each (Mayo)OutsideLaboratory,,86381,CPT,Facility,Both,,,90,101,85.85,28.9466,101,First Health Group Corporation,First Health Network,97.97,97,,percent of total billed charges,,
Mitochondrial Antibody Each (Mayo)OutsideLaboratory,,86381,CPT,Facility,Both,,,90,101,85.85,28.9466,101,"Health Partners, Inc.",Commercial,95.546,94.6,,percent of total billed charges,,
Mitochondrial Antibody Each (Mayo)OutsideLaboratory,,86381,CPT,Facility,Outpatient,,,90,101,85.85,28.9466,101,"Health Partners, Inc.",Medicare Advantage,49.49,49,,percent of total billed charges,,
Mitochondrial Antibody Each (Mayo)OutsideLaboratory,,86381,CPT,Facility,Inpatient,,,90,101,85.85,28.9466,101,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mitochondrial Antibody Each (Mayo)OutsideLaboratory,,86381,CPT,Facility,Both,,,90,101,85.85,28.9466,101,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),60.6,60,,percent of total billed charges,,
Mitochondrial Antibody Each (Mayo)OutsideLaboratory,,86381,CPT,Facility,Both,,,90,101,85.85,28.9466,101,"Health Partners, Inc.",State of Minnesota Advantage Program,82.315,81.5,,percent of total billed charges,,
Mitochondrial Antibody Each (Mayo)OutsideLaboratory,,86381,CPT,Facility,Both,,,90,101,85.85,28.9466,101,"Health Partners, Inc.",State Public Programs,50.5,50,,percent of total billed charges,,
Mitochondrial Antibody Each (Mayo)OutsideLaboratory,,86381,CPT,Facility,Both,,,90,101,85.85,28.9466,101,Humana Insurance Company,Commercial PPO,95.95,95,,percent of total billed charges,,
Mitochondrial Antibody Each (Mayo)OutsideLaboratory,,86381,CPT,Facility,Outpatient,,,90,101,85.85,28.9466,101,Humana Insurance Company,Medicare PPO,49.49,49,,percent of total billed charges,,
Mitochondrial Antibody Each (Mayo)OutsideLaboratory,,86381,CPT,Facility,Inpatient,,,90,101,85.85,28.9466,101,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Mitochondrial Antibody Each (Mayo)OutsideLaboratory,,86381,CPT,Facility,Both,,,90,101,85.85,28.9466,101,Medica,Individual & Family,100.091,99.1,,percent of total billed charges,,
Mitochondrial Antibody Each (Mayo)OutsideLaboratory,,86381,CPT,Facility,Outpatient,,,90,101,85.85,28.9466,101,Medica,Medica Advantage Solution,50.298,49.8,,percent of total billed charges,,
Mitochondrial Antibody Each (Mayo)OutsideLaboratory,,86381,CPT,Facility,Inpatient,,,90,101,85.85,28.9466,101,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Mitochondrial Antibody Each (Mayo)OutsideLaboratory,,86381,CPT,Facility,Outpatient,,,90,101,85.85,28.9466,101,Medica,Medical Assistance,45.046,44.6,,percent of total billed charges,,
Mitochondrial Antibody Each (Mayo)OutsideLaboratory,,86381,CPT,Facility,Inpatient,,,90,101,85.85,28.9466,101,Medica,Medical Assistance,,,,,Included in per diem rate,
Mitochondrial Antibody Each (Mayo)OutsideLaboratory,,86381,CPT,Facility,Outpatient,,,90,101,85.85,28.9466,101,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,50.298,49.8,,percent of total billed charges,,
Mitochondrial Antibody Each (Mayo)OutsideLaboratory,,86381,CPT,Facility,Inpatient,,,90,101,85.85,28.9466,101,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Mitochondrial Antibody Each (Mayo)OutsideLaboratory,,86381,CPT,Facility,Both,,,90,101,85.85,28.9466,101,"Multiplan, Inc.","Multiplan, Inc.",94.94,94,,percent of total billed charges,,
Mitochondrial Antibody Each (Mayo)OutsideLaboratory,,86381,CPT,Facility,Outpatient,,,90,101,85.85,28.9466,101,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,87.264,86.4,,percent of total billed charges,,
Mitochondrial Antibody Each (Mayo)OutsideLaboratory,,86381,CPT,Facility,Inpatient,,,90,101,85.85,28.9466,101,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Mitochondrial Antibody Each (Mayo)OutsideLaboratory,,86381,CPT,Facility,Both,,,90,101,85.85,28.9466,101,"Preferred One Administrative Services, INC.",PPO,99.586,98.6,,percent of total billed charges,,
Mitochondrial Antibody Each (Mayo)OutsideLaboratory,,86381,CPT,Facility,Outpatient,,,90,101,85.85,28.9466,101,PrimeWest Health,Minnesota Senior Health Options (MSHO),51.9645,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Mitochondrial Antibody Each (Mayo)OutsideLaboratory,,86381,CPT,Facility,Inpatient,,,90,101,85.85,28.9466,101,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mitochondrial Antibody Each (Mayo)OutsideLaboratory,,86381,CPT,Facility,Outpatient,,,90,101,85.85,28.9466,101,PrimeWest Health,MinnesotaCare,51.8736,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Mitochondrial Antibody Each (Mayo)OutsideLaboratory,,86381,CPT,Facility,Inpatient,,,90,101,85.85,28.9466,101,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Mitochondrial Antibody Each (Mayo)OutsideLaboratory,,86381,CPT,Facility,Both,,,90,101,85.85,28.9466,101,Sanford Health Plan,Sanford Health Plan,92.92,92,,percent of total billed charges,,
Mitochondrial Antibody Each (Mayo)OutsideLaboratory,,86381,CPT,Facility,Outpatient,,,90,101,85.85,28.9466,101,"UCare Health, Inc.",Individual & Family Plan,56.9135,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Mitochondrial Antibody Each (Mayo)OutsideLaboratory,,86381,CPT,Facility,Inpatient,,,90,101,85.85,28.9466,101,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Mitochondrial Antibody Each (Mayo)OutsideLaboratory,,86381,CPT,Facility,Outpatient,,,90,101,85.85,28.9466,101,"UCare Health, Inc.",Medical Assistance,50.9747,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mitochondrial Antibody Each (Mayo)OutsideLaboratory,,86381,CPT,Facility,Inpatient,,,90,101,85.85,28.9466,101,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Mitochondrial Antibody Each (Mayo)OutsideLaboratory,,86381,CPT,Facility,Outpatient,,,90,101,85.85,28.9466,101,"UCare Health, Inc.",Medicare Advantage,50.9747,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mitochondrial Antibody Each (Mayo)OutsideLaboratory,,86381,CPT,Facility,Inpatient,,,90,101,85.85,28.9466,101,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mitochondrial Antibody Each (Mayo)OutsideLaboratory,,86381,CPT,Facility,Outpatient,,,90,101,85.85,28.9466,101,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),50.9747,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mitochondrial Antibody Each (Mayo)OutsideLaboratory,,86381,CPT,Facility,Inpatient,,,90,101,85.85,28.9466,101,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mitochondrial Antibody Each (Mayo)OutsideLaboratory,,86381,CPT,Facility,Both,,,90,101,85.85,28.9466,101,UnitedHealthcare,Individual & Family,94.94,94,,percent of total billed charges,,
Mitochondrial Antibody Each (Mayo)OutsideLaboratory,,86381,CPT,Facility,Outpatient,,,90,101,85.85,28.9466,101,UnitedHealthcare,Medicare Advantage,49.49,49,,percent of total billed charges,,
Mitochondrial Antibody Each (Mayo)OutsideLaboratory,,86381,CPT,Facility,Inpatient,,,90,101,85.85,28.9466,101,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Mitochondrial Antibody Each (Mayo)OutsideLaboratory,,86381,CPT,Facility,Outpatient,,,90,101,85.85,28.9466,101,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,48.48,48,,percent of total billed charges,,100% of DHS outpatient percentage
Mitochondrial Antibody Each (Mayo)OutsideLaboratory,,86381,CPT,Facility,Inpatient,,,90,101,85.85,28.9466,101,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Rabies Rffit Endpoint, S (Mayo)OutsideLaboratory",,86382,CPT,Facility,Both,,,90,255,216.75,73.083,255,Aetna,Commercial,234.6,92,,percent of total billed charges,,
"Rabies Rffit Endpoint, S (Mayo)OutsideLaboratory",,86382,CPT,Facility,Outpatient,,,90,255,216.75,73.083,255,Aetna,Medicare Advantage,124.95,49,,percent of total billed charges,,
"Rabies Rffit Endpoint, S (Mayo)OutsideLaboratory",,86382,CPT,Facility,Inpatient,,,90,255,216.75,73.083,255,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Rabies Rffit Endpoint, S (Mayo)OutsideLaboratory",,86382,CPT,Facility,Both,,,90,255,216.75,73.083,255,Aetna,PPO,237.15,93,,percent of total billed charges,,
"Rabies Rffit Endpoint, S (Mayo)OutsideLaboratory",,86382,CPT,Facility,Both,,,90,255,216.75,73.083,255,America's PPO,America's PPO,244.8765,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Rabies Rffit Endpoint, S (Mayo)OutsideLaboratory",,86382,CPT,Facility,Both,,,90,255,216.75,73.083,255,BlueCross BlueShield Minnesota, Federal Employee Program,250.92,98.4,,percent of total billed charges,,
"Rabies Rffit Endpoint, S (Mayo)OutsideLaboratory",,86382,CPT,Facility,Both,,,90,255,216.75,73.083,255,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,255,100,,percent of total billed charges,,
"Rabies Rffit Endpoint, S (Mayo)OutsideLaboratory",,86382,CPT,Facility,Both,,,90,255,216.75,73.083,255,BlueCross BlueShield Minnesota,High Value Network Plan,229.5,90,,percent of total billed charges,,
"Rabies Rffit Endpoint, S (Mayo)OutsideLaboratory",,86382,CPT,Facility,Outpatient,,,90,255,216.75,73.083,255,BlueCross BlueShield Minnesota,Medicare Advantage,124.95,49,,percent of total billed charges,,
"Rabies Rffit Endpoint, S (Mayo)OutsideLaboratory",,86382,CPT,Facility,Inpatient,,,90,255,216.75,73.083,255,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Rabies Rffit Endpoint, S (Mayo)OutsideLaboratory",,86382,CPT,Facility,Both,,,90,255,216.75,73.083,255,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,225.8535,88.57,,percent of total billed charges,,
"Rabies Rffit Endpoint, S (Mayo)OutsideLaboratory",,86382,CPT,Facility,Both,,,90,255,216.75,73.083,255,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,73.083,28.66,,percent of total billed charges,,
"Rabies Rffit Endpoint, S (Mayo)OutsideLaboratory",,86382,CPT,Facility,Outpatient,,,90,255,216.75,73.083,255,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),124.95,49,,percent of total billed charges,,
"Rabies Rffit Endpoint, S (Mayo)OutsideLaboratory",,86382,CPT,Facility,Inpatient,,,90,255,216.75,73.083,255,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Rabies Rffit Endpoint, S (Mayo)OutsideLaboratory",,86382,CPT,Facility,Both,,,90,255,216.75,73.083,255,CorVel,Worker's Compensation,255,100,,percent of total billed charges,,
"Rabies Rffit Endpoint, S (Mayo)OutsideLaboratory",,86382,CPT,Facility,Both,,,90,255,216.75,73.083,255,First Health Group Corporation,First Health Network,247.35,97,,percent of total billed charges,,
"Rabies Rffit Endpoint, S (Mayo)OutsideLaboratory",,86382,CPT,Facility,Both,,,90,255,216.75,73.083,255,"Health Partners, Inc.",Commercial,241.23,94.6,,percent of total billed charges,,
"Rabies Rffit Endpoint, S (Mayo)OutsideLaboratory",,86382,CPT,Facility,Outpatient,,,90,255,216.75,73.083,255,"Health Partners, Inc.",Medicare Advantage,124.95,49,,percent of total billed charges,,
"Rabies Rffit Endpoint, S (Mayo)OutsideLaboratory",,86382,CPT,Facility,Inpatient,,,90,255,216.75,73.083,255,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Rabies Rffit Endpoint, S (Mayo)OutsideLaboratory",,86382,CPT,Facility,Both,,,90,255,216.75,73.083,255,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),153,60,,percent of total billed charges,,
"Rabies Rffit Endpoint, S (Mayo)OutsideLaboratory",,86382,CPT,Facility,Both,,,90,255,216.75,73.083,255,"Health Partners, Inc.",State of Minnesota Advantage Program,207.825,81.5,,percent of total billed charges,,
"Rabies Rffit Endpoint, S (Mayo)OutsideLaboratory",,86382,CPT,Facility,Both,,,90,255,216.75,73.083,255,"Health Partners, Inc.",State Public Programs,127.5,50,,percent of total billed charges,,
"Rabies Rffit Endpoint, S (Mayo)OutsideLaboratory",,86382,CPT,Facility,Both,,,90,255,216.75,73.083,255,Humana Insurance Company,Commercial PPO,242.25,95,,percent of total billed charges,,
"Rabies Rffit Endpoint, S (Mayo)OutsideLaboratory",,86382,CPT,Facility,Outpatient,,,90,255,216.75,73.083,255,Humana Insurance Company,Medicare PPO,124.95,49,,percent of total billed charges,,
"Rabies Rffit Endpoint, S (Mayo)OutsideLaboratory",,86382,CPT,Facility,Inpatient,,,90,255,216.75,73.083,255,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Rabies Rffit Endpoint, S (Mayo)OutsideLaboratory",,86382,CPT,Facility,Both,,,90,255,216.75,73.083,255,Medica,Individual & Family,252.705,99.1,,percent of total billed charges,,
"Rabies Rffit Endpoint, S (Mayo)OutsideLaboratory",,86382,CPT,Facility,Outpatient,,,90,255,216.75,73.083,255,Medica,Medica Advantage Solution,126.99,49.8,,percent of total billed charges,,
"Rabies Rffit Endpoint, S (Mayo)OutsideLaboratory",,86382,CPT,Facility,Inpatient,,,90,255,216.75,73.083,255,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Rabies Rffit Endpoint, S (Mayo)OutsideLaboratory",,86382,CPT,Facility,Outpatient,,,90,255,216.75,73.083,255,Medica,Medical Assistance,113.73,44.6,,percent of total billed charges,,
"Rabies Rffit Endpoint, S (Mayo)OutsideLaboratory",,86382,CPT,Facility,Inpatient,,,90,255,216.75,73.083,255,Medica,Medical Assistance,,,,,Included in per diem rate,
"Rabies Rffit Endpoint, S (Mayo)OutsideLaboratory",,86382,CPT,Facility,Outpatient,,,90,255,216.75,73.083,255,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,126.99,49.8,,percent of total billed charges,,
"Rabies Rffit Endpoint, S (Mayo)OutsideLaboratory",,86382,CPT,Facility,Inpatient,,,90,255,216.75,73.083,255,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Rabies Rffit Endpoint, S (Mayo)OutsideLaboratory",,86382,CPT,Facility,Both,,,90,255,216.75,73.083,255,"Multiplan, Inc.","Multiplan, Inc.",239.7,94,,percent of total billed charges,,
"Rabies Rffit Endpoint, S (Mayo)OutsideLaboratory",,86382,CPT,Facility,Outpatient,,,90,255,216.75,73.083,255,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,220.32,86.4,,percent of total billed charges,,
"Rabies Rffit Endpoint, S (Mayo)OutsideLaboratory",,86382,CPT,Facility,Inpatient,,,90,255,216.75,73.083,255,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Rabies Rffit Endpoint, S (Mayo)OutsideLaboratory",,86382,CPT,Facility,Both,,,90,255,216.75,73.083,255,"Preferred One Administrative Services, INC.",PPO,251.43,98.6,,percent of total billed charges,,
"Rabies Rffit Endpoint, S (Mayo)OutsideLaboratory",,86382,CPT,Facility,Outpatient,,,90,255,216.75,73.083,255,PrimeWest Health,Minnesota Senior Health Options (MSHO),131.1975,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Rabies Rffit Endpoint, S (Mayo)OutsideLaboratory",,86382,CPT,Facility,Inpatient,,,90,255,216.75,73.083,255,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Rabies Rffit Endpoint, S (Mayo)OutsideLaboratory",,86382,CPT,Facility,Outpatient,,,90,255,216.75,73.083,255,PrimeWest Health,MinnesotaCare,130.968,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Rabies Rffit Endpoint, S (Mayo)OutsideLaboratory",,86382,CPT,Facility,Inpatient,,,90,255,216.75,73.083,255,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Rabies Rffit Endpoint, S (Mayo)OutsideLaboratory",,86382,CPT,Facility,Both,,,90,255,216.75,73.083,255,Sanford Health Plan,Sanford Health Plan,234.6,92,,percent of total billed charges,,
"Rabies Rffit Endpoint, S (Mayo)OutsideLaboratory",,86382,CPT,Facility,Outpatient,,,90,255,216.75,73.083,255,"UCare Health, Inc.",Individual & Family Plan,143.6925,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Rabies Rffit Endpoint, S (Mayo)OutsideLaboratory",,86382,CPT,Facility,Inpatient,,,90,255,216.75,73.083,255,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Rabies Rffit Endpoint, S (Mayo)OutsideLaboratory",,86382,CPT,Facility,Outpatient,,,90,255,216.75,73.083,255,"UCare Health, Inc.",Medical Assistance,128.6985,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Rabies Rffit Endpoint, S (Mayo)OutsideLaboratory",,86382,CPT,Facility,Inpatient,,,90,255,216.75,73.083,255,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Rabies Rffit Endpoint, S (Mayo)OutsideLaboratory",,86382,CPT,Facility,Outpatient,,,90,255,216.75,73.083,255,"UCare Health, Inc.",Medicare Advantage,128.6985,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Rabies Rffit Endpoint, S (Mayo)OutsideLaboratory",,86382,CPT,Facility,Inpatient,,,90,255,216.75,73.083,255,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Rabies Rffit Endpoint, S (Mayo)OutsideLaboratory",,86382,CPT,Facility,Outpatient,,,90,255,216.75,73.083,255,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),128.6985,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Rabies Rffit Endpoint, S (Mayo)OutsideLaboratory",,86382,CPT,Facility,Inpatient,,,90,255,216.75,73.083,255,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Rabies Rffit Endpoint, S (Mayo)OutsideLaboratory",,86382,CPT,Facility,Both,,,90,255,216.75,73.083,255,UnitedHealthcare,Individual & Family,239.7,94,,percent of total billed charges,,
"Rabies Rffit Endpoint, S (Mayo)OutsideLaboratory",,86382,CPT,Facility,Outpatient,,,90,255,216.75,73.083,255,UnitedHealthcare,Medicare Advantage,124.95,49,,percent of total billed charges,,
"Rabies Rffit Endpoint, S (Mayo)OutsideLaboratory",,86382,CPT,Facility,Inpatient,,,90,255,216.75,73.083,255,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Rabies Rffit Endpoint, S (Mayo)OutsideLaboratory",,86382,CPT,Facility,Outpatient,,,90,255,216.75,73.083,255,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,122.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Rabies Rffit Endpoint, S (Mayo)OutsideLaboratory",,86382,CPT,Facility,Inpatient,,,90,255,216.75,73.083,255,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Quantiferon-Tb Gold In-Tube, B (Mayo)OutsideLaboratory",,86480,CPT,Facility,Both,,,90,230,195.5,65.918,230,Aetna,Commercial,211.6,92,,percent of total billed charges,,
"Quantiferon-Tb Gold In-Tube, B (Mayo)OutsideLaboratory",,86480,CPT,Facility,Outpatient,,,90,230,195.5,65.918,230,Aetna,Medicare Advantage,112.7,49,,percent of total billed charges,,
"Quantiferon-Tb Gold In-Tube, B (Mayo)OutsideLaboratory",,86480,CPT,Facility,Inpatient,,,90,230,195.5,65.918,230,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Quantiferon-Tb Gold In-Tube, B (Mayo)OutsideLaboratory",,86480,CPT,Facility,Both,,,90,230,195.5,65.918,230,Aetna,PPO,213.9,93,,percent of total billed charges,,
"Quantiferon-Tb Gold In-Tube, B (Mayo)OutsideLaboratory",,86480,CPT,Facility,Both,,,90,230,195.5,65.918,230,America's PPO,America's PPO,220.869,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Quantiferon-Tb Gold In-Tube, B (Mayo)OutsideLaboratory",,86480,CPT,Facility,Both,,,90,230,195.5,65.918,230,BlueCross BlueShield Minnesota, Federal Employee Program,226.32,98.4,,percent of total billed charges,,
"Quantiferon-Tb Gold In-Tube, B (Mayo)OutsideLaboratory",,86480,CPT,Facility,Both,,,90,230,195.5,65.918,230,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,230,100,,percent of total billed charges,,
"Quantiferon-Tb Gold In-Tube, B (Mayo)OutsideLaboratory",,86480,CPT,Facility,Both,,,90,230,195.5,65.918,230,BlueCross BlueShield Minnesota,High Value Network Plan,207,90,,percent of total billed charges,,
"Quantiferon-Tb Gold In-Tube, B (Mayo)OutsideLaboratory",,86480,CPT,Facility,Outpatient,,,90,230,195.5,65.918,230,BlueCross BlueShield Minnesota,Medicare Advantage,112.7,49,,percent of total billed charges,,
"Quantiferon-Tb Gold In-Tube, B (Mayo)OutsideLaboratory",,86480,CPT,Facility,Inpatient,,,90,230,195.5,65.918,230,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Quantiferon-Tb Gold In-Tube, B (Mayo)OutsideLaboratory",,86480,CPT,Facility,Both,,,90,230,195.5,65.918,230,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,203.711,88.57,,percent of total billed charges,,
"Quantiferon-Tb Gold In-Tube, B (Mayo)OutsideLaboratory",,86480,CPT,Facility,Both,,,90,230,195.5,65.918,230,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,65.918,28.66,,percent of total billed charges,,
"Quantiferon-Tb Gold In-Tube, B (Mayo)OutsideLaboratory",,86480,CPT,Facility,Outpatient,,,90,230,195.5,65.918,230,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),112.7,49,,percent of total billed charges,,
"Quantiferon-Tb Gold In-Tube, B (Mayo)OutsideLaboratory",,86480,CPT,Facility,Inpatient,,,90,230,195.5,65.918,230,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Quantiferon-Tb Gold In-Tube, B (Mayo)OutsideLaboratory",,86480,CPT,Facility,Both,,,90,230,195.5,65.918,230,CorVel,Worker's Compensation,230,100,,percent of total billed charges,,
"Quantiferon-Tb Gold In-Tube, B (Mayo)OutsideLaboratory",,86480,CPT,Facility,Both,,,90,230,195.5,65.918,230,First Health Group Corporation,First Health Network,223.1,97,,percent of total billed charges,,
"Quantiferon-Tb Gold In-Tube, B (Mayo)OutsideLaboratory",,86480,CPT,Facility,Both,,,90,230,195.5,65.918,230,"Health Partners, Inc.",Commercial,217.58,94.6,,percent of total billed charges,,
"Quantiferon-Tb Gold In-Tube, B (Mayo)OutsideLaboratory",,86480,CPT,Facility,Outpatient,,,90,230,195.5,65.918,230,"Health Partners, Inc.",Medicare Advantage,112.7,49,,percent of total billed charges,,
"Quantiferon-Tb Gold In-Tube, B (Mayo)OutsideLaboratory",,86480,CPT,Facility,Inpatient,,,90,230,195.5,65.918,230,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Quantiferon-Tb Gold In-Tube, B (Mayo)OutsideLaboratory",,86480,CPT,Facility,Both,,,90,230,195.5,65.918,230,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),138,60,,percent of total billed charges,,
"Quantiferon-Tb Gold In-Tube, B (Mayo)OutsideLaboratory",,86480,CPT,Facility,Both,,,90,230,195.5,65.918,230,"Health Partners, Inc.",State of Minnesota Advantage Program,187.45,81.5,,percent of total billed charges,,
"Quantiferon-Tb Gold In-Tube, B (Mayo)OutsideLaboratory",,86480,CPT,Facility,Both,,,90,230,195.5,65.918,230,"Health Partners, Inc.",State Public Programs,115,50,,percent of total billed charges,,
"Quantiferon-Tb Gold In-Tube, B (Mayo)OutsideLaboratory",,86480,CPT,Facility,Both,,,90,230,195.5,65.918,230,Humana Insurance Company,Commercial PPO,218.5,95,,percent of total billed charges,,
"Quantiferon-Tb Gold In-Tube, B (Mayo)OutsideLaboratory",,86480,CPT,Facility,Outpatient,,,90,230,195.5,65.918,230,Humana Insurance Company,Medicare PPO,112.7,49,,percent of total billed charges,,
"Quantiferon-Tb Gold In-Tube, B (Mayo)OutsideLaboratory",,86480,CPT,Facility,Inpatient,,,90,230,195.5,65.918,230,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Quantiferon-Tb Gold In-Tube, B (Mayo)OutsideLaboratory",,86480,CPT,Facility,Both,,,90,230,195.5,65.918,230,Medica,Individual & Family,227.93,99.1,,percent of total billed charges,,
"Quantiferon-Tb Gold In-Tube, B (Mayo)OutsideLaboratory",,86480,CPT,Facility,Outpatient,,,90,230,195.5,65.918,230,Medica,Medica Advantage Solution,114.54,49.8,,percent of total billed charges,,
"Quantiferon-Tb Gold In-Tube, B (Mayo)OutsideLaboratory",,86480,CPT,Facility,Inpatient,,,90,230,195.5,65.918,230,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Quantiferon-Tb Gold In-Tube, B (Mayo)OutsideLaboratory",,86480,CPT,Facility,Outpatient,,,90,230,195.5,65.918,230,Medica,Medical Assistance,102.58,44.6,,percent of total billed charges,,
"Quantiferon-Tb Gold In-Tube, B (Mayo)OutsideLaboratory",,86480,CPT,Facility,Inpatient,,,90,230,195.5,65.918,230,Medica,Medical Assistance,,,,,Included in per diem rate,
"Quantiferon-Tb Gold In-Tube, B (Mayo)OutsideLaboratory",,86480,CPT,Facility,Outpatient,,,90,230,195.5,65.918,230,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,114.54,49.8,,percent of total billed charges,,
"Quantiferon-Tb Gold In-Tube, B (Mayo)OutsideLaboratory",,86480,CPT,Facility,Inpatient,,,90,230,195.5,65.918,230,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Quantiferon-Tb Gold In-Tube, B (Mayo)OutsideLaboratory",,86480,CPT,Facility,Both,,,90,230,195.5,65.918,230,"Multiplan, Inc.","Multiplan, Inc.",216.2,94,,percent of total billed charges,,
"Quantiferon-Tb Gold In-Tube, B (Mayo)OutsideLaboratory",,86480,CPT,Facility,Outpatient,,,90,230,195.5,65.918,230,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,198.72,86.4,,percent of total billed charges,,
"Quantiferon-Tb Gold In-Tube, B (Mayo)OutsideLaboratory",,86480,CPT,Facility,Inpatient,,,90,230,195.5,65.918,230,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Quantiferon-Tb Gold In-Tube, B (Mayo)OutsideLaboratory",,86480,CPT,Facility,Both,,,90,230,195.5,65.918,230,"Preferred One Administrative Services, INC.",PPO,226.78,98.6,,percent of total billed charges,,
"Quantiferon-Tb Gold In-Tube, B (Mayo)OutsideLaboratory",,86480,CPT,Facility,Outpatient,,,90,230,195.5,65.918,230,PrimeWest Health,Minnesota Senior Health Options (MSHO),118.335,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Quantiferon-Tb Gold In-Tube, B (Mayo)OutsideLaboratory",,86480,CPT,Facility,Inpatient,,,90,230,195.5,65.918,230,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Quantiferon-Tb Gold In-Tube, B (Mayo)OutsideLaboratory",,86480,CPT,Facility,Outpatient,,,90,230,195.5,65.918,230,PrimeWest Health,MinnesotaCare,118.128,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Quantiferon-Tb Gold In-Tube, B (Mayo)OutsideLaboratory",,86480,CPT,Facility,Inpatient,,,90,230,195.5,65.918,230,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Quantiferon-Tb Gold In-Tube, B (Mayo)OutsideLaboratory",,86480,CPT,Facility,Both,,,90,230,195.5,65.918,230,Sanford Health Plan,Sanford Health Plan,211.6,92,,percent of total billed charges,,
"Quantiferon-Tb Gold In-Tube, B (Mayo)OutsideLaboratory",,86480,CPT,Facility,Outpatient,,,90,230,195.5,65.918,230,"UCare Health, Inc.",Individual & Family Plan,129.605,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Quantiferon-Tb Gold In-Tube, B (Mayo)OutsideLaboratory",,86480,CPT,Facility,Inpatient,,,90,230,195.5,65.918,230,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Quantiferon-Tb Gold In-Tube, B (Mayo)OutsideLaboratory",,86480,CPT,Facility,Outpatient,,,90,230,195.5,65.918,230,"UCare Health, Inc.",Medical Assistance,116.081,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Quantiferon-Tb Gold In-Tube, B (Mayo)OutsideLaboratory",,86480,CPT,Facility,Inpatient,,,90,230,195.5,65.918,230,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Quantiferon-Tb Gold In-Tube, B (Mayo)OutsideLaboratory",,86480,CPT,Facility,Outpatient,,,90,230,195.5,65.918,230,"UCare Health, Inc.",Medicare Advantage,116.081,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Quantiferon-Tb Gold In-Tube, B (Mayo)OutsideLaboratory",,86480,CPT,Facility,Inpatient,,,90,230,195.5,65.918,230,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Quantiferon-Tb Gold In-Tube, B (Mayo)OutsideLaboratory",,86480,CPT,Facility,Outpatient,,,90,230,195.5,65.918,230,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),116.081,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Quantiferon-Tb Gold In-Tube, B (Mayo)OutsideLaboratory",,86480,CPT,Facility,Inpatient,,,90,230,195.5,65.918,230,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Quantiferon-Tb Gold In-Tube, B (Mayo)OutsideLaboratory",,86480,CPT,Facility,Both,,,90,230,195.5,65.918,230,UnitedHealthcare,Individual & Family,216.2,94,,percent of total billed charges,,
"Quantiferon-Tb Gold In-Tube, B (Mayo)OutsideLaboratory",,86480,CPT,Facility,Outpatient,,,90,230,195.5,65.918,230,UnitedHealthcare,Medicare Advantage,112.7,49,,percent of total billed charges,,
"Quantiferon-Tb Gold In-Tube, B (Mayo)OutsideLaboratory",,86480,CPT,Facility,Inpatient,,,90,230,195.5,65.918,230,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Quantiferon-Tb Gold In-Tube, B (Mayo)OutsideLaboratory",,86480,CPT,Facility,Outpatient,,,90,230,195.5,65.918,230,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,110.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Quantiferon-Tb Gold In-Tube, B (Mayo)OutsideLaboratory",,86480,CPT,Facility,Inpatient,,,90,230,195.5,65.918,230,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Rapid Plasma Reagin W/Reflex (Mayo)OutsideLaboratory,,86592,CPT,Facility,Both,,,90,49,41.65,14.0434,49,Aetna,Commercial,45.08,92,,percent of total billed charges,,
Rapid Plasma Reagin W/Reflex (Mayo)OutsideLaboratory,,86592,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,Aetna,Medicare Advantage,24.01,49,,percent of total billed charges,,
Rapid Plasma Reagin W/Reflex (Mayo)OutsideLaboratory,,86592,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Rapid Plasma Reagin W/Reflex (Mayo)OutsideLaboratory,,86592,CPT,Facility,Both,,,90,49,41.65,14.0434,49,Aetna,PPO,45.57,93,,percent of total billed charges,,
Rapid Plasma Reagin W/Reflex (Mayo)OutsideLaboratory,,86592,CPT,Facility,Both,,,90,49,41.65,14.0434,49,America's PPO,America's PPO,47.0547,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Rapid Plasma Reagin W/Reflex (Mayo)OutsideLaboratory,,86592,CPT,Facility,Both,,,90,49,41.65,14.0434,49,BlueCross BlueShield Minnesota, Federal Employee Program,48.216,98.4,,percent of total billed charges,,
Rapid Plasma Reagin W/Reflex (Mayo)OutsideLaboratory,,86592,CPT,Facility,Both,,,90,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,49,100,,percent of total billed charges,,
Rapid Plasma Reagin W/Reflex (Mayo)OutsideLaboratory,,86592,CPT,Facility,Both,,,90,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,High Value Network Plan,44.1,90,,percent of total billed charges,,
Rapid Plasma Reagin W/Reflex (Mayo)OutsideLaboratory,,86592,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Medicare Advantage,24.01,49,,percent of total billed charges,,
Rapid Plasma Reagin W/Reflex (Mayo)OutsideLaboratory,,86592,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Rapid Plasma Reagin W/Reflex (Mayo)OutsideLaboratory,,86592,CPT,Facility,Both,,,90,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,43.3993,88.57,,percent of total billed charges,,
Rapid Plasma Reagin W/Reflex (Mayo)OutsideLaboratory,,86592,CPT,Facility,Both,,,90,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,14.0434,28.66,,percent of total billed charges,,
Rapid Plasma Reagin W/Reflex (Mayo)OutsideLaboratory,,86592,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),24.01,49,,percent of total billed charges,,
Rapid Plasma Reagin W/Reflex (Mayo)OutsideLaboratory,,86592,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Rapid Plasma Reagin W/Reflex (Mayo)OutsideLaboratory,,86592,CPT,Facility,Both,,,90,49,41.65,14.0434,49,CorVel,Worker's Compensation,49,100,,percent of total billed charges,,
Rapid Plasma Reagin W/Reflex (Mayo)OutsideLaboratory,,86592,CPT,Facility,Both,,,90,49,41.65,14.0434,49,First Health Group Corporation,First Health Network,47.53,97,,percent of total billed charges,,
Rapid Plasma Reagin W/Reflex (Mayo)OutsideLaboratory,,86592,CPT,Facility,Both,,,90,49,41.65,14.0434,49,"Health Partners, Inc.",Commercial,46.354,94.6,,percent of total billed charges,,
Rapid Plasma Reagin W/Reflex (Mayo)OutsideLaboratory,,86592,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,"Health Partners, Inc.",Medicare Advantage,24.01,49,,percent of total billed charges,,
Rapid Plasma Reagin W/Reflex (Mayo)OutsideLaboratory,,86592,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Rapid Plasma Reagin W/Reflex (Mayo)OutsideLaboratory,,86592,CPT,Facility,Both,,,90,49,41.65,14.0434,49,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),29.4,60,,percent of total billed charges,,
Rapid Plasma Reagin W/Reflex (Mayo)OutsideLaboratory,,86592,CPT,Facility,Both,,,90,49,41.65,14.0434,49,"Health Partners, Inc.",State of Minnesota Advantage Program,39.935,81.5,,percent of total billed charges,,
Rapid Plasma Reagin W/Reflex (Mayo)OutsideLaboratory,,86592,CPT,Facility,Both,,,90,49,41.65,14.0434,49,"Health Partners, Inc.",State Public Programs,24.5,50,,percent of total billed charges,,
Rapid Plasma Reagin W/Reflex (Mayo)OutsideLaboratory,,86592,CPT,Facility,Both,,,90,49,41.65,14.0434,49,Humana Insurance Company,Commercial PPO,46.55,95,,percent of total billed charges,,
Rapid Plasma Reagin W/Reflex (Mayo)OutsideLaboratory,,86592,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,Humana Insurance Company,Medicare PPO,24.01,49,,percent of total billed charges,,
Rapid Plasma Reagin W/Reflex (Mayo)OutsideLaboratory,,86592,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Rapid Plasma Reagin W/Reflex (Mayo)OutsideLaboratory,,86592,CPT,Facility,Both,,,90,49,41.65,14.0434,49,Medica,Individual & Family,48.559,99.1,,percent of total billed charges,,
Rapid Plasma Reagin W/Reflex (Mayo)OutsideLaboratory,,86592,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,Medica,Medica Advantage Solution,24.402,49.8,,percent of total billed charges,,
Rapid Plasma Reagin W/Reflex (Mayo)OutsideLaboratory,,86592,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Rapid Plasma Reagin W/Reflex (Mayo)OutsideLaboratory,,86592,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,Medica,Medical Assistance,21.854,44.6,,percent of total billed charges,,
Rapid Plasma Reagin W/Reflex (Mayo)OutsideLaboratory,,86592,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,Medica,Medical Assistance,,,,,Included in per diem rate,
Rapid Plasma Reagin W/Reflex (Mayo)OutsideLaboratory,,86592,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,24.402,49.8,,percent of total billed charges,,
Rapid Plasma Reagin W/Reflex (Mayo)OutsideLaboratory,,86592,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Rapid Plasma Reagin W/Reflex (Mayo)OutsideLaboratory,,86592,CPT,Facility,Both,,,90,49,41.65,14.0434,49,"Multiplan, Inc.","Multiplan, Inc.",46.06,94,,percent of total billed charges,,
Rapid Plasma Reagin W/Reflex (Mayo)OutsideLaboratory,,86592,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,42.336,86.4,,percent of total billed charges,,
Rapid Plasma Reagin W/Reflex (Mayo)OutsideLaboratory,,86592,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Rapid Plasma Reagin W/Reflex (Mayo)OutsideLaboratory,,86592,CPT,Facility,Both,,,90,49,41.65,14.0434,49,"Preferred One Administrative Services, INC.",PPO,48.314,98.6,,percent of total billed charges,,
Rapid Plasma Reagin W/Reflex (Mayo)OutsideLaboratory,,86592,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,PrimeWest Health,Minnesota Senior Health Options (MSHO),25.2105,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Rapid Plasma Reagin W/Reflex (Mayo)OutsideLaboratory,,86592,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Rapid Plasma Reagin W/Reflex (Mayo)OutsideLaboratory,,86592,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,PrimeWest Health,MinnesotaCare,25.1664,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Rapid Plasma Reagin W/Reflex (Mayo)OutsideLaboratory,,86592,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Rapid Plasma Reagin W/Reflex (Mayo)OutsideLaboratory,,86592,CPT,Facility,Both,,,90,49,41.65,14.0434,49,Sanford Health Plan,Sanford Health Plan,45.08,92,,percent of total billed charges,,
Rapid Plasma Reagin W/Reflex (Mayo)OutsideLaboratory,,86592,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,"UCare Health, Inc.",Individual & Family Plan,27.6115,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Rapid Plasma Reagin W/Reflex (Mayo)OutsideLaboratory,,86592,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Rapid Plasma Reagin W/Reflex (Mayo)OutsideLaboratory,,86592,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,"UCare Health, Inc.",Medical Assistance,24.7303,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Rapid Plasma Reagin W/Reflex (Mayo)OutsideLaboratory,,86592,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Rapid Plasma Reagin W/Reflex (Mayo)OutsideLaboratory,,86592,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,"UCare Health, Inc.",Medicare Advantage,24.7303,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Rapid Plasma Reagin W/Reflex (Mayo)OutsideLaboratory,,86592,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Rapid Plasma Reagin W/Reflex (Mayo)OutsideLaboratory,,86592,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),24.7303,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Rapid Plasma Reagin W/Reflex (Mayo)OutsideLaboratory,,86592,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Rapid Plasma Reagin W/Reflex (Mayo)OutsideLaboratory,,86592,CPT,Facility,Both,,,90,49,41.65,14.0434,49,UnitedHealthcare,Individual & Family,46.06,94,,percent of total billed charges,,
Rapid Plasma Reagin W/Reflex (Mayo)OutsideLaboratory,,86592,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,UnitedHealthcare,Medicare Advantage,24.01,49,,percent of total billed charges,,
Rapid Plasma Reagin W/Reflex (Mayo)OutsideLaboratory,,86592,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Rapid Plasma Reagin W/Reflex (Mayo)OutsideLaboratory,,86592,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,23.52,48,,percent of total billed charges,,100% of DHS outpatient percentage
Rapid Plasma Reagin W/Reflex (Mayo)OutsideLaboratory,,86592,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Aspergillus Fumigatus, Igg Ab, S (Mayo)OutsideLaboratory",,86606,CPT,Facility,Both,,,90,118,100.3,33.8188,118,Aetna,Commercial,108.56,92,,percent of total billed charges,,
"Aspergillus Fumigatus, Igg Ab, S (Mayo)OutsideLaboratory",,86606,CPT,Facility,Outpatient,,,90,118,100.3,33.8188,118,Aetna,Medicare Advantage,57.82,49,,percent of total billed charges,,
"Aspergillus Fumigatus, Igg Ab, S (Mayo)OutsideLaboratory",,86606,CPT,Facility,Inpatient,,,90,118,100.3,33.8188,118,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Aspergillus Fumigatus, Igg Ab, S (Mayo)OutsideLaboratory",,86606,CPT,Facility,Both,,,90,118,100.3,33.8188,118,Aetna,PPO,109.74,93,,percent of total billed charges,,
"Aspergillus Fumigatus, Igg Ab, S (Mayo)OutsideLaboratory",,86606,CPT,Facility,Both,,,90,118,100.3,33.8188,118,America's PPO,America's PPO,113.3154,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Aspergillus Fumigatus, Igg Ab, S (Mayo)OutsideLaboratory",,86606,CPT,Facility,Both,,,90,118,100.3,33.8188,118,BlueCross BlueShield Minnesota, Federal Employee Program,116.112,98.4,,percent of total billed charges,,
"Aspergillus Fumigatus, Igg Ab, S (Mayo)OutsideLaboratory",,86606,CPT,Facility,Both,,,90,118,100.3,33.8188,118,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,118,100,,percent of total billed charges,,
"Aspergillus Fumigatus, Igg Ab, S (Mayo)OutsideLaboratory",,86606,CPT,Facility,Both,,,90,118,100.3,33.8188,118,BlueCross BlueShield Minnesota,High Value Network Plan,106.2,90,,percent of total billed charges,,
"Aspergillus Fumigatus, Igg Ab, S (Mayo)OutsideLaboratory",,86606,CPT,Facility,Outpatient,,,90,118,100.3,33.8188,118,BlueCross BlueShield Minnesota,Medicare Advantage,57.82,49,,percent of total billed charges,,
"Aspergillus Fumigatus, Igg Ab, S (Mayo)OutsideLaboratory",,86606,CPT,Facility,Inpatient,,,90,118,100.3,33.8188,118,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Aspergillus Fumigatus, Igg Ab, S (Mayo)OutsideLaboratory",,86606,CPT,Facility,Both,,,90,118,100.3,33.8188,118,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,104.5126,88.57,,percent of total billed charges,,
"Aspergillus Fumigatus, Igg Ab, S (Mayo)OutsideLaboratory",,86606,CPT,Facility,Both,,,90,118,100.3,33.8188,118,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,33.8188,28.66,,percent of total billed charges,,
"Aspergillus Fumigatus, Igg Ab, S (Mayo)OutsideLaboratory",,86606,CPT,Facility,Outpatient,,,90,118,100.3,33.8188,118,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),57.82,49,,percent of total billed charges,,
"Aspergillus Fumigatus, Igg Ab, S (Mayo)OutsideLaboratory",,86606,CPT,Facility,Inpatient,,,90,118,100.3,33.8188,118,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Aspergillus Fumigatus, Igg Ab, S (Mayo)OutsideLaboratory",,86606,CPT,Facility,Both,,,90,118,100.3,33.8188,118,CorVel,Worker's Compensation,118,100,,percent of total billed charges,,
"Aspergillus Fumigatus, Igg Ab, S (Mayo)OutsideLaboratory",,86606,CPT,Facility,Both,,,90,118,100.3,33.8188,118,First Health Group Corporation,First Health Network,114.46,97,,percent of total billed charges,,
"Aspergillus Fumigatus, Igg Ab, S (Mayo)OutsideLaboratory",,86606,CPT,Facility,Both,,,90,118,100.3,33.8188,118,"Health Partners, Inc.",Commercial,111.628,94.6,,percent of total billed charges,,
"Aspergillus Fumigatus, Igg Ab, S (Mayo)OutsideLaboratory",,86606,CPT,Facility,Outpatient,,,90,118,100.3,33.8188,118,"Health Partners, Inc.",Medicare Advantage,57.82,49,,percent of total billed charges,,
"Aspergillus Fumigatus, Igg Ab, S (Mayo)OutsideLaboratory",,86606,CPT,Facility,Inpatient,,,90,118,100.3,33.8188,118,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Aspergillus Fumigatus, Igg Ab, S (Mayo)OutsideLaboratory",,86606,CPT,Facility,Both,,,90,118,100.3,33.8188,118,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),70.8,60,,percent of total billed charges,,
"Aspergillus Fumigatus, Igg Ab, S (Mayo)OutsideLaboratory",,86606,CPT,Facility,Both,,,90,118,100.3,33.8188,118,"Health Partners, Inc.",State of Minnesota Advantage Program,96.17,81.5,,percent of total billed charges,,
"Aspergillus Fumigatus, Igg Ab, S (Mayo)OutsideLaboratory",,86606,CPT,Facility,Both,,,90,118,100.3,33.8188,118,"Health Partners, Inc.",State Public Programs,59,50,,percent of total billed charges,,
"Aspergillus Fumigatus, Igg Ab, S (Mayo)OutsideLaboratory",,86606,CPT,Facility,Both,,,90,118,100.3,33.8188,118,Humana Insurance Company,Commercial PPO,112.1,95,,percent of total billed charges,,
"Aspergillus Fumigatus, Igg Ab, S (Mayo)OutsideLaboratory",,86606,CPT,Facility,Outpatient,,,90,118,100.3,33.8188,118,Humana Insurance Company,Medicare PPO,57.82,49,,percent of total billed charges,,
"Aspergillus Fumigatus, Igg Ab, S (Mayo)OutsideLaboratory",,86606,CPT,Facility,Inpatient,,,90,118,100.3,33.8188,118,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Aspergillus Fumigatus, Igg Ab, S (Mayo)OutsideLaboratory",,86606,CPT,Facility,Both,,,90,118,100.3,33.8188,118,Medica,Individual & Family,116.938,99.1,,percent of total billed charges,,
"Aspergillus Fumigatus, Igg Ab, S (Mayo)OutsideLaboratory",,86606,CPT,Facility,Outpatient,,,90,118,100.3,33.8188,118,Medica,Medica Advantage Solution,58.764,49.8,,percent of total billed charges,,
"Aspergillus Fumigatus, Igg Ab, S (Mayo)OutsideLaboratory",,86606,CPT,Facility,Inpatient,,,90,118,100.3,33.8188,118,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Aspergillus Fumigatus, Igg Ab, S (Mayo)OutsideLaboratory",,86606,CPT,Facility,Outpatient,,,90,118,100.3,33.8188,118,Medica,Medical Assistance,52.628,44.6,,percent of total billed charges,,
"Aspergillus Fumigatus, Igg Ab, S (Mayo)OutsideLaboratory",,86606,CPT,Facility,Inpatient,,,90,118,100.3,33.8188,118,Medica,Medical Assistance,,,,,Included in per diem rate,
"Aspergillus Fumigatus, Igg Ab, S (Mayo)OutsideLaboratory",,86606,CPT,Facility,Outpatient,,,90,118,100.3,33.8188,118,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,58.764,49.8,,percent of total billed charges,,
"Aspergillus Fumigatus, Igg Ab, S (Mayo)OutsideLaboratory",,86606,CPT,Facility,Inpatient,,,90,118,100.3,33.8188,118,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Aspergillus Fumigatus, Igg Ab, S (Mayo)OutsideLaboratory",,86606,CPT,Facility,Both,,,90,118,100.3,33.8188,118,"Multiplan, Inc.","Multiplan, Inc.",110.92,94,,percent of total billed charges,,
"Aspergillus Fumigatus, Igg Ab, S (Mayo)OutsideLaboratory",,86606,CPT,Facility,Outpatient,,,90,118,100.3,33.8188,118,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,101.952,86.4,,percent of total billed charges,,
"Aspergillus Fumigatus, Igg Ab, S (Mayo)OutsideLaboratory",,86606,CPT,Facility,Inpatient,,,90,118,100.3,33.8188,118,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Aspergillus Fumigatus, Igg Ab, S (Mayo)OutsideLaboratory",,86606,CPT,Facility,Both,,,90,118,100.3,33.8188,118,"Preferred One Administrative Services, INC.",PPO,116.348,98.6,,percent of total billed charges,,
"Aspergillus Fumigatus, Igg Ab, S (Mayo)OutsideLaboratory",,86606,CPT,Facility,Outpatient,,,90,118,100.3,33.8188,118,PrimeWest Health,Minnesota Senior Health Options (MSHO),60.711,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Aspergillus Fumigatus, Igg Ab, S (Mayo)OutsideLaboratory",,86606,CPT,Facility,Inpatient,,,90,118,100.3,33.8188,118,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Aspergillus Fumigatus, Igg Ab, S (Mayo)OutsideLaboratory",,86606,CPT,Facility,Outpatient,,,90,118,100.3,33.8188,118,PrimeWest Health,MinnesotaCare,60.6048,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Aspergillus Fumigatus, Igg Ab, S (Mayo)OutsideLaboratory",,86606,CPT,Facility,Inpatient,,,90,118,100.3,33.8188,118,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Aspergillus Fumigatus, Igg Ab, S (Mayo)OutsideLaboratory",,86606,CPT,Facility,Both,,,90,118,100.3,33.8188,118,Sanford Health Plan,Sanford Health Plan,108.56,92,,percent of total billed charges,,
"Aspergillus Fumigatus, Igg Ab, S (Mayo)OutsideLaboratory",,86606,CPT,Facility,Outpatient,,,90,118,100.3,33.8188,118,"UCare Health, Inc.",Individual & Family Plan,66.493,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Aspergillus Fumigatus, Igg Ab, S (Mayo)OutsideLaboratory",,86606,CPT,Facility,Inpatient,,,90,118,100.3,33.8188,118,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Aspergillus Fumigatus, Igg Ab, S (Mayo)OutsideLaboratory",,86606,CPT,Facility,Outpatient,,,90,118,100.3,33.8188,118,"UCare Health, Inc.",Medical Assistance,59.5546,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Aspergillus Fumigatus, Igg Ab, S (Mayo)OutsideLaboratory",,86606,CPT,Facility,Inpatient,,,90,118,100.3,33.8188,118,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Aspergillus Fumigatus, Igg Ab, S (Mayo)OutsideLaboratory",,86606,CPT,Facility,Outpatient,,,90,118,100.3,33.8188,118,"UCare Health, Inc.",Medicare Advantage,59.5546,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Aspergillus Fumigatus, Igg Ab, S (Mayo)OutsideLaboratory",,86606,CPT,Facility,Inpatient,,,90,118,100.3,33.8188,118,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Aspergillus Fumigatus, Igg Ab, S (Mayo)OutsideLaboratory",,86606,CPT,Facility,Outpatient,,,90,118,100.3,33.8188,118,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),59.5546,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Aspergillus Fumigatus, Igg Ab, S (Mayo)OutsideLaboratory",,86606,CPT,Facility,Inpatient,,,90,118,100.3,33.8188,118,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Aspergillus Fumigatus, Igg Ab, S (Mayo)OutsideLaboratory",,86606,CPT,Facility,Both,,,90,118,100.3,33.8188,118,UnitedHealthcare,Individual & Family,110.92,94,,percent of total billed charges,,
"Aspergillus Fumigatus, Igg Ab, S (Mayo)OutsideLaboratory",,86606,CPT,Facility,Outpatient,,,90,118,100.3,33.8188,118,UnitedHealthcare,Medicare Advantage,57.82,49,,percent of total billed charges,,
"Aspergillus Fumigatus, Igg Ab, S (Mayo)OutsideLaboratory",,86606,CPT,Facility,Inpatient,,,90,118,100.3,33.8188,118,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Aspergillus Fumigatus, Igg Ab, S (Mayo)OutsideLaboratory",,86606,CPT,Facility,Outpatient,,,90,118,100.3,33.8188,118,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,56.64,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Aspergillus Fumigatus, Igg Ab, S (Mayo)OutsideLaboratory",,86606,CPT,Facility,Inpatient,,,90,118,100.3,33.8188,118,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Blastomyces Ab, Eia, S (Mayo)OutsideLaboratory",,86612,CPT,Facility,Both,,,90,60,51,17.196,60,Aetna,Commercial,55.2,92,,percent of total billed charges,,
"Blastomyces Ab, Eia, S (Mayo)OutsideLaboratory",,86612,CPT,Facility,Outpatient,,,90,60,51,17.196,60,Aetna,Medicare Advantage,29.4,49,,percent of total billed charges,,
"Blastomyces Ab, Eia, S (Mayo)OutsideLaboratory",,86612,CPT,Facility,Inpatient,,,90,60,51,17.196,60,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Blastomyces Ab, Eia, S (Mayo)OutsideLaboratory",,86612,CPT,Facility,Both,,,90,60,51,17.196,60,Aetna,PPO,55.8,93,,percent of total billed charges,,
"Blastomyces Ab, Eia, S (Mayo)OutsideLaboratory",,86612,CPT,Facility,Both,,,90,60,51,17.196,60,America's PPO,America's PPO,57.618,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Blastomyces Ab, Eia, S (Mayo)OutsideLaboratory",,86612,CPT,Facility,Both,,,90,60,51,17.196,60,BlueCross BlueShield Minnesota, Federal Employee Program,59.04,98.4,,percent of total billed charges,,
"Blastomyces Ab, Eia, S (Mayo)OutsideLaboratory",,86612,CPT,Facility,Both,,,90,60,51,17.196,60,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,60,100,,percent of total billed charges,,
"Blastomyces Ab, Eia, S (Mayo)OutsideLaboratory",,86612,CPT,Facility,Both,,,90,60,51,17.196,60,BlueCross BlueShield Minnesota,High Value Network Plan,54,90,,percent of total billed charges,,
"Blastomyces Ab, Eia, S (Mayo)OutsideLaboratory",,86612,CPT,Facility,Outpatient,,,90,60,51,17.196,60,BlueCross BlueShield Minnesota,Medicare Advantage,29.4,49,,percent of total billed charges,,
"Blastomyces Ab, Eia, S (Mayo)OutsideLaboratory",,86612,CPT,Facility,Inpatient,,,90,60,51,17.196,60,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Blastomyces Ab, Eia, S (Mayo)OutsideLaboratory",,86612,CPT,Facility,Both,,,90,60,51,17.196,60,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,53.142,88.57,,percent of total billed charges,,
"Blastomyces Ab, Eia, S (Mayo)OutsideLaboratory",,86612,CPT,Facility,Both,,,90,60,51,17.196,60,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,17.196,28.66,,percent of total billed charges,,
"Blastomyces Ab, Eia, S (Mayo)OutsideLaboratory",,86612,CPT,Facility,Outpatient,,,90,60,51,17.196,60,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),29.4,49,,percent of total billed charges,,
"Blastomyces Ab, Eia, S (Mayo)OutsideLaboratory",,86612,CPT,Facility,Inpatient,,,90,60,51,17.196,60,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Blastomyces Ab, Eia, S (Mayo)OutsideLaboratory",,86612,CPT,Facility,Both,,,90,60,51,17.196,60,CorVel,Worker's Compensation,60,100,,percent of total billed charges,,
"Blastomyces Ab, Eia, S (Mayo)OutsideLaboratory",,86612,CPT,Facility,Both,,,90,60,51,17.196,60,First Health Group Corporation,First Health Network,58.2,97,,percent of total billed charges,,
"Blastomyces Ab, Eia, S (Mayo)OutsideLaboratory",,86612,CPT,Facility,Both,,,90,60,51,17.196,60,"Health Partners, Inc.",Commercial,56.76,94.6,,percent of total billed charges,,
"Blastomyces Ab, Eia, S (Mayo)OutsideLaboratory",,86612,CPT,Facility,Outpatient,,,90,60,51,17.196,60,"Health Partners, Inc.",Medicare Advantage,29.4,49,,percent of total billed charges,,
"Blastomyces Ab, Eia, S (Mayo)OutsideLaboratory",,86612,CPT,Facility,Inpatient,,,90,60,51,17.196,60,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Blastomyces Ab, Eia, S (Mayo)OutsideLaboratory",,86612,CPT,Facility,Both,,,90,60,51,17.196,60,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),36,60,,percent of total billed charges,,
"Blastomyces Ab, Eia, S (Mayo)OutsideLaboratory",,86612,CPT,Facility,Both,,,90,60,51,17.196,60,"Health Partners, Inc.",State of Minnesota Advantage Program,48.9,81.5,,percent of total billed charges,,
"Blastomyces Ab, Eia, S (Mayo)OutsideLaboratory",,86612,CPT,Facility,Both,,,90,60,51,17.196,60,"Health Partners, Inc.",State Public Programs,30,50,,percent of total billed charges,,
"Blastomyces Ab, Eia, S (Mayo)OutsideLaboratory",,86612,CPT,Facility,Both,,,90,60,51,17.196,60,Humana Insurance Company,Commercial PPO,57,95,,percent of total billed charges,,
"Blastomyces Ab, Eia, S (Mayo)OutsideLaboratory",,86612,CPT,Facility,Outpatient,,,90,60,51,17.196,60,Humana Insurance Company,Medicare PPO,29.4,49,,percent of total billed charges,,
"Blastomyces Ab, Eia, S (Mayo)OutsideLaboratory",,86612,CPT,Facility,Inpatient,,,90,60,51,17.196,60,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Blastomyces Ab, Eia, S (Mayo)OutsideLaboratory",,86612,CPT,Facility,Both,,,90,60,51,17.196,60,Medica,Individual & Family,59.46,99.1,,percent of total billed charges,,
"Blastomyces Ab, Eia, S (Mayo)OutsideLaboratory",,86612,CPT,Facility,Outpatient,,,90,60,51,17.196,60,Medica,Medica Advantage Solution,29.88,49.8,,percent of total billed charges,,
"Blastomyces Ab, Eia, S (Mayo)OutsideLaboratory",,86612,CPT,Facility,Inpatient,,,90,60,51,17.196,60,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Blastomyces Ab, Eia, S (Mayo)OutsideLaboratory",,86612,CPT,Facility,Outpatient,,,90,60,51,17.196,60,Medica,Medical Assistance,26.76,44.6,,percent of total billed charges,,
"Blastomyces Ab, Eia, S (Mayo)OutsideLaboratory",,86612,CPT,Facility,Inpatient,,,90,60,51,17.196,60,Medica,Medical Assistance,,,,,Included in per diem rate,
"Blastomyces Ab, Eia, S (Mayo)OutsideLaboratory",,86612,CPT,Facility,Outpatient,,,90,60,51,17.196,60,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,29.88,49.8,,percent of total billed charges,,
"Blastomyces Ab, Eia, S (Mayo)OutsideLaboratory",,86612,CPT,Facility,Inpatient,,,90,60,51,17.196,60,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Blastomyces Ab, Eia, S (Mayo)OutsideLaboratory",,86612,CPT,Facility,Both,,,90,60,51,17.196,60,"Multiplan, Inc.","Multiplan, Inc.",56.4,94,,percent of total billed charges,,
"Blastomyces Ab, Eia, S (Mayo)OutsideLaboratory",,86612,CPT,Facility,Outpatient,,,90,60,51,17.196,60,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,51.84,86.4,,percent of total billed charges,,
"Blastomyces Ab, Eia, S (Mayo)OutsideLaboratory",,86612,CPT,Facility,Inpatient,,,90,60,51,17.196,60,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Blastomyces Ab, Eia, S (Mayo)OutsideLaboratory",,86612,CPT,Facility,Both,,,90,60,51,17.196,60,"Preferred One Administrative Services, INC.",PPO,59.16,98.6,,percent of total billed charges,,
"Blastomyces Ab, Eia, S (Mayo)OutsideLaboratory",,86612,CPT,Facility,Outpatient,,,90,60,51,17.196,60,PrimeWest Health,Minnesota Senior Health Options (MSHO),30.87,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Blastomyces Ab, Eia, S (Mayo)OutsideLaboratory",,86612,CPT,Facility,Inpatient,,,90,60,51,17.196,60,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Blastomyces Ab, Eia, S (Mayo)OutsideLaboratory",,86612,CPT,Facility,Outpatient,,,90,60,51,17.196,60,PrimeWest Health,MinnesotaCare,30.816,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Blastomyces Ab, Eia, S (Mayo)OutsideLaboratory",,86612,CPT,Facility,Inpatient,,,90,60,51,17.196,60,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Blastomyces Ab, Eia, S (Mayo)OutsideLaboratory",,86612,CPT,Facility,Both,,,90,60,51,17.196,60,Sanford Health Plan,Sanford Health Plan,55.2,92,,percent of total billed charges,,
"Blastomyces Ab, Eia, S (Mayo)OutsideLaboratory",,86612,CPT,Facility,Outpatient,,,90,60,51,17.196,60,"UCare Health, Inc.",Individual & Family Plan,33.81,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Blastomyces Ab, Eia, S (Mayo)OutsideLaboratory",,86612,CPT,Facility,Inpatient,,,90,60,51,17.196,60,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Blastomyces Ab, Eia, S (Mayo)OutsideLaboratory",,86612,CPT,Facility,Outpatient,,,90,60,51,17.196,60,"UCare Health, Inc.",Medical Assistance,30.282,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Blastomyces Ab, Eia, S (Mayo)OutsideLaboratory",,86612,CPT,Facility,Inpatient,,,90,60,51,17.196,60,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Blastomyces Ab, Eia, S (Mayo)OutsideLaboratory",,86612,CPT,Facility,Outpatient,,,90,60,51,17.196,60,"UCare Health, Inc.",Medicare Advantage,30.282,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Blastomyces Ab, Eia, S (Mayo)OutsideLaboratory",,86612,CPT,Facility,Inpatient,,,90,60,51,17.196,60,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Blastomyces Ab, Eia, S (Mayo)OutsideLaboratory",,86612,CPT,Facility,Outpatient,,,90,60,51,17.196,60,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),30.282,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Blastomyces Ab, Eia, S (Mayo)OutsideLaboratory",,86612,CPT,Facility,Inpatient,,,90,60,51,17.196,60,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Blastomyces Ab, Eia, S (Mayo)OutsideLaboratory",,86612,CPT,Facility,Both,,,90,60,51,17.196,60,UnitedHealthcare,Individual & Family,56.4,94,,percent of total billed charges,,
"Blastomyces Ab, Eia, S (Mayo)OutsideLaboratory",,86612,CPT,Facility,Outpatient,,,90,60,51,17.196,60,UnitedHealthcare,Medicare Advantage,29.4,49,,percent of total billed charges,,
"Blastomyces Ab, Eia, S (Mayo)OutsideLaboratory",,86612,CPT,Facility,Inpatient,,,90,60,51,17.196,60,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Blastomyces Ab, Eia, S (Mayo)OutsideLaboratory",,86612,CPT,Facility,Outpatient,,,90,60,51,17.196,60,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,28.8,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Blastomyces Ab, Eia, S (Mayo)OutsideLaboratory",,86612,CPT,Facility,Inpatient,,,90,60,51,17.196,60,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"B. Pertussis Ab, Igg, S (Mayo)OutsideLaboratory",,86615,CPT,Facility,Both,,,90,242,205.7,69.3572,242,Aetna,Commercial,222.64,92,,percent of total billed charges,,
"B. Pertussis Ab, Igg, S (Mayo)OutsideLaboratory",,86615,CPT,Facility,Outpatient,,,90,242,205.7,69.3572,242,Aetna,Medicare Advantage,118.58,49,,percent of total billed charges,,
"B. Pertussis Ab, Igg, S (Mayo)OutsideLaboratory",,86615,CPT,Facility,Inpatient,,,90,242,205.7,69.3572,242,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"B. Pertussis Ab, Igg, S (Mayo)OutsideLaboratory",,86615,CPT,Facility,Both,,,90,242,205.7,69.3572,242,Aetna,PPO,225.06,93,,percent of total billed charges,,
"B. Pertussis Ab, Igg, S (Mayo)OutsideLaboratory",,86615,CPT,Facility,Both,,,90,242,205.7,69.3572,242,America's PPO,America's PPO,232.3926,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"B. Pertussis Ab, Igg, S (Mayo)OutsideLaboratory",,86615,CPT,Facility,Both,,,90,242,205.7,69.3572,242,BlueCross BlueShield Minnesota, Federal Employee Program,238.128,98.4,,percent of total billed charges,,
"B. Pertussis Ab, Igg, S (Mayo)OutsideLaboratory",,86615,CPT,Facility,Both,,,90,242,205.7,69.3572,242,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,242,100,,percent of total billed charges,,
"B. Pertussis Ab, Igg, S (Mayo)OutsideLaboratory",,86615,CPT,Facility,Both,,,90,242,205.7,69.3572,242,BlueCross BlueShield Minnesota,High Value Network Plan,217.8,90,,percent of total billed charges,,
"B. Pertussis Ab, Igg, S (Mayo)OutsideLaboratory",,86615,CPT,Facility,Outpatient,,,90,242,205.7,69.3572,242,BlueCross BlueShield Minnesota,Medicare Advantage,118.58,49,,percent of total billed charges,,
"B. Pertussis Ab, Igg, S (Mayo)OutsideLaboratory",,86615,CPT,Facility,Inpatient,,,90,242,205.7,69.3572,242,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"B. Pertussis Ab, Igg, S (Mayo)OutsideLaboratory",,86615,CPT,Facility,Both,,,90,242,205.7,69.3572,242,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,214.3394,88.57,,percent of total billed charges,,
"B. Pertussis Ab, Igg, S (Mayo)OutsideLaboratory",,86615,CPT,Facility,Both,,,90,242,205.7,69.3572,242,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,69.3572,28.66,,percent of total billed charges,,
"B. Pertussis Ab, Igg, S (Mayo)OutsideLaboratory",,86615,CPT,Facility,Outpatient,,,90,242,205.7,69.3572,242,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),118.58,49,,percent of total billed charges,,
"B. Pertussis Ab, Igg, S (Mayo)OutsideLaboratory",,86615,CPT,Facility,Inpatient,,,90,242,205.7,69.3572,242,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"B. Pertussis Ab, Igg, S (Mayo)OutsideLaboratory",,86615,CPT,Facility,Both,,,90,242,205.7,69.3572,242,CorVel,Worker's Compensation,242,100,,percent of total billed charges,,
"B. Pertussis Ab, Igg, S (Mayo)OutsideLaboratory",,86615,CPT,Facility,Both,,,90,242,205.7,69.3572,242,First Health Group Corporation,First Health Network,234.74,97,,percent of total billed charges,,
"B. Pertussis Ab, Igg, S (Mayo)OutsideLaboratory",,86615,CPT,Facility,Both,,,90,242,205.7,69.3572,242,"Health Partners, Inc.",Commercial,228.932,94.6,,percent of total billed charges,,
"B. Pertussis Ab, Igg, S (Mayo)OutsideLaboratory",,86615,CPT,Facility,Outpatient,,,90,242,205.7,69.3572,242,"Health Partners, Inc.",Medicare Advantage,118.58,49,,percent of total billed charges,,
"B. Pertussis Ab, Igg, S (Mayo)OutsideLaboratory",,86615,CPT,Facility,Inpatient,,,90,242,205.7,69.3572,242,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"B. Pertussis Ab, Igg, S (Mayo)OutsideLaboratory",,86615,CPT,Facility,Both,,,90,242,205.7,69.3572,242,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),145.2,60,,percent of total billed charges,,
"B. Pertussis Ab, Igg, S (Mayo)OutsideLaboratory",,86615,CPT,Facility,Both,,,90,242,205.7,69.3572,242,"Health Partners, Inc.",State of Minnesota Advantage Program,197.23,81.5,,percent of total billed charges,,
"B. Pertussis Ab, Igg, S (Mayo)OutsideLaboratory",,86615,CPT,Facility,Both,,,90,242,205.7,69.3572,242,"Health Partners, Inc.",State Public Programs,121,50,,percent of total billed charges,,
"B. Pertussis Ab, Igg, S (Mayo)OutsideLaboratory",,86615,CPT,Facility,Both,,,90,242,205.7,69.3572,242,Humana Insurance Company,Commercial PPO,229.9,95,,percent of total billed charges,,
"B. Pertussis Ab, Igg, S (Mayo)OutsideLaboratory",,86615,CPT,Facility,Outpatient,,,90,242,205.7,69.3572,242,Humana Insurance Company,Medicare PPO,118.58,49,,percent of total billed charges,,
"B. Pertussis Ab, Igg, S (Mayo)OutsideLaboratory",,86615,CPT,Facility,Inpatient,,,90,242,205.7,69.3572,242,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"B. Pertussis Ab, Igg, S (Mayo)OutsideLaboratory",,86615,CPT,Facility,Both,,,90,242,205.7,69.3572,242,Medica,Individual & Family,239.822,99.1,,percent of total billed charges,,
"B. Pertussis Ab, Igg, S (Mayo)OutsideLaboratory",,86615,CPT,Facility,Outpatient,,,90,242,205.7,69.3572,242,Medica,Medica Advantage Solution,120.516,49.8,,percent of total billed charges,,
"B. Pertussis Ab, Igg, S (Mayo)OutsideLaboratory",,86615,CPT,Facility,Inpatient,,,90,242,205.7,69.3572,242,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"B. Pertussis Ab, Igg, S (Mayo)OutsideLaboratory",,86615,CPT,Facility,Outpatient,,,90,242,205.7,69.3572,242,Medica,Medical Assistance,107.932,44.6,,percent of total billed charges,,
"B. Pertussis Ab, Igg, S (Mayo)OutsideLaboratory",,86615,CPT,Facility,Inpatient,,,90,242,205.7,69.3572,242,Medica,Medical Assistance,,,,,Included in per diem rate,
"B. Pertussis Ab, Igg, S (Mayo)OutsideLaboratory",,86615,CPT,Facility,Outpatient,,,90,242,205.7,69.3572,242,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,120.516,49.8,,percent of total billed charges,,
"B. Pertussis Ab, Igg, S (Mayo)OutsideLaboratory",,86615,CPT,Facility,Inpatient,,,90,242,205.7,69.3572,242,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"B. Pertussis Ab, Igg, S (Mayo)OutsideLaboratory",,86615,CPT,Facility,Both,,,90,242,205.7,69.3572,242,"Multiplan, Inc.","Multiplan, Inc.",227.48,94,,percent of total billed charges,,
"B. Pertussis Ab, Igg, S (Mayo)OutsideLaboratory",,86615,CPT,Facility,Outpatient,,,90,242,205.7,69.3572,242,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,209.088,86.4,,percent of total billed charges,,
"B. Pertussis Ab, Igg, S (Mayo)OutsideLaboratory",,86615,CPT,Facility,Inpatient,,,90,242,205.7,69.3572,242,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"B. Pertussis Ab, Igg, S (Mayo)OutsideLaboratory",,86615,CPT,Facility,Both,,,90,242,205.7,69.3572,242,"Preferred One Administrative Services, INC.",PPO,238.612,98.6,,percent of total billed charges,,
"B. Pertussis Ab, Igg, S (Mayo)OutsideLaboratory",,86615,CPT,Facility,Outpatient,,,90,242,205.7,69.3572,242,PrimeWest Health,Minnesota Senior Health Options (MSHO),124.509,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"B. Pertussis Ab, Igg, S (Mayo)OutsideLaboratory",,86615,CPT,Facility,Inpatient,,,90,242,205.7,69.3572,242,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"B. Pertussis Ab, Igg, S (Mayo)OutsideLaboratory",,86615,CPT,Facility,Outpatient,,,90,242,205.7,69.3572,242,PrimeWest Health,MinnesotaCare,124.2912,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"B. Pertussis Ab, Igg, S (Mayo)OutsideLaboratory",,86615,CPT,Facility,Inpatient,,,90,242,205.7,69.3572,242,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"B. Pertussis Ab, Igg, S (Mayo)OutsideLaboratory",,86615,CPT,Facility,Both,,,90,242,205.7,69.3572,242,Sanford Health Plan,Sanford Health Plan,222.64,92,,percent of total billed charges,,
"B. Pertussis Ab, Igg, S (Mayo)OutsideLaboratory",,86615,CPT,Facility,Outpatient,,,90,242,205.7,69.3572,242,"UCare Health, Inc.",Individual & Family Plan,136.367,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"B. Pertussis Ab, Igg, S (Mayo)OutsideLaboratory",,86615,CPT,Facility,Inpatient,,,90,242,205.7,69.3572,242,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"B. Pertussis Ab, Igg, S (Mayo)OutsideLaboratory",,86615,CPT,Facility,Outpatient,,,90,242,205.7,69.3572,242,"UCare Health, Inc.",Medical Assistance,122.1374,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"B. Pertussis Ab, Igg, S (Mayo)OutsideLaboratory",,86615,CPT,Facility,Inpatient,,,90,242,205.7,69.3572,242,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"B. Pertussis Ab, Igg, S (Mayo)OutsideLaboratory",,86615,CPT,Facility,Outpatient,,,90,242,205.7,69.3572,242,"UCare Health, Inc.",Medicare Advantage,122.1374,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"B. Pertussis Ab, Igg, S (Mayo)OutsideLaboratory",,86615,CPT,Facility,Inpatient,,,90,242,205.7,69.3572,242,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"B. Pertussis Ab, Igg, S (Mayo)OutsideLaboratory",,86615,CPT,Facility,Outpatient,,,90,242,205.7,69.3572,242,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),122.1374,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"B. Pertussis Ab, Igg, S (Mayo)OutsideLaboratory",,86615,CPT,Facility,Inpatient,,,90,242,205.7,69.3572,242,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"B. Pertussis Ab, Igg, S (Mayo)OutsideLaboratory",,86615,CPT,Facility,Both,,,90,242,205.7,69.3572,242,UnitedHealthcare,Individual & Family,227.48,94,,percent of total billed charges,,
"B. Pertussis Ab, Igg, S (Mayo)OutsideLaboratory",,86615,CPT,Facility,Outpatient,,,90,242,205.7,69.3572,242,UnitedHealthcare,Medicare Advantage,118.58,49,,percent of total billed charges,,
"B. Pertussis Ab, Igg, S (Mayo)OutsideLaboratory",,86615,CPT,Facility,Inpatient,,,90,242,205.7,69.3572,242,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"B. Pertussis Ab, Igg, S (Mayo)OutsideLaboratory",,86615,CPT,Facility,Outpatient,,,90,242,205.7,69.3572,242,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,116.16,48,,percent of total billed charges,,100% of DHS outpatient percentage
"B. Pertussis Ab, Igg, S (Mayo)OutsideLaboratory",,86615,CPT,Facility,Inpatient,,,90,242,205.7,69.3572,242,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Lyme Disease Ab, Immunoblot, S (Mayo)OutsideLaboratory",,86617,CPT,Facility,Both,,,90,112,95.2,32.0992,112,Aetna,Commercial,103.04,92,,percent of total billed charges,,
"Lyme Disease Ab, Immunoblot, S (Mayo)OutsideLaboratory",,86617,CPT,Facility,Outpatient,,,90,112,95.2,32.0992,112,Aetna,Medicare Advantage,54.88,49,,percent of total billed charges,,
"Lyme Disease Ab, Immunoblot, S (Mayo)OutsideLaboratory",,86617,CPT,Facility,Inpatient,,,90,112,95.2,32.0992,112,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Lyme Disease Ab, Immunoblot, S (Mayo)OutsideLaboratory",,86617,CPT,Facility,Both,,,90,112,95.2,32.0992,112,Aetna,PPO,104.16,93,,percent of total billed charges,,
"Lyme Disease Ab, Immunoblot, S (Mayo)OutsideLaboratory",,86617,CPT,Facility,Both,,,90,112,95.2,32.0992,112,America's PPO,America's PPO,107.5536,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Lyme Disease Ab, Immunoblot, S (Mayo)OutsideLaboratory",,86617,CPT,Facility,Both,,,90,112,95.2,32.0992,112,BlueCross BlueShield Minnesota, Federal Employee Program,110.208,98.4,,percent of total billed charges,,
"Lyme Disease Ab, Immunoblot, S (Mayo)OutsideLaboratory",,86617,CPT,Facility,Both,,,90,112,95.2,32.0992,112,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,112,100,,percent of total billed charges,,
"Lyme Disease Ab, Immunoblot, S (Mayo)OutsideLaboratory",,86617,CPT,Facility,Both,,,90,112,95.2,32.0992,112,BlueCross BlueShield Minnesota,High Value Network Plan,100.8,90,,percent of total billed charges,,
"Lyme Disease Ab, Immunoblot, S (Mayo)OutsideLaboratory",,86617,CPT,Facility,Outpatient,,,90,112,95.2,32.0992,112,BlueCross BlueShield Minnesota,Medicare Advantage,54.88,49,,percent of total billed charges,,
"Lyme Disease Ab, Immunoblot, S (Mayo)OutsideLaboratory",,86617,CPT,Facility,Inpatient,,,90,112,95.2,32.0992,112,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Lyme Disease Ab, Immunoblot, S (Mayo)OutsideLaboratory",,86617,CPT,Facility,Both,,,90,112,95.2,32.0992,112,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,99.1984,88.57,,percent of total billed charges,,
"Lyme Disease Ab, Immunoblot, S (Mayo)OutsideLaboratory",,86617,CPT,Facility,Both,,,90,112,95.2,32.0992,112,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,32.0992,28.66,,percent of total billed charges,,
"Lyme Disease Ab, Immunoblot, S (Mayo)OutsideLaboratory",,86617,CPT,Facility,Outpatient,,,90,112,95.2,32.0992,112,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),54.88,49,,percent of total billed charges,,
"Lyme Disease Ab, Immunoblot, S (Mayo)OutsideLaboratory",,86617,CPT,Facility,Inpatient,,,90,112,95.2,32.0992,112,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Lyme Disease Ab, Immunoblot, S (Mayo)OutsideLaboratory",,86617,CPT,Facility,Both,,,90,112,95.2,32.0992,112,CorVel,Worker's Compensation,112,100,,percent of total billed charges,,
"Lyme Disease Ab, Immunoblot, S (Mayo)OutsideLaboratory",,86617,CPT,Facility,Both,,,90,112,95.2,32.0992,112,First Health Group Corporation,First Health Network,108.64,97,,percent of total billed charges,,
"Lyme Disease Ab, Immunoblot, S (Mayo)OutsideLaboratory",,86617,CPT,Facility,Both,,,90,112,95.2,32.0992,112,"Health Partners, Inc.",Commercial,105.952,94.6,,percent of total billed charges,,
"Lyme Disease Ab, Immunoblot, S (Mayo)OutsideLaboratory",,86617,CPT,Facility,Outpatient,,,90,112,95.2,32.0992,112,"Health Partners, Inc.",Medicare Advantage,54.88,49,,percent of total billed charges,,
"Lyme Disease Ab, Immunoblot, S (Mayo)OutsideLaboratory",,86617,CPT,Facility,Inpatient,,,90,112,95.2,32.0992,112,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Lyme Disease Ab, Immunoblot, S (Mayo)OutsideLaboratory",,86617,CPT,Facility,Both,,,90,112,95.2,32.0992,112,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),67.2,60,,percent of total billed charges,,
"Lyme Disease Ab, Immunoblot, S (Mayo)OutsideLaboratory",,86617,CPT,Facility,Both,,,90,112,95.2,32.0992,112,"Health Partners, Inc.",State of Minnesota Advantage Program,91.28,81.5,,percent of total billed charges,,
"Lyme Disease Ab, Immunoblot, S (Mayo)OutsideLaboratory",,86617,CPT,Facility,Both,,,90,112,95.2,32.0992,112,"Health Partners, Inc.",State Public Programs,56,50,,percent of total billed charges,,
"Lyme Disease Ab, Immunoblot, S (Mayo)OutsideLaboratory",,86617,CPT,Facility,Both,,,90,112,95.2,32.0992,112,Humana Insurance Company,Commercial PPO,106.4,95,,percent of total billed charges,,
"Lyme Disease Ab, Immunoblot, S (Mayo)OutsideLaboratory",,86617,CPT,Facility,Outpatient,,,90,112,95.2,32.0992,112,Humana Insurance Company,Medicare PPO,54.88,49,,percent of total billed charges,,
"Lyme Disease Ab, Immunoblot, S (Mayo)OutsideLaboratory",,86617,CPT,Facility,Inpatient,,,90,112,95.2,32.0992,112,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Lyme Disease Ab, Immunoblot, S (Mayo)OutsideLaboratory",,86617,CPT,Facility,Both,,,90,112,95.2,32.0992,112,Medica,Individual & Family,110.992,99.1,,percent of total billed charges,,
"Lyme Disease Ab, Immunoblot, S (Mayo)OutsideLaboratory",,86617,CPT,Facility,Outpatient,,,90,112,95.2,32.0992,112,Medica,Medica Advantage Solution,55.776,49.8,,percent of total billed charges,,
"Lyme Disease Ab, Immunoblot, S (Mayo)OutsideLaboratory",,86617,CPT,Facility,Inpatient,,,90,112,95.2,32.0992,112,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Lyme Disease Ab, Immunoblot, S (Mayo)OutsideLaboratory",,86617,CPT,Facility,Outpatient,,,90,112,95.2,32.0992,112,Medica,Medical Assistance,49.952,44.6,,percent of total billed charges,,
"Lyme Disease Ab, Immunoblot, S (Mayo)OutsideLaboratory",,86617,CPT,Facility,Inpatient,,,90,112,95.2,32.0992,112,Medica,Medical Assistance,,,,,Included in per diem rate,
"Lyme Disease Ab, Immunoblot, S (Mayo)OutsideLaboratory",,86617,CPT,Facility,Outpatient,,,90,112,95.2,32.0992,112,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,55.776,49.8,,percent of total billed charges,,
"Lyme Disease Ab, Immunoblot, S (Mayo)OutsideLaboratory",,86617,CPT,Facility,Inpatient,,,90,112,95.2,32.0992,112,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Lyme Disease Ab, Immunoblot, S (Mayo)OutsideLaboratory",,86617,CPT,Facility,Both,,,90,112,95.2,32.0992,112,"Multiplan, Inc.","Multiplan, Inc.",105.28,94,,percent of total billed charges,,
"Lyme Disease Ab, Immunoblot, S (Mayo)OutsideLaboratory",,86617,CPT,Facility,Outpatient,,,90,112,95.2,32.0992,112,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,96.768,86.4,,percent of total billed charges,,
"Lyme Disease Ab, Immunoblot, S (Mayo)OutsideLaboratory",,86617,CPT,Facility,Inpatient,,,90,112,95.2,32.0992,112,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Lyme Disease Ab, Immunoblot, S (Mayo)OutsideLaboratory",,86617,CPT,Facility,Both,,,90,112,95.2,32.0992,112,"Preferred One Administrative Services, INC.",PPO,110.432,98.6,,percent of total billed charges,,
"Lyme Disease Ab, Immunoblot, S (Mayo)OutsideLaboratory",,86617,CPT,Facility,Outpatient,,,90,112,95.2,32.0992,112,PrimeWest Health,Minnesota Senior Health Options (MSHO),57.624,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Lyme Disease Ab, Immunoblot, S (Mayo)OutsideLaboratory",,86617,CPT,Facility,Inpatient,,,90,112,95.2,32.0992,112,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Lyme Disease Ab, Immunoblot, S (Mayo)OutsideLaboratory",,86617,CPT,Facility,Outpatient,,,90,112,95.2,32.0992,112,PrimeWest Health,MinnesotaCare,57.5232,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Lyme Disease Ab, Immunoblot, S (Mayo)OutsideLaboratory",,86617,CPT,Facility,Inpatient,,,90,112,95.2,32.0992,112,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Lyme Disease Ab, Immunoblot, S (Mayo)OutsideLaboratory",,86617,CPT,Facility,Both,,,90,112,95.2,32.0992,112,Sanford Health Plan,Sanford Health Plan,103.04,92,,percent of total billed charges,,
"Lyme Disease Ab, Immunoblot, S (Mayo)OutsideLaboratory",,86617,CPT,Facility,Outpatient,,,90,112,95.2,32.0992,112,"UCare Health, Inc.",Individual & Family Plan,63.112,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Lyme Disease Ab, Immunoblot, S (Mayo)OutsideLaboratory",,86617,CPT,Facility,Inpatient,,,90,112,95.2,32.0992,112,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Lyme Disease Ab, Immunoblot, S (Mayo)OutsideLaboratory",,86617,CPT,Facility,Outpatient,,,90,112,95.2,32.0992,112,"UCare Health, Inc.",Medical Assistance,56.5264,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Lyme Disease Ab, Immunoblot, S (Mayo)OutsideLaboratory",,86617,CPT,Facility,Inpatient,,,90,112,95.2,32.0992,112,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Lyme Disease Ab, Immunoblot, S (Mayo)OutsideLaboratory",,86617,CPT,Facility,Outpatient,,,90,112,95.2,32.0992,112,"UCare Health, Inc.",Medicare Advantage,56.5264,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Lyme Disease Ab, Immunoblot, S (Mayo)OutsideLaboratory",,86617,CPT,Facility,Inpatient,,,90,112,95.2,32.0992,112,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Lyme Disease Ab, Immunoblot, S (Mayo)OutsideLaboratory",,86617,CPT,Facility,Outpatient,,,90,112,95.2,32.0992,112,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),56.5264,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Lyme Disease Ab, Immunoblot, S (Mayo)OutsideLaboratory",,86617,CPT,Facility,Inpatient,,,90,112,95.2,32.0992,112,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Lyme Disease Ab, Immunoblot, S (Mayo)OutsideLaboratory",,86617,CPT,Facility,Both,,,90,112,95.2,32.0992,112,UnitedHealthcare,Individual & Family,105.28,94,,percent of total billed charges,,
"Lyme Disease Ab, Immunoblot, S (Mayo)OutsideLaboratory",,86617,CPT,Facility,Outpatient,,,90,112,95.2,32.0992,112,UnitedHealthcare,Medicare Advantage,54.88,49,,percent of total billed charges,,
"Lyme Disease Ab, Immunoblot, S (Mayo)OutsideLaboratory",,86617,CPT,Facility,Inpatient,,,90,112,95.2,32.0992,112,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Lyme Disease Ab, Immunoblot, S (Mayo)OutsideLaboratory",,86617,CPT,Facility,Outpatient,,,90,112,95.2,32.0992,112,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,53.76,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Lyme Disease Ab, Immunoblot, S (Mayo)OutsideLaboratory",,86617,CPT,Facility,Inpatient,,,90,112,95.2,32.0992,112,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Lyme Antibodies Igg/Igm-Ii (Mayo)OutsideLaboratory,,86618,CPT,Facility,Both,,,90,123,104.55,35.2518,123,Aetna,Commercial,113.16,92,,percent of total billed charges,,
Lyme Antibodies Igg/Igm-Ii (Mayo)OutsideLaboratory,,86618,CPT,Facility,Outpatient,,,90,123,104.55,35.2518,123,Aetna,Medicare Advantage,60.27,49,,percent of total billed charges,,
Lyme Antibodies Igg/Igm-Ii (Mayo)OutsideLaboratory,,86618,CPT,Facility,Inpatient,,,90,123,104.55,35.2518,123,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Lyme Antibodies Igg/Igm-Ii (Mayo)OutsideLaboratory,,86618,CPT,Facility,Both,,,90,123,104.55,35.2518,123,Aetna,PPO,114.39,93,,percent of total billed charges,,
Lyme Antibodies Igg/Igm-Ii (Mayo)OutsideLaboratory,,86618,CPT,Facility,Both,,,90,123,104.55,35.2518,123,America's PPO,America's PPO,118.1169,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Lyme Antibodies Igg/Igm-Ii (Mayo)OutsideLaboratory,,86618,CPT,Facility,Both,,,90,123,104.55,35.2518,123,BlueCross BlueShield Minnesota, Federal Employee Program,121.032,98.4,,percent of total billed charges,,
Lyme Antibodies Igg/Igm-Ii (Mayo)OutsideLaboratory,,86618,CPT,Facility,Both,,,90,123,104.55,35.2518,123,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,123,100,,percent of total billed charges,,
Lyme Antibodies Igg/Igm-Ii (Mayo)OutsideLaboratory,,86618,CPT,Facility,Both,,,90,123,104.55,35.2518,123,BlueCross BlueShield Minnesota,High Value Network Plan,110.7,90,,percent of total billed charges,,
Lyme Antibodies Igg/Igm-Ii (Mayo)OutsideLaboratory,,86618,CPT,Facility,Outpatient,,,90,123,104.55,35.2518,123,BlueCross BlueShield Minnesota,Medicare Advantage,60.27,49,,percent of total billed charges,,
Lyme Antibodies Igg/Igm-Ii (Mayo)OutsideLaboratory,,86618,CPT,Facility,Inpatient,,,90,123,104.55,35.2518,123,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Lyme Antibodies Igg/Igm-Ii (Mayo)OutsideLaboratory,,86618,CPT,Facility,Both,,,90,123,104.55,35.2518,123,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,108.9411,88.57,,percent of total billed charges,,
Lyme Antibodies Igg/Igm-Ii (Mayo)OutsideLaboratory,,86618,CPT,Facility,Both,,,90,123,104.55,35.2518,123,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,35.2518,28.66,,percent of total billed charges,,
Lyme Antibodies Igg/Igm-Ii (Mayo)OutsideLaboratory,,86618,CPT,Facility,Outpatient,,,90,123,104.55,35.2518,123,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),60.27,49,,percent of total billed charges,,
Lyme Antibodies Igg/Igm-Ii (Mayo)OutsideLaboratory,,86618,CPT,Facility,Inpatient,,,90,123,104.55,35.2518,123,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Lyme Antibodies Igg/Igm-Ii (Mayo)OutsideLaboratory,,86618,CPT,Facility,Both,,,90,123,104.55,35.2518,123,CorVel,Worker's Compensation,123,100,,percent of total billed charges,,
Lyme Antibodies Igg/Igm-Ii (Mayo)OutsideLaboratory,,86618,CPT,Facility,Both,,,90,123,104.55,35.2518,123,First Health Group Corporation,First Health Network,119.31,97,,percent of total billed charges,,
Lyme Antibodies Igg/Igm-Ii (Mayo)OutsideLaboratory,,86618,CPT,Facility,Both,,,90,123,104.55,35.2518,123,"Health Partners, Inc.",Commercial,116.358,94.6,,percent of total billed charges,,
Lyme Antibodies Igg/Igm-Ii (Mayo)OutsideLaboratory,,86618,CPT,Facility,Outpatient,,,90,123,104.55,35.2518,123,"Health Partners, Inc.",Medicare Advantage,60.27,49,,percent of total billed charges,,
Lyme Antibodies Igg/Igm-Ii (Mayo)OutsideLaboratory,,86618,CPT,Facility,Inpatient,,,90,123,104.55,35.2518,123,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Lyme Antibodies Igg/Igm-Ii (Mayo)OutsideLaboratory,,86618,CPT,Facility,Both,,,90,123,104.55,35.2518,123,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),73.8,60,,percent of total billed charges,,
Lyme Antibodies Igg/Igm-Ii (Mayo)OutsideLaboratory,,86618,CPT,Facility,Both,,,90,123,104.55,35.2518,123,"Health Partners, Inc.",State of Minnesota Advantage Program,100.245,81.5,,percent of total billed charges,,
Lyme Antibodies Igg/Igm-Ii (Mayo)OutsideLaboratory,,86618,CPT,Facility,Both,,,90,123,104.55,35.2518,123,"Health Partners, Inc.",State Public Programs,61.5,50,,percent of total billed charges,,
Lyme Antibodies Igg/Igm-Ii (Mayo)OutsideLaboratory,,86618,CPT,Facility,Both,,,90,123,104.55,35.2518,123,Humana Insurance Company,Commercial PPO,116.85,95,,percent of total billed charges,,
Lyme Antibodies Igg/Igm-Ii (Mayo)OutsideLaboratory,,86618,CPT,Facility,Outpatient,,,90,123,104.55,35.2518,123,Humana Insurance Company,Medicare PPO,60.27,49,,percent of total billed charges,,
Lyme Antibodies Igg/Igm-Ii (Mayo)OutsideLaboratory,,86618,CPT,Facility,Inpatient,,,90,123,104.55,35.2518,123,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Lyme Antibodies Igg/Igm-Ii (Mayo)OutsideLaboratory,,86618,CPT,Facility,Both,,,90,123,104.55,35.2518,123,Medica,Individual & Family,121.893,99.1,,percent of total billed charges,,
Lyme Antibodies Igg/Igm-Ii (Mayo)OutsideLaboratory,,86618,CPT,Facility,Outpatient,,,90,123,104.55,35.2518,123,Medica,Medica Advantage Solution,61.254,49.8,,percent of total billed charges,,
Lyme Antibodies Igg/Igm-Ii (Mayo)OutsideLaboratory,,86618,CPT,Facility,Inpatient,,,90,123,104.55,35.2518,123,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Lyme Antibodies Igg/Igm-Ii (Mayo)OutsideLaboratory,,86618,CPT,Facility,Outpatient,,,90,123,104.55,35.2518,123,Medica,Medical Assistance,54.858,44.6,,percent of total billed charges,,
Lyme Antibodies Igg/Igm-Ii (Mayo)OutsideLaboratory,,86618,CPT,Facility,Inpatient,,,90,123,104.55,35.2518,123,Medica,Medical Assistance,,,,,Included in per diem rate,
Lyme Antibodies Igg/Igm-Ii (Mayo)OutsideLaboratory,,86618,CPT,Facility,Outpatient,,,90,123,104.55,35.2518,123,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,61.254,49.8,,percent of total billed charges,,
Lyme Antibodies Igg/Igm-Ii (Mayo)OutsideLaboratory,,86618,CPT,Facility,Inpatient,,,90,123,104.55,35.2518,123,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Lyme Antibodies Igg/Igm-Ii (Mayo)OutsideLaboratory,,86618,CPT,Facility,Both,,,90,123,104.55,35.2518,123,"Multiplan, Inc.","Multiplan, Inc.",115.62,94,,percent of total billed charges,,
Lyme Antibodies Igg/Igm-Ii (Mayo)OutsideLaboratory,,86618,CPT,Facility,Outpatient,,,90,123,104.55,35.2518,123,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,106.272,86.4,,percent of total billed charges,,
Lyme Antibodies Igg/Igm-Ii (Mayo)OutsideLaboratory,,86618,CPT,Facility,Inpatient,,,90,123,104.55,35.2518,123,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Lyme Antibodies Igg/Igm-Ii (Mayo)OutsideLaboratory,,86618,CPT,Facility,Both,,,90,123,104.55,35.2518,123,"Preferred One Administrative Services, INC.",PPO,121.278,98.6,,percent of total billed charges,,
Lyme Antibodies Igg/Igm-Ii (Mayo)OutsideLaboratory,,86618,CPT,Facility,Outpatient,,,90,123,104.55,35.2518,123,PrimeWest Health,Minnesota Senior Health Options (MSHO),63.2835,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Lyme Antibodies Igg/Igm-Ii (Mayo)OutsideLaboratory,,86618,CPT,Facility,Inpatient,,,90,123,104.55,35.2518,123,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Lyme Antibodies Igg/Igm-Ii (Mayo)OutsideLaboratory,,86618,CPT,Facility,Outpatient,,,90,123,104.55,35.2518,123,PrimeWest Health,MinnesotaCare,63.1728,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Lyme Antibodies Igg/Igm-Ii (Mayo)OutsideLaboratory,,86618,CPT,Facility,Inpatient,,,90,123,104.55,35.2518,123,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Lyme Antibodies Igg/Igm-Ii (Mayo)OutsideLaboratory,,86618,CPT,Facility,Both,,,90,123,104.55,35.2518,123,Sanford Health Plan,Sanford Health Plan,113.16,92,,percent of total billed charges,,
Lyme Antibodies Igg/Igm-Ii (Mayo)OutsideLaboratory,,86618,CPT,Facility,Outpatient,,,90,123,104.55,35.2518,123,"UCare Health, Inc.",Individual & Family Plan,69.3105,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Lyme Antibodies Igg/Igm-Ii (Mayo)OutsideLaboratory,,86618,CPT,Facility,Inpatient,,,90,123,104.55,35.2518,123,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Lyme Antibodies Igg/Igm-Ii (Mayo)OutsideLaboratory,,86618,CPT,Facility,Outpatient,,,90,123,104.55,35.2518,123,"UCare Health, Inc.",Medical Assistance,62.0781,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Lyme Antibodies Igg/Igm-Ii (Mayo)OutsideLaboratory,,86618,CPT,Facility,Inpatient,,,90,123,104.55,35.2518,123,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Lyme Antibodies Igg/Igm-Ii (Mayo)OutsideLaboratory,,86618,CPT,Facility,Outpatient,,,90,123,104.55,35.2518,123,"UCare Health, Inc.",Medicare Advantage,62.0781,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Lyme Antibodies Igg/Igm-Ii (Mayo)OutsideLaboratory,,86618,CPT,Facility,Inpatient,,,90,123,104.55,35.2518,123,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Lyme Antibodies Igg/Igm-Ii (Mayo)OutsideLaboratory,,86618,CPT,Facility,Outpatient,,,90,123,104.55,35.2518,123,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),62.0781,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Lyme Antibodies Igg/Igm-Ii (Mayo)OutsideLaboratory,,86618,CPT,Facility,Inpatient,,,90,123,104.55,35.2518,123,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Lyme Antibodies Igg/Igm-Ii (Mayo)OutsideLaboratory,,86618,CPT,Facility,Both,,,90,123,104.55,35.2518,123,UnitedHealthcare,Individual & Family,115.62,94,,percent of total billed charges,,
Lyme Antibodies Igg/Igm-Ii (Mayo)OutsideLaboratory,,86618,CPT,Facility,Outpatient,,,90,123,104.55,35.2518,123,UnitedHealthcare,Medicare Advantage,60.27,49,,percent of total billed charges,,
Lyme Antibodies Igg/Igm-Ii (Mayo)OutsideLaboratory,,86618,CPT,Facility,Inpatient,,,90,123,104.55,35.2518,123,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Lyme Antibodies Igg/Igm-Ii (Mayo)OutsideLaboratory,,86618,CPT,Facility,Outpatient,,,90,123,104.55,35.2518,123,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,59.04,48,,percent of total billed charges,,100% of DHS outpatient percentage
Lyme Antibodies Igg/Igm-Ii (Mayo)OutsideLaboratory,,86618,CPT,Facility,Inpatient,,,90,123,104.55,35.2518,123,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Coccidioides (Mayo)OutsideLaboratory,,86635,CPT,Facility,Both,,,90,45,38.25,12.897,45,Aetna,Commercial,41.4,92,,percent of total billed charges,,
Coccidioides (Mayo)OutsideLaboratory,,86635,CPT,Facility,Outpatient,,,90,45,38.25,12.897,45,Aetna,Medicare Advantage,22.05,49,,percent of total billed charges,,
Coccidioides (Mayo)OutsideLaboratory,,86635,CPT,Facility,Inpatient,,,90,45,38.25,12.897,45,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Coccidioides (Mayo)OutsideLaboratory,,86635,CPT,Facility,Both,,,90,45,38.25,12.897,45,Aetna,PPO,41.85,93,,percent of total billed charges,,
Coccidioides (Mayo)OutsideLaboratory,,86635,CPT,Facility,Both,,,90,45,38.25,12.897,45,America's PPO,America's PPO,43.2135,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Coccidioides (Mayo)OutsideLaboratory,,86635,CPT,Facility,Both,,,90,45,38.25,12.897,45,BlueCross BlueShield Minnesota, Federal Employee Program,44.28,98.4,,percent of total billed charges,,
Coccidioides (Mayo)OutsideLaboratory,,86635,CPT,Facility,Both,,,90,45,38.25,12.897,45,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,45,100,,percent of total billed charges,,
Coccidioides (Mayo)OutsideLaboratory,,86635,CPT,Facility,Both,,,90,45,38.25,12.897,45,BlueCross BlueShield Minnesota,High Value Network Plan,40.5,90,,percent of total billed charges,,
Coccidioides (Mayo)OutsideLaboratory,,86635,CPT,Facility,Outpatient,,,90,45,38.25,12.897,45,BlueCross BlueShield Minnesota,Medicare Advantage,22.05,49,,percent of total billed charges,,
Coccidioides (Mayo)OutsideLaboratory,,86635,CPT,Facility,Inpatient,,,90,45,38.25,12.897,45,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Coccidioides (Mayo)OutsideLaboratory,,86635,CPT,Facility,Both,,,90,45,38.25,12.897,45,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,39.8565,88.57,,percent of total billed charges,,
Coccidioides (Mayo)OutsideLaboratory,,86635,CPT,Facility,Both,,,90,45,38.25,12.897,45,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,12.897,28.66,,percent of total billed charges,,
Coccidioides (Mayo)OutsideLaboratory,,86635,CPT,Facility,Outpatient,,,90,45,38.25,12.897,45,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),22.05,49,,percent of total billed charges,,
Coccidioides (Mayo)OutsideLaboratory,,86635,CPT,Facility,Inpatient,,,90,45,38.25,12.897,45,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Coccidioides (Mayo)OutsideLaboratory,,86635,CPT,Facility,Both,,,90,45,38.25,12.897,45,CorVel,Worker's Compensation,45,100,,percent of total billed charges,,
Coccidioides (Mayo)OutsideLaboratory,,86635,CPT,Facility,Both,,,90,45,38.25,12.897,45,First Health Group Corporation,First Health Network,43.65,97,,percent of total billed charges,,
Coccidioides (Mayo)OutsideLaboratory,,86635,CPT,Facility,Both,,,90,45,38.25,12.897,45,"Health Partners, Inc.",Commercial,42.57,94.6,,percent of total billed charges,,
Coccidioides (Mayo)OutsideLaboratory,,86635,CPT,Facility,Outpatient,,,90,45,38.25,12.897,45,"Health Partners, Inc.",Medicare Advantage,22.05,49,,percent of total billed charges,,
Coccidioides (Mayo)OutsideLaboratory,,86635,CPT,Facility,Inpatient,,,90,45,38.25,12.897,45,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Coccidioides (Mayo)OutsideLaboratory,,86635,CPT,Facility,Both,,,90,45,38.25,12.897,45,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),27,60,,percent of total billed charges,,
Coccidioides (Mayo)OutsideLaboratory,,86635,CPT,Facility,Both,,,90,45,38.25,12.897,45,"Health Partners, Inc.",State of Minnesota Advantage Program,36.675,81.5,,percent of total billed charges,,
Coccidioides (Mayo)OutsideLaboratory,,86635,CPT,Facility,Both,,,90,45,38.25,12.897,45,"Health Partners, Inc.",State Public Programs,22.5,50,,percent of total billed charges,,
Coccidioides (Mayo)OutsideLaboratory,,86635,CPT,Facility,Both,,,90,45,38.25,12.897,45,Humana Insurance Company,Commercial PPO,42.75,95,,percent of total billed charges,,
Coccidioides (Mayo)OutsideLaboratory,,86635,CPT,Facility,Outpatient,,,90,45,38.25,12.897,45,Humana Insurance Company,Medicare PPO,22.05,49,,percent of total billed charges,,
Coccidioides (Mayo)OutsideLaboratory,,86635,CPT,Facility,Inpatient,,,90,45,38.25,12.897,45,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Coccidioides (Mayo)OutsideLaboratory,,86635,CPT,Facility,Both,,,90,45,38.25,12.897,45,Medica,Individual & Family,44.595,99.1,,percent of total billed charges,,
Coccidioides (Mayo)OutsideLaboratory,,86635,CPT,Facility,Outpatient,,,90,45,38.25,12.897,45,Medica,Medica Advantage Solution,22.41,49.8,,percent of total billed charges,,
Coccidioides (Mayo)OutsideLaboratory,,86635,CPT,Facility,Inpatient,,,90,45,38.25,12.897,45,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Coccidioides (Mayo)OutsideLaboratory,,86635,CPT,Facility,Outpatient,,,90,45,38.25,12.897,45,Medica,Medical Assistance,20.07,44.6,,percent of total billed charges,,
Coccidioides (Mayo)OutsideLaboratory,,86635,CPT,Facility,Inpatient,,,90,45,38.25,12.897,45,Medica,Medical Assistance,,,,,Included in per diem rate,
Coccidioides (Mayo)OutsideLaboratory,,86635,CPT,Facility,Outpatient,,,90,45,38.25,12.897,45,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,22.41,49.8,,percent of total billed charges,,
Coccidioides (Mayo)OutsideLaboratory,,86635,CPT,Facility,Inpatient,,,90,45,38.25,12.897,45,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Coccidioides (Mayo)OutsideLaboratory,,86635,CPT,Facility,Both,,,90,45,38.25,12.897,45,"Multiplan, Inc.","Multiplan, Inc.",42.3,94,,percent of total billed charges,,
Coccidioides (Mayo)OutsideLaboratory,,86635,CPT,Facility,Outpatient,,,90,45,38.25,12.897,45,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,38.88,86.4,,percent of total billed charges,,
Coccidioides (Mayo)OutsideLaboratory,,86635,CPT,Facility,Inpatient,,,90,45,38.25,12.897,45,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Coccidioides (Mayo)OutsideLaboratory,,86635,CPT,Facility,Both,,,90,45,38.25,12.897,45,"Preferred One Administrative Services, INC.",PPO,44.37,98.6,,percent of total billed charges,,
Coccidioides (Mayo)OutsideLaboratory,,86635,CPT,Facility,Outpatient,,,90,45,38.25,12.897,45,PrimeWest Health,Minnesota Senior Health Options (MSHO),23.1525,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Coccidioides (Mayo)OutsideLaboratory,,86635,CPT,Facility,Inpatient,,,90,45,38.25,12.897,45,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Coccidioides (Mayo)OutsideLaboratory,,86635,CPT,Facility,Outpatient,,,90,45,38.25,12.897,45,PrimeWest Health,MinnesotaCare,23.112,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Coccidioides (Mayo)OutsideLaboratory,,86635,CPT,Facility,Inpatient,,,90,45,38.25,12.897,45,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Coccidioides (Mayo)OutsideLaboratory,,86635,CPT,Facility,Both,,,90,45,38.25,12.897,45,Sanford Health Plan,Sanford Health Plan,41.4,92,,percent of total billed charges,,
Coccidioides (Mayo)OutsideLaboratory,,86635,CPT,Facility,Outpatient,,,90,45,38.25,12.897,45,"UCare Health, Inc.",Individual & Family Plan,25.3575,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Coccidioides (Mayo)OutsideLaboratory,,86635,CPT,Facility,Inpatient,,,90,45,38.25,12.897,45,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Coccidioides (Mayo)OutsideLaboratory,,86635,CPT,Facility,Outpatient,,,90,45,38.25,12.897,45,"UCare Health, Inc.",Medical Assistance,22.7115,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Coccidioides (Mayo)OutsideLaboratory,,86635,CPT,Facility,Inpatient,,,90,45,38.25,12.897,45,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Coccidioides (Mayo)OutsideLaboratory,,86635,CPT,Facility,Outpatient,,,90,45,38.25,12.897,45,"UCare Health, Inc.",Medicare Advantage,22.7115,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Coccidioides (Mayo)OutsideLaboratory,,86635,CPT,Facility,Inpatient,,,90,45,38.25,12.897,45,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Coccidioides (Mayo)OutsideLaboratory,,86635,CPT,Facility,Outpatient,,,90,45,38.25,12.897,45,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),22.7115,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Coccidioides (Mayo)OutsideLaboratory,,86635,CPT,Facility,Inpatient,,,90,45,38.25,12.897,45,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Coccidioides (Mayo)OutsideLaboratory,,86635,CPT,Facility,Both,,,90,45,38.25,12.897,45,UnitedHealthcare,Individual & Family,42.3,94,,percent of total billed charges,,
Coccidioides (Mayo)OutsideLaboratory,,86635,CPT,Facility,Outpatient,,,90,45,38.25,12.897,45,UnitedHealthcare,Medicare Advantage,22.05,49,,percent of total billed charges,,
Coccidioides (Mayo)OutsideLaboratory,,86635,CPT,Facility,Inpatient,,,90,45,38.25,12.897,45,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Coccidioides (Mayo)OutsideLaboratory,,86635,CPT,Facility,Outpatient,,,90,45,38.25,12.897,45,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,21.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
Coccidioides (Mayo)OutsideLaboratory,,86635,CPT,Facility,Inpatient,,,90,45,38.25,12.897,45,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Coccidioides Ab W/ Reflex, S (Mayo)OutsideLaboratory",,86635,CPT,Facility,Both,,,90,120,102,34.392,120,Aetna,Commercial,110.4,92,,percent of total billed charges,,
"Coccidioides Ab W/ Reflex, S (Mayo)OutsideLaboratory",,86635,CPT,Facility,Outpatient,,,90,120,102,34.392,120,Aetna,Medicare Advantage,58.8,49,,percent of total billed charges,,
"Coccidioides Ab W/ Reflex, S (Mayo)OutsideLaboratory",,86635,CPT,Facility,Inpatient,,,90,120,102,34.392,120,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Coccidioides Ab W/ Reflex, S (Mayo)OutsideLaboratory",,86635,CPT,Facility,Both,,,90,120,102,34.392,120,Aetna,PPO,111.6,93,,percent of total billed charges,,
"Coccidioides Ab W/ Reflex, S (Mayo)OutsideLaboratory",,86635,CPT,Facility,Both,,,90,120,102,34.392,120,America's PPO,America's PPO,115.236,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Coccidioides Ab W/ Reflex, S (Mayo)OutsideLaboratory",,86635,CPT,Facility,Both,,,90,120,102,34.392,120,BlueCross BlueShield Minnesota, Federal Employee Program,118.08,98.4,,percent of total billed charges,,
"Coccidioides Ab W/ Reflex, S (Mayo)OutsideLaboratory",,86635,CPT,Facility,Both,,,90,120,102,34.392,120,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,120,100,,percent of total billed charges,,
"Coccidioides Ab W/ Reflex, S (Mayo)OutsideLaboratory",,86635,CPT,Facility,Both,,,90,120,102,34.392,120,BlueCross BlueShield Minnesota,High Value Network Plan,108,90,,percent of total billed charges,,
"Coccidioides Ab W/ Reflex, S (Mayo)OutsideLaboratory",,86635,CPT,Facility,Outpatient,,,90,120,102,34.392,120,BlueCross BlueShield Minnesota,Medicare Advantage,58.8,49,,percent of total billed charges,,
"Coccidioides Ab W/ Reflex, S (Mayo)OutsideLaboratory",,86635,CPT,Facility,Inpatient,,,90,120,102,34.392,120,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Coccidioides Ab W/ Reflex, S (Mayo)OutsideLaboratory",,86635,CPT,Facility,Both,,,90,120,102,34.392,120,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,106.284,88.57,,percent of total billed charges,,
"Coccidioides Ab W/ Reflex, S (Mayo)OutsideLaboratory",,86635,CPT,Facility,Both,,,90,120,102,34.392,120,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,34.392,28.66,,percent of total billed charges,,
"Coccidioides Ab W/ Reflex, S (Mayo)OutsideLaboratory",,86635,CPT,Facility,Outpatient,,,90,120,102,34.392,120,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),58.8,49,,percent of total billed charges,,
"Coccidioides Ab W/ Reflex, S (Mayo)OutsideLaboratory",,86635,CPT,Facility,Inpatient,,,90,120,102,34.392,120,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Coccidioides Ab W/ Reflex, S (Mayo)OutsideLaboratory",,86635,CPT,Facility,Both,,,90,120,102,34.392,120,CorVel,Worker's Compensation,120,100,,percent of total billed charges,,
"Coccidioides Ab W/ Reflex, S (Mayo)OutsideLaboratory",,86635,CPT,Facility,Both,,,90,120,102,34.392,120,First Health Group Corporation,First Health Network,116.4,97,,percent of total billed charges,,
"Coccidioides Ab W/ Reflex, S (Mayo)OutsideLaboratory",,86635,CPT,Facility,Both,,,90,120,102,34.392,120,"Health Partners, Inc.",Commercial,113.52,94.6,,percent of total billed charges,,
"Coccidioides Ab W/ Reflex, S (Mayo)OutsideLaboratory",,86635,CPT,Facility,Outpatient,,,90,120,102,34.392,120,"Health Partners, Inc.",Medicare Advantage,58.8,49,,percent of total billed charges,,
"Coccidioides Ab W/ Reflex, S (Mayo)OutsideLaboratory",,86635,CPT,Facility,Inpatient,,,90,120,102,34.392,120,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Coccidioides Ab W/ Reflex, S (Mayo)OutsideLaboratory",,86635,CPT,Facility,Both,,,90,120,102,34.392,120,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),72,60,,percent of total billed charges,,
"Coccidioides Ab W/ Reflex, S (Mayo)OutsideLaboratory",,86635,CPT,Facility,Both,,,90,120,102,34.392,120,"Health Partners, Inc.",State of Minnesota Advantage Program,97.8,81.5,,percent of total billed charges,,
"Coccidioides Ab W/ Reflex, S (Mayo)OutsideLaboratory",,86635,CPT,Facility,Both,,,90,120,102,34.392,120,"Health Partners, Inc.",State Public Programs,60,50,,percent of total billed charges,,
"Coccidioides Ab W/ Reflex, S (Mayo)OutsideLaboratory",,86635,CPT,Facility,Both,,,90,120,102,34.392,120,Humana Insurance Company,Commercial PPO,114,95,,percent of total billed charges,,
"Coccidioides Ab W/ Reflex, S (Mayo)OutsideLaboratory",,86635,CPT,Facility,Outpatient,,,90,120,102,34.392,120,Humana Insurance Company,Medicare PPO,58.8,49,,percent of total billed charges,,
"Coccidioides Ab W/ Reflex, S (Mayo)OutsideLaboratory",,86635,CPT,Facility,Inpatient,,,90,120,102,34.392,120,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Coccidioides Ab W/ Reflex, S (Mayo)OutsideLaboratory",,86635,CPT,Facility,Both,,,90,120,102,34.392,120,Medica,Individual & Family,118.92,99.1,,percent of total billed charges,,
"Coccidioides Ab W/ Reflex, S (Mayo)OutsideLaboratory",,86635,CPT,Facility,Outpatient,,,90,120,102,34.392,120,Medica,Medica Advantage Solution,59.76,49.8,,percent of total billed charges,,
"Coccidioides Ab W/ Reflex, S (Mayo)OutsideLaboratory",,86635,CPT,Facility,Inpatient,,,90,120,102,34.392,120,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Coccidioides Ab W/ Reflex, S (Mayo)OutsideLaboratory",,86635,CPT,Facility,Outpatient,,,90,120,102,34.392,120,Medica,Medical Assistance,53.52,44.6,,percent of total billed charges,,
"Coccidioides Ab W/ Reflex, S (Mayo)OutsideLaboratory",,86635,CPT,Facility,Inpatient,,,90,120,102,34.392,120,Medica,Medical Assistance,,,,,Included in per diem rate,
"Coccidioides Ab W/ Reflex, S (Mayo)OutsideLaboratory",,86635,CPT,Facility,Outpatient,,,90,120,102,34.392,120,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,59.76,49.8,,percent of total billed charges,,
"Coccidioides Ab W/ Reflex, S (Mayo)OutsideLaboratory",,86635,CPT,Facility,Inpatient,,,90,120,102,34.392,120,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Coccidioides Ab W/ Reflex, S (Mayo)OutsideLaboratory",,86635,CPT,Facility,Both,,,90,120,102,34.392,120,"Multiplan, Inc.","Multiplan, Inc.",112.8,94,,percent of total billed charges,,
"Coccidioides Ab W/ Reflex, S (Mayo)OutsideLaboratory",,86635,CPT,Facility,Outpatient,,,90,120,102,34.392,120,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,103.68,86.4,,percent of total billed charges,,
"Coccidioides Ab W/ Reflex, S (Mayo)OutsideLaboratory",,86635,CPT,Facility,Inpatient,,,90,120,102,34.392,120,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Coccidioides Ab W/ Reflex, S (Mayo)OutsideLaboratory",,86635,CPT,Facility,Both,,,90,120,102,34.392,120,"Preferred One Administrative Services, INC.",PPO,118.32,98.6,,percent of total billed charges,,
"Coccidioides Ab W/ Reflex, S (Mayo)OutsideLaboratory",,86635,CPT,Facility,Outpatient,,,90,120,102,34.392,120,PrimeWest Health,Minnesota Senior Health Options (MSHO),61.74,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Coccidioides Ab W/ Reflex, S (Mayo)OutsideLaboratory",,86635,CPT,Facility,Inpatient,,,90,120,102,34.392,120,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Coccidioides Ab W/ Reflex, S (Mayo)OutsideLaboratory",,86635,CPT,Facility,Outpatient,,,90,120,102,34.392,120,PrimeWest Health,MinnesotaCare,61.632,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Coccidioides Ab W/ Reflex, S (Mayo)OutsideLaboratory",,86635,CPT,Facility,Inpatient,,,90,120,102,34.392,120,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Coccidioides Ab W/ Reflex, S (Mayo)OutsideLaboratory",,86635,CPT,Facility,Both,,,90,120,102,34.392,120,Sanford Health Plan,Sanford Health Plan,110.4,92,,percent of total billed charges,,
"Coccidioides Ab W/ Reflex, S (Mayo)OutsideLaboratory",,86635,CPT,Facility,Outpatient,,,90,120,102,34.392,120,"UCare Health, Inc.",Individual & Family Plan,67.62,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Coccidioides Ab W/ Reflex, S (Mayo)OutsideLaboratory",,86635,CPT,Facility,Inpatient,,,90,120,102,34.392,120,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Coccidioides Ab W/ Reflex, S (Mayo)OutsideLaboratory",,86635,CPT,Facility,Outpatient,,,90,120,102,34.392,120,"UCare Health, Inc.",Medical Assistance,60.564,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Coccidioides Ab W/ Reflex, S (Mayo)OutsideLaboratory",,86635,CPT,Facility,Inpatient,,,90,120,102,34.392,120,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Coccidioides Ab W/ Reflex, S (Mayo)OutsideLaboratory",,86635,CPT,Facility,Outpatient,,,90,120,102,34.392,120,"UCare Health, Inc.",Medicare Advantage,60.564,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Coccidioides Ab W/ Reflex, S (Mayo)OutsideLaboratory",,86635,CPT,Facility,Inpatient,,,90,120,102,34.392,120,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Coccidioides Ab W/ Reflex, S (Mayo)OutsideLaboratory",,86635,CPT,Facility,Outpatient,,,90,120,102,34.392,120,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),60.564,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Coccidioides Ab W/ Reflex, S (Mayo)OutsideLaboratory",,86635,CPT,Facility,Inpatient,,,90,120,102,34.392,120,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Coccidioides Ab W/ Reflex, S (Mayo)OutsideLaboratory",,86635,CPT,Facility,Both,,,90,120,102,34.392,120,UnitedHealthcare,Individual & Family,112.8,94,,percent of total billed charges,,
"Coccidioides Ab W/ Reflex, S (Mayo)OutsideLaboratory",,86635,CPT,Facility,Outpatient,,,90,120,102,34.392,120,UnitedHealthcare,Medicare Advantage,58.8,49,,percent of total billed charges,,
"Coccidioides Ab W/ Reflex, S (Mayo)OutsideLaboratory",,86635,CPT,Facility,Inpatient,,,90,120,102,34.392,120,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Coccidioides Ab W/ Reflex, S (Mayo)OutsideLaboratory",,86635,CPT,Facility,Outpatient,,,90,120,102,34.392,120,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,57.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Coccidioides Ab W/ Reflex, S (Mayo)OutsideLaboratory",,86635,CPT,Facility,Inpatient,,,90,120,102,34.392,120,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Coccidioides Ab, S (Mayo)OutsideLaboratory",,86635,CPT,Facility,Both,,,90,114,96.9,32.6724,114,Aetna,Commercial,104.88,92,,percent of total billed charges,,
"Coccidioides Ab, S (Mayo)OutsideLaboratory",,86635,CPT,Facility,Outpatient,,,90,114,96.9,32.6724,114,Aetna,Medicare Advantage,55.86,49,,percent of total billed charges,,
"Coccidioides Ab, S (Mayo)OutsideLaboratory",,86635,CPT,Facility,Inpatient,,,90,114,96.9,32.6724,114,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Coccidioides Ab, S (Mayo)OutsideLaboratory",,86635,CPT,Facility,Both,,,90,114,96.9,32.6724,114,Aetna,PPO,106.02,93,,percent of total billed charges,,
"Coccidioides Ab, S (Mayo)OutsideLaboratory",,86635,CPT,Facility,Both,,,90,114,96.9,32.6724,114,America's PPO,America's PPO,109.4742,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Coccidioides Ab, S (Mayo)OutsideLaboratory",,86635,CPT,Facility,Both,,,90,114,96.9,32.6724,114,BlueCross BlueShield Minnesota, Federal Employee Program,112.176,98.4,,percent of total billed charges,,
"Coccidioides Ab, S (Mayo)OutsideLaboratory",,86635,CPT,Facility,Both,,,90,114,96.9,32.6724,114,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,114,100,,percent of total billed charges,,
"Coccidioides Ab, S (Mayo)OutsideLaboratory",,86635,CPT,Facility,Both,,,90,114,96.9,32.6724,114,BlueCross BlueShield Minnesota,High Value Network Plan,102.6,90,,percent of total billed charges,,
"Coccidioides Ab, S (Mayo)OutsideLaboratory",,86635,CPT,Facility,Outpatient,,,90,114,96.9,32.6724,114,BlueCross BlueShield Minnesota,Medicare Advantage,55.86,49,,percent of total billed charges,,
"Coccidioides Ab, S (Mayo)OutsideLaboratory",,86635,CPT,Facility,Inpatient,,,90,114,96.9,32.6724,114,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Coccidioides Ab, S (Mayo)OutsideLaboratory",,86635,CPT,Facility,Both,,,90,114,96.9,32.6724,114,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,100.9698,88.57,,percent of total billed charges,,
"Coccidioides Ab, S (Mayo)OutsideLaboratory",,86635,CPT,Facility,Both,,,90,114,96.9,32.6724,114,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,32.6724,28.66,,percent of total billed charges,,
"Coccidioides Ab, S (Mayo)OutsideLaboratory",,86635,CPT,Facility,Outpatient,,,90,114,96.9,32.6724,114,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),55.86,49,,percent of total billed charges,,
"Coccidioides Ab, S (Mayo)OutsideLaboratory",,86635,CPT,Facility,Inpatient,,,90,114,96.9,32.6724,114,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Coccidioides Ab, S (Mayo)OutsideLaboratory",,86635,CPT,Facility,Both,,,90,114,96.9,32.6724,114,CorVel,Worker's Compensation,114,100,,percent of total billed charges,,
"Coccidioides Ab, S (Mayo)OutsideLaboratory",,86635,CPT,Facility,Both,,,90,114,96.9,32.6724,114,First Health Group Corporation,First Health Network,110.58,97,,percent of total billed charges,,
"Coccidioides Ab, S (Mayo)OutsideLaboratory",,86635,CPT,Facility,Both,,,90,114,96.9,32.6724,114,"Health Partners, Inc.",Commercial,107.844,94.6,,percent of total billed charges,,
"Coccidioides Ab, S (Mayo)OutsideLaboratory",,86635,CPT,Facility,Outpatient,,,90,114,96.9,32.6724,114,"Health Partners, Inc.",Medicare Advantage,55.86,49,,percent of total billed charges,,
"Coccidioides Ab, S (Mayo)OutsideLaboratory",,86635,CPT,Facility,Inpatient,,,90,114,96.9,32.6724,114,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Coccidioides Ab, S (Mayo)OutsideLaboratory",,86635,CPT,Facility,Both,,,90,114,96.9,32.6724,114,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),68.4,60,,percent of total billed charges,,
"Coccidioides Ab, S (Mayo)OutsideLaboratory",,86635,CPT,Facility,Both,,,90,114,96.9,32.6724,114,"Health Partners, Inc.",State of Minnesota Advantage Program,92.91,81.5,,percent of total billed charges,,
"Coccidioides Ab, S (Mayo)OutsideLaboratory",,86635,CPT,Facility,Both,,,90,114,96.9,32.6724,114,"Health Partners, Inc.",State Public Programs,57,50,,percent of total billed charges,,
"Coccidioides Ab, S (Mayo)OutsideLaboratory",,86635,CPT,Facility,Both,,,90,114,96.9,32.6724,114,Humana Insurance Company,Commercial PPO,108.3,95,,percent of total billed charges,,
"Coccidioides Ab, S (Mayo)OutsideLaboratory",,86635,CPT,Facility,Outpatient,,,90,114,96.9,32.6724,114,Humana Insurance Company,Medicare PPO,55.86,49,,percent of total billed charges,,
"Coccidioides Ab, S (Mayo)OutsideLaboratory",,86635,CPT,Facility,Inpatient,,,90,114,96.9,32.6724,114,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Coccidioides Ab, S (Mayo)OutsideLaboratory",,86635,CPT,Facility,Both,,,90,114,96.9,32.6724,114,Medica,Individual & Family,112.974,99.1,,percent of total billed charges,,
"Coccidioides Ab, S (Mayo)OutsideLaboratory",,86635,CPT,Facility,Outpatient,,,90,114,96.9,32.6724,114,Medica,Medica Advantage Solution,56.772,49.8,,percent of total billed charges,,
"Coccidioides Ab, S (Mayo)OutsideLaboratory",,86635,CPT,Facility,Inpatient,,,90,114,96.9,32.6724,114,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Coccidioides Ab, S (Mayo)OutsideLaboratory",,86635,CPT,Facility,Outpatient,,,90,114,96.9,32.6724,114,Medica,Medical Assistance,50.844,44.6,,percent of total billed charges,,
"Coccidioides Ab, S (Mayo)OutsideLaboratory",,86635,CPT,Facility,Inpatient,,,90,114,96.9,32.6724,114,Medica,Medical Assistance,,,,,Included in per diem rate,
"Coccidioides Ab, S (Mayo)OutsideLaboratory",,86635,CPT,Facility,Outpatient,,,90,114,96.9,32.6724,114,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,56.772,49.8,,percent of total billed charges,,
"Coccidioides Ab, S (Mayo)OutsideLaboratory",,86635,CPT,Facility,Inpatient,,,90,114,96.9,32.6724,114,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Coccidioides Ab, S (Mayo)OutsideLaboratory",,86635,CPT,Facility,Both,,,90,114,96.9,32.6724,114,"Multiplan, Inc.","Multiplan, Inc.",107.16,94,,percent of total billed charges,,
"Coccidioides Ab, S (Mayo)OutsideLaboratory",,86635,CPT,Facility,Outpatient,,,90,114,96.9,32.6724,114,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,98.496,86.4,,percent of total billed charges,,
"Coccidioides Ab, S (Mayo)OutsideLaboratory",,86635,CPT,Facility,Inpatient,,,90,114,96.9,32.6724,114,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Coccidioides Ab, S (Mayo)OutsideLaboratory",,86635,CPT,Facility,Both,,,90,114,96.9,32.6724,114,"Preferred One Administrative Services, INC.",PPO,112.404,98.6,,percent of total billed charges,,
"Coccidioides Ab, S (Mayo)OutsideLaboratory",,86635,CPT,Facility,Outpatient,,,90,114,96.9,32.6724,114,PrimeWest Health,Minnesota Senior Health Options (MSHO),58.653,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Coccidioides Ab, S (Mayo)OutsideLaboratory",,86635,CPT,Facility,Inpatient,,,90,114,96.9,32.6724,114,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Coccidioides Ab, S (Mayo)OutsideLaboratory",,86635,CPT,Facility,Outpatient,,,90,114,96.9,32.6724,114,PrimeWest Health,MinnesotaCare,58.5504,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Coccidioides Ab, S (Mayo)OutsideLaboratory",,86635,CPT,Facility,Inpatient,,,90,114,96.9,32.6724,114,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Coccidioides Ab, S (Mayo)OutsideLaboratory",,86635,CPT,Facility,Both,,,90,114,96.9,32.6724,114,Sanford Health Plan,Sanford Health Plan,104.88,92,,percent of total billed charges,,
"Coccidioides Ab, S (Mayo)OutsideLaboratory",,86635,CPT,Facility,Outpatient,,,90,114,96.9,32.6724,114,"UCare Health, Inc.",Individual & Family Plan,64.239,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Coccidioides Ab, S (Mayo)OutsideLaboratory",,86635,CPT,Facility,Inpatient,,,90,114,96.9,32.6724,114,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Coccidioides Ab, S (Mayo)OutsideLaboratory",,86635,CPT,Facility,Outpatient,,,90,114,96.9,32.6724,114,"UCare Health, Inc.",Medical Assistance,57.5358,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Coccidioides Ab, S (Mayo)OutsideLaboratory",,86635,CPT,Facility,Inpatient,,,90,114,96.9,32.6724,114,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Coccidioides Ab, S (Mayo)OutsideLaboratory",,86635,CPT,Facility,Outpatient,,,90,114,96.9,32.6724,114,"UCare Health, Inc.",Medicare Advantage,57.5358,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Coccidioides Ab, S (Mayo)OutsideLaboratory",,86635,CPT,Facility,Inpatient,,,90,114,96.9,32.6724,114,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Coccidioides Ab, S (Mayo)OutsideLaboratory",,86635,CPT,Facility,Outpatient,,,90,114,96.9,32.6724,114,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),57.5358,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Coccidioides Ab, S (Mayo)OutsideLaboratory",,86635,CPT,Facility,Inpatient,,,90,114,96.9,32.6724,114,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Coccidioides Ab, S (Mayo)OutsideLaboratory",,86635,CPT,Facility,Both,,,90,114,96.9,32.6724,114,UnitedHealthcare,Individual & Family,107.16,94,,percent of total billed charges,,
"Coccidioides Ab, S (Mayo)OutsideLaboratory",,86635,CPT,Facility,Outpatient,,,90,114,96.9,32.6724,114,UnitedHealthcare,Medicare Advantage,55.86,49,,percent of total billed charges,,
"Coccidioides Ab, S (Mayo)OutsideLaboratory",,86635,CPT,Facility,Inpatient,,,90,114,96.9,32.6724,114,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Coccidioides Ab, S (Mayo)OutsideLaboratory",,86635,CPT,Facility,Outpatient,,,90,114,96.9,32.6724,114,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,54.72,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Coccidioides Ab, S (Mayo)OutsideLaboratory",,86635,CPT,Facility,Inpatient,,,90,114,96.9,32.6724,114,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Coccidioides Antibody Cf/Id (Mayo)OutsideLaboratory,,86635,CPT,Facility,Both,,,90,112,95.2,32.0992,112,Aetna,Commercial,103.04,92,,percent of total billed charges,,
Coccidioides Antibody Cf/Id (Mayo)OutsideLaboratory,,86635,CPT,Facility,Outpatient,,,90,112,95.2,32.0992,112,Aetna,Medicare Advantage,54.88,49,,percent of total billed charges,,
Coccidioides Antibody Cf/Id (Mayo)OutsideLaboratory,,86635,CPT,Facility,Inpatient,,,90,112,95.2,32.0992,112,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Coccidioides Antibody Cf/Id (Mayo)OutsideLaboratory,,86635,CPT,Facility,Both,,,90,112,95.2,32.0992,112,Aetna,PPO,104.16,93,,percent of total billed charges,,
Coccidioides Antibody Cf/Id (Mayo)OutsideLaboratory,,86635,CPT,Facility,Both,,,90,112,95.2,32.0992,112,America's PPO,America's PPO,107.5536,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Coccidioides Antibody Cf/Id (Mayo)OutsideLaboratory,,86635,CPT,Facility,Both,,,90,112,95.2,32.0992,112,BlueCross BlueShield Minnesota, Federal Employee Program,110.208,98.4,,percent of total billed charges,,
Coccidioides Antibody Cf/Id (Mayo)OutsideLaboratory,,86635,CPT,Facility,Both,,,90,112,95.2,32.0992,112,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,112,100,,percent of total billed charges,,
Coccidioides Antibody Cf/Id (Mayo)OutsideLaboratory,,86635,CPT,Facility,Both,,,90,112,95.2,32.0992,112,BlueCross BlueShield Minnesota,High Value Network Plan,100.8,90,,percent of total billed charges,,
Coccidioides Antibody Cf/Id (Mayo)OutsideLaboratory,,86635,CPT,Facility,Outpatient,,,90,112,95.2,32.0992,112,BlueCross BlueShield Minnesota,Medicare Advantage,54.88,49,,percent of total billed charges,,
Coccidioides Antibody Cf/Id (Mayo)OutsideLaboratory,,86635,CPT,Facility,Inpatient,,,90,112,95.2,32.0992,112,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Coccidioides Antibody Cf/Id (Mayo)OutsideLaboratory,,86635,CPT,Facility,Both,,,90,112,95.2,32.0992,112,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,99.1984,88.57,,percent of total billed charges,,
Coccidioides Antibody Cf/Id (Mayo)OutsideLaboratory,,86635,CPT,Facility,Both,,,90,112,95.2,32.0992,112,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,32.0992,28.66,,percent of total billed charges,,
Coccidioides Antibody Cf/Id (Mayo)OutsideLaboratory,,86635,CPT,Facility,Outpatient,,,90,112,95.2,32.0992,112,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),54.88,49,,percent of total billed charges,,
Coccidioides Antibody Cf/Id (Mayo)OutsideLaboratory,,86635,CPT,Facility,Inpatient,,,90,112,95.2,32.0992,112,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Coccidioides Antibody Cf/Id (Mayo)OutsideLaboratory,,86635,CPT,Facility,Both,,,90,112,95.2,32.0992,112,CorVel,Worker's Compensation,112,100,,percent of total billed charges,,
Coccidioides Antibody Cf/Id (Mayo)OutsideLaboratory,,86635,CPT,Facility,Both,,,90,112,95.2,32.0992,112,First Health Group Corporation,First Health Network,108.64,97,,percent of total billed charges,,
Coccidioides Antibody Cf/Id (Mayo)OutsideLaboratory,,86635,CPT,Facility,Both,,,90,112,95.2,32.0992,112,"Health Partners, Inc.",Commercial,105.952,94.6,,percent of total billed charges,,
Coccidioides Antibody Cf/Id (Mayo)OutsideLaboratory,,86635,CPT,Facility,Outpatient,,,90,112,95.2,32.0992,112,"Health Partners, Inc.",Medicare Advantage,54.88,49,,percent of total billed charges,,
Coccidioides Antibody Cf/Id (Mayo)OutsideLaboratory,,86635,CPT,Facility,Inpatient,,,90,112,95.2,32.0992,112,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Coccidioides Antibody Cf/Id (Mayo)OutsideLaboratory,,86635,CPT,Facility,Both,,,90,112,95.2,32.0992,112,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),67.2,60,,percent of total billed charges,,
Coccidioides Antibody Cf/Id (Mayo)OutsideLaboratory,,86635,CPT,Facility,Both,,,90,112,95.2,32.0992,112,"Health Partners, Inc.",State of Minnesota Advantage Program,91.28,81.5,,percent of total billed charges,,
Coccidioides Antibody Cf/Id (Mayo)OutsideLaboratory,,86635,CPT,Facility,Both,,,90,112,95.2,32.0992,112,"Health Partners, Inc.",State Public Programs,56,50,,percent of total billed charges,,
Coccidioides Antibody Cf/Id (Mayo)OutsideLaboratory,,86635,CPT,Facility,Both,,,90,112,95.2,32.0992,112,Humana Insurance Company,Commercial PPO,106.4,95,,percent of total billed charges,,
Coccidioides Antibody Cf/Id (Mayo)OutsideLaboratory,,86635,CPT,Facility,Outpatient,,,90,112,95.2,32.0992,112,Humana Insurance Company,Medicare PPO,54.88,49,,percent of total billed charges,,
Coccidioides Antibody Cf/Id (Mayo)OutsideLaboratory,,86635,CPT,Facility,Inpatient,,,90,112,95.2,32.0992,112,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Coccidioides Antibody Cf/Id (Mayo)OutsideLaboratory,,86635,CPT,Facility,Both,,,90,112,95.2,32.0992,112,Medica,Individual & Family,110.992,99.1,,percent of total billed charges,,
Coccidioides Antibody Cf/Id (Mayo)OutsideLaboratory,,86635,CPT,Facility,Outpatient,,,90,112,95.2,32.0992,112,Medica,Medica Advantage Solution,55.776,49.8,,percent of total billed charges,,
Coccidioides Antibody Cf/Id (Mayo)OutsideLaboratory,,86635,CPT,Facility,Inpatient,,,90,112,95.2,32.0992,112,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Coccidioides Antibody Cf/Id (Mayo)OutsideLaboratory,,86635,CPT,Facility,Outpatient,,,90,112,95.2,32.0992,112,Medica,Medical Assistance,49.952,44.6,,percent of total billed charges,,
Coccidioides Antibody Cf/Id (Mayo)OutsideLaboratory,,86635,CPT,Facility,Inpatient,,,90,112,95.2,32.0992,112,Medica,Medical Assistance,,,,,Included in per diem rate,
Coccidioides Antibody Cf/Id (Mayo)OutsideLaboratory,,86635,CPT,Facility,Outpatient,,,90,112,95.2,32.0992,112,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,55.776,49.8,,percent of total billed charges,,
Coccidioides Antibody Cf/Id (Mayo)OutsideLaboratory,,86635,CPT,Facility,Inpatient,,,90,112,95.2,32.0992,112,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Coccidioides Antibody Cf/Id (Mayo)OutsideLaboratory,,86635,CPT,Facility,Both,,,90,112,95.2,32.0992,112,"Multiplan, Inc.","Multiplan, Inc.",105.28,94,,percent of total billed charges,,
Coccidioides Antibody Cf/Id (Mayo)OutsideLaboratory,,86635,CPT,Facility,Outpatient,,,90,112,95.2,32.0992,112,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,96.768,86.4,,percent of total billed charges,,
Coccidioides Antibody Cf/Id (Mayo)OutsideLaboratory,,86635,CPT,Facility,Inpatient,,,90,112,95.2,32.0992,112,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Coccidioides Antibody Cf/Id (Mayo)OutsideLaboratory,,86635,CPT,Facility,Both,,,90,112,95.2,32.0992,112,"Preferred One Administrative Services, INC.",PPO,110.432,98.6,,percent of total billed charges,,
Coccidioides Antibody Cf/Id (Mayo)OutsideLaboratory,,86635,CPT,Facility,Outpatient,,,90,112,95.2,32.0992,112,PrimeWest Health,Minnesota Senior Health Options (MSHO),57.624,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Coccidioides Antibody Cf/Id (Mayo)OutsideLaboratory,,86635,CPT,Facility,Inpatient,,,90,112,95.2,32.0992,112,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Coccidioides Antibody Cf/Id (Mayo)OutsideLaboratory,,86635,CPT,Facility,Outpatient,,,90,112,95.2,32.0992,112,PrimeWest Health,MinnesotaCare,57.5232,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Coccidioides Antibody Cf/Id (Mayo)OutsideLaboratory,,86635,CPT,Facility,Inpatient,,,90,112,95.2,32.0992,112,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Coccidioides Antibody Cf/Id (Mayo)OutsideLaboratory,,86635,CPT,Facility,Both,,,90,112,95.2,32.0992,112,Sanford Health Plan,Sanford Health Plan,103.04,92,,percent of total billed charges,,
Coccidioides Antibody Cf/Id (Mayo)OutsideLaboratory,,86635,CPT,Facility,Outpatient,,,90,112,95.2,32.0992,112,"UCare Health, Inc.",Individual & Family Plan,63.112,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Coccidioides Antibody Cf/Id (Mayo)OutsideLaboratory,,86635,CPT,Facility,Inpatient,,,90,112,95.2,32.0992,112,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Coccidioides Antibody Cf/Id (Mayo)OutsideLaboratory,,86635,CPT,Facility,Outpatient,,,90,112,95.2,32.0992,112,"UCare Health, Inc.",Medical Assistance,56.5264,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Coccidioides Antibody Cf/Id (Mayo)OutsideLaboratory,,86635,CPT,Facility,Inpatient,,,90,112,95.2,32.0992,112,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Coccidioides Antibody Cf/Id (Mayo)OutsideLaboratory,,86635,CPT,Facility,Outpatient,,,90,112,95.2,32.0992,112,"UCare Health, Inc.",Medicare Advantage,56.5264,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Coccidioides Antibody Cf/Id (Mayo)OutsideLaboratory,,86635,CPT,Facility,Inpatient,,,90,112,95.2,32.0992,112,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Coccidioides Antibody Cf/Id (Mayo)OutsideLaboratory,,86635,CPT,Facility,Outpatient,,,90,112,95.2,32.0992,112,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),56.5264,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Coccidioides Antibody Cf/Id (Mayo)OutsideLaboratory,,86635,CPT,Facility,Inpatient,,,90,112,95.2,32.0992,112,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Coccidioides Antibody Cf/Id (Mayo)OutsideLaboratory,,86635,CPT,Facility,Both,,,90,112,95.2,32.0992,112,UnitedHealthcare,Individual & Family,105.28,94,,percent of total billed charges,,
Coccidioides Antibody Cf/Id (Mayo)OutsideLaboratory,,86635,CPT,Facility,Outpatient,,,90,112,95.2,32.0992,112,UnitedHealthcare,Medicare Advantage,54.88,49,,percent of total billed charges,,
Coccidioides Antibody Cf/Id (Mayo)OutsideLaboratory,,86635,CPT,Facility,Inpatient,,,90,112,95.2,32.0992,112,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Coccidioides Antibody Cf/Id (Mayo)OutsideLaboratory,,86635,CPT,Facility,Outpatient,,,90,112,95.2,32.0992,112,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,53.76,48,,percent of total billed charges,,100% of DHS outpatient percentage
Coccidioides Antibody Cf/Id (Mayo)OutsideLaboratory,,86635,CPT,Facility,Inpatient,,,90,112,95.2,32.0992,112,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Cytomegalovirus Ab, Igg, S (Mayo)OutsideLaboratory",,86644,CPT,Facility,Both,,,90,98,83.3,28.0868,98,Aetna,Commercial,90.16,92,,percent of total billed charges,,
"Cytomegalovirus Ab, Igg, S (Mayo)OutsideLaboratory",,86644,CPT,Facility,Outpatient,,,90,98,83.3,28.0868,98,Aetna,Medicare Advantage,48.02,49,,percent of total billed charges,,
"Cytomegalovirus Ab, Igg, S (Mayo)OutsideLaboratory",,86644,CPT,Facility,Inpatient,,,90,98,83.3,28.0868,98,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Cytomegalovirus Ab, Igg, S (Mayo)OutsideLaboratory",,86644,CPT,Facility,Both,,,90,98,83.3,28.0868,98,Aetna,PPO,91.14,93,,percent of total billed charges,,
"Cytomegalovirus Ab, Igg, S (Mayo)OutsideLaboratory",,86644,CPT,Facility,Both,,,90,98,83.3,28.0868,98,America's PPO,America's PPO,94.1094,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Cytomegalovirus Ab, Igg, S (Mayo)OutsideLaboratory",,86644,CPT,Facility,Both,,,90,98,83.3,28.0868,98,BlueCross BlueShield Minnesota, Federal Employee Program,96.432,98.4,,percent of total billed charges,,
"Cytomegalovirus Ab, Igg, S (Mayo)OutsideLaboratory",,86644,CPT,Facility,Both,,,90,98,83.3,28.0868,98,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,98,100,,percent of total billed charges,,
"Cytomegalovirus Ab, Igg, S (Mayo)OutsideLaboratory",,86644,CPT,Facility,Both,,,90,98,83.3,28.0868,98,BlueCross BlueShield Minnesota,High Value Network Plan,88.2,90,,percent of total billed charges,,
"Cytomegalovirus Ab, Igg, S (Mayo)OutsideLaboratory",,86644,CPT,Facility,Outpatient,,,90,98,83.3,28.0868,98,BlueCross BlueShield Minnesota,Medicare Advantage,48.02,49,,percent of total billed charges,,
"Cytomegalovirus Ab, Igg, S (Mayo)OutsideLaboratory",,86644,CPT,Facility,Inpatient,,,90,98,83.3,28.0868,98,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Cytomegalovirus Ab, Igg, S (Mayo)OutsideLaboratory",,86644,CPT,Facility,Both,,,90,98,83.3,28.0868,98,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,86.7986,88.57,,percent of total billed charges,,
"Cytomegalovirus Ab, Igg, S (Mayo)OutsideLaboratory",,86644,CPT,Facility,Both,,,90,98,83.3,28.0868,98,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,28.0868,28.66,,percent of total billed charges,,
"Cytomegalovirus Ab, Igg, S (Mayo)OutsideLaboratory",,86644,CPT,Facility,Outpatient,,,90,98,83.3,28.0868,98,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),48.02,49,,percent of total billed charges,,
"Cytomegalovirus Ab, Igg, S (Mayo)OutsideLaboratory",,86644,CPT,Facility,Inpatient,,,90,98,83.3,28.0868,98,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Cytomegalovirus Ab, Igg, S (Mayo)OutsideLaboratory",,86644,CPT,Facility,Both,,,90,98,83.3,28.0868,98,CorVel,Worker's Compensation,98,100,,percent of total billed charges,,
"Cytomegalovirus Ab, Igg, S (Mayo)OutsideLaboratory",,86644,CPT,Facility,Both,,,90,98,83.3,28.0868,98,First Health Group Corporation,First Health Network,95.06,97,,percent of total billed charges,,
"Cytomegalovirus Ab, Igg, S (Mayo)OutsideLaboratory",,86644,CPT,Facility,Both,,,90,98,83.3,28.0868,98,"Health Partners, Inc.",Commercial,92.708,94.6,,percent of total billed charges,,
"Cytomegalovirus Ab, Igg, S (Mayo)OutsideLaboratory",,86644,CPT,Facility,Outpatient,,,90,98,83.3,28.0868,98,"Health Partners, Inc.",Medicare Advantage,48.02,49,,percent of total billed charges,,
"Cytomegalovirus Ab, Igg, S (Mayo)OutsideLaboratory",,86644,CPT,Facility,Inpatient,,,90,98,83.3,28.0868,98,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Cytomegalovirus Ab, Igg, S (Mayo)OutsideLaboratory",,86644,CPT,Facility,Both,,,90,98,83.3,28.0868,98,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),58.8,60,,percent of total billed charges,,
"Cytomegalovirus Ab, Igg, S (Mayo)OutsideLaboratory",,86644,CPT,Facility,Both,,,90,98,83.3,28.0868,98,"Health Partners, Inc.",State of Minnesota Advantage Program,79.87,81.5,,percent of total billed charges,,
"Cytomegalovirus Ab, Igg, S (Mayo)OutsideLaboratory",,86644,CPT,Facility,Both,,,90,98,83.3,28.0868,98,"Health Partners, Inc.",State Public Programs,49,50,,percent of total billed charges,,
"Cytomegalovirus Ab, Igg, S (Mayo)OutsideLaboratory",,86644,CPT,Facility,Both,,,90,98,83.3,28.0868,98,Humana Insurance Company,Commercial PPO,93.1,95,,percent of total billed charges,,
"Cytomegalovirus Ab, Igg, S (Mayo)OutsideLaboratory",,86644,CPT,Facility,Outpatient,,,90,98,83.3,28.0868,98,Humana Insurance Company,Medicare PPO,48.02,49,,percent of total billed charges,,
"Cytomegalovirus Ab, Igg, S (Mayo)OutsideLaboratory",,86644,CPT,Facility,Inpatient,,,90,98,83.3,28.0868,98,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Cytomegalovirus Ab, Igg, S (Mayo)OutsideLaboratory",,86644,CPT,Facility,Both,,,90,98,83.3,28.0868,98,Medica,Individual & Family,97.118,99.1,,percent of total billed charges,,
"Cytomegalovirus Ab, Igg, S (Mayo)OutsideLaboratory",,86644,CPT,Facility,Outpatient,,,90,98,83.3,28.0868,98,Medica,Medica Advantage Solution,48.804,49.8,,percent of total billed charges,,
"Cytomegalovirus Ab, Igg, S (Mayo)OutsideLaboratory",,86644,CPT,Facility,Inpatient,,,90,98,83.3,28.0868,98,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Cytomegalovirus Ab, Igg, S (Mayo)OutsideLaboratory",,86644,CPT,Facility,Outpatient,,,90,98,83.3,28.0868,98,Medica,Medical Assistance,43.708,44.6,,percent of total billed charges,,
"Cytomegalovirus Ab, Igg, S (Mayo)OutsideLaboratory",,86644,CPT,Facility,Inpatient,,,90,98,83.3,28.0868,98,Medica,Medical Assistance,,,,,Included in per diem rate,
"Cytomegalovirus Ab, Igg, S (Mayo)OutsideLaboratory",,86644,CPT,Facility,Outpatient,,,90,98,83.3,28.0868,98,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,48.804,49.8,,percent of total billed charges,,
"Cytomegalovirus Ab, Igg, S (Mayo)OutsideLaboratory",,86644,CPT,Facility,Inpatient,,,90,98,83.3,28.0868,98,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Cytomegalovirus Ab, Igg, S (Mayo)OutsideLaboratory",,86644,CPT,Facility,Both,,,90,98,83.3,28.0868,98,"Multiplan, Inc.","Multiplan, Inc.",92.12,94,,percent of total billed charges,,
"Cytomegalovirus Ab, Igg, S (Mayo)OutsideLaboratory",,86644,CPT,Facility,Outpatient,,,90,98,83.3,28.0868,98,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,84.672,86.4,,percent of total billed charges,,
"Cytomegalovirus Ab, Igg, S (Mayo)OutsideLaboratory",,86644,CPT,Facility,Inpatient,,,90,98,83.3,28.0868,98,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Cytomegalovirus Ab, Igg, S (Mayo)OutsideLaboratory",,86644,CPT,Facility,Both,,,90,98,83.3,28.0868,98,"Preferred One Administrative Services, INC.",PPO,96.628,98.6,,percent of total billed charges,,
"Cytomegalovirus Ab, Igg, S (Mayo)OutsideLaboratory",,86644,CPT,Facility,Outpatient,,,90,98,83.3,28.0868,98,PrimeWest Health,Minnesota Senior Health Options (MSHO),50.421,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Cytomegalovirus Ab, Igg, S (Mayo)OutsideLaboratory",,86644,CPT,Facility,Inpatient,,,90,98,83.3,28.0868,98,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Cytomegalovirus Ab, Igg, S (Mayo)OutsideLaboratory",,86644,CPT,Facility,Outpatient,,,90,98,83.3,28.0868,98,PrimeWest Health,MinnesotaCare,50.3328,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Cytomegalovirus Ab, Igg, S (Mayo)OutsideLaboratory",,86644,CPT,Facility,Inpatient,,,90,98,83.3,28.0868,98,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Cytomegalovirus Ab, Igg, S (Mayo)OutsideLaboratory",,86644,CPT,Facility,Both,,,90,98,83.3,28.0868,98,Sanford Health Plan,Sanford Health Plan,90.16,92,,percent of total billed charges,,
"Cytomegalovirus Ab, Igg, S (Mayo)OutsideLaboratory",,86644,CPT,Facility,Outpatient,,,90,98,83.3,28.0868,98,"UCare Health, Inc.",Individual & Family Plan,55.223,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Cytomegalovirus Ab, Igg, S (Mayo)OutsideLaboratory",,86644,CPT,Facility,Inpatient,,,90,98,83.3,28.0868,98,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Cytomegalovirus Ab, Igg, S (Mayo)OutsideLaboratory",,86644,CPT,Facility,Outpatient,,,90,98,83.3,28.0868,98,"UCare Health, Inc.",Medical Assistance,49.4606,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Cytomegalovirus Ab, Igg, S (Mayo)OutsideLaboratory",,86644,CPT,Facility,Inpatient,,,90,98,83.3,28.0868,98,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Cytomegalovirus Ab, Igg, S (Mayo)OutsideLaboratory",,86644,CPT,Facility,Outpatient,,,90,98,83.3,28.0868,98,"UCare Health, Inc.",Medicare Advantage,49.4606,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Cytomegalovirus Ab, Igg, S (Mayo)OutsideLaboratory",,86644,CPT,Facility,Inpatient,,,90,98,83.3,28.0868,98,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Cytomegalovirus Ab, Igg, S (Mayo)OutsideLaboratory",,86644,CPT,Facility,Outpatient,,,90,98,83.3,28.0868,98,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),49.4606,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Cytomegalovirus Ab, Igg, S (Mayo)OutsideLaboratory",,86644,CPT,Facility,Inpatient,,,90,98,83.3,28.0868,98,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Cytomegalovirus Ab, Igg, S (Mayo)OutsideLaboratory",,86644,CPT,Facility,Both,,,90,98,83.3,28.0868,98,UnitedHealthcare,Individual & Family,92.12,94,,percent of total billed charges,,
"Cytomegalovirus Ab, Igg, S (Mayo)OutsideLaboratory",,86644,CPT,Facility,Outpatient,,,90,98,83.3,28.0868,98,UnitedHealthcare,Medicare Advantage,48.02,49,,percent of total billed charges,,
"Cytomegalovirus Ab, Igg, S (Mayo)OutsideLaboratory",,86644,CPT,Facility,Inpatient,,,90,98,83.3,28.0868,98,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Cytomegalovirus Ab, Igg, S (Mayo)OutsideLaboratory",,86644,CPT,Facility,Outpatient,,,90,98,83.3,28.0868,98,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,47.04,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Cytomegalovirus Ab, Igg, S (Mayo)OutsideLaboratory",,86644,CPT,Facility,Inpatient,,,90,98,83.3,28.0868,98,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Cytomegalovirus Ab, Igm And Igg, S (Mayo)OutsideLaboratory",,86644,CPT,Facility,Both,,,90,61,51.85,17.4826,61,Aetna,Commercial,56.12,92,,percent of total billed charges,,
"Cytomegalovirus Ab, Igm And Igg, S (Mayo)OutsideLaboratory",,86644,CPT,Facility,Outpatient,,,90,61,51.85,17.4826,61,Aetna,Medicare Advantage,29.89,49,,percent of total billed charges,,
"Cytomegalovirus Ab, Igm And Igg, S (Mayo)OutsideLaboratory",,86644,CPT,Facility,Inpatient,,,90,61,51.85,17.4826,61,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Cytomegalovirus Ab, Igm And Igg, S (Mayo)OutsideLaboratory",,86644,CPT,Facility,Both,,,90,61,51.85,17.4826,61,Aetna,PPO,56.73,93,,percent of total billed charges,,
"Cytomegalovirus Ab, Igm And Igg, S (Mayo)OutsideLaboratory",,86644,CPT,Facility,Both,,,90,61,51.85,17.4826,61,America's PPO,America's PPO,58.5783,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Cytomegalovirus Ab, Igm And Igg, S (Mayo)OutsideLaboratory",,86644,CPT,Facility,Both,,,90,61,51.85,17.4826,61,BlueCross BlueShield Minnesota, Federal Employee Program,60.024,98.4,,percent of total billed charges,,
"Cytomegalovirus Ab, Igm And Igg, S (Mayo)OutsideLaboratory",,86644,CPT,Facility,Both,,,90,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,61,100,,percent of total billed charges,,
"Cytomegalovirus Ab, Igm And Igg, S (Mayo)OutsideLaboratory",,86644,CPT,Facility,Both,,,90,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,High Value Network Plan,54.9,90,,percent of total billed charges,,
"Cytomegalovirus Ab, Igm And Igg, S (Mayo)OutsideLaboratory",,86644,CPT,Facility,Outpatient,,,90,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,Medicare Advantage,29.89,49,,percent of total billed charges,,
"Cytomegalovirus Ab, Igm And Igg, S (Mayo)OutsideLaboratory",,86644,CPT,Facility,Inpatient,,,90,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Cytomegalovirus Ab, Igm And Igg, S (Mayo)OutsideLaboratory",,86644,CPT,Facility,Both,,,90,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,54.0277,88.57,,percent of total billed charges,,
"Cytomegalovirus Ab, Igm And Igg, S (Mayo)OutsideLaboratory",,86644,CPT,Facility,Both,,,90,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,17.4826,28.66,,percent of total billed charges,,
"Cytomegalovirus Ab, Igm And Igg, S (Mayo)OutsideLaboratory",,86644,CPT,Facility,Outpatient,,,90,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),29.89,49,,percent of total billed charges,,
"Cytomegalovirus Ab, Igm And Igg, S (Mayo)OutsideLaboratory",,86644,CPT,Facility,Inpatient,,,90,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Cytomegalovirus Ab, Igm And Igg, S (Mayo)OutsideLaboratory",,86644,CPT,Facility,Both,,,90,61,51.85,17.4826,61,CorVel,Worker's Compensation,61,100,,percent of total billed charges,,
"Cytomegalovirus Ab, Igm And Igg, S (Mayo)OutsideLaboratory",,86644,CPT,Facility,Both,,,90,61,51.85,17.4826,61,First Health Group Corporation,First Health Network,59.17,97,,percent of total billed charges,,
"Cytomegalovirus Ab, Igm And Igg, S (Mayo)OutsideLaboratory",,86644,CPT,Facility,Both,,,90,61,51.85,17.4826,61,"Health Partners, Inc.",Commercial,57.706,94.6,,percent of total billed charges,,
"Cytomegalovirus Ab, Igm And Igg, S (Mayo)OutsideLaboratory",,86644,CPT,Facility,Outpatient,,,90,61,51.85,17.4826,61,"Health Partners, Inc.",Medicare Advantage,29.89,49,,percent of total billed charges,,
"Cytomegalovirus Ab, Igm And Igg, S (Mayo)OutsideLaboratory",,86644,CPT,Facility,Inpatient,,,90,61,51.85,17.4826,61,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Cytomegalovirus Ab, Igm And Igg, S (Mayo)OutsideLaboratory",,86644,CPT,Facility,Both,,,90,61,51.85,17.4826,61,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),36.6,60,,percent of total billed charges,,
"Cytomegalovirus Ab, Igm And Igg, S (Mayo)OutsideLaboratory",,86644,CPT,Facility,Both,,,90,61,51.85,17.4826,61,"Health Partners, Inc.",State of Minnesota Advantage Program,49.715,81.5,,percent of total billed charges,,
"Cytomegalovirus Ab, Igm And Igg, S (Mayo)OutsideLaboratory",,86644,CPT,Facility,Both,,,90,61,51.85,17.4826,61,"Health Partners, Inc.",State Public Programs,30.5,50,,percent of total billed charges,,
"Cytomegalovirus Ab, Igm And Igg, S (Mayo)OutsideLaboratory",,86644,CPT,Facility,Both,,,90,61,51.85,17.4826,61,Humana Insurance Company,Commercial PPO,57.95,95,,percent of total billed charges,,
"Cytomegalovirus Ab, Igm And Igg, S (Mayo)OutsideLaboratory",,86644,CPT,Facility,Outpatient,,,90,61,51.85,17.4826,61,Humana Insurance Company,Medicare PPO,29.89,49,,percent of total billed charges,,
"Cytomegalovirus Ab, Igm And Igg, S (Mayo)OutsideLaboratory",,86644,CPT,Facility,Inpatient,,,90,61,51.85,17.4826,61,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Cytomegalovirus Ab, Igm And Igg, S (Mayo)OutsideLaboratory",,86644,CPT,Facility,Both,,,90,61,51.85,17.4826,61,Medica,Individual & Family,60.451,99.1,,percent of total billed charges,,
"Cytomegalovirus Ab, Igm And Igg, S (Mayo)OutsideLaboratory",,86644,CPT,Facility,Outpatient,,,90,61,51.85,17.4826,61,Medica,Medica Advantage Solution,30.378,49.8,,percent of total billed charges,,
"Cytomegalovirus Ab, Igm And Igg, S (Mayo)OutsideLaboratory",,86644,CPT,Facility,Inpatient,,,90,61,51.85,17.4826,61,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Cytomegalovirus Ab, Igm And Igg, S (Mayo)OutsideLaboratory",,86644,CPT,Facility,Outpatient,,,90,61,51.85,17.4826,61,Medica,Medical Assistance,27.206,44.6,,percent of total billed charges,,
"Cytomegalovirus Ab, Igm And Igg, S (Mayo)OutsideLaboratory",,86644,CPT,Facility,Inpatient,,,90,61,51.85,17.4826,61,Medica,Medical Assistance,,,,,Included in per diem rate,
"Cytomegalovirus Ab, Igm And Igg, S (Mayo)OutsideLaboratory",,86644,CPT,Facility,Outpatient,,,90,61,51.85,17.4826,61,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,30.378,49.8,,percent of total billed charges,,
"Cytomegalovirus Ab, Igm And Igg, S (Mayo)OutsideLaboratory",,86644,CPT,Facility,Inpatient,,,90,61,51.85,17.4826,61,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Cytomegalovirus Ab, Igm And Igg, S (Mayo)OutsideLaboratory",,86644,CPT,Facility,Both,,,90,61,51.85,17.4826,61,"Multiplan, Inc.","Multiplan, Inc.",57.34,94,,percent of total billed charges,,
"Cytomegalovirus Ab, Igm And Igg, S (Mayo)OutsideLaboratory",,86644,CPT,Facility,Outpatient,,,90,61,51.85,17.4826,61,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,52.704,86.4,,percent of total billed charges,,
"Cytomegalovirus Ab, Igm And Igg, S (Mayo)OutsideLaboratory",,86644,CPT,Facility,Inpatient,,,90,61,51.85,17.4826,61,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Cytomegalovirus Ab, Igm And Igg, S (Mayo)OutsideLaboratory",,86644,CPT,Facility,Both,,,90,61,51.85,17.4826,61,"Preferred One Administrative Services, INC.",PPO,60.146,98.6,,percent of total billed charges,,
"Cytomegalovirus Ab, Igm And Igg, S (Mayo)OutsideLaboratory",,86644,CPT,Facility,Outpatient,,,90,61,51.85,17.4826,61,PrimeWest Health,Minnesota Senior Health Options (MSHO),31.3845,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Cytomegalovirus Ab, Igm And Igg, S (Mayo)OutsideLaboratory",,86644,CPT,Facility,Inpatient,,,90,61,51.85,17.4826,61,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Cytomegalovirus Ab, Igm And Igg, S (Mayo)OutsideLaboratory",,86644,CPT,Facility,Outpatient,,,90,61,51.85,17.4826,61,PrimeWest Health,MinnesotaCare,31.3296,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Cytomegalovirus Ab, Igm And Igg, S (Mayo)OutsideLaboratory",,86644,CPT,Facility,Inpatient,,,90,61,51.85,17.4826,61,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Cytomegalovirus Ab, Igm And Igg, S (Mayo)OutsideLaboratory",,86644,CPT,Facility,Both,,,90,61,51.85,17.4826,61,Sanford Health Plan,Sanford Health Plan,56.12,92,,percent of total billed charges,,
"Cytomegalovirus Ab, Igm And Igg, S (Mayo)OutsideLaboratory",,86644,CPT,Facility,Outpatient,,,90,61,51.85,17.4826,61,"UCare Health, Inc.",Individual & Family Plan,34.3735,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Cytomegalovirus Ab, Igm And Igg, S (Mayo)OutsideLaboratory",,86644,CPT,Facility,Inpatient,,,90,61,51.85,17.4826,61,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Cytomegalovirus Ab, Igm And Igg, S (Mayo)OutsideLaboratory",,86644,CPT,Facility,Outpatient,,,90,61,51.85,17.4826,61,"UCare Health, Inc.",Medical Assistance,30.7867,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Cytomegalovirus Ab, Igm And Igg, S (Mayo)OutsideLaboratory",,86644,CPT,Facility,Inpatient,,,90,61,51.85,17.4826,61,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Cytomegalovirus Ab, Igm And Igg, S (Mayo)OutsideLaboratory",,86644,CPT,Facility,Outpatient,,,90,61,51.85,17.4826,61,"UCare Health, Inc.",Medicare Advantage,30.7867,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Cytomegalovirus Ab, Igm And Igg, S (Mayo)OutsideLaboratory",,86644,CPT,Facility,Inpatient,,,90,61,51.85,17.4826,61,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Cytomegalovirus Ab, Igm And Igg, S (Mayo)OutsideLaboratory",,86644,CPT,Facility,Outpatient,,,90,61,51.85,17.4826,61,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),30.7867,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Cytomegalovirus Ab, Igm And Igg, S (Mayo)OutsideLaboratory",,86644,CPT,Facility,Inpatient,,,90,61,51.85,17.4826,61,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Cytomegalovirus Ab, Igm And Igg, S (Mayo)OutsideLaboratory",,86644,CPT,Facility,Both,,,90,61,51.85,17.4826,61,UnitedHealthcare,Individual & Family,57.34,94,,percent of total billed charges,,
"Cytomegalovirus Ab, Igm And Igg, S (Mayo)OutsideLaboratory",,86644,CPT,Facility,Outpatient,,,90,61,51.85,17.4826,61,UnitedHealthcare,Medicare Advantage,29.89,49,,percent of total billed charges,,
"Cytomegalovirus Ab, Igm And Igg, S (Mayo)OutsideLaboratory",,86644,CPT,Facility,Inpatient,,,90,61,51.85,17.4826,61,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Cytomegalovirus Ab, Igm And Igg, S (Mayo)OutsideLaboratory",,86644,CPT,Facility,Outpatient,,,90,61,51.85,17.4826,61,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,29.28,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Cytomegalovirus Ab, Igm And Igg, S (Mayo)OutsideLaboratory",,86644,CPT,Facility,Inpatient,,,90,61,51.85,17.4826,61,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Cytomegalovirus Igg/Igm Ii (Mayo)OutsideLaboratory,,86645,CPT,Facility,Both,,,90,51,43.35,14.6166,51,Aetna,Commercial,46.92,92,,percent of total billed charges,,
Cytomegalovirus Igg/Igm Ii (Mayo)OutsideLaboratory,,86645,CPT,Facility,Outpatient,,,90,51,43.35,14.6166,51,Aetna,Medicare Advantage,24.99,49,,percent of total billed charges,,
Cytomegalovirus Igg/Igm Ii (Mayo)OutsideLaboratory,,86645,CPT,Facility,Inpatient,,,90,51,43.35,14.6166,51,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Cytomegalovirus Igg/Igm Ii (Mayo)OutsideLaboratory,,86645,CPT,Facility,Both,,,90,51,43.35,14.6166,51,Aetna,PPO,47.43,93,,percent of total billed charges,,
Cytomegalovirus Igg/Igm Ii (Mayo)OutsideLaboratory,,86645,CPT,Facility,Both,,,90,51,43.35,14.6166,51,America's PPO,America's PPO,48.9753,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Cytomegalovirus Igg/Igm Ii (Mayo)OutsideLaboratory,,86645,CPT,Facility,Both,,,90,51,43.35,14.6166,51,BlueCross BlueShield Minnesota, Federal Employee Program,50.184,98.4,,percent of total billed charges,,
Cytomegalovirus Igg/Igm Ii (Mayo)OutsideLaboratory,,86645,CPT,Facility,Both,,,90,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,51,100,,percent of total billed charges,,
Cytomegalovirus Igg/Igm Ii (Mayo)OutsideLaboratory,,86645,CPT,Facility,Both,,,90,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,High Value Network Plan,45.9,90,,percent of total billed charges,,
Cytomegalovirus Igg/Igm Ii (Mayo)OutsideLaboratory,,86645,CPT,Facility,Outpatient,,,90,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,Medicare Advantage,24.99,49,,percent of total billed charges,,
Cytomegalovirus Igg/Igm Ii (Mayo)OutsideLaboratory,,86645,CPT,Facility,Inpatient,,,90,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Cytomegalovirus Igg/Igm Ii (Mayo)OutsideLaboratory,,86645,CPT,Facility,Both,,,90,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,45.1707,88.57,,percent of total billed charges,,
Cytomegalovirus Igg/Igm Ii (Mayo)OutsideLaboratory,,86645,CPT,Facility,Both,,,90,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,14.6166,28.66,,percent of total billed charges,,
Cytomegalovirus Igg/Igm Ii (Mayo)OutsideLaboratory,,86645,CPT,Facility,Outpatient,,,90,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),24.99,49,,percent of total billed charges,,
Cytomegalovirus Igg/Igm Ii (Mayo)OutsideLaboratory,,86645,CPT,Facility,Inpatient,,,90,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Cytomegalovirus Igg/Igm Ii (Mayo)OutsideLaboratory,,86645,CPT,Facility,Both,,,90,51,43.35,14.6166,51,CorVel,Worker's Compensation,51,100,,percent of total billed charges,,
Cytomegalovirus Igg/Igm Ii (Mayo)OutsideLaboratory,,86645,CPT,Facility,Both,,,90,51,43.35,14.6166,51,First Health Group Corporation,First Health Network,49.47,97,,percent of total billed charges,,
Cytomegalovirus Igg/Igm Ii (Mayo)OutsideLaboratory,,86645,CPT,Facility,Both,,,90,51,43.35,14.6166,51,"Health Partners, Inc.",Commercial,48.246,94.6,,percent of total billed charges,,
Cytomegalovirus Igg/Igm Ii (Mayo)OutsideLaboratory,,86645,CPT,Facility,Outpatient,,,90,51,43.35,14.6166,51,"Health Partners, Inc.",Medicare Advantage,24.99,49,,percent of total billed charges,,
Cytomegalovirus Igg/Igm Ii (Mayo)OutsideLaboratory,,86645,CPT,Facility,Inpatient,,,90,51,43.35,14.6166,51,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Cytomegalovirus Igg/Igm Ii (Mayo)OutsideLaboratory,,86645,CPT,Facility,Both,,,90,51,43.35,14.6166,51,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),30.6,60,,percent of total billed charges,,
Cytomegalovirus Igg/Igm Ii (Mayo)OutsideLaboratory,,86645,CPT,Facility,Both,,,90,51,43.35,14.6166,51,"Health Partners, Inc.",State of Minnesota Advantage Program,41.565,81.5,,percent of total billed charges,,
Cytomegalovirus Igg/Igm Ii (Mayo)OutsideLaboratory,,86645,CPT,Facility,Both,,,90,51,43.35,14.6166,51,"Health Partners, Inc.",State Public Programs,25.5,50,,percent of total billed charges,,
Cytomegalovirus Igg/Igm Ii (Mayo)OutsideLaboratory,,86645,CPT,Facility,Both,,,90,51,43.35,14.6166,51,Humana Insurance Company,Commercial PPO,48.45,95,,percent of total billed charges,,
Cytomegalovirus Igg/Igm Ii (Mayo)OutsideLaboratory,,86645,CPT,Facility,Outpatient,,,90,51,43.35,14.6166,51,Humana Insurance Company,Medicare PPO,24.99,49,,percent of total billed charges,,
Cytomegalovirus Igg/Igm Ii (Mayo)OutsideLaboratory,,86645,CPT,Facility,Inpatient,,,90,51,43.35,14.6166,51,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Cytomegalovirus Igg/Igm Ii (Mayo)OutsideLaboratory,,86645,CPT,Facility,Both,,,90,51,43.35,14.6166,51,Medica,Individual & Family,50.541,99.1,,percent of total billed charges,,
Cytomegalovirus Igg/Igm Ii (Mayo)OutsideLaboratory,,86645,CPT,Facility,Outpatient,,,90,51,43.35,14.6166,51,Medica,Medica Advantage Solution,25.398,49.8,,percent of total billed charges,,
Cytomegalovirus Igg/Igm Ii (Mayo)OutsideLaboratory,,86645,CPT,Facility,Inpatient,,,90,51,43.35,14.6166,51,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Cytomegalovirus Igg/Igm Ii (Mayo)OutsideLaboratory,,86645,CPT,Facility,Outpatient,,,90,51,43.35,14.6166,51,Medica,Medical Assistance,22.746,44.6,,percent of total billed charges,,
Cytomegalovirus Igg/Igm Ii (Mayo)OutsideLaboratory,,86645,CPT,Facility,Inpatient,,,90,51,43.35,14.6166,51,Medica,Medical Assistance,,,,,Included in per diem rate,
Cytomegalovirus Igg/Igm Ii (Mayo)OutsideLaboratory,,86645,CPT,Facility,Outpatient,,,90,51,43.35,14.6166,51,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,25.398,49.8,,percent of total billed charges,,
Cytomegalovirus Igg/Igm Ii (Mayo)OutsideLaboratory,,86645,CPT,Facility,Inpatient,,,90,51,43.35,14.6166,51,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Cytomegalovirus Igg/Igm Ii (Mayo)OutsideLaboratory,,86645,CPT,Facility,Both,,,90,51,43.35,14.6166,51,"Multiplan, Inc.","Multiplan, Inc.",47.94,94,,percent of total billed charges,,
Cytomegalovirus Igg/Igm Ii (Mayo)OutsideLaboratory,,86645,CPT,Facility,Outpatient,,,90,51,43.35,14.6166,51,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,44.064,86.4,,percent of total billed charges,,
Cytomegalovirus Igg/Igm Ii (Mayo)OutsideLaboratory,,86645,CPT,Facility,Inpatient,,,90,51,43.35,14.6166,51,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Cytomegalovirus Igg/Igm Ii (Mayo)OutsideLaboratory,,86645,CPT,Facility,Both,,,90,51,43.35,14.6166,51,"Preferred One Administrative Services, INC.",PPO,50.286,98.6,,percent of total billed charges,,
Cytomegalovirus Igg/Igm Ii (Mayo)OutsideLaboratory,,86645,CPT,Facility,Outpatient,,,90,51,43.35,14.6166,51,PrimeWest Health,Minnesota Senior Health Options (MSHO),26.2395,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Cytomegalovirus Igg/Igm Ii (Mayo)OutsideLaboratory,,86645,CPT,Facility,Inpatient,,,90,51,43.35,14.6166,51,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Cytomegalovirus Igg/Igm Ii (Mayo)OutsideLaboratory,,86645,CPT,Facility,Outpatient,,,90,51,43.35,14.6166,51,PrimeWest Health,MinnesotaCare,26.1936,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Cytomegalovirus Igg/Igm Ii (Mayo)OutsideLaboratory,,86645,CPT,Facility,Inpatient,,,90,51,43.35,14.6166,51,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Cytomegalovirus Igg/Igm Ii (Mayo)OutsideLaboratory,,86645,CPT,Facility,Both,,,90,51,43.35,14.6166,51,Sanford Health Plan,Sanford Health Plan,46.92,92,,percent of total billed charges,,
Cytomegalovirus Igg/Igm Ii (Mayo)OutsideLaboratory,,86645,CPT,Facility,Outpatient,,,90,51,43.35,14.6166,51,"UCare Health, Inc.",Individual & Family Plan,28.7385,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Cytomegalovirus Igg/Igm Ii (Mayo)OutsideLaboratory,,86645,CPT,Facility,Inpatient,,,90,51,43.35,14.6166,51,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Cytomegalovirus Igg/Igm Ii (Mayo)OutsideLaboratory,,86645,CPT,Facility,Outpatient,,,90,51,43.35,14.6166,51,"UCare Health, Inc.",Medical Assistance,25.7397,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Cytomegalovirus Igg/Igm Ii (Mayo)OutsideLaboratory,,86645,CPT,Facility,Inpatient,,,90,51,43.35,14.6166,51,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Cytomegalovirus Igg/Igm Ii (Mayo)OutsideLaboratory,,86645,CPT,Facility,Outpatient,,,90,51,43.35,14.6166,51,"UCare Health, Inc.",Medicare Advantage,25.7397,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Cytomegalovirus Igg/Igm Ii (Mayo)OutsideLaboratory,,86645,CPT,Facility,Inpatient,,,90,51,43.35,14.6166,51,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Cytomegalovirus Igg/Igm Ii (Mayo)OutsideLaboratory,,86645,CPT,Facility,Outpatient,,,90,51,43.35,14.6166,51,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),25.7397,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Cytomegalovirus Igg/Igm Ii (Mayo)OutsideLaboratory,,86645,CPT,Facility,Inpatient,,,90,51,43.35,14.6166,51,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Cytomegalovirus Igg/Igm Ii (Mayo)OutsideLaboratory,,86645,CPT,Facility,Both,,,90,51,43.35,14.6166,51,UnitedHealthcare,Individual & Family,47.94,94,,percent of total billed charges,,
Cytomegalovirus Igg/Igm Ii (Mayo)OutsideLaboratory,,86645,CPT,Facility,Outpatient,,,90,51,43.35,14.6166,51,UnitedHealthcare,Medicare Advantage,24.99,49,,percent of total billed charges,,
Cytomegalovirus Igg/Igm Ii (Mayo)OutsideLaboratory,,86645,CPT,Facility,Inpatient,,,90,51,43.35,14.6166,51,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Cytomegalovirus Igg/Igm Ii (Mayo)OutsideLaboratory,,86645,CPT,Facility,Outpatient,,,90,51,43.35,14.6166,51,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,24.48,48,,percent of total billed charges,,100% of DHS outpatient percentage
Cytomegalovirus Igg/Igm Ii (Mayo)OutsideLaboratory,,86645,CPT,Facility,Inpatient,,,90,51,43.35,14.6166,51,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Ebv Ab Profile, S (Mayo)OutsideLaboratory",,86664,CPT,Facility,Both,,,90,84,71.4,24.0744,84,Aetna,Commercial,77.28,92,,percent of total billed charges,,
"Ebv Ab Profile, S (Mayo)OutsideLaboratory",,86664,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,Aetna,Medicare Advantage,41.16,49,,percent of total billed charges,,
"Ebv Ab Profile, S (Mayo)OutsideLaboratory",,86664,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Ebv Ab Profile, S (Mayo)OutsideLaboratory",,86664,CPT,Facility,Both,,,90,84,71.4,24.0744,84,Aetna,PPO,78.12,93,,percent of total billed charges,,
"Ebv Ab Profile, S (Mayo)OutsideLaboratory",,86664,CPT,Facility,Both,,,90,84,71.4,24.0744,84,America's PPO,America's PPO,80.6652,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Ebv Ab Profile, S (Mayo)OutsideLaboratory",,86664,CPT,Facility,Both,,,90,84,71.4,24.0744,84,BlueCross BlueShield Minnesota, Federal Employee Program,82.656,98.4,,percent of total billed charges,,
"Ebv Ab Profile, S (Mayo)OutsideLaboratory",,86664,CPT,Facility,Both,,,90,84,71.4,24.0744,84,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,84,100,,percent of total billed charges,,
"Ebv Ab Profile, S (Mayo)OutsideLaboratory",,86664,CPT,Facility,Both,,,90,84,71.4,24.0744,84,BlueCross BlueShield Minnesota,High Value Network Plan,75.6,90,,percent of total billed charges,,
"Ebv Ab Profile, S (Mayo)OutsideLaboratory",,86664,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,BlueCross BlueShield Minnesota,Medicare Advantage,41.16,49,,percent of total billed charges,,
"Ebv Ab Profile, S (Mayo)OutsideLaboratory",,86664,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Ebv Ab Profile, S (Mayo)OutsideLaboratory",,86664,CPT,Facility,Both,,,90,84,71.4,24.0744,84,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,74.3988,88.57,,percent of total billed charges,,
"Ebv Ab Profile, S (Mayo)OutsideLaboratory",,86664,CPT,Facility,Both,,,90,84,71.4,24.0744,84,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,24.0744,28.66,,percent of total billed charges,,
"Ebv Ab Profile, S (Mayo)OutsideLaboratory",,86664,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),41.16,49,,percent of total billed charges,,
"Ebv Ab Profile, S (Mayo)OutsideLaboratory",,86664,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Ebv Ab Profile, S (Mayo)OutsideLaboratory",,86664,CPT,Facility,Both,,,90,84,71.4,24.0744,84,CorVel,Worker's Compensation,84,100,,percent of total billed charges,,
"Ebv Ab Profile, S (Mayo)OutsideLaboratory",,86664,CPT,Facility,Both,,,90,84,71.4,24.0744,84,First Health Group Corporation,First Health Network,81.48,97,,percent of total billed charges,,
"Ebv Ab Profile, S (Mayo)OutsideLaboratory",,86664,CPT,Facility,Both,,,90,84,71.4,24.0744,84,"Health Partners, Inc.",Commercial,79.464,94.6,,percent of total billed charges,,
"Ebv Ab Profile, S (Mayo)OutsideLaboratory",,86664,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,"Health Partners, Inc.",Medicare Advantage,41.16,49,,percent of total billed charges,,
"Ebv Ab Profile, S (Mayo)OutsideLaboratory",,86664,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Ebv Ab Profile, S (Mayo)OutsideLaboratory",,86664,CPT,Facility,Both,,,90,84,71.4,24.0744,84,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),50.4,60,,percent of total billed charges,,
"Ebv Ab Profile, S (Mayo)OutsideLaboratory",,86664,CPT,Facility,Both,,,90,84,71.4,24.0744,84,"Health Partners, Inc.",State of Minnesota Advantage Program,68.46,81.5,,percent of total billed charges,,
"Ebv Ab Profile, S (Mayo)OutsideLaboratory",,86664,CPT,Facility,Both,,,90,84,71.4,24.0744,84,"Health Partners, Inc.",State Public Programs,42,50,,percent of total billed charges,,
"Ebv Ab Profile, S (Mayo)OutsideLaboratory",,86664,CPT,Facility,Both,,,90,84,71.4,24.0744,84,Humana Insurance Company,Commercial PPO,79.8,95,,percent of total billed charges,,
"Ebv Ab Profile, S (Mayo)OutsideLaboratory",,86664,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,Humana Insurance Company,Medicare PPO,41.16,49,,percent of total billed charges,,
"Ebv Ab Profile, S (Mayo)OutsideLaboratory",,86664,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Ebv Ab Profile, S (Mayo)OutsideLaboratory",,86664,CPT,Facility,Both,,,90,84,71.4,24.0744,84,Medica,Individual & Family,83.244,99.1,,percent of total billed charges,,
"Ebv Ab Profile, S (Mayo)OutsideLaboratory",,86664,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,Medica,Medica Advantage Solution,41.832,49.8,,percent of total billed charges,,
"Ebv Ab Profile, S (Mayo)OutsideLaboratory",,86664,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Ebv Ab Profile, S (Mayo)OutsideLaboratory",,86664,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,Medica,Medical Assistance,37.464,44.6,,percent of total billed charges,,
"Ebv Ab Profile, S (Mayo)OutsideLaboratory",,86664,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,Medica,Medical Assistance,,,,,Included in per diem rate,
"Ebv Ab Profile, S (Mayo)OutsideLaboratory",,86664,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,41.832,49.8,,percent of total billed charges,,
"Ebv Ab Profile, S (Mayo)OutsideLaboratory",,86664,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Ebv Ab Profile, S (Mayo)OutsideLaboratory",,86664,CPT,Facility,Both,,,90,84,71.4,24.0744,84,"Multiplan, Inc.","Multiplan, Inc.",78.96,94,,percent of total billed charges,,
"Ebv Ab Profile, S (Mayo)OutsideLaboratory",,86664,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,72.576,86.4,,percent of total billed charges,,
"Ebv Ab Profile, S (Mayo)OutsideLaboratory",,86664,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Ebv Ab Profile, S (Mayo)OutsideLaboratory",,86664,CPT,Facility,Both,,,90,84,71.4,24.0744,84,"Preferred One Administrative Services, INC.",PPO,82.824,98.6,,percent of total billed charges,,
"Ebv Ab Profile, S (Mayo)OutsideLaboratory",,86664,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,PrimeWest Health,Minnesota Senior Health Options (MSHO),43.218,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Ebv Ab Profile, S (Mayo)OutsideLaboratory",,86664,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Ebv Ab Profile, S (Mayo)OutsideLaboratory",,86664,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,PrimeWest Health,MinnesotaCare,43.1424,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Ebv Ab Profile, S (Mayo)OutsideLaboratory",,86664,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Ebv Ab Profile, S (Mayo)OutsideLaboratory",,86664,CPT,Facility,Both,,,90,84,71.4,24.0744,84,Sanford Health Plan,Sanford Health Plan,77.28,92,,percent of total billed charges,,
"Ebv Ab Profile, S (Mayo)OutsideLaboratory",,86664,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,"UCare Health, Inc.",Individual & Family Plan,47.334,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Ebv Ab Profile, S (Mayo)OutsideLaboratory",,86664,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Ebv Ab Profile, S (Mayo)OutsideLaboratory",,86664,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,"UCare Health, Inc.",Medical Assistance,42.3948,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Ebv Ab Profile, S (Mayo)OutsideLaboratory",,86664,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Ebv Ab Profile, S (Mayo)OutsideLaboratory",,86664,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,"UCare Health, Inc.",Medicare Advantage,42.3948,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Ebv Ab Profile, S (Mayo)OutsideLaboratory",,86664,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Ebv Ab Profile, S (Mayo)OutsideLaboratory",,86664,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),42.3948,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Ebv Ab Profile, S (Mayo)OutsideLaboratory",,86664,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Ebv Ab Profile, S (Mayo)OutsideLaboratory",,86664,CPT,Facility,Both,,,90,84,71.4,24.0744,84,UnitedHealthcare,Individual & Family,78.96,94,,percent of total billed charges,,
"Ebv Ab Profile, S (Mayo)OutsideLaboratory",,86664,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,UnitedHealthcare,Medicare Advantage,41.16,49,,percent of total billed charges,,
"Ebv Ab Profile, S (Mayo)OutsideLaboratory",,86664,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Ebv Ab Profile, S (Mayo)OutsideLaboratory",,86664,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,40.32,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Ebv Ab Profile, S (Mayo)OutsideLaboratory",,86664,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Anaplasma Phagocytophilum Ab, Igg,S (Mayo)OutsideLaboratory",,86666,CPT,Facility,Both,,,90,150,127.5,42.99,150,Aetna,Commercial,138,92,,percent of total billed charges,,
"Anaplasma Phagocytophilum Ab, Igg,S (Mayo)OutsideLaboratory",,86666,CPT,Facility,Outpatient,,,90,150,127.5,42.99,150,Aetna,Medicare Advantage,73.5,49,,percent of total billed charges,,
"Anaplasma Phagocytophilum Ab, Igg,S (Mayo)OutsideLaboratory",,86666,CPT,Facility,Inpatient,,,90,150,127.5,42.99,150,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Anaplasma Phagocytophilum Ab, Igg,S (Mayo)OutsideLaboratory",,86666,CPT,Facility,Both,,,90,150,127.5,42.99,150,Aetna,PPO,139.5,93,,percent of total billed charges,,
"Anaplasma Phagocytophilum Ab, Igg,S (Mayo)OutsideLaboratory",,86666,CPT,Facility,Both,,,90,150,127.5,42.99,150,America's PPO,America's PPO,144.045,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Anaplasma Phagocytophilum Ab, Igg,S (Mayo)OutsideLaboratory",,86666,CPT,Facility,Both,,,90,150,127.5,42.99,150,BlueCross BlueShield Minnesota, Federal Employee Program,147.6,98.4,,percent of total billed charges,,
"Anaplasma Phagocytophilum Ab, Igg,S (Mayo)OutsideLaboratory",,86666,CPT,Facility,Both,,,90,150,127.5,42.99,150,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,150,100,,percent of total billed charges,,
"Anaplasma Phagocytophilum Ab, Igg,S (Mayo)OutsideLaboratory",,86666,CPT,Facility,Both,,,90,150,127.5,42.99,150,BlueCross BlueShield Minnesota,High Value Network Plan,135,90,,percent of total billed charges,,
"Anaplasma Phagocytophilum Ab, Igg,S (Mayo)OutsideLaboratory",,86666,CPT,Facility,Outpatient,,,90,150,127.5,42.99,150,BlueCross BlueShield Minnesota,Medicare Advantage,73.5,49,,percent of total billed charges,,
"Anaplasma Phagocytophilum Ab, Igg,S (Mayo)OutsideLaboratory",,86666,CPT,Facility,Inpatient,,,90,150,127.5,42.99,150,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Anaplasma Phagocytophilum Ab, Igg,S (Mayo)OutsideLaboratory",,86666,CPT,Facility,Both,,,90,150,127.5,42.99,150,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,132.855,88.57,,percent of total billed charges,,
"Anaplasma Phagocytophilum Ab, Igg,S (Mayo)OutsideLaboratory",,86666,CPT,Facility,Both,,,90,150,127.5,42.99,150,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,42.99,28.66,,percent of total billed charges,,
"Anaplasma Phagocytophilum Ab, Igg,S (Mayo)OutsideLaboratory",,86666,CPT,Facility,Outpatient,,,90,150,127.5,42.99,150,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),73.5,49,,percent of total billed charges,,
"Anaplasma Phagocytophilum Ab, Igg,S (Mayo)OutsideLaboratory",,86666,CPT,Facility,Inpatient,,,90,150,127.5,42.99,150,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Anaplasma Phagocytophilum Ab, Igg,S (Mayo)OutsideLaboratory",,86666,CPT,Facility,Both,,,90,150,127.5,42.99,150,CorVel,Worker's Compensation,150,100,,percent of total billed charges,,
"Anaplasma Phagocytophilum Ab, Igg,S (Mayo)OutsideLaboratory",,86666,CPT,Facility,Both,,,90,150,127.5,42.99,150,First Health Group Corporation,First Health Network,145.5,97,,percent of total billed charges,,
"Anaplasma Phagocytophilum Ab, Igg,S (Mayo)OutsideLaboratory",,86666,CPT,Facility,Both,,,90,150,127.5,42.99,150,"Health Partners, Inc.",Commercial,141.9,94.6,,percent of total billed charges,,
"Anaplasma Phagocytophilum Ab, Igg,S (Mayo)OutsideLaboratory",,86666,CPT,Facility,Outpatient,,,90,150,127.5,42.99,150,"Health Partners, Inc.",Medicare Advantage,73.5,49,,percent of total billed charges,,
"Anaplasma Phagocytophilum Ab, Igg,S (Mayo)OutsideLaboratory",,86666,CPT,Facility,Inpatient,,,90,150,127.5,42.99,150,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Anaplasma Phagocytophilum Ab, Igg,S (Mayo)OutsideLaboratory",,86666,CPT,Facility,Both,,,90,150,127.5,42.99,150,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),90,60,,percent of total billed charges,,
"Anaplasma Phagocytophilum Ab, Igg,S (Mayo)OutsideLaboratory",,86666,CPT,Facility,Both,,,90,150,127.5,42.99,150,"Health Partners, Inc.",State of Minnesota Advantage Program,122.25,81.5,,percent of total billed charges,,
"Anaplasma Phagocytophilum Ab, Igg,S (Mayo)OutsideLaboratory",,86666,CPT,Facility,Both,,,90,150,127.5,42.99,150,"Health Partners, Inc.",State Public Programs,75,50,,percent of total billed charges,,
"Anaplasma Phagocytophilum Ab, Igg,S (Mayo)OutsideLaboratory",,86666,CPT,Facility,Both,,,90,150,127.5,42.99,150,Humana Insurance Company,Commercial PPO,142.5,95,,percent of total billed charges,,
"Anaplasma Phagocytophilum Ab, Igg,S (Mayo)OutsideLaboratory",,86666,CPT,Facility,Outpatient,,,90,150,127.5,42.99,150,Humana Insurance Company,Medicare PPO,73.5,49,,percent of total billed charges,,
"Anaplasma Phagocytophilum Ab, Igg,S (Mayo)OutsideLaboratory",,86666,CPT,Facility,Inpatient,,,90,150,127.5,42.99,150,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Anaplasma Phagocytophilum Ab, Igg,S (Mayo)OutsideLaboratory",,86666,CPT,Facility,Both,,,90,150,127.5,42.99,150,Medica,Individual & Family,148.65,99.1,,percent of total billed charges,,
"Anaplasma Phagocytophilum Ab, Igg,S (Mayo)OutsideLaboratory",,86666,CPT,Facility,Outpatient,,,90,150,127.5,42.99,150,Medica,Medica Advantage Solution,74.7,49.8,,percent of total billed charges,,
"Anaplasma Phagocytophilum Ab, Igg,S (Mayo)OutsideLaboratory",,86666,CPT,Facility,Inpatient,,,90,150,127.5,42.99,150,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Anaplasma Phagocytophilum Ab, Igg,S (Mayo)OutsideLaboratory",,86666,CPT,Facility,Outpatient,,,90,150,127.5,42.99,150,Medica,Medical Assistance,66.9,44.6,,percent of total billed charges,,
"Anaplasma Phagocytophilum Ab, Igg,S (Mayo)OutsideLaboratory",,86666,CPT,Facility,Inpatient,,,90,150,127.5,42.99,150,Medica,Medical Assistance,,,,,Included in per diem rate,
"Anaplasma Phagocytophilum Ab, Igg,S (Mayo)OutsideLaboratory",,86666,CPT,Facility,Outpatient,,,90,150,127.5,42.99,150,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,74.7,49.8,,percent of total billed charges,,
"Anaplasma Phagocytophilum Ab, Igg,S (Mayo)OutsideLaboratory",,86666,CPT,Facility,Inpatient,,,90,150,127.5,42.99,150,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Anaplasma Phagocytophilum Ab, Igg,S (Mayo)OutsideLaboratory",,86666,CPT,Facility,Both,,,90,150,127.5,42.99,150,"Multiplan, Inc.","Multiplan, Inc.",141,94,,percent of total billed charges,,
"Anaplasma Phagocytophilum Ab, Igg,S (Mayo)OutsideLaboratory",,86666,CPT,Facility,Outpatient,,,90,150,127.5,42.99,150,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,129.6,86.4,,percent of total billed charges,,
"Anaplasma Phagocytophilum Ab, Igg,S (Mayo)OutsideLaboratory",,86666,CPT,Facility,Inpatient,,,90,150,127.5,42.99,150,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Anaplasma Phagocytophilum Ab, Igg,S (Mayo)OutsideLaboratory",,86666,CPT,Facility,Both,,,90,150,127.5,42.99,150,"Preferred One Administrative Services, INC.",PPO,147.9,98.6,,percent of total billed charges,,
"Anaplasma Phagocytophilum Ab, Igg,S (Mayo)OutsideLaboratory",,86666,CPT,Facility,Outpatient,,,90,150,127.5,42.99,150,PrimeWest Health,Minnesota Senior Health Options (MSHO),77.175,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Anaplasma Phagocytophilum Ab, Igg,S (Mayo)OutsideLaboratory",,86666,CPT,Facility,Inpatient,,,90,150,127.5,42.99,150,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Anaplasma Phagocytophilum Ab, Igg,S (Mayo)OutsideLaboratory",,86666,CPT,Facility,Outpatient,,,90,150,127.5,42.99,150,PrimeWest Health,MinnesotaCare,77.04,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Anaplasma Phagocytophilum Ab, Igg,S (Mayo)OutsideLaboratory",,86666,CPT,Facility,Inpatient,,,90,150,127.5,42.99,150,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Anaplasma Phagocytophilum Ab, Igg,S (Mayo)OutsideLaboratory",,86666,CPT,Facility,Both,,,90,150,127.5,42.99,150,Sanford Health Plan,Sanford Health Plan,138,92,,percent of total billed charges,,
"Anaplasma Phagocytophilum Ab, Igg,S (Mayo)OutsideLaboratory",,86666,CPT,Facility,Outpatient,,,90,150,127.5,42.99,150,"UCare Health, Inc.",Individual & Family Plan,84.525,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Anaplasma Phagocytophilum Ab, Igg,S (Mayo)OutsideLaboratory",,86666,CPT,Facility,Inpatient,,,90,150,127.5,42.99,150,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Anaplasma Phagocytophilum Ab, Igg,S (Mayo)OutsideLaboratory",,86666,CPT,Facility,Outpatient,,,90,150,127.5,42.99,150,"UCare Health, Inc.",Medical Assistance,75.705,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Anaplasma Phagocytophilum Ab, Igg,S (Mayo)OutsideLaboratory",,86666,CPT,Facility,Inpatient,,,90,150,127.5,42.99,150,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Anaplasma Phagocytophilum Ab, Igg,S (Mayo)OutsideLaboratory",,86666,CPT,Facility,Outpatient,,,90,150,127.5,42.99,150,"UCare Health, Inc.",Medicare Advantage,75.705,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Anaplasma Phagocytophilum Ab, Igg,S (Mayo)OutsideLaboratory",,86666,CPT,Facility,Inpatient,,,90,150,127.5,42.99,150,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Anaplasma Phagocytophilum Ab, Igg,S (Mayo)OutsideLaboratory",,86666,CPT,Facility,Outpatient,,,90,150,127.5,42.99,150,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),75.705,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Anaplasma Phagocytophilum Ab, Igg,S (Mayo)OutsideLaboratory",,86666,CPT,Facility,Inpatient,,,90,150,127.5,42.99,150,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Anaplasma Phagocytophilum Ab, Igg,S (Mayo)OutsideLaboratory",,86666,CPT,Facility,Both,,,90,150,127.5,42.99,150,UnitedHealthcare,Individual & Family,141,94,,percent of total billed charges,,
"Anaplasma Phagocytophilum Ab, Igg,S (Mayo)OutsideLaboratory",,86666,CPT,Facility,Outpatient,,,90,150,127.5,42.99,150,UnitedHealthcare,Medicare Advantage,73.5,49,,percent of total billed charges,,
"Anaplasma Phagocytophilum Ab, Igg,S (Mayo)OutsideLaboratory",,86666,CPT,Facility,Inpatient,,,90,150,127.5,42.99,150,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Anaplasma Phagocytophilum Ab, Igg,S (Mayo)OutsideLaboratory",,86666,CPT,Facility,Outpatient,,,90,150,127.5,42.99,150,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,72,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Anaplasma Phagocytophilum Ab, Igg,S (Mayo)OutsideLaboratory",,86666,CPT,Facility,Inpatient,,,90,150,127.5,42.99,150,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Antibody Ehrlichia (Mayo)OutsideLaboratory,,86666,CPT,Facility,Both,,,90,165,140.25,47.289,165,Aetna,Commercial,151.8,92,,percent of total billed charges,,
Antibody Ehrlichia (Mayo)OutsideLaboratory,,86666,CPT,Facility,Outpatient,,,90,165,140.25,47.289,165,Aetna,Medicare Advantage,80.85,49,,percent of total billed charges,,
Antibody Ehrlichia (Mayo)OutsideLaboratory,,86666,CPT,Facility,Inpatient,,,90,165,140.25,47.289,165,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Antibody Ehrlichia (Mayo)OutsideLaboratory,,86666,CPT,Facility,Both,,,90,165,140.25,47.289,165,Aetna,PPO,153.45,93,,percent of total billed charges,,
Antibody Ehrlichia (Mayo)OutsideLaboratory,,86666,CPT,Facility,Both,,,90,165,140.25,47.289,165,America's PPO,America's PPO,158.4495,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Antibody Ehrlichia (Mayo)OutsideLaboratory,,86666,CPT,Facility,Both,,,90,165,140.25,47.289,165,BlueCross BlueShield Minnesota, Federal Employee Program,162.36,98.4,,percent of total billed charges,,
Antibody Ehrlichia (Mayo)OutsideLaboratory,,86666,CPT,Facility,Both,,,90,165,140.25,47.289,165,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,165,100,,percent of total billed charges,,
Antibody Ehrlichia (Mayo)OutsideLaboratory,,86666,CPT,Facility,Both,,,90,165,140.25,47.289,165,BlueCross BlueShield Minnesota,High Value Network Plan,148.5,90,,percent of total billed charges,,
Antibody Ehrlichia (Mayo)OutsideLaboratory,,86666,CPT,Facility,Outpatient,,,90,165,140.25,47.289,165,BlueCross BlueShield Minnesota,Medicare Advantage,80.85,49,,percent of total billed charges,,
Antibody Ehrlichia (Mayo)OutsideLaboratory,,86666,CPT,Facility,Inpatient,,,90,165,140.25,47.289,165,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Antibody Ehrlichia (Mayo)OutsideLaboratory,,86666,CPT,Facility,Both,,,90,165,140.25,47.289,165,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,146.1405,88.57,,percent of total billed charges,,
Antibody Ehrlichia (Mayo)OutsideLaboratory,,86666,CPT,Facility,Both,,,90,165,140.25,47.289,165,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,47.289,28.66,,percent of total billed charges,,
Antibody Ehrlichia (Mayo)OutsideLaboratory,,86666,CPT,Facility,Outpatient,,,90,165,140.25,47.289,165,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),80.85,49,,percent of total billed charges,,
Antibody Ehrlichia (Mayo)OutsideLaboratory,,86666,CPT,Facility,Inpatient,,,90,165,140.25,47.289,165,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Antibody Ehrlichia (Mayo)OutsideLaboratory,,86666,CPT,Facility,Both,,,90,165,140.25,47.289,165,CorVel,Worker's Compensation,165,100,,percent of total billed charges,,
Antibody Ehrlichia (Mayo)OutsideLaboratory,,86666,CPT,Facility,Both,,,90,165,140.25,47.289,165,First Health Group Corporation,First Health Network,160.05,97,,percent of total billed charges,,
Antibody Ehrlichia (Mayo)OutsideLaboratory,,86666,CPT,Facility,Both,,,90,165,140.25,47.289,165,"Health Partners, Inc.",Commercial,156.09,94.6,,percent of total billed charges,,
Antibody Ehrlichia (Mayo)OutsideLaboratory,,86666,CPT,Facility,Outpatient,,,90,165,140.25,47.289,165,"Health Partners, Inc.",Medicare Advantage,80.85,49,,percent of total billed charges,,
Antibody Ehrlichia (Mayo)OutsideLaboratory,,86666,CPT,Facility,Inpatient,,,90,165,140.25,47.289,165,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Antibody Ehrlichia (Mayo)OutsideLaboratory,,86666,CPT,Facility,Both,,,90,165,140.25,47.289,165,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),99,60,,percent of total billed charges,,
Antibody Ehrlichia (Mayo)OutsideLaboratory,,86666,CPT,Facility,Both,,,90,165,140.25,47.289,165,"Health Partners, Inc.",State of Minnesota Advantage Program,134.475,81.5,,percent of total billed charges,,
Antibody Ehrlichia (Mayo)OutsideLaboratory,,86666,CPT,Facility,Both,,,90,165,140.25,47.289,165,"Health Partners, Inc.",State Public Programs,82.5,50,,percent of total billed charges,,
Antibody Ehrlichia (Mayo)OutsideLaboratory,,86666,CPT,Facility,Both,,,90,165,140.25,47.289,165,Humana Insurance Company,Commercial PPO,156.75,95,,percent of total billed charges,,
Antibody Ehrlichia (Mayo)OutsideLaboratory,,86666,CPT,Facility,Outpatient,,,90,165,140.25,47.289,165,Humana Insurance Company,Medicare PPO,80.85,49,,percent of total billed charges,,
Antibody Ehrlichia (Mayo)OutsideLaboratory,,86666,CPT,Facility,Inpatient,,,90,165,140.25,47.289,165,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Antibody Ehrlichia (Mayo)OutsideLaboratory,,86666,CPT,Facility,Both,,,90,165,140.25,47.289,165,Medica,Individual & Family,163.515,99.1,,percent of total billed charges,,
Antibody Ehrlichia (Mayo)OutsideLaboratory,,86666,CPT,Facility,Outpatient,,,90,165,140.25,47.289,165,Medica,Medica Advantage Solution,82.17,49.8,,percent of total billed charges,,
Antibody Ehrlichia (Mayo)OutsideLaboratory,,86666,CPT,Facility,Inpatient,,,90,165,140.25,47.289,165,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Antibody Ehrlichia (Mayo)OutsideLaboratory,,86666,CPT,Facility,Outpatient,,,90,165,140.25,47.289,165,Medica,Medical Assistance,73.59,44.6,,percent of total billed charges,,
Antibody Ehrlichia (Mayo)OutsideLaboratory,,86666,CPT,Facility,Inpatient,,,90,165,140.25,47.289,165,Medica,Medical Assistance,,,,,Included in per diem rate,
Antibody Ehrlichia (Mayo)OutsideLaboratory,,86666,CPT,Facility,Outpatient,,,90,165,140.25,47.289,165,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,82.17,49.8,,percent of total billed charges,,
Antibody Ehrlichia (Mayo)OutsideLaboratory,,86666,CPT,Facility,Inpatient,,,90,165,140.25,47.289,165,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Antibody Ehrlichia (Mayo)OutsideLaboratory,,86666,CPT,Facility,Both,,,90,165,140.25,47.289,165,"Multiplan, Inc.","Multiplan, Inc.",155.1,94,,percent of total billed charges,,
Antibody Ehrlichia (Mayo)OutsideLaboratory,,86666,CPT,Facility,Outpatient,,,90,165,140.25,47.289,165,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,142.56,86.4,,percent of total billed charges,,
Antibody Ehrlichia (Mayo)OutsideLaboratory,,86666,CPT,Facility,Inpatient,,,90,165,140.25,47.289,165,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Antibody Ehrlichia (Mayo)OutsideLaboratory,,86666,CPT,Facility,Both,,,90,165,140.25,47.289,165,"Preferred One Administrative Services, INC.",PPO,162.69,98.6,,percent of total billed charges,,
Antibody Ehrlichia (Mayo)OutsideLaboratory,,86666,CPT,Facility,Outpatient,,,90,165,140.25,47.289,165,PrimeWest Health,Minnesota Senior Health Options (MSHO),84.8925,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Antibody Ehrlichia (Mayo)OutsideLaboratory,,86666,CPT,Facility,Inpatient,,,90,165,140.25,47.289,165,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Antibody Ehrlichia (Mayo)OutsideLaboratory,,86666,CPT,Facility,Outpatient,,,90,165,140.25,47.289,165,PrimeWest Health,MinnesotaCare,84.744,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Antibody Ehrlichia (Mayo)OutsideLaboratory,,86666,CPT,Facility,Inpatient,,,90,165,140.25,47.289,165,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Antibody Ehrlichia (Mayo)OutsideLaboratory,,86666,CPT,Facility,Both,,,90,165,140.25,47.289,165,Sanford Health Plan,Sanford Health Plan,151.8,92,,percent of total billed charges,,
Antibody Ehrlichia (Mayo)OutsideLaboratory,,86666,CPT,Facility,Outpatient,,,90,165,140.25,47.289,165,"UCare Health, Inc.",Individual & Family Plan,92.9775,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Antibody Ehrlichia (Mayo)OutsideLaboratory,,86666,CPT,Facility,Inpatient,,,90,165,140.25,47.289,165,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Antibody Ehrlichia (Mayo)OutsideLaboratory,,86666,CPT,Facility,Outpatient,,,90,165,140.25,47.289,165,"UCare Health, Inc.",Medical Assistance,83.2755,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Antibody Ehrlichia (Mayo)OutsideLaboratory,,86666,CPT,Facility,Inpatient,,,90,165,140.25,47.289,165,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Antibody Ehrlichia (Mayo)OutsideLaboratory,,86666,CPT,Facility,Outpatient,,,90,165,140.25,47.289,165,"UCare Health, Inc.",Medicare Advantage,83.2755,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Antibody Ehrlichia (Mayo)OutsideLaboratory,,86666,CPT,Facility,Inpatient,,,90,165,140.25,47.289,165,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Antibody Ehrlichia (Mayo)OutsideLaboratory,,86666,CPT,Facility,Outpatient,,,90,165,140.25,47.289,165,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),83.2755,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Antibody Ehrlichia (Mayo)OutsideLaboratory,,86666,CPT,Facility,Inpatient,,,90,165,140.25,47.289,165,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Antibody Ehrlichia (Mayo)OutsideLaboratory,,86666,CPT,Facility,Both,,,90,165,140.25,47.289,165,UnitedHealthcare,Individual & Family,155.1,94,,percent of total billed charges,,
Antibody Ehrlichia (Mayo)OutsideLaboratory,,86666,CPT,Facility,Outpatient,,,90,165,140.25,47.289,165,UnitedHealthcare,Medicare Advantage,80.85,49,,percent of total billed charges,,
Antibody Ehrlichia (Mayo)OutsideLaboratory,,86666,CPT,Facility,Inpatient,,,90,165,140.25,47.289,165,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Antibody Ehrlichia (Mayo)OutsideLaboratory,,86666,CPT,Facility,Outpatient,,,90,165,140.25,47.289,165,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,79.2,48,,percent of total billed charges,,100% of DHS outpatient percentage
Antibody Ehrlichia (Mayo)OutsideLaboratory,,86666,CPT,Facility,Inpatient,,,90,165,140.25,47.289,165,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Saccharomyces Cerevisiae Ab, Iga, S (Mayo)OutsideLaboratory",,86671,CPT,Facility,Both,,,90,104,88.4,29.8064,104,Aetna,Commercial,95.68,92,,percent of total billed charges,,
"Saccharomyces Cerevisiae Ab, Iga, S (Mayo)OutsideLaboratory",,86671,CPT,Facility,Outpatient,,,90,104,88.4,29.8064,104,Aetna,Medicare Advantage,50.96,49,,percent of total billed charges,,
"Saccharomyces Cerevisiae Ab, Iga, S (Mayo)OutsideLaboratory",,86671,CPT,Facility,Inpatient,,,90,104,88.4,29.8064,104,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Saccharomyces Cerevisiae Ab, Iga, S (Mayo)OutsideLaboratory",,86671,CPT,Facility,Both,,,90,104,88.4,29.8064,104,Aetna,PPO,96.72,93,,percent of total billed charges,,
"Saccharomyces Cerevisiae Ab, Iga, S (Mayo)OutsideLaboratory",,86671,CPT,Facility,Both,,,90,104,88.4,29.8064,104,America's PPO,America's PPO,99.8712,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Saccharomyces Cerevisiae Ab, Iga, S (Mayo)OutsideLaboratory",,86671,CPT,Facility,Both,,,90,104,88.4,29.8064,104,BlueCross BlueShield Minnesota, Federal Employee Program,102.336,98.4,,percent of total billed charges,,
"Saccharomyces Cerevisiae Ab, Iga, S (Mayo)OutsideLaboratory",,86671,CPT,Facility,Both,,,90,104,88.4,29.8064,104,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,104,100,,percent of total billed charges,,
"Saccharomyces Cerevisiae Ab, Iga, S (Mayo)OutsideLaboratory",,86671,CPT,Facility,Both,,,90,104,88.4,29.8064,104,BlueCross BlueShield Minnesota,High Value Network Plan,93.6,90,,percent of total billed charges,,
"Saccharomyces Cerevisiae Ab, Iga, S (Mayo)OutsideLaboratory",,86671,CPT,Facility,Outpatient,,,90,104,88.4,29.8064,104,BlueCross BlueShield Minnesota,Medicare Advantage,50.96,49,,percent of total billed charges,,
"Saccharomyces Cerevisiae Ab, Iga, S (Mayo)OutsideLaboratory",,86671,CPT,Facility,Inpatient,,,90,104,88.4,29.8064,104,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Saccharomyces Cerevisiae Ab, Iga, S (Mayo)OutsideLaboratory",,86671,CPT,Facility,Both,,,90,104,88.4,29.8064,104,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,92.1128,88.57,,percent of total billed charges,,
"Saccharomyces Cerevisiae Ab, Iga, S (Mayo)OutsideLaboratory",,86671,CPT,Facility,Both,,,90,104,88.4,29.8064,104,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,29.8064,28.66,,percent of total billed charges,,
"Saccharomyces Cerevisiae Ab, Iga, S (Mayo)OutsideLaboratory",,86671,CPT,Facility,Outpatient,,,90,104,88.4,29.8064,104,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),50.96,49,,percent of total billed charges,,
"Saccharomyces Cerevisiae Ab, Iga, S (Mayo)OutsideLaboratory",,86671,CPT,Facility,Inpatient,,,90,104,88.4,29.8064,104,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Saccharomyces Cerevisiae Ab, Iga, S (Mayo)OutsideLaboratory",,86671,CPT,Facility,Both,,,90,104,88.4,29.8064,104,CorVel,Worker's Compensation,104,100,,percent of total billed charges,,
"Saccharomyces Cerevisiae Ab, Iga, S (Mayo)OutsideLaboratory",,86671,CPT,Facility,Both,,,90,104,88.4,29.8064,104,First Health Group Corporation,First Health Network,100.88,97,,percent of total billed charges,,
"Saccharomyces Cerevisiae Ab, Iga, S (Mayo)OutsideLaboratory",,86671,CPT,Facility,Both,,,90,104,88.4,29.8064,104,"Health Partners, Inc.",Commercial,98.384,94.6,,percent of total billed charges,,
"Saccharomyces Cerevisiae Ab, Iga, S (Mayo)OutsideLaboratory",,86671,CPT,Facility,Outpatient,,,90,104,88.4,29.8064,104,"Health Partners, Inc.",Medicare Advantage,50.96,49,,percent of total billed charges,,
"Saccharomyces Cerevisiae Ab, Iga, S (Mayo)OutsideLaboratory",,86671,CPT,Facility,Inpatient,,,90,104,88.4,29.8064,104,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Saccharomyces Cerevisiae Ab, Iga, S (Mayo)OutsideLaboratory",,86671,CPT,Facility,Both,,,90,104,88.4,29.8064,104,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),62.4,60,,percent of total billed charges,,
"Saccharomyces Cerevisiae Ab, Iga, S (Mayo)OutsideLaboratory",,86671,CPT,Facility,Both,,,90,104,88.4,29.8064,104,"Health Partners, Inc.",State of Minnesota Advantage Program,84.76,81.5,,percent of total billed charges,,
"Saccharomyces Cerevisiae Ab, Iga, S (Mayo)OutsideLaboratory",,86671,CPT,Facility,Both,,,90,104,88.4,29.8064,104,"Health Partners, Inc.",State Public Programs,52,50,,percent of total billed charges,,
"Saccharomyces Cerevisiae Ab, Iga, S (Mayo)OutsideLaboratory",,86671,CPT,Facility,Both,,,90,104,88.4,29.8064,104,Humana Insurance Company,Commercial PPO,98.8,95,,percent of total billed charges,,
"Saccharomyces Cerevisiae Ab, Iga, S (Mayo)OutsideLaboratory",,86671,CPT,Facility,Outpatient,,,90,104,88.4,29.8064,104,Humana Insurance Company,Medicare PPO,50.96,49,,percent of total billed charges,,
"Saccharomyces Cerevisiae Ab, Iga, S (Mayo)OutsideLaboratory",,86671,CPT,Facility,Inpatient,,,90,104,88.4,29.8064,104,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Saccharomyces Cerevisiae Ab, Iga, S (Mayo)OutsideLaboratory",,86671,CPT,Facility,Both,,,90,104,88.4,29.8064,104,Medica,Individual & Family,103.064,99.1,,percent of total billed charges,,
"Saccharomyces Cerevisiae Ab, Iga, S (Mayo)OutsideLaboratory",,86671,CPT,Facility,Outpatient,,,90,104,88.4,29.8064,104,Medica,Medica Advantage Solution,51.792,49.8,,percent of total billed charges,,
"Saccharomyces Cerevisiae Ab, Iga, S (Mayo)OutsideLaboratory",,86671,CPT,Facility,Inpatient,,,90,104,88.4,29.8064,104,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Saccharomyces Cerevisiae Ab, Iga, S (Mayo)OutsideLaboratory",,86671,CPT,Facility,Outpatient,,,90,104,88.4,29.8064,104,Medica,Medical Assistance,46.384,44.6,,percent of total billed charges,,
"Saccharomyces Cerevisiae Ab, Iga, S (Mayo)OutsideLaboratory",,86671,CPT,Facility,Inpatient,,,90,104,88.4,29.8064,104,Medica,Medical Assistance,,,,,Included in per diem rate,
"Saccharomyces Cerevisiae Ab, Iga, S (Mayo)OutsideLaboratory",,86671,CPT,Facility,Outpatient,,,90,104,88.4,29.8064,104,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,51.792,49.8,,percent of total billed charges,,
"Saccharomyces Cerevisiae Ab, Iga, S (Mayo)OutsideLaboratory",,86671,CPT,Facility,Inpatient,,,90,104,88.4,29.8064,104,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Saccharomyces Cerevisiae Ab, Iga, S (Mayo)OutsideLaboratory",,86671,CPT,Facility,Both,,,90,104,88.4,29.8064,104,"Multiplan, Inc.","Multiplan, Inc.",97.76,94,,percent of total billed charges,,
"Saccharomyces Cerevisiae Ab, Iga, S (Mayo)OutsideLaboratory",,86671,CPT,Facility,Outpatient,,,90,104,88.4,29.8064,104,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,89.856,86.4,,percent of total billed charges,,
"Saccharomyces Cerevisiae Ab, Iga, S (Mayo)OutsideLaboratory",,86671,CPT,Facility,Inpatient,,,90,104,88.4,29.8064,104,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Saccharomyces Cerevisiae Ab, Iga, S (Mayo)OutsideLaboratory",,86671,CPT,Facility,Both,,,90,104,88.4,29.8064,104,"Preferred One Administrative Services, INC.",PPO,102.544,98.6,,percent of total billed charges,,
"Saccharomyces Cerevisiae Ab, Iga, S (Mayo)OutsideLaboratory",,86671,CPT,Facility,Outpatient,,,90,104,88.4,29.8064,104,PrimeWest Health,Minnesota Senior Health Options (MSHO),53.508,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Saccharomyces Cerevisiae Ab, Iga, S (Mayo)OutsideLaboratory",,86671,CPT,Facility,Inpatient,,,90,104,88.4,29.8064,104,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Saccharomyces Cerevisiae Ab, Iga, S (Mayo)OutsideLaboratory",,86671,CPT,Facility,Outpatient,,,90,104,88.4,29.8064,104,PrimeWest Health,MinnesotaCare,53.4144,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Saccharomyces Cerevisiae Ab, Iga, S (Mayo)OutsideLaboratory",,86671,CPT,Facility,Inpatient,,,90,104,88.4,29.8064,104,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Saccharomyces Cerevisiae Ab, Iga, S (Mayo)OutsideLaboratory",,86671,CPT,Facility,Both,,,90,104,88.4,29.8064,104,Sanford Health Plan,Sanford Health Plan,95.68,92,,percent of total billed charges,,
"Saccharomyces Cerevisiae Ab, Iga, S (Mayo)OutsideLaboratory",,86671,CPT,Facility,Outpatient,,,90,104,88.4,29.8064,104,"UCare Health, Inc.",Individual & Family Plan,58.604,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Saccharomyces Cerevisiae Ab, Iga, S (Mayo)OutsideLaboratory",,86671,CPT,Facility,Inpatient,,,90,104,88.4,29.8064,104,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Saccharomyces Cerevisiae Ab, Iga, S (Mayo)OutsideLaboratory",,86671,CPT,Facility,Outpatient,,,90,104,88.4,29.8064,104,"UCare Health, Inc.",Medical Assistance,52.4888,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Saccharomyces Cerevisiae Ab, Iga, S (Mayo)OutsideLaboratory",,86671,CPT,Facility,Inpatient,,,90,104,88.4,29.8064,104,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Saccharomyces Cerevisiae Ab, Iga, S (Mayo)OutsideLaboratory",,86671,CPT,Facility,Outpatient,,,90,104,88.4,29.8064,104,"UCare Health, Inc.",Medicare Advantage,52.4888,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Saccharomyces Cerevisiae Ab, Iga, S (Mayo)OutsideLaboratory",,86671,CPT,Facility,Inpatient,,,90,104,88.4,29.8064,104,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Saccharomyces Cerevisiae Ab, Iga, S (Mayo)OutsideLaboratory",,86671,CPT,Facility,Outpatient,,,90,104,88.4,29.8064,104,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),52.4888,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Saccharomyces Cerevisiae Ab, Iga, S (Mayo)OutsideLaboratory",,86671,CPT,Facility,Inpatient,,,90,104,88.4,29.8064,104,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Saccharomyces Cerevisiae Ab, Iga, S (Mayo)OutsideLaboratory",,86671,CPT,Facility,Both,,,90,104,88.4,29.8064,104,UnitedHealthcare,Individual & Family,97.76,94,,percent of total billed charges,,
"Saccharomyces Cerevisiae Ab, Iga, S (Mayo)OutsideLaboratory",,86671,CPT,Facility,Outpatient,,,90,104,88.4,29.8064,104,UnitedHealthcare,Medicare Advantage,50.96,49,,percent of total billed charges,,
"Saccharomyces Cerevisiae Ab, Iga, S (Mayo)OutsideLaboratory",,86671,CPT,Facility,Inpatient,,,90,104,88.4,29.8064,104,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Saccharomyces Cerevisiae Ab, Iga, S (Mayo)OutsideLaboratory",,86671,CPT,Facility,Outpatient,,,90,104,88.4,29.8064,104,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,49.92,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Saccharomyces Cerevisiae Ab, Iga, S (Mayo)OutsideLaboratory",,86671,CPT,Facility,Inpatient,,,90,104,88.4,29.8064,104,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Saccharomyces Cerevisiae Ab, Igg, S (Mayo)OutsideLaboratory",,86671,CPT,Facility,Both,,,90,104,88.4,29.8064,104,Aetna,Commercial,95.68,92,,percent of total billed charges,,
"Saccharomyces Cerevisiae Ab, Igg, S (Mayo)OutsideLaboratory",,86671,CPT,Facility,Outpatient,,,90,104,88.4,29.8064,104,Aetna,Medicare Advantage,50.96,49,,percent of total billed charges,,
"Saccharomyces Cerevisiae Ab, Igg, S (Mayo)OutsideLaboratory",,86671,CPT,Facility,Inpatient,,,90,104,88.4,29.8064,104,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Saccharomyces Cerevisiae Ab, Igg, S (Mayo)OutsideLaboratory",,86671,CPT,Facility,Both,,,90,104,88.4,29.8064,104,Aetna,PPO,96.72,93,,percent of total billed charges,,
"Saccharomyces Cerevisiae Ab, Igg, S (Mayo)OutsideLaboratory",,86671,CPT,Facility,Both,,,90,104,88.4,29.8064,104,America's PPO,America's PPO,99.8712,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Saccharomyces Cerevisiae Ab, Igg, S (Mayo)OutsideLaboratory",,86671,CPT,Facility,Both,,,90,104,88.4,29.8064,104,BlueCross BlueShield Minnesota, Federal Employee Program,102.336,98.4,,percent of total billed charges,,
"Saccharomyces Cerevisiae Ab, Igg, S (Mayo)OutsideLaboratory",,86671,CPT,Facility,Both,,,90,104,88.4,29.8064,104,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,104,100,,percent of total billed charges,,
"Saccharomyces Cerevisiae Ab, Igg, S (Mayo)OutsideLaboratory",,86671,CPT,Facility,Both,,,90,104,88.4,29.8064,104,BlueCross BlueShield Minnesota,High Value Network Plan,93.6,90,,percent of total billed charges,,
"Saccharomyces Cerevisiae Ab, Igg, S (Mayo)OutsideLaboratory",,86671,CPT,Facility,Outpatient,,,90,104,88.4,29.8064,104,BlueCross BlueShield Minnesota,Medicare Advantage,50.96,49,,percent of total billed charges,,
"Saccharomyces Cerevisiae Ab, Igg, S (Mayo)OutsideLaboratory",,86671,CPT,Facility,Inpatient,,,90,104,88.4,29.8064,104,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Saccharomyces Cerevisiae Ab, Igg, S (Mayo)OutsideLaboratory",,86671,CPT,Facility,Both,,,90,104,88.4,29.8064,104,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,92.1128,88.57,,percent of total billed charges,,
"Saccharomyces Cerevisiae Ab, Igg, S (Mayo)OutsideLaboratory",,86671,CPT,Facility,Both,,,90,104,88.4,29.8064,104,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,29.8064,28.66,,percent of total billed charges,,
"Saccharomyces Cerevisiae Ab, Igg, S (Mayo)OutsideLaboratory",,86671,CPT,Facility,Outpatient,,,90,104,88.4,29.8064,104,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),50.96,49,,percent of total billed charges,,
"Saccharomyces Cerevisiae Ab, Igg, S (Mayo)OutsideLaboratory",,86671,CPT,Facility,Inpatient,,,90,104,88.4,29.8064,104,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Saccharomyces Cerevisiae Ab, Igg, S (Mayo)OutsideLaboratory",,86671,CPT,Facility,Both,,,90,104,88.4,29.8064,104,CorVel,Worker's Compensation,104,100,,percent of total billed charges,,
"Saccharomyces Cerevisiae Ab, Igg, S (Mayo)OutsideLaboratory",,86671,CPT,Facility,Both,,,90,104,88.4,29.8064,104,First Health Group Corporation,First Health Network,100.88,97,,percent of total billed charges,,
"Saccharomyces Cerevisiae Ab, Igg, S (Mayo)OutsideLaboratory",,86671,CPT,Facility,Both,,,90,104,88.4,29.8064,104,"Health Partners, Inc.",Commercial,98.384,94.6,,percent of total billed charges,,
"Saccharomyces Cerevisiae Ab, Igg, S (Mayo)OutsideLaboratory",,86671,CPT,Facility,Outpatient,,,90,104,88.4,29.8064,104,"Health Partners, Inc.",Medicare Advantage,50.96,49,,percent of total billed charges,,
"Saccharomyces Cerevisiae Ab, Igg, S (Mayo)OutsideLaboratory",,86671,CPT,Facility,Inpatient,,,90,104,88.4,29.8064,104,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Saccharomyces Cerevisiae Ab, Igg, S (Mayo)OutsideLaboratory",,86671,CPT,Facility,Both,,,90,104,88.4,29.8064,104,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),62.4,60,,percent of total billed charges,,
"Saccharomyces Cerevisiae Ab, Igg, S (Mayo)OutsideLaboratory",,86671,CPT,Facility,Both,,,90,104,88.4,29.8064,104,"Health Partners, Inc.",State of Minnesota Advantage Program,84.76,81.5,,percent of total billed charges,,
"Saccharomyces Cerevisiae Ab, Igg, S (Mayo)OutsideLaboratory",,86671,CPT,Facility,Both,,,90,104,88.4,29.8064,104,"Health Partners, Inc.",State Public Programs,52,50,,percent of total billed charges,,
"Saccharomyces Cerevisiae Ab, Igg, S (Mayo)OutsideLaboratory",,86671,CPT,Facility,Both,,,90,104,88.4,29.8064,104,Humana Insurance Company,Commercial PPO,98.8,95,,percent of total billed charges,,
"Saccharomyces Cerevisiae Ab, Igg, S (Mayo)OutsideLaboratory",,86671,CPT,Facility,Outpatient,,,90,104,88.4,29.8064,104,Humana Insurance Company,Medicare PPO,50.96,49,,percent of total billed charges,,
"Saccharomyces Cerevisiae Ab, Igg, S (Mayo)OutsideLaboratory",,86671,CPT,Facility,Inpatient,,,90,104,88.4,29.8064,104,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Saccharomyces Cerevisiae Ab, Igg, S (Mayo)OutsideLaboratory",,86671,CPT,Facility,Both,,,90,104,88.4,29.8064,104,Medica,Individual & Family,103.064,99.1,,percent of total billed charges,,
"Saccharomyces Cerevisiae Ab, Igg, S (Mayo)OutsideLaboratory",,86671,CPT,Facility,Outpatient,,,90,104,88.4,29.8064,104,Medica,Medica Advantage Solution,51.792,49.8,,percent of total billed charges,,
"Saccharomyces Cerevisiae Ab, Igg, S (Mayo)OutsideLaboratory",,86671,CPT,Facility,Inpatient,,,90,104,88.4,29.8064,104,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Saccharomyces Cerevisiae Ab, Igg, S (Mayo)OutsideLaboratory",,86671,CPT,Facility,Outpatient,,,90,104,88.4,29.8064,104,Medica,Medical Assistance,46.384,44.6,,percent of total billed charges,,
"Saccharomyces Cerevisiae Ab, Igg, S (Mayo)OutsideLaboratory",,86671,CPT,Facility,Inpatient,,,90,104,88.4,29.8064,104,Medica,Medical Assistance,,,,,Included in per diem rate,
"Saccharomyces Cerevisiae Ab, Igg, S (Mayo)OutsideLaboratory",,86671,CPT,Facility,Outpatient,,,90,104,88.4,29.8064,104,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,51.792,49.8,,percent of total billed charges,,
"Saccharomyces Cerevisiae Ab, Igg, S (Mayo)OutsideLaboratory",,86671,CPT,Facility,Inpatient,,,90,104,88.4,29.8064,104,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Saccharomyces Cerevisiae Ab, Igg, S (Mayo)OutsideLaboratory",,86671,CPT,Facility,Both,,,90,104,88.4,29.8064,104,"Multiplan, Inc.","Multiplan, Inc.",97.76,94,,percent of total billed charges,,
"Saccharomyces Cerevisiae Ab, Igg, S (Mayo)OutsideLaboratory",,86671,CPT,Facility,Outpatient,,,90,104,88.4,29.8064,104,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,89.856,86.4,,percent of total billed charges,,
"Saccharomyces Cerevisiae Ab, Igg, S (Mayo)OutsideLaboratory",,86671,CPT,Facility,Inpatient,,,90,104,88.4,29.8064,104,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Saccharomyces Cerevisiae Ab, Igg, S (Mayo)OutsideLaboratory",,86671,CPT,Facility,Both,,,90,104,88.4,29.8064,104,"Preferred One Administrative Services, INC.",PPO,102.544,98.6,,percent of total billed charges,,
"Saccharomyces Cerevisiae Ab, Igg, S (Mayo)OutsideLaboratory",,86671,CPT,Facility,Outpatient,,,90,104,88.4,29.8064,104,PrimeWest Health,Minnesota Senior Health Options (MSHO),53.508,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Saccharomyces Cerevisiae Ab, Igg, S (Mayo)OutsideLaboratory",,86671,CPT,Facility,Inpatient,,,90,104,88.4,29.8064,104,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Saccharomyces Cerevisiae Ab, Igg, S (Mayo)OutsideLaboratory",,86671,CPT,Facility,Outpatient,,,90,104,88.4,29.8064,104,PrimeWest Health,MinnesotaCare,53.4144,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Saccharomyces Cerevisiae Ab, Igg, S (Mayo)OutsideLaboratory",,86671,CPT,Facility,Inpatient,,,90,104,88.4,29.8064,104,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Saccharomyces Cerevisiae Ab, Igg, S (Mayo)OutsideLaboratory",,86671,CPT,Facility,Both,,,90,104,88.4,29.8064,104,Sanford Health Plan,Sanford Health Plan,95.68,92,,percent of total billed charges,,
"Saccharomyces Cerevisiae Ab, Igg, S (Mayo)OutsideLaboratory",,86671,CPT,Facility,Outpatient,,,90,104,88.4,29.8064,104,"UCare Health, Inc.",Individual & Family Plan,58.604,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Saccharomyces Cerevisiae Ab, Igg, S (Mayo)OutsideLaboratory",,86671,CPT,Facility,Inpatient,,,90,104,88.4,29.8064,104,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Saccharomyces Cerevisiae Ab, Igg, S (Mayo)OutsideLaboratory",,86671,CPT,Facility,Outpatient,,,90,104,88.4,29.8064,104,"UCare Health, Inc.",Medical Assistance,52.4888,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Saccharomyces Cerevisiae Ab, Igg, S (Mayo)OutsideLaboratory",,86671,CPT,Facility,Inpatient,,,90,104,88.4,29.8064,104,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Saccharomyces Cerevisiae Ab, Igg, S (Mayo)OutsideLaboratory",,86671,CPT,Facility,Outpatient,,,90,104,88.4,29.8064,104,"UCare Health, Inc.",Medicare Advantage,52.4888,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Saccharomyces Cerevisiae Ab, Igg, S (Mayo)OutsideLaboratory",,86671,CPT,Facility,Inpatient,,,90,104,88.4,29.8064,104,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Saccharomyces Cerevisiae Ab, Igg, S (Mayo)OutsideLaboratory",,86671,CPT,Facility,Outpatient,,,90,104,88.4,29.8064,104,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),52.4888,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Saccharomyces Cerevisiae Ab, Igg, S (Mayo)OutsideLaboratory",,86671,CPT,Facility,Inpatient,,,90,104,88.4,29.8064,104,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Saccharomyces Cerevisiae Ab, Igg, S (Mayo)OutsideLaboratory",,86671,CPT,Facility,Both,,,90,104,88.4,29.8064,104,UnitedHealthcare,Individual & Family,97.76,94,,percent of total billed charges,,
"Saccharomyces Cerevisiae Ab, Igg, S (Mayo)OutsideLaboratory",,86671,CPT,Facility,Outpatient,,,90,104,88.4,29.8064,104,UnitedHealthcare,Medicare Advantage,50.96,49,,percent of total billed charges,,
"Saccharomyces Cerevisiae Ab, Igg, S (Mayo)OutsideLaboratory",,86671,CPT,Facility,Inpatient,,,90,104,88.4,29.8064,104,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Saccharomyces Cerevisiae Ab, Igg, S (Mayo)OutsideLaboratory",,86671,CPT,Facility,Outpatient,,,90,104,88.4,29.8064,104,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,49.92,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Saccharomyces Cerevisiae Ab, Igg, S (Mayo)OutsideLaboratory",,86671,CPT,Facility,Inpatient,,,90,104,88.4,29.8064,104,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Saccharomyces Cerevisiae Iga (Mayo)OutsideLaboratory,,86671,CPT,Facility,Both,,,90,104,88.4,29.8064,104,Aetna,Commercial,95.68,92,,percent of total billed charges,,
Saccharomyces Cerevisiae Iga (Mayo)OutsideLaboratory,,86671,CPT,Facility,Outpatient,,,90,104,88.4,29.8064,104,Aetna,Medicare Advantage,50.96,49,,percent of total billed charges,,
Saccharomyces Cerevisiae Iga (Mayo)OutsideLaboratory,,86671,CPT,Facility,Inpatient,,,90,104,88.4,29.8064,104,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Saccharomyces Cerevisiae Iga (Mayo)OutsideLaboratory,,86671,CPT,Facility,Both,,,90,104,88.4,29.8064,104,Aetna,PPO,96.72,93,,percent of total billed charges,,
Saccharomyces Cerevisiae Iga (Mayo)OutsideLaboratory,,86671,CPT,Facility,Both,,,90,104,88.4,29.8064,104,America's PPO,America's PPO,99.8712,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Saccharomyces Cerevisiae Iga (Mayo)OutsideLaboratory,,86671,CPT,Facility,Both,,,90,104,88.4,29.8064,104,BlueCross BlueShield Minnesota, Federal Employee Program,102.336,98.4,,percent of total billed charges,,
Saccharomyces Cerevisiae Iga (Mayo)OutsideLaboratory,,86671,CPT,Facility,Both,,,90,104,88.4,29.8064,104,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,104,100,,percent of total billed charges,,
Saccharomyces Cerevisiae Iga (Mayo)OutsideLaboratory,,86671,CPT,Facility,Both,,,90,104,88.4,29.8064,104,BlueCross BlueShield Minnesota,High Value Network Plan,93.6,90,,percent of total billed charges,,
Saccharomyces Cerevisiae Iga (Mayo)OutsideLaboratory,,86671,CPT,Facility,Outpatient,,,90,104,88.4,29.8064,104,BlueCross BlueShield Minnesota,Medicare Advantage,50.96,49,,percent of total billed charges,,
Saccharomyces Cerevisiae Iga (Mayo)OutsideLaboratory,,86671,CPT,Facility,Inpatient,,,90,104,88.4,29.8064,104,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Saccharomyces Cerevisiae Iga (Mayo)OutsideLaboratory,,86671,CPT,Facility,Both,,,90,104,88.4,29.8064,104,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,92.1128,88.57,,percent of total billed charges,,
Saccharomyces Cerevisiae Iga (Mayo)OutsideLaboratory,,86671,CPT,Facility,Both,,,90,104,88.4,29.8064,104,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,29.8064,28.66,,percent of total billed charges,,
Saccharomyces Cerevisiae Iga (Mayo)OutsideLaboratory,,86671,CPT,Facility,Outpatient,,,90,104,88.4,29.8064,104,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),50.96,49,,percent of total billed charges,,
Saccharomyces Cerevisiae Iga (Mayo)OutsideLaboratory,,86671,CPT,Facility,Inpatient,,,90,104,88.4,29.8064,104,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Saccharomyces Cerevisiae Iga (Mayo)OutsideLaboratory,,86671,CPT,Facility,Both,,,90,104,88.4,29.8064,104,CorVel,Worker's Compensation,104,100,,percent of total billed charges,,
Saccharomyces Cerevisiae Iga (Mayo)OutsideLaboratory,,86671,CPT,Facility,Both,,,90,104,88.4,29.8064,104,First Health Group Corporation,First Health Network,100.88,97,,percent of total billed charges,,
Saccharomyces Cerevisiae Iga (Mayo)OutsideLaboratory,,86671,CPT,Facility,Both,,,90,104,88.4,29.8064,104,"Health Partners, Inc.",Commercial,98.384,94.6,,percent of total billed charges,,
Saccharomyces Cerevisiae Iga (Mayo)OutsideLaboratory,,86671,CPT,Facility,Outpatient,,,90,104,88.4,29.8064,104,"Health Partners, Inc.",Medicare Advantage,50.96,49,,percent of total billed charges,,
Saccharomyces Cerevisiae Iga (Mayo)OutsideLaboratory,,86671,CPT,Facility,Inpatient,,,90,104,88.4,29.8064,104,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Saccharomyces Cerevisiae Iga (Mayo)OutsideLaboratory,,86671,CPT,Facility,Both,,,90,104,88.4,29.8064,104,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),62.4,60,,percent of total billed charges,,
Saccharomyces Cerevisiae Iga (Mayo)OutsideLaboratory,,86671,CPT,Facility,Both,,,90,104,88.4,29.8064,104,"Health Partners, Inc.",State of Minnesota Advantage Program,84.76,81.5,,percent of total billed charges,,
Saccharomyces Cerevisiae Iga (Mayo)OutsideLaboratory,,86671,CPT,Facility,Both,,,90,104,88.4,29.8064,104,"Health Partners, Inc.",State Public Programs,52,50,,percent of total billed charges,,
Saccharomyces Cerevisiae Iga (Mayo)OutsideLaboratory,,86671,CPT,Facility,Both,,,90,104,88.4,29.8064,104,Humana Insurance Company,Commercial PPO,98.8,95,,percent of total billed charges,,
Saccharomyces Cerevisiae Iga (Mayo)OutsideLaboratory,,86671,CPT,Facility,Outpatient,,,90,104,88.4,29.8064,104,Humana Insurance Company,Medicare PPO,50.96,49,,percent of total billed charges,,
Saccharomyces Cerevisiae Iga (Mayo)OutsideLaboratory,,86671,CPT,Facility,Inpatient,,,90,104,88.4,29.8064,104,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Saccharomyces Cerevisiae Iga (Mayo)OutsideLaboratory,,86671,CPT,Facility,Both,,,90,104,88.4,29.8064,104,Medica,Individual & Family,103.064,99.1,,percent of total billed charges,,
Saccharomyces Cerevisiae Iga (Mayo)OutsideLaboratory,,86671,CPT,Facility,Outpatient,,,90,104,88.4,29.8064,104,Medica,Medica Advantage Solution,51.792,49.8,,percent of total billed charges,,
Saccharomyces Cerevisiae Iga (Mayo)OutsideLaboratory,,86671,CPT,Facility,Inpatient,,,90,104,88.4,29.8064,104,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Saccharomyces Cerevisiae Iga (Mayo)OutsideLaboratory,,86671,CPT,Facility,Outpatient,,,90,104,88.4,29.8064,104,Medica,Medical Assistance,46.384,44.6,,percent of total billed charges,,
Saccharomyces Cerevisiae Iga (Mayo)OutsideLaboratory,,86671,CPT,Facility,Inpatient,,,90,104,88.4,29.8064,104,Medica,Medical Assistance,,,,,Included in per diem rate,
Saccharomyces Cerevisiae Iga (Mayo)OutsideLaboratory,,86671,CPT,Facility,Outpatient,,,90,104,88.4,29.8064,104,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,51.792,49.8,,percent of total billed charges,,
Saccharomyces Cerevisiae Iga (Mayo)OutsideLaboratory,,86671,CPT,Facility,Inpatient,,,90,104,88.4,29.8064,104,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Saccharomyces Cerevisiae Iga (Mayo)OutsideLaboratory,,86671,CPT,Facility,Both,,,90,104,88.4,29.8064,104,"Multiplan, Inc.","Multiplan, Inc.",97.76,94,,percent of total billed charges,,
Saccharomyces Cerevisiae Iga (Mayo)OutsideLaboratory,,86671,CPT,Facility,Outpatient,,,90,104,88.4,29.8064,104,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,89.856,86.4,,percent of total billed charges,,
Saccharomyces Cerevisiae Iga (Mayo)OutsideLaboratory,,86671,CPT,Facility,Inpatient,,,90,104,88.4,29.8064,104,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Saccharomyces Cerevisiae Iga (Mayo)OutsideLaboratory,,86671,CPT,Facility,Both,,,90,104,88.4,29.8064,104,"Preferred One Administrative Services, INC.",PPO,102.544,98.6,,percent of total billed charges,,
Saccharomyces Cerevisiae Iga (Mayo)OutsideLaboratory,,86671,CPT,Facility,Outpatient,,,90,104,88.4,29.8064,104,PrimeWest Health,Minnesota Senior Health Options (MSHO),53.508,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Saccharomyces Cerevisiae Iga (Mayo)OutsideLaboratory,,86671,CPT,Facility,Inpatient,,,90,104,88.4,29.8064,104,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Saccharomyces Cerevisiae Iga (Mayo)OutsideLaboratory,,86671,CPT,Facility,Outpatient,,,90,104,88.4,29.8064,104,PrimeWest Health,MinnesotaCare,53.4144,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Saccharomyces Cerevisiae Iga (Mayo)OutsideLaboratory,,86671,CPT,Facility,Inpatient,,,90,104,88.4,29.8064,104,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Saccharomyces Cerevisiae Iga (Mayo)OutsideLaboratory,,86671,CPT,Facility,Both,,,90,104,88.4,29.8064,104,Sanford Health Plan,Sanford Health Plan,95.68,92,,percent of total billed charges,,
Saccharomyces Cerevisiae Iga (Mayo)OutsideLaboratory,,86671,CPT,Facility,Outpatient,,,90,104,88.4,29.8064,104,"UCare Health, Inc.",Individual & Family Plan,58.604,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Saccharomyces Cerevisiae Iga (Mayo)OutsideLaboratory,,86671,CPT,Facility,Inpatient,,,90,104,88.4,29.8064,104,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Saccharomyces Cerevisiae Iga (Mayo)OutsideLaboratory,,86671,CPT,Facility,Outpatient,,,90,104,88.4,29.8064,104,"UCare Health, Inc.",Medical Assistance,52.4888,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Saccharomyces Cerevisiae Iga (Mayo)OutsideLaboratory,,86671,CPT,Facility,Inpatient,,,90,104,88.4,29.8064,104,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Saccharomyces Cerevisiae Iga (Mayo)OutsideLaboratory,,86671,CPT,Facility,Outpatient,,,90,104,88.4,29.8064,104,"UCare Health, Inc.",Medicare Advantage,52.4888,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Saccharomyces Cerevisiae Iga (Mayo)OutsideLaboratory,,86671,CPT,Facility,Inpatient,,,90,104,88.4,29.8064,104,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Saccharomyces Cerevisiae Iga (Mayo)OutsideLaboratory,,86671,CPT,Facility,Outpatient,,,90,104,88.4,29.8064,104,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),52.4888,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Saccharomyces Cerevisiae Iga (Mayo)OutsideLaboratory,,86671,CPT,Facility,Inpatient,,,90,104,88.4,29.8064,104,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Saccharomyces Cerevisiae Iga (Mayo)OutsideLaboratory,,86671,CPT,Facility,Both,,,90,104,88.4,29.8064,104,UnitedHealthcare,Individual & Family,97.76,94,,percent of total billed charges,,
Saccharomyces Cerevisiae Iga (Mayo)OutsideLaboratory,,86671,CPT,Facility,Outpatient,,,90,104,88.4,29.8064,104,UnitedHealthcare,Medicare Advantage,50.96,49,,percent of total billed charges,,
Saccharomyces Cerevisiae Iga (Mayo)OutsideLaboratory,,86671,CPT,Facility,Inpatient,,,90,104,88.4,29.8064,104,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Saccharomyces Cerevisiae Iga (Mayo)OutsideLaboratory,,86671,CPT,Facility,Outpatient,,,90,104,88.4,29.8064,104,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,49.92,48,,percent of total billed charges,,100% of DHS outpatient percentage
Saccharomyces Cerevisiae Iga (Mayo)OutsideLaboratory,,86671,CPT,Facility,Inpatient,,,90,104,88.4,29.8064,104,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Saccharomyces Cerevisiae Igg (Mayo)OutsideLaboratory,,86671,CPT,Facility,Both,,,90,104,88.4,29.8064,104,Aetna,Commercial,95.68,92,,percent of total billed charges,,
Saccharomyces Cerevisiae Igg (Mayo)OutsideLaboratory,,86671,CPT,Facility,Outpatient,,,90,104,88.4,29.8064,104,Aetna,Medicare Advantage,50.96,49,,percent of total billed charges,,
Saccharomyces Cerevisiae Igg (Mayo)OutsideLaboratory,,86671,CPT,Facility,Inpatient,,,90,104,88.4,29.8064,104,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Saccharomyces Cerevisiae Igg (Mayo)OutsideLaboratory,,86671,CPT,Facility,Both,,,90,104,88.4,29.8064,104,Aetna,PPO,96.72,93,,percent of total billed charges,,
Saccharomyces Cerevisiae Igg (Mayo)OutsideLaboratory,,86671,CPT,Facility,Both,,,90,104,88.4,29.8064,104,America's PPO,America's PPO,99.8712,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Saccharomyces Cerevisiae Igg (Mayo)OutsideLaboratory,,86671,CPT,Facility,Both,,,90,104,88.4,29.8064,104,BlueCross BlueShield Minnesota, Federal Employee Program,102.336,98.4,,percent of total billed charges,,
Saccharomyces Cerevisiae Igg (Mayo)OutsideLaboratory,,86671,CPT,Facility,Both,,,90,104,88.4,29.8064,104,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,104,100,,percent of total billed charges,,
Saccharomyces Cerevisiae Igg (Mayo)OutsideLaboratory,,86671,CPT,Facility,Both,,,90,104,88.4,29.8064,104,BlueCross BlueShield Minnesota,High Value Network Plan,93.6,90,,percent of total billed charges,,
Saccharomyces Cerevisiae Igg (Mayo)OutsideLaboratory,,86671,CPT,Facility,Outpatient,,,90,104,88.4,29.8064,104,BlueCross BlueShield Minnesota,Medicare Advantage,50.96,49,,percent of total billed charges,,
Saccharomyces Cerevisiae Igg (Mayo)OutsideLaboratory,,86671,CPT,Facility,Inpatient,,,90,104,88.4,29.8064,104,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Saccharomyces Cerevisiae Igg (Mayo)OutsideLaboratory,,86671,CPT,Facility,Both,,,90,104,88.4,29.8064,104,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,92.1128,88.57,,percent of total billed charges,,
Saccharomyces Cerevisiae Igg (Mayo)OutsideLaboratory,,86671,CPT,Facility,Both,,,90,104,88.4,29.8064,104,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,29.8064,28.66,,percent of total billed charges,,
Saccharomyces Cerevisiae Igg (Mayo)OutsideLaboratory,,86671,CPT,Facility,Outpatient,,,90,104,88.4,29.8064,104,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),50.96,49,,percent of total billed charges,,
Saccharomyces Cerevisiae Igg (Mayo)OutsideLaboratory,,86671,CPT,Facility,Inpatient,,,90,104,88.4,29.8064,104,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Saccharomyces Cerevisiae Igg (Mayo)OutsideLaboratory,,86671,CPT,Facility,Both,,,90,104,88.4,29.8064,104,CorVel,Worker's Compensation,104,100,,percent of total billed charges,,
Saccharomyces Cerevisiae Igg (Mayo)OutsideLaboratory,,86671,CPT,Facility,Both,,,90,104,88.4,29.8064,104,First Health Group Corporation,First Health Network,100.88,97,,percent of total billed charges,,
Saccharomyces Cerevisiae Igg (Mayo)OutsideLaboratory,,86671,CPT,Facility,Both,,,90,104,88.4,29.8064,104,"Health Partners, Inc.",Commercial,98.384,94.6,,percent of total billed charges,,
Saccharomyces Cerevisiae Igg (Mayo)OutsideLaboratory,,86671,CPT,Facility,Outpatient,,,90,104,88.4,29.8064,104,"Health Partners, Inc.",Medicare Advantage,50.96,49,,percent of total billed charges,,
Saccharomyces Cerevisiae Igg (Mayo)OutsideLaboratory,,86671,CPT,Facility,Inpatient,,,90,104,88.4,29.8064,104,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Saccharomyces Cerevisiae Igg (Mayo)OutsideLaboratory,,86671,CPT,Facility,Both,,,90,104,88.4,29.8064,104,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),62.4,60,,percent of total billed charges,,
Saccharomyces Cerevisiae Igg (Mayo)OutsideLaboratory,,86671,CPT,Facility,Both,,,90,104,88.4,29.8064,104,"Health Partners, Inc.",State of Minnesota Advantage Program,84.76,81.5,,percent of total billed charges,,
Saccharomyces Cerevisiae Igg (Mayo)OutsideLaboratory,,86671,CPT,Facility,Both,,,90,104,88.4,29.8064,104,"Health Partners, Inc.",State Public Programs,52,50,,percent of total billed charges,,
Saccharomyces Cerevisiae Igg (Mayo)OutsideLaboratory,,86671,CPT,Facility,Both,,,90,104,88.4,29.8064,104,Humana Insurance Company,Commercial PPO,98.8,95,,percent of total billed charges,,
Saccharomyces Cerevisiae Igg (Mayo)OutsideLaboratory,,86671,CPT,Facility,Outpatient,,,90,104,88.4,29.8064,104,Humana Insurance Company,Medicare PPO,50.96,49,,percent of total billed charges,,
Saccharomyces Cerevisiae Igg (Mayo)OutsideLaboratory,,86671,CPT,Facility,Inpatient,,,90,104,88.4,29.8064,104,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Saccharomyces Cerevisiae Igg (Mayo)OutsideLaboratory,,86671,CPT,Facility,Both,,,90,104,88.4,29.8064,104,Medica,Individual & Family,103.064,99.1,,percent of total billed charges,,
Saccharomyces Cerevisiae Igg (Mayo)OutsideLaboratory,,86671,CPT,Facility,Outpatient,,,90,104,88.4,29.8064,104,Medica,Medica Advantage Solution,51.792,49.8,,percent of total billed charges,,
Saccharomyces Cerevisiae Igg (Mayo)OutsideLaboratory,,86671,CPT,Facility,Inpatient,,,90,104,88.4,29.8064,104,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Saccharomyces Cerevisiae Igg (Mayo)OutsideLaboratory,,86671,CPT,Facility,Outpatient,,,90,104,88.4,29.8064,104,Medica,Medical Assistance,46.384,44.6,,percent of total billed charges,,
Saccharomyces Cerevisiae Igg (Mayo)OutsideLaboratory,,86671,CPT,Facility,Inpatient,,,90,104,88.4,29.8064,104,Medica,Medical Assistance,,,,,Included in per diem rate,
Saccharomyces Cerevisiae Igg (Mayo)OutsideLaboratory,,86671,CPT,Facility,Outpatient,,,90,104,88.4,29.8064,104,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,51.792,49.8,,percent of total billed charges,,
Saccharomyces Cerevisiae Igg (Mayo)OutsideLaboratory,,86671,CPT,Facility,Inpatient,,,90,104,88.4,29.8064,104,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Saccharomyces Cerevisiae Igg (Mayo)OutsideLaboratory,,86671,CPT,Facility,Both,,,90,104,88.4,29.8064,104,"Multiplan, Inc.","Multiplan, Inc.",97.76,94,,percent of total billed charges,,
Saccharomyces Cerevisiae Igg (Mayo)OutsideLaboratory,,86671,CPT,Facility,Outpatient,,,90,104,88.4,29.8064,104,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,89.856,86.4,,percent of total billed charges,,
Saccharomyces Cerevisiae Igg (Mayo)OutsideLaboratory,,86671,CPT,Facility,Inpatient,,,90,104,88.4,29.8064,104,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Saccharomyces Cerevisiae Igg (Mayo)OutsideLaboratory,,86671,CPT,Facility,Both,,,90,104,88.4,29.8064,104,"Preferred One Administrative Services, INC.",PPO,102.544,98.6,,percent of total billed charges,,
Saccharomyces Cerevisiae Igg (Mayo)OutsideLaboratory,,86671,CPT,Facility,Outpatient,,,90,104,88.4,29.8064,104,PrimeWest Health,Minnesota Senior Health Options (MSHO),53.508,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Saccharomyces Cerevisiae Igg (Mayo)OutsideLaboratory,,86671,CPT,Facility,Inpatient,,,90,104,88.4,29.8064,104,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Saccharomyces Cerevisiae Igg (Mayo)OutsideLaboratory,,86671,CPT,Facility,Outpatient,,,90,104,88.4,29.8064,104,PrimeWest Health,MinnesotaCare,53.4144,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Saccharomyces Cerevisiae Igg (Mayo)OutsideLaboratory,,86671,CPT,Facility,Inpatient,,,90,104,88.4,29.8064,104,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Saccharomyces Cerevisiae Igg (Mayo)OutsideLaboratory,,86671,CPT,Facility,Both,,,90,104,88.4,29.8064,104,Sanford Health Plan,Sanford Health Plan,95.68,92,,percent of total billed charges,,
Saccharomyces Cerevisiae Igg (Mayo)OutsideLaboratory,,86671,CPT,Facility,Outpatient,,,90,104,88.4,29.8064,104,"UCare Health, Inc.",Individual & Family Plan,58.604,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Saccharomyces Cerevisiae Igg (Mayo)OutsideLaboratory,,86671,CPT,Facility,Inpatient,,,90,104,88.4,29.8064,104,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Saccharomyces Cerevisiae Igg (Mayo)OutsideLaboratory,,86671,CPT,Facility,Outpatient,,,90,104,88.4,29.8064,104,"UCare Health, Inc.",Medical Assistance,52.4888,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Saccharomyces Cerevisiae Igg (Mayo)OutsideLaboratory,,86671,CPT,Facility,Inpatient,,,90,104,88.4,29.8064,104,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Saccharomyces Cerevisiae Igg (Mayo)OutsideLaboratory,,86671,CPT,Facility,Outpatient,,,90,104,88.4,29.8064,104,"UCare Health, Inc.",Medicare Advantage,52.4888,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Saccharomyces Cerevisiae Igg (Mayo)OutsideLaboratory,,86671,CPT,Facility,Inpatient,,,90,104,88.4,29.8064,104,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Saccharomyces Cerevisiae Igg (Mayo)OutsideLaboratory,,86671,CPT,Facility,Outpatient,,,90,104,88.4,29.8064,104,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),52.4888,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Saccharomyces Cerevisiae Igg (Mayo)OutsideLaboratory,,86671,CPT,Facility,Inpatient,,,90,104,88.4,29.8064,104,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Saccharomyces Cerevisiae Igg (Mayo)OutsideLaboratory,,86671,CPT,Facility,Both,,,90,104,88.4,29.8064,104,UnitedHealthcare,Individual & Family,97.76,94,,percent of total billed charges,,
Saccharomyces Cerevisiae Igg (Mayo)OutsideLaboratory,,86671,CPT,Facility,Outpatient,,,90,104,88.4,29.8064,104,UnitedHealthcare,Medicare Advantage,50.96,49,,percent of total billed charges,,
Saccharomyces Cerevisiae Igg (Mayo)OutsideLaboratory,,86671,CPT,Facility,Inpatient,,,90,104,88.4,29.8064,104,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Saccharomyces Cerevisiae Igg (Mayo)OutsideLaboratory,,86671,CPT,Facility,Outpatient,,,90,104,88.4,29.8064,104,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,49.92,48,,percent of total billed charges,,100% of DHS outpatient percentage
Saccharomyces Cerevisiae Igg (Mayo)OutsideLaboratory,,86671,CPT,Facility,Inpatient,,,90,104,88.4,29.8064,104,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Strongyloides Ab, Igg, S (Mayo)OutsideLaboratory",,86682,CPT,Facility,Both,,,90,167,141.95,47.8622,167,Aetna,Commercial,153.64,92,,percent of total billed charges,,
"Strongyloides Ab, Igg, S (Mayo)OutsideLaboratory",,86682,CPT,Facility,Outpatient,,,90,167,141.95,47.8622,167,Aetna,Medicare Advantage,81.83,49,,percent of total billed charges,,
"Strongyloides Ab, Igg, S (Mayo)OutsideLaboratory",,86682,CPT,Facility,Inpatient,,,90,167,141.95,47.8622,167,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Strongyloides Ab, Igg, S (Mayo)OutsideLaboratory",,86682,CPT,Facility,Both,,,90,167,141.95,47.8622,167,Aetna,PPO,155.31,93,,percent of total billed charges,,
"Strongyloides Ab, Igg, S (Mayo)OutsideLaboratory",,86682,CPT,Facility,Both,,,90,167,141.95,47.8622,167,America's PPO,America's PPO,160.3701,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Strongyloides Ab, Igg, S (Mayo)OutsideLaboratory",,86682,CPT,Facility,Both,,,90,167,141.95,47.8622,167,BlueCross BlueShield Minnesota, Federal Employee Program,164.328,98.4,,percent of total billed charges,,
"Strongyloides Ab, Igg, S (Mayo)OutsideLaboratory",,86682,CPT,Facility,Both,,,90,167,141.95,47.8622,167,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,167,100,,percent of total billed charges,,
"Strongyloides Ab, Igg, S (Mayo)OutsideLaboratory",,86682,CPT,Facility,Both,,,90,167,141.95,47.8622,167,BlueCross BlueShield Minnesota,High Value Network Plan,150.3,90,,percent of total billed charges,,
"Strongyloides Ab, Igg, S (Mayo)OutsideLaboratory",,86682,CPT,Facility,Outpatient,,,90,167,141.95,47.8622,167,BlueCross BlueShield Minnesota,Medicare Advantage,81.83,49,,percent of total billed charges,,
"Strongyloides Ab, Igg, S (Mayo)OutsideLaboratory",,86682,CPT,Facility,Inpatient,,,90,167,141.95,47.8622,167,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Strongyloides Ab, Igg, S (Mayo)OutsideLaboratory",,86682,CPT,Facility,Both,,,90,167,141.95,47.8622,167,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,147.9119,88.57,,percent of total billed charges,,
"Strongyloides Ab, Igg, S (Mayo)OutsideLaboratory",,86682,CPT,Facility,Both,,,90,167,141.95,47.8622,167,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,47.8622,28.66,,percent of total billed charges,,
"Strongyloides Ab, Igg, S (Mayo)OutsideLaboratory",,86682,CPT,Facility,Outpatient,,,90,167,141.95,47.8622,167,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),81.83,49,,percent of total billed charges,,
"Strongyloides Ab, Igg, S (Mayo)OutsideLaboratory",,86682,CPT,Facility,Inpatient,,,90,167,141.95,47.8622,167,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Strongyloides Ab, Igg, S (Mayo)OutsideLaboratory",,86682,CPT,Facility,Both,,,90,167,141.95,47.8622,167,CorVel,Worker's Compensation,167,100,,percent of total billed charges,,
"Strongyloides Ab, Igg, S (Mayo)OutsideLaboratory",,86682,CPT,Facility,Both,,,90,167,141.95,47.8622,167,First Health Group Corporation,First Health Network,161.99,97,,percent of total billed charges,,
"Strongyloides Ab, Igg, S (Mayo)OutsideLaboratory",,86682,CPT,Facility,Both,,,90,167,141.95,47.8622,167,"Health Partners, Inc.",Commercial,157.982,94.6,,percent of total billed charges,,
"Strongyloides Ab, Igg, S (Mayo)OutsideLaboratory",,86682,CPT,Facility,Outpatient,,,90,167,141.95,47.8622,167,"Health Partners, Inc.",Medicare Advantage,81.83,49,,percent of total billed charges,,
"Strongyloides Ab, Igg, S (Mayo)OutsideLaboratory",,86682,CPT,Facility,Inpatient,,,90,167,141.95,47.8622,167,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Strongyloides Ab, Igg, S (Mayo)OutsideLaboratory",,86682,CPT,Facility,Both,,,90,167,141.95,47.8622,167,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),100.2,60,,percent of total billed charges,,
"Strongyloides Ab, Igg, S (Mayo)OutsideLaboratory",,86682,CPT,Facility,Both,,,90,167,141.95,47.8622,167,"Health Partners, Inc.",State of Minnesota Advantage Program,136.105,81.5,,percent of total billed charges,,
"Strongyloides Ab, Igg, S (Mayo)OutsideLaboratory",,86682,CPT,Facility,Both,,,90,167,141.95,47.8622,167,"Health Partners, Inc.",State Public Programs,83.5,50,,percent of total billed charges,,
"Strongyloides Ab, Igg, S (Mayo)OutsideLaboratory",,86682,CPT,Facility,Both,,,90,167,141.95,47.8622,167,Humana Insurance Company,Commercial PPO,158.65,95,,percent of total billed charges,,
"Strongyloides Ab, Igg, S (Mayo)OutsideLaboratory",,86682,CPT,Facility,Outpatient,,,90,167,141.95,47.8622,167,Humana Insurance Company,Medicare PPO,81.83,49,,percent of total billed charges,,
"Strongyloides Ab, Igg, S (Mayo)OutsideLaboratory",,86682,CPT,Facility,Inpatient,,,90,167,141.95,47.8622,167,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Strongyloides Ab, Igg, S (Mayo)OutsideLaboratory",,86682,CPT,Facility,Both,,,90,167,141.95,47.8622,167,Medica,Individual & Family,165.497,99.1,,percent of total billed charges,,
"Strongyloides Ab, Igg, S (Mayo)OutsideLaboratory",,86682,CPT,Facility,Outpatient,,,90,167,141.95,47.8622,167,Medica,Medica Advantage Solution,83.166,49.8,,percent of total billed charges,,
"Strongyloides Ab, Igg, S (Mayo)OutsideLaboratory",,86682,CPT,Facility,Inpatient,,,90,167,141.95,47.8622,167,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Strongyloides Ab, Igg, S (Mayo)OutsideLaboratory",,86682,CPT,Facility,Outpatient,,,90,167,141.95,47.8622,167,Medica,Medical Assistance,74.482,44.6,,percent of total billed charges,,
"Strongyloides Ab, Igg, S (Mayo)OutsideLaboratory",,86682,CPT,Facility,Inpatient,,,90,167,141.95,47.8622,167,Medica,Medical Assistance,,,,,Included in per diem rate,
"Strongyloides Ab, Igg, S (Mayo)OutsideLaboratory",,86682,CPT,Facility,Outpatient,,,90,167,141.95,47.8622,167,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,83.166,49.8,,percent of total billed charges,,
"Strongyloides Ab, Igg, S (Mayo)OutsideLaboratory",,86682,CPT,Facility,Inpatient,,,90,167,141.95,47.8622,167,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Strongyloides Ab, Igg, S (Mayo)OutsideLaboratory",,86682,CPT,Facility,Both,,,90,167,141.95,47.8622,167,"Multiplan, Inc.","Multiplan, Inc.",156.98,94,,percent of total billed charges,,
"Strongyloides Ab, Igg, S (Mayo)OutsideLaboratory",,86682,CPT,Facility,Outpatient,,,90,167,141.95,47.8622,167,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,144.288,86.4,,percent of total billed charges,,
"Strongyloides Ab, Igg, S (Mayo)OutsideLaboratory",,86682,CPT,Facility,Inpatient,,,90,167,141.95,47.8622,167,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Strongyloides Ab, Igg, S (Mayo)OutsideLaboratory",,86682,CPT,Facility,Both,,,90,167,141.95,47.8622,167,"Preferred One Administrative Services, INC.",PPO,164.662,98.6,,percent of total billed charges,,
"Strongyloides Ab, Igg, S (Mayo)OutsideLaboratory",,86682,CPT,Facility,Outpatient,,,90,167,141.95,47.8622,167,PrimeWest Health,Minnesota Senior Health Options (MSHO),85.9215,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Strongyloides Ab, Igg, S (Mayo)OutsideLaboratory",,86682,CPT,Facility,Inpatient,,,90,167,141.95,47.8622,167,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Strongyloides Ab, Igg, S (Mayo)OutsideLaboratory",,86682,CPT,Facility,Outpatient,,,90,167,141.95,47.8622,167,PrimeWest Health,MinnesotaCare,85.7712,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Strongyloides Ab, Igg, S (Mayo)OutsideLaboratory",,86682,CPT,Facility,Inpatient,,,90,167,141.95,47.8622,167,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Strongyloides Ab, Igg, S (Mayo)OutsideLaboratory",,86682,CPT,Facility,Both,,,90,167,141.95,47.8622,167,Sanford Health Plan,Sanford Health Plan,153.64,92,,percent of total billed charges,,
"Strongyloides Ab, Igg, S (Mayo)OutsideLaboratory",,86682,CPT,Facility,Outpatient,,,90,167,141.95,47.8622,167,"UCare Health, Inc.",Individual & Family Plan,94.1045,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Strongyloides Ab, Igg, S (Mayo)OutsideLaboratory",,86682,CPT,Facility,Inpatient,,,90,167,141.95,47.8622,167,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Strongyloides Ab, Igg, S (Mayo)OutsideLaboratory",,86682,CPT,Facility,Outpatient,,,90,167,141.95,47.8622,167,"UCare Health, Inc.",Medical Assistance,84.2849,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Strongyloides Ab, Igg, S (Mayo)OutsideLaboratory",,86682,CPT,Facility,Inpatient,,,90,167,141.95,47.8622,167,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Strongyloides Ab, Igg, S (Mayo)OutsideLaboratory",,86682,CPT,Facility,Outpatient,,,90,167,141.95,47.8622,167,"UCare Health, Inc.",Medicare Advantage,84.2849,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Strongyloides Ab, Igg, S (Mayo)OutsideLaboratory",,86682,CPT,Facility,Inpatient,,,90,167,141.95,47.8622,167,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Strongyloides Ab, Igg, S (Mayo)OutsideLaboratory",,86682,CPT,Facility,Outpatient,,,90,167,141.95,47.8622,167,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),84.2849,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Strongyloides Ab, Igg, S (Mayo)OutsideLaboratory",,86682,CPT,Facility,Inpatient,,,90,167,141.95,47.8622,167,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Strongyloides Ab, Igg, S (Mayo)OutsideLaboratory",,86682,CPT,Facility,Both,,,90,167,141.95,47.8622,167,UnitedHealthcare,Individual & Family,156.98,94,,percent of total billed charges,,
"Strongyloides Ab, Igg, S (Mayo)OutsideLaboratory",,86682,CPT,Facility,Outpatient,,,90,167,141.95,47.8622,167,UnitedHealthcare,Medicare Advantage,81.83,49,,percent of total billed charges,,
"Strongyloides Ab, Igg, S (Mayo)OutsideLaboratory",,86682,CPT,Facility,Inpatient,,,90,167,141.95,47.8622,167,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Strongyloides Ab, Igg, S (Mayo)OutsideLaboratory",,86682,CPT,Facility,Outpatient,,,90,167,141.95,47.8622,167,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,80.16,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Strongyloides Ab, Igg, S (Mayo)OutsideLaboratory",,86682,CPT,Facility,Inpatient,,,90,167,141.95,47.8622,167,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Haemophilus Influenzae B Ab, Igg, S (Mayo)OutsideLaboratory",,86684,CPT,Facility,Both,,,90,230,195.5,65.918,230,Aetna,Commercial,211.6,92,,percent of total billed charges,,
"Haemophilus Influenzae B Ab, Igg, S (Mayo)OutsideLaboratory",,86684,CPT,Facility,Outpatient,,,90,230,195.5,65.918,230,Aetna,Medicare Advantage,112.7,49,,percent of total billed charges,,
"Haemophilus Influenzae B Ab, Igg, S (Mayo)OutsideLaboratory",,86684,CPT,Facility,Inpatient,,,90,230,195.5,65.918,230,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Haemophilus Influenzae B Ab, Igg, S (Mayo)OutsideLaboratory",,86684,CPT,Facility,Both,,,90,230,195.5,65.918,230,Aetna,PPO,213.9,93,,percent of total billed charges,,
"Haemophilus Influenzae B Ab, Igg, S (Mayo)OutsideLaboratory",,86684,CPT,Facility,Both,,,90,230,195.5,65.918,230,America's PPO,America's PPO,220.869,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Haemophilus Influenzae B Ab, Igg, S (Mayo)OutsideLaboratory",,86684,CPT,Facility,Both,,,90,230,195.5,65.918,230,BlueCross BlueShield Minnesota, Federal Employee Program,226.32,98.4,,percent of total billed charges,,
"Haemophilus Influenzae B Ab, Igg, S (Mayo)OutsideLaboratory",,86684,CPT,Facility,Both,,,90,230,195.5,65.918,230,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,230,100,,percent of total billed charges,,
"Haemophilus Influenzae B Ab, Igg, S (Mayo)OutsideLaboratory",,86684,CPT,Facility,Both,,,90,230,195.5,65.918,230,BlueCross BlueShield Minnesota,High Value Network Plan,207,90,,percent of total billed charges,,
"Haemophilus Influenzae B Ab, Igg, S (Mayo)OutsideLaboratory",,86684,CPT,Facility,Outpatient,,,90,230,195.5,65.918,230,BlueCross BlueShield Minnesota,Medicare Advantage,112.7,49,,percent of total billed charges,,
"Haemophilus Influenzae B Ab, Igg, S (Mayo)OutsideLaboratory",,86684,CPT,Facility,Inpatient,,,90,230,195.5,65.918,230,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Haemophilus Influenzae B Ab, Igg, S (Mayo)OutsideLaboratory",,86684,CPT,Facility,Both,,,90,230,195.5,65.918,230,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,203.711,88.57,,percent of total billed charges,,
"Haemophilus Influenzae B Ab, Igg, S (Mayo)OutsideLaboratory",,86684,CPT,Facility,Both,,,90,230,195.5,65.918,230,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,65.918,28.66,,percent of total billed charges,,
"Haemophilus Influenzae B Ab, Igg, S (Mayo)OutsideLaboratory",,86684,CPT,Facility,Outpatient,,,90,230,195.5,65.918,230,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),112.7,49,,percent of total billed charges,,
"Haemophilus Influenzae B Ab, Igg, S (Mayo)OutsideLaboratory",,86684,CPT,Facility,Inpatient,,,90,230,195.5,65.918,230,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Haemophilus Influenzae B Ab, Igg, S (Mayo)OutsideLaboratory",,86684,CPT,Facility,Both,,,90,230,195.5,65.918,230,CorVel,Worker's Compensation,230,100,,percent of total billed charges,,
"Haemophilus Influenzae B Ab, Igg, S (Mayo)OutsideLaboratory",,86684,CPT,Facility,Both,,,90,230,195.5,65.918,230,First Health Group Corporation,First Health Network,223.1,97,,percent of total billed charges,,
"Haemophilus Influenzae B Ab, Igg, S (Mayo)OutsideLaboratory",,86684,CPT,Facility,Both,,,90,230,195.5,65.918,230,"Health Partners, Inc.",Commercial,217.58,94.6,,percent of total billed charges,,
"Haemophilus Influenzae B Ab, Igg, S (Mayo)OutsideLaboratory",,86684,CPT,Facility,Outpatient,,,90,230,195.5,65.918,230,"Health Partners, Inc.",Medicare Advantage,112.7,49,,percent of total billed charges,,
"Haemophilus Influenzae B Ab, Igg, S (Mayo)OutsideLaboratory",,86684,CPT,Facility,Inpatient,,,90,230,195.5,65.918,230,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Haemophilus Influenzae B Ab, Igg, S (Mayo)OutsideLaboratory",,86684,CPT,Facility,Both,,,90,230,195.5,65.918,230,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),138,60,,percent of total billed charges,,
"Haemophilus Influenzae B Ab, Igg, S (Mayo)OutsideLaboratory",,86684,CPT,Facility,Both,,,90,230,195.5,65.918,230,"Health Partners, Inc.",State of Minnesota Advantage Program,187.45,81.5,,percent of total billed charges,,
"Haemophilus Influenzae B Ab, Igg, S (Mayo)OutsideLaboratory",,86684,CPT,Facility,Both,,,90,230,195.5,65.918,230,"Health Partners, Inc.",State Public Programs,115,50,,percent of total billed charges,,
"Haemophilus Influenzae B Ab, Igg, S (Mayo)OutsideLaboratory",,86684,CPT,Facility,Both,,,90,230,195.5,65.918,230,Humana Insurance Company,Commercial PPO,218.5,95,,percent of total billed charges,,
"Haemophilus Influenzae B Ab, Igg, S (Mayo)OutsideLaboratory",,86684,CPT,Facility,Outpatient,,,90,230,195.5,65.918,230,Humana Insurance Company,Medicare PPO,112.7,49,,percent of total billed charges,,
"Haemophilus Influenzae B Ab, Igg, S (Mayo)OutsideLaboratory",,86684,CPT,Facility,Inpatient,,,90,230,195.5,65.918,230,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Haemophilus Influenzae B Ab, Igg, S (Mayo)OutsideLaboratory",,86684,CPT,Facility,Both,,,90,230,195.5,65.918,230,Medica,Individual & Family,227.93,99.1,,percent of total billed charges,,
"Haemophilus Influenzae B Ab, Igg, S (Mayo)OutsideLaboratory",,86684,CPT,Facility,Outpatient,,,90,230,195.5,65.918,230,Medica,Medica Advantage Solution,114.54,49.8,,percent of total billed charges,,
"Haemophilus Influenzae B Ab, Igg, S (Mayo)OutsideLaboratory",,86684,CPT,Facility,Inpatient,,,90,230,195.5,65.918,230,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Haemophilus Influenzae B Ab, Igg, S (Mayo)OutsideLaboratory",,86684,CPT,Facility,Outpatient,,,90,230,195.5,65.918,230,Medica,Medical Assistance,102.58,44.6,,percent of total billed charges,,
"Haemophilus Influenzae B Ab, Igg, S (Mayo)OutsideLaboratory",,86684,CPT,Facility,Inpatient,,,90,230,195.5,65.918,230,Medica,Medical Assistance,,,,,Included in per diem rate,
"Haemophilus Influenzae B Ab, Igg, S (Mayo)OutsideLaboratory",,86684,CPT,Facility,Outpatient,,,90,230,195.5,65.918,230,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,114.54,49.8,,percent of total billed charges,,
"Haemophilus Influenzae B Ab, Igg, S (Mayo)OutsideLaboratory",,86684,CPT,Facility,Inpatient,,,90,230,195.5,65.918,230,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Haemophilus Influenzae B Ab, Igg, S (Mayo)OutsideLaboratory",,86684,CPT,Facility,Both,,,90,230,195.5,65.918,230,"Multiplan, Inc.","Multiplan, Inc.",216.2,94,,percent of total billed charges,,
"Haemophilus Influenzae B Ab, Igg, S (Mayo)OutsideLaboratory",,86684,CPT,Facility,Outpatient,,,90,230,195.5,65.918,230,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,198.72,86.4,,percent of total billed charges,,
"Haemophilus Influenzae B Ab, Igg, S (Mayo)OutsideLaboratory",,86684,CPT,Facility,Inpatient,,,90,230,195.5,65.918,230,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Haemophilus Influenzae B Ab, Igg, S (Mayo)OutsideLaboratory",,86684,CPT,Facility,Both,,,90,230,195.5,65.918,230,"Preferred One Administrative Services, INC.",PPO,226.78,98.6,,percent of total billed charges,,
"Haemophilus Influenzae B Ab, Igg, S (Mayo)OutsideLaboratory",,86684,CPT,Facility,Outpatient,,,90,230,195.5,65.918,230,PrimeWest Health,Minnesota Senior Health Options (MSHO),118.335,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Haemophilus Influenzae B Ab, Igg, S (Mayo)OutsideLaboratory",,86684,CPT,Facility,Inpatient,,,90,230,195.5,65.918,230,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Haemophilus Influenzae B Ab, Igg, S (Mayo)OutsideLaboratory",,86684,CPT,Facility,Outpatient,,,90,230,195.5,65.918,230,PrimeWest Health,MinnesotaCare,118.128,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Haemophilus Influenzae B Ab, Igg, S (Mayo)OutsideLaboratory",,86684,CPT,Facility,Inpatient,,,90,230,195.5,65.918,230,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Haemophilus Influenzae B Ab, Igg, S (Mayo)OutsideLaboratory",,86684,CPT,Facility,Both,,,90,230,195.5,65.918,230,Sanford Health Plan,Sanford Health Plan,211.6,92,,percent of total billed charges,,
"Haemophilus Influenzae B Ab, Igg, S (Mayo)OutsideLaboratory",,86684,CPT,Facility,Outpatient,,,90,230,195.5,65.918,230,"UCare Health, Inc.",Individual & Family Plan,129.605,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Haemophilus Influenzae B Ab, Igg, S (Mayo)OutsideLaboratory",,86684,CPT,Facility,Inpatient,,,90,230,195.5,65.918,230,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Haemophilus Influenzae B Ab, Igg, S (Mayo)OutsideLaboratory",,86684,CPT,Facility,Outpatient,,,90,230,195.5,65.918,230,"UCare Health, Inc.",Medical Assistance,116.081,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Haemophilus Influenzae B Ab, Igg, S (Mayo)OutsideLaboratory",,86684,CPT,Facility,Inpatient,,,90,230,195.5,65.918,230,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Haemophilus Influenzae B Ab, Igg, S (Mayo)OutsideLaboratory",,86684,CPT,Facility,Outpatient,,,90,230,195.5,65.918,230,"UCare Health, Inc.",Medicare Advantage,116.081,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Haemophilus Influenzae B Ab, Igg, S (Mayo)OutsideLaboratory",,86684,CPT,Facility,Inpatient,,,90,230,195.5,65.918,230,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Haemophilus Influenzae B Ab, Igg, S (Mayo)OutsideLaboratory",,86684,CPT,Facility,Outpatient,,,90,230,195.5,65.918,230,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),116.081,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Haemophilus Influenzae B Ab, Igg, S (Mayo)OutsideLaboratory",,86684,CPT,Facility,Inpatient,,,90,230,195.5,65.918,230,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Haemophilus Influenzae B Ab, Igg, S (Mayo)OutsideLaboratory",,86684,CPT,Facility,Both,,,90,230,195.5,65.918,230,UnitedHealthcare,Individual & Family,216.2,94,,percent of total billed charges,,
"Haemophilus Influenzae B Ab, Igg, S (Mayo)OutsideLaboratory",,86684,CPT,Facility,Outpatient,,,90,230,195.5,65.918,230,UnitedHealthcare,Medicare Advantage,112.7,49,,percent of total billed charges,,
"Haemophilus Influenzae B Ab, Igg, S (Mayo)OutsideLaboratory",,86684,CPT,Facility,Inpatient,,,90,230,195.5,65.918,230,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Haemophilus Influenzae B Ab, Igg, S (Mayo)OutsideLaboratory",,86684,CPT,Facility,Outpatient,,,90,230,195.5,65.918,230,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,110.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Haemophilus Influenzae B Ab, Igg, S (Mayo)OutsideLaboratory",,86684,CPT,Facility,Inpatient,,,90,230,195.5,65.918,230,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Hsv Igm Antibody By Ifa (Mayo)OutsideLaboratory,,86694,CPT,Facility,Both,,,90,55,46.75,15.763,55,Aetna,Commercial,50.6,92,,percent of total billed charges,,
Hsv Igm Antibody By Ifa (Mayo)OutsideLaboratory,,86694,CPT,Facility,Outpatient,,,90,55,46.75,15.763,55,Aetna,Medicare Advantage,26.95,49,,percent of total billed charges,,
Hsv Igm Antibody By Ifa (Mayo)OutsideLaboratory,,86694,CPT,Facility,Inpatient,,,90,55,46.75,15.763,55,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Hsv Igm Antibody By Ifa (Mayo)OutsideLaboratory,,86694,CPT,Facility,Both,,,90,55,46.75,15.763,55,Aetna,PPO,51.15,93,,percent of total billed charges,,
Hsv Igm Antibody By Ifa (Mayo)OutsideLaboratory,,86694,CPT,Facility,Both,,,90,55,46.75,15.763,55,America's PPO,America's PPO,52.8165,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Hsv Igm Antibody By Ifa (Mayo)OutsideLaboratory,,86694,CPT,Facility,Both,,,90,55,46.75,15.763,55,BlueCross BlueShield Minnesota, Federal Employee Program,54.12,98.4,,percent of total billed charges,,
Hsv Igm Antibody By Ifa (Mayo)OutsideLaboratory,,86694,CPT,Facility,Both,,,90,55,46.75,15.763,55,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,55,100,,percent of total billed charges,,
Hsv Igm Antibody By Ifa (Mayo)OutsideLaboratory,,86694,CPT,Facility,Both,,,90,55,46.75,15.763,55,BlueCross BlueShield Minnesota,High Value Network Plan,49.5,90,,percent of total billed charges,,
Hsv Igm Antibody By Ifa (Mayo)OutsideLaboratory,,86694,CPT,Facility,Outpatient,,,90,55,46.75,15.763,55,BlueCross BlueShield Minnesota,Medicare Advantage,26.95,49,,percent of total billed charges,,
Hsv Igm Antibody By Ifa (Mayo)OutsideLaboratory,,86694,CPT,Facility,Inpatient,,,90,55,46.75,15.763,55,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Hsv Igm Antibody By Ifa (Mayo)OutsideLaboratory,,86694,CPT,Facility,Both,,,90,55,46.75,15.763,55,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,48.7135,88.57,,percent of total billed charges,,
Hsv Igm Antibody By Ifa (Mayo)OutsideLaboratory,,86694,CPT,Facility,Both,,,90,55,46.75,15.763,55,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,15.763,28.66,,percent of total billed charges,,
Hsv Igm Antibody By Ifa (Mayo)OutsideLaboratory,,86694,CPT,Facility,Outpatient,,,90,55,46.75,15.763,55,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),26.95,49,,percent of total billed charges,,
Hsv Igm Antibody By Ifa (Mayo)OutsideLaboratory,,86694,CPT,Facility,Inpatient,,,90,55,46.75,15.763,55,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Hsv Igm Antibody By Ifa (Mayo)OutsideLaboratory,,86694,CPT,Facility,Both,,,90,55,46.75,15.763,55,CorVel,Worker's Compensation,55,100,,percent of total billed charges,,
Hsv Igm Antibody By Ifa (Mayo)OutsideLaboratory,,86694,CPT,Facility,Both,,,90,55,46.75,15.763,55,First Health Group Corporation,First Health Network,53.35,97,,percent of total billed charges,,
Hsv Igm Antibody By Ifa (Mayo)OutsideLaboratory,,86694,CPT,Facility,Both,,,90,55,46.75,15.763,55,"Health Partners, Inc.",Commercial,52.03,94.6,,percent of total billed charges,,
Hsv Igm Antibody By Ifa (Mayo)OutsideLaboratory,,86694,CPT,Facility,Outpatient,,,90,55,46.75,15.763,55,"Health Partners, Inc.",Medicare Advantage,26.95,49,,percent of total billed charges,,
Hsv Igm Antibody By Ifa (Mayo)OutsideLaboratory,,86694,CPT,Facility,Inpatient,,,90,55,46.75,15.763,55,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Hsv Igm Antibody By Ifa (Mayo)OutsideLaboratory,,86694,CPT,Facility,Both,,,90,55,46.75,15.763,55,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),33,60,,percent of total billed charges,,
Hsv Igm Antibody By Ifa (Mayo)OutsideLaboratory,,86694,CPT,Facility,Both,,,90,55,46.75,15.763,55,"Health Partners, Inc.",State of Minnesota Advantage Program,44.825,81.5,,percent of total billed charges,,
Hsv Igm Antibody By Ifa (Mayo)OutsideLaboratory,,86694,CPT,Facility,Both,,,90,55,46.75,15.763,55,"Health Partners, Inc.",State Public Programs,27.5,50,,percent of total billed charges,,
Hsv Igm Antibody By Ifa (Mayo)OutsideLaboratory,,86694,CPT,Facility,Both,,,90,55,46.75,15.763,55,Humana Insurance Company,Commercial PPO,52.25,95,,percent of total billed charges,,
Hsv Igm Antibody By Ifa (Mayo)OutsideLaboratory,,86694,CPT,Facility,Outpatient,,,90,55,46.75,15.763,55,Humana Insurance Company,Medicare PPO,26.95,49,,percent of total billed charges,,
Hsv Igm Antibody By Ifa (Mayo)OutsideLaboratory,,86694,CPT,Facility,Inpatient,,,90,55,46.75,15.763,55,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Hsv Igm Antibody By Ifa (Mayo)OutsideLaboratory,,86694,CPT,Facility,Both,,,90,55,46.75,15.763,55,Medica,Individual & Family,54.505,99.1,,percent of total billed charges,,
Hsv Igm Antibody By Ifa (Mayo)OutsideLaboratory,,86694,CPT,Facility,Outpatient,,,90,55,46.75,15.763,55,Medica,Medica Advantage Solution,27.39,49.8,,percent of total billed charges,,
Hsv Igm Antibody By Ifa (Mayo)OutsideLaboratory,,86694,CPT,Facility,Inpatient,,,90,55,46.75,15.763,55,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Hsv Igm Antibody By Ifa (Mayo)OutsideLaboratory,,86694,CPT,Facility,Outpatient,,,90,55,46.75,15.763,55,Medica,Medical Assistance,24.53,44.6,,percent of total billed charges,,
Hsv Igm Antibody By Ifa (Mayo)OutsideLaboratory,,86694,CPT,Facility,Inpatient,,,90,55,46.75,15.763,55,Medica,Medical Assistance,,,,,Included in per diem rate,
Hsv Igm Antibody By Ifa (Mayo)OutsideLaboratory,,86694,CPT,Facility,Outpatient,,,90,55,46.75,15.763,55,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,27.39,49.8,,percent of total billed charges,,
Hsv Igm Antibody By Ifa (Mayo)OutsideLaboratory,,86694,CPT,Facility,Inpatient,,,90,55,46.75,15.763,55,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Hsv Igm Antibody By Ifa (Mayo)OutsideLaboratory,,86694,CPT,Facility,Both,,,90,55,46.75,15.763,55,"Multiplan, Inc.","Multiplan, Inc.",51.7,94,,percent of total billed charges,,
Hsv Igm Antibody By Ifa (Mayo)OutsideLaboratory,,86694,CPT,Facility,Outpatient,,,90,55,46.75,15.763,55,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,47.52,86.4,,percent of total billed charges,,
Hsv Igm Antibody By Ifa (Mayo)OutsideLaboratory,,86694,CPT,Facility,Inpatient,,,90,55,46.75,15.763,55,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Hsv Igm Antibody By Ifa (Mayo)OutsideLaboratory,,86694,CPT,Facility,Both,,,90,55,46.75,15.763,55,"Preferred One Administrative Services, INC.",PPO,54.23,98.6,,percent of total billed charges,,
Hsv Igm Antibody By Ifa (Mayo)OutsideLaboratory,,86694,CPT,Facility,Outpatient,,,90,55,46.75,15.763,55,PrimeWest Health,Minnesota Senior Health Options (MSHO),28.2975,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Hsv Igm Antibody By Ifa (Mayo)OutsideLaboratory,,86694,CPT,Facility,Inpatient,,,90,55,46.75,15.763,55,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Hsv Igm Antibody By Ifa (Mayo)OutsideLaboratory,,86694,CPT,Facility,Outpatient,,,90,55,46.75,15.763,55,PrimeWest Health,MinnesotaCare,28.248,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Hsv Igm Antibody By Ifa (Mayo)OutsideLaboratory,,86694,CPT,Facility,Inpatient,,,90,55,46.75,15.763,55,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Hsv Igm Antibody By Ifa (Mayo)OutsideLaboratory,,86694,CPT,Facility,Both,,,90,55,46.75,15.763,55,Sanford Health Plan,Sanford Health Plan,50.6,92,,percent of total billed charges,,
Hsv Igm Antibody By Ifa (Mayo)OutsideLaboratory,,86694,CPT,Facility,Outpatient,,,90,55,46.75,15.763,55,"UCare Health, Inc.",Individual & Family Plan,30.9925,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Hsv Igm Antibody By Ifa (Mayo)OutsideLaboratory,,86694,CPT,Facility,Inpatient,,,90,55,46.75,15.763,55,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Hsv Igm Antibody By Ifa (Mayo)OutsideLaboratory,,86694,CPT,Facility,Outpatient,,,90,55,46.75,15.763,55,"UCare Health, Inc.",Medical Assistance,27.7585,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Hsv Igm Antibody By Ifa (Mayo)OutsideLaboratory,,86694,CPT,Facility,Inpatient,,,90,55,46.75,15.763,55,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Hsv Igm Antibody By Ifa (Mayo)OutsideLaboratory,,86694,CPT,Facility,Outpatient,,,90,55,46.75,15.763,55,"UCare Health, Inc.",Medicare Advantage,27.7585,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Hsv Igm Antibody By Ifa (Mayo)OutsideLaboratory,,86694,CPT,Facility,Inpatient,,,90,55,46.75,15.763,55,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Hsv Igm Antibody By Ifa (Mayo)OutsideLaboratory,,86694,CPT,Facility,Outpatient,,,90,55,46.75,15.763,55,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),27.7585,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Hsv Igm Antibody By Ifa (Mayo)OutsideLaboratory,,86694,CPT,Facility,Inpatient,,,90,55,46.75,15.763,55,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Hsv Igm Antibody By Ifa (Mayo)OutsideLaboratory,,86694,CPT,Facility,Both,,,90,55,46.75,15.763,55,UnitedHealthcare,Individual & Family,51.7,94,,percent of total billed charges,,
Hsv Igm Antibody By Ifa (Mayo)OutsideLaboratory,,86694,CPT,Facility,Outpatient,,,90,55,46.75,15.763,55,UnitedHealthcare,Medicare Advantage,26.95,49,,percent of total billed charges,,
Hsv Igm Antibody By Ifa (Mayo)OutsideLaboratory,,86694,CPT,Facility,Inpatient,,,90,55,46.75,15.763,55,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Hsv Igm Antibody By Ifa (Mayo)OutsideLaboratory,,86694,CPT,Facility,Outpatient,,,90,55,46.75,15.763,55,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,26.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
Hsv Igm Antibody By Ifa (Mayo)OutsideLaboratory,,86694,CPT,Facility,Inpatient,,,90,55,46.75,15.763,55,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Antibody; Herpes Simplex, Type 1 (Mayo)OutsideLaboratory",,86695,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Aetna,Commercial,42.32,92,,percent of total billed charges,,
"Antibody; Herpes Simplex, Type 1 (Mayo)OutsideLaboratory",,86695,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Aetna,Medicare Advantage,22.54,49,,percent of total billed charges,,
"Antibody; Herpes Simplex, Type 1 (Mayo)OutsideLaboratory",,86695,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Antibody; Herpes Simplex, Type 1 (Mayo)OutsideLaboratory",,86695,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Aetna,PPO,42.78,93,,percent of total billed charges,,
"Antibody; Herpes Simplex, Type 1 (Mayo)OutsideLaboratory",,86695,CPT,Facility,Both,,,90,46,39.1,13.1836,46,America's PPO,America's PPO,44.1738,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Antibody; Herpes Simplex, Type 1 (Mayo)OutsideLaboratory",,86695,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota, Federal Employee Program,45.264,98.4,,percent of total billed charges,,
"Antibody; Herpes Simplex, Type 1 (Mayo)OutsideLaboratory",,86695,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,46,100,,percent of total billed charges,,
"Antibody; Herpes Simplex, Type 1 (Mayo)OutsideLaboratory",,86695,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,High Value Network Plan,41.4,90,,percent of total billed charges,,
"Antibody; Herpes Simplex, Type 1 (Mayo)OutsideLaboratory",,86695,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Medicare Advantage,22.54,49,,percent of total billed charges,,
"Antibody; Herpes Simplex, Type 1 (Mayo)OutsideLaboratory",,86695,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Antibody; Herpes Simplex, Type 1 (Mayo)OutsideLaboratory",,86695,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,40.7422,88.57,,percent of total billed charges,,
"Antibody; Herpes Simplex, Type 1 (Mayo)OutsideLaboratory",,86695,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,13.1836,28.66,,percent of total billed charges,,
"Antibody; Herpes Simplex, Type 1 (Mayo)OutsideLaboratory",,86695,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),22.54,49,,percent of total billed charges,,
"Antibody; Herpes Simplex, Type 1 (Mayo)OutsideLaboratory",,86695,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Antibody; Herpes Simplex, Type 1 (Mayo)OutsideLaboratory",,86695,CPT,Facility,Both,,,90,46,39.1,13.1836,46,CorVel,Worker's Compensation,46,100,,percent of total billed charges,,
"Antibody; Herpes Simplex, Type 1 (Mayo)OutsideLaboratory",,86695,CPT,Facility,Both,,,90,46,39.1,13.1836,46,First Health Group Corporation,First Health Network,44.62,97,,percent of total billed charges,,
"Antibody; Herpes Simplex, Type 1 (Mayo)OutsideLaboratory",,86695,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Commercial,43.516,94.6,,percent of total billed charges,,
"Antibody; Herpes Simplex, Type 1 (Mayo)OutsideLaboratory",,86695,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Medicare Advantage,22.54,49,,percent of total billed charges,,
"Antibody; Herpes Simplex, Type 1 (Mayo)OutsideLaboratory",,86695,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Antibody; Herpes Simplex, Type 1 (Mayo)OutsideLaboratory",,86695,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),27.6,60,,percent of total billed charges,,
"Antibody; Herpes Simplex, Type 1 (Mayo)OutsideLaboratory",,86695,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",State of Minnesota Advantage Program,37.49,81.5,,percent of total billed charges,,
"Antibody; Herpes Simplex, Type 1 (Mayo)OutsideLaboratory",,86695,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",State Public Programs,23,50,,percent of total billed charges,,
"Antibody; Herpes Simplex, Type 1 (Mayo)OutsideLaboratory",,86695,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Humana Insurance Company,Commercial PPO,43.7,95,,percent of total billed charges,,
"Antibody; Herpes Simplex, Type 1 (Mayo)OutsideLaboratory",,86695,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Humana Insurance Company,Medicare PPO,22.54,49,,percent of total billed charges,,
"Antibody; Herpes Simplex, Type 1 (Mayo)OutsideLaboratory",,86695,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Antibody; Herpes Simplex, Type 1 (Mayo)OutsideLaboratory",,86695,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Medica,Individual & Family,45.586,99.1,,percent of total billed charges,,
"Antibody; Herpes Simplex, Type 1 (Mayo)OutsideLaboratory",,86695,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Medica,Medica Advantage Solution,22.908,49.8,,percent of total billed charges,,
"Antibody; Herpes Simplex, Type 1 (Mayo)OutsideLaboratory",,86695,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Antibody; Herpes Simplex, Type 1 (Mayo)OutsideLaboratory",,86695,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Medica,Medical Assistance,20.516,44.6,,percent of total billed charges,,
"Antibody; Herpes Simplex, Type 1 (Mayo)OutsideLaboratory",,86695,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Medica,Medical Assistance,,,,,Included in per diem rate,
"Antibody; Herpes Simplex, Type 1 (Mayo)OutsideLaboratory",,86695,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,22.908,49.8,,percent of total billed charges,,
"Antibody; Herpes Simplex, Type 1 (Mayo)OutsideLaboratory",,86695,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Antibody; Herpes Simplex, Type 1 (Mayo)OutsideLaboratory",,86695,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Multiplan, Inc.","Multiplan, Inc.",43.24,94,,percent of total billed charges,,
"Antibody; Herpes Simplex, Type 1 (Mayo)OutsideLaboratory",,86695,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,39.744,86.4,,percent of total billed charges,,
"Antibody; Herpes Simplex, Type 1 (Mayo)OutsideLaboratory",,86695,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Antibody; Herpes Simplex, Type 1 (Mayo)OutsideLaboratory",,86695,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PPO,45.356,98.6,,percent of total billed charges,,
"Antibody; Herpes Simplex, Type 1 (Mayo)OutsideLaboratory",,86695,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,Minnesota Senior Health Options (MSHO),23.667,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Antibody; Herpes Simplex, Type 1 (Mayo)OutsideLaboratory",,86695,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Antibody; Herpes Simplex, Type 1 (Mayo)OutsideLaboratory",,86695,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,MinnesotaCare,23.6256,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Antibody; Herpes Simplex, Type 1 (Mayo)OutsideLaboratory",,86695,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Antibody; Herpes Simplex, Type 1 (Mayo)OutsideLaboratory",,86695,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Sanford Health Plan,Sanford Health Plan,42.32,92,,percent of total billed charges,,
"Antibody; Herpes Simplex, Type 1 (Mayo)OutsideLaboratory",,86695,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Individual & Family Plan,25.921,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Antibody; Herpes Simplex, Type 1 (Mayo)OutsideLaboratory",,86695,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Antibody; Herpes Simplex, Type 1 (Mayo)OutsideLaboratory",,86695,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medical Assistance,23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Antibody; Herpes Simplex, Type 1 (Mayo)OutsideLaboratory",,86695,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Antibody; Herpes Simplex, Type 1 (Mayo)OutsideLaboratory",,86695,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medicare Advantage,23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Antibody; Herpes Simplex, Type 1 (Mayo)OutsideLaboratory",,86695,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Antibody; Herpes Simplex, Type 1 (Mayo)OutsideLaboratory",,86695,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Antibody; Herpes Simplex, Type 1 (Mayo)OutsideLaboratory",,86695,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Antibody; Herpes Simplex, Type 1 (Mayo)OutsideLaboratory",,86695,CPT,Facility,Both,,,90,46,39.1,13.1836,46,UnitedHealthcare,Individual & Family,43.24,94,,percent of total billed charges,,
"Antibody; Herpes Simplex, Type 1 (Mayo)OutsideLaboratory",,86695,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Medicare Advantage,22.54,49,,percent of total billed charges,,
"Antibody; Herpes Simplex, Type 1 (Mayo)OutsideLaboratory",,86695,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Antibody; Herpes Simplex, Type 1 (Mayo)OutsideLaboratory",,86695,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,22.08,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Antibody; Herpes Simplex, Type 1 (Mayo)OutsideLaboratory",,86695,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Herpes Simplex Test (Mayo)OutsideLaboratory,,86695,CPT,Facility,Both,,,90,73,62.05,20.9218,73,Aetna,Commercial,67.16,92,,percent of total billed charges,,
Herpes Simplex Test (Mayo)OutsideLaboratory,,86695,CPT,Facility,Outpatient,,,90,73,62.05,20.9218,73,Aetna,Medicare Advantage,35.77,49,,percent of total billed charges,,
Herpes Simplex Test (Mayo)OutsideLaboratory,,86695,CPT,Facility,Inpatient,,,90,73,62.05,20.9218,73,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Herpes Simplex Test (Mayo)OutsideLaboratory,,86695,CPT,Facility,Both,,,90,73,62.05,20.9218,73,Aetna,PPO,67.89,93,,percent of total billed charges,,
Herpes Simplex Test (Mayo)OutsideLaboratory,,86695,CPT,Facility,Both,,,90,73,62.05,20.9218,73,America's PPO,America's PPO,70.1019,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Herpes Simplex Test (Mayo)OutsideLaboratory,,86695,CPT,Facility,Both,,,90,73,62.05,20.9218,73,BlueCross BlueShield Minnesota, Federal Employee Program,71.832,98.4,,percent of total billed charges,,
Herpes Simplex Test (Mayo)OutsideLaboratory,,86695,CPT,Facility,Both,,,90,73,62.05,20.9218,73,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,73,100,,percent of total billed charges,,
Herpes Simplex Test (Mayo)OutsideLaboratory,,86695,CPT,Facility,Both,,,90,73,62.05,20.9218,73,BlueCross BlueShield Minnesota,High Value Network Plan,65.7,90,,percent of total billed charges,,
Herpes Simplex Test (Mayo)OutsideLaboratory,,86695,CPT,Facility,Outpatient,,,90,73,62.05,20.9218,73,BlueCross BlueShield Minnesota,Medicare Advantage,35.77,49,,percent of total billed charges,,
Herpes Simplex Test (Mayo)OutsideLaboratory,,86695,CPT,Facility,Inpatient,,,90,73,62.05,20.9218,73,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Herpes Simplex Test (Mayo)OutsideLaboratory,,86695,CPT,Facility,Both,,,90,73,62.05,20.9218,73,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,64.6561,88.57,,percent of total billed charges,,
Herpes Simplex Test (Mayo)OutsideLaboratory,,86695,CPT,Facility,Both,,,90,73,62.05,20.9218,73,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,20.9218,28.66,,percent of total billed charges,,
Herpes Simplex Test (Mayo)OutsideLaboratory,,86695,CPT,Facility,Outpatient,,,90,73,62.05,20.9218,73,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),35.77,49,,percent of total billed charges,,
Herpes Simplex Test (Mayo)OutsideLaboratory,,86695,CPT,Facility,Inpatient,,,90,73,62.05,20.9218,73,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Herpes Simplex Test (Mayo)OutsideLaboratory,,86695,CPT,Facility,Both,,,90,73,62.05,20.9218,73,CorVel,Worker's Compensation,73,100,,percent of total billed charges,,
Herpes Simplex Test (Mayo)OutsideLaboratory,,86695,CPT,Facility,Both,,,90,73,62.05,20.9218,73,First Health Group Corporation,First Health Network,70.81,97,,percent of total billed charges,,
Herpes Simplex Test (Mayo)OutsideLaboratory,,86695,CPT,Facility,Both,,,90,73,62.05,20.9218,73,"Health Partners, Inc.",Commercial,69.058,94.6,,percent of total billed charges,,
Herpes Simplex Test (Mayo)OutsideLaboratory,,86695,CPT,Facility,Outpatient,,,90,73,62.05,20.9218,73,"Health Partners, Inc.",Medicare Advantage,35.77,49,,percent of total billed charges,,
Herpes Simplex Test (Mayo)OutsideLaboratory,,86695,CPT,Facility,Inpatient,,,90,73,62.05,20.9218,73,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Herpes Simplex Test (Mayo)OutsideLaboratory,,86695,CPT,Facility,Both,,,90,73,62.05,20.9218,73,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),43.8,60,,percent of total billed charges,,
Herpes Simplex Test (Mayo)OutsideLaboratory,,86695,CPT,Facility,Both,,,90,73,62.05,20.9218,73,"Health Partners, Inc.",State of Minnesota Advantage Program,59.495,81.5,,percent of total billed charges,,
Herpes Simplex Test (Mayo)OutsideLaboratory,,86695,CPT,Facility,Both,,,90,73,62.05,20.9218,73,"Health Partners, Inc.",State Public Programs,36.5,50,,percent of total billed charges,,
Herpes Simplex Test (Mayo)OutsideLaboratory,,86695,CPT,Facility,Both,,,90,73,62.05,20.9218,73,Humana Insurance Company,Commercial PPO,69.35,95,,percent of total billed charges,,
Herpes Simplex Test (Mayo)OutsideLaboratory,,86695,CPT,Facility,Outpatient,,,90,73,62.05,20.9218,73,Humana Insurance Company,Medicare PPO,35.77,49,,percent of total billed charges,,
Herpes Simplex Test (Mayo)OutsideLaboratory,,86695,CPT,Facility,Inpatient,,,90,73,62.05,20.9218,73,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Herpes Simplex Test (Mayo)OutsideLaboratory,,86695,CPT,Facility,Both,,,90,73,62.05,20.9218,73,Medica,Individual & Family,72.343,99.1,,percent of total billed charges,,
Herpes Simplex Test (Mayo)OutsideLaboratory,,86695,CPT,Facility,Outpatient,,,90,73,62.05,20.9218,73,Medica,Medica Advantage Solution,36.354,49.8,,percent of total billed charges,,
Herpes Simplex Test (Mayo)OutsideLaboratory,,86695,CPT,Facility,Inpatient,,,90,73,62.05,20.9218,73,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Herpes Simplex Test (Mayo)OutsideLaboratory,,86695,CPT,Facility,Outpatient,,,90,73,62.05,20.9218,73,Medica,Medical Assistance,32.558,44.6,,percent of total billed charges,,
Herpes Simplex Test (Mayo)OutsideLaboratory,,86695,CPT,Facility,Inpatient,,,90,73,62.05,20.9218,73,Medica,Medical Assistance,,,,,Included in per diem rate,
Herpes Simplex Test (Mayo)OutsideLaboratory,,86695,CPT,Facility,Outpatient,,,90,73,62.05,20.9218,73,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,36.354,49.8,,percent of total billed charges,,
Herpes Simplex Test (Mayo)OutsideLaboratory,,86695,CPT,Facility,Inpatient,,,90,73,62.05,20.9218,73,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Herpes Simplex Test (Mayo)OutsideLaboratory,,86695,CPT,Facility,Both,,,90,73,62.05,20.9218,73,"Multiplan, Inc.","Multiplan, Inc.",68.62,94,,percent of total billed charges,,
Herpes Simplex Test (Mayo)OutsideLaboratory,,86695,CPT,Facility,Outpatient,,,90,73,62.05,20.9218,73,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,63.072,86.4,,percent of total billed charges,,
Herpes Simplex Test (Mayo)OutsideLaboratory,,86695,CPT,Facility,Inpatient,,,90,73,62.05,20.9218,73,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Herpes Simplex Test (Mayo)OutsideLaboratory,,86695,CPT,Facility,Both,,,90,73,62.05,20.9218,73,"Preferred One Administrative Services, INC.",PPO,71.978,98.6,,percent of total billed charges,,
Herpes Simplex Test (Mayo)OutsideLaboratory,,86695,CPT,Facility,Outpatient,,,90,73,62.05,20.9218,73,PrimeWest Health,Minnesota Senior Health Options (MSHO),37.5585,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Herpes Simplex Test (Mayo)OutsideLaboratory,,86695,CPT,Facility,Inpatient,,,90,73,62.05,20.9218,73,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Herpes Simplex Test (Mayo)OutsideLaboratory,,86695,CPT,Facility,Outpatient,,,90,73,62.05,20.9218,73,PrimeWest Health,MinnesotaCare,37.4928,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Herpes Simplex Test (Mayo)OutsideLaboratory,,86695,CPT,Facility,Inpatient,,,90,73,62.05,20.9218,73,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Herpes Simplex Test (Mayo)OutsideLaboratory,,86695,CPT,Facility,Both,,,90,73,62.05,20.9218,73,Sanford Health Plan,Sanford Health Plan,67.16,92,,percent of total billed charges,,
Herpes Simplex Test (Mayo)OutsideLaboratory,,86695,CPT,Facility,Outpatient,,,90,73,62.05,20.9218,73,"UCare Health, Inc.",Individual & Family Plan,41.1355,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Herpes Simplex Test (Mayo)OutsideLaboratory,,86695,CPT,Facility,Inpatient,,,90,73,62.05,20.9218,73,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Herpes Simplex Test (Mayo)OutsideLaboratory,,86695,CPT,Facility,Outpatient,,,90,73,62.05,20.9218,73,"UCare Health, Inc.",Medical Assistance,36.8431,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Herpes Simplex Test (Mayo)OutsideLaboratory,,86695,CPT,Facility,Inpatient,,,90,73,62.05,20.9218,73,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Herpes Simplex Test (Mayo)OutsideLaboratory,,86695,CPT,Facility,Outpatient,,,90,73,62.05,20.9218,73,"UCare Health, Inc.",Medicare Advantage,36.8431,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Herpes Simplex Test (Mayo)OutsideLaboratory,,86695,CPT,Facility,Inpatient,,,90,73,62.05,20.9218,73,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Herpes Simplex Test (Mayo)OutsideLaboratory,,86695,CPT,Facility,Outpatient,,,90,73,62.05,20.9218,73,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),36.8431,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Herpes Simplex Test (Mayo)OutsideLaboratory,,86695,CPT,Facility,Inpatient,,,90,73,62.05,20.9218,73,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Herpes Simplex Test (Mayo)OutsideLaboratory,,86695,CPT,Facility,Both,,,90,73,62.05,20.9218,73,UnitedHealthcare,Individual & Family,68.62,94,,percent of total billed charges,,
Herpes Simplex Test (Mayo)OutsideLaboratory,,86695,CPT,Facility,Outpatient,,,90,73,62.05,20.9218,73,UnitedHealthcare,Medicare Advantage,35.77,49,,percent of total billed charges,,
Herpes Simplex Test (Mayo)OutsideLaboratory,,86695,CPT,Facility,Inpatient,,,90,73,62.05,20.9218,73,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Herpes Simplex Test (Mayo)OutsideLaboratory,,86695,CPT,Facility,Outpatient,,,90,73,62.05,20.9218,73,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,35.04,48,,percent of total billed charges,,100% of DHS outpatient percentage
Herpes Simplex Test (Mayo)OutsideLaboratory,,86695,CPT,Facility,Inpatient,,,90,73,62.05,20.9218,73,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Herpes Simplex Type 2 (Mayo)OutsideLaboratory,,86696,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Aetna,Commercial,42.32,92,,percent of total billed charges,,
Herpes Simplex Type 2 (Mayo)OutsideLaboratory,,86696,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Aetna,Medicare Advantage,22.54,49,,percent of total billed charges,,
Herpes Simplex Type 2 (Mayo)OutsideLaboratory,,86696,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Herpes Simplex Type 2 (Mayo)OutsideLaboratory,,86696,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Aetna,PPO,42.78,93,,percent of total billed charges,,
Herpes Simplex Type 2 (Mayo)OutsideLaboratory,,86696,CPT,Facility,Both,,,90,46,39.1,13.1836,46,America's PPO,America's PPO,44.1738,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Herpes Simplex Type 2 (Mayo)OutsideLaboratory,,86696,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota, Federal Employee Program,45.264,98.4,,percent of total billed charges,,
Herpes Simplex Type 2 (Mayo)OutsideLaboratory,,86696,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,46,100,,percent of total billed charges,,
Herpes Simplex Type 2 (Mayo)OutsideLaboratory,,86696,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,High Value Network Plan,41.4,90,,percent of total billed charges,,
Herpes Simplex Type 2 (Mayo)OutsideLaboratory,,86696,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Medicare Advantage,22.54,49,,percent of total billed charges,,
Herpes Simplex Type 2 (Mayo)OutsideLaboratory,,86696,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Herpes Simplex Type 2 (Mayo)OutsideLaboratory,,86696,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,40.7422,88.57,,percent of total billed charges,,
Herpes Simplex Type 2 (Mayo)OutsideLaboratory,,86696,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,13.1836,28.66,,percent of total billed charges,,
Herpes Simplex Type 2 (Mayo)OutsideLaboratory,,86696,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),22.54,49,,percent of total billed charges,,
Herpes Simplex Type 2 (Mayo)OutsideLaboratory,,86696,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Herpes Simplex Type 2 (Mayo)OutsideLaboratory,,86696,CPT,Facility,Both,,,90,46,39.1,13.1836,46,CorVel,Worker's Compensation,46,100,,percent of total billed charges,,
Herpes Simplex Type 2 (Mayo)OutsideLaboratory,,86696,CPT,Facility,Both,,,90,46,39.1,13.1836,46,First Health Group Corporation,First Health Network,44.62,97,,percent of total billed charges,,
Herpes Simplex Type 2 (Mayo)OutsideLaboratory,,86696,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Commercial,43.516,94.6,,percent of total billed charges,,
Herpes Simplex Type 2 (Mayo)OutsideLaboratory,,86696,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Medicare Advantage,22.54,49,,percent of total billed charges,,
Herpes Simplex Type 2 (Mayo)OutsideLaboratory,,86696,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Herpes Simplex Type 2 (Mayo)OutsideLaboratory,,86696,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),27.6,60,,percent of total billed charges,,
Herpes Simplex Type 2 (Mayo)OutsideLaboratory,,86696,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",State of Minnesota Advantage Program,37.49,81.5,,percent of total billed charges,,
Herpes Simplex Type 2 (Mayo)OutsideLaboratory,,86696,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",State Public Programs,23,50,,percent of total billed charges,,
Herpes Simplex Type 2 (Mayo)OutsideLaboratory,,86696,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Humana Insurance Company,Commercial PPO,43.7,95,,percent of total billed charges,,
Herpes Simplex Type 2 (Mayo)OutsideLaboratory,,86696,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Humana Insurance Company,Medicare PPO,22.54,49,,percent of total billed charges,,
Herpes Simplex Type 2 (Mayo)OutsideLaboratory,,86696,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Herpes Simplex Type 2 (Mayo)OutsideLaboratory,,86696,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Medica,Individual & Family,45.586,99.1,,percent of total billed charges,,
Herpes Simplex Type 2 (Mayo)OutsideLaboratory,,86696,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Medica,Medica Advantage Solution,22.908,49.8,,percent of total billed charges,,
Herpes Simplex Type 2 (Mayo)OutsideLaboratory,,86696,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Herpes Simplex Type 2 (Mayo)OutsideLaboratory,,86696,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Medica,Medical Assistance,20.516,44.6,,percent of total billed charges,,
Herpes Simplex Type 2 (Mayo)OutsideLaboratory,,86696,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Medica,Medical Assistance,,,,,Included in per diem rate,
Herpes Simplex Type 2 (Mayo)OutsideLaboratory,,86696,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,22.908,49.8,,percent of total billed charges,,
Herpes Simplex Type 2 (Mayo)OutsideLaboratory,,86696,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Herpes Simplex Type 2 (Mayo)OutsideLaboratory,,86696,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Multiplan, Inc.","Multiplan, Inc.",43.24,94,,percent of total billed charges,,
Herpes Simplex Type 2 (Mayo)OutsideLaboratory,,86696,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,39.744,86.4,,percent of total billed charges,,
Herpes Simplex Type 2 (Mayo)OutsideLaboratory,,86696,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Herpes Simplex Type 2 (Mayo)OutsideLaboratory,,86696,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PPO,45.356,98.6,,percent of total billed charges,,
Herpes Simplex Type 2 (Mayo)OutsideLaboratory,,86696,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,Minnesota Senior Health Options (MSHO),23.667,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Herpes Simplex Type 2 (Mayo)OutsideLaboratory,,86696,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Herpes Simplex Type 2 (Mayo)OutsideLaboratory,,86696,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,MinnesotaCare,23.6256,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Herpes Simplex Type 2 (Mayo)OutsideLaboratory,,86696,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Herpes Simplex Type 2 (Mayo)OutsideLaboratory,,86696,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Sanford Health Plan,Sanford Health Plan,42.32,92,,percent of total billed charges,,
Herpes Simplex Type 2 (Mayo)OutsideLaboratory,,86696,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Individual & Family Plan,25.921,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Herpes Simplex Type 2 (Mayo)OutsideLaboratory,,86696,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Herpes Simplex Type 2 (Mayo)OutsideLaboratory,,86696,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medical Assistance,23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Herpes Simplex Type 2 (Mayo)OutsideLaboratory,,86696,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Herpes Simplex Type 2 (Mayo)OutsideLaboratory,,86696,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medicare Advantage,23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Herpes Simplex Type 2 (Mayo)OutsideLaboratory,,86696,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Herpes Simplex Type 2 (Mayo)OutsideLaboratory,,86696,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Herpes Simplex Type 2 (Mayo)OutsideLaboratory,,86696,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Herpes Simplex Type 2 (Mayo)OutsideLaboratory,,86696,CPT,Facility,Both,,,90,46,39.1,13.1836,46,UnitedHealthcare,Individual & Family,43.24,94,,percent of total billed charges,,
Herpes Simplex Type 2 (Mayo)OutsideLaboratory,,86696,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Medicare Advantage,22.54,49,,percent of total billed charges,,
Herpes Simplex Type 2 (Mayo)OutsideLaboratory,,86696,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Herpes Simplex Type 2 (Mayo)OutsideLaboratory,,86696,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,22.08,48,,percent of total billed charges,,100% of DHS outpatient percentage
Herpes Simplex Type 2 (Mayo)OutsideLaboratory,,86696,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Histoplasma Ab, S (Mayo)OutsideLaboratory",,86698,CPT,Facility,Both,,,90,141,119.85,40.4106,141,Aetna,Commercial,129.72,92,,percent of total billed charges,,
"Histoplasma Ab, S (Mayo)OutsideLaboratory",,86698,CPT,Facility,Outpatient,,,90,141,119.85,40.4106,141,Aetna,Medicare Advantage,69.09,49,,percent of total billed charges,,
"Histoplasma Ab, S (Mayo)OutsideLaboratory",,86698,CPT,Facility,Inpatient,,,90,141,119.85,40.4106,141,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Histoplasma Ab, S (Mayo)OutsideLaboratory",,86698,CPT,Facility,Both,,,90,141,119.85,40.4106,141,Aetna,PPO,131.13,93,,percent of total billed charges,,
"Histoplasma Ab, S (Mayo)OutsideLaboratory",,86698,CPT,Facility,Both,,,90,141,119.85,40.4106,141,America's PPO,America's PPO,135.4023,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Histoplasma Ab, S (Mayo)OutsideLaboratory",,86698,CPT,Facility,Both,,,90,141,119.85,40.4106,141,BlueCross BlueShield Minnesota, Federal Employee Program,138.744,98.4,,percent of total billed charges,,
"Histoplasma Ab, S (Mayo)OutsideLaboratory",,86698,CPT,Facility,Both,,,90,141,119.85,40.4106,141,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,141,100,,percent of total billed charges,,
"Histoplasma Ab, S (Mayo)OutsideLaboratory",,86698,CPT,Facility,Both,,,90,141,119.85,40.4106,141,BlueCross BlueShield Minnesota,High Value Network Plan,126.9,90,,percent of total billed charges,,
"Histoplasma Ab, S (Mayo)OutsideLaboratory",,86698,CPT,Facility,Outpatient,,,90,141,119.85,40.4106,141,BlueCross BlueShield Minnesota,Medicare Advantage,69.09,49,,percent of total billed charges,,
"Histoplasma Ab, S (Mayo)OutsideLaboratory",,86698,CPT,Facility,Inpatient,,,90,141,119.85,40.4106,141,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Histoplasma Ab, S (Mayo)OutsideLaboratory",,86698,CPT,Facility,Both,,,90,141,119.85,40.4106,141,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,124.8837,88.57,,percent of total billed charges,,
"Histoplasma Ab, S (Mayo)OutsideLaboratory",,86698,CPT,Facility,Both,,,90,141,119.85,40.4106,141,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,40.4106,28.66,,percent of total billed charges,,
"Histoplasma Ab, S (Mayo)OutsideLaboratory",,86698,CPT,Facility,Outpatient,,,90,141,119.85,40.4106,141,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),69.09,49,,percent of total billed charges,,
"Histoplasma Ab, S (Mayo)OutsideLaboratory",,86698,CPT,Facility,Inpatient,,,90,141,119.85,40.4106,141,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Histoplasma Ab, S (Mayo)OutsideLaboratory",,86698,CPT,Facility,Both,,,90,141,119.85,40.4106,141,CorVel,Worker's Compensation,141,100,,percent of total billed charges,,
"Histoplasma Ab, S (Mayo)OutsideLaboratory",,86698,CPT,Facility,Both,,,90,141,119.85,40.4106,141,First Health Group Corporation,First Health Network,136.77,97,,percent of total billed charges,,
"Histoplasma Ab, S (Mayo)OutsideLaboratory",,86698,CPT,Facility,Both,,,90,141,119.85,40.4106,141,"Health Partners, Inc.",Commercial,133.386,94.6,,percent of total billed charges,,
"Histoplasma Ab, S (Mayo)OutsideLaboratory",,86698,CPT,Facility,Outpatient,,,90,141,119.85,40.4106,141,"Health Partners, Inc.",Medicare Advantage,69.09,49,,percent of total billed charges,,
"Histoplasma Ab, S (Mayo)OutsideLaboratory",,86698,CPT,Facility,Inpatient,,,90,141,119.85,40.4106,141,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Histoplasma Ab, S (Mayo)OutsideLaboratory",,86698,CPT,Facility,Both,,,90,141,119.85,40.4106,141,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),84.6,60,,percent of total billed charges,,
"Histoplasma Ab, S (Mayo)OutsideLaboratory",,86698,CPT,Facility,Both,,,90,141,119.85,40.4106,141,"Health Partners, Inc.",State of Minnesota Advantage Program,114.915,81.5,,percent of total billed charges,,
"Histoplasma Ab, S (Mayo)OutsideLaboratory",,86698,CPT,Facility,Both,,,90,141,119.85,40.4106,141,"Health Partners, Inc.",State Public Programs,70.5,50,,percent of total billed charges,,
"Histoplasma Ab, S (Mayo)OutsideLaboratory",,86698,CPT,Facility,Both,,,90,141,119.85,40.4106,141,Humana Insurance Company,Commercial PPO,133.95,95,,percent of total billed charges,,
"Histoplasma Ab, S (Mayo)OutsideLaboratory",,86698,CPT,Facility,Outpatient,,,90,141,119.85,40.4106,141,Humana Insurance Company,Medicare PPO,69.09,49,,percent of total billed charges,,
"Histoplasma Ab, S (Mayo)OutsideLaboratory",,86698,CPT,Facility,Inpatient,,,90,141,119.85,40.4106,141,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Histoplasma Ab, S (Mayo)OutsideLaboratory",,86698,CPT,Facility,Both,,,90,141,119.85,40.4106,141,Medica,Individual & Family,139.731,99.1,,percent of total billed charges,,
"Histoplasma Ab, S (Mayo)OutsideLaboratory",,86698,CPT,Facility,Outpatient,,,90,141,119.85,40.4106,141,Medica,Medica Advantage Solution,70.218,49.8,,percent of total billed charges,,
"Histoplasma Ab, S (Mayo)OutsideLaboratory",,86698,CPT,Facility,Inpatient,,,90,141,119.85,40.4106,141,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Histoplasma Ab, S (Mayo)OutsideLaboratory",,86698,CPT,Facility,Outpatient,,,90,141,119.85,40.4106,141,Medica,Medical Assistance,62.886,44.6,,percent of total billed charges,,
"Histoplasma Ab, S (Mayo)OutsideLaboratory",,86698,CPT,Facility,Inpatient,,,90,141,119.85,40.4106,141,Medica,Medical Assistance,,,,,Included in per diem rate,
"Histoplasma Ab, S (Mayo)OutsideLaboratory",,86698,CPT,Facility,Outpatient,,,90,141,119.85,40.4106,141,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,70.218,49.8,,percent of total billed charges,,
"Histoplasma Ab, S (Mayo)OutsideLaboratory",,86698,CPT,Facility,Inpatient,,,90,141,119.85,40.4106,141,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Histoplasma Ab, S (Mayo)OutsideLaboratory",,86698,CPT,Facility,Both,,,90,141,119.85,40.4106,141,"Multiplan, Inc.","Multiplan, Inc.",132.54,94,,percent of total billed charges,,
"Histoplasma Ab, S (Mayo)OutsideLaboratory",,86698,CPT,Facility,Outpatient,,,90,141,119.85,40.4106,141,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,121.824,86.4,,percent of total billed charges,,
"Histoplasma Ab, S (Mayo)OutsideLaboratory",,86698,CPT,Facility,Inpatient,,,90,141,119.85,40.4106,141,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Histoplasma Ab, S (Mayo)OutsideLaboratory",,86698,CPT,Facility,Both,,,90,141,119.85,40.4106,141,"Preferred One Administrative Services, INC.",PPO,139.026,98.6,,percent of total billed charges,,
"Histoplasma Ab, S (Mayo)OutsideLaboratory",,86698,CPT,Facility,Outpatient,,,90,141,119.85,40.4106,141,PrimeWest Health,Minnesota Senior Health Options (MSHO),72.5445,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Histoplasma Ab, S (Mayo)OutsideLaboratory",,86698,CPT,Facility,Inpatient,,,90,141,119.85,40.4106,141,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Histoplasma Ab, S (Mayo)OutsideLaboratory",,86698,CPT,Facility,Outpatient,,,90,141,119.85,40.4106,141,PrimeWest Health,MinnesotaCare,72.4176,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Histoplasma Ab, S (Mayo)OutsideLaboratory",,86698,CPT,Facility,Inpatient,,,90,141,119.85,40.4106,141,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Histoplasma Ab, S (Mayo)OutsideLaboratory",,86698,CPT,Facility,Both,,,90,141,119.85,40.4106,141,Sanford Health Plan,Sanford Health Plan,129.72,92,,percent of total billed charges,,
"Histoplasma Ab, S (Mayo)OutsideLaboratory",,86698,CPT,Facility,Outpatient,,,90,141,119.85,40.4106,141,"UCare Health, Inc.",Individual & Family Plan,79.4535,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Histoplasma Ab, S (Mayo)OutsideLaboratory",,86698,CPT,Facility,Inpatient,,,90,141,119.85,40.4106,141,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Histoplasma Ab, S (Mayo)OutsideLaboratory",,86698,CPT,Facility,Outpatient,,,90,141,119.85,40.4106,141,"UCare Health, Inc.",Medical Assistance,71.1627,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Histoplasma Ab, S (Mayo)OutsideLaboratory",,86698,CPT,Facility,Inpatient,,,90,141,119.85,40.4106,141,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Histoplasma Ab, S (Mayo)OutsideLaboratory",,86698,CPT,Facility,Outpatient,,,90,141,119.85,40.4106,141,"UCare Health, Inc.",Medicare Advantage,71.1627,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Histoplasma Ab, S (Mayo)OutsideLaboratory",,86698,CPT,Facility,Inpatient,,,90,141,119.85,40.4106,141,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Histoplasma Ab, S (Mayo)OutsideLaboratory",,86698,CPT,Facility,Outpatient,,,90,141,119.85,40.4106,141,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),71.1627,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Histoplasma Ab, S (Mayo)OutsideLaboratory",,86698,CPT,Facility,Inpatient,,,90,141,119.85,40.4106,141,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Histoplasma Ab, S (Mayo)OutsideLaboratory",,86698,CPT,Facility,Both,,,90,141,119.85,40.4106,141,UnitedHealthcare,Individual & Family,132.54,94,,percent of total billed charges,,
"Histoplasma Ab, S (Mayo)OutsideLaboratory",,86698,CPT,Facility,Outpatient,,,90,141,119.85,40.4106,141,UnitedHealthcare,Medicare Advantage,69.09,49,,percent of total billed charges,,
"Histoplasma Ab, S (Mayo)OutsideLaboratory",,86698,CPT,Facility,Inpatient,,,90,141,119.85,40.4106,141,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Histoplasma Ab, S (Mayo)OutsideLaboratory",,86698,CPT,Facility,Outpatient,,,90,141,119.85,40.4106,141,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,67.68,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Histoplasma Ab, S (Mayo)OutsideLaboratory",,86698,CPT,Facility,Inpatient,,,90,141,119.85,40.4106,141,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Hiv-1 Ab Confirm And Differentiation, Plasma (Mayo)OutsideLaboratory",,86701,CPT,Facility,Both,,,90,188,159.8,53.8808,188,Aetna,Commercial,172.96,92,,percent of total billed charges,,
"Hiv-1 Ab Confirm And Differentiation, Plasma (Mayo)OutsideLaboratory",,86701,CPT,Facility,Outpatient,,,90,188,159.8,53.8808,188,Aetna,Medicare Advantage,92.12,49,,percent of total billed charges,,
"Hiv-1 Ab Confirm And Differentiation, Plasma (Mayo)OutsideLaboratory",,86701,CPT,Facility,Inpatient,,,90,188,159.8,53.8808,188,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Hiv-1 Ab Confirm And Differentiation, Plasma (Mayo)OutsideLaboratory",,86701,CPT,Facility,Both,,,90,188,159.8,53.8808,188,Aetna,PPO,174.84,93,,percent of total billed charges,,
"Hiv-1 Ab Confirm And Differentiation, Plasma (Mayo)OutsideLaboratory",,86701,CPT,Facility,Both,,,90,188,159.8,53.8808,188,America's PPO,America's PPO,180.5364,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Hiv-1 Ab Confirm And Differentiation, Plasma (Mayo)OutsideLaboratory",,86701,CPT,Facility,Both,,,90,188,159.8,53.8808,188,BlueCross BlueShield Minnesota, Federal Employee Program,184.992,98.4,,percent of total billed charges,,
"Hiv-1 Ab Confirm And Differentiation, Plasma (Mayo)OutsideLaboratory",,86701,CPT,Facility,Both,,,90,188,159.8,53.8808,188,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,188,100,,percent of total billed charges,,
"Hiv-1 Ab Confirm And Differentiation, Plasma (Mayo)OutsideLaboratory",,86701,CPT,Facility,Both,,,90,188,159.8,53.8808,188,BlueCross BlueShield Minnesota,High Value Network Plan,169.2,90,,percent of total billed charges,,
"Hiv-1 Ab Confirm And Differentiation, Plasma (Mayo)OutsideLaboratory",,86701,CPT,Facility,Outpatient,,,90,188,159.8,53.8808,188,BlueCross BlueShield Minnesota,Medicare Advantage,92.12,49,,percent of total billed charges,,
"Hiv-1 Ab Confirm And Differentiation, Plasma (Mayo)OutsideLaboratory",,86701,CPT,Facility,Inpatient,,,90,188,159.8,53.8808,188,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Hiv-1 Ab Confirm And Differentiation, Plasma (Mayo)OutsideLaboratory",,86701,CPT,Facility,Both,,,90,188,159.8,53.8808,188,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,166.5116,88.57,,percent of total billed charges,,
"Hiv-1 Ab Confirm And Differentiation, Plasma (Mayo)OutsideLaboratory",,86701,CPT,Facility,Both,,,90,188,159.8,53.8808,188,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,53.8808,28.66,,percent of total billed charges,,
"Hiv-1 Ab Confirm And Differentiation, Plasma (Mayo)OutsideLaboratory",,86701,CPT,Facility,Outpatient,,,90,188,159.8,53.8808,188,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),92.12,49,,percent of total billed charges,,
"Hiv-1 Ab Confirm And Differentiation, Plasma (Mayo)OutsideLaboratory",,86701,CPT,Facility,Inpatient,,,90,188,159.8,53.8808,188,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Hiv-1 Ab Confirm And Differentiation, Plasma (Mayo)OutsideLaboratory",,86701,CPT,Facility,Both,,,90,188,159.8,53.8808,188,CorVel,Worker's Compensation,188,100,,percent of total billed charges,,
"Hiv-1 Ab Confirm And Differentiation, Plasma (Mayo)OutsideLaboratory",,86701,CPT,Facility,Both,,,90,188,159.8,53.8808,188,First Health Group Corporation,First Health Network,182.36,97,,percent of total billed charges,,
"Hiv-1 Ab Confirm And Differentiation, Plasma (Mayo)OutsideLaboratory",,86701,CPT,Facility,Both,,,90,188,159.8,53.8808,188,"Health Partners, Inc.",Commercial,177.848,94.6,,percent of total billed charges,,
"Hiv-1 Ab Confirm And Differentiation, Plasma (Mayo)OutsideLaboratory",,86701,CPT,Facility,Outpatient,,,90,188,159.8,53.8808,188,"Health Partners, Inc.",Medicare Advantage,92.12,49,,percent of total billed charges,,
"Hiv-1 Ab Confirm And Differentiation, Plasma (Mayo)OutsideLaboratory",,86701,CPT,Facility,Inpatient,,,90,188,159.8,53.8808,188,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Hiv-1 Ab Confirm And Differentiation, Plasma (Mayo)OutsideLaboratory",,86701,CPT,Facility,Both,,,90,188,159.8,53.8808,188,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),112.8,60,,percent of total billed charges,,
"Hiv-1 Ab Confirm And Differentiation, Plasma (Mayo)OutsideLaboratory",,86701,CPT,Facility,Both,,,90,188,159.8,53.8808,188,"Health Partners, Inc.",State of Minnesota Advantage Program,153.22,81.5,,percent of total billed charges,,
"Hiv-1 Ab Confirm And Differentiation, Plasma (Mayo)OutsideLaboratory",,86701,CPT,Facility,Both,,,90,188,159.8,53.8808,188,"Health Partners, Inc.",State Public Programs,94,50,,percent of total billed charges,,
"Hiv-1 Ab Confirm And Differentiation, Plasma (Mayo)OutsideLaboratory",,86701,CPT,Facility,Both,,,90,188,159.8,53.8808,188,Humana Insurance Company,Commercial PPO,178.6,95,,percent of total billed charges,,
"Hiv-1 Ab Confirm And Differentiation, Plasma (Mayo)OutsideLaboratory",,86701,CPT,Facility,Outpatient,,,90,188,159.8,53.8808,188,Humana Insurance Company,Medicare PPO,92.12,49,,percent of total billed charges,,
"Hiv-1 Ab Confirm And Differentiation, Plasma (Mayo)OutsideLaboratory",,86701,CPT,Facility,Inpatient,,,90,188,159.8,53.8808,188,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Hiv-1 Ab Confirm And Differentiation, Plasma (Mayo)OutsideLaboratory",,86701,CPT,Facility,Both,,,90,188,159.8,53.8808,188,Medica,Individual & Family,186.308,99.1,,percent of total billed charges,,
"Hiv-1 Ab Confirm And Differentiation, Plasma (Mayo)OutsideLaboratory",,86701,CPT,Facility,Outpatient,,,90,188,159.8,53.8808,188,Medica,Medica Advantage Solution,93.624,49.8,,percent of total billed charges,,
"Hiv-1 Ab Confirm And Differentiation, Plasma (Mayo)OutsideLaboratory",,86701,CPT,Facility,Inpatient,,,90,188,159.8,53.8808,188,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Hiv-1 Ab Confirm And Differentiation, Plasma (Mayo)OutsideLaboratory",,86701,CPT,Facility,Outpatient,,,90,188,159.8,53.8808,188,Medica,Medical Assistance,83.848,44.6,,percent of total billed charges,,
"Hiv-1 Ab Confirm And Differentiation, Plasma (Mayo)OutsideLaboratory",,86701,CPT,Facility,Inpatient,,,90,188,159.8,53.8808,188,Medica,Medical Assistance,,,,,Included in per diem rate,
"Hiv-1 Ab Confirm And Differentiation, Plasma (Mayo)OutsideLaboratory",,86701,CPT,Facility,Outpatient,,,90,188,159.8,53.8808,188,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,93.624,49.8,,percent of total billed charges,,
"Hiv-1 Ab Confirm And Differentiation, Plasma (Mayo)OutsideLaboratory",,86701,CPT,Facility,Inpatient,,,90,188,159.8,53.8808,188,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Hiv-1 Ab Confirm And Differentiation, Plasma (Mayo)OutsideLaboratory",,86701,CPT,Facility,Both,,,90,188,159.8,53.8808,188,"Multiplan, Inc.","Multiplan, Inc.",176.72,94,,percent of total billed charges,,
"Hiv-1 Ab Confirm And Differentiation, Plasma (Mayo)OutsideLaboratory",,86701,CPT,Facility,Outpatient,,,90,188,159.8,53.8808,188,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,162.432,86.4,,percent of total billed charges,,
"Hiv-1 Ab Confirm And Differentiation, Plasma (Mayo)OutsideLaboratory",,86701,CPT,Facility,Inpatient,,,90,188,159.8,53.8808,188,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Hiv-1 Ab Confirm And Differentiation, Plasma (Mayo)OutsideLaboratory",,86701,CPT,Facility,Both,,,90,188,159.8,53.8808,188,"Preferred One Administrative Services, INC.",PPO,185.368,98.6,,percent of total billed charges,,
"Hiv-1 Ab Confirm And Differentiation, Plasma (Mayo)OutsideLaboratory",,86701,CPT,Facility,Outpatient,,,90,188,159.8,53.8808,188,PrimeWest Health,Minnesota Senior Health Options (MSHO),96.726,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Hiv-1 Ab Confirm And Differentiation, Plasma (Mayo)OutsideLaboratory",,86701,CPT,Facility,Inpatient,,,90,188,159.8,53.8808,188,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Hiv-1 Ab Confirm And Differentiation, Plasma (Mayo)OutsideLaboratory",,86701,CPT,Facility,Outpatient,,,90,188,159.8,53.8808,188,PrimeWest Health,MinnesotaCare,96.5568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Hiv-1 Ab Confirm And Differentiation, Plasma (Mayo)OutsideLaboratory",,86701,CPT,Facility,Inpatient,,,90,188,159.8,53.8808,188,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Hiv-1 Ab Confirm And Differentiation, Plasma (Mayo)OutsideLaboratory",,86701,CPT,Facility,Both,,,90,188,159.8,53.8808,188,Sanford Health Plan,Sanford Health Plan,172.96,92,,percent of total billed charges,,
"Hiv-1 Ab Confirm And Differentiation, Plasma (Mayo)OutsideLaboratory",,86701,CPT,Facility,Outpatient,,,90,188,159.8,53.8808,188,"UCare Health, Inc.",Individual & Family Plan,105.938,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Hiv-1 Ab Confirm And Differentiation, Plasma (Mayo)OutsideLaboratory",,86701,CPT,Facility,Inpatient,,,90,188,159.8,53.8808,188,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Hiv-1 Ab Confirm And Differentiation, Plasma (Mayo)OutsideLaboratory",,86701,CPT,Facility,Outpatient,,,90,188,159.8,53.8808,188,"UCare Health, Inc.",Medical Assistance,94.8836,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Hiv-1 Ab Confirm And Differentiation, Plasma (Mayo)OutsideLaboratory",,86701,CPT,Facility,Inpatient,,,90,188,159.8,53.8808,188,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Hiv-1 Ab Confirm And Differentiation, Plasma (Mayo)OutsideLaboratory",,86701,CPT,Facility,Outpatient,,,90,188,159.8,53.8808,188,"UCare Health, Inc.",Medicare Advantage,94.8836,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Hiv-1 Ab Confirm And Differentiation, Plasma (Mayo)OutsideLaboratory",,86701,CPT,Facility,Inpatient,,,90,188,159.8,53.8808,188,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Hiv-1 Ab Confirm And Differentiation, Plasma (Mayo)OutsideLaboratory",,86701,CPT,Facility,Outpatient,,,90,188,159.8,53.8808,188,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),94.8836,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Hiv-1 Ab Confirm And Differentiation, Plasma (Mayo)OutsideLaboratory",,86701,CPT,Facility,Inpatient,,,90,188,159.8,53.8808,188,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Hiv-1 Ab Confirm And Differentiation, Plasma (Mayo)OutsideLaboratory",,86701,CPT,Facility,Both,,,90,188,159.8,53.8808,188,UnitedHealthcare,Individual & Family,176.72,94,,percent of total billed charges,,
"Hiv-1 Ab Confirm And Differentiation, Plasma (Mayo)OutsideLaboratory",,86701,CPT,Facility,Outpatient,,,90,188,159.8,53.8808,188,UnitedHealthcare,Medicare Advantage,92.12,49,,percent of total billed charges,,
"Hiv-1 Ab Confirm And Differentiation, Plasma (Mayo)OutsideLaboratory",,86701,CPT,Facility,Inpatient,,,90,188,159.8,53.8808,188,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Hiv-1 Ab Confirm And Differentiation, Plasma (Mayo)OutsideLaboratory",,86701,CPT,Facility,Outpatient,,,90,188,159.8,53.8808,188,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,90.24,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Hiv-1 Ab Confirm And Differentiation, Plasma (Mayo)OutsideLaboratory",,86701,CPT,Facility,Inpatient,,,90,188,159.8,53.8808,188,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Hiv-2 Ab Confirm And Differentiation, Plasma (Mayo)OutsideLaboratory",,86702,CPT,Facility,Both,,,90,179,152.15,51.3014,179,Aetna,Commercial,164.68,92,,percent of total billed charges,,
"Hiv-2 Ab Confirm And Differentiation, Plasma (Mayo)OutsideLaboratory",,86702,CPT,Facility,Outpatient,,,90,179,152.15,51.3014,179,Aetna,Medicare Advantage,87.71,49,,percent of total billed charges,,
"Hiv-2 Ab Confirm And Differentiation, Plasma (Mayo)OutsideLaboratory",,86702,CPT,Facility,Inpatient,,,90,179,152.15,51.3014,179,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Hiv-2 Ab Confirm And Differentiation, Plasma (Mayo)OutsideLaboratory",,86702,CPT,Facility,Both,,,90,179,152.15,51.3014,179,Aetna,PPO,166.47,93,,percent of total billed charges,,
"Hiv-2 Ab Confirm And Differentiation, Plasma (Mayo)OutsideLaboratory",,86702,CPT,Facility,Both,,,90,179,152.15,51.3014,179,America's PPO,America's PPO,171.8937,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Hiv-2 Ab Confirm And Differentiation, Plasma (Mayo)OutsideLaboratory",,86702,CPT,Facility,Both,,,90,179,152.15,51.3014,179,BlueCross BlueShield Minnesota, Federal Employee Program,176.136,98.4,,percent of total billed charges,,
"Hiv-2 Ab Confirm And Differentiation, Plasma (Mayo)OutsideLaboratory",,86702,CPT,Facility,Both,,,90,179,152.15,51.3014,179,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,179,100,,percent of total billed charges,,
"Hiv-2 Ab Confirm And Differentiation, Plasma (Mayo)OutsideLaboratory",,86702,CPT,Facility,Both,,,90,179,152.15,51.3014,179,BlueCross BlueShield Minnesota,High Value Network Plan,161.1,90,,percent of total billed charges,,
"Hiv-2 Ab Confirm And Differentiation, Plasma (Mayo)OutsideLaboratory",,86702,CPT,Facility,Outpatient,,,90,179,152.15,51.3014,179,BlueCross BlueShield Minnesota,Medicare Advantage,87.71,49,,percent of total billed charges,,
"Hiv-2 Ab Confirm And Differentiation, Plasma (Mayo)OutsideLaboratory",,86702,CPT,Facility,Inpatient,,,90,179,152.15,51.3014,179,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Hiv-2 Ab Confirm And Differentiation, Plasma (Mayo)OutsideLaboratory",,86702,CPT,Facility,Both,,,90,179,152.15,51.3014,179,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,158.5403,88.57,,percent of total billed charges,,
"Hiv-2 Ab Confirm And Differentiation, Plasma (Mayo)OutsideLaboratory",,86702,CPT,Facility,Both,,,90,179,152.15,51.3014,179,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,51.3014,28.66,,percent of total billed charges,,
"Hiv-2 Ab Confirm And Differentiation, Plasma (Mayo)OutsideLaboratory",,86702,CPT,Facility,Outpatient,,,90,179,152.15,51.3014,179,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),87.71,49,,percent of total billed charges,,
"Hiv-2 Ab Confirm And Differentiation, Plasma (Mayo)OutsideLaboratory",,86702,CPT,Facility,Inpatient,,,90,179,152.15,51.3014,179,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Hiv-2 Ab Confirm And Differentiation, Plasma (Mayo)OutsideLaboratory",,86702,CPT,Facility,Both,,,90,179,152.15,51.3014,179,CorVel,Worker's Compensation,179,100,,percent of total billed charges,,
"Hiv-2 Ab Confirm And Differentiation, Plasma (Mayo)OutsideLaboratory",,86702,CPT,Facility,Both,,,90,179,152.15,51.3014,179,First Health Group Corporation,First Health Network,173.63,97,,percent of total billed charges,,
"Hiv-2 Ab Confirm And Differentiation, Plasma (Mayo)OutsideLaboratory",,86702,CPT,Facility,Both,,,90,179,152.15,51.3014,179,"Health Partners, Inc.",Commercial,169.334,94.6,,percent of total billed charges,,
"Hiv-2 Ab Confirm And Differentiation, Plasma (Mayo)OutsideLaboratory",,86702,CPT,Facility,Outpatient,,,90,179,152.15,51.3014,179,"Health Partners, Inc.",Medicare Advantage,87.71,49,,percent of total billed charges,,
"Hiv-2 Ab Confirm And Differentiation, Plasma (Mayo)OutsideLaboratory",,86702,CPT,Facility,Inpatient,,,90,179,152.15,51.3014,179,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Hiv-2 Ab Confirm And Differentiation, Plasma (Mayo)OutsideLaboratory",,86702,CPT,Facility,Both,,,90,179,152.15,51.3014,179,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),107.4,60,,percent of total billed charges,,
"Hiv-2 Ab Confirm And Differentiation, Plasma (Mayo)OutsideLaboratory",,86702,CPT,Facility,Both,,,90,179,152.15,51.3014,179,"Health Partners, Inc.",State of Minnesota Advantage Program,145.885,81.5,,percent of total billed charges,,
"Hiv-2 Ab Confirm And Differentiation, Plasma (Mayo)OutsideLaboratory",,86702,CPT,Facility,Both,,,90,179,152.15,51.3014,179,"Health Partners, Inc.",State Public Programs,89.5,50,,percent of total billed charges,,
"Hiv-2 Ab Confirm And Differentiation, Plasma (Mayo)OutsideLaboratory",,86702,CPT,Facility,Both,,,90,179,152.15,51.3014,179,Humana Insurance Company,Commercial PPO,170.05,95,,percent of total billed charges,,
"Hiv-2 Ab Confirm And Differentiation, Plasma (Mayo)OutsideLaboratory",,86702,CPT,Facility,Outpatient,,,90,179,152.15,51.3014,179,Humana Insurance Company,Medicare PPO,87.71,49,,percent of total billed charges,,
"Hiv-2 Ab Confirm And Differentiation, Plasma (Mayo)OutsideLaboratory",,86702,CPT,Facility,Inpatient,,,90,179,152.15,51.3014,179,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Hiv-2 Ab Confirm And Differentiation, Plasma (Mayo)OutsideLaboratory",,86702,CPT,Facility,Both,,,90,179,152.15,51.3014,179,Medica,Individual & Family,177.389,99.1,,percent of total billed charges,,
"Hiv-2 Ab Confirm And Differentiation, Plasma (Mayo)OutsideLaboratory",,86702,CPT,Facility,Outpatient,,,90,179,152.15,51.3014,179,Medica,Medica Advantage Solution,89.142,49.8,,percent of total billed charges,,
"Hiv-2 Ab Confirm And Differentiation, Plasma (Mayo)OutsideLaboratory",,86702,CPT,Facility,Inpatient,,,90,179,152.15,51.3014,179,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Hiv-2 Ab Confirm And Differentiation, Plasma (Mayo)OutsideLaboratory",,86702,CPT,Facility,Outpatient,,,90,179,152.15,51.3014,179,Medica,Medical Assistance,79.834,44.6,,percent of total billed charges,,
"Hiv-2 Ab Confirm And Differentiation, Plasma (Mayo)OutsideLaboratory",,86702,CPT,Facility,Inpatient,,,90,179,152.15,51.3014,179,Medica,Medical Assistance,,,,,Included in per diem rate,
"Hiv-2 Ab Confirm And Differentiation, Plasma (Mayo)OutsideLaboratory",,86702,CPT,Facility,Outpatient,,,90,179,152.15,51.3014,179,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,89.142,49.8,,percent of total billed charges,,
"Hiv-2 Ab Confirm And Differentiation, Plasma (Mayo)OutsideLaboratory",,86702,CPT,Facility,Inpatient,,,90,179,152.15,51.3014,179,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Hiv-2 Ab Confirm And Differentiation, Plasma (Mayo)OutsideLaboratory",,86702,CPT,Facility,Both,,,90,179,152.15,51.3014,179,"Multiplan, Inc.","Multiplan, Inc.",168.26,94,,percent of total billed charges,,
"Hiv-2 Ab Confirm And Differentiation, Plasma (Mayo)OutsideLaboratory",,86702,CPT,Facility,Outpatient,,,90,179,152.15,51.3014,179,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,154.656,86.4,,percent of total billed charges,,
"Hiv-2 Ab Confirm And Differentiation, Plasma (Mayo)OutsideLaboratory",,86702,CPT,Facility,Inpatient,,,90,179,152.15,51.3014,179,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Hiv-2 Ab Confirm And Differentiation, Plasma (Mayo)OutsideLaboratory",,86702,CPT,Facility,Both,,,90,179,152.15,51.3014,179,"Preferred One Administrative Services, INC.",PPO,176.494,98.6,,percent of total billed charges,,
"Hiv-2 Ab Confirm And Differentiation, Plasma (Mayo)OutsideLaboratory",,86702,CPT,Facility,Outpatient,,,90,179,152.15,51.3014,179,PrimeWest Health,Minnesota Senior Health Options (MSHO),92.0955,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Hiv-2 Ab Confirm And Differentiation, Plasma (Mayo)OutsideLaboratory",,86702,CPT,Facility,Inpatient,,,90,179,152.15,51.3014,179,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Hiv-2 Ab Confirm And Differentiation, Plasma (Mayo)OutsideLaboratory",,86702,CPT,Facility,Outpatient,,,90,179,152.15,51.3014,179,PrimeWest Health,MinnesotaCare,91.9344,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Hiv-2 Ab Confirm And Differentiation, Plasma (Mayo)OutsideLaboratory",,86702,CPT,Facility,Inpatient,,,90,179,152.15,51.3014,179,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Hiv-2 Ab Confirm And Differentiation, Plasma (Mayo)OutsideLaboratory",,86702,CPT,Facility,Both,,,90,179,152.15,51.3014,179,Sanford Health Plan,Sanford Health Plan,164.68,92,,percent of total billed charges,,
"Hiv-2 Ab Confirm And Differentiation, Plasma (Mayo)OutsideLaboratory",,86702,CPT,Facility,Outpatient,,,90,179,152.15,51.3014,179,"UCare Health, Inc.",Individual & Family Plan,100.8665,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Hiv-2 Ab Confirm And Differentiation, Plasma (Mayo)OutsideLaboratory",,86702,CPT,Facility,Inpatient,,,90,179,152.15,51.3014,179,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Hiv-2 Ab Confirm And Differentiation, Plasma (Mayo)OutsideLaboratory",,86702,CPT,Facility,Outpatient,,,90,179,152.15,51.3014,179,"UCare Health, Inc.",Medical Assistance,90.3413,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Hiv-2 Ab Confirm And Differentiation, Plasma (Mayo)OutsideLaboratory",,86702,CPT,Facility,Inpatient,,,90,179,152.15,51.3014,179,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Hiv-2 Ab Confirm And Differentiation, Plasma (Mayo)OutsideLaboratory",,86702,CPT,Facility,Outpatient,,,90,179,152.15,51.3014,179,"UCare Health, Inc.",Medicare Advantage,90.3413,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Hiv-2 Ab Confirm And Differentiation, Plasma (Mayo)OutsideLaboratory",,86702,CPT,Facility,Inpatient,,,90,179,152.15,51.3014,179,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Hiv-2 Ab Confirm And Differentiation, Plasma (Mayo)OutsideLaboratory",,86702,CPT,Facility,Outpatient,,,90,179,152.15,51.3014,179,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),90.3413,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Hiv-2 Ab Confirm And Differentiation, Plasma (Mayo)OutsideLaboratory",,86702,CPT,Facility,Inpatient,,,90,179,152.15,51.3014,179,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Hiv-2 Ab Confirm And Differentiation, Plasma (Mayo)OutsideLaboratory",,86702,CPT,Facility,Both,,,90,179,152.15,51.3014,179,UnitedHealthcare,Individual & Family,168.26,94,,percent of total billed charges,,
"Hiv-2 Ab Confirm And Differentiation, Plasma (Mayo)OutsideLaboratory",,86702,CPT,Facility,Outpatient,,,90,179,152.15,51.3014,179,UnitedHealthcare,Medicare Advantage,87.71,49,,percent of total billed charges,,
"Hiv-2 Ab Confirm And Differentiation, Plasma (Mayo)OutsideLaboratory",,86702,CPT,Facility,Inpatient,,,90,179,152.15,51.3014,179,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Hiv-2 Ab Confirm And Differentiation, Plasma (Mayo)OutsideLaboratory",,86702,CPT,Facility,Outpatient,,,90,179,152.15,51.3014,179,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,85.92,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Hiv-2 Ab Confirm And Differentiation, Plasma (Mayo)OutsideLaboratory",,86702,CPT,Facility,Inpatient,,,90,179,152.15,51.3014,179,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Hbc Antibody Total (Mayo)OutsideLaboratory,,86704,CPT,Facility,Both,,,90,92,78.2,26.3672,92,Aetna,Commercial,84.64,92,,percent of total billed charges,,
Hbc Antibody Total (Mayo)OutsideLaboratory,,86704,CPT,Facility,Outpatient,,,90,92,78.2,26.3672,92,Aetna,Medicare Advantage,45.08,49,,percent of total billed charges,,
Hbc Antibody Total (Mayo)OutsideLaboratory,,86704,CPT,Facility,Inpatient,,,90,92,78.2,26.3672,92,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Hbc Antibody Total (Mayo)OutsideLaboratory,,86704,CPT,Facility,Both,,,90,92,78.2,26.3672,92,Aetna,PPO,85.56,93,,percent of total billed charges,,
Hbc Antibody Total (Mayo)OutsideLaboratory,,86704,CPT,Facility,Both,,,90,92,78.2,26.3672,92,America's PPO,America's PPO,88.3476,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Hbc Antibody Total (Mayo)OutsideLaboratory,,86704,CPT,Facility,Both,,,90,92,78.2,26.3672,92,BlueCross BlueShield Minnesota, Federal Employee Program,90.528,98.4,,percent of total billed charges,,
Hbc Antibody Total (Mayo)OutsideLaboratory,,86704,CPT,Facility,Both,,,90,92,78.2,26.3672,92,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,92,100,,percent of total billed charges,,
Hbc Antibody Total (Mayo)OutsideLaboratory,,86704,CPT,Facility,Both,,,90,92,78.2,26.3672,92,BlueCross BlueShield Minnesota,High Value Network Plan,82.8,90,,percent of total billed charges,,
Hbc Antibody Total (Mayo)OutsideLaboratory,,86704,CPT,Facility,Outpatient,,,90,92,78.2,26.3672,92,BlueCross BlueShield Minnesota,Medicare Advantage,45.08,49,,percent of total billed charges,,
Hbc Antibody Total (Mayo)OutsideLaboratory,,86704,CPT,Facility,Inpatient,,,90,92,78.2,26.3672,92,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Hbc Antibody Total (Mayo)OutsideLaboratory,,86704,CPT,Facility,Both,,,90,92,78.2,26.3672,92,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,81.4844,88.57,,percent of total billed charges,,
Hbc Antibody Total (Mayo)OutsideLaboratory,,86704,CPT,Facility,Both,,,90,92,78.2,26.3672,92,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,26.3672,28.66,,percent of total billed charges,,
Hbc Antibody Total (Mayo)OutsideLaboratory,,86704,CPT,Facility,Outpatient,,,90,92,78.2,26.3672,92,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),45.08,49,,percent of total billed charges,,
Hbc Antibody Total (Mayo)OutsideLaboratory,,86704,CPT,Facility,Inpatient,,,90,92,78.2,26.3672,92,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Hbc Antibody Total (Mayo)OutsideLaboratory,,86704,CPT,Facility,Both,,,90,92,78.2,26.3672,92,CorVel,Worker's Compensation,92,100,,percent of total billed charges,,
Hbc Antibody Total (Mayo)OutsideLaboratory,,86704,CPT,Facility,Both,,,90,92,78.2,26.3672,92,First Health Group Corporation,First Health Network,89.24,97,,percent of total billed charges,,
Hbc Antibody Total (Mayo)OutsideLaboratory,,86704,CPT,Facility,Both,,,90,92,78.2,26.3672,92,"Health Partners, Inc.",Commercial,87.032,94.6,,percent of total billed charges,,
Hbc Antibody Total (Mayo)OutsideLaboratory,,86704,CPT,Facility,Outpatient,,,90,92,78.2,26.3672,92,"Health Partners, Inc.",Medicare Advantage,45.08,49,,percent of total billed charges,,
Hbc Antibody Total (Mayo)OutsideLaboratory,,86704,CPT,Facility,Inpatient,,,90,92,78.2,26.3672,92,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Hbc Antibody Total (Mayo)OutsideLaboratory,,86704,CPT,Facility,Both,,,90,92,78.2,26.3672,92,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),55.2,60,,percent of total billed charges,,
Hbc Antibody Total (Mayo)OutsideLaboratory,,86704,CPT,Facility,Both,,,90,92,78.2,26.3672,92,"Health Partners, Inc.",State of Minnesota Advantage Program,74.98,81.5,,percent of total billed charges,,
Hbc Antibody Total (Mayo)OutsideLaboratory,,86704,CPT,Facility,Both,,,90,92,78.2,26.3672,92,"Health Partners, Inc.",State Public Programs,46,50,,percent of total billed charges,,
Hbc Antibody Total (Mayo)OutsideLaboratory,,86704,CPT,Facility,Both,,,90,92,78.2,26.3672,92,Humana Insurance Company,Commercial PPO,87.4,95,,percent of total billed charges,,
Hbc Antibody Total (Mayo)OutsideLaboratory,,86704,CPT,Facility,Outpatient,,,90,92,78.2,26.3672,92,Humana Insurance Company,Medicare PPO,45.08,49,,percent of total billed charges,,
Hbc Antibody Total (Mayo)OutsideLaboratory,,86704,CPT,Facility,Inpatient,,,90,92,78.2,26.3672,92,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Hbc Antibody Total (Mayo)OutsideLaboratory,,86704,CPT,Facility,Both,,,90,92,78.2,26.3672,92,Medica,Individual & Family,91.172,99.1,,percent of total billed charges,,
Hbc Antibody Total (Mayo)OutsideLaboratory,,86704,CPT,Facility,Outpatient,,,90,92,78.2,26.3672,92,Medica,Medica Advantage Solution,45.816,49.8,,percent of total billed charges,,
Hbc Antibody Total (Mayo)OutsideLaboratory,,86704,CPT,Facility,Inpatient,,,90,92,78.2,26.3672,92,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Hbc Antibody Total (Mayo)OutsideLaboratory,,86704,CPT,Facility,Outpatient,,,90,92,78.2,26.3672,92,Medica,Medical Assistance,41.032,44.6,,percent of total billed charges,,
Hbc Antibody Total (Mayo)OutsideLaboratory,,86704,CPT,Facility,Inpatient,,,90,92,78.2,26.3672,92,Medica,Medical Assistance,,,,,Included in per diem rate,
Hbc Antibody Total (Mayo)OutsideLaboratory,,86704,CPT,Facility,Outpatient,,,90,92,78.2,26.3672,92,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,45.816,49.8,,percent of total billed charges,,
Hbc Antibody Total (Mayo)OutsideLaboratory,,86704,CPT,Facility,Inpatient,,,90,92,78.2,26.3672,92,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Hbc Antibody Total (Mayo)OutsideLaboratory,,86704,CPT,Facility,Both,,,90,92,78.2,26.3672,92,"Multiplan, Inc.","Multiplan, Inc.",86.48,94,,percent of total billed charges,,
Hbc Antibody Total (Mayo)OutsideLaboratory,,86704,CPT,Facility,Outpatient,,,90,92,78.2,26.3672,92,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,79.488,86.4,,percent of total billed charges,,
Hbc Antibody Total (Mayo)OutsideLaboratory,,86704,CPT,Facility,Inpatient,,,90,92,78.2,26.3672,92,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Hbc Antibody Total (Mayo)OutsideLaboratory,,86704,CPT,Facility,Both,,,90,92,78.2,26.3672,92,"Preferred One Administrative Services, INC.",PPO,90.712,98.6,,percent of total billed charges,,
Hbc Antibody Total (Mayo)OutsideLaboratory,,86704,CPT,Facility,Outpatient,,,90,92,78.2,26.3672,92,PrimeWest Health,Minnesota Senior Health Options (MSHO),47.334,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Hbc Antibody Total (Mayo)OutsideLaboratory,,86704,CPT,Facility,Inpatient,,,90,92,78.2,26.3672,92,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Hbc Antibody Total (Mayo)OutsideLaboratory,,86704,CPT,Facility,Outpatient,,,90,92,78.2,26.3672,92,PrimeWest Health,MinnesotaCare,47.2512,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Hbc Antibody Total (Mayo)OutsideLaboratory,,86704,CPT,Facility,Inpatient,,,90,92,78.2,26.3672,92,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Hbc Antibody Total (Mayo)OutsideLaboratory,,86704,CPT,Facility,Both,,,90,92,78.2,26.3672,92,Sanford Health Plan,Sanford Health Plan,84.64,92,,percent of total billed charges,,
Hbc Antibody Total (Mayo)OutsideLaboratory,,86704,CPT,Facility,Outpatient,,,90,92,78.2,26.3672,92,"UCare Health, Inc.",Individual & Family Plan,51.842,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Hbc Antibody Total (Mayo)OutsideLaboratory,,86704,CPT,Facility,Inpatient,,,90,92,78.2,26.3672,92,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Hbc Antibody Total (Mayo)OutsideLaboratory,,86704,CPT,Facility,Outpatient,,,90,92,78.2,26.3672,92,"UCare Health, Inc.",Medical Assistance,46.4324,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Hbc Antibody Total (Mayo)OutsideLaboratory,,86704,CPT,Facility,Inpatient,,,90,92,78.2,26.3672,92,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Hbc Antibody Total (Mayo)OutsideLaboratory,,86704,CPT,Facility,Outpatient,,,90,92,78.2,26.3672,92,"UCare Health, Inc.",Medicare Advantage,46.4324,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Hbc Antibody Total (Mayo)OutsideLaboratory,,86704,CPT,Facility,Inpatient,,,90,92,78.2,26.3672,92,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Hbc Antibody Total (Mayo)OutsideLaboratory,,86704,CPT,Facility,Outpatient,,,90,92,78.2,26.3672,92,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),46.4324,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Hbc Antibody Total (Mayo)OutsideLaboratory,,86704,CPT,Facility,Inpatient,,,90,92,78.2,26.3672,92,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Hbc Antibody Total (Mayo)OutsideLaboratory,,86704,CPT,Facility,Both,,,90,92,78.2,26.3672,92,UnitedHealthcare,Individual & Family,86.48,94,,percent of total billed charges,,
Hbc Antibody Total (Mayo)OutsideLaboratory,,86704,CPT,Facility,Outpatient,,,90,92,78.2,26.3672,92,UnitedHealthcare,Medicare Advantage,45.08,49,,percent of total billed charges,,
Hbc Antibody Total (Mayo)OutsideLaboratory,,86704,CPT,Facility,Inpatient,,,90,92,78.2,26.3672,92,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Hbc Antibody Total (Mayo)OutsideLaboratory,,86704,CPT,Facility,Outpatient,,,90,92,78.2,26.3672,92,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,44.16,48,,percent of total billed charges,,100% of DHS outpatient percentage
Hbc Antibody Total (Mayo)OutsideLaboratory,,86704,CPT,Facility,Inpatient,,,90,92,78.2,26.3672,92,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Hbc Total Ab, S (Mayo)OutsideLaboratory",,86704,CPT,Facility,Both,,,90,83,70.55,23.7878,83,Aetna,Commercial,76.36,92,,percent of total billed charges,,
"Hbc Total Ab, S (Mayo)OutsideLaboratory",,86704,CPT,Facility,Outpatient,,,90,83,70.55,23.7878,83,Aetna,Medicare Advantage,40.67,49,,percent of total billed charges,,
"Hbc Total Ab, S (Mayo)OutsideLaboratory",,86704,CPT,Facility,Inpatient,,,90,83,70.55,23.7878,83,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Hbc Total Ab, S (Mayo)OutsideLaboratory",,86704,CPT,Facility,Both,,,90,83,70.55,23.7878,83,Aetna,PPO,77.19,93,,percent of total billed charges,,
"Hbc Total Ab, S (Mayo)OutsideLaboratory",,86704,CPT,Facility,Both,,,90,83,70.55,23.7878,83,America's PPO,America's PPO,79.7049,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Hbc Total Ab, S (Mayo)OutsideLaboratory",,86704,CPT,Facility,Both,,,90,83,70.55,23.7878,83,BlueCross BlueShield Minnesota, Federal Employee Program,81.672,98.4,,percent of total billed charges,,
"Hbc Total Ab, S (Mayo)OutsideLaboratory",,86704,CPT,Facility,Both,,,90,83,70.55,23.7878,83,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,83,100,,percent of total billed charges,,
"Hbc Total Ab, S (Mayo)OutsideLaboratory",,86704,CPT,Facility,Both,,,90,83,70.55,23.7878,83,BlueCross BlueShield Minnesota,High Value Network Plan,74.7,90,,percent of total billed charges,,
"Hbc Total Ab, S (Mayo)OutsideLaboratory",,86704,CPT,Facility,Outpatient,,,90,83,70.55,23.7878,83,BlueCross BlueShield Minnesota,Medicare Advantage,40.67,49,,percent of total billed charges,,
"Hbc Total Ab, S (Mayo)OutsideLaboratory",,86704,CPT,Facility,Inpatient,,,90,83,70.55,23.7878,83,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Hbc Total Ab, S (Mayo)OutsideLaboratory",,86704,CPT,Facility,Both,,,90,83,70.55,23.7878,83,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,73.5131,88.57,,percent of total billed charges,,
"Hbc Total Ab, S (Mayo)OutsideLaboratory",,86704,CPT,Facility,Both,,,90,83,70.55,23.7878,83,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,23.7878,28.66,,percent of total billed charges,,
"Hbc Total Ab, S (Mayo)OutsideLaboratory",,86704,CPT,Facility,Outpatient,,,90,83,70.55,23.7878,83,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),40.67,49,,percent of total billed charges,,
"Hbc Total Ab, S (Mayo)OutsideLaboratory",,86704,CPT,Facility,Inpatient,,,90,83,70.55,23.7878,83,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Hbc Total Ab, S (Mayo)OutsideLaboratory",,86704,CPT,Facility,Both,,,90,83,70.55,23.7878,83,CorVel,Worker's Compensation,83,100,,percent of total billed charges,,
"Hbc Total Ab, S (Mayo)OutsideLaboratory",,86704,CPT,Facility,Both,,,90,83,70.55,23.7878,83,First Health Group Corporation,First Health Network,80.51,97,,percent of total billed charges,,
"Hbc Total Ab, S (Mayo)OutsideLaboratory",,86704,CPT,Facility,Both,,,90,83,70.55,23.7878,83,"Health Partners, Inc.",Commercial,78.518,94.6,,percent of total billed charges,,
"Hbc Total Ab, S (Mayo)OutsideLaboratory",,86704,CPT,Facility,Outpatient,,,90,83,70.55,23.7878,83,"Health Partners, Inc.",Medicare Advantage,40.67,49,,percent of total billed charges,,
"Hbc Total Ab, S (Mayo)OutsideLaboratory",,86704,CPT,Facility,Inpatient,,,90,83,70.55,23.7878,83,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Hbc Total Ab, S (Mayo)OutsideLaboratory",,86704,CPT,Facility,Both,,,90,83,70.55,23.7878,83,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),49.8,60,,percent of total billed charges,,
"Hbc Total Ab, S (Mayo)OutsideLaboratory",,86704,CPT,Facility,Both,,,90,83,70.55,23.7878,83,"Health Partners, Inc.",State of Minnesota Advantage Program,67.645,81.5,,percent of total billed charges,,
"Hbc Total Ab, S (Mayo)OutsideLaboratory",,86704,CPT,Facility,Both,,,90,83,70.55,23.7878,83,"Health Partners, Inc.",State Public Programs,41.5,50,,percent of total billed charges,,
"Hbc Total Ab, S (Mayo)OutsideLaboratory",,86704,CPT,Facility,Both,,,90,83,70.55,23.7878,83,Humana Insurance Company,Commercial PPO,78.85,95,,percent of total billed charges,,
"Hbc Total Ab, S (Mayo)OutsideLaboratory",,86704,CPT,Facility,Outpatient,,,90,83,70.55,23.7878,83,Humana Insurance Company,Medicare PPO,40.67,49,,percent of total billed charges,,
"Hbc Total Ab, S (Mayo)OutsideLaboratory",,86704,CPT,Facility,Inpatient,,,90,83,70.55,23.7878,83,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Hbc Total Ab, S (Mayo)OutsideLaboratory",,86704,CPT,Facility,Both,,,90,83,70.55,23.7878,83,Medica,Individual & Family,82.253,99.1,,percent of total billed charges,,
"Hbc Total Ab, S (Mayo)OutsideLaboratory",,86704,CPT,Facility,Outpatient,,,90,83,70.55,23.7878,83,Medica,Medica Advantage Solution,41.334,49.8,,percent of total billed charges,,
"Hbc Total Ab, S (Mayo)OutsideLaboratory",,86704,CPT,Facility,Inpatient,,,90,83,70.55,23.7878,83,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Hbc Total Ab, S (Mayo)OutsideLaboratory",,86704,CPT,Facility,Outpatient,,,90,83,70.55,23.7878,83,Medica,Medical Assistance,37.018,44.6,,percent of total billed charges,,
"Hbc Total Ab, S (Mayo)OutsideLaboratory",,86704,CPT,Facility,Inpatient,,,90,83,70.55,23.7878,83,Medica,Medical Assistance,,,,,Included in per diem rate,
"Hbc Total Ab, S (Mayo)OutsideLaboratory",,86704,CPT,Facility,Outpatient,,,90,83,70.55,23.7878,83,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,41.334,49.8,,percent of total billed charges,,
"Hbc Total Ab, S (Mayo)OutsideLaboratory",,86704,CPT,Facility,Inpatient,,,90,83,70.55,23.7878,83,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Hbc Total Ab, S (Mayo)OutsideLaboratory",,86704,CPT,Facility,Both,,,90,83,70.55,23.7878,83,"Multiplan, Inc.","Multiplan, Inc.",78.02,94,,percent of total billed charges,,
"Hbc Total Ab, S (Mayo)OutsideLaboratory",,86704,CPT,Facility,Outpatient,,,90,83,70.55,23.7878,83,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,71.712,86.4,,percent of total billed charges,,
"Hbc Total Ab, S (Mayo)OutsideLaboratory",,86704,CPT,Facility,Inpatient,,,90,83,70.55,23.7878,83,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Hbc Total Ab, S (Mayo)OutsideLaboratory",,86704,CPT,Facility,Both,,,90,83,70.55,23.7878,83,"Preferred One Administrative Services, INC.",PPO,81.838,98.6,,percent of total billed charges,,
"Hbc Total Ab, S (Mayo)OutsideLaboratory",,86704,CPT,Facility,Outpatient,,,90,83,70.55,23.7878,83,PrimeWest Health,Minnesota Senior Health Options (MSHO),42.7035,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Hbc Total Ab, S (Mayo)OutsideLaboratory",,86704,CPT,Facility,Inpatient,,,90,83,70.55,23.7878,83,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Hbc Total Ab, S (Mayo)OutsideLaboratory",,86704,CPT,Facility,Outpatient,,,90,83,70.55,23.7878,83,PrimeWest Health,MinnesotaCare,42.6288,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Hbc Total Ab, S (Mayo)OutsideLaboratory",,86704,CPT,Facility,Inpatient,,,90,83,70.55,23.7878,83,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Hbc Total Ab, S (Mayo)OutsideLaboratory",,86704,CPT,Facility,Both,,,90,83,70.55,23.7878,83,Sanford Health Plan,Sanford Health Plan,76.36,92,,percent of total billed charges,,
"Hbc Total Ab, S (Mayo)OutsideLaboratory",,86704,CPT,Facility,Outpatient,,,90,83,70.55,23.7878,83,"UCare Health, Inc.",Individual & Family Plan,46.7705,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Hbc Total Ab, S (Mayo)OutsideLaboratory",,86704,CPT,Facility,Inpatient,,,90,83,70.55,23.7878,83,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Hbc Total Ab, S (Mayo)OutsideLaboratory",,86704,CPT,Facility,Outpatient,,,90,83,70.55,23.7878,83,"UCare Health, Inc.",Medical Assistance,41.8901,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Hbc Total Ab, S (Mayo)OutsideLaboratory",,86704,CPT,Facility,Inpatient,,,90,83,70.55,23.7878,83,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Hbc Total Ab, S (Mayo)OutsideLaboratory",,86704,CPT,Facility,Outpatient,,,90,83,70.55,23.7878,83,"UCare Health, Inc.",Medicare Advantage,41.8901,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Hbc Total Ab, S (Mayo)OutsideLaboratory",,86704,CPT,Facility,Inpatient,,,90,83,70.55,23.7878,83,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Hbc Total Ab, S (Mayo)OutsideLaboratory",,86704,CPT,Facility,Outpatient,,,90,83,70.55,23.7878,83,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),41.8901,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Hbc Total Ab, S (Mayo)OutsideLaboratory",,86704,CPT,Facility,Inpatient,,,90,83,70.55,23.7878,83,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Hbc Total Ab, S (Mayo)OutsideLaboratory",,86704,CPT,Facility,Both,,,90,83,70.55,23.7878,83,UnitedHealthcare,Individual & Family,78.02,94,,percent of total billed charges,,
"Hbc Total Ab, S (Mayo)OutsideLaboratory",,86704,CPT,Facility,Outpatient,,,90,83,70.55,23.7878,83,UnitedHealthcare,Medicare Advantage,40.67,49,,percent of total billed charges,,
"Hbc Total Ab, S (Mayo)OutsideLaboratory",,86704,CPT,Facility,Inpatient,,,90,83,70.55,23.7878,83,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Hbc Total Ab, S (Mayo)OutsideLaboratory",,86704,CPT,Facility,Outpatient,,,90,83,70.55,23.7878,83,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,39.84,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Hbc Total Ab, S (Mayo)OutsideLaboratory",,86704,CPT,Facility,Inpatient,,,90,83,70.55,23.7878,83,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Hepatitis A Total Ab, S (Mayo)OutsideLaboratory",,86708,CPT,Facility,Both,,,90,102,86.7,29.2332,102,Aetna,Commercial,93.84,92,,percent of total billed charges,,
"Hepatitis A Total Ab, S (Mayo)OutsideLaboratory",,86708,CPT,Facility,Outpatient,,,90,102,86.7,29.2332,102,Aetna,Medicare Advantage,49.98,49,,percent of total billed charges,,
"Hepatitis A Total Ab, S (Mayo)OutsideLaboratory",,86708,CPT,Facility,Inpatient,,,90,102,86.7,29.2332,102,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Hepatitis A Total Ab, S (Mayo)OutsideLaboratory",,86708,CPT,Facility,Both,,,90,102,86.7,29.2332,102,Aetna,PPO,94.86,93,,percent of total billed charges,,
"Hepatitis A Total Ab, S (Mayo)OutsideLaboratory",,86708,CPT,Facility,Both,,,90,102,86.7,29.2332,102,America's PPO,America's PPO,97.9506,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Hepatitis A Total Ab, S (Mayo)OutsideLaboratory",,86708,CPT,Facility,Both,,,90,102,86.7,29.2332,102,BlueCross BlueShield Minnesota, Federal Employee Program,100.368,98.4,,percent of total billed charges,,
"Hepatitis A Total Ab, S (Mayo)OutsideLaboratory",,86708,CPT,Facility,Both,,,90,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,102,100,,percent of total billed charges,,
"Hepatitis A Total Ab, S (Mayo)OutsideLaboratory",,86708,CPT,Facility,Both,,,90,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,High Value Network Plan,91.8,90,,percent of total billed charges,,
"Hepatitis A Total Ab, S (Mayo)OutsideLaboratory",,86708,CPT,Facility,Outpatient,,,90,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,Medicare Advantage,49.98,49,,percent of total billed charges,,
"Hepatitis A Total Ab, S (Mayo)OutsideLaboratory",,86708,CPT,Facility,Inpatient,,,90,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Hepatitis A Total Ab, S (Mayo)OutsideLaboratory",,86708,CPT,Facility,Both,,,90,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,90.3414,88.57,,percent of total billed charges,,
"Hepatitis A Total Ab, S (Mayo)OutsideLaboratory",,86708,CPT,Facility,Both,,,90,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,29.2332,28.66,,percent of total billed charges,,
"Hepatitis A Total Ab, S (Mayo)OutsideLaboratory",,86708,CPT,Facility,Outpatient,,,90,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),49.98,49,,percent of total billed charges,,
"Hepatitis A Total Ab, S (Mayo)OutsideLaboratory",,86708,CPT,Facility,Inpatient,,,90,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Hepatitis A Total Ab, S (Mayo)OutsideLaboratory",,86708,CPT,Facility,Both,,,90,102,86.7,29.2332,102,CorVel,Worker's Compensation,102,100,,percent of total billed charges,,
"Hepatitis A Total Ab, S (Mayo)OutsideLaboratory",,86708,CPT,Facility,Both,,,90,102,86.7,29.2332,102,First Health Group Corporation,First Health Network,98.94,97,,percent of total billed charges,,
"Hepatitis A Total Ab, S (Mayo)OutsideLaboratory",,86708,CPT,Facility,Both,,,90,102,86.7,29.2332,102,"Health Partners, Inc.",Commercial,96.492,94.6,,percent of total billed charges,,
"Hepatitis A Total Ab, S (Mayo)OutsideLaboratory",,86708,CPT,Facility,Outpatient,,,90,102,86.7,29.2332,102,"Health Partners, Inc.",Medicare Advantage,49.98,49,,percent of total billed charges,,
"Hepatitis A Total Ab, S (Mayo)OutsideLaboratory",,86708,CPT,Facility,Inpatient,,,90,102,86.7,29.2332,102,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Hepatitis A Total Ab, S (Mayo)OutsideLaboratory",,86708,CPT,Facility,Both,,,90,102,86.7,29.2332,102,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),61.2,60,,percent of total billed charges,,
"Hepatitis A Total Ab, S (Mayo)OutsideLaboratory",,86708,CPT,Facility,Both,,,90,102,86.7,29.2332,102,"Health Partners, Inc.",State of Minnesota Advantage Program,83.13,81.5,,percent of total billed charges,,
"Hepatitis A Total Ab, S (Mayo)OutsideLaboratory",,86708,CPT,Facility,Both,,,90,102,86.7,29.2332,102,"Health Partners, Inc.",State Public Programs,51,50,,percent of total billed charges,,
"Hepatitis A Total Ab, S (Mayo)OutsideLaboratory",,86708,CPT,Facility,Both,,,90,102,86.7,29.2332,102,Humana Insurance Company,Commercial PPO,96.9,95,,percent of total billed charges,,
"Hepatitis A Total Ab, S (Mayo)OutsideLaboratory",,86708,CPT,Facility,Outpatient,,,90,102,86.7,29.2332,102,Humana Insurance Company,Medicare PPO,49.98,49,,percent of total billed charges,,
"Hepatitis A Total Ab, S (Mayo)OutsideLaboratory",,86708,CPT,Facility,Inpatient,,,90,102,86.7,29.2332,102,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Hepatitis A Total Ab, S (Mayo)OutsideLaboratory",,86708,CPT,Facility,Both,,,90,102,86.7,29.2332,102,Medica,Individual & Family,101.082,99.1,,percent of total billed charges,,
"Hepatitis A Total Ab, S (Mayo)OutsideLaboratory",,86708,CPT,Facility,Outpatient,,,90,102,86.7,29.2332,102,Medica,Medica Advantage Solution,50.796,49.8,,percent of total billed charges,,
"Hepatitis A Total Ab, S (Mayo)OutsideLaboratory",,86708,CPT,Facility,Inpatient,,,90,102,86.7,29.2332,102,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Hepatitis A Total Ab, S (Mayo)OutsideLaboratory",,86708,CPT,Facility,Outpatient,,,90,102,86.7,29.2332,102,Medica,Medical Assistance,45.492,44.6,,percent of total billed charges,,
"Hepatitis A Total Ab, S (Mayo)OutsideLaboratory",,86708,CPT,Facility,Inpatient,,,90,102,86.7,29.2332,102,Medica,Medical Assistance,,,,,Included in per diem rate,
"Hepatitis A Total Ab, S (Mayo)OutsideLaboratory",,86708,CPT,Facility,Outpatient,,,90,102,86.7,29.2332,102,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,50.796,49.8,,percent of total billed charges,,
"Hepatitis A Total Ab, S (Mayo)OutsideLaboratory",,86708,CPT,Facility,Inpatient,,,90,102,86.7,29.2332,102,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Hepatitis A Total Ab, S (Mayo)OutsideLaboratory",,86708,CPT,Facility,Both,,,90,102,86.7,29.2332,102,"Multiplan, Inc.","Multiplan, Inc.",95.88,94,,percent of total billed charges,,
"Hepatitis A Total Ab, S (Mayo)OutsideLaboratory",,86708,CPT,Facility,Outpatient,,,90,102,86.7,29.2332,102,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,88.128,86.4,,percent of total billed charges,,
"Hepatitis A Total Ab, S (Mayo)OutsideLaboratory",,86708,CPT,Facility,Inpatient,,,90,102,86.7,29.2332,102,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Hepatitis A Total Ab, S (Mayo)OutsideLaboratory",,86708,CPT,Facility,Both,,,90,102,86.7,29.2332,102,"Preferred One Administrative Services, INC.",PPO,100.572,98.6,,percent of total billed charges,,
"Hepatitis A Total Ab, S (Mayo)OutsideLaboratory",,86708,CPT,Facility,Outpatient,,,90,102,86.7,29.2332,102,PrimeWest Health,Minnesota Senior Health Options (MSHO),52.479,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Hepatitis A Total Ab, S (Mayo)OutsideLaboratory",,86708,CPT,Facility,Inpatient,,,90,102,86.7,29.2332,102,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Hepatitis A Total Ab, S (Mayo)OutsideLaboratory",,86708,CPT,Facility,Outpatient,,,90,102,86.7,29.2332,102,PrimeWest Health,MinnesotaCare,52.3872,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Hepatitis A Total Ab, S (Mayo)OutsideLaboratory",,86708,CPT,Facility,Inpatient,,,90,102,86.7,29.2332,102,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Hepatitis A Total Ab, S (Mayo)OutsideLaboratory",,86708,CPT,Facility,Both,,,90,102,86.7,29.2332,102,Sanford Health Plan,Sanford Health Plan,93.84,92,,percent of total billed charges,,
"Hepatitis A Total Ab, S (Mayo)OutsideLaboratory",,86708,CPT,Facility,Outpatient,,,90,102,86.7,29.2332,102,"UCare Health, Inc.",Individual & Family Plan,57.477,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Hepatitis A Total Ab, S (Mayo)OutsideLaboratory",,86708,CPT,Facility,Inpatient,,,90,102,86.7,29.2332,102,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Hepatitis A Total Ab, S (Mayo)OutsideLaboratory",,86708,CPT,Facility,Outpatient,,,90,102,86.7,29.2332,102,"UCare Health, Inc.",Medical Assistance,51.4794,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Hepatitis A Total Ab, S (Mayo)OutsideLaboratory",,86708,CPT,Facility,Inpatient,,,90,102,86.7,29.2332,102,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Hepatitis A Total Ab, S (Mayo)OutsideLaboratory",,86708,CPT,Facility,Outpatient,,,90,102,86.7,29.2332,102,"UCare Health, Inc.",Medicare Advantage,51.4794,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Hepatitis A Total Ab, S (Mayo)OutsideLaboratory",,86708,CPT,Facility,Inpatient,,,90,102,86.7,29.2332,102,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Hepatitis A Total Ab, S (Mayo)OutsideLaboratory",,86708,CPT,Facility,Outpatient,,,90,102,86.7,29.2332,102,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),51.4794,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Hepatitis A Total Ab, S (Mayo)OutsideLaboratory",,86708,CPT,Facility,Inpatient,,,90,102,86.7,29.2332,102,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Hepatitis A Total Ab, S (Mayo)OutsideLaboratory",,86708,CPT,Facility,Both,,,90,102,86.7,29.2332,102,UnitedHealthcare,Individual & Family,95.88,94,,percent of total billed charges,,
"Hepatitis A Total Ab, S (Mayo)OutsideLaboratory",,86708,CPT,Facility,Outpatient,,,90,102,86.7,29.2332,102,UnitedHealthcare,Medicare Advantage,49.98,49,,percent of total billed charges,,
"Hepatitis A Total Ab, S (Mayo)OutsideLaboratory",,86708,CPT,Facility,Inpatient,,,90,102,86.7,29.2332,102,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Hepatitis A Total Ab, S (Mayo)OutsideLaboratory",,86708,CPT,Facility,Outpatient,,,90,102,86.7,29.2332,102,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,48.96,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Hepatitis A Total Ab, S (Mayo)OutsideLaboratory",,86708,CPT,Facility,Inpatient,,,90,102,86.7,29.2332,102,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Hepatitis A Igm Ab, S (Mayo)OutsideLaboratory",,86709,CPT,Facility,Both,,,90,139,118.15,39.8374,139,Aetna,Commercial,127.88,92,,percent of total billed charges,,
"Hepatitis A Igm Ab, S (Mayo)OutsideLaboratory",,86709,CPT,Facility,Outpatient,,,90,139,118.15,39.8374,139,Aetna,Medicare Advantage,68.11,49,,percent of total billed charges,,
"Hepatitis A Igm Ab, S (Mayo)OutsideLaboratory",,86709,CPT,Facility,Inpatient,,,90,139,118.15,39.8374,139,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Hepatitis A Igm Ab, S (Mayo)OutsideLaboratory",,86709,CPT,Facility,Both,,,90,139,118.15,39.8374,139,Aetna,PPO,129.27,93,,percent of total billed charges,,
"Hepatitis A Igm Ab, S (Mayo)OutsideLaboratory",,86709,CPT,Facility,Both,,,90,139,118.15,39.8374,139,America's PPO,America's PPO,133.4817,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Hepatitis A Igm Ab, S (Mayo)OutsideLaboratory",,86709,CPT,Facility,Both,,,90,139,118.15,39.8374,139,BlueCross BlueShield Minnesota, Federal Employee Program,136.776,98.4,,percent of total billed charges,,
"Hepatitis A Igm Ab, S (Mayo)OutsideLaboratory",,86709,CPT,Facility,Both,,,90,139,118.15,39.8374,139,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,139,100,,percent of total billed charges,,
"Hepatitis A Igm Ab, S (Mayo)OutsideLaboratory",,86709,CPT,Facility,Both,,,90,139,118.15,39.8374,139,BlueCross BlueShield Minnesota,High Value Network Plan,125.1,90,,percent of total billed charges,,
"Hepatitis A Igm Ab, S (Mayo)OutsideLaboratory",,86709,CPT,Facility,Outpatient,,,90,139,118.15,39.8374,139,BlueCross BlueShield Minnesota,Medicare Advantage,68.11,49,,percent of total billed charges,,
"Hepatitis A Igm Ab, S (Mayo)OutsideLaboratory",,86709,CPT,Facility,Inpatient,,,90,139,118.15,39.8374,139,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Hepatitis A Igm Ab, S (Mayo)OutsideLaboratory",,86709,CPT,Facility,Both,,,90,139,118.15,39.8374,139,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,123.1123,88.57,,percent of total billed charges,,
"Hepatitis A Igm Ab, S (Mayo)OutsideLaboratory",,86709,CPT,Facility,Both,,,90,139,118.15,39.8374,139,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,39.8374,28.66,,percent of total billed charges,,
"Hepatitis A Igm Ab, S (Mayo)OutsideLaboratory",,86709,CPT,Facility,Outpatient,,,90,139,118.15,39.8374,139,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),68.11,49,,percent of total billed charges,,
"Hepatitis A Igm Ab, S (Mayo)OutsideLaboratory",,86709,CPT,Facility,Inpatient,,,90,139,118.15,39.8374,139,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Hepatitis A Igm Ab, S (Mayo)OutsideLaboratory",,86709,CPT,Facility,Both,,,90,139,118.15,39.8374,139,CorVel,Worker's Compensation,139,100,,percent of total billed charges,,
"Hepatitis A Igm Ab, S (Mayo)OutsideLaboratory",,86709,CPT,Facility,Both,,,90,139,118.15,39.8374,139,First Health Group Corporation,First Health Network,134.83,97,,percent of total billed charges,,
"Hepatitis A Igm Ab, S (Mayo)OutsideLaboratory",,86709,CPT,Facility,Both,,,90,139,118.15,39.8374,139,"Health Partners, Inc.",Commercial,131.494,94.6,,percent of total billed charges,,
"Hepatitis A Igm Ab, S (Mayo)OutsideLaboratory",,86709,CPT,Facility,Outpatient,,,90,139,118.15,39.8374,139,"Health Partners, Inc.",Medicare Advantage,68.11,49,,percent of total billed charges,,
"Hepatitis A Igm Ab, S (Mayo)OutsideLaboratory",,86709,CPT,Facility,Inpatient,,,90,139,118.15,39.8374,139,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Hepatitis A Igm Ab, S (Mayo)OutsideLaboratory",,86709,CPT,Facility,Both,,,90,139,118.15,39.8374,139,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),83.4,60,,percent of total billed charges,,
"Hepatitis A Igm Ab, S (Mayo)OutsideLaboratory",,86709,CPT,Facility,Both,,,90,139,118.15,39.8374,139,"Health Partners, Inc.",State of Minnesota Advantage Program,113.285,81.5,,percent of total billed charges,,
"Hepatitis A Igm Ab, S (Mayo)OutsideLaboratory",,86709,CPT,Facility,Both,,,90,139,118.15,39.8374,139,"Health Partners, Inc.",State Public Programs,69.5,50,,percent of total billed charges,,
"Hepatitis A Igm Ab, S (Mayo)OutsideLaboratory",,86709,CPT,Facility,Both,,,90,139,118.15,39.8374,139,Humana Insurance Company,Commercial PPO,132.05,95,,percent of total billed charges,,
"Hepatitis A Igm Ab, S (Mayo)OutsideLaboratory",,86709,CPT,Facility,Outpatient,,,90,139,118.15,39.8374,139,Humana Insurance Company,Medicare PPO,68.11,49,,percent of total billed charges,,
"Hepatitis A Igm Ab, S (Mayo)OutsideLaboratory",,86709,CPT,Facility,Inpatient,,,90,139,118.15,39.8374,139,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Hepatitis A Igm Ab, S (Mayo)OutsideLaboratory",,86709,CPT,Facility,Both,,,90,139,118.15,39.8374,139,Medica,Individual & Family,137.749,99.1,,percent of total billed charges,,
"Hepatitis A Igm Ab, S (Mayo)OutsideLaboratory",,86709,CPT,Facility,Outpatient,,,90,139,118.15,39.8374,139,Medica,Medica Advantage Solution,69.222,49.8,,percent of total billed charges,,
"Hepatitis A Igm Ab, S (Mayo)OutsideLaboratory",,86709,CPT,Facility,Inpatient,,,90,139,118.15,39.8374,139,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Hepatitis A Igm Ab, S (Mayo)OutsideLaboratory",,86709,CPT,Facility,Outpatient,,,90,139,118.15,39.8374,139,Medica,Medical Assistance,61.994,44.6,,percent of total billed charges,,
"Hepatitis A Igm Ab, S (Mayo)OutsideLaboratory",,86709,CPT,Facility,Inpatient,,,90,139,118.15,39.8374,139,Medica,Medical Assistance,,,,,Included in per diem rate,
"Hepatitis A Igm Ab, S (Mayo)OutsideLaboratory",,86709,CPT,Facility,Outpatient,,,90,139,118.15,39.8374,139,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,69.222,49.8,,percent of total billed charges,,
"Hepatitis A Igm Ab, S (Mayo)OutsideLaboratory",,86709,CPT,Facility,Inpatient,,,90,139,118.15,39.8374,139,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Hepatitis A Igm Ab, S (Mayo)OutsideLaboratory",,86709,CPT,Facility,Both,,,90,139,118.15,39.8374,139,"Multiplan, Inc.","Multiplan, Inc.",130.66,94,,percent of total billed charges,,
"Hepatitis A Igm Ab, S (Mayo)OutsideLaboratory",,86709,CPT,Facility,Outpatient,,,90,139,118.15,39.8374,139,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,120.096,86.4,,percent of total billed charges,,
"Hepatitis A Igm Ab, S (Mayo)OutsideLaboratory",,86709,CPT,Facility,Inpatient,,,90,139,118.15,39.8374,139,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Hepatitis A Igm Ab, S (Mayo)OutsideLaboratory",,86709,CPT,Facility,Both,,,90,139,118.15,39.8374,139,"Preferred One Administrative Services, INC.",PPO,137.054,98.6,,percent of total billed charges,,
"Hepatitis A Igm Ab, S (Mayo)OutsideLaboratory",,86709,CPT,Facility,Outpatient,,,90,139,118.15,39.8374,139,PrimeWest Health,Minnesota Senior Health Options (MSHO),71.5155,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Hepatitis A Igm Ab, S (Mayo)OutsideLaboratory",,86709,CPT,Facility,Inpatient,,,90,139,118.15,39.8374,139,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Hepatitis A Igm Ab, S (Mayo)OutsideLaboratory",,86709,CPT,Facility,Outpatient,,,90,139,118.15,39.8374,139,PrimeWest Health,MinnesotaCare,71.3904,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Hepatitis A Igm Ab, S (Mayo)OutsideLaboratory",,86709,CPT,Facility,Inpatient,,,90,139,118.15,39.8374,139,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Hepatitis A Igm Ab, S (Mayo)OutsideLaboratory",,86709,CPT,Facility,Both,,,90,139,118.15,39.8374,139,Sanford Health Plan,Sanford Health Plan,127.88,92,,percent of total billed charges,,
"Hepatitis A Igm Ab, S (Mayo)OutsideLaboratory",,86709,CPT,Facility,Outpatient,,,90,139,118.15,39.8374,139,"UCare Health, Inc.",Individual & Family Plan,78.3265,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Hepatitis A Igm Ab, S (Mayo)OutsideLaboratory",,86709,CPT,Facility,Inpatient,,,90,139,118.15,39.8374,139,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Hepatitis A Igm Ab, S (Mayo)OutsideLaboratory",,86709,CPT,Facility,Outpatient,,,90,139,118.15,39.8374,139,"UCare Health, Inc.",Medical Assistance,70.1533,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Hepatitis A Igm Ab, S (Mayo)OutsideLaboratory",,86709,CPT,Facility,Inpatient,,,90,139,118.15,39.8374,139,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Hepatitis A Igm Ab, S (Mayo)OutsideLaboratory",,86709,CPT,Facility,Outpatient,,,90,139,118.15,39.8374,139,"UCare Health, Inc.",Medicare Advantage,70.1533,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Hepatitis A Igm Ab, S (Mayo)OutsideLaboratory",,86709,CPT,Facility,Inpatient,,,90,139,118.15,39.8374,139,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Hepatitis A Igm Ab, S (Mayo)OutsideLaboratory",,86709,CPT,Facility,Outpatient,,,90,139,118.15,39.8374,139,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),70.1533,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Hepatitis A Igm Ab, S (Mayo)OutsideLaboratory",,86709,CPT,Facility,Inpatient,,,90,139,118.15,39.8374,139,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Hepatitis A Igm Ab, S (Mayo)OutsideLaboratory",,86709,CPT,Facility,Both,,,90,139,118.15,39.8374,139,UnitedHealthcare,Individual & Family,130.66,94,,percent of total billed charges,,
"Hepatitis A Igm Ab, S (Mayo)OutsideLaboratory",,86709,CPT,Facility,Outpatient,,,90,139,118.15,39.8374,139,UnitedHealthcare,Medicare Advantage,68.11,49,,percent of total billed charges,,
"Hepatitis A Igm Ab, S (Mayo)OutsideLaboratory",,86709,CPT,Facility,Inpatient,,,90,139,118.15,39.8374,139,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Hepatitis A Igm Ab, S (Mayo)OutsideLaboratory",,86709,CPT,Facility,Outpatient,,,90,139,118.15,39.8374,139,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,66.72,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Hepatitis A Igm Ab, S (Mayo)OutsideLaboratory",,86709,CPT,Facility,Inpatient,,,90,139,118.15,39.8374,139,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Legionella Pneumophila Ab, S (Mayo)OutsideLaboratory",,86713,CPT,Facility,Both,,,90,165,140.25,47.289,165,Aetna,Commercial,151.8,92,,percent of total billed charges,,
"Legionella Pneumophila Ab, S (Mayo)OutsideLaboratory",,86713,CPT,Facility,Outpatient,,,90,165,140.25,47.289,165,Aetna,Medicare Advantage,80.85,49,,percent of total billed charges,,
"Legionella Pneumophila Ab, S (Mayo)OutsideLaboratory",,86713,CPT,Facility,Inpatient,,,90,165,140.25,47.289,165,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Legionella Pneumophila Ab, S (Mayo)OutsideLaboratory",,86713,CPT,Facility,Both,,,90,165,140.25,47.289,165,Aetna,PPO,153.45,93,,percent of total billed charges,,
"Legionella Pneumophila Ab, S (Mayo)OutsideLaboratory",,86713,CPT,Facility,Both,,,90,165,140.25,47.289,165,America's PPO,America's PPO,158.4495,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Legionella Pneumophila Ab, S (Mayo)OutsideLaboratory",,86713,CPT,Facility,Both,,,90,165,140.25,47.289,165,BlueCross BlueShield Minnesota, Federal Employee Program,162.36,98.4,,percent of total billed charges,,
"Legionella Pneumophila Ab, S (Mayo)OutsideLaboratory",,86713,CPT,Facility,Both,,,90,165,140.25,47.289,165,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,165,100,,percent of total billed charges,,
"Legionella Pneumophila Ab, S (Mayo)OutsideLaboratory",,86713,CPT,Facility,Both,,,90,165,140.25,47.289,165,BlueCross BlueShield Minnesota,High Value Network Plan,148.5,90,,percent of total billed charges,,
"Legionella Pneumophila Ab, S (Mayo)OutsideLaboratory",,86713,CPT,Facility,Outpatient,,,90,165,140.25,47.289,165,BlueCross BlueShield Minnesota,Medicare Advantage,80.85,49,,percent of total billed charges,,
"Legionella Pneumophila Ab, S (Mayo)OutsideLaboratory",,86713,CPT,Facility,Inpatient,,,90,165,140.25,47.289,165,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Legionella Pneumophila Ab, S (Mayo)OutsideLaboratory",,86713,CPT,Facility,Both,,,90,165,140.25,47.289,165,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,146.1405,88.57,,percent of total billed charges,,
"Legionella Pneumophila Ab, S (Mayo)OutsideLaboratory",,86713,CPT,Facility,Both,,,90,165,140.25,47.289,165,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,47.289,28.66,,percent of total billed charges,,
"Legionella Pneumophila Ab, S (Mayo)OutsideLaboratory",,86713,CPT,Facility,Outpatient,,,90,165,140.25,47.289,165,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),80.85,49,,percent of total billed charges,,
"Legionella Pneumophila Ab, S (Mayo)OutsideLaboratory",,86713,CPT,Facility,Inpatient,,,90,165,140.25,47.289,165,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Legionella Pneumophila Ab, S (Mayo)OutsideLaboratory",,86713,CPT,Facility,Both,,,90,165,140.25,47.289,165,CorVel,Worker's Compensation,165,100,,percent of total billed charges,,
"Legionella Pneumophila Ab, S (Mayo)OutsideLaboratory",,86713,CPT,Facility,Both,,,90,165,140.25,47.289,165,First Health Group Corporation,First Health Network,160.05,97,,percent of total billed charges,,
"Legionella Pneumophila Ab, S (Mayo)OutsideLaboratory",,86713,CPT,Facility,Both,,,90,165,140.25,47.289,165,"Health Partners, Inc.",Commercial,156.09,94.6,,percent of total billed charges,,
"Legionella Pneumophila Ab, S (Mayo)OutsideLaboratory",,86713,CPT,Facility,Outpatient,,,90,165,140.25,47.289,165,"Health Partners, Inc.",Medicare Advantage,80.85,49,,percent of total billed charges,,
"Legionella Pneumophila Ab, S (Mayo)OutsideLaboratory",,86713,CPT,Facility,Inpatient,,,90,165,140.25,47.289,165,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Legionella Pneumophila Ab, S (Mayo)OutsideLaboratory",,86713,CPT,Facility,Both,,,90,165,140.25,47.289,165,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),99,60,,percent of total billed charges,,
"Legionella Pneumophila Ab, S (Mayo)OutsideLaboratory",,86713,CPT,Facility,Both,,,90,165,140.25,47.289,165,"Health Partners, Inc.",State of Minnesota Advantage Program,134.475,81.5,,percent of total billed charges,,
"Legionella Pneumophila Ab, S (Mayo)OutsideLaboratory",,86713,CPT,Facility,Both,,,90,165,140.25,47.289,165,"Health Partners, Inc.",State Public Programs,82.5,50,,percent of total billed charges,,
"Legionella Pneumophila Ab, S (Mayo)OutsideLaboratory",,86713,CPT,Facility,Both,,,90,165,140.25,47.289,165,Humana Insurance Company,Commercial PPO,156.75,95,,percent of total billed charges,,
"Legionella Pneumophila Ab, S (Mayo)OutsideLaboratory",,86713,CPT,Facility,Outpatient,,,90,165,140.25,47.289,165,Humana Insurance Company,Medicare PPO,80.85,49,,percent of total billed charges,,
"Legionella Pneumophila Ab, S (Mayo)OutsideLaboratory",,86713,CPT,Facility,Inpatient,,,90,165,140.25,47.289,165,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Legionella Pneumophila Ab, S (Mayo)OutsideLaboratory",,86713,CPT,Facility,Both,,,90,165,140.25,47.289,165,Medica,Individual & Family,163.515,99.1,,percent of total billed charges,,
"Legionella Pneumophila Ab, S (Mayo)OutsideLaboratory",,86713,CPT,Facility,Outpatient,,,90,165,140.25,47.289,165,Medica,Medica Advantage Solution,82.17,49.8,,percent of total billed charges,,
"Legionella Pneumophila Ab, S (Mayo)OutsideLaboratory",,86713,CPT,Facility,Inpatient,,,90,165,140.25,47.289,165,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Legionella Pneumophila Ab, S (Mayo)OutsideLaboratory",,86713,CPT,Facility,Outpatient,,,90,165,140.25,47.289,165,Medica,Medical Assistance,73.59,44.6,,percent of total billed charges,,
"Legionella Pneumophila Ab, S (Mayo)OutsideLaboratory",,86713,CPT,Facility,Inpatient,,,90,165,140.25,47.289,165,Medica,Medical Assistance,,,,,Included in per diem rate,
"Legionella Pneumophila Ab, S (Mayo)OutsideLaboratory",,86713,CPT,Facility,Outpatient,,,90,165,140.25,47.289,165,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,82.17,49.8,,percent of total billed charges,,
"Legionella Pneumophila Ab, S (Mayo)OutsideLaboratory",,86713,CPT,Facility,Inpatient,,,90,165,140.25,47.289,165,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Legionella Pneumophila Ab, S (Mayo)OutsideLaboratory",,86713,CPT,Facility,Both,,,90,165,140.25,47.289,165,"Multiplan, Inc.","Multiplan, Inc.",155.1,94,,percent of total billed charges,,
"Legionella Pneumophila Ab, S (Mayo)OutsideLaboratory",,86713,CPT,Facility,Outpatient,,,90,165,140.25,47.289,165,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,142.56,86.4,,percent of total billed charges,,
"Legionella Pneumophila Ab, S (Mayo)OutsideLaboratory",,86713,CPT,Facility,Inpatient,,,90,165,140.25,47.289,165,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Legionella Pneumophila Ab, S (Mayo)OutsideLaboratory",,86713,CPT,Facility,Both,,,90,165,140.25,47.289,165,"Preferred One Administrative Services, INC.",PPO,162.69,98.6,,percent of total billed charges,,
"Legionella Pneumophila Ab, S (Mayo)OutsideLaboratory",,86713,CPT,Facility,Outpatient,,,90,165,140.25,47.289,165,PrimeWest Health,Minnesota Senior Health Options (MSHO),84.8925,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Legionella Pneumophila Ab, S (Mayo)OutsideLaboratory",,86713,CPT,Facility,Inpatient,,,90,165,140.25,47.289,165,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Legionella Pneumophila Ab, S (Mayo)OutsideLaboratory",,86713,CPT,Facility,Outpatient,,,90,165,140.25,47.289,165,PrimeWest Health,MinnesotaCare,84.744,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Legionella Pneumophila Ab, S (Mayo)OutsideLaboratory",,86713,CPT,Facility,Inpatient,,,90,165,140.25,47.289,165,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Legionella Pneumophila Ab, S (Mayo)OutsideLaboratory",,86713,CPT,Facility,Both,,,90,165,140.25,47.289,165,Sanford Health Plan,Sanford Health Plan,151.8,92,,percent of total billed charges,,
"Legionella Pneumophila Ab, S (Mayo)OutsideLaboratory",,86713,CPT,Facility,Outpatient,,,90,165,140.25,47.289,165,"UCare Health, Inc.",Individual & Family Plan,92.9775,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Legionella Pneumophila Ab, S (Mayo)OutsideLaboratory",,86713,CPT,Facility,Inpatient,,,90,165,140.25,47.289,165,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Legionella Pneumophila Ab, S (Mayo)OutsideLaboratory",,86713,CPT,Facility,Outpatient,,,90,165,140.25,47.289,165,"UCare Health, Inc.",Medical Assistance,83.2755,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Legionella Pneumophila Ab, S (Mayo)OutsideLaboratory",,86713,CPT,Facility,Inpatient,,,90,165,140.25,47.289,165,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Legionella Pneumophila Ab, S (Mayo)OutsideLaboratory",,86713,CPT,Facility,Outpatient,,,90,165,140.25,47.289,165,"UCare Health, Inc.",Medicare Advantage,83.2755,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Legionella Pneumophila Ab, S (Mayo)OutsideLaboratory",,86713,CPT,Facility,Inpatient,,,90,165,140.25,47.289,165,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Legionella Pneumophila Ab, S (Mayo)OutsideLaboratory",,86713,CPT,Facility,Outpatient,,,90,165,140.25,47.289,165,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),83.2755,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Legionella Pneumophila Ab, S (Mayo)OutsideLaboratory",,86713,CPT,Facility,Inpatient,,,90,165,140.25,47.289,165,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Legionella Pneumophila Ab, S (Mayo)OutsideLaboratory",,86713,CPT,Facility,Both,,,90,165,140.25,47.289,165,UnitedHealthcare,Individual & Family,155.1,94,,percent of total billed charges,,
"Legionella Pneumophila Ab, S (Mayo)OutsideLaboratory",,86713,CPT,Facility,Outpatient,,,90,165,140.25,47.289,165,UnitedHealthcare,Medicare Advantage,80.85,49,,percent of total billed charges,,
"Legionella Pneumophila Ab, S (Mayo)OutsideLaboratory",,86713,CPT,Facility,Inpatient,,,90,165,140.25,47.289,165,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Legionella Pneumophila Ab, S (Mayo)OutsideLaboratory",,86713,CPT,Facility,Outpatient,,,90,165,140.25,47.289,165,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,79.2,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Legionella Pneumophila Ab, S (Mayo)OutsideLaboratory",,86713,CPT,Facility,Inpatient,,,90,165,140.25,47.289,165,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Mumps Ab, Igg, S (Mayo)OutsideLaboratory",,86735,CPT,Facility,Both,,,90,82,69.7,23.5012,82,Aetna,Commercial,75.44,92,,percent of total billed charges,,
"Mumps Ab, Igg, S (Mayo)OutsideLaboratory",,86735,CPT,Facility,Outpatient,,,90,82,69.7,23.5012,82,Aetna,Medicare Advantage,40.18,49,,percent of total billed charges,,
"Mumps Ab, Igg, S (Mayo)OutsideLaboratory",,86735,CPT,Facility,Inpatient,,,90,82,69.7,23.5012,82,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Mumps Ab, Igg, S (Mayo)OutsideLaboratory",,86735,CPT,Facility,Both,,,90,82,69.7,23.5012,82,Aetna,PPO,76.26,93,,percent of total billed charges,,
"Mumps Ab, Igg, S (Mayo)OutsideLaboratory",,86735,CPT,Facility,Both,,,90,82,69.7,23.5012,82,America's PPO,America's PPO,78.7446,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Mumps Ab, Igg, S (Mayo)OutsideLaboratory",,86735,CPT,Facility,Both,,,90,82,69.7,23.5012,82,BlueCross BlueShield Minnesota, Federal Employee Program,80.688,98.4,,percent of total billed charges,,
"Mumps Ab, Igg, S (Mayo)OutsideLaboratory",,86735,CPT,Facility,Both,,,90,82,69.7,23.5012,82,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,82,100,,percent of total billed charges,,
"Mumps Ab, Igg, S (Mayo)OutsideLaboratory",,86735,CPT,Facility,Both,,,90,82,69.7,23.5012,82,BlueCross BlueShield Minnesota,High Value Network Plan,73.8,90,,percent of total billed charges,,
"Mumps Ab, Igg, S (Mayo)OutsideLaboratory",,86735,CPT,Facility,Outpatient,,,90,82,69.7,23.5012,82,BlueCross BlueShield Minnesota,Medicare Advantage,40.18,49,,percent of total billed charges,,
"Mumps Ab, Igg, S (Mayo)OutsideLaboratory",,86735,CPT,Facility,Inpatient,,,90,82,69.7,23.5012,82,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Mumps Ab, Igg, S (Mayo)OutsideLaboratory",,86735,CPT,Facility,Both,,,90,82,69.7,23.5012,82,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,72.6274,88.57,,percent of total billed charges,,
"Mumps Ab, Igg, S (Mayo)OutsideLaboratory",,86735,CPT,Facility,Both,,,90,82,69.7,23.5012,82,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,23.5012,28.66,,percent of total billed charges,,
"Mumps Ab, Igg, S (Mayo)OutsideLaboratory",,86735,CPT,Facility,Outpatient,,,90,82,69.7,23.5012,82,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),40.18,49,,percent of total billed charges,,
"Mumps Ab, Igg, S (Mayo)OutsideLaboratory",,86735,CPT,Facility,Inpatient,,,90,82,69.7,23.5012,82,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Mumps Ab, Igg, S (Mayo)OutsideLaboratory",,86735,CPT,Facility,Both,,,90,82,69.7,23.5012,82,CorVel,Worker's Compensation,82,100,,percent of total billed charges,,
"Mumps Ab, Igg, S (Mayo)OutsideLaboratory",,86735,CPT,Facility,Both,,,90,82,69.7,23.5012,82,First Health Group Corporation,First Health Network,79.54,97,,percent of total billed charges,,
"Mumps Ab, Igg, S (Mayo)OutsideLaboratory",,86735,CPT,Facility,Both,,,90,82,69.7,23.5012,82,"Health Partners, Inc.",Commercial,77.572,94.6,,percent of total billed charges,,
"Mumps Ab, Igg, S (Mayo)OutsideLaboratory",,86735,CPT,Facility,Outpatient,,,90,82,69.7,23.5012,82,"Health Partners, Inc.",Medicare Advantage,40.18,49,,percent of total billed charges,,
"Mumps Ab, Igg, S (Mayo)OutsideLaboratory",,86735,CPT,Facility,Inpatient,,,90,82,69.7,23.5012,82,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Mumps Ab, Igg, S (Mayo)OutsideLaboratory",,86735,CPT,Facility,Both,,,90,82,69.7,23.5012,82,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),49.2,60,,percent of total billed charges,,
"Mumps Ab, Igg, S (Mayo)OutsideLaboratory",,86735,CPT,Facility,Both,,,90,82,69.7,23.5012,82,"Health Partners, Inc.",State of Minnesota Advantage Program,66.83,81.5,,percent of total billed charges,,
"Mumps Ab, Igg, S (Mayo)OutsideLaboratory",,86735,CPT,Facility,Both,,,90,82,69.7,23.5012,82,"Health Partners, Inc.",State Public Programs,41,50,,percent of total billed charges,,
"Mumps Ab, Igg, S (Mayo)OutsideLaboratory",,86735,CPT,Facility,Both,,,90,82,69.7,23.5012,82,Humana Insurance Company,Commercial PPO,77.9,95,,percent of total billed charges,,
"Mumps Ab, Igg, S (Mayo)OutsideLaboratory",,86735,CPT,Facility,Outpatient,,,90,82,69.7,23.5012,82,Humana Insurance Company,Medicare PPO,40.18,49,,percent of total billed charges,,
"Mumps Ab, Igg, S (Mayo)OutsideLaboratory",,86735,CPT,Facility,Inpatient,,,90,82,69.7,23.5012,82,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Mumps Ab, Igg, S (Mayo)OutsideLaboratory",,86735,CPT,Facility,Both,,,90,82,69.7,23.5012,82,Medica,Individual & Family,81.262,99.1,,percent of total billed charges,,
"Mumps Ab, Igg, S (Mayo)OutsideLaboratory",,86735,CPT,Facility,Outpatient,,,90,82,69.7,23.5012,82,Medica,Medica Advantage Solution,40.836,49.8,,percent of total billed charges,,
"Mumps Ab, Igg, S (Mayo)OutsideLaboratory",,86735,CPT,Facility,Inpatient,,,90,82,69.7,23.5012,82,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Mumps Ab, Igg, S (Mayo)OutsideLaboratory",,86735,CPT,Facility,Outpatient,,,90,82,69.7,23.5012,82,Medica,Medical Assistance,36.572,44.6,,percent of total billed charges,,
"Mumps Ab, Igg, S (Mayo)OutsideLaboratory",,86735,CPT,Facility,Inpatient,,,90,82,69.7,23.5012,82,Medica,Medical Assistance,,,,,Included in per diem rate,
"Mumps Ab, Igg, S (Mayo)OutsideLaboratory",,86735,CPT,Facility,Outpatient,,,90,82,69.7,23.5012,82,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,40.836,49.8,,percent of total billed charges,,
"Mumps Ab, Igg, S (Mayo)OutsideLaboratory",,86735,CPT,Facility,Inpatient,,,90,82,69.7,23.5012,82,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Mumps Ab, Igg, S (Mayo)OutsideLaboratory",,86735,CPT,Facility,Both,,,90,82,69.7,23.5012,82,"Multiplan, Inc.","Multiplan, Inc.",77.08,94,,percent of total billed charges,,
"Mumps Ab, Igg, S (Mayo)OutsideLaboratory",,86735,CPT,Facility,Outpatient,,,90,82,69.7,23.5012,82,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,70.848,86.4,,percent of total billed charges,,
"Mumps Ab, Igg, S (Mayo)OutsideLaboratory",,86735,CPT,Facility,Inpatient,,,90,82,69.7,23.5012,82,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Mumps Ab, Igg, S (Mayo)OutsideLaboratory",,86735,CPT,Facility,Both,,,90,82,69.7,23.5012,82,"Preferred One Administrative Services, INC.",PPO,80.852,98.6,,percent of total billed charges,,
"Mumps Ab, Igg, S (Mayo)OutsideLaboratory",,86735,CPT,Facility,Outpatient,,,90,82,69.7,23.5012,82,PrimeWest Health,Minnesota Senior Health Options (MSHO),42.189,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Mumps Ab, Igg, S (Mayo)OutsideLaboratory",,86735,CPT,Facility,Inpatient,,,90,82,69.7,23.5012,82,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Mumps Ab, Igg, S (Mayo)OutsideLaboratory",,86735,CPT,Facility,Outpatient,,,90,82,69.7,23.5012,82,PrimeWest Health,MinnesotaCare,42.1152,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Mumps Ab, Igg, S (Mayo)OutsideLaboratory",,86735,CPT,Facility,Inpatient,,,90,82,69.7,23.5012,82,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Mumps Ab, Igg, S (Mayo)OutsideLaboratory",,86735,CPT,Facility,Both,,,90,82,69.7,23.5012,82,Sanford Health Plan,Sanford Health Plan,75.44,92,,percent of total billed charges,,
"Mumps Ab, Igg, S (Mayo)OutsideLaboratory",,86735,CPT,Facility,Outpatient,,,90,82,69.7,23.5012,82,"UCare Health, Inc.",Individual & Family Plan,46.207,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Mumps Ab, Igg, S (Mayo)OutsideLaboratory",,86735,CPT,Facility,Inpatient,,,90,82,69.7,23.5012,82,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Mumps Ab, Igg, S (Mayo)OutsideLaboratory",,86735,CPT,Facility,Outpatient,,,90,82,69.7,23.5012,82,"UCare Health, Inc.",Medical Assistance,41.3854,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Mumps Ab, Igg, S (Mayo)OutsideLaboratory",,86735,CPT,Facility,Inpatient,,,90,82,69.7,23.5012,82,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Mumps Ab, Igg, S (Mayo)OutsideLaboratory",,86735,CPT,Facility,Outpatient,,,90,82,69.7,23.5012,82,"UCare Health, Inc.",Medicare Advantage,41.3854,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Mumps Ab, Igg, S (Mayo)OutsideLaboratory",,86735,CPT,Facility,Inpatient,,,90,82,69.7,23.5012,82,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Mumps Ab, Igg, S (Mayo)OutsideLaboratory",,86735,CPT,Facility,Outpatient,,,90,82,69.7,23.5012,82,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),41.3854,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Mumps Ab, Igg, S (Mayo)OutsideLaboratory",,86735,CPT,Facility,Inpatient,,,90,82,69.7,23.5012,82,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Mumps Ab, Igg, S (Mayo)OutsideLaboratory",,86735,CPT,Facility,Both,,,90,82,69.7,23.5012,82,UnitedHealthcare,Individual & Family,77.08,94,,percent of total billed charges,,
"Mumps Ab, Igg, S (Mayo)OutsideLaboratory",,86735,CPT,Facility,Outpatient,,,90,82,69.7,23.5012,82,UnitedHealthcare,Medicare Advantage,40.18,49,,percent of total billed charges,,
"Mumps Ab, Igg, S (Mayo)OutsideLaboratory",,86735,CPT,Facility,Inpatient,,,90,82,69.7,23.5012,82,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Mumps Ab, Igg, S (Mayo)OutsideLaboratory",,86735,CPT,Facility,Outpatient,,,90,82,69.7,23.5012,82,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,39.36,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Mumps Ab, Igg, S (Mayo)OutsideLaboratory",,86735,CPT,Facility,Inpatient,,,90,82,69.7,23.5012,82,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Mumps Ab, Igm And Igg, S (Mayo)OutsideLaboratory",,86735,CPT,Facility,Both,,,90,131,111.35,37.5446,131,Aetna,Commercial,120.52,92,,percent of total billed charges,,
"Mumps Ab, Igm And Igg, S (Mayo)OutsideLaboratory",,86735,CPT,Facility,Outpatient,,,90,131,111.35,37.5446,131,Aetna,Medicare Advantage,64.19,49,,percent of total billed charges,,
"Mumps Ab, Igm And Igg, S (Mayo)OutsideLaboratory",,86735,CPT,Facility,Inpatient,,,90,131,111.35,37.5446,131,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Mumps Ab, Igm And Igg, S (Mayo)OutsideLaboratory",,86735,CPT,Facility,Both,,,90,131,111.35,37.5446,131,Aetna,PPO,121.83,93,,percent of total billed charges,,
"Mumps Ab, Igm And Igg, S (Mayo)OutsideLaboratory",,86735,CPT,Facility,Both,,,90,131,111.35,37.5446,131,America's PPO,America's PPO,125.7993,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Mumps Ab, Igm And Igg, S (Mayo)OutsideLaboratory",,86735,CPT,Facility,Both,,,90,131,111.35,37.5446,131,BlueCross BlueShield Minnesota, Federal Employee Program,128.904,98.4,,percent of total billed charges,,
"Mumps Ab, Igm And Igg, S (Mayo)OutsideLaboratory",,86735,CPT,Facility,Both,,,90,131,111.35,37.5446,131,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,131,100,,percent of total billed charges,,
"Mumps Ab, Igm And Igg, S (Mayo)OutsideLaboratory",,86735,CPT,Facility,Both,,,90,131,111.35,37.5446,131,BlueCross BlueShield Minnesota,High Value Network Plan,117.9,90,,percent of total billed charges,,
"Mumps Ab, Igm And Igg, S (Mayo)OutsideLaboratory",,86735,CPT,Facility,Outpatient,,,90,131,111.35,37.5446,131,BlueCross BlueShield Minnesota,Medicare Advantage,64.19,49,,percent of total billed charges,,
"Mumps Ab, Igm And Igg, S (Mayo)OutsideLaboratory",,86735,CPT,Facility,Inpatient,,,90,131,111.35,37.5446,131,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Mumps Ab, Igm And Igg, S (Mayo)OutsideLaboratory",,86735,CPT,Facility,Both,,,90,131,111.35,37.5446,131,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,116.0267,88.57,,percent of total billed charges,,
"Mumps Ab, Igm And Igg, S (Mayo)OutsideLaboratory",,86735,CPT,Facility,Both,,,90,131,111.35,37.5446,131,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,37.5446,28.66,,percent of total billed charges,,
"Mumps Ab, Igm And Igg, S (Mayo)OutsideLaboratory",,86735,CPT,Facility,Outpatient,,,90,131,111.35,37.5446,131,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),64.19,49,,percent of total billed charges,,
"Mumps Ab, Igm And Igg, S (Mayo)OutsideLaboratory",,86735,CPT,Facility,Inpatient,,,90,131,111.35,37.5446,131,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Mumps Ab, Igm And Igg, S (Mayo)OutsideLaboratory",,86735,CPT,Facility,Both,,,90,131,111.35,37.5446,131,CorVel,Worker's Compensation,131,100,,percent of total billed charges,,
"Mumps Ab, Igm And Igg, S (Mayo)OutsideLaboratory",,86735,CPT,Facility,Both,,,90,131,111.35,37.5446,131,First Health Group Corporation,First Health Network,127.07,97,,percent of total billed charges,,
"Mumps Ab, Igm And Igg, S (Mayo)OutsideLaboratory",,86735,CPT,Facility,Both,,,90,131,111.35,37.5446,131,"Health Partners, Inc.",Commercial,123.926,94.6,,percent of total billed charges,,
"Mumps Ab, Igm And Igg, S (Mayo)OutsideLaboratory",,86735,CPT,Facility,Outpatient,,,90,131,111.35,37.5446,131,"Health Partners, Inc.",Medicare Advantage,64.19,49,,percent of total billed charges,,
"Mumps Ab, Igm And Igg, S (Mayo)OutsideLaboratory",,86735,CPT,Facility,Inpatient,,,90,131,111.35,37.5446,131,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Mumps Ab, Igm And Igg, S (Mayo)OutsideLaboratory",,86735,CPT,Facility,Both,,,90,131,111.35,37.5446,131,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),78.6,60,,percent of total billed charges,,
"Mumps Ab, Igm And Igg, S (Mayo)OutsideLaboratory",,86735,CPT,Facility,Both,,,90,131,111.35,37.5446,131,"Health Partners, Inc.",State of Minnesota Advantage Program,106.765,81.5,,percent of total billed charges,,
"Mumps Ab, Igm And Igg, S (Mayo)OutsideLaboratory",,86735,CPT,Facility,Both,,,90,131,111.35,37.5446,131,"Health Partners, Inc.",State Public Programs,65.5,50,,percent of total billed charges,,
"Mumps Ab, Igm And Igg, S (Mayo)OutsideLaboratory",,86735,CPT,Facility,Both,,,90,131,111.35,37.5446,131,Humana Insurance Company,Commercial PPO,124.45,95,,percent of total billed charges,,
"Mumps Ab, Igm And Igg, S (Mayo)OutsideLaboratory",,86735,CPT,Facility,Outpatient,,,90,131,111.35,37.5446,131,Humana Insurance Company,Medicare PPO,64.19,49,,percent of total billed charges,,
"Mumps Ab, Igm And Igg, S (Mayo)OutsideLaboratory",,86735,CPT,Facility,Inpatient,,,90,131,111.35,37.5446,131,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Mumps Ab, Igm And Igg, S (Mayo)OutsideLaboratory",,86735,CPT,Facility,Both,,,90,131,111.35,37.5446,131,Medica,Individual & Family,129.821,99.1,,percent of total billed charges,,
"Mumps Ab, Igm And Igg, S (Mayo)OutsideLaboratory",,86735,CPT,Facility,Outpatient,,,90,131,111.35,37.5446,131,Medica,Medica Advantage Solution,65.238,49.8,,percent of total billed charges,,
"Mumps Ab, Igm And Igg, S (Mayo)OutsideLaboratory",,86735,CPT,Facility,Inpatient,,,90,131,111.35,37.5446,131,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Mumps Ab, Igm And Igg, S (Mayo)OutsideLaboratory",,86735,CPT,Facility,Outpatient,,,90,131,111.35,37.5446,131,Medica,Medical Assistance,58.426,44.6,,percent of total billed charges,,
"Mumps Ab, Igm And Igg, S (Mayo)OutsideLaboratory",,86735,CPT,Facility,Inpatient,,,90,131,111.35,37.5446,131,Medica,Medical Assistance,,,,,Included in per diem rate,
"Mumps Ab, Igm And Igg, S (Mayo)OutsideLaboratory",,86735,CPT,Facility,Outpatient,,,90,131,111.35,37.5446,131,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,65.238,49.8,,percent of total billed charges,,
"Mumps Ab, Igm And Igg, S (Mayo)OutsideLaboratory",,86735,CPT,Facility,Inpatient,,,90,131,111.35,37.5446,131,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Mumps Ab, Igm And Igg, S (Mayo)OutsideLaboratory",,86735,CPT,Facility,Both,,,90,131,111.35,37.5446,131,"Multiplan, Inc.","Multiplan, Inc.",123.14,94,,percent of total billed charges,,
"Mumps Ab, Igm And Igg, S (Mayo)OutsideLaboratory",,86735,CPT,Facility,Outpatient,,,90,131,111.35,37.5446,131,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,113.184,86.4,,percent of total billed charges,,
"Mumps Ab, Igm And Igg, S (Mayo)OutsideLaboratory",,86735,CPT,Facility,Inpatient,,,90,131,111.35,37.5446,131,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Mumps Ab, Igm And Igg, S (Mayo)OutsideLaboratory",,86735,CPT,Facility,Both,,,90,131,111.35,37.5446,131,"Preferred One Administrative Services, INC.",PPO,129.166,98.6,,percent of total billed charges,,
"Mumps Ab, Igm And Igg, S (Mayo)OutsideLaboratory",,86735,CPT,Facility,Outpatient,,,90,131,111.35,37.5446,131,PrimeWest Health,Minnesota Senior Health Options (MSHO),67.3995,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Mumps Ab, Igm And Igg, S (Mayo)OutsideLaboratory",,86735,CPT,Facility,Inpatient,,,90,131,111.35,37.5446,131,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Mumps Ab, Igm And Igg, S (Mayo)OutsideLaboratory",,86735,CPT,Facility,Outpatient,,,90,131,111.35,37.5446,131,PrimeWest Health,MinnesotaCare,67.2816,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Mumps Ab, Igm And Igg, S (Mayo)OutsideLaboratory",,86735,CPT,Facility,Inpatient,,,90,131,111.35,37.5446,131,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Mumps Ab, Igm And Igg, S (Mayo)OutsideLaboratory",,86735,CPT,Facility,Both,,,90,131,111.35,37.5446,131,Sanford Health Plan,Sanford Health Plan,120.52,92,,percent of total billed charges,,
"Mumps Ab, Igm And Igg, S (Mayo)OutsideLaboratory",,86735,CPT,Facility,Outpatient,,,90,131,111.35,37.5446,131,"UCare Health, Inc.",Individual & Family Plan,73.8185,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Mumps Ab, Igm And Igg, S (Mayo)OutsideLaboratory",,86735,CPT,Facility,Inpatient,,,90,131,111.35,37.5446,131,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Mumps Ab, Igm And Igg, S (Mayo)OutsideLaboratory",,86735,CPT,Facility,Outpatient,,,90,131,111.35,37.5446,131,"UCare Health, Inc.",Medical Assistance,66.1157,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Mumps Ab, Igm And Igg, S (Mayo)OutsideLaboratory",,86735,CPT,Facility,Inpatient,,,90,131,111.35,37.5446,131,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Mumps Ab, Igm And Igg, S (Mayo)OutsideLaboratory",,86735,CPT,Facility,Outpatient,,,90,131,111.35,37.5446,131,"UCare Health, Inc.",Medicare Advantage,66.1157,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Mumps Ab, Igm And Igg, S (Mayo)OutsideLaboratory",,86735,CPT,Facility,Inpatient,,,90,131,111.35,37.5446,131,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Mumps Ab, Igm And Igg, S (Mayo)OutsideLaboratory",,86735,CPT,Facility,Outpatient,,,90,131,111.35,37.5446,131,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),66.1157,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Mumps Ab, Igm And Igg, S (Mayo)OutsideLaboratory",,86735,CPT,Facility,Inpatient,,,90,131,111.35,37.5446,131,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Mumps Ab, Igm And Igg, S (Mayo)OutsideLaboratory",,86735,CPT,Facility,Both,,,90,131,111.35,37.5446,131,UnitedHealthcare,Individual & Family,123.14,94,,percent of total billed charges,,
"Mumps Ab, Igm And Igg, S (Mayo)OutsideLaboratory",,86735,CPT,Facility,Outpatient,,,90,131,111.35,37.5446,131,UnitedHealthcare,Medicare Advantage,64.19,49,,percent of total billed charges,,
"Mumps Ab, Igm And Igg, S (Mayo)OutsideLaboratory",,86735,CPT,Facility,Inpatient,,,90,131,111.35,37.5446,131,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Mumps Ab, Igm And Igg, S (Mayo)OutsideLaboratory",,86735,CPT,Facility,Outpatient,,,90,131,111.35,37.5446,131,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,62.88,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Mumps Ab, Igm And Igg, S (Mayo)OutsideLaboratory",,86735,CPT,Facility,Inpatient,,,90,131,111.35,37.5446,131,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Antibody Parvovirus (Mayo)OutsideLaboratory,,86747,CPT,Facility,Both,,,90,66,56.1,18.9156,66,Aetna,Commercial,60.72,92,,percent of total billed charges,,
Antibody Parvovirus (Mayo)OutsideLaboratory,,86747,CPT,Facility,Outpatient,,,90,66,56.1,18.9156,66,Aetna,Medicare Advantage,32.34,49,,percent of total billed charges,,
Antibody Parvovirus (Mayo)OutsideLaboratory,,86747,CPT,Facility,Inpatient,,,90,66,56.1,18.9156,66,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Antibody Parvovirus (Mayo)OutsideLaboratory,,86747,CPT,Facility,Both,,,90,66,56.1,18.9156,66,Aetna,PPO,61.38,93,,percent of total billed charges,,
Antibody Parvovirus (Mayo)OutsideLaboratory,,86747,CPT,Facility,Both,,,90,66,56.1,18.9156,66,America's PPO,America's PPO,63.3798,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Antibody Parvovirus (Mayo)OutsideLaboratory,,86747,CPT,Facility,Both,,,90,66,56.1,18.9156,66,BlueCross BlueShield Minnesota, Federal Employee Program,64.944,98.4,,percent of total billed charges,,
Antibody Parvovirus (Mayo)OutsideLaboratory,,86747,CPT,Facility,Both,,,90,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,66,100,,percent of total billed charges,,
Antibody Parvovirus (Mayo)OutsideLaboratory,,86747,CPT,Facility,Both,,,90,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,High Value Network Plan,59.4,90,,percent of total billed charges,,
Antibody Parvovirus (Mayo)OutsideLaboratory,,86747,CPT,Facility,Outpatient,,,90,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,Medicare Advantage,32.34,49,,percent of total billed charges,,
Antibody Parvovirus (Mayo)OutsideLaboratory,,86747,CPT,Facility,Inpatient,,,90,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Antibody Parvovirus (Mayo)OutsideLaboratory,,86747,CPT,Facility,Both,,,90,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,58.4562,88.57,,percent of total billed charges,,
Antibody Parvovirus (Mayo)OutsideLaboratory,,86747,CPT,Facility,Both,,,90,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,18.9156,28.66,,percent of total billed charges,,
Antibody Parvovirus (Mayo)OutsideLaboratory,,86747,CPT,Facility,Outpatient,,,90,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),32.34,49,,percent of total billed charges,,
Antibody Parvovirus (Mayo)OutsideLaboratory,,86747,CPT,Facility,Inpatient,,,90,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Antibody Parvovirus (Mayo)OutsideLaboratory,,86747,CPT,Facility,Both,,,90,66,56.1,18.9156,66,CorVel,Worker's Compensation,66,100,,percent of total billed charges,,
Antibody Parvovirus (Mayo)OutsideLaboratory,,86747,CPT,Facility,Both,,,90,66,56.1,18.9156,66,First Health Group Corporation,First Health Network,64.02,97,,percent of total billed charges,,
Antibody Parvovirus (Mayo)OutsideLaboratory,,86747,CPT,Facility,Both,,,90,66,56.1,18.9156,66,"Health Partners, Inc.",Commercial,62.436,94.6,,percent of total billed charges,,
Antibody Parvovirus (Mayo)OutsideLaboratory,,86747,CPT,Facility,Outpatient,,,90,66,56.1,18.9156,66,"Health Partners, Inc.",Medicare Advantage,32.34,49,,percent of total billed charges,,
Antibody Parvovirus (Mayo)OutsideLaboratory,,86747,CPT,Facility,Inpatient,,,90,66,56.1,18.9156,66,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Antibody Parvovirus (Mayo)OutsideLaboratory,,86747,CPT,Facility,Both,,,90,66,56.1,18.9156,66,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),39.6,60,,percent of total billed charges,,
Antibody Parvovirus (Mayo)OutsideLaboratory,,86747,CPT,Facility,Both,,,90,66,56.1,18.9156,66,"Health Partners, Inc.",State of Minnesota Advantage Program,53.79,81.5,,percent of total billed charges,,
Antibody Parvovirus (Mayo)OutsideLaboratory,,86747,CPT,Facility,Both,,,90,66,56.1,18.9156,66,"Health Partners, Inc.",State Public Programs,33,50,,percent of total billed charges,,
Antibody Parvovirus (Mayo)OutsideLaboratory,,86747,CPT,Facility,Both,,,90,66,56.1,18.9156,66,Humana Insurance Company,Commercial PPO,62.7,95,,percent of total billed charges,,
Antibody Parvovirus (Mayo)OutsideLaboratory,,86747,CPT,Facility,Outpatient,,,90,66,56.1,18.9156,66,Humana Insurance Company,Medicare PPO,32.34,49,,percent of total billed charges,,
Antibody Parvovirus (Mayo)OutsideLaboratory,,86747,CPT,Facility,Inpatient,,,90,66,56.1,18.9156,66,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Antibody Parvovirus (Mayo)OutsideLaboratory,,86747,CPT,Facility,Both,,,90,66,56.1,18.9156,66,Medica,Individual & Family,65.406,99.1,,percent of total billed charges,,
Antibody Parvovirus (Mayo)OutsideLaboratory,,86747,CPT,Facility,Outpatient,,,90,66,56.1,18.9156,66,Medica,Medica Advantage Solution,32.868,49.8,,percent of total billed charges,,
Antibody Parvovirus (Mayo)OutsideLaboratory,,86747,CPT,Facility,Inpatient,,,90,66,56.1,18.9156,66,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Antibody Parvovirus (Mayo)OutsideLaboratory,,86747,CPT,Facility,Outpatient,,,90,66,56.1,18.9156,66,Medica,Medical Assistance,29.436,44.6,,percent of total billed charges,,
Antibody Parvovirus (Mayo)OutsideLaboratory,,86747,CPT,Facility,Inpatient,,,90,66,56.1,18.9156,66,Medica,Medical Assistance,,,,,Included in per diem rate,
Antibody Parvovirus (Mayo)OutsideLaboratory,,86747,CPT,Facility,Outpatient,,,90,66,56.1,18.9156,66,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,32.868,49.8,,percent of total billed charges,,
Antibody Parvovirus (Mayo)OutsideLaboratory,,86747,CPT,Facility,Inpatient,,,90,66,56.1,18.9156,66,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Antibody Parvovirus (Mayo)OutsideLaboratory,,86747,CPT,Facility,Both,,,90,66,56.1,18.9156,66,"Multiplan, Inc.","Multiplan, Inc.",62.04,94,,percent of total billed charges,,
Antibody Parvovirus (Mayo)OutsideLaboratory,,86747,CPT,Facility,Outpatient,,,90,66,56.1,18.9156,66,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,57.024,86.4,,percent of total billed charges,,
Antibody Parvovirus (Mayo)OutsideLaboratory,,86747,CPT,Facility,Inpatient,,,90,66,56.1,18.9156,66,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Antibody Parvovirus (Mayo)OutsideLaboratory,,86747,CPT,Facility,Both,,,90,66,56.1,18.9156,66,"Preferred One Administrative Services, INC.",PPO,65.076,98.6,,percent of total billed charges,,
Antibody Parvovirus (Mayo)OutsideLaboratory,,86747,CPT,Facility,Outpatient,,,90,66,56.1,18.9156,66,PrimeWest Health,Minnesota Senior Health Options (MSHO),33.957,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Antibody Parvovirus (Mayo)OutsideLaboratory,,86747,CPT,Facility,Inpatient,,,90,66,56.1,18.9156,66,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Antibody Parvovirus (Mayo)OutsideLaboratory,,86747,CPT,Facility,Outpatient,,,90,66,56.1,18.9156,66,PrimeWest Health,MinnesotaCare,33.8976,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Antibody Parvovirus (Mayo)OutsideLaboratory,,86747,CPT,Facility,Inpatient,,,90,66,56.1,18.9156,66,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Antibody Parvovirus (Mayo)OutsideLaboratory,,86747,CPT,Facility,Both,,,90,66,56.1,18.9156,66,Sanford Health Plan,Sanford Health Plan,60.72,92,,percent of total billed charges,,
Antibody Parvovirus (Mayo)OutsideLaboratory,,86747,CPT,Facility,Outpatient,,,90,66,56.1,18.9156,66,"UCare Health, Inc.",Individual & Family Plan,37.191,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Antibody Parvovirus (Mayo)OutsideLaboratory,,86747,CPT,Facility,Inpatient,,,90,66,56.1,18.9156,66,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Antibody Parvovirus (Mayo)OutsideLaboratory,,86747,CPT,Facility,Outpatient,,,90,66,56.1,18.9156,66,"UCare Health, Inc.",Medical Assistance,33.3102,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Antibody Parvovirus (Mayo)OutsideLaboratory,,86747,CPT,Facility,Inpatient,,,90,66,56.1,18.9156,66,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Antibody Parvovirus (Mayo)OutsideLaboratory,,86747,CPT,Facility,Outpatient,,,90,66,56.1,18.9156,66,"UCare Health, Inc.",Medicare Advantage,33.3102,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Antibody Parvovirus (Mayo)OutsideLaboratory,,86747,CPT,Facility,Inpatient,,,90,66,56.1,18.9156,66,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Antibody Parvovirus (Mayo)OutsideLaboratory,,86747,CPT,Facility,Outpatient,,,90,66,56.1,18.9156,66,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),33.3102,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Antibody Parvovirus (Mayo)OutsideLaboratory,,86747,CPT,Facility,Inpatient,,,90,66,56.1,18.9156,66,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Antibody Parvovirus (Mayo)OutsideLaboratory,,86747,CPT,Facility,Both,,,90,66,56.1,18.9156,66,UnitedHealthcare,Individual & Family,62.04,94,,percent of total billed charges,,
Antibody Parvovirus (Mayo)OutsideLaboratory,,86747,CPT,Facility,Outpatient,,,90,66,56.1,18.9156,66,UnitedHealthcare,Medicare Advantage,32.34,49,,percent of total billed charges,,
Antibody Parvovirus (Mayo)OutsideLaboratory,,86747,CPT,Facility,Inpatient,,,90,66,56.1,18.9156,66,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Antibody Parvovirus (Mayo)OutsideLaboratory,,86747,CPT,Facility,Outpatient,,,90,66,56.1,18.9156,66,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,31.68,48,,percent of total billed charges,,100% of DHS outpatient percentage
Antibody Parvovirus (Mayo)OutsideLaboratory,,86747,CPT,Facility,Inpatient,,,90,66,56.1,18.9156,66,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Parvovirus B19 Ab, Igg And Igm, S (Mayo)OutsideLaboratory",,86747,CPT,Facility,Both,,,90,104,88.4,29.8064,104,Aetna,Commercial,95.68,92,,percent of total billed charges,,
"Parvovirus B19 Ab, Igg And Igm, S (Mayo)OutsideLaboratory",,86747,CPT,Facility,Outpatient,,,90,104,88.4,29.8064,104,Aetna,Medicare Advantage,50.96,49,,percent of total billed charges,,
"Parvovirus B19 Ab, Igg And Igm, S (Mayo)OutsideLaboratory",,86747,CPT,Facility,Inpatient,,,90,104,88.4,29.8064,104,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Parvovirus B19 Ab, Igg And Igm, S (Mayo)OutsideLaboratory",,86747,CPT,Facility,Both,,,90,104,88.4,29.8064,104,Aetna,PPO,96.72,93,,percent of total billed charges,,
"Parvovirus B19 Ab, Igg And Igm, S (Mayo)OutsideLaboratory",,86747,CPT,Facility,Both,,,90,104,88.4,29.8064,104,America's PPO,America's PPO,99.8712,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Parvovirus B19 Ab, Igg And Igm, S (Mayo)OutsideLaboratory",,86747,CPT,Facility,Both,,,90,104,88.4,29.8064,104,BlueCross BlueShield Minnesota, Federal Employee Program,102.336,98.4,,percent of total billed charges,,
"Parvovirus B19 Ab, Igg And Igm, S (Mayo)OutsideLaboratory",,86747,CPT,Facility,Both,,,90,104,88.4,29.8064,104,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,104,100,,percent of total billed charges,,
"Parvovirus B19 Ab, Igg And Igm, S (Mayo)OutsideLaboratory",,86747,CPT,Facility,Both,,,90,104,88.4,29.8064,104,BlueCross BlueShield Minnesota,High Value Network Plan,93.6,90,,percent of total billed charges,,
"Parvovirus B19 Ab, Igg And Igm, S (Mayo)OutsideLaboratory",,86747,CPT,Facility,Outpatient,,,90,104,88.4,29.8064,104,BlueCross BlueShield Minnesota,Medicare Advantage,50.96,49,,percent of total billed charges,,
"Parvovirus B19 Ab, Igg And Igm, S (Mayo)OutsideLaboratory",,86747,CPT,Facility,Inpatient,,,90,104,88.4,29.8064,104,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Parvovirus B19 Ab, Igg And Igm, S (Mayo)OutsideLaboratory",,86747,CPT,Facility,Both,,,90,104,88.4,29.8064,104,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,92.1128,88.57,,percent of total billed charges,,
"Parvovirus B19 Ab, Igg And Igm, S (Mayo)OutsideLaboratory",,86747,CPT,Facility,Both,,,90,104,88.4,29.8064,104,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,29.8064,28.66,,percent of total billed charges,,
"Parvovirus B19 Ab, Igg And Igm, S (Mayo)OutsideLaboratory",,86747,CPT,Facility,Outpatient,,,90,104,88.4,29.8064,104,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),50.96,49,,percent of total billed charges,,
"Parvovirus B19 Ab, Igg And Igm, S (Mayo)OutsideLaboratory",,86747,CPT,Facility,Inpatient,,,90,104,88.4,29.8064,104,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Parvovirus B19 Ab, Igg And Igm, S (Mayo)OutsideLaboratory",,86747,CPT,Facility,Both,,,90,104,88.4,29.8064,104,CorVel,Worker's Compensation,104,100,,percent of total billed charges,,
"Parvovirus B19 Ab, Igg And Igm, S (Mayo)OutsideLaboratory",,86747,CPT,Facility,Both,,,90,104,88.4,29.8064,104,First Health Group Corporation,First Health Network,100.88,97,,percent of total billed charges,,
"Parvovirus B19 Ab, Igg And Igm, S (Mayo)OutsideLaboratory",,86747,CPT,Facility,Both,,,90,104,88.4,29.8064,104,"Health Partners, Inc.",Commercial,98.384,94.6,,percent of total billed charges,,
"Parvovirus B19 Ab, Igg And Igm, S (Mayo)OutsideLaboratory",,86747,CPT,Facility,Outpatient,,,90,104,88.4,29.8064,104,"Health Partners, Inc.",Medicare Advantage,50.96,49,,percent of total billed charges,,
"Parvovirus B19 Ab, Igg And Igm, S (Mayo)OutsideLaboratory",,86747,CPT,Facility,Inpatient,,,90,104,88.4,29.8064,104,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Parvovirus B19 Ab, Igg And Igm, S (Mayo)OutsideLaboratory",,86747,CPT,Facility,Both,,,90,104,88.4,29.8064,104,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),62.4,60,,percent of total billed charges,,
"Parvovirus B19 Ab, Igg And Igm, S (Mayo)OutsideLaboratory",,86747,CPT,Facility,Both,,,90,104,88.4,29.8064,104,"Health Partners, Inc.",State of Minnesota Advantage Program,84.76,81.5,,percent of total billed charges,,
"Parvovirus B19 Ab, Igg And Igm, S (Mayo)OutsideLaboratory",,86747,CPT,Facility,Both,,,90,104,88.4,29.8064,104,"Health Partners, Inc.",State Public Programs,52,50,,percent of total billed charges,,
"Parvovirus B19 Ab, Igg And Igm, S (Mayo)OutsideLaboratory",,86747,CPT,Facility,Both,,,90,104,88.4,29.8064,104,Humana Insurance Company,Commercial PPO,98.8,95,,percent of total billed charges,,
"Parvovirus B19 Ab, Igg And Igm, S (Mayo)OutsideLaboratory",,86747,CPT,Facility,Outpatient,,,90,104,88.4,29.8064,104,Humana Insurance Company,Medicare PPO,50.96,49,,percent of total billed charges,,
"Parvovirus B19 Ab, Igg And Igm, S (Mayo)OutsideLaboratory",,86747,CPT,Facility,Inpatient,,,90,104,88.4,29.8064,104,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Parvovirus B19 Ab, Igg And Igm, S (Mayo)OutsideLaboratory",,86747,CPT,Facility,Both,,,90,104,88.4,29.8064,104,Medica,Individual & Family,103.064,99.1,,percent of total billed charges,,
"Parvovirus B19 Ab, Igg And Igm, S (Mayo)OutsideLaboratory",,86747,CPT,Facility,Outpatient,,,90,104,88.4,29.8064,104,Medica,Medica Advantage Solution,51.792,49.8,,percent of total billed charges,,
"Parvovirus B19 Ab, Igg And Igm, S (Mayo)OutsideLaboratory",,86747,CPT,Facility,Inpatient,,,90,104,88.4,29.8064,104,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Parvovirus B19 Ab, Igg And Igm, S (Mayo)OutsideLaboratory",,86747,CPT,Facility,Outpatient,,,90,104,88.4,29.8064,104,Medica,Medical Assistance,46.384,44.6,,percent of total billed charges,,
"Parvovirus B19 Ab, Igg And Igm, S (Mayo)OutsideLaboratory",,86747,CPT,Facility,Inpatient,,,90,104,88.4,29.8064,104,Medica,Medical Assistance,,,,,Included in per diem rate,
"Parvovirus B19 Ab, Igg And Igm, S (Mayo)OutsideLaboratory",,86747,CPT,Facility,Outpatient,,,90,104,88.4,29.8064,104,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,51.792,49.8,,percent of total billed charges,,
"Parvovirus B19 Ab, Igg And Igm, S (Mayo)OutsideLaboratory",,86747,CPT,Facility,Inpatient,,,90,104,88.4,29.8064,104,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Parvovirus B19 Ab, Igg And Igm, S (Mayo)OutsideLaboratory",,86747,CPT,Facility,Both,,,90,104,88.4,29.8064,104,"Multiplan, Inc.","Multiplan, Inc.",97.76,94,,percent of total billed charges,,
"Parvovirus B19 Ab, Igg And Igm, S (Mayo)OutsideLaboratory",,86747,CPT,Facility,Outpatient,,,90,104,88.4,29.8064,104,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,89.856,86.4,,percent of total billed charges,,
"Parvovirus B19 Ab, Igg And Igm, S (Mayo)OutsideLaboratory",,86747,CPT,Facility,Inpatient,,,90,104,88.4,29.8064,104,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Parvovirus B19 Ab, Igg And Igm, S (Mayo)OutsideLaboratory",,86747,CPT,Facility,Both,,,90,104,88.4,29.8064,104,"Preferred One Administrative Services, INC.",PPO,102.544,98.6,,percent of total billed charges,,
"Parvovirus B19 Ab, Igg And Igm, S (Mayo)OutsideLaboratory",,86747,CPT,Facility,Outpatient,,,90,104,88.4,29.8064,104,PrimeWest Health,Minnesota Senior Health Options (MSHO),53.508,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Parvovirus B19 Ab, Igg And Igm, S (Mayo)OutsideLaboratory",,86747,CPT,Facility,Inpatient,,,90,104,88.4,29.8064,104,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Parvovirus B19 Ab, Igg And Igm, S (Mayo)OutsideLaboratory",,86747,CPT,Facility,Outpatient,,,90,104,88.4,29.8064,104,PrimeWest Health,MinnesotaCare,53.4144,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Parvovirus B19 Ab, Igg And Igm, S (Mayo)OutsideLaboratory",,86747,CPT,Facility,Inpatient,,,90,104,88.4,29.8064,104,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Parvovirus B19 Ab, Igg And Igm, S (Mayo)OutsideLaboratory",,86747,CPT,Facility,Both,,,90,104,88.4,29.8064,104,Sanford Health Plan,Sanford Health Plan,95.68,92,,percent of total billed charges,,
"Parvovirus B19 Ab, Igg And Igm, S (Mayo)OutsideLaboratory",,86747,CPT,Facility,Outpatient,,,90,104,88.4,29.8064,104,"UCare Health, Inc.",Individual & Family Plan,58.604,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Parvovirus B19 Ab, Igg And Igm, S (Mayo)OutsideLaboratory",,86747,CPT,Facility,Inpatient,,,90,104,88.4,29.8064,104,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Parvovirus B19 Ab, Igg And Igm, S (Mayo)OutsideLaboratory",,86747,CPT,Facility,Outpatient,,,90,104,88.4,29.8064,104,"UCare Health, Inc.",Medical Assistance,52.4888,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Parvovirus B19 Ab, Igg And Igm, S (Mayo)OutsideLaboratory",,86747,CPT,Facility,Inpatient,,,90,104,88.4,29.8064,104,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Parvovirus B19 Ab, Igg And Igm, S (Mayo)OutsideLaboratory",,86747,CPT,Facility,Outpatient,,,90,104,88.4,29.8064,104,"UCare Health, Inc.",Medicare Advantage,52.4888,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Parvovirus B19 Ab, Igg And Igm, S (Mayo)OutsideLaboratory",,86747,CPT,Facility,Inpatient,,,90,104,88.4,29.8064,104,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Parvovirus B19 Ab, Igg And Igm, S (Mayo)OutsideLaboratory",,86747,CPT,Facility,Outpatient,,,90,104,88.4,29.8064,104,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),52.4888,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Parvovirus B19 Ab, Igg And Igm, S (Mayo)OutsideLaboratory",,86747,CPT,Facility,Inpatient,,,90,104,88.4,29.8064,104,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Parvovirus B19 Ab, Igg And Igm, S (Mayo)OutsideLaboratory",,86747,CPT,Facility,Both,,,90,104,88.4,29.8064,104,UnitedHealthcare,Individual & Family,97.76,94,,percent of total billed charges,,
"Parvovirus B19 Ab, Igg And Igm, S (Mayo)OutsideLaboratory",,86747,CPT,Facility,Outpatient,,,90,104,88.4,29.8064,104,UnitedHealthcare,Medicare Advantage,50.96,49,,percent of total billed charges,,
"Parvovirus B19 Ab, Igg And Igm, S (Mayo)OutsideLaboratory",,86747,CPT,Facility,Inpatient,,,90,104,88.4,29.8064,104,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Parvovirus B19 Ab, Igg And Igm, S (Mayo)OutsideLaboratory",,86747,CPT,Facility,Outpatient,,,90,104,88.4,29.8064,104,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,49.92,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Parvovirus B19 Ab, Igg And Igm, S (Mayo)OutsideLaboratory",,86747,CPT,Facility,Inpatient,,,90,104,88.4,29.8064,104,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Tick-Borne Ab Panel, S (Mayo)OutsideLaboratory",,86753,CPT,Facility,Both,,,90,224,190.4,64.1984,224,Aetna,Commercial,206.08,92,,percent of total billed charges,,
"Tick-Borne Ab Panel, S (Mayo)OutsideLaboratory",,86753,CPT,Facility,Outpatient,,,90,224,190.4,64.1984,224,Aetna,Medicare Advantage,109.76,49,,percent of total billed charges,,
"Tick-Borne Ab Panel, S (Mayo)OutsideLaboratory",,86753,CPT,Facility,Inpatient,,,90,224,190.4,64.1984,224,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Tick-Borne Ab Panel, S (Mayo)OutsideLaboratory",,86753,CPT,Facility,Both,,,90,224,190.4,64.1984,224,Aetna,PPO,208.32,93,,percent of total billed charges,,
"Tick-Borne Ab Panel, S (Mayo)OutsideLaboratory",,86753,CPT,Facility,Both,,,90,224,190.4,64.1984,224,America's PPO,America's PPO,215.1072,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Tick-Borne Ab Panel, S (Mayo)OutsideLaboratory",,86753,CPT,Facility,Both,,,90,224,190.4,64.1984,224,BlueCross BlueShield Minnesota, Federal Employee Program,220.416,98.4,,percent of total billed charges,,
"Tick-Borne Ab Panel, S (Mayo)OutsideLaboratory",,86753,CPT,Facility,Both,,,90,224,190.4,64.1984,224,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,224,100,,percent of total billed charges,,
"Tick-Borne Ab Panel, S (Mayo)OutsideLaboratory",,86753,CPT,Facility,Both,,,90,224,190.4,64.1984,224,BlueCross BlueShield Minnesota,High Value Network Plan,201.6,90,,percent of total billed charges,,
"Tick-Borne Ab Panel, S (Mayo)OutsideLaboratory",,86753,CPT,Facility,Outpatient,,,90,224,190.4,64.1984,224,BlueCross BlueShield Minnesota,Medicare Advantage,109.76,49,,percent of total billed charges,,
"Tick-Borne Ab Panel, S (Mayo)OutsideLaboratory",,86753,CPT,Facility,Inpatient,,,90,224,190.4,64.1984,224,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Tick-Borne Ab Panel, S (Mayo)OutsideLaboratory",,86753,CPT,Facility,Both,,,90,224,190.4,64.1984,224,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,198.3968,88.57,,percent of total billed charges,,
"Tick-Borne Ab Panel, S (Mayo)OutsideLaboratory",,86753,CPT,Facility,Both,,,90,224,190.4,64.1984,224,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,64.1984,28.66,,percent of total billed charges,,
"Tick-Borne Ab Panel, S (Mayo)OutsideLaboratory",,86753,CPT,Facility,Outpatient,,,90,224,190.4,64.1984,224,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),109.76,49,,percent of total billed charges,,
"Tick-Borne Ab Panel, S (Mayo)OutsideLaboratory",,86753,CPT,Facility,Inpatient,,,90,224,190.4,64.1984,224,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Tick-Borne Ab Panel, S (Mayo)OutsideLaboratory",,86753,CPT,Facility,Both,,,90,224,190.4,64.1984,224,CorVel,Worker's Compensation,224,100,,percent of total billed charges,,
"Tick-Borne Ab Panel, S (Mayo)OutsideLaboratory",,86753,CPT,Facility,Both,,,90,224,190.4,64.1984,224,First Health Group Corporation,First Health Network,217.28,97,,percent of total billed charges,,
"Tick-Borne Ab Panel, S (Mayo)OutsideLaboratory",,86753,CPT,Facility,Both,,,90,224,190.4,64.1984,224,"Health Partners, Inc.",Commercial,211.904,94.6,,percent of total billed charges,,
"Tick-Borne Ab Panel, S (Mayo)OutsideLaboratory",,86753,CPT,Facility,Outpatient,,,90,224,190.4,64.1984,224,"Health Partners, Inc.",Medicare Advantage,109.76,49,,percent of total billed charges,,
"Tick-Borne Ab Panel, S (Mayo)OutsideLaboratory",,86753,CPT,Facility,Inpatient,,,90,224,190.4,64.1984,224,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Tick-Borne Ab Panel, S (Mayo)OutsideLaboratory",,86753,CPT,Facility,Both,,,90,224,190.4,64.1984,224,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),134.4,60,,percent of total billed charges,,
"Tick-Borne Ab Panel, S (Mayo)OutsideLaboratory",,86753,CPT,Facility,Both,,,90,224,190.4,64.1984,224,"Health Partners, Inc.",State of Minnesota Advantage Program,182.56,81.5,,percent of total billed charges,,
"Tick-Borne Ab Panel, S (Mayo)OutsideLaboratory",,86753,CPT,Facility,Both,,,90,224,190.4,64.1984,224,"Health Partners, Inc.",State Public Programs,112,50,,percent of total billed charges,,
"Tick-Borne Ab Panel, S (Mayo)OutsideLaboratory",,86753,CPT,Facility,Both,,,90,224,190.4,64.1984,224,Humana Insurance Company,Commercial PPO,212.8,95,,percent of total billed charges,,
"Tick-Borne Ab Panel, S (Mayo)OutsideLaboratory",,86753,CPT,Facility,Outpatient,,,90,224,190.4,64.1984,224,Humana Insurance Company,Medicare PPO,109.76,49,,percent of total billed charges,,
"Tick-Borne Ab Panel, S (Mayo)OutsideLaboratory",,86753,CPT,Facility,Inpatient,,,90,224,190.4,64.1984,224,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Tick-Borne Ab Panel, S (Mayo)OutsideLaboratory",,86753,CPT,Facility,Both,,,90,224,190.4,64.1984,224,Medica,Individual & Family,221.984,99.1,,percent of total billed charges,,
"Tick-Borne Ab Panel, S (Mayo)OutsideLaboratory",,86753,CPT,Facility,Outpatient,,,90,224,190.4,64.1984,224,Medica,Medica Advantage Solution,111.552,49.8,,percent of total billed charges,,
"Tick-Borne Ab Panel, S (Mayo)OutsideLaboratory",,86753,CPT,Facility,Inpatient,,,90,224,190.4,64.1984,224,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Tick-Borne Ab Panel, S (Mayo)OutsideLaboratory",,86753,CPT,Facility,Outpatient,,,90,224,190.4,64.1984,224,Medica,Medical Assistance,99.904,44.6,,percent of total billed charges,,
"Tick-Borne Ab Panel, S (Mayo)OutsideLaboratory",,86753,CPT,Facility,Inpatient,,,90,224,190.4,64.1984,224,Medica,Medical Assistance,,,,,Included in per diem rate,
"Tick-Borne Ab Panel, S (Mayo)OutsideLaboratory",,86753,CPT,Facility,Outpatient,,,90,224,190.4,64.1984,224,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,111.552,49.8,,percent of total billed charges,,
"Tick-Borne Ab Panel, S (Mayo)OutsideLaboratory",,86753,CPT,Facility,Inpatient,,,90,224,190.4,64.1984,224,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Tick-Borne Ab Panel, S (Mayo)OutsideLaboratory",,86753,CPT,Facility,Both,,,90,224,190.4,64.1984,224,"Multiplan, Inc.","Multiplan, Inc.",210.56,94,,percent of total billed charges,,
"Tick-Borne Ab Panel, S (Mayo)OutsideLaboratory",,86753,CPT,Facility,Outpatient,,,90,224,190.4,64.1984,224,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,193.536,86.4,,percent of total billed charges,,
"Tick-Borne Ab Panel, S (Mayo)OutsideLaboratory",,86753,CPT,Facility,Inpatient,,,90,224,190.4,64.1984,224,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Tick-Borne Ab Panel, S (Mayo)OutsideLaboratory",,86753,CPT,Facility,Both,,,90,224,190.4,64.1984,224,"Preferred One Administrative Services, INC.",PPO,220.864,98.6,,percent of total billed charges,,
"Tick-Borne Ab Panel, S (Mayo)OutsideLaboratory",,86753,CPT,Facility,Outpatient,,,90,224,190.4,64.1984,224,PrimeWest Health,Minnesota Senior Health Options (MSHO),115.248,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Tick-Borne Ab Panel, S (Mayo)OutsideLaboratory",,86753,CPT,Facility,Inpatient,,,90,224,190.4,64.1984,224,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Tick-Borne Ab Panel, S (Mayo)OutsideLaboratory",,86753,CPT,Facility,Outpatient,,,90,224,190.4,64.1984,224,PrimeWest Health,MinnesotaCare,115.0464,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Tick-Borne Ab Panel, S (Mayo)OutsideLaboratory",,86753,CPT,Facility,Inpatient,,,90,224,190.4,64.1984,224,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Tick-Borne Ab Panel, S (Mayo)OutsideLaboratory",,86753,CPT,Facility,Both,,,90,224,190.4,64.1984,224,Sanford Health Plan,Sanford Health Plan,206.08,92,,percent of total billed charges,,
"Tick-Borne Ab Panel, S (Mayo)OutsideLaboratory",,86753,CPT,Facility,Outpatient,,,90,224,190.4,64.1984,224,"UCare Health, Inc.",Individual & Family Plan,126.224,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Tick-Borne Ab Panel, S (Mayo)OutsideLaboratory",,86753,CPT,Facility,Inpatient,,,90,224,190.4,64.1984,224,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Tick-Borne Ab Panel, S (Mayo)OutsideLaboratory",,86753,CPT,Facility,Outpatient,,,90,224,190.4,64.1984,224,"UCare Health, Inc.",Medical Assistance,113.0528,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Tick-Borne Ab Panel, S (Mayo)OutsideLaboratory",,86753,CPT,Facility,Inpatient,,,90,224,190.4,64.1984,224,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Tick-Borne Ab Panel, S (Mayo)OutsideLaboratory",,86753,CPT,Facility,Outpatient,,,90,224,190.4,64.1984,224,"UCare Health, Inc.",Medicare Advantage,113.0528,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Tick-Borne Ab Panel, S (Mayo)OutsideLaboratory",,86753,CPT,Facility,Inpatient,,,90,224,190.4,64.1984,224,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Tick-Borne Ab Panel, S (Mayo)OutsideLaboratory",,86753,CPT,Facility,Outpatient,,,90,224,190.4,64.1984,224,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),113.0528,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Tick-Borne Ab Panel, S (Mayo)OutsideLaboratory",,86753,CPT,Facility,Inpatient,,,90,224,190.4,64.1984,224,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Tick-Borne Ab Panel, S (Mayo)OutsideLaboratory",,86753,CPT,Facility,Both,,,90,224,190.4,64.1984,224,UnitedHealthcare,Individual & Family,210.56,94,,percent of total billed charges,,
"Tick-Borne Ab Panel, S (Mayo)OutsideLaboratory",,86753,CPT,Facility,Outpatient,,,90,224,190.4,64.1984,224,UnitedHealthcare,Medicare Advantage,109.76,49,,percent of total billed charges,,
"Tick-Borne Ab Panel, S (Mayo)OutsideLaboratory",,86753,CPT,Facility,Inpatient,,,90,224,190.4,64.1984,224,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Tick-Borne Ab Panel, S (Mayo)OutsideLaboratory",,86753,CPT,Facility,Outpatient,,,90,224,190.4,64.1984,224,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,107.52,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Tick-Borne Ab Panel, S (Mayo)OutsideLaboratory",,86753,CPT,Facility,Inpatient,,,90,224,190.4,64.1984,224,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Rubella - Igm Antibody (Mayo)OutsideLaboratory,,86762,CPT,Facility,Both,,,90,66,56.1,18.9156,66,Aetna,Commercial,60.72,92,,percent of total billed charges,,
Rubella - Igm Antibody (Mayo)OutsideLaboratory,,86762,CPT,Facility,Outpatient,,,90,66,56.1,18.9156,66,Aetna,Medicare Advantage,32.34,49,,percent of total billed charges,,
Rubella - Igm Antibody (Mayo)OutsideLaboratory,,86762,CPT,Facility,Inpatient,,,90,66,56.1,18.9156,66,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Rubella - Igm Antibody (Mayo)OutsideLaboratory,,86762,CPT,Facility,Both,,,90,66,56.1,18.9156,66,Aetna,PPO,61.38,93,,percent of total billed charges,,
Rubella - Igm Antibody (Mayo)OutsideLaboratory,,86762,CPT,Facility,Both,,,90,66,56.1,18.9156,66,America's PPO,America's PPO,63.3798,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Rubella - Igm Antibody (Mayo)OutsideLaboratory,,86762,CPT,Facility,Both,,,90,66,56.1,18.9156,66,BlueCross BlueShield Minnesota, Federal Employee Program,64.944,98.4,,percent of total billed charges,,
Rubella - Igm Antibody (Mayo)OutsideLaboratory,,86762,CPT,Facility,Both,,,90,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,66,100,,percent of total billed charges,,
Rubella - Igm Antibody (Mayo)OutsideLaboratory,,86762,CPT,Facility,Both,,,90,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,High Value Network Plan,59.4,90,,percent of total billed charges,,
Rubella - Igm Antibody (Mayo)OutsideLaboratory,,86762,CPT,Facility,Outpatient,,,90,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,Medicare Advantage,32.34,49,,percent of total billed charges,,
Rubella - Igm Antibody (Mayo)OutsideLaboratory,,86762,CPT,Facility,Inpatient,,,90,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Rubella - Igm Antibody (Mayo)OutsideLaboratory,,86762,CPT,Facility,Both,,,90,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,58.4562,88.57,,percent of total billed charges,,
Rubella - Igm Antibody (Mayo)OutsideLaboratory,,86762,CPT,Facility,Both,,,90,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,18.9156,28.66,,percent of total billed charges,,
Rubella - Igm Antibody (Mayo)OutsideLaboratory,,86762,CPT,Facility,Outpatient,,,90,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),32.34,49,,percent of total billed charges,,
Rubella - Igm Antibody (Mayo)OutsideLaboratory,,86762,CPT,Facility,Inpatient,,,90,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Rubella - Igm Antibody (Mayo)OutsideLaboratory,,86762,CPT,Facility,Both,,,90,66,56.1,18.9156,66,CorVel,Worker's Compensation,66,100,,percent of total billed charges,,
Rubella - Igm Antibody (Mayo)OutsideLaboratory,,86762,CPT,Facility,Both,,,90,66,56.1,18.9156,66,First Health Group Corporation,First Health Network,64.02,97,,percent of total billed charges,,
Rubella - Igm Antibody (Mayo)OutsideLaboratory,,86762,CPT,Facility,Both,,,90,66,56.1,18.9156,66,"Health Partners, Inc.",Commercial,62.436,94.6,,percent of total billed charges,,
Rubella - Igm Antibody (Mayo)OutsideLaboratory,,86762,CPT,Facility,Outpatient,,,90,66,56.1,18.9156,66,"Health Partners, Inc.",Medicare Advantage,32.34,49,,percent of total billed charges,,
Rubella - Igm Antibody (Mayo)OutsideLaboratory,,86762,CPT,Facility,Inpatient,,,90,66,56.1,18.9156,66,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Rubella - Igm Antibody (Mayo)OutsideLaboratory,,86762,CPT,Facility,Both,,,90,66,56.1,18.9156,66,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),39.6,60,,percent of total billed charges,,
Rubella - Igm Antibody (Mayo)OutsideLaboratory,,86762,CPT,Facility,Both,,,90,66,56.1,18.9156,66,"Health Partners, Inc.",State of Minnesota Advantage Program,53.79,81.5,,percent of total billed charges,,
Rubella - Igm Antibody (Mayo)OutsideLaboratory,,86762,CPT,Facility,Both,,,90,66,56.1,18.9156,66,"Health Partners, Inc.",State Public Programs,33,50,,percent of total billed charges,,
Rubella - Igm Antibody (Mayo)OutsideLaboratory,,86762,CPT,Facility,Both,,,90,66,56.1,18.9156,66,Humana Insurance Company,Commercial PPO,62.7,95,,percent of total billed charges,,
Rubella - Igm Antibody (Mayo)OutsideLaboratory,,86762,CPT,Facility,Outpatient,,,90,66,56.1,18.9156,66,Humana Insurance Company,Medicare PPO,32.34,49,,percent of total billed charges,,
Rubella - Igm Antibody (Mayo)OutsideLaboratory,,86762,CPT,Facility,Inpatient,,,90,66,56.1,18.9156,66,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Rubella - Igm Antibody (Mayo)OutsideLaboratory,,86762,CPT,Facility,Both,,,90,66,56.1,18.9156,66,Medica,Individual & Family,65.406,99.1,,percent of total billed charges,,
Rubella - Igm Antibody (Mayo)OutsideLaboratory,,86762,CPT,Facility,Outpatient,,,90,66,56.1,18.9156,66,Medica,Medica Advantage Solution,32.868,49.8,,percent of total billed charges,,
Rubella - Igm Antibody (Mayo)OutsideLaboratory,,86762,CPT,Facility,Inpatient,,,90,66,56.1,18.9156,66,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Rubella - Igm Antibody (Mayo)OutsideLaboratory,,86762,CPT,Facility,Outpatient,,,90,66,56.1,18.9156,66,Medica,Medical Assistance,29.436,44.6,,percent of total billed charges,,
Rubella - Igm Antibody (Mayo)OutsideLaboratory,,86762,CPT,Facility,Inpatient,,,90,66,56.1,18.9156,66,Medica,Medical Assistance,,,,,Included in per diem rate,
Rubella - Igm Antibody (Mayo)OutsideLaboratory,,86762,CPT,Facility,Outpatient,,,90,66,56.1,18.9156,66,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,32.868,49.8,,percent of total billed charges,,
Rubella - Igm Antibody (Mayo)OutsideLaboratory,,86762,CPT,Facility,Inpatient,,,90,66,56.1,18.9156,66,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Rubella - Igm Antibody (Mayo)OutsideLaboratory,,86762,CPT,Facility,Both,,,90,66,56.1,18.9156,66,"Multiplan, Inc.","Multiplan, Inc.",62.04,94,,percent of total billed charges,,
Rubella - Igm Antibody (Mayo)OutsideLaboratory,,86762,CPT,Facility,Outpatient,,,90,66,56.1,18.9156,66,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,57.024,86.4,,percent of total billed charges,,
Rubella - Igm Antibody (Mayo)OutsideLaboratory,,86762,CPT,Facility,Inpatient,,,90,66,56.1,18.9156,66,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Rubella - Igm Antibody (Mayo)OutsideLaboratory,,86762,CPT,Facility,Both,,,90,66,56.1,18.9156,66,"Preferred One Administrative Services, INC.",PPO,65.076,98.6,,percent of total billed charges,,
Rubella - Igm Antibody (Mayo)OutsideLaboratory,,86762,CPT,Facility,Outpatient,,,90,66,56.1,18.9156,66,PrimeWest Health,Minnesota Senior Health Options (MSHO),33.957,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Rubella - Igm Antibody (Mayo)OutsideLaboratory,,86762,CPT,Facility,Inpatient,,,90,66,56.1,18.9156,66,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Rubella - Igm Antibody (Mayo)OutsideLaboratory,,86762,CPT,Facility,Outpatient,,,90,66,56.1,18.9156,66,PrimeWest Health,MinnesotaCare,33.8976,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Rubella - Igm Antibody (Mayo)OutsideLaboratory,,86762,CPT,Facility,Inpatient,,,90,66,56.1,18.9156,66,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Rubella - Igm Antibody (Mayo)OutsideLaboratory,,86762,CPT,Facility,Both,,,90,66,56.1,18.9156,66,Sanford Health Plan,Sanford Health Plan,60.72,92,,percent of total billed charges,,
Rubella - Igm Antibody (Mayo)OutsideLaboratory,,86762,CPT,Facility,Outpatient,,,90,66,56.1,18.9156,66,"UCare Health, Inc.",Individual & Family Plan,37.191,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Rubella - Igm Antibody (Mayo)OutsideLaboratory,,86762,CPT,Facility,Inpatient,,,90,66,56.1,18.9156,66,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Rubella - Igm Antibody (Mayo)OutsideLaboratory,,86762,CPT,Facility,Outpatient,,,90,66,56.1,18.9156,66,"UCare Health, Inc.",Medical Assistance,33.3102,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Rubella - Igm Antibody (Mayo)OutsideLaboratory,,86762,CPT,Facility,Inpatient,,,90,66,56.1,18.9156,66,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Rubella - Igm Antibody (Mayo)OutsideLaboratory,,86762,CPT,Facility,Outpatient,,,90,66,56.1,18.9156,66,"UCare Health, Inc.",Medicare Advantage,33.3102,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Rubella - Igm Antibody (Mayo)OutsideLaboratory,,86762,CPT,Facility,Inpatient,,,90,66,56.1,18.9156,66,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Rubella - Igm Antibody (Mayo)OutsideLaboratory,,86762,CPT,Facility,Outpatient,,,90,66,56.1,18.9156,66,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),33.3102,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Rubella - Igm Antibody (Mayo)OutsideLaboratory,,86762,CPT,Facility,Inpatient,,,90,66,56.1,18.9156,66,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Rubella - Igm Antibody (Mayo)OutsideLaboratory,,86762,CPT,Facility,Both,,,90,66,56.1,18.9156,66,UnitedHealthcare,Individual & Family,62.04,94,,percent of total billed charges,,
Rubella - Igm Antibody (Mayo)OutsideLaboratory,,86762,CPT,Facility,Outpatient,,,90,66,56.1,18.9156,66,UnitedHealthcare,Medicare Advantage,32.34,49,,percent of total billed charges,,
Rubella - Igm Antibody (Mayo)OutsideLaboratory,,86762,CPT,Facility,Inpatient,,,90,66,56.1,18.9156,66,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Rubella - Igm Antibody (Mayo)OutsideLaboratory,,86762,CPT,Facility,Outpatient,,,90,66,56.1,18.9156,66,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,31.68,48,,percent of total billed charges,,100% of DHS outpatient percentage
Rubella - Igm Antibody (Mayo)OutsideLaboratory,,86762,CPT,Facility,Inpatient,,,90,66,56.1,18.9156,66,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Measles (Rubeola) Ab, Igg, S (Mayo)OutsideLaboratory",,86765,CPT,Facility,Both,,,90,110,93.5,31.526,110,Aetna,Commercial,101.2,92,,percent of total billed charges,,
"Measles (Rubeola) Ab, Igg, S (Mayo)OutsideLaboratory",,86765,CPT,Facility,Outpatient,,,90,110,93.5,31.526,110,Aetna,Medicare Advantage,53.9,49,,percent of total billed charges,,
"Measles (Rubeola) Ab, Igg, S (Mayo)OutsideLaboratory",,86765,CPT,Facility,Inpatient,,,90,110,93.5,31.526,110,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Measles (Rubeola) Ab, Igg, S (Mayo)OutsideLaboratory",,86765,CPT,Facility,Both,,,90,110,93.5,31.526,110,Aetna,PPO,102.3,93,,percent of total billed charges,,
"Measles (Rubeola) Ab, Igg, S (Mayo)OutsideLaboratory",,86765,CPT,Facility,Both,,,90,110,93.5,31.526,110,America's PPO,America's PPO,105.633,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Measles (Rubeola) Ab, Igg, S (Mayo)OutsideLaboratory",,86765,CPT,Facility,Both,,,90,110,93.5,31.526,110,BlueCross BlueShield Minnesota, Federal Employee Program,108.24,98.4,,percent of total billed charges,,
"Measles (Rubeola) Ab, Igg, S (Mayo)OutsideLaboratory",,86765,CPT,Facility,Both,,,90,110,93.5,31.526,110,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,110,100,,percent of total billed charges,,
"Measles (Rubeola) Ab, Igg, S (Mayo)OutsideLaboratory",,86765,CPT,Facility,Both,,,90,110,93.5,31.526,110,BlueCross BlueShield Minnesota,High Value Network Plan,99,90,,percent of total billed charges,,
"Measles (Rubeola) Ab, Igg, S (Mayo)OutsideLaboratory",,86765,CPT,Facility,Outpatient,,,90,110,93.5,31.526,110,BlueCross BlueShield Minnesota,Medicare Advantage,53.9,49,,percent of total billed charges,,
"Measles (Rubeola) Ab, Igg, S (Mayo)OutsideLaboratory",,86765,CPT,Facility,Inpatient,,,90,110,93.5,31.526,110,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Measles (Rubeola) Ab, Igg, S (Mayo)OutsideLaboratory",,86765,CPT,Facility,Both,,,90,110,93.5,31.526,110,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,97.427,88.57,,percent of total billed charges,,
"Measles (Rubeola) Ab, Igg, S (Mayo)OutsideLaboratory",,86765,CPT,Facility,Both,,,90,110,93.5,31.526,110,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,31.526,28.66,,percent of total billed charges,,
"Measles (Rubeola) Ab, Igg, S (Mayo)OutsideLaboratory",,86765,CPT,Facility,Outpatient,,,90,110,93.5,31.526,110,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),53.9,49,,percent of total billed charges,,
"Measles (Rubeola) Ab, Igg, S (Mayo)OutsideLaboratory",,86765,CPT,Facility,Inpatient,,,90,110,93.5,31.526,110,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Measles (Rubeola) Ab, Igg, S (Mayo)OutsideLaboratory",,86765,CPT,Facility,Both,,,90,110,93.5,31.526,110,CorVel,Worker's Compensation,110,100,,percent of total billed charges,,
"Measles (Rubeola) Ab, Igg, S (Mayo)OutsideLaboratory",,86765,CPT,Facility,Both,,,90,110,93.5,31.526,110,First Health Group Corporation,First Health Network,106.7,97,,percent of total billed charges,,
"Measles (Rubeola) Ab, Igg, S (Mayo)OutsideLaboratory",,86765,CPT,Facility,Both,,,90,110,93.5,31.526,110,"Health Partners, Inc.",Commercial,104.06,94.6,,percent of total billed charges,,
"Measles (Rubeola) Ab, Igg, S (Mayo)OutsideLaboratory",,86765,CPT,Facility,Outpatient,,,90,110,93.5,31.526,110,"Health Partners, Inc.",Medicare Advantage,53.9,49,,percent of total billed charges,,
"Measles (Rubeola) Ab, Igg, S (Mayo)OutsideLaboratory",,86765,CPT,Facility,Inpatient,,,90,110,93.5,31.526,110,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Measles (Rubeola) Ab, Igg, S (Mayo)OutsideLaboratory",,86765,CPT,Facility,Both,,,90,110,93.5,31.526,110,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),66,60,,percent of total billed charges,,
"Measles (Rubeola) Ab, Igg, S (Mayo)OutsideLaboratory",,86765,CPT,Facility,Both,,,90,110,93.5,31.526,110,"Health Partners, Inc.",State of Minnesota Advantage Program,89.65,81.5,,percent of total billed charges,,
"Measles (Rubeola) Ab, Igg, S (Mayo)OutsideLaboratory",,86765,CPT,Facility,Both,,,90,110,93.5,31.526,110,"Health Partners, Inc.",State Public Programs,55,50,,percent of total billed charges,,
"Measles (Rubeola) Ab, Igg, S (Mayo)OutsideLaboratory",,86765,CPT,Facility,Both,,,90,110,93.5,31.526,110,Humana Insurance Company,Commercial PPO,104.5,95,,percent of total billed charges,,
"Measles (Rubeola) Ab, Igg, S (Mayo)OutsideLaboratory",,86765,CPT,Facility,Outpatient,,,90,110,93.5,31.526,110,Humana Insurance Company,Medicare PPO,53.9,49,,percent of total billed charges,,
"Measles (Rubeola) Ab, Igg, S (Mayo)OutsideLaboratory",,86765,CPT,Facility,Inpatient,,,90,110,93.5,31.526,110,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Measles (Rubeola) Ab, Igg, S (Mayo)OutsideLaboratory",,86765,CPT,Facility,Both,,,90,110,93.5,31.526,110,Medica,Individual & Family,109.01,99.1,,percent of total billed charges,,
"Measles (Rubeola) Ab, Igg, S (Mayo)OutsideLaboratory",,86765,CPT,Facility,Outpatient,,,90,110,93.5,31.526,110,Medica,Medica Advantage Solution,54.78,49.8,,percent of total billed charges,,
"Measles (Rubeola) Ab, Igg, S (Mayo)OutsideLaboratory",,86765,CPT,Facility,Inpatient,,,90,110,93.5,31.526,110,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Measles (Rubeola) Ab, Igg, S (Mayo)OutsideLaboratory",,86765,CPT,Facility,Outpatient,,,90,110,93.5,31.526,110,Medica,Medical Assistance,49.06,44.6,,percent of total billed charges,,
"Measles (Rubeola) Ab, Igg, S (Mayo)OutsideLaboratory",,86765,CPT,Facility,Inpatient,,,90,110,93.5,31.526,110,Medica,Medical Assistance,,,,,Included in per diem rate,
"Measles (Rubeola) Ab, Igg, S (Mayo)OutsideLaboratory",,86765,CPT,Facility,Outpatient,,,90,110,93.5,31.526,110,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,54.78,49.8,,percent of total billed charges,,
"Measles (Rubeola) Ab, Igg, S (Mayo)OutsideLaboratory",,86765,CPT,Facility,Inpatient,,,90,110,93.5,31.526,110,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Measles (Rubeola) Ab, Igg, S (Mayo)OutsideLaboratory",,86765,CPT,Facility,Both,,,90,110,93.5,31.526,110,"Multiplan, Inc.","Multiplan, Inc.",103.4,94,,percent of total billed charges,,
"Measles (Rubeola) Ab, Igg, S (Mayo)OutsideLaboratory",,86765,CPT,Facility,Outpatient,,,90,110,93.5,31.526,110,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,95.04,86.4,,percent of total billed charges,,
"Measles (Rubeola) Ab, Igg, S (Mayo)OutsideLaboratory",,86765,CPT,Facility,Inpatient,,,90,110,93.5,31.526,110,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Measles (Rubeola) Ab, Igg, S (Mayo)OutsideLaboratory",,86765,CPT,Facility,Both,,,90,110,93.5,31.526,110,"Preferred One Administrative Services, INC.",PPO,108.46,98.6,,percent of total billed charges,,
"Measles (Rubeola) Ab, Igg, S (Mayo)OutsideLaboratory",,86765,CPT,Facility,Outpatient,,,90,110,93.5,31.526,110,PrimeWest Health,Minnesota Senior Health Options (MSHO),56.595,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Measles (Rubeola) Ab, Igg, S (Mayo)OutsideLaboratory",,86765,CPT,Facility,Inpatient,,,90,110,93.5,31.526,110,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Measles (Rubeola) Ab, Igg, S (Mayo)OutsideLaboratory",,86765,CPT,Facility,Outpatient,,,90,110,93.5,31.526,110,PrimeWest Health,MinnesotaCare,56.496,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Measles (Rubeola) Ab, Igg, S (Mayo)OutsideLaboratory",,86765,CPT,Facility,Inpatient,,,90,110,93.5,31.526,110,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Measles (Rubeola) Ab, Igg, S (Mayo)OutsideLaboratory",,86765,CPT,Facility,Both,,,90,110,93.5,31.526,110,Sanford Health Plan,Sanford Health Plan,101.2,92,,percent of total billed charges,,
"Measles (Rubeola) Ab, Igg, S (Mayo)OutsideLaboratory",,86765,CPT,Facility,Outpatient,,,90,110,93.5,31.526,110,"UCare Health, Inc.",Individual & Family Plan,61.985,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Measles (Rubeola) Ab, Igg, S (Mayo)OutsideLaboratory",,86765,CPT,Facility,Inpatient,,,90,110,93.5,31.526,110,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Measles (Rubeola) Ab, Igg, S (Mayo)OutsideLaboratory",,86765,CPT,Facility,Outpatient,,,90,110,93.5,31.526,110,"UCare Health, Inc.",Medical Assistance,55.517,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Measles (Rubeola) Ab, Igg, S (Mayo)OutsideLaboratory",,86765,CPT,Facility,Inpatient,,,90,110,93.5,31.526,110,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Measles (Rubeola) Ab, Igg, S (Mayo)OutsideLaboratory",,86765,CPT,Facility,Outpatient,,,90,110,93.5,31.526,110,"UCare Health, Inc.",Medicare Advantage,55.517,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Measles (Rubeola) Ab, Igg, S (Mayo)OutsideLaboratory",,86765,CPT,Facility,Inpatient,,,90,110,93.5,31.526,110,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Measles (Rubeola) Ab, Igg, S (Mayo)OutsideLaboratory",,86765,CPT,Facility,Outpatient,,,90,110,93.5,31.526,110,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),55.517,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Measles (Rubeola) Ab, Igg, S (Mayo)OutsideLaboratory",,86765,CPT,Facility,Inpatient,,,90,110,93.5,31.526,110,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Measles (Rubeola) Ab, Igg, S (Mayo)OutsideLaboratory",,86765,CPT,Facility,Both,,,90,110,93.5,31.526,110,UnitedHealthcare,Individual & Family,103.4,94,,percent of total billed charges,,
"Measles (Rubeola) Ab, Igg, S (Mayo)OutsideLaboratory",,86765,CPT,Facility,Outpatient,,,90,110,93.5,31.526,110,UnitedHealthcare,Medicare Advantage,53.9,49,,percent of total billed charges,,
"Measles (Rubeola) Ab, Igg, S (Mayo)OutsideLaboratory",,86765,CPT,Facility,Inpatient,,,90,110,93.5,31.526,110,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Measles (Rubeola) Ab, Igg, S (Mayo)OutsideLaboratory",,86765,CPT,Facility,Outpatient,,,90,110,93.5,31.526,110,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,52.8,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Measles (Rubeola) Ab, Igg, S (Mayo)OutsideLaboratory",,86765,CPT,Facility,Inpatient,,,90,110,93.5,31.526,110,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Toxoplasma Aby Ii (Mayo)OutsideLaboratory,,86777,CPT,Facility,Both,,,90,61,51.85,17.4826,61,Aetna,Commercial,56.12,92,,percent of total billed charges,,
Toxoplasma Aby Ii (Mayo)OutsideLaboratory,,86777,CPT,Facility,Outpatient,,,90,61,51.85,17.4826,61,Aetna,Medicare Advantage,29.89,49,,percent of total billed charges,,
Toxoplasma Aby Ii (Mayo)OutsideLaboratory,,86777,CPT,Facility,Inpatient,,,90,61,51.85,17.4826,61,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Toxoplasma Aby Ii (Mayo)OutsideLaboratory,,86777,CPT,Facility,Both,,,90,61,51.85,17.4826,61,Aetna,PPO,56.73,93,,percent of total billed charges,,
Toxoplasma Aby Ii (Mayo)OutsideLaboratory,,86777,CPT,Facility,Both,,,90,61,51.85,17.4826,61,America's PPO,America's PPO,58.5783,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Toxoplasma Aby Ii (Mayo)OutsideLaboratory,,86777,CPT,Facility,Both,,,90,61,51.85,17.4826,61,BlueCross BlueShield Minnesota, Federal Employee Program,60.024,98.4,,percent of total billed charges,,
Toxoplasma Aby Ii (Mayo)OutsideLaboratory,,86777,CPT,Facility,Both,,,90,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,61,100,,percent of total billed charges,,
Toxoplasma Aby Ii (Mayo)OutsideLaboratory,,86777,CPT,Facility,Both,,,90,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,High Value Network Plan,54.9,90,,percent of total billed charges,,
Toxoplasma Aby Ii (Mayo)OutsideLaboratory,,86777,CPT,Facility,Outpatient,,,90,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,Medicare Advantage,29.89,49,,percent of total billed charges,,
Toxoplasma Aby Ii (Mayo)OutsideLaboratory,,86777,CPT,Facility,Inpatient,,,90,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Toxoplasma Aby Ii (Mayo)OutsideLaboratory,,86777,CPT,Facility,Both,,,90,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,54.0277,88.57,,percent of total billed charges,,
Toxoplasma Aby Ii (Mayo)OutsideLaboratory,,86777,CPT,Facility,Both,,,90,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,17.4826,28.66,,percent of total billed charges,,
Toxoplasma Aby Ii (Mayo)OutsideLaboratory,,86777,CPT,Facility,Outpatient,,,90,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),29.89,49,,percent of total billed charges,,
Toxoplasma Aby Ii (Mayo)OutsideLaboratory,,86777,CPT,Facility,Inpatient,,,90,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Toxoplasma Aby Ii (Mayo)OutsideLaboratory,,86777,CPT,Facility,Both,,,90,61,51.85,17.4826,61,CorVel,Worker's Compensation,61,100,,percent of total billed charges,,
Toxoplasma Aby Ii (Mayo)OutsideLaboratory,,86777,CPT,Facility,Both,,,90,61,51.85,17.4826,61,First Health Group Corporation,First Health Network,59.17,97,,percent of total billed charges,,
Toxoplasma Aby Ii (Mayo)OutsideLaboratory,,86777,CPT,Facility,Both,,,90,61,51.85,17.4826,61,"Health Partners, Inc.",Commercial,57.706,94.6,,percent of total billed charges,,
Toxoplasma Aby Ii (Mayo)OutsideLaboratory,,86777,CPT,Facility,Outpatient,,,90,61,51.85,17.4826,61,"Health Partners, Inc.",Medicare Advantage,29.89,49,,percent of total billed charges,,
Toxoplasma Aby Ii (Mayo)OutsideLaboratory,,86777,CPT,Facility,Inpatient,,,90,61,51.85,17.4826,61,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Toxoplasma Aby Ii (Mayo)OutsideLaboratory,,86777,CPT,Facility,Both,,,90,61,51.85,17.4826,61,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),36.6,60,,percent of total billed charges,,
Toxoplasma Aby Ii (Mayo)OutsideLaboratory,,86777,CPT,Facility,Both,,,90,61,51.85,17.4826,61,"Health Partners, Inc.",State of Minnesota Advantage Program,49.715,81.5,,percent of total billed charges,,
Toxoplasma Aby Ii (Mayo)OutsideLaboratory,,86777,CPT,Facility,Both,,,90,61,51.85,17.4826,61,"Health Partners, Inc.",State Public Programs,30.5,50,,percent of total billed charges,,
Toxoplasma Aby Ii (Mayo)OutsideLaboratory,,86777,CPT,Facility,Both,,,90,61,51.85,17.4826,61,Humana Insurance Company,Commercial PPO,57.95,95,,percent of total billed charges,,
Toxoplasma Aby Ii (Mayo)OutsideLaboratory,,86777,CPT,Facility,Outpatient,,,90,61,51.85,17.4826,61,Humana Insurance Company,Medicare PPO,29.89,49,,percent of total billed charges,,
Toxoplasma Aby Ii (Mayo)OutsideLaboratory,,86777,CPT,Facility,Inpatient,,,90,61,51.85,17.4826,61,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Toxoplasma Aby Ii (Mayo)OutsideLaboratory,,86777,CPT,Facility,Both,,,90,61,51.85,17.4826,61,Medica,Individual & Family,60.451,99.1,,percent of total billed charges,,
Toxoplasma Aby Ii (Mayo)OutsideLaboratory,,86777,CPT,Facility,Outpatient,,,90,61,51.85,17.4826,61,Medica,Medica Advantage Solution,30.378,49.8,,percent of total billed charges,,
Toxoplasma Aby Ii (Mayo)OutsideLaboratory,,86777,CPT,Facility,Inpatient,,,90,61,51.85,17.4826,61,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Toxoplasma Aby Ii (Mayo)OutsideLaboratory,,86777,CPT,Facility,Outpatient,,,90,61,51.85,17.4826,61,Medica,Medical Assistance,27.206,44.6,,percent of total billed charges,,
Toxoplasma Aby Ii (Mayo)OutsideLaboratory,,86777,CPT,Facility,Inpatient,,,90,61,51.85,17.4826,61,Medica,Medical Assistance,,,,,Included in per diem rate,
Toxoplasma Aby Ii (Mayo)OutsideLaboratory,,86777,CPT,Facility,Outpatient,,,90,61,51.85,17.4826,61,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,30.378,49.8,,percent of total billed charges,,
Toxoplasma Aby Ii (Mayo)OutsideLaboratory,,86777,CPT,Facility,Inpatient,,,90,61,51.85,17.4826,61,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Toxoplasma Aby Ii (Mayo)OutsideLaboratory,,86777,CPT,Facility,Both,,,90,61,51.85,17.4826,61,"Multiplan, Inc.","Multiplan, Inc.",57.34,94,,percent of total billed charges,,
Toxoplasma Aby Ii (Mayo)OutsideLaboratory,,86777,CPT,Facility,Outpatient,,,90,61,51.85,17.4826,61,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,52.704,86.4,,percent of total billed charges,,
Toxoplasma Aby Ii (Mayo)OutsideLaboratory,,86777,CPT,Facility,Inpatient,,,90,61,51.85,17.4826,61,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Toxoplasma Aby Ii (Mayo)OutsideLaboratory,,86777,CPT,Facility,Both,,,90,61,51.85,17.4826,61,"Preferred One Administrative Services, INC.",PPO,60.146,98.6,,percent of total billed charges,,
Toxoplasma Aby Ii (Mayo)OutsideLaboratory,,86777,CPT,Facility,Outpatient,,,90,61,51.85,17.4826,61,PrimeWest Health,Minnesota Senior Health Options (MSHO),31.3845,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Toxoplasma Aby Ii (Mayo)OutsideLaboratory,,86777,CPT,Facility,Inpatient,,,90,61,51.85,17.4826,61,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Toxoplasma Aby Ii (Mayo)OutsideLaboratory,,86777,CPT,Facility,Outpatient,,,90,61,51.85,17.4826,61,PrimeWest Health,MinnesotaCare,31.3296,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Toxoplasma Aby Ii (Mayo)OutsideLaboratory,,86777,CPT,Facility,Inpatient,,,90,61,51.85,17.4826,61,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Toxoplasma Aby Ii (Mayo)OutsideLaboratory,,86777,CPT,Facility,Both,,,90,61,51.85,17.4826,61,Sanford Health Plan,Sanford Health Plan,56.12,92,,percent of total billed charges,,
Toxoplasma Aby Ii (Mayo)OutsideLaboratory,,86777,CPT,Facility,Outpatient,,,90,61,51.85,17.4826,61,"UCare Health, Inc.",Individual & Family Plan,34.3735,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Toxoplasma Aby Ii (Mayo)OutsideLaboratory,,86777,CPT,Facility,Inpatient,,,90,61,51.85,17.4826,61,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Toxoplasma Aby Ii (Mayo)OutsideLaboratory,,86777,CPT,Facility,Outpatient,,,90,61,51.85,17.4826,61,"UCare Health, Inc.",Medical Assistance,30.7867,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Toxoplasma Aby Ii (Mayo)OutsideLaboratory,,86777,CPT,Facility,Inpatient,,,90,61,51.85,17.4826,61,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Toxoplasma Aby Ii (Mayo)OutsideLaboratory,,86777,CPT,Facility,Outpatient,,,90,61,51.85,17.4826,61,"UCare Health, Inc.",Medicare Advantage,30.7867,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Toxoplasma Aby Ii (Mayo)OutsideLaboratory,,86777,CPT,Facility,Inpatient,,,90,61,51.85,17.4826,61,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Toxoplasma Aby Ii (Mayo)OutsideLaboratory,,86777,CPT,Facility,Outpatient,,,90,61,51.85,17.4826,61,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),30.7867,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Toxoplasma Aby Ii (Mayo)OutsideLaboratory,,86777,CPT,Facility,Inpatient,,,90,61,51.85,17.4826,61,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Toxoplasma Aby Ii (Mayo)OutsideLaboratory,,86777,CPT,Facility,Both,,,90,61,51.85,17.4826,61,UnitedHealthcare,Individual & Family,57.34,94,,percent of total billed charges,,
Toxoplasma Aby Ii (Mayo)OutsideLaboratory,,86777,CPT,Facility,Outpatient,,,90,61,51.85,17.4826,61,UnitedHealthcare,Medicare Advantage,29.89,49,,percent of total billed charges,,
Toxoplasma Aby Ii (Mayo)OutsideLaboratory,,86777,CPT,Facility,Inpatient,,,90,61,51.85,17.4826,61,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Toxoplasma Aby Ii (Mayo)OutsideLaboratory,,86777,CPT,Facility,Outpatient,,,90,61,51.85,17.4826,61,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,29.28,48,,percent of total billed charges,,100% of DHS outpatient percentage
Toxoplasma Aby Ii (Mayo)OutsideLaboratory,,86777,CPT,Facility,Inpatient,,,90,61,51.85,17.4826,61,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Toxoplasma Ab, Igm And Igg, S (Mayo)OutsideLaboratory",,86778,CPT,Facility,Both,,,90,112,95.2,32.0992,112,Aetna,Commercial,103.04,92,,percent of total billed charges,,
"Toxoplasma Ab, Igm And Igg, S (Mayo)OutsideLaboratory",,86778,CPT,Facility,Outpatient,,,90,112,95.2,32.0992,112,Aetna,Medicare Advantage,54.88,49,,percent of total billed charges,,
"Toxoplasma Ab, Igm And Igg, S (Mayo)OutsideLaboratory",,86778,CPT,Facility,Inpatient,,,90,112,95.2,32.0992,112,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Toxoplasma Ab, Igm And Igg, S (Mayo)OutsideLaboratory",,86778,CPT,Facility,Both,,,90,112,95.2,32.0992,112,Aetna,PPO,104.16,93,,percent of total billed charges,,
"Toxoplasma Ab, Igm And Igg, S (Mayo)OutsideLaboratory",,86778,CPT,Facility,Both,,,90,112,95.2,32.0992,112,America's PPO,America's PPO,107.5536,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Toxoplasma Ab, Igm And Igg, S (Mayo)OutsideLaboratory",,86778,CPT,Facility,Both,,,90,112,95.2,32.0992,112,BlueCross BlueShield Minnesota, Federal Employee Program,110.208,98.4,,percent of total billed charges,,
"Toxoplasma Ab, Igm And Igg, S (Mayo)OutsideLaboratory",,86778,CPT,Facility,Both,,,90,112,95.2,32.0992,112,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,112,100,,percent of total billed charges,,
"Toxoplasma Ab, Igm And Igg, S (Mayo)OutsideLaboratory",,86778,CPT,Facility,Both,,,90,112,95.2,32.0992,112,BlueCross BlueShield Minnesota,High Value Network Plan,100.8,90,,percent of total billed charges,,
"Toxoplasma Ab, Igm And Igg, S (Mayo)OutsideLaboratory",,86778,CPT,Facility,Outpatient,,,90,112,95.2,32.0992,112,BlueCross BlueShield Minnesota,Medicare Advantage,54.88,49,,percent of total billed charges,,
"Toxoplasma Ab, Igm And Igg, S (Mayo)OutsideLaboratory",,86778,CPT,Facility,Inpatient,,,90,112,95.2,32.0992,112,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Toxoplasma Ab, Igm And Igg, S (Mayo)OutsideLaboratory",,86778,CPT,Facility,Both,,,90,112,95.2,32.0992,112,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,99.1984,88.57,,percent of total billed charges,,
"Toxoplasma Ab, Igm And Igg, S (Mayo)OutsideLaboratory",,86778,CPT,Facility,Both,,,90,112,95.2,32.0992,112,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,32.0992,28.66,,percent of total billed charges,,
"Toxoplasma Ab, Igm And Igg, S (Mayo)OutsideLaboratory",,86778,CPT,Facility,Outpatient,,,90,112,95.2,32.0992,112,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),54.88,49,,percent of total billed charges,,
"Toxoplasma Ab, Igm And Igg, S (Mayo)OutsideLaboratory",,86778,CPT,Facility,Inpatient,,,90,112,95.2,32.0992,112,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Toxoplasma Ab, Igm And Igg, S (Mayo)OutsideLaboratory",,86778,CPT,Facility,Both,,,90,112,95.2,32.0992,112,CorVel,Worker's Compensation,112,100,,percent of total billed charges,,
"Toxoplasma Ab, Igm And Igg, S (Mayo)OutsideLaboratory",,86778,CPT,Facility,Both,,,90,112,95.2,32.0992,112,First Health Group Corporation,First Health Network,108.64,97,,percent of total billed charges,,
"Toxoplasma Ab, Igm And Igg, S (Mayo)OutsideLaboratory",,86778,CPT,Facility,Both,,,90,112,95.2,32.0992,112,"Health Partners, Inc.",Commercial,105.952,94.6,,percent of total billed charges,,
"Toxoplasma Ab, Igm And Igg, S (Mayo)OutsideLaboratory",,86778,CPT,Facility,Outpatient,,,90,112,95.2,32.0992,112,"Health Partners, Inc.",Medicare Advantage,54.88,49,,percent of total billed charges,,
"Toxoplasma Ab, Igm And Igg, S (Mayo)OutsideLaboratory",,86778,CPT,Facility,Inpatient,,,90,112,95.2,32.0992,112,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Toxoplasma Ab, Igm And Igg, S (Mayo)OutsideLaboratory",,86778,CPT,Facility,Both,,,90,112,95.2,32.0992,112,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),67.2,60,,percent of total billed charges,,
"Toxoplasma Ab, Igm And Igg, S (Mayo)OutsideLaboratory",,86778,CPT,Facility,Both,,,90,112,95.2,32.0992,112,"Health Partners, Inc.",State of Minnesota Advantage Program,91.28,81.5,,percent of total billed charges,,
"Toxoplasma Ab, Igm And Igg, S (Mayo)OutsideLaboratory",,86778,CPT,Facility,Both,,,90,112,95.2,32.0992,112,"Health Partners, Inc.",State Public Programs,56,50,,percent of total billed charges,,
"Toxoplasma Ab, Igm And Igg, S (Mayo)OutsideLaboratory",,86778,CPT,Facility,Both,,,90,112,95.2,32.0992,112,Humana Insurance Company,Commercial PPO,106.4,95,,percent of total billed charges,,
"Toxoplasma Ab, Igm And Igg, S (Mayo)OutsideLaboratory",,86778,CPT,Facility,Outpatient,,,90,112,95.2,32.0992,112,Humana Insurance Company,Medicare PPO,54.88,49,,percent of total billed charges,,
"Toxoplasma Ab, Igm And Igg, S (Mayo)OutsideLaboratory",,86778,CPT,Facility,Inpatient,,,90,112,95.2,32.0992,112,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Toxoplasma Ab, Igm And Igg, S (Mayo)OutsideLaboratory",,86778,CPT,Facility,Both,,,90,112,95.2,32.0992,112,Medica,Individual & Family,110.992,99.1,,percent of total billed charges,,
"Toxoplasma Ab, Igm And Igg, S (Mayo)OutsideLaboratory",,86778,CPT,Facility,Outpatient,,,90,112,95.2,32.0992,112,Medica,Medica Advantage Solution,55.776,49.8,,percent of total billed charges,,
"Toxoplasma Ab, Igm And Igg, S (Mayo)OutsideLaboratory",,86778,CPT,Facility,Inpatient,,,90,112,95.2,32.0992,112,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Toxoplasma Ab, Igm And Igg, S (Mayo)OutsideLaboratory",,86778,CPT,Facility,Outpatient,,,90,112,95.2,32.0992,112,Medica,Medical Assistance,49.952,44.6,,percent of total billed charges,,
"Toxoplasma Ab, Igm And Igg, S (Mayo)OutsideLaboratory",,86778,CPT,Facility,Inpatient,,,90,112,95.2,32.0992,112,Medica,Medical Assistance,,,,,Included in per diem rate,
"Toxoplasma Ab, Igm And Igg, S (Mayo)OutsideLaboratory",,86778,CPT,Facility,Outpatient,,,90,112,95.2,32.0992,112,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,55.776,49.8,,percent of total billed charges,,
"Toxoplasma Ab, Igm And Igg, S (Mayo)OutsideLaboratory",,86778,CPT,Facility,Inpatient,,,90,112,95.2,32.0992,112,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Toxoplasma Ab, Igm And Igg, S (Mayo)OutsideLaboratory",,86778,CPT,Facility,Both,,,90,112,95.2,32.0992,112,"Multiplan, Inc.","Multiplan, Inc.",105.28,94,,percent of total billed charges,,
"Toxoplasma Ab, Igm And Igg, S (Mayo)OutsideLaboratory",,86778,CPT,Facility,Outpatient,,,90,112,95.2,32.0992,112,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,96.768,86.4,,percent of total billed charges,,
"Toxoplasma Ab, Igm And Igg, S (Mayo)OutsideLaboratory",,86778,CPT,Facility,Inpatient,,,90,112,95.2,32.0992,112,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Toxoplasma Ab, Igm And Igg, S (Mayo)OutsideLaboratory",,86778,CPT,Facility,Both,,,90,112,95.2,32.0992,112,"Preferred One Administrative Services, INC.",PPO,110.432,98.6,,percent of total billed charges,,
"Toxoplasma Ab, Igm And Igg, S (Mayo)OutsideLaboratory",,86778,CPT,Facility,Outpatient,,,90,112,95.2,32.0992,112,PrimeWest Health,Minnesota Senior Health Options (MSHO),57.624,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Toxoplasma Ab, Igm And Igg, S (Mayo)OutsideLaboratory",,86778,CPT,Facility,Inpatient,,,90,112,95.2,32.0992,112,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Toxoplasma Ab, Igm And Igg, S (Mayo)OutsideLaboratory",,86778,CPT,Facility,Outpatient,,,90,112,95.2,32.0992,112,PrimeWest Health,MinnesotaCare,57.5232,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Toxoplasma Ab, Igm And Igg, S (Mayo)OutsideLaboratory",,86778,CPT,Facility,Inpatient,,,90,112,95.2,32.0992,112,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Toxoplasma Ab, Igm And Igg, S (Mayo)OutsideLaboratory",,86778,CPT,Facility,Both,,,90,112,95.2,32.0992,112,Sanford Health Plan,Sanford Health Plan,103.04,92,,percent of total billed charges,,
"Toxoplasma Ab, Igm And Igg, S (Mayo)OutsideLaboratory",,86778,CPT,Facility,Outpatient,,,90,112,95.2,32.0992,112,"UCare Health, Inc.",Individual & Family Plan,63.112,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Toxoplasma Ab, Igm And Igg, S (Mayo)OutsideLaboratory",,86778,CPT,Facility,Inpatient,,,90,112,95.2,32.0992,112,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Toxoplasma Ab, Igm And Igg, S (Mayo)OutsideLaboratory",,86778,CPT,Facility,Outpatient,,,90,112,95.2,32.0992,112,"UCare Health, Inc.",Medical Assistance,56.5264,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Toxoplasma Ab, Igm And Igg, S (Mayo)OutsideLaboratory",,86778,CPT,Facility,Inpatient,,,90,112,95.2,32.0992,112,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Toxoplasma Ab, Igm And Igg, S (Mayo)OutsideLaboratory",,86778,CPT,Facility,Outpatient,,,90,112,95.2,32.0992,112,"UCare Health, Inc.",Medicare Advantage,56.5264,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Toxoplasma Ab, Igm And Igg, S (Mayo)OutsideLaboratory",,86778,CPT,Facility,Inpatient,,,90,112,95.2,32.0992,112,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Toxoplasma Ab, Igm And Igg, S (Mayo)OutsideLaboratory",,86778,CPT,Facility,Outpatient,,,90,112,95.2,32.0992,112,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),56.5264,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Toxoplasma Ab, Igm And Igg, S (Mayo)OutsideLaboratory",,86778,CPT,Facility,Inpatient,,,90,112,95.2,32.0992,112,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Toxoplasma Ab, Igm And Igg, S (Mayo)OutsideLaboratory",,86778,CPT,Facility,Both,,,90,112,95.2,32.0992,112,UnitedHealthcare,Individual & Family,105.28,94,,percent of total billed charges,,
"Toxoplasma Ab, Igm And Igg, S (Mayo)OutsideLaboratory",,86778,CPT,Facility,Outpatient,,,90,112,95.2,32.0992,112,UnitedHealthcare,Medicare Advantage,54.88,49,,percent of total billed charges,,
"Toxoplasma Ab, Igm And Igg, S (Mayo)OutsideLaboratory",,86778,CPT,Facility,Inpatient,,,90,112,95.2,32.0992,112,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Toxoplasma Ab, Igm And Igg, S (Mayo)OutsideLaboratory",,86778,CPT,Facility,Outpatient,,,90,112,95.2,32.0992,112,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,53.76,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Toxoplasma Ab, Igm And Igg, S (Mayo)OutsideLaboratory",,86778,CPT,Facility,Inpatient,,,90,112,95.2,32.0992,112,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Varicella-Zoster Ab, Igg, S (Mayo)OutsideLaboratory",,86787,CPT,Facility,Both,,,90,114,96.9,32.6724,114,Aetna,Commercial,104.88,92,,percent of total billed charges,,
"Varicella-Zoster Ab, Igg, S (Mayo)OutsideLaboratory",,86787,CPT,Facility,Outpatient,,,90,114,96.9,32.6724,114,Aetna,Medicare Advantage,55.86,49,,percent of total billed charges,,
"Varicella-Zoster Ab, Igg, S (Mayo)OutsideLaboratory",,86787,CPT,Facility,Inpatient,,,90,114,96.9,32.6724,114,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Varicella-Zoster Ab, Igg, S (Mayo)OutsideLaboratory",,86787,CPT,Facility,Both,,,90,114,96.9,32.6724,114,Aetna,PPO,106.02,93,,percent of total billed charges,,
"Varicella-Zoster Ab, Igg, S (Mayo)OutsideLaboratory",,86787,CPT,Facility,Both,,,90,114,96.9,32.6724,114,America's PPO,America's PPO,109.4742,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Varicella-Zoster Ab, Igg, S (Mayo)OutsideLaboratory",,86787,CPT,Facility,Both,,,90,114,96.9,32.6724,114,BlueCross BlueShield Minnesota, Federal Employee Program,112.176,98.4,,percent of total billed charges,,
"Varicella-Zoster Ab, Igg, S (Mayo)OutsideLaboratory",,86787,CPT,Facility,Both,,,90,114,96.9,32.6724,114,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,114,100,,percent of total billed charges,,
"Varicella-Zoster Ab, Igg, S (Mayo)OutsideLaboratory",,86787,CPT,Facility,Both,,,90,114,96.9,32.6724,114,BlueCross BlueShield Minnesota,High Value Network Plan,102.6,90,,percent of total billed charges,,
"Varicella-Zoster Ab, Igg, S (Mayo)OutsideLaboratory",,86787,CPT,Facility,Outpatient,,,90,114,96.9,32.6724,114,BlueCross BlueShield Minnesota,Medicare Advantage,55.86,49,,percent of total billed charges,,
"Varicella-Zoster Ab, Igg, S (Mayo)OutsideLaboratory",,86787,CPT,Facility,Inpatient,,,90,114,96.9,32.6724,114,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Varicella-Zoster Ab, Igg, S (Mayo)OutsideLaboratory",,86787,CPT,Facility,Both,,,90,114,96.9,32.6724,114,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,100.9698,88.57,,percent of total billed charges,,
"Varicella-Zoster Ab, Igg, S (Mayo)OutsideLaboratory",,86787,CPT,Facility,Both,,,90,114,96.9,32.6724,114,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,32.6724,28.66,,percent of total billed charges,,
"Varicella-Zoster Ab, Igg, S (Mayo)OutsideLaboratory",,86787,CPT,Facility,Outpatient,,,90,114,96.9,32.6724,114,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),55.86,49,,percent of total billed charges,,
"Varicella-Zoster Ab, Igg, S (Mayo)OutsideLaboratory",,86787,CPT,Facility,Inpatient,,,90,114,96.9,32.6724,114,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Varicella-Zoster Ab, Igg, S (Mayo)OutsideLaboratory",,86787,CPT,Facility,Both,,,90,114,96.9,32.6724,114,CorVel,Worker's Compensation,114,100,,percent of total billed charges,,
"Varicella-Zoster Ab, Igg, S (Mayo)OutsideLaboratory",,86787,CPT,Facility,Both,,,90,114,96.9,32.6724,114,First Health Group Corporation,First Health Network,110.58,97,,percent of total billed charges,,
"Varicella-Zoster Ab, Igg, S (Mayo)OutsideLaboratory",,86787,CPT,Facility,Both,,,90,114,96.9,32.6724,114,"Health Partners, Inc.",Commercial,107.844,94.6,,percent of total billed charges,,
"Varicella-Zoster Ab, Igg, S (Mayo)OutsideLaboratory",,86787,CPT,Facility,Outpatient,,,90,114,96.9,32.6724,114,"Health Partners, Inc.",Medicare Advantage,55.86,49,,percent of total billed charges,,
"Varicella-Zoster Ab, Igg, S (Mayo)OutsideLaboratory",,86787,CPT,Facility,Inpatient,,,90,114,96.9,32.6724,114,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Varicella-Zoster Ab, Igg, S (Mayo)OutsideLaboratory",,86787,CPT,Facility,Both,,,90,114,96.9,32.6724,114,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),68.4,60,,percent of total billed charges,,
"Varicella-Zoster Ab, Igg, S (Mayo)OutsideLaboratory",,86787,CPT,Facility,Both,,,90,114,96.9,32.6724,114,"Health Partners, Inc.",State of Minnesota Advantage Program,92.91,81.5,,percent of total billed charges,,
"Varicella-Zoster Ab, Igg, S (Mayo)OutsideLaboratory",,86787,CPT,Facility,Both,,,90,114,96.9,32.6724,114,"Health Partners, Inc.",State Public Programs,57,50,,percent of total billed charges,,
"Varicella-Zoster Ab, Igg, S (Mayo)OutsideLaboratory",,86787,CPT,Facility,Both,,,90,114,96.9,32.6724,114,Humana Insurance Company,Commercial PPO,108.3,95,,percent of total billed charges,,
"Varicella-Zoster Ab, Igg, S (Mayo)OutsideLaboratory",,86787,CPT,Facility,Outpatient,,,90,114,96.9,32.6724,114,Humana Insurance Company,Medicare PPO,55.86,49,,percent of total billed charges,,
"Varicella-Zoster Ab, Igg, S (Mayo)OutsideLaboratory",,86787,CPT,Facility,Inpatient,,,90,114,96.9,32.6724,114,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Varicella-Zoster Ab, Igg, S (Mayo)OutsideLaboratory",,86787,CPT,Facility,Both,,,90,114,96.9,32.6724,114,Medica,Individual & Family,112.974,99.1,,percent of total billed charges,,
"Varicella-Zoster Ab, Igg, S (Mayo)OutsideLaboratory",,86787,CPT,Facility,Outpatient,,,90,114,96.9,32.6724,114,Medica,Medica Advantage Solution,56.772,49.8,,percent of total billed charges,,
"Varicella-Zoster Ab, Igg, S (Mayo)OutsideLaboratory",,86787,CPT,Facility,Inpatient,,,90,114,96.9,32.6724,114,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Varicella-Zoster Ab, Igg, S (Mayo)OutsideLaboratory",,86787,CPT,Facility,Outpatient,,,90,114,96.9,32.6724,114,Medica,Medical Assistance,50.844,44.6,,percent of total billed charges,,
"Varicella-Zoster Ab, Igg, S (Mayo)OutsideLaboratory",,86787,CPT,Facility,Inpatient,,,90,114,96.9,32.6724,114,Medica,Medical Assistance,,,,,Included in per diem rate,
"Varicella-Zoster Ab, Igg, S (Mayo)OutsideLaboratory",,86787,CPT,Facility,Outpatient,,,90,114,96.9,32.6724,114,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,56.772,49.8,,percent of total billed charges,,
"Varicella-Zoster Ab, Igg, S (Mayo)OutsideLaboratory",,86787,CPT,Facility,Inpatient,,,90,114,96.9,32.6724,114,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Varicella-Zoster Ab, Igg, S (Mayo)OutsideLaboratory",,86787,CPT,Facility,Both,,,90,114,96.9,32.6724,114,"Multiplan, Inc.","Multiplan, Inc.",107.16,94,,percent of total billed charges,,
"Varicella-Zoster Ab, Igg, S (Mayo)OutsideLaboratory",,86787,CPT,Facility,Outpatient,,,90,114,96.9,32.6724,114,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,98.496,86.4,,percent of total billed charges,,
"Varicella-Zoster Ab, Igg, S (Mayo)OutsideLaboratory",,86787,CPT,Facility,Inpatient,,,90,114,96.9,32.6724,114,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Varicella-Zoster Ab, Igg, S (Mayo)OutsideLaboratory",,86787,CPT,Facility,Both,,,90,114,96.9,32.6724,114,"Preferred One Administrative Services, INC.",PPO,112.404,98.6,,percent of total billed charges,,
"Varicella-Zoster Ab, Igg, S (Mayo)OutsideLaboratory",,86787,CPT,Facility,Outpatient,,,90,114,96.9,32.6724,114,PrimeWest Health,Minnesota Senior Health Options (MSHO),58.653,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Varicella-Zoster Ab, Igg, S (Mayo)OutsideLaboratory",,86787,CPT,Facility,Inpatient,,,90,114,96.9,32.6724,114,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Varicella-Zoster Ab, Igg, S (Mayo)OutsideLaboratory",,86787,CPT,Facility,Outpatient,,,90,114,96.9,32.6724,114,PrimeWest Health,MinnesotaCare,58.5504,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Varicella-Zoster Ab, Igg, S (Mayo)OutsideLaboratory",,86787,CPT,Facility,Inpatient,,,90,114,96.9,32.6724,114,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Varicella-Zoster Ab, Igg, S (Mayo)OutsideLaboratory",,86787,CPT,Facility,Both,,,90,114,96.9,32.6724,114,Sanford Health Plan,Sanford Health Plan,104.88,92,,percent of total billed charges,,
"Varicella-Zoster Ab, Igg, S (Mayo)OutsideLaboratory",,86787,CPT,Facility,Outpatient,,,90,114,96.9,32.6724,114,"UCare Health, Inc.",Individual & Family Plan,64.239,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Varicella-Zoster Ab, Igg, S (Mayo)OutsideLaboratory",,86787,CPT,Facility,Inpatient,,,90,114,96.9,32.6724,114,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Varicella-Zoster Ab, Igg, S (Mayo)OutsideLaboratory",,86787,CPT,Facility,Outpatient,,,90,114,96.9,32.6724,114,"UCare Health, Inc.",Medical Assistance,57.5358,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Varicella-Zoster Ab, Igg, S (Mayo)OutsideLaboratory",,86787,CPT,Facility,Inpatient,,,90,114,96.9,32.6724,114,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Varicella-Zoster Ab, Igg, S (Mayo)OutsideLaboratory",,86787,CPT,Facility,Outpatient,,,90,114,96.9,32.6724,114,"UCare Health, Inc.",Medicare Advantage,57.5358,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Varicella-Zoster Ab, Igg, S (Mayo)OutsideLaboratory",,86787,CPT,Facility,Inpatient,,,90,114,96.9,32.6724,114,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Varicella-Zoster Ab, Igg, S (Mayo)OutsideLaboratory",,86787,CPT,Facility,Outpatient,,,90,114,96.9,32.6724,114,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),57.5358,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Varicella-Zoster Ab, Igg, S (Mayo)OutsideLaboratory",,86787,CPT,Facility,Inpatient,,,90,114,96.9,32.6724,114,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Varicella-Zoster Ab, Igg, S (Mayo)OutsideLaboratory",,86787,CPT,Facility,Both,,,90,114,96.9,32.6724,114,UnitedHealthcare,Individual & Family,107.16,94,,percent of total billed charges,,
"Varicella-Zoster Ab, Igg, S (Mayo)OutsideLaboratory",,86787,CPT,Facility,Outpatient,,,90,114,96.9,32.6724,114,UnitedHealthcare,Medicare Advantage,55.86,49,,percent of total billed charges,,
"Varicella-Zoster Ab, Igg, S (Mayo)OutsideLaboratory",,86787,CPT,Facility,Inpatient,,,90,114,96.9,32.6724,114,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Varicella-Zoster Ab, Igg, S (Mayo)OutsideLaboratory",,86787,CPT,Facility,Outpatient,,,90,114,96.9,32.6724,114,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,54.72,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Varicella-Zoster Ab, Igg, S (Mayo)OutsideLaboratory",,86787,CPT,Facility,Inpatient,,,90,114,96.9,32.6724,114,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Varicella-Zoster Ab, Igm, S (Mayo)OutsideLaboratory",,86787,CPT,Facility,Both,,,90,114,96.9,32.6724,114,Aetna,Commercial,104.88,92,,percent of total billed charges,,
"Varicella-Zoster Ab, Igm, S (Mayo)OutsideLaboratory",,86787,CPT,Facility,Outpatient,,,90,114,96.9,32.6724,114,Aetna,Medicare Advantage,55.86,49,,percent of total billed charges,,
"Varicella-Zoster Ab, Igm, S (Mayo)OutsideLaboratory",,86787,CPT,Facility,Inpatient,,,90,114,96.9,32.6724,114,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Varicella-Zoster Ab, Igm, S (Mayo)OutsideLaboratory",,86787,CPT,Facility,Both,,,90,114,96.9,32.6724,114,Aetna,PPO,106.02,93,,percent of total billed charges,,
"Varicella-Zoster Ab, Igm, S (Mayo)OutsideLaboratory",,86787,CPT,Facility,Both,,,90,114,96.9,32.6724,114,America's PPO,America's PPO,109.4742,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Varicella-Zoster Ab, Igm, S (Mayo)OutsideLaboratory",,86787,CPT,Facility,Both,,,90,114,96.9,32.6724,114,BlueCross BlueShield Minnesota, Federal Employee Program,112.176,98.4,,percent of total billed charges,,
"Varicella-Zoster Ab, Igm, S (Mayo)OutsideLaboratory",,86787,CPT,Facility,Both,,,90,114,96.9,32.6724,114,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,114,100,,percent of total billed charges,,
"Varicella-Zoster Ab, Igm, S (Mayo)OutsideLaboratory",,86787,CPT,Facility,Both,,,90,114,96.9,32.6724,114,BlueCross BlueShield Minnesota,High Value Network Plan,102.6,90,,percent of total billed charges,,
"Varicella-Zoster Ab, Igm, S (Mayo)OutsideLaboratory",,86787,CPT,Facility,Outpatient,,,90,114,96.9,32.6724,114,BlueCross BlueShield Minnesota,Medicare Advantage,55.86,49,,percent of total billed charges,,
"Varicella-Zoster Ab, Igm, S (Mayo)OutsideLaboratory",,86787,CPT,Facility,Inpatient,,,90,114,96.9,32.6724,114,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Varicella-Zoster Ab, Igm, S (Mayo)OutsideLaboratory",,86787,CPT,Facility,Both,,,90,114,96.9,32.6724,114,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,100.9698,88.57,,percent of total billed charges,,
"Varicella-Zoster Ab, Igm, S (Mayo)OutsideLaboratory",,86787,CPT,Facility,Both,,,90,114,96.9,32.6724,114,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,32.6724,28.66,,percent of total billed charges,,
"Varicella-Zoster Ab, Igm, S (Mayo)OutsideLaboratory",,86787,CPT,Facility,Outpatient,,,90,114,96.9,32.6724,114,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),55.86,49,,percent of total billed charges,,
"Varicella-Zoster Ab, Igm, S (Mayo)OutsideLaboratory",,86787,CPT,Facility,Inpatient,,,90,114,96.9,32.6724,114,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Varicella-Zoster Ab, Igm, S (Mayo)OutsideLaboratory",,86787,CPT,Facility,Both,,,90,114,96.9,32.6724,114,CorVel,Worker's Compensation,114,100,,percent of total billed charges,,
"Varicella-Zoster Ab, Igm, S (Mayo)OutsideLaboratory",,86787,CPT,Facility,Both,,,90,114,96.9,32.6724,114,First Health Group Corporation,First Health Network,110.58,97,,percent of total billed charges,,
"Varicella-Zoster Ab, Igm, S (Mayo)OutsideLaboratory",,86787,CPT,Facility,Both,,,90,114,96.9,32.6724,114,"Health Partners, Inc.",Commercial,107.844,94.6,,percent of total billed charges,,
"Varicella-Zoster Ab, Igm, S (Mayo)OutsideLaboratory",,86787,CPT,Facility,Outpatient,,,90,114,96.9,32.6724,114,"Health Partners, Inc.",Medicare Advantage,55.86,49,,percent of total billed charges,,
"Varicella-Zoster Ab, Igm, S (Mayo)OutsideLaboratory",,86787,CPT,Facility,Inpatient,,,90,114,96.9,32.6724,114,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Varicella-Zoster Ab, Igm, S (Mayo)OutsideLaboratory",,86787,CPT,Facility,Both,,,90,114,96.9,32.6724,114,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),68.4,60,,percent of total billed charges,,
"Varicella-Zoster Ab, Igm, S (Mayo)OutsideLaboratory",,86787,CPT,Facility,Both,,,90,114,96.9,32.6724,114,"Health Partners, Inc.",State of Minnesota Advantage Program,92.91,81.5,,percent of total billed charges,,
"Varicella-Zoster Ab, Igm, S (Mayo)OutsideLaboratory",,86787,CPT,Facility,Both,,,90,114,96.9,32.6724,114,"Health Partners, Inc.",State Public Programs,57,50,,percent of total billed charges,,
"Varicella-Zoster Ab, Igm, S (Mayo)OutsideLaboratory",,86787,CPT,Facility,Both,,,90,114,96.9,32.6724,114,Humana Insurance Company,Commercial PPO,108.3,95,,percent of total billed charges,,
"Varicella-Zoster Ab, Igm, S (Mayo)OutsideLaboratory",,86787,CPT,Facility,Outpatient,,,90,114,96.9,32.6724,114,Humana Insurance Company,Medicare PPO,55.86,49,,percent of total billed charges,,
"Varicella-Zoster Ab, Igm, S (Mayo)OutsideLaboratory",,86787,CPT,Facility,Inpatient,,,90,114,96.9,32.6724,114,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Varicella-Zoster Ab, Igm, S (Mayo)OutsideLaboratory",,86787,CPT,Facility,Both,,,90,114,96.9,32.6724,114,Medica,Individual & Family,112.974,99.1,,percent of total billed charges,,
"Varicella-Zoster Ab, Igm, S (Mayo)OutsideLaboratory",,86787,CPT,Facility,Outpatient,,,90,114,96.9,32.6724,114,Medica,Medica Advantage Solution,56.772,49.8,,percent of total billed charges,,
"Varicella-Zoster Ab, Igm, S (Mayo)OutsideLaboratory",,86787,CPT,Facility,Inpatient,,,90,114,96.9,32.6724,114,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Varicella-Zoster Ab, Igm, S (Mayo)OutsideLaboratory",,86787,CPT,Facility,Outpatient,,,90,114,96.9,32.6724,114,Medica,Medical Assistance,50.844,44.6,,percent of total billed charges,,
"Varicella-Zoster Ab, Igm, S (Mayo)OutsideLaboratory",,86787,CPT,Facility,Inpatient,,,90,114,96.9,32.6724,114,Medica,Medical Assistance,,,,,Included in per diem rate,
"Varicella-Zoster Ab, Igm, S (Mayo)OutsideLaboratory",,86787,CPT,Facility,Outpatient,,,90,114,96.9,32.6724,114,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,56.772,49.8,,percent of total billed charges,,
"Varicella-Zoster Ab, Igm, S (Mayo)OutsideLaboratory",,86787,CPT,Facility,Inpatient,,,90,114,96.9,32.6724,114,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Varicella-Zoster Ab, Igm, S (Mayo)OutsideLaboratory",,86787,CPT,Facility,Both,,,90,114,96.9,32.6724,114,"Multiplan, Inc.","Multiplan, Inc.",107.16,94,,percent of total billed charges,,
"Varicella-Zoster Ab, Igm, S (Mayo)OutsideLaboratory",,86787,CPT,Facility,Outpatient,,,90,114,96.9,32.6724,114,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,98.496,86.4,,percent of total billed charges,,
"Varicella-Zoster Ab, Igm, S (Mayo)OutsideLaboratory",,86787,CPT,Facility,Inpatient,,,90,114,96.9,32.6724,114,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Varicella-Zoster Ab, Igm, S (Mayo)OutsideLaboratory",,86787,CPT,Facility,Both,,,90,114,96.9,32.6724,114,"Preferred One Administrative Services, INC.",PPO,112.404,98.6,,percent of total billed charges,,
"Varicella-Zoster Ab, Igm, S (Mayo)OutsideLaboratory",,86787,CPT,Facility,Outpatient,,,90,114,96.9,32.6724,114,PrimeWest Health,Minnesota Senior Health Options (MSHO),58.653,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Varicella-Zoster Ab, Igm, S (Mayo)OutsideLaboratory",,86787,CPT,Facility,Inpatient,,,90,114,96.9,32.6724,114,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Varicella-Zoster Ab, Igm, S (Mayo)OutsideLaboratory",,86787,CPT,Facility,Outpatient,,,90,114,96.9,32.6724,114,PrimeWest Health,MinnesotaCare,58.5504,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Varicella-Zoster Ab, Igm, S (Mayo)OutsideLaboratory",,86787,CPT,Facility,Inpatient,,,90,114,96.9,32.6724,114,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Varicella-Zoster Ab, Igm, S (Mayo)OutsideLaboratory",,86787,CPT,Facility,Both,,,90,114,96.9,32.6724,114,Sanford Health Plan,Sanford Health Plan,104.88,92,,percent of total billed charges,,
"Varicella-Zoster Ab, Igm, S (Mayo)OutsideLaboratory",,86787,CPT,Facility,Outpatient,,,90,114,96.9,32.6724,114,"UCare Health, Inc.",Individual & Family Plan,64.239,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Varicella-Zoster Ab, Igm, S (Mayo)OutsideLaboratory",,86787,CPT,Facility,Inpatient,,,90,114,96.9,32.6724,114,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Varicella-Zoster Ab, Igm, S (Mayo)OutsideLaboratory",,86787,CPT,Facility,Outpatient,,,90,114,96.9,32.6724,114,"UCare Health, Inc.",Medical Assistance,57.5358,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Varicella-Zoster Ab, Igm, S (Mayo)OutsideLaboratory",,86787,CPT,Facility,Inpatient,,,90,114,96.9,32.6724,114,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Varicella-Zoster Ab, Igm, S (Mayo)OutsideLaboratory",,86787,CPT,Facility,Outpatient,,,90,114,96.9,32.6724,114,"UCare Health, Inc.",Medicare Advantage,57.5358,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Varicella-Zoster Ab, Igm, S (Mayo)OutsideLaboratory",,86787,CPT,Facility,Inpatient,,,90,114,96.9,32.6724,114,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Varicella-Zoster Ab, Igm, S (Mayo)OutsideLaboratory",,86787,CPT,Facility,Outpatient,,,90,114,96.9,32.6724,114,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),57.5358,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Varicella-Zoster Ab, Igm, S (Mayo)OutsideLaboratory",,86787,CPT,Facility,Inpatient,,,90,114,96.9,32.6724,114,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Varicella-Zoster Ab, Igm, S (Mayo)OutsideLaboratory",,86787,CPT,Facility,Both,,,90,114,96.9,32.6724,114,UnitedHealthcare,Individual & Family,107.16,94,,percent of total billed charges,,
"Varicella-Zoster Ab, Igm, S (Mayo)OutsideLaboratory",,86787,CPT,Facility,Outpatient,,,90,114,96.9,32.6724,114,UnitedHealthcare,Medicare Advantage,55.86,49,,percent of total billed charges,,
"Varicella-Zoster Ab, Igm, S (Mayo)OutsideLaboratory",,86787,CPT,Facility,Inpatient,,,90,114,96.9,32.6724,114,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Varicella-Zoster Ab, Igm, S (Mayo)OutsideLaboratory",,86787,CPT,Facility,Outpatient,,,90,114,96.9,32.6724,114,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,54.72,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Varicella-Zoster Ab, Igm, S (Mayo)OutsideLaboratory",,86787,CPT,Facility,Inpatient,,,90,114,96.9,32.6724,114,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"West Nile Virus Ab, Igg And Igm, S (Mayo)OutsideLaboratory",,86788,CPT,Facility,Both,,,90,97,82.45,27.8002,97,Aetna,Commercial,89.24,92,,percent of total billed charges,,
"West Nile Virus Ab, Igg And Igm, S (Mayo)OutsideLaboratory",,86788,CPT,Facility,Outpatient,,,90,97,82.45,27.8002,97,Aetna,Medicare Advantage,47.53,49,,percent of total billed charges,,
"West Nile Virus Ab, Igg And Igm, S (Mayo)OutsideLaboratory",,86788,CPT,Facility,Inpatient,,,90,97,82.45,27.8002,97,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"West Nile Virus Ab, Igg And Igm, S (Mayo)OutsideLaboratory",,86788,CPT,Facility,Both,,,90,97,82.45,27.8002,97,Aetna,PPO,90.21,93,,percent of total billed charges,,
"West Nile Virus Ab, Igg And Igm, S (Mayo)OutsideLaboratory",,86788,CPT,Facility,Both,,,90,97,82.45,27.8002,97,America's PPO,America's PPO,93.1491,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"West Nile Virus Ab, Igg And Igm, S (Mayo)OutsideLaboratory",,86788,CPT,Facility,Both,,,90,97,82.45,27.8002,97,BlueCross BlueShield Minnesota, Federal Employee Program,95.448,98.4,,percent of total billed charges,,
"West Nile Virus Ab, Igg And Igm, S (Mayo)OutsideLaboratory",,86788,CPT,Facility,Both,,,90,97,82.45,27.8002,97,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,97,100,,percent of total billed charges,,
"West Nile Virus Ab, Igg And Igm, S (Mayo)OutsideLaboratory",,86788,CPT,Facility,Both,,,90,97,82.45,27.8002,97,BlueCross BlueShield Minnesota,High Value Network Plan,87.3,90,,percent of total billed charges,,
"West Nile Virus Ab, Igg And Igm, S (Mayo)OutsideLaboratory",,86788,CPT,Facility,Outpatient,,,90,97,82.45,27.8002,97,BlueCross BlueShield Minnesota,Medicare Advantage,47.53,49,,percent of total billed charges,,
"West Nile Virus Ab, Igg And Igm, S (Mayo)OutsideLaboratory",,86788,CPT,Facility,Inpatient,,,90,97,82.45,27.8002,97,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"West Nile Virus Ab, Igg And Igm, S (Mayo)OutsideLaboratory",,86788,CPT,Facility,Both,,,90,97,82.45,27.8002,97,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,85.9129,88.57,,percent of total billed charges,,
"West Nile Virus Ab, Igg And Igm, S (Mayo)OutsideLaboratory",,86788,CPT,Facility,Both,,,90,97,82.45,27.8002,97,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,27.8002,28.66,,percent of total billed charges,,
"West Nile Virus Ab, Igg And Igm, S (Mayo)OutsideLaboratory",,86788,CPT,Facility,Outpatient,,,90,97,82.45,27.8002,97,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),47.53,49,,percent of total billed charges,,
"West Nile Virus Ab, Igg And Igm, S (Mayo)OutsideLaboratory",,86788,CPT,Facility,Inpatient,,,90,97,82.45,27.8002,97,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"West Nile Virus Ab, Igg And Igm, S (Mayo)OutsideLaboratory",,86788,CPT,Facility,Both,,,90,97,82.45,27.8002,97,CorVel,Worker's Compensation,97,100,,percent of total billed charges,,
"West Nile Virus Ab, Igg And Igm, S (Mayo)OutsideLaboratory",,86788,CPT,Facility,Both,,,90,97,82.45,27.8002,97,First Health Group Corporation,First Health Network,94.09,97,,percent of total billed charges,,
"West Nile Virus Ab, Igg And Igm, S (Mayo)OutsideLaboratory",,86788,CPT,Facility,Both,,,90,97,82.45,27.8002,97,"Health Partners, Inc.",Commercial,91.762,94.6,,percent of total billed charges,,
"West Nile Virus Ab, Igg And Igm, S (Mayo)OutsideLaboratory",,86788,CPT,Facility,Outpatient,,,90,97,82.45,27.8002,97,"Health Partners, Inc.",Medicare Advantage,47.53,49,,percent of total billed charges,,
"West Nile Virus Ab, Igg And Igm, S (Mayo)OutsideLaboratory",,86788,CPT,Facility,Inpatient,,,90,97,82.45,27.8002,97,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"West Nile Virus Ab, Igg And Igm, S (Mayo)OutsideLaboratory",,86788,CPT,Facility,Both,,,90,97,82.45,27.8002,97,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),58.2,60,,percent of total billed charges,,
"West Nile Virus Ab, Igg And Igm, S (Mayo)OutsideLaboratory",,86788,CPT,Facility,Both,,,90,97,82.45,27.8002,97,"Health Partners, Inc.",State of Minnesota Advantage Program,79.055,81.5,,percent of total billed charges,,
"West Nile Virus Ab, Igg And Igm, S (Mayo)OutsideLaboratory",,86788,CPT,Facility,Both,,,90,97,82.45,27.8002,97,"Health Partners, Inc.",State Public Programs,48.5,50,,percent of total billed charges,,
"West Nile Virus Ab, Igg And Igm, S (Mayo)OutsideLaboratory",,86788,CPT,Facility,Both,,,90,97,82.45,27.8002,97,Humana Insurance Company,Commercial PPO,92.15,95,,percent of total billed charges,,
"West Nile Virus Ab, Igg And Igm, S (Mayo)OutsideLaboratory",,86788,CPT,Facility,Outpatient,,,90,97,82.45,27.8002,97,Humana Insurance Company,Medicare PPO,47.53,49,,percent of total billed charges,,
"West Nile Virus Ab, Igg And Igm, S (Mayo)OutsideLaboratory",,86788,CPT,Facility,Inpatient,,,90,97,82.45,27.8002,97,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"West Nile Virus Ab, Igg And Igm, S (Mayo)OutsideLaboratory",,86788,CPT,Facility,Both,,,90,97,82.45,27.8002,97,Medica,Individual & Family,96.127,99.1,,percent of total billed charges,,
"West Nile Virus Ab, Igg And Igm, S (Mayo)OutsideLaboratory",,86788,CPT,Facility,Outpatient,,,90,97,82.45,27.8002,97,Medica,Medica Advantage Solution,48.306,49.8,,percent of total billed charges,,
"West Nile Virus Ab, Igg And Igm, S (Mayo)OutsideLaboratory",,86788,CPT,Facility,Inpatient,,,90,97,82.45,27.8002,97,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"West Nile Virus Ab, Igg And Igm, S (Mayo)OutsideLaboratory",,86788,CPT,Facility,Outpatient,,,90,97,82.45,27.8002,97,Medica,Medical Assistance,43.262,44.6,,percent of total billed charges,,
"West Nile Virus Ab, Igg And Igm, S (Mayo)OutsideLaboratory",,86788,CPT,Facility,Inpatient,,,90,97,82.45,27.8002,97,Medica,Medical Assistance,,,,,Included in per diem rate,
"West Nile Virus Ab, Igg And Igm, S (Mayo)OutsideLaboratory",,86788,CPT,Facility,Outpatient,,,90,97,82.45,27.8002,97,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,48.306,49.8,,percent of total billed charges,,
"West Nile Virus Ab, Igg And Igm, S (Mayo)OutsideLaboratory",,86788,CPT,Facility,Inpatient,,,90,97,82.45,27.8002,97,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"West Nile Virus Ab, Igg And Igm, S (Mayo)OutsideLaboratory",,86788,CPT,Facility,Both,,,90,97,82.45,27.8002,97,"Multiplan, Inc.","Multiplan, Inc.",91.18,94,,percent of total billed charges,,
"West Nile Virus Ab, Igg And Igm, S (Mayo)OutsideLaboratory",,86788,CPT,Facility,Outpatient,,,90,97,82.45,27.8002,97,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,83.808,86.4,,percent of total billed charges,,
"West Nile Virus Ab, Igg And Igm, S (Mayo)OutsideLaboratory",,86788,CPT,Facility,Inpatient,,,90,97,82.45,27.8002,97,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"West Nile Virus Ab, Igg And Igm, S (Mayo)OutsideLaboratory",,86788,CPT,Facility,Both,,,90,97,82.45,27.8002,97,"Preferred One Administrative Services, INC.",PPO,95.642,98.6,,percent of total billed charges,,
"West Nile Virus Ab, Igg And Igm, S (Mayo)OutsideLaboratory",,86788,CPT,Facility,Outpatient,,,90,97,82.45,27.8002,97,PrimeWest Health,Minnesota Senior Health Options (MSHO),49.9065,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"West Nile Virus Ab, Igg And Igm, S (Mayo)OutsideLaboratory",,86788,CPT,Facility,Inpatient,,,90,97,82.45,27.8002,97,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"West Nile Virus Ab, Igg And Igm, S (Mayo)OutsideLaboratory",,86788,CPT,Facility,Outpatient,,,90,97,82.45,27.8002,97,PrimeWest Health,MinnesotaCare,49.8192,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"West Nile Virus Ab, Igg And Igm, S (Mayo)OutsideLaboratory",,86788,CPT,Facility,Inpatient,,,90,97,82.45,27.8002,97,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"West Nile Virus Ab, Igg And Igm, S (Mayo)OutsideLaboratory",,86788,CPT,Facility,Both,,,90,97,82.45,27.8002,97,Sanford Health Plan,Sanford Health Plan,89.24,92,,percent of total billed charges,,
"West Nile Virus Ab, Igg And Igm, S (Mayo)OutsideLaboratory",,86788,CPT,Facility,Outpatient,,,90,97,82.45,27.8002,97,"UCare Health, Inc.",Individual & Family Plan,54.6595,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"West Nile Virus Ab, Igg And Igm, S (Mayo)OutsideLaboratory",,86788,CPT,Facility,Inpatient,,,90,97,82.45,27.8002,97,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"West Nile Virus Ab, Igg And Igm, S (Mayo)OutsideLaboratory",,86788,CPT,Facility,Outpatient,,,90,97,82.45,27.8002,97,"UCare Health, Inc.",Medical Assistance,48.9559,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"West Nile Virus Ab, Igg And Igm, S (Mayo)OutsideLaboratory",,86788,CPT,Facility,Inpatient,,,90,97,82.45,27.8002,97,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"West Nile Virus Ab, Igg And Igm, S (Mayo)OutsideLaboratory",,86788,CPT,Facility,Outpatient,,,90,97,82.45,27.8002,97,"UCare Health, Inc.",Medicare Advantage,48.9559,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"West Nile Virus Ab, Igg And Igm, S (Mayo)OutsideLaboratory",,86788,CPT,Facility,Inpatient,,,90,97,82.45,27.8002,97,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"West Nile Virus Ab, Igg And Igm, S (Mayo)OutsideLaboratory",,86788,CPT,Facility,Outpatient,,,90,97,82.45,27.8002,97,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),48.9559,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"West Nile Virus Ab, Igg And Igm, S (Mayo)OutsideLaboratory",,86788,CPT,Facility,Inpatient,,,90,97,82.45,27.8002,97,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"West Nile Virus Ab, Igg And Igm, S (Mayo)OutsideLaboratory",,86788,CPT,Facility,Both,,,90,97,82.45,27.8002,97,UnitedHealthcare,Individual & Family,91.18,94,,percent of total billed charges,,
"West Nile Virus Ab, Igg And Igm, S (Mayo)OutsideLaboratory",,86788,CPT,Facility,Outpatient,,,90,97,82.45,27.8002,97,UnitedHealthcare,Medicare Advantage,47.53,49,,percent of total billed charges,,
"West Nile Virus Ab, Igg And Igm, S (Mayo)OutsideLaboratory",,86788,CPT,Facility,Inpatient,,,90,97,82.45,27.8002,97,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"West Nile Virus Ab, Igg And Igm, S (Mayo)OutsideLaboratory",,86788,CPT,Facility,Outpatient,,,90,97,82.45,27.8002,97,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,46.56,48,,percent of total billed charges,,100% of DHS outpatient percentage
"West Nile Virus Ab, Igg And Igm, S (Mayo)OutsideLaboratory",,86788,CPT,Facility,Inpatient,,,90,97,82.45,27.8002,97,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"West Nile Virus Ab, Igg, S (Mayo)OutsideLaboratory",,86789,CPT,Facility,Both,,,90,97,82.45,27.8002,97,Aetna,Commercial,89.24,92,,percent of total billed charges,,
"West Nile Virus Ab, Igg, S (Mayo)OutsideLaboratory",,86789,CPT,Facility,Outpatient,,,90,97,82.45,27.8002,97,Aetna,Medicare Advantage,47.53,49,,percent of total billed charges,,
"West Nile Virus Ab, Igg, S (Mayo)OutsideLaboratory",,86789,CPT,Facility,Inpatient,,,90,97,82.45,27.8002,97,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"West Nile Virus Ab, Igg, S (Mayo)OutsideLaboratory",,86789,CPT,Facility,Both,,,90,97,82.45,27.8002,97,Aetna,PPO,90.21,93,,percent of total billed charges,,
"West Nile Virus Ab, Igg, S (Mayo)OutsideLaboratory",,86789,CPT,Facility,Both,,,90,97,82.45,27.8002,97,America's PPO,America's PPO,93.1491,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"West Nile Virus Ab, Igg, S (Mayo)OutsideLaboratory",,86789,CPT,Facility,Both,,,90,97,82.45,27.8002,97,BlueCross BlueShield Minnesota, Federal Employee Program,95.448,98.4,,percent of total billed charges,,
"West Nile Virus Ab, Igg, S (Mayo)OutsideLaboratory",,86789,CPT,Facility,Both,,,90,97,82.45,27.8002,97,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,97,100,,percent of total billed charges,,
"West Nile Virus Ab, Igg, S (Mayo)OutsideLaboratory",,86789,CPT,Facility,Both,,,90,97,82.45,27.8002,97,BlueCross BlueShield Minnesota,High Value Network Plan,87.3,90,,percent of total billed charges,,
"West Nile Virus Ab, Igg, S (Mayo)OutsideLaboratory",,86789,CPT,Facility,Outpatient,,,90,97,82.45,27.8002,97,BlueCross BlueShield Minnesota,Medicare Advantage,47.53,49,,percent of total billed charges,,
"West Nile Virus Ab, Igg, S (Mayo)OutsideLaboratory",,86789,CPT,Facility,Inpatient,,,90,97,82.45,27.8002,97,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"West Nile Virus Ab, Igg, S (Mayo)OutsideLaboratory",,86789,CPT,Facility,Both,,,90,97,82.45,27.8002,97,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,85.9129,88.57,,percent of total billed charges,,
"West Nile Virus Ab, Igg, S (Mayo)OutsideLaboratory",,86789,CPT,Facility,Both,,,90,97,82.45,27.8002,97,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,27.8002,28.66,,percent of total billed charges,,
"West Nile Virus Ab, Igg, S (Mayo)OutsideLaboratory",,86789,CPT,Facility,Outpatient,,,90,97,82.45,27.8002,97,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),47.53,49,,percent of total billed charges,,
"West Nile Virus Ab, Igg, S (Mayo)OutsideLaboratory",,86789,CPT,Facility,Inpatient,,,90,97,82.45,27.8002,97,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"West Nile Virus Ab, Igg, S (Mayo)OutsideLaboratory",,86789,CPT,Facility,Both,,,90,97,82.45,27.8002,97,CorVel,Worker's Compensation,97,100,,percent of total billed charges,,
"West Nile Virus Ab, Igg, S (Mayo)OutsideLaboratory",,86789,CPT,Facility,Both,,,90,97,82.45,27.8002,97,First Health Group Corporation,First Health Network,94.09,97,,percent of total billed charges,,
"West Nile Virus Ab, Igg, S (Mayo)OutsideLaboratory",,86789,CPT,Facility,Both,,,90,97,82.45,27.8002,97,"Health Partners, Inc.",Commercial,91.762,94.6,,percent of total billed charges,,
"West Nile Virus Ab, Igg, S (Mayo)OutsideLaboratory",,86789,CPT,Facility,Outpatient,,,90,97,82.45,27.8002,97,"Health Partners, Inc.",Medicare Advantage,47.53,49,,percent of total billed charges,,
"West Nile Virus Ab, Igg, S (Mayo)OutsideLaboratory",,86789,CPT,Facility,Inpatient,,,90,97,82.45,27.8002,97,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"West Nile Virus Ab, Igg, S (Mayo)OutsideLaboratory",,86789,CPT,Facility,Both,,,90,97,82.45,27.8002,97,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),58.2,60,,percent of total billed charges,,
"West Nile Virus Ab, Igg, S (Mayo)OutsideLaboratory",,86789,CPT,Facility,Both,,,90,97,82.45,27.8002,97,"Health Partners, Inc.",State of Minnesota Advantage Program,79.055,81.5,,percent of total billed charges,,
"West Nile Virus Ab, Igg, S (Mayo)OutsideLaboratory",,86789,CPT,Facility,Both,,,90,97,82.45,27.8002,97,"Health Partners, Inc.",State Public Programs,48.5,50,,percent of total billed charges,,
"West Nile Virus Ab, Igg, S (Mayo)OutsideLaboratory",,86789,CPT,Facility,Both,,,90,97,82.45,27.8002,97,Humana Insurance Company,Commercial PPO,92.15,95,,percent of total billed charges,,
"West Nile Virus Ab, Igg, S (Mayo)OutsideLaboratory",,86789,CPT,Facility,Outpatient,,,90,97,82.45,27.8002,97,Humana Insurance Company,Medicare PPO,47.53,49,,percent of total billed charges,,
"West Nile Virus Ab, Igg, S (Mayo)OutsideLaboratory",,86789,CPT,Facility,Inpatient,,,90,97,82.45,27.8002,97,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"West Nile Virus Ab, Igg, S (Mayo)OutsideLaboratory",,86789,CPT,Facility,Both,,,90,97,82.45,27.8002,97,Medica,Individual & Family,96.127,99.1,,percent of total billed charges,,
"West Nile Virus Ab, Igg, S (Mayo)OutsideLaboratory",,86789,CPT,Facility,Outpatient,,,90,97,82.45,27.8002,97,Medica,Medica Advantage Solution,48.306,49.8,,percent of total billed charges,,
"West Nile Virus Ab, Igg, S (Mayo)OutsideLaboratory",,86789,CPT,Facility,Inpatient,,,90,97,82.45,27.8002,97,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"West Nile Virus Ab, Igg, S (Mayo)OutsideLaboratory",,86789,CPT,Facility,Outpatient,,,90,97,82.45,27.8002,97,Medica,Medical Assistance,43.262,44.6,,percent of total billed charges,,
"West Nile Virus Ab, Igg, S (Mayo)OutsideLaboratory",,86789,CPT,Facility,Inpatient,,,90,97,82.45,27.8002,97,Medica,Medical Assistance,,,,,Included in per diem rate,
"West Nile Virus Ab, Igg, S (Mayo)OutsideLaboratory",,86789,CPT,Facility,Outpatient,,,90,97,82.45,27.8002,97,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,48.306,49.8,,percent of total billed charges,,
"West Nile Virus Ab, Igg, S (Mayo)OutsideLaboratory",,86789,CPT,Facility,Inpatient,,,90,97,82.45,27.8002,97,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"West Nile Virus Ab, Igg, S (Mayo)OutsideLaboratory",,86789,CPT,Facility,Both,,,90,97,82.45,27.8002,97,"Multiplan, Inc.","Multiplan, Inc.",91.18,94,,percent of total billed charges,,
"West Nile Virus Ab, Igg, S (Mayo)OutsideLaboratory",,86789,CPT,Facility,Outpatient,,,90,97,82.45,27.8002,97,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,83.808,86.4,,percent of total billed charges,,
"West Nile Virus Ab, Igg, S (Mayo)OutsideLaboratory",,86789,CPT,Facility,Inpatient,,,90,97,82.45,27.8002,97,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"West Nile Virus Ab, Igg, S (Mayo)OutsideLaboratory",,86789,CPT,Facility,Both,,,90,97,82.45,27.8002,97,"Preferred One Administrative Services, INC.",PPO,95.642,98.6,,percent of total billed charges,,
"West Nile Virus Ab, Igg, S (Mayo)OutsideLaboratory",,86789,CPT,Facility,Outpatient,,,90,97,82.45,27.8002,97,PrimeWest Health,Minnesota Senior Health Options (MSHO),49.9065,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"West Nile Virus Ab, Igg, S (Mayo)OutsideLaboratory",,86789,CPT,Facility,Inpatient,,,90,97,82.45,27.8002,97,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"West Nile Virus Ab, Igg, S (Mayo)OutsideLaboratory",,86789,CPT,Facility,Outpatient,,,90,97,82.45,27.8002,97,PrimeWest Health,MinnesotaCare,49.8192,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"West Nile Virus Ab, Igg, S (Mayo)OutsideLaboratory",,86789,CPT,Facility,Inpatient,,,90,97,82.45,27.8002,97,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"West Nile Virus Ab, Igg, S (Mayo)OutsideLaboratory",,86789,CPT,Facility,Both,,,90,97,82.45,27.8002,97,Sanford Health Plan,Sanford Health Plan,89.24,92,,percent of total billed charges,,
"West Nile Virus Ab, Igg, S (Mayo)OutsideLaboratory",,86789,CPT,Facility,Outpatient,,,90,97,82.45,27.8002,97,"UCare Health, Inc.",Individual & Family Plan,54.6595,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"West Nile Virus Ab, Igg, S (Mayo)OutsideLaboratory",,86789,CPT,Facility,Inpatient,,,90,97,82.45,27.8002,97,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"West Nile Virus Ab, Igg, S (Mayo)OutsideLaboratory",,86789,CPT,Facility,Outpatient,,,90,97,82.45,27.8002,97,"UCare Health, Inc.",Medical Assistance,48.9559,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"West Nile Virus Ab, Igg, S (Mayo)OutsideLaboratory",,86789,CPT,Facility,Inpatient,,,90,97,82.45,27.8002,97,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"West Nile Virus Ab, Igg, S (Mayo)OutsideLaboratory",,86789,CPT,Facility,Outpatient,,,90,97,82.45,27.8002,97,"UCare Health, Inc.",Medicare Advantage,48.9559,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"West Nile Virus Ab, Igg, S (Mayo)OutsideLaboratory",,86789,CPT,Facility,Inpatient,,,90,97,82.45,27.8002,97,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"West Nile Virus Ab, Igg, S (Mayo)OutsideLaboratory",,86789,CPT,Facility,Outpatient,,,90,97,82.45,27.8002,97,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),48.9559,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"West Nile Virus Ab, Igg, S (Mayo)OutsideLaboratory",,86789,CPT,Facility,Inpatient,,,90,97,82.45,27.8002,97,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"West Nile Virus Ab, Igg, S (Mayo)OutsideLaboratory",,86789,CPT,Facility,Both,,,90,97,82.45,27.8002,97,UnitedHealthcare,Individual & Family,91.18,94,,percent of total billed charges,,
"West Nile Virus Ab, Igg, S (Mayo)OutsideLaboratory",,86789,CPT,Facility,Outpatient,,,90,97,82.45,27.8002,97,UnitedHealthcare,Medicare Advantage,47.53,49,,percent of total billed charges,,
"West Nile Virus Ab, Igg, S (Mayo)OutsideLaboratory",,86789,CPT,Facility,Inpatient,,,90,97,82.45,27.8002,97,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"West Nile Virus Ab, Igg, S (Mayo)OutsideLaboratory",,86789,CPT,Facility,Outpatient,,,90,97,82.45,27.8002,97,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,46.56,48,,percent of total billed charges,,100% of DHS outpatient percentage
"West Nile Virus Ab, Igg, S (Mayo)OutsideLaboratory",,86789,CPT,Facility,Inpatient,,,90,97,82.45,27.8002,97,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Thyroglobulin Antibody (Mayo)OutsideLaboratory,,86800,CPT,Facility,Both,,,90,114,96.9,32.6724,114,Aetna,Commercial,104.88,92,,percent of total billed charges,,
Thyroglobulin Antibody (Mayo)OutsideLaboratory,,86800,CPT,Facility,Outpatient,,,90,114,96.9,32.6724,114,Aetna,Medicare Advantage,55.86,49,,percent of total billed charges,,
Thyroglobulin Antibody (Mayo)OutsideLaboratory,,86800,CPT,Facility,Inpatient,,,90,114,96.9,32.6724,114,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Thyroglobulin Antibody (Mayo)OutsideLaboratory,,86800,CPT,Facility,Both,,,90,114,96.9,32.6724,114,Aetna,PPO,106.02,93,,percent of total billed charges,,
Thyroglobulin Antibody (Mayo)OutsideLaboratory,,86800,CPT,Facility,Both,,,90,114,96.9,32.6724,114,America's PPO,America's PPO,109.4742,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Thyroglobulin Antibody (Mayo)OutsideLaboratory,,86800,CPT,Facility,Both,,,90,114,96.9,32.6724,114,BlueCross BlueShield Minnesota, Federal Employee Program,112.176,98.4,,percent of total billed charges,,
Thyroglobulin Antibody (Mayo)OutsideLaboratory,,86800,CPT,Facility,Both,,,90,114,96.9,32.6724,114,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,114,100,,percent of total billed charges,,
Thyroglobulin Antibody (Mayo)OutsideLaboratory,,86800,CPT,Facility,Both,,,90,114,96.9,32.6724,114,BlueCross BlueShield Minnesota,High Value Network Plan,102.6,90,,percent of total billed charges,,
Thyroglobulin Antibody (Mayo)OutsideLaboratory,,86800,CPT,Facility,Outpatient,,,90,114,96.9,32.6724,114,BlueCross BlueShield Minnesota,Medicare Advantage,55.86,49,,percent of total billed charges,,
Thyroglobulin Antibody (Mayo)OutsideLaboratory,,86800,CPT,Facility,Inpatient,,,90,114,96.9,32.6724,114,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Thyroglobulin Antibody (Mayo)OutsideLaboratory,,86800,CPT,Facility,Both,,,90,114,96.9,32.6724,114,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,100.9698,88.57,,percent of total billed charges,,
Thyroglobulin Antibody (Mayo)OutsideLaboratory,,86800,CPT,Facility,Both,,,90,114,96.9,32.6724,114,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,32.6724,28.66,,percent of total billed charges,,
Thyroglobulin Antibody (Mayo)OutsideLaboratory,,86800,CPT,Facility,Outpatient,,,90,114,96.9,32.6724,114,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),55.86,49,,percent of total billed charges,,
Thyroglobulin Antibody (Mayo)OutsideLaboratory,,86800,CPT,Facility,Inpatient,,,90,114,96.9,32.6724,114,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Thyroglobulin Antibody (Mayo)OutsideLaboratory,,86800,CPT,Facility,Both,,,90,114,96.9,32.6724,114,CorVel,Worker's Compensation,114,100,,percent of total billed charges,,
Thyroglobulin Antibody (Mayo)OutsideLaboratory,,86800,CPT,Facility,Both,,,90,114,96.9,32.6724,114,First Health Group Corporation,First Health Network,110.58,97,,percent of total billed charges,,
Thyroglobulin Antibody (Mayo)OutsideLaboratory,,86800,CPT,Facility,Both,,,90,114,96.9,32.6724,114,"Health Partners, Inc.",Commercial,107.844,94.6,,percent of total billed charges,,
Thyroglobulin Antibody (Mayo)OutsideLaboratory,,86800,CPT,Facility,Outpatient,,,90,114,96.9,32.6724,114,"Health Partners, Inc.",Medicare Advantage,55.86,49,,percent of total billed charges,,
Thyroglobulin Antibody (Mayo)OutsideLaboratory,,86800,CPT,Facility,Inpatient,,,90,114,96.9,32.6724,114,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Thyroglobulin Antibody (Mayo)OutsideLaboratory,,86800,CPT,Facility,Both,,,90,114,96.9,32.6724,114,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),68.4,60,,percent of total billed charges,,
Thyroglobulin Antibody (Mayo)OutsideLaboratory,,86800,CPT,Facility,Both,,,90,114,96.9,32.6724,114,"Health Partners, Inc.",State of Minnesota Advantage Program,92.91,81.5,,percent of total billed charges,,
Thyroglobulin Antibody (Mayo)OutsideLaboratory,,86800,CPT,Facility,Both,,,90,114,96.9,32.6724,114,"Health Partners, Inc.",State Public Programs,57,50,,percent of total billed charges,,
Thyroglobulin Antibody (Mayo)OutsideLaboratory,,86800,CPT,Facility,Both,,,90,114,96.9,32.6724,114,Humana Insurance Company,Commercial PPO,108.3,95,,percent of total billed charges,,
Thyroglobulin Antibody (Mayo)OutsideLaboratory,,86800,CPT,Facility,Outpatient,,,90,114,96.9,32.6724,114,Humana Insurance Company,Medicare PPO,55.86,49,,percent of total billed charges,,
Thyroglobulin Antibody (Mayo)OutsideLaboratory,,86800,CPT,Facility,Inpatient,,,90,114,96.9,32.6724,114,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Thyroglobulin Antibody (Mayo)OutsideLaboratory,,86800,CPT,Facility,Both,,,90,114,96.9,32.6724,114,Medica,Individual & Family,112.974,99.1,,percent of total billed charges,,
Thyroglobulin Antibody (Mayo)OutsideLaboratory,,86800,CPT,Facility,Outpatient,,,90,114,96.9,32.6724,114,Medica,Medica Advantage Solution,56.772,49.8,,percent of total billed charges,,
Thyroglobulin Antibody (Mayo)OutsideLaboratory,,86800,CPT,Facility,Inpatient,,,90,114,96.9,32.6724,114,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Thyroglobulin Antibody (Mayo)OutsideLaboratory,,86800,CPT,Facility,Outpatient,,,90,114,96.9,32.6724,114,Medica,Medical Assistance,50.844,44.6,,percent of total billed charges,,
Thyroglobulin Antibody (Mayo)OutsideLaboratory,,86800,CPT,Facility,Inpatient,,,90,114,96.9,32.6724,114,Medica,Medical Assistance,,,,,Included in per diem rate,
Thyroglobulin Antibody (Mayo)OutsideLaboratory,,86800,CPT,Facility,Outpatient,,,90,114,96.9,32.6724,114,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,56.772,49.8,,percent of total billed charges,,
Thyroglobulin Antibody (Mayo)OutsideLaboratory,,86800,CPT,Facility,Inpatient,,,90,114,96.9,32.6724,114,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Thyroglobulin Antibody (Mayo)OutsideLaboratory,,86800,CPT,Facility,Both,,,90,114,96.9,32.6724,114,"Multiplan, Inc.","Multiplan, Inc.",107.16,94,,percent of total billed charges,,
Thyroglobulin Antibody (Mayo)OutsideLaboratory,,86800,CPT,Facility,Outpatient,,,90,114,96.9,32.6724,114,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,98.496,86.4,,percent of total billed charges,,
Thyroglobulin Antibody (Mayo)OutsideLaboratory,,86800,CPT,Facility,Inpatient,,,90,114,96.9,32.6724,114,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Thyroglobulin Antibody (Mayo)OutsideLaboratory,,86800,CPT,Facility,Both,,,90,114,96.9,32.6724,114,"Preferred One Administrative Services, INC.",PPO,112.404,98.6,,percent of total billed charges,,
Thyroglobulin Antibody (Mayo)OutsideLaboratory,,86800,CPT,Facility,Outpatient,,,90,114,96.9,32.6724,114,PrimeWest Health,Minnesota Senior Health Options (MSHO),58.653,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Thyroglobulin Antibody (Mayo)OutsideLaboratory,,86800,CPT,Facility,Inpatient,,,90,114,96.9,32.6724,114,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Thyroglobulin Antibody (Mayo)OutsideLaboratory,,86800,CPT,Facility,Outpatient,,,90,114,96.9,32.6724,114,PrimeWest Health,MinnesotaCare,58.5504,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Thyroglobulin Antibody (Mayo)OutsideLaboratory,,86800,CPT,Facility,Inpatient,,,90,114,96.9,32.6724,114,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Thyroglobulin Antibody (Mayo)OutsideLaboratory,,86800,CPT,Facility,Both,,,90,114,96.9,32.6724,114,Sanford Health Plan,Sanford Health Plan,104.88,92,,percent of total billed charges,,
Thyroglobulin Antibody (Mayo)OutsideLaboratory,,86800,CPT,Facility,Outpatient,,,90,114,96.9,32.6724,114,"UCare Health, Inc.",Individual & Family Plan,64.239,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Thyroglobulin Antibody (Mayo)OutsideLaboratory,,86800,CPT,Facility,Inpatient,,,90,114,96.9,32.6724,114,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Thyroglobulin Antibody (Mayo)OutsideLaboratory,,86800,CPT,Facility,Outpatient,,,90,114,96.9,32.6724,114,"UCare Health, Inc.",Medical Assistance,57.5358,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Thyroglobulin Antibody (Mayo)OutsideLaboratory,,86800,CPT,Facility,Inpatient,,,90,114,96.9,32.6724,114,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Thyroglobulin Antibody (Mayo)OutsideLaboratory,,86800,CPT,Facility,Outpatient,,,90,114,96.9,32.6724,114,"UCare Health, Inc.",Medicare Advantage,57.5358,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Thyroglobulin Antibody (Mayo)OutsideLaboratory,,86800,CPT,Facility,Inpatient,,,90,114,96.9,32.6724,114,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Thyroglobulin Antibody (Mayo)OutsideLaboratory,,86800,CPT,Facility,Outpatient,,,90,114,96.9,32.6724,114,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),57.5358,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Thyroglobulin Antibody (Mayo)OutsideLaboratory,,86800,CPT,Facility,Inpatient,,,90,114,96.9,32.6724,114,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Thyroglobulin Antibody (Mayo)OutsideLaboratory,,86800,CPT,Facility,Both,,,90,114,96.9,32.6724,114,UnitedHealthcare,Individual & Family,107.16,94,,percent of total billed charges,,
Thyroglobulin Antibody (Mayo)OutsideLaboratory,,86800,CPT,Facility,Outpatient,,,90,114,96.9,32.6724,114,UnitedHealthcare,Medicare Advantage,55.86,49,,percent of total billed charges,,
Thyroglobulin Antibody (Mayo)OutsideLaboratory,,86800,CPT,Facility,Inpatient,,,90,114,96.9,32.6724,114,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Thyroglobulin Antibody (Mayo)OutsideLaboratory,,86800,CPT,Facility,Outpatient,,,90,114,96.9,32.6724,114,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,54.72,48,,percent of total billed charges,,100% of DHS outpatient percentage
Thyroglobulin Antibody (Mayo)OutsideLaboratory,,86800,CPT,Facility,Inpatient,,,90,114,96.9,32.6724,114,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Thyroglobulin Antibody (Tab) (Mayo)OutsideLaboratory,,86800,CPT,Facility,Both,,,90,114,96.9,32.6724,114,Aetna,Commercial,104.88,92,,percent of total billed charges,,
Thyroglobulin Antibody (Tab) (Mayo)OutsideLaboratory,,86800,CPT,Facility,Outpatient,,,90,114,96.9,32.6724,114,Aetna,Medicare Advantage,55.86,49,,percent of total billed charges,,
Thyroglobulin Antibody (Tab) (Mayo)OutsideLaboratory,,86800,CPT,Facility,Inpatient,,,90,114,96.9,32.6724,114,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Thyroglobulin Antibody (Tab) (Mayo)OutsideLaboratory,,86800,CPT,Facility,Both,,,90,114,96.9,32.6724,114,Aetna,PPO,106.02,93,,percent of total billed charges,,
Thyroglobulin Antibody (Tab) (Mayo)OutsideLaboratory,,86800,CPT,Facility,Both,,,90,114,96.9,32.6724,114,America's PPO,America's PPO,109.4742,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Thyroglobulin Antibody (Tab) (Mayo)OutsideLaboratory,,86800,CPT,Facility,Both,,,90,114,96.9,32.6724,114,BlueCross BlueShield Minnesota, Federal Employee Program,112.176,98.4,,percent of total billed charges,,
Thyroglobulin Antibody (Tab) (Mayo)OutsideLaboratory,,86800,CPT,Facility,Both,,,90,114,96.9,32.6724,114,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,114,100,,percent of total billed charges,,
Thyroglobulin Antibody (Tab) (Mayo)OutsideLaboratory,,86800,CPT,Facility,Both,,,90,114,96.9,32.6724,114,BlueCross BlueShield Minnesota,High Value Network Plan,102.6,90,,percent of total billed charges,,
Thyroglobulin Antibody (Tab) (Mayo)OutsideLaboratory,,86800,CPT,Facility,Outpatient,,,90,114,96.9,32.6724,114,BlueCross BlueShield Minnesota,Medicare Advantage,55.86,49,,percent of total billed charges,,
Thyroglobulin Antibody (Tab) (Mayo)OutsideLaboratory,,86800,CPT,Facility,Inpatient,,,90,114,96.9,32.6724,114,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Thyroglobulin Antibody (Tab) (Mayo)OutsideLaboratory,,86800,CPT,Facility,Both,,,90,114,96.9,32.6724,114,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,100.9698,88.57,,percent of total billed charges,,
Thyroglobulin Antibody (Tab) (Mayo)OutsideLaboratory,,86800,CPT,Facility,Both,,,90,114,96.9,32.6724,114,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,32.6724,28.66,,percent of total billed charges,,
Thyroglobulin Antibody (Tab) (Mayo)OutsideLaboratory,,86800,CPT,Facility,Outpatient,,,90,114,96.9,32.6724,114,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),55.86,49,,percent of total billed charges,,
Thyroglobulin Antibody (Tab) (Mayo)OutsideLaboratory,,86800,CPT,Facility,Inpatient,,,90,114,96.9,32.6724,114,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Thyroglobulin Antibody (Tab) (Mayo)OutsideLaboratory,,86800,CPT,Facility,Both,,,90,114,96.9,32.6724,114,CorVel,Worker's Compensation,114,100,,percent of total billed charges,,
Thyroglobulin Antibody (Tab) (Mayo)OutsideLaboratory,,86800,CPT,Facility,Both,,,90,114,96.9,32.6724,114,First Health Group Corporation,First Health Network,110.58,97,,percent of total billed charges,,
Thyroglobulin Antibody (Tab) (Mayo)OutsideLaboratory,,86800,CPT,Facility,Both,,,90,114,96.9,32.6724,114,"Health Partners, Inc.",Commercial,107.844,94.6,,percent of total billed charges,,
Thyroglobulin Antibody (Tab) (Mayo)OutsideLaboratory,,86800,CPT,Facility,Outpatient,,,90,114,96.9,32.6724,114,"Health Partners, Inc.",Medicare Advantage,55.86,49,,percent of total billed charges,,
Thyroglobulin Antibody (Tab) (Mayo)OutsideLaboratory,,86800,CPT,Facility,Inpatient,,,90,114,96.9,32.6724,114,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Thyroglobulin Antibody (Tab) (Mayo)OutsideLaboratory,,86800,CPT,Facility,Both,,,90,114,96.9,32.6724,114,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),68.4,60,,percent of total billed charges,,
Thyroglobulin Antibody (Tab) (Mayo)OutsideLaboratory,,86800,CPT,Facility,Both,,,90,114,96.9,32.6724,114,"Health Partners, Inc.",State of Minnesota Advantage Program,92.91,81.5,,percent of total billed charges,,
Thyroglobulin Antibody (Tab) (Mayo)OutsideLaboratory,,86800,CPT,Facility,Both,,,90,114,96.9,32.6724,114,"Health Partners, Inc.",State Public Programs,57,50,,percent of total billed charges,,
Thyroglobulin Antibody (Tab) (Mayo)OutsideLaboratory,,86800,CPT,Facility,Both,,,90,114,96.9,32.6724,114,Humana Insurance Company,Commercial PPO,108.3,95,,percent of total billed charges,,
Thyroglobulin Antibody (Tab) (Mayo)OutsideLaboratory,,86800,CPT,Facility,Outpatient,,,90,114,96.9,32.6724,114,Humana Insurance Company,Medicare PPO,55.86,49,,percent of total billed charges,,
Thyroglobulin Antibody (Tab) (Mayo)OutsideLaboratory,,86800,CPT,Facility,Inpatient,,,90,114,96.9,32.6724,114,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Thyroglobulin Antibody (Tab) (Mayo)OutsideLaboratory,,86800,CPT,Facility,Both,,,90,114,96.9,32.6724,114,Medica,Individual & Family,112.974,99.1,,percent of total billed charges,,
Thyroglobulin Antibody (Tab) (Mayo)OutsideLaboratory,,86800,CPT,Facility,Outpatient,,,90,114,96.9,32.6724,114,Medica,Medica Advantage Solution,56.772,49.8,,percent of total billed charges,,
Thyroglobulin Antibody (Tab) (Mayo)OutsideLaboratory,,86800,CPT,Facility,Inpatient,,,90,114,96.9,32.6724,114,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Thyroglobulin Antibody (Tab) (Mayo)OutsideLaboratory,,86800,CPT,Facility,Outpatient,,,90,114,96.9,32.6724,114,Medica,Medical Assistance,50.844,44.6,,percent of total billed charges,,
Thyroglobulin Antibody (Tab) (Mayo)OutsideLaboratory,,86800,CPT,Facility,Inpatient,,,90,114,96.9,32.6724,114,Medica,Medical Assistance,,,,,Included in per diem rate,
Thyroglobulin Antibody (Tab) (Mayo)OutsideLaboratory,,86800,CPT,Facility,Outpatient,,,90,114,96.9,32.6724,114,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,56.772,49.8,,percent of total billed charges,,
Thyroglobulin Antibody (Tab) (Mayo)OutsideLaboratory,,86800,CPT,Facility,Inpatient,,,90,114,96.9,32.6724,114,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Thyroglobulin Antibody (Tab) (Mayo)OutsideLaboratory,,86800,CPT,Facility,Both,,,90,114,96.9,32.6724,114,"Multiplan, Inc.","Multiplan, Inc.",107.16,94,,percent of total billed charges,,
Thyroglobulin Antibody (Tab) (Mayo)OutsideLaboratory,,86800,CPT,Facility,Outpatient,,,90,114,96.9,32.6724,114,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,98.496,86.4,,percent of total billed charges,,
Thyroglobulin Antibody (Tab) (Mayo)OutsideLaboratory,,86800,CPT,Facility,Inpatient,,,90,114,96.9,32.6724,114,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Thyroglobulin Antibody (Tab) (Mayo)OutsideLaboratory,,86800,CPT,Facility,Both,,,90,114,96.9,32.6724,114,"Preferred One Administrative Services, INC.",PPO,112.404,98.6,,percent of total billed charges,,
Thyroglobulin Antibody (Tab) (Mayo)OutsideLaboratory,,86800,CPT,Facility,Outpatient,,,90,114,96.9,32.6724,114,PrimeWest Health,Minnesota Senior Health Options (MSHO),58.653,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Thyroglobulin Antibody (Tab) (Mayo)OutsideLaboratory,,86800,CPT,Facility,Inpatient,,,90,114,96.9,32.6724,114,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Thyroglobulin Antibody (Tab) (Mayo)OutsideLaboratory,,86800,CPT,Facility,Outpatient,,,90,114,96.9,32.6724,114,PrimeWest Health,MinnesotaCare,58.5504,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Thyroglobulin Antibody (Tab) (Mayo)OutsideLaboratory,,86800,CPT,Facility,Inpatient,,,90,114,96.9,32.6724,114,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Thyroglobulin Antibody (Tab) (Mayo)OutsideLaboratory,,86800,CPT,Facility,Both,,,90,114,96.9,32.6724,114,Sanford Health Plan,Sanford Health Plan,104.88,92,,percent of total billed charges,,
Thyroglobulin Antibody (Tab) (Mayo)OutsideLaboratory,,86800,CPT,Facility,Outpatient,,,90,114,96.9,32.6724,114,"UCare Health, Inc.",Individual & Family Plan,64.239,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Thyroglobulin Antibody (Tab) (Mayo)OutsideLaboratory,,86800,CPT,Facility,Inpatient,,,90,114,96.9,32.6724,114,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Thyroglobulin Antibody (Tab) (Mayo)OutsideLaboratory,,86800,CPT,Facility,Outpatient,,,90,114,96.9,32.6724,114,"UCare Health, Inc.",Medical Assistance,57.5358,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Thyroglobulin Antibody (Tab) (Mayo)OutsideLaboratory,,86800,CPT,Facility,Inpatient,,,90,114,96.9,32.6724,114,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Thyroglobulin Antibody (Tab) (Mayo)OutsideLaboratory,,86800,CPT,Facility,Outpatient,,,90,114,96.9,32.6724,114,"UCare Health, Inc.",Medicare Advantage,57.5358,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Thyroglobulin Antibody (Tab) (Mayo)OutsideLaboratory,,86800,CPT,Facility,Inpatient,,,90,114,96.9,32.6724,114,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Thyroglobulin Antibody (Tab) (Mayo)OutsideLaboratory,,86800,CPT,Facility,Outpatient,,,90,114,96.9,32.6724,114,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),57.5358,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Thyroglobulin Antibody (Tab) (Mayo)OutsideLaboratory,,86800,CPT,Facility,Inpatient,,,90,114,96.9,32.6724,114,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Thyroglobulin Antibody (Tab) (Mayo)OutsideLaboratory,,86800,CPT,Facility,Both,,,90,114,96.9,32.6724,114,UnitedHealthcare,Individual & Family,107.16,94,,percent of total billed charges,,
Thyroglobulin Antibody (Tab) (Mayo)OutsideLaboratory,,86800,CPT,Facility,Outpatient,,,90,114,96.9,32.6724,114,UnitedHealthcare,Medicare Advantage,55.86,49,,percent of total billed charges,,
Thyroglobulin Antibody (Tab) (Mayo)OutsideLaboratory,,86800,CPT,Facility,Inpatient,,,90,114,96.9,32.6724,114,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Thyroglobulin Antibody (Tab) (Mayo)OutsideLaboratory,,86800,CPT,Facility,Outpatient,,,90,114,96.9,32.6724,114,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,54.72,48,,percent of total billed charges,,100% of DHS outpatient percentage
Thyroglobulin Antibody (Tab) (Mayo)OutsideLaboratory,,86800,CPT,Facility,Inpatient,,,90,114,96.9,32.6724,114,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Thyroglobulin Antibody, S (Mayo)OutsideLaboratory",,86800,CPT,Facility,Both,,,90,114,96.9,32.6724,114,Aetna,Commercial,104.88,92,,percent of total billed charges,,
"Thyroglobulin Antibody, S (Mayo)OutsideLaboratory",,86800,CPT,Facility,Outpatient,,,90,114,96.9,32.6724,114,Aetna,Medicare Advantage,55.86,49,,percent of total billed charges,,
"Thyroglobulin Antibody, S (Mayo)OutsideLaboratory",,86800,CPT,Facility,Inpatient,,,90,114,96.9,32.6724,114,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Thyroglobulin Antibody, S (Mayo)OutsideLaboratory",,86800,CPT,Facility,Both,,,90,114,96.9,32.6724,114,Aetna,PPO,106.02,93,,percent of total billed charges,,
"Thyroglobulin Antibody, S (Mayo)OutsideLaboratory",,86800,CPT,Facility,Both,,,90,114,96.9,32.6724,114,America's PPO,America's PPO,109.4742,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Thyroglobulin Antibody, S (Mayo)OutsideLaboratory",,86800,CPT,Facility,Both,,,90,114,96.9,32.6724,114,BlueCross BlueShield Minnesota, Federal Employee Program,112.176,98.4,,percent of total billed charges,,
"Thyroglobulin Antibody, S (Mayo)OutsideLaboratory",,86800,CPT,Facility,Both,,,90,114,96.9,32.6724,114,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,114,100,,percent of total billed charges,,
"Thyroglobulin Antibody, S (Mayo)OutsideLaboratory",,86800,CPT,Facility,Both,,,90,114,96.9,32.6724,114,BlueCross BlueShield Minnesota,High Value Network Plan,102.6,90,,percent of total billed charges,,
"Thyroglobulin Antibody, S (Mayo)OutsideLaboratory",,86800,CPT,Facility,Outpatient,,,90,114,96.9,32.6724,114,BlueCross BlueShield Minnesota,Medicare Advantage,55.86,49,,percent of total billed charges,,
"Thyroglobulin Antibody, S (Mayo)OutsideLaboratory",,86800,CPT,Facility,Inpatient,,,90,114,96.9,32.6724,114,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Thyroglobulin Antibody, S (Mayo)OutsideLaboratory",,86800,CPT,Facility,Both,,,90,114,96.9,32.6724,114,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,100.9698,88.57,,percent of total billed charges,,
"Thyroglobulin Antibody, S (Mayo)OutsideLaboratory",,86800,CPT,Facility,Both,,,90,114,96.9,32.6724,114,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,32.6724,28.66,,percent of total billed charges,,
"Thyroglobulin Antibody, S (Mayo)OutsideLaboratory",,86800,CPT,Facility,Outpatient,,,90,114,96.9,32.6724,114,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),55.86,49,,percent of total billed charges,,
"Thyroglobulin Antibody, S (Mayo)OutsideLaboratory",,86800,CPT,Facility,Inpatient,,,90,114,96.9,32.6724,114,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Thyroglobulin Antibody, S (Mayo)OutsideLaboratory",,86800,CPT,Facility,Both,,,90,114,96.9,32.6724,114,CorVel,Worker's Compensation,114,100,,percent of total billed charges,,
"Thyroglobulin Antibody, S (Mayo)OutsideLaboratory",,86800,CPT,Facility,Both,,,90,114,96.9,32.6724,114,First Health Group Corporation,First Health Network,110.58,97,,percent of total billed charges,,
"Thyroglobulin Antibody, S (Mayo)OutsideLaboratory",,86800,CPT,Facility,Both,,,90,114,96.9,32.6724,114,"Health Partners, Inc.",Commercial,107.844,94.6,,percent of total billed charges,,
"Thyroglobulin Antibody, S (Mayo)OutsideLaboratory",,86800,CPT,Facility,Outpatient,,,90,114,96.9,32.6724,114,"Health Partners, Inc.",Medicare Advantage,55.86,49,,percent of total billed charges,,
"Thyroglobulin Antibody, S (Mayo)OutsideLaboratory",,86800,CPT,Facility,Inpatient,,,90,114,96.9,32.6724,114,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Thyroglobulin Antibody, S (Mayo)OutsideLaboratory",,86800,CPT,Facility,Both,,,90,114,96.9,32.6724,114,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),68.4,60,,percent of total billed charges,,
"Thyroglobulin Antibody, S (Mayo)OutsideLaboratory",,86800,CPT,Facility,Both,,,90,114,96.9,32.6724,114,"Health Partners, Inc.",State of Minnesota Advantage Program,92.91,81.5,,percent of total billed charges,,
"Thyroglobulin Antibody, S (Mayo)OutsideLaboratory",,86800,CPT,Facility,Both,,,90,114,96.9,32.6724,114,"Health Partners, Inc.",State Public Programs,57,50,,percent of total billed charges,,
"Thyroglobulin Antibody, S (Mayo)OutsideLaboratory",,86800,CPT,Facility,Both,,,90,114,96.9,32.6724,114,Humana Insurance Company,Commercial PPO,108.3,95,,percent of total billed charges,,
"Thyroglobulin Antibody, S (Mayo)OutsideLaboratory",,86800,CPT,Facility,Outpatient,,,90,114,96.9,32.6724,114,Humana Insurance Company,Medicare PPO,55.86,49,,percent of total billed charges,,
"Thyroglobulin Antibody, S (Mayo)OutsideLaboratory",,86800,CPT,Facility,Inpatient,,,90,114,96.9,32.6724,114,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Thyroglobulin Antibody, S (Mayo)OutsideLaboratory",,86800,CPT,Facility,Both,,,90,114,96.9,32.6724,114,Medica,Individual & Family,112.974,99.1,,percent of total billed charges,,
"Thyroglobulin Antibody, S (Mayo)OutsideLaboratory",,86800,CPT,Facility,Outpatient,,,90,114,96.9,32.6724,114,Medica,Medica Advantage Solution,56.772,49.8,,percent of total billed charges,,
"Thyroglobulin Antibody, S (Mayo)OutsideLaboratory",,86800,CPT,Facility,Inpatient,,,90,114,96.9,32.6724,114,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Thyroglobulin Antibody, S (Mayo)OutsideLaboratory",,86800,CPT,Facility,Outpatient,,,90,114,96.9,32.6724,114,Medica,Medical Assistance,50.844,44.6,,percent of total billed charges,,
"Thyroglobulin Antibody, S (Mayo)OutsideLaboratory",,86800,CPT,Facility,Inpatient,,,90,114,96.9,32.6724,114,Medica,Medical Assistance,,,,,Included in per diem rate,
"Thyroglobulin Antibody, S (Mayo)OutsideLaboratory",,86800,CPT,Facility,Outpatient,,,90,114,96.9,32.6724,114,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,56.772,49.8,,percent of total billed charges,,
"Thyroglobulin Antibody, S (Mayo)OutsideLaboratory",,86800,CPT,Facility,Inpatient,,,90,114,96.9,32.6724,114,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Thyroglobulin Antibody, S (Mayo)OutsideLaboratory",,86800,CPT,Facility,Both,,,90,114,96.9,32.6724,114,"Multiplan, Inc.","Multiplan, Inc.",107.16,94,,percent of total billed charges,,
"Thyroglobulin Antibody, S (Mayo)OutsideLaboratory",,86800,CPT,Facility,Outpatient,,,90,114,96.9,32.6724,114,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,98.496,86.4,,percent of total billed charges,,
"Thyroglobulin Antibody, S (Mayo)OutsideLaboratory",,86800,CPT,Facility,Inpatient,,,90,114,96.9,32.6724,114,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Thyroglobulin Antibody, S (Mayo)OutsideLaboratory",,86800,CPT,Facility,Both,,,90,114,96.9,32.6724,114,"Preferred One Administrative Services, INC.",PPO,112.404,98.6,,percent of total billed charges,,
"Thyroglobulin Antibody, S (Mayo)OutsideLaboratory",,86800,CPT,Facility,Outpatient,,,90,114,96.9,32.6724,114,PrimeWest Health,Minnesota Senior Health Options (MSHO),58.653,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Thyroglobulin Antibody, S (Mayo)OutsideLaboratory",,86800,CPT,Facility,Inpatient,,,90,114,96.9,32.6724,114,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Thyroglobulin Antibody, S (Mayo)OutsideLaboratory",,86800,CPT,Facility,Outpatient,,,90,114,96.9,32.6724,114,PrimeWest Health,MinnesotaCare,58.5504,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Thyroglobulin Antibody, S (Mayo)OutsideLaboratory",,86800,CPT,Facility,Inpatient,,,90,114,96.9,32.6724,114,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Thyroglobulin Antibody, S (Mayo)OutsideLaboratory",,86800,CPT,Facility,Both,,,90,114,96.9,32.6724,114,Sanford Health Plan,Sanford Health Plan,104.88,92,,percent of total billed charges,,
"Thyroglobulin Antibody, S (Mayo)OutsideLaboratory",,86800,CPT,Facility,Outpatient,,,90,114,96.9,32.6724,114,"UCare Health, Inc.",Individual & Family Plan,64.239,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Thyroglobulin Antibody, S (Mayo)OutsideLaboratory",,86800,CPT,Facility,Inpatient,,,90,114,96.9,32.6724,114,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Thyroglobulin Antibody, S (Mayo)OutsideLaboratory",,86800,CPT,Facility,Outpatient,,,90,114,96.9,32.6724,114,"UCare Health, Inc.",Medical Assistance,57.5358,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Thyroglobulin Antibody, S (Mayo)OutsideLaboratory",,86800,CPT,Facility,Inpatient,,,90,114,96.9,32.6724,114,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Thyroglobulin Antibody, S (Mayo)OutsideLaboratory",,86800,CPT,Facility,Outpatient,,,90,114,96.9,32.6724,114,"UCare Health, Inc.",Medicare Advantage,57.5358,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Thyroglobulin Antibody, S (Mayo)OutsideLaboratory",,86800,CPT,Facility,Inpatient,,,90,114,96.9,32.6724,114,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Thyroglobulin Antibody, S (Mayo)OutsideLaboratory",,86800,CPT,Facility,Outpatient,,,90,114,96.9,32.6724,114,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),57.5358,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Thyroglobulin Antibody, S (Mayo)OutsideLaboratory",,86800,CPT,Facility,Inpatient,,,90,114,96.9,32.6724,114,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Thyroglobulin Antibody, S (Mayo)OutsideLaboratory",,86800,CPT,Facility,Both,,,90,114,96.9,32.6724,114,UnitedHealthcare,Individual & Family,107.16,94,,percent of total billed charges,,
"Thyroglobulin Antibody, S (Mayo)OutsideLaboratory",,86800,CPT,Facility,Outpatient,,,90,114,96.9,32.6724,114,UnitedHealthcare,Medicare Advantage,55.86,49,,percent of total billed charges,,
"Thyroglobulin Antibody, S (Mayo)OutsideLaboratory",,86800,CPT,Facility,Inpatient,,,90,114,96.9,32.6724,114,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Thyroglobulin Antibody, S (Mayo)OutsideLaboratory",,86800,CPT,Facility,Outpatient,,,90,114,96.9,32.6724,114,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,54.72,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Thyroglobulin Antibody, S (Mayo)OutsideLaboratory",,86800,CPT,Facility,Inpatient,,,90,114,96.9,32.6724,114,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Thyroglobulin Reflex To Ms Or Ia (Mayo)OutsideLaboratory,,86800,CPT,Facility,Both,,,90,96,81.6,27.5136,96,Aetna,Commercial,88.32,92,,percent of total billed charges,,
Thyroglobulin Reflex To Ms Or Ia (Mayo)OutsideLaboratory,,86800,CPT,Facility,Outpatient,,,90,96,81.6,27.5136,96,Aetna,Medicare Advantage,47.04,49,,percent of total billed charges,,
Thyroglobulin Reflex To Ms Or Ia (Mayo)OutsideLaboratory,,86800,CPT,Facility,Inpatient,,,90,96,81.6,27.5136,96,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Thyroglobulin Reflex To Ms Or Ia (Mayo)OutsideLaboratory,,86800,CPT,Facility,Both,,,90,96,81.6,27.5136,96,Aetna,PPO,89.28,93,,percent of total billed charges,,
Thyroglobulin Reflex To Ms Or Ia (Mayo)OutsideLaboratory,,86800,CPT,Facility,Both,,,90,96,81.6,27.5136,96,America's PPO,America's PPO,92.1888,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Thyroglobulin Reflex To Ms Or Ia (Mayo)OutsideLaboratory,,86800,CPT,Facility,Both,,,90,96,81.6,27.5136,96,BlueCross BlueShield Minnesota, Federal Employee Program,94.464,98.4,,percent of total billed charges,,
Thyroglobulin Reflex To Ms Or Ia (Mayo)OutsideLaboratory,,86800,CPT,Facility,Both,,,90,96,81.6,27.5136,96,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,96,100,,percent of total billed charges,,
Thyroglobulin Reflex To Ms Or Ia (Mayo)OutsideLaboratory,,86800,CPT,Facility,Both,,,90,96,81.6,27.5136,96,BlueCross BlueShield Minnesota,High Value Network Plan,86.4,90,,percent of total billed charges,,
Thyroglobulin Reflex To Ms Or Ia (Mayo)OutsideLaboratory,,86800,CPT,Facility,Outpatient,,,90,96,81.6,27.5136,96,BlueCross BlueShield Minnesota,Medicare Advantage,47.04,49,,percent of total billed charges,,
Thyroglobulin Reflex To Ms Or Ia (Mayo)OutsideLaboratory,,86800,CPT,Facility,Inpatient,,,90,96,81.6,27.5136,96,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Thyroglobulin Reflex To Ms Or Ia (Mayo)OutsideLaboratory,,86800,CPT,Facility,Both,,,90,96,81.6,27.5136,96,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,85.0272,88.57,,percent of total billed charges,,
Thyroglobulin Reflex To Ms Or Ia (Mayo)OutsideLaboratory,,86800,CPT,Facility,Both,,,90,96,81.6,27.5136,96,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,27.5136,28.66,,percent of total billed charges,,
Thyroglobulin Reflex To Ms Or Ia (Mayo)OutsideLaboratory,,86800,CPT,Facility,Outpatient,,,90,96,81.6,27.5136,96,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),47.04,49,,percent of total billed charges,,
Thyroglobulin Reflex To Ms Or Ia (Mayo)OutsideLaboratory,,86800,CPT,Facility,Inpatient,,,90,96,81.6,27.5136,96,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Thyroglobulin Reflex To Ms Or Ia (Mayo)OutsideLaboratory,,86800,CPT,Facility,Both,,,90,96,81.6,27.5136,96,CorVel,Worker's Compensation,96,100,,percent of total billed charges,,
Thyroglobulin Reflex To Ms Or Ia (Mayo)OutsideLaboratory,,86800,CPT,Facility,Both,,,90,96,81.6,27.5136,96,First Health Group Corporation,First Health Network,93.12,97,,percent of total billed charges,,
Thyroglobulin Reflex To Ms Or Ia (Mayo)OutsideLaboratory,,86800,CPT,Facility,Both,,,90,96,81.6,27.5136,96,"Health Partners, Inc.",Commercial,90.816,94.6,,percent of total billed charges,,
Thyroglobulin Reflex To Ms Or Ia (Mayo)OutsideLaboratory,,86800,CPT,Facility,Outpatient,,,90,96,81.6,27.5136,96,"Health Partners, Inc.",Medicare Advantage,47.04,49,,percent of total billed charges,,
Thyroglobulin Reflex To Ms Or Ia (Mayo)OutsideLaboratory,,86800,CPT,Facility,Inpatient,,,90,96,81.6,27.5136,96,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Thyroglobulin Reflex To Ms Or Ia (Mayo)OutsideLaboratory,,86800,CPT,Facility,Both,,,90,96,81.6,27.5136,96,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),57.6,60,,percent of total billed charges,,
Thyroglobulin Reflex To Ms Or Ia (Mayo)OutsideLaboratory,,86800,CPT,Facility,Both,,,90,96,81.6,27.5136,96,"Health Partners, Inc.",State of Minnesota Advantage Program,78.24,81.5,,percent of total billed charges,,
Thyroglobulin Reflex To Ms Or Ia (Mayo)OutsideLaboratory,,86800,CPT,Facility,Both,,,90,96,81.6,27.5136,96,"Health Partners, Inc.",State Public Programs,48,50,,percent of total billed charges,,
Thyroglobulin Reflex To Ms Or Ia (Mayo)OutsideLaboratory,,86800,CPT,Facility,Both,,,90,96,81.6,27.5136,96,Humana Insurance Company,Commercial PPO,91.2,95,,percent of total billed charges,,
Thyroglobulin Reflex To Ms Or Ia (Mayo)OutsideLaboratory,,86800,CPT,Facility,Outpatient,,,90,96,81.6,27.5136,96,Humana Insurance Company,Medicare PPO,47.04,49,,percent of total billed charges,,
Thyroglobulin Reflex To Ms Or Ia (Mayo)OutsideLaboratory,,86800,CPT,Facility,Inpatient,,,90,96,81.6,27.5136,96,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Thyroglobulin Reflex To Ms Or Ia (Mayo)OutsideLaboratory,,86800,CPT,Facility,Both,,,90,96,81.6,27.5136,96,Medica,Individual & Family,95.136,99.1,,percent of total billed charges,,
Thyroglobulin Reflex To Ms Or Ia (Mayo)OutsideLaboratory,,86800,CPT,Facility,Outpatient,,,90,96,81.6,27.5136,96,Medica,Medica Advantage Solution,47.808,49.8,,percent of total billed charges,,
Thyroglobulin Reflex To Ms Or Ia (Mayo)OutsideLaboratory,,86800,CPT,Facility,Inpatient,,,90,96,81.6,27.5136,96,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Thyroglobulin Reflex To Ms Or Ia (Mayo)OutsideLaboratory,,86800,CPT,Facility,Outpatient,,,90,96,81.6,27.5136,96,Medica,Medical Assistance,42.816,44.6,,percent of total billed charges,,
Thyroglobulin Reflex To Ms Or Ia (Mayo)OutsideLaboratory,,86800,CPT,Facility,Inpatient,,,90,96,81.6,27.5136,96,Medica,Medical Assistance,,,,,Included in per diem rate,
Thyroglobulin Reflex To Ms Or Ia (Mayo)OutsideLaboratory,,86800,CPT,Facility,Outpatient,,,90,96,81.6,27.5136,96,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,47.808,49.8,,percent of total billed charges,,
Thyroglobulin Reflex To Ms Or Ia (Mayo)OutsideLaboratory,,86800,CPT,Facility,Inpatient,,,90,96,81.6,27.5136,96,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Thyroglobulin Reflex To Ms Or Ia (Mayo)OutsideLaboratory,,86800,CPT,Facility,Both,,,90,96,81.6,27.5136,96,"Multiplan, Inc.","Multiplan, Inc.",90.24,94,,percent of total billed charges,,
Thyroglobulin Reflex To Ms Or Ia (Mayo)OutsideLaboratory,,86800,CPT,Facility,Outpatient,,,90,96,81.6,27.5136,96,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,82.944,86.4,,percent of total billed charges,,
Thyroglobulin Reflex To Ms Or Ia (Mayo)OutsideLaboratory,,86800,CPT,Facility,Inpatient,,,90,96,81.6,27.5136,96,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Thyroglobulin Reflex To Ms Or Ia (Mayo)OutsideLaboratory,,86800,CPT,Facility,Both,,,90,96,81.6,27.5136,96,"Preferred One Administrative Services, INC.",PPO,94.656,98.6,,percent of total billed charges,,
Thyroglobulin Reflex To Ms Or Ia (Mayo)OutsideLaboratory,,86800,CPT,Facility,Outpatient,,,90,96,81.6,27.5136,96,PrimeWest Health,Minnesota Senior Health Options (MSHO),49.392,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Thyroglobulin Reflex To Ms Or Ia (Mayo)OutsideLaboratory,,86800,CPT,Facility,Inpatient,,,90,96,81.6,27.5136,96,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Thyroglobulin Reflex To Ms Or Ia (Mayo)OutsideLaboratory,,86800,CPT,Facility,Outpatient,,,90,96,81.6,27.5136,96,PrimeWest Health,MinnesotaCare,49.3056,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Thyroglobulin Reflex To Ms Or Ia (Mayo)OutsideLaboratory,,86800,CPT,Facility,Inpatient,,,90,96,81.6,27.5136,96,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Thyroglobulin Reflex To Ms Or Ia (Mayo)OutsideLaboratory,,86800,CPT,Facility,Both,,,90,96,81.6,27.5136,96,Sanford Health Plan,Sanford Health Plan,88.32,92,,percent of total billed charges,,
Thyroglobulin Reflex To Ms Or Ia (Mayo)OutsideLaboratory,,86800,CPT,Facility,Outpatient,,,90,96,81.6,27.5136,96,"UCare Health, Inc.",Individual & Family Plan,54.096,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Thyroglobulin Reflex To Ms Or Ia (Mayo)OutsideLaboratory,,86800,CPT,Facility,Inpatient,,,90,96,81.6,27.5136,96,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Thyroglobulin Reflex To Ms Or Ia (Mayo)OutsideLaboratory,,86800,CPT,Facility,Outpatient,,,90,96,81.6,27.5136,96,"UCare Health, Inc.",Medical Assistance,48.4512,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Thyroglobulin Reflex To Ms Or Ia (Mayo)OutsideLaboratory,,86800,CPT,Facility,Inpatient,,,90,96,81.6,27.5136,96,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Thyroglobulin Reflex To Ms Or Ia (Mayo)OutsideLaboratory,,86800,CPT,Facility,Outpatient,,,90,96,81.6,27.5136,96,"UCare Health, Inc.",Medicare Advantage,48.4512,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Thyroglobulin Reflex To Ms Or Ia (Mayo)OutsideLaboratory,,86800,CPT,Facility,Inpatient,,,90,96,81.6,27.5136,96,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Thyroglobulin Reflex To Ms Or Ia (Mayo)OutsideLaboratory,,86800,CPT,Facility,Outpatient,,,90,96,81.6,27.5136,96,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),48.4512,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Thyroglobulin Reflex To Ms Or Ia (Mayo)OutsideLaboratory,,86800,CPT,Facility,Inpatient,,,90,96,81.6,27.5136,96,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Thyroglobulin Reflex To Ms Or Ia (Mayo)OutsideLaboratory,,86800,CPT,Facility,Both,,,90,96,81.6,27.5136,96,UnitedHealthcare,Individual & Family,90.24,94,,percent of total billed charges,,
Thyroglobulin Reflex To Ms Or Ia (Mayo)OutsideLaboratory,,86800,CPT,Facility,Outpatient,,,90,96,81.6,27.5136,96,UnitedHealthcare,Medicare Advantage,47.04,49,,percent of total billed charges,,
Thyroglobulin Reflex To Ms Or Ia (Mayo)OutsideLaboratory,,86800,CPT,Facility,Inpatient,,,90,96,81.6,27.5136,96,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Thyroglobulin Reflex To Ms Or Ia (Mayo)OutsideLaboratory,,86800,CPT,Facility,Outpatient,,,90,96,81.6,27.5136,96,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,46.08,48,,percent of total billed charges,,100% of DHS outpatient percentage
Thyroglobulin Reflex To Ms Or Ia (Mayo)OutsideLaboratory,,86800,CPT,Facility,Inpatient,,,90,96,81.6,27.5136,96,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Hla-B27, B (Mayo)OutsideLaboratory",,86812,CPT,Facility,Both,,,90,73,62.05,20.9218,73,Aetna,Commercial,67.16,92,,percent of total billed charges,,
"Hla-B27, B (Mayo)OutsideLaboratory",,86812,CPT,Facility,Outpatient,,,90,73,62.05,20.9218,73,Aetna,Medicare Advantage,35.77,49,,percent of total billed charges,,
"Hla-B27, B (Mayo)OutsideLaboratory",,86812,CPT,Facility,Inpatient,,,90,73,62.05,20.9218,73,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Hla-B27, B (Mayo)OutsideLaboratory",,86812,CPT,Facility,Both,,,90,73,62.05,20.9218,73,Aetna,PPO,67.89,93,,percent of total billed charges,,
"Hla-B27, B (Mayo)OutsideLaboratory",,86812,CPT,Facility,Both,,,90,73,62.05,20.9218,73,America's PPO,America's PPO,70.1019,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Hla-B27, B (Mayo)OutsideLaboratory",,86812,CPT,Facility,Both,,,90,73,62.05,20.9218,73,BlueCross BlueShield Minnesota, Federal Employee Program,71.832,98.4,,percent of total billed charges,,
"Hla-B27, B (Mayo)OutsideLaboratory",,86812,CPT,Facility,Both,,,90,73,62.05,20.9218,73,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,73,100,,percent of total billed charges,,
"Hla-B27, B (Mayo)OutsideLaboratory",,86812,CPT,Facility,Both,,,90,73,62.05,20.9218,73,BlueCross BlueShield Minnesota,High Value Network Plan,65.7,90,,percent of total billed charges,,
"Hla-B27, B (Mayo)OutsideLaboratory",,86812,CPT,Facility,Outpatient,,,90,73,62.05,20.9218,73,BlueCross BlueShield Minnesota,Medicare Advantage,35.77,49,,percent of total billed charges,,
"Hla-B27, B (Mayo)OutsideLaboratory",,86812,CPT,Facility,Inpatient,,,90,73,62.05,20.9218,73,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Hla-B27, B (Mayo)OutsideLaboratory",,86812,CPT,Facility,Both,,,90,73,62.05,20.9218,73,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,64.6561,88.57,,percent of total billed charges,,
"Hla-B27, B (Mayo)OutsideLaboratory",,86812,CPT,Facility,Both,,,90,73,62.05,20.9218,73,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,20.9218,28.66,,percent of total billed charges,,
"Hla-B27, B (Mayo)OutsideLaboratory",,86812,CPT,Facility,Outpatient,,,90,73,62.05,20.9218,73,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),35.77,49,,percent of total billed charges,,
"Hla-B27, B (Mayo)OutsideLaboratory",,86812,CPT,Facility,Inpatient,,,90,73,62.05,20.9218,73,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Hla-B27, B (Mayo)OutsideLaboratory",,86812,CPT,Facility,Both,,,90,73,62.05,20.9218,73,CorVel,Worker's Compensation,73,100,,percent of total billed charges,,
"Hla-B27, B (Mayo)OutsideLaboratory",,86812,CPT,Facility,Both,,,90,73,62.05,20.9218,73,First Health Group Corporation,First Health Network,70.81,97,,percent of total billed charges,,
"Hla-B27, B (Mayo)OutsideLaboratory",,86812,CPT,Facility,Both,,,90,73,62.05,20.9218,73,"Health Partners, Inc.",Commercial,69.058,94.6,,percent of total billed charges,,
"Hla-B27, B (Mayo)OutsideLaboratory",,86812,CPT,Facility,Outpatient,,,90,73,62.05,20.9218,73,"Health Partners, Inc.",Medicare Advantage,35.77,49,,percent of total billed charges,,
"Hla-B27, B (Mayo)OutsideLaboratory",,86812,CPT,Facility,Inpatient,,,90,73,62.05,20.9218,73,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Hla-B27, B (Mayo)OutsideLaboratory",,86812,CPT,Facility,Both,,,90,73,62.05,20.9218,73,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),43.8,60,,percent of total billed charges,,
"Hla-B27, B (Mayo)OutsideLaboratory",,86812,CPT,Facility,Both,,,90,73,62.05,20.9218,73,"Health Partners, Inc.",State of Minnesota Advantage Program,59.495,81.5,,percent of total billed charges,,
"Hla-B27, B (Mayo)OutsideLaboratory",,86812,CPT,Facility,Both,,,90,73,62.05,20.9218,73,"Health Partners, Inc.",State Public Programs,36.5,50,,percent of total billed charges,,
"Hla-B27, B (Mayo)OutsideLaboratory",,86812,CPT,Facility,Both,,,90,73,62.05,20.9218,73,Humana Insurance Company,Commercial PPO,69.35,95,,percent of total billed charges,,
"Hla-B27, B (Mayo)OutsideLaboratory",,86812,CPT,Facility,Outpatient,,,90,73,62.05,20.9218,73,Humana Insurance Company,Medicare PPO,35.77,49,,percent of total billed charges,,
"Hla-B27, B (Mayo)OutsideLaboratory",,86812,CPT,Facility,Inpatient,,,90,73,62.05,20.9218,73,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Hla-B27, B (Mayo)OutsideLaboratory",,86812,CPT,Facility,Both,,,90,73,62.05,20.9218,73,Medica,Individual & Family,72.343,99.1,,percent of total billed charges,,
"Hla-B27, B (Mayo)OutsideLaboratory",,86812,CPT,Facility,Outpatient,,,90,73,62.05,20.9218,73,Medica,Medica Advantage Solution,36.354,49.8,,percent of total billed charges,,
"Hla-B27, B (Mayo)OutsideLaboratory",,86812,CPT,Facility,Inpatient,,,90,73,62.05,20.9218,73,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Hla-B27, B (Mayo)OutsideLaboratory",,86812,CPT,Facility,Outpatient,,,90,73,62.05,20.9218,73,Medica,Medical Assistance,32.558,44.6,,percent of total billed charges,,
"Hla-B27, B (Mayo)OutsideLaboratory",,86812,CPT,Facility,Inpatient,,,90,73,62.05,20.9218,73,Medica,Medical Assistance,,,,,Included in per diem rate,
"Hla-B27, B (Mayo)OutsideLaboratory",,86812,CPT,Facility,Outpatient,,,90,73,62.05,20.9218,73,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,36.354,49.8,,percent of total billed charges,,
"Hla-B27, B (Mayo)OutsideLaboratory",,86812,CPT,Facility,Inpatient,,,90,73,62.05,20.9218,73,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Hla-B27, B (Mayo)OutsideLaboratory",,86812,CPT,Facility,Both,,,90,73,62.05,20.9218,73,"Multiplan, Inc.","Multiplan, Inc.",68.62,94,,percent of total billed charges,,
"Hla-B27, B (Mayo)OutsideLaboratory",,86812,CPT,Facility,Outpatient,,,90,73,62.05,20.9218,73,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,63.072,86.4,,percent of total billed charges,,
"Hla-B27, B (Mayo)OutsideLaboratory",,86812,CPT,Facility,Inpatient,,,90,73,62.05,20.9218,73,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Hla-B27, B (Mayo)OutsideLaboratory",,86812,CPT,Facility,Both,,,90,73,62.05,20.9218,73,"Preferred One Administrative Services, INC.",PPO,71.978,98.6,,percent of total billed charges,,
"Hla-B27, B (Mayo)OutsideLaboratory",,86812,CPT,Facility,Outpatient,,,90,73,62.05,20.9218,73,PrimeWest Health,Minnesota Senior Health Options (MSHO),37.5585,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Hla-B27, B (Mayo)OutsideLaboratory",,86812,CPT,Facility,Inpatient,,,90,73,62.05,20.9218,73,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Hla-B27, B (Mayo)OutsideLaboratory",,86812,CPT,Facility,Outpatient,,,90,73,62.05,20.9218,73,PrimeWest Health,MinnesotaCare,37.4928,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Hla-B27, B (Mayo)OutsideLaboratory",,86812,CPT,Facility,Inpatient,,,90,73,62.05,20.9218,73,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Hla-B27, B (Mayo)OutsideLaboratory",,86812,CPT,Facility,Both,,,90,73,62.05,20.9218,73,Sanford Health Plan,Sanford Health Plan,67.16,92,,percent of total billed charges,,
"Hla-B27, B (Mayo)OutsideLaboratory",,86812,CPT,Facility,Outpatient,,,90,73,62.05,20.9218,73,"UCare Health, Inc.",Individual & Family Plan,41.1355,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Hla-B27, B (Mayo)OutsideLaboratory",,86812,CPT,Facility,Inpatient,,,90,73,62.05,20.9218,73,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Hla-B27, B (Mayo)OutsideLaboratory",,86812,CPT,Facility,Outpatient,,,90,73,62.05,20.9218,73,"UCare Health, Inc.",Medical Assistance,36.8431,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Hla-B27, B (Mayo)OutsideLaboratory",,86812,CPT,Facility,Inpatient,,,90,73,62.05,20.9218,73,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Hla-B27, B (Mayo)OutsideLaboratory",,86812,CPT,Facility,Outpatient,,,90,73,62.05,20.9218,73,"UCare Health, Inc.",Medicare Advantage,36.8431,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Hla-B27, B (Mayo)OutsideLaboratory",,86812,CPT,Facility,Inpatient,,,90,73,62.05,20.9218,73,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Hla-B27, B (Mayo)OutsideLaboratory",,86812,CPT,Facility,Outpatient,,,90,73,62.05,20.9218,73,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),36.8431,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Hla-B27, B (Mayo)OutsideLaboratory",,86812,CPT,Facility,Inpatient,,,90,73,62.05,20.9218,73,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Hla-B27, B (Mayo)OutsideLaboratory",,86812,CPT,Facility,Both,,,90,73,62.05,20.9218,73,UnitedHealthcare,Individual & Family,68.62,94,,percent of total billed charges,,
"Hla-B27, B (Mayo)OutsideLaboratory",,86812,CPT,Facility,Outpatient,,,90,73,62.05,20.9218,73,UnitedHealthcare,Medicare Advantage,35.77,49,,percent of total billed charges,,
"Hla-B27, B (Mayo)OutsideLaboratory",,86812,CPT,Facility,Inpatient,,,90,73,62.05,20.9218,73,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Hla-B27, B (Mayo)OutsideLaboratory",,86812,CPT,Facility,Outpatient,,,90,73,62.05,20.9218,73,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,35.04,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Hla-B27, B (Mayo)OutsideLaboratory",,86812,CPT,Facility,Inpatient,,,90,73,62.05,20.9218,73,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Arc Elution Rbc (Bb)OutsideLaboratory,,86860,CPT,Facility,Both,,,90,101,85.85,28.9466,101,Aetna,Commercial,92.92,92,,percent of total billed charges,,
Arc Elution Rbc (Bb)OutsideLaboratory,,86860,CPT,Facility,Outpatient,,,90,101,85.85,28.9466,101,Aetna,Medicare Advantage,49.49,49,,percent of total billed charges,,
Arc Elution Rbc (Bb)OutsideLaboratory,,86860,CPT,Facility,Inpatient,,,90,101,85.85,28.9466,101,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Arc Elution Rbc (Bb)OutsideLaboratory,,86860,CPT,Facility,Both,,,90,101,85.85,28.9466,101,Aetna,PPO,93.93,93,,percent of total billed charges,,
Arc Elution Rbc (Bb)OutsideLaboratory,,86860,CPT,Facility,Both,,,90,101,85.85,28.9466,101,America's PPO,America's PPO,96.9903,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Arc Elution Rbc (Bb)OutsideLaboratory,,86860,CPT,Facility,Both,,,90,101,85.85,28.9466,101,BlueCross BlueShield Minnesota, Federal Employee Program,99.384,98.4,,percent of total billed charges,,
Arc Elution Rbc (Bb)OutsideLaboratory,,86860,CPT,Facility,Both,,,90,101,85.85,28.9466,101,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,101,100,,percent of total billed charges,,
Arc Elution Rbc (Bb)OutsideLaboratory,,86860,CPT,Facility,Both,,,90,101,85.85,28.9466,101,BlueCross BlueShield Minnesota,High Value Network Plan,90.9,90,,percent of total billed charges,,
Arc Elution Rbc (Bb)OutsideLaboratory,,86860,CPT,Facility,Outpatient,,,90,101,85.85,28.9466,101,BlueCross BlueShield Minnesota,Medicare Advantage,49.49,49,,percent of total billed charges,,
Arc Elution Rbc (Bb)OutsideLaboratory,,86860,CPT,Facility,Inpatient,,,90,101,85.85,28.9466,101,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Arc Elution Rbc (Bb)OutsideLaboratory,,86860,CPT,Facility,Both,,,90,101,85.85,28.9466,101,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,89.4557,88.57,,percent of total billed charges,,
Arc Elution Rbc (Bb)OutsideLaboratory,,86860,CPT,Facility,Both,,,90,101,85.85,28.9466,101,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,28.9466,28.66,,percent of total billed charges,,
Arc Elution Rbc (Bb)OutsideLaboratory,,86860,CPT,Facility,Outpatient,,,90,101,85.85,28.9466,101,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),49.49,49,,percent of total billed charges,,
Arc Elution Rbc (Bb)OutsideLaboratory,,86860,CPT,Facility,Inpatient,,,90,101,85.85,28.9466,101,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Arc Elution Rbc (Bb)OutsideLaboratory,,86860,CPT,Facility,Both,,,90,101,85.85,28.9466,101,CorVel,Worker's Compensation,101,100,,percent of total billed charges,,
Arc Elution Rbc (Bb)OutsideLaboratory,,86860,CPT,Facility,Both,,,90,101,85.85,28.9466,101,First Health Group Corporation,First Health Network,97.97,97,,percent of total billed charges,,
Arc Elution Rbc (Bb)OutsideLaboratory,,86860,CPT,Facility,Both,,,90,101,85.85,28.9466,101,"Health Partners, Inc.",Commercial,95.546,94.6,,percent of total billed charges,,
Arc Elution Rbc (Bb)OutsideLaboratory,,86860,CPT,Facility,Outpatient,,,90,101,85.85,28.9466,101,"Health Partners, Inc.",Medicare Advantage,49.49,49,,percent of total billed charges,,
Arc Elution Rbc (Bb)OutsideLaboratory,,86860,CPT,Facility,Inpatient,,,90,101,85.85,28.9466,101,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Arc Elution Rbc (Bb)OutsideLaboratory,,86860,CPT,Facility,Both,,,90,101,85.85,28.9466,101,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),60.6,60,,percent of total billed charges,,
Arc Elution Rbc (Bb)OutsideLaboratory,,86860,CPT,Facility,Both,,,90,101,85.85,28.9466,101,"Health Partners, Inc.",State of Minnesota Advantage Program,82.315,81.5,,percent of total billed charges,,
Arc Elution Rbc (Bb)OutsideLaboratory,,86860,CPT,Facility,Both,,,90,101,85.85,28.9466,101,"Health Partners, Inc.",State Public Programs,50.5,50,,percent of total billed charges,,
Arc Elution Rbc (Bb)OutsideLaboratory,,86860,CPT,Facility,Both,,,90,101,85.85,28.9466,101,Humana Insurance Company,Commercial PPO,95.95,95,,percent of total billed charges,,
Arc Elution Rbc (Bb)OutsideLaboratory,,86860,CPT,Facility,Outpatient,,,90,101,85.85,28.9466,101,Humana Insurance Company,Medicare PPO,49.49,49,,percent of total billed charges,,
Arc Elution Rbc (Bb)OutsideLaboratory,,86860,CPT,Facility,Inpatient,,,90,101,85.85,28.9466,101,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Arc Elution Rbc (Bb)OutsideLaboratory,,86860,CPT,Facility,Both,,,90,101,85.85,28.9466,101,Medica,Individual & Family,100.091,99.1,,percent of total billed charges,,
Arc Elution Rbc (Bb)OutsideLaboratory,,86860,CPT,Facility,Outpatient,,,90,101,85.85,28.9466,101,Medica,Medica Advantage Solution,50.298,49.8,,percent of total billed charges,,
Arc Elution Rbc (Bb)OutsideLaboratory,,86860,CPT,Facility,Inpatient,,,90,101,85.85,28.9466,101,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Arc Elution Rbc (Bb)OutsideLaboratory,,86860,CPT,Facility,Outpatient,,,90,101,85.85,28.9466,101,Medica,Medical Assistance,45.046,44.6,,percent of total billed charges,,
Arc Elution Rbc (Bb)OutsideLaboratory,,86860,CPT,Facility,Inpatient,,,90,101,85.85,28.9466,101,Medica,Medical Assistance,,,,,Included in per diem rate,
Arc Elution Rbc (Bb)OutsideLaboratory,,86860,CPT,Facility,Outpatient,,,90,101,85.85,28.9466,101,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,50.298,49.8,,percent of total billed charges,,
Arc Elution Rbc (Bb)OutsideLaboratory,,86860,CPT,Facility,Inpatient,,,90,101,85.85,28.9466,101,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Arc Elution Rbc (Bb)OutsideLaboratory,,86860,CPT,Facility,Both,,,90,101,85.85,28.9466,101,"Multiplan, Inc.","Multiplan, Inc.",94.94,94,,percent of total billed charges,,
Arc Elution Rbc (Bb)OutsideLaboratory,,86860,CPT,Facility,Outpatient,,,90,101,85.85,28.9466,101,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,87.264,86.4,,percent of total billed charges,,
Arc Elution Rbc (Bb)OutsideLaboratory,,86860,CPT,Facility,Inpatient,,,90,101,85.85,28.9466,101,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Arc Elution Rbc (Bb)OutsideLaboratory,,86860,CPT,Facility,Both,,,90,101,85.85,28.9466,101,"Preferred One Administrative Services, INC.",PPO,99.586,98.6,,percent of total billed charges,,
Arc Elution Rbc (Bb)OutsideLaboratory,,86860,CPT,Facility,Outpatient,,,90,101,85.85,28.9466,101,PrimeWest Health,Minnesota Senior Health Options (MSHO),51.9645,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Arc Elution Rbc (Bb)OutsideLaboratory,,86860,CPT,Facility,Inpatient,,,90,101,85.85,28.9466,101,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Arc Elution Rbc (Bb)OutsideLaboratory,,86860,CPT,Facility,Outpatient,,,90,101,85.85,28.9466,101,PrimeWest Health,MinnesotaCare,51.8736,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Arc Elution Rbc (Bb)OutsideLaboratory,,86860,CPT,Facility,Inpatient,,,90,101,85.85,28.9466,101,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Arc Elution Rbc (Bb)OutsideLaboratory,,86860,CPT,Facility,Both,,,90,101,85.85,28.9466,101,Sanford Health Plan,Sanford Health Plan,92.92,92,,percent of total billed charges,,
Arc Elution Rbc (Bb)OutsideLaboratory,,86860,CPT,Facility,Outpatient,,,90,101,85.85,28.9466,101,"UCare Health, Inc.",Individual & Family Plan,56.9135,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Arc Elution Rbc (Bb)OutsideLaboratory,,86860,CPT,Facility,Inpatient,,,90,101,85.85,28.9466,101,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Arc Elution Rbc (Bb)OutsideLaboratory,,86860,CPT,Facility,Outpatient,,,90,101,85.85,28.9466,101,"UCare Health, Inc.",Medical Assistance,50.9747,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Arc Elution Rbc (Bb)OutsideLaboratory,,86860,CPT,Facility,Inpatient,,,90,101,85.85,28.9466,101,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Arc Elution Rbc (Bb)OutsideLaboratory,,86860,CPT,Facility,Outpatient,,,90,101,85.85,28.9466,101,"UCare Health, Inc.",Medicare Advantage,50.9747,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Arc Elution Rbc (Bb)OutsideLaboratory,,86860,CPT,Facility,Inpatient,,,90,101,85.85,28.9466,101,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Arc Elution Rbc (Bb)OutsideLaboratory,,86860,CPT,Facility,Outpatient,,,90,101,85.85,28.9466,101,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),50.9747,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Arc Elution Rbc (Bb)OutsideLaboratory,,86860,CPT,Facility,Inpatient,,,90,101,85.85,28.9466,101,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Arc Elution Rbc (Bb)OutsideLaboratory,,86860,CPT,Facility,Both,,,90,101,85.85,28.9466,101,UnitedHealthcare,Individual & Family,94.94,94,,percent of total billed charges,,
Arc Elution Rbc (Bb)OutsideLaboratory,,86860,CPT,Facility,Outpatient,,,90,101,85.85,28.9466,101,UnitedHealthcare,Medicare Advantage,49.49,49,,percent of total billed charges,,
Arc Elution Rbc (Bb)OutsideLaboratory,,86860,CPT,Facility,Inpatient,,,90,101,85.85,28.9466,101,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Arc Elution Rbc (Bb)OutsideLaboratory,,86860,CPT,Facility,Outpatient,,,90,101,85.85,28.9466,101,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,48.48,48,,percent of total billed charges,,100% of DHS outpatient percentage
Arc Elution Rbc (Bb)OutsideLaboratory,,86860,CPT,Facility,Inpatient,,,90,101,85.85,28.9466,101,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Arc  Antigen Screening For Compatible Unit ,Each Unit (Bb)OutsideLaboratory",,86904,CPT,Facility,Both,,,90,153,130.05,43.8498,153,Aetna,Commercial,140.76,92,,percent of total billed charges,,
"Arc  Antigen Screening For Compatible Unit ,Each Unit (Bb)OutsideLaboratory",,86904,CPT,Facility,Outpatient,,,90,153,130.05,43.8498,153,Aetna,Medicare Advantage,74.97,49,,percent of total billed charges,,
"Arc  Antigen Screening For Compatible Unit ,Each Unit (Bb)OutsideLaboratory",,86904,CPT,Facility,Inpatient,,,90,153,130.05,43.8498,153,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Arc  Antigen Screening For Compatible Unit ,Each Unit (Bb)OutsideLaboratory",,86904,CPT,Facility,Both,,,90,153,130.05,43.8498,153,Aetna,PPO,142.29,93,,percent of total billed charges,,
"Arc  Antigen Screening For Compatible Unit ,Each Unit (Bb)OutsideLaboratory",,86904,CPT,Facility,Both,,,90,153,130.05,43.8498,153,America's PPO,America's PPO,146.9259,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Arc  Antigen Screening For Compatible Unit ,Each Unit (Bb)OutsideLaboratory",,86904,CPT,Facility,Both,,,90,153,130.05,43.8498,153,BlueCross BlueShield Minnesota, Federal Employee Program,150.552,98.4,,percent of total billed charges,,
"Arc  Antigen Screening For Compatible Unit ,Each Unit (Bb)OutsideLaboratory",,86904,CPT,Facility,Both,,,90,153,130.05,43.8498,153,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,153,100,,percent of total billed charges,,
"Arc  Antigen Screening For Compatible Unit ,Each Unit (Bb)OutsideLaboratory",,86904,CPT,Facility,Both,,,90,153,130.05,43.8498,153,BlueCross BlueShield Minnesota,High Value Network Plan,137.7,90,,percent of total billed charges,,
"Arc  Antigen Screening For Compatible Unit ,Each Unit (Bb)OutsideLaboratory",,86904,CPT,Facility,Outpatient,,,90,153,130.05,43.8498,153,BlueCross BlueShield Minnesota,Medicare Advantage,74.97,49,,percent of total billed charges,,
"Arc  Antigen Screening For Compatible Unit ,Each Unit (Bb)OutsideLaboratory",,86904,CPT,Facility,Inpatient,,,90,153,130.05,43.8498,153,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Arc  Antigen Screening For Compatible Unit ,Each Unit (Bb)OutsideLaboratory",,86904,CPT,Facility,Both,,,90,153,130.05,43.8498,153,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,135.5121,88.57,,percent of total billed charges,,
"Arc  Antigen Screening For Compatible Unit ,Each Unit (Bb)OutsideLaboratory",,86904,CPT,Facility,Both,,,90,153,130.05,43.8498,153,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,43.8498,28.66,,percent of total billed charges,,
"Arc  Antigen Screening For Compatible Unit ,Each Unit (Bb)OutsideLaboratory",,86904,CPT,Facility,Outpatient,,,90,153,130.05,43.8498,153,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),74.97,49,,percent of total billed charges,,
"Arc  Antigen Screening For Compatible Unit ,Each Unit (Bb)OutsideLaboratory",,86904,CPT,Facility,Inpatient,,,90,153,130.05,43.8498,153,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Arc  Antigen Screening For Compatible Unit ,Each Unit (Bb)OutsideLaboratory",,86904,CPT,Facility,Both,,,90,153,130.05,43.8498,153,CorVel,Worker's Compensation,153,100,,percent of total billed charges,,
"Arc  Antigen Screening For Compatible Unit ,Each Unit (Bb)OutsideLaboratory",,86904,CPT,Facility,Both,,,90,153,130.05,43.8498,153,First Health Group Corporation,First Health Network,148.41,97,,percent of total billed charges,,
"Arc  Antigen Screening For Compatible Unit ,Each Unit (Bb)OutsideLaboratory",,86904,CPT,Facility,Both,,,90,153,130.05,43.8498,153,"Health Partners, Inc.",Commercial,144.738,94.6,,percent of total billed charges,,
"Arc  Antigen Screening For Compatible Unit ,Each Unit (Bb)OutsideLaboratory",,86904,CPT,Facility,Outpatient,,,90,153,130.05,43.8498,153,"Health Partners, Inc.",Medicare Advantage,74.97,49,,percent of total billed charges,,
"Arc  Antigen Screening For Compatible Unit ,Each Unit (Bb)OutsideLaboratory",,86904,CPT,Facility,Inpatient,,,90,153,130.05,43.8498,153,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Arc  Antigen Screening For Compatible Unit ,Each Unit (Bb)OutsideLaboratory",,86904,CPT,Facility,Both,,,90,153,130.05,43.8498,153,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),91.8,60,,percent of total billed charges,,
"Arc  Antigen Screening For Compatible Unit ,Each Unit (Bb)OutsideLaboratory",,86904,CPT,Facility,Both,,,90,153,130.05,43.8498,153,"Health Partners, Inc.",State of Minnesota Advantage Program,124.695,81.5,,percent of total billed charges,,
"Arc  Antigen Screening For Compatible Unit ,Each Unit (Bb)OutsideLaboratory",,86904,CPT,Facility,Both,,,90,153,130.05,43.8498,153,"Health Partners, Inc.",State Public Programs,76.5,50,,percent of total billed charges,,
"Arc  Antigen Screening For Compatible Unit ,Each Unit (Bb)OutsideLaboratory",,86904,CPT,Facility,Both,,,90,153,130.05,43.8498,153,Humana Insurance Company,Commercial PPO,145.35,95,,percent of total billed charges,,
"Arc  Antigen Screening For Compatible Unit ,Each Unit (Bb)OutsideLaboratory",,86904,CPT,Facility,Outpatient,,,90,153,130.05,43.8498,153,Humana Insurance Company,Medicare PPO,74.97,49,,percent of total billed charges,,
"Arc  Antigen Screening For Compatible Unit ,Each Unit (Bb)OutsideLaboratory",,86904,CPT,Facility,Inpatient,,,90,153,130.05,43.8498,153,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Arc  Antigen Screening For Compatible Unit ,Each Unit (Bb)OutsideLaboratory",,86904,CPT,Facility,Both,,,90,153,130.05,43.8498,153,Medica,Individual & Family,151.623,99.1,,percent of total billed charges,,
"Arc  Antigen Screening For Compatible Unit ,Each Unit (Bb)OutsideLaboratory",,86904,CPT,Facility,Outpatient,,,90,153,130.05,43.8498,153,Medica,Medica Advantage Solution,76.194,49.8,,percent of total billed charges,,
"Arc  Antigen Screening For Compatible Unit ,Each Unit (Bb)OutsideLaboratory",,86904,CPT,Facility,Inpatient,,,90,153,130.05,43.8498,153,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Arc  Antigen Screening For Compatible Unit ,Each Unit (Bb)OutsideLaboratory",,86904,CPT,Facility,Outpatient,,,90,153,130.05,43.8498,153,Medica,Medical Assistance,68.238,44.6,,percent of total billed charges,,
"Arc  Antigen Screening For Compatible Unit ,Each Unit (Bb)OutsideLaboratory",,86904,CPT,Facility,Inpatient,,,90,153,130.05,43.8498,153,Medica,Medical Assistance,,,,,Included in per diem rate,
"Arc  Antigen Screening For Compatible Unit ,Each Unit (Bb)OutsideLaboratory",,86904,CPT,Facility,Outpatient,,,90,153,130.05,43.8498,153,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,76.194,49.8,,percent of total billed charges,,
"Arc  Antigen Screening For Compatible Unit ,Each Unit (Bb)OutsideLaboratory",,86904,CPT,Facility,Inpatient,,,90,153,130.05,43.8498,153,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Arc  Antigen Screening For Compatible Unit ,Each Unit (Bb)OutsideLaboratory",,86904,CPT,Facility,Both,,,90,153,130.05,43.8498,153,"Multiplan, Inc.","Multiplan, Inc.",143.82,94,,percent of total billed charges,,
"Arc  Antigen Screening For Compatible Unit ,Each Unit (Bb)OutsideLaboratory",,86904,CPT,Facility,Outpatient,,,90,153,130.05,43.8498,153,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,132.192,86.4,,percent of total billed charges,,
"Arc  Antigen Screening For Compatible Unit ,Each Unit (Bb)OutsideLaboratory",,86904,CPT,Facility,Inpatient,,,90,153,130.05,43.8498,153,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Arc  Antigen Screening For Compatible Unit ,Each Unit (Bb)OutsideLaboratory",,86904,CPT,Facility,Both,,,90,153,130.05,43.8498,153,"Preferred One Administrative Services, INC.",PPO,150.858,98.6,,percent of total billed charges,,
"Arc  Antigen Screening For Compatible Unit ,Each Unit (Bb)OutsideLaboratory",,86904,CPT,Facility,Outpatient,,,90,153,130.05,43.8498,153,PrimeWest Health,Minnesota Senior Health Options (MSHO),78.7185,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Arc  Antigen Screening For Compatible Unit ,Each Unit (Bb)OutsideLaboratory",,86904,CPT,Facility,Inpatient,,,90,153,130.05,43.8498,153,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Arc  Antigen Screening For Compatible Unit ,Each Unit (Bb)OutsideLaboratory",,86904,CPT,Facility,Outpatient,,,90,153,130.05,43.8498,153,PrimeWest Health,MinnesotaCare,78.5808,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Arc  Antigen Screening For Compatible Unit ,Each Unit (Bb)OutsideLaboratory",,86904,CPT,Facility,Inpatient,,,90,153,130.05,43.8498,153,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Arc  Antigen Screening For Compatible Unit ,Each Unit (Bb)OutsideLaboratory",,86904,CPT,Facility,Both,,,90,153,130.05,43.8498,153,Sanford Health Plan,Sanford Health Plan,140.76,92,,percent of total billed charges,,
"Arc  Antigen Screening For Compatible Unit ,Each Unit (Bb)OutsideLaboratory",,86904,CPT,Facility,Outpatient,,,90,153,130.05,43.8498,153,"UCare Health, Inc.",Individual & Family Plan,86.2155,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Arc  Antigen Screening For Compatible Unit ,Each Unit (Bb)OutsideLaboratory",,86904,CPT,Facility,Inpatient,,,90,153,130.05,43.8498,153,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Arc  Antigen Screening For Compatible Unit ,Each Unit (Bb)OutsideLaboratory",,86904,CPT,Facility,Outpatient,,,90,153,130.05,43.8498,153,"UCare Health, Inc.",Medical Assistance,77.2191,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Arc  Antigen Screening For Compatible Unit ,Each Unit (Bb)OutsideLaboratory",,86904,CPT,Facility,Inpatient,,,90,153,130.05,43.8498,153,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Arc  Antigen Screening For Compatible Unit ,Each Unit (Bb)OutsideLaboratory",,86904,CPT,Facility,Outpatient,,,90,153,130.05,43.8498,153,"UCare Health, Inc.",Medicare Advantage,77.2191,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Arc  Antigen Screening For Compatible Unit ,Each Unit (Bb)OutsideLaboratory",,86904,CPT,Facility,Inpatient,,,90,153,130.05,43.8498,153,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Arc  Antigen Screening For Compatible Unit ,Each Unit (Bb)OutsideLaboratory",,86904,CPT,Facility,Outpatient,,,90,153,130.05,43.8498,153,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),77.2191,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Arc  Antigen Screening For Compatible Unit ,Each Unit (Bb)OutsideLaboratory",,86904,CPT,Facility,Inpatient,,,90,153,130.05,43.8498,153,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Arc  Antigen Screening For Compatible Unit ,Each Unit (Bb)OutsideLaboratory",,86904,CPT,Facility,Both,,,90,153,130.05,43.8498,153,UnitedHealthcare,Individual & Family,143.82,94,,percent of total billed charges,,
"Arc  Antigen Screening For Compatible Unit ,Each Unit (Bb)OutsideLaboratory",,86904,CPT,Facility,Outpatient,,,90,153,130.05,43.8498,153,UnitedHealthcare,Medicare Advantage,74.97,49,,percent of total billed charges,,
"Arc  Antigen Screening For Compatible Unit ,Each Unit (Bb)OutsideLaboratory",,86904,CPT,Facility,Inpatient,,,90,153,130.05,43.8498,153,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Arc  Antigen Screening For Compatible Unit ,Each Unit (Bb)OutsideLaboratory",,86904,CPT,Facility,Outpatient,,,90,153,130.05,43.8498,153,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,73.44,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Arc  Antigen Screening For Compatible Unit ,Each Unit (Bb)OutsideLaboratory",,86904,CPT,Facility,Inpatient,,,90,153,130.05,43.8498,153,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Arc Pre-Rx Rbcs With Chemical/Drugs Per Cell (Bb)OutsideLaboratory,,86970,CPT,Facility,Both,,,90,100,85,28.66,100,Aetna,Commercial,92,92,,percent of total billed charges,,
Arc Pre-Rx Rbcs With Chemical/Drugs Per Cell (Bb)OutsideLaboratory,,86970,CPT,Facility,Outpatient,,,90,100,85,28.66,100,Aetna,Medicare Advantage,49,49,,percent of total billed charges,,
Arc Pre-Rx Rbcs With Chemical/Drugs Per Cell (Bb)OutsideLaboratory,,86970,CPT,Facility,Inpatient,,,90,100,85,28.66,100,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Arc Pre-Rx Rbcs With Chemical/Drugs Per Cell (Bb)OutsideLaboratory,,86970,CPT,Facility,Both,,,90,100,85,28.66,100,Aetna,PPO,93,93,,percent of total billed charges,,
Arc Pre-Rx Rbcs With Chemical/Drugs Per Cell (Bb)OutsideLaboratory,,86970,CPT,Facility,Both,,,90,100,85,28.66,100,America's PPO,America's PPO,96.03,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Arc Pre-Rx Rbcs With Chemical/Drugs Per Cell (Bb)OutsideLaboratory,,86970,CPT,Facility,Both,,,90,100,85,28.66,100,BlueCross BlueShield Minnesota, Federal Employee Program,98.4,98.4,,percent of total billed charges,,
Arc Pre-Rx Rbcs With Chemical/Drugs Per Cell (Bb)OutsideLaboratory,,86970,CPT,Facility,Both,,,90,100,85,28.66,100,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,100,100,,percent of total billed charges,,
Arc Pre-Rx Rbcs With Chemical/Drugs Per Cell (Bb)OutsideLaboratory,,86970,CPT,Facility,Both,,,90,100,85,28.66,100,BlueCross BlueShield Minnesota,High Value Network Plan,90,90,,percent of total billed charges,,
Arc Pre-Rx Rbcs With Chemical/Drugs Per Cell (Bb)OutsideLaboratory,,86970,CPT,Facility,Outpatient,,,90,100,85,28.66,100,BlueCross BlueShield Minnesota,Medicare Advantage,49,49,,percent of total billed charges,,
Arc Pre-Rx Rbcs With Chemical/Drugs Per Cell (Bb)OutsideLaboratory,,86970,CPT,Facility,Inpatient,,,90,100,85,28.66,100,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Arc Pre-Rx Rbcs With Chemical/Drugs Per Cell (Bb)OutsideLaboratory,,86970,CPT,Facility,Both,,,90,100,85,28.66,100,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,88.57,88.57,,percent of total billed charges,,
Arc Pre-Rx Rbcs With Chemical/Drugs Per Cell (Bb)OutsideLaboratory,,86970,CPT,Facility,Both,,,90,100,85,28.66,100,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,28.66,28.66,,percent of total billed charges,,
Arc Pre-Rx Rbcs With Chemical/Drugs Per Cell (Bb)OutsideLaboratory,,86970,CPT,Facility,Outpatient,,,90,100,85,28.66,100,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),49,49,,percent of total billed charges,,
Arc Pre-Rx Rbcs With Chemical/Drugs Per Cell (Bb)OutsideLaboratory,,86970,CPT,Facility,Inpatient,,,90,100,85,28.66,100,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Arc Pre-Rx Rbcs With Chemical/Drugs Per Cell (Bb)OutsideLaboratory,,86970,CPT,Facility,Both,,,90,100,85,28.66,100,CorVel,Worker's Compensation,100,100,,percent of total billed charges,,
Arc Pre-Rx Rbcs With Chemical/Drugs Per Cell (Bb)OutsideLaboratory,,86970,CPT,Facility,Both,,,90,100,85,28.66,100,First Health Group Corporation,First Health Network,97,97,,percent of total billed charges,,
Arc Pre-Rx Rbcs With Chemical/Drugs Per Cell (Bb)OutsideLaboratory,,86970,CPT,Facility,Both,,,90,100,85,28.66,100,"Health Partners, Inc.",Commercial,94.6,94.6,,percent of total billed charges,,
Arc Pre-Rx Rbcs With Chemical/Drugs Per Cell (Bb)OutsideLaboratory,,86970,CPT,Facility,Outpatient,,,90,100,85,28.66,100,"Health Partners, Inc.",Medicare Advantage,49,49,,percent of total billed charges,,
Arc Pre-Rx Rbcs With Chemical/Drugs Per Cell (Bb)OutsideLaboratory,,86970,CPT,Facility,Inpatient,,,90,100,85,28.66,100,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Arc Pre-Rx Rbcs With Chemical/Drugs Per Cell (Bb)OutsideLaboratory,,86970,CPT,Facility,Both,,,90,100,85,28.66,100,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),60,60,,percent of total billed charges,,
Arc Pre-Rx Rbcs With Chemical/Drugs Per Cell (Bb)OutsideLaboratory,,86970,CPT,Facility,Both,,,90,100,85,28.66,100,"Health Partners, Inc.",State of Minnesota Advantage Program,81.5,81.5,,percent of total billed charges,,
Arc Pre-Rx Rbcs With Chemical/Drugs Per Cell (Bb)OutsideLaboratory,,86970,CPT,Facility,Both,,,90,100,85,28.66,100,"Health Partners, Inc.",State Public Programs,50,50,,percent of total billed charges,,
Arc Pre-Rx Rbcs With Chemical/Drugs Per Cell (Bb)OutsideLaboratory,,86970,CPT,Facility,Both,,,90,100,85,28.66,100,Humana Insurance Company,Commercial PPO,95,95,,percent of total billed charges,,
Arc Pre-Rx Rbcs With Chemical/Drugs Per Cell (Bb)OutsideLaboratory,,86970,CPT,Facility,Outpatient,,,90,100,85,28.66,100,Humana Insurance Company,Medicare PPO,49,49,,percent of total billed charges,,
Arc Pre-Rx Rbcs With Chemical/Drugs Per Cell (Bb)OutsideLaboratory,,86970,CPT,Facility,Inpatient,,,90,100,85,28.66,100,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Arc Pre-Rx Rbcs With Chemical/Drugs Per Cell (Bb)OutsideLaboratory,,86970,CPT,Facility,Both,,,90,100,85,28.66,100,Medica,Individual & Family,99.1,99.1,,percent of total billed charges,,
Arc Pre-Rx Rbcs With Chemical/Drugs Per Cell (Bb)OutsideLaboratory,,86970,CPT,Facility,Outpatient,,,90,100,85,28.66,100,Medica,Medica Advantage Solution,49.8,49.8,,percent of total billed charges,,
Arc Pre-Rx Rbcs With Chemical/Drugs Per Cell (Bb)OutsideLaboratory,,86970,CPT,Facility,Inpatient,,,90,100,85,28.66,100,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Arc Pre-Rx Rbcs With Chemical/Drugs Per Cell (Bb)OutsideLaboratory,,86970,CPT,Facility,Outpatient,,,90,100,85,28.66,100,Medica,Medical Assistance,44.6,44.6,,percent of total billed charges,,
Arc Pre-Rx Rbcs With Chemical/Drugs Per Cell (Bb)OutsideLaboratory,,86970,CPT,Facility,Inpatient,,,90,100,85,28.66,100,Medica,Medical Assistance,,,,,Included in per diem rate,
Arc Pre-Rx Rbcs With Chemical/Drugs Per Cell (Bb)OutsideLaboratory,,86970,CPT,Facility,Outpatient,,,90,100,85,28.66,100,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,49.8,49.8,,percent of total billed charges,,
Arc Pre-Rx Rbcs With Chemical/Drugs Per Cell (Bb)OutsideLaboratory,,86970,CPT,Facility,Inpatient,,,90,100,85,28.66,100,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Arc Pre-Rx Rbcs With Chemical/Drugs Per Cell (Bb)OutsideLaboratory,,86970,CPT,Facility,Both,,,90,100,85,28.66,100,"Multiplan, Inc.","Multiplan, Inc.",94,94,,percent of total billed charges,,
Arc Pre-Rx Rbcs With Chemical/Drugs Per Cell (Bb)OutsideLaboratory,,86970,CPT,Facility,Outpatient,,,90,100,85,28.66,100,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,86.4,86.4,,percent of total billed charges,,
Arc Pre-Rx Rbcs With Chemical/Drugs Per Cell (Bb)OutsideLaboratory,,86970,CPT,Facility,Inpatient,,,90,100,85,28.66,100,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Arc Pre-Rx Rbcs With Chemical/Drugs Per Cell (Bb)OutsideLaboratory,,86970,CPT,Facility,Both,,,90,100,85,28.66,100,"Preferred One Administrative Services, INC.",PPO,98.6,98.6,,percent of total billed charges,,
Arc Pre-Rx Rbcs With Chemical/Drugs Per Cell (Bb)OutsideLaboratory,,86970,CPT,Facility,Outpatient,,,90,100,85,28.66,100,PrimeWest Health,Minnesota Senior Health Options (MSHO),51.45,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Arc Pre-Rx Rbcs With Chemical/Drugs Per Cell (Bb)OutsideLaboratory,,86970,CPT,Facility,Inpatient,,,90,100,85,28.66,100,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Arc Pre-Rx Rbcs With Chemical/Drugs Per Cell (Bb)OutsideLaboratory,,86970,CPT,Facility,Outpatient,,,90,100,85,28.66,100,PrimeWest Health,MinnesotaCare,51.36,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Arc Pre-Rx Rbcs With Chemical/Drugs Per Cell (Bb)OutsideLaboratory,,86970,CPT,Facility,Inpatient,,,90,100,85,28.66,100,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Arc Pre-Rx Rbcs With Chemical/Drugs Per Cell (Bb)OutsideLaboratory,,86970,CPT,Facility,Both,,,90,100,85,28.66,100,Sanford Health Plan,Sanford Health Plan,92,92,,percent of total billed charges,,
Arc Pre-Rx Rbcs With Chemical/Drugs Per Cell (Bb)OutsideLaboratory,,86970,CPT,Facility,Outpatient,,,90,100,85,28.66,100,"UCare Health, Inc.",Individual & Family Plan,56.35,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Arc Pre-Rx Rbcs With Chemical/Drugs Per Cell (Bb)OutsideLaboratory,,86970,CPT,Facility,Inpatient,,,90,100,85,28.66,100,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Arc Pre-Rx Rbcs With Chemical/Drugs Per Cell (Bb)OutsideLaboratory,,86970,CPT,Facility,Outpatient,,,90,100,85,28.66,100,"UCare Health, Inc.",Medical Assistance,50.47,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Arc Pre-Rx Rbcs With Chemical/Drugs Per Cell (Bb)OutsideLaboratory,,86970,CPT,Facility,Inpatient,,,90,100,85,28.66,100,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Arc Pre-Rx Rbcs With Chemical/Drugs Per Cell (Bb)OutsideLaboratory,,86970,CPT,Facility,Outpatient,,,90,100,85,28.66,100,"UCare Health, Inc.",Medicare Advantage,50.47,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Arc Pre-Rx Rbcs With Chemical/Drugs Per Cell (Bb)OutsideLaboratory,,86970,CPT,Facility,Inpatient,,,90,100,85,28.66,100,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Arc Pre-Rx Rbcs With Chemical/Drugs Per Cell (Bb)OutsideLaboratory,,86970,CPT,Facility,Outpatient,,,90,100,85,28.66,100,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),50.47,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Arc Pre-Rx Rbcs With Chemical/Drugs Per Cell (Bb)OutsideLaboratory,,86970,CPT,Facility,Inpatient,,,90,100,85,28.66,100,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Arc Pre-Rx Rbcs With Chemical/Drugs Per Cell (Bb)OutsideLaboratory,,86970,CPT,Facility,Both,,,90,100,85,28.66,100,UnitedHealthcare,Individual & Family,94,94,,percent of total billed charges,,
Arc Pre-Rx Rbcs With Chemical/Drugs Per Cell (Bb)OutsideLaboratory,,86970,CPT,Facility,Outpatient,,,90,100,85,28.66,100,UnitedHealthcare,Medicare Advantage,49,49,,percent of total billed charges,,
Arc Pre-Rx Rbcs With Chemical/Drugs Per Cell (Bb)OutsideLaboratory,,86970,CPT,Facility,Inpatient,,,90,100,85,28.66,100,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Arc Pre-Rx Rbcs With Chemical/Drugs Per Cell (Bb)OutsideLaboratory,,86970,CPT,Facility,Outpatient,,,90,100,85,28.66,100,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,48,48,,percent of total billed charges,,100% of DHS outpatient percentage
Arc Pre-Rx Rbcs With Chemical/Drugs Per Cell (Bb)OutsideLaboratory,,86970,CPT,Facility,Inpatient,,,90,100,85,28.66,100,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Arc Differential/Auto Ads Of Serum/Per Unit (Bb)OutsideLaboratory,,86978,CPT,Facility,Both,,,90,97,82.45,27.8002,97,Aetna,Commercial,89.24,92,,percent of total billed charges,,
Arc Differential/Auto Ads Of Serum/Per Unit (Bb)OutsideLaboratory,,86978,CPT,Facility,Outpatient,,,90,97,82.45,27.8002,97,Aetna,Medicare Advantage,47.53,49,,percent of total billed charges,,
Arc Differential/Auto Ads Of Serum/Per Unit (Bb)OutsideLaboratory,,86978,CPT,Facility,Inpatient,,,90,97,82.45,27.8002,97,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Arc Differential/Auto Ads Of Serum/Per Unit (Bb)OutsideLaboratory,,86978,CPT,Facility,Both,,,90,97,82.45,27.8002,97,Aetna,PPO,90.21,93,,percent of total billed charges,,
Arc Differential/Auto Ads Of Serum/Per Unit (Bb)OutsideLaboratory,,86978,CPT,Facility,Both,,,90,97,82.45,27.8002,97,America's PPO,America's PPO,93.1491,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Arc Differential/Auto Ads Of Serum/Per Unit (Bb)OutsideLaboratory,,86978,CPT,Facility,Both,,,90,97,82.45,27.8002,97,BlueCross BlueShield Minnesota, Federal Employee Program,95.448,98.4,,percent of total billed charges,,
Arc Differential/Auto Ads Of Serum/Per Unit (Bb)OutsideLaboratory,,86978,CPT,Facility,Both,,,90,97,82.45,27.8002,97,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,97,100,,percent of total billed charges,,
Arc Differential/Auto Ads Of Serum/Per Unit (Bb)OutsideLaboratory,,86978,CPT,Facility,Both,,,90,97,82.45,27.8002,97,BlueCross BlueShield Minnesota,High Value Network Plan,87.3,90,,percent of total billed charges,,
Arc Differential/Auto Ads Of Serum/Per Unit (Bb)OutsideLaboratory,,86978,CPT,Facility,Outpatient,,,90,97,82.45,27.8002,97,BlueCross BlueShield Minnesota,Medicare Advantage,47.53,49,,percent of total billed charges,,
Arc Differential/Auto Ads Of Serum/Per Unit (Bb)OutsideLaboratory,,86978,CPT,Facility,Inpatient,,,90,97,82.45,27.8002,97,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Arc Differential/Auto Ads Of Serum/Per Unit (Bb)OutsideLaboratory,,86978,CPT,Facility,Both,,,90,97,82.45,27.8002,97,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,85.9129,88.57,,percent of total billed charges,,
Arc Differential/Auto Ads Of Serum/Per Unit (Bb)OutsideLaboratory,,86978,CPT,Facility,Both,,,90,97,82.45,27.8002,97,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,27.8002,28.66,,percent of total billed charges,,
Arc Differential/Auto Ads Of Serum/Per Unit (Bb)OutsideLaboratory,,86978,CPT,Facility,Outpatient,,,90,97,82.45,27.8002,97,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),47.53,49,,percent of total billed charges,,
Arc Differential/Auto Ads Of Serum/Per Unit (Bb)OutsideLaboratory,,86978,CPT,Facility,Inpatient,,,90,97,82.45,27.8002,97,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Arc Differential/Auto Ads Of Serum/Per Unit (Bb)OutsideLaboratory,,86978,CPT,Facility,Both,,,90,97,82.45,27.8002,97,CorVel,Worker's Compensation,97,100,,percent of total billed charges,,
Arc Differential/Auto Ads Of Serum/Per Unit (Bb)OutsideLaboratory,,86978,CPT,Facility,Both,,,90,97,82.45,27.8002,97,First Health Group Corporation,First Health Network,94.09,97,,percent of total billed charges,,
Arc Differential/Auto Ads Of Serum/Per Unit (Bb)OutsideLaboratory,,86978,CPT,Facility,Both,,,90,97,82.45,27.8002,97,"Health Partners, Inc.",Commercial,91.762,94.6,,percent of total billed charges,,
Arc Differential/Auto Ads Of Serum/Per Unit (Bb)OutsideLaboratory,,86978,CPT,Facility,Outpatient,,,90,97,82.45,27.8002,97,"Health Partners, Inc.",Medicare Advantage,47.53,49,,percent of total billed charges,,
Arc Differential/Auto Ads Of Serum/Per Unit (Bb)OutsideLaboratory,,86978,CPT,Facility,Inpatient,,,90,97,82.45,27.8002,97,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Arc Differential/Auto Ads Of Serum/Per Unit (Bb)OutsideLaboratory,,86978,CPT,Facility,Both,,,90,97,82.45,27.8002,97,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),58.2,60,,percent of total billed charges,,
Arc Differential/Auto Ads Of Serum/Per Unit (Bb)OutsideLaboratory,,86978,CPT,Facility,Both,,,90,97,82.45,27.8002,97,"Health Partners, Inc.",State of Minnesota Advantage Program,79.055,81.5,,percent of total billed charges,,
Arc Differential/Auto Ads Of Serum/Per Unit (Bb)OutsideLaboratory,,86978,CPT,Facility,Both,,,90,97,82.45,27.8002,97,"Health Partners, Inc.",State Public Programs,48.5,50,,percent of total billed charges,,
Arc Differential/Auto Ads Of Serum/Per Unit (Bb)OutsideLaboratory,,86978,CPT,Facility,Both,,,90,97,82.45,27.8002,97,Humana Insurance Company,Commercial PPO,92.15,95,,percent of total billed charges,,
Arc Differential/Auto Ads Of Serum/Per Unit (Bb)OutsideLaboratory,,86978,CPT,Facility,Outpatient,,,90,97,82.45,27.8002,97,Humana Insurance Company,Medicare PPO,47.53,49,,percent of total billed charges,,
Arc Differential/Auto Ads Of Serum/Per Unit (Bb)OutsideLaboratory,,86978,CPT,Facility,Inpatient,,,90,97,82.45,27.8002,97,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Arc Differential/Auto Ads Of Serum/Per Unit (Bb)OutsideLaboratory,,86978,CPT,Facility,Both,,,90,97,82.45,27.8002,97,Medica,Individual & Family,96.127,99.1,,percent of total billed charges,,
Arc Differential/Auto Ads Of Serum/Per Unit (Bb)OutsideLaboratory,,86978,CPT,Facility,Outpatient,,,90,97,82.45,27.8002,97,Medica,Medica Advantage Solution,48.306,49.8,,percent of total billed charges,,
Arc Differential/Auto Ads Of Serum/Per Unit (Bb)OutsideLaboratory,,86978,CPT,Facility,Inpatient,,,90,97,82.45,27.8002,97,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Arc Differential/Auto Ads Of Serum/Per Unit (Bb)OutsideLaboratory,,86978,CPT,Facility,Outpatient,,,90,97,82.45,27.8002,97,Medica,Medical Assistance,43.262,44.6,,percent of total billed charges,,
Arc Differential/Auto Ads Of Serum/Per Unit (Bb)OutsideLaboratory,,86978,CPT,Facility,Inpatient,,,90,97,82.45,27.8002,97,Medica,Medical Assistance,,,,,Included in per diem rate,
Arc Differential/Auto Ads Of Serum/Per Unit (Bb)OutsideLaboratory,,86978,CPT,Facility,Outpatient,,,90,97,82.45,27.8002,97,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,48.306,49.8,,percent of total billed charges,,
Arc Differential/Auto Ads Of Serum/Per Unit (Bb)OutsideLaboratory,,86978,CPT,Facility,Inpatient,,,90,97,82.45,27.8002,97,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Arc Differential/Auto Ads Of Serum/Per Unit (Bb)OutsideLaboratory,,86978,CPT,Facility,Both,,,90,97,82.45,27.8002,97,"Multiplan, Inc.","Multiplan, Inc.",91.18,94,,percent of total billed charges,,
Arc Differential/Auto Ads Of Serum/Per Unit (Bb)OutsideLaboratory,,86978,CPT,Facility,Outpatient,,,90,97,82.45,27.8002,97,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,83.808,86.4,,percent of total billed charges,,
Arc Differential/Auto Ads Of Serum/Per Unit (Bb)OutsideLaboratory,,86978,CPT,Facility,Inpatient,,,90,97,82.45,27.8002,97,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Arc Differential/Auto Ads Of Serum/Per Unit (Bb)OutsideLaboratory,,86978,CPT,Facility,Both,,,90,97,82.45,27.8002,97,"Preferred One Administrative Services, INC.",PPO,95.642,98.6,,percent of total billed charges,,
Arc Differential/Auto Ads Of Serum/Per Unit (Bb)OutsideLaboratory,,86978,CPT,Facility,Outpatient,,,90,97,82.45,27.8002,97,PrimeWest Health,Minnesota Senior Health Options (MSHO),49.9065,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Arc Differential/Auto Ads Of Serum/Per Unit (Bb)OutsideLaboratory,,86978,CPT,Facility,Inpatient,,,90,97,82.45,27.8002,97,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Arc Differential/Auto Ads Of Serum/Per Unit (Bb)OutsideLaboratory,,86978,CPT,Facility,Outpatient,,,90,97,82.45,27.8002,97,PrimeWest Health,MinnesotaCare,49.8192,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Arc Differential/Auto Ads Of Serum/Per Unit (Bb)OutsideLaboratory,,86978,CPT,Facility,Inpatient,,,90,97,82.45,27.8002,97,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Arc Differential/Auto Ads Of Serum/Per Unit (Bb)OutsideLaboratory,,86978,CPT,Facility,Both,,,90,97,82.45,27.8002,97,Sanford Health Plan,Sanford Health Plan,89.24,92,,percent of total billed charges,,
Arc Differential/Auto Ads Of Serum/Per Unit (Bb)OutsideLaboratory,,86978,CPT,Facility,Outpatient,,,90,97,82.45,27.8002,97,"UCare Health, Inc.",Individual & Family Plan,54.6595,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Arc Differential/Auto Ads Of Serum/Per Unit (Bb)OutsideLaboratory,,86978,CPT,Facility,Inpatient,,,90,97,82.45,27.8002,97,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Arc Differential/Auto Ads Of Serum/Per Unit (Bb)OutsideLaboratory,,86978,CPT,Facility,Outpatient,,,90,97,82.45,27.8002,97,"UCare Health, Inc.",Medical Assistance,48.9559,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Arc Differential/Auto Ads Of Serum/Per Unit (Bb)OutsideLaboratory,,86978,CPT,Facility,Inpatient,,,90,97,82.45,27.8002,97,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Arc Differential/Auto Ads Of Serum/Per Unit (Bb)OutsideLaboratory,,86978,CPT,Facility,Outpatient,,,90,97,82.45,27.8002,97,"UCare Health, Inc.",Medicare Advantage,48.9559,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Arc Differential/Auto Ads Of Serum/Per Unit (Bb)OutsideLaboratory,,86978,CPT,Facility,Inpatient,,,90,97,82.45,27.8002,97,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Arc Differential/Auto Ads Of Serum/Per Unit (Bb)OutsideLaboratory,,86978,CPT,Facility,Outpatient,,,90,97,82.45,27.8002,97,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),48.9559,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Arc Differential/Auto Ads Of Serum/Per Unit (Bb)OutsideLaboratory,,86978,CPT,Facility,Inpatient,,,90,97,82.45,27.8002,97,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Arc Differential/Auto Ads Of Serum/Per Unit (Bb)OutsideLaboratory,,86978,CPT,Facility,Both,,,90,97,82.45,27.8002,97,UnitedHealthcare,Individual & Family,91.18,94,,percent of total billed charges,,
Arc Differential/Auto Ads Of Serum/Per Unit (Bb)OutsideLaboratory,,86978,CPT,Facility,Outpatient,,,90,97,82.45,27.8002,97,UnitedHealthcare,Medicare Advantage,47.53,49,,percent of total billed charges,,
Arc Differential/Auto Ads Of Serum/Per Unit (Bb)OutsideLaboratory,,86978,CPT,Facility,Inpatient,,,90,97,82.45,27.8002,97,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Arc Differential/Auto Ads Of Serum/Per Unit (Bb)OutsideLaboratory,,86978,CPT,Facility,Outpatient,,,90,97,82.45,27.8002,97,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,46.56,48,,percent of total billed charges,,100% of DHS outpatient percentage
Arc Differential/Auto Ads Of Serum/Per Unit (Bb)OutsideLaboratory,,86978,CPT,Facility,Inpatient,,,90,97,82.45,27.8002,97,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Concentration For Any Infectious Agents (Mayo)OutsideLaboratory,,87015,CPT,Facility,Both,,,90,97,82.45,27.8002,97,Aetna,Commercial,89.24,92,,percent of total billed charges,,
Concentration For Any Infectious Agents (Mayo)OutsideLaboratory,,87015,CPT,Facility,Outpatient,,,90,97,82.45,27.8002,97,Aetna,Medicare Advantage,47.53,49,,percent of total billed charges,,
Concentration For Any Infectious Agents (Mayo)OutsideLaboratory,,87015,CPT,Facility,Inpatient,,,90,97,82.45,27.8002,97,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Concentration For Any Infectious Agents (Mayo)OutsideLaboratory,,87015,CPT,Facility,Both,,,90,97,82.45,27.8002,97,Aetna,PPO,90.21,93,,percent of total billed charges,,
Concentration For Any Infectious Agents (Mayo)OutsideLaboratory,,87015,CPT,Facility,Both,,,90,97,82.45,27.8002,97,America's PPO,America's PPO,93.1491,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Concentration For Any Infectious Agents (Mayo)OutsideLaboratory,,87015,CPT,Facility,Both,,,90,97,82.45,27.8002,97,BlueCross BlueShield Minnesota, Federal Employee Program,95.448,98.4,,percent of total billed charges,,
Concentration For Any Infectious Agents (Mayo)OutsideLaboratory,,87015,CPT,Facility,Both,,,90,97,82.45,27.8002,97,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,97,100,,percent of total billed charges,,
Concentration For Any Infectious Agents (Mayo)OutsideLaboratory,,87015,CPT,Facility,Both,,,90,97,82.45,27.8002,97,BlueCross BlueShield Minnesota,High Value Network Plan,87.3,90,,percent of total billed charges,,
Concentration For Any Infectious Agents (Mayo)OutsideLaboratory,,87015,CPT,Facility,Outpatient,,,90,97,82.45,27.8002,97,BlueCross BlueShield Minnesota,Medicare Advantage,47.53,49,,percent of total billed charges,,
Concentration For Any Infectious Agents (Mayo)OutsideLaboratory,,87015,CPT,Facility,Inpatient,,,90,97,82.45,27.8002,97,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Concentration For Any Infectious Agents (Mayo)OutsideLaboratory,,87015,CPT,Facility,Both,,,90,97,82.45,27.8002,97,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,85.9129,88.57,,percent of total billed charges,,
Concentration For Any Infectious Agents (Mayo)OutsideLaboratory,,87015,CPT,Facility,Both,,,90,97,82.45,27.8002,97,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,27.8002,28.66,,percent of total billed charges,,
Concentration For Any Infectious Agents (Mayo)OutsideLaboratory,,87015,CPT,Facility,Outpatient,,,90,97,82.45,27.8002,97,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),47.53,49,,percent of total billed charges,,
Concentration For Any Infectious Agents (Mayo)OutsideLaboratory,,87015,CPT,Facility,Inpatient,,,90,97,82.45,27.8002,97,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Concentration For Any Infectious Agents (Mayo)OutsideLaboratory,,87015,CPT,Facility,Both,,,90,97,82.45,27.8002,97,CorVel,Worker's Compensation,97,100,,percent of total billed charges,,
Concentration For Any Infectious Agents (Mayo)OutsideLaboratory,,87015,CPT,Facility,Both,,,90,97,82.45,27.8002,97,First Health Group Corporation,First Health Network,94.09,97,,percent of total billed charges,,
Concentration For Any Infectious Agents (Mayo)OutsideLaboratory,,87015,CPT,Facility,Both,,,90,97,82.45,27.8002,97,"Health Partners, Inc.",Commercial,91.762,94.6,,percent of total billed charges,,
Concentration For Any Infectious Agents (Mayo)OutsideLaboratory,,87015,CPT,Facility,Outpatient,,,90,97,82.45,27.8002,97,"Health Partners, Inc.",Medicare Advantage,47.53,49,,percent of total billed charges,,
Concentration For Any Infectious Agents (Mayo)OutsideLaboratory,,87015,CPT,Facility,Inpatient,,,90,97,82.45,27.8002,97,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Concentration For Any Infectious Agents (Mayo)OutsideLaboratory,,87015,CPT,Facility,Both,,,90,97,82.45,27.8002,97,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),58.2,60,,percent of total billed charges,,
Concentration For Any Infectious Agents (Mayo)OutsideLaboratory,,87015,CPT,Facility,Both,,,90,97,82.45,27.8002,97,"Health Partners, Inc.",State of Minnesota Advantage Program,79.055,81.5,,percent of total billed charges,,
Concentration For Any Infectious Agents (Mayo)OutsideLaboratory,,87015,CPT,Facility,Both,,,90,97,82.45,27.8002,97,"Health Partners, Inc.",State Public Programs,48.5,50,,percent of total billed charges,,
Concentration For Any Infectious Agents (Mayo)OutsideLaboratory,,87015,CPT,Facility,Both,,,90,97,82.45,27.8002,97,Humana Insurance Company,Commercial PPO,92.15,95,,percent of total billed charges,,
Concentration For Any Infectious Agents (Mayo)OutsideLaboratory,,87015,CPT,Facility,Outpatient,,,90,97,82.45,27.8002,97,Humana Insurance Company,Medicare PPO,47.53,49,,percent of total billed charges,,
Concentration For Any Infectious Agents (Mayo)OutsideLaboratory,,87015,CPT,Facility,Inpatient,,,90,97,82.45,27.8002,97,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Concentration For Any Infectious Agents (Mayo)OutsideLaboratory,,87015,CPT,Facility,Both,,,90,97,82.45,27.8002,97,Medica,Individual & Family,96.127,99.1,,percent of total billed charges,,
Concentration For Any Infectious Agents (Mayo)OutsideLaboratory,,87015,CPT,Facility,Outpatient,,,90,97,82.45,27.8002,97,Medica,Medica Advantage Solution,48.306,49.8,,percent of total billed charges,,
Concentration For Any Infectious Agents (Mayo)OutsideLaboratory,,87015,CPT,Facility,Inpatient,,,90,97,82.45,27.8002,97,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Concentration For Any Infectious Agents (Mayo)OutsideLaboratory,,87015,CPT,Facility,Outpatient,,,90,97,82.45,27.8002,97,Medica,Medical Assistance,43.262,44.6,,percent of total billed charges,,
Concentration For Any Infectious Agents (Mayo)OutsideLaboratory,,87015,CPT,Facility,Inpatient,,,90,97,82.45,27.8002,97,Medica,Medical Assistance,,,,,Included in per diem rate,
Concentration For Any Infectious Agents (Mayo)OutsideLaboratory,,87015,CPT,Facility,Outpatient,,,90,97,82.45,27.8002,97,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,48.306,49.8,,percent of total billed charges,,
Concentration For Any Infectious Agents (Mayo)OutsideLaboratory,,87015,CPT,Facility,Inpatient,,,90,97,82.45,27.8002,97,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Concentration For Any Infectious Agents (Mayo)OutsideLaboratory,,87015,CPT,Facility,Both,,,90,97,82.45,27.8002,97,"Multiplan, Inc.","Multiplan, Inc.",91.18,94,,percent of total billed charges,,
Concentration For Any Infectious Agents (Mayo)OutsideLaboratory,,87015,CPT,Facility,Outpatient,,,90,97,82.45,27.8002,97,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,83.808,86.4,,percent of total billed charges,,
Concentration For Any Infectious Agents (Mayo)OutsideLaboratory,,87015,CPT,Facility,Inpatient,,,90,97,82.45,27.8002,97,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Concentration For Any Infectious Agents (Mayo)OutsideLaboratory,,87015,CPT,Facility,Both,,,90,97,82.45,27.8002,97,"Preferred One Administrative Services, INC.",PPO,95.642,98.6,,percent of total billed charges,,
Concentration For Any Infectious Agents (Mayo)OutsideLaboratory,,87015,CPT,Facility,Outpatient,,,90,97,82.45,27.8002,97,PrimeWest Health,Minnesota Senior Health Options (MSHO),49.9065,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Concentration For Any Infectious Agents (Mayo)OutsideLaboratory,,87015,CPT,Facility,Inpatient,,,90,97,82.45,27.8002,97,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Concentration For Any Infectious Agents (Mayo)OutsideLaboratory,,87015,CPT,Facility,Outpatient,,,90,97,82.45,27.8002,97,PrimeWest Health,MinnesotaCare,49.8192,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Concentration For Any Infectious Agents (Mayo)OutsideLaboratory,,87015,CPT,Facility,Inpatient,,,90,97,82.45,27.8002,97,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Concentration For Any Infectious Agents (Mayo)OutsideLaboratory,,87015,CPT,Facility,Both,,,90,97,82.45,27.8002,97,Sanford Health Plan,Sanford Health Plan,89.24,92,,percent of total billed charges,,
Concentration For Any Infectious Agents (Mayo)OutsideLaboratory,,87015,CPT,Facility,Outpatient,,,90,97,82.45,27.8002,97,"UCare Health, Inc.",Individual & Family Plan,54.6595,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Concentration For Any Infectious Agents (Mayo)OutsideLaboratory,,87015,CPT,Facility,Inpatient,,,90,97,82.45,27.8002,97,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Concentration For Any Infectious Agents (Mayo)OutsideLaboratory,,87015,CPT,Facility,Outpatient,,,90,97,82.45,27.8002,97,"UCare Health, Inc.",Medical Assistance,48.9559,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Concentration For Any Infectious Agents (Mayo)OutsideLaboratory,,87015,CPT,Facility,Inpatient,,,90,97,82.45,27.8002,97,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Concentration For Any Infectious Agents (Mayo)OutsideLaboratory,,87015,CPT,Facility,Outpatient,,,90,97,82.45,27.8002,97,"UCare Health, Inc.",Medicare Advantage,48.9559,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Concentration For Any Infectious Agents (Mayo)OutsideLaboratory,,87015,CPT,Facility,Inpatient,,,90,97,82.45,27.8002,97,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Concentration For Any Infectious Agents (Mayo)OutsideLaboratory,,87015,CPT,Facility,Outpatient,,,90,97,82.45,27.8002,97,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),48.9559,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Concentration For Any Infectious Agents (Mayo)OutsideLaboratory,,87015,CPT,Facility,Inpatient,,,90,97,82.45,27.8002,97,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Concentration For Any Infectious Agents (Mayo)OutsideLaboratory,,87015,CPT,Facility,Both,,,90,97,82.45,27.8002,97,UnitedHealthcare,Individual & Family,91.18,94,,percent of total billed charges,,
Concentration For Any Infectious Agents (Mayo)OutsideLaboratory,,87015,CPT,Facility,Outpatient,,,90,97,82.45,27.8002,97,UnitedHealthcare,Medicare Advantage,47.53,49,,percent of total billed charges,,
Concentration For Any Infectious Agents (Mayo)OutsideLaboratory,,87015,CPT,Facility,Inpatient,,,90,97,82.45,27.8002,97,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Concentration For Any Infectious Agents (Mayo)OutsideLaboratory,,87015,CPT,Facility,Outpatient,,,90,97,82.45,27.8002,97,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,46.56,48,,percent of total billed charges,,100% of DHS outpatient percentage
Concentration For Any Infectious Agents (Mayo)OutsideLaboratory,,87015,CPT,Facility,Inpatient,,,90,97,82.45,27.8002,97,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Cyclospora Stain (Mayo)OutsideLaboratory,,87015,CPT,Facility,Both,,,90,75,63.75,21.495,75,Aetna,Commercial,69,92,,percent of total billed charges,,
Cyclospora Stain (Mayo)OutsideLaboratory,,87015,CPT,Facility,Outpatient,,,90,75,63.75,21.495,75,Aetna,Medicare Advantage,36.75,49,,percent of total billed charges,,
Cyclospora Stain (Mayo)OutsideLaboratory,,87015,CPT,Facility,Inpatient,,,90,75,63.75,21.495,75,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Cyclospora Stain (Mayo)OutsideLaboratory,,87015,CPT,Facility,Both,,,90,75,63.75,21.495,75,Aetna,PPO,69.75,93,,percent of total billed charges,,
Cyclospora Stain (Mayo)OutsideLaboratory,,87015,CPT,Facility,Both,,,90,75,63.75,21.495,75,America's PPO,America's PPO,72.0225,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Cyclospora Stain (Mayo)OutsideLaboratory,,87015,CPT,Facility,Both,,,90,75,63.75,21.495,75,BlueCross BlueShield Minnesota, Federal Employee Program,73.8,98.4,,percent of total billed charges,,
Cyclospora Stain (Mayo)OutsideLaboratory,,87015,CPT,Facility,Both,,,90,75,63.75,21.495,75,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,75,100,,percent of total billed charges,,
Cyclospora Stain (Mayo)OutsideLaboratory,,87015,CPT,Facility,Both,,,90,75,63.75,21.495,75,BlueCross BlueShield Minnesota,High Value Network Plan,67.5,90,,percent of total billed charges,,
Cyclospora Stain (Mayo)OutsideLaboratory,,87015,CPT,Facility,Outpatient,,,90,75,63.75,21.495,75,BlueCross BlueShield Minnesota,Medicare Advantage,36.75,49,,percent of total billed charges,,
Cyclospora Stain (Mayo)OutsideLaboratory,,87015,CPT,Facility,Inpatient,,,90,75,63.75,21.495,75,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Cyclospora Stain (Mayo)OutsideLaboratory,,87015,CPT,Facility,Both,,,90,75,63.75,21.495,75,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,66.4275,88.57,,percent of total billed charges,,
Cyclospora Stain (Mayo)OutsideLaboratory,,87015,CPT,Facility,Both,,,90,75,63.75,21.495,75,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,21.495,28.66,,percent of total billed charges,,
Cyclospora Stain (Mayo)OutsideLaboratory,,87015,CPT,Facility,Outpatient,,,90,75,63.75,21.495,75,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),36.75,49,,percent of total billed charges,,
Cyclospora Stain (Mayo)OutsideLaboratory,,87015,CPT,Facility,Inpatient,,,90,75,63.75,21.495,75,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Cyclospora Stain (Mayo)OutsideLaboratory,,87015,CPT,Facility,Both,,,90,75,63.75,21.495,75,CorVel,Worker's Compensation,75,100,,percent of total billed charges,,
Cyclospora Stain (Mayo)OutsideLaboratory,,87015,CPT,Facility,Both,,,90,75,63.75,21.495,75,First Health Group Corporation,First Health Network,72.75,97,,percent of total billed charges,,
Cyclospora Stain (Mayo)OutsideLaboratory,,87015,CPT,Facility,Both,,,90,75,63.75,21.495,75,"Health Partners, Inc.",Commercial,70.95,94.6,,percent of total billed charges,,
Cyclospora Stain (Mayo)OutsideLaboratory,,87015,CPT,Facility,Outpatient,,,90,75,63.75,21.495,75,"Health Partners, Inc.",Medicare Advantage,36.75,49,,percent of total billed charges,,
Cyclospora Stain (Mayo)OutsideLaboratory,,87015,CPT,Facility,Inpatient,,,90,75,63.75,21.495,75,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Cyclospora Stain (Mayo)OutsideLaboratory,,87015,CPT,Facility,Both,,,90,75,63.75,21.495,75,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),45,60,,percent of total billed charges,,
Cyclospora Stain (Mayo)OutsideLaboratory,,87015,CPT,Facility,Both,,,90,75,63.75,21.495,75,"Health Partners, Inc.",State of Minnesota Advantage Program,61.125,81.5,,percent of total billed charges,,
Cyclospora Stain (Mayo)OutsideLaboratory,,87015,CPT,Facility,Both,,,90,75,63.75,21.495,75,"Health Partners, Inc.",State Public Programs,37.5,50,,percent of total billed charges,,
Cyclospora Stain (Mayo)OutsideLaboratory,,87015,CPT,Facility,Both,,,90,75,63.75,21.495,75,Humana Insurance Company,Commercial PPO,71.25,95,,percent of total billed charges,,
Cyclospora Stain (Mayo)OutsideLaboratory,,87015,CPT,Facility,Outpatient,,,90,75,63.75,21.495,75,Humana Insurance Company,Medicare PPO,36.75,49,,percent of total billed charges,,
Cyclospora Stain (Mayo)OutsideLaboratory,,87015,CPT,Facility,Inpatient,,,90,75,63.75,21.495,75,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Cyclospora Stain (Mayo)OutsideLaboratory,,87015,CPT,Facility,Both,,,90,75,63.75,21.495,75,Medica,Individual & Family,74.325,99.1,,percent of total billed charges,,
Cyclospora Stain (Mayo)OutsideLaboratory,,87015,CPT,Facility,Outpatient,,,90,75,63.75,21.495,75,Medica,Medica Advantage Solution,37.35,49.8,,percent of total billed charges,,
Cyclospora Stain (Mayo)OutsideLaboratory,,87015,CPT,Facility,Inpatient,,,90,75,63.75,21.495,75,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Cyclospora Stain (Mayo)OutsideLaboratory,,87015,CPT,Facility,Outpatient,,,90,75,63.75,21.495,75,Medica,Medical Assistance,33.45,44.6,,percent of total billed charges,,
Cyclospora Stain (Mayo)OutsideLaboratory,,87015,CPT,Facility,Inpatient,,,90,75,63.75,21.495,75,Medica,Medical Assistance,,,,,Included in per diem rate,
Cyclospora Stain (Mayo)OutsideLaboratory,,87015,CPT,Facility,Outpatient,,,90,75,63.75,21.495,75,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,37.35,49.8,,percent of total billed charges,,
Cyclospora Stain (Mayo)OutsideLaboratory,,87015,CPT,Facility,Inpatient,,,90,75,63.75,21.495,75,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Cyclospora Stain (Mayo)OutsideLaboratory,,87015,CPT,Facility,Both,,,90,75,63.75,21.495,75,"Multiplan, Inc.","Multiplan, Inc.",70.5,94,,percent of total billed charges,,
Cyclospora Stain (Mayo)OutsideLaboratory,,87015,CPT,Facility,Outpatient,,,90,75,63.75,21.495,75,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,64.8,86.4,,percent of total billed charges,,
Cyclospora Stain (Mayo)OutsideLaboratory,,87015,CPT,Facility,Inpatient,,,90,75,63.75,21.495,75,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Cyclospora Stain (Mayo)OutsideLaboratory,,87015,CPT,Facility,Both,,,90,75,63.75,21.495,75,"Preferred One Administrative Services, INC.",PPO,73.95,98.6,,percent of total billed charges,,
Cyclospora Stain (Mayo)OutsideLaboratory,,87015,CPT,Facility,Outpatient,,,90,75,63.75,21.495,75,PrimeWest Health,Minnesota Senior Health Options (MSHO),38.5875,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Cyclospora Stain (Mayo)OutsideLaboratory,,87015,CPT,Facility,Inpatient,,,90,75,63.75,21.495,75,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Cyclospora Stain (Mayo)OutsideLaboratory,,87015,CPT,Facility,Outpatient,,,90,75,63.75,21.495,75,PrimeWest Health,MinnesotaCare,38.52,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Cyclospora Stain (Mayo)OutsideLaboratory,,87015,CPT,Facility,Inpatient,,,90,75,63.75,21.495,75,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Cyclospora Stain (Mayo)OutsideLaboratory,,87015,CPT,Facility,Both,,,90,75,63.75,21.495,75,Sanford Health Plan,Sanford Health Plan,69,92,,percent of total billed charges,,
Cyclospora Stain (Mayo)OutsideLaboratory,,87015,CPT,Facility,Outpatient,,,90,75,63.75,21.495,75,"UCare Health, Inc.",Individual & Family Plan,42.2625,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Cyclospora Stain (Mayo)OutsideLaboratory,,87015,CPT,Facility,Inpatient,,,90,75,63.75,21.495,75,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Cyclospora Stain (Mayo)OutsideLaboratory,,87015,CPT,Facility,Outpatient,,,90,75,63.75,21.495,75,"UCare Health, Inc.",Medical Assistance,37.8525,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Cyclospora Stain (Mayo)OutsideLaboratory,,87015,CPT,Facility,Inpatient,,,90,75,63.75,21.495,75,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Cyclospora Stain (Mayo)OutsideLaboratory,,87015,CPT,Facility,Outpatient,,,90,75,63.75,21.495,75,"UCare Health, Inc.",Medicare Advantage,37.8525,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Cyclospora Stain (Mayo)OutsideLaboratory,,87015,CPT,Facility,Inpatient,,,90,75,63.75,21.495,75,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Cyclospora Stain (Mayo)OutsideLaboratory,,87015,CPT,Facility,Outpatient,,,90,75,63.75,21.495,75,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),37.8525,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Cyclospora Stain (Mayo)OutsideLaboratory,,87015,CPT,Facility,Inpatient,,,90,75,63.75,21.495,75,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Cyclospora Stain (Mayo)OutsideLaboratory,,87015,CPT,Facility,Both,,,90,75,63.75,21.495,75,UnitedHealthcare,Individual & Family,70.5,94,,percent of total billed charges,,
Cyclospora Stain (Mayo)OutsideLaboratory,,87015,CPT,Facility,Outpatient,,,90,75,63.75,21.495,75,UnitedHealthcare,Medicare Advantage,36.75,49,,percent of total billed charges,,
Cyclospora Stain (Mayo)OutsideLaboratory,,87015,CPT,Facility,Inpatient,,,90,75,63.75,21.495,75,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Cyclospora Stain (Mayo)OutsideLaboratory,,87015,CPT,Facility,Outpatient,,,90,75,63.75,21.495,75,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,36,48,,percent of total billed charges,,100% of DHS outpatient percentage
Cyclospora Stain (Mayo)OutsideLaboratory,,87015,CPT,Facility,Inpatient,,,90,75,63.75,21.495,75,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Mycobacteria Culture, Conc (Bill Only) (Mayo)OutsideLaboratory",,87015,CPT,Facility,Both,,,90,101,85.85,28.9466,101,Aetna,Commercial,92.92,92,,percent of total billed charges,,
"Mycobacteria Culture, Conc (Bill Only) (Mayo)OutsideLaboratory",,87015,CPT,Facility,Outpatient,,,90,101,85.85,28.9466,101,Aetna,Medicare Advantage,49.49,49,,percent of total billed charges,,
"Mycobacteria Culture, Conc (Bill Only) (Mayo)OutsideLaboratory",,87015,CPT,Facility,Inpatient,,,90,101,85.85,28.9466,101,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Mycobacteria Culture, Conc (Bill Only) (Mayo)OutsideLaboratory",,87015,CPT,Facility,Both,,,90,101,85.85,28.9466,101,Aetna,PPO,93.93,93,,percent of total billed charges,,
"Mycobacteria Culture, Conc (Bill Only) (Mayo)OutsideLaboratory",,87015,CPT,Facility,Both,,,90,101,85.85,28.9466,101,America's PPO,America's PPO,96.9903,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Mycobacteria Culture, Conc (Bill Only) (Mayo)OutsideLaboratory",,87015,CPT,Facility,Both,,,90,101,85.85,28.9466,101,BlueCross BlueShield Minnesota, Federal Employee Program,99.384,98.4,,percent of total billed charges,,
"Mycobacteria Culture, Conc (Bill Only) (Mayo)OutsideLaboratory",,87015,CPT,Facility,Both,,,90,101,85.85,28.9466,101,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,101,100,,percent of total billed charges,,
"Mycobacteria Culture, Conc (Bill Only) (Mayo)OutsideLaboratory",,87015,CPT,Facility,Both,,,90,101,85.85,28.9466,101,BlueCross BlueShield Minnesota,High Value Network Plan,90.9,90,,percent of total billed charges,,
"Mycobacteria Culture, Conc (Bill Only) (Mayo)OutsideLaboratory",,87015,CPT,Facility,Outpatient,,,90,101,85.85,28.9466,101,BlueCross BlueShield Minnesota,Medicare Advantage,49.49,49,,percent of total billed charges,,
"Mycobacteria Culture, Conc (Bill Only) (Mayo)OutsideLaboratory",,87015,CPT,Facility,Inpatient,,,90,101,85.85,28.9466,101,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Mycobacteria Culture, Conc (Bill Only) (Mayo)OutsideLaboratory",,87015,CPT,Facility,Both,,,90,101,85.85,28.9466,101,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,89.4557,88.57,,percent of total billed charges,,
"Mycobacteria Culture, Conc (Bill Only) (Mayo)OutsideLaboratory",,87015,CPT,Facility,Both,,,90,101,85.85,28.9466,101,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,28.9466,28.66,,percent of total billed charges,,
"Mycobacteria Culture, Conc (Bill Only) (Mayo)OutsideLaboratory",,87015,CPT,Facility,Outpatient,,,90,101,85.85,28.9466,101,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),49.49,49,,percent of total billed charges,,
"Mycobacteria Culture, Conc (Bill Only) (Mayo)OutsideLaboratory",,87015,CPT,Facility,Inpatient,,,90,101,85.85,28.9466,101,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Mycobacteria Culture, Conc (Bill Only) (Mayo)OutsideLaboratory",,87015,CPT,Facility,Both,,,90,101,85.85,28.9466,101,CorVel,Worker's Compensation,101,100,,percent of total billed charges,,
"Mycobacteria Culture, Conc (Bill Only) (Mayo)OutsideLaboratory",,87015,CPT,Facility,Both,,,90,101,85.85,28.9466,101,First Health Group Corporation,First Health Network,97.97,97,,percent of total billed charges,,
"Mycobacteria Culture, Conc (Bill Only) (Mayo)OutsideLaboratory",,87015,CPT,Facility,Both,,,90,101,85.85,28.9466,101,"Health Partners, Inc.",Commercial,95.546,94.6,,percent of total billed charges,,
"Mycobacteria Culture, Conc (Bill Only) (Mayo)OutsideLaboratory",,87015,CPT,Facility,Outpatient,,,90,101,85.85,28.9466,101,"Health Partners, Inc.",Medicare Advantage,49.49,49,,percent of total billed charges,,
"Mycobacteria Culture, Conc (Bill Only) (Mayo)OutsideLaboratory",,87015,CPT,Facility,Inpatient,,,90,101,85.85,28.9466,101,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Mycobacteria Culture, Conc (Bill Only) (Mayo)OutsideLaboratory",,87015,CPT,Facility,Both,,,90,101,85.85,28.9466,101,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),60.6,60,,percent of total billed charges,,
"Mycobacteria Culture, Conc (Bill Only) (Mayo)OutsideLaboratory",,87015,CPT,Facility,Both,,,90,101,85.85,28.9466,101,"Health Partners, Inc.",State of Minnesota Advantage Program,82.315,81.5,,percent of total billed charges,,
"Mycobacteria Culture, Conc (Bill Only) (Mayo)OutsideLaboratory",,87015,CPT,Facility,Both,,,90,101,85.85,28.9466,101,"Health Partners, Inc.",State Public Programs,50.5,50,,percent of total billed charges,,
"Mycobacteria Culture, Conc (Bill Only) (Mayo)OutsideLaboratory",,87015,CPT,Facility,Both,,,90,101,85.85,28.9466,101,Humana Insurance Company,Commercial PPO,95.95,95,,percent of total billed charges,,
"Mycobacteria Culture, Conc (Bill Only) (Mayo)OutsideLaboratory",,87015,CPT,Facility,Outpatient,,,90,101,85.85,28.9466,101,Humana Insurance Company,Medicare PPO,49.49,49,,percent of total billed charges,,
"Mycobacteria Culture, Conc (Bill Only) (Mayo)OutsideLaboratory",,87015,CPT,Facility,Inpatient,,,90,101,85.85,28.9466,101,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Mycobacteria Culture, Conc (Bill Only) (Mayo)OutsideLaboratory",,87015,CPT,Facility,Both,,,90,101,85.85,28.9466,101,Medica,Individual & Family,100.091,99.1,,percent of total billed charges,,
"Mycobacteria Culture, Conc (Bill Only) (Mayo)OutsideLaboratory",,87015,CPT,Facility,Outpatient,,,90,101,85.85,28.9466,101,Medica,Medica Advantage Solution,50.298,49.8,,percent of total billed charges,,
"Mycobacteria Culture, Conc (Bill Only) (Mayo)OutsideLaboratory",,87015,CPT,Facility,Inpatient,,,90,101,85.85,28.9466,101,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Mycobacteria Culture, Conc (Bill Only) (Mayo)OutsideLaboratory",,87015,CPT,Facility,Outpatient,,,90,101,85.85,28.9466,101,Medica,Medical Assistance,45.046,44.6,,percent of total billed charges,,
"Mycobacteria Culture, Conc (Bill Only) (Mayo)OutsideLaboratory",,87015,CPT,Facility,Inpatient,,,90,101,85.85,28.9466,101,Medica,Medical Assistance,,,,,Included in per diem rate,
"Mycobacteria Culture, Conc (Bill Only) (Mayo)OutsideLaboratory",,87015,CPT,Facility,Outpatient,,,90,101,85.85,28.9466,101,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,50.298,49.8,,percent of total billed charges,,
"Mycobacteria Culture, Conc (Bill Only) (Mayo)OutsideLaboratory",,87015,CPT,Facility,Inpatient,,,90,101,85.85,28.9466,101,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Mycobacteria Culture, Conc (Bill Only) (Mayo)OutsideLaboratory",,87015,CPT,Facility,Both,,,90,101,85.85,28.9466,101,"Multiplan, Inc.","Multiplan, Inc.",94.94,94,,percent of total billed charges,,
"Mycobacteria Culture, Conc (Bill Only) (Mayo)OutsideLaboratory",,87015,CPT,Facility,Outpatient,,,90,101,85.85,28.9466,101,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,87.264,86.4,,percent of total billed charges,,
"Mycobacteria Culture, Conc (Bill Only) (Mayo)OutsideLaboratory",,87015,CPT,Facility,Inpatient,,,90,101,85.85,28.9466,101,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Mycobacteria Culture, Conc (Bill Only) (Mayo)OutsideLaboratory",,87015,CPT,Facility,Both,,,90,101,85.85,28.9466,101,"Preferred One Administrative Services, INC.",PPO,99.586,98.6,,percent of total billed charges,,
"Mycobacteria Culture, Conc (Bill Only) (Mayo)OutsideLaboratory",,87015,CPT,Facility,Outpatient,,,90,101,85.85,28.9466,101,PrimeWest Health,Minnesota Senior Health Options (MSHO),51.9645,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Mycobacteria Culture, Conc (Bill Only) (Mayo)OutsideLaboratory",,87015,CPT,Facility,Inpatient,,,90,101,85.85,28.9466,101,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Mycobacteria Culture, Conc (Bill Only) (Mayo)OutsideLaboratory",,87015,CPT,Facility,Outpatient,,,90,101,85.85,28.9466,101,PrimeWest Health,MinnesotaCare,51.8736,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Mycobacteria Culture, Conc (Bill Only) (Mayo)OutsideLaboratory",,87015,CPT,Facility,Inpatient,,,90,101,85.85,28.9466,101,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Mycobacteria Culture, Conc (Bill Only) (Mayo)OutsideLaboratory",,87015,CPT,Facility,Both,,,90,101,85.85,28.9466,101,Sanford Health Plan,Sanford Health Plan,92.92,92,,percent of total billed charges,,
"Mycobacteria Culture, Conc (Bill Only) (Mayo)OutsideLaboratory",,87015,CPT,Facility,Outpatient,,,90,101,85.85,28.9466,101,"UCare Health, Inc.",Individual & Family Plan,56.9135,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Mycobacteria Culture, Conc (Bill Only) (Mayo)OutsideLaboratory",,87015,CPT,Facility,Inpatient,,,90,101,85.85,28.9466,101,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Mycobacteria Culture, Conc (Bill Only) (Mayo)OutsideLaboratory",,87015,CPT,Facility,Outpatient,,,90,101,85.85,28.9466,101,"UCare Health, Inc.",Medical Assistance,50.9747,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Mycobacteria Culture, Conc (Bill Only) (Mayo)OutsideLaboratory",,87015,CPT,Facility,Inpatient,,,90,101,85.85,28.9466,101,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Mycobacteria Culture, Conc (Bill Only) (Mayo)OutsideLaboratory",,87015,CPT,Facility,Outpatient,,,90,101,85.85,28.9466,101,"UCare Health, Inc.",Medicare Advantage,50.9747,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Mycobacteria Culture, Conc (Bill Only) (Mayo)OutsideLaboratory",,87015,CPT,Facility,Inpatient,,,90,101,85.85,28.9466,101,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Mycobacteria Culture, Conc (Bill Only) (Mayo)OutsideLaboratory",,87015,CPT,Facility,Outpatient,,,90,101,85.85,28.9466,101,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),50.9747,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Mycobacteria Culture, Conc (Bill Only) (Mayo)OutsideLaboratory",,87015,CPT,Facility,Inpatient,,,90,101,85.85,28.9466,101,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Mycobacteria Culture, Conc (Bill Only) (Mayo)OutsideLaboratory",,87015,CPT,Facility,Both,,,90,101,85.85,28.9466,101,UnitedHealthcare,Individual & Family,94.94,94,,percent of total billed charges,,
"Mycobacteria Culture, Conc (Bill Only) (Mayo)OutsideLaboratory",,87015,CPT,Facility,Outpatient,,,90,101,85.85,28.9466,101,UnitedHealthcare,Medicare Advantage,49.49,49,,percent of total billed charges,,
"Mycobacteria Culture, Conc (Bill Only) (Mayo)OutsideLaboratory",,87015,CPT,Facility,Inpatient,,,90,101,85.85,28.9466,101,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Mycobacteria Culture, Conc (Bill Only) (Mayo)OutsideLaboratory",,87015,CPT,Facility,Outpatient,,,90,101,85.85,28.9466,101,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,48.48,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Mycobacteria Culture, Conc (Bill Only) (Mayo)OutsideLaboratory",,87015,CPT,Facility,Inpatient,,,90,101,85.85,28.9466,101,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Organism Ref For Id, Anaerobic Bact (Mayo)OutsideLaboratory",,87076,CPT,Facility,Both,,,90,56,47.6,16.0496,56,Aetna,Commercial,51.52,92,,percent of total billed charges,,
"Organism Ref For Id, Anaerobic Bact (Mayo)OutsideLaboratory",,87076,CPT,Facility,Outpatient,,,90,56,47.6,16.0496,56,Aetna,Medicare Advantage,27.44,49,,percent of total billed charges,,
"Organism Ref For Id, Anaerobic Bact (Mayo)OutsideLaboratory",,87076,CPT,Facility,Inpatient,,,90,56,47.6,16.0496,56,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Organism Ref For Id, Anaerobic Bact (Mayo)OutsideLaboratory",,87076,CPT,Facility,Both,,,90,56,47.6,16.0496,56,Aetna,PPO,52.08,93,,percent of total billed charges,,
"Organism Ref For Id, Anaerobic Bact (Mayo)OutsideLaboratory",,87076,CPT,Facility,Both,,,90,56,47.6,16.0496,56,America's PPO,America's PPO,53.7768,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Organism Ref For Id, Anaerobic Bact (Mayo)OutsideLaboratory",,87076,CPT,Facility,Both,,,90,56,47.6,16.0496,56,BlueCross BlueShield Minnesota, Federal Employee Program,55.104,98.4,,percent of total billed charges,,
"Organism Ref For Id, Anaerobic Bact (Mayo)OutsideLaboratory",,87076,CPT,Facility,Both,,,90,56,47.6,16.0496,56,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,56,100,,percent of total billed charges,,
"Organism Ref For Id, Anaerobic Bact (Mayo)OutsideLaboratory",,87076,CPT,Facility,Both,,,90,56,47.6,16.0496,56,BlueCross BlueShield Minnesota,High Value Network Plan,50.4,90,,percent of total billed charges,,
"Organism Ref For Id, Anaerobic Bact (Mayo)OutsideLaboratory",,87076,CPT,Facility,Outpatient,,,90,56,47.6,16.0496,56,BlueCross BlueShield Minnesota,Medicare Advantage,27.44,49,,percent of total billed charges,,
"Organism Ref For Id, Anaerobic Bact (Mayo)OutsideLaboratory",,87076,CPT,Facility,Inpatient,,,90,56,47.6,16.0496,56,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Organism Ref For Id, Anaerobic Bact (Mayo)OutsideLaboratory",,87076,CPT,Facility,Both,,,90,56,47.6,16.0496,56,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,49.5992,88.57,,percent of total billed charges,,
"Organism Ref For Id, Anaerobic Bact (Mayo)OutsideLaboratory",,87076,CPT,Facility,Both,,,90,56,47.6,16.0496,56,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,16.0496,28.66,,percent of total billed charges,,
"Organism Ref For Id, Anaerobic Bact (Mayo)OutsideLaboratory",,87076,CPT,Facility,Outpatient,,,90,56,47.6,16.0496,56,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),27.44,49,,percent of total billed charges,,
"Organism Ref For Id, Anaerobic Bact (Mayo)OutsideLaboratory",,87076,CPT,Facility,Inpatient,,,90,56,47.6,16.0496,56,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Organism Ref For Id, Anaerobic Bact (Mayo)OutsideLaboratory",,87076,CPT,Facility,Both,,,90,56,47.6,16.0496,56,CorVel,Worker's Compensation,56,100,,percent of total billed charges,,
"Organism Ref For Id, Anaerobic Bact (Mayo)OutsideLaboratory",,87076,CPT,Facility,Both,,,90,56,47.6,16.0496,56,First Health Group Corporation,First Health Network,54.32,97,,percent of total billed charges,,
"Organism Ref For Id, Anaerobic Bact (Mayo)OutsideLaboratory",,87076,CPT,Facility,Both,,,90,56,47.6,16.0496,56,"Health Partners, Inc.",Commercial,52.976,94.6,,percent of total billed charges,,
"Organism Ref For Id, Anaerobic Bact (Mayo)OutsideLaboratory",,87076,CPT,Facility,Outpatient,,,90,56,47.6,16.0496,56,"Health Partners, Inc.",Medicare Advantage,27.44,49,,percent of total billed charges,,
"Organism Ref For Id, Anaerobic Bact (Mayo)OutsideLaboratory",,87076,CPT,Facility,Inpatient,,,90,56,47.6,16.0496,56,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Organism Ref For Id, Anaerobic Bact (Mayo)OutsideLaboratory",,87076,CPT,Facility,Both,,,90,56,47.6,16.0496,56,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),33.6,60,,percent of total billed charges,,
"Organism Ref For Id, Anaerobic Bact (Mayo)OutsideLaboratory",,87076,CPT,Facility,Both,,,90,56,47.6,16.0496,56,"Health Partners, Inc.",State of Minnesota Advantage Program,45.64,81.5,,percent of total billed charges,,
"Organism Ref For Id, Anaerobic Bact (Mayo)OutsideLaboratory",,87076,CPT,Facility,Both,,,90,56,47.6,16.0496,56,"Health Partners, Inc.",State Public Programs,28,50,,percent of total billed charges,,
"Organism Ref For Id, Anaerobic Bact (Mayo)OutsideLaboratory",,87076,CPT,Facility,Both,,,90,56,47.6,16.0496,56,Humana Insurance Company,Commercial PPO,53.2,95,,percent of total billed charges,,
"Organism Ref For Id, Anaerobic Bact (Mayo)OutsideLaboratory",,87076,CPT,Facility,Outpatient,,,90,56,47.6,16.0496,56,Humana Insurance Company,Medicare PPO,27.44,49,,percent of total billed charges,,
"Organism Ref For Id, Anaerobic Bact (Mayo)OutsideLaboratory",,87076,CPT,Facility,Inpatient,,,90,56,47.6,16.0496,56,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Organism Ref For Id, Anaerobic Bact (Mayo)OutsideLaboratory",,87076,CPT,Facility,Both,,,90,56,47.6,16.0496,56,Medica,Individual & Family,55.496,99.1,,percent of total billed charges,,
"Organism Ref For Id, Anaerobic Bact (Mayo)OutsideLaboratory",,87076,CPT,Facility,Outpatient,,,90,56,47.6,16.0496,56,Medica,Medica Advantage Solution,27.888,49.8,,percent of total billed charges,,
"Organism Ref For Id, Anaerobic Bact (Mayo)OutsideLaboratory",,87076,CPT,Facility,Inpatient,,,90,56,47.6,16.0496,56,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Organism Ref For Id, Anaerobic Bact (Mayo)OutsideLaboratory",,87076,CPT,Facility,Outpatient,,,90,56,47.6,16.0496,56,Medica,Medical Assistance,24.976,44.6,,percent of total billed charges,,
"Organism Ref For Id, Anaerobic Bact (Mayo)OutsideLaboratory",,87076,CPT,Facility,Inpatient,,,90,56,47.6,16.0496,56,Medica,Medical Assistance,,,,,Included in per diem rate,
"Organism Ref For Id, Anaerobic Bact (Mayo)OutsideLaboratory",,87076,CPT,Facility,Outpatient,,,90,56,47.6,16.0496,56,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,27.888,49.8,,percent of total billed charges,,
"Organism Ref For Id, Anaerobic Bact (Mayo)OutsideLaboratory",,87076,CPT,Facility,Inpatient,,,90,56,47.6,16.0496,56,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Organism Ref For Id, Anaerobic Bact (Mayo)OutsideLaboratory",,87076,CPT,Facility,Both,,,90,56,47.6,16.0496,56,"Multiplan, Inc.","Multiplan, Inc.",52.64,94,,percent of total billed charges,,
"Organism Ref For Id, Anaerobic Bact (Mayo)OutsideLaboratory",,87076,CPT,Facility,Outpatient,,,90,56,47.6,16.0496,56,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,48.384,86.4,,percent of total billed charges,,
"Organism Ref For Id, Anaerobic Bact (Mayo)OutsideLaboratory",,87076,CPT,Facility,Inpatient,,,90,56,47.6,16.0496,56,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Organism Ref For Id, Anaerobic Bact (Mayo)OutsideLaboratory",,87076,CPT,Facility,Both,,,90,56,47.6,16.0496,56,"Preferred One Administrative Services, INC.",PPO,55.216,98.6,,percent of total billed charges,,
"Organism Ref For Id, Anaerobic Bact (Mayo)OutsideLaboratory",,87076,CPT,Facility,Outpatient,,,90,56,47.6,16.0496,56,PrimeWest Health,Minnesota Senior Health Options (MSHO),28.812,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Organism Ref For Id, Anaerobic Bact (Mayo)OutsideLaboratory",,87076,CPT,Facility,Inpatient,,,90,56,47.6,16.0496,56,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Organism Ref For Id, Anaerobic Bact (Mayo)OutsideLaboratory",,87076,CPT,Facility,Outpatient,,,90,56,47.6,16.0496,56,PrimeWest Health,MinnesotaCare,28.7616,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Organism Ref For Id, Anaerobic Bact (Mayo)OutsideLaboratory",,87076,CPT,Facility,Inpatient,,,90,56,47.6,16.0496,56,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Organism Ref For Id, Anaerobic Bact (Mayo)OutsideLaboratory",,87076,CPT,Facility,Both,,,90,56,47.6,16.0496,56,Sanford Health Plan,Sanford Health Plan,51.52,92,,percent of total billed charges,,
"Organism Ref For Id, Anaerobic Bact (Mayo)OutsideLaboratory",,87076,CPT,Facility,Outpatient,,,90,56,47.6,16.0496,56,"UCare Health, Inc.",Individual & Family Plan,31.556,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Organism Ref For Id, Anaerobic Bact (Mayo)OutsideLaboratory",,87076,CPT,Facility,Inpatient,,,90,56,47.6,16.0496,56,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Organism Ref For Id, Anaerobic Bact (Mayo)OutsideLaboratory",,87076,CPT,Facility,Outpatient,,,90,56,47.6,16.0496,56,"UCare Health, Inc.",Medical Assistance,28.2632,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Organism Ref For Id, Anaerobic Bact (Mayo)OutsideLaboratory",,87076,CPT,Facility,Inpatient,,,90,56,47.6,16.0496,56,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Organism Ref For Id, Anaerobic Bact (Mayo)OutsideLaboratory",,87076,CPT,Facility,Outpatient,,,90,56,47.6,16.0496,56,"UCare Health, Inc.",Medicare Advantage,28.2632,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Organism Ref For Id, Anaerobic Bact (Mayo)OutsideLaboratory",,87076,CPT,Facility,Inpatient,,,90,56,47.6,16.0496,56,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Organism Ref For Id, Anaerobic Bact (Mayo)OutsideLaboratory",,87076,CPT,Facility,Outpatient,,,90,56,47.6,16.0496,56,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),28.2632,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Organism Ref For Id, Anaerobic Bact (Mayo)OutsideLaboratory",,87076,CPT,Facility,Inpatient,,,90,56,47.6,16.0496,56,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Organism Ref For Id, Anaerobic Bact (Mayo)OutsideLaboratory",,87076,CPT,Facility,Both,,,90,56,47.6,16.0496,56,UnitedHealthcare,Individual & Family,52.64,94,,percent of total billed charges,,
"Organism Ref For Id, Anaerobic Bact (Mayo)OutsideLaboratory",,87076,CPT,Facility,Outpatient,,,90,56,47.6,16.0496,56,UnitedHealthcare,Medicare Advantage,27.44,49,,percent of total billed charges,,
"Organism Ref For Id, Anaerobic Bact (Mayo)OutsideLaboratory",,87076,CPT,Facility,Inpatient,,,90,56,47.6,16.0496,56,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Organism Ref For Id, Anaerobic Bact (Mayo)OutsideLaboratory",,87076,CPT,Facility,Outpatient,,,90,56,47.6,16.0496,56,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,26.88,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Organism Ref For Id, Anaerobic Bact (Mayo)OutsideLaboratory",,87076,CPT,Facility,Inpatient,,,90,56,47.6,16.0496,56,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Organism Refer For Id, Aerobic Bact (Mayo)OutsideLaboratory",,87077,CPT,Facility,Both,,,90,71,60.35,20.3486,71,Aetna,Commercial,65.32,92,,percent of total billed charges,,
"Organism Refer For Id, Aerobic Bact (Mayo)OutsideLaboratory",,87077,CPT,Facility,Outpatient,,,90,71,60.35,20.3486,71,Aetna,Medicare Advantage,34.79,49,,percent of total billed charges,,
"Organism Refer For Id, Aerobic Bact (Mayo)OutsideLaboratory",,87077,CPT,Facility,Inpatient,,,90,71,60.35,20.3486,71,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Organism Refer For Id, Aerobic Bact (Mayo)OutsideLaboratory",,87077,CPT,Facility,Both,,,90,71,60.35,20.3486,71,Aetna,PPO,66.03,93,,percent of total billed charges,,
"Organism Refer For Id, Aerobic Bact (Mayo)OutsideLaboratory",,87077,CPT,Facility,Both,,,90,71,60.35,20.3486,71,America's PPO,America's PPO,68.1813,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Organism Refer For Id, Aerobic Bact (Mayo)OutsideLaboratory",,87077,CPT,Facility,Both,,,90,71,60.35,20.3486,71,BlueCross BlueShield Minnesota, Federal Employee Program,69.864,98.4,,percent of total billed charges,,
"Organism Refer For Id, Aerobic Bact (Mayo)OutsideLaboratory",,87077,CPT,Facility,Both,,,90,71,60.35,20.3486,71,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,71,100,,percent of total billed charges,,
"Organism Refer For Id, Aerobic Bact (Mayo)OutsideLaboratory",,87077,CPT,Facility,Both,,,90,71,60.35,20.3486,71,BlueCross BlueShield Minnesota,High Value Network Plan,63.9,90,,percent of total billed charges,,
"Organism Refer For Id, Aerobic Bact (Mayo)OutsideLaboratory",,87077,CPT,Facility,Outpatient,,,90,71,60.35,20.3486,71,BlueCross BlueShield Minnesota,Medicare Advantage,34.79,49,,percent of total billed charges,,
"Organism Refer For Id, Aerobic Bact (Mayo)OutsideLaboratory",,87077,CPT,Facility,Inpatient,,,90,71,60.35,20.3486,71,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Organism Refer For Id, Aerobic Bact (Mayo)OutsideLaboratory",,87077,CPT,Facility,Both,,,90,71,60.35,20.3486,71,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,62.8847,88.57,,percent of total billed charges,,
"Organism Refer For Id, Aerobic Bact (Mayo)OutsideLaboratory",,87077,CPT,Facility,Both,,,90,71,60.35,20.3486,71,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,20.3486,28.66,,percent of total billed charges,,
"Organism Refer For Id, Aerobic Bact (Mayo)OutsideLaboratory",,87077,CPT,Facility,Outpatient,,,90,71,60.35,20.3486,71,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),34.79,49,,percent of total billed charges,,
"Organism Refer For Id, Aerobic Bact (Mayo)OutsideLaboratory",,87077,CPT,Facility,Inpatient,,,90,71,60.35,20.3486,71,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Organism Refer For Id, Aerobic Bact (Mayo)OutsideLaboratory",,87077,CPT,Facility,Both,,,90,71,60.35,20.3486,71,CorVel,Worker's Compensation,71,100,,percent of total billed charges,,
"Organism Refer For Id, Aerobic Bact (Mayo)OutsideLaboratory",,87077,CPT,Facility,Both,,,90,71,60.35,20.3486,71,First Health Group Corporation,First Health Network,68.87,97,,percent of total billed charges,,
"Organism Refer For Id, Aerobic Bact (Mayo)OutsideLaboratory",,87077,CPT,Facility,Both,,,90,71,60.35,20.3486,71,"Health Partners, Inc.",Commercial,67.166,94.6,,percent of total billed charges,,
"Organism Refer For Id, Aerobic Bact (Mayo)OutsideLaboratory",,87077,CPT,Facility,Outpatient,,,90,71,60.35,20.3486,71,"Health Partners, Inc.",Medicare Advantage,34.79,49,,percent of total billed charges,,
"Organism Refer For Id, Aerobic Bact (Mayo)OutsideLaboratory",,87077,CPT,Facility,Inpatient,,,90,71,60.35,20.3486,71,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Organism Refer For Id, Aerobic Bact (Mayo)OutsideLaboratory",,87077,CPT,Facility,Both,,,90,71,60.35,20.3486,71,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),42.6,60,,percent of total billed charges,,
"Organism Refer For Id, Aerobic Bact (Mayo)OutsideLaboratory",,87077,CPT,Facility,Both,,,90,71,60.35,20.3486,71,"Health Partners, Inc.",State of Minnesota Advantage Program,57.865,81.5,,percent of total billed charges,,
"Organism Refer For Id, Aerobic Bact (Mayo)OutsideLaboratory",,87077,CPT,Facility,Both,,,90,71,60.35,20.3486,71,"Health Partners, Inc.",State Public Programs,35.5,50,,percent of total billed charges,,
"Organism Refer For Id, Aerobic Bact (Mayo)OutsideLaboratory",,87077,CPT,Facility,Both,,,90,71,60.35,20.3486,71,Humana Insurance Company,Commercial PPO,67.45,95,,percent of total billed charges,,
"Organism Refer For Id, Aerobic Bact (Mayo)OutsideLaboratory",,87077,CPT,Facility,Outpatient,,,90,71,60.35,20.3486,71,Humana Insurance Company,Medicare PPO,34.79,49,,percent of total billed charges,,
"Organism Refer For Id, Aerobic Bact (Mayo)OutsideLaboratory",,87077,CPT,Facility,Inpatient,,,90,71,60.35,20.3486,71,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Organism Refer For Id, Aerobic Bact (Mayo)OutsideLaboratory",,87077,CPT,Facility,Both,,,90,71,60.35,20.3486,71,Medica,Individual & Family,70.361,99.1,,percent of total billed charges,,
"Organism Refer For Id, Aerobic Bact (Mayo)OutsideLaboratory",,87077,CPT,Facility,Outpatient,,,90,71,60.35,20.3486,71,Medica,Medica Advantage Solution,35.358,49.8,,percent of total billed charges,,
"Organism Refer For Id, Aerobic Bact (Mayo)OutsideLaboratory",,87077,CPT,Facility,Inpatient,,,90,71,60.35,20.3486,71,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Organism Refer For Id, Aerobic Bact (Mayo)OutsideLaboratory",,87077,CPT,Facility,Outpatient,,,90,71,60.35,20.3486,71,Medica,Medical Assistance,31.666,44.6,,percent of total billed charges,,
"Organism Refer For Id, Aerobic Bact (Mayo)OutsideLaboratory",,87077,CPT,Facility,Inpatient,,,90,71,60.35,20.3486,71,Medica,Medical Assistance,,,,,Included in per diem rate,
"Organism Refer For Id, Aerobic Bact (Mayo)OutsideLaboratory",,87077,CPT,Facility,Outpatient,,,90,71,60.35,20.3486,71,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,35.358,49.8,,percent of total billed charges,,
"Organism Refer For Id, Aerobic Bact (Mayo)OutsideLaboratory",,87077,CPT,Facility,Inpatient,,,90,71,60.35,20.3486,71,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Organism Refer For Id, Aerobic Bact (Mayo)OutsideLaboratory",,87077,CPT,Facility,Both,,,90,71,60.35,20.3486,71,"Multiplan, Inc.","Multiplan, Inc.",66.74,94,,percent of total billed charges,,
"Organism Refer For Id, Aerobic Bact (Mayo)OutsideLaboratory",,87077,CPT,Facility,Outpatient,,,90,71,60.35,20.3486,71,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,61.344,86.4,,percent of total billed charges,,
"Organism Refer For Id, Aerobic Bact (Mayo)OutsideLaboratory",,87077,CPT,Facility,Inpatient,,,90,71,60.35,20.3486,71,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Organism Refer For Id, Aerobic Bact (Mayo)OutsideLaboratory",,87077,CPT,Facility,Both,,,90,71,60.35,20.3486,71,"Preferred One Administrative Services, INC.",PPO,70.006,98.6,,percent of total billed charges,,
"Organism Refer For Id, Aerobic Bact (Mayo)OutsideLaboratory",,87077,CPT,Facility,Outpatient,,,90,71,60.35,20.3486,71,PrimeWest Health,Minnesota Senior Health Options (MSHO),36.5295,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Organism Refer For Id, Aerobic Bact (Mayo)OutsideLaboratory",,87077,CPT,Facility,Inpatient,,,90,71,60.35,20.3486,71,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Organism Refer For Id, Aerobic Bact (Mayo)OutsideLaboratory",,87077,CPT,Facility,Outpatient,,,90,71,60.35,20.3486,71,PrimeWest Health,MinnesotaCare,36.4656,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Organism Refer For Id, Aerobic Bact (Mayo)OutsideLaboratory",,87077,CPT,Facility,Inpatient,,,90,71,60.35,20.3486,71,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Organism Refer For Id, Aerobic Bact (Mayo)OutsideLaboratory",,87077,CPT,Facility,Both,,,90,71,60.35,20.3486,71,Sanford Health Plan,Sanford Health Plan,65.32,92,,percent of total billed charges,,
"Organism Refer For Id, Aerobic Bact (Mayo)OutsideLaboratory",,87077,CPT,Facility,Outpatient,,,90,71,60.35,20.3486,71,"UCare Health, Inc.",Individual & Family Plan,40.0085,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Organism Refer For Id, Aerobic Bact (Mayo)OutsideLaboratory",,87077,CPT,Facility,Inpatient,,,90,71,60.35,20.3486,71,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Organism Refer For Id, Aerobic Bact (Mayo)OutsideLaboratory",,87077,CPT,Facility,Outpatient,,,90,71,60.35,20.3486,71,"UCare Health, Inc.",Medical Assistance,35.8337,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Organism Refer For Id, Aerobic Bact (Mayo)OutsideLaboratory",,87077,CPT,Facility,Inpatient,,,90,71,60.35,20.3486,71,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Organism Refer For Id, Aerobic Bact (Mayo)OutsideLaboratory",,87077,CPT,Facility,Outpatient,,,90,71,60.35,20.3486,71,"UCare Health, Inc.",Medicare Advantage,35.8337,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Organism Refer For Id, Aerobic Bact (Mayo)OutsideLaboratory",,87077,CPT,Facility,Inpatient,,,90,71,60.35,20.3486,71,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Organism Refer For Id, Aerobic Bact (Mayo)OutsideLaboratory",,87077,CPT,Facility,Outpatient,,,90,71,60.35,20.3486,71,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),35.8337,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Organism Refer For Id, Aerobic Bact (Mayo)OutsideLaboratory",,87077,CPT,Facility,Inpatient,,,90,71,60.35,20.3486,71,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Organism Refer For Id, Aerobic Bact (Mayo)OutsideLaboratory",,87077,CPT,Facility,Both,,,90,71,60.35,20.3486,71,UnitedHealthcare,Individual & Family,66.74,94,,percent of total billed charges,,
"Organism Refer For Id, Aerobic Bact (Mayo)OutsideLaboratory",,87077,CPT,Facility,Outpatient,,,90,71,60.35,20.3486,71,UnitedHealthcare,Medicare Advantage,34.79,49,,percent of total billed charges,,
"Organism Refer For Id, Aerobic Bact (Mayo)OutsideLaboratory",,87077,CPT,Facility,Inpatient,,,90,71,60.35,20.3486,71,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Organism Refer For Id, Aerobic Bact (Mayo)OutsideLaboratory",,87077,CPT,Facility,Outpatient,,,90,71,60.35,20.3486,71,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,34.08,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Organism Refer For Id, Aerobic Bact (Mayo)OutsideLaboratory",,87077,CPT,Facility,Inpatient,,,90,71,60.35,20.3486,71,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Fungal Culture, Blood (Mayo)OutsideLaboratory",,87103,CPT,Facility,Both,,,90,110,93.5,31.526,110,Aetna,Commercial,101.2,92,,percent of total billed charges,,
"Fungal Culture, Blood (Mayo)OutsideLaboratory",,87103,CPT,Facility,Outpatient,,,90,110,93.5,31.526,110,Aetna,Medicare Advantage,53.9,49,,percent of total billed charges,,
"Fungal Culture, Blood (Mayo)OutsideLaboratory",,87103,CPT,Facility,Inpatient,,,90,110,93.5,31.526,110,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Fungal Culture, Blood (Mayo)OutsideLaboratory",,87103,CPT,Facility,Both,,,90,110,93.5,31.526,110,Aetna,PPO,102.3,93,,percent of total billed charges,,
"Fungal Culture, Blood (Mayo)OutsideLaboratory",,87103,CPT,Facility,Both,,,90,110,93.5,31.526,110,America's PPO,America's PPO,105.633,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Fungal Culture, Blood (Mayo)OutsideLaboratory",,87103,CPT,Facility,Both,,,90,110,93.5,31.526,110,BlueCross BlueShield Minnesota, Federal Employee Program,108.24,98.4,,percent of total billed charges,,
"Fungal Culture, Blood (Mayo)OutsideLaboratory",,87103,CPT,Facility,Both,,,90,110,93.5,31.526,110,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,110,100,,percent of total billed charges,,
"Fungal Culture, Blood (Mayo)OutsideLaboratory",,87103,CPT,Facility,Both,,,90,110,93.5,31.526,110,BlueCross BlueShield Minnesota,High Value Network Plan,99,90,,percent of total billed charges,,
"Fungal Culture, Blood (Mayo)OutsideLaboratory",,87103,CPT,Facility,Outpatient,,,90,110,93.5,31.526,110,BlueCross BlueShield Minnesota,Medicare Advantage,53.9,49,,percent of total billed charges,,
"Fungal Culture, Blood (Mayo)OutsideLaboratory",,87103,CPT,Facility,Inpatient,,,90,110,93.5,31.526,110,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Fungal Culture, Blood (Mayo)OutsideLaboratory",,87103,CPT,Facility,Both,,,90,110,93.5,31.526,110,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,97.427,88.57,,percent of total billed charges,,
"Fungal Culture, Blood (Mayo)OutsideLaboratory",,87103,CPT,Facility,Both,,,90,110,93.5,31.526,110,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,31.526,28.66,,percent of total billed charges,,
"Fungal Culture, Blood (Mayo)OutsideLaboratory",,87103,CPT,Facility,Outpatient,,,90,110,93.5,31.526,110,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),53.9,49,,percent of total billed charges,,
"Fungal Culture, Blood (Mayo)OutsideLaboratory",,87103,CPT,Facility,Inpatient,,,90,110,93.5,31.526,110,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Fungal Culture, Blood (Mayo)OutsideLaboratory",,87103,CPT,Facility,Both,,,90,110,93.5,31.526,110,CorVel,Worker's Compensation,110,100,,percent of total billed charges,,
"Fungal Culture, Blood (Mayo)OutsideLaboratory",,87103,CPT,Facility,Both,,,90,110,93.5,31.526,110,First Health Group Corporation,First Health Network,106.7,97,,percent of total billed charges,,
"Fungal Culture, Blood (Mayo)OutsideLaboratory",,87103,CPT,Facility,Both,,,90,110,93.5,31.526,110,"Health Partners, Inc.",Commercial,104.06,94.6,,percent of total billed charges,,
"Fungal Culture, Blood (Mayo)OutsideLaboratory",,87103,CPT,Facility,Outpatient,,,90,110,93.5,31.526,110,"Health Partners, Inc.",Medicare Advantage,53.9,49,,percent of total billed charges,,
"Fungal Culture, Blood (Mayo)OutsideLaboratory",,87103,CPT,Facility,Inpatient,,,90,110,93.5,31.526,110,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Fungal Culture, Blood (Mayo)OutsideLaboratory",,87103,CPT,Facility,Both,,,90,110,93.5,31.526,110,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),66,60,,percent of total billed charges,,
"Fungal Culture, Blood (Mayo)OutsideLaboratory",,87103,CPT,Facility,Both,,,90,110,93.5,31.526,110,"Health Partners, Inc.",State of Minnesota Advantage Program,89.65,81.5,,percent of total billed charges,,
"Fungal Culture, Blood (Mayo)OutsideLaboratory",,87103,CPT,Facility,Both,,,90,110,93.5,31.526,110,"Health Partners, Inc.",State Public Programs,55,50,,percent of total billed charges,,
"Fungal Culture, Blood (Mayo)OutsideLaboratory",,87103,CPT,Facility,Both,,,90,110,93.5,31.526,110,Humana Insurance Company,Commercial PPO,104.5,95,,percent of total billed charges,,
"Fungal Culture, Blood (Mayo)OutsideLaboratory",,87103,CPT,Facility,Outpatient,,,90,110,93.5,31.526,110,Humana Insurance Company,Medicare PPO,53.9,49,,percent of total billed charges,,
"Fungal Culture, Blood (Mayo)OutsideLaboratory",,87103,CPT,Facility,Inpatient,,,90,110,93.5,31.526,110,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Fungal Culture, Blood (Mayo)OutsideLaboratory",,87103,CPT,Facility,Both,,,90,110,93.5,31.526,110,Medica,Individual & Family,109.01,99.1,,percent of total billed charges,,
"Fungal Culture, Blood (Mayo)OutsideLaboratory",,87103,CPT,Facility,Outpatient,,,90,110,93.5,31.526,110,Medica,Medica Advantage Solution,54.78,49.8,,percent of total billed charges,,
"Fungal Culture, Blood (Mayo)OutsideLaboratory",,87103,CPT,Facility,Inpatient,,,90,110,93.5,31.526,110,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Fungal Culture, Blood (Mayo)OutsideLaboratory",,87103,CPT,Facility,Outpatient,,,90,110,93.5,31.526,110,Medica,Medical Assistance,49.06,44.6,,percent of total billed charges,,
"Fungal Culture, Blood (Mayo)OutsideLaboratory",,87103,CPT,Facility,Inpatient,,,90,110,93.5,31.526,110,Medica,Medical Assistance,,,,,Included in per diem rate,
"Fungal Culture, Blood (Mayo)OutsideLaboratory",,87103,CPT,Facility,Outpatient,,,90,110,93.5,31.526,110,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,54.78,49.8,,percent of total billed charges,,
"Fungal Culture, Blood (Mayo)OutsideLaboratory",,87103,CPT,Facility,Inpatient,,,90,110,93.5,31.526,110,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Fungal Culture, Blood (Mayo)OutsideLaboratory",,87103,CPT,Facility,Both,,,90,110,93.5,31.526,110,"Multiplan, Inc.","Multiplan, Inc.",103.4,94,,percent of total billed charges,,
"Fungal Culture, Blood (Mayo)OutsideLaboratory",,87103,CPT,Facility,Outpatient,,,90,110,93.5,31.526,110,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,95.04,86.4,,percent of total billed charges,,
"Fungal Culture, Blood (Mayo)OutsideLaboratory",,87103,CPT,Facility,Inpatient,,,90,110,93.5,31.526,110,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Fungal Culture, Blood (Mayo)OutsideLaboratory",,87103,CPT,Facility,Both,,,90,110,93.5,31.526,110,"Preferred One Administrative Services, INC.",PPO,108.46,98.6,,percent of total billed charges,,
"Fungal Culture, Blood (Mayo)OutsideLaboratory",,87103,CPT,Facility,Outpatient,,,90,110,93.5,31.526,110,PrimeWest Health,Minnesota Senior Health Options (MSHO),56.595,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Fungal Culture, Blood (Mayo)OutsideLaboratory",,87103,CPT,Facility,Inpatient,,,90,110,93.5,31.526,110,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Fungal Culture, Blood (Mayo)OutsideLaboratory",,87103,CPT,Facility,Outpatient,,,90,110,93.5,31.526,110,PrimeWest Health,MinnesotaCare,56.496,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Fungal Culture, Blood (Mayo)OutsideLaboratory",,87103,CPT,Facility,Inpatient,,,90,110,93.5,31.526,110,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Fungal Culture, Blood (Mayo)OutsideLaboratory",,87103,CPT,Facility,Both,,,90,110,93.5,31.526,110,Sanford Health Plan,Sanford Health Plan,101.2,92,,percent of total billed charges,,
"Fungal Culture, Blood (Mayo)OutsideLaboratory",,87103,CPT,Facility,Outpatient,,,90,110,93.5,31.526,110,"UCare Health, Inc.",Individual & Family Plan,61.985,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Fungal Culture, Blood (Mayo)OutsideLaboratory",,87103,CPT,Facility,Inpatient,,,90,110,93.5,31.526,110,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Fungal Culture, Blood (Mayo)OutsideLaboratory",,87103,CPT,Facility,Outpatient,,,90,110,93.5,31.526,110,"UCare Health, Inc.",Medical Assistance,55.517,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Fungal Culture, Blood (Mayo)OutsideLaboratory",,87103,CPT,Facility,Inpatient,,,90,110,93.5,31.526,110,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Fungal Culture, Blood (Mayo)OutsideLaboratory",,87103,CPT,Facility,Outpatient,,,90,110,93.5,31.526,110,"UCare Health, Inc.",Medicare Advantage,55.517,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Fungal Culture, Blood (Mayo)OutsideLaboratory",,87103,CPT,Facility,Inpatient,,,90,110,93.5,31.526,110,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Fungal Culture, Blood (Mayo)OutsideLaboratory",,87103,CPT,Facility,Outpatient,,,90,110,93.5,31.526,110,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),55.517,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Fungal Culture, Blood (Mayo)OutsideLaboratory",,87103,CPT,Facility,Inpatient,,,90,110,93.5,31.526,110,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Fungal Culture, Blood (Mayo)OutsideLaboratory",,87103,CPT,Facility,Both,,,90,110,93.5,31.526,110,UnitedHealthcare,Individual & Family,103.4,94,,percent of total billed charges,,
"Fungal Culture, Blood (Mayo)OutsideLaboratory",,87103,CPT,Facility,Outpatient,,,90,110,93.5,31.526,110,UnitedHealthcare,Medicare Advantage,53.9,49,,percent of total billed charges,,
"Fungal Culture, Blood (Mayo)OutsideLaboratory",,87103,CPT,Facility,Inpatient,,,90,110,93.5,31.526,110,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Fungal Culture, Blood (Mayo)OutsideLaboratory",,87103,CPT,Facility,Outpatient,,,90,110,93.5,31.526,110,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,52.8,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Fungal Culture, Blood (Mayo)OutsideLaboratory",,87103,CPT,Facility,Inpatient,,,90,110,93.5,31.526,110,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Ident Maldi-Tof Mass Spec Yeast (Bill Only) (Mayo)OutsideLaboratory,,87106,CPT,Facility,Both,,,90,70,59.5,20.062,70,Aetna,Commercial,64.4,92,,percent of total billed charges,,
Ident Maldi-Tof Mass Spec Yeast (Bill Only) (Mayo)OutsideLaboratory,,87106,CPT,Facility,Outpatient,,,90,70,59.5,20.062,70,Aetna,Medicare Advantage,34.3,49,,percent of total billed charges,,
Ident Maldi-Tof Mass Spec Yeast (Bill Only) (Mayo)OutsideLaboratory,,87106,CPT,Facility,Inpatient,,,90,70,59.5,20.062,70,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Ident Maldi-Tof Mass Spec Yeast (Bill Only) (Mayo)OutsideLaboratory,,87106,CPT,Facility,Both,,,90,70,59.5,20.062,70,Aetna,PPO,65.1,93,,percent of total billed charges,,
Ident Maldi-Tof Mass Spec Yeast (Bill Only) (Mayo)OutsideLaboratory,,87106,CPT,Facility,Both,,,90,70,59.5,20.062,70,America's PPO,America's PPO,67.221,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Ident Maldi-Tof Mass Spec Yeast (Bill Only) (Mayo)OutsideLaboratory,,87106,CPT,Facility,Both,,,90,70,59.5,20.062,70,BlueCross BlueShield Minnesota, Federal Employee Program,68.88,98.4,,percent of total billed charges,,
Ident Maldi-Tof Mass Spec Yeast (Bill Only) (Mayo)OutsideLaboratory,,87106,CPT,Facility,Both,,,90,70,59.5,20.062,70,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,70,100,,percent of total billed charges,,
Ident Maldi-Tof Mass Spec Yeast (Bill Only) (Mayo)OutsideLaboratory,,87106,CPT,Facility,Both,,,90,70,59.5,20.062,70,BlueCross BlueShield Minnesota,High Value Network Plan,63,90,,percent of total billed charges,,
Ident Maldi-Tof Mass Spec Yeast (Bill Only) (Mayo)OutsideLaboratory,,87106,CPT,Facility,Outpatient,,,90,70,59.5,20.062,70,BlueCross BlueShield Minnesota,Medicare Advantage,34.3,49,,percent of total billed charges,,
Ident Maldi-Tof Mass Spec Yeast (Bill Only) (Mayo)OutsideLaboratory,,87106,CPT,Facility,Inpatient,,,90,70,59.5,20.062,70,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Ident Maldi-Tof Mass Spec Yeast (Bill Only) (Mayo)OutsideLaboratory,,87106,CPT,Facility,Both,,,90,70,59.5,20.062,70,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,61.999,88.57,,percent of total billed charges,,
Ident Maldi-Tof Mass Spec Yeast (Bill Only) (Mayo)OutsideLaboratory,,87106,CPT,Facility,Both,,,90,70,59.5,20.062,70,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,20.062,28.66,,percent of total billed charges,,
Ident Maldi-Tof Mass Spec Yeast (Bill Only) (Mayo)OutsideLaboratory,,87106,CPT,Facility,Outpatient,,,90,70,59.5,20.062,70,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),34.3,49,,percent of total billed charges,,
Ident Maldi-Tof Mass Spec Yeast (Bill Only) (Mayo)OutsideLaboratory,,87106,CPT,Facility,Inpatient,,,90,70,59.5,20.062,70,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Ident Maldi-Tof Mass Spec Yeast (Bill Only) (Mayo)OutsideLaboratory,,87106,CPT,Facility,Both,,,90,70,59.5,20.062,70,CorVel,Worker's Compensation,70,100,,percent of total billed charges,,
Ident Maldi-Tof Mass Spec Yeast (Bill Only) (Mayo)OutsideLaboratory,,87106,CPT,Facility,Both,,,90,70,59.5,20.062,70,First Health Group Corporation,First Health Network,67.9,97,,percent of total billed charges,,
Ident Maldi-Tof Mass Spec Yeast (Bill Only) (Mayo)OutsideLaboratory,,87106,CPT,Facility,Both,,,90,70,59.5,20.062,70,"Health Partners, Inc.",Commercial,66.22,94.6,,percent of total billed charges,,
Ident Maldi-Tof Mass Spec Yeast (Bill Only) (Mayo)OutsideLaboratory,,87106,CPT,Facility,Outpatient,,,90,70,59.5,20.062,70,"Health Partners, Inc.",Medicare Advantage,34.3,49,,percent of total billed charges,,
Ident Maldi-Tof Mass Spec Yeast (Bill Only) (Mayo)OutsideLaboratory,,87106,CPT,Facility,Inpatient,,,90,70,59.5,20.062,70,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ident Maldi-Tof Mass Spec Yeast (Bill Only) (Mayo)OutsideLaboratory,,87106,CPT,Facility,Both,,,90,70,59.5,20.062,70,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),42,60,,percent of total billed charges,,
Ident Maldi-Tof Mass Spec Yeast (Bill Only) (Mayo)OutsideLaboratory,,87106,CPT,Facility,Both,,,90,70,59.5,20.062,70,"Health Partners, Inc.",State of Minnesota Advantage Program,57.05,81.5,,percent of total billed charges,,
Ident Maldi-Tof Mass Spec Yeast (Bill Only) (Mayo)OutsideLaboratory,,87106,CPT,Facility,Both,,,90,70,59.5,20.062,70,"Health Partners, Inc.",State Public Programs,35,50,,percent of total billed charges,,
Ident Maldi-Tof Mass Spec Yeast (Bill Only) (Mayo)OutsideLaboratory,,87106,CPT,Facility,Both,,,90,70,59.5,20.062,70,Humana Insurance Company,Commercial PPO,66.5,95,,percent of total billed charges,,
Ident Maldi-Tof Mass Spec Yeast (Bill Only) (Mayo)OutsideLaboratory,,87106,CPT,Facility,Outpatient,,,90,70,59.5,20.062,70,Humana Insurance Company,Medicare PPO,34.3,49,,percent of total billed charges,,
Ident Maldi-Tof Mass Spec Yeast (Bill Only) (Mayo)OutsideLaboratory,,87106,CPT,Facility,Inpatient,,,90,70,59.5,20.062,70,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Ident Maldi-Tof Mass Spec Yeast (Bill Only) (Mayo)OutsideLaboratory,,87106,CPT,Facility,Both,,,90,70,59.5,20.062,70,Medica,Individual & Family,69.37,99.1,,percent of total billed charges,,
Ident Maldi-Tof Mass Spec Yeast (Bill Only) (Mayo)OutsideLaboratory,,87106,CPT,Facility,Outpatient,,,90,70,59.5,20.062,70,Medica,Medica Advantage Solution,34.86,49.8,,percent of total billed charges,,
Ident Maldi-Tof Mass Spec Yeast (Bill Only) (Mayo)OutsideLaboratory,,87106,CPT,Facility,Inpatient,,,90,70,59.5,20.062,70,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Ident Maldi-Tof Mass Spec Yeast (Bill Only) (Mayo)OutsideLaboratory,,87106,CPT,Facility,Outpatient,,,90,70,59.5,20.062,70,Medica,Medical Assistance,31.22,44.6,,percent of total billed charges,,
Ident Maldi-Tof Mass Spec Yeast (Bill Only) (Mayo)OutsideLaboratory,,87106,CPT,Facility,Inpatient,,,90,70,59.5,20.062,70,Medica,Medical Assistance,,,,,Included in per diem rate,
Ident Maldi-Tof Mass Spec Yeast (Bill Only) (Mayo)OutsideLaboratory,,87106,CPT,Facility,Outpatient,,,90,70,59.5,20.062,70,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,34.86,49.8,,percent of total billed charges,,
Ident Maldi-Tof Mass Spec Yeast (Bill Only) (Mayo)OutsideLaboratory,,87106,CPT,Facility,Inpatient,,,90,70,59.5,20.062,70,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Ident Maldi-Tof Mass Spec Yeast (Bill Only) (Mayo)OutsideLaboratory,,87106,CPT,Facility,Both,,,90,70,59.5,20.062,70,"Multiplan, Inc.","Multiplan, Inc.",65.8,94,,percent of total billed charges,,
Ident Maldi-Tof Mass Spec Yeast (Bill Only) (Mayo)OutsideLaboratory,,87106,CPT,Facility,Outpatient,,,90,70,59.5,20.062,70,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,60.48,86.4,,percent of total billed charges,,
Ident Maldi-Tof Mass Spec Yeast (Bill Only) (Mayo)OutsideLaboratory,,87106,CPT,Facility,Inpatient,,,90,70,59.5,20.062,70,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Ident Maldi-Tof Mass Spec Yeast (Bill Only) (Mayo)OutsideLaboratory,,87106,CPT,Facility,Both,,,90,70,59.5,20.062,70,"Preferred One Administrative Services, INC.",PPO,69.02,98.6,,percent of total billed charges,,
Ident Maldi-Tof Mass Spec Yeast (Bill Only) (Mayo)OutsideLaboratory,,87106,CPT,Facility,Outpatient,,,90,70,59.5,20.062,70,PrimeWest Health,Minnesota Senior Health Options (MSHO),36.015,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Ident Maldi-Tof Mass Spec Yeast (Bill Only) (Mayo)OutsideLaboratory,,87106,CPT,Facility,Inpatient,,,90,70,59.5,20.062,70,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ident Maldi-Tof Mass Spec Yeast (Bill Only) (Mayo)OutsideLaboratory,,87106,CPT,Facility,Outpatient,,,90,70,59.5,20.062,70,PrimeWest Health,MinnesotaCare,35.952,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Ident Maldi-Tof Mass Spec Yeast (Bill Only) (Mayo)OutsideLaboratory,,87106,CPT,Facility,Inpatient,,,90,70,59.5,20.062,70,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Ident Maldi-Tof Mass Spec Yeast (Bill Only) (Mayo)OutsideLaboratory,,87106,CPT,Facility,Both,,,90,70,59.5,20.062,70,Sanford Health Plan,Sanford Health Plan,64.4,92,,percent of total billed charges,,
Ident Maldi-Tof Mass Spec Yeast (Bill Only) (Mayo)OutsideLaboratory,,87106,CPT,Facility,Outpatient,,,90,70,59.5,20.062,70,"UCare Health, Inc.",Individual & Family Plan,39.445,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Ident Maldi-Tof Mass Spec Yeast (Bill Only) (Mayo)OutsideLaboratory,,87106,CPT,Facility,Inpatient,,,90,70,59.5,20.062,70,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Ident Maldi-Tof Mass Spec Yeast (Bill Only) (Mayo)OutsideLaboratory,,87106,CPT,Facility,Outpatient,,,90,70,59.5,20.062,70,"UCare Health, Inc.",Medical Assistance,35.329,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ident Maldi-Tof Mass Spec Yeast (Bill Only) (Mayo)OutsideLaboratory,,87106,CPT,Facility,Inpatient,,,90,70,59.5,20.062,70,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Ident Maldi-Tof Mass Spec Yeast (Bill Only) (Mayo)OutsideLaboratory,,87106,CPT,Facility,Outpatient,,,90,70,59.5,20.062,70,"UCare Health, Inc.",Medicare Advantage,35.329,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ident Maldi-Tof Mass Spec Yeast (Bill Only) (Mayo)OutsideLaboratory,,87106,CPT,Facility,Inpatient,,,90,70,59.5,20.062,70,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ident Maldi-Tof Mass Spec Yeast (Bill Only) (Mayo)OutsideLaboratory,,87106,CPT,Facility,Outpatient,,,90,70,59.5,20.062,70,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),35.329,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ident Maldi-Tof Mass Spec Yeast (Bill Only) (Mayo)OutsideLaboratory,,87106,CPT,Facility,Inpatient,,,90,70,59.5,20.062,70,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ident Maldi-Tof Mass Spec Yeast (Bill Only) (Mayo)OutsideLaboratory,,87106,CPT,Facility,Both,,,90,70,59.5,20.062,70,UnitedHealthcare,Individual & Family,65.8,94,,percent of total billed charges,,
Ident Maldi-Tof Mass Spec Yeast (Bill Only) (Mayo)OutsideLaboratory,,87106,CPT,Facility,Outpatient,,,90,70,59.5,20.062,70,UnitedHealthcare,Medicare Advantage,34.3,49,,percent of total billed charges,,
Ident Maldi-Tof Mass Spec Yeast (Bill Only) (Mayo)OutsideLaboratory,,87106,CPT,Facility,Inpatient,,,90,70,59.5,20.062,70,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Ident Maldi-Tof Mass Spec Yeast (Bill Only) (Mayo)OutsideLaboratory,,87106,CPT,Facility,Outpatient,,,90,70,59.5,20.062,70,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,33.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
Ident Maldi-Tof Mass Spec Yeast (Bill Only) (Mayo)OutsideLaboratory,,87106,CPT,Facility,Inpatient,,,90,70,59.5,20.062,70,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Culture Referred For Id, Fungus (Mayo)OutsideLaboratory",,87107,CPT,Facility,Both,,,90,84,71.4,24.0744,84,Aetna,Commercial,77.28,92,,percent of total billed charges,,
"Culture Referred For Id, Fungus (Mayo)OutsideLaboratory",,87107,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,Aetna,Medicare Advantage,41.16,49,,percent of total billed charges,,
"Culture Referred For Id, Fungus (Mayo)OutsideLaboratory",,87107,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Culture Referred For Id, Fungus (Mayo)OutsideLaboratory",,87107,CPT,Facility,Both,,,90,84,71.4,24.0744,84,Aetna,PPO,78.12,93,,percent of total billed charges,,
"Culture Referred For Id, Fungus (Mayo)OutsideLaboratory",,87107,CPT,Facility,Both,,,90,84,71.4,24.0744,84,America's PPO,America's PPO,80.6652,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Culture Referred For Id, Fungus (Mayo)OutsideLaboratory",,87107,CPT,Facility,Both,,,90,84,71.4,24.0744,84,BlueCross BlueShield Minnesota, Federal Employee Program,82.656,98.4,,percent of total billed charges,,
"Culture Referred For Id, Fungus (Mayo)OutsideLaboratory",,87107,CPT,Facility,Both,,,90,84,71.4,24.0744,84,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,84,100,,percent of total billed charges,,
"Culture Referred For Id, Fungus (Mayo)OutsideLaboratory",,87107,CPT,Facility,Both,,,90,84,71.4,24.0744,84,BlueCross BlueShield Minnesota,High Value Network Plan,75.6,90,,percent of total billed charges,,
"Culture Referred For Id, Fungus (Mayo)OutsideLaboratory",,87107,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,BlueCross BlueShield Minnesota,Medicare Advantage,41.16,49,,percent of total billed charges,,
"Culture Referred For Id, Fungus (Mayo)OutsideLaboratory",,87107,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Culture Referred For Id, Fungus (Mayo)OutsideLaboratory",,87107,CPT,Facility,Both,,,90,84,71.4,24.0744,84,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,74.3988,88.57,,percent of total billed charges,,
"Culture Referred For Id, Fungus (Mayo)OutsideLaboratory",,87107,CPT,Facility,Both,,,90,84,71.4,24.0744,84,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,24.0744,28.66,,percent of total billed charges,,
"Culture Referred For Id, Fungus (Mayo)OutsideLaboratory",,87107,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),41.16,49,,percent of total billed charges,,
"Culture Referred For Id, Fungus (Mayo)OutsideLaboratory",,87107,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Culture Referred For Id, Fungus (Mayo)OutsideLaboratory",,87107,CPT,Facility,Both,,,90,84,71.4,24.0744,84,CorVel,Worker's Compensation,84,100,,percent of total billed charges,,
"Culture Referred For Id, Fungus (Mayo)OutsideLaboratory",,87107,CPT,Facility,Both,,,90,84,71.4,24.0744,84,First Health Group Corporation,First Health Network,81.48,97,,percent of total billed charges,,
"Culture Referred For Id, Fungus (Mayo)OutsideLaboratory",,87107,CPT,Facility,Both,,,90,84,71.4,24.0744,84,"Health Partners, Inc.",Commercial,79.464,94.6,,percent of total billed charges,,
"Culture Referred For Id, Fungus (Mayo)OutsideLaboratory",,87107,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,"Health Partners, Inc.",Medicare Advantage,41.16,49,,percent of total billed charges,,
"Culture Referred For Id, Fungus (Mayo)OutsideLaboratory",,87107,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Culture Referred For Id, Fungus (Mayo)OutsideLaboratory",,87107,CPT,Facility,Both,,,90,84,71.4,24.0744,84,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),50.4,60,,percent of total billed charges,,
"Culture Referred For Id, Fungus (Mayo)OutsideLaboratory",,87107,CPT,Facility,Both,,,90,84,71.4,24.0744,84,"Health Partners, Inc.",State of Minnesota Advantage Program,68.46,81.5,,percent of total billed charges,,
"Culture Referred For Id, Fungus (Mayo)OutsideLaboratory",,87107,CPT,Facility,Both,,,90,84,71.4,24.0744,84,"Health Partners, Inc.",State Public Programs,42,50,,percent of total billed charges,,
"Culture Referred For Id, Fungus (Mayo)OutsideLaboratory",,87107,CPT,Facility,Both,,,90,84,71.4,24.0744,84,Humana Insurance Company,Commercial PPO,79.8,95,,percent of total billed charges,,
"Culture Referred For Id, Fungus (Mayo)OutsideLaboratory",,87107,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,Humana Insurance Company,Medicare PPO,41.16,49,,percent of total billed charges,,
"Culture Referred For Id, Fungus (Mayo)OutsideLaboratory",,87107,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Culture Referred For Id, Fungus (Mayo)OutsideLaboratory",,87107,CPT,Facility,Both,,,90,84,71.4,24.0744,84,Medica,Individual & Family,83.244,99.1,,percent of total billed charges,,
"Culture Referred For Id, Fungus (Mayo)OutsideLaboratory",,87107,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,Medica,Medica Advantage Solution,41.832,49.8,,percent of total billed charges,,
"Culture Referred For Id, Fungus (Mayo)OutsideLaboratory",,87107,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Culture Referred For Id, Fungus (Mayo)OutsideLaboratory",,87107,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,Medica,Medical Assistance,37.464,44.6,,percent of total billed charges,,
"Culture Referred For Id, Fungus (Mayo)OutsideLaboratory",,87107,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,Medica,Medical Assistance,,,,,Included in per diem rate,
"Culture Referred For Id, Fungus (Mayo)OutsideLaboratory",,87107,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,41.832,49.8,,percent of total billed charges,,
"Culture Referred For Id, Fungus (Mayo)OutsideLaboratory",,87107,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Culture Referred For Id, Fungus (Mayo)OutsideLaboratory",,87107,CPT,Facility,Both,,,90,84,71.4,24.0744,84,"Multiplan, Inc.","Multiplan, Inc.",78.96,94,,percent of total billed charges,,
"Culture Referred For Id, Fungus (Mayo)OutsideLaboratory",,87107,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,72.576,86.4,,percent of total billed charges,,
"Culture Referred For Id, Fungus (Mayo)OutsideLaboratory",,87107,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Culture Referred For Id, Fungus (Mayo)OutsideLaboratory",,87107,CPT,Facility,Both,,,90,84,71.4,24.0744,84,"Preferred One Administrative Services, INC.",PPO,82.824,98.6,,percent of total billed charges,,
"Culture Referred For Id, Fungus (Mayo)OutsideLaboratory",,87107,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,PrimeWest Health,Minnesota Senior Health Options (MSHO),43.218,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Culture Referred For Id, Fungus (Mayo)OutsideLaboratory",,87107,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Culture Referred For Id, Fungus (Mayo)OutsideLaboratory",,87107,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,PrimeWest Health,MinnesotaCare,43.1424,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Culture Referred For Id, Fungus (Mayo)OutsideLaboratory",,87107,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Culture Referred For Id, Fungus (Mayo)OutsideLaboratory",,87107,CPT,Facility,Both,,,90,84,71.4,24.0744,84,Sanford Health Plan,Sanford Health Plan,77.28,92,,percent of total billed charges,,
"Culture Referred For Id, Fungus (Mayo)OutsideLaboratory",,87107,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,"UCare Health, Inc.",Individual & Family Plan,47.334,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Culture Referred For Id, Fungus (Mayo)OutsideLaboratory",,87107,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Culture Referred For Id, Fungus (Mayo)OutsideLaboratory",,87107,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,"UCare Health, Inc.",Medical Assistance,42.3948,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Culture Referred For Id, Fungus (Mayo)OutsideLaboratory",,87107,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Culture Referred For Id, Fungus (Mayo)OutsideLaboratory",,87107,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,"UCare Health, Inc.",Medicare Advantage,42.3948,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Culture Referred For Id, Fungus (Mayo)OutsideLaboratory",,87107,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Culture Referred For Id, Fungus (Mayo)OutsideLaboratory",,87107,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),42.3948,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Culture Referred For Id, Fungus (Mayo)OutsideLaboratory",,87107,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Culture Referred For Id, Fungus (Mayo)OutsideLaboratory",,87107,CPT,Facility,Both,,,90,84,71.4,24.0744,84,UnitedHealthcare,Individual & Family,78.96,94,,percent of total billed charges,,
"Culture Referred For Id, Fungus (Mayo)OutsideLaboratory",,87107,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,UnitedHealthcare,Medicare Advantage,41.16,49,,percent of total billed charges,,
"Culture Referred For Id, Fungus (Mayo)OutsideLaboratory",,87107,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Culture Referred For Id, Fungus (Mayo)OutsideLaboratory",,87107,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,40.32,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Culture Referred For Id, Fungus (Mayo)OutsideLaboratory",,87107,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Mycobacterial Culture (Mayo)OutsideLaboratory,,87116,CPT,Facility,Both,,,90,57,48.45,16.3362,57,Aetna,Commercial,52.44,92,,percent of total billed charges,,
Mycobacterial Culture (Mayo)OutsideLaboratory,,87116,CPT,Facility,Outpatient,,,90,57,48.45,16.3362,57,Aetna,Medicare Advantage,27.93,49,,percent of total billed charges,,
Mycobacterial Culture (Mayo)OutsideLaboratory,,87116,CPT,Facility,Inpatient,,,90,57,48.45,16.3362,57,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Mycobacterial Culture (Mayo)OutsideLaboratory,,87116,CPT,Facility,Both,,,90,57,48.45,16.3362,57,Aetna,PPO,53.01,93,,percent of total billed charges,,
Mycobacterial Culture (Mayo)OutsideLaboratory,,87116,CPT,Facility,Both,,,90,57,48.45,16.3362,57,America's PPO,America's PPO,54.7371,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Mycobacterial Culture (Mayo)OutsideLaboratory,,87116,CPT,Facility,Both,,,90,57,48.45,16.3362,57,BlueCross BlueShield Minnesota, Federal Employee Program,56.088,98.4,,percent of total billed charges,,
Mycobacterial Culture (Mayo)OutsideLaboratory,,87116,CPT,Facility,Both,,,90,57,48.45,16.3362,57,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,57,100,,percent of total billed charges,,
Mycobacterial Culture (Mayo)OutsideLaboratory,,87116,CPT,Facility,Both,,,90,57,48.45,16.3362,57,BlueCross BlueShield Minnesota,High Value Network Plan,51.3,90,,percent of total billed charges,,
Mycobacterial Culture (Mayo)OutsideLaboratory,,87116,CPT,Facility,Outpatient,,,90,57,48.45,16.3362,57,BlueCross BlueShield Minnesota,Medicare Advantage,27.93,49,,percent of total billed charges,,
Mycobacterial Culture (Mayo)OutsideLaboratory,,87116,CPT,Facility,Inpatient,,,90,57,48.45,16.3362,57,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Mycobacterial Culture (Mayo)OutsideLaboratory,,87116,CPT,Facility,Both,,,90,57,48.45,16.3362,57,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,50.4849,88.57,,percent of total billed charges,,
Mycobacterial Culture (Mayo)OutsideLaboratory,,87116,CPT,Facility,Both,,,90,57,48.45,16.3362,57,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,16.3362,28.66,,percent of total billed charges,,
Mycobacterial Culture (Mayo)OutsideLaboratory,,87116,CPT,Facility,Outpatient,,,90,57,48.45,16.3362,57,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),27.93,49,,percent of total billed charges,,
Mycobacterial Culture (Mayo)OutsideLaboratory,,87116,CPT,Facility,Inpatient,,,90,57,48.45,16.3362,57,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Mycobacterial Culture (Mayo)OutsideLaboratory,,87116,CPT,Facility,Both,,,90,57,48.45,16.3362,57,CorVel,Worker's Compensation,57,100,,percent of total billed charges,,
Mycobacterial Culture (Mayo)OutsideLaboratory,,87116,CPT,Facility,Both,,,90,57,48.45,16.3362,57,First Health Group Corporation,First Health Network,55.29,97,,percent of total billed charges,,
Mycobacterial Culture (Mayo)OutsideLaboratory,,87116,CPT,Facility,Both,,,90,57,48.45,16.3362,57,"Health Partners, Inc.",Commercial,53.922,94.6,,percent of total billed charges,,
Mycobacterial Culture (Mayo)OutsideLaboratory,,87116,CPT,Facility,Outpatient,,,90,57,48.45,16.3362,57,"Health Partners, Inc.",Medicare Advantage,27.93,49,,percent of total billed charges,,
Mycobacterial Culture (Mayo)OutsideLaboratory,,87116,CPT,Facility,Inpatient,,,90,57,48.45,16.3362,57,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mycobacterial Culture (Mayo)OutsideLaboratory,,87116,CPT,Facility,Both,,,90,57,48.45,16.3362,57,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),34.2,60,,percent of total billed charges,,
Mycobacterial Culture (Mayo)OutsideLaboratory,,87116,CPT,Facility,Both,,,90,57,48.45,16.3362,57,"Health Partners, Inc.",State of Minnesota Advantage Program,46.455,81.5,,percent of total billed charges,,
Mycobacterial Culture (Mayo)OutsideLaboratory,,87116,CPT,Facility,Both,,,90,57,48.45,16.3362,57,"Health Partners, Inc.",State Public Programs,28.5,50,,percent of total billed charges,,
Mycobacterial Culture (Mayo)OutsideLaboratory,,87116,CPT,Facility,Both,,,90,57,48.45,16.3362,57,Humana Insurance Company,Commercial PPO,54.15,95,,percent of total billed charges,,
Mycobacterial Culture (Mayo)OutsideLaboratory,,87116,CPT,Facility,Outpatient,,,90,57,48.45,16.3362,57,Humana Insurance Company,Medicare PPO,27.93,49,,percent of total billed charges,,
Mycobacterial Culture (Mayo)OutsideLaboratory,,87116,CPT,Facility,Inpatient,,,90,57,48.45,16.3362,57,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Mycobacterial Culture (Mayo)OutsideLaboratory,,87116,CPT,Facility,Both,,,90,57,48.45,16.3362,57,Medica,Individual & Family,56.487,99.1,,percent of total billed charges,,
Mycobacterial Culture (Mayo)OutsideLaboratory,,87116,CPT,Facility,Outpatient,,,90,57,48.45,16.3362,57,Medica,Medica Advantage Solution,28.386,49.8,,percent of total billed charges,,
Mycobacterial Culture (Mayo)OutsideLaboratory,,87116,CPT,Facility,Inpatient,,,90,57,48.45,16.3362,57,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Mycobacterial Culture (Mayo)OutsideLaboratory,,87116,CPT,Facility,Outpatient,,,90,57,48.45,16.3362,57,Medica,Medical Assistance,25.422,44.6,,percent of total billed charges,,
Mycobacterial Culture (Mayo)OutsideLaboratory,,87116,CPT,Facility,Inpatient,,,90,57,48.45,16.3362,57,Medica,Medical Assistance,,,,,Included in per diem rate,
Mycobacterial Culture (Mayo)OutsideLaboratory,,87116,CPT,Facility,Outpatient,,,90,57,48.45,16.3362,57,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,28.386,49.8,,percent of total billed charges,,
Mycobacterial Culture (Mayo)OutsideLaboratory,,87116,CPT,Facility,Inpatient,,,90,57,48.45,16.3362,57,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Mycobacterial Culture (Mayo)OutsideLaboratory,,87116,CPT,Facility,Both,,,90,57,48.45,16.3362,57,"Multiplan, Inc.","Multiplan, Inc.",53.58,94,,percent of total billed charges,,
Mycobacterial Culture (Mayo)OutsideLaboratory,,87116,CPT,Facility,Outpatient,,,90,57,48.45,16.3362,57,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,49.248,86.4,,percent of total billed charges,,
Mycobacterial Culture (Mayo)OutsideLaboratory,,87116,CPT,Facility,Inpatient,,,90,57,48.45,16.3362,57,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Mycobacterial Culture (Mayo)OutsideLaboratory,,87116,CPT,Facility,Both,,,90,57,48.45,16.3362,57,"Preferred One Administrative Services, INC.",PPO,56.202,98.6,,percent of total billed charges,,
Mycobacterial Culture (Mayo)OutsideLaboratory,,87116,CPT,Facility,Outpatient,,,90,57,48.45,16.3362,57,PrimeWest Health,Minnesota Senior Health Options (MSHO),29.3265,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Mycobacterial Culture (Mayo)OutsideLaboratory,,87116,CPT,Facility,Inpatient,,,90,57,48.45,16.3362,57,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mycobacterial Culture (Mayo)OutsideLaboratory,,87116,CPT,Facility,Outpatient,,,90,57,48.45,16.3362,57,PrimeWest Health,MinnesotaCare,29.2752,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Mycobacterial Culture (Mayo)OutsideLaboratory,,87116,CPT,Facility,Inpatient,,,90,57,48.45,16.3362,57,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Mycobacterial Culture (Mayo)OutsideLaboratory,,87116,CPT,Facility,Both,,,90,57,48.45,16.3362,57,Sanford Health Plan,Sanford Health Plan,52.44,92,,percent of total billed charges,,
Mycobacterial Culture (Mayo)OutsideLaboratory,,87116,CPT,Facility,Outpatient,,,90,57,48.45,16.3362,57,"UCare Health, Inc.",Individual & Family Plan,32.1195,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Mycobacterial Culture (Mayo)OutsideLaboratory,,87116,CPT,Facility,Inpatient,,,90,57,48.45,16.3362,57,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Mycobacterial Culture (Mayo)OutsideLaboratory,,87116,CPT,Facility,Outpatient,,,90,57,48.45,16.3362,57,"UCare Health, Inc.",Medical Assistance,28.7679,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mycobacterial Culture (Mayo)OutsideLaboratory,,87116,CPT,Facility,Inpatient,,,90,57,48.45,16.3362,57,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Mycobacterial Culture (Mayo)OutsideLaboratory,,87116,CPT,Facility,Outpatient,,,90,57,48.45,16.3362,57,"UCare Health, Inc.",Medicare Advantage,28.7679,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mycobacterial Culture (Mayo)OutsideLaboratory,,87116,CPT,Facility,Inpatient,,,90,57,48.45,16.3362,57,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mycobacterial Culture (Mayo)OutsideLaboratory,,87116,CPT,Facility,Outpatient,,,90,57,48.45,16.3362,57,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),28.7679,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mycobacterial Culture (Mayo)OutsideLaboratory,,87116,CPT,Facility,Inpatient,,,90,57,48.45,16.3362,57,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mycobacterial Culture (Mayo)OutsideLaboratory,,87116,CPT,Facility,Both,,,90,57,48.45,16.3362,57,UnitedHealthcare,Individual & Family,53.58,94,,percent of total billed charges,,
Mycobacterial Culture (Mayo)OutsideLaboratory,,87116,CPT,Facility,Outpatient,,,90,57,48.45,16.3362,57,UnitedHealthcare,Medicare Advantage,27.93,49,,percent of total billed charges,,
Mycobacterial Culture (Mayo)OutsideLaboratory,,87116,CPT,Facility,Inpatient,,,90,57,48.45,16.3362,57,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Mycobacterial Culture (Mayo)OutsideLaboratory,,87116,CPT,Facility,Outpatient,,,90,57,48.45,16.3362,57,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,27.36,48,,percent of total billed charges,,100% of DHS outpatient percentage
Mycobacterial Culture (Mayo)OutsideLaboratory,,87116,CPT,Facility,Inpatient,,,90,57,48.45,16.3362,57,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Ctbid, Culture, Ref Id, Mycobact (Mayo)OutsideLaboratory",,87118,CPT,Facility,Both,,,90,286,243.1,81.9676,286,Aetna,Commercial,263.12,92,,percent of total billed charges,,
"Ctbid, Culture, Ref Id, Mycobact (Mayo)OutsideLaboratory",,87118,CPT,Facility,Outpatient,,,90,286,243.1,81.9676,286,Aetna,Medicare Advantage,140.14,49,,percent of total billed charges,,
"Ctbid, Culture, Ref Id, Mycobact (Mayo)OutsideLaboratory",,87118,CPT,Facility,Inpatient,,,90,286,243.1,81.9676,286,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Ctbid, Culture, Ref Id, Mycobact (Mayo)OutsideLaboratory",,87118,CPT,Facility,Both,,,90,286,243.1,81.9676,286,Aetna,PPO,265.98,93,,percent of total billed charges,,
"Ctbid, Culture, Ref Id, Mycobact (Mayo)OutsideLaboratory",,87118,CPT,Facility,Both,,,90,286,243.1,81.9676,286,America's PPO,America's PPO,274.6458,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Ctbid, Culture, Ref Id, Mycobact (Mayo)OutsideLaboratory",,87118,CPT,Facility,Both,,,90,286,243.1,81.9676,286,BlueCross BlueShield Minnesota, Federal Employee Program,281.424,98.4,,percent of total billed charges,,
"Ctbid, Culture, Ref Id, Mycobact (Mayo)OutsideLaboratory",,87118,CPT,Facility,Both,,,90,286,243.1,81.9676,286,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,286,100,,percent of total billed charges,,
"Ctbid, Culture, Ref Id, Mycobact (Mayo)OutsideLaboratory",,87118,CPT,Facility,Both,,,90,286,243.1,81.9676,286,BlueCross BlueShield Minnesota,High Value Network Plan,257.4,90,,percent of total billed charges,,
"Ctbid, Culture, Ref Id, Mycobact (Mayo)OutsideLaboratory",,87118,CPT,Facility,Outpatient,,,90,286,243.1,81.9676,286,BlueCross BlueShield Minnesota,Medicare Advantage,140.14,49,,percent of total billed charges,,
"Ctbid, Culture, Ref Id, Mycobact (Mayo)OutsideLaboratory",,87118,CPT,Facility,Inpatient,,,90,286,243.1,81.9676,286,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Ctbid, Culture, Ref Id, Mycobact (Mayo)OutsideLaboratory",,87118,CPT,Facility,Both,,,90,286,243.1,81.9676,286,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,253.3102,88.57,,percent of total billed charges,,
"Ctbid, Culture, Ref Id, Mycobact (Mayo)OutsideLaboratory",,87118,CPT,Facility,Both,,,90,286,243.1,81.9676,286,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,81.9676,28.66,,percent of total billed charges,,
"Ctbid, Culture, Ref Id, Mycobact (Mayo)OutsideLaboratory",,87118,CPT,Facility,Outpatient,,,90,286,243.1,81.9676,286,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),140.14,49,,percent of total billed charges,,
"Ctbid, Culture, Ref Id, Mycobact (Mayo)OutsideLaboratory",,87118,CPT,Facility,Inpatient,,,90,286,243.1,81.9676,286,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Ctbid, Culture, Ref Id, Mycobact (Mayo)OutsideLaboratory",,87118,CPT,Facility,Both,,,90,286,243.1,81.9676,286,CorVel,Worker's Compensation,286,100,,percent of total billed charges,,
"Ctbid, Culture, Ref Id, Mycobact (Mayo)OutsideLaboratory",,87118,CPT,Facility,Both,,,90,286,243.1,81.9676,286,First Health Group Corporation,First Health Network,277.42,97,,percent of total billed charges,,
"Ctbid, Culture, Ref Id, Mycobact (Mayo)OutsideLaboratory",,87118,CPT,Facility,Both,,,90,286,243.1,81.9676,286,"Health Partners, Inc.",Commercial,270.556,94.6,,percent of total billed charges,,
"Ctbid, Culture, Ref Id, Mycobact (Mayo)OutsideLaboratory",,87118,CPT,Facility,Outpatient,,,90,286,243.1,81.9676,286,"Health Partners, Inc.",Medicare Advantage,140.14,49,,percent of total billed charges,,
"Ctbid, Culture, Ref Id, Mycobact (Mayo)OutsideLaboratory",,87118,CPT,Facility,Inpatient,,,90,286,243.1,81.9676,286,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Ctbid, Culture, Ref Id, Mycobact (Mayo)OutsideLaboratory",,87118,CPT,Facility,Both,,,90,286,243.1,81.9676,286,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),171.6,60,,percent of total billed charges,,
"Ctbid, Culture, Ref Id, Mycobact (Mayo)OutsideLaboratory",,87118,CPT,Facility,Both,,,90,286,243.1,81.9676,286,"Health Partners, Inc.",State of Minnesota Advantage Program,233.09,81.5,,percent of total billed charges,,
"Ctbid, Culture, Ref Id, Mycobact (Mayo)OutsideLaboratory",,87118,CPT,Facility,Both,,,90,286,243.1,81.9676,286,"Health Partners, Inc.",State Public Programs,143,50,,percent of total billed charges,,
"Ctbid, Culture, Ref Id, Mycobact (Mayo)OutsideLaboratory",,87118,CPT,Facility,Both,,,90,286,243.1,81.9676,286,Humana Insurance Company,Commercial PPO,271.7,95,,percent of total billed charges,,
"Ctbid, Culture, Ref Id, Mycobact (Mayo)OutsideLaboratory",,87118,CPT,Facility,Outpatient,,,90,286,243.1,81.9676,286,Humana Insurance Company,Medicare PPO,140.14,49,,percent of total billed charges,,
"Ctbid, Culture, Ref Id, Mycobact (Mayo)OutsideLaboratory",,87118,CPT,Facility,Inpatient,,,90,286,243.1,81.9676,286,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Ctbid, Culture, Ref Id, Mycobact (Mayo)OutsideLaboratory",,87118,CPT,Facility,Both,,,90,286,243.1,81.9676,286,Medica,Individual & Family,283.426,99.1,,percent of total billed charges,,
"Ctbid, Culture, Ref Id, Mycobact (Mayo)OutsideLaboratory",,87118,CPT,Facility,Outpatient,,,90,286,243.1,81.9676,286,Medica,Medica Advantage Solution,142.428,49.8,,percent of total billed charges,,
"Ctbid, Culture, Ref Id, Mycobact (Mayo)OutsideLaboratory",,87118,CPT,Facility,Inpatient,,,90,286,243.1,81.9676,286,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Ctbid, Culture, Ref Id, Mycobact (Mayo)OutsideLaboratory",,87118,CPT,Facility,Outpatient,,,90,286,243.1,81.9676,286,Medica,Medical Assistance,127.556,44.6,,percent of total billed charges,,
"Ctbid, Culture, Ref Id, Mycobact (Mayo)OutsideLaboratory",,87118,CPT,Facility,Inpatient,,,90,286,243.1,81.9676,286,Medica,Medical Assistance,,,,,Included in per diem rate,
"Ctbid, Culture, Ref Id, Mycobact (Mayo)OutsideLaboratory",,87118,CPT,Facility,Outpatient,,,90,286,243.1,81.9676,286,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,142.428,49.8,,percent of total billed charges,,
"Ctbid, Culture, Ref Id, Mycobact (Mayo)OutsideLaboratory",,87118,CPT,Facility,Inpatient,,,90,286,243.1,81.9676,286,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Ctbid, Culture, Ref Id, Mycobact (Mayo)OutsideLaboratory",,87118,CPT,Facility,Both,,,90,286,243.1,81.9676,286,"Multiplan, Inc.","Multiplan, Inc.",268.84,94,,percent of total billed charges,,
"Ctbid, Culture, Ref Id, Mycobact (Mayo)OutsideLaboratory",,87118,CPT,Facility,Outpatient,,,90,286,243.1,81.9676,286,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,247.104,86.4,,percent of total billed charges,,
"Ctbid, Culture, Ref Id, Mycobact (Mayo)OutsideLaboratory",,87118,CPT,Facility,Inpatient,,,90,286,243.1,81.9676,286,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Ctbid, Culture, Ref Id, Mycobact (Mayo)OutsideLaboratory",,87118,CPT,Facility,Both,,,90,286,243.1,81.9676,286,"Preferred One Administrative Services, INC.",PPO,281.996,98.6,,percent of total billed charges,,
"Ctbid, Culture, Ref Id, Mycobact (Mayo)OutsideLaboratory",,87118,CPT,Facility,Outpatient,,,90,286,243.1,81.9676,286,PrimeWest Health,Minnesota Senior Health Options (MSHO),147.147,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Ctbid, Culture, Ref Id, Mycobact (Mayo)OutsideLaboratory",,87118,CPT,Facility,Inpatient,,,90,286,243.1,81.9676,286,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Ctbid, Culture, Ref Id, Mycobact (Mayo)OutsideLaboratory",,87118,CPT,Facility,Outpatient,,,90,286,243.1,81.9676,286,PrimeWest Health,MinnesotaCare,146.8896,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Ctbid, Culture, Ref Id, Mycobact (Mayo)OutsideLaboratory",,87118,CPT,Facility,Inpatient,,,90,286,243.1,81.9676,286,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Ctbid, Culture, Ref Id, Mycobact (Mayo)OutsideLaboratory",,87118,CPT,Facility,Both,,,90,286,243.1,81.9676,286,Sanford Health Plan,Sanford Health Plan,263.12,92,,percent of total billed charges,,
"Ctbid, Culture, Ref Id, Mycobact (Mayo)OutsideLaboratory",,87118,CPT,Facility,Outpatient,,,90,286,243.1,81.9676,286,"UCare Health, Inc.",Individual & Family Plan,161.161,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Ctbid, Culture, Ref Id, Mycobact (Mayo)OutsideLaboratory",,87118,CPT,Facility,Inpatient,,,90,286,243.1,81.9676,286,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Ctbid, Culture, Ref Id, Mycobact (Mayo)OutsideLaboratory",,87118,CPT,Facility,Outpatient,,,90,286,243.1,81.9676,286,"UCare Health, Inc.",Medical Assistance,144.3442,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Ctbid, Culture, Ref Id, Mycobact (Mayo)OutsideLaboratory",,87118,CPT,Facility,Inpatient,,,90,286,243.1,81.9676,286,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Ctbid, Culture, Ref Id, Mycobact (Mayo)OutsideLaboratory",,87118,CPT,Facility,Outpatient,,,90,286,243.1,81.9676,286,"UCare Health, Inc.",Medicare Advantage,144.3442,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Ctbid, Culture, Ref Id, Mycobact (Mayo)OutsideLaboratory",,87118,CPT,Facility,Inpatient,,,90,286,243.1,81.9676,286,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Ctbid, Culture, Ref Id, Mycobact (Mayo)OutsideLaboratory",,87118,CPT,Facility,Outpatient,,,90,286,243.1,81.9676,286,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),144.3442,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Ctbid, Culture, Ref Id, Mycobact (Mayo)OutsideLaboratory",,87118,CPT,Facility,Inpatient,,,90,286,243.1,81.9676,286,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Ctbid, Culture, Ref Id, Mycobact (Mayo)OutsideLaboratory",,87118,CPT,Facility,Both,,,90,286,243.1,81.9676,286,UnitedHealthcare,Individual & Family,268.84,94,,percent of total billed charges,,
"Ctbid, Culture, Ref Id, Mycobact (Mayo)OutsideLaboratory",,87118,CPT,Facility,Outpatient,,,90,286,243.1,81.9676,286,UnitedHealthcare,Medicare Advantage,140.14,49,,percent of total billed charges,,
"Ctbid, Culture, Ref Id, Mycobact (Mayo)OutsideLaboratory",,87118,CPT,Facility,Inpatient,,,90,286,243.1,81.9676,286,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Ctbid, Culture, Ref Id, Mycobact (Mayo)OutsideLaboratory",,87118,CPT,Facility,Outpatient,,,90,286,243.1,81.9676,286,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,137.28,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Ctbid, Culture, Ref Id, Mycobact (Mayo)OutsideLaboratory",,87118,CPT,Facility,Inpatient,,,90,286,243.1,81.9676,286,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Concentration (Any Type), For Infectious Agents (Mayo)OutsideLaboratory",,87177,CPT,Facility,Both,,,90,49,41.65,14.0434,49,Aetna,Commercial,45.08,92,,percent of total billed charges,,
"Concentration (Any Type), For Infectious Agents (Mayo)OutsideLaboratory",,87177,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,Aetna,Medicare Advantage,24.01,49,,percent of total billed charges,,
"Concentration (Any Type), For Infectious Agents (Mayo)OutsideLaboratory",,87177,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Concentration (Any Type), For Infectious Agents (Mayo)OutsideLaboratory",,87177,CPT,Facility,Both,,,90,49,41.65,14.0434,49,Aetna,PPO,45.57,93,,percent of total billed charges,,
"Concentration (Any Type), For Infectious Agents (Mayo)OutsideLaboratory",,87177,CPT,Facility,Both,,,90,49,41.65,14.0434,49,America's PPO,America's PPO,47.0547,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Concentration (Any Type), For Infectious Agents (Mayo)OutsideLaboratory",,87177,CPT,Facility,Both,,,90,49,41.65,14.0434,49,BlueCross BlueShield Minnesota, Federal Employee Program,48.216,98.4,,percent of total billed charges,,
"Concentration (Any Type), For Infectious Agents (Mayo)OutsideLaboratory",,87177,CPT,Facility,Both,,,90,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,49,100,,percent of total billed charges,,
"Concentration (Any Type), For Infectious Agents (Mayo)OutsideLaboratory",,87177,CPT,Facility,Both,,,90,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,High Value Network Plan,44.1,90,,percent of total billed charges,,
"Concentration (Any Type), For Infectious Agents (Mayo)OutsideLaboratory",,87177,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Medicare Advantage,24.01,49,,percent of total billed charges,,
"Concentration (Any Type), For Infectious Agents (Mayo)OutsideLaboratory",,87177,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Concentration (Any Type), For Infectious Agents (Mayo)OutsideLaboratory",,87177,CPT,Facility,Both,,,90,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,43.3993,88.57,,percent of total billed charges,,
"Concentration (Any Type), For Infectious Agents (Mayo)OutsideLaboratory",,87177,CPT,Facility,Both,,,90,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,14.0434,28.66,,percent of total billed charges,,
"Concentration (Any Type), For Infectious Agents (Mayo)OutsideLaboratory",,87177,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),24.01,49,,percent of total billed charges,,
"Concentration (Any Type), For Infectious Agents (Mayo)OutsideLaboratory",,87177,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Concentration (Any Type), For Infectious Agents (Mayo)OutsideLaboratory",,87177,CPT,Facility,Both,,,90,49,41.65,14.0434,49,CorVel,Worker's Compensation,49,100,,percent of total billed charges,,
"Concentration (Any Type), For Infectious Agents (Mayo)OutsideLaboratory",,87177,CPT,Facility,Both,,,90,49,41.65,14.0434,49,First Health Group Corporation,First Health Network,47.53,97,,percent of total billed charges,,
"Concentration (Any Type), For Infectious Agents (Mayo)OutsideLaboratory",,87177,CPT,Facility,Both,,,90,49,41.65,14.0434,49,"Health Partners, Inc.",Commercial,46.354,94.6,,percent of total billed charges,,
"Concentration (Any Type), For Infectious Agents (Mayo)OutsideLaboratory",,87177,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,"Health Partners, Inc.",Medicare Advantage,24.01,49,,percent of total billed charges,,
"Concentration (Any Type), For Infectious Agents (Mayo)OutsideLaboratory",,87177,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Concentration (Any Type), For Infectious Agents (Mayo)OutsideLaboratory",,87177,CPT,Facility,Both,,,90,49,41.65,14.0434,49,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),29.4,60,,percent of total billed charges,,
"Concentration (Any Type), For Infectious Agents (Mayo)OutsideLaboratory",,87177,CPT,Facility,Both,,,90,49,41.65,14.0434,49,"Health Partners, Inc.",State of Minnesota Advantage Program,39.935,81.5,,percent of total billed charges,,
"Concentration (Any Type), For Infectious Agents (Mayo)OutsideLaboratory",,87177,CPT,Facility,Both,,,90,49,41.65,14.0434,49,"Health Partners, Inc.",State Public Programs,24.5,50,,percent of total billed charges,,
"Concentration (Any Type), For Infectious Agents (Mayo)OutsideLaboratory",,87177,CPT,Facility,Both,,,90,49,41.65,14.0434,49,Humana Insurance Company,Commercial PPO,46.55,95,,percent of total billed charges,,
"Concentration (Any Type), For Infectious Agents (Mayo)OutsideLaboratory",,87177,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,Humana Insurance Company,Medicare PPO,24.01,49,,percent of total billed charges,,
"Concentration (Any Type), For Infectious Agents (Mayo)OutsideLaboratory",,87177,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Concentration (Any Type), For Infectious Agents (Mayo)OutsideLaboratory",,87177,CPT,Facility,Both,,,90,49,41.65,14.0434,49,Medica,Individual & Family,48.559,99.1,,percent of total billed charges,,
"Concentration (Any Type), For Infectious Agents (Mayo)OutsideLaboratory",,87177,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,Medica,Medica Advantage Solution,24.402,49.8,,percent of total billed charges,,
"Concentration (Any Type), For Infectious Agents (Mayo)OutsideLaboratory",,87177,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Concentration (Any Type), For Infectious Agents (Mayo)OutsideLaboratory",,87177,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,Medica,Medical Assistance,21.854,44.6,,percent of total billed charges,,
"Concentration (Any Type), For Infectious Agents (Mayo)OutsideLaboratory",,87177,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,Medica,Medical Assistance,,,,,Included in per diem rate,
"Concentration (Any Type), For Infectious Agents (Mayo)OutsideLaboratory",,87177,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,24.402,49.8,,percent of total billed charges,,
"Concentration (Any Type), For Infectious Agents (Mayo)OutsideLaboratory",,87177,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Concentration (Any Type), For Infectious Agents (Mayo)OutsideLaboratory",,87177,CPT,Facility,Both,,,90,49,41.65,14.0434,49,"Multiplan, Inc.","Multiplan, Inc.",46.06,94,,percent of total billed charges,,
"Concentration (Any Type), For Infectious Agents (Mayo)OutsideLaboratory",,87177,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,42.336,86.4,,percent of total billed charges,,
"Concentration (Any Type), For Infectious Agents (Mayo)OutsideLaboratory",,87177,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Concentration (Any Type), For Infectious Agents (Mayo)OutsideLaboratory",,87177,CPT,Facility,Both,,,90,49,41.65,14.0434,49,"Preferred One Administrative Services, INC.",PPO,48.314,98.6,,percent of total billed charges,,
"Concentration (Any Type), For Infectious Agents (Mayo)OutsideLaboratory",,87177,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,PrimeWest Health,Minnesota Senior Health Options (MSHO),25.2105,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Concentration (Any Type), For Infectious Agents (Mayo)OutsideLaboratory",,87177,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Concentration (Any Type), For Infectious Agents (Mayo)OutsideLaboratory",,87177,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,PrimeWest Health,MinnesotaCare,25.1664,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Concentration (Any Type), For Infectious Agents (Mayo)OutsideLaboratory",,87177,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Concentration (Any Type), For Infectious Agents (Mayo)OutsideLaboratory",,87177,CPT,Facility,Both,,,90,49,41.65,14.0434,49,Sanford Health Plan,Sanford Health Plan,45.08,92,,percent of total billed charges,,
"Concentration (Any Type), For Infectious Agents (Mayo)OutsideLaboratory",,87177,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,"UCare Health, Inc.",Individual & Family Plan,27.6115,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Concentration (Any Type), For Infectious Agents (Mayo)OutsideLaboratory",,87177,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Concentration (Any Type), For Infectious Agents (Mayo)OutsideLaboratory",,87177,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,"UCare Health, Inc.",Medical Assistance,24.7303,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Concentration (Any Type), For Infectious Agents (Mayo)OutsideLaboratory",,87177,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Concentration (Any Type), For Infectious Agents (Mayo)OutsideLaboratory",,87177,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,"UCare Health, Inc.",Medicare Advantage,24.7303,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Concentration (Any Type), For Infectious Agents (Mayo)OutsideLaboratory",,87177,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Concentration (Any Type), For Infectious Agents (Mayo)OutsideLaboratory",,87177,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),24.7303,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Concentration (Any Type), For Infectious Agents (Mayo)OutsideLaboratory",,87177,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Concentration (Any Type), For Infectious Agents (Mayo)OutsideLaboratory",,87177,CPT,Facility,Both,,,90,49,41.65,14.0434,49,UnitedHealthcare,Individual & Family,46.06,94,,percent of total billed charges,,
"Concentration (Any Type), For Infectious Agents (Mayo)OutsideLaboratory",,87177,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,UnitedHealthcare,Medicare Advantage,24.01,49,,percent of total billed charges,,
"Concentration (Any Type), For Infectious Agents (Mayo)OutsideLaboratory",,87177,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Concentration (Any Type), For Infectious Agents (Mayo)OutsideLaboratory",,87177,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,23.52,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Concentration (Any Type), For Infectious Agents (Mayo)OutsideLaboratory",,87177,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Acid Fast Smear For Mycobacterium (Mayo)OutsideLaboratory,,87206,CPT,Facility,Both,,,90,59,50.15,16.9094,59,Aetna,Commercial,54.28,92,,percent of total billed charges,,
Acid Fast Smear For Mycobacterium (Mayo)OutsideLaboratory,,87206,CPT,Facility,Outpatient,,,90,59,50.15,16.9094,59,Aetna,Medicare Advantage,28.91,49,,percent of total billed charges,,
Acid Fast Smear For Mycobacterium (Mayo)OutsideLaboratory,,87206,CPT,Facility,Inpatient,,,90,59,50.15,16.9094,59,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Acid Fast Smear For Mycobacterium (Mayo)OutsideLaboratory,,87206,CPT,Facility,Both,,,90,59,50.15,16.9094,59,Aetna,PPO,54.87,93,,percent of total billed charges,,
Acid Fast Smear For Mycobacterium (Mayo)OutsideLaboratory,,87206,CPT,Facility,Both,,,90,59,50.15,16.9094,59,America's PPO,America's PPO,56.6577,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Acid Fast Smear For Mycobacterium (Mayo)OutsideLaboratory,,87206,CPT,Facility,Both,,,90,59,50.15,16.9094,59,BlueCross BlueShield Minnesota, Federal Employee Program,58.056,98.4,,percent of total billed charges,,
Acid Fast Smear For Mycobacterium (Mayo)OutsideLaboratory,,87206,CPT,Facility,Both,,,90,59,50.15,16.9094,59,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,59,100,,percent of total billed charges,,
Acid Fast Smear For Mycobacterium (Mayo)OutsideLaboratory,,87206,CPT,Facility,Both,,,90,59,50.15,16.9094,59,BlueCross BlueShield Minnesota,High Value Network Plan,53.1,90,,percent of total billed charges,,
Acid Fast Smear For Mycobacterium (Mayo)OutsideLaboratory,,87206,CPT,Facility,Outpatient,,,90,59,50.15,16.9094,59,BlueCross BlueShield Minnesota,Medicare Advantage,28.91,49,,percent of total billed charges,,
Acid Fast Smear For Mycobacterium (Mayo)OutsideLaboratory,,87206,CPT,Facility,Inpatient,,,90,59,50.15,16.9094,59,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Acid Fast Smear For Mycobacterium (Mayo)OutsideLaboratory,,87206,CPT,Facility,Both,,,90,59,50.15,16.9094,59,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,52.2563,88.57,,percent of total billed charges,,
Acid Fast Smear For Mycobacterium (Mayo)OutsideLaboratory,,87206,CPT,Facility,Both,,,90,59,50.15,16.9094,59,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,16.9094,28.66,,percent of total billed charges,,
Acid Fast Smear For Mycobacterium (Mayo)OutsideLaboratory,,87206,CPT,Facility,Outpatient,,,90,59,50.15,16.9094,59,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),28.91,49,,percent of total billed charges,,
Acid Fast Smear For Mycobacterium (Mayo)OutsideLaboratory,,87206,CPT,Facility,Inpatient,,,90,59,50.15,16.9094,59,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Acid Fast Smear For Mycobacterium (Mayo)OutsideLaboratory,,87206,CPT,Facility,Both,,,90,59,50.15,16.9094,59,CorVel,Worker's Compensation,59,100,,percent of total billed charges,,
Acid Fast Smear For Mycobacterium (Mayo)OutsideLaboratory,,87206,CPT,Facility,Both,,,90,59,50.15,16.9094,59,First Health Group Corporation,First Health Network,57.23,97,,percent of total billed charges,,
Acid Fast Smear For Mycobacterium (Mayo)OutsideLaboratory,,87206,CPT,Facility,Both,,,90,59,50.15,16.9094,59,"Health Partners, Inc.",Commercial,55.814,94.6,,percent of total billed charges,,
Acid Fast Smear For Mycobacterium (Mayo)OutsideLaboratory,,87206,CPT,Facility,Outpatient,,,90,59,50.15,16.9094,59,"Health Partners, Inc.",Medicare Advantage,28.91,49,,percent of total billed charges,,
Acid Fast Smear For Mycobacterium (Mayo)OutsideLaboratory,,87206,CPT,Facility,Inpatient,,,90,59,50.15,16.9094,59,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Acid Fast Smear For Mycobacterium (Mayo)OutsideLaboratory,,87206,CPT,Facility,Both,,,90,59,50.15,16.9094,59,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),35.4,60,,percent of total billed charges,,
Acid Fast Smear For Mycobacterium (Mayo)OutsideLaboratory,,87206,CPT,Facility,Both,,,90,59,50.15,16.9094,59,"Health Partners, Inc.",State of Minnesota Advantage Program,48.085,81.5,,percent of total billed charges,,
Acid Fast Smear For Mycobacterium (Mayo)OutsideLaboratory,,87206,CPT,Facility,Both,,,90,59,50.15,16.9094,59,"Health Partners, Inc.",State Public Programs,29.5,50,,percent of total billed charges,,
Acid Fast Smear For Mycobacterium (Mayo)OutsideLaboratory,,87206,CPT,Facility,Both,,,90,59,50.15,16.9094,59,Humana Insurance Company,Commercial PPO,56.05,95,,percent of total billed charges,,
Acid Fast Smear For Mycobacterium (Mayo)OutsideLaboratory,,87206,CPT,Facility,Outpatient,,,90,59,50.15,16.9094,59,Humana Insurance Company,Medicare PPO,28.91,49,,percent of total billed charges,,
Acid Fast Smear For Mycobacterium (Mayo)OutsideLaboratory,,87206,CPT,Facility,Inpatient,,,90,59,50.15,16.9094,59,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Acid Fast Smear For Mycobacterium (Mayo)OutsideLaboratory,,87206,CPT,Facility,Both,,,90,59,50.15,16.9094,59,Medica,Individual & Family,58.469,99.1,,percent of total billed charges,,
Acid Fast Smear For Mycobacterium (Mayo)OutsideLaboratory,,87206,CPT,Facility,Outpatient,,,90,59,50.15,16.9094,59,Medica,Medica Advantage Solution,29.382,49.8,,percent of total billed charges,,
Acid Fast Smear For Mycobacterium (Mayo)OutsideLaboratory,,87206,CPT,Facility,Inpatient,,,90,59,50.15,16.9094,59,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Acid Fast Smear For Mycobacterium (Mayo)OutsideLaboratory,,87206,CPT,Facility,Outpatient,,,90,59,50.15,16.9094,59,Medica,Medical Assistance,26.314,44.6,,percent of total billed charges,,
Acid Fast Smear For Mycobacterium (Mayo)OutsideLaboratory,,87206,CPT,Facility,Inpatient,,,90,59,50.15,16.9094,59,Medica,Medical Assistance,,,,,Included in per diem rate,
Acid Fast Smear For Mycobacterium (Mayo)OutsideLaboratory,,87206,CPT,Facility,Outpatient,,,90,59,50.15,16.9094,59,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,29.382,49.8,,percent of total billed charges,,
Acid Fast Smear For Mycobacterium (Mayo)OutsideLaboratory,,87206,CPT,Facility,Inpatient,,,90,59,50.15,16.9094,59,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Acid Fast Smear For Mycobacterium (Mayo)OutsideLaboratory,,87206,CPT,Facility,Both,,,90,59,50.15,16.9094,59,"Multiplan, Inc.","Multiplan, Inc.",55.46,94,,percent of total billed charges,,
Acid Fast Smear For Mycobacterium (Mayo)OutsideLaboratory,,87206,CPT,Facility,Outpatient,,,90,59,50.15,16.9094,59,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,50.976,86.4,,percent of total billed charges,,
Acid Fast Smear For Mycobacterium (Mayo)OutsideLaboratory,,87206,CPT,Facility,Inpatient,,,90,59,50.15,16.9094,59,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Acid Fast Smear For Mycobacterium (Mayo)OutsideLaboratory,,87206,CPT,Facility,Both,,,90,59,50.15,16.9094,59,"Preferred One Administrative Services, INC.",PPO,58.174,98.6,,percent of total billed charges,,
Acid Fast Smear For Mycobacterium (Mayo)OutsideLaboratory,,87206,CPT,Facility,Outpatient,,,90,59,50.15,16.9094,59,PrimeWest Health,Minnesota Senior Health Options (MSHO),30.3555,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Acid Fast Smear For Mycobacterium (Mayo)OutsideLaboratory,,87206,CPT,Facility,Inpatient,,,90,59,50.15,16.9094,59,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Acid Fast Smear For Mycobacterium (Mayo)OutsideLaboratory,,87206,CPT,Facility,Outpatient,,,90,59,50.15,16.9094,59,PrimeWest Health,MinnesotaCare,30.3024,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Acid Fast Smear For Mycobacterium (Mayo)OutsideLaboratory,,87206,CPT,Facility,Inpatient,,,90,59,50.15,16.9094,59,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Acid Fast Smear For Mycobacterium (Mayo)OutsideLaboratory,,87206,CPT,Facility,Both,,,90,59,50.15,16.9094,59,Sanford Health Plan,Sanford Health Plan,54.28,92,,percent of total billed charges,,
Acid Fast Smear For Mycobacterium (Mayo)OutsideLaboratory,,87206,CPT,Facility,Outpatient,,,90,59,50.15,16.9094,59,"UCare Health, Inc.",Individual & Family Plan,33.2465,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Acid Fast Smear For Mycobacterium (Mayo)OutsideLaboratory,,87206,CPT,Facility,Inpatient,,,90,59,50.15,16.9094,59,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Acid Fast Smear For Mycobacterium (Mayo)OutsideLaboratory,,87206,CPT,Facility,Outpatient,,,90,59,50.15,16.9094,59,"UCare Health, Inc.",Medical Assistance,29.7773,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Acid Fast Smear For Mycobacterium (Mayo)OutsideLaboratory,,87206,CPT,Facility,Inpatient,,,90,59,50.15,16.9094,59,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Acid Fast Smear For Mycobacterium (Mayo)OutsideLaboratory,,87206,CPT,Facility,Outpatient,,,90,59,50.15,16.9094,59,"UCare Health, Inc.",Medicare Advantage,29.7773,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Acid Fast Smear For Mycobacterium (Mayo)OutsideLaboratory,,87206,CPT,Facility,Inpatient,,,90,59,50.15,16.9094,59,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Acid Fast Smear For Mycobacterium (Mayo)OutsideLaboratory,,87206,CPT,Facility,Outpatient,,,90,59,50.15,16.9094,59,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),29.7773,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Acid Fast Smear For Mycobacterium (Mayo)OutsideLaboratory,,87206,CPT,Facility,Inpatient,,,90,59,50.15,16.9094,59,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Acid Fast Smear For Mycobacterium (Mayo)OutsideLaboratory,,87206,CPT,Facility,Both,,,90,59,50.15,16.9094,59,UnitedHealthcare,Individual & Family,55.46,94,,percent of total billed charges,,
Acid Fast Smear For Mycobacterium (Mayo)OutsideLaboratory,,87206,CPT,Facility,Outpatient,,,90,59,50.15,16.9094,59,UnitedHealthcare,Medicare Advantage,28.91,49,,percent of total billed charges,,
Acid Fast Smear For Mycobacterium (Mayo)OutsideLaboratory,,87206,CPT,Facility,Inpatient,,,90,59,50.15,16.9094,59,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Acid Fast Smear For Mycobacterium (Mayo)OutsideLaboratory,,87206,CPT,Facility,Outpatient,,,90,59,50.15,16.9094,59,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,28.32,48,,percent of total billed charges,,100% of DHS outpatient percentage
Acid Fast Smear For Mycobacterium (Mayo)OutsideLaboratory,,87206,CPT,Facility,Inpatient,,,90,59,50.15,16.9094,59,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Special Stain For Microsporidia (Mayo)OutsideLaboratory,,87207,CPT,Facility,Both,,,90,65,55.25,18.629,65,Aetna,Commercial,59.8,92,,percent of total billed charges,,
Special Stain For Microsporidia (Mayo)OutsideLaboratory,,87207,CPT,Facility,Outpatient,,,90,65,55.25,18.629,65,Aetna,Medicare Advantage,31.85,49,,percent of total billed charges,,
Special Stain For Microsporidia (Mayo)OutsideLaboratory,,87207,CPT,Facility,Inpatient,,,90,65,55.25,18.629,65,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Special Stain For Microsporidia (Mayo)OutsideLaboratory,,87207,CPT,Facility,Both,,,90,65,55.25,18.629,65,Aetna,PPO,60.45,93,,percent of total billed charges,,
Special Stain For Microsporidia (Mayo)OutsideLaboratory,,87207,CPT,Facility,Both,,,90,65,55.25,18.629,65,America's PPO,America's PPO,62.4195,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Special Stain For Microsporidia (Mayo)OutsideLaboratory,,87207,CPT,Facility,Both,,,90,65,55.25,18.629,65,BlueCross BlueShield Minnesota, Federal Employee Program,63.96,98.4,,percent of total billed charges,,
Special Stain For Microsporidia (Mayo)OutsideLaboratory,,87207,CPT,Facility,Both,,,90,65,55.25,18.629,65,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,65,100,,percent of total billed charges,,
Special Stain For Microsporidia (Mayo)OutsideLaboratory,,87207,CPT,Facility,Both,,,90,65,55.25,18.629,65,BlueCross BlueShield Minnesota,High Value Network Plan,58.5,90,,percent of total billed charges,,
Special Stain For Microsporidia (Mayo)OutsideLaboratory,,87207,CPT,Facility,Outpatient,,,90,65,55.25,18.629,65,BlueCross BlueShield Minnesota,Medicare Advantage,31.85,49,,percent of total billed charges,,
Special Stain For Microsporidia (Mayo)OutsideLaboratory,,87207,CPT,Facility,Inpatient,,,90,65,55.25,18.629,65,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Special Stain For Microsporidia (Mayo)OutsideLaboratory,,87207,CPT,Facility,Both,,,90,65,55.25,18.629,65,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,57.5705,88.57,,percent of total billed charges,,
Special Stain For Microsporidia (Mayo)OutsideLaboratory,,87207,CPT,Facility,Both,,,90,65,55.25,18.629,65,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,18.629,28.66,,percent of total billed charges,,
Special Stain For Microsporidia (Mayo)OutsideLaboratory,,87207,CPT,Facility,Outpatient,,,90,65,55.25,18.629,65,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),31.85,49,,percent of total billed charges,,
Special Stain For Microsporidia (Mayo)OutsideLaboratory,,87207,CPT,Facility,Inpatient,,,90,65,55.25,18.629,65,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Special Stain For Microsporidia (Mayo)OutsideLaboratory,,87207,CPT,Facility,Both,,,90,65,55.25,18.629,65,CorVel,Worker's Compensation,65,100,,percent of total billed charges,,
Special Stain For Microsporidia (Mayo)OutsideLaboratory,,87207,CPT,Facility,Both,,,90,65,55.25,18.629,65,First Health Group Corporation,First Health Network,63.05,97,,percent of total billed charges,,
Special Stain For Microsporidia (Mayo)OutsideLaboratory,,87207,CPT,Facility,Both,,,90,65,55.25,18.629,65,"Health Partners, Inc.",Commercial,61.49,94.6,,percent of total billed charges,,
Special Stain For Microsporidia (Mayo)OutsideLaboratory,,87207,CPT,Facility,Outpatient,,,90,65,55.25,18.629,65,"Health Partners, Inc.",Medicare Advantage,31.85,49,,percent of total billed charges,,
Special Stain For Microsporidia (Mayo)OutsideLaboratory,,87207,CPT,Facility,Inpatient,,,90,65,55.25,18.629,65,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Special Stain For Microsporidia (Mayo)OutsideLaboratory,,87207,CPT,Facility,Both,,,90,65,55.25,18.629,65,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),39,60,,percent of total billed charges,,
Special Stain For Microsporidia (Mayo)OutsideLaboratory,,87207,CPT,Facility,Both,,,90,65,55.25,18.629,65,"Health Partners, Inc.",State of Minnesota Advantage Program,52.975,81.5,,percent of total billed charges,,
Special Stain For Microsporidia (Mayo)OutsideLaboratory,,87207,CPT,Facility,Both,,,90,65,55.25,18.629,65,"Health Partners, Inc.",State Public Programs,32.5,50,,percent of total billed charges,,
Special Stain For Microsporidia (Mayo)OutsideLaboratory,,87207,CPT,Facility,Both,,,90,65,55.25,18.629,65,Humana Insurance Company,Commercial PPO,61.75,95,,percent of total billed charges,,
Special Stain For Microsporidia (Mayo)OutsideLaboratory,,87207,CPT,Facility,Outpatient,,,90,65,55.25,18.629,65,Humana Insurance Company,Medicare PPO,31.85,49,,percent of total billed charges,,
Special Stain For Microsporidia (Mayo)OutsideLaboratory,,87207,CPT,Facility,Inpatient,,,90,65,55.25,18.629,65,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Special Stain For Microsporidia (Mayo)OutsideLaboratory,,87207,CPT,Facility,Both,,,90,65,55.25,18.629,65,Medica,Individual & Family,64.415,99.1,,percent of total billed charges,,
Special Stain For Microsporidia (Mayo)OutsideLaboratory,,87207,CPT,Facility,Outpatient,,,90,65,55.25,18.629,65,Medica,Medica Advantage Solution,32.37,49.8,,percent of total billed charges,,
Special Stain For Microsporidia (Mayo)OutsideLaboratory,,87207,CPT,Facility,Inpatient,,,90,65,55.25,18.629,65,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Special Stain For Microsporidia (Mayo)OutsideLaboratory,,87207,CPT,Facility,Outpatient,,,90,65,55.25,18.629,65,Medica,Medical Assistance,28.99,44.6,,percent of total billed charges,,
Special Stain For Microsporidia (Mayo)OutsideLaboratory,,87207,CPT,Facility,Inpatient,,,90,65,55.25,18.629,65,Medica,Medical Assistance,,,,,Included in per diem rate,
Special Stain For Microsporidia (Mayo)OutsideLaboratory,,87207,CPT,Facility,Outpatient,,,90,65,55.25,18.629,65,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,32.37,49.8,,percent of total billed charges,,
Special Stain For Microsporidia (Mayo)OutsideLaboratory,,87207,CPT,Facility,Inpatient,,,90,65,55.25,18.629,65,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Special Stain For Microsporidia (Mayo)OutsideLaboratory,,87207,CPT,Facility,Both,,,90,65,55.25,18.629,65,"Multiplan, Inc.","Multiplan, Inc.",61.1,94,,percent of total billed charges,,
Special Stain For Microsporidia (Mayo)OutsideLaboratory,,87207,CPT,Facility,Outpatient,,,90,65,55.25,18.629,65,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,56.16,86.4,,percent of total billed charges,,
Special Stain For Microsporidia (Mayo)OutsideLaboratory,,87207,CPT,Facility,Inpatient,,,90,65,55.25,18.629,65,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Special Stain For Microsporidia (Mayo)OutsideLaboratory,,87207,CPT,Facility,Both,,,90,65,55.25,18.629,65,"Preferred One Administrative Services, INC.",PPO,64.09,98.6,,percent of total billed charges,,
Special Stain For Microsporidia (Mayo)OutsideLaboratory,,87207,CPT,Facility,Outpatient,,,90,65,55.25,18.629,65,PrimeWest Health,Minnesota Senior Health Options (MSHO),33.4425,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Special Stain For Microsporidia (Mayo)OutsideLaboratory,,87207,CPT,Facility,Inpatient,,,90,65,55.25,18.629,65,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Special Stain For Microsporidia (Mayo)OutsideLaboratory,,87207,CPT,Facility,Outpatient,,,90,65,55.25,18.629,65,PrimeWest Health,MinnesotaCare,33.384,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Special Stain For Microsporidia (Mayo)OutsideLaboratory,,87207,CPT,Facility,Inpatient,,,90,65,55.25,18.629,65,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Special Stain For Microsporidia (Mayo)OutsideLaboratory,,87207,CPT,Facility,Both,,,90,65,55.25,18.629,65,Sanford Health Plan,Sanford Health Plan,59.8,92,,percent of total billed charges,,
Special Stain For Microsporidia (Mayo)OutsideLaboratory,,87207,CPT,Facility,Outpatient,,,90,65,55.25,18.629,65,"UCare Health, Inc.",Individual & Family Plan,36.6275,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Special Stain For Microsporidia (Mayo)OutsideLaboratory,,87207,CPT,Facility,Inpatient,,,90,65,55.25,18.629,65,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Special Stain For Microsporidia (Mayo)OutsideLaboratory,,87207,CPT,Facility,Outpatient,,,90,65,55.25,18.629,65,"UCare Health, Inc.",Medical Assistance,32.8055,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Special Stain For Microsporidia (Mayo)OutsideLaboratory,,87207,CPT,Facility,Inpatient,,,90,65,55.25,18.629,65,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Special Stain For Microsporidia (Mayo)OutsideLaboratory,,87207,CPT,Facility,Outpatient,,,90,65,55.25,18.629,65,"UCare Health, Inc.",Medicare Advantage,32.8055,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Special Stain For Microsporidia (Mayo)OutsideLaboratory,,87207,CPT,Facility,Inpatient,,,90,65,55.25,18.629,65,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Special Stain For Microsporidia (Mayo)OutsideLaboratory,,87207,CPT,Facility,Outpatient,,,90,65,55.25,18.629,65,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),32.8055,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Special Stain For Microsporidia (Mayo)OutsideLaboratory,,87207,CPT,Facility,Inpatient,,,90,65,55.25,18.629,65,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Special Stain For Microsporidia (Mayo)OutsideLaboratory,,87207,CPT,Facility,Both,,,90,65,55.25,18.629,65,UnitedHealthcare,Individual & Family,61.1,94,,percent of total billed charges,,
Special Stain For Microsporidia (Mayo)OutsideLaboratory,,87207,CPT,Facility,Outpatient,,,90,65,55.25,18.629,65,UnitedHealthcare,Medicare Advantage,31.85,49,,percent of total billed charges,,
Special Stain For Microsporidia (Mayo)OutsideLaboratory,,87207,CPT,Facility,Inpatient,,,90,65,55.25,18.629,65,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Special Stain For Microsporidia (Mayo)OutsideLaboratory,,87207,CPT,Facility,Outpatient,,,90,65,55.25,18.629,65,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,31.2,48,,percent of total billed charges,,100% of DHS outpatient percentage
Special Stain For Microsporidia (Mayo)OutsideLaboratory,,87207,CPT,Facility,Inpatient,,,90,65,55.25,18.629,65,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Smear, Primary Source With Interpretation; Complex Special Stain For Ova And Parasites (Mayo)OutsideLaboratory",,87209,CPT,Facility,Both,,,90,49,41.65,14.0434,49,Aetna,Commercial,45.08,92,,percent of total billed charges,,
"Smear, Primary Source With Interpretation; Complex Special Stain For Ova And Parasites (Mayo)OutsideLaboratory",,87209,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,Aetna,Medicare Advantage,24.01,49,,percent of total billed charges,,
"Smear, Primary Source With Interpretation; Complex Special Stain For Ova And Parasites (Mayo)OutsideLaboratory",,87209,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Smear, Primary Source With Interpretation; Complex Special Stain For Ova And Parasites (Mayo)OutsideLaboratory",,87209,CPT,Facility,Both,,,90,49,41.65,14.0434,49,Aetna,PPO,45.57,93,,percent of total billed charges,,
"Smear, Primary Source With Interpretation; Complex Special Stain For Ova And Parasites (Mayo)OutsideLaboratory",,87209,CPT,Facility,Both,,,90,49,41.65,14.0434,49,America's PPO,America's PPO,47.0547,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Smear, Primary Source With Interpretation; Complex Special Stain For Ova And Parasites (Mayo)OutsideLaboratory",,87209,CPT,Facility,Both,,,90,49,41.65,14.0434,49,BlueCross BlueShield Minnesota, Federal Employee Program,48.216,98.4,,percent of total billed charges,,
"Smear, Primary Source With Interpretation; Complex Special Stain For Ova And Parasites (Mayo)OutsideLaboratory",,87209,CPT,Facility,Both,,,90,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,49,100,,percent of total billed charges,,
"Smear, Primary Source With Interpretation; Complex Special Stain For Ova And Parasites (Mayo)OutsideLaboratory",,87209,CPT,Facility,Both,,,90,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,High Value Network Plan,44.1,90,,percent of total billed charges,,
"Smear, Primary Source With Interpretation; Complex Special Stain For Ova And Parasites (Mayo)OutsideLaboratory",,87209,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Medicare Advantage,24.01,49,,percent of total billed charges,,
"Smear, Primary Source With Interpretation; Complex Special Stain For Ova And Parasites (Mayo)OutsideLaboratory",,87209,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Smear, Primary Source With Interpretation; Complex Special Stain For Ova And Parasites (Mayo)OutsideLaboratory",,87209,CPT,Facility,Both,,,90,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,43.3993,88.57,,percent of total billed charges,,
"Smear, Primary Source With Interpretation; Complex Special Stain For Ova And Parasites (Mayo)OutsideLaboratory",,87209,CPT,Facility,Both,,,90,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,14.0434,28.66,,percent of total billed charges,,
"Smear, Primary Source With Interpretation; Complex Special Stain For Ova And Parasites (Mayo)OutsideLaboratory",,87209,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),24.01,49,,percent of total billed charges,,
"Smear, Primary Source With Interpretation; Complex Special Stain For Ova And Parasites (Mayo)OutsideLaboratory",,87209,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Smear, Primary Source With Interpretation; Complex Special Stain For Ova And Parasites (Mayo)OutsideLaboratory",,87209,CPT,Facility,Both,,,90,49,41.65,14.0434,49,CorVel,Worker's Compensation,49,100,,percent of total billed charges,,
"Smear, Primary Source With Interpretation; Complex Special Stain For Ova And Parasites (Mayo)OutsideLaboratory",,87209,CPT,Facility,Both,,,90,49,41.65,14.0434,49,First Health Group Corporation,First Health Network,47.53,97,,percent of total billed charges,,
"Smear, Primary Source With Interpretation; Complex Special Stain For Ova And Parasites (Mayo)OutsideLaboratory",,87209,CPT,Facility,Both,,,90,49,41.65,14.0434,49,"Health Partners, Inc.",Commercial,46.354,94.6,,percent of total billed charges,,
"Smear, Primary Source With Interpretation; Complex Special Stain For Ova And Parasites (Mayo)OutsideLaboratory",,87209,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,"Health Partners, Inc.",Medicare Advantage,24.01,49,,percent of total billed charges,,
"Smear, Primary Source With Interpretation; Complex Special Stain For Ova And Parasites (Mayo)OutsideLaboratory",,87209,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Smear, Primary Source With Interpretation; Complex Special Stain For Ova And Parasites (Mayo)OutsideLaboratory",,87209,CPT,Facility,Both,,,90,49,41.65,14.0434,49,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),29.4,60,,percent of total billed charges,,
"Smear, Primary Source With Interpretation; Complex Special Stain For Ova And Parasites (Mayo)OutsideLaboratory",,87209,CPT,Facility,Both,,,90,49,41.65,14.0434,49,"Health Partners, Inc.",State of Minnesota Advantage Program,39.935,81.5,,percent of total billed charges,,
"Smear, Primary Source With Interpretation; Complex Special Stain For Ova And Parasites (Mayo)OutsideLaboratory",,87209,CPT,Facility,Both,,,90,49,41.65,14.0434,49,"Health Partners, Inc.",State Public Programs,24.5,50,,percent of total billed charges,,
"Smear, Primary Source With Interpretation; Complex Special Stain For Ova And Parasites (Mayo)OutsideLaboratory",,87209,CPT,Facility,Both,,,90,49,41.65,14.0434,49,Humana Insurance Company,Commercial PPO,46.55,95,,percent of total billed charges,,
"Smear, Primary Source With Interpretation; Complex Special Stain For Ova And Parasites (Mayo)OutsideLaboratory",,87209,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,Humana Insurance Company,Medicare PPO,24.01,49,,percent of total billed charges,,
"Smear, Primary Source With Interpretation; Complex Special Stain For Ova And Parasites (Mayo)OutsideLaboratory",,87209,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Smear, Primary Source With Interpretation; Complex Special Stain For Ova And Parasites (Mayo)OutsideLaboratory",,87209,CPT,Facility,Both,,,90,49,41.65,14.0434,49,Medica,Individual & Family,48.559,99.1,,percent of total billed charges,,
"Smear, Primary Source With Interpretation; Complex Special Stain For Ova And Parasites (Mayo)OutsideLaboratory",,87209,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,Medica,Medica Advantage Solution,24.402,49.8,,percent of total billed charges,,
"Smear, Primary Source With Interpretation; Complex Special Stain For Ova And Parasites (Mayo)OutsideLaboratory",,87209,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Smear, Primary Source With Interpretation; Complex Special Stain For Ova And Parasites (Mayo)OutsideLaboratory",,87209,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,Medica,Medical Assistance,21.854,44.6,,percent of total billed charges,,
"Smear, Primary Source With Interpretation; Complex Special Stain For Ova And Parasites (Mayo)OutsideLaboratory",,87209,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,Medica,Medical Assistance,,,,,Included in per diem rate,
"Smear, Primary Source With Interpretation; Complex Special Stain For Ova And Parasites (Mayo)OutsideLaboratory",,87209,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,24.402,49.8,,percent of total billed charges,,
"Smear, Primary Source With Interpretation; Complex Special Stain For Ova And Parasites (Mayo)OutsideLaboratory",,87209,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Smear, Primary Source With Interpretation; Complex Special Stain For Ova And Parasites (Mayo)OutsideLaboratory",,87209,CPT,Facility,Both,,,90,49,41.65,14.0434,49,"Multiplan, Inc.","Multiplan, Inc.",46.06,94,,percent of total billed charges,,
"Smear, Primary Source With Interpretation; Complex Special Stain For Ova And Parasites (Mayo)OutsideLaboratory",,87209,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,42.336,86.4,,percent of total billed charges,,
"Smear, Primary Source With Interpretation; Complex Special Stain For Ova And Parasites (Mayo)OutsideLaboratory",,87209,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Smear, Primary Source With Interpretation; Complex Special Stain For Ova And Parasites (Mayo)OutsideLaboratory",,87209,CPT,Facility,Both,,,90,49,41.65,14.0434,49,"Preferred One Administrative Services, INC.",PPO,48.314,98.6,,percent of total billed charges,,
"Smear, Primary Source With Interpretation; Complex Special Stain For Ova And Parasites (Mayo)OutsideLaboratory",,87209,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,PrimeWest Health,Minnesota Senior Health Options (MSHO),25.2105,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Smear, Primary Source With Interpretation; Complex Special Stain For Ova And Parasites (Mayo)OutsideLaboratory",,87209,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Smear, Primary Source With Interpretation; Complex Special Stain For Ova And Parasites (Mayo)OutsideLaboratory",,87209,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,PrimeWest Health,MinnesotaCare,25.1664,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Smear, Primary Source With Interpretation; Complex Special Stain For Ova And Parasites (Mayo)OutsideLaboratory",,87209,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Smear, Primary Source With Interpretation; Complex Special Stain For Ova And Parasites (Mayo)OutsideLaboratory",,87209,CPT,Facility,Both,,,90,49,41.65,14.0434,49,Sanford Health Plan,Sanford Health Plan,45.08,92,,percent of total billed charges,,
"Smear, Primary Source With Interpretation; Complex Special Stain For Ova And Parasites (Mayo)OutsideLaboratory",,87209,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,"UCare Health, Inc.",Individual & Family Plan,27.6115,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Smear, Primary Source With Interpretation; Complex Special Stain For Ova And Parasites (Mayo)OutsideLaboratory",,87209,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Smear, Primary Source With Interpretation; Complex Special Stain For Ova And Parasites (Mayo)OutsideLaboratory",,87209,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,"UCare Health, Inc.",Medical Assistance,24.7303,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Smear, Primary Source With Interpretation; Complex Special Stain For Ova And Parasites (Mayo)OutsideLaboratory",,87209,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Smear, Primary Source With Interpretation; Complex Special Stain For Ova And Parasites (Mayo)OutsideLaboratory",,87209,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,"UCare Health, Inc.",Medicare Advantage,24.7303,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Smear, Primary Source With Interpretation; Complex Special Stain For Ova And Parasites (Mayo)OutsideLaboratory",,87209,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Smear, Primary Source With Interpretation; Complex Special Stain For Ova And Parasites (Mayo)OutsideLaboratory",,87209,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),24.7303,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Smear, Primary Source With Interpretation; Complex Special Stain For Ova And Parasites (Mayo)OutsideLaboratory",,87209,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Smear, Primary Source With Interpretation; Complex Special Stain For Ova And Parasites (Mayo)OutsideLaboratory",,87209,CPT,Facility,Both,,,90,49,41.65,14.0434,49,UnitedHealthcare,Individual & Family,46.06,94,,percent of total billed charges,,
"Smear, Primary Source With Interpretation; Complex Special Stain For Ova And Parasites (Mayo)OutsideLaboratory",,87209,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,UnitedHealthcare,Medicare Advantage,24.01,49,,percent of total billed charges,,
"Smear, Primary Source With Interpretation; Complex Special Stain For Ova And Parasites (Mayo)OutsideLaboratory",,87209,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Smear, Primary Source With Interpretation; Complex Special Stain For Ova And Parasites (Mayo)OutsideLaboratory",,87209,CPT,Facility,Outpatient,,,90,49,41.65,14.0434,49,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,23.52,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Smear, Primary Source With Interpretation; Complex Special Stain For Ova And Parasites (Mayo)OutsideLaboratory",,87209,CPT,Facility,Inpatient,,,90,49,41.65,14.0434,49,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Cryptosporidium Ag, F (Mayo)OutsideLaboratory",,87328,CPT,Facility,Both,,,90,69,58.65,19.7754,69,Aetna,Commercial,63.48,92,,percent of total billed charges,,
"Cryptosporidium Ag, F (Mayo)OutsideLaboratory",,87328,CPT,Facility,Outpatient,,,90,69,58.65,19.7754,69,Aetna,Medicare Advantage,33.81,49,,percent of total billed charges,,
"Cryptosporidium Ag, F (Mayo)OutsideLaboratory",,87328,CPT,Facility,Inpatient,,,90,69,58.65,19.7754,69,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Cryptosporidium Ag, F (Mayo)OutsideLaboratory",,87328,CPT,Facility,Both,,,90,69,58.65,19.7754,69,Aetna,PPO,64.17,93,,percent of total billed charges,,
"Cryptosporidium Ag, F (Mayo)OutsideLaboratory",,87328,CPT,Facility,Both,,,90,69,58.65,19.7754,69,America's PPO,America's PPO,66.2607,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Cryptosporidium Ag, F (Mayo)OutsideLaboratory",,87328,CPT,Facility,Both,,,90,69,58.65,19.7754,69,BlueCross BlueShield Minnesota, Federal Employee Program,67.896,98.4,,percent of total billed charges,,
"Cryptosporidium Ag, F (Mayo)OutsideLaboratory",,87328,CPT,Facility,Both,,,90,69,58.65,19.7754,69,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,69,100,,percent of total billed charges,,
"Cryptosporidium Ag, F (Mayo)OutsideLaboratory",,87328,CPT,Facility,Both,,,90,69,58.65,19.7754,69,BlueCross BlueShield Minnesota,High Value Network Plan,62.1,90,,percent of total billed charges,,
"Cryptosporidium Ag, F (Mayo)OutsideLaboratory",,87328,CPT,Facility,Outpatient,,,90,69,58.65,19.7754,69,BlueCross BlueShield Minnesota,Medicare Advantage,33.81,49,,percent of total billed charges,,
"Cryptosporidium Ag, F (Mayo)OutsideLaboratory",,87328,CPT,Facility,Inpatient,,,90,69,58.65,19.7754,69,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Cryptosporidium Ag, F (Mayo)OutsideLaboratory",,87328,CPT,Facility,Both,,,90,69,58.65,19.7754,69,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,61.1133,88.57,,percent of total billed charges,,
"Cryptosporidium Ag, F (Mayo)OutsideLaboratory",,87328,CPT,Facility,Both,,,90,69,58.65,19.7754,69,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,19.7754,28.66,,percent of total billed charges,,
"Cryptosporidium Ag, F (Mayo)OutsideLaboratory",,87328,CPT,Facility,Outpatient,,,90,69,58.65,19.7754,69,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),33.81,49,,percent of total billed charges,,
"Cryptosporidium Ag, F (Mayo)OutsideLaboratory",,87328,CPT,Facility,Inpatient,,,90,69,58.65,19.7754,69,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Cryptosporidium Ag, F (Mayo)OutsideLaboratory",,87328,CPT,Facility,Both,,,90,69,58.65,19.7754,69,CorVel,Worker's Compensation,69,100,,percent of total billed charges,,
"Cryptosporidium Ag, F (Mayo)OutsideLaboratory",,87328,CPT,Facility,Both,,,90,69,58.65,19.7754,69,First Health Group Corporation,First Health Network,66.93,97,,percent of total billed charges,,
"Cryptosporidium Ag, F (Mayo)OutsideLaboratory",,87328,CPT,Facility,Both,,,90,69,58.65,19.7754,69,"Health Partners, Inc.",Commercial,65.274,94.6,,percent of total billed charges,,
"Cryptosporidium Ag, F (Mayo)OutsideLaboratory",,87328,CPT,Facility,Outpatient,,,90,69,58.65,19.7754,69,"Health Partners, Inc.",Medicare Advantage,33.81,49,,percent of total billed charges,,
"Cryptosporidium Ag, F (Mayo)OutsideLaboratory",,87328,CPT,Facility,Inpatient,,,90,69,58.65,19.7754,69,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Cryptosporidium Ag, F (Mayo)OutsideLaboratory",,87328,CPT,Facility,Both,,,90,69,58.65,19.7754,69,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),41.4,60,,percent of total billed charges,,
"Cryptosporidium Ag, F (Mayo)OutsideLaboratory",,87328,CPT,Facility,Both,,,90,69,58.65,19.7754,69,"Health Partners, Inc.",State of Minnesota Advantage Program,56.235,81.5,,percent of total billed charges,,
"Cryptosporidium Ag, F (Mayo)OutsideLaboratory",,87328,CPT,Facility,Both,,,90,69,58.65,19.7754,69,"Health Partners, Inc.",State Public Programs,34.5,50,,percent of total billed charges,,
"Cryptosporidium Ag, F (Mayo)OutsideLaboratory",,87328,CPT,Facility,Both,,,90,69,58.65,19.7754,69,Humana Insurance Company,Commercial PPO,65.55,95,,percent of total billed charges,,
"Cryptosporidium Ag, F (Mayo)OutsideLaboratory",,87328,CPT,Facility,Outpatient,,,90,69,58.65,19.7754,69,Humana Insurance Company,Medicare PPO,33.81,49,,percent of total billed charges,,
"Cryptosporidium Ag, F (Mayo)OutsideLaboratory",,87328,CPT,Facility,Inpatient,,,90,69,58.65,19.7754,69,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Cryptosporidium Ag, F (Mayo)OutsideLaboratory",,87328,CPT,Facility,Both,,,90,69,58.65,19.7754,69,Medica,Individual & Family,68.379,99.1,,percent of total billed charges,,
"Cryptosporidium Ag, F (Mayo)OutsideLaboratory",,87328,CPT,Facility,Outpatient,,,90,69,58.65,19.7754,69,Medica,Medica Advantage Solution,34.362,49.8,,percent of total billed charges,,
"Cryptosporidium Ag, F (Mayo)OutsideLaboratory",,87328,CPT,Facility,Inpatient,,,90,69,58.65,19.7754,69,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Cryptosporidium Ag, F (Mayo)OutsideLaboratory",,87328,CPT,Facility,Outpatient,,,90,69,58.65,19.7754,69,Medica,Medical Assistance,30.774,44.6,,percent of total billed charges,,
"Cryptosporidium Ag, F (Mayo)OutsideLaboratory",,87328,CPT,Facility,Inpatient,,,90,69,58.65,19.7754,69,Medica,Medical Assistance,,,,,Included in per diem rate,
"Cryptosporidium Ag, F (Mayo)OutsideLaboratory",,87328,CPT,Facility,Outpatient,,,90,69,58.65,19.7754,69,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,34.362,49.8,,percent of total billed charges,,
"Cryptosporidium Ag, F (Mayo)OutsideLaboratory",,87328,CPT,Facility,Inpatient,,,90,69,58.65,19.7754,69,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Cryptosporidium Ag, F (Mayo)OutsideLaboratory",,87328,CPT,Facility,Both,,,90,69,58.65,19.7754,69,"Multiplan, Inc.","Multiplan, Inc.",64.86,94,,percent of total billed charges,,
"Cryptosporidium Ag, F (Mayo)OutsideLaboratory",,87328,CPT,Facility,Outpatient,,,90,69,58.65,19.7754,69,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,59.616,86.4,,percent of total billed charges,,
"Cryptosporidium Ag, F (Mayo)OutsideLaboratory",,87328,CPT,Facility,Inpatient,,,90,69,58.65,19.7754,69,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Cryptosporidium Ag, F (Mayo)OutsideLaboratory",,87328,CPT,Facility,Both,,,90,69,58.65,19.7754,69,"Preferred One Administrative Services, INC.",PPO,68.034,98.6,,percent of total billed charges,,
"Cryptosporidium Ag, F (Mayo)OutsideLaboratory",,87328,CPT,Facility,Outpatient,,,90,69,58.65,19.7754,69,PrimeWest Health,Minnesota Senior Health Options (MSHO),35.5005,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Cryptosporidium Ag, F (Mayo)OutsideLaboratory",,87328,CPT,Facility,Inpatient,,,90,69,58.65,19.7754,69,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Cryptosporidium Ag, F (Mayo)OutsideLaboratory",,87328,CPT,Facility,Outpatient,,,90,69,58.65,19.7754,69,PrimeWest Health,MinnesotaCare,35.4384,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Cryptosporidium Ag, F (Mayo)OutsideLaboratory",,87328,CPT,Facility,Inpatient,,,90,69,58.65,19.7754,69,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Cryptosporidium Ag, F (Mayo)OutsideLaboratory",,87328,CPT,Facility,Both,,,90,69,58.65,19.7754,69,Sanford Health Plan,Sanford Health Plan,63.48,92,,percent of total billed charges,,
"Cryptosporidium Ag, F (Mayo)OutsideLaboratory",,87328,CPT,Facility,Outpatient,,,90,69,58.65,19.7754,69,"UCare Health, Inc.",Individual & Family Plan,38.8815,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Cryptosporidium Ag, F (Mayo)OutsideLaboratory",,87328,CPT,Facility,Inpatient,,,90,69,58.65,19.7754,69,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Cryptosporidium Ag, F (Mayo)OutsideLaboratory",,87328,CPT,Facility,Outpatient,,,90,69,58.65,19.7754,69,"UCare Health, Inc.",Medical Assistance,34.8243,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Cryptosporidium Ag, F (Mayo)OutsideLaboratory",,87328,CPT,Facility,Inpatient,,,90,69,58.65,19.7754,69,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Cryptosporidium Ag, F (Mayo)OutsideLaboratory",,87328,CPT,Facility,Outpatient,,,90,69,58.65,19.7754,69,"UCare Health, Inc.",Medicare Advantage,34.8243,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Cryptosporidium Ag, F (Mayo)OutsideLaboratory",,87328,CPT,Facility,Inpatient,,,90,69,58.65,19.7754,69,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Cryptosporidium Ag, F (Mayo)OutsideLaboratory",,87328,CPT,Facility,Outpatient,,,90,69,58.65,19.7754,69,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),34.8243,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Cryptosporidium Ag, F (Mayo)OutsideLaboratory",,87328,CPT,Facility,Inpatient,,,90,69,58.65,19.7754,69,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Cryptosporidium Ag, F (Mayo)OutsideLaboratory",,87328,CPT,Facility,Both,,,90,69,58.65,19.7754,69,UnitedHealthcare,Individual & Family,64.86,94,,percent of total billed charges,,
"Cryptosporidium Ag, F (Mayo)OutsideLaboratory",,87328,CPT,Facility,Outpatient,,,90,69,58.65,19.7754,69,UnitedHealthcare,Medicare Advantage,33.81,49,,percent of total billed charges,,
"Cryptosporidium Ag, F (Mayo)OutsideLaboratory",,87328,CPT,Facility,Inpatient,,,90,69,58.65,19.7754,69,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Cryptosporidium Ag, F (Mayo)OutsideLaboratory",,87328,CPT,Facility,Outpatient,,,90,69,58.65,19.7754,69,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,33.12,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Cryptosporidium Ag, F (Mayo)OutsideLaboratory",,87328,CPT,Facility,Inpatient,,,90,69,58.65,19.7754,69,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Giardia Ag, F (Mayo)OutsideLaboratory",,87329,CPT,Facility,Both,,,90,77,65.45,22.0682,77,Aetna,Commercial,70.84,92,,percent of total billed charges,,
"Giardia Ag, F (Mayo)OutsideLaboratory",,87329,CPT,Facility,Outpatient,,,90,77,65.45,22.0682,77,Aetna,Medicare Advantage,37.73,49,,percent of total billed charges,,
"Giardia Ag, F (Mayo)OutsideLaboratory",,87329,CPT,Facility,Inpatient,,,90,77,65.45,22.0682,77,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Giardia Ag, F (Mayo)OutsideLaboratory",,87329,CPT,Facility,Both,,,90,77,65.45,22.0682,77,Aetna,PPO,71.61,93,,percent of total billed charges,,
"Giardia Ag, F (Mayo)OutsideLaboratory",,87329,CPT,Facility,Both,,,90,77,65.45,22.0682,77,America's PPO,America's PPO,73.9431,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Giardia Ag, F (Mayo)OutsideLaboratory",,87329,CPT,Facility,Both,,,90,77,65.45,22.0682,77,BlueCross BlueShield Minnesota, Federal Employee Program,75.768,98.4,,percent of total billed charges,,
"Giardia Ag, F (Mayo)OutsideLaboratory",,87329,CPT,Facility,Both,,,90,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,77,100,,percent of total billed charges,,
"Giardia Ag, F (Mayo)OutsideLaboratory",,87329,CPT,Facility,Both,,,90,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,High Value Network Plan,69.3,90,,percent of total billed charges,,
"Giardia Ag, F (Mayo)OutsideLaboratory",,87329,CPT,Facility,Outpatient,,,90,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,Medicare Advantage,37.73,49,,percent of total billed charges,,
"Giardia Ag, F (Mayo)OutsideLaboratory",,87329,CPT,Facility,Inpatient,,,90,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Giardia Ag, F (Mayo)OutsideLaboratory",,87329,CPT,Facility,Both,,,90,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,68.1989,88.57,,percent of total billed charges,,
"Giardia Ag, F (Mayo)OutsideLaboratory",,87329,CPT,Facility,Both,,,90,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,22.0682,28.66,,percent of total billed charges,,
"Giardia Ag, F (Mayo)OutsideLaboratory",,87329,CPT,Facility,Outpatient,,,90,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),37.73,49,,percent of total billed charges,,
"Giardia Ag, F (Mayo)OutsideLaboratory",,87329,CPT,Facility,Inpatient,,,90,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Giardia Ag, F (Mayo)OutsideLaboratory",,87329,CPT,Facility,Both,,,90,77,65.45,22.0682,77,CorVel,Worker's Compensation,77,100,,percent of total billed charges,,
"Giardia Ag, F (Mayo)OutsideLaboratory",,87329,CPT,Facility,Both,,,90,77,65.45,22.0682,77,First Health Group Corporation,First Health Network,74.69,97,,percent of total billed charges,,
"Giardia Ag, F (Mayo)OutsideLaboratory",,87329,CPT,Facility,Both,,,90,77,65.45,22.0682,77,"Health Partners, Inc.",Commercial,72.842,94.6,,percent of total billed charges,,
"Giardia Ag, F (Mayo)OutsideLaboratory",,87329,CPT,Facility,Outpatient,,,90,77,65.45,22.0682,77,"Health Partners, Inc.",Medicare Advantage,37.73,49,,percent of total billed charges,,
"Giardia Ag, F (Mayo)OutsideLaboratory",,87329,CPT,Facility,Inpatient,,,90,77,65.45,22.0682,77,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Giardia Ag, F (Mayo)OutsideLaboratory",,87329,CPT,Facility,Both,,,90,77,65.45,22.0682,77,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),46.2,60,,percent of total billed charges,,
"Giardia Ag, F (Mayo)OutsideLaboratory",,87329,CPT,Facility,Both,,,90,77,65.45,22.0682,77,"Health Partners, Inc.",State of Minnesota Advantage Program,62.755,81.5,,percent of total billed charges,,
"Giardia Ag, F (Mayo)OutsideLaboratory",,87329,CPT,Facility,Both,,,90,77,65.45,22.0682,77,"Health Partners, Inc.",State Public Programs,38.5,50,,percent of total billed charges,,
"Giardia Ag, F (Mayo)OutsideLaboratory",,87329,CPT,Facility,Both,,,90,77,65.45,22.0682,77,Humana Insurance Company,Commercial PPO,73.15,95,,percent of total billed charges,,
"Giardia Ag, F (Mayo)OutsideLaboratory",,87329,CPT,Facility,Outpatient,,,90,77,65.45,22.0682,77,Humana Insurance Company,Medicare PPO,37.73,49,,percent of total billed charges,,
"Giardia Ag, F (Mayo)OutsideLaboratory",,87329,CPT,Facility,Inpatient,,,90,77,65.45,22.0682,77,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Giardia Ag, F (Mayo)OutsideLaboratory",,87329,CPT,Facility,Both,,,90,77,65.45,22.0682,77,Medica,Individual & Family,76.307,99.1,,percent of total billed charges,,
"Giardia Ag, F (Mayo)OutsideLaboratory",,87329,CPT,Facility,Outpatient,,,90,77,65.45,22.0682,77,Medica,Medica Advantage Solution,38.346,49.8,,percent of total billed charges,,
"Giardia Ag, F (Mayo)OutsideLaboratory",,87329,CPT,Facility,Inpatient,,,90,77,65.45,22.0682,77,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Giardia Ag, F (Mayo)OutsideLaboratory",,87329,CPT,Facility,Outpatient,,,90,77,65.45,22.0682,77,Medica,Medical Assistance,34.342,44.6,,percent of total billed charges,,
"Giardia Ag, F (Mayo)OutsideLaboratory",,87329,CPT,Facility,Inpatient,,,90,77,65.45,22.0682,77,Medica,Medical Assistance,,,,,Included in per diem rate,
"Giardia Ag, F (Mayo)OutsideLaboratory",,87329,CPT,Facility,Outpatient,,,90,77,65.45,22.0682,77,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,38.346,49.8,,percent of total billed charges,,
"Giardia Ag, F (Mayo)OutsideLaboratory",,87329,CPT,Facility,Inpatient,,,90,77,65.45,22.0682,77,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Giardia Ag, F (Mayo)OutsideLaboratory",,87329,CPT,Facility,Both,,,90,77,65.45,22.0682,77,"Multiplan, Inc.","Multiplan, Inc.",72.38,94,,percent of total billed charges,,
"Giardia Ag, F (Mayo)OutsideLaboratory",,87329,CPT,Facility,Outpatient,,,90,77,65.45,22.0682,77,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,66.528,86.4,,percent of total billed charges,,
"Giardia Ag, F (Mayo)OutsideLaboratory",,87329,CPT,Facility,Inpatient,,,90,77,65.45,22.0682,77,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Giardia Ag, F (Mayo)OutsideLaboratory",,87329,CPT,Facility,Both,,,90,77,65.45,22.0682,77,"Preferred One Administrative Services, INC.",PPO,75.922,98.6,,percent of total billed charges,,
"Giardia Ag, F (Mayo)OutsideLaboratory",,87329,CPT,Facility,Outpatient,,,90,77,65.45,22.0682,77,PrimeWest Health,Minnesota Senior Health Options (MSHO),39.6165,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Giardia Ag, F (Mayo)OutsideLaboratory",,87329,CPT,Facility,Inpatient,,,90,77,65.45,22.0682,77,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Giardia Ag, F (Mayo)OutsideLaboratory",,87329,CPT,Facility,Outpatient,,,90,77,65.45,22.0682,77,PrimeWest Health,MinnesotaCare,39.5472,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Giardia Ag, F (Mayo)OutsideLaboratory",,87329,CPT,Facility,Inpatient,,,90,77,65.45,22.0682,77,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Giardia Ag, F (Mayo)OutsideLaboratory",,87329,CPT,Facility,Both,,,90,77,65.45,22.0682,77,Sanford Health Plan,Sanford Health Plan,70.84,92,,percent of total billed charges,,
"Giardia Ag, F (Mayo)OutsideLaboratory",,87329,CPT,Facility,Outpatient,,,90,77,65.45,22.0682,77,"UCare Health, Inc.",Individual & Family Plan,43.3895,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Giardia Ag, F (Mayo)OutsideLaboratory",,87329,CPT,Facility,Inpatient,,,90,77,65.45,22.0682,77,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Giardia Ag, F (Mayo)OutsideLaboratory",,87329,CPT,Facility,Outpatient,,,90,77,65.45,22.0682,77,"UCare Health, Inc.",Medical Assistance,38.8619,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Giardia Ag, F (Mayo)OutsideLaboratory",,87329,CPT,Facility,Inpatient,,,90,77,65.45,22.0682,77,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Giardia Ag, F (Mayo)OutsideLaboratory",,87329,CPT,Facility,Outpatient,,,90,77,65.45,22.0682,77,"UCare Health, Inc.",Medicare Advantage,38.8619,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Giardia Ag, F (Mayo)OutsideLaboratory",,87329,CPT,Facility,Inpatient,,,90,77,65.45,22.0682,77,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Giardia Ag, F (Mayo)OutsideLaboratory",,87329,CPT,Facility,Outpatient,,,90,77,65.45,22.0682,77,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),38.8619,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Giardia Ag, F (Mayo)OutsideLaboratory",,87329,CPT,Facility,Inpatient,,,90,77,65.45,22.0682,77,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Giardia Ag, F (Mayo)OutsideLaboratory",,87329,CPT,Facility,Both,,,90,77,65.45,22.0682,77,UnitedHealthcare,Individual & Family,72.38,94,,percent of total billed charges,,
"Giardia Ag, F (Mayo)OutsideLaboratory",,87329,CPT,Facility,Outpatient,,,90,77,65.45,22.0682,77,UnitedHealthcare,Medicare Advantage,37.73,49,,percent of total billed charges,,
"Giardia Ag, F (Mayo)OutsideLaboratory",,87329,CPT,Facility,Inpatient,,,90,77,65.45,22.0682,77,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Giardia Ag, F (Mayo)OutsideLaboratory",,87329,CPT,Facility,Outpatient,,,90,77,65.45,22.0682,77,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,36.96,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Giardia Ag, F (Mayo)OutsideLaboratory",,87329,CPT,Facility,Inpatient,,,90,77,65.45,22.0682,77,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Hepatitis B Surface Antigen (Mayo)OutsideLaboratory,,87340,CPT,Facility,Both,,,90,45,38.25,12.897,45,Aetna,Commercial,41.4,92,,percent of total billed charges,,
Hepatitis B Surface Antigen (Mayo)OutsideLaboratory,,87340,CPT,Facility,Outpatient,,,90,45,38.25,12.897,45,Aetna,Medicare Advantage,22.05,49,,percent of total billed charges,,
Hepatitis B Surface Antigen (Mayo)OutsideLaboratory,,87340,CPT,Facility,Inpatient,,,90,45,38.25,12.897,45,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Hepatitis B Surface Antigen (Mayo)OutsideLaboratory,,87340,CPT,Facility,Both,,,90,45,38.25,12.897,45,Aetna,PPO,41.85,93,,percent of total billed charges,,
Hepatitis B Surface Antigen (Mayo)OutsideLaboratory,,87340,CPT,Facility,Both,,,90,45,38.25,12.897,45,America's PPO,America's PPO,43.2135,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Hepatitis B Surface Antigen (Mayo)OutsideLaboratory,,87340,CPT,Facility,Both,,,90,45,38.25,12.897,45,BlueCross BlueShield Minnesota, Federal Employee Program,44.28,98.4,,percent of total billed charges,,
Hepatitis B Surface Antigen (Mayo)OutsideLaboratory,,87340,CPT,Facility,Both,,,90,45,38.25,12.897,45,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,45,100,,percent of total billed charges,,
Hepatitis B Surface Antigen (Mayo)OutsideLaboratory,,87340,CPT,Facility,Both,,,90,45,38.25,12.897,45,BlueCross BlueShield Minnesota,High Value Network Plan,40.5,90,,percent of total billed charges,,
Hepatitis B Surface Antigen (Mayo)OutsideLaboratory,,87340,CPT,Facility,Outpatient,,,90,45,38.25,12.897,45,BlueCross BlueShield Minnesota,Medicare Advantage,22.05,49,,percent of total billed charges,,
Hepatitis B Surface Antigen (Mayo)OutsideLaboratory,,87340,CPT,Facility,Inpatient,,,90,45,38.25,12.897,45,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Hepatitis B Surface Antigen (Mayo)OutsideLaboratory,,87340,CPT,Facility,Both,,,90,45,38.25,12.897,45,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,39.8565,88.57,,percent of total billed charges,,
Hepatitis B Surface Antigen (Mayo)OutsideLaboratory,,87340,CPT,Facility,Both,,,90,45,38.25,12.897,45,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,12.897,28.66,,percent of total billed charges,,
Hepatitis B Surface Antigen (Mayo)OutsideLaboratory,,87340,CPT,Facility,Outpatient,,,90,45,38.25,12.897,45,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),22.05,49,,percent of total billed charges,,
Hepatitis B Surface Antigen (Mayo)OutsideLaboratory,,87340,CPT,Facility,Inpatient,,,90,45,38.25,12.897,45,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Hepatitis B Surface Antigen (Mayo)OutsideLaboratory,,87340,CPT,Facility,Both,,,90,45,38.25,12.897,45,CorVel,Worker's Compensation,45,100,,percent of total billed charges,,
Hepatitis B Surface Antigen (Mayo)OutsideLaboratory,,87340,CPT,Facility,Both,,,90,45,38.25,12.897,45,First Health Group Corporation,First Health Network,43.65,97,,percent of total billed charges,,
Hepatitis B Surface Antigen (Mayo)OutsideLaboratory,,87340,CPT,Facility,Both,,,90,45,38.25,12.897,45,"Health Partners, Inc.",Commercial,42.57,94.6,,percent of total billed charges,,
Hepatitis B Surface Antigen (Mayo)OutsideLaboratory,,87340,CPT,Facility,Outpatient,,,90,45,38.25,12.897,45,"Health Partners, Inc.",Medicare Advantage,22.05,49,,percent of total billed charges,,
Hepatitis B Surface Antigen (Mayo)OutsideLaboratory,,87340,CPT,Facility,Inpatient,,,90,45,38.25,12.897,45,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Hepatitis B Surface Antigen (Mayo)OutsideLaboratory,,87340,CPT,Facility,Both,,,90,45,38.25,12.897,45,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),27,60,,percent of total billed charges,,
Hepatitis B Surface Antigen (Mayo)OutsideLaboratory,,87340,CPT,Facility,Both,,,90,45,38.25,12.897,45,"Health Partners, Inc.",State of Minnesota Advantage Program,36.675,81.5,,percent of total billed charges,,
Hepatitis B Surface Antigen (Mayo)OutsideLaboratory,,87340,CPT,Facility,Both,,,90,45,38.25,12.897,45,"Health Partners, Inc.",State Public Programs,22.5,50,,percent of total billed charges,,
Hepatitis B Surface Antigen (Mayo)OutsideLaboratory,,87340,CPT,Facility,Both,,,90,45,38.25,12.897,45,Humana Insurance Company,Commercial PPO,42.75,95,,percent of total billed charges,,
Hepatitis B Surface Antigen (Mayo)OutsideLaboratory,,87340,CPT,Facility,Outpatient,,,90,45,38.25,12.897,45,Humana Insurance Company,Medicare PPO,22.05,49,,percent of total billed charges,,
Hepatitis B Surface Antigen (Mayo)OutsideLaboratory,,87340,CPT,Facility,Inpatient,,,90,45,38.25,12.897,45,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Hepatitis B Surface Antigen (Mayo)OutsideLaboratory,,87340,CPT,Facility,Both,,,90,45,38.25,12.897,45,Medica,Individual & Family,44.595,99.1,,percent of total billed charges,,
Hepatitis B Surface Antigen (Mayo)OutsideLaboratory,,87340,CPT,Facility,Outpatient,,,90,45,38.25,12.897,45,Medica,Medica Advantage Solution,22.41,49.8,,percent of total billed charges,,
Hepatitis B Surface Antigen (Mayo)OutsideLaboratory,,87340,CPT,Facility,Inpatient,,,90,45,38.25,12.897,45,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Hepatitis B Surface Antigen (Mayo)OutsideLaboratory,,87340,CPT,Facility,Outpatient,,,90,45,38.25,12.897,45,Medica,Medical Assistance,20.07,44.6,,percent of total billed charges,,
Hepatitis B Surface Antigen (Mayo)OutsideLaboratory,,87340,CPT,Facility,Inpatient,,,90,45,38.25,12.897,45,Medica,Medical Assistance,,,,,Included in per diem rate,
Hepatitis B Surface Antigen (Mayo)OutsideLaboratory,,87340,CPT,Facility,Outpatient,,,90,45,38.25,12.897,45,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,22.41,49.8,,percent of total billed charges,,
Hepatitis B Surface Antigen (Mayo)OutsideLaboratory,,87340,CPT,Facility,Inpatient,,,90,45,38.25,12.897,45,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Hepatitis B Surface Antigen (Mayo)OutsideLaboratory,,87340,CPT,Facility,Both,,,90,45,38.25,12.897,45,"Multiplan, Inc.","Multiplan, Inc.",42.3,94,,percent of total billed charges,,
Hepatitis B Surface Antigen (Mayo)OutsideLaboratory,,87340,CPT,Facility,Outpatient,,,90,45,38.25,12.897,45,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,38.88,86.4,,percent of total billed charges,,
Hepatitis B Surface Antigen (Mayo)OutsideLaboratory,,87340,CPT,Facility,Inpatient,,,90,45,38.25,12.897,45,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Hepatitis B Surface Antigen (Mayo)OutsideLaboratory,,87340,CPT,Facility,Both,,,90,45,38.25,12.897,45,"Preferred One Administrative Services, INC.",PPO,44.37,98.6,,percent of total billed charges,,
Hepatitis B Surface Antigen (Mayo)OutsideLaboratory,,87340,CPT,Facility,Outpatient,,,90,45,38.25,12.897,45,PrimeWest Health,Minnesota Senior Health Options (MSHO),23.1525,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Hepatitis B Surface Antigen (Mayo)OutsideLaboratory,,87340,CPT,Facility,Inpatient,,,90,45,38.25,12.897,45,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Hepatitis B Surface Antigen (Mayo)OutsideLaboratory,,87340,CPT,Facility,Outpatient,,,90,45,38.25,12.897,45,PrimeWest Health,MinnesotaCare,23.112,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Hepatitis B Surface Antigen (Mayo)OutsideLaboratory,,87340,CPT,Facility,Inpatient,,,90,45,38.25,12.897,45,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Hepatitis B Surface Antigen (Mayo)OutsideLaboratory,,87340,CPT,Facility,Both,,,90,45,38.25,12.897,45,Sanford Health Plan,Sanford Health Plan,41.4,92,,percent of total billed charges,,
Hepatitis B Surface Antigen (Mayo)OutsideLaboratory,,87340,CPT,Facility,Outpatient,,,90,45,38.25,12.897,45,"UCare Health, Inc.",Individual & Family Plan,25.3575,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Hepatitis B Surface Antigen (Mayo)OutsideLaboratory,,87340,CPT,Facility,Inpatient,,,90,45,38.25,12.897,45,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Hepatitis B Surface Antigen (Mayo)OutsideLaboratory,,87340,CPT,Facility,Outpatient,,,90,45,38.25,12.897,45,"UCare Health, Inc.",Medical Assistance,22.7115,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Hepatitis B Surface Antigen (Mayo)OutsideLaboratory,,87340,CPT,Facility,Inpatient,,,90,45,38.25,12.897,45,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Hepatitis B Surface Antigen (Mayo)OutsideLaboratory,,87340,CPT,Facility,Outpatient,,,90,45,38.25,12.897,45,"UCare Health, Inc.",Medicare Advantage,22.7115,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Hepatitis B Surface Antigen (Mayo)OutsideLaboratory,,87340,CPT,Facility,Inpatient,,,90,45,38.25,12.897,45,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Hepatitis B Surface Antigen (Mayo)OutsideLaboratory,,87340,CPT,Facility,Outpatient,,,90,45,38.25,12.897,45,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),22.7115,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Hepatitis B Surface Antigen (Mayo)OutsideLaboratory,,87340,CPT,Facility,Inpatient,,,90,45,38.25,12.897,45,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Hepatitis B Surface Antigen (Mayo)OutsideLaboratory,,87340,CPT,Facility,Both,,,90,45,38.25,12.897,45,UnitedHealthcare,Individual & Family,42.3,94,,percent of total billed charges,,
Hepatitis B Surface Antigen (Mayo)OutsideLaboratory,,87340,CPT,Facility,Outpatient,,,90,45,38.25,12.897,45,UnitedHealthcare,Medicare Advantage,22.05,49,,percent of total billed charges,,
Hepatitis B Surface Antigen (Mayo)OutsideLaboratory,,87340,CPT,Facility,Inpatient,,,90,45,38.25,12.897,45,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Hepatitis B Surface Antigen (Mayo)OutsideLaboratory,,87340,CPT,Facility,Outpatient,,,90,45,38.25,12.897,45,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,21.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
Hepatitis B Surface Antigen (Mayo)OutsideLaboratory,,87340,CPT,Facility,Inpatient,,,90,45,38.25,12.897,45,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Histoplasma Ag (Mayo)OutsideLaboratory,,87385,CPT,Facility,Both,,,90,245,208.25,70.217,245,Aetna,Commercial,225.4,92,,percent of total billed charges,,
Histoplasma Ag (Mayo)OutsideLaboratory,,87385,CPT,Facility,Outpatient,,,90,245,208.25,70.217,245,Aetna,Medicare Advantage,120.05,49,,percent of total billed charges,,
Histoplasma Ag (Mayo)OutsideLaboratory,,87385,CPT,Facility,Inpatient,,,90,245,208.25,70.217,245,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Histoplasma Ag (Mayo)OutsideLaboratory,,87385,CPT,Facility,Both,,,90,245,208.25,70.217,245,Aetna,PPO,227.85,93,,percent of total billed charges,,
Histoplasma Ag (Mayo)OutsideLaboratory,,87385,CPT,Facility,Both,,,90,245,208.25,70.217,245,America's PPO,America's PPO,235.2735,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Histoplasma Ag (Mayo)OutsideLaboratory,,87385,CPT,Facility,Both,,,90,245,208.25,70.217,245,BlueCross BlueShield Minnesota, Federal Employee Program,241.08,98.4,,percent of total billed charges,,
Histoplasma Ag (Mayo)OutsideLaboratory,,87385,CPT,Facility,Both,,,90,245,208.25,70.217,245,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,245,100,,percent of total billed charges,,
Histoplasma Ag (Mayo)OutsideLaboratory,,87385,CPT,Facility,Both,,,90,245,208.25,70.217,245,BlueCross BlueShield Minnesota,High Value Network Plan,220.5,90,,percent of total billed charges,,
Histoplasma Ag (Mayo)OutsideLaboratory,,87385,CPT,Facility,Outpatient,,,90,245,208.25,70.217,245,BlueCross BlueShield Minnesota,Medicare Advantage,120.05,49,,percent of total billed charges,,
Histoplasma Ag (Mayo)OutsideLaboratory,,87385,CPT,Facility,Inpatient,,,90,245,208.25,70.217,245,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Histoplasma Ag (Mayo)OutsideLaboratory,,87385,CPT,Facility,Both,,,90,245,208.25,70.217,245,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,216.9965,88.57,,percent of total billed charges,,
Histoplasma Ag (Mayo)OutsideLaboratory,,87385,CPT,Facility,Both,,,90,245,208.25,70.217,245,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,70.217,28.66,,percent of total billed charges,,
Histoplasma Ag (Mayo)OutsideLaboratory,,87385,CPT,Facility,Outpatient,,,90,245,208.25,70.217,245,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),120.05,49,,percent of total billed charges,,
Histoplasma Ag (Mayo)OutsideLaboratory,,87385,CPT,Facility,Inpatient,,,90,245,208.25,70.217,245,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Histoplasma Ag (Mayo)OutsideLaboratory,,87385,CPT,Facility,Both,,,90,245,208.25,70.217,245,CorVel,Worker's Compensation,245,100,,percent of total billed charges,,
Histoplasma Ag (Mayo)OutsideLaboratory,,87385,CPT,Facility,Both,,,90,245,208.25,70.217,245,First Health Group Corporation,First Health Network,237.65,97,,percent of total billed charges,,
Histoplasma Ag (Mayo)OutsideLaboratory,,87385,CPT,Facility,Both,,,90,245,208.25,70.217,245,"Health Partners, Inc.",Commercial,231.77,94.6,,percent of total billed charges,,
Histoplasma Ag (Mayo)OutsideLaboratory,,87385,CPT,Facility,Outpatient,,,90,245,208.25,70.217,245,"Health Partners, Inc.",Medicare Advantage,120.05,49,,percent of total billed charges,,
Histoplasma Ag (Mayo)OutsideLaboratory,,87385,CPT,Facility,Inpatient,,,90,245,208.25,70.217,245,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Histoplasma Ag (Mayo)OutsideLaboratory,,87385,CPT,Facility,Both,,,90,245,208.25,70.217,245,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),147,60,,percent of total billed charges,,
Histoplasma Ag (Mayo)OutsideLaboratory,,87385,CPT,Facility,Both,,,90,245,208.25,70.217,245,"Health Partners, Inc.",State of Minnesota Advantage Program,199.675,81.5,,percent of total billed charges,,
Histoplasma Ag (Mayo)OutsideLaboratory,,87385,CPT,Facility,Both,,,90,245,208.25,70.217,245,"Health Partners, Inc.",State Public Programs,122.5,50,,percent of total billed charges,,
Histoplasma Ag (Mayo)OutsideLaboratory,,87385,CPT,Facility,Both,,,90,245,208.25,70.217,245,Humana Insurance Company,Commercial PPO,232.75,95,,percent of total billed charges,,
Histoplasma Ag (Mayo)OutsideLaboratory,,87385,CPT,Facility,Outpatient,,,90,245,208.25,70.217,245,Humana Insurance Company,Medicare PPO,120.05,49,,percent of total billed charges,,
Histoplasma Ag (Mayo)OutsideLaboratory,,87385,CPT,Facility,Inpatient,,,90,245,208.25,70.217,245,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Histoplasma Ag (Mayo)OutsideLaboratory,,87385,CPT,Facility,Both,,,90,245,208.25,70.217,245,Medica,Individual & Family,242.795,99.1,,percent of total billed charges,,
Histoplasma Ag (Mayo)OutsideLaboratory,,87385,CPT,Facility,Outpatient,,,90,245,208.25,70.217,245,Medica,Medica Advantage Solution,122.01,49.8,,percent of total billed charges,,
Histoplasma Ag (Mayo)OutsideLaboratory,,87385,CPT,Facility,Inpatient,,,90,245,208.25,70.217,245,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Histoplasma Ag (Mayo)OutsideLaboratory,,87385,CPT,Facility,Outpatient,,,90,245,208.25,70.217,245,Medica,Medical Assistance,109.27,44.6,,percent of total billed charges,,
Histoplasma Ag (Mayo)OutsideLaboratory,,87385,CPT,Facility,Inpatient,,,90,245,208.25,70.217,245,Medica,Medical Assistance,,,,,Included in per diem rate,
Histoplasma Ag (Mayo)OutsideLaboratory,,87385,CPT,Facility,Outpatient,,,90,245,208.25,70.217,245,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,122.01,49.8,,percent of total billed charges,,
Histoplasma Ag (Mayo)OutsideLaboratory,,87385,CPT,Facility,Inpatient,,,90,245,208.25,70.217,245,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Histoplasma Ag (Mayo)OutsideLaboratory,,87385,CPT,Facility,Both,,,90,245,208.25,70.217,245,"Multiplan, Inc.","Multiplan, Inc.",230.3,94,,percent of total billed charges,,
Histoplasma Ag (Mayo)OutsideLaboratory,,87385,CPT,Facility,Outpatient,,,90,245,208.25,70.217,245,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,211.68,86.4,,percent of total billed charges,,
Histoplasma Ag (Mayo)OutsideLaboratory,,87385,CPT,Facility,Inpatient,,,90,245,208.25,70.217,245,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Histoplasma Ag (Mayo)OutsideLaboratory,,87385,CPT,Facility,Both,,,90,245,208.25,70.217,245,"Preferred One Administrative Services, INC.",PPO,241.57,98.6,,percent of total billed charges,,
Histoplasma Ag (Mayo)OutsideLaboratory,,87385,CPT,Facility,Outpatient,,,90,245,208.25,70.217,245,PrimeWest Health,Minnesota Senior Health Options (MSHO),126.0525,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Histoplasma Ag (Mayo)OutsideLaboratory,,87385,CPT,Facility,Inpatient,,,90,245,208.25,70.217,245,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Histoplasma Ag (Mayo)OutsideLaboratory,,87385,CPT,Facility,Outpatient,,,90,245,208.25,70.217,245,PrimeWest Health,MinnesotaCare,125.832,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Histoplasma Ag (Mayo)OutsideLaboratory,,87385,CPT,Facility,Inpatient,,,90,245,208.25,70.217,245,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Histoplasma Ag (Mayo)OutsideLaboratory,,87385,CPT,Facility,Both,,,90,245,208.25,70.217,245,Sanford Health Plan,Sanford Health Plan,225.4,92,,percent of total billed charges,,
Histoplasma Ag (Mayo)OutsideLaboratory,,87385,CPT,Facility,Outpatient,,,90,245,208.25,70.217,245,"UCare Health, Inc.",Individual & Family Plan,138.0575,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Histoplasma Ag (Mayo)OutsideLaboratory,,87385,CPT,Facility,Inpatient,,,90,245,208.25,70.217,245,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Histoplasma Ag (Mayo)OutsideLaboratory,,87385,CPT,Facility,Outpatient,,,90,245,208.25,70.217,245,"UCare Health, Inc.",Medical Assistance,123.6515,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Histoplasma Ag (Mayo)OutsideLaboratory,,87385,CPT,Facility,Inpatient,,,90,245,208.25,70.217,245,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Histoplasma Ag (Mayo)OutsideLaboratory,,87385,CPT,Facility,Outpatient,,,90,245,208.25,70.217,245,"UCare Health, Inc.",Medicare Advantage,123.6515,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Histoplasma Ag (Mayo)OutsideLaboratory,,87385,CPT,Facility,Inpatient,,,90,245,208.25,70.217,245,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Histoplasma Ag (Mayo)OutsideLaboratory,,87385,CPT,Facility,Outpatient,,,90,245,208.25,70.217,245,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),123.6515,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Histoplasma Ag (Mayo)OutsideLaboratory,,87385,CPT,Facility,Inpatient,,,90,245,208.25,70.217,245,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Histoplasma Ag (Mayo)OutsideLaboratory,,87385,CPT,Facility,Both,,,90,245,208.25,70.217,245,UnitedHealthcare,Individual & Family,230.3,94,,percent of total billed charges,,
Histoplasma Ag (Mayo)OutsideLaboratory,,87385,CPT,Facility,Outpatient,,,90,245,208.25,70.217,245,UnitedHealthcare,Medicare Advantage,120.05,49,,percent of total billed charges,,
Histoplasma Ag (Mayo)OutsideLaboratory,,87385,CPT,Facility,Inpatient,,,90,245,208.25,70.217,245,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Histoplasma Ag (Mayo)OutsideLaboratory,,87385,CPT,Facility,Outpatient,,,90,245,208.25,70.217,245,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,117.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
Histoplasma Ag (Mayo)OutsideLaboratory,,87385,CPT,Facility,Inpatient,,,90,245,208.25,70.217,245,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Blastomyces Antigen (Mayo)OutsideLaboratory,,87449,CPT,Facility,Both,,,90,109,92.65,31.2394,109,Aetna,Commercial,100.28,92,,percent of total billed charges,,
Blastomyces Antigen (Mayo)OutsideLaboratory,,87449,CPT,Facility,Outpatient,,,90,109,92.65,31.2394,109,Aetna,Medicare Advantage,53.41,49,,percent of total billed charges,,
Blastomyces Antigen (Mayo)OutsideLaboratory,,87449,CPT,Facility,Inpatient,,,90,109,92.65,31.2394,109,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Blastomyces Antigen (Mayo)OutsideLaboratory,,87449,CPT,Facility,Both,,,90,109,92.65,31.2394,109,Aetna,PPO,101.37,93,,percent of total billed charges,,
Blastomyces Antigen (Mayo)OutsideLaboratory,,87449,CPT,Facility,Both,,,90,109,92.65,31.2394,109,America's PPO,America's PPO,104.6727,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Blastomyces Antigen (Mayo)OutsideLaboratory,,87449,CPT,Facility,Both,,,90,109,92.65,31.2394,109,BlueCross BlueShield Minnesota, Federal Employee Program,107.256,98.4,,percent of total billed charges,,
Blastomyces Antigen (Mayo)OutsideLaboratory,,87449,CPT,Facility,Both,,,90,109,92.65,31.2394,109,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,109,100,,percent of total billed charges,,
Blastomyces Antigen (Mayo)OutsideLaboratory,,87449,CPT,Facility,Both,,,90,109,92.65,31.2394,109,BlueCross BlueShield Minnesota,High Value Network Plan,98.1,90,,percent of total billed charges,,
Blastomyces Antigen (Mayo)OutsideLaboratory,,87449,CPT,Facility,Outpatient,,,90,109,92.65,31.2394,109,BlueCross BlueShield Minnesota,Medicare Advantage,53.41,49,,percent of total billed charges,,
Blastomyces Antigen (Mayo)OutsideLaboratory,,87449,CPT,Facility,Inpatient,,,90,109,92.65,31.2394,109,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Blastomyces Antigen (Mayo)OutsideLaboratory,,87449,CPT,Facility,Both,,,90,109,92.65,31.2394,109,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,96.5413,88.57,,percent of total billed charges,,
Blastomyces Antigen (Mayo)OutsideLaboratory,,87449,CPT,Facility,Both,,,90,109,92.65,31.2394,109,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,31.2394,28.66,,percent of total billed charges,,
Blastomyces Antigen (Mayo)OutsideLaboratory,,87449,CPT,Facility,Outpatient,,,90,109,92.65,31.2394,109,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),53.41,49,,percent of total billed charges,,
Blastomyces Antigen (Mayo)OutsideLaboratory,,87449,CPT,Facility,Inpatient,,,90,109,92.65,31.2394,109,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Blastomyces Antigen (Mayo)OutsideLaboratory,,87449,CPT,Facility,Both,,,90,109,92.65,31.2394,109,CorVel,Worker's Compensation,109,100,,percent of total billed charges,,
Blastomyces Antigen (Mayo)OutsideLaboratory,,87449,CPT,Facility,Both,,,90,109,92.65,31.2394,109,First Health Group Corporation,First Health Network,105.73,97,,percent of total billed charges,,
Blastomyces Antigen (Mayo)OutsideLaboratory,,87449,CPT,Facility,Both,,,90,109,92.65,31.2394,109,"Health Partners, Inc.",Commercial,103.114,94.6,,percent of total billed charges,,
Blastomyces Antigen (Mayo)OutsideLaboratory,,87449,CPT,Facility,Outpatient,,,90,109,92.65,31.2394,109,"Health Partners, Inc.",Medicare Advantage,53.41,49,,percent of total billed charges,,
Blastomyces Antigen (Mayo)OutsideLaboratory,,87449,CPT,Facility,Inpatient,,,90,109,92.65,31.2394,109,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Blastomyces Antigen (Mayo)OutsideLaboratory,,87449,CPT,Facility,Both,,,90,109,92.65,31.2394,109,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),65.4,60,,percent of total billed charges,,
Blastomyces Antigen (Mayo)OutsideLaboratory,,87449,CPT,Facility,Both,,,90,109,92.65,31.2394,109,"Health Partners, Inc.",State of Minnesota Advantage Program,88.835,81.5,,percent of total billed charges,,
Blastomyces Antigen (Mayo)OutsideLaboratory,,87449,CPT,Facility,Both,,,90,109,92.65,31.2394,109,"Health Partners, Inc.",State Public Programs,54.5,50,,percent of total billed charges,,
Blastomyces Antigen (Mayo)OutsideLaboratory,,87449,CPT,Facility,Both,,,90,109,92.65,31.2394,109,Humana Insurance Company,Commercial PPO,103.55,95,,percent of total billed charges,,
Blastomyces Antigen (Mayo)OutsideLaboratory,,87449,CPT,Facility,Outpatient,,,90,109,92.65,31.2394,109,Humana Insurance Company,Medicare PPO,53.41,49,,percent of total billed charges,,
Blastomyces Antigen (Mayo)OutsideLaboratory,,87449,CPT,Facility,Inpatient,,,90,109,92.65,31.2394,109,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Blastomyces Antigen (Mayo)OutsideLaboratory,,87449,CPT,Facility,Both,,,90,109,92.65,31.2394,109,Medica,Individual & Family,108.019,99.1,,percent of total billed charges,,
Blastomyces Antigen (Mayo)OutsideLaboratory,,87449,CPT,Facility,Outpatient,,,90,109,92.65,31.2394,109,Medica,Medica Advantage Solution,54.282,49.8,,percent of total billed charges,,
Blastomyces Antigen (Mayo)OutsideLaboratory,,87449,CPT,Facility,Inpatient,,,90,109,92.65,31.2394,109,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Blastomyces Antigen (Mayo)OutsideLaboratory,,87449,CPT,Facility,Outpatient,,,90,109,92.65,31.2394,109,Medica,Medical Assistance,48.614,44.6,,percent of total billed charges,,
Blastomyces Antigen (Mayo)OutsideLaboratory,,87449,CPT,Facility,Inpatient,,,90,109,92.65,31.2394,109,Medica,Medical Assistance,,,,,Included in per diem rate,
Blastomyces Antigen (Mayo)OutsideLaboratory,,87449,CPT,Facility,Outpatient,,,90,109,92.65,31.2394,109,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,54.282,49.8,,percent of total billed charges,,
Blastomyces Antigen (Mayo)OutsideLaboratory,,87449,CPT,Facility,Inpatient,,,90,109,92.65,31.2394,109,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Blastomyces Antigen (Mayo)OutsideLaboratory,,87449,CPT,Facility,Both,,,90,109,92.65,31.2394,109,"Multiplan, Inc.","Multiplan, Inc.",102.46,94,,percent of total billed charges,,
Blastomyces Antigen (Mayo)OutsideLaboratory,,87449,CPT,Facility,Outpatient,,,90,109,92.65,31.2394,109,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,94.176,86.4,,percent of total billed charges,,
Blastomyces Antigen (Mayo)OutsideLaboratory,,87449,CPT,Facility,Inpatient,,,90,109,92.65,31.2394,109,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Blastomyces Antigen (Mayo)OutsideLaboratory,,87449,CPT,Facility,Both,,,90,109,92.65,31.2394,109,"Preferred One Administrative Services, INC.",PPO,107.474,98.6,,percent of total billed charges,,
Blastomyces Antigen (Mayo)OutsideLaboratory,,87449,CPT,Facility,Outpatient,,,90,109,92.65,31.2394,109,PrimeWest Health,Minnesota Senior Health Options (MSHO),56.0805,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Blastomyces Antigen (Mayo)OutsideLaboratory,,87449,CPT,Facility,Inpatient,,,90,109,92.65,31.2394,109,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Blastomyces Antigen (Mayo)OutsideLaboratory,,87449,CPT,Facility,Outpatient,,,90,109,92.65,31.2394,109,PrimeWest Health,MinnesotaCare,55.9824,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Blastomyces Antigen (Mayo)OutsideLaboratory,,87449,CPT,Facility,Inpatient,,,90,109,92.65,31.2394,109,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Blastomyces Antigen (Mayo)OutsideLaboratory,,87449,CPT,Facility,Both,,,90,109,92.65,31.2394,109,Sanford Health Plan,Sanford Health Plan,100.28,92,,percent of total billed charges,,
Blastomyces Antigen (Mayo)OutsideLaboratory,,87449,CPT,Facility,Outpatient,,,90,109,92.65,31.2394,109,"UCare Health, Inc.",Individual & Family Plan,61.4215,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Blastomyces Antigen (Mayo)OutsideLaboratory,,87449,CPT,Facility,Inpatient,,,90,109,92.65,31.2394,109,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Blastomyces Antigen (Mayo)OutsideLaboratory,,87449,CPT,Facility,Outpatient,,,90,109,92.65,31.2394,109,"UCare Health, Inc.",Medical Assistance,55.0123,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Blastomyces Antigen (Mayo)OutsideLaboratory,,87449,CPT,Facility,Inpatient,,,90,109,92.65,31.2394,109,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Blastomyces Antigen (Mayo)OutsideLaboratory,,87449,CPT,Facility,Outpatient,,,90,109,92.65,31.2394,109,"UCare Health, Inc.",Medicare Advantage,55.0123,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Blastomyces Antigen (Mayo)OutsideLaboratory,,87449,CPT,Facility,Inpatient,,,90,109,92.65,31.2394,109,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Blastomyces Antigen (Mayo)OutsideLaboratory,,87449,CPT,Facility,Outpatient,,,90,109,92.65,31.2394,109,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),55.0123,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Blastomyces Antigen (Mayo)OutsideLaboratory,,87449,CPT,Facility,Inpatient,,,90,109,92.65,31.2394,109,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Blastomyces Antigen (Mayo)OutsideLaboratory,,87449,CPT,Facility,Both,,,90,109,92.65,31.2394,109,UnitedHealthcare,Individual & Family,102.46,94,,percent of total billed charges,,
Blastomyces Antigen (Mayo)OutsideLaboratory,,87449,CPT,Facility,Outpatient,,,90,109,92.65,31.2394,109,UnitedHealthcare,Medicare Advantage,53.41,49,,percent of total billed charges,,
Blastomyces Antigen (Mayo)OutsideLaboratory,,87449,CPT,Facility,Inpatient,,,90,109,92.65,31.2394,109,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Blastomyces Antigen (Mayo)OutsideLaboratory,,87449,CPT,Facility,Outpatient,,,90,109,92.65,31.2394,109,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,52.32,48,,percent of total billed charges,,100% of DHS outpatient percentage
Blastomyces Antigen (Mayo)OutsideLaboratory,,87449,CPT,Facility,Inpatient,,,90,109,92.65,31.2394,109,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Lyme Disease Pcr, B (Mayo)OutsideLaboratory",,87476,CPT,Facility,Both,,,90,222,188.7,63.6252,222,Aetna,Commercial,204.24,92,,percent of total billed charges,,
"Lyme Disease Pcr, B (Mayo)OutsideLaboratory",,87476,CPT,Facility,Outpatient,,,90,222,188.7,63.6252,222,Aetna,Medicare Advantage,108.78,49,,percent of total billed charges,,
"Lyme Disease Pcr, B (Mayo)OutsideLaboratory",,87476,CPT,Facility,Inpatient,,,90,222,188.7,63.6252,222,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Lyme Disease Pcr, B (Mayo)OutsideLaboratory",,87476,CPT,Facility,Both,,,90,222,188.7,63.6252,222,Aetna,PPO,206.46,93,,percent of total billed charges,,
"Lyme Disease Pcr, B (Mayo)OutsideLaboratory",,87476,CPT,Facility,Both,,,90,222,188.7,63.6252,222,America's PPO,America's PPO,213.1866,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Lyme Disease Pcr, B (Mayo)OutsideLaboratory",,87476,CPT,Facility,Both,,,90,222,188.7,63.6252,222,BlueCross BlueShield Minnesota, Federal Employee Program,218.448,98.4,,percent of total billed charges,,
"Lyme Disease Pcr, B (Mayo)OutsideLaboratory",,87476,CPT,Facility,Both,,,90,222,188.7,63.6252,222,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,222,100,,percent of total billed charges,,
"Lyme Disease Pcr, B (Mayo)OutsideLaboratory",,87476,CPT,Facility,Both,,,90,222,188.7,63.6252,222,BlueCross BlueShield Minnesota,High Value Network Plan,199.8,90,,percent of total billed charges,,
"Lyme Disease Pcr, B (Mayo)OutsideLaboratory",,87476,CPT,Facility,Outpatient,,,90,222,188.7,63.6252,222,BlueCross BlueShield Minnesota,Medicare Advantage,108.78,49,,percent of total billed charges,,
"Lyme Disease Pcr, B (Mayo)OutsideLaboratory",,87476,CPT,Facility,Inpatient,,,90,222,188.7,63.6252,222,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Lyme Disease Pcr, B (Mayo)OutsideLaboratory",,87476,CPT,Facility,Both,,,90,222,188.7,63.6252,222,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,196.6254,88.57,,percent of total billed charges,,
"Lyme Disease Pcr, B (Mayo)OutsideLaboratory",,87476,CPT,Facility,Both,,,90,222,188.7,63.6252,222,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,63.6252,28.66,,percent of total billed charges,,
"Lyme Disease Pcr, B (Mayo)OutsideLaboratory",,87476,CPT,Facility,Outpatient,,,90,222,188.7,63.6252,222,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),108.78,49,,percent of total billed charges,,
"Lyme Disease Pcr, B (Mayo)OutsideLaboratory",,87476,CPT,Facility,Inpatient,,,90,222,188.7,63.6252,222,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Lyme Disease Pcr, B (Mayo)OutsideLaboratory",,87476,CPT,Facility,Both,,,90,222,188.7,63.6252,222,CorVel,Worker's Compensation,222,100,,percent of total billed charges,,
"Lyme Disease Pcr, B (Mayo)OutsideLaboratory",,87476,CPT,Facility,Both,,,90,222,188.7,63.6252,222,First Health Group Corporation,First Health Network,215.34,97,,percent of total billed charges,,
"Lyme Disease Pcr, B (Mayo)OutsideLaboratory",,87476,CPT,Facility,Both,,,90,222,188.7,63.6252,222,"Health Partners, Inc.",Commercial,210.012,94.6,,percent of total billed charges,,
"Lyme Disease Pcr, B (Mayo)OutsideLaboratory",,87476,CPT,Facility,Outpatient,,,90,222,188.7,63.6252,222,"Health Partners, Inc.",Medicare Advantage,108.78,49,,percent of total billed charges,,
"Lyme Disease Pcr, B (Mayo)OutsideLaboratory",,87476,CPT,Facility,Inpatient,,,90,222,188.7,63.6252,222,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Lyme Disease Pcr, B (Mayo)OutsideLaboratory",,87476,CPT,Facility,Both,,,90,222,188.7,63.6252,222,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),133.2,60,,percent of total billed charges,,
"Lyme Disease Pcr, B (Mayo)OutsideLaboratory",,87476,CPT,Facility,Both,,,90,222,188.7,63.6252,222,"Health Partners, Inc.",State of Minnesota Advantage Program,180.93,81.5,,percent of total billed charges,,
"Lyme Disease Pcr, B (Mayo)OutsideLaboratory",,87476,CPT,Facility,Both,,,90,222,188.7,63.6252,222,"Health Partners, Inc.",State Public Programs,111,50,,percent of total billed charges,,
"Lyme Disease Pcr, B (Mayo)OutsideLaboratory",,87476,CPT,Facility,Both,,,90,222,188.7,63.6252,222,Humana Insurance Company,Commercial PPO,210.9,95,,percent of total billed charges,,
"Lyme Disease Pcr, B (Mayo)OutsideLaboratory",,87476,CPT,Facility,Outpatient,,,90,222,188.7,63.6252,222,Humana Insurance Company,Medicare PPO,108.78,49,,percent of total billed charges,,
"Lyme Disease Pcr, B (Mayo)OutsideLaboratory",,87476,CPT,Facility,Inpatient,,,90,222,188.7,63.6252,222,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Lyme Disease Pcr, B (Mayo)OutsideLaboratory",,87476,CPT,Facility,Both,,,90,222,188.7,63.6252,222,Medica,Individual & Family,220.002,99.1,,percent of total billed charges,,
"Lyme Disease Pcr, B (Mayo)OutsideLaboratory",,87476,CPT,Facility,Outpatient,,,90,222,188.7,63.6252,222,Medica,Medica Advantage Solution,110.556,49.8,,percent of total billed charges,,
"Lyme Disease Pcr, B (Mayo)OutsideLaboratory",,87476,CPT,Facility,Inpatient,,,90,222,188.7,63.6252,222,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Lyme Disease Pcr, B (Mayo)OutsideLaboratory",,87476,CPT,Facility,Outpatient,,,90,222,188.7,63.6252,222,Medica,Medical Assistance,99.012,44.6,,percent of total billed charges,,
"Lyme Disease Pcr, B (Mayo)OutsideLaboratory",,87476,CPT,Facility,Inpatient,,,90,222,188.7,63.6252,222,Medica,Medical Assistance,,,,,Included in per diem rate,
"Lyme Disease Pcr, B (Mayo)OutsideLaboratory",,87476,CPT,Facility,Outpatient,,,90,222,188.7,63.6252,222,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,110.556,49.8,,percent of total billed charges,,
"Lyme Disease Pcr, B (Mayo)OutsideLaboratory",,87476,CPT,Facility,Inpatient,,,90,222,188.7,63.6252,222,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Lyme Disease Pcr, B (Mayo)OutsideLaboratory",,87476,CPT,Facility,Both,,,90,222,188.7,63.6252,222,"Multiplan, Inc.","Multiplan, Inc.",208.68,94,,percent of total billed charges,,
"Lyme Disease Pcr, B (Mayo)OutsideLaboratory",,87476,CPT,Facility,Outpatient,,,90,222,188.7,63.6252,222,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,191.808,86.4,,percent of total billed charges,,
"Lyme Disease Pcr, B (Mayo)OutsideLaboratory",,87476,CPT,Facility,Inpatient,,,90,222,188.7,63.6252,222,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Lyme Disease Pcr, B (Mayo)OutsideLaboratory",,87476,CPT,Facility,Both,,,90,222,188.7,63.6252,222,"Preferred One Administrative Services, INC.",PPO,218.892,98.6,,percent of total billed charges,,
"Lyme Disease Pcr, B (Mayo)OutsideLaboratory",,87476,CPT,Facility,Outpatient,,,90,222,188.7,63.6252,222,PrimeWest Health,Minnesota Senior Health Options (MSHO),114.219,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Lyme Disease Pcr, B (Mayo)OutsideLaboratory",,87476,CPT,Facility,Inpatient,,,90,222,188.7,63.6252,222,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Lyme Disease Pcr, B (Mayo)OutsideLaboratory",,87476,CPT,Facility,Outpatient,,,90,222,188.7,63.6252,222,PrimeWest Health,MinnesotaCare,114.0192,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Lyme Disease Pcr, B (Mayo)OutsideLaboratory",,87476,CPT,Facility,Inpatient,,,90,222,188.7,63.6252,222,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Lyme Disease Pcr, B (Mayo)OutsideLaboratory",,87476,CPT,Facility,Both,,,90,222,188.7,63.6252,222,Sanford Health Plan,Sanford Health Plan,204.24,92,,percent of total billed charges,,
"Lyme Disease Pcr, B (Mayo)OutsideLaboratory",,87476,CPT,Facility,Outpatient,,,90,222,188.7,63.6252,222,"UCare Health, Inc.",Individual & Family Plan,125.097,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Lyme Disease Pcr, B (Mayo)OutsideLaboratory",,87476,CPT,Facility,Inpatient,,,90,222,188.7,63.6252,222,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Lyme Disease Pcr, B (Mayo)OutsideLaboratory",,87476,CPT,Facility,Outpatient,,,90,222,188.7,63.6252,222,"UCare Health, Inc.",Medical Assistance,112.0434,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Lyme Disease Pcr, B (Mayo)OutsideLaboratory",,87476,CPT,Facility,Inpatient,,,90,222,188.7,63.6252,222,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Lyme Disease Pcr, B (Mayo)OutsideLaboratory",,87476,CPT,Facility,Outpatient,,,90,222,188.7,63.6252,222,"UCare Health, Inc.",Medicare Advantage,112.0434,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Lyme Disease Pcr, B (Mayo)OutsideLaboratory",,87476,CPT,Facility,Inpatient,,,90,222,188.7,63.6252,222,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Lyme Disease Pcr, B (Mayo)OutsideLaboratory",,87476,CPT,Facility,Outpatient,,,90,222,188.7,63.6252,222,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),112.0434,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Lyme Disease Pcr, B (Mayo)OutsideLaboratory",,87476,CPT,Facility,Inpatient,,,90,222,188.7,63.6252,222,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Lyme Disease Pcr, B (Mayo)OutsideLaboratory",,87476,CPT,Facility,Both,,,90,222,188.7,63.6252,222,UnitedHealthcare,Individual & Family,208.68,94,,percent of total billed charges,,
"Lyme Disease Pcr, B (Mayo)OutsideLaboratory",,87476,CPT,Facility,Outpatient,,,90,222,188.7,63.6252,222,UnitedHealthcare,Medicare Advantage,108.78,49,,percent of total billed charges,,
"Lyme Disease Pcr, B (Mayo)OutsideLaboratory",,87476,CPT,Facility,Inpatient,,,90,222,188.7,63.6252,222,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Lyme Disease Pcr, B (Mayo)OutsideLaboratory",,87476,CPT,Facility,Outpatient,,,90,222,188.7,63.6252,222,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,106.56,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Lyme Disease Pcr, B (Mayo)OutsideLaboratory",,87476,CPT,Facility,Inpatient,,,90,222,188.7,63.6252,222,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Cytomegalovirus Pcr (Mayo)OutsideLaboratory,,87496,CPT,Facility,Both,,,90,185,157.25,53.021,185,Aetna,Commercial,170.2,92,,percent of total billed charges,,
Cytomegalovirus Pcr (Mayo)OutsideLaboratory,,87496,CPT,Facility,Outpatient,,,90,185,157.25,53.021,185,Aetna,Medicare Advantage,90.65,49,,percent of total billed charges,,
Cytomegalovirus Pcr (Mayo)OutsideLaboratory,,87496,CPT,Facility,Inpatient,,,90,185,157.25,53.021,185,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Cytomegalovirus Pcr (Mayo)OutsideLaboratory,,87496,CPT,Facility,Both,,,90,185,157.25,53.021,185,Aetna,PPO,172.05,93,,percent of total billed charges,,
Cytomegalovirus Pcr (Mayo)OutsideLaboratory,,87496,CPT,Facility,Both,,,90,185,157.25,53.021,185,America's PPO,America's PPO,177.6555,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Cytomegalovirus Pcr (Mayo)OutsideLaboratory,,87496,CPT,Facility,Both,,,90,185,157.25,53.021,185,BlueCross BlueShield Minnesota, Federal Employee Program,182.04,98.4,,percent of total billed charges,,
Cytomegalovirus Pcr (Mayo)OutsideLaboratory,,87496,CPT,Facility,Both,,,90,185,157.25,53.021,185,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,185,100,,percent of total billed charges,,
Cytomegalovirus Pcr (Mayo)OutsideLaboratory,,87496,CPT,Facility,Both,,,90,185,157.25,53.021,185,BlueCross BlueShield Minnesota,High Value Network Plan,166.5,90,,percent of total billed charges,,
Cytomegalovirus Pcr (Mayo)OutsideLaboratory,,87496,CPT,Facility,Outpatient,,,90,185,157.25,53.021,185,BlueCross BlueShield Minnesota,Medicare Advantage,90.65,49,,percent of total billed charges,,
Cytomegalovirus Pcr (Mayo)OutsideLaboratory,,87496,CPT,Facility,Inpatient,,,90,185,157.25,53.021,185,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Cytomegalovirus Pcr (Mayo)OutsideLaboratory,,87496,CPT,Facility,Both,,,90,185,157.25,53.021,185,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,163.8545,88.57,,percent of total billed charges,,
Cytomegalovirus Pcr (Mayo)OutsideLaboratory,,87496,CPT,Facility,Both,,,90,185,157.25,53.021,185,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,53.021,28.66,,percent of total billed charges,,
Cytomegalovirus Pcr (Mayo)OutsideLaboratory,,87496,CPT,Facility,Outpatient,,,90,185,157.25,53.021,185,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),90.65,49,,percent of total billed charges,,
Cytomegalovirus Pcr (Mayo)OutsideLaboratory,,87496,CPT,Facility,Inpatient,,,90,185,157.25,53.021,185,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Cytomegalovirus Pcr (Mayo)OutsideLaboratory,,87496,CPT,Facility,Both,,,90,185,157.25,53.021,185,CorVel,Worker's Compensation,185,100,,percent of total billed charges,,
Cytomegalovirus Pcr (Mayo)OutsideLaboratory,,87496,CPT,Facility,Both,,,90,185,157.25,53.021,185,First Health Group Corporation,First Health Network,179.45,97,,percent of total billed charges,,
Cytomegalovirus Pcr (Mayo)OutsideLaboratory,,87496,CPT,Facility,Both,,,90,185,157.25,53.021,185,"Health Partners, Inc.",Commercial,175.01,94.6,,percent of total billed charges,,
Cytomegalovirus Pcr (Mayo)OutsideLaboratory,,87496,CPT,Facility,Outpatient,,,90,185,157.25,53.021,185,"Health Partners, Inc.",Medicare Advantage,90.65,49,,percent of total billed charges,,
Cytomegalovirus Pcr (Mayo)OutsideLaboratory,,87496,CPT,Facility,Inpatient,,,90,185,157.25,53.021,185,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Cytomegalovirus Pcr (Mayo)OutsideLaboratory,,87496,CPT,Facility,Both,,,90,185,157.25,53.021,185,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),111,60,,percent of total billed charges,,
Cytomegalovirus Pcr (Mayo)OutsideLaboratory,,87496,CPT,Facility,Both,,,90,185,157.25,53.021,185,"Health Partners, Inc.",State of Minnesota Advantage Program,150.775,81.5,,percent of total billed charges,,
Cytomegalovirus Pcr (Mayo)OutsideLaboratory,,87496,CPT,Facility,Both,,,90,185,157.25,53.021,185,"Health Partners, Inc.",State Public Programs,92.5,50,,percent of total billed charges,,
Cytomegalovirus Pcr (Mayo)OutsideLaboratory,,87496,CPT,Facility,Both,,,90,185,157.25,53.021,185,Humana Insurance Company,Commercial PPO,175.75,95,,percent of total billed charges,,
Cytomegalovirus Pcr (Mayo)OutsideLaboratory,,87496,CPT,Facility,Outpatient,,,90,185,157.25,53.021,185,Humana Insurance Company,Medicare PPO,90.65,49,,percent of total billed charges,,
Cytomegalovirus Pcr (Mayo)OutsideLaboratory,,87496,CPT,Facility,Inpatient,,,90,185,157.25,53.021,185,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Cytomegalovirus Pcr (Mayo)OutsideLaboratory,,87496,CPT,Facility,Both,,,90,185,157.25,53.021,185,Medica,Individual & Family,183.335,99.1,,percent of total billed charges,,
Cytomegalovirus Pcr (Mayo)OutsideLaboratory,,87496,CPT,Facility,Outpatient,,,90,185,157.25,53.021,185,Medica,Medica Advantage Solution,92.13,49.8,,percent of total billed charges,,
Cytomegalovirus Pcr (Mayo)OutsideLaboratory,,87496,CPT,Facility,Inpatient,,,90,185,157.25,53.021,185,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Cytomegalovirus Pcr (Mayo)OutsideLaboratory,,87496,CPT,Facility,Outpatient,,,90,185,157.25,53.021,185,Medica,Medical Assistance,82.51,44.6,,percent of total billed charges,,
Cytomegalovirus Pcr (Mayo)OutsideLaboratory,,87496,CPT,Facility,Inpatient,,,90,185,157.25,53.021,185,Medica,Medical Assistance,,,,,Included in per diem rate,
Cytomegalovirus Pcr (Mayo)OutsideLaboratory,,87496,CPT,Facility,Outpatient,,,90,185,157.25,53.021,185,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,92.13,49.8,,percent of total billed charges,,
Cytomegalovirus Pcr (Mayo)OutsideLaboratory,,87496,CPT,Facility,Inpatient,,,90,185,157.25,53.021,185,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Cytomegalovirus Pcr (Mayo)OutsideLaboratory,,87496,CPT,Facility,Both,,,90,185,157.25,53.021,185,"Multiplan, Inc.","Multiplan, Inc.",173.9,94,,percent of total billed charges,,
Cytomegalovirus Pcr (Mayo)OutsideLaboratory,,87496,CPT,Facility,Outpatient,,,90,185,157.25,53.021,185,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,159.84,86.4,,percent of total billed charges,,
Cytomegalovirus Pcr (Mayo)OutsideLaboratory,,87496,CPT,Facility,Inpatient,,,90,185,157.25,53.021,185,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Cytomegalovirus Pcr (Mayo)OutsideLaboratory,,87496,CPT,Facility,Both,,,90,185,157.25,53.021,185,"Preferred One Administrative Services, INC.",PPO,182.41,98.6,,percent of total billed charges,,
Cytomegalovirus Pcr (Mayo)OutsideLaboratory,,87496,CPT,Facility,Outpatient,,,90,185,157.25,53.021,185,PrimeWest Health,Minnesota Senior Health Options (MSHO),95.1825,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Cytomegalovirus Pcr (Mayo)OutsideLaboratory,,87496,CPT,Facility,Inpatient,,,90,185,157.25,53.021,185,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Cytomegalovirus Pcr (Mayo)OutsideLaboratory,,87496,CPT,Facility,Outpatient,,,90,185,157.25,53.021,185,PrimeWest Health,MinnesotaCare,95.016,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Cytomegalovirus Pcr (Mayo)OutsideLaboratory,,87496,CPT,Facility,Inpatient,,,90,185,157.25,53.021,185,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Cytomegalovirus Pcr (Mayo)OutsideLaboratory,,87496,CPT,Facility,Both,,,90,185,157.25,53.021,185,Sanford Health Plan,Sanford Health Plan,170.2,92,,percent of total billed charges,,
Cytomegalovirus Pcr (Mayo)OutsideLaboratory,,87496,CPT,Facility,Outpatient,,,90,185,157.25,53.021,185,"UCare Health, Inc.",Individual & Family Plan,104.2475,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Cytomegalovirus Pcr (Mayo)OutsideLaboratory,,87496,CPT,Facility,Inpatient,,,90,185,157.25,53.021,185,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Cytomegalovirus Pcr (Mayo)OutsideLaboratory,,87496,CPT,Facility,Outpatient,,,90,185,157.25,53.021,185,"UCare Health, Inc.",Medical Assistance,93.3695,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Cytomegalovirus Pcr (Mayo)OutsideLaboratory,,87496,CPT,Facility,Inpatient,,,90,185,157.25,53.021,185,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Cytomegalovirus Pcr (Mayo)OutsideLaboratory,,87496,CPT,Facility,Outpatient,,,90,185,157.25,53.021,185,"UCare Health, Inc.",Medicare Advantage,93.3695,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Cytomegalovirus Pcr (Mayo)OutsideLaboratory,,87496,CPT,Facility,Inpatient,,,90,185,157.25,53.021,185,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Cytomegalovirus Pcr (Mayo)OutsideLaboratory,,87496,CPT,Facility,Outpatient,,,90,185,157.25,53.021,185,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),93.3695,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Cytomegalovirus Pcr (Mayo)OutsideLaboratory,,87496,CPT,Facility,Inpatient,,,90,185,157.25,53.021,185,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Cytomegalovirus Pcr (Mayo)OutsideLaboratory,,87496,CPT,Facility,Both,,,90,185,157.25,53.021,185,UnitedHealthcare,Individual & Family,173.9,94,,percent of total billed charges,,
Cytomegalovirus Pcr (Mayo)OutsideLaboratory,,87496,CPT,Facility,Outpatient,,,90,185,157.25,53.021,185,UnitedHealthcare,Medicare Advantage,90.65,49,,percent of total billed charges,,
Cytomegalovirus Pcr (Mayo)OutsideLaboratory,,87496,CPT,Facility,Inpatient,,,90,185,157.25,53.021,185,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Cytomegalovirus Pcr (Mayo)OutsideLaboratory,,87496,CPT,Facility,Outpatient,,,90,185,157.25,53.021,185,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,88.8,48,,percent of total billed charges,,100% of DHS outpatient percentage
Cytomegalovirus Pcr (Mayo)OutsideLaboratory,,87496,CPT,Facility,Inpatient,,,90,185,157.25,53.021,185,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Cmv Dna Detect/Quant, P (Mayo)OutsideLaboratory",,87497,CPT,Facility,Both,,,90,171,145.35,49.0086,171,Aetna,Commercial,157.32,92,,percent of total billed charges,,
"Cmv Dna Detect/Quant, P (Mayo)OutsideLaboratory",,87497,CPT,Facility,Outpatient,,,90,171,145.35,49.0086,171,Aetna,Medicare Advantage,83.79,49,,percent of total billed charges,,
"Cmv Dna Detect/Quant, P (Mayo)OutsideLaboratory",,87497,CPT,Facility,Inpatient,,,90,171,145.35,49.0086,171,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Cmv Dna Detect/Quant, P (Mayo)OutsideLaboratory",,87497,CPT,Facility,Both,,,90,171,145.35,49.0086,171,Aetna,PPO,159.03,93,,percent of total billed charges,,
"Cmv Dna Detect/Quant, P (Mayo)OutsideLaboratory",,87497,CPT,Facility,Both,,,90,171,145.35,49.0086,171,America's PPO,America's PPO,164.2113,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Cmv Dna Detect/Quant, P (Mayo)OutsideLaboratory",,87497,CPT,Facility,Both,,,90,171,145.35,49.0086,171,BlueCross BlueShield Minnesota, Federal Employee Program,168.264,98.4,,percent of total billed charges,,
"Cmv Dna Detect/Quant, P (Mayo)OutsideLaboratory",,87497,CPT,Facility,Both,,,90,171,145.35,49.0086,171,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,171,100,,percent of total billed charges,,
"Cmv Dna Detect/Quant, P (Mayo)OutsideLaboratory",,87497,CPT,Facility,Both,,,90,171,145.35,49.0086,171,BlueCross BlueShield Minnesota,High Value Network Plan,153.9,90,,percent of total billed charges,,
"Cmv Dna Detect/Quant, P (Mayo)OutsideLaboratory",,87497,CPT,Facility,Outpatient,,,90,171,145.35,49.0086,171,BlueCross BlueShield Minnesota,Medicare Advantage,83.79,49,,percent of total billed charges,,
"Cmv Dna Detect/Quant, P (Mayo)OutsideLaboratory",,87497,CPT,Facility,Inpatient,,,90,171,145.35,49.0086,171,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Cmv Dna Detect/Quant, P (Mayo)OutsideLaboratory",,87497,CPT,Facility,Both,,,90,171,145.35,49.0086,171,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,151.4547,88.57,,percent of total billed charges,,
"Cmv Dna Detect/Quant, P (Mayo)OutsideLaboratory",,87497,CPT,Facility,Both,,,90,171,145.35,49.0086,171,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,49.0086,28.66,,percent of total billed charges,,
"Cmv Dna Detect/Quant, P (Mayo)OutsideLaboratory",,87497,CPT,Facility,Outpatient,,,90,171,145.35,49.0086,171,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),83.79,49,,percent of total billed charges,,
"Cmv Dna Detect/Quant, P (Mayo)OutsideLaboratory",,87497,CPT,Facility,Inpatient,,,90,171,145.35,49.0086,171,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Cmv Dna Detect/Quant, P (Mayo)OutsideLaboratory",,87497,CPT,Facility,Both,,,90,171,145.35,49.0086,171,CorVel,Worker's Compensation,171,100,,percent of total billed charges,,
"Cmv Dna Detect/Quant, P (Mayo)OutsideLaboratory",,87497,CPT,Facility,Both,,,90,171,145.35,49.0086,171,First Health Group Corporation,First Health Network,165.87,97,,percent of total billed charges,,
"Cmv Dna Detect/Quant, P (Mayo)OutsideLaboratory",,87497,CPT,Facility,Both,,,90,171,145.35,49.0086,171,"Health Partners, Inc.",Commercial,161.766,94.6,,percent of total billed charges,,
"Cmv Dna Detect/Quant, P (Mayo)OutsideLaboratory",,87497,CPT,Facility,Outpatient,,,90,171,145.35,49.0086,171,"Health Partners, Inc.",Medicare Advantage,83.79,49,,percent of total billed charges,,
"Cmv Dna Detect/Quant, P (Mayo)OutsideLaboratory",,87497,CPT,Facility,Inpatient,,,90,171,145.35,49.0086,171,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Cmv Dna Detect/Quant, P (Mayo)OutsideLaboratory",,87497,CPT,Facility,Both,,,90,171,145.35,49.0086,171,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),102.6,60,,percent of total billed charges,,
"Cmv Dna Detect/Quant, P (Mayo)OutsideLaboratory",,87497,CPT,Facility,Both,,,90,171,145.35,49.0086,171,"Health Partners, Inc.",State of Minnesota Advantage Program,139.365,81.5,,percent of total billed charges,,
"Cmv Dna Detect/Quant, P (Mayo)OutsideLaboratory",,87497,CPT,Facility,Both,,,90,171,145.35,49.0086,171,"Health Partners, Inc.",State Public Programs,85.5,50,,percent of total billed charges,,
"Cmv Dna Detect/Quant, P (Mayo)OutsideLaboratory",,87497,CPT,Facility,Both,,,90,171,145.35,49.0086,171,Humana Insurance Company,Commercial PPO,162.45,95,,percent of total billed charges,,
"Cmv Dna Detect/Quant, P (Mayo)OutsideLaboratory",,87497,CPT,Facility,Outpatient,,,90,171,145.35,49.0086,171,Humana Insurance Company,Medicare PPO,83.79,49,,percent of total billed charges,,
"Cmv Dna Detect/Quant, P (Mayo)OutsideLaboratory",,87497,CPT,Facility,Inpatient,,,90,171,145.35,49.0086,171,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Cmv Dna Detect/Quant, P (Mayo)OutsideLaboratory",,87497,CPT,Facility,Both,,,90,171,145.35,49.0086,171,Medica,Individual & Family,169.461,99.1,,percent of total billed charges,,
"Cmv Dna Detect/Quant, P (Mayo)OutsideLaboratory",,87497,CPT,Facility,Outpatient,,,90,171,145.35,49.0086,171,Medica,Medica Advantage Solution,85.158,49.8,,percent of total billed charges,,
"Cmv Dna Detect/Quant, P (Mayo)OutsideLaboratory",,87497,CPT,Facility,Inpatient,,,90,171,145.35,49.0086,171,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Cmv Dna Detect/Quant, P (Mayo)OutsideLaboratory",,87497,CPT,Facility,Outpatient,,,90,171,145.35,49.0086,171,Medica,Medical Assistance,76.266,44.6,,percent of total billed charges,,
"Cmv Dna Detect/Quant, P (Mayo)OutsideLaboratory",,87497,CPT,Facility,Inpatient,,,90,171,145.35,49.0086,171,Medica,Medical Assistance,,,,,Included in per diem rate,
"Cmv Dna Detect/Quant, P (Mayo)OutsideLaboratory",,87497,CPT,Facility,Outpatient,,,90,171,145.35,49.0086,171,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,85.158,49.8,,percent of total billed charges,,
"Cmv Dna Detect/Quant, P (Mayo)OutsideLaboratory",,87497,CPT,Facility,Inpatient,,,90,171,145.35,49.0086,171,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Cmv Dna Detect/Quant, P (Mayo)OutsideLaboratory",,87497,CPT,Facility,Both,,,90,171,145.35,49.0086,171,"Multiplan, Inc.","Multiplan, Inc.",160.74,94,,percent of total billed charges,,
"Cmv Dna Detect/Quant, P (Mayo)OutsideLaboratory",,87497,CPT,Facility,Outpatient,,,90,171,145.35,49.0086,171,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,147.744,86.4,,percent of total billed charges,,
"Cmv Dna Detect/Quant, P (Mayo)OutsideLaboratory",,87497,CPT,Facility,Inpatient,,,90,171,145.35,49.0086,171,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Cmv Dna Detect/Quant, P (Mayo)OutsideLaboratory",,87497,CPT,Facility,Both,,,90,171,145.35,49.0086,171,"Preferred One Administrative Services, INC.",PPO,168.606,98.6,,percent of total billed charges,,
"Cmv Dna Detect/Quant, P (Mayo)OutsideLaboratory",,87497,CPT,Facility,Outpatient,,,90,171,145.35,49.0086,171,PrimeWest Health,Minnesota Senior Health Options (MSHO),87.9795,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Cmv Dna Detect/Quant, P (Mayo)OutsideLaboratory",,87497,CPT,Facility,Inpatient,,,90,171,145.35,49.0086,171,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Cmv Dna Detect/Quant, P (Mayo)OutsideLaboratory",,87497,CPT,Facility,Outpatient,,,90,171,145.35,49.0086,171,PrimeWest Health,MinnesotaCare,87.8256,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Cmv Dna Detect/Quant, P (Mayo)OutsideLaboratory",,87497,CPT,Facility,Inpatient,,,90,171,145.35,49.0086,171,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Cmv Dna Detect/Quant, P (Mayo)OutsideLaboratory",,87497,CPT,Facility,Both,,,90,171,145.35,49.0086,171,Sanford Health Plan,Sanford Health Plan,157.32,92,,percent of total billed charges,,
"Cmv Dna Detect/Quant, P (Mayo)OutsideLaboratory",,87497,CPT,Facility,Outpatient,,,90,171,145.35,49.0086,171,"UCare Health, Inc.",Individual & Family Plan,96.3585,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Cmv Dna Detect/Quant, P (Mayo)OutsideLaboratory",,87497,CPT,Facility,Inpatient,,,90,171,145.35,49.0086,171,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Cmv Dna Detect/Quant, P (Mayo)OutsideLaboratory",,87497,CPT,Facility,Outpatient,,,90,171,145.35,49.0086,171,"UCare Health, Inc.",Medical Assistance,86.3037,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Cmv Dna Detect/Quant, P (Mayo)OutsideLaboratory",,87497,CPT,Facility,Inpatient,,,90,171,145.35,49.0086,171,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Cmv Dna Detect/Quant, P (Mayo)OutsideLaboratory",,87497,CPT,Facility,Outpatient,,,90,171,145.35,49.0086,171,"UCare Health, Inc.",Medicare Advantage,86.3037,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Cmv Dna Detect/Quant, P (Mayo)OutsideLaboratory",,87497,CPT,Facility,Inpatient,,,90,171,145.35,49.0086,171,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Cmv Dna Detect/Quant, P (Mayo)OutsideLaboratory",,87497,CPT,Facility,Outpatient,,,90,171,145.35,49.0086,171,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),86.3037,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Cmv Dna Detect/Quant, P (Mayo)OutsideLaboratory",,87497,CPT,Facility,Inpatient,,,90,171,145.35,49.0086,171,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Cmv Dna Detect/Quant, P (Mayo)OutsideLaboratory",,87497,CPT,Facility,Both,,,90,171,145.35,49.0086,171,UnitedHealthcare,Individual & Family,160.74,94,,percent of total billed charges,,
"Cmv Dna Detect/Quant, P (Mayo)OutsideLaboratory",,87497,CPT,Facility,Outpatient,,,90,171,145.35,49.0086,171,UnitedHealthcare,Medicare Advantage,83.79,49,,percent of total billed charges,,
"Cmv Dna Detect/Quant, P (Mayo)OutsideLaboratory",,87497,CPT,Facility,Inpatient,,,90,171,145.35,49.0086,171,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Cmv Dna Detect/Quant, P (Mayo)OutsideLaboratory",,87497,CPT,Facility,Outpatient,,,90,171,145.35,49.0086,171,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,82.08,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Cmv Dna Detect/Quant, P (Mayo)OutsideLaboratory",,87497,CPT,Facility,Inpatient,,,90,171,145.35,49.0086,171,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Gi Pathogen Panel, Pcr, F (Mayo)OutsideLaboratory",,87507,CPT,Facility,Both,,,90,809,687.65,231.8594,809,Aetna,Commercial,744.28,92,,percent of total billed charges,,
"Gi Pathogen Panel, Pcr, F (Mayo)OutsideLaboratory",,87507,CPT,Facility,Outpatient,,,90,809,687.65,231.8594,809,Aetna,Medicare Advantage,396.41,49,,percent of total billed charges,,
"Gi Pathogen Panel, Pcr, F (Mayo)OutsideLaboratory",,87507,CPT,Facility,Inpatient,,,90,809,687.65,231.8594,809,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Gi Pathogen Panel, Pcr, F (Mayo)OutsideLaboratory",,87507,CPT,Facility,Both,,,90,809,687.65,231.8594,809,Aetna,PPO,752.37,93,,percent of total billed charges,,
"Gi Pathogen Panel, Pcr, F (Mayo)OutsideLaboratory",,87507,CPT,Facility,Both,,,90,809,687.65,231.8594,809,America's PPO,America's PPO,776.8827,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Gi Pathogen Panel, Pcr, F (Mayo)OutsideLaboratory",,87507,CPT,Facility,Both,,,90,809,687.65,231.8594,809,BlueCross BlueShield Minnesota, Federal Employee Program,796.056,98.4,,percent of total billed charges,,
"Gi Pathogen Panel, Pcr, F (Mayo)OutsideLaboratory",,87507,CPT,Facility,Both,,,90,809,687.65,231.8594,809,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,809,100,,percent of total billed charges,,
"Gi Pathogen Panel, Pcr, F (Mayo)OutsideLaboratory",,87507,CPT,Facility,Both,,,90,809,687.65,231.8594,809,BlueCross BlueShield Minnesota,High Value Network Plan,728.1,90,,percent of total billed charges,,
"Gi Pathogen Panel, Pcr, F (Mayo)OutsideLaboratory",,87507,CPT,Facility,Outpatient,,,90,809,687.65,231.8594,809,BlueCross BlueShield Minnesota,Medicare Advantage,396.41,49,,percent of total billed charges,,
"Gi Pathogen Panel, Pcr, F (Mayo)OutsideLaboratory",,87507,CPT,Facility,Inpatient,,,90,809,687.65,231.8594,809,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Gi Pathogen Panel, Pcr, F (Mayo)OutsideLaboratory",,87507,CPT,Facility,Both,,,90,809,687.65,231.8594,809,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,716.5313,88.57,,percent of total billed charges,,
"Gi Pathogen Panel, Pcr, F (Mayo)OutsideLaboratory",,87507,CPT,Facility,Both,,,90,809,687.65,231.8594,809,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,231.8594,28.66,,percent of total billed charges,,
"Gi Pathogen Panel, Pcr, F (Mayo)OutsideLaboratory",,87507,CPT,Facility,Outpatient,,,90,809,687.65,231.8594,809,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),396.41,49,,percent of total billed charges,,
"Gi Pathogen Panel, Pcr, F (Mayo)OutsideLaboratory",,87507,CPT,Facility,Inpatient,,,90,809,687.65,231.8594,809,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Gi Pathogen Panel, Pcr, F (Mayo)OutsideLaboratory",,87507,CPT,Facility,Both,,,90,809,687.65,231.8594,809,CorVel,Worker's Compensation,809,100,,percent of total billed charges,,
"Gi Pathogen Panel, Pcr, F (Mayo)OutsideLaboratory",,87507,CPT,Facility,Both,,,90,809,687.65,231.8594,809,First Health Group Corporation,First Health Network,784.73,97,,percent of total billed charges,,
"Gi Pathogen Panel, Pcr, F (Mayo)OutsideLaboratory",,87507,CPT,Facility,Both,,,90,809,687.65,231.8594,809,"Health Partners, Inc.",Commercial,765.314,94.6,,percent of total billed charges,,
"Gi Pathogen Panel, Pcr, F (Mayo)OutsideLaboratory",,87507,CPT,Facility,Outpatient,,,90,809,687.65,231.8594,809,"Health Partners, Inc.",Medicare Advantage,396.41,49,,percent of total billed charges,,
"Gi Pathogen Panel, Pcr, F (Mayo)OutsideLaboratory",,87507,CPT,Facility,Inpatient,,,90,809,687.65,231.8594,809,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Gi Pathogen Panel, Pcr, F (Mayo)OutsideLaboratory",,87507,CPT,Facility,Both,,,90,809,687.65,231.8594,809,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),485.4,60,,percent of total billed charges,,
"Gi Pathogen Panel, Pcr, F (Mayo)OutsideLaboratory",,87507,CPT,Facility,Both,,,90,809,687.65,231.8594,809,"Health Partners, Inc.",State of Minnesota Advantage Program,659.335,81.5,,percent of total billed charges,,
"Gi Pathogen Panel, Pcr, F (Mayo)OutsideLaboratory",,87507,CPT,Facility,Both,,,90,809,687.65,231.8594,809,"Health Partners, Inc.",State Public Programs,404.5,50,,percent of total billed charges,,
"Gi Pathogen Panel, Pcr, F (Mayo)OutsideLaboratory",,87507,CPT,Facility,Both,,,90,809,687.65,231.8594,809,Humana Insurance Company,Commercial PPO,768.55,95,,percent of total billed charges,,
"Gi Pathogen Panel, Pcr, F (Mayo)OutsideLaboratory",,87507,CPT,Facility,Outpatient,,,90,809,687.65,231.8594,809,Humana Insurance Company,Medicare PPO,396.41,49,,percent of total billed charges,,
"Gi Pathogen Panel, Pcr, F (Mayo)OutsideLaboratory",,87507,CPT,Facility,Inpatient,,,90,809,687.65,231.8594,809,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Gi Pathogen Panel, Pcr, F (Mayo)OutsideLaboratory",,87507,CPT,Facility,Both,,,90,809,687.65,231.8594,809,Medica,Individual & Family,801.719,99.1,,percent of total billed charges,,
"Gi Pathogen Panel, Pcr, F (Mayo)OutsideLaboratory",,87507,CPT,Facility,Outpatient,,,90,809,687.65,231.8594,809,Medica,Medica Advantage Solution,402.882,49.8,,percent of total billed charges,,
"Gi Pathogen Panel, Pcr, F (Mayo)OutsideLaboratory",,87507,CPT,Facility,Inpatient,,,90,809,687.65,231.8594,809,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Gi Pathogen Panel, Pcr, F (Mayo)OutsideLaboratory",,87507,CPT,Facility,Outpatient,,,90,809,687.65,231.8594,809,Medica,Medical Assistance,360.814,44.6,,percent of total billed charges,,
"Gi Pathogen Panel, Pcr, F (Mayo)OutsideLaboratory",,87507,CPT,Facility,Inpatient,,,90,809,687.65,231.8594,809,Medica,Medical Assistance,,,,,Included in per diem rate,
"Gi Pathogen Panel, Pcr, F (Mayo)OutsideLaboratory",,87507,CPT,Facility,Outpatient,,,90,809,687.65,231.8594,809,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,402.882,49.8,,percent of total billed charges,,
"Gi Pathogen Panel, Pcr, F (Mayo)OutsideLaboratory",,87507,CPT,Facility,Inpatient,,,90,809,687.65,231.8594,809,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Gi Pathogen Panel, Pcr, F (Mayo)OutsideLaboratory",,87507,CPT,Facility,Both,,,90,809,687.65,231.8594,809,"Multiplan, Inc.","Multiplan, Inc.",760.46,94,,percent of total billed charges,,
"Gi Pathogen Panel, Pcr, F (Mayo)OutsideLaboratory",,87507,CPT,Facility,Outpatient,,,90,809,687.65,231.8594,809,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,728.909,90.1,,percent of total billed charges,,
"Gi Pathogen Panel, Pcr, F (Mayo)OutsideLaboratory",,87507,CPT,Facility,Inpatient,,,90,809,687.65,231.8594,809,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Gi Pathogen Panel, Pcr, F (Mayo)OutsideLaboratory",,87507,CPT,Facility,Both,,,90,809,687.65,231.8594,809,"Preferred One Administrative Services, INC.",PPO,797.674,98.6,,percent of total billed charges,,
"Gi Pathogen Panel, Pcr, F (Mayo)OutsideLaboratory",,87507,CPT,Facility,Outpatient,,,90,809,687.65,231.8594,809,PrimeWest Health,Minnesota Senior Health Options (MSHO),416.2305,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Gi Pathogen Panel, Pcr, F (Mayo)OutsideLaboratory",,87507,CPT,Facility,Inpatient,,,90,809,687.65,231.8594,809,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Gi Pathogen Panel, Pcr, F (Mayo)OutsideLaboratory",,87507,CPT,Facility,Outpatient,,,90,809,687.65,231.8594,809,PrimeWest Health,MinnesotaCare,415.5024,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Gi Pathogen Panel, Pcr, F (Mayo)OutsideLaboratory",,87507,CPT,Facility,Inpatient,,,90,809,687.65,231.8594,809,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Gi Pathogen Panel, Pcr, F (Mayo)OutsideLaboratory",,87507,CPT,Facility,Both,,,90,809,687.65,231.8594,809,Sanford Health Plan,Sanford Health Plan,744.28,92,,percent of total billed charges,,
"Gi Pathogen Panel, Pcr, F (Mayo)OutsideLaboratory",,87507,CPT,Facility,Outpatient,,,90,809,687.65,231.8594,809,"UCare Health, Inc.",Individual & Family Plan,455.8715,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Gi Pathogen Panel, Pcr, F (Mayo)OutsideLaboratory",,87507,CPT,Facility,Inpatient,,,90,809,687.65,231.8594,809,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Gi Pathogen Panel, Pcr, F (Mayo)OutsideLaboratory",,87507,CPT,Facility,Outpatient,,,90,809,687.65,231.8594,809,"UCare Health, Inc.",Medical Assistance,408.3023,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Gi Pathogen Panel, Pcr, F (Mayo)OutsideLaboratory",,87507,CPT,Facility,Inpatient,,,90,809,687.65,231.8594,809,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Gi Pathogen Panel, Pcr, F (Mayo)OutsideLaboratory",,87507,CPT,Facility,Outpatient,,,90,809,687.65,231.8594,809,"UCare Health, Inc.",Medicare Advantage,408.3023,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Gi Pathogen Panel, Pcr, F (Mayo)OutsideLaboratory",,87507,CPT,Facility,Inpatient,,,90,809,687.65,231.8594,809,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Gi Pathogen Panel, Pcr, F (Mayo)OutsideLaboratory",,87507,CPT,Facility,Outpatient,,,90,809,687.65,231.8594,809,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),408.3023,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Gi Pathogen Panel, Pcr, F (Mayo)OutsideLaboratory",,87507,CPT,Facility,Inpatient,,,90,809,687.65,231.8594,809,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Gi Pathogen Panel, Pcr, F (Mayo)OutsideLaboratory",,87507,CPT,Facility,Both,,,90,809,687.65,231.8594,809,UnitedHealthcare,Individual & Family,760.46,94,,percent of total billed charges,,
"Gi Pathogen Panel, Pcr, F (Mayo)OutsideLaboratory",,87507,CPT,Facility,Outpatient,,,90,809,687.65,231.8594,809,UnitedHealthcare,Medicare Advantage,396.41,49,,percent of total billed charges,,
"Gi Pathogen Panel, Pcr, F (Mayo)OutsideLaboratory",,87507,CPT,Facility,Inpatient,,,90,809,687.65,231.8594,809,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Gi Pathogen Panel, Pcr, F (Mayo)OutsideLaboratory",,87507,CPT,Facility,Outpatient,,,90,809,687.65,231.8594,809,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,388.32,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Gi Pathogen Panel, Pcr, F (Mayo)OutsideLaboratory",,87507,CPT,Facility,Inpatient,,,90,809,687.65,231.8594,809,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Hbv Dna Detect/Quant, S (Mayo)OutsideLaboratory",,87517,CPT,Facility,Both,,,90,246,209.1,70.5036,246,Aetna,Commercial,226.32,92,,percent of total billed charges,,
"Hbv Dna Detect/Quant, S (Mayo)OutsideLaboratory",,87517,CPT,Facility,Outpatient,,,90,246,209.1,70.5036,246,Aetna,Medicare Advantage,120.54,49,,percent of total billed charges,,
"Hbv Dna Detect/Quant, S (Mayo)OutsideLaboratory",,87517,CPT,Facility,Inpatient,,,90,246,209.1,70.5036,246,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Hbv Dna Detect/Quant, S (Mayo)OutsideLaboratory",,87517,CPT,Facility,Both,,,90,246,209.1,70.5036,246,Aetna,PPO,228.78,93,,percent of total billed charges,,
"Hbv Dna Detect/Quant, S (Mayo)OutsideLaboratory",,87517,CPT,Facility,Both,,,90,246,209.1,70.5036,246,America's PPO,America's PPO,236.2338,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Hbv Dna Detect/Quant, S (Mayo)OutsideLaboratory",,87517,CPT,Facility,Both,,,90,246,209.1,70.5036,246,BlueCross BlueShield Minnesota, Federal Employee Program,242.064,98.4,,percent of total billed charges,,
"Hbv Dna Detect/Quant, S (Mayo)OutsideLaboratory",,87517,CPT,Facility,Both,,,90,246,209.1,70.5036,246,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,246,100,,percent of total billed charges,,
"Hbv Dna Detect/Quant, S (Mayo)OutsideLaboratory",,87517,CPT,Facility,Both,,,90,246,209.1,70.5036,246,BlueCross BlueShield Minnesota,High Value Network Plan,221.4,90,,percent of total billed charges,,
"Hbv Dna Detect/Quant, S (Mayo)OutsideLaboratory",,87517,CPT,Facility,Outpatient,,,90,246,209.1,70.5036,246,BlueCross BlueShield Minnesota,Medicare Advantage,120.54,49,,percent of total billed charges,,
"Hbv Dna Detect/Quant, S (Mayo)OutsideLaboratory",,87517,CPT,Facility,Inpatient,,,90,246,209.1,70.5036,246,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Hbv Dna Detect/Quant, S (Mayo)OutsideLaboratory",,87517,CPT,Facility,Both,,,90,246,209.1,70.5036,246,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,217.8822,88.57,,percent of total billed charges,,
"Hbv Dna Detect/Quant, S (Mayo)OutsideLaboratory",,87517,CPT,Facility,Both,,,90,246,209.1,70.5036,246,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,70.5036,28.66,,percent of total billed charges,,
"Hbv Dna Detect/Quant, S (Mayo)OutsideLaboratory",,87517,CPT,Facility,Outpatient,,,90,246,209.1,70.5036,246,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),120.54,49,,percent of total billed charges,,
"Hbv Dna Detect/Quant, S (Mayo)OutsideLaboratory",,87517,CPT,Facility,Inpatient,,,90,246,209.1,70.5036,246,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Hbv Dna Detect/Quant, S (Mayo)OutsideLaboratory",,87517,CPT,Facility,Both,,,90,246,209.1,70.5036,246,CorVel,Worker's Compensation,246,100,,percent of total billed charges,,
"Hbv Dna Detect/Quant, S (Mayo)OutsideLaboratory",,87517,CPT,Facility,Both,,,90,246,209.1,70.5036,246,First Health Group Corporation,First Health Network,238.62,97,,percent of total billed charges,,
"Hbv Dna Detect/Quant, S (Mayo)OutsideLaboratory",,87517,CPT,Facility,Both,,,90,246,209.1,70.5036,246,"Health Partners, Inc.",Commercial,232.716,94.6,,percent of total billed charges,,
"Hbv Dna Detect/Quant, S (Mayo)OutsideLaboratory",,87517,CPT,Facility,Outpatient,,,90,246,209.1,70.5036,246,"Health Partners, Inc.",Medicare Advantage,120.54,49,,percent of total billed charges,,
"Hbv Dna Detect/Quant, S (Mayo)OutsideLaboratory",,87517,CPT,Facility,Inpatient,,,90,246,209.1,70.5036,246,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Hbv Dna Detect/Quant, S (Mayo)OutsideLaboratory",,87517,CPT,Facility,Both,,,90,246,209.1,70.5036,246,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),147.6,60,,percent of total billed charges,,
"Hbv Dna Detect/Quant, S (Mayo)OutsideLaboratory",,87517,CPT,Facility,Both,,,90,246,209.1,70.5036,246,"Health Partners, Inc.",State of Minnesota Advantage Program,200.49,81.5,,percent of total billed charges,,
"Hbv Dna Detect/Quant, S (Mayo)OutsideLaboratory",,87517,CPT,Facility,Both,,,90,246,209.1,70.5036,246,"Health Partners, Inc.",State Public Programs,123,50,,percent of total billed charges,,
"Hbv Dna Detect/Quant, S (Mayo)OutsideLaboratory",,87517,CPT,Facility,Both,,,90,246,209.1,70.5036,246,Humana Insurance Company,Commercial PPO,233.7,95,,percent of total billed charges,,
"Hbv Dna Detect/Quant, S (Mayo)OutsideLaboratory",,87517,CPT,Facility,Outpatient,,,90,246,209.1,70.5036,246,Humana Insurance Company,Medicare PPO,120.54,49,,percent of total billed charges,,
"Hbv Dna Detect/Quant, S (Mayo)OutsideLaboratory",,87517,CPT,Facility,Inpatient,,,90,246,209.1,70.5036,246,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Hbv Dna Detect/Quant, S (Mayo)OutsideLaboratory",,87517,CPT,Facility,Both,,,90,246,209.1,70.5036,246,Medica,Individual & Family,243.786,99.1,,percent of total billed charges,,
"Hbv Dna Detect/Quant, S (Mayo)OutsideLaboratory",,87517,CPT,Facility,Outpatient,,,90,246,209.1,70.5036,246,Medica,Medica Advantage Solution,122.508,49.8,,percent of total billed charges,,
"Hbv Dna Detect/Quant, S (Mayo)OutsideLaboratory",,87517,CPT,Facility,Inpatient,,,90,246,209.1,70.5036,246,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Hbv Dna Detect/Quant, S (Mayo)OutsideLaboratory",,87517,CPT,Facility,Outpatient,,,90,246,209.1,70.5036,246,Medica,Medical Assistance,109.716,44.6,,percent of total billed charges,,
"Hbv Dna Detect/Quant, S (Mayo)OutsideLaboratory",,87517,CPT,Facility,Inpatient,,,90,246,209.1,70.5036,246,Medica,Medical Assistance,,,,,Included in per diem rate,
"Hbv Dna Detect/Quant, S (Mayo)OutsideLaboratory",,87517,CPT,Facility,Outpatient,,,90,246,209.1,70.5036,246,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,122.508,49.8,,percent of total billed charges,,
"Hbv Dna Detect/Quant, S (Mayo)OutsideLaboratory",,87517,CPT,Facility,Inpatient,,,90,246,209.1,70.5036,246,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Hbv Dna Detect/Quant, S (Mayo)OutsideLaboratory",,87517,CPT,Facility,Both,,,90,246,209.1,70.5036,246,"Multiplan, Inc.","Multiplan, Inc.",231.24,94,,percent of total billed charges,,
"Hbv Dna Detect/Quant, S (Mayo)OutsideLaboratory",,87517,CPT,Facility,Outpatient,,,90,246,209.1,70.5036,246,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,212.544,86.4,,percent of total billed charges,,
"Hbv Dna Detect/Quant, S (Mayo)OutsideLaboratory",,87517,CPT,Facility,Inpatient,,,90,246,209.1,70.5036,246,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Hbv Dna Detect/Quant, S (Mayo)OutsideLaboratory",,87517,CPT,Facility,Both,,,90,246,209.1,70.5036,246,"Preferred One Administrative Services, INC.",PPO,242.556,98.6,,percent of total billed charges,,
"Hbv Dna Detect/Quant, S (Mayo)OutsideLaboratory",,87517,CPT,Facility,Outpatient,,,90,246,209.1,70.5036,246,PrimeWest Health,Minnesota Senior Health Options (MSHO),126.567,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Hbv Dna Detect/Quant, S (Mayo)OutsideLaboratory",,87517,CPT,Facility,Inpatient,,,90,246,209.1,70.5036,246,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Hbv Dna Detect/Quant, S (Mayo)OutsideLaboratory",,87517,CPT,Facility,Outpatient,,,90,246,209.1,70.5036,246,PrimeWest Health,MinnesotaCare,126.3456,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Hbv Dna Detect/Quant, S (Mayo)OutsideLaboratory",,87517,CPT,Facility,Inpatient,,,90,246,209.1,70.5036,246,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Hbv Dna Detect/Quant, S (Mayo)OutsideLaboratory",,87517,CPT,Facility,Both,,,90,246,209.1,70.5036,246,Sanford Health Plan,Sanford Health Plan,226.32,92,,percent of total billed charges,,
"Hbv Dna Detect/Quant, S (Mayo)OutsideLaboratory",,87517,CPT,Facility,Outpatient,,,90,246,209.1,70.5036,246,"UCare Health, Inc.",Individual & Family Plan,138.621,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Hbv Dna Detect/Quant, S (Mayo)OutsideLaboratory",,87517,CPT,Facility,Inpatient,,,90,246,209.1,70.5036,246,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Hbv Dna Detect/Quant, S (Mayo)OutsideLaboratory",,87517,CPT,Facility,Outpatient,,,90,246,209.1,70.5036,246,"UCare Health, Inc.",Medical Assistance,124.1562,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Hbv Dna Detect/Quant, S (Mayo)OutsideLaboratory",,87517,CPT,Facility,Inpatient,,,90,246,209.1,70.5036,246,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Hbv Dna Detect/Quant, S (Mayo)OutsideLaboratory",,87517,CPT,Facility,Outpatient,,,90,246,209.1,70.5036,246,"UCare Health, Inc.",Medicare Advantage,124.1562,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Hbv Dna Detect/Quant, S (Mayo)OutsideLaboratory",,87517,CPT,Facility,Inpatient,,,90,246,209.1,70.5036,246,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Hbv Dna Detect/Quant, S (Mayo)OutsideLaboratory",,87517,CPT,Facility,Outpatient,,,90,246,209.1,70.5036,246,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),124.1562,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Hbv Dna Detect/Quant, S (Mayo)OutsideLaboratory",,87517,CPT,Facility,Inpatient,,,90,246,209.1,70.5036,246,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Hbv Dna Detect/Quant, S (Mayo)OutsideLaboratory",,87517,CPT,Facility,Both,,,90,246,209.1,70.5036,246,UnitedHealthcare,Individual & Family,231.24,94,,percent of total billed charges,,
"Hbv Dna Detect/Quant, S (Mayo)OutsideLaboratory",,87517,CPT,Facility,Outpatient,,,90,246,209.1,70.5036,246,UnitedHealthcare,Medicare Advantage,120.54,49,,percent of total billed charges,,
"Hbv Dna Detect/Quant, S (Mayo)OutsideLaboratory",,87517,CPT,Facility,Inpatient,,,90,246,209.1,70.5036,246,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Hbv Dna Detect/Quant, S (Mayo)OutsideLaboratory",,87517,CPT,Facility,Outpatient,,,90,246,209.1,70.5036,246,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,118.08,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Hbv Dna Detect/Quant, S (Mayo)OutsideLaboratory",,87517,CPT,Facility,Inpatient,,,90,246,209.1,70.5036,246,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Hcv Rna Detect/Quant, S (Mayo)OutsideLaboratory",,87522,CPT,Facility,Both,,,90,536,455.6,153.6176,536,Aetna,Commercial,493.12,92,,percent of total billed charges,,
"Hcv Rna Detect/Quant, S (Mayo)OutsideLaboratory",,87522,CPT,Facility,Outpatient,,,90,536,455.6,153.6176,536,Aetna,Medicare Advantage,262.64,49,,percent of total billed charges,,
"Hcv Rna Detect/Quant, S (Mayo)OutsideLaboratory",,87522,CPT,Facility,Inpatient,,,90,536,455.6,153.6176,536,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Hcv Rna Detect/Quant, S (Mayo)OutsideLaboratory",,87522,CPT,Facility,Both,,,90,536,455.6,153.6176,536,Aetna,PPO,498.48,93,,percent of total billed charges,,
"Hcv Rna Detect/Quant, S (Mayo)OutsideLaboratory",,87522,CPT,Facility,Both,,,90,536,455.6,153.6176,536,America's PPO,America's PPO,514.7208,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Hcv Rna Detect/Quant, S (Mayo)OutsideLaboratory",,87522,CPT,Facility,Both,,,90,536,455.6,153.6176,536,BlueCross BlueShield Minnesota, Federal Employee Program,527.424,98.4,,percent of total billed charges,,
"Hcv Rna Detect/Quant, S (Mayo)OutsideLaboratory",,87522,CPT,Facility,Both,,,90,536,455.6,153.6176,536,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,536,100,,percent of total billed charges,,
"Hcv Rna Detect/Quant, S (Mayo)OutsideLaboratory",,87522,CPT,Facility,Both,,,90,536,455.6,153.6176,536,BlueCross BlueShield Minnesota,High Value Network Plan,482.4,90,,percent of total billed charges,,
"Hcv Rna Detect/Quant, S (Mayo)OutsideLaboratory",,87522,CPT,Facility,Outpatient,,,90,536,455.6,153.6176,536,BlueCross BlueShield Minnesota,Medicare Advantage,262.64,49,,percent of total billed charges,,
"Hcv Rna Detect/Quant, S (Mayo)OutsideLaboratory",,87522,CPT,Facility,Inpatient,,,90,536,455.6,153.6176,536,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Hcv Rna Detect/Quant, S (Mayo)OutsideLaboratory",,87522,CPT,Facility,Both,,,90,536,455.6,153.6176,536,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,474.7352,88.57,,percent of total billed charges,,
"Hcv Rna Detect/Quant, S (Mayo)OutsideLaboratory",,87522,CPT,Facility,Both,,,90,536,455.6,153.6176,536,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,153.6176,28.66,,percent of total billed charges,,
"Hcv Rna Detect/Quant, S (Mayo)OutsideLaboratory",,87522,CPT,Facility,Outpatient,,,90,536,455.6,153.6176,536,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),262.64,49,,percent of total billed charges,,
"Hcv Rna Detect/Quant, S (Mayo)OutsideLaboratory",,87522,CPT,Facility,Inpatient,,,90,536,455.6,153.6176,536,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Hcv Rna Detect/Quant, S (Mayo)OutsideLaboratory",,87522,CPT,Facility,Both,,,90,536,455.6,153.6176,536,CorVel,Worker's Compensation,536,100,,percent of total billed charges,,
"Hcv Rna Detect/Quant, S (Mayo)OutsideLaboratory",,87522,CPT,Facility,Both,,,90,536,455.6,153.6176,536,First Health Group Corporation,First Health Network,519.92,97,,percent of total billed charges,,
"Hcv Rna Detect/Quant, S (Mayo)OutsideLaboratory",,87522,CPT,Facility,Both,,,90,536,455.6,153.6176,536,"Health Partners, Inc.",Commercial,507.056,94.6,,percent of total billed charges,,
"Hcv Rna Detect/Quant, S (Mayo)OutsideLaboratory",,87522,CPT,Facility,Outpatient,,,90,536,455.6,153.6176,536,"Health Partners, Inc.",Medicare Advantage,262.64,49,,percent of total billed charges,,
"Hcv Rna Detect/Quant, S (Mayo)OutsideLaboratory",,87522,CPT,Facility,Inpatient,,,90,536,455.6,153.6176,536,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Hcv Rna Detect/Quant, S (Mayo)OutsideLaboratory",,87522,CPT,Facility,Both,,,90,536,455.6,153.6176,536,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),321.6,60,,percent of total billed charges,,
"Hcv Rna Detect/Quant, S (Mayo)OutsideLaboratory",,87522,CPT,Facility,Both,,,90,536,455.6,153.6176,536,"Health Partners, Inc.",State of Minnesota Advantage Program,436.84,81.5,,percent of total billed charges,,
"Hcv Rna Detect/Quant, S (Mayo)OutsideLaboratory",,87522,CPT,Facility,Both,,,90,536,455.6,153.6176,536,"Health Partners, Inc.",State Public Programs,268,50,,percent of total billed charges,,
"Hcv Rna Detect/Quant, S (Mayo)OutsideLaboratory",,87522,CPT,Facility,Both,,,90,536,455.6,153.6176,536,Humana Insurance Company,Commercial PPO,509.2,95,,percent of total billed charges,,
"Hcv Rna Detect/Quant, S (Mayo)OutsideLaboratory",,87522,CPT,Facility,Outpatient,,,90,536,455.6,153.6176,536,Humana Insurance Company,Medicare PPO,262.64,49,,percent of total billed charges,,
"Hcv Rna Detect/Quant, S (Mayo)OutsideLaboratory",,87522,CPT,Facility,Inpatient,,,90,536,455.6,153.6176,536,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Hcv Rna Detect/Quant, S (Mayo)OutsideLaboratory",,87522,CPT,Facility,Both,,,90,536,455.6,153.6176,536,Medica,Individual & Family,531.176,99.1,,percent of total billed charges,,
"Hcv Rna Detect/Quant, S (Mayo)OutsideLaboratory",,87522,CPT,Facility,Outpatient,,,90,536,455.6,153.6176,536,Medica,Medica Advantage Solution,266.928,49.8,,percent of total billed charges,,
"Hcv Rna Detect/Quant, S (Mayo)OutsideLaboratory",,87522,CPT,Facility,Inpatient,,,90,536,455.6,153.6176,536,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Hcv Rna Detect/Quant, S (Mayo)OutsideLaboratory",,87522,CPT,Facility,Outpatient,,,90,536,455.6,153.6176,536,Medica,Medical Assistance,239.056,44.6,,percent of total billed charges,,
"Hcv Rna Detect/Quant, S (Mayo)OutsideLaboratory",,87522,CPT,Facility,Inpatient,,,90,536,455.6,153.6176,536,Medica,Medical Assistance,,,,,Included in per diem rate,
"Hcv Rna Detect/Quant, S (Mayo)OutsideLaboratory",,87522,CPT,Facility,Outpatient,,,90,536,455.6,153.6176,536,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,266.928,49.8,,percent of total billed charges,,
"Hcv Rna Detect/Quant, S (Mayo)OutsideLaboratory",,87522,CPT,Facility,Inpatient,,,90,536,455.6,153.6176,536,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Hcv Rna Detect/Quant, S (Mayo)OutsideLaboratory",,87522,CPT,Facility,Both,,,90,536,455.6,153.6176,536,"Multiplan, Inc.","Multiplan, Inc.",503.84,94,,percent of total billed charges,,
"Hcv Rna Detect/Quant, S (Mayo)OutsideLaboratory",,87522,CPT,Facility,Outpatient,,,90,536,455.6,153.6176,536,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,463.104,86.4,,percent of total billed charges,,
"Hcv Rna Detect/Quant, S (Mayo)OutsideLaboratory",,87522,CPT,Facility,Inpatient,,,90,536,455.6,153.6176,536,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Hcv Rna Detect/Quant, S (Mayo)OutsideLaboratory",,87522,CPT,Facility,Both,,,90,536,455.6,153.6176,536,"Preferred One Administrative Services, INC.",PPO,528.496,98.6,,percent of total billed charges,,
"Hcv Rna Detect/Quant, S (Mayo)OutsideLaboratory",,87522,CPT,Facility,Outpatient,,,90,536,455.6,153.6176,536,PrimeWest Health,Minnesota Senior Health Options (MSHO),275.772,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Hcv Rna Detect/Quant, S (Mayo)OutsideLaboratory",,87522,CPT,Facility,Inpatient,,,90,536,455.6,153.6176,536,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Hcv Rna Detect/Quant, S (Mayo)OutsideLaboratory",,87522,CPT,Facility,Outpatient,,,90,536,455.6,153.6176,536,PrimeWest Health,MinnesotaCare,275.2896,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Hcv Rna Detect/Quant, S (Mayo)OutsideLaboratory",,87522,CPT,Facility,Inpatient,,,90,536,455.6,153.6176,536,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Hcv Rna Detect/Quant, S (Mayo)OutsideLaboratory",,87522,CPT,Facility,Both,,,90,536,455.6,153.6176,536,Sanford Health Plan,Sanford Health Plan,493.12,92,,percent of total billed charges,,
"Hcv Rna Detect/Quant, S (Mayo)OutsideLaboratory",,87522,CPT,Facility,Outpatient,,,90,536,455.6,153.6176,536,"UCare Health, Inc.",Individual & Family Plan,302.036,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Hcv Rna Detect/Quant, S (Mayo)OutsideLaboratory",,87522,CPT,Facility,Inpatient,,,90,536,455.6,153.6176,536,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Hcv Rna Detect/Quant, S (Mayo)OutsideLaboratory",,87522,CPT,Facility,Outpatient,,,90,536,455.6,153.6176,536,"UCare Health, Inc.",Medical Assistance,270.5192,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Hcv Rna Detect/Quant, S (Mayo)OutsideLaboratory",,87522,CPT,Facility,Inpatient,,,90,536,455.6,153.6176,536,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Hcv Rna Detect/Quant, S (Mayo)OutsideLaboratory",,87522,CPT,Facility,Outpatient,,,90,536,455.6,153.6176,536,"UCare Health, Inc.",Medicare Advantage,270.5192,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Hcv Rna Detect/Quant, S (Mayo)OutsideLaboratory",,87522,CPT,Facility,Inpatient,,,90,536,455.6,153.6176,536,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Hcv Rna Detect/Quant, S (Mayo)OutsideLaboratory",,87522,CPT,Facility,Outpatient,,,90,536,455.6,153.6176,536,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),270.5192,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Hcv Rna Detect/Quant, S (Mayo)OutsideLaboratory",,87522,CPT,Facility,Inpatient,,,90,536,455.6,153.6176,536,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Hcv Rna Detect/Quant, S (Mayo)OutsideLaboratory",,87522,CPT,Facility,Both,,,90,536,455.6,153.6176,536,UnitedHealthcare,Individual & Family,503.84,94,,percent of total billed charges,,
"Hcv Rna Detect/Quant, S (Mayo)OutsideLaboratory",,87522,CPT,Facility,Outpatient,,,90,536,455.6,153.6176,536,UnitedHealthcare,Medicare Advantage,262.64,49,,percent of total billed charges,,
"Hcv Rna Detect/Quant, S (Mayo)OutsideLaboratory",,87522,CPT,Facility,Inpatient,,,90,536,455.6,153.6176,536,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Hcv Rna Detect/Quant, S (Mayo)OutsideLaboratory",,87522,CPT,Facility,Outpatient,,,90,536,455.6,153.6176,536,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,257.28,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Hcv Rna Detect/Quant, S (Mayo)OutsideLaboratory",,87522,CPT,Facility,Inpatient,,,90,536,455.6,153.6176,536,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Herpes Simplex Virus, Blood, Pcr (Mayo)OutsideLaboratory",,87529,CPT,Facility,Both,,,90,184,156.4,52.7344,184,Aetna,Commercial,169.28,92,,percent of total billed charges,,
"Herpes Simplex Virus, Blood, Pcr (Mayo)OutsideLaboratory",,87529,CPT,Facility,Outpatient,,,90,184,156.4,52.7344,184,Aetna,Medicare Advantage,90.16,49,,percent of total billed charges,,
"Herpes Simplex Virus, Blood, Pcr (Mayo)OutsideLaboratory",,87529,CPT,Facility,Inpatient,,,90,184,156.4,52.7344,184,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Herpes Simplex Virus, Blood, Pcr (Mayo)OutsideLaboratory",,87529,CPT,Facility,Both,,,90,184,156.4,52.7344,184,Aetna,PPO,171.12,93,,percent of total billed charges,,
"Herpes Simplex Virus, Blood, Pcr (Mayo)OutsideLaboratory",,87529,CPT,Facility,Both,,,90,184,156.4,52.7344,184,America's PPO,America's PPO,176.6952,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Herpes Simplex Virus, Blood, Pcr (Mayo)OutsideLaboratory",,87529,CPT,Facility,Both,,,90,184,156.4,52.7344,184,BlueCross BlueShield Minnesota, Federal Employee Program,181.056,98.4,,percent of total billed charges,,
"Herpes Simplex Virus, Blood, Pcr (Mayo)OutsideLaboratory",,87529,CPT,Facility,Both,,,90,184,156.4,52.7344,184,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,184,100,,percent of total billed charges,,
"Herpes Simplex Virus, Blood, Pcr (Mayo)OutsideLaboratory",,87529,CPT,Facility,Both,,,90,184,156.4,52.7344,184,BlueCross BlueShield Minnesota,High Value Network Plan,165.6,90,,percent of total billed charges,,
"Herpes Simplex Virus, Blood, Pcr (Mayo)OutsideLaboratory",,87529,CPT,Facility,Outpatient,,,90,184,156.4,52.7344,184,BlueCross BlueShield Minnesota,Medicare Advantage,90.16,49,,percent of total billed charges,,
"Herpes Simplex Virus, Blood, Pcr (Mayo)OutsideLaboratory",,87529,CPT,Facility,Inpatient,,,90,184,156.4,52.7344,184,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Herpes Simplex Virus, Blood, Pcr (Mayo)OutsideLaboratory",,87529,CPT,Facility,Both,,,90,184,156.4,52.7344,184,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,162.9688,88.57,,percent of total billed charges,,
"Herpes Simplex Virus, Blood, Pcr (Mayo)OutsideLaboratory",,87529,CPT,Facility,Both,,,90,184,156.4,52.7344,184,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,52.7344,28.66,,percent of total billed charges,,
"Herpes Simplex Virus, Blood, Pcr (Mayo)OutsideLaboratory",,87529,CPT,Facility,Outpatient,,,90,184,156.4,52.7344,184,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),90.16,49,,percent of total billed charges,,
"Herpes Simplex Virus, Blood, Pcr (Mayo)OutsideLaboratory",,87529,CPT,Facility,Inpatient,,,90,184,156.4,52.7344,184,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Herpes Simplex Virus, Blood, Pcr (Mayo)OutsideLaboratory",,87529,CPT,Facility,Both,,,90,184,156.4,52.7344,184,CorVel,Worker's Compensation,184,100,,percent of total billed charges,,
"Herpes Simplex Virus, Blood, Pcr (Mayo)OutsideLaboratory",,87529,CPT,Facility,Both,,,90,184,156.4,52.7344,184,First Health Group Corporation,First Health Network,178.48,97,,percent of total billed charges,,
"Herpes Simplex Virus, Blood, Pcr (Mayo)OutsideLaboratory",,87529,CPT,Facility,Both,,,90,184,156.4,52.7344,184,"Health Partners, Inc.",Commercial,174.064,94.6,,percent of total billed charges,,
"Herpes Simplex Virus, Blood, Pcr (Mayo)OutsideLaboratory",,87529,CPT,Facility,Outpatient,,,90,184,156.4,52.7344,184,"Health Partners, Inc.",Medicare Advantage,90.16,49,,percent of total billed charges,,
"Herpes Simplex Virus, Blood, Pcr (Mayo)OutsideLaboratory",,87529,CPT,Facility,Inpatient,,,90,184,156.4,52.7344,184,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Herpes Simplex Virus, Blood, Pcr (Mayo)OutsideLaboratory",,87529,CPT,Facility,Both,,,90,184,156.4,52.7344,184,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),110.4,60,,percent of total billed charges,,
"Herpes Simplex Virus, Blood, Pcr (Mayo)OutsideLaboratory",,87529,CPT,Facility,Both,,,90,184,156.4,52.7344,184,"Health Partners, Inc.",State of Minnesota Advantage Program,149.96,81.5,,percent of total billed charges,,
"Herpes Simplex Virus, Blood, Pcr (Mayo)OutsideLaboratory",,87529,CPT,Facility,Both,,,90,184,156.4,52.7344,184,"Health Partners, Inc.",State Public Programs,92,50,,percent of total billed charges,,
"Herpes Simplex Virus, Blood, Pcr (Mayo)OutsideLaboratory",,87529,CPT,Facility,Both,,,90,184,156.4,52.7344,184,Humana Insurance Company,Commercial PPO,174.8,95,,percent of total billed charges,,
"Herpes Simplex Virus, Blood, Pcr (Mayo)OutsideLaboratory",,87529,CPT,Facility,Outpatient,,,90,184,156.4,52.7344,184,Humana Insurance Company,Medicare PPO,90.16,49,,percent of total billed charges,,
"Herpes Simplex Virus, Blood, Pcr (Mayo)OutsideLaboratory",,87529,CPT,Facility,Inpatient,,,90,184,156.4,52.7344,184,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Herpes Simplex Virus, Blood, Pcr (Mayo)OutsideLaboratory",,87529,CPT,Facility,Both,,,90,184,156.4,52.7344,184,Medica,Individual & Family,182.344,99.1,,percent of total billed charges,,
"Herpes Simplex Virus, Blood, Pcr (Mayo)OutsideLaboratory",,87529,CPT,Facility,Outpatient,,,90,184,156.4,52.7344,184,Medica,Medica Advantage Solution,91.632,49.8,,percent of total billed charges,,
"Herpes Simplex Virus, Blood, Pcr (Mayo)OutsideLaboratory",,87529,CPT,Facility,Inpatient,,,90,184,156.4,52.7344,184,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Herpes Simplex Virus, Blood, Pcr (Mayo)OutsideLaboratory",,87529,CPT,Facility,Outpatient,,,90,184,156.4,52.7344,184,Medica,Medical Assistance,82.064,44.6,,percent of total billed charges,,
"Herpes Simplex Virus, Blood, Pcr (Mayo)OutsideLaboratory",,87529,CPT,Facility,Inpatient,,,90,184,156.4,52.7344,184,Medica,Medical Assistance,,,,,Included in per diem rate,
"Herpes Simplex Virus, Blood, Pcr (Mayo)OutsideLaboratory",,87529,CPT,Facility,Outpatient,,,90,184,156.4,52.7344,184,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,91.632,49.8,,percent of total billed charges,,
"Herpes Simplex Virus, Blood, Pcr (Mayo)OutsideLaboratory",,87529,CPT,Facility,Inpatient,,,90,184,156.4,52.7344,184,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Herpes Simplex Virus, Blood, Pcr (Mayo)OutsideLaboratory",,87529,CPT,Facility,Both,,,90,184,156.4,52.7344,184,"Multiplan, Inc.","Multiplan, Inc.",172.96,94,,percent of total billed charges,,
"Herpes Simplex Virus, Blood, Pcr (Mayo)OutsideLaboratory",,87529,CPT,Facility,Outpatient,,,90,184,156.4,52.7344,184,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,158.976,86.4,,percent of total billed charges,,
"Herpes Simplex Virus, Blood, Pcr (Mayo)OutsideLaboratory",,87529,CPT,Facility,Inpatient,,,90,184,156.4,52.7344,184,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Herpes Simplex Virus, Blood, Pcr (Mayo)OutsideLaboratory",,87529,CPT,Facility,Both,,,90,184,156.4,52.7344,184,"Preferred One Administrative Services, INC.",PPO,181.424,98.6,,percent of total billed charges,,
"Herpes Simplex Virus, Blood, Pcr (Mayo)OutsideLaboratory",,87529,CPT,Facility,Outpatient,,,90,184,156.4,52.7344,184,PrimeWest Health,Minnesota Senior Health Options (MSHO),94.668,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Herpes Simplex Virus, Blood, Pcr (Mayo)OutsideLaboratory",,87529,CPT,Facility,Inpatient,,,90,184,156.4,52.7344,184,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Herpes Simplex Virus, Blood, Pcr (Mayo)OutsideLaboratory",,87529,CPT,Facility,Outpatient,,,90,184,156.4,52.7344,184,PrimeWest Health,MinnesotaCare,94.5024,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Herpes Simplex Virus, Blood, Pcr (Mayo)OutsideLaboratory",,87529,CPT,Facility,Inpatient,,,90,184,156.4,52.7344,184,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Herpes Simplex Virus, Blood, Pcr (Mayo)OutsideLaboratory",,87529,CPT,Facility,Both,,,90,184,156.4,52.7344,184,Sanford Health Plan,Sanford Health Plan,169.28,92,,percent of total billed charges,,
"Herpes Simplex Virus, Blood, Pcr (Mayo)OutsideLaboratory",,87529,CPT,Facility,Outpatient,,,90,184,156.4,52.7344,184,"UCare Health, Inc.",Individual & Family Plan,103.684,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Herpes Simplex Virus, Blood, Pcr (Mayo)OutsideLaboratory",,87529,CPT,Facility,Inpatient,,,90,184,156.4,52.7344,184,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Herpes Simplex Virus, Blood, Pcr (Mayo)OutsideLaboratory",,87529,CPT,Facility,Outpatient,,,90,184,156.4,52.7344,184,"UCare Health, Inc.",Medical Assistance,92.8648,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Herpes Simplex Virus, Blood, Pcr (Mayo)OutsideLaboratory",,87529,CPT,Facility,Inpatient,,,90,184,156.4,52.7344,184,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Herpes Simplex Virus, Blood, Pcr (Mayo)OutsideLaboratory",,87529,CPT,Facility,Outpatient,,,90,184,156.4,52.7344,184,"UCare Health, Inc.",Medicare Advantage,92.8648,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Herpes Simplex Virus, Blood, Pcr (Mayo)OutsideLaboratory",,87529,CPT,Facility,Inpatient,,,90,184,156.4,52.7344,184,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Herpes Simplex Virus, Blood, Pcr (Mayo)OutsideLaboratory",,87529,CPT,Facility,Outpatient,,,90,184,156.4,52.7344,184,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),92.8648,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Herpes Simplex Virus, Blood, Pcr (Mayo)OutsideLaboratory",,87529,CPT,Facility,Inpatient,,,90,184,156.4,52.7344,184,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Herpes Simplex Virus, Blood, Pcr (Mayo)OutsideLaboratory",,87529,CPT,Facility,Both,,,90,184,156.4,52.7344,184,UnitedHealthcare,Individual & Family,172.96,94,,percent of total billed charges,,
"Herpes Simplex Virus, Blood, Pcr (Mayo)OutsideLaboratory",,87529,CPT,Facility,Outpatient,,,90,184,156.4,52.7344,184,UnitedHealthcare,Medicare Advantage,90.16,49,,percent of total billed charges,,
"Herpes Simplex Virus, Blood, Pcr (Mayo)OutsideLaboratory",,87529,CPT,Facility,Inpatient,,,90,184,156.4,52.7344,184,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Herpes Simplex Virus, Blood, Pcr (Mayo)OutsideLaboratory",,87529,CPT,Facility,Outpatient,,,90,184,156.4,52.7344,184,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,88.32,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Herpes Simplex Virus, Blood, Pcr (Mayo)OutsideLaboratory",,87529,CPT,Facility,Inpatient,,,90,184,156.4,52.7344,184,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Herpes Simplex Virus, Non - Blood, Pcr (Mayo)OutsideLaboratory",,87529,CPT,Facility,Both,,,90,158,134.3,45.2828,158,Aetna,Commercial,145.36,92,,percent of total billed charges,,
"Herpes Simplex Virus, Non - Blood, Pcr (Mayo)OutsideLaboratory",,87529,CPT,Facility,Outpatient,,,90,158,134.3,45.2828,158,Aetna,Medicare Advantage,77.42,49,,percent of total billed charges,,
"Herpes Simplex Virus, Non - Blood, Pcr (Mayo)OutsideLaboratory",,87529,CPT,Facility,Inpatient,,,90,158,134.3,45.2828,158,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Herpes Simplex Virus, Non - Blood, Pcr (Mayo)OutsideLaboratory",,87529,CPT,Facility,Both,,,90,158,134.3,45.2828,158,Aetna,PPO,146.94,93,,percent of total billed charges,,
"Herpes Simplex Virus, Non - Blood, Pcr (Mayo)OutsideLaboratory",,87529,CPT,Facility,Both,,,90,158,134.3,45.2828,158,America's PPO,America's PPO,151.7274,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Herpes Simplex Virus, Non - Blood, Pcr (Mayo)OutsideLaboratory",,87529,CPT,Facility,Both,,,90,158,134.3,45.2828,158,BlueCross BlueShield Minnesota, Federal Employee Program,155.472,98.4,,percent of total billed charges,,
"Herpes Simplex Virus, Non - Blood, Pcr (Mayo)OutsideLaboratory",,87529,CPT,Facility,Both,,,90,158,134.3,45.2828,158,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,158,100,,percent of total billed charges,,
"Herpes Simplex Virus, Non - Blood, Pcr (Mayo)OutsideLaboratory",,87529,CPT,Facility,Both,,,90,158,134.3,45.2828,158,BlueCross BlueShield Minnesota,High Value Network Plan,142.2,90,,percent of total billed charges,,
"Herpes Simplex Virus, Non - Blood, Pcr (Mayo)OutsideLaboratory",,87529,CPT,Facility,Outpatient,,,90,158,134.3,45.2828,158,BlueCross BlueShield Minnesota,Medicare Advantage,77.42,49,,percent of total billed charges,,
"Herpes Simplex Virus, Non - Blood, Pcr (Mayo)OutsideLaboratory",,87529,CPT,Facility,Inpatient,,,90,158,134.3,45.2828,158,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Herpes Simplex Virus, Non - Blood, Pcr (Mayo)OutsideLaboratory",,87529,CPT,Facility,Both,,,90,158,134.3,45.2828,158,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,139.9406,88.57,,percent of total billed charges,,
"Herpes Simplex Virus, Non - Blood, Pcr (Mayo)OutsideLaboratory",,87529,CPT,Facility,Both,,,90,158,134.3,45.2828,158,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,45.2828,28.66,,percent of total billed charges,,
"Herpes Simplex Virus, Non - Blood, Pcr (Mayo)OutsideLaboratory",,87529,CPT,Facility,Outpatient,,,90,158,134.3,45.2828,158,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),77.42,49,,percent of total billed charges,,
"Herpes Simplex Virus, Non - Blood, Pcr (Mayo)OutsideLaboratory",,87529,CPT,Facility,Inpatient,,,90,158,134.3,45.2828,158,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Herpes Simplex Virus, Non - Blood, Pcr (Mayo)OutsideLaboratory",,87529,CPT,Facility,Both,,,90,158,134.3,45.2828,158,CorVel,Worker's Compensation,158,100,,percent of total billed charges,,
"Herpes Simplex Virus, Non - Blood, Pcr (Mayo)OutsideLaboratory",,87529,CPT,Facility,Both,,,90,158,134.3,45.2828,158,First Health Group Corporation,First Health Network,153.26,97,,percent of total billed charges,,
"Herpes Simplex Virus, Non - Blood, Pcr (Mayo)OutsideLaboratory",,87529,CPT,Facility,Both,,,90,158,134.3,45.2828,158,"Health Partners, Inc.",Commercial,149.468,94.6,,percent of total billed charges,,
"Herpes Simplex Virus, Non - Blood, Pcr (Mayo)OutsideLaboratory",,87529,CPT,Facility,Outpatient,,,90,158,134.3,45.2828,158,"Health Partners, Inc.",Medicare Advantage,77.42,49,,percent of total billed charges,,
"Herpes Simplex Virus, Non - Blood, Pcr (Mayo)OutsideLaboratory",,87529,CPT,Facility,Inpatient,,,90,158,134.3,45.2828,158,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Herpes Simplex Virus, Non - Blood, Pcr (Mayo)OutsideLaboratory",,87529,CPT,Facility,Both,,,90,158,134.3,45.2828,158,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),94.8,60,,percent of total billed charges,,
"Herpes Simplex Virus, Non - Blood, Pcr (Mayo)OutsideLaboratory",,87529,CPT,Facility,Both,,,90,158,134.3,45.2828,158,"Health Partners, Inc.",State of Minnesota Advantage Program,128.77,81.5,,percent of total billed charges,,
"Herpes Simplex Virus, Non - Blood, Pcr (Mayo)OutsideLaboratory",,87529,CPT,Facility,Both,,,90,158,134.3,45.2828,158,"Health Partners, Inc.",State Public Programs,79,50,,percent of total billed charges,,
"Herpes Simplex Virus, Non - Blood, Pcr (Mayo)OutsideLaboratory",,87529,CPT,Facility,Both,,,90,158,134.3,45.2828,158,Humana Insurance Company,Commercial PPO,150.1,95,,percent of total billed charges,,
"Herpes Simplex Virus, Non - Blood, Pcr (Mayo)OutsideLaboratory",,87529,CPT,Facility,Outpatient,,,90,158,134.3,45.2828,158,Humana Insurance Company,Medicare PPO,77.42,49,,percent of total billed charges,,
"Herpes Simplex Virus, Non - Blood, Pcr (Mayo)OutsideLaboratory",,87529,CPT,Facility,Inpatient,,,90,158,134.3,45.2828,158,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Herpes Simplex Virus, Non - Blood, Pcr (Mayo)OutsideLaboratory",,87529,CPT,Facility,Both,,,90,158,134.3,45.2828,158,Medica,Individual & Family,156.578,99.1,,percent of total billed charges,,
"Herpes Simplex Virus, Non - Blood, Pcr (Mayo)OutsideLaboratory",,87529,CPT,Facility,Outpatient,,,90,158,134.3,45.2828,158,Medica,Medica Advantage Solution,78.684,49.8,,percent of total billed charges,,
"Herpes Simplex Virus, Non - Blood, Pcr (Mayo)OutsideLaboratory",,87529,CPT,Facility,Inpatient,,,90,158,134.3,45.2828,158,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Herpes Simplex Virus, Non - Blood, Pcr (Mayo)OutsideLaboratory",,87529,CPT,Facility,Outpatient,,,90,158,134.3,45.2828,158,Medica,Medical Assistance,70.468,44.6,,percent of total billed charges,,
"Herpes Simplex Virus, Non - Blood, Pcr (Mayo)OutsideLaboratory",,87529,CPT,Facility,Inpatient,,,90,158,134.3,45.2828,158,Medica,Medical Assistance,,,,,Included in per diem rate,
"Herpes Simplex Virus, Non - Blood, Pcr (Mayo)OutsideLaboratory",,87529,CPT,Facility,Outpatient,,,90,158,134.3,45.2828,158,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,78.684,49.8,,percent of total billed charges,,
"Herpes Simplex Virus, Non - Blood, Pcr (Mayo)OutsideLaboratory",,87529,CPT,Facility,Inpatient,,,90,158,134.3,45.2828,158,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Herpes Simplex Virus, Non - Blood, Pcr (Mayo)OutsideLaboratory",,87529,CPT,Facility,Both,,,90,158,134.3,45.2828,158,"Multiplan, Inc.","Multiplan, Inc.",148.52,94,,percent of total billed charges,,
"Herpes Simplex Virus, Non - Blood, Pcr (Mayo)OutsideLaboratory",,87529,CPT,Facility,Outpatient,,,90,158,134.3,45.2828,158,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,136.512,86.4,,percent of total billed charges,,
"Herpes Simplex Virus, Non - Blood, Pcr (Mayo)OutsideLaboratory",,87529,CPT,Facility,Inpatient,,,90,158,134.3,45.2828,158,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Herpes Simplex Virus, Non - Blood, Pcr (Mayo)OutsideLaboratory",,87529,CPT,Facility,Both,,,90,158,134.3,45.2828,158,"Preferred One Administrative Services, INC.",PPO,155.788,98.6,,percent of total billed charges,,
"Herpes Simplex Virus, Non - Blood, Pcr (Mayo)OutsideLaboratory",,87529,CPT,Facility,Outpatient,,,90,158,134.3,45.2828,158,PrimeWest Health,Minnesota Senior Health Options (MSHO),81.291,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Herpes Simplex Virus, Non - Blood, Pcr (Mayo)OutsideLaboratory",,87529,CPT,Facility,Inpatient,,,90,158,134.3,45.2828,158,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Herpes Simplex Virus, Non - Blood, Pcr (Mayo)OutsideLaboratory",,87529,CPT,Facility,Outpatient,,,90,158,134.3,45.2828,158,PrimeWest Health,MinnesotaCare,81.1488,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Herpes Simplex Virus, Non - Blood, Pcr (Mayo)OutsideLaboratory",,87529,CPT,Facility,Inpatient,,,90,158,134.3,45.2828,158,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Herpes Simplex Virus, Non - Blood, Pcr (Mayo)OutsideLaboratory",,87529,CPT,Facility,Both,,,90,158,134.3,45.2828,158,Sanford Health Plan,Sanford Health Plan,145.36,92,,percent of total billed charges,,
"Herpes Simplex Virus, Non - Blood, Pcr (Mayo)OutsideLaboratory",,87529,CPT,Facility,Outpatient,,,90,158,134.3,45.2828,158,"UCare Health, Inc.",Individual & Family Plan,89.033,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Herpes Simplex Virus, Non - Blood, Pcr (Mayo)OutsideLaboratory",,87529,CPT,Facility,Inpatient,,,90,158,134.3,45.2828,158,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Herpes Simplex Virus, Non - Blood, Pcr (Mayo)OutsideLaboratory",,87529,CPT,Facility,Outpatient,,,90,158,134.3,45.2828,158,"UCare Health, Inc.",Medical Assistance,79.7426,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Herpes Simplex Virus, Non - Blood, Pcr (Mayo)OutsideLaboratory",,87529,CPT,Facility,Inpatient,,,90,158,134.3,45.2828,158,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Herpes Simplex Virus, Non - Blood, Pcr (Mayo)OutsideLaboratory",,87529,CPT,Facility,Outpatient,,,90,158,134.3,45.2828,158,"UCare Health, Inc.",Medicare Advantage,79.7426,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Herpes Simplex Virus, Non - Blood, Pcr (Mayo)OutsideLaboratory",,87529,CPT,Facility,Inpatient,,,90,158,134.3,45.2828,158,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Herpes Simplex Virus, Non - Blood, Pcr (Mayo)OutsideLaboratory",,87529,CPT,Facility,Outpatient,,,90,158,134.3,45.2828,158,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),79.7426,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Herpes Simplex Virus, Non - Blood, Pcr (Mayo)OutsideLaboratory",,87529,CPT,Facility,Inpatient,,,90,158,134.3,45.2828,158,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Herpes Simplex Virus, Non - Blood, Pcr (Mayo)OutsideLaboratory",,87529,CPT,Facility,Both,,,90,158,134.3,45.2828,158,UnitedHealthcare,Individual & Family,148.52,94,,percent of total billed charges,,
"Herpes Simplex Virus, Non - Blood, Pcr (Mayo)OutsideLaboratory",,87529,CPT,Facility,Outpatient,,,90,158,134.3,45.2828,158,UnitedHealthcare,Medicare Advantage,77.42,49,,percent of total billed charges,,
"Herpes Simplex Virus, Non - Blood, Pcr (Mayo)OutsideLaboratory",,87529,CPT,Facility,Inpatient,,,90,158,134.3,45.2828,158,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Herpes Simplex Virus, Non - Blood, Pcr (Mayo)OutsideLaboratory",,87529,CPT,Facility,Outpatient,,,90,158,134.3,45.2828,158,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,75.84,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Herpes Simplex Virus, Non - Blood, Pcr (Mayo)OutsideLaboratory",,87529,CPT,Facility,Inpatient,,,90,158,134.3,45.2828,158,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Hiv-1 Rna Detect / Quant, P (Mayo)OutsideLaboratory",,87536,CPT,Facility,Both,,,90,224,190.4,64.1984,224,Aetna,Commercial,206.08,92,,percent of total billed charges,,
"Hiv-1 Rna Detect / Quant, P (Mayo)OutsideLaboratory",,87536,CPT,Facility,Outpatient,,,90,224,190.4,64.1984,224,Aetna,Medicare Advantage,109.76,49,,percent of total billed charges,,
"Hiv-1 Rna Detect / Quant, P (Mayo)OutsideLaboratory",,87536,CPT,Facility,Inpatient,,,90,224,190.4,64.1984,224,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Hiv-1 Rna Detect / Quant, P (Mayo)OutsideLaboratory",,87536,CPT,Facility,Both,,,90,224,190.4,64.1984,224,Aetna,PPO,208.32,93,,percent of total billed charges,,
"Hiv-1 Rna Detect / Quant, P (Mayo)OutsideLaboratory",,87536,CPT,Facility,Both,,,90,224,190.4,64.1984,224,America's PPO,America's PPO,215.1072,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Hiv-1 Rna Detect / Quant, P (Mayo)OutsideLaboratory",,87536,CPT,Facility,Both,,,90,224,190.4,64.1984,224,BlueCross BlueShield Minnesota, Federal Employee Program,220.416,98.4,,percent of total billed charges,,
"Hiv-1 Rna Detect / Quant, P (Mayo)OutsideLaboratory",,87536,CPT,Facility,Both,,,90,224,190.4,64.1984,224,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,224,100,,percent of total billed charges,,
"Hiv-1 Rna Detect / Quant, P (Mayo)OutsideLaboratory",,87536,CPT,Facility,Both,,,90,224,190.4,64.1984,224,BlueCross BlueShield Minnesota,High Value Network Plan,201.6,90,,percent of total billed charges,,
"Hiv-1 Rna Detect / Quant, P (Mayo)OutsideLaboratory",,87536,CPT,Facility,Outpatient,,,90,224,190.4,64.1984,224,BlueCross BlueShield Minnesota,Medicare Advantage,109.76,49,,percent of total billed charges,,
"Hiv-1 Rna Detect / Quant, P (Mayo)OutsideLaboratory",,87536,CPT,Facility,Inpatient,,,90,224,190.4,64.1984,224,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Hiv-1 Rna Detect / Quant, P (Mayo)OutsideLaboratory",,87536,CPT,Facility,Both,,,90,224,190.4,64.1984,224,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,198.3968,88.57,,percent of total billed charges,,
"Hiv-1 Rna Detect / Quant, P (Mayo)OutsideLaboratory",,87536,CPT,Facility,Both,,,90,224,190.4,64.1984,224,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,64.1984,28.66,,percent of total billed charges,,
"Hiv-1 Rna Detect / Quant, P (Mayo)OutsideLaboratory",,87536,CPT,Facility,Outpatient,,,90,224,190.4,64.1984,224,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),109.76,49,,percent of total billed charges,,
"Hiv-1 Rna Detect / Quant, P (Mayo)OutsideLaboratory",,87536,CPT,Facility,Inpatient,,,90,224,190.4,64.1984,224,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Hiv-1 Rna Detect / Quant, P (Mayo)OutsideLaboratory",,87536,CPT,Facility,Both,,,90,224,190.4,64.1984,224,CorVel,Worker's Compensation,224,100,,percent of total billed charges,,
"Hiv-1 Rna Detect / Quant, P (Mayo)OutsideLaboratory",,87536,CPT,Facility,Both,,,90,224,190.4,64.1984,224,First Health Group Corporation,First Health Network,217.28,97,,percent of total billed charges,,
"Hiv-1 Rna Detect / Quant, P (Mayo)OutsideLaboratory",,87536,CPT,Facility,Both,,,90,224,190.4,64.1984,224,"Health Partners, Inc.",Commercial,211.904,94.6,,percent of total billed charges,,
"Hiv-1 Rna Detect / Quant, P (Mayo)OutsideLaboratory",,87536,CPT,Facility,Outpatient,,,90,224,190.4,64.1984,224,"Health Partners, Inc.",Medicare Advantage,109.76,49,,percent of total billed charges,,
"Hiv-1 Rna Detect / Quant, P (Mayo)OutsideLaboratory",,87536,CPT,Facility,Inpatient,,,90,224,190.4,64.1984,224,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Hiv-1 Rna Detect / Quant, P (Mayo)OutsideLaboratory",,87536,CPT,Facility,Both,,,90,224,190.4,64.1984,224,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),134.4,60,,percent of total billed charges,,
"Hiv-1 Rna Detect / Quant, P (Mayo)OutsideLaboratory",,87536,CPT,Facility,Both,,,90,224,190.4,64.1984,224,"Health Partners, Inc.",State of Minnesota Advantage Program,182.56,81.5,,percent of total billed charges,,
"Hiv-1 Rna Detect / Quant, P (Mayo)OutsideLaboratory",,87536,CPT,Facility,Both,,,90,224,190.4,64.1984,224,"Health Partners, Inc.",State Public Programs,112,50,,percent of total billed charges,,
"Hiv-1 Rna Detect / Quant, P (Mayo)OutsideLaboratory",,87536,CPT,Facility,Both,,,90,224,190.4,64.1984,224,Humana Insurance Company,Commercial PPO,212.8,95,,percent of total billed charges,,
"Hiv-1 Rna Detect / Quant, P (Mayo)OutsideLaboratory",,87536,CPT,Facility,Outpatient,,,90,224,190.4,64.1984,224,Humana Insurance Company,Medicare PPO,109.76,49,,percent of total billed charges,,
"Hiv-1 Rna Detect / Quant, P (Mayo)OutsideLaboratory",,87536,CPT,Facility,Inpatient,,,90,224,190.4,64.1984,224,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Hiv-1 Rna Detect / Quant, P (Mayo)OutsideLaboratory",,87536,CPT,Facility,Both,,,90,224,190.4,64.1984,224,Medica,Individual & Family,221.984,99.1,,percent of total billed charges,,
"Hiv-1 Rna Detect / Quant, P (Mayo)OutsideLaboratory",,87536,CPT,Facility,Outpatient,,,90,224,190.4,64.1984,224,Medica,Medica Advantage Solution,111.552,49.8,,percent of total billed charges,,
"Hiv-1 Rna Detect / Quant, P (Mayo)OutsideLaboratory",,87536,CPT,Facility,Inpatient,,,90,224,190.4,64.1984,224,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Hiv-1 Rna Detect / Quant, P (Mayo)OutsideLaboratory",,87536,CPT,Facility,Outpatient,,,90,224,190.4,64.1984,224,Medica,Medical Assistance,99.904,44.6,,percent of total billed charges,,
"Hiv-1 Rna Detect / Quant, P (Mayo)OutsideLaboratory",,87536,CPT,Facility,Inpatient,,,90,224,190.4,64.1984,224,Medica,Medical Assistance,,,,,Included in per diem rate,
"Hiv-1 Rna Detect / Quant, P (Mayo)OutsideLaboratory",,87536,CPT,Facility,Outpatient,,,90,224,190.4,64.1984,224,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,111.552,49.8,,percent of total billed charges,,
"Hiv-1 Rna Detect / Quant, P (Mayo)OutsideLaboratory",,87536,CPT,Facility,Inpatient,,,90,224,190.4,64.1984,224,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Hiv-1 Rna Detect / Quant, P (Mayo)OutsideLaboratory",,87536,CPT,Facility,Both,,,90,224,190.4,64.1984,224,"Multiplan, Inc.","Multiplan, Inc.",210.56,94,,percent of total billed charges,,
"Hiv-1 Rna Detect / Quant, P (Mayo)OutsideLaboratory",,87536,CPT,Facility,Outpatient,,,90,224,190.4,64.1984,224,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,193.536,86.4,,percent of total billed charges,,
"Hiv-1 Rna Detect / Quant, P (Mayo)OutsideLaboratory",,87536,CPT,Facility,Inpatient,,,90,224,190.4,64.1984,224,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Hiv-1 Rna Detect / Quant, P (Mayo)OutsideLaboratory",,87536,CPT,Facility,Both,,,90,224,190.4,64.1984,224,"Preferred One Administrative Services, INC.",PPO,220.864,98.6,,percent of total billed charges,,
"Hiv-1 Rna Detect / Quant, P (Mayo)OutsideLaboratory",,87536,CPT,Facility,Outpatient,,,90,224,190.4,64.1984,224,PrimeWest Health,Minnesota Senior Health Options (MSHO),115.248,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Hiv-1 Rna Detect / Quant, P (Mayo)OutsideLaboratory",,87536,CPT,Facility,Inpatient,,,90,224,190.4,64.1984,224,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Hiv-1 Rna Detect / Quant, P (Mayo)OutsideLaboratory",,87536,CPT,Facility,Outpatient,,,90,224,190.4,64.1984,224,PrimeWest Health,MinnesotaCare,115.0464,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Hiv-1 Rna Detect / Quant, P (Mayo)OutsideLaboratory",,87536,CPT,Facility,Inpatient,,,90,224,190.4,64.1984,224,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Hiv-1 Rna Detect / Quant, P (Mayo)OutsideLaboratory",,87536,CPT,Facility,Both,,,90,224,190.4,64.1984,224,Sanford Health Plan,Sanford Health Plan,206.08,92,,percent of total billed charges,,
"Hiv-1 Rna Detect / Quant, P (Mayo)OutsideLaboratory",,87536,CPT,Facility,Outpatient,,,90,224,190.4,64.1984,224,"UCare Health, Inc.",Individual & Family Plan,126.224,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Hiv-1 Rna Detect / Quant, P (Mayo)OutsideLaboratory",,87536,CPT,Facility,Inpatient,,,90,224,190.4,64.1984,224,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Hiv-1 Rna Detect / Quant, P (Mayo)OutsideLaboratory",,87536,CPT,Facility,Outpatient,,,90,224,190.4,64.1984,224,"UCare Health, Inc.",Medical Assistance,113.0528,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Hiv-1 Rna Detect / Quant, P (Mayo)OutsideLaboratory",,87536,CPT,Facility,Inpatient,,,90,224,190.4,64.1984,224,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Hiv-1 Rna Detect / Quant, P (Mayo)OutsideLaboratory",,87536,CPT,Facility,Outpatient,,,90,224,190.4,64.1984,224,"UCare Health, Inc.",Medicare Advantage,113.0528,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Hiv-1 Rna Detect / Quant, P (Mayo)OutsideLaboratory",,87536,CPT,Facility,Inpatient,,,90,224,190.4,64.1984,224,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Hiv-1 Rna Detect / Quant, P (Mayo)OutsideLaboratory",,87536,CPT,Facility,Outpatient,,,90,224,190.4,64.1984,224,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),113.0528,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Hiv-1 Rna Detect / Quant, P (Mayo)OutsideLaboratory",,87536,CPT,Facility,Inpatient,,,90,224,190.4,64.1984,224,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Hiv-1 Rna Detect / Quant, P (Mayo)OutsideLaboratory",,87536,CPT,Facility,Both,,,90,224,190.4,64.1984,224,UnitedHealthcare,Individual & Family,210.56,94,,percent of total billed charges,,
"Hiv-1 Rna Detect / Quant, P (Mayo)OutsideLaboratory",,87536,CPT,Facility,Outpatient,,,90,224,190.4,64.1984,224,UnitedHealthcare,Medicare Advantage,109.76,49,,percent of total billed charges,,
"Hiv-1 Rna Detect / Quant, P (Mayo)OutsideLaboratory",,87536,CPT,Facility,Inpatient,,,90,224,190.4,64.1984,224,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Hiv-1 Rna Detect / Quant, P (Mayo)OutsideLaboratory",,87536,CPT,Facility,Outpatient,,,90,224,190.4,64.1984,224,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,107.52,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Hiv-1 Rna Detect / Quant, P (Mayo)OutsideLaboratory",,87536,CPT,Facility,Inpatient,,,90,224,190.4,64.1984,224,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Mycoplasma Tuberculosis Complex, Pcr (Mayo)OutsideLaboratory",,87556,CPT,Facility,Both,,,90,414,351.9,118.6524,414,Aetna,Commercial,380.88,92,,percent of total billed charges,,
"Mycoplasma Tuberculosis Complex, Pcr (Mayo)OutsideLaboratory",,87556,CPT,Facility,Outpatient,,,90,414,351.9,118.6524,414,Aetna,Medicare Advantage,202.86,49,,percent of total billed charges,,
"Mycoplasma Tuberculosis Complex, Pcr (Mayo)OutsideLaboratory",,87556,CPT,Facility,Inpatient,,,90,414,351.9,118.6524,414,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Mycoplasma Tuberculosis Complex, Pcr (Mayo)OutsideLaboratory",,87556,CPT,Facility,Both,,,90,414,351.9,118.6524,414,Aetna,PPO,385.02,93,,percent of total billed charges,,
"Mycoplasma Tuberculosis Complex, Pcr (Mayo)OutsideLaboratory",,87556,CPT,Facility,Both,,,90,414,351.9,118.6524,414,America's PPO,America's PPO,397.5642,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Mycoplasma Tuberculosis Complex, Pcr (Mayo)OutsideLaboratory",,87556,CPT,Facility,Both,,,90,414,351.9,118.6524,414,BlueCross BlueShield Minnesota, Federal Employee Program,407.376,98.4,,percent of total billed charges,,
"Mycoplasma Tuberculosis Complex, Pcr (Mayo)OutsideLaboratory",,87556,CPT,Facility,Both,,,90,414,351.9,118.6524,414,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,414,100,,percent of total billed charges,,
"Mycoplasma Tuberculosis Complex, Pcr (Mayo)OutsideLaboratory",,87556,CPT,Facility,Both,,,90,414,351.9,118.6524,414,BlueCross BlueShield Minnesota,High Value Network Plan,372.6,90,,percent of total billed charges,,
"Mycoplasma Tuberculosis Complex, Pcr (Mayo)OutsideLaboratory",,87556,CPT,Facility,Outpatient,,,90,414,351.9,118.6524,414,BlueCross BlueShield Minnesota,Medicare Advantage,202.86,49,,percent of total billed charges,,
"Mycoplasma Tuberculosis Complex, Pcr (Mayo)OutsideLaboratory",,87556,CPT,Facility,Inpatient,,,90,414,351.9,118.6524,414,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Mycoplasma Tuberculosis Complex, Pcr (Mayo)OutsideLaboratory",,87556,CPT,Facility,Both,,,90,414,351.9,118.6524,414,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,366.6798,88.57,,percent of total billed charges,,
"Mycoplasma Tuberculosis Complex, Pcr (Mayo)OutsideLaboratory",,87556,CPT,Facility,Both,,,90,414,351.9,118.6524,414,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,118.6524,28.66,,percent of total billed charges,,
"Mycoplasma Tuberculosis Complex, Pcr (Mayo)OutsideLaboratory",,87556,CPT,Facility,Outpatient,,,90,414,351.9,118.6524,414,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),202.86,49,,percent of total billed charges,,
"Mycoplasma Tuberculosis Complex, Pcr (Mayo)OutsideLaboratory",,87556,CPT,Facility,Inpatient,,,90,414,351.9,118.6524,414,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Mycoplasma Tuberculosis Complex, Pcr (Mayo)OutsideLaboratory",,87556,CPT,Facility,Both,,,90,414,351.9,118.6524,414,CorVel,Worker's Compensation,414,100,,percent of total billed charges,,
"Mycoplasma Tuberculosis Complex, Pcr (Mayo)OutsideLaboratory",,87556,CPT,Facility,Both,,,90,414,351.9,118.6524,414,First Health Group Corporation,First Health Network,401.58,97,,percent of total billed charges,,
"Mycoplasma Tuberculosis Complex, Pcr (Mayo)OutsideLaboratory",,87556,CPT,Facility,Both,,,90,414,351.9,118.6524,414,"Health Partners, Inc.",Commercial,391.644,94.6,,percent of total billed charges,,
"Mycoplasma Tuberculosis Complex, Pcr (Mayo)OutsideLaboratory",,87556,CPT,Facility,Outpatient,,,90,414,351.9,118.6524,414,"Health Partners, Inc.",Medicare Advantage,202.86,49,,percent of total billed charges,,
"Mycoplasma Tuberculosis Complex, Pcr (Mayo)OutsideLaboratory",,87556,CPT,Facility,Inpatient,,,90,414,351.9,118.6524,414,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Mycoplasma Tuberculosis Complex, Pcr (Mayo)OutsideLaboratory",,87556,CPT,Facility,Both,,,90,414,351.9,118.6524,414,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),248.4,60,,percent of total billed charges,,
"Mycoplasma Tuberculosis Complex, Pcr (Mayo)OutsideLaboratory",,87556,CPT,Facility,Both,,,90,414,351.9,118.6524,414,"Health Partners, Inc.",State of Minnesota Advantage Program,337.41,81.5,,percent of total billed charges,,
"Mycoplasma Tuberculosis Complex, Pcr (Mayo)OutsideLaboratory",,87556,CPT,Facility,Both,,,90,414,351.9,118.6524,414,"Health Partners, Inc.",State Public Programs,207,50,,percent of total billed charges,,
"Mycoplasma Tuberculosis Complex, Pcr (Mayo)OutsideLaboratory",,87556,CPT,Facility,Both,,,90,414,351.9,118.6524,414,Humana Insurance Company,Commercial PPO,393.3,95,,percent of total billed charges,,
"Mycoplasma Tuberculosis Complex, Pcr (Mayo)OutsideLaboratory",,87556,CPT,Facility,Outpatient,,,90,414,351.9,118.6524,414,Humana Insurance Company,Medicare PPO,202.86,49,,percent of total billed charges,,
"Mycoplasma Tuberculosis Complex, Pcr (Mayo)OutsideLaboratory",,87556,CPT,Facility,Inpatient,,,90,414,351.9,118.6524,414,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Mycoplasma Tuberculosis Complex, Pcr (Mayo)OutsideLaboratory",,87556,CPT,Facility,Both,,,90,414,351.9,118.6524,414,Medica,Individual & Family,410.274,99.1,,percent of total billed charges,,
"Mycoplasma Tuberculosis Complex, Pcr (Mayo)OutsideLaboratory",,87556,CPT,Facility,Outpatient,,,90,414,351.9,118.6524,414,Medica,Medica Advantage Solution,206.172,49.8,,percent of total billed charges,,
"Mycoplasma Tuberculosis Complex, Pcr (Mayo)OutsideLaboratory",,87556,CPT,Facility,Inpatient,,,90,414,351.9,118.6524,414,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Mycoplasma Tuberculosis Complex, Pcr (Mayo)OutsideLaboratory",,87556,CPT,Facility,Outpatient,,,90,414,351.9,118.6524,414,Medica,Medical Assistance,184.644,44.6,,percent of total billed charges,,
"Mycoplasma Tuberculosis Complex, Pcr (Mayo)OutsideLaboratory",,87556,CPT,Facility,Inpatient,,,90,414,351.9,118.6524,414,Medica,Medical Assistance,,,,,Included in per diem rate,
"Mycoplasma Tuberculosis Complex, Pcr (Mayo)OutsideLaboratory",,87556,CPT,Facility,Outpatient,,,90,414,351.9,118.6524,414,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,206.172,49.8,,percent of total billed charges,,
"Mycoplasma Tuberculosis Complex, Pcr (Mayo)OutsideLaboratory",,87556,CPT,Facility,Inpatient,,,90,414,351.9,118.6524,414,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Mycoplasma Tuberculosis Complex, Pcr (Mayo)OutsideLaboratory",,87556,CPT,Facility,Both,,,90,414,351.9,118.6524,414,"Multiplan, Inc.","Multiplan, Inc.",389.16,94,,percent of total billed charges,,
"Mycoplasma Tuberculosis Complex, Pcr (Mayo)OutsideLaboratory",,87556,CPT,Facility,Outpatient,,,90,414,351.9,118.6524,414,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,357.696,86.4,,percent of total billed charges,,
"Mycoplasma Tuberculosis Complex, Pcr (Mayo)OutsideLaboratory",,87556,CPT,Facility,Inpatient,,,90,414,351.9,118.6524,414,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Mycoplasma Tuberculosis Complex, Pcr (Mayo)OutsideLaboratory",,87556,CPT,Facility,Both,,,90,414,351.9,118.6524,414,"Preferred One Administrative Services, INC.",PPO,408.204,98.6,,percent of total billed charges,,
"Mycoplasma Tuberculosis Complex, Pcr (Mayo)OutsideLaboratory",,87556,CPT,Facility,Outpatient,,,90,414,351.9,118.6524,414,PrimeWest Health,Minnesota Senior Health Options (MSHO),213.003,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Mycoplasma Tuberculosis Complex, Pcr (Mayo)OutsideLaboratory",,87556,CPT,Facility,Inpatient,,,90,414,351.9,118.6524,414,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Mycoplasma Tuberculosis Complex, Pcr (Mayo)OutsideLaboratory",,87556,CPT,Facility,Outpatient,,,90,414,351.9,118.6524,414,PrimeWest Health,MinnesotaCare,212.6304,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Mycoplasma Tuberculosis Complex, Pcr (Mayo)OutsideLaboratory",,87556,CPT,Facility,Inpatient,,,90,414,351.9,118.6524,414,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Mycoplasma Tuberculosis Complex, Pcr (Mayo)OutsideLaboratory",,87556,CPT,Facility,Both,,,90,414,351.9,118.6524,414,Sanford Health Plan,Sanford Health Plan,380.88,92,,percent of total billed charges,,
"Mycoplasma Tuberculosis Complex, Pcr (Mayo)OutsideLaboratory",,87556,CPT,Facility,Outpatient,,,90,414,351.9,118.6524,414,"UCare Health, Inc.",Individual & Family Plan,233.289,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Mycoplasma Tuberculosis Complex, Pcr (Mayo)OutsideLaboratory",,87556,CPT,Facility,Inpatient,,,90,414,351.9,118.6524,414,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Mycoplasma Tuberculosis Complex, Pcr (Mayo)OutsideLaboratory",,87556,CPT,Facility,Outpatient,,,90,414,351.9,118.6524,414,"UCare Health, Inc.",Medical Assistance,208.9458,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Mycoplasma Tuberculosis Complex, Pcr (Mayo)OutsideLaboratory",,87556,CPT,Facility,Inpatient,,,90,414,351.9,118.6524,414,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Mycoplasma Tuberculosis Complex, Pcr (Mayo)OutsideLaboratory",,87556,CPT,Facility,Outpatient,,,90,414,351.9,118.6524,414,"UCare Health, Inc.",Medicare Advantage,208.9458,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Mycoplasma Tuberculosis Complex, Pcr (Mayo)OutsideLaboratory",,87556,CPT,Facility,Inpatient,,,90,414,351.9,118.6524,414,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Mycoplasma Tuberculosis Complex, Pcr (Mayo)OutsideLaboratory",,87556,CPT,Facility,Outpatient,,,90,414,351.9,118.6524,414,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),208.9458,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Mycoplasma Tuberculosis Complex, Pcr (Mayo)OutsideLaboratory",,87556,CPT,Facility,Inpatient,,,90,414,351.9,118.6524,414,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Mycoplasma Tuberculosis Complex, Pcr (Mayo)OutsideLaboratory",,87556,CPT,Facility,Both,,,90,414,351.9,118.6524,414,UnitedHealthcare,Individual & Family,389.16,94,,percent of total billed charges,,
"Mycoplasma Tuberculosis Complex, Pcr (Mayo)OutsideLaboratory",,87556,CPT,Facility,Outpatient,,,90,414,351.9,118.6524,414,UnitedHealthcare,Medicare Advantage,202.86,49,,percent of total billed charges,,
"Mycoplasma Tuberculosis Complex, Pcr (Mayo)OutsideLaboratory",,87556,CPT,Facility,Inpatient,,,90,414,351.9,118.6524,414,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Mycoplasma Tuberculosis Complex, Pcr (Mayo)OutsideLaboratory",,87556,CPT,Facility,Outpatient,,,90,414,351.9,118.6524,414,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,198.72,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Mycoplasma Tuberculosis Complex, Pcr (Mayo)OutsideLaboratory",,87556,CPT,Facility,Inpatient,,,90,414,351.9,118.6524,414,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Covid-19/Sars-Cov2, Pcr (Covoo) (Mayo)OutsideLaboratory",,87635,CPT,Facility,Both,,,90,172,146.2,49.2952,172,Aetna,Commercial,158.24,92,,percent of total billed charges,,
"Covid-19/Sars-Cov2, Pcr (Covoo) (Mayo)OutsideLaboratory",,87635,CPT,Facility,Outpatient,,,90,172,146.2,49.2952,172,Aetna,Medicare Advantage,84.28,49,,percent of total billed charges,,
"Covid-19/Sars-Cov2, Pcr (Covoo) (Mayo)OutsideLaboratory",,87635,CPT,Facility,Inpatient,,,90,172,146.2,49.2952,172,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Covid-19/Sars-Cov2, Pcr (Covoo) (Mayo)OutsideLaboratory",,87635,CPT,Facility,Both,,,90,172,146.2,49.2952,172,Aetna,PPO,159.96,93,,percent of total billed charges,,
"Covid-19/Sars-Cov2, Pcr (Covoo) (Mayo)OutsideLaboratory",,87635,CPT,Facility,Both,,,90,172,146.2,49.2952,172,America's PPO,America's PPO,165.1716,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Covid-19/Sars-Cov2, Pcr (Covoo) (Mayo)OutsideLaboratory",,87635,CPT,Facility,Both,,,90,172,146.2,49.2952,172,BlueCross BlueShield Minnesota, Federal Employee Program,169.248,98.4,,percent of total billed charges,,
"Covid-19/Sars-Cov2, Pcr (Covoo) (Mayo)OutsideLaboratory",,87635,CPT,Facility,Both,,,90,172,146.2,49.2952,172,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,172,100,,percent of total billed charges,,
"Covid-19/Sars-Cov2, Pcr (Covoo) (Mayo)OutsideLaboratory",,87635,CPT,Facility,Both,,,90,172,146.2,49.2952,172,BlueCross BlueShield Minnesota,High Value Network Plan,154.8,90,,percent of total billed charges,,
"Covid-19/Sars-Cov2, Pcr (Covoo) (Mayo)OutsideLaboratory",,87635,CPT,Facility,Outpatient,,,90,172,146.2,49.2952,172,BlueCross BlueShield Minnesota,Medicare Advantage,84.28,49,,percent of total billed charges,,
"Covid-19/Sars-Cov2, Pcr (Covoo) (Mayo)OutsideLaboratory",,87635,CPT,Facility,Inpatient,,,90,172,146.2,49.2952,172,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Covid-19/Sars-Cov2, Pcr (Covoo) (Mayo)OutsideLaboratory",,87635,CPT,Facility,Both,,,90,172,146.2,49.2952,172,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,152.3404,88.57,,percent of total billed charges,,
"Covid-19/Sars-Cov2, Pcr (Covoo) (Mayo)OutsideLaboratory",,87635,CPT,Facility,Both,,,90,172,146.2,49.2952,172,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,49.2952,28.66,,percent of total billed charges,,
"Covid-19/Sars-Cov2, Pcr (Covoo) (Mayo)OutsideLaboratory",,87635,CPT,Facility,Outpatient,,,90,172,146.2,49.2952,172,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),84.28,49,,percent of total billed charges,,
"Covid-19/Sars-Cov2, Pcr (Covoo) (Mayo)OutsideLaboratory",,87635,CPT,Facility,Inpatient,,,90,172,146.2,49.2952,172,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Covid-19/Sars-Cov2, Pcr (Covoo) (Mayo)OutsideLaboratory",,87635,CPT,Facility,Both,,,90,172,146.2,49.2952,172,CorVel,Worker's Compensation,172,100,,percent of total billed charges,,
"Covid-19/Sars-Cov2, Pcr (Covoo) (Mayo)OutsideLaboratory",,87635,CPT,Facility,Both,,,90,172,146.2,49.2952,172,First Health Group Corporation,First Health Network,166.84,97,,percent of total billed charges,,
"Covid-19/Sars-Cov2, Pcr (Covoo) (Mayo)OutsideLaboratory",,87635,CPT,Facility,Both,,,90,172,146.2,49.2952,172,"Health Partners, Inc.",Commercial,162.712,94.6,,percent of total billed charges,,
"Covid-19/Sars-Cov2, Pcr (Covoo) (Mayo)OutsideLaboratory",,87635,CPT,Facility,Outpatient,,,90,172,146.2,49.2952,172,"Health Partners, Inc.",Medicare Advantage,84.28,49,,percent of total billed charges,,
"Covid-19/Sars-Cov2, Pcr (Covoo) (Mayo)OutsideLaboratory",,87635,CPT,Facility,Inpatient,,,90,172,146.2,49.2952,172,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Covid-19/Sars-Cov2, Pcr (Covoo) (Mayo)OutsideLaboratory",,87635,CPT,Facility,Both,,,90,172,146.2,49.2952,172,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),103.2,60,,percent of total billed charges,,
"Covid-19/Sars-Cov2, Pcr (Covoo) (Mayo)OutsideLaboratory",,87635,CPT,Facility,Both,,,90,172,146.2,49.2952,172,"Health Partners, Inc.",State of Minnesota Advantage Program,140.18,81.5,,percent of total billed charges,,
"Covid-19/Sars-Cov2, Pcr (Covoo) (Mayo)OutsideLaboratory",,87635,CPT,Facility,Both,,,90,172,146.2,49.2952,172,"Health Partners, Inc.",State Public Programs,86,50,,percent of total billed charges,,
"Covid-19/Sars-Cov2, Pcr (Covoo) (Mayo)OutsideLaboratory",,87635,CPT,Facility,Both,,,90,172,146.2,49.2952,172,Humana Insurance Company,Commercial PPO,163.4,95,,percent of total billed charges,,
"Covid-19/Sars-Cov2, Pcr (Covoo) (Mayo)OutsideLaboratory",,87635,CPT,Facility,Outpatient,,,90,172,146.2,49.2952,172,Humana Insurance Company,Medicare PPO,84.28,49,,percent of total billed charges,,
"Covid-19/Sars-Cov2, Pcr (Covoo) (Mayo)OutsideLaboratory",,87635,CPT,Facility,Inpatient,,,90,172,146.2,49.2952,172,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Covid-19/Sars-Cov2, Pcr (Covoo) (Mayo)OutsideLaboratory",,87635,CPT,Facility,Both,,,90,172,146.2,49.2952,172,Medica,Individual & Family,170.452,99.1,,percent of total billed charges,,
"Covid-19/Sars-Cov2, Pcr (Covoo) (Mayo)OutsideLaboratory",,87635,CPT,Facility,Outpatient,,,90,172,146.2,49.2952,172,Medica,Medica Advantage Solution,85.656,49.8,,percent of total billed charges,,
"Covid-19/Sars-Cov2, Pcr (Covoo) (Mayo)OutsideLaboratory",,87635,CPT,Facility,Inpatient,,,90,172,146.2,49.2952,172,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Covid-19/Sars-Cov2, Pcr (Covoo) (Mayo)OutsideLaboratory",,87635,CPT,Facility,Outpatient,,,90,172,146.2,49.2952,172,Medica,Medical Assistance,76.712,44.6,,percent of total billed charges,,
"Covid-19/Sars-Cov2, Pcr (Covoo) (Mayo)OutsideLaboratory",,87635,CPT,Facility,Inpatient,,,90,172,146.2,49.2952,172,Medica,Medical Assistance,,,,,Included in per diem rate,
"Covid-19/Sars-Cov2, Pcr (Covoo) (Mayo)OutsideLaboratory",,87635,CPT,Facility,Outpatient,,,90,172,146.2,49.2952,172,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,85.656,49.8,,percent of total billed charges,,
"Covid-19/Sars-Cov2, Pcr (Covoo) (Mayo)OutsideLaboratory",,87635,CPT,Facility,Inpatient,,,90,172,146.2,49.2952,172,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Covid-19/Sars-Cov2, Pcr (Covoo) (Mayo)OutsideLaboratory",,87635,CPT,Facility,Both,,,90,172,146.2,49.2952,172,"Multiplan, Inc.","Multiplan, Inc.",161.68,94,,percent of total billed charges,,
"Covid-19/Sars-Cov2, Pcr (Covoo) (Mayo)OutsideLaboratory",,87635,CPT,Facility,Outpatient,,,90,172,146.2,49.2952,172,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,148.608,86.4,,percent of total billed charges,,
"Covid-19/Sars-Cov2, Pcr (Covoo) (Mayo)OutsideLaboratory",,87635,CPT,Facility,Inpatient,,,90,172,146.2,49.2952,172,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Covid-19/Sars-Cov2, Pcr (Covoo) (Mayo)OutsideLaboratory",,87635,CPT,Facility,Both,,,90,172,146.2,49.2952,172,"Preferred One Administrative Services, INC.",PPO,169.592,98.6,,percent of total billed charges,,
"Covid-19/Sars-Cov2, Pcr (Covoo) (Mayo)OutsideLaboratory",,87635,CPT,Facility,Outpatient,,,90,172,146.2,49.2952,172,PrimeWest Health,Minnesota Senior Health Options (MSHO),88.494,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Covid-19/Sars-Cov2, Pcr (Covoo) (Mayo)OutsideLaboratory",,87635,CPT,Facility,Inpatient,,,90,172,146.2,49.2952,172,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Covid-19/Sars-Cov2, Pcr (Covoo) (Mayo)OutsideLaboratory",,87635,CPT,Facility,Outpatient,,,90,172,146.2,49.2952,172,PrimeWest Health,MinnesotaCare,88.3392,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Covid-19/Sars-Cov2, Pcr (Covoo) (Mayo)OutsideLaboratory",,87635,CPT,Facility,Inpatient,,,90,172,146.2,49.2952,172,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Covid-19/Sars-Cov2, Pcr (Covoo) (Mayo)OutsideLaboratory",,87635,CPT,Facility,Both,,,90,172,146.2,49.2952,172,Sanford Health Plan,Sanford Health Plan,158.24,92,,percent of total billed charges,,
"Covid-19/Sars-Cov2, Pcr (Covoo) (Mayo)OutsideLaboratory",,87635,CPT,Facility,Outpatient,,,90,172,146.2,49.2952,172,"UCare Health, Inc.",Individual & Family Plan,96.922,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Covid-19/Sars-Cov2, Pcr (Covoo) (Mayo)OutsideLaboratory",,87635,CPT,Facility,Inpatient,,,90,172,146.2,49.2952,172,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Covid-19/Sars-Cov2, Pcr (Covoo) (Mayo)OutsideLaboratory",,87635,CPT,Facility,Outpatient,,,90,172,146.2,49.2952,172,"UCare Health, Inc.",Medical Assistance,86.8084,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Covid-19/Sars-Cov2, Pcr (Covoo) (Mayo)OutsideLaboratory",,87635,CPT,Facility,Inpatient,,,90,172,146.2,49.2952,172,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Covid-19/Sars-Cov2, Pcr (Covoo) (Mayo)OutsideLaboratory",,87635,CPT,Facility,Outpatient,,,90,172,146.2,49.2952,172,"UCare Health, Inc.",Medicare Advantage,86.8084,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Covid-19/Sars-Cov2, Pcr (Covoo) (Mayo)OutsideLaboratory",,87635,CPT,Facility,Inpatient,,,90,172,146.2,49.2952,172,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Covid-19/Sars-Cov2, Pcr (Covoo) (Mayo)OutsideLaboratory",,87635,CPT,Facility,Outpatient,,,90,172,146.2,49.2952,172,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),86.8084,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Covid-19/Sars-Cov2, Pcr (Covoo) (Mayo)OutsideLaboratory",,87635,CPT,Facility,Inpatient,,,90,172,146.2,49.2952,172,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Covid-19/Sars-Cov2, Pcr (Covoo) (Mayo)OutsideLaboratory",,87635,CPT,Facility,Both,,,90,172,146.2,49.2952,172,UnitedHealthcare,Individual & Family,161.68,94,,percent of total billed charges,,
"Covid-19/Sars-Cov2, Pcr (Covoo) (Mayo)OutsideLaboratory",,87635,CPT,Facility,Outpatient,,,90,172,146.2,49.2952,172,UnitedHealthcare,Medicare Advantage,84.28,49,,percent of total billed charges,,
"Covid-19/Sars-Cov2, Pcr (Covoo) (Mayo)OutsideLaboratory",,87635,CPT,Facility,Inpatient,,,90,172,146.2,49.2952,172,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Covid-19/Sars-Cov2, Pcr (Covoo) (Mayo)OutsideLaboratory",,87635,CPT,Facility,Outpatient,,,90,172,146.2,49.2952,172,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,82.56,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Covid-19/Sars-Cov2, Pcr (Covoo) (Mayo)OutsideLaboratory",,87635,CPT,Facility,Inpatient,,,90,172,146.2,49.2952,172,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Bordetella Pertussis And Bordetella Parapertussis, Pcr (Mayo)OutsideLaboratory",,87798,CPT,Facility,Both,,,90,248,210.8,71.0768,248,Aetna,Commercial,228.16,92,,percent of total billed charges,,
"Bordetella Pertussis And Bordetella Parapertussis, Pcr (Mayo)OutsideLaboratory",,87798,CPT,Facility,Outpatient,,,90,248,210.8,71.0768,248,Aetna,Medicare Advantage,121.52,49,,percent of total billed charges,,
"Bordetella Pertussis And Bordetella Parapertussis, Pcr (Mayo)OutsideLaboratory",,87798,CPT,Facility,Inpatient,,,90,248,210.8,71.0768,248,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Bordetella Pertussis And Bordetella Parapertussis, Pcr (Mayo)OutsideLaboratory",,87798,CPT,Facility,Both,,,90,248,210.8,71.0768,248,Aetna,PPO,230.64,93,,percent of total billed charges,,
"Bordetella Pertussis And Bordetella Parapertussis, Pcr (Mayo)OutsideLaboratory",,87798,CPT,Facility,Both,,,90,248,210.8,71.0768,248,America's PPO,America's PPO,238.1544,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Bordetella Pertussis And Bordetella Parapertussis, Pcr (Mayo)OutsideLaboratory",,87798,CPT,Facility,Both,,,90,248,210.8,71.0768,248,BlueCross BlueShield Minnesota, Federal Employee Program,244.032,98.4,,percent of total billed charges,,
"Bordetella Pertussis And Bordetella Parapertussis, Pcr (Mayo)OutsideLaboratory",,87798,CPT,Facility,Both,,,90,248,210.8,71.0768,248,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,248,100,,percent of total billed charges,,
"Bordetella Pertussis And Bordetella Parapertussis, Pcr (Mayo)OutsideLaboratory",,87798,CPT,Facility,Both,,,90,248,210.8,71.0768,248,BlueCross BlueShield Minnesota,High Value Network Plan,223.2,90,,percent of total billed charges,,
"Bordetella Pertussis And Bordetella Parapertussis, Pcr (Mayo)OutsideLaboratory",,87798,CPT,Facility,Outpatient,,,90,248,210.8,71.0768,248,BlueCross BlueShield Minnesota,Medicare Advantage,121.52,49,,percent of total billed charges,,
"Bordetella Pertussis And Bordetella Parapertussis, Pcr (Mayo)OutsideLaboratory",,87798,CPT,Facility,Inpatient,,,90,248,210.8,71.0768,248,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Bordetella Pertussis And Bordetella Parapertussis, Pcr (Mayo)OutsideLaboratory",,87798,CPT,Facility,Both,,,90,248,210.8,71.0768,248,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,219.6536,88.57,,percent of total billed charges,,
"Bordetella Pertussis And Bordetella Parapertussis, Pcr (Mayo)OutsideLaboratory",,87798,CPT,Facility,Both,,,90,248,210.8,71.0768,248,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,71.0768,28.66,,percent of total billed charges,,
"Bordetella Pertussis And Bordetella Parapertussis, Pcr (Mayo)OutsideLaboratory",,87798,CPT,Facility,Outpatient,,,90,248,210.8,71.0768,248,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),121.52,49,,percent of total billed charges,,
"Bordetella Pertussis And Bordetella Parapertussis, Pcr (Mayo)OutsideLaboratory",,87798,CPT,Facility,Inpatient,,,90,248,210.8,71.0768,248,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Bordetella Pertussis And Bordetella Parapertussis, Pcr (Mayo)OutsideLaboratory",,87798,CPT,Facility,Both,,,90,248,210.8,71.0768,248,CorVel,Worker's Compensation,248,100,,percent of total billed charges,,
"Bordetella Pertussis And Bordetella Parapertussis, Pcr (Mayo)OutsideLaboratory",,87798,CPT,Facility,Both,,,90,248,210.8,71.0768,248,First Health Group Corporation,First Health Network,240.56,97,,percent of total billed charges,,
"Bordetella Pertussis And Bordetella Parapertussis, Pcr (Mayo)OutsideLaboratory",,87798,CPT,Facility,Both,,,90,248,210.8,71.0768,248,"Health Partners, Inc.",Commercial,234.608,94.6,,percent of total billed charges,,
"Bordetella Pertussis And Bordetella Parapertussis, Pcr (Mayo)OutsideLaboratory",,87798,CPT,Facility,Outpatient,,,90,248,210.8,71.0768,248,"Health Partners, Inc.",Medicare Advantage,121.52,49,,percent of total billed charges,,
"Bordetella Pertussis And Bordetella Parapertussis, Pcr (Mayo)OutsideLaboratory",,87798,CPT,Facility,Inpatient,,,90,248,210.8,71.0768,248,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Bordetella Pertussis And Bordetella Parapertussis, Pcr (Mayo)OutsideLaboratory",,87798,CPT,Facility,Both,,,90,248,210.8,71.0768,248,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),148.8,60,,percent of total billed charges,,
"Bordetella Pertussis And Bordetella Parapertussis, Pcr (Mayo)OutsideLaboratory",,87798,CPT,Facility,Both,,,90,248,210.8,71.0768,248,"Health Partners, Inc.",State of Minnesota Advantage Program,202.12,81.5,,percent of total billed charges,,
"Bordetella Pertussis And Bordetella Parapertussis, Pcr (Mayo)OutsideLaboratory",,87798,CPT,Facility,Both,,,90,248,210.8,71.0768,248,"Health Partners, Inc.",State Public Programs,124,50,,percent of total billed charges,,
"Bordetella Pertussis And Bordetella Parapertussis, Pcr (Mayo)OutsideLaboratory",,87798,CPT,Facility,Both,,,90,248,210.8,71.0768,248,Humana Insurance Company,Commercial PPO,235.6,95,,percent of total billed charges,,
"Bordetella Pertussis And Bordetella Parapertussis, Pcr (Mayo)OutsideLaboratory",,87798,CPT,Facility,Outpatient,,,90,248,210.8,71.0768,248,Humana Insurance Company,Medicare PPO,121.52,49,,percent of total billed charges,,
"Bordetella Pertussis And Bordetella Parapertussis, Pcr (Mayo)OutsideLaboratory",,87798,CPT,Facility,Inpatient,,,90,248,210.8,71.0768,248,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Bordetella Pertussis And Bordetella Parapertussis, Pcr (Mayo)OutsideLaboratory",,87798,CPT,Facility,Both,,,90,248,210.8,71.0768,248,Medica,Individual & Family,245.768,99.1,,percent of total billed charges,,
"Bordetella Pertussis And Bordetella Parapertussis, Pcr (Mayo)OutsideLaboratory",,87798,CPT,Facility,Outpatient,,,90,248,210.8,71.0768,248,Medica,Medica Advantage Solution,123.504,49.8,,percent of total billed charges,,
"Bordetella Pertussis And Bordetella Parapertussis, Pcr (Mayo)OutsideLaboratory",,87798,CPT,Facility,Inpatient,,,90,248,210.8,71.0768,248,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Bordetella Pertussis And Bordetella Parapertussis, Pcr (Mayo)OutsideLaboratory",,87798,CPT,Facility,Outpatient,,,90,248,210.8,71.0768,248,Medica,Medical Assistance,110.608,44.6,,percent of total billed charges,,
"Bordetella Pertussis And Bordetella Parapertussis, Pcr (Mayo)OutsideLaboratory",,87798,CPT,Facility,Inpatient,,,90,248,210.8,71.0768,248,Medica,Medical Assistance,,,,,Included in per diem rate,
"Bordetella Pertussis And Bordetella Parapertussis, Pcr (Mayo)OutsideLaboratory",,87798,CPT,Facility,Outpatient,,,90,248,210.8,71.0768,248,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,123.504,49.8,,percent of total billed charges,,
"Bordetella Pertussis And Bordetella Parapertussis, Pcr (Mayo)OutsideLaboratory",,87798,CPT,Facility,Inpatient,,,90,248,210.8,71.0768,248,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Bordetella Pertussis And Bordetella Parapertussis, Pcr (Mayo)OutsideLaboratory",,87798,CPT,Facility,Both,,,90,248,210.8,71.0768,248,"Multiplan, Inc.","Multiplan, Inc.",233.12,94,,percent of total billed charges,,
"Bordetella Pertussis And Bordetella Parapertussis, Pcr (Mayo)OutsideLaboratory",,87798,CPT,Facility,Outpatient,,,90,248,210.8,71.0768,248,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,214.272,86.4,,percent of total billed charges,,
"Bordetella Pertussis And Bordetella Parapertussis, Pcr (Mayo)OutsideLaboratory",,87798,CPT,Facility,Inpatient,,,90,248,210.8,71.0768,248,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Bordetella Pertussis And Bordetella Parapertussis, Pcr (Mayo)OutsideLaboratory",,87798,CPT,Facility,Both,,,90,248,210.8,71.0768,248,"Preferred One Administrative Services, INC.",PPO,244.528,98.6,,percent of total billed charges,,
"Bordetella Pertussis And Bordetella Parapertussis, Pcr (Mayo)OutsideLaboratory",,87798,CPT,Facility,Outpatient,,,90,248,210.8,71.0768,248,PrimeWest Health,Minnesota Senior Health Options (MSHO),127.596,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Bordetella Pertussis And Bordetella Parapertussis, Pcr (Mayo)OutsideLaboratory",,87798,CPT,Facility,Inpatient,,,90,248,210.8,71.0768,248,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Bordetella Pertussis And Bordetella Parapertussis, Pcr (Mayo)OutsideLaboratory",,87798,CPT,Facility,Outpatient,,,90,248,210.8,71.0768,248,PrimeWest Health,MinnesotaCare,127.3728,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Bordetella Pertussis And Bordetella Parapertussis, Pcr (Mayo)OutsideLaboratory",,87798,CPT,Facility,Inpatient,,,90,248,210.8,71.0768,248,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Bordetella Pertussis And Bordetella Parapertussis, Pcr (Mayo)OutsideLaboratory",,87798,CPT,Facility,Both,,,90,248,210.8,71.0768,248,Sanford Health Plan,Sanford Health Plan,228.16,92,,percent of total billed charges,,
"Bordetella Pertussis And Bordetella Parapertussis, Pcr (Mayo)OutsideLaboratory",,87798,CPT,Facility,Outpatient,,,90,248,210.8,71.0768,248,"UCare Health, Inc.",Individual & Family Plan,139.748,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Bordetella Pertussis And Bordetella Parapertussis, Pcr (Mayo)OutsideLaboratory",,87798,CPT,Facility,Inpatient,,,90,248,210.8,71.0768,248,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Bordetella Pertussis And Bordetella Parapertussis, Pcr (Mayo)OutsideLaboratory",,87798,CPT,Facility,Outpatient,,,90,248,210.8,71.0768,248,"UCare Health, Inc.",Medical Assistance,125.1656,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Bordetella Pertussis And Bordetella Parapertussis, Pcr (Mayo)OutsideLaboratory",,87798,CPT,Facility,Inpatient,,,90,248,210.8,71.0768,248,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Bordetella Pertussis And Bordetella Parapertussis, Pcr (Mayo)OutsideLaboratory",,87798,CPT,Facility,Outpatient,,,90,248,210.8,71.0768,248,"UCare Health, Inc.",Medicare Advantage,125.1656,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Bordetella Pertussis And Bordetella Parapertussis, Pcr (Mayo)OutsideLaboratory",,87798,CPT,Facility,Inpatient,,,90,248,210.8,71.0768,248,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Bordetella Pertussis And Bordetella Parapertussis, Pcr (Mayo)OutsideLaboratory",,87798,CPT,Facility,Outpatient,,,90,248,210.8,71.0768,248,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),125.1656,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Bordetella Pertussis And Bordetella Parapertussis, Pcr (Mayo)OutsideLaboratory",,87798,CPT,Facility,Inpatient,,,90,248,210.8,71.0768,248,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Bordetella Pertussis And Bordetella Parapertussis, Pcr (Mayo)OutsideLaboratory",,87798,CPT,Facility,Both,,,90,248,210.8,71.0768,248,UnitedHealthcare,Individual & Family,233.12,94,,percent of total billed charges,,
"Bordetella Pertussis And Bordetella Parapertussis, Pcr (Mayo)OutsideLaboratory",,87798,CPT,Facility,Outpatient,,,90,248,210.8,71.0768,248,UnitedHealthcare,Medicare Advantage,121.52,49,,percent of total billed charges,,
"Bordetella Pertussis And Bordetella Parapertussis, Pcr (Mayo)OutsideLaboratory",,87798,CPT,Facility,Inpatient,,,90,248,210.8,71.0768,248,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Bordetella Pertussis And Bordetella Parapertussis, Pcr (Mayo)OutsideLaboratory",,87798,CPT,Facility,Outpatient,,,90,248,210.8,71.0768,248,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,119.04,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Bordetella Pertussis And Bordetella Parapertussis, Pcr (Mayo)OutsideLaboratory",,87798,CPT,Facility,Inpatient,,,90,248,210.8,71.0768,248,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Epstein-Barr Virus Pcr (Mayo)OutsideLaboratory,,87798,CPT,Facility,Both,,,90,259,220.15,74.2294,259,Aetna,Commercial,238.28,92,,percent of total billed charges,,
Epstein-Barr Virus Pcr (Mayo)OutsideLaboratory,,87798,CPT,Facility,Outpatient,,,90,259,220.15,74.2294,259,Aetna,Medicare Advantage,126.91,49,,percent of total billed charges,,
Epstein-Barr Virus Pcr (Mayo)OutsideLaboratory,,87798,CPT,Facility,Inpatient,,,90,259,220.15,74.2294,259,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Epstein-Barr Virus Pcr (Mayo)OutsideLaboratory,,87798,CPT,Facility,Both,,,90,259,220.15,74.2294,259,Aetna,PPO,240.87,93,,percent of total billed charges,,
Epstein-Barr Virus Pcr (Mayo)OutsideLaboratory,,87798,CPT,Facility,Both,,,90,259,220.15,74.2294,259,America's PPO,America's PPO,248.7177,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Epstein-Barr Virus Pcr (Mayo)OutsideLaboratory,,87798,CPT,Facility,Both,,,90,259,220.15,74.2294,259,BlueCross BlueShield Minnesota, Federal Employee Program,254.856,98.4,,percent of total billed charges,,
Epstein-Barr Virus Pcr (Mayo)OutsideLaboratory,,87798,CPT,Facility,Both,,,90,259,220.15,74.2294,259,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,259,100,,percent of total billed charges,,
Epstein-Barr Virus Pcr (Mayo)OutsideLaboratory,,87798,CPT,Facility,Both,,,90,259,220.15,74.2294,259,BlueCross BlueShield Minnesota,High Value Network Plan,233.1,90,,percent of total billed charges,,
Epstein-Barr Virus Pcr (Mayo)OutsideLaboratory,,87798,CPT,Facility,Outpatient,,,90,259,220.15,74.2294,259,BlueCross BlueShield Minnesota,Medicare Advantage,126.91,49,,percent of total billed charges,,
Epstein-Barr Virus Pcr (Mayo)OutsideLaboratory,,87798,CPT,Facility,Inpatient,,,90,259,220.15,74.2294,259,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Epstein-Barr Virus Pcr (Mayo)OutsideLaboratory,,87798,CPT,Facility,Both,,,90,259,220.15,74.2294,259,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,229.3963,88.57,,percent of total billed charges,,
Epstein-Barr Virus Pcr (Mayo)OutsideLaboratory,,87798,CPT,Facility,Both,,,90,259,220.15,74.2294,259,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,74.2294,28.66,,percent of total billed charges,,
Epstein-Barr Virus Pcr (Mayo)OutsideLaboratory,,87798,CPT,Facility,Outpatient,,,90,259,220.15,74.2294,259,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),126.91,49,,percent of total billed charges,,
Epstein-Barr Virus Pcr (Mayo)OutsideLaboratory,,87798,CPT,Facility,Inpatient,,,90,259,220.15,74.2294,259,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Epstein-Barr Virus Pcr (Mayo)OutsideLaboratory,,87798,CPT,Facility,Both,,,90,259,220.15,74.2294,259,CorVel,Worker's Compensation,259,100,,percent of total billed charges,,
Epstein-Barr Virus Pcr (Mayo)OutsideLaboratory,,87798,CPT,Facility,Both,,,90,259,220.15,74.2294,259,First Health Group Corporation,First Health Network,251.23,97,,percent of total billed charges,,
Epstein-Barr Virus Pcr (Mayo)OutsideLaboratory,,87798,CPT,Facility,Both,,,90,259,220.15,74.2294,259,"Health Partners, Inc.",Commercial,245.014,94.6,,percent of total billed charges,,
Epstein-Barr Virus Pcr (Mayo)OutsideLaboratory,,87798,CPT,Facility,Outpatient,,,90,259,220.15,74.2294,259,"Health Partners, Inc.",Medicare Advantage,126.91,49,,percent of total billed charges,,
Epstein-Barr Virus Pcr (Mayo)OutsideLaboratory,,87798,CPT,Facility,Inpatient,,,90,259,220.15,74.2294,259,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Epstein-Barr Virus Pcr (Mayo)OutsideLaboratory,,87798,CPT,Facility,Both,,,90,259,220.15,74.2294,259,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),155.4,60,,percent of total billed charges,,
Epstein-Barr Virus Pcr (Mayo)OutsideLaboratory,,87798,CPT,Facility,Both,,,90,259,220.15,74.2294,259,"Health Partners, Inc.",State of Minnesota Advantage Program,211.085,81.5,,percent of total billed charges,,
Epstein-Barr Virus Pcr (Mayo)OutsideLaboratory,,87798,CPT,Facility,Both,,,90,259,220.15,74.2294,259,"Health Partners, Inc.",State Public Programs,129.5,50,,percent of total billed charges,,
Epstein-Barr Virus Pcr (Mayo)OutsideLaboratory,,87798,CPT,Facility,Both,,,90,259,220.15,74.2294,259,Humana Insurance Company,Commercial PPO,246.05,95,,percent of total billed charges,,
Epstein-Barr Virus Pcr (Mayo)OutsideLaboratory,,87798,CPT,Facility,Outpatient,,,90,259,220.15,74.2294,259,Humana Insurance Company,Medicare PPO,126.91,49,,percent of total billed charges,,
Epstein-Barr Virus Pcr (Mayo)OutsideLaboratory,,87798,CPT,Facility,Inpatient,,,90,259,220.15,74.2294,259,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Epstein-Barr Virus Pcr (Mayo)OutsideLaboratory,,87798,CPT,Facility,Both,,,90,259,220.15,74.2294,259,Medica,Individual & Family,256.669,99.1,,percent of total billed charges,,
Epstein-Barr Virus Pcr (Mayo)OutsideLaboratory,,87798,CPT,Facility,Outpatient,,,90,259,220.15,74.2294,259,Medica,Medica Advantage Solution,128.982,49.8,,percent of total billed charges,,
Epstein-Barr Virus Pcr (Mayo)OutsideLaboratory,,87798,CPT,Facility,Inpatient,,,90,259,220.15,74.2294,259,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Epstein-Barr Virus Pcr (Mayo)OutsideLaboratory,,87798,CPT,Facility,Outpatient,,,90,259,220.15,74.2294,259,Medica,Medical Assistance,115.514,44.6,,percent of total billed charges,,
Epstein-Barr Virus Pcr (Mayo)OutsideLaboratory,,87798,CPT,Facility,Inpatient,,,90,259,220.15,74.2294,259,Medica,Medical Assistance,,,,,Included in per diem rate,
Epstein-Barr Virus Pcr (Mayo)OutsideLaboratory,,87798,CPT,Facility,Outpatient,,,90,259,220.15,74.2294,259,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,128.982,49.8,,percent of total billed charges,,
Epstein-Barr Virus Pcr (Mayo)OutsideLaboratory,,87798,CPT,Facility,Inpatient,,,90,259,220.15,74.2294,259,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Epstein-Barr Virus Pcr (Mayo)OutsideLaboratory,,87798,CPT,Facility,Both,,,90,259,220.15,74.2294,259,"Multiplan, Inc.","Multiplan, Inc.",243.46,94,,percent of total billed charges,,
Epstein-Barr Virus Pcr (Mayo)OutsideLaboratory,,87798,CPT,Facility,Outpatient,,,90,259,220.15,74.2294,259,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,223.776,86.4,,percent of total billed charges,,
Epstein-Barr Virus Pcr (Mayo)OutsideLaboratory,,87798,CPT,Facility,Inpatient,,,90,259,220.15,74.2294,259,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Epstein-Barr Virus Pcr (Mayo)OutsideLaboratory,,87798,CPT,Facility,Both,,,90,259,220.15,74.2294,259,"Preferred One Administrative Services, INC.",PPO,255.374,98.6,,percent of total billed charges,,
Epstein-Barr Virus Pcr (Mayo)OutsideLaboratory,,87798,CPT,Facility,Outpatient,,,90,259,220.15,74.2294,259,PrimeWest Health,Minnesota Senior Health Options (MSHO),133.2555,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Epstein-Barr Virus Pcr (Mayo)OutsideLaboratory,,87798,CPT,Facility,Inpatient,,,90,259,220.15,74.2294,259,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Epstein-Barr Virus Pcr (Mayo)OutsideLaboratory,,87798,CPT,Facility,Outpatient,,,90,259,220.15,74.2294,259,PrimeWest Health,MinnesotaCare,133.0224,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Epstein-Barr Virus Pcr (Mayo)OutsideLaboratory,,87798,CPT,Facility,Inpatient,,,90,259,220.15,74.2294,259,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Epstein-Barr Virus Pcr (Mayo)OutsideLaboratory,,87798,CPT,Facility,Both,,,90,259,220.15,74.2294,259,Sanford Health Plan,Sanford Health Plan,238.28,92,,percent of total billed charges,,
Epstein-Barr Virus Pcr (Mayo)OutsideLaboratory,,87798,CPT,Facility,Outpatient,,,90,259,220.15,74.2294,259,"UCare Health, Inc.",Individual & Family Plan,145.9465,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Epstein-Barr Virus Pcr (Mayo)OutsideLaboratory,,87798,CPT,Facility,Inpatient,,,90,259,220.15,74.2294,259,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Epstein-Barr Virus Pcr (Mayo)OutsideLaboratory,,87798,CPT,Facility,Outpatient,,,90,259,220.15,74.2294,259,"UCare Health, Inc.",Medical Assistance,130.7173,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Epstein-Barr Virus Pcr (Mayo)OutsideLaboratory,,87798,CPT,Facility,Inpatient,,,90,259,220.15,74.2294,259,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Epstein-Barr Virus Pcr (Mayo)OutsideLaboratory,,87798,CPT,Facility,Outpatient,,,90,259,220.15,74.2294,259,"UCare Health, Inc.",Medicare Advantage,130.7173,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Epstein-Barr Virus Pcr (Mayo)OutsideLaboratory,,87798,CPT,Facility,Inpatient,,,90,259,220.15,74.2294,259,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Epstein-Barr Virus Pcr (Mayo)OutsideLaboratory,,87798,CPT,Facility,Outpatient,,,90,259,220.15,74.2294,259,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),130.7173,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Epstein-Barr Virus Pcr (Mayo)OutsideLaboratory,,87798,CPT,Facility,Inpatient,,,90,259,220.15,74.2294,259,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Epstein-Barr Virus Pcr (Mayo)OutsideLaboratory,,87798,CPT,Facility,Both,,,90,259,220.15,74.2294,259,UnitedHealthcare,Individual & Family,243.46,94,,percent of total billed charges,,
Epstein-Barr Virus Pcr (Mayo)OutsideLaboratory,,87798,CPT,Facility,Outpatient,,,90,259,220.15,74.2294,259,UnitedHealthcare,Medicare Advantage,126.91,49,,percent of total billed charges,,
Epstein-Barr Virus Pcr (Mayo)OutsideLaboratory,,87798,CPT,Facility,Inpatient,,,90,259,220.15,74.2294,259,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Epstein-Barr Virus Pcr (Mayo)OutsideLaboratory,,87798,CPT,Facility,Outpatient,,,90,259,220.15,74.2294,259,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,124.32,48,,percent of total billed charges,,100% of DHS outpatient percentage
Epstein-Barr Virus Pcr (Mayo)OutsideLaboratory,,87798,CPT,Facility,Inpatient,,,90,259,220.15,74.2294,259,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Infectious Agent Detection By Nucleic Acid, Not Other Specified; Amplified Probe Tech, Each Organism (Mayo)OutsideLaboratory",,87798,CPT,Facility,Both,,,90,355,301.75,101.743,355,Aetna,Commercial,326.6,92,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid, Not Other Specified; Amplified Probe Tech, Each Organism (Mayo)OutsideLaboratory",,87798,CPT,Facility,Outpatient,,,90,355,301.75,101.743,355,Aetna,Medicare Advantage,173.95,49,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid, Not Other Specified; Amplified Probe Tech, Each Organism (Mayo)OutsideLaboratory",,87798,CPT,Facility,Inpatient,,,90,355,301.75,101.743,355,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Infectious Agent Detection By Nucleic Acid, Not Other Specified; Amplified Probe Tech, Each Organism (Mayo)OutsideLaboratory",,87798,CPT,Facility,Both,,,90,355,301.75,101.743,355,Aetna,PPO,330.15,93,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid, Not Other Specified; Amplified Probe Tech, Each Organism (Mayo)OutsideLaboratory",,87798,CPT,Facility,Both,,,90,355,301.75,101.743,355,America's PPO,America's PPO,340.9065,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Infectious Agent Detection By Nucleic Acid, Not Other Specified; Amplified Probe Tech, Each Organism (Mayo)OutsideLaboratory",,87798,CPT,Facility,Both,,,90,355,301.75,101.743,355,BlueCross BlueShield Minnesota, Federal Employee Program,349.32,98.4,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid, Not Other Specified; Amplified Probe Tech, Each Organism (Mayo)OutsideLaboratory",,87798,CPT,Facility,Both,,,90,355,301.75,101.743,355,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,355,100,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid, Not Other Specified; Amplified Probe Tech, Each Organism (Mayo)OutsideLaboratory",,87798,CPT,Facility,Both,,,90,355,301.75,101.743,355,BlueCross BlueShield Minnesota,High Value Network Plan,319.5,90,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid, Not Other Specified; Amplified Probe Tech, Each Organism (Mayo)OutsideLaboratory",,87798,CPT,Facility,Outpatient,,,90,355,301.75,101.743,355,BlueCross BlueShield Minnesota,Medicare Advantage,173.95,49,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid, Not Other Specified; Amplified Probe Tech, Each Organism (Mayo)OutsideLaboratory",,87798,CPT,Facility,Inpatient,,,90,355,301.75,101.743,355,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Infectious Agent Detection By Nucleic Acid, Not Other Specified; Amplified Probe Tech, Each Organism (Mayo)OutsideLaboratory",,87798,CPT,Facility,Both,,,90,355,301.75,101.743,355,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,314.4235,88.57,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid, Not Other Specified; Amplified Probe Tech, Each Organism (Mayo)OutsideLaboratory",,87798,CPT,Facility,Both,,,90,355,301.75,101.743,355,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,101.743,28.66,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid, Not Other Specified; Amplified Probe Tech, Each Organism (Mayo)OutsideLaboratory",,87798,CPT,Facility,Outpatient,,,90,355,301.75,101.743,355,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),173.95,49,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid, Not Other Specified; Amplified Probe Tech, Each Organism (Mayo)OutsideLaboratory",,87798,CPT,Facility,Inpatient,,,90,355,301.75,101.743,355,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Infectious Agent Detection By Nucleic Acid, Not Other Specified; Amplified Probe Tech, Each Organism (Mayo)OutsideLaboratory",,87798,CPT,Facility,Both,,,90,355,301.75,101.743,355,CorVel,Worker's Compensation,355,100,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid, Not Other Specified; Amplified Probe Tech, Each Organism (Mayo)OutsideLaboratory",,87798,CPT,Facility,Both,,,90,355,301.75,101.743,355,First Health Group Corporation,First Health Network,344.35,97,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid, Not Other Specified; Amplified Probe Tech, Each Organism (Mayo)OutsideLaboratory",,87798,CPT,Facility,Both,,,90,355,301.75,101.743,355,"Health Partners, Inc.",Commercial,335.83,94.6,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid, Not Other Specified; Amplified Probe Tech, Each Organism (Mayo)OutsideLaboratory",,87798,CPT,Facility,Outpatient,,,90,355,301.75,101.743,355,"Health Partners, Inc.",Medicare Advantage,173.95,49,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid, Not Other Specified; Amplified Probe Tech, Each Organism (Mayo)OutsideLaboratory",,87798,CPT,Facility,Inpatient,,,90,355,301.75,101.743,355,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Infectious Agent Detection By Nucleic Acid, Not Other Specified; Amplified Probe Tech, Each Organism (Mayo)OutsideLaboratory",,87798,CPT,Facility,Both,,,90,355,301.75,101.743,355,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),213,60,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid, Not Other Specified; Amplified Probe Tech, Each Organism (Mayo)OutsideLaboratory",,87798,CPT,Facility,Both,,,90,355,301.75,101.743,355,"Health Partners, Inc.",State of Minnesota Advantage Program,289.325,81.5,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid, Not Other Specified; Amplified Probe Tech, Each Organism (Mayo)OutsideLaboratory",,87798,CPT,Facility,Both,,,90,355,301.75,101.743,355,"Health Partners, Inc.",State Public Programs,177.5,50,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid, Not Other Specified; Amplified Probe Tech, Each Organism (Mayo)OutsideLaboratory",,87798,CPT,Facility,Both,,,90,355,301.75,101.743,355,Humana Insurance Company,Commercial PPO,337.25,95,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid, Not Other Specified; Amplified Probe Tech, Each Organism (Mayo)OutsideLaboratory",,87798,CPT,Facility,Outpatient,,,90,355,301.75,101.743,355,Humana Insurance Company,Medicare PPO,173.95,49,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid, Not Other Specified; Amplified Probe Tech, Each Organism (Mayo)OutsideLaboratory",,87798,CPT,Facility,Inpatient,,,90,355,301.75,101.743,355,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Infectious Agent Detection By Nucleic Acid, Not Other Specified; Amplified Probe Tech, Each Organism (Mayo)OutsideLaboratory",,87798,CPT,Facility,Both,,,90,355,301.75,101.743,355,Medica,Individual & Family,351.805,99.1,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid, Not Other Specified; Amplified Probe Tech, Each Organism (Mayo)OutsideLaboratory",,87798,CPT,Facility,Outpatient,,,90,355,301.75,101.743,355,Medica,Medica Advantage Solution,176.79,49.8,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid, Not Other Specified; Amplified Probe Tech, Each Organism (Mayo)OutsideLaboratory",,87798,CPT,Facility,Inpatient,,,90,355,301.75,101.743,355,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Infectious Agent Detection By Nucleic Acid, Not Other Specified; Amplified Probe Tech, Each Organism (Mayo)OutsideLaboratory",,87798,CPT,Facility,Outpatient,,,90,355,301.75,101.743,355,Medica,Medical Assistance,158.33,44.6,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid, Not Other Specified; Amplified Probe Tech, Each Organism (Mayo)OutsideLaboratory",,87798,CPT,Facility,Inpatient,,,90,355,301.75,101.743,355,Medica,Medical Assistance,,,,,Included in per diem rate,
"Infectious Agent Detection By Nucleic Acid, Not Other Specified; Amplified Probe Tech, Each Organism (Mayo)OutsideLaboratory",,87798,CPT,Facility,Outpatient,,,90,355,301.75,101.743,355,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,176.79,49.8,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid, Not Other Specified; Amplified Probe Tech, Each Organism (Mayo)OutsideLaboratory",,87798,CPT,Facility,Inpatient,,,90,355,301.75,101.743,355,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Infectious Agent Detection By Nucleic Acid, Not Other Specified; Amplified Probe Tech, Each Organism (Mayo)OutsideLaboratory",,87798,CPT,Facility,Both,,,90,355,301.75,101.743,355,"Multiplan, Inc.","Multiplan, Inc.",333.7,94,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid, Not Other Specified; Amplified Probe Tech, Each Organism (Mayo)OutsideLaboratory",,87798,CPT,Facility,Outpatient,,,90,355,301.75,101.743,355,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,306.72,86.4,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid, Not Other Specified; Amplified Probe Tech, Each Organism (Mayo)OutsideLaboratory",,87798,CPT,Facility,Inpatient,,,90,355,301.75,101.743,355,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Infectious Agent Detection By Nucleic Acid, Not Other Specified; Amplified Probe Tech, Each Organism (Mayo)OutsideLaboratory",,87798,CPT,Facility,Both,,,90,355,301.75,101.743,355,"Preferred One Administrative Services, INC.",PPO,350.03,98.6,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid, Not Other Specified; Amplified Probe Tech, Each Organism (Mayo)OutsideLaboratory",,87798,CPT,Facility,Outpatient,,,90,355,301.75,101.743,355,PrimeWest Health,Minnesota Senior Health Options (MSHO),182.6475,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Infectious Agent Detection By Nucleic Acid, Not Other Specified; Amplified Probe Tech, Each Organism (Mayo)OutsideLaboratory",,87798,CPT,Facility,Inpatient,,,90,355,301.75,101.743,355,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Infectious Agent Detection By Nucleic Acid, Not Other Specified; Amplified Probe Tech, Each Organism (Mayo)OutsideLaboratory",,87798,CPT,Facility,Outpatient,,,90,355,301.75,101.743,355,PrimeWest Health,MinnesotaCare,182.328,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Infectious Agent Detection By Nucleic Acid, Not Other Specified; Amplified Probe Tech, Each Organism (Mayo)OutsideLaboratory",,87798,CPT,Facility,Inpatient,,,90,355,301.75,101.743,355,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Infectious Agent Detection By Nucleic Acid, Not Other Specified; Amplified Probe Tech, Each Organism (Mayo)OutsideLaboratory",,87798,CPT,Facility,Both,,,90,355,301.75,101.743,355,Sanford Health Plan,Sanford Health Plan,326.6,92,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid, Not Other Specified; Amplified Probe Tech, Each Organism (Mayo)OutsideLaboratory",,87798,CPT,Facility,Outpatient,,,90,355,301.75,101.743,355,"UCare Health, Inc.",Individual & Family Plan,200.0425,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Infectious Agent Detection By Nucleic Acid, Not Other Specified; Amplified Probe Tech, Each Organism (Mayo)OutsideLaboratory",,87798,CPT,Facility,Inpatient,,,90,355,301.75,101.743,355,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Infectious Agent Detection By Nucleic Acid, Not Other Specified; Amplified Probe Tech, Each Organism (Mayo)OutsideLaboratory",,87798,CPT,Facility,Outpatient,,,90,355,301.75,101.743,355,"UCare Health, Inc.",Medical Assistance,179.1685,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Infectious Agent Detection By Nucleic Acid, Not Other Specified; Amplified Probe Tech, Each Organism (Mayo)OutsideLaboratory",,87798,CPT,Facility,Inpatient,,,90,355,301.75,101.743,355,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Infectious Agent Detection By Nucleic Acid, Not Other Specified; Amplified Probe Tech, Each Organism (Mayo)OutsideLaboratory",,87798,CPT,Facility,Outpatient,,,90,355,301.75,101.743,355,"UCare Health, Inc.",Medicare Advantage,179.1685,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Infectious Agent Detection By Nucleic Acid, Not Other Specified; Amplified Probe Tech, Each Organism (Mayo)OutsideLaboratory",,87798,CPT,Facility,Inpatient,,,90,355,301.75,101.743,355,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Infectious Agent Detection By Nucleic Acid, Not Other Specified; Amplified Probe Tech, Each Organism (Mayo)OutsideLaboratory",,87798,CPT,Facility,Outpatient,,,90,355,301.75,101.743,355,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),179.1685,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Infectious Agent Detection By Nucleic Acid, Not Other Specified; Amplified Probe Tech, Each Organism (Mayo)OutsideLaboratory",,87798,CPT,Facility,Inpatient,,,90,355,301.75,101.743,355,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Infectious Agent Detection By Nucleic Acid, Not Other Specified; Amplified Probe Tech, Each Organism (Mayo)OutsideLaboratory",,87798,CPT,Facility,Both,,,90,355,301.75,101.743,355,UnitedHealthcare,Individual & Family,333.7,94,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid, Not Other Specified; Amplified Probe Tech, Each Organism (Mayo)OutsideLaboratory",,87798,CPT,Facility,Outpatient,,,90,355,301.75,101.743,355,UnitedHealthcare,Medicare Advantage,173.95,49,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid, Not Other Specified; Amplified Probe Tech, Each Organism (Mayo)OutsideLaboratory",,87798,CPT,Facility,Inpatient,,,90,355,301.75,101.743,355,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Infectious Agent Detection By Nucleic Acid, Not Other Specified; Amplified Probe Tech, Each Organism (Mayo)OutsideLaboratory",,87798,CPT,Facility,Outpatient,,,90,355,301.75,101.743,355,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,170.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Infectious Agent Detection By Nucleic Acid, Not Other Specified; Amplified Probe Tech, Each Organism (Mayo)OutsideLaboratory",,87798,CPT,Facility,Inpatient,,,90,355,301.75,101.743,355,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Microsporidia Species, Pcr (Mayo)OutsideLaboratory",,87798,CPT,Facility,Both,,,90,619,526.15,177.4054,619,Aetna,Commercial,569.48,92,,percent of total billed charges,,
"Microsporidia Species, Pcr (Mayo)OutsideLaboratory",,87798,CPT,Facility,Outpatient,,,90,619,526.15,177.4054,619,Aetna,Medicare Advantage,303.31,49,,percent of total billed charges,,
"Microsporidia Species, Pcr (Mayo)OutsideLaboratory",,87798,CPT,Facility,Inpatient,,,90,619,526.15,177.4054,619,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Microsporidia Species, Pcr (Mayo)OutsideLaboratory",,87798,CPT,Facility,Both,,,90,619,526.15,177.4054,619,Aetna,PPO,575.67,93,,percent of total billed charges,,
"Microsporidia Species, Pcr (Mayo)OutsideLaboratory",,87798,CPT,Facility,Both,,,90,619,526.15,177.4054,619,America's PPO,America's PPO,594.4257,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Microsporidia Species, Pcr (Mayo)OutsideLaboratory",,87798,CPT,Facility,Both,,,90,619,526.15,177.4054,619,BlueCross BlueShield Minnesota, Federal Employee Program,609.096,98.4,,percent of total billed charges,,
"Microsporidia Species, Pcr (Mayo)OutsideLaboratory",,87798,CPT,Facility,Both,,,90,619,526.15,177.4054,619,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,619,100,,percent of total billed charges,,
"Microsporidia Species, Pcr (Mayo)OutsideLaboratory",,87798,CPT,Facility,Both,,,90,619,526.15,177.4054,619,BlueCross BlueShield Minnesota,High Value Network Plan,557.1,90,,percent of total billed charges,,
"Microsporidia Species, Pcr (Mayo)OutsideLaboratory",,87798,CPT,Facility,Outpatient,,,90,619,526.15,177.4054,619,BlueCross BlueShield Minnesota,Medicare Advantage,303.31,49,,percent of total billed charges,,
"Microsporidia Species, Pcr (Mayo)OutsideLaboratory",,87798,CPT,Facility,Inpatient,,,90,619,526.15,177.4054,619,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Microsporidia Species, Pcr (Mayo)OutsideLaboratory",,87798,CPT,Facility,Both,,,90,619,526.15,177.4054,619,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,548.2483,88.57,,percent of total billed charges,,
"Microsporidia Species, Pcr (Mayo)OutsideLaboratory",,87798,CPT,Facility,Both,,,90,619,526.15,177.4054,619,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,177.4054,28.66,,percent of total billed charges,,
"Microsporidia Species, Pcr (Mayo)OutsideLaboratory",,87798,CPT,Facility,Outpatient,,,90,619,526.15,177.4054,619,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),303.31,49,,percent of total billed charges,,
"Microsporidia Species, Pcr (Mayo)OutsideLaboratory",,87798,CPT,Facility,Inpatient,,,90,619,526.15,177.4054,619,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Microsporidia Species, Pcr (Mayo)OutsideLaboratory",,87798,CPT,Facility,Both,,,90,619,526.15,177.4054,619,CorVel,Worker's Compensation,619,100,,percent of total billed charges,,
"Microsporidia Species, Pcr (Mayo)OutsideLaboratory",,87798,CPT,Facility,Both,,,90,619,526.15,177.4054,619,First Health Group Corporation,First Health Network,600.43,97,,percent of total billed charges,,
"Microsporidia Species, Pcr (Mayo)OutsideLaboratory",,87798,CPT,Facility,Both,,,90,619,526.15,177.4054,619,"Health Partners, Inc.",Commercial,585.574,94.6,,percent of total billed charges,,
"Microsporidia Species, Pcr (Mayo)OutsideLaboratory",,87798,CPT,Facility,Outpatient,,,90,619,526.15,177.4054,619,"Health Partners, Inc.",Medicare Advantage,303.31,49,,percent of total billed charges,,
"Microsporidia Species, Pcr (Mayo)OutsideLaboratory",,87798,CPT,Facility,Inpatient,,,90,619,526.15,177.4054,619,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Microsporidia Species, Pcr (Mayo)OutsideLaboratory",,87798,CPT,Facility,Both,,,90,619,526.15,177.4054,619,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),371.4,60,,percent of total billed charges,,
"Microsporidia Species, Pcr (Mayo)OutsideLaboratory",,87798,CPT,Facility,Both,,,90,619,526.15,177.4054,619,"Health Partners, Inc.",State of Minnesota Advantage Program,504.485,81.5,,percent of total billed charges,,
"Microsporidia Species, Pcr (Mayo)OutsideLaboratory",,87798,CPT,Facility,Both,,,90,619,526.15,177.4054,619,"Health Partners, Inc.",State Public Programs,309.5,50,,percent of total billed charges,,
"Microsporidia Species, Pcr (Mayo)OutsideLaboratory",,87798,CPT,Facility,Both,,,90,619,526.15,177.4054,619,Humana Insurance Company,Commercial PPO,588.05,95,,percent of total billed charges,,
"Microsporidia Species, Pcr (Mayo)OutsideLaboratory",,87798,CPT,Facility,Outpatient,,,90,619,526.15,177.4054,619,Humana Insurance Company,Medicare PPO,303.31,49,,percent of total billed charges,,
"Microsporidia Species, Pcr (Mayo)OutsideLaboratory",,87798,CPT,Facility,Inpatient,,,90,619,526.15,177.4054,619,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Microsporidia Species, Pcr (Mayo)OutsideLaboratory",,87798,CPT,Facility,Both,,,90,619,526.15,177.4054,619,Medica,Individual & Family,613.429,99.1,,percent of total billed charges,,
"Microsporidia Species, Pcr (Mayo)OutsideLaboratory",,87798,CPT,Facility,Outpatient,,,90,619,526.15,177.4054,619,Medica,Medica Advantage Solution,308.262,49.8,,percent of total billed charges,,
"Microsporidia Species, Pcr (Mayo)OutsideLaboratory",,87798,CPT,Facility,Inpatient,,,90,619,526.15,177.4054,619,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Microsporidia Species, Pcr (Mayo)OutsideLaboratory",,87798,CPT,Facility,Outpatient,,,90,619,526.15,177.4054,619,Medica,Medical Assistance,276.074,44.6,,percent of total billed charges,,
"Microsporidia Species, Pcr (Mayo)OutsideLaboratory",,87798,CPT,Facility,Inpatient,,,90,619,526.15,177.4054,619,Medica,Medical Assistance,,,,,Included in per diem rate,
"Microsporidia Species, Pcr (Mayo)OutsideLaboratory",,87798,CPT,Facility,Outpatient,,,90,619,526.15,177.4054,619,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,308.262,49.8,,percent of total billed charges,,
"Microsporidia Species, Pcr (Mayo)OutsideLaboratory",,87798,CPT,Facility,Inpatient,,,90,619,526.15,177.4054,619,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Microsporidia Species, Pcr (Mayo)OutsideLaboratory",,87798,CPT,Facility,Both,,,90,619,526.15,177.4054,619,"Multiplan, Inc.","Multiplan, Inc.",581.86,94,,percent of total billed charges,,
"Microsporidia Species, Pcr (Mayo)OutsideLaboratory",,87798,CPT,Facility,Outpatient,,,90,619,526.15,177.4054,619,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,534.816,86.4,,percent of total billed charges,,
"Microsporidia Species, Pcr (Mayo)OutsideLaboratory",,87798,CPT,Facility,Inpatient,,,90,619,526.15,177.4054,619,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Microsporidia Species, Pcr (Mayo)OutsideLaboratory",,87798,CPT,Facility,Both,,,90,619,526.15,177.4054,619,"Preferred One Administrative Services, INC.",PPO,610.334,98.6,,percent of total billed charges,,
"Microsporidia Species, Pcr (Mayo)OutsideLaboratory",,87798,CPT,Facility,Outpatient,,,90,619,526.15,177.4054,619,PrimeWest Health,Minnesota Senior Health Options (MSHO),318.4755,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Microsporidia Species, Pcr (Mayo)OutsideLaboratory",,87798,CPT,Facility,Inpatient,,,90,619,526.15,177.4054,619,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Microsporidia Species, Pcr (Mayo)OutsideLaboratory",,87798,CPT,Facility,Outpatient,,,90,619,526.15,177.4054,619,PrimeWest Health,MinnesotaCare,317.9184,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Microsporidia Species, Pcr (Mayo)OutsideLaboratory",,87798,CPT,Facility,Inpatient,,,90,619,526.15,177.4054,619,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Microsporidia Species, Pcr (Mayo)OutsideLaboratory",,87798,CPT,Facility,Both,,,90,619,526.15,177.4054,619,Sanford Health Plan,Sanford Health Plan,569.48,92,,percent of total billed charges,,
"Microsporidia Species, Pcr (Mayo)OutsideLaboratory",,87798,CPT,Facility,Outpatient,,,90,619,526.15,177.4054,619,"UCare Health, Inc.",Individual & Family Plan,348.8065,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Microsporidia Species, Pcr (Mayo)OutsideLaboratory",,87798,CPT,Facility,Inpatient,,,90,619,526.15,177.4054,619,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Microsporidia Species, Pcr (Mayo)OutsideLaboratory",,87798,CPT,Facility,Outpatient,,,90,619,526.15,177.4054,619,"UCare Health, Inc.",Medical Assistance,312.4093,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Microsporidia Species, Pcr (Mayo)OutsideLaboratory",,87798,CPT,Facility,Inpatient,,,90,619,526.15,177.4054,619,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Microsporidia Species, Pcr (Mayo)OutsideLaboratory",,87798,CPT,Facility,Outpatient,,,90,619,526.15,177.4054,619,"UCare Health, Inc.",Medicare Advantage,312.4093,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Microsporidia Species, Pcr (Mayo)OutsideLaboratory",,87798,CPT,Facility,Inpatient,,,90,619,526.15,177.4054,619,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Microsporidia Species, Pcr (Mayo)OutsideLaboratory",,87798,CPT,Facility,Outpatient,,,90,619,526.15,177.4054,619,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),312.4093,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Microsporidia Species, Pcr (Mayo)OutsideLaboratory",,87798,CPT,Facility,Inpatient,,,90,619,526.15,177.4054,619,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Microsporidia Species, Pcr (Mayo)OutsideLaboratory",,87798,CPT,Facility,Both,,,90,619,526.15,177.4054,619,UnitedHealthcare,Individual & Family,581.86,94,,percent of total billed charges,,
"Microsporidia Species, Pcr (Mayo)OutsideLaboratory",,87798,CPT,Facility,Outpatient,,,90,619,526.15,177.4054,619,UnitedHealthcare,Medicare Advantage,303.31,49,,percent of total billed charges,,
"Microsporidia Species, Pcr (Mayo)OutsideLaboratory",,87798,CPT,Facility,Inpatient,,,90,619,526.15,177.4054,619,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Microsporidia Species, Pcr (Mayo)OutsideLaboratory",,87798,CPT,Facility,Outpatient,,,90,619,526.15,177.4054,619,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,297.12,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Microsporidia Species, Pcr (Mayo)OutsideLaboratory",,87798,CPT,Facility,Inpatient,,,90,619,526.15,177.4054,619,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Parvovirus B19 Pcr, P (Mayo)OutsideLaboratory",,87798,CPT,Facility,Both,,,90,306,260.1,87.6996,306,Aetna,Commercial,281.52,92,,percent of total billed charges,,
"Parvovirus B19 Pcr, P (Mayo)OutsideLaboratory",,87798,CPT,Facility,Outpatient,,,90,306,260.1,87.6996,306,Aetna,Medicare Advantage,149.94,49,,percent of total billed charges,,
"Parvovirus B19 Pcr, P (Mayo)OutsideLaboratory",,87798,CPT,Facility,Inpatient,,,90,306,260.1,87.6996,306,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Parvovirus B19 Pcr, P (Mayo)OutsideLaboratory",,87798,CPT,Facility,Both,,,90,306,260.1,87.6996,306,Aetna,PPO,284.58,93,,percent of total billed charges,,
"Parvovirus B19 Pcr, P (Mayo)OutsideLaboratory",,87798,CPT,Facility,Both,,,90,306,260.1,87.6996,306,America's PPO,America's PPO,293.8518,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Parvovirus B19 Pcr, P (Mayo)OutsideLaboratory",,87798,CPT,Facility,Both,,,90,306,260.1,87.6996,306,BlueCross BlueShield Minnesota, Federal Employee Program,301.104,98.4,,percent of total billed charges,,
"Parvovirus B19 Pcr, P (Mayo)OutsideLaboratory",,87798,CPT,Facility,Both,,,90,306,260.1,87.6996,306,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,306,100,,percent of total billed charges,,
"Parvovirus B19 Pcr, P (Mayo)OutsideLaboratory",,87798,CPT,Facility,Both,,,90,306,260.1,87.6996,306,BlueCross BlueShield Minnesota,High Value Network Plan,275.4,90,,percent of total billed charges,,
"Parvovirus B19 Pcr, P (Mayo)OutsideLaboratory",,87798,CPT,Facility,Outpatient,,,90,306,260.1,87.6996,306,BlueCross BlueShield Minnesota,Medicare Advantage,149.94,49,,percent of total billed charges,,
"Parvovirus B19 Pcr, P (Mayo)OutsideLaboratory",,87798,CPT,Facility,Inpatient,,,90,306,260.1,87.6996,306,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Parvovirus B19 Pcr, P (Mayo)OutsideLaboratory",,87798,CPT,Facility,Both,,,90,306,260.1,87.6996,306,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,271.0242,88.57,,percent of total billed charges,,
"Parvovirus B19 Pcr, P (Mayo)OutsideLaboratory",,87798,CPT,Facility,Both,,,90,306,260.1,87.6996,306,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,87.6996,28.66,,percent of total billed charges,,
"Parvovirus B19 Pcr, P (Mayo)OutsideLaboratory",,87798,CPT,Facility,Outpatient,,,90,306,260.1,87.6996,306,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),149.94,49,,percent of total billed charges,,
"Parvovirus B19 Pcr, P (Mayo)OutsideLaboratory",,87798,CPT,Facility,Inpatient,,,90,306,260.1,87.6996,306,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Parvovirus B19 Pcr, P (Mayo)OutsideLaboratory",,87798,CPT,Facility,Both,,,90,306,260.1,87.6996,306,CorVel,Worker's Compensation,306,100,,percent of total billed charges,,
"Parvovirus B19 Pcr, P (Mayo)OutsideLaboratory",,87798,CPT,Facility,Both,,,90,306,260.1,87.6996,306,First Health Group Corporation,First Health Network,296.82,97,,percent of total billed charges,,
"Parvovirus B19 Pcr, P (Mayo)OutsideLaboratory",,87798,CPT,Facility,Both,,,90,306,260.1,87.6996,306,"Health Partners, Inc.",Commercial,289.476,94.6,,percent of total billed charges,,
"Parvovirus B19 Pcr, P (Mayo)OutsideLaboratory",,87798,CPT,Facility,Outpatient,,,90,306,260.1,87.6996,306,"Health Partners, Inc.",Medicare Advantage,149.94,49,,percent of total billed charges,,
"Parvovirus B19 Pcr, P (Mayo)OutsideLaboratory",,87798,CPT,Facility,Inpatient,,,90,306,260.1,87.6996,306,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Parvovirus B19 Pcr, P (Mayo)OutsideLaboratory",,87798,CPT,Facility,Both,,,90,306,260.1,87.6996,306,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),183.6,60,,percent of total billed charges,,
"Parvovirus B19 Pcr, P (Mayo)OutsideLaboratory",,87798,CPT,Facility,Both,,,90,306,260.1,87.6996,306,"Health Partners, Inc.",State of Minnesota Advantage Program,249.39,81.5,,percent of total billed charges,,
"Parvovirus B19 Pcr, P (Mayo)OutsideLaboratory",,87798,CPT,Facility,Both,,,90,306,260.1,87.6996,306,"Health Partners, Inc.",State Public Programs,153,50,,percent of total billed charges,,
"Parvovirus B19 Pcr, P (Mayo)OutsideLaboratory",,87798,CPT,Facility,Both,,,90,306,260.1,87.6996,306,Humana Insurance Company,Commercial PPO,290.7,95,,percent of total billed charges,,
"Parvovirus B19 Pcr, P (Mayo)OutsideLaboratory",,87798,CPT,Facility,Outpatient,,,90,306,260.1,87.6996,306,Humana Insurance Company,Medicare PPO,149.94,49,,percent of total billed charges,,
"Parvovirus B19 Pcr, P (Mayo)OutsideLaboratory",,87798,CPT,Facility,Inpatient,,,90,306,260.1,87.6996,306,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Parvovirus B19 Pcr, P (Mayo)OutsideLaboratory",,87798,CPT,Facility,Both,,,90,306,260.1,87.6996,306,Medica,Individual & Family,303.246,99.1,,percent of total billed charges,,
"Parvovirus B19 Pcr, P (Mayo)OutsideLaboratory",,87798,CPT,Facility,Outpatient,,,90,306,260.1,87.6996,306,Medica,Medica Advantage Solution,152.388,49.8,,percent of total billed charges,,
"Parvovirus B19 Pcr, P (Mayo)OutsideLaboratory",,87798,CPT,Facility,Inpatient,,,90,306,260.1,87.6996,306,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Parvovirus B19 Pcr, P (Mayo)OutsideLaboratory",,87798,CPT,Facility,Outpatient,,,90,306,260.1,87.6996,306,Medica,Medical Assistance,136.476,44.6,,percent of total billed charges,,
"Parvovirus B19 Pcr, P (Mayo)OutsideLaboratory",,87798,CPT,Facility,Inpatient,,,90,306,260.1,87.6996,306,Medica,Medical Assistance,,,,,Included in per diem rate,
"Parvovirus B19 Pcr, P (Mayo)OutsideLaboratory",,87798,CPT,Facility,Outpatient,,,90,306,260.1,87.6996,306,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,152.388,49.8,,percent of total billed charges,,
"Parvovirus B19 Pcr, P (Mayo)OutsideLaboratory",,87798,CPT,Facility,Inpatient,,,90,306,260.1,87.6996,306,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Parvovirus B19 Pcr, P (Mayo)OutsideLaboratory",,87798,CPT,Facility,Both,,,90,306,260.1,87.6996,306,"Multiplan, Inc.","Multiplan, Inc.",287.64,94,,percent of total billed charges,,
"Parvovirus B19 Pcr, P (Mayo)OutsideLaboratory",,87798,CPT,Facility,Outpatient,,,90,306,260.1,87.6996,306,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,264.384,86.4,,percent of total billed charges,,
"Parvovirus B19 Pcr, P (Mayo)OutsideLaboratory",,87798,CPT,Facility,Inpatient,,,90,306,260.1,87.6996,306,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Parvovirus B19 Pcr, P (Mayo)OutsideLaboratory",,87798,CPT,Facility,Both,,,90,306,260.1,87.6996,306,"Preferred One Administrative Services, INC.",PPO,301.716,98.6,,percent of total billed charges,,
"Parvovirus B19 Pcr, P (Mayo)OutsideLaboratory",,87798,CPT,Facility,Outpatient,,,90,306,260.1,87.6996,306,PrimeWest Health,Minnesota Senior Health Options (MSHO),157.437,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Parvovirus B19 Pcr, P (Mayo)OutsideLaboratory",,87798,CPT,Facility,Inpatient,,,90,306,260.1,87.6996,306,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Parvovirus B19 Pcr, P (Mayo)OutsideLaboratory",,87798,CPT,Facility,Outpatient,,,90,306,260.1,87.6996,306,PrimeWest Health,MinnesotaCare,157.1616,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Parvovirus B19 Pcr, P (Mayo)OutsideLaboratory",,87798,CPT,Facility,Inpatient,,,90,306,260.1,87.6996,306,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Parvovirus B19 Pcr, P (Mayo)OutsideLaboratory",,87798,CPT,Facility,Both,,,90,306,260.1,87.6996,306,Sanford Health Plan,Sanford Health Plan,281.52,92,,percent of total billed charges,,
"Parvovirus B19 Pcr, P (Mayo)OutsideLaboratory",,87798,CPT,Facility,Outpatient,,,90,306,260.1,87.6996,306,"UCare Health, Inc.",Individual & Family Plan,172.431,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Parvovirus B19 Pcr, P (Mayo)OutsideLaboratory",,87798,CPT,Facility,Inpatient,,,90,306,260.1,87.6996,306,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Parvovirus B19 Pcr, P (Mayo)OutsideLaboratory",,87798,CPT,Facility,Outpatient,,,90,306,260.1,87.6996,306,"UCare Health, Inc.",Medical Assistance,154.4382,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Parvovirus B19 Pcr, P (Mayo)OutsideLaboratory",,87798,CPT,Facility,Inpatient,,,90,306,260.1,87.6996,306,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Parvovirus B19 Pcr, P (Mayo)OutsideLaboratory",,87798,CPT,Facility,Outpatient,,,90,306,260.1,87.6996,306,"UCare Health, Inc.",Medicare Advantage,154.4382,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Parvovirus B19 Pcr, P (Mayo)OutsideLaboratory",,87798,CPT,Facility,Inpatient,,,90,306,260.1,87.6996,306,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Parvovirus B19 Pcr, P (Mayo)OutsideLaboratory",,87798,CPT,Facility,Outpatient,,,90,306,260.1,87.6996,306,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),154.4382,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Parvovirus B19 Pcr, P (Mayo)OutsideLaboratory",,87798,CPT,Facility,Inpatient,,,90,306,260.1,87.6996,306,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Parvovirus B19 Pcr, P (Mayo)OutsideLaboratory",,87798,CPT,Facility,Both,,,90,306,260.1,87.6996,306,UnitedHealthcare,Individual & Family,287.64,94,,percent of total billed charges,,
"Parvovirus B19 Pcr, P (Mayo)OutsideLaboratory",,87798,CPT,Facility,Outpatient,,,90,306,260.1,87.6996,306,UnitedHealthcare,Medicare Advantage,149.94,49,,percent of total billed charges,,
"Parvovirus B19 Pcr, P (Mayo)OutsideLaboratory",,87798,CPT,Facility,Inpatient,,,90,306,260.1,87.6996,306,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Parvovirus B19 Pcr, P (Mayo)OutsideLaboratory",,87798,CPT,Facility,Outpatient,,,90,306,260.1,87.6996,306,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,146.88,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Parvovirus B19 Pcr, P (Mayo)OutsideLaboratory",,87798,CPT,Facility,Inpatient,,,90,306,260.1,87.6996,306,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Varicella-Zoster Virus Pcr (Mayo)OutsideLaboratory,,87798,CPT,Facility,Both,,,90,227,192.95,65.0582,227,Aetna,Commercial,208.84,92,,percent of total billed charges,,
Varicella-Zoster Virus Pcr (Mayo)OutsideLaboratory,,87798,CPT,Facility,Outpatient,,,90,227,192.95,65.0582,227,Aetna,Medicare Advantage,111.23,49,,percent of total billed charges,,
Varicella-Zoster Virus Pcr (Mayo)OutsideLaboratory,,87798,CPT,Facility,Inpatient,,,90,227,192.95,65.0582,227,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Varicella-Zoster Virus Pcr (Mayo)OutsideLaboratory,,87798,CPT,Facility,Both,,,90,227,192.95,65.0582,227,Aetna,PPO,211.11,93,,percent of total billed charges,,
Varicella-Zoster Virus Pcr (Mayo)OutsideLaboratory,,87798,CPT,Facility,Both,,,90,227,192.95,65.0582,227,America's PPO,America's PPO,217.9881,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Varicella-Zoster Virus Pcr (Mayo)OutsideLaboratory,,87798,CPT,Facility,Both,,,90,227,192.95,65.0582,227,BlueCross BlueShield Minnesota, Federal Employee Program,223.368,98.4,,percent of total billed charges,,
Varicella-Zoster Virus Pcr (Mayo)OutsideLaboratory,,87798,CPT,Facility,Both,,,90,227,192.95,65.0582,227,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,227,100,,percent of total billed charges,,
Varicella-Zoster Virus Pcr (Mayo)OutsideLaboratory,,87798,CPT,Facility,Both,,,90,227,192.95,65.0582,227,BlueCross BlueShield Minnesota,High Value Network Plan,204.3,90,,percent of total billed charges,,
Varicella-Zoster Virus Pcr (Mayo)OutsideLaboratory,,87798,CPT,Facility,Outpatient,,,90,227,192.95,65.0582,227,BlueCross BlueShield Minnesota,Medicare Advantage,111.23,49,,percent of total billed charges,,
Varicella-Zoster Virus Pcr (Mayo)OutsideLaboratory,,87798,CPT,Facility,Inpatient,,,90,227,192.95,65.0582,227,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Varicella-Zoster Virus Pcr (Mayo)OutsideLaboratory,,87798,CPT,Facility,Both,,,90,227,192.95,65.0582,227,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,201.0539,88.57,,percent of total billed charges,,
Varicella-Zoster Virus Pcr (Mayo)OutsideLaboratory,,87798,CPT,Facility,Both,,,90,227,192.95,65.0582,227,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,65.0582,28.66,,percent of total billed charges,,
Varicella-Zoster Virus Pcr (Mayo)OutsideLaboratory,,87798,CPT,Facility,Outpatient,,,90,227,192.95,65.0582,227,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),111.23,49,,percent of total billed charges,,
Varicella-Zoster Virus Pcr (Mayo)OutsideLaboratory,,87798,CPT,Facility,Inpatient,,,90,227,192.95,65.0582,227,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Varicella-Zoster Virus Pcr (Mayo)OutsideLaboratory,,87798,CPT,Facility,Both,,,90,227,192.95,65.0582,227,CorVel,Worker's Compensation,227,100,,percent of total billed charges,,
Varicella-Zoster Virus Pcr (Mayo)OutsideLaboratory,,87798,CPT,Facility,Both,,,90,227,192.95,65.0582,227,First Health Group Corporation,First Health Network,220.19,97,,percent of total billed charges,,
Varicella-Zoster Virus Pcr (Mayo)OutsideLaboratory,,87798,CPT,Facility,Both,,,90,227,192.95,65.0582,227,"Health Partners, Inc.",Commercial,214.742,94.6,,percent of total billed charges,,
Varicella-Zoster Virus Pcr (Mayo)OutsideLaboratory,,87798,CPT,Facility,Outpatient,,,90,227,192.95,65.0582,227,"Health Partners, Inc.",Medicare Advantage,111.23,49,,percent of total billed charges,,
Varicella-Zoster Virus Pcr (Mayo)OutsideLaboratory,,87798,CPT,Facility,Inpatient,,,90,227,192.95,65.0582,227,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Varicella-Zoster Virus Pcr (Mayo)OutsideLaboratory,,87798,CPT,Facility,Both,,,90,227,192.95,65.0582,227,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),136.2,60,,percent of total billed charges,,
Varicella-Zoster Virus Pcr (Mayo)OutsideLaboratory,,87798,CPT,Facility,Both,,,90,227,192.95,65.0582,227,"Health Partners, Inc.",State of Minnesota Advantage Program,185.005,81.5,,percent of total billed charges,,
Varicella-Zoster Virus Pcr (Mayo)OutsideLaboratory,,87798,CPT,Facility,Both,,,90,227,192.95,65.0582,227,"Health Partners, Inc.",State Public Programs,113.5,50,,percent of total billed charges,,
Varicella-Zoster Virus Pcr (Mayo)OutsideLaboratory,,87798,CPT,Facility,Both,,,90,227,192.95,65.0582,227,Humana Insurance Company,Commercial PPO,215.65,95,,percent of total billed charges,,
Varicella-Zoster Virus Pcr (Mayo)OutsideLaboratory,,87798,CPT,Facility,Outpatient,,,90,227,192.95,65.0582,227,Humana Insurance Company,Medicare PPO,111.23,49,,percent of total billed charges,,
Varicella-Zoster Virus Pcr (Mayo)OutsideLaboratory,,87798,CPT,Facility,Inpatient,,,90,227,192.95,65.0582,227,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Varicella-Zoster Virus Pcr (Mayo)OutsideLaboratory,,87798,CPT,Facility,Both,,,90,227,192.95,65.0582,227,Medica,Individual & Family,224.957,99.1,,percent of total billed charges,,
Varicella-Zoster Virus Pcr (Mayo)OutsideLaboratory,,87798,CPT,Facility,Outpatient,,,90,227,192.95,65.0582,227,Medica,Medica Advantage Solution,113.046,49.8,,percent of total billed charges,,
Varicella-Zoster Virus Pcr (Mayo)OutsideLaboratory,,87798,CPT,Facility,Inpatient,,,90,227,192.95,65.0582,227,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Varicella-Zoster Virus Pcr (Mayo)OutsideLaboratory,,87798,CPT,Facility,Outpatient,,,90,227,192.95,65.0582,227,Medica,Medical Assistance,101.242,44.6,,percent of total billed charges,,
Varicella-Zoster Virus Pcr (Mayo)OutsideLaboratory,,87798,CPT,Facility,Inpatient,,,90,227,192.95,65.0582,227,Medica,Medical Assistance,,,,,Included in per diem rate,
Varicella-Zoster Virus Pcr (Mayo)OutsideLaboratory,,87798,CPT,Facility,Outpatient,,,90,227,192.95,65.0582,227,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,113.046,49.8,,percent of total billed charges,,
Varicella-Zoster Virus Pcr (Mayo)OutsideLaboratory,,87798,CPT,Facility,Inpatient,,,90,227,192.95,65.0582,227,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Varicella-Zoster Virus Pcr (Mayo)OutsideLaboratory,,87798,CPT,Facility,Both,,,90,227,192.95,65.0582,227,"Multiplan, Inc.","Multiplan, Inc.",213.38,94,,percent of total billed charges,,
Varicella-Zoster Virus Pcr (Mayo)OutsideLaboratory,,87798,CPT,Facility,Outpatient,,,90,227,192.95,65.0582,227,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,196.128,86.4,,percent of total billed charges,,
Varicella-Zoster Virus Pcr (Mayo)OutsideLaboratory,,87798,CPT,Facility,Inpatient,,,90,227,192.95,65.0582,227,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Varicella-Zoster Virus Pcr (Mayo)OutsideLaboratory,,87798,CPT,Facility,Both,,,90,227,192.95,65.0582,227,"Preferred One Administrative Services, INC.",PPO,223.822,98.6,,percent of total billed charges,,
Varicella-Zoster Virus Pcr (Mayo)OutsideLaboratory,,87798,CPT,Facility,Outpatient,,,90,227,192.95,65.0582,227,PrimeWest Health,Minnesota Senior Health Options (MSHO),116.7915,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Varicella-Zoster Virus Pcr (Mayo)OutsideLaboratory,,87798,CPT,Facility,Inpatient,,,90,227,192.95,65.0582,227,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Varicella-Zoster Virus Pcr (Mayo)OutsideLaboratory,,87798,CPT,Facility,Outpatient,,,90,227,192.95,65.0582,227,PrimeWest Health,MinnesotaCare,116.5872,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Varicella-Zoster Virus Pcr (Mayo)OutsideLaboratory,,87798,CPT,Facility,Inpatient,,,90,227,192.95,65.0582,227,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Varicella-Zoster Virus Pcr (Mayo)OutsideLaboratory,,87798,CPT,Facility,Both,,,90,227,192.95,65.0582,227,Sanford Health Plan,Sanford Health Plan,208.84,92,,percent of total billed charges,,
Varicella-Zoster Virus Pcr (Mayo)OutsideLaboratory,,87798,CPT,Facility,Outpatient,,,90,227,192.95,65.0582,227,"UCare Health, Inc.",Individual & Family Plan,127.9145,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Varicella-Zoster Virus Pcr (Mayo)OutsideLaboratory,,87798,CPT,Facility,Inpatient,,,90,227,192.95,65.0582,227,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Varicella-Zoster Virus Pcr (Mayo)OutsideLaboratory,,87798,CPT,Facility,Outpatient,,,90,227,192.95,65.0582,227,"UCare Health, Inc.",Medical Assistance,114.5669,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Varicella-Zoster Virus Pcr (Mayo)OutsideLaboratory,,87798,CPT,Facility,Inpatient,,,90,227,192.95,65.0582,227,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Varicella-Zoster Virus Pcr (Mayo)OutsideLaboratory,,87798,CPT,Facility,Outpatient,,,90,227,192.95,65.0582,227,"UCare Health, Inc.",Medicare Advantage,114.5669,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Varicella-Zoster Virus Pcr (Mayo)OutsideLaboratory,,87798,CPT,Facility,Inpatient,,,90,227,192.95,65.0582,227,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Varicella-Zoster Virus Pcr (Mayo)OutsideLaboratory,,87798,CPT,Facility,Outpatient,,,90,227,192.95,65.0582,227,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),114.5669,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Varicella-Zoster Virus Pcr (Mayo)OutsideLaboratory,,87798,CPT,Facility,Inpatient,,,90,227,192.95,65.0582,227,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Varicella-Zoster Virus Pcr (Mayo)OutsideLaboratory,,87798,CPT,Facility,Both,,,90,227,192.95,65.0582,227,UnitedHealthcare,Individual & Family,213.38,94,,percent of total billed charges,,
Varicella-Zoster Virus Pcr (Mayo)OutsideLaboratory,,87798,CPT,Facility,Outpatient,,,90,227,192.95,65.0582,227,UnitedHealthcare,Medicare Advantage,111.23,49,,percent of total billed charges,,
Varicella-Zoster Virus Pcr (Mayo)OutsideLaboratory,,87798,CPT,Facility,Inpatient,,,90,227,192.95,65.0582,227,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Varicella-Zoster Virus Pcr (Mayo)OutsideLaboratory,,87798,CPT,Facility,Outpatient,,,90,227,192.95,65.0582,227,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,108.96,48,,percent of total billed charges,,100% of DHS outpatient percentage
Varicella-Zoster Virus Pcr (Mayo)OutsideLaboratory,,87798,CPT,Facility,Inpatient,,,90,227,192.95,65.0582,227,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"West Nile Virus Pcr, P (Mayo)OutsideLaboratory",,87798,CPT,Facility,Both,,,90,234,198.9,67.0644,234,Aetna,Commercial,215.28,92,,percent of total billed charges,,
"West Nile Virus Pcr, P (Mayo)OutsideLaboratory",,87798,CPT,Facility,Outpatient,,,90,234,198.9,67.0644,234,Aetna,Medicare Advantage,114.66,49,,percent of total billed charges,,
"West Nile Virus Pcr, P (Mayo)OutsideLaboratory",,87798,CPT,Facility,Inpatient,,,90,234,198.9,67.0644,234,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"West Nile Virus Pcr, P (Mayo)OutsideLaboratory",,87798,CPT,Facility,Both,,,90,234,198.9,67.0644,234,Aetna,PPO,217.62,93,,percent of total billed charges,,
"West Nile Virus Pcr, P (Mayo)OutsideLaboratory",,87798,CPT,Facility,Both,,,90,234,198.9,67.0644,234,America's PPO,America's PPO,224.7102,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"West Nile Virus Pcr, P (Mayo)OutsideLaboratory",,87798,CPT,Facility,Both,,,90,234,198.9,67.0644,234,BlueCross BlueShield Minnesota, Federal Employee Program,230.256,98.4,,percent of total billed charges,,
"West Nile Virus Pcr, P (Mayo)OutsideLaboratory",,87798,CPT,Facility,Both,,,90,234,198.9,67.0644,234,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,234,100,,percent of total billed charges,,
"West Nile Virus Pcr, P (Mayo)OutsideLaboratory",,87798,CPT,Facility,Both,,,90,234,198.9,67.0644,234,BlueCross BlueShield Minnesota,High Value Network Plan,210.6,90,,percent of total billed charges,,
"West Nile Virus Pcr, P (Mayo)OutsideLaboratory",,87798,CPT,Facility,Outpatient,,,90,234,198.9,67.0644,234,BlueCross BlueShield Minnesota,Medicare Advantage,114.66,49,,percent of total billed charges,,
"West Nile Virus Pcr, P (Mayo)OutsideLaboratory",,87798,CPT,Facility,Inpatient,,,90,234,198.9,67.0644,234,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"West Nile Virus Pcr, P (Mayo)OutsideLaboratory",,87798,CPT,Facility,Both,,,90,234,198.9,67.0644,234,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,207.2538,88.57,,percent of total billed charges,,
"West Nile Virus Pcr, P (Mayo)OutsideLaboratory",,87798,CPT,Facility,Both,,,90,234,198.9,67.0644,234,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,67.0644,28.66,,percent of total billed charges,,
"West Nile Virus Pcr, P (Mayo)OutsideLaboratory",,87798,CPT,Facility,Outpatient,,,90,234,198.9,67.0644,234,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),114.66,49,,percent of total billed charges,,
"West Nile Virus Pcr, P (Mayo)OutsideLaboratory",,87798,CPT,Facility,Inpatient,,,90,234,198.9,67.0644,234,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"West Nile Virus Pcr, P (Mayo)OutsideLaboratory",,87798,CPT,Facility,Both,,,90,234,198.9,67.0644,234,CorVel,Worker's Compensation,234,100,,percent of total billed charges,,
"West Nile Virus Pcr, P (Mayo)OutsideLaboratory",,87798,CPT,Facility,Both,,,90,234,198.9,67.0644,234,First Health Group Corporation,First Health Network,226.98,97,,percent of total billed charges,,
"West Nile Virus Pcr, P (Mayo)OutsideLaboratory",,87798,CPT,Facility,Both,,,90,234,198.9,67.0644,234,"Health Partners, Inc.",Commercial,221.364,94.6,,percent of total billed charges,,
"West Nile Virus Pcr, P (Mayo)OutsideLaboratory",,87798,CPT,Facility,Outpatient,,,90,234,198.9,67.0644,234,"Health Partners, Inc.",Medicare Advantage,114.66,49,,percent of total billed charges,,
"West Nile Virus Pcr, P (Mayo)OutsideLaboratory",,87798,CPT,Facility,Inpatient,,,90,234,198.9,67.0644,234,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"West Nile Virus Pcr, P (Mayo)OutsideLaboratory",,87798,CPT,Facility,Both,,,90,234,198.9,67.0644,234,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),140.4,60,,percent of total billed charges,,
"West Nile Virus Pcr, P (Mayo)OutsideLaboratory",,87798,CPT,Facility,Both,,,90,234,198.9,67.0644,234,"Health Partners, Inc.",State of Minnesota Advantage Program,190.71,81.5,,percent of total billed charges,,
"West Nile Virus Pcr, P (Mayo)OutsideLaboratory",,87798,CPT,Facility,Both,,,90,234,198.9,67.0644,234,"Health Partners, Inc.",State Public Programs,117,50,,percent of total billed charges,,
"West Nile Virus Pcr, P (Mayo)OutsideLaboratory",,87798,CPT,Facility,Both,,,90,234,198.9,67.0644,234,Humana Insurance Company,Commercial PPO,222.3,95,,percent of total billed charges,,
"West Nile Virus Pcr, P (Mayo)OutsideLaboratory",,87798,CPT,Facility,Outpatient,,,90,234,198.9,67.0644,234,Humana Insurance Company,Medicare PPO,114.66,49,,percent of total billed charges,,
"West Nile Virus Pcr, P (Mayo)OutsideLaboratory",,87798,CPT,Facility,Inpatient,,,90,234,198.9,67.0644,234,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"West Nile Virus Pcr, P (Mayo)OutsideLaboratory",,87798,CPT,Facility,Both,,,90,234,198.9,67.0644,234,Medica,Individual & Family,231.894,99.1,,percent of total billed charges,,
"West Nile Virus Pcr, P (Mayo)OutsideLaboratory",,87798,CPT,Facility,Outpatient,,,90,234,198.9,67.0644,234,Medica,Medica Advantage Solution,116.532,49.8,,percent of total billed charges,,
"West Nile Virus Pcr, P (Mayo)OutsideLaboratory",,87798,CPT,Facility,Inpatient,,,90,234,198.9,67.0644,234,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"West Nile Virus Pcr, P (Mayo)OutsideLaboratory",,87798,CPT,Facility,Outpatient,,,90,234,198.9,67.0644,234,Medica,Medical Assistance,104.364,44.6,,percent of total billed charges,,
"West Nile Virus Pcr, P (Mayo)OutsideLaboratory",,87798,CPT,Facility,Inpatient,,,90,234,198.9,67.0644,234,Medica,Medical Assistance,,,,,Included in per diem rate,
"West Nile Virus Pcr, P (Mayo)OutsideLaboratory",,87798,CPT,Facility,Outpatient,,,90,234,198.9,67.0644,234,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,116.532,49.8,,percent of total billed charges,,
"West Nile Virus Pcr, P (Mayo)OutsideLaboratory",,87798,CPT,Facility,Inpatient,,,90,234,198.9,67.0644,234,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"West Nile Virus Pcr, P (Mayo)OutsideLaboratory",,87798,CPT,Facility,Both,,,90,234,198.9,67.0644,234,"Multiplan, Inc.","Multiplan, Inc.",219.96,94,,percent of total billed charges,,
"West Nile Virus Pcr, P (Mayo)OutsideLaboratory",,87798,CPT,Facility,Outpatient,,,90,234,198.9,67.0644,234,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,202.176,86.4,,percent of total billed charges,,
"West Nile Virus Pcr, P (Mayo)OutsideLaboratory",,87798,CPT,Facility,Inpatient,,,90,234,198.9,67.0644,234,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"West Nile Virus Pcr, P (Mayo)OutsideLaboratory",,87798,CPT,Facility,Both,,,90,234,198.9,67.0644,234,"Preferred One Administrative Services, INC.",PPO,230.724,98.6,,percent of total billed charges,,
"West Nile Virus Pcr, P (Mayo)OutsideLaboratory",,87798,CPT,Facility,Outpatient,,,90,234,198.9,67.0644,234,PrimeWest Health,Minnesota Senior Health Options (MSHO),120.393,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"West Nile Virus Pcr, P (Mayo)OutsideLaboratory",,87798,CPT,Facility,Inpatient,,,90,234,198.9,67.0644,234,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"West Nile Virus Pcr, P (Mayo)OutsideLaboratory",,87798,CPT,Facility,Outpatient,,,90,234,198.9,67.0644,234,PrimeWest Health,MinnesotaCare,120.1824,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"West Nile Virus Pcr, P (Mayo)OutsideLaboratory",,87798,CPT,Facility,Inpatient,,,90,234,198.9,67.0644,234,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"West Nile Virus Pcr, P (Mayo)OutsideLaboratory",,87798,CPT,Facility,Both,,,90,234,198.9,67.0644,234,Sanford Health Plan,Sanford Health Plan,215.28,92,,percent of total billed charges,,
"West Nile Virus Pcr, P (Mayo)OutsideLaboratory",,87798,CPT,Facility,Outpatient,,,90,234,198.9,67.0644,234,"UCare Health, Inc.",Individual & Family Plan,131.859,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"West Nile Virus Pcr, P (Mayo)OutsideLaboratory",,87798,CPT,Facility,Inpatient,,,90,234,198.9,67.0644,234,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"West Nile Virus Pcr, P (Mayo)OutsideLaboratory",,87798,CPT,Facility,Outpatient,,,90,234,198.9,67.0644,234,"UCare Health, Inc.",Medical Assistance,118.0998,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"West Nile Virus Pcr, P (Mayo)OutsideLaboratory",,87798,CPT,Facility,Inpatient,,,90,234,198.9,67.0644,234,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"West Nile Virus Pcr, P (Mayo)OutsideLaboratory",,87798,CPT,Facility,Outpatient,,,90,234,198.9,67.0644,234,"UCare Health, Inc.",Medicare Advantage,118.0998,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"West Nile Virus Pcr, P (Mayo)OutsideLaboratory",,87798,CPT,Facility,Inpatient,,,90,234,198.9,67.0644,234,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"West Nile Virus Pcr, P (Mayo)OutsideLaboratory",,87798,CPT,Facility,Outpatient,,,90,234,198.9,67.0644,234,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),118.0998,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"West Nile Virus Pcr, P (Mayo)OutsideLaboratory",,87798,CPT,Facility,Inpatient,,,90,234,198.9,67.0644,234,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"West Nile Virus Pcr, P (Mayo)OutsideLaboratory",,87798,CPT,Facility,Both,,,90,234,198.9,67.0644,234,UnitedHealthcare,Individual & Family,219.96,94,,percent of total billed charges,,
"West Nile Virus Pcr, P (Mayo)OutsideLaboratory",,87798,CPT,Facility,Outpatient,,,90,234,198.9,67.0644,234,UnitedHealthcare,Medicare Advantage,114.66,49,,percent of total billed charges,,
"West Nile Virus Pcr, P (Mayo)OutsideLaboratory",,87798,CPT,Facility,Inpatient,,,90,234,198.9,67.0644,234,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"West Nile Virus Pcr, P (Mayo)OutsideLaboratory",,87798,CPT,Facility,Outpatient,,,90,234,198.9,67.0644,234,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,112.32,48,,percent of total billed charges,,100% of DHS outpatient percentage
"West Nile Virus Pcr, P (Mayo)OutsideLaboratory",,87798,CPT,Facility,Inpatient,,,90,234,198.9,67.0644,234,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Bk Virus Pcr, Quant, P (Mayo)OutsideLaboratory",,87799,CPT,Facility,Both,,,90,216,183.6,61.9056,216,Aetna,Commercial,198.72,92,,percent of total billed charges,,
"Bk Virus Pcr, Quant, P (Mayo)OutsideLaboratory",,87799,CPT,Facility,Outpatient,,,90,216,183.6,61.9056,216,Aetna,Medicare Advantage,105.84,49,,percent of total billed charges,,
"Bk Virus Pcr, Quant, P (Mayo)OutsideLaboratory",,87799,CPT,Facility,Inpatient,,,90,216,183.6,61.9056,216,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Bk Virus Pcr, Quant, P (Mayo)OutsideLaboratory",,87799,CPT,Facility,Both,,,90,216,183.6,61.9056,216,Aetna,PPO,200.88,93,,percent of total billed charges,,
"Bk Virus Pcr, Quant, P (Mayo)OutsideLaboratory",,87799,CPT,Facility,Both,,,90,216,183.6,61.9056,216,America's PPO,America's PPO,207.4248,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Bk Virus Pcr, Quant, P (Mayo)OutsideLaboratory",,87799,CPT,Facility,Both,,,90,216,183.6,61.9056,216,BlueCross BlueShield Minnesota, Federal Employee Program,212.544,98.4,,percent of total billed charges,,
"Bk Virus Pcr, Quant, P (Mayo)OutsideLaboratory",,87799,CPT,Facility,Both,,,90,216,183.6,61.9056,216,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,216,100,,percent of total billed charges,,
"Bk Virus Pcr, Quant, P (Mayo)OutsideLaboratory",,87799,CPT,Facility,Both,,,90,216,183.6,61.9056,216,BlueCross BlueShield Minnesota,High Value Network Plan,194.4,90,,percent of total billed charges,,
"Bk Virus Pcr, Quant, P (Mayo)OutsideLaboratory",,87799,CPT,Facility,Outpatient,,,90,216,183.6,61.9056,216,BlueCross BlueShield Minnesota,Medicare Advantage,105.84,49,,percent of total billed charges,,
"Bk Virus Pcr, Quant, P (Mayo)OutsideLaboratory",,87799,CPT,Facility,Inpatient,,,90,216,183.6,61.9056,216,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Bk Virus Pcr, Quant, P (Mayo)OutsideLaboratory",,87799,CPT,Facility,Both,,,90,216,183.6,61.9056,216,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,191.3112,88.57,,percent of total billed charges,,
"Bk Virus Pcr, Quant, P (Mayo)OutsideLaboratory",,87799,CPT,Facility,Both,,,90,216,183.6,61.9056,216,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,61.9056,28.66,,percent of total billed charges,,
"Bk Virus Pcr, Quant, P (Mayo)OutsideLaboratory",,87799,CPT,Facility,Outpatient,,,90,216,183.6,61.9056,216,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),105.84,49,,percent of total billed charges,,
"Bk Virus Pcr, Quant, P (Mayo)OutsideLaboratory",,87799,CPT,Facility,Inpatient,,,90,216,183.6,61.9056,216,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Bk Virus Pcr, Quant, P (Mayo)OutsideLaboratory",,87799,CPT,Facility,Both,,,90,216,183.6,61.9056,216,CorVel,Worker's Compensation,216,100,,percent of total billed charges,,
"Bk Virus Pcr, Quant, P (Mayo)OutsideLaboratory",,87799,CPT,Facility,Both,,,90,216,183.6,61.9056,216,First Health Group Corporation,First Health Network,209.52,97,,percent of total billed charges,,
"Bk Virus Pcr, Quant, P (Mayo)OutsideLaboratory",,87799,CPT,Facility,Both,,,90,216,183.6,61.9056,216,"Health Partners, Inc.",Commercial,204.336,94.6,,percent of total billed charges,,
"Bk Virus Pcr, Quant, P (Mayo)OutsideLaboratory",,87799,CPT,Facility,Outpatient,,,90,216,183.6,61.9056,216,"Health Partners, Inc.",Medicare Advantage,105.84,49,,percent of total billed charges,,
"Bk Virus Pcr, Quant, P (Mayo)OutsideLaboratory",,87799,CPT,Facility,Inpatient,,,90,216,183.6,61.9056,216,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Bk Virus Pcr, Quant, P (Mayo)OutsideLaboratory",,87799,CPT,Facility,Both,,,90,216,183.6,61.9056,216,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),129.6,60,,percent of total billed charges,,
"Bk Virus Pcr, Quant, P (Mayo)OutsideLaboratory",,87799,CPT,Facility,Both,,,90,216,183.6,61.9056,216,"Health Partners, Inc.",State of Minnesota Advantage Program,176.04,81.5,,percent of total billed charges,,
"Bk Virus Pcr, Quant, P (Mayo)OutsideLaboratory",,87799,CPT,Facility,Both,,,90,216,183.6,61.9056,216,"Health Partners, Inc.",State Public Programs,108,50,,percent of total billed charges,,
"Bk Virus Pcr, Quant, P (Mayo)OutsideLaboratory",,87799,CPT,Facility,Both,,,90,216,183.6,61.9056,216,Humana Insurance Company,Commercial PPO,205.2,95,,percent of total billed charges,,
"Bk Virus Pcr, Quant, P (Mayo)OutsideLaboratory",,87799,CPT,Facility,Outpatient,,,90,216,183.6,61.9056,216,Humana Insurance Company,Medicare PPO,105.84,49,,percent of total billed charges,,
"Bk Virus Pcr, Quant, P (Mayo)OutsideLaboratory",,87799,CPT,Facility,Inpatient,,,90,216,183.6,61.9056,216,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Bk Virus Pcr, Quant, P (Mayo)OutsideLaboratory",,87799,CPT,Facility,Both,,,90,216,183.6,61.9056,216,Medica,Individual & Family,214.056,99.1,,percent of total billed charges,,
"Bk Virus Pcr, Quant, P (Mayo)OutsideLaboratory",,87799,CPT,Facility,Outpatient,,,90,216,183.6,61.9056,216,Medica,Medica Advantage Solution,107.568,49.8,,percent of total billed charges,,
"Bk Virus Pcr, Quant, P (Mayo)OutsideLaboratory",,87799,CPT,Facility,Inpatient,,,90,216,183.6,61.9056,216,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Bk Virus Pcr, Quant, P (Mayo)OutsideLaboratory",,87799,CPT,Facility,Outpatient,,,90,216,183.6,61.9056,216,Medica,Medical Assistance,96.336,44.6,,percent of total billed charges,,
"Bk Virus Pcr, Quant, P (Mayo)OutsideLaboratory",,87799,CPT,Facility,Inpatient,,,90,216,183.6,61.9056,216,Medica,Medical Assistance,,,,,Included in per diem rate,
"Bk Virus Pcr, Quant, P (Mayo)OutsideLaboratory",,87799,CPT,Facility,Outpatient,,,90,216,183.6,61.9056,216,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,107.568,49.8,,percent of total billed charges,,
"Bk Virus Pcr, Quant, P (Mayo)OutsideLaboratory",,87799,CPT,Facility,Inpatient,,,90,216,183.6,61.9056,216,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Bk Virus Pcr, Quant, P (Mayo)OutsideLaboratory",,87799,CPT,Facility,Both,,,90,216,183.6,61.9056,216,"Multiplan, Inc.","Multiplan, Inc.",203.04,94,,percent of total billed charges,,
"Bk Virus Pcr, Quant, P (Mayo)OutsideLaboratory",,87799,CPT,Facility,Outpatient,,,90,216,183.6,61.9056,216,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,186.624,86.4,,percent of total billed charges,,
"Bk Virus Pcr, Quant, P (Mayo)OutsideLaboratory",,87799,CPT,Facility,Inpatient,,,90,216,183.6,61.9056,216,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Bk Virus Pcr, Quant, P (Mayo)OutsideLaboratory",,87799,CPT,Facility,Both,,,90,216,183.6,61.9056,216,"Preferred One Administrative Services, INC.",PPO,212.976,98.6,,percent of total billed charges,,
"Bk Virus Pcr, Quant, P (Mayo)OutsideLaboratory",,87799,CPT,Facility,Outpatient,,,90,216,183.6,61.9056,216,PrimeWest Health,Minnesota Senior Health Options (MSHO),111.132,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Bk Virus Pcr, Quant, P (Mayo)OutsideLaboratory",,87799,CPT,Facility,Inpatient,,,90,216,183.6,61.9056,216,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Bk Virus Pcr, Quant, P (Mayo)OutsideLaboratory",,87799,CPT,Facility,Outpatient,,,90,216,183.6,61.9056,216,PrimeWest Health,MinnesotaCare,110.9376,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Bk Virus Pcr, Quant, P (Mayo)OutsideLaboratory",,87799,CPT,Facility,Inpatient,,,90,216,183.6,61.9056,216,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Bk Virus Pcr, Quant, P (Mayo)OutsideLaboratory",,87799,CPT,Facility,Both,,,90,216,183.6,61.9056,216,Sanford Health Plan,Sanford Health Plan,198.72,92,,percent of total billed charges,,
"Bk Virus Pcr, Quant, P (Mayo)OutsideLaboratory",,87799,CPT,Facility,Outpatient,,,90,216,183.6,61.9056,216,"UCare Health, Inc.",Individual & Family Plan,121.716,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Bk Virus Pcr, Quant, P (Mayo)OutsideLaboratory",,87799,CPT,Facility,Inpatient,,,90,216,183.6,61.9056,216,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Bk Virus Pcr, Quant, P (Mayo)OutsideLaboratory",,87799,CPT,Facility,Outpatient,,,90,216,183.6,61.9056,216,"UCare Health, Inc.",Medical Assistance,109.0152,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Bk Virus Pcr, Quant, P (Mayo)OutsideLaboratory",,87799,CPT,Facility,Inpatient,,,90,216,183.6,61.9056,216,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Bk Virus Pcr, Quant, P (Mayo)OutsideLaboratory",,87799,CPT,Facility,Outpatient,,,90,216,183.6,61.9056,216,"UCare Health, Inc.",Medicare Advantage,109.0152,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Bk Virus Pcr, Quant, P (Mayo)OutsideLaboratory",,87799,CPT,Facility,Inpatient,,,90,216,183.6,61.9056,216,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Bk Virus Pcr, Quant, P (Mayo)OutsideLaboratory",,87799,CPT,Facility,Outpatient,,,90,216,183.6,61.9056,216,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),109.0152,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Bk Virus Pcr, Quant, P (Mayo)OutsideLaboratory",,87799,CPT,Facility,Inpatient,,,90,216,183.6,61.9056,216,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Bk Virus Pcr, Quant, P (Mayo)OutsideLaboratory",,87799,CPT,Facility,Both,,,90,216,183.6,61.9056,216,UnitedHealthcare,Individual & Family,203.04,94,,percent of total billed charges,,
"Bk Virus Pcr, Quant, P (Mayo)OutsideLaboratory",,87799,CPT,Facility,Outpatient,,,90,216,183.6,61.9056,216,UnitedHealthcare,Medicare Advantage,105.84,49,,percent of total billed charges,,
"Bk Virus Pcr, Quant, P (Mayo)OutsideLaboratory",,87799,CPT,Facility,Inpatient,,,90,216,183.6,61.9056,216,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Bk Virus Pcr, Quant, P (Mayo)OutsideLaboratory",,87799,CPT,Facility,Outpatient,,,90,216,183.6,61.9056,216,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,103.68,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Bk Virus Pcr, Quant, P (Mayo)OutsideLaboratory",,87799,CPT,Facility,Inpatient,,,90,216,183.6,61.9056,216,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Epstein-Barr Virus Pcr, Quant, B (Mayo)OutsideLaboratory",,87799,CPT,Facility,Both,,,90,259,220.15,74.2294,259,Aetna,Commercial,238.28,92,,percent of total billed charges,,
"Epstein-Barr Virus Pcr, Quant, B (Mayo)OutsideLaboratory",,87799,CPT,Facility,Outpatient,,,90,259,220.15,74.2294,259,Aetna,Medicare Advantage,126.91,49,,percent of total billed charges,,
"Epstein-Barr Virus Pcr, Quant, B (Mayo)OutsideLaboratory",,87799,CPT,Facility,Inpatient,,,90,259,220.15,74.2294,259,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Epstein-Barr Virus Pcr, Quant, B (Mayo)OutsideLaboratory",,87799,CPT,Facility,Both,,,90,259,220.15,74.2294,259,Aetna,PPO,240.87,93,,percent of total billed charges,,
"Epstein-Barr Virus Pcr, Quant, B (Mayo)OutsideLaboratory",,87799,CPT,Facility,Both,,,90,259,220.15,74.2294,259,America's PPO,America's PPO,248.7177,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Epstein-Barr Virus Pcr, Quant, B (Mayo)OutsideLaboratory",,87799,CPT,Facility,Both,,,90,259,220.15,74.2294,259,BlueCross BlueShield Minnesota, Federal Employee Program,254.856,98.4,,percent of total billed charges,,
"Epstein-Barr Virus Pcr, Quant, B (Mayo)OutsideLaboratory",,87799,CPT,Facility,Both,,,90,259,220.15,74.2294,259,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,259,100,,percent of total billed charges,,
"Epstein-Barr Virus Pcr, Quant, B (Mayo)OutsideLaboratory",,87799,CPT,Facility,Both,,,90,259,220.15,74.2294,259,BlueCross BlueShield Minnesota,High Value Network Plan,233.1,90,,percent of total billed charges,,
"Epstein-Barr Virus Pcr, Quant, B (Mayo)OutsideLaboratory",,87799,CPT,Facility,Outpatient,,,90,259,220.15,74.2294,259,BlueCross BlueShield Minnesota,Medicare Advantage,126.91,49,,percent of total billed charges,,
"Epstein-Barr Virus Pcr, Quant, B (Mayo)OutsideLaboratory",,87799,CPT,Facility,Inpatient,,,90,259,220.15,74.2294,259,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Epstein-Barr Virus Pcr, Quant, B (Mayo)OutsideLaboratory",,87799,CPT,Facility,Both,,,90,259,220.15,74.2294,259,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,229.3963,88.57,,percent of total billed charges,,
"Epstein-Barr Virus Pcr, Quant, B (Mayo)OutsideLaboratory",,87799,CPT,Facility,Both,,,90,259,220.15,74.2294,259,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,74.2294,28.66,,percent of total billed charges,,
"Epstein-Barr Virus Pcr, Quant, B (Mayo)OutsideLaboratory",,87799,CPT,Facility,Outpatient,,,90,259,220.15,74.2294,259,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),126.91,49,,percent of total billed charges,,
"Epstein-Barr Virus Pcr, Quant, B (Mayo)OutsideLaboratory",,87799,CPT,Facility,Inpatient,,,90,259,220.15,74.2294,259,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Epstein-Barr Virus Pcr, Quant, B (Mayo)OutsideLaboratory",,87799,CPT,Facility,Both,,,90,259,220.15,74.2294,259,CorVel,Worker's Compensation,259,100,,percent of total billed charges,,
"Epstein-Barr Virus Pcr, Quant, B (Mayo)OutsideLaboratory",,87799,CPT,Facility,Both,,,90,259,220.15,74.2294,259,First Health Group Corporation,First Health Network,251.23,97,,percent of total billed charges,,
"Epstein-Barr Virus Pcr, Quant, B (Mayo)OutsideLaboratory",,87799,CPT,Facility,Both,,,90,259,220.15,74.2294,259,"Health Partners, Inc.",Commercial,245.014,94.6,,percent of total billed charges,,
"Epstein-Barr Virus Pcr, Quant, B (Mayo)OutsideLaboratory",,87799,CPT,Facility,Outpatient,,,90,259,220.15,74.2294,259,"Health Partners, Inc.",Medicare Advantage,126.91,49,,percent of total billed charges,,
"Epstein-Barr Virus Pcr, Quant, B (Mayo)OutsideLaboratory",,87799,CPT,Facility,Inpatient,,,90,259,220.15,74.2294,259,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Epstein-Barr Virus Pcr, Quant, B (Mayo)OutsideLaboratory",,87799,CPT,Facility,Both,,,90,259,220.15,74.2294,259,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),155.4,60,,percent of total billed charges,,
"Epstein-Barr Virus Pcr, Quant, B (Mayo)OutsideLaboratory",,87799,CPT,Facility,Both,,,90,259,220.15,74.2294,259,"Health Partners, Inc.",State of Minnesota Advantage Program,211.085,81.5,,percent of total billed charges,,
"Epstein-Barr Virus Pcr, Quant, B (Mayo)OutsideLaboratory",,87799,CPT,Facility,Both,,,90,259,220.15,74.2294,259,"Health Partners, Inc.",State Public Programs,129.5,50,,percent of total billed charges,,
"Epstein-Barr Virus Pcr, Quant, B (Mayo)OutsideLaboratory",,87799,CPT,Facility,Both,,,90,259,220.15,74.2294,259,Humana Insurance Company,Commercial PPO,246.05,95,,percent of total billed charges,,
"Epstein-Barr Virus Pcr, Quant, B (Mayo)OutsideLaboratory",,87799,CPT,Facility,Outpatient,,,90,259,220.15,74.2294,259,Humana Insurance Company,Medicare PPO,126.91,49,,percent of total billed charges,,
"Epstein-Barr Virus Pcr, Quant, B (Mayo)OutsideLaboratory",,87799,CPT,Facility,Inpatient,,,90,259,220.15,74.2294,259,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Epstein-Barr Virus Pcr, Quant, B (Mayo)OutsideLaboratory",,87799,CPT,Facility,Both,,,90,259,220.15,74.2294,259,Medica,Individual & Family,256.669,99.1,,percent of total billed charges,,
"Epstein-Barr Virus Pcr, Quant, B (Mayo)OutsideLaboratory",,87799,CPT,Facility,Outpatient,,,90,259,220.15,74.2294,259,Medica,Medica Advantage Solution,128.982,49.8,,percent of total billed charges,,
"Epstein-Barr Virus Pcr, Quant, B (Mayo)OutsideLaboratory",,87799,CPT,Facility,Inpatient,,,90,259,220.15,74.2294,259,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Epstein-Barr Virus Pcr, Quant, B (Mayo)OutsideLaboratory",,87799,CPT,Facility,Outpatient,,,90,259,220.15,74.2294,259,Medica,Medical Assistance,115.514,44.6,,percent of total billed charges,,
"Epstein-Barr Virus Pcr, Quant, B (Mayo)OutsideLaboratory",,87799,CPT,Facility,Inpatient,,,90,259,220.15,74.2294,259,Medica,Medical Assistance,,,,,Included in per diem rate,
"Epstein-Barr Virus Pcr, Quant, B (Mayo)OutsideLaboratory",,87799,CPT,Facility,Outpatient,,,90,259,220.15,74.2294,259,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,128.982,49.8,,percent of total billed charges,,
"Epstein-Barr Virus Pcr, Quant, B (Mayo)OutsideLaboratory",,87799,CPT,Facility,Inpatient,,,90,259,220.15,74.2294,259,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Epstein-Barr Virus Pcr, Quant, B (Mayo)OutsideLaboratory",,87799,CPT,Facility,Both,,,90,259,220.15,74.2294,259,"Multiplan, Inc.","Multiplan, Inc.",243.46,94,,percent of total billed charges,,
"Epstein-Barr Virus Pcr, Quant, B (Mayo)OutsideLaboratory",,87799,CPT,Facility,Outpatient,,,90,259,220.15,74.2294,259,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,223.776,86.4,,percent of total billed charges,,
"Epstein-Barr Virus Pcr, Quant, B (Mayo)OutsideLaboratory",,87799,CPT,Facility,Inpatient,,,90,259,220.15,74.2294,259,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Epstein-Barr Virus Pcr, Quant, B (Mayo)OutsideLaboratory",,87799,CPT,Facility,Both,,,90,259,220.15,74.2294,259,"Preferred One Administrative Services, INC.",PPO,255.374,98.6,,percent of total billed charges,,
"Epstein-Barr Virus Pcr, Quant, B (Mayo)OutsideLaboratory",,87799,CPT,Facility,Outpatient,,,90,259,220.15,74.2294,259,PrimeWest Health,Minnesota Senior Health Options (MSHO),133.2555,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Epstein-Barr Virus Pcr, Quant, B (Mayo)OutsideLaboratory",,87799,CPT,Facility,Inpatient,,,90,259,220.15,74.2294,259,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Epstein-Barr Virus Pcr, Quant, B (Mayo)OutsideLaboratory",,87799,CPT,Facility,Outpatient,,,90,259,220.15,74.2294,259,PrimeWest Health,MinnesotaCare,133.0224,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Epstein-Barr Virus Pcr, Quant, B (Mayo)OutsideLaboratory",,87799,CPT,Facility,Inpatient,,,90,259,220.15,74.2294,259,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Epstein-Barr Virus Pcr, Quant, B (Mayo)OutsideLaboratory",,87799,CPT,Facility,Both,,,90,259,220.15,74.2294,259,Sanford Health Plan,Sanford Health Plan,238.28,92,,percent of total billed charges,,
"Epstein-Barr Virus Pcr, Quant, B (Mayo)OutsideLaboratory",,87799,CPT,Facility,Outpatient,,,90,259,220.15,74.2294,259,"UCare Health, Inc.",Individual & Family Plan,145.9465,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Epstein-Barr Virus Pcr, Quant, B (Mayo)OutsideLaboratory",,87799,CPT,Facility,Inpatient,,,90,259,220.15,74.2294,259,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Epstein-Barr Virus Pcr, Quant, B (Mayo)OutsideLaboratory",,87799,CPT,Facility,Outpatient,,,90,259,220.15,74.2294,259,"UCare Health, Inc.",Medical Assistance,130.7173,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Epstein-Barr Virus Pcr, Quant, B (Mayo)OutsideLaboratory",,87799,CPT,Facility,Inpatient,,,90,259,220.15,74.2294,259,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Epstein-Barr Virus Pcr, Quant, B (Mayo)OutsideLaboratory",,87799,CPT,Facility,Outpatient,,,90,259,220.15,74.2294,259,"UCare Health, Inc.",Medicare Advantage,130.7173,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Epstein-Barr Virus Pcr, Quant, B (Mayo)OutsideLaboratory",,87799,CPT,Facility,Inpatient,,,90,259,220.15,74.2294,259,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Epstein-Barr Virus Pcr, Quant, B (Mayo)OutsideLaboratory",,87799,CPT,Facility,Outpatient,,,90,259,220.15,74.2294,259,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),130.7173,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Epstein-Barr Virus Pcr, Quant, B (Mayo)OutsideLaboratory",,87799,CPT,Facility,Inpatient,,,90,259,220.15,74.2294,259,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Epstein-Barr Virus Pcr, Quant, B (Mayo)OutsideLaboratory",,87799,CPT,Facility,Both,,,90,259,220.15,74.2294,259,UnitedHealthcare,Individual & Family,243.46,94,,percent of total billed charges,,
"Epstein-Barr Virus Pcr, Quant, B (Mayo)OutsideLaboratory",,87799,CPT,Facility,Outpatient,,,90,259,220.15,74.2294,259,UnitedHealthcare,Medicare Advantage,126.91,49,,percent of total billed charges,,
"Epstein-Barr Virus Pcr, Quant, B (Mayo)OutsideLaboratory",,87799,CPT,Facility,Inpatient,,,90,259,220.15,74.2294,259,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Epstein-Barr Virus Pcr, Quant, B (Mayo)OutsideLaboratory",,87799,CPT,Facility,Outpatient,,,90,259,220.15,74.2294,259,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,124.32,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Epstein-Barr Virus Pcr, Quant, B (Mayo)OutsideLaboratory",,87799,CPT,Facility,Inpatient,,,90,259,220.15,74.2294,259,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Hcv Genotype, S (Mayo)OutsideLaboratory",,87902,CPT,Facility,Both,,,90,384,326.4,110.0544,384,Aetna,Commercial,353.28,92,,percent of total billed charges,,
"Hcv Genotype, S (Mayo)OutsideLaboratory",,87902,CPT,Facility,Outpatient,,,90,384,326.4,110.0544,384,Aetna,Medicare Advantage,188.16,49,,percent of total billed charges,,
"Hcv Genotype, S (Mayo)OutsideLaboratory",,87902,CPT,Facility,Inpatient,,,90,384,326.4,110.0544,384,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Hcv Genotype, S (Mayo)OutsideLaboratory",,87902,CPT,Facility,Both,,,90,384,326.4,110.0544,384,Aetna,PPO,357.12,93,,percent of total billed charges,,
"Hcv Genotype, S (Mayo)OutsideLaboratory",,87902,CPT,Facility,Both,,,90,384,326.4,110.0544,384,America's PPO,America's PPO,368.7552,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Hcv Genotype, S (Mayo)OutsideLaboratory",,87902,CPT,Facility,Both,,,90,384,326.4,110.0544,384,BlueCross BlueShield Minnesota, Federal Employee Program,377.856,98.4,,percent of total billed charges,,
"Hcv Genotype, S (Mayo)OutsideLaboratory",,87902,CPT,Facility,Both,,,90,384,326.4,110.0544,384,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,384,100,,percent of total billed charges,,
"Hcv Genotype, S (Mayo)OutsideLaboratory",,87902,CPT,Facility,Both,,,90,384,326.4,110.0544,384,BlueCross BlueShield Minnesota,High Value Network Plan,345.6,90,,percent of total billed charges,,
"Hcv Genotype, S (Mayo)OutsideLaboratory",,87902,CPT,Facility,Outpatient,,,90,384,326.4,110.0544,384,BlueCross BlueShield Minnesota,Medicare Advantage,188.16,49,,percent of total billed charges,,
"Hcv Genotype, S (Mayo)OutsideLaboratory",,87902,CPT,Facility,Inpatient,,,90,384,326.4,110.0544,384,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Hcv Genotype, S (Mayo)OutsideLaboratory",,87902,CPT,Facility,Both,,,90,384,326.4,110.0544,384,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,340.1088,88.57,,percent of total billed charges,,
"Hcv Genotype, S (Mayo)OutsideLaboratory",,87902,CPT,Facility,Both,,,90,384,326.4,110.0544,384,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,110.0544,28.66,,percent of total billed charges,,
"Hcv Genotype, S (Mayo)OutsideLaboratory",,87902,CPT,Facility,Outpatient,,,90,384,326.4,110.0544,384,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),188.16,49,,percent of total billed charges,,
"Hcv Genotype, S (Mayo)OutsideLaboratory",,87902,CPT,Facility,Inpatient,,,90,384,326.4,110.0544,384,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Hcv Genotype, S (Mayo)OutsideLaboratory",,87902,CPT,Facility,Both,,,90,384,326.4,110.0544,384,CorVel,Worker's Compensation,384,100,,percent of total billed charges,,
"Hcv Genotype, S (Mayo)OutsideLaboratory",,87902,CPT,Facility,Both,,,90,384,326.4,110.0544,384,First Health Group Corporation,First Health Network,372.48,97,,percent of total billed charges,,
"Hcv Genotype, S (Mayo)OutsideLaboratory",,87902,CPT,Facility,Both,,,90,384,326.4,110.0544,384,"Health Partners, Inc.",Commercial,363.264,94.6,,percent of total billed charges,,
"Hcv Genotype, S (Mayo)OutsideLaboratory",,87902,CPT,Facility,Outpatient,,,90,384,326.4,110.0544,384,"Health Partners, Inc.",Medicare Advantage,188.16,49,,percent of total billed charges,,
"Hcv Genotype, S (Mayo)OutsideLaboratory",,87902,CPT,Facility,Inpatient,,,90,384,326.4,110.0544,384,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Hcv Genotype, S (Mayo)OutsideLaboratory",,87902,CPT,Facility,Both,,,90,384,326.4,110.0544,384,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),230.4,60,,percent of total billed charges,,
"Hcv Genotype, S (Mayo)OutsideLaboratory",,87902,CPT,Facility,Both,,,90,384,326.4,110.0544,384,"Health Partners, Inc.",State of Minnesota Advantage Program,312.96,81.5,,percent of total billed charges,,
"Hcv Genotype, S (Mayo)OutsideLaboratory",,87902,CPT,Facility,Both,,,90,384,326.4,110.0544,384,"Health Partners, Inc.",State Public Programs,192,50,,percent of total billed charges,,
"Hcv Genotype, S (Mayo)OutsideLaboratory",,87902,CPT,Facility,Both,,,90,384,326.4,110.0544,384,Humana Insurance Company,Commercial PPO,364.8,95,,percent of total billed charges,,
"Hcv Genotype, S (Mayo)OutsideLaboratory",,87902,CPT,Facility,Outpatient,,,90,384,326.4,110.0544,384,Humana Insurance Company,Medicare PPO,188.16,49,,percent of total billed charges,,
"Hcv Genotype, S (Mayo)OutsideLaboratory",,87902,CPT,Facility,Inpatient,,,90,384,326.4,110.0544,384,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Hcv Genotype, S (Mayo)OutsideLaboratory",,87902,CPT,Facility,Both,,,90,384,326.4,110.0544,384,Medica,Individual & Family,380.544,99.1,,percent of total billed charges,,
"Hcv Genotype, S (Mayo)OutsideLaboratory",,87902,CPT,Facility,Outpatient,,,90,384,326.4,110.0544,384,Medica,Medica Advantage Solution,191.232,49.8,,percent of total billed charges,,
"Hcv Genotype, S (Mayo)OutsideLaboratory",,87902,CPT,Facility,Inpatient,,,90,384,326.4,110.0544,384,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Hcv Genotype, S (Mayo)OutsideLaboratory",,87902,CPT,Facility,Outpatient,,,90,384,326.4,110.0544,384,Medica,Medical Assistance,171.264,44.6,,percent of total billed charges,,
"Hcv Genotype, S (Mayo)OutsideLaboratory",,87902,CPT,Facility,Inpatient,,,90,384,326.4,110.0544,384,Medica,Medical Assistance,,,,,Included in per diem rate,
"Hcv Genotype, S (Mayo)OutsideLaboratory",,87902,CPT,Facility,Outpatient,,,90,384,326.4,110.0544,384,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,191.232,49.8,,percent of total billed charges,,
"Hcv Genotype, S (Mayo)OutsideLaboratory",,87902,CPT,Facility,Inpatient,,,90,384,326.4,110.0544,384,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Hcv Genotype, S (Mayo)OutsideLaboratory",,87902,CPT,Facility,Both,,,90,384,326.4,110.0544,384,"Multiplan, Inc.","Multiplan, Inc.",360.96,94,,percent of total billed charges,,
"Hcv Genotype, S (Mayo)OutsideLaboratory",,87902,CPT,Facility,Outpatient,,,90,384,326.4,110.0544,384,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,331.776,86.4,,percent of total billed charges,,
"Hcv Genotype, S (Mayo)OutsideLaboratory",,87902,CPT,Facility,Inpatient,,,90,384,326.4,110.0544,384,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Hcv Genotype, S (Mayo)OutsideLaboratory",,87902,CPT,Facility,Both,,,90,384,326.4,110.0544,384,"Preferred One Administrative Services, INC.",PPO,378.624,98.6,,percent of total billed charges,,
"Hcv Genotype, S (Mayo)OutsideLaboratory",,87902,CPT,Facility,Outpatient,,,90,384,326.4,110.0544,384,PrimeWest Health,Minnesota Senior Health Options (MSHO),197.568,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Hcv Genotype, S (Mayo)OutsideLaboratory",,87902,CPT,Facility,Inpatient,,,90,384,326.4,110.0544,384,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Hcv Genotype, S (Mayo)OutsideLaboratory",,87902,CPT,Facility,Outpatient,,,90,384,326.4,110.0544,384,PrimeWest Health,MinnesotaCare,197.2224,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Hcv Genotype, S (Mayo)OutsideLaboratory",,87902,CPT,Facility,Inpatient,,,90,384,326.4,110.0544,384,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Hcv Genotype, S (Mayo)OutsideLaboratory",,87902,CPT,Facility,Both,,,90,384,326.4,110.0544,384,Sanford Health Plan,Sanford Health Plan,353.28,92,,percent of total billed charges,,
"Hcv Genotype, S (Mayo)OutsideLaboratory",,87902,CPT,Facility,Outpatient,,,90,384,326.4,110.0544,384,"UCare Health, Inc.",Individual & Family Plan,216.384,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Hcv Genotype, S (Mayo)OutsideLaboratory",,87902,CPT,Facility,Inpatient,,,90,384,326.4,110.0544,384,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Hcv Genotype, S (Mayo)OutsideLaboratory",,87902,CPT,Facility,Outpatient,,,90,384,326.4,110.0544,384,"UCare Health, Inc.",Medical Assistance,193.8048,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Hcv Genotype, S (Mayo)OutsideLaboratory",,87902,CPT,Facility,Inpatient,,,90,384,326.4,110.0544,384,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Hcv Genotype, S (Mayo)OutsideLaboratory",,87902,CPT,Facility,Outpatient,,,90,384,326.4,110.0544,384,"UCare Health, Inc.",Medicare Advantage,193.8048,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Hcv Genotype, S (Mayo)OutsideLaboratory",,87902,CPT,Facility,Inpatient,,,90,384,326.4,110.0544,384,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Hcv Genotype, S (Mayo)OutsideLaboratory",,87902,CPT,Facility,Outpatient,,,90,384,326.4,110.0544,384,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),193.8048,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Hcv Genotype, S (Mayo)OutsideLaboratory",,87902,CPT,Facility,Inpatient,,,90,384,326.4,110.0544,384,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Hcv Genotype, S (Mayo)OutsideLaboratory",,87902,CPT,Facility,Both,,,90,384,326.4,110.0544,384,UnitedHealthcare,Individual & Family,360.96,94,,percent of total billed charges,,
"Hcv Genotype, S (Mayo)OutsideLaboratory",,87902,CPT,Facility,Outpatient,,,90,384,326.4,110.0544,384,UnitedHealthcare,Medicare Advantage,188.16,49,,percent of total billed charges,,
"Hcv Genotype, S (Mayo)OutsideLaboratory",,87902,CPT,Facility,Inpatient,,,90,384,326.4,110.0544,384,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Hcv Genotype, S (Mayo)OutsideLaboratory",,87902,CPT,Facility,Outpatient,,,90,384,326.4,110.0544,384,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,184.32,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Hcv Genotype, S (Mayo)OutsideLaboratory",,87902,CPT,Facility,Inpatient,,,90,384,326.4,110.0544,384,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Urovysion (R) For Bladder Cancer (Mayo)OutsideLaboratory,,88120,CPT,Facility,Both,,,90,942,800.7,269.9772,942,Aetna,Commercial,866.64,92,,percent of total billed charges,,
Urovysion (R) For Bladder Cancer (Mayo)OutsideLaboratory,,88120,CPT,Facility,Outpatient,,,90,942,800.7,269.9772,942,Aetna,Medicare Advantage,461.58,49,,percent of total billed charges,,
Urovysion (R) For Bladder Cancer (Mayo)OutsideLaboratory,,88120,CPT,Facility,Inpatient,,,90,942,800.7,269.9772,942,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Urovysion (R) For Bladder Cancer (Mayo)OutsideLaboratory,,88120,CPT,Facility,Both,,,90,942,800.7,269.9772,942,Aetna,PPO,876.06,93,,percent of total billed charges,,
Urovysion (R) For Bladder Cancer (Mayo)OutsideLaboratory,,88120,CPT,Facility,Both,,,90,942,800.7,269.9772,942,America's PPO,America's PPO,904.6026,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Urovysion (R) For Bladder Cancer (Mayo)OutsideLaboratory,,88120,CPT,Facility,Both,,,90,942,800.7,269.9772,942,BlueCross BlueShield Minnesota, Federal Employee Program,926.928,98.4,,percent of total billed charges,,
Urovysion (R) For Bladder Cancer (Mayo)OutsideLaboratory,,88120,CPT,Facility,Both,,,90,942,800.7,269.9772,942,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,942,100,,percent of total billed charges,,
Urovysion (R) For Bladder Cancer (Mayo)OutsideLaboratory,,88120,CPT,Facility,Both,,,90,942,800.7,269.9772,942,BlueCross BlueShield Minnesota,High Value Network Plan,847.8,90,,percent of total billed charges,,
Urovysion (R) For Bladder Cancer (Mayo)OutsideLaboratory,,88120,CPT,Facility,Outpatient,,,90,942,800.7,269.9772,942,BlueCross BlueShield Minnesota,Medicare Advantage,461.58,49,,percent of total billed charges,,
Urovysion (R) For Bladder Cancer (Mayo)OutsideLaboratory,,88120,CPT,Facility,Inpatient,,,90,942,800.7,269.9772,942,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Urovysion (R) For Bladder Cancer (Mayo)OutsideLaboratory,,88120,CPT,Facility,Both,,,90,942,800.7,269.9772,942,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,834.3294,88.57,,percent of total billed charges,,
Urovysion (R) For Bladder Cancer (Mayo)OutsideLaboratory,,88120,CPT,Facility,Both,,,90,942,800.7,269.9772,942,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,269.9772,28.66,,percent of total billed charges,,
Urovysion (R) For Bladder Cancer (Mayo)OutsideLaboratory,,88120,CPT,Facility,Outpatient,,,90,942,800.7,269.9772,942,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),461.58,49,,percent of total billed charges,,
Urovysion (R) For Bladder Cancer (Mayo)OutsideLaboratory,,88120,CPT,Facility,Inpatient,,,90,942,800.7,269.9772,942,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Urovysion (R) For Bladder Cancer (Mayo)OutsideLaboratory,,88120,CPT,Facility,Both,,,90,942,800.7,269.9772,942,CorVel,Worker's Compensation,942,100,,percent of total billed charges,,
Urovysion (R) For Bladder Cancer (Mayo)OutsideLaboratory,,88120,CPT,Facility,Both,,,90,942,800.7,269.9772,942,First Health Group Corporation,First Health Network,913.74,97,,percent of total billed charges,,
Urovysion (R) For Bladder Cancer (Mayo)OutsideLaboratory,,88120,CPT,Facility,Both,,,90,942,800.7,269.9772,942,"Health Partners, Inc.",Commercial,891.132,94.6,,percent of total billed charges,,
Urovysion (R) For Bladder Cancer (Mayo)OutsideLaboratory,,88120,CPT,Facility,Outpatient,,,90,942,800.7,269.9772,942,"Health Partners, Inc.",Medicare Advantage,461.58,49,,percent of total billed charges,,
Urovysion (R) For Bladder Cancer (Mayo)OutsideLaboratory,,88120,CPT,Facility,Inpatient,,,90,942,800.7,269.9772,942,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Urovysion (R) For Bladder Cancer (Mayo)OutsideLaboratory,,88120,CPT,Facility,Both,,,90,942,800.7,269.9772,942,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),565.2,60,,percent of total billed charges,,
Urovysion (R) For Bladder Cancer (Mayo)OutsideLaboratory,,88120,CPT,Facility,Both,,,90,942,800.7,269.9772,942,"Health Partners, Inc.",State of Minnesota Advantage Program,767.73,81.5,,percent of total billed charges,,
Urovysion (R) For Bladder Cancer (Mayo)OutsideLaboratory,,88120,CPT,Facility,Both,,,90,942,800.7,269.9772,942,"Health Partners, Inc.",State Public Programs,471,50,,percent of total billed charges,,
Urovysion (R) For Bladder Cancer (Mayo)OutsideLaboratory,,88120,CPT,Facility,Both,,,90,942,800.7,269.9772,942,Humana Insurance Company,Commercial PPO,894.9,95,,percent of total billed charges,,
Urovysion (R) For Bladder Cancer (Mayo)OutsideLaboratory,,88120,CPT,Facility,Outpatient,,,90,942,800.7,269.9772,942,Humana Insurance Company,Medicare PPO,461.58,49,,percent of total billed charges,,
Urovysion (R) For Bladder Cancer (Mayo)OutsideLaboratory,,88120,CPT,Facility,Inpatient,,,90,942,800.7,269.9772,942,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Urovysion (R) For Bladder Cancer (Mayo)OutsideLaboratory,,88120,CPT,Facility,Both,,,90,942,800.7,269.9772,942,Medica,Individual & Family,933.522,99.1,,percent of total billed charges,,
Urovysion (R) For Bladder Cancer (Mayo)OutsideLaboratory,,88120,CPT,Facility,Outpatient,,,90,942,800.7,269.9772,942,Medica,Medica Advantage Solution,469.116,49.8,,percent of total billed charges,,
Urovysion (R) For Bladder Cancer (Mayo)OutsideLaboratory,,88120,CPT,Facility,Inpatient,,,90,942,800.7,269.9772,942,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Urovysion (R) For Bladder Cancer (Mayo)OutsideLaboratory,,88120,CPT,Facility,Outpatient,,,90,942,800.7,269.9772,942,Medica,Medical Assistance,420.132,44.6,,percent of total billed charges,,
Urovysion (R) For Bladder Cancer (Mayo)OutsideLaboratory,,88120,CPT,Facility,Inpatient,,,90,942,800.7,269.9772,942,Medica,Medical Assistance,,,,,Included in per diem rate,
Urovysion (R) For Bladder Cancer (Mayo)OutsideLaboratory,,88120,CPT,Facility,Outpatient,,,90,942,800.7,269.9772,942,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,469.116,49.8,,percent of total billed charges,,
Urovysion (R) For Bladder Cancer (Mayo)OutsideLaboratory,,88120,CPT,Facility,Inpatient,,,90,942,800.7,269.9772,942,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Urovysion (R) For Bladder Cancer (Mayo)OutsideLaboratory,,88120,CPT,Facility,Both,,,90,942,800.7,269.9772,942,"Multiplan, Inc.","Multiplan, Inc.",885.48,94,,percent of total billed charges,,
Urovysion (R) For Bladder Cancer (Mayo)OutsideLaboratory,,88120,CPT,Facility,Outpatient,,,90,942,800.7,269.9772,942,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,813.888,86.4,,percent of total billed charges,,
Urovysion (R) For Bladder Cancer (Mayo)OutsideLaboratory,,88120,CPT,Facility,Inpatient,,,90,942,800.7,269.9772,942,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Urovysion (R) For Bladder Cancer (Mayo)OutsideLaboratory,,88120,CPT,Facility,Both,,,90,942,800.7,269.9772,942,"Preferred One Administrative Services, INC.",PPO,928.812,98.6,,percent of total billed charges,,
Urovysion (R) For Bladder Cancer (Mayo)OutsideLaboratory,,88120,CPT,Facility,Outpatient,,,90,942,800.7,269.9772,942,PrimeWest Health,Minnesota Senior Health Options (MSHO),484.659,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Urovysion (R) For Bladder Cancer (Mayo)OutsideLaboratory,,88120,CPT,Facility,Inpatient,,,90,942,800.7,269.9772,942,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Urovysion (R) For Bladder Cancer (Mayo)OutsideLaboratory,,88120,CPT,Facility,Outpatient,,,90,942,800.7,269.9772,942,PrimeWest Health,MinnesotaCare,483.8112,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Urovysion (R) For Bladder Cancer (Mayo)OutsideLaboratory,,88120,CPT,Facility,Inpatient,,,90,942,800.7,269.9772,942,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Urovysion (R) For Bladder Cancer (Mayo)OutsideLaboratory,,88120,CPT,Facility,Both,,,90,942,800.7,269.9772,942,Sanford Health Plan,Sanford Health Plan,866.64,92,,percent of total billed charges,,
Urovysion (R) For Bladder Cancer (Mayo)OutsideLaboratory,,88120,CPT,Facility,Outpatient,,,90,942,800.7,269.9772,942,"UCare Health, Inc.",Individual & Family Plan,530.817,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Urovysion (R) For Bladder Cancer (Mayo)OutsideLaboratory,,88120,CPT,Facility,Inpatient,,,90,942,800.7,269.9772,942,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Urovysion (R) For Bladder Cancer (Mayo)OutsideLaboratory,,88120,CPT,Facility,Outpatient,,,90,942,800.7,269.9772,942,"UCare Health, Inc.",Medical Assistance,475.4274,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Urovysion (R) For Bladder Cancer (Mayo)OutsideLaboratory,,88120,CPT,Facility,Inpatient,,,90,942,800.7,269.9772,942,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Urovysion (R) For Bladder Cancer (Mayo)OutsideLaboratory,,88120,CPT,Facility,Outpatient,,,90,942,800.7,269.9772,942,"UCare Health, Inc.",Medicare Advantage,475.4274,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Urovysion (R) For Bladder Cancer (Mayo)OutsideLaboratory,,88120,CPT,Facility,Inpatient,,,90,942,800.7,269.9772,942,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Urovysion (R) For Bladder Cancer (Mayo)OutsideLaboratory,,88120,CPT,Facility,Outpatient,,,90,942,800.7,269.9772,942,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),475.4274,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Urovysion (R) For Bladder Cancer (Mayo)OutsideLaboratory,,88120,CPT,Facility,Inpatient,,,90,942,800.7,269.9772,942,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Urovysion (R) For Bladder Cancer (Mayo)OutsideLaboratory,,88120,CPT,Facility,Both,,,90,942,800.7,269.9772,942,UnitedHealthcare,Individual & Family,885.48,94,,percent of total billed charges,,
Urovysion (R) For Bladder Cancer (Mayo)OutsideLaboratory,,88120,CPT,Facility,Outpatient,,,90,942,800.7,269.9772,942,UnitedHealthcare,Medicare Advantage,461.58,49,,percent of total billed charges,,
Urovysion (R) For Bladder Cancer (Mayo)OutsideLaboratory,,88120,CPT,Facility,Inpatient,,,90,942,800.7,269.9772,942,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Urovysion (R) For Bladder Cancer (Mayo)OutsideLaboratory,,88120,CPT,Facility,Outpatient,,,90,942,800.7,269.9772,942,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,452.16,48,,percent of total billed charges,,100% of DHS outpatient percentage
Urovysion (R) For Bladder Cancer (Mayo)OutsideLaboratory,,88120,CPT,Facility,Inpatient,,,90,942,800.7,269.9772,942,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Flow Cytometry, Cell Surface, Cytoplasmic, Or Nuclear Marker, Technical Component Only; First Marker (Mayo)OutsideLaboratory",,88184,CPT,Facility,Both,,,90,259,220.15,74.2294,259,Aetna,Commercial,238.28,92,,percent of total billed charges,,
"Flow Cytometry, Cell Surface, Cytoplasmic, Or Nuclear Marker, Technical Component Only; First Marker (Mayo)OutsideLaboratory",,88184,CPT,Facility,Outpatient,,,90,259,220.15,74.2294,259,Aetna,Medicare Advantage,126.91,49,,percent of total billed charges,,
"Flow Cytometry, Cell Surface, Cytoplasmic, Or Nuclear Marker, Technical Component Only; First Marker (Mayo)OutsideLaboratory",,88184,CPT,Facility,Inpatient,,,90,259,220.15,74.2294,259,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Flow Cytometry, Cell Surface, Cytoplasmic, Or Nuclear Marker, Technical Component Only; First Marker (Mayo)OutsideLaboratory",,88184,CPT,Facility,Both,,,90,259,220.15,74.2294,259,Aetna,PPO,240.87,93,,percent of total billed charges,,
"Flow Cytometry, Cell Surface, Cytoplasmic, Or Nuclear Marker, Technical Component Only; First Marker (Mayo)OutsideLaboratory",,88184,CPT,Facility,Both,,,90,259,220.15,74.2294,259,America's PPO,America's PPO,248.7177,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Flow Cytometry, Cell Surface, Cytoplasmic, Or Nuclear Marker, Technical Component Only; First Marker (Mayo)OutsideLaboratory",,88184,CPT,Facility,Both,,,90,259,220.15,74.2294,259,BlueCross BlueShield Minnesota, Federal Employee Program,254.856,98.4,,percent of total billed charges,,
"Flow Cytometry, Cell Surface, Cytoplasmic, Or Nuclear Marker, Technical Component Only; First Marker (Mayo)OutsideLaboratory",,88184,CPT,Facility,Both,,,90,259,220.15,74.2294,259,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,259,100,,percent of total billed charges,,
"Flow Cytometry, Cell Surface, Cytoplasmic, Or Nuclear Marker, Technical Component Only; First Marker (Mayo)OutsideLaboratory",,88184,CPT,Facility,Both,,,90,259,220.15,74.2294,259,BlueCross BlueShield Minnesota,High Value Network Plan,233.1,90,,percent of total billed charges,,
"Flow Cytometry, Cell Surface, Cytoplasmic, Or Nuclear Marker, Technical Component Only; First Marker (Mayo)OutsideLaboratory",,88184,CPT,Facility,Outpatient,,,90,259,220.15,74.2294,259,BlueCross BlueShield Minnesota,Medicare Advantage,126.91,49,,percent of total billed charges,,
"Flow Cytometry, Cell Surface, Cytoplasmic, Or Nuclear Marker, Technical Component Only; First Marker (Mayo)OutsideLaboratory",,88184,CPT,Facility,Inpatient,,,90,259,220.15,74.2294,259,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Flow Cytometry, Cell Surface, Cytoplasmic, Or Nuclear Marker, Technical Component Only; First Marker (Mayo)OutsideLaboratory",,88184,CPT,Facility,Both,,,90,259,220.15,74.2294,259,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,229.3963,88.57,,percent of total billed charges,,
"Flow Cytometry, Cell Surface, Cytoplasmic, Or Nuclear Marker, Technical Component Only; First Marker (Mayo)OutsideLaboratory",,88184,CPT,Facility,Both,,,90,259,220.15,74.2294,259,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,74.2294,28.66,,percent of total billed charges,,
"Flow Cytometry, Cell Surface, Cytoplasmic, Or Nuclear Marker, Technical Component Only; First Marker (Mayo)OutsideLaboratory",,88184,CPT,Facility,Outpatient,,,90,259,220.15,74.2294,259,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),126.91,49,,percent of total billed charges,,
"Flow Cytometry, Cell Surface, Cytoplasmic, Or Nuclear Marker, Technical Component Only; First Marker (Mayo)OutsideLaboratory",,88184,CPT,Facility,Inpatient,,,90,259,220.15,74.2294,259,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Flow Cytometry, Cell Surface, Cytoplasmic, Or Nuclear Marker, Technical Component Only; First Marker (Mayo)OutsideLaboratory",,88184,CPT,Facility,Both,,,90,259,220.15,74.2294,259,CorVel,Worker's Compensation,259,100,,percent of total billed charges,,
"Flow Cytometry, Cell Surface, Cytoplasmic, Or Nuclear Marker, Technical Component Only; First Marker (Mayo)OutsideLaboratory",,88184,CPT,Facility,Both,,,90,259,220.15,74.2294,259,First Health Group Corporation,First Health Network,251.23,97,,percent of total billed charges,,
"Flow Cytometry, Cell Surface, Cytoplasmic, Or Nuclear Marker, Technical Component Only; First Marker (Mayo)OutsideLaboratory",,88184,CPT,Facility,Both,,,90,259,220.15,74.2294,259,"Health Partners, Inc.",Commercial,245.014,94.6,,percent of total billed charges,,
"Flow Cytometry, Cell Surface, Cytoplasmic, Or Nuclear Marker, Technical Component Only; First Marker (Mayo)OutsideLaboratory",,88184,CPT,Facility,Outpatient,,,90,259,220.15,74.2294,259,"Health Partners, Inc.",Medicare Advantage,126.91,49,,percent of total billed charges,,
"Flow Cytometry, Cell Surface, Cytoplasmic, Or Nuclear Marker, Technical Component Only; First Marker (Mayo)OutsideLaboratory",,88184,CPT,Facility,Inpatient,,,90,259,220.15,74.2294,259,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Flow Cytometry, Cell Surface, Cytoplasmic, Or Nuclear Marker, Technical Component Only; First Marker (Mayo)OutsideLaboratory",,88184,CPT,Facility,Both,,,90,259,220.15,74.2294,259,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),155.4,60,,percent of total billed charges,,
"Flow Cytometry, Cell Surface, Cytoplasmic, Or Nuclear Marker, Technical Component Only; First Marker (Mayo)OutsideLaboratory",,88184,CPT,Facility,Both,,,90,259,220.15,74.2294,259,"Health Partners, Inc.",State of Minnesota Advantage Program,211.085,81.5,,percent of total billed charges,,
"Flow Cytometry, Cell Surface, Cytoplasmic, Or Nuclear Marker, Technical Component Only; First Marker (Mayo)OutsideLaboratory",,88184,CPT,Facility,Both,,,90,259,220.15,74.2294,259,"Health Partners, Inc.",State Public Programs,129.5,50,,percent of total billed charges,,
"Flow Cytometry, Cell Surface, Cytoplasmic, Or Nuclear Marker, Technical Component Only; First Marker (Mayo)OutsideLaboratory",,88184,CPT,Facility,Both,,,90,259,220.15,74.2294,259,Humana Insurance Company,Commercial PPO,246.05,95,,percent of total billed charges,,
"Flow Cytometry, Cell Surface, Cytoplasmic, Or Nuclear Marker, Technical Component Only; First Marker (Mayo)OutsideLaboratory",,88184,CPT,Facility,Outpatient,,,90,259,220.15,74.2294,259,Humana Insurance Company,Medicare PPO,126.91,49,,percent of total billed charges,,
"Flow Cytometry, Cell Surface, Cytoplasmic, Or Nuclear Marker, Technical Component Only; First Marker (Mayo)OutsideLaboratory",,88184,CPT,Facility,Inpatient,,,90,259,220.15,74.2294,259,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Flow Cytometry, Cell Surface, Cytoplasmic, Or Nuclear Marker, Technical Component Only; First Marker (Mayo)OutsideLaboratory",,88184,CPT,Facility,Both,,,90,259,220.15,74.2294,259,Medica,Individual & Family,256.669,99.1,,percent of total billed charges,,
"Flow Cytometry, Cell Surface, Cytoplasmic, Or Nuclear Marker, Technical Component Only; First Marker (Mayo)OutsideLaboratory",,88184,CPT,Facility,Outpatient,,,90,259,220.15,74.2294,259,Medica,Medica Advantage Solution,128.982,49.8,,percent of total billed charges,,
"Flow Cytometry, Cell Surface, Cytoplasmic, Or Nuclear Marker, Technical Component Only; First Marker (Mayo)OutsideLaboratory",,88184,CPT,Facility,Inpatient,,,90,259,220.15,74.2294,259,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Flow Cytometry, Cell Surface, Cytoplasmic, Or Nuclear Marker, Technical Component Only; First Marker (Mayo)OutsideLaboratory",,88184,CPT,Facility,Outpatient,,,90,259,220.15,74.2294,259,Medica,Medical Assistance,115.514,44.6,,percent of total billed charges,,
"Flow Cytometry, Cell Surface, Cytoplasmic, Or Nuclear Marker, Technical Component Only; First Marker (Mayo)OutsideLaboratory",,88184,CPT,Facility,Inpatient,,,90,259,220.15,74.2294,259,Medica,Medical Assistance,,,,,Included in per diem rate,
"Flow Cytometry, Cell Surface, Cytoplasmic, Or Nuclear Marker, Technical Component Only; First Marker (Mayo)OutsideLaboratory",,88184,CPT,Facility,Outpatient,,,90,259,220.15,74.2294,259,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,128.982,49.8,,percent of total billed charges,,
"Flow Cytometry, Cell Surface, Cytoplasmic, Or Nuclear Marker, Technical Component Only; First Marker (Mayo)OutsideLaboratory",,88184,CPT,Facility,Inpatient,,,90,259,220.15,74.2294,259,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Flow Cytometry, Cell Surface, Cytoplasmic, Or Nuclear Marker, Technical Component Only; First Marker (Mayo)OutsideLaboratory",,88184,CPT,Facility,Both,,,90,259,220.15,74.2294,259,"Multiplan, Inc.","Multiplan, Inc.",243.46,94,,percent of total billed charges,,
"Flow Cytometry, Cell Surface, Cytoplasmic, Or Nuclear Marker, Technical Component Only; First Marker (Mayo)OutsideLaboratory",,88184,CPT,Facility,Outpatient,,,90,259,220.15,74.2294,259,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,223.776,86.4,,percent of total billed charges,,
"Flow Cytometry, Cell Surface, Cytoplasmic, Or Nuclear Marker, Technical Component Only; First Marker (Mayo)OutsideLaboratory",,88184,CPT,Facility,Inpatient,,,90,259,220.15,74.2294,259,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Flow Cytometry, Cell Surface, Cytoplasmic, Or Nuclear Marker, Technical Component Only; First Marker (Mayo)OutsideLaboratory",,88184,CPT,Facility,Both,,,90,259,220.15,74.2294,259,"Preferred One Administrative Services, INC.",PPO,255.374,98.6,,percent of total billed charges,,
"Flow Cytometry, Cell Surface, Cytoplasmic, Or Nuclear Marker, Technical Component Only; First Marker (Mayo)OutsideLaboratory",,88184,CPT,Facility,Outpatient,,,90,259,220.15,74.2294,259,PrimeWest Health,Minnesota Senior Health Options (MSHO),133.2555,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Flow Cytometry, Cell Surface, Cytoplasmic, Or Nuclear Marker, Technical Component Only; First Marker (Mayo)OutsideLaboratory",,88184,CPT,Facility,Inpatient,,,90,259,220.15,74.2294,259,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Flow Cytometry, Cell Surface, Cytoplasmic, Or Nuclear Marker, Technical Component Only; First Marker (Mayo)OutsideLaboratory",,88184,CPT,Facility,Outpatient,,,90,259,220.15,74.2294,259,PrimeWest Health,MinnesotaCare,133.0224,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Flow Cytometry, Cell Surface, Cytoplasmic, Or Nuclear Marker, Technical Component Only; First Marker (Mayo)OutsideLaboratory",,88184,CPT,Facility,Inpatient,,,90,259,220.15,74.2294,259,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Flow Cytometry, Cell Surface, Cytoplasmic, Or Nuclear Marker, Technical Component Only; First Marker (Mayo)OutsideLaboratory",,88184,CPT,Facility,Both,,,90,259,220.15,74.2294,259,Sanford Health Plan,Sanford Health Plan,238.28,92,,percent of total billed charges,,
"Flow Cytometry, Cell Surface, Cytoplasmic, Or Nuclear Marker, Technical Component Only; First Marker (Mayo)OutsideLaboratory",,88184,CPT,Facility,Outpatient,,,90,259,220.15,74.2294,259,"UCare Health, Inc.",Individual & Family Plan,145.9465,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Flow Cytometry, Cell Surface, Cytoplasmic, Or Nuclear Marker, Technical Component Only; First Marker (Mayo)OutsideLaboratory",,88184,CPT,Facility,Inpatient,,,90,259,220.15,74.2294,259,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Flow Cytometry, Cell Surface, Cytoplasmic, Or Nuclear Marker, Technical Component Only; First Marker (Mayo)OutsideLaboratory",,88184,CPT,Facility,Outpatient,,,90,259,220.15,74.2294,259,"UCare Health, Inc.",Medical Assistance,130.7173,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Flow Cytometry, Cell Surface, Cytoplasmic, Or Nuclear Marker, Technical Component Only; First Marker (Mayo)OutsideLaboratory",,88184,CPT,Facility,Inpatient,,,90,259,220.15,74.2294,259,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Flow Cytometry, Cell Surface, Cytoplasmic, Or Nuclear Marker, Technical Component Only; First Marker (Mayo)OutsideLaboratory",,88184,CPT,Facility,Outpatient,,,90,259,220.15,74.2294,259,"UCare Health, Inc.",Medicare Advantage,130.7173,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Flow Cytometry, Cell Surface, Cytoplasmic, Or Nuclear Marker, Technical Component Only; First Marker (Mayo)OutsideLaboratory",,88184,CPT,Facility,Inpatient,,,90,259,220.15,74.2294,259,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Flow Cytometry, Cell Surface, Cytoplasmic, Or Nuclear Marker, Technical Component Only; First Marker (Mayo)OutsideLaboratory",,88184,CPT,Facility,Outpatient,,,90,259,220.15,74.2294,259,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),130.7173,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Flow Cytometry, Cell Surface, Cytoplasmic, Or Nuclear Marker, Technical Component Only; First Marker (Mayo)OutsideLaboratory",,88184,CPT,Facility,Inpatient,,,90,259,220.15,74.2294,259,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Flow Cytometry, Cell Surface, Cytoplasmic, Or Nuclear Marker, Technical Component Only; First Marker (Mayo)OutsideLaboratory",,88184,CPT,Facility,Both,,,90,259,220.15,74.2294,259,UnitedHealthcare,Individual & Family,243.46,94,,percent of total billed charges,,
"Flow Cytometry, Cell Surface, Cytoplasmic, Or Nuclear Marker, Technical Component Only; First Marker (Mayo)OutsideLaboratory",,88184,CPT,Facility,Outpatient,,,90,259,220.15,74.2294,259,UnitedHealthcare,Medicare Advantage,126.91,49,,percent of total billed charges,,
"Flow Cytometry, Cell Surface, Cytoplasmic, Or Nuclear Marker, Technical Component Only; First Marker (Mayo)OutsideLaboratory",,88184,CPT,Facility,Inpatient,,,90,259,220.15,74.2294,259,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Flow Cytometry, Cell Surface, Cytoplasmic, Or Nuclear Marker, Technical Component Only; First Marker (Mayo)OutsideLaboratory",,88184,CPT,Facility,Outpatient,,,90,259,220.15,74.2294,259,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,124.32,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Flow Cytometry, Cell Surface, Cytoplasmic, Or Nuclear Marker, Technical Component Only; First Marker (Mayo)OutsideLaboratory",,88184,CPT,Facility,Inpatient,,,90,259,220.15,74.2294,259,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Leukemia/Lymphoma, Phenotype (Mayo)OutsideLaboratory",,88184,CPT,Facility,Both,,,90,259,220.15,74.2294,259,Aetna,Commercial,238.28,92,,percent of total billed charges,,
"Leukemia/Lymphoma, Phenotype (Mayo)OutsideLaboratory",,88184,CPT,Facility,Outpatient,,,90,259,220.15,74.2294,259,Aetna,Medicare Advantage,126.91,49,,percent of total billed charges,,
"Leukemia/Lymphoma, Phenotype (Mayo)OutsideLaboratory",,88184,CPT,Facility,Inpatient,,,90,259,220.15,74.2294,259,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Leukemia/Lymphoma, Phenotype (Mayo)OutsideLaboratory",,88184,CPT,Facility,Both,,,90,259,220.15,74.2294,259,Aetna,PPO,240.87,93,,percent of total billed charges,,
"Leukemia/Lymphoma, Phenotype (Mayo)OutsideLaboratory",,88184,CPT,Facility,Both,,,90,259,220.15,74.2294,259,America's PPO,America's PPO,248.7177,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Leukemia/Lymphoma, Phenotype (Mayo)OutsideLaboratory",,88184,CPT,Facility,Both,,,90,259,220.15,74.2294,259,BlueCross BlueShield Minnesota, Federal Employee Program,254.856,98.4,,percent of total billed charges,,
"Leukemia/Lymphoma, Phenotype (Mayo)OutsideLaboratory",,88184,CPT,Facility,Both,,,90,259,220.15,74.2294,259,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,259,100,,percent of total billed charges,,
"Leukemia/Lymphoma, Phenotype (Mayo)OutsideLaboratory",,88184,CPT,Facility,Both,,,90,259,220.15,74.2294,259,BlueCross BlueShield Minnesota,High Value Network Plan,233.1,90,,percent of total billed charges,,
"Leukemia/Lymphoma, Phenotype (Mayo)OutsideLaboratory",,88184,CPT,Facility,Outpatient,,,90,259,220.15,74.2294,259,BlueCross BlueShield Minnesota,Medicare Advantage,126.91,49,,percent of total billed charges,,
"Leukemia/Lymphoma, Phenotype (Mayo)OutsideLaboratory",,88184,CPT,Facility,Inpatient,,,90,259,220.15,74.2294,259,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Leukemia/Lymphoma, Phenotype (Mayo)OutsideLaboratory",,88184,CPT,Facility,Both,,,90,259,220.15,74.2294,259,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,229.3963,88.57,,percent of total billed charges,,
"Leukemia/Lymphoma, Phenotype (Mayo)OutsideLaboratory",,88184,CPT,Facility,Both,,,90,259,220.15,74.2294,259,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,74.2294,28.66,,percent of total billed charges,,
"Leukemia/Lymphoma, Phenotype (Mayo)OutsideLaboratory",,88184,CPT,Facility,Outpatient,,,90,259,220.15,74.2294,259,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),126.91,49,,percent of total billed charges,,
"Leukemia/Lymphoma, Phenotype (Mayo)OutsideLaboratory",,88184,CPT,Facility,Inpatient,,,90,259,220.15,74.2294,259,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Leukemia/Lymphoma, Phenotype (Mayo)OutsideLaboratory",,88184,CPT,Facility,Both,,,90,259,220.15,74.2294,259,CorVel,Worker's Compensation,259,100,,percent of total billed charges,,
"Leukemia/Lymphoma, Phenotype (Mayo)OutsideLaboratory",,88184,CPT,Facility,Both,,,90,259,220.15,74.2294,259,First Health Group Corporation,First Health Network,251.23,97,,percent of total billed charges,,
"Leukemia/Lymphoma, Phenotype (Mayo)OutsideLaboratory",,88184,CPT,Facility,Both,,,90,259,220.15,74.2294,259,"Health Partners, Inc.",Commercial,245.014,94.6,,percent of total billed charges,,
"Leukemia/Lymphoma, Phenotype (Mayo)OutsideLaboratory",,88184,CPT,Facility,Outpatient,,,90,259,220.15,74.2294,259,"Health Partners, Inc.",Medicare Advantage,126.91,49,,percent of total billed charges,,
"Leukemia/Lymphoma, Phenotype (Mayo)OutsideLaboratory",,88184,CPT,Facility,Inpatient,,,90,259,220.15,74.2294,259,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Leukemia/Lymphoma, Phenotype (Mayo)OutsideLaboratory",,88184,CPT,Facility,Both,,,90,259,220.15,74.2294,259,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),155.4,60,,percent of total billed charges,,
"Leukemia/Lymphoma, Phenotype (Mayo)OutsideLaboratory",,88184,CPT,Facility,Both,,,90,259,220.15,74.2294,259,"Health Partners, Inc.",State of Minnesota Advantage Program,211.085,81.5,,percent of total billed charges,,
"Leukemia/Lymphoma, Phenotype (Mayo)OutsideLaboratory",,88184,CPT,Facility,Both,,,90,259,220.15,74.2294,259,"Health Partners, Inc.",State Public Programs,129.5,50,,percent of total billed charges,,
"Leukemia/Lymphoma, Phenotype (Mayo)OutsideLaboratory",,88184,CPT,Facility,Both,,,90,259,220.15,74.2294,259,Humana Insurance Company,Commercial PPO,246.05,95,,percent of total billed charges,,
"Leukemia/Lymphoma, Phenotype (Mayo)OutsideLaboratory",,88184,CPT,Facility,Outpatient,,,90,259,220.15,74.2294,259,Humana Insurance Company,Medicare PPO,126.91,49,,percent of total billed charges,,
"Leukemia/Lymphoma, Phenotype (Mayo)OutsideLaboratory",,88184,CPT,Facility,Inpatient,,,90,259,220.15,74.2294,259,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Leukemia/Lymphoma, Phenotype (Mayo)OutsideLaboratory",,88184,CPT,Facility,Both,,,90,259,220.15,74.2294,259,Medica,Individual & Family,256.669,99.1,,percent of total billed charges,,
"Leukemia/Lymphoma, Phenotype (Mayo)OutsideLaboratory",,88184,CPT,Facility,Outpatient,,,90,259,220.15,74.2294,259,Medica,Medica Advantage Solution,128.982,49.8,,percent of total billed charges,,
"Leukemia/Lymphoma, Phenotype (Mayo)OutsideLaboratory",,88184,CPT,Facility,Inpatient,,,90,259,220.15,74.2294,259,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Leukemia/Lymphoma, Phenotype (Mayo)OutsideLaboratory",,88184,CPT,Facility,Outpatient,,,90,259,220.15,74.2294,259,Medica,Medical Assistance,115.514,44.6,,percent of total billed charges,,
"Leukemia/Lymphoma, Phenotype (Mayo)OutsideLaboratory",,88184,CPT,Facility,Inpatient,,,90,259,220.15,74.2294,259,Medica,Medical Assistance,,,,,Included in per diem rate,
"Leukemia/Lymphoma, Phenotype (Mayo)OutsideLaboratory",,88184,CPT,Facility,Outpatient,,,90,259,220.15,74.2294,259,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,128.982,49.8,,percent of total billed charges,,
"Leukemia/Lymphoma, Phenotype (Mayo)OutsideLaboratory",,88184,CPT,Facility,Inpatient,,,90,259,220.15,74.2294,259,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Leukemia/Lymphoma, Phenotype (Mayo)OutsideLaboratory",,88184,CPT,Facility,Both,,,90,259,220.15,74.2294,259,"Multiplan, Inc.","Multiplan, Inc.",243.46,94,,percent of total billed charges,,
"Leukemia/Lymphoma, Phenotype (Mayo)OutsideLaboratory",,88184,CPT,Facility,Outpatient,,,90,259,220.15,74.2294,259,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,233.359,90.1,,percent of total billed charges,,
"Leukemia/Lymphoma, Phenotype (Mayo)OutsideLaboratory",,88184,CPT,Facility,Inpatient,,,90,259,220.15,74.2294,259,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Leukemia/Lymphoma, Phenotype (Mayo)OutsideLaboratory",,88184,CPT,Facility,Both,,,90,259,220.15,74.2294,259,"Preferred One Administrative Services, INC.",PPO,255.374,98.6,,percent of total billed charges,,
"Leukemia/Lymphoma, Phenotype (Mayo)OutsideLaboratory",,88184,CPT,Facility,Outpatient,,,90,259,220.15,74.2294,259,PrimeWest Health,Minnesota Senior Health Options (MSHO),133.2555,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Leukemia/Lymphoma, Phenotype (Mayo)OutsideLaboratory",,88184,CPT,Facility,Inpatient,,,90,259,220.15,74.2294,259,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Leukemia/Lymphoma, Phenotype (Mayo)OutsideLaboratory",,88184,CPT,Facility,Outpatient,,,90,259,220.15,74.2294,259,PrimeWest Health,MinnesotaCare,133.0224,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Leukemia/Lymphoma, Phenotype (Mayo)OutsideLaboratory",,88184,CPT,Facility,Inpatient,,,90,259,220.15,74.2294,259,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Leukemia/Lymphoma, Phenotype (Mayo)OutsideLaboratory",,88184,CPT,Facility,Both,,,90,259,220.15,74.2294,259,Sanford Health Plan,Sanford Health Plan,238.28,92,,percent of total billed charges,,
"Leukemia/Lymphoma, Phenotype (Mayo)OutsideLaboratory",,88184,CPT,Facility,Outpatient,,,90,259,220.15,74.2294,259,"UCare Health, Inc.",Individual & Family Plan,145.9465,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Leukemia/Lymphoma, Phenotype (Mayo)OutsideLaboratory",,88184,CPT,Facility,Inpatient,,,90,259,220.15,74.2294,259,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Leukemia/Lymphoma, Phenotype (Mayo)OutsideLaboratory",,88184,CPT,Facility,Outpatient,,,90,259,220.15,74.2294,259,"UCare Health, Inc.",Medical Assistance,130.7173,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Leukemia/Lymphoma, Phenotype (Mayo)OutsideLaboratory",,88184,CPT,Facility,Inpatient,,,90,259,220.15,74.2294,259,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Leukemia/Lymphoma, Phenotype (Mayo)OutsideLaboratory",,88184,CPT,Facility,Outpatient,,,90,259,220.15,74.2294,259,"UCare Health, Inc.",Medicare Advantage,130.7173,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Leukemia/Lymphoma, Phenotype (Mayo)OutsideLaboratory",,88184,CPT,Facility,Inpatient,,,90,259,220.15,74.2294,259,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Leukemia/Lymphoma, Phenotype (Mayo)OutsideLaboratory",,88184,CPT,Facility,Outpatient,,,90,259,220.15,74.2294,259,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),130.7173,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Leukemia/Lymphoma, Phenotype (Mayo)OutsideLaboratory",,88184,CPT,Facility,Inpatient,,,90,259,220.15,74.2294,259,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Leukemia/Lymphoma, Phenotype (Mayo)OutsideLaboratory",,88184,CPT,Facility,Both,,,90,259,220.15,74.2294,259,UnitedHealthcare,Individual & Family,243.46,94,,percent of total billed charges,,
"Leukemia/Lymphoma, Phenotype (Mayo)OutsideLaboratory",,88184,CPT,Facility,Outpatient,,,90,259,220.15,74.2294,259,UnitedHealthcare,Medicare Advantage,126.91,49,,percent of total billed charges,,
"Leukemia/Lymphoma, Phenotype (Mayo)OutsideLaboratory",,88184,CPT,Facility,Inpatient,,,90,259,220.15,74.2294,259,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Leukemia/Lymphoma, Phenotype (Mayo)OutsideLaboratory",,88184,CPT,Facility,Outpatient,,,90,259,220.15,74.2294,259,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,124.32,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Leukemia/Lymphoma, Phenotype (Mayo)OutsideLaboratory",,88184,CPT,Facility,Inpatient,,,90,259,220.15,74.2294,259,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Pnh, Pi-Linked Ag, B (Mayo)OutsideLaboratory",,88184,CPT,Facility,Both,,,90,84,71.4,24.0744,84,Aetna,Commercial,77.28,92,,percent of total billed charges,,
"Pnh, Pi-Linked Ag, B (Mayo)OutsideLaboratory",,88184,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,Aetna,Medicare Advantage,41.16,49,,percent of total billed charges,,
"Pnh, Pi-Linked Ag, B (Mayo)OutsideLaboratory",,88184,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Pnh, Pi-Linked Ag, B (Mayo)OutsideLaboratory",,88184,CPT,Facility,Both,,,90,84,71.4,24.0744,84,Aetna,PPO,78.12,93,,percent of total billed charges,,
"Pnh, Pi-Linked Ag, B (Mayo)OutsideLaboratory",,88184,CPT,Facility,Both,,,90,84,71.4,24.0744,84,America's PPO,America's PPO,80.6652,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Pnh, Pi-Linked Ag, B (Mayo)OutsideLaboratory",,88184,CPT,Facility,Both,,,90,84,71.4,24.0744,84,BlueCross BlueShield Minnesota, Federal Employee Program,82.656,98.4,,percent of total billed charges,,
"Pnh, Pi-Linked Ag, B (Mayo)OutsideLaboratory",,88184,CPT,Facility,Both,,,90,84,71.4,24.0744,84,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,84,100,,percent of total billed charges,,
"Pnh, Pi-Linked Ag, B (Mayo)OutsideLaboratory",,88184,CPT,Facility,Both,,,90,84,71.4,24.0744,84,BlueCross BlueShield Minnesota,High Value Network Plan,75.6,90,,percent of total billed charges,,
"Pnh, Pi-Linked Ag, B (Mayo)OutsideLaboratory",,88184,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,BlueCross BlueShield Minnesota,Medicare Advantage,41.16,49,,percent of total billed charges,,
"Pnh, Pi-Linked Ag, B (Mayo)OutsideLaboratory",,88184,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Pnh, Pi-Linked Ag, B (Mayo)OutsideLaboratory",,88184,CPT,Facility,Both,,,90,84,71.4,24.0744,84,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,74.3988,88.57,,percent of total billed charges,,
"Pnh, Pi-Linked Ag, B (Mayo)OutsideLaboratory",,88184,CPT,Facility,Both,,,90,84,71.4,24.0744,84,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,24.0744,28.66,,percent of total billed charges,,
"Pnh, Pi-Linked Ag, B (Mayo)OutsideLaboratory",,88184,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),41.16,49,,percent of total billed charges,,
"Pnh, Pi-Linked Ag, B (Mayo)OutsideLaboratory",,88184,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Pnh, Pi-Linked Ag, B (Mayo)OutsideLaboratory",,88184,CPT,Facility,Both,,,90,84,71.4,24.0744,84,CorVel,Worker's Compensation,84,100,,percent of total billed charges,,
"Pnh, Pi-Linked Ag, B (Mayo)OutsideLaboratory",,88184,CPT,Facility,Both,,,90,84,71.4,24.0744,84,First Health Group Corporation,First Health Network,81.48,97,,percent of total billed charges,,
"Pnh, Pi-Linked Ag, B (Mayo)OutsideLaboratory",,88184,CPT,Facility,Both,,,90,84,71.4,24.0744,84,"Health Partners, Inc.",Commercial,79.464,94.6,,percent of total billed charges,,
"Pnh, Pi-Linked Ag, B (Mayo)OutsideLaboratory",,88184,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,"Health Partners, Inc.",Medicare Advantage,41.16,49,,percent of total billed charges,,
"Pnh, Pi-Linked Ag, B (Mayo)OutsideLaboratory",,88184,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Pnh, Pi-Linked Ag, B (Mayo)OutsideLaboratory",,88184,CPT,Facility,Both,,,90,84,71.4,24.0744,84,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),50.4,60,,percent of total billed charges,,
"Pnh, Pi-Linked Ag, B (Mayo)OutsideLaboratory",,88184,CPT,Facility,Both,,,90,84,71.4,24.0744,84,"Health Partners, Inc.",State of Minnesota Advantage Program,68.46,81.5,,percent of total billed charges,,
"Pnh, Pi-Linked Ag, B (Mayo)OutsideLaboratory",,88184,CPT,Facility,Both,,,90,84,71.4,24.0744,84,"Health Partners, Inc.",State Public Programs,42,50,,percent of total billed charges,,
"Pnh, Pi-Linked Ag, B (Mayo)OutsideLaboratory",,88184,CPT,Facility,Both,,,90,84,71.4,24.0744,84,Humana Insurance Company,Commercial PPO,79.8,95,,percent of total billed charges,,
"Pnh, Pi-Linked Ag, B (Mayo)OutsideLaboratory",,88184,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,Humana Insurance Company,Medicare PPO,41.16,49,,percent of total billed charges,,
"Pnh, Pi-Linked Ag, B (Mayo)OutsideLaboratory",,88184,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Pnh, Pi-Linked Ag, B (Mayo)OutsideLaboratory",,88184,CPT,Facility,Both,,,90,84,71.4,24.0744,84,Medica,Individual & Family,83.244,99.1,,percent of total billed charges,,
"Pnh, Pi-Linked Ag, B (Mayo)OutsideLaboratory",,88184,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,Medica,Medica Advantage Solution,41.832,49.8,,percent of total billed charges,,
"Pnh, Pi-Linked Ag, B (Mayo)OutsideLaboratory",,88184,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Pnh, Pi-Linked Ag, B (Mayo)OutsideLaboratory",,88184,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,Medica,Medical Assistance,37.464,44.6,,percent of total billed charges,,
"Pnh, Pi-Linked Ag, B (Mayo)OutsideLaboratory",,88184,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,Medica,Medical Assistance,,,,,Included in per diem rate,
"Pnh, Pi-Linked Ag, B (Mayo)OutsideLaboratory",,88184,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,41.832,49.8,,percent of total billed charges,,
"Pnh, Pi-Linked Ag, B (Mayo)OutsideLaboratory",,88184,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Pnh, Pi-Linked Ag, B (Mayo)OutsideLaboratory",,88184,CPT,Facility,Both,,,90,84,71.4,24.0744,84,"Multiplan, Inc.","Multiplan, Inc.",78.96,94,,percent of total billed charges,,
"Pnh, Pi-Linked Ag, B (Mayo)OutsideLaboratory",,88184,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,72.576,86.4,,percent of total billed charges,,
"Pnh, Pi-Linked Ag, B (Mayo)OutsideLaboratory",,88184,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Pnh, Pi-Linked Ag, B (Mayo)OutsideLaboratory",,88184,CPT,Facility,Both,,,90,84,71.4,24.0744,84,"Preferred One Administrative Services, INC.",PPO,82.824,98.6,,percent of total billed charges,,
"Pnh, Pi-Linked Ag, B (Mayo)OutsideLaboratory",,88184,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,PrimeWest Health,Minnesota Senior Health Options (MSHO),43.218,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Pnh, Pi-Linked Ag, B (Mayo)OutsideLaboratory",,88184,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Pnh, Pi-Linked Ag, B (Mayo)OutsideLaboratory",,88184,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,PrimeWest Health,MinnesotaCare,43.1424,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Pnh, Pi-Linked Ag, B (Mayo)OutsideLaboratory",,88184,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Pnh, Pi-Linked Ag, B (Mayo)OutsideLaboratory",,88184,CPT,Facility,Both,,,90,84,71.4,24.0744,84,Sanford Health Plan,Sanford Health Plan,77.28,92,,percent of total billed charges,,
"Pnh, Pi-Linked Ag, B (Mayo)OutsideLaboratory",,88184,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,"UCare Health, Inc.",Individual & Family Plan,47.334,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Pnh, Pi-Linked Ag, B (Mayo)OutsideLaboratory",,88184,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Pnh, Pi-Linked Ag, B (Mayo)OutsideLaboratory",,88184,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,"UCare Health, Inc.",Medical Assistance,42.3948,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Pnh, Pi-Linked Ag, B (Mayo)OutsideLaboratory",,88184,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Pnh, Pi-Linked Ag, B (Mayo)OutsideLaboratory",,88184,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,"UCare Health, Inc.",Medicare Advantage,42.3948,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Pnh, Pi-Linked Ag, B (Mayo)OutsideLaboratory",,88184,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Pnh, Pi-Linked Ag, B (Mayo)OutsideLaboratory",,88184,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),42.3948,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Pnh, Pi-Linked Ag, B (Mayo)OutsideLaboratory",,88184,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Pnh, Pi-Linked Ag, B (Mayo)OutsideLaboratory",,88184,CPT,Facility,Both,,,90,84,71.4,24.0744,84,UnitedHealthcare,Individual & Family,78.96,94,,percent of total billed charges,,
"Pnh, Pi-Linked Ag, B (Mayo)OutsideLaboratory",,88184,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,UnitedHealthcare,Medicare Advantage,41.16,49,,percent of total billed charges,,
"Pnh, Pi-Linked Ag, B (Mayo)OutsideLaboratory",,88184,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Pnh, Pi-Linked Ag, B (Mayo)OutsideLaboratory",,88184,CPT,Facility,Outpatient,,,90,84,71.4,24.0744,84,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,40.32,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Pnh, Pi-Linked Ag, B (Mayo)OutsideLaboratory",,88184,CPT,Facility,Inpatient,,,90,84,71.4,24.0744,84,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Flow Cytometry Additional Marker (Mayo)OutsideLaboratory,,88185,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Aetna,Commercial,42.32,92,,percent of total billed charges,,
Flow Cytometry Additional Marker (Mayo)OutsideLaboratory,,88185,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Aetna,Medicare Advantage,22.54,49,,percent of total billed charges,,
Flow Cytometry Additional Marker (Mayo)OutsideLaboratory,,88185,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Flow Cytometry Additional Marker (Mayo)OutsideLaboratory,,88185,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Aetna,PPO,42.78,93,,percent of total billed charges,,
Flow Cytometry Additional Marker (Mayo)OutsideLaboratory,,88185,CPT,Facility,Both,,,90,46,39.1,13.1836,46,America's PPO,America's PPO,44.1738,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Flow Cytometry Additional Marker (Mayo)OutsideLaboratory,,88185,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota, Federal Employee Program,45.264,98.4,,percent of total billed charges,,
Flow Cytometry Additional Marker (Mayo)OutsideLaboratory,,88185,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,46,100,,percent of total billed charges,,
Flow Cytometry Additional Marker (Mayo)OutsideLaboratory,,88185,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,High Value Network Plan,41.4,90,,percent of total billed charges,,
Flow Cytometry Additional Marker (Mayo)OutsideLaboratory,,88185,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Medicare Advantage,22.54,49,,percent of total billed charges,,
Flow Cytometry Additional Marker (Mayo)OutsideLaboratory,,88185,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Flow Cytometry Additional Marker (Mayo)OutsideLaboratory,,88185,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,40.7422,88.57,,percent of total billed charges,,
Flow Cytometry Additional Marker (Mayo)OutsideLaboratory,,88185,CPT,Facility,Both,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,13.1836,28.66,,percent of total billed charges,,
Flow Cytometry Additional Marker (Mayo)OutsideLaboratory,,88185,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),22.54,49,,percent of total billed charges,,
Flow Cytometry Additional Marker (Mayo)OutsideLaboratory,,88185,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Flow Cytometry Additional Marker (Mayo)OutsideLaboratory,,88185,CPT,Facility,Both,,,90,46,39.1,13.1836,46,CorVel,Worker's Compensation,46,100,,percent of total billed charges,,
Flow Cytometry Additional Marker (Mayo)OutsideLaboratory,,88185,CPT,Facility,Both,,,90,46,39.1,13.1836,46,First Health Group Corporation,First Health Network,44.62,97,,percent of total billed charges,,
Flow Cytometry Additional Marker (Mayo)OutsideLaboratory,,88185,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Commercial,43.516,94.6,,percent of total billed charges,,
Flow Cytometry Additional Marker (Mayo)OutsideLaboratory,,88185,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Medicare Advantage,22.54,49,,percent of total billed charges,,
Flow Cytometry Additional Marker (Mayo)OutsideLaboratory,,88185,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Flow Cytometry Additional Marker (Mayo)OutsideLaboratory,,88185,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),27.6,60,,percent of total billed charges,,
Flow Cytometry Additional Marker (Mayo)OutsideLaboratory,,88185,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",State of Minnesota Advantage Program,37.49,81.5,,percent of total billed charges,,
Flow Cytometry Additional Marker (Mayo)OutsideLaboratory,,88185,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Health Partners, Inc.",State Public Programs,23,50,,percent of total billed charges,,
Flow Cytometry Additional Marker (Mayo)OutsideLaboratory,,88185,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Humana Insurance Company,Commercial PPO,43.7,95,,percent of total billed charges,,
Flow Cytometry Additional Marker (Mayo)OutsideLaboratory,,88185,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Humana Insurance Company,Medicare PPO,22.54,49,,percent of total billed charges,,
Flow Cytometry Additional Marker (Mayo)OutsideLaboratory,,88185,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Flow Cytometry Additional Marker (Mayo)OutsideLaboratory,,88185,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Medica,Individual & Family,45.586,99.1,,percent of total billed charges,,
Flow Cytometry Additional Marker (Mayo)OutsideLaboratory,,88185,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Medica,Medica Advantage Solution,22.908,49.8,,percent of total billed charges,,
Flow Cytometry Additional Marker (Mayo)OutsideLaboratory,,88185,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Flow Cytometry Additional Marker (Mayo)OutsideLaboratory,,88185,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Medica,Medical Assistance,20.516,44.6,,percent of total billed charges,,
Flow Cytometry Additional Marker (Mayo)OutsideLaboratory,,88185,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Medica,Medical Assistance,,,,,Included in per diem rate,
Flow Cytometry Additional Marker (Mayo)OutsideLaboratory,,88185,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,22.908,49.8,,percent of total billed charges,,
Flow Cytometry Additional Marker (Mayo)OutsideLaboratory,,88185,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Flow Cytometry Additional Marker (Mayo)OutsideLaboratory,,88185,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Multiplan, Inc.","Multiplan, Inc.",43.24,94,,percent of total billed charges,,
Flow Cytometry Additional Marker (Mayo)OutsideLaboratory,,88185,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,39.744,86.4,,percent of total billed charges,,
Flow Cytometry Additional Marker (Mayo)OutsideLaboratory,,88185,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Flow Cytometry Additional Marker (Mayo)OutsideLaboratory,,88185,CPT,Facility,Both,,,90,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PPO,45.356,98.6,,percent of total billed charges,,
Flow Cytometry Additional Marker (Mayo)OutsideLaboratory,,88185,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,Minnesota Senior Health Options (MSHO),23.667,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Flow Cytometry Additional Marker (Mayo)OutsideLaboratory,,88185,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Flow Cytometry Additional Marker (Mayo)OutsideLaboratory,,88185,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,MinnesotaCare,23.6256,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Flow Cytometry Additional Marker (Mayo)OutsideLaboratory,,88185,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Flow Cytometry Additional Marker (Mayo)OutsideLaboratory,,88185,CPT,Facility,Both,,,90,46,39.1,13.1836,46,Sanford Health Plan,Sanford Health Plan,42.32,92,,percent of total billed charges,,
Flow Cytometry Additional Marker (Mayo)OutsideLaboratory,,88185,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Individual & Family Plan,25.921,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Flow Cytometry Additional Marker (Mayo)OutsideLaboratory,,88185,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Flow Cytometry Additional Marker (Mayo)OutsideLaboratory,,88185,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medical Assistance,23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Flow Cytometry Additional Marker (Mayo)OutsideLaboratory,,88185,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Flow Cytometry Additional Marker (Mayo)OutsideLaboratory,,88185,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medicare Advantage,23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Flow Cytometry Additional Marker (Mayo)OutsideLaboratory,,88185,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Flow Cytometry Additional Marker (Mayo)OutsideLaboratory,,88185,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Flow Cytometry Additional Marker (Mayo)OutsideLaboratory,,88185,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Flow Cytometry Additional Marker (Mayo)OutsideLaboratory,,88185,CPT,Facility,Both,,,90,46,39.1,13.1836,46,UnitedHealthcare,Individual & Family,43.24,94,,percent of total billed charges,,
Flow Cytometry Additional Marker (Mayo)OutsideLaboratory,,88185,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Medicare Advantage,22.54,49,,percent of total billed charges,,
Flow Cytometry Additional Marker (Mayo)OutsideLaboratory,,88185,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Flow Cytometry Additional Marker (Mayo)OutsideLaboratory,,88185,CPT,Facility,Outpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,22.08,48,,percent of total billed charges,,100% of DHS outpatient percentage
Flow Cytometry Additional Marker (Mayo)OutsideLaboratory,,88185,CPT,Facility,Inpatient,,,90,46,39.1,13.1836,46,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Flow Cytometry, Cell Surface, Addl (Mayo)OutsideLaboratory",,88185,CPT,Facility,Both,,,90,457,388.45,130.9762,457,Aetna,Commercial,420.44,92,,percent of total billed charges,,
"Flow Cytometry, Cell Surface, Addl (Mayo)OutsideLaboratory",,88185,CPT,Facility,Outpatient,,,90,457,388.45,130.9762,457,Aetna,Medicare Advantage,223.93,49,,percent of total billed charges,,
"Flow Cytometry, Cell Surface, Addl (Mayo)OutsideLaboratory",,88185,CPT,Facility,Inpatient,,,90,457,388.45,130.9762,457,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Flow Cytometry, Cell Surface, Addl (Mayo)OutsideLaboratory",,88185,CPT,Facility,Both,,,90,457,388.45,130.9762,457,Aetna,PPO,425.01,93,,percent of total billed charges,,
"Flow Cytometry, Cell Surface, Addl (Mayo)OutsideLaboratory",,88185,CPT,Facility,Both,,,90,457,388.45,130.9762,457,America's PPO,America's PPO,438.8571,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Flow Cytometry, Cell Surface, Addl (Mayo)OutsideLaboratory",,88185,CPT,Facility,Both,,,90,457,388.45,130.9762,457,BlueCross BlueShield Minnesota, Federal Employee Program,449.688,98.4,,percent of total billed charges,,
"Flow Cytometry, Cell Surface, Addl (Mayo)OutsideLaboratory",,88185,CPT,Facility,Both,,,90,457,388.45,130.9762,457,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,457,100,,percent of total billed charges,,
"Flow Cytometry, Cell Surface, Addl (Mayo)OutsideLaboratory",,88185,CPT,Facility,Both,,,90,457,388.45,130.9762,457,BlueCross BlueShield Minnesota,High Value Network Plan,411.3,90,,percent of total billed charges,,
"Flow Cytometry, Cell Surface, Addl (Mayo)OutsideLaboratory",,88185,CPT,Facility,Outpatient,,,90,457,388.45,130.9762,457,BlueCross BlueShield Minnesota,Medicare Advantage,223.93,49,,percent of total billed charges,,
"Flow Cytometry, Cell Surface, Addl (Mayo)OutsideLaboratory",,88185,CPT,Facility,Inpatient,,,90,457,388.45,130.9762,457,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Flow Cytometry, Cell Surface, Addl (Mayo)OutsideLaboratory",,88185,CPT,Facility,Both,,,90,457,388.45,130.9762,457,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,404.7649,88.57,,percent of total billed charges,,
"Flow Cytometry, Cell Surface, Addl (Mayo)OutsideLaboratory",,88185,CPT,Facility,Both,,,90,457,388.45,130.9762,457,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,130.9762,28.66,,percent of total billed charges,,
"Flow Cytometry, Cell Surface, Addl (Mayo)OutsideLaboratory",,88185,CPT,Facility,Outpatient,,,90,457,388.45,130.9762,457,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),223.93,49,,percent of total billed charges,,
"Flow Cytometry, Cell Surface, Addl (Mayo)OutsideLaboratory",,88185,CPT,Facility,Inpatient,,,90,457,388.45,130.9762,457,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Flow Cytometry, Cell Surface, Addl (Mayo)OutsideLaboratory",,88185,CPT,Facility,Both,,,90,457,388.45,130.9762,457,CorVel,Worker's Compensation,457,100,,percent of total billed charges,,
"Flow Cytometry, Cell Surface, Addl (Mayo)OutsideLaboratory",,88185,CPT,Facility,Both,,,90,457,388.45,130.9762,457,First Health Group Corporation,First Health Network,443.29,97,,percent of total billed charges,,
"Flow Cytometry, Cell Surface, Addl (Mayo)OutsideLaboratory",,88185,CPT,Facility,Both,,,90,457,388.45,130.9762,457,"Health Partners, Inc.",Commercial,432.322,94.6,,percent of total billed charges,,
"Flow Cytometry, Cell Surface, Addl (Mayo)OutsideLaboratory",,88185,CPT,Facility,Outpatient,,,90,457,388.45,130.9762,457,"Health Partners, Inc.",Medicare Advantage,223.93,49,,percent of total billed charges,,
"Flow Cytometry, Cell Surface, Addl (Mayo)OutsideLaboratory",,88185,CPT,Facility,Inpatient,,,90,457,388.45,130.9762,457,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Flow Cytometry, Cell Surface, Addl (Mayo)OutsideLaboratory",,88185,CPT,Facility,Both,,,90,457,388.45,130.9762,457,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),274.2,60,,percent of total billed charges,,
"Flow Cytometry, Cell Surface, Addl (Mayo)OutsideLaboratory",,88185,CPT,Facility,Both,,,90,457,388.45,130.9762,457,"Health Partners, Inc.",State of Minnesota Advantage Program,372.455,81.5,,percent of total billed charges,,
"Flow Cytometry, Cell Surface, Addl (Mayo)OutsideLaboratory",,88185,CPT,Facility,Both,,,90,457,388.45,130.9762,457,"Health Partners, Inc.",State Public Programs,228.5,50,,percent of total billed charges,,
"Flow Cytometry, Cell Surface, Addl (Mayo)OutsideLaboratory",,88185,CPT,Facility,Both,,,90,457,388.45,130.9762,457,Humana Insurance Company,Commercial PPO,434.15,95,,percent of total billed charges,,
"Flow Cytometry, Cell Surface, Addl (Mayo)OutsideLaboratory",,88185,CPT,Facility,Outpatient,,,90,457,388.45,130.9762,457,Humana Insurance Company,Medicare PPO,223.93,49,,percent of total billed charges,,
"Flow Cytometry, Cell Surface, Addl (Mayo)OutsideLaboratory",,88185,CPT,Facility,Inpatient,,,90,457,388.45,130.9762,457,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Flow Cytometry, Cell Surface, Addl (Mayo)OutsideLaboratory",,88185,CPT,Facility,Both,,,90,457,388.45,130.9762,457,Medica,Individual & Family,452.887,99.1,,percent of total billed charges,,
"Flow Cytometry, Cell Surface, Addl (Mayo)OutsideLaboratory",,88185,CPT,Facility,Outpatient,,,90,457,388.45,130.9762,457,Medica,Medica Advantage Solution,227.586,49.8,,percent of total billed charges,,
"Flow Cytometry, Cell Surface, Addl (Mayo)OutsideLaboratory",,88185,CPT,Facility,Inpatient,,,90,457,388.45,130.9762,457,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Flow Cytometry, Cell Surface, Addl (Mayo)OutsideLaboratory",,88185,CPT,Facility,Outpatient,,,90,457,388.45,130.9762,457,Medica,Medical Assistance,203.822,44.6,,percent of total billed charges,,
"Flow Cytometry, Cell Surface, Addl (Mayo)OutsideLaboratory",,88185,CPT,Facility,Inpatient,,,90,457,388.45,130.9762,457,Medica,Medical Assistance,,,,,Included in per diem rate,
"Flow Cytometry, Cell Surface, Addl (Mayo)OutsideLaboratory",,88185,CPT,Facility,Outpatient,,,90,457,388.45,130.9762,457,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,227.586,49.8,,percent of total billed charges,,
"Flow Cytometry, Cell Surface, Addl (Mayo)OutsideLaboratory",,88185,CPT,Facility,Inpatient,,,90,457,388.45,130.9762,457,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Flow Cytometry, Cell Surface, Addl (Mayo)OutsideLaboratory",,88185,CPT,Facility,Both,,,90,457,388.45,130.9762,457,"Multiplan, Inc.","Multiplan, Inc.",429.58,94,,percent of total billed charges,,
"Flow Cytometry, Cell Surface, Addl (Mayo)OutsideLaboratory",,88185,CPT,Facility,Outpatient,,,90,457,388.45,130.9762,457,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,394.848,86.4,,percent of total billed charges,,
"Flow Cytometry, Cell Surface, Addl (Mayo)OutsideLaboratory",,88185,CPT,Facility,Inpatient,,,90,457,388.45,130.9762,457,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Flow Cytometry, Cell Surface, Addl (Mayo)OutsideLaboratory",,88185,CPT,Facility,Both,,,90,457,388.45,130.9762,457,"Preferred One Administrative Services, INC.",PPO,450.602,98.6,,percent of total billed charges,,
"Flow Cytometry, Cell Surface, Addl (Mayo)OutsideLaboratory",,88185,CPT,Facility,Outpatient,,,90,457,388.45,130.9762,457,PrimeWest Health,Minnesota Senior Health Options (MSHO),235.1265,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Flow Cytometry, Cell Surface, Addl (Mayo)OutsideLaboratory",,88185,CPT,Facility,Inpatient,,,90,457,388.45,130.9762,457,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Flow Cytometry, Cell Surface, Addl (Mayo)OutsideLaboratory",,88185,CPT,Facility,Outpatient,,,90,457,388.45,130.9762,457,PrimeWest Health,MinnesotaCare,234.7152,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Flow Cytometry, Cell Surface, Addl (Mayo)OutsideLaboratory",,88185,CPT,Facility,Inpatient,,,90,457,388.45,130.9762,457,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Flow Cytometry, Cell Surface, Addl (Mayo)OutsideLaboratory",,88185,CPT,Facility,Both,,,90,457,388.45,130.9762,457,Sanford Health Plan,Sanford Health Plan,420.44,92,,percent of total billed charges,,
"Flow Cytometry, Cell Surface, Addl (Mayo)OutsideLaboratory",,88185,CPT,Facility,Outpatient,,,90,457,388.45,130.9762,457,"UCare Health, Inc.",Individual & Family Plan,257.5195,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Flow Cytometry, Cell Surface, Addl (Mayo)OutsideLaboratory",,88185,CPT,Facility,Inpatient,,,90,457,388.45,130.9762,457,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Flow Cytometry, Cell Surface, Addl (Mayo)OutsideLaboratory",,88185,CPT,Facility,Outpatient,,,90,457,388.45,130.9762,457,"UCare Health, Inc.",Medical Assistance,230.6479,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Flow Cytometry, Cell Surface, Addl (Mayo)OutsideLaboratory",,88185,CPT,Facility,Inpatient,,,90,457,388.45,130.9762,457,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Flow Cytometry, Cell Surface, Addl (Mayo)OutsideLaboratory",,88185,CPT,Facility,Outpatient,,,90,457,388.45,130.9762,457,"UCare Health, Inc.",Medicare Advantage,230.6479,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Flow Cytometry, Cell Surface, Addl (Mayo)OutsideLaboratory",,88185,CPT,Facility,Inpatient,,,90,457,388.45,130.9762,457,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Flow Cytometry, Cell Surface, Addl (Mayo)OutsideLaboratory",,88185,CPT,Facility,Outpatient,,,90,457,388.45,130.9762,457,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),230.6479,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Flow Cytometry, Cell Surface, Addl (Mayo)OutsideLaboratory",,88185,CPT,Facility,Inpatient,,,90,457,388.45,130.9762,457,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Flow Cytometry, Cell Surface, Addl (Mayo)OutsideLaboratory",,88185,CPT,Facility,Both,,,90,457,388.45,130.9762,457,UnitedHealthcare,Individual & Family,429.58,94,,percent of total billed charges,,
"Flow Cytometry, Cell Surface, Addl (Mayo)OutsideLaboratory",,88185,CPT,Facility,Outpatient,,,90,457,388.45,130.9762,457,UnitedHealthcare,Medicare Advantage,223.93,49,,percent of total billed charges,,
"Flow Cytometry, Cell Surface, Addl (Mayo)OutsideLaboratory",,88185,CPT,Facility,Inpatient,,,90,457,388.45,130.9762,457,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Flow Cytometry, Cell Surface, Addl (Mayo)OutsideLaboratory",,88185,CPT,Facility,Outpatient,,,90,457,388.45,130.9762,457,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,219.36,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Flow Cytometry, Cell Surface, Addl (Mayo)OutsideLaboratory",,88185,CPT,Facility,Inpatient,,,90,457,388.45,130.9762,457,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Flow Cytometry, Cytoplasmic/Nuc Marker, Tc Only, Each Addl (Mayo)OutsideLaboratory",,88185,CPT,Facility,Both,,,90,457,388.45,130.9762,457,Aetna,Commercial,420.44,92,,percent of total billed charges,,
"Flow Cytometry, Cytoplasmic/Nuc Marker, Tc Only, Each Addl (Mayo)OutsideLaboratory",,88185,CPT,Facility,Outpatient,,,90,457,388.45,130.9762,457,Aetna,Medicare Advantage,223.93,49,,percent of total billed charges,,
"Flow Cytometry, Cytoplasmic/Nuc Marker, Tc Only, Each Addl (Mayo)OutsideLaboratory",,88185,CPT,Facility,Inpatient,,,90,457,388.45,130.9762,457,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Flow Cytometry, Cytoplasmic/Nuc Marker, Tc Only, Each Addl (Mayo)OutsideLaboratory",,88185,CPT,Facility,Both,,,90,457,388.45,130.9762,457,Aetna,PPO,425.01,93,,percent of total billed charges,,
"Flow Cytometry, Cytoplasmic/Nuc Marker, Tc Only, Each Addl (Mayo)OutsideLaboratory",,88185,CPT,Facility,Both,,,90,457,388.45,130.9762,457,America's PPO,America's PPO,438.8571,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Flow Cytometry, Cytoplasmic/Nuc Marker, Tc Only, Each Addl (Mayo)OutsideLaboratory",,88185,CPT,Facility,Both,,,90,457,388.45,130.9762,457,BlueCross BlueShield Minnesota, Federal Employee Program,449.688,98.4,,percent of total billed charges,,
"Flow Cytometry, Cytoplasmic/Nuc Marker, Tc Only, Each Addl (Mayo)OutsideLaboratory",,88185,CPT,Facility,Both,,,90,457,388.45,130.9762,457,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,457,100,,percent of total billed charges,,
"Flow Cytometry, Cytoplasmic/Nuc Marker, Tc Only, Each Addl (Mayo)OutsideLaboratory",,88185,CPT,Facility,Both,,,90,457,388.45,130.9762,457,BlueCross BlueShield Minnesota,High Value Network Plan,411.3,90,,percent of total billed charges,,
"Flow Cytometry, Cytoplasmic/Nuc Marker, Tc Only, Each Addl (Mayo)OutsideLaboratory",,88185,CPT,Facility,Outpatient,,,90,457,388.45,130.9762,457,BlueCross BlueShield Minnesota,Medicare Advantage,223.93,49,,percent of total billed charges,,
"Flow Cytometry, Cytoplasmic/Nuc Marker, Tc Only, Each Addl (Mayo)OutsideLaboratory",,88185,CPT,Facility,Inpatient,,,90,457,388.45,130.9762,457,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Flow Cytometry, Cytoplasmic/Nuc Marker, Tc Only, Each Addl (Mayo)OutsideLaboratory",,88185,CPT,Facility,Both,,,90,457,388.45,130.9762,457,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,404.7649,88.57,,percent of total billed charges,,
"Flow Cytometry, Cytoplasmic/Nuc Marker, Tc Only, Each Addl (Mayo)OutsideLaboratory",,88185,CPT,Facility,Both,,,90,457,388.45,130.9762,457,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,130.9762,28.66,,percent of total billed charges,,
"Flow Cytometry, Cytoplasmic/Nuc Marker, Tc Only, Each Addl (Mayo)OutsideLaboratory",,88185,CPT,Facility,Outpatient,,,90,457,388.45,130.9762,457,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),223.93,49,,percent of total billed charges,,
"Flow Cytometry, Cytoplasmic/Nuc Marker, Tc Only, Each Addl (Mayo)OutsideLaboratory",,88185,CPT,Facility,Inpatient,,,90,457,388.45,130.9762,457,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Flow Cytometry, Cytoplasmic/Nuc Marker, Tc Only, Each Addl (Mayo)OutsideLaboratory",,88185,CPT,Facility,Both,,,90,457,388.45,130.9762,457,CorVel,Worker's Compensation,457,100,,percent of total billed charges,,
"Flow Cytometry, Cytoplasmic/Nuc Marker, Tc Only, Each Addl (Mayo)OutsideLaboratory",,88185,CPT,Facility,Both,,,90,457,388.45,130.9762,457,First Health Group Corporation,First Health Network,443.29,97,,percent of total billed charges,,
"Flow Cytometry, Cytoplasmic/Nuc Marker, Tc Only, Each Addl (Mayo)OutsideLaboratory",,88185,CPT,Facility,Both,,,90,457,388.45,130.9762,457,"Health Partners, Inc.",Commercial,432.322,94.6,,percent of total billed charges,,
"Flow Cytometry, Cytoplasmic/Nuc Marker, Tc Only, Each Addl (Mayo)OutsideLaboratory",,88185,CPT,Facility,Outpatient,,,90,457,388.45,130.9762,457,"Health Partners, Inc.",Medicare Advantage,223.93,49,,percent of total billed charges,,
"Flow Cytometry, Cytoplasmic/Nuc Marker, Tc Only, Each Addl (Mayo)OutsideLaboratory",,88185,CPT,Facility,Inpatient,,,90,457,388.45,130.9762,457,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Flow Cytometry, Cytoplasmic/Nuc Marker, Tc Only, Each Addl (Mayo)OutsideLaboratory",,88185,CPT,Facility,Both,,,90,457,388.45,130.9762,457,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),274.2,60,,percent of total billed charges,,
"Flow Cytometry, Cytoplasmic/Nuc Marker, Tc Only, Each Addl (Mayo)OutsideLaboratory",,88185,CPT,Facility,Both,,,90,457,388.45,130.9762,457,"Health Partners, Inc.",State of Minnesota Advantage Program,372.455,81.5,,percent of total billed charges,,
"Flow Cytometry, Cytoplasmic/Nuc Marker, Tc Only, Each Addl (Mayo)OutsideLaboratory",,88185,CPT,Facility,Both,,,90,457,388.45,130.9762,457,"Health Partners, Inc.",State Public Programs,228.5,50,,percent of total billed charges,,
"Flow Cytometry, Cytoplasmic/Nuc Marker, Tc Only, Each Addl (Mayo)OutsideLaboratory",,88185,CPT,Facility,Both,,,90,457,388.45,130.9762,457,Humana Insurance Company,Commercial PPO,434.15,95,,percent of total billed charges,,
"Flow Cytometry, Cytoplasmic/Nuc Marker, Tc Only, Each Addl (Mayo)OutsideLaboratory",,88185,CPT,Facility,Outpatient,,,90,457,388.45,130.9762,457,Humana Insurance Company,Medicare PPO,223.93,49,,percent of total billed charges,,
"Flow Cytometry, Cytoplasmic/Nuc Marker, Tc Only, Each Addl (Mayo)OutsideLaboratory",,88185,CPT,Facility,Inpatient,,,90,457,388.45,130.9762,457,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Flow Cytometry, Cytoplasmic/Nuc Marker, Tc Only, Each Addl (Mayo)OutsideLaboratory",,88185,CPT,Facility,Both,,,90,457,388.45,130.9762,457,Medica,Individual & Family,452.887,99.1,,percent of total billed charges,,
"Flow Cytometry, Cytoplasmic/Nuc Marker, Tc Only, Each Addl (Mayo)OutsideLaboratory",,88185,CPT,Facility,Outpatient,,,90,457,388.45,130.9762,457,Medica,Medica Advantage Solution,227.586,49.8,,percent of total billed charges,,
"Flow Cytometry, Cytoplasmic/Nuc Marker, Tc Only, Each Addl (Mayo)OutsideLaboratory",,88185,CPT,Facility,Inpatient,,,90,457,388.45,130.9762,457,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Flow Cytometry, Cytoplasmic/Nuc Marker, Tc Only, Each Addl (Mayo)OutsideLaboratory",,88185,CPT,Facility,Outpatient,,,90,457,388.45,130.9762,457,Medica,Medical Assistance,203.822,44.6,,percent of total billed charges,,
"Flow Cytometry, Cytoplasmic/Nuc Marker, Tc Only, Each Addl (Mayo)OutsideLaboratory",,88185,CPT,Facility,Inpatient,,,90,457,388.45,130.9762,457,Medica,Medical Assistance,,,,,Included in per diem rate,
"Flow Cytometry, Cytoplasmic/Nuc Marker, Tc Only, Each Addl (Mayo)OutsideLaboratory",,88185,CPT,Facility,Outpatient,,,90,457,388.45,130.9762,457,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,227.586,49.8,,percent of total billed charges,,
"Flow Cytometry, Cytoplasmic/Nuc Marker, Tc Only, Each Addl (Mayo)OutsideLaboratory",,88185,CPT,Facility,Inpatient,,,90,457,388.45,130.9762,457,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Flow Cytometry, Cytoplasmic/Nuc Marker, Tc Only, Each Addl (Mayo)OutsideLaboratory",,88185,CPT,Facility,Both,,,90,457,388.45,130.9762,457,"Multiplan, Inc.","Multiplan, Inc.",429.58,94,,percent of total billed charges,,
"Flow Cytometry, Cytoplasmic/Nuc Marker, Tc Only, Each Addl (Mayo)OutsideLaboratory",,88185,CPT,Facility,Outpatient,,,90,457,388.45,130.9762,457,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,394.848,86.4,,percent of total billed charges,,
"Flow Cytometry, Cytoplasmic/Nuc Marker, Tc Only, Each Addl (Mayo)OutsideLaboratory",,88185,CPT,Facility,Inpatient,,,90,457,388.45,130.9762,457,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Flow Cytometry, Cytoplasmic/Nuc Marker, Tc Only, Each Addl (Mayo)OutsideLaboratory",,88185,CPT,Facility,Both,,,90,457,388.45,130.9762,457,"Preferred One Administrative Services, INC.",PPO,450.602,98.6,,percent of total billed charges,,
"Flow Cytometry, Cytoplasmic/Nuc Marker, Tc Only, Each Addl (Mayo)OutsideLaboratory",,88185,CPT,Facility,Outpatient,,,90,457,388.45,130.9762,457,PrimeWest Health,Minnesota Senior Health Options (MSHO),235.1265,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Flow Cytometry, Cytoplasmic/Nuc Marker, Tc Only, Each Addl (Mayo)OutsideLaboratory",,88185,CPT,Facility,Inpatient,,,90,457,388.45,130.9762,457,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Flow Cytometry, Cytoplasmic/Nuc Marker, Tc Only, Each Addl (Mayo)OutsideLaboratory",,88185,CPT,Facility,Outpatient,,,90,457,388.45,130.9762,457,PrimeWest Health,MinnesotaCare,234.7152,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Flow Cytometry, Cytoplasmic/Nuc Marker, Tc Only, Each Addl (Mayo)OutsideLaboratory",,88185,CPT,Facility,Inpatient,,,90,457,388.45,130.9762,457,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Flow Cytometry, Cytoplasmic/Nuc Marker, Tc Only, Each Addl (Mayo)OutsideLaboratory",,88185,CPT,Facility,Both,,,90,457,388.45,130.9762,457,Sanford Health Plan,Sanford Health Plan,420.44,92,,percent of total billed charges,,
"Flow Cytometry, Cytoplasmic/Nuc Marker, Tc Only, Each Addl (Mayo)OutsideLaboratory",,88185,CPT,Facility,Outpatient,,,90,457,388.45,130.9762,457,"UCare Health, Inc.",Individual & Family Plan,257.5195,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Flow Cytometry, Cytoplasmic/Nuc Marker, Tc Only, Each Addl (Mayo)OutsideLaboratory",,88185,CPT,Facility,Inpatient,,,90,457,388.45,130.9762,457,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Flow Cytometry, Cytoplasmic/Nuc Marker, Tc Only, Each Addl (Mayo)OutsideLaboratory",,88185,CPT,Facility,Outpatient,,,90,457,388.45,130.9762,457,"UCare Health, Inc.",Medical Assistance,230.6479,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Flow Cytometry, Cytoplasmic/Nuc Marker, Tc Only, Each Addl (Mayo)OutsideLaboratory",,88185,CPT,Facility,Inpatient,,,90,457,388.45,130.9762,457,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Flow Cytometry, Cytoplasmic/Nuc Marker, Tc Only, Each Addl (Mayo)OutsideLaboratory",,88185,CPT,Facility,Outpatient,,,90,457,388.45,130.9762,457,"UCare Health, Inc.",Medicare Advantage,230.6479,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Flow Cytometry, Cytoplasmic/Nuc Marker, Tc Only, Each Addl (Mayo)OutsideLaboratory",,88185,CPT,Facility,Inpatient,,,90,457,388.45,130.9762,457,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Flow Cytometry, Cytoplasmic/Nuc Marker, Tc Only, Each Addl (Mayo)OutsideLaboratory",,88185,CPT,Facility,Outpatient,,,90,457,388.45,130.9762,457,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),230.6479,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Flow Cytometry, Cytoplasmic/Nuc Marker, Tc Only, Each Addl (Mayo)OutsideLaboratory",,88185,CPT,Facility,Inpatient,,,90,457,388.45,130.9762,457,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Flow Cytometry, Cytoplasmic/Nuc Marker, Tc Only, Each Addl (Mayo)OutsideLaboratory",,88185,CPT,Facility,Both,,,90,457,388.45,130.9762,457,UnitedHealthcare,Individual & Family,429.58,94,,percent of total billed charges,,
"Flow Cytometry, Cytoplasmic/Nuc Marker, Tc Only, Each Addl (Mayo)OutsideLaboratory",,88185,CPT,Facility,Outpatient,,,90,457,388.45,130.9762,457,UnitedHealthcare,Medicare Advantage,223.93,49,,percent of total billed charges,,
"Flow Cytometry, Cytoplasmic/Nuc Marker, Tc Only, Each Addl (Mayo)OutsideLaboratory",,88185,CPT,Facility,Inpatient,,,90,457,388.45,130.9762,457,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Flow Cytometry, Cytoplasmic/Nuc Marker, Tc Only, Each Addl (Mayo)OutsideLaboratory",,88185,CPT,Facility,Outpatient,,,90,457,388.45,130.9762,457,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,219.36,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Flow Cytometry, Cytoplasmic/Nuc Marker, Tc Only, Each Addl (Mayo)OutsideLaboratory",,88185,CPT,Facility,Inpatient,,,90,457,388.45,130.9762,457,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Flow Cytometry, Each Additional Marker (Mayo)OutsideLaboratory",,88185,CPT,Facility,Both,,,90,68,57.8,19.4888,68,Aetna,Commercial,62.56,92,,percent of total billed charges,,
"Flow Cytometry, Each Additional Marker (Mayo)OutsideLaboratory",,88185,CPT,Facility,Outpatient,,,90,68,57.8,19.4888,68,Aetna,Medicare Advantage,33.32,49,,percent of total billed charges,,
"Flow Cytometry, Each Additional Marker (Mayo)OutsideLaboratory",,88185,CPT,Facility,Inpatient,,,90,68,57.8,19.4888,68,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Flow Cytometry, Each Additional Marker (Mayo)OutsideLaboratory",,88185,CPT,Facility,Both,,,90,68,57.8,19.4888,68,Aetna,PPO,63.24,93,,percent of total billed charges,,
"Flow Cytometry, Each Additional Marker (Mayo)OutsideLaboratory",,88185,CPT,Facility,Both,,,90,68,57.8,19.4888,68,America's PPO,America's PPO,65.3004,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Flow Cytometry, Each Additional Marker (Mayo)OutsideLaboratory",,88185,CPT,Facility,Both,,,90,68,57.8,19.4888,68,BlueCross BlueShield Minnesota, Federal Employee Program,66.912,98.4,,percent of total billed charges,,
"Flow Cytometry, Each Additional Marker (Mayo)OutsideLaboratory",,88185,CPT,Facility,Both,,,90,68,57.8,19.4888,68,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,68,100,,percent of total billed charges,,
"Flow Cytometry, Each Additional Marker (Mayo)OutsideLaboratory",,88185,CPT,Facility,Both,,,90,68,57.8,19.4888,68,BlueCross BlueShield Minnesota,High Value Network Plan,61.2,90,,percent of total billed charges,,
"Flow Cytometry, Each Additional Marker (Mayo)OutsideLaboratory",,88185,CPT,Facility,Outpatient,,,90,68,57.8,19.4888,68,BlueCross BlueShield Minnesota,Medicare Advantage,33.32,49,,percent of total billed charges,,
"Flow Cytometry, Each Additional Marker (Mayo)OutsideLaboratory",,88185,CPT,Facility,Inpatient,,,90,68,57.8,19.4888,68,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Flow Cytometry, Each Additional Marker (Mayo)OutsideLaboratory",,88185,CPT,Facility,Both,,,90,68,57.8,19.4888,68,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,60.2276,88.57,,percent of total billed charges,,
"Flow Cytometry, Each Additional Marker (Mayo)OutsideLaboratory",,88185,CPT,Facility,Both,,,90,68,57.8,19.4888,68,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,19.4888,28.66,,percent of total billed charges,,
"Flow Cytometry, Each Additional Marker (Mayo)OutsideLaboratory",,88185,CPT,Facility,Outpatient,,,90,68,57.8,19.4888,68,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),33.32,49,,percent of total billed charges,,
"Flow Cytometry, Each Additional Marker (Mayo)OutsideLaboratory",,88185,CPT,Facility,Inpatient,,,90,68,57.8,19.4888,68,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Flow Cytometry, Each Additional Marker (Mayo)OutsideLaboratory",,88185,CPT,Facility,Both,,,90,68,57.8,19.4888,68,CorVel,Worker's Compensation,68,100,,percent of total billed charges,,
"Flow Cytometry, Each Additional Marker (Mayo)OutsideLaboratory",,88185,CPT,Facility,Both,,,90,68,57.8,19.4888,68,First Health Group Corporation,First Health Network,65.96,97,,percent of total billed charges,,
"Flow Cytometry, Each Additional Marker (Mayo)OutsideLaboratory",,88185,CPT,Facility,Both,,,90,68,57.8,19.4888,68,"Health Partners, Inc.",Commercial,64.328,94.6,,percent of total billed charges,,
"Flow Cytometry, Each Additional Marker (Mayo)OutsideLaboratory",,88185,CPT,Facility,Outpatient,,,90,68,57.8,19.4888,68,"Health Partners, Inc.",Medicare Advantage,33.32,49,,percent of total billed charges,,
"Flow Cytometry, Each Additional Marker (Mayo)OutsideLaboratory",,88185,CPT,Facility,Inpatient,,,90,68,57.8,19.4888,68,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Flow Cytometry, Each Additional Marker (Mayo)OutsideLaboratory",,88185,CPT,Facility,Both,,,90,68,57.8,19.4888,68,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),40.8,60,,percent of total billed charges,,
"Flow Cytometry, Each Additional Marker (Mayo)OutsideLaboratory",,88185,CPT,Facility,Both,,,90,68,57.8,19.4888,68,"Health Partners, Inc.",State of Minnesota Advantage Program,55.42,81.5,,percent of total billed charges,,
"Flow Cytometry, Each Additional Marker (Mayo)OutsideLaboratory",,88185,CPT,Facility,Both,,,90,68,57.8,19.4888,68,"Health Partners, Inc.",State Public Programs,34,50,,percent of total billed charges,,
"Flow Cytometry, Each Additional Marker (Mayo)OutsideLaboratory",,88185,CPT,Facility,Both,,,90,68,57.8,19.4888,68,Humana Insurance Company,Commercial PPO,64.6,95,,percent of total billed charges,,
"Flow Cytometry, Each Additional Marker (Mayo)OutsideLaboratory",,88185,CPT,Facility,Outpatient,,,90,68,57.8,19.4888,68,Humana Insurance Company,Medicare PPO,33.32,49,,percent of total billed charges,,
"Flow Cytometry, Each Additional Marker (Mayo)OutsideLaboratory",,88185,CPT,Facility,Inpatient,,,90,68,57.8,19.4888,68,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Flow Cytometry, Each Additional Marker (Mayo)OutsideLaboratory",,88185,CPT,Facility,Both,,,90,68,57.8,19.4888,68,Medica,Individual & Family,67.388,99.1,,percent of total billed charges,,
"Flow Cytometry, Each Additional Marker (Mayo)OutsideLaboratory",,88185,CPT,Facility,Outpatient,,,90,68,57.8,19.4888,68,Medica,Medica Advantage Solution,33.864,49.8,,percent of total billed charges,,
"Flow Cytometry, Each Additional Marker (Mayo)OutsideLaboratory",,88185,CPT,Facility,Inpatient,,,90,68,57.8,19.4888,68,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Flow Cytometry, Each Additional Marker (Mayo)OutsideLaboratory",,88185,CPT,Facility,Outpatient,,,90,68,57.8,19.4888,68,Medica,Medical Assistance,30.328,44.6,,percent of total billed charges,,
"Flow Cytometry, Each Additional Marker (Mayo)OutsideLaboratory",,88185,CPT,Facility,Inpatient,,,90,68,57.8,19.4888,68,Medica,Medical Assistance,,,,,Included in per diem rate,
"Flow Cytometry, Each Additional Marker (Mayo)OutsideLaboratory",,88185,CPT,Facility,Outpatient,,,90,68,57.8,19.4888,68,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,33.864,49.8,,percent of total billed charges,,
"Flow Cytometry, Each Additional Marker (Mayo)OutsideLaboratory",,88185,CPT,Facility,Inpatient,,,90,68,57.8,19.4888,68,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Flow Cytometry, Each Additional Marker (Mayo)OutsideLaboratory",,88185,CPT,Facility,Both,,,90,68,57.8,19.4888,68,"Multiplan, Inc.","Multiplan, Inc.",63.92,94,,percent of total billed charges,,
"Flow Cytometry, Each Additional Marker (Mayo)OutsideLaboratory",,88185,CPT,Facility,Outpatient,,,90,68,57.8,19.4888,68,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,58.752,86.4,,percent of total billed charges,,
"Flow Cytometry, Each Additional Marker (Mayo)OutsideLaboratory",,88185,CPT,Facility,Inpatient,,,90,68,57.8,19.4888,68,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Flow Cytometry, Each Additional Marker (Mayo)OutsideLaboratory",,88185,CPT,Facility,Both,,,90,68,57.8,19.4888,68,"Preferred One Administrative Services, INC.",PPO,67.048,98.6,,percent of total billed charges,,
"Flow Cytometry, Each Additional Marker (Mayo)OutsideLaboratory",,88185,CPT,Facility,Outpatient,,,90,68,57.8,19.4888,68,PrimeWest Health,Minnesota Senior Health Options (MSHO),34.986,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Flow Cytometry, Each Additional Marker (Mayo)OutsideLaboratory",,88185,CPT,Facility,Inpatient,,,90,68,57.8,19.4888,68,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Flow Cytometry, Each Additional Marker (Mayo)OutsideLaboratory",,88185,CPT,Facility,Outpatient,,,90,68,57.8,19.4888,68,PrimeWest Health,MinnesotaCare,34.9248,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Flow Cytometry, Each Additional Marker (Mayo)OutsideLaboratory",,88185,CPT,Facility,Inpatient,,,90,68,57.8,19.4888,68,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Flow Cytometry, Each Additional Marker (Mayo)OutsideLaboratory",,88185,CPT,Facility,Both,,,90,68,57.8,19.4888,68,Sanford Health Plan,Sanford Health Plan,62.56,92,,percent of total billed charges,,
"Flow Cytometry, Each Additional Marker (Mayo)OutsideLaboratory",,88185,CPT,Facility,Outpatient,,,90,68,57.8,19.4888,68,"UCare Health, Inc.",Individual & Family Plan,38.318,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Flow Cytometry, Each Additional Marker (Mayo)OutsideLaboratory",,88185,CPT,Facility,Inpatient,,,90,68,57.8,19.4888,68,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Flow Cytometry, Each Additional Marker (Mayo)OutsideLaboratory",,88185,CPT,Facility,Outpatient,,,90,68,57.8,19.4888,68,"UCare Health, Inc.",Medical Assistance,34.3196,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Flow Cytometry, Each Additional Marker (Mayo)OutsideLaboratory",,88185,CPT,Facility,Inpatient,,,90,68,57.8,19.4888,68,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Flow Cytometry, Each Additional Marker (Mayo)OutsideLaboratory",,88185,CPT,Facility,Outpatient,,,90,68,57.8,19.4888,68,"UCare Health, Inc.",Medicare Advantage,34.3196,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Flow Cytometry, Each Additional Marker (Mayo)OutsideLaboratory",,88185,CPT,Facility,Inpatient,,,90,68,57.8,19.4888,68,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Flow Cytometry, Each Additional Marker (Mayo)OutsideLaboratory",,88185,CPT,Facility,Outpatient,,,90,68,57.8,19.4888,68,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),34.3196,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Flow Cytometry, Each Additional Marker (Mayo)OutsideLaboratory",,88185,CPT,Facility,Inpatient,,,90,68,57.8,19.4888,68,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Flow Cytometry, Each Additional Marker (Mayo)OutsideLaboratory",,88185,CPT,Facility,Both,,,90,68,57.8,19.4888,68,UnitedHealthcare,Individual & Family,63.92,94,,percent of total billed charges,,
"Flow Cytometry, Each Additional Marker (Mayo)OutsideLaboratory",,88185,CPT,Facility,Outpatient,,,90,68,57.8,19.4888,68,UnitedHealthcare,Medicare Advantage,33.32,49,,percent of total billed charges,,
"Flow Cytometry, Each Additional Marker (Mayo)OutsideLaboratory",,88185,CPT,Facility,Inpatient,,,90,68,57.8,19.4888,68,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Flow Cytometry, Each Additional Marker (Mayo)OutsideLaboratory",,88185,CPT,Facility,Outpatient,,,90,68,57.8,19.4888,68,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,32.64,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Flow Cytometry, Each Additional Marker (Mayo)OutsideLaboratory",,88185,CPT,Facility,Inpatient,,,90,68,57.8,19.4888,68,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Flow Cytometry Interp, 9-15 Markers (Mayo)OutsideLaboratory",,88188,CPT,Facility,Both,,,90,284,241.4,81.3944,284,Aetna,Commercial,261.28,92,,percent of total billed charges,,
"Flow Cytometry Interp, 9-15 Markers (Mayo)OutsideLaboratory",,88188,CPT,Facility,Outpatient,,,90,284,241.4,81.3944,284,Aetna,Medicare Advantage,139.16,49,,percent of total billed charges,,
"Flow Cytometry Interp, 9-15 Markers (Mayo)OutsideLaboratory",,88188,CPT,Facility,Inpatient,,,90,284,241.4,81.3944,284,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Flow Cytometry Interp, 9-15 Markers (Mayo)OutsideLaboratory",,88188,CPT,Facility,Both,,,90,284,241.4,81.3944,284,Aetna,PPO,264.12,93,,percent of total billed charges,,
"Flow Cytometry Interp, 9-15 Markers (Mayo)OutsideLaboratory",,88188,CPT,Facility,Both,,,90,284,241.4,81.3944,284,America's PPO,America's PPO,272.7252,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Flow Cytometry Interp, 9-15 Markers (Mayo)OutsideLaboratory",,88188,CPT,Facility,Both,,,90,284,241.4,81.3944,284,BlueCross BlueShield Minnesota, Federal Employee Program,279.456,98.4,,percent of total billed charges,,
"Flow Cytometry Interp, 9-15 Markers (Mayo)OutsideLaboratory",,88188,CPT,Facility,Both,,,90,284,241.4,81.3944,284,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,284,100,,percent of total billed charges,,
"Flow Cytometry Interp, 9-15 Markers (Mayo)OutsideLaboratory",,88188,CPT,Facility,Both,,,90,284,241.4,81.3944,284,BlueCross BlueShield Minnesota,High Value Network Plan,255.6,90,,percent of total billed charges,,
"Flow Cytometry Interp, 9-15 Markers (Mayo)OutsideLaboratory",,88188,CPT,Facility,Outpatient,,,90,284,241.4,81.3944,284,BlueCross BlueShield Minnesota,Medicare Advantage,139.16,49,,percent of total billed charges,,
"Flow Cytometry Interp, 9-15 Markers (Mayo)OutsideLaboratory",,88188,CPT,Facility,Inpatient,,,90,284,241.4,81.3944,284,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Flow Cytometry Interp, 9-15 Markers (Mayo)OutsideLaboratory",,88188,CPT,Facility,Both,,,90,284,241.4,81.3944,284,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,251.5388,88.57,,percent of total billed charges,,
"Flow Cytometry Interp, 9-15 Markers (Mayo)OutsideLaboratory",,88188,CPT,Facility,Both,,,90,284,241.4,81.3944,284,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,81.3944,28.66,,percent of total billed charges,,
"Flow Cytometry Interp, 9-15 Markers (Mayo)OutsideLaboratory",,88188,CPT,Facility,Outpatient,,,90,284,241.4,81.3944,284,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),139.16,49,,percent of total billed charges,,
"Flow Cytometry Interp, 9-15 Markers (Mayo)OutsideLaboratory",,88188,CPT,Facility,Inpatient,,,90,284,241.4,81.3944,284,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Flow Cytometry Interp, 9-15 Markers (Mayo)OutsideLaboratory",,88188,CPT,Facility,Both,,,90,284,241.4,81.3944,284,CorVel,Worker's Compensation,284,100,,percent of total billed charges,,
"Flow Cytometry Interp, 9-15 Markers (Mayo)OutsideLaboratory",,88188,CPT,Facility,Both,,,90,284,241.4,81.3944,284,First Health Group Corporation,First Health Network,275.48,97,,percent of total billed charges,,
"Flow Cytometry Interp, 9-15 Markers (Mayo)OutsideLaboratory",,88188,CPT,Facility,Both,,,90,284,241.4,81.3944,284,"Health Partners, Inc.",Commercial,268.664,94.6,,percent of total billed charges,,
"Flow Cytometry Interp, 9-15 Markers (Mayo)OutsideLaboratory",,88188,CPT,Facility,Outpatient,,,90,284,241.4,81.3944,284,"Health Partners, Inc.",Medicare Advantage,139.16,49,,percent of total billed charges,,
"Flow Cytometry Interp, 9-15 Markers (Mayo)OutsideLaboratory",,88188,CPT,Facility,Inpatient,,,90,284,241.4,81.3944,284,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Flow Cytometry Interp, 9-15 Markers (Mayo)OutsideLaboratory",,88188,CPT,Facility,Both,,,90,284,241.4,81.3944,284,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),170.4,60,,percent of total billed charges,,
"Flow Cytometry Interp, 9-15 Markers (Mayo)OutsideLaboratory",,88188,CPT,Facility,Both,,,90,284,241.4,81.3944,284,"Health Partners, Inc.",State of Minnesota Advantage Program,231.46,81.5,,percent of total billed charges,,
"Flow Cytometry Interp, 9-15 Markers (Mayo)OutsideLaboratory",,88188,CPT,Facility,Both,,,90,284,241.4,81.3944,284,"Health Partners, Inc.",State Public Programs,142,50,,percent of total billed charges,,
"Flow Cytometry Interp, 9-15 Markers (Mayo)OutsideLaboratory",,88188,CPT,Facility,Both,,,90,284,241.4,81.3944,284,Humana Insurance Company,Commercial PPO,269.8,95,,percent of total billed charges,,
"Flow Cytometry Interp, 9-15 Markers (Mayo)OutsideLaboratory",,88188,CPT,Facility,Outpatient,,,90,284,241.4,81.3944,284,Humana Insurance Company,Medicare PPO,139.16,49,,percent of total billed charges,,
"Flow Cytometry Interp, 9-15 Markers (Mayo)OutsideLaboratory",,88188,CPT,Facility,Inpatient,,,90,284,241.4,81.3944,284,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Flow Cytometry Interp, 9-15 Markers (Mayo)OutsideLaboratory",,88188,CPT,Facility,Both,,,90,284,241.4,81.3944,284,Medica,Individual & Family,281.444,99.1,,percent of total billed charges,,
"Flow Cytometry Interp, 9-15 Markers (Mayo)OutsideLaboratory",,88188,CPT,Facility,Outpatient,,,90,284,241.4,81.3944,284,Medica,Medica Advantage Solution,141.432,49.8,,percent of total billed charges,,
"Flow Cytometry Interp, 9-15 Markers (Mayo)OutsideLaboratory",,88188,CPT,Facility,Inpatient,,,90,284,241.4,81.3944,284,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Flow Cytometry Interp, 9-15 Markers (Mayo)OutsideLaboratory",,88188,CPT,Facility,Outpatient,,,90,284,241.4,81.3944,284,Medica,Medical Assistance,126.664,44.6,,percent of total billed charges,,
"Flow Cytometry Interp, 9-15 Markers (Mayo)OutsideLaboratory",,88188,CPT,Facility,Inpatient,,,90,284,241.4,81.3944,284,Medica,Medical Assistance,,,,,Included in per diem rate,
"Flow Cytometry Interp, 9-15 Markers (Mayo)OutsideLaboratory",,88188,CPT,Facility,Outpatient,,,90,284,241.4,81.3944,284,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,141.432,49.8,,percent of total billed charges,,
"Flow Cytometry Interp, 9-15 Markers (Mayo)OutsideLaboratory",,88188,CPT,Facility,Inpatient,,,90,284,241.4,81.3944,284,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Flow Cytometry Interp, 9-15 Markers (Mayo)OutsideLaboratory",,88188,CPT,Facility,Both,,,90,284,241.4,81.3944,284,"Multiplan, Inc.","Multiplan, Inc.",266.96,94,,percent of total billed charges,,
"Flow Cytometry Interp, 9-15 Markers (Mayo)OutsideLaboratory",,88188,CPT,Facility,Outpatient,,,90,284,241.4,81.3944,284,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,245.376,86.4,,percent of total billed charges,,
"Flow Cytometry Interp, 9-15 Markers (Mayo)OutsideLaboratory",,88188,CPT,Facility,Inpatient,,,90,284,241.4,81.3944,284,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Flow Cytometry Interp, 9-15 Markers (Mayo)OutsideLaboratory",,88188,CPT,Facility,Both,,,90,284,241.4,81.3944,284,"Preferred One Administrative Services, INC.",PPO,280.024,98.6,,percent of total billed charges,,
"Flow Cytometry Interp, 9-15 Markers (Mayo)OutsideLaboratory",,88188,CPT,Facility,Outpatient,,,90,284,241.4,81.3944,284,PrimeWest Health,Minnesota Senior Health Options (MSHO),146.118,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Flow Cytometry Interp, 9-15 Markers (Mayo)OutsideLaboratory",,88188,CPT,Facility,Inpatient,,,90,284,241.4,81.3944,284,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Flow Cytometry Interp, 9-15 Markers (Mayo)OutsideLaboratory",,88188,CPT,Facility,Outpatient,,,90,284,241.4,81.3944,284,PrimeWest Health,MinnesotaCare,145.8624,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Flow Cytometry Interp, 9-15 Markers (Mayo)OutsideLaboratory",,88188,CPT,Facility,Inpatient,,,90,284,241.4,81.3944,284,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Flow Cytometry Interp, 9-15 Markers (Mayo)OutsideLaboratory",,88188,CPT,Facility,Both,,,90,284,241.4,81.3944,284,Sanford Health Plan,Sanford Health Plan,261.28,92,,percent of total billed charges,,
"Flow Cytometry Interp, 9-15 Markers (Mayo)OutsideLaboratory",,88188,CPT,Facility,Outpatient,,,90,284,241.4,81.3944,284,"UCare Health, Inc.",Individual & Family Plan,160.034,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Flow Cytometry Interp, 9-15 Markers (Mayo)OutsideLaboratory",,88188,CPT,Facility,Inpatient,,,90,284,241.4,81.3944,284,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Flow Cytometry Interp, 9-15 Markers (Mayo)OutsideLaboratory",,88188,CPT,Facility,Outpatient,,,90,284,241.4,81.3944,284,"UCare Health, Inc.",Medical Assistance,143.3348,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Flow Cytometry Interp, 9-15 Markers (Mayo)OutsideLaboratory",,88188,CPT,Facility,Inpatient,,,90,284,241.4,81.3944,284,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Flow Cytometry Interp, 9-15 Markers (Mayo)OutsideLaboratory",,88188,CPT,Facility,Outpatient,,,90,284,241.4,81.3944,284,"UCare Health, Inc.",Medicare Advantage,143.3348,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Flow Cytometry Interp, 9-15 Markers (Mayo)OutsideLaboratory",,88188,CPT,Facility,Inpatient,,,90,284,241.4,81.3944,284,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Flow Cytometry Interp, 9-15 Markers (Mayo)OutsideLaboratory",,88188,CPT,Facility,Outpatient,,,90,284,241.4,81.3944,284,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),143.3348,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Flow Cytometry Interp, 9-15 Markers (Mayo)OutsideLaboratory",,88188,CPT,Facility,Inpatient,,,90,284,241.4,81.3944,284,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Flow Cytometry Interp, 9-15 Markers (Mayo)OutsideLaboratory",,88188,CPT,Facility,Both,,,90,284,241.4,81.3944,284,UnitedHealthcare,Individual & Family,266.96,94,,percent of total billed charges,,
"Flow Cytometry Interp, 9-15 Markers (Mayo)OutsideLaboratory",,88188,CPT,Facility,Outpatient,,,90,284,241.4,81.3944,284,UnitedHealthcare,Medicare Advantage,139.16,49,,percent of total billed charges,,
"Flow Cytometry Interp, 9-15 Markers (Mayo)OutsideLaboratory",,88188,CPT,Facility,Inpatient,,,90,284,241.4,81.3944,284,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Flow Cytometry Interp, 9-15 Markers (Mayo)OutsideLaboratory",,88188,CPT,Facility,Outpatient,,,90,284,241.4,81.3944,284,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,136.32,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Flow Cytometry Interp, 9-15 Markers (Mayo)OutsideLaboratory",,88188,CPT,Facility,Inpatient,,,90,284,241.4,81.3944,284,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Cx04 - Culture 04 (Mayo)OutsideLaboratory,,88237,CPT,Facility,Both,,,90,561,476.85,160.7826,561,Aetna,Commercial,516.12,92,,percent of total billed charges,,
Cx04 - Culture 04 (Mayo)OutsideLaboratory,,88237,CPT,Facility,Outpatient,,,90,561,476.85,160.7826,561,Aetna,Medicare Advantage,274.89,49,,percent of total billed charges,,
Cx04 - Culture 04 (Mayo)OutsideLaboratory,,88237,CPT,Facility,Inpatient,,,90,561,476.85,160.7826,561,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Cx04 - Culture 04 (Mayo)OutsideLaboratory,,88237,CPT,Facility,Both,,,90,561,476.85,160.7826,561,Aetna,PPO,521.73,93,,percent of total billed charges,,
Cx04 - Culture 04 (Mayo)OutsideLaboratory,,88237,CPT,Facility,Both,,,90,561,476.85,160.7826,561,America's PPO,America's PPO,538.7283,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Cx04 - Culture 04 (Mayo)OutsideLaboratory,,88237,CPT,Facility,Both,,,90,561,476.85,160.7826,561,BlueCross BlueShield Minnesota, Federal Employee Program,552.024,98.4,,percent of total billed charges,,
Cx04 - Culture 04 (Mayo)OutsideLaboratory,,88237,CPT,Facility,Both,,,90,561,476.85,160.7826,561,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,561,100,,percent of total billed charges,,
Cx04 - Culture 04 (Mayo)OutsideLaboratory,,88237,CPT,Facility,Both,,,90,561,476.85,160.7826,561,BlueCross BlueShield Minnesota,High Value Network Plan,504.9,90,,percent of total billed charges,,
Cx04 - Culture 04 (Mayo)OutsideLaboratory,,88237,CPT,Facility,Outpatient,,,90,561,476.85,160.7826,561,BlueCross BlueShield Minnesota,Medicare Advantage,274.89,49,,percent of total billed charges,,
Cx04 - Culture 04 (Mayo)OutsideLaboratory,,88237,CPT,Facility,Inpatient,,,90,561,476.85,160.7826,561,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Cx04 - Culture 04 (Mayo)OutsideLaboratory,,88237,CPT,Facility,Both,,,90,561,476.85,160.7826,561,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,496.8777,88.57,,percent of total billed charges,,
Cx04 - Culture 04 (Mayo)OutsideLaboratory,,88237,CPT,Facility,Both,,,90,561,476.85,160.7826,561,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,160.7826,28.66,,percent of total billed charges,,
Cx04 - Culture 04 (Mayo)OutsideLaboratory,,88237,CPT,Facility,Outpatient,,,90,561,476.85,160.7826,561,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),274.89,49,,percent of total billed charges,,
Cx04 - Culture 04 (Mayo)OutsideLaboratory,,88237,CPT,Facility,Inpatient,,,90,561,476.85,160.7826,561,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Cx04 - Culture 04 (Mayo)OutsideLaboratory,,88237,CPT,Facility,Both,,,90,561,476.85,160.7826,561,CorVel,Worker's Compensation,561,100,,percent of total billed charges,,
Cx04 - Culture 04 (Mayo)OutsideLaboratory,,88237,CPT,Facility,Both,,,90,561,476.85,160.7826,561,First Health Group Corporation,First Health Network,544.17,97,,percent of total billed charges,,
Cx04 - Culture 04 (Mayo)OutsideLaboratory,,88237,CPT,Facility,Both,,,90,561,476.85,160.7826,561,"Health Partners, Inc.",Commercial,530.706,94.6,,percent of total billed charges,,
Cx04 - Culture 04 (Mayo)OutsideLaboratory,,88237,CPT,Facility,Outpatient,,,90,561,476.85,160.7826,561,"Health Partners, Inc.",Medicare Advantage,274.89,49,,percent of total billed charges,,
Cx04 - Culture 04 (Mayo)OutsideLaboratory,,88237,CPT,Facility,Inpatient,,,90,561,476.85,160.7826,561,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Cx04 - Culture 04 (Mayo)OutsideLaboratory,,88237,CPT,Facility,Both,,,90,561,476.85,160.7826,561,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),336.6,60,,percent of total billed charges,,
Cx04 - Culture 04 (Mayo)OutsideLaboratory,,88237,CPT,Facility,Both,,,90,561,476.85,160.7826,561,"Health Partners, Inc.",State of Minnesota Advantage Program,457.215,81.5,,percent of total billed charges,,
Cx04 - Culture 04 (Mayo)OutsideLaboratory,,88237,CPT,Facility,Both,,,90,561,476.85,160.7826,561,"Health Partners, Inc.",State Public Programs,280.5,50,,percent of total billed charges,,
Cx04 - Culture 04 (Mayo)OutsideLaboratory,,88237,CPT,Facility,Both,,,90,561,476.85,160.7826,561,Humana Insurance Company,Commercial PPO,532.95,95,,percent of total billed charges,,
Cx04 - Culture 04 (Mayo)OutsideLaboratory,,88237,CPT,Facility,Outpatient,,,90,561,476.85,160.7826,561,Humana Insurance Company,Medicare PPO,274.89,49,,percent of total billed charges,,
Cx04 - Culture 04 (Mayo)OutsideLaboratory,,88237,CPT,Facility,Inpatient,,,90,561,476.85,160.7826,561,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Cx04 - Culture 04 (Mayo)OutsideLaboratory,,88237,CPT,Facility,Both,,,90,561,476.85,160.7826,561,Medica,Individual & Family,555.951,99.1,,percent of total billed charges,,
Cx04 - Culture 04 (Mayo)OutsideLaboratory,,88237,CPT,Facility,Outpatient,,,90,561,476.85,160.7826,561,Medica,Medica Advantage Solution,279.378,49.8,,percent of total billed charges,,
Cx04 - Culture 04 (Mayo)OutsideLaboratory,,88237,CPT,Facility,Inpatient,,,90,561,476.85,160.7826,561,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Cx04 - Culture 04 (Mayo)OutsideLaboratory,,88237,CPT,Facility,Outpatient,,,90,561,476.85,160.7826,561,Medica,Medical Assistance,250.206,44.6,,percent of total billed charges,,
Cx04 - Culture 04 (Mayo)OutsideLaboratory,,88237,CPT,Facility,Inpatient,,,90,561,476.85,160.7826,561,Medica,Medical Assistance,,,,,Included in per diem rate,
Cx04 - Culture 04 (Mayo)OutsideLaboratory,,88237,CPT,Facility,Outpatient,,,90,561,476.85,160.7826,561,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,279.378,49.8,,percent of total billed charges,,
Cx04 - Culture 04 (Mayo)OutsideLaboratory,,88237,CPT,Facility,Inpatient,,,90,561,476.85,160.7826,561,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Cx04 - Culture 04 (Mayo)OutsideLaboratory,,88237,CPT,Facility,Both,,,90,561,476.85,160.7826,561,"Multiplan, Inc.","Multiplan, Inc.",527.34,94,,percent of total billed charges,,
Cx04 - Culture 04 (Mayo)OutsideLaboratory,,88237,CPT,Facility,Outpatient,,,90,561,476.85,160.7826,561,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,484.704,86.4,,percent of total billed charges,,
Cx04 - Culture 04 (Mayo)OutsideLaboratory,,88237,CPT,Facility,Inpatient,,,90,561,476.85,160.7826,561,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Cx04 - Culture 04 (Mayo)OutsideLaboratory,,88237,CPT,Facility,Both,,,90,561,476.85,160.7826,561,"Preferred One Administrative Services, INC.",PPO,553.146,98.6,,percent of total billed charges,,
Cx04 - Culture 04 (Mayo)OutsideLaboratory,,88237,CPT,Facility,Outpatient,,,90,561,476.85,160.7826,561,PrimeWest Health,Minnesota Senior Health Options (MSHO),288.6345,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Cx04 - Culture 04 (Mayo)OutsideLaboratory,,88237,CPT,Facility,Inpatient,,,90,561,476.85,160.7826,561,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Cx04 - Culture 04 (Mayo)OutsideLaboratory,,88237,CPT,Facility,Outpatient,,,90,561,476.85,160.7826,561,PrimeWest Health,MinnesotaCare,288.1296,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Cx04 - Culture 04 (Mayo)OutsideLaboratory,,88237,CPT,Facility,Inpatient,,,90,561,476.85,160.7826,561,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Cx04 - Culture 04 (Mayo)OutsideLaboratory,,88237,CPT,Facility,Both,,,90,561,476.85,160.7826,561,Sanford Health Plan,Sanford Health Plan,516.12,92,,percent of total billed charges,,
Cx04 - Culture 04 (Mayo)OutsideLaboratory,,88237,CPT,Facility,Outpatient,,,90,561,476.85,160.7826,561,"UCare Health, Inc.",Individual & Family Plan,316.1235,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Cx04 - Culture 04 (Mayo)OutsideLaboratory,,88237,CPT,Facility,Inpatient,,,90,561,476.85,160.7826,561,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Cx04 - Culture 04 (Mayo)OutsideLaboratory,,88237,CPT,Facility,Outpatient,,,90,561,476.85,160.7826,561,"UCare Health, Inc.",Medical Assistance,283.1367,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Cx04 - Culture 04 (Mayo)OutsideLaboratory,,88237,CPT,Facility,Inpatient,,,90,561,476.85,160.7826,561,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Cx04 - Culture 04 (Mayo)OutsideLaboratory,,88237,CPT,Facility,Outpatient,,,90,561,476.85,160.7826,561,"UCare Health, Inc.",Medicare Advantage,283.1367,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Cx04 - Culture 04 (Mayo)OutsideLaboratory,,88237,CPT,Facility,Inpatient,,,90,561,476.85,160.7826,561,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Cx04 - Culture 04 (Mayo)OutsideLaboratory,,88237,CPT,Facility,Outpatient,,,90,561,476.85,160.7826,561,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),283.1367,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Cx04 - Culture 04 (Mayo)OutsideLaboratory,,88237,CPT,Facility,Inpatient,,,90,561,476.85,160.7826,561,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Cx04 - Culture 04 (Mayo)OutsideLaboratory,,88237,CPT,Facility,Both,,,90,561,476.85,160.7826,561,UnitedHealthcare,Individual & Family,527.34,94,,percent of total billed charges,,
Cx04 - Culture 04 (Mayo)OutsideLaboratory,,88237,CPT,Facility,Outpatient,,,90,561,476.85,160.7826,561,UnitedHealthcare,Medicare Advantage,274.89,49,,percent of total billed charges,,
Cx04 - Culture 04 (Mayo)OutsideLaboratory,,88237,CPT,Facility,Inpatient,,,90,561,476.85,160.7826,561,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Cx04 - Culture 04 (Mayo)OutsideLaboratory,,88237,CPT,Facility,Outpatient,,,90,561,476.85,160.7826,561,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,269.28,48,,percent of total billed charges,,100% of DHS outpatient percentage
Cx04 - Culture 04 (Mayo)OutsideLaboratory,,88237,CPT,Facility,Inpatient,,,90,561,476.85,160.7826,561,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Ml20 Metaphases, 1-19 (Bill Only) (Mayo)OutsideLaboratory",,88264,CPT,Facility,Both,,,90,398,338.3,114.0668,398,Aetna,Commercial,366.16,92,,percent of total billed charges,,
"Ml20 Metaphases, 1-19 (Bill Only) (Mayo)OutsideLaboratory",,88264,CPT,Facility,Outpatient,,,90,398,338.3,114.0668,398,Aetna,Medicare Advantage,195.02,49,,percent of total billed charges,,
"Ml20 Metaphases, 1-19 (Bill Only) (Mayo)OutsideLaboratory",,88264,CPT,Facility,Inpatient,,,90,398,338.3,114.0668,398,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Ml20 Metaphases, 1-19 (Bill Only) (Mayo)OutsideLaboratory",,88264,CPT,Facility,Both,,,90,398,338.3,114.0668,398,Aetna,PPO,370.14,93,,percent of total billed charges,,
"Ml20 Metaphases, 1-19 (Bill Only) (Mayo)OutsideLaboratory",,88264,CPT,Facility,Both,,,90,398,338.3,114.0668,398,America's PPO,America's PPO,382.1994,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Ml20 Metaphases, 1-19 (Bill Only) (Mayo)OutsideLaboratory",,88264,CPT,Facility,Both,,,90,398,338.3,114.0668,398,BlueCross BlueShield Minnesota, Federal Employee Program,391.632,98.4,,percent of total billed charges,,
"Ml20 Metaphases, 1-19 (Bill Only) (Mayo)OutsideLaboratory",,88264,CPT,Facility,Both,,,90,398,338.3,114.0668,398,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,398,100,,percent of total billed charges,,
"Ml20 Metaphases, 1-19 (Bill Only) (Mayo)OutsideLaboratory",,88264,CPT,Facility,Both,,,90,398,338.3,114.0668,398,BlueCross BlueShield Minnesota,High Value Network Plan,358.2,90,,percent of total billed charges,,
"Ml20 Metaphases, 1-19 (Bill Only) (Mayo)OutsideLaboratory",,88264,CPT,Facility,Outpatient,,,90,398,338.3,114.0668,398,BlueCross BlueShield Minnesota,Medicare Advantage,195.02,49,,percent of total billed charges,,
"Ml20 Metaphases, 1-19 (Bill Only) (Mayo)OutsideLaboratory",,88264,CPT,Facility,Inpatient,,,90,398,338.3,114.0668,398,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Ml20 Metaphases, 1-19 (Bill Only) (Mayo)OutsideLaboratory",,88264,CPT,Facility,Both,,,90,398,338.3,114.0668,398,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,352.5086,88.57,,percent of total billed charges,,
"Ml20 Metaphases, 1-19 (Bill Only) (Mayo)OutsideLaboratory",,88264,CPT,Facility,Both,,,90,398,338.3,114.0668,398,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,114.0668,28.66,,percent of total billed charges,,
"Ml20 Metaphases, 1-19 (Bill Only) (Mayo)OutsideLaboratory",,88264,CPT,Facility,Outpatient,,,90,398,338.3,114.0668,398,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),195.02,49,,percent of total billed charges,,
"Ml20 Metaphases, 1-19 (Bill Only) (Mayo)OutsideLaboratory",,88264,CPT,Facility,Inpatient,,,90,398,338.3,114.0668,398,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Ml20 Metaphases, 1-19 (Bill Only) (Mayo)OutsideLaboratory",,88264,CPT,Facility,Both,,,90,398,338.3,114.0668,398,CorVel,Worker's Compensation,398,100,,percent of total billed charges,,
"Ml20 Metaphases, 1-19 (Bill Only) (Mayo)OutsideLaboratory",,88264,CPT,Facility,Both,,,90,398,338.3,114.0668,398,First Health Group Corporation,First Health Network,386.06,97,,percent of total billed charges,,
"Ml20 Metaphases, 1-19 (Bill Only) (Mayo)OutsideLaboratory",,88264,CPT,Facility,Both,,,90,398,338.3,114.0668,398,"Health Partners, Inc.",Commercial,376.508,94.6,,percent of total billed charges,,
"Ml20 Metaphases, 1-19 (Bill Only) (Mayo)OutsideLaboratory",,88264,CPT,Facility,Outpatient,,,90,398,338.3,114.0668,398,"Health Partners, Inc.",Medicare Advantage,195.02,49,,percent of total billed charges,,
"Ml20 Metaphases, 1-19 (Bill Only) (Mayo)OutsideLaboratory",,88264,CPT,Facility,Inpatient,,,90,398,338.3,114.0668,398,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Ml20 Metaphases, 1-19 (Bill Only) (Mayo)OutsideLaboratory",,88264,CPT,Facility,Both,,,90,398,338.3,114.0668,398,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),238.8,60,,percent of total billed charges,,
"Ml20 Metaphases, 1-19 (Bill Only) (Mayo)OutsideLaboratory",,88264,CPT,Facility,Both,,,90,398,338.3,114.0668,398,"Health Partners, Inc.",State of Minnesota Advantage Program,324.37,81.5,,percent of total billed charges,,
"Ml20 Metaphases, 1-19 (Bill Only) (Mayo)OutsideLaboratory",,88264,CPT,Facility,Both,,,90,398,338.3,114.0668,398,"Health Partners, Inc.",State Public Programs,199,50,,percent of total billed charges,,
"Ml20 Metaphases, 1-19 (Bill Only) (Mayo)OutsideLaboratory",,88264,CPT,Facility,Both,,,90,398,338.3,114.0668,398,Humana Insurance Company,Commercial PPO,378.1,95,,percent of total billed charges,,
"Ml20 Metaphases, 1-19 (Bill Only) (Mayo)OutsideLaboratory",,88264,CPT,Facility,Outpatient,,,90,398,338.3,114.0668,398,Humana Insurance Company,Medicare PPO,195.02,49,,percent of total billed charges,,
"Ml20 Metaphases, 1-19 (Bill Only) (Mayo)OutsideLaboratory",,88264,CPT,Facility,Inpatient,,,90,398,338.3,114.0668,398,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Ml20 Metaphases, 1-19 (Bill Only) (Mayo)OutsideLaboratory",,88264,CPT,Facility,Both,,,90,398,338.3,114.0668,398,Medica,Individual & Family,394.418,99.1,,percent of total billed charges,,
"Ml20 Metaphases, 1-19 (Bill Only) (Mayo)OutsideLaboratory",,88264,CPT,Facility,Outpatient,,,90,398,338.3,114.0668,398,Medica,Medica Advantage Solution,198.204,49.8,,percent of total billed charges,,
"Ml20 Metaphases, 1-19 (Bill Only) (Mayo)OutsideLaboratory",,88264,CPT,Facility,Inpatient,,,90,398,338.3,114.0668,398,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Ml20 Metaphases, 1-19 (Bill Only) (Mayo)OutsideLaboratory",,88264,CPT,Facility,Outpatient,,,90,398,338.3,114.0668,398,Medica,Medical Assistance,177.508,44.6,,percent of total billed charges,,
"Ml20 Metaphases, 1-19 (Bill Only) (Mayo)OutsideLaboratory",,88264,CPT,Facility,Inpatient,,,90,398,338.3,114.0668,398,Medica,Medical Assistance,,,,,Included in per diem rate,
"Ml20 Metaphases, 1-19 (Bill Only) (Mayo)OutsideLaboratory",,88264,CPT,Facility,Outpatient,,,90,398,338.3,114.0668,398,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,198.204,49.8,,percent of total billed charges,,
"Ml20 Metaphases, 1-19 (Bill Only) (Mayo)OutsideLaboratory",,88264,CPT,Facility,Inpatient,,,90,398,338.3,114.0668,398,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Ml20 Metaphases, 1-19 (Bill Only) (Mayo)OutsideLaboratory",,88264,CPT,Facility,Both,,,90,398,338.3,114.0668,398,"Multiplan, Inc.","Multiplan, Inc.",374.12,94,,percent of total billed charges,,
"Ml20 Metaphases, 1-19 (Bill Only) (Mayo)OutsideLaboratory",,88264,CPT,Facility,Outpatient,,,90,398,338.3,114.0668,398,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,343.872,86.4,,percent of total billed charges,,
"Ml20 Metaphases, 1-19 (Bill Only) (Mayo)OutsideLaboratory",,88264,CPT,Facility,Inpatient,,,90,398,338.3,114.0668,398,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Ml20 Metaphases, 1-19 (Bill Only) (Mayo)OutsideLaboratory",,88264,CPT,Facility,Both,,,90,398,338.3,114.0668,398,"Preferred One Administrative Services, INC.",PPO,392.428,98.6,,percent of total billed charges,,
"Ml20 Metaphases, 1-19 (Bill Only) (Mayo)OutsideLaboratory",,88264,CPT,Facility,Outpatient,,,90,398,338.3,114.0668,398,PrimeWest Health,Minnesota Senior Health Options (MSHO),204.771,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Ml20 Metaphases, 1-19 (Bill Only) (Mayo)OutsideLaboratory",,88264,CPT,Facility,Inpatient,,,90,398,338.3,114.0668,398,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Ml20 Metaphases, 1-19 (Bill Only) (Mayo)OutsideLaboratory",,88264,CPT,Facility,Outpatient,,,90,398,338.3,114.0668,398,PrimeWest Health,MinnesotaCare,204.4128,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Ml20 Metaphases, 1-19 (Bill Only) (Mayo)OutsideLaboratory",,88264,CPT,Facility,Inpatient,,,90,398,338.3,114.0668,398,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Ml20 Metaphases, 1-19 (Bill Only) (Mayo)OutsideLaboratory",,88264,CPT,Facility,Both,,,90,398,338.3,114.0668,398,Sanford Health Plan,Sanford Health Plan,366.16,92,,percent of total billed charges,,
"Ml20 Metaphases, 1-19 (Bill Only) (Mayo)OutsideLaboratory",,88264,CPT,Facility,Outpatient,,,90,398,338.3,114.0668,398,"UCare Health, Inc.",Individual & Family Plan,224.273,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Ml20 Metaphases, 1-19 (Bill Only) (Mayo)OutsideLaboratory",,88264,CPT,Facility,Inpatient,,,90,398,338.3,114.0668,398,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Ml20 Metaphases, 1-19 (Bill Only) (Mayo)OutsideLaboratory",,88264,CPT,Facility,Outpatient,,,90,398,338.3,114.0668,398,"UCare Health, Inc.",Medical Assistance,200.8706,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Ml20 Metaphases, 1-19 (Bill Only) (Mayo)OutsideLaboratory",,88264,CPT,Facility,Inpatient,,,90,398,338.3,114.0668,398,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Ml20 Metaphases, 1-19 (Bill Only) (Mayo)OutsideLaboratory",,88264,CPT,Facility,Outpatient,,,90,398,338.3,114.0668,398,"UCare Health, Inc.",Medicare Advantage,200.8706,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Ml20 Metaphases, 1-19 (Bill Only) (Mayo)OutsideLaboratory",,88264,CPT,Facility,Inpatient,,,90,398,338.3,114.0668,398,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Ml20 Metaphases, 1-19 (Bill Only) (Mayo)OutsideLaboratory",,88264,CPT,Facility,Outpatient,,,90,398,338.3,114.0668,398,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),200.8706,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Ml20 Metaphases, 1-19 (Bill Only) (Mayo)OutsideLaboratory",,88264,CPT,Facility,Inpatient,,,90,398,338.3,114.0668,398,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Ml20 Metaphases, 1-19 (Bill Only) (Mayo)OutsideLaboratory",,88264,CPT,Facility,Both,,,90,398,338.3,114.0668,398,UnitedHealthcare,Individual & Family,374.12,94,,percent of total billed charges,,
"Ml20 Metaphases, 1-19 (Bill Only) (Mayo)OutsideLaboratory",,88264,CPT,Facility,Outpatient,,,90,398,338.3,114.0668,398,UnitedHealthcare,Medicare Advantage,195.02,49,,percent of total billed charges,,
"Ml20 Metaphases, 1-19 (Bill Only) (Mayo)OutsideLaboratory",,88264,CPT,Facility,Inpatient,,,90,398,338.3,114.0668,398,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Ml20 Metaphases, 1-19 (Bill Only) (Mayo)OutsideLaboratory",,88264,CPT,Facility,Outpatient,,,90,398,338.3,114.0668,398,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,191.04,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Ml20 Metaphases, 1-19 (Bill Only) (Mayo)OutsideLaboratory",,88264,CPT,Facility,Inpatient,,,90,398,338.3,114.0668,398,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Molecular Cytogenetics, Dna Probe (Mayo)OutsideLaboratory",,88271,CPT,Facility,Both,,,90,52,44.2,14.9032,52,Aetna,Commercial,47.84,92,,percent of total billed charges,,
"Molecular Cytogenetics, Dna Probe (Mayo)OutsideLaboratory",,88271,CPT,Facility,Outpatient,,,90,52,44.2,14.9032,52,Aetna,Medicare Advantage,25.48,49,,percent of total billed charges,,
"Molecular Cytogenetics, Dna Probe (Mayo)OutsideLaboratory",,88271,CPT,Facility,Inpatient,,,90,52,44.2,14.9032,52,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Molecular Cytogenetics, Dna Probe (Mayo)OutsideLaboratory",,88271,CPT,Facility,Both,,,90,52,44.2,14.9032,52,Aetna,PPO,48.36,93,,percent of total billed charges,,
"Molecular Cytogenetics, Dna Probe (Mayo)OutsideLaboratory",,88271,CPT,Facility,Both,,,90,52,44.2,14.9032,52,America's PPO,America's PPO,49.9356,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Molecular Cytogenetics, Dna Probe (Mayo)OutsideLaboratory",,88271,CPT,Facility,Both,,,90,52,44.2,14.9032,52,BlueCross BlueShield Minnesota, Federal Employee Program,51.168,98.4,,percent of total billed charges,,
"Molecular Cytogenetics, Dna Probe (Mayo)OutsideLaboratory",,88271,CPT,Facility,Both,,,90,52,44.2,14.9032,52,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,52,100,,percent of total billed charges,,
"Molecular Cytogenetics, Dna Probe (Mayo)OutsideLaboratory",,88271,CPT,Facility,Both,,,90,52,44.2,14.9032,52,BlueCross BlueShield Minnesota,High Value Network Plan,46.8,90,,percent of total billed charges,,
"Molecular Cytogenetics, Dna Probe (Mayo)OutsideLaboratory",,88271,CPT,Facility,Outpatient,,,90,52,44.2,14.9032,52,BlueCross BlueShield Minnesota,Medicare Advantage,25.48,49,,percent of total billed charges,,
"Molecular Cytogenetics, Dna Probe (Mayo)OutsideLaboratory",,88271,CPT,Facility,Inpatient,,,90,52,44.2,14.9032,52,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Molecular Cytogenetics, Dna Probe (Mayo)OutsideLaboratory",,88271,CPT,Facility,Both,,,90,52,44.2,14.9032,52,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,46.0564,88.57,,percent of total billed charges,,
"Molecular Cytogenetics, Dna Probe (Mayo)OutsideLaboratory",,88271,CPT,Facility,Both,,,90,52,44.2,14.9032,52,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,14.9032,28.66,,percent of total billed charges,,
"Molecular Cytogenetics, Dna Probe (Mayo)OutsideLaboratory",,88271,CPT,Facility,Outpatient,,,90,52,44.2,14.9032,52,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),25.48,49,,percent of total billed charges,,
"Molecular Cytogenetics, Dna Probe (Mayo)OutsideLaboratory",,88271,CPT,Facility,Inpatient,,,90,52,44.2,14.9032,52,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Molecular Cytogenetics, Dna Probe (Mayo)OutsideLaboratory",,88271,CPT,Facility,Both,,,90,52,44.2,14.9032,52,CorVel,Worker's Compensation,52,100,,percent of total billed charges,,
"Molecular Cytogenetics, Dna Probe (Mayo)OutsideLaboratory",,88271,CPT,Facility,Both,,,90,52,44.2,14.9032,52,First Health Group Corporation,First Health Network,50.44,97,,percent of total billed charges,,
"Molecular Cytogenetics, Dna Probe (Mayo)OutsideLaboratory",,88271,CPT,Facility,Both,,,90,52,44.2,14.9032,52,"Health Partners, Inc.",Commercial,49.192,94.6,,percent of total billed charges,,
"Molecular Cytogenetics, Dna Probe (Mayo)OutsideLaboratory",,88271,CPT,Facility,Outpatient,,,90,52,44.2,14.9032,52,"Health Partners, Inc.",Medicare Advantage,25.48,49,,percent of total billed charges,,
"Molecular Cytogenetics, Dna Probe (Mayo)OutsideLaboratory",,88271,CPT,Facility,Inpatient,,,90,52,44.2,14.9032,52,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Molecular Cytogenetics, Dna Probe (Mayo)OutsideLaboratory",,88271,CPT,Facility,Both,,,90,52,44.2,14.9032,52,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),31.2,60,,percent of total billed charges,,
"Molecular Cytogenetics, Dna Probe (Mayo)OutsideLaboratory",,88271,CPT,Facility,Both,,,90,52,44.2,14.9032,52,"Health Partners, Inc.",State of Minnesota Advantage Program,42.38,81.5,,percent of total billed charges,,
"Molecular Cytogenetics, Dna Probe (Mayo)OutsideLaboratory",,88271,CPT,Facility,Both,,,90,52,44.2,14.9032,52,"Health Partners, Inc.",State Public Programs,26,50,,percent of total billed charges,,
"Molecular Cytogenetics, Dna Probe (Mayo)OutsideLaboratory",,88271,CPT,Facility,Both,,,90,52,44.2,14.9032,52,Humana Insurance Company,Commercial PPO,49.4,95,,percent of total billed charges,,
"Molecular Cytogenetics, Dna Probe (Mayo)OutsideLaboratory",,88271,CPT,Facility,Outpatient,,,90,52,44.2,14.9032,52,Humana Insurance Company,Medicare PPO,25.48,49,,percent of total billed charges,,
"Molecular Cytogenetics, Dna Probe (Mayo)OutsideLaboratory",,88271,CPT,Facility,Inpatient,,,90,52,44.2,14.9032,52,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Molecular Cytogenetics, Dna Probe (Mayo)OutsideLaboratory",,88271,CPT,Facility,Both,,,90,52,44.2,14.9032,52,Medica,Individual & Family,51.532,99.1,,percent of total billed charges,,
"Molecular Cytogenetics, Dna Probe (Mayo)OutsideLaboratory",,88271,CPT,Facility,Outpatient,,,90,52,44.2,14.9032,52,Medica,Medica Advantage Solution,25.896,49.8,,percent of total billed charges,,
"Molecular Cytogenetics, Dna Probe (Mayo)OutsideLaboratory",,88271,CPT,Facility,Inpatient,,,90,52,44.2,14.9032,52,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Molecular Cytogenetics, Dna Probe (Mayo)OutsideLaboratory",,88271,CPT,Facility,Outpatient,,,90,52,44.2,14.9032,52,Medica,Medical Assistance,23.192,44.6,,percent of total billed charges,,
"Molecular Cytogenetics, Dna Probe (Mayo)OutsideLaboratory",,88271,CPT,Facility,Inpatient,,,90,52,44.2,14.9032,52,Medica,Medical Assistance,,,,,Included in per diem rate,
"Molecular Cytogenetics, Dna Probe (Mayo)OutsideLaboratory",,88271,CPT,Facility,Outpatient,,,90,52,44.2,14.9032,52,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,25.896,49.8,,percent of total billed charges,,
"Molecular Cytogenetics, Dna Probe (Mayo)OutsideLaboratory",,88271,CPT,Facility,Inpatient,,,90,52,44.2,14.9032,52,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Molecular Cytogenetics, Dna Probe (Mayo)OutsideLaboratory",,88271,CPT,Facility,Both,,,90,52,44.2,14.9032,52,"Multiplan, Inc.","Multiplan, Inc.",48.88,94,,percent of total billed charges,,
"Molecular Cytogenetics, Dna Probe (Mayo)OutsideLaboratory",,88271,CPT,Facility,Outpatient,,,90,52,44.2,14.9032,52,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,44.928,86.4,,percent of total billed charges,,
"Molecular Cytogenetics, Dna Probe (Mayo)OutsideLaboratory",,88271,CPT,Facility,Inpatient,,,90,52,44.2,14.9032,52,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Molecular Cytogenetics, Dna Probe (Mayo)OutsideLaboratory",,88271,CPT,Facility,Both,,,90,52,44.2,14.9032,52,"Preferred One Administrative Services, INC.",PPO,51.272,98.6,,percent of total billed charges,,
"Molecular Cytogenetics, Dna Probe (Mayo)OutsideLaboratory",,88271,CPT,Facility,Outpatient,,,90,52,44.2,14.9032,52,PrimeWest Health,Minnesota Senior Health Options (MSHO),26.754,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Molecular Cytogenetics, Dna Probe (Mayo)OutsideLaboratory",,88271,CPT,Facility,Inpatient,,,90,52,44.2,14.9032,52,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Molecular Cytogenetics, Dna Probe (Mayo)OutsideLaboratory",,88271,CPT,Facility,Outpatient,,,90,52,44.2,14.9032,52,PrimeWest Health,MinnesotaCare,26.7072,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Molecular Cytogenetics, Dna Probe (Mayo)OutsideLaboratory",,88271,CPT,Facility,Inpatient,,,90,52,44.2,14.9032,52,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Molecular Cytogenetics, Dna Probe (Mayo)OutsideLaboratory",,88271,CPT,Facility,Both,,,90,52,44.2,14.9032,52,Sanford Health Plan,Sanford Health Plan,47.84,92,,percent of total billed charges,,
"Molecular Cytogenetics, Dna Probe (Mayo)OutsideLaboratory",,88271,CPT,Facility,Outpatient,,,90,52,44.2,14.9032,52,"UCare Health, Inc.",Individual & Family Plan,29.302,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Molecular Cytogenetics, Dna Probe (Mayo)OutsideLaboratory",,88271,CPT,Facility,Inpatient,,,90,52,44.2,14.9032,52,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Molecular Cytogenetics, Dna Probe (Mayo)OutsideLaboratory",,88271,CPT,Facility,Outpatient,,,90,52,44.2,14.9032,52,"UCare Health, Inc.",Medical Assistance,26.2444,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Molecular Cytogenetics, Dna Probe (Mayo)OutsideLaboratory",,88271,CPT,Facility,Inpatient,,,90,52,44.2,14.9032,52,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Molecular Cytogenetics, Dna Probe (Mayo)OutsideLaboratory",,88271,CPT,Facility,Outpatient,,,90,52,44.2,14.9032,52,"UCare Health, Inc.",Medicare Advantage,26.2444,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Molecular Cytogenetics, Dna Probe (Mayo)OutsideLaboratory",,88271,CPT,Facility,Inpatient,,,90,52,44.2,14.9032,52,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Molecular Cytogenetics, Dna Probe (Mayo)OutsideLaboratory",,88271,CPT,Facility,Outpatient,,,90,52,44.2,14.9032,52,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),26.2444,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Molecular Cytogenetics, Dna Probe (Mayo)OutsideLaboratory",,88271,CPT,Facility,Inpatient,,,90,52,44.2,14.9032,52,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Molecular Cytogenetics, Dna Probe (Mayo)OutsideLaboratory",,88271,CPT,Facility,Both,,,90,52,44.2,14.9032,52,UnitedHealthcare,Individual & Family,48.88,94,,percent of total billed charges,,
"Molecular Cytogenetics, Dna Probe (Mayo)OutsideLaboratory",,88271,CPT,Facility,Outpatient,,,90,52,44.2,14.9032,52,UnitedHealthcare,Medicare Advantage,25.48,49,,percent of total billed charges,,
"Molecular Cytogenetics, Dna Probe (Mayo)OutsideLaboratory",,88271,CPT,Facility,Inpatient,,,90,52,44.2,14.9032,52,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Molecular Cytogenetics, Dna Probe (Mayo)OutsideLaboratory",,88271,CPT,Facility,Outpatient,,,90,52,44.2,14.9032,52,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,24.96,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Molecular Cytogenetics, Dna Probe (Mayo)OutsideLaboratory",,88271,CPT,Facility,Inpatient,,,90,52,44.2,14.9032,52,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Molecular Cytogenetics; Dna Probe, Each (Mayo)OutsideLaboratory",,88271,CPT,Facility,Both,,,90,52,44.2,14.9032,52,Aetna,Commercial,47.84,92,,percent of total billed charges,,
"Molecular Cytogenetics; Dna Probe, Each (Mayo)OutsideLaboratory",,88271,CPT,Facility,Both,,,90,52,44.2,14.9032,52,Aetna,Commercial,47.84,92,,percent of total billed charges,,
"Molecular Cytogenetics; Dna Probe, Each (Mayo)OutsideLaboratory",,88271,CPT,Facility,Outpatient,,,90,52,44.2,14.9032,52,Aetna,Medicare Advantage,25.48,49,,percent of total billed charges,,
"Molecular Cytogenetics; Dna Probe, Each (Mayo)OutsideLaboratory",,88271,CPT,Facility,Outpatient,,,90,52,44.2,14.9032,52,Aetna,Medicare Advantage,25.48,49,,percent of total billed charges,,
"Molecular Cytogenetics; Dna Probe, Each (Mayo)OutsideLaboratory",,88271,CPT,Facility,Inpatient,,,90,52,44.2,14.9032,52,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Molecular Cytogenetics; Dna Probe, Each (Mayo)OutsideLaboratory",,88271,CPT,Facility,Inpatient,,,90,52,44.2,14.9032,52,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Molecular Cytogenetics; Dna Probe, Each (Mayo)OutsideLaboratory",,88271,CPT,Facility,Both,,,90,52,44.2,14.9032,52,Aetna,PPO,48.36,93,,percent of total billed charges,,
"Molecular Cytogenetics; Dna Probe, Each (Mayo)OutsideLaboratory",,88271,CPT,Facility,Both,,,90,52,44.2,14.9032,52,Aetna,PPO,48.36,93,,percent of total billed charges,,
"Molecular Cytogenetics; Dna Probe, Each (Mayo)OutsideLaboratory",,88271,CPT,Facility,Both,,,90,52,44.2,14.9032,52,America's PPO,America's PPO,49.9356,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Molecular Cytogenetics; Dna Probe, Each (Mayo)OutsideLaboratory",,88271,CPT,Facility,Both,,,90,52,44.2,14.9032,52,America's PPO,America's PPO,49.9356,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Molecular Cytogenetics; Dna Probe, Each (Mayo)OutsideLaboratory",,88271,CPT,Facility,Both,,,90,52,44.2,14.9032,52,BlueCross BlueShield Minnesota, Federal Employee Program,51.168,98.4,,percent of total billed charges,,
"Molecular Cytogenetics; Dna Probe, Each (Mayo)OutsideLaboratory",,88271,CPT,Facility,Both,,,90,52,44.2,14.9032,52,BlueCross BlueShield Minnesota, Federal Employee Program,51.168,98.4,,percent of total billed charges,,
"Molecular Cytogenetics; Dna Probe, Each (Mayo)OutsideLaboratory",,88271,CPT,Facility,Both,,,90,52,44.2,14.9032,52,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,52,100,,percent of total billed charges,,
"Molecular Cytogenetics; Dna Probe, Each (Mayo)OutsideLaboratory",,88271,CPT,Facility,Both,,,90,52,44.2,14.9032,52,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,52,100,,percent of total billed charges,,
"Molecular Cytogenetics; Dna Probe, Each (Mayo)OutsideLaboratory",,88271,CPT,Facility,Both,,,90,52,44.2,14.9032,52,BlueCross BlueShield Minnesota,High Value Network Plan,46.8,90,,percent of total billed charges,,
"Molecular Cytogenetics; Dna Probe, Each (Mayo)OutsideLaboratory",,88271,CPT,Facility,Both,,,90,52,44.2,14.9032,52,BlueCross BlueShield Minnesota,High Value Network Plan,46.8,90,,percent of total billed charges,,
"Molecular Cytogenetics; Dna Probe, Each (Mayo)OutsideLaboratory",,88271,CPT,Facility,Outpatient,,,90,52,44.2,14.9032,52,BlueCross BlueShield Minnesota,Medicare Advantage,25.48,49,,percent of total billed charges,,
"Molecular Cytogenetics; Dna Probe, Each (Mayo)OutsideLaboratory",,88271,CPT,Facility,Outpatient,,,90,52,44.2,14.9032,52,BlueCross BlueShield Minnesota,Medicare Advantage,25.48,49,,percent of total billed charges,,
"Molecular Cytogenetics; Dna Probe, Each (Mayo)OutsideLaboratory",,88271,CPT,Facility,Inpatient,,,90,52,44.2,14.9032,52,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Molecular Cytogenetics; Dna Probe, Each (Mayo)OutsideLaboratory",,88271,CPT,Facility,Inpatient,,,90,52,44.2,14.9032,52,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Molecular Cytogenetics; Dna Probe, Each (Mayo)OutsideLaboratory",,88271,CPT,Facility,Both,,,90,52,44.2,14.9032,52,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,46.0564,88.57,,percent of total billed charges,,
"Molecular Cytogenetics; Dna Probe, Each (Mayo)OutsideLaboratory",,88271,CPT,Facility,Both,,,90,52,44.2,14.9032,52,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,46.0564,88.57,,percent of total billed charges,,
"Molecular Cytogenetics; Dna Probe, Each (Mayo)OutsideLaboratory",,88271,CPT,Facility,Both,,,90,52,44.2,14.9032,52,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,14.9032,28.66,,percent of total billed charges,,
"Molecular Cytogenetics; Dna Probe, Each (Mayo)OutsideLaboratory",,88271,CPT,Facility,Both,,,90,52,44.2,14.9032,52,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,14.9032,28.66,,percent of total billed charges,,
"Molecular Cytogenetics; Dna Probe, Each (Mayo)OutsideLaboratory",,88271,CPT,Facility,Outpatient,,,90,52,44.2,14.9032,52,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),25.48,49,,percent of total billed charges,,
"Molecular Cytogenetics; Dna Probe, Each (Mayo)OutsideLaboratory",,88271,CPT,Facility,Outpatient,,,90,52,44.2,14.9032,52,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),25.48,49,,percent of total billed charges,,
"Molecular Cytogenetics; Dna Probe, Each (Mayo)OutsideLaboratory",,88271,CPT,Facility,Inpatient,,,90,52,44.2,14.9032,52,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Molecular Cytogenetics; Dna Probe, Each (Mayo)OutsideLaboratory",,88271,CPT,Facility,Inpatient,,,90,52,44.2,14.9032,52,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Molecular Cytogenetics; Dna Probe, Each (Mayo)OutsideLaboratory",,88271,CPT,Facility,Both,,,90,52,44.2,14.9032,52,CorVel,Worker's Compensation,52,100,,percent of total billed charges,,
"Molecular Cytogenetics; Dna Probe, Each (Mayo)OutsideLaboratory",,88271,CPT,Facility,Both,,,90,52,44.2,14.9032,52,CorVel,Worker's Compensation,52,100,,percent of total billed charges,,
"Molecular Cytogenetics; Dna Probe, Each (Mayo)OutsideLaboratory",,88271,CPT,Facility,Both,,,90,52,44.2,14.9032,52,First Health Group Corporation,First Health Network,50.44,97,,percent of total billed charges,,
"Molecular Cytogenetics; Dna Probe, Each (Mayo)OutsideLaboratory",,88271,CPT,Facility,Both,,,90,52,44.2,14.9032,52,First Health Group Corporation,First Health Network,50.44,97,,percent of total billed charges,,
"Molecular Cytogenetics; Dna Probe, Each (Mayo)OutsideLaboratory",,88271,CPT,Facility,Both,,,90,52,44.2,14.9032,52,"Health Partners, Inc.",Commercial,49.192,94.6,,percent of total billed charges,,
"Molecular Cytogenetics; Dna Probe, Each (Mayo)OutsideLaboratory",,88271,CPT,Facility,Both,,,90,52,44.2,14.9032,52,"Health Partners, Inc.",Commercial,49.192,94.6,,percent of total billed charges,,
"Molecular Cytogenetics; Dna Probe, Each (Mayo)OutsideLaboratory",,88271,CPT,Facility,Outpatient,,,90,52,44.2,14.9032,52,"Health Partners, Inc.",Medicare Advantage,25.48,49,,percent of total billed charges,,
"Molecular Cytogenetics; Dna Probe, Each (Mayo)OutsideLaboratory",,88271,CPT,Facility,Outpatient,,,90,52,44.2,14.9032,52,"Health Partners, Inc.",Medicare Advantage,25.48,49,,percent of total billed charges,,
"Molecular Cytogenetics; Dna Probe, Each (Mayo)OutsideLaboratory",,88271,CPT,Facility,Inpatient,,,90,52,44.2,14.9032,52,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Molecular Cytogenetics; Dna Probe, Each (Mayo)OutsideLaboratory",,88271,CPT,Facility,Inpatient,,,90,52,44.2,14.9032,52,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Molecular Cytogenetics; Dna Probe, Each (Mayo)OutsideLaboratory",,88271,CPT,Facility,Both,,,90,52,44.2,14.9032,52,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),31.2,60,,percent of total billed charges,,
"Molecular Cytogenetics; Dna Probe, Each (Mayo)OutsideLaboratory",,88271,CPT,Facility,Both,,,90,52,44.2,14.9032,52,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),31.2,60,,percent of total billed charges,,
"Molecular Cytogenetics; Dna Probe, Each (Mayo)OutsideLaboratory",,88271,CPT,Facility,Both,,,90,52,44.2,14.9032,52,"Health Partners, Inc.",State of Minnesota Advantage Program,42.38,81.5,,percent of total billed charges,,
"Molecular Cytogenetics; Dna Probe, Each (Mayo)OutsideLaboratory",,88271,CPT,Facility,Both,,,90,52,44.2,14.9032,52,"Health Partners, Inc.",State of Minnesota Advantage Program,42.38,81.5,,percent of total billed charges,,
"Molecular Cytogenetics; Dna Probe, Each (Mayo)OutsideLaboratory",,88271,CPT,Facility,Both,,,90,52,44.2,14.9032,52,"Health Partners, Inc.",State Public Programs,26,50,,percent of total billed charges,,
"Molecular Cytogenetics; Dna Probe, Each (Mayo)OutsideLaboratory",,88271,CPT,Facility,Both,,,90,52,44.2,14.9032,52,"Health Partners, Inc.",State Public Programs,26,50,,percent of total billed charges,,
"Molecular Cytogenetics; Dna Probe, Each (Mayo)OutsideLaboratory",,88271,CPT,Facility,Both,,,90,52,44.2,14.9032,52,Humana Insurance Company,Commercial PPO,49.4,95,,percent of total billed charges,,
"Molecular Cytogenetics; Dna Probe, Each (Mayo)OutsideLaboratory",,88271,CPT,Facility,Both,,,90,52,44.2,14.9032,52,Humana Insurance Company,Commercial PPO,49.4,95,,percent of total billed charges,,
"Molecular Cytogenetics; Dna Probe, Each (Mayo)OutsideLaboratory",,88271,CPT,Facility,Outpatient,,,90,52,44.2,14.9032,52,Humana Insurance Company,Medicare PPO,25.48,49,,percent of total billed charges,,
"Molecular Cytogenetics; Dna Probe, Each (Mayo)OutsideLaboratory",,88271,CPT,Facility,Outpatient,,,90,52,44.2,14.9032,52,Humana Insurance Company,Medicare PPO,25.48,49,,percent of total billed charges,,
"Molecular Cytogenetics; Dna Probe, Each (Mayo)OutsideLaboratory",,88271,CPT,Facility,Inpatient,,,90,52,44.2,14.9032,52,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Molecular Cytogenetics; Dna Probe, Each (Mayo)OutsideLaboratory",,88271,CPT,Facility,Inpatient,,,90,52,44.2,14.9032,52,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Molecular Cytogenetics; Dna Probe, Each (Mayo)OutsideLaboratory",,88271,CPT,Facility,Both,,,90,52,44.2,14.9032,52,Medica,Individual & Family,51.532,99.1,,percent of total billed charges,,
"Molecular Cytogenetics; Dna Probe, Each (Mayo)OutsideLaboratory",,88271,CPT,Facility,Both,,,90,52,44.2,14.9032,52,Medica,Individual & Family,51.532,99.1,,percent of total billed charges,,
"Molecular Cytogenetics; Dna Probe, Each (Mayo)OutsideLaboratory",,88271,CPT,Facility,Outpatient,,,90,52,44.2,14.9032,52,Medica,Medica Advantage Solution,25.896,49.8,,percent of total billed charges,,
"Molecular Cytogenetics; Dna Probe, Each (Mayo)OutsideLaboratory",,88271,CPT,Facility,Outpatient,,,90,52,44.2,14.9032,52,Medica,Medica Advantage Solution,25.896,49.8,,percent of total billed charges,,
"Molecular Cytogenetics; Dna Probe, Each (Mayo)OutsideLaboratory",,88271,CPT,Facility,Inpatient,,,90,52,44.2,14.9032,52,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Molecular Cytogenetics; Dna Probe, Each (Mayo)OutsideLaboratory",,88271,CPT,Facility,Inpatient,,,90,52,44.2,14.9032,52,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Molecular Cytogenetics; Dna Probe, Each (Mayo)OutsideLaboratory",,88271,CPT,Facility,Outpatient,,,90,52,44.2,14.9032,52,Medica,Medical Assistance,23.192,44.6,,percent of total billed charges,,
"Molecular Cytogenetics; Dna Probe, Each (Mayo)OutsideLaboratory",,88271,CPT,Facility,Outpatient,,,90,52,44.2,14.9032,52,Medica,Medical Assistance,23.192,44.6,,percent of total billed charges,,
"Molecular Cytogenetics; Dna Probe, Each (Mayo)OutsideLaboratory",,88271,CPT,Facility,Inpatient,,,90,52,44.2,14.9032,52,Medica,Medical Assistance,,,,,Included in per diem rate,
"Molecular Cytogenetics; Dna Probe, Each (Mayo)OutsideLaboratory",,88271,CPT,Facility,Inpatient,,,90,52,44.2,14.9032,52,Medica,Medical Assistance,,,,,Included in per diem rate,
"Molecular Cytogenetics; Dna Probe, Each (Mayo)OutsideLaboratory",,88271,CPT,Facility,Outpatient,,,90,52,44.2,14.9032,52,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,25.896,49.8,,percent of total billed charges,,
"Molecular Cytogenetics; Dna Probe, Each (Mayo)OutsideLaboratory",,88271,CPT,Facility,Outpatient,,,90,52,44.2,14.9032,52,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,25.896,49.8,,percent of total billed charges,,
"Molecular Cytogenetics; Dna Probe, Each (Mayo)OutsideLaboratory",,88271,CPT,Facility,Inpatient,,,90,52,44.2,14.9032,52,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Molecular Cytogenetics; Dna Probe, Each (Mayo)OutsideLaboratory",,88271,CPT,Facility,Inpatient,,,90,52,44.2,14.9032,52,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Molecular Cytogenetics; Dna Probe, Each (Mayo)OutsideLaboratory",,88271,CPT,Facility,Both,,,90,52,44.2,14.9032,52,"Multiplan, Inc.","Multiplan, Inc.",48.88,94,,percent of total billed charges,,
"Molecular Cytogenetics; Dna Probe, Each (Mayo)OutsideLaboratory",,88271,CPT,Facility,Both,,,90,52,44.2,14.9032,52,"Multiplan, Inc.","Multiplan, Inc.",48.88,94,,percent of total billed charges,,
"Molecular Cytogenetics; Dna Probe, Each (Mayo)OutsideLaboratory",,88271,CPT,Facility,Outpatient,,,90,52,44.2,14.9032,52,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,44.928,86.4,,percent of total billed charges,,
"Molecular Cytogenetics; Dna Probe, Each (Mayo)OutsideLaboratory",,88271,CPT,Facility,Outpatient,,,90,52,44.2,14.9032,52,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,44.928,86.4,,percent of total billed charges,,
"Molecular Cytogenetics; Dna Probe, Each (Mayo)OutsideLaboratory",,88271,CPT,Facility,Inpatient,,,90,52,44.2,14.9032,52,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Molecular Cytogenetics; Dna Probe, Each (Mayo)OutsideLaboratory",,88271,CPT,Facility,Inpatient,,,90,52,44.2,14.9032,52,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Molecular Cytogenetics; Dna Probe, Each (Mayo)OutsideLaboratory",,88271,CPT,Facility,Both,,,90,52,44.2,14.9032,52,"Preferred One Administrative Services, INC.",PPO,51.272,98.6,,percent of total billed charges,,
"Molecular Cytogenetics; Dna Probe, Each (Mayo)OutsideLaboratory",,88271,CPT,Facility,Both,,,90,52,44.2,14.9032,52,"Preferred One Administrative Services, INC.",PPO,51.272,98.6,,percent of total billed charges,,
"Molecular Cytogenetics; Dna Probe, Each (Mayo)OutsideLaboratory",,88271,CPT,Facility,Outpatient,,,90,52,44.2,14.9032,52,PrimeWest Health,Minnesota Senior Health Options (MSHO),26.754,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Molecular Cytogenetics; Dna Probe, Each (Mayo)OutsideLaboratory",,88271,CPT,Facility,Outpatient,,,90,52,44.2,14.9032,52,PrimeWest Health,Minnesota Senior Health Options (MSHO),26.754,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Molecular Cytogenetics; Dna Probe, Each (Mayo)OutsideLaboratory",,88271,CPT,Facility,Inpatient,,,90,52,44.2,14.9032,52,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Molecular Cytogenetics; Dna Probe, Each (Mayo)OutsideLaboratory",,88271,CPT,Facility,Inpatient,,,90,52,44.2,14.9032,52,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Molecular Cytogenetics; Dna Probe, Each (Mayo)OutsideLaboratory",,88271,CPT,Facility,Outpatient,,,90,52,44.2,14.9032,52,PrimeWest Health,MinnesotaCare,26.7072,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Molecular Cytogenetics; Dna Probe, Each (Mayo)OutsideLaboratory",,88271,CPT,Facility,Outpatient,,,90,52,44.2,14.9032,52,PrimeWest Health,MinnesotaCare,26.7072,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Molecular Cytogenetics; Dna Probe, Each (Mayo)OutsideLaboratory",,88271,CPT,Facility,Inpatient,,,90,52,44.2,14.9032,52,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Molecular Cytogenetics; Dna Probe, Each (Mayo)OutsideLaboratory",,88271,CPT,Facility,Inpatient,,,90,52,44.2,14.9032,52,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Molecular Cytogenetics; Dna Probe, Each (Mayo)OutsideLaboratory",,88271,CPT,Facility,Both,,,90,52,44.2,14.9032,52,Sanford Health Plan,Sanford Health Plan,47.84,92,,percent of total billed charges,,
"Molecular Cytogenetics; Dna Probe, Each (Mayo)OutsideLaboratory",,88271,CPT,Facility,Both,,,90,52,44.2,14.9032,52,Sanford Health Plan,Sanford Health Plan,47.84,92,,percent of total billed charges,,
"Molecular Cytogenetics; Dna Probe, Each (Mayo)OutsideLaboratory",,88271,CPT,Facility,Outpatient,,,90,52,44.2,14.9032,52,"UCare Health, Inc.",Individual & Family Plan,29.302,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Molecular Cytogenetics; Dna Probe, Each (Mayo)OutsideLaboratory",,88271,CPT,Facility,Outpatient,,,90,52,44.2,14.9032,52,"UCare Health, Inc.",Individual & Family Plan,29.302,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Molecular Cytogenetics; Dna Probe, Each (Mayo)OutsideLaboratory",,88271,CPT,Facility,Inpatient,,,90,52,44.2,14.9032,52,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Molecular Cytogenetics; Dna Probe, Each (Mayo)OutsideLaboratory",,88271,CPT,Facility,Inpatient,,,90,52,44.2,14.9032,52,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Molecular Cytogenetics; Dna Probe, Each (Mayo)OutsideLaboratory",,88271,CPT,Facility,Outpatient,,,90,52,44.2,14.9032,52,"UCare Health, Inc.",Medical Assistance,26.2444,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Molecular Cytogenetics; Dna Probe, Each (Mayo)OutsideLaboratory",,88271,CPT,Facility,Outpatient,,,90,52,44.2,14.9032,52,"UCare Health, Inc.",Medical Assistance,26.2444,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Molecular Cytogenetics; Dna Probe, Each (Mayo)OutsideLaboratory",,88271,CPT,Facility,Inpatient,,,90,52,44.2,14.9032,52,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Molecular Cytogenetics; Dna Probe, Each (Mayo)OutsideLaboratory",,88271,CPT,Facility,Inpatient,,,90,52,44.2,14.9032,52,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Molecular Cytogenetics; Dna Probe, Each (Mayo)OutsideLaboratory",,88271,CPT,Facility,Outpatient,,,90,52,44.2,14.9032,52,"UCare Health, Inc.",Medicare Advantage,26.2444,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Molecular Cytogenetics; Dna Probe, Each (Mayo)OutsideLaboratory",,88271,CPT,Facility,Outpatient,,,90,52,44.2,14.9032,52,"UCare Health, Inc.",Medicare Advantage,26.2444,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Molecular Cytogenetics; Dna Probe, Each (Mayo)OutsideLaboratory",,88271,CPT,Facility,Inpatient,,,90,52,44.2,14.9032,52,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Molecular Cytogenetics; Dna Probe, Each (Mayo)OutsideLaboratory",,88271,CPT,Facility,Inpatient,,,90,52,44.2,14.9032,52,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Molecular Cytogenetics; Dna Probe, Each (Mayo)OutsideLaboratory",,88271,CPT,Facility,Outpatient,,,90,52,44.2,14.9032,52,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),26.2444,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Molecular Cytogenetics; Dna Probe, Each (Mayo)OutsideLaboratory",,88271,CPT,Facility,Outpatient,,,90,52,44.2,14.9032,52,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),26.2444,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Molecular Cytogenetics; Dna Probe, Each (Mayo)OutsideLaboratory",,88271,CPT,Facility,Inpatient,,,90,52,44.2,14.9032,52,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Molecular Cytogenetics; Dna Probe, Each (Mayo)OutsideLaboratory",,88271,CPT,Facility,Inpatient,,,90,52,44.2,14.9032,52,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Molecular Cytogenetics; Dna Probe, Each (Mayo)OutsideLaboratory",,88271,CPT,Facility,Both,,,90,52,44.2,14.9032,52,UnitedHealthcare,Individual & Family,48.88,94,,percent of total billed charges,,
"Molecular Cytogenetics; Dna Probe, Each (Mayo)OutsideLaboratory",,88271,CPT,Facility,Both,,,90,52,44.2,14.9032,52,UnitedHealthcare,Individual & Family,48.88,94,,percent of total billed charges,,
"Molecular Cytogenetics; Dna Probe, Each (Mayo)OutsideLaboratory",,88271,CPT,Facility,Outpatient,,,90,52,44.2,14.9032,52,UnitedHealthcare,Medicare Advantage,25.48,49,,percent of total billed charges,,
"Molecular Cytogenetics; Dna Probe, Each (Mayo)OutsideLaboratory",,88271,CPT,Facility,Outpatient,,,90,52,44.2,14.9032,52,UnitedHealthcare,Medicare Advantage,25.48,49,,percent of total billed charges,,
"Molecular Cytogenetics; Dna Probe, Each (Mayo)OutsideLaboratory",,88271,CPT,Facility,Inpatient,,,90,52,44.2,14.9032,52,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Molecular Cytogenetics; Dna Probe, Each (Mayo)OutsideLaboratory",,88271,CPT,Facility,Inpatient,,,90,52,44.2,14.9032,52,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Molecular Cytogenetics; Dna Probe, Each (Mayo)OutsideLaboratory",,88271,CPT,Facility,Outpatient,,,90,52,44.2,14.9032,52,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,24.96,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Molecular Cytogenetics; Dna Probe, Each (Mayo)OutsideLaboratory",,88271,CPT,Facility,Outpatient,,,90,52,44.2,14.9032,52,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,24.96,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Molecular Cytogenetics; Dna Probe, Each (Mayo)OutsideLaboratory",,88271,CPT,Facility,Inpatient,,,90,52,44.2,14.9032,52,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Molecular Cytogenetics; Dna Probe, Each (Mayo)OutsideLaboratory",,88271,CPT,Facility,Inpatient,,,90,52,44.2,14.9032,52,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Alk (2P23), Lung Cancer, Fish, Ts (Mayo)OutsideLaboratory",,88291,CPT,Facility,Both,,,90,204,173.4,58.4664,204,Aetna,Commercial,187.68,92,,percent of total billed charges,,
"Alk (2P23), Lung Cancer, Fish, Ts (Mayo)OutsideLaboratory",,88291,CPT,Facility,Outpatient,,,90,204,173.4,58.4664,204,Aetna,Medicare Advantage,99.96,49,,percent of total billed charges,,
"Alk (2P23), Lung Cancer, Fish, Ts (Mayo)OutsideLaboratory",,88291,CPT,Facility,Inpatient,,,90,204,173.4,58.4664,204,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Alk (2P23), Lung Cancer, Fish, Ts (Mayo)OutsideLaboratory",,88291,CPT,Facility,Both,,,90,204,173.4,58.4664,204,Aetna,PPO,189.72,93,,percent of total billed charges,,
"Alk (2P23), Lung Cancer, Fish, Ts (Mayo)OutsideLaboratory",,88291,CPT,Facility,Both,,,90,204,173.4,58.4664,204,America's PPO,America's PPO,195.9012,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Alk (2P23), Lung Cancer, Fish, Ts (Mayo)OutsideLaboratory",,88291,CPT,Facility,Both,,,90,204,173.4,58.4664,204,BlueCross BlueShield Minnesota, Federal Employee Program,200.736,98.4,,percent of total billed charges,,
"Alk (2P23), Lung Cancer, Fish, Ts (Mayo)OutsideLaboratory",,88291,CPT,Facility,Both,,,90,204,173.4,58.4664,204,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,204,100,,percent of total billed charges,,
"Alk (2P23), Lung Cancer, Fish, Ts (Mayo)OutsideLaboratory",,88291,CPT,Facility,Both,,,90,204,173.4,58.4664,204,BlueCross BlueShield Minnesota,High Value Network Plan,183.6,90,,percent of total billed charges,,
"Alk (2P23), Lung Cancer, Fish, Ts (Mayo)OutsideLaboratory",,88291,CPT,Facility,Outpatient,,,90,204,173.4,58.4664,204,BlueCross BlueShield Minnesota,Medicare Advantage,99.96,49,,percent of total billed charges,,
"Alk (2P23), Lung Cancer, Fish, Ts (Mayo)OutsideLaboratory",,88291,CPT,Facility,Inpatient,,,90,204,173.4,58.4664,204,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Alk (2P23), Lung Cancer, Fish, Ts (Mayo)OutsideLaboratory",,88291,CPT,Facility,Both,,,90,204,173.4,58.4664,204,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,180.6828,88.57,,percent of total billed charges,,
"Alk (2P23), Lung Cancer, Fish, Ts (Mayo)OutsideLaboratory",,88291,CPT,Facility,Both,,,90,204,173.4,58.4664,204,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,58.4664,28.66,,percent of total billed charges,,
"Alk (2P23), Lung Cancer, Fish, Ts (Mayo)OutsideLaboratory",,88291,CPT,Facility,Outpatient,,,90,204,173.4,58.4664,204,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),99.96,49,,percent of total billed charges,,
"Alk (2P23), Lung Cancer, Fish, Ts (Mayo)OutsideLaboratory",,88291,CPT,Facility,Inpatient,,,90,204,173.4,58.4664,204,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Alk (2P23), Lung Cancer, Fish, Ts (Mayo)OutsideLaboratory",,88291,CPT,Facility,Both,,,90,204,173.4,58.4664,204,CorVel,Worker's Compensation,204,100,,percent of total billed charges,,
"Alk (2P23), Lung Cancer, Fish, Ts (Mayo)OutsideLaboratory",,88291,CPT,Facility,Both,,,90,204,173.4,58.4664,204,First Health Group Corporation,First Health Network,197.88,97,,percent of total billed charges,,
"Alk (2P23), Lung Cancer, Fish, Ts (Mayo)OutsideLaboratory",,88291,CPT,Facility,Both,,,90,204,173.4,58.4664,204,"Health Partners, Inc.",Commercial,192.984,94.6,,percent of total billed charges,,
"Alk (2P23), Lung Cancer, Fish, Ts (Mayo)OutsideLaboratory",,88291,CPT,Facility,Outpatient,,,90,204,173.4,58.4664,204,"Health Partners, Inc.",Medicare Advantage,99.96,49,,percent of total billed charges,,
"Alk (2P23), Lung Cancer, Fish, Ts (Mayo)OutsideLaboratory",,88291,CPT,Facility,Inpatient,,,90,204,173.4,58.4664,204,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Alk (2P23), Lung Cancer, Fish, Ts (Mayo)OutsideLaboratory",,88291,CPT,Facility,Both,,,90,204,173.4,58.4664,204,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),122.4,60,,percent of total billed charges,,
"Alk (2P23), Lung Cancer, Fish, Ts (Mayo)OutsideLaboratory",,88291,CPT,Facility,Both,,,90,204,173.4,58.4664,204,"Health Partners, Inc.",State of Minnesota Advantage Program,166.26,81.5,,percent of total billed charges,,
"Alk (2P23), Lung Cancer, Fish, Ts (Mayo)OutsideLaboratory",,88291,CPT,Facility,Both,,,90,204,173.4,58.4664,204,"Health Partners, Inc.",State Public Programs,102,50,,percent of total billed charges,,
"Alk (2P23), Lung Cancer, Fish, Ts (Mayo)OutsideLaboratory",,88291,CPT,Facility,Both,,,90,204,173.4,58.4664,204,Humana Insurance Company,Commercial PPO,193.8,95,,percent of total billed charges,,
"Alk (2P23), Lung Cancer, Fish, Ts (Mayo)OutsideLaboratory",,88291,CPT,Facility,Outpatient,,,90,204,173.4,58.4664,204,Humana Insurance Company,Medicare PPO,99.96,49,,percent of total billed charges,,
"Alk (2P23), Lung Cancer, Fish, Ts (Mayo)OutsideLaboratory",,88291,CPT,Facility,Inpatient,,,90,204,173.4,58.4664,204,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Alk (2P23), Lung Cancer, Fish, Ts (Mayo)OutsideLaboratory",,88291,CPT,Facility,Both,,,90,204,173.4,58.4664,204,Medica,Individual & Family,202.164,99.1,,percent of total billed charges,,
"Alk (2P23), Lung Cancer, Fish, Ts (Mayo)OutsideLaboratory",,88291,CPT,Facility,Outpatient,,,90,204,173.4,58.4664,204,Medica,Medica Advantage Solution,101.592,49.8,,percent of total billed charges,,
"Alk (2P23), Lung Cancer, Fish, Ts (Mayo)OutsideLaboratory",,88291,CPT,Facility,Inpatient,,,90,204,173.4,58.4664,204,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Alk (2P23), Lung Cancer, Fish, Ts (Mayo)OutsideLaboratory",,88291,CPT,Facility,Outpatient,,,90,204,173.4,58.4664,204,Medica,Medical Assistance,90.984,44.6,,percent of total billed charges,,
"Alk (2P23), Lung Cancer, Fish, Ts (Mayo)OutsideLaboratory",,88291,CPT,Facility,Inpatient,,,90,204,173.4,58.4664,204,Medica,Medical Assistance,,,,,Included in per diem rate,
"Alk (2P23), Lung Cancer, Fish, Ts (Mayo)OutsideLaboratory",,88291,CPT,Facility,Outpatient,,,90,204,173.4,58.4664,204,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,101.592,49.8,,percent of total billed charges,,
"Alk (2P23), Lung Cancer, Fish, Ts (Mayo)OutsideLaboratory",,88291,CPT,Facility,Inpatient,,,90,204,173.4,58.4664,204,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Alk (2P23), Lung Cancer, Fish, Ts (Mayo)OutsideLaboratory",,88291,CPT,Facility,Both,,,90,204,173.4,58.4664,204,"Multiplan, Inc.","Multiplan, Inc.",191.76,94,,percent of total billed charges,,
"Alk (2P23), Lung Cancer, Fish, Ts (Mayo)OutsideLaboratory",,88291,CPT,Facility,Outpatient,,,90,204,173.4,58.4664,204,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,176.256,86.4,,percent of total billed charges,,
"Alk (2P23), Lung Cancer, Fish, Ts (Mayo)OutsideLaboratory",,88291,CPT,Facility,Inpatient,,,90,204,173.4,58.4664,204,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Alk (2P23), Lung Cancer, Fish, Ts (Mayo)OutsideLaboratory",,88291,CPT,Facility,Both,,,90,204,173.4,58.4664,204,"Preferred One Administrative Services, INC.",PPO,201.144,98.6,,percent of total billed charges,,
"Alk (2P23), Lung Cancer, Fish, Ts (Mayo)OutsideLaboratory",,88291,CPT,Facility,Outpatient,,,90,204,173.4,58.4664,204,PrimeWest Health,Minnesota Senior Health Options (MSHO),104.958,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Alk (2P23), Lung Cancer, Fish, Ts (Mayo)OutsideLaboratory",,88291,CPT,Facility,Inpatient,,,90,204,173.4,58.4664,204,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Alk (2P23), Lung Cancer, Fish, Ts (Mayo)OutsideLaboratory",,88291,CPT,Facility,Outpatient,,,90,204,173.4,58.4664,204,PrimeWest Health,MinnesotaCare,104.7744,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Alk (2P23), Lung Cancer, Fish, Ts (Mayo)OutsideLaboratory",,88291,CPT,Facility,Inpatient,,,90,204,173.4,58.4664,204,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Alk (2P23), Lung Cancer, Fish, Ts (Mayo)OutsideLaboratory",,88291,CPT,Facility,Both,,,90,204,173.4,58.4664,204,Sanford Health Plan,Sanford Health Plan,187.68,92,,percent of total billed charges,,
"Alk (2P23), Lung Cancer, Fish, Ts (Mayo)OutsideLaboratory",,88291,CPT,Facility,Outpatient,,,90,204,173.4,58.4664,204,"UCare Health, Inc.",Individual & Family Plan,114.954,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Alk (2P23), Lung Cancer, Fish, Ts (Mayo)OutsideLaboratory",,88291,CPT,Facility,Inpatient,,,90,204,173.4,58.4664,204,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Alk (2P23), Lung Cancer, Fish, Ts (Mayo)OutsideLaboratory",,88291,CPT,Facility,Outpatient,,,90,204,173.4,58.4664,204,"UCare Health, Inc.",Medical Assistance,102.9588,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Alk (2P23), Lung Cancer, Fish, Ts (Mayo)OutsideLaboratory",,88291,CPT,Facility,Inpatient,,,90,204,173.4,58.4664,204,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Alk (2P23), Lung Cancer, Fish, Ts (Mayo)OutsideLaboratory",,88291,CPT,Facility,Outpatient,,,90,204,173.4,58.4664,204,"UCare Health, Inc.",Medicare Advantage,102.9588,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Alk (2P23), Lung Cancer, Fish, Ts (Mayo)OutsideLaboratory",,88291,CPT,Facility,Inpatient,,,90,204,173.4,58.4664,204,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Alk (2P23), Lung Cancer, Fish, Ts (Mayo)OutsideLaboratory",,88291,CPT,Facility,Outpatient,,,90,204,173.4,58.4664,204,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),102.9588,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Alk (2P23), Lung Cancer, Fish, Ts (Mayo)OutsideLaboratory",,88291,CPT,Facility,Inpatient,,,90,204,173.4,58.4664,204,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Alk (2P23), Lung Cancer, Fish, Ts (Mayo)OutsideLaboratory",,88291,CPT,Facility,Both,,,90,204,173.4,58.4664,204,UnitedHealthcare,Individual & Family,191.76,94,,percent of total billed charges,,
"Alk (2P23), Lung Cancer, Fish, Ts (Mayo)OutsideLaboratory",,88291,CPT,Facility,Outpatient,,,90,204,173.4,58.4664,204,UnitedHealthcare,Medicare Advantage,99.96,49,,percent of total billed charges,,
"Alk (2P23), Lung Cancer, Fish, Ts (Mayo)OutsideLaboratory",,88291,CPT,Facility,Inpatient,,,90,204,173.4,58.4664,204,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Alk (2P23), Lung Cancer, Fish, Ts (Mayo)OutsideLaboratory",,88291,CPT,Facility,Outpatient,,,90,204,173.4,58.4664,204,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,97.92,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Alk (2P23), Lung Cancer, Fish, Ts (Mayo)OutsideLaboratory",,88291,CPT,Facility,Inpatient,,,90,204,173.4,58.4664,204,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Chromosomes, Hematologic, Bone Marrow (Mayo)OutsideLaboratory",,88291,CPT,Facility,Both,,,90,379,322.15,108.6214,379,Aetna,Commercial,348.68,92,,percent of total billed charges,,
"Chromosomes, Hematologic, Bone Marrow (Mayo)OutsideLaboratory",,88291,CPT,Facility,Outpatient,,,90,379,322.15,108.6214,379,Aetna,Medicare Advantage,185.71,49,,percent of total billed charges,,
"Chromosomes, Hematologic, Bone Marrow (Mayo)OutsideLaboratory",,88291,CPT,Facility,Inpatient,,,90,379,322.15,108.6214,379,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Chromosomes, Hematologic, Bone Marrow (Mayo)OutsideLaboratory",,88291,CPT,Facility,Both,,,90,379,322.15,108.6214,379,Aetna,PPO,352.47,93,,percent of total billed charges,,
"Chromosomes, Hematologic, Bone Marrow (Mayo)OutsideLaboratory",,88291,CPT,Facility,Both,,,90,379,322.15,108.6214,379,America's PPO,America's PPO,363.9537,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Chromosomes, Hematologic, Bone Marrow (Mayo)OutsideLaboratory",,88291,CPT,Facility,Both,,,90,379,322.15,108.6214,379,BlueCross BlueShield Minnesota, Federal Employee Program,372.936,98.4,,percent of total billed charges,,
"Chromosomes, Hematologic, Bone Marrow (Mayo)OutsideLaboratory",,88291,CPT,Facility,Both,,,90,379,322.15,108.6214,379,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,379,100,,percent of total billed charges,,
"Chromosomes, Hematologic, Bone Marrow (Mayo)OutsideLaboratory",,88291,CPT,Facility,Both,,,90,379,322.15,108.6214,379,BlueCross BlueShield Minnesota,High Value Network Plan,341.1,90,,percent of total billed charges,,
"Chromosomes, Hematologic, Bone Marrow (Mayo)OutsideLaboratory",,88291,CPT,Facility,Outpatient,,,90,379,322.15,108.6214,379,BlueCross BlueShield Minnesota,Medicare Advantage,185.71,49,,percent of total billed charges,,
"Chromosomes, Hematologic, Bone Marrow (Mayo)OutsideLaboratory",,88291,CPT,Facility,Inpatient,,,90,379,322.15,108.6214,379,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Chromosomes, Hematologic, Bone Marrow (Mayo)OutsideLaboratory",,88291,CPT,Facility,Both,,,90,379,322.15,108.6214,379,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,335.6803,88.57,,percent of total billed charges,,
"Chromosomes, Hematologic, Bone Marrow (Mayo)OutsideLaboratory",,88291,CPT,Facility,Both,,,90,379,322.15,108.6214,379,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,108.6214,28.66,,percent of total billed charges,,
"Chromosomes, Hematologic, Bone Marrow (Mayo)OutsideLaboratory",,88291,CPT,Facility,Outpatient,,,90,379,322.15,108.6214,379,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),185.71,49,,percent of total billed charges,,
"Chromosomes, Hematologic, Bone Marrow (Mayo)OutsideLaboratory",,88291,CPT,Facility,Inpatient,,,90,379,322.15,108.6214,379,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Chromosomes, Hematologic, Bone Marrow (Mayo)OutsideLaboratory",,88291,CPT,Facility,Both,,,90,379,322.15,108.6214,379,CorVel,Worker's Compensation,379,100,,percent of total billed charges,,
"Chromosomes, Hematologic, Bone Marrow (Mayo)OutsideLaboratory",,88291,CPT,Facility,Both,,,90,379,322.15,108.6214,379,First Health Group Corporation,First Health Network,367.63,97,,percent of total billed charges,,
"Chromosomes, Hematologic, Bone Marrow (Mayo)OutsideLaboratory",,88291,CPT,Facility,Both,,,90,379,322.15,108.6214,379,"Health Partners, Inc.",Commercial,358.534,94.6,,percent of total billed charges,,
"Chromosomes, Hematologic, Bone Marrow (Mayo)OutsideLaboratory",,88291,CPT,Facility,Outpatient,,,90,379,322.15,108.6214,379,"Health Partners, Inc.",Medicare Advantage,185.71,49,,percent of total billed charges,,
"Chromosomes, Hematologic, Bone Marrow (Mayo)OutsideLaboratory",,88291,CPT,Facility,Inpatient,,,90,379,322.15,108.6214,379,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Chromosomes, Hematologic, Bone Marrow (Mayo)OutsideLaboratory",,88291,CPT,Facility,Both,,,90,379,322.15,108.6214,379,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),227.4,60,,percent of total billed charges,,
"Chromosomes, Hematologic, Bone Marrow (Mayo)OutsideLaboratory",,88291,CPT,Facility,Both,,,90,379,322.15,108.6214,379,"Health Partners, Inc.",State of Minnesota Advantage Program,308.885,81.5,,percent of total billed charges,,
"Chromosomes, Hematologic, Bone Marrow (Mayo)OutsideLaboratory",,88291,CPT,Facility,Both,,,90,379,322.15,108.6214,379,"Health Partners, Inc.",State Public Programs,189.5,50,,percent of total billed charges,,
"Chromosomes, Hematologic, Bone Marrow (Mayo)OutsideLaboratory",,88291,CPT,Facility,Both,,,90,379,322.15,108.6214,379,Humana Insurance Company,Commercial PPO,360.05,95,,percent of total billed charges,,
"Chromosomes, Hematologic, Bone Marrow (Mayo)OutsideLaboratory",,88291,CPT,Facility,Outpatient,,,90,379,322.15,108.6214,379,Humana Insurance Company,Medicare PPO,185.71,49,,percent of total billed charges,,
"Chromosomes, Hematologic, Bone Marrow (Mayo)OutsideLaboratory",,88291,CPT,Facility,Inpatient,,,90,379,322.15,108.6214,379,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Chromosomes, Hematologic, Bone Marrow (Mayo)OutsideLaboratory",,88291,CPT,Facility,Both,,,90,379,322.15,108.6214,379,Medica,Individual & Family,375.589,99.1,,percent of total billed charges,,
"Chromosomes, Hematologic, Bone Marrow (Mayo)OutsideLaboratory",,88291,CPT,Facility,Outpatient,,,90,379,322.15,108.6214,379,Medica,Medica Advantage Solution,188.742,49.8,,percent of total billed charges,,
"Chromosomes, Hematologic, Bone Marrow (Mayo)OutsideLaboratory",,88291,CPT,Facility,Inpatient,,,90,379,322.15,108.6214,379,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Chromosomes, Hematologic, Bone Marrow (Mayo)OutsideLaboratory",,88291,CPT,Facility,Outpatient,,,90,379,322.15,108.6214,379,Medica,Medical Assistance,169.034,44.6,,percent of total billed charges,,
"Chromosomes, Hematologic, Bone Marrow (Mayo)OutsideLaboratory",,88291,CPT,Facility,Inpatient,,,90,379,322.15,108.6214,379,Medica,Medical Assistance,,,,,Included in per diem rate,
"Chromosomes, Hematologic, Bone Marrow (Mayo)OutsideLaboratory",,88291,CPT,Facility,Outpatient,,,90,379,322.15,108.6214,379,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,188.742,49.8,,percent of total billed charges,,
"Chromosomes, Hematologic, Bone Marrow (Mayo)OutsideLaboratory",,88291,CPT,Facility,Inpatient,,,90,379,322.15,108.6214,379,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Chromosomes, Hematologic, Bone Marrow (Mayo)OutsideLaboratory",,88291,CPT,Facility,Both,,,90,379,322.15,108.6214,379,"Multiplan, Inc.","Multiplan, Inc.",356.26,94,,percent of total billed charges,,
"Chromosomes, Hematologic, Bone Marrow (Mayo)OutsideLaboratory",,88291,CPT,Facility,Outpatient,,,90,379,322.15,108.6214,379,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,327.456,86.4,,percent of total billed charges,,
"Chromosomes, Hematologic, Bone Marrow (Mayo)OutsideLaboratory",,88291,CPT,Facility,Inpatient,,,90,379,322.15,108.6214,379,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Chromosomes, Hematologic, Bone Marrow (Mayo)OutsideLaboratory",,88291,CPT,Facility,Both,,,90,379,322.15,108.6214,379,"Preferred One Administrative Services, INC.",PPO,373.694,98.6,,percent of total billed charges,,
"Chromosomes, Hematologic, Bone Marrow (Mayo)OutsideLaboratory",,88291,CPT,Facility,Outpatient,,,90,379,322.15,108.6214,379,PrimeWest Health,Minnesota Senior Health Options (MSHO),194.9955,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Chromosomes, Hematologic, Bone Marrow (Mayo)OutsideLaboratory",,88291,CPT,Facility,Inpatient,,,90,379,322.15,108.6214,379,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Chromosomes, Hematologic, Bone Marrow (Mayo)OutsideLaboratory",,88291,CPT,Facility,Outpatient,,,90,379,322.15,108.6214,379,PrimeWest Health,MinnesotaCare,194.6544,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Chromosomes, Hematologic, Bone Marrow (Mayo)OutsideLaboratory",,88291,CPT,Facility,Inpatient,,,90,379,322.15,108.6214,379,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Chromosomes, Hematologic, Bone Marrow (Mayo)OutsideLaboratory",,88291,CPT,Facility,Both,,,90,379,322.15,108.6214,379,Sanford Health Plan,Sanford Health Plan,348.68,92,,percent of total billed charges,,
"Chromosomes, Hematologic, Bone Marrow (Mayo)OutsideLaboratory",,88291,CPT,Facility,Outpatient,,,90,379,322.15,108.6214,379,"UCare Health, Inc.",Individual & Family Plan,213.5665,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Chromosomes, Hematologic, Bone Marrow (Mayo)OutsideLaboratory",,88291,CPT,Facility,Inpatient,,,90,379,322.15,108.6214,379,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Chromosomes, Hematologic, Bone Marrow (Mayo)OutsideLaboratory",,88291,CPT,Facility,Outpatient,,,90,379,322.15,108.6214,379,"UCare Health, Inc.",Medical Assistance,191.2813,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Chromosomes, Hematologic, Bone Marrow (Mayo)OutsideLaboratory",,88291,CPT,Facility,Inpatient,,,90,379,322.15,108.6214,379,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Chromosomes, Hematologic, Bone Marrow (Mayo)OutsideLaboratory",,88291,CPT,Facility,Outpatient,,,90,379,322.15,108.6214,379,"UCare Health, Inc.",Medicare Advantage,191.2813,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Chromosomes, Hematologic, Bone Marrow (Mayo)OutsideLaboratory",,88291,CPT,Facility,Inpatient,,,90,379,322.15,108.6214,379,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Chromosomes, Hematologic, Bone Marrow (Mayo)OutsideLaboratory",,88291,CPT,Facility,Outpatient,,,90,379,322.15,108.6214,379,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),191.2813,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Chromosomes, Hematologic, Bone Marrow (Mayo)OutsideLaboratory",,88291,CPT,Facility,Inpatient,,,90,379,322.15,108.6214,379,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Chromosomes, Hematologic, Bone Marrow (Mayo)OutsideLaboratory",,88291,CPT,Facility,Both,,,90,379,322.15,108.6214,379,UnitedHealthcare,Individual & Family,356.26,94,,percent of total billed charges,,
"Chromosomes, Hematologic, Bone Marrow (Mayo)OutsideLaboratory",,88291,CPT,Facility,Outpatient,,,90,379,322.15,108.6214,379,UnitedHealthcare,Medicare Advantage,185.71,49,,percent of total billed charges,,
"Chromosomes, Hematologic, Bone Marrow (Mayo)OutsideLaboratory",,88291,CPT,Facility,Inpatient,,,90,379,322.15,108.6214,379,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Chromosomes, Hematologic, Bone Marrow (Mayo)OutsideLaboratory",,88291,CPT,Facility,Outpatient,,,90,379,322.15,108.6214,379,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,181.92,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Chromosomes, Hematologic, Bone Marrow (Mayo)OutsideLaboratory",,88291,CPT,Facility,Inpatient,,,90,379,322.15,108.6214,379,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Plasma Cell Prolif, Cig, Fish (Mayo)OutsideLaboratory",,88291,CPT,Facility,Both,,,90,379,322.15,108.6214,379,Aetna,Commercial,348.68,92,,percent of total billed charges,,
"Plasma Cell Prolif, Cig, Fish (Mayo)OutsideLaboratory",,88291,CPT,Facility,Outpatient,,,90,379,322.15,108.6214,379,Aetna,Medicare Advantage,185.71,49,,percent of total billed charges,,
"Plasma Cell Prolif, Cig, Fish (Mayo)OutsideLaboratory",,88291,CPT,Facility,Inpatient,,,90,379,322.15,108.6214,379,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Plasma Cell Prolif, Cig, Fish (Mayo)OutsideLaboratory",,88291,CPT,Facility,Both,,,90,379,322.15,108.6214,379,Aetna,PPO,352.47,93,,percent of total billed charges,,
"Plasma Cell Prolif, Cig, Fish (Mayo)OutsideLaboratory",,88291,CPT,Facility,Both,,,90,379,322.15,108.6214,379,America's PPO,America's PPO,363.9537,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Plasma Cell Prolif, Cig, Fish (Mayo)OutsideLaboratory",,88291,CPT,Facility,Both,,,90,379,322.15,108.6214,379,BlueCross BlueShield Minnesota, Federal Employee Program,372.936,98.4,,percent of total billed charges,,
"Plasma Cell Prolif, Cig, Fish (Mayo)OutsideLaboratory",,88291,CPT,Facility,Both,,,90,379,322.15,108.6214,379,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,379,100,,percent of total billed charges,,
"Plasma Cell Prolif, Cig, Fish (Mayo)OutsideLaboratory",,88291,CPT,Facility,Both,,,90,379,322.15,108.6214,379,BlueCross BlueShield Minnesota,High Value Network Plan,341.1,90,,percent of total billed charges,,
"Plasma Cell Prolif, Cig, Fish (Mayo)OutsideLaboratory",,88291,CPT,Facility,Outpatient,,,90,379,322.15,108.6214,379,BlueCross BlueShield Minnesota,Medicare Advantage,185.71,49,,percent of total billed charges,,
"Plasma Cell Prolif, Cig, Fish (Mayo)OutsideLaboratory",,88291,CPT,Facility,Inpatient,,,90,379,322.15,108.6214,379,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Plasma Cell Prolif, Cig, Fish (Mayo)OutsideLaboratory",,88291,CPT,Facility,Both,,,90,379,322.15,108.6214,379,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,335.6803,88.57,,percent of total billed charges,,
"Plasma Cell Prolif, Cig, Fish (Mayo)OutsideLaboratory",,88291,CPT,Facility,Both,,,90,379,322.15,108.6214,379,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,108.6214,28.66,,percent of total billed charges,,
"Plasma Cell Prolif, Cig, Fish (Mayo)OutsideLaboratory",,88291,CPT,Facility,Outpatient,,,90,379,322.15,108.6214,379,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),185.71,49,,percent of total billed charges,,
"Plasma Cell Prolif, Cig, Fish (Mayo)OutsideLaboratory",,88291,CPT,Facility,Inpatient,,,90,379,322.15,108.6214,379,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Plasma Cell Prolif, Cig, Fish (Mayo)OutsideLaboratory",,88291,CPT,Facility,Both,,,90,379,322.15,108.6214,379,CorVel,Worker's Compensation,379,100,,percent of total billed charges,,
"Plasma Cell Prolif, Cig, Fish (Mayo)OutsideLaboratory",,88291,CPT,Facility,Both,,,90,379,322.15,108.6214,379,First Health Group Corporation,First Health Network,367.63,97,,percent of total billed charges,,
"Plasma Cell Prolif, Cig, Fish (Mayo)OutsideLaboratory",,88291,CPT,Facility,Both,,,90,379,322.15,108.6214,379,"Health Partners, Inc.",Commercial,358.534,94.6,,percent of total billed charges,,
"Plasma Cell Prolif, Cig, Fish (Mayo)OutsideLaboratory",,88291,CPT,Facility,Outpatient,,,90,379,322.15,108.6214,379,"Health Partners, Inc.",Medicare Advantage,185.71,49,,percent of total billed charges,,
"Plasma Cell Prolif, Cig, Fish (Mayo)OutsideLaboratory",,88291,CPT,Facility,Inpatient,,,90,379,322.15,108.6214,379,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Plasma Cell Prolif, Cig, Fish (Mayo)OutsideLaboratory",,88291,CPT,Facility,Both,,,90,379,322.15,108.6214,379,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),227.4,60,,percent of total billed charges,,
"Plasma Cell Prolif, Cig, Fish (Mayo)OutsideLaboratory",,88291,CPT,Facility,Both,,,90,379,322.15,108.6214,379,"Health Partners, Inc.",State of Minnesota Advantage Program,308.885,81.5,,percent of total billed charges,,
"Plasma Cell Prolif, Cig, Fish (Mayo)OutsideLaboratory",,88291,CPT,Facility,Both,,,90,379,322.15,108.6214,379,"Health Partners, Inc.",State Public Programs,189.5,50,,percent of total billed charges,,
"Plasma Cell Prolif, Cig, Fish (Mayo)OutsideLaboratory",,88291,CPT,Facility,Both,,,90,379,322.15,108.6214,379,Humana Insurance Company,Commercial PPO,360.05,95,,percent of total billed charges,,
"Plasma Cell Prolif, Cig, Fish (Mayo)OutsideLaboratory",,88291,CPT,Facility,Outpatient,,,90,379,322.15,108.6214,379,Humana Insurance Company,Medicare PPO,185.71,49,,percent of total billed charges,,
"Plasma Cell Prolif, Cig, Fish (Mayo)OutsideLaboratory",,88291,CPT,Facility,Inpatient,,,90,379,322.15,108.6214,379,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Plasma Cell Prolif, Cig, Fish (Mayo)OutsideLaboratory",,88291,CPT,Facility,Both,,,90,379,322.15,108.6214,379,Medica,Individual & Family,375.589,99.1,,percent of total billed charges,,
"Plasma Cell Prolif, Cig, Fish (Mayo)OutsideLaboratory",,88291,CPT,Facility,Outpatient,,,90,379,322.15,108.6214,379,Medica,Medica Advantage Solution,188.742,49.8,,percent of total billed charges,,
"Plasma Cell Prolif, Cig, Fish (Mayo)OutsideLaboratory",,88291,CPT,Facility,Inpatient,,,90,379,322.15,108.6214,379,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Plasma Cell Prolif, Cig, Fish (Mayo)OutsideLaboratory",,88291,CPT,Facility,Outpatient,,,90,379,322.15,108.6214,379,Medica,Medical Assistance,169.034,44.6,,percent of total billed charges,,
"Plasma Cell Prolif, Cig, Fish (Mayo)OutsideLaboratory",,88291,CPT,Facility,Inpatient,,,90,379,322.15,108.6214,379,Medica,Medical Assistance,,,,,Included in per diem rate,
"Plasma Cell Prolif, Cig, Fish (Mayo)OutsideLaboratory",,88291,CPT,Facility,Outpatient,,,90,379,322.15,108.6214,379,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,188.742,49.8,,percent of total billed charges,,
"Plasma Cell Prolif, Cig, Fish (Mayo)OutsideLaboratory",,88291,CPT,Facility,Inpatient,,,90,379,322.15,108.6214,379,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Plasma Cell Prolif, Cig, Fish (Mayo)OutsideLaboratory",,88291,CPT,Facility,Both,,,90,379,322.15,108.6214,379,"Multiplan, Inc.","Multiplan, Inc.",356.26,94,,percent of total billed charges,,
"Plasma Cell Prolif, Cig, Fish (Mayo)OutsideLaboratory",,88291,CPT,Facility,Outpatient,,,90,379,322.15,108.6214,379,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,327.456,86.4,,percent of total billed charges,,
"Plasma Cell Prolif, Cig, Fish (Mayo)OutsideLaboratory",,88291,CPT,Facility,Inpatient,,,90,379,322.15,108.6214,379,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Plasma Cell Prolif, Cig, Fish (Mayo)OutsideLaboratory",,88291,CPT,Facility,Both,,,90,379,322.15,108.6214,379,"Preferred One Administrative Services, INC.",PPO,373.694,98.6,,percent of total billed charges,,
"Plasma Cell Prolif, Cig, Fish (Mayo)OutsideLaboratory",,88291,CPT,Facility,Outpatient,,,90,379,322.15,108.6214,379,PrimeWest Health,Minnesota Senior Health Options (MSHO),194.9955,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Plasma Cell Prolif, Cig, Fish (Mayo)OutsideLaboratory",,88291,CPT,Facility,Inpatient,,,90,379,322.15,108.6214,379,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Plasma Cell Prolif, Cig, Fish (Mayo)OutsideLaboratory",,88291,CPT,Facility,Outpatient,,,90,379,322.15,108.6214,379,PrimeWest Health,MinnesotaCare,194.6544,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Plasma Cell Prolif, Cig, Fish (Mayo)OutsideLaboratory",,88291,CPT,Facility,Inpatient,,,90,379,322.15,108.6214,379,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Plasma Cell Prolif, Cig, Fish (Mayo)OutsideLaboratory",,88291,CPT,Facility,Both,,,90,379,322.15,108.6214,379,Sanford Health Plan,Sanford Health Plan,348.68,92,,percent of total billed charges,,
"Plasma Cell Prolif, Cig, Fish (Mayo)OutsideLaboratory",,88291,CPT,Facility,Outpatient,,,90,379,322.15,108.6214,379,"UCare Health, Inc.",Individual & Family Plan,213.5665,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Plasma Cell Prolif, Cig, Fish (Mayo)OutsideLaboratory",,88291,CPT,Facility,Inpatient,,,90,379,322.15,108.6214,379,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Plasma Cell Prolif, Cig, Fish (Mayo)OutsideLaboratory",,88291,CPT,Facility,Outpatient,,,90,379,322.15,108.6214,379,"UCare Health, Inc.",Medical Assistance,191.2813,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Plasma Cell Prolif, Cig, Fish (Mayo)OutsideLaboratory",,88291,CPT,Facility,Inpatient,,,90,379,322.15,108.6214,379,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Plasma Cell Prolif, Cig, Fish (Mayo)OutsideLaboratory",,88291,CPT,Facility,Outpatient,,,90,379,322.15,108.6214,379,"UCare Health, Inc.",Medicare Advantage,191.2813,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Plasma Cell Prolif, Cig, Fish (Mayo)OutsideLaboratory",,88291,CPT,Facility,Inpatient,,,90,379,322.15,108.6214,379,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Plasma Cell Prolif, Cig, Fish (Mayo)OutsideLaboratory",,88291,CPT,Facility,Outpatient,,,90,379,322.15,108.6214,379,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),191.2813,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Plasma Cell Prolif, Cig, Fish (Mayo)OutsideLaboratory",,88291,CPT,Facility,Inpatient,,,90,379,322.15,108.6214,379,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Plasma Cell Prolif, Cig, Fish (Mayo)OutsideLaboratory",,88291,CPT,Facility,Both,,,90,379,322.15,108.6214,379,UnitedHealthcare,Individual & Family,356.26,94,,percent of total billed charges,,
"Plasma Cell Prolif, Cig, Fish (Mayo)OutsideLaboratory",,88291,CPT,Facility,Outpatient,,,90,379,322.15,108.6214,379,UnitedHealthcare,Medicare Advantage,185.71,49,,percent of total billed charges,,
"Plasma Cell Prolif, Cig, Fish (Mayo)OutsideLaboratory",,88291,CPT,Facility,Inpatient,,,90,379,322.15,108.6214,379,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Plasma Cell Prolif, Cig, Fish (Mayo)OutsideLaboratory",,88291,CPT,Facility,Outpatient,,,90,379,322.15,108.6214,379,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,181.92,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Plasma Cell Prolif, Cig, Fish (Mayo)OutsideLaboratory",,88291,CPT,Facility,Inpatient,,,90,379,322.15,108.6214,379,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"(Hcmc) Morphometric Analysis, In Situ Hybridization, Manual, Per Spec; 1St Single Probe Stain (Path)OutsideLaboratory",,88368,CPT,Facility,Both,,,90,204,173.4,58.4664,204,Aetna,Commercial,187.68,92,,Percent of total billed charges,,
"(Hcmc) Morphometric Analysis, In Situ Hybridization, Manual, Per Spec; 1St Single Probe Stain (Path)OutsideLaboratory",,88368,CPT,Facility,Outpatient,,,90,204,173.4,58.4664,204,Aetna,Medicare Advantage,99.96,49,,Percent of total billed charges,,
"(Hcmc) Morphometric Analysis, In Situ Hybridization, Manual, Per Spec; 1St Single Probe Stain (Path)OutsideLaboratory",,88368,CPT,Facility,Inpatient,,,90,204,173.4,58.4664,204,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"(Hcmc) Morphometric Analysis, In Situ Hybridization, Manual, Per Spec; 1St Single Probe Stain (Path)OutsideLaboratory",,88368,CPT,Facility,Both,,,90,204,173.4,58.4664,204,Aetna,PPO,189.72,93,,percent of total billed charges,,
"(Hcmc) Morphometric Analysis, In Situ Hybridization, Manual, Per Spec; 1St Single Probe Stain (Path)OutsideLaboratory",,88368,CPT,Facility,Both,,,90,204,173.4,58.4664,204,America's PPO,America's PPO,195.9012,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"(Hcmc) Morphometric Analysis, In Situ Hybridization, Manual, Per Spec; 1St Single Probe Stain (Path)OutsideLaboratory",,88368,CPT,Facility,Both,,,90,204,173.4,58.4664,204,BlueCross BlueShield Minnesota, Federal Employee Program,200.736,98.4,,percent of total billed charges,,
"(Hcmc) Morphometric Analysis, In Situ Hybridization, Manual, Per Spec; 1St Single Probe Stain (Path)OutsideLaboratory",,88368,CPT,Facility,Both,,,90,204,173.4,58.4664,204,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,204,100,,percent of total billed charges,,
"(Hcmc) Morphometric Analysis, In Situ Hybridization, Manual, Per Spec; 1St Single Probe Stain (Path)OutsideLaboratory",,88368,CPT,Facility,Both,,,90,204,173.4,58.4664,204,BlueCross BlueShield Minnesota,High Value Network Plan,183.6,90,,percent of total billed charges,,
"(Hcmc) Morphometric Analysis, In Situ Hybridization, Manual, Per Spec; 1St Single Probe Stain (Path)OutsideLaboratory",,88368,CPT,Facility,Outpatient,,,90,204,173.4,58.4664,204,BlueCross BlueShield Minnesota,Medicare Advantage,99.96,49,,percent of total billed charges,,
"(Hcmc) Morphometric Analysis, In Situ Hybridization, Manual, Per Spec; 1St Single Probe Stain (Path)OutsideLaboratory",,88368,CPT,Facility,Inpatient,,,90,204,173.4,58.4664,204,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"(Hcmc) Morphometric Analysis, In Situ Hybridization, Manual, Per Spec; 1St Single Probe Stain (Path)OutsideLaboratory",,88368,CPT,Facility,Both,,,90,204,173.4,58.4664,204,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,180.6828,88.57,,percent of total billed charges,,
"(Hcmc) Morphometric Analysis, In Situ Hybridization, Manual, Per Spec; 1St Single Probe Stain (Path)OutsideLaboratory",,88368,CPT,Facility,Both,,,90,204,173.4,58.4664,204,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,58.4664,28.66,,percent of total billed charges,,
"(Hcmc) Morphometric Analysis, In Situ Hybridization, Manual, Per Spec; 1St Single Probe Stain (Path)OutsideLaboratory",,88368,CPT,Facility,Outpatient,,,90,204,173.4,58.4664,204,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),99.96,49,,percent of total billed charges,,
"(Hcmc) Morphometric Analysis, In Situ Hybridization, Manual, Per Spec; 1St Single Probe Stain (Path)OutsideLaboratory",,88368,CPT,Facility,Inpatient,,,90,204,173.4,58.4664,204,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"(Hcmc) Morphometric Analysis, In Situ Hybridization, Manual, Per Spec; 1St Single Probe Stain (Path)OutsideLaboratory",,88368,CPT,Facility,Both,,,90,204,173.4,58.4664,204,CorVel,Worker's Compensation,204,100,,percent of total billed charges,,
"(Hcmc) Morphometric Analysis, In Situ Hybridization, Manual, Per Spec; 1St Single Probe Stain (Path)OutsideLaboratory",,88368,CPT,Facility,Both,,,90,204,173.4,58.4664,204,First Health Group Corporation,First Health Network,197.88,97,,percent of total billed charges,,
"(Hcmc) Morphometric Analysis, In Situ Hybridization, Manual, Per Spec; 1St Single Probe Stain (Path)OutsideLaboratory",,88368,CPT,Facility,Both,,,90,204,173.4,58.4664,204,"Health Partners, Inc.",Commercial,192.984,94.6,,percent of total billed charges,,
"(Hcmc) Morphometric Analysis, In Situ Hybridization, Manual, Per Spec; 1St Single Probe Stain (Path)OutsideLaboratory",,88368,CPT,Facility,Outpatient,,,90,204,173.4,58.4664,204,"Health Partners, Inc.",Medicare Advantage,99.96,49,,percent of total billed charges,,
"(Hcmc) Morphometric Analysis, In Situ Hybridization, Manual, Per Spec; 1St Single Probe Stain (Path)OutsideLaboratory",,88368,CPT,Facility,Inpatient,,,90,204,173.4,58.4664,204,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"(Hcmc) Morphometric Analysis, In Situ Hybridization, Manual, Per Spec; 1St Single Probe Stain (Path)OutsideLaboratory",,88368,CPT,Facility,Both,,,90,204,173.4,58.4664,204,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),122.4,60,,percent of total billed charges,,
"(Hcmc) Morphometric Analysis, In Situ Hybridization, Manual, Per Spec; 1St Single Probe Stain (Path)OutsideLaboratory",,88368,CPT,Facility,Both,,,90,204,173.4,58.4664,204,"Health Partners, Inc.",State of Minnesota Advantage Program,166.26,81.5,,percent of total billed charges,,
"(Hcmc) Morphometric Analysis, In Situ Hybridization, Manual, Per Spec; 1St Single Probe Stain (Path)OutsideLaboratory",,88368,CPT,Facility,Both,,,90,204,173.4,58.4664,204,"Health Partners, Inc.",State Public Programs,102,50,,percent of total billed charges,,
"(Hcmc) Morphometric Analysis, In Situ Hybridization, Manual, Per Spec; 1St Single Probe Stain (Path)OutsideLaboratory",,88368,CPT,Facility,Both,,,90,204,173.4,58.4664,204,Humana Insurance Company,Commercial PPO,193.8,95,,percent of total billed charges,,
"(Hcmc) Morphometric Analysis, In Situ Hybridization, Manual, Per Spec; 1St Single Probe Stain (Path)OutsideLaboratory",,88368,CPT,Facility,Outpatient,,,90,204,173.4,58.4664,204,Humana Insurance Company,Medicare PPO,99.96,49,,percent of total billed charges,,
"(Hcmc) Morphometric Analysis, In Situ Hybridization, Manual, Per Spec; 1St Single Probe Stain (Path)OutsideLaboratory",,88368,CPT,Facility,Inpatient,,,90,204,173.4,58.4664,204,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"(Hcmc) Morphometric Analysis, In Situ Hybridization, Manual, Per Spec; 1St Single Probe Stain (Path)OutsideLaboratory",,88368,CPT,Facility,Both,,,90,204,173.4,58.4664,204,Medica,Individual & Family,202.164,99.1,,percent of total billed charges,,
"(Hcmc) Morphometric Analysis, In Situ Hybridization, Manual, Per Spec; 1St Single Probe Stain (Path)OutsideLaboratory",,88368,CPT,Facility,Outpatient,,,90,204,173.4,58.4664,204,Medica,Medica Advantage Solution,101.592,49.8,,percent of total billed charges,,
"(Hcmc) Morphometric Analysis, In Situ Hybridization, Manual, Per Spec; 1St Single Probe Stain (Path)OutsideLaboratory",,88368,CPT,Facility,Inpatient,,,90,204,173.4,58.4664,204,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"(Hcmc) Morphometric Analysis, In Situ Hybridization, Manual, Per Spec; 1St Single Probe Stain (Path)OutsideLaboratory",,88368,CPT,Facility,Outpatient,,,90,204,173.4,58.4664,204,Medica,Medical Assistance,90.984,44.6,,percent of total billed charges,,
"(Hcmc) Morphometric Analysis, In Situ Hybridization, Manual, Per Spec; 1St Single Probe Stain (Path)OutsideLaboratory",,88368,CPT,Facility,Inpatient,,,90,204,173.4,58.4664,204,Medica,Medical Assistance,,,,,Included in per diem rate,
"(Hcmc) Morphometric Analysis, In Situ Hybridization, Manual, Per Spec; 1St Single Probe Stain (Path)OutsideLaboratory",,88368,CPT,Facility,Outpatient,,,90,204,173.4,58.4664,204,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,101.592,49.8,,percent of total billed charges,,
"(Hcmc) Morphometric Analysis, In Situ Hybridization, Manual, Per Spec; 1St Single Probe Stain (Path)OutsideLaboratory",,88368,CPT,Facility,Inpatient,,,90,204,173.4,58.4664,204,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"(Hcmc) Morphometric Analysis, In Situ Hybridization, Manual, Per Spec; 1St Single Probe Stain (Path)OutsideLaboratory",,88368,CPT,Facility,Both,,,90,204,173.4,58.4664,204,"Multiplan, Inc.","Multiplan, Inc.",191.76,94,,percent of total billed charges,,
"(Hcmc) Morphometric Analysis, In Situ Hybridization, Manual, Per Spec; 1St Single Probe Stain (Path)OutsideLaboratory",,88368,CPT,Facility,Outpatient,,,90,204,173.4,58.4664,204,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,183.804,90.1,,percent of total billed charges,,
"(Hcmc) Morphometric Analysis, In Situ Hybridization, Manual, Per Spec; 1St Single Probe Stain (Path)OutsideLaboratory",,88368,CPT,Facility,Inpatient,,,90,204,173.4,58.4664,204,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"(Hcmc) Morphometric Analysis, In Situ Hybridization, Manual, Per Spec; 1St Single Probe Stain (Path)OutsideLaboratory",,88368,CPT,Facility,Both,,,90,204,173.4,58.4664,204,"Preferred One Administrative Services, INC.",PPO,201.144,98.6,,percent of total billed charges,,
"(Hcmc) Morphometric Analysis, In Situ Hybridization, Manual, Per Spec; 1St Single Probe Stain (Path)OutsideLaboratory",,88368,CPT,Facility,Outpatient,,,90,204,173.4,58.4664,204,PrimeWest Health,Minnesota Senior Health Options (MSHO),104.958,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"(Hcmc) Morphometric Analysis, In Situ Hybridization, Manual, Per Spec; 1St Single Probe Stain (Path)OutsideLaboratory",,88368,CPT,Facility,Inpatient,,,90,204,173.4,58.4664,204,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"(Hcmc) Morphometric Analysis, In Situ Hybridization, Manual, Per Spec; 1St Single Probe Stain (Path)OutsideLaboratory",,88368,CPT,Facility,Outpatient,,,90,204,173.4,58.4664,204,PrimeWest Health,MinnesotaCare,104.7744,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"(Hcmc) Morphometric Analysis, In Situ Hybridization, Manual, Per Spec; 1St Single Probe Stain (Path)OutsideLaboratory",,88368,CPT,Facility,Inpatient,,,90,204,173.4,58.4664,204,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"(Hcmc) Morphometric Analysis, In Situ Hybridization, Manual, Per Spec; 1St Single Probe Stain (Path)OutsideLaboratory",,88368,CPT,Facility,Both,,,90,204,173.4,58.4664,204,Sanford Health Plan,Sanford Health Plan,187.68,92,,percent of total billed charges,,
"(Hcmc) Morphometric Analysis, In Situ Hybridization, Manual, Per Spec; 1St Single Probe Stain (Path)OutsideLaboratory",,88368,CPT,Facility,Outpatient,,,90,204,173.4,58.4664,204,"UCare Health, Inc.",Individual & Family Plan,114.954,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"(Hcmc) Morphometric Analysis, In Situ Hybridization, Manual, Per Spec; 1St Single Probe Stain (Path)OutsideLaboratory",,88368,CPT,Facility,Inpatient,,,90,204,173.4,58.4664,204,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"(Hcmc) Morphometric Analysis, In Situ Hybridization, Manual, Per Spec; 1St Single Probe Stain (Path)OutsideLaboratory",,88368,CPT,Facility,Outpatient,,,90,204,173.4,58.4664,204,"UCare Health, Inc.",Medical Assistance,102.9588,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"(Hcmc) Morphometric Analysis, In Situ Hybridization, Manual, Per Spec; 1St Single Probe Stain (Path)OutsideLaboratory",,88368,CPT,Facility,Inpatient,,,90,204,173.4,58.4664,204,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"(Hcmc) Morphometric Analysis, In Situ Hybridization, Manual, Per Spec; 1St Single Probe Stain (Path)OutsideLaboratory",,88368,CPT,Facility,Outpatient,,,90,204,173.4,58.4664,204,"UCare Health, Inc.",Medicare Advantage,102.9588,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"(Hcmc) Morphometric Analysis, In Situ Hybridization, Manual, Per Spec; 1St Single Probe Stain (Path)OutsideLaboratory",,88368,CPT,Facility,Inpatient,,,90,204,173.4,58.4664,204,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"(Hcmc) Morphometric Analysis, In Situ Hybridization, Manual, Per Spec; 1St Single Probe Stain (Path)OutsideLaboratory",,88368,CPT,Facility,Outpatient,,,90,204,173.4,58.4664,204,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),102.9588,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"(Hcmc) Morphometric Analysis, In Situ Hybridization, Manual, Per Spec; 1St Single Probe Stain (Path)OutsideLaboratory",,88368,CPT,Facility,Inpatient,,,90,204,173.4,58.4664,204,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"(Hcmc) Morphometric Analysis, In Situ Hybridization, Manual, Per Spec; 1St Single Probe Stain (Path)OutsideLaboratory",,88368,CPT,Facility,Both,,,90,204,173.4,58.4664,204,UnitedHealthcare,Individual & Family,191.76,94,,percent of total billed charges,,
"(Hcmc) Morphometric Analysis, In Situ Hybridization, Manual, Per Spec; 1St Single Probe Stain (Path)OutsideLaboratory",,88368,CPT,Facility,Outpatient,,,90,204,173.4,58.4664,204,UnitedHealthcare,Medicare Advantage,99.96,49,,percent of total billed charges,,
"(Hcmc) Morphometric Analysis, In Situ Hybridization, Manual, Per Spec; 1St Single Probe Stain (Path)OutsideLaboratory",,88368,CPT,Facility,Inpatient,,,90,204,173.4,58.4664,204,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"(Hcmc) Morphometric Analysis, In Situ Hybridization, Manual, Per Spec; 1St Single Probe Stain (Path)OutsideLaboratory",,88368,CPT,Facility,Outpatient,,,90,204,173.4,58.4664,204,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,97.92,48,,percent of total billed charges,,100% of DHS outpatient percentage
"(Hcmc) Morphometric Analysis, In Situ Hybridization, Manual, Per Spec; 1St Single Probe Stain (Path)OutsideLaboratory",,88368,CPT,Facility,Inpatient,,,90,204,173.4,58.4664,204,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"(Hcmc) Morphometric Analysis, In Situ Hybridization, Manual, Per Spec; Ea Addtl Single Probe Stain (Path)OutsideLaboratory",,88369,CPT,Facility,Both,,,90,286,243.1,81.9676,286,Aetna,Commercial,263.12,92,,percent of total billed charges,,
"(Hcmc) Morphometric Analysis, In Situ Hybridization, Manual, Per Spec; Ea Addtl Single Probe Stain (Path)OutsideLaboratory",,88369,CPT,Facility,Outpatient,,,90,286,243.1,81.9676,286,Aetna,Medicare Advantage,140.14,49,,percent of total billed charges,,
"(Hcmc) Morphometric Analysis, In Situ Hybridization, Manual, Per Spec; Ea Addtl Single Probe Stain (Path)OutsideLaboratory",,88369,CPT,Facility,Inpatient,,,90,286,243.1,81.9676,286,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"(Hcmc) Morphometric Analysis, In Situ Hybridization, Manual, Per Spec; Ea Addtl Single Probe Stain (Path)OutsideLaboratory",,88369,CPT,Facility,Both,,,90,286,243.1,81.9676,286,Aetna,PPO,265.98,93,,percent of total billed charges,,
"(Hcmc) Morphometric Analysis, In Situ Hybridization, Manual, Per Spec; Ea Addtl Single Probe Stain (Path)OutsideLaboratory",,88369,CPT,Facility,Both,,,90,286,243.1,81.9676,286,America's PPO,America's PPO,274.6458,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"(Hcmc) Morphometric Analysis, In Situ Hybridization, Manual, Per Spec; Ea Addtl Single Probe Stain (Path)OutsideLaboratory",,88369,CPT,Facility,Both,,,90,286,243.1,81.9676,286,BlueCross BlueShield Minnesota, Federal Employee Program,281.424,98.4,,percent of total billed charges,,
"(Hcmc) Morphometric Analysis, In Situ Hybridization, Manual, Per Spec; Ea Addtl Single Probe Stain (Path)OutsideLaboratory",,88369,CPT,Facility,Both,,,90,286,243.1,81.9676,286,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,286,100,,percent of total billed charges,,
"(Hcmc) Morphometric Analysis, In Situ Hybridization, Manual, Per Spec; Ea Addtl Single Probe Stain (Path)OutsideLaboratory",,88369,CPT,Facility,Both,,,90,286,243.1,81.9676,286,BlueCross BlueShield Minnesota,High Value Network Plan,257.4,90,,percent of total billed charges,,
"(Hcmc) Morphometric Analysis, In Situ Hybridization, Manual, Per Spec; Ea Addtl Single Probe Stain (Path)OutsideLaboratory",,88369,CPT,Facility,Outpatient,,,90,286,243.1,81.9676,286,BlueCross BlueShield Minnesota,Medicare Advantage,140.14,49,,percent of total billed charges,,
"(Hcmc) Morphometric Analysis, In Situ Hybridization, Manual, Per Spec; Ea Addtl Single Probe Stain (Path)OutsideLaboratory",,88369,CPT,Facility,Inpatient,,,90,286,243.1,81.9676,286,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"(Hcmc) Morphometric Analysis, In Situ Hybridization, Manual, Per Spec; Ea Addtl Single Probe Stain (Path)OutsideLaboratory",,88369,CPT,Facility,Both,,,90,286,243.1,81.9676,286,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,253.3102,88.57,,percent of total billed charges,,
"(Hcmc) Morphometric Analysis, In Situ Hybridization, Manual, Per Spec; Ea Addtl Single Probe Stain (Path)OutsideLaboratory",,88369,CPT,Facility,Both,,,90,286,243.1,81.9676,286,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,81.9676,28.66,,percent of total billed charges,,
"(Hcmc) Morphometric Analysis, In Situ Hybridization, Manual, Per Spec; Ea Addtl Single Probe Stain (Path)OutsideLaboratory",,88369,CPT,Facility,Outpatient,,,90,286,243.1,81.9676,286,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),140.14,49,,percent of total billed charges,,
"(Hcmc) Morphometric Analysis, In Situ Hybridization, Manual, Per Spec; Ea Addtl Single Probe Stain (Path)OutsideLaboratory",,88369,CPT,Facility,Inpatient,,,90,286,243.1,81.9676,286,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"(Hcmc) Morphometric Analysis, In Situ Hybridization, Manual, Per Spec; Ea Addtl Single Probe Stain (Path)OutsideLaboratory",,88369,CPT,Facility,Both,,,90,286,243.1,81.9676,286,CorVel,Worker's Compensation,286,100,,percent of total billed charges,,
"(Hcmc) Morphometric Analysis, In Situ Hybridization, Manual, Per Spec; Ea Addtl Single Probe Stain (Path)OutsideLaboratory",,88369,CPT,Facility,Both,,,90,286,243.1,81.9676,286,First Health Group Corporation,First Health Network,277.42,97,,percent of total billed charges,,
"(Hcmc) Morphometric Analysis, In Situ Hybridization, Manual, Per Spec; Ea Addtl Single Probe Stain (Path)OutsideLaboratory",,88369,CPT,Facility,Both,,,90,286,243.1,81.9676,286,"Health Partners, Inc.",Commercial,270.556,94.6,,percent of total billed charges,,
"(Hcmc) Morphometric Analysis, In Situ Hybridization, Manual, Per Spec; Ea Addtl Single Probe Stain (Path)OutsideLaboratory",,88369,CPT,Facility,Outpatient,,,90,286,243.1,81.9676,286,"Health Partners, Inc.",Medicare Advantage,140.14,49,,percent of total billed charges,,
"(Hcmc) Morphometric Analysis, In Situ Hybridization, Manual, Per Spec; Ea Addtl Single Probe Stain (Path)OutsideLaboratory",,88369,CPT,Facility,Inpatient,,,90,286,243.1,81.9676,286,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"(Hcmc) Morphometric Analysis, In Situ Hybridization, Manual, Per Spec; Ea Addtl Single Probe Stain (Path)OutsideLaboratory",,88369,CPT,Facility,Both,,,90,286,243.1,81.9676,286,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),171.6,60,,percent of total billed charges,,
"(Hcmc) Morphometric Analysis, In Situ Hybridization, Manual, Per Spec; Ea Addtl Single Probe Stain (Path)OutsideLaboratory",,88369,CPT,Facility,Both,,,90,286,243.1,81.9676,286,"Health Partners, Inc.",State of Minnesota Advantage Program,233.09,81.5,,percent of total billed charges,,
"(Hcmc) Morphometric Analysis, In Situ Hybridization, Manual, Per Spec; Ea Addtl Single Probe Stain (Path)OutsideLaboratory",,88369,CPT,Facility,Both,,,90,286,243.1,81.9676,286,"Health Partners, Inc.",State Public Programs,143,50,,percent of total billed charges,,
"(Hcmc) Morphometric Analysis, In Situ Hybridization, Manual, Per Spec; Ea Addtl Single Probe Stain (Path)OutsideLaboratory",,88369,CPT,Facility,Both,,,90,286,243.1,81.9676,286,Humana Insurance Company,Commercial PPO,271.7,95,,percent of total billed charges,,
"(Hcmc) Morphometric Analysis, In Situ Hybridization, Manual, Per Spec; Ea Addtl Single Probe Stain (Path)OutsideLaboratory",,88369,CPT,Facility,Outpatient,,,90,286,243.1,81.9676,286,Humana Insurance Company,Medicare PPO,140.14,49,,percent of total billed charges,,
"(Hcmc) Morphometric Analysis, In Situ Hybridization, Manual, Per Spec; Ea Addtl Single Probe Stain (Path)OutsideLaboratory",,88369,CPT,Facility,Inpatient,,,90,286,243.1,81.9676,286,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"(Hcmc) Morphometric Analysis, In Situ Hybridization, Manual, Per Spec; Ea Addtl Single Probe Stain (Path)OutsideLaboratory",,88369,CPT,Facility,Both,,,90,286,243.1,81.9676,286,Medica,Individual & Family,283.426,99.1,,percent of total billed charges,,
"(Hcmc) Morphometric Analysis, In Situ Hybridization, Manual, Per Spec; Ea Addtl Single Probe Stain (Path)OutsideLaboratory",,88369,CPT,Facility,Outpatient,,,90,286,243.1,81.9676,286,Medica,Medica Advantage Solution,142.428,49.8,,percent of total billed charges,,
"(Hcmc) Morphometric Analysis, In Situ Hybridization, Manual, Per Spec; Ea Addtl Single Probe Stain (Path)OutsideLaboratory",,88369,CPT,Facility,Inpatient,,,90,286,243.1,81.9676,286,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"(Hcmc) Morphometric Analysis, In Situ Hybridization, Manual, Per Spec; Ea Addtl Single Probe Stain (Path)OutsideLaboratory",,88369,CPT,Facility,Outpatient,,,90,286,243.1,81.9676,286,Medica,Medical Assistance,127.556,44.6,,percent of total billed charges,,
"(Hcmc) Morphometric Analysis, In Situ Hybridization, Manual, Per Spec; Ea Addtl Single Probe Stain (Path)OutsideLaboratory",,88369,CPT,Facility,Inpatient,,,90,286,243.1,81.9676,286,Medica,Medical Assistance,,,,,Included in per diem rate,
"(Hcmc) Morphometric Analysis, In Situ Hybridization, Manual, Per Spec; Ea Addtl Single Probe Stain (Path)OutsideLaboratory",,88369,CPT,Facility,Outpatient,,,90,286,243.1,81.9676,286,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,142.428,49.8,,percent of total billed charges,,
"(Hcmc) Morphometric Analysis, In Situ Hybridization, Manual, Per Spec; Ea Addtl Single Probe Stain (Path)OutsideLaboratory",,88369,CPT,Facility,Inpatient,,,90,286,243.1,81.9676,286,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"(Hcmc) Morphometric Analysis, In Situ Hybridization, Manual, Per Spec; Ea Addtl Single Probe Stain (Path)OutsideLaboratory",,88369,CPT,Facility,Both,,,90,286,243.1,81.9676,286,"Multiplan, Inc.","Multiplan, Inc.",268.84,94,,percent of total billed charges,,
"(Hcmc) Morphometric Analysis, In Situ Hybridization, Manual, Per Spec; Ea Addtl Single Probe Stain (Path)OutsideLaboratory",,88369,CPT,Facility,Outpatient,,,90,286,243.1,81.9676,286,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,257.686,90.1,,percent of total billed charges,,
"(Hcmc) Morphometric Analysis, In Situ Hybridization, Manual, Per Spec; Ea Addtl Single Probe Stain (Path)OutsideLaboratory",,88369,CPT,Facility,Inpatient,,,90,286,243.1,81.9676,286,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"(Hcmc) Morphometric Analysis, In Situ Hybridization, Manual, Per Spec; Ea Addtl Single Probe Stain (Path)OutsideLaboratory",,88369,CPT,Facility,Both,,,90,286,243.1,81.9676,286,"Preferred One Administrative Services, INC.",PPO,281.996,98.6,,percent of total billed charges,,
"(Hcmc) Morphometric Analysis, In Situ Hybridization, Manual, Per Spec; Ea Addtl Single Probe Stain (Path)OutsideLaboratory",,88369,CPT,Facility,Outpatient,,,90,286,243.1,81.9676,286,PrimeWest Health,Minnesota Senior Health Options (MSHO),147.147,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"(Hcmc) Morphometric Analysis, In Situ Hybridization, Manual, Per Spec; Ea Addtl Single Probe Stain (Path)OutsideLaboratory",,88369,CPT,Facility,Inpatient,,,90,286,243.1,81.9676,286,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"(Hcmc) Morphometric Analysis, In Situ Hybridization, Manual, Per Spec; Ea Addtl Single Probe Stain (Path)OutsideLaboratory",,88369,CPT,Facility,Outpatient,,,90,286,243.1,81.9676,286,PrimeWest Health,MinnesotaCare,146.8896,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"(Hcmc) Morphometric Analysis, In Situ Hybridization, Manual, Per Spec; Ea Addtl Single Probe Stain (Path)OutsideLaboratory",,88369,CPT,Facility,Inpatient,,,90,286,243.1,81.9676,286,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"(Hcmc) Morphometric Analysis, In Situ Hybridization, Manual, Per Spec; Ea Addtl Single Probe Stain (Path)OutsideLaboratory",,88369,CPT,Facility,Both,,,90,286,243.1,81.9676,286,Sanford Health Plan,Sanford Health Plan,263.12,92,,percent of total billed charges,,
"(Hcmc) Morphometric Analysis, In Situ Hybridization, Manual, Per Spec; Ea Addtl Single Probe Stain (Path)OutsideLaboratory",,88369,CPT,Facility,Outpatient,,,90,286,243.1,81.9676,286,"UCare Health, Inc.",Individual & Family Plan,161.161,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"(Hcmc) Morphometric Analysis, In Situ Hybridization, Manual, Per Spec; Ea Addtl Single Probe Stain (Path)OutsideLaboratory",,88369,CPT,Facility,Inpatient,,,90,286,243.1,81.9676,286,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"(Hcmc) Morphometric Analysis, In Situ Hybridization, Manual, Per Spec; Ea Addtl Single Probe Stain (Path)OutsideLaboratory",,88369,CPT,Facility,Outpatient,,,90,286,243.1,81.9676,286,"UCare Health, Inc.",Medical Assistance,144.3442,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"(Hcmc) Morphometric Analysis, In Situ Hybridization, Manual, Per Spec; Ea Addtl Single Probe Stain (Path)OutsideLaboratory",,88369,CPT,Facility,Inpatient,,,90,286,243.1,81.9676,286,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"(Hcmc) Morphometric Analysis, In Situ Hybridization, Manual, Per Spec; Ea Addtl Single Probe Stain (Path)OutsideLaboratory",,88369,CPT,Facility,Outpatient,,,90,286,243.1,81.9676,286,"UCare Health, Inc.",Medicare Advantage,144.3442,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"(Hcmc) Morphometric Analysis, In Situ Hybridization, Manual, Per Spec; Ea Addtl Single Probe Stain (Path)OutsideLaboratory",,88369,CPT,Facility,Inpatient,,,90,286,243.1,81.9676,286,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"(Hcmc) Morphometric Analysis, In Situ Hybridization, Manual, Per Spec; Ea Addtl Single Probe Stain (Path)OutsideLaboratory",,88369,CPT,Facility,Outpatient,,,90,286,243.1,81.9676,286,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),144.3442,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"(Hcmc) Morphometric Analysis, In Situ Hybridization, Manual, Per Spec; Ea Addtl Single Probe Stain (Path)OutsideLaboratory",,88369,CPT,Facility,Inpatient,,,90,286,243.1,81.9676,286,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"(Hcmc) Morphometric Analysis, In Situ Hybridization, Manual, Per Spec; Ea Addtl Single Probe Stain (Path)OutsideLaboratory",,88369,CPT,Facility,Both,,,90,286,243.1,81.9676,286,UnitedHealthcare,Individual & Family,268.84,94,,percent of total billed charges,,
"(Hcmc) Morphometric Analysis, In Situ Hybridization, Manual, Per Spec; Ea Addtl Single Probe Stain (Path)OutsideLaboratory",,88369,CPT,Facility,Outpatient,,,90,286,243.1,81.9676,286,UnitedHealthcare,Medicare Advantage,140.14,49,,percent of total billed charges,,
"(Hcmc) Morphometric Analysis, In Situ Hybridization, Manual, Per Spec; Ea Addtl Single Probe Stain (Path)OutsideLaboratory",,88369,CPT,Facility,Inpatient,,,90,286,243.1,81.9676,286,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"(Hcmc) Morphometric Analysis, In Situ Hybridization, Manual, Per Spec; Ea Addtl Single Probe Stain (Path)OutsideLaboratory",,88369,CPT,Facility,Outpatient,,,90,286,243.1,81.9676,286,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,137.28,48,,percent of total billed charges,,100% of DHS outpatient percentage
"(Hcmc) Morphometric Analysis, In Situ Hybridization, Manual, Per Spec; Ea Addtl Single Probe Stain (Path)OutsideLaboratory",,88369,CPT,Facility,Inpatient,,,90,286,243.1,81.9676,286,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"(Neo) Morphometric Analysis, In Situ Hybrid, Manual, Per Specimen; Each Multiplex Probe StainOutsideLaboratory",,88377,CPT,Facility,Both,,,90,755,641.75,216.383,755,Aetna,Commercial,694.6,92,,percent of total billed charges,,
"(Neo) Morphometric Analysis, In Situ Hybrid, Manual, Per Specimen; Each Multiplex Probe StainOutsideLaboratory",,88377,CPT,Facility,Outpatient,,,90,755,641.75,216.383,755,Aetna,Medicare Advantage,369.95,49,,percent of total billed charges,,
"(Neo) Morphometric Analysis, In Situ Hybrid, Manual, Per Specimen; Each Multiplex Probe StainOutsideLaboratory",,88377,CPT,Facility,Inpatient,,,90,755,641.75,216.383,755,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"(Neo) Morphometric Analysis, In Situ Hybrid, Manual, Per Specimen; Each Multiplex Probe StainOutsideLaboratory",,88377,CPT,Facility,Both,,,90,755,641.75,216.383,755,Aetna,PPO,702.15,93,,percent of total billed charges,,
"(Neo) Morphometric Analysis, In Situ Hybrid, Manual, Per Specimen; Each Multiplex Probe StainOutsideLaboratory",,88377,CPT,Facility,Both,,,90,755,641.75,216.383,755,America's PPO,America's PPO,725.0265,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"(Neo) Morphometric Analysis, In Situ Hybrid, Manual, Per Specimen; Each Multiplex Probe StainOutsideLaboratory",,88377,CPT,Facility,Both,,,90,755,641.75,216.383,755,BlueCross BlueShield Minnesota, Federal Employee Program,742.92,98.4,,percent of total billed charges,,
"(Neo) Morphometric Analysis, In Situ Hybrid, Manual, Per Specimen; Each Multiplex Probe StainOutsideLaboratory",,88377,CPT,Facility,Both,,,90,755,641.75,216.383,755,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,755,100,,percent of total billed charges,,
"(Neo) Morphometric Analysis, In Situ Hybrid, Manual, Per Specimen; Each Multiplex Probe StainOutsideLaboratory",,88377,CPT,Facility,Both,,,90,755,641.75,216.383,755,BlueCross BlueShield Minnesota,High Value Network Plan,679.5,90,,percent of total billed charges,,
"(Neo) Morphometric Analysis, In Situ Hybrid, Manual, Per Specimen; Each Multiplex Probe StainOutsideLaboratory",,88377,CPT,Facility,Outpatient,,,90,755,641.75,216.383,755,BlueCross BlueShield Minnesota,Medicare Advantage,369.95,49,,percent of total billed charges,,
"(Neo) Morphometric Analysis, In Situ Hybrid, Manual, Per Specimen; Each Multiplex Probe StainOutsideLaboratory",,88377,CPT,Facility,Inpatient,,,90,755,641.75,216.383,755,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"(Neo) Morphometric Analysis, In Situ Hybrid, Manual, Per Specimen; Each Multiplex Probe StainOutsideLaboratory",,88377,CPT,Facility,Both,,,90,755,641.75,216.383,755,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,668.7035,88.57,,percent of total billed charges,,
"(Neo) Morphometric Analysis, In Situ Hybrid, Manual, Per Specimen; Each Multiplex Probe StainOutsideLaboratory",,88377,CPT,Facility,Both,,,90,755,641.75,216.383,755,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,216.383,28.66,,percent of total billed charges,,
"(Neo) Morphometric Analysis, In Situ Hybrid, Manual, Per Specimen; Each Multiplex Probe StainOutsideLaboratory",,88377,CPT,Facility,Outpatient,,,90,755,641.75,216.383,755,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),369.95,49,,percent of total billed charges,,
"(Neo) Morphometric Analysis, In Situ Hybrid, Manual, Per Specimen; Each Multiplex Probe StainOutsideLaboratory",,88377,CPT,Facility,Inpatient,,,90,755,641.75,216.383,755,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"(Neo) Morphometric Analysis, In Situ Hybrid, Manual, Per Specimen; Each Multiplex Probe StainOutsideLaboratory",,88377,CPT,Facility,Both,,,90,755,641.75,216.383,755,CorVel,Worker's Compensation,755,100,,percent of total billed charges,,
"(Neo) Morphometric Analysis, In Situ Hybrid, Manual, Per Specimen; Each Multiplex Probe StainOutsideLaboratory",,88377,CPT,Facility,Both,,,90,755,641.75,216.383,755,First Health Group Corporation,First Health Network,732.35,97,,percent of total billed charges,,
"(Neo) Morphometric Analysis, In Situ Hybrid, Manual, Per Specimen; Each Multiplex Probe StainOutsideLaboratory",,88377,CPT,Facility,Both,,,90,755,641.75,216.383,755,"Health Partners, Inc.",Commercial,714.23,94.6,,percent of total billed charges,,
"(Neo) Morphometric Analysis, In Situ Hybrid, Manual, Per Specimen; Each Multiplex Probe StainOutsideLaboratory",,88377,CPT,Facility,Outpatient,,,90,755,641.75,216.383,755,"Health Partners, Inc.",Medicare Advantage,369.95,49,,percent of total billed charges,,
"(Neo) Morphometric Analysis, In Situ Hybrid, Manual, Per Specimen; Each Multiplex Probe StainOutsideLaboratory",,88377,CPT,Facility,Inpatient,,,90,755,641.75,216.383,755,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"(Neo) Morphometric Analysis, In Situ Hybrid, Manual, Per Specimen; Each Multiplex Probe StainOutsideLaboratory",,88377,CPT,Facility,Both,,,90,755,641.75,216.383,755,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),453,60,,percent of total billed charges,,
"(Neo) Morphometric Analysis, In Situ Hybrid, Manual, Per Specimen; Each Multiplex Probe StainOutsideLaboratory",,88377,CPT,Facility,Both,,,90,755,641.75,216.383,755,"Health Partners, Inc.",State of Minnesota Advantage Program,615.325,81.5,,percent of total billed charges,,
"(Neo) Morphometric Analysis, In Situ Hybrid, Manual, Per Specimen; Each Multiplex Probe StainOutsideLaboratory",,88377,CPT,Facility,Both,,,90,755,641.75,216.383,755,"Health Partners, Inc.",State Public Programs,377.5,50,,percent of total billed charges,,
"(Neo) Morphometric Analysis, In Situ Hybrid, Manual, Per Specimen; Each Multiplex Probe StainOutsideLaboratory",,88377,CPT,Facility,Both,,,90,755,641.75,216.383,755,Humana Insurance Company,Commercial PPO,717.25,95,,percent of total billed charges,,
"(Neo) Morphometric Analysis, In Situ Hybrid, Manual, Per Specimen; Each Multiplex Probe StainOutsideLaboratory",,88377,CPT,Facility,Outpatient,,,90,755,641.75,216.383,755,Humana Insurance Company,Medicare PPO,369.95,49,,percent of total billed charges,,
"(Neo) Morphometric Analysis, In Situ Hybrid, Manual, Per Specimen; Each Multiplex Probe StainOutsideLaboratory",,88377,CPT,Facility,Inpatient,,,90,755,641.75,216.383,755,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"(Neo) Morphometric Analysis, In Situ Hybrid, Manual, Per Specimen; Each Multiplex Probe StainOutsideLaboratory",,88377,CPT,Facility,Both,,,90,755,641.75,216.383,755,Medica,Individual & Family,748.205,99.1,,percent of total billed charges,,
"(Neo) Morphometric Analysis, In Situ Hybrid, Manual, Per Specimen; Each Multiplex Probe StainOutsideLaboratory",,88377,CPT,Facility,Outpatient,,,90,755,641.75,216.383,755,Medica,Medica Advantage Solution,375.99,49.8,,percent of total billed charges,,
"(Neo) Morphometric Analysis, In Situ Hybrid, Manual, Per Specimen; Each Multiplex Probe StainOutsideLaboratory",,88377,CPT,Facility,Inpatient,,,90,755,641.75,216.383,755,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"(Neo) Morphometric Analysis, In Situ Hybrid, Manual, Per Specimen; Each Multiplex Probe StainOutsideLaboratory",,88377,CPT,Facility,Outpatient,,,90,755,641.75,216.383,755,Medica,Medical Assistance,336.73,44.6,,percent of total billed charges,,
"(Neo) Morphometric Analysis, In Situ Hybrid, Manual, Per Specimen; Each Multiplex Probe StainOutsideLaboratory",,88377,CPT,Facility,Inpatient,,,90,755,641.75,216.383,755,Medica,Medical Assistance,,,,,Included in per diem rate,
"(Neo) Morphometric Analysis, In Situ Hybrid, Manual, Per Specimen; Each Multiplex Probe StainOutsideLaboratory",,88377,CPT,Facility,Outpatient,,,90,755,641.75,216.383,755,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,375.99,49.8,,percent of total billed charges,,
"(Neo) Morphometric Analysis, In Situ Hybrid, Manual, Per Specimen; Each Multiplex Probe StainOutsideLaboratory",,88377,CPT,Facility,Inpatient,,,90,755,641.75,216.383,755,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"(Neo) Morphometric Analysis, In Situ Hybrid, Manual, Per Specimen; Each Multiplex Probe StainOutsideLaboratory",,88377,CPT,Facility,Both,,,90,755,641.75,216.383,755,"Multiplan, Inc.","Multiplan, Inc.",709.7,94,,percent of total billed charges,,
"(Neo) Morphometric Analysis, In Situ Hybrid, Manual, Per Specimen; Each Multiplex Probe StainOutsideLaboratory",,88377,CPT,Facility,Outpatient,,,90,755,641.75,216.383,755,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,680.255,90.1,,percent of total billed charges,,
"(Neo) Morphometric Analysis, In Situ Hybrid, Manual, Per Specimen; Each Multiplex Probe StainOutsideLaboratory",,88377,CPT,Facility,Inpatient,,,90,755,641.75,216.383,755,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"(Neo) Morphometric Analysis, In Situ Hybrid, Manual, Per Specimen; Each Multiplex Probe StainOutsideLaboratory",,88377,CPT,Facility,Both,,,90,755,641.75,216.383,755,"Preferred One Administrative Services, INC.",PPO,744.43,98.6,,percent of total billed charges,,
"(Neo) Morphometric Analysis, In Situ Hybrid, Manual, Per Specimen; Each Multiplex Probe StainOutsideLaboratory",,88377,CPT,Facility,Outpatient,,,90,755,641.75,216.383,755,PrimeWest Health,Minnesota Senior Health Options (MSHO),388.4475,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"(Neo) Morphometric Analysis, In Situ Hybrid, Manual, Per Specimen; Each Multiplex Probe StainOutsideLaboratory",,88377,CPT,Facility,Inpatient,,,90,755,641.75,216.383,755,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"(Neo) Morphometric Analysis, In Situ Hybrid, Manual, Per Specimen; Each Multiplex Probe StainOutsideLaboratory",,88377,CPT,Facility,Outpatient,,,90,755,641.75,216.383,755,PrimeWest Health,MinnesotaCare,387.768,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"(Neo) Morphometric Analysis, In Situ Hybrid, Manual, Per Specimen; Each Multiplex Probe StainOutsideLaboratory",,88377,CPT,Facility,Inpatient,,,90,755,641.75,216.383,755,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"(Neo) Morphometric Analysis, In Situ Hybrid, Manual, Per Specimen; Each Multiplex Probe StainOutsideLaboratory",,88377,CPT,Facility,Both,,,90,755,641.75,216.383,755,Sanford Health Plan,Sanford Health Plan,694.6,92,,percent of total billed charges,,
"(Neo) Morphometric Analysis, In Situ Hybrid, Manual, Per Specimen; Each Multiplex Probe StainOutsideLaboratory",,88377,CPT,Facility,Outpatient,,,90,755,641.75,216.383,755,"UCare Health, Inc.",Individual & Family Plan,425.4425,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"(Neo) Morphometric Analysis, In Situ Hybrid, Manual, Per Specimen; Each Multiplex Probe StainOutsideLaboratory",,88377,CPT,Facility,Inpatient,,,90,755,641.75,216.383,755,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"(Neo) Morphometric Analysis, In Situ Hybrid, Manual, Per Specimen; Each Multiplex Probe StainOutsideLaboratory",,88377,CPT,Facility,Outpatient,,,90,755,641.75,216.383,755,"UCare Health, Inc.",Medical Assistance,381.0485,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"(Neo) Morphometric Analysis, In Situ Hybrid, Manual, Per Specimen; Each Multiplex Probe StainOutsideLaboratory",,88377,CPT,Facility,Inpatient,,,90,755,641.75,216.383,755,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"(Neo) Morphometric Analysis, In Situ Hybrid, Manual, Per Specimen; Each Multiplex Probe StainOutsideLaboratory",,88377,CPT,Facility,Outpatient,,,90,755,641.75,216.383,755,"UCare Health, Inc.",Medicare Advantage,381.0485,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"(Neo) Morphometric Analysis, In Situ Hybrid, Manual, Per Specimen; Each Multiplex Probe StainOutsideLaboratory",,88377,CPT,Facility,Inpatient,,,90,755,641.75,216.383,755,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"(Neo) Morphometric Analysis, In Situ Hybrid, Manual, Per Specimen; Each Multiplex Probe StainOutsideLaboratory",,88377,CPT,Facility,Outpatient,,,90,755,641.75,216.383,755,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),381.0485,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"(Neo) Morphometric Analysis, In Situ Hybrid, Manual, Per Specimen; Each Multiplex Probe StainOutsideLaboratory",,88377,CPT,Facility,Inpatient,,,90,755,641.75,216.383,755,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"(Neo) Morphometric Analysis, In Situ Hybrid, Manual, Per Specimen; Each Multiplex Probe StainOutsideLaboratory",,88377,CPT,Facility,Both,,,90,755,641.75,216.383,755,UnitedHealthcare,Individual & Family,709.7,94,,percent of total billed charges,,
"(Neo) Morphometric Analysis, In Situ Hybrid, Manual, Per Specimen; Each Multiplex Probe StainOutsideLaboratory",,88377,CPT,Facility,Outpatient,,,90,755,641.75,216.383,755,UnitedHealthcare,Medicare Advantage,369.95,49,,percent of total billed charges,,
"(Neo) Morphometric Analysis, In Situ Hybrid, Manual, Per Specimen; Each Multiplex Probe StainOutsideLaboratory",,88377,CPT,Facility,Inpatient,,,90,755,641.75,216.383,755,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"(Neo) Morphometric Analysis, In Situ Hybrid, Manual, Per Specimen; Each Multiplex Probe StainOutsideLaboratory",,88377,CPT,Facility,Outpatient,,,90,755,641.75,216.383,755,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,362.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
"(Neo) Morphometric Analysis, In Situ Hybrid, Manual, Per Specimen; Each Multiplex Probe StainOutsideLaboratory",,88377,CPT,Facility,Inpatient,,,90,755,641.75,216.383,755,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Post Vasectomy Check, Semen (Mayo)OutsideLaboratory",,89321,CPT,Facility,Both,,,90,228,193.8,65.3448,228,Aetna,Commercial,209.76,92,,percent of total billed charges,,
"Post Vasectomy Check, Semen (Mayo)OutsideLaboratory",,89321,CPT,Facility,Outpatient,,,90,228,193.8,65.3448,228,Aetna,Medicare Advantage,111.72,49,,percent of total billed charges,,
"Post Vasectomy Check, Semen (Mayo)OutsideLaboratory",,89321,CPT,Facility,Inpatient,,,90,228,193.8,65.3448,228,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Post Vasectomy Check, Semen (Mayo)OutsideLaboratory",,89321,CPT,Facility,Both,,,90,228,193.8,65.3448,228,Aetna,PPO,212.04,93,,percent of total billed charges,,
"Post Vasectomy Check, Semen (Mayo)OutsideLaboratory",,89321,CPT,Facility,Both,,,90,228,193.8,65.3448,228,America's PPO,America's PPO,218.9484,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Post Vasectomy Check, Semen (Mayo)OutsideLaboratory",,89321,CPT,Facility,Both,,,90,228,193.8,65.3448,228,BlueCross BlueShield Minnesota, Federal Employee Program,224.352,98.4,,percent of total billed charges,,
"Post Vasectomy Check, Semen (Mayo)OutsideLaboratory",,89321,CPT,Facility,Both,,,90,228,193.8,65.3448,228,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,228,100,,percent of total billed charges,,
"Post Vasectomy Check, Semen (Mayo)OutsideLaboratory",,89321,CPT,Facility,Both,,,90,228,193.8,65.3448,228,BlueCross BlueShield Minnesota,High Value Network Plan,205.2,90,,percent of total billed charges,,
"Post Vasectomy Check, Semen (Mayo)OutsideLaboratory",,89321,CPT,Facility,Outpatient,,,90,228,193.8,65.3448,228,BlueCross BlueShield Minnesota,Medicare Advantage,111.72,49,,percent of total billed charges,,
"Post Vasectomy Check, Semen (Mayo)OutsideLaboratory",,89321,CPT,Facility,Inpatient,,,90,228,193.8,65.3448,228,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Post Vasectomy Check, Semen (Mayo)OutsideLaboratory",,89321,CPT,Facility,Both,,,90,228,193.8,65.3448,228,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,201.9396,88.57,,percent of total billed charges,,
"Post Vasectomy Check, Semen (Mayo)OutsideLaboratory",,89321,CPT,Facility,Both,,,90,228,193.8,65.3448,228,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,65.3448,28.66,,percent of total billed charges,,
"Post Vasectomy Check, Semen (Mayo)OutsideLaboratory",,89321,CPT,Facility,Outpatient,,,90,228,193.8,65.3448,228,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),111.72,49,,percent of total billed charges,,
"Post Vasectomy Check, Semen (Mayo)OutsideLaboratory",,89321,CPT,Facility,Inpatient,,,90,228,193.8,65.3448,228,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Post Vasectomy Check, Semen (Mayo)OutsideLaboratory",,89321,CPT,Facility,Both,,,90,228,193.8,65.3448,228,CorVel,Worker's Compensation,228,100,,percent of total billed charges,,
"Post Vasectomy Check, Semen (Mayo)OutsideLaboratory",,89321,CPT,Facility,Both,,,90,228,193.8,65.3448,228,First Health Group Corporation,First Health Network,221.16,97,,percent of total billed charges,,
"Post Vasectomy Check, Semen (Mayo)OutsideLaboratory",,89321,CPT,Facility,Both,,,90,228,193.8,65.3448,228,"Health Partners, Inc.",Commercial,215.688,94.6,,percent of total billed charges,,
"Post Vasectomy Check, Semen (Mayo)OutsideLaboratory",,89321,CPT,Facility,Outpatient,,,90,228,193.8,65.3448,228,"Health Partners, Inc.",Medicare Advantage,111.72,49,,percent of total billed charges,,
"Post Vasectomy Check, Semen (Mayo)OutsideLaboratory",,89321,CPT,Facility,Inpatient,,,90,228,193.8,65.3448,228,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Post Vasectomy Check, Semen (Mayo)OutsideLaboratory",,89321,CPT,Facility,Both,,,90,228,193.8,65.3448,228,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),136.8,60,,percent of total billed charges,,
"Post Vasectomy Check, Semen (Mayo)OutsideLaboratory",,89321,CPT,Facility,Both,,,90,228,193.8,65.3448,228,"Health Partners, Inc.",State of Minnesota Advantage Program,185.82,81.5,,percent of total billed charges,,
"Post Vasectomy Check, Semen (Mayo)OutsideLaboratory",,89321,CPT,Facility,Both,,,90,228,193.8,65.3448,228,"Health Partners, Inc.",State Public Programs,114,50,,percent of total billed charges,,
"Post Vasectomy Check, Semen (Mayo)OutsideLaboratory",,89321,CPT,Facility,Both,,,90,228,193.8,65.3448,228,Humana Insurance Company,Commercial PPO,216.6,95,,percent of total billed charges,,
"Post Vasectomy Check, Semen (Mayo)OutsideLaboratory",,89321,CPT,Facility,Outpatient,,,90,228,193.8,65.3448,228,Humana Insurance Company,Medicare PPO,111.72,49,,percent of total billed charges,,
"Post Vasectomy Check, Semen (Mayo)OutsideLaboratory",,89321,CPT,Facility,Inpatient,,,90,228,193.8,65.3448,228,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Post Vasectomy Check, Semen (Mayo)OutsideLaboratory",,89321,CPT,Facility,Both,,,90,228,193.8,65.3448,228,Medica,Individual & Family,225.948,99.1,,percent of total billed charges,,
"Post Vasectomy Check, Semen (Mayo)OutsideLaboratory",,89321,CPT,Facility,Outpatient,,,90,228,193.8,65.3448,228,Medica,Medica Advantage Solution,113.544,49.8,,percent of total billed charges,,
"Post Vasectomy Check, Semen (Mayo)OutsideLaboratory",,89321,CPT,Facility,Inpatient,,,90,228,193.8,65.3448,228,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Post Vasectomy Check, Semen (Mayo)OutsideLaboratory",,89321,CPT,Facility,Outpatient,,,90,228,193.8,65.3448,228,Medica,Medical Assistance,101.688,44.6,,percent of total billed charges,,
"Post Vasectomy Check, Semen (Mayo)OutsideLaboratory",,89321,CPT,Facility,Inpatient,,,90,228,193.8,65.3448,228,Medica,Medical Assistance,,,,,Included in per diem rate,
"Post Vasectomy Check, Semen (Mayo)OutsideLaboratory",,89321,CPT,Facility,Outpatient,,,90,228,193.8,65.3448,228,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,113.544,49.8,,percent of total billed charges,,
"Post Vasectomy Check, Semen (Mayo)OutsideLaboratory",,89321,CPT,Facility,Inpatient,,,90,228,193.8,65.3448,228,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Post Vasectomy Check, Semen (Mayo)OutsideLaboratory",,89321,CPT,Facility,Both,,,90,228,193.8,65.3448,228,"Multiplan, Inc.","Multiplan, Inc.",214.32,94,,percent of total billed charges,,
"Post Vasectomy Check, Semen (Mayo)OutsideLaboratory",,89321,CPT,Facility,Outpatient,,,90,228,193.8,65.3448,228,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,196.992,86.4,,percent of total billed charges,,
"Post Vasectomy Check, Semen (Mayo)OutsideLaboratory",,89321,CPT,Facility,Inpatient,,,90,228,193.8,65.3448,228,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Post Vasectomy Check, Semen (Mayo)OutsideLaboratory",,89321,CPT,Facility,Both,,,90,228,193.8,65.3448,228,"Preferred One Administrative Services, INC.",PPO,224.808,98.6,,percent of total billed charges,,
"Post Vasectomy Check, Semen (Mayo)OutsideLaboratory",,89321,CPT,Facility,Outpatient,,,90,228,193.8,65.3448,228,PrimeWest Health,Minnesota Senior Health Options (MSHO),117.306,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Post Vasectomy Check, Semen (Mayo)OutsideLaboratory",,89321,CPT,Facility,Inpatient,,,90,228,193.8,65.3448,228,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Post Vasectomy Check, Semen (Mayo)OutsideLaboratory",,89321,CPT,Facility,Outpatient,,,90,228,193.8,65.3448,228,PrimeWest Health,MinnesotaCare,117.1008,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Post Vasectomy Check, Semen (Mayo)OutsideLaboratory",,89321,CPT,Facility,Inpatient,,,90,228,193.8,65.3448,228,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Post Vasectomy Check, Semen (Mayo)OutsideLaboratory",,89321,CPT,Facility,Both,,,90,228,193.8,65.3448,228,Sanford Health Plan,Sanford Health Plan,209.76,92,,percent of total billed charges,,
"Post Vasectomy Check, Semen (Mayo)OutsideLaboratory",,89321,CPT,Facility,Outpatient,,,90,228,193.8,65.3448,228,"UCare Health, Inc.",Individual & Family Plan,128.478,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Post Vasectomy Check, Semen (Mayo)OutsideLaboratory",,89321,CPT,Facility,Inpatient,,,90,228,193.8,65.3448,228,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Post Vasectomy Check, Semen (Mayo)OutsideLaboratory",,89321,CPT,Facility,Outpatient,,,90,228,193.8,65.3448,228,"UCare Health, Inc.",Medical Assistance,115.0716,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Post Vasectomy Check, Semen (Mayo)OutsideLaboratory",,89321,CPT,Facility,Inpatient,,,90,228,193.8,65.3448,228,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Post Vasectomy Check, Semen (Mayo)OutsideLaboratory",,89321,CPT,Facility,Outpatient,,,90,228,193.8,65.3448,228,"UCare Health, Inc.",Medicare Advantage,115.0716,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Post Vasectomy Check, Semen (Mayo)OutsideLaboratory",,89321,CPT,Facility,Inpatient,,,90,228,193.8,65.3448,228,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Post Vasectomy Check, Semen (Mayo)OutsideLaboratory",,89321,CPT,Facility,Outpatient,,,90,228,193.8,65.3448,228,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),115.0716,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Post Vasectomy Check, Semen (Mayo)OutsideLaboratory",,89321,CPT,Facility,Inpatient,,,90,228,193.8,65.3448,228,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Post Vasectomy Check, Semen (Mayo)OutsideLaboratory",,89321,CPT,Facility,Both,,,90,228,193.8,65.3448,228,UnitedHealthcare,Individual & Family,214.32,94,,percent of total billed charges,,
"Post Vasectomy Check, Semen (Mayo)OutsideLaboratory",,89321,CPT,Facility,Outpatient,,,90,228,193.8,65.3448,228,UnitedHealthcare,Medicare Advantage,111.72,49,,percent of total billed charges,,
"Post Vasectomy Check, Semen (Mayo)OutsideLaboratory",,89321,CPT,Facility,Inpatient,,,90,228,193.8,65.3448,228,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Post Vasectomy Check, Semen (Mayo)OutsideLaboratory",,89321,CPT,Facility,Outpatient,,,90,228,193.8,65.3448,228,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,109.44,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Post Vasectomy Check, Semen (Mayo)OutsideLaboratory",,89321,CPT,Facility,Inpatient,,,90,228,193.8,65.3448,228,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Semen Analysis; Volume, Count, Motility, And Differential Using Strict Morphologic Criteria (Mayo)OutsideLaboratory",,89322,CPT,Facility,Both,,,90,267,226.95,76.5222,267,Aetna,Commercial,245.64,92,,percent of total billed charges,,
"Semen Analysis; Volume, Count, Motility, And Differential Using Strict Morphologic Criteria (Mayo)OutsideLaboratory",,89322,CPT,Facility,Outpatient,,,90,267,226.95,76.5222,267,Aetna,Medicare Advantage,130.83,49,,percent of total billed charges,,
"Semen Analysis; Volume, Count, Motility, And Differential Using Strict Morphologic Criteria (Mayo)OutsideLaboratory",,89322,CPT,Facility,Inpatient,,,90,267,226.95,76.5222,267,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Semen Analysis; Volume, Count, Motility, And Differential Using Strict Morphologic Criteria (Mayo)OutsideLaboratory",,89322,CPT,Facility,Both,,,90,267,226.95,76.5222,267,Aetna,PPO,248.31,93,,percent of total billed charges,,
"Semen Analysis; Volume, Count, Motility, And Differential Using Strict Morphologic Criteria (Mayo)OutsideLaboratory",,89322,CPT,Facility,Both,,,90,267,226.95,76.5222,267,America's PPO,America's PPO,256.4001,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Semen Analysis; Volume, Count, Motility, And Differential Using Strict Morphologic Criteria (Mayo)OutsideLaboratory",,89322,CPT,Facility,Both,,,90,267,226.95,76.5222,267,BlueCross BlueShield Minnesota, Federal Employee Program,262.728,98.4,,percent of total billed charges,,
"Semen Analysis; Volume, Count, Motility, And Differential Using Strict Morphologic Criteria (Mayo)OutsideLaboratory",,89322,CPT,Facility,Both,,,90,267,226.95,76.5222,267,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,267,100,,percent of total billed charges,,
"Semen Analysis; Volume, Count, Motility, And Differential Using Strict Morphologic Criteria (Mayo)OutsideLaboratory",,89322,CPT,Facility,Both,,,90,267,226.95,76.5222,267,BlueCross BlueShield Minnesota,High Value Network Plan,240.3,90,,percent of total billed charges,,
"Semen Analysis; Volume, Count, Motility, And Differential Using Strict Morphologic Criteria (Mayo)OutsideLaboratory",,89322,CPT,Facility,Outpatient,,,90,267,226.95,76.5222,267,BlueCross BlueShield Minnesota,Medicare Advantage,130.83,49,,percent of total billed charges,,
"Semen Analysis; Volume, Count, Motility, And Differential Using Strict Morphologic Criteria (Mayo)OutsideLaboratory",,89322,CPT,Facility,Inpatient,,,90,267,226.95,76.5222,267,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Semen Analysis; Volume, Count, Motility, And Differential Using Strict Morphologic Criteria (Mayo)OutsideLaboratory",,89322,CPT,Facility,Both,,,90,267,226.95,76.5222,267,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,236.4819,88.57,,percent of total billed charges,,
"Semen Analysis; Volume, Count, Motility, And Differential Using Strict Morphologic Criteria (Mayo)OutsideLaboratory",,89322,CPT,Facility,Both,,,90,267,226.95,76.5222,267,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,76.5222,28.66,,percent of total billed charges,,
"Semen Analysis; Volume, Count, Motility, And Differential Using Strict Morphologic Criteria (Mayo)OutsideLaboratory",,89322,CPT,Facility,Outpatient,,,90,267,226.95,76.5222,267,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),130.83,49,,percent of total billed charges,,
"Semen Analysis; Volume, Count, Motility, And Differential Using Strict Morphologic Criteria (Mayo)OutsideLaboratory",,89322,CPT,Facility,Inpatient,,,90,267,226.95,76.5222,267,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Semen Analysis; Volume, Count, Motility, And Differential Using Strict Morphologic Criteria (Mayo)OutsideLaboratory",,89322,CPT,Facility,Both,,,90,267,226.95,76.5222,267,CorVel,Worker's Compensation,267,100,,percent of total billed charges,,
"Semen Analysis; Volume, Count, Motility, And Differential Using Strict Morphologic Criteria (Mayo)OutsideLaboratory",,89322,CPT,Facility,Both,,,90,267,226.95,76.5222,267,First Health Group Corporation,First Health Network,258.99,97,,percent of total billed charges,,
"Semen Analysis; Volume, Count, Motility, And Differential Using Strict Morphologic Criteria (Mayo)OutsideLaboratory",,89322,CPT,Facility,Both,,,90,267,226.95,76.5222,267,"Health Partners, Inc.",Commercial,252.582,94.6,,percent of total billed charges,,
"Semen Analysis; Volume, Count, Motility, And Differential Using Strict Morphologic Criteria (Mayo)OutsideLaboratory",,89322,CPT,Facility,Outpatient,,,90,267,226.95,76.5222,267,"Health Partners, Inc.",Medicare Advantage,130.83,49,,percent of total billed charges,,
"Semen Analysis; Volume, Count, Motility, And Differential Using Strict Morphologic Criteria (Mayo)OutsideLaboratory",,89322,CPT,Facility,Inpatient,,,90,267,226.95,76.5222,267,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Semen Analysis; Volume, Count, Motility, And Differential Using Strict Morphologic Criteria (Mayo)OutsideLaboratory",,89322,CPT,Facility,Both,,,90,267,226.95,76.5222,267,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),160.2,60,,percent of total billed charges,,
"Semen Analysis; Volume, Count, Motility, And Differential Using Strict Morphologic Criteria (Mayo)OutsideLaboratory",,89322,CPT,Facility,Both,,,90,267,226.95,76.5222,267,"Health Partners, Inc.",State of Minnesota Advantage Program,217.605,81.5,,percent of total billed charges,,
"Semen Analysis; Volume, Count, Motility, And Differential Using Strict Morphologic Criteria (Mayo)OutsideLaboratory",,89322,CPT,Facility,Both,,,90,267,226.95,76.5222,267,"Health Partners, Inc.",State Public Programs,133.5,50,,percent of total billed charges,,
"Semen Analysis; Volume, Count, Motility, And Differential Using Strict Morphologic Criteria (Mayo)OutsideLaboratory",,89322,CPT,Facility,Both,,,90,267,226.95,76.5222,267,Humana Insurance Company,Commercial PPO,253.65,95,,percent of total billed charges,,
"Semen Analysis; Volume, Count, Motility, And Differential Using Strict Morphologic Criteria (Mayo)OutsideLaboratory",,89322,CPT,Facility,Outpatient,,,90,267,226.95,76.5222,267,Humana Insurance Company,Medicare PPO,130.83,49,,percent of total billed charges,,
"Semen Analysis; Volume, Count, Motility, And Differential Using Strict Morphologic Criteria (Mayo)OutsideLaboratory",,89322,CPT,Facility,Inpatient,,,90,267,226.95,76.5222,267,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Semen Analysis; Volume, Count, Motility, And Differential Using Strict Morphologic Criteria (Mayo)OutsideLaboratory",,89322,CPT,Facility,Both,,,90,267,226.95,76.5222,267,Medica,Individual & Family,264.597,99.1,,percent of total billed charges,,
"Semen Analysis; Volume, Count, Motility, And Differential Using Strict Morphologic Criteria (Mayo)OutsideLaboratory",,89322,CPT,Facility,Outpatient,,,90,267,226.95,76.5222,267,Medica,Medica Advantage Solution,132.966,49.8,,percent of total billed charges,,
"Semen Analysis; Volume, Count, Motility, And Differential Using Strict Morphologic Criteria (Mayo)OutsideLaboratory",,89322,CPT,Facility,Inpatient,,,90,267,226.95,76.5222,267,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Semen Analysis; Volume, Count, Motility, And Differential Using Strict Morphologic Criteria (Mayo)OutsideLaboratory",,89322,CPT,Facility,Outpatient,,,90,267,226.95,76.5222,267,Medica,Medical Assistance,119.082,44.6,,percent of total billed charges,,
"Semen Analysis; Volume, Count, Motility, And Differential Using Strict Morphologic Criteria (Mayo)OutsideLaboratory",,89322,CPT,Facility,Inpatient,,,90,267,226.95,76.5222,267,Medica,Medical Assistance,,,,,Included in per diem rate,
"Semen Analysis; Volume, Count, Motility, And Differential Using Strict Morphologic Criteria (Mayo)OutsideLaboratory",,89322,CPT,Facility,Outpatient,,,90,267,226.95,76.5222,267,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,132.966,49.8,,percent of total billed charges,,
"Semen Analysis; Volume, Count, Motility, And Differential Using Strict Morphologic Criteria (Mayo)OutsideLaboratory",,89322,CPT,Facility,Inpatient,,,90,267,226.95,76.5222,267,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Semen Analysis; Volume, Count, Motility, And Differential Using Strict Morphologic Criteria (Mayo)OutsideLaboratory",,89322,CPT,Facility,Both,,,90,267,226.95,76.5222,267,"Multiplan, Inc.","Multiplan, Inc.",250.98,94,,percent of total billed charges,,
"Semen Analysis; Volume, Count, Motility, And Differential Using Strict Morphologic Criteria (Mayo)OutsideLaboratory",,89322,CPT,Facility,Outpatient,,,90,267,226.95,76.5222,267,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,230.688,86.4,,percent of total billed charges,,
"Semen Analysis; Volume, Count, Motility, And Differential Using Strict Morphologic Criteria (Mayo)OutsideLaboratory",,89322,CPT,Facility,Inpatient,,,90,267,226.95,76.5222,267,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Semen Analysis; Volume, Count, Motility, And Differential Using Strict Morphologic Criteria (Mayo)OutsideLaboratory",,89322,CPT,Facility,Both,,,90,267,226.95,76.5222,267,"Preferred One Administrative Services, INC.",PPO,263.262,98.6,,percent of total billed charges,,
"Semen Analysis; Volume, Count, Motility, And Differential Using Strict Morphologic Criteria (Mayo)OutsideLaboratory",,89322,CPT,Facility,Outpatient,,,90,267,226.95,76.5222,267,PrimeWest Health,Minnesota Senior Health Options (MSHO),137.3715,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Semen Analysis; Volume, Count, Motility, And Differential Using Strict Morphologic Criteria (Mayo)OutsideLaboratory",,89322,CPT,Facility,Inpatient,,,90,267,226.95,76.5222,267,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Semen Analysis; Volume, Count, Motility, And Differential Using Strict Morphologic Criteria (Mayo)OutsideLaboratory",,89322,CPT,Facility,Outpatient,,,90,267,226.95,76.5222,267,PrimeWest Health,MinnesotaCare,137.1312,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Semen Analysis; Volume, Count, Motility, And Differential Using Strict Morphologic Criteria (Mayo)OutsideLaboratory",,89322,CPT,Facility,Inpatient,,,90,267,226.95,76.5222,267,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Semen Analysis; Volume, Count, Motility, And Differential Using Strict Morphologic Criteria (Mayo)OutsideLaboratory",,89322,CPT,Facility,Both,,,90,267,226.95,76.5222,267,Sanford Health Plan,Sanford Health Plan,245.64,92,,percent of total billed charges,,
"Semen Analysis; Volume, Count, Motility, And Differential Using Strict Morphologic Criteria (Mayo)OutsideLaboratory",,89322,CPT,Facility,Outpatient,,,90,267,226.95,76.5222,267,"UCare Health, Inc.",Individual & Family Plan,150.4545,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Semen Analysis; Volume, Count, Motility, And Differential Using Strict Morphologic Criteria (Mayo)OutsideLaboratory",,89322,CPT,Facility,Inpatient,,,90,267,226.95,76.5222,267,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Semen Analysis; Volume, Count, Motility, And Differential Using Strict Morphologic Criteria (Mayo)OutsideLaboratory",,89322,CPT,Facility,Outpatient,,,90,267,226.95,76.5222,267,"UCare Health, Inc.",Medical Assistance,134.7549,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Semen Analysis; Volume, Count, Motility, And Differential Using Strict Morphologic Criteria (Mayo)OutsideLaboratory",,89322,CPT,Facility,Inpatient,,,90,267,226.95,76.5222,267,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Semen Analysis; Volume, Count, Motility, And Differential Using Strict Morphologic Criteria (Mayo)OutsideLaboratory",,89322,CPT,Facility,Outpatient,,,90,267,226.95,76.5222,267,"UCare Health, Inc.",Medicare Advantage,134.7549,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Semen Analysis; Volume, Count, Motility, And Differential Using Strict Morphologic Criteria (Mayo)OutsideLaboratory",,89322,CPT,Facility,Inpatient,,,90,267,226.95,76.5222,267,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Semen Analysis; Volume, Count, Motility, And Differential Using Strict Morphologic Criteria (Mayo)OutsideLaboratory",,89322,CPT,Facility,Outpatient,,,90,267,226.95,76.5222,267,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),134.7549,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Semen Analysis; Volume, Count, Motility, And Differential Using Strict Morphologic Criteria (Mayo)OutsideLaboratory",,89322,CPT,Facility,Inpatient,,,90,267,226.95,76.5222,267,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Semen Analysis; Volume, Count, Motility, And Differential Using Strict Morphologic Criteria (Mayo)OutsideLaboratory",,89322,CPT,Facility,Both,,,90,267,226.95,76.5222,267,UnitedHealthcare,Individual & Family,250.98,94,,percent of total billed charges,,
"Semen Analysis; Volume, Count, Motility, And Differential Using Strict Morphologic Criteria (Mayo)OutsideLaboratory",,89322,CPT,Facility,Outpatient,,,90,267,226.95,76.5222,267,UnitedHealthcare,Medicare Advantage,130.83,49,,percent of total billed charges,,
"Semen Analysis; Volume, Count, Motility, And Differential Using Strict Morphologic Criteria (Mayo)OutsideLaboratory",,89322,CPT,Facility,Inpatient,,,90,267,226.95,76.5222,267,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Semen Analysis; Volume, Count, Motility, And Differential Using Strict Morphologic Criteria (Mayo)OutsideLaboratory",,89322,CPT,Facility,Outpatient,,,90,267,226.95,76.5222,267,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,128.16,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Semen Analysis; Volume, Count, Motility, And Differential Using Strict Morphologic Criteria (Mayo)OutsideLaboratory",,89322,CPT,Facility,Inpatient,,,90,267,226.95,76.5222,267,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Amitriptyline And Nortriptyline, S (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Outpatient,,,90,173,147.05,84.77,155.7,Aetna,Medicare Advantage,84.77,49,,percent of total billed charges,,
"Amitriptyline And Nortriptyline, S (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Inpatient,,,90,173,147.05,84.77,155.7,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Amitriptyline And Nortriptyline, S (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Outpatient,,,90,173,147.05,84.77,155.7,BlueCross BlueShield Minnesota,Medicare Advantage,84.77,49,,percent of total billed charges,,
"Amitriptyline And Nortriptyline, S (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Inpatient,,,90,173,147.05,84.77,155.7,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Amitriptyline And Nortriptyline, S (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Outpatient,,,90,173,147.05,84.77,155.7,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),84.77,49,,percent of total billed charges,,
"Amitriptyline And Nortriptyline, S (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Inpatient,,,90,173,147.05,84.77,155.7,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Amitriptyline And Nortriptyline, S (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Outpatient,,,90,173,147.05,84.77,155.7,"Health Partners, Inc.",Medicare Advantage,84.77,49,,percent of total billed charges,,
"Amitriptyline And Nortriptyline, S (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Inpatient,,,90,173,147.05,84.77,155.7,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Amitriptyline And Nortriptyline, S (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Both,,,90,173,147.05,84.77,155.7,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),103.8,60,,percent of total billed charges,,
"Amitriptyline And Nortriptyline, S (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Outpatient,,,90,173,147.05,84.77,155.7,Humana Insurance Company,Medicare PPO,84.77,49,,percent of total billed charges,,
"Amitriptyline And Nortriptyline, S (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Inpatient,,,90,173,147.05,84.77,155.7,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Amitriptyline And Nortriptyline, S (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Outpatient,,,90,173,147.05,84.77,155.7,Medica,Medica Advantage Solution,86.154,49.8,,percent of total billed charges,,
"Amitriptyline And Nortriptyline, S (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Inpatient,,,90,173,147.05,84.77,155.7,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Amitriptyline And Nortriptyline, S (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Outpatient,,,90,173,147.05,84.77,155.7,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,86.154,49.8,,percent of total billed charges,,
"Amitriptyline And Nortriptyline, S (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Inpatient,,,90,173,147.05,84.77,155.7,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Amitriptyline And Nortriptyline, S (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Outpatient,,,90,173,147.05,84.77,155.7,PrimeWest Health,Minnesota Senior Health Options (MSHO),89.0085,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Amitriptyline And Nortriptyline, S (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Inpatient,,,90,173,147.05,84.77,155.7,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Amitriptyline And Nortriptyline, S (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Outpatient,,,90,173,147.05,84.77,155.7,"UCare Health, Inc.",Medicare Advantage,87.3131,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Amitriptyline And Nortriptyline, S (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Inpatient,,,90,173,147.05,84.77,155.7,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Amitriptyline And Nortriptyline, S (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Outpatient,,,90,173,147.05,84.77,155.7,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),87.3131,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Amitriptyline And Nortriptyline, S (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Inpatient,,,90,173,147.05,84.77,155.7,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Amitriptyline And Nortriptyline, S (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Outpatient,,,90,173,147.05,84.77,155.7,UnitedHealthcare,Medicare Advantage,84.77,49,,percent of total billed charges,,
"Amitriptyline And Nortriptyline, S (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Inpatient,,,90,173,147.05,84.77,155.7,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Amphetamines Confirmation, U (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Outpatient,,,90,125,106.25,61.25,112.5,Aetna,Medicare Advantage,61.25,49,,percent of total billed charges,,
"Amphetamines Confirmation, U (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Inpatient,,,90,125,106.25,61.25,112.5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Amphetamines Confirmation, U (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Outpatient,,,90,125,106.25,61.25,112.5,BlueCross BlueShield Minnesota,Medicare Advantage,61.25,49,,percent of total billed charges,,
"Amphetamines Confirmation, U (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Inpatient,,,90,125,106.25,61.25,112.5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Amphetamines Confirmation, U (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Outpatient,,,90,125,106.25,61.25,112.5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),61.25,49,,percent of total billed charges,,
"Amphetamines Confirmation, U (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Inpatient,,,90,125,106.25,61.25,112.5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Amphetamines Confirmation, U (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Outpatient,,,90,125,106.25,61.25,112.5,"Health Partners, Inc.",Medicare Advantage,61.25,49,,percent of total billed charges,,
"Amphetamines Confirmation, U (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Inpatient,,,90,125,106.25,61.25,112.5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Amphetamines Confirmation, U (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Both,,,90,125,106.25,61.25,112.5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),75,60,,percent of total billed charges,,
"Amphetamines Confirmation, U (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Outpatient,,,90,125,106.25,61.25,112.5,Humana Insurance Company,Medicare PPO,61.25,49,,percent of total billed charges,,
"Amphetamines Confirmation, U (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Inpatient,,,90,125,106.25,61.25,112.5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Amphetamines Confirmation, U (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Outpatient,,,90,125,106.25,61.25,112.5,Medica,Medica Advantage Solution,62.25,49.8,,percent of total billed charges,,
"Amphetamines Confirmation, U (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Inpatient,,,90,125,106.25,61.25,112.5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Amphetamines Confirmation, U (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Outpatient,,,90,125,106.25,61.25,112.5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,62.25,49.8,,percent of total billed charges,,
"Amphetamines Confirmation, U (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Inpatient,,,90,125,106.25,61.25,112.5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Amphetamines Confirmation, U (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Outpatient,,,90,125,106.25,61.25,112.5,PrimeWest Health,Minnesota Senior Health Options (MSHO),64.3125,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Amphetamines Confirmation, U (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Inpatient,,,90,125,106.25,61.25,112.5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Amphetamines Confirmation, U (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Outpatient,,,90,125,106.25,61.25,112.5,"UCare Health, Inc.",Medicare Advantage,63.0875,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Amphetamines Confirmation, U (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Inpatient,,,90,125,106.25,61.25,112.5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Amphetamines Confirmation, U (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Outpatient,,,90,125,106.25,61.25,112.5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),63.0875,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Amphetamines Confirmation, U (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Inpatient,,,90,125,106.25,61.25,112.5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Amphetamines Confirmation, U (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Outpatient,,,90,125,106.25,61.25,112.5,UnitedHealthcare,Medicare Advantage,61.25,49,,percent of total billed charges,,
"Amphetamines Confirmation, U (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Inpatient,,,90,125,106.25,61.25,112.5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Amphetamines, Confirmation, M (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Outpatient,,,90,125,106.25,61.25,112.5,Aetna,Medicare Advantage,61.25,49,,percent of total billed charges,,
"Amphetamines, Confirmation, M (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Inpatient,,,90,125,106.25,61.25,112.5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Amphetamines, Confirmation, M (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Outpatient,,,90,125,106.25,61.25,112.5,BlueCross BlueShield Minnesota,Medicare Advantage,61.25,49,,percent of total billed charges,,
"Amphetamines, Confirmation, M (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Inpatient,,,90,125,106.25,61.25,112.5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Amphetamines, Confirmation, M (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Outpatient,,,90,125,106.25,61.25,112.5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),61.25,49,,percent of total billed charges,,
"Amphetamines, Confirmation, M (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Inpatient,,,90,125,106.25,61.25,112.5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Amphetamines, Confirmation, M (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Outpatient,,,90,125,106.25,61.25,112.5,"Health Partners, Inc.",Medicare Advantage,61.25,49,,percent of total billed charges,,
"Amphetamines, Confirmation, M (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Inpatient,,,90,125,106.25,61.25,112.5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Amphetamines, Confirmation, M (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Both,,,90,125,106.25,61.25,112.5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),75,60,,percent of total billed charges,,
"Amphetamines, Confirmation, M (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Outpatient,,,90,125,106.25,61.25,112.5,Humana Insurance Company,Medicare PPO,61.25,49,,percent of total billed charges,,
"Amphetamines, Confirmation, M (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Inpatient,,,90,125,106.25,61.25,112.5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Amphetamines, Confirmation, M (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Outpatient,,,90,125,106.25,61.25,112.5,Medica,Medica Advantage Solution,62.25,49.8,,percent of total billed charges,,
"Amphetamines, Confirmation, M (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Inpatient,,,90,125,106.25,61.25,112.5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Amphetamines, Confirmation, M (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Outpatient,,,90,125,106.25,61.25,112.5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,62.25,49.8,,percent of total billed charges,,
"Amphetamines, Confirmation, M (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Inpatient,,,90,125,106.25,61.25,112.5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Amphetamines, Confirmation, M (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Outpatient,,,90,125,106.25,61.25,112.5,PrimeWest Health,Minnesota Senior Health Options (MSHO),64.3125,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Amphetamines, Confirmation, M (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Inpatient,,,90,125,106.25,61.25,112.5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Amphetamines, Confirmation, M (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Outpatient,,,90,125,106.25,61.25,112.5,"UCare Health, Inc.",Medicare Advantage,63.0875,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Amphetamines, Confirmation, M (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Inpatient,,,90,125,106.25,61.25,112.5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Amphetamines, Confirmation, M (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Outpatient,,,90,125,106.25,61.25,112.5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),63.0875,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Amphetamines, Confirmation, M (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Inpatient,,,90,125,106.25,61.25,112.5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Amphetamines, Confirmation, M (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Outpatient,,,90,125,106.25,61.25,112.5,UnitedHealthcare,Medicare Advantage,61.25,49,,percent of total billed charges,,
"Amphetamines, Confirmation, M (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Inpatient,,,90,125,106.25,61.25,112.5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Antidepressants, Class; 3-5 (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Outpatient,,,90,124,105.4,60.76,111.6,Aetna,Medicare Advantage,60.76,49,,percent of total billed charges,,
"Antidepressants, Class; 3-5 (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Inpatient,,,90,124,105.4,60.76,111.6,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Antidepressants, Class; 3-5 (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Outpatient,,,90,124,105.4,60.76,111.6,BlueCross BlueShield Minnesota,Medicare Advantage,60.76,49,,percent of total billed charges,,
"Antidepressants, Class; 3-5 (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Inpatient,,,90,124,105.4,60.76,111.6,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Antidepressants, Class; 3-5 (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Outpatient,,,90,124,105.4,60.76,111.6,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),60.76,49,,percent of total billed charges,,
"Antidepressants, Class; 3-5 (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Inpatient,,,90,124,105.4,60.76,111.6,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Antidepressants, Class; 3-5 (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Outpatient,,,90,124,105.4,60.76,111.6,"Health Partners, Inc.",Medicare Advantage,60.76,49,,percent of total billed charges,,
"Antidepressants, Class; 3-5 (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Inpatient,,,90,124,105.4,60.76,111.6,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Antidepressants, Class; 3-5 (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Both,,,90,124,105.4,60.76,111.6,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),74.4,60,,percent of total billed charges,,
"Antidepressants, Class; 3-5 (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Outpatient,,,90,124,105.4,60.76,111.6,Humana Insurance Company,Medicare PPO,60.76,49,,percent of total billed charges,,
"Antidepressants, Class; 3-5 (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Inpatient,,,90,124,105.4,60.76,111.6,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Antidepressants, Class; 3-5 (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Outpatient,,,90,124,105.4,60.76,111.6,Medica,Medica Advantage Solution,61.752,49.8,,percent of total billed charges,,
"Antidepressants, Class; 3-5 (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Inpatient,,,90,124,105.4,60.76,111.6,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Antidepressants, Class; 3-5 (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Outpatient,,,90,124,105.4,60.76,111.6,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,61.752,49.8,,percent of total billed charges,,
"Antidepressants, Class; 3-5 (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Inpatient,,,90,124,105.4,60.76,111.6,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Antidepressants, Class; 3-5 (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Outpatient,,,90,124,105.4,60.76,111.6,PrimeWest Health,Minnesota Senior Health Options (MSHO),63.798,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Antidepressants, Class; 3-5 (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Inpatient,,,90,124,105.4,60.76,111.6,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Antidepressants, Class; 3-5 (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Outpatient,,,90,124,105.4,60.76,111.6,"UCare Health, Inc.",Medicare Advantage,62.5828,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Antidepressants, Class; 3-5 (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Inpatient,,,90,124,105.4,60.76,111.6,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Antidepressants, Class; 3-5 (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Outpatient,,,90,124,105.4,60.76,111.6,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),62.5828,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Antidepressants, Class; 3-5 (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Inpatient,,,90,124,105.4,60.76,111.6,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Antidepressants, Class; 3-5 (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Outpatient,,,90,124,105.4,60.76,111.6,UnitedHealthcare,Medicare Advantage,60.76,49,,percent of total billed charges,,
"Antidepressants, Class; 3-5 (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Inpatient,,,90,124,105.4,60.76,111.6,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Desipramine, S (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Outpatient,,,90,56,47.6,27.44,50.4,Aetna,Medicare Advantage,27.44,49,,percent of total billed charges,,
"Desipramine, S (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Inpatient,,,90,56,47.6,27.44,50.4,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Desipramine, S (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Outpatient,,,90,56,47.6,27.44,50.4,BlueCross BlueShield Minnesota,Medicare Advantage,27.44,49,,percent of total billed charges,,
"Desipramine, S (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Inpatient,,,90,56,47.6,27.44,50.4,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Desipramine, S (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Outpatient,,,90,56,47.6,27.44,50.4,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),27.44,49,,percent of total billed charges,,
"Desipramine, S (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Inpatient,,,90,56,47.6,27.44,50.4,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Desipramine, S (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Outpatient,,,90,56,47.6,27.44,50.4,"Health Partners, Inc.",Medicare Advantage,27.44,49,,percent of total billed charges,,
"Desipramine, S (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Inpatient,,,90,56,47.6,27.44,50.4,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Desipramine, S (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Both,,,90,56,47.6,27.44,50.4,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),33.6,60,,percent of total billed charges,,
"Desipramine, S (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Outpatient,,,90,56,47.6,27.44,50.4,Humana Insurance Company,Medicare PPO,27.44,49,,percent of total billed charges,,
"Desipramine, S (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Inpatient,,,90,56,47.6,27.44,50.4,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Desipramine, S (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Outpatient,,,90,56,47.6,27.44,50.4,Medica,Medica Advantage Solution,27.888,49.8,,percent of total billed charges,,
"Desipramine, S (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Inpatient,,,90,56,47.6,27.44,50.4,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Desipramine, S (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Outpatient,,,90,56,47.6,27.44,50.4,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,27.888,49.8,,percent of total billed charges,,
"Desipramine, S (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Inpatient,,,90,56,47.6,27.44,50.4,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Desipramine, S (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Outpatient,,,90,56,47.6,27.44,50.4,PrimeWest Health,Minnesota Senior Health Options (MSHO),28.812,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Desipramine, S (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Inpatient,,,90,56,47.6,27.44,50.4,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Desipramine, S (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Outpatient,,,90,56,47.6,27.44,50.4,"UCare Health, Inc.",Medicare Advantage,28.2632,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Desipramine, S (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Inpatient,,,90,56,47.6,27.44,50.4,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Desipramine, S (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Outpatient,,,90,56,47.6,27.44,50.4,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),28.2632,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Desipramine, S (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Inpatient,,,90,56,47.6,27.44,50.4,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Desipramine, S (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Outpatient,,,90,56,47.6,27.44,50.4,UnitedHealthcare,Medicare Advantage,27.44,49,,percent of total billed charges,,
"Desipramine, S (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Inpatient,,,90,56,47.6,27.44,50.4,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Dihydrotestosterone, S (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Outpatient,,,90,219,186.15,107.31,197.1,Aetna,Medicare Advantage,107.31,49,,percent of total billed charges,,
"Dihydrotestosterone, S (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Inpatient,,,90,219,186.15,107.31,197.1,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Dihydrotestosterone, S (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Outpatient,,,90,219,186.15,107.31,197.1,BlueCross BlueShield Minnesota,Medicare Advantage,107.31,49,,percent of total billed charges,,
"Dihydrotestosterone, S (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Inpatient,,,90,219,186.15,107.31,197.1,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Dihydrotestosterone, S (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Outpatient,,,90,219,186.15,107.31,197.1,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),107.31,49,,percent of total billed charges,,
"Dihydrotestosterone, S (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Inpatient,,,90,219,186.15,107.31,197.1,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Dihydrotestosterone, S (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Outpatient,,,90,219,186.15,107.31,197.1,"Health Partners, Inc.",Medicare Advantage,107.31,49,,percent of total billed charges,,
"Dihydrotestosterone, S (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Inpatient,,,90,219,186.15,107.31,197.1,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Dihydrotestosterone, S (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Both,,,90,219,186.15,107.31,197.1,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),131.4,60,,percent of total billed charges,,
"Dihydrotestosterone, S (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Outpatient,,,90,219,186.15,107.31,197.1,Humana Insurance Company,Medicare PPO,107.31,49,,percent of total billed charges,,
"Dihydrotestosterone, S (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Inpatient,,,90,219,186.15,107.31,197.1,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Dihydrotestosterone, S (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Outpatient,,,90,219,186.15,107.31,197.1,Medica,Medica Advantage Solution,109.062,49.8,,percent of total billed charges,,
"Dihydrotestosterone, S (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Inpatient,,,90,219,186.15,107.31,197.1,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Dihydrotestosterone, S (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Outpatient,,,90,219,186.15,107.31,197.1,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,109.062,49.8,,percent of total billed charges,,
"Dihydrotestosterone, S (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Inpatient,,,90,219,186.15,107.31,197.1,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Dihydrotestosterone, S (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Outpatient,,,90,219,186.15,107.31,197.1,PrimeWest Health,Minnesota Senior Health Options (MSHO),112.6755,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Dihydrotestosterone, S (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Inpatient,,,90,219,186.15,107.31,197.1,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Dihydrotestosterone, S (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Outpatient,,,90,219,186.15,107.31,197.1,"UCare Health, Inc.",Medicare Advantage,110.5293,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Dihydrotestosterone, S (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Inpatient,,,90,219,186.15,107.31,197.1,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Dihydrotestosterone, S (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Outpatient,,,90,219,186.15,107.31,197.1,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),110.5293,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Dihydrotestosterone, S (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Inpatient,,,90,219,186.15,107.31,197.1,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Dihydrotestosterone, S (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Outpatient,,,90,219,186.15,107.31,197.1,UnitedHealthcare,Medicare Advantage,107.31,49,,percent of total billed charges,,
"Dihydrotestosterone, S (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Inpatient,,,90,219,186.15,107.31,197.1,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Ethanol, Urine (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Outpatient,,,90,161,136.85,78.89,144.9,Aetna,Medicare Advantage,78.89,49,,percent of total billed charges,,
"Ethanol, Urine (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Inpatient,,,90,161,136.85,78.89,144.9,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Ethanol, Urine (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Outpatient,,,90,161,136.85,78.89,144.9,BlueCross BlueShield Minnesota,Medicare Advantage,78.89,49,,percent of total billed charges,,
"Ethanol, Urine (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Inpatient,,,90,161,136.85,78.89,144.9,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Ethanol, Urine (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Outpatient,,,90,161,136.85,78.89,144.9,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),78.89,49,,percent of total billed charges,,
"Ethanol, Urine (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Inpatient,,,90,161,136.85,78.89,144.9,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Ethanol, Urine (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Outpatient,,,90,161,136.85,78.89,144.9,"Health Partners, Inc.",Medicare Advantage,78.89,49,,percent of total billed charges,,
"Ethanol, Urine (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Inpatient,,,90,161,136.85,78.89,144.9,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Ethanol, Urine (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Both,,,90,161,136.85,78.89,144.9,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),96.6,60,,percent of total billed charges,,
"Ethanol, Urine (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Outpatient,,,90,161,136.85,78.89,144.9,Humana Insurance Company,Medicare PPO,78.89,49,,percent of total billed charges,,
"Ethanol, Urine (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Inpatient,,,90,161,136.85,78.89,144.9,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Ethanol, Urine (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Outpatient,,,90,161,136.85,78.89,144.9,Medica,Medica Advantage Solution,80.178,49.8,,percent of total billed charges,,
"Ethanol, Urine (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Inpatient,,,90,161,136.85,78.89,144.9,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Ethanol, Urine (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Outpatient,,,90,161,136.85,78.89,144.9,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,80.178,49.8,,percent of total billed charges,,
"Ethanol, Urine (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Inpatient,,,90,161,136.85,78.89,144.9,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Ethanol, Urine (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Outpatient,,,90,161,136.85,78.89,144.9,PrimeWest Health,Minnesota Senior Health Options (MSHO),82.8345,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Ethanol, Urine (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Inpatient,,,90,161,136.85,78.89,144.9,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Ethanol, Urine (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Outpatient,,,90,161,136.85,78.89,144.9,"UCare Health, Inc.",Medicare Advantage,81.2567,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Ethanol, Urine (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Inpatient,,,90,161,136.85,78.89,144.9,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Ethanol, Urine (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Outpatient,,,90,161,136.85,78.89,144.9,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),81.2567,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Ethanol, Urine (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Inpatient,,,90,161,136.85,78.89,144.9,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Ethanol, Urine (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Outpatient,,,90,161,136.85,78.89,144.9,UnitedHealthcare,Medicare Advantage,78.89,49,,percent of total billed charges,,
"Ethanol, Urine (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Inpatient,,,90,161,136.85,78.89,144.9,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Methylenedioxyamphetamines (Mayo)OutsideLaboratory,,G0480,HCPCS,Facility,Outpatient,,,90,66,56.1,32.34,59.4,Aetna,Medicare Advantage,32.34,49,,percent of total billed charges,,
Methylenedioxyamphetamines (Mayo)OutsideLaboratory,,G0480,HCPCS,Facility,Inpatient,,,90,66,56.1,32.34,59.4,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Methylenedioxyamphetamines (Mayo)OutsideLaboratory,,G0480,HCPCS,Facility,Outpatient,,,90,66,56.1,32.34,59.4,BlueCross BlueShield Minnesota,Medicare Advantage,32.34,49,,percent of total billed charges,,
Methylenedioxyamphetamines (Mayo)OutsideLaboratory,,G0480,HCPCS,Facility,Inpatient,,,90,66,56.1,32.34,59.4,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Methylenedioxyamphetamines (Mayo)OutsideLaboratory,,G0480,HCPCS,Facility,Outpatient,,,90,66,56.1,32.34,59.4,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),32.34,49,,percent of total billed charges,,
Methylenedioxyamphetamines (Mayo)OutsideLaboratory,,G0480,HCPCS,Facility,Inpatient,,,90,66,56.1,32.34,59.4,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Methylenedioxyamphetamines (Mayo)OutsideLaboratory,,G0480,HCPCS,Facility,Outpatient,,,90,66,56.1,32.34,59.4,"Health Partners, Inc.",Medicare Advantage,32.34,49,,percent of total billed charges,,
Methylenedioxyamphetamines (Mayo)OutsideLaboratory,,G0480,HCPCS,Facility,Inpatient,,,90,66,56.1,32.34,59.4,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Methylenedioxyamphetamines (Mayo)OutsideLaboratory,,G0480,HCPCS,Facility,Both,,,90,66,56.1,32.34,59.4,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),39.6,60,,percent of total billed charges,,
Methylenedioxyamphetamines (Mayo)OutsideLaboratory,,G0480,HCPCS,Facility,Outpatient,,,90,66,56.1,32.34,59.4,Humana Insurance Company,Medicare PPO,32.34,49,,percent of total billed charges,,
Methylenedioxyamphetamines (Mayo)OutsideLaboratory,,G0480,HCPCS,Facility,Inpatient,,,90,66,56.1,32.34,59.4,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Methylenedioxyamphetamines (Mayo)OutsideLaboratory,,G0480,HCPCS,Facility,Outpatient,,,90,66,56.1,32.34,59.4,Medica,Medica Advantage Solution,32.868,49.8,,percent of total billed charges,,
Methylenedioxyamphetamines (Mayo)OutsideLaboratory,,G0480,HCPCS,Facility,Inpatient,,,90,66,56.1,32.34,59.4,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Methylenedioxyamphetamines (Mayo)OutsideLaboratory,,G0480,HCPCS,Facility,Outpatient,,,90,66,56.1,32.34,59.4,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,32.868,49.8,,percent of total billed charges,,
Methylenedioxyamphetamines (Mayo)OutsideLaboratory,,G0480,HCPCS,Facility,Inpatient,,,90,66,56.1,32.34,59.4,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Methylenedioxyamphetamines (Mayo)OutsideLaboratory,,G0480,HCPCS,Facility,Outpatient,,,90,66,56.1,32.34,59.4,PrimeWest Health,Minnesota Senior Health Options (MSHO),33.957,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Methylenedioxyamphetamines (Mayo)OutsideLaboratory,,G0480,HCPCS,Facility,Inpatient,,,90,66,56.1,32.34,59.4,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Methylenedioxyamphetamines (Mayo)OutsideLaboratory,,G0480,HCPCS,Facility,Outpatient,,,90,66,56.1,32.34,59.4,"UCare Health, Inc.",Medicare Advantage,33.3102,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Methylenedioxyamphetamines (Mayo)OutsideLaboratory,,G0480,HCPCS,Facility,Inpatient,,,90,66,56.1,32.34,59.4,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Methylenedioxyamphetamines (Mayo)OutsideLaboratory,,G0480,HCPCS,Facility,Outpatient,,,90,66,56.1,32.34,59.4,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),33.3102,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Methylenedioxyamphetamines (Mayo)OutsideLaboratory,,G0480,HCPCS,Facility,Inpatient,,,90,66,56.1,32.34,59.4,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Methylenedioxyamphetamines (Mayo)OutsideLaboratory,,G0480,HCPCS,Facility,Outpatient,,,90,66,56.1,32.34,59.4,UnitedHealthcare,Medicare Advantage,32.34,49,,percent of total billed charges,,
Methylenedioxyamphetamines (Mayo)OutsideLaboratory,,G0480,HCPCS,Facility,Inpatient,,,90,66,56.1,32.34,59.4,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Methylphenidate (Ritalin) (Mayo)OutsideLaboratory,,G0480,HCPCS,Facility,Outpatient,,,90,172,146.2,84.28,154.8,Aetna,Medicare Advantage,84.28,49,,percent of total billed charges,,
Methylphenidate (Ritalin) (Mayo)OutsideLaboratory,,G0480,HCPCS,Facility,Inpatient,,,90,172,146.2,84.28,154.8,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Methylphenidate (Ritalin) (Mayo)OutsideLaboratory,,G0480,HCPCS,Facility,Outpatient,,,90,172,146.2,84.28,154.8,BlueCross BlueShield Minnesota,Medicare Advantage,84.28,49,,percent of total billed charges,,
Methylphenidate (Ritalin) (Mayo)OutsideLaboratory,,G0480,HCPCS,Facility,Inpatient,,,90,172,146.2,84.28,154.8,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Methylphenidate (Ritalin) (Mayo)OutsideLaboratory,,G0480,HCPCS,Facility,Outpatient,,,90,172,146.2,84.28,154.8,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),84.28,49,,percent of total billed charges,,
Methylphenidate (Ritalin) (Mayo)OutsideLaboratory,,G0480,HCPCS,Facility,Inpatient,,,90,172,146.2,84.28,154.8,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Methylphenidate (Ritalin) (Mayo)OutsideLaboratory,,G0480,HCPCS,Facility,Outpatient,,,90,172,146.2,84.28,154.8,"Health Partners, Inc.",Medicare Advantage,84.28,49,,percent of total billed charges,,
Methylphenidate (Ritalin) (Mayo)OutsideLaboratory,,G0480,HCPCS,Facility,Inpatient,,,90,172,146.2,84.28,154.8,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Methylphenidate (Ritalin) (Mayo)OutsideLaboratory,,G0480,HCPCS,Facility,Both,,,90,172,146.2,84.28,154.8,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),103.2,60,,percent of total billed charges,,
Methylphenidate (Ritalin) (Mayo)OutsideLaboratory,,G0480,HCPCS,Facility,Outpatient,,,90,172,146.2,84.28,154.8,Humana Insurance Company,Medicare PPO,84.28,49,,percent of total billed charges,,
Methylphenidate (Ritalin) (Mayo)OutsideLaboratory,,G0480,HCPCS,Facility,Inpatient,,,90,172,146.2,84.28,154.8,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Methylphenidate (Ritalin) (Mayo)OutsideLaboratory,,G0480,HCPCS,Facility,Outpatient,,,90,172,146.2,84.28,154.8,Medica,Medica Advantage Solution,85.656,49.8,,percent of total billed charges,,
Methylphenidate (Ritalin) (Mayo)OutsideLaboratory,,G0480,HCPCS,Facility,Inpatient,,,90,172,146.2,84.28,154.8,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Methylphenidate (Ritalin) (Mayo)OutsideLaboratory,,G0480,HCPCS,Facility,Outpatient,,,90,172,146.2,84.28,154.8,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,85.656,49.8,,percent of total billed charges,,
Methylphenidate (Ritalin) (Mayo)OutsideLaboratory,,G0480,HCPCS,Facility,Inpatient,,,90,172,146.2,84.28,154.8,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Methylphenidate (Ritalin) (Mayo)OutsideLaboratory,,G0480,HCPCS,Facility,Outpatient,,,90,172,146.2,84.28,154.8,PrimeWest Health,Minnesota Senior Health Options (MSHO),88.494,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Methylphenidate (Ritalin) (Mayo)OutsideLaboratory,,G0480,HCPCS,Facility,Inpatient,,,90,172,146.2,84.28,154.8,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Methylphenidate (Ritalin) (Mayo)OutsideLaboratory,,G0480,HCPCS,Facility,Outpatient,,,90,172,146.2,84.28,154.8,"UCare Health, Inc.",Medicare Advantage,86.8084,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Methylphenidate (Ritalin) (Mayo)OutsideLaboratory,,G0480,HCPCS,Facility,Inpatient,,,90,172,146.2,84.28,154.8,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Methylphenidate (Ritalin) (Mayo)OutsideLaboratory,,G0480,HCPCS,Facility,Outpatient,,,90,172,146.2,84.28,154.8,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),86.8084,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Methylphenidate (Ritalin) (Mayo)OutsideLaboratory,,G0480,HCPCS,Facility,Inpatient,,,90,172,146.2,84.28,154.8,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Methylphenidate (Ritalin) (Mayo)OutsideLaboratory,,G0480,HCPCS,Facility,Outpatient,,,90,172,146.2,84.28,154.8,UnitedHealthcare,Medicare Advantage,84.28,49,,percent of total billed charges,,
Methylphenidate (Ritalin) (Mayo)OutsideLaboratory,,G0480,HCPCS,Facility,Inpatient,,,90,172,146.2,84.28,154.8,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Nicotine And Metabolites, S (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Outpatient,,,90,150,127.5,73.5,135,Aetna,Medicare Advantage,73.5,49,,percent of total billed charges,,
"Nicotine And Metabolites, S (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Inpatient,,,90,150,127.5,73.5,135,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Nicotine And Metabolites, S (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Outpatient,,,90,150,127.5,73.5,135,BlueCross BlueShield Minnesota,Medicare Advantage,73.5,49,,percent of total billed charges,,
"Nicotine And Metabolites, S (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Inpatient,,,90,150,127.5,73.5,135,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Nicotine And Metabolites, S (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Outpatient,,,90,150,127.5,73.5,135,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),73.5,49,,percent of total billed charges,,
"Nicotine And Metabolites, S (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Inpatient,,,90,150,127.5,73.5,135,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Nicotine And Metabolites, S (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Outpatient,,,90,150,127.5,73.5,135,"Health Partners, Inc.",Medicare Advantage,73.5,49,,percent of total billed charges,,
"Nicotine And Metabolites, S (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Inpatient,,,90,150,127.5,73.5,135,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Nicotine And Metabolites, S (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Both,,,90,150,127.5,73.5,135,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),90,60,,percent of total billed charges,,
"Nicotine And Metabolites, S (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Outpatient,,,90,150,127.5,73.5,135,Humana Insurance Company,Medicare PPO,73.5,49,,percent of total billed charges,,
"Nicotine And Metabolites, S (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Inpatient,,,90,150,127.5,73.5,135,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Nicotine And Metabolites, S (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Outpatient,,,90,150,127.5,73.5,135,Medica,Medica Advantage Solution,74.7,49.8,,percent of total billed charges,,
"Nicotine And Metabolites, S (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Inpatient,,,90,150,127.5,73.5,135,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Nicotine And Metabolites, S (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Outpatient,,,90,150,127.5,73.5,135,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,74.7,49.8,,percent of total billed charges,,
"Nicotine And Metabolites, S (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Inpatient,,,90,150,127.5,73.5,135,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Nicotine And Metabolites, S (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Outpatient,,,90,150,127.5,73.5,135,PrimeWest Health,Minnesota Senior Health Options (MSHO),77.175,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Nicotine And Metabolites, S (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Inpatient,,,90,150,127.5,73.5,135,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Nicotine And Metabolites, S (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Outpatient,,,90,150,127.5,73.5,135,"UCare Health, Inc.",Medicare Advantage,75.705,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Nicotine And Metabolites, S (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Inpatient,,,90,150,127.5,73.5,135,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Nicotine And Metabolites, S (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Outpatient,,,90,150,127.5,73.5,135,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),75.705,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Nicotine And Metabolites, S (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Inpatient,,,90,150,127.5,73.5,135,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Nicotine And Metabolites, S (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Outpatient,,,90,150,127.5,73.5,135,UnitedHealthcare,Medicare Advantage,73.5,49,,percent of total billed charges,,
"Nicotine And Metabolites, S (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Inpatient,,,90,150,127.5,73.5,135,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Nicotine And Metabolites, U (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Outpatient,,,90,150,127.5,73.5,135,Aetna,Medicare Advantage,73.5,49,,percent of total billed charges,,
"Nicotine And Metabolites, U (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Inpatient,,,90,150,127.5,73.5,135,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Nicotine And Metabolites, U (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Outpatient,,,90,150,127.5,73.5,135,BlueCross BlueShield Minnesota,Medicare Advantage,73.5,49,,percent of total billed charges,,
"Nicotine And Metabolites, U (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Inpatient,,,90,150,127.5,73.5,135,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Nicotine And Metabolites, U (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Outpatient,,,90,150,127.5,73.5,135,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),73.5,49,,percent of total billed charges,,
"Nicotine And Metabolites, U (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Inpatient,,,90,150,127.5,73.5,135,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Nicotine And Metabolites, U (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Outpatient,,,90,150,127.5,73.5,135,"Health Partners, Inc.",Medicare Advantage,73.5,49,,percent of total billed charges,,
"Nicotine And Metabolites, U (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Inpatient,,,90,150,127.5,73.5,135,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Nicotine And Metabolites, U (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Both,,,90,150,127.5,73.5,135,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),90,60,,percent of total billed charges,,
"Nicotine And Metabolites, U (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Outpatient,,,90,150,127.5,73.5,135,Humana Insurance Company,Medicare PPO,73.5,49,,percent of total billed charges,,
"Nicotine And Metabolites, U (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Inpatient,,,90,150,127.5,73.5,135,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Nicotine And Metabolites, U (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Outpatient,,,90,150,127.5,73.5,135,Medica,Medica Advantage Solution,74.7,49.8,,percent of total billed charges,,
"Nicotine And Metabolites, U (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Inpatient,,,90,150,127.5,73.5,135,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Nicotine And Metabolites, U (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Outpatient,,,90,150,127.5,73.5,135,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,74.7,49.8,,percent of total billed charges,,
"Nicotine And Metabolites, U (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Inpatient,,,90,150,127.5,73.5,135,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Nicotine And Metabolites, U (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Outpatient,,,90,150,127.5,73.5,135,PrimeWest Health,Minnesota Senior Health Options (MSHO),77.175,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Nicotine And Metabolites, U (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Inpatient,,,90,150,127.5,73.5,135,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Nicotine And Metabolites, U (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Outpatient,,,90,150,127.5,73.5,135,"UCare Health, Inc.",Medicare Advantage,75.705,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Nicotine And Metabolites, U (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Inpatient,,,90,150,127.5,73.5,135,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Nicotine And Metabolites, U (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Outpatient,,,90,150,127.5,73.5,135,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),75.705,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Nicotine And Metabolites, U (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Inpatient,,,90,150,127.5,73.5,135,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Nicotine And Metabolites, U (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Outpatient,,,90,150,127.5,73.5,135,UnitedHealthcare,Medicare Advantage,73.5,49,,percent of total billed charges,,
"Nicotine And Metabolites, U (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Inpatient,,,90,150,127.5,73.5,135,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Nortriptyline, S (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Outpatient,,,90,65,55.25,31.85,58.5,Aetna,Medicare Advantage,31.85,49,,percent of total billed charges,,
"Nortriptyline, S (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Inpatient,,,90,65,55.25,31.85,58.5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Nortriptyline, S (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Outpatient,,,90,65,55.25,31.85,58.5,BlueCross BlueShield Minnesota,Medicare Advantage,31.85,49,,percent of total billed charges,,
"Nortriptyline, S (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Inpatient,,,90,65,55.25,31.85,58.5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Nortriptyline, S (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Outpatient,,,90,65,55.25,31.85,58.5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),31.85,49,,percent of total billed charges,,
"Nortriptyline, S (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Inpatient,,,90,65,55.25,31.85,58.5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Nortriptyline, S (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Outpatient,,,90,65,55.25,31.85,58.5,"Health Partners, Inc.",Medicare Advantage,31.85,49,,percent of total billed charges,,
"Nortriptyline, S (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Inpatient,,,90,65,55.25,31.85,58.5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Nortriptyline, S (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Both,,,90,65,55.25,31.85,58.5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),39,60,,percent of total billed charges,,
"Nortriptyline, S (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Outpatient,,,90,65,55.25,31.85,58.5,Humana Insurance Company,Medicare PPO,31.85,49,,percent of total billed charges,,
"Nortriptyline, S (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Inpatient,,,90,65,55.25,31.85,58.5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Nortriptyline, S (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Outpatient,,,90,65,55.25,31.85,58.5,Medica,Medica Advantage Solution,32.37,49.8,,percent of total billed charges,,
"Nortriptyline, S (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Inpatient,,,90,65,55.25,31.85,58.5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Nortriptyline, S (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Outpatient,,,90,65,55.25,31.85,58.5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,32.37,49.8,,percent of total billed charges,,
"Nortriptyline, S (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Inpatient,,,90,65,55.25,31.85,58.5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Nortriptyline, S (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Outpatient,,,90,65,55.25,31.85,58.5,PrimeWest Health,Minnesota Senior Health Options (MSHO),33.4425,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Nortriptyline, S (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Inpatient,,,90,65,55.25,31.85,58.5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Nortriptyline, S (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Outpatient,,,90,65,55.25,31.85,58.5,"UCare Health, Inc.",Medicare Advantage,32.8055,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Nortriptyline, S (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Inpatient,,,90,65,55.25,31.85,58.5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Nortriptyline, S (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Outpatient,,,90,65,55.25,31.85,58.5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),32.8055,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Nortriptyline, S (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Inpatient,,,90,65,55.25,31.85,58.5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Nortriptyline, S (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Outpatient,,,90,65,55.25,31.85,58.5,UnitedHealthcare,Medicare Advantage,31.85,49,,percent of total billed charges,,
"Nortriptyline, S (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Inpatient,,,90,65,55.25,31.85,58.5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Opiate Confirmation, U (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Outpatient,,,90,163,138.55,79.87,146.7,Aetna,Medicare Advantage,79.87,49,,percent of total billed charges,,
"Opiate Confirmation, U (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Inpatient,,,90,163,138.55,79.87,146.7,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Opiate Confirmation, U (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Outpatient,,,90,163,138.55,79.87,146.7,BlueCross BlueShield Minnesota,Medicare Advantage,79.87,49,,percent of total billed charges,,
"Opiate Confirmation, U (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Inpatient,,,90,163,138.55,79.87,146.7,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Opiate Confirmation, U (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Outpatient,,,90,163,138.55,79.87,146.7,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),79.87,49,,percent of total billed charges,,
"Opiate Confirmation, U (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Inpatient,,,90,163,138.55,79.87,146.7,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Opiate Confirmation, U (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Outpatient,,,90,163,138.55,79.87,146.7,"Health Partners, Inc.",Medicare Advantage,79.87,49,,percent of total billed charges,,
"Opiate Confirmation, U (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Inpatient,,,90,163,138.55,79.87,146.7,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Opiate Confirmation, U (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Both,,,90,163,138.55,79.87,146.7,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),97.8,60,,percent of total billed charges,,
"Opiate Confirmation, U (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Outpatient,,,90,163,138.55,79.87,146.7,Humana Insurance Company,Medicare PPO,79.87,49,,percent of total billed charges,,
"Opiate Confirmation, U (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Inpatient,,,90,163,138.55,79.87,146.7,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Opiate Confirmation, U (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Outpatient,,,90,163,138.55,79.87,146.7,Medica,Medica Advantage Solution,81.174,49.8,,percent of total billed charges,,
"Opiate Confirmation, U (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Inpatient,,,90,163,138.55,79.87,146.7,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Opiate Confirmation, U (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Outpatient,,,90,163,138.55,79.87,146.7,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,81.174,49.8,,percent of total billed charges,,
"Opiate Confirmation, U (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Inpatient,,,90,163,138.55,79.87,146.7,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Opiate Confirmation, U (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Outpatient,,,90,163,138.55,79.87,146.7,PrimeWest Health,Minnesota Senior Health Options (MSHO),83.8635,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Opiate Confirmation, U (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Inpatient,,,90,163,138.55,79.87,146.7,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Opiate Confirmation, U (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Outpatient,,,90,163,138.55,79.87,146.7,"UCare Health, Inc.",Medicare Advantage,82.2661,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Opiate Confirmation, U (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Inpatient,,,90,163,138.55,79.87,146.7,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Opiate Confirmation, U (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Outpatient,,,90,163,138.55,79.87,146.7,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),82.2661,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Opiate Confirmation, U (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Inpatient,,,90,163,138.55,79.87,146.7,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Opiate Confirmation, U (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Outpatient,,,90,163,138.55,79.87,146.7,UnitedHealthcare,Medicare Advantage,79.87,49,,percent of total billed charges,,
"Opiate Confirmation, U (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Inpatient,,,90,163,138.55,79.87,146.7,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Oxycodone (Mayo)OutsideLaboratory,,G0480,HCPCS,Facility,Outpatient,,,90,167,141.95,81.83,150.3,Aetna,Medicare Advantage,81.83,49,,percent of total billed charges,,
Oxycodone (Mayo)OutsideLaboratory,,G0480,HCPCS,Facility,Inpatient,,,90,167,141.95,81.83,150.3,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Oxycodone (Mayo)OutsideLaboratory,,G0480,HCPCS,Facility,Outpatient,,,90,167,141.95,81.83,150.3,BlueCross BlueShield Minnesota,Medicare Advantage,81.83,49,,percent of total billed charges,,
Oxycodone (Mayo)OutsideLaboratory,,G0480,HCPCS,Facility,Inpatient,,,90,167,141.95,81.83,150.3,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Oxycodone (Mayo)OutsideLaboratory,,G0480,HCPCS,Facility,Outpatient,,,90,167,141.95,81.83,150.3,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),81.83,49,,percent of total billed charges,,
Oxycodone (Mayo)OutsideLaboratory,,G0480,HCPCS,Facility,Inpatient,,,90,167,141.95,81.83,150.3,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Oxycodone (Mayo)OutsideLaboratory,,G0480,HCPCS,Facility,Outpatient,,,90,167,141.95,81.83,150.3,"Health Partners, Inc.",Medicare Advantage,81.83,49,,percent of total billed charges,,
Oxycodone (Mayo)OutsideLaboratory,,G0480,HCPCS,Facility,Inpatient,,,90,167,141.95,81.83,150.3,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Oxycodone (Mayo)OutsideLaboratory,,G0480,HCPCS,Facility,Both,,,90,167,141.95,81.83,150.3,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),100.2,60,,percent of total billed charges,,
Oxycodone (Mayo)OutsideLaboratory,,G0480,HCPCS,Facility,Outpatient,,,90,167,141.95,81.83,150.3,Humana Insurance Company,Medicare PPO,81.83,49,,percent of total billed charges,,
Oxycodone (Mayo)OutsideLaboratory,,G0480,HCPCS,Facility,Inpatient,,,90,167,141.95,81.83,150.3,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Oxycodone (Mayo)OutsideLaboratory,,G0480,HCPCS,Facility,Outpatient,,,90,167,141.95,81.83,150.3,Medica,Medica Advantage Solution,83.166,49.8,,percent of total billed charges,,
Oxycodone (Mayo)OutsideLaboratory,,G0480,HCPCS,Facility,Inpatient,,,90,167,141.95,81.83,150.3,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Oxycodone (Mayo)OutsideLaboratory,,G0480,HCPCS,Facility,Outpatient,,,90,167,141.95,81.83,150.3,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,83.166,49.8,,percent of total billed charges,,
Oxycodone (Mayo)OutsideLaboratory,,G0480,HCPCS,Facility,Inpatient,,,90,167,141.95,81.83,150.3,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Oxycodone (Mayo)OutsideLaboratory,,G0480,HCPCS,Facility,Outpatient,,,90,167,141.95,81.83,150.3,PrimeWest Health,Minnesota Senior Health Options (MSHO),85.9215,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Oxycodone (Mayo)OutsideLaboratory,,G0480,HCPCS,Facility,Inpatient,,,90,167,141.95,81.83,150.3,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Oxycodone (Mayo)OutsideLaboratory,,G0480,HCPCS,Facility,Outpatient,,,90,167,141.95,81.83,150.3,"UCare Health, Inc.",Medicare Advantage,84.2849,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Oxycodone (Mayo)OutsideLaboratory,,G0480,HCPCS,Facility,Inpatient,,,90,167,141.95,81.83,150.3,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Oxycodone (Mayo)OutsideLaboratory,,G0480,HCPCS,Facility,Outpatient,,,90,167,141.95,81.83,150.3,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),84.2849,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Oxycodone (Mayo)OutsideLaboratory,,G0480,HCPCS,Facility,Inpatient,,,90,167,141.95,81.83,150.3,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Oxycodone (Mayo)OutsideLaboratory,,G0480,HCPCS,Facility,Outpatient,,,90,167,141.95,81.83,150.3,UnitedHealthcare,Medicare Advantage,81.83,49,,percent of total billed charges,,
Oxycodone (Mayo)OutsideLaboratory,,G0480,HCPCS,Facility,Inpatient,,,90,167,141.95,81.83,150.3,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Oxycodone, Urine (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Outpatient,,,90,167,141.95,81.83,150.3,Aetna,Medicare Advantage,81.83,49,,percent of total billed charges,,
"Oxycodone, Urine (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Inpatient,,,90,167,141.95,81.83,150.3,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Oxycodone, Urine (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Outpatient,,,90,167,141.95,81.83,150.3,BlueCross BlueShield Minnesota,Medicare Advantage,81.83,49,,percent of total billed charges,,
"Oxycodone, Urine (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Inpatient,,,90,167,141.95,81.83,150.3,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Oxycodone, Urine (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Outpatient,,,90,167,141.95,81.83,150.3,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),81.83,49,,percent of total billed charges,,
"Oxycodone, Urine (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Inpatient,,,90,167,141.95,81.83,150.3,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Oxycodone, Urine (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Outpatient,,,90,167,141.95,81.83,150.3,"Health Partners, Inc.",Medicare Advantage,81.83,49,,percent of total billed charges,,
"Oxycodone, Urine (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Inpatient,,,90,167,141.95,81.83,150.3,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Oxycodone, Urine (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Both,,,90,167,141.95,81.83,150.3,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),100.2,60,,percent of total billed charges,,
"Oxycodone, Urine (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Outpatient,,,90,167,141.95,81.83,150.3,Humana Insurance Company,Medicare PPO,81.83,49,,percent of total billed charges,,
"Oxycodone, Urine (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Inpatient,,,90,167,141.95,81.83,150.3,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Oxycodone, Urine (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Outpatient,,,90,167,141.95,81.83,150.3,Medica,Medica Advantage Solution,83.166,49.8,,percent of total billed charges,,
"Oxycodone, Urine (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Inpatient,,,90,167,141.95,81.83,150.3,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Oxycodone, Urine (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Outpatient,,,90,167,141.95,81.83,150.3,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,83.166,49.8,,percent of total billed charges,,
"Oxycodone, Urine (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Inpatient,,,90,167,141.95,81.83,150.3,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Oxycodone, Urine (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Outpatient,,,90,167,141.95,81.83,150.3,PrimeWest Health,Minnesota Senior Health Options (MSHO),85.9215,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Oxycodone, Urine (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Inpatient,,,90,167,141.95,81.83,150.3,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Oxycodone, Urine (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Outpatient,,,90,167,141.95,81.83,150.3,"UCare Health, Inc.",Medicare Advantage,84.2849,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Oxycodone, Urine (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Inpatient,,,90,167,141.95,81.83,150.3,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Oxycodone, Urine (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Outpatient,,,90,167,141.95,81.83,150.3,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),84.2849,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Oxycodone, Urine (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Inpatient,,,90,167,141.95,81.83,150.3,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Oxycodone, Urine (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Outpatient,,,90,167,141.95,81.83,150.3,UnitedHealthcare,Medicare Advantage,81.83,49,,percent of total billed charges,,
"Oxycodone, Urine (Mayo)OutsideLaboratory",,G0480,HCPCS,Facility,Inpatient,,,90,167,141.95,81.83,150.3,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Skeletal Muscle Relaxants (Mayo)OutsideLaboratory,,G0480,HCPCS,Facility,Outpatient,,,90,113,96.05,55.37,101.7,Aetna,Medicare Advantage,55.37,49,,percent of total billed charges,,
Skeletal Muscle Relaxants (Mayo)OutsideLaboratory,,G0480,HCPCS,Facility,Inpatient,,,90,113,96.05,55.37,101.7,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Skeletal Muscle Relaxants (Mayo)OutsideLaboratory,,G0480,HCPCS,Facility,Outpatient,,,90,113,96.05,55.37,101.7,BlueCross BlueShield Minnesota,Medicare Advantage,55.37,49,,percent of total billed charges,,
Skeletal Muscle Relaxants (Mayo)OutsideLaboratory,,G0480,HCPCS,Facility,Inpatient,,,90,113,96.05,55.37,101.7,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Skeletal Muscle Relaxants (Mayo)OutsideLaboratory,,G0480,HCPCS,Facility,Outpatient,,,90,113,96.05,55.37,101.7,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),55.37,49,,percent of total billed charges,,
Skeletal Muscle Relaxants (Mayo)OutsideLaboratory,,G0480,HCPCS,Facility,Inpatient,,,90,113,96.05,55.37,101.7,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Skeletal Muscle Relaxants (Mayo)OutsideLaboratory,,G0480,HCPCS,Facility,Outpatient,,,90,113,96.05,55.37,101.7,"Health Partners, Inc.",Medicare Advantage,55.37,49,,percent of total billed charges,,
Skeletal Muscle Relaxants (Mayo)OutsideLaboratory,,G0480,HCPCS,Facility,Inpatient,,,90,113,96.05,55.37,101.7,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Skeletal Muscle Relaxants (Mayo)OutsideLaboratory,,G0480,HCPCS,Facility,Both,,,90,113,96.05,55.37,101.7,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),67.8,60,,percent of total billed charges,,
Skeletal Muscle Relaxants (Mayo)OutsideLaboratory,,G0480,HCPCS,Facility,Outpatient,,,90,113,96.05,55.37,101.7,Humana Insurance Company,Medicare PPO,55.37,49,,percent of total billed charges,,
Skeletal Muscle Relaxants (Mayo)OutsideLaboratory,,G0480,HCPCS,Facility,Inpatient,,,90,113,96.05,55.37,101.7,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Skeletal Muscle Relaxants (Mayo)OutsideLaboratory,,G0480,HCPCS,Facility,Outpatient,,,90,113,96.05,55.37,101.7,Medica,Medica Advantage Solution,56.274,49.8,,percent of total billed charges,,
Skeletal Muscle Relaxants (Mayo)OutsideLaboratory,,G0480,HCPCS,Facility,Inpatient,,,90,113,96.05,55.37,101.7,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Skeletal Muscle Relaxants (Mayo)OutsideLaboratory,,G0480,HCPCS,Facility,Outpatient,,,90,113,96.05,55.37,101.7,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,56.274,49.8,,percent of total billed charges,,
Skeletal Muscle Relaxants (Mayo)OutsideLaboratory,,G0480,HCPCS,Facility,Inpatient,,,90,113,96.05,55.37,101.7,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Skeletal Muscle Relaxants (Mayo)OutsideLaboratory,,G0480,HCPCS,Facility,Outpatient,,,90,113,96.05,55.37,101.7,PrimeWest Health,Minnesota Senior Health Options (MSHO),58.1385,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Skeletal Muscle Relaxants (Mayo)OutsideLaboratory,,G0480,HCPCS,Facility,Inpatient,,,90,113,96.05,55.37,101.7,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Skeletal Muscle Relaxants (Mayo)OutsideLaboratory,,G0480,HCPCS,Facility,Outpatient,,,90,113,96.05,55.37,101.7,"UCare Health, Inc.",Medicare Advantage,57.0311,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Skeletal Muscle Relaxants (Mayo)OutsideLaboratory,,G0480,HCPCS,Facility,Inpatient,,,90,113,96.05,55.37,101.7,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Skeletal Muscle Relaxants (Mayo)OutsideLaboratory,,G0480,HCPCS,Facility,Outpatient,,,90,113,96.05,55.37,101.7,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),57.0311,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Skeletal Muscle Relaxants (Mayo)OutsideLaboratory,,G0480,HCPCS,Facility,Inpatient,,,90,113,96.05,55.37,101.7,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Skeletal Muscle Relaxants (Mayo)OutsideLaboratory,,G0480,HCPCS,Facility,Outpatient,,,90,113,96.05,55.37,101.7,UnitedHealthcare,Medicare Advantage,55.37,49,,percent of total billed charges,,
Skeletal Muscle Relaxants (Mayo)OutsideLaboratory,,G0480,HCPCS,Facility,Inpatient,,,90,113,96.05,55.37,101.7,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Tricyclic And Cyclicals 6/More (Mayo)OutsideLaboratory,,G0480,HCPCS,Facility,Outpatient,,,90,90,76.5,44.1,81,Aetna,Medicare Advantage,44.1,49,,percent of total billed charges,,
Tricyclic And Cyclicals 6/More (Mayo)OutsideLaboratory,,G0480,HCPCS,Facility,Inpatient,,,90,90,76.5,44.1,81,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Tricyclic And Cyclicals 6/More (Mayo)OutsideLaboratory,,G0480,HCPCS,Facility,Outpatient,,,90,90,76.5,44.1,81,BlueCross BlueShield Minnesota,Medicare Advantage,44.1,49,,percent of total billed charges,,
Tricyclic And Cyclicals 6/More (Mayo)OutsideLaboratory,,G0480,HCPCS,Facility,Inpatient,,,90,90,76.5,44.1,81,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Tricyclic And Cyclicals 6/More (Mayo)OutsideLaboratory,,G0480,HCPCS,Facility,Outpatient,,,90,90,76.5,44.1,81,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),44.1,49,,percent of total billed charges,,
Tricyclic And Cyclicals 6/More (Mayo)OutsideLaboratory,,G0480,HCPCS,Facility,Inpatient,,,90,90,76.5,44.1,81,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Tricyclic And Cyclicals 6/More (Mayo)OutsideLaboratory,,G0480,HCPCS,Facility,Outpatient,,,90,90,76.5,44.1,81,"Health Partners, Inc.",Medicare Advantage,44.1,49,,percent of total billed charges,,
Tricyclic And Cyclicals 6/More (Mayo)OutsideLaboratory,,G0480,HCPCS,Facility,Inpatient,,,90,90,76.5,44.1,81,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Tricyclic And Cyclicals 6/More (Mayo)OutsideLaboratory,,G0480,HCPCS,Facility,Both,,,90,90,76.5,44.1,81,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),54,60,,percent of total billed charges,,
Tricyclic And Cyclicals 6/More (Mayo)OutsideLaboratory,,G0480,HCPCS,Facility,Outpatient,,,90,90,76.5,44.1,81,Humana Insurance Company,Medicare PPO,44.1,49,,percent of total billed charges,,
Tricyclic And Cyclicals 6/More (Mayo)OutsideLaboratory,,G0480,HCPCS,Facility,Inpatient,,,90,90,76.5,44.1,81,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Tricyclic And Cyclicals 6/More (Mayo)OutsideLaboratory,,G0480,HCPCS,Facility,Outpatient,,,90,90,76.5,44.1,81,Medica,Medica Advantage Solution,44.82,49.8,,percent of total billed charges,,
Tricyclic And Cyclicals 6/More (Mayo)OutsideLaboratory,,G0480,HCPCS,Facility,Inpatient,,,90,90,76.5,44.1,81,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Tricyclic And Cyclicals 6/More (Mayo)OutsideLaboratory,,G0480,HCPCS,Facility,Outpatient,,,90,90,76.5,44.1,81,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,44.82,49.8,,percent of total billed charges,,
Tricyclic And Cyclicals 6/More (Mayo)OutsideLaboratory,,G0480,HCPCS,Facility,Inpatient,,,90,90,76.5,44.1,81,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Tricyclic And Cyclicals 6/More (Mayo)OutsideLaboratory,,G0480,HCPCS,Facility,Outpatient,,,90,90,76.5,44.1,81,PrimeWest Health,Minnesota Senior Health Options (MSHO),46.305,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Tricyclic And Cyclicals 6/More (Mayo)OutsideLaboratory,,G0480,HCPCS,Facility,Inpatient,,,90,90,76.5,44.1,81,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Tricyclic And Cyclicals 6/More (Mayo)OutsideLaboratory,,G0480,HCPCS,Facility,Outpatient,,,90,90,76.5,44.1,81,"UCare Health, Inc.",Medicare Advantage,45.423,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Tricyclic And Cyclicals 6/More (Mayo)OutsideLaboratory,,G0480,HCPCS,Facility,Inpatient,,,90,90,76.5,44.1,81,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Tricyclic And Cyclicals 6/More (Mayo)OutsideLaboratory,,G0480,HCPCS,Facility,Outpatient,,,90,90,76.5,44.1,81,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),45.423,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Tricyclic And Cyclicals 6/More (Mayo)OutsideLaboratory,,G0480,HCPCS,Facility,Inpatient,,,90,90,76.5,44.1,81,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Tricyclic And Cyclicals 6/More (Mayo)OutsideLaboratory,,G0480,HCPCS,Facility,Outpatient,,,90,90,76.5,44.1,81,UnitedHealthcare,Medicare Advantage,44.1,49,,percent of total billed charges,,
Tricyclic And Cyclicals 6/More (Mayo)OutsideLaboratory,,G0480,HCPCS,Facility,Inpatient,,,90,90,76.5,44.1,81,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Xr Finger Lt Second,,73140,CPT,Facility,Both,,,F1,224,190.4,64.1984,224,Aetna,Commercial,206.08,92,,percent of total billed charges,,
Xr Finger Lt Second,,73140,CPT,Facility,Outpatient,,,F1,224,190.4,64.1984,224,Aetna,Medicare Advantage,109.76,49,,percent of total billed charges,,
Xr Finger Lt Second,,73140,CPT,Facility,Inpatient,,,F1,224,190.4,64.1984,224,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Xr Finger Lt Second,,73140,CPT,Facility,Both,,,F1,224,190.4,64.1984,224,Aetna,PPO,208.32,93,,percent of total billed charges,,
Xr Finger Lt Second,,73140,CPT,Facility,Both,,,F1,224,190.4,64.1984,224,America's PPO,America's PPO,215.1072,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Xr Finger Lt Second,,73140,CPT,Facility,Both,,,F1,224,190.4,64.1984,224,BlueCross BlueShield Minnesota, Federal Employee Program,220.416,98.4,,percent of total billed charges,,
Xr Finger Lt Second,,73140,CPT,Facility,Both,,,F1,224,190.4,64.1984,224,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,224,100,,percent of total billed charges,,
Xr Finger Lt Second,,73140,CPT,Facility,Both,,,F1,224,190.4,64.1984,224,BlueCross BlueShield Minnesota,High Value Network Plan,201.6,90,,percent of total billed charges,,
Xr Finger Lt Second,,73140,CPT,Facility,Outpatient,,,F1,224,190.4,64.1984,224,BlueCross BlueShield Minnesota,Medicare Advantage,109.76,49,,percent of total billed charges,,
Xr Finger Lt Second,,73140,CPT,Facility,Inpatient,,,F1,224,190.4,64.1984,224,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Xr Finger Lt Second,,73140,CPT,Facility,Both,,,F1,224,190.4,64.1984,224,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,198.3968,88.57,,percent of total billed charges,,
Xr Finger Lt Second,,73140,CPT,Facility,Both,,,F1,224,190.4,64.1984,224,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,64.1984,28.66,,percent of total billed charges,,
Xr Finger Lt Second,,73140,CPT,Facility,Outpatient,,,F1,224,190.4,64.1984,224,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),109.76,49,,percent of total billed charges,,
Xr Finger Lt Second,,73140,CPT,Facility,Inpatient,,,F1,224,190.4,64.1984,224,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Xr Finger Lt Second,,73140,CPT,Facility,Both,,,F1,224,190.4,64.1984,224,CorVel,Worker's Compensation,224,100,,percent of total billed charges,,
Xr Finger Lt Second,,73140,CPT,Facility,Both,,,F1,224,190.4,64.1984,224,First Health Group Corporation,First Health Network,217.28,97,,percent of total billed charges,,
Xr Finger Lt Second,,73140,CPT,Facility,Both,,,F1,224,190.4,64.1984,224,"Health Partners, Inc.",Commercial,211.904,94.6,,percent of total billed charges,,
Xr Finger Lt Second,,73140,CPT,Facility,Outpatient,,,F1,224,190.4,64.1984,224,"Health Partners, Inc.",Medicare Advantage,109.76,49,,percent of total billed charges,,
Xr Finger Lt Second,,73140,CPT,Facility,Inpatient,,,F1,224,190.4,64.1984,224,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Finger Lt Second,,73140,CPT,Facility,Both,,,F1,224,190.4,64.1984,224,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),134.4,60,,percent of total billed charges,,
Xr Finger Lt Second,,73140,CPT,Facility,Both,,,F1,224,190.4,64.1984,224,"Health Partners, Inc.",State of Minnesota Advantage Program,182.56,81.5,,percent of total billed charges,,
Xr Finger Lt Second,,73140,CPT,Facility,Both,,,F1,224,190.4,64.1984,224,"Health Partners, Inc.",State Public Programs,112,50,,percent of total billed charges,,
Xr Finger Lt Second,,73140,CPT,Facility,Both,,,F1,224,190.4,64.1984,224,Humana Insurance Company,Commercial PPO,212.8,95,,percent of total billed charges,,
Xr Finger Lt Second,,73140,CPT,Facility,Outpatient,,,F1,224,190.4,64.1984,224,Humana Insurance Company,Medicare PPO,109.76,49,,percent of total billed charges,,
Xr Finger Lt Second,,73140,CPT,Facility,Inpatient,,,F1,224,190.4,64.1984,224,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Xr Finger Lt Second,,73140,CPT,Facility,Both,,,F1,224,190.4,64.1984,224,Medica,Individual & Family,221.984,99.1,,percent of total billed charges,,
Xr Finger Lt Second,,73140,CPT,Facility,Outpatient,,,F1,224,190.4,64.1984,224,Medica,Medica Advantage Solution,111.552,49.8,,percent of total billed charges,,
Xr Finger Lt Second,,73140,CPT,Facility,Inpatient,,,F1,224,190.4,64.1984,224,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Xr Finger Lt Second,,73140,CPT,Facility,Outpatient,,,F1,224,190.4,64.1984,224,Medica,Medical Assistance,99.904,44.6,,percent of total billed charges,,
Xr Finger Lt Second,,73140,CPT,Facility,Inpatient,,,F1,224,190.4,64.1984,224,Medica,Medical Assistance,,,,,Included in per diem rate,
Xr Finger Lt Second,,73140,CPT,Facility,Outpatient,,,F1,224,190.4,64.1984,224,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,111.552,49.8,,percent of total billed charges,,
Xr Finger Lt Second,,73140,CPT,Facility,Inpatient,,,F1,224,190.4,64.1984,224,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Xr Finger Lt Second,,73140,CPT,Facility,Both,,,F1,224,190.4,64.1984,224,"Multiplan, Inc.","Multiplan, Inc.",210.56,94,,percent of total billed charges,,
Xr Finger Lt Second,,73140,CPT,Facility,Outpatient,,,F1,224,190.4,64.1984,224,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,201.824,90.1,,percent of total billed charges,,
Xr Finger Lt Second,,73140,CPT,Facility,Inpatient,,,F1,224,190.4,64.1984,224,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Xr Finger Lt Second,,73140,CPT,Facility,Both,,,F1,224,190.4,64.1984,224,"Preferred One Administrative Services, INC.",PPO,220.864,98.6,,percent of total billed charges,,
Xr Finger Lt Second,,73140,CPT,Facility,Outpatient,,,F1,224,190.4,64.1984,224,PrimeWest Health,Minnesota Senior Health Options (MSHO),115.248,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Xr Finger Lt Second,,73140,CPT,Facility,Inpatient,,,F1,224,190.4,64.1984,224,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Finger Lt Second,,73140,CPT,Facility,Outpatient,,,F1,224,190.4,64.1984,224,PrimeWest Health,MinnesotaCare,115.0464,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Xr Finger Lt Second,,73140,CPT,Facility,Inpatient,,,F1,224,190.4,64.1984,224,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Xr Finger Lt Second,,73140,CPT,Facility,Both,,,F1,224,190.4,64.1984,224,Sanford Health Plan,Sanford Health Plan,206.08,92,,percent of total billed charges,,
Xr Finger Lt Second,,73140,CPT,Facility,Outpatient,,,F1,224,190.4,64.1984,224,"UCare Health, Inc.",Individual & Family Plan,126.224,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Xr Finger Lt Second,,73140,CPT,Facility,Inpatient,,,F1,224,190.4,64.1984,224,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Xr Finger Lt Second,,73140,CPT,Facility,Outpatient,,,F1,224,190.4,64.1984,224,"UCare Health, Inc.",Medical Assistance,113.0528,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Finger Lt Second,,73140,CPT,Facility,Inpatient,,,F1,224,190.4,64.1984,224,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Xr Finger Lt Second,,73140,CPT,Facility,Outpatient,,,F1,224,190.4,64.1984,224,"UCare Health, Inc.",Medicare Advantage,113.0528,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Finger Lt Second,,73140,CPT,Facility,Inpatient,,,F1,224,190.4,64.1984,224,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Finger Lt Second,,73140,CPT,Facility,Outpatient,,,F1,224,190.4,64.1984,224,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),113.0528,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Finger Lt Second,,73140,CPT,Facility,Inpatient,,,F1,224,190.4,64.1984,224,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Finger Lt Second,,73140,CPT,Facility,Both,,,F1,224,190.4,64.1984,224,UnitedHealthcare,Individual & Family,210.56,94,,percent of total billed charges,,
Xr Finger Lt Second,,73140,CPT,Facility,Outpatient,,,F1,224,190.4,64.1984,224,UnitedHealthcare,Medicare Advantage,109.76,49,,percent of total billed charges,,
Xr Finger Lt Second,,73140,CPT,Facility,Inpatient,,,F1,224,190.4,64.1984,224,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Xr Finger Lt Second,,73140,CPT,Facility,Outpatient,,,F1,224,190.4,64.1984,224,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,107.52,48,,percent of total billed charges,,100% of DHS outpatient percentage
Xr Finger Lt Second,,73140,CPT,Facility,Inpatient,,,F1,224,190.4,64.1984,224,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Xr Finger Lt Third,,73140,CPT,Facility,Both,,,F2,224,190.4,64.1984,224,Aetna,Commercial,206.08,92,,percent of total billed charges,,
Xr Finger Lt Third,,73140,CPT,Facility,Outpatient,,,F2,224,190.4,64.1984,224,Aetna,Medicare Advantage,109.76,49,,percent of total billed charges,,
Xr Finger Lt Third,,73140,CPT,Facility,Inpatient,,,F2,224,190.4,64.1984,224,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Xr Finger Lt Third,,73140,CPT,Facility,Both,,,F2,224,190.4,64.1984,224,Aetna,PPO,208.32,93,,percent of total billed charges,,
Xr Finger Lt Third,,73140,CPT,Facility,Both,,,F2,224,190.4,64.1984,224,America's PPO,America's PPO,215.1072,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Xr Finger Lt Third,,73140,CPT,Facility,Both,,,F2,224,190.4,64.1984,224,BlueCross BlueShield Minnesota, Federal Employee Program,220.416,98.4,,percent of total billed charges,,
Xr Finger Lt Third,,73140,CPT,Facility,Both,,,F2,224,190.4,64.1984,224,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,224,100,,percent of total billed charges,,
Xr Finger Lt Third,,73140,CPT,Facility,Both,,,F2,224,190.4,64.1984,224,BlueCross BlueShield Minnesota,High Value Network Plan,201.6,90,,percent of total billed charges,,
Xr Finger Lt Third,,73140,CPT,Facility,Outpatient,,,F2,224,190.4,64.1984,224,BlueCross BlueShield Minnesota,Medicare Advantage,109.76,49,,percent of total billed charges,,
Xr Finger Lt Third,,73140,CPT,Facility,Inpatient,,,F2,224,190.4,64.1984,224,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Xr Finger Lt Third,,73140,CPT,Facility,Both,,,F2,224,190.4,64.1984,224,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,198.3968,88.57,,percent of total billed charges,,
Xr Finger Lt Third,,73140,CPT,Facility,Both,,,F2,224,190.4,64.1984,224,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,64.1984,28.66,,percent of total billed charges,,
Xr Finger Lt Third,,73140,CPT,Facility,Outpatient,,,F2,224,190.4,64.1984,224,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),109.76,49,,percent of total billed charges,,
Xr Finger Lt Third,,73140,CPT,Facility,Inpatient,,,F2,224,190.4,64.1984,224,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Xr Finger Lt Third,,73140,CPT,Facility,Both,,,F2,224,190.4,64.1984,224,CorVel,Worker's Compensation,224,100,,percent of total billed charges,,
Xr Finger Lt Third,,73140,CPT,Facility,Both,,,F2,224,190.4,64.1984,224,First Health Group Corporation,First Health Network,217.28,97,,percent of total billed charges,,
Xr Finger Lt Third,,73140,CPT,Facility,Both,,,F2,224,190.4,64.1984,224,"Health Partners, Inc.",Commercial,211.904,94.6,,percent of total billed charges,,
Xr Finger Lt Third,,73140,CPT,Facility,Outpatient,,,F2,224,190.4,64.1984,224,"Health Partners, Inc.",Medicare Advantage,109.76,49,,percent of total billed charges,,
Xr Finger Lt Third,,73140,CPT,Facility,Inpatient,,,F2,224,190.4,64.1984,224,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Finger Lt Third,,73140,CPT,Facility,Both,,,F2,224,190.4,64.1984,224,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),134.4,60,,percent of total billed charges,,
Xr Finger Lt Third,,73140,CPT,Facility,Both,,,F2,224,190.4,64.1984,224,"Health Partners, Inc.",State of Minnesota Advantage Program,182.56,81.5,,percent of total billed charges,,
Xr Finger Lt Third,,73140,CPT,Facility,Both,,,F2,224,190.4,64.1984,224,"Health Partners, Inc.",State Public Programs,112,50,,percent of total billed charges,,
Xr Finger Lt Third,,73140,CPT,Facility,Both,,,F2,224,190.4,64.1984,224,Humana Insurance Company,Commercial PPO,212.8,95,,percent of total billed charges,,
Xr Finger Lt Third,,73140,CPT,Facility,Outpatient,,,F2,224,190.4,64.1984,224,Humana Insurance Company,Medicare PPO,109.76,49,,percent of total billed charges,,
Xr Finger Lt Third,,73140,CPT,Facility,Inpatient,,,F2,224,190.4,64.1984,224,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Xr Finger Lt Third,,73140,CPT,Facility,Both,,,F2,224,190.4,64.1984,224,Medica,Individual & Family,221.984,99.1,,percent of total billed charges,,
Xr Finger Lt Third,,73140,CPT,Facility,Outpatient,,,F2,224,190.4,64.1984,224,Medica,Medica Advantage Solution,111.552,49.8,,percent of total billed charges,,
Xr Finger Lt Third,,73140,CPT,Facility,Inpatient,,,F2,224,190.4,64.1984,224,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Xr Finger Lt Third,,73140,CPT,Facility,Outpatient,,,F2,224,190.4,64.1984,224,Medica,Medical Assistance,99.904,44.6,,percent of total billed charges,,
Xr Finger Lt Third,,73140,CPT,Facility,Inpatient,,,F2,224,190.4,64.1984,224,Medica,Medical Assistance,,,,,Included in per diem rate,
Xr Finger Lt Third,,73140,CPT,Facility,Outpatient,,,F2,224,190.4,64.1984,224,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,111.552,49.8,,percent of total billed charges,,
Xr Finger Lt Third,,73140,CPT,Facility,Inpatient,,,F2,224,190.4,64.1984,224,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Xr Finger Lt Third,,73140,CPT,Facility,Both,,,F2,224,190.4,64.1984,224,"Multiplan, Inc.","Multiplan, Inc.",210.56,94,,percent of total billed charges,,
Xr Finger Lt Third,,73140,CPT,Facility,Outpatient,,,F2,224,190.4,64.1984,224,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,201.824,90.1,,percent of total billed charges,,
Xr Finger Lt Third,,73140,CPT,Facility,Inpatient,,,F2,224,190.4,64.1984,224,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Xr Finger Lt Third,,73140,CPT,Facility,Both,,,F2,224,190.4,64.1984,224,"Preferred One Administrative Services, INC.",PPO,220.864,98.6,,percent of total billed charges,,
Xr Finger Lt Third,,73140,CPT,Facility,Outpatient,,,F2,224,190.4,64.1984,224,PrimeWest Health,Minnesota Senior Health Options (MSHO),115.248,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Xr Finger Lt Third,,73140,CPT,Facility,Inpatient,,,F2,224,190.4,64.1984,224,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Finger Lt Third,,73140,CPT,Facility,Outpatient,,,F2,224,190.4,64.1984,224,PrimeWest Health,MinnesotaCare,115.0464,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Xr Finger Lt Third,,73140,CPT,Facility,Inpatient,,,F2,224,190.4,64.1984,224,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Xr Finger Lt Third,,73140,CPT,Facility,Both,,,F2,224,190.4,64.1984,224,Sanford Health Plan,Sanford Health Plan,206.08,92,,percent of total billed charges,,
Xr Finger Lt Third,,73140,CPT,Facility,Outpatient,,,F2,224,190.4,64.1984,224,"UCare Health, Inc.",Individual & Family Plan,126.224,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Xr Finger Lt Third,,73140,CPT,Facility,Inpatient,,,F2,224,190.4,64.1984,224,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Xr Finger Lt Third,,73140,CPT,Facility,Outpatient,,,F2,224,190.4,64.1984,224,"UCare Health, Inc.",Medical Assistance,113.0528,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Finger Lt Third,,73140,CPT,Facility,Inpatient,,,F2,224,190.4,64.1984,224,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Xr Finger Lt Third,,73140,CPT,Facility,Outpatient,,,F2,224,190.4,64.1984,224,"UCare Health, Inc.",Medicare Advantage,113.0528,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Finger Lt Third,,73140,CPT,Facility,Inpatient,,,F2,224,190.4,64.1984,224,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Finger Lt Third,,73140,CPT,Facility,Outpatient,,,F2,224,190.4,64.1984,224,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),113.0528,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Finger Lt Third,,73140,CPT,Facility,Inpatient,,,F2,224,190.4,64.1984,224,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Finger Lt Third,,73140,CPT,Facility,Both,,,F2,224,190.4,64.1984,224,UnitedHealthcare,Individual & Family,210.56,94,,percent of total billed charges,,
Xr Finger Lt Third,,73140,CPT,Facility,Outpatient,,,F2,224,190.4,64.1984,224,UnitedHealthcare,Medicare Advantage,109.76,49,,percent of total billed charges,,
Xr Finger Lt Third,,73140,CPT,Facility,Inpatient,,,F2,224,190.4,64.1984,224,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Xr Finger Lt Third,,73140,CPT,Facility,Outpatient,,,F2,224,190.4,64.1984,224,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,107.52,48,,percent of total billed charges,,100% of DHS outpatient percentage
Xr Finger Lt Third,,73140,CPT,Facility,Inpatient,,,F2,224,190.4,64.1984,224,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Xr Finger Lt Fourth,,73140,CPT,Facility,Both,,,F3,224,190.4,64.1984,224,Aetna,Commercial,206.08,92,,percent of total billed charges,,
Xr Finger Lt Fourth,,73140,CPT,Facility,Outpatient,,,F3,224,190.4,64.1984,224,Aetna,Medicare Advantage,109.76,49,,percent of total billed charges,,
Xr Finger Lt Fourth,,73140,CPT,Facility,Inpatient,,,F3,224,190.4,64.1984,224,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Xr Finger Lt Fourth,,73140,CPT,Facility,Both,,,F3,224,190.4,64.1984,224,Aetna,PPO,208.32,93,,percent of total billed charges,,
Xr Finger Lt Fourth,,73140,CPT,Facility,Both,,,F3,224,190.4,64.1984,224,America's PPO,America's PPO,215.1072,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Xr Finger Lt Fourth,,73140,CPT,Facility,Both,,,F3,224,190.4,64.1984,224,BlueCross BlueShield Minnesota, Federal Employee Program,220.416,98.4,,percent of total billed charges,,
Xr Finger Lt Fourth,,73140,CPT,Facility,Both,,,F3,224,190.4,64.1984,224,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,224,100,,percent of total billed charges,,
Xr Finger Lt Fourth,,73140,CPT,Facility,Both,,,F3,224,190.4,64.1984,224,BlueCross BlueShield Minnesota,High Value Network Plan,201.6,90,,percent of total billed charges,,
Xr Finger Lt Fourth,,73140,CPT,Facility,Outpatient,,,F3,224,190.4,64.1984,224,BlueCross BlueShield Minnesota,Medicare Advantage,109.76,49,,percent of total billed charges,,
Xr Finger Lt Fourth,,73140,CPT,Facility,Inpatient,,,F3,224,190.4,64.1984,224,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Xr Finger Lt Fourth,,73140,CPT,Facility,Both,,,F3,224,190.4,64.1984,224,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,198.3968,88.57,,percent of total billed charges,,
Xr Finger Lt Fourth,,73140,CPT,Facility,Both,,,F3,224,190.4,64.1984,224,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,64.1984,28.66,,percent of total billed charges,,
Xr Finger Lt Fourth,,73140,CPT,Facility,Outpatient,,,F3,224,190.4,64.1984,224,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),109.76,49,,percent of total billed charges,,
Xr Finger Lt Fourth,,73140,CPT,Facility,Inpatient,,,F3,224,190.4,64.1984,224,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Xr Finger Lt Fourth,,73140,CPT,Facility,Both,,,F3,224,190.4,64.1984,224,CorVel,Worker's Compensation,224,100,,percent of total billed charges,,
Xr Finger Lt Fourth,,73140,CPT,Facility,Both,,,F3,224,190.4,64.1984,224,First Health Group Corporation,First Health Network,217.28,97,,percent of total billed charges,,
Xr Finger Lt Fourth,,73140,CPT,Facility,Both,,,F3,224,190.4,64.1984,224,"Health Partners, Inc.",Commercial,211.904,94.6,,percent of total billed charges,,
Xr Finger Lt Fourth,,73140,CPT,Facility,Outpatient,,,F3,224,190.4,64.1984,224,"Health Partners, Inc.",Medicare Advantage,109.76,49,,percent of total billed charges,,
Xr Finger Lt Fourth,,73140,CPT,Facility,Inpatient,,,F3,224,190.4,64.1984,224,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Finger Lt Fourth,,73140,CPT,Facility,Both,,,F3,224,190.4,64.1984,224,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),134.4,60,,percent of total billed charges,,
Xr Finger Lt Fourth,,73140,CPT,Facility,Both,,,F3,224,190.4,64.1984,224,"Health Partners, Inc.",State of Minnesota Advantage Program,182.56,81.5,,percent of total billed charges,,
Xr Finger Lt Fourth,,73140,CPT,Facility,Both,,,F3,224,190.4,64.1984,224,"Health Partners, Inc.",State Public Programs,112,50,,percent of total billed charges,,
Xr Finger Lt Fourth,,73140,CPT,Facility,Both,,,F3,224,190.4,64.1984,224,Humana Insurance Company,Commercial PPO,212.8,95,,percent of total billed charges,,
Xr Finger Lt Fourth,,73140,CPT,Facility,Outpatient,,,F3,224,190.4,64.1984,224,Humana Insurance Company,Medicare PPO,109.76,49,,percent of total billed charges,,
Xr Finger Lt Fourth,,73140,CPT,Facility,Inpatient,,,F3,224,190.4,64.1984,224,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Xr Finger Lt Fourth,,73140,CPT,Facility,Both,,,F3,224,190.4,64.1984,224,Medica,Individual & Family,221.984,99.1,,percent of total billed charges,,
Xr Finger Lt Fourth,,73140,CPT,Facility,Outpatient,,,F3,224,190.4,64.1984,224,Medica,Medica Advantage Solution,111.552,49.8,,percent of total billed charges,,
Xr Finger Lt Fourth,,73140,CPT,Facility,Inpatient,,,F3,224,190.4,64.1984,224,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Xr Finger Lt Fourth,,73140,CPT,Facility,Outpatient,,,F3,224,190.4,64.1984,224,Medica,Medical Assistance,99.904,44.6,,percent of total billed charges,,
Xr Finger Lt Fourth,,73140,CPT,Facility,Inpatient,,,F3,224,190.4,64.1984,224,Medica,Medical Assistance,,,,,Included in per diem rate,
Xr Finger Lt Fourth,,73140,CPT,Facility,Outpatient,,,F3,224,190.4,64.1984,224,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,111.552,49.8,,percent of total billed charges,,
Xr Finger Lt Fourth,,73140,CPT,Facility,Inpatient,,,F3,224,190.4,64.1984,224,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Xr Finger Lt Fourth,,73140,CPT,Facility,Both,,,F3,224,190.4,64.1984,224,"Multiplan, Inc.","Multiplan, Inc.",210.56,94,,percent of total billed charges,,
Xr Finger Lt Fourth,,73140,CPT,Facility,Outpatient,,,F3,224,190.4,64.1984,224,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,201.824,90.1,,percent of total billed charges,,
Xr Finger Lt Fourth,,73140,CPT,Facility,Inpatient,,,F3,224,190.4,64.1984,224,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Xr Finger Lt Fourth,,73140,CPT,Facility,Both,,,F3,224,190.4,64.1984,224,"Preferred One Administrative Services, INC.",PPO,220.864,98.6,,percent of total billed charges,,
Xr Finger Lt Fourth,,73140,CPT,Facility,Outpatient,,,F3,224,190.4,64.1984,224,PrimeWest Health,Minnesota Senior Health Options (MSHO),115.248,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Xr Finger Lt Fourth,,73140,CPT,Facility,Inpatient,,,F3,224,190.4,64.1984,224,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Finger Lt Fourth,,73140,CPT,Facility,Outpatient,,,F3,224,190.4,64.1984,224,PrimeWest Health,MinnesotaCare,115.0464,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Xr Finger Lt Fourth,,73140,CPT,Facility,Inpatient,,,F3,224,190.4,64.1984,224,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Xr Finger Lt Fourth,,73140,CPT,Facility,Both,,,F3,224,190.4,64.1984,224,Sanford Health Plan,Sanford Health Plan,206.08,92,,percent of total billed charges,,
Xr Finger Lt Fourth,,73140,CPT,Facility,Outpatient,,,F3,224,190.4,64.1984,224,"UCare Health, Inc.",Individual & Family Plan,126.224,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Xr Finger Lt Fourth,,73140,CPT,Facility,Inpatient,,,F3,224,190.4,64.1984,224,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Xr Finger Lt Fourth,,73140,CPT,Facility,Outpatient,,,F3,224,190.4,64.1984,224,"UCare Health, Inc.",Medical Assistance,113.0528,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Finger Lt Fourth,,73140,CPT,Facility,Inpatient,,,F3,224,190.4,64.1984,224,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Xr Finger Lt Fourth,,73140,CPT,Facility,Outpatient,,,F3,224,190.4,64.1984,224,"UCare Health, Inc.",Medicare Advantage,113.0528,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Finger Lt Fourth,,73140,CPT,Facility,Inpatient,,,F3,224,190.4,64.1984,224,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Finger Lt Fourth,,73140,CPT,Facility,Outpatient,,,F3,224,190.4,64.1984,224,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),113.0528,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Finger Lt Fourth,,73140,CPT,Facility,Inpatient,,,F3,224,190.4,64.1984,224,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Finger Lt Fourth,,73140,CPT,Facility,Both,,,F3,224,190.4,64.1984,224,UnitedHealthcare,Individual & Family,210.56,94,,percent of total billed charges,,
Xr Finger Lt Fourth,,73140,CPT,Facility,Outpatient,,,F3,224,190.4,64.1984,224,UnitedHealthcare,Medicare Advantage,109.76,49,,percent of total billed charges,,
Xr Finger Lt Fourth,,73140,CPT,Facility,Inpatient,,,F3,224,190.4,64.1984,224,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Xr Finger Lt Fourth,,73140,CPT,Facility,Outpatient,,,F3,224,190.4,64.1984,224,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,107.52,48,,percent of total billed charges,,100% of DHS outpatient percentage
Xr Finger Lt Fourth,,73140,CPT,Facility,Inpatient,,,F3,224,190.4,64.1984,224,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Xr Finger Lt Fifth,,73140,CPT,Facility,Both,,,F4,224,190.4,64.1984,224,Aetna,Commercial,206.08,92,,percent of total billed charges,,
Xr Finger Lt Fifth,,73140,CPT,Facility,Outpatient,,,F4,224,190.4,64.1984,224,Aetna,Medicare Advantage,109.76,49,,percent of total billed charges,,
Xr Finger Lt Fifth,,73140,CPT,Facility,Inpatient,,,F4,224,190.4,64.1984,224,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Xr Finger Lt Fifth,,73140,CPT,Facility,Both,,,F4,224,190.4,64.1984,224,Aetna,PPO,208.32,93,,percent of total billed charges,,
Xr Finger Lt Fifth,,73140,CPT,Facility,Both,,,F4,224,190.4,64.1984,224,America's PPO,America's PPO,215.1072,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Xr Finger Lt Fifth,,73140,CPT,Facility,Both,,,F4,224,190.4,64.1984,224,BlueCross BlueShield Minnesota, Federal Employee Program,220.416,98.4,,percent of total billed charges,,
Xr Finger Lt Fifth,,73140,CPT,Facility,Both,,,F4,224,190.4,64.1984,224,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,224,100,,percent of total billed charges,,
Xr Finger Lt Fifth,,73140,CPT,Facility,Both,,,F4,224,190.4,64.1984,224,BlueCross BlueShield Minnesota,High Value Network Plan,201.6,90,,percent of total billed charges,,
Xr Finger Lt Fifth,,73140,CPT,Facility,Outpatient,,,F4,224,190.4,64.1984,224,BlueCross BlueShield Minnesota,Medicare Advantage,109.76,49,,percent of total billed charges,,
Xr Finger Lt Fifth,,73140,CPT,Facility,Inpatient,,,F4,224,190.4,64.1984,224,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Xr Finger Lt Fifth,,73140,CPT,Facility,Both,,,F4,224,190.4,64.1984,224,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,198.3968,88.57,,percent of total billed charges,,
Xr Finger Lt Fifth,,73140,CPT,Facility,Both,,,F4,224,190.4,64.1984,224,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,64.1984,28.66,,percent of total billed charges,,
Xr Finger Lt Fifth,,73140,CPT,Facility,Outpatient,,,F4,224,190.4,64.1984,224,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),109.76,49,,percent of total billed charges,,
Xr Finger Lt Fifth,,73140,CPT,Facility,Inpatient,,,F4,224,190.4,64.1984,224,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Xr Finger Lt Fifth,,73140,CPT,Facility,Both,,,F4,224,190.4,64.1984,224,CorVel,Worker's Compensation,224,100,,percent of total billed charges,,
Xr Finger Lt Fifth,,73140,CPT,Facility,Both,,,F4,224,190.4,64.1984,224,First Health Group Corporation,First Health Network,217.28,97,,percent of total billed charges,,
Xr Finger Lt Fifth,,73140,CPT,Facility,Both,,,F4,224,190.4,64.1984,224,"Health Partners, Inc.",Commercial,211.904,94.6,,percent of total billed charges,,
Xr Finger Lt Fifth,,73140,CPT,Facility,Outpatient,,,F4,224,190.4,64.1984,224,"Health Partners, Inc.",Medicare Advantage,109.76,49,,percent of total billed charges,,
Xr Finger Lt Fifth,,73140,CPT,Facility,Inpatient,,,F4,224,190.4,64.1984,224,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Finger Lt Fifth,,73140,CPT,Facility,Both,,,F4,224,190.4,64.1984,224,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),134.4,60,,percent of total billed charges,,
Xr Finger Lt Fifth,,73140,CPT,Facility,Both,,,F4,224,190.4,64.1984,224,"Health Partners, Inc.",State of Minnesota Advantage Program,182.56,81.5,,percent of total billed charges,,
Xr Finger Lt Fifth,,73140,CPT,Facility,Both,,,F4,224,190.4,64.1984,224,"Health Partners, Inc.",State Public Programs,112,50,,percent of total billed charges,,
Xr Finger Lt Fifth,,73140,CPT,Facility,Both,,,F4,224,190.4,64.1984,224,Humana Insurance Company,Commercial PPO,212.8,95,,percent of total billed charges,,
Xr Finger Lt Fifth,,73140,CPT,Facility,Outpatient,,,F4,224,190.4,64.1984,224,Humana Insurance Company,Medicare PPO,109.76,49,,percent of total billed charges,,
Xr Finger Lt Fifth,,73140,CPT,Facility,Inpatient,,,F4,224,190.4,64.1984,224,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Xr Finger Lt Fifth,,73140,CPT,Facility,Both,,,F4,224,190.4,64.1984,224,Medica,Individual & Family,221.984,99.1,,percent of total billed charges,,
Xr Finger Lt Fifth,,73140,CPT,Facility,Outpatient,,,F4,224,190.4,64.1984,224,Medica,Medica Advantage Solution,111.552,49.8,,percent of total billed charges,,
Xr Finger Lt Fifth,,73140,CPT,Facility,Inpatient,,,F4,224,190.4,64.1984,224,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Xr Finger Lt Fifth,,73140,CPT,Facility,Outpatient,,,F4,224,190.4,64.1984,224,Medica,Medical Assistance,99.904,44.6,,percent of total billed charges,,
Xr Finger Lt Fifth,,73140,CPT,Facility,Inpatient,,,F4,224,190.4,64.1984,224,Medica,Medical Assistance,,,,,Included in per diem rate,
Xr Finger Lt Fifth,,73140,CPT,Facility,Outpatient,,,F4,224,190.4,64.1984,224,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,111.552,49.8,,percent of total billed charges,,
Xr Finger Lt Fifth,,73140,CPT,Facility,Inpatient,,,F4,224,190.4,64.1984,224,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Xr Finger Lt Fifth,,73140,CPT,Facility,Both,,,F4,224,190.4,64.1984,224,"Multiplan, Inc.","Multiplan, Inc.",210.56,94,,percent of total billed charges,,
Xr Finger Lt Fifth,,73140,CPT,Facility,Outpatient,,,F4,224,190.4,64.1984,224,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,201.824,90.1,,percent of total billed charges,,
Xr Finger Lt Fifth,,73140,CPT,Facility,Inpatient,,,F4,224,190.4,64.1984,224,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Xr Finger Lt Fifth,,73140,CPT,Facility,Both,,,F4,224,190.4,64.1984,224,"Preferred One Administrative Services, INC.",PPO,220.864,98.6,,percent of total billed charges,,
Xr Finger Lt Fifth,,73140,CPT,Facility,Outpatient,,,F4,224,190.4,64.1984,224,PrimeWest Health,Minnesota Senior Health Options (MSHO),115.248,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Xr Finger Lt Fifth,,73140,CPT,Facility,Inpatient,,,F4,224,190.4,64.1984,224,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Finger Lt Fifth,,73140,CPT,Facility,Outpatient,,,F4,224,190.4,64.1984,224,PrimeWest Health,MinnesotaCare,115.0464,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Xr Finger Lt Fifth,,73140,CPT,Facility,Inpatient,,,F4,224,190.4,64.1984,224,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Xr Finger Lt Fifth,,73140,CPT,Facility,Both,,,F4,224,190.4,64.1984,224,Sanford Health Plan,Sanford Health Plan,206.08,92,,percent of total billed charges,,
Xr Finger Lt Fifth,,73140,CPT,Facility,Outpatient,,,F4,224,190.4,64.1984,224,"UCare Health, Inc.",Individual & Family Plan,126.224,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Xr Finger Lt Fifth,,73140,CPT,Facility,Inpatient,,,F4,224,190.4,64.1984,224,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Xr Finger Lt Fifth,,73140,CPT,Facility,Outpatient,,,F4,224,190.4,64.1984,224,"UCare Health, Inc.",Medical Assistance,113.0528,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Finger Lt Fifth,,73140,CPT,Facility,Inpatient,,,F4,224,190.4,64.1984,224,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Xr Finger Lt Fifth,,73140,CPT,Facility,Outpatient,,,F4,224,190.4,64.1984,224,"UCare Health, Inc.",Medicare Advantage,113.0528,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Finger Lt Fifth,,73140,CPT,Facility,Inpatient,,,F4,224,190.4,64.1984,224,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Finger Lt Fifth,,73140,CPT,Facility,Outpatient,,,F4,224,190.4,64.1984,224,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),113.0528,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Finger Lt Fifth,,73140,CPT,Facility,Inpatient,,,F4,224,190.4,64.1984,224,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Finger Lt Fifth,,73140,CPT,Facility,Both,,,F4,224,190.4,64.1984,224,UnitedHealthcare,Individual & Family,210.56,94,,percent of total billed charges,,
Xr Finger Lt Fifth,,73140,CPT,Facility,Outpatient,,,F4,224,190.4,64.1984,224,UnitedHealthcare,Medicare Advantage,109.76,49,,percent of total billed charges,,
Xr Finger Lt Fifth,,73140,CPT,Facility,Inpatient,,,F4,224,190.4,64.1984,224,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Xr Finger Lt Fifth,,73140,CPT,Facility,Outpatient,,,F4,224,190.4,64.1984,224,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,107.52,48,,percent of total billed charges,,100% of DHS outpatient percentage
Xr Finger Lt Fifth,,73140,CPT,Facility,Inpatient,,,F4,224,190.4,64.1984,224,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Xr Finger Rt Thumb,,73140,CPT,Facility,Both,,,F5,224,190.4,64.1984,224,Aetna,Commercial,206.08,92,,percent of total billed charges,,
Xr Finger Rt Thumb,,73140,CPT,Facility,Outpatient,,,F5,224,190.4,64.1984,224,Aetna,Medicare Advantage,109.76,49,,percent of total billed charges,,
Xr Finger Rt Thumb,,73140,CPT,Facility,Inpatient,,,F5,224,190.4,64.1984,224,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Xr Finger Rt Thumb,,73140,CPT,Facility,Both,,,F5,224,190.4,64.1984,224,Aetna,PPO,208.32,93,,percent of total billed charges,,
Xr Finger Rt Thumb,,73140,CPT,Facility,Both,,,F5,224,190.4,64.1984,224,America's PPO,America's PPO,215.1072,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Xr Finger Rt Thumb,,73140,CPT,Facility,Both,,,F5,224,190.4,64.1984,224,BlueCross BlueShield Minnesota, Federal Employee Program,220.416,98.4,,percent of total billed charges,,
Xr Finger Rt Thumb,,73140,CPT,Facility,Both,,,F5,224,190.4,64.1984,224,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,224,100,,percent of total billed charges,,
Xr Finger Rt Thumb,,73140,CPT,Facility,Both,,,F5,224,190.4,64.1984,224,BlueCross BlueShield Minnesota,High Value Network Plan,201.6,90,,percent of total billed charges,,
Xr Finger Rt Thumb,,73140,CPT,Facility,Outpatient,,,F5,224,190.4,64.1984,224,BlueCross BlueShield Minnesota,Medicare Advantage,109.76,49,,percent of total billed charges,,
Xr Finger Rt Thumb,,73140,CPT,Facility,Inpatient,,,F5,224,190.4,64.1984,224,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Xr Finger Rt Thumb,,73140,CPT,Facility,Both,,,F5,224,190.4,64.1984,224,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,198.3968,88.57,,percent of total billed charges,,
Xr Finger Rt Thumb,,73140,CPT,Facility,Both,,,F5,224,190.4,64.1984,224,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,64.1984,28.66,,percent of total billed charges,,
Xr Finger Rt Thumb,,73140,CPT,Facility,Outpatient,,,F5,224,190.4,64.1984,224,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),109.76,49,,percent of total billed charges,,
Xr Finger Rt Thumb,,73140,CPT,Facility,Inpatient,,,F5,224,190.4,64.1984,224,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Xr Finger Rt Thumb,,73140,CPT,Facility,Both,,,F5,224,190.4,64.1984,224,CorVel,Worker's Compensation,224,100,,percent of total billed charges,,
Xr Finger Rt Thumb,,73140,CPT,Facility,Both,,,F5,224,190.4,64.1984,224,First Health Group Corporation,First Health Network,217.28,97,,percent of total billed charges,,
Xr Finger Rt Thumb,,73140,CPT,Facility,Both,,,F5,224,190.4,64.1984,224,"Health Partners, Inc.",Commercial,211.904,94.6,,percent of total billed charges,,
Xr Finger Rt Thumb,,73140,CPT,Facility,Outpatient,,,F5,224,190.4,64.1984,224,"Health Partners, Inc.",Medicare Advantage,109.76,49,,percent of total billed charges,,
Xr Finger Rt Thumb,,73140,CPT,Facility,Inpatient,,,F5,224,190.4,64.1984,224,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Finger Rt Thumb,,73140,CPT,Facility,Both,,,F5,224,190.4,64.1984,224,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),134.4,60,,percent of total billed charges,,
Xr Finger Rt Thumb,,73140,CPT,Facility,Both,,,F5,224,190.4,64.1984,224,"Health Partners, Inc.",State of Minnesota Advantage Program,182.56,81.5,,percent of total billed charges,,
Xr Finger Rt Thumb,,73140,CPT,Facility,Both,,,F5,224,190.4,64.1984,224,"Health Partners, Inc.",State Public Programs,112,50,,percent of total billed charges,,
Xr Finger Rt Thumb,,73140,CPT,Facility,Both,,,F5,224,190.4,64.1984,224,Humana Insurance Company,Commercial PPO,212.8,95,,percent of total billed charges,,
Xr Finger Rt Thumb,,73140,CPT,Facility,Outpatient,,,F5,224,190.4,64.1984,224,Humana Insurance Company,Medicare PPO,109.76,49,,percent of total billed charges,,
Xr Finger Rt Thumb,,73140,CPT,Facility,Inpatient,,,F5,224,190.4,64.1984,224,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Xr Finger Rt Thumb,,73140,CPT,Facility,Both,,,F5,224,190.4,64.1984,224,Medica,Individual & Family,221.984,99.1,,percent of total billed charges,,
Xr Finger Rt Thumb,,73140,CPT,Facility,Outpatient,,,F5,224,190.4,64.1984,224,Medica,Medica Advantage Solution,111.552,49.8,,percent of total billed charges,,
Xr Finger Rt Thumb,,73140,CPT,Facility,Inpatient,,,F5,224,190.4,64.1984,224,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Xr Finger Rt Thumb,,73140,CPT,Facility,Outpatient,,,F5,224,190.4,64.1984,224,Medica,Medical Assistance,99.904,44.6,,percent of total billed charges,,
Xr Finger Rt Thumb,,73140,CPT,Facility,Inpatient,,,F5,224,190.4,64.1984,224,Medica,Medical Assistance,,,,,Included in per diem rate,
Xr Finger Rt Thumb,,73140,CPT,Facility,Outpatient,,,F5,224,190.4,64.1984,224,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,111.552,49.8,,percent of total billed charges,,
Xr Finger Rt Thumb,,73140,CPT,Facility,Inpatient,,,F5,224,190.4,64.1984,224,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Xr Finger Rt Thumb,,73140,CPT,Facility,Both,,,F5,224,190.4,64.1984,224,"Multiplan, Inc.","Multiplan, Inc.",210.56,94,,percent of total billed charges,,
Xr Finger Rt Thumb,,73140,CPT,Facility,Outpatient,,,F5,224,190.4,64.1984,224,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,201.824,90.1,,percent of total billed charges,,
Xr Finger Rt Thumb,,73140,CPT,Facility,Inpatient,,,F5,224,190.4,64.1984,224,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Xr Finger Rt Thumb,,73140,CPT,Facility,Both,,,F5,224,190.4,64.1984,224,"Preferred One Administrative Services, INC.",PPO,220.864,98.6,,percent of total billed charges,,
Xr Finger Rt Thumb,,73140,CPT,Facility,Outpatient,,,F5,224,190.4,64.1984,224,PrimeWest Health,Minnesota Senior Health Options (MSHO),115.248,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Xr Finger Rt Thumb,,73140,CPT,Facility,Inpatient,,,F5,224,190.4,64.1984,224,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Finger Rt Thumb,,73140,CPT,Facility,Outpatient,,,F5,224,190.4,64.1984,224,PrimeWest Health,MinnesotaCare,115.0464,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Xr Finger Rt Thumb,,73140,CPT,Facility,Inpatient,,,F5,224,190.4,64.1984,224,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Xr Finger Rt Thumb,,73140,CPT,Facility,Both,,,F5,224,190.4,64.1984,224,Sanford Health Plan,Sanford Health Plan,206.08,92,,percent of total billed charges,,
Xr Finger Rt Thumb,,73140,CPT,Facility,Outpatient,,,F5,224,190.4,64.1984,224,"UCare Health, Inc.",Individual & Family Plan,126.224,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Xr Finger Rt Thumb,,73140,CPT,Facility,Inpatient,,,F5,224,190.4,64.1984,224,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Xr Finger Rt Thumb,,73140,CPT,Facility,Outpatient,,,F5,224,190.4,64.1984,224,"UCare Health, Inc.",Medical Assistance,113.0528,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Finger Rt Thumb,,73140,CPT,Facility,Inpatient,,,F5,224,190.4,64.1984,224,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Xr Finger Rt Thumb,,73140,CPT,Facility,Outpatient,,,F5,224,190.4,64.1984,224,"UCare Health, Inc.",Medicare Advantage,113.0528,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Finger Rt Thumb,,73140,CPT,Facility,Inpatient,,,F5,224,190.4,64.1984,224,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Finger Rt Thumb,,73140,CPT,Facility,Outpatient,,,F5,224,190.4,64.1984,224,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),113.0528,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Finger Rt Thumb,,73140,CPT,Facility,Inpatient,,,F5,224,190.4,64.1984,224,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Finger Rt Thumb,,73140,CPT,Facility,Both,,,F5,224,190.4,64.1984,224,UnitedHealthcare,Individual & Family,210.56,94,,percent of total billed charges,,
Xr Finger Rt Thumb,,73140,CPT,Facility,Outpatient,,,F5,224,190.4,64.1984,224,UnitedHealthcare,Medicare Advantage,109.76,49,,percent of total billed charges,,
Xr Finger Rt Thumb,,73140,CPT,Facility,Inpatient,,,F5,224,190.4,64.1984,224,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Xr Finger Rt Thumb,,73140,CPT,Facility,Outpatient,,,F5,224,190.4,64.1984,224,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,107.52,48,,percent of total billed charges,,100% of DHS outpatient percentage
Xr Finger Rt Thumb,,73140,CPT,Facility,Inpatient,,,F5,224,190.4,64.1984,224,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Xr Finger Rt Second,,73140,CPT,Facility,Both,,,F6,224,190.4,64.1984,224,Aetna,Commercial,206.08,92,,percent of total billed charges,,
Xr Finger Rt Second,,73140,CPT,Facility,Outpatient,,,F6,224,190.4,64.1984,224,Aetna,Medicare Advantage,109.76,49,,percent of total billed charges,,
Xr Finger Rt Second,,73140,CPT,Facility,Inpatient,,,F6,224,190.4,64.1984,224,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Xr Finger Rt Second,,73140,CPT,Facility,Both,,,F6,224,190.4,64.1984,224,Aetna,PPO,208.32,93,,percent of total billed charges,,
Xr Finger Rt Second,,73140,CPT,Facility,Both,,,F6,224,190.4,64.1984,224,America's PPO,America's PPO,215.1072,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Xr Finger Rt Second,,73140,CPT,Facility,Both,,,F6,224,190.4,64.1984,224,BlueCross BlueShield Minnesota, Federal Employee Program,220.416,98.4,,percent of total billed charges,,
Xr Finger Rt Second,,73140,CPT,Facility,Both,,,F6,224,190.4,64.1984,224,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,224,100,,percent of total billed charges,,
Xr Finger Rt Second,,73140,CPT,Facility,Both,,,F6,224,190.4,64.1984,224,BlueCross BlueShield Minnesota,High Value Network Plan,201.6,90,,percent of total billed charges,,
Xr Finger Rt Second,,73140,CPT,Facility,Outpatient,,,F6,224,190.4,64.1984,224,BlueCross BlueShield Minnesota,Medicare Advantage,109.76,49,,percent of total billed charges,,
Xr Finger Rt Second,,73140,CPT,Facility,Inpatient,,,F6,224,190.4,64.1984,224,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Xr Finger Rt Second,,73140,CPT,Facility,Both,,,F6,224,190.4,64.1984,224,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,198.3968,88.57,,percent of total billed charges,,
Xr Finger Rt Second,,73140,CPT,Facility,Both,,,F6,224,190.4,64.1984,224,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,64.1984,28.66,,percent of total billed charges,,
Xr Finger Rt Second,,73140,CPT,Facility,Outpatient,,,F6,224,190.4,64.1984,224,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),109.76,49,,percent of total billed charges,,
Xr Finger Rt Second,,73140,CPT,Facility,Inpatient,,,F6,224,190.4,64.1984,224,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Xr Finger Rt Second,,73140,CPT,Facility,Both,,,F6,224,190.4,64.1984,224,CorVel,Worker's Compensation,224,100,,percent of total billed charges,,
Xr Finger Rt Second,,73140,CPT,Facility,Both,,,F6,224,190.4,64.1984,224,First Health Group Corporation,First Health Network,217.28,97,,percent of total billed charges,,
Xr Finger Rt Second,,73140,CPT,Facility,Both,,,F6,224,190.4,64.1984,224,"Health Partners, Inc.",Commercial,211.904,94.6,,percent of total billed charges,,
Xr Finger Rt Second,,73140,CPT,Facility,Outpatient,,,F6,224,190.4,64.1984,224,"Health Partners, Inc.",Medicare Advantage,109.76,49,,percent of total billed charges,,
Xr Finger Rt Second,,73140,CPT,Facility,Inpatient,,,F6,224,190.4,64.1984,224,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Finger Rt Second,,73140,CPT,Facility,Both,,,F6,224,190.4,64.1984,224,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),134.4,60,,percent of total billed charges,,
Xr Finger Rt Second,,73140,CPT,Facility,Both,,,F6,224,190.4,64.1984,224,"Health Partners, Inc.",State of Minnesota Advantage Program,182.56,81.5,,percent of total billed charges,,
Xr Finger Rt Second,,73140,CPT,Facility,Both,,,F6,224,190.4,64.1984,224,"Health Partners, Inc.",State Public Programs,112,50,,percent of total billed charges,,
Xr Finger Rt Second,,73140,CPT,Facility,Both,,,F6,224,190.4,64.1984,224,Humana Insurance Company,Commercial PPO,212.8,95,,percent of total billed charges,,
Xr Finger Rt Second,,73140,CPT,Facility,Outpatient,,,F6,224,190.4,64.1984,224,Humana Insurance Company,Medicare PPO,109.76,49,,percent of total billed charges,,
Xr Finger Rt Second,,73140,CPT,Facility,Inpatient,,,F6,224,190.4,64.1984,224,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Xr Finger Rt Second,,73140,CPT,Facility,Both,,,F6,224,190.4,64.1984,224,Medica,Individual & Family,221.984,99.1,,percent of total billed charges,,
Xr Finger Rt Second,,73140,CPT,Facility,Outpatient,,,F6,224,190.4,64.1984,224,Medica,Medica Advantage Solution,111.552,49.8,,percent of total billed charges,,
Xr Finger Rt Second,,73140,CPT,Facility,Inpatient,,,F6,224,190.4,64.1984,224,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Xr Finger Rt Second,,73140,CPT,Facility,Outpatient,,,F6,224,190.4,64.1984,224,Medica,Medical Assistance,99.904,44.6,,percent of total billed charges,,
Xr Finger Rt Second,,73140,CPT,Facility,Inpatient,,,F6,224,190.4,64.1984,224,Medica,Medical Assistance,,,,,Included in per diem rate,
Xr Finger Rt Second,,73140,CPT,Facility,Outpatient,,,F6,224,190.4,64.1984,224,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,111.552,49.8,,percent of total billed charges,,
Xr Finger Rt Second,,73140,CPT,Facility,Inpatient,,,F6,224,190.4,64.1984,224,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Xr Finger Rt Second,,73140,CPT,Facility,Both,,,F6,224,190.4,64.1984,224,"Multiplan, Inc.","Multiplan, Inc.",210.56,94,,percent of total billed charges,,
Xr Finger Rt Second,,73140,CPT,Facility,Outpatient,,,F6,224,190.4,64.1984,224,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,201.824,90.1,,percent of total billed charges,,
Xr Finger Rt Second,,73140,CPT,Facility,Inpatient,,,F6,224,190.4,64.1984,224,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Xr Finger Rt Second,,73140,CPT,Facility,Both,,,F6,224,190.4,64.1984,224,"Preferred One Administrative Services, INC.",PPO,220.864,98.6,,percent of total billed charges,,
Xr Finger Rt Second,,73140,CPT,Facility,Outpatient,,,F6,224,190.4,64.1984,224,PrimeWest Health,Minnesota Senior Health Options (MSHO),115.248,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Xr Finger Rt Second,,73140,CPT,Facility,Inpatient,,,F6,224,190.4,64.1984,224,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Finger Rt Second,,73140,CPT,Facility,Outpatient,,,F6,224,190.4,64.1984,224,PrimeWest Health,MinnesotaCare,115.0464,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Xr Finger Rt Second,,73140,CPT,Facility,Inpatient,,,F6,224,190.4,64.1984,224,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Xr Finger Rt Second,,73140,CPT,Facility,Both,,,F6,224,190.4,64.1984,224,Sanford Health Plan,Sanford Health Plan,206.08,92,,percent of total billed charges,,
Xr Finger Rt Second,,73140,CPT,Facility,Outpatient,,,F6,224,190.4,64.1984,224,"UCare Health, Inc.",Individual & Family Plan,126.224,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Xr Finger Rt Second,,73140,CPT,Facility,Inpatient,,,F6,224,190.4,64.1984,224,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Xr Finger Rt Second,,73140,CPT,Facility,Outpatient,,,F6,224,190.4,64.1984,224,"UCare Health, Inc.",Medical Assistance,113.0528,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Finger Rt Second,,73140,CPT,Facility,Inpatient,,,F6,224,190.4,64.1984,224,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Xr Finger Rt Second,,73140,CPT,Facility,Outpatient,,,F6,224,190.4,64.1984,224,"UCare Health, Inc.",Medicare Advantage,113.0528,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Finger Rt Second,,73140,CPT,Facility,Inpatient,,,F6,224,190.4,64.1984,224,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Finger Rt Second,,73140,CPT,Facility,Outpatient,,,F6,224,190.4,64.1984,224,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),113.0528,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Finger Rt Second,,73140,CPT,Facility,Inpatient,,,F6,224,190.4,64.1984,224,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Finger Rt Second,,73140,CPT,Facility,Both,,,F6,224,190.4,64.1984,224,UnitedHealthcare,Individual & Family,210.56,94,,percent of total billed charges,,
Xr Finger Rt Second,,73140,CPT,Facility,Outpatient,,,F6,224,190.4,64.1984,224,UnitedHealthcare,Medicare Advantage,109.76,49,,percent of total billed charges,,
Xr Finger Rt Second,,73140,CPT,Facility,Inpatient,,,F6,224,190.4,64.1984,224,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Xr Finger Rt Second,,73140,CPT,Facility,Outpatient,,,F6,224,190.4,64.1984,224,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,107.52,48,,percent of total billed charges,,100% of DHS outpatient percentage
Xr Finger Rt Second,,73140,CPT,Facility,Inpatient,,,F6,224,190.4,64.1984,224,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Xr Finger Rt Third,,73140,CPT,Facility,Both,,,F7,224,190.4,64.1984,224,Aetna,Commercial,206.08,92,,percent of total billed charges,,
Xr Finger Rt Third,,73140,CPT,Facility,Outpatient,,,F7,224,190.4,64.1984,224,Aetna,Medicare Advantage,109.76,49,,percent of total billed charges,,
Xr Finger Rt Third,,73140,CPT,Facility,Inpatient,,,F7,224,190.4,64.1984,224,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Xr Finger Rt Third,,73140,CPT,Facility,Both,,,F7,224,190.4,64.1984,224,Aetna,PPO,208.32,93,,percent of total billed charges,,
Xr Finger Rt Third,,73140,CPT,Facility,Both,,,F7,224,190.4,64.1984,224,America's PPO,America's PPO,215.1072,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Xr Finger Rt Third,,73140,CPT,Facility,Both,,,F7,224,190.4,64.1984,224,BlueCross BlueShield Minnesota, Federal Employee Program,220.416,98.4,,percent of total billed charges,,
Xr Finger Rt Third,,73140,CPT,Facility,Both,,,F7,224,190.4,64.1984,224,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,224,100,,percent of total billed charges,,
Xr Finger Rt Third,,73140,CPT,Facility,Both,,,F7,224,190.4,64.1984,224,BlueCross BlueShield Minnesota,High Value Network Plan,201.6,90,,percent of total billed charges,,
Xr Finger Rt Third,,73140,CPT,Facility,Outpatient,,,F7,224,190.4,64.1984,224,BlueCross BlueShield Minnesota,Medicare Advantage,109.76,49,,percent of total billed charges,,
Xr Finger Rt Third,,73140,CPT,Facility,Inpatient,,,F7,224,190.4,64.1984,224,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Xr Finger Rt Third,,73140,CPT,Facility,Both,,,F7,224,190.4,64.1984,224,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,198.3968,88.57,,percent of total billed charges,,
Xr Finger Rt Third,,73140,CPT,Facility,Both,,,F7,224,190.4,64.1984,224,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,64.1984,28.66,,percent of total billed charges,,
Xr Finger Rt Third,,73140,CPT,Facility,Outpatient,,,F7,224,190.4,64.1984,224,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),109.76,49,,percent of total billed charges,,
Xr Finger Rt Third,,73140,CPT,Facility,Inpatient,,,F7,224,190.4,64.1984,224,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Xr Finger Rt Third,,73140,CPT,Facility,Both,,,F7,224,190.4,64.1984,224,CorVel,Worker's Compensation,224,100,,percent of total billed charges,,
Xr Finger Rt Third,,73140,CPT,Facility,Both,,,F7,224,190.4,64.1984,224,First Health Group Corporation,First Health Network,217.28,97,,percent of total billed charges,,
Xr Finger Rt Third,,73140,CPT,Facility,Both,,,F7,224,190.4,64.1984,224,"Health Partners, Inc.",Commercial,211.904,94.6,,percent of total billed charges,,
Xr Finger Rt Third,,73140,CPT,Facility,Outpatient,,,F7,224,190.4,64.1984,224,"Health Partners, Inc.",Medicare Advantage,109.76,49,,percent of total billed charges,,
Xr Finger Rt Third,,73140,CPT,Facility,Inpatient,,,F7,224,190.4,64.1984,224,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Finger Rt Third,,73140,CPT,Facility,Both,,,F7,224,190.4,64.1984,224,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),134.4,60,,percent of total billed charges,,
Xr Finger Rt Third,,73140,CPT,Facility,Both,,,F7,224,190.4,64.1984,224,"Health Partners, Inc.",State of Minnesota Advantage Program,182.56,81.5,,percent of total billed charges,,
Xr Finger Rt Third,,73140,CPT,Facility,Both,,,F7,224,190.4,64.1984,224,"Health Partners, Inc.",State Public Programs,112,50,,percent of total billed charges,,
Xr Finger Rt Third,,73140,CPT,Facility,Both,,,F7,224,190.4,64.1984,224,Humana Insurance Company,Commercial PPO,212.8,95,,percent of total billed charges,,
Xr Finger Rt Third,,73140,CPT,Facility,Outpatient,,,F7,224,190.4,64.1984,224,Humana Insurance Company,Medicare PPO,109.76,49,,percent of total billed charges,,
Xr Finger Rt Third,,73140,CPT,Facility,Inpatient,,,F7,224,190.4,64.1984,224,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Xr Finger Rt Third,,73140,CPT,Facility,Both,,,F7,224,190.4,64.1984,224,Medica,Individual & Family,221.984,99.1,,percent of total billed charges,,
Xr Finger Rt Third,,73140,CPT,Facility,Outpatient,,,F7,224,190.4,64.1984,224,Medica,Medica Advantage Solution,111.552,49.8,,percent of total billed charges,,
Xr Finger Rt Third,,73140,CPT,Facility,Inpatient,,,F7,224,190.4,64.1984,224,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Xr Finger Rt Third,,73140,CPT,Facility,Outpatient,,,F7,224,190.4,64.1984,224,Medica,Medical Assistance,99.904,44.6,,percent of total billed charges,,
Xr Finger Rt Third,,73140,CPT,Facility,Inpatient,,,F7,224,190.4,64.1984,224,Medica,Medical Assistance,,,,,Included in per diem rate,
Xr Finger Rt Third,,73140,CPT,Facility,Outpatient,,,F7,224,190.4,64.1984,224,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,111.552,49.8,,percent of total billed charges,,
Xr Finger Rt Third,,73140,CPT,Facility,Inpatient,,,F7,224,190.4,64.1984,224,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Xr Finger Rt Third,,73140,CPT,Facility,Both,,,F7,224,190.4,64.1984,224,"Multiplan, Inc.","Multiplan, Inc.",210.56,94,,percent of total billed charges,,
Xr Finger Rt Third,,73140,CPT,Facility,Outpatient,,,F7,224,190.4,64.1984,224,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,201.824,90.1,,percent of total billed charges,,
Xr Finger Rt Third,,73140,CPT,Facility,Inpatient,,,F7,224,190.4,64.1984,224,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Xr Finger Rt Third,,73140,CPT,Facility,Both,,,F7,224,190.4,64.1984,224,"Preferred One Administrative Services, INC.",PPO,220.864,98.6,,percent of total billed charges,,
Xr Finger Rt Third,,73140,CPT,Facility,Outpatient,,,F7,224,190.4,64.1984,224,PrimeWest Health,Minnesota Senior Health Options (MSHO),115.248,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Xr Finger Rt Third,,73140,CPT,Facility,Inpatient,,,F7,224,190.4,64.1984,224,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Finger Rt Third,,73140,CPT,Facility,Outpatient,,,F7,224,190.4,64.1984,224,PrimeWest Health,MinnesotaCare,115.0464,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Xr Finger Rt Third,,73140,CPT,Facility,Inpatient,,,F7,224,190.4,64.1984,224,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Xr Finger Rt Third,,73140,CPT,Facility,Both,,,F7,224,190.4,64.1984,224,Sanford Health Plan,Sanford Health Plan,206.08,92,,percent of total billed charges,,
Xr Finger Rt Third,,73140,CPT,Facility,Outpatient,,,F7,224,190.4,64.1984,224,"UCare Health, Inc.",Individual & Family Plan,126.224,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Xr Finger Rt Third,,73140,CPT,Facility,Inpatient,,,F7,224,190.4,64.1984,224,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Xr Finger Rt Third,,73140,CPT,Facility,Outpatient,,,F7,224,190.4,64.1984,224,"UCare Health, Inc.",Medical Assistance,113.0528,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Finger Rt Third,,73140,CPT,Facility,Inpatient,,,F7,224,190.4,64.1984,224,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Xr Finger Rt Third,,73140,CPT,Facility,Outpatient,,,F7,224,190.4,64.1984,224,"UCare Health, Inc.",Medicare Advantage,113.0528,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Finger Rt Third,,73140,CPT,Facility,Inpatient,,,F7,224,190.4,64.1984,224,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Finger Rt Third,,73140,CPT,Facility,Outpatient,,,F7,224,190.4,64.1984,224,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),113.0528,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Finger Rt Third,,73140,CPT,Facility,Inpatient,,,F7,224,190.4,64.1984,224,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Finger Rt Third,,73140,CPT,Facility,Both,,,F7,224,190.4,64.1984,224,UnitedHealthcare,Individual & Family,210.56,94,,percent of total billed charges,,
Xr Finger Rt Third,,73140,CPT,Facility,Outpatient,,,F7,224,190.4,64.1984,224,UnitedHealthcare,Medicare Advantage,109.76,49,,percent of total billed charges,,
Xr Finger Rt Third,,73140,CPT,Facility,Inpatient,,,F7,224,190.4,64.1984,224,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Xr Finger Rt Third,,73140,CPT,Facility,Outpatient,,,F7,224,190.4,64.1984,224,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,107.52,48,,percent of total billed charges,,100% of DHS outpatient percentage
Xr Finger Rt Third,,73140,CPT,Facility,Inpatient,,,F7,224,190.4,64.1984,224,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Xr Finger Rt Fourth,,73140,CPT,Facility,Both,,,F8,224,190.4,64.1984,224,Aetna,Commercial,206.08,92,,percent of total billed charges,,
Xr Finger Rt Fourth,,73140,CPT,Facility,Outpatient,,,F8,224,190.4,64.1984,224,Aetna,Medicare Advantage,109.76,49,,percent of total billed charges,,
Xr Finger Rt Fourth,,73140,CPT,Facility,Inpatient,,,F8,224,190.4,64.1984,224,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Xr Finger Rt Fourth,,73140,CPT,Facility,Both,,,F8,224,190.4,64.1984,224,Aetna,PPO,208.32,93,,percent of total billed charges,,
Xr Finger Rt Fourth,,73140,CPT,Facility,Both,,,F8,224,190.4,64.1984,224,America's PPO,America's PPO,215.1072,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Xr Finger Rt Fourth,,73140,CPT,Facility,Both,,,F8,224,190.4,64.1984,224,BlueCross BlueShield Minnesota, Federal Employee Program,220.416,98.4,,percent of total billed charges,,
Xr Finger Rt Fourth,,73140,CPT,Facility,Both,,,F8,224,190.4,64.1984,224,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,224,100,,percent of total billed charges,,
Xr Finger Rt Fourth,,73140,CPT,Facility,Both,,,F8,224,190.4,64.1984,224,BlueCross BlueShield Minnesota,High Value Network Plan,201.6,90,,percent of total billed charges,,
Xr Finger Rt Fourth,,73140,CPT,Facility,Outpatient,,,F8,224,190.4,64.1984,224,BlueCross BlueShield Minnesota,Medicare Advantage,109.76,49,,percent of total billed charges,,
Xr Finger Rt Fourth,,73140,CPT,Facility,Inpatient,,,F8,224,190.4,64.1984,224,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Xr Finger Rt Fourth,,73140,CPT,Facility,Both,,,F8,224,190.4,64.1984,224,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,198.3968,88.57,,percent of total billed charges,,
Xr Finger Rt Fourth,,73140,CPT,Facility,Both,,,F8,224,190.4,64.1984,224,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,64.1984,28.66,,percent of total billed charges,,
Xr Finger Rt Fourth,,73140,CPT,Facility,Outpatient,,,F8,224,190.4,64.1984,224,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),109.76,49,,percent of total billed charges,,
Xr Finger Rt Fourth,,73140,CPT,Facility,Inpatient,,,F8,224,190.4,64.1984,224,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Xr Finger Rt Fourth,,73140,CPT,Facility,Both,,,F8,224,190.4,64.1984,224,CorVel,Worker's Compensation,224,100,,percent of total billed charges,,
Xr Finger Rt Fourth,,73140,CPT,Facility,Both,,,F8,224,190.4,64.1984,224,First Health Group Corporation,First Health Network,217.28,97,,percent of total billed charges,,
Xr Finger Rt Fourth,,73140,CPT,Facility,Both,,,F8,224,190.4,64.1984,224,"Health Partners, Inc.",Commercial,211.904,94.6,,percent of total billed charges,,
Xr Finger Rt Fourth,,73140,CPT,Facility,Outpatient,,,F8,224,190.4,64.1984,224,"Health Partners, Inc.",Medicare Advantage,109.76,49,,percent of total billed charges,,
Xr Finger Rt Fourth,,73140,CPT,Facility,Inpatient,,,F8,224,190.4,64.1984,224,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Finger Rt Fourth,,73140,CPT,Facility,Both,,,F8,224,190.4,64.1984,224,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),134.4,60,,percent of total billed charges,,
Xr Finger Rt Fourth,,73140,CPT,Facility,Both,,,F8,224,190.4,64.1984,224,"Health Partners, Inc.",State of Minnesota Advantage Program,182.56,81.5,,percent of total billed charges,,
Xr Finger Rt Fourth,,73140,CPT,Facility,Both,,,F8,224,190.4,64.1984,224,"Health Partners, Inc.",State Public Programs,112,50,,percent of total billed charges,,
Xr Finger Rt Fourth,,73140,CPT,Facility,Both,,,F8,224,190.4,64.1984,224,Humana Insurance Company,Commercial PPO,212.8,95,,percent of total billed charges,,
Xr Finger Rt Fourth,,73140,CPT,Facility,Outpatient,,,F8,224,190.4,64.1984,224,Humana Insurance Company,Medicare PPO,109.76,49,,percent of total billed charges,,
Xr Finger Rt Fourth,,73140,CPT,Facility,Inpatient,,,F8,224,190.4,64.1984,224,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Xr Finger Rt Fourth,,73140,CPT,Facility,Both,,,F8,224,190.4,64.1984,224,Medica,Individual & Family,221.984,99.1,,percent of total billed charges,,
Xr Finger Rt Fourth,,73140,CPT,Facility,Outpatient,,,F8,224,190.4,64.1984,224,Medica,Medica Advantage Solution,111.552,49.8,,percent of total billed charges,,
Xr Finger Rt Fourth,,73140,CPT,Facility,Inpatient,,,F8,224,190.4,64.1984,224,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Xr Finger Rt Fourth,,73140,CPT,Facility,Outpatient,,,F8,224,190.4,64.1984,224,Medica,Medical Assistance,99.904,44.6,,percent of total billed charges,,
Xr Finger Rt Fourth,,73140,CPT,Facility,Inpatient,,,F8,224,190.4,64.1984,224,Medica,Medical Assistance,,,,,Included in per diem rate,
Xr Finger Rt Fourth,,73140,CPT,Facility,Outpatient,,,F8,224,190.4,64.1984,224,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,111.552,49.8,,percent of total billed charges,,
Xr Finger Rt Fourth,,73140,CPT,Facility,Inpatient,,,F8,224,190.4,64.1984,224,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Xr Finger Rt Fourth,,73140,CPT,Facility,Both,,,F8,224,190.4,64.1984,224,"Multiplan, Inc.","Multiplan, Inc.",210.56,94,,percent of total billed charges,,
Xr Finger Rt Fourth,,73140,CPT,Facility,Outpatient,,,F8,224,190.4,64.1984,224,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,201.824,90.1,,percent of total billed charges,,
Xr Finger Rt Fourth,,73140,CPT,Facility,Inpatient,,,F8,224,190.4,64.1984,224,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Xr Finger Rt Fourth,,73140,CPT,Facility,Both,,,F8,224,190.4,64.1984,224,"Preferred One Administrative Services, INC.",PPO,220.864,98.6,,percent of total billed charges,,
Xr Finger Rt Fourth,,73140,CPT,Facility,Outpatient,,,F8,224,190.4,64.1984,224,PrimeWest Health,Minnesota Senior Health Options (MSHO),115.248,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Xr Finger Rt Fourth,,73140,CPT,Facility,Inpatient,,,F8,224,190.4,64.1984,224,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Finger Rt Fourth,,73140,CPT,Facility,Outpatient,,,F8,224,190.4,64.1984,224,PrimeWest Health,MinnesotaCare,115.0464,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Xr Finger Rt Fourth,,73140,CPT,Facility,Inpatient,,,F8,224,190.4,64.1984,224,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Xr Finger Rt Fourth,,73140,CPT,Facility,Both,,,F8,224,190.4,64.1984,224,Sanford Health Plan,Sanford Health Plan,206.08,92,,percent of total billed charges,,
Xr Finger Rt Fourth,,73140,CPT,Facility,Outpatient,,,F8,224,190.4,64.1984,224,"UCare Health, Inc.",Individual & Family Plan,126.224,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Xr Finger Rt Fourth,,73140,CPT,Facility,Inpatient,,,F8,224,190.4,64.1984,224,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Xr Finger Rt Fourth,,73140,CPT,Facility,Outpatient,,,F8,224,190.4,64.1984,224,"UCare Health, Inc.",Medical Assistance,113.0528,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Finger Rt Fourth,,73140,CPT,Facility,Inpatient,,,F8,224,190.4,64.1984,224,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Xr Finger Rt Fourth,,73140,CPT,Facility,Outpatient,,,F8,224,190.4,64.1984,224,"UCare Health, Inc.",Medicare Advantage,113.0528,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Finger Rt Fourth,,73140,CPT,Facility,Inpatient,,,F8,224,190.4,64.1984,224,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Finger Rt Fourth,,73140,CPT,Facility,Outpatient,,,F8,224,190.4,64.1984,224,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),113.0528,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Finger Rt Fourth,,73140,CPT,Facility,Inpatient,,,F8,224,190.4,64.1984,224,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Finger Rt Fourth,,73140,CPT,Facility,Both,,,F8,224,190.4,64.1984,224,UnitedHealthcare,Individual & Family,210.56,94,,percent of total billed charges,,
Xr Finger Rt Fourth,,73140,CPT,Facility,Outpatient,,,F8,224,190.4,64.1984,224,UnitedHealthcare,Medicare Advantage,109.76,49,,percent of total billed charges,,
Xr Finger Rt Fourth,,73140,CPT,Facility,Inpatient,,,F8,224,190.4,64.1984,224,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Xr Finger Rt Fourth,,73140,CPT,Facility,Outpatient,,,F8,224,190.4,64.1984,224,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,107.52,48,,percent of total billed charges,,100% of DHS outpatient percentage
Xr Finger Rt Fourth,,73140,CPT,Facility,Inpatient,,,F8,224,190.4,64.1984,224,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Xr Finger Rt Fifth,,73140,CPT,Facility,Both,,,F9,224,190.4,64.1984,224,Aetna,Commercial,206.08,92,,percent of total billed charges,,
Xr Finger Rt Fifth,,73140,CPT,Facility,Outpatient,,,F9,224,190.4,64.1984,224,Aetna,Medicare Advantage,109.76,49,,percent of total billed charges,,
Xr Finger Rt Fifth,,73140,CPT,Facility,Inpatient,,,F9,224,190.4,64.1984,224,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Xr Finger Rt Fifth,,73140,CPT,Facility,Both,,,F9,224,190.4,64.1984,224,Aetna,PPO,208.32,93,,percent of total billed charges,,
Xr Finger Rt Fifth,,73140,CPT,Facility,Both,,,F9,224,190.4,64.1984,224,America's PPO,America's PPO,215.1072,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Xr Finger Rt Fifth,,73140,CPT,Facility,Both,,,F9,224,190.4,64.1984,224,BlueCross BlueShield Minnesota, Federal Employee Program,220.416,98.4,,percent of total billed charges,,
Xr Finger Rt Fifth,,73140,CPT,Facility,Both,,,F9,224,190.4,64.1984,224,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,224,100,,percent of total billed charges,,
Xr Finger Rt Fifth,,73140,CPT,Facility,Both,,,F9,224,190.4,64.1984,224,BlueCross BlueShield Minnesota,High Value Network Plan,201.6,90,,percent of total billed charges,,
Xr Finger Rt Fifth,,73140,CPT,Facility,Outpatient,,,F9,224,190.4,64.1984,224,BlueCross BlueShield Minnesota,Medicare Advantage,109.76,49,,percent of total billed charges,,
Xr Finger Rt Fifth,,73140,CPT,Facility,Inpatient,,,F9,224,190.4,64.1984,224,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Xr Finger Rt Fifth,,73140,CPT,Facility,Both,,,F9,224,190.4,64.1984,224,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,198.3968,88.57,,percent of total billed charges,,
Xr Finger Rt Fifth,,73140,CPT,Facility,Both,,,F9,224,190.4,64.1984,224,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,64.1984,28.66,,percent of total billed charges,,
Xr Finger Rt Fifth,,73140,CPT,Facility,Outpatient,,,F9,224,190.4,64.1984,224,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),109.76,49,,percent of total billed charges,,
Xr Finger Rt Fifth,,73140,CPT,Facility,Inpatient,,,F9,224,190.4,64.1984,224,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Xr Finger Rt Fifth,,73140,CPT,Facility,Both,,,F9,224,190.4,64.1984,224,CorVel,Worker's Compensation,224,100,,percent of total billed charges,,
Xr Finger Rt Fifth,,73140,CPT,Facility,Both,,,F9,224,190.4,64.1984,224,First Health Group Corporation,First Health Network,217.28,97,,percent of total billed charges,,
Xr Finger Rt Fifth,,73140,CPT,Facility,Both,,,F9,224,190.4,64.1984,224,"Health Partners, Inc.",Commercial,211.904,94.6,,percent of total billed charges,,
Xr Finger Rt Fifth,,73140,CPT,Facility,Outpatient,,,F9,224,190.4,64.1984,224,"Health Partners, Inc.",Medicare Advantage,109.76,49,,percent of total billed charges,,
Xr Finger Rt Fifth,,73140,CPT,Facility,Inpatient,,,F9,224,190.4,64.1984,224,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Finger Rt Fifth,,73140,CPT,Facility,Both,,,F9,224,190.4,64.1984,224,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),134.4,60,,percent of total billed charges,,
Xr Finger Rt Fifth,,73140,CPT,Facility,Both,,,F9,224,190.4,64.1984,224,"Health Partners, Inc.",State of Minnesota Advantage Program,182.56,81.5,,percent of total billed charges,,
Xr Finger Rt Fifth,,73140,CPT,Facility,Both,,,F9,224,190.4,64.1984,224,"Health Partners, Inc.",State Public Programs,112,50,,percent of total billed charges,,
Xr Finger Rt Fifth,,73140,CPT,Facility,Both,,,F9,224,190.4,64.1984,224,Humana Insurance Company,Commercial PPO,212.8,95,,percent of total billed charges,,
Xr Finger Rt Fifth,,73140,CPT,Facility,Outpatient,,,F9,224,190.4,64.1984,224,Humana Insurance Company,Medicare PPO,109.76,49,,percent of total billed charges,,
Xr Finger Rt Fifth,,73140,CPT,Facility,Inpatient,,,F9,224,190.4,64.1984,224,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Xr Finger Rt Fifth,,73140,CPT,Facility,Both,,,F9,224,190.4,64.1984,224,Medica,Individual & Family,221.984,99.1,,percent of total billed charges,,
Xr Finger Rt Fifth,,73140,CPT,Facility,Outpatient,,,F9,224,190.4,64.1984,224,Medica,Medica Advantage Solution,111.552,49.8,,percent of total billed charges,,
Xr Finger Rt Fifth,,73140,CPT,Facility,Inpatient,,,F9,224,190.4,64.1984,224,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Xr Finger Rt Fifth,,73140,CPT,Facility,Outpatient,,,F9,224,190.4,64.1984,224,Medica,Medical Assistance,99.904,44.6,,percent of total billed charges,,
Xr Finger Rt Fifth,,73140,CPT,Facility,Inpatient,,,F9,224,190.4,64.1984,224,Medica,Medical Assistance,,,,,Included in per diem rate,
Xr Finger Rt Fifth,,73140,CPT,Facility,Outpatient,,,F9,224,190.4,64.1984,224,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,111.552,49.8,,percent of total billed charges,,
Xr Finger Rt Fifth,,73140,CPT,Facility,Inpatient,,,F9,224,190.4,64.1984,224,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Xr Finger Rt Fifth,,73140,CPT,Facility,Both,,,F9,224,190.4,64.1984,224,"Multiplan, Inc.","Multiplan, Inc.",210.56,94,,percent of total billed charges,,
Xr Finger Rt Fifth,,73140,CPT,Facility,Outpatient,,,F9,224,190.4,64.1984,224,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,201.824,90.1,,percent of total billed charges,,
Xr Finger Rt Fifth,,73140,CPT,Facility,Inpatient,,,F9,224,190.4,64.1984,224,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Xr Finger Rt Fifth,,73140,CPT,Facility,Both,,,F9,224,190.4,64.1984,224,"Preferred One Administrative Services, INC.",PPO,220.864,98.6,,percent of total billed charges,,
Xr Finger Rt Fifth,,73140,CPT,Facility,Outpatient,,,F9,224,190.4,64.1984,224,PrimeWest Health,Minnesota Senior Health Options (MSHO),115.248,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Xr Finger Rt Fifth,,73140,CPT,Facility,Inpatient,,,F9,224,190.4,64.1984,224,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Finger Rt Fifth,,73140,CPT,Facility,Outpatient,,,F9,224,190.4,64.1984,224,PrimeWest Health,MinnesotaCare,115.0464,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Xr Finger Rt Fifth,,73140,CPT,Facility,Inpatient,,,F9,224,190.4,64.1984,224,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Xr Finger Rt Fifth,,73140,CPT,Facility,Both,,,F9,224,190.4,64.1984,224,Sanford Health Plan,Sanford Health Plan,206.08,92,,percent of total billed charges,,
Xr Finger Rt Fifth,,73140,CPT,Facility,Outpatient,,,F9,224,190.4,64.1984,224,"UCare Health, Inc.",Individual & Family Plan,126.224,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Xr Finger Rt Fifth,,73140,CPT,Facility,Inpatient,,,F9,224,190.4,64.1984,224,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Xr Finger Rt Fifth,,73140,CPT,Facility,Outpatient,,,F9,224,190.4,64.1984,224,"UCare Health, Inc.",Medical Assistance,113.0528,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Finger Rt Fifth,,73140,CPT,Facility,Inpatient,,,F9,224,190.4,64.1984,224,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Xr Finger Rt Fifth,,73140,CPT,Facility,Outpatient,,,F9,224,190.4,64.1984,224,"UCare Health, Inc.",Medicare Advantage,113.0528,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Finger Rt Fifth,,73140,CPT,Facility,Inpatient,,,F9,224,190.4,64.1984,224,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Finger Rt Fifth,,73140,CPT,Facility,Outpatient,,,F9,224,190.4,64.1984,224,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),113.0528,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Finger Rt Fifth,,73140,CPT,Facility,Inpatient,,,F9,224,190.4,64.1984,224,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Finger Rt Fifth,,73140,CPT,Facility,Both,,,F9,224,190.4,64.1984,224,UnitedHealthcare,Individual & Family,210.56,94,,percent of total billed charges,,
Xr Finger Rt Fifth,,73140,CPT,Facility,Outpatient,,,F9,224,190.4,64.1984,224,UnitedHealthcare,Medicare Advantage,109.76,49,,percent of total billed charges,,
Xr Finger Rt Fifth,,73140,CPT,Facility,Inpatient,,,F9,224,190.4,64.1984,224,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Xr Finger Rt Fifth,,73140,CPT,Facility,Outpatient,,,F9,224,190.4,64.1984,224,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,107.52,48,,percent of total billed charges,,100% of DHS outpatient percentage
Xr Finger Rt Fifth,,73140,CPT,Facility,Inpatient,,,F9,224,190.4,64.1984,224,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Xr Finger Lt Thumb,,73140,CPT,Facility,Both,,,FA,224,190.4,64.1984,224,Aetna,Commercial,206.08,92,,percent of total billed charges,,
Xr Finger Lt Thumb,,73140,CPT,Facility,Outpatient,,,FA,224,190.4,64.1984,224,Aetna,Medicare Advantage,109.76,49,,percent of total billed charges,,
Xr Finger Lt Thumb,,73140,CPT,Facility,Inpatient,,,FA,224,190.4,64.1984,224,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Xr Finger Lt Thumb,,73140,CPT,Facility,Both,,,FA,224,190.4,64.1984,224,Aetna,PPO,208.32,93,,percent of total billed charges,,
Xr Finger Lt Thumb,,73140,CPT,Facility,Both,,,FA,224,190.4,64.1984,224,America's PPO,America's PPO,215.1072,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Xr Finger Lt Thumb,,73140,CPT,Facility,Both,,,FA,224,190.4,64.1984,224,BlueCross BlueShield Minnesota, Federal Employee Program,220.416,98.4,,percent of total billed charges,,
Xr Finger Lt Thumb,,73140,CPT,Facility,Both,,,FA,224,190.4,64.1984,224,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,224,100,,percent of total billed charges,,
Xr Finger Lt Thumb,,73140,CPT,Facility,Both,,,FA,224,190.4,64.1984,224,BlueCross BlueShield Minnesota,High Value Network Plan,201.6,90,,percent of total billed charges,,
Xr Finger Lt Thumb,,73140,CPT,Facility,Outpatient,,,FA,224,190.4,64.1984,224,BlueCross BlueShield Minnesota,Medicare Advantage,109.76,49,,percent of total billed charges,,
Xr Finger Lt Thumb,,73140,CPT,Facility,Inpatient,,,FA,224,190.4,64.1984,224,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Xr Finger Lt Thumb,,73140,CPT,Facility,Both,,,FA,224,190.4,64.1984,224,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,198.3968,88.57,,percent of total billed charges,,
Xr Finger Lt Thumb,,73140,CPT,Facility,Both,,,FA,224,190.4,64.1984,224,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,64.1984,28.66,,percent of total billed charges,,
Xr Finger Lt Thumb,,73140,CPT,Facility,Outpatient,,,FA,224,190.4,64.1984,224,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),109.76,49,,percent of total billed charges,,
Xr Finger Lt Thumb,,73140,CPT,Facility,Inpatient,,,FA,224,190.4,64.1984,224,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Xr Finger Lt Thumb,,73140,CPT,Facility,Both,,,FA,224,190.4,64.1984,224,CorVel,Worker's Compensation,224,100,,percent of total billed charges,,
Xr Finger Lt Thumb,,73140,CPT,Facility,Both,,,FA,224,190.4,64.1984,224,First Health Group Corporation,First Health Network,217.28,97,,percent of total billed charges,,
Xr Finger Lt Thumb,,73140,CPT,Facility,Both,,,FA,224,190.4,64.1984,224,"Health Partners, Inc.",Commercial,211.904,94.6,,percent of total billed charges,,
Xr Finger Lt Thumb,,73140,CPT,Facility,Outpatient,,,FA,224,190.4,64.1984,224,"Health Partners, Inc.",Medicare Advantage,109.76,49,,percent of total billed charges,,
Xr Finger Lt Thumb,,73140,CPT,Facility,Inpatient,,,FA,224,190.4,64.1984,224,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Finger Lt Thumb,,73140,CPT,Facility,Both,,,FA,224,190.4,64.1984,224,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),134.4,60,,percent of total billed charges,,
Xr Finger Lt Thumb,,73140,CPT,Facility,Both,,,FA,224,190.4,64.1984,224,"Health Partners, Inc.",State of Minnesota Advantage Program,182.56,81.5,,percent of total billed charges,,
Xr Finger Lt Thumb,,73140,CPT,Facility,Both,,,FA,224,190.4,64.1984,224,"Health Partners, Inc.",State Public Programs,112,50,,percent of total billed charges,,
Xr Finger Lt Thumb,,73140,CPT,Facility,Both,,,FA,224,190.4,64.1984,224,Humana Insurance Company,Commercial PPO,212.8,95,,percent of total billed charges,,
Xr Finger Lt Thumb,,73140,CPT,Facility,Outpatient,,,FA,224,190.4,64.1984,224,Humana Insurance Company,Medicare PPO,109.76,49,,percent of total billed charges,,
Xr Finger Lt Thumb,,73140,CPT,Facility,Inpatient,,,FA,224,190.4,64.1984,224,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Xr Finger Lt Thumb,,73140,CPT,Facility,Both,,,FA,224,190.4,64.1984,224,Medica,Individual & Family,221.984,99.1,,percent of total billed charges,,
Xr Finger Lt Thumb,,73140,CPT,Facility,Outpatient,,,FA,224,190.4,64.1984,224,Medica,Medica Advantage Solution,111.552,49.8,,percent of total billed charges,,
Xr Finger Lt Thumb,,73140,CPT,Facility,Inpatient,,,FA,224,190.4,64.1984,224,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Xr Finger Lt Thumb,,73140,CPT,Facility,Outpatient,,,FA,224,190.4,64.1984,224,Medica,Medical Assistance,99.904,44.6,,percent of total billed charges,,
Xr Finger Lt Thumb,,73140,CPT,Facility,Inpatient,,,FA,224,190.4,64.1984,224,Medica,Medical Assistance,,,,,Included in per diem rate,
Xr Finger Lt Thumb,,73140,CPT,Facility,Outpatient,,,FA,224,190.4,64.1984,224,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,111.552,49.8,,percent of total billed charges,,
Xr Finger Lt Thumb,,73140,CPT,Facility,Inpatient,,,FA,224,190.4,64.1984,224,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Xr Finger Lt Thumb,,73140,CPT,Facility,Both,,,FA,224,190.4,64.1984,224,"Multiplan, Inc.","Multiplan, Inc.",210.56,94,,percent of total billed charges,,
Xr Finger Lt Thumb,,73140,CPT,Facility,Outpatient,,,FA,224,190.4,64.1984,224,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,201.824,90.1,,percent of total billed charges,,
Xr Finger Lt Thumb,,73140,CPT,Facility,Inpatient,,,FA,224,190.4,64.1984,224,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Xr Finger Lt Thumb,,73140,CPT,Facility,Both,,,FA,224,190.4,64.1984,224,"Preferred One Administrative Services, INC.",PPO,220.864,98.6,,percent of total billed charges,,
Xr Finger Lt Thumb,,73140,CPT,Facility,Outpatient,,,FA,224,190.4,64.1984,224,PrimeWest Health,Minnesota Senior Health Options (MSHO),115.248,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Xr Finger Lt Thumb,,73140,CPT,Facility,Inpatient,,,FA,224,190.4,64.1984,224,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Finger Lt Thumb,,73140,CPT,Facility,Outpatient,,,FA,224,190.4,64.1984,224,PrimeWest Health,MinnesotaCare,115.0464,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Xr Finger Lt Thumb,,73140,CPT,Facility,Inpatient,,,FA,224,190.4,64.1984,224,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Xr Finger Lt Thumb,,73140,CPT,Facility,Both,,,FA,224,190.4,64.1984,224,Sanford Health Plan,Sanford Health Plan,206.08,92,,percent of total billed charges,,
Xr Finger Lt Thumb,,73140,CPT,Facility,Outpatient,,,FA,224,190.4,64.1984,224,"UCare Health, Inc.",Individual & Family Plan,126.224,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Xr Finger Lt Thumb,,73140,CPT,Facility,Inpatient,,,FA,224,190.4,64.1984,224,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Xr Finger Lt Thumb,,73140,CPT,Facility,Outpatient,,,FA,224,190.4,64.1984,224,"UCare Health, Inc.",Medical Assistance,113.0528,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Finger Lt Thumb,,73140,CPT,Facility,Inpatient,,,FA,224,190.4,64.1984,224,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Xr Finger Lt Thumb,,73140,CPT,Facility,Outpatient,,,FA,224,190.4,64.1984,224,"UCare Health, Inc.",Medicare Advantage,113.0528,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Finger Lt Thumb,,73140,CPT,Facility,Inpatient,,,FA,224,190.4,64.1984,224,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Finger Lt Thumb,,73140,CPT,Facility,Outpatient,,,FA,224,190.4,64.1984,224,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),113.0528,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Finger Lt Thumb,,73140,CPT,Facility,Inpatient,,,FA,224,190.4,64.1984,224,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Finger Lt Thumb,,73140,CPT,Facility,Both,,,FA,224,190.4,64.1984,224,UnitedHealthcare,Individual & Family,210.56,94,,percent of total billed charges,,
Xr Finger Lt Thumb,,73140,CPT,Facility,Outpatient,,,FA,224,190.4,64.1984,224,UnitedHealthcare,Medicare Advantage,109.76,49,,percent of total billed charges,,
Xr Finger Lt Thumb,,73140,CPT,Facility,Inpatient,,,FA,224,190.4,64.1984,224,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Xr Finger Lt Thumb,,73140,CPT,Facility,Outpatient,,,FA,224,190.4,64.1984,224,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,107.52,48,,percent of total billed charges,,100% of DHS outpatient percentage
Xr Finger Lt Thumb,,73140,CPT,Facility,Inpatient,,,FA,224,190.4,64.1984,224,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Slp Speech & Language Therapy,,92507,CPT,Facility,Both,,,GN,168,142.8,48.1488,168,Aetna,Commercial,154.56,92,,percent of total billed charges,,
Slp Speech & Language Therapy,,92507,CPT,Facility,Outpatient,,,GN,168,142.8,48.1488,168,Aetna,Medicare Advantage,82.32,49,,percent of total billed charges,,
Slp Speech & Language Therapy,,92507,CPT,Facility,Inpatient,,,GN,168,142.8,48.1488,168,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Slp Speech & Language Therapy,,92507,CPT,Facility,Both,,,GN,168,142.8,48.1488,168,Aetna,PPO,156.24,93,,percent of total billed charges,,
Slp Speech & Language Therapy,,92507,CPT,Facility,Both,,,GN,168,142.8,48.1488,168,America's PPO,America's PPO,161.3304,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Slp Speech & Language Therapy,,92507,CPT,Facility,Both,,,GN,168,142.8,48.1488,168,BlueCross BlueShield Minnesota, Federal Employee Program,165.312,98.4,,percent of total billed charges,,
Slp Speech & Language Therapy,,92507,CPT,Facility,Both,,,GN,168,142.8,48.1488,168,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,168,100,,percent of total billed charges,,
Slp Speech & Language Therapy,,92507,CPT,Facility,Both,,,GN,168,142.8,48.1488,168,BlueCross BlueShield Minnesota,High Value Network Plan,151.2,90,,percent of total billed charges,,
Slp Speech & Language Therapy,,92507,CPT,Facility,Outpatient,,,GN,168,142.8,48.1488,168,BlueCross BlueShield Minnesota,Medicare Advantage,82.32,49,,percent of total billed charges,,
Slp Speech & Language Therapy,,92507,CPT,Facility,Inpatient,,,GN,168,142.8,48.1488,168,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Slp Speech & Language Therapy,,92507,CPT,Facility,Both,,,GN,168,142.8,48.1488,168,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,148.7976,88.57,,percent of total billed charges,,
Slp Speech & Language Therapy,,92507,CPT,Facility,Both,,,GN,168,142.8,48.1488,168,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,48.1488,28.66,,percent of total billed charges,,
Slp Speech & Language Therapy,,92507,CPT,Facility,Outpatient,,,GN,168,142.8,48.1488,168,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),82.32,49,,percent of total billed charges,,
Slp Speech & Language Therapy,,92507,CPT,Facility,Inpatient,,,GN,168,142.8,48.1488,168,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Slp Speech & Language Therapy,,92507,CPT,Facility,Both,,,GN,168,142.8,48.1488,168,CorVel,Worker's Compensation,168,100,,percent of total billed charges,,
Slp Speech & Language Therapy,,92507,CPT,Facility,Both,,,GN,168,142.8,48.1488,168,First Health Group Corporation,First Health Network,162.96,97,,percent of total billed charges,,
Slp Speech & Language Therapy,,92507,CPT,Facility,Both,,,GN,168,142.8,48.1488,168,"Health Partners, Inc.",Commercial,158.928,94.6,,percent of total billed charges,,
Slp Speech & Language Therapy,,92507,CPT,Facility,Outpatient,,,GN,168,142.8,48.1488,168,"Health Partners, Inc.",Medicare Advantage,82.32,49,,percent of total billed charges,,
Slp Speech & Language Therapy,,92507,CPT,Facility,Inpatient,,,GN,168,142.8,48.1488,168,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Slp Speech & Language Therapy,,92507,CPT,Facility,Both,,,GN,168,142.8,48.1488,168,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),100.8,60,,percent of total billed charges,,
Slp Speech & Language Therapy,,92507,CPT,Facility,Both,,,GN,168,142.8,48.1488,168,"Health Partners, Inc.",State of Minnesota Advantage Program,136.92,81.5,,percent of total billed charges,,
Slp Speech & Language Therapy,,92507,CPT,Facility,Both,,,GN,168,142.8,48.1488,168,"Health Partners, Inc.",State Public Programs,84,50,,percent of total billed charges,,
Slp Speech & Language Therapy,,92507,CPT,Facility,Both,,,GN,168,142.8,48.1488,168,Humana Insurance Company,Commercial PPO,159.6,95,,percent of total billed charges,,
Slp Speech & Language Therapy,,92507,CPT,Facility,Outpatient,,,GN,168,142.8,48.1488,168,Humana Insurance Company,Medicare PPO,82.32,49,,percent of total billed charges,,
Slp Speech & Language Therapy,,92507,CPT,Facility,Inpatient,,,GN,168,142.8,48.1488,168,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Slp Speech & Language Therapy,,92507,CPT,Facility,Both,,,GN,168,142.8,48.1488,168,Medica,Individual & Family,166.488,99.1,,percent of total billed charges,,
Slp Speech & Language Therapy,,92507,CPT,Facility,Outpatient,,,GN,168,142.8,48.1488,168,Medica,Medica Advantage Solution,83.664,49.8,,percent of total billed charges,,
Slp Speech & Language Therapy,,92507,CPT,Facility,Inpatient,,,GN,168,142.8,48.1488,168,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Slp Speech & Language Therapy,,92507,CPT,Facility,Outpatient,,,GN,168,142.8,48.1488,168,Medica,Medical Assistance,74.928,44.6,,percent of total billed charges,,
Slp Speech & Language Therapy,,92507,CPT,Facility,Inpatient,,,GN,168,142.8,48.1488,168,Medica,Medical Assistance,,,,,Included in per diem rate,
Slp Speech & Language Therapy,,92507,CPT,Facility,Outpatient,,,GN,168,142.8,48.1488,168,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,83.664,49.8,,percent of total billed charges,,
Slp Speech & Language Therapy,,92507,CPT,Facility,Inpatient,,,GN,168,142.8,48.1488,168,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Slp Speech & Language Therapy,,92507,CPT,Facility,Both,,,GN,168,142.8,48.1488,168,"Multiplan, Inc.","Multiplan, Inc.",157.92,94,,percent of total billed charges,,
Slp Speech & Language Therapy,,92507,CPT,Facility,Outpatient,,,GN,168,142.8,48.1488,168,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,145.152,86.4,,percent of total billed charges,,
Slp Speech & Language Therapy,,92507,CPT,Facility,Inpatient,,,GN,168,142.8,48.1488,168,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Slp Speech & Language Therapy,,92507,CPT,Facility,Both,,,GN,168,142.8,48.1488,168,"Preferred One Administrative Services, INC.",PPO,165.648,98.6,,percent of total billed charges,,
Slp Speech & Language Therapy,,92507,CPT,Facility,Outpatient,,,GN,168,142.8,48.1488,168,PrimeWest Health,Minnesota Senior Health Options (MSHO),86.436,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Slp Speech & Language Therapy,,92507,CPT,Facility,Inpatient,,,GN,168,142.8,48.1488,168,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Slp Speech & Language Therapy,,92507,CPT,Facility,Outpatient,,,GN,168,142.8,48.1488,168,PrimeWest Health,MinnesotaCare,86.2848,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Slp Speech & Language Therapy,,92507,CPT,Facility,Inpatient,,,GN,168,142.8,48.1488,168,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Slp Speech & Language Therapy,,92507,CPT,Facility,Both,,,GN,168,142.8,48.1488,168,Sanford Health Plan,Sanford Health Plan,154.56,92,,percent of total billed charges,,
Slp Speech & Language Therapy,,92507,CPT,Facility,Outpatient,,,GN,168,142.8,48.1488,168,"UCare Health, Inc.",Individual & Family Plan,94.668,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Slp Speech & Language Therapy,,92507,CPT,Facility,Inpatient,,,GN,168,142.8,48.1488,168,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Slp Speech & Language Therapy,,92507,CPT,Facility,Outpatient,,,GN,168,142.8,48.1488,168,"UCare Health, Inc.",Medical Assistance,84.7896,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Slp Speech & Language Therapy,,92507,CPT,Facility,Inpatient,,,GN,168,142.8,48.1488,168,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Slp Speech & Language Therapy,,92507,CPT,Facility,Outpatient,,,GN,168,142.8,48.1488,168,"UCare Health, Inc.",Medicare Advantage,84.7896,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Slp Speech & Language Therapy,,92507,CPT,Facility,Inpatient,,,GN,168,142.8,48.1488,168,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Slp Speech & Language Therapy,,92507,CPT,Facility,Outpatient,,,GN,168,142.8,48.1488,168,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),84.7896,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Slp Speech & Language Therapy,,92507,CPT,Facility,Inpatient,,,GN,168,142.8,48.1488,168,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Slp Speech & Language Therapy,,92507,CPT,Facility,Both,,,GN,168,142.8,48.1488,168,UnitedHealthcare,Individual & Family,157.92,94,,percent of total billed charges,,
Slp Speech & Language Therapy,,92507,CPT,Facility,Outpatient,,,GN,168,142.8,48.1488,168,UnitedHealthcare,Medicare Advantage,82.32,49,,percent of total billed charges,,
Slp Speech & Language Therapy,,92507,CPT,Facility,Inpatient,,,GN,168,142.8,48.1488,168,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Slp Speech & Language Therapy,,92507,CPT,Facility,Outpatient,,,GN,168,142.8,48.1488,168,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,80.64,48,,percent of total billed charges,,100% of DHS outpatient percentage
Slp Speech & Language Therapy,,92507,CPT,Facility,Inpatient,,,GN,168,142.8,48.1488,168,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Slp Eval Of Speech Fluency,,92521,CPT,Facility,Both,,,GN,361,306.85,103.4626,361,Aetna,Commercial,332.12,92,,percent of total billed charges,,
Slp Eval Of Speech Fluency,,92521,CPT,Facility,Outpatient,,,GN,361,306.85,103.4626,361,Aetna,Medicare Advantage,176.89,49,,percent of total billed charges,,
Slp Eval Of Speech Fluency,,92521,CPT,Facility,Inpatient,,,GN,361,306.85,103.4626,361,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Slp Eval Of Speech Fluency,,92521,CPT,Facility,Both,,,GN,361,306.85,103.4626,361,Aetna,PPO,335.73,93,,percent of total billed charges,,
Slp Eval Of Speech Fluency,,92521,CPT,Facility,Both,,,GN,361,306.85,103.4626,361,America's PPO,America's PPO,346.6683,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Slp Eval Of Speech Fluency,,92521,CPT,Facility,Both,,,GN,361,306.85,103.4626,361,BlueCross BlueShield Minnesota, Federal Employee Program,355.224,98.4,,percent of total billed charges,,
Slp Eval Of Speech Fluency,,92521,CPT,Facility,Both,,,GN,361,306.85,103.4626,361,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,361,100,,percent of total billed charges,,
Slp Eval Of Speech Fluency,,92521,CPT,Facility,Both,,,GN,361,306.85,103.4626,361,BlueCross BlueShield Minnesota,High Value Network Plan,324.9,90,,percent of total billed charges,,
Slp Eval Of Speech Fluency,,92521,CPT,Facility,Outpatient,,,GN,361,306.85,103.4626,361,BlueCross BlueShield Minnesota,Medicare Advantage,176.89,49,,percent of total billed charges,,
Slp Eval Of Speech Fluency,,92521,CPT,Facility,Inpatient,,,GN,361,306.85,103.4626,361,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Slp Eval Of Speech Fluency,,92521,CPT,Facility,Both,,,GN,361,306.85,103.4626,361,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,319.7377,88.57,,percent of total billed charges,,
Slp Eval Of Speech Fluency,,92521,CPT,Facility,Both,,,GN,361,306.85,103.4626,361,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,103.4626,28.66,,percent of total billed charges,,
Slp Eval Of Speech Fluency,,92521,CPT,Facility,Outpatient,,,GN,361,306.85,103.4626,361,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),176.89,49,,percent of total billed charges,,
Slp Eval Of Speech Fluency,,92521,CPT,Facility,Inpatient,,,GN,361,306.85,103.4626,361,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Slp Eval Of Speech Fluency,,92521,CPT,Facility,Both,,,GN,361,306.85,103.4626,361,CorVel,Worker's Compensation,361,100,,percent of total billed charges,,
Slp Eval Of Speech Fluency,,92521,CPT,Facility,Both,,,GN,361,306.85,103.4626,361,First Health Group Corporation,First Health Network,350.17,97,,percent of total billed charges,,
Slp Eval Of Speech Fluency,,92521,CPT,Facility,Both,,,GN,361,306.85,103.4626,361,"Health Partners, Inc.",Commercial,341.506,94.6,,percent of total billed charges,,
Slp Eval Of Speech Fluency,,92521,CPT,Facility,Outpatient,,,GN,361,306.85,103.4626,361,"Health Partners, Inc.",Medicare Advantage,176.89,49,,percent of total billed charges,,
Slp Eval Of Speech Fluency,,92521,CPT,Facility,Inpatient,,,GN,361,306.85,103.4626,361,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Slp Eval Of Speech Fluency,,92521,CPT,Facility,Both,,,GN,361,306.85,103.4626,361,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),216.6,60,,percent of total billed charges,,
Slp Eval Of Speech Fluency,,92521,CPT,Facility,Both,,,GN,361,306.85,103.4626,361,"Health Partners, Inc.",State of Minnesota Advantage Program,294.215,81.5,,percent of total billed charges,,
Slp Eval Of Speech Fluency,,92521,CPT,Facility,Both,,,GN,361,306.85,103.4626,361,"Health Partners, Inc.",State Public Programs,180.5,50,,percent of total billed charges,,
Slp Eval Of Speech Fluency,,92521,CPT,Facility,Both,,,GN,361,306.85,103.4626,361,Humana Insurance Company,Commercial PPO,342.95,95,,percent of total billed charges,,
Slp Eval Of Speech Fluency,,92521,CPT,Facility,Outpatient,,,GN,361,306.85,103.4626,361,Humana Insurance Company,Medicare PPO,176.89,49,,percent of total billed charges,,
Slp Eval Of Speech Fluency,,92521,CPT,Facility,Inpatient,,,GN,361,306.85,103.4626,361,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Slp Eval Of Speech Fluency,,92521,CPT,Facility,Both,,,GN,361,306.85,103.4626,361,Medica,Individual & Family,357.751,99.1,,percent of total billed charges,,
Slp Eval Of Speech Fluency,,92521,CPT,Facility,Outpatient,,,GN,361,306.85,103.4626,361,Medica,Medica Advantage Solution,179.778,49.8,,percent of total billed charges,,
Slp Eval Of Speech Fluency,,92521,CPT,Facility,Inpatient,,,GN,361,306.85,103.4626,361,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Slp Eval Of Speech Fluency,,92521,CPT,Facility,Outpatient,,,GN,361,306.85,103.4626,361,Medica,Medical Assistance,161.006,44.6,,percent of total billed charges,,
Slp Eval Of Speech Fluency,,92521,CPT,Facility,Inpatient,,,GN,361,306.85,103.4626,361,Medica,Medical Assistance,,,,,Included in per diem rate,
Slp Eval Of Speech Fluency,,92521,CPT,Facility,Outpatient,,,GN,361,306.85,103.4626,361,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,179.778,49.8,,percent of total billed charges,,
Slp Eval Of Speech Fluency,,92521,CPT,Facility,Inpatient,,,GN,361,306.85,103.4626,361,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Slp Eval Of Speech Fluency,,92521,CPT,Facility,Both,,,GN,361,306.85,103.4626,361,"Multiplan, Inc.","Multiplan, Inc.",339.34,94,,percent of total billed charges,,
Slp Eval Of Speech Fluency,,92521,CPT,Facility,Outpatient,,,GN,361,306.85,103.4626,361,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,311.904,86.4,,percent of total billed charges,,
Slp Eval Of Speech Fluency,,92521,CPT,Facility,Inpatient,,,GN,361,306.85,103.4626,361,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Slp Eval Of Speech Fluency,,92521,CPT,Facility,Both,,,GN,361,306.85,103.4626,361,"Preferred One Administrative Services, INC.",PPO,355.946,98.6,,percent of total billed charges,,
Slp Eval Of Speech Fluency,,92521,CPT,Facility,Outpatient,,,GN,361,306.85,103.4626,361,PrimeWest Health,Minnesota Senior Health Options (MSHO),185.7345,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Slp Eval Of Speech Fluency,,92521,CPT,Facility,Inpatient,,,GN,361,306.85,103.4626,361,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Slp Eval Of Speech Fluency,,92521,CPT,Facility,Outpatient,,,GN,361,306.85,103.4626,361,PrimeWest Health,MinnesotaCare,185.4096,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Slp Eval Of Speech Fluency,,92521,CPT,Facility,Inpatient,,,GN,361,306.85,103.4626,361,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Slp Eval Of Speech Fluency,,92521,CPT,Facility,Both,,,GN,361,306.85,103.4626,361,Sanford Health Plan,Sanford Health Plan,332.12,92,,percent of total billed charges,,
Slp Eval Of Speech Fluency,,92521,CPT,Facility,Outpatient,,,GN,361,306.85,103.4626,361,"UCare Health, Inc.",Individual & Family Plan,203.4235,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Slp Eval Of Speech Fluency,,92521,CPT,Facility,Inpatient,,,GN,361,306.85,103.4626,361,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Slp Eval Of Speech Fluency,,92521,CPT,Facility,Outpatient,,,GN,361,306.85,103.4626,361,"UCare Health, Inc.",Medical Assistance,182.1967,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Slp Eval Of Speech Fluency,,92521,CPT,Facility,Inpatient,,,GN,361,306.85,103.4626,361,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Slp Eval Of Speech Fluency,,92521,CPT,Facility,Outpatient,,,GN,361,306.85,103.4626,361,"UCare Health, Inc.",Medicare Advantage,182.1967,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Slp Eval Of Speech Fluency,,92521,CPT,Facility,Inpatient,,,GN,361,306.85,103.4626,361,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Slp Eval Of Speech Fluency,,92521,CPT,Facility,Outpatient,,,GN,361,306.85,103.4626,361,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),182.1967,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Slp Eval Of Speech Fluency,,92521,CPT,Facility,Inpatient,,,GN,361,306.85,103.4626,361,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Slp Eval Of Speech Fluency,,92521,CPT,Facility,Both,,,GN,361,306.85,103.4626,361,UnitedHealthcare,Individual & Family,339.34,94,,percent of total billed charges,,
Slp Eval Of Speech Fluency,,92521,CPT,Facility,Outpatient,,,GN,361,306.85,103.4626,361,UnitedHealthcare,Medicare Advantage,176.89,49,,percent of total billed charges,,
Slp Eval Of Speech Fluency,,92521,CPT,Facility,Inpatient,,,GN,361,306.85,103.4626,361,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Slp Eval Of Speech Fluency,,92521,CPT,Facility,Outpatient,,,GN,361,306.85,103.4626,361,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,173.28,48,,percent of total billed charges,,100% of DHS outpatient percentage
Slp Eval Of Speech Fluency,,92521,CPT,Facility,Inpatient,,,GN,361,306.85,103.4626,361,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Slp Eval Of Speech Sound Production,,92522,CPT,Facility,Both,,,GN,361,306.85,103.4626,361,Aetna,Commercial,332.12,92,,percent of total billed charges,,
Slp Eval Of Speech Sound Production,,92522,CPT,Facility,Outpatient,,,GN,361,306.85,103.4626,361,Aetna,Medicare Advantage,176.89,49,,percent of total billed charges,,
Slp Eval Of Speech Sound Production,,92522,CPT,Facility,Inpatient,,,GN,361,306.85,103.4626,361,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Slp Eval Of Speech Sound Production,,92522,CPT,Facility,Both,,,GN,361,306.85,103.4626,361,Aetna,PPO,335.73,93,,percent of total billed charges,,
Slp Eval Of Speech Sound Production,,92522,CPT,Facility,Both,,,GN,361,306.85,103.4626,361,America's PPO,America's PPO,346.6683,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Slp Eval Of Speech Sound Production,,92522,CPT,Facility,Both,,,GN,361,306.85,103.4626,361,BlueCross BlueShield Minnesota, Federal Employee Program,355.224,98.4,,percent of total billed charges,,
Slp Eval Of Speech Sound Production,,92522,CPT,Facility,Both,,,GN,361,306.85,103.4626,361,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,361,100,,percent of total billed charges,,
Slp Eval Of Speech Sound Production,,92522,CPT,Facility,Both,,,GN,361,306.85,103.4626,361,BlueCross BlueShield Minnesota,High Value Network Plan,324.9,90,,percent of total billed charges,,
Slp Eval Of Speech Sound Production,,92522,CPT,Facility,Outpatient,,,GN,361,306.85,103.4626,361,BlueCross BlueShield Minnesota,Medicare Advantage,176.89,49,,percent of total billed charges,,
Slp Eval Of Speech Sound Production,,92522,CPT,Facility,Inpatient,,,GN,361,306.85,103.4626,361,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Slp Eval Of Speech Sound Production,,92522,CPT,Facility,Both,,,GN,361,306.85,103.4626,361,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,319.7377,88.57,,percent of total billed charges,,
Slp Eval Of Speech Sound Production,,92522,CPT,Facility,Both,,,GN,361,306.85,103.4626,361,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,103.4626,28.66,,percent of total billed charges,,
Slp Eval Of Speech Sound Production,,92522,CPT,Facility,Outpatient,,,GN,361,306.85,103.4626,361,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),176.89,49,,percent of total billed charges,,
Slp Eval Of Speech Sound Production,,92522,CPT,Facility,Inpatient,,,GN,361,306.85,103.4626,361,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Slp Eval Of Speech Sound Production,,92522,CPT,Facility,Both,,,GN,361,306.85,103.4626,361,CorVel,Worker's Compensation,361,100,,percent of total billed charges,,
Slp Eval Of Speech Sound Production,,92522,CPT,Facility,Both,,,GN,361,306.85,103.4626,361,First Health Group Corporation,First Health Network,350.17,97,,percent of total billed charges,,
Slp Eval Of Speech Sound Production,,92522,CPT,Facility,Both,,,GN,361,306.85,103.4626,361,"Health Partners, Inc.",Commercial,341.506,94.6,,percent of total billed charges,,
Slp Eval Of Speech Sound Production,,92522,CPT,Facility,Outpatient,,,GN,361,306.85,103.4626,361,"Health Partners, Inc.",Medicare Advantage,176.89,49,,percent of total billed charges,,
Slp Eval Of Speech Sound Production,,92522,CPT,Facility,Inpatient,,,GN,361,306.85,103.4626,361,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Slp Eval Of Speech Sound Production,,92522,CPT,Facility,Both,,,GN,361,306.85,103.4626,361,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),216.6,60,,percent of total billed charges,,
Slp Eval Of Speech Sound Production,,92522,CPT,Facility,Both,,,GN,361,306.85,103.4626,361,"Health Partners, Inc.",State of Minnesota Advantage Program,294.215,81.5,,percent of total billed charges,,
Slp Eval Of Speech Sound Production,,92522,CPT,Facility,Both,,,GN,361,306.85,103.4626,361,"Health Partners, Inc.",State Public Programs,180.5,50,,percent of total billed charges,,
Slp Eval Of Speech Sound Production,,92522,CPT,Facility,Both,,,GN,361,306.85,103.4626,361,Humana Insurance Company,Commercial PPO,342.95,95,,percent of total billed charges,,
Slp Eval Of Speech Sound Production,,92522,CPT,Facility,Outpatient,,,GN,361,306.85,103.4626,361,Humana Insurance Company,Medicare PPO,176.89,49,,percent of total billed charges,,
Slp Eval Of Speech Sound Production,,92522,CPT,Facility,Inpatient,,,GN,361,306.85,103.4626,361,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Slp Eval Of Speech Sound Production,,92522,CPT,Facility,Both,,,GN,361,306.85,103.4626,361,Medica,Individual & Family,357.751,99.1,,percent of total billed charges,,
Slp Eval Of Speech Sound Production,,92522,CPT,Facility,Outpatient,,,GN,361,306.85,103.4626,361,Medica,Medica Advantage Solution,179.778,49.8,,percent of total billed charges,,
Slp Eval Of Speech Sound Production,,92522,CPT,Facility,Inpatient,,,GN,361,306.85,103.4626,361,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Slp Eval Of Speech Sound Production,,92522,CPT,Facility,Outpatient,,,GN,361,306.85,103.4626,361,Medica,Medical Assistance,161.006,44.6,,percent of total billed charges,,
Slp Eval Of Speech Sound Production,,92522,CPT,Facility,Inpatient,,,GN,361,306.85,103.4626,361,Medica,Medical Assistance,,,,,Included in per diem rate,
Slp Eval Of Speech Sound Production,,92522,CPT,Facility,Outpatient,,,GN,361,306.85,103.4626,361,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,179.778,49.8,,percent of total billed charges,,
Slp Eval Of Speech Sound Production,,92522,CPT,Facility,Inpatient,,,GN,361,306.85,103.4626,361,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Slp Eval Of Speech Sound Production,,92522,CPT,Facility,Both,,,GN,361,306.85,103.4626,361,"Multiplan, Inc.","Multiplan, Inc.",339.34,94,,percent of total billed charges,,
Slp Eval Of Speech Sound Production,,92522,CPT,Facility,Outpatient,,,GN,361,306.85,103.4626,361,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,311.904,86.4,,percent of total billed charges,,
Slp Eval Of Speech Sound Production,,92522,CPT,Facility,Inpatient,,,GN,361,306.85,103.4626,361,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Slp Eval Of Speech Sound Production,,92522,CPT,Facility,Both,,,GN,361,306.85,103.4626,361,"Preferred One Administrative Services, INC.",PPO,355.946,98.6,,percent of total billed charges,,
Slp Eval Of Speech Sound Production,,92522,CPT,Facility,Outpatient,,,GN,361,306.85,103.4626,361,PrimeWest Health,Minnesota Senior Health Options (MSHO),185.7345,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Slp Eval Of Speech Sound Production,,92522,CPT,Facility,Inpatient,,,GN,361,306.85,103.4626,361,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Slp Eval Of Speech Sound Production,,92522,CPT,Facility,Outpatient,,,GN,361,306.85,103.4626,361,PrimeWest Health,MinnesotaCare,185.4096,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Slp Eval Of Speech Sound Production,,92522,CPT,Facility,Inpatient,,,GN,361,306.85,103.4626,361,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Slp Eval Of Speech Sound Production,,92522,CPT,Facility,Both,,,GN,361,306.85,103.4626,361,Sanford Health Plan,Sanford Health Plan,332.12,92,,percent of total billed charges,,
Slp Eval Of Speech Sound Production,,92522,CPT,Facility,Outpatient,,,GN,361,306.85,103.4626,361,"UCare Health, Inc.",Individual & Family Plan,203.4235,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Slp Eval Of Speech Sound Production,,92522,CPT,Facility,Inpatient,,,GN,361,306.85,103.4626,361,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Slp Eval Of Speech Sound Production,,92522,CPT,Facility,Outpatient,,,GN,361,306.85,103.4626,361,"UCare Health, Inc.",Medical Assistance,182.1967,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Slp Eval Of Speech Sound Production,,92522,CPT,Facility,Inpatient,,,GN,361,306.85,103.4626,361,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Slp Eval Of Speech Sound Production,,92522,CPT,Facility,Outpatient,,,GN,361,306.85,103.4626,361,"UCare Health, Inc.",Medicare Advantage,182.1967,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Slp Eval Of Speech Sound Production,,92522,CPT,Facility,Inpatient,,,GN,361,306.85,103.4626,361,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Slp Eval Of Speech Sound Production,,92522,CPT,Facility,Outpatient,,,GN,361,306.85,103.4626,361,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),182.1967,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Slp Eval Of Speech Sound Production,,92522,CPT,Facility,Inpatient,,,GN,361,306.85,103.4626,361,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Slp Eval Of Speech Sound Production,,92522,CPT,Facility,Both,,,GN,361,306.85,103.4626,361,UnitedHealthcare,Individual & Family,339.34,94,,percent of total billed charges,,
Slp Eval Of Speech Sound Production,,92522,CPT,Facility,Outpatient,,,GN,361,306.85,103.4626,361,UnitedHealthcare,Medicare Advantage,176.89,49,,percent of total billed charges,,
Slp Eval Of Speech Sound Production,,92522,CPT,Facility,Inpatient,,,GN,361,306.85,103.4626,361,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Slp Eval Of Speech Sound Production,,92522,CPT,Facility,Outpatient,,,GN,361,306.85,103.4626,361,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,173.28,48,,percent of total billed charges,,100% of DHS outpatient percentage
Slp Eval Of Speech Sound Production,,92522,CPT,Facility,Inpatient,,,GN,361,306.85,103.4626,361,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Slp Eval Of Speech Sound Production W/Eval Comp & Express,,92523,CPT,Facility,Both,,,GN,361,306.85,103.4626,361,Aetna,Commercial,332.12,92,,percent of total billed charges,,
Slp Eval Of Speech Sound Production W/Eval Comp & Express,,92523,CPT,Facility,Outpatient,,,GN,361,306.85,103.4626,361,Aetna,Medicare Advantage,176.89,49,,percent of total billed charges,,
Slp Eval Of Speech Sound Production W/Eval Comp & Express,,92523,CPT,Facility,Inpatient,,,GN,361,306.85,103.4626,361,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Slp Eval Of Speech Sound Production W/Eval Comp & Express,,92523,CPT,Facility,Both,,,GN,361,306.85,103.4626,361,Aetna,PPO,335.73,93,,percent of total billed charges,,
Slp Eval Of Speech Sound Production W/Eval Comp & Express,,92523,CPT,Facility,Both,,,GN,361,306.85,103.4626,361,America's PPO,America's PPO,346.6683,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Slp Eval Of Speech Sound Production W/Eval Comp & Express,,92523,CPT,Facility,Both,,,GN,361,306.85,103.4626,361,BlueCross BlueShield Minnesota, Federal Employee Program,355.224,98.4,,percent of total billed charges,,
Slp Eval Of Speech Sound Production W/Eval Comp & Express,,92523,CPT,Facility,Both,,,GN,361,306.85,103.4626,361,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,361,100,,percent of total billed charges,,
Slp Eval Of Speech Sound Production W/Eval Comp & Express,,92523,CPT,Facility,Both,,,GN,361,306.85,103.4626,361,BlueCross BlueShield Minnesota,High Value Network Plan,324.9,90,,percent of total billed charges,,
Slp Eval Of Speech Sound Production W/Eval Comp & Express,,92523,CPT,Facility,Outpatient,,,GN,361,306.85,103.4626,361,BlueCross BlueShield Minnesota,Medicare Advantage,176.89,49,,percent of total billed charges,,
Slp Eval Of Speech Sound Production W/Eval Comp & Express,,92523,CPT,Facility,Inpatient,,,GN,361,306.85,103.4626,361,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Slp Eval Of Speech Sound Production W/Eval Comp & Express,,92523,CPT,Facility,Both,,,GN,361,306.85,103.4626,361,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,319.7377,88.57,,percent of total billed charges,,
Slp Eval Of Speech Sound Production W/Eval Comp & Express,,92523,CPT,Facility,Both,,,GN,361,306.85,103.4626,361,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,103.4626,28.66,,percent of total billed charges,,
Slp Eval Of Speech Sound Production W/Eval Comp & Express,,92523,CPT,Facility,Outpatient,,,GN,361,306.85,103.4626,361,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),176.89,49,,percent of total billed charges,,
Slp Eval Of Speech Sound Production W/Eval Comp & Express,,92523,CPT,Facility,Inpatient,,,GN,361,306.85,103.4626,361,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Slp Eval Of Speech Sound Production W/Eval Comp & Express,,92523,CPT,Facility,Both,,,GN,361,306.85,103.4626,361,CorVel,Worker's Compensation,361,100,,percent of total billed charges,,
Slp Eval Of Speech Sound Production W/Eval Comp & Express,,92523,CPT,Facility,Both,,,GN,361,306.85,103.4626,361,First Health Group Corporation,First Health Network,350.17,97,,percent of total billed charges,,
Slp Eval Of Speech Sound Production W/Eval Comp & Express,,92523,CPT,Facility,Both,,,GN,361,306.85,103.4626,361,"Health Partners, Inc.",Commercial,341.506,94.6,,percent of total billed charges,,
Slp Eval Of Speech Sound Production W/Eval Comp & Express,,92523,CPT,Facility,Outpatient,,,GN,361,306.85,103.4626,361,"Health Partners, Inc.",Medicare Advantage,176.89,49,,percent of total billed charges,,
Slp Eval Of Speech Sound Production W/Eval Comp & Express,,92523,CPT,Facility,Inpatient,,,GN,361,306.85,103.4626,361,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Slp Eval Of Speech Sound Production W/Eval Comp & Express,,92523,CPT,Facility,Both,,,GN,361,306.85,103.4626,361,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),216.6,60,,percent of total billed charges,,
Slp Eval Of Speech Sound Production W/Eval Comp & Express,,92523,CPT,Facility,Both,,,GN,361,306.85,103.4626,361,"Health Partners, Inc.",State of Minnesota Advantage Program,294.215,81.5,,percent of total billed charges,,
Slp Eval Of Speech Sound Production W/Eval Comp & Express,,92523,CPT,Facility,Both,,,GN,361,306.85,103.4626,361,"Health Partners, Inc.",State Public Programs,180.5,50,,percent of total billed charges,,
Slp Eval Of Speech Sound Production W/Eval Comp & Express,,92523,CPT,Facility,Both,,,GN,361,306.85,103.4626,361,Humana Insurance Company,Commercial PPO,342.95,95,,percent of total billed charges,,
Slp Eval Of Speech Sound Production W/Eval Comp & Express,,92523,CPT,Facility,Outpatient,,,GN,361,306.85,103.4626,361,Humana Insurance Company,Medicare PPO,176.89,49,,percent of total billed charges,,
Slp Eval Of Speech Sound Production W/Eval Comp & Express,,92523,CPT,Facility,Inpatient,,,GN,361,306.85,103.4626,361,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Slp Eval Of Speech Sound Production W/Eval Comp & Express,,92523,CPT,Facility,Both,,,GN,361,306.85,103.4626,361,Medica,Individual & Family,357.751,99.1,,percent of total billed charges,,
Slp Eval Of Speech Sound Production W/Eval Comp & Express,,92523,CPT,Facility,Outpatient,,,GN,361,306.85,103.4626,361,Medica,Medica Advantage Solution,179.778,49.8,,percent of total billed charges,,
Slp Eval Of Speech Sound Production W/Eval Comp & Express,,92523,CPT,Facility,Inpatient,,,GN,361,306.85,103.4626,361,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Slp Eval Of Speech Sound Production W/Eval Comp & Express,,92523,CPT,Facility,Outpatient,,,GN,361,306.85,103.4626,361,Medica,Medical Assistance,161.006,44.6,,percent of total billed charges,,
Slp Eval Of Speech Sound Production W/Eval Comp & Express,,92523,CPT,Facility,Inpatient,,,GN,361,306.85,103.4626,361,Medica,Medical Assistance,,,,,Included in per diem rate,
Slp Eval Of Speech Sound Production W/Eval Comp & Express,,92523,CPT,Facility,Outpatient,,,GN,361,306.85,103.4626,361,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,179.778,49.8,,percent of total billed charges,,
Slp Eval Of Speech Sound Production W/Eval Comp & Express,,92523,CPT,Facility,Inpatient,,,GN,361,306.85,103.4626,361,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Slp Eval Of Speech Sound Production W/Eval Comp & Express,,92523,CPT,Facility,Both,,,GN,361,306.85,103.4626,361,"Multiplan, Inc.","Multiplan, Inc.",339.34,94,,percent of total billed charges,,
Slp Eval Of Speech Sound Production W/Eval Comp & Express,,92523,CPT,Facility,Outpatient,,,GN,361,306.85,103.4626,361,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,311.904,86.4,,percent of total billed charges,,
Slp Eval Of Speech Sound Production W/Eval Comp & Express,,92523,CPT,Facility,Inpatient,,,GN,361,306.85,103.4626,361,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Slp Eval Of Speech Sound Production W/Eval Comp & Express,,92523,CPT,Facility,Both,,,GN,361,306.85,103.4626,361,"Preferred One Administrative Services, INC.",PPO,355.946,98.6,,percent of total billed charges,,
Slp Eval Of Speech Sound Production W/Eval Comp & Express,,92523,CPT,Facility,Outpatient,,,GN,361,306.85,103.4626,361,PrimeWest Health,Minnesota Senior Health Options (MSHO),185.7345,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Slp Eval Of Speech Sound Production W/Eval Comp & Express,,92523,CPT,Facility,Inpatient,,,GN,361,306.85,103.4626,361,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Slp Eval Of Speech Sound Production W/Eval Comp & Express,,92523,CPT,Facility,Outpatient,,,GN,361,306.85,103.4626,361,PrimeWest Health,MinnesotaCare,185.4096,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Slp Eval Of Speech Sound Production W/Eval Comp & Express,,92523,CPT,Facility,Inpatient,,,GN,361,306.85,103.4626,361,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Slp Eval Of Speech Sound Production W/Eval Comp & Express,,92523,CPT,Facility,Both,,,GN,361,306.85,103.4626,361,Sanford Health Plan,Sanford Health Plan,332.12,92,,percent of total billed charges,,
Slp Eval Of Speech Sound Production W/Eval Comp & Express,,92523,CPT,Facility,Outpatient,,,GN,361,306.85,103.4626,361,"UCare Health, Inc.",Individual & Family Plan,203.4235,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Slp Eval Of Speech Sound Production W/Eval Comp & Express,,92523,CPT,Facility,Inpatient,,,GN,361,306.85,103.4626,361,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Slp Eval Of Speech Sound Production W/Eval Comp & Express,,92523,CPT,Facility,Outpatient,,,GN,361,306.85,103.4626,361,"UCare Health, Inc.",Medical Assistance,182.1967,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Slp Eval Of Speech Sound Production W/Eval Comp & Express,,92523,CPT,Facility,Inpatient,,,GN,361,306.85,103.4626,361,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Slp Eval Of Speech Sound Production W/Eval Comp & Express,,92523,CPT,Facility,Outpatient,,,GN,361,306.85,103.4626,361,"UCare Health, Inc.",Medicare Advantage,182.1967,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Slp Eval Of Speech Sound Production W/Eval Comp & Express,,92523,CPT,Facility,Inpatient,,,GN,361,306.85,103.4626,361,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Slp Eval Of Speech Sound Production W/Eval Comp & Express,,92523,CPT,Facility,Outpatient,,,GN,361,306.85,103.4626,361,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),182.1967,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Slp Eval Of Speech Sound Production W/Eval Comp & Express,,92523,CPT,Facility,Inpatient,,,GN,361,306.85,103.4626,361,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Slp Eval Of Speech Sound Production W/Eval Comp & Express,,92523,CPT,Facility,Both,,,GN,361,306.85,103.4626,361,UnitedHealthcare,Individual & Family,339.34,94,,percent of total billed charges,,
Slp Eval Of Speech Sound Production W/Eval Comp & Express,,92523,CPT,Facility,Outpatient,,,GN,361,306.85,103.4626,361,UnitedHealthcare,Medicare Advantage,176.89,49,,percent of total billed charges,,
Slp Eval Of Speech Sound Production W/Eval Comp & Express,,92523,CPT,Facility,Inpatient,,,GN,361,306.85,103.4626,361,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Slp Eval Of Speech Sound Production W/Eval Comp & Express,,92523,CPT,Facility,Outpatient,,,GN,361,306.85,103.4626,361,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,173.28,48,,percent of total billed charges,,100% of DHS outpatient percentage
Slp Eval Of Speech Sound Production W/Eval Comp & Express,,92523,CPT,Facility,Inpatient,,,GN,361,306.85,103.4626,361,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Slp Behavioral & Qualitative Analysis Of Voice & Resonance,,92524,CPT,Facility,Both,,,GN,361,306.85,103.4626,361,Aetna,Commercial,332.12,92,,percent of total billed charges,,
Slp Behavioral & Qualitative Analysis Of Voice & Resonance,,92524,CPT,Facility,Outpatient,,,GN,361,306.85,103.4626,361,Aetna,Medicare Advantage,176.89,49,,percent of total billed charges,,
Slp Behavioral & Qualitative Analysis Of Voice & Resonance,,92524,CPT,Facility,Inpatient,,,GN,361,306.85,103.4626,361,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Slp Behavioral & Qualitative Analysis Of Voice & Resonance,,92524,CPT,Facility,Both,,,GN,361,306.85,103.4626,361,Aetna,PPO,335.73,93,,percent of total billed charges,,
Slp Behavioral & Qualitative Analysis Of Voice & Resonance,,92524,CPT,Facility,Both,,,GN,361,306.85,103.4626,361,America's PPO,America's PPO,346.6683,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Slp Behavioral & Qualitative Analysis Of Voice & Resonance,,92524,CPT,Facility,Both,,,GN,361,306.85,103.4626,361,BlueCross BlueShield Minnesota, Federal Employee Program,355.224,98.4,,percent of total billed charges,,
Slp Behavioral & Qualitative Analysis Of Voice & Resonance,,92524,CPT,Facility,Both,,,GN,361,306.85,103.4626,361,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,361,100,,percent of total billed charges,,
Slp Behavioral & Qualitative Analysis Of Voice & Resonance,,92524,CPT,Facility,Both,,,GN,361,306.85,103.4626,361,BlueCross BlueShield Minnesota,High Value Network Plan,324.9,90,,percent of total billed charges,,
Slp Behavioral & Qualitative Analysis Of Voice & Resonance,,92524,CPT,Facility,Outpatient,,,GN,361,306.85,103.4626,361,BlueCross BlueShield Minnesota,Medicare Advantage,176.89,49,,percent of total billed charges,,
Slp Behavioral & Qualitative Analysis Of Voice & Resonance,,92524,CPT,Facility,Inpatient,,,GN,361,306.85,103.4626,361,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Slp Behavioral & Qualitative Analysis Of Voice & Resonance,,92524,CPT,Facility,Both,,,GN,361,306.85,103.4626,361,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,319.7377,88.57,,percent of total billed charges,,
Slp Behavioral & Qualitative Analysis Of Voice & Resonance,,92524,CPT,Facility,Both,,,GN,361,306.85,103.4626,361,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,103.4626,28.66,,percent of total billed charges,,
Slp Behavioral & Qualitative Analysis Of Voice & Resonance,,92524,CPT,Facility,Outpatient,,,GN,361,306.85,103.4626,361,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),176.89,49,,percent of total billed charges,,
Slp Behavioral & Qualitative Analysis Of Voice & Resonance,,92524,CPT,Facility,Inpatient,,,GN,361,306.85,103.4626,361,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Slp Behavioral & Qualitative Analysis Of Voice & Resonance,,92524,CPT,Facility,Both,,,GN,361,306.85,103.4626,361,CorVel,Worker's Compensation,361,100,,percent of total billed charges,,
Slp Behavioral & Qualitative Analysis Of Voice & Resonance,,92524,CPT,Facility,Both,,,GN,361,306.85,103.4626,361,First Health Group Corporation,First Health Network,350.17,97,,percent of total billed charges,,
Slp Behavioral & Qualitative Analysis Of Voice & Resonance,,92524,CPT,Facility,Both,,,GN,361,306.85,103.4626,361,"Health Partners, Inc.",Commercial,341.506,94.6,,percent of total billed charges,,
Slp Behavioral & Qualitative Analysis Of Voice & Resonance,,92524,CPT,Facility,Outpatient,,,GN,361,306.85,103.4626,361,"Health Partners, Inc.",Medicare Advantage,176.89,49,,percent of total billed charges,,
Slp Behavioral & Qualitative Analysis Of Voice & Resonance,,92524,CPT,Facility,Inpatient,,,GN,361,306.85,103.4626,361,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Slp Behavioral & Qualitative Analysis Of Voice & Resonance,,92524,CPT,Facility,Both,,,GN,361,306.85,103.4626,361,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),216.6,60,,percent of total billed charges,,
Slp Behavioral & Qualitative Analysis Of Voice & Resonance,,92524,CPT,Facility,Both,,,GN,361,306.85,103.4626,361,"Health Partners, Inc.",State of Minnesota Advantage Program,294.215,81.5,,percent of total billed charges,,
Slp Behavioral & Qualitative Analysis Of Voice & Resonance,,92524,CPT,Facility,Both,,,GN,361,306.85,103.4626,361,"Health Partners, Inc.",State Public Programs,180.5,50,,percent of total billed charges,,
Slp Behavioral & Qualitative Analysis Of Voice & Resonance,,92524,CPT,Facility,Both,,,GN,361,306.85,103.4626,361,Humana Insurance Company,Commercial PPO,342.95,95,,percent of total billed charges,,
Slp Behavioral & Qualitative Analysis Of Voice & Resonance,,92524,CPT,Facility,Outpatient,,,GN,361,306.85,103.4626,361,Humana Insurance Company,Medicare PPO,176.89,49,,percent of total billed charges,,
Slp Behavioral & Qualitative Analysis Of Voice & Resonance,,92524,CPT,Facility,Inpatient,,,GN,361,306.85,103.4626,361,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Slp Behavioral & Qualitative Analysis Of Voice & Resonance,,92524,CPT,Facility,Both,,,GN,361,306.85,103.4626,361,Medica,Individual & Family,357.751,99.1,,percent of total billed charges,,
Slp Behavioral & Qualitative Analysis Of Voice & Resonance,,92524,CPT,Facility,Outpatient,,,GN,361,306.85,103.4626,361,Medica,Medica Advantage Solution,179.778,49.8,,percent of total billed charges,,
Slp Behavioral & Qualitative Analysis Of Voice & Resonance,,92524,CPT,Facility,Inpatient,,,GN,361,306.85,103.4626,361,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Slp Behavioral & Qualitative Analysis Of Voice & Resonance,,92524,CPT,Facility,Outpatient,,,GN,361,306.85,103.4626,361,Medica,Medical Assistance,161.006,44.6,,percent of total billed charges,,
Slp Behavioral & Qualitative Analysis Of Voice & Resonance,,92524,CPT,Facility,Inpatient,,,GN,361,306.85,103.4626,361,Medica,Medical Assistance,,,,,Included in per diem rate,
Slp Behavioral & Qualitative Analysis Of Voice & Resonance,,92524,CPT,Facility,Outpatient,,,GN,361,306.85,103.4626,361,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,179.778,49.8,,percent of total billed charges,,
Slp Behavioral & Qualitative Analysis Of Voice & Resonance,,92524,CPT,Facility,Inpatient,,,GN,361,306.85,103.4626,361,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Slp Behavioral & Qualitative Analysis Of Voice & Resonance,,92524,CPT,Facility,Both,,,GN,361,306.85,103.4626,361,"Multiplan, Inc.","Multiplan, Inc.",339.34,94,,percent of total billed charges,,
Slp Behavioral & Qualitative Analysis Of Voice & Resonance,,92524,CPT,Facility,Outpatient,,,GN,361,306.85,103.4626,361,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,311.904,86.4,,percent of total billed charges,,
Slp Behavioral & Qualitative Analysis Of Voice & Resonance,,92524,CPT,Facility,Inpatient,,,GN,361,306.85,103.4626,361,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Slp Behavioral & Qualitative Analysis Of Voice & Resonance,,92524,CPT,Facility,Both,,,GN,361,306.85,103.4626,361,"Preferred One Administrative Services, INC.",PPO,355.946,98.6,,percent of total billed charges,,
Slp Behavioral & Qualitative Analysis Of Voice & Resonance,,92524,CPT,Facility,Outpatient,,,GN,361,306.85,103.4626,361,PrimeWest Health,Minnesota Senior Health Options (MSHO),185.7345,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Slp Behavioral & Qualitative Analysis Of Voice & Resonance,,92524,CPT,Facility,Inpatient,,,GN,361,306.85,103.4626,361,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Slp Behavioral & Qualitative Analysis Of Voice & Resonance,,92524,CPT,Facility,Outpatient,,,GN,361,306.85,103.4626,361,PrimeWest Health,MinnesotaCare,185.4096,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Slp Behavioral & Qualitative Analysis Of Voice & Resonance,,92524,CPT,Facility,Inpatient,,,GN,361,306.85,103.4626,361,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Slp Behavioral & Qualitative Analysis Of Voice & Resonance,,92524,CPT,Facility,Both,,,GN,361,306.85,103.4626,361,Sanford Health Plan,Sanford Health Plan,332.12,92,,percent of total billed charges,,
Slp Behavioral & Qualitative Analysis Of Voice & Resonance,,92524,CPT,Facility,Outpatient,,,GN,361,306.85,103.4626,361,"UCare Health, Inc.",Individual & Family Plan,203.4235,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Slp Behavioral & Qualitative Analysis Of Voice & Resonance,,92524,CPT,Facility,Inpatient,,,GN,361,306.85,103.4626,361,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Slp Behavioral & Qualitative Analysis Of Voice & Resonance,,92524,CPT,Facility,Outpatient,,,GN,361,306.85,103.4626,361,"UCare Health, Inc.",Medical Assistance,182.1967,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Slp Behavioral & Qualitative Analysis Of Voice & Resonance,,92524,CPT,Facility,Inpatient,,,GN,361,306.85,103.4626,361,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Slp Behavioral & Qualitative Analysis Of Voice & Resonance,,92524,CPT,Facility,Outpatient,,,GN,361,306.85,103.4626,361,"UCare Health, Inc.",Medicare Advantage,182.1967,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Slp Behavioral & Qualitative Analysis Of Voice & Resonance,,92524,CPT,Facility,Inpatient,,,GN,361,306.85,103.4626,361,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Slp Behavioral & Qualitative Analysis Of Voice & Resonance,,92524,CPT,Facility,Outpatient,,,GN,361,306.85,103.4626,361,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),182.1967,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Slp Behavioral & Qualitative Analysis Of Voice & Resonance,,92524,CPT,Facility,Inpatient,,,GN,361,306.85,103.4626,361,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Slp Behavioral & Qualitative Analysis Of Voice & Resonance,,92524,CPT,Facility,Both,,,GN,361,306.85,103.4626,361,UnitedHealthcare,Individual & Family,339.34,94,,percent of total billed charges,,
Slp Behavioral & Qualitative Analysis Of Voice & Resonance,,92524,CPT,Facility,Outpatient,,,GN,361,306.85,103.4626,361,UnitedHealthcare,Medicare Advantage,176.89,49,,percent of total billed charges,,
Slp Behavioral & Qualitative Analysis Of Voice & Resonance,,92524,CPT,Facility,Inpatient,,,GN,361,306.85,103.4626,361,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Slp Behavioral & Qualitative Analysis Of Voice & Resonance,,92524,CPT,Facility,Outpatient,,,GN,361,306.85,103.4626,361,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,173.28,48,,percent of total billed charges,,100% of DHS outpatient percentage
Slp Behavioral & Qualitative Analysis Of Voice & Resonance,,92524,CPT,Facility,Inpatient,,,GN,361,306.85,103.4626,361,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Slp Treatment Of Swallow (Session For 43000080),,92526,CPT,Facility,Both,,,GN,281,238.85,80.5346,281,Aetna,Commercial,258.52,92,,percent of total billed charges,,
Slp Treatment Of Swallow (Session For 43000080),,92526,CPT,Facility,Outpatient,,,GN,281,238.85,80.5346,281,Aetna,Medicare Advantage,137.69,49,,percent of total billed charges,,
Slp Treatment Of Swallow (Session For 43000080),,92526,CPT,Facility,Inpatient,,,GN,281,238.85,80.5346,281,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Slp Treatment Of Swallow (Session For 43000080),,92526,CPT,Facility,Both,,,GN,281,238.85,80.5346,281,Aetna,PPO,261.33,93,,percent of total billed charges,,
Slp Treatment Of Swallow (Session For 43000080),,92526,CPT,Facility,Both,,,GN,281,238.85,80.5346,281,America's PPO,America's PPO,269.8443,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Slp Treatment Of Swallow (Session For 43000080),,92526,CPT,Facility,Both,,,GN,281,238.85,80.5346,281,BlueCross BlueShield Minnesota, Federal Employee Program,276.504,98.4,,percent of total billed charges,,
Slp Treatment Of Swallow (Session For 43000080),,92526,CPT,Facility,Both,,,GN,281,238.85,80.5346,281,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,281,100,,percent of total billed charges,,
Slp Treatment Of Swallow (Session For 43000080),,92526,CPT,Facility,Both,,,GN,281,238.85,80.5346,281,BlueCross BlueShield Minnesota,High Value Network Plan,252.9,90,,percent of total billed charges,,
Slp Treatment Of Swallow (Session For 43000080),,92526,CPT,Facility,Outpatient,,,GN,281,238.85,80.5346,281,BlueCross BlueShield Minnesota,Medicare Advantage,137.69,49,,percent of total billed charges,,
Slp Treatment Of Swallow (Session For 43000080),,92526,CPT,Facility,Inpatient,,,GN,281,238.85,80.5346,281,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Slp Treatment Of Swallow (Session For 43000080),,92526,CPT,Facility,Both,,,GN,281,238.85,80.5346,281,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,248.8817,88.57,,percent of total billed charges,,
Slp Treatment Of Swallow (Session For 43000080),,92526,CPT,Facility,Both,,,GN,281,238.85,80.5346,281,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,80.5346,28.66,,percent of total billed charges,,
Slp Treatment Of Swallow (Session For 43000080),,92526,CPT,Facility,Outpatient,,,GN,281,238.85,80.5346,281,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),137.69,49,,percent of total billed charges,,
Slp Treatment Of Swallow (Session For 43000080),,92526,CPT,Facility,Inpatient,,,GN,281,238.85,80.5346,281,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Slp Treatment Of Swallow (Session For 43000080),,92526,CPT,Facility,Both,,,GN,281,238.85,80.5346,281,CorVel,Worker's Compensation,281,100,,percent of total billed charges,,
Slp Treatment Of Swallow (Session For 43000080),,92526,CPT,Facility,Both,,,GN,281,238.85,80.5346,281,First Health Group Corporation,First Health Network,272.57,97,,percent of total billed charges,,
Slp Treatment Of Swallow (Session For 43000080),,92526,CPT,Facility,Both,,,GN,281,238.85,80.5346,281,"Health Partners, Inc.",Commercial,265.826,94.6,,percent of total billed charges,,
Slp Treatment Of Swallow (Session For 43000080),,92526,CPT,Facility,Outpatient,,,GN,281,238.85,80.5346,281,"Health Partners, Inc.",Medicare Advantage,137.69,49,,percent of total billed charges,,
Slp Treatment Of Swallow (Session For 43000080),,92526,CPT,Facility,Inpatient,,,GN,281,238.85,80.5346,281,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Slp Treatment Of Swallow (Session For 43000080),,92526,CPT,Facility,Both,,,GN,281,238.85,80.5346,281,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),168.6,60,,percent of total billed charges,,
Slp Treatment Of Swallow (Session For 43000080),,92526,CPT,Facility,Both,,,GN,281,238.85,80.5346,281,"Health Partners, Inc.",State of Minnesota Advantage Program,229.015,81.5,,percent of total billed charges,,
Slp Treatment Of Swallow (Session For 43000080),,92526,CPT,Facility,Both,,,GN,281,238.85,80.5346,281,"Health Partners, Inc.",State Public Programs,140.5,50,,percent of total billed charges,,
Slp Treatment Of Swallow (Session For 43000080),,92526,CPT,Facility,Both,,,GN,281,238.85,80.5346,281,Humana Insurance Company,Commercial PPO,266.95,95,,percent of total billed charges,,
Slp Treatment Of Swallow (Session For 43000080),,92526,CPT,Facility,Outpatient,,,GN,281,238.85,80.5346,281,Humana Insurance Company,Medicare PPO,137.69,49,,percent of total billed charges,,
Slp Treatment Of Swallow (Session For 43000080),,92526,CPT,Facility,Inpatient,,,GN,281,238.85,80.5346,281,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Slp Treatment Of Swallow (Session For 43000080),,92526,CPT,Facility,Both,,,GN,281,238.85,80.5346,281,Medica,Individual & Family,278.471,99.1,,percent of total billed charges,,
Slp Treatment Of Swallow (Session For 43000080),,92526,CPT,Facility,Outpatient,,,GN,281,238.85,80.5346,281,Medica,Medica Advantage Solution,139.938,49.8,,percent of total billed charges,,
Slp Treatment Of Swallow (Session For 43000080),,92526,CPT,Facility,Inpatient,,,GN,281,238.85,80.5346,281,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Slp Treatment Of Swallow (Session For 43000080),,92526,CPT,Facility,Outpatient,,,GN,281,238.85,80.5346,281,Medica,Medical Assistance,125.326,44.6,,percent of total billed charges,,
Slp Treatment Of Swallow (Session For 43000080),,92526,CPT,Facility,Inpatient,,,GN,281,238.85,80.5346,281,Medica,Medical Assistance,,,,,Included in per diem rate,
Slp Treatment Of Swallow (Session For 43000080),,92526,CPT,Facility,Outpatient,,,GN,281,238.85,80.5346,281,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,139.938,49.8,,percent of total billed charges,,
Slp Treatment Of Swallow (Session For 43000080),,92526,CPT,Facility,Inpatient,,,GN,281,238.85,80.5346,281,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Slp Treatment Of Swallow (Session For 43000080),,92526,CPT,Facility,Both,,,GN,281,238.85,80.5346,281,"Multiplan, Inc.","Multiplan, Inc.",264.14,94,,percent of total billed charges,,
Slp Treatment Of Swallow (Session For 43000080),,92526,CPT,Facility,Outpatient,,,GN,281,238.85,80.5346,281,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,242.784,86.4,,percent of total billed charges,,
Slp Treatment Of Swallow (Session For 43000080),,92526,CPT,Facility,Inpatient,,,GN,281,238.85,80.5346,281,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Slp Treatment Of Swallow (Session For 43000080),,92526,CPT,Facility,Both,,,GN,281,238.85,80.5346,281,"Preferred One Administrative Services, INC.",PPO,277.066,98.6,,percent of total billed charges,,
Slp Treatment Of Swallow (Session For 43000080),,92526,CPT,Facility,Outpatient,,,GN,281,238.85,80.5346,281,PrimeWest Health,Minnesota Senior Health Options (MSHO),144.5745,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Slp Treatment Of Swallow (Session For 43000080),,92526,CPT,Facility,Inpatient,,,GN,281,238.85,80.5346,281,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Slp Treatment Of Swallow (Session For 43000080),,92526,CPT,Facility,Outpatient,,,GN,281,238.85,80.5346,281,PrimeWest Health,MinnesotaCare,144.3216,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Slp Treatment Of Swallow (Session For 43000080),,92526,CPT,Facility,Inpatient,,,GN,281,238.85,80.5346,281,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Slp Treatment Of Swallow (Session For 43000080),,92526,CPT,Facility,Both,,,GN,281,238.85,80.5346,281,Sanford Health Plan,Sanford Health Plan,258.52,92,,percent of total billed charges,,
Slp Treatment Of Swallow (Session For 43000080),,92526,CPT,Facility,Outpatient,,,GN,281,238.85,80.5346,281,"UCare Health, Inc.",Individual & Family Plan,158.3435,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Slp Treatment Of Swallow (Session For 43000080),,92526,CPT,Facility,Inpatient,,,GN,281,238.85,80.5346,281,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Slp Treatment Of Swallow (Session For 43000080),,92526,CPT,Facility,Outpatient,,,GN,281,238.85,80.5346,281,"UCare Health, Inc.",Medical Assistance,141.8207,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Slp Treatment Of Swallow (Session For 43000080),,92526,CPT,Facility,Inpatient,,,GN,281,238.85,80.5346,281,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Slp Treatment Of Swallow (Session For 43000080),,92526,CPT,Facility,Outpatient,,,GN,281,238.85,80.5346,281,"UCare Health, Inc.",Medicare Advantage,141.8207,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Slp Treatment Of Swallow (Session For 43000080),,92526,CPT,Facility,Inpatient,,,GN,281,238.85,80.5346,281,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Slp Treatment Of Swallow (Session For 43000080),,92526,CPT,Facility,Outpatient,,,GN,281,238.85,80.5346,281,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),141.8207,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Slp Treatment Of Swallow (Session For 43000080),,92526,CPT,Facility,Inpatient,,,GN,281,238.85,80.5346,281,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Slp Treatment Of Swallow (Session For 43000080),,92526,CPT,Facility,Both,,,GN,281,238.85,80.5346,281,UnitedHealthcare,Individual & Family,264.14,94,,percent of total billed charges,,
Slp Treatment Of Swallow (Session For 43000080),,92526,CPT,Facility,Outpatient,,,GN,281,238.85,80.5346,281,UnitedHealthcare,Medicare Advantage,137.69,49,,percent of total billed charges,,
Slp Treatment Of Swallow (Session For 43000080),,92526,CPT,Facility,Inpatient,,,GN,281,238.85,80.5346,281,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Slp Treatment Of Swallow (Session For 43000080),,92526,CPT,Facility,Outpatient,,,GN,281,238.85,80.5346,281,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,134.88,48,,percent of total billed charges,,100% of DHS outpatient percentage
Slp Treatment Of Swallow (Session For 43000080),,92526,CPT,Facility,Inpatient,,,GN,281,238.85,80.5346,281,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Slp Eval Voice Prosth Device,,92597,CPT,Facility,Both,,,GN,347,294.95,99.4502,347,Aetna,Commercial,319.24,92,,percent of total billed charges,,
Slp Eval Voice Prosth Device,,92597,CPT,Facility,Outpatient,,,GN,347,294.95,99.4502,347,Aetna,Medicare Advantage,170.03,49,,percent of total billed charges,,
Slp Eval Voice Prosth Device,,92597,CPT,Facility,Inpatient,,,GN,347,294.95,99.4502,347,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Slp Eval Voice Prosth Device,,92597,CPT,Facility,Both,,,GN,347,294.95,99.4502,347,Aetna,PPO,322.71,93,,percent of total billed charges,,
Slp Eval Voice Prosth Device,,92597,CPT,Facility,Both,,,GN,347,294.95,99.4502,347,America's PPO,America's PPO,333.2241,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Slp Eval Voice Prosth Device,,92597,CPT,Facility,Both,,,GN,347,294.95,99.4502,347,BlueCross BlueShield Minnesota, Federal Employee Program,341.448,98.4,,percent of total billed charges,,
Slp Eval Voice Prosth Device,,92597,CPT,Facility,Both,,,GN,347,294.95,99.4502,347,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,347,100,,percent of total billed charges,,
Slp Eval Voice Prosth Device,,92597,CPT,Facility,Both,,,GN,347,294.95,99.4502,347,BlueCross BlueShield Minnesota,High Value Network Plan,312.3,90,,percent of total billed charges,,
Slp Eval Voice Prosth Device,,92597,CPT,Facility,Outpatient,,,GN,347,294.95,99.4502,347,BlueCross BlueShield Minnesota,Medicare Advantage,170.03,49,,percent of total billed charges,,
Slp Eval Voice Prosth Device,,92597,CPT,Facility,Inpatient,,,GN,347,294.95,99.4502,347,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Slp Eval Voice Prosth Device,,92597,CPT,Facility,Both,,,GN,347,294.95,99.4502,347,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,307.3379,88.57,,percent of total billed charges,,
Slp Eval Voice Prosth Device,,92597,CPT,Facility,Both,,,GN,347,294.95,99.4502,347,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,99.4502,28.66,,percent of total billed charges,,
Slp Eval Voice Prosth Device,,92597,CPT,Facility,Outpatient,,,GN,347,294.95,99.4502,347,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),170.03,49,,percent of total billed charges,,
Slp Eval Voice Prosth Device,,92597,CPT,Facility,Inpatient,,,GN,347,294.95,99.4502,347,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Slp Eval Voice Prosth Device,,92597,CPT,Facility,Both,,,GN,347,294.95,99.4502,347,CorVel,Worker's Compensation,347,100,,percent of total billed charges,,
Slp Eval Voice Prosth Device,,92597,CPT,Facility,Both,,,GN,347,294.95,99.4502,347,First Health Group Corporation,First Health Network,336.59,97,,percent of total billed charges,,
Slp Eval Voice Prosth Device,,92597,CPT,Facility,Both,,,GN,347,294.95,99.4502,347,"Health Partners, Inc.",Commercial,328.262,94.6,,percent of total billed charges,,
Slp Eval Voice Prosth Device,,92597,CPT,Facility,Outpatient,,,GN,347,294.95,99.4502,347,"Health Partners, Inc.",Medicare Advantage,170.03,49,,percent of total billed charges,,
Slp Eval Voice Prosth Device,,92597,CPT,Facility,Inpatient,,,GN,347,294.95,99.4502,347,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Slp Eval Voice Prosth Device,,92597,CPT,Facility,Both,,,GN,347,294.95,99.4502,347,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),208.2,60,,percent of total billed charges,,
Slp Eval Voice Prosth Device,,92597,CPT,Facility,Both,,,GN,347,294.95,99.4502,347,"Health Partners, Inc.",State of Minnesota Advantage Program,282.805,81.5,,percent of total billed charges,,
Slp Eval Voice Prosth Device,,92597,CPT,Facility,Both,,,GN,347,294.95,99.4502,347,"Health Partners, Inc.",State Public Programs,173.5,50,,percent of total billed charges,,
Slp Eval Voice Prosth Device,,92597,CPT,Facility,Both,,,GN,347,294.95,99.4502,347,Humana Insurance Company,Commercial PPO,329.65,95,,percent of total billed charges,,
Slp Eval Voice Prosth Device,,92597,CPT,Facility,Outpatient,,,GN,347,294.95,99.4502,347,Humana Insurance Company,Medicare PPO,170.03,49,,percent of total billed charges,,
Slp Eval Voice Prosth Device,,92597,CPT,Facility,Inpatient,,,GN,347,294.95,99.4502,347,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Slp Eval Voice Prosth Device,,92597,CPT,Facility,Both,,,GN,347,294.95,99.4502,347,Medica,Individual & Family,343.877,99.1,,percent of total billed charges,,
Slp Eval Voice Prosth Device,,92597,CPT,Facility,Outpatient,,,GN,347,294.95,99.4502,347,Medica,Medica Advantage Solution,172.806,49.8,,percent of total billed charges,,
Slp Eval Voice Prosth Device,,92597,CPT,Facility,Inpatient,,,GN,347,294.95,99.4502,347,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Slp Eval Voice Prosth Device,,92597,CPT,Facility,Outpatient,,,GN,347,294.95,99.4502,347,Medica,Medical Assistance,154.762,44.6,,percent of total billed charges,,
Slp Eval Voice Prosth Device,,92597,CPT,Facility,Inpatient,,,GN,347,294.95,99.4502,347,Medica,Medical Assistance,,,,,Included in per diem rate,
Slp Eval Voice Prosth Device,,92597,CPT,Facility,Outpatient,,,GN,347,294.95,99.4502,347,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,172.806,49.8,,percent of total billed charges,,
Slp Eval Voice Prosth Device,,92597,CPT,Facility,Inpatient,,,GN,347,294.95,99.4502,347,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Slp Eval Voice Prosth Device,,92597,CPT,Facility,Both,,,GN,347,294.95,99.4502,347,"Multiplan, Inc.","Multiplan, Inc.",326.18,94,,percent of total billed charges,,
Slp Eval Voice Prosth Device,,92597,CPT,Facility,Outpatient,,,GN,347,294.95,99.4502,347,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,299.808,86.4,,percent of total billed charges,,
Slp Eval Voice Prosth Device,,92597,CPT,Facility,Inpatient,,,GN,347,294.95,99.4502,347,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Slp Eval Voice Prosth Device,,92597,CPT,Facility,Both,,,GN,347,294.95,99.4502,347,"Preferred One Administrative Services, INC.",PPO,342.142,98.6,,percent of total billed charges,,
Slp Eval Voice Prosth Device,,92597,CPT,Facility,Outpatient,,,GN,347,294.95,99.4502,347,PrimeWest Health,Minnesota Senior Health Options (MSHO),178.5315,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Slp Eval Voice Prosth Device,,92597,CPT,Facility,Inpatient,,,GN,347,294.95,99.4502,347,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Slp Eval Voice Prosth Device,,92597,CPT,Facility,Outpatient,,,GN,347,294.95,99.4502,347,PrimeWest Health,MinnesotaCare,178.2192,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Slp Eval Voice Prosth Device,,92597,CPT,Facility,Inpatient,,,GN,347,294.95,99.4502,347,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Slp Eval Voice Prosth Device,,92597,CPT,Facility,Both,,,GN,347,294.95,99.4502,347,Sanford Health Plan,Sanford Health Plan,319.24,92,,percent of total billed charges,,
Slp Eval Voice Prosth Device,,92597,CPT,Facility,Outpatient,,,GN,347,294.95,99.4502,347,"UCare Health, Inc.",Individual & Family Plan,195.5345,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Slp Eval Voice Prosth Device,,92597,CPT,Facility,Inpatient,,,GN,347,294.95,99.4502,347,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Slp Eval Voice Prosth Device,,92597,CPT,Facility,Outpatient,,,GN,347,294.95,99.4502,347,"UCare Health, Inc.",Medical Assistance,175.1309,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Slp Eval Voice Prosth Device,,92597,CPT,Facility,Inpatient,,,GN,347,294.95,99.4502,347,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Slp Eval Voice Prosth Device,,92597,CPT,Facility,Outpatient,,,GN,347,294.95,99.4502,347,"UCare Health, Inc.",Medicare Advantage,175.1309,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Slp Eval Voice Prosth Device,,92597,CPT,Facility,Inpatient,,,GN,347,294.95,99.4502,347,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Slp Eval Voice Prosth Device,,92597,CPT,Facility,Outpatient,,,GN,347,294.95,99.4502,347,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),175.1309,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Slp Eval Voice Prosth Device,,92597,CPT,Facility,Inpatient,,,GN,347,294.95,99.4502,347,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Slp Eval Voice Prosth Device,,92597,CPT,Facility,Both,,,GN,347,294.95,99.4502,347,UnitedHealthcare,Individual & Family,326.18,94,,percent of total billed charges,,
Slp Eval Voice Prosth Device,,92597,CPT,Facility,Outpatient,,,GN,347,294.95,99.4502,347,UnitedHealthcare,Medicare Advantage,170.03,49,,percent of total billed charges,,
Slp Eval Voice Prosth Device,,92597,CPT,Facility,Inpatient,,,GN,347,294.95,99.4502,347,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Slp Eval Voice Prosth Device,,92597,CPT,Facility,Outpatient,,,GN,347,294.95,99.4502,347,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,166.56,48,,percent of total billed charges,,100% of DHS outpatient percentage
Slp Eval Voice Prosth Device,,92597,CPT,Facility,Inpatient,,,GN,347,294.95,99.4502,347,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Slp Eval For Rx Non-Speech Device (1St Hour),,92605,CPT,Facility,Both,,,GN,253,215.05,72.5098,253,Aetna,Commercial,232.76,92,,percent of total billed charges,,
Slp Eval For Rx Non-Speech Device (1St Hour),,92605,CPT,Facility,Outpatient,,,GN,253,215.05,72.5098,253,Aetna,Medicare Advantage,123.97,49,,percent of total billed charges,,
Slp Eval For Rx Non-Speech Device (1St Hour),,92605,CPT,Facility,Inpatient,,,GN,253,215.05,72.5098,253,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Slp Eval For Rx Non-Speech Device (1St Hour),,92605,CPT,Facility,Both,,,GN,253,215.05,72.5098,253,Aetna,PPO,235.29,93,,percent of total billed charges,,
Slp Eval For Rx Non-Speech Device (1St Hour),,92605,CPT,Facility,Both,,,GN,253,215.05,72.5098,253,America's PPO,America's PPO,242.9559,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Slp Eval For Rx Non-Speech Device (1St Hour),,92605,CPT,Facility,Both,,,GN,253,215.05,72.5098,253,BlueCross BlueShield Minnesota, Federal Employee Program,248.952,98.4,,percent of total billed charges,,
Slp Eval For Rx Non-Speech Device (1St Hour),,92605,CPT,Facility,Both,,,GN,253,215.05,72.5098,253,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,253,100,,percent of total billed charges,,
Slp Eval For Rx Non-Speech Device (1St Hour),,92605,CPT,Facility,Both,,,GN,253,215.05,72.5098,253,BlueCross BlueShield Minnesota,High Value Network Plan,227.7,90,,percent of total billed charges,,
Slp Eval For Rx Non-Speech Device (1St Hour),,92605,CPT,Facility,Outpatient,,,GN,253,215.05,72.5098,253,BlueCross BlueShield Minnesota,Medicare Advantage,123.97,49,,percent of total billed charges,,
Slp Eval For Rx Non-Speech Device (1St Hour),,92605,CPT,Facility,Inpatient,,,GN,253,215.05,72.5098,253,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Slp Eval For Rx Non-Speech Device (1St Hour),,92605,CPT,Facility,Both,,,GN,253,215.05,72.5098,253,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,224.0821,88.57,,percent of total billed charges,,
Slp Eval For Rx Non-Speech Device (1St Hour),,92605,CPT,Facility,Both,,,GN,253,215.05,72.5098,253,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,72.5098,28.66,,percent of total billed charges,,
Slp Eval For Rx Non-Speech Device (1St Hour),,92605,CPT,Facility,Outpatient,,,GN,253,215.05,72.5098,253,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),123.97,49,,percent of total billed charges,,
Slp Eval For Rx Non-Speech Device (1St Hour),,92605,CPT,Facility,Inpatient,,,GN,253,215.05,72.5098,253,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Slp Eval For Rx Non-Speech Device (1St Hour),,92605,CPT,Facility,Both,,,GN,253,215.05,72.5098,253,CorVel,Worker's Compensation,253,100,,percent of total billed charges,,
Slp Eval For Rx Non-Speech Device (1St Hour),,92605,CPT,Facility,Both,,,GN,253,215.05,72.5098,253,First Health Group Corporation,First Health Network,245.41,97,,percent of total billed charges,,
Slp Eval For Rx Non-Speech Device (1St Hour),,92605,CPT,Facility,Both,,,GN,253,215.05,72.5098,253,"Health Partners, Inc.",Commercial,239.338,94.6,,percent of total billed charges,,
Slp Eval For Rx Non-Speech Device (1St Hour),,92605,CPT,Facility,Outpatient,,,GN,253,215.05,72.5098,253,"Health Partners, Inc.",Medicare Advantage,123.97,49,,percent of total billed charges,,
Slp Eval For Rx Non-Speech Device (1St Hour),,92605,CPT,Facility,Inpatient,,,GN,253,215.05,72.5098,253,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Slp Eval For Rx Non-Speech Device (1St Hour),,92605,CPT,Facility,Both,,,GN,253,215.05,72.5098,253,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),151.8,60,,percent of total billed charges,,
Slp Eval For Rx Non-Speech Device (1St Hour),,92605,CPT,Facility,Both,,,GN,253,215.05,72.5098,253,"Health Partners, Inc.",State of Minnesota Advantage Program,206.195,81.5,,percent of total billed charges,,
Slp Eval For Rx Non-Speech Device (1St Hour),,92605,CPT,Facility,Both,,,GN,253,215.05,72.5098,253,"Health Partners, Inc.",State Public Programs,126.5,50,,percent of total billed charges,,
Slp Eval For Rx Non-Speech Device (1St Hour),,92605,CPT,Facility,Both,,,GN,253,215.05,72.5098,253,Humana Insurance Company,Commercial PPO,240.35,95,,percent of total billed charges,,
Slp Eval For Rx Non-Speech Device (1St Hour),,92605,CPT,Facility,Outpatient,,,GN,253,215.05,72.5098,253,Humana Insurance Company,Medicare PPO,123.97,49,,percent of total billed charges,,
Slp Eval For Rx Non-Speech Device (1St Hour),,92605,CPT,Facility,Inpatient,,,GN,253,215.05,72.5098,253,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Slp Eval For Rx Non-Speech Device (1St Hour),,92605,CPT,Facility,Both,,,GN,253,215.05,72.5098,253,Medica,Individual & Family,250.723,99.1,,percent of total billed charges,,
Slp Eval For Rx Non-Speech Device (1St Hour),,92605,CPT,Facility,Outpatient,,,GN,253,215.05,72.5098,253,Medica,Medica Advantage Solution,125.994,49.8,,percent of total billed charges,,
Slp Eval For Rx Non-Speech Device (1St Hour),,92605,CPT,Facility,Inpatient,,,GN,253,215.05,72.5098,253,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Slp Eval For Rx Non-Speech Device (1St Hour),,92605,CPT,Facility,Outpatient,,,GN,253,215.05,72.5098,253,Medica,Medical Assistance,112.838,44.6,,percent of total billed charges,,
Slp Eval For Rx Non-Speech Device (1St Hour),,92605,CPT,Facility,Inpatient,,,GN,253,215.05,72.5098,253,Medica,Medical Assistance,,,,,Included in per diem rate,
Slp Eval For Rx Non-Speech Device (1St Hour),,92605,CPT,Facility,Outpatient,,,GN,253,215.05,72.5098,253,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,125.994,49.8,,percent of total billed charges,,
Slp Eval For Rx Non-Speech Device (1St Hour),,92605,CPT,Facility,Inpatient,,,GN,253,215.05,72.5098,253,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Slp Eval For Rx Non-Speech Device (1St Hour),,92605,CPT,Facility,Both,,,GN,253,215.05,72.5098,253,"Multiplan, Inc.","Multiplan, Inc.",237.82,94,,percent of total billed charges,,
Slp Eval For Rx Non-Speech Device (1St Hour),,92605,CPT,Facility,Outpatient,,,GN,253,215.05,72.5098,253,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,218.592,86.4,,percent of total billed charges,,
Slp Eval For Rx Non-Speech Device (1St Hour),,92605,CPT,Facility,Inpatient,,,GN,253,215.05,72.5098,253,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Slp Eval For Rx Non-Speech Device (1St Hour),,92605,CPT,Facility,Both,,,GN,253,215.05,72.5098,253,"Preferred One Administrative Services, INC.",PPO,249.458,98.6,,percent of total billed charges,,
Slp Eval For Rx Non-Speech Device (1St Hour),,92605,CPT,Facility,Outpatient,,,GN,253,215.05,72.5098,253,PrimeWest Health,Minnesota Senior Health Options (MSHO),130.1685,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Slp Eval For Rx Non-Speech Device (1St Hour),,92605,CPT,Facility,Inpatient,,,GN,253,215.05,72.5098,253,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Slp Eval For Rx Non-Speech Device (1St Hour),,92605,CPT,Facility,Outpatient,,,GN,253,215.05,72.5098,253,PrimeWest Health,MinnesotaCare,129.9408,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Slp Eval For Rx Non-Speech Device (1St Hour),,92605,CPT,Facility,Inpatient,,,GN,253,215.05,72.5098,253,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Slp Eval For Rx Non-Speech Device (1St Hour),,92605,CPT,Facility,Both,,,GN,253,215.05,72.5098,253,Sanford Health Plan,Sanford Health Plan,232.76,92,,percent of total billed charges,,
Slp Eval For Rx Non-Speech Device (1St Hour),,92605,CPT,Facility,Outpatient,,,GN,253,215.05,72.5098,253,"UCare Health, Inc.",Individual & Family Plan,142.5655,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Slp Eval For Rx Non-Speech Device (1St Hour),,92605,CPT,Facility,Inpatient,,,GN,253,215.05,72.5098,253,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Slp Eval For Rx Non-Speech Device (1St Hour),,92605,CPT,Facility,Outpatient,,,GN,253,215.05,72.5098,253,"UCare Health, Inc.",Medical Assistance,127.6891,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Slp Eval For Rx Non-Speech Device (1St Hour),,92605,CPT,Facility,Inpatient,,,GN,253,215.05,72.5098,253,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Slp Eval For Rx Non-Speech Device (1St Hour),,92605,CPT,Facility,Outpatient,,,GN,253,215.05,72.5098,253,"UCare Health, Inc.",Medicare Advantage,127.6891,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Slp Eval For Rx Non-Speech Device (1St Hour),,92605,CPT,Facility,Inpatient,,,GN,253,215.05,72.5098,253,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Slp Eval For Rx Non-Speech Device (1St Hour),,92605,CPT,Facility,Outpatient,,,GN,253,215.05,72.5098,253,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),127.6891,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Slp Eval For Rx Non-Speech Device (1St Hour),,92605,CPT,Facility,Inpatient,,,GN,253,215.05,72.5098,253,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Slp Eval For Rx Non-Speech Device (1St Hour),,92605,CPT,Facility,Both,,,GN,253,215.05,72.5098,253,UnitedHealthcare,Individual & Family,237.82,94,,percent of total billed charges,,
Slp Eval For Rx Non-Speech Device (1St Hour),,92605,CPT,Facility,Outpatient,,,GN,253,215.05,72.5098,253,UnitedHealthcare,Medicare Advantage,123.97,49,,percent of total billed charges,,
Slp Eval For Rx Non-Speech Device (1St Hour),,92605,CPT,Facility,Inpatient,,,GN,253,215.05,72.5098,253,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Slp Eval For Rx Non-Speech Device (1St Hour),,92605,CPT,Facility,Outpatient,,,GN,253,215.05,72.5098,253,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,121.44,48,,percent of total billed charges,,100% of DHS outpatient percentage
Slp Eval For Rx Non-Speech Device (1St Hour),,92605,CPT,Facility,Inpatient,,,GN,253,215.05,72.5098,253,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Slp Eval For Rx Speech Device (1 Hour),,92607,CPT,Facility,Both,,,GN,291,247.35,83.4006,291,Aetna,Commercial,267.72,92,,percent of total billed charges,,
Slp Eval For Rx Speech Device (1 Hour),,92607,CPT,Facility,Outpatient,,,GN,291,247.35,83.4006,291,Aetna,Medicare Advantage,142.59,49,,percent of total billed charges,,
Slp Eval For Rx Speech Device (1 Hour),,92607,CPT,Facility,Inpatient,,,GN,291,247.35,83.4006,291,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Slp Eval For Rx Speech Device (1 Hour),,92607,CPT,Facility,Both,,,GN,291,247.35,83.4006,291,Aetna,PPO,270.63,93,,percent of total billed charges,,
Slp Eval For Rx Speech Device (1 Hour),,92607,CPT,Facility,Both,,,GN,291,247.35,83.4006,291,America's PPO,America's PPO,279.4473,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Slp Eval For Rx Speech Device (1 Hour),,92607,CPT,Facility,Both,,,GN,291,247.35,83.4006,291,BlueCross BlueShield Minnesota, Federal Employee Program,286.344,98.4,,percent of total billed charges,,
Slp Eval For Rx Speech Device (1 Hour),,92607,CPT,Facility,Both,,,GN,291,247.35,83.4006,291,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,291,100,,percent of total billed charges,,
Slp Eval For Rx Speech Device (1 Hour),,92607,CPT,Facility,Both,,,GN,291,247.35,83.4006,291,BlueCross BlueShield Minnesota,High Value Network Plan,261.9,90,,percent of total billed charges,,
Slp Eval For Rx Speech Device (1 Hour),,92607,CPT,Facility,Outpatient,,,GN,291,247.35,83.4006,291,BlueCross BlueShield Minnesota,Medicare Advantage,142.59,49,,percent of total billed charges,,
Slp Eval For Rx Speech Device (1 Hour),,92607,CPT,Facility,Inpatient,,,GN,291,247.35,83.4006,291,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Slp Eval For Rx Speech Device (1 Hour),,92607,CPT,Facility,Both,,,GN,291,247.35,83.4006,291,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,257.7387,88.57,,percent of total billed charges,,
Slp Eval For Rx Speech Device (1 Hour),,92607,CPT,Facility,Both,,,GN,291,247.35,83.4006,291,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,83.4006,28.66,,percent of total billed charges,,
Slp Eval For Rx Speech Device (1 Hour),,92607,CPT,Facility,Outpatient,,,GN,291,247.35,83.4006,291,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),142.59,49,,percent of total billed charges,,
Slp Eval For Rx Speech Device (1 Hour),,92607,CPT,Facility,Inpatient,,,GN,291,247.35,83.4006,291,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Slp Eval For Rx Speech Device (1 Hour),,92607,CPT,Facility,Both,,,GN,291,247.35,83.4006,291,CorVel,Worker's Compensation,291,100,,percent of total billed charges,,
Slp Eval For Rx Speech Device (1 Hour),,92607,CPT,Facility,Both,,,GN,291,247.35,83.4006,291,First Health Group Corporation,First Health Network,282.27,97,,percent of total billed charges,,
Slp Eval For Rx Speech Device (1 Hour),,92607,CPT,Facility,Both,,,GN,291,247.35,83.4006,291,"Health Partners, Inc.",Commercial,275.286,94.6,,percent of total billed charges,,
Slp Eval For Rx Speech Device (1 Hour),,92607,CPT,Facility,Outpatient,,,GN,291,247.35,83.4006,291,"Health Partners, Inc.",Medicare Advantage,142.59,49,,percent of total billed charges,,
Slp Eval For Rx Speech Device (1 Hour),,92607,CPT,Facility,Inpatient,,,GN,291,247.35,83.4006,291,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Slp Eval For Rx Speech Device (1 Hour),,92607,CPT,Facility,Both,,,GN,291,247.35,83.4006,291,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),174.6,60,,percent of total billed charges,,
Slp Eval For Rx Speech Device (1 Hour),,92607,CPT,Facility,Both,,,GN,291,247.35,83.4006,291,"Health Partners, Inc.",State of Minnesota Advantage Program,237.165,81.5,,percent of total billed charges,,
Slp Eval For Rx Speech Device (1 Hour),,92607,CPT,Facility,Both,,,GN,291,247.35,83.4006,291,"Health Partners, Inc.",State Public Programs,145.5,50,,percent of total billed charges,,
Slp Eval For Rx Speech Device (1 Hour),,92607,CPT,Facility,Both,,,GN,291,247.35,83.4006,291,Humana Insurance Company,Commercial PPO,276.45,95,,percent of total billed charges,,
Slp Eval For Rx Speech Device (1 Hour),,92607,CPT,Facility,Outpatient,,,GN,291,247.35,83.4006,291,Humana Insurance Company,Medicare PPO,142.59,49,,percent of total billed charges,,
Slp Eval For Rx Speech Device (1 Hour),,92607,CPT,Facility,Inpatient,,,GN,291,247.35,83.4006,291,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Slp Eval For Rx Speech Device (1 Hour),,92607,CPT,Facility,Both,,,GN,291,247.35,83.4006,291,Medica,Individual & Family,288.381,99.1,,percent of total billed charges,,
Slp Eval For Rx Speech Device (1 Hour),,92607,CPT,Facility,Outpatient,,,GN,291,247.35,83.4006,291,Medica,Medica Advantage Solution,144.918,49.8,,percent of total billed charges,,
Slp Eval For Rx Speech Device (1 Hour),,92607,CPT,Facility,Inpatient,,,GN,291,247.35,83.4006,291,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Slp Eval For Rx Speech Device (1 Hour),,92607,CPT,Facility,Outpatient,,,GN,291,247.35,83.4006,291,Medica,Medical Assistance,129.786,44.6,,percent of total billed charges,,
Slp Eval For Rx Speech Device (1 Hour),,92607,CPT,Facility,Inpatient,,,GN,291,247.35,83.4006,291,Medica,Medical Assistance,,,,,Included in per diem rate,
Slp Eval For Rx Speech Device (1 Hour),,92607,CPT,Facility,Outpatient,,,GN,291,247.35,83.4006,291,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,144.918,49.8,,percent of total billed charges,,
Slp Eval For Rx Speech Device (1 Hour),,92607,CPT,Facility,Inpatient,,,GN,291,247.35,83.4006,291,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Slp Eval For Rx Speech Device (1 Hour),,92607,CPT,Facility,Both,,,GN,291,247.35,83.4006,291,"Multiplan, Inc.","Multiplan, Inc.",273.54,94,,percent of total billed charges,,
Slp Eval For Rx Speech Device (1 Hour),,92607,CPT,Facility,Outpatient,,,GN,291,247.35,83.4006,291,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,251.424,86.4,,percent of total billed charges,,
Slp Eval For Rx Speech Device (1 Hour),,92607,CPT,Facility,Inpatient,,,GN,291,247.35,83.4006,291,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Slp Eval For Rx Speech Device (1 Hour),,92607,CPT,Facility,Both,,,GN,291,247.35,83.4006,291,"Preferred One Administrative Services, INC.",PPO,286.926,98.6,,percent of total billed charges,,
Slp Eval For Rx Speech Device (1 Hour),,92607,CPT,Facility,Outpatient,,,GN,291,247.35,83.4006,291,PrimeWest Health,Minnesota Senior Health Options (MSHO),149.7195,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Slp Eval For Rx Speech Device (1 Hour),,92607,CPT,Facility,Inpatient,,,GN,291,247.35,83.4006,291,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Slp Eval For Rx Speech Device (1 Hour),,92607,CPT,Facility,Outpatient,,,GN,291,247.35,83.4006,291,PrimeWest Health,MinnesotaCare,149.4576,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Slp Eval For Rx Speech Device (1 Hour),,92607,CPT,Facility,Inpatient,,,GN,291,247.35,83.4006,291,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Slp Eval For Rx Speech Device (1 Hour),,92607,CPT,Facility,Both,,,GN,291,247.35,83.4006,291,Sanford Health Plan,Sanford Health Plan,267.72,92,,percent of total billed charges,,
Slp Eval For Rx Speech Device (1 Hour),,92607,CPT,Facility,Outpatient,,,GN,291,247.35,83.4006,291,"UCare Health, Inc.",Individual & Family Plan,163.9785,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Slp Eval For Rx Speech Device (1 Hour),,92607,CPT,Facility,Inpatient,,,GN,291,247.35,83.4006,291,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Slp Eval For Rx Speech Device (1 Hour),,92607,CPT,Facility,Outpatient,,,GN,291,247.35,83.4006,291,"UCare Health, Inc.",Medical Assistance,146.8677,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Slp Eval For Rx Speech Device (1 Hour),,92607,CPT,Facility,Inpatient,,,GN,291,247.35,83.4006,291,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Slp Eval For Rx Speech Device (1 Hour),,92607,CPT,Facility,Outpatient,,,GN,291,247.35,83.4006,291,"UCare Health, Inc.",Medicare Advantage,146.8677,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Slp Eval For Rx Speech Device (1 Hour),,92607,CPT,Facility,Inpatient,,,GN,291,247.35,83.4006,291,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Slp Eval For Rx Speech Device (1 Hour),,92607,CPT,Facility,Outpatient,,,GN,291,247.35,83.4006,291,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),146.8677,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Slp Eval For Rx Speech Device (1 Hour),,92607,CPT,Facility,Inpatient,,,GN,291,247.35,83.4006,291,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Slp Eval For Rx Speech Device (1 Hour),,92607,CPT,Facility,Both,,,GN,291,247.35,83.4006,291,UnitedHealthcare,Individual & Family,273.54,94,,percent of total billed charges,,
Slp Eval For Rx Speech Device (1 Hour),,92607,CPT,Facility,Outpatient,,,GN,291,247.35,83.4006,291,UnitedHealthcare,Medicare Advantage,142.59,49,,percent of total billed charges,,
Slp Eval For Rx Speech Device (1 Hour),,92607,CPT,Facility,Inpatient,,,GN,291,247.35,83.4006,291,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Slp Eval For Rx Speech Device (1 Hour),,92607,CPT,Facility,Outpatient,,,GN,291,247.35,83.4006,291,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,139.68,48,,percent of total billed charges,,100% of DHS outpatient percentage
Slp Eval For Rx Speech Device (1 Hour),,92607,CPT,Facility,Inpatient,,,GN,291,247.35,83.4006,291,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Slp Eval For Rx Speech Device (Addl 30 Min),,92608,CPT,Facility,Both,,,GN,174,147.9,49.8684,174,Aetna,Commercial,160.08,92,,percent of total billed charges,,
Slp Eval For Rx Speech Device (Addl 30 Min),,92608,CPT,Facility,Outpatient,,,GN,174,147.9,49.8684,174,Aetna,Medicare Advantage,85.26,49,,percent of total billed charges,,
Slp Eval For Rx Speech Device (Addl 30 Min),,92608,CPT,Facility,Inpatient,,,GN,174,147.9,49.8684,174,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Slp Eval For Rx Speech Device (Addl 30 Min),,92608,CPT,Facility,Both,,,GN,174,147.9,49.8684,174,Aetna,PPO,161.82,93,,percent of total billed charges,,
Slp Eval For Rx Speech Device (Addl 30 Min),,92608,CPT,Facility,Both,,,GN,174,147.9,49.8684,174,America's PPO,America's PPO,167.0922,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Slp Eval For Rx Speech Device (Addl 30 Min),,92608,CPT,Facility,Both,,,GN,174,147.9,49.8684,174,BlueCross BlueShield Minnesota, Federal Employee Program,171.216,98.4,,percent of total billed charges,,
Slp Eval For Rx Speech Device (Addl 30 Min),,92608,CPT,Facility,Both,,,GN,174,147.9,49.8684,174,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,174,100,,percent of total billed charges,,
Slp Eval For Rx Speech Device (Addl 30 Min),,92608,CPT,Facility,Both,,,GN,174,147.9,49.8684,174,BlueCross BlueShield Minnesota,High Value Network Plan,156.6,90,,percent of total billed charges,,
Slp Eval For Rx Speech Device (Addl 30 Min),,92608,CPT,Facility,Outpatient,,,GN,174,147.9,49.8684,174,BlueCross BlueShield Minnesota,Medicare Advantage,85.26,49,,percent of total billed charges,,
Slp Eval For Rx Speech Device (Addl 30 Min),,92608,CPT,Facility,Inpatient,,,GN,174,147.9,49.8684,174,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Slp Eval For Rx Speech Device (Addl 30 Min),,92608,CPT,Facility,Both,,,GN,174,147.9,49.8684,174,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,154.1118,88.57,,percent of total billed charges,,
Slp Eval For Rx Speech Device (Addl 30 Min),,92608,CPT,Facility,Both,,,GN,174,147.9,49.8684,174,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,49.8684,28.66,,percent of total billed charges,,
Slp Eval For Rx Speech Device (Addl 30 Min),,92608,CPT,Facility,Outpatient,,,GN,174,147.9,49.8684,174,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),85.26,49,,percent of total billed charges,,
Slp Eval For Rx Speech Device (Addl 30 Min),,92608,CPT,Facility,Inpatient,,,GN,174,147.9,49.8684,174,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Slp Eval For Rx Speech Device (Addl 30 Min),,92608,CPT,Facility,Both,,,GN,174,147.9,49.8684,174,CorVel,Worker's Compensation,174,100,,percent of total billed charges,,
Slp Eval For Rx Speech Device (Addl 30 Min),,92608,CPT,Facility,Both,,,GN,174,147.9,49.8684,174,First Health Group Corporation,First Health Network,168.78,97,,percent of total billed charges,,
Slp Eval For Rx Speech Device (Addl 30 Min),,92608,CPT,Facility,Both,,,GN,174,147.9,49.8684,174,"Health Partners, Inc.",Commercial,164.604,94.6,,percent of total billed charges,,
Slp Eval For Rx Speech Device (Addl 30 Min),,92608,CPT,Facility,Outpatient,,,GN,174,147.9,49.8684,174,"Health Partners, Inc.",Medicare Advantage,85.26,49,,percent of total billed charges,,
Slp Eval For Rx Speech Device (Addl 30 Min),,92608,CPT,Facility,Inpatient,,,GN,174,147.9,49.8684,174,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Slp Eval For Rx Speech Device (Addl 30 Min),,92608,CPT,Facility,Both,,,GN,174,147.9,49.8684,174,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),104.4,60,,percent of total billed charges,,
Slp Eval For Rx Speech Device (Addl 30 Min),,92608,CPT,Facility,Both,,,GN,174,147.9,49.8684,174,"Health Partners, Inc.",State of Minnesota Advantage Program,141.81,81.5,,percent of total billed charges,,
Slp Eval For Rx Speech Device (Addl 30 Min),,92608,CPT,Facility,Both,,,GN,174,147.9,49.8684,174,"Health Partners, Inc.",State Public Programs,87,50,,percent of total billed charges,,
Slp Eval For Rx Speech Device (Addl 30 Min),,92608,CPT,Facility,Both,,,GN,174,147.9,49.8684,174,Humana Insurance Company,Commercial PPO,165.3,95,,percent of total billed charges,,
Slp Eval For Rx Speech Device (Addl 30 Min),,92608,CPT,Facility,Outpatient,,,GN,174,147.9,49.8684,174,Humana Insurance Company,Medicare PPO,85.26,49,,percent of total billed charges,,
Slp Eval For Rx Speech Device (Addl 30 Min),,92608,CPT,Facility,Inpatient,,,GN,174,147.9,49.8684,174,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Slp Eval For Rx Speech Device (Addl 30 Min),,92608,CPT,Facility,Both,,,GN,174,147.9,49.8684,174,Medica,Individual & Family,172.434,99.1,,percent of total billed charges,,
Slp Eval For Rx Speech Device (Addl 30 Min),,92608,CPT,Facility,Outpatient,,,GN,174,147.9,49.8684,174,Medica,Medica Advantage Solution,86.652,49.8,,percent of total billed charges,,
Slp Eval For Rx Speech Device (Addl 30 Min),,92608,CPT,Facility,Inpatient,,,GN,174,147.9,49.8684,174,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Slp Eval For Rx Speech Device (Addl 30 Min),,92608,CPT,Facility,Outpatient,,,GN,174,147.9,49.8684,174,Medica,Medical Assistance,77.604,44.6,,percent of total billed charges,,
Slp Eval For Rx Speech Device (Addl 30 Min),,92608,CPT,Facility,Inpatient,,,GN,174,147.9,49.8684,174,Medica,Medical Assistance,,,,,Included in per diem rate,
Slp Eval For Rx Speech Device (Addl 30 Min),,92608,CPT,Facility,Outpatient,,,GN,174,147.9,49.8684,174,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,86.652,49.8,,percent of total billed charges,,
Slp Eval For Rx Speech Device (Addl 30 Min),,92608,CPT,Facility,Inpatient,,,GN,174,147.9,49.8684,174,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Slp Eval For Rx Speech Device (Addl 30 Min),,92608,CPT,Facility,Both,,,GN,174,147.9,49.8684,174,"Multiplan, Inc.","Multiplan, Inc.",163.56,94,,percent of total billed charges,,
Slp Eval For Rx Speech Device (Addl 30 Min),,92608,CPT,Facility,Outpatient,,,GN,174,147.9,49.8684,174,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,150.336,86.4,,percent of total billed charges,,
Slp Eval For Rx Speech Device (Addl 30 Min),,92608,CPT,Facility,Inpatient,,,GN,174,147.9,49.8684,174,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Slp Eval For Rx Speech Device (Addl 30 Min),,92608,CPT,Facility,Both,,,GN,174,147.9,49.8684,174,"Preferred One Administrative Services, INC.",PPO,171.564,98.6,,percent of total billed charges,,
Slp Eval For Rx Speech Device (Addl 30 Min),,92608,CPT,Facility,Outpatient,,,GN,174,147.9,49.8684,174,PrimeWest Health,Minnesota Senior Health Options (MSHO),89.523,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Slp Eval For Rx Speech Device (Addl 30 Min),,92608,CPT,Facility,Inpatient,,,GN,174,147.9,49.8684,174,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Slp Eval For Rx Speech Device (Addl 30 Min),,92608,CPT,Facility,Outpatient,,,GN,174,147.9,49.8684,174,PrimeWest Health,MinnesotaCare,89.3664,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Slp Eval For Rx Speech Device (Addl 30 Min),,92608,CPT,Facility,Inpatient,,,GN,174,147.9,49.8684,174,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Slp Eval For Rx Speech Device (Addl 30 Min),,92608,CPT,Facility,Both,,,GN,174,147.9,49.8684,174,Sanford Health Plan,Sanford Health Plan,160.08,92,,percent of total billed charges,,
Slp Eval For Rx Speech Device (Addl 30 Min),,92608,CPT,Facility,Outpatient,,,GN,174,147.9,49.8684,174,"UCare Health, Inc.",Individual & Family Plan,98.049,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Slp Eval For Rx Speech Device (Addl 30 Min),,92608,CPT,Facility,Inpatient,,,GN,174,147.9,49.8684,174,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Slp Eval For Rx Speech Device (Addl 30 Min),,92608,CPT,Facility,Outpatient,,,GN,174,147.9,49.8684,174,"UCare Health, Inc.",Medical Assistance,87.8178,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Slp Eval For Rx Speech Device (Addl 30 Min),,92608,CPT,Facility,Inpatient,,,GN,174,147.9,49.8684,174,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Slp Eval For Rx Speech Device (Addl 30 Min),,92608,CPT,Facility,Outpatient,,,GN,174,147.9,49.8684,174,"UCare Health, Inc.",Medicare Advantage,87.8178,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Slp Eval For Rx Speech Device (Addl 30 Min),,92608,CPT,Facility,Inpatient,,,GN,174,147.9,49.8684,174,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Slp Eval For Rx Speech Device (Addl 30 Min),,92608,CPT,Facility,Outpatient,,,GN,174,147.9,49.8684,174,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),87.8178,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Slp Eval For Rx Speech Device (Addl 30 Min),,92608,CPT,Facility,Inpatient,,,GN,174,147.9,49.8684,174,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Slp Eval For Rx Speech Device (Addl 30 Min),,92608,CPT,Facility,Both,,,GN,174,147.9,49.8684,174,UnitedHealthcare,Individual & Family,163.56,94,,percent of total billed charges,,
Slp Eval For Rx Speech Device (Addl 30 Min),,92608,CPT,Facility,Outpatient,,,GN,174,147.9,49.8684,174,UnitedHealthcare,Medicare Advantage,85.26,49,,percent of total billed charges,,
Slp Eval For Rx Speech Device (Addl 30 Min),,92608,CPT,Facility,Inpatient,,,GN,174,147.9,49.8684,174,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Slp Eval For Rx Speech Device (Addl 30 Min),,92608,CPT,Facility,Outpatient,,,GN,174,147.9,49.8684,174,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,83.52,48,,percent of total billed charges,,100% of DHS outpatient percentage
Slp Eval For Rx Speech Device (Addl 30 Min),,92608,CPT,Facility,Inpatient,,,GN,174,147.9,49.8684,174,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Slp Therapy Service Speech Device,,92609,CPT,Facility,Both,,,GN,182,154.7,52.1612,182,Aetna,Commercial,167.44,92,,percent of total billed charges,,
Slp Therapy Service Speech Device,,92609,CPT,Facility,Outpatient,,,GN,182,154.7,52.1612,182,Aetna,Medicare Advantage,89.18,49,,percent of total billed charges,,
Slp Therapy Service Speech Device,,92609,CPT,Facility,Inpatient,,,GN,182,154.7,52.1612,182,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Slp Therapy Service Speech Device,,92609,CPT,Facility,Both,,,GN,182,154.7,52.1612,182,Aetna,PPO,169.26,93,,percent of total billed charges,,
Slp Therapy Service Speech Device,,92609,CPT,Facility,Both,,,GN,182,154.7,52.1612,182,America's PPO,America's PPO,174.7746,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Slp Therapy Service Speech Device,,92609,CPT,Facility,Both,,,GN,182,154.7,52.1612,182,BlueCross BlueShield Minnesota, Federal Employee Program,179.088,98.4,,percent of total billed charges,,
Slp Therapy Service Speech Device,,92609,CPT,Facility,Both,,,GN,182,154.7,52.1612,182,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,182,100,,percent of total billed charges,,
Slp Therapy Service Speech Device,,92609,CPT,Facility,Both,,,GN,182,154.7,52.1612,182,BlueCross BlueShield Minnesota,High Value Network Plan,163.8,90,,percent of total billed charges,,
Slp Therapy Service Speech Device,,92609,CPT,Facility,Outpatient,,,GN,182,154.7,52.1612,182,BlueCross BlueShield Minnesota,Medicare Advantage,89.18,49,,percent of total billed charges,,
Slp Therapy Service Speech Device,,92609,CPT,Facility,Inpatient,,,GN,182,154.7,52.1612,182,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Slp Therapy Service Speech Device,,92609,CPT,Facility,Both,,,GN,182,154.7,52.1612,182,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,161.1974,88.57,,percent of total billed charges,,
Slp Therapy Service Speech Device,,92609,CPT,Facility,Both,,,GN,182,154.7,52.1612,182,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,52.1612,28.66,,percent of total billed charges,,
Slp Therapy Service Speech Device,,92609,CPT,Facility,Outpatient,,,GN,182,154.7,52.1612,182,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),89.18,49,,percent of total billed charges,,
Slp Therapy Service Speech Device,,92609,CPT,Facility,Inpatient,,,GN,182,154.7,52.1612,182,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Slp Therapy Service Speech Device,,92609,CPT,Facility,Both,,,GN,182,154.7,52.1612,182,CorVel,Worker's Compensation,182,100,,percent of total billed charges,,
Slp Therapy Service Speech Device,,92609,CPT,Facility,Both,,,GN,182,154.7,52.1612,182,First Health Group Corporation,First Health Network,176.54,97,,percent of total billed charges,,
Slp Therapy Service Speech Device,,92609,CPT,Facility,Both,,,GN,182,154.7,52.1612,182,"Health Partners, Inc.",Commercial,172.172,94.6,,percent of total billed charges,,
Slp Therapy Service Speech Device,,92609,CPT,Facility,Outpatient,,,GN,182,154.7,52.1612,182,"Health Partners, Inc.",Medicare Advantage,89.18,49,,percent of total billed charges,,
Slp Therapy Service Speech Device,,92609,CPT,Facility,Inpatient,,,GN,182,154.7,52.1612,182,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Slp Therapy Service Speech Device,,92609,CPT,Facility,Both,,,GN,182,154.7,52.1612,182,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),109.2,60,,percent of total billed charges,,
Slp Therapy Service Speech Device,,92609,CPT,Facility,Both,,,GN,182,154.7,52.1612,182,"Health Partners, Inc.",State of Minnesota Advantage Program,148.33,81.5,,percent of total billed charges,,
Slp Therapy Service Speech Device,,92609,CPT,Facility,Both,,,GN,182,154.7,52.1612,182,"Health Partners, Inc.",State Public Programs,91,50,,percent of total billed charges,,
Slp Therapy Service Speech Device,,92609,CPT,Facility,Both,,,GN,182,154.7,52.1612,182,Humana Insurance Company,Commercial PPO,172.9,95,,percent of total billed charges,,
Slp Therapy Service Speech Device,,92609,CPT,Facility,Outpatient,,,GN,182,154.7,52.1612,182,Humana Insurance Company,Medicare PPO,89.18,49,,percent of total billed charges,,
Slp Therapy Service Speech Device,,92609,CPT,Facility,Inpatient,,,GN,182,154.7,52.1612,182,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Slp Therapy Service Speech Device,,92609,CPT,Facility,Both,,,GN,182,154.7,52.1612,182,Medica,Individual & Family,180.362,99.1,,percent of total billed charges,,
Slp Therapy Service Speech Device,,92609,CPT,Facility,Outpatient,,,GN,182,154.7,52.1612,182,Medica,Medica Advantage Solution,90.636,49.8,,percent of total billed charges,,
Slp Therapy Service Speech Device,,92609,CPT,Facility,Inpatient,,,GN,182,154.7,52.1612,182,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Slp Therapy Service Speech Device,,92609,CPT,Facility,Outpatient,,,GN,182,154.7,52.1612,182,Medica,Medical Assistance,81.172,44.6,,percent of total billed charges,,
Slp Therapy Service Speech Device,,92609,CPT,Facility,Inpatient,,,GN,182,154.7,52.1612,182,Medica,Medical Assistance,,,,,Included in per diem rate,
Slp Therapy Service Speech Device,,92609,CPT,Facility,Outpatient,,,GN,182,154.7,52.1612,182,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,90.636,49.8,,percent of total billed charges,,
Slp Therapy Service Speech Device,,92609,CPT,Facility,Inpatient,,,GN,182,154.7,52.1612,182,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Slp Therapy Service Speech Device,,92609,CPT,Facility,Both,,,GN,182,154.7,52.1612,182,"Multiplan, Inc.","Multiplan, Inc.",171.08,94,,percent of total billed charges,,
Slp Therapy Service Speech Device,,92609,CPT,Facility,Outpatient,,,GN,182,154.7,52.1612,182,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,157.248,86.4,,percent of total billed charges,,
Slp Therapy Service Speech Device,,92609,CPT,Facility,Inpatient,,,GN,182,154.7,52.1612,182,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Slp Therapy Service Speech Device,,92609,CPT,Facility,Both,,,GN,182,154.7,52.1612,182,"Preferred One Administrative Services, INC.",PPO,179.452,98.6,,percent of total billed charges,,
Slp Therapy Service Speech Device,,92609,CPT,Facility,Outpatient,,,GN,182,154.7,52.1612,182,PrimeWest Health,Minnesota Senior Health Options (MSHO),93.639,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Slp Therapy Service Speech Device,,92609,CPT,Facility,Inpatient,,,GN,182,154.7,52.1612,182,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Slp Therapy Service Speech Device,,92609,CPT,Facility,Outpatient,,,GN,182,154.7,52.1612,182,PrimeWest Health,MinnesotaCare,93.4752,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Slp Therapy Service Speech Device,,92609,CPT,Facility,Inpatient,,,GN,182,154.7,52.1612,182,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Slp Therapy Service Speech Device,,92609,CPT,Facility,Both,,,GN,182,154.7,52.1612,182,Sanford Health Plan,Sanford Health Plan,167.44,92,,percent of total billed charges,,
Slp Therapy Service Speech Device,,92609,CPT,Facility,Outpatient,,,GN,182,154.7,52.1612,182,"UCare Health, Inc.",Individual & Family Plan,102.557,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Slp Therapy Service Speech Device,,92609,CPT,Facility,Inpatient,,,GN,182,154.7,52.1612,182,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Slp Therapy Service Speech Device,,92609,CPT,Facility,Outpatient,,,GN,182,154.7,52.1612,182,"UCare Health, Inc.",Medical Assistance,91.8554,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Slp Therapy Service Speech Device,,92609,CPT,Facility,Inpatient,,,GN,182,154.7,52.1612,182,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Slp Therapy Service Speech Device,,92609,CPT,Facility,Outpatient,,,GN,182,154.7,52.1612,182,"UCare Health, Inc.",Medicare Advantage,91.8554,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Slp Therapy Service Speech Device,,92609,CPT,Facility,Inpatient,,,GN,182,154.7,52.1612,182,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Slp Therapy Service Speech Device,,92609,CPT,Facility,Outpatient,,,GN,182,154.7,52.1612,182,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),91.8554,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Slp Therapy Service Speech Device,,92609,CPT,Facility,Inpatient,,,GN,182,154.7,52.1612,182,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Slp Therapy Service Speech Device,,92609,CPT,Facility,Both,,,GN,182,154.7,52.1612,182,UnitedHealthcare,Individual & Family,171.08,94,,percent of total billed charges,,
Slp Therapy Service Speech Device,,92609,CPT,Facility,Outpatient,,,GN,182,154.7,52.1612,182,UnitedHealthcare,Medicare Advantage,89.18,49,,percent of total billed charges,,
Slp Therapy Service Speech Device,,92609,CPT,Facility,Inpatient,,,GN,182,154.7,52.1612,182,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Slp Therapy Service Speech Device,,92609,CPT,Facility,Outpatient,,,GN,182,154.7,52.1612,182,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,87.36,48,,percent of total billed charges,,100% of DHS outpatient percentage
Slp Therapy Service Speech Device,,92609,CPT,Facility,Inpatient,,,GN,182,154.7,52.1612,182,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Slp Swallow Evaluation (Session For 43000457),,92610,CPT,Facility,Both,,,GN,265,225.25,75.949,265,Aetna,Commercial,243.8,92,,percent of total billed charges,,
Slp Swallow Evaluation (Session For 43000457),,92610,CPT,Facility,Outpatient,,,GN,265,225.25,75.949,265,Aetna,Medicare Advantage,129.85,49,,percent of total billed charges,,
Slp Swallow Evaluation (Session For 43000457),,92610,CPT,Facility,Inpatient,,,GN,265,225.25,75.949,265,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Slp Swallow Evaluation (Session For 43000457),,92610,CPT,Facility,Both,,,GN,265,225.25,75.949,265,Aetna,PPO,246.45,93,,percent of total billed charges,,
Slp Swallow Evaluation (Session For 43000457),,92610,CPT,Facility,Both,,,GN,265,225.25,75.949,265,America's PPO,America's PPO,254.4795,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Slp Swallow Evaluation (Session For 43000457),,92610,CPT,Facility,Both,,,GN,265,225.25,75.949,265,BlueCross BlueShield Minnesota, Federal Employee Program,260.76,98.4,,percent of total billed charges,,
Slp Swallow Evaluation (Session For 43000457),,92610,CPT,Facility,Both,,,GN,265,225.25,75.949,265,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,265,100,,percent of total billed charges,,
Slp Swallow Evaluation (Session For 43000457),,92610,CPT,Facility,Both,,,GN,265,225.25,75.949,265,BlueCross BlueShield Minnesota,High Value Network Plan,238.5,90,,percent of total billed charges,,
Slp Swallow Evaluation (Session For 43000457),,92610,CPT,Facility,Outpatient,,,GN,265,225.25,75.949,265,BlueCross BlueShield Minnesota,Medicare Advantage,129.85,49,,percent of total billed charges,,
Slp Swallow Evaluation (Session For 43000457),,92610,CPT,Facility,Inpatient,,,GN,265,225.25,75.949,265,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Slp Swallow Evaluation (Session For 43000457),,92610,CPT,Facility,Both,,,GN,265,225.25,75.949,265,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,234.7105,88.57,,percent of total billed charges,,
Slp Swallow Evaluation (Session For 43000457),,92610,CPT,Facility,Both,,,GN,265,225.25,75.949,265,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,75.949,28.66,,percent of total billed charges,,
Slp Swallow Evaluation (Session For 43000457),,92610,CPT,Facility,Outpatient,,,GN,265,225.25,75.949,265,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),129.85,49,,percent of total billed charges,,
Slp Swallow Evaluation (Session For 43000457),,92610,CPT,Facility,Inpatient,,,GN,265,225.25,75.949,265,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Slp Swallow Evaluation (Session For 43000457),,92610,CPT,Facility,Both,,,GN,265,225.25,75.949,265,CorVel,Worker's Compensation,265,100,,percent of total billed charges,,
Slp Swallow Evaluation (Session For 43000457),,92610,CPT,Facility,Both,,,GN,265,225.25,75.949,265,First Health Group Corporation,First Health Network,257.05,97,,percent of total billed charges,,
Slp Swallow Evaluation (Session For 43000457),,92610,CPT,Facility,Both,,,GN,265,225.25,75.949,265,"Health Partners, Inc.",Commercial,250.69,94.6,,percent of total billed charges,,
Slp Swallow Evaluation (Session For 43000457),,92610,CPT,Facility,Outpatient,,,GN,265,225.25,75.949,265,"Health Partners, Inc.",Medicare Advantage,129.85,49,,percent of total billed charges,,
Slp Swallow Evaluation (Session For 43000457),,92610,CPT,Facility,Inpatient,,,GN,265,225.25,75.949,265,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Slp Swallow Evaluation (Session For 43000457),,92610,CPT,Facility,Both,,,GN,265,225.25,75.949,265,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),159,60,,percent of total billed charges,,
Slp Swallow Evaluation (Session For 43000457),,92610,CPT,Facility,Both,,,GN,265,225.25,75.949,265,"Health Partners, Inc.",State of Minnesota Advantage Program,215.975,81.5,,percent of total billed charges,,
Slp Swallow Evaluation (Session For 43000457),,92610,CPT,Facility,Both,,,GN,265,225.25,75.949,265,"Health Partners, Inc.",State Public Programs,132.5,50,,percent of total billed charges,,
Slp Swallow Evaluation (Session For 43000457),,92610,CPT,Facility,Both,,,GN,265,225.25,75.949,265,Humana Insurance Company,Commercial PPO,251.75,95,,percent of total billed charges,,
Slp Swallow Evaluation (Session For 43000457),,92610,CPT,Facility,Outpatient,,,GN,265,225.25,75.949,265,Humana Insurance Company,Medicare PPO,129.85,49,,percent of total billed charges,,
Slp Swallow Evaluation (Session For 43000457),,92610,CPT,Facility,Inpatient,,,GN,265,225.25,75.949,265,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Slp Swallow Evaluation (Session For 43000457),,92610,CPT,Facility,Both,,,GN,265,225.25,75.949,265,Medica,Individual & Family,262.615,99.1,,percent of total billed charges,,
Slp Swallow Evaluation (Session For 43000457),,92610,CPT,Facility,Outpatient,,,GN,265,225.25,75.949,265,Medica,Medica Advantage Solution,131.97,49.8,,percent of total billed charges,,
Slp Swallow Evaluation (Session For 43000457),,92610,CPT,Facility,Inpatient,,,GN,265,225.25,75.949,265,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Slp Swallow Evaluation (Session For 43000457),,92610,CPT,Facility,Outpatient,,,GN,265,225.25,75.949,265,Medica,Medical Assistance,118.19,44.6,,percent of total billed charges,,
Slp Swallow Evaluation (Session For 43000457),,92610,CPT,Facility,Inpatient,,,GN,265,225.25,75.949,265,Medica,Medical Assistance,,,,,Included in per diem rate,
Slp Swallow Evaluation (Session For 43000457),,92610,CPT,Facility,Outpatient,,,GN,265,225.25,75.949,265,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,131.97,49.8,,percent of total billed charges,,
Slp Swallow Evaluation (Session For 43000457),,92610,CPT,Facility,Inpatient,,,GN,265,225.25,75.949,265,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Slp Swallow Evaluation (Session For 43000457),,92610,CPT,Facility,Both,,,GN,265,225.25,75.949,265,"Multiplan, Inc.","Multiplan, Inc.",249.1,94,,percent of total billed charges,,
Slp Swallow Evaluation (Session For 43000457),,92610,CPT,Facility,Outpatient,,,GN,265,225.25,75.949,265,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,228.96,86.4,,percent of total billed charges,,
Slp Swallow Evaluation (Session For 43000457),,92610,CPT,Facility,Inpatient,,,GN,265,225.25,75.949,265,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Slp Swallow Evaluation (Session For 43000457),,92610,CPT,Facility,Both,,,GN,265,225.25,75.949,265,"Preferred One Administrative Services, INC.",PPO,261.29,98.6,,percent of total billed charges,,
Slp Swallow Evaluation (Session For 43000457),,92610,CPT,Facility,Outpatient,,,GN,265,225.25,75.949,265,PrimeWest Health,Minnesota Senior Health Options (MSHO),136.3425,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Slp Swallow Evaluation (Session For 43000457),,92610,CPT,Facility,Inpatient,,,GN,265,225.25,75.949,265,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Slp Swallow Evaluation (Session For 43000457),,92610,CPT,Facility,Outpatient,,,GN,265,225.25,75.949,265,PrimeWest Health,MinnesotaCare,136.104,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Slp Swallow Evaluation (Session For 43000457),,92610,CPT,Facility,Inpatient,,,GN,265,225.25,75.949,265,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Slp Swallow Evaluation (Session For 43000457),,92610,CPT,Facility,Both,,,GN,265,225.25,75.949,265,Sanford Health Plan,Sanford Health Plan,243.8,92,,percent of total billed charges,,
Slp Swallow Evaluation (Session For 43000457),,92610,CPT,Facility,Outpatient,,,GN,265,225.25,75.949,265,"UCare Health, Inc.",Individual & Family Plan,149.3275,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Slp Swallow Evaluation (Session For 43000457),,92610,CPT,Facility,Inpatient,,,GN,265,225.25,75.949,265,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Slp Swallow Evaluation (Session For 43000457),,92610,CPT,Facility,Outpatient,,,GN,265,225.25,75.949,265,"UCare Health, Inc.",Medical Assistance,133.7455,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Slp Swallow Evaluation (Session For 43000457),,92610,CPT,Facility,Inpatient,,,GN,265,225.25,75.949,265,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Slp Swallow Evaluation (Session For 43000457),,92610,CPT,Facility,Outpatient,,,GN,265,225.25,75.949,265,"UCare Health, Inc.",Medicare Advantage,133.7455,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Slp Swallow Evaluation (Session For 43000457),,92610,CPT,Facility,Inpatient,,,GN,265,225.25,75.949,265,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Slp Swallow Evaluation (Session For 43000457),,92610,CPT,Facility,Outpatient,,,GN,265,225.25,75.949,265,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),133.7455,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Slp Swallow Evaluation (Session For 43000457),,92610,CPT,Facility,Inpatient,,,GN,265,225.25,75.949,265,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Slp Swallow Evaluation (Session For 43000457),,92610,CPT,Facility,Both,,,GN,265,225.25,75.949,265,UnitedHealthcare,Individual & Family,249.1,94,,percent of total billed charges,,
Slp Swallow Evaluation (Session For 43000457),,92610,CPT,Facility,Outpatient,,,GN,265,225.25,75.949,265,UnitedHealthcare,Medicare Advantage,129.85,49,,percent of total billed charges,,
Slp Swallow Evaluation (Session For 43000457),,92610,CPT,Facility,Inpatient,,,GN,265,225.25,75.949,265,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Slp Swallow Evaluation (Session For 43000457),,92610,CPT,Facility,Outpatient,,,GN,265,225.25,75.949,265,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,127.2,48,,percent of total billed charges,,100% of DHS outpatient percentage
Slp Swallow Evaluation (Session For 43000457),,92610,CPT,Facility,Inpatient,,,GN,265,225.25,75.949,265,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Slp Swallow Study Eval Video,,92611,CPT,Facility,Both,,,GN,338,287.3,96.8708,338,Aetna,Commercial,310.96,92,,percent of total billed charges,,
Slp Swallow Study Eval Video,,92611,CPT,Facility,Outpatient,,,GN,338,287.3,96.8708,338,Aetna,Medicare Advantage,165.62,49,,percent of total billed charges,,
Slp Swallow Study Eval Video,,92611,CPT,Facility,Inpatient,,,GN,338,287.3,96.8708,338,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Slp Swallow Study Eval Video,,92611,CPT,Facility,Both,,,GN,338,287.3,96.8708,338,Aetna,PPO,314.34,93,,percent of total billed charges,,
Slp Swallow Study Eval Video,,92611,CPT,Facility,Both,,,GN,338,287.3,96.8708,338,America's PPO,America's PPO,324.5814,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Slp Swallow Study Eval Video,,92611,CPT,Facility,Both,,,GN,338,287.3,96.8708,338,BlueCross BlueShield Minnesota, Federal Employee Program,332.592,98.4,,percent of total billed charges,,
Slp Swallow Study Eval Video,,92611,CPT,Facility,Both,,,GN,338,287.3,96.8708,338,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,338,100,,percent of total billed charges,,
Slp Swallow Study Eval Video,,92611,CPT,Facility,Both,,,GN,338,287.3,96.8708,338,BlueCross BlueShield Minnesota,High Value Network Plan,304.2,90,,percent of total billed charges,,
Slp Swallow Study Eval Video,,92611,CPT,Facility,Outpatient,,,GN,338,287.3,96.8708,338,BlueCross BlueShield Minnesota,Medicare Advantage,165.62,49,,percent of total billed charges,,
Slp Swallow Study Eval Video,,92611,CPT,Facility,Inpatient,,,GN,338,287.3,96.8708,338,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Slp Swallow Study Eval Video,,92611,CPT,Facility,Both,,,GN,338,287.3,96.8708,338,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,299.3666,88.57,,percent of total billed charges,,
Slp Swallow Study Eval Video,,92611,CPT,Facility,Both,,,GN,338,287.3,96.8708,338,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,96.8708,28.66,,percent of total billed charges,,
Slp Swallow Study Eval Video,,92611,CPT,Facility,Outpatient,,,GN,338,287.3,96.8708,338,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),165.62,49,,percent of total billed charges,,
Slp Swallow Study Eval Video,,92611,CPT,Facility,Inpatient,,,GN,338,287.3,96.8708,338,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Slp Swallow Study Eval Video,,92611,CPT,Facility,Both,,,GN,338,287.3,96.8708,338,CorVel,Worker's Compensation,338,100,,percent of total billed charges,,
Slp Swallow Study Eval Video,,92611,CPT,Facility,Both,,,GN,338,287.3,96.8708,338,First Health Group Corporation,First Health Network,327.86,97,,percent of total billed charges,,
Slp Swallow Study Eval Video,,92611,CPT,Facility,Both,,,GN,338,287.3,96.8708,338,"Health Partners, Inc.",Commercial,319.748,94.6,,percent of total billed charges,,
Slp Swallow Study Eval Video,,92611,CPT,Facility,Outpatient,,,GN,338,287.3,96.8708,338,"Health Partners, Inc.",Medicare Advantage,165.62,49,,percent of total billed charges,,
Slp Swallow Study Eval Video,,92611,CPT,Facility,Inpatient,,,GN,338,287.3,96.8708,338,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Slp Swallow Study Eval Video,,92611,CPT,Facility,Both,,,GN,338,287.3,96.8708,338,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),202.8,60,,percent of total billed charges,,
Slp Swallow Study Eval Video,,92611,CPT,Facility,Both,,,GN,338,287.3,96.8708,338,"Health Partners, Inc.",State of Minnesota Advantage Program,275.47,81.5,,percent of total billed charges,,
Slp Swallow Study Eval Video,,92611,CPT,Facility,Both,,,GN,338,287.3,96.8708,338,"Health Partners, Inc.",State Public Programs,169,50,,percent of total billed charges,,
Slp Swallow Study Eval Video,,92611,CPT,Facility,Both,,,GN,338,287.3,96.8708,338,Humana Insurance Company,Commercial PPO,321.1,95,,percent of total billed charges,,
Slp Swallow Study Eval Video,,92611,CPT,Facility,Outpatient,,,GN,338,287.3,96.8708,338,Humana Insurance Company,Medicare PPO,165.62,49,,percent of total billed charges,,
Slp Swallow Study Eval Video,,92611,CPT,Facility,Inpatient,,,GN,338,287.3,96.8708,338,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Slp Swallow Study Eval Video,,92611,CPT,Facility,Both,,,GN,338,287.3,96.8708,338,Medica,Individual & Family,334.958,99.1,,percent of total billed charges,,
Slp Swallow Study Eval Video,,92611,CPT,Facility,Outpatient,,,GN,338,287.3,96.8708,338,Medica,Medica Advantage Solution,168.324,49.8,,percent of total billed charges,,
Slp Swallow Study Eval Video,,92611,CPT,Facility,Inpatient,,,GN,338,287.3,96.8708,338,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Slp Swallow Study Eval Video,,92611,CPT,Facility,Outpatient,,,GN,338,287.3,96.8708,338,Medica,Medical Assistance,150.748,44.6,,percent of total billed charges,,
Slp Swallow Study Eval Video,,92611,CPT,Facility,Inpatient,,,GN,338,287.3,96.8708,338,Medica,Medical Assistance,,,,,Included in per diem rate,
Slp Swallow Study Eval Video,,92611,CPT,Facility,Outpatient,,,GN,338,287.3,96.8708,338,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,168.324,49.8,,percent of total billed charges,,
Slp Swallow Study Eval Video,,92611,CPT,Facility,Inpatient,,,GN,338,287.3,96.8708,338,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Slp Swallow Study Eval Video,,92611,CPT,Facility,Both,,,GN,338,287.3,96.8708,338,"Multiplan, Inc.","Multiplan, Inc.",317.72,94,,percent of total billed charges,,
Slp Swallow Study Eval Video,,92611,CPT,Facility,Outpatient,,,GN,338,287.3,96.8708,338,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,292.032,86.4,,percent of total billed charges,,
Slp Swallow Study Eval Video,,92611,CPT,Facility,Inpatient,,,GN,338,287.3,96.8708,338,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Slp Swallow Study Eval Video,,92611,CPT,Facility,Both,,,GN,338,287.3,96.8708,338,"Preferred One Administrative Services, INC.",PPO,333.268,98.6,,percent of total billed charges,,
Slp Swallow Study Eval Video,,92611,CPT,Facility,Outpatient,,,GN,338,287.3,96.8708,338,PrimeWest Health,Minnesota Senior Health Options (MSHO),173.901,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Slp Swallow Study Eval Video,,92611,CPT,Facility,Inpatient,,,GN,338,287.3,96.8708,338,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Slp Swallow Study Eval Video,,92611,CPT,Facility,Outpatient,,,GN,338,287.3,96.8708,338,PrimeWest Health,MinnesotaCare,173.5968,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Slp Swallow Study Eval Video,,92611,CPT,Facility,Inpatient,,,GN,338,287.3,96.8708,338,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Slp Swallow Study Eval Video,,92611,CPT,Facility,Both,,,GN,338,287.3,96.8708,338,Sanford Health Plan,Sanford Health Plan,310.96,92,,percent of total billed charges,,
Slp Swallow Study Eval Video,,92611,CPT,Facility,Outpatient,,,GN,338,287.3,96.8708,338,"UCare Health, Inc.",Individual & Family Plan,190.463,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Slp Swallow Study Eval Video,,92611,CPT,Facility,Inpatient,,,GN,338,287.3,96.8708,338,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Slp Swallow Study Eval Video,,92611,CPT,Facility,Outpatient,,,GN,338,287.3,96.8708,338,"UCare Health, Inc.",Medical Assistance,170.5886,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Slp Swallow Study Eval Video,,92611,CPT,Facility,Inpatient,,,GN,338,287.3,96.8708,338,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Slp Swallow Study Eval Video,,92611,CPT,Facility,Outpatient,,,GN,338,287.3,96.8708,338,"UCare Health, Inc.",Medicare Advantage,170.5886,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Slp Swallow Study Eval Video,,92611,CPT,Facility,Inpatient,,,GN,338,287.3,96.8708,338,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Slp Swallow Study Eval Video,,92611,CPT,Facility,Outpatient,,,GN,338,287.3,96.8708,338,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),170.5886,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Slp Swallow Study Eval Video,,92611,CPT,Facility,Inpatient,,,GN,338,287.3,96.8708,338,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Slp Swallow Study Eval Video,,92611,CPT,Facility,Both,,,GN,338,287.3,96.8708,338,UnitedHealthcare,Individual & Family,317.72,94,,percent of total billed charges,,
Slp Swallow Study Eval Video,,92611,CPT,Facility,Outpatient,,,GN,338,287.3,96.8708,338,UnitedHealthcare,Medicare Advantage,165.62,49,,percent of total billed charges,,
Slp Swallow Study Eval Video,,92611,CPT,Facility,Inpatient,,,GN,338,287.3,96.8708,338,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Slp Swallow Study Eval Video,,92611,CPT,Facility,Outpatient,,,GN,338,287.3,96.8708,338,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,162.24,48,,percent of total billed charges,,100% of DHS outpatient percentage
Slp Swallow Study Eval Video,,92611,CPT,Facility,Inpatient,,,GN,338,287.3,96.8708,338,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Slp Eval For Rx Non-Speech Device (Ea Add'L 30 Min),,92618,CPT,Facility,Both,,,GN,114,96.9,32.6724,114,Aetna,Commercial,104.88,92,,percent of total billed charges,,
Slp Eval For Rx Non-Speech Device (Ea Add'L 30 Min),,92618,CPT,Facility,Outpatient,,,GN,114,96.9,32.6724,114,Aetna,Medicare Advantage,55.86,49,,percent of total billed charges,,
Slp Eval For Rx Non-Speech Device (Ea Add'L 30 Min),,92618,CPT,Facility,Inpatient,,,GN,114,96.9,32.6724,114,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Slp Eval For Rx Non-Speech Device (Ea Add'L 30 Min),,92618,CPT,Facility,Both,,,GN,114,96.9,32.6724,114,Aetna,PPO,106.02,93,,percent of total billed charges,,
Slp Eval For Rx Non-Speech Device (Ea Add'L 30 Min),,92618,CPT,Facility,Both,,,GN,114,96.9,32.6724,114,America's PPO,America's PPO,109.4742,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Slp Eval For Rx Non-Speech Device (Ea Add'L 30 Min),,92618,CPT,Facility,Both,,,GN,114,96.9,32.6724,114,BlueCross BlueShield Minnesota, Federal Employee Program,112.176,98.4,,percent of total billed charges,,
Slp Eval For Rx Non-Speech Device (Ea Add'L 30 Min),,92618,CPT,Facility,Both,,,GN,114,96.9,32.6724,114,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,114,100,,percent of total billed charges,,
Slp Eval For Rx Non-Speech Device (Ea Add'L 30 Min),,92618,CPT,Facility,Both,,,GN,114,96.9,32.6724,114,BlueCross BlueShield Minnesota,High Value Network Plan,102.6,90,,percent of total billed charges,,
Slp Eval For Rx Non-Speech Device (Ea Add'L 30 Min),,92618,CPT,Facility,Outpatient,,,GN,114,96.9,32.6724,114,BlueCross BlueShield Minnesota,Medicare Advantage,55.86,49,,percent of total billed charges,,
Slp Eval For Rx Non-Speech Device (Ea Add'L 30 Min),,92618,CPT,Facility,Inpatient,,,GN,114,96.9,32.6724,114,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Slp Eval For Rx Non-Speech Device (Ea Add'L 30 Min),,92618,CPT,Facility,Both,,,GN,114,96.9,32.6724,114,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,100.9698,88.57,,percent of total billed charges,,
Slp Eval For Rx Non-Speech Device (Ea Add'L 30 Min),,92618,CPT,Facility,Both,,,GN,114,96.9,32.6724,114,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,32.6724,28.66,,percent of total billed charges,,
Slp Eval For Rx Non-Speech Device (Ea Add'L 30 Min),,92618,CPT,Facility,Outpatient,,,GN,114,96.9,32.6724,114,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),55.86,49,,percent of total billed charges,,
Slp Eval For Rx Non-Speech Device (Ea Add'L 30 Min),,92618,CPT,Facility,Inpatient,,,GN,114,96.9,32.6724,114,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Slp Eval For Rx Non-Speech Device (Ea Add'L 30 Min),,92618,CPT,Facility,Both,,,GN,114,96.9,32.6724,114,CorVel,Worker's Compensation,114,100,,percent of total billed charges,,
Slp Eval For Rx Non-Speech Device (Ea Add'L 30 Min),,92618,CPT,Facility,Both,,,GN,114,96.9,32.6724,114,First Health Group Corporation,First Health Network,110.58,97,,percent of total billed charges,,
Slp Eval For Rx Non-Speech Device (Ea Add'L 30 Min),,92618,CPT,Facility,Both,,,GN,114,96.9,32.6724,114,"Health Partners, Inc.",Commercial,107.844,94.6,,percent of total billed charges,,
Slp Eval For Rx Non-Speech Device (Ea Add'L 30 Min),,92618,CPT,Facility,Outpatient,,,GN,114,96.9,32.6724,114,"Health Partners, Inc.",Medicare Advantage,55.86,49,,percent of total billed charges,,
Slp Eval For Rx Non-Speech Device (Ea Add'L 30 Min),,92618,CPT,Facility,Inpatient,,,GN,114,96.9,32.6724,114,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Slp Eval For Rx Non-Speech Device (Ea Add'L 30 Min),,92618,CPT,Facility,Both,,,GN,114,96.9,32.6724,114,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),68.4,60,,percent of total billed charges,,
Slp Eval For Rx Non-Speech Device (Ea Add'L 30 Min),,92618,CPT,Facility,Both,,,GN,114,96.9,32.6724,114,"Health Partners, Inc.",State of Minnesota Advantage Program,92.91,81.5,,percent of total billed charges,,
Slp Eval For Rx Non-Speech Device (Ea Add'L 30 Min),,92618,CPT,Facility,Both,,,GN,114,96.9,32.6724,114,"Health Partners, Inc.",State Public Programs,57,50,,percent of total billed charges,,
Slp Eval For Rx Non-Speech Device (Ea Add'L 30 Min),,92618,CPT,Facility,Both,,,GN,114,96.9,32.6724,114,Humana Insurance Company,Commercial PPO,108.3,95,,percent of total billed charges,,
Slp Eval For Rx Non-Speech Device (Ea Add'L 30 Min),,92618,CPT,Facility,Outpatient,,,GN,114,96.9,32.6724,114,Humana Insurance Company,Medicare PPO,55.86,49,,percent of total billed charges,,
Slp Eval For Rx Non-Speech Device (Ea Add'L 30 Min),,92618,CPT,Facility,Inpatient,,,GN,114,96.9,32.6724,114,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Slp Eval For Rx Non-Speech Device (Ea Add'L 30 Min),,92618,CPT,Facility,Both,,,GN,114,96.9,32.6724,114,Medica,Individual & Family,112.974,99.1,,percent of total billed charges,,
Slp Eval For Rx Non-Speech Device (Ea Add'L 30 Min),,92618,CPT,Facility,Outpatient,,,GN,114,96.9,32.6724,114,Medica,Medica Advantage Solution,56.772,49.8,,percent of total billed charges,,
Slp Eval For Rx Non-Speech Device (Ea Add'L 30 Min),,92618,CPT,Facility,Inpatient,,,GN,114,96.9,32.6724,114,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Slp Eval For Rx Non-Speech Device (Ea Add'L 30 Min),,92618,CPT,Facility,Outpatient,,,GN,114,96.9,32.6724,114,Medica,Medical Assistance,50.844,44.6,,percent of total billed charges,,
Slp Eval For Rx Non-Speech Device (Ea Add'L 30 Min),,92618,CPT,Facility,Inpatient,,,GN,114,96.9,32.6724,114,Medica,Medical Assistance,,,,,Included in per diem rate,
Slp Eval For Rx Non-Speech Device (Ea Add'L 30 Min),,92618,CPT,Facility,Outpatient,,,GN,114,96.9,32.6724,114,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,56.772,49.8,,percent of total billed charges,,
Slp Eval For Rx Non-Speech Device (Ea Add'L 30 Min),,92618,CPT,Facility,Inpatient,,,GN,114,96.9,32.6724,114,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Slp Eval For Rx Non-Speech Device (Ea Add'L 30 Min),,92618,CPT,Facility,Both,,,GN,114,96.9,32.6724,114,"Multiplan, Inc.","Multiplan, Inc.",107.16,94,,percent of total billed charges,,
Slp Eval For Rx Non-Speech Device (Ea Add'L 30 Min),,92618,CPT,Facility,Outpatient,,,GN,114,96.9,32.6724,114,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,98.496,86.4,,percent of total billed charges,,
Slp Eval For Rx Non-Speech Device (Ea Add'L 30 Min),,92618,CPT,Facility,Inpatient,,,GN,114,96.9,32.6724,114,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Slp Eval For Rx Non-Speech Device (Ea Add'L 30 Min),,92618,CPT,Facility,Both,,,GN,114,96.9,32.6724,114,"Preferred One Administrative Services, INC.",PPO,112.404,98.6,,percent of total billed charges,,
Slp Eval For Rx Non-Speech Device (Ea Add'L 30 Min),,92618,CPT,Facility,Outpatient,,,GN,114,96.9,32.6724,114,PrimeWest Health,Minnesota Senior Health Options (MSHO),58.653,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Slp Eval For Rx Non-Speech Device (Ea Add'L 30 Min),,92618,CPT,Facility,Inpatient,,,GN,114,96.9,32.6724,114,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Slp Eval For Rx Non-Speech Device (Ea Add'L 30 Min),,92618,CPT,Facility,Outpatient,,,GN,114,96.9,32.6724,114,PrimeWest Health,MinnesotaCare,58.5504,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Slp Eval For Rx Non-Speech Device (Ea Add'L 30 Min),,92618,CPT,Facility,Inpatient,,,GN,114,96.9,32.6724,114,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Slp Eval For Rx Non-Speech Device (Ea Add'L 30 Min),,92618,CPT,Facility,Both,,,GN,114,96.9,32.6724,114,Sanford Health Plan,Sanford Health Plan,104.88,92,,percent of total billed charges,,
Slp Eval For Rx Non-Speech Device (Ea Add'L 30 Min),,92618,CPT,Facility,Outpatient,,,GN,114,96.9,32.6724,114,"UCare Health, Inc.",Individual & Family Plan,64.239,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Slp Eval For Rx Non-Speech Device (Ea Add'L 30 Min),,92618,CPT,Facility,Inpatient,,,GN,114,96.9,32.6724,114,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Slp Eval For Rx Non-Speech Device (Ea Add'L 30 Min),,92618,CPT,Facility,Outpatient,,,GN,114,96.9,32.6724,114,"UCare Health, Inc.",Medical Assistance,57.5358,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Slp Eval For Rx Non-Speech Device (Ea Add'L 30 Min),,92618,CPT,Facility,Inpatient,,,GN,114,96.9,32.6724,114,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Slp Eval For Rx Non-Speech Device (Ea Add'L 30 Min),,92618,CPT,Facility,Outpatient,,,GN,114,96.9,32.6724,114,"UCare Health, Inc.",Medicare Advantage,57.5358,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Slp Eval For Rx Non-Speech Device (Ea Add'L 30 Min),,92618,CPT,Facility,Inpatient,,,GN,114,96.9,32.6724,114,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Slp Eval For Rx Non-Speech Device (Ea Add'L 30 Min),,92618,CPT,Facility,Outpatient,,,GN,114,96.9,32.6724,114,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),57.5358,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Slp Eval For Rx Non-Speech Device (Ea Add'L 30 Min),,92618,CPT,Facility,Inpatient,,,GN,114,96.9,32.6724,114,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Slp Eval For Rx Non-Speech Device (Ea Add'L 30 Min),,92618,CPT,Facility,Both,,,GN,114,96.9,32.6724,114,UnitedHealthcare,Individual & Family,107.16,94,,percent of total billed charges,,
Slp Eval For Rx Non-Speech Device (Ea Add'L 30 Min),,92618,CPT,Facility,Outpatient,,,GN,114,96.9,32.6724,114,UnitedHealthcare,Medicare Advantage,55.86,49,,percent of total billed charges,,
Slp Eval For Rx Non-Speech Device (Ea Add'L 30 Min),,92618,CPT,Facility,Inpatient,,,GN,114,96.9,32.6724,114,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Slp Eval For Rx Non-Speech Device (Ea Add'L 30 Min),,92618,CPT,Facility,Outpatient,,,GN,114,96.9,32.6724,114,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,54.72,48,,percent of total billed charges,,100% of DHS outpatient percentage
Slp Eval For Rx Non-Speech Device (Ea Add'L 30 Min),,92618,CPT,Facility,Inpatient,,,GN,114,96.9,32.6724,114,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Slp Aphasia Assessment,,96105,CPT,Facility,Both,,,GN,287,243.95,82.2542,287,Aetna,Commercial,264.04,92,,percent of total billed charges,,
Slp Aphasia Assessment,,96105,CPT,Facility,Outpatient,,,GN,287,243.95,82.2542,287,Aetna,Medicare Advantage,140.63,49,,percent of total billed charges,,
Slp Aphasia Assessment,,96105,CPT,Facility,Inpatient,,,GN,287,243.95,82.2542,287,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Slp Aphasia Assessment,,96105,CPT,Facility,Both,,,GN,287,243.95,82.2542,287,Aetna,PPO,266.91,93,,percent of total billed charges,,
Slp Aphasia Assessment,,96105,CPT,Facility,Both,,,GN,287,243.95,82.2542,287,America's PPO,America's PPO,275.6061,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Slp Aphasia Assessment,,96105,CPT,Facility,Both,,,GN,287,243.95,82.2542,287,BlueCross BlueShield Minnesota, Federal Employee Program,282.408,98.4,,percent of total billed charges,,
Slp Aphasia Assessment,,96105,CPT,Facility,Both,,,GN,287,243.95,82.2542,287,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,287,100,,percent of total billed charges,,
Slp Aphasia Assessment,,96105,CPT,Facility,Both,,,GN,287,243.95,82.2542,287,BlueCross BlueShield Minnesota,High Value Network Plan,258.3,90,,percent of total billed charges,,
Slp Aphasia Assessment,,96105,CPT,Facility,Outpatient,,,GN,287,243.95,82.2542,287,BlueCross BlueShield Minnesota,Medicare Advantage,140.63,49,,percent of total billed charges,,
Slp Aphasia Assessment,,96105,CPT,Facility,Inpatient,,,GN,287,243.95,82.2542,287,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Slp Aphasia Assessment,,96105,CPT,Facility,Both,,,GN,287,243.95,82.2542,287,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,254.1959,88.57,,percent of total billed charges,,
Slp Aphasia Assessment,,96105,CPT,Facility,Both,,,GN,287,243.95,82.2542,287,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,82.2542,28.66,,percent of total billed charges,,
Slp Aphasia Assessment,,96105,CPT,Facility,Outpatient,,,GN,287,243.95,82.2542,287,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),140.63,49,,percent of total billed charges,,
Slp Aphasia Assessment,,96105,CPT,Facility,Inpatient,,,GN,287,243.95,82.2542,287,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Slp Aphasia Assessment,,96105,CPT,Facility,Both,,,GN,287,243.95,82.2542,287,CorVel,Worker's Compensation,287,100,,percent of total billed charges,,
Slp Aphasia Assessment,,96105,CPT,Facility,Both,,,GN,287,243.95,82.2542,287,First Health Group Corporation,First Health Network,278.39,97,,percent of total billed charges,,
Slp Aphasia Assessment,,96105,CPT,Facility,Both,,,GN,287,243.95,82.2542,287,"Health Partners, Inc.",Commercial,271.502,94.6,,percent of total billed charges,,
Slp Aphasia Assessment,,96105,CPT,Facility,Outpatient,,,GN,287,243.95,82.2542,287,"Health Partners, Inc.",Medicare Advantage,140.63,49,,percent of total billed charges,,
Slp Aphasia Assessment,,96105,CPT,Facility,Inpatient,,,GN,287,243.95,82.2542,287,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Slp Aphasia Assessment,,96105,CPT,Facility,Both,,,GN,287,243.95,82.2542,287,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),172.2,60,,percent of total billed charges,,
Slp Aphasia Assessment,,96105,CPT,Facility,Both,,,GN,287,243.95,82.2542,287,"Health Partners, Inc.",State of Minnesota Advantage Program,233.905,81.5,,percent of total billed charges,,
Slp Aphasia Assessment,,96105,CPT,Facility,Both,,,GN,287,243.95,82.2542,287,"Health Partners, Inc.",State Public Programs,143.5,50,,percent of total billed charges,,
Slp Aphasia Assessment,,96105,CPT,Facility,Both,,,GN,287,243.95,82.2542,287,Humana Insurance Company,Commercial PPO,272.65,95,,percent of total billed charges,,
Slp Aphasia Assessment,,96105,CPT,Facility,Outpatient,,,GN,287,243.95,82.2542,287,Humana Insurance Company,Medicare PPO,140.63,49,,percent of total billed charges,,
Slp Aphasia Assessment,,96105,CPT,Facility,Inpatient,,,GN,287,243.95,82.2542,287,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Slp Aphasia Assessment,,96105,CPT,Facility,Both,,,GN,287,243.95,82.2542,287,Medica,Individual & Family,284.417,99.1,,percent of total billed charges,,
Slp Aphasia Assessment,,96105,CPT,Facility,Outpatient,,,GN,287,243.95,82.2542,287,Medica,Medica Advantage Solution,142.926,49.8,,percent of total billed charges,,
Slp Aphasia Assessment,,96105,CPT,Facility,Inpatient,,,GN,287,243.95,82.2542,287,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Slp Aphasia Assessment,,96105,CPT,Facility,Outpatient,,,GN,287,243.95,82.2542,287,Medica,Medical Assistance,128.002,44.6,,percent of total billed charges,,
Slp Aphasia Assessment,,96105,CPT,Facility,Inpatient,,,GN,287,243.95,82.2542,287,Medica,Medical Assistance,,,,,Included in per diem rate,
Slp Aphasia Assessment,,96105,CPT,Facility,Outpatient,,,GN,287,243.95,82.2542,287,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,142.926,49.8,,percent of total billed charges,,
Slp Aphasia Assessment,,96105,CPT,Facility,Inpatient,,,GN,287,243.95,82.2542,287,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Slp Aphasia Assessment,,96105,CPT,Facility,Both,,,GN,287,243.95,82.2542,287,"Multiplan, Inc.","Multiplan, Inc.",269.78,94,,percent of total billed charges,,
Slp Aphasia Assessment,,96105,CPT,Facility,Outpatient,,,GN,287,243.95,82.2542,287,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,247.968,86.4,,percent of total billed charges,,
Slp Aphasia Assessment,,96105,CPT,Facility,Inpatient,,,GN,287,243.95,82.2542,287,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Slp Aphasia Assessment,,96105,CPT,Facility,Both,,,GN,287,243.95,82.2542,287,"Preferred One Administrative Services, INC.",PPO,282.982,98.6,,percent of total billed charges,,
Slp Aphasia Assessment,,96105,CPT,Facility,Outpatient,,,GN,287,243.95,82.2542,287,PrimeWest Health,Minnesota Senior Health Options (MSHO),147.6615,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Slp Aphasia Assessment,,96105,CPT,Facility,Inpatient,,,GN,287,243.95,82.2542,287,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Slp Aphasia Assessment,,96105,CPT,Facility,Outpatient,,,GN,287,243.95,82.2542,287,PrimeWest Health,MinnesotaCare,147.4032,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Slp Aphasia Assessment,,96105,CPT,Facility,Inpatient,,,GN,287,243.95,82.2542,287,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Slp Aphasia Assessment,,96105,CPT,Facility,Both,,,GN,287,243.95,82.2542,287,Sanford Health Plan,Sanford Health Plan,264.04,92,,percent of total billed charges,,
Slp Aphasia Assessment,,96105,CPT,Facility,Outpatient,,,GN,287,243.95,82.2542,287,"UCare Health, Inc.",Individual & Family Plan,161.7245,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Slp Aphasia Assessment,,96105,CPT,Facility,Inpatient,,,GN,287,243.95,82.2542,287,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Slp Aphasia Assessment,,96105,CPT,Facility,Outpatient,,,GN,287,243.95,82.2542,287,"UCare Health, Inc.",Medical Assistance,144.8489,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Slp Aphasia Assessment,,96105,CPT,Facility,Inpatient,,,GN,287,243.95,82.2542,287,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Slp Aphasia Assessment,,96105,CPT,Facility,Outpatient,,,GN,287,243.95,82.2542,287,"UCare Health, Inc.",Medicare Advantage,144.8489,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Slp Aphasia Assessment,,96105,CPT,Facility,Inpatient,,,GN,287,243.95,82.2542,287,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Slp Aphasia Assessment,,96105,CPT,Facility,Outpatient,,,GN,287,243.95,82.2542,287,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),144.8489,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Slp Aphasia Assessment,,96105,CPT,Facility,Inpatient,,,GN,287,243.95,82.2542,287,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Slp Aphasia Assessment,,96105,CPT,Facility,Both,,,GN,287,243.95,82.2542,287,UnitedHealthcare,Individual & Family,269.78,94,,percent of total billed charges,,
Slp Aphasia Assessment,,96105,CPT,Facility,Outpatient,,,GN,287,243.95,82.2542,287,UnitedHealthcare,Medicare Advantage,140.63,49,,percent of total billed charges,,
Slp Aphasia Assessment,,96105,CPT,Facility,Inpatient,,,GN,287,243.95,82.2542,287,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Slp Aphasia Assessment,,96105,CPT,Facility,Outpatient,,,GN,287,243.95,82.2542,287,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,137.76,48,,percent of total billed charges,,100% of DHS outpatient percentage
Slp Aphasia Assessment,,96105,CPT,Facility,Inpatient,,,GN,287,243.95,82.2542,287,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Slp Cognitive Performance Test,,96125,CPT,Facility,Both,,,GN,260,221,74.516,260,Aetna,Commercial,239.2,92,,percent of total billed charges,,
Slp Cognitive Performance Test,,96125,CPT,Facility,Outpatient,,,GN,260,221,74.516,260,Aetna,Medicare Advantage,127.4,49,,percent of total billed charges,,
Slp Cognitive Performance Test,,96125,CPT,Facility,Inpatient,,,GN,260,221,74.516,260,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Slp Cognitive Performance Test,,96125,CPT,Facility,Both,,,GN,260,221,74.516,260,Aetna,PPO,241.8,93,,percent of total billed charges,,
Slp Cognitive Performance Test,,96125,CPT,Facility,Both,,,GN,260,221,74.516,260,America's PPO,America's PPO,249.678,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Slp Cognitive Performance Test,,96125,CPT,Facility,Both,,,GN,260,221,74.516,260,BlueCross BlueShield Minnesota, Federal Employee Program,255.84,98.4,,percent of total billed charges,,
Slp Cognitive Performance Test,,96125,CPT,Facility,Both,,,GN,260,221,74.516,260,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,260,100,,percent of total billed charges,,
Slp Cognitive Performance Test,,96125,CPT,Facility,Both,,,GN,260,221,74.516,260,BlueCross BlueShield Minnesota,High Value Network Plan,234,90,,percent of total billed charges,,
Slp Cognitive Performance Test,,96125,CPT,Facility,Outpatient,,,GN,260,221,74.516,260,BlueCross BlueShield Minnesota,Medicare Advantage,127.4,49,,percent of total billed charges,,
Slp Cognitive Performance Test,,96125,CPT,Facility,Inpatient,,,GN,260,221,74.516,260,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Slp Cognitive Performance Test,,96125,CPT,Facility,Both,,,GN,260,221,74.516,260,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,230.282,88.57,,percent of total billed charges,,
Slp Cognitive Performance Test,,96125,CPT,Facility,Both,,,GN,260,221,74.516,260,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,74.516,28.66,,percent of total billed charges,,
Slp Cognitive Performance Test,,96125,CPT,Facility,Outpatient,,,GN,260,221,74.516,260,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),127.4,49,,percent of total billed charges,,
Slp Cognitive Performance Test,,96125,CPT,Facility,Inpatient,,,GN,260,221,74.516,260,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Slp Cognitive Performance Test,,96125,CPT,Facility,Both,,,GN,260,221,74.516,260,CorVel,Worker's Compensation,260,100,,percent of total billed charges,,
Slp Cognitive Performance Test,,96125,CPT,Facility,Both,,,GN,260,221,74.516,260,First Health Group Corporation,First Health Network,252.2,97,,percent of total billed charges,,
Slp Cognitive Performance Test,,96125,CPT,Facility,Both,,,GN,260,221,74.516,260,"Health Partners, Inc.",Commercial,245.96,94.6,,percent of total billed charges,,
Slp Cognitive Performance Test,,96125,CPT,Facility,Outpatient,,,GN,260,221,74.516,260,"Health Partners, Inc.",Medicare Advantage,127.4,49,,percent of total billed charges,,
Slp Cognitive Performance Test,,96125,CPT,Facility,Inpatient,,,GN,260,221,74.516,260,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Slp Cognitive Performance Test,,96125,CPT,Facility,Both,,,GN,260,221,74.516,260,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),156,60,,percent of total billed charges,,
Slp Cognitive Performance Test,,96125,CPT,Facility,Both,,,GN,260,221,74.516,260,"Health Partners, Inc.",State of Minnesota Advantage Program,211.9,81.5,,percent of total billed charges,,
Slp Cognitive Performance Test,,96125,CPT,Facility,Both,,,GN,260,221,74.516,260,"Health Partners, Inc.",State Public Programs,130,50,,percent of total billed charges,,
Slp Cognitive Performance Test,,96125,CPT,Facility,Both,,,GN,260,221,74.516,260,Humana Insurance Company,Commercial PPO,247,95,,percent of total billed charges,,
Slp Cognitive Performance Test,,96125,CPT,Facility,Outpatient,,,GN,260,221,74.516,260,Humana Insurance Company,Medicare PPO,127.4,49,,percent of total billed charges,,
Slp Cognitive Performance Test,,96125,CPT,Facility,Inpatient,,,GN,260,221,74.516,260,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Slp Cognitive Performance Test,,96125,CPT,Facility,Both,,,GN,260,221,74.516,260,Medica,Individual & Family,257.66,99.1,,percent of total billed charges,,
Slp Cognitive Performance Test,,96125,CPT,Facility,Outpatient,,,GN,260,221,74.516,260,Medica,Medica Advantage Solution,129.48,49.8,,percent of total billed charges,,
Slp Cognitive Performance Test,,96125,CPT,Facility,Inpatient,,,GN,260,221,74.516,260,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Slp Cognitive Performance Test,,96125,CPT,Facility,Outpatient,,,GN,260,221,74.516,260,Medica,Medical Assistance,115.96,44.6,,percent of total billed charges,,
Slp Cognitive Performance Test,,96125,CPT,Facility,Inpatient,,,GN,260,221,74.516,260,Medica,Medical Assistance,,,,,Included in per diem rate,
Slp Cognitive Performance Test,,96125,CPT,Facility,Outpatient,,,GN,260,221,74.516,260,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,129.48,49.8,,percent of total billed charges,,
Slp Cognitive Performance Test,,96125,CPT,Facility,Inpatient,,,GN,260,221,74.516,260,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Slp Cognitive Performance Test,,96125,CPT,Facility,Both,,,GN,260,221,74.516,260,"Multiplan, Inc.","Multiplan, Inc.",244.4,94,,percent of total billed charges,,
Slp Cognitive Performance Test,,96125,CPT,Facility,Outpatient,,,GN,260,221,74.516,260,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,224.64,86.4,,percent of total billed charges,,
Slp Cognitive Performance Test,,96125,CPT,Facility,Inpatient,,,GN,260,221,74.516,260,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Slp Cognitive Performance Test,,96125,CPT,Facility,Both,,,GN,260,221,74.516,260,"Preferred One Administrative Services, INC.",PPO,256.36,98.6,,percent of total billed charges,,
Slp Cognitive Performance Test,,96125,CPT,Facility,Outpatient,,,GN,260,221,74.516,260,PrimeWest Health,Minnesota Senior Health Options (MSHO),133.77,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Slp Cognitive Performance Test,,96125,CPT,Facility,Inpatient,,,GN,260,221,74.516,260,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Slp Cognitive Performance Test,,96125,CPT,Facility,Outpatient,,,GN,260,221,74.516,260,PrimeWest Health,MinnesotaCare,133.536,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Slp Cognitive Performance Test,,96125,CPT,Facility,Inpatient,,,GN,260,221,74.516,260,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Slp Cognitive Performance Test,,96125,CPT,Facility,Both,,,GN,260,221,74.516,260,Sanford Health Plan,Sanford Health Plan,239.2,92,,percent of total billed charges,,
Slp Cognitive Performance Test,,96125,CPT,Facility,Outpatient,,,GN,260,221,74.516,260,"UCare Health, Inc.",Individual & Family Plan,146.51,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Slp Cognitive Performance Test,,96125,CPT,Facility,Inpatient,,,GN,260,221,74.516,260,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Slp Cognitive Performance Test,,96125,CPT,Facility,Outpatient,,,GN,260,221,74.516,260,"UCare Health, Inc.",Medical Assistance,131.222,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Slp Cognitive Performance Test,,96125,CPT,Facility,Inpatient,,,GN,260,221,74.516,260,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Slp Cognitive Performance Test,,96125,CPT,Facility,Outpatient,,,GN,260,221,74.516,260,"UCare Health, Inc.",Medicare Advantage,131.222,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Slp Cognitive Performance Test,,96125,CPT,Facility,Inpatient,,,GN,260,221,74.516,260,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Slp Cognitive Performance Test,,96125,CPT,Facility,Outpatient,,,GN,260,221,74.516,260,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),131.222,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Slp Cognitive Performance Test,,96125,CPT,Facility,Inpatient,,,GN,260,221,74.516,260,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Slp Cognitive Performance Test,,96125,CPT,Facility,Both,,,GN,260,221,74.516,260,UnitedHealthcare,Individual & Family,244.4,94,,percent of total billed charges,,
Slp Cognitive Performance Test,,96125,CPT,Facility,Outpatient,,,GN,260,221,74.516,260,UnitedHealthcare,Medicare Advantage,127.4,49,,percent of total billed charges,,
Slp Cognitive Performance Test,,96125,CPT,Facility,Inpatient,,,GN,260,221,74.516,260,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Slp Cognitive Performance Test,,96125,CPT,Facility,Outpatient,,,GN,260,221,74.516,260,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,124.8,48,,percent of total billed charges,,100% of DHS outpatient percentage
Slp Cognitive Performance Test,,96125,CPT,Facility,Inpatient,,,GN,260,221,74.516,260,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Slp  Cognitive Function Intervention (Initial 15 Min),,97129,CPT,Facility,Both,,,GN,77,65.45,22.0682,77,Aetna,Commercial,70.84,92,,percent of total billed charges,,
Slp  Cognitive Function Intervention (Initial 15 Min),,97129,CPT,Facility,Outpatient,,,GN,77,65.45,22.0682,77,Aetna,Medicare Advantage,37.73,49,,percent of total billed charges,,
Slp  Cognitive Function Intervention (Initial 15 Min),,97129,CPT,Facility,Inpatient,,,GN,77,65.45,22.0682,77,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Slp  Cognitive Function Intervention (Initial 15 Min),,97129,CPT,Facility,Both,,,GN,77,65.45,22.0682,77,Aetna,PPO,71.61,93,,percent of total billed charges,,
Slp  Cognitive Function Intervention (Initial 15 Min),,97129,CPT,Facility,Both,,,GN,77,65.45,22.0682,77,America's PPO,America's PPO,73.9431,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Slp  Cognitive Function Intervention (Initial 15 Min),,97129,CPT,Facility,Both,,,GN,77,65.45,22.0682,77,BlueCross BlueShield Minnesota, Federal Employee Program,75.768,98.4,,percent of total billed charges,,
Slp  Cognitive Function Intervention (Initial 15 Min),,97129,CPT,Facility,Both,,,GN,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,77,100,,percent of total billed charges,,
Slp  Cognitive Function Intervention (Initial 15 Min),,97129,CPT,Facility,Both,,,GN,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,High Value Network Plan,69.3,90,,percent of total billed charges,,
Slp  Cognitive Function Intervention (Initial 15 Min),,97129,CPT,Facility,Outpatient,,,GN,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,Medicare Advantage,37.73,49,,percent of total billed charges,,
Slp  Cognitive Function Intervention (Initial 15 Min),,97129,CPT,Facility,Inpatient,,,GN,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Slp  Cognitive Function Intervention (Initial 15 Min),,97129,CPT,Facility,Both,,,GN,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,68.1989,88.57,,percent of total billed charges,,
Slp  Cognitive Function Intervention (Initial 15 Min),,97129,CPT,Facility,Both,,,GN,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,22.0682,28.66,,percent of total billed charges,,
Slp  Cognitive Function Intervention (Initial 15 Min),,97129,CPT,Facility,Outpatient,,,GN,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),37.73,49,,percent of total billed charges,,
Slp  Cognitive Function Intervention (Initial 15 Min),,97129,CPT,Facility,Inpatient,,,GN,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Slp  Cognitive Function Intervention (Initial 15 Min),,97129,CPT,Facility,Both,,,GN,77,65.45,22.0682,77,CorVel,Worker's Compensation,77,100,,percent of total billed charges,,
Slp  Cognitive Function Intervention (Initial 15 Min),,97129,CPT,Facility,Both,,,GN,77,65.45,22.0682,77,First Health Group Corporation,First Health Network,74.69,97,,percent of total billed charges,,
Slp  Cognitive Function Intervention (Initial 15 Min),,97129,CPT,Facility,Both,,,GN,77,65.45,22.0682,77,"Health Partners, Inc.",Commercial,72.842,94.6,,percent of total billed charges,,
Slp  Cognitive Function Intervention (Initial 15 Min),,97129,CPT,Facility,Outpatient,,,GN,77,65.45,22.0682,77,"Health Partners, Inc.",Medicare Advantage,37.73,49,,percent of total billed charges,,
Slp  Cognitive Function Intervention (Initial 15 Min),,97129,CPT,Facility,Inpatient,,,GN,77,65.45,22.0682,77,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Slp  Cognitive Function Intervention (Initial 15 Min),,97129,CPT,Facility,Both,,,GN,77,65.45,22.0682,77,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),46.2,60,,percent of total billed charges,,
Slp  Cognitive Function Intervention (Initial 15 Min),,97129,CPT,Facility,Both,,,GN,77,65.45,22.0682,77,"Health Partners, Inc.",State of Minnesota Advantage Program,62.755,81.5,,percent of total billed charges,,
Slp  Cognitive Function Intervention (Initial 15 Min),,97129,CPT,Facility,Both,,,GN,77,65.45,22.0682,77,"Health Partners, Inc.",State Public Programs,38.5,50,,percent of total billed charges,,
Slp  Cognitive Function Intervention (Initial 15 Min),,97129,CPT,Facility,Both,,,GN,77,65.45,22.0682,77,Humana Insurance Company,Commercial PPO,73.15,95,,percent of total billed charges,,
Slp  Cognitive Function Intervention (Initial 15 Min),,97129,CPT,Facility,Outpatient,,,GN,77,65.45,22.0682,77,Humana Insurance Company,Medicare PPO,37.73,49,,percent of total billed charges,,
Slp  Cognitive Function Intervention (Initial 15 Min),,97129,CPT,Facility,Inpatient,,,GN,77,65.45,22.0682,77,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Slp  Cognitive Function Intervention (Initial 15 Min),,97129,CPT,Facility,Both,,,GN,77,65.45,22.0682,77,Medica,Individual & Family,76.307,99.1,,percent of total billed charges,,
Slp  Cognitive Function Intervention (Initial 15 Min),,97129,CPT,Facility,Outpatient,,,GN,77,65.45,22.0682,77,Medica,Medica Advantage Solution,38.346,49.8,,percent of total billed charges,,
Slp  Cognitive Function Intervention (Initial 15 Min),,97129,CPT,Facility,Inpatient,,,GN,77,65.45,22.0682,77,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Slp  Cognitive Function Intervention (Initial 15 Min),,97129,CPT,Facility,Outpatient,,,GN,77,65.45,22.0682,77,Medica,Medical Assistance,34.342,44.6,,percent of total billed charges,,
Slp  Cognitive Function Intervention (Initial 15 Min),,97129,CPT,Facility,Inpatient,,,GN,77,65.45,22.0682,77,Medica,Medical Assistance,,,,,Included in per diem rate,
Slp  Cognitive Function Intervention (Initial 15 Min),,97129,CPT,Facility,Outpatient,,,GN,77,65.45,22.0682,77,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,38.346,49.8,,percent of total billed charges,,
Slp  Cognitive Function Intervention (Initial 15 Min),,97129,CPT,Facility,Inpatient,,,GN,77,65.45,22.0682,77,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Slp  Cognitive Function Intervention (Initial 15 Min),,97129,CPT,Facility,Both,,,GN,77,65.45,22.0682,77,"Multiplan, Inc.","Multiplan, Inc.",72.38,94,,percent of total billed charges,,
Slp  Cognitive Function Intervention (Initial 15 Min),,97129,CPT,Facility,Outpatient,,,GN,77,65.45,22.0682,77,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,66.528,86.4,,percent of total billed charges,,
Slp  Cognitive Function Intervention (Initial 15 Min),,97129,CPT,Facility,Inpatient,,,GN,77,65.45,22.0682,77,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Slp  Cognitive Function Intervention (Initial 15 Min),,97129,CPT,Facility,Both,,,GN,77,65.45,22.0682,77,"Preferred One Administrative Services, INC.",PPO,75.922,98.6,,percent of total billed charges,,
Slp  Cognitive Function Intervention (Initial 15 Min),,97129,CPT,Facility,Outpatient,,,GN,77,65.45,22.0682,77,PrimeWest Health,Minnesota Senior Health Options (MSHO),39.6165,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Slp  Cognitive Function Intervention (Initial 15 Min),,97129,CPT,Facility,Inpatient,,,GN,77,65.45,22.0682,77,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Slp  Cognitive Function Intervention (Initial 15 Min),,97129,CPT,Facility,Outpatient,,,GN,77,65.45,22.0682,77,PrimeWest Health,MinnesotaCare,39.5472,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Slp  Cognitive Function Intervention (Initial 15 Min),,97129,CPT,Facility,Inpatient,,,GN,77,65.45,22.0682,77,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Slp  Cognitive Function Intervention (Initial 15 Min),,97129,CPT,Facility,Both,,,GN,77,65.45,22.0682,77,Sanford Health Plan,Sanford Health Plan,70.84,92,,percent of total billed charges,,
Slp  Cognitive Function Intervention (Initial 15 Min),,97129,CPT,Facility,Outpatient,,,GN,77,65.45,22.0682,77,"UCare Health, Inc.",Individual & Family Plan,43.3895,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Slp  Cognitive Function Intervention (Initial 15 Min),,97129,CPT,Facility,Inpatient,,,GN,77,65.45,22.0682,77,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Slp  Cognitive Function Intervention (Initial 15 Min),,97129,CPT,Facility,Outpatient,,,GN,77,65.45,22.0682,77,"UCare Health, Inc.",Medical Assistance,38.8619,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Slp  Cognitive Function Intervention (Initial 15 Min),,97129,CPT,Facility,Inpatient,,,GN,77,65.45,22.0682,77,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Slp  Cognitive Function Intervention (Initial 15 Min),,97129,CPT,Facility,Outpatient,,,GN,77,65.45,22.0682,77,"UCare Health, Inc.",Medicare Advantage,38.8619,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Slp  Cognitive Function Intervention (Initial 15 Min),,97129,CPT,Facility,Inpatient,,,GN,77,65.45,22.0682,77,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Slp  Cognitive Function Intervention (Initial 15 Min),,97129,CPT,Facility,Outpatient,,,GN,77,65.45,22.0682,77,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),38.8619,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Slp  Cognitive Function Intervention (Initial 15 Min),,97129,CPT,Facility,Inpatient,,,GN,77,65.45,22.0682,77,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Slp  Cognitive Function Intervention (Initial 15 Min),,97129,CPT,Facility,Both,,,GN,77,65.45,22.0682,77,UnitedHealthcare,Individual & Family,72.38,94,,percent of total billed charges,,
Slp  Cognitive Function Intervention (Initial 15 Min),,97129,CPT,Facility,Outpatient,,,GN,77,65.45,22.0682,77,UnitedHealthcare,Medicare Advantage,37.73,49,,percent of total billed charges,,
Slp  Cognitive Function Intervention (Initial 15 Min),,97129,CPT,Facility,Inpatient,,,GN,77,65.45,22.0682,77,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Slp  Cognitive Function Intervention (Initial 15 Min),,97129,CPT,Facility,Outpatient,,,GN,77,65.45,22.0682,77,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,36.96,48,,percent of total billed charges,,100% of DHS outpatient percentage
Slp  Cognitive Function Intervention (Initial 15 Min),,97129,CPT,Facility,Inpatient,,,GN,77,65.45,22.0682,77,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Slp Cognitive Function Intervention (Each Subsequent 15 Min),,97130,CPT,Facility,Both,,,GN,77,65.45,22.0682,77,Aetna,Commercial,70.84,92,,percent of total billed charges,,
Slp Cognitive Function Intervention (Each Subsequent 15 Min),,97130,CPT,Facility,Outpatient,,,GN,77,65.45,22.0682,77,Aetna,Medicare Advantage,37.73,49,,percent of total billed charges,,
Slp Cognitive Function Intervention (Each Subsequent 15 Min),,97130,CPT,Facility,Inpatient,,,GN,77,65.45,22.0682,77,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Slp Cognitive Function Intervention (Each Subsequent 15 Min),,97130,CPT,Facility,Both,,,GN,77,65.45,22.0682,77,Aetna,PPO,71.61,93,,percent of total billed charges,,
Slp Cognitive Function Intervention (Each Subsequent 15 Min),,97130,CPT,Facility,Both,,,GN,77,65.45,22.0682,77,America's PPO,America's PPO,73.9431,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Slp Cognitive Function Intervention (Each Subsequent 15 Min),,97130,CPT,Facility,Both,,,GN,77,65.45,22.0682,77,BlueCross BlueShield Minnesota, Federal Employee Program,75.768,98.4,,percent of total billed charges,,
Slp Cognitive Function Intervention (Each Subsequent 15 Min),,97130,CPT,Facility,Both,,,GN,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,77,100,,percent of total billed charges,,
Slp Cognitive Function Intervention (Each Subsequent 15 Min),,97130,CPT,Facility,Both,,,GN,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,High Value Network Plan,69.3,90,,percent of total billed charges,,
Slp Cognitive Function Intervention (Each Subsequent 15 Min),,97130,CPT,Facility,Outpatient,,,GN,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,Medicare Advantage,37.73,49,,percent of total billed charges,,
Slp Cognitive Function Intervention (Each Subsequent 15 Min),,97130,CPT,Facility,Inpatient,,,GN,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Slp Cognitive Function Intervention (Each Subsequent 15 Min),,97130,CPT,Facility,Both,,,GN,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,68.1989,88.57,,percent of total billed charges,,
Slp Cognitive Function Intervention (Each Subsequent 15 Min),,97130,CPT,Facility,Both,,,GN,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,22.0682,28.66,,percent of total billed charges,,
Slp Cognitive Function Intervention (Each Subsequent 15 Min),,97130,CPT,Facility,Outpatient,,,GN,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),37.73,49,,percent of total billed charges,,
Slp Cognitive Function Intervention (Each Subsequent 15 Min),,97130,CPT,Facility,Inpatient,,,GN,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Slp Cognitive Function Intervention (Each Subsequent 15 Min),,97130,CPT,Facility,Both,,,GN,77,65.45,22.0682,77,CorVel,Worker's Compensation,77,100,,percent of total billed charges,,
Slp Cognitive Function Intervention (Each Subsequent 15 Min),,97130,CPT,Facility,Both,,,GN,77,65.45,22.0682,77,First Health Group Corporation,First Health Network,74.69,97,,percent of total billed charges,,
Slp Cognitive Function Intervention (Each Subsequent 15 Min),,97130,CPT,Facility,Both,,,GN,77,65.45,22.0682,77,"Health Partners, Inc.",Commercial,72.842,94.6,,percent of total billed charges,,
Slp Cognitive Function Intervention (Each Subsequent 15 Min),,97130,CPT,Facility,Outpatient,,,GN,77,65.45,22.0682,77,"Health Partners, Inc.",Medicare Advantage,37.73,49,,percent of total billed charges,,
Slp Cognitive Function Intervention (Each Subsequent 15 Min),,97130,CPT,Facility,Inpatient,,,GN,77,65.45,22.0682,77,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Slp Cognitive Function Intervention (Each Subsequent 15 Min),,97130,CPT,Facility,Both,,,GN,77,65.45,22.0682,77,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),46.2,60,,percent of total billed charges,,
Slp Cognitive Function Intervention (Each Subsequent 15 Min),,97130,CPT,Facility,Both,,,GN,77,65.45,22.0682,77,"Health Partners, Inc.",State of Minnesota Advantage Program,62.755,81.5,,percent of total billed charges,,
Slp Cognitive Function Intervention (Each Subsequent 15 Min),,97130,CPT,Facility,Both,,,GN,77,65.45,22.0682,77,"Health Partners, Inc.",State Public Programs,38.5,50,,percent of total billed charges,,
Slp Cognitive Function Intervention (Each Subsequent 15 Min),,97130,CPT,Facility,Both,,,GN,77,65.45,22.0682,77,Humana Insurance Company,Commercial PPO,73.15,95,,percent of total billed charges,,
Slp Cognitive Function Intervention (Each Subsequent 15 Min),,97130,CPT,Facility,Outpatient,,,GN,77,65.45,22.0682,77,Humana Insurance Company,Medicare PPO,37.73,49,,percent of total billed charges,,
Slp Cognitive Function Intervention (Each Subsequent 15 Min),,97130,CPT,Facility,Inpatient,,,GN,77,65.45,22.0682,77,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Slp Cognitive Function Intervention (Each Subsequent 15 Min),,97130,CPT,Facility,Both,,,GN,77,65.45,22.0682,77,Medica,Individual & Family,76.307,99.1,,percent of total billed charges,,
Slp Cognitive Function Intervention (Each Subsequent 15 Min),,97130,CPT,Facility,Outpatient,,,GN,77,65.45,22.0682,77,Medica,Medica Advantage Solution,38.346,49.8,,percent of total billed charges,,
Slp Cognitive Function Intervention (Each Subsequent 15 Min),,97130,CPT,Facility,Inpatient,,,GN,77,65.45,22.0682,77,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Slp Cognitive Function Intervention (Each Subsequent 15 Min),,97130,CPT,Facility,Outpatient,,,GN,77,65.45,22.0682,77,Medica,Medical Assistance,34.342,44.6,,percent of total billed charges,,
Slp Cognitive Function Intervention (Each Subsequent 15 Min),,97130,CPT,Facility,Inpatient,,,GN,77,65.45,22.0682,77,Medica,Medical Assistance,,,,,Included in per diem rate,
Slp Cognitive Function Intervention (Each Subsequent 15 Min),,97130,CPT,Facility,Outpatient,,,GN,77,65.45,22.0682,77,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,38.346,49.8,,percent of total billed charges,,
Slp Cognitive Function Intervention (Each Subsequent 15 Min),,97130,CPT,Facility,Inpatient,,,GN,77,65.45,22.0682,77,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Slp Cognitive Function Intervention (Each Subsequent 15 Min),,97130,CPT,Facility,Both,,,GN,77,65.45,22.0682,77,"Multiplan, Inc.","Multiplan, Inc.",72.38,94,,percent of total billed charges,,
Slp Cognitive Function Intervention (Each Subsequent 15 Min),,97130,CPT,Facility,Outpatient,,,GN,77,65.45,22.0682,77,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,66.528,86.4,,percent of total billed charges,,
Slp Cognitive Function Intervention (Each Subsequent 15 Min),,97130,CPT,Facility,Inpatient,,,GN,77,65.45,22.0682,77,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Slp Cognitive Function Intervention (Each Subsequent 15 Min),,97130,CPT,Facility,Both,,,GN,77,65.45,22.0682,77,"Preferred One Administrative Services, INC.",PPO,75.922,98.6,,percent of total billed charges,,
Slp Cognitive Function Intervention (Each Subsequent 15 Min),,97130,CPT,Facility,Outpatient,,,GN,77,65.45,22.0682,77,PrimeWest Health,Minnesota Senior Health Options (MSHO),39.6165,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Slp Cognitive Function Intervention (Each Subsequent 15 Min),,97130,CPT,Facility,Inpatient,,,GN,77,65.45,22.0682,77,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Slp Cognitive Function Intervention (Each Subsequent 15 Min),,97130,CPT,Facility,Outpatient,,,GN,77,65.45,22.0682,77,PrimeWest Health,MinnesotaCare,39.5472,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Slp Cognitive Function Intervention (Each Subsequent 15 Min),,97130,CPT,Facility,Inpatient,,,GN,77,65.45,22.0682,77,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Slp Cognitive Function Intervention (Each Subsequent 15 Min),,97130,CPT,Facility,Both,,,GN,77,65.45,22.0682,77,Sanford Health Plan,Sanford Health Plan,70.84,92,,percent of total billed charges,,
Slp Cognitive Function Intervention (Each Subsequent 15 Min),,97130,CPT,Facility,Outpatient,,,GN,77,65.45,22.0682,77,"UCare Health, Inc.",Individual & Family Plan,43.3895,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Slp Cognitive Function Intervention (Each Subsequent 15 Min),,97130,CPT,Facility,Inpatient,,,GN,77,65.45,22.0682,77,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Slp Cognitive Function Intervention (Each Subsequent 15 Min),,97130,CPT,Facility,Outpatient,,,GN,77,65.45,22.0682,77,"UCare Health, Inc.",Medical Assistance,38.8619,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Slp Cognitive Function Intervention (Each Subsequent 15 Min),,97130,CPT,Facility,Inpatient,,,GN,77,65.45,22.0682,77,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Slp Cognitive Function Intervention (Each Subsequent 15 Min),,97130,CPT,Facility,Outpatient,,,GN,77,65.45,22.0682,77,"UCare Health, Inc.",Medicare Advantage,38.8619,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Slp Cognitive Function Intervention (Each Subsequent 15 Min),,97130,CPT,Facility,Inpatient,,,GN,77,65.45,22.0682,77,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Slp Cognitive Function Intervention (Each Subsequent 15 Min),,97130,CPT,Facility,Outpatient,,,GN,77,65.45,22.0682,77,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),38.8619,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Slp Cognitive Function Intervention (Each Subsequent 15 Min),,97130,CPT,Facility,Inpatient,,,GN,77,65.45,22.0682,77,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Slp Cognitive Function Intervention (Each Subsequent 15 Min),,97130,CPT,Facility,Both,,,GN,77,65.45,22.0682,77,UnitedHealthcare,Individual & Family,72.38,94,,percent of total billed charges,,
Slp Cognitive Function Intervention (Each Subsequent 15 Min),,97130,CPT,Facility,Outpatient,,,GN,77,65.45,22.0682,77,UnitedHealthcare,Medicare Advantage,37.73,49,,percent of total billed charges,,
Slp Cognitive Function Intervention (Each Subsequent 15 Min),,97130,CPT,Facility,Inpatient,,,GN,77,65.45,22.0682,77,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Slp Cognitive Function Intervention (Each Subsequent 15 Min),,97130,CPT,Facility,Outpatient,,,GN,77,65.45,22.0682,77,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,36.96,48,,percent of total billed charges,,100% of DHS outpatient percentage
Slp Cognitive Function Intervention (Each Subsequent 15 Min),,97130,CPT,Facility,Inpatient,,,GN,77,65.45,22.0682,77,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Slp Sensory Integration (15 Min),,97533,CPT,Facility,Both,,,GN,77,65.45,22.0682,77,Aetna,Commercial,70.84,92,,percent of total billed charges,,
Slp Sensory Integration (15 Min),,97533,CPT,Facility,Outpatient,,,GN,77,65.45,22.0682,77,Aetna,Medicare Advantage,37.73,49,,percent of total billed charges,,
Slp Sensory Integration (15 Min),,97533,CPT,Facility,Inpatient,,,GN,77,65.45,22.0682,77,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Slp Sensory Integration (15 Min),,97533,CPT,Facility,Both,,,GN,77,65.45,22.0682,77,Aetna,PPO,71.61,93,,percent of total billed charges,,
Slp Sensory Integration (15 Min),,97533,CPT,Facility,Both,,,GN,77,65.45,22.0682,77,America's PPO,America's PPO,73.9431,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Slp Sensory Integration (15 Min),,97533,CPT,Facility,Both,,,GN,77,65.45,22.0682,77,BlueCross BlueShield Minnesota, Federal Employee Program,75.768,98.4,,percent of total billed charges,,
Slp Sensory Integration (15 Min),,97533,CPT,Facility,Both,,,GN,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,77,100,,percent of total billed charges,,
Slp Sensory Integration (15 Min),,97533,CPT,Facility,Both,,,GN,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,High Value Network Plan,69.3,90,,percent of total billed charges,,
Slp Sensory Integration (15 Min),,97533,CPT,Facility,Outpatient,,,GN,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,Medicare Advantage,37.73,49,,percent of total billed charges,,
Slp Sensory Integration (15 Min),,97533,CPT,Facility,Inpatient,,,GN,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Slp Sensory Integration (15 Min),,97533,CPT,Facility,Both,,,GN,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,68.1989,88.57,,percent of total billed charges,,
Slp Sensory Integration (15 Min),,97533,CPT,Facility,Both,,,GN,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,22.0682,28.66,,percent of total billed charges,,
Slp Sensory Integration (15 Min),,97533,CPT,Facility,Outpatient,,,GN,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),37.73,49,,percent of total billed charges,,
Slp Sensory Integration (15 Min),,97533,CPT,Facility,Inpatient,,,GN,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Slp Sensory Integration (15 Min),,97533,CPT,Facility,Both,,,GN,77,65.45,22.0682,77,CorVel,Worker's Compensation,77,100,,percent of total billed charges,,
Slp Sensory Integration (15 Min),,97533,CPT,Facility,Both,,,GN,77,65.45,22.0682,77,First Health Group Corporation,First Health Network,74.69,97,,percent of total billed charges,,
Slp Sensory Integration (15 Min),,97533,CPT,Facility,Both,,,GN,77,65.45,22.0682,77,"Health Partners, Inc.",Commercial,72.842,94.6,,percent of total billed charges,,
Slp Sensory Integration (15 Min),,97533,CPT,Facility,Outpatient,,,GN,77,65.45,22.0682,77,"Health Partners, Inc.",Medicare Advantage,37.73,49,,percent of total billed charges,,
Slp Sensory Integration (15 Min),,97533,CPT,Facility,Inpatient,,,GN,77,65.45,22.0682,77,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Slp Sensory Integration (15 Min),,97533,CPT,Facility,Both,,,GN,77,65.45,22.0682,77,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),46.2,60,,percent of total billed charges,,
Slp Sensory Integration (15 Min),,97533,CPT,Facility,Both,,,GN,77,65.45,22.0682,77,"Health Partners, Inc.",State of Minnesota Advantage Program,62.755,81.5,,percent of total billed charges,,
Slp Sensory Integration (15 Min),,97533,CPT,Facility,Both,,,GN,77,65.45,22.0682,77,"Health Partners, Inc.",State Public Programs,38.5,50,,percent of total billed charges,,
Slp Sensory Integration (15 Min),,97533,CPT,Facility,Both,,,GN,77,65.45,22.0682,77,Humana Insurance Company,Commercial PPO,73.15,95,,percent of total billed charges,,
Slp Sensory Integration (15 Min),,97533,CPT,Facility,Outpatient,,,GN,77,65.45,22.0682,77,Humana Insurance Company,Medicare PPO,37.73,49,,percent of total billed charges,,
Slp Sensory Integration (15 Min),,97533,CPT,Facility,Inpatient,,,GN,77,65.45,22.0682,77,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Slp Sensory Integration (15 Min),,97533,CPT,Facility,Both,,,GN,77,65.45,22.0682,77,Medica,Individual & Family,76.307,99.1,,percent of total billed charges,,
Slp Sensory Integration (15 Min),,97533,CPT,Facility,Outpatient,,,GN,77,65.45,22.0682,77,Medica,Medica Advantage Solution,38.346,49.8,,percent of total billed charges,,
Slp Sensory Integration (15 Min),,97533,CPT,Facility,Inpatient,,,GN,77,65.45,22.0682,77,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Slp Sensory Integration (15 Min),,97533,CPT,Facility,Outpatient,,,GN,77,65.45,22.0682,77,Medica,Medical Assistance,34.342,44.6,,percent of total billed charges,,
Slp Sensory Integration (15 Min),,97533,CPT,Facility,Inpatient,,,GN,77,65.45,22.0682,77,Medica,Medical Assistance,,,,,Included in per diem rate,
Slp Sensory Integration (15 Min),,97533,CPT,Facility,Outpatient,,,GN,77,65.45,22.0682,77,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,38.346,49.8,,percent of total billed charges,,
Slp Sensory Integration (15 Min),,97533,CPT,Facility,Inpatient,,,GN,77,65.45,22.0682,77,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Slp Sensory Integration (15 Min),,97533,CPT,Facility,Both,,,GN,77,65.45,22.0682,77,"Multiplan, Inc.","Multiplan, Inc.",72.38,94,,percent of total billed charges,,
Slp Sensory Integration (15 Min),,97533,CPT,Facility,Outpatient,,,GN,77,65.45,22.0682,77,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,66.528,86.4,,percent of total billed charges,,
Slp Sensory Integration (15 Min),,97533,CPT,Facility,Inpatient,,,GN,77,65.45,22.0682,77,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Slp Sensory Integration (15 Min),,97533,CPT,Facility,Both,,,GN,77,65.45,22.0682,77,"Preferred One Administrative Services, INC.",PPO,75.922,98.6,,percent of total billed charges,,
Slp Sensory Integration (15 Min),,97533,CPT,Facility,Outpatient,,,GN,77,65.45,22.0682,77,PrimeWest Health,Minnesota Senior Health Options (MSHO),39.6165,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Slp Sensory Integration (15 Min),,97533,CPT,Facility,Inpatient,,,GN,77,65.45,22.0682,77,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Slp Sensory Integration (15 Min),,97533,CPT,Facility,Outpatient,,,GN,77,65.45,22.0682,77,PrimeWest Health,MinnesotaCare,39.5472,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Slp Sensory Integration (15 Min),,97533,CPT,Facility,Inpatient,,,GN,77,65.45,22.0682,77,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Slp Sensory Integration (15 Min),,97533,CPT,Facility,Both,,,GN,77,65.45,22.0682,77,Sanford Health Plan,Sanford Health Plan,70.84,92,,percent of total billed charges,,
Slp Sensory Integration (15 Min),,97533,CPT,Facility,Outpatient,,,GN,77,65.45,22.0682,77,"UCare Health, Inc.",Individual & Family Plan,43.3895,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Slp Sensory Integration (15 Min),,97533,CPT,Facility,Inpatient,,,GN,77,65.45,22.0682,77,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Slp Sensory Integration (15 Min),,97533,CPT,Facility,Outpatient,,,GN,77,65.45,22.0682,77,"UCare Health, Inc.",Medical Assistance,38.8619,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Slp Sensory Integration (15 Min),,97533,CPT,Facility,Inpatient,,,GN,77,65.45,22.0682,77,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Slp Sensory Integration (15 Min),,97533,CPT,Facility,Outpatient,,,GN,77,65.45,22.0682,77,"UCare Health, Inc.",Medicare Advantage,38.8619,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Slp Sensory Integration (15 Min),,97533,CPT,Facility,Inpatient,,,GN,77,65.45,22.0682,77,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Slp Sensory Integration (15 Min),,97533,CPT,Facility,Outpatient,,,GN,77,65.45,22.0682,77,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),38.8619,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Slp Sensory Integration (15 Min),,97533,CPT,Facility,Inpatient,,,GN,77,65.45,22.0682,77,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Slp Sensory Integration (15 Min),,97533,CPT,Facility,Both,,,GN,77,65.45,22.0682,77,UnitedHealthcare,Individual & Family,72.38,94,,percent of total billed charges,,
Slp Sensory Integration (15 Min),,97533,CPT,Facility,Outpatient,,,GN,77,65.45,22.0682,77,UnitedHealthcare,Medicare Advantage,37.73,49,,percent of total billed charges,,
Slp Sensory Integration (15 Min),,97533,CPT,Facility,Inpatient,,,GN,77,65.45,22.0682,77,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Slp Sensory Integration (15 Min),,97533,CPT,Facility,Outpatient,,,GN,77,65.45,22.0682,77,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,36.96,48,,percent of total billed charges,,100% of DHS outpatient percentage
Slp Sensory Integration (15 Min),,97533,CPT,Facility,Inpatient,,,GN,77,65.45,22.0682,77,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Ot Apply Static Short Arm Splint,,29125,CPT,Facility,Both,,,GO,158,134.3,45.2828,158,Aetna,Commercial,145.36,92,,percent of total billed charges,,
Ot Apply Static Short Arm Splint,,29125,CPT,Facility,Outpatient,,,GO,158,134.3,45.2828,158,Aetna,Medicare Advantage,77.42,49,,percent of total billed charges,,
Ot Apply Static Short Arm Splint,,29125,CPT,Facility,Inpatient,,,GO,158,134.3,45.2828,158,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Ot Apply Static Short Arm Splint,,29125,CPT,Facility,Both,,,GO,158,134.3,45.2828,158,Aetna,PPO,146.94,93,,percent of total billed charges,,
Ot Apply Static Short Arm Splint,,29125,CPT,Facility,Both,,,GO,158,134.3,45.2828,158,America's PPO,America's PPO,151.7274,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Ot Apply Static Short Arm Splint,,29125,CPT,Facility,Both,,,GO,158,134.3,45.2828,158,BlueCross BlueShield Minnesota, Federal Employee Program,155.472,98.4,,percent of total billed charges,,
Ot Apply Static Short Arm Splint,,29125,CPT,Facility,Both,,,GO,158,134.3,45.2828,158,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,158,100,,percent of total billed charges,,
Ot Apply Static Short Arm Splint,,29125,CPT,Facility,Both,,,GO,158,134.3,45.2828,158,BlueCross BlueShield Minnesota,High Value Network Plan,142.2,90,,percent of total billed charges,,
Ot Apply Static Short Arm Splint,,29125,CPT,Facility,Outpatient,,,GO,158,134.3,45.2828,158,BlueCross BlueShield Minnesota,Medicare Advantage,77.42,49,,percent of total billed charges,,
Ot Apply Static Short Arm Splint,,29125,CPT,Facility,Inpatient,,,GO,158,134.3,45.2828,158,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Ot Apply Static Short Arm Splint,,29125,CPT,Facility,Both,,,GO,158,134.3,45.2828,158,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,139.9406,88.57,,percent of total billed charges,,
Ot Apply Static Short Arm Splint,,29125,CPT,Facility,Both,,,GO,158,134.3,45.2828,158,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,45.2828,28.66,,percent of total billed charges,,
Ot Apply Static Short Arm Splint,,29125,CPT,Facility,Outpatient,,,GO,158,134.3,45.2828,158,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),77.42,49,,percent of total billed charges,,
Ot Apply Static Short Arm Splint,,29125,CPT,Facility,Inpatient,,,GO,158,134.3,45.2828,158,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Ot Apply Static Short Arm Splint,,29125,CPT,Facility,Both,,,GO,158,134.3,45.2828,158,CorVel,Worker's Compensation,158,100,,percent of total billed charges,,
Ot Apply Static Short Arm Splint,,29125,CPT,Facility,Both,,,GO,158,134.3,45.2828,158,First Health Group Corporation,First Health Network,153.26,97,,percent of total billed charges,,
Ot Apply Static Short Arm Splint,,29125,CPT,Facility,Both,,,GO,158,134.3,45.2828,158,"Health Partners, Inc.",Commercial,149.468,94.6,,percent of total billed charges,,
Ot Apply Static Short Arm Splint,,29125,CPT,Facility,Outpatient,,,GO,158,134.3,45.2828,158,"Health Partners, Inc.",Medicare Advantage,77.42,49,,percent of total billed charges,,
Ot Apply Static Short Arm Splint,,29125,CPT,Facility,Inpatient,,,GO,158,134.3,45.2828,158,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ot Apply Static Short Arm Splint,,29125,CPT,Facility,Both,,,GO,158,134.3,45.2828,158,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),94.8,60,,percent of total billed charges,,
Ot Apply Static Short Arm Splint,,29125,CPT,Facility,Both,,,GO,158,134.3,45.2828,158,"Health Partners, Inc.",State of Minnesota Advantage Program,128.77,81.5,,percent of total billed charges,,
Ot Apply Static Short Arm Splint,,29125,CPT,Facility,Both,,,GO,158,134.3,45.2828,158,"Health Partners, Inc.",State Public Programs,79,50,,percent of total billed charges,,
Ot Apply Static Short Arm Splint,,29125,CPT,Facility,Both,,,GO,158,134.3,45.2828,158,Humana Insurance Company,Commercial PPO,150.1,95,,percent of total billed charges,,
Ot Apply Static Short Arm Splint,,29125,CPT,Facility,Outpatient,,,GO,158,134.3,45.2828,158,Humana Insurance Company,Medicare PPO,77.42,49,,percent of total billed charges,,
Ot Apply Static Short Arm Splint,,29125,CPT,Facility,Inpatient,,,GO,158,134.3,45.2828,158,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Ot Apply Static Short Arm Splint,,29125,CPT,Facility,Both,,,GO,158,134.3,45.2828,158,Medica,Individual & Family,156.578,99.1,,percent of total billed charges,,
Ot Apply Static Short Arm Splint,,29125,CPT,Facility,Outpatient,,,GO,158,134.3,45.2828,158,Medica,Medica Advantage Solution,78.684,49.8,,percent of total billed charges,,
Ot Apply Static Short Arm Splint,,29125,CPT,Facility,Inpatient,,,GO,158,134.3,45.2828,158,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Ot Apply Static Short Arm Splint,,29125,CPT,Facility,Outpatient,,,GO,158,134.3,45.2828,158,Medica,Medical Assistance,70.468,44.6,,percent of total billed charges,,
Ot Apply Static Short Arm Splint,,29125,CPT,Facility,Inpatient,,,GO,158,134.3,45.2828,158,Medica,Medical Assistance,,,,,Included in per diem rate,
Ot Apply Static Short Arm Splint,,29125,CPT,Facility,Outpatient,,,GO,158,134.3,45.2828,158,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,78.684,49.8,,percent of total billed charges,,
Ot Apply Static Short Arm Splint,,29125,CPT,Facility,Inpatient,,,GO,158,134.3,45.2828,158,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Ot Apply Static Short Arm Splint,,29125,CPT,Facility,Both,,,GO,158,134.3,45.2828,158,"Multiplan, Inc.","Multiplan, Inc.",148.52,94,,percent of total billed charges,,
Ot Apply Static Short Arm Splint,,29125,CPT,Facility,Outpatient,,,GO,158,134.3,45.2828,158,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,136.512,86.4,,percent of total billed charges,,
Ot Apply Static Short Arm Splint,,29125,CPT,Facility,Inpatient,,,GO,158,134.3,45.2828,158,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Ot Apply Static Short Arm Splint,,29125,CPT,Facility,Both,,,GO,158,134.3,45.2828,158,"Preferred One Administrative Services, INC.",PPO,155.788,98.6,,percent of total billed charges,,
Ot Apply Static Short Arm Splint,,29125,CPT,Facility,Outpatient,,,GO,158,134.3,45.2828,158,PrimeWest Health,Minnesota Senior Health Options (MSHO),81.291,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Ot Apply Static Short Arm Splint,,29125,CPT,Facility,Inpatient,,,GO,158,134.3,45.2828,158,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ot Apply Static Short Arm Splint,,29125,CPT,Facility,Outpatient,,,GO,158,134.3,45.2828,158,PrimeWest Health,MinnesotaCare,81.1488,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Ot Apply Static Short Arm Splint,,29125,CPT,Facility,Inpatient,,,GO,158,134.3,45.2828,158,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Ot Apply Static Short Arm Splint,,29125,CPT,Facility,Both,,,GO,158,134.3,45.2828,158,Sanford Health Plan,Sanford Health Plan,145.36,92,,percent of total billed charges,,
Ot Apply Static Short Arm Splint,,29125,CPT,Facility,Outpatient,,,GO,158,134.3,45.2828,158,"UCare Health, Inc.",Individual & Family Plan,89.033,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Ot Apply Static Short Arm Splint,,29125,CPT,Facility,Inpatient,,,GO,158,134.3,45.2828,158,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Ot Apply Static Short Arm Splint,,29125,CPT,Facility,Outpatient,,,GO,158,134.3,45.2828,158,"UCare Health, Inc.",Medical Assistance,79.7426,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ot Apply Static Short Arm Splint,,29125,CPT,Facility,Inpatient,,,GO,158,134.3,45.2828,158,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Ot Apply Static Short Arm Splint,,29125,CPT,Facility,Outpatient,,,GO,158,134.3,45.2828,158,"UCare Health, Inc.",Medicare Advantage,79.7426,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ot Apply Static Short Arm Splint,,29125,CPT,Facility,Inpatient,,,GO,158,134.3,45.2828,158,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ot Apply Static Short Arm Splint,,29125,CPT,Facility,Outpatient,,,GO,158,134.3,45.2828,158,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),79.7426,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ot Apply Static Short Arm Splint,,29125,CPT,Facility,Inpatient,,,GO,158,134.3,45.2828,158,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ot Apply Static Short Arm Splint,,29125,CPT,Facility,Both,,,GO,158,134.3,45.2828,158,UnitedHealthcare,Individual & Family,148.52,94,,percent of total billed charges,,
Ot Apply Static Short Arm Splint,,29125,CPT,Facility,Outpatient,,,GO,158,134.3,45.2828,158,UnitedHealthcare,Medicare Advantage,77.42,49,,percent of total billed charges,,
Ot Apply Static Short Arm Splint,,29125,CPT,Facility,Inpatient,,,GO,158,134.3,45.2828,158,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Ot Apply Static Short Arm Splint,,29125,CPT,Facility,Outpatient,,,GO,158,134.3,45.2828,158,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,75.84,48,,percent of total billed charges,,100% of DHS outpatient percentage
Ot Apply Static Short Arm Splint,,29125,CPT,Facility,Inpatient,,,GO,158,134.3,45.2828,158,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Ot Cognitive Performance Testing Per Hr,,96125,CPT,Facility,Both,,,GO,260,221,74.516,260,Aetna,Commercial,239.2,92,,percent of total billed charges,,
Ot Cognitive Performance Testing Per Hr,,96125,CPT,Facility,Outpatient,,,GO,260,221,74.516,260,Aetna,Medicare Advantage,127.4,49,,percent of total billed charges,,
Ot Cognitive Performance Testing Per Hr,,96125,CPT,Facility,Inpatient,,,GO,260,221,74.516,260,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Ot Cognitive Performance Testing Per Hr,,96125,CPT,Facility,Both,,,GO,260,221,74.516,260,Aetna,PPO,241.8,93,,percent of total billed charges,,
Ot Cognitive Performance Testing Per Hr,,96125,CPT,Facility,Both,,,GO,260,221,74.516,260,America's PPO,America's PPO,249.678,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Ot Cognitive Performance Testing Per Hr,,96125,CPT,Facility,Both,,,GO,260,221,74.516,260,BlueCross BlueShield Minnesota, Federal Employee Program,255.84,98.4,,percent of total billed charges,,
Ot Cognitive Performance Testing Per Hr,,96125,CPT,Facility,Both,,,GO,260,221,74.516,260,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,260,100,,percent of total billed charges,,
Ot Cognitive Performance Testing Per Hr,,96125,CPT,Facility,Both,,,GO,260,221,74.516,260,BlueCross BlueShield Minnesota,High Value Network Plan,234,90,,percent of total billed charges,,
Ot Cognitive Performance Testing Per Hr,,96125,CPT,Facility,Outpatient,,,GO,260,221,74.516,260,BlueCross BlueShield Minnesota,Medicare Advantage,127.4,49,,percent of total billed charges,,
Ot Cognitive Performance Testing Per Hr,,96125,CPT,Facility,Inpatient,,,GO,260,221,74.516,260,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Ot Cognitive Performance Testing Per Hr,,96125,CPT,Facility,Both,,,GO,260,221,74.516,260,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,230.282,88.57,,percent of total billed charges,,
Ot Cognitive Performance Testing Per Hr,,96125,CPT,Facility,Both,,,GO,260,221,74.516,260,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,74.516,28.66,,percent of total billed charges,,
Ot Cognitive Performance Testing Per Hr,,96125,CPT,Facility,Outpatient,,,GO,260,221,74.516,260,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),127.4,49,,percent of total billed charges,,
Ot Cognitive Performance Testing Per Hr,,96125,CPT,Facility,Inpatient,,,GO,260,221,74.516,260,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Ot Cognitive Performance Testing Per Hr,,96125,CPT,Facility,Both,,,GO,260,221,74.516,260,CorVel,Worker's Compensation,260,100,,percent of total billed charges,,
Ot Cognitive Performance Testing Per Hr,,96125,CPT,Facility,Both,,,GO,260,221,74.516,260,First Health Group Corporation,First Health Network,252.2,97,,percent of total billed charges,,
Ot Cognitive Performance Testing Per Hr,,96125,CPT,Facility,Both,,,GO,260,221,74.516,260,"Health Partners, Inc.",Commercial,245.96,94.6,,percent of total billed charges,,
Ot Cognitive Performance Testing Per Hr,,96125,CPT,Facility,Outpatient,,,GO,260,221,74.516,260,"Health Partners, Inc.",Medicare Advantage,127.4,49,,percent of total billed charges,,
Ot Cognitive Performance Testing Per Hr,,96125,CPT,Facility,Inpatient,,,GO,260,221,74.516,260,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ot Cognitive Performance Testing Per Hr,,96125,CPT,Facility,Both,,,GO,260,221,74.516,260,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),156,60,,percent of total billed charges,,
Ot Cognitive Performance Testing Per Hr,,96125,CPT,Facility,Both,,,GO,260,221,74.516,260,"Health Partners, Inc.",State of Minnesota Advantage Program,211.9,81.5,,percent of total billed charges,,
Ot Cognitive Performance Testing Per Hr,,96125,CPT,Facility,Both,,,GO,260,221,74.516,260,"Health Partners, Inc.",State Public Programs,130,50,,percent of total billed charges,,
Ot Cognitive Performance Testing Per Hr,,96125,CPT,Facility,Both,,,GO,260,221,74.516,260,Humana Insurance Company,Commercial PPO,247,95,,percent of total billed charges,,
Ot Cognitive Performance Testing Per Hr,,96125,CPT,Facility,Outpatient,,,GO,260,221,74.516,260,Humana Insurance Company,Medicare PPO,127.4,49,,percent of total billed charges,,
Ot Cognitive Performance Testing Per Hr,,96125,CPT,Facility,Inpatient,,,GO,260,221,74.516,260,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Ot Cognitive Performance Testing Per Hr,,96125,CPT,Facility,Both,,,GO,260,221,74.516,260,Medica,Individual & Family,257.66,99.1,,percent of total billed charges,,
Ot Cognitive Performance Testing Per Hr,,96125,CPT,Facility,Outpatient,,,GO,260,221,74.516,260,Medica,Medica Advantage Solution,129.48,49.8,,percent of total billed charges,,
Ot Cognitive Performance Testing Per Hr,,96125,CPT,Facility,Inpatient,,,GO,260,221,74.516,260,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Ot Cognitive Performance Testing Per Hr,,96125,CPT,Facility,Outpatient,,,GO,260,221,74.516,260,Medica,Medical Assistance,115.96,44.6,,percent of total billed charges,,
Ot Cognitive Performance Testing Per Hr,,96125,CPT,Facility,Inpatient,,,GO,260,221,74.516,260,Medica,Medical Assistance,,,,,Included in per diem rate,
Ot Cognitive Performance Testing Per Hr,,96125,CPT,Facility,Outpatient,,,GO,260,221,74.516,260,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,129.48,49.8,,percent of total billed charges,,
Ot Cognitive Performance Testing Per Hr,,96125,CPT,Facility,Inpatient,,,GO,260,221,74.516,260,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Ot Cognitive Performance Testing Per Hr,,96125,CPT,Facility,Both,,,GO,260,221,74.516,260,"Multiplan, Inc.","Multiplan, Inc.",244.4,94,,percent of total billed charges,,
Ot Cognitive Performance Testing Per Hr,,96125,CPT,Facility,Outpatient,,,GO,260,221,74.516,260,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,224.64,86.4,,percent of total billed charges,,
Ot Cognitive Performance Testing Per Hr,,96125,CPT,Facility,Inpatient,,,GO,260,221,74.516,260,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Ot Cognitive Performance Testing Per Hr,,96125,CPT,Facility,Both,,,GO,260,221,74.516,260,"Preferred One Administrative Services, INC.",PPO,256.36,98.6,,percent of total billed charges,,
Ot Cognitive Performance Testing Per Hr,,96125,CPT,Facility,Outpatient,,,GO,260,221,74.516,260,PrimeWest Health,Minnesota Senior Health Options (MSHO),133.77,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Ot Cognitive Performance Testing Per Hr,,96125,CPT,Facility,Inpatient,,,GO,260,221,74.516,260,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ot Cognitive Performance Testing Per Hr,,96125,CPT,Facility,Outpatient,,,GO,260,221,74.516,260,PrimeWest Health,MinnesotaCare,133.536,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Ot Cognitive Performance Testing Per Hr,,96125,CPT,Facility,Inpatient,,,GO,260,221,74.516,260,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Ot Cognitive Performance Testing Per Hr,,96125,CPT,Facility,Both,,,GO,260,221,74.516,260,Sanford Health Plan,Sanford Health Plan,239.2,92,,percent of total billed charges,,
Ot Cognitive Performance Testing Per Hr,,96125,CPT,Facility,Outpatient,,,GO,260,221,74.516,260,"UCare Health, Inc.",Individual & Family Plan,146.51,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Ot Cognitive Performance Testing Per Hr,,96125,CPT,Facility,Inpatient,,,GO,260,221,74.516,260,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Ot Cognitive Performance Testing Per Hr,,96125,CPT,Facility,Outpatient,,,GO,260,221,74.516,260,"UCare Health, Inc.",Medical Assistance,131.222,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ot Cognitive Performance Testing Per Hr,,96125,CPT,Facility,Inpatient,,,GO,260,221,74.516,260,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Ot Cognitive Performance Testing Per Hr,,96125,CPT,Facility,Outpatient,,,GO,260,221,74.516,260,"UCare Health, Inc.",Medicare Advantage,131.222,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ot Cognitive Performance Testing Per Hr,,96125,CPT,Facility,Inpatient,,,GO,260,221,74.516,260,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ot Cognitive Performance Testing Per Hr,,96125,CPT,Facility,Outpatient,,,GO,260,221,74.516,260,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),131.222,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ot Cognitive Performance Testing Per Hr,,96125,CPT,Facility,Inpatient,,,GO,260,221,74.516,260,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ot Cognitive Performance Testing Per Hr,,96125,CPT,Facility,Both,,,GO,260,221,74.516,260,UnitedHealthcare,Individual & Family,244.4,94,,percent of total billed charges,,
Ot Cognitive Performance Testing Per Hr,,96125,CPT,Facility,Outpatient,,,GO,260,221,74.516,260,UnitedHealthcare,Medicare Advantage,127.4,49,,percent of total billed charges,,
Ot Cognitive Performance Testing Per Hr,,96125,CPT,Facility,Inpatient,,,GO,260,221,74.516,260,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Ot Cognitive Performance Testing Per Hr,,96125,CPT,Facility,Outpatient,,,GO,260,221,74.516,260,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,124.8,48,,percent of total billed charges,,100% of DHS outpatient percentage
Ot Cognitive Performance Testing Per Hr,,96125,CPT,Facility,Inpatient,,,GO,260,221,74.516,260,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Ot Electrical Stimulation Unattended,,97014,CPT,Facility,Both,,,GO,82,69.7,23.5012,82,Aetna,Commercial,75.44,92,,percent of total billed charges,,
Ot Electrical Stimulation Unattended,,97014,CPT,Facility,Outpatient,,,GO,82,69.7,23.5012,82,Aetna,Medicare Advantage,40.18,49,,percent of total billed charges,,
Ot Electrical Stimulation Unattended,,97014,CPT,Facility,Inpatient,,,GO,82,69.7,23.5012,82,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Ot Electrical Stimulation Unattended,,97014,CPT,Facility,Both,,,GO,82,69.7,23.5012,82,Aetna,PPO,76.26,93,,percent of total billed charges,,
Ot Electrical Stimulation Unattended,,97014,CPT,Facility,Both,,,GO,82,69.7,23.5012,82,America's PPO,America's PPO,78.7446,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Ot Electrical Stimulation Unattended,,97014,CPT,Facility,Both,,,GO,82,69.7,23.5012,82,BlueCross BlueShield Minnesota, Federal Employee Program,80.688,98.4,,percent of total billed charges,,
Ot Electrical Stimulation Unattended,,97014,CPT,Facility,Both,,,GO,82,69.7,23.5012,82,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,82,100,,percent of total billed charges,,
Ot Electrical Stimulation Unattended,,97014,CPT,Facility,Both,,,GO,82,69.7,23.5012,82,BlueCross BlueShield Minnesota,High Value Network Plan,73.8,90,,percent of total billed charges,,
Ot Electrical Stimulation Unattended,,97014,CPT,Facility,Outpatient,,,GO,82,69.7,23.5012,82,BlueCross BlueShield Minnesota,Medicare Advantage,40.18,49,,percent of total billed charges,,
Ot Electrical Stimulation Unattended,,97014,CPT,Facility,Inpatient,,,GO,82,69.7,23.5012,82,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Ot Electrical Stimulation Unattended,,97014,CPT,Facility,Both,,,GO,82,69.7,23.5012,82,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,72.6274,88.57,,percent of total billed charges,,
Ot Electrical Stimulation Unattended,,97014,CPT,Facility,Both,,,GO,82,69.7,23.5012,82,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,23.5012,28.66,,percent of total billed charges,,
Ot Electrical Stimulation Unattended,,97014,CPT,Facility,Outpatient,,,GO,82,69.7,23.5012,82,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),40.18,49,,percent of total billed charges,,
Ot Electrical Stimulation Unattended,,97014,CPT,Facility,Inpatient,,,GO,82,69.7,23.5012,82,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Ot Electrical Stimulation Unattended,,97014,CPT,Facility,Both,,,GO,82,69.7,23.5012,82,CorVel,Worker's Compensation,82,100,,percent of total billed charges,,
Ot Electrical Stimulation Unattended,,97014,CPT,Facility,Both,,,GO,82,69.7,23.5012,82,First Health Group Corporation,First Health Network,79.54,97,,percent of total billed charges,,
Ot Electrical Stimulation Unattended,,97014,CPT,Facility,Both,,,GO,82,69.7,23.5012,82,"Health Partners, Inc.",Commercial,77.572,94.6,,percent of total billed charges,,
Ot Electrical Stimulation Unattended,,97014,CPT,Facility,Outpatient,,,GO,82,69.7,23.5012,82,"Health Partners, Inc.",Medicare Advantage,40.18,49,,percent of total billed charges,,
Ot Electrical Stimulation Unattended,,97014,CPT,Facility,Inpatient,,,GO,82,69.7,23.5012,82,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ot Electrical Stimulation Unattended,,97014,CPT,Facility,Both,,,GO,82,69.7,23.5012,82,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),49.2,60,,percent of total billed charges,,
Ot Electrical Stimulation Unattended,,97014,CPT,Facility,Both,,,GO,82,69.7,23.5012,82,"Health Partners, Inc.",State of Minnesota Advantage Program,66.83,81.5,,percent of total billed charges,,
Ot Electrical Stimulation Unattended,,97014,CPT,Facility,Both,,,GO,82,69.7,23.5012,82,"Health Partners, Inc.",State Public Programs,41,50,,percent of total billed charges,,
Ot Electrical Stimulation Unattended,,97014,CPT,Facility,Both,,,GO,82,69.7,23.5012,82,Humana Insurance Company,Commercial PPO,77.9,95,,percent of total billed charges,,
Ot Electrical Stimulation Unattended,,97014,CPT,Facility,Outpatient,,,GO,82,69.7,23.5012,82,Humana Insurance Company,Medicare PPO,40.18,49,,percent of total billed charges,,
Ot Electrical Stimulation Unattended,,97014,CPT,Facility,Inpatient,,,GO,82,69.7,23.5012,82,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Ot Electrical Stimulation Unattended,,97014,CPT,Facility,Both,,,GO,82,69.7,23.5012,82,Medica,Individual & Family,81.262,99.1,,percent of total billed charges,,
Ot Electrical Stimulation Unattended,,97014,CPT,Facility,Outpatient,,,GO,82,69.7,23.5012,82,Medica,Medica Advantage Solution,40.836,49.8,,percent of total billed charges,,
Ot Electrical Stimulation Unattended,,97014,CPT,Facility,Inpatient,,,GO,82,69.7,23.5012,82,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Ot Electrical Stimulation Unattended,,97014,CPT,Facility,Outpatient,,,GO,82,69.7,23.5012,82,Medica,Medical Assistance,36.572,44.6,,percent of total billed charges,,
Ot Electrical Stimulation Unattended,,97014,CPT,Facility,Inpatient,,,GO,82,69.7,23.5012,82,Medica,Medical Assistance,,,,,Included in per diem rate,
Ot Electrical Stimulation Unattended,,97014,CPT,Facility,Outpatient,,,GO,82,69.7,23.5012,82,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,40.836,49.8,,percent of total billed charges,,
Ot Electrical Stimulation Unattended,,97014,CPT,Facility,Inpatient,,,GO,82,69.7,23.5012,82,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Ot Electrical Stimulation Unattended,,97014,CPT,Facility,Both,,,GO,82,69.7,23.5012,82,"Multiplan, Inc.","Multiplan, Inc.",77.08,94,,percent of total billed charges,,
Ot Electrical Stimulation Unattended,,97014,CPT,Facility,Outpatient,,,GO,82,69.7,23.5012,82,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,70.848,86.4,,percent of total billed charges,,
Ot Electrical Stimulation Unattended,,97014,CPT,Facility,Inpatient,,,GO,82,69.7,23.5012,82,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Ot Electrical Stimulation Unattended,,97014,CPT,Facility,Both,,,GO,82,69.7,23.5012,82,"Preferred One Administrative Services, INC.",PPO,80.852,98.6,,percent of total billed charges,,
Ot Electrical Stimulation Unattended,,97014,CPT,Facility,Outpatient,,,GO,82,69.7,23.5012,82,PrimeWest Health,Minnesota Senior Health Options (MSHO),42.189,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Ot Electrical Stimulation Unattended,,97014,CPT,Facility,Inpatient,,,GO,82,69.7,23.5012,82,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ot Electrical Stimulation Unattended,,97014,CPT,Facility,Outpatient,,,GO,82,69.7,23.5012,82,PrimeWest Health,MinnesotaCare,42.1152,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Ot Electrical Stimulation Unattended,,97014,CPT,Facility,Inpatient,,,GO,82,69.7,23.5012,82,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Ot Electrical Stimulation Unattended,,97014,CPT,Facility,Both,,,GO,82,69.7,23.5012,82,Sanford Health Plan,Sanford Health Plan,75.44,92,,percent of total billed charges,,
Ot Electrical Stimulation Unattended,,97014,CPT,Facility,Outpatient,,,GO,82,69.7,23.5012,82,"UCare Health, Inc.",Individual & Family Plan,46.207,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Ot Electrical Stimulation Unattended,,97014,CPT,Facility,Inpatient,,,GO,82,69.7,23.5012,82,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Ot Electrical Stimulation Unattended,,97014,CPT,Facility,Outpatient,,,GO,82,69.7,23.5012,82,"UCare Health, Inc.",Medical Assistance,41.3854,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ot Electrical Stimulation Unattended,,97014,CPT,Facility,Inpatient,,,GO,82,69.7,23.5012,82,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Ot Electrical Stimulation Unattended,,97014,CPT,Facility,Outpatient,,,GO,82,69.7,23.5012,82,"UCare Health, Inc.",Medicare Advantage,41.3854,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ot Electrical Stimulation Unattended,,97014,CPT,Facility,Inpatient,,,GO,82,69.7,23.5012,82,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ot Electrical Stimulation Unattended,,97014,CPT,Facility,Outpatient,,,GO,82,69.7,23.5012,82,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),41.3854,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ot Electrical Stimulation Unattended,,97014,CPT,Facility,Inpatient,,,GO,82,69.7,23.5012,82,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ot Electrical Stimulation Unattended,,97014,CPT,Facility,Both,,,GO,82,69.7,23.5012,82,UnitedHealthcare,Individual & Family,77.08,94,,percent of total billed charges,,
Ot Electrical Stimulation Unattended,,97014,CPT,Facility,Outpatient,,,GO,82,69.7,23.5012,82,UnitedHealthcare,Medicare Advantage,40.18,49,,percent of total billed charges,,
Ot Electrical Stimulation Unattended,,97014,CPT,Facility,Inpatient,,,GO,82,69.7,23.5012,82,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Ot Electrical Stimulation Unattended,,97014,CPT,Facility,Outpatient,,,GO,82,69.7,23.5012,82,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,39.36,48,,percent of total billed charges,,100% of DHS outpatient percentage
Ot Electrical Stimulation Unattended,,97014,CPT,Facility,Inpatient,,,GO,82,69.7,23.5012,82,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Ot Paraffin Bath (15 Min),,97018,CPT,Facility,Both,,,GO,80,68,22.928,80,Aetna,Commercial,73.6,92,,percent of total billed charges,,
Ot Paraffin Bath (15 Min),,97018,CPT,Facility,Outpatient,,,GO,80,68,22.928,80,Aetna,Medicare Advantage,39.2,49,,percent of total billed charges,,
Ot Paraffin Bath (15 Min),,97018,CPT,Facility,Inpatient,,,GO,80,68,22.928,80,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Ot Paraffin Bath (15 Min),,97018,CPT,Facility,Both,,,GO,80,68,22.928,80,Aetna,PPO,74.4,93,,percent of total billed charges,,
Ot Paraffin Bath (15 Min),,97018,CPT,Facility,Both,,,GO,80,68,22.928,80,America's PPO,America's PPO,76.824,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Ot Paraffin Bath (15 Min),,97018,CPT,Facility,Both,,,GO,80,68,22.928,80,BlueCross BlueShield Minnesota, Federal Employee Program,78.72,98.4,,percent of total billed charges,,
Ot Paraffin Bath (15 Min),,97018,CPT,Facility,Both,,,GO,80,68,22.928,80,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,80,100,,percent of total billed charges,,
Ot Paraffin Bath (15 Min),,97018,CPT,Facility,Both,,,GO,80,68,22.928,80,BlueCross BlueShield Minnesota,High Value Network Plan,72,90,,percent of total billed charges,,
Ot Paraffin Bath (15 Min),,97018,CPT,Facility,Outpatient,,,GO,80,68,22.928,80,BlueCross BlueShield Minnesota,Medicare Advantage,39.2,49,,percent of total billed charges,,
Ot Paraffin Bath (15 Min),,97018,CPT,Facility,Inpatient,,,GO,80,68,22.928,80,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Ot Paraffin Bath (15 Min),,97018,CPT,Facility,Both,,,GO,80,68,22.928,80,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,70.856,88.57,,percent of total billed charges,,
Ot Paraffin Bath (15 Min),,97018,CPT,Facility,Both,,,GO,80,68,22.928,80,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,22.928,28.66,,percent of total billed charges,,
Ot Paraffin Bath (15 Min),,97018,CPT,Facility,Outpatient,,,GO,80,68,22.928,80,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),39.2,49,,percent of total billed charges,,
Ot Paraffin Bath (15 Min),,97018,CPT,Facility,Inpatient,,,GO,80,68,22.928,80,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Ot Paraffin Bath (15 Min),,97018,CPT,Facility,Both,,,GO,80,68,22.928,80,CorVel,Worker's Compensation,80,100,,percent of total billed charges,,
Ot Paraffin Bath (15 Min),,97018,CPT,Facility,Both,,,GO,80,68,22.928,80,First Health Group Corporation,First Health Network,77.6,97,,percent of total billed charges,,
Ot Paraffin Bath (15 Min),,97018,CPT,Facility,Both,,,GO,80,68,22.928,80,"Health Partners, Inc.",Commercial,75.68,94.6,,percent of total billed charges,,
Ot Paraffin Bath (15 Min),,97018,CPT,Facility,Outpatient,,,GO,80,68,22.928,80,"Health Partners, Inc.",Medicare Advantage,39.2,49,,percent of total billed charges,,
Ot Paraffin Bath (15 Min),,97018,CPT,Facility,Inpatient,,,GO,80,68,22.928,80,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ot Paraffin Bath (15 Min),,97018,CPT,Facility,Both,,,GO,80,68,22.928,80,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),48,60,,percent of total billed charges,,
Ot Paraffin Bath (15 Min),,97018,CPT,Facility,Both,,,GO,80,68,22.928,80,"Health Partners, Inc.",State of Minnesota Advantage Program,65.2,81.5,,percent of total billed charges,,
Ot Paraffin Bath (15 Min),,97018,CPT,Facility,Both,,,GO,80,68,22.928,80,"Health Partners, Inc.",State Public Programs,40,50,,percent of total billed charges,,
Ot Paraffin Bath (15 Min),,97018,CPT,Facility,Both,,,GO,80,68,22.928,80,Humana Insurance Company,Commercial PPO,76,95,,percent of total billed charges,,
Ot Paraffin Bath (15 Min),,97018,CPT,Facility,Outpatient,,,GO,80,68,22.928,80,Humana Insurance Company,Medicare PPO,39.2,49,,percent of total billed charges,,
Ot Paraffin Bath (15 Min),,97018,CPT,Facility,Inpatient,,,GO,80,68,22.928,80,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Ot Paraffin Bath (15 Min),,97018,CPT,Facility,Both,,,GO,80,68,22.928,80,Medica,Individual & Family,79.28,99.1,,percent of total billed charges,,
Ot Paraffin Bath (15 Min),,97018,CPT,Facility,Outpatient,,,GO,80,68,22.928,80,Medica,Medica Advantage Solution,39.84,49.8,,percent of total billed charges,,
Ot Paraffin Bath (15 Min),,97018,CPT,Facility,Inpatient,,,GO,80,68,22.928,80,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Ot Paraffin Bath (15 Min),,97018,CPT,Facility,Outpatient,,,GO,80,68,22.928,80,Medica,Medical Assistance,35.68,44.6,,percent of total billed charges,,
Ot Paraffin Bath (15 Min),,97018,CPT,Facility,Inpatient,,,GO,80,68,22.928,80,Medica,Medical Assistance,,,,,Included in per diem rate,
Ot Paraffin Bath (15 Min),,97018,CPT,Facility,Outpatient,,,GO,80,68,22.928,80,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,39.84,49.8,,percent of total billed charges,,
Ot Paraffin Bath (15 Min),,97018,CPT,Facility,Inpatient,,,GO,80,68,22.928,80,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Ot Paraffin Bath (15 Min),,97018,CPT,Facility,Both,,,GO,80,68,22.928,80,"Multiplan, Inc.","Multiplan, Inc.",75.2,94,,percent of total billed charges,,
Ot Paraffin Bath (15 Min),,97018,CPT,Facility,Outpatient,,,GO,80,68,22.928,80,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,69.12,86.4,,percent of total billed charges,,
Ot Paraffin Bath (15 Min),,97018,CPT,Facility,Inpatient,,,GO,80,68,22.928,80,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Ot Paraffin Bath (15 Min),,97018,CPT,Facility,Both,,,GO,80,68,22.928,80,"Preferred One Administrative Services, INC.",PPO,78.88,98.6,,percent of total billed charges,,
Ot Paraffin Bath (15 Min),,97018,CPT,Facility,Outpatient,,,GO,80,68,22.928,80,PrimeWest Health,Minnesota Senior Health Options (MSHO),41.16,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Ot Paraffin Bath (15 Min),,97018,CPT,Facility,Inpatient,,,GO,80,68,22.928,80,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ot Paraffin Bath (15 Min),,97018,CPT,Facility,Outpatient,,,GO,80,68,22.928,80,PrimeWest Health,MinnesotaCare,41.088,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Ot Paraffin Bath (15 Min),,97018,CPT,Facility,Inpatient,,,GO,80,68,22.928,80,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Ot Paraffin Bath (15 Min),,97018,CPT,Facility,Both,,,GO,80,68,22.928,80,Sanford Health Plan,Sanford Health Plan,73.6,92,,percent of total billed charges,,
Ot Paraffin Bath (15 Min),,97018,CPT,Facility,Outpatient,,,GO,80,68,22.928,80,"UCare Health, Inc.",Individual & Family Plan,45.08,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Ot Paraffin Bath (15 Min),,97018,CPT,Facility,Inpatient,,,GO,80,68,22.928,80,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Ot Paraffin Bath (15 Min),,97018,CPT,Facility,Outpatient,,,GO,80,68,22.928,80,"UCare Health, Inc.",Medical Assistance,40.376,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ot Paraffin Bath (15 Min),,97018,CPT,Facility,Inpatient,,,GO,80,68,22.928,80,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Ot Paraffin Bath (15 Min),,97018,CPT,Facility,Outpatient,,,GO,80,68,22.928,80,"UCare Health, Inc.",Medicare Advantage,40.376,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ot Paraffin Bath (15 Min),,97018,CPT,Facility,Inpatient,,,GO,80,68,22.928,80,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ot Paraffin Bath (15 Min),,97018,CPT,Facility,Outpatient,,,GO,80,68,22.928,80,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),40.376,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ot Paraffin Bath (15 Min),,97018,CPT,Facility,Inpatient,,,GO,80,68,22.928,80,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ot Paraffin Bath (15 Min),,97018,CPT,Facility,Both,,,GO,80,68,22.928,80,UnitedHealthcare,Individual & Family,75.2,94,,percent of total billed charges,,
Ot Paraffin Bath (15 Min),,97018,CPT,Facility,Outpatient,,,GO,80,68,22.928,80,UnitedHealthcare,Medicare Advantage,39.2,49,,percent of total billed charges,,
Ot Paraffin Bath (15 Min),,97018,CPT,Facility,Inpatient,,,GO,80,68,22.928,80,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Ot Paraffin Bath (15 Min),,97018,CPT,Facility,Outpatient,,,GO,80,68,22.928,80,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,38.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
Ot Paraffin Bath (15 Min),,97018,CPT,Facility,Inpatient,,,GO,80,68,22.928,80,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Ot Electrical Stim Attended (15 Min),,97032,CPT,Facility,Both,,,GO,67,56.95,19.2022,67,Aetna,Commercial,61.64,92,,percent of total billed charges,,
Ot Electrical Stim Attended (15 Min),,97032,CPT,Facility,Outpatient,,,GO,67,56.95,19.2022,67,Aetna,Medicare Advantage,32.83,49,,percent of total billed charges,,
Ot Electrical Stim Attended (15 Min),,97032,CPT,Facility,Inpatient,,,GO,67,56.95,19.2022,67,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Ot Electrical Stim Attended (15 Min),,97032,CPT,Facility,Both,,,GO,67,56.95,19.2022,67,Aetna,PPO,62.31,93,,percent of total billed charges,,
Ot Electrical Stim Attended (15 Min),,97032,CPT,Facility,Both,,,GO,67,56.95,19.2022,67,America's PPO,America's PPO,64.3401,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Ot Electrical Stim Attended (15 Min),,97032,CPT,Facility,Both,,,GO,67,56.95,19.2022,67,BlueCross BlueShield Minnesota, Federal Employee Program,65.928,98.4,,percent of total billed charges,,
Ot Electrical Stim Attended (15 Min),,97032,CPT,Facility,Both,,,GO,67,56.95,19.2022,67,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,67,100,,percent of total billed charges,,
Ot Electrical Stim Attended (15 Min),,97032,CPT,Facility,Both,,,GO,67,56.95,19.2022,67,BlueCross BlueShield Minnesota,High Value Network Plan,60.3,90,,percent of total billed charges,,
Ot Electrical Stim Attended (15 Min),,97032,CPT,Facility,Outpatient,,,GO,67,56.95,19.2022,67,BlueCross BlueShield Minnesota,Medicare Advantage,32.83,49,,percent of total billed charges,,
Ot Electrical Stim Attended (15 Min),,97032,CPT,Facility,Inpatient,,,GO,67,56.95,19.2022,67,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Ot Electrical Stim Attended (15 Min),,97032,CPT,Facility,Both,,,GO,67,56.95,19.2022,67,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,59.3419,88.57,,percent of total billed charges,,
Ot Electrical Stim Attended (15 Min),,97032,CPT,Facility,Both,,,GO,67,56.95,19.2022,67,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,19.2022,28.66,,percent of total billed charges,,
Ot Electrical Stim Attended (15 Min),,97032,CPT,Facility,Outpatient,,,GO,67,56.95,19.2022,67,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),32.83,49,,percent of total billed charges,,
Ot Electrical Stim Attended (15 Min),,97032,CPT,Facility,Inpatient,,,GO,67,56.95,19.2022,67,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Ot Electrical Stim Attended (15 Min),,97032,CPT,Facility,Both,,,GO,67,56.95,19.2022,67,CorVel,Worker's Compensation,67,100,,percent of total billed charges,,
Ot Electrical Stim Attended (15 Min),,97032,CPT,Facility,Both,,,GO,67,56.95,19.2022,67,First Health Group Corporation,First Health Network,64.99,97,,percent of total billed charges,,
Ot Electrical Stim Attended (15 Min),,97032,CPT,Facility,Both,,,GO,67,56.95,19.2022,67,"Health Partners, Inc.",Commercial,63.382,94.6,,percent of total billed charges,,
Ot Electrical Stim Attended (15 Min),,97032,CPT,Facility,Outpatient,,,GO,67,56.95,19.2022,67,"Health Partners, Inc.",Medicare Advantage,32.83,49,,percent of total billed charges,,
Ot Electrical Stim Attended (15 Min),,97032,CPT,Facility,Inpatient,,,GO,67,56.95,19.2022,67,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ot Electrical Stim Attended (15 Min),,97032,CPT,Facility,Both,,,GO,67,56.95,19.2022,67,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),40.2,60,,percent of total billed charges,,
Ot Electrical Stim Attended (15 Min),,97032,CPT,Facility,Both,,,GO,67,56.95,19.2022,67,"Health Partners, Inc.",State of Minnesota Advantage Program,54.605,81.5,,percent of total billed charges,,
Ot Electrical Stim Attended (15 Min),,97032,CPT,Facility,Both,,,GO,67,56.95,19.2022,67,"Health Partners, Inc.",State Public Programs,33.5,50,,percent of total billed charges,,
Ot Electrical Stim Attended (15 Min),,97032,CPT,Facility,Both,,,GO,67,56.95,19.2022,67,Humana Insurance Company,Commercial PPO,63.65,95,,percent of total billed charges,,
Ot Electrical Stim Attended (15 Min),,97032,CPT,Facility,Outpatient,,,GO,67,56.95,19.2022,67,Humana Insurance Company,Medicare PPO,32.83,49,,percent of total billed charges,,
Ot Electrical Stim Attended (15 Min),,97032,CPT,Facility,Inpatient,,,GO,67,56.95,19.2022,67,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Ot Electrical Stim Attended (15 Min),,97032,CPT,Facility,Both,,,GO,67,56.95,19.2022,67,Medica,Individual & Family,66.397,99.1,,percent of total billed charges,,
Ot Electrical Stim Attended (15 Min),,97032,CPT,Facility,Outpatient,,,GO,67,56.95,19.2022,67,Medica,Medica Advantage Solution,33.366,49.8,,percent of total billed charges,,
Ot Electrical Stim Attended (15 Min),,97032,CPT,Facility,Inpatient,,,GO,67,56.95,19.2022,67,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Ot Electrical Stim Attended (15 Min),,97032,CPT,Facility,Outpatient,,,GO,67,56.95,19.2022,67,Medica,Medical Assistance,29.882,44.6,,percent of total billed charges,,
Ot Electrical Stim Attended (15 Min),,97032,CPT,Facility,Inpatient,,,GO,67,56.95,19.2022,67,Medica,Medical Assistance,,,,,Included in per diem rate,
Ot Electrical Stim Attended (15 Min),,97032,CPT,Facility,Outpatient,,,GO,67,56.95,19.2022,67,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,33.366,49.8,,percent of total billed charges,,
Ot Electrical Stim Attended (15 Min),,97032,CPT,Facility,Inpatient,,,GO,67,56.95,19.2022,67,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Ot Electrical Stim Attended (15 Min),,97032,CPT,Facility,Both,,,GO,67,56.95,19.2022,67,"Multiplan, Inc.","Multiplan, Inc.",62.98,94,,percent of total billed charges,,
Ot Electrical Stim Attended (15 Min),,97032,CPT,Facility,Outpatient,,,GO,67,56.95,19.2022,67,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,57.888,86.4,,percent of total billed charges,,
Ot Electrical Stim Attended (15 Min),,97032,CPT,Facility,Inpatient,,,GO,67,56.95,19.2022,67,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Ot Electrical Stim Attended (15 Min),,97032,CPT,Facility,Both,,,GO,67,56.95,19.2022,67,"Preferred One Administrative Services, INC.",PPO,66.062,98.6,,percent of total billed charges,,
Ot Electrical Stim Attended (15 Min),,97032,CPT,Facility,Outpatient,,,GO,67,56.95,19.2022,67,PrimeWest Health,Minnesota Senior Health Options (MSHO),34.4715,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Ot Electrical Stim Attended (15 Min),,97032,CPT,Facility,Inpatient,,,GO,67,56.95,19.2022,67,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ot Electrical Stim Attended (15 Min),,97032,CPT,Facility,Outpatient,,,GO,67,56.95,19.2022,67,PrimeWest Health,MinnesotaCare,34.4112,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Ot Electrical Stim Attended (15 Min),,97032,CPT,Facility,Inpatient,,,GO,67,56.95,19.2022,67,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Ot Electrical Stim Attended (15 Min),,97032,CPT,Facility,Both,,,GO,67,56.95,19.2022,67,Sanford Health Plan,Sanford Health Plan,61.64,92,,percent of total billed charges,,
Ot Electrical Stim Attended (15 Min),,97032,CPT,Facility,Outpatient,,,GO,67,56.95,19.2022,67,"UCare Health, Inc.",Individual & Family Plan,37.7545,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Ot Electrical Stim Attended (15 Min),,97032,CPT,Facility,Inpatient,,,GO,67,56.95,19.2022,67,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Ot Electrical Stim Attended (15 Min),,97032,CPT,Facility,Outpatient,,,GO,67,56.95,19.2022,67,"UCare Health, Inc.",Medical Assistance,33.8149,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ot Electrical Stim Attended (15 Min),,97032,CPT,Facility,Inpatient,,,GO,67,56.95,19.2022,67,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Ot Electrical Stim Attended (15 Min),,97032,CPT,Facility,Outpatient,,,GO,67,56.95,19.2022,67,"UCare Health, Inc.",Medicare Advantage,33.8149,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ot Electrical Stim Attended (15 Min),,97032,CPT,Facility,Inpatient,,,GO,67,56.95,19.2022,67,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ot Electrical Stim Attended (15 Min),,97032,CPT,Facility,Outpatient,,,GO,67,56.95,19.2022,67,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),33.8149,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ot Electrical Stim Attended (15 Min),,97032,CPT,Facility,Inpatient,,,GO,67,56.95,19.2022,67,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ot Electrical Stim Attended (15 Min),,97032,CPT,Facility,Both,,,GO,67,56.95,19.2022,67,UnitedHealthcare,Individual & Family,62.98,94,,percent of total billed charges,,
Ot Electrical Stim Attended (15 Min),,97032,CPT,Facility,Outpatient,,,GO,67,56.95,19.2022,67,UnitedHealthcare,Medicare Advantage,32.83,49,,percent of total billed charges,,
Ot Electrical Stim Attended (15 Min),,97032,CPT,Facility,Inpatient,,,GO,67,56.95,19.2022,67,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Ot Electrical Stim Attended (15 Min),,97032,CPT,Facility,Outpatient,,,GO,67,56.95,19.2022,67,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,32.16,48,,percent of total billed charges,,100% of DHS outpatient percentage
Ot Electrical Stim Attended (15 Min),,97032,CPT,Facility,Inpatient,,,GO,67,56.95,19.2022,67,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Ot Iontophoresis (15 Min),,97033,CPT,Facility,Both,,,GO,93,79.05,26.6538,93,Aetna,Commercial,85.56,92,,percent of total billed charges,,
Ot Iontophoresis (15 Min),,97033,CPT,Facility,Outpatient,,,GO,93,79.05,26.6538,93,Aetna,Medicare Advantage,45.57,49,,percent of total billed charges,,
Ot Iontophoresis (15 Min),,97033,CPT,Facility,Inpatient,,,GO,93,79.05,26.6538,93,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Ot Iontophoresis (15 Min),,97033,CPT,Facility,Both,,,GO,93,79.05,26.6538,93,Aetna,PPO,86.49,93,,percent of total billed charges,,
Ot Iontophoresis (15 Min),,97033,CPT,Facility,Both,,,GO,93,79.05,26.6538,93,America's PPO,America's PPO,89.3079,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Ot Iontophoresis (15 Min),,97033,CPT,Facility,Both,,,GO,93,79.05,26.6538,93,BlueCross BlueShield Minnesota, Federal Employee Program,91.512,98.4,,percent of total billed charges,,
Ot Iontophoresis (15 Min),,97033,CPT,Facility,Both,,,GO,93,79.05,26.6538,93,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,93,100,,percent of total billed charges,,
Ot Iontophoresis (15 Min),,97033,CPT,Facility,Both,,,GO,93,79.05,26.6538,93,BlueCross BlueShield Minnesota,High Value Network Plan,83.7,90,,percent of total billed charges,,
Ot Iontophoresis (15 Min),,97033,CPT,Facility,Outpatient,,,GO,93,79.05,26.6538,93,BlueCross BlueShield Minnesota,Medicare Advantage,45.57,49,,percent of total billed charges,,
Ot Iontophoresis (15 Min),,97033,CPT,Facility,Inpatient,,,GO,93,79.05,26.6538,93,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Ot Iontophoresis (15 Min),,97033,CPT,Facility,Both,,,GO,93,79.05,26.6538,93,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,82.3701,88.57,,percent of total billed charges,,
Ot Iontophoresis (15 Min),,97033,CPT,Facility,Both,,,GO,93,79.05,26.6538,93,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,26.6538,28.66,,percent of total billed charges,,
Ot Iontophoresis (15 Min),,97033,CPT,Facility,Outpatient,,,GO,93,79.05,26.6538,93,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),45.57,49,,percent of total billed charges,,
Ot Iontophoresis (15 Min),,97033,CPT,Facility,Inpatient,,,GO,93,79.05,26.6538,93,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Ot Iontophoresis (15 Min),,97033,CPT,Facility,Both,,,GO,93,79.05,26.6538,93,CorVel,Worker's Compensation,93,100,,percent of total billed charges,,
Ot Iontophoresis (15 Min),,97033,CPT,Facility,Both,,,GO,93,79.05,26.6538,93,First Health Group Corporation,First Health Network,90.21,97,,percent of total billed charges,,
Ot Iontophoresis (15 Min),,97033,CPT,Facility,Both,,,GO,93,79.05,26.6538,93,"Health Partners, Inc.",Commercial,87.978,94.6,,percent of total billed charges,,
Ot Iontophoresis (15 Min),,97033,CPT,Facility,Outpatient,,,GO,93,79.05,26.6538,93,"Health Partners, Inc.",Medicare Advantage,45.57,49,,percent of total billed charges,,
Ot Iontophoresis (15 Min),,97033,CPT,Facility,Inpatient,,,GO,93,79.05,26.6538,93,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ot Iontophoresis (15 Min),,97033,CPT,Facility,Both,,,GO,93,79.05,26.6538,93,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),55.8,60,,percent of total billed charges,,
Ot Iontophoresis (15 Min),,97033,CPT,Facility,Both,,,GO,93,79.05,26.6538,93,"Health Partners, Inc.",State of Minnesota Advantage Program,75.795,81.5,,percent of total billed charges,,
Ot Iontophoresis (15 Min),,97033,CPT,Facility,Both,,,GO,93,79.05,26.6538,93,"Health Partners, Inc.",State Public Programs,46.5,50,,percent of total billed charges,,
Ot Iontophoresis (15 Min),,97033,CPT,Facility,Both,,,GO,93,79.05,26.6538,93,Humana Insurance Company,Commercial PPO,88.35,95,,percent of total billed charges,,
Ot Iontophoresis (15 Min),,97033,CPT,Facility,Outpatient,,,GO,93,79.05,26.6538,93,Humana Insurance Company,Medicare PPO,45.57,49,,percent of total billed charges,,
Ot Iontophoresis (15 Min),,97033,CPT,Facility,Inpatient,,,GO,93,79.05,26.6538,93,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Ot Iontophoresis (15 Min),,97033,CPT,Facility,Both,,,GO,93,79.05,26.6538,93,Medica,Individual & Family,92.163,99.1,,percent of total billed charges,,
Ot Iontophoresis (15 Min),,97033,CPT,Facility,Outpatient,,,GO,93,79.05,26.6538,93,Medica,Medica Advantage Solution,46.314,49.8,,percent of total billed charges,,
Ot Iontophoresis (15 Min),,97033,CPT,Facility,Inpatient,,,GO,93,79.05,26.6538,93,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Ot Iontophoresis (15 Min),,97033,CPT,Facility,Outpatient,,,GO,93,79.05,26.6538,93,Medica,Medical Assistance,41.478,44.6,,percent of total billed charges,,
Ot Iontophoresis (15 Min),,97033,CPT,Facility,Inpatient,,,GO,93,79.05,26.6538,93,Medica,Medical Assistance,,,,,Included in per diem rate,
Ot Iontophoresis (15 Min),,97033,CPT,Facility,Outpatient,,,GO,93,79.05,26.6538,93,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,46.314,49.8,,percent of total billed charges,,
Ot Iontophoresis (15 Min),,97033,CPT,Facility,Inpatient,,,GO,93,79.05,26.6538,93,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Ot Iontophoresis (15 Min),,97033,CPT,Facility,Both,,,GO,93,79.05,26.6538,93,"Multiplan, Inc.","Multiplan, Inc.",87.42,94,,percent of total billed charges,,
Ot Iontophoresis (15 Min),,97033,CPT,Facility,Outpatient,,,GO,93,79.05,26.6538,93,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,80.352,86.4,,percent of total billed charges,,
Ot Iontophoresis (15 Min),,97033,CPT,Facility,Inpatient,,,GO,93,79.05,26.6538,93,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Ot Iontophoresis (15 Min),,97033,CPT,Facility,Both,,,GO,93,79.05,26.6538,93,"Preferred One Administrative Services, INC.",PPO,91.698,98.6,,percent of total billed charges,,
Ot Iontophoresis (15 Min),,97033,CPT,Facility,Outpatient,,,GO,93,79.05,26.6538,93,PrimeWest Health,Minnesota Senior Health Options (MSHO),47.8485,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Ot Iontophoresis (15 Min),,97033,CPT,Facility,Inpatient,,,GO,93,79.05,26.6538,93,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ot Iontophoresis (15 Min),,97033,CPT,Facility,Outpatient,,,GO,93,79.05,26.6538,93,PrimeWest Health,MinnesotaCare,47.7648,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Ot Iontophoresis (15 Min),,97033,CPT,Facility,Inpatient,,,GO,93,79.05,26.6538,93,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Ot Iontophoresis (15 Min),,97033,CPT,Facility,Both,,,GO,93,79.05,26.6538,93,Sanford Health Plan,Sanford Health Plan,85.56,92,,percent of total billed charges,,
Ot Iontophoresis (15 Min),,97033,CPT,Facility,Outpatient,,,GO,93,79.05,26.6538,93,"UCare Health, Inc.",Individual & Family Plan,52.4055,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Ot Iontophoresis (15 Min),,97033,CPT,Facility,Inpatient,,,GO,93,79.05,26.6538,93,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Ot Iontophoresis (15 Min),,97033,CPT,Facility,Outpatient,,,GO,93,79.05,26.6538,93,"UCare Health, Inc.",Medical Assistance,46.9371,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ot Iontophoresis (15 Min),,97033,CPT,Facility,Inpatient,,,GO,93,79.05,26.6538,93,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Ot Iontophoresis (15 Min),,97033,CPT,Facility,Outpatient,,,GO,93,79.05,26.6538,93,"UCare Health, Inc.",Medicare Advantage,46.9371,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ot Iontophoresis (15 Min),,97033,CPT,Facility,Inpatient,,,GO,93,79.05,26.6538,93,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ot Iontophoresis (15 Min),,97033,CPT,Facility,Outpatient,,,GO,93,79.05,26.6538,93,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),46.9371,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ot Iontophoresis (15 Min),,97033,CPT,Facility,Inpatient,,,GO,93,79.05,26.6538,93,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ot Iontophoresis (15 Min),,97033,CPT,Facility,Both,,,GO,93,79.05,26.6538,93,UnitedHealthcare,Individual & Family,87.42,94,,percent of total billed charges,,
Ot Iontophoresis (15 Min),,97033,CPT,Facility,Outpatient,,,GO,93,79.05,26.6538,93,UnitedHealthcare,Medicare Advantage,45.57,49,,percent of total billed charges,,
Ot Iontophoresis (15 Min),,97033,CPT,Facility,Inpatient,,,GO,93,79.05,26.6538,93,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Ot Iontophoresis (15 Min),,97033,CPT,Facility,Outpatient,,,GO,93,79.05,26.6538,93,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,44.64,48,,percent of total billed charges,,100% of DHS outpatient percentage
Ot Iontophoresis (15 Min),,97033,CPT,Facility,Inpatient,,,GO,93,79.05,26.6538,93,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Ot Contrast Bath (15 Min),,97034,CPT,Facility,Both,,,GO,77,65.45,22.0682,77,Aetna,Commercial,70.84,92,,percent of total billed charges,,
Ot Contrast Bath (15 Min),,97034,CPT,Facility,Outpatient,,,GO,77,65.45,22.0682,77,Aetna,Medicare Advantage,37.73,49,,percent of total billed charges,,
Ot Contrast Bath (15 Min),,97034,CPT,Facility,Inpatient,,,GO,77,65.45,22.0682,77,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Ot Contrast Bath (15 Min),,97034,CPT,Facility,Both,,,GO,77,65.45,22.0682,77,Aetna,PPO,71.61,93,,percent of total billed charges,,
Ot Contrast Bath (15 Min),,97034,CPT,Facility,Both,,,GO,77,65.45,22.0682,77,America's PPO,America's PPO,73.9431,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Ot Contrast Bath (15 Min),,97034,CPT,Facility,Both,,,GO,77,65.45,22.0682,77,BlueCross BlueShield Minnesota, Federal Employee Program,75.768,98.4,,percent of total billed charges,,
Ot Contrast Bath (15 Min),,97034,CPT,Facility,Both,,,GO,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,77,100,,percent of total billed charges,,
Ot Contrast Bath (15 Min),,97034,CPT,Facility,Both,,,GO,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,High Value Network Plan,69.3,90,,percent of total billed charges,,
Ot Contrast Bath (15 Min),,97034,CPT,Facility,Outpatient,,,GO,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,Medicare Advantage,37.73,49,,percent of total billed charges,,
Ot Contrast Bath (15 Min),,97034,CPT,Facility,Inpatient,,,GO,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Ot Contrast Bath (15 Min),,97034,CPT,Facility,Both,,,GO,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,68.1989,88.57,,percent of total billed charges,,
Ot Contrast Bath (15 Min),,97034,CPT,Facility,Both,,,GO,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,22.0682,28.66,,percent of total billed charges,,
Ot Contrast Bath (15 Min),,97034,CPT,Facility,Outpatient,,,GO,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),37.73,49,,percent of total billed charges,,
Ot Contrast Bath (15 Min),,97034,CPT,Facility,Inpatient,,,GO,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Ot Contrast Bath (15 Min),,97034,CPT,Facility,Both,,,GO,77,65.45,22.0682,77,CorVel,Worker's Compensation,77,100,,percent of total billed charges,,
Ot Contrast Bath (15 Min),,97034,CPT,Facility,Both,,,GO,77,65.45,22.0682,77,First Health Group Corporation,First Health Network,74.69,97,,percent of total billed charges,,
Ot Contrast Bath (15 Min),,97034,CPT,Facility,Both,,,GO,77,65.45,22.0682,77,"Health Partners, Inc.",Commercial,72.842,94.6,,percent of total billed charges,,
Ot Contrast Bath (15 Min),,97034,CPT,Facility,Outpatient,,,GO,77,65.45,22.0682,77,"Health Partners, Inc.",Medicare Advantage,37.73,49,,percent of total billed charges,,
Ot Contrast Bath (15 Min),,97034,CPT,Facility,Inpatient,,,GO,77,65.45,22.0682,77,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ot Contrast Bath (15 Min),,97034,CPT,Facility,Both,,,GO,77,65.45,22.0682,77,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),46.2,60,,percent of total billed charges,,
Ot Contrast Bath (15 Min),,97034,CPT,Facility,Both,,,GO,77,65.45,22.0682,77,"Health Partners, Inc.",State of Minnesota Advantage Program,62.755,81.5,,percent of total billed charges,,
Ot Contrast Bath (15 Min),,97034,CPT,Facility,Both,,,GO,77,65.45,22.0682,77,"Health Partners, Inc.",State Public Programs,38.5,50,,percent of total billed charges,,
Ot Contrast Bath (15 Min),,97034,CPT,Facility,Both,,,GO,77,65.45,22.0682,77,Humana Insurance Company,Commercial PPO,73.15,95,,percent of total billed charges,,
Ot Contrast Bath (15 Min),,97034,CPT,Facility,Outpatient,,,GO,77,65.45,22.0682,77,Humana Insurance Company,Medicare PPO,37.73,49,,percent of total billed charges,,
Ot Contrast Bath (15 Min),,97034,CPT,Facility,Inpatient,,,GO,77,65.45,22.0682,77,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Ot Contrast Bath (15 Min),,97034,CPT,Facility,Both,,,GO,77,65.45,22.0682,77,Medica,Individual & Family,76.307,99.1,,percent of total billed charges,,
Ot Contrast Bath (15 Min),,97034,CPT,Facility,Outpatient,,,GO,77,65.45,22.0682,77,Medica,Medica Advantage Solution,38.346,49.8,,percent of total billed charges,,
Ot Contrast Bath (15 Min),,97034,CPT,Facility,Inpatient,,,GO,77,65.45,22.0682,77,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Ot Contrast Bath (15 Min),,97034,CPT,Facility,Outpatient,,,GO,77,65.45,22.0682,77,Medica,Medical Assistance,34.342,44.6,,percent of total billed charges,,
Ot Contrast Bath (15 Min),,97034,CPT,Facility,Inpatient,,,GO,77,65.45,22.0682,77,Medica,Medical Assistance,,,,,Included in per diem rate,
Ot Contrast Bath (15 Min),,97034,CPT,Facility,Outpatient,,,GO,77,65.45,22.0682,77,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,38.346,49.8,,percent of total billed charges,,
Ot Contrast Bath (15 Min),,97034,CPT,Facility,Inpatient,,,GO,77,65.45,22.0682,77,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Ot Contrast Bath (15 Min),,97034,CPT,Facility,Both,,,GO,77,65.45,22.0682,77,"Multiplan, Inc.","Multiplan, Inc.",72.38,94,,percent of total billed charges,,
Ot Contrast Bath (15 Min),,97034,CPT,Facility,Outpatient,,,GO,77,65.45,22.0682,77,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,66.528,86.4,,percent of total billed charges,,
Ot Contrast Bath (15 Min),,97034,CPT,Facility,Inpatient,,,GO,77,65.45,22.0682,77,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Ot Contrast Bath (15 Min),,97034,CPT,Facility,Both,,,GO,77,65.45,22.0682,77,"Preferred One Administrative Services, INC.",PPO,75.922,98.6,,percent of total billed charges,,
Ot Contrast Bath (15 Min),,97034,CPT,Facility,Outpatient,,,GO,77,65.45,22.0682,77,PrimeWest Health,Minnesota Senior Health Options (MSHO),39.6165,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Ot Contrast Bath (15 Min),,97034,CPT,Facility,Inpatient,,,GO,77,65.45,22.0682,77,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ot Contrast Bath (15 Min),,97034,CPT,Facility,Outpatient,,,GO,77,65.45,22.0682,77,PrimeWest Health,MinnesotaCare,39.5472,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Ot Contrast Bath (15 Min),,97034,CPT,Facility,Inpatient,,,GO,77,65.45,22.0682,77,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Ot Contrast Bath (15 Min),,97034,CPT,Facility,Both,,,GO,77,65.45,22.0682,77,Sanford Health Plan,Sanford Health Plan,70.84,92,,percent of total billed charges,,
Ot Contrast Bath (15 Min),,97034,CPT,Facility,Outpatient,,,GO,77,65.45,22.0682,77,"UCare Health, Inc.",Individual & Family Plan,43.3895,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Ot Contrast Bath (15 Min),,97034,CPT,Facility,Inpatient,,,GO,77,65.45,22.0682,77,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Ot Contrast Bath (15 Min),,97034,CPT,Facility,Outpatient,,,GO,77,65.45,22.0682,77,"UCare Health, Inc.",Medical Assistance,38.8619,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ot Contrast Bath (15 Min),,97034,CPT,Facility,Inpatient,,,GO,77,65.45,22.0682,77,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Ot Contrast Bath (15 Min),,97034,CPT,Facility,Outpatient,,,GO,77,65.45,22.0682,77,"UCare Health, Inc.",Medicare Advantage,38.8619,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ot Contrast Bath (15 Min),,97034,CPT,Facility,Inpatient,,,GO,77,65.45,22.0682,77,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ot Contrast Bath (15 Min),,97034,CPT,Facility,Outpatient,,,GO,77,65.45,22.0682,77,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),38.8619,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ot Contrast Bath (15 Min),,97034,CPT,Facility,Inpatient,,,GO,77,65.45,22.0682,77,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ot Contrast Bath (15 Min),,97034,CPT,Facility,Both,,,GO,77,65.45,22.0682,77,UnitedHealthcare,Individual & Family,72.38,94,,percent of total billed charges,,
Ot Contrast Bath (15 Min),,97034,CPT,Facility,Outpatient,,,GO,77,65.45,22.0682,77,UnitedHealthcare,Medicare Advantage,37.73,49,,percent of total billed charges,,
Ot Contrast Bath (15 Min),,97034,CPT,Facility,Inpatient,,,GO,77,65.45,22.0682,77,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Ot Contrast Bath (15 Min),,97034,CPT,Facility,Outpatient,,,GO,77,65.45,22.0682,77,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,36.96,48,,percent of total billed charges,,100% of DHS outpatient percentage
Ot Contrast Bath (15 Min),,97034,CPT,Facility,Inpatient,,,GO,77,65.45,22.0682,77,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Ot Ultrasound (15 Min),,97035,CPT,Facility,Both,,,GO,102,86.7,29.2332,102,Aetna,Commercial,93.84,92,,percent of total billed charges,,
Ot Ultrasound (15 Min),,97035,CPT,Facility,Outpatient,,,GO,102,86.7,29.2332,102,Aetna,Medicare Advantage,49.98,49,,percent of total billed charges,,
Ot Ultrasound (15 Min),,97035,CPT,Facility,Inpatient,,,GO,102,86.7,29.2332,102,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Ot Ultrasound (15 Min),,97035,CPT,Facility,Both,,,GO,102,86.7,29.2332,102,Aetna,PPO,94.86,93,,percent of total billed charges,,
Ot Ultrasound (15 Min),,97035,CPT,Facility,Both,,,GO,102,86.7,29.2332,102,America's PPO,America's PPO,97.9506,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Ot Ultrasound (15 Min),,97035,CPT,Facility,Both,,,GO,102,86.7,29.2332,102,BlueCross BlueShield Minnesota, Federal Employee Program,100.368,98.4,,percent of total billed charges,,
Ot Ultrasound (15 Min),,97035,CPT,Facility,Both,,,GO,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,102,100,,percent of total billed charges,,
Ot Ultrasound (15 Min),,97035,CPT,Facility,Both,,,GO,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,High Value Network Plan,91.8,90,,percent of total billed charges,,
Ot Ultrasound (15 Min),,97035,CPT,Facility,Outpatient,,,GO,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,Medicare Advantage,49.98,49,,percent of total billed charges,,
Ot Ultrasound (15 Min),,97035,CPT,Facility,Inpatient,,,GO,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Ot Ultrasound (15 Min),,97035,CPT,Facility,Both,,,GO,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,90.3414,88.57,,percent of total billed charges,,
Ot Ultrasound (15 Min),,97035,CPT,Facility,Both,,,GO,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,29.2332,28.66,,percent of total billed charges,,
Ot Ultrasound (15 Min),,97035,CPT,Facility,Outpatient,,,GO,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),49.98,49,,percent of total billed charges,,
Ot Ultrasound (15 Min),,97035,CPT,Facility,Inpatient,,,GO,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Ot Ultrasound (15 Min),,97035,CPT,Facility,Both,,,GO,102,86.7,29.2332,102,CorVel,Worker's Compensation,102,100,,percent of total billed charges,,
Ot Ultrasound (15 Min),,97035,CPT,Facility,Both,,,GO,102,86.7,29.2332,102,First Health Group Corporation,First Health Network,98.94,97,,percent of total billed charges,,
Ot Ultrasound (15 Min),,97035,CPT,Facility,Both,,,GO,102,86.7,29.2332,102,"Health Partners, Inc.",Commercial,96.492,94.6,,percent of total billed charges,,
Ot Ultrasound (15 Min),,97035,CPT,Facility,Outpatient,,,GO,102,86.7,29.2332,102,"Health Partners, Inc.",Medicare Advantage,49.98,49,,percent of total billed charges,,
Ot Ultrasound (15 Min),,97035,CPT,Facility,Inpatient,,,GO,102,86.7,29.2332,102,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ot Ultrasound (15 Min),,97035,CPT,Facility,Both,,,GO,102,86.7,29.2332,102,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),61.2,60,,percent of total billed charges,,
Ot Ultrasound (15 Min),,97035,CPT,Facility,Both,,,GO,102,86.7,29.2332,102,"Health Partners, Inc.",State of Minnesota Advantage Program,83.13,81.5,,percent of total billed charges,,
Ot Ultrasound (15 Min),,97035,CPT,Facility,Both,,,GO,102,86.7,29.2332,102,"Health Partners, Inc.",State Public Programs,51,50,,percent of total billed charges,,
Ot Ultrasound (15 Min),,97035,CPT,Facility,Both,,,GO,102,86.7,29.2332,102,Humana Insurance Company,Commercial PPO,96.9,95,,percent of total billed charges,,
Ot Ultrasound (15 Min),,97035,CPT,Facility,Outpatient,,,GO,102,86.7,29.2332,102,Humana Insurance Company,Medicare PPO,49.98,49,,percent of total billed charges,,
Ot Ultrasound (15 Min),,97035,CPT,Facility,Inpatient,,,GO,102,86.7,29.2332,102,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Ot Ultrasound (15 Min),,97035,CPT,Facility,Both,,,GO,102,86.7,29.2332,102,Medica,Individual & Family,101.082,99.1,,percent of total billed charges,,
Ot Ultrasound (15 Min),,97035,CPT,Facility,Outpatient,,,GO,102,86.7,29.2332,102,Medica,Medica Advantage Solution,50.796,49.8,,percent of total billed charges,,
Ot Ultrasound (15 Min),,97035,CPT,Facility,Inpatient,,,GO,102,86.7,29.2332,102,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Ot Ultrasound (15 Min),,97035,CPT,Facility,Outpatient,,,GO,102,86.7,29.2332,102,Medica,Medical Assistance,45.492,44.6,,percent of total billed charges,,
Ot Ultrasound (15 Min),,97035,CPT,Facility,Inpatient,,,GO,102,86.7,29.2332,102,Medica,Medical Assistance,,,,,Included in per diem rate,
Ot Ultrasound (15 Min),,97035,CPT,Facility,Outpatient,,,GO,102,86.7,29.2332,102,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,50.796,49.8,,percent of total billed charges,,
Ot Ultrasound (15 Min),,97035,CPT,Facility,Inpatient,,,GO,102,86.7,29.2332,102,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Ot Ultrasound (15 Min),,97035,CPT,Facility,Both,,,GO,102,86.7,29.2332,102,"Multiplan, Inc.","Multiplan, Inc.",95.88,94,,percent of total billed charges,,
Ot Ultrasound (15 Min),,97035,CPT,Facility,Outpatient,,,GO,102,86.7,29.2332,102,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,88.128,86.4,,percent of total billed charges,,
Ot Ultrasound (15 Min),,97035,CPT,Facility,Inpatient,,,GO,102,86.7,29.2332,102,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Ot Ultrasound (15 Min),,97035,CPT,Facility,Both,,,GO,102,86.7,29.2332,102,"Preferred One Administrative Services, INC.",PPO,100.572,98.6,,percent of total billed charges,,
Ot Ultrasound (15 Min),,97035,CPT,Facility,Outpatient,,,GO,102,86.7,29.2332,102,PrimeWest Health,Minnesota Senior Health Options (MSHO),52.479,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Ot Ultrasound (15 Min),,97035,CPT,Facility,Inpatient,,,GO,102,86.7,29.2332,102,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ot Ultrasound (15 Min),,97035,CPT,Facility,Outpatient,,,GO,102,86.7,29.2332,102,PrimeWest Health,MinnesotaCare,52.3872,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Ot Ultrasound (15 Min),,97035,CPT,Facility,Inpatient,,,GO,102,86.7,29.2332,102,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Ot Ultrasound (15 Min),,97035,CPT,Facility,Both,,,GO,102,86.7,29.2332,102,Sanford Health Plan,Sanford Health Plan,93.84,92,,percent of total billed charges,,
Ot Ultrasound (15 Min),,97035,CPT,Facility,Outpatient,,,GO,102,86.7,29.2332,102,"UCare Health, Inc.",Individual & Family Plan,57.477,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Ot Ultrasound (15 Min),,97035,CPT,Facility,Inpatient,,,GO,102,86.7,29.2332,102,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Ot Ultrasound (15 Min),,97035,CPT,Facility,Outpatient,,,GO,102,86.7,29.2332,102,"UCare Health, Inc.",Medical Assistance,51.4794,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ot Ultrasound (15 Min),,97035,CPT,Facility,Inpatient,,,GO,102,86.7,29.2332,102,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Ot Ultrasound (15 Min),,97035,CPT,Facility,Outpatient,,,GO,102,86.7,29.2332,102,"UCare Health, Inc.",Medicare Advantage,51.4794,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ot Ultrasound (15 Min),,97035,CPT,Facility,Inpatient,,,GO,102,86.7,29.2332,102,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ot Ultrasound (15 Min),,97035,CPT,Facility,Outpatient,,,GO,102,86.7,29.2332,102,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),51.4794,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ot Ultrasound (15 Min),,97035,CPT,Facility,Inpatient,,,GO,102,86.7,29.2332,102,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ot Ultrasound (15 Min),,97035,CPT,Facility,Both,,,GO,102,86.7,29.2332,102,UnitedHealthcare,Individual & Family,95.88,94,,percent of total billed charges,,
Ot Ultrasound (15 Min),,97035,CPT,Facility,Outpatient,,,GO,102,86.7,29.2332,102,UnitedHealthcare,Medicare Advantage,49.98,49,,percent of total billed charges,,
Ot Ultrasound (15 Min),,97035,CPT,Facility,Inpatient,,,GO,102,86.7,29.2332,102,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Ot Ultrasound (15 Min),,97035,CPT,Facility,Outpatient,,,GO,102,86.7,29.2332,102,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,48.96,48,,percent of total billed charges,,100% of DHS outpatient percentage
Ot Ultrasound (15 Min),,97035,CPT,Facility,Inpatient,,,GO,102,86.7,29.2332,102,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Ot Exercise (Rom, Strength, Flex) (15 Min)",,97110,CPT,Facility,Both,,,GO,102,86.7,29.2332,102,Aetna,Commercial,93.84,92,,percent of total billed charges,,
"Ot Exercise (Rom, Strength, Flex) (15 Min)",,97110,CPT,Facility,Outpatient,,,GO,102,86.7,29.2332,102,Aetna,Medicare Advantage,49.98,49,,percent of total billed charges,,
"Ot Exercise (Rom, Strength, Flex) (15 Min)",,97110,CPT,Facility,Inpatient,,,GO,102,86.7,29.2332,102,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Ot Exercise (Rom, Strength, Flex) (15 Min)",,97110,CPT,Facility,Both,,,GO,102,86.7,29.2332,102,Aetna,PPO,94.86,93,,percent of total billed charges,,
"Ot Exercise (Rom, Strength, Flex) (15 Min)",,97110,CPT,Facility,Both,,,GO,102,86.7,29.2332,102,America's PPO,America's PPO,97.9506,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Ot Exercise (Rom, Strength, Flex) (15 Min)",,97110,CPT,Facility,Both,,,GO,102,86.7,29.2332,102,BlueCross BlueShield Minnesota, Federal Employee Program,100.368,98.4,,percent of total billed charges,,
"Ot Exercise (Rom, Strength, Flex) (15 Min)",,97110,CPT,Facility,Both,,,GO,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,102,100,,percent of total billed charges,,
"Ot Exercise (Rom, Strength, Flex) (15 Min)",,97110,CPT,Facility,Both,,,GO,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,High Value Network Plan,91.8,90,,percent of total billed charges,,
"Ot Exercise (Rom, Strength, Flex) (15 Min)",,97110,CPT,Facility,Outpatient,,,GO,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,Medicare Advantage,49.98,49,,percent of total billed charges,,
"Ot Exercise (Rom, Strength, Flex) (15 Min)",,97110,CPT,Facility,Inpatient,,,GO,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Ot Exercise (Rom, Strength, Flex) (15 Min)",,97110,CPT,Facility,Both,,,GO,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,90.3414,88.57,,percent of total billed charges,,
"Ot Exercise (Rom, Strength, Flex) (15 Min)",,97110,CPT,Facility,Both,,,GO,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,29.2332,28.66,,percent of total billed charges,,
"Ot Exercise (Rom, Strength, Flex) (15 Min)",,97110,CPT,Facility,Outpatient,,,GO,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),49.98,49,,percent of total billed charges,,
"Ot Exercise (Rom, Strength, Flex) (15 Min)",,97110,CPT,Facility,Inpatient,,,GO,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Ot Exercise (Rom, Strength, Flex) (15 Min)",,97110,CPT,Facility,Both,,,GO,102,86.7,29.2332,102,CorVel,Worker's Compensation,102,100,,percent of total billed charges,,
"Ot Exercise (Rom, Strength, Flex) (15 Min)",,97110,CPT,Facility,Both,,,GO,102,86.7,29.2332,102,First Health Group Corporation,First Health Network,98.94,97,,percent of total billed charges,,
"Ot Exercise (Rom, Strength, Flex) (15 Min)",,97110,CPT,Facility,Both,,,GO,102,86.7,29.2332,102,"Health Partners, Inc.",Commercial,96.492,94.6,,percent of total billed charges,,
"Ot Exercise (Rom, Strength, Flex) (15 Min)",,97110,CPT,Facility,Outpatient,,,GO,102,86.7,29.2332,102,"Health Partners, Inc.",Medicare Advantage,49.98,49,,percent of total billed charges,,
"Ot Exercise (Rom, Strength, Flex) (15 Min)",,97110,CPT,Facility,Inpatient,,,GO,102,86.7,29.2332,102,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Ot Exercise (Rom, Strength, Flex) (15 Min)",,97110,CPT,Facility,Both,,,GO,102,86.7,29.2332,102,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),61.2,60,,percent of total billed charges,,
"Ot Exercise (Rom, Strength, Flex) (15 Min)",,97110,CPT,Facility,Both,,,GO,102,86.7,29.2332,102,"Health Partners, Inc.",State of Minnesota Advantage Program,83.13,81.5,,percent of total billed charges,,
"Ot Exercise (Rom, Strength, Flex) (15 Min)",,97110,CPT,Facility,Both,,,GO,102,86.7,29.2332,102,"Health Partners, Inc.",State Public Programs,51,50,,percent of total billed charges,,
"Ot Exercise (Rom, Strength, Flex) (15 Min)",,97110,CPT,Facility,Both,,,GO,102,86.7,29.2332,102,Humana Insurance Company,Commercial PPO,96.9,95,,percent of total billed charges,,
"Ot Exercise (Rom, Strength, Flex) (15 Min)",,97110,CPT,Facility,Outpatient,,,GO,102,86.7,29.2332,102,Humana Insurance Company,Medicare PPO,49.98,49,,percent of total billed charges,,
"Ot Exercise (Rom, Strength, Flex) (15 Min)",,97110,CPT,Facility,Inpatient,,,GO,102,86.7,29.2332,102,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Ot Exercise (Rom, Strength, Flex) (15 Min)",,97110,CPT,Facility,Both,,,GO,102,86.7,29.2332,102,Medica,Individual & Family,101.082,99.1,,percent of total billed charges,,
"Ot Exercise (Rom, Strength, Flex) (15 Min)",,97110,CPT,Facility,Outpatient,,,GO,102,86.7,29.2332,102,Medica,Medica Advantage Solution,50.796,49.8,,percent of total billed charges,,
"Ot Exercise (Rom, Strength, Flex) (15 Min)",,97110,CPT,Facility,Inpatient,,,GO,102,86.7,29.2332,102,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Ot Exercise (Rom, Strength, Flex) (15 Min)",,97110,CPT,Facility,Outpatient,,,GO,102,86.7,29.2332,102,Medica,Medical Assistance,45.492,44.6,,percent of total billed charges,,
"Ot Exercise (Rom, Strength, Flex) (15 Min)",,97110,CPT,Facility,Inpatient,,,GO,102,86.7,29.2332,102,Medica,Medical Assistance,,,,,Included in per diem rate,
"Ot Exercise (Rom, Strength, Flex) (15 Min)",,97110,CPT,Facility,Outpatient,,,GO,102,86.7,29.2332,102,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,50.796,49.8,,percent of total billed charges,,
"Ot Exercise (Rom, Strength, Flex) (15 Min)",,97110,CPT,Facility,Inpatient,,,GO,102,86.7,29.2332,102,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Ot Exercise (Rom, Strength, Flex) (15 Min)",,97110,CPT,Facility,Both,,,GO,102,86.7,29.2332,102,"Multiplan, Inc.","Multiplan, Inc.",95.88,94,,percent of total billed charges,,
"Ot Exercise (Rom, Strength, Flex) (15 Min)",,97110,CPT,Facility,Outpatient,,,GO,102,86.7,29.2332,102,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,88.128,86.4,,percent of total billed charges,,
"Ot Exercise (Rom, Strength, Flex) (15 Min)",,97110,CPT,Facility,Inpatient,,,GO,102,86.7,29.2332,102,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Ot Exercise (Rom, Strength, Flex) (15 Min)",,97110,CPT,Facility,Both,,,GO,102,86.7,29.2332,102,"Preferred One Administrative Services, INC.",PPO,100.572,98.6,,percent of total billed charges,,
"Ot Exercise (Rom, Strength, Flex) (15 Min)",,97110,CPT,Facility,Outpatient,,,GO,102,86.7,29.2332,102,PrimeWest Health,Minnesota Senior Health Options (MSHO),52.479,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Ot Exercise (Rom, Strength, Flex) (15 Min)",,97110,CPT,Facility,Inpatient,,,GO,102,86.7,29.2332,102,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Ot Exercise (Rom, Strength, Flex) (15 Min)",,97110,CPT,Facility,Outpatient,,,GO,102,86.7,29.2332,102,PrimeWest Health,MinnesotaCare,52.3872,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Ot Exercise (Rom, Strength, Flex) (15 Min)",,97110,CPT,Facility,Inpatient,,,GO,102,86.7,29.2332,102,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Ot Exercise (Rom, Strength, Flex) (15 Min)",,97110,CPT,Facility,Both,,,GO,102,86.7,29.2332,102,Sanford Health Plan,Sanford Health Plan,93.84,92,,percent of total billed charges,,
"Ot Exercise (Rom, Strength, Flex) (15 Min)",,97110,CPT,Facility,Outpatient,,,GO,102,86.7,29.2332,102,"UCare Health, Inc.",Individual & Family Plan,57.477,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Ot Exercise (Rom, Strength, Flex) (15 Min)",,97110,CPT,Facility,Inpatient,,,GO,102,86.7,29.2332,102,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Ot Exercise (Rom, Strength, Flex) (15 Min)",,97110,CPT,Facility,Outpatient,,,GO,102,86.7,29.2332,102,"UCare Health, Inc.",Medical Assistance,51.4794,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Ot Exercise (Rom, Strength, Flex) (15 Min)",,97110,CPT,Facility,Inpatient,,,GO,102,86.7,29.2332,102,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Ot Exercise (Rom, Strength, Flex) (15 Min)",,97110,CPT,Facility,Outpatient,,,GO,102,86.7,29.2332,102,"UCare Health, Inc.",Medicare Advantage,51.4794,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Ot Exercise (Rom, Strength, Flex) (15 Min)",,97110,CPT,Facility,Inpatient,,,GO,102,86.7,29.2332,102,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Ot Exercise (Rom, Strength, Flex) (15 Min)",,97110,CPT,Facility,Outpatient,,,GO,102,86.7,29.2332,102,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),51.4794,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Ot Exercise (Rom, Strength, Flex) (15 Min)",,97110,CPT,Facility,Inpatient,,,GO,102,86.7,29.2332,102,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Ot Exercise (Rom, Strength, Flex) (15 Min)",,97110,CPT,Facility,Both,,,GO,102,86.7,29.2332,102,UnitedHealthcare,Individual & Family,95.88,94,,percent of total billed charges,,
"Ot Exercise (Rom, Strength, Flex) (15 Min)",,97110,CPT,Facility,Outpatient,,,GO,102,86.7,29.2332,102,UnitedHealthcare,Medicare Advantage,49.98,49,,percent of total billed charges,,
"Ot Exercise (Rom, Strength, Flex) (15 Min)",,97110,CPT,Facility,Inpatient,,,GO,102,86.7,29.2332,102,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Ot Exercise (Rom, Strength, Flex) (15 Min)",,97110,CPT,Facility,Outpatient,,,GO,102,86.7,29.2332,102,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,48.96,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Ot Exercise (Rom, Strength, Flex) (15 Min)",,97110,CPT,Facility,Inpatient,,,GO,102,86.7,29.2332,102,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Ot Nmr Neuro Musc Re-Ed (Bal, Cor, Pos) (15 Min)",,97112,CPT,Facility,Both,,,GO,102,86.7,29.2332,102,Aetna,Commercial,93.84,92,,percent of total billed charges,,
"Ot Nmr Neuro Musc Re-Ed (Bal, Cor, Pos) (15 Min)",,97112,CPT,Facility,Outpatient,,,GO,102,86.7,29.2332,102,Aetna,Medicare Advantage,49.98,49,,percent of total billed charges,,
"Ot Nmr Neuro Musc Re-Ed (Bal, Cor, Pos) (15 Min)",,97112,CPT,Facility,Inpatient,,,GO,102,86.7,29.2332,102,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Ot Nmr Neuro Musc Re-Ed (Bal, Cor, Pos) (15 Min)",,97112,CPT,Facility,Both,,,GO,102,86.7,29.2332,102,Aetna,PPO,94.86,93,,percent of total billed charges,,
"Ot Nmr Neuro Musc Re-Ed (Bal, Cor, Pos) (15 Min)",,97112,CPT,Facility,Both,,,GO,102,86.7,29.2332,102,America's PPO,America's PPO,97.9506,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Ot Nmr Neuro Musc Re-Ed (Bal, Cor, Pos) (15 Min)",,97112,CPT,Facility,Both,,,GO,102,86.7,29.2332,102,BlueCross BlueShield Minnesota, Federal Employee Program,100.368,98.4,,percent of total billed charges,,
"Ot Nmr Neuro Musc Re-Ed (Bal, Cor, Pos) (15 Min)",,97112,CPT,Facility,Both,,,GO,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,102,100,,percent of total billed charges,,
"Ot Nmr Neuro Musc Re-Ed (Bal, Cor, Pos) (15 Min)",,97112,CPT,Facility,Both,,,GO,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,High Value Network Plan,91.8,90,,percent of total billed charges,,
"Ot Nmr Neuro Musc Re-Ed (Bal, Cor, Pos) (15 Min)",,97112,CPT,Facility,Outpatient,,,GO,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,Medicare Advantage,49.98,49,,percent of total billed charges,,
"Ot Nmr Neuro Musc Re-Ed (Bal, Cor, Pos) (15 Min)",,97112,CPT,Facility,Inpatient,,,GO,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Ot Nmr Neuro Musc Re-Ed (Bal, Cor, Pos) (15 Min)",,97112,CPT,Facility,Both,,,GO,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,90.3414,88.57,,percent of total billed charges,,
"Ot Nmr Neuro Musc Re-Ed (Bal, Cor, Pos) (15 Min)",,97112,CPT,Facility,Both,,,GO,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,29.2332,28.66,,percent of total billed charges,,
"Ot Nmr Neuro Musc Re-Ed (Bal, Cor, Pos) (15 Min)",,97112,CPT,Facility,Outpatient,,,GO,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),49.98,49,,percent of total billed charges,,
"Ot Nmr Neuro Musc Re-Ed (Bal, Cor, Pos) (15 Min)",,97112,CPT,Facility,Inpatient,,,GO,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Ot Nmr Neuro Musc Re-Ed (Bal, Cor, Pos) (15 Min)",,97112,CPT,Facility,Both,,,GO,102,86.7,29.2332,102,CorVel,Worker's Compensation,102,100,,percent of total billed charges,,
"Ot Nmr Neuro Musc Re-Ed (Bal, Cor, Pos) (15 Min)",,97112,CPT,Facility,Both,,,GO,102,86.7,29.2332,102,First Health Group Corporation,First Health Network,98.94,97,,percent of total billed charges,,
"Ot Nmr Neuro Musc Re-Ed (Bal, Cor, Pos) (15 Min)",,97112,CPT,Facility,Both,,,GO,102,86.7,29.2332,102,"Health Partners, Inc.",Commercial,96.492,94.6,,percent of total billed charges,,
"Ot Nmr Neuro Musc Re-Ed (Bal, Cor, Pos) (15 Min)",,97112,CPT,Facility,Outpatient,,,GO,102,86.7,29.2332,102,"Health Partners, Inc.",Medicare Advantage,49.98,49,,percent of total billed charges,,
"Ot Nmr Neuro Musc Re-Ed (Bal, Cor, Pos) (15 Min)",,97112,CPT,Facility,Inpatient,,,GO,102,86.7,29.2332,102,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Ot Nmr Neuro Musc Re-Ed (Bal, Cor, Pos) (15 Min)",,97112,CPT,Facility,Both,,,GO,102,86.7,29.2332,102,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),61.2,60,,percent of total billed charges,,
"Ot Nmr Neuro Musc Re-Ed (Bal, Cor, Pos) (15 Min)",,97112,CPT,Facility,Both,,,GO,102,86.7,29.2332,102,"Health Partners, Inc.",State of Minnesota Advantage Program,83.13,81.5,,percent of total billed charges,,
"Ot Nmr Neuro Musc Re-Ed (Bal, Cor, Pos) (15 Min)",,97112,CPT,Facility,Both,,,GO,102,86.7,29.2332,102,"Health Partners, Inc.",State Public Programs,51,50,,percent of total billed charges,,
"Ot Nmr Neuro Musc Re-Ed (Bal, Cor, Pos) (15 Min)",,97112,CPT,Facility,Both,,,GO,102,86.7,29.2332,102,Humana Insurance Company,Commercial PPO,96.9,95,,percent of total billed charges,,
"Ot Nmr Neuro Musc Re-Ed (Bal, Cor, Pos) (15 Min)",,97112,CPT,Facility,Outpatient,,,GO,102,86.7,29.2332,102,Humana Insurance Company,Medicare PPO,49.98,49,,percent of total billed charges,,
"Ot Nmr Neuro Musc Re-Ed (Bal, Cor, Pos) (15 Min)",,97112,CPT,Facility,Inpatient,,,GO,102,86.7,29.2332,102,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Ot Nmr Neuro Musc Re-Ed (Bal, Cor, Pos) (15 Min)",,97112,CPT,Facility,Both,,,GO,102,86.7,29.2332,102,Medica,Individual & Family,101.082,99.1,,percent of total billed charges,,
"Ot Nmr Neuro Musc Re-Ed (Bal, Cor, Pos) (15 Min)",,97112,CPT,Facility,Outpatient,,,GO,102,86.7,29.2332,102,Medica,Medica Advantage Solution,50.796,49.8,,percent of total billed charges,,
"Ot Nmr Neuro Musc Re-Ed (Bal, Cor, Pos) (15 Min)",,97112,CPT,Facility,Inpatient,,,GO,102,86.7,29.2332,102,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Ot Nmr Neuro Musc Re-Ed (Bal, Cor, Pos) (15 Min)",,97112,CPT,Facility,Outpatient,,,GO,102,86.7,29.2332,102,Medica,Medical Assistance,45.492,44.6,,percent of total billed charges,,
"Ot Nmr Neuro Musc Re-Ed (Bal, Cor, Pos) (15 Min)",,97112,CPT,Facility,Inpatient,,,GO,102,86.7,29.2332,102,Medica,Medical Assistance,,,,,Included in per diem rate,
"Ot Nmr Neuro Musc Re-Ed (Bal, Cor, Pos) (15 Min)",,97112,CPT,Facility,Outpatient,,,GO,102,86.7,29.2332,102,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,50.796,49.8,,percent of total billed charges,,
"Ot Nmr Neuro Musc Re-Ed (Bal, Cor, Pos) (15 Min)",,97112,CPT,Facility,Inpatient,,,GO,102,86.7,29.2332,102,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Ot Nmr Neuro Musc Re-Ed (Bal, Cor, Pos) (15 Min)",,97112,CPT,Facility,Both,,,GO,102,86.7,29.2332,102,"Multiplan, Inc.","Multiplan, Inc.",95.88,94,,percent of total billed charges,,
"Ot Nmr Neuro Musc Re-Ed (Bal, Cor, Pos) (15 Min)",,97112,CPT,Facility,Outpatient,,,GO,102,86.7,29.2332,102,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,88.128,86.4,,percent of total billed charges,,
"Ot Nmr Neuro Musc Re-Ed (Bal, Cor, Pos) (15 Min)",,97112,CPT,Facility,Inpatient,,,GO,102,86.7,29.2332,102,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Ot Nmr Neuro Musc Re-Ed (Bal, Cor, Pos) (15 Min)",,97112,CPT,Facility,Both,,,GO,102,86.7,29.2332,102,"Preferred One Administrative Services, INC.",PPO,100.572,98.6,,percent of total billed charges,,
"Ot Nmr Neuro Musc Re-Ed (Bal, Cor, Pos) (15 Min)",,97112,CPT,Facility,Outpatient,,,GO,102,86.7,29.2332,102,PrimeWest Health,Minnesota Senior Health Options (MSHO),52.479,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Ot Nmr Neuro Musc Re-Ed (Bal, Cor, Pos) (15 Min)",,97112,CPT,Facility,Inpatient,,,GO,102,86.7,29.2332,102,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Ot Nmr Neuro Musc Re-Ed (Bal, Cor, Pos) (15 Min)",,97112,CPT,Facility,Outpatient,,,GO,102,86.7,29.2332,102,PrimeWest Health,MinnesotaCare,52.3872,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Ot Nmr Neuro Musc Re-Ed (Bal, Cor, Pos) (15 Min)",,97112,CPT,Facility,Inpatient,,,GO,102,86.7,29.2332,102,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Ot Nmr Neuro Musc Re-Ed (Bal, Cor, Pos) (15 Min)",,97112,CPT,Facility,Both,,,GO,102,86.7,29.2332,102,Sanford Health Plan,Sanford Health Plan,93.84,92,,percent of total billed charges,,
"Ot Nmr Neuro Musc Re-Ed (Bal, Cor, Pos) (15 Min)",,97112,CPT,Facility,Outpatient,,,GO,102,86.7,29.2332,102,"UCare Health, Inc.",Individual & Family Plan,57.477,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Ot Nmr Neuro Musc Re-Ed (Bal, Cor, Pos) (15 Min)",,97112,CPT,Facility,Inpatient,,,GO,102,86.7,29.2332,102,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Ot Nmr Neuro Musc Re-Ed (Bal, Cor, Pos) (15 Min)",,97112,CPT,Facility,Outpatient,,,GO,102,86.7,29.2332,102,"UCare Health, Inc.",Medical Assistance,51.4794,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Ot Nmr Neuro Musc Re-Ed (Bal, Cor, Pos) (15 Min)",,97112,CPT,Facility,Inpatient,,,GO,102,86.7,29.2332,102,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Ot Nmr Neuro Musc Re-Ed (Bal, Cor, Pos) (15 Min)",,97112,CPT,Facility,Outpatient,,,GO,102,86.7,29.2332,102,"UCare Health, Inc.",Medicare Advantage,51.4794,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Ot Nmr Neuro Musc Re-Ed (Bal, Cor, Pos) (15 Min)",,97112,CPT,Facility,Inpatient,,,GO,102,86.7,29.2332,102,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Ot Nmr Neuro Musc Re-Ed (Bal, Cor, Pos) (15 Min)",,97112,CPT,Facility,Outpatient,,,GO,102,86.7,29.2332,102,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),51.4794,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Ot Nmr Neuro Musc Re-Ed (Bal, Cor, Pos) (15 Min)",,97112,CPT,Facility,Inpatient,,,GO,102,86.7,29.2332,102,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Ot Nmr Neuro Musc Re-Ed (Bal, Cor, Pos) (15 Min)",,97112,CPT,Facility,Both,,,GO,102,86.7,29.2332,102,UnitedHealthcare,Individual & Family,95.88,94,,percent of total billed charges,,
"Ot Nmr Neuro Musc Re-Ed (Bal, Cor, Pos) (15 Min)",,97112,CPT,Facility,Outpatient,,,GO,102,86.7,29.2332,102,UnitedHealthcare,Medicare Advantage,49.98,49,,percent of total billed charges,,
"Ot Nmr Neuro Musc Re-Ed (Bal, Cor, Pos) (15 Min)",,97112,CPT,Facility,Inpatient,,,GO,102,86.7,29.2332,102,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Ot Nmr Neuro Musc Re-Ed (Bal, Cor, Pos) (15 Min)",,97112,CPT,Facility,Outpatient,,,GO,102,86.7,29.2332,102,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,48.96,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Ot Nmr Neuro Musc Re-Ed (Bal, Cor, Pos) (15 Min)",,97112,CPT,Facility,Inpatient,,,GO,102,86.7,29.2332,102,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Ot Gait Training (15 Min),,97116,CPT,Facility,Both,,,GO,62,52.7,17.7692,62,Aetna,Commercial,57.04,92,,percent of total billed charges,,
Ot Gait Training (15 Min),,97116,CPT,Facility,Outpatient,,,GO,62,52.7,17.7692,62,Aetna,Medicare Advantage,30.38,49,,percent of total billed charges,,
Ot Gait Training (15 Min),,97116,CPT,Facility,Inpatient,,,GO,62,52.7,17.7692,62,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Ot Gait Training (15 Min),,97116,CPT,Facility,Both,,,GO,62,52.7,17.7692,62,Aetna,PPO,57.66,93,,percent of total billed charges,,
Ot Gait Training (15 Min),,97116,CPT,Facility,Both,,,GO,62,52.7,17.7692,62,America's PPO,America's PPO,59.5386,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Ot Gait Training (15 Min),,97116,CPT,Facility,Both,,,GO,62,52.7,17.7692,62,BlueCross BlueShield Minnesota, Federal Employee Program,61.008,98.4,,percent of total billed charges,,
Ot Gait Training (15 Min),,97116,CPT,Facility,Both,,,GO,62,52.7,17.7692,62,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,62,100,,percent of total billed charges,,
Ot Gait Training (15 Min),,97116,CPT,Facility,Both,,,GO,62,52.7,17.7692,62,BlueCross BlueShield Minnesota,High Value Network Plan,55.8,90,,percent of total billed charges,,
Ot Gait Training (15 Min),,97116,CPT,Facility,Outpatient,,,GO,62,52.7,17.7692,62,BlueCross BlueShield Minnesota,Medicare Advantage,30.38,49,,percent of total billed charges,,
Ot Gait Training (15 Min),,97116,CPT,Facility,Inpatient,,,GO,62,52.7,17.7692,62,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Ot Gait Training (15 Min),,97116,CPT,Facility,Both,,,GO,62,52.7,17.7692,62,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,54.9134,88.57,,percent of total billed charges,,
Ot Gait Training (15 Min),,97116,CPT,Facility,Both,,,GO,62,52.7,17.7692,62,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,17.7692,28.66,,percent of total billed charges,,
Ot Gait Training (15 Min),,97116,CPT,Facility,Outpatient,,,GO,62,52.7,17.7692,62,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),30.38,49,,percent of total billed charges,,
Ot Gait Training (15 Min),,97116,CPT,Facility,Inpatient,,,GO,62,52.7,17.7692,62,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Ot Gait Training (15 Min),,97116,CPT,Facility,Both,,,GO,62,52.7,17.7692,62,CorVel,Worker's Compensation,62,100,,percent of total billed charges,,
Ot Gait Training (15 Min),,97116,CPT,Facility,Both,,,GO,62,52.7,17.7692,62,First Health Group Corporation,First Health Network,60.14,97,,percent of total billed charges,,
Ot Gait Training (15 Min),,97116,CPT,Facility,Both,,,GO,62,52.7,17.7692,62,"Health Partners, Inc.",Commercial,58.652,94.6,,percent of total billed charges,,
Ot Gait Training (15 Min),,97116,CPT,Facility,Outpatient,,,GO,62,52.7,17.7692,62,"Health Partners, Inc.",Medicare Advantage,30.38,49,,percent of total billed charges,,
Ot Gait Training (15 Min),,97116,CPT,Facility,Inpatient,,,GO,62,52.7,17.7692,62,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ot Gait Training (15 Min),,97116,CPT,Facility,Both,,,GO,62,52.7,17.7692,62,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),37.2,60,,percent of total billed charges,,
Ot Gait Training (15 Min),,97116,CPT,Facility,Both,,,GO,62,52.7,17.7692,62,"Health Partners, Inc.",State of Minnesota Advantage Program,50.53,81.5,,percent of total billed charges,,
Ot Gait Training (15 Min),,97116,CPT,Facility,Both,,,GO,62,52.7,17.7692,62,"Health Partners, Inc.",State Public Programs,31,50,,percent of total billed charges,,
Ot Gait Training (15 Min),,97116,CPT,Facility,Both,,,GO,62,52.7,17.7692,62,Humana Insurance Company,Commercial PPO,58.9,95,,percent of total billed charges,,
Ot Gait Training (15 Min),,97116,CPT,Facility,Outpatient,,,GO,62,52.7,17.7692,62,Humana Insurance Company,Medicare PPO,30.38,49,,percent of total billed charges,,
Ot Gait Training (15 Min),,97116,CPT,Facility,Inpatient,,,GO,62,52.7,17.7692,62,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Ot Gait Training (15 Min),,97116,CPT,Facility,Both,,,GO,62,52.7,17.7692,62,Medica,Individual & Family,61.442,99.1,,percent of total billed charges,,
Ot Gait Training (15 Min),,97116,CPT,Facility,Outpatient,,,GO,62,52.7,17.7692,62,Medica,Medica Advantage Solution,30.876,49.8,,percent of total billed charges,,
Ot Gait Training (15 Min),,97116,CPT,Facility,Inpatient,,,GO,62,52.7,17.7692,62,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Ot Gait Training (15 Min),,97116,CPT,Facility,Outpatient,,,GO,62,52.7,17.7692,62,Medica,Medical Assistance,27.652,44.6,,percent of total billed charges,,
Ot Gait Training (15 Min),,97116,CPT,Facility,Inpatient,,,GO,62,52.7,17.7692,62,Medica,Medical Assistance,,,,,Included in per diem rate,
Ot Gait Training (15 Min),,97116,CPT,Facility,Outpatient,,,GO,62,52.7,17.7692,62,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,30.876,49.8,,percent of total billed charges,,
Ot Gait Training (15 Min),,97116,CPT,Facility,Inpatient,,,GO,62,52.7,17.7692,62,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Ot Gait Training (15 Min),,97116,CPT,Facility,Both,,,GO,62,52.7,17.7692,62,"Multiplan, Inc.","Multiplan, Inc.",58.28,94,,percent of total billed charges,,
Ot Gait Training (15 Min),,97116,CPT,Facility,Outpatient,,,GO,62,52.7,17.7692,62,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,53.568,86.4,,percent of total billed charges,,
Ot Gait Training (15 Min),,97116,CPT,Facility,Inpatient,,,GO,62,52.7,17.7692,62,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Ot Gait Training (15 Min),,97116,CPT,Facility,Both,,,GO,62,52.7,17.7692,62,"Preferred One Administrative Services, INC.",PPO,61.132,98.6,,percent of total billed charges,,
Ot Gait Training (15 Min),,97116,CPT,Facility,Outpatient,,,GO,62,52.7,17.7692,62,PrimeWest Health,Minnesota Senior Health Options (MSHO),31.899,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Ot Gait Training (15 Min),,97116,CPT,Facility,Inpatient,,,GO,62,52.7,17.7692,62,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ot Gait Training (15 Min),,97116,CPT,Facility,Outpatient,,,GO,62,52.7,17.7692,62,PrimeWest Health,MinnesotaCare,31.8432,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Ot Gait Training (15 Min),,97116,CPT,Facility,Inpatient,,,GO,62,52.7,17.7692,62,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Ot Gait Training (15 Min),,97116,CPT,Facility,Both,,,GO,62,52.7,17.7692,62,Sanford Health Plan,Sanford Health Plan,57.04,92,,percent of total billed charges,,
Ot Gait Training (15 Min),,97116,CPT,Facility,Outpatient,,,GO,62,52.7,17.7692,62,"UCare Health, Inc.",Individual & Family Plan,34.937,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Ot Gait Training (15 Min),,97116,CPT,Facility,Inpatient,,,GO,62,52.7,17.7692,62,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Ot Gait Training (15 Min),,97116,CPT,Facility,Outpatient,,,GO,62,52.7,17.7692,62,"UCare Health, Inc.",Medical Assistance,31.2914,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ot Gait Training (15 Min),,97116,CPT,Facility,Inpatient,,,GO,62,52.7,17.7692,62,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Ot Gait Training (15 Min),,97116,CPT,Facility,Outpatient,,,GO,62,52.7,17.7692,62,"UCare Health, Inc.",Medicare Advantage,31.2914,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ot Gait Training (15 Min),,97116,CPT,Facility,Inpatient,,,GO,62,52.7,17.7692,62,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ot Gait Training (15 Min),,97116,CPT,Facility,Outpatient,,,GO,62,52.7,17.7692,62,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),31.2914,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ot Gait Training (15 Min),,97116,CPT,Facility,Inpatient,,,GO,62,52.7,17.7692,62,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ot Gait Training (15 Min),,97116,CPT,Facility,Both,,,GO,62,52.7,17.7692,62,UnitedHealthcare,Individual & Family,58.28,94,,percent of total billed charges,,
Ot Gait Training (15 Min),,97116,CPT,Facility,Outpatient,,,GO,62,52.7,17.7692,62,UnitedHealthcare,Medicare Advantage,30.38,49,,percent of total billed charges,,
Ot Gait Training (15 Min),,97116,CPT,Facility,Inpatient,,,GO,62,52.7,17.7692,62,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Ot Gait Training (15 Min),,97116,CPT,Facility,Outpatient,,,GO,62,52.7,17.7692,62,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,29.76,48,,percent of total billed charges,,100% of DHS outpatient percentage
Ot Gait Training (15 Min),,97116,CPT,Facility,Inpatient,,,GO,62,52.7,17.7692,62,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Ot Massage (15 Min),,97124,CPT,Facility,Both,,,GO,69,58.65,19.7754,69,Aetna,Commercial,63.48,92,,percent of total billed charges,,
Ot Massage (15 Min),,97124,CPT,Facility,Outpatient,,,GO,69,58.65,19.7754,69,Aetna,Medicare Advantage,33.81,49,,percent of total billed charges,,
Ot Massage (15 Min),,97124,CPT,Facility,Inpatient,,,GO,69,58.65,19.7754,69,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Ot Massage (15 Min),,97124,CPT,Facility,Both,,,GO,69,58.65,19.7754,69,Aetna,PPO,64.17,93,,percent of total billed charges,,
Ot Massage (15 Min),,97124,CPT,Facility,Both,,,GO,69,58.65,19.7754,69,America's PPO,America's PPO,66.2607,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Ot Massage (15 Min),,97124,CPT,Facility,Both,,,GO,69,58.65,19.7754,69,BlueCross BlueShield Minnesota, Federal Employee Program,67.896,98.4,,percent of total billed charges,,
Ot Massage (15 Min),,97124,CPT,Facility,Both,,,GO,69,58.65,19.7754,69,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,69,100,,percent of total billed charges,,
Ot Massage (15 Min),,97124,CPT,Facility,Both,,,GO,69,58.65,19.7754,69,BlueCross BlueShield Minnesota,High Value Network Plan,62.1,90,,percent of total billed charges,,
Ot Massage (15 Min),,97124,CPT,Facility,Outpatient,,,GO,69,58.65,19.7754,69,BlueCross BlueShield Minnesota,Medicare Advantage,33.81,49,,percent of total billed charges,,
Ot Massage (15 Min),,97124,CPT,Facility,Inpatient,,,GO,69,58.65,19.7754,69,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Ot Massage (15 Min),,97124,CPT,Facility,Both,,,GO,69,58.65,19.7754,69,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,61.1133,88.57,,percent of total billed charges,,
Ot Massage (15 Min),,97124,CPT,Facility,Both,,,GO,69,58.65,19.7754,69,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,19.7754,28.66,,percent of total billed charges,,
Ot Massage (15 Min),,97124,CPT,Facility,Outpatient,,,GO,69,58.65,19.7754,69,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),33.81,49,,percent of total billed charges,,
Ot Massage (15 Min),,97124,CPT,Facility,Inpatient,,,GO,69,58.65,19.7754,69,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Ot Massage (15 Min),,97124,CPT,Facility,Both,,,GO,69,58.65,19.7754,69,CorVel,Worker's Compensation,69,100,,percent of total billed charges,,
Ot Massage (15 Min),,97124,CPT,Facility,Both,,,GO,69,58.65,19.7754,69,First Health Group Corporation,First Health Network,66.93,97,,percent of total billed charges,,
Ot Massage (15 Min),,97124,CPT,Facility,Both,,,GO,69,58.65,19.7754,69,"Health Partners, Inc.",Commercial,65.274,94.6,,percent of total billed charges,,
Ot Massage (15 Min),,97124,CPT,Facility,Outpatient,,,GO,69,58.65,19.7754,69,"Health Partners, Inc.",Medicare Advantage,33.81,49,,percent of total billed charges,,
Ot Massage (15 Min),,97124,CPT,Facility,Inpatient,,,GO,69,58.65,19.7754,69,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ot Massage (15 Min),,97124,CPT,Facility,Both,,,GO,69,58.65,19.7754,69,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),41.4,60,,percent of total billed charges,,
Ot Massage (15 Min),,97124,CPT,Facility,Both,,,GO,69,58.65,19.7754,69,"Health Partners, Inc.",State of Minnesota Advantage Program,56.235,81.5,,percent of total billed charges,,
Ot Massage (15 Min),,97124,CPT,Facility,Both,,,GO,69,58.65,19.7754,69,"Health Partners, Inc.",State Public Programs,34.5,50,,percent of total billed charges,,
Ot Massage (15 Min),,97124,CPT,Facility,Both,,,GO,69,58.65,19.7754,69,Humana Insurance Company,Commercial PPO,65.55,95,,percent of total billed charges,,
Ot Massage (15 Min),,97124,CPT,Facility,Outpatient,,,GO,69,58.65,19.7754,69,Humana Insurance Company,Medicare PPO,33.81,49,,percent of total billed charges,,
Ot Massage (15 Min),,97124,CPT,Facility,Inpatient,,,GO,69,58.65,19.7754,69,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Ot Massage (15 Min),,97124,CPT,Facility,Both,,,GO,69,58.65,19.7754,69,Medica,Individual & Family,68.379,99.1,,percent of total billed charges,,
Ot Massage (15 Min),,97124,CPT,Facility,Outpatient,,,GO,69,58.65,19.7754,69,Medica,Medica Advantage Solution,34.362,49.8,,percent of total billed charges,,
Ot Massage (15 Min),,97124,CPT,Facility,Inpatient,,,GO,69,58.65,19.7754,69,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Ot Massage (15 Min),,97124,CPT,Facility,Outpatient,,,GO,69,58.65,19.7754,69,Medica,Medical Assistance,30.774,44.6,,percent of total billed charges,,
Ot Massage (15 Min),,97124,CPT,Facility,Inpatient,,,GO,69,58.65,19.7754,69,Medica,Medical Assistance,,,,,Included in per diem rate,
Ot Massage (15 Min),,97124,CPT,Facility,Outpatient,,,GO,69,58.65,19.7754,69,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,34.362,49.8,,percent of total billed charges,,
Ot Massage (15 Min),,97124,CPT,Facility,Inpatient,,,GO,69,58.65,19.7754,69,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Ot Massage (15 Min),,97124,CPT,Facility,Both,,,GO,69,58.65,19.7754,69,"Multiplan, Inc.","Multiplan, Inc.",64.86,94,,percent of total billed charges,,
Ot Massage (15 Min),,97124,CPT,Facility,Outpatient,,,GO,69,58.65,19.7754,69,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,59.616,86.4,,percent of total billed charges,,
Ot Massage (15 Min),,97124,CPT,Facility,Inpatient,,,GO,69,58.65,19.7754,69,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Ot Massage (15 Min),,97124,CPT,Facility,Both,,,GO,69,58.65,19.7754,69,"Preferred One Administrative Services, INC.",PPO,68.034,98.6,,percent of total billed charges,,
Ot Massage (15 Min),,97124,CPT,Facility,Outpatient,,,GO,69,58.65,19.7754,69,PrimeWest Health,Minnesota Senior Health Options (MSHO),35.5005,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Ot Massage (15 Min),,97124,CPT,Facility,Inpatient,,,GO,69,58.65,19.7754,69,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ot Massage (15 Min),,97124,CPT,Facility,Outpatient,,,GO,69,58.65,19.7754,69,PrimeWest Health,MinnesotaCare,35.4384,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Ot Massage (15 Min),,97124,CPT,Facility,Inpatient,,,GO,69,58.65,19.7754,69,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Ot Massage (15 Min),,97124,CPT,Facility,Both,,,GO,69,58.65,19.7754,69,Sanford Health Plan,Sanford Health Plan,63.48,92,,percent of total billed charges,,
Ot Massage (15 Min),,97124,CPT,Facility,Outpatient,,,GO,69,58.65,19.7754,69,"UCare Health, Inc.",Individual & Family Plan,38.8815,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Ot Massage (15 Min),,97124,CPT,Facility,Inpatient,,,GO,69,58.65,19.7754,69,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Ot Massage (15 Min),,97124,CPT,Facility,Outpatient,,,GO,69,58.65,19.7754,69,"UCare Health, Inc.",Medical Assistance,34.8243,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ot Massage (15 Min),,97124,CPT,Facility,Inpatient,,,GO,69,58.65,19.7754,69,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Ot Massage (15 Min),,97124,CPT,Facility,Outpatient,,,GO,69,58.65,19.7754,69,"UCare Health, Inc.",Medicare Advantage,34.8243,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ot Massage (15 Min),,97124,CPT,Facility,Inpatient,,,GO,69,58.65,19.7754,69,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ot Massage (15 Min),,97124,CPT,Facility,Outpatient,,,GO,69,58.65,19.7754,69,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),34.8243,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ot Massage (15 Min),,97124,CPT,Facility,Inpatient,,,GO,69,58.65,19.7754,69,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ot Massage (15 Min),,97124,CPT,Facility,Both,,,GO,69,58.65,19.7754,69,UnitedHealthcare,Individual & Family,64.86,94,,percent of total billed charges,,
Ot Massage (15 Min),,97124,CPT,Facility,Outpatient,,,GO,69,58.65,19.7754,69,UnitedHealthcare,Medicare Advantage,33.81,49,,percent of total billed charges,,
Ot Massage (15 Min),,97124,CPT,Facility,Inpatient,,,GO,69,58.65,19.7754,69,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Ot Massage (15 Min),,97124,CPT,Facility,Outpatient,,,GO,69,58.65,19.7754,69,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,33.12,48,,percent of total billed charges,,100% of DHS outpatient percentage
Ot Massage (15 Min),,97124,CPT,Facility,Inpatient,,,GO,69,58.65,19.7754,69,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Ot Cognitive Function Intervention (Initial 15 Min),,97129,CPT,Facility,Both,,,GO,77,65.45,22.0682,77,Aetna,Commercial,70.84,92,,percent of total billed charges,,
Ot Cognitive Function Intervention (Initial 15 Min),,97129,CPT,Facility,Outpatient,,,GO,77,65.45,22.0682,77,Aetna,Medicare Advantage,37.73,49,,percent of total billed charges,,
Ot Cognitive Function Intervention (Initial 15 Min),,97129,CPT,Facility,Inpatient,,,GO,77,65.45,22.0682,77,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Ot Cognitive Function Intervention (Initial 15 Min),,97129,CPT,Facility,Both,,,GO,77,65.45,22.0682,77,Aetna,PPO,71.61,93,,percent of total billed charges,,
Ot Cognitive Function Intervention (Initial 15 Min),,97129,CPT,Facility,Both,,,GO,77,65.45,22.0682,77,America's PPO,America's PPO,73.9431,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Ot Cognitive Function Intervention (Initial 15 Min),,97129,CPT,Facility,Both,,,GO,77,65.45,22.0682,77,BlueCross BlueShield Minnesota, Federal Employee Program,75.768,98.4,,percent of total billed charges,,
Ot Cognitive Function Intervention (Initial 15 Min),,97129,CPT,Facility,Both,,,GO,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,77,100,,percent of total billed charges,,
Ot Cognitive Function Intervention (Initial 15 Min),,97129,CPT,Facility,Both,,,GO,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,High Value Network Plan,69.3,90,,percent of total billed charges,,
Ot Cognitive Function Intervention (Initial 15 Min),,97129,CPT,Facility,Outpatient,,,GO,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,Medicare Advantage,37.73,49,,percent of total billed charges,,
Ot Cognitive Function Intervention (Initial 15 Min),,97129,CPT,Facility,Inpatient,,,GO,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Ot Cognitive Function Intervention (Initial 15 Min),,97129,CPT,Facility,Both,,,GO,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,68.1989,88.57,,percent of total billed charges,,
Ot Cognitive Function Intervention (Initial 15 Min),,97129,CPT,Facility,Both,,,GO,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,22.0682,28.66,,percent of total billed charges,,
Ot Cognitive Function Intervention (Initial 15 Min),,97129,CPT,Facility,Outpatient,,,GO,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),37.73,49,,percent of total billed charges,,
Ot Cognitive Function Intervention (Initial 15 Min),,97129,CPT,Facility,Inpatient,,,GO,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Ot Cognitive Function Intervention (Initial 15 Min),,97129,CPT,Facility,Both,,,GO,77,65.45,22.0682,77,CorVel,Worker's Compensation,77,100,,percent of total billed charges,,
Ot Cognitive Function Intervention (Initial 15 Min),,97129,CPT,Facility,Both,,,GO,77,65.45,22.0682,77,First Health Group Corporation,First Health Network,74.69,97,,percent of total billed charges,,
Ot Cognitive Function Intervention (Initial 15 Min),,97129,CPT,Facility,Both,,,GO,77,65.45,22.0682,77,"Health Partners, Inc.",Commercial,72.842,94.6,,percent of total billed charges,,
Ot Cognitive Function Intervention (Initial 15 Min),,97129,CPT,Facility,Outpatient,,,GO,77,65.45,22.0682,77,"Health Partners, Inc.",Medicare Advantage,37.73,49,,percent of total billed charges,,
Ot Cognitive Function Intervention (Initial 15 Min),,97129,CPT,Facility,Inpatient,,,GO,77,65.45,22.0682,77,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ot Cognitive Function Intervention (Initial 15 Min),,97129,CPT,Facility,Both,,,GO,77,65.45,22.0682,77,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),46.2,60,,percent of total billed charges,,
Ot Cognitive Function Intervention (Initial 15 Min),,97129,CPT,Facility,Both,,,GO,77,65.45,22.0682,77,"Health Partners, Inc.",State of Minnesota Advantage Program,62.755,81.5,,percent of total billed charges,,
Ot Cognitive Function Intervention (Initial 15 Min),,97129,CPT,Facility,Both,,,GO,77,65.45,22.0682,77,"Health Partners, Inc.",State Public Programs,38.5,50,,percent of total billed charges,,
Ot Cognitive Function Intervention (Initial 15 Min),,97129,CPT,Facility,Both,,,GO,77,65.45,22.0682,77,Humana Insurance Company,Commercial PPO,73.15,95,,percent of total billed charges,,
Ot Cognitive Function Intervention (Initial 15 Min),,97129,CPT,Facility,Outpatient,,,GO,77,65.45,22.0682,77,Humana Insurance Company,Medicare PPO,37.73,49,,percent of total billed charges,,
Ot Cognitive Function Intervention (Initial 15 Min),,97129,CPT,Facility,Inpatient,,,GO,77,65.45,22.0682,77,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Ot Cognitive Function Intervention (Initial 15 Min),,97129,CPT,Facility,Both,,,GO,77,65.45,22.0682,77,Medica,Individual & Family,76.307,99.1,,percent of total billed charges,,
Ot Cognitive Function Intervention (Initial 15 Min),,97129,CPT,Facility,Outpatient,,,GO,77,65.45,22.0682,77,Medica,Medica Advantage Solution,38.346,49.8,,percent of total billed charges,,
Ot Cognitive Function Intervention (Initial 15 Min),,97129,CPT,Facility,Inpatient,,,GO,77,65.45,22.0682,77,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Ot Cognitive Function Intervention (Initial 15 Min),,97129,CPT,Facility,Outpatient,,,GO,77,65.45,22.0682,77,Medica,Medical Assistance,34.342,44.6,,percent of total billed charges,,
Ot Cognitive Function Intervention (Initial 15 Min),,97129,CPT,Facility,Inpatient,,,GO,77,65.45,22.0682,77,Medica,Medical Assistance,,,,,Included in per diem rate,
Ot Cognitive Function Intervention (Initial 15 Min),,97129,CPT,Facility,Outpatient,,,GO,77,65.45,22.0682,77,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,38.346,49.8,,percent of total billed charges,,
Ot Cognitive Function Intervention (Initial 15 Min),,97129,CPT,Facility,Inpatient,,,GO,77,65.45,22.0682,77,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Ot Cognitive Function Intervention (Initial 15 Min),,97129,CPT,Facility,Both,,,GO,77,65.45,22.0682,77,"Multiplan, Inc.","Multiplan, Inc.",72.38,94,,percent of total billed charges,,
Ot Cognitive Function Intervention (Initial 15 Min),,97129,CPT,Facility,Outpatient,,,GO,77,65.45,22.0682,77,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,66.528,86.4,,percent of total billed charges,,
Ot Cognitive Function Intervention (Initial 15 Min),,97129,CPT,Facility,Inpatient,,,GO,77,65.45,22.0682,77,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Ot Cognitive Function Intervention (Initial 15 Min),,97129,CPT,Facility,Both,,,GO,77,65.45,22.0682,77,"Preferred One Administrative Services, INC.",PPO,75.922,98.6,,percent of total billed charges,,
Ot Cognitive Function Intervention (Initial 15 Min),,97129,CPT,Facility,Outpatient,,,GO,77,65.45,22.0682,77,PrimeWest Health,Minnesota Senior Health Options (MSHO),39.6165,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Ot Cognitive Function Intervention (Initial 15 Min),,97129,CPT,Facility,Inpatient,,,GO,77,65.45,22.0682,77,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ot Cognitive Function Intervention (Initial 15 Min),,97129,CPT,Facility,Outpatient,,,GO,77,65.45,22.0682,77,PrimeWest Health,MinnesotaCare,39.5472,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Ot Cognitive Function Intervention (Initial 15 Min),,97129,CPT,Facility,Inpatient,,,GO,77,65.45,22.0682,77,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Ot Cognitive Function Intervention (Initial 15 Min),,97129,CPT,Facility,Both,,,GO,77,65.45,22.0682,77,Sanford Health Plan,Sanford Health Plan,70.84,92,,percent of total billed charges,,
Ot Cognitive Function Intervention (Initial 15 Min),,97129,CPT,Facility,Outpatient,,,GO,77,65.45,22.0682,77,"UCare Health, Inc.",Individual & Family Plan,43.3895,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Ot Cognitive Function Intervention (Initial 15 Min),,97129,CPT,Facility,Inpatient,,,GO,77,65.45,22.0682,77,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Ot Cognitive Function Intervention (Initial 15 Min),,97129,CPT,Facility,Outpatient,,,GO,77,65.45,22.0682,77,"UCare Health, Inc.",Medical Assistance,38.8619,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ot Cognitive Function Intervention (Initial 15 Min),,97129,CPT,Facility,Inpatient,,,GO,77,65.45,22.0682,77,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Ot Cognitive Function Intervention (Initial 15 Min),,97129,CPT,Facility,Outpatient,,,GO,77,65.45,22.0682,77,"UCare Health, Inc.",Medicare Advantage,38.8619,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ot Cognitive Function Intervention (Initial 15 Min),,97129,CPT,Facility,Inpatient,,,GO,77,65.45,22.0682,77,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ot Cognitive Function Intervention (Initial 15 Min),,97129,CPT,Facility,Outpatient,,,GO,77,65.45,22.0682,77,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),38.8619,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ot Cognitive Function Intervention (Initial 15 Min),,97129,CPT,Facility,Inpatient,,,GO,77,65.45,22.0682,77,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ot Cognitive Function Intervention (Initial 15 Min),,97129,CPT,Facility,Both,,,GO,77,65.45,22.0682,77,UnitedHealthcare,Individual & Family,72.38,94,,percent of total billed charges,,
Ot Cognitive Function Intervention (Initial 15 Min),,97129,CPT,Facility,Outpatient,,,GO,77,65.45,22.0682,77,UnitedHealthcare,Medicare Advantage,37.73,49,,percent of total billed charges,,
Ot Cognitive Function Intervention (Initial 15 Min),,97129,CPT,Facility,Inpatient,,,GO,77,65.45,22.0682,77,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Ot Cognitive Function Intervention (Initial 15 Min),,97129,CPT,Facility,Outpatient,,,GO,77,65.45,22.0682,77,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,36.96,48,,percent of total billed charges,,100% of DHS outpatient percentage
Ot Cognitive Function Intervention (Initial 15 Min),,97129,CPT,Facility,Inpatient,,,GO,77,65.45,22.0682,77,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Ot Cognitive Function Intervention (Each Subsequent 15 Min),,97130,CPT,Facility,Both,,,GO,77,65.45,22.0682,77,Aetna,Commercial,70.84,92,,percent of total billed charges,,
Ot Cognitive Function Intervention (Each Subsequent 15 Min),,97130,CPT,Facility,Outpatient,,,GO,77,65.45,22.0682,77,Aetna,Medicare Advantage,37.73,49,,percent of total billed charges,,
Ot Cognitive Function Intervention (Each Subsequent 15 Min),,97130,CPT,Facility,Inpatient,,,GO,77,65.45,22.0682,77,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Ot Cognitive Function Intervention (Each Subsequent 15 Min),,97130,CPT,Facility,Both,,,GO,77,65.45,22.0682,77,Aetna,PPO,71.61,93,,percent of total billed charges,,
Ot Cognitive Function Intervention (Each Subsequent 15 Min),,97130,CPT,Facility,Both,,,GO,77,65.45,22.0682,77,America's PPO,America's PPO,73.9431,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Ot Cognitive Function Intervention (Each Subsequent 15 Min),,97130,CPT,Facility,Both,,,GO,77,65.45,22.0682,77,BlueCross BlueShield Minnesota, Federal Employee Program,75.768,98.4,,percent of total billed charges,,
Ot Cognitive Function Intervention (Each Subsequent 15 Min),,97130,CPT,Facility,Both,,,GO,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,77,100,,percent of total billed charges,,
Ot Cognitive Function Intervention (Each Subsequent 15 Min),,97130,CPT,Facility,Both,,,GO,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,High Value Network Plan,69.3,90,,percent of total billed charges,,
Ot Cognitive Function Intervention (Each Subsequent 15 Min),,97130,CPT,Facility,Outpatient,,,GO,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,Medicare Advantage,37.73,49,,percent of total billed charges,,
Ot Cognitive Function Intervention (Each Subsequent 15 Min),,97130,CPT,Facility,Inpatient,,,GO,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Ot Cognitive Function Intervention (Each Subsequent 15 Min),,97130,CPT,Facility,Both,,,GO,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,68.1989,88.57,,percent of total billed charges,,
Ot Cognitive Function Intervention (Each Subsequent 15 Min),,97130,CPT,Facility,Both,,,GO,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,22.0682,28.66,,percent of total billed charges,,
Ot Cognitive Function Intervention (Each Subsequent 15 Min),,97130,CPT,Facility,Outpatient,,,GO,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),37.73,49,,percent of total billed charges,,
Ot Cognitive Function Intervention (Each Subsequent 15 Min),,97130,CPT,Facility,Inpatient,,,GO,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Ot Cognitive Function Intervention (Each Subsequent 15 Min),,97130,CPT,Facility,Both,,,GO,77,65.45,22.0682,77,CorVel,Worker's Compensation,77,100,,percent of total billed charges,,
Ot Cognitive Function Intervention (Each Subsequent 15 Min),,97130,CPT,Facility,Both,,,GO,77,65.45,22.0682,77,First Health Group Corporation,First Health Network,74.69,97,,percent of total billed charges,,
Ot Cognitive Function Intervention (Each Subsequent 15 Min),,97130,CPT,Facility,Both,,,GO,77,65.45,22.0682,77,"Health Partners, Inc.",Commercial,72.842,94.6,,percent of total billed charges,,
Ot Cognitive Function Intervention (Each Subsequent 15 Min),,97130,CPT,Facility,Outpatient,,,GO,77,65.45,22.0682,77,"Health Partners, Inc.",Medicare Advantage,37.73,49,,percent of total billed charges,,
Ot Cognitive Function Intervention (Each Subsequent 15 Min),,97130,CPT,Facility,Inpatient,,,GO,77,65.45,22.0682,77,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ot Cognitive Function Intervention (Each Subsequent 15 Min),,97130,CPT,Facility,Both,,,GO,77,65.45,22.0682,77,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),46.2,60,,percent of total billed charges,,
Ot Cognitive Function Intervention (Each Subsequent 15 Min),,97130,CPT,Facility,Both,,,GO,77,65.45,22.0682,77,"Health Partners, Inc.",State of Minnesota Advantage Program,62.755,81.5,,percent of total billed charges,,
Ot Cognitive Function Intervention (Each Subsequent 15 Min),,97130,CPT,Facility,Both,,,GO,77,65.45,22.0682,77,"Health Partners, Inc.",State Public Programs,38.5,50,,percent of total billed charges,,
Ot Cognitive Function Intervention (Each Subsequent 15 Min),,97130,CPT,Facility,Both,,,GO,77,65.45,22.0682,77,Humana Insurance Company,Commercial PPO,73.15,95,,percent of total billed charges,,
Ot Cognitive Function Intervention (Each Subsequent 15 Min),,97130,CPT,Facility,Outpatient,,,GO,77,65.45,22.0682,77,Humana Insurance Company,Medicare PPO,37.73,49,,percent of total billed charges,,
Ot Cognitive Function Intervention (Each Subsequent 15 Min),,97130,CPT,Facility,Inpatient,,,GO,77,65.45,22.0682,77,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Ot Cognitive Function Intervention (Each Subsequent 15 Min),,97130,CPT,Facility,Both,,,GO,77,65.45,22.0682,77,Medica,Individual & Family,76.307,99.1,,percent of total billed charges,,
Ot Cognitive Function Intervention (Each Subsequent 15 Min),,97130,CPT,Facility,Outpatient,,,GO,77,65.45,22.0682,77,Medica,Medica Advantage Solution,38.346,49.8,,percent of total billed charges,,
Ot Cognitive Function Intervention (Each Subsequent 15 Min),,97130,CPT,Facility,Inpatient,,,GO,77,65.45,22.0682,77,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Ot Cognitive Function Intervention (Each Subsequent 15 Min),,97130,CPT,Facility,Outpatient,,,GO,77,65.45,22.0682,77,Medica,Medical Assistance,34.342,44.6,,percent of total billed charges,,
Ot Cognitive Function Intervention (Each Subsequent 15 Min),,97130,CPT,Facility,Inpatient,,,GO,77,65.45,22.0682,77,Medica,Medical Assistance,,,,,Included in per diem rate,
Ot Cognitive Function Intervention (Each Subsequent 15 Min),,97130,CPT,Facility,Outpatient,,,GO,77,65.45,22.0682,77,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,38.346,49.8,,percent of total billed charges,,
Ot Cognitive Function Intervention (Each Subsequent 15 Min),,97130,CPT,Facility,Inpatient,,,GO,77,65.45,22.0682,77,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Ot Cognitive Function Intervention (Each Subsequent 15 Min),,97130,CPT,Facility,Both,,,GO,77,65.45,22.0682,77,"Multiplan, Inc.","Multiplan, Inc.",72.38,94,,percent of total billed charges,,
Ot Cognitive Function Intervention (Each Subsequent 15 Min),,97130,CPT,Facility,Outpatient,,,GO,77,65.45,22.0682,77,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,66.528,86.4,,percent of total billed charges,,
Ot Cognitive Function Intervention (Each Subsequent 15 Min),,97130,CPT,Facility,Inpatient,,,GO,77,65.45,22.0682,77,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Ot Cognitive Function Intervention (Each Subsequent 15 Min),,97130,CPT,Facility,Both,,,GO,77,65.45,22.0682,77,"Preferred One Administrative Services, INC.",PPO,75.922,98.6,,percent of total billed charges,,
Ot Cognitive Function Intervention (Each Subsequent 15 Min),,97130,CPT,Facility,Outpatient,,,GO,77,65.45,22.0682,77,PrimeWest Health,Minnesota Senior Health Options (MSHO),39.6165,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Ot Cognitive Function Intervention (Each Subsequent 15 Min),,97130,CPT,Facility,Inpatient,,,GO,77,65.45,22.0682,77,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ot Cognitive Function Intervention (Each Subsequent 15 Min),,97130,CPT,Facility,Outpatient,,,GO,77,65.45,22.0682,77,PrimeWest Health,MinnesotaCare,39.5472,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Ot Cognitive Function Intervention (Each Subsequent 15 Min),,97130,CPT,Facility,Inpatient,,,GO,77,65.45,22.0682,77,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Ot Cognitive Function Intervention (Each Subsequent 15 Min),,97130,CPT,Facility,Both,,,GO,77,65.45,22.0682,77,Sanford Health Plan,Sanford Health Plan,70.84,92,,percent of total billed charges,,
Ot Cognitive Function Intervention (Each Subsequent 15 Min),,97130,CPT,Facility,Outpatient,,,GO,77,65.45,22.0682,77,"UCare Health, Inc.",Individual & Family Plan,43.3895,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Ot Cognitive Function Intervention (Each Subsequent 15 Min),,97130,CPT,Facility,Inpatient,,,GO,77,65.45,22.0682,77,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Ot Cognitive Function Intervention (Each Subsequent 15 Min),,97130,CPT,Facility,Outpatient,,,GO,77,65.45,22.0682,77,"UCare Health, Inc.",Medical Assistance,38.8619,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ot Cognitive Function Intervention (Each Subsequent 15 Min),,97130,CPT,Facility,Inpatient,,,GO,77,65.45,22.0682,77,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Ot Cognitive Function Intervention (Each Subsequent 15 Min),,97130,CPT,Facility,Outpatient,,,GO,77,65.45,22.0682,77,"UCare Health, Inc.",Medicare Advantage,38.8619,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ot Cognitive Function Intervention (Each Subsequent 15 Min),,97130,CPT,Facility,Inpatient,,,GO,77,65.45,22.0682,77,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ot Cognitive Function Intervention (Each Subsequent 15 Min),,97130,CPT,Facility,Outpatient,,,GO,77,65.45,22.0682,77,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),38.8619,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ot Cognitive Function Intervention (Each Subsequent 15 Min),,97130,CPT,Facility,Inpatient,,,GO,77,65.45,22.0682,77,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ot Cognitive Function Intervention (Each Subsequent 15 Min),,97130,CPT,Facility,Both,,,GO,77,65.45,22.0682,77,UnitedHealthcare,Individual & Family,72.38,94,,percent of total billed charges,,
Ot Cognitive Function Intervention (Each Subsequent 15 Min),,97130,CPT,Facility,Outpatient,,,GO,77,65.45,22.0682,77,UnitedHealthcare,Medicare Advantage,37.73,49,,percent of total billed charges,,
Ot Cognitive Function Intervention (Each Subsequent 15 Min),,97130,CPT,Facility,Inpatient,,,GO,77,65.45,22.0682,77,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Ot Cognitive Function Intervention (Each Subsequent 15 Min),,97130,CPT,Facility,Outpatient,,,GO,77,65.45,22.0682,77,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,36.96,48,,percent of total billed charges,,100% of DHS outpatient percentage
Ot Cognitive Function Intervention (Each Subsequent 15 Min),,97130,CPT,Facility,Inpatient,,,GO,77,65.45,22.0682,77,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Ot Manual Therapy (15 Min),,97140,CPT,Facility,Both,,,GO,102,86.7,29.2332,102,Aetna,Commercial,93.84,92,,percent of total billed charges,,
Ot Manual Therapy (15 Min),,97140,CPT,Facility,Outpatient,,,GO,102,86.7,29.2332,102,Aetna,Medicare Advantage,49.98,49,,percent of total billed charges,,
Ot Manual Therapy (15 Min),,97140,CPT,Facility,Inpatient,,,GO,102,86.7,29.2332,102,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Ot Manual Therapy (15 Min),,97140,CPT,Facility,Both,,,GO,102,86.7,29.2332,102,Aetna,PPO,94.86,93,,percent of total billed charges,,
Ot Manual Therapy (15 Min),,97140,CPT,Facility,Both,,,GO,102,86.7,29.2332,102,America's PPO,America's PPO,97.9506,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Ot Manual Therapy (15 Min),,97140,CPT,Facility,Both,,,GO,102,86.7,29.2332,102,BlueCross BlueShield Minnesota, Federal Employee Program,100.368,98.4,,percent of total billed charges,,
Ot Manual Therapy (15 Min),,97140,CPT,Facility,Both,,,GO,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,102,100,,percent of total billed charges,,
Ot Manual Therapy (15 Min),,97140,CPT,Facility,Both,,,GO,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,High Value Network Plan,91.8,90,,percent of total billed charges,,
Ot Manual Therapy (15 Min),,97140,CPT,Facility,Outpatient,,,GO,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,Medicare Advantage,49.98,49,,percent of total billed charges,,
Ot Manual Therapy (15 Min),,97140,CPT,Facility,Inpatient,,,GO,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Ot Manual Therapy (15 Min),,97140,CPT,Facility,Both,,,GO,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,90.3414,88.57,,percent of total billed charges,,
Ot Manual Therapy (15 Min),,97140,CPT,Facility,Both,,,GO,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,29.2332,28.66,,percent of total billed charges,,
Ot Manual Therapy (15 Min),,97140,CPT,Facility,Outpatient,,,GO,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),49.98,49,,percent of total billed charges,,
Ot Manual Therapy (15 Min),,97140,CPT,Facility,Inpatient,,,GO,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Ot Manual Therapy (15 Min),,97140,CPT,Facility,Both,,,GO,102,86.7,29.2332,102,CorVel,Worker's Compensation,102,100,,percent of total billed charges,,
Ot Manual Therapy (15 Min),,97140,CPT,Facility,Both,,,GO,102,86.7,29.2332,102,First Health Group Corporation,First Health Network,98.94,97,,percent of total billed charges,,
Ot Manual Therapy (15 Min),,97140,CPT,Facility,Both,,,GO,102,86.7,29.2332,102,"Health Partners, Inc.",Commercial,96.492,94.6,,percent of total billed charges,,
Ot Manual Therapy (15 Min),,97140,CPT,Facility,Outpatient,,,GO,102,86.7,29.2332,102,"Health Partners, Inc.",Medicare Advantage,49.98,49,,percent of total billed charges,,
Ot Manual Therapy (15 Min),,97140,CPT,Facility,Inpatient,,,GO,102,86.7,29.2332,102,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ot Manual Therapy (15 Min),,97140,CPT,Facility,Both,,,GO,102,86.7,29.2332,102,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),61.2,60,,percent of total billed charges,,
Ot Manual Therapy (15 Min),,97140,CPT,Facility,Both,,,GO,102,86.7,29.2332,102,"Health Partners, Inc.",State of Minnesota Advantage Program,83.13,81.5,,percent of total billed charges,,
Ot Manual Therapy (15 Min),,97140,CPT,Facility,Both,,,GO,102,86.7,29.2332,102,"Health Partners, Inc.",State Public Programs,51,50,,percent of total billed charges,,
Ot Manual Therapy (15 Min),,97140,CPT,Facility,Both,,,GO,102,86.7,29.2332,102,Humana Insurance Company,Commercial PPO,96.9,95,,percent of total billed charges,,
Ot Manual Therapy (15 Min),,97140,CPT,Facility,Outpatient,,,GO,102,86.7,29.2332,102,Humana Insurance Company,Medicare PPO,49.98,49,,percent of total billed charges,,
Ot Manual Therapy (15 Min),,97140,CPT,Facility,Inpatient,,,GO,102,86.7,29.2332,102,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Ot Manual Therapy (15 Min),,97140,CPT,Facility,Both,,,GO,102,86.7,29.2332,102,Medica,Individual & Family,101.082,99.1,,percent of total billed charges,,
Ot Manual Therapy (15 Min),,97140,CPT,Facility,Outpatient,,,GO,102,86.7,29.2332,102,Medica,Medica Advantage Solution,50.796,49.8,,percent of total billed charges,,
Ot Manual Therapy (15 Min),,97140,CPT,Facility,Inpatient,,,GO,102,86.7,29.2332,102,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Ot Manual Therapy (15 Min),,97140,CPT,Facility,Outpatient,,,GO,102,86.7,29.2332,102,Medica,Medical Assistance,45.492,44.6,,percent of total billed charges,,
Ot Manual Therapy (15 Min),,97140,CPT,Facility,Inpatient,,,GO,102,86.7,29.2332,102,Medica,Medical Assistance,,,,,Included in per diem rate,
Ot Manual Therapy (15 Min),,97140,CPT,Facility,Outpatient,,,GO,102,86.7,29.2332,102,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,50.796,49.8,,percent of total billed charges,,
Ot Manual Therapy (15 Min),,97140,CPT,Facility,Inpatient,,,GO,102,86.7,29.2332,102,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Ot Manual Therapy (15 Min),,97140,CPT,Facility,Both,,,GO,102,86.7,29.2332,102,"Multiplan, Inc.","Multiplan, Inc.",95.88,94,,percent of total billed charges,,
Ot Manual Therapy (15 Min),,97140,CPT,Facility,Outpatient,,,GO,102,86.7,29.2332,102,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,88.128,86.4,,percent of total billed charges,,
Ot Manual Therapy (15 Min),,97140,CPT,Facility,Inpatient,,,GO,102,86.7,29.2332,102,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Ot Manual Therapy (15 Min),,97140,CPT,Facility,Both,,,GO,102,86.7,29.2332,102,"Preferred One Administrative Services, INC.",PPO,100.572,98.6,,percent of total billed charges,,
Ot Manual Therapy (15 Min),,97140,CPT,Facility,Outpatient,,,GO,102,86.7,29.2332,102,PrimeWest Health,Minnesota Senior Health Options (MSHO),52.479,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Ot Manual Therapy (15 Min),,97140,CPT,Facility,Inpatient,,,GO,102,86.7,29.2332,102,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ot Manual Therapy (15 Min),,97140,CPT,Facility,Outpatient,,,GO,102,86.7,29.2332,102,PrimeWest Health,MinnesotaCare,52.3872,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Ot Manual Therapy (15 Min),,97140,CPT,Facility,Inpatient,,,GO,102,86.7,29.2332,102,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Ot Manual Therapy (15 Min),,97140,CPT,Facility,Both,,,GO,102,86.7,29.2332,102,Sanford Health Plan,Sanford Health Plan,93.84,92,,percent of total billed charges,,
Ot Manual Therapy (15 Min),,97140,CPT,Facility,Outpatient,,,GO,102,86.7,29.2332,102,"UCare Health, Inc.",Individual & Family Plan,57.477,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Ot Manual Therapy (15 Min),,97140,CPT,Facility,Inpatient,,,GO,102,86.7,29.2332,102,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Ot Manual Therapy (15 Min),,97140,CPT,Facility,Outpatient,,,GO,102,86.7,29.2332,102,"UCare Health, Inc.",Medical Assistance,51.4794,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ot Manual Therapy (15 Min),,97140,CPT,Facility,Inpatient,,,GO,102,86.7,29.2332,102,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Ot Manual Therapy (15 Min),,97140,CPT,Facility,Outpatient,,,GO,102,86.7,29.2332,102,"UCare Health, Inc.",Medicare Advantage,51.4794,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ot Manual Therapy (15 Min),,97140,CPT,Facility,Inpatient,,,GO,102,86.7,29.2332,102,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ot Manual Therapy (15 Min),,97140,CPT,Facility,Outpatient,,,GO,102,86.7,29.2332,102,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),51.4794,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ot Manual Therapy (15 Min),,97140,CPT,Facility,Inpatient,,,GO,102,86.7,29.2332,102,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ot Manual Therapy (15 Min),,97140,CPT,Facility,Both,,,GO,102,86.7,29.2332,102,UnitedHealthcare,Individual & Family,95.88,94,,percent of total billed charges,,
Ot Manual Therapy (15 Min),,97140,CPT,Facility,Outpatient,,,GO,102,86.7,29.2332,102,UnitedHealthcare,Medicare Advantage,49.98,49,,percent of total billed charges,,
Ot Manual Therapy (15 Min),,97140,CPT,Facility,Inpatient,,,GO,102,86.7,29.2332,102,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Ot Manual Therapy (15 Min),,97140,CPT,Facility,Outpatient,,,GO,102,86.7,29.2332,102,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,48.96,48,,percent of total billed charges,,100% of DHS outpatient percentage
Ot Manual Therapy (15 Min),,97140,CPT,Facility,Inpatient,,,GO,102,86.7,29.2332,102,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Ot Group 1 (Session For 41000168),,97150,CPT,Facility,Both,,,GO,69,58.65,19.7754,69,Aetna,Commercial,63.48,92,,percent of total billed charges,,
Ot Group 1 (Session For 41000168),,97150,CPT,Facility,Outpatient,,,GO,69,58.65,19.7754,69,Aetna,Medicare Advantage,33.81,49,,percent of total billed charges,,
Ot Group 1 (Session For 41000168),,97150,CPT,Facility,Inpatient,,,GO,69,58.65,19.7754,69,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Ot Group 1 (Session For 41000168),,97150,CPT,Facility,Both,,,GO,69,58.65,19.7754,69,Aetna,PPO,64.17,93,,percent of total billed charges,,
Ot Group 1 (Session For 41000168),,97150,CPT,Facility,Both,,,GO,69,58.65,19.7754,69,America's PPO,America's PPO,66.2607,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Ot Group 1 (Session For 41000168),,97150,CPT,Facility,Both,,,GO,69,58.65,19.7754,69,BlueCross BlueShield Minnesota, Federal Employee Program,67.896,98.4,,percent of total billed charges,,
Ot Group 1 (Session For 41000168),,97150,CPT,Facility,Both,,,GO,69,58.65,19.7754,69,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,69,100,,percent of total billed charges,,
Ot Group 1 (Session For 41000168),,97150,CPT,Facility,Both,,,GO,69,58.65,19.7754,69,BlueCross BlueShield Minnesota,High Value Network Plan,62.1,90,,percent of total billed charges,,
Ot Group 1 (Session For 41000168),,97150,CPT,Facility,Outpatient,,,GO,69,58.65,19.7754,69,BlueCross BlueShield Minnesota,Medicare Advantage,33.81,49,,percent of total billed charges,,
Ot Group 1 (Session For 41000168),,97150,CPT,Facility,Inpatient,,,GO,69,58.65,19.7754,69,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Ot Group 1 (Session For 41000168),,97150,CPT,Facility,Both,,,GO,69,58.65,19.7754,69,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,61.1133,88.57,,percent of total billed charges,,
Ot Group 1 (Session For 41000168),,97150,CPT,Facility,Both,,,GO,69,58.65,19.7754,69,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,19.7754,28.66,,percent of total billed charges,,
Ot Group 1 (Session For 41000168),,97150,CPT,Facility,Outpatient,,,GO,69,58.65,19.7754,69,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),33.81,49,,percent of total billed charges,,
Ot Group 1 (Session For 41000168),,97150,CPT,Facility,Inpatient,,,GO,69,58.65,19.7754,69,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Ot Group 1 (Session For 41000168),,97150,CPT,Facility,Both,,,GO,69,58.65,19.7754,69,CorVel,Worker's Compensation,69,100,,percent of total billed charges,,
Ot Group 1 (Session For 41000168),,97150,CPT,Facility,Both,,,GO,69,58.65,19.7754,69,First Health Group Corporation,First Health Network,66.93,97,,percent of total billed charges,,
Ot Group 1 (Session For 41000168),,97150,CPT,Facility,Both,,,GO,69,58.65,19.7754,69,"Health Partners, Inc.",Commercial,65.274,94.6,,percent of total billed charges,,
Ot Group 1 (Session For 41000168),,97150,CPT,Facility,Outpatient,,,GO,69,58.65,19.7754,69,"Health Partners, Inc.",Medicare Advantage,33.81,49,,percent of total billed charges,,
Ot Group 1 (Session For 41000168),,97150,CPT,Facility,Inpatient,,,GO,69,58.65,19.7754,69,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ot Group 1 (Session For 41000168),,97150,CPT,Facility,Both,,,GO,69,58.65,19.7754,69,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),41.4,60,,percent of total billed charges,,
Ot Group 1 (Session For 41000168),,97150,CPT,Facility,Both,,,GO,69,58.65,19.7754,69,"Health Partners, Inc.",State of Minnesota Advantage Program,56.235,81.5,,percent of total billed charges,,
Ot Group 1 (Session For 41000168),,97150,CPT,Facility,Both,,,GO,69,58.65,19.7754,69,"Health Partners, Inc.",State Public Programs,34.5,50,,percent of total billed charges,,
Ot Group 1 (Session For 41000168),,97150,CPT,Facility,Both,,,GO,69,58.65,19.7754,69,Humana Insurance Company,Commercial PPO,65.55,95,,percent of total billed charges,,
Ot Group 1 (Session For 41000168),,97150,CPT,Facility,Outpatient,,,GO,69,58.65,19.7754,69,Humana Insurance Company,Medicare PPO,33.81,49,,percent of total billed charges,,
Ot Group 1 (Session For 41000168),,97150,CPT,Facility,Inpatient,,,GO,69,58.65,19.7754,69,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Ot Group 1 (Session For 41000168),,97150,CPT,Facility,Both,,,GO,69,58.65,19.7754,69,Medica,Individual & Family,68.379,99.1,,percent of total billed charges,,
Ot Group 1 (Session For 41000168),,97150,CPT,Facility,Outpatient,,,GO,69,58.65,19.7754,69,Medica,Medica Advantage Solution,34.362,49.8,,percent of total billed charges,,
Ot Group 1 (Session For 41000168),,97150,CPT,Facility,Inpatient,,,GO,69,58.65,19.7754,69,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Ot Group 1 (Session For 41000168),,97150,CPT,Facility,Outpatient,,,GO,69,58.65,19.7754,69,Medica,Medical Assistance,30.774,44.6,,percent of total billed charges,,
Ot Group 1 (Session For 41000168),,97150,CPT,Facility,Inpatient,,,GO,69,58.65,19.7754,69,Medica,Medical Assistance,,,,,Included in per diem rate,
Ot Group 1 (Session For 41000168),,97150,CPT,Facility,Outpatient,,,GO,69,58.65,19.7754,69,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,34.362,49.8,,percent of total billed charges,,
Ot Group 1 (Session For 41000168),,97150,CPT,Facility,Inpatient,,,GO,69,58.65,19.7754,69,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Ot Group 1 (Session For 41000168),,97150,CPT,Facility,Both,,,GO,69,58.65,19.7754,69,"Multiplan, Inc.","Multiplan, Inc.",64.86,94,,percent of total billed charges,,
Ot Group 1 (Session For 41000168),,97150,CPT,Facility,Outpatient,,,GO,69,58.65,19.7754,69,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,59.616,86.4,,percent of total billed charges,,
Ot Group 1 (Session For 41000168),,97150,CPT,Facility,Inpatient,,,GO,69,58.65,19.7754,69,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Ot Group 1 (Session For 41000168),,97150,CPT,Facility,Both,,,GO,69,58.65,19.7754,69,"Preferred One Administrative Services, INC.",PPO,68.034,98.6,,percent of total billed charges,,
Ot Group 1 (Session For 41000168),,97150,CPT,Facility,Outpatient,,,GO,69,58.65,19.7754,69,PrimeWest Health,Minnesota Senior Health Options (MSHO),35.5005,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Ot Group 1 (Session For 41000168),,97150,CPT,Facility,Inpatient,,,GO,69,58.65,19.7754,69,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ot Group 1 (Session For 41000168),,97150,CPT,Facility,Outpatient,,,GO,69,58.65,19.7754,69,PrimeWest Health,MinnesotaCare,35.4384,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Ot Group 1 (Session For 41000168),,97150,CPT,Facility,Inpatient,,,GO,69,58.65,19.7754,69,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Ot Group 1 (Session For 41000168),,97150,CPT,Facility,Both,,,GO,69,58.65,19.7754,69,Sanford Health Plan,Sanford Health Plan,63.48,92,,percent of total billed charges,,
Ot Group 1 (Session For 41000168),,97150,CPT,Facility,Outpatient,,,GO,69,58.65,19.7754,69,"UCare Health, Inc.",Individual & Family Plan,38.8815,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Ot Group 1 (Session For 41000168),,97150,CPT,Facility,Inpatient,,,GO,69,58.65,19.7754,69,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Ot Group 1 (Session For 41000168),,97150,CPT,Facility,Outpatient,,,GO,69,58.65,19.7754,69,"UCare Health, Inc.",Medical Assistance,34.8243,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ot Group 1 (Session For 41000168),,97150,CPT,Facility,Inpatient,,,GO,69,58.65,19.7754,69,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Ot Group 1 (Session For 41000168),,97150,CPT,Facility,Outpatient,,,GO,69,58.65,19.7754,69,"UCare Health, Inc.",Medicare Advantage,34.8243,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ot Group 1 (Session For 41000168),,97150,CPT,Facility,Inpatient,,,GO,69,58.65,19.7754,69,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ot Group 1 (Session For 41000168),,97150,CPT,Facility,Outpatient,,,GO,69,58.65,19.7754,69,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),34.8243,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ot Group 1 (Session For 41000168),,97150,CPT,Facility,Inpatient,,,GO,69,58.65,19.7754,69,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ot Group 1 (Session For 41000168),,97150,CPT,Facility,Both,,,GO,69,58.65,19.7754,69,UnitedHealthcare,Individual & Family,64.86,94,,percent of total billed charges,,
Ot Group 1 (Session For 41000168),,97150,CPT,Facility,Outpatient,,,GO,69,58.65,19.7754,69,UnitedHealthcare,Medicare Advantage,33.81,49,,percent of total billed charges,,
Ot Group 1 (Session For 41000168),,97150,CPT,Facility,Inpatient,,,GO,69,58.65,19.7754,69,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Ot Group 1 (Session For 41000168),,97150,CPT,Facility,Outpatient,,,GO,69,58.65,19.7754,69,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,33.12,48,,percent of total billed charges,,100% of DHS outpatient percentage
Ot Group 1 (Session For 41000168),,97150,CPT,Facility,Inpatient,,,GO,69,58.65,19.7754,69,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Ot Eval Low Complexity,,97165,CPT,Facility,Both,,,GO,143,121.55,40.9838,143,Aetna,Commercial,131.56,92,,percent of total billed charges,,
Ot Eval Low Complexity,,97165,CPT,Facility,Outpatient,,,GO,143,121.55,40.9838,143,Aetna,Medicare Advantage,70.07,49,,percent of total billed charges,,
Ot Eval Low Complexity,,97165,CPT,Facility,Inpatient,,,GO,143,121.55,40.9838,143,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Ot Eval Low Complexity,,97165,CPT,Facility,Both,,,GO,143,121.55,40.9838,143,Aetna,PPO,132.99,93,,percent of total billed charges,,
Ot Eval Low Complexity,,97165,CPT,Facility,Both,,,GO,143,121.55,40.9838,143,America's PPO,America's PPO,137.3229,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Ot Eval Low Complexity,,97165,CPT,Facility,Both,,,GO,143,121.55,40.9838,143,BlueCross BlueShield Minnesota, Federal Employee Program,140.712,98.4,,percent of total billed charges,,
Ot Eval Low Complexity,,97165,CPT,Facility,Both,,,GO,143,121.55,40.9838,143,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,143,100,,percent of total billed charges,,
Ot Eval Low Complexity,,97165,CPT,Facility,Both,,,GO,143,121.55,40.9838,143,BlueCross BlueShield Minnesota,High Value Network Plan,128.7,90,,percent of total billed charges,,
Ot Eval Low Complexity,,97165,CPT,Facility,Outpatient,,,GO,143,121.55,40.9838,143,BlueCross BlueShield Minnesota,Medicare Advantage,70.07,49,,percent of total billed charges,,
Ot Eval Low Complexity,,97165,CPT,Facility,Inpatient,,,GO,143,121.55,40.9838,143,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Ot Eval Low Complexity,,97165,CPT,Facility,Both,,,GO,143,121.55,40.9838,143,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,126.6551,88.57,,percent of total billed charges,,
Ot Eval Low Complexity,,97165,CPT,Facility,Both,,,GO,143,121.55,40.9838,143,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,40.9838,28.66,,percent of total billed charges,,
Ot Eval Low Complexity,,97165,CPT,Facility,Outpatient,,,GO,143,121.55,40.9838,143,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),70.07,49,,percent of total billed charges,,
Ot Eval Low Complexity,,97165,CPT,Facility,Inpatient,,,GO,143,121.55,40.9838,143,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Ot Eval Low Complexity,,97165,CPT,Facility,Both,,,GO,143,121.55,40.9838,143,CorVel,Worker's Compensation,143,100,,percent of total billed charges,,
Ot Eval Low Complexity,,97165,CPT,Facility,Both,,,GO,143,121.55,40.9838,143,First Health Group Corporation,First Health Network,138.71,97,,percent of total billed charges,,
Ot Eval Low Complexity,,97165,CPT,Facility,Both,,,GO,143,121.55,40.9838,143,"Health Partners, Inc.",Commercial,135.278,94.6,,percent of total billed charges,,
Ot Eval Low Complexity,,97165,CPT,Facility,Outpatient,,,GO,143,121.55,40.9838,143,"Health Partners, Inc.",Medicare Advantage,70.07,49,,percent of total billed charges,,
Ot Eval Low Complexity,,97165,CPT,Facility,Inpatient,,,GO,143,121.55,40.9838,143,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ot Eval Low Complexity,,97165,CPT,Facility,Both,,,GO,143,121.55,40.9838,143,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),85.8,60,,percent of total billed charges,,
Ot Eval Low Complexity,,97165,CPT,Facility,Both,,,GO,143,121.55,40.9838,143,"Health Partners, Inc.",State of Minnesota Advantage Program,116.545,81.5,,percent of total billed charges,,
Ot Eval Low Complexity,,97165,CPT,Facility,Both,,,GO,143,121.55,40.9838,143,"Health Partners, Inc.",State Public Programs,71.5,50,,percent of total billed charges,,
Ot Eval Low Complexity,,97165,CPT,Facility,Both,,,GO,143,121.55,40.9838,143,Humana Insurance Company,Commercial PPO,135.85,95,,percent of total billed charges,,
Ot Eval Low Complexity,,97165,CPT,Facility,Outpatient,,,GO,143,121.55,40.9838,143,Humana Insurance Company,Medicare PPO,70.07,49,,percent of total billed charges,,
Ot Eval Low Complexity,,97165,CPT,Facility,Inpatient,,,GO,143,121.55,40.9838,143,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Ot Eval Low Complexity,,97165,CPT,Facility,Both,,,GO,143,121.55,40.9838,143,Medica,Individual & Family,141.713,99.1,,percent of total billed charges,,
Ot Eval Low Complexity,,97165,CPT,Facility,Outpatient,,,GO,143,121.55,40.9838,143,Medica,Medica Advantage Solution,71.214,49.8,,percent of total billed charges,,
Ot Eval Low Complexity,,97165,CPT,Facility,Inpatient,,,GO,143,121.55,40.9838,143,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Ot Eval Low Complexity,,97165,CPT,Facility,Outpatient,,,GO,143,121.55,40.9838,143,Medica,Medical Assistance,63.778,44.6,,percent of total billed charges,,
Ot Eval Low Complexity,,97165,CPT,Facility,Inpatient,,,GO,143,121.55,40.9838,143,Medica,Medical Assistance,,,,,Included in per diem rate,
Ot Eval Low Complexity,,97165,CPT,Facility,Outpatient,,,GO,143,121.55,40.9838,143,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,71.214,49.8,,percent of total billed charges,,
Ot Eval Low Complexity,,97165,CPT,Facility,Inpatient,,,GO,143,121.55,40.9838,143,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Ot Eval Low Complexity,,97165,CPT,Facility,Both,,,GO,143,121.55,40.9838,143,"Multiplan, Inc.","Multiplan, Inc.",134.42,94,,percent of total billed charges,,
Ot Eval Low Complexity,,97165,CPT,Facility,Outpatient,,,GO,143,121.55,40.9838,143,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,123.552,86.4,,percent of total billed charges,,
Ot Eval Low Complexity,,97165,CPT,Facility,Inpatient,,,GO,143,121.55,40.9838,143,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Ot Eval Low Complexity,,97165,CPT,Facility,Both,,,GO,143,121.55,40.9838,143,"Preferred One Administrative Services, INC.",PPO,140.998,98.6,,percent of total billed charges,,
Ot Eval Low Complexity,,97165,CPT,Facility,Outpatient,,,GO,143,121.55,40.9838,143,PrimeWest Health,Minnesota Senior Health Options (MSHO),73.5735,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Ot Eval Low Complexity,,97165,CPT,Facility,Inpatient,,,GO,143,121.55,40.9838,143,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ot Eval Low Complexity,,97165,CPT,Facility,Outpatient,,,GO,143,121.55,40.9838,143,PrimeWest Health,MinnesotaCare,73.4448,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Ot Eval Low Complexity,,97165,CPT,Facility,Inpatient,,,GO,143,121.55,40.9838,143,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Ot Eval Low Complexity,,97165,CPT,Facility,Both,,,GO,143,121.55,40.9838,143,Sanford Health Plan,Sanford Health Plan,131.56,92,,percent of total billed charges,,
Ot Eval Low Complexity,,97165,CPT,Facility,Outpatient,,,GO,143,121.55,40.9838,143,"UCare Health, Inc.",Individual & Family Plan,80.5805,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Ot Eval Low Complexity,,97165,CPT,Facility,Inpatient,,,GO,143,121.55,40.9838,143,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Ot Eval Low Complexity,,97165,CPT,Facility,Outpatient,,,GO,143,121.55,40.9838,143,"UCare Health, Inc.",Medical Assistance,72.1721,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ot Eval Low Complexity,,97165,CPT,Facility,Inpatient,,,GO,143,121.55,40.9838,143,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Ot Eval Low Complexity,,97165,CPT,Facility,Outpatient,,,GO,143,121.55,40.9838,143,"UCare Health, Inc.",Medicare Advantage,72.1721,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ot Eval Low Complexity,,97165,CPT,Facility,Inpatient,,,GO,143,121.55,40.9838,143,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ot Eval Low Complexity,,97165,CPT,Facility,Outpatient,,,GO,143,121.55,40.9838,143,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),72.1721,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ot Eval Low Complexity,,97165,CPT,Facility,Inpatient,,,GO,143,121.55,40.9838,143,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ot Eval Low Complexity,,97165,CPT,Facility,Both,,,GO,143,121.55,40.9838,143,UnitedHealthcare,Individual & Family,134.42,94,,percent of total billed charges,,
Ot Eval Low Complexity,,97165,CPT,Facility,Outpatient,,,GO,143,121.55,40.9838,143,UnitedHealthcare,Medicare Advantage,70.07,49,,percent of total billed charges,,
Ot Eval Low Complexity,,97165,CPT,Facility,Inpatient,,,GO,143,121.55,40.9838,143,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Ot Eval Low Complexity,,97165,CPT,Facility,Outpatient,,,GO,143,121.55,40.9838,143,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,68.64,48,,percent of total billed charges,,100% of DHS outpatient percentage
Ot Eval Low Complexity,,97165,CPT,Facility,Inpatient,,,GO,143,121.55,40.9838,143,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Ot Eval Moderate Complexity,,97166,CPT,Facility,Both,,,GO,204,173.4,58.4664,204,Aetna,Commercial,187.68,92,,percent of total billed charges,,
Ot Eval Moderate Complexity,,97166,CPT,Facility,Outpatient,,,GO,204,173.4,58.4664,204,Aetna,Medicare Advantage,99.96,49,,percent of total billed charges,,
Ot Eval Moderate Complexity,,97166,CPT,Facility,Inpatient,,,GO,204,173.4,58.4664,204,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Ot Eval Moderate Complexity,,97166,CPT,Facility,Both,,,GO,204,173.4,58.4664,204,Aetna,PPO,189.72,93,,percent of total billed charges,,
Ot Eval Moderate Complexity,,97166,CPT,Facility,Both,,,GO,204,173.4,58.4664,204,America's PPO,America's PPO,195.9012,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Ot Eval Moderate Complexity,,97166,CPT,Facility,Both,,,GO,204,173.4,58.4664,204,BlueCross BlueShield Minnesota, Federal Employee Program,200.736,98.4,,percent of total billed charges,,
Ot Eval Moderate Complexity,,97166,CPT,Facility,Both,,,GO,204,173.4,58.4664,204,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,204,100,,percent of total billed charges,,
Ot Eval Moderate Complexity,,97166,CPT,Facility,Both,,,GO,204,173.4,58.4664,204,BlueCross BlueShield Minnesota,High Value Network Plan,183.6,90,,percent of total billed charges,,
Ot Eval Moderate Complexity,,97166,CPT,Facility,Outpatient,,,GO,204,173.4,58.4664,204,BlueCross BlueShield Minnesota,Medicare Advantage,99.96,49,,percent of total billed charges,,
Ot Eval Moderate Complexity,,97166,CPT,Facility,Inpatient,,,GO,204,173.4,58.4664,204,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Ot Eval Moderate Complexity,,97166,CPT,Facility,Both,,,GO,204,173.4,58.4664,204,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,180.6828,88.57,,percent of total billed charges,,
Ot Eval Moderate Complexity,,97166,CPT,Facility,Both,,,GO,204,173.4,58.4664,204,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,58.4664,28.66,,percent of total billed charges,,
Ot Eval Moderate Complexity,,97166,CPT,Facility,Outpatient,,,GO,204,173.4,58.4664,204,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),99.96,49,,percent of total billed charges,,
Ot Eval Moderate Complexity,,97166,CPT,Facility,Inpatient,,,GO,204,173.4,58.4664,204,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Ot Eval Moderate Complexity,,97166,CPT,Facility,Both,,,GO,204,173.4,58.4664,204,CorVel,Worker's Compensation,204,100,,percent of total billed charges,,
Ot Eval Moderate Complexity,,97166,CPT,Facility,Both,,,GO,204,173.4,58.4664,204,First Health Group Corporation,First Health Network,197.88,97,,percent of total billed charges,,
Ot Eval Moderate Complexity,,97166,CPT,Facility,Both,,,GO,204,173.4,58.4664,204,"Health Partners, Inc.",Commercial,192.984,94.6,,percent of total billed charges,,
Ot Eval Moderate Complexity,,97166,CPT,Facility,Outpatient,,,GO,204,173.4,58.4664,204,"Health Partners, Inc.",Medicare Advantage,99.96,49,,percent of total billed charges,,
Ot Eval Moderate Complexity,,97166,CPT,Facility,Inpatient,,,GO,204,173.4,58.4664,204,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ot Eval Moderate Complexity,,97166,CPT,Facility,Both,,,GO,204,173.4,58.4664,204,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),122.4,60,,percent of total billed charges,,
Ot Eval Moderate Complexity,,97166,CPT,Facility,Both,,,GO,204,173.4,58.4664,204,"Health Partners, Inc.",State of Minnesota Advantage Program,166.26,81.5,,percent of total billed charges,,
Ot Eval Moderate Complexity,,97166,CPT,Facility,Both,,,GO,204,173.4,58.4664,204,"Health Partners, Inc.",State Public Programs,102,50,,percent of total billed charges,,
Ot Eval Moderate Complexity,,97166,CPT,Facility,Both,,,GO,204,173.4,58.4664,204,Humana Insurance Company,Commercial PPO,193.8,95,,percent of total billed charges,,
Ot Eval Moderate Complexity,,97166,CPT,Facility,Outpatient,,,GO,204,173.4,58.4664,204,Humana Insurance Company,Medicare PPO,99.96,49,,percent of total billed charges,,
Ot Eval Moderate Complexity,,97166,CPT,Facility,Inpatient,,,GO,204,173.4,58.4664,204,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Ot Eval Moderate Complexity,,97166,CPT,Facility,Both,,,GO,204,173.4,58.4664,204,Medica,Individual & Family,202.164,99.1,,percent of total billed charges,,
Ot Eval Moderate Complexity,,97166,CPT,Facility,Outpatient,,,GO,204,173.4,58.4664,204,Medica,Medica Advantage Solution,101.592,49.8,,percent of total billed charges,,
Ot Eval Moderate Complexity,,97166,CPT,Facility,Inpatient,,,GO,204,173.4,58.4664,204,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Ot Eval Moderate Complexity,,97166,CPT,Facility,Outpatient,,,GO,204,173.4,58.4664,204,Medica,Medical Assistance,90.984,44.6,,percent of total billed charges,,
Ot Eval Moderate Complexity,,97166,CPT,Facility,Inpatient,,,GO,204,173.4,58.4664,204,Medica,Medical Assistance,,,,,Included in per diem rate,
Ot Eval Moderate Complexity,,97166,CPT,Facility,Outpatient,,,GO,204,173.4,58.4664,204,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,101.592,49.8,,percent of total billed charges,,
Ot Eval Moderate Complexity,,97166,CPT,Facility,Inpatient,,,GO,204,173.4,58.4664,204,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Ot Eval Moderate Complexity,,97166,CPT,Facility,Both,,,GO,204,173.4,58.4664,204,"Multiplan, Inc.","Multiplan, Inc.",191.76,94,,percent of total billed charges,,
Ot Eval Moderate Complexity,,97166,CPT,Facility,Outpatient,,,GO,204,173.4,58.4664,204,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,176.256,86.4,,percent of total billed charges,,
Ot Eval Moderate Complexity,,97166,CPT,Facility,Inpatient,,,GO,204,173.4,58.4664,204,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Ot Eval Moderate Complexity,,97166,CPT,Facility,Both,,,GO,204,173.4,58.4664,204,"Preferred One Administrative Services, INC.",PPO,201.144,98.6,,percent of total billed charges,,
Ot Eval Moderate Complexity,,97166,CPT,Facility,Outpatient,,,GO,204,173.4,58.4664,204,PrimeWest Health,Minnesota Senior Health Options (MSHO),104.958,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Ot Eval Moderate Complexity,,97166,CPT,Facility,Inpatient,,,GO,204,173.4,58.4664,204,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ot Eval Moderate Complexity,,97166,CPT,Facility,Outpatient,,,GO,204,173.4,58.4664,204,PrimeWest Health,MinnesotaCare,104.7744,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Ot Eval Moderate Complexity,,97166,CPT,Facility,Inpatient,,,GO,204,173.4,58.4664,204,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Ot Eval Moderate Complexity,,97166,CPT,Facility,Both,,,GO,204,173.4,58.4664,204,Sanford Health Plan,Sanford Health Plan,187.68,92,,percent of total billed charges,,
Ot Eval Moderate Complexity,,97166,CPT,Facility,Outpatient,,,GO,204,173.4,58.4664,204,"UCare Health, Inc.",Individual & Family Plan,114.954,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Ot Eval Moderate Complexity,,97166,CPT,Facility,Inpatient,,,GO,204,173.4,58.4664,204,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Ot Eval Moderate Complexity,,97166,CPT,Facility,Outpatient,,,GO,204,173.4,58.4664,204,"UCare Health, Inc.",Medical Assistance,102.9588,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ot Eval Moderate Complexity,,97166,CPT,Facility,Inpatient,,,GO,204,173.4,58.4664,204,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Ot Eval Moderate Complexity,,97166,CPT,Facility,Outpatient,,,GO,204,173.4,58.4664,204,"UCare Health, Inc.",Medicare Advantage,102.9588,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ot Eval Moderate Complexity,,97166,CPT,Facility,Inpatient,,,GO,204,173.4,58.4664,204,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ot Eval Moderate Complexity,,97166,CPT,Facility,Outpatient,,,GO,204,173.4,58.4664,204,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),102.9588,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ot Eval Moderate Complexity,,97166,CPT,Facility,Inpatient,,,GO,204,173.4,58.4664,204,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ot Eval Moderate Complexity,,97166,CPT,Facility,Both,,,GO,204,173.4,58.4664,204,UnitedHealthcare,Individual & Family,191.76,94,,percent of total billed charges,,
Ot Eval Moderate Complexity,,97166,CPT,Facility,Outpatient,,,GO,204,173.4,58.4664,204,UnitedHealthcare,Medicare Advantage,99.96,49,,percent of total billed charges,,
Ot Eval Moderate Complexity,,97166,CPT,Facility,Inpatient,,,GO,204,173.4,58.4664,204,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Ot Eval Moderate Complexity,,97166,CPT,Facility,Outpatient,,,GO,204,173.4,58.4664,204,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,97.92,48,,percent of total billed charges,,100% of DHS outpatient percentage
Ot Eval Moderate Complexity,,97166,CPT,Facility,Inpatient,,,GO,204,173.4,58.4664,204,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Ot Eval High Complexity,,97167,CPT,Facility,Both,,,GO,204,173.4,58.4664,204,Aetna,Commercial,187.68,92,,percent of total billed charges,,
Ot Eval High Complexity,,97167,CPT,Facility,Outpatient,,,GO,204,173.4,58.4664,204,Aetna,Medicare Advantage,99.96,49,,percent of total billed charges,,
Ot Eval High Complexity,,97167,CPT,Facility,Inpatient,,,GO,204,173.4,58.4664,204,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Ot Eval High Complexity,,97167,CPT,Facility,Both,,,GO,204,173.4,58.4664,204,Aetna,PPO,189.72,93,,percent of total billed charges,,
Ot Eval High Complexity,,97167,CPT,Facility,Both,,,GO,204,173.4,58.4664,204,America's PPO,America's PPO,195.9012,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Ot Eval High Complexity,,97167,CPT,Facility,Both,,,GO,204,173.4,58.4664,204,BlueCross BlueShield Minnesota, Federal Employee Program,200.736,98.4,,percent of total billed charges,,
Ot Eval High Complexity,,97167,CPT,Facility,Both,,,GO,204,173.4,58.4664,204,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,204,100,,percent of total billed charges,,
Ot Eval High Complexity,,97167,CPT,Facility,Both,,,GO,204,173.4,58.4664,204,BlueCross BlueShield Minnesota,High Value Network Plan,183.6,90,,percent of total billed charges,,
Ot Eval High Complexity,,97167,CPT,Facility,Outpatient,,,GO,204,173.4,58.4664,204,BlueCross BlueShield Minnesota,Medicare Advantage,99.96,49,,percent of total billed charges,,
Ot Eval High Complexity,,97167,CPT,Facility,Inpatient,,,GO,204,173.4,58.4664,204,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Ot Eval High Complexity,,97167,CPT,Facility,Both,,,GO,204,173.4,58.4664,204,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,180.6828,88.57,,percent of total billed charges,,
Ot Eval High Complexity,,97167,CPT,Facility,Both,,,GO,204,173.4,58.4664,204,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,58.4664,28.66,,percent of total billed charges,,
Ot Eval High Complexity,,97167,CPT,Facility,Outpatient,,,GO,204,173.4,58.4664,204,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),99.96,49,,percent of total billed charges,,
Ot Eval High Complexity,,97167,CPT,Facility,Inpatient,,,GO,204,173.4,58.4664,204,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Ot Eval High Complexity,,97167,CPT,Facility,Both,,,GO,204,173.4,58.4664,204,CorVel,Worker's Compensation,204,100,,percent of total billed charges,,
Ot Eval High Complexity,,97167,CPT,Facility,Both,,,GO,204,173.4,58.4664,204,First Health Group Corporation,First Health Network,197.88,97,,percent of total billed charges,,
Ot Eval High Complexity,,97167,CPT,Facility,Both,,,GO,204,173.4,58.4664,204,"Health Partners, Inc.",Commercial,192.984,94.6,,percent of total billed charges,,
Ot Eval High Complexity,,97167,CPT,Facility,Outpatient,,,GO,204,173.4,58.4664,204,"Health Partners, Inc.",Medicare Advantage,99.96,49,,percent of total billed charges,,
Ot Eval High Complexity,,97167,CPT,Facility,Inpatient,,,GO,204,173.4,58.4664,204,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ot Eval High Complexity,,97167,CPT,Facility,Both,,,GO,204,173.4,58.4664,204,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),122.4,60,,percent of total billed charges,,
Ot Eval High Complexity,,97167,CPT,Facility,Both,,,GO,204,173.4,58.4664,204,"Health Partners, Inc.",State of Minnesota Advantage Program,166.26,81.5,,percent of total billed charges,,
Ot Eval High Complexity,,97167,CPT,Facility,Both,,,GO,204,173.4,58.4664,204,"Health Partners, Inc.",State Public Programs,102,50,,percent of total billed charges,,
Ot Eval High Complexity,,97167,CPT,Facility,Both,,,GO,204,173.4,58.4664,204,Humana Insurance Company,Commercial PPO,193.8,95,,percent of total billed charges,,
Ot Eval High Complexity,,97167,CPT,Facility,Outpatient,,,GO,204,173.4,58.4664,204,Humana Insurance Company,Medicare PPO,99.96,49,,percent of total billed charges,,
Ot Eval High Complexity,,97167,CPT,Facility,Inpatient,,,GO,204,173.4,58.4664,204,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Ot Eval High Complexity,,97167,CPT,Facility,Both,,,GO,204,173.4,58.4664,204,Medica,Individual & Family,202.164,99.1,,percent of total billed charges,,
Ot Eval High Complexity,,97167,CPT,Facility,Outpatient,,,GO,204,173.4,58.4664,204,Medica,Medica Advantage Solution,101.592,49.8,,percent of total billed charges,,
Ot Eval High Complexity,,97167,CPT,Facility,Inpatient,,,GO,204,173.4,58.4664,204,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Ot Eval High Complexity,,97167,CPT,Facility,Outpatient,,,GO,204,173.4,58.4664,204,Medica,Medical Assistance,90.984,44.6,,percent of total billed charges,,
Ot Eval High Complexity,,97167,CPT,Facility,Inpatient,,,GO,204,173.4,58.4664,204,Medica,Medical Assistance,,,,,Included in per diem rate,
Ot Eval High Complexity,,97167,CPT,Facility,Outpatient,,,GO,204,173.4,58.4664,204,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,101.592,49.8,,percent of total billed charges,,
Ot Eval High Complexity,,97167,CPT,Facility,Inpatient,,,GO,204,173.4,58.4664,204,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Ot Eval High Complexity,,97167,CPT,Facility,Both,,,GO,204,173.4,58.4664,204,"Multiplan, Inc.","Multiplan, Inc.",191.76,94,,percent of total billed charges,,
Ot Eval High Complexity,,97167,CPT,Facility,Outpatient,,,GO,204,173.4,58.4664,204,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,176.256,86.4,,percent of total billed charges,,
Ot Eval High Complexity,,97167,CPT,Facility,Inpatient,,,GO,204,173.4,58.4664,204,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Ot Eval High Complexity,,97167,CPT,Facility,Both,,,GO,204,173.4,58.4664,204,"Preferred One Administrative Services, INC.",PPO,201.144,98.6,,percent of total billed charges,,
Ot Eval High Complexity,,97167,CPT,Facility,Outpatient,,,GO,204,173.4,58.4664,204,PrimeWest Health,Minnesota Senior Health Options (MSHO),104.958,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Ot Eval High Complexity,,97167,CPT,Facility,Inpatient,,,GO,204,173.4,58.4664,204,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ot Eval High Complexity,,97167,CPT,Facility,Outpatient,,,GO,204,173.4,58.4664,204,PrimeWest Health,MinnesotaCare,104.7744,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Ot Eval High Complexity,,97167,CPT,Facility,Inpatient,,,GO,204,173.4,58.4664,204,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Ot Eval High Complexity,,97167,CPT,Facility,Both,,,GO,204,173.4,58.4664,204,Sanford Health Plan,Sanford Health Plan,187.68,92,,percent of total billed charges,,
Ot Eval High Complexity,,97167,CPT,Facility,Outpatient,,,GO,204,173.4,58.4664,204,"UCare Health, Inc.",Individual & Family Plan,114.954,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Ot Eval High Complexity,,97167,CPT,Facility,Inpatient,,,GO,204,173.4,58.4664,204,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Ot Eval High Complexity,,97167,CPT,Facility,Outpatient,,,GO,204,173.4,58.4664,204,"UCare Health, Inc.",Medical Assistance,102.9588,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ot Eval High Complexity,,97167,CPT,Facility,Inpatient,,,GO,204,173.4,58.4664,204,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Ot Eval High Complexity,,97167,CPT,Facility,Outpatient,,,GO,204,173.4,58.4664,204,"UCare Health, Inc.",Medicare Advantage,102.9588,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ot Eval High Complexity,,97167,CPT,Facility,Inpatient,,,GO,204,173.4,58.4664,204,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ot Eval High Complexity,,97167,CPT,Facility,Outpatient,,,GO,204,173.4,58.4664,204,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),102.9588,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ot Eval High Complexity,,97167,CPT,Facility,Inpatient,,,GO,204,173.4,58.4664,204,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ot Eval High Complexity,,97167,CPT,Facility,Both,,,GO,204,173.4,58.4664,204,UnitedHealthcare,Individual & Family,191.76,94,,percent of total billed charges,,
Ot Eval High Complexity,,97167,CPT,Facility,Outpatient,,,GO,204,173.4,58.4664,204,UnitedHealthcare,Medicare Advantage,99.96,49,,percent of total billed charges,,
Ot Eval High Complexity,,97167,CPT,Facility,Inpatient,,,GO,204,173.4,58.4664,204,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Ot Eval High Complexity,,97167,CPT,Facility,Outpatient,,,GO,204,173.4,58.4664,204,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,97.92,48,,percent of total billed charges,,100% of DHS outpatient percentage
Ot Eval High Complexity,,97167,CPT,Facility,Inpatient,,,GO,204,173.4,58.4664,204,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Ot Re-Eval (Session For 41000060),,97168,CPT,Facility,Both,,,GO,80,68,22.928,80,Aetna,Commercial,73.6,92,,percent of total billed charges,,
Ot Re-Eval (Session For 41000060),,97168,CPT,Facility,Outpatient,,,GO,80,68,22.928,80,Aetna,Medicare Advantage,39.2,49,,percent of total billed charges,,
Ot Re-Eval (Session For 41000060),,97168,CPT,Facility,Inpatient,,,GO,80,68,22.928,80,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Ot Re-Eval (Session For 41000060),,97168,CPT,Facility,Both,,,GO,80,68,22.928,80,Aetna,PPO,74.4,93,,percent of total billed charges,,
Ot Re-Eval (Session For 41000060),,97168,CPT,Facility,Both,,,GO,80,68,22.928,80,America's PPO,America's PPO,76.824,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Ot Re-Eval (Session For 41000060),,97168,CPT,Facility,Both,,,GO,80,68,22.928,80,BlueCross BlueShield Minnesota, Federal Employee Program,78.72,98.4,,percent of total billed charges,,
Ot Re-Eval (Session For 41000060),,97168,CPT,Facility,Both,,,GO,80,68,22.928,80,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,80,100,,percent of total billed charges,,
Ot Re-Eval (Session For 41000060),,97168,CPT,Facility,Both,,,GO,80,68,22.928,80,BlueCross BlueShield Minnesota,High Value Network Plan,72,90,,percent of total billed charges,,
Ot Re-Eval (Session For 41000060),,97168,CPT,Facility,Outpatient,,,GO,80,68,22.928,80,BlueCross BlueShield Minnesota,Medicare Advantage,39.2,49,,percent of total billed charges,,
Ot Re-Eval (Session For 41000060),,97168,CPT,Facility,Inpatient,,,GO,80,68,22.928,80,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Ot Re-Eval (Session For 41000060),,97168,CPT,Facility,Both,,,GO,80,68,22.928,80,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,70.856,88.57,,percent of total billed charges,,
Ot Re-Eval (Session For 41000060),,97168,CPT,Facility,Both,,,GO,80,68,22.928,80,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,22.928,28.66,,percent of total billed charges,,
Ot Re-Eval (Session For 41000060),,97168,CPT,Facility,Outpatient,,,GO,80,68,22.928,80,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),39.2,49,,percent of total billed charges,,
Ot Re-Eval (Session For 41000060),,97168,CPT,Facility,Inpatient,,,GO,80,68,22.928,80,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Ot Re-Eval (Session For 41000060),,97168,CPT,Facility,Both,,,GO,80,68,22.928,80,CorVel,Worker's Compensation,80,100,,percent of total billed charges,,
Ot Re-Eval (Session For 41000060),,97168,CPT,Facility,Both,,,GO,80,68,22.928,80,First Health Group Corporation,First Health Network,77.6,97,,percent of total billed charges,,
Ot Re-Eval (Session For 41000060),,97168,CPT,Facility,Both,,,GO,80,68,22.928,80,"Health Partners, Inc.",Commercial,75.68,94.6,,percent of total billed charges,,
Ot Re-Eval (Session For 41000060),,97168,CPT,Facility,Outpatient,,,GO,80,68,22.928,80,"Health Partners, Inc.",Medicare Advantage,39.2,49,,percent of total billed charges,,
Ot Re-Eval (Session For 41000060),,97168,CPT,Facility,Inpatient,,,GO,80,68,22.928,80,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ot Re-Eval (Session For 41000060),,97168,CPT,Facility,Both,,,GO,80,68,22.928,80,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),48,60,,percent of total billed charges,,
Ot Re-Eval (Session For 41000060),,97168,CPT,Facility,Both,,,GO,80,68,22.928,80,"Health Partners, Inc.",State of Minnesota Advantage Program,65.2,81.5,,percent of total billed charges,,
Ot Re-Eval (Session For 41000060),,97168,CPT,Facility,Both,,,GO,80,68,22.928,80,"Health Partners, Inc.",State Public Programs,40,50,,percent of total billed charges,,
Ot Re-Eval (Session For 41000060),,97168,CPT,Facility,Both,,,GO,80,68,22.928,80,Humana Insurance Company,Commercial PPO,76,95,,percent of total billed charges,,
Ot Re-Eval (Session For 41000060),,97168,CPT,Facility,Outpatient,,,GO,80,68,22.928,80,Humana Insurance Company,Medicare PPO,39.2,49,,percent of total billed charges,,
Ot Re-Eval (Session For 41000060),,97168,CPT,Facility,Inpatient,,,GO,80,68,22.928,80,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Ot Re-Eval (Session For 41000060),,97168,CPT,Facility,Both,,,GO,80,68,22.928,80,Medica,Individual & Family,79.28,99.1,,percent of total billed charges,,
Ot Re-Eval (Session For 41000060),,97168,CPT,Facility,Outpatient,,,GO,80,68,22.928,80,Medica,Medica Advantage Solution,39.84,49.8,,percent of total billed charges,,
Ot Re-Eval (Session For 41000060),,97168,CPT,Facility,Inpatient,,,GO,80,68,22.928,80,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Ot Re-Eval (Session For 41000060),,97168,CPT,Facility,Outpatient,,,GO,80,68,22.928,80,Medica,Medical Assistance,35.68,44.6,,percent of total billed charges,,
Ot Re-Eval (Session For 41000060),,97168,CPT,Facility,Inpatient,,,GO,80,68,22.928,80,Medica,Medical Assistance,,,,,Included in per diem rate,
Ot Re-Eval (Session For 41000060),,97168,CPT,Facility,Outpatient,,,GO,80,68,22.928,80,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,39.84,49.8,,percent of total billed charges,,
Ot Re-Eval (Session For 41000060),,97168,CPT,Facility,Inpatient,,,GO,80,68,22.928,80,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Ot Re-Eval (Session For 41000060),,97168,CPT,Facility,Both,,,GO,80,68,22.928,80,"Multiplan, Inc.","Multiplan, Inc.",75.2,94,,percent of total billed charges,,
Ot Re-Eval (Session For 41000060),,97168,CPT,Facility,Outpatient,,,GO,80,68,22.928,80,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,69.12,86.4,,percent of total billed charges,,
Ot Re-Eval (Session For 41000060),,97168,CPT,Facility,Inpatient,,,GO,80,68,22.928,80,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Ot Re-Eval (Session For 41000060),,97168,CPT,Facility,Both,,,GO,80,68,22.928,80,"Preferred One Administrative Services, INC.",PPO,78.88,98.6,,percent of total billed charges,,
Ot Re-Eval (Session For 41000060),,97168,CPT,Facility,Outpatient,,,GO,80,68,22.928,80,PrimeWest Health,Minnesota Senior Health Options (MSHO),41.16,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Ot Re-Eval (Session For 41000060),,97168,CPT,Facility,Inpatient,,,GO,80,68,22.928,80,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ot Re-Eval (Session For 41000060),,97168,CPT,Facility,Outpatient,,,GO,80,68,22.928,80,PrimeWest Health,MinnesotaCare,41.088,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Ot Re-Eval (Session For 41000060),,97168,CPT,Facility,Inpatient,,,GO,80,68,22.928,80,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Ot Re-Eval (Session For 41000060),,97168,CPT,Facility,Both,,,GO,80,68,22.928,80,Sanford Health Plan,Sanford Health Plan,73.6,92,,percent of total billed charges,,
Ot Re-Eval (Session For 41000060),,97168,CPT,Facility,Outpatient,,,GO,80,68,22.928,80,"UCare Health, Inc.",Individual & Family Plan,45.08,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Ot Re-Eval (Session For 41000060),,97168,CPT,Facility,Inpatient,,,GO,80,68,22.928,80,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Ot Re-Eval (Session For 41000060),,97168,CPT,Facility,Outpatient,,,GO,80,68,22.928,80,"UCare Health, Inc.",Medical Assistance,40.376,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ot Re-Eval (Session For 41000060),,97168,CPT,Facility,Inpatient,,,GO,80,68,22.928,80,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Ot Re-Eval (Session For 41000060),,97168,CPT,Facility,Outpatient,,,GO,80,68,22.928,80,"UCare Health, Inc.",Medicare Advantage,40.376,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ot Re-Eval (Session For 41000060),,97168,CPT,Facility,Inpatient,,,GO,80,68,22.928,80,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ot Re-Eval (Session For 41000060),,97168,CPT,Facility,Outpatient,,,GO,80,68,22.928,80,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),40.376,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ot Re-Eval (Session For 41000060),,97168,CPT,Facility,Inpatient,,,GO,80,68,22.928,80,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ot Re-Eval (Session For 41000060),,97168,CPT,Facility,Both,,,GO,80,68,22.928,80,UnitedHealthcare,Individual & Family,75.2,94,,percent of total billed charges,,
Ot Re-Eval (Session For 41000060),,97168,CPT,Facility,Outpatient,,,GO,80,68,22.928,80,UnitedHealthcare,Medicare Advantage,39.2,49,,percent of total billed charges,,
Ot Re-Eval (Session For 41000060),,97168,CPT,Facility,Inpatient,,,GO,80,68,22.928,80,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Ot Re-Eval (Session For 41000060),,97168,CPT,Facility,Outpatient,,,GO,80,68,22.928,80,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,38.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
Ot Re-Eval (Session For 41000060),,97168,CPT,Facility,Inpatient,,,GO,80,68,22.928,80,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Ot Dynamic Therapeutic Activities (15 Min),,97530,CPT,Facility,Both,,,GO,102,86.7,29.2332,102,Aetna,Commercial,93.84,92,,percent of total billed charges,,
Ot Dynamic Therapeutic Activities (15 Min),,97530,CPT,Facility,Outpatient,,,GO,102,86.7,29.2332,102,Aetna,Medicare Advantage,49.98,49,,percent of total billed charges,,
Ot Dynamic Therapeutic Activities (15 Min),,97530,CPT,Facility,Inpatient,,,GO,102,86.7,29.2332,102,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Ot Dynamic Therapeutic Activities (15 Min),,97530,CPT,Facility,Both,,,GO,102,86.7,29.2332,102,Aetna,PPO,94.86,93,,percent of total billed charges,,
Ot Dynamic Therapeutic Activities (15 Min),,97530,CPT,Facility,Both,,,GO,102,86.7,29.2332,102,America's PPO,America's PPO,97.9506,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Ot Dynamic Therapeutic Activities (15 Min),,97530,CPT,Facility,Both,,,GO,102,86.7,29.2332,102,BlueCross BlueShield Minnesota, Federal Employee Program,100.368,98.4,,percent of total billed charges,,
Ot Dynamic Therapeutic Activities (15 Min),,97530,CPT,Facility,Both,,,GO,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,102,100,,percent of total billed charges,,
Ot Dynamic Therapeutic Activities (15 Min),,97530,CPT,Facility,Both,,,GO,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,High Value Network Plan,91.8,90,,percent of total billed charges,,
Ot Dynamic Therapeutic Activities (15 Min),,97530,CPT,Facility,Outpatient,,,GO,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,Medicare Advantage,49.98,49,,percent of total billed charges,,
Ot Dynamic Therapeutic Activities (15 Min),,97530,CPT,Facility,Inpatient,,,GO,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Ot Dynamic Therapeutic Activities (15 Min),,97530,CPT,Facility,Both,,,GO,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,90.3414,88.57,,percent of total billed charges,,
Ot Dynamic Therapeutic Activities (15 Min),,97530,CPT,Facility,Both,,,GO,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,29.2332,28.66,,percent of total billed charges,,
Ot Dynamic Therapeutic Activities (15 Min),,97530,CPT,Facility,Outpatient,,,GO,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),49.98,49,,percent of total billed charges,,
Ot Dynamic Therapeutic Activities (15 Min),,97530,CPT,Facility,Inpatient,,,GO,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Ot Dynamic Therapeutic Activities (15 Min),,97530,CPT,Facility,Both,,,GO,102,86.7,29.2332,102,CorVel,Worker's Compensation,102,100,,percent of total billed charges,,
Ot Dynamic Therapeutic Activities (15 Min),,97530,CPT,Facility,Both,,,GO,102,86.7,29.2332,102,First Health Group Corporation,First Health Network,98.94,97,,percent of total billed charges,,
Ot Dynamic Therapeutic Activities (15 Min),,97530,CPT,Facility,Both,,,GO,102,86.7,29.2332,102,"Health Partners, Inc.",Commercial,96.492,94.6,,percent of total billed charges,,
Ot Dynamic Therapeutic Activities (15 Min),,97530,CPT,Facility,Outpatient,,,GO,102,86.7,29.2332,102,"Health Partners, Inc.",Medicare Advantage,49.98,49,,percent of total billed charges,,
Ot Dynamic Therapeutic Activities (15 Min),,97530,CPT,Facility,Inpatient,,,GO,102,86.7,29.2332,102,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ot Dynamic Therapeutic Activities (15 Min),,97530,CPT,Facility,Both,,,GO,102,86.7,29.2332,102,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),61.2,60,,percent of total billed charges,,
Ot Dynamic Therapeutic Activities (15 Min),,97530,CPT,Facility,Both,,,GO,102,86.7,29.2332,102,"Health Partners, Inc.",State of Minnesota Advantage Program,83.13,81.5,,percent of total billed charges,,
Ot Dynamic Therapeutic Activities (15 Min),,97530,CPT,Facility,Both,,,GO,102,86.7,29.2332,102,"Health Partners, Inc.",State Public Programs,51,50,,percent of total billed charges,,
Ot Dynamic Therapeutic Activities (15 Min),,97530,CPT,Facility,Both,,,GO,102,86.7,29.2332,102,Humana Insurance Company,Commercial PPO,96.9,95,,percent of total billed charges,,
Ot Dynamic Therapeutic Activities (15 Min),,97530,CPT,Facility,Outpatient,,,GO,102,86.7,29.2332,102,Humana Insurance Company,Medicare PPO,49.98,49,,percent of total billed charges,,
Ot Dynamic Therapeutic Activities (15 Min),,97530,CPT,Facility,Inpatient,,,GO,102,86.7,29.2332,102,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Ot Dynamic Therapeutic Activities (15 Min),,97530,CPT,Facility,Both,,,GO,102,86.7,29.2332,102,Medica,Individual & Family,101.082,99.1,,percent of total billed charges,,
Ot Dynamic Therapeutic Activities (15 Min),,97530,CPT,Facility,Outpatient,,,GO,102,86.7,29.2332,102,Medica,Medica Advantage Solution,50.796,49.8,,percent of total billed charges,,
Ot Dynamic Therapeutic Activities (15 Min),,97530,CPT,Facility,Inpatient,,,GO,102,86.7,29.2332,102,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Ot Dynamic Therapeutic Activities (15 Min),,97530,CPT,Facility,Outpatient,,,GO,102,86.7,29.2332,102,Medica,Medical Assistance,45.492,44.6,,percent of total billed charges,,
Ot Dynamic Therapeutic Activities (15 Min),,97530,CPT,Facility,Inpatient,,,GO,102,86.7,29.2332,102,Medica,Medical Assistance,,,,,Included in per diem rate,
Ot Dynamic Therapeutic Activities (15 Min),,97530,CPT,Facility,Outpatient,,,GO,102,86.7,29.2332,102,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,50.796,49.8,,percent of total billed charges,,
Ot Dynamic Therapeutic Activities (15 Min),,97530,CPT,Facility,Inpatient,,,GO,102,86.7,29.2332,102,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Ot Dynamic Therapeutic Activities (15 Min),,97530,CPT,Facility,Both,,,GO,102,86.7,29.2332,102,"Multiplan, Inc.","Multiplan, Inc.",95.88,94,,percent of total billed charges,,
Ot Dynamic Therapeutic Activities (15 Min),,97530,CPT,Facility,Outpatient,,,GO,102,86.7,29.2332,102,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,88.128,86.4,,percent of total billed charges,,
Ot Dynamic Therapeutic Activities (15 Min),,97530,CPT,Facility,Inpatient,,,GO,102,86.7,29.2332,102,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Ot Dynamic Therapeutic Activities (15 Min),,97530,CPT,Facility,Both,,,GO,102,86.7,29.2332,102,"Preferred One Administrative Services, INC.",PPO,100.572,98.6,,percent of total billed charges,,
Ot Dynamic Therapeutic Activities (15 Min),,97530,CPT,Facility,Outpatient,,,GO,102,86.7,29.2332,102,PrimeWest Health,Minnesota Senior Health Options (MSHO),52.479,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Ot Dynamic Therapeutic Activities (15 Min),,97530,CPT,Facility,Inpatient,,,GO,102,86.7,29.2332,102,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ot Dynamic Therapeutic Activities (15 Min),,97530,CPT,Facility,Outpatient,,,GO,102,86.7,29.2332,102,PrimeWest Health,MinnesotaCare,52.3872,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Ot Dynamic Therapeutic Activities (15 Min),,97530,CPT,Facility,Inpatient,,,GO,102,86.7,29.2332,102,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Ot Dynamic Therapeutic Activities (15 Min),,97530,CPT,Facility,Both,,,GO,102,86.7,29.2332,102,Sanford Health Plan,Sanford Health Plan,93.84,92,,percent of total billed charges,,
Ot Dynamic Therapeutic Activities (15 Min),,97530,CPT,Facility,Outpatient,,,GO,102,86.7,29.2332,102,"UCare Health, Inc.",Individual & Family Plan,57.477,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Ot Dynamic Therapeutic Activities (15 Min),,97530,CPT,Facility,Inpatient,,,GO,102,86.7,29.2332,102,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Ot Dynamic Therapeutic Activities (15 Min),,97530,CPT,Facility,Outpatient,,,GO,102,86.7,29.2332,102,"UCare Health, Inc.",Medical Assistance,51.4794,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ot Dynamic Therapeutic Activities (15 Min),,97530,CPT,Facility,Inpatient,,,GO,102,86.7,29.2332,102,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Ot Dynamic Therapeutic Activities (15 Min),,97530,CPT,Facility,Outpatient,,,GO,102,86.7,29.2332,102,"UCare Health, Inc.",Medicare Advantage,51.4794,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ot Dynamic Therapeutic Activities (15 Min),,97530,CPT,Facility,Inpatient,,,GO,102,86.7,29.2332,102,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ot Dynamic Therapeutic Activities (15 Min),,97530,CPT,Facility,Outpatient,,,GO,102,86.7,29.2332,102,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),51.4794,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ot Dynamic Therapeutic Activities (15 Min),,97530,CPT,Facility,Inpatient,,,GO,102,86.7,29.2332,102,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ot Dynamic Therapeutic Activities (15 Min),,97530,CPT,Facility,Both,,,GO,102,86.7,29.2332,102,UnitedHealthcare,Individual & Family,95.88,94,,percent of total billed charges,,
Ot Dynamic Therapeutic Activities (15 Min),,97530,CPT,Facility,Outpatient,,,GO,102,86.7,29.2332,102,UnitedHealthcare,Medicare Advantage,49.98,49,,percent of total billed charges,,
Ot Dynamic Therapeutic Activities (15 Min),,97530,CPT,Facility,Inpatient,,,GO,102,86.7,29.2332,102,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Ot Dynamic Therapeutic Activities (15 Min),,97530,CPT,Facility,Outpatient,,,GO,102,86.7,29.2332,102,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,48.96,48,,percent of total billed charges,,100% of DHS outpatient percentage
Ot Dynamic Therapeutic Activities (15 Min),,97530,CPT,Facility,Inpatient,,,GO,102,86.7,29.2332,102,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Ot Sensory Integration (15 Min),,97533,CPT,Facility,Both,,,GO,77,65.45,22.0682,77,Aetna,Commercial,70.84,92,,percent of total billed charges,,
Ot Sensory Integration (15 Min),,97533,CPT,Facility,Outpatient,,,GO,77,65.45,22.0682,77,Aetna,Medicare Advantage,37.73,49,,percent of total billed charges,,
Ot Sensory Integration (15 Min),,97533,CPT,Facility,Inpatient,,,GO,77,65.45,22.0682,77,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Ot Sensory Integration (15 Min),,97533,CPT,Facility,Both,,,GO,77,65.45,22.0682,77,Aetna,PPO,71.61,93,,percent of total billed charges,,
Ot Sensory Integration (15 Min),,97533,CPT,Facility,Both,,,GO,77,65.45,22.0682,77,America's PPO,America's PPO,73.9431,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Ot Sensory Integration (15 Min),,97533,CPT,Facility,Both,,,GO,77,65.45,22.0682,77,BlueCross BlueShield Minnesota, Federal Employee Program,75.768,98.4,,percent of total billed charges,,
Ot Sensory Integration (15 Min),,97533,CPT,Facility,Both,,,GO,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,77,100,,percent of total billed charges,,
Ot Sensory Integration (15 Min),,97533,CPT,Facility,Both,,,GO,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,High Value Network Plan,69.3,90,,percent of total billed charges,,
Ot Sensory Integration (15 Min),,97533,CPT,Facility,Outpatient,,,GO,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,Medicare Advantage,37.73,49,,percent of total billed charges,,
Ot Sensory Integration (15 Min),,97533,CPT,Facility,Inpatient,,,GO,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Ot Sensory Integration (15 Min),,97533,CPT,Facility,Both,,,GO,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,68.1989,88.57,,percent of total billed charges,,
Ot Sensory Integration (15 Min),,97533,CPT,Facility,Both,,,GO,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,22.0682,28.66,,percent of total billed charges,,
Ot Sensory Integration (15 Min),,97533,CPT,Facility,Outpatient,,,GO,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),37.73,49,,percent of total billed charges,,
Ot Sensory Integration (15 Min),,97533,CPT,Facility,Inpatient,,,GO,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Ot Sensory Integration (15 Min),,97533,CPT,Facility,Both,,,GO,77,65.45,22.0682,77,CorVel,Worker's Compensation,77,100,,percent of total billed charges,,
Ot Sensory Integration (15 Min),,97533,CPT,Facility,Both,,,GO,77,65.45,22.0682,77,First Health Group Corporation,First Health Network,74.69,97,,percent of total billed charges,,
Ot Sensory Integration (15 Min),,97533,CPT,Facility,Both,,,GO,77,65.45,22.0682,77,"Health Partners, Inc.",Commercial,72.842,94.6,,percent of total billed charges,,
Ot Sensory Integration (15 Min),,97533,CPT,Facility,Outpatient,,,GO,77,65.45,22.0682,77,"Health Partners, Inc.",Medicare Advantage,37.73,49,,percent of total billed charges,,
Ot Sensory Integration (15 Min),,97533,CPT,Facility,Inpatient,,,GO,77,65.45,22.0682,77,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ot Sensory Integration (15 Min),,97533,CPT,Facility,Both,,,GO,77,65.45,22.0682,77,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),46.2,60,,percent of total billed charges,,
Ot Sensory Integration (15 Min),,97533,CPT,Facility,Both,,,GO,77,65.45,22.0682,77,"Health Partners, Inc.",State of Minnesota Advantage Program,62.755,81.5,,percent of total billed charges,,
Ot Sensory Integration (15 Min),,97533,CPT,Facility,Both,,,GO,77,65.45,22.0682,77,"Health Partners, Inc.",State Public Programs,38.5,50,,percent of total billed charges,,
Ot Sensory Integration (15 Min),,97533,CPT,Facility,Both,,,GO,77,65.45,22.0682,77,Humana Insurance Company,Commercial PPO,73.15,95,,percent of total billed charges,,
Ot Sensory Integration (15 Min),,97533,CPT,Facility,Outpatient,,,GO,77,65.45,22.0682,77,Humana Insurance Company,Medicare PPO,37.73,49,,percent of total billed charges,,
Ot Sensory Integration (15 Min),,97533,CPT,Facility,Inpatient,,,GO,77,65.45,22.0682,77,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Ot Sensory Integration (15 Min),,97533,CPT,Facility,Both,,,GO,77,65.45,22.0682,77,Medica,Individual & Family,76.307,99.1,,percent of total billed charges,,
Ot Sensory Integration (15 Min),,97533,CPT,Facility,Outpatient,,,GO,77,65.45,22.0682,77,Medica,Medica Advantage Solution,38.346,49.8,,percent of total billed charges,,
Ot Sensory Integration (15 Min),,97533,CPT,Facility,Inpatient,,,GO,77,65.45,22.0682,77,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Ot Sensory Integration (15 Min),,97533,CPT,Facility,Outpatient,,,GO,77,65.45,22.0682,77,Medica,Medical Assistance,34.342,44.6,,percent of total billed charges,,
Ot Sensory Integration (15 Min),,97533,CPT,Facility,Inpatient,,,GO,77,65.45,22.0682,77,Medica,Medical Assistance,,,,,Included in per diem rate,
Ot Sensory Integration (15 Min),,97533,CPT,Facility,Outpatient,,,GO,77,65.45,22.0682,77,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,38.346,49.8,,percent of total billed charges,,
Ot Sensory Integration (15 Min),,97533,CPT,Facility,Inpatient,,,GO,77,65.45,22.0682,77,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Ot Sensory Integration (15 Min),,97533,CPT,Facility,Both,,,GO,77,65.45,22.0682,77,"Multiplan, Inc.","Multiplan, Inc.",72.38,94,,percent of total billed charges,,
Ot Sensory Integration (15 Min),,97533,CPT,Facility,Outpatient,,,GO,77,65.45,22.0682,77,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,66.528,86.4,,percent of total billed charges,,
Ot Sensory Integration (15 Min),,97533,CPT,Facility,Inpatient,,,GO,77,65.45,22.0682,77,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Ot Sensory Integration (15 Min),,97533,CPT,Facility,Both,,,GO,77,65.45,22.0682,77,"Preferred One Administrative Services, INC.",PPO,75.922,98.6,,percent of total billed charges,,
Ot Sensory Integration (15 Min),,97533,CPT,Facility,Outpatient,,,GO,77,65.45,22.0682,77,PrimeWest Health,Minnesota Senior Health Options (MSHO),39.6165,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Ot Sensory Integration (15 Min),,97533,CPT,Facility,Inpatient,,,GO,77,65.45,22.0682,77,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ot Sensory Integration (15 Min),,97533,CPT,Facility,Outpatient,,,GO,77,65.45,22.0682,77,PrimeWest Health,MinnesotaCare,39.5472,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Ot Sensory Integration (15 Min),,97533,CPT,Facility,Inpatient,,,GO,77,65.45,22.0682,77,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Ot Sensory Integration (15 Min),,97533,CPT,Facility,Both,,,GO,77,65.45,22.0682,77,Sanford Health Plan,Sanford Health Plan,70.84,92,,percent of total billed charges,,
Ot Sensory Integration (15 Min),,97533,CPT,Facility,Outpatient,,,GO,77,65.45,22.0682,77,"UCare Health, Inc.",Individual & Family Plan,43.3895,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Ot Sensory Integration (15 Min),,97533,CPT,Facility,Inpatient,,,GO,77,65.45,22.0682,77,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Ot Sensory Integration (15 Min),,97533,CPT,Facility,Outpatient,,,GO,77,65.45,22.0682,77,"UCare Health, Inc.",Medical Assistance,38.8619,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ot Sensory Integration (15 Min),,97533,CPT,Facility,Inpatient,,,GO,77,65.45,22.0682,77,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Ot Sensory Integration (15 Min),,97533,CPT,Facility,Outpatient,,,GO,77,65.45,22.0682,77,"UCare Health, Inc.",Medicare Advantage,38.8619,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ot Sensory Integration (15 Min),,97533,CPT,Facility,Inpatient,,,GO,77,65.45,22.0682,77,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ot Sensory Integration (15 Min),,97533,CPT,Facility,Outpatient,,,GO,77,65.45,22.0682,77,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),38.8619,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ot Sensory Integration (15 Min),,97533,CPT,Facility,Inpatient,,,GO,77,65.45,22.0682,77,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ot Sensory Integration (15 Min),,97533,CPT,Facility,Both,,,GO,77,65.45,22.0682,77,UnitedHealthcare,Individual & Family,72.38,94,,percent of total billed charges,,
Ot Sensory Integration (15 Min),,97533,CPT,Facility,Outpatient,,,GO,77,65.45,22.0682,77,UnitedHealthcare,Medicare Advantage,37.73,49,,percent of total billed charges,,
Ot Sensory Integration (15 Min),,97533,CPT,Facility,Inpatient,,,GO,77,65.45,22.0682,77,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Ot Sensory Integration (15 Min),,97533,CPT,Facility,Outpatient,,,GO,77,65.45,22.0682,77,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,36.96,48,,percent of total billed charges,,100% of DHS outpatient percentage
Ot Sensory Integration (15 Min),,97533,CPT,Facility,Inpatient,,,GO,77,65.45,22.0682,77,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Ot Self Care/Adl/Home Management (15 Min),,97535,CPT,Facility,Both,,,GO,102,86.7,29.2332,102,Aetna,Commercial,93.84,92,,percent of total billed charges,,
Ot Self Care/Adl/Home Management (15 Min),,97535,CPT,Facility,Outpatient,,,GO,102,86.7,29.2332,102,Aetna,Medicare Advantage,49.98,49,,percent of total billed charges,,
Ot Self Care/Adl/Home Management (15 Min),,97535,CPT,Facility,Inpatient,,,GO,102,86.7,29.2332,102,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Ot Self Care/Adl/Home Management (15 Min),,97535,CPT,Facility,Both,,,GO,102,86.7,29.2332,102,Aetna,PPO,94.86,93,,percent of total billed charges,,
Ot Self Care/Adl/Home Management (15 Min),,97535,CPT,Facility,Both,,,GO,102,86.7,29.2332,102,America's PPO,America's PPO,97.9506,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Ot Self Care/Adl/Home Management (15 Min),,97535,CPT,Facility,Both,,,GO,102,86.7,29.2332,102,BlueCross BlueShield Minnesota, Federal Employee Program,100.368,98.4,,percent of total billed charges,,
Ot Self Care/Adl/Home Management (15 Min),,97535,CPT,Facility,Both,,,GO,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,102,100,,percent of total billed charges,,
Ot Self Care/Adl/Home Management (15 Min),,97535,CPT,Facility,Both,,,GO,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,High Value Network Plan,91.8,90,,percent of total billed charges,,
Ot Self Care/Adl/Home Management (15 Min),,97535,CPT,Facility,Outpatient,,,GO,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,Medicare Advantage,49.98,49,,percent of total billed charges,,
Ot Self Care/Adl/Home Management (15 Min),,97535,CPT,Facility,Inpatient,,,GO,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Ot Self Care/Adl/Home Management (15 Min),,97535,CPT,Facility,Both,,,GO,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,90.3414,88.57,,percent of total billed charges,,
Ot Self Care/Adl/Home Management (15 Min),,97535,CPT,Facility,Both,,,GO,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,29.2332,28.66,,percent of total billed charges,,
Ot Self Care/Adl/Home Management (15 Min),,97535,CPT,Facility,Outpatient,,,GO,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),49.98,49,,percent of total billed charges,,
Ot Self Care/Adl/Home Management (15 Min),,97535,CPT,Facility,Inpatient,,,GO,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Ot Self Care/Adl/Home Management (15 Min),,97535,CPT,Facility,Both,,,GO,102,86.7,29.2332,102,CorVel,Worker's Compensation,102,100,,percent of total billed charges,,
Ot Self Care/Adl/Home Management (15 Min),,97535,CPT,Facility,Both,,,GO,102,86.7,29.2332,102,First Health Group Corporation,First Health Network,98.94,97,,percent of total billed charges,,
Ot Self Care/Adl/Home Management (15 Min),,97535,CPT,Facility,Both,,,GO,102,86.7,29.2332,102,"Health Partners, Inc.",Commercial,96.492,94.6,,percent of total billed charges,,
Ot Self Care/Adl/Home Management (15 Min),,97535,CPT,Facility,Outpatient,,,GO,102,86.7,29.2332,102,"Health Partners, Inc.",Medicare Advantage,49.98,49,,percent of total billed charges,,
Ot Self Care/Adl/Home Management (15 Min),,97535,CPT,Facility,Inpatient,,,GO,102,86.7,29.2332,102,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ot Self Care/Adl/Home Management (15 Min),,97535,CPT,Facility,Both,,,GO,102,86.7,29.2332,102,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),61.2,60,,percent of total billed charges,,
Ot Self Care/Adl/Home Management (15 Min),,97535,CPT,Facility,Both,,,GO,102,86.7,29.2332,102,"Health Partners, Inc.",State of Minnesota Advantage Program,83.13,81.5,,percent of total billed charges,,
Ot Self Care/Adl/Home Management (15 Min),,97535,CPT,Facility,Both,,,GO,102,86.7,29.2332,102,"Health Partners, Inc.",State Public Programs,51,50,,percent of total billed charges,,
Ot Self Care/Adl/Home Management (15 Min),,97535,CPT,Facility,Both,,,GO,102,86.7,29.2332,102,Humana Insurance Company,Commercial PPO,96.9,95,,percent of total billed charges,,
Ot Self Care/Adl/Home Management (15 Min),,97535,CPT,Facility,Outpatient,,,GO,102,86.7,29.2332,102,Humana Insurance Company,Medicare PPO,49.98,49,,percent of total billed charges,,
Ot Self Care/Adl/Home Management (15 Min),,97535,CPT,Facility,Inpatient,,,GO,102,86.7,29.2332,102,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Ot Self Care/Adl/Home Management (15 Min),,97535,CPT,Facility,Both,,,GO,102,86.7,29.2332,102,Medica,Individual & Family,101.082,99.1,,percent of total billed charges,,
Ot Self Care/Adl/Home Management (15 Min),,97535,CPT,Facility,Outpatient,,,GO,102,86.7,29.2332,102,Medica,Medica Advantage Solution,50.796,49.8,,percent of total billed charges,,
Ot Self Care/Adl/Home Management (15 Min),,97535,CPT,Facility,Inpatient,,,GO,102,86.7,29.2332,102,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Ot Self Care/Adl/Home Management (15 Min),,97535,CPT,Facility,Outpatient,,,GO,102,86.7,29.2332,102,Medica,Medical Assistance,45.492,44.6,,percent of total billed charges,,
Ot Self Care/Adl/Home Management (15 Min),,97535,CPT,Facility,Inpatient,,,GO,102,86.7,29.2332,102,Medica,Medical Assistance,,,,,Included in per diem rate,
Ot Self Care/Adl/Home Management (15 Min),,97535,CPT,Facility,Outpatient,,,GO,102,86.7,29.2332,102,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,50.796,49.8,,percent of total billed charges,,
Ot Self Care/Adl/Home Management (15 Min),,97535,CPT,Facility,Inpatient,,,GO,102,86.7,29.2332,102,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Ot Self Care/Adl/Home Management (15 Min),,97535,CPT,Facility,Both,,,GO,102,86.7,29.2332,102,"Multiplan, Inc.","Multiplan, Inc.",95.88,94,,percent of total billed charges,,
Ot Self Care/Adl/Home Management (15 Min),,97535,CPT,Facility,Outpatient,,,GO,102,86.7,29.2332,102,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,88.128,86.4,,percent of total billed charges,,
Ot Self Care/Adl/Home Management (15 Min),,97535,CPT,Facility,Inpatient,,,GO,102,86.7,29.2332,102,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Ot Self Care/Adl/Home Management (15 Min),,97535,CPT,Facility,Both,,,GO,102,86.7,29.2332,102,"Preferred One Administrative Services, INC.",PPO,100.572,98.6,,percent of total billed charges,,
Ot Self Care/Adl/Home Management (15 Min),,97535,CPT,Facility,Outpatient,,,GO,102,86.7,29.2332,102,PrimeWest Health,Minnesota Senior Health Options (MSHO),52.479,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Ot Self Care/Adl/Home Management (15 Min),,97535,CPT,Facility,Inpatient,,,GO,102,86.7,29.2332,102,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ot Self Care/Adl/Home Management (15 Min),,97535,CPT,Facility,Outpatient,,,GO,102,86.7,29.2332,102,PrimeWest Health,MinnesotaCare,52.3872,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Ot Self Care/Adl/Home Management (15 Min),,97535,CPT,Facility,Inpatient,,,GO,102,86.7,29.2332,102,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Ot Self Care/Adl/Home Management (15 Min),,97535,CPT,Facility,Both,,,GO,102,86.7,29.2332,102,Sanford Health Plan,Sanford Health Plan,93.84,92,,percent of total billed charges,,
Ot Self Care/Adl/Home Management (15 Min),,97535,CPT,Facility,Outpatient,,,GO,102,86.7,29.2332,102,"UCare Health, Inc.",Individual & Family Plan,57.477,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Ot Self Care/Adl/Home Management (15 Min),,97535,CPT,Facility,Inpatient,,,GO,102,86.7,29.2332,102,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Ot Self Care/Adl/Home Management (15 Min),,97535,CPT,Facility,Outpatient,,,GO,102,86.7,29.2332,102,"UCare Health, Inc.",Medical Assistance,51.4794,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ot Self Care/Adl/Home Management (15 Min),,97535,CPT,Facility,Inpatient,,,GO,102,86.7,29.2332,102,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Ot Self Care/Adl/Home Management (15 Min),,97535,CPT,Facility,Outpatient,,,GO,102,86.7,29.2332,102,"UCare Health, Inc.",Medicare Advantage,51.4794,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ot Self Care/Adl/Home Management (15 Min),,97535,CPT,Facility,Inpatient,,,GO,102,86.7,29.2332,102,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ot Self Care/Adl/Home Management (15 Min),,97535,CPT,Facility,Outpatient,,,GO,102,86.7,29.2332,102,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),51.4794,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ot Self Care/Adl/Home Management (15 Min),,97535,CPT,Facility,Inpatient,,,GO,102,86.7,29.2332,102,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ot Self Care/Adl/Home Management (15 Min),,97535,CPT,Facility,Both,,,GO,102,86.7,29.2332,102,UnitedHealthcare,Individual & Family,95.88,94,,percent of total billed charges,,
Ot Self Care/Adl/Home Management (15 Min),,97535,CPT,Facility,Outpatient,,,GO,102,86.7,29.2332,102,UnitedHealthcare,Medicare Advantage,49.98,49,,percent of total billed charges,,
Ot Self Care/Adl/Home Management (15 Min),,97535,CPT,Facility,Inpatient,,,GO,102,86.7,29.2332,102,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Ot Self Care/Adl/Home Management (15 Min),,97535,CPT,Facility,Outpatient,,,GO,102,86.7,29.2332,102,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,48.96,48,,percent of total billed charges,,100% of DHS outpatient percentage
Ot Self Care/Adl/Home Management (15 Min),,97535,CPT,Facility,Inpatient,,,GO,102,86.7,29.2332,102,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Ot Dls Community/Work Reintegration,,97537,CPT,Facility,Both,,,GO,69,58.65,19.7754,69,Aetna,Commercial,63.48,92,,percent of total billed charges,,
Ot Dls Community/Work Reintegration,,97537,CPT,Facility,Outpatient,,,GO,69,58.65,19.7754,69,Aetna,Medicare Advantage,33.81,49,,percent of total billed charges,,
Ot Dls Community/Work Reintegration,,97537,CPT,Facility,Inpatient,,,GO,69,58.65,19.7754,69,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Ot Dls Community/Work Reintegration,,97537,CPT,Facility,Both,,,GO,69,58.65,19.7754,69,Aetna,PPO,64.17,93,,percent of total billed charges,,
Ot Dls Community/Work Reintegration,,97537,CPT,Facility,Both,,,GO,69,58.65,19.7754,69,America's PPO,America's PPO,66.2607,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Ot Dls Community/Work Reintegration,,97537,CPT,Facility,Both,,,GO,69,58.65,19.7754,69,BlueCross BlueShield Minnesota, Federal Employee Program,67.896,98.4,,percent of total billed charges,,
Ot Dls Community/Work Reintegration,,97537,CPT,Facility,Both,,,GO,69,58.65,19.7754,69,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,69,100,,percent of total billed charges,,
Ot Dls Community/Work Reintegration,,97537,CPT,Facility,Both,,,GO,69,58.65,19.7754,69,BlueCross BlueShield Minnesota,High Value Network Plan,62.1,90,,percent of total billed charges,,
Ot Dls Community/Work Reintegration,,97537,CPT,Facility,Outpatient,,,GO,69,58.65,19.7754,69,BlueCross BlueShield Minnesota,Medicare Advantage,33.81,49,,percent of total billed charges,,
Ot Dls Community/Work Reintegration,,97537,CPT,Facility,Inpatient,,,GO,69,58.65,19.7754,69,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Ot Dls Community/Work Reintegration,,97537,CPT,Facility,Both,,,GO,69,58.65,19.7754,69,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,61.1133,88.57,,percent of total billed charges,,
Ot Dls Community/Work Reintegration,,97537,CPT,Facility,Both,,,GO,69,58.65,19.7754,69,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,19.7754,28.66,,percent of total billed charges,,
Ot Dls Community/Work Reintegration,,97537,CPT,Facility,Outpatient,,,GO,69,58.65,19.7754,69,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),33.81,49,,percent of total billed charges,,
Ot Dls Community/Work Reintegration,,97537,CPT,Facility,Inpatient,,,GO,69,58.65,19.7754,69,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Ot Dls Community/Work Reintegration,,97537,CPT,Facility,Both,,,GO,69,58.65,19.7754,69,CorVel,Worker's Compensation,69,100,,percent of total billed charges,,
Ot Dls Community/Work Reintegration,,97537,CPT,Facility,Both,,,GO,69,58.65,19.7754,69,First Health Group Corporation,First Health Network,66.93,97,,percent of total billed charges,,
Ot Dls Community/Work Reintegration,,97537,CPT,Facility,Both,,,GO,69,58.65,19.7754,69,"Health Partners, Inc.",Commercial,65.274,94.6,,percent of total billed charges,,
Ot Dls Community/Work Reintegration,,97537,CPT,Facility,Outpatient,,,GO,69,58.65,19.7754,69,"Health Partners, Inc.",Medicare Advantage,33.81,49,,percent of total billed charges,,
Ot Dls Community/Work Reintegration,,97537,CPT,Facility,Inpatient,,,GO,69,58.65,19.7754,69,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ot Dls Community/Work Reintegration,,97537,CPT,Facility,Both,,,GO,69,58.65,19.7754,69,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),41.4,60,,percent of total billed charges,,
Ot Dls Community/Work Reintegration,,97537,CPT,Facility,Both,,,GO,69,58.65,19.7754,69,"Health Partners, Inc.",State of Minnesota Advantage Program,56.235,81.5,,percent of total billed charges,,
Ot Dls Community/Work Reintegration,,97537,CPT,Facility,Both,,,GO,69,58.65,19.7754,69,"Health Partners, Inc.",State Public Programs,34.5,50,,percent of total billed charges,,
Ot Dls Community/Work Reintegration,,97537,CPT,Facility,Both,,,GO,69,58.65,19.7754,69,Humana Insurance Company,Commercial PPO,65.55,95,,percent of total billed charges,,
Ot Dls Community/Work Reintegration,,97537,CPT,Facility,Outpatient,,,GO,69,58.65,19.7754,69,Humana Insurance Company,Medicare PPO,33.81,49,,percent of total billed charges,,
Ot Dls Community/Work Reintegration,,97537,CPT,Facility,Inpatient,,,GO,69,58.65,19.7754,69,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Ot Dls Community/Work Reintegration,,97537,CPT,Facility,Both,,,GO,69,58.65,19.7754,69,Medica,Individual & Family,68.379,99.1,,percent of total billed charges,,
Ot Dls Community/Work Reintegration,,97537,CPT,Facility,Outpatient,,,GO,69,58.65,19.7754,69,Medica,Medica Advantage Solution,34.362,49.8,,percent of total billed charges,,
Ot Dls Community/Work Reintegration,,97537,CPT,Facility,Inpatient,,,GO,69,58.65,19.7754,69,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Ot Dls Community/Work Reintegration,,97537,CPT,Facility,Outpatient,,,GO,69,58.65,19.7754,69,Medica,Medical Assistance,30.774,44.6,,percent of total billed charges,,
Ot Dls Community/Work Reintegration,,97537,CPT,Facility,Inpatient,,,GO,69,58.65,19.7754,69,Medica,Medical Assistance,,,,,Included in per diem rate,
Ot Dls Community/Work Reintegration,,97537,CPT,Facility,Outpatient,,,GO,69,58.65,19.7754,69,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,34.362,49.8,,percent of total billed charges,,
Ot Dls Community/Work Reintegration,,97537,CPT,Facility,Inpatient,,,GO,69,58.65,19.7754,69,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Ot Dls Community/Work Reintegration,,97537,CPT,Facility,Both,,,GO,69,58.65,19.7754,69,"Multiplan, Inc.","Multiplan, Inc.",64.86,94,,percent of total billed charges,,
Ot Dls Community/Work Reintegration,,97537,CPT,Facility,Outpatient,,,GO,69,58.65,19.7754,69,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,59.616,86.4,,percent of total billed charges,,
Ot Dls Community/Work Reintegration,,97537,CPT,Facility,Inpatient,,,GO,69,58.65,19.7754,69,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Ot Dls Community/Work Reintegration,,97537,CPT,Facility,Both,,,GO,69,58.65,19.7754,69,"Preferred One Administrative Services, INC.",PPO,68.034,98.6,,percent of total billed charges,,
Ot Dls Community/Work Reintegration,,97537,CPT,Facility,Outpatient,,,GO,69,58.65,19.7754,69,PrimeWest Health,Minnesota Senior Health Options (MSHO),35.5005,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Ot Dls Community/Work Reintegration,,97537,CPT,Facility,Inpatient,,,GO,69,58.65,19.7754,69,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ot Dls Community/Work Reintegration,,97537,CPT,Facility,Outpatient,,,GO,69,58.65,19.7754,69,PrimeWest Health,MinnesotaCare,35.4384,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Ot Dls Community/Work Reintegration,,97537,CPT,Facility,Inpatient,,,GO,69,58.65,19.7754,69,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Ot Dls Community/Work Reintegration,,97537,CPT,Facility,Both,,,GO,69,58.65,19.7754,69,Sanford Health Plan,Sanford Health Plan,63.48,92,,percent of total billed charges,,
Ot Dls Community/Work Reintegration,,97537,CPT,Facility,Outpatient,,,GO,69,58.65,19.7754,69,"UCare Health, Inc.",Individual & Family Plan,38.8815,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Ot Dls Community/Work Reintegration,,97537,CPT,Facility,Inpatient,,,GO,69,58.65,19.7754,69,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Ot Dls Community/Work Reintegration,,97537,CPT,Facility,Outpatient,,,GO,69,58.65,19.7754,69,"UCare Health, Inc.",Medical Assistance,34.8243,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ot Dls Community/Work Reintegration,,97537,CPT,Facility,Inpatient,,,GO,69,58.65,19.7754,69,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Ot Dls Community/Work Reintegration,,97537,CPT,Facility,Outpatient,,,GO,69,58.65,19.7754,69,"UCare Health, Inc.",Medicare Advantage,34.8243,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ot Dls Community/Work Reintegration,,97537,CPT,Facility,Inpatient,,,GO,69,58.65,19.7754,69,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ot Dls Community/Work Reintegration,,97537,CPT,Facility,Outpatient,,,GO,69,58.65,19.7754,69,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),34.8243,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ot Dls Community/Work Reintegration,,97537,CPT,Facility,Inpatient,,,GO,69,58.65,19.7754,69,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ot Dls Community/Work Reintegration,,97537,CPT,Facility,Both,,,GO,69,58.65,19.7754,69,UnitedHealthcare,Individual & Family,64.86,94,,percent of total billed charges,,
Ot Dls Community/Work Reintegration,,97537,CPT,Facility,Outpatient,,,GO,69,58.65,19.7754,69,UnitedHealthcare,Medicare Advantage,33.81,49,,percent of total billed charges,,
Ot Dls Community/Work Reintegration,,97537,CPT,Facility,Inpatient,,,GO,69,58.65,19.7754,69,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Ot Dls Community/Work Reintegration,,97537,CPT,Facility,Outpatient,,,GO,69,58.65,19.7754,69,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,33.12,48,,percent of total billed charges,,100% of DHS outpatient percentage
Ot Dls Community/Work Reintegration,,97537,CPT,Facility,Inpatient,,,GO,69,58.65,19.7754,69,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Ot Wheelchair Management/Training (15 Min),,97542,CPT,Facility,Both,,,GO,77,65.45,22.0682,77,Aetna,Commercial,70.84,92,,percent of total billed charges,,
Ot Wheelchair Management/Training (15 Min),,97542,CPT,Facility,Outpatient,,,GO,77,65.45,22.0682,77,Aetna,Medicare Advantage,37.73,49,,percent of total billed charges,,
Ot Wheelchair Management/Training (15 Min),,97542,CPT,Facility,Inpatient,,,GO,77,65.45,22.0682,77,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Ot Wheelchair Management/Training (15 Min),,97542,CPT,Facility,Both,,,GO,77,65.45,22.0682,77,Aetna,PPO,71.61,93,,percent of total billed charges,,
Ot Wheelchair Management/Training (15 Min),,97542,CPT,Facility,Both,,,GO,77,65.45,22.0682,77,America's PPO,America's PPO,73.9431,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Ot Wheelchair Management/Training (15 Min),,97542,CPT,Facility,Both,,,GO,77,65.45,22.0682,77,BlueCross BlueShield Minnesota, Federal Employee Program,75.768,98.4,,percent of total billed charges,,
Ot Wheelchair Management/Training (15 Min),,97542,CPT,Facility,Both,,,GO,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,77,100,,percent of total billed charges,,
Ot Wheelchair Management/Training (15 Min),,97542,CPT,Facility,Both,,,GO,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,High Value Network Plan,69.3,90,,percent of total billed charges,,
Ot Wheelchair Management/Training (15 Min),,97542,CPT,Facility,Outpatient,,,GO,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,Medicare Advantage,37.73,49,,percent of total billed charges,,
Ot Wheelchair Management/Training (15 Min),,97542,CPT,Facility,Inpatient,,,GO,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Ot Wheelchair Management/Training (15 Min),,97542,CPT,Facility,Both,,,GO,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,68.1989,88.57,,percent of total billed charges,,
Ot Wheelchair Management/Training (15 Min),,97542,CPT,Facility,Both,,,GO,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,22.0682,28.66,,percent of total billed charges,,
Ot Wheelchair Management/Training (15 Min),,97542,CPT,Facility,Outpatient,,,GO,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),37.73,49,,percent of total billed charges,,
Ot Wheelchair Management/Training (15 Min),,97542,CPT,Facility,Inpatient,,,GO,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Ot Wheelchair Management/Training (15 Min),,97542,CPT,Facility,Both,,,GO,77,65.45,22.0682,77,CorVel,Worker's Compensation,77,100,,percent of total billed charges,,
Ot Wheelchair Management/Training (15 Min),,97542,CPT,Facility,Both,,,GO,77,65.45,22.0682,77,First Health Group Corporation,First Health Network,74.69,97,,percent of total billed charges,,
Ot Wheelchair Management/Training (15 Min),,97542,CPT,Facility,Both,,,GO,77,65.45,22.0682,77,"Health Partners, Inc.",Commercial,72.842,94.6,,percent of total billed charges,,
Ot Wheelchair Management/Training (15 Min),,97542,CPT,Facility,Outpatient,,,GO,77,65.45,22.0682,77,"Health Partners, Inc.",Medicare Advantage,37.73,49,,percent of total billed charges,,
Ot Wheelchair Management/Training (15 Min),,97542,CPT,Facility,Inpatient,,,GO,77,65.45,22.0682,77,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ot Wheelchair Management/Training (15 Min),,97542,CPT,Facility,Both,,,GO,77,65.45,22.0682,77,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),46.2,60,,percent of total billed charges,,
Ot Wheelchair Management/Training (15 Min),,97542,CPT,Facility,Both,,,GO,77,65.45,22.0682,77,"Health Partners, Inc.",State of Minnesota Advantage Program,62.755,81.5,,percent of total billed charges,,
Ot Wheelchair Management/Training (15 Min),,97542,CPT,Facility,Both,,,GO,77,65.45,22.0682,77,"Health Partners, Inc.",State Public Programs,38.5,50,,percent of total billed charges,,
Ot Wheelchair Management/Training (15 Min),,97542,CPT,Facility,Both,,,GO,77,65.45,22.0682,77,Humana Insurance Company,Commercial PPO,73.15,95,,percent of total billed charges,,
Ot Wheelchair Management/Training (15 Min),,97542,CPT,Facility,Outpatient,,,GO,77,65.45,22.0682,77,Humana Insurance Company,Medicare PPO,37.73,49,,percent of total billed charges,,
Ot Wheelchair Management/Training (15 Min),,97542,CPT,Facility,Inpatient,,,GO,77,65.45,22.0682,77,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Ot Wheelchair Management/Training (15 Min),,97542,CPT,Facility,Both,,,GO,77,65.45,22.0682,77,Medica,Individual & Family,76.307,99.1,,percent of total billed charges,,
Ot Wheelchair Management/Training (15 Min),,97542,CPT,Facility,Outpatient,,,GO,77,65.45,22.0682,77,Medica,Medica Advantage Solution,38.346,49.8,,percent of total billed charges,,
Ot Wheelchair Management/Training (15 Min),,97542,CPT,Facility,Inpatient,,,GO,77,65.45,22.0682,77,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Ot Wheelchair Management/Training (15 Min),,97542,CPT,Facility,Outpatient,,,GO,77,65.45,22.0682,77,Medica,Medical Assistance,34.342,44.6,,percent of total billed charges,,
Ot Wheelchair Management/Training (15 Min),,97542,CPT,Facility,Inpatient,,,GO,77,65.45,22.0682,77,Medica,Medical Assistance,,,,,Included in per diem rate,
Ot Wheelchair Management/Training (15 Min),,97542,CPT,Facility,Outpatient,,,GO,77,65.45,22.0682,77,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,38.346,49.8,,percent of total billed charges,,
Ot Wheelchair Management/Training (15 Min),,97542,CPT,Facility,Inpatient,,,GO,77,65.45,22.0682,77,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Ot Wheelchair Management/Training (15 Min),,97542,CPT,Facility,Both,,,GO,77,65.45,22.0682,77,"Multiplan, Inc.","Multiplan, Inc.",72.38,94,,percent of total billed charges,,
Ot Wheelchair Management/Training (15 Min),,97542,CPT,Facility,Outpatient,,,GO,77,65.45,22.0682,77,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,66.528,86.4,,percent of total billed charges,,
Ot Wheelchair Management/Training (15 Min),,97542,CPT,Facility,Inpatient,,,GO,77,65.45,22.0682,77,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Ot Wheelchair Management/Training (15 Min),,97542,CPT,Facility,Both,,,GO,77,65.45,22.0682,77,"Preferred One Administrative Services, INC.",PPO,75.922,98.6,,percent of total billed charges,,
Ot Wheelchair Management/Training (15 Min),,97542,CPT,Facility,Outpatient,,,GO,77,65.45,22.0682,77,PrimeWest Health,Minnesota Senior Health Options (MSHO),39.6165,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Ot Wheelchair Management/Training (15 Min),,97542,CPT,Facility,Inpatient,,,GO,77,65.45,22.0682,77,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ot Wheelchair Management/Training (15 Min),,97542,CPT,Facility,Outpatient,,,GO,77,65.45,22.0682,77,PrimeWest Health,MinnesotaCare,39.5472,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Ot Wheelchair Management/Training (15 Min),,97542,CPT,Facility,Inpatient,,,GO,77,65.45,22.0682,77,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Ot Wheelchair Management/Training (15 Min),,97542,CPT,Facility,Both,,,GO,77,65.45,22.0682,77,Sanford Health Plan,Sanford Health Plan,70.84,92,,percent of total billed charges,,
Ot Wheelchair Management/Training (15 Min),,97542,CPT,Facility,Outpatient,,,GO,77,65.45,22.0682,77,"UCare Health, Inc.",Individual & Family Plan,43.3895,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Ot Wheelchair Management/Training (15 Min),,97542,CPT,Facility,Inpatient,,,GO,77,65.45,22.0682,77,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Ot Wheelchair Management/Training (15 Min),,97542,CPT,Facility,Outpatient,,,GO,77,65.45,22.0682,77,"UCare Health, Inc.",Medical Assistance,38.8619,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ot Wheelchair Management/Training (15 Min),,97542,CPT,Facility,Inpatient,,,GO,77,65.45,22.0682,77,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Ot Wheelchair Management/Training (15 Min),,97542,CPT,Facility,Outpatient,,,GO,77,65.45,22.0682,77,"UCare Health, Inc.",Medicare Advantage,38.8619,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ot Wheelchair Management/Training (15 Min),,97542,CPT,Facility,Inpatient,,,GO,77,65.45,22.0682,77,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ot Wheelchair Management/Training (15 Min),,97542,CPT,Facility,Outpatient,,,GO,77,65.45,22.0682,77,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),38.8619,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ot Wheelchair Management/Training (15 Min),,97542,CPT,Facility,Inpatient,,,GO,77,65.45,22.0682,77,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ot Wheelchair Management/Training (15 Min),,97542,CPT,Facility,Both,,,GO,77,65.45,22.0682,77,UnitedHealthcare,Individual & Family,72.38,94,,percent of total billed charges,,
Ot Wheelchair Management/Training (15 Min),,97542,CPT,Facility,Outpatient,,,GO,77,65.45,22.0682,77,UnitedHealthcare,Medicare Advantage,37.73,49,,percent of total billed charges,,
Ot Wheelchair Management/Training (15 Min),,97542,CPT,Facility,Inpatient,,,GO,77,65.45,22.0682,77,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Ot Wheelchair Management/Training (15 Min),,97542,CPT,Facility,Outpatient,,,GO,77,65.45,22.0682,77,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,36.96,48,,percent of total billed charges,,100% of DHS outpatient percentage
Ot Wheelchair Management/Training (15 Min),,97542,CPT,Facility,Inpatient,,,GO,77,65.45,22.0682,77,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Ot Orthotic Management And Training Initial Encounter (15 Min),,97760,CPT,Facility,Both,,,GO,102,86.7,29.2332,102,Aetna,Commercial,93.84,92,,percent of total billed charges,,
Ot Orthotic Management And Training Initial Encounter (15 Min),,97760,CPT,Facility,Outpatient,,,GO,102,86.7,29.2332,102,Aetna,Medicare Advantage,49.98,49,,percent of total billed charges,,
Ot Orthotic Management And Training Initial Encounter (15 Min),,97760,CPT,Facility,Inpatient,,,GO,102,86.7,29.2332,102,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Ot Orthotic Management And Training Initial Encounter (15 Min),,97760,CPT,Facility,Both,,,GO,102,86.7,29.2332,102,Aetna,PPO,94.86,93,,percent of total billed charges,,
Ot Orthotic Management And Training Initial Encounter (15 Min),,97760,CPT,Facility,Both,,,GO,102,86.7,29.2332,102,America's PPO,America's PPO,97.9506,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Ot Orthotic Management And Training Initial Encounter (15 Min),,97760,CPT,Facility,Both,,,GO,102,86.7,29.2332,102,BlueCross BlueShield Minnesota, Federal Employee Program,100.368,98.4,,percent of total billed charges,,
Ot Orthotic Management And Training Initial Encounter (15 Min),,97760,CPT,Facility,Both,,,GO,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,102,100,,percent of total billed charges,,
Ot Orthotic Management And Training Initial Encounter (15 Min),,97760,CPT,Facility,Both,,,GO,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,High Value Network Plan,91.8,90,,percent of total billed charges,,
Ot Orthotic Management And Training Initial Encounter (15 Min),,97760,CPT,Facility,Outpatient,,,GO,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,Medicare Advantage,49.98,49,,percent of total billed charges,,
Ot Orthotic Management And Training Initial Encounter (15 Min),,97760,CPT,Facility,Inpatient,,,GO,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Ot Orthotic Management And Training Initial Encounter (15 Min),,97760,CPT,Facility,Both,,,GO,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,90.3414,88.57,,percent of total billed charges,,
Ot Orthotic Management And Training Initial Encounter (15 Min),,97760,CPT,Facility,Both,,,GO,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,29.2332,28.66,,percent of total billed charges,,
Ot Orthotic Management And Training Initial Encounter (15 Min),,97760,CPT,Facility,Outpatient,,,GO,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),49.98,49,,percent of total billed charges,,
Ot Orthotic Management And Training Initial Encounter (15 Min),,97760,CPT,Facility,Inpatient,,,GO,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Ot Orthotic Management And Training Initial Encounter (15 Min),,97760,CPT,Facility,Both,,,GO,102,86.7,29.2332,102,CorVel,Worker's Compensation,102,100,,percent of total billed charges,,
Ot Orthotic Management And Training Initial Encounter (15 Min),,97760,CPT,Facility,Both,,,GO,102,86.7,29.2332,102,First Health Group Corporation,First Health Network,98.94,97,,percent of total billed charges,,
Ot Orthotic Management And Training Initial Encounter (15 Min),,97760,CPT,Facility,Both,,,GO,102,86.7,29.2332,102,"Health Partners, Inc.",Commercial,96.492,94.6,,percent of total billed charges,,
Ot Orthotic Management And Training Initial Encounter (15 Min),,97760,CPT,Facility,Outpatient,,,GO,102,86.7,29.2332,102,"Health Partners, Inc.",Medicare Advantage,49.98,49,,percent of total billed charges,,
Ot Orthotic Management And Training Initial Encounter (15 Min),,97760,CPT,Facility,Inpatient,,,GO,102,86.7,29.2332,102,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ot Orthotic Management And Training Initial Encounter (15 Min),,97760,CPT,Facility,Both,,,GO,102,86.7,29.2332,102,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),61.2,60,,percent of total billed charges,,
Ot Orthotic Management And Training Initial Encounter (15 Min),,97760,CPT,Facility,Both,,,GO,102,86.7,29.2332,102,"Health Partners, Inc.",State of Minnesota Advantage Program,83.13,81.5,,percent of total billed charges,,
Ot Orthotic Management And Training Initial Encounter (15 Min),,97760,CPT,Facility,Both,,,GO,102,86.7,29.2332,102,"Health Partners, Inc.",State Public Programs,51,50,,percent of total billed charges,,
Ot Orthotic Management And Training Initial Encounter (15 Min),,97760,CPT,Facility,Both,,,GO,102,86.7,29.2332,102,Humana Insurance Company,Commercial PPO,96.9,95,,percent of total billed charges,,
Ot Orthotic Management And Training Initial Encounter (15 Min),,97760,CPT,Facility,Outpatient,,,GO,102,86.7,29.2332,102,Humana Insurance Company,Medicare PPO,49.98,49,,percent of total billed charges,,
Ot Orthotic Management And Training Initial Encounter (15 Min),,97760,CPT,Facility,Inpatient,,,GO,102,86.7,29.2332,102,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Ot Orthotic Management And Training Initial Encounter (15 Min),,97760,CPT,Facility,Both,,,GO,102,86.7,29.2332,102,Medica,Individual & Family,101.082,99.1,,percent of total billed charges,,
Ot Orthotic Management And Training Initial Encounter (15 Min),,97760,CPT,Facility,Outpatient,,,GO,102,86.7,29.2332,102,Medica,Medica Advantage Solution,50.796,49.8,,percent of total billed charges,,
Ot Orthotic Management And Training Initial Encounter (15 Min),,97760,CPT,Facility,Inpatient,,,GO,102,86.7,29.2332,102,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Ot Orthotic Management And Training Initial Encounter (15 Min),,97760,CPT,Facility,Outpatient,,,GO,102,86.7,29.2332,102,Medica,Medical Assistance,45.492,44.6,,percent of total billed charges,,
Ot Orthotic Management And Training Initial Encounter (15 Min),,97760,CPT,Facility,Inpatient,,,GO,102,86.7,29.2332,102,Medica,Medical Assistance,,,,,Included in per diem rate,
Ot Orthotic Management And Training Initial Encounter (15 Min),,97760,CPT,Facility,Outpatient,,,GO,102,86.7,29.2332,102,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,50.796,49.8,,percent of total billed charges,,
Ot Orthotic Management And Training Initial Encounter (15 Min),,97760,CPT,Facility,Inpatient,,,GO,102,86.7,29.2332,102,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Ot Orthotic Management And Training Initial Encounter (15 Min),,97760,CPT,Facility,Both,,,GO,102,86.7,29.2332,102,"Multiplan, Inc.","Multiplan, Inc.",95.88,94,,percent of total billed charges,,
Ot Orthotic Management And Training Initial Encounter (15 Min),,97760,CPT,Facility,Outpatient,,,GO,102,86.7,29.2332,102,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,88.128,86.4,,percent of total billed charges,,
Ot Orthotic Management And Training Initial Encounter (15 Min),,97760,CPT,Facility,Inpatient,,,GO,102,86.7,29.2332,102,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Ot Orthotic Management And Training Initial Encounter (15 Min),,97760,CPT,Facility,Both,,,GO,102,86.7,29.2332,102,"Preferred One Administrative Services, INC.",PPO,100.572,98.6,,percent of total billed charges,,
Ot Orthotic Management And Training Initial Encounter (15 Min),,97760,CPT,Facility,Outpatient,,,GO,102,86.7,29.2332,102,PrimeWest Health,Minnesota Senior Health Options (MSHO),52.479,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Ot Orthotic Management And Training Initial Encounter (15 Min),,97760,CPT,Facility,Inpatient,,,GO,102,86.7,29.2332,102,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ot Orthotic Management And Training Initial Encounter (15 Min),,97760,CPT,Facility,Outpatient,,,GO,102,86.7,29.2332,102,PrimeWest Health,MinnesotaCare,52.3872,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Ot Orthotic Management And Training Initial Encounter (15 Min),,97760,CPT,Facility,Inpatient,,,GO,102,86.7,29.2332,102,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Ot Orthotic Management And Training Initial Encounter (15 Min),,97760,CPT,Facility,Both,,,GO,102,86.7,29.2332,102,Sanford Health Plan,Sanford Health Plan,93.84,92,,percent of total billed charges,,
Ot Orthotic Management And Training Initial Encounter (15 Min),,97760,CPT,Facility,Outpatient,,,GO,102,86.7,29.2332,102,"UCare Health, Inc.",Individual & Family Plan,57.477,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Ot Orthotic Management And Training Initial Encounter (15 Min),,97760,CPT,Facility,Inpatient,,,GO,102,86.7,29.2332,102,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Ot Orthotic Management And Training Initial Encounter (15 Min),,97760,CPT,Facility,Outpatient,,,GO,102,86.7,29.2332,102,"UCare Health, Inc.",Medical Assistance,51.4794,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ot Orthotic Management And Training Initial Encounter (15 Min),,97760,CPT,Facility,Inpatient,,,GO,102,86.7,29.2332,102,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Ot Orthotic Management And Training Initial Encounter (15 Min),,97760,CPT,Facility,Outpatient,,,GO,102,86.7,29.2332,102,"UCare Health, Inc.",Medicare Advantage,51.4794,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ot Orthotic Management And Training Initial Encounter (15 Min),,97760,CPT,Facility,Inpatient,,,GO,102,86.7,29.2332,102,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ot Orthotic Management And Training Initial Encounter (15 Min),,97760,CPT,Facility,Outpatient,,,GO,102,86.7,29.2332,102,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),51.4794,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ot Orthotic Management And Training Initial Encounter (15 Min),,97760,CPT,Facility,Inpatient,,,GO,102,86.7,29.2332,102,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ot Orthotic Management And Training Initial Encounter (15 Min),,97760,CPT,Facility,Both,,,GO,102,86.7,29.2332,102,UnitedHealthcare,Individual & Family,95.88,94,,percent of total billed charges,,
Ot Orthotic Management And Training Initial Encounter (15 Min),,97760,CPT,Facility,Outpatient,,,GO,102,86.7,29.2332,102,UnitedHealthcare,Medicare Advantage,49.98,49,,percent of total billed charges,,
Ot Orthotic Management And Training Initial Encounter (15 Min),,97760,CPT,Facility,Inpatient,,,GO,102,86.7,29.2332,102,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Ot Orthotic Management And Training Initial Encounter (15 Min),,97760,CPT,Facility,Outpatient,,,GO,102,86.7,29.2332,102,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,48.96,48,,percent of total billed charges,,100% of DHS outpatient percentage
Ot Orthotic Management And Training Initial Encounter (15 Min),,97760,CPT,Facility,Inpatient,,,GO,102,86.7,29.2332,102,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Ot Prosthetic Training Initial Encounter (15 Min),,97761,CPT,Facility,Both,,,GO,69,58.65,19.7754,69,Aetna,Commercial,63.48,92,,percent of total billed charges,,
Ot Prosthetic Training Initial Encounter (15 Min),,97761,CPT,Facility,Outpatient,,,GO,69,58.65,19.7754,69,Aetna,Medicare Advantage,33.81,49,,percent of total billed charges,,
Ot Prosthetic Training Initial Encounter (15 Min),,97761,CPT,Facility,Inpatient,,,GO,69,58.65,19.7754,69,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Ot Prosthetic Training Initial Encounter (15 Min),,97761,CPT,Facility,Both,,,GO,69,58.65,19.7754,69,Aetna,PPO,64.17,93,,percent of total billed charges,,
Ot Prosthetic Training Initial Encounter (15 Min),,97761,CPT,Facility,Both,,,GO,69,58.65,19.7754,69,America's PPO,America's PPO,66.2607,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Ot Prosthetic Training Initial Encounter (15 Min),,97761,CPT,Facility,Both,,,GO,69,58.65,19.7754,69,BlueCross BlueShield Minnesota, Federal Employee Program,67.896,98.4,,percent of total billed charges,,
Ot Prosthetic Training Initial Encounter (15 Min),,97761,CPT,Facility,Both,,,GO,69,58.65,19.7754,69,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,69,100,,percent of total billed charges,,
Ot Prosthetic Training Initial Encounter (15 Min),,97761,CPT,Facility,Both,,,GO,69,58.65,19.7754,69,BlueCross BlueShield Minnesota,High Value Network Plan,62.1,90,,percent of total billed charges,,
Ot Prosthetic Training Initial Encounter (15 Min),,97761,CPT,Facility,Outpatient,,,GO,69,58.65,19.7754,69,BlueCross BlueShield Minnesota,Medicare Advantage,33.81,49,,percent of total billed charges,,
Ot Prosthetic Training Initial Encounter (15 Min),,97761,CPT,Facility,Inpatient,,,GO,69,58.65,19.7754,69,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Ot Prosthetic Training Initial Encounter (15 Min),,97761,CPT,Facility,Both,,,GO,69,58.65,19.7754,69,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,61.1133,88.57,,percent of total billed charges,,
Ot Prosthetic Training Initial Encounter (15 Min),,97761,CPT,Facility,Both,,,GO,69,58.65,19.7754,69,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,19.7754,28.66,,percent of total billed charges,,
Ot Prosthetic Training Initial Encounter (15 Min),,97761,CPT,Facility,Outpatient,,,GO,69,58.65,19.7754,69,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),33.81,49,,percent of total billed charges,,
Ot Prosthetic Training Initial Encounter (15 Min),,97761,CPT,Facility,Inpatient,,,GO,69,58.65,19.7754,69,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Ot Prosthetic Training Initial Encounter (15 Min),,97761,CPT,Facility,Both,,,GO,69,58.65,19.7754,69,CorVel,Worker's Compensation,69,100,,percent of total billed charges,,
Ot Prosthetic Training Initial Encounter (15 Min),,97761,CPT,Facility,Both,,,GO,69,58.65,19.7754,69,First Health Group Corporation,First Health Network,66.93,97,,percent of total billed charges,,
Ot Prosthetic Training Initial Encounter (15 Min),,97761,CPT,Facility,Both,,,GO,69,58.65,19.7754,69,"Health Partners, Inc.",Commercial,65.274,94.6,,percent of total billed charges,,
Ot Prosthetic Training Initial Encounter (15 Min),,97761,CPT,Facility,Outpatient,,,GO,69,58.65,19.7754,69,"Health Partners, Inc.",Medicare Advantage,33.81,49,,percent of total billed charges,,
Ot Prosthetic Training Initial Encounter (15 Min),,97761,CPT,Facility,Inpatient,,,GO,69,58.65,19.7754,69,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ot Prosthetic Training Initial Encounter (15 Min),,97761,CPT,Facility,Both,,,GO,69,58.65,19.7754,69,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),41.4,60,,percent of total billed charges,,
Ot Prosthetic Training Initial Encounter (15 Min),,97761,CPT,Facility,Both,,,GO,69,58.65,19.7754,69,"Health Partners, Inc.",State of Minnesota Advantage Program,56.235,81.5,,percent of total billed charges,,
Ot Prosthetic Training Initial Encounter (15 Min),,97761,CPT,Facility,Both,,,GO,69,58.65,19.7754,69,"Health Partners, Inc.",State Public Programs,34.5,50,,percent of total billed charges,,
Ot Prosthetic Training Initial Encounter (15 Min),,97761,CPT,Facility,Both,,,GO,69,58.65,19.7754,69,Humana Insurance Company,Commercial PPO,65.55,95,,percent of total billed charges,,
Ot Prosthetic Training Initial Encounter (15 Min),,97761,CPT,Facility,Outpatient,,,GO,69,58.65,19.7754,69,Humana Insurance Company,Medicare PPO,33.81,49,,percent of total billed charges,,
Ot Prosthetic Training Initial Encounter (15 Min),,97761,CPT,Facility,Inpatient,,,GO,69,58.65,19.7754,69,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Ot Prosthetic Training Initial Encounter (15 Min),,97761,CPT,Facility,Both,,,GO,69,58.65,19.7754,69,Medica,Individual & Family,68.379,99.1,,percent of total billed charges,,
Ot Prosthetic Training Initial Encounter (15 Min),,97761,CPT,Facility,Outpatient,,,GO,69,58.65,19.7754,69,Medica,Medica Advantage Solution,34.362,49.8,,percent of total billed charges,,
Ot Prosthetic Training Initial Encounter (15 Min),,97761,CPT,Facility,Inpatient,,,GO,69,58.65,19.7754,69,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Ot Prosthetic Training Initial Encounter (15 Min),,97761,CPT,Facility,Outpatient,,,GO,69,58.65,19.7754,69,Medica,Medical Assistance,30.774,44.6,,percent of total billed charges,,
Ot Prosthetic Training Initial Encounter (15 Min),,97761,CPT,Facility,Inpatient,,,GO,69,58.65,19.7754,69,Medica,Medical Assistance,,,,,Included in per diem rate,
Ot Prosthetic Training Initial Encounter (15 Min),,97761,CPT,Facility,Outpatient,,,GO,69,58.65,19.7754,69,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,34.362,49.8,,percent of total billed charges,,
Ot Prosthetic Training Initial Encounter (15 Min),,97761,CPT,Facility,Inpatient,,,GO,69,58.65,19.7754,69,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Ot Prosthetic Training Initial Encounter (15 Min),,97761,CPT,Facility,Both,,,GO,69,58.65,19.7754,69,"Multiplan, Inc.","Multiplan, Inc.",64.86,94,,percent of total billed charges,,
Ot Prosthetic Training Initial Encounter (15 Min),,97761,CPT,Facility,Outpatient,,,GO,69,58.65,19.7754,69,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,59.616,86.4,,percent of total billed charges,,
Ot Prosthetic Training Initial Encounter (15 Min),,97761,CPT,Facility,Inpatient,,,GO,69,58.65,19.7754,69,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Ot Prosthetic Training Initial Encounter (15 Min),,97761,CPT,Facility,Both,,,GO,69,58.65,19.7754,69,"Preferred One Administrative Services, INC.",PPO,68.034,98.6,,percent of total billed charges,,
Ot Prosthetic Training Initial Encounter (15 Min),,97761,CPT,Facility,Outpatient,,,GO,69,58.65,19.7754,69,PrimeWest Health,Minnesota Senior Health Options (MSHO),35.5005,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Ot Prosthetic Training Initial Encounter (15 Min),,97761,CPT,Facility,Inpatient,,,GO,69,58.65,19.7754,69,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ot Prosthetic Training Initial Encounter (15 Min),,97761,CPT,Facility,Outpatient,,,GO,69,58.65,19.7754,69,PrimeWest Health,MinnesotaCare,35.4384,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Ot Prosthetic Training Initial Encounter (15 Min),,97761,CPT,Facility,Inpatient,,,GO,69,58.65,19.7754,69,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Ot Prosthetic Training Initial Encounter (15 Min),,97761,CPT,Facility,Both,,,GO,69,58.65,19.7754,69,Sanford Health Plan,Sanford Health Plan,63.48,92,,percent of total billed charges,,
Ot Prosthetic Training Initial Encounter (15 Min),,97761,CPT,Facility,Outpatient,,,GO,69,58.65,19.7754,69,"UCare Health, Inc.",Individual & Family Plan,38.8815,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Ot Prosthetic Training Initial Encounter (15 Min),,97761,CPT,Facility,Inpatient,,,GO,69,58.65,19.7754,69,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Ot Prosthetic Training Initial Encounter (15 Min),,97761,CPT,Facility,Outpatient,,,GO,69,58.65,19.7754,69,"UCare Health, Inc.",Medical Assistance,34.8243,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ot Prosthetic Training Initial Encounter (15 Min),,97761,CPT,Facility,Inpatient,,,GO,69,58.65,19.7754,69,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Ot Prosthetic Training Initial Encounter (15 Min),,97761,CPT,Facility,Outpatient,,,GO,69,58.65,19.7754,69,"UCare Health, Inc.",Medicare Advantage,34.8243,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ot Prosthetic Training Initial Encounter (15 Min),,97761,CPT,Facility,Inpatient,,,GO,69,58.65,19.7754,69,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ot Prosthetic Training Initial Encounter (15 Min),,97761,CPT,Facility,Outpatient,,,GO,69,58.65,19.7754,69,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),34.8243,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ot Prosthetic Training Initial Encounter (15 Min),,97761,CPT,Facility,Inpatient,,,GO,69,58.65,19.7754,69,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ot Prosthetic Training Initial Encounter (15 Min),,97761,CPT,Facility,Both,,,GO,69,58.65,19.7754,69,UnitedHealthcare,Individual & Family,64.86,94,,percent of total billed charges,,
Ot Prosthetic Training Initial Encounter (15 Min),,97761,CPT,Facility,Outpatient,,,GO,69,58.65,19.7754,69,UnitedHealthcare,Medicare Advantage,33.81,49,,percent of total billed charges,,
Ot Prosthetic Training Initial Encounter (15 Min),,97761,CPT,Facility,Inpatient,,,GO,69,58.65,19.7754,69,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Ot Prosthetic Training Initial Encounter (15 Min),,97761,CPT,Facility,Outpatient,,,GO,69,58.65,19.7754,69,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,33.12,48,,percent of total billed charges,,100% of DHS outpatient percentage
Ot Prosthetic Training Initial Encounter (15 Min),,97761,CPT,Facility,Inpatient,,,GO,69,58.65,19.7754,69,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Ot Orthotic/Prosthetic Management And Training Subsequent Encounter (15 Min),,97763,CPT,Facility,Both,,,GO,62,52.7,17.7692,62,Aetna,Commercial,57.04,92,,percent of total billed charges,,
Ot Orthotic/Prosthetic Management And Training Subsequent Encounter (15 Min),,97763,CPT,Facility,Outpatient,,,GO,62,52.7,17.7692,62,Aetna,Medicare Advantage,30.38,49,,percent of total billed charges,,
Ot Orthotic/Prosthetic Management And Training Subsequent Encounter (15 Min),,97763,CPT,Facility,Inpatient,,,GO,62,52.7,17.7692,62,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Ot Orthotic/Prosthetic Management And Training Subsequent Encounter (15 Min),,97763,CPT,Facility,Both,,,GO,62,52.7,17.7692,62,Aetna,PPO,57.66,93,,percent of total billed charges,,
Ot Orthotic/Prosthetic Management And Training Subsequent Encounter (15 Min),,97763,CPT,Facility,Both,,,GO,62,52.7,17.7692,62,America's PPO,America's PPO,59.5386,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Ot Orthotic/Prosthetic Management And Training Subsequent Encounter (15 Min),,97763,CPT,Facility,Both,,,GO,62,52.7,17.7692,62,BlueCross BlueShield Minnesota, Federal Employee Program,61.008,98.4,,percent of total billed charges,,
Ot Orthotic/Prosthetic Management And Training Subsequent Encounter (15 Min),,97763,CPT,Facility,Both,,,GO,62,52.7,17.7692,62,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,62,100,,percent of total billed charges,,
Ot Orthotic/Prosthetic Management And Training Subsequent Encounter (15 Min),,97763,CPT,Facility,Both,,,GO,62,52.7,17.7692,62,BlueCross BlueShield Minnesota,High Value Network Plan,55.8,90,,percent of total billed charges,,
Ot Orthotic/Prosthetic Management And Training Subsequent Encounter (15 Min),,97763,CPT,Facility,Outpatient,,,GO,62,52.7,17.7692,62,BlueCross BlueShield Minnesota,Medicare Advantage,30.38,49,,percent of total billed charges,,
Ot Orthotic/Prosthetic Management And Training Subsequent Encounter (15 Min),,97763,CPT,Facility,Inpatient,,,GO,62,52.7,17.7692,62,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Ot Orthotic/Prosthetic Management And Training Subsequent Encounter (15 Min),,97763,CPT,Facility,Both,,,GO,62,52.7,17.7692,62,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,54.9134,88.57,,percent of total billed charges,,
Ot Orthotic/Prosthetic Management And Training Subsequent Encounter (15 Min),,97763,CPT,Facility,Both,,,GO,62,52.7,17.7692,62,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,17.7692,28.66,,percent of total billed charges,,
Ot Orthotic/Prosthetic Management And Training Subsequent Encounter (15 Min),,97763,CPT,Facility,Outpatient,,,GO,62,52.7,17.7692,62,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),30.38,49,,percent of total billed charges,,
Ot Orthotic/Prosthetic Management And Training Subsequent Encounter (15 Min),,97763,CPT,Facility,Inpatient,,,GO,62,52.7,17.7692,62,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Ot Orthotic/Prosthetic Management And Training Subsequent Encounter (15 Min),,97763,CPT,Facility,Both,,,GO,62,52.7,17.7692,62,CorVel,Worker's Compensation,62,100,,percent of total billed charges,,
Ot Orthotic/Prosthetic Management And Training Subsequent Encounter (15 Min),,97763,CPT,Facility,Both,,,GO,62,52.7,17.7692,62,First Health Group Corporation,First Health Network,60.14,97,,percent of total billed charges,,
Ot Orthotic/Prosthetic Management And Training Subsequent Encounter (15 Min),,97763,CPT,Facility,Both,,,GO,62,52.7,17.7692,62,"Health Partners, Inc.",Commercial,58.652,94.6,,percent of total billed charges,,
Ot Orthotic/Prosthetic Management And Training Subsequent Encounter (15 Min),,97763,CPT,Facility,Outpatient,,,GO,62,52.7,17.7692,62,"Health Partners, Inc.",Medicare Advantage,30.38,49,,percent of total billed charges,,
Ot Orthotic/Prosthetic Management And Training Subsequent Encounter (15 Min),,97763,CPT,Facility,Inpatient,,,GO,62,52.7,17.7692,62,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ot Orthotic/Prosthetic Management And Training Subsequent Encounter (15 Min),,97763,CPT,Facility,Both,,,GO,62,52.7,17.7692,62,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),37.2,60,,percent of total billed charges,,
Ot Orthotic/Prosthetic Management And Training Subsequent Encounter (15 Min),,97763,CPT,Facility,Both,,,GO,62,52.7,17.7692,62,"Health Partners, Inc.",State of Minnesota Advantage Program,50.53,81.5,,percent of total billed charges,,
Ot Orthotic/Prosthetic Management And Training Subsequent Encounter (15 Min),,97763,CPT,Facility,Both,,,GO,62,52.7,17.7692,62,"Health Partners, Inc.",State Public Programs,31,50,,percent of total billed charges,,
Ot Orthotic/Prosthetic Management And Training Subsequent Encounter (15 Min),,97763,CPT,Facility,Both,,,GO,62,52.7,17.7692,62,Humana Insurance Company,Commercial PPO,58.9,95,,percent of total billed charges,,
Ot Orthotic/Prosthetic Management And Training Subsequent Encounter (15 Min),,97763,CPT,Facility,Outpatient,,,GO,62,52.7,17.7692,62,Humana Insurance Company,Medicare PPO,30.38,49,,percent of total billed charges,,
Ot Orthotic/Prosthetic Management And Training Subsequent Encounter (15 Min),,97763,CPT,Facility,Inpatient,,,GO,62,52.7,17.7692,62,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Ot Orthotic/Prosthetic Management And Training Subsequent Encounter (15 Min),,97763,CPT,Facility,Both,,,GO,62,52.7,17.7692,62,Medica,Individual & Family,61.442,99.1,,percent of total billed charges,,
Ot Orthotic/Prosthetic Management And Training Subsequent Encounter (15 Min),,97763,CPT,Facility,Outpatient,,,GO,62,52.7,17.7692,62,Medica,Medica Advantage Solution,30.876,49.8,,percent of total billed charges,,
Ot Orthotic/Prosthetic Management And Training Subsequent Encounter (15 Min),,97763,CPT,Facility,Inpatient,,,GO,62,52.7,17.7692,62,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Ot Orthotic/Prosthetic Management And Training Subsequent Encounter (15 Min),,97763,CPT,Facility,Outpatient,,,GO,62,52.7,17.7692,62,Medica,Medical Assistance,27.652,44.6,,percent of total billed charges,,
Ot Orthotic/Prosthetic Management And Training Subsequent Encounter (15 Min),,97763,CPT,Facility,Inpatient,,,GO,62,52.7,17.7692,62,Medica,Medical Assistance,,,,,Included in per diem rate,
Ot Orthotic/Prosthetic Management And Training Subsequent Encounter (15 Min),,97763,CPT,Facility,Outpatient,,,GO,62,52.7,17.7692,62,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,30.876,49.8,,percent of total billed charges,,
Ot Orthotic/Prosthetic Management And Training Subsequent Encounter (15 Min),,97763,CPT,Facility,Inpatient,,,GO,62,52.7,17.7692,62,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Ot Orthotic/Prosthetic Management And Training Subsequent Encounter (15 Min),,97763,CPT,Facility,Both,,,GO,62,52.7,17.7692,62,"Multiplan, Inc.","Multiplan, Inc.",58.28,94,,percent of total billed charges,,
Ot Orthotic/Prosthetic Management And Training Subsequent Encounter (15 Min),,97763,CPT,Facility,Outpatient,,,GO,62,52.7,17.7692,62,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,53.568,86.4,,percent of total billed charges,,
Ot Orthotic/Prosthetic Management And Training Subsequent Encounter (15 Min),,97763,CPT,Facility,Inpatient,,,GO,62,52.7,17.7692,62,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Ot Orthotic/Prosthetic Management And Training Subsequent Encounter (15 Min),,97763,CPT,Facility,Both,,,GO,62,52.7,17.7692,62,"Preferred One Administrative Services, INC.",PPO,61.132,98.6,,percent of total billed charges,,
Ot Orthotic/Prosthetic Management And Training Subsequent Encounter (15 Min),,97763,CPT,Facility,Outpatient,,,GO,62,52.7,17.7692,62,PrimeWest Health,Minnesota Senior Health Options (MSHO),31.899,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Ot Orthotic/Prosthetic Management And Training Subsequent Encounter (15 Min),,97763,CPT,Facility,Inpatient,,,GO,62,52.7,17.7692,62,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ot Orthotic/Prosthetic Management And Training Subsequent Encounter (15 Min),,97763,CPT,Facility,Outpatient,,,GO,62,52.7,17.7692,62,PrimeWest Health,MinnesotaCare,31.8432,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Ot Orthotic/Prosthetic Management And Training Subsequent Encounter (15 Min),,97763,CPT,Facility,Inpatient,,,GO,62,52.7,17.7692,62,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Ot Orthotic/Prosthetic Management And Training Subsequent Encounter (15 Min),,97763,CPT,Facility,Both,,,GO,62,52.7,17.7692,62,Sanford Health Plan,Sanford Health Plan,57.04,92,,percent of total billed charges,,
Ot Orthotic/Prosthetic Management And Training Subsequent Encounter (15 Min),,97763,CPT,Facility,Outpatient,,,GO,62,52.7,17.7692,62,"UCare Health, Inc.",Individual & Family Plan,34.937,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Ot Orthotic/Prosthetic Management And Training Subsequent Encounter (15 Min),,97763,CPT,Facility,Inpatient,,,GO,62,52.7,17.7692,62,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Ot Orthotic/Prosthetic Management And Training Subsequent Encounter (15 Min),,97763,CPT,Facility,Outpatient,,,GO,62,52.7,17.7692,62,"UCare Health, Inc.",Medical Assistance,31.2914,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ot Orthotic/Prosthetic Management And Training Subsequent Encounter (15 Min),,97763,CPT,Facility,Inpatient,,,GO,62,52.7,17.7692,62,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Ot Orthotic/Prosthetic Management And Training Subsequent Encounter (15 Min),,97763,CPT,Facility,Outpatient,,,GO,62,52.7,17.7692,62,"UCare Health, Inc.",Medicare Advantage,31.2914,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ot Orthotic/Prosthetic Management And Training Subsequent Encounter (15 Min),,97763,CPT,Facility,Inpatient,,,GO,62,52.7,17.7692,62,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ot Orthotic/Prosthetic Management And Training Subsequent Encounter (15 Min),,97763,CPT,Facility,Outpatient,,,GO,62,52.7,17.7692,62,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),31.2914,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ot Orthotic/Prosthetic Management And Training Subsequent Encounter (15 Min),,97763,CPT,Facility,Inpatient,,,GO,62,52.7,17.7692,62,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ot Orthotic/Prosthetic Management And Training Subsequent Encounter (15 Min),,97763,CPT,Facility,Both,,,GO,62,52.7,17.7692,62,UnitedHealthcare,Individual & Family,58.28,94,,percent of total billed charges,,
Ot Orthotic/Prosthetic Management And Training Subsequent Encounter (15 Min),,97763,CPT,Facility,Outpatient,,,GO,62,52.7,17.7692,62,UnitedHealthcare,Medicare Advantage,30.38,49,,percent of total billed charges,,
Ot Orthotic/Prosthetic Management And Training Subsequent Encounter (15 Min),,97763,CPT,Facility,Inpatient,,,GO,62,52.7,17.7692,62,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Ot Orthotic/Prosthetic Management And Training Subsequent Encounter (15 Min),,97763,CPT,Facility,Outpatient,,,GO,62,52.7,17.7692,62,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,29.76,48,,percent of total billed charges,,100% of DHS outpatient percentage
Ot Orthotic/Prosthetic Management And Training Subsequent Encounter (15 Min),,97763,CPT,Facility,Inpatient,,,GO,62,52.7,17.7692,62,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Ot Electrical Stimulation Unattended,,G0283,HCPCS,Facility,Outpatient,,,GO,82,69.7,40.18,73.8,Aetna,Medicare Advantage,40.18,49,,percent of total billed charges,,
Ot Electrical Stimulation Unattended,,G0283,HCPCS,Facility,Inpatient,,,GO,82,69.7,40.18,73.8,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Ot Electrical Stimulation Unattended,,G0283,HCPCS,Facility,Outpatient,,,GO,82,69.7,40.18,73.8,BlueCross BlueShield Minnesota,Medicare Advantage,40.18,49,,percent of total billed charges,,
Ot Electrical Stimulation Unattended,,G0283,HCPCS,Facility,Inpatient,,,GO,82,69.7,40.18,73.8,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Ot Electrical Stimulation Unattended,,G0283,HCPCS,Facility,Outpatient,,,GO,82,69.7,40.18,73.8,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),40.18,49,,percent of total billed charges,,
Ot Electrical Stimulation Unattended,,G0283,HCPCS,Facility,Inpatient,,,GO,82,69.7,40.18,73.8,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Ot Electrical Stimulation Unattended,,G0283,HCPCS,Facility,Outpatient,,,GO,82,69.7,40.18,73.8,"Health Partners, Inc.",Medicare Advantage,40.18,49,,percent of total billed charges,,
Ot Electrical Stimulation Unattended,,G0283,HCPCS,Facility,Inpatient,,,GO,82,69.7,40.18,73.8,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ot Electrical Stimulation Unattended,,G0283,HCPCS,Facility,Both,,,GO,82,69.7,40.18,73.8,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),49.2,60,,percent of total billed charges,,
Ot Electrical Stimulation Unattended,,G0283,HCPCS,Facility,Outpatient,,,GO,82,69.7,40.18,73.8,Humana Insurance Company,Medicare PPO,40.18,49,,percent of total billed charges,,
Ot Electrical Stimulation Unattended,,G0283,HCPCS,Facility,Inpatient,,,GO,82,69.7,40.18,73.8,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Ot Electrical Stimulation Unattended,,G0283,HCPCS,Facility,Outpatient,,,GO,82,69.7,40.18,73.8,Medica,Medica Advantage Solution,40.836,49.8,,percent of total billed charges,,
Ot Electrical Stimulation Unattended,,G0283,HCPCS,Facility,Inpatient,,,GO,82,69.7,40.18,73.8,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Ot Electrical Stimulation Unattended,,G0283,HCPCS,Facility,Outpatient,,,GO,82,69.7,40.18,73.8,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,40.836,49.8,,percent of total billed charges,,
Ot Electrical Stimulation Unattended,,G0283,HCPCS,Facility,Inpatient,,,GO,82,69.7,40.18,73.8,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Ot Electrical Stimulation Unattended,,G0283,HCPCS,Facility,Outpatient,,,GO,82,69.7,40.18,73.8,PrimeWest Health,Minnesota Senior Health Options (MSHO),42.189,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Ot Electrical Stimulation Unattended,,G0283,HCPCS,Facility,Inpatient,,,GO,82,69.7,40.18,73.8,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ot Electrical Stimulation Unattended,,G0283,HCPCS,Facility,Outpatient,,,GO,82,69.7,40.18,73.8,"UCare Health, Inc.",Medicare Advantage,41.3854,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ot Electrical Stimulation Unattended,,G0283,HCPCS,Facility,Inpatient,,,GO,82,69.7,40.18,73.8,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ot Electrical Stimulation Unattended,,G0283,HCPCS,Facility,Outpatient,,,GO,82,69.7,40.18,73.8,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),41.3854,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ot Electrical Stimulation Unattended,,G0283,HCPCS,Facility,Inpatient,,,GO,82,69.7,40.18,73.8,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ot Electrical Stimulation Unattended,,G0283,HCPCS,Facility,Outpatient,,,GO,82,69.7,40.18,73.8,UnitedHealthcare,Medicare Advantage,40.18,49,,percent of total billed charges,,
Ot Electrical Stimulation Unattended,,G0283,HCPCS,Facility,Inpatient,,,GO,82,69.7,40.18,73.8,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Pt Biofeedback Pelvic Floor (Initial 15 Min),,90912,CPT,Facility,Both,,,GP,122,103.7,34.9652,122,Aetna,Commercial,112.24,92,,percent of total billed charges,,
Pt Biofeedback Pelvic Floor (Initial 15 Min),,90912,CPT,Facility,Outpatient,,,GP,122,103.7,34.9652,122,Aetna,Medicare Advantage,59.78,49,,percent of total billed charges,,
Pt Biofeedback Pelvic Floor (Initial 15 Min),,90912,CPT,Facility,Inpatient,,,GP,122,103.7,34.9652,122,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Pt Biofeedback Pelvic Floor (Initial 15 Min),,90912,CPT,Facility,Both,,,GP,122,103.7,34.9652,122,Aetna,PPO,113.46,93,,percent of total billed charges,,
Pt Biofeedback Pelvic Floor (Initial 15 Min),,90912,CPT,Facility,Both,,,GP,122,103.7,34.9652,122,America's PPO,America's PPO,117.1566,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Pt Biofeedback Pelvic Floor (Initial 15 Min),,90912,CPT,Facility,Both,,,GP,122,103.7,34.9652,122,BlueCross BlueShield Minnesota, Federal Employee Program,120.048,98.4,,percent of total billed charges,,
Pt Biofeedback Pelvic Floor (Initial 15 Min),,90912,CPT,Facility,Both,,,GP,122,103.7,34.9652,122,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,122,100,,percent of total billed charges,,
Pt Biofeedback Pelvic Floor (Initial 15 Min),,90912,CPT,Facility,Both,,,GP,122,103.7,34.9652,122,BlueCross BlueShield Minnesota,High Value Network Plan,109.8,90,,percent of total billed charges,,
Pt Biofeedback Pelvic Floor (Initial 15 Min),,90912,CPT,Facility,Outpatient,,,GP,122,103.7,34.9652,122,BlueCross BlueShield Minnesota,Medicare Advantage,59.78,49,,percent of total billed charges,,
Pt Biofeedback Pelvic Floor (Initial 15 Min),,90912,CPT,Facility,Inpatient,,,GP,122,103.7,34.9652,122,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Pt Biofeedback Pelvic Floor (Initial 15 Min),,90912,CPT,Facility,Both,,,GP,122,103.7,34.9652,122,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,108.0554,88.57,,percent of total billed charges,,
Pt Biofeedback Pelvic Floor (Initial 15 Min),,90912,CPT,Facility,Both,,,GP,122,103.7,34.9652,122,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,34.9652,28.66,,percent of total billed charges,,
Pt Biofeedback Pelvic Floor (Initial 15 Min),,90912,CPT,Facility,Outpatient,,,GP,122,103.7,34.9652,122,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),59.78,49,,percent of total billed charges,,
Pt Biofeedback Pelvic Floor (Initial 15 Min),,90912,CPT,Facility,Inpatient,,,GP,122,103.7,34.9652,122,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Pt Biofeedback Pelvic Floor (Initial 15 Min),,90912,CPT,Facility,Both,,,GP,122,103.7,34.9652,122,CorVel,Worker's Compensation,122,100,,percent of total billed charges,,
Pt Biofeedback Pelvic Floor (Initial 15 Min),,90912,CPT,Facility,Both,,,GP,122,103.7,34.9652,122,First Health Group Corporation,First Health Network,118.34,97,,percent of total billed charges,,
Pt Biofeedback Pelvic Floor (Initial 15 Min),,90912,CPT,Facility,Both,,,GP,122,103.7,34.9652,122,"Health Partners, Inc.",Commercial,115.412,94.6,,percent of total billed charges,,
Pt Biofeedback Pelvic Floor (Initial 15 Min),,90912,CPT,Facility,Outpatient,,,GP,122,103.7,34.9652,122,"Health Partners, Inc.",Medicare Advantage,59.78,49,,percent of total billed charges,,
Pt Biofeedback Pelvic Floor (Initial 15 Min),,90912,CPT,Facility,Inpatient,,,GP,122,103.7,34.9652,122,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Pt Biofeedback Pelvic Floor (Initial 15 Min),,90912,CPT,Facility,Both,,,GP,122,103.7,34.9652,122,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),73.2,60,,percent of total billed charges,,
Pt Biofeedback Pelvic Floor (Initial 15 Min),,90912,CPT,Facility,Both,,,GP,122,103.7,34.9652,122,"Health Partners, Inc.",State of Minnesota Advantage Program,99.43,81.5,,percent of total billed charges,,
Pt Biofeedback Pelvic Floor (Initial 15 Min),,90912,CPT,Facility,Both,,,GP,122,103.7,34.9652,122,"Health Partners, Inc.",State Public Programs,61,50,,percent of total billed charges,,
Pt Biofeedback Pelvic Floor (Initial 15 Min),,90912,CPT,Facility,Both,,,GP,122,103.7,34.9652,122,Humana Insurance Company,Commercial PPO,115.9,95,,percent of total billed charges,,
Pt Biofeedback Pelvic Floor (Initial 15 Min),,90912,CPT,Facility,Outpatient,,,GP,122,103.7,34.9652,122,Humana Insurance Company,Medicare PPO,59.78,49,,percent of total billed charges,,
Pt Biofeedback Pelvic Floor (Initial 15 Min),,90912,CPT,Facility,Inpatient,,,GP,122,103.7,34.9652,122,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Pt Biofeedback Pelvic Floor (Initial 15 Min),,90912,CPT,Facility,Both,,,GP,122,103.7,34.9652,122,Medica,Individual & Family,120.902,99.1,,percent of total billed charges,,
Pt Biofeedback Pelvic Floor (Initial 15 Min),,90912,CPT,Facility,Outpatient,,,GP,122,103.7,34.9652,122,Medica,Medica Advantage Solution,60.756,49.8,,percent of total billed charges,,
Pt Biofeedback Pelvic Floor (Initial 15 Min),,90912,CPT,Facility,Inpatient,,,GP,122,103.7,34.9652,122,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Pt Biofeedback Pelvic Floor (Initial 15 Min),,90912,CPT,Facility,Outpatient,,,GP,122,103.7,34.9652,122,Medica,Medical Assistance,54.412,44.6,,percent of total billed charges,,
Pt Biofeedback Pelvic Floor (Initial 15 Min),,90912,CPT,Facility,Inpatient,,,GP,122,103.7,34.9652,122,Medica,Medical Assistance,,,,,Included in per diem rate,
Pt Biofeedback Pelvic Floor (Initial 15 Min),,90912,CPT,Facility,Outpatient,,,GP,122,103.7,34.9652,122,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,60.756,49.8,,percent of total billed charges,,
Pt Biofeedback Pelvic Floor (Initial 15 Min),,90912,CPT,Facility,Inpatient,,,GP,122,103.7,34.9652,122,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Pt Biofeedback Pelvic Floor (Initial 15 Min),,90912,CPT,Facility,Both,,,GP,122,103.7,34.9652,122,"Multiplan, Inc.","Multiplan, Inc.",114.68,94,,percent of total billed charges,,
Pt Biofeedback Pelvic Floor (Initial 15 Min),,90912,CPT,Facility,Outpatient,,,GP,122,103.7,34.9652,122,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,105.408,86.4,,percent of total billed charges,,
Pt Biofeedback Pelvic Floor (Initial 15 Min),,90912,CPT,Facility,Inpatient,,,GP,122,103.7,34.9652,122,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Pt Biofeedback Pelvic Floor (Initial 15 Min),,90912,CPT,Facility,Both,,,GP,122,103.7,34.9652,122,"Preferred One Administrative Services, INC.",PPO,120.292,98.6,,percent of total billed charges,,
Pt Biofeedback Pelvic Floor (Initial 15 Min),,90912,CPT,Facility,Outpatient,,,GP,122,103.7,34.9652,122,PrimeWest Health,Minnesota Senior Health Options (MSHO),62.769,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Pt Biofeedback Pelvic Floor (Initial 15 Min),,90912,CPT,Facility,Inpatient,,,GP,122,103.7,34.9652,122,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Pt Biofeedback Pelvic Floor (Initial 15 Min),,90912,CPT,Facility,Outpatient,,,GP,122,103.7,34.9652,122,PrimeWest Health,MinnesotaCare,62.6592,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Pt Biofeedback Pelvic Floor (Initial 15 Min),,90912,CPT,Facility,Inpatient,,,GP,122,103.7,34.9652,122,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Pt Biofeedback Pelvic Floor (Initial 15 Min),,90912,CPT,Facility,Both,,,GP,122,103.7,34.9652,122,Sanford Health Plan,Sanford Health Plan,112.24,92,,percent of total billed charges,,
Pt Biofeedback Pelvic Floor (Initial 15 Min),,90912,CPT,Facility,Outpatient,,,GP,122,103.7,34.9652,122,"UCare Health, Inc.",Individual & Family Plan,68.747,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Pt Biofeedback Pelvic Floor (Initial 15 Min),,90912,CPT,Facility,Inpatient,,,GP,122,103.7,34.9652,122,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Pt Biofeedback Pelvic Floor (Initial 15 Min),,90912,CPT,Facility,Outpatient,,,GP,122,103.7,34.9652,122,"UCare Health, Inc.",Medical Assistance,61.5734,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Pt Biofeedback Pelvic Floor (Initial 15 Min),,90912,CPT,Facility,Inpatient,,,GP,122,103.7,34.9652,122,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Pt Biofeedback Pelvic Floor (Initial 15 Min),,90912,CPT,Facility,Outpatient,,,GP,122,103.7,34.9652,122,"UCare Health, Inc.",Medicare Advantage,61.5734,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Pt Biofeedback Pelvic Floor (Initial 15 Min),,90912,CPT,Facility,Inpatient,,,GP,122,103.7,34.9652,122,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Pt Biofeedback Pelvic Floor (Initial 15 Min),,90912,CPT,Facility,Outpatient,,,GP,122,103.7,34.9652,122,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),61.5734,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Pt Biofeedback Pelvic Floor (Initial 15 Min),,90912,CPT,Facility,Inpatient,,,GP,122,103.7,34.9652,122,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Pt Biofeedback Pelvic Floor (Initial 15 Min),,90912,CPT,Facility,Both,,,GP,122,103.7,34.9652,122,UnitedHealthcare,Individual & Family,114.68,94,,percent of total billed charges,,
Pt Biofeedback Pelvic Floor (Initial 15 Min),,90912,CPT,Facility,Outpatient,,,GP,122,103.7,34.9652,122,UnitedHealthcare,Medicare Advantage,59.78,49,,percent of total billed charges,,
Pt Biofeedback Pelvic Floor (Initial 15 Min),,90912,CPT,Facility,Inpatient,,,GP,122,103.7,34.9652,122,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Pt Biofeedback Pelvic Floor (Initial 15 Min),,90912,CPT,Facility,Outpatient,,,GP,122,103.7,34.9652,122,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,58.56,48,,percent of total billed charges,,100% of DHS outpatient percentage
Pt Biofeedback Pelvic Floor (Initial 15 Min),,90912,CPT,Facility,Inpatient,,,GP,122,103.7,34.9652,122,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Pt Biofeedback Pelvic Floor (Each Subsequent 15 Min),,90913,CPT,Facility,Both,,,GP,122,103.7,34.9652,122,Aetna,Commercial,112.24,92,,percent of total billed charges,,
Pt Biofeedback Pelvic Floor (Each Subsequent 15 Min),,90913,CPT,Facility,Outpatient,,,GP,122,103.7,34.9652,122,Aetna,Medicare Advantage,59.78,49,,percent of total billed charges,,
Pt Biofeedback Pelvic Floor (Each Subsequent 15 Min),,90913,CPT,Facility,Inpatient,,,GP,122,103.7,34.9652,122,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Pt Biofeedback Pelvic Floor (Each Subsequent 15 Min),,90913,CPT,Facility,Both,,,GP,122,103.7,34.9652,122,Aetna,PPO,113.46,93,,percent of total billed charges,,
Pt Biofeedback Pelvic Floor (Each Subsequent 15 Min),,90913,CPT,Facility,Both,,,GP,122,103.7,34.9652,122,America's PPO,America's PPO,117.1566,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Pt Biofeedback Pelvic Floor (Each Subsequent 15 Min),,90913,CPT,Facility,Both,,,GP,122,103.7,34.9652,122,BlueCross BlueShield Minnesota, Federal Employee Program,120.048,98.4,,percent of total billed charges,,
Pt Biofeedback Pelvic Floor (Each Subsequent 15 Min),,90913,CPT,Facility,Both,,,GP,122,103.7,34.9652,122,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,122,100,,percent of total billed charges,,
Pt Biofeedback Pelvic Floor (Each Subsequent 15 Min),,90913,CPT,Facility,Both,,,GP,122,103.7,34.9652,122,BlueCross BlueShield Minnesota,High Value Network Plan,109.8,90,,percent of total billed charges,,
Pt Biofeedback Pelvic Floor (Each Subsequent 15 Min),,90913,CPT,Facility,Outpatient,,,GP,122,103.7,34.9652,122,BlueCross BlueShield Minnesota,Medicare Advantage,59.78,49,,percent of total billed charges,,
Pt Biofeedback Pelvic Floor (Each Subsequent 15 Min),,90913,CPT,Facility,Inpatient,,,GP,122,103.7,34.9652,122,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Pt Biofeedback Pelvic Floor (Each Subsequent 15 Min),,90913,CPT,Facility,Both,,,GP,122,103.7,34.9652,122,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,108.0554,88.57,,percent of total billed charges,,
Pt Biofeedback Pelvic Floor (Each Subsequent 15 Min),,90913,CPT,Facility,Both,,,GP,122,103.7,34.9652,122,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,34.9652,28.66,,percent of total billed charges,,
Pt Biofeedback Pelvic Floor (Each Subsequent 15 Min),,90913,CPT,Facility,Outpatient,,,GP,122,103.7,34.9652,122,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),59.78,49,,percent of total billed charges,,
Pt Biofeedback Pelvic Floor (Each Subsequent 15 Min),,90913,CPT,Facility,Inpatient,,,GP,122,103.7,34.9652,122,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Pt Biofeedback Pelvic Floor (Each Subsequent 15 Min),,90913,CPT,Facility,Both,,,GP,122,103.7,34.9652,122,CorVel,Worker's Compensation,122,100,,percent of total billed charges,,
Pt Biofeedback Pelvic Floor (Each Subsequent 15 Min),,90913,CPT,Facility,Both,,,GP,122,103.7,34.9652,122,First Health Group Corporation,First Health Network,118.34,97,,percent of total billed charges,,
Pt Biofeedback Pelvic Floor (Each Subsequent 15 Min),,90913,CPT,Facility,Both,,,GP,122,103.7,34.9652,122,"Health Partners, Inc.",Commercial,115.412,94.6,,percent of total billed charges,,
Pt Biofeedback Pelvic Floor (Each Subsequent 15 Min),,90913,CPT,Facility,Outpatient,,,GP,122,103.7,34.9652,122,"Health Partners, Inc.",Medicare Advantage,59.78,49,,percent of total billed charges,,
Pt Biofeedback Pelvic Floor (Each Subsequent 15 Min),,90913,CPT,Facility,Inpatient,,,GP,122,103.7,34.9652,122,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Pt Biofeedback Pelvic Floor (Each Subsequent 15 Min),,90913,CPT,Facility,Both,,,GP,122,103.7,34.9652,122,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),73.2,60,,percent of total billed charges,,
Pt Biofeedback Pelvic Floor (Each Subsequent 15 Min),,90913,CPT,Facility,Both,,,GP,122,103.7,34.9652,122,"Health Partners, Inc.",State of Minnesota Advantage Program,99.43,81.5,,percent of total billed charges,,
Pt Biofeedback Pelvic Floor (Each Subsequent 15 Min),,90913,CPT,Facility,Both,,,GP,122,103.7,34.9652,122,"Health Partners, Inc.",State Public Programs,61,50,,percent of total billed charges,,
Pt Biofeedback Pelvic Floor (Each Subsequent 15 Min),,90913,CPT,Facility,Both,,,GP,122,103.7,34.9652,122,Humana Insurance Company,Commercial PPO,115.9,95,,percent of total billed charges,,
Pt Biofeedback Pelvic Floor (Each Subsequent 15 Min),,90913,CPT,Facility,Outpatient,,,GP,122,103.7,34.9652,122,Humana Insurance Company,Medicare PPO,59.78,49,,percent of total billed charges,,
Pt Biofeedback Pelvic Floor (Each Subsequent 15 Min),,90913,CPT,Facility,Inpatient,,,GP,122,103.7,34.9652,122,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Pt Biofeedback Pelvic Floor (Each Subsequent 15 Min),,90913,CPT,Facility,Both,,,GP,122,103.7,34.9652,122,Medica,Individual & Family,120.902,99.1,,percent of total billed charges,,
Pt Biofeedback Pelvic Floor (Each Subsequent 15 Min),,90913,CPT,Facility,Outpatient,,,GP,122,103.7,34.9652,122,Medica,Medica Advantage Solution,60.756,49.8,,percent of total billed charges,,
Pt Biofeedback Pelvic Floor (Each Subsequent 15 Min),,90913,CPT,Facility,Inpatient,,,GP,122,103.7,34.9652,122,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Pt Biofeedback Pelvic Floor (Each Subsequent 15 Min),,90913,CPT,Facility,Outpatient,,,GP,122,103.7,34.9652,122,Medica,Medical Assistance,54.412,44.6,,percent of total billed charges,,
Pt Biofeedback Pelvic Floor (Each Subsequent 15 Min),,90913,CPT,Facility,Inpatient,,,GP,122,103.7,34.9652,122,Medica,Medical Assistance,,,,,Included in per diem rate,
Pt Biofeedback Pelvic Floor (Each Subsequent 15 Min),,90913,CPT,Facility,Outpatient,,,GP,122,103.7,34.9652,122,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,60.756,49.8,,percent of total billed charges,,
Pt Biofeedback Pelvic Floor (Each Subsequent 15 Min),,90913,CPT,Facility,Inpatient,,,GP,122,103.7,34.9652,122,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Pt Biofeedback Pelvic Floor (Each Subsequent 15 Min),,90913,CPT,Facility,Both,,,GP,122,103.7,34.9652,122,"Multiplan, Inc.","Multiplan, Inc.",114.68,94,,percent of total billed charges,,
Pt Biofeedback Pelvic Floor (Each Subsequent 15 Min),,90913,CPT,Facility,Outpatient,,,GP,122,103.7,34.9652,122,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,105.408,86.4,,percent of total billed charges,,
Pt Biofeedback Pelvic Floor (Each Subsequent 15 Min),,90913,CPT,Facility,Inpatient,,,GP,122,103.7,34.9652,122,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Pt Biofeedback Pelvic Floor (Each Subsequent 15 Min),,90913,CPT,Facility,Both,,,GP,122,103.7,34.9652,122,"Preferred One Administrative Services, INC.",PPO,120.292,98.6,,percent of total billed charges,,
Pt Biofeedback Pelvic Floor (Each Subsequent 15 Min),,90913,CPT,Facility,Outpatient,,,GP,122,103.7,34.9652,122,PrimeWest Health,Minnesota Senior Health Options (MSHO),62.769,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Pt Biofeedback Pelvic Floor (Each Subsequent 15 Min),,90913,CPT,Facility,Inpatient,,,GP,122,103.7,34.9652,122,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Pt Biofeedback Pelvic Floor (Each Subsequent 15 Min),,90913,CPT,Facility,Outpatient,,,GP,122,103.7,34.9652,122,PrimeWest Health,MinnesotaCare,62.6592,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Pt Biofeedback Pelvic Floor (Each Subsequent 15 Min),,90913,CPT,Facility,Inpatient,,,GP,122,103.7,34.9652,122,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Pt Biofeedback Pelvic Floor (Each Subsequent 15 Min),,90913,CPT,Facility,Both,,,GP,122,103.7,34.9652,122,Sanford Health Plan,Sanford Health Plan,112.24,92,,percent of total billed charges,,
Pt Biofeedback Pelvic Floor (Each Subsequent 15 Min),,90913,CPT,Facility,Outpatient,,,GP,122,103.7,34.9652,122,"UCare Health, Inc.",Individual & Family Plan,68.747,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Pt Biofeedback Pelvic Floor (Each Subsequent 15 Min),,90913,CPT,Facility,Inpatient,,,GP,122,103.7,34.9652,122,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Pt Biofeedback Pelvic Floor (Each Subsequent 15 Min),,90913,CPT,Facility,Outpatient,,,GP,122,103.7,34.9652,122,"UCare Health, Inc.",Medical Assistance,61.5734,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Pt Biofeedback Pelvic Floor (Each Subsequent 15 Min),,90913,CPT,Facility,Inpatient,,,GP,122,103.7,34.9652,122,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Pt Biofeedback Pelvic Floor (Each Subsequent 15 Min),,90913,CPT,Facility,Outpatient,,,GP,122,103.7,34.9652,122,"UCare Health, Inc.",Medicare Advantage,61.5734,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Pt Biofeedback Pelvic Floor (Each Subsequent 15 Min),,90913,CPT,Facility,Inpatient,,,GP,122,103.7,34.9652,122,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Pt Biofeedback Pelvic Floor (Each Subsequent 15 Min),,90913,CPT,Facility,Outpatient,,,GP,122,103.7,34.9652,122,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),61.5734,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Pt Biofeedback Pelvic Floor (Each Subsequent 15 Min),,90913,CPT,Facility,Inpatient,,,GP,122,103.7,34.9652,122,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Pt Biofeedback Pelvic Floor (Each Subsequent 15 Min),,90913,CPT,Facility,Both,,,GP,122,103.7,34.9652,122,UnitedHealthcare,Individual & Family,114.68,94,,percent of total billed charges,,
Pt Biofeedback Pelvic Floor (Each Subsequent 15 Min),,90913,CPT,Facility,Outpatient,,,GP,122,103.7,34.9652,122,UnitedHealthcare,Medicare Advantage,59.78,49,,percent of total billed charges,,
Pt Biofeedback Pelvic Floor (Each Subsequent 15 Min),,90913,CPT,Facility,Inpatient,,,GP,122,103.7,34.9652,122,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Pt Biofeedback Pelvic Floor (Each Subsequent 15 Min),,90913,CPT,Facility,Outpatient,,,GP,122,103.7,34.9652,122,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,58.56,48,,percent of total billed charges,,100% of DHS outpatient percentage
Pt Biofeedback Pelvic Floor (Each Subsequent 15 Min),,90913,CPT,Facility,Inpatient,,,GP,122,103.7,34.9652,122,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Pt Canalith Repositioning (Session For 42001912),,95992,CPT,Facility,Both,,,GP,143,121.55,40.9838,143,Aetna,Commercial,131.56,92,,percent of total billed charges,,
Pt Canalith Repositioning (Session For 42001912),,95992,CPT,Facility,Outpatient,,,GP,143,121.55,40.9838,143,Aetna,Medicare Advantage,70.07,49,,percent of total billed charges,,
Pt Canalith Repositioning (Session For 42001912),,95992,CPT,Facility,Inpatient,,,GP,143,121.55,40.9838,143,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Pt Canalith Repositioning (Session For 42001912),,95992,CPT,Facility,Both,,,GP,143,121.55,40.9838,143,Aetna,PPO,132.99,93,,percent of total billed charges,,
Pt Canalith Repositioning (Session For 42001912),,95992,CPT,Facility,Both,,,GP,143,121.55,40.9838,143,America's PPO,America's PPO,137.3229,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Pt Canalith Repositioning (Session For 42001912),,95992,CPT,Facility,Both,,,GP,143,121.55,40.9838,143,BlueCross BlueShield Minnesota, Federal Employee Program,140.712,98.4,,percent of total billed charges,,
Pt Canalith Repositioning (Session For 42001912),,95992,CPT,Facility,Both,,,GP,143,121.55,40.9838,143,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,143,100,,percent of total billed charges,,
Pt Canalith Repositioning (Session For 42001912),,95992,CPT,Facility,Both,,,GP,143,121.55,40.9838,143,BlueCross BlueShield Minnesota,High Value Network Plan,128.7,90,,percent of total billed charges,,
Pt Canalith Repositioning (Session For 42001912),,95992,CPT,Facility,Outpatient,,,GP,143,121.55,40.9838,143,BlueCross BlueShield Minnesota,Medicare Advantage,70.07,49,,percent of total billed charges,,
Pt Canalith Repositioning (Session For 42001912),,95992,CPT,Facility,Inpatient,,,GP,143,121.55,40.9838,143,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Pt Canalith Repositioning (Session For 42001912),,95992,CPT,Facility,Both,,,GP,143,121.55,40.9838,143,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,126.6551,88.57,,percent of total billed charges,,
Pt Canalith Repositioning (Session For 42001912),,95992,CPT,Facility,Both,,,GP,143,121.55,40.9838,143,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,40.9838,28.66,,percent of total billed charges,,
Pt Canalith Repositioning (Session For 42001912),,95992,CPT,Facility,Outpatient,,,GP,143,121.55,40.9838,143,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),70.07,49,,percent of total billed charges,,
Pt Canalith Repositioning (Session For 42001912),,95992,CPT,Facility,Inpatient,,,GP,143,121.55,40.9838,143,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Pt Canalith Repositioning (Session For 42001912),,95992,CPT,Facility,Both,,,GP,143,121.55,40.9838,143,CorVel,Worker's Compensation,143,100,,percent of total billed charges,,
Pt Canalith Repositioning (Session For 42001912),,95992,CPT,Facility,Both,,,GP,143,121.55,40.9838,143,First Health Group Corporation,First Health Network,138.71,97,,percent of total billed charges,,
Pt Canalith Repositioning (Session For 42001912),,95992,CPT,Facility,Both,,,GP,143,121.55,40.9838,143,"Health Partners, Inc.",Commercial,135.278,94.6,,percent of total billed charges,,
Pt Canalith Repositioning (Session For 42001912),,95992,CPT,Facility,Outpatient,,,GP,143,121.55,40.9838,143,"Health Partners, Inc.",Medicare Advantage,70.07,49,,percent of total billed charges,,
Pt Canalith Repositioning (Session For 42001912),,95992,CPT,Facility,Inpatient,,,GP,143,121.55,40.9838,143,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Pt Canalith Repositioning (Session For 42001912),,95992,CPT,Facility,Both,,,GP,143,121.55,40.9838,143,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),85.8,60,,percent of total billed charges,,
Pt Canalith Repositioning (Session For 42001912),,95992,CPT,Facility,Both,,,GP,143,121.55,40.9838,143,"Health Partners, Inc.",State of Minnesota Advantage Program,116.545,81.5,,percent of total billed charges,,
Pt Canalith Repositioning (Session For 42001912),,95992,CPT,Facility,Both,,,GP,143,121.55,40.9838,143,"Health Partners, Inc.",State Public Programs,71.5,50,,percent of total billed charges,,
Pt Canalith Repositioning (Session For 42001912),,95992,CPT,Facility,Both,,,GP,143,121.55,40.9838,143,Humana Insurance Company,Commercial PPO,135.85,95,,percent of total billed charges,,
Pt Canalith Repositioning (Session For 42001912),,95992,CPT,Facility,Outpatient,,,GP,143,121.55,40.9838,143,Humana Insurance Company,Medicare PPO,70.07,49,,percent of total billed charges,,
Pt Canalith Repositioning (Session For 42001912),,95992,CPT,Facility,Inpatient,,,GP,143,121.55,40.9838,143,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Pt Canalith Repositioning (Session For 42001912),,95992,CPT,Facility,Both,,,GP,143,121.55,40.9838,143,Medica,Individual & Family,141.713,99.1,,percent of total billed charges,,
Pt Canalith Repositioning (Session For 42001912),,95992,CPT,Facility,Outpatient,,,GP,143,121.55,40.9838,143,Medica,Medica Advantage Solution,71.214,49.8,,percent of total billed charges,,
Pt Canalith Repositioning (Session For 42001912),,95992,CPT,Facility,Inpatient,,,GP,143,121.55,40.9838,143,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Pt Canalith Repositioning (Session For 42001912),,95992,CPT,Facility,Outpatient,,,GP,143,121.55,40.9838,143,Medica,Medical Assistance,63.778,44.6,,percent of total billed charges,,
Pt Canalith Repositioning (Session For 42001912),,95992,CPT,Facility,Inpatient,,,GP,143,121.55,40.9838,143,Medica,Medical Assistance,,,,,Included in per diem rate,
Pt Canalith Repositioning (Session For 42001912),,95992,CPT,Facility,Outpatient,,,GP,143,121.55,40.9838,143,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,71.214,49.8,,percent of total billed charges,,
Pt Canalith Repositioning (Session For 42001912),,95992,CPT,Facility,Inpatient,,,GP,143,121.55,40.9838,143,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Pt Canalith Repositioning (Session For 42001912),,95992,CPT,Facility,Both,,,GP,143,121.55,40.9838,143,"Multiplan, Inc.","Multiplan, Inc.",134.42,94,,percent of total billed charges,,
Pt Canalith Repositioning (Session For 42001912),,95992,CPT,Facility,Outpatient,,,GP,143,121.55,40.9838,143,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,123.552,86.4,,percent of total billed charges,,
Pt Canalith Repositioning (Session For 42001912),,95992,CPT,Facility,Inpatient,,,GP,143,121.55,40.9838,143,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Pt Canalith Repositioning (Session For 42001912),,95992,CPT,Facility,Both,,,GP,143,121.55,40.9838,143,"Preferred One Administrative Services, INC.",PPO,140.998,98.6,,percent of total billed charges,,
Pt Canalith Repositioning (Session For 42001912),,95992,CPT,Facility,Outpatient,,,GP,143,121.55,40.9838,143,PrimeWest Health,Minnesota Senior Health Options (MSHO),73.5735,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Pt Canalith Repositioning (Session For 42001912),,95992,CPT,Facility,Inpatient,,,GP,143,121.55,40.9838,143,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Pt Canalith Repositioning (Session For 42001912),,95992,CPT,Facility,Outpatient,,,GP,143,121.55,40.9838,143,PrimeWest Health,MinnesotaCare,73.4448,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Pt Canalith Repositioning (Session For 42001912),,95992,CPT,Facility,Inpatient,,,GP,143,121.55,40.9838,143,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Pt Canalith Repositioning (Session For 42001912),,95992,CPT,Facility,Both,,,GP,143,121.55,40.9838,143,Sanford Health Plan,Sanford Health Plan,131.56,92,,percent of total billed charges,,
Pt Canalith Repositioning (Session For 42001912),,95992,CPT,Facility,Outpatient,,,GP,143,121.55,40.9838,143,"UCare Health, Inc.",Individual & Family Plan,80.5805,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Pt Canalith Repositioning (Session For 42001912),,95992,CPT,Facility,Inpatient,,,GP,143,121.55,40.9838,143,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Pt Canalith Repositioning (Session For 42001912),,95992,CPT,Facility,Outpatient,,,GP,143,121.55,40.9838,143,"UCare Health, Inc.",Medical Assistance,72.1721,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Pt Canalith Repositioning (Session For 42001912),,95992,CPT,Facility,Inpatient,,,GP,143,121.55,40.9838,143,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Pt Canalith Repositioning (Session For 42001912),,95992,CPT,Facility,Outpatient,,,GP,143,121.55,40.9838,143,"UCare Health, Inc.",Medicare Advantage,72.1721,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Pt Canalith Repositioning (Session For 42001912),,95992,CPT,Facility,Inpatient,,,GP,143,121.55,40.9838,143,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Pt Canalith Repositioning (Session For 42001912),,95992,CPT,Facility,Outpatient,,,GP,143,121.55,40.9838,143,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),72.1721,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Pt Canalith Repositioning (Session For 42001912),,95992,CPT,Facility,Inpatient,,,GP,143,121.55,40.9838,143,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Pt Canalith Repositioning (Session For 42001912),,95992,CPT,Facility,Both,,,GP,143,121.55,40.9838,143,UnitedHealthcare,Individual & Family,134.42,94,,percent of total billed charges,,
Pt Canalith Repositioning (Session For 42001912),,95992,CPT,Facility,Outpatient,,,GP,143,121.55,40.9838,143,UnitedHealthcare,Medicare Advantage,70.07,49,,percent of total billed charges,,
Pt Canalith Repositioning (Session For 42001912),,95992,CPT,Facility,Inpatient,,,GP,143,121.55,40.9838,143,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Pt Canalith Repositioning (Session For 42001912),,95992,CPT,Facility,Outpatient,,,GP,143,121.55,40.9838,143,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,68.64,48,,percent of total billed charges,,100% of DHS outpatient percentage
Pt Canalith Repositioning (Session For 42001912),,95992,CPT,Facility,Inpatient,,,GP,143,121.55,40.9838,143,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Pt Traction (Mechanical) (15 Min),,97012,CPT,Facility,Both,,,GP,102,86.7,29.2332,102,Aetna,Commercial,93.84,92,,percent of total billed charges,,
Pt Traction (Mechanical) (15 Min),,97012,CPT,Facility,Outpatient,,,GP,102,86.7,29.2332,102,Aetna,Medicare Advantage,49.98,49,,percent of total billed charges,,
Pt Traction (Mechanical) (15 Min),,97012,CPT,Facility,Inpatient,,,GP,102,86.7,29.2332,102,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Pt Traction (Mechanical) (15 Min),,97012,CPT,Facility,Both,,,GP,102,86.7,29.2332,102,Aetna,PPO,94.86,93,,percent of total billed charges,,
Pt Traction (Mechanical) (15 Min),,97012,CPT,Facility,Both,,,GP,102,86.7,29.2332,102,America's PPO,America's PPO,97.9506,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Pt Traction (Mechanical) (15 Min),,97012,CPT,Facility,Both,,,GP,102,86.7,29.2332,102,BlueCross BlueShield Minnesota, Federal Employee Program,100.368,98.4,,percent of total billed charges,,
Pt Traction (Mechanical) (15 Min),,97012,CPT,Facility,Both,,,GP,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,102,100,,percent of total billed charges,,
Pt Traction (Mechanical) (15 Min),,97012,CPT,Facility,Both,,,GP,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,High Value Network Plan,91.8,90,,percent of total billed charges,,
Pt Traction (Mechanical) (15 Min),,97012,CPT,Facility,Outpatient,,,GP,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,Medicare Advantage,49.98,49,,percent of total billed charges,,
Pt Traction (Mechanical) (15 Min),,97012,CPT,Facility,Inpatient,,,GP,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Pt Traction (Mechanical) (15 Min),,97012,CPT,Facility,Both,,,GP,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,90.3414,88.57,,percent of total billed charges,,
Pt Traction (Mechanical) (15 Min),,97012,CPT,Facility,Both,,,GP,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,29.2332,28.66,,percent of total billed charges,,
Pt Traction (Mechanical) (15 Min),,97012,CPT,Facility,Outpatient,,,GP,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),49.98,49,,percent of total billed charges,,
Pt Traction (Mechanical) (15 Min),,97012,CPT,Facility,Inpatient,,,GP,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Pt Traction (Mechanical) (15 Min),,97012,CPT,Facility,Both,,,GP,102,86.7,29.2332,102,CorVel,Worker's Compensation,102,100,,percent of total billed charges,,
Pt Traction (Mechanical) (15 Min),,97012,CPT,Facility,Both,,,GP,102,86.7,29.2332,102,First Health Group Corporation,First Health Network,98.94,97,,percent of total billed charges,,
Pt Traction (Mechanical) (15 Min),,97012,CPT,Facility,Both,,,GP,102,86.7,29.2332,102,"Health Partners, Inc.",Commercial,96.492,94.6,,percent of total billed charges,,
Pt Traction (Mechanical) (15 Min),,97012,CPT,Facility,Outpatient,,,GP,102,86.7,29.2332,102,"Health Partners, Inc.",Medicare Advantage,49.98,49,,percent of total billed charges,,
Pt Traction (Mechanical) (15 Min),,97012,CPT,Facility,Inpatient,,,GP,102,86.7,29.2332,102,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Pt Traction (Mechanical) (15 Min),,97012,CPT,Facility,Both,,,GP,102,86.7,29.2332,102,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),61.2,60,,percent of total billed charges,,
Pt Traction (Mechanical) (15 Min),,97012,CPT,Facility,Both,,,GP,102,86.7,29.2332,102,"Health Partners, Inc.",State of Minnesota Advantage Program,83.13,81.5,,percent of total billed charges,,
Pt Traction (Mechanical) (15 Min),,97012,CPT,Facility,Both,,,GP,102,86.7,29.2332,102,"Health Partners, Inc.",State Public Programs,51,50,,percent of total billed charges,,
Pt Traction (Mechanical) (15 Min),,97012,CPT,Facility,Both,,,GP,102,86.7,29.2332,102,Humana Insurance Company,Commercial PPO,96.9,95,,percent of total billed charges,,
Pt Traction (Mechanical) (15 Min),,97012,CPT,Facility,Outpatient,,,GP,102,86.7,29.2332,102,Humana Insurance Company,Medicare PPO,49.98,49,,percent of total billed charges,,
Pt Traction (Mechanical) (15 Min),,97012,CPT,Facility,Inpatient,,,GP,102,86.7,29.2332,102,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Pt Traction (Mechanical) (15 Min),,97012,CPT,Facility,Both,,,GP,102,86.7,29.2332,102,Medica,Individual & Family,101.082,99.1,,percent of total billed charges,,
Pt Traction (Mechanical) (15 Min),,97012,CPT,Facility,Outpatient,,,GP,102,86.7,29.2332,102,Medica,Medica Advantage Solution,50.796,49.8,,percent of total billed charges,,
Pt Traction (Mechanical) (15 Min),,97012,CPT,Facility,Inpatient,,,GP,102,86.7,29.2332,102,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Pt Traction (Mechanical) (15 Min),,97012,CPT,Facility,Outpatient,,,GP,102,86.7,29.2332,102,Medica,Medical Assistance,45.492,44.6,,percent of total billed charges,,
Pt Traction (Mechanical) (15 Min),,97012,CPT,Facility,Inpatient,,,GP,102,86.7,29.2332,102,Medica,Medical Assistance,,,,,Included in per diem rate,
Pt Traction (Mechanical) (15 Min),,97012,CPT,Facility,Outpatient,,,GP,102,86.7,29.2332,102,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,50.796,49.8,,percent of total billed charges,,
Pt Traction (Mechanical) (15 Min),,97012,CPT,Facility,Inpatient,,,GP,102,86.7,29.2332,102,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Pt Traction (Mechanical) (15 Min),,97012,CPT,Facility,Both,,,GP,102,86.7,29.2332,102,"Multiplan, Inc.","Multiplan, Inc.",95.88,94,,percent of total billed charges,,
Pt Traction (Mechanical) (15 Min),,97012,CPT,Facility,Outpatient,,,GP,102,86.7,29.2332,102,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,88.128,86.4,,percent of total billed charges,,
Pt Traction (Mechanical) (15 Min),,97012,CPT,Facility,Inpatient,,,GP,102,86.7,29.2332,102,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Pt Traction (Mechanical) (15 Min),,97012,CPT,Facility,Both,,,GP,102,86.7,29.2332,102,"Preferred One Administrative Services, INC.",PPO,100.572,98.6,,percent of total billed charges,,
Pt Traction (Mechanical) (15 Min),,97012,CPT,Facility,Outpatient,,,GP,102,86.7,29.2332,102,PrimeWest Health,Minnesota Senior Health Options (MSHO),52.479,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Pt Traction (Mechanical) (15 Min),,97012,CPT,Facility,Inpatient,,,GP,102,86.7,29.2332,102,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Pt Traction (Mechanical) (15 Min),,97012,CPT,Facility,Outpatient,,,GP,102,86.7,29.2332,102,PrimeWest Health,MinnesotaCare,52.3872,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Pt Traction (Mechanical) (15 Min),,97012,CPT,Facility,Inpatient,,,GP,102,86.7,29.2332,102,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Pt Traction (Mechanical) (15 Min),,97012,CPT,Facility,Both,,,GP,102,86.7,29.2332,102,Sanford Health Plan,Sanford Health Plan,93.84,92,,percent of total billed charges,,
Pt Traction (Mechanical) (15 Min),,97012,CPT,Facility,Outpatient,,,GP,102,86.7,29.2332,102,"UCare Health, Inc.",Individual & Family Plan,57.477,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Pt Traction (Mechanical) (15 Min),,97012,CPT,Facility,Inpatient,,,GP,102,86.7,29.2332,102,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Pt Traction (Mechanical) (15 Min),,97012,CPT,Facility,Outpatient,,,GP,102,86.7,29.2332,102,"UCare Health, Inc.",Medical Assistance,51.4794,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Pt Traction (Mechanical) (15 Min),,97012,CPT,Facility,Inpatient,,,GP,102,86.7,29.2332,102,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Pt Traction (Mechanical) (15 Min),,97012,CPT,Facility,Outpatient,,,GP,102,86.7,29.2332,102,"UCare Health, Inc.",Medicare Advantage,51.4794,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Pt Traction (Mechanical) (15 Min),,97012,CPT,Facility,Inpatient,,,GP,102,86.7,29.2332,102,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Pt Traction (Mechanical) (15 Min),,97012,CPT,Facility,Outpatient,,,GP,102,86.7,29.2332,102,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),51.4794,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Pt Traction (Mechanical) (15 Min),,97012,CPT,Facility,Inpatient,,,GP,102,86.7,29.2332,102,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Pt Traction (Mechanical) (15 Min),,97012,CPT,Facility,Both,,,GP,102,86.7,29.2332,102,UnitedHealthcare,Individual & Family,95.88,94,,percent of total billed charges,,
Pt Traction (Mechanical) (15 Min),,97012,CPT,Facility,Outpatient,,,GP,102,86.7,29.2332,102,UnitedHealthcare,Medicare Advantage,49.98,49,,percent of total billed charges,,
Pt Traction (Mechanical) (15 Min),,97012,CPT,Facility,Inpatient,,,GP,102,86.7,29.2332,102,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Pt Traction (Mechanical) (15 Min),,97012,CPT,Facility,Outpatient,,,GP,102,86.7,29.2332,102,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,48.96,48,,percent of total billed charges,,100% of DHS outpatient percentage
Pt Traction (Mechanical) (15 Min),,97012,CPT,Facility,Inpatient,,,GP,102,86.7,29.2332,102,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Pt Electrical Stim Unattended (15 Min),,97014,CPT,Facility,Both,,,GP,82,69.7,23.5012,82,Aetna,Commercial,75.44,92,,percent of total billed charges,,
Pt Electrical Stim Unattended (15 Min),,97014,CPT,Facility,Outpatient,,,GP,82,69.7,23.5012,82,Aetna,Medicare Advantage,40.18,49,,percent of total billed charges,,
Pt Electrical Stim Unattended (15 Min),,97014,CPT,Facility,Inpatient,,,GP,82,69.7,23.5012,82,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Pt Electrical Stim Unattended (15 Min),,97014,CPT,Facility,Both,,,GP,82,69.7,23.5012,82,Aetna,PPO,76.26,93,,percent of total billed charges,,
Pt Electrical Stim Unattended (15 Min),,97014,CPT,Facility,Both,,,GP,82,69.7,23.5012,82,America's PPO,America's PPO,78.7446,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Pt Electrical Stim Unattended (15 Min),,97014,CPT,Facility,Both,,,GP,82,69.7,23.5012,82,BlueCross BlueShield Minnesota, Federal Employee Program,80.688,98.4,,percent of total billed charges,,
Pt Electrical Stim Unattended (15 Min),,97014,CPT,Facility,Both,,,GP,82,69.7,23.5012,82,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,82,100,,percent of total billed charges,,
Pt Electrical Stim Unattended (15 Min),,97014,CPT,Facility,Both,,,GP,82,69.7,23.5012,82,BlueCross BlueShield Minnesota,High Value Network Plan,73.8,90,,percent of total billed charges,,
Pt Electrical Stim Unattended (15 Min),,97014,CPT,Facility,Outpatient,,,GP,82,69.7,23.5012,82,BlueCross BlueShield Minnesota,Medicare Advantage,40.18,49,,percent of total billed charges,,
Pt Electrical Stim Unattended (15 Min),,97014,CPT,Facility,Inpatient,,,GP,82,69.7,23.5012,82,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Pt Electrical Stim Unattended (15 Min),,97014,CPT,Facility,Both,,,GP,82,69.7,23.5012,82,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,72.6274,88.57,,percent of total billed charges,,
Pt Electrical Stim Unattended (15 Min),,97014,CPT,Facility,Both,,,GP,82,69.7,23.5012,82,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,23.5012,28.66,,percent of total billed charges,,
Pt Electrical Stim Unattended (15 Min),,97014,CPT,Facility,Outpatient,,,GP,82,69.7,23.5012,82,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),40.18,49,,percent of total billed charges,,
Pt Electrical Stim Unattended (15 Min),,97014,CPT,Facility,Inpatient,,,GP,82,69.7,23.5012,82,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Pt Electrical Stim Unattended (15 Min),,97014,CPT,Facility,Both,,,GP,82,69.7,23.5012,82,CorVel,Worker's Compensation,82,100,,percent of total billed charges,,
Pt Electrical Stim Unattended (15 Min),,97014,CPT,Facility,Both,,,GP,82,69.7,23.5012,82,First Health Group Corporation,First Health Network,79.54,97,,percent of total billed charges,,
Pt Electrical Stim Unattended (15 Min),,97014,CPT,Facility,Both,,,GP,82,69.7,23.5012,82,"Health Partners, Inc.",Commercial,77.572,94.6,,percent of total billed charges,,
Pt Electrical Stim Unattended (15 Min),,97014,CPT,Facility,Outpatient,,,GP,82,69.7,23.5012,82,"Health Partners, Inc.",Medicare Advantage,40.18,49,,percent of total billed charges,,
Pt Electrical Stim Unattended (15 Min),,97014,CPT,Facility,Inpatient,,,GP,82,69.7,23.5012,82,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Pt Electrical Stim Unattended (15 Min),,97014,CPT,Facility,Both,,,GP,82,69.7,23.5012,82,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),49.2,60,,percent of total billed charges,,
Pt Electrical Stim Unattended (15 Min),,97014,CPT,Facility,Both,,,GP,82,69.7,23.5012,82,"Health Partners, Inc.",State of Minnesota Advantage Program,66.83,81.5,,percent of total billed charges,,
Pt Electrical Stim Unattended (15 Min),,97014,CPT,Facility,Both,,,GP,82,69.7,23.5012,82,"Health Partners, Inc.",State Public Programs,41,50,,percent of total billed charges,,
Pt Electrical Stim Unattended (15 Min),,97014,CPT,Facility,Both,,,GP,82,69.7,23.5012,82,Humana Insurance Company,Commercial PPO,77.9,95,,percent of total billed charges,,
Pt Electrical Stim Unattended (15 Min),,97014,CPT,Facility,Outpatient,,,GP,82,69.7,23.5012,82,Humana Insurance Company,Medicare PPO,40.18,49,,percent of total billed charges,,
Pt Electrical Stim Unattended (15 Min),,97014,CPT,Facility,Inpatient,,,GP,82,69.7,23.5012,82,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Pt Electrical Stim Unattended (15 Min),,97014,CPT,Facility,Both,,,GP,82,69.7,23.5012,82,Medica,Individual & Family,81.262,99.1,,percent of total billed charges,,
Pt Electrical Stim Unattended (15 Min),,97014,CPT,Facility,Outpatient,,,GP,82,69.7,23.5012,82,Medica,Medica Advantage Solution,40.836,49.8,,percent of total billed charges,,
Pt Electrical Stim Unattended (15 Min),,97014,CPT,Facility,Inpatient,,,GP,82,69.7,23.5012,82,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Pt Electrical Stim Unattended (15 Min),,97014,CPT,Facility,Outpatient,,,GP,82,69.7,23.5012,82,Medica,Medical Assistance,36.572,44.6,,percent of total billed charges,,
Pt Electrical Stim Unattended (15 Min),,97014,CPT,Facility,Inpatient,,,GP,82,69.7,23.5012,82,Medica,Medical Assistance,,,,,Included in per diem rate,
Pt Electrical Stim Unattended (15 Min),,97014,CPT,Facility,Outpatient,,,GP,82,69.7,23.5012,82,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,40.836,49.8,,percent of total billed charges,,
Pt Electrical Stim Unattended (15 Min),,97014,CPT,Facility,Inpatient,,,GP,82,69.7,23.5012,82,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Pt Electrical Stim Unattended (15 Min),,97014,CPT,Facility,Both,,,GP,82,69.7,23.5012,82,"Multiplan, Inc.","Multiplan, Inc.",77.08,94,,percent of total billed charges,,
Pt Electrical Stim Unattended (15 Min),,97014,CPT,Facility,Outpatient,,,GP,82,69.7,23.5012,82,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,70.848,86.4,,percent of total billed charges,,
Pt Electrical Stim Unattended (15 Min),,97014,CPT,Facility,Inpatient,,,GP,82,69.7,23.5012,82,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Pt Electrical Stim Unattended (15 Min),,97014,CPT,Facility,Both,,,GP,82,69.7,23.5012,82,"Preferred One Administrative Services, INC.",PPO,80.852,98.6,,percent of total billed charges,,
Pt Electrical Stim Unattended (15 Min),,97014,CPT,Facility,Outpatient,,,GP,82,69.7,23.5012,82,PrimeWest Health,Minnesota Senior Health Options (MSHO),42.189,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Pt Electrical Stim Unattended (15 Min),,97014,CPT,Facility,Inpatient,,,GP,82,69.7,23.5012,82,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Pt Electrical Stim Unattended (15 Min),,97014,CPT,Facility,Outpatient,,,GP,82,69.7,23.5012,82,PrimeWest Health,MinnesotaCare,42.1152,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Pt Electrical Stim Unattended (15 Min),,97014,CPT,Facility,Inpatient,,,GP,82,69.7,23.5012,82,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Pt Electrical Stim Unattended (15 Min),,97014,CPT,Facility,Both,,,GP,82,69.7,23.5012,82,Sanford Health Plan,Sanford Health Plan,75.44,92,,percent of total billed charges,,
Pt Electrical Stim Unattended (15 Min),,97014,CPT,Facility,Outpatient,,,GP,82,69.7,23.5012,82,"UCare Health, Inc.",Individual & Family Plan,46.207,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Pt Electrical Stim Unattended (15 Min),,97014,CPT,Facility,Inpatient,,,GP,82,69.7,23.5012,82,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Pt Electrical Stim Unattended (15 Min),,97014,CPT,Facility,Outpatient,,,GP,82,69.7,23.5012,82,"UCare Health, Inc.",Medical Assistance,41.3854,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Pt Electrical Stim Unattended (15 Min),,97014,CPT,Facility,Inpatient,,,GP,82,69.7,23.5012,82,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Pt Electrical Stim Unattended (15 Min),,97014,CPT,Facility,Outpatient,,,GP,82,69.7,23.5012,82,"UCare Health, Inc.",Medicare Advantage,41.3854,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Pt Electrical Stim Unattended (15 Min),,97014,CPT,Facility,Inpatient,,,GP,82,69.7,23.5012,82,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Pt Electrical Stim Unattended (15 Min),,97014,CPT,Facility,Outpatient,,,GP,82,69.7,23.5012,82,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),41.3854,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Pt Electrical Stim Unattended (15 Min),,97014,CPT,Facility,Inpatient,,,GP,82,69.7,23.5012,82,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Pt Electrical Stim Unattended (15 Min),,97014,CPT,Facility,Both,,,GP,82,69.7,23.5012,82,UnitedHealthcare,Individual & Family,77.08,94,,percent of total billed charges,,
Pt Electrical Stim Unattended (15 Min),,97014,CPT,Facility,Outpatient,,,GP,82,69.7,23.5012,82,UnitedHealthcare,Medicare Advantage,40.18,49,,percent of total billed charges,,
Pt Electrical Stim Unattended (15 Min),,97014,CPT,Facility,Inpatient,,,GP,82,69.7,23.5012,82,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Pt Electrical Stim Unattended (15 Min),,97014,CPT,Facility,Outpatient,,,GP,82,69.7,23.5012,82,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,39.36,48,,percent of total billed charges,,100% of DHS outpatient percentage
Pt Electrical Stim Unattended (15 Min),,97014,CPT,Facility,Inpatient,,,GP,82,69.7,23.5012,82,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Pt Vasopneumatic Device,,97016,CPT,Facility,Both,,,GP,69,58.65,19.7754,69,Aetna,Commercial,63.48,92,,percent of total billed charges,,
Pt Vasopneumatic Device,,97016,CPT,Facility,Outpatient,,,GP,69,58.65,19.7754,69,Aetna,Medicare Advantage,33.81,49,,percent of total billed charges,,
Pt Vasopneumatic Device,,97016,CPT,Facility,Inpatient,,,GP,69,58.65,19.7754,69,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Pt Vasopneumatic Device,,97016,CPT,Facility,Both,,,GP,69,58.65,19.7754,69,Aetna,PPO,64.17,93,,percent of total billed charges,,
Pt Vasopneumatic Device,,97016,CPT,Facility,Both,,,GP,69,58.65,19.7754,69,America's PPO,America's PPO,66.2607,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Pt Vasopneumatic Device,,97016,CPT,Facility,Both,,,GP,69,58.65,19.7754,69,BlueCross BlueShield Minnesota, Federal Employee Program,67.896,98.4,,percent of total billed charges,,
Pt Vasopneumatic Device,,97016,CPT,Facility,Both,,,GP,69,58.65,19.7754,69,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,69,100,,percent of total billed charges,,
Pt Vasopneumatic Device,,97016,CPT,Facility,Both,,,GP,69,58.65,19.7754,69,BlueCross BlueShield Minnesota,High Value Network Plan,62.1,90,,percent of total billed charges,,
Pt Vasopneumatic Device,,97016,CPT,Facility,Outpatient,,,GP,69,58.65,19.7754,69,BlueCross BlueShield Minnesota,Medicare Advantage,33.81,49,,percent of total billed charges,,
Pt Vasopneumatic Device,,97016,CPT,Facility,Inpatient,,,GP,69,58.65,19.7754,69,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Pt Vasopneumatic Device,,97016,CPT,Facility,Both,,,GP,69,58.65,19.7754,69,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,61.1133,88.57,,percent of total billed charges,,
Pt Vasopneumatic Device,,97016,CPT,Facility,Both,,,GP,69,58.65,19.7754,69,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,19.7754,28.66,,percent of total billed charges,,
Pt Vasopneumatic Device,,97016,CPT,Facility,Outpatient,,,GP,69,58.65,19.7754,69,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),33.81,49,,percent of total billed charges,,
Pt Vasopneumatic Device,,97016,CPT,Facility,Inpatient,,,GP,69,58.65,19.7754,69,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Pt Vasopneumatic Device,,97016,CPT,Facility,Both,,,GP,69,58.65,19.7754,69,CorVel,Worker's Compensation,69,100,,percent of total billed charges,,
Pt Vasopneumatic Device,,97016,CPT,Facility,Both,,,GP,69,58.65,19.7754,69,First Health Group Corporation,First Health Network,66.93,97,,percent of total billed charges,,
Pt Vasopneumatic Device,,97016,CPT,Facility,Both,,,GP,69,58.65,19.7754,69,"Health Partners, Inc.",Commercial,65.274,94.6,,percent of total billed charges,,
Pt Vasopneumatic Device,,97016,CPT,Facility,Outpatient,,,GP,69,58.65,19.7754,69,"Health Partners, Inc.",Medicare Advantage,33.81,49,,percent of total billed charges,,
Pt Vasopneumatic Device,,97016,CPT,Facility,Inpatient,,,GP,69,58.65,19.7754,69,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Pt Vasopneumatic Device,,97016,CPT,Facility,Both,,,GP,69,58.65,19.7754,69,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),41.4,60,,percent of total billed charges,,
Pt Vasopneumatic Device,,97016,CPT,Facility,Both,,,GP,69,58.65,19.7754,69,"Health Partners, Inc.",State of Minnesota Advantage Program,56.235,81.5,,percent of total billed charges,,
Pt Vasopneumatic Device,,97016,CPT,Facility,Both,,,GP,69,58.65,19.7754,69,"Health Partners, Inc.",State Public Programs,34.5,50,,percent of total billed charges,,
Pt Vasopneumatic Device,,97016,CPT,Facility,Both,,,GP,69,58.65,19.7754,69,Humana Insurance Company,Commercial PPO,65.55,95,,percent of total billed charges,,
Pt Vasopneumatic Device,,97016,CPT,Facility,Outpatient,,,GP,69,58.65,19.7754,69,Humana Insurance Company,Medicare PPO,33.81,49,,percent of total billed charges,,
Pt Vasopneumatic Device,,97016,CPT,Facility,Inpatient,,,GP,69,58.65,19.7754,69,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Pt Vasopneumatic Device,,97016,CPT,Facility,Both,,,GP,69,58.65,19.7754,69,Medica,Individual & Family,68.379,99.1,,percent of total billed charges,,
Pt Vasopneumatic Device,,97016,CPT,Facility,Outpatient,,,GP,69,58.65,19.7754,69,Medica,Medica Advantage Solution,34.362,49.8,,percent of total billed charges,,
Pt Vasopneumatic Device,,97016,CPT,Facility,Inpatient,,,GP,69,58.65,19.7754,69,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Pt Vasopneumatic Device,,97016,CPT,Facility,Outpatient,,,GP,69,58.65,19.7754,69,Medica,Medical Assistance,30.774,44.6,,percent of total billed charges,,
Pt Vasopneumatic Device,,97016,CPT,Facility,Inpatient,,,GP,69,58.65,19.7754,69,Medica,Medical Assistance,,,,,Included in per diem rate,
Pt Vasopneumatic Device,,97016,CPT,Facility,Outpatient,,,GP,69,58.65,19.7754,69,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,34.362,49.8,,percent of total billed charges,,
Pt Vasopneumatic Device,,97016,CPT,Facility,Inpatient,,,GP,69,58.65,19.7754,69,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Pt Vasopneumatic Device,,97016,CPT,Facility,Both,,,GP,69,58.65,19.7754,69,"Multiplan, Inc.","Multiplan, Inc.",64.86,94,,percent of total billed charges,,
Pt Vasopneumatic Device,,97016,CPT,Facility,Outpatient,,,GP,69,58.65,19.7754,69,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,59.616,86.4,,percent of total billed charges,,
Pt Vasopneumatic Device,,97016,CPT,Facility,Inpatient,,,GP,69,58.65,19.7754,69,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Pt Vasopneumatic Device,,97016,CPT,Facility,Both,,,GP,69,58.65,19.7754,69,"Preferred One Administrative Services, INC.",PPO,68.034,98.6,,percent of total billed charges,,
Pt Vasopneumatic Device,,97016,CPT,Facility,Outpatient,,,GP,69,58.65,19.7754,69,PrimeWest Health,Minnesota Senior Health Options (MSHO),35.5005,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Pt Vasopneumatic Device,,97016,CPT,Facility,Inpatient,,,GP,69,58.65,19.7754,69,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Pt Vasopneumatic Device,,97016,CPT,Facility,Outpatient,,,GP,69,58.65,19.7754,69,PrimeWest Health,MinnesotaCare,35.4384,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Pt Vasopneumatic Device,,97016,CPT,Facility,Inpatient,,,GP,69,58.65,19.7754,69,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Pt Vasopneumatic Device,,97016,CPT,Facility,Both,,,GP,69,58.65,19.7754,69,Sanford Health Plan,Sanford Health Plan,63.48,92,,percent of total billed charges,,
Pt Vasopneumatic Device,,97016,CPT,Facility,Outpatient,,,GP,69,58.65,19.7754,69,"UCare Health, Inc.",Individual & Family Plan,38.8815,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Pt Vasopneumatic Device,,97016,CPT,Facility,Inpatient,,,GP,69,58.65,19.7754,69,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Pt Vasopneumatic Device,,97016,CPT,Facility,Outpatient,,,GP,69,58.65,19.7754,69,"UCare Health, Inc.",Medical Assistance,34.8243,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Pt Vasopneumatic Device,,97016,CPT,Facility,Inpatient,,,GP,69,58.65,19.7754,69,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Pt Vasopneumatic Device,,97016,CPT,Facility,Outpatient,,,GP,69,58.65,19.7754,69,"UCare Health, Inc.",Medicare Advantage,34.8243,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Pt Vasopneumatic Device,,97016,CPT,Facility,Inpatient,,,GP,69,58.65,19.7754,69,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Pt Vasopneumatic Device,,97016,CPT,Facility,Outpatient,,,GP,69,58.65,19.7754,69,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),34.8243,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Pt Vasopneumatic Device,,97016,CPT,Facility,Inpatient,,,GP,69,58.65,19.7754,69,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Pt Vasopneumatic Device,,97016,CPT,Facility,Both,,,GP,69,58.65,19.7754,69,UnitedHealthcare,Individual & Family,64.86,94,,percent of total billed charges,,
Pt Vasopneumatic Device,,97016,CPT,Facility,Outpatient,,,GP,69,58.65,19.7754,69,UnitedHealthcare,Medicare Advantage,33.81,49,,percent of total billed charges,,
Pt Vasopneumatic Device,,97016,CPT,Facility,Inpatient,,,GP,69,58.65,19.7754,69,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Pt Vasopneumatic Device,,97016,CPT,Facility,Outpatient,,,GP,69,58.65,19.7754,69,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,33.12,48,,percent of total billed charges,,100% of DHS outpatient percentage
Pt Vasopneumatic Device,,97016,CPT,Facility,Inpatient,,,GP,69,58.65,19.7754,69,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Pt Paraffin Bath,,97018,CPT,Facility,Both,,,GP,80,68,22.928,80,Aetna,Commercial,73.6,92,,percent of total billed charges,,
Pt Paraffin Bath,,97018,CPT,Facility,Outpatient,,,GP,80,68,22.928,80,Aetna,Medicare Advantage,39.2,49,,percent of total billed charges,,
Pt Paraffin Bath,,97018,CPT,Facility,Inpatient,,,GP,80,68,22.928,80,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Pt Paraffin Bath,,97018,CPT,Facility,Both,,,GP,80,68,22.928,80,Aetna,PPO,74.4,93,,percent of total billed charges,,
Pt Paraffin Bath,,97018,CPT,Facility,Both,,,GP,80,68,22.928,80,America's PPO,America's PPO,76.824,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Pt Paraffin Bath,,97018,CPT,Facility,Both,,,GP,80,68,22.928,80,BlueCross BlueShield Minnesota, Federal Employee Program,78.72,98.4,,percent of total billed charges,,
Pt Paraffin Bath,,97018,CPT,Facility,Both,,,GP,80,68,22.928,80,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,80,100,,percent of total billed charges,,
Pt Paraffin Bath,,97018,CPT,Facility,Both,,,GP,80,68,22.928,80,BlueCross BlueShield Minnesota,High Value Network Plan,72,90,,percent of total billed charges,,
Pt Paraffin Bath,,97018,CPT,Facility,Outpatient,,,GP,80,68,22.928,80,BlueCross BlueShield Minnesota,Medicare Advantage,39.2,49,,percent of total billed charges,,
Pt Paraffin Bath,,97018,CPT,Facility,Inpatient,,,GP,80,68,22.928,80,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Pt Paraffin Bath,,97018,CPT,Facility,Both,,,GP,80,68,22.928,80,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,70.856,88.57,,percent of total billed charges,,
Pt Paraffin Bath,,97018,CPT,Facility,Both,,,GP,80,68,22.928,80,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,22.928,28.66,,percent of total billed charges,,
Pt Paraffin Bath,,97018,CPT,Facility,Outpatient,,,GP,80,68,22.928,80,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),39.2,49,,percent of total billed charges,,
Pt Paraffin Bath,,97018,CPT,Facility,Inpatient,,,GP,80,68,22.928,80,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Pt Paraffin Bath,,97018,CPT,Facility,Both,,,GP,80,68,22.928,80,CorVel,Worker's Compensation,80,100,,percent of total billed charges,,
Pt Paraffin Bath,,97018,CPT,Facility,Both,,,GP,80,68,22.928,80,First Health Group Corporation,First Health Network,77.6,97,,percent of total billed charges,,
Pt Paraffin Bath,,97018,CPT,Facility,Both,,,GP,80,68,22.928,80,"Health Partners, Inc.",Commercial,75.68,94.6,,percent of total billed charges,,
Pt Paraffin Bath,,97018,CPT,Facility,Outpatient,,,GP,80,68,22.928,80,"Health Partners, Inc.",Medicare Advantage,39.2,49,,percent of total billed charges,,
Pt Paraffin Bath,,97018,CPT,Facility,Inpatient,,,GP,80,68,22.928,80,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Pt Paraffin Bath,,97018,CPT,Facility,Both,,,GP,80,68,22.928,80,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),48,60,,percent of total billed charges,,
Pt Paraffin Bath,,97018,CPT,Facility,Both,,,GP,80,68,22.928,80,"Health Partners, Inc.",State of Minnesota Advantage Program,65.2,81.5,,percent of total billed charges,,
Pt Paraffin Bath,,97018,CPT,Facility,Both,,,GP,80,68,22.928,80,"Health Partners, Inc.",State Public Programs,40,50,,percent of total billed charges,,
Pt Paraffin Bath,,97018,CPT,Facility,Both,,,GP,80,68,22.928,80,Humana Insurance Company,Commercial PPO,76,95,,percent of total billed charges,,
Pt Paraffin Bath,,97018,CPT,Facility,Outpatient,,,GP,80,68,22.928,80,Humana Insurance Company,Medicare PPO,39.2,49,,percent of total billed charges,,
Pt Paraffin Bath,,97018,CPT,Facility,Inpatient,,,GP,80,68,22.928,80,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Pt Paraffin Bath,,97018,CPT,Facility,Both,,,GP,80,68,22.928,80,Medica,Individual & Family,79.28,99.1,,percent of total billed charges,,
Pt Paraffin Bath,,97018,CPT,Facility,Outpatient,,,GP,80,68,22.928,80,Medica,Medica Advantage Solution,39.84,49.8,,percent of total billed charges,,
Pt Paraffin Bath,,97018,CPT,Facility,Inpatient,,,GP,80,68,22.928,80,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Pt Paraffin Bath,,97018,CPT,Facility,Outpatient,,,GP,80,68,22.928,80,Medica,Medical Assistance,35.68,44.6,,percent of total billed charges,,
Pt Paraffin Bath,,97018,CPT,Facility,Inpatient,,,GP,80,68,22.928,80,Medica,Medical Assistance,,,,,Included in per diem rate,
Pt Paraffin Bath,,97018,CPT,Facility,Outpatient,,,GP,80,68,22.928,80,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,39.84,49.8,,percent of total billed charges,,
Pt Paraffin Bath,,97018,CPT,Facility,Inpatient,,,GP,80,68,22.928,80,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Pt Paraffin Bath,,97018,CPT,Facility,Both,,,GP,80,68,22.928,80,"Multiplan, Inc.","Multiplan, Inc.",75.2,94,,percent of total billed charges,,
Pt Paraffin Bath,,97018,CPT,Facility,Outpatient,,,GP,80,68,22.928,80,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,69.12,86.4,,percent of total billed charges,,
Pt Paraffin Bath,,97018,CPT,Facility,Inpatient,,,GP,80,68,22.928,80,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Pt Paraffin Bath,,97018,CPT,Facility,Both,,,GP,80,68,22.928,80,"Preferred One Administrative Services, INC.",PPO,78.88,98.6,,percent of total billed charges,,
Pt Paraffin Bath,,97018,CPT,Facility,Outpatient,,,GP,80,68,22.928,80,PrimeWest Health,Minnesota Senior Health Options (MSHO),41.16,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Pt Paraffin Bath,,97018,CPT,Facility,Inpatient,,,GP,80,68,22.928,80,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Pt Paraffin Bath,,97018,CPT,Facility,Outpatient,,,GP,80,68,22.928,80,PrimeWest Health,MinnesotaCare,41.088,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Pt Paraffin Bath,,97018,CPT,Facility,Inpatient,,,GP,80,68,22.928,80,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Pt Paraffin Bath,,97018,CPT,Facility,Both,,,GP,80,68,22.928,80,Sanford Health Plan,Sanford Health Plan,73.6,92,,percent of total billed charges,,
Pt Paraffin Bath,,97018,CPT,Facility,Outpatient,,,GP,80,68,22.928,80,"UCare Health, Inc.",Individual & Family Plan,45.08,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Pt Paraffin Bath,,97018,CPT,Facility,Inpatient,,,GP,80,68,22.928,80,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Pt Paraffin Bath,,97018,CPT,Facility,Outpatient,,,GP,80,68,22.928,80,"UCare Health, Inc.",Medical Assistance,40.376,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Pt Paraffin Bath,,97018,CPT,Facility,Inpatient,,,GP,80,68,22.928,80,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Pt Paraffin Bath,,97018,CPT,Facility,Outpatient,,,GP,80,68,22.928,80,"UCare Health, Inc.",Medicare Advantage,40.376,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Pt Paraffin Bath,,97018,CPT,Facility,Inpatient,,,GP,80,68,22.928,80,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Pt Paraffin Bath,,97018,CPT,Facility,Outpatient,,,GP,80,68,22.928,80,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),40.376,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Pt Paraffin Bath,,97018,CPT,Facility,Inpatient,,,GP,80,68,22.928,80,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Pt Paraffin Bath,,97018,CPT,Facility,Both,,,GP,80,68,22.928,80,UnitedHealthcare,Individual & Family,75.2,94,,percent of total billed charges,,
Pt Paraffin Bath,,97018,CPT,Facility,Outpatient,,,GP,80,68,22.928,80,UnitedHealthcare,Medicare Advantage,39.2,49,,percent of total billed charges,,
Pt Paraffin Bath,,97018,CPT,Facility,Inpatient,,,GP,80,68,22.928,80,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Pt Paraffin Bath,,97018,CPT,Facility,Outpatient,,,GP,80,68,22.928,80,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,38.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
Pt Paraffin Bath,,97018,CPT,Facility,Inpatient,,,GP,80,68,22.928,80,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Pt Whirlpool,,97022,CPT,Facility,Both,,,GP,80,68,22.928,80,Aetna,Commercial,73.6,92,,percent of total billed charges,,
Pt Whirlpool,,97022,CPT,Facility,Outpatient,,,GP,80,68,22.928,80,Aetna,Medicare Advantage,39.2,49,,percent of total billed charges,,
Pt Whirlpool,,97022,CPT,Facility,Inpatient,,,GP,80,68,22.928,80,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Pt Whirlpool,,97022,CPT,Facility,Both,,,GP,80,68,22.928,80,Aetna,PPO,74.4,93,,percent of total billed charges,,
Pt Whirlpool,,97022,CPT,Facility,Both,,,GP,80,68,22.928,80,America's PPO,America's PPO,76.824,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Pt Whirlpool,,97022,CPT,Facility,Both,,,GP,80,68,22.928,80,BlueCross BlueShield Minnesota, Federal Employee Program,78.72,98.4,,percent of total billed charges,,
Pt Whirlpool,,97022,CPT,Facility,Both,,,GP,80,68,22.928,80,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,80,100,,percent of total billed charges,,
Pt Whirlpool,,97022,CPT,Facility,Both,,,GP,80,68,22.928,80,BlueCross BlueShield Minnesota,High Value Network Plan,72,90,,percent of total billed charges,,
Pt Whirlpool,,97022,CPT,Facility,Outpatient,,,GP,80,68,22.928,80,BlueCross BlueShield Minnesota,Medicare Advantage,39.2,49,,percent of total billed charges,,
Pt Whirlpool,,97022,CPT,Facility,Inpatient,,,GP,80,68,22.928,80,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Pt Whirlpool,,97022,CPT,Facility,Both,,,GP,80,68,22.928,80,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,70.856,88.57,,percent of total billed charges,,
Pt Whirlpool,,97022,CPT,Facility,Both,,,GP,80,68,22.928,80,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,22.928,28.66,,percent of total billed charges,,
Pt Whirlpool,,97022,CPT,Facility,Outpatient,,,GP,80,68,22.928,80,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),39.2,49,,percent of total billed charges,,
Pt Whirlpool,,97022,CPT,Facility,Inpatient,,,GP,80,68,22.928,80,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Pt Whirlpool,,97022,CPT,Facility,Both,,,GP,80,68,22.928,80,CorVel,Worker's Compensation,80,100,,percent of total billed charges,,
Pt Whirlpool,,97022,CPT,Facility,Both,,,GP,80,68,22.928,80,First Health Group Corporation,First Health Network,77.6,97,,percent of total billed charges,,
Pt Whirlpool,,97022,CPT,Facility,Both,,,GP,80,68,22.928,80,"Health Partners, Inc.",Commercial,75.68,94.6,,percent of total billed charges,,
Pt Whirlpool,,97022,CPT,Facility,Outpatient,,,GP,80,68,22.928,80,"Health Partners, Inc.",Medicare Advantage,39.2,49,,percent of total billed charges,,
Pt Whirlpool,,97022,CPT,Facility,Inpatient,,,GP,80,68,22.928,80,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Pt Whirlpool,,97022,CPT,Facility,Both,,,GP,80,68,22.928,80,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),48,60,,percent of total billed charges,,
Pt Whirlpool,,97022,CPT,Facility,Both,,,GP,80,68,22.928,80,"Health Partners, Inc.",State of Minnesota Advantage Program,65.2,81.5,,percent of total billed charges,,
Pt Whirlpool,,97022,CPT,Facility,Both,,,GP,80,68,22.928,80,"Health Partners, Inc.",State Public Programs,40,50,,percent of total billed charges,,
Pt Whirlpool,,97022,CPT,Facility,Both,,,GP,80,68,22.928,80,Humana Insurance Company,Commercial PPO,76,95,,percent of total billed charges,,
Pt Whirlpool,,97022,CPT,Facility,Outpatient,,,GP,80,68,22.928,80,Humana Insurance Company,Medicare PPO,39.2,49,,percent of total billed charges,,
Pt Whirlpool,,97022,CPT,Facility,Inpatient,,,GP,80,68,22.928,80,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Pt Whirlpool,,97022,CPT,Facility,Both,,,GP,80,68,22.928,80,Medica,Individual & Family,79.28,99.1,,percent of total billed charges,,
Pt Whirlpool,,97022,CPT,Facility,Outpatient,,,GP,80,68,22.928,80,Medica,Medica Advantage Solution,39.84,49.8,,percent of total billed charges,,
Pt Whirlpool,,97022,CPT,Facility,Inpatient,,,GP,80,68,22.928,80,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Pt Whirlpool,,97022,CPT,Facility,Outpatient,,,GP,80,68,22.928,80,Medica,Medical Assistance,35.68,44.6,,percent of total billed charges,,
Pt Whirlpool,,97022,CPT,Facility,Inpatient,,,GP,80,68,22.928,80,Medica,Medical Assistance,,,,,Included in per diem rate,
Pt Whirlpool,,97022,CPT,Facility,Outpatient,,,GP,80,68,22.928,80,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,39.84,49.8,,percent of total billed charges,,
Pt Whirlpool,,97022,CPT,Facility,Inpatient,,,GP,80,68,22.928,80,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Pt Whirlpool,,97022,CPT,Facility,Both,,,GP,80,68,22.928,80,"Multiplan, Inc.","Multiplan, Inc.",75.2,94,,percent of total billed charges,,
Pt Whirlpool,,97022,CPT,Facility,Outpatient,,,GP,80,68,22.928,80,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,69.12,86.4,,percent of total billed charges,,
Pt Whirlpool,,97022,CPT,Facility,Inpatient,,,GP,80,68,22.928,80,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Pt Whirlpool,,97022,CPT,Facility,Both,,,GP,80,68,22.928,80,"Preferred One Administrative Services, INC.",PPO,78.88,98.6,,percent of total billed charges,,
Pt Whirlpool,,97022,CPT,Facility,Outpatient,,,GP,80,68,22.928,80,PrimeWest Health,Minnesota Senior Health Options (MSHO),41.16,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Pt Whirlpool,,97022,CPT,Facility,Inpatient,,,GP,80,68,22.928,80,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Pt Whirlpool,,97022,CPT,Facility,Outpatient,,,GP,80,68,22.928,80,PrimeWest Health,MinnesotaCare,41.088,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Pt Whirlpool,,97022,CPT,Facility,Inpatient,,,GP,80,68,22.928,80,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Pt Whirlpool,,97022,CPT,Facility,Both,,,GP,80,68,22.928,80,Sanford Health Plan,Sanford Health Plan,73.6,92,,percent of total billed charges,,
Pt Whirlpool,,97022,CPT,Facility,Outpatient,,,GP,80,68,22.928,80,"UCare Health, Inc.",Individual & Family Plan,45.08,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Pt Whirlpool,,97022,CPT,Facility,Inpatient,,,GP,80,68,22.928,80,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Pt Whirlpool,,97022,CPT,Facility,Outpatient,,,GP,80,68,22.928,80,"UCare Health, Inc.",Medical Assistance,40.376,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Pt Whirlpool,,97022,CPT,Facility,Inpatient,,,GP,80,68,22.928,80,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Pt Whirlpool,,97022,CPT,Facility,Outpatient,,,GP,80,68,22.928,80,"UCare Health, Inc.",Medicare Advantage,40.376,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Pt Whirlpool,,97022,CPT,Facility,Inpatient,,,GP,80,68,22.928,80,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Pt Whirlpool,,97022,CPT,Facility,Outpatient,,,GP,80,68,22.928,80,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),40.376,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Pt Whirlpool,,97022,CPT,Facility,Inpatient,,,GP,80,68,22.928,80,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Pt Whirlpool,,97022,CPT,Facility,Both,,,GP,80,68,22.928,80,UnitedHealthcare,Individual & Family,75.2,94,,percent of total billed charges,,
Pt Whirlpool,,97022,CPT,Facility,Outpatient,,,GP,80,68,22.928,80,UnitedHealthcare,Medicare Advantage,39.2,49,,percent of total billed charges,,
Pt Whirlpool,,97022,CPT,Facility,Inpatient,,,GP,80,68,22.928,80,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Pt Whirlpool,,97022,CPT,Facility,Outpatient,,,GP,80,68,22.928,80,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,38.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
Pt Whirlpool,,97022,CPT,Facility,Inpatient,,,GP,80,68,22.928,80,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Pt Electrical Stim Attended (15 Min),,97032,CPT,Facility,Both,,,GP,67,56.95,19.2022,67,Aetna,Commercial,61.64,92,,percent of total billed charges,,
Pt Electrical Stim Attended (15 Min),,97032,CPT,Facility,Outpatient,,,GP,67,56.95,19.2022,67,Aetna,Medicare Advantage,32.83,49,,percent of total billed charges,,
Pt Electrical Stim Attended (15 Min),,97032,CPT,Facility,Inpatient,,,GP,67,56.95,19.2022,67,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Pt Electrical Stim Attended (15 Min),,97032,CPT,Facility,Both,,,GP,67,56.95,19.2022,67,Aetna,PPO,62.31,93,,percent of total billed charges,,
Pt Electrical Stim Attended (15 Min),,97032,CPT,Facility,Both,,,GP,67,56.95,19.2022,67,America's PPO,America's PPO,64.3401,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Pt Electrical Stim Attended (15 Min),,97032,CPT,Facility,Both,,,GP,67,56.95,19.2022,67,BlueCross BlueShield Minnesota, Federal Employee Program,65.928,98.4,,percent of total billed charges,,
Pt Electrical Stim Attended (15 Min),,97032,CPT,Facility,Both,,,GP,67,56.95,19.2022,67,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,67,100,,percent of total billed charges,,
Pt Electrical Stim Attended (15 Min),,97032,CPT,Facility,Both,,,GP,67,56.95,19.2022,67,BlueCross BlueShield Minnesota,High Value Network Plan,60.3,90,,percent of total billed charges,,
Pt Electrical Stim Attended (15 Min),,97032,CPT,Facility,Outpatient,,,GP,67,56.95,19.2022,67,BlueCross BlueShield Minnesota,Medicare Advantage,32.83,49,,percent of total billed charges,,
Pt Electrical Stim Attended (15 Min),,97032,CPT,Facility,Inpatient,,,GP,67,56.95,19.2022,67,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Pt Electrical Stim Attended (15 Min),,97032,CPT,Facility,Both,,,GP,67,56.95,19.2022,67,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,59.3419,88.57,,percent of total billed charges,,
Pt Electrical Stim Attended (15 Min),,97032,CPT,Facility,Both,,,GP,67,56.95,19.2022,67,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,19.2022,28.66,,percent of total billed charges,,
Pt Electrical Stim Attended (15 Min),,97032,CPT,Facility,Outpatient,,,GP,67,56.95,19.2022,67,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),32.83,49,,percent of total billed charges,,
Pt Electrical Stim Attended (15 Min),,97032,CPT,Facility,Inpatient,,,GP,67,56.95,19.2022,67,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Pt Electrical Stim Attended (15 Min),,97032,CPT,Facility,Both,,,GP,67,56.95,19.2022,67,CorVel,Worker's Compensation,67,100,,percent of total billed charges,,
Pt Electrical Stim Attended (15 Min),,97032,CPT,Facility,Both,,,GP,67,56.95,19.2022,67,First Health Group Corporation,First Health Network,64.99,97,,percent of total billed charges,,
Pt Electrical Stim Attended (15 Min),,97032,CPT,Facility,Both,,,GP,67,56.95,19.2022,67,"Health Partners, Inc.",Commercial,63.382,94.6,,percent of total billed charges,,
Pt Electrical Stim Attended (15 Min),,97032,CPT,Facility,Outpatient,,,GP,67,56.95,19.2022,67,"Health Partners, Inc.",Medicare Advantage,32.83,49,,percent of total billed charges,,
Pt Electrical Stim Attended (15 Min),,97032,CPT,Facility,Inpatient,,,GP,67,56.95,19.2022,67,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Pt Electrical Stim Attended (15 Min),,97032,CPT,Facility,Both,,,GP,67,56.95,19.2022,67,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),40.2,60,,percent of total billed charges,,
Pt Electrical Stim Attended (15 Min),,97032,CPT,Facility,Both,,,GP,67,56.95,19.2022,67,"Health Partners, Inc.",State of Minnesota Advantage Program,54.605,81.5,,percent of total billed charges,,
Pt Electrical Stim Attended (15 Min),,97032,CPT,Facility,Both,,,GP,67,56.95,19.2022,67,"Health Partners, Inc.",State Public Programs,33.5,50,,percent of total billed charges,,
Pt Electrical Stim Attended (15 Min),,97032,CPT,Facility,Both,,,GP,67,56.95,19.2022,67,Humana Insurance Company,Commercial PPO,63.65,95,,percent of total billed charges,,
Pt Electrical Stim Attended (15 Min),,97032,CPT,Facility,Outpatient,,,GP,67,56.95,19.2022,67,Humana Insurance Company,Medicare PPO,32.83,49,,percent of total billed charges,,
Pt Electrical Stim Attended (15 Min),,97032,CPT,Facility,Inpatient,,,GP,67,56.95,19.2022,67,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Pt Electrical Stim Attended (15 Min),,97032,CPT,Facility,Both,,,GP,67,56.95,19.2022,67,Medica,Individual & Family,66.397,99.1,,percent of total billed charges,,
Pt Electrical Stim Attended (15 Min),,97032,CPT,Facility,Outpatient,,,GP,67,56.95,19.2022,67,Medica,Medica Advantage Solution,33.366,49.8,,percent of total billed charges,,
Pt Electrical Stim Attended (15 Min),,97032,CPT,Facility,Inpatient,,,GP,67,56.95,19.2022,67,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Pt Electrical Stim Attended (15 Min),,97032,CPT,Facility,Outpatient,,,GP,67,56.95,19.2022,67,Medica,Medical Assistance,29.882,44.6,,percent of total billed charges,,
Pt Electrical Stim Attended (15 Min),,97032,CPT,Facility,Inpatient,,,GP,67,56.95,19.2022,67,Medica,Medical Assistance,,,,,Included in per diem rate,
Pt Electrical Stim Attended (15 Min),,97032,CPT,Facility,Outpatient,,,GP,67,56.95,19.2022,67,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,33.366,49.8,,percent of total billed charges,,
Pt Electrical Stim Attended (15 Min),,97032,CPT,Facility,Inpatient,,,GP,67,56.95,19.2022,67,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Pt Electrical Stim Attended (15 Min),,97032,CPT,Facility,Both,,,GP,67,56.95,19.2022,67,"Multiplan, Inc.","Multiplan, Inc.",62.98,94,,percent of total billed charges,,
Pt Electrical Stim Attended (15 Min),,97032,CPT,Facility,Outpatient,,,GP,67,56.95,19.2022,67,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,57.888,86.4,,percent of total billed charges,,
Pt Electrical Stim Attended (15 Min),,97032,CPT,Facility,Inpatient,,,GP,67,56.95,19.2022,67,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Pt Electrical Stim Attended (15 Min),,97032,CPT,Facility,Both,,,GP,67,56.95,19.2022,67,"Preferred One Administrative Services, INC.",PPO,66.062,98.6,,percent of total billed charges,,
Pt Electrical Stim Attended (15 Min),,97032,CPT,Facility,Outpatient,,,GP,67,56.95,19.2022,67,PrimeWest Health,Minnesota Senior Health Options (MSHO),34.4715,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Pt Electrical Stim Attended (15 Min),,97032,CPT,Facility,Inpatient,,,GP,67,56.95,19.2022,67,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Pt Electrical Stim Attended (15 Min),,97032,CPT,Facility,Outpatient,,,GP,67,56.95,19.2022,67,PrimeWest Health,MinnesotaCare,34.4112,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Pt Electrical Stim Attended (15 Min),,97032,CPT,Facility,Inpatient,,,GP,67,56.95,19.2022,67,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Pt Electrical Stim Attended (15 Min),,97032,CPT,Facility,Both,,,GP,67,56.95,19.2022,67,Sanford Health Plan,Sanford Health Plan,61.64,92,,percent of total billed charges,,
Pt Electrical Stim Attended (15 Min),,97032,CPT,Facility,Outpatient,,,GP,67,56.95,19.2022,67,"UCare Health, Inc.",Individual & Family Plan,37.7545,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Pt Electrical Stim Attended (15 Min),,97032,CPT,Facility,Inpatient,,,GP,67,56.95,19.2022,67,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Pt Electrical Stim Attended (15 Min),,97032,CPT,Facility,Outpatient,,,GP,67,56.95,19.2022,67,"UCare Health, Inc.",Medical Assistance,33.8149,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Pt Electrical Stim Attended (15 Min),,97032,CPT,Facility,Inpatient,,,GP,67,56.95,19.2022,67,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Pt Electrical Stim Attended (15 Min),,97032,CPT,Facility,Outpatient,,,GP,67,56.95,19.2022,67,"UCare Health, Inc.",Medicare Advantage,33.8149,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Pt Electrical Stim Attended (15 Min),,97032,CPT,Facility,Inpatient,,,GP,67,56.95,19.2022,67,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Pt Electrical Stim Attended (15 Min),,97032,CPT,Facility,Outpatient,,,GP,67,56.95,19.2022,67,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),33.8149,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Pt Electrical Stim Attended (15 Min),,97032,CPT,Facility,Inpatient,,,GP,67,56.95,19.2022,67,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Pt Electrical Stim Attended (15 Min),,97032,CPT,Facility,Both,,,GP,67,56.95,19.2022,67,UnitedHealthcare,Individual & Family,62.98,94,,percent of total billed charges,,
Pt Electrical Stim Attended (15 Min),,97032,CPT,Facility,Outpatient,,,GP,67,56.95,19.2022,67,UnitedHealthcare,Medicare Advantage,32.83,49,,percent of total billed charges,,
Pt Electrical Stim Attended (15 Min),,97032,CPT,Facility,Inpatient,,,GP,67,56.95,19.2022,67,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Pt Electrical Stim Attended (15 Min),,97032,CPT,Facility,Outpatient,,,GP,67,56.95,19.2022,67,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,32.16,48,,percent of total billed charges,,100% of DHS outpatient percentage
Pt Electrical Stim Attended (15 Min),,97032,CPT,Facility,Inpatient,,,GP,67,56.95,19.2022,67,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Pt Iontophoresis (15 Min),,97033,CPT,Facility,Both,,,GP,93,79.05,26.6538,93,Aetna,Commercial,85.56,92,,percent of total billed charges,,
Pt Iontophoresis (15 Min),,97033,CPT,Facility,Outpatient,,,GP,93,79.05,26.6538,93,Aetna,Medicare Advantage,45.57,49,,percent of total billed charges,,
Pt Iontophoresis (15 Min),,97033,CPT,Facility,Inpatient,,,GP,93,79.05,26.6538,93,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Pt Iontophoresis (15 Min),,97033,CPT,Facility,Both,,,GP,93,79.05,26.6538,93,Aetna,PPO,86.49,93,,percent of total billed charges,,
Pt Iontophoresis (15 Min),,97033,CPT,Facility,Both,,,GP,93,79.05,26.6538,93,America's PPO,America's PPO,89.3079,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Pt Iontophoresis (15 Min),,97033,CPT,Facility,Both,,,GP,93,79.05,26.6538,93,BlueCross BlueShield Minnesota, Federal Employee Program,91.512,98.4,,percent of total billed charges,,
Pt Iontophoresis (15 Min),,97033,CPT,Facility,Both,,,GP,93,79.05,26.6538,93,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,93,100,,percent of total billed charges,,
Pt Iontophoresis (15 Min),,97033,CPT,Facility,Both,,,GP,93,79.05,26.6538,93,BlueCross BlueShield Minnesota,High Value Network Plan,83.7,90,,percent of total billed charges,,
Pt Iontophoresis (15 Min),,97033,CPT,Facility,Outpatient,,,GP,93,79.05,26.6538,93,BlueCross BlueShield Minnesota,Medicare Advantage,45.57,49,,percent of total billed charges,,
Pt Iontophoresis (15 Min),,97033,CPT,Facility,Inpatient,,,GP,93,79.05,26.6538,93,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Pt Iontophoresis (15 Min),,97033,CPT,Facility,Both,,,GP,93,79.05,26.6538,93,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,82.3701,88.57,,percent of total billed charges,,
Pt Iontophoresis (15 Min),,97033,CPT,Facility,Both,,,GP,93,79.05,26.6538,93,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,26.6538,28.66,,percent of total billed charges,,
Pt Iontophoresis (15 Min),,97033,CPT,Facility,Outpatient,,,GP,93,79.05,26.6538,93,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),45.57,49,,percent of total billed charges,,
Pt Iontophoresis (15 Min),,97033,CPT,Facility,Inpatient,,,GP,93,79.05,26.6538,93,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Pt Iontophoresis (15 Min),,97033,CPT,Facility,Both,,,GP,93,79.05,26.6538,93,CorVel,Worker's Compensation,93,100,,percent of total billed charges,,
Pt Iontophoresis (15 Min),,97033,CPT,Facility,Both,,,GP,93,79.05,26.6538,93,First Health Group Corporation,First Health Network,90.21,97,,percent of total billed charges,,
Pt Iontophoresis (15 Min),,97033,CPT,Facility,Both,,,GP,93,79.05,26.6538,93,"Health Partners, Inc.",Commercial,87.978,94.6,,percent of total billed charges,,
Pt Iontophoresis (15 Min),,97033,CPT,Facility,Outpatient,,,GP,93,79.05,26.6538,93,"Health Partners, Inc.",Medicare Advantage,45.57,49,,percent of total billed charges,,
Pt Iontophoresis (15 Min),,97033,CPT,Facility,Inpatient,,,GP,93,79.05,26.6538,93,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Pt Iontophoresis (15 Min),,97033,CPT,Facility,Both,,,GP,93,79.05,26.6538,93,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),55.8,60,,percent of total billed charges,,
Pt Iontophoresis (15 Min),,97033,CPT,Facility,Both,,,GP,93,79.05,26.6538,93,"Health Partners, Inc.",State of Minnesota Advantage Program,75.795,81.5,,percent of total billed charges,,
Pt Iontophoresis (15 Min),,97033,CPT,Facility,Both,,,GP,93,79.05,26.6538,93,"Health Partners, Inc.",State Public Programs,46.5,50,,percent of total billed charges,,
Pt Iontophoresis (15 Min),,97033,CPT,Facility,Both,,,GP,93,79.05,26.6538,93,Humana Insurance Company,Commercial PPO,88.35,95,,percent of total billed charges,,
Pt Iontophoresis (15 Min),,97033,CPT,Facility,Outpatient,,,GP,93,79.05,26.6538,93,Humana Insurance Company,Medicare PPO,45.57,49,,percent of total billed charges,,
Pt Iontophoresis (15 Min),,97033,CPT,Facility,Inpatient,,,GP,93,79.05,26.6538,93,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Pt Iontophoresis (15 Min),,97033,CPT,Facility,Both,,,GP,93,79.05,26.6538,93,Medica,Individual & Family,92.163,99.1,,percent of total billed charges,,
Pt Iontophoresis (15 Min),,97033,CPT,Facility,Outpatient,,,GP,93,79.05,26.6538,93,Medica,Medica Advantage Solution,46.314,49.8,,percent of total billed charges,,
Pt Iontophoresis (15 Min),,97033,CPT,Facility,Inpatient,,,GP,93,79.05,26.6538,93,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Pt Iontophoresis (15 Min),,97033,CPT,Facility,Outpatient,,,GP,93,79.05,26.6538,93,Medica,Medical Assistance,41.478,44.6,,percent of total billed charges,,
Pt Iontophoresis (15 Min),,97033,CPT,Facility,Inpatient,,,GP,93,79.05,26.6538,93,Medica,Medical Assistance,,,,,Included in per diem rate,
Pt Iontophoresis (15 Min),,97033,CPT,Facility,Outpatient,,,GP,93,79.05,26.6538,93,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,46.314,49.8,,percent of total billed charges,,
Pt Iontophoresis (15 Min),,97033,CPT,Facility,Inpatient,,,GP,93,79.05,26.6538,93,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Pt Iontophoresis (15 Min),,97033,CPT,Facility,Both,,,GP,93,79.05,26.6538,93,"Multiplan, Inc.","Multiplan, Inc.",87.42,94,,percent of total billed charges,,
Pt Iontophoresis (15 Min),,97033,CPT,Facility,Outpatient,,,GP,93,79.05,26.6538,93,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,80.352,86.4,,percent of total billed charges,,
Pt Iontophoresis (15 Min),,97033,CPT,Facility,Inpatient,,,GP,93,79.05,26.6538,93,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Pt Iontophoresis (15 Min),,97033,CPT,Facility,Both,,,GP,93,79.05,26.6538,93,"Preferred One Administrative Services, INC.",PPO,91.698,98.6,,percent of total billed charges,,
Pt Iontophoresis (15 Min),,97033,CPT,Facility,Outpatient,,,GP,93,79.05,26.6538,93,PrimeWest Health,Minnesota Senior Health Options (MSHO),47.8485,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Pt Iontophoresis (15 Min),,97033,CPT,Facility,Inpatient,,,GP,93,79.05,26.6538,93,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Pt Iontophoresis (15 Min),,97033,CPT,Facility,Outpatient,,,GP,93,79.05,26.6538,93,PrimeWest Health,MinnesotaCare,47.7648,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Pt Iontophoresis (15 Min),,97033,CPT,Facility,Inpatient,,,GP,93,79.05,26.6538,93,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Pt Iontophoresis (15 Min),,97033,CPT,Facility,Both,,,GP,93,79.05,26.6538,93,Sanford Health Plan,Sanford Health Plan,85.56,92,,percent of total billed charges,,
Pt Iontophoresis (15 Min),,97033,CPT,Facility,Outpatient,,,GP,93,79.05,26.6538,93,"UCare Health, Inc.",Individual & Family Plan,52.4055,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Pt Iontophoresis (15 Min),,97033,CPT,Facility,Inpatient,,,GP,93,79.05,26.6538,93,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Pt Iontophoresis (15 Min),,97033,CPT,Facility,Outpatient,,,GP,93,79.05,26.6538,93,"UCare Health, Inc.",Medical Assistance,46.9371,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Pt Iontophoresis (15 Min),,97033,CPT,Facility,Inpatient,,,GP,93,79.05,26.6538,93,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Pt Iontophoresis (15 Min),,97033,CPT,Facility,Outpatient,,,GP,93,79.05,26.6538,93,"UCare Health, Inc.",Medicare Advantage,46.9371,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Pt Iontophoresis (15 Min),,97033,CPT,Facility,Inpatient,,,GP,93,79.05,26.6538,93,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Pt Iontophoresis (15 Min),,97033,CPT,Facility,Outpatient,,,GP,93,79.05,26.6538,93,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),46.9371,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Pt Iontophoresis (15 Min),,97033,CPT,Facility,Inpatient,,,GP,93,79.05,26.6538,93,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Pt Iontophoresis (15 Min),,97033,CPT,Facility,Both,,,GP,93,79.05,26.6538,93,UnitedHealthcare,Individual & Family,87.42,94,,percent of total billed charges,,
Pt Iontophoresis (15 Min),,97033,CPT,Facility,Outpatient,,,GP,93,79.05,26.6538,93,UnitedHealthcare,Medicare Advantage,45.57,49,,percent of total billed charges,,
Pt Iontophoresis (15 Min),,97033,CPT,Facility,Inpatient,,,GP,93,79.05,26.6538,93,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Pt Iontophoresis (15 Min),,97033,CPT,Facility,Outpatient,,,GP,93,79.05,26.6538,93,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,44.64,48,,percent of total billed charges,,100% of DHS outpatient percentage
Pt Iontophoresis (15 Min),,97033,CPT,Facility,Inpatient,,,GP,93,79.05,26.6538,93,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Pt Contrast Bath (15 Min),,97034,CPT,Facility,Both,,,GP,77,65.45,22.0682,77,Aetna,Commercial,70.84,92,,percent of total billed charges,,
Pt Contrast Bath (15 Min),,97034,CPT,Facility,Outpatient,,,GP,77,65.45,22.0682,77,Aetna,Medicare Advantage,37.73,49,,percent of total billed charges,,
Pt Contrast Bath (15 Min),,97034,CPT,Facility,Inpatient,,,GP,77,65.45,22.0682,77,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Pt Contrast Bath (15 Min),,97034,CPT,Facility,Both,,,GP,77,65.45,22.0682,77,Aetna,PPO,71.61,93,,percent of total billed charges,,
Pt Contrast Bath (15 Min),,97034,CPT,Facility,Both,,,GP,77,65.45,22.0682,77,America's PPO,America's PPO,73.9431,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Pt Contrast Bath (15 Min),,97034,CPT,Facility,Both,,,GP,77,65.45,22.0682,77,BlueCross BlueShield Minnesota, Federal Employee Program,75.768,98.4,,percent of total billed charges,,
Pt Contrast Bath (15 Min),,97034,CPT,Facility,Both,,,GP,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,77,100,,percent of total billed charges,,
Pt Contrast Bath (15 Min),,97034,CPT,Facility,Both,,,GP,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,High Value Network Plan,69.3,90,,percent of total billed charges,,
Pt Contrast Bath (15 Min),,97034,CPT,Facility,Outpatient,,,GP,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,Medicare Advantage,37.73,49,,percent of total billed charges,,
Pt Contrast Bath (15 Min),,97034,CPT,Facility,Inpatient,,,GP,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Pt Contrast Bath (15 Min),,97034,CPT,Facility,Both,,,GP,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,68.1989,88.57,,percent of total billed charges,,
Pt Contrast Bath (15 Min),,97034,CPT,Facility,Both,,,GP,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,22.0682,28.66,,percent of total billed charges,,
Pt Contrast Bath (15 Min),,97034,CPT,Facility,Outpatient,,,GP,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),37.73,49,,percent of total billed charges,,
Pt Contrast Bath (15 Min),,97034,CPT,Facility,Inpatient,,,GP,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Pt Contrast Bath (15 Min),,97034,CPT,Facility,Both,,,GP,77,65.45,22.0682,77,CorVel,Worker's Compensation,77,100,,percent of total billed charges,,
Pt Contrast Bath (15 Min),,97034,CPT,Facility,Both,,,GP,77,65.45,22.0682,77,First Health Group Corporation,First Health Network,74.69,97,,percent of total billed charges,,
Pt Contrast Bath (15 Min),,97034,CPT,Facility,Both,,,GP,77,65.45,22.0682,77,"Health Partners, Inc.",Commercial,72.842,94.6,,percent of total billed charges,,
Pt Contrast Bath (15 Min),,97034,CPT,Facility,Outpatient,,,GP,77,65.45,22.0682,77,"Health Partners, Inc.",Medicare Advantage,37.73,49,,percent of total billed charges,,
Pt Contrast Bath (15 Min),,97034,CPT,Facility,Inpatient,,,GP,77,65.45,22.0682,77,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Pt Contrast Bath (15 Min),,97034,CPT,Facility,Both,,,GP,77,65.45,22.0682,77,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),46.2,60,,percent of total billed charges,,
Pt Contrast Bath (15 Min),,97034,CPT,Facility,Both,,,GP,77,65.45,22.0682,77,"Health Partners, Inc.",State of Minnesota Advantage Program,62.755,81.5,,percent of total billed charges,,
Pt Contrast Bath (15 Min),,97034,CPT,Facility,Both,,,GP,77,65.45,22.0682,77,"Health Partners, Inc.",State Public Programs,38.5,50,,percent of total billed charges,,
Pt Contrast Bath (15 Min),,97034,CPT,Facility,Both,,,GP,77,65.45,22.0682,77,Humana Insurance Company,Commercial PPO,73.15,95,,percent of total billed charges,,
Pt Contrast Bath (15 Min),,97034,CPT,Facility,Outpatient,,,GP,77,65.45,22.0682,77,Humana Insurance Company,Medicare PPO,37.73,49,,percent of total billed charges,,
Pt Contrast Bath (15 Min),,97034,CPT,Facility,Inpatient,,,GP,77,65.45,22.0682,77,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Pt Contrast Bath (15 Min),,97034,CPT,Facility,Both,,,GP,77,65.45,22.0682,77,Medica,Individual & Family,76.307,99.1,,percent of total billed charges,,
Pt Contrast Bath (15 Min),,97034,CPT,Facility,Outpatient,,,GP,77,65.45,22.0682,77,Medica,Medica Advantage Solution,38.346,49.8,,percent of total billed charges,,
Pt Contrast Bath (15 Min),,97034,CPT,Facility,Inpatient,,,GP,77,65.45,22.0682,77,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Pt Contrast Bath (15 Min),,97034,CPT,Facility,Outpatient,,,GP,77,65.45,22.0682,77,Medica,Medical Assistance,34.342,44.6,,percent of total billed charges,,
Pt Contrast Bath (15 Min),,97034,CPT,Facility,Inpatient,,,GP,77,65.45,22.0682,77,Medica,Medical Assistance,,,,,Included in per diem rate,
Pt Contrast Bath (15 Min),,97034,CPT,Facility,Outpatient,,,GP,77,65.45,22.0682,77,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,38.346,49.8,,percent of total billed charges,,
Pt Contrast Bath (15 Min),,97034,CPT,Facility,Inpatient,,,GP,77,65.45,22.0682,77,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Pt Contrast Bath (15 Min),,97034,CPT,Facility,Both,,,GP,77,65.45,22.0682,77,"Multiplan, Inc.","Multiplan, Inc.",72.38,94,,percent of total billed charges,,
Pt Contrast Bath (15 Min),,97034,CPT,Facility,Outpatient,,,GP,77,65.45,22.0682,77,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,66.528,86.4,,percent of total billed charges,,
Pt Contrast Bath (15 Min),,97034,CPT,Facility,Inpatient,,,GP,77,65.45,22.0682,77,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Pt Contrast Bath (15 Min),,97034,CPT,Facility,Both,,,GP,77,65.45,22.0682,77,"Preferred One Administrative Services, INC.",PPO,75.922,98.6,,percent of total billed charges,,
Pt Contrast Bath (15 Min),,97034,CPT,Facility,Outpatient,,,GP,77,65.45,22.0682,77,PrimeWest Health,Minnesota Senior Health Options (MSHO),39.6165,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Pt Contrast Bath (15 Min),,97034,CPT,Facility,Inpatient,,,GP,77,65.45,22.0682,77,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Pt Contrast Bath (15 Min),,97034,CPT,Facility,Outpatient,,,GP,77,65.45,22.0682,77,PrimeWest Health,MinnesotaCare,39.5472,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Pt Contrast Bath (15 Min),,97034,CPT,Facility,Inpatient,,,GP,77,65.45,22.0682,77,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Pt Contrast Bath (15 Min),,97034,CPT,Facility,Both,,,GP,77,65.45,22.0682,77,Sanford Health Plan,Sanford Health Plan,70.84,92,,percent of total billed charges,,
Pt Contrast Bath (15 Min),,97034,CPT,Facility,Outpatient,,,GP,77,65.45,22.0682,77,"UCare Health, Inc.",Individual & Family Plan,43.3895,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Pt Contrast Bath (15 Min),,97034,CPT,Facility,Inpatient,,,GP,77,65.45,22.0682,77,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Pt Contrast Bath (15 Min),,97034,CPT,Facility,Outpatient,,,GP,77,65.45,22.0682,77,"UCare Health, Inc.",Medical Assistance,38.8619,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Pt Contrast Bath (15 Min),,97034,CPT,Facility,Inpatient,,,GP,77,65.45,22.0682,77,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Pt Contrast Bath (15 Min),,97034,CPT,Facility,Outpatient,,,GP,77,65.45,22.0682,77,"UCare Health, Inc.",Medicare Advantage,38.8619,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Pt Contrast Bath (15 Min),,97034,CPT,Facility,Inpatient,,,GP,77,65.45,22.0682,77,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Pt Contrast Bath (15 Min),,97034,CPT,Facility,Outpatient,,,GP,77,65.45,22.0682,77,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),38.8619,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Pt Contrast Bath (15 Min),,97034,CPT,Facility,Inpatient,,,GP,77,65.45,22.0682,77,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Pt Contrast Bath (15 Min),,97034,CPT,Facility,Both,,,GP,77,65.45,22.0682,77,UnitedHealthcare,Individual & Family,72.38,94,,percent of total billed charges,,
Pt Contrast Bath (15 Min),,97034,CPT,Facility,Outpatient,,,GP,77,65.45,22.0682,77,UnitedHealthcare,Medicare Advantage,37.73,49,,percent of total billed charges,,
Pt Contrast Bath (15 Min),,97034,CPT,Facility,Inpatient,,,GP,77,65.45,22.0682,77,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Pt Contrast Bath (15 Min),,97034,CPT,Facility,Outpatient,,,GP,77,65.45,22.0682,77,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,36.96,48,,percent of total billed charges,,100% of DHS outpatient percentage
Pt Contrast Bath (15 Min),,97034,CPT,Facility,Inpatient,,,GP,77,65.45,22.0682,77,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Pt Ultrasound (15 Min),,97035,CPT,Facility,Both,,,GP,77,65.45,22.0682,77,Aetna,Commercial,70.84,92,,percent of total billed charges,,
Pt Ultrasound (15 Min),,97035,CPT,Facility,Outpatient,,,GP,77,65.45,22.0682,77,Aetna,Medicare Advantage,37.73,49,,percent of total billed charges,,
Pt Ultrasound (15 Min),,97035,CPT,Facility,Inpatient,,,GP,77,65.45,22.0682,77,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Pt Ultrasound (15 Min),,97035,CPT,Facility,Both,,,GP,77,65.45,22.0682,77,Aetna,PPO,71.61,93,,percent of total billed charges,,
Pt Ultrasound (15 Min),,97035,CPT,Facility,Both,,,GP,77,65.45,22.0682,77,America's PPO,America's PPO,73.9431,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Pt Ultrasound (15 Min),,97035,CPT,Facility,Both,,,GP,77,65.45,22.0682,77,BlueCross BlueShield Minnesota, Federal Employee Program,75.768,98.4,,percent of total billed charges,,
Pt Ultrasound (15 Min),,97035,CPT,Facility,Both,,,GP,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,77,100,,percent of total billed charges,,
Pt Ultrasound (15 Min),,97035,CPT,Facility,Both,,,GP,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,High Value Network Plan,69.3,90,,percent of total billed charges,,
Pt Ultrasound (15 Min),,97035,CPT,Facility,Outpatient,,,GP,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,Medicare Advantage,37.73,49,,percent of total billed charges,,
Pt Ultrasound (15 Min),,97035,CPT,Facility,Inpatient,,,GP,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Pt Ultrasound (15 Min),,97035,CPT,Facility,Both,,,GP,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,68.1989,88.57,,percent of total billed charges,,
Pt Ultrasound (15 Min),,97035,CPT,Facility,Both,,,GP,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,22.0682,28.66,,percent of total billed charges,,
Pt Ultrasound (15 Min),,97035,CPT,Facility,Outpatient,,,GP,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),37.73,49,,percent of total billed charges,,
Pt Ultrasound (15 Min),,97035,CPT,Facility,Inpatient,,,GP,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Pt Ultrasound (15 Min),,97035,CPT,Facility,Both,,,GP,77,65.45,22.0682,77,CorVel,Worker's Compensation,77,100,,percent of total billed charges,,
Pt Ultrasound (15 Min),,97035,CPT,Facility,Both,,,GP,77,65.45,22.0682,77,First Health Group Corporation,First Health Network,74.69,97,,percent of total billed charges,,
Pt Ultrasound (15 Min),,97035,CPT,Facility,Both,,,GP,77,65.45,22.0682,77,"Health Partners, Inc.",Commercial,72.842,94.6,,percent of total billed charges,,
Pt Ultrasound (15 Min),,97035,CPT,Facility,Outpatient,,,GP,77,65.45,22.0682,77,"Health Partners, Inc.",Medicare Advantage,37.73,49,,percent of total billed charges,,
Pt Ultrasound (15 Min),,97035,CPT,Facility,Inpatient,,,GP,77,65.45,22.0682,77,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Pt Ultrasound (15 Min),,97035,CPT,Facility,Both,,,GP,77,65.45,22.0682,77,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),46.2,60,,percent of total billed charges,,
Pt Ultrasound (15 Min),,97035,CPT,Facility,Both,,,GP,77,65.45,22.0682,77,"Health Partners, Inc.",State of Minnesota Advantage Program,62.755,81.5,,percent of total billed charges,,
Pt Ultrasound (15 Min),,97035,CPT,Facility,Both,,,GP,77,65.45,22.0682,77,"Health Partners, Inc.",State Public Programs,38.5,50,,percent of total billed charges,,
Pt Ultrasound (15 Min),,97035,CPT,Facility,Both,,,GP,77,65.45,22.0682,77,Humana Insurance Company,Commercial PPO,73.15,95,,percent of total billed charges,,
Pt Ultrasound (15 Min),,97035,CPT,Facility,Outpatient,,,GP,77,65.45,22.0682,77,Humana Insurance Company,Medicare PPO,37.73,49,,percent of total billed charges,,
Pt Ultrasound (15 Min),,97035,CPT,Facility,Inpatient,,,GP,77,65.45,22.0682,77,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Pt Ultrasound (15 Min),,97035,CPT,Facility,Both,,,GP,77,65.45,22.0682,77,Medica,Individual & Family,76.307,99.1,,percent of total billed charges,,
Pt Ultrasound (15 Min),,97035,CPT,Facility,Outpatient,,,GP,77,65.45,22.0682,77,Medica,Medica Advantage Solution,38.346,49.8,,percent of total billed charges,,
Pt Ultrasound (15 Min),,97035,CPT,Facility,Inpatient,,,GP,77,65.45,22.0682,77,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Pt Ultrasound (15 Min),,97035,CPT,Facility,Outpatient,,,GP,77,65.45,22.0682,77,Medica,Medical Assistance,34.342,44.6,,percent of total billed charges,,
Pt Ultrasound (15 Min),,97035,CPT,Facility,Inpatient,,,GP,77,65.45,22.0682,77,Medica,Medical Assistance,,,,,Included in per diem rate,
Pt Ultrasound (15 Min),,97035,CPT,Facility,Outpatient,,,GP,77,65.45,22.0682,77,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,38.346,49.8,,percent of total billed charges,,
Pt Ultrasound (15 Min),,97035,CPT,Facility,Inpatient,,,GP,77,65.45,22.0682,77,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Pt Ultrasound (15 Min),,97035,CPT,Facility,Both,,,GP,77,65.45,22.0682,77,"Multiplan, Inc.","Multiplan, Inc.",72.38,94,,percent of total billed charges,,
Pt Ultrasound (15 Min),,97035,CPT,Facility,Outpatient,,,GP,77,65.45,22.0682,77,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,66.528,86.4,,percent of total billed charges,,
Pt Ultrasound (15 Min),,97035,CPT,Facility,Inpatient,,,GP,77,65.45,22.0682,77,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Pt Ultrasound (15 Min),,97035,CPT,Facility,Both,,,GP,77,65.45,22.0682,77,"Preferred One Administrative Services, INC.",PPO,75.922,98.6,,percent of total billed charges,,
Pt Ultrasound (15 Min),,97035,CPT,Facility,Outpatient,,,GP,77,65.45,22.0682,77,PrimeWest Health,Minnesota Senior Health Options (MSHO),39.6165,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Pt Ultrasound (15 Min),,97035,CPT,Facility,Inpatient,,,GP,77,65.45,22.0682,77,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Pt Ultrasound (15 Min),,97035,CPT,Facility,Outpatient,,,GP,77,65.45,22.0682,77,PrimeWest Health,MinnesotaCare,39.5472,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Pt Ultrasound (15 Min),,97035,CPT,Facility,Inpatient,,,GP,77,65.45,22.0682,77,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Pt Ultrasound (15 Min),,97035,CPT,Facility,Both,,,GP,77,65.45,22.0682,77,Sanford Health Plan,Sanford Health Plan,70.84,92,,percent of total billed charges,,
Pt Ultrasound (15 Min),,97035,CPT,Facility,Outpatient,,,GP,77,65.45,22.0682,77,"UCare Health, Inc.",Individual & Family Plan,43.3895,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Pt Ultrasound (15 Min),,97035,CPT,Facility,Inpatient,,,GP,77,65.45,22.0682,77,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Pt Ultrasound (15 Min),,97035,CPT,Facility,Outpatient,,,GP,77,65.45,22.0682,77,"UCare Health, Inc.",Medical Assistance,38.8619,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Pt Ultrasound (15 Min),,97035,CPT,Facility,Inpatient,,,GP,77,65.45,22.0682,77,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Pt Ultrasound (15 Min),,97035,CPT,Facility,Outpatient,,,GP,77,65.45,22.0682,77,"UCare Health, Inc.",Medicare Advantage,38.8619,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Pt Ultrasound (15 Min),,97035,CPT,Facility,Inpatient,,,GP,77,65.45,22.0682,77,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Pt Ultrasound (15 Min),,97035,CPT,Facility,Outpatient,,,GP,77,65.45,22.0682,77,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),38.8619,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Pt Ultrasound (15 Min),,97035,CPT,Facility,Inpatient,,,GP,77,65.45,22.0682,77,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Pt Ultrasound (15 Min),,97035,CPT,Facility,Both,,,GP,77,65.45,22.0682,77,UnitedHealthcare,Individual & Family,72.38,94,,percent of total billed charges,,
Pt Ultrasound (15 Min),,97035,CPT,Facility,Outpatient,,,GP,77,65.45,22.0682,77,UnitedHealthcare,Medicare Advantage,37.73,49,,percent of total billed charges,,
Pt Ultrasound (15 Min),,97035,CPT,Facility,Inpatient,,,GP,77,65.45,22.0682,77,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Pt Ultrasound (15 Min),,97035,CPT,Facility,Outpatient,,,GP,77,65.45,22.0682,77,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,36.96,48,,percent of total billed charges,,100% of DHS outpatient percentage
Pt Ultrasound (15 Min),,97035,CPT,Facility,Inpatient,,,GP,77,65.45,22.0682,77,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Pt Exercise (Rom, Strength, Flex) (15 Min)",,97110,CPT,Facility,Both,,,GP,102,86.7,29.2332,102,Aetna,Commercial,93.84,92,,percent of total billed charges,,
"Pt Exercise (Rom, Strength, Flex) (15 Min)",,97110,CPT,Facility,Outpatient,,,GP,102,86.7,29.2332,102,Aetna,Medicare Advantage,49.98,49,,percent of total billed charges,,
"Pt Exercise (Rom, Strength, Flex) (15 Min)",,97110,CPT,Facility,Inpatient,,,GP,102,86.7,29.2332,102,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Pt Exercise (Rom, Strength, Flex) (15 Min)",,97110,CPT,Facility,Both,,,GP,102,86.7,29.2332,102,Aetna,PPO,94.86,93,,percent of total billed charges,,
"Pt Exercise (Rom, Strength, Flex) (15 Min)",,97110,CPT,Facility,Both,,,GP,102,86.7,29.2332,102,America's PPO,America's PPO,97.9506,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Pt Exercise (Rom, Strength, Flex) (15 Min)",,97110,CPT,Facility,Both,,,GP,102,86.7,29.2332,102,BlueCross BlueShield Minnesota, Federal Employee Program,100.368,98.4,,percent of total billed charges,,
"Pt Exercise (Rom, Strength, Flex) (15 Min)",,97110,CPT,Facility,Both,,,GP,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,102,100,,percent of total billed charges,,
"Pt Exercise (Rom, Strength, Flex) (15 Min)",,97110,CPT,Facility,Both,,,GP,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,High Value Network Plan,91.8,90,,percent of total billed charges,,
"Pt Exercise (Rom, Strength, Flex) (15 Min)",,97110,CPT,Facility,Outpatient,,,GP,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,Medicare Advantage,49.98,49,,percent of total billed charges,,
"Pt Exercise (Rom, Strength, Flex) (15 Min)",,97110,CPT,Facility,Inpatient,,,GP,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Pt Exercise (Rom, Strength, Flex) (15 Min)",,97110,CPT,Facility,Both,,,GP,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,90.3414,88.57,,percent of total billed charges,,
"Pt Exercise (Rom, Strength, Flex) (15 Min)",,97110,CPT,Facility,Both,,,GP,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,29.2332,28.66,,percent of total billed charges,,
"Pt Exercise (Rom, Strength, Flex) (15 Min)",,97110,CPT,Facility,Outpatient,,,GP,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),49.98,49,,percent of total billed charges,,
"Pt Exercise (Rom, Strength, Flex) (15 Min)",,97110,CPT,Facility,Inpatient,,,GP,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Pt Exercise (Rom, Strength, Flex) (15 Min)",,97110,CPT,Facility,Both,,,GP,102,86.7,29.2332,102,CorVel,Worker's Compensation,102,100,,percent of total billed charges,,
"Pt Exercise (Rom, Strength, Flex) (15 Min)",,97110,CPT,Facility,Both,,,GP,102,86.7,29.2332,102,First Health Group Corporation,First Health Network,98.94,97,,percent of total billed charges,,
"Pt Exercise (Rom, Strength, Flex) (15 Min)",,97110,CPT,Facility,Both,,,GP,102,86.7,29.2332,102,"Health Partners, Inc.",Commercial,96.492,94.6,,percent of total billed charges,,
"Pt Exercise (Rom, Strength, Flex) (15 Min)",,97110,CPT,Facility,Outpatient,,,GP,102,86.7,29.2332,102,"Health Partners, Inc.",Medicare Advantage,49.98,49,,percent of total billed charges,,
"Pt Exercise (Rom, Strength, Flex) (15 Min)",,97110,CPT,Facility,Inpatient,,,GP,102,86.7,29.2332,102,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Pt Exercise (Rom, Strength, Flex) (15 Min)",,97110,CPT,Facility,Both,,,GP,102,86.7,29.2332,102,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),61.2,60,,percent of total billed charges,,
"Pt Exercise (Rom, Strength, Flex) (15 Min)",,97110,CPT,Facility,Both,,,GP,102,86.7,29.2332,102,"Health Partners, Inc.",State of Minnesota Advantage Program,83.13,81.5,,percent of total billed charges,,
"Pt Exercise (Rom, Strength, Flex) (15 Min)",,97110,CPT,Facility,Both,,,GP,102,86.7,29.2332,102,"Health Partners, Inc.",State Public Programs,51,50,,percent of total billed charges,,
"Pt Exercise (Rom, Strength, Flex) (15 Min)",,97110,CPT,Facility,Both,,,GP,102,86.7,29.2332,102,Humana Insurance Company,Commercial PPO,96.9,95,,percent of total billed charges,,
"Pt Exercise (Rom, Strength, Flex) (15 Min)",,97110,CPT,Facility,Outpatient,,,GP,102,86.7,29.2332,102,Humana Insurance Company,Medicare PPO,49.98,49,,percent of total billed charges,,
"Pt Exercise (Rom, Strength, Flex) (15 Min)",,97110,CPT,Facility,Inpatient,,,GP,102,86.7,29.2332,102,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Pt Exercise (Rom, Strength, Flex) (15 Min)",,97110,CPT,Facility,Both,,,GP,102,86.7,29.2332,102,Medica,Individual & Family,101.082,99.1,,percent of total billed charges,,
"Pt Exercise (Rom, Strength, Flex) (15 Min)",,97110,CPT,Facility,Outpatient,,,GP,102,86.7,29.2332,102,Medica,Medica Advantage Solution,50.796,49.8,,percent of total billed charges,,
"Pt Exercise (Rom, Strength, Flex) (15 Min)",,97110,CPT,Facility,Inpatient,,,GP,102,86.7,29.2332,102,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Pt Exercise (Rom, Strength, Flex) (15 Min)",,97110,CPT,Facility,Outpatient,,,GP,102,86.7,29.2332,102,Medica,Medical Assistance,45.492,44.6,,percent of total billed charges,,
"Pt Exercise (Rom, Strength, Flex) (15 Min)",,97110,CPT,Facility,Inpatient,,,GP,102,86.7,29.2332,102,Medica,Medical Assistance,,,,,Included in per diem rate,
"Pt Exercise (Rom, Strength, Flex) (15 Min)",,97110,CPT,Facility,Outpatient,,,GP,102,86.7,29.2332,102,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,50.796,49.8,,percent of total billed charges,,
"Pt Exercise (Rom, Strength, Flex) (15 Min)",,97110,CPT,Facility,Inpatient,,,GP,102,86.7,29.2332,102,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Pt Exercise (Rom, Strength, Flex) (15 Min)",,97110,CPT,Facility,Both,,,GP,102,86.7,29.2332,102,"Multiplan, Inc.","Multiplan, Inc.",95.88,94,,percent of total billed charges,,
"Pt Exercise (Rom, Strength, Flex) (15 Min)",,97110,CPT,Facility,Outpatient,,,GP,102,86.7,29.2332,102,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,88.128,86.4,,percent of total billed charges,,
"Pt Exercise (Rom, Strength, Flex) (15 Min)",,97110,CPT,Facility,Inpatient,,,GP,102,86.7,29.2332,102,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Pt Exercise (Rom, Strength, Flex) (15 Min)",,97110,CPT,Facility,Both,,,GP,102,86.7,29.2332,102,"Preferred One Administrative Services, INC.",PPO,100.572,98.6,,percent of total billed charges,,
"Pt Exercise (Rom, Strength, Flex) (15 Min)",,97110,CPT,Facility,Outpatient,,,GP,102,86.7,29.2332,102,PrimeWest Health,Minnesota Senior Health Options (MSHO),52.479,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Pt Exercise (Rom, Strength, Flex) (15 Min)",,97110,CPT,Facility,Inpatient,,,GP,102,86.7,29.2332,102,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Pt Exercise (Rom, Strength, Flex) (15 Min)",,97110,CPT,Facility,Outpatient,,,GP,102,86.7,29.2332,102,PrimeWest Health,MinnesotaCare,52.3872,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Pt Exercise (Rom, Strength, Flex) (15 Min)",,97110,CPT,Facility,Inpatient,,,GP,102,86.7,29.2332,102,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Pt Exercise (Rom, Strength, Flex) (15 Min)",,97110,CPT,Facility,Both,,,GP,102,86.7,29.2332,102,Sanford Health Plan,Sanford Health Plan,93.84,92,,percent of total billed charges,,
"Pt Exercise (Rom, Strength, Flex) (15 Min)",,97110,CPT,Facility,Outpatient,,,GP,102,86.7,29.2332,102,"UCare Health, Inc.",Individual & Family Plan,57.477,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Pt Exercise (Rom, Strength, Flex) (15 Min)",,97110,CPT,Facility,Inpatient,,,GP,102,86.7,29.2332,102,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Pt Exercise (Rom, Strength, Flex) (15 Min)",,97110,CPT,Facility,Outpatient,,,GP,102,86.7,29.2332,102,"UCare Health, Inc.",Medical Assistance,51.4794,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Pt Exercise (Rom, Strength, Flex) (15 Min)",,97110,CPT,Facility,Inpatient,,,GP,102,86.7,29.2332,102,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Pt Exercise (Rom, Strength, Flex) (15 Min)",,97110,CPT,Facility,Outpatient,,,GP,102,86.7,29.2332,102,"UCare Health, Inc.",Medicare Advantage,51.4794,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Pt Exercise (Rom, Strength, Flex) (15 Min)",,97110,CPT,Facility,Inpatient,,,GP,102,86.7,29.2332,102,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Pt Exercise (Rom, Strength, Flex) (15 Min)",,97110,CPT,Facility,Outpatient,,,GP,102,86.7,29.2332,102,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),51.4794,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Pt Exercise (Rom, Strength, Flex) (15 Min)",,97110,CPT,Facility,Inpatient,,,GP,102,86.7,29.2332,102,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Pt Exercise (Rom, Strength, Flex) (15 Min)",,97110,CPT,Facility,Both,,,GP,102,86.7,29.2332,102,UnitedHealthcare,Individual & Family,95.88,94,,percent of total billed charges,,
"Pt Exercise (Rom, Strength, Flex) (15 Min)",,97110,CPT,Facility,Outpatient,,,GP,102,86.7,29.2332,102,UnitedHealthcare,Medicare Advantage,49.98,49,,percent of total billed charges,,
"Pt Exercise (Rom, Strength, Flex) (15 Min)",,97110,CPT,Facility,Inpatient,,,GP,102,86.7,29.2332,102,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Pt Exercise (Rom, Strength, Flex) (15 Min)",,97110,CPT,Facility,Outpatient,,,GP,102,86.7,29.2332,102,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,48.96,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Pt Exercise (Rom, Strength, Flex) (15 Min)",,97110,CPT,Facility,Inpatient,,,GP,102,86.7,29.2332,102,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Pt Nmr Neuro Musc Re-Ed (Bal, Cor, Pos) (15 Min)",,97112,CPT,Facility,Both,,,GP,102,86.7,29.2332,102,Aetna,Commercial,93.84,92,,percent of total billed charges,,
"Pt Nmr Neuro Musc Re-Ed (Bal, Cor, Pos) (15 Min)",,97112,CPT,Facility,Outpatient,,,GP,102,86.7,29.2332,102,Aetna,Medicare Advantage,49.98,49,,percent of total billed charges,,
"Pt Nmr Neuro Musc Re-Ed (Bal, Cor, Pos) (15 Min)",,97112,CPT,Facility,Inpatient,,,GP,102,86.7,29.2332,102,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Pt Nmr Neuro Musc Re-Ed (Bal, Cor, Pos) (15 Min)",,97112,CPT,Facility,Both,,,GP,102,86.7,29.2332,102,Aetna,PPO,94.86,93,,percent of total billed charges,,
"Pt Nmr Neuro Musc Re-Ed (Bal, Cor, Pos) (15 Min)",,97112,CPT,Facility,Both,,,GP,102,86.7,29.2332,102,America's PPO,America's PPO,97.9506,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Pt Nmr Neuro Musc Re-Ed (Bal, Cor, Pos) (15 Min)",,97112,CPT,Facility,Both,,,GP,102,86.7,29.2332,102,BlueCross BlueShield Minnesota, Federal Employee Program,100.368,98.4,,percent of total billed charges,,
"Pt Nmr Neuro Musc Re-Ed (Bal, Cor, Pos) (15 Min)",,97112,CPT,Facility,Both,,,GP,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,102,100,,percent of total billed charges,,
"Pt Nmr Neuro Musc Re-Ed (Bal, Cor, Pos) (15 Min)",,97112,CPT,Facility,Both,,,GP,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,High Value Network Plan,91.8,90,,percent of total billed charges,,
"Pt Nmr Neuro Musc Re-Ed (Bal, Cor, Pos) (15 Min)",,97112,CPT,Facility,Outpatient,,,GP,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,Medicare Advantage,49.98,49,,percent of total billed charges,,
"Pt Nmr Neuro Musc Re-Ed (Bal, Cor, Pos) (15 Min)",,97112,CPT,Facility,Inpatient,,,GP,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Pt Nmr Neuro Musc Re-Ed (Bal, Cor, Pos) (15 Min)",,97112,CPT,Facility,Both,,,GP,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,90.3414,88.57,,percent of total billed charges,,
"Pt Nmr Neuro Musc Re-Ed (Bal, Cor, Pos) (15 Min)",,97112,CPT,Facility,Both,,,GP,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,29.2332,28.66,,percent of total billed charges,,
"Pt Nmr Neuro Musc Re-Ed (Bal, Cor, Pos) (15 Min)",,97112,CPT,Facility,Outpatient,,,GP,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),49.98,49,,percent of total billed charges,,
"Pt Nmr Neuro Musc Re-Ed (Bal, Cor, Pos) (15 Min)",,97112,CPT,Facility,Inpatient,,,GP,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Pt Nmr Neuro Musc Re-Ed (Bal, Cor, Pos) (15 Min)",,97112,CPT,Facility,Both,,,GP,102,86.7,29.2332,102,CorVel,Worker's Compensation,102,100,,percent of total billed charges,,
"Pt Nmr Neuro Musc Re-Ed (Bal, Cor, Pos) (15 Min)",,97112,CPT,Facility,Both,,,GP,102,86.7,29.2332,102,First Health Group Corporation,First Health Network,98.94,97,,percent of total billed charges,,
"Pt Nmr Neuro Musc Re-Ed (Bal, Cor, Pos) (15 Min)",,97112,CPT,Facility,Both,,,GP,102,86.7,29.2332,102,"Health Partners, Inc.",Commercial,96.492,94.6,,percent of total billed charges,,
"Pt Nmr Neuro Musc Re-Ed (Bal, Cor, Pos) (15 Min)",,97112,CPT,Facility,Outpatient,,,GP,102,86.7,29.2332,102,"Health Partners, Inc.",Medicare Advantage,49.98,49,,percent of total billed charges,,
"Pt Nmr Neuro Musc Re-Ed (Bal, Cor, Pos) (15 Min)",,97112,CPT,Facility,Inpatient,,,GP,102,86.7,29.2332,102,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Pt Nmr Neuro Musc Re-Ed (Bal, Cor, Pos) (15 Min)",,97112,CPT,Facility,Both,,,GP,102,86.7,29.2332,102,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),61.2,60,,percent of total billed charges,,
"Pt Nmr Neuro Musc Re-Ed (Bal, Cor, Pos) (15 Min)",,97112,CPT,Facility,Both,,,GP,102,86.7,29.2332,102,"Health Partners, Inc.",State of Minnesota Advantage Program,83.13,81.5,,percent of total billed charges,,
"Pt Nmr Neuro Musc Re-Ed (Bal, Cor, Pos) (15 Min)",,97112,CPT,Facility,Both,,,GP,102,86.7,29.2332,102,"Health Partners, Inc.",State Public Programs,51,50,,percent of total billed charges,,
"Pt Nmr Neuro Musc Re-Ed (Bal, Cor, Pos) (15 Min)",,97112,CPT,Facility,Both,,,GP,102,86.7,29.2332,102,Humana Insurance Company,Commercial PPO,96.9,95,,percent of total billed charges,,
"Pt Nmr Neuro Musc Re-Ed (Bal, Cor, Pos) (15 Min)",,97112,CPT,Facility,Outpatient,,,GP,102,86.7,29.2332,102,Humana Insurance Company,Medicare PPO,49.98,49,,percent of total billed charges,,
"Pt Nmr Neuro Musc Re-Ed (Bal, Cor, Pos) (15 Min)",,97112,CPT,Facility,Inpatient,,,GP,102,86.7,29.2332,102,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Pt Nmr Neuro Musc Re-Ed (Bal, Cor, Pos) (15 Min)",,97112,CPT,Facility,Both,,,GP,102,86.7,29.2332,102,Medica,Individual & Family,101.082,99.1,,percent of total billed charges,,
"Pt Nmr Neuro Musc Re-Ed (Bal, Cor, Pos) (15 Min)",,97112,CPT,Facility,Outpatient,,,GP,102,86.7,29.2332,102,Medica,Medica Advantage Solution,50.796,49.8,,percent of total billed charges,,
"Pt Nmr Neuro Musc Re-Ed (Bal, Cor, Pos) (15 Min)",,97112,CPT,Facility,Inpatient,,,GP,102,86.7,29.2332,102,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Pt Nmr Neuro Musc Re-Ed (Bal, Cor, Pos) (15 Min)",,97112,CPT,Facility,Outpatient,,,GP,102,86.7,29.2332,102,Medica,Medical Assistance,45.492,44.6,,percent of total billed charges,,
"Pt Nmr Neuro Musc Re-Ed (Bal, Cor, Pos) (15 Min)",,97112,CPT,Facility,Inpatient,,,GP,102,86.7,29.2332,102,Medica,Medical Assistance,,,,,Included in per diem rate,
"Pt Nmr Neuro Musc Re-Ed (Bal, Cor, Pos) (15 Min)",,97112,CPT,Facility,Outpatient,,,GP,102,86.7,29.2332,102,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,50.796,49.8,,percent of total billed charges,,
"Pt Nmr Neuro Musc Re-Ed (Bal, Cor, Pos) (15 Min)",,97112,CPT,Facility,Inpatient,,,GP,102,86.7,29.2332,102,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Pt Nmr Neuro Musc Re-Ed (Bal, Cor, Pos) (15 Min)",,97112,CPT,Facility,Both,,,GP,102,86.7,29.2332,102,"Multiplan, Inc.","Multiplan, Inc.",95.88,94,,percent of total billed charges,,
"Pt Nmr Neuro Musc Re-Ed (Bal, Cor, Pos) (15 Min)",,97112,CPT,Facility,Outpatient,,,GP,102,86.7,29.2332,102,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,88.128,86.4,,percent of total billed charges,,
"Pt Nmr Neuro Musc Re-Ed (Bal, Cor, Pos) (15 Min)",,97112,CPT,Facility,Inpatient,,,GP,102,86.7,29.2332,102,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Pt Nmr Neuro Musc Re-Ed (Bal, Cor, Pos) (15 Min)",,97112,CPT,Facility,Both,,,GP,102,86.7,29.2332,102,"Preferred One Administrative Services, INC.",PPO,100.572,98.6,,percent of total billed charges,,
"Pt Nmr Neuro Musc Re-Ed (Bal, Cor, Pos) (15 Min)",,97112,CPT,Facility,Outpatient,,,GP,102,86.7,29.2332,102,PrimeWest Health,Minnesota Senior Health Options (MSHO),52.479,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Pt Nmr Neuro Musc Re-Ed (Bal, Cor, Pos) (15 Min)",,97112,CPT,Facility,Inpatient,,,GP,102,86.7,29.2332,102,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Pt Nmr Neuro Musc Re-Ed (Bal, Cor, Pos) (15 Min)",,97112,CPT,Facility,Outpatient,,,GP,102,86.7,29.2332,102,PrimeWest Health,MinnesotaCare,52.3872,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Pt Nmr Neuro Musc Re-Ed (Bal, Cor, Pos) (15 Min)",,97112,CPT,Facility,Inpatient,,,GP,102,86.7,29.2332,102,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Pt Nmr Neuro Musc Re-Ed (Bal, Cor, Pos) (15 Min)",,97112,CPT,Facility,Both,,,GP,102,86.7,29.2332,102,Sanford Health Plan,Sanford Health Plan,93.84,92,,percent of total billed charges,,
"Pt Nmr Neuro Musc Re-Ed (Bal, Cor, Pos) (15 Min)",,97112,CPT,Facility,Outpatient,,,GP,102,86.7,29.2332,102,"UCare Health, Inc.",Individual & Family Plan,57.477,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Pt Nmr Neuro Musc Re-Ed (Bal, Cor, Pos) (15 Min)",,97112,CPT,Facility,Inpatient,,,GP,102,86.7,29.2332,102,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Pt Nmr Neuro Musc Re-Ed (Bal, Cor, Pos) (15 Min)",,97112,CPT,Facility,Outpatient,,,GP,102,86.7,29.2332,102,"UCare Health, Inc.",Medical Assistance,51.4794,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Pt Nmr Neuro Musc Re-Ed (Bal, Cor, Pos) (15 Min)",,97112,CPT,Facility,Inpatient,,,GP,102,86.7,29.2332,102,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Pt Nmr Neuro Musc Re-Ed (Bal, Cor, Pos) (15 Min)",,97112,CPT,Facility,Outpatient,,,GP,102,86.7,29.2332,102,"UCare Health, Inc.",Medicare Advantage,51.4794,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Pt Nmr Neuro Musc Re-Ed (Bal, Cor, Pos) (15 Min)",,97112,CPT,Facility,Inpatient,,,GP,102,86.7,29.2332,102,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Pt Nmr Neuro Musc Re-Ed (Bal, Cor, Pos) (15 Min)",,97112,CPT,Facility,Outpatient,,,GP,102,86.7,29.2332,102,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),51.4794,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Pt Nmr Neuro Musc Re-Ed (Bal, Cor, Pos) (15 Min)",,97112,CPT,Facility,Inpatient,,,GP,102,86.7,29.2332,102,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Pt Nmr Neuro Musc Re-Ed (Bal, Cor, Pos) (15 Min)",,97112,CPT,Facility,Both,,,GP,102,86.7,29.2332,102,UnitedHealthcare,Individual & Family,95.88,94,,percent of total billed charges,,
"Pt Nmr Neuro Musc Re-Ed (Bal, Cor, Pos) (15 Min)",,97112,CPT,Facility,Outpatient,,,GP,102,86.7,29.2332,102,UnitedHealthcare,Medicare Advantage,49.98,49,,percent of total billed charges,,
"Pt Nmr Neuro Musc Re-Ed (Bal, Cor, Pos) (15 Min)",,97112,CPT,Facility,Inpatient,,,GP,102,86.7,29.2332,102,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Pt Nmr Neuro Musc Re-Ed (Bal, Cor, Pos) (15 Min)",,97112,CPT,Facility,Outpatient,,,GP,102,86.7,29.2332,102,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,48.96,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Pt Nmr Neuro Musc Re-Ed (Bal, Cor, Pos) (15 Min)",,97112,CPT,Facility,Inpatient,,,GP,102,86.7,29.2332,102,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Pt Aquatic Therapy (15 Min),,97113,CPT,Facility,Both,,,GP,102,86.7,29.2332,102,Aetna,Commercial,93.84,92,,percent of total billed charges,,
Pt Aquatic Therapy (15 Min),,97113,CPT,Facility,Outpatient,,,GP,102,86.7,29.2332,102,Aetna,Medicare Advantage,49.98,49,,percent of total billed charges,,
Pt Aquatic Therapy (15 Min),,97113,CPT,Facility,Inpatient,,,GP,102,86.7,29.2332,102,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Pt Aquatic Therapy (15 Min),,97113,CPT,Facility,Both,,,GP,102,86.7,29.2332,102,Aetna,PPO,94.86,93,,percent of total billed charges,,
Pt Aquatic Therapy (15 Min),,97113,CPT,Facility,Both,,,GP,102,86.7,29.2332,102,America's PPO,America's PPO,97.9506,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Pt Aquatic Therapy (15 Min),,97113,CPT,Facility,Both,,,GP,102,86.7,29.2332,102,BlueCross BlueShield Minnesota, Federal Employee Program,100.368,98.4,,percent of total billed charges,,
Pt Aquatic Therapy (15 Min),,97113,CPT,Facility,Both,,,GP,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,102,100,,percent of total billed charges,,
Pt Aquatic Therapy (15 Min),,97113,CPT,Facility,Both,,,GP,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,High Value Network Plan,91.8,90,,percent of total billed charges,,
Pt Aquatic Therapy (15 Min),,97113,CPT,Facility,Outpatient,,,GP,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,Medicare Advantage,49.98,49,,percent of total billed charges,,
Pt Aquatic Therapy (15 Min),,97113,CPT,Facility,Inpatient,,,GP,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Pt Aquatic Therapy (15 Min),,97113,CPT,Facility,Both,,,GP,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,90.3414,88.57,,percent of total billed charges,,
Pt Aquatic Therapy (15 Min),,97113,CPT,Facility,Both,,,GP,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,29.2332,28.66,,percent of total billed charges,,
Pt Aquatic Therapy (15 Min),,97113,CPT,Facility,Outpatient,,,GP,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),49.98,49,,percent of total billed charges,,
Pt Aquatic Therapy (15 Min),,97113,CPT,Facility,Inpatient,,,GP,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Pt Aquatic Therapy (15 Min),,97113,CPT,Facility,Both,,,GP,102,86.7,29.2332,102,CorVel,Worker's Compensation,102,100,,percent of total billed charges,,
Pt Aquatic Therapy (15 Min),,97113,CPT,Facility,Both,,,GP,102,86.7,29.2332,102,First Health Group Corporation,First Health Network,98.94,97,,percent of total billed charges,,
Pt Aquatic Therapy (15 Min),,97113,CPT,Facility,Both,,,GP,102,86.7,29.2332,102,"Health Partners, Inc.",Commercial,96.492,94.6,,percent of total billed charges,,
Pt Aquatic Therapy (15 Min),,97113,CPT,Facility,Outpatient,,,GP,102,86.7,29.2332,102,"Health Partners, Inc.",Medicare Advantage,49.98,49,,percent of total billed charges,,
Pt Aquatic Therapy (15 Min),,97113,CPT,Facility,Inpatient,,,GP,102,86.7,29.2332,102,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Pt Aquatic Therapy (15 Min),,97113,CPT,Facility,Both,,,GP,102,86.7,29.2332,102,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),61.2,60,,percent of total billed charges,,
Pt Aquatic Therapy (15 Min),,97113,CPT,Facility,Both,,,GP,102,86.7,29.2332,102,"Health Partners, Inc.",State of Minnesota Advantage Program,83.13,81.5,,percent of total billed charges,,
Pt Aquatic Therapy (15 Min),,97113,CPT,Facility,Both,,,GP,102,86.7,29.2332,102,"Health Partners, Inc.",State Public Programs,51,50,,percent of total billed charges,,
Pt Aquatic Therapy (15 Min),,97113,CPT,Facility,Both,,,GP,102,86.7,29.2332,102,Humana Insurance Company,Commercial PPO,96.9,95,,percent of total billed charges,,
Pt Aquatic Therapy (15 Min),,97113,CPT,Facility,Outpatient,,,GP,102,86.7,29.2332,102,Humana Insurance Company,Medicare PPO,49.98,49,,percent of total billed charges,,
Pt Aquatic Therapy (15 Min),,97113,CPT,Facility,Inpatient,,,GP,102,86.7,29.2332,102,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Pt Aquatic Therapy (15 Min),,97113,CPT,Facility,Both,,,GP,102,86.7,29.2332,102,Medica,Individual & Family,101.082,99.1,,percent of total billed charges,,
Pt Aquatic Therapy (15 Min),,97113,CPT,Facility,Outpatient,,,GP,102,86.7,29.2332,102,Medica,Medica Advantage Solution,50.796,49.8,,percent of total billed charges,,
Pt Aquatic Therapy (15 Min),,97113,CPT,Facility,Inpatient,,,GP,102,86.7,29.2332,102,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Pt Aquatic Therapy (15 Min),,97113,CPT,Facility,Outpatient,,,GP,102,86.7,29.2332,102,Medica,Medical Assistance,45.492,44.6,,percent of total billed charges,,
Pt Aquatic Therapy (15 Min),,97113,CPT,Facility,Inpatient,,,GP,102,86.7,29.2332,102,Medica,Medical Assistance,,,,,Included in per diem rate,
Pt Aquatic Therapy (15 Min),,97113,CPT,Facility,Outpatient,,,GP,102,86.7,29.2332,102,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,50.796,49.8,,percent of total billed charges,,
Pt Aquatic Therapy (15 Min),,97113,CPT,Facility,Inpatient,,,GP,102,86.7,29.2332,102,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Pt Aquatic Therapy (15 Min),,97113,CPT,Facility,Both,,,GP,102,86.7,29.2332,102,"Multiplan, Inc.","Multiplan, Inc.",95.88,94,,percent of total billed charges,,
Pt Aquatic Therapy (15 Min),,97113,CPT,Facility,Outpatient,,,GP,102,86.7,29.2332,102,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,88.128,86.4,,percent of total billed charges,,
Pt Aquatic Therapy (15 Min),,97113,CPT,Facility,Inpatient,,,GP,102,86.7,29.2332,102,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Pt Aquatic Therapy (15 Min),,97113,CPT,Facility,Both,,,GP,102,86.7,29.2332,102,"Preferred One Administrative Services, INC.",PPO,100.572,98.6,,percent of total billed charges,,
Pt Aquatic Therapy (15 Min),,97113,CPT,Facility,Outpatient,,,GP,102,86.7,29.2332,102,PrimeWest Health,Minnesota Senior Health Options (MSHO),52.479,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Pt Aquatic Therapy (15 Min),,97113,CPT,Facility,Inpatient,,,GP,102,86.7,29.2332,102,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Pt Aquatic Therapy (15 Min),,97113,CPT,Facility,Outpatient,,,GP,102,86.7,29.2332,102,PrimeWest Health,MinnesotaCare,52.3872,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Pt Aquatic Therapy (15 Min),,97113,CPT,Facility,Inpatient,,,GP,102,86.7,29.2332,102,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Pt Aquatic Therapy (15 Min),,97113,CPT,Facility,Both,,,GP,102,86.7,29.2332,102,Sanford Health Plan,Sanford Health Plan,93.84,92,,percent of total billed charges,,
Pt Aquatic Therapy (15 Min),,97113,CPT,Facility,Outpatient,,,GP,102,86.7,29.2332,102,"UCare Health, Inc.",Individual & Family Plan,57.477,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Pt Aquatic Therapy (15 Min),,97113,CPT,Facility,Inpatient,,,GP,102,86.7,29.2332,102,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Pt Aquatic Therapy (15 Min),,97113,CPT,Facility,Outpatient,,,GP,102,86.7,29.2332,102,"UCare Health, Inc.",Medical Assistance,51.4794,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Pt Aquatic Therapy (15 Min),,97113,CPT,Facility,Inpatient,,,GP,102,86.7,29.2332,102,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Pt Aquatic Therapy (15 Min),,97113,CPT,Facility,Outpatient,,,GP,102,86.7,29.2332,102,"UCare Health, Inc.",Medicare Advantage,51.4794,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Pt Aquatic Therapy (15 Min),,97113,CPT,Facility,Inpatient,,,GP,102,86.7,29.2332,102,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Pt Aquatic Therapy (15 Min),,97113,CPT,Facility,Outpatient,,,GP,102,86.7,29.2332,102,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),51.4794,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Pt Aquatic Therapy (15 Min),,97113,CPT,Facility,Inpatient,,,GP,102,86.7,29.2332,102,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Pt Aquatic Therapy (15 Min),,97113,CPT,Facility,Both,,,GP,102,86.7,29.2332,102,UnitedHealthcare,Individual & Family,95.88,94,,percent of total billed charges,,
Pt Aquatic Therapy (15 Min),,97113,CPT,Facility,Outpatient,,,GP,102,86.7,29.2332,102,UnitedHealthcare,Medicare Advantage,49.98,49,,percent of total billed charges,,
Pt Aquatic Therapy (15 Min),,97113,CPT,Facility,Inpatient,,,GP,102,86.7,29.2332,102,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Pt Aquatic Therapy (15 Min),,97113,CPT,Facility,Outpatient,,,GP,102,86.7,29.2332,102,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,48.96,48,,percent of total billed charges,,100% of DHS outpatient percentage
Pt Aquatic Therapy (15 Min),,97113,CPT,Facility,Inpatient,,,GP,102,86.7,29.2332,102,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Pt Gait Training (Per 15 Min),,97116,CPT,Facility,Both,,,GP,62,52.7,17.7692,62,Aetna,Commercial,57.04,92,,percent of total billed charges,,
Pt Gait Training (Per 15 Min),,97116,CPT,Facility,Outpatient,,,GP,62,52.7,17.7692,62,Aetna,Medicare Advantage,30.38,49,,percent of total billed charges,,
Pt Gait Training (Per 15 Min),,97116,CPT,Facility,Inpatient,,,GP,62,52.7,17.7692,62,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Pt Gait Training (Per 15 Min),,97116,CPT,Facility,Both,,,GP,62,52.7,17.7692,62,Aetna,PPO,57.66,93,,percent of total billed charges,,
Pt Gait Training (Per 15 Min),,97116,CPT,Facility,Both,,,GP,62,52.7,17.7692,62,America's PPO,America's PPO,59.5386,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Pt Gait Training (Per 15 Min),,97116,CPT,Facility,Both,,,GP,62,52.7,17.7692,62,BlueCross BlueShield Minnesota, Federal Employee Program,61.008,98.4,,percent of total billed charges,,
Pt Gait Training (Per 15 Min),,97116,CPT,Facility,Both,,,GP,62,52.7,17.7692,62,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,62,100,,percent of total billed charges,,
Pt Gait Training (Per 15 Min),,97116,CPT,Facility,Both,,,GP,62,52.7,17.7692,62,BlueCross BlueShield Minnesota,High Value Network Plan,55.8,90,,percent of total billed charges,,
Pt Gait Training (Per 15 Min),,97116,CPT,Facility,Outpatient,,,GP,62,52.7,17.7692,62,BlueCross BlueShield Minnesota,Medicare Advantage,30.38,49,,percent of total billed charges,,
Pt Gait Training (Per 15 Min),,97116,CPT,Facility,Inpatient,,,GP,62,52.7,17.7692,62,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Pt Gait Training (Per 15 Min),,97116,CPT,Facility,Both,,,GP,62,52.7,17.7692,62,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,54.9134,88.57,,percent of total billed charges,,
Pt Gait Training (Per 15 Min),,97116,CPT,Facility,Both,,,GP,62,52.7,17.7692,62,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,17.7692,28.66,,percent of total billed charges,,
Pt Gait Training (Per 15 Min),,97116,CPT,Facility,Outpatient,,,GP,62,52.7,17.7692,62,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),30.38,49,,percent of total billed charges,,
Pt Gait Training (Per 15 Min),,97116,CPT,Facility,Inpatient,,,GP,62,52.7,17.7692,62,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Pt Gait Training (Per 15 Min),,97116,CPT,Facility,Both,,,GP,62,52.7,17.7692,62,CorVel,Worker's Compensation,62,100,,percent of total billed charges,,
Pt Gait Training (Per 15 Min),,97116,CPT,Facility,Both,,,GP,62,52.7,17.7692,62,First Health Group Corporation,First Health Network,60.14,97,,percent of total billed charges,,
Pt Gait Training (Per 15 Min),,97116,CPT,Facility,Both,,,GP,62,52.7,17.7692,62,"Health Partners, Inc.",Commercial,58.652,94.6,,percent of total billed charges,,
Pt Gait Training (Per 15 Min),,97116,CPT,Facility,Outpatient,,,GP,62,52.7,17.7692,62,"Health Partners, Inc.",Medicare Advantage,30.38,49,,percent of total billed charges,,
Pt Gait Training (Per 15 Min),,97116,CPT,Facility,Inpatient,,,GP,62,52.7,17.7692,62,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Pt Gait Training (Per 15 Min),,97116,CPT,Facility,Both,,,GP,62,52.7,17.7692,62,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),37.2,60,,percent of total billed charges,,
Pt Gait Training (Per 15 Min),,97116,CPT,Facility,Both,,,GP,62,52.7,17.7692,62,"Health Partners, Inc.",State of Minnesota Advantage Program,50.53,81.5,,percent of total billed charges,,
Pt Gait Training (Per 15 Min),,97116,CPT,Facility,Both,,,GP,62,52.7,17.7692,62,"Health Partners, Inc.",State Public Programs,31,50,,percent of total billed charges,,
Pt Gait Training (Per 15 Min),,97116,CPT,Facility,Both,,,GP,62,52.7,17.7692,62,Humana Insurance Company,Commercial PPO,58.9,95,,percent of total billed charges,,
Pt Gait Training (Per 15 Min),,97116,CPT,Facility,Outpatient,,,GP,62,52.7,17.7692,62,Humana Insurance Company,Medicare PPO,30.38,49,,percent of total billed charges,,
Pt Gait Training (Per 15 Min),,97116,CPT,Facility,Inpatient,,,GP,62,52.7,17.7692,62,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Pt Gait Training (Per 15 Min),,97116,CPT,Facility,Both,,,GP,62,52.7,17.7692,62,Medica,Individual & Family,61.442,99.1,,percent of total billed charges,,
Pt Gait Training (Per 15 Min),,97116,CPT,Facility,Outpatient,,,GP,62,52.7,17.7692,62,Medica,Medica Advantage Solution,30.876,49.8,,percent of total billed charges,,
Pt Gait Training (Per 15 Min),,97116,CPT,Facility,Inpatient,,,GP,62,52.7,17.7692,62,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Pt Gait Training (Per 15 Min),,97116,CPT,Facility,Outpatient,,,GP,62,52.7,17.7692,62,Medica,Medical Assistance,27.652,44.6,,percent of total billed charges,,
Pt Gait Training (Per 15 Min),,97116,CPT,Facility,Inpatient,,,GP,62,52.7,17.7692,62,Medica,Medical Assistance,,,,,Included in per diem rate,
Pt Gait Training (Per 15 Min),,97116,CPT,Facility,Outpatient,,,GP,62,52.7,17.7692,62,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,30.876,49.8,,percent of total billed charges,,
Pt Gait Training (Per 15 Min),,97116,CPT,Facility,Inpatient,,,GP,62,52.7,17.7692,62,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Pt Gait Training (Per 15 Min),,97116,CPT,Facility,Both,,,GP,62,52.7,17.7692,62,"Multiplan, Inc.","Multiplan, Inc.",58.28,94,,percent of total billed charges,,
Pt Gait Training (Per 15 Min),,97116,CPT,Facility,Outpatient,,,GP,62,52.7,17.7692,62,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,53.568,86.4,,percent of total billed charges,,
Pt Gait Training (Per 15 Min),,97116,CPT,Facility,Inpatient,,,GP,62,52.7,17.7692,62,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Pt Gait Training (Per 15 Min),,97116,CPT,Facility,Both,,,GP,62,52.7,17.7692,62,"Preferred One Administrative Services, INC.",PPO,61.132,98.6,,percent of total billed charges,,
Pt Gait Training (Per 15 Min),,97116,CPT,Facility,Outpatient,,,GP,62,52.7,17.7692,62,PrimeWest Health,Minnesota Senior Health Options (MSHO),31.899,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Pt Gait Training (Per 15 Min),,97116,CPT,Facility,Inpatient,,,GP,62,52.7,17.7692,62,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Pt Gait Training (Per 15 Min),,97116,CPT,Facility,Outpatient,,,GP,62,52.7,17.7692,62,PrimeWest Health,MinnesotaCare,31.8432,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Pt Gait Training (Per 15 Min),,97116,CPT,Facility,Inpatient,,,GP,62,52.7,17.7692,62,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Pt Gait Training (Per 15 Min),,97116,CPT,Facility,Both,,,GP,62,52.7,17.7692,62,Sanford Health Plan,Sanford Health Plan,57.04,92,,percent of total billed charges,,
Pt Gait Training (Per 15 Min),,97116,CPT,Facility,Outpatient,,,GP,62,52.7,17.7692,62,"UCare Health, Inc.",Individual & Family Plan,34.937,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Pt Gait Training (Per 15 Min),,97116,CPT,Facility,Inpatient,,,GP,62,52.7,17.7692,62,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Pt Gait Training (Per 15 Min),,97116,CPT,Facility,Outpatient,,,GP,62,52.7,17.7692,62,"UCare Health, Inc.",Medical Assistance,31.2914,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Pt Gait Training (Per 15 Min),,97116,CPT,Facility,Inpatient,,,GP,62,52.7,17.7692,62,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Pt Gait Training (Per 15 Min),,97116,CPT,Facility,Outpatient,,,GP,62,52.7,17.7692,62,"UCare Health, Inc.",Medicare Advantage,31.2914,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Pt Gait Training (Per 15 Min),,97116,CPT,Facility,Inpatient,,,GP,62,52.7,17.7692,62,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Pt Gait Training (Per 15 Min),,97116,CPT,Facility,Outpatient,,,GP,62,52.7,17.7692,62,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),31.2914,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Pt Gait Training (Per 15 Min),,97116,CPT,Facility,Inpatient,,,GP,62,52.7,17.7692,62,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Pt Gait Training (Per 15 Min),,97116,CPT,Facility,Both,,,GP,62,52.7,17.7692,62,UnitedHealthcare,Individual & Family,58.28,94,,percent of total billed charges,,
Pt Gait Training (Per 15 Min),,97116,CPT,Facility,Outpatient,,,GP,62,52.7,17.7692,62,UnitedHealthcare,Medicare Advantage,30.38,49,,percent of total billed charges,,
Pt Gait Training (Per 15 Min),,97116,CPT,Facility,Inpatient,,,GP,62,52.7,17.7692,62,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Pt Gait Training (Per 15 Min),,97116,CPT,Facility,Outpatient,,,GP,62,52.7,17.7692,62,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,29.76,48,,percent of total billed charges,,100% of DHS outpatient percentage
Pt Gait Training (Per 15 Min),,97116,CPT,Facility,Inpatient,,,GP,62,52.7,17.7692,62,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Pt Massage,,97124,CPT,Facility,Both,,,GP,69,58.65,19.7754,69,Aetna,Commercial,63.48,92,,percent of total billed charges,,
Pt Massage,,97124,CPT,Facility,Outpatient,,,GP,69,58.65,19.7754,69,Aetna,Medicare Advantage,33.81,49,,percent of total billed charges,,
Pt Massage,,97124,CPT,Facility,Inpatient,,,GP,69,58.65,19.7754,69,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Pt Massage,,97124,CPT,Facility,Both,,,GP,69,58.65,19.7754,69,Aetna,PPO,64.17,93,,percent of total billed charges,,
Pt Massage,,97124,CPT,Facility,Both,,,GP,69,58.65,19.7754,69,America's PPO,America's PPO,66.2607,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Pt Massage,,97124,CPT,Facility,Both,,,GP,69,58.65,19.7754,69,BlueCross BlueShield Minnesota, Federal Employee Program,67.896,98.4,,percent of total billed charges,,
Pt Massage,,97124,CPT,Facility,Both,,,GP,69,58.65,19.7754,69,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,69,100,,percent of total billed charges,,
Pt Massage,,97124,CPT,Facility,Both,,,GP,69,58.65,19.7754,69,BlueCross BlueShield Minnesota,High Value Network Plan,62.1,90,,percent of total billed charges,,
Pt Massage,,97124,CPT,Facility,Outpatient,,,GP,69,58.65,19.7754,69,BlueCross BlueShield Minnesota,Medicare Advantage,33.81,49,,percent of total billed charges,,
Pt Massage,,97124,CPT,Facility,Inpatient,,,GP,69,58.65,19.7754,69,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Pt Massage,,97124,CPT,Facility,Both,,,GP,69,58.65,19.7754,69,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,61.1133,88.57,,percent of total billed charges,,
Pt Massage,,97124,CPT,Facility,Both,,,GP,69,58.65,19.7754,69,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,19.7754,28.66,,percent of total billed charges,,
Pt Massage,,97124,CPT,Facility,Outpatient,,,GP,69,58.65,19.7754,69,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),33.81,49,,percent of total billed charges,,
Pt Massage,,97124,CPT,Facility,Inpatient,,,GP,69,58.65,19.7754,69,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Pt Massage,,97124,CPT,Facility,Both,,,GP,69,58.65,19.7754,69,CorVel,Worker's Compensation,69,100,,percent of total billed charges,,
Pt Massage,,97124,CPT,Facility,Both,,,GP,69,58.65,19.7754,69,First Health Group Corporation,First Health Network,66.93,97,,percent of total billed charges,,
Pt Massage,,97124,CPT,Facility,Both,,,GP,69,58.65,19.7754,69,"Health Partners, Inc.",Commercial,65.274,94.6,,percent of total billed charges,,
Pt Massage,,97124,CPT,Facility,Outpatient,,,GP,69,58.65,19.7754,69,"Health Partners, Inc.",Medicare Advantage,33.81,49,,percent of total billed charges,,
Pt Massage,,97124,CPT,Facility,Inpatient,,,GP,69,58.65,19.7754,69,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Pt Massage,,97124,CPT,Facility,Both,,,GP,69,58.65,19.7754,69,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),41.4,60,,percent of total billed charges,,
Pt Massage,,97124,CPT,Facility,Both,,,GP,69,58.65,19.7754,69,"Health Partners, Inc.",State of Minnesota Advantage Program,56.235,81.5,,percent of total billed charges,,
Pt Massage,,97124,CPT,Facility,Both,,,GP,69,58.65,19.7754,69,"Health Partners, Inc.",State Public Programs,34.5,50,,percent of total billed charges,,
Pt Massage,,97124,CPT,Facility,Both,,,GP,69,58.65,19.7754,69,Humana Insurance Company,Commercial PPO,65.55,95,,percent of total billed charges,,
Pt Massage,,97124,CPT,Facility,Outpatient,,,GP,69,58.65,19.7754,69,Humana Insurance Company,Medicare PPO,33.81,49,,percent of total billed charges,,
Pt Massage,,97124,CPT,Facility,Inpatient,,,GP,69,58.65,19.7754,69,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Pt Massage,,97124,CPT,Facility,Both,,,GP,69,58.65,19.7754,69,Medica,Individual & Family,68.379,99.1,,percent of total billed charges,,
Pt Massage,,97124,CPT,Facility,Outpatient,,,GP,69,58.65,19.7754,69,Medica,Medica Advantage Solution,34.362,49.8,,percent of total billed charges,,
Pt Massage,,97124,CPT,Facility,Inpatient,,,GP,69,58.65,19.7754,69,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Pt Massage,,97124,CPT,Facility,Outpatient,,,GP,69,58.65,19.7754,69,Medica,Medical Assistance,30.774,44.6,,percent of total billed charges,,
Pt Massage,,97124,CPT,Facility,Inpatient,,,GP,69,58.65,19.7754,69,Medica,Medical Assistance,,,,,Included in per diem rate,
Pt Massage,,97124,CPT,Facility,Outpatient,,,GP,69,58.65,19.7754,69,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,34.362,49.8,,percent of total billed charges,,
Pt Massage,,97124,CPT,Facility,Inpatient,,,GP,69,58.65,19.7754,69,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Pt Massage,,97124,CPT,Facility,Both,,,GP,69,58.65,19.7754,69,"Multiplan, Inc.","Multiplan, Inc.",64.86,94,,percent of total billed charges,,
Pt Massage,,97124,CPT,Facility,Outpatient,,,GP,69,58.65,19.7754,69,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,59.616,86.4,,percent of total billed charges,,
Pt Massage,,97124,CPT,Facility,Inpatient,,,GP,69,58.65,19.7754,69,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Pt Massage,,97124,CPT,Facility,Both,,,GP,69,58.65,19.7754,69,"Preferred One Administrative Services, INC.",PPO,68.034,98.6,,percent of total billed charges,,
Pt Massage,,97124,CPT,Facility,Outpatient,,,GP,69,58.65,19.7754,69,PrimeWest Health,Minnesota Senior Health Options (MSHO),35.5005,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Pt Massage,,97124,CPT,Facility,Inpatient,,,GP,69,58.65,19.7754,69,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Pt Massage,,97124,CPT,Facility,Outpatient,,,GP,69,58.65,19.7754,69,PrimeWest Health,MinnesotaCare,35.4384,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Pt Massage,,97124,CPT,Facility,Inpatient,,,GP,69,58.65,19.7754,69,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Pt Massage,,97124,CPT,Facility,Both,,,GP,69,58.65,19.7754,69,Sanford Health Plan,Sanford Health Plan,63.48,92,,percent of total billed charges,,
Pt Massage,,97124,CPT,Facility,Outpatient,,,GP,69,58.65,19.7754,69,"UCare Health, Inc.",Individual & Family Plan,38.8815,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Pt Massage,,97124,CPT,Facility,Inpatient,,,GP,69,58.65,19.7754,69,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Pt Massage,,97124,CPT,Facility,Outpatient,,,GP,69,58.65,19.7754,69,"UCare Health, Inc.",Medical Assistance,34.8243,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Pt Massage,,97124,CPT,Facility,Inpatient,,,GP,69,58.65,19.7754,69,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Pt Massage,,97124,CPT,Facility,Outpatient,,,GP,69,58.65,19.7754,69,"UCare Health, Inc.",Medicare Advantage,34.8243,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Pt Massage,,97124,CPT,Facility,Inpatient,,,GP,69,58.65,19.7754,69,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Pt Massage,,97124,CPT,Facility,Outpatient,,,GP,69,58.65,19.7754,69,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),34.8243,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Pt Massage,,97124,CPT,Facility,Inpatient,,,GP,69,58.65,19.7754,69,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Pt Massage,,97124,CPT,Facility,Both,,,GP,69,58.65,19.7754,69,UnitedHealthcare,Individual & Family,64.86,94,,percent of total billed charges,,
Pt Massage,,97124,CPT,Facility,Outpatient,,,GP,69,58.65,19.7754,69,UnitedHealthcare,Medicare Advantage,33.81,49,,percent of total billed charges,,
Pt Massage,,97124,CPT,Facility,Inpatient,,,GP,69,58.65,19.7754,69,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Pt Massage,,97124,CPT,Facility,Outpatient,,,GP,69,58.65,19.7754,69,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,33.12,48,,percent of total billed charges,,100% of DHS outpatient percentage
Pt Massage,,97124,CPT,Facility,Inpatient,,,GP,69,58.65,19.7754,69,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Pt Phonophoresis/15 Min,,97139,CPT,Facility,Both,,,GP,69,58.65,19.7754,69,Aetna,Commercial,63.48,92,,percent of total billed charges,,
Pt Phonophoresis/15 Min,,97139,CPT,Facility,Outpatient,,,GP,69,58.65,19.7754,69,Aetna,Medicare Advantage,33.81,49,,percent of total billed charges,,
Pt Phonophoresis/15 Min,,97139,CPT,Facility,Inpatient,,,GP,69,58.65,19.7754,69,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Pt Phonophoresis/15 Min,,97139,CPT,Facility,Both,,,GP,69,58.65,19.7754,69,Aetna,PPO,64.17,93,,percent of total billed charges,,
Pt Phonophoresis/15 Min,,97139,CPT,Facility,Both,,,GP,69,58.65,19.7754,69,America's PPO,America's PPO,66.2607,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Pt Phonophoresis/15 Min,,97139,CPT,Facility,Both,,,GP,69,58.65,19.7754,69,BlueCross BlueShield Minnesota, Federal Employee Program,67.896,98.4,,percent of total billed charges,,
Pt Phonophoresis/15 Min,,97139,CPT,Facility,Both,,,GP,69,58.65,19.7754,69,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,69,100,,percent of total billed charges,,
Pt Phonophoresis/15 Min,,97139,CPT,Facility,Both,,,GP,69,58.65,19.7754,69,BlueCross BlueShield Minnesota,High Value Network Plan,62.1,90,,percent of total billed charges,,
Pt Phonophoresis/15 Min,,97139,CPT,Facility,Outpatient,,,GP,69,58.65,19.7754,69,BlueCross BlueShield Minnesota,Medicare Advantage,33.81,49,,percent of total billed charges,,
Pt Phonophoresis/15 Min,,97139,CPT,Facility,Inpatient,,,GP,69,58.65,19.7754,69,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Pt Phonophoresis/15 Min,,97139,CPT,Facility,Both,,,GP,69,58.65,19.7754,69,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,61.1133,88.57,,percent of total billed charges,,
Pt Phonophoresis/15 Min,,97139,CPT,Facility,Both,,,GP,69,58.65,19.7754,69,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,19.7754,28.66,,percent of total billed charges,,
Pt Phonophoresis/15 Min,,97139,CPT,Facility,Outpatient,,,GP,69,58.65,19.7754,69,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),33.81,49,,percent of total billed charges,,
Pt Phonophoresis/15 Min,,97139,CPT,Facility,Inpatient,,,GP,69,58.65,19.7754,69,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Pt Phonophoresis/15 Min,,97139,CPT,Facility,Both,,,GP,69,58.65,19.7754,69,CorVel,Worker's Compensation,69,100,,percent of total billed charges,,
Pt Phonophoresis/15 Min,,97139,CPT,Facility,Both,,,GP,69,58.65,19.7754,69,First Health Group Corporation,First Health Network,66.93,97,,percent of total billed charges,,
Pt Phonophoresis/15 Min,,97139,CPT,Facility,Both,,,GP,69,58.65,19.7754,69,"Health Partners, Inc.",Commercial,65.274,94.6,,percent of total billed charges,,
Pt Phonophoresis/15 Min,,97139,CPT,Facility,Outpatient,,,GP,69,58.65,19.7754,69,"Health Partners, Inc.",Medicare Advantage,33.81,49,,percent of total billed charges,,
Pt Phonophoresis/15 Min,,97139,CPT,Facility,Inpatient,,,GP,69,58.65,19.7754,69,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Pt Phonophoresis/15 Min,,97139,CPT,Facility,Both,,,GP,69,58.65,19.7754,69,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),41.4,60,,percent of total billed charges,,
Pt Phonophoresis/15 Min,,97139,CPT,Facility,Both,,,GP,69,58.65,19.7754,69,"Health Partners, Inc.",State of Minnesota Advantage Program,56.235,81.5,,percent of total billed charges,,
Pt Phonophoresis/15 Min,,97139,CPT,Facility,Both,,,GP,69,58.65,19.7754,69,"Health Partners, Inc.",State Public Programs,34.5,50,,percent of total billed charges,,
Pt Phonophoresis/15 Min,,97139,CPT,Facility,Both,,,GP,69,58.65,19.7754,69,Humana Insurance Company,Commercial PPO,65.55,95,,percent of total billed charges,,
Pt Phonophoresis/15 Min,,97139,CPT,Facility,Outpatient,,,GP,69,58.65,19.7754,69,Humana Insurance Company,Medicare PPO,33.81,49,,percent of total billed charges,,
Pt Phonophoresis/15 Min,,97139,CPT,Facility,Inpatient,,,GP,69,58.65,19.7754,69,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Pt Phonophoresis/15 Min,,97139,CPT,Facility,Both,,,GP,69,58.65,19.7754,69,Medica,Individual & Family,68.379,99.1,,percent of total billed charges,,
Pt Phonophoresis/15 Min,,97139,CPT,Facility,Outpatient,,,GP,69,58.65,19.7754,69,Medica,Medica Advantage Solution,34.362,49.8,,percent of total billed charges,,
Pt Phonophoresis/15 Min,,97139,CPT,Facility,Inpatient,,,GP,69,58.65,19.7754,69,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Pt Phonophoresis/15 Min,,97139,CPT,Facility,Outpatient,,,GP,69,58.65,19.7754,69,Medica,Medical Assistance,30.774,44.6,,percent of total billed charges,,
Pt Phonophoresis/15 Min,,97139,CPT,Facility,Inpatient,,,GP,69,58.65,19.7754,69,Medica,Medical Assistance,,,,,Included in per diem rate,
Pt Phonophoresis/15 Min,,97139,CPT,Facility,Outpatient,,,GP,69,58.65,19.7754,69,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,34.362,49.8,,percent of total billed charges,,
Pt Phonophoresis/15 Min,,97139,CPT,Facility,Inpatient,,,GP,69,58.65,19.7754,69,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Pt Phonophoresis/15 Min,,97139,CPT,Facility,Both,,,GP,69,58.65,19.7754,69,"Multiplan, Inc.","Multiplan, Inc.",64.86,94,,percent of total billed charges,,
Pt Phonophoresis/15 Min,,97139,CPT,Facility,Outpatient,,,GP,69,58.65,19.7754,69,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,59.616,86.4,,percent of total billed charges,,
Pt Phonophoresis/15 Min,,97139,CPT,Facility,Inpatient,,,GP,69,58.65,19.7754,69,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Pt Phonophoresis/15 Min,,97139,CPT,Facility,Both,,,GP,69,58.65,19.7754,69,"Preferred One Administrative Services, INC.",PPO,68.034,98.6,,percent of total billed charges,,
Pt Phonophoresis/15 Min,,97139,CPT,Facility,Outpatient,,,GP,69,58.65,19.7754,69,PrimeWest Health,Minnesota Senior Health Options (MSHO),35.5005,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Pt Phonophoresis/15 Min,,97139,CPT,Facility,Inpatient,,,GP,69,58.65,19.7754,69,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Pt Phonophoresis/15 Min,,97139,CPT,Facility,Outpatient,,,GP,69,58.65,19.7754,69,PrimeWest Health,MinnesotaCare,35.4384,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Pt Phonophoresis/15 Min,,97139,CPT,Facility,Inpatient,,,GP,69,58.65,19.7754,69,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Pt Phonophoresis/15 Min,,97139,CPT,Facility,Both,,,GP,69,58.65,19.7754,69,Sanford Health Plan,Sanford Health Plan,63.48,92,,percent of total billed charges,,
Pt Phonophoresis/15 Min,,97139,CPT,Facility,Outpatient,,,GP,69,58.65,19.7754,69,"UCare Health, Inc.",Individual & Family Plan,38.8815,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Pt Phonophoresis/15 Min,,97139,CPT,Facility,Inpatient,,,GP,69,58.65,19.7754,69,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Pt Phonophoresis/15 Min,,97139,CPT,Facility,Outpatient,,,GP,69,58.65,19.7754,69,"UCare Health, Inc.",Medical Assistance,34.8243,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Pt Phonophoresis/15 Min,,97139,CPT,Facility,Inpatient,,,GP,69,58.65,19.7754,69,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Pt Phonophoresis/15 Min,,97139,CPT,Facility,Outpatient,,,GP,69,58.65,19.7754,69,"UCare Health, Inc.",Medicare Advantage,34.8243,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Pt Phonophoresis/15 Min,,97139,CPT,Facility,Inpatient,,,GP,69,58.65,19.7754,69,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Pt Phonophoresis/15 Min,,97139,CPT,Facility,Outpatient,,,GP,69,58.65,19.7754,69,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),34.8243,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Pt Phonophoresis/15 Min,,97139,CPT,Facility,Inpatient,,,GP,69,58.65,19.7754,69,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Pt Phonophoresis/15 Min,,97139,CPT,Facility,Both,,,GP,69,58.65,19.7754,69,UnitedHealthcare,Individual & Family,64.86,94,,percent of total billed charges,,
Pt Phonophoresis/15 Min,,97139,CPT,Facility,Outpatient,,,GP,69,58.65,19.7754,69,UnitedHealthcare,Medicare Advantage,33.81,49,,percent of total billed charges,,
Pt Phonophoresis/15 Min,,97139,CPT,Facility,Inpatient,,,GP,69,58.65,19.7754,69,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Pt Phonophoresis/15 Min,,97139,CPT,Facility,Outpatient,,,GP,69,58.65,19.7754,69,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,33.12,48,,percent of total billed charges,,100% of DHS outpatient percentage
Pt Phonophoresis/15 Min,,97139,CPT,Facility,Inpatient,,,GP,69,58.65,19.7754,69,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Pt Manual Therapy (15 Min),,97140,CPT,Facility,Both,,,GP,102,86.7,29.2332,102,Aetna,Commercial,93.84,92,,percent of total billed charges,,
Pt Manual Therapy (15 Min),,97140,CPT,Facility,Outpatient,,,GP,102,86.7,29.2332,102,Aetna,Medicare Advantage,49.98,49,,percent of total billed charges,,
Pt Manual Therapy (15 Min),,97140,CPT,Facility,Inpatient,,,GP,102,86.7,29.2332,102,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Pt Manual Therapy (15 Min),,97140,CPT,Facility,Both,,,GP,102,86.7,29.2332,102,Aetna,PPO,94.86,93,,percent of total billed charges,,
Pt Manual Therapy (15 Min),,97140,CPT,Facility,Both,,,GP,102,86.7,29.2332,102,America's PPO,America's PPO,97.9506,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Pt Manual Therapy (15 Min),,97140,CPT,Facility,Both,,,GP,102,86.7,29.2332,102,BlueCross BlueShield Minnesota, Federal Employee Program,100.368,98.4,,percent of total billed charges,,
Pt Manual Therapy (15 Min),,97140,CPT,Facility,Both,,,GP,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,102,100,,percent of total billed charges,,
Pt Manual Therapy (15 Min),,97140,CPT,Facility,Both,,,GP,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,High Value Network Plan,91.8,90,,percent of total billed charges,,
Pt Manual Therapy (15 Min),,97140,CPT,Facility,Outpatient,,,GP,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,Medicare Advantage,49.98,49,,percent of total billed charges,,
Pt Manual Therapy (15 Min),,97140,CPT,Facility,Inpatient,,,GP,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Pt Manual Therapy (15 Min),,97140,CPT,Facility,Both,,,GP,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,90.3414,88.57,,percent of total billed charges,,
Pt Manual Therapy (15 Min),,97140,CPT,Facility,Both,,,GP,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,29.2332,28.66,,percent of total billed charges,,
Pt Manual Therapy (15 Min),,97140,CPT,Facility,Outpatient,,,GP,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),49.98,49,,percent of total billed charges,,
Pt Manual Therapy (15 Min),,97140,CPT,Facility,Inpatient,,,GP,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Pt Manual Therapy (15 Min),,97140,CPT,Facility,Both,,,GP,102,86.7,29.2332,102,CorVel,Worker's Compensation,102,100,,percent of total billed charges,,
Pt Manual Therapy (15 Min),,97140,CPT,Facility,Both,,,GP,102,86.7,29.2332,102,First Health Group Corporation,First Health Network,98.94,97,,percent of total billed charges,,
Pt Manual Therapy (15 Min),,97140,CPT,Facility,Both,,,GP,102,86.7,29.2332,102,"Health Partners, Inc.",Commercial,96.492,94.6,,percent of total billed charges,,
Pt Manual Therapy (15 Min),,97140,CPT,Facility,Outpatient,,,GP,102,86.7,29.2332,102,"Health Partners, Inc.",Medicare Advantage,49.98,49,,percent of total billed charges,,
Pt Manual Therapy (15 Min),,97140,CPT,Facility,Inpatient,,,GP,102,86.7,29.2332,102,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Pt Manual Therapy (15 Min),,97140,CPT,Facility,Both,,,GP,102,86.7,29.2332,102,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),61.2,60,,percent of total billed charges,,
Pt Manual Therapy (15 Min),,97140,CPT,Facility,Both,,,GP,102,86.7,29.2332,102,"Health Partners, Inc.",State of Minnesota Advantage Program,83.13,81.5,,percent of total billed charges,,
Pt Manual Therapy (15 Min),,97140,CPT,Facility,Both,,,GP,102,86.7,29.2332,102,"Health Partners, Inc.",State Public Programs,51,50,,percent of total billed charges,,
Pt Manual Therapy (15 Min),,97140,CPT,Facility,Both,,,GP,102,86.7,29.2332,102,Humana Insurance Company,Commercial PPO,96.9,95,,percent of total billed charges,,
Pt Manual Therapy (15 Min),,97140,CPT,Facility,Outpatient,,,GP,102,86.7,29.2332,102,Humana Insurance Company,Medicare PPO,49.98,49,,percent of total billed charges,,
Pt Manual Therapy (15 Min),,97140,CPT,Facility,Inpatient,,,GP,102,86.7,29.2332,102,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Pt Manual Therapy (15 Min),,97140,CPT,Facility,Both,,,GP,102,86.7,29.2332,102,Medica,Individual & Family,101.082,99.1,,percent of total billed charges,,
Pt Manual Therapy (15 Min),,97140,CPT,Facility,Outpatient,,,GP,102,86.7,29.2332,102,Medica,Medica Advantage Solution,50.796,49.8,,percent of total billed charges,,
Pt Manual Therapy (15 Min),,97140,CPT,Facility,Inpatient,,,GP,102,86.7,29.2332,102,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Pt Manual Therapy (15 Min),,97140,CPT,Facility,Outpatient,,,GP,102,86.7,29.2332,102,Medica,Medical Assistance,45.492,44.6,,percent of total billed charges,,
Pt Manual Therapy (15 Min),,97140,CPT,Facility,Inpatient,,,GP,102,86.7,29.2332,102,Medica,Medical Assistance,,,,,Included in per diem rate,
Pt Manual Therapy (15 Min),,97140,CPT,Facility,Outpatient,,,GP,102,86.7,29.2332,102,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,50.796,49.8,,percent of total billed charges,,
Pt Manual Therapy (15 Min),,97140,CPT,Facility,Inpatient,,,GP,102,86.7,29.2332,102,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Pt Manual Therapy (15 Min),,97140,CPT,Facility,Both,,,GP,102,86.7,29.2332,102,"Multiplan, Inc.","Multiplan, Inc.",95.88,94,,percent of total billed charges,,
Pt Manual Therapy (15 Min),,97140,CPT,Facility,Outpatient,,,GP,102,86.7,29.2332,102,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,88.128,86.4,,percent of total billed charges,,
Pt Manual Therapy (15 Min),,97140,CPT,Facility,Inpatient,,,GP,102,86.7,29.2332,102,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Pt Manual Therapy (15 Min),,97140,CPT,Facility,Both,,,GP,102,86.7,29.2332,102,"Preferred One Administrative Services, INC.",PPO,100.572,98.6,,percent of total billed charges,,
Pt Manual Therapy (15 Min),,97140,CPT,Facility,Outpatient,,,GP,102,86.7,29.2332,102,PrimeWest Health,Minnesota Senior Health Options (MSHO),52.479,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Pt Manual Therapy (15 Min),,97140,CPT,Facility,Inpatient,,,GP,102,86.7,29.2332,102,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Pt Manual Therapy (15 Min),,97140,CPT,Facility,Outpatient,,,GP,102,86.7,29.2332,102,PrimeWest Health,MinnesotaCare,52.3872,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Pt Manual Therapy (15 Min),,97140,CPT,Facility,Inpatient,,,GP,102,86.7,29.2332,102,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Pt Manual Therapy (15 Min),,97140,CPT,Facility,Both,,,GP,102,86.7,29.2332,102,Sanford Health Plan,Sanford Health Plan,93.84,92,,percent of total billed charges,,
Pt Manual Therapy (15 Min),,97140,CPT,Facility,Outpatient,,,GP,102,86.7,29.2332,102,"UCare Health, Inc.",Individual & Family Plan,57.477,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Pt Manual Therapy (15 Min),,97140,CPT,Facility,Inpatient,,,GP,102,86.7,29.2332,102,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Pt Manual Therapy (15 Min),,97140,CPT,Facility,Outpatient,,,GP,102,86.7,29.2332,102,"UCare Health, Inc.",Medical Assistance,51.4794,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Pt Manual Therapy (15 Min),,97140,CPT,Facility,Inpatient,,,GP,102,86.7,29.2332,102,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Pt Manual Therapy (15 Min),,97140,CPT,Facility,Outpatient,,,GP,102,86.7,29.2332,102,"UCare Health, Inc.",Medicare Advantage,51.4794,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Pt Manual Therapy (15 Min),,97140,CPT,Facility,Inpatient,,,GP,102,86.7,29.2332,102,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Pt Manual Therapy (15 Min),,97140,CPT,Facility,Outpatient,,,GP,102,86.7,29.2332,102,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),51.4794,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Pt Manual Therapy (15 Min),,97140,CPT,Facility,Inpatient,,,GP,102,86.7,29.2332,102,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Pt Manual Therapy (15 Min),,97140,CPT,Facility,Both,,,GP,102,86.7,29.2332,102,UnitedHealthcare,Individual & Family,95.88,94,,percent of total billed charges,,
Pt Manual Therapy (15 Min),,97140,CPT,Facility,Outpatient,,,GP,102,86.7,29.2332,102,UnitedHealthcare,Medicare Advantage,49.98,49,,percent of total billed charges,,
Pt Manual Therapy (15 Min),,97140,CPT,Facility,Inpatient,,,GP,102,86.7,29.2332,102,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Pt Manual Therapy (15 Min),,97140,CPT,Facility,Outpatient,,,GP,102,86.7,29.2332,102,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,48.96,48,,percent of total billed charges,,100% of DHS outpatient percentage
Pt Manual Therapy (15 Min),,97140,CPT,Facility,Inpatient,,,GP,102,86.7,29.2332,102,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Pt Group Therapy,,97150,CPT,Facility,Both,,,GP,69,58.65,19.7754,69,Aetna,Commercial,63.48,92,,percent of total billed charges,,
Pt Group Therapy,,97150,CPT,Facility,Outpatient,,,GP,69,58.65,19.7754,69,Aetna,Medicare Advantage,33.81,49,,percent of total billed charges,,
Pt Group Therapy,,97150,CPT,Facility,Inpatient,,,GP,69,58.65,19.7754,69,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Pt Group Therapy,,97150,CPT,Facility,Both,,,GP,69,58.65,19.7754,69,Aetna,PPO,64.17,93,,percent of total billed charges,,
Pt Group Therapy,,97150,CPT,Facility,Both,,,GP,69,58.65,19.7754,69,America's PPO,America's PPO,66.2607,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Pt Group Therapy,,97150,CPT,Facility,Both,,,GP,69,58.65,19.7754,69,BlueCross BlueShield Minnesota, Federal Employee Program,67.896,98.4,,percent of total billed charges,,
Pt Group Therapy,,97150,CPT,Facility,Both,,,GP,69,58.65,19.7754,69,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,69,100,,percent of total billed charges,,
Pt Group Therapy,,97150,CPT,Facility,Both,,,GP,69,58.65,19.7754,69,BlueCross BlueShield Minnesota,High Value Network Plan,62.1,90,,percent of total billed charges,,
Pt Group Therapy,,97150,CPT,Facility,Outpatient,,,GP,69,58.65,19.7754,69,BlueCross BlueShield Minnesota,Medicare Advantage,33.81,49,,percent of total billed charges,,
Pt Group Therapy,,97150,CPT,Facility,Inpatient,,,GP,69,58.65,19.7754,69,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Pt Group Therapy,,97150,CPT,Facility,Both,,,GP,69,58.65,19.7754,69,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,61.1133,88.57,,percent of total billed charges,,
Pt Group Therapy,,97150,CPT,Facility,Both,,,GP,69,58.65,19.7754,69,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,19.7754,28.66,,percent of total billed charges,,
Pt Group Therapy,,97150,CPT,Facility,Outpatient,,,GP,69,58.65,19.7754,69,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),33.81,49,,percent of total billed charges,,
Pt Group Therapy,,97150,CPT,Facility,Inpatient,,,GP,69,58.65,19.7754,69,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Pt Group Therapy,,97150,CPT,Facility,Both,,,GP,69,58.65,19.7754,69,CorVel,Worker's Compensation,69,100,,percent of total billed charges,,
Pt Group Therapy,,97150,CPT,Facility,Both,,,GP,69,58.65,19.7754,69,First Health Group Corporation,First Health Network,66.93,97,,percent of total billed charges,,
Pt Group Therapy,,97150,CPT,Facility,Both,,,GP,69,58.65,19.7754,69,"Health Partners, Inc.",Commercial,65.274,94.6,,percent of total billed charges,,
Pt Group Therapy,,97150,CPT,Facility,Outpatient,,,GP,69,58.65,19.7754,69,"Health Partners, Inc.",Medicare Advantage,33.81,49,,percent of total billed charges,,
Pt Group Therapy,,97150,CPT,Facility,Inpatient,,,GP,69,58.65,19.7754,69,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Pt Group Therapy,,97150,CPT,Facility,Both,,,GP,69,58.65,19.7754,69,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),41.4,60,,percent of total billed charges,,
Pt Group Therapy,,97150,CPT,Facility,Both,,,GP,69,58.65,19.7754,69,"Health Partners, Inc.",State of Minnesota Advantage Program,56.235,81.5,,percent of total billed charges,,
Pt Group Therapy,,97150,CPT,Facility,Both,,,GP,69,58.65,19.7754,69,"Health Partners, Inc.",State Public Programs,34.5,50,,percent of total billed charges,,
Pt Group Therapy,,97150,CPT,Facility,Both,,,GP,69,58.65,19.7754,69,Humana Insurance Company,Commercial PPO,65.55,95,,percent of total billed charges,,
Pt Group Therapy,,97150,CPT,Facility,Outpatient,,,GP,69,58.65,19.7754,69,Humana Insurance Company,Medicare PPO,33.81,49,,percent of total billed charges,,
Pt Group Therapy,,97150,CPT,Facility,Inpatient,,,GP,69,58.65,19.7754,69,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Pt Group Therapy,,97150,CPT,Facility,Both,,,GP,69,58.65,19.7754,69,Medica,Individual & Family,68.379,99.1,,percent of total billed charges,,
Pt Group Therapy,,97150,CPT,Facility,Outpatient,,,GP,69,58.65,19.7754,69,Medica,Medica Advantage Solution,34.362,49.8,,percent of total billed charges,,
Pt Group Therapy,,97150,CPT,Facility,Inpatient,,,GP,69,58.65,19.7754,69,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Pt Group Therapy,,97150,CPT,Facility,Outpatient,,,GP,69,58.65,19.7754,69,Medica,Medical Assistance,30.774,44.6,,percent of total billed charges,,
Pt Group Therapy,,97150,CPT,Facility,Inpatient,,,GP,69,58.65,19.7754,69,Medica,Medical Assistance,,,,,Included in per diem rate,
Pt Group Therapy,,97150,CPT,Facility,Outpatient,,,GP,69,58.65,19.7754,69,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,34.362,49.8,,percent of total billed charges,,
Pt Group Therapy,,97150,CPT,Facility,Inpatient,,,GP,69,58.65,19.7754,69,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Pt Group Therapy,,97150,CPT,Facility,Both,,,GP,69,58.65,19.7754,69,"Multiplan, Inc.","Multiplan, Inc.",64.86,94,,percent of total billed charges,,
Pt Group Therapy,,97150,CPT,Facility,Outpatient,,,GP,69,58.65,19.7754,69,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,59.616,86.4,,percent of total billed charges,,
Pt Group Therapy,,97150,CPT,Facility,Inpatient,,,GP,69,58.65,19.7754,69,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Pt Group Therapy,,97150,CPT,Facility,Both,,,GP,69,58.65,19.7754,69,"Preferred One Administrative Services, INC.",PPO,68.034,98.6,,percent of total billed charges,,
Pt Group Therapy,,97150,CPT,Facility,Outpatient,,,GP,69,58.65,19.7754,69,PrimeWest Health,Minnesota Senior Health Options (MSHO),35.5005,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Pt Group Therapy,,97150,CPT,Facility,Inpatient,,,GP,69,58.65,19.7754,69,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Pt Group Therapy,,97150,CPT,Facility,Outpatient,,,GP,69,58.65,19.7754,69,PrimeWest Health,MinnesotaCare,35.4384,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Pt Group Therapy,,97150,CPT,Facility,Inpatient,,,GP,69,58.65,19.7754,69,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Pt Group Therapy,,97150,CPT,Facility,Both,,,GP,69,58.65,19.7754,69,Sanford Health Plan,Sanford Health Plan,63.48,92,,percent of total billed charges,,
Pt Group Therapy,,97150,CPT,Facility,Outpatient,,,GP,69,58.65,19.7754,69,"UCare Health, Inc.",Individual & Family Plan,38.8815,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Pt Group Therapy,,97150,CPT,Facility,Inpatient,,,GP,69,58.65,19.7754,69,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Pt Group Therapy,,97150,CPT,Facility,Outpatient,,,GP,69,58.65,19.7754,69,"UCare Health, Inc.",Medical Assistance,34.8243,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Pt Group Therapy,,97150,CPT,Facility,Inpatient,,,GP,69,58.65,19.7754,69,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Pt Group Therapy,,97150,CPT,Facility,Outpatient,,,GP,69,58.65,19.7754,69,"UCare Health, Inc.",Medicare Advantage,34.8243,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Pt Group Therapy,,97150,CPT,Facility,Inpatient,,,GP,69,58.65,19.7754,69,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Pt Group Therapy,,97150,CPT,Facility,Outpatient,,,GP,69,58.65,19.7754,69,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),34.8243,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Pt Group Therapy,,97150,CPT,Facility,Inpatient,,,GP,69,58.65,19.7754,69,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Pt Group Therapy,,97150,CPT,Facility,Both,,,GP,69,58.65,19.7754,69,UnitedHealthcare,Individual & Family,64.86,94,,percent of total billed charges,,
Pt Group Therapy,,97150,CPT,Facility,Outpatient,,,GP,69,58.65,19.7754,69,UnitedHealthcare,Medicare Advantage,33.81,49,,percent of total billed charges,,
Pt Group Therapy,,97150,CPT,Facility,Inpatient,,,GP,69,58.65,19.7754,69,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Pt Group Therapy,,97150,CPT,Facility,Outpatient,,,GP,69,58.65,19.7754,69,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,33.12,48,,percent of total billed charges,,100% of DHS outpatient percentage
Pt Group Therapy,,97150,CPT,Facility,Inpatient,,,GP,69,58.65,19.7754,69,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Pt Eval Low Complexity,,97161,CPT,Facility,Both,,,GP,222,188.7,63.6252,222,Aetna,Commercial,204.24,92,,percent of total billed charges,,
Pt Eval Low Complexity,,97161,CPT,Facility,Outpatient,,,GP,222,188.7,63.6252,222,Aetna,Medicare Advantage,108.78,49,,percent of total billed charges,,
Pt Eval Low Complexity,,97161,CPT,Facility,Inpatient,,,GP,222,188.7,63.6252,222,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Pt Eval Low Complexity,,97161,CPT,Facility,Both,,,GP,222,188.7,63.6252,222,Aetna,PPO,206.46,93,,percent of total billed charges,,
Pt Eval Low Complexity,,97161,CPT,Facility,Both,,,GP,222,188.7,63.6252,222,America's PPO,America's PPO,213.1866,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Pt Eval Low Complexity,,97161,CPT,Facility,Both,,,GP,222,188.7,63.6252,222,BlueCross BlueShield Minnesota, Federal Employee Program,218.448,98.4,,percent of total billed charges,,
Pt Eval Low Complexity,,97161,CPT,Facility,Both,,,GP,222,188.7,63.6252,222,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,222,100,,percent of total billed charges,,
Pt Eval Low Complexity,,97161,CPT,Facility,Both,,,GP,222,188.7,63.6252,222,BlueCross BlueShield Minnesota,High Value Network Plan,199.8,90,,percent of total billed charges,,
Pt Eval Low Complexity,,97161,CPT,Facility,Outpatient,,,GP,222,188.7,63.6252,222,BlueCross BlueShield Minnesota,Medicare Advantage,108.78,49,,percent of total billed charges,,
Pt Eval Low Complexity,,97161,CPT,Facility,Inpatient,,,GP,222,188.7,63.6252,222,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Pt Eval Low Complexity,,97161,CPT,Facility,Both,,,GP,222,188.7,63.6252,222,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,196.6254,88.57,,percent of total billed charges,,
Pt Eval Low Complexity,,97161,CPT,Facility,Both,,,GP,222,188.7,63.6252,222,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,63.6252,28.66,,percent of total billed charges,,
Pt Eval Low Complexity,,97161,CPT,Facility,Outpatient,,,GP,222,188.7,63.6252,222,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),108.78,49,,percent of total billed charges,,
Pt Eval Low Complexity,,97161,CPT,Facility,Inpatient,,,GP,222,188.7,63.6252,222,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Pt Eval Low Complexity,,97161,CPT,Facility,Both,,,GP,222,188.7,63.6252,222,CorVel,Worker's Compensation,222,100,,percent of total billed charges,,
Pt Eval Low Complexity,,97161,CPT,Facility,Both,,,GP,222,188.7,63.6252,222,First Health Group Corporation,First Health Network,215.34,97,,percent of total billed charges,,
Pt Eval Low Complexity,,97161,CPT,Facility,Both,,,GP,222,188.7,63.6252,222,"Health Partners, Inc.",Commercial,210.012,94.6,,percent of total billed charges,,
Pt Eval Low Complexity,,97161,CPT,Facility,Outpatient,,,GP,222,188.7,63.6252,222,"Health Partners, Inc.",Medicare Advantage,108.78,49,,percent of total billed charges,,
Pt Eval Low Complexity,,97161,CPT,Facility,Inpatient,,,GP,222,188.7,63.6252,222,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Pt Eval Low Complexity,,97161,CPT,Facility,Both,,,GP,222,188.7,63.6252,222,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),133.2,60,,percent of total billed charges,,
Pt Eval Low Complexity,,97161,CPT,Facility,Both,,,GP,222,188.7,63.6252,222,"Health Partners, Inc.",State of Minnesota Advantage Program,180.93,81.5,,percent of total billed charges,,
Pt Eval Low Complexity,,97161,CPT,Facility,Both,,,GP,222,188.7,63.6252,222,"Health Partners, Inc.",State Public Programs,111,50,,percent of total billed charges,,
Pt Eval Low Complexity,,97161,CPT,Facility,Both,,,GP,222,188.7,63.6252,222,Humana Insurance Company,Commercial PPO,210.9,95,,percent of total billed charges,,
Pt Eval Low Complexity,,97161,CPT,Facility,Outpatient,,,GP,222,188.7,63.6252,222,Humana Insurance Company,Medicare PPO,108.78,49,,percent of total billed charges,,
Pt Eval Low Complexity,,97161,CPT,Facility,Inpatient,,,GP,222,188.7,63.6252,222,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Pt Eval Low Complexity,,97161,CPT,Facility,Both,,,GP,222,188.7,63.6252,222,Medica,Individual & Family,220.002,99.1,,percent of total billed charges,,
Pt Eval Low Complexity,,97161,CPT,Facility,Outpatient,,,GP,222,188.7,63.6252,222,Medica,Medica Advantage Solution,110.556,49.8,,percent of total billed charges,,
Pt Eval Low Complexity,,97161,CPT,Facility,Inpatient,,,GP,222,188.7,63.6252,222,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Pt Eval Low Complexity,,97161,CPT,Facility,Outpatient,,,GP,222,188.7,63.6252,222,Medica,Medical Assistance,99.012,44.6,,percent of total billed charges,,
Pt Eval Low Complexity,,97161,CPT,Facility,Inpatient,,,GP,222,188.7,63.6252,222,Medica,Medical Assistance,,,,,Included in per diem rate,
Pt Eval Low Complexity,,97161,CPT,Facility,Outpatient,,,GP,222,188.7,63.6252,222,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,110.556,49.8,,percent of total billed charges,,
Pt Eval Low Complexity,,97161,CPT,Facility,Inpatient,,,GP,222,188.7,63.6252,222,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Pt Eval Low Complexity,,97161,CPT,Facility,Both,,,GP,222,188.7,63.6252,222,"Multiplan, Inc.","Multiplan, Inc.",208.68,94,,percent of total billed charges,,
Pt Eval Low Complexity,,97161,CPT,Facility,Outpatient,,,GP,222,188.7,63.6252,222,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,191.808,86.4,,percent of total billed charges,,
Pt Eval Low Complexity,,97161,CPT,Facility,Inpatient,,,GP,222,188.7,63.6252,222,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Pt Eval Low Complexity,,97161,CPT,Facility,Both,,,GP,222,188.7,63.6252,222,"Preferred One Administrative Services, INC.",PPO,218.892,98.6,,percent of total billed charges,,
Pt Eval Low Complexity,,97161,CPT,Facility,Outpatient,,,GP,222,188.7,63.6252,222,PrimeWest Health,Minnesota Senior Health Options (MSHO),114.219,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Pt Eval Low Complexity,,97161,CPT,Facility,Inpatient,,,GP,222,188.7,63.6252,222,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Pt Eval Low Complexity,,97161,CPT,Facility,Outpatient,,,GP,222,188.7,63.6252,222,PrimeWest Health,MinnesotaCare,114.0192,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Pt Eval Low Complexity,,97161,CPT,Facility,Inpatient,,,GP,222,188.7,63.6252,222,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Pt Eval Low Complexity,,97161,CPT,Facility,Both,,,GP,222,188.7,63.6252,222,Sanford Health Plan,Sanford Health Plan,204.24,92,,percent of total billed charges,,
Pt Eval Low Complexity,,97161,CPT,Facility,Outpatient,,,GP,222,188.7,63.6252,222,"UCare Health, Inc.",Individual & Family Plan,125.097,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Pt Eval Low Complexity,,97161,CPT,Facility,Inpatient,,,GP,222,188.7,63.6252,222,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Pt Eval Low Complexity,,97161,CPT,Facility,Outpatient,,,GP,222,188.7,63.6252,222,"UCare Health, Inc.",Medical Assistance,112.0434,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Pt Eval Low Complexity,,97161,CPT,Facility,Inpatient,,,GP,222,188.7,63.6252,222,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Pt Eval Low Complexity,,97161,CPT,Facility,Outpatient,,,GP,222,188.7,63.6252,222,"UCare Health, Inc.",Medicare Advantage,112.0434,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Pt Eval Low Complexity,,97161,CPT,Facility,Inpatient,,,GP,222,188.7,63.6252,222,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Pt Eval Low Complexity,,97161,CPT,Facility,Outpatient,,,GP,222,188.7,63.6252,222,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),112.0434,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Pt Eval Low Complexity,,97161,CPT,Facility,Inpatient,,,GP,222,188.7,63.6252,222,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Pt Eval Low Complexity,,97161,CPT,Facility,Both,,,GP,222,188.7,63.6252,222,UnitedHealthcare,Individual & Family,208.68,94,,percent of total billed charges,,
Pt Eval Low Complexity,,97161,CPT,Facility,Outpatient,,,GP,222,188.7,63.6252,222,UnitedHealthcare,Medicare Advantage,108.78,49,,percent of total billed charges,,
Pt Eval Low Complexity,,97161,CPT,Facility,Inpatient,,,GP,222,188.7,63.6252,222,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Pt Eval Low Complexity,,97161,CPT,Facility,Outpatient,,,GP,222,188.7,63.6252,222,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,106.56,48,,percent of total billed charges,,100% of DHS outpatient percentage
Pt Eval Low Complexity,,97161,CPT,Facility,Inpatient,,,GP,222,188.7,63.6252,222,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Pt Eval Moderate Complexity,,97162,CPT,Facility,Both,,,GP,255,216.75,73.083,255,Aetna,Commercial,234.6,92,,percent of total billed charges,,
Pt Eval Moderate Complexity,,97162,CPT,Facility,Outpatient,,,GP,255,216.75,73.083,255,Aetna,Medicare Advantage,124.95,49,,percent of total billed charges,,
Pt Eval Moderate Complexity,,97162,CPT,Facility,Inpatient,,,GP,255,216.75,73.083,255,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Pt Eval Moderate Complexity,,97162,CPT,Facility,Both,,,GP,255,216.75,73.083,255,Aetna,PPO,237.15,93,,percent of total billed charges,,
Pt Eval Moderate Complexity,,97162,CPT,Facility,Both,,,GP,255,216.75,73.083,255,America's PPO,America's PPO,244.8765,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Pt Eval Moderate Complexity,,97162,CPT,Facility,Both,,,GP,255,216.75,73.083,255,BlueCross BlueShield Minnesota, Federal Employee Program,250.92,98.4,,percent of total billed charges,,
Pt Eval Moderate Complexity,,97162,CPT,Facility,Both,,,GP,255,216.75,73.083,255,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,255,100,,percent of total billed charges,,
Pt Eval Moderate Complexity,,97162,CPT,Facility,Both,,,GP,255,216.75,73.083,255,BlueCross BlueShield Minnesota,High Value Network Plan,229.5,90,,percent of total billed charges,,
Pt Eval Moderate Complexity,,97162,CPT,Facility,Outpatient,,,GP,255,216.75,73.083,255,BlueCross BlueShield Minnesota,Medicare Advantage,124.95,49,,percent of total billed charges,,
Pt Eval Moderate Complexity,,97162,CPT,Facility,Inpatient,,,GP,255,216.75,73.083,255,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Pt Eval Moderate Complexity,,97162,CPT,Facility,Both,,,GP,255,216.75,73.083,255,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,225.8535,88.57,,percent of total billed charges,,
Pt Eval Moderate Complexity,,97162,CPT,Facility,Both,,,GP,255,216.75,73.083,255,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,73.083,28.66,,percent of total billed charges,,
Pt Eval Moderate Complexity,,97162,CPT,Facility,Outpatient,,,GP,255,216.75,73.083,255,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),124.95,49,,percent of total billed charges,,
Pt Eval Moderate Complexity,,97162,CPT,Facility,Inpatient,,,GP,255,216.75,73.083,255,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Pt Eval Moderate Complexity,,97162,CPT,Facility,Both,,,GP,255,216.75,73.083,255,CorVel,Worker's Compensation,255,100,,percent of total billed charges,,
Pt Eval Moderate Complexity,,97162,CPT,Facility,Both,,,GP,255,216.75,73.083,255,First Health Group Corporation,First Health Network,247.35,97,,percent of total billed charges,,
Pt Eval Moderate Complexity,,97162,CPT,Facility,Both,,,GP,255,216.75,73.083,255,"Health Partners, Inc.",Commercial,241.23,94.6,,percent of total billed charges,,
Pt Eval Moderate Complexity,,97162,CPT,Facility,Outpatient,,,GP,255,216.75,73.083,255,"Health Partners, Inc.",Medicare Advantage,124.95,49,,percent of total billed charges,,
Pt Eval Moderate Complexity,,97162,CPT,Facility,Inpatient,,,GP,255,216.75,73.083,255,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Pt Eval Moderate Complexity,,97162,CPT,Facility,Both,,,GP,255,216.75,73.083,255,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),153,60,,percent of total billed charges,,
Pt Eval Moderate Complexity,,97162,CPT,Facility,Both,,,GP,255,216.75,73.083,255,"Health Partners, Inc.",State of Minnesota Advantage Program,207.825,81.5,,percent of total billed charges,,
Pt Eval Moderate Complexity,,97162,CPT,Facility,Both,,,GP,255,216.75,73.083,255,"Health Partners, Inc.",State Public Programs,127.5,50,,percent of total billed charges,,
Pt Eval Moderate Complexity,,97162,CPT,Facility,Both,,,GP,255,216.75,73.083,255,Humana Insurance Company,Commercial PPO,242.25,95,,percent of total billed charges,,
Pt Eval Moderate Complexity,,97162,CPT,Facility,Outpatient,,,GP,255,216.75,73.083,255,Humana Insurance Company,Medicare PPO,124.95,49,,percent of total billed charges,,
Pt Eval Moderate Complexity,,97162,CPT,Facility,Inpatient,,,GP,255,216.75,73.083,255,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Pt Eval Moderate Complexity,,97162,CPT,Facility,Both,,,GP,255,216.75,73.083,255,Medica,Individual & Family,252.705,99.1,,percent of total billed charges,,
Pt Eval Moderate Complexity,,97162,CPT,Facility,Outpatient,,,GP,255,216.75,73.083,255,Medica,Medica Advantage Solution,126.99,49.8,,percent of total billed charges,,
Pt Eval Moderate Complexity,,97162,CPT,Facility,Inpatient,,,GP,255,216.75,73.083,255,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Pt Eval Moderate Complexity,,97162,CPT,Facility,Outpatient,,,GP,255,216.75,73.083,255,Medica,Medical Assistance,113.73,44.6,,percent of total billed charges,,
Pt Eval Moderate Complexity,,97162,CPT,Facility,Inpatient,,,GP,255,216.75,73.083,255,Medica,Medical Assistance,,,,,Included in per diem rate,
Pt Eval Moderate Complexity,,97162,CPT,Facility,Outpatient,,,GP,255,216.75,73.083,255,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,126.99,49.8,,percent of total billed charges,,
Pt Eval Moderate Complexity,,97162,CPT,Facility,Inpatient,,,GP,255,216.75,73.083,255,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Pt Eval Moderate Complexity,,97162,CPT,Facility,Both,,,GP,255,216.75,73.083,255,"Multiplan, Inc.","Multiplan, Inc.",239.7,94,,percent of total billed charges,,
Pt Eval Moderate Complexity,,97162,CPT,Facility,Outpatient,,,GP,255,216.75,73.083,255,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,220.32,86.4,,percent of total billed charges,,
Pt Eval Moderate Complexity,,97162,CPT,Facility,Inpatient,,,GP,255,216.75,73.083,255,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Pt Eval Moderate Complexity,,97162,CPT,Facility,Both,,,GP,255,216.75,73.083,255,"Preferred One Administrative Services, INC.",PPO,251.43,98.6,,percent of total billed charges,,
Pt Eval Moderate Complexity,,97162,CPT,Facility,Outpatient,,,GP,255,216.75,73.083,255,PrimeWest Health,Minnesota Senior Health Options (MSHO),131.1975,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Pt Eval Moderate Complexity,,97162,CPT,Facility,Inpatient,,,GP,255,216.75,73.083,255,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Pt Eval Moderate Complexity,,97162,CPT,Facility,Outpatient,,,GP,255,216.75,73.083,255,PrimeWest Health,MinnesotaCare,130.968,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Pt Eval Moderate Complexity,,97162,CPT,Facility,Inpatient,,,GP,255,216.75,73.083,255,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Pt Eval Moderate Complexity,,97162,CPT,Facility,Both,,,GP,255,216.75,73.083,255,Sanford Health Plan,Sanford Health Plan,234.6,92,,percent of total billed charges,,
Pt Eval Moderate Complexity,,97162,CPT,Facility,Outpatient,,,GP,255,216.75,73.083,255,"UCare Health, Inc.",Individual & Family Plan,143.6925,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Pt Eval Moderate Complexity,,97162,CPT,Facility,Inpatient,,,GP,255,216.75,73.083,255,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Pt Eval Moderate Complexity,,97162,CPT,Facility,Outpatient,,,GP,255,216.75,73.083,255,"UCare Health, Inc.",Medical Assistance,128.6985,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Pt Eval Moderate Complexity,,97162,CPT,Facility,Inpatient,,,GP,255,216.75,73.083,255,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Pt Eval Moderate Complexity,,97162,CPT,Facility,Outpatient,,,GP,255,216.75,73.083,255,"UCare Health, Inc.",Medicare Advantage,128.6985,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Pt Eval Moderate Complexity,,97162,CPT,Facility,Inpatient,,,GP,255,216.75,73.083,255,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Pt Eval Moderate Complexity,,97162,CPT,Facility,Outpatient,,,GP,255,216.75,73.083,255,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),128.6985,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Pt Eval Moderate Complexity,,97162,CPT,Facility,Inpatient,,,GP,255,216.75,73.083,255,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Pt Eval Moderate Complexity,,97162,CPT,Facility,Both,,,GP,255,216.75,73.083,255,UnitedHealthcare,Individual & Family,239.7,94,,percent of total billed charges,,
Pt Eval Moderate Complexity,,97162,CPT,Facility,Outpatient,,,GP,255,216.75,73.083,255,UnitedHealthcare,Medicare Advantage,124.95,49,,percent of total billed charges,,
Pt Eval Moderate Complexity,,97162,CPT,Facility,Inpatient,,,GP,255,216.75,73.083,255,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Pt Eval Moderate Complexity,,97162,CPT,Facility,Outpatient,,,GP,255,216.75,73.083,255,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,122.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
Pt Eval Moderate Complexity,,97162,CPT,Facility,Inpatient,,,GP,255,216.75,73.083,255,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Pt Eval High Complexity,,97163,CPT,Facility,Both,,,GP,286,243.1,81.9676,286,Aetna,Commercial,263.12,92,,percent of total billed charges,,
Pt Eval High Complexity,,97163,CPT,Facility,Outpatient,,,GP,286,243.1,81.9676,286,Aetna,Medicare Advantage,140.14,49,,percent of total billed charges,,
Pt Eval High Complexity,,97163,CPT,Facility,Inpatient,,,GP,286,243.1,81.9676,286,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Pt Eval High Complexity,,97163,CPT,Facility,Both,,,GP,286,243.1,81.9676,286,Aetna,PPO,265.98,93,,percent of total billed charges,,
Pt Eval High Complexity,,97163,CPT,Facility,Both,,,GP,286,243.1,81.9676,286,America's PPO,America's PPO,274.6458,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Pt Eval High Complexity,,97163,CPT,Facility,Both,,,GP,286,243.1,81.9676,286,BlueCross BlueShield Minnesota, Federal Employee Program,281.424,98.4,,percent of total billed charges,,
Pt Eval High Complexity,,97163,CPT,Facility,Both,,,GP,286,243.1,81.9676,286,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,286,100,,percent of total billed charges,,
Pt Eval High Complexity,,97163,CPT,Facility,Both,,,GP,286,243.1,81.9676,286,BlueCross BlueShield Minnesota,High Value Network Plan,257.4,90,,percent of total billed charges,,
Pt Eval High Complexity,,97163,CPT,Facility,Outpatient,,,GP,286,243.1,81.9676,286,BlueCross BlueShield Minnesota,Medicare Advantage,140.14,49,,percent of total billed charges,,
Pt Eval High Complexity,,97163,CPT,Facility,Inpatient,,,GP,286,243.1,81.9676,286,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Pt Eval High Complexity,,97163,CPT,Facility,Both,,,GP,286,243.1,81.9676,286,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,253.3102,88.57,,percent of total billed charges,,
Pt Eval High Complexity,,97163,CPT,Facility,Both,,,GP,286,243.1,81.9676,286,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,81.9676,28.66,,percent of total billed charges,,
Pt Eval High Complexity,,97163,CPT,Facility,Outpatient,,,GP,286,243.1,81.9676,286,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),140.14,49,,percent of total billed charges,,
Pt Eval High Complexity,,97163,CPT,Facility,Inpatient,,,GP,286,243.1,81.9676,286,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Pt Eval High Complexity,,97163,CPT,Facility,Both,,,GP,286,243.1,81.9676,286,CorVel,Worker's Compensation,286,100,,percent of total billed charges,,
Pt Eval High Complexity,,97163,CPT,Facility,Both,,,GP,286,243.1,81.9676,286,First Health Group Corporation,First Health Network,277.42,97,,percent of total billed charges,,
Pt Eval High Complexity,,97163,CPT,Facility,Both,,,GP,286,243.1,81.9676,286,"Health Partners, Inc.",Commercial,270.556,94.6,,percent of total billed charges,,
Pt Eval High Complexity,,97163,CPT,Facility,Outpatient,,,GP,286,243.1,81.9676,286,"Health Partners, Inc.",Medicare Advantage,140.14,49,,percent of total billed charges,,
Pt Eval High Complexity,,97163,CPT,Facility,Inpatient,,,GP,286,243.1,81.9676,286,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Pt Eval High Complexity,,97163,CPT,Facility,Both,,,GP,286,243.1,81.9676,286,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),171.6,60,,percent of total billed charges,,
Pt Eval High Complexity,,97163,CPT,Facility,Both,,,GP,286,243.1,81.9676,286,"Health Partners, Inc.",State of Minnesota Advantage Program,233.09,81.5,,percent of total billed charges,,
Pt Eval High Complexity,,97163,CPT,Facility,Both,,,GP,286,243.1,81.9676,286,"Health Partners, Inc.",State Public Programs,143,50,,percent of total billed charges,,
Pt Eval High Complexity,,97163,CPT,Facility,Both,,,GP,286,243.1,81.9676,286,Humana Insurance Company,Commercial PPO,271.7,95,,percent of total billed charges,,
Pt Eval High Complexity,,97163,CPT,Facility,Outpatient,,,GP,286,243.1,81.9676,286,Humana Insurance Company,Medicare PPO,140.14,49,,percent of total billed charges,,
Pt Eval High Complexity,,97163,CPT,Facility,Inpatient,,,GP,286,243.1,81.9676,286,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Pt Eval High Complexity,,97163,CPT,Facility,Both,,,GP,286,243.1,81.9676,286,Medica,Individual & Family,283.426,99.1,,percent of total billed charges,,
Pt Eval High Complexity,,97163,CPT,Facility,Outpatient,,,GP,286,243.1,81.9676,286,Medica,Medica Advantage Solution,142.428,49.8,,percent of total billed charges,,
Pt Eval High Complexity,,97163,CPT,Facility,Inpatient,,,GP,286,243.1,81.9676,286,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Pt Eval High Complexity,,97163,CPT,Facility,Outpatient,,,GP,286,243.1,81.9676,286,Medica,Medical Assistance,127.556,44.6,,percent of total billed charges,,
Pt Eval High Complexity,,97163,CPT,Facility,Inpatient,,,GP,286,243.1,81.9676,286,Medica,Medical Assistance,,,,,Included in per diem rate,
Pt Eval High Complexity,,97163,CPT,Facility,Outpatient,,,GP,286,243.1,81.9676,286,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,142.428,49.8,,percent of total billed charges,,
Pt Eval High Complexity,,97163,CPT,Facility,Inpatient,,,GP,286,243.1,81.9676,286,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Pt Eval High Complexity,,97163,CPT,Facility,Both,,,GP,286,243.1,81.9676,286,"Multiplan, Inc.","Multiplan, Inc.",268.84,94,,percent of total billed charges,,
Pt Eval High Complexity,,97163,CPT,Facility,Outpatient,,,GP,286,243.1,81.9676,286,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,247.104,86.4,,percent of total billed charges,,
Pt Eval High Complexity,,97163,CPT,Facility,Inpatient,,,GP,286,243.1,81.9676,286,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Pt Eval High Complexity,,97163,CPT,Facility,Both,,,GP,286,243.1,81.9676,286,"Preferred One Administrative Services, INC.",PPO,281.996,98.6,,percent of total billed charges,,
Pt Eval High Complexity,,97163,CPT,Facility,Outpatient,,,GP,286,243.1,81.9676,286,PrimeWest Health,Minnesota Senior Health Options (MSHO),147.147,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Pt Eval High Complexity,,97163,CPT,Facility,Inpatient,,,GP,286,243.1,81.9676,286,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Pt Eval High Complexity,,97163,CPT,Facility,Outpatient,,,GP,286,243.1,81.9676,286,PrimeWest Health,MinnesotaCare,146.8896,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Pt Eval High Complexity,,97163,CPT,Facility,Inpatient,,,GP,286,243.1,81.9676,286,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Pt Eval High Complexity,,97163,CPT,Facility,Both,,,GP,286,243.1,81.9676,286,Sanford Health Plan,Sanford Health Plan,263.12,92,,percent of total billed charges,,
Pt Eval High Complexity,,97163,CPT,Facility,Outpatient,,,GP,286,243.1,81.9676,286,"UCare Health, Inc.",Individual & Family Plan,161.161,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Pt Eval High Complexity,,97163,CPT,Facility,Inpatient,,,GP,286,243.1,81.9676,286,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Pt Eval High Complexity,,97163,CPT,Facility,Outpatient,,,GP,286,243.1,81.9676,286,"UCare Health, Inc.",Medical Assistance,144.3442,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Pt Eval High Complexity,,97163,CPT,Facility,Inpatient,,,GP,286,243.1,81.9676,286,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Pt Eval High Complexity,,97163,CPT,Facility,Outpatient,,,GP,286,243.1,81.9676,286,"UCare Health, Inc.",Medicare Advantage,144.3442,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Pt Eval High Complexity,,97163,CPT,Facility,Inpatient,,,GP,286,243.1,81.9676,286,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Pt Eval High Complexity,,97163,CPT,Facility,Outpatient,,,GP,286,243.1,81.9676,286,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),144.3442,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Pt Eval High Complexity,,97163,CPT,Facility,Inpatient,,,GP,286,243.1,81.9676,286,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Pt Eval High Complexity,,97163,CPT,Facility,Both,,,GP,286,243.1,81.9676,286,UnitedHealthcare,Individual & Family,268.84,94,,percent of total billed charges,,
Pt Eval High Complexity,,97163,CPT,Facility,Outpatient,,,GP,286,243.1,81.9676,286,UnitedHealthcare,Medicare Advantage,140.14,49,,percent of total billed charges,,
Pt Eval High Complexity,,97163,CPT,Facility,Inpatient,,,GP,286,243.1,81.9676,286,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Pt Eval High Complexity,,97163,CPT,Facility,Outpatient,,,GP,286,243.1,81.9676,286,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,137.28,48,,percent of total billed charges,,100% of DHS outpatient percentage
Pt Eval High Complexity,,97163,CPT,Facility,Inpatient,,,GP,286,243.1,81.9676,286,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Pt Re-Evaluation,,97164,CPT,Facility,Both,,,GP,111,94.35,31.8126,111,Aetna,Commercial,102.12,92,,percent of total billed charges,,
Pt Re-Evaluation,,97164,CPT,Facility,Outpatient,,,GP,111,94.35,31.8126,111,Aetna,Medicare Advantage,54.39,49,,percent of total billed charges,,
Pt Re-Evaluation,,97164,CPT,Facility,Inpatient,,,GP,111,94.35,31.8126,111,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Pt Re-Evaluation,,97164,CPT,Facility,Both,,,GP,111,94.35,31.8126,111,Aetna,PPO,103.23,93,,percent of total billed charges,,
Pt Re-Evaluation,,97164,CPT,Facility,Both,,,GP,111,94.35,31.8126,111,America's PPO,America's PPO,106.5933,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Pt Re-Evaluation,,97164,CPT,Facility,Both,,,GP,111,94.35,31.8126,111,BlueCross BlueShield Minnesota, Federal Employee Program,109.224,98.4,,percent of total billed charges,,
Pt Re-Evaluation,,97164,CPT,Facility,Both,,,GP,111,94.35,31.8126,111,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,111,100,,percent of total billed charges,,
Pt Re-Evaluation,,97164,CPT,Facility,Both,,,GP,111,94.35,31.8126,111,BlueCross BlueShield Minnesota,High Value Network Plan,99.9,90,,percent of total billed charges,,
Pt Re-Evaluation,,97164,CPT,Facility,Outpatient,,,GP,111,94.35,31.8126,111,BlueCross BlueShield Minnesota,Medicare Advantage,54.39,49,,percent of total billed charges,,
Pt Re-Evaluation,,97164,CPT,Facility,Inpatient,,,GP,111,94.35,31.8126,111,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Pt Re-Evaluation,,97164,CPT,Facility,Both,,,GP,111,94.35,31.8126,111,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,98.3127,88.57,,percent of total billed charges,,
Pt Re-Evaluation,,97164,CPT,Facility,Both,,,GP,111,94.35,31.8126,111,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,31.8126,28.66,,percent of total billed charges,,
Pt Re-Evaluation,,97164,CPT,Facility,Outpatient,,,GP,111,94.35,31.8126,111,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),54.39,49,,percent of total billed charges,,
Pt Re-Evaluation,,97164,CPT,Facility,Inpatient,,,GP,111,94.35,31.8126,111,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Pt Re-Evaluation,,97164,CPT,Facility,Both,,,GP,111,94.35,31.8126,111,CorVel,Worker's Compensation,111,100,,percent of total billed charges,,
Pt Re-Evaluation,,97164,CPT,Facility,Both,,,GP,111,94.35,31.8126,111,First Health Group Corporation,First Health Network,107.67,97,,percent of total billed charges,,
Pt Re-Evaluation,,97164,CPT,Facility,Both,,,GP,111,94.35,31.8126,111,"Health Partners, Inc.",Commercial,105.006,94.6,,percent of total billed charges,,
Pt Re-Evaluation,,97164,CPT,Facility,Outpatient,,,GP,111,94.35,31.8126,111,"Health Partners, Inc.",Medicare Advantage,54.39,49,,percent of total billed charges,,
Pt Re-Evaluation,,97164,CPT,Facility,Inpatient,,,GP,111,94.35,31.8126,111,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Pt Re-Evaluation,,97164,CPT,Facility,Both,,,GP,111,94.35,31.8126,111,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),66.6,60,,percent of total billed charges,,
Pt Re-Evaluation,,97164,CPT,Facility,Both,,,GP,111,94.35,31.8126,111,"Health Partners, Inc.",State of Minnesota Advantage Program,90.465,81.5,,percent of total billed charges,,
Pt Re-Evaluation,,97164,CPT,Facility,Both,,,GP,111,94.35,31.8126,111,"Health Partners, Inc.",State Public Programs,55.5,50,,percent of total billed charges,,
Pt Re-Evaluation,,97164,CPT,Facility,Both,,,GP,111,94.35,31.8126,111,Humana Insurance Company,Commercial PPO,105.45,95,,percent of total billed charges,,
Pt Re-Evaluation,,97164,CPT,Facility,Outpatient,,,GP,111,94.35,31.8126,111,Humana Insurance Company,Medicare PPO,54.39,49,,percent of total billed charges,,
Pt Re-Evaluation,,97164,CPT,Facility,Inpatient,,,GP,111,94.35,31.8126,111,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Pt Re-Evaluation,,97164,CPT,Facility,Both,,,GP,111,94.35,31.8126,111,Medica,Individual & Family,110.001,99.1,,percent of total billed charges,,
Pt Re-Evaluation,,97164,CPT,Facility,Outpatient,,,GP,111,94.35,31.8126,111,Medica,Medica Advantage Solution,55.278,49.8,,percent of total billed charges,,
Pt Re-Evaluation,,97164,CPT,Facility,Inpatient,,,GP,111,94.35,31.8126,111,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Pt Re-Evaluation,,97164,CPT,Facility,Outpatient,,,GP,111,94.35,31.8126,111,Medica,Medical Assistance,49.506,44.6,,percent of total billed charges,,
Pt Re-Evaluation,,97164,CPT,Facility,Inpatient,,,GP,111,94.35,31.8126,111,Medica,Medical Assistance,,,,,Included in per diem rate,
Pt Re-Evaluation,,97164,CPT,Facility,Outpatient,,,GP,111,94.35,31.8126,111,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,55.278,49.8,,percent of total billed charges,,
Pt Re-Evaluation,,97164,CPT,Facility,Inpatient,,,GP,111,94.35,31.8126,111,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Pt Re-Evaluation,,97164,CPT,Facility,Both,,,GP,111,94.35,31.8126,111,"Multiplan, Inc.","Multiplan, Inc.",104.34,94,,percent of total billed charges,,
Pt Re-Evaluation,,97164,CPT,Facility,Outpatient,,,GP,111,94.35,31.8126,111,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,95.904,86.4,,percent of total billed charges,,
Pt Re-Evaluation,,97164,CPT,Facility,Inpatient,,,GP,111,94.35,31.8126,111,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Pt Re-Evaluation,,97164,CPT,Facility,Both,,,GP,111,94.35,31.8126,111,"Preferred One Administrative Services, INC.",PPO,109.446,98.6,,percent of total billed charges,,
Pt Re-Evaluation,,97164,CPT,Facility,Outpatient,,,GP,111,94.35,31.8126,111,PrimeWest Health,Minnesota Senior Health Options (MSHO),57.1095,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Pt Re-Evaluation,,97164,CPT,Facility,Inpatient,,,GP,111,94.35,31.8126,111,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Pt Re-Evaluation,,97164,CPT,Facility,Outpatient,,,GP,111,94.35,31.8126,111,PrimeWest Health,MinnesotaCare,57.0096,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Pt Re-Evaluation,,97164,CPT,Facility,Inpatient,,,GP,111,94.35,31.8126,111,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Pt Re-Evaluation,,97164,CPT,Facility,Both,,,GP,111,94.35,31.8126,111,Sanford Health Plan,Sanford Health Plan,102.12,92,,percent of total billed charges,,
Pt Re-Evaluation,,97164,CPT,Facility,Outpatient,,,GP,111,94.35,31.8126,111,"UCare Health, Inc.",Individual & Family Plan,62.5485,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Pt Re-Evaluation,,97164,CPT,Facility,Inpatient,,,GP,111,94.35,31.8126,111,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Pt Re-Evaluation,,97164,CPT,Facility,Outpatient,,,GP,111,94.35,31.8126,111,"UCare Health, Inc.",Medical Assistance,56.0217,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Pt Re-Evaluation,,97164,CPT,Facility,Inpatient,,,GP,111,94.35,31.8126,111,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Pt Re-Evaluation,,97164,CPT,Facility,Outpatient,,,GP,111,94.35,31.8126,111,"UCare Health, Inc.",Medicare Advantage,56.0217,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Pt Re-Evaluation,,97164,CPT,Facility,Inpatient,,,GP,111,94.35,31.8126,111,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Pt Re-Evaluation,,97164,CPT,Facility,Outpatient,,,GP,111,94.35,31.8126,111,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),56.0217,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Pt Re-Evaluation,,97164,CPT,Facility,Inpatient,,,GP,111,94.35,31.8126,111,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Pt Re-Evaluation,,97164,CPT,Facility,Both,,,GP,111,94.35,31.8126,111,UnitedHealthcare,Individual & Family,104.34,94,,percent of total billed charges,,
Pt Re-Evaluation,,97164,CPT,Facility,Outpatient,,,GP,111,94.35,31.8126,111,UnitedHealthcare,Medicare Advantage,54.39,49,,percent of total billed charges,,
Pt Re-Evaluation,,97164,CPT,Facility,Inpatient,,,GP,111,94.35,31.8126,111,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Pt Re-Evaluation,,97164,CPT,Facility,Outpatient,,,GP,111,94.35,31.8126,111,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,53.28,48,,percent of total billed charges,,100% of DHS outpatient percentage
Pt Re-Evaluation,,97164,CPT,Facility,Inpatient,,,GP,111,94.35,31.8126,111,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Pt Therapeutic Activities (Func/Dynam) (15 Min),,97530,CPT,Facility,Both,,,GP,102,86.7,29.2332,102,Aetna,Commercial,93.84,92,,percent of total billed charges,,
Pt Therapeutic Activities (Func/Dynam) (15 Min),,97530,CPT,Facility,Outpatient,,,GP,102,86.7,29.2332,102,Aetna,Medicare Advantage,49.98,49,,percent of total billed charges,,
Pt Therapeutic Activities (Func/Dynam) (15 Min),,97530,CPT,Facility,Inpatient,,,GP,102,86.7,29.2332,102,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Pt Therapeutic Activities (Func/Dynam) (15 Min),,97530,CPT,Facility,Both,,,GP,102,86.7,29.2332,102,Aetna,PPO,94.86,93,,percent of total billed charges,,
Pt Therapeutic Activities (Func/Dynam) (15 Min),,97530,CPT,Facility,Both,,,GP,102,86.7,29.2332,102,America's PPO,America's PPO,97.9506,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Pt Therapeutic Activities (Func/Dynam) (15 Min),,97530,CPT,Facility,Both,,,GP,102,86.7,29.2332,102,BlueCross BlueShield Minnesota, Federal Employee Program,100.368,98.4,,percent of total billed charges,,
Pt Therapeutic Activities (Func/Dynam) (15 Min),,97530,CPT,Facility,Both,,,GP,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,102,100,,percent of total billed charges,,
Pt Therapeutic Activities (Func/Dynam) (15 Min),,97530,CPT,Facility,Both,,,GP,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,High Value Network Plan,91.8,90,,percent of total billed charges,,
Pt Therapeutic Activities (Func/Dynam) (15 Min),,97530,CPT,Facility,Outpatient,,,GP,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,Medicare Advantage,49.98,49,,percent of total billed charges,,
Pt Therapeutic Activities (Func/Dynam) (15 Min),,97530,CPT,Facility,Inpatient,,,GP,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Pt Therapeutic Activities (Func/Dynam) (15 Min),,97530,CPT,Facility,Both,,,GP,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,90.3414,88.57,,percent of total billed charges,,
Pt Therapeutic Activities (Func/Dynam) (15 Min),,97530,CPT,Facility,Both,,,GP,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,29.2332,28.66,,percent of total billed charges,,
Pt Therapeutic Activities (Func/Dynam) (15 Min),,97530,CPT,Facility,Outpatient,,,GP,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),49.98,49,,percent of total billed charges,,
Pt Therapeutic Activities (Func/Dynam) (15 Min),,97530,CPT,Facility,Inpatient,,,GP,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Pt Therapeutic Activities (Func/Dynam) (15 Min),,97530,CPT,Facility,Both,,,GP,102,86.7,29.2332,102,CorVel,Worker's Compensation,102,100,,percent of total billed charges,,
Pt Therapeutic Activities (Func/Dynam) (15 Min),,97530,CPT,Facility,Both,,,GP,102,86.7,29.2332,102,First Health Group Corporation,First Health Network,98.94,97,,percent of total billed charges,,
Pt Therapeutic Activities (Func/Dynam) (15 Min),,97530,CPT,Facility,Both,,,GP,102,86.7,29.2332,102,"Health Partners, Inc.",Commercial,96.492,94.6,,percent of total billed charges,,
Pt Therapeutic Activities (Func/Dynam) (15 Min),,97530,CPT,Facility,Outpatient,,,GP,102,86.7,29.2332,102,"Health Partners, Inc.",Medicare Advantage,49.98,49,,percent of total billed charges,,
Pt Therapeutic Activities (Func/Dynam) (15 Min),,97530,CPT,Facility,Inpatient,,,GP,102,86.7,29.2332,102,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Pt Therapeutic Activities (Func/Dynam) (15 Min),,97530,CPT,Facility,Both,,,GP,102,86.7,29.2332,102,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),61.2,60,,percent of total billed charges,,
Pt Therapeutic Activities (Func/Dynam) (15 Min),,97530,CPT,Facility,Both,,,GP,102,86.7,29.2332,102,"Health Partners, Inc.",State of Minnesota Advantage Program,83.13,81.5,,percent of total billed charges,,
Pt Therapeutic Activities (Func/Dynam) (15 Min),,97530,CPT,Facility,Both,,,GP,102,86.7,29.2332,102,"Health Partners, Inc.",State Public Programs,51,50,,percent of total billed charges,,
Pt Therapeutic Activities (Func/Dynam) (15 Min),,97530,CPT,Facility,Both,,,GP,102,86.7,29.2332,102,Humana Insurance Company,Commercial PPO,96.9,95,,percent of total billed charges,,
Pt Therapeutic Activities (Func/Dynam) (15 Min),,97530,CPT,Facility,Outpatient,,,GP,102,86.7,29.2332,102,Humana Insurance Company,Medicare PPO,49.98,49,,percent of total billed charges,,
Pt Therapeutic Activities (Func/Dynam) (15 Min),,97530,CPT,Facility,Inpatient,,,GP,102,86.7,29.2332,102,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Pt Therapeutic Activities (Func/Dynam) (15 Min),,97530,CPT,Facility,Both,,,GP,102,86.7,29.2332,102,Medica,Individual & Family,101.082,99.1,,percent of total billed charges,,
Pt Therapeutic Activities (Func/Dynam) (15 Min),,97530,CPT,Facility,Outpatient,,,GP,102,86.7,29.2332,102,Medica,Medica Advantage Solution,50.796,49.8,,percent of total billed charges,,
Pt Therapeutic Activities (Func/Dynam) (15 Min),,97530,CPT,Facility,Inpatient,,,GP,102,86.7,29.2332,102,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Pt Therapeutic Activities (Func/Dynam) (15 Min),,97530,CPT,Facility,Outpatient,,,GP,102,86.7,29.2332,102,Medica,Medical Assistance,45.492,44.6,,percent of total billed charges,,
Pt Therapeutic Activities (Func/Dynam) (15 Min),,97530,CPT,Facility,Inpatient,,,GP,102,86.7,29.2332,102,Medica,Medical Assistance,,,,,Included in per diem rate,
Pt Therapeutic Activities (Func/Dynam) (15 Min),,97530,CPT,Facility,Outpatient,,,GP,102,86.7,29.2332,102,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,50.796,49.8,,percent of total billed charges,,
Pt Therapeutic Activities (Func/Dynam) (15 Min),,97530,CPT,Facility,Inpatient,,,GP,102,86.7,29.2332,102,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Pt Therapeutic Activities (Func/Dynam) (15 Min),,97530,CPT,Facility,Both,,,GP,102,86.7,29.2332,102,"Multiplan, Inc.","Multiplan, Inc.",95.88,94,,percent of total billed charges,,
Pt Therapeutic Activities (Func/Dynam) (15 Min),,97530,CPT,Facility,Outpatient,,,GP,102,86.7,29.2332,102,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,88.128,86.4,,percent of total billed charges,,
Pt Therapeutic Activities (Func/Dynam) (15 Min),,97530,CPT,Facility,Inpatient,,,GP,102,86.7,29.2332,102,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Pt Therapeutic Activities (Func/Dynam) (15 Min),,97530,CPT,Facility,Both,,,GP,102,86.7,29.2332,102,"Preferred One Administrative Services, INC.",PPO,100.572,98.6,,percent of total billed charges,,
Pt Therapeutic Activities (Func/Dynam) (15 Min),,97530,CPT,Facility,Outpatient,,,GP,102,86.7,29.2332,102,PrimeWest Health,Minnesota Senior Health Options (MSHO),52.479,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Pt Therapeutic Activities (Func/Dynam) (15 Min),,97530,CPT,Facility,Inpatient,,,GP,102,86.7,29.2332,102,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Pt Therapeutic Activities (Func/Dynam) (15 Min),,97530,CPT,Facility,Outpatient,,,GP,102,86.7,29.2332,102,PrimeWest Health,MinnesotaCare,52.3872,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Pt Therapeutic Activities (Func/Dynam) (15 Min),,97530,CPT,Facility,Inpatient,,,GP,102,86.7,29.2332,102,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Pt Therapeutic Activities (Func/Dynam) (15 Min),,97530,CPT,Facility,Both,,,GP,102,86.7,29.2332,102,Sanford Health Plan,Sanford Health Plan,93.84,92,,percent of total billed charges,,
Pt Therapeutic Activities (Func/Dynam) (15 Min),,97530,CPT,Facility,Outpatient,,,GP,102,86.7,29.2332,102,"UCare Health, Inc.",Individual & Family Plan,57.477,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Pt Therapeutic Activities (Func/Dynam) (15 Min),,97530,CPT,Facility,Inpatient,,,GP,102,86.7,29.2332,102,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Pt Therapeutic Activities (Func/Dynam) (15 Min),,97530,CPT,Facility,Outpatient,,,GP,102,86.7,29.2332,102,"UCare Health, Inc.",Medical Assistance,51.4794,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Pt Therapeutic Activities (Func/Dynam) (15 Min),,97530,CPT,Facility,Inpatient,,,GP,102,86.7,29.2332,102,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Pt Therapeutic Activities (Func/Dynam) (15 Min),,97530,CPT,Facility,Outpatient,,,GP,102,86.7,29.2332,102,"UCare Health, Inc.",Medicare Advantage,51.4794,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Pt Therapeutic Activities (Func/Dynam) (15 Min),,97530,CPT,Facility,Inpatient,,,GP,102,86.7,29.2332,102,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Pt Therapeutic Activities (Func/Dynam) (15 Min),,97530,CPT,Facility,Outpatient,,,GP,102,86.7,29.2332,102,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),51.4794,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Pt Therapeutic Activities (Func/Dynam) (15 Min),,97530,CPT,Facility,Inpatient,,,GP,102,86.7,29.2332,102,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Pt Therapeutic Activities (Func/Dynam) (15 Min),,97530,CPT,Facility,Both,,,GP,102,86.7,29.2332,102,UnitedHealthcare,Individual & Family,95.88,94,,percent of total billed charges,,
Pt Therapeutic Activities (Func/Dynam) (15 Min),,97530,CPT,Facility,Outpatient,,,GP,102,86.7,29.2332,102,UnitedHealthcare,Medicare Advantage,49.98,49,,percent of total billed charges,,
Pt Therapeutic Activities (Func/Dynam) (15 Min),,97530,CPT,Facility,Inpatient,,,GP,102,86.7,29.2332,102,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Pt Therapeutic Activities (Func/Dynam) (15 Min),,97530,CPT,Facility,Outpatient,,,GP,102,86.7,29.2332,102,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,48.96,48,,percent of total billed charges,,100% of DHS outpatient percentage
Pt Therapeutic Activities (Func/Dynam) (15 Min),,97530,CPT,Facility,Inpatient,,,GP,102,86.7,29.2332,102,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Pt Self Care/Adl/Home Mgmt Training (15 Min),,97535,CPT,Facility,Both,,,GP,82,69.7,23.5012,82,Aetna,Commercial,75.44,92,,percent of total billed charges,,
Pt Self Care/Adl/Home Mgmt Training (15 Min),,97535,CPT,Facility,Outpatient,,,GP,82,69.7,23.5012,82,Aetna,Medicare Advantage,40.18,49,,percent of total billed charges,,
Pt Self Care/Adl/Home Mgmt Training (15 Min),,97535,CPT,Facility,Inpatient,,,GP,82,69.7,23.5012,82,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Pt Self Care/Adl/Home Mgmt Training (15 Min),,97535,CPT,Facility,Both,,,GP,82,69.7,23.5012,82,Aetna,PPO,76.26,93,,percent of total billed charges,,
Pt Self Care/Adl/Home Mgmt Training (15 Min),,97535,CPT,Facility,Both,,,GP,82,69.7,23.5012,82,America's PPO,America's PPO,78.7446,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Pt Self Care/Adl/Home Mgmt Training (15 Min),,97535,CPT,Facility,Both,,,GP,82,69.7,23.5012,82,BlueCross BlueShield Minnesota, Federal Employee Program,80.688,98.4,,percent of total billed charges,,
Pt Self Care/Adl/Home Mgmt Training (15 Min),,97535,CPT,Facility,Both,,,GP,82,69.7,23.5012,82,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,82,100,,percent of total billed charges,,
Pt Self Care/Adl/Home Mgmt Training (15 Min),,97535,CPT,Facility,Both,,,GP,82,69.7,23.5012,82,BlueCross BlueShield Minnesota,High Value Network Plan,73.8,90,,percent of total billed charges,,
Pt Self Care/Adl/Home Mgmt Training (15 Min),,97535,CPT,Facility,Outpatient,,,GP,82,69.7,23.5012,82,BlueCross BlueShield Minnesota,Medicare Advantage,40.18,49,,percent of total billed charges,,
Pt Self Care/Adl/Home Mgmt Training (15 Min),,97535,CPT,Facility,Inpatient,,,GP,82,69.7,23.5012,82,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Pt Self Care/Adl/Home Mgmt Training (15 Min),,97535,CPT,Facility,Both,,,GP,82,69.7,23.5012,82,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,72.6274,88.57,,percent of total billed charges,,
Pt Self Care/Adl/Home Mgmt Training (15 Min),,97535,CPT,Facility,Both,,,GP,82,69.7,23.5012,82,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,23.5012,28.66,,percent of total billed charges,,
Pt Self Care/Adl/Home Mgmt Training (15 Min),,97535,CPT,Facility,Outpatient,,,GP,82,69.7,23.5012,82,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),40.18,49,,percent of total billed charges,,
Pt Self Care/Adl/Home Mgmt Training (15 Min),,97535,CPT,Facility,Inpatient,,,GP,82,69.7,23.5012,82,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Pt Self Care/Adl/Home Mgmt Training (15 Min),,97535,CPT,Facility,Both,,,GP,82,69.7,23.5012,82,CorVel,Worker's Compensation,82,100,,percent of total billed charges,,
Pt Self Care/Adl/Home Mgmt Training (15 Min),,97535,CPT,Facility,Both,,,GP,82,69.7,23.5012,82,First Health Group Corporation,First Health Network,79.54,97,,percent of total billed charges,,
Pt Self Care/Adl/Home Mgmt Training (15 Min),,97535,CPT,Facility,Both,,,GP,82,69.7,23.5012,82,"Health Partners, Inc.",Commercial,77.572,94.6,,percent of total billed charges,,
Pt Self Care/Adl/Home Mgmt Training (15 Min),,97535,CPT,Facility,Outpatient,,,GP,82,69.7,23.5012,82,"Health Partners, Inc.",Medicare Advantage,40.18,49,,percent of total billed charges,,
Pt Self Care/Adl/Home Mgmt Training (15 Min),,97535,CPT,Facility,Inpatient,,,GP,82,69.7,23.5012,82,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Pt Self Care/Adl/Home Mgmt Training (15 Min),,97535,CPT,Facility,Both,,,GP,82,69.7,23.5012,82,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),49.2,60,,percent of total billed charges,,
Pt Self Care/Adl/Home Mgmt Training (15 Min),,97535,CPT,Facility,Both,,,GP,82,69.7,23.5012,82,"Health Partners, Inc.",State of Minnesota Advantage Program,66.83,81.5,,percent of total billed charges,,
Pt Self Care/Adl/Home Mgmt Training (15 Min),,97535,CPT,Facility,Both,,,GP,82,69.7,23.5012,82,"Health Partners, Inc.",State Public Programs,41,50,,percent of total billed charges,,
Pt Self Care/Adl/Home Mgmt Training (15 Min),,97535,CPT,Facility,Both,,,GP,82,69.7,23.5012,82,Humana Insurance Company,Commercial PPO,77.9,95,,percent of total billed charges,,
Pt Self Care/Adl/Home Mgmt Training (15 Min),,97535,CPT,Facility,Outpatient,,,GP,82,69.7,23.5012,82,Humana Insurance Company,Medicare PPO,40.18,49,,percent of total billed charges,,
Pt Self Care/Adl/Home Mgmt Training (15 Min),,97535,CPT,Facility,Inpatient,,,GP,82,69.7,23.5012,82,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Pt Self Care/Adl/Home Mgmt Training (15 Min),,97535,CPT,Facility,Both,,,GP,82,69.7,23.5012,82,Medica,Individual & Family,81.262,99.1,,percent of total billed charges,,
Pt Self Care/Adl/Home Mgmt Training (15 Min),,97535,CPT,Facility,Outpatient,,,GP,82,69.7,23.5012,82,Medica,Medica Advantage Solution,40.836,49.8,,percent of total billed charges,,
Pt Self Care/Adl/Home Mgmt Training (15 Min),,97535,CPT,Facility,Inpatient,,,GP,82,69.7,23.5012,82,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Pt Self Care/Adl/Home Mgmt Training (15 Min),,97535,CPT,Facility,Outpatient,,,GP,82,69.7,23.5012,82,Medica,Medical Assistance,36.572,44.6,,percent of total billed charges,,
Pt Self Care/Adl/Home Mgmt Training (15 Min),,97535,CPT,Facility,Inpatient,,,GP,82,69.7,23.5012,82,Medica,Medical Assistance,,,,,Included in per diem rate,
Pt Self Care/Adl/Home Mgmt Training (15 Min),,97535,CPT,Facility,Outpatient,,,GP,82,69.7,23.5012,82,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,40.836,49.8,,percent of total billed charges,,
Pt Self Care/Adl/Home Mgmt Training (15 Min),,97535,CPT,Facility,Inpatient,,,GP,82,69.7,23.5012,82,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Pt Self Care/Adl/Home Mgmt Training (15 Min),,97535,CPT,Facility,Both,,,GP,82,69.7,23.5012,82,"Multiplan, Inc.","Multiplan, Inc.",77.08,94,,percent of total billed charges,,
Pt Self Care/Adl/Home Mgmt Training (15 Min),,97535,CPT,Facility,Outpatient,,,GP,82,69.7,23.5012,82,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,70.848,86.4,,percent of total billed charges,,
Pt Self Care/Adl/Home Mgmt Training (15 Min),,97535,CPT,Facility,Inpatient,,,GP,82,69.7,23.5012,82,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Pt Self Care/Adl/Home Mgmt Training (15 Min),,97535,CPT,Facility,Both,,,GP,82,69.7,23.5012,82,"Preferred One Administrative Services, INC.",PPO,80.852,98.6,,percent of total billed charges,,
Pt Self Care/Adl/Home Mgmt Training (15 Min),,97535,CPT,Facility,Outpatient,,,GP,82,69.7,23.5012,82,PrimeWest Health,Minnesota Senior Health Options (MSHO),42.189,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Pt Self Care/Adl/Home Mgmt Training (15 Min),,97535,CPT,Facility,Inpatient,,,GP,82,69.7,23.5012,82,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Pt Self Care/Adl/Home Mgmt Training (15 Min),,97535,CPT,Facility,Outpatient,,,GP,82,69.7,23.5012,82,PrimeWest Health,MinnesotaCare,42.1152,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Pt Self Care/Adl/Home Mgmt Training (15 Min),,97535,CPT,Facility,Inpatient,,,GP,82,69.7,23.5012,82,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Pt Self Care/Adl/Home Mgmt Training (15 Min),,97535,CPT,Facility,Both,,,GP,82,69.7,23.5012,82,Sanford Health Plan,Sanford Health Plan,75.44,92,,percent of total billed charges,,
Pt Self Care/Adl/Home Mgmt Training (15 Min),,97535,CPT,Facility,Outpatient,,,GP,82,69.7,23.5012,82,"UCare Health, Inc.",Individual & Family Plan,46.207,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Pt Self Care/Adl/Home Mgmt Training (15 Min),,97535,CPT,Facility,Inpatient,,,GP,82,69.7,23.5012,82,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Pt Self Care/Adl/Home Mgmt Training (15 Min),,97535,CPT,Facility,Outpatient,,,GP,82,69.7,23.5012,82,"UCare Health, Inc.",Medical Assistance,41.3854,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Pt Self Care/Adl/Home Mgmt Training (15 Min),,97535,CPT,Facility,Inpatient,,,GP,82,69.7,23.5012,82,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Pt Self Care/Adl/Home Mgmt Training (15 Min),,97535,CPT,Facility,Outpatient,,,GP,82,69.7,23.5012,82,"UCare Health, Inc.",Medicare Advantage,41.3854,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Pt Self Care/Adl/Home Mgmt Training (15 Min),,97535,CPT,Facility,Inpatient,,,GP,82,69.7,23.5012,82,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Pt Self Care/Adl/Home Mgmt Training (15 Min),,97535,CPT,Facility,Outpatient,,,GP,82,69.7,23.5012,82,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),41.3854,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Pt Self Care/Adl/Home Mgmt Training (15 Min),,97535,CPT,Facility,Inpatient,,,GP,82,69.7,23.5012,82,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Pt Self Care/Adl/Home Mgmt Training (15 Min),,97535,CPT,Facility,Both,,,GP,82,69.7,23.5012,82,UnitedHealthcare,Individual & Family,77.08,94,,percent of total billed charges,,
Pt Self Care/Adl/Home Mgmt Training (15 Min),,97535,CPT,Facility,Outpatient,,,GP,82,69.7,23.5012,82,UnitedHealthcare,Medicare Advantage,40.18,49,,percent of total billed charges,,
Pt Self Care/Adl/Home Mgmt Training (15 Min),,97535,CPT,Facility,Inpatient,,,GP,82,69.7,23.5012,82,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Pt Self Care/Adl/Home Mgmt Training (15 Min),,97535,CPT,Facility,Outpatient,,,GP,82,69.7,23.5012,82,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,39.36,48,,percent of total billed charges,,100% of DHS outpatient percentage
Pt Self Care/Adl/Home Mgmt Training (15 Min),,97535,CPT,Facility,Inpatient,,,GP,82,69.7,23.5012,82,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Pt Community Work Reintegration (15 Min),,97537,CPT,Facility,Both,,,GP,69,58.65,19.7754,69,Aetna,Commercial,63.48,92,,percent of total billed charges,,
Pt Community Work Reintegration (15 Min),,97537,CPT,Facility,Outpatient,,,GP,69,58.65,19.7754,69,Aetna,Medicare Advantage,33.81,49,,percent of total billed charges,,
Pt Community Work Reintegration (15 Min),,97537,CPT,Facility,Inpatient,,,GP,69,58.65,19.7754,69,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Pt Community Work Reintegration (15 Min),,97537,CPT,Facility,Both,,,GP,69,58.65,19.7754,69,Aetna,PPO,64.17,93,,percent of total billed charges,,
Pt Community Work Reintegration (15 Min),,97537,CPT,Facility,Both,,,GP,69,58.65,19.7754,69,America's PPO,America's PPO,66.2607,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Pt Community Work Reintegration (15 Min),,97537,CPT,Facility,Both,,,GP,69,58.65,19.7754,69,BlueCross BlueShield Minnesota, Federal Employee Program,67.896,98.4,,percent of total billed charges,,
Pt Community Work Reintegration (15 Min),,97537,CPT,Facility,Both,,,GP,69,58.65,19.7754,69,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,69,100,,percent of total billed charges,,
Pt Community Work Reintegration (15 Min),,97537,CPT,Facility,Both,,,GP,69,58.65,19.7754,69,BlueCross BlueShield Minnesota,High Value Network Plan,62.1,90,,percent of total billed charges,,
Pt Community Work Reintegration (15 Min),,97537,CPT,Facility,Outpatient,,,GP,69,58.65,19.7754,69,BlueCross BlueShield Minnesota,Medicare Advantage,33.81,49,,percent of total billed charges,,
Pt Community Work Reintegration (15 Min),,97537,CPT,Facility,Inpatient,,,GP,69,58.65,19.7754,69,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Pt Community Work Reintegration (15 Min),,97537,CPT,Facility,Both,,,GP,69,58.65,19.7754,69,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,61.1133,88.57,,percent of total billed charges,,
Pt Community Work Reintegration (15 Min),,97537,CPT,Facility,Both,,,GP,69,58.65,19.7754,69,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,19.7754,28.66,,percent of total billed charges,,
Pt Community Work Reintegration (15 Min),,97537,CPT,Facility,Outpatient,,,GP,69,58.65,19.7754,69,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),33.81,49,,percent of total billed charges,,
Pt Community Work Reintegration (15 Min),,97537,CPT,Facility,Inpatient,,,GP,69,58.65,19.7754,69,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Pt Community Work Reintegration (15 Min),,97537,CPT,Facility,Both,,,GP,69,58.65,19.7754,69,CorVel,Worker's Compensation,69,100,,percent of total billed charges,,
Pt Community Work Reintegration (15 Min),,97537,CPT,Facility,Both,,,GP,69,58.65,19.7754,69,First Health Group Corporation,First Health Network,66.93,97,,percent of total billed charges,,
Pt Community Work Reintegration (15 Min),,97537,CPT,Facility,Both,,,GP,69,58.65,19.7754,69,"Health Partners, Inc.",Commercial,65.274,94.6,,percent of total billed charges,,
Pt Community Work Reintegration (15 Min),,97537,CPT,Facility,Outpatient,,,GP,69,58.65,19.7754,69,"Health Partners, Inc.",Medicare Advantage,33.81,49,,percent of total billed charges,,
Pt Community Work Reintegration (15 Min),,97537,CPT,Facility,Inpatient,,,GP,69,58.65,19.7754,69,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Pt Community Work Reintegration (15 Min),,97537,CPT,Facility,Both,,,GP,69,58.65,19.7754,69,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),41.4,60,,percent of total billed charges,,
Pt Community Work Reintegration (15 Min),,97537,CPT,Facility,Both,,,GP,69,58.65,19.7754,69,"Health Partners, Inc.",State of Minnesota Advantage Program,56.235,81.5,,percent of total billed charges,,
Pt Community Work Reintegration (15 Min),,97537,CPT,Facility,Both,,,GP,69,58.65,19.7754,69,"Health Partners, Inc.",State Public Programs,34.5,50,,percent of total billed charges,,
Pt Community Work Reintegration (15 Min),,97537,CPT,Facility,Both,,,GP,69,58.65,19.7754,69,Humana Insurance Company,Commercial PPO,65.55,95,,percent of total billed charges,,
Pt Community Work Reintegration (15 Min),,97537,CPT,Facility,Outpatient,,,GP,69,58.65,19.7754,69,Humana Insurance Company,Medicare PPO,33.81,49,,percent of total billed charges,,
Pt Community Work Reintegration (15 Min),,97537,CPT,Facility,Inpatient,,,GP,69,58.65,19.7754,69,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Pt Community Work Reintegration (15 Min),,97537,CPT,Facility,Both,,,GP,69,58.65,19.7754,69,Medica,Individual & Family,68.379,99.1,,percent of total billed charges,,
Pt Community Work Reintegration (15 Min),,97537,CPT,Facility,Outpatient,,,GP,69,58.65,19.7754,69,Medica,Medica Advantage Solution,34.362,49.8,,percent of total billed charges,,
Pt Community Work Reintegration (15 Min),,97537,CPT,Facility,Inpatient,,,GP,69,58.65,19.7754,69,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Pt Community Work Reintegration (15 Min),,97537,CPT,Facility,Outpatient,,,GP,69,58.65,19.7754,69,Medica,Medical Assistance,30.774,44.6,,percent of total billed charges,,
Pt Community Work Reintegration (15 Min),,97537,CPT,Facility,Inpatient,,,GP,69,58.65,19.7754,69,Medica,Medical Assistance,,,,,Included in per diem rate,
Pt Community Work Reintegration (15 Min),,97537,CPT,Facility,Outpatient,,,GP,69,58.65,19.7754,69,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,34.362,49.8,,percent of total billed charges,,
Pt Community Work Reintegration (15 Min),,97537,CPT,Facility,Inpatient,,,GP,69,58.65,19.7754,69,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Pt Community Work Reintegration (15 Min),,97537,CPT,Facility,Both,,,GP,69,58.65,19.7754,69,"Multiplan, Inc.","Multiplan, Inc.",64.86,94,,percent of total billed charges,,
Pt Community Work Reintegration (15 Min),,97537,CPT,Facility,Outpatient,,,GP,69,58.65,19.7754,69,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,59.616,86.4,,percent of total billed charges,,
Pt Community Work Reintegration (15 Min),,97537,CPT,Facility,Inpatient,,,GP,69,58.65,19.7754,69,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Pt Community Work Reintegration (15 Min),,97537,CPT,Facility,Both,,,GP,69,58.65,19.7754,69,"Preferred One Administrative Services, INC.",PPO,68.034,98.6,,percent of total billed charges,,
Pt Community Work Reintegration (15 Min),,97537,CPT,Facility,Outpatient,,,GP,69,58.65,19.7754,69,PrimeWest Health,Minnesota Senior Health Options (MSHO),35.5005,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Pt Community Work Reintegration (15 Min),,97537,CPT,Facility,Inpatient,,,GP,69,58.65,19.7754,69,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Pt Community Work Reintegration (15 Min),,97537,CPT,Facility,Outpatient,,,GP,69,58.65,19.7754,69,PrimeWest Health,MinnesotaCare,35.4384,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Pt Community Work Reintegration (15 Min),,97537,CPT,Facility,Inpatient,,,GP,69,58.65,19.7754,69,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Pt Community Work Reintegration (15 Min),,97537,CPT,Facility,Both,,,GP,69,58.65,19.7754,69,Sanford Health Plan,Sanford Health Plan,63.48,92,,percent of total billed charges,,
Pt Community Work Reintegration (15 Min),,97537,CPT,Facility,Outpatient,,,GP,69,58.65,19.7754,69,"UCare Health, Inc.",Individual & Family Plan,38.8815,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Pt Community Work Reintegration (15 Min),,97537,CPT,Facility,Inpatient,,,GP,69,58.65,19.7754,69,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Pt Community Work Reintegration (15 Min),,97537,CPT,Facility,Outpatient,,,GP,69,58.65,19.7754,69,"UCare Health, Inc.",Medical Assistance,34.8243,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Pt Community Work Reintegration (15 Min),,97537,CPT,Facility,Inpatient,,,GP,69,58.65,19.7754,69,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Pt Community Work Reintegration (15 Min),,97537,CPT,Facility,Outpatient,,,GP,69,58.65,19.7754,69,"UCare Health, Inc.",Medicare Advantage,34.8243,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Pt Community Work Reintegration (15 Min),,97537,CPT,Facility,Inpatient,,,GP,69,58.65,19.7754,69,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Pt Community Work Reintegration (15 Min),,97537,CPT,Facility,Outpatient,,,GP,69,58.65,19.7754,69,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),34.8243,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Pt Community Work Reintegration (15 Min),,97537,CPT,Facility,Inpatient,,,GP,69,58.65,19.7754,69,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Pt Community Work Reintegration (15 Min),,97537,CPT,Facility,Both,,,GP,69,58.65,19.7754,69,UnitedHealthcare,Individual & Family,64.86,94,,percent of total billed charges,,
Pt Community Work Reintegration (15 Min),,97537,CPT,Facility,Outpatient,,,GP,69,58.65,19.7754,69,UnitedHealthcare,Medicare Advantage,33.81,49,,percent of total billed charges,,
Pt Community Work Reintegration (15 Min),,97537,CPT,Facility,Inpatient,,,GP,69,58.65,19.7754,69,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Pt Community Work Reintegration (15 Min),,97537,CPT,Facility,Outpatient,,,GP,69,58.65,19.7754,69,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,33.12,48,,percent of total billed charges,,100% of DHS outpatient percentage
Pt Community Work Reintegration (15 Min),,97537,CPT,Facility,Inpatient,,,GP,69,58.65,19.7754,69,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Pt Job Analysis (Per 15 Min),,97537,CPT,Facility,Both,,,GP,69,58.65,19.7754,69,Aetna,Commercial,63.48,92,,percent of total billed charges,,
Pt Job Analysis (Per 15 Min),,97537,CPT,Facility,Outpatient,,,GP,69,58.65,19.7754,69,Aetna,Medicare Advantage,33.81,49,,percent of total billed charges,,
Pt Job Analysis (Per 15 Min),,97537,CPT,Facility,Inpatient,,,GP,69,58.65,19.7754,69,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Pt Job Analysis (Per 15 Min),,97537,CPT,Facility,Both,,,GP,69,58.65,19.7754,69,Aetna,PPO,64.17,93,,percent of total billed charges,,
Pt Job Analysis (Per 15 Min),,97537,CPT,Facility,Both,,,GP,69,58.65,19.7754,69,America's PPO,America's PPO,66.2607,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Pt Job Analysis (Per 15 Min),,97537,CPT,Facility,Both,,,GP,69,58.65,19.7754,69,BlueCross BlueShield Minnesota, Federal Employee Program,67.896,98.4,,percent of total billed charges,,
Pt Job Analysis (Per 15 Min),,97537,CPT,Facility,Both,,,GP,69,58.65,19.7754,69,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,69,100,,percent of total billed charges,,
Pt Job Analysis (Per 15 Min),,97537,CPT,Facility,Both,,,GP,69,58.65,19.7754,69,BlueCross BlueShield Minnesota,High Value Network Plan,62.1,90,,percent of total billed charges,,
Pt Job Analysis (Per 15 Min),,97537,CPT,Facility,Outpatient,,,GP,69,58.65,19.7754,69,BlueCross BlueShield Minnesota,Medicare Advantage,33.81,49,,percent of total billed charges,,
Pt Job Analysis (Per 15 Min),,97537,CPT,Facility,Inpatient,,,GP,69,58.65,19.7754,69,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Pt Job Analysis (Per 15 Min),,97537,CPT,Facility,Both,,,GP,69,58.65,19.7754,69,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,61.1133,88.57,,percent of total billed charges,,
Pt Job Analysis (Per 15 Min),,97537,CPT,Facility,Both,,,GP,69,58.65,19.7754,69,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,19.7754,28.66,,percent of total billed charges,,
Pt Job Analysis (Per 15 Min),,97537,CPT,Facility,Outpatient,,,GP,69,58.65,19.7754,69,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),33.81,49,,percent of total billed charges,,
Pt Job Analysis (Per 15 Min),,97537,CPT,Facility,Inpatient,,,GP,69,58.65,19.7754,69,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Pt Job Analysis (Per 15 Min),,97537,CPT,Facility,Both,,,GP,69,58.65,19.7754,69,CorVel,Worker's Compensation,69,100,,percent of total billed charges,,
Pt Job Analysis (Per 15 Min),,97537,CPT,Facility,Both,,,GP,69,58.65,19.7754,69,First Health Group Corporation,First Health Network,66.93,97,,percent of total billed charges,,
Pt Job Analysis (Per 15 Min),,97537,CPT,Facility,Both,,,GP,69,58.65,19.7754,69,"Health Partners, Inc.",Commercial,65.274,94.6,,percent of total billed charges,,
Pt Job Analysis (Per 15 Min),,97537,CPT,Facility,Outpatient,,,GP,69,58.65,19.7754,69,"Health Partners, Inc.",Medicare Advantage,33.81,49,,percent of total billed charges,,
Pt Job Analysis (Per 15 Min),,97537,CPT,Facility,Inpatient,,,GP,69,58.65,19.7754,69,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Pt Job Analysis (Per 15 Min),,97537,CPT,Facility,Both,,,GP,69,58.65,19.7754,69,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),41.4,60,,percent of total billed charges,,
Pt Job Analysis (Per 15 Min),,97537,CPT,Facility,Both,,,GP,69,58.65,19.7754,69,"Health Partners, Inc.",State of Minnesota Advantage Program,56.235,81.5,,percent of total billed charges,,
Pt Job Analysis (Per 15 Min),,97537,CPT,Facility,Both,,,GP,69,58.65,19.7754,69,"Health Partners, Inc.",State Public Programs,34.5,50,,percent of total billed charges,,
Pt Job Analysis (Per 15 Min),,97537,CPT,Facility,Both,,,GP,69,58.65,19.7754,69,Humana Insurance Company,Commercial PPO,65.55,95,,percent of total billed charges,,
Pt Job Analysis (Per 15 Min),,97537,CPT,Facility,Outpatient,,,GP,69,58.65,19.7754,69,Humana Insurance Company,Medicare PPO,33.81,49,,percent of total billed charges,,
Pt Job Analysis (Per 15 Min),,97537,CPT,Facility,Inpatient,,,GP,69,58.65,19.7754,69,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Pt Job Analysis (Per 15 Min),,97537,CPT,Facility,Both,,,GP,69,58.65,19.7754,69,Medica,Individual & Family,68.379,99.1,,percent of total billed charges,,
Pt Job Analysis (Per 15 Min),,97537,CPT,Facility,Outpatient,,,GP,69,58.65,19.7754,69,Medica,Medica Advantage Solution,34.362,49.8,,percent of total billed charges,,
Pt Job Analysis (Per 15 Min),,97537,CPT,Facility,Inpatient,,,GP,69,58.65,19.7754,69,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Pt Job Analysis (Per 15 Min),,97537,CPT,Facility,Outpatient,,,GP,69,58.65,19.7754,69,Medica,Medical Assistance,30.774,44.6,,percent of total billed charges,,
Pt Job Analysis (Per 15 Min),,97537,CPT,Facility,Inpatient,,,GP,69,58.65,19.7754,69,Medica,Medical Assistance,,,,,Included in per diem rate,
Pt Job Analysis (Per 15 Min),,97537,CPT,Facility,Outpatient,,,GP,69,58.65,19.7754,69,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,34.362,49.8,,percent of total billed charges,,
Pt Job Analysis (Per 15 Min),,97537,CPT,Facility,Inpatient,,,GP,69,58.65,19.7754,69,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Pt Job Analysis (Per 15 Min),,97537,CPT,Facility,Both,,,GP,69,58.65,19.7754,69,"Multiplan, Inc.","Multiplan, Inc.",64.86,94,,percent of total billed charges,,
Pt Job Analysis (Per 15 Min),,97537,CPT,Facility,Outpatient,,,GP,69,58.65,19.7754,69,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,59.616,86.4,,percent of total billed charges,,
Pt Job Analysis (Per 15 Min),,97537,CPT,Facility,Inpatient,,,GP,69,58.65,19.7754,69,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Pt Job Analysis (Per 15 Min),,97537,CPT,Facility,Both,,,GP,69,58.65,19.7754,69,"Preferred One Administrative Services, INC.",PPO,68.034,98.6,,percent of total billed charges,,
Pt Job Analysis (Per 15 Min),,97537,CPT,Facility,Outpatient,,,GP,69,58.65,19.7754,69,PrimeWest Health,Minnesota Senior Health Options (MSHO),35.5005,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Pt Job Analysis (Per 15 Min),,97537,CPT,Facility,Inpatient,,,GP,69,58.65,19.7754,69,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Pt Job Analysis (Per 15 Min),,97537,CPT,Facility,Outpatient,,,GP,69,58.65,19.7754,69,PrimeWest Health,MinnesotaCare,35.4384,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Pt Job Analysis (Per 15 Min),,97537,CPT,Facility,Inpatient,,,GP,69,58.65,19.7754,69,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Pt Job Analysis (Per 15 Min),,97537,CPT,Facility,Both,,,GP,69,58.65,19.7754,69,Sanford Health Plan,Sanford Health Plan,63.48,92,,percent of total billed charges,,
Pt Job Analysis (Per 15 Min),,97537,CPT,Facility,Outpatient,,,GP,69,58.65,19.7754,69,"UCare Health, Inc.",Individual & Family Plan,38.8815,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Pt Job Analysis (Per 15 Min),,97537,CPT,Facility,Inpatient,,,GP,69,58.65,19.7754,69,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Pt Job Analysis (Per 15 Min),,97537,CPT,Facility,Outpatient,,,GP,69,58.65,19.7754,69,"UCare Health, Inc.",Medical Assistance,34.8243,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Pt Job Analysis (Per 15 Min),,97537,CPT,Facility,Inpatient,,,GP,69,58.65,19.7754,69,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Pt Job Analysis (Per 15 Min),,97537,CPT,Facility,Outpatient,,,GP,69,58.65,19.7754,69,"UCare Health, Inc.",Medicare Advantage,34.8243,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Pt Job Analysis (Per 15 Min),,97537,CPT,Facility,Inpatient,,,GP,69,58.65,19.7754,69,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Pt Job Analysis (Per 15 Min),,97537,CPT,Facility,Outpatient,,,GP,69,58.65,19.7754,69,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),34.8243,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Pt Job Analysis (Per 15 Min),,97537,CPT,Facility,Inpatient,,,GP,69,58.65,19.7754,69,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Pt Job Analysis (Per 15 Min),,97537,CPT,Facility,Both,,,GP,69,58.65,19.7754,69,UnitedHealthcare,Individual & Family,64.86,94,,percent of total billed charges,,
Pt Job Analysis (Per 15 Min),,97537,CPT,Facility,Outpatient,,,GP,69,58.65,19.7754,69,UnitedHealthcare,Medicare Advantage,33.81,49,,percent of total billed charges,,
Pt Job Analysis (Per 15 Min),,97537,CPT,Facility,Inpatient,,,GP,69,58.65,19.7754,69,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Pt Job Analysis (Per 15 Min),,97537,CPT,Facility,Outpatient,,,GP,69,58.65,19.7754,69,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,33.12,48,,percent of total billed charges,,100% of DHS outpatient percentage
Pt Job Analysis (Per 15 Min),,97537,CPT,Facility,Inpatient,,,GP,69,58.65,19.7754,69,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Pt Wheelchair Mgmt/Training (15 Min),,97542,CPT,Facility,Both,,,GP,77,65.45,22.0682,77,Aetna,Commercial,70.84,92,,percent of total billed charges,,
Pt Wheelchair Mgmt/Training (15 Min),,97542,CPT,Facility,Outpatient,,,GP,77,65.45,22.0682,77,Aetna,Medicare Advantage,37.73,49,,percent of total billed charges,,
Pt Wheelchair Mgmt/Training (15 Min),,97542,CPT,Facility,Inpatient,,,GP,77,65.45,22.0682,77,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Pt Wheelchair Mgmt/Training (15 Min),,97542,CPT,Facility,Both,,,GP,77,65.45,22.0682,77,Aetna,PPO,71.61,93,,percent of total billed charges,,
Pt Wheelchair Mgmt/Training (15 Min),,97542,CPT,Facility,Both,,,GP,77,65.45,22.0682,77,America's PPO,America's PPO,73.9431,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Pt Wheelchair Mgmt/Training (15 Min),,97542,CPT,Facility,Both,,,GP,77,65.45,22.0682,77,BlueCross BlueShield Minnesota, Federal Employee Program,75.768,98.4,,percent of total billed charges,,
Pt Wheelchair Mgmt/Training (15 Min),,97542,CPT,Facility,Both,,,GP,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,77,100,,percent of total billed charges,,
Pt Wheelchair Mgmt/Training (15 Min),,97542,CPT,Facility,Both,,,GP,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,High Value Network Plan,69.3,90,,percent of total billed charges,,
Pt Wheelchair Mgmt/Training (15 Min),,97542,CPT,Facility,Outpatient,,,GP,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,Medicare Advantage,37.73,49,,percent of total billed charges,,
Pt Wheelchair Mgmt/Training (15 Min),,97542,CPT,Facility,Inpatient,,,GP,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Pt Wheelchair Mgmt/Training (15 Min),,97542,CPT,Facility,Both,,,GP,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,68.1989,88.57,,percent of total billed charges,,
Pt Wheelchair Mgmt/Training (15 Min),,97542,CPT,Facility,Both,,,GP,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,22.0682,28.66,,percent of total billed charges,,
Pt Wheelchair Mgmt/Training (15 Min),,97542,CPT,Facility,Outpatient,,,GP,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),37.73,49,,percent of total billed charges,,
Pt Wheelchair Mgmt/Training (15 Min),,97542,CPT,Facility,Inpatient,,,GP,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Pt Wheelchair Mgmt/Training (15 Min),,97542,CPT,Facility,Both,,,GP,77,65.45,22.0682,77,CorVel,Worker's Compensation,77,100,,percent of total billed charges,,
Pt Wheelchair Mgmt/Training (15 Min),,97542,CPT,Facility,Both,,,GP,77,65.45,22.0682,77,First Health Group Corporation,First Health Network,74.69,97,,percent of total billed charges,,
Pt Wheelchair Mgmt/Training (15 Min),,97542,CPT,Facility,Both,,,GP,77,65.45,22.0682,77,"Health Partners, Inc.",Commercial,72.842,94.6,,percent of total billed charges,,
Pt Wheelchair Mgmt/Training (15 Min),,97542,CPT,Facility,Outpatient,,,GP,77,65.45,22.0682,77,"Health Partners, Inc.",Medicare Advantage,37.73,49,,percent of total billed charges,,
Pt Wheelchair Mgmt/Training (15 Min),,97542,CPT,Facility,Inpatient,,,GP,77,65.45,22.0682,77,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Pt Wheelchair Mgmt/Training (15 Min),,97542,CPT,Facility,Both,,,GP,77,65.45,22.0682,77,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),46.2,60,,percent of total billed charges,,
Pt Wheelchair Mgmt/Training (15 Min),,97542,CPT,Facility,Both,,,GP,77,65.45,22.0682,77,"Health Partners, Inc.",State of Minnesota Advantage Program,62.755,81.5,,percent of total billed charges,,
Pt Wheelchair Mgmt/Training (15 Min),,97542,CPT,Facility,Both,,,GP,77,65.45,22.0682,77,"Health Partners, Inc.",State Public Programs,38.5,50,,percent of total billed charges,,
Pt Wheelchair Mgmt/Training (15 Min),,97542,CPT,Facility,Both,,,GP,77,65.45,22.0682,77,Humana Insurance Company,Commercial PPO,73.15,95,,percent of total billed charges,,
Pt Wheelchair Mgmt/Training (15 Min),,97542,CPT,Facility,Outpatient,,,GP,77,65.45,22.0682,77,Humana Insurance Company,Medicare PPO,37.73,49,,percent of total billed charges,,
Pt Wheelchair Mgmt/Training (15 Min),,97542,CPT,Facility,Inpatient,,,GP,77,65.45,22.0682,77,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Pt Wheelchair Mgmt/Training (15 Min),,97542,CPT,Facility,Both,,,GP,77,65.45,22.0682,77,Medica,Individual & Family,76.307,99.1,,percent of total billed charges,,
Pt Wheelchair Mgmt/Training (15 Min),,97542,CPT,Facility,Outpatient,,,GP,77,65.45,22.0682,77,Medica,Medica Advantage Solution,38.346,49.8,,percent of total billed charges,,
Pt Wheelchair Mgmt/Training (15 Min),,97542,CPT,Facility,Inpatient,,,GP,77,65.45,22.0682,77,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Pt Wheelchair Mgmt/Training (15 Min),,97542,CPT,Facility,Outpatient,,,GP,77,65.45,22.0682,77,Medica,Medical Assistance,34.342,44.6,,percent of total billed charges,,
Pt Wheelchair Mgmt/Training (15 Min),,97542,CPT,Facility,Inpatient,,,GP,77,65.45,22.0682,77,Medica,Medical Assistance,,,,,Included in per diem rate,
Pt Wheelchair Mgmt/Training (15 Min),,97542,CPT,Facility,Outpatient,,,GP,77,65.45,22.0682,77,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,38.346,49.8,,percent of total billed charges,,
Pt Wheelchair Mgmt/Training (15 Min),,97542,CPT,Facility,Inpatient,,,GP,77,65.45,22.0682,77,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Pt Wheelchair Mgmt/Training (15 Min),,97542,CPT,Facility,Both,,,GP,77,65.45,22.0682,77,"Multiplan, Inc.","Multiplan, Inc.",72.38,94,,percent of total billed charges,,
Pt Wheelchair Mgmt/Training (15 Min),,97542,CPT,Facility,Outpatient,,,GP,77,65.45,22.0682,77,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,66.528,86.4,,percent of total billed charges,,
Pt Wheelchair Mgmt/Training (15 Min),,97542,CPT,Facility,Inpatient,,,GP,77,65.45,22.0682,77,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Pt Wheelchair Mgmt/Training (15 Min),,97542,CPT,Facility,Both,,,GP,77,65.45,22.0682,77,"Preferred One Administrative Services, INC.",PPO,75.922,98.6,,percent of total billed charges,,
Pt Wheelchair Mgmt/Training (15 Min),,97542,CPT,Facility,Outpatient,,,GP,77,65.45,22.0682,77,PrimeWest Health,Minnesota Senior Health Options (MSHO),39.6165,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Pt Wheelchair Mgmt/Training (15 Min),,97542,CPT,Facility,Inpatient,,,GP,77,65.45,22.0682,77,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Pt Wheelchair Mgmt/Training (15 Min),,97542,CPT,Facility,Outpatient,,,GP,77,65.45,22.0682,77,PrimeWest Health,MinnesotaCare,39.5472,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Pt Wheelchair Mgmt/Training (15 Min),,97542,CPT,Facility,Inpatient,,,GP,77,65.45,22.0682,77,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Pt Wheelchair Mgmt/Training (15 Min),,97542,CPT,Facility,Both,,,GP,77,65.45,22.0682,77,Sanford Health Plan,Sanford Health Plan,70.84,92,,percent of total billed charges,,
Pt Wheelchair Mgmt/Training (15 Min),,97542,CPT,Facility,Outpatient,,,GP,77,65.45,22.0682,77,"UCare Health, Inc.",Individual & Family Plan,43.3895,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Pt Wheelchair Mgmt/Training (15 Min),,97542,CPT,Facility,Inpatient,,,GP,77,65.45,22.0682,77,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Pt Wheelchair Mgmt/Training (15 Min),,97542,CPT,Facility,Outpatient,,,GP,77,65.45,22.0682,77,"UCare Health, Inc.",Medical Assistance,38.8619,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Pt Wheelchair Mgmt/Training (15 Min),,97542,CPT,Facility,Inpatient,,,GP,77,65.45,22.0682,77,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Pt Wheelchair Mgmt/Training (15 Min),,97542,CPT,Facility,Outpatient,,,GP,77,65.45,22.0682,77,"UCare Health, Inc.",Medicare Advantage,38.8619,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Pt Wheelchair Mgmt/Training (15 Min),,97542,CPT,Facility,Inpatient,,,GP,77,65.45,22.0682,77,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Pt Wheelchair Mgmt/Training (15 Min),,97542,CPT,Facility,Outpatient,,,GP,77,65.45,22.0682,77,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),38.8619,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Pt Wheelchair Mgmt/Training (15 Min),,97542,CPT,Facility,Inpatient,,,GP,77,65.45,22.0682,77,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Pt Wheelchair Mgmt/Training (15 Min),,97542,CPT,Facility,Both,,,GP,77,65.45,22.0682,77,UnitedHealthcare,Individual & Family,72.38,94,,percent of total billed charges,,
Pt Wheelchair Mgmt/Training (15 Min),,97542,CPT,Facility,Outpatient,,,GP,77,65.45,22.0682,77,UnitedHealthcare,Medicare Advantage,37.73,49,,percent of total billed charges,,
Pt Wheelchair Mgmt/Training (15 Min),,97542,CPT,Facility,Inpatient,,,GP,77,65.45,22.0682,77,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Pt Wheelchair Mgmt/Training (15 Min),,97542,CPT,Facility,Outpatient,,,GP,77,65.45,22.0682,77,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,36.96,48,,percent of total billed charges,,100% of DHS outpatient percentage
Pt Wheelchair Mgmt/Training (15 Min),,97542,CPT,Facility,Inpatient,,,GP,77,65.45,22.0682,77,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Pt Work Hard/Conditioning (Initial 2 Hours),,97545,CPT,Facility,Both,,,GP,296,251.6,84.8336,296,Aetna,Commercial,272.32,92,,percent of total billed charges,,
Pt Work Hard/Conditioning (Initial 2 Hours),,97545,CPT,Facility,Outpatient,,,GP,296,251.6,84.8336,296,Aetna,Medicare Advantage,145.04,49,,percent of total billed charges,,
Pt Work Hard/Conditioning (Initial 2 Hours),,97545,CPT,Facility,Inpatient,,,GP,296,251.6,84.8336,296,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Pt Work Hard/Conditioning (Initial 2 Hours),,97545,CPT,Facility,Both,,,GP,296,251.6,84.8336,296,Aetna,PPO,275.28,93,,percent of total billed charges,,
Pt Work Hard/Conditioning (Initial 2 Hours),,97545,CPT,Facility,Both,,,GP,296,251.6,84.8336,296,America's PPO,America's PPO,284.2488,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Pt Work Hard/Conditioning (Initial 2 Hours),,97545,CPT,Facility,Both,,,GP,296,251.6,84.8336,296,BlueCross BlueShield Minnesota, Federal Employee Program,291.264,98.4,,percent of total billed charges,,
Pt Work Hard/Conditioning (Initial 2 Hours),,97545,CPT,Facility,Both,,,GP,296,251.6,84.8336,296,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,296,100,,percent of total billed charges,,
Pt Work Hard/Conditioning (Initial 2 Hours),,97545,CPT,Facility,Both,,,GP,296,251.6,84.8336,296,BlueCross BlueShield Minnesota,High Value Network Plan,266.4,90,,percent of total billed charges,,
Pt Work Hard/Conditioning (Initial 2 Hours),,97545,CPT,Facility,Outpatient,,,GP,296,251.6,84.8336,296,BlueCross BlueShield Minnesota,Medicare Advantage,145.04,49,,percent of total billed charges,,
Pt Work Hard/Conditioning (Initial 2 Hours),,97545,CPT,Facility,Inpatient,,,GP,296,251.6,84.8336,296,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Pt Work Hard/Conditioning (Initial 2 Hours),,97545,CPT,Facility,Both,,,GP,296,251.6,84.8336,296,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,262.1672,88.57,,percent of total billed charges,,
Pt Work Hard/Conditioning (Initial 2 Hours),,97545,CPT,Facility,Both,,,GP,296,251.6,84.8336,296,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,84.8336,28.66,,percent of total billed charges,,
Pt Work Hard/Conditioning (Initial 2 Hours),,97545,CPT,Facility,Outpatient,,,GP,296,251.6,84.8336,296,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),145.04,49,,percent of total billed charges,,
Pt Work Hard/Conditioning (Initial 2 Hours),,97545,CPT,Facility,Inpatient,,,GP,296,251.6,84.8336,296,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Pt Work Hard/Conditioning (Initial 2 Hours),,97545,CPT,Facility,Both,,,GP,296,251.6,84.8336,296,CorVel,Worker's Compensation,296,100,,percent of total billed charges,,
Pt Work Hard/Conditioning (Initial 2 Hours),,97545,CPT,Facility,Both,,,GP,296,251.6,84.8336,296,First Health Group Corporation,First Health Network,287.12,97,,percent of total billed charges,,
Pt Work Hard/Conditioning (Initial 2 Hours),,97545,CPT,Facility,Both,,,GP,296,251.6,84.8336,296,"Health Partners, Inc.",Commercial,280.016,94.6,,percent of total billed charges,,
Pt Work Hard/Conditioning (Initial 2 Hours),,97545,CPT,Facility,Outpatient,,,GP,296,251.6,84.8336,296,"Health Partners, Inc.",Medicare Advantage,145.04,49,,percent of total billed charges,,
Pt Work Hard/Conditioning (Initial 2 Hours),,97545,CPT,Facility,Inpatient,,,GP,296,251.6,84.8336,296,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Pt Work Hard/Conditioning (Initial 2 Hours),,97545,CPT,Facility,Both,,,GP,296,251.6,84.8336,296,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),177.6,60,,percent of total billed charges,,
Pt Work Hard/Conditioning (Initial 2 Hours),,97545,CPT,Facility,Both,,,GP,296,251.6,84.8336,296,"Health Partners, Inc.",State of Minnesota Advantage Program,241.24,81.5,,percent of total billed charges,,
Pt Work Hard/Conditioning (Initial 2 Hours),,97545,CPT,Facility,Both,,,GP,296,251.6,84.8336,296,"Health Partners, Inc.",State Public Programs,148,50,,percent of total billed charges,,
Pt Work Hard/Conditioning (Initial 2 Hours),,97545,CPT,Facility,Both,,,GP,296,251.6,84.8336,296,Humana Insurance Company,Commercial PPO,281.2,95,,percent of total billed charges,,
Pt Work Hard/Conditioning (Initial 2 Hours),,97545,CPT,Facility,Outpatient,,,GP,296,251.6,84.8336,296,Humana Insurance Company,Medicare PPO,145.04,49,,percent of total billed charges,,
Pt Work Hard/Conditioning (Initial 2 Hours),,97545,CPT,Facility,Inpatient,,,GP,296,251.6,84.8336,296,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Pt Work Hard/Conditioning (Initial 2 Hours),,97545,CPT,Facility,Both,,,GP,296,251.6,84.8336,296,Medica,Individual & Family,293.336,99.1,,percent of total billed charges,,
Pt Work Hard/Conditioning (Initial 2 Hours),,97545,CPT,Facility,Outpatient,,,GP,296,251.6,84.8336,296,Medica,Medica Advantage Solution,147.408,49.8,,percent of total billed charges,,
Pt Work Hard/Conditioning (Initial 2 Hours),,97545,CPT,Facility,Inpatient,,,GP,296,251.6,84.8336,296,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Pt Work Hard/Conditioning (Initial 2 Hours),,97545,CPT,Facility,Outpatient,,,GP,296,251.6,84.8336,296,Medica,Medical Assistance,132.016,44.6,,percent of total billed charges,,
Pt Work Hard/Conditioning (Initial 2 Hours),,97545,CPT,Facility,Inpatient,,,GP,296,251.6,84.8336,296,Medica,Medical Assistance,,,,,Included in per diem rate,
Pt Work Hard/Conditioning (Initial 2 Hours),,97545,CPT,Facility,Outpatient,,,GP,296,251.6,84.8336,296,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,147.408,49.8,,percent of total billed charges,,
Pt Work Hard/Conditioning (Initial 2 Hours),,97545,CPT,Facility,Inpatient,,,GP,296,251.6,84.8336,296,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Pt Work Hard/Conditioning (Initial 2 Hours),,97545,CPT,Facility,Both,,,GP,296,251.6,84.8336,296,"Multiplan, Inc.","Multiplan, Inc.",278.24,94,,percent of total billed charges,,
Pt Work Hard/Conditioning (Initial 2 Hours),,97545,CPT,Facility,Outpatient,,,GP,296,251.6,84.8336,296,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,255.744,86.4,,percent of total billed charges,,
Pt Work Hard/Conditioning (Initial 2 Hours),,97545,CPT,Facility,Inpatient,,,GP,296,251.6,84.8336,296,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Pt Work Hard/Conditioning (Initial 2 Hours),,97545,CPT,Facility,Both,,,GP,296,251.6,84.8336,296,"Preferred One Administrative Services, INC.",PPO,291.856,98.6,,percent of total billed charges,,
Pt Work Hard/Conditioning (Initial 2 Hours),,97545,CPT,Facility,Outpatient,,,GP,296,251.6,84.8336,296,PrimeWest Health,Minnesota Senior Health Options (MSHO),152.292,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Pt Work Hard/Conditioning (Initial 2 Hours),,97545,CPT,Facility,Inpatient,,,GP,296,251.6,84.8336,296,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Pt Work Hard/Conditioning (Initial 2 Hours),,97545,CPT,Facility,Outpatient,,,GP,296,251.6,84.8336,296,PrimeWest Health,MinnesotaCare,152.0256,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Pt Work Hard/Conditioning (Initial 2 Hours),,97545,CPT,Facility,Inpatient,,,GP,296,251.6,84.8336,296,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Pt Work Hard/Conditioning (Initial 2 Hours),,97545,CPT,Facility,Both,,,GP,296,251.6,84.8336,296,Sanford Health Plan,Sanford Health Plan,272.32,92,,percent of total billed charges,,
Pt Work Hard/Conditioning (Initial 2 Hours),,97545,CPT,Facility,Outpatient,,,GP,296,251.6,84.8336,296,"UCare Health, Inc.",Individual & Family Plan,166.796,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Pt Work Hard/Conditioning (Initial 2 Hours),,97545,CPT,Facility,Inpatient,,,GP,296,251.6,84.8336,296,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Pt Work Hard/Conditioning (Initial 2 Hours),,97545,CPT,Facility,Outpatient,,,GP,296,251.6,84.8336,296,"UCare Health, Inc.",Medical Assistance,149.3912,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Pt Work Hard/Conditioning (Initial 2 Hours),,97545,CPT,Facility,Inpatient,,,GP,296,251.6,84.8336,296,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Pt Work Hard/Conditioning (Initial 2 Hours),,97545,CPT,Facility,Outpatient,,,GP,296,251.6,84.8336,296,"UCare Health, Inc.",Medicare Advantage,149.3912,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Pt Work Hard/Conditioning (Initial 2 Hours),,97545,CPT,Facility,Inpatient,,,GP,296,251.6,84.8336,296,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Pt Work Hard/Conditioning (Initial 2 Hours),,97545,CPT,Facility,Outpatient,,,GP,296,251.6,84.8336,296,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),149.3912,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Pt Work Hard/Conditioning (Initial 2 Hours),,97545,CPT,Facility,Inpatient,,,GP,296,251.6,84.8336,296,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Pt Work Hard/Conditioning (Initial 2 Hours),,97545,CPT,Facility,Both,,,GP,296,251.6,84.8336,296,UnitedHealthcare,Individual & Family,278.24,94,,percent of total billed charges,,
Pt Work Hard/Conditioning (Initial 2 Hours),,97545,CPT,Facility,Outpatient,,,GP,296,251.6,84.8336,296,UnitedHealthcare,Medicare Advantage,145.04,49,,percent of total billed charges,,
Pt Work Hard/Conditioning (Initial 2 Hours),,97545,CPT,Facility,Inpatient,,,GP,296,251.6,84.8336,296,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Pt Work Hard/Conditioning (Initial 2 Hours),,97545,CPT,Facility,Outpatient,,,GP,296,251.6,84.8336,296,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,142.08,48,,percent of total billed charges,,100% of DHS outpatient percentage
Pt Work Hard/Conditioning (Initial 2 Hours),,97545,CPT,Facility,Inpatient,,,GP,296,251.6,84.8336,296,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Pt Work Hardening/Conditioning Ea Addl Hr,,97546,CPT,Facility,Both,,,GP,112,95.2,32.0992,112,Aetna,Commercial,103.04,92,,percent of total billed charges,,
Pt Work Hardening/Conditioning Ea Addl Hr,,97546,CPT,Facility,Outpatient,,,GP,112,95.2,32.0992,112,Aetna,Medicare Advantage,54.88,49,,percent of total billed charges,,
Pt Work Hardening/Conditioning Ea Addl Hr,,97546,CPT,Facility,Inpatient,,,GP,112,95.2,32.0992,112,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Pt Work Hardening/Conditioning Ea Addl Hr,,97546,CPT,Facility,Both,,,GP,112,95.2,32.0992,112,Aetna,PPO,104.16,93,,percent of total billed charges,,
Pt Work Hardening/Conditioning Ea Addl Hr,,97546,CPT,Facility,Both,,,GP,112,95.2,32.0992,112,America's PPO,America's PPO,107.5536,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Pt Work Hardening/Conditioning Ea Addl Hr,,97546,CPT,Facility,Both,,,GP,112,95.2,32.0992,112,BlueCross BlueShield Minnesota, Federal Employee Program,110.208,98.4,,percent of total billed charges,,
Pt Work Hardening/Conditioning Ea Addl Hr,,97546,CPT,Facility,Both,,,GP,112,95.2,32.0992,112,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,112,100,,percent of total billed charges,,
Pt Work Hardening/Conditioning Ea Addl Hr,,97546,CPT,Facility,Both,,,GP,112,95.2,32.0992,112,BlueCross BlueShield Minnesota,High Value Network Plan,100.8,90,,percent of total billed charges,,
Pt Work Hardening/Conditioning Ea Addl Hr,,97546,CPT,Facility,Outpatient,,,GP,112,95.2,32.0992,112,BlueCross BlueShield Minnesota,Medicare Advantage,54.88,49,,percent of total billed charges,,
Pt Work Hardening/Conditioning Ea Addl Hr,,97546,CPT,Facility,Inpatient,,,GP,112,95.2,32.0992,112,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Pt Work Hardening/Conditioning Ea Addl Hr,,97546,CPT,Facility,Both,,,GP,112,95.2,32.0992,112,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,99.1984,88.57,,percent of total billed charges,,
Pt Work Hardening/Conditioning Ea Addl Hr,,97546,CPT,Facility,Both,,,GP,112,95.2,32.0992,112,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,32.0992,28.66,,percent of total billed charges,,
Pt Work Hardening/Conditioning Ea Addl Hr,,97546,CPT,Facility,Outpatient,,,GP,112,95.2,32.0992,112,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),54.88,49,,percent of total billed charges,,
Pt Work Hardening/Conditioning Ea Addl Hr,,97546,CPT,Facility,Inpatient,,,GP,112,95.2,32.0992,112,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Pt Work Hardening/Conditioning Ea Addl Hr,,97546,CPT,Facility,Both,,,GP,112,95.2,32.0992,112,CorVel,Worker's Compensation,112,100,,percent of total billed charges,,
Pt Work Hardening/Conditioning Ea Addl Hr,,97546,CPT,Facility,Both,,,GP,112,95.2,32.0992,112,First Health Group Corporation,First Health Network,108.64,97,,percent of total billed charges,,
Pt Work Hardening/Conditioning Ea Addl Hr,,97546,CPT,Facility,Both,,,GP,112,95.2,32.0992,112,"Health Partners, Inc.",Commercial,105.952,94.6,,percent of total billed charges,,
Pt Work Hardening/Conditioning Ea Addl Hr,,97546,CPT,Facility,Outpatient,,,GP,112,95.2,32.0992,112,"Health Partners, Inc.",Medicare Advantage,54.88,49,,percent of total billed charges,,
Pt Work Hardening/Conditioning Ea Addl Hr,,97546,CPT,Facility,Inpatient,,,GP,112,95.2,32.0992,112,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Pt Work Hardening/Conditioning Ea Addl Hr,,97546,CPT,Facility,Both,,,GP,112,95.2,32.0992,112,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),67.2,60,,percent of total billed charges,,
Pt Work Hardening/Conditioning Ea Addl Hr,,97546,CPT,Facility,Both,,,GP,112,95.2,32.0992,112,"Health Partners, Inc.",State of Minnesota Advantage Program,91.28,81.5,,percent of total billed charges,,
Pt Work Hardening/Conditioning Ea Addl Hr,,97546,CPT,Facility,Both,,,GP,112,95.2,32.0992,112,"Health Partners, Inc.",State Public Programs,56,50,,percent of total billed charges,,
Pt Work Hardening/Conditioning Ea Addl Hr,,97546,CPT,Facility,Both,,,GP,112,95.2,32.0992,112,Humana Insurance Company,Commercial PPO,106.4,95,,percent of total billed charges,,
Pt Work Hardening/Conditioning Ea Addl Hr,,97546,CPT,Facility,Outpatient,,,GP,112,95.2,32.0992,112,Humana Insurance Company,Medicare PPO,54.88,49,,percent of total billed charges,,
Pt Work Hardening/Conditioning Ea Addl Hr,,97546,CPT,Facility,Inpatient,,,GP,112,95.2,32.0992,112,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Pt Work Hardening/Conditioning Ea Addl Hr,,97546,CPT,Facility,Both,,,GP,112,95.2,32.0992,112,Medica,Individual & Family,110.992,99.1,,percent of total billed charges,,
Pt Work Hardening/Conditioning Ea Addl Hr,,97546,CPT,Facility,Outpatient,,,GP,112,95.2,32.0992,112,Medica,Medica Advantage Solution,55.776,49.8,,percent of total billed charges,,
Pt Work Hardening/Conditioning Ea Addl Hr,,97546,CPT,Facility,Inpatient,,,GP,112,95.2,32.0992,112,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Pt Work Hardening/Conditioning Ea Addl Hr,,97546,CPT,Facility,Outpatient,,,GP,112,95.2,32.0992,112,Medica,Medical Assistance,49.952,44.6,,percent of total billed charges,,
Pt Work Hardening/Conditioning Ea Addl Hr,,97546,CPT,Facility,Inpatient,,,GP,112,95.2,32.0992,112,Medica,Medical Assistance,,,,,Included in per diem rate,
Pt Work Hardening/Conditioning Ea Addl Hr,,97546,CPT,Facility,Outpatient,,,GP,112,95.2,32.0992,112,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,55.776,49.8,,percent of total billed charges,,
Pt Work Hardening/Conditioning Ea Addl Hr,,97546,CPT,Facility,Inpatient,,,GP,112,95.2,32.0992,112,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Pt Work Hardening/Conditioning Ea Addl Hr,,97546,CPT,Facility,Both,,,GP,112,95.2,32.0992,112,"Multiplan, Inc.","Multiplan, Inc.",105.28,94,,percent of total billed charges,,
Pt Work Hardening/Conditioning Ea Addl Hr,,97546,CPT,Facility,Outpatient,,,GP,112,95.2,32.0992,112,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,96.768,86.4,,percent of total billed charges,,
Pt Work Hardening/Conditioning Ea Addl Hr,,97546,CPT,Facility,Inpatient,,,GP,112,95.2,32.0992,112,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Pt Work Hardening/Conditioning Ea Addl Hr,,97546,CPT,Facility,Both,,,GP,112,95.2,32.0992,112,"Preferred One Administrative Services, INC.",PPO,110.432,98.6,,percent of total billed charges,,
Pt Work Hardening/Conditioning Ea Addl Hr,,97546,CPT,Facility,Outpatient,,,GP,112,95.2,32.0992,112,PrimeWest Health,Minnesota Senior Health Options (MSHO),57.624,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Pt Work Hardening/Conditioning Ea Addl Hr,,97546,CPT,Facility,Inpatient,,,GP,112,95.2,32.0992,112,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Pt Work Hardening/Conditioning Ea Addl Hr,,97546,CPT,Facility,Outpatient,,,GP,112,95.2,32.0992,112,PrimeWest Health,MinnesotaCare,57.5232,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Pt Work Hardening/Conditioning Ea Addl Hr,,97546,CPT,Facility,Inpatient,,,GP,112,95.2,32.0992,112,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Pt Work Hardening/Conditioning Ea Addl Hr,,97546,CPT,Facility,Both,,,GP,112,95.2,32.0992,112,Sanford Health Plan,Sanford Health Plan,103.04,92,,percent of total billed charges,,
Pt Work Hardening/Conditioning Ea Addl Hr,,97546,CPT,Facility,Outpatient,,,GP,112,95.2,32.0992,112,"UCare Health, Inc.",Individual & Family Plan,63.112,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Pt Work Hardening/Conditioning Ea Addl Hr,,97546,CPT,Facility,Inpatient,,,GP,112,95.2,32.0992,112,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Pt Work Hardening/Conditioning Ea Addl Hr,,97546,CPT,Facility,Outpatient,,,GP,112,95.2,32.0992,112,"UCare Health, Inc.",Medical Assistance,56.5264,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Pt Work Hardening/Conditioning Ea Addl Hr,,97546,CPT,Facility,Inpatient,,,GP,112,95.2,32.0992,112,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Pt Work Hardening/Conditioning Ea Addl Hr,,97546,CPT,Facility,Outpatient,,,GP,112,95.2,32.0992,112,"UCare Health, Inc.",Medicare Advantage,56.5264,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Pt Work Hardening/Conditioning Ea Addl Hr,,97546,CPT,Facility,Inpatient,,,GP,112,95.2,32.0992,112,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Pt Work Hardening/Conditioning Ea Addl Hr,,97546,CPT,Facility,Outpatient,,,GP,112,95.2,32.0992,112,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),56.5264,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Pt Work Hardening/Conditioning Ea Addl Hr,,97546,CPT,Facility,Inpatient,,,GP,112,95.2,32.0992,112,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Pt Work Hardening/Conditioning Ea Addl Hr,,97546,CPT,Facility,Both,,,GP,112,95.2,32.0992,112,UnitedHealthcare,Individual & Family,105.28,94,,percent of total billed charges,,
Pt Work Hardening/Conditioning Ea Addl Hr,,97546,CPT,Facility,Outpatient,,,GP,112,95.2,32.0992,112,UnitedHealthcare,Medicare Advantage,54.88,49,,percent of total billed charges,,
Pt Work Hardening/Conditioning Ea Addl Hr,,97546,CPT,Facility,Inpatient,,,GP,112,95.2,32.0992,112,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Pt Work Hardening/Conditioning Ea Addl Hr,,97546,CPT,Facility,Outpatient,,,GP,112,95.2,32.0992,112,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,53.76,48,,percent of total billed charges,,100% of DHS outpatient percentage
Pt Work Hardening/Conditioning Ea Addl Hr,,97546,CPT,Facility,Inpatient,,,GP,112,95.2,32.0992,112,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Pt Selective Debridement 1St 20 Cm,,97597,CPT,Facility,Both,,,GP,101,85.85,28.9466,101,Aetna,Commercial,92.92,92,,percent of total billed charges,,
Pt Selective Debridement 1St 20 Cm,,97597,CPT,Facility,Outpatient,,,GP,101,85.85,28.9466,101,Aetna,Medicare Advantage,49.49,49,,percent of total billed charges,,
Pt Selective Debridement 1St 20 Cm,,97597,CPT,Facility,Inpatient,,,GP,101,85.85,28.9466,101,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Pt Selective Debridement 1St 20 Cm,,97597,CPT,Facility,Both,,,GP,101,85.85,28.9466,101,Aetna,PPO,93.93,93,,percent of total billed charges,,
Pt Selective Debridement 1St 20 Cm,,97597,CPT,Facility,Both,,,GP,101,85.85,28.9466,101,America's PPO,America's PPO,96.9903,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Pt Selective Debridement 1St 20 Cm,,97597,CPT,Facility,Both,,,GP,101,85.85,28.9466,101,BlueCross BlueShield Minnesota, Federal Employee Program,99.384,98.4,,percent of total billed charges,,
Pt Selective Debridement 1St 20 Cm,,97597,CPT,Facility,Both,,,GP,101,85.85,28.9466,101,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,101,100,,percent of total billed charges,,
Pt Selective Debridement 1St 20 Cm,,97597,CPT,Facility,Both,,,GP,101,85.85,28.9466,101,BlueCross BlueShield Minnesota,High Value Network Plan,90.9,90,,percent of total billed charges,,
Pt Selective Debridement 1St 20 Cm,,97597,CPT,Facility,Outpatient,,,GP,101,85.85,28.9466,101,BlueCross BlueShield Minnesota,Medicare Advantage,49.49,49,,percent of total billed charges,,
Pt Selective Debridement 1St 20 Cm,,97597,CPT,Facility,Inpatient,,,GP,101,85.85,28.9466,101,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Pt Selective Debridement 1St 20 Cm,,97597,CPT,Facility,Both,,,GP,101,85.85,28.9466,101,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,89.4557,88.57,,percent of total billed charges,,
Pt Selective Debridement 1St 20 Cm,,97597,CPT,Facility,Both,,,GP,101,85.85,28.9466,101,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,28.9466,28.66,,percent of total billed charges,,
Pt Selective Debridement 1St 20 Cm,,97597,CPT,Facility,Outpatient,,,GP,101,85.85,28.9466,101,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),49.49,49,,percent of total billed charges,,
Pt Selective Debridement 1St 20 Cm,,97597,CPT,Facility,Inpatient,,,GP,101,85.85,28.9466,101,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Pt Selective Debridement 1St 20 Cm,,97597,CPT,Facility,Both,,,GP,101,85.85,28.9466,101,CorVel,Worker's Compensation,101,100,,percent of total billed charges,,
Pt Selective Debridement 1St 20 Cm,,97597,CPT,Facility,Both,,,GP,101,85.85,28.9466,101,First Health Group Corporation,First Health Network,97.97,97,,percent of total billed charges,,
Pt Selective Debridement 1St 20 Cm,,97597,CPT,Facility,Both,,,GP,101,85.85,28.9466,101,"Health Partners, Inc.",Commercial,95.546,94.6,,percent of total billed charges,,
Pt Selective Debridement 1St 20 Cm,,97597,CPT,Facility,Outpatient,,,GP,101,85.85,28.9466,101,"Health Partners, Inc.",Medicare Advantage,49.49,49,,percent of total billed charges,,
Pt Selective Debridement 1St 20 Cm,,97597,CPT,Facility,Inpatient,,,GP,101,85.85,28.9466,101,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Pt Selective Debridement 1St 20 Cm,,97597,CPT,Facility,Both,,,GP,101,85.85,28.9466,101,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),60.6,60,,percent of total billed charges,,
Pt Selective Debridement 1St 20 Cm,,97597,CPT,Facility,Both,,,GP,101,85.85,28.9466,101,"Health Partners, Inc.",State of Minnesota Advantage Program,82.315,81.5,,percent of total billed charges,,
Pt Selective Debridement 1St 20 Cm,,97597,CPT,Facility,Both,,,GP,101,85.85,28.9466,101,"Health Partners, Inc.",State Public Programs,50.5,50,,percent of total billed charges,,
Pt Selective Debridement 1St 20 Cm,,97597,CPT,Facility,Both,,,GP,101,85.85,28.9466,101,Humana Insurance Company,Commercial PPO,95.95,95,,percent of total billed charges,,
Pt Selective Debridement 1St 20 Cm,,97597,CPT,Facility,Outpatient,,,GP,101,85.85,28.9466,101,Humana Insurance Company,Medicare PPO,49.49,49,,percent of total billed charges,,
Pt Selective Debridement 1St 20 Cm,,97597,CPT,Facility,Inpatient,,,GP,101,85.85,28.9466,101,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Pt Selective Debridement 1St 20 Cm,,97597,CPT,Facility,Both,,,GP,101,85.85,28.9466,101,Medica,Individual & Family,100.091,99.1,,percent of total billed charges,,
Pt Selective Debridement 1St 20 Cm,,97597,CPT,Facility,Outpatient,,,GP,101,85.85,28.9466,101,Medica,Medica Advantage Solution,50.298,49.8,,percent of total billed charges,,
Pt Selective Debridement 1St 20 Cm,,97597,CPT,Facility,Inpatient,,,GP,101,85.85,28.9466,101,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Pt Selective Debridement 1St 20 Cm,,97597,CPT,Facility,Outpatient,,,GP,101,85.85,28.9466,101,Medica,Medical Assistance,45.046,44.6,,percent of total billed charges,,
Pt Selective Debridement 1St 20 Cm,,97597,CPT,Facility,Inpatient,,,GP,101,85.85,28.9466,101,Medica,Medical Assistance,,,,,Included in per diem rate,
Pt Selective Debridement 1St 20 Cm,,97597,CPT,Facility,Outpatient,,,GP,101,85.85,28.9466,101,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,50.298,49.8,,percent of total billed charges,,
Pt Selective Debridement 1St 20 Cm,,97597,CPT,Facility,Inpatient,,,GP,101,85.85,28.9466,101,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Pt Selective Debridement 1St 20 Cm,,97597,CPT,Facility,Both,,,GP,101,85.85,28.9466,101,"Multiplan, Inc.","Multiplan, Inc.",94.94,94,,percent of total billed charges,,
Pt Selective Debridement 1St 20 Cm,,97597,CPT,Facility,Outpatient,,,GP,101,85.85,28.9466,101,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,87.264,86.4,,percent of total billed charges,,
Pt Selective Debridement 1St 20 Cm,,97597,CPT,Facility,Inpatient,,,GP,101,85.85,28.9466,101,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Pt Selective Debridement 1St 20 Cm,,97597,CPT,Facility,Both,,,GP,101,85.85,28.9466,101,"Preferred One Administrative Services, INC.",PPO,99.586,98.6,,percent of total billed charges,,
Pt Selective Debridement 1St 20 Cm,,97597,CPT,Facility,Outpatient,,,GP,101,85.85,28.9466,101,PrimeWest Health,Minnesota Senior Health Options (MSHO),51.9645,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Pt Selective Debridement 1St 20 Cm,,97597,CPT,Facility,Inpatient,,,GP,101,85.85,28.9466,101,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Pt Selective Debridement 1St 20 Cm,,97597,CPT,Facility,Outpatient,,,GP,101,85.85,28.9466,101,PrimeWest Health,MinnesotaCare,51.8736,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Pt Selective Debridement 1St 20 Cm,,97597,CPT,Facility,Inpatient,,,GP,101,85.85,28.9466,101,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Pt Selective Debridement 1St 20 Cm,,97597,CPT,Facility,Both,,,GP,101,85.85,28.9466,101,Sanford Health Plan,Sanford Health Plan,92.92,92,,percent of total billed charges,,
Pt Selective Debridement 1St 20 Cm,,97597,CPT,Facility,Outpatient,,,GP,101,85.85,28.9466,101,"UCare Health, Inc.",Individual & Family Plan,56.9135,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Pt Selective Debridement 1St 20 Cm,,97597,CPT,Facility,Inpatient,,,GP,101,85.85,28.9466,101,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Pt Selective Debridement 1St 20 Cm,,97597,CPT,Facility,Outpatient,,,GP,101,85.85,28.9466,101,"UCare Health, Inc.",Medical Assistance,50.9747,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Pt Selective Debridement 1St 20 Cm,,97597,CPT,Facility,Inpatient,,,GP,101,85.85,28.9466,101,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Pt Selective Debridement 1St 20 Cm,,97597,CPT,Facility,Outpatient,,,GP,101,85.85,28.9466,101,"UCare Health, Inc.",Medicare Advantage,50.9747,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Pt Selective Debridement 1St 20 Cm,,97597,CPT,Facility,Inpatient,,,GP,101,85.85,28.9466,101,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Pt Selective Debridement 1St 20 Cm,,97597,CPT,Facility,Outpatient,,,GP,101,85.85,28.9466,101,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),50.9747,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Pt Selective Debridement 1St 20 Cm,,97597,CPT,Facility,Inpatient,,,GP,101,85.85,28.9466,101,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Pt Selective Debridement 1St 20 Cm,,97597,CPT,Facility,Both,,,GP,101,85.85,28.9466,101,UnitedHealthcare,Individual & Family,94.94,94,,percent of total billed charges,,
Pt Selective Debridement 1St 20 Cm,,97597,CPT,Facility,Outpatient,,,GP,101,85.85,28.9466,101,UnitedHealthcare,Medicare Advantage,49.49,49,,percent of total billed charges,,
Pt Selective Debridement 1St 20 Cm,,97597,CPT,Facility,Inpatient,,,GP,101,85.85,28.9466,101,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Pt Selective Debridement 1St 20 Cm,,97597,CPT,Facility,Outpatient,,,GP,101,85.85,28.9466,101,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,48.48,48,,percent of total billed charges,,100% of DHS outpatient percentage
Pt Selective Debridement 1St 20 Cm,,97597,CPT,Facility,Inpatient,,,GP,101,85.85,28.9466,101,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Pt Selective Debridemetn Ea Addl 20Cm,,97598,CPT,Facility,Both,,,GP,116,98.6,33.2456,116,Aetna,Commercial,106.72,92,,percent of total billed charges,,
Pt Selective Debridemetn Ea Addl 20Cm,,97598,CPT,Facility,Outpatient,,,GP,116,98.6,33.2456,116,Aetna,Medicare Advantage,56.84,49,,percent of total billed charges,,
Pt Selective Debridemetn Ea Addl 20Cm,,97598,CPT,Facility,Inpatient,,,GP,116,98.6,33.2456,116,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Pt Selective Debridemetn Ea Addl 20Cm,,97598,CPT,Facility,Both,,,GP,116,98.6,33.2456,116,Aetna,PPO,107.88,93,,percent of total billed charges,,
Pt Selective Debridemetn Ea Addl 20Cm,,97598,CPT,Facility,Both,,,GP,116,98.6,33.2456,116,America's PPO,America's PPO,111.3948,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Pt Selective Debridemetn Ea Addl 20Cm,,97598,CPT,Facility,Both,,,GP,116,98.6,33.2456,116,BlueCross BlueShield Minnesota, Federal Employee Program,114.144,98.4,,percent of total billed charges,,
Pt Selective Debridemetn Ea Addl 20Cm,,97598,CPT,Facility,Both,,,GP,116,98.6,33.2456,116,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,116,100,,percent of total billed charges,,
Pt Selective Debridemetn Ea Addl 20Cm,,97598,CPT,Facility,Both,,,GP,116,98.6,33.2456,116,BlueCross BlueShield Minnesota,High Value Network Plan,104.4,90,,percent of total billed charges,,
Pt Selective Debridemetn Ea Addl 20Cm,,97598,CPT,Facility,Outpatient,,,GP,116,98.6,33.2456,116,BlueCross BlueShield Minnesota,Medicare Advantage,56.84,49,,percent of total billed charges,,
Pt Selective Debridemetn Ea Addl 20Cm,,97598,CPT,Facility,Inpatient,,,GP,116,98.6,33.2456,116,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Pt Selective Debridemetn Ea Addl 20Cm,,97598,CPT,Facility,Both,,,GP,116,98.6,33.2456,116,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,102.7412,88.57,,percent of total billed charges,,
Pt Selective Debridemetn Ea Addl 20Cm,,97598,CPT,Facility,Both,,,GP,116,98.6,33.2456,116,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,33.2456,28.66,,percent of total billed charges,,
Pt Selective Debridemetn Ea Addl 20Cm,,97598,CPT,Facility,Outpatient,,,GP,116,98.6,33.2456,116,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),56.84,49,,percent of total billed charges,,
Pt Selective Debridemetn Ea Addl 20Cm,,97598,CPT,Facility,Inpatient,,,GP,116,98.6,33.2456,116,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Pt Selective Debridemetn Ea Addl 20Cm,,97598,CPT,Facility,Both,,,GP,116,98.6,33.2456,116,CorVel,Worker's Compensation,116,100,,percent of total billed charges,,
Pt Selective Debridemetn Ea Addl 20Cm,,97598,CPT,Facility,Both,,,GP,116,98.6,33.2456,116,First Health Group Corporation,First Health Network,112.52,97,,percent of total billed charges,,
Pt Selective Debridemetn Ea Addl 20Cm,,97598,CPT,Facility,Both,,,GP,116,98.6,33.2456,116,"Health Partners, Inc.",Commercial,109.736,94.6,,percent of total billed charges,,
Pt Selective Debridemetn Ea Addl 20Cm,,97598,CPT,Facility,Outpatient,,,GP,116,98.6,33.2456,116,"Health Partners, Inc.",Medicare Advantage,56.84,49,,percent of total billed charges,,
Pt Selective Debridemetn Ea Addl 20Cm,,97598,CPT,Facility,Inpatient,,,GP,116,98.6,33.2456,116,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Pt Selective Debridemetn Ea Addl 20Cm,,97598,CPT,Facility,Both,,,GP,116,98.6,33.2456,116,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),69.6,60,,percent of total billed charges,,
Pt Selective Debridemetn Ea Addl 20Cm,,97598,CPT,Facility,Both,,,GP,116,98.6,33.2456,116,"Health Partners, Inc.",State of Minnesota Advantage Program,94.54,81.5,,percent of total billed charges,,
Pt Selective Debridemetn Ea Addl 20Cm,,97598,CPT,Facility,Both,,,GP,116,98.6,33.2456,116,"Health Partners, Inc.",State Public Programs,58,50,,percent of total billed charges,,
Pt Selective Debridemetn Ea Addl 20Cm,,97598,CPT,Facility,Both,,,GP,116,98.6,33.2456,116,Humana Insurance Company,Commercial PPO,110.2,95,,percent of total billed charges,,
Pt Selective Debridemetn Ea Addl 20Cm,,97598,CPT,Facility,Outpatient,,,GP,116,98.6,33.2456,116,Humana Insurance Company,Medicare PPO,56.84,49,,percent of total billed charges,,
Pt Selective Debridemetn Ea Addl 20Cm,,97598,CPT,Facility,Inpatient,,,GP,116,98.6,33.2456,116,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Pt Selective Debridemetn Ea Addl 20Cm,,97598,CPT,Facility,Both,,,GP,116,98.6,33.2456,116,Medica,Individual & Family,114.956,99.1,,percent of total billed charges,,
Pt Selective Debridemetn Ea Addl 20Cm,,97598,CPT,Facility,Outpatient,,,GP,116,98.6,33.2456,116,Medica,Medica Advantage Solution,57.768,49.8,,percent of total billed charges,,
Pt Selective Debridemetn Ea Addl 20Cm,,97598,CPT,Facility,Inpatient,,,GP,116,98.6,33.2456,116,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Pt Selective Debridemetn Ea Addl 20Cm,,97598,CPT,Facility,Outpatient,,,GP,116,98.6,33.2456,116,Medica,Medical Assistance,51.736,44.6,,percent of total billed charges,,
Pt Selective Debridemetn Ea Addl 20Cm,,97598,CPT,Facility,Inpatient,,,GP,116,98.6,33.2456,116,Medica,Medical Assistance,,,,,Included in per diem rate,
Pt Selective Debridemetn Ea Addl 20Cm,,97598,CPT,Facility,Outpatient,,,GP,116,98.6,33.2456,116,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,57.768,49.8,,percent of total billed charges,,
Pt Selective Debridemetn Ea Addl 20Cm,,97598,CPT,Facility,Inpatient,,,GP,116,98.6,33.2456,116,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Pt Selective Debridemetn Ea Addl 20Cm,,97598,CPT,Facility,Both,,,GP,116,98.6,33.2456,116,"Multiplan, Inc.","Multiplan, Inc.",109.04,94,,percent of total billed charges,,
Pt Selective Debridemetn Ea Addl 20Cm,,97598,CPT,Facility,Outpatient,,,GP,116,98.6,33.2456,116,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,100.224,86.4,,percent of total billed charges,,
Pt Selective Debridemetn Ea Addl 20Cm,,97598,CPT,Facility,Inpatient,,,GP,116,98.6,33.2456,116,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Pt Selective Debridemetn Ea Addl 20Cm,,97598,CPT,Facility,Both,,,GP,116,98.6,33.2456,116,"Preferred One Administrative Services, INC.",PPO,114.376,98.6,,percent of total billed charges,,
Pt Selective Debridemetn Ea Addl 20Cm,,97598,CPT,Facility,Outpatient,,,GP,116,98.6,33.2456,116,PrimeWest Health,Minnesota Senior Health Options (MSHO),59.682,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Pt Selective Debridemetn Ea Addl 20Cm,,97598,CPT,Facility,Inpatient,,,GP,116,98.6,33.2456,116,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Pt Selective Debridemetn Ea Addl 20Cm,,97598,CPT,Facility,Outpatient,,,GP,116,98.6,33.2456,116,PrimeWest Health,MinnesotaCare,59.5776,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Pt Selective Debridemetn Ea Addl 20Cm,,97598,CPT,Facility,Inpatient,,,GP,116,98.6,33.2456,116,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Pt Selective Debridemetn Ea Addl 20Cm,,97598,CPT,Facility,Both,,,GP,116,98.6,33.2456,116,Sanford Health Plan,Sanford Health Plan,106.72,92,,percent of total billed charges,,
Pt Selective Debridemetn Ea Addl 20Cm,,97598,CPT,Facility,Outpatient,,,GP,116,98.6,33.2456,116,"UCare Health, Inc.",Individual & Family Plan,65.366,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Pt Selective Debridemetn Ea Addl 20Cm,,97598,CPT,Facility,Inpatient,,,GP,116,98.6,33.2456,116,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Pt Selective Debridemetn Ea Addl 20Cm,,97598,CPT,Facility,Outpatient,,,GP,116,98.6,33.2456,116,"UCare Health, Inc.",Medical Assistance,58.5452,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Pt Selective Debridemetn Ea Addl 20Cm,,97598,CPT,Facility,Inpatient,,,GP,116,98.6,33.2456,116,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Pt Selective Debridemetn Ea Addl 20Cm,,97598,CPT,Facility,Outpatient,,,GP,116,98.6,33.2456,116,"UCare Health, Inc.",Medicare Advantage,58.5452,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Pt Selective Debridemetn Ea Addl 20Cm,,97598,CPT,Facility,Inpatient,,,GP,116,98.6,33.2456,116,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Pt Selective Debridemetn Ea Addl 20Cm,,97598,CPT,Facility,Outpatient,,,GP,116,98.6,33.2456,116,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),58.5452,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Pt Selective Debridemetn Ea Addl 20Cm,,97598,CPT,Facility,Inpatient,,,GP,116,98.6,33.2456,116,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Pt Selective Debridemetn Ea Addl 20Cm,,97598,CPT,Facility,Both,,,GP,116,98.6,33.2456,116,UnitedHealthcare,Individual & Family,109.04,94,,percent of total billed charges,,
Pt Selective Debridemetn Ea Addl 20Cm,,97598,CPT,Facility,Outpatient,,,GP,116,98.6,33.2456,116,UnitedHealthcare,Medicare Advantage,56.84,49,,percent of total billed charges,,
Pt Selective Debridemetn Ea Addl 20Cm,,97598,CPT,Facility,Inpatient,,,GP,116,98.6,33.2456,116,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Pt Selective Debridemetn Ea Addl 20Cm,,97598,CPT,Facility,Outpatient,,,GP,116,98.6,33.2456,116,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,55.68,48,,percent of total billed charges,,100% of DHS outpatient percentage
Pt Selective Debridemetn Ea Addl 20Cm,,97598,CPT,Facility,Inpatient,,,GP,116,98.6,33.2456,116,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Pt Orthotic Management And Training Initial Encounter (15 Min),,97760,CPT,Facility,Both,,,GP,82,69.7,23.5012,82,Aetna,Commercial,75.44,92,,percent of total billed charges,,
Pt Orthotic Management And Training Initial Encounter (15 Min),,97760,CPT,Facility,Outpatient,,,GP,82,69.7,23.5012,82,Aetna,Medicare Advantage,40.18,49,,percent of total billed charges,,
Pt Orthotic Management And Training Initial Encounter (15 Min),,97760,CPT,Facility,Inpatient,,,GP,82,69.7,23.5012,82,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Pt Orthotic Management And Training Initial Encounter (15 Min),,97760,CPT,Facility,Both,,,GP,82,69.7,23.5012,82,Aetna,PPO,76.26,93,,percent of total billed charges,,
Pt Orthotic Management And Training Initial Encounter (15 Min),,97760,CPT,Facility,Both,,,GP,82,69.7,23.5012,82,America's PPO,America's PPO,78.7446,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Pt Orthotic Management And Training Initial Encounter (15 Min),,97760,CPT,Facility,Both,,,GP,82,69.7,23.5012,82,BlueCross BlueShield Minnesota, Federal Employee Program,80.688,98.4,,percent of total billed charges,,
Pt Orthotic Management And Training Initial Encounter (15 Min),,97760,CPT,Facility,Both,,,GP,82,69.7,23.5012,82,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,82,100,,percent of total billed charges,,
Pt Orthotic Management And Training Initial Encounter (15 Min),,97760,CPT,Facility,Both,,,GP,82,69.7,23.5012,82,BlueCross BlueShield Minnesota,High Value Network Plan,73.8,90,,percent of total billed charges,,
Pt Orthotic Management And Training Initial Encounter (15 Min),,97760,CPT,Facility,Outpatient,,,GP,82,69.7,23.5012,82,BlueCross BlueShield Minnesota,Medicare Advantage,40.18,49,,percent of total billed charges,,
Pt Orthotic Management And Training Initial Encounter (15 Min),,97760,CPT,Facility,Inpatient,,,GP,82,69.7,23.5012,82,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Pt Orthotic Management And Training Initial Encounter (15 Min),,97760,CPT,Facility,Both,,,GP,82,69.7,23.5012,82,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,72.6274,88.57,,percent of total billed charges,,
Pt Orthotic Management And Training Initial Encounter (15 Min),,97760,CPT,Facility,Both,,,GP,82,69.7,23.5012,82,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,23.5012,28.66,,percent of total billed charges,,
Pt Orthotic Management And Training Initial Encounter (15 Min),,97760,CPT,Facility,Outpatient,,,GP,82,69.7,23.5012,82,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),40.18,49,,percent of total billed charges,,
Pt Orthotic Management And Training Initial Encounter (15 Min),,97760,CPT,Facility,Inpatient,,,GP,82,69.7,23.5012,82,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Pt Orthotic Management And Training Initial Encounter (15 Min),,97760,CPT,Facility,Both,,,GP,82,69.7,23.5012,82,CorVel,Worker's Compensation,82,100,,percent of total billed charges,,
Pt Orthotic Management And Training Initial Encounter (15 Min),,97760,CPT,Facility,Both,,,GP,82,69.7,23.5012,82,First Health Group Corporation,First Health Network,79.54,97,,percent of total billed charges,,
Pt Orthotic Management And Training Initial Encounter (15 Min),,97760,CPT,Facility,Both,,,GP,82,69.7,23.5012,82,"Health Partners, Inc.",Commercial,77.572,94.6,,percent of total billed charges,,
Pt Orthotic Management And Training Initial Encounter (15 Min),,97760,CPT,Facility,Outpatient,,,GP,82,69.7,23.5012,82,"Health Partners, Inc.",Medicare Advantage,40.18,49,,percent of total billed charges,,
Pt Orthotic Management And Training Initial Encounter (15 Min),,97760,CPT,Facility,Inpatient,,,GP,82,69.7,23.5012,82,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Pt Orthotic Management And Training Initial Encounter (15 Min),,97760,CPT,Facility,Both,,,GP,82,69.7,23.5012,82,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),49.2,60,,percent of total billed charges,,
Pt Orthotic Management And Training Initial Encounter (15 Min),,97760,CPT,Facility,Both,,,GP,82,69.7,23.5012,82,"Health Partners, Inc.",State of Minnesota Advantage Program,66.83,81.5,,percent of total billed charges,,
Pt Orthotic Management And Training Initial Encounter (15 Min),,97760,CPT,Facility,Both,,,GP,82,69.7,23.5012,82,"Health Partners, Inc.",State Public Programs,41,50,,percent of total billed charges,,
Pt Orthotic Management And Training Initial Encounter (15 Min),,97760,CPT,Facility,Both,,,GP,82,69.7,23.5012,82,Humana Insurance Company,Commercial PPO,77.9,95,,percent of total billed charges,,
Pt Orthotic Management And Training Initial Encounter (15 Min),,97760,CPT,Facility,Outpatient,,,GP,82,69.7,23.5012,82,Humana Insurance Company,Medicare PPO,40.18,49,,percent of total billed charges,,
Pt Orthotic Management And Training Initial Encounter (15 Min),,97760,CPT,Facility,Inpatient,,,GP,82,69.7,23.5012,82,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Pt Orthotic Management And Training Initial Encounter (15 Min),,97760,CPT,Facility,Both,,,GP,82,69.7,23.5012,82,Medica,Individual & Family,81.262,99.1,,percent of total billed charges,,
Pt Orthotic Management And Training Initial Encounter (15 Min),,97760,CPT,Facility,Outpatient,,,GP,82,69.7,23.5012,82,Medica,Medica Advantage Solution,40.836,49.8,,percent of total billed charges,,
Pt Orthotic Management And Training Initial Encounter (15 Min),,97760,CPT,Facility,Inpatient,,,GP,82,69.7,23.5012,82,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Pt Orthotic Management And Training Initial Encounter (15 Min),,97760,CPT,Facility,Outpatient,,,GP,82,69.7,23.5012,82,Medica,Medical Assistance,36.572,44.6,,percent of total billed charges,,
Pt Orthotic Management And Training Initial Encounter (15 Min),,97760,CPT,Facility,Inpatient,,,GP,82,69.7,23.5012,82,Medica,Medical Assistance,,,,,Included in per diem rate,
Pt Orthotic Management And Training Initial Encounter (15 Min),,97760,CPT,Facility,Outpatient,,,GP,82,69.7,23.5012,82,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,40.836,49.8,,percent of total billed charges,,
Pt Orthotic Management And Training Initial Encounter (15 Min),,97760,CPT,Facility,Inpatient,,,GP,82,69.7,23.5012,82,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Pt Orthotic Management And Training Initial Encounter (15 Min),,97760,CPT,Facility,Both,,,GP,82,69.7,23.5012,82,"Multiplan, Inc.","Multiplan, Inc.",77.08,94,,percent of total billed charges,,
Pt Orthotic Management And Training Initial Encounter (15 Min),,97760,CPT,Facility,Outpatient,,,GP,82,69.7,23.5012,82,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,70.848,86.4,,percent of total billed charges,,
Pt Orthotic Management And Training Initial Encounter (15 Min),,97760,CPT,Facility,Inpatient,,,GP,82,69.7,23.5012,82,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Pt Orthotic Management And Training Initial Encounter (15 Min),,97760,CPT,Facility,Both,,,GP,82,69.7,23.5012,82,"Preferred One Administrative Services, INC.",PPO,80.852,98.6,,percent of total billed charges,,
Pt Orthotic Management And Training Initial Encounter (15 Min),,97760,CPT,Facility,Outpatient,,,GP,82,69.7,23.5012,82,PrimeWest Health,Minnesota Senior Health Options (MSHO),42.189,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Pt Orthotic Management And Training Initial Encounter (15 Min),,97760,CPT,Facility,Inpatient,,,GP,82,69.7,23.5012,82,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Pt Orthotic Management And Training Initial Encounter (15 Min),,97760,CPT,Facility,Outpatient,,,GP,82,69.7,23.5012,82,PrimeWest Health,MinnesotaCare,42.1152,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Pt Orthotic Management And Training Initial Encounter (15 Min),,97760,CPT,Facility,Inpatient,,,GP,82,69.7,23.5012,82,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Pt Orthotic Management And Training Initial Encounter (15 Min),,97760,CPT,Facility,Both,,,GP,82,69.7,23.5012,82,Sanford Health Plan,Sanford Health Plan,75.44,92,,percent of total billed charges,,
Pt Orthotic Management And Training Initial Encounter (15 Min),,97760,CPT,Facility,Outpatient,,,GP,82,69.7,23.5012,82,"UCare Health, Inc.",Individual & Family Plan,46.207,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Pt Orthotic Management And Training Initial Encounter (15 Min),,97760,CPT,Facility,Inpatient,,,GP,82,69.7,23.5012,82,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Pt Orthotic Management And Training Initial Encounter (15 Min),,97760,CPT,Facility,Outpatient,,,GP,82,69.7,23.5012,82,"UCare Health, Inc.",Medical Assistance,41.3854,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Pt Orthotic Management And Training Initial Encounter (15 Min),,97760,CPT,Facility,Inpatient,,,GP,82,69.7,23.5012,82,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Pt Orthotic Management And Training Initial Encounter (15 Min),,97760,CPT,Facility,Outpatient,,,GP,82,69.7,23.5012,82,"UCare Health, Inc.",Medicare Advantage,41.3854,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Pt Orthotic Management And Training Initial Encounter (15 Min),,97760,CPT,Facility,Inpatient,,,GP,82,69.7,23.5012,82,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Pt Orthotic Management And Training Initial Encounter (15 Min),,97760,CPT,Facility,Outpatient,,,GP,82,69.7,23.5012,82,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),41.3854,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Pt Orthotic Management And Training Initial Encounter (15 Min),,97760,CPT,Facility,Inpatient,,,GP,82,69.7,23.5012,82,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Pt Orthotic Management And Training Initial Encounter (15 Min),,97760,CPT,Facility,Both,,,GP,82,69.7,23.5012,82,UnitedHealthcare,Individual & Family,77.08,94,,percent of total billed charges,,
Pt Orthotic Management And Training Initial Encounter (15 Min),,97760,CPT,Facility,Outpatient,,,GP,82,69.7,23.5012,82,UnitedHealthcare,Medicare Advantage,40.18,49,,percent of total billed charges,,
Pt Orthotic Management And Training Initial Encounter (15 Min),,97760,CPT,Facility,Inpatient,,,GP,82,69.7,23.5012,82,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Pt Orthotic Management And Training Initial Encounter (15 Min),,97760,CPT,Facility,Outpatient,,,GP,82,69.7,23.5012,82,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,39.36,48,,percent of total billed charges,,100% of DHS outpatient percentage
Pt Orthotic Management And Training Initial Encounter (15 Min),,97760,CPT,Facility,Inpatient,,,GP,82,69.7,23.5012,82,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Pt Prosthetic Training Initial Encounter (15 Min),,97761,CPT,Facility,Both,,,GP,69,58.65,19.7754,69,Aetna,Commercial,63.48,92,,percent of total billed charges,,
Pt Prosthetic Training Initial Encounter (15 Min),,97761,CPT,Facility,Outpatient,,,GP,69,58.65,19.7754,69,Aetna,Medicare Advantage,33.81,49,,percent of total billed charges,,
Pt Prosthetic Training Initial Encounter (15 Min),,97761,CPT,Facility,Inpatient,,,GP,69,58.65,19.7754,69,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Pt Prosthetic Training Initial Encounter (15 Min),,97761,CPT,Facility,Both,,,GP,69,58.65,19.7754,69,Aetna,PPO,64.17,93,,percent of total billed charges,,
Pt Prosthetic Training Initial Encounter (15 Min),,97761,CPT,Facility,Both,,,GP,69,58.65,19.7754,69,America's PPO,America's PPO,66.2607,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Pt Prosthetic Training Initial Encounter (15 Min),,97761,CPT,Facility,Both,,,GP,69,58.65,19.7754,69,BlueCross BlueShield Minnesota, Federal Employee Program,67.896,98.4,,percent of total billed charges,,
Pt Prosthetic Training Initial Encounter (15 Min),,97761,CPT,Facility,Both,,,GP,69,58.65,19.7754,69,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,69,100,,percent of total billed charges,,
Pt Prosthetic Training Initial Encounter (15 Min),,97761,CPT,Facility,Both,,,GP,69,58.65,19.7754,69,BlueCross BlueShield Minnesota,High Value Network Plan,62.1,90,,percent of total billed charges,,
Pt Prosthetic Training Initial Encounter (15 Min),,97761,CPT,Facility,Outpatient,,,GP,69,58.65,19.7754,69,BlueCross BlueShield Minnesota,Medicare Advantage,33.81,49,,percent of total billed charges,,
Pt Prosthetic Training Initial Encounter (15 Min),,97761,CPT,Facility,Inpatient,,,GP,69,58.65,19.7754,69,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Pt Prosthetic Training Initial Encounter (15 Min),,97761,CPT,Facility,Both,,,GP,69,58.65,19.7754,69,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,61.1133,88.57,,percent of total billed charges,,
Pt Prosthetic Training Initial Encounter (15 Min),,97761,CPT,Facility,Both,,,GP,69,58.65,19.7754,69,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,19.7754,28.66,,percent of total billed charges,,
Pt Prosthetic Training Initial Encounter (15 Min),,97761,CPT,Facility,Outpatient,,,GP,69,58.65,19.7754,69,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),33.81,49,,percent of total billed charges,,
Pt Prosthetic Training Initial Encounter (15 Min),,97761,CPT,Facility,Inpatient,,,GP,69,58.65,19.7754,69,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Pt Prosthetic Training Initial Encounter (15 Min),,97761,CPT,Facility,Both,,,GP,69,58.65,19.7754,69,CorVel,Worker's Compensation,69,100,,percent of total billed charges,,
Pt Prosthetic Training Initial Encounter (15 Min),,97761,CPT,Facility,Both,,,GP,69,58.65,19.7754,69,First Health Group Corporation,First Health Network,66.93,97,,percent of total billed charges,,
Pt Prosthetic Training Initial Encounter (15 Min),,97761,CPT,Facility,Both,,,GP,69,58.65,19.7754,69,"Health Partners, Inc.",Commercial,65.274,94.6,,percent of total billed charges,,
Pt Prosthetic Training Initial Encounter (15 Min),,97761,CPT,Facility,Outpatient,,,GP,69,58.65,19.7754,69,"Health Partners, Inc.",Medicare Advantage,33.81,49,,percent of total billed charges,,
Pt Prosthetic Training Initial Encounter (15 Min),,97761,CPT,Facility,Inpatient,,,GP,69,58.65,19.7754,69,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Pt Prosthetic Training Initial Encounter (15 Min),,97761,CPT,Facility,Both,,,GP,69,58.65,19.7754,69,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),41.4,60,,percent of total billed charges,,
Pt Prosthetic Training Initial Encounter (15 Min),,97761,CPT,Facility,Both,,,GP,69,58.65,19.7754,69,"Health Partners, Inc.",State of Minnesota Advantage Program,56.235,81.5,,percent of total billed charges,,
Pt Prosthetic Training Initial Encounter (15 Min),,97761,CPT,Facility,Both,,,GP,69,58.65,19.7754,69,"Health Partners, Inc.",State Public Programs,34.5,50,,percent of total billed charges,,
Pt Prosthetic Training Initial Encounter (15 Min),,97761,CPT,Facility,Both,,,GP,69,58.65,19.7754,69,Humana Insurance Company,Commercial PPO,65.55,95,,percent of total billed charges,,
Pt Prosthetic Training Initial Encounter (15 Min),,97761,CPT,Facility,Outpatient,,,GP,69,58.65,19.7754,69,Humana Insurance Company,Medicare PPO,33.81,49,,percent of total billed charges,,
Pt Prosthetic Training Initial Encounter (15 Min),,97761,CPT,Facility,Inpatient,,,GP,69,58.65,19.7754,69,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Pt Prosthetic Training Initial Encounter (15 Min),,97761,CPT,Facility,Both,,,GP,69,58.65,19.7754,69,Medica,Individual & Family,68.379,99.1,,percent of total billed charges,,
Pt Prosthetic Training Initial Encounter (15 Min),,97761,CPT,Facility,Outpatient,,,GP,69,58.65,19.7754,69,Medica,Medica Advantage Solution,34.362,49.8,,percent of total billed charges,,
Pt Prosthetic Training Initial Encounter (15 Min),,97761,CPT,Facility,Inpatient,,,GP,69,58.65,19.7754,69,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Pt Prosthetic Training Initial Encounter (15 Min),,97761,CPT,Facility,Outpatient,,,GP,69,58.65,19.7754,69,Medica,Medical Assistance,30.774,44.6,,percent of total billed charges,,
Pt Prosthetic Training Initial Encounter (15 Min),,97761,CPT,Facility,Inpatient,,,GP,69,58.65,19.7754,69,Medica,Medical Assistance,,,,,Included in per diem rate,
Pt Prosthetic Training Initial Encounter (15 Min),,97761,CPT,Facility,Outpatient,,,GP,69,58.65,19.7754,69,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,34.362,49.8,,percent of total billed charges,,
Pt Prosthetic Training Initial Encounter (15 Min),,97761,CPT,Facility,Inpatient,,,GP,69,58.65,19.7754,69,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Pt Prosthetic Training Initial Encounter (15 Min),,97761,CPT,Facility,Both,,,GP,69,58.65,19.7754,69,"Multiplan, Inc.","Multiplan, Inc.",64.86,94,,percent of total billed charges,,
Pt Prosthetic Training Initial Encounter (15 Min),,97761,CPT,Facility,Outpatient,,,GP,69,58.65,19.7754,69,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,59.616,86.4,,percent of total billed charges,,
Pt Prosthetic Training Initial Encounter (15 Min),,97761,CPT,Facility,Inpatient,,,GP,69,58.65,19.7754,69,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Pt Prosthetic Training Initial Encounter (15 Min),,97761,CPT,Facility,Both,,,GP,69,58.65,19.7754,69,"Preferred One Administrative Services, INC.",PPO,68.034,98.6,,percent of total billed charges,,
Pt Prosthetic Training Initial Encounter (15 Min),,97761,CPT,Facility,Outpatient,,,GP,69,58.65,19.7754,69,PrimeWest Health,Minnesota Senior Health Options (MSHO),35.5005,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Pt Prosthetic Training Initial Encounter (15 Min),,97761,CPT,Facility,Inpatient,,,GP,69,58.65,19.7754,69,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Pt Prosthetic Training Initial Encounter (15 Min),,97761,CPT,Facility,Outpatient,,,GP,69,58.65,19.7754,69,PrimeWest Health,MinnesotaCare,35.4384,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Pt Prosthetic Training Initial Encounter (15 Min),,97761,CPT,Facility,Inpatient,,,GP,69,58.65,19.7754,69,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Pt Prosthetic Training Initial Encounter (15 Min),,97761,CPT,Facility,Both,,,GP,69,58.65,19.7754,69,Sanford Health Plan,Sanford Health Plan,63.48,92,,percent of total billed charges,,
Pt Prosthetic Training Initial Encounter (15 Min),,97761,CPT,Facility,Outpatient,,,GP,69,58.65,19.7754,69,"UCare Health, Inc.",Individual & Family Plan,38.8815,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Pt Prosthetic Training Initial Encounter (15 Min),,97761,CPT,Facility,Inpatient,,,GP,69,58.65,19.7754,69,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Pt Prosthetic Training Initial Encounter (15 Min),,97761,CPT,Facility,Outpatient,,,GP,69,58.65,19.7754,69,"UCare Health, Inc.",Medical Assistance,34.8243,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Pt Prosthetic Training Initial Encounter (15 Min),,97761,CPT,Facility,Inpatient,,,GP,69,58.65,19.7754,69,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Pt Prosthetic Training Initial Encounter (15 Min),,97761,CPT,Facility,Outpatient,,,GP,69,58.65,19.7754,69,"UCare Health, Inc.",Medicare Advantage,34.8243,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Pt Prosthetic Training Initial Encounter (15 Min),,97761,CPT,Facility,Inpatient,,,GP,69,58.65,19.7754,69,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Pt Prosthetic Training Initial Encounter (15 Min),,97761,CPT,Facility,Outpatient,,,GP,69,58.65,19.7754,69,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),34.8243,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Pt Prosthetic Training Initial Encounter (15 Min),,97761,CPT,Facility,Inpatient,,,GP,69,58.65,19.7754,69,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Pt Prosthetic Training Initial Encounter (15 Min),,97761,CPT,Facility,Both,,,GP,69,58.65,19.7754,69,UnitedHealthcare,Individual & Family,64.86,94,,percent of total billed charges,,
Pt Prosthetic Training Initial Encounter (15 Min),,97761,CPT,Facility,Outpatient,,,GP,69,58.65,19.7754,69,UnitedHealthcare,Medicare Advantage,33.81,49,,percent of total billed charges,,
Pt Prosthetic Training Initial Encounter (15 Min),,97761,CPT,Facility,Inpatient,,,GP,69,58.65,19.7754,69,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Pt Prosthetic Training Initial Encounter (15 Min),,97761,CPT,Facility,Outpatient,,,GP,69,58.65,19.7754,69,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,33.12,48,,percent of total billed charges,,100% of DHS outpatient percentage
Pt Prosthetic Training Initial Encounter (15 Min),,97761,CPT,Facility,Inpatient,,,GP,69,58.65,19.7754,69,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Pt Orthotic/Prosthetic Management And Training Subsequent Encounter (15 Min),,97763,CPT,Facility,Both,,,GP,62,52.7,17.7692,62,Aetna,Commercial,57.04,92,,percent of total billed charges,,
Pt Orthotic/Prosthetic Management And Training Subsequent Encounter (15 Min),,97763,CPT,Facility,Outpatient,,,GP,62,52.7,17.7692,62,Aetna,Medicare Advantage,30.38,49,,percent of total billed charges,,
Pt Orthotic/Prosthetic Management And Training Subsequent Encounter (15 Min),,97763,CPT,Facility,Inpatient,,,GP,62,52.7,17.7692,62,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Pt Orthotic/Prosthetic Management And Training Subsequent Encounter (15 Min),,97763,CPT,Facility,Both,,,GP,62,52.7,17.7692,62,Aetna,PPO,57.66,93,,percent of total billed charges,,
Pt Orthotic/Prosthetic Management And Training Subsequent Encounter (15 Min),,97763,CPT,Facility,Both,,,GP,62,52.7,17.7692,62,America's PPO,America's PPO,59.5386,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Pt Orthotic/Prosthetic Management And Training Subsequent Encounter (15 Min),,97763,CPT,Facility,Both,,,GP,62,52.7,17.7692,62,BlueCross BlueShield Minnesota, Federal Employee Program,61.008,98.4,,percent of total billed charges,,
Pt Orthotic/Prosthetic Management And Training Subsequent Encounter (15 Min),,97763,CPT,Facility,Both,,,GP,62,52.7,17.7692,62,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,62,100,,percent of total billed charges,,
Pt Orthotic/Prosthetic Management And Training Subsequent Encounter (15 Min),,97763,CPT,Facility,Both,,,GP,62,52.7,17.7692,62,BlueCross BlueShield Minnesota,High Value Network Plan,55.8,90,,percent of total billed charges,,
Pt Orthotic/Prosthetic Management And Training Subsequent Encounter (15 Min),,97763,CPT,Facility,Outpatient,,,GP,62,52.7,17.7692,62,BlueCross BlueShield Minnesota,Medicare Advantage,30.38,49,,percent of total billed charges,,
Pt Orthotic/Prosthetic Management And Training Subsequent Encounter (15 Min),,97763,CPT,Facility,Inpatient,,,GP,62,52.7,17.7692,62,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Pt Orthotic/Prosthetic Management And Training Subsequent Encounter (15 Min),,97763,CPT,Facility,Both,,,GP,62,52.7,17.7692,62,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,54.9134,88.57,,percent of total billed charges,,
Pt Orthotic/Prosthetic Management And Training Subsequent Encounter (15 Min),,97763,CPT,Facility,Both,,,GP,62,52.7,17.7692,62,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,17.7692,28.66,,percent of total billed charges,,
Pt Orthotic/Prosthetic Management And Training Subsequent Encounter (15 Min),,97763,CPT,Facility,Outpatient,,,GP,62,52.7,17.7692,62,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),30.38,49,,percent of total billed charges,,
Pt Orthotic/Prosthetic Management And Training Subsequent Encounter (15 Min),,97763,CPT,Facility,Inpatient,,,GP,62,52.7,17.7692,62,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Pt Orthotic/Prosthetic Management And Training Subsequent Encounter (15 Min),,97763,CPT,Facility,Both,,,GP,62,52.7,17.7692,62,CorVel,Worker's Compensation,62,100,,percent of total billed charges,,
Pt Orthotic/Prosthetic Management And Training Subsequent Encounter (15 Min),,97763,CPT,Facility,Both,,,GP,62,52.7,17.7692,62,First Health Group Corporation,First Health Network,60.14,97,,percent of total billed charges,,
Pt Orthotic/Prosthetic Management And Training Subsequent Encounter (15 Min),,97763,CPT,Facility,Both,,,GP,62,52.7,17.7692,62,"Health Partners, Inc.",Commercial,58.652,94.6,,percent of total billed charges,,
Pt Orthotic/Prosthetic Management And Training Subsequent Encounter (15 Min),,97763,CPT,Facility,Outpatient,,,GP,62,52.7,17.7692,62,"Health Partners, Inc.",Medicare Advantage,30.38,49,,percent of total billed charges,,
Pt Orthotic/Prosthetic Management And Training Subsequent Encounter (15 Min),,97763,CPT,Facility,Inpatient,,,GP,62,52.7,17.7692,62,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Pt Orthotic/Prosthetic Management And Training Subsequent Encounter (15 Min),,97763,CPT,Facility,Both,,,GP,62,52.7,17.7692,62,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),37.2,60,,percent of total billed charges,,
Pt Orthotic/Prosthetic Management And Training Subsequent Encounter (15 Min),,97763,CPT,Facility,Both,,,GP,62,52.7,17.7692,62,"Health Partners, Inc.",State of Minnesota Advantage Program,50.53,81.5,,percent of total billed charges,,
Pt Orthotic/Prosthetic Management And Training Subsequent Encounter (15 Min),,97763,CPT,Facility,Both,,,GP,62,52.7,17.7692,62,"Health Partners, Inc.",State Public Programs,31,50,,percent of total billed charges,,
Pt Orthotic/Prosthetic Management And Training Subsequent Encounter (15 Min),,97763,CPT,Facility,Both,,,GP,62,52.7,17.7692,62,Humana Insurance Company,Commercial PPO,58.9,95,,percent of total billed charges,,
Pt Orthotic/Prosthetic Management And Training Subsequent Encounter (15 Min),,97763,CPT,Facility,Outpatient,,,GP,62,52.7,17.7692,62,Humana Insurance Company,Medicare PPO,30.38,49,,percent of total billed charges,,
Pt Orthotic/Prosthetic Management And Training Subsequent Encounter (15 Min),,97763,CPT,Facility,Inpatient,,,GP,62,52.7,17.7692,62,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Pt Orthotic/Prosthetic Management And Training Subsequent Encounter (15 Min),,97763,CPT,Facility,Both,,,GP,62,52.7,17.7692,62,Medica,Individual & Family,61.442,99.1,,percent of total billed charges,,
Pt Orthotic/Prosthetic Management And Training Subsequent Encounter (15 Min),,97763,CPT,Facility,Outpatient,,,GP,62,52.7,17.7692,62,Medica,Medica Advantage Solution,30.876,49.8,,percent of total billed charges,,
Pt Orthotic/Prosthetic Management And Training Subsequent Encounter (15 Min),,97763,CPT,Facility,Inpatient,,,GP,62,52.7,17.7692,62,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Pt Orthotic/Prosthetic Management And Training Subsequent Encounter (15 Min),,97763,CPT,Facility,Outpatient,,,GP,62,52.7,17.7692,62,Medica,Medical Assistance,27.652,44.6,,percent of total billed charges,,
Pt Orthotic/Prosthetic Management And Training Subsequent Encounter (15 Min),,97763,CPT,Facility,Inpatient,,,GP,62,52.7,17.7692,62,Medica,Medical Assistance,,,,,Included in per diem rate,
Pt Orthotic/Prosthetic Management And Training Subsequent Encounter (15 Min),,97763,CPT,Facility,Outpatient,,,GP,62,52.7,17.7692,62,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,30.876,49.8,,percent of total billed charges,,
Pt Orthotic/Prosthetic Management And Training Subsequent Encounter (15 Min),,97763,CPT,Facility,Inpatient,,,GP,62,52.7,17.7692,62,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Pt Orthotic/Prosthetic Management And Training Subsequent Encounter (15 Min),,97763,CPT,Facility,Both,,,GP,62,52.7,17.7692,62,"Multiplan, Inc.","Multiplan, Inc.",58.28,94,,percent of total billed charges,,
Pt Orthotic/Prosthetic Management And Training Subsequent Encounter (15 Min),,97763,CPT,Facility,Outpatient,,,GP,62,52.7,17.7692,62,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,53.568,86.4,,percent of total billed charges,,
Pt Orthotic/Prosthetic Management And Training Subsequent Encounter (15 Min),,97763,CPT,Facility,Inpatient,,,GP,62,52.7,17.7692,62,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Pt Orthotic/Prosthetic Management And Training Subsequent Encounter (15 Min),,97763,CPT,Facility,Both,,,GP,62,52.7,17.7692,62,"Preferred One Administrative Services, INC.",PPO,61.132,98.6,,percent of total billed charges,,
Pt Orthotic/Prosthetic Management And Training Subsequent Encounter (15 Min),,97763,CPT,Facility,Outpatient,,,GP,62,52.7,17.7692,62,PrimeWest Health,Minnesota Senior Health Options (MSHO),31.899,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Pt Orthotic/Prosthetic Management And Training Subsequent Encounter (15 Min),,97763,CPT,Facility,Inpatient,,,GP,62,52.7,17.7692,62,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Pt Orthotic/Prosthetic Management And Training Subsequent Encounter (15 Min),,97763,CPT,Facility,Outpatient,,,GP,62,52.7,17.7692,62,PrimeWest Health,MinnesotaCare,31.8432,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Pt Orthotic/Prosthetic Management And Training Subsequent Encounter (15 Min),,97763,CPT,Facility,Inpatient,,,GP,62,52.7,17.7692,62,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Pt Orthotic/Prosthetic Management And Training Subsequent Encounter (15 Min),,97763,CPT,Facility,Both,,,GP,62,52.7,17.7692,62,Sanford Health Plan,Sanford Health Plan,57.04,92,,percent of total billed charges,,
Pt Orthotic/Prosthetic Management And Training Subsequent Encounter (15 Min),,97763,CPT,Facility,Outpatient,,,GP,62,52.7,17.7692,62,"UCare Health, Inc.",Individual & Family Plan,34.937,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Pt Orthotic/Prosthetic Management And Training Subsequent Encounter (15 Min),,97763,CPT,Facility,Inpatient,,,GP,62,52.7,17.7692,62,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Pt Orthotic/Prosthetic Management And Training Subsequent Encounter (15 Min),,97763,CPT,Facility,Outpatient,,,GP,62,52.7,17.7692,62,"UCare Health, Inc.",Medical Assistance,31.2914,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Pt Orthotic/Prosthetic Management And Training Subsequent Encounter (15 Min),,97763,CPT,Facility,Inpatient,,,GP,62,52.7,17.7692,62,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Pt Orthotic/Prosthetic Management And Training Subsequent Encounter (15 Min),,97763,CPT,Facility,Outpatient,,,GP,62,52.7,17.7692,62,"UCare Health, Inc.",Medicare Advantage,31.2914,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Pt Orthotic/Prosthetic Management And Training Subsequent Encounter (15 Min),,97763,CPT,Facility,Inpatient,,,GP,62,52.7,17.7692,62,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Pt Orthotic/Prosthetic Management And Training Subsequent Encounter (15 Min),,97763,CPT,Facility,Outpatient,,,GP,62,52.7,17.7692,62,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),31.2914,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Pt Orthotic/Prosthetic Management And Training Subsequent Encounter (15 Min),,97763,CPT,Facility,Inpatient,,,GP,62,52.7,17.7692,62,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Pt Orthotic/Prosthetic Management And Training Subsequent Encounter (15 Min),,97763,CPT,Facility,Both,,,GP,62,52.7,17.7692,62,UnitedHealthcare,Individual & Family,58.28,94,,percent of total billed charges,,
Pt Orthotic/Prosthetic Management And Training Subsequent Encounter (15 Min),,97763,CPT,Facility,Outpatient,,,GP,62,52.7,17.7692,62,UnitedHealthcare,Medicare Advantage,30.38,49,,percent of total billed charges,,
Pt Orthotic/Prosthetic Management And Training Subsequent Encounter (15 Min),,97763,CPT,Facility,Inpatient,,,GP,62,52.7,17.7692,62,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Pt Orthotic/Prosthetic Management And Training Subsequent Encounter (15 Min),,97763,CPT,Facility,Outpatient,,,GP,62,52.7,17.7692,62,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,29.76,48,,percent of total billed charges,,100% of DHS outpatient percentage
Pt Orthotic/Prosthetic Management And Training Subsequent Encounter (15 Min),,97763,CPT,Facility,Inpatient,,,GP,62,52.7,17.7692,62,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Pt Home Visit,,42002920,LOCAL,Facility,Both,,,GP,175,148.75,50.155,175,Aetna,Commercial,161,92,,percent of total billed charges,,
Pt Home Visit,,42002920,LOCAL,Facility,Outpatient,,,GP,175,148.75,50.155,175,Aetna,Medicare Advantage,85.75,49,,percent of total billed charges,,
Pt Home Visit,,42002920,LOCAL,Facility,Inpatient,,,GP,175,148.75,50.155,175,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Pt Home Visit,,42002920,LOCAL,Facility,Both,,,GP,175,148.75,50.155,175,Aetna,PPO,162.75,93,,percent of total billed charges,,
Pt Home Visit,,42002920,LOCAL,Facility,Both,,,GP,175,148.75,50.155,175,America's PPO,America's PPO,168.0525,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Pt Home Visit,,42002920,LOCAL,Facility,Both,,,GP,175,148.75,50.155,175,BlueCross BlueShield Minnesota, Federal Employee Program,172.2,98.4,,percent of total billed charges,,
Pt Home Visit,,42002920,LOCAL,Facility,Both,,,GP,175,148.75,50.155,175,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,175,100,,percent of total billed charges,,
Pt Home Visit,,42002920,LOCAL,Facility,Both,,,GP,175,148.75,50.155,175,BlueCross BlueShield Minnesota,High Value Network Plan,157.5,90,,percent of total billed charges,,
Pt Home Visit,,42002920,LOCAL,Facility,Outpatient,,,GP,175,148.75,50.155,175,BlueCross BlueShield Minnesota,Medicare Advantage,85.75,49,,percent of total billed charges,,
Pt Home Visit,,42002920,LOCAL,Facility,Inpatient,,,GP,175,148.75,50.155,175,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Pt Home Visit,,42002920,LOCAL,Facility,Both,,,GP,175,148.75,50.155,175,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,154.9975,88.57,,percent of total billed charges,,
Pt Home Visit,,42002920,LOCAL,Facility,Both,,,GP,175,148.75,50.155,175,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,50.155,28.66,,percent of total billed charges,,
Pt Home Visit,,42002920,LOCAL,Facility,Outpatient,,,GP,175,148.75,50.155,175,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),85.75,49,,percent of total billed charges,,
Pt Home Visit,,42002920,LOCAL,Facility,Inpatient,,,GP,175,148.75,50.155,175,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Pt Home Visit,,42002920,LOCAL,Facility,Both,,,GP,175,148.75,50.155,175,CorVel,Worker's Compensation,175,100,,percent of total billed charges,,
Pt Home Visit,,42002920,LOCAL,Facility,Both,,,GP,175,148.75,50.155,175,First Health Group Corporation,First Health Network,169.75,97,,percent of total billed charges,,
Pt Home Visit,,42002920,LOCAL,Facility,Both,,,GP,175,148.75,50.155,175,"Health Partners, Inc.",Commercial,165.55,94.6,,percent of total billed charges,,
Pt Home Visit,,42002920,LOCAL,Facility,Outpatient,,,GP,175,148.75,50.155,175,"Health Partners, Inc.",Medicare Advantage,85.75,49,,percent of total billed charges,,
Pt Home Visit,,42002920,LOCAL,Facility,Inpatient,,,GP,175,148.75,50.155,175,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Pt Home Visit,,42002920,LOCAL,Facility,Both,,,GP,175,148.75,50.155,175,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),105,60,,percent of total billed charges,,
Pt Home Visit,,42002920,LOCAL,Facility,Both,,,GP,175,148.75,50.155,175,"Health Partners, Inc.",State of Minnesota Advantage Program,142.625,81.5,,percent of total billed charges,,
Pt Home Visit,,42002920,LOCAL,Facility,Both,,,GP,175,148.75,50.155,175,"Health Partners, Inc.",State Public Programs,87.5,50,,percent of total billed charges,,
Pt Home Visit,,42002920,LOCAL,Facility,Both,,,GP,175,148.75,50.155,175,Humana Insurance Company,Commercial PPO,166.25,95,,percent of total billed charges,,
Pt Home Visit,,42002920,LOCAL,Facility,Outpatient,,,GP,175,148.75,50.155,175,Humana Insurance Company,Medicare PPO,85.75,49,,percent of total billed charges,,
Pt Home Visit,,42002920,LOCAL,Facility,Inpatient,,,GP,175,148.75,50.155,175,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Pt Home Visit,,42002920,LOCAL,Facility,Both,,,GP,175,148.75,50.155,175,Medica,Individual & Family,173.425,99.1,,percent of total billed charges,,
Pt Home Visit,,42002920,LOCAL,Facility,Outpatient,,,GP,175,148.75,50.155,175,Medica,Medica Advantage Solution,87.15,49.8,,percent of total billed charges,,
Pt Home Visit,,42002920,LOCAL,Facility,Inpatient,,,GP,175,148.75,50.155,175,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Pt Home Visit,,42002920,LOCAL,Facility,Outpatient,,,GP,175,148.75,50.155,175,Medica,Medical Assistance,78.05,44.6,,percent of total billed charges,,
Pt Home Visit,,42002920,LOCAL,Facility,Inpatient,,,GP,175,148.75,50.155,175,Medica,Medical Assistance,,,,,Included in per diem rate,
Pt Home Visit,,42002920,LOCAL,Facility,Outpatient,,,GP,175,148.75,50.155,175,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,87.15,49.8,,percent of total billed charges,,
Pt Home Visit,,42002920,LOCAL,Facility,Inpatient,,,GP,175,148.75,50.155,175,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Pt Home Visit,,42002920,LOCAL,Facility,Both,,,GP,175,148.75,50.155,175,"Multiplan, Inc.","Multiplan, Inc.",164.5,94,,percent of total billed charges,,
Pt Home Visit,,42002920,LOCAL,Facility,Outpatient,,,GP,175,148.75,50.155,175,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,151.2,86.4,,percent of total billed charges,,
Pt Home Visit,,42002920,LOCAL,Facility,Inpatient,,,GP,175,148.75,50.155,175,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Pt Home Visit,,42002920,LOCAL,Facility,Both,,,GP,175,148.75,50.155,175,"Preferred One Administrative Services, INC.",PPO,172.55,98.6,,percent of total billed charges,,
Pt Home Visit,,42002920,LOCAL,Facility,Outpatient,,,GP,175,148.75,50.155,175,PrimeWest Health,Minnesota Senior Health Options (MSHO),90.0375,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Pt Home Visit,,42002920,LOCAL,Facility,Inpatient,,,GP,175,148.75,50.155,175,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Pt Home Visit,,42002920,LOCAL,Facility,Outpatient,,,GP,175,148.75,50.155,175,PrimeWest Health,MinnesotaCare,89.88,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Pt Home Visit,,42002920,LOCAL,Facility,Inpatient,,,GP,175,148.75,50.155,175,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Pt Home Visit,,42002920,LOCAL,Facility,Both,,,GP,175,148.75,50.155,175,Sanford Health Plan,Sanford Health Plan,161,92,,percent of total billed charges,,
Pt Home Visit,,42002920,LOCAL,Facility,Outpatient,,,GP,175,148.75,50.155,175,"UCare Health, Inc.",Individual & Family Plan,98.6125,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Pt Home Visit,,42002920,LOCAL,Facility,Inpatient,,,GP,175,148.75,50.155,175,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Pt Home Visit,,42002920,LOCAL,Facility,Outpatient,,,GP,175,148.75,50.155,175,"UCare Health, Inc.",Medical Assistance,88.3225,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Pt Home Visit,,42002920,LOCAL,Facility,Inpatient,,,GP,175,148.75,50.155,175,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Pt Home Visit,,42002920,LOCAL,Facility,Outpatient,,,GP,175,148.75,50.155,175,"UCare Health, Inc.",Medicare Advantage,88.3225,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Pt Home Visit,,42002920,LOCAL,Facility,Inpatient,,,GP,175,148.75,50.155,175,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Pt Home Visit,,42002920,LOCAL,Facility,Outpatient,,,GP,175,148.75,50.155,175,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),88.3225,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Pt Home Visit,,42002920,LOCAL,Facility,Inpatient,,,GP,175,148.75,50.155,175,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Pt Home Visit,,42002920,LOCAL,Facility,Both,,,GP,175,148.75,50.155,175,UnitedHealthcare,Individual & Family,164.5,94,,percent of total billed charges,,
Pt Home Visit,,42002920,LOCAL,Facility,Outpatient,,,GP,175,148.75,50.155,175,UnitedHealthcare,Medicare Advantage,85.75,49,,percent of total billed charges,,
Pt Home Visit,,42002920,LOCAL,Facility,Inpatient,,,GP,175,148.75,50.155,175,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Pt Home Visit,,42002920,LOCAL,Facility,Outpatient,,,GP,175,148.75,50.155,175,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,84,48,,percent of total billed charges,,100% of DHS outpatient percentage
Pt Home Visit,,42002920,LOCAL,Facility,Inpatient,,,GP,175,148.75,50.155,175,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Pt Electrical Stim Unattended (15 Min),,G0283,HCPCS,Facility,Outpatient,,,GP,82,69.7,40.18,73.8,Aetna,Medicare Advantage,40.18,49,,percent of total billed charges,,
Pt Electrical Stim Unattended (15 Min),,G0283,HCPCS,Facility,Inpatient,,,GP,82,69.7,40.18,73.8,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Pt Electrical Stim Unattended (15 Min),,G0283,HCPCS,Facility,Outpatient,,,GP,82,69.7,40.18,73.8,BlueCross BlueShield Minnesota,Medicare Advantage,40.18,49,,percent of total billed charges,,
Pt Electrical Stim Unattended (15 Min),,G0283,HCPCS,Facility,Inpatient,,,GP,82,69.7,40.18,73.8,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Pt Electrical Stim Unattended (15 Min),,G0283,HCPCS,Facility,Outpatient,,,GP,82,69.7,40.18,73.8,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),40.18,49,,percent of total billed charges,,
Pt Electrical Stim Unattended (15 Min),,G0283,HCPCS,Facility,Inpatient,,,GP,82,69.7,40.18,73.8,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Pt Electrical Stim Unattended (15 Min),,G0283,HCPCS,Facility,Outpatient,,,GP,82,69.7,40.18,73.8,"Health Partners, Inc.",Medicare Advantage,40.18,49,,percent of total billed charges,,
Pt Electrical Stim Unattended (15 Min),,G0283,HCPCS,Facility,Inpatient,,,GP,82,69.7,40.18,73.8,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Pt Electrical Stim Unattended (15 Min),,G0283,HCPCS,Facility,Both,,,GP,82,69.7,40.18,73.8,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),49.2,60,,percent of total billed charges,,
Pt Electrical Stim Unattended (15 Min),,G0283,HCPCS,Facility,Outpatient,,,GP,82,69.7,40.18,73.8,Humana Insurance Company,Medicare PPO,40.18,49,,percent of total billed charges,,
Pt Electrical Stim Unattended (15 Min),,G0283,HCPCS,Facility,Inpatient,,,GP,82,69.7,40.18,73.8,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Pt Electrical Stim Unattended (15 Min),,G0283,HCPCS,Facility,Outpatient,,,GP,82,69.7,40.18,73.8,Medica,Medica Advantage Solution,40.836,49.8,,percent of total billed charges,,
Pt Electrical Stim Unattended (15 Min),,G0283,HCPCS,Facility,Inpatient,,,GP,82,69.7,40.18,73.8,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Pt Electrical Stim Unattended (15 Min),,G0283,HCPCS,Facility,Outpatient,,,GP,82,69.7,40.18,73.8,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,40.836,49.8,,percent of total billed charges,,
Pt Electrical Stim Unattended (15 Min),,G0283,HCPCS,Facility,Inpatient,,,GP,82,69.7,40.18,73.8,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Pt Electrical Stim Unattended (15 Min),,G0283,HCPCS,Facility,Outpatient,,,GP,82,69.7,40.18,73.8,PrimeWest Health,Minnesota Senior Health Options (MSHO),42.189,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Pt Electrical Stim Unattended (15 Min),,G0283,HCPCS,Facility,Inpatient,,,GP,82,69.7,40.18,73.8,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Pt Electrical Stim Unattended (15 Min),,G0283,HCPCS,Facility,Outpatient,,,GP,82,69.7,40.18,73.8,"UCare Health, Inc.",Medicare Advantage,41.3854,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Pt Electrical Stim Unattended (15 Min),,G0283,HCPCS,Facility,Inpatient,,,GP,82,69.7,40.18,73.8,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Pt Electrical Stim Unattended (15 Min),,G0283,HCPCS,Facility,Outpatient,,,GP,82,69.7,40.18,73.8,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),41.3854,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Pt Electrical Stim Unattended (15 Min),,G0283,HCPCS,Facility,Inpatient,,,GP,82,69.7,40.18,73.8,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Pt Electrical Stim Unattended (15 Min),,G0283,HCPCS,Facility,Outpatient,,,GP,82,69.7,40.18,73.8,UnitedHealthcare,Medicare Advantage,40.18,49,,percent of total billed charges,,
Pt Electrical Stim Unattended (15 Min),,G0283,HCPCS,Facility,Inpatient,,,GP,82,69.7,40.18,73.8,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Xr Ribs Lt Unil,,71100,CPT,Facility,Both,,,LT,261,221.85,74.8026,261,Aetna,Commercial,240.12,92,,percent of total billed charges,,
Xr Ribs Lt Unil,,71100,CPT,Facility,Outpatient,,,LT,261,221.85,74.8026,261,Aetna,Medicare Advantage,127.89,49,,percent of total billed charges,,
Xr Ribs Lt Unil,,71100,CPT,Facility,Inpatient,,,LT,261,221.85,74.8026,261,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Xr Ribs Lt Unil,,71100,CPT,Facility,Both,,,LT,261,221.85,74.8026,261,Aetna,PPO,242.73,93,,percent of total billed charges,,
Xr Ribs Lt Unil,,71100,CPT,Facility,Both,,,LT,261,221.85,74.8026,261,America's PPO,America's PPO,250.6383,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Xr Ribs Lt Unil,,71100,CPT,Facility,Both,,,LT,261,221.85,74.8026,261,BlueCross BlueShield Minnesota, Federal Employee Program,256.824,98.4,,percent of total billed charges,,
Xr Ribs Lt Unil,,71100,CPT,Facility,Both,,,LT,261,221.85,74.8026,261,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,261,100,,percent of total billed charges,,
Xr Ribs Lt Unil,,71100,CPT,Facility,Both,,,LT,261,221.85,74.8026,261,BlueCross BlueShield Minnesota,High Value Network Plan,234.9,90,,percent of total billed charges,,
Xr Ribs Lt Unil,,71100,CPT,Facility,Outpatient,,,LT,261,221.85,74.8026,261,BlueCross BlueShield Minnesota,Medicare Advantage,127.89,49,,percent of total billed charges,,
Xr Ribs Lt Unil,,71100,CPT,Facility,Inpatient,,,LT,261,221.85,74.8026,261,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Xr Ribs Lt Unil,,71100,CPT,Facility,Both,,,LT,261,221.85,74.8026,261,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,231.1677,88.57,,percent of total billed charges,,
Xr Ribs Lt Unil,,71100,CPT,Facility,Both,,,LT,261,221.85,74.8026,261,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,74.8026,28.66,,percent of total billed charges,,
Xr Ribs Lt Unil,,71100,CPT,Facility,Outpatient,,,LT,261,221.85,74.8026,261,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),127.89,49,,percent of total billed charges,,
Xr Ribs Lt Unil,,71100,CPT,Facility,Inpatient,,,LT,261,221.85,74.8026,261,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Xr Ribs Lt Unil,,71100,CPT,Facility,Both,,,LT,261,221.85,74.8026,261,CorVel,Worker's Compensation,261,100,,percent of total billed charges,,
Xr Ribs Lt Unil,,71100,CPT,Facility,Both,,,LT,261,221.85,74.8026,261,First Health Group Corporation,First Health Network,253.17,97,,percent of total billed charges,,
Xr Ribs Lt Unil,,71100,CPT,Facility,Both,,,LT,261,221.85,74.8026,261,"Health Partners, Inc.",Commercial,246.906,94.6,,percent of total billed charges,,
Xr Ribs Lt Unil,,71100,CPT,Facility,Outpatient,,,LT,261,221.85,74.8026,261,"Health Partners, Inc.",Medicare Advantage,127.89,49,,percent of total billed charges,,
Xr Ribs Lt Unil,,71100,CPT,Facility,Inpatient,,,LT,261,221.85,74.8026,261,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Ribs Lt Unil,,71100,CPT,Facility,Both,,,LT,261,221.85,74.8026,261,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),156.6,60,,percent of total billed charges,,
Xr Ribs Lt Unil,,71100,CPT,Facility,Both,,,LT,261,221.85,74.8026,261,"Health Partners, Inc.",State of Minnesota Advantage Program,212.715,81.5,,percent of total billed charges,,
Xr Ribs Lt Unil,,71100,CPT,Facility,Both,,,LT,261,221.85,74.8026,261,"Health Partners, Inc.",State Public Programs,130.5,50,,percent of total billed charges,,
Xr Ribs Lt Unil,,71100,CPT,Facility,Both,,,LT,261,221.85,74.8026,261,Humana Insurance Company,Commercial PPO,247.95,95,,percent of total billed charges,,
Xr Ribs Lt Unil,,71100,CPT,Facility,Outpatient,,,LT,261,221.85,74.8026,261,Humana Insurance Company,Medicare PPO,127.89,49,,percent of total billed charges,,
Xr Ribs Lt Unil,,71100,CPT,Facility,Inpatient,,,LT,261,221.85,74.8026,261,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Xr Ribs Lt Unil,,71100,CPT,Facility,Both,,,LT,261,221.85,74.8026,261,Medica,Individual & Family,258.651,99.1,,percent of total billed charges,,
Xr Ribs Lt Unil,,71100,CPT,Facility,Outpatient,,,LT,261,221.85,74.8026,261,Medica,Medica Advantage Solution,129.978,49.8,,percent of total billed charges,,
Xr Ribs Lt Unil,,71100,CPT,Facility,Inpatient,,,LT,261,221.85,74.8026,261,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Xr Ribs Lt Unil,,71100,CPT,Facility,Outpatient,,,LT,261,221.85,74.8026,261,Medica,Medical Assistance,116.406,44.6,,percent of total billed charges,,
Xr Ribs Lt Unil,,71100,CPT,Facility,Inpatient,,,LT,261,221.85,74.8026,261,Medica,Medical Assistance,,,,,Included in per diem rate,
Xr Ribs Lt Unil,,71100,CPT,Facility,Outpatient,,,LT,261,221.85,74.8026,261,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,129.978,49.8,,percent of total billed charges,,
Xr Ribs Lt Unil,,71100,CPT,Facility,Inpatient,,,LT,261,221.85,74.8026,261,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Xr Ribs Lt Unil,,71100,CPT,Facility,Both,,,LT,261,221.85,74.8026,261,"Multiplan, Inc.","Multiplan, Inc.",245.34,94,,percent of total billed charges,,
Xr Ribs Lt Unil,,71100,CPT,Facility,Outpatient,,,LT,261,221.85,74.8026,261,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,235.161,90.1,,percent of total billed charges,,
Xr Ribs Lt Unil,,71100,CPT,Facility,Inpatient,,,LT,261,221.85,74.8026,261,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Xr Ribs Lt Unil,,71100,CPT,Facility,Both,,,LT,261,221.85,74.8026,261,"Preferred One Administrative Services, INC.",PPO,257.346,98.6,,percent of total billed charges,,
Xr Ribs Lt Unil,,71100,CPT,Facility,Outpatient,,,LT,261,221.85,74.8026,261,PrimeWest Health,Minnesota Senior Health Options (MSHO),134.2845,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Xr Ribs Lt Unil,,71100,CPT,Facility,Inpatient,,,LT,261,221.85,74.8026,261,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Ribs Lt Unil,,71100,CPT,Facility,Outpatient,,,LT,261,221.85,74.8026,261,PrimeWest Health,MinnesotaCare,134.0496,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Xr Ribs Lt Unil,,71100,CPT,Facility,Inpatient,,,LT,261,221.85,74.8026,261,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Xr Ribs Lt Unil,,71100,CPT,Facility,Both,,,LT,261,221.85,74.8026,261,Sanford Health Plan,Sanford Health Plan,240.12,92,,percent of total billed charges,,
Xr Ribs Lt Unil,,71100,CPT,Facility,Outpatient,,,LT,261,221.85,74.8026,261,"UCare Health, Inc.",Individual & Family Plan,147.0735,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Xr Ribs Lt Unil,,71100,CPT,Facility,Inpatient,,,LT,261,221.85,74.8026,261,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Xr Ribs Lt Unil,,71100,CPT,Facility,Outpatient,,,LT,261,221.85,74.8026,261,"UCare Health, Inc.",Medical Assistance,131.7267,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Ribs Lt Unil,,71100,CPT,Facility,Inpatient,,,LT,261,221.85,74.8026,261,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Xr Ribs Lt Unil,,71100,CPT,Facility,Outpatient,,,LT,261,221.85,74.8026,261,"UCare Health, Inc.",Medicare Advantage,131.7267,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Ribs Lt Unil,,71100,CPT,Facility,Inpatient,,,LT,261,221.85,74.8026,261,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Ribs Lt Unil,,71100,CPT,Facility,Outpatient,,,LT,261,221.85,74.8026,261,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),131.7267,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Ribs Lt Unil,,71100,CPT,Facility,Inpatient,,,LT,261,221.85,74.8026,261,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Ribs Lt Unil,,71100,CPT,Facility,Both,,,LT,261,221.85,74.8026,261,UnitedHealthcare,Individual & Family,245.34,94,,percent of total billed charges,,
Xr Ribs Lt Unil,,71100,CPT,Facility,Outpatient,,,LT,261,221.85,74.8026,261,UnitedHealthcare,Medicare Advantage,127.89,49,,percent of total billed charges,,
Xr Ribs Lt Unil,,71100,CPT,Facility,Inpatient,,,LT,261,221.85,74.8026,261,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Xr Ribs Lt Unil,,71100,CPT,Facility,Outpatient,,,LT,261,221.85,74.8026,261,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,125.28,48,,percent of total billed charges,,100% of DHS outpatient percentage
Xr Ribs Lt Unil,,71100,CPT,Facility,Inpatient,,,LT,261,221.85,74.8026,261,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Xr Ribs Lt Unil W Chest 1 View,,71101,CPT,Facility,Both,,,LT,377,320.45,108.0482,377,Aetna,Commercial,346.84,92,,percent of total billed charges,,
Xr Ribs Lt Unil W Chest 1 View,,71101,CPT,Facility,Outpatient,,,LT,377,320.45,108.0482,377,Aetna,Medicare Advantage,184.73,49,,percent of total billed charges,,
Xr Ribs Lt Unil W Chest 1 View,,71101,CPT,Facility,Inpatient,,,LT,377,320.45,108.0482,377,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Xr Ribs Lt Unil W Chest 1 View,,71101,CPT,Facility,Both,,,LT,377,320.45,108.0482,377,Aetna,PPO,350.61,93,,percent of total billed charges,,
Xr Ribs Lt Unil W Chest 1 View,,71101,CPT,Facility,Both,,,LT,377,320.45,108.0482,377,America's PPO,America's PPO,362.0331,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Xr Ribs Lt Unil W Chest 1 View,,71101,CPT,Facility,Both,,,LT,377,320.45,108.0482,377,BlueCross BlueShield Minnesota, Federal Employee Program,370.968,98.4,,percent of total billed charges,,
Xr Ribs Lt Unil W Chest 1 View,,71101,CPT,Facility,Both,,,LT,377,320.45,108.0482,377,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,377,100,,percent of total billed charges,,
Xr Ribs Lt Unil W Chest 1 View,,71101,CPT,Facility,Both,,,LT,377,320.45,108.0482,377,BlueCross BlueShield Minnesota,High Value Network Plan,339.3,90,,percent of total billed charges,,
Xr Ribs Lt Unil W Chest 1 View,,71101,CPT,Facility,Outpatient,,,LT,377,320.45,108.0482,377,BlueCross BlueShield Minnesota,Medicare Advantage,184.73,49,,percent of total billed charges,,
Xr Ribs Lt Unil W Chest 1 View,,71101,CPT,Facility,Inpatient,,,LT,377,320.45,108.0482,377,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Xr Ribs Lt Unil W Chest 1 View,,71101,CPT,Facility,Both,,,LT,377,320.45,108.0482,377,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,333.9089,88.57,,percent of total billed charges,,
Xr Ribs Lt Unil W Chest 1 View,,71101,CPT,Facility,Both,,,LT,377,320.45,108.0482,377,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,108.0482,28.66,,percent of total billed charges,,
Xr Ribs Lt Unil W Chest 1 View,,71101,CPT,Facility,Outpatient,,,LT,377,320.45,108.0482,377,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),184.73,49,,percent of total billed charges,,
Xr Ribs Lt Unil W Chest 1 View,,71101,CPT,Facility,Inpatient,,,LT,377,320.45,108.0482,377,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Xr Ribs Lt Unil W Chest 1 View,,71101,CPT,Facility,Both,,,LT,377,320.45,108.0482,377,CorVel,Worker's Compensation,377,100,,percent of total billed charges,,
Xr Ribs Lt Unil W Chest 1 View,,71101,CPT,Facility,Both,,,LT,377,320.45,108.0482,377,First Health Group Corporation,First Health Network,365.69,97,,percent of total billed charges,,
Xr Ribs Lt Unil W Chest 1 View,,71101,CPT,Facility,Both,,,LT,377,320.45,108.0482,377,"Health Partners, Inc.",Commercial,356.642,94.6,,percent of total billed charges,,
Xr Ribs Lt Unil W Chest 1 View,,71101,CPT,Facility,Outpatient,,,LT,377,320.45,108.0482,377,"Health Partners, Inc.",Medicare Advantage,184.73,49,,percent of total billed charges,,
Xr Ribs Lt Unil W Chest 1 View,,71101,CPT,Facility,Inpatient,,,LT,377,320.45,108.0482,377,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Ribs Lt Unil W Chest 1 View,,71101,CPT,Facility,Both,,,LT,377,320.45,108.0482,377,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),226.2,60,,percent of total billed charges,,
Xr Ribs Lt Unil W Chest 1 View,,71101,CPT,Facility,Both,,,LT,377,320.45,108.0482,377,"Health Partners, Inc.",State of Minnesota Advantage Program,307.255,81.5,,percent of total billed charges,,
Xr Ribs Lt Unil W Chest 1 View,,71101,CPT,Facility,Both,,,LT,377,320.45,108.0482,377,"Health Partners, Inc.",State Public Programs,188.5,50,,percent of total billed charges,,
Xr Ribs Lt Unil W Chest 1 View,,71101,CPT,Facility,Both,,,LT,377,320.45,108.0482,377,Humana Insurance Company,Commercial PPO,358.15,95,,percent of total billed charges,,
Xr Ribs Lt Unil W Chest 1 View,,71101,CPT,Facility,Outpatient,,,LT,377,320.45,108.0482,377,Humana Insurance Company,Medicare PPO,184.73,49,,percent of total billed charges,,
Xr Ribs Lt Unil W Chest 1 View,,71101,CPT,Facility,Inpatient,,,LT,377,320.45,108.0482,377,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Xr Ribs Lt Unil W Chest 1 View,,71101,CPT,Facility,Both,,,LT,377,320.45,108.0482,377,Medica,Individual & Family,373.607,99.1,,percent of total billed charges,,
Xr Ribs Lt Unil W Chest 1 View,,71101,CPT,Facility,Outpatient,,,LT,377,320.45,108.0482,377,Medica,Medica Advantage Solution,187.746,49.8,,percent of total billed charges,,
Xr Ribs Lt Unil W Chest 1 View,,71101,CPT,Facility,Inpatient,,,LT,377,320.45,108.0482,377,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Xr Ribs Lt Unil W Chest 1 View,,71101,CPT,Facility,Outpatient,,,LT,377,320.45,108.0482,377,Medica,Medical Assistance,168.142,44.6,,percent of total billed charges,,
Xr Ribs Lt Unil W Chest 1 View,,71101,CPT,Facility,Inpatient,,,LT,377,320.45,108.0482,377,Medica,Medical Assistance,,,,,Included in per diem rate,
Xr Ribs Lt Unil W Chest 1 View,,71101,CPT,Facility,Outpatient,,,LT,377,320.45,108.0482,377,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,187.746,49.8,,percent of total billed charges,,
Xr Ribs Lt Unil W Chest 1 View,,71101,CPT,Facility,Inpatient,,,LT,377,320.45,108.0482,377,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Xr Ribs Lt Unil W Chest 1 View,,71101,CPT,Facility,Both,,,LT,377,320.45,108.0482,377,"Multiplan, Inc.","Multiplan, Inc.",354.38,94,,percent of total billed charges,,
Xr Ribs Lt Unil W Chest 1 View,,71101,CPT,Facility,Outpatient,,,LT,377,320.45,108.0482,377,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,339.677,90.1,,percent of total billed charges,,
Xr Ribs Lt Unil W Chest 1 View,,71101,CPT,Facility,Inpatient,,,LT,377,320.45,108.0482,377,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Xr Ribs Lt Unil W Chest 1 View,,71101,CPT,Facility,Both,,,LT,377,320.45,108.0482,377,"Preferred One Administrative Services, INC.",PPO,371.722,98.6,,percent of total billed charges,,
Xr Ribs Lt Unil W Chest 1 View,,71101,CPT,Facility,Outpatient,,,LT,377,320.45,108.0482,377,PrimeWest Health,Minnesota Senior Health Options (MSHO),193.9665,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Xr Ribs Lt Unil W Chest 1 View,,71101,CPT,Facility,Inpatient,,,LT,377,320.45,108.0482,377,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Ribs Lt Unil W Chest 1 View,,71101,CPT,Facility,Outpatient,,,LT,377,320.45,108.0482,377,PrimeWest Health,MinnesotaCare,193.6272,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Xr Ribs Lt Unil W Chest 1 View,,71101,CPT,Facility,Inpatient,,,LT,377,320.45,108.0482,377,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Xr Ribs Lt Unil W Chest 1 View,,71101,CPT,Facility,Both,,,LT,377,320.45,108.0482,377,Sanford Health Plan,Sanford Health Plan,346.84,92,,percent of total billed charges,,
Xr Ribs Lt Unil W Chest 1 View,,71101,CPT,Facility,Outpatient,,,LT,377,320.45,108.0482,377,"UCare Health, Inc.",Individual & Family Plan,212.4395,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Xr Ribs Lt Unil W Chest 1 View,,71101,CPT,Facility,Inpatient,,,LT,377,320.45,108.0482,377,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Xr Ribs Lt Unil W Chest 1 View,,71101,CPT,Facility,Outpatient,,,LT,377,320.45,108.0482,377,"UCare Health, Inc.",Medical Assistance,190.2719,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Ribs Lt Unil W Chest 1 View,,71101,CPT,Facility,Inpatient,,,LT,377,320.45,108.0482,377,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Xr Ribs Lt Unil W Chest 1 View,,71101,CPT,Facility,Outpatient,,,LT,377,320.45,108.0482,377,"UCare Health, Inc.",Medicare Advantage,190.2719,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Ribs Lt Unil W Chest 1 View,,71101,CPT,Facility,Inpatient,,,LT,377,320.45,108.0482,377,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Ribs Lt Unil W Chest 1 View,,71101,CPT,Facility,Outpatient,,,LT,377,320.45,108.0482,377,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),190.2719,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Ribs Lt Unil W Chest 1 View,,71101,CPT,Facility,Inpatient,,,LT,377,320.45,108.0482,377,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Ribs Lt Unil W Chest 1 View,,71101,CPT,Facility,Both,,,LT,377,320.45,108.0482,377,UnitedHealthcare,Individual & Family,354.38,94,,percent of total billed charges,,
Xr Ribs Lt Unil W Chest 1 View,,71101,CPT,Facility,Outpatient,,,LT,377,320.45,108.0482,377,UnitedHealthcare,Medicare Advantage,184.73,49,,percent of total billed charges,,
Xr Ribs Lt Unil W Chest 1 View,,71101,CPT,Facility,Inpatient,,,LT,377,320.45,108.0482,377,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Xr Ribs Lt Unil W Chest 1 View,,71101,CPT,Facility,Outpatient,,,LT,377,320.45,108.0482,377,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,180.96,48,,percent of total billed charges,,100% of DHS outpatient percentage
Xr Ribs Lt Unil W Chest 1 View,,71101,CPT,Facility,Inpatient,,,LT,377,320.45,108.0482,377,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Xr Clavicle Lt,,73000,CPT,Facility,Both,,,LT,286,243.1,81.9676,286,Aetna,Commercial,263.12,92,,percent of total billed charges,,
Xr Clavicle Lt,,73000,CPT,Facility,Outpatient,,,LT,286,243.1,81.9676,286,Aetna,Medicare Advantage,140.14,49,,percent of total billed charges,,
Xr Clavicle Lt,,73000,CPT,Facility,Inpatient,,,LT,286,243.1,81.9676,286,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Xr Clavicle Lt,,73000,CPT,Facility,Both,,,LT,286,243.1,81.9676,286,Aetna,PPO,265.98,93,,percent of total billed charges,,
Xr Clavicle Lt,,73000,CPT,Facility,Both,,,LT,286,243.1,81.9676,286,America's PPO,America's PPO,274.6458,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Xr Clavicle Lt,,73000,CPT,Facility,Both,,,LT,286,243.1,81.9676,286,BlueCross BlueShield Minnesota, Federal Employee Program,281.424,98.4,,percent of total billed charges,,
Xr Clavicle Lt,,73000,CPT,Facility,Both,,,LT,286,243.1,81.9676,286,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,286,100,,percent of total billed charges,,
Xr Clavicle Lt,,73000,CPT,Facility,Both,,,LT,286,243.1,81.9676,286,BlueCross BlueShield Minnesota,High Value Network Plan,257.4,90,,percent of total billed charges,,
Xr Clavicle Lt,,73000,CPT,Facility,Outpatient,,,LT,286,243.1,81.9676,286,BlueCross BlueShield Minnesota,Medicare Advantage,140.14,49,,percent of total billed charges,,
Xr Clavicle Lt,,73000,CPT,Facility,Inpatient,,,LT,286,243.1,81.9676,286,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Xr Clavicle Lt,,73000,CPT,Facility,Both,,,LT,286,243.1,81.9676,286,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,253.3102,88.57,,percent of total billed charges,,
Xr Clavicle Lt,,73000,CPT,Facility,Both,,,LT,286,243.1,81.9676,286,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,81.9676,28.66,,percent of total billed charges,,
Xr Clavicle Lt,,73000,CPT,Facility,Outpatient,,,LT,286,243.1,81.9676,286,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),140.14,49,,percent of total billed charges,,
Xr Clavicle Lt,,73000,CPT,Facility,Inpatient,,,LT,286,243.1,81.9676,286,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Xr Clavicle Lt,,73000,CPT,Facility,Both,,,LT,286,243.1,81.9676,286,CorVel,Worker's Compensation,286,100,,percent of total billed charges,,
Xr Clavicle Lt,,73000,CPT,Facility,Both,,,LT,286,243.1,81.9676,286,First Health Group Corporation,First Health Network,277.42,97,,percent of total billed charges,,
Xr Clavicle Lt,,73000,CPT,Facility,Both,,,LT,286,243.1,81.9676,286,"Health Partners, Inc.",Commercial,270.556,94.6,,percent of total billed charges,,
Xr Clavicle Lt,,73000,CPT,Facility,Outpatient,,,LT,286,243.1,81.9676,286,"Health Partners, Inc.",Medicare Advantage,140.14,49,,percent of total billed charges,,
Xr Clavicle Lt,,73000,CPT,Facility,Inpatient,,,LT,286,243.1,81.9676,286,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Clavicle Lt,,73000,CPT,Facility,Both,,,LT,286,243.1,81.9676,286,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),171.6,60,,percent of total billed charges,,
Xr Clavicle Lt,,73000,CPT,Facility,Both,,,LT,286,243.1,81.9676,286,"Health Partners, Inc.",State of Minnesota Advantage Program,233.09,81.5,,percent of total billed charges,,
Xr Clavicle Lt,,73000,CPT,Facility,Both,,,LT,286,243.1,81.9676,286,"Health Partners, Inc.",State Public Programs,143,50,,percent of total billed charges,,
Xr Clavicle Lt,,73000,CPT,Facility,Both,,,LT,286,243.1,81.9676,286,Humana Insurance Company,Commercial PPO,271.7,95,,percent of total billed charges,,
Xr Clavicle Lt,,73000,CPT,Facility,Outpatient,,,LT,286,243.1,81.9676,286,Humana Insurance Company,Medicare PPO,140.14,49,,percent of total billed charges,,
Xr Clavicle Lt,,73000,CPT,Facility,Inpatient,,,LT,286,243.1,81.9676,286,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Xr Clavicle Lt,,73000,CPT,Facility,Both,,,LT,286,243.1,81.9676,286,Medica,Individual & Family,283.426,99.1,,percent of total billed charges,,
Xr Clavicle Lt,,73000,CPT,Facility,Outpatient,,,LT,286,243.1,81.9676,286,Medica,Medica Advantage Solution,142.428,49.8,,percent of total billed charges,,
Xr Clavicle Lt,,73000,CPT,Facility,Inpatient,,,LT,286,243.1,81.9676,286,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Xr Clavicle Lt,,73000,CPT,Facility,Outpatient,,,LT,286,243.1,81.9676,286,Medica,Medical Assistance,127.556,44.6,,percent of total billed charges,,
Xr Clavicle Lt,,73000,CPT,Facility,Inpatient,,,LT,286,243.1,81.9676,286,Medica,Medical Assistance,,,,,Included in per diem rate,
Xr Clavicle Lt,,73000,CPT,Facility,Outpatient,,,LT,286,243.1,81.9676,286,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,142.428,49.8,,percent of total billed charges,,
Xr Clavicle Lt,,73000,CPT,Facility,Inpatient,,,LT,286,243.1,81.9676,286,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Xr Clavicle Lt,,73000,CPT,Facility,Both,,,LT,286,243.1,81.9676,286,"Multiplan, Inc.","Multiplan, Inc.",268.84,94,,percent of total billed charges,,
Xr Clavicle Lt,,73000,CPT,Facility,Outpatient,,,LT,286,243.1,81.9676,286,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,257.686,90.1,,percent of total billed charges,,
Xr Clavicle Lt,,73000,CPT,Facility,Inpatient,,,LT,286,243.1,81.9676,286,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Xr Clavicle Lt,,73000,CPT,Facility,Both,,,LT,286,243.1,81.9676,286,"Preferred One Administrative Services, INC.",PPO,281.996,98.6,,percent of total billed charges,,
Xr Clavicle Lt,,73000,CPT,Facility,Outpatient,,,LT,286,243.1,81.9676,286,PrimeWest Health,Minnesota Senior Health Options (MSHO),147.147,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Xr Clavicle Lt,,73000,CPT,Facility,Inpatient,,,LT,286,243.1,81.9676,286,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Clavicle Lt,,73000,CPT,Facility,Outpatient,,,LT,286,243.1,81.9676,286,PrimeWest Health,MinnesotaCare,146.8896,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Xr Clavicle Lt,,73000,CPT,Facility,Inpatient,,,LT,286,243.1,81.9676,286,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Xr Clavicle Lt,,73000,CPT,Facility,Both,,,LT,286,243.1,81.9676,286,Sanford Health Plan,Sanford Health Plan,263.12,92,,percent of total billed charges,,
Xr Clavicle Lt,,73000,CPT,Facility,Outpatient,,,LT,286,243.1,81.9676,286,"UCare Health, Inc.",Individual & Family Plan,161.161,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Xr Clavicle Lt,,73000,CPT,Facility,Inpatient,,,LT,286,243.1,81.9676,286,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Xr Clavicle Lt,,73000,CPT,Facility,Outpatient,,,LT,286,243.1,81.9676,286,"UCare Health, Inc.",Medical Assistance,144.3442,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Clavicle Lt,,73000,CPT,Facility,Inpatient,,,LT,286,243.1,81.9676,286,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Xr Clavicle Lt,,73000,CPT,Facility,Outpatient,,,LT,286,243.1,81.9676,286,"UCare Health, Inc.",Medicare Advantage,144.3442,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Clavicle Lt,,73000,CPT,Facility,Inpatient,,,LT,286,243.1,81.9676,286,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Clavicle Lt,,73000,CPT,Facility,Outpatient,,,LT,286,243.1,81.9676,286,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),144.3442,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Clavicle Lt,,73000,CPT,Facility,Inpatient,,,LT,286,243.1,81.9676,286,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Clavicle Lt,,73000,CPT,Facility,Both,,,LT,286,243.1,81.9676,286,UnitedHealthcare,Individual & Family,268.84,94,,percent of total billed charges,,
Xr Clavicle Lt,,73000,CPT,Facility,Outpatient,,,LT,286,243.1,81.9676,286,UnitedHealthcare,Medicare Advantage,140.14,49,,percent of total billed charges,,
Xr Clavicle Lt,,73000,CPT,Facility,Inpatient,,,LT,286,243.1,81.9676,286,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Xr Clavicle Lt,,73000,CPT,Facility,Outpatient,,,LT,286,243.1,81.9676,286,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,137.28,48,,percent of total billed charges,,100% of DHS outpatient percentage
Xr Clavicle Lt,,73000,CPT,Facility,Inpatient,,,LT,286,243.1,81.9676,286,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Xr Scapula Lt,,73010,CPT,Facility,Both,,,LT,224,190.4,64.1984,224,Aetna,Commercial,206.08,92,,percent of total billed charges,,
Xr Scapula Lt,,73010,CPT,Facility,Outpatient,,,LT,224,190.4,64.1984,224,Aetna,Medicare Advantage,109.76,49,,percent of total billed charges,,
Xr Scapula Lt,,73010,CPT,Facility,Inpatient,,,LT,224,190.4,64.1984,224,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Xr Scapula Lt,,73010,CPT,Facility,Both,,,LT,224,190.4,64.1984,224,Aetna,PPO,208.32,93,,percent of total billed charges,,
Xr Scapula Lt,,73010,CPT,Facility,Both,,,LT,224,190.4,64.1984,224,America's PPO,America's PPO,215.1072,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Xr Scapula Lt,,73010,CPT,Facility,Both,,,LT,224,190.4,64.1984,224,BlueCross BlueShield Minnesota, Federal Employee Program,220.416,98.4,,percent of total billed charges,,
Xr Scapula Lt,,73010,CPT,Facility,Both,,,LT,224,190.4,64.1984,224,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,224,100,,percent of total billed charges,,
Xr Scapula Lt,,73010,CPT,Facility,Both,,,LT,224,190.4,64.1984,224,BlueCross BlueShield Minnesota,High Value Network Plan,201.6,90,,percent of total billed charges,,
Xr Scapula Lt,,73010,CPT,Facility,Outpatient,,,LT,224,190.4,64.1984,224,BlueCross BlueShield Minnesota,Medicare Advantage,109.76,49,,percent of total billed charges,,
Xr Scapula Lt,,73010,CPT,Facility,Inpatient,,,LT,224,190.4,64.1984,224,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Xr Scapula Lt,,73010,CPT,Facility,Both,,,LT,224,190.4,64.1984,224,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,198.3968,88.57,,percent of total billed charges,,
Xr Scapula Lt,,73010,CPT,Facility,Both,,,LT,224,190.4,64.1984,224,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,64.1984,28.66,,percent of total billed charges,,
Xr Scapula Lt,,73010,CPT,Facility,Outpatient,,,LT,224,190.4,64.1984,224,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),109.76,49,,percent of total billed charges,,
Xr Scapula Lt,,73010,CPT,Facility,Inpatient,,,LT,224,190.4,64.1984,224,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Xr Scapula Lt,,73010,CPT,Facility,Both,,,LT,224,190.4,64.1984,224,CorVel,Worker's Compensation,224,100,,percent of total billed charges,,
Xr Scapula Lt,,73010,CPT,Facility,Both,,,LT,224,190.4,64.1984,224,First Health Group Corporation,First Health Network,217.28,97,,percent of total billed charges,,
Xr Scapula Lt,,73010,CPT,Facility,Both,,,LT,224,190.4,64.1984,224,"Health Partners, Inc.",Commercial,211.904,94.6,,percent of total billed charges,,
Xr Scapula Lt,,73010,CPT,Facility,Outpatient,,,LT,224,190.4,64.1984,224,"Health Partners, Inc.",Medicare Advantage,109.76,49,,percent of total billed charges,,
Xr Scapula Lt,,73010,CPT,Facility,Inpatient,,,LT,224,190.4,64.1984,224,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Scapula Lt,,73010,CPT,Facility,Both,,,LT,224,190.4,64.1984,224,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),134.4,60,,percent of total billed charges,,
Xr Scapula Lt,,73010,CPT,Facility,Both,,,LT,224,190.4,64.1984,224,"Health Partners, Inc.",State of Minnesota Advantage Program,182.56,81.5,,percent of total billed charges,,
Xr Scapula Lt,,73010,CPT,Facility,Both,,,LT,224,190.4,64.1984,224,"Health Partners, Inc.",State Public Programs,112,50,,percent of total billed charges,,
Xr Scapula Lt,,73010,CPT,Facility,Both,,,LT,224,190.4,64.1984,224,Humana Insurance Company,Commercial PPO,212.8,95,,percent of total billed charges,,
Xr Scapula Lt,,73010,CPT,Facility,Outpatient,,,LT,224,190.4,64.1984,224,Humana Insurance Company,Medicare PPO,109.76,49,,percent of total billed charges,,
Xr Scapula Lt,,73010,CPT,Facility,Inpatient,,,LT,224,190.4,64.1984,224,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Xr Scapula Lt,,73010,CPT,Facility,Both,,,LT,224,190.4,64.1984,224,Medica,Individual & Family,221.984,99.1,,percent of total billed charges,,
Xr Scapula Lt,,73010,CPT,Facility,Outpatient,,,LT,224,190.4,64.1984,224,Medica,Medica Advantage Solution,111.552,49.8,,percent of total billed charges,,
Xr Scapula Lt,,73010,CPT,Facility,Inpatient,,,LT,224,190.4,64.1984,224,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Xr Scapula Lt,,73010,CPT,Facility,Outpatient,,,LT,224,190.4,64.1984,224,Medica,Medical Assistance,99.904,44.6,,percent of total billed charges,,
Xr Scapula Lt,,73010,CPT,Facility,Inpatient,,,LT,224,190.4,64.1984,224,Medica,Medical Assistance,,,,,Included in per diem rate,
Xr Scapula Lt,,73010,CPT,Facility,Outpatient,,,LT,224,190.4,64.1984,224,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,111.552,49.8,,percent of total billed charges,,
Xr Scapula Lt,,73010,CPT,Facility,Inpatient,,,LT,224,190.4,64.1984,224,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Xr Scapula Lt,,73010,CPT,Facility,Both,,,LT,224,190.4,64.1984,224,"Multiplan, Inc.","Multiplan, Inc.",210.56,94,,percent of total billed charges,,
Xr Scapula Lt,,73010,CPT,Facility,Outpatient,,,LT,224,190.4,64.1984,224,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,201.824,90.1,,percent of total billed charges,,
Xr Scapula Lt,,73010,CPT,Facility,Inpatient,,,LT,224,190.4,64.1984,224,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Xr Scapula Lt,,73010,CPT,Facility,Both,,,LT,224,190.4,64.1984,224,"Preferred One Administrative Services, INC.",PPO,220.864,98.6,,percent of total billed charges,,
Xr Scapula Lt,,73010,CPT,Facility,Outpatient,,,LT,224,190.4,64.1984,224,PrimeWest Health,Minnesota Senior Health Options (MSHO),115.248,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Xr Scapula Lt,,73010,CPT,Facility,Inpatient,,,LT,224,190.4,64.1984,224,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Scapula Lt,,73010,CPT,Facility,Outpatient,,,LT,224,190.4,64.1984,224,PrimeWest Health,MinnesotaCare,115.0464,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Xr Scapula Lt,,73010,CPT,Facility,Inpatient,,,LT,224,190.4,64.1984,224,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Xr Scapula Lt,,73010,CPT,Facility,Both,,,LT,224,190.4,64.1984,224,Sanford Health Plan,Sanford Health Plan,206.08,92,,percent of total billed charges,,
Xr Scapula Lt,,73010,CPT,Facility,Outpatient,,,LT,224,190.4,64.1984,224,"UCare Health, Inc.",Individual & Family Plan,126.224,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Xr Scapula Lt,,73010,CPT,Facility,Inpatient,,,LT,224,190.4,64.1984,224,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Xr Scapula Lt,,73010,CPT,Facility,Outpatient,,,LT,224,190.4,64.1984,224,"UCare Health, Inc.",Medical Assistance,113.0528,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Scapula Lt,,73010,CPT,Facility,Inpatient,,,LT,224,190.4,64.1984,224,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Xr Scapula Lt,,73010,CPT,Facility,Outpatient,,,LT,224,190.4,64.1984,224,"UCare Health, Inc.",Medicare Advantage,113.0528,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Scapula Lt,,73010,CPT,Facility,Inpatient,,,LT,224,190.4,64.1984,224,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Scapula Lt,,73010,CPT,Facility,Outpatient,,,LT,224,190.4,64.1984,224,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),113.0528,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Scapula Lt,,73010,CPT,Facility,Inpatient,,,LT,224,190.4,64.1984,224,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Scapula Lt,,73010,CPT,Facility,Both,,,LT,224,190.4,64.1984,224,UnitedHealthcare,Individual & Family,210.56,94,,percent of total billed charges,,
Xr Scapula Lt,,73010,CPT,Facility,Outpatient,,,LT,224,190.4,64.1984,224,UnitedHealthcare,Medicare Advantage,109.76,49,,percent of total billed charges,,
Xr Scapula Lt,,73010,CPT,Facility,Inpatient,,,LT,224,190.4,64.1984,224,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Xr Scapula Lt,,73010,CPT,Facility,Outpatient,,,LT,224,190.4,64.1984,224,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,107.52,48,,percent of total billed charges,,100% of DHS outpatient percentage
Xr Scapula Lt,,73010,CPT,Facility,Inpatient,,,LT,224,190.4,64.1984,224,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Xr Shoulder Lt 1 View,,73020,CPT,Facility,Both,,,LT,224,190.4,64.1984,224,Aetna,Commercial,206.08,92,,percent of total billed charges,,
Xr Shoulder Lt 1 View,,73020,CPT,Facility,Outpatient,,,LT,224,190.4,64.1984,224,Aetna,Medicare Advantage,109.76,49,,percent of total billed charges,,
Xr Shoulder Lt 1 View,,73020,CPT,Facility,Inpatient,,,LT,224,190.4,64.1984,224,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Xr Shoulder Lt 1 View,,73020,CPT,Facility,Both,,,LT,224,190.4,64.1984,224,Aetna,PPO,208.32,93,,percent of total billed charges,,
Xr Shoulder Lt 1 View,,73020,CPT,Facility,Both,,,LT,224,190.4,64.1984,224,America's PPO,America's PPO,215.1072,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Xr Shoulder Lt 1 View,,73020,CPT,Facility,Both,,,LT,224,190.4,64.1984,224,BlueCross BlueShield Minnesota, Federal Employee Program,220.416,98.4,,percent of total billed charges,,
Xr Shoulder Lt 1 View,,73020,CPT,Facility,Both,,,LT,224,190.4,64.1984,224,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,224,100,,percent of total billed charges,,
Xr Shoulder Lt 1 View,,73020,CPT,Facility,Both,,,LT,224,190.4,64.1984,224,BlueCross BlueShield Minnesota,High Value Network Plan,201.6,90,,percent of total billed charges,,
Xr Shoulder Lt 1 View,,73020,CPT,Facility,Outpatient,,,LT,224,190.4,64.1984,224,BlueCross BlueShield Minnesota,Medicare Advantage,109.76,49,,percent of total billed charges,,
Xr Shoulder Lt 1 View,,73020,CPT,Facility,Inpatient,,,LT,224,190.4,64.1984,224,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Xr Shoulder Lt 1 View,,73020,CPT,Facility,Both,,,LT,224,190.4,64.1984,224,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,198.3968,88.57,,percent of total billed charges,,
Xr Shoulder Lt 1 View,,73020,CPT,Facility,Both,,,LT,224,190.4,64.1984,224,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,64.1984,28.66,,percent of total billed charges,,
Xr Shoulder Lt 1 View,,73020,CPT,Facility,Outpatient,,,LT,224,190.4,64.1984,224,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),109.76,49,,percent of total billed charges,,
Xr Shoulder Lt 1 View,,73020,CPT,Facility,Inpatient,,,LT,224,190.4,64.1984,224,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Xr Shoulder Lt 1 View,,73020,CPT,Facility,Both,,,LT,224,190.4,64.1984,224,CorVel,Worker's Compensation,224,100,,percent of total billed charges,,
Xr Shoulder Lt 1 View,,73020,CPT,Facility,Both,,,LT,224,190.4,64.1984,224,First Health Group Corporation,First Health Network,217.28,97,,percent of total billed charges,,
Xr Shoulder Lt 1 View,,73020,CPT,Facility,Both,,,LT,224,190.4,64.1984,224,"Health Partners, Inc.",Commercial,211.904,94.6,,percent of total billed charges,,
Xr Shoulder Lt 1 View,,73020,CPT,Facility,Outpatient,,,LT,224,190.4,64.1984,224,"Health Partners, Inc.",Medicare Advantage,109.76,49,,percent of total billed charges,,
Xr Shoulder Lt 1 View,,73020,CPT,Facility,Inpatient,,,LT,224,190.4,64.1984,224,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Shoulder Lt 1 View,,73020,CPT,Facility,Both,,,LT,224,190.4,64.1984,224,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),134.4,60,,percent of total billed charges,,
Xr Shoulder Lt 1 View,,73020,CPT,Facility,Both,,,LT,224,190.4,64.1984,224,"Health Partners, Inc.",State of Minnesota Advantage Program,182.56,81.5,,percent of total billed charges,,
Xr Shoulder Lt 1 View,,73020,CPT,Facility,Both,,,LT,224,190.4,64.1984,224,"Health Partners, Inc.",State Public Programs,112,50,,percent of total billed charges,,
Xr Shoulder Lt 1 View,,73020,CPT,Facility,Both,,,LT,224,190.4,64.1984,224,Humana Insurance Company,Commercial PPO,212.8,95,,percent of total billed charges,,
Xr Shoulder Lt 1 View,,73020,CPT,Facility,Outpatient,,,LT,224,190.4,64.1984,224,Humana Insurance Company,Medicare PPO,109.76,49,,percent of total billed charges,,
Xr Shoulder Lt 1 View,,73020,CPT,Facility,Inpatient,,,LT,224,190.4,64.1984,224,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Xr Shoulder Lt 1 View,,73020,CPT,Facility,Both,,,LT,224,190.4,64.1984,224,Medica,Individual & Family,221.984,99.1,,percent of total billed charges,,
Xr Shoulder Lt 1 View,,73020,CPT,Facility,Outpatient,,,LT,224,190.4,64.1984,224,Medica,Medica Advantage Solution,111.552,49.8,,percent of total billed charges,,
Xr Shoulder Lt 1 View,,73020,CPT,Facility,Inpatient,,,LT,224,190.4,64.1984,224,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Xr Shoulder Lt 1 View,,73020,CPT,Facility,Outpatient,,,LT,224,190.4,64.1984,224,Medica,Medical Assistance,99.904,44.6,,percent of total billed charges,,
Xr Shoulder Lt 1 View,,73020,CPT,Facility,Inpatient,,,LT,224,190.4,64.1984,224,Medica,Medical Assistance,,,,,Included in per diem rate,
Xr Shoulder Lt 1 View,,73020,CPT,Facility,Outpatient,,,LT,224,190.4,64.1984,224,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,111.552,49.8,,percent of total billed charges,,
Xr Shoulder Lt 1 View,,73020,CPT,Facility,Inpatient,,,LT,224,190.4,64.1984,224,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Xr Shoulder Lt 1 View,,73020,CPT,Facility,Both,,,LT,224,190.4,64.1984,224,"Multiplan, Inc.","Multiplan, Inc.",210.56,94,,percent of total billed charges,,
Xr Shoulder Lt 1 View,,73020,CPT,Facility,Outpatient,,,LT,224,190.4,64.1984,224,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,201.824,90.1,,percent of total billed charges,,
Xr Shoulder Lt 1 View,,73020,CPT,Facility,Inpatient,,,LT,224,190.4,64.1984,224,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Xr Shoulder Lt 1 View,,73020,CPT,Facility,Both,,,LT,224,190.4,64.1984,224,"Preferred One Administrative Services, INC.",PPO,220.864,98.6,,percent of total billed charges,,
Xr Shoulder Lt 1 View,,73020,CPT,Facility,Outpatient,,,LT,224,190.4,64.1984,224,PrimeWest Health,Minnesota Senior Health Options (MSHO),115.248,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Xr Shoulder Lt 1 View,,73020,CPT,Facility,Inpatient,,,LT,224,190.4,64.1984,224,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Shoulder Lt 1 View,,73020,CPT,Facility,Outpatient,,,LT,224,190.4,64.1984,224,PrimeWest Health,MinnesotaCare,115.0464,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Xr Shoulder Lt 1 View,,73020,CPT,Facility,Inpatient,,,LT,224,190.4,64.1984,224,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Xr Shoulder Lt 1 View,,73020,CPT,Facility,Both,,,LT,224,190.4,64.1984,224,Sanford Health Plan,Sanford Health Plan,206.08,92,,percent of total billed charges,,
Xr Shoulder Lt 1 View,,73020,CPT,Facility,Outpatient,,,LT,224,190.4,64.1984,224,"UCare Health, Inc.",Individual & Family Plan,126.224,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Xr Shoulder Lt 1 View,,73020,CPT,Facility,Inpatient,,,LT,224,190.4,64.1984,224,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Xr Shoulder Lt 1 View,,73020,CPT,Facility,Outpatient,,,LT,224,190.4,64.1984,224,"UCare Health, Inc.",Medical Assistance,113.0528,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Shoulder Lt 1 View,,73020,CPT,Facility,Inpatient,,,LT,224,190.4,64.1984,224,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Xr Shoulder Lt 1 View,,73020,CPT,Facility,Outpatient,,,LT,224,190.4,64.1984,224,"UCare Health, Inc.",Medicare Advantage,113.0528,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Shoulder Lt 1 View,,73020,CPT,Facility,Inpatient,,,LT,224,190.4,64.1984,224,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Shoulder Lt 1 View,,73020,CPT,Facility,Outpatient,,,LT,224,190.4,64.1984,224,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),113.0528,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Shoulder Lt 1 View,,73020,CPT,Facility,Inpatient,,,LT,224,190.4,64.1984,224,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Shoulder Lt 1 View,,73020,CPT,Facility,Both,,,LT,224,190.4,64.1984,224,UnitedHealthcare,Individual & Family,210.56,94,,percent of total billed charges,,
Xr Shoulder Lt 1 View,,73020,CPT,Facility,Outpatient,,,LT,224,190.4,64.1984,224,UnitedHealthcare,Medicare Advantage,109.76,49,,percent of total billed charges,,
Xr Shoulder Lt 1 View,,73020,CPT,Facility,Inpatient,,,LT,224,190.4,64.1984,224,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Xr Shoulder Lt 1 View,,73020,CPT,Facility,Outpatient,,,LT,224,190.4,64.1984,224,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,107.52,48,,percent of total billed charges,,100% of DHS outpatient percentage
Xr Shoulder Lt 1 View,,73020,CPT,Facility,Inpatient,,,LT,224,190.4,64.1984,224,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Xr Shoulder Routine Lt 2 Or More Views,,73030,CPT,Facility,Both,,,LT,281,238.85,80.5346,281,Aetna,Commercial,258.52,92,,percent of total billed charges,,
Xr Shoulder Routine Lt 2 Or More Views,,73030,CPT,Facility,Outpatient,,,LT,281,238.85,80.5346,281,Aetna,Medicare Advantage,137.69,49,,percent of total billed charges,,
Xr Shoulder Routine Lt 2 Or More Views,,73030,CPT,Facility,Inpatient,,,LT,281,238.85,80.5346,281,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Xr Shoulder Routine Lt 2 Or More Views,,73030,CPT,Facility,Both,,,LT,281,238.85,80.5346,281,Aetna,PPO,261.33,93,,percent of total billed charges,,
Xr Shoulder Routine Lt 2 Or More Views,,73030,CPT,Facility,Both,,,LT,281,238.85,80.5346,281,America's PPO,America's PPO,269.8443,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Xr Shoulder Routine Lt 2 Or More Views,,73030,CPT,Facility,Both,,,LT,281,238.85,80.5346,281,BlueCross BlueShield Minnesota, Federal Employee Program,276.504,98.4,,percent of total billed charges,,
Xr Shoulder Routine Lt 2 Or More Views,,73030,CPT,Facility,Both,,,LT,281,238.85,80.5346,281,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,281,100,,percent of total billed charges,,
Xr Shoulder Routine Lt 2 Or More Views,,73030,CPT,Facility,Both,,,LT,281,238.85,80.5346,281,BlueCross BlueShield Minnesota,High Value Network Plan,252.9,90,,percent of total billed charges,,
Xr Shoulder Routine Lt 2 Or More Views,,73030,CPT,Facility,Outpatient,,,LT,281,238.85,80.5346,281,BlueCross BlueShield Minnesota,Medicare Advantage,137.69,49,,percent of total billed charges,,
Xr Shoulder Routine Lt 2 Or More Views,,73030,CPT,Facility,Inpatient,,,LT,281,238.85,80.5346,281,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Xr Shoulder Routine Lt 2 Or More Views,,73030,CPT,Facility,Both,,,LT,281,238.85,80.5346,281,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,248.8817,88.57,,percent of total billed charges,,
Xr Shoulder Routine Lt 2 Or More Views,,73030,CPT,Facility,Both,,,LT,281,238.85,80.5346,281,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,80.5346,28.66,,percent of total billed charges,,
Xr Shoulder Routine Lt 2 Or More Views,,73030,CPT,Facility,Outpatient,,,LT,281,238.85,80.5346,281,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),137.69,49,,percent of total billed charges,,
Xr Shoulder Routine Lt 2 Or More Views,,73030,CPT,Facility,Inpatient,,,LT,281,238.85,80.5346,281,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Xr Shoulder Routine Lt 2 Or More Views,,73030,CPT,Facility,Both,,,LT,281,238.85,80.5346,281,CorVel,Worker's Compensation,281,100,,percent of total billed charges,,
Xr Shoulder Routine Lt 2 Or More Views,,73030,CPT,Facility,Both,,,LT,281,238.85,80.5346,281,First Health Group Corporation,First Health Network,272.57,97,,percent of total billed charges,,
Xr Shoulder Routine Lt 2 Or More Views,,73030,CPT,Facility,Both,,,LT,281,238.85,80.5346,281,"Health Partners, Inc.",Commercial,265.826,94.6,,percent of total billed charges,,
Xr Shoulder Routine Lt 2 Or More Views,,73030,CPT,Facility,Outpatient,,,LT,281,238.85,80.5346,281,"Health Partners, Inc.",Medicare Advantage,137.69,49,,percent of total billed charges,,
Xr Shoulder Routine Lt 2 Or More Views,,73030,CPT,Facility,Inpatient,,,LT,281,238.85,80.5346,281,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Shoulder Routine Lt 2 Or More Views,,73030,CPT,Facility,Both,,,LT,281,238.85,80.5346,281,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),168.6,60,,percent of total billed charges,,
Xr Shoulder Routine Lt 2 Or More Views,,73030,CPT,Facility,Both,,,LT,281,238.85,80.5346,281,"Health Partners, Inc.",State of Minnesota Advantage Program,229.015,81.5,,percent of total billed charges,,
Xr Shoulder Routine Lt 2 Or More Views,,73030,CPT,Facility,Both,,,LT,281,238.85,80.5346,281,"Health Partners, Inc.",State Public Programs,140.5,50,,percent of total billed charges,,
Xr Shoulder Routine Lt 2 Or More Views,,73030,CPT,Facility,Both,,,LT,281,238.85,80.5346,281,Humana Insurance Company,Commercial PPO,266.95,95,,percent of total billed charges,,
Xr Shoulder Routine Lt 2 Or More Views,,73030,CPT,Facility,Outpatient,,,LT,281,238.85,80.5346,281,Humana Insurance Company,Medicare PPO,137.69,49,,percent of total billed charges,,
Xr Shoulder Routine Lt 2 Or More Views,,73030,CPT,Facility,Inpatient,,,LT,281,238.85,80.5346,281,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Xr Shoulder Routine Lt 2 Or More Views,,73030,CPT,Facility,Both,,,LT,281,238.85,80.5346,281,Medica,Individual & Family,278.471,99.1,,percent of total billed charges,,
Xr Shoulder Routine Lt 2 Or More Views,,73030,CPT,Facility,Outpatient,,,LT,281,238.85,80.5346,281,Medica,Medica Advantage Solution,139.938,49.8,,percent of total billed charges,,
Xr Shoulder Routine Lt 2 Or More Views,,73030,CPT,Facility,Inpatient,,,LT,281,238.85,80.5346,281,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Xr Shoulder Routine Lt 2 Or More Views,,73030,CPT,Facility,Outpatient,,,LT,281,238.85,80.5346,281,Medica,Medical Assistance,125.326,44.6,,percent of total billed charges,,
Xr Shoulder Routine Lt 2 Or More Views,,73030,CPT,Facility,Inpatient,,,LT,281,238.85,80.5346,281,Medica,Medical Assistance,,,,,Included in per diem rate,
Xr Shoulder Routine Lt 2 Or More Views,,73030,CPT,Facility,Outpatient,,,LT,281,238.85,80.5346,281,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,139.938,49.8,,percent of total billed charges,,
Xr Shoulder Routine Lt 2 Or More Views,,73030,CPT,Facility,Inpatient,,,LT,281,238.85,80.5346,281,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Xr Shoulder Routine Lt 2 Or More Views,,73030,CPT,Facility,Both,,,LT,281,238.85,80.5346,281,"Multiplan, Inc.","Multiplan, Inc.",264.14,94,,percent of total billed charges,,
Xr Shoulder Routine Lt 2 Or More Views,,73030,CPT,Facility,Outpatient,,,LT,281,238.85,80.5346,281,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,253.181,90.1,,percent of total billed charges,,
Xr Shoulder Routine Lt 2 Or More Views,,73030,CPT,Facility,Inpatient,,,LT,281,238.85,80.5346,281,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Xr Shoulder Routine Lt 2 Or More Views,,73030,CPT,Facility,Both,,,LT,281,238.85,80.5346,281,"Preferred One Administrative Services, INC.",PPO,277.066,98.6,,percent of total billed charges,,
Xr Shoulder Routine Lt 2 Or More Views,,73030,CPT,Facility,Outpatient,,,LT,281,238.85,80.5346,281,PrimeWest Health,Minnesota Senior Health Options (MSHO),144.5745,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Xr Shoulder Routine Lt 2 Or More Views,,73030,CPT,Facility,Inpatient,,,LT,281,238.85,80.5346,281,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Shoulder Routine Lt 2 Or More Views,,73030,CPT,Facility,Outpatient,,,LT,281,238.85,80.5346,281,PrimeWest Health,MinnesotaCare,144.3216,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Xr Shoulder Routine Lt 2 Or More Views,,73030,CPT,Facility,Inpatient,,,LT,281,238.85,80.5346,281,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Xr Shoulder Routine Lt 2 Or More Views,,73030,CPT,Facility,Both,,,LT,281,238.85,80.5346,281,Sanford Health Plan,Sanford Health Plan,258.52,92,,percent of total billed charges,,
Xr Shoulder Routine Lt 2 Or More Views,,73030,CPT,Facility,Outpatient,,,LT,281,238.85,80.5346,281,"UCare Health, Inc.",Individual & Family Plan,158.3435,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Xr Shoulder Routine Lt 2 Or More Views,,73030,CPT,Facility,Inpatient,,,LT,281,238.85,80.5346,281,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Xr Shoulder Routine Lt 2 Or More Views,,73030,CPT,Facility,Outpatient,,,LT,281,238.85,80.5346,281,"UCare Health, Inc.",Medical Assistance,141.8207,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Shoulder Routine Lt 2 Or More Views,,73030,CPT,Facility,Inpatient,,,LT,281,238.85,80.5346,281,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Xr Shoulder Routine Lt 2 Or More Views,,73030,CPT,Facility,Outpatient,,,LT,281,238.85,80.5346,281,"UCare Health, Inc.",Medicare Advantage,141.8207,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Shoulder Routine Lt 2 Or More Views,,73030,CPT,Facility,Inpatient,,,LT,281,238.85,80.5346,281,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Shoulder Routine Lt 2 Or More Views,,73030,CPT,Facility,Outpatient,,,LT,281,238.85,80.5346,281,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),141.8207,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Shoulder Routine Lt 2 Or More Views,,73030,CPT,Facility,Inpatient,,,LT,281,238.85,80.5346,281,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Shoulder Routine Lt 2 Or More Views,,73030,CPT,Facility,Both,,,LT,281,238.85,80.5346,281,UnitedHealthcare,Individual & Family,264.14,94,,percent of total billed charges,,
Xr Shoulder Routine Lt 2 Or More Views,,73030,CPT,Facility,Outpatient,,,LT,281,238.85,80.5346,281,UnitedHealthcare,Medicare Advantage,137.69,49,,percent of total billed charges,,
Xr Shoulder Routine Lt 2 Or More Views,,73030,CPT,Facility,Inpatient,,,LT,281,238.85,80.5346,281,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Xr Shoulder Routine Lt 2 Or More Views,,73030,CPT,Facility,Outpatient,,,LT,281,238.85,80.5346,281,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,134.88,48,,percent of total billed charges,,100% of DHS outpatient percentage
Xr Shoulder Routine Lt 2 Or More Views,,73030,CPT,Facility,Inpatient,,,LT,281,238.85,80.5346,281,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Xr Humerus Routine Lt 2 Views,,73060,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,Aetna,Commercial,237.36,92,,percent of total billed charges,,
Xr Humerus Routine Lt 2 Views,,73060,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,Aetna,Medicare Advantage,126.42,49,,percent of total billed charges,,
Xr Humerus Routine Lt 2 Views,,73060,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Xr Humerus Routine Lt 2 Views,,73060,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,Aetna,PPO,239.94,93,,percent of total billed charges,,
Xr Humerus Routine Lt 2 Views,,73060,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,America's PPO,America's PPO,247.7574,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Xr Humerus Routine Lt 2 Views,,73060,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota, Federal Employee Program,253.872,98.4,,percent of total billed charges,,
Xr Humerus Routine Lt 2 Views,,73060,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,258,100,,percent of total billed charges,,
Xr Humerus Routine Lt 2 Views,,73060,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,High Value Network Plan,232.2,90,,percent of total billed charges,,
Xr Humerus Routine Lt 2 Views,,73060,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,Medicare Advantage,126.42,49,,percent of total billed charges,,
Xr Humerus Routine Lt 2 Views,,73060,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Xr Humerus Routine Lt 2 Views,,73060,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,228.5106,88.57,,percent of total billed charges,,
Xr Humerus Routine Lt 2 Views,,73060,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,73.9428,28.66,,percent of total billed charges,,
Xr Humerus Routine Lt 2 Views,,73060,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),126.42,49,,percent of total billed charges,,
Xr Humerus Routine Lt 2 Views,,73060,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Xr Humerus Routine Lt 2 Views,,73060,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,CorVel,Worker's Compensation,258,100,,percent of total billed charges,,
Xr Humerus Routine Lt 2 Views,,73060,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,First Health Group Corporation,First Health Network,250.26,97,,percent of total billed charges,,
Xr Humerus Routine Lt 2 Views,,73060,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,"Health Partners, Inc.",Commercial,244.068,94.6,,percent of total billed charges,,
Xr Humerus Routine Lt 2 Views,,73060,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,"Health Partners, Inc.",Medicare Advantage,126.42,49,,percent of total billed charges,,
Xr Humerus Routine Lt 2 Views,,73060,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Humerus Routine Lt 2 Views,,73060,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),154.8,60,,percent of total billed charges,,
Xr Humerus Routine Lt 2 Views,,73060,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,"Health Partners, Inc.",State of Minnesota Advantage Program,210.27,81.5,,percent of total billed charges,,
Xr Humerus Routine Lt 2 Views,,73060,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,"Health Partners, Inc.",State Public Programs,129,50,,percent of total billed charges,,
Xr Humerus Routine Lt 2 Views,,73060,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,Humana Insurance Company,Commercial PPO,245.1,95,,percent of total billed charges,,
Xr Humerus Routine Lt 2 Views,,73060,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,Humana Insurance Company,Medicare PPO,126.42,49,,percent of total billed charges,,
Xr Humerus Routine Lt 2 Views,,73060,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Xr Humerus Routine Lt 2 Views,,73060,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,Medica,Individual & Family,255.678,99.1,,percent of total billed charges,,
Xr Humerus Routine Lt 2 Views,,73060,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,Medica,Medica Advantage Solution,128.484,49.8,,percent of total billed charges,,
Xr Humerus Routine Lt 2 Views,,73060,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Xr Humerus Routine Lt 2 Views,,73060,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,Medica,Medical Assistance,115.068,44.6,,percent of total billed charges,,
Xr Humerus Routine Lt 2 Views,,73060,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,Medica,Medical Assistance,,,,,Included in per diem rate,
Xr Humerus Routine Lt 2 Views,,73060,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,128.484,49.8,,percent of total billed charges,,
Xr Humerus Routine Lt 2 Views,,73060,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Xr Humerus Routine Lt 2 Views,,73060,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,"Multiplan, Inc.","Multiplan, Inc.",242.52,94,,percent of total billed charges,,
Xr Humerus Routine Lt 2 Views,,73060,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,232.458,90.1,,percent of total billed charges,,
Xr Humerus Routine Lt 2 Views,,73060,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Xr Humerus Routine Lt 2 Views,,73060,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,"Preferred One Administrative Services, INC.",PPO,254.388,98.6,,percent of total billed charges,,
Xr Humerus Routine Lt 2 Views,,73060,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,PrimeWest Health,Minnesota Senior Health Options (MSHO),132.741,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Xr Humerus Routine Lt 2 Views,,73060,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Humerus Routine Lt 2 Views,,73060,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,PrimeWest Health,MinnesotaCare,132.5088,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Xr Humerus Routine Lt 2 Views,,73060,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Xr Humerus Routine Lt 2 Views,,73060,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,Sanford Health Plan,Sanford Health Plan,237.36,92,,percent of total billed charges,,
Xr Humerus Routine Lt 2 Views,,73060,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,"UCare Health, Inc.",Individual & Family Plan,145.383,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Xr Humerus Routine Lt 2 Views,,73060,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Xr Humerus Routine Lt 2 Views,,73060,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,"UCare Health, Inc.",Medical Assistance,130.2126,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Humerus Routine Lt 2 Views,,73060,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Xr Humerus Routine Lt 2 Views,,73060,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,"UCare Health, Inc.",Medicare Advantage,130.2126,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Humerus Routine Lt 2 Views,,73060,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Humerus Routine Lt 2 Views,,73060,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),130.2126,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Humerus Routine Lt 2 Views,,73060,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Humerus Routine Lt 2 Views,,73060,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,UnitedHealthcare,Individual & Family,242.52,94,,percent of total billed charges,,
Xr Humerus Routine Lt 2 Views,,73060,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,UnitedHealthcare,Medicare Advantage,126.42,49,,percent of total billed charges,,
Xr Humerus Routine Lt 2 Views,,73060,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Xr Humerus Routine Lt 2 Views,,73060,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,123.84,48,,percent of total billed charges,,100% of DHS outpatient percentage
Xr Humerus Routine Lt 2 Views,,73060,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Xr Elbow Lt 2 Views,,73070,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,Aetna,Commercial,237.36,92,,percent of total billed charges,,
Xr Elbow Lt 2 Views,,73070,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,Aetna,Medicare Advantage,126.42,49,,percent of total billed charges,,
Xr Elbow Lt 2 Views,,73070,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Xr Elbow Lt 2 Views,,73070,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,Aetna,PPO,239.94,93,,percent of total billed charges,,
Xr Elbow Lt 2 Views,,73070,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,America's PPO,America's PPO,247.7574,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Xr Elbow Lt 2 Views,,73070,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota, Federal Employee Program,253.872,98.4,,percent of total billed charges,,
Xr Elbow Lt 2 Views,,73070,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,258,100,,percent of total billed charges,,
Xr Elbow Lt 2 Views,,73070,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,High Value Network Plan,232.2,90,,percent of total billed charges,,
Xr Elbow Lt 2 Views,,73070,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,Medicare Advantage,126.42,49,,percent of total billed charges,,
Xr Elbow Lt 2 Views,,73070,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Xr Elbow Lt 2 Views,,73070,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,228.5106,88.57,,percent of total billed charges,,
Xr Elbow Lt 2 Views,,73070,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,73.9428,28.66,,percent of total billed charges,,
Xr Elbow Lt 2 Views,,73070,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),126.42,49,,percent of total billed charges,,
Xr Elbow Lt 2 Views,,73070,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Xr Elbow Lt 2 Views,,73070,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,CorVel,Worker's Compensation,258,100,,percent of total billed charges,,
Xr Elbow Lt 2 Views,,73070,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,First Health Group Corporation,First Health Network,250.26,97,,percent of total billed charges,,
Xr Elbow Lt 2 Views,,73070,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,"Health Partners, Inc.",Commercial,244.068,94.6,,percent of total billed charges,,
Xr Elbow Lt 2 Views,,73070,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,"Health Partners, Inc.",Medicare Advantage,126.42,49,,percent of total billed charges,,
Xr Elbow Lt 2 Views,,73070,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Elbow Lt 2 Views,,73070,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),154.8,60,,percent of total billed charges,,
Xr Elbow Lt 2 Views,,73070,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,"Health Partners, Inc.",State of Minnesota Advantage Program,210.27,81.5,,percent of total billed charges,,
Xr Elbow Lt 2 Views,,73070,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,"Health Partners, Inc.",State Public Programs,129,50,,percent of total billed charges,,
Xr Elbow Lt 2 Views,,73070,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,Humana Insurance Company,Commercial PPO,245.1,95,,percent of total billed charges,,
Xr Elbow Lt 2 Views,,73070,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,Humana Insurance Company,Medicare PPO,126.42,49,,percent of total billed charges,,
Xr Elbow Lt 2 Views,,73070,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Xr Elbow Lt 2 Views,,73070,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,Medica,Individual & Family,255.678,99.1,,percent of total billed charges,,
Xr Elbow Lt 2 Views,,73070,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,Medica,Medica Advantage Solution,128.484,49.8,,percent of total billed charges,,
Xr Elbow Lt 2 Views,,73070,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Xr Elbow Lt 2 Views,,73070,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,Medica,Medical Assistance,115.068,44.6,,percent of total billed charges,,
Xr Elbow Lt 2 Views,,73070,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,Medica,Medical Assistance,,,,,Included in per diem rate,
Xr Elbow Lt 2 Views,,73070,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,128.484,49.8,,percent of total billed charges,,
Xr Elbow Lt 2 Views,,73070,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Xr Elbow Lt 2 Views,,73070,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,"Multiplan, Inc.","Multiplan, Inc.",242.52,94,,percent of total billed charges,,
Xr Elbow Lt 2 Views,,73070,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,232.458,90.1,,percent of total billed charges,,
Xr Elbow Lt 2 Views,,73070,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Xr Elbow Lt 2 Views,,73070,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,"Preferred One Administrative Services, INC.",PPO,254.388,98.6,,percent of total billed charges,,
Xr Elbow Lt 2 Views,,73070,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,PrimeWest Health,Minnesota Senior Health Options (MSHO),132.741,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Xr Elbow Lt 2 Views,,73070,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Elbow Lt 2 Views,,73070,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,PrimeWest Health,MinnesotaCare,132.5088,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Xr Elbow Lt 2 Views,,73070,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Xr Elbow Lt 2 Views,,73070,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,Sanford Health Plan,Sanford Health Plan,237.36,92,,percent of total billed charges,,
Xr Elbow Lt 2 Views,,73070,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,"UCare Health, Inc.",Individual & Family Plan,145.383,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Xr Elbow Lt 2 Views,,73070,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Xr Elbow Lt 2 Views,,73070,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,"UCare Health, Inc.",Medical Assistance,130.2126,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Elbow Lt 2 Views,,73070,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Xr Elbow Lt 2 Views,,73070,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,"UCare Health, Inc.",Medicare Advantage,130.2126,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Elbow Lt 2 Views,,73070,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Elbow Lt 2 Views,,73070,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),130.2126,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Elbow Lt 2 Views,,73070,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Elbow Lt 2 Views,,73070,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,UnitedHealthcare,Individual & Family,242.52,94,,percent of total billed charges,,
Xr Elbow Lt 2 Views,,73070,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,UnitedHealthcare,Medicare Advantage,126.42,49,,percent of total billed charges,,
Xr Elbow Lt 2 Views,,73070,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Xr Elbow Lt 2 Views,,73070,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,123.84,48,,percent of total billed charges,,100% of DHS outpatient percentage
Xr Elbow Lt 2 Views,,73070,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Xr Elbow Routine Lt 3 Views,,73080,CPT,Facility,Both,,,LT,281,238.85,80.5346,281,Aetna,Commercial,258.52,92,,percent of total billed charges,,
Xr Elbow Routine Lt 3 Views,,73080,CPT,Facility,Outpatient,,,LT,281,238.85,80.5346,281,Aetna,Medicare Advantage,137.69,49,,percent of total billed charges,,
Xr Elbow Routine Lt 3 Views,,73080,CPT,Facility,Inpatient,,,LT,281,238.85,80.5346,281,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Xr Elbow Routine Lt 3 Views,,73080,CPT,Facility,Both,,,LT,281,238.85,80.5346,281,Aetna,PPO,261.33,93,,percent of total billed charges,,
Xr Elbow Routine Lt 3 Views,,73080,CPT,Facility,Both,,,LT,281,238.85,80.5346,281,America's PPO,America's PPO,269.8443,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Xr Elbow Routine Lt 3 Views,,73080,CPT,Facility,Both,,,LT,281,238.85,80.5346,281,BlueCross BlueShield Minnesota, Federal Employee Program,276.504,98.4,,percent of total billed charges,,
Xr Elbow Routine Lt 3 Views,,73080,CPT,Facility,Both,,,LT,281,238.85,80.5346,281,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,281,100,,percent of total billed charges,,
Xr Elbow Routine Lt 3 Views,,73080,CPT,Facility,Both,,,LT,281,238.85,80.5346,281,BlueCross BlueShield Minnesota,High Value Network Plan,252.9,90,,percent of total billed charges,,
Xr Elbow Routine Lt 3 Views,,73080,CPT,Facility,Outpatient,,,LT,281,238.85,80.5346,281,BlueCross BlueShield Minnesota,Medicare Advantage,137.69,49,,percent of total billed charges,,
Xr Elbow Routine Lt 3 Views,,73080,CPT,Facility,Inpatient,,,LT,281,238.85,80.5346,281,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Xr Elbow Routine Lt 3 Views,,73080,CPT,Facility,Both,,,LT,281,238.85,80.5346,281,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,248.8817,88.57,,percent of total billed charges,,
Xr Elbow Routine Lt 3 Views,,73080,CPT,Facility,Both,,,LT,281,238.85,80.5346,281,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,80.5346,28.66,,percent of total billed charges,,
Xr Elbow Routine Lt 3 Views,,73080,CPT,Facility,Outpatient,,,LT,281,238.85,80.5346,281,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),137.69,49,,percent of total billed charges,,
Xr Elbow Routine Lt 3 Views,,73080,CPT,Facility,Inpatient,,,LT,281,238.85,80.5346,281,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Xr Elbow Routine Lt 3 Views,,73080,CPT,Facility,Both,,,LT,281,238.85,80.5346,281,CorVel,Worker's Compensation,281,100,,percent of total billed charges,,
Xr Elbow Routine Lt 3 Views,,73080,CPT,Facility,Both,,,LT,281,238.85,80.5346,281,First Health Group Corporation,First Health Network,272.57,97,,percent of total billed charges,,
Xr Elbow Routine Lt 3 Views,,73080,CPT,Facility,Both,,,LT,281,238.85,80.5346,281,"Health Partners, Inc.",Commercial,265.826,94.6,,percent of total billed charges,,
Xr Elbow Routine Lt 3 Views,,73080,CPT,Facility,Outpatient,,,LT,281,238.85,80.5346,281,"Health Partners, Inc.",Medicare Advantage,137.69,49,,percent of total billed charges,,
Xr Elbow Routine Lt 3 Views,,73080,CPT,Facility,Inpatient,,,LT,281,238.85,80.5346,281,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Elbow Routine Lt 3 Views,,73080,CPT,Facility,Both,,,LT,281,238.85,80.5346,281,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),168.6,60,,percent of total billed charges,,
Xr Elbow Routine Lt 3 Views,,73080,CPT,Facility,Both,,,LT,281,238.85,80.5346,281,"Health Partners, Inc.",State of Minnesota Advantage Program,229.015,81.5,,percent of total billed charges,,
Xr Elbow Routine Lt 3 Views,,73080,CPT,Facility,Both,,,LT,281,238.85,80.5346,281,"Health Partners, Inc.",State Public Programs,140.5,50,,percent of total billed charges,,
Xr Elbow Routine Lt 3 Views,,73080,CPT,Facility,Both,,,LT,281,238.85,80.5346,281,Humana Insurance Company,Commercial PPO,266.95,95,,percent of total billed charges,,
Xr Elbow Routine Lt 3 Views,,73080,CPT,Facility,Outpatient,,,LT,281,238.85,80.5346,281,Humana Insurance Company,Medicare PPO,137.69,49,,percent of total billed charges,,
Xr Elbow Routine Lt 3 Views,,73080,CPT,Facility,Inpatient,,,LT,281,238.85,80.5346,281,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Xr Elbow Routine Lt 3 Views,,73080,CPT,Facility,Both,,,LT,281,238.85,80.5346,281,Medica,Individual & Family,278.471,99.1,,percent of total billed charges,,
Xr Elbow Routine Lt 3 Views,,73080,CPT,Facility,Outpatient,,,LT,281,238.85,80.5346,281,Medica,Medica Advantage Solution,139.938,49.8,,percent of total billed charges,,
Xr Elbow Routine Lt 3 Views,,73080,CPT,Facility,Inpatient,,,LT,281,238.85,80.5346,281,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Xr Elbow Routine Lt 3 Views,,73080,CPT,Facility,Outpatient,,,LT,281,238.85,80.5346,281,Medica,Medical Assistance,125.326,44.6,,percent of total billed charges,,
Xr Elbow Routine Lt 3 Views,,73080,CPT,Facility,Inpatient,,,LT,281,238.85,80.5346,281,Medica,Medical Assistance,,,,,Included in per diem rate,
Xr Elbow Routine Lt 3 Views,,73080,CPT,Facility,Outpatient,,,LT,281,238.85,80.5346,281,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,139.938,49.8,,percent of total billed charges,,
Xr Elbow Routine Lt 3 Views,,73080,CPT,Facility,Inpatient,,,LT,281,238.85,80.5346,281,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Xr Elbow Routine Lt 3 Views,,73080,CPT,Facility,Both,,,LT,281,238.85,80.5346,281,"Multiplan, Inc.","Multiplan, Inc.",264.14,94,,percent of total billed charges,,
Xr Elbow Routine Lt 3 Views,,73080,CPT,Facility,Outpatient,,,LT,281,238.85,80.5346,281,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,253.181,90.1,,percent of total billed charges,,
Xr Elbow Routine Lt 3 Views,,73080,CPT,Facility,Inpatient,,,LT,281,238.85,80.5346,281,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Xr Elbow Routine Lt 3 Views,,73080,CPT,Facility,Both,,,LT,281,238.85,80.5346,281,"Preferred One Administrative Services, INC.",PPO,277.066,98.6,,percent of total billed charges,,
Xr Elbow Routine Lt 3 Views,,73080,CPT,Facility,Outpatient,,,LT,281,238.85,80.5346,281,PrimeWest Health,Minnesota Senior Health Options (MSHO),144.5745,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Xr Elbow Routine Lt 3 Views,,73080,CPT,Facility,Inpatient,,,LT,281,238.85,80.5346,281,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Elbow Routine Lt 3 Views,,73080,CPT,Facility,Outpatient,,,LT,281,238.85,80.5346,281,PrimeWest Health,MinnesotaCare,144.3216,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Xr Elbow Routine Lt 3 Views,,73080,CPT,Facility,Inpatient,,,LT,281,238.85,80.5346,281,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Xr Elbow Routine Lt 3 Views,,73080,CPT,Facility,Both,,,LT,281,238.85,80.5346,281,Sanford Health Plan,Sanford Health Plan,258.52,92,,percent of total billed charges,,
Xr Elbow Routine Lt 3 Views,,73080,CPT,Facility,Outpatient,,,LT,281,238.85,80.5346,281,"UCare Health, Inc.",Individual & Family Plan,158.3435,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Xr Elbow Routine Lt 3 Views,,73080,CPT,Facility,Inpatient,,,LT,281,238.85,80.5346,281,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Xr Elbow Routine Lt 3 Views,,73080,CPT,Facility,Outpatient,,,LT,281,238.85,80.5346,281,"UCare Health, Inc.",Medical Assistance,141.8207,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Elbow Routine Lt 3 Views,,73080,CPT,Facility,Inpatient,,,LT,281,238.85,80.5346,281,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Xr Elbow Routine Lt 3 Views,,73080,CPT,Facility,Outpatient,,,LT,281,238.85,80.5346,281,"UCare Health, Inc.",Medicare Advantage,141.8207,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Elbow Routine Lt 3 Views,,73080,CPT,Facility,Inpatient,,,LT,281,238.85,80.5346,281,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Elbow Routine Lt 3 Views,,73080,CPT,Facility,Outpatient,,,LT,281,238.85,80.5346,281,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),141.8207,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Elbow Routine Lt 3 Views,,73080,CPT,Facility,Inpatient,,,LT,281,238.85,80.5346,281,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Elbow Routine Lt 3 Views,,73080,CPT,Facility,Both,,,LT,281,238.85,80.5346,281,UnitedHealthcare,Individual & Family,264.14,94,,percent of total billed charges,,
Xr Elbow Routine Lt 3 Views,,73080,CPT,Facility,Outpatient,,,LT,281,238.85,80.5346,281,UnitedHealthcare,Medicare Advantage,137.69,49,,percent of total billed charges,,
Xr Elbow Routine Lt 3 Views,,73080,CPT,Facility,Inpatient,,,LT,281,238.85,80.5346,281,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Xr Elbow Routine Lt 3 Views,,73080,CPT,Facility,Outpatient,,,LT,281,238.85,80.5346,281,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,134.88,48,,percent of total billed charges,,100% of DHS outpatient percentage
Xr Elbow Routine Lt 3 Views,,73080,CPT,Facility,Inpatient,,,LT,281,238.85,80.5346,281,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Xr Forearm Routine Lt 2 Views,,73090,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,Aetna,Commercial,237.36,92,,percent of total billed charges,,
Xr Forearm Routine Lt 2 Views,,73090,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,Aetna,Medicare Advantage,126.42,49,,percent of total billed charges,,
Xr Forearm Routine Lt 2 Views,,73090,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Xr Forearm Routine Lt 2 Views,,73090,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,Aetna,PPO,239.94,93,,percent of total billed charges,,
Xr Forearm Routine Lt 2 Views,,73090,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,America's PPO,America's PPO,247.7574,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Xr Forearm Routine Lt 2 Views,,73090,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota, Federal Employee Program,253.872,98.4,,percent of total billed charges,,
Xr Forearm Routine Lt 2 Views,,73090,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,258,100,,percent of total billed charges,,
Xr Forearm Routine Lt 2 Views,,73090,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,High Value Network Plan,232.2,90,,percent of total billed charges,,
Xr Forearm Routine Lt 2 Views,,73090,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,Medicare Advantage,126.42,49,,percent of total billed charges,,
Xr Forearm Routine Lt 2 Views,,73090,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Xr Forearm Routine Lt 2 Views,,73090,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,228.5106,88.57,,percent of total billed charges,,
Xr Forearm Routine Lt 2 Views,,73090,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,73.9428,28.66,,percent of total billed charges,,
Xr Forearm Routine Lt 2 Views,,73090,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),126.42,49,,percent of total billed charges,,
Xr Forearm Routine Lt 2 Views,,73090,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Xr Forearm Routine Lt 2 Views,,73090,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,CorVel,Worker's Compensation,258,100,,percent of total billed charges,,
Xr Forearm Routine Lt 2 Views,,73090,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,First Health Group Corporation,First Health Network,250.26,97,,percent of total billed charges,,
Xr Forearm Routine Lt 2 Views,,73090,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,"Health Partners, Inc.",Commercial,244.068,94.6,,percent of total billed charges,,
Xr Forearm Routine Lt 2 Views,,73090,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,"Health Partners, Inc.",Medicare Advantage,126.42,49,,percent of total billed charges,,
Xr Forearm Routine Lt 2 Views,,73090,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Forearm Routine Lt 2 Views,,73090,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),154.8,60,,percent of total billed charges,,
Xr Forearm Routine Lt 2 Views,,73090,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,"Health Partners, Inc.",State of Minnesota Advantage Program,210.27,81.5,,percent of total billed charges,,
Xr Forearm Routine Lt 2 Views,,73090,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,"Health Partners, Inc.",State Public Programs,129,50,,percent of total billed charges,,
Xr Forearm Routine Lt 2 Views,,73090,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,Humana Insurance Company,Commercial PPO,245.1,95,,percent of total billed charges,,
Xr Forearm Routine Lt 2 Views,,73090,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,Humana Insurance Company,Medicare PPO,126.42,49,,percent of total billed charges,,
Xr Forearm Routine Lt 2 Views,,73090,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Xr Forearm Routine Lt 2 Views,,73090,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,Medica,Individual & Family,255.678,99.1,,percent of total billed charges,,
Xr Forearm Routine Lt 2 Views,,73090,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,Medica,Medica Advantage Solution,128.484,49.8,,percent of total billed charges,,
Xr Forearm Routine Lt 2 Views,,73090,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Xr Forearm Routine Lt 2 Views,,73090,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,Medica,Medical Assistance,115.068,44.6,,percent of total billed charges,,
Xr Forearm Routine Lt 2 Views,,73090,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,Medica,Medical Assistance,,,,,Included in per diem rate,
Xr Forearm Routine Lt 2 Views,,73090,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,128.484,49.8,,percent of total billed charges,,
Xr Forearm Routine Lt 2 Views,,73090,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Xr Forearm Routine Lt 2 Views,,73090,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,"Multiplan, Inc.","Multiplan, Inc.",242.52,94,,percent of total billed charges,,
Xr Forearm Routine Lt 2 Views,,73090,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,232.458,90.1,,percent of total billed charges,,
Xr Forearm Routine Lt 2 Views,,73090,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Xr Forearm Routine Lt 2 Views,,73090,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,"Preferred One Administrative Services, INC.",PPO,254.388,98.6,,percent of total billed charges,,
Xr Forearm Routine Lt 2 Views,,73090,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,PrimeWest Health,Minnesota Senior Health Options (MSHO),132.741,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Xr Forearm Routine Lt 2 Views,,73090,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Forearm Routine Lt 2 Views,,73090,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,PrimeWest Health,MinnesotaCare,132.5088,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Xr Forearm Routine Lt 2 Views,,73090,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Xr Forearm Routine Lt 2 Views,,73090,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,Sanford Health Plan,Sanford Health Plan,237.36,92,,percent of total billed charges,,
Xr Forearm Routine Lt 2 Views,,73090,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,"UCare Health, Inc.",Individual & Family Plan,145.383,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Xr Forearm Routine Lt 2 Views,,73090,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Xr Forearm Routine Lt 2 Views,,73090,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,"UCare Health, Inc.",Medical Assistance,130.2126,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Forearm Routine Lt 2 Views,,73090,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Xr Forearm Routine Lt 2 Views,,73090,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,"UCare Health, Inc.",Medicare Advantage,130.2126,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Forearm Routine Lt 2 Views,,73090,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Forearm Routine Lt 2 Views,,73090,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),130.2126,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Forearm Routine Lt 2 Views,,73090,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Forearm Routine Lt 2 Views,,73090,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,UnitedHealthcare,Individual & Family,242.52,94,,percent of total billed charges,,
Xr Forearm Routine Lt 2 Views,,73090,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,UnitedHealthcare,Medicare Advantage,126.42,49,,percent of total billed charges,,
Xr Forearm Routine Lt 2 Views,,73090,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Xr Forearm Routine Lt 2 Views,,73090,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,123.84,48,,percent of total billed charges,,100% of DHS outpatient percentage
Xr Forearm Routine Lt 2 Views,,73090,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Xr Upper Ext Lt Infant,,73092,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,Aetna,Commercial,237.36,92,,percent of total billed charges,,
Xr Upper Ext Lt Infant,,73092,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,Aetna,Medicare Advantage,126.42,49,,percent of total billed charges,,
Xr Upper Ext Lt Infant,,73092,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Xr Upper Ext Lt Infant,,73092,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,Aetna,PPO,239.94,93,,percent of total billed charges,,
Xr Upper Ext Lt Infant,,73092,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,America's PPO,America's PPO,247.7574,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Xr Upper Ext Lt Infant,,73092,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota, Federal Employee Program,253.872,98.4,,percent of total billed charges,,
Xr Upper Ext Lt Infant,,73092,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,258,100,,percent of total billed charges,,
Xr Upper Ext Lt Infant,,73092,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,High Value Network Plan,232.2,90,,percent of total billed charges,,
Xr Upper Ext Lt Infant,,73092,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,Medicare Advantage,126.42,49,,percent of total billed charges,,
Xr Upper Ext Lt Infant,,73092,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Xr Upper Ext Lt Infant,,73092,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,228.5106,88.57,,percent of total billed charges,,
Xr Upper Ext Lt Infant,,73092,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,73.9428,28.66,,percent of total billed charges,,
Xr Upper Ext Lt Infant,,73092,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),126.42,49,,percent of total billed charges,,
Xr Upper Ext Lt Infant,,73092,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Xr Upper Ext Lt Infant,,73092,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,CorVel,Worker's Compensation,258,100,,percent of total billed charges,,
Xr Upper Ext Lt Infant,,73092,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,First Health Group Corporation,First Health Network,250.26,97,,percent of total billed charges,,
Xr Upper Ext Lt Infant,,73092,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,"Health Partners, Inc.",Commercial,244.068,94.6,,percent of total billed charges,,
Xr Upper Ext Lt Infant,,73092,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,"Health Partners, Inc.",Medicare Advantage,126.42,49,,percent of total billed charges,,
Xr Upper Ext Lt Infant,,73092,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Upper Ext Lt Infant,,73092,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),154.8,60,,percent of total billed charges,,
Xr Upper Ext Lt Infant,,73092,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,"Health Partners, Inc.",State of Minnesota Advantage Program,210.27,81.5,,percent of total billed charges,,
Xr Upper Ext Lt Infant,,73092,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,"Health Partners, Inc.",State Public Programs,129,50,,percent of total billed charges,,
Xr Upper Ext Lt Infant,,73092,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,Humana Insurance Company,Commercial PPO,245.1,95,,percent of total billed charges,,
Xr Upper Ext Lt Infant,,73092,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,Humana Insurance Company,Medicare PPO,126.42,49,,percent of total billed charges,,
Xr Upper Ext Lt Infant,,73092,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Xr Upper Ext Lt Infant,,73092,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,Medica,Individual & Family,255.678,99.1,,percent of total billed charges,,
Xr Upper Ext Lt Infant,,73092,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,Medica,Medica Advantage Solution,128.484,49.8,,percent of total billed charges,,
Xr Upper Ext Lt Infant,,73092,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Xr Upper Ext Lt Infant,,73092,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,Medica,Medical Assistance,115.068,44.6,,percent of total billed charges,,
Xr Upper Ext Lt Infant,,73092,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,Medica,Medical Assistance,,,,,Included in per diem rate,
Xr Upper Ext Lt Infant,,73092,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,128.484,49.8,,percent of total billed charges,,
Xr Upper Ext Lt Infant,,73092,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Xr Upper Ext Lt Infant,,73092,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,"Multiplan, Inc.","Multiplan, Inc.",242.52,94,,percent of total billed charges,,
Xr Upper Ext Lt Infant,,73092,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,232.458,90.1,,percent of total billed charges,,
Xr Upper Ext Lt Infant,,73092,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Xr Upper Ext Lt Infant,,73092,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,"Preferred One Administrative Services, INC.",PPO,254.388,98.6,,percent of total billed charges,,
Xr Upper Ext Lt Infant,,73092,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,PrimeWest Health,Minnesota Senior Health Options (MSHO),132.741,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Xr Upper Ext Lt Infant,,73092,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Upper Ext Lt Infant,,73092,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,PrimeWest Health,MinnesotaCare,132.5088,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Xr Upper Ext Lt Infant,,73092,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Xr Upper Ext Lt Infant,,73092,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,Sanford Health Plan,Sanford Health Plan,237.36,92,,percent of total billed charges,,
Xr Upper Ext Lt Infant,,73092,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,"UCare Health, Inc.",Individual & Family Plan,145.383,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Xr Upper Ext Lt Infant,,73092,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Xr Upper Ext Lt Infant,,73092,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,"UCare Health, Inc.",Medical Assistance,130.2126,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Upper Ext Lt Infant,,73092,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Xr Upper Ext Lt Infant,,73092,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,"UCare Health, Inc.",Medicare Advantage,130.2126,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Upper Ext Lt Infant,,73092,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Upper Ext Lt Infant,,73092,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),130.2126,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Upper Ext Lt Infant,,73092,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Upper Ext Lt Infant,,73092,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,UnitedHealthcare,Individual & Family,242.52,94,,percent of total billed charges,,
Xr Upper Ext Lt Infant,,73092,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,UnitedHealthcare,Medicare Advantage,126.42,49,,percent of total billed charges,,
Xr Upper Ext Lt Infant,,73092,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Xr Upper Ext Lt Infant,,73092,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,123.84,48,,percent of total billed charges,,100% of DHS outpatient percentage
Xr Upper Ext Lt Infant,,73092,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Xr Wrist Lt 2 Views,,73100,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,Aetna,Commercial,237.36,92,,percent of total billed charges,,
Xr Wrist Lt 2 Views,,73100,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,Aetna,Medicare Advantage,126.42,49,,percent of total billed charges,,
Xr Wrist Lt 2 Views,,73100,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Xr Wrist Lt 2 Views,,73100,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,Aetna,PPO,239.94,93,,percent of total billed charges,,
Xr Wrist Lt 2 Views,,73100,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,America's PPO,America's PPO,247.7574,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Xr Wrist Lt 2 Views,,73100,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota, Federal Employee Program,253.872,98.4,,percent of total billed charges,,
Xr Wrist Lt 2 Views,,73100,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,258,100,,percent of total billed charges,,
Xr Wrist Lt 2 Views,,73100,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,High Value Network Plan,232.2,90,,percent of total billed charges,,
Xr Wrist Lt 2 Views,,73100,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,Medicare Advantage,126.42,49,,percent of total billed charges,,
Xr Wrist Lt 2 Views,,73100,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Xr Wrist Lt 2 Views,,73100,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,228.5106,88.57,,percent of total billed charges,,
Xr Wrist Lt 2 Views,,73100,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,73.9428,28.66,,percent of total billed charges,,
Xr Wrist Lt 2 Views,,73100,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),126.42,49,,percent of total billed charges,,
Xr Wrist Lt 2 Views,,73100,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Xr Wrist Lt 2 Views,,73100,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,CorVel,Worker's Compensation,258,100,,percent of total billed charges,,
Xr Wrist Lt 2 Views,,73100,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,First Health Group Corporation,First Health Network,250.26,97,,percent of total billed charges,,
Xr Wrist Lt 2 Views,,73100,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,"Health Partners, Inc.",Commercial,244.068,94.6,,percent of total billed charges,,
Xr Wrist Lt 2 Views,,73100,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,"Health Partners, Inc.",Medicare Advantage,126.42,49,,percent of total billed charges,,
Xr Wrist Lt 2 Views,,73100,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Wrist Lt 2 Views,,73100,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),154.8,60,,percent of total billed charges,,
Xr Wrist Lt 2 Views,,73100,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,"Health Partners, Inc.",State of Minnesota Advantage Program,210.27,81.5,,percent of total billed charges,,
Xr Wrist Lt 2 Views,,73100,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,"Health Partners, Inc.",State Public Programs,129,50,,percent of total billed charges,,
Xr Wrist Lt 2 Views,,73100,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,Humana Insurance Company,Commercial PPO,245.1,95,,percent of total billed charges,,
Xr Wrist Lt 2 Views,,73100,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,Humana Insurance Company,Medicare PPO,126.42,49,,percent of total billed charges,,
Xr Wrist Lt 2 Views,,73100,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Xr Wrist Lt 2 Views,,73100,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,Medica,Individual & Family,255.678,99.1,,percent of total billed charges,,
Xr Wrist Lt 2 Views,,73100,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,Medica,Medica Advantage Solution,128.484,49.8,,percent of total billed charges,,
Xr Wrist Lt 2 Views,,73100,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Xr Wrist Lt 2 Views,,73100,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,Medica,Medical Assistance,115.068,44.6,,percent of total billed charges,,
Xr Wrist Lt 2 Views,,73100,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,Medica,Medical Assistance,,,,,Included in per diem rate,
Xr Wrist Lt 2 Views,,73100,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,128.484,49.8,,percent of total billed charges,,
Xr Wrist Lt 2 Views,,73100,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Xr Wrist Lt 2 Views,,73100,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,"Multiplan, Inc.","Multiplan, Inc.",242.52,94,,percent of total billed charges,,
Xr Wrist Lt 2 Views,,73100,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,232.458,90.1,,percent of total billed charges,,
Xr Wrist Lt 2 Views,,73100,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Xr Wrist Lt 2 Views,,73100,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,"Preferred One Administrative Services, INC.",PPO,254.388,98.6,,percent of total billed charges,,
Xr Wrist Lt 2 Views,,73100,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,PrimeWest Health,Minnesota Senior Health Options (MSHO),132.741,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Xr Wrist Lt 2 Views,,73100,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Wrist Lt 2 Views,,73100,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,PrimeWest Health,MinnesotaCare,132.5088,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Xr Wrist Lt 2 Views,,73100,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Xr Wrist Lt 2 Views,,73100,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,Sanford Health Plan,Sanford Health Plan,237.36,92,,percent of total billed charges,,
Xr Wrist Lt 2 Views,,73100,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,"UCare Health, Inc.",Individual & Family Plan,145.383,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Xr Wrist Lt 2 Views,,73100,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Xr Wrist Lt 2 Views,,73100,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,"UCare Health, Inc.",Medical Assistance,130.2126,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Wrist Lt 2 Views,,73100,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Xr Wrist Lt 2 Views,,73100,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,"UCare Health, Inc.",Medicare Advantage,130.2126,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Wrist Lt 2 Views,,73100,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Wrist Lt 2 Views,,73100,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),130.2126,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Wrist Lt 2 Views,,73100,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Wrist Lt 2 Views,,73100,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,UnitedHealthcare,Individual & Family,242.52,94,,percent of total billed charges,,
Xr Wrist Lt 2 Views,,73100,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,UnitedHealthcare,Medicare Advantage,126.42,49,,percent of total billed charges,,
Xr Wrist Lt 2 Views,,73100,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Xr Wrist Lt 2 Views,,73100,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,123.84,48,,percent of total billed charges,,100% of DHS outpatient percentage
Xr Wrist Lt 2 Views,,73100,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Xr Wrist Routine Lt 3 Or More Views,,73110,CPT,Facility,Both,,,LT,270,229.5,77.382,270,Aetna,Commercial,248.4,92,,percent of total billed charges,,
Xr Wrist Routine Lt 3 Or More Views,,73110,CPT,Facility,Outpatient,,,LT,270,229.5,77.382,270,Aetna,Medicare Advantage,132.3,49,,percent of total billed charges,,
Xr Wrist Routine Lt 3 Or More Views,,73110,CPT,Facility,Inpatient,,,LT,270,229.5,77.382,270,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Xr Wrist Routine Lt 3 Or More Views,,73110,CPT,Facility,Both,,,LT,270,229.5,77.382,270,Aetna,PPO,251.1,93,,percent of total billed charges,,
Xr Wrist Routine Lt 3 Or More Views,,73110,CPT,Facility,Both,,,LT,270,229.5,77.382,270,America's PPO,America's PPO,259.281,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Xr Wrist Routine Lt 3 Or More Views,,73110,CPT,Facility,Both,,,LT,270,229.5,77.382,270,BlueCross BlueShield Minnesota, Federal Employee Program,265.68,98.4,,percent of total billed charges,,
Xr Wrist Routine Lt 3 Or More Views,,73110,CPT,Facility,Both,,,LT,270,229.5,77.382,270,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,270,100,,percent of total billed charges,,
Xr Wrist Routine Lt 3 Or More Views,,73110,CPT,Facility,Both,,,LT,270,229.5,77.382,270,BlueCross BlueShield Minnesota,High Value Network Plan,243,90,,percent of total billed charges,,
Xr Wrist Routine Lt 3 Or More Views,,73110,CPT,Facility,Outpatient,,,LT,270,229.5,77.382,270,BlueCross BlueShield Minnesota,Medicare Advantage,132.3,49,,percent of total billed charges,,
Xr Wrist Routine Lt 3 Or More Views,,73110,CPT,Facility,Inpatient,,,LT,270,229.5,77.382,270,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Xr Wrist Routine Lt 3 Or More Views,,73110,CPT,Facility,Both,,,LT,270,229.5,77.382,270,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,239.139,88.57,,percent of total billed charges,,
Xr Wrist Routine Lt 3 Or More Views,,73110,CPT,Facility,Both,,,LT,270,229.5,77.382,270,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,77.382,28.66,,percent of total billed charges,,
Xr Wrist Routine Lt 3 Or More Views,,73110,CPT,Facility,Outpatient,,,LT,270,229.5,77.382,270,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),132.3,49,,percent of total billed charges,,
Xr Wrist Routine Lt 3 Or More Views,,73110,CPT,Facility,Inpatient,,,LT,270,229.5,77.382,270,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Xr Wrist Routine Lt 3 Or More Views,,73110,CPT,Facility,Both,,,LT,270,229.5,77.382,270,CorVel,Worker's Compensation,270,100,,percent of total billed charges,,
Xr Wrist Routine Lt 3 Or More Views,,73110,CPT,Facility,Both,,,LT,270,229.5,77.382,270,First Health Group Corporation,First Health Network,261.9,97,,percent of total billed charges,,
Xr Wrist Routine Lt 3 Or More Views,,73110,CPT,Facility,Both,,,LT,270,229.5,77.382,270,"Health Partners, Inc.",Commercial,255.42,94.6,,percent of total billed charges,,
Xr Wrist Routine Lt 3 Or More Views,,73110,CPT,Facility,Outpatient,,,LT,270,229.5,77.382,270,"Health Partners, Inc.",Medicare Advantage,132.3,49,,percent of total billed charges,,
Xr Wrist Routine Lt 3 Or More Views,,73110,CPT,Facility,Inpatient,,,LT,270,229.5,77.382,270,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Wrist Routine Lt 3 Or More Views,,73110,CPT,Facility,Both,,,LT,270,229.5,77.382,270,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),162,60,,percent of total billed charges,,
Xr Wrist Routine Lt 3 Or More Views,,73110,CPT,Facility,Both,,,LT,270,229.5,77.382,270,"Health Partners, Inc.",State of Minnesota Advantage Program,220.05,81.5,,percent of total billed charges,,
Xr Wrist Routine Lt 3 Or More Views,,73110,CPT,Facility,Both,,,LT,270,229.5,77.382,270,"Health Partners, Inc.",State Public Programs,135,50,,percent of total billed charges,,
Xr Wrist Routine Lt 3 Or More Views,,73110,CPT,Facility,Both,,,LT,270,229.5,77.382,270,Humana Insurance Company,Commercial PPO,256.5,95,,percent of total billed charges,,
Xr Wrist Routine Lt 3 Or More Views,,73110,CPT,Facility,Outpatient,,,LT,270,229.5,77.382,270,Humana Insurance Company,Medicare PPO,132.3,49,,percent of total billed charges,,
Xr Wrist Routine Lt 3 Or More Views,,73110,CPT,Facility,Inpatient,,,LT,270,229.5,77.382,270,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Xr Wrist Routine Lt 3 Or More Views,,73110,CPT,Facility,Both,,,LT,270,229.5,77.382,270,Medica,Individual & Family,267.57,99.1,,percent of total billed charges,,
Xr Wrist Routine Lt 3 Or More Views,,73110,CPT,Facility,Outpatient,,,LT,270,229.5,77.382,270,Medica,Medica Advantage Solution,134.46,49.8,,percent of total billed charges,,
Xr Wrist Routine Lt 3 Or More Views,,73110,CPT,Facility,Inpatient,,,LT,270,229.5,77.382,270,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Xr Wrist Routine Lt 3 Or More Views,,73110,CPT,Facility,Outpatient,,,LT,270,229.5,77.382,270,Medica,Medical Assistance,120.42,44.6,,percent of total billed charges,,
Xr Wrist Routine Lt 3 Or More Views,,73110,CPT,Facility,Inpatient,,,LT,270,229.5,77.382,270,Medica,Medical Assistance,,,,,Included in per diem rate,
Xr Wrist Routine Lt 3 Or More Views,,73110,CPT,Facility,Outpatient,,,LT,270,229.5,77.382,270,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,134.46,49.8,,percent of total billed charges,,
Xr Wrist Routine Lt 3 Or More Views,,73110,CPT,Facility,Inpatient,,,LT,270,229.5,77.382,270,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Xr Wrist Routine Lt 3 Or More Views,,73110,CPT,Facility,Both,,,LT,270,229.5,77.382,270,"Multiplan, Inc.","Multiplan, Inc.",253.8,94,,percent of total billed charges,,
Xr Wrist Routine Lt 3 Or More Views,,73110,CPT,Facility,Outpatient,,,LT,270,229.5,77.382,270,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,243.27,90.1,,percent of total billed charges,,
Xr Wrist Routine Lt 3 Or More Views,,73110,CPT,Facility,Inpatient,,,LT,270,229.5,77.382,270,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Xr Wrist Routine Lt 3 Or More Views,,73110,CPT,Facility,Both,,,LT,270,229.5,77.382,270,"Preferred One Administrative Services, INC.",PPO,266.22,98.6,,percent of total billed charges,,
Xr Wrist Routine Lt 3 Or More Views,,73110,CPT,Facility,Outpatient,,,LT,270,229.5,77.382,270,PrimeWest Health,Minnesota Senior Health Options (MSHO),138.915,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Xr Wrist Routine Lt 3 Or More Views,,73110,CPT,Facility,Inpatient,,,LT,270,229.5,77.382,270,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Wrist Routine Lt 3 Or More Views,,73110,CPT,Facility,Outpatient,,,LT,270,229.5,77.382,270,PrimeWest Health,MinnesotaCare,138.672,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Xr Wrist Routine Lt 3 Or More Views,,73110,CPT,Facility,Inpatient,,,LT,270,229.5,77.382,270,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Xr Wrist Routine Lt 3 Or More Views,,73110,CPT,Facility,Both,,,LT,270,229.5,77.382,270,Sanford Health Plan,Sanford Health Plan,248.4,92,,percent of total billed charges,,
Xr Wrist Routine Lt 3 Or More Views,,73110,CPT,Facility,Outpatient,,,LT,270,229.5,77.382,270,"UCare Health, Inc.",Individual & Family Plan,152.145,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Xr Wrist Routine Lt 3 Or More Views,,73110,CPT,Facility,Inpatient,,,LT,270,229.5,77.382,270,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Xr Wrist Routine Lt 3 Or More Views,,73110,CPT,Facility,Outpatient,,,LT,270,229.5,77.382,270,"UCare Health, Inc.",Medical Assistance,136.269,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Wrist Routine Lt 3 Or More Views,,73110,CPT,Facility,Inpatient,,,LT,270,229.5,77.382,270,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Xr Wrist Routine Lt 3 Or More Views,,73110,CPT,Facility,Outpatient,,,LT,270,229.5,77.382,270,"UCare Health, Inc.",Medicare Advantage,136.269,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Wrist Routine Lt 3 Or More Views,,73110,CPT,Facility,Inpatient,,,LT,270,229.5,77.382,270,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Wrist Routine Lt 3 Or More Views,,73110,CPT,Facility,Outpatient,,,LT,270,229.5,77.382,270,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),136.269,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Wrist Routine Lt 3 Or More Views,,73110,CPT,Facility,Inpatient,,,LT,270,229.5,77.382,270,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Wrist Routine Lt 3 Or More Views,,73110,CPT,Facility,Both,,,LT,270,229.5,77.382,270,UnitedHealthcare,Individual & Family,253.8,94,,percent of total billed charges,,
Xr Wrist Routine Lt 3 Or More Views,,73110,CPT,Facility,Outpatient,,,LT,270,229.5,77.382,270,UnitedHealthcare,Medicare Advantage,132.3,49,,percent of total billed charges,,
Xr Wrist Routine Lt 3 Or More Views,,73110,CPT,Facility,Inpatient,,,LT,270,229.5,77.382,270,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Xr Wrist Routine Lt 3 Or More Views,,73110,CPT,Facility,Outpatient,,,LT,270,229.5,77.382,270,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,129.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
Xr Wrist Routine Lt 3 Or More Views,,73110,CPT,Facility,Inpatient,,,LT,270,229.5,77.382,270,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Xr Hand Lt 2 Views,,73120,CPT,Facility,Both,,,LT,270,229.5,77.382,270,Aetna,Commercial,248.4,92,,percent of total billed charges,,
Xr Hand Lt 2 Views,,73120,CPT,Facility,Outpatient,,,LT,270,229.5,77.382,270,Aetna,Medicare Advantage,132.3,49,,percent of total billed charges,,
Xr Hand Lt 2 Views,,73120,CPT,Facility,Inpatient,,,LT,270,229.5,77.382,270,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Xr Hand Lt 2 Views,,73120,CPT,Facility,Both,,,LT,270,229.5,77.382,270,Aetna,PPO,251.1,93,,percent of total billed charges,,
Xr Hand Lt 2 Views,,73120,CPT,Facility,Both,,,LT,270,229.5,77.382,270,America's PPO,America's PPO,259.281,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Xr Hand Lt 2 Views,,73120,CPT,Facility,Both,,,LT,270,229.5,77.382,270,BlueCross BlueShield Minnesota, Federal Employee Program,265.68,98.4,,percent of total billed charges,,
Xr Hand Lt 2 Views,,73120,CPT,Facility,Both,,,LT,270,229.5,77.382,270,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,270,100,,percent of total billed charges,,
Xr Hand Lt 2 Views,,73120,CPT,Facility,Both,,,LT,270,229.5,77.382,270,BlueCross BlueShield Minnesota,High Value Network Plan,243,90,,percent of total billed charges,,
Xr Hand Lt 2 Views,,73120,CPT,Facility,Outpatient,,,LT,270,229.5,77.382,270,BlueCross BlueShield Minnesota,Medicare Advantage,132.3,49,,percent of total billed charges,,
Xr Hand Lt 2 Views,,73120,CPT,Facility,Inpatient,,,LT,270,229.5,77.382,270,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Xr Hand Lt 2 Views,,73120,CPT,Facility,Both,,,LT,270,229.5,77.382,270,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,239.139,88.57,,percent of total billed charges,,
Xr Hand Lt 2 Views,,73120,CPT,Facility,Both,,,LT,270,229.5,77.382,270,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,77.382,28.66,,percent of total billed charges,,
Xr Hand Lt 2 Views,,73120,CPT,Facility,Outpatient,,,LT,270,229.5,77.382,270,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),132.3,49,,percent of total billed charges,,
Xr Hand Lt 2 Views,,73120,CPT,Facility,Inpatient,,,LT,270,229.5,77.382,270,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Xr Hand Lt 2 Views,,73120,CPT,Facility,Both,,,LT,270,229.5,77.382,270,CorVel,Worker's Compensation,270,100,,percent of total billed charges,,
Xr Hand Lt 2 Views,,73120,CPT,Facility,Both,,,LT,270,229.5,77.382,270,First Health Group Corporation,First Health Network,261.9,97,,percent of total billed charges,,
Xr Hand Lt 2 Views,,73120,CPT,Facility,Both,,,LT,270,229.5,77.382,270,"Health Partners, Inc.",Commercial,255.42,94.6,,percent of total billed charges,,
Xr Hand Lt 2 Views,,73120,CPT,Facility,Outpatient,,,LT,270,229.5,77.382,270,"Health Partners, Inc.",Medicare Advantage,132.3,49,,percent of total billed charges,,
Xr Hand Lt 2 Views,,73120,CPT,Facility,Inpatient,,,LT,270,229.5,77.382,270,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Hand Lt 2 Views,,73120,CPT,Facility,Both,,,LT,270,229.5,77.382,270,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),162,60,,percent of total billed charges,,
Xr Hand Lt 2 Views,,73120,CPT,Facility,Both,,,LT,270,229.5,77.382,270,"Health Partners, Inc.",State of Minnesota Advantage Program,220.05,81.5,,percent of total billed charges,,
Xr Hand Lt 2 Views,,73120,CPT,Facility,Both,,,LT,270,229.5,77.382,270,"Health Partners, Inc.",State Public Programs,135,50,,percent of total billed charges,,
Xr Hand Lt 2 Views,,73120,CPT,Facility,Both,,,LT,270,229.5,77.382,270,Humana Insurance Company,Commercial PPO,256.5,95,,percent of total billed charges,,
Xr Hand Lt 2 Views,,73120,CPT,Facility,Outpatient,,,LT,270,229.5,77.382,270,Humana Insurance Company,Medicare PPO,132.3,49,,percent of total billed charges,,
Xr Hand Lt 2 Views,,73120,CPT,Facility,Inpatient,,,LT,270,229.5,77.382,270,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Xr Hand Lt 2 Views,,73120,CPT,Facility,Both,,,LT,270,229.5,77.382,270,Medica,Individual & Family,267.57,99.1,,percent of total billed charges,,
Xr Hand Lt 2 Views,,73120,CPT,Facility,Outpatient,,,LT,270,229.5,77.382,270,Medica,Medica Advantage Solution,134.46,49.8,,percent of total billed charges,,
Xr Hand Lt 2 Views,,73120,CPT,Facility,Inpatient,,,LT,270,229.5,77.382,270,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Xr Hand Lt 2 Views,,73120,CPT,Facility,Outpatient,,,LT,270,229.5,77.382,270,Medica,Medical Assistance,120.42,44.6,,percent of total billed charges,,
Xr Hand Lt 2 Views,,73120,CPT,Facility,Inpatient,,,LT,270,229.5,77.382,270,Medica,Medical Assistance,,,,,Included in per diem rate,
Xr Hand Lt 2 Views,,73120,CPT,Facility,Outpatient,,,LT,270,229.5,77.382,270,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,134.46,49.8,,percent of total billed charges,,
Xr Hand Lt 2 Views,,73120,CPT,Facility,Inpatient,,,LT,270,229.5,77.382,270,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Xr Hand Lt 2 Views,,73120,CPT,Facility,Both,,,LT,270,229.5,77.382,270,"Multiplan, Inc.","Multiplan, Inc.",253.8,94,,percent of total billed charges,,
Xr Hand Lt 2 Views,,73120,CPT,Facility,Outpatient,,,LT,270,229.5,77.382,270,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,243.27,90.1,,percent of total billed charges,,
Xr Hand Lt 2 Views,,73120,CPT,Facility,Inpatient,,,LT,270,229.5,77.382,270,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Xr Hand Lt 2 Views,,73120,CPT,Facility,Both,,,LT,270,229.5,77.382,270,"Preferred One Administrative Services, INC.",PPO,266.22,98.6,,percent of total billed charges,,
Xr Hand Lt 2 Views,,73120,CPT,Facility,Outpatient,,,LT,270,229.5,77.382,270,PrimeWest Health,Minnesota Senior Health Options (MSHO),138.915,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Xr Hand Lt 2 Views,,73120,CPT,Facility,Inpatient,,,LT,270,229.5,77.382,270,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Hand Lt 2 Views,,73120,CPT,Facility,Outpatient,,,LT,270,229.5,77.382,270,PrimeWest Health,MinnesotaCare,138.672,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Xr Hand Lt 2 Views,,73120,CPT,Facility,Inpatient,,,LT,270,229.5,77.382,270,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Xr Hand Lt 2 Views,,73120,CPT,Facility,Both,,,LT,270,229.5,77.382,270,Sanford Health Plan,Sanford Health Plan,248.4,92,,percent of total billed charges,,
Xr Hand Lt 2 Views,,73120,CPT,Facility,Outpatient,,,LT,270,229.5,77.382,270,"UCare Health, Inc.",Individual & Family Plan,152.145,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Xr Hand Lt 2 Views,,73120,CPT,Facility,Inpatient,,,LT,270,229.5,77.382,270,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Xr Hand Lt 2 Views,,73120,CPT,Facility,Outpatient,,,LT,270,229.5,77.382,270,"UCare Health, Inc.",Medical Assistance,136.269,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Hand Lt 2 Views,,73120,CPT,Facility,Inpatient,,,LT,270,229.5,77.382,270,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Xr Hand Lt 2 Views,,73120,CPT,Facility,Outpatient,,,LT,270,229.5,77.382,270,"UCare Health, Inc.",Medicare Advantage,136.269,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Hand Lt 2 Views,,73120,CPT,Facility,Inpatient,,,LT,270,229.5,77.382,270,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Hand Lt 2 Views,,73120,CPT,Facility,Outpatient,,,LT,270,229.5,77.382,270,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),136.269,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Hand Lt 2 Views,,73120,CPT,Facility,Inpatient,,,LT,270,229.5,77.382,270,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Hand Lt 2 Views,,73120,CPT,Facility,Both,,,LT,270,229.5,77.382,270,UnitedHealthcare,Individual & Family,253.8,94,,percent of total billed charges,,
Xr Hand Lt 2 Views,,73120,CPT,Facility,Outpatient,,,LT,270,229.5,77.382,270,UnitedHealthcare,Medicare Advantage,132.3,49,,percent of total billed charges,,
Xr Hand Lt 2 Views,,73120,CPT,Facility,Inpatient,,,LT,270,229.5,77.382,270,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Xr Hand Lt 2 Views,,73120,CPT,Facility,Outpatient,,,LT,270,229.5,77.382,270,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,129.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
Xr Hand Lt 2 Views,,73120,CPT,Facility,Inpatient,,,LT,270,229.5,77.382,270,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Xr Hand Routine Lt 3 Views,,73130,CPT,Facility,Both,,,LT,281,238.85,80.5346,281,Aetna,Commercial,258.52,92,,percent of total billed charges,,
Xr Hand Routine Lt 3 Views,,73130,CPT,Facility,Outpatient,,,LT,281,238.85,80.5346,281,Aetna,Medicare Advantage,137.69,49,,percent of total billed charges,,
Xr Hand Routine Lt 3 Views,,73130,CPT,Facility,Inpatient,,,LT,281,238.85,80.5346,281,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Xr Hand Routine Lt 3 Views,,73130,CPT,Facility,Both,,,LT,281,238.85,80.5346,281,Aetna,PPO,261.33,93,,percent of total billed charges,,
Xr Hand Routine Lt 3 Views,,73130,CPT,Facility,Both,,,LT,281,238.85,80.5346,281,America's PPO,America's PPO,269.8443,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Xr Hand Routine Lt 3 Views,,73130,CPT,Facility,Both,,,LT,281,238.85,80.5346,281,BlueCross BlueShield Minnesota, Federal Employee Program,276.504,98.4,,percent of total billed charges,,
Xr Hand Routine Lt 3 Views,,73130,CPT,Facility,Both,,,LT,281,238.85,80.5346,281,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,281,100,,percent of total billed charges,,
Xr Hand Routine Lt 3 Views,,73130,CPT,Facility,Both,,,LT,281,238.85,80.5346,281,BlueCross BlueShield Minnesota,High Value Network Plan,252.9,90,,percent of total billed charges,,
Xr Hand Routine Lt 3 Views,,73130,CPT,Facility,Outpatient,,,LT,281,238.85,80.5346,281,BlueCross BlueShield Minnesota,Medicare Advantage,137.69,49,,percent of total billed charges,,
Xr Hand Routine Lt 3 Views,,73130,CPT,Facility,Inpatient,,,LT,281,238.85,80.5346,281,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Xr Hand Routine Lt 3 Views,,73130,CPT,Facility,Both,,,LT,281,238.85,80.5346,281,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,248.8817,88.57,,percent of total billed charges,,
Xr Hand Routine Lt 3 Views,,73130,CPT,Facility,Both,,,LT,281,238.85,80.5346,281,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,80.5346,28.66,,percent of total billed charges,,
Xr Hand Routine Lt 3 Views,,73130,CPT,Facility,Outpatient,,,LT,281,238.85,80.5346,281,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),137.69,49,,percent of total billed charges,,
Xr Hand Routine Lt 3 Views,,73130,CPT,Facility,Inpatient,,,LT,281,238.85,80.5346,281,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Xr Hand Routine Lt 3 Views,,73130,CPT,Facility,Both,,,LT,281,238.85,80.5346,281,CorVel,Worker's Compensation,281,100,,percent of total billed charges,,
Xr Hand Routine Lt 3 Views,,73130,CPT,Facility,Both,,,LT,281,238.85,80.5346,281,First Health Group Corporation,First Health Network,272.57,97,,percent of total billed charges,,
Xr Hand Routine Lt 3 Views,,73130,CPT,Facility,Both,,,LT,281,238.85,80.5346,281,"Health Partners, Inc.",Commercial,265.826,94.6,,percent of total billed charges,,
Xr Hand Routine Lt 3 Views,,73130,CPT,Facility,Outpatient,,,LT,281,238.85,80.5346,281,"Health Partners, Inc.",Medicare Advantage,137.69,49,,percent of total billed charges,,
Xr Hand Routine Lt 3 Views,,73130,CPT,Facility,Inpatient,,,LT,281,238.85,80.5346,281,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Hand Routine Lt 3 Views,,73130,CPT,Facility,Both,,,LT,281,238.85,80.5346,281,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),168.6,60,,percent of total billed charges,,
Xr Hand Routine Lt 3 Views,,73130,CPT,Facility,Both,,,LT,281,238.85,80.5346,281,"Health Partners, Inc.",State of Minnesota Advantage Program,229.015,81.5,,percent of total billed charges,,
Xr Hand Routine Lt 3 Views,,73130,CPT,Facility,Both,,,LT,281,238.85,80.5346,281,"Health Partners, Inc.",State Public Programs,140.5,50,,percent of total billed charges,,
Xr Hand Routine Lt 3 Views,,73130,CPT,Facility,Both,,,LT,281,238.85,80.5346,281,Humana Insurance Company,Commercial PPO,266.95,95,,percent of total billed charges,,
Xr Hand Routine Lt 3 Views,,73130,CPT,Facility,Outpatient,,,LT,281,238.85,80.5346,281,Humana Insurance Company,Medicare PPO,137.69,49,,percent of total billed charges,,
Xr Hand Routine Lt 3 Views,,73130,CPT,Facility,Inpatient,,,LT,281,238.85,80.5346,281,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Xr Hand Routine Lt 3 Views,,73130,CPT,Facility,Both,,,LT,281,238.85,80.5346,281,Medica,Individual & Family,278.471,99.1,,percent of total billed charges,,
Xr Hand Routine Lt 3 Views,,73130,CPT,Facility,Outpatient,,,LT,281,238.85,80.5346,281,Medica,Medica Advantage Solution,139.938,49.8,,percent of total billed charges,,
Xr Hand Routine Lt 3 Views,,73130,CPT,Facility,Inpatient,,,LT,281,238.85,80.5346,281,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Xr Hand Routine Lt 3 Views,,73130,CPT,Facility,Outpatient,,,LT,281,238.85,80.5346,281,Medica,Medical Assistance,125.326,44.6,,percent of total billed charges,,
Xr Hand Routine Lt 3 Views,,73130,CPT,Facility,Inpatient,,,LT,281,238.85,80.5346,281,Medica,Medical Assistance,,,,,Included in per diem rate,
Xr Hand Routine Lt 3 Views,,73130,CPT,Facility,Outpatient,,,LT,281,238.85,80.5346,281,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,139.938,49.8,,percent of total billed charges,,
Xr Hand Routine Lt 3 Views,,73130,CPT,Facility,Inpatient,,,LT,281,238.85,80.5346,281,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Xr Hand Routine Lt 3 Views,,73130,CPT,Facility,Both,,,LT,281,238.85,80.5346,281,"Multiplan, Inc.","Multiplan, Inc.",264.14,94,,percent of total billed charges,,
Xr Hand Routine Lt 3 Views,,73130,CPT,Facility,Outpatient,,,LT,281,238.85,80.5346,281,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,253.181,90.1,,percent of total billed charges,,
Xr Hand Routine Lt 3 Views,,73130,CPT,Facility,Inpatient,,,LT,281,238.85,80.5346,281,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Xr Hand Routine Lt 3 Views,,73130,CPT,Facility,Both,,,LT,281,238.85,80.5346,281,"Preferred One Administrative Services, INC.",PPO,277.066,98.6,,percent of total billed charges,,
Xr Hand Routine Lt 3 Views,,73130,CPT,Facility,Outpatient,,,LT,281,238.85,80.5346,281,PrimeWest Health,Minnesota Senior Health Options (MSHO),144.5745,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Xr Hand Routine Lt 3 Views,,73130,CPT,Facility,Inpatient,,,LT,281,238.85,80.5346,281,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Hand Routine Lt 3 Views,,73130,CPT,Facility,Outpatient,,,LT,281,238.85,80.5346,281,PrimeWest Health,MinnesotaCare,144.3216,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Xr Hand Routine Lt 3 Views,,73130,CPT,Facility,Inpatient,,,LT,281,238.85,80.5346,281,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Xr Hand Routine Lt 3 Views,,73130,CPT,Facility,Both,,,LT,281,238.85,80.5346,281,Sanford Health Plan,Sanford Health Plan,258.52,92,,percent of total billed charges,,
Xr Hand Routine Lt 3 Views,,73130,CPT,Facility,Outpatient,,,LT,281,238.85,80.5346,281,"UCare Health, Inc.",Individual & Family Plan,158.3435,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Xr Hand Routine Lt 3 Views,,73130,CPT,Facility,Inpatient,,,LT,281,238.85,80.5346,281,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Xr Hand Routine Lt 3 Views,,73130,CPT,Facility,Outpatient,,,LT,281,238.85,80.5346,281,"UCare Health, Inc.",Medical Assistance,141.8207,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Hand Routine Lt 3 Views,,73130,CPT,Facility,Inpatient,,,LT,281,238.85,80.5346,281,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Xr Hand Routine Lt 3 Views,,73130,CPT,Facility,Outpatient,,,LT,281,238.85,80.5346,281,"UCare Health, Inc.",Medicare Advantage,141.8207,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Hand Routine Lt 3 Views,,73130,CPT,Facility,Inpatient,,,LT,281,238.85,80.5346,281,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Hand Routine Lt 3 Views,,73130,CPT,Facility,Outpatient,,,LT,281,238.85,80.5346,281,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),141.8207,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Hand Routine Lt 3 Views,,73130,CPT,Facility,Inpatient,,,LT,281,238.85,80.5346,281,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Hand Routine Lt 3 Views,,73130,CPT,Facility,Both,,,LT,281,238.85,80.5346,281,UnitedHealthcare,Individual & Family,264.14,94,,percent of total billed charges,,
Xr Hand Routine Lt 3 Views,,73130,CPT,Facility,Outpatient,,,LT,281,238.85,80.5346,281,UnitedHealthcare,Medicare Advantage,137.69,49,,percent of total billed charges,,
Xr Hand Routine Lt 3 Views,,73130,CPT,Facility,Inpatient,,,LT,281,238.85,80.5346,281,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Xr Hand Routine Lt 3 Views,,73130,CPT,Facility,Outpatient,,,LT,281,238.85,80.5346,281,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,134.88,48,,percent of total billed charges,,100% of DHS outpatient percentage
Xr Hand Routine Lt 3 Views,,73130,CPT,Facility,Inpatient,,,LT,281,238.85,80.5346,281,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Cta Upper Extremity Left,,73206,CPT,Facility,Both,,,LT,2244,1907.4,499,2244,Aetna,Commercial,2064.48,92,,percent of total billed charges,,
Cta Upper Extremity Left,,73206,CPT,Facility,Outpatient,,,LT,2244,1907.4,499,2244,Aetna,Medicare Advantage,1099.56,49,,percent of total billed charges,,
Cta Upper Extremity Left,,73206,CPT,Facility,Inpatient,,,LT,2244,1907.4,499,2244,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Cta Upper Extremity Left,,73206,CPT,Facility,Both,,,LT,2244,1907.4,499,2244,Aetna,PPO,2086.92,93,,percent of total billed charges,,
Cta Upper Extremity Left,,73206,CPT,Facility,Both,,,LT,2244,1907.4,499,2244,America's PPO,America's PPO,2154.9132,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Cta Upper Extremity Left,,73206,CPT,Facility,Both,,,LT,2244,1907.4,499,2244,BlueCross BlueShield Minnesota, Federal Employee Program,2208.096,98.4,,percent of total billed charges,,
Cta Upper Extremity Left,,73206,CPT,Facility,Both,,,LT,2244,1907.4,499,2244,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,2244,100,,percent of total billed charges,,
Cta Upper Extremity Left,,73206,CPT,Facility,Both,,,LT,2244,1907.4,499,2244,BlueCross BlueShield Minnesota,High Value Network Plan,2019.6,90,,percent of total billed charges,,
Cta Upper Extremity Left,,73206,CPT,Facility,Outpatient,,,LT,2244,1907.4,499,2244,BlueCross BlueShield Minnesota,Medicare Advantage,1099.56,49,,percent of total billed charges,,
Cta Upper Extremity Left,,73206,CPT,Facility,Inpatient,,,LT,2244,1907.4,499,2244,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Cta Upper Extremity Left,,73206,CPT,Facility,Both,,,LT,2244,1907.4,499,2244,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1987.5108,88.57,,percent of total billed charges,,
Cta Upper Extremity Left,,73206,CPT,Facility,Both,,,LT,2244,1907.4,499,2244,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,643.1304,28.66,,percent of total billed charges,,
Cta Upper Extremity Left,,73206,CPT,Facility,Outpatient,,,LT,2244,1907.4,499,2244,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1099.56,49,,percent of total billed charges,,
Cta Upper Extremity Left,,73206,CPT,Facility,Inpatient,,,LT,2244,1907.4,499,2244,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Cta Upper Extremity Left,,73206,CPT,Facility,Both,,,LT,2244,1907.4,499,2244,CorVel,Worker's Compensation,2244,100,,percent of total billed charges,,
Cta Upper Extremity Left,,73206,CPT,Facility,Both,,,LT,2244,1907.4,499,2244,First Health Group Corporation,First Health Network,2176.68,97,,percent of total billed charges,,
Cta Upper Extremity Left,,73206,CPT,Facility,Both,,,LT,2244,1907.4,499,2244,"Health Partners, Inc.",Commercial,2122.824,94.6,,percent of total billed charges,,
Cta Upper Extremity Left,,73206,CPT,Facility,Outpatient,,,LT,2244,1907.4,499,2244,"Health Partners, Inc.",Medicare Advantage,1099.56,49,,percent of total billed charges,,
Cta Upper Extremity Left,,73206,CPT,Facility,Inpatient,,,LT,2244,1907.4,499,2244,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Cta Upper Extremity Left,,73206,CPT,Facility,Both,,,LT,2244,1907.4,499,2244,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1346.4,60,,percent of total billed charges,,
Cta Upper Extremity Left,,73206,CPT,Facility,Both,,,LT,2244,1907.4,499,2244,"Health Partners, Inc.",State of Minnesota Advantage Program,1828.86,81.5,,percent of total billed charges,,
Cta Upper Extremity Left,,73206,CPT,Facility,Both,,,LT,2244,1907.4,499,2244,"Health Partners, Inc.",State Public Programs,1122,50,,percent of total billed charges,,
Cta Upper Extremity Left,,73206,CPT,Facility,Both,,,LT,2244,1907.4,499,2244,Humana Insurance Company,Commercial PPO,2131.8,95,,percent of total billed charges,,
Cta Upper Extremity Left,,73206,CPT,Facility,Outpatient,,,LT,2244,1907.4,499,2244,Humana Insurance Company,Medicare PPO,1099.56,49,,percent of total billed charges,,
Cta Upper Extremity Left,,73206,CPT,Facility,Inpatient,,,LT,2244,1907.4,499,2244,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Cta Upper Extremity Left,,73206,CPT,Facility,Both,,,LT,2244,1907.4,499,2244,Medica,Individual & Family,2223.804,99.1,,percent of total billed charges,,
Cta Upper Extremity Left,,73206,CPT,Facility,Outpatient,,,LT,2244,1907.4,499,2244,Medica,Medica Advantage Solution,1117.512,49.8,,percent of total billed charges,,
Cta Upper Extremity Left,,73206,CPT,Facility,Inpatient,,,LT,2244,1907.4,499,2244,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Cta Upper Extremity Left,,73206,CPT,Facility,Outpatient,,,LT,2244,1907.4,499,2244,Medica,Medical Assistance,499,,,Other,Per visit,Pays in addition to all Outpatient Service Categories
Cta Upper Extremity Left,,73206,CPT,Facility,Inpatient,,,LT,2244,1907.4,499,2244,Medica,Medical Assistance,,,,,Included in per diem rate,
Cta Upper Extremity Left,,73206,CPT,Facility,Outpatient,,,LT,2244,1907.4,499,2244,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1117.512,49.8,,percent of total billed charges,,
Cta Upper Extremity Left,,73206,CPT,Facility,Inpatient,,,LT,2244,1907.4,499,2244,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Cta Upper Extremity Left,,73206,CPT,Facility,Both,,,LT,2244,1907.4,499,2244,"Multiplan, Inc.","Multiplan, Inc.",2109.36,94,,percent of total billed charges,,
Cta Upper Extremity Left,,73206,CPT,Facility,Outpatient,,,LT,2244,1907.4,499,2244,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1283,,,Other,Per scan,
Cta Upper Extremity Left,,73206,CPT,Facility,Inpatient,,,LT,2244,1907.4,499,2244,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Cta Upper Extremity Left,,73206,CPT,Facility,Both,,,LT,2244,1907.4,499,2244,"Preferred One Administrative Services, INC.",PPO,2212.584,98.6,,percent of total billed charges,,
Cta Upper Extremity Left,,73206,CPT,Facility,Outpatient,,,LT,2244,1907.4,499,2244,PrimeWest Health,Minnesota Senior Health Options (MSHO),1154.538,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Cta Upper Extremity Left,,73206,CPT,Facility,Inpatient,,,LT,2244,1907.4,499,2244,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Cta Upper Extremity Left,,73206,CPT,Facility,Outpatient,,,LT,2244,1907.4,499,2244,PrimeWest Health,MinnesotaCare,1152.5184,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Cta Upper Extremity Left,,73206,CPT,Facility,Inpatient,,,LT,2244,1907.4,499,2244,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Cta Upper Extremity Left,,73206,CPT,Facility,Both,,,LT,2244,1907.4,499,2244,Sanford Health Plan,Sanford Health Plan,2064.48,92,,percent of total billed charges,,
Cta Upper Extremity Left,,73206,CPT,Facility,Outpatient,,,LT,2244,1907.4,499,2244,"UCare Health, Inc.",Individual & Family Plan,1264.494,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Cta Upper Extremity Left,,73206,CPT,Facility,Inpatient,,,LT,2244,1907.4,499,2244,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Cta Upper Extremity Left,,73206,CPT,Facility,Outpatient,,,LT,2244,1907.4,499,2244,"UCare Health, Inc.",Medical Assistance,1132.5468,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Cta Upper Extremity Left,,73206,CPT,Facility,Inpatient,,,LT,2244,1907.4,499,2244,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Cta Upper Extremity Left,,73206,CPT,Facility,Outpatient,,,LT,2244,1907.4,499,2244,"UCare Health, Inc.",Medicare Advantage,1132.5468,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Cta Upper Extremity Left,,73206,CPT,Facility,Inpatient,,,LT,2244,1907.4,499,2244,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Cta Upper Extremity Left,,73206,CPT,Facility,Outpatient,,,LT,2244,1907.4,499,2244,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1132.5468,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Cta Upper Extremity Left,,73206,CPT,Facility,Inpatient,,,LT,2244,1907.4,499,2244,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Cta Upper Extremity Left,,73206,CPT,Facility,Both,,,LT,2244,1907.4,499,2244,UnitedHealthcare,Individual & Family,2109.36,94,,percent of total billed charges,,
Cta Upper Extremity Left,,73206,CPT,Facility,Outpatient,,,LT,2244,1907.4,499,2244,UnitedHealthcare,Medicare Advantage,1099.56,49,,percent of total billed charges,,
Cta Upper Extremity Left,,73206,CPT,Facility,Inpatient,,,LT,2244,1907.4,499,2244,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Cta Upper Extremity Left,,73206,CPT,Facility,Outpatient,,,LT,2244,1907.4,499,2244,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1077.12,48,,percent of total billed charges,,100% of DHS outpatient percentage
Cta Upper Extremity Left,,73206,CPT,Facility,Inpatient,,,LT,2244,1907.4,499,2244,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Mri Upper Extremity Lt Not Jt Wo Contrast,,73218,CPT,Facility,Both,,,LT,2339,1988.15,670.3574,2339,Aetna,Commercial,2151.88,92,,percent of total billed charges,,
Mri Upper Extremity Lt Not Jt Wo Contrast,,73218,CPT,Facility,Outpatient,,,LT,2339,1988.15,670.3574,2339,Aetna,Medicare Advantage,1146.11,49,,percent of total billed charges,,
Mri Upper Extremity Lt Not Jt Wo Contrast,,73218,CPT,Facility,Inpatient,,,LT,2339,1988.15,670.3574,2339,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Mri Upper Extremity Lt Not Jt Wo Contrast,,73218,CPT,Facility,Both,,,LT,2339,1988.15,670.3574,2339,Aetna,PPO,2175.27,93,,percent of total billed charges,,
Mri Upper Extremity Lt Not Jt Wo Contrast,,73218,CPT,Facility,Both,,,LT,2339,1988.15,670.3574,2339,America's PPO,America's PPO,2246.1417,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Mri Upper Extremity Lt Not Jt Wo Contrast,,73218,CPT,Facility,Both,,,LT,2339,1988.15,670.3574,2339,BlueCross BlueShield Minnesota, Federal Employee Program,2301.576,98.4,,percent of total billed charges,,
Mri Upper Extremity Lt Not Jt Wo Contrast,,73218,CPT,Facility,Both,,,LT,2339,1988.15,670.3574,2339,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,2339,100,,percent of total billed charges,,
Mri Upper Extremity Lt Not Jt Wo Contrast,,73218,CPT,Facility,Both,,,LT,2339,1988.15,670.3574,2339,BlueCross BlueShield Minnesota,High Value Network Plan,2105.1,90,,percent of total billed charges,,
Mri Upper Extremity Lt Not Jt Wo Contrast,,73218,CPT,Facility,Outpatient,,,LT,2339,1988.15,670.3574,2339,BlueCross BlueShield Minnesota,Medicare Advantage,1146.11,49,,percent of total billed charges,,
Mri Upper Extremity Lt Not Jt Wo Contrast,,73218,CPT,Facility,Inpatient,,,LT,2339,1988.15,670.3574,2339,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Mri Upper Extremity Lt Not Jt Wo Contrast,,73218,CPT,Facility,Both,,,LT,2339,1988.15,670.3574,2339,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,2071.6523,88.57,,percent of total billed charges,,
Mri Upper Extremity Lt Not Jt Wo Contrast,,73218,CPT,Facility,Both,,,LT,2339,1988.15,670.3574,2339,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,670.3574,28.66,,percent of total billed charges,,
Mri Upper Extremity Lt Not Jt Wo Contrast,,73218,CPT,Facility,Outpatient,,,LT,2339,1988.15,670.3574,2339,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1146.11,49,,percent of total billed charges,,
Mri Upper Extremity Lt Not Jt Wo Contrast,,73218,CPT,Facility,Inpatient,,,LT,2339,1988.15,670.3574,2339,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Mri Upper Extremity Lt Not Jt Wo Contrast,,73218,CPT,Facility,Both,,,LT,2339,1988.15,670.3574,2339,CorVel,Worker's Compensation,2339,100,,percent of total billed charges,,
Mri Upper Extremity Lt Not Jt Wo Contrast,,73218,CPT,Facility,Both,,,LT,2339,1988.15,670.3574,2339,First Health Group Corporation,First Health Network,2268.83,97,,percent of total billed charges,,
Mri Upper Extremity Lt Not Jt Wo Contrast,,73218,CPT,Facility,Both,,,LT,2339,1988.15,670.3574,2339,"Health Partners, Inc.",Commercial,2212.694,94.6,,percent of total billed charges,,
Mri Upper Extremity Lt Not Jt Wo Contrast,,73218,CPT,Facility,Outpatient,,,LT,2339,1988.15,670.3574,2339,"Health Partners, Inc.",Medicare Advantage,1146.11,49,,percent of total billed charges,,
Mri Upper Extremity Lt Not Jt Wo Contrast,,73218,CPT,Facility,Inpatient,,,LT,2339,1988.15,670.3574,2339,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mri Upper Extremity Lt Not Jt Wo Contrast,,73218,CPT,Facility,Both,,,LT,2339,1988.15,670.3574,2339,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1403.4,60,,percent of total billed charges,,
Mri Upper Extremity Lt Not Jt Wo Contrast,,73218,CPT,Facility,Both,,,LT,2339,1988.15,670.3574,2339,"Health Partners, Inc.",State of Minnesota Advantage Program,1906.285,81.5,,percent of total billed charges,,
Mri Upper Extremity Lt Not Jt Wo Contrast,,73218,CPT,Facility,Both,,,LT,2339,1988.15,670.3574,2339,"Health Partners, Inc.",State Public Programs,1169.5,50,,percent of total billed charges,,
Mri Upper Extremity Lt Not Jt Wo Contrast,,73218,CPT,Facility,Both,,,LT,2339,1988.15,670.3574,2339,Humana Insurance Company,Commercial PPO,2222.05,95,,percent of total billed charges,,
Mri Upper Extremity Lt Not Jt Wo Contrast,,73218,CPT,Facility,Outpatient,,,LT,2339,1988.15,670.3574,2339,Humana Insurance Company,Medicare PPO,1146.11,49,,percent of total billed charges,,
Mri Upper Extremity Lt Not Jt Wo Contrast,,73218,CPT,Facility,Inpatient,,,LT,2339,1988.15,670.3574,2339,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Mri Upper Extremity Lt Not Jt Wo Contrast,,73218,CPT,Facility,Both,,,LT,2339,1988.15,670.3574,2339,Medica,Individual & Family,2317.949,99.1,,percent of total billed charges,,
Mri Upper Extremity Lt Not Jt Wo Contrast,,73218,CPT,Facility,Outpatient,,,LT,2339,1988.15,670.3574,2339,Medica,Medica Advantage Solution,1164.822,49.8,,percent of total billed charges,,
Mri Upper Extremity Lt Not Jt Wo Contrast,,73218,CPT,Facility,Inpatient,,,LT,2339,1988.15,670.3574,2339,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Mri Upper Extremity Lt Not Jt Wo Contrast,,73218,CPT,Facility,Outpatient,,,LT,2339,1988.15,670.3574,2339,Medica,Medical Assistance,747,,,Other  ,per vist,Pays in addition to all Outpatient Service Categories
Mri Upper Extremity Lt Not Jt Wo Contrast,,73218,CPT,Facility,Inpatient,,,LT,2339,1988.15,670.3574,2339,Medica,Medical Assistance,,,,,Included in per diem rate,
Mri Upper Extremity Lt Not Jt Wo Contrast,,73218,CPT,Facility,Outpatient,,,LT,2339,1988.15,670.3574,2339,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1164.822,49.8,,percent of total billed charges,,
Mri Upper Extremity Lt Not Jt Wo Contrast,,73218,CPT,Facility,Inpatient,,,LT,2339,1988.15,670.3574,2339,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Mri Upper Extremity Lt Not Jt Wo Contrast,,73218,CPT,Facility,Both,,,LT,2339,1988.15,670.3574,2339,"Multiplan, Inc.","Multiplan, Inc.",2198.66,94,,percent of total billed charges,,
Mri Upper Extremity Lt Not Jt Wo Contrast,,73218,CPT,Facility,Outpatient,,,LT,2339,1988.15,670.3574,2339,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1535,,,Other  ,per scan,
Mri Upper Extremity Lt Not Jt Wo Contrast,,73218,CPT,Facility,Inpatient,,,LT,2339,1988.15,670.3574,2339,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Mri Upper Extremity Lt Not Jt Wo Contrast,,73218,CPT,Facility,Both,,,LT,2339,1988.15,670.3574,2339,"Preferred One Administrative Services, INC.",PPO,2306.254,98.6,,percent of total billed charges,,
Mri Upper Extremity Lt Not Jt Wo Contrast,,73218,CPT,Facility,Outpatient,,,LT,2339,1988.15,670.3574,2339,PrimeWest Health,Minnesota Senior Health Options (MSHO),1203.4155,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Mri Upper Extremity Lt Not Jt Wo Contrast,,73218,CPT,Facility,Inpatient,,,LT,2339,1988.15,670.3574,2339,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mri Upper Extremity Lt Not Jt Wo Contrast,,73218,CPT,Facility,Outpatient,,,LT,2339,1988.15,670.3574,2339,PrimeWest Health,MinnesotaCare,1201.3104,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Mri Upper Extremity Lt Not Jt Wo Contrast,,73218,CPT,Facility,Inpatient,,,LT,2339,1988.15,670.3574,2339,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Mri Upper Extremity Lt Not Jt Wo Contrast,,73218,CPT,Facility,Both,,,LT,2339,1988.15,670.3574,2339,Sanford Health Plan,Sanford Health Plan,2151.88,92,,percent of total billed charges,,
Mri Upper Extremity Lt Not Jt Wo Contrast,,73218,CPT,Facility,Outpatient,,,LT,2339,1988.15,670.3574,2339,"UCare Health, Inc.",Individual & Family Plan,1318.0265,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Mri Upper Extremity Lt Not Jt Wo Contrast,,73218,CPT,Facility,Inpatient,,,LT,2339,1988.15,670.3574,2339,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Mri Upper Extremity Lt Not Jt Wo Contrast,,73218,CPT,Facility,Outpatient,,,LT,2339,1988.15,670.3574,2339,"UCare Health, Inc.",Medical Assistance,1180.4933,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mri Upper Extremity Lt Not Jt Wo Contrast,,73218,CPT,Facility,Inpatient,,,LT,2339,1988.15,670.3574,2339,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Mri Upper Extremity Lt Not Jt Wo Contrast,,73218,CPT,Facility,Outpatient,,,LT,2339,1988.15,670.3574,2339,"UCare Health, Inc.",Medicare Advantage,1180.4933,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mri Upper Extremity Lt Not Jt Wo Contrast,,73218,CPT,Facility,Inpatient,,,LT,2339,1988.15,670.3574,2339,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mri Upper Extremity Lt Not Jt Wo Contrast,,73218,CPT,Facility,Outpatient,,,LT,2339,1988.15,670.3574,2339,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1180.4933,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mri Upper Extremity Lt Not Jt Wo Contrast,,73218,CPT,Facility,Inpatient,,,LT,2339,1988.15,670.3574,2339,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mri Upper Extremity Lt Not Jt Wo Contrast,,73218,CPT,Facility,Both,,,LT,2339,1988.15,670.3574,2339,UnitedHealthcare,Individual & Family,2198.66,94,,percent of total billed charges,,
Mri Upper Extremity Lt Not Jt Wo Contrast,,73218,CPT,Facility,Outpatient,,,LT,2339,1988.15,670.3574,2339,UnitedHealthcare,Medicare Advantage,1146.11,49,,percent of total billed charges,,
Mri Upper Extremity Lt Not Jt Wo Contrast,,73218,CPT,Facility,Inpatient,,,LT,2339,1988.15,670.3574,2339,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Mri Upper Extremity Lt Not Jt Wo Contrast,,73218,CPT,Facility,Outpatient,,,LT,2339,1988.15,670.3574,2339,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1122.72,48,,percent of total billed charges,,100% of DHS outpatient percentage
Mri Upper Extremity Lt Not Jt Wo Contrast,,73218,CPT,Facility,Inpatient,,,LT,2339,1988.15,670.3574,2339,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Mri Upper Extremity Lt Not Jt W Contrast,,73219,CPT,Facility,Both,,,LT,2917,2479.45,747,2917,Aetna,Commercial,2683.64,92,,percent of total billed charges,,
Mri Upper Extremity Lt Not Jt W Contrast,,73219,CPT,Facility,Outpatient,,,LT,2917,2479.45,747,2917,Aetna,Medicare Advantage,1429.33,49,,percent of total billed charges,,
Mri Upper Extremity Lt Not Jt W Contrast,,73219,CPT,Facility,Inpatient,,,LT,2917,2479.45,747,2917,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Mri Upper Extremity Lt Not Jt W Contrast,,73219,CPT,Facility,Both,,,LT,2917,2479.45,747,2917,Aetna,PPO,2712.81,93,,percent of total billed charges,,
Mri Upper Extremity Lt Not Jt W Contrast,,73219,CPT,Facility,Both,,,LT,2917,2479.45,747,2917,America's PPO,America's PPO,2801.1951,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Mri Upper Extremity Lt Not Jt W Contrast,,73219,CPT,Facility,Both,,,LT,2917,2479.45,747,2917,BlueCross BlueShield Minnesota, Federal Employee Program,2870.328,98.4,,percent of total billed charges,,
Mri Upper Extremity Lt Not Jt W Contrast,,73219,CPT,Facility,Both,,,LT,2917,2479.45,747,2917,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,2917,100,,percent of total billed charges,,
Mri Upper Extremity Lt Not Jt W Contrast,,73219,CPT,Facility,Both,,,LT,2917,2479.45,747,2917,BlueCross BlueShield Minnesota,High Value Network Plan,2625.3,90,,percent of total billed charges,,
Mri Upper Extremity Lt Not Jt W Contrast,,73219,CPT,Facility,Outpatient,,,LT,2917,2479.45,747,2917,BlueCross BlueShield Minnesota,Medicare Advantage,1429.33,49,,percent of total billed charges,,
Mri Upper Extremity Lt Not Jt W Contrast,,73219,CPT,Facility,Inpatient,,,LT,2917,2479.45,747,2917,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Mri Upper Extremity Lt Not Jt W Contrast,,73219,CPT,Facility,Both,,,LT,2917,2479.45,747,2917,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,2583.5869,88.57,,percent of total billed charges,,
Mri Upper Extremity Lt Not Jt W Contrast,,73219,CPT,Facility,Both,,,LT,2917,2479.45,747,2917,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,836.0122,28.66,,percent of total billed charges,,
Mri Upper Extremity Lt Not Jt W Contrast,,73219,CPT,Facility,Outpatient,,,LT,2917,2479.45,747,2917,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1429.33,49,,percent of total billed charges,,
Mri Upper Extremity Lt Not Jt W Contrast,,73219,CPT,Facility,Inpatient,,,LT,2917,2479.45,747,2917,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Mri Upper Extremity Lt Not Jt W Contrast,,73219,CPT,Facility,Both,,,LT,2917,2479.45,747,2917,CorVel,Worker's Compensation,2917,100,,percent of total billed charges,,
Mri Upper Extremity Lt Not Jt W Contrast,,73219,CPT,Facility,Both,,,LT,2917,2479.45,747,2917,First Health Group Corporation,First Health Network,2829.49,97,,percent of total billed charges,,
Mri Upper Extremity Lt Not Jt W Contrast,,73219,CPT,Facility,Both,,,LT,2917,2479.45,747,2917,"Health Partners, Inc.",Commercial,2759.482,94.6,,percent of total billed charges,,
Mri Upper Extremity Lt Not Jt W Contrast,,73219,CPT,Facility,Outpatient,,,LT,2917,2479.45,747,2917,"Health Partners, Inc.",Medicare Advantage,1429.33,49,,percent of total billed charges,,
Mri Upper Extremity Lt Not Jt W Contrast,,73219,CPT,Facility,Inpatient,,,LT,2917,2479.45,747,2917,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mri Upper Extremity Lt Not Jt W Contrast,,73219,CPT,Facility,Both,,,LT,2917,2479.45,747,2917,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1750.2,60,,percent of total billed charges,,
Mri Upper Extremity Lt Not Jt W Contrast,,73219,CPT,Facility,Both,,,LT,2917,2479.45,747,2917,"Health Partners, Inc.",State of Minnesota Advantage Program,2377.355,81.5,,percent of total billed charges,,
Mri Upper Extremity Lt Not Jt W Contrast,,73219,CPT,Facility,Both,,,LT,2917,2479.45,747,2917,"Health Partners, Inc.",State Public Programs,1458.5,50,,percent of total billed charges,,
Mri Upper Extremity Lt Not Jt W Contrast,,73219,CPT,Facility,Both,,,LT,2917,2479.45,747,2917,Humana Insurance Company,Commercial PPO,2771.15,95,,percent of total billed charges,,
Mri Upper Extremity Lt Not Jt W Contrast,,73219,CPT,Facility,Outpatient,,,LT,2917,2479.45,747,2917,Humana Insurance Company,Medicare PPO,1429.33,49,,percent of total billed charges,,
Mri Upper Extremity Lt Not Jt W Contrast,,73219,CPT,Facility,Inpatient,,,LT,2917,2479.45,747,2917,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Mri Upper Extremity Lt Not Jt W Contrast,,73219,CPT,Facility,Both,,,LT,2917,2479.45,747,2917,Medica,Individual & Family,2890.747,99.1,,percent of total billed charges,,
Mri Upper Extremity Lt Not Jt W Contrast,,73219,CPT,Facility,Outpatient,,,LT,2917,2479.45,747,2917,Medica,Medica Advantage Solution,1452.666,49.8,,percent of total billed charges,,
Mri Upper Extremity Lt Not Jt W Contrast,,73219,CPT,Facility,Inpatient,,,LT,2917,2479.45,747,2917,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Mri Upper Extremity Lt Not Jt W Contrast,,73219,CPT,Facility,Outpatient,,,LT,2917,2479.45,747,2917,Medica,Medical Assistance,747,,,Other ,per vist,Pays in addition to all Outpatient Service Categories
Mri Upper Extremity Lt Not Jt W Contrast,,73219,CPT,Facility,Inpatient,,,LT,2917,2479.45,747,2917,Medica,Medical Assistance,,,,,Included in per diem rate,
Mri Upper Extremity Lt Not Jt W Contrast,,73219,CPT,Facility,Outpatient,,,LT,2917,2479.45,747,2917,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1452.666,49.8,,percent of total billed charges,,
Mri Upper Extremity Lt Not Jt W Contrast,,73219,CPT,Facility,Inpatient,,,LT,2917,2479.45,747,2917,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Mri Upper Extremity Lt Not Jt W Contrast,,73219,CPT,Facility,Both,,,LT,2917,2479.45,747,2917,"Multiplan, Inc.","Multiplan, Inc.",2741.98,94,,percent of total billed charges,,
Mri Upper Extremity Lt Not Jt W Contrast,,73219,CPT,Facility,Outpatient,,,LT,2917,2479.45,747,2917,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1535,,,Other ,per scan,
Mri Upper Extremity Lt Not Jt W Contrast,,73219,CPT,Facility,Inpatient,,,LT,2917,2479.45,747,2917,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Mri Upper Extremity Lt Not Jt W Contrast,,73219,CPT,Facility,Both,,,LT,2917,2479.45,747,2917,"Preferred One Administrative Services, INC.",PPO,2876.162,98.6,,percent of total billed charges,,
Mri Upper Extremity Lt Not Jt W Contrast,,73219,CPT,Facility,Outpatient,,,LT,2917,2479.45,747,2917,PrimeWest Health,Minnesota Senior Health Options (MSHO),1500.7965,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Mri Upper Extremity Lt Not Jt W Contrast,,73219,CPT,Facility,Inpatient,,,LT,2917,2479.45,747,2917,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mri Upper Extremity Lt Not Jt W Contrast,,73219,CPT,Facility,Outpatient,,,LT,2917,2479.45,747,2917,PrimeWest Health,MinnesotaCare,1498.1712,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Mri Upper Extremity Lt Not Jt W Contrast,,73219,CPT,Facility,Inpatient,,,LT,2917,2479.45,747,2917,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Mri Upper Extremity Lt Not Jt W Contrast,,73219,CPT,Facility,Both,,,LT,2917,2479.45,747,2917,Sanford Health Plan,Sanford Health Plan,2683.64,92,,percent of total billed charges,,
Mri Upper Extremity Lt Not Jt W Contrast,,73219,CPT,Facility,Outpatient,,,LT,2917,2479.45,747,2917,"UCare Health, Inc.",Individual & Family Plan,1643.7295,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Mri Upper Extremity Lt Not Jt W Contrast,,73219,CPT,Facility,Inpatient,,,LT,2917,2479.45,747,2917,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Mri Upper Extremity Lt Not Jt W Contrast,,73219,CPT,Facility,Outpatient,,,LT,2917,2479.45,747,2917,"UCare Health, Inc.",Medical Assistance,1472.2099,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mri Upper Extremity Lt Not Jt W Contrast,,73219,CPT,Facility,Inpatient,,,LT,2917,2479.45,747,2917,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Mri Upper Extremity Lt Not Jt W Contrast,,73219,CPT,Facility,Outpatient,,,LT,2917,2479.45,747,2917,"UCare Health, Inc.",Medicare Advantage,1472.2099,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mri Upper Extremity Lt Not Jt W Contrast,,73219,CPT,Facility,Inpatient,,,LT,2917,2479.45,747,2917,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mri Upper Extremity Lt Not Jt W Contrast,,73219,CPT,Facility,Outpatient,,,LT,2917,2479.45,747,2917,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1472.2099,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mri Upper Extremity Lt Not Jt W Contrast,,73219,CPT,Facility,Inpatient,,,LT,2917,2479.45,747,2917,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mri Upper Extremity Lt Not Jt W Contrast,,73219,CPT,Facility,Both,,,LT,2917,2479.45,747,2917,UnitedHealthcare,Individual & Family,2741.98,94,,percent of total billed charges,,
Mri Upper Extremity Lt Not Jt W Contrast,,73219,CPT,Facility,Outpatient,,,LT,2917,2479.45,747,2917,UnitedHealthcare,Medicare Advantage,1429.33,49,,percent of total billed charges,,
Mri Upper Extremity Lt Not Jt W Contrast,,73219,CPT,Facility,Inpatient,,,LT,2917,2479.45,747,2917,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Mri Upper Extremity Lt Not Jt W Contrast,,73219,CPT,Facility,Outpatient,,,LT,2917,2479.45,747,2917,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1400.16,48,,percent of total billed charges,,100% of DHS outpatient percentage
Mri Upper Extremity Lt Not Jt W Contrast,,73219,CPT,Facility,Inpatient,,,LT,2917,2479.45,747,2917,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Mri Upper Extremity Lt Not Jt Wo W Contrast,,73220,CPT,Facility,Both,,,LT,3254,2765.9,747,3254,Aetna,Commercial,2993.68,92,,percent of total billed charges,,
Mri Upper Extremity Lt Not Jt Wo W Contrast,,73220,CPT,Facility,Outpatient,,,LT,3254,2765.9,747,3254,Aetna,Medicare Advantage,1594.46,49,,percent of total billed charges,,
Mri Upper Extremity Lt Not Jt Wo W Contrast,,73220,CPT,Facility,Inpatient,,,LT,3254,2765.9,747,3254,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Mri Upper Extremity Lt Not Jt Wo W Contrast,,73220,CPT,Facility,Both,,,LT,3254,2765.9,747,3254,Aetna,PPO,3026.22,93,,percent of total billed charges,,
Mri Upper Extremity Lt Not Jt Wo W Contrast,,73220,CPT,Facility,Both,,,LT,3254,2765.9,747,3254,America's PPO,America's PPO,3124.8162,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Mri Upper Extremity Lt Not Jt Wo W Contrast,,73220,CPT,Facility,Both,,,LT,3254,2765.9,747,3254,BlueCross BlueShield Minnesota, Federal Employee Program,3201.936,98.4,,percent of total billed charges,,
Mri Upper Extremity Lt Not Jt Wo W Contrast,,73220,CPT,Facility,Both,,,LT,3254,2765.9,747,3254,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,3254,100,,percent of total billed charges,,
Mri Upper Extremity Lt Not Jt Wo W Contrast,,73220,CPT,Facility,Both,,,LT,3254,2765.9,747,3254,BlueCross BlueShield Minnesota,High Value Network Plan,2928.6,90,,percent of total billed charges,,
Mri Upper Extremity Lt Not Jt Wo W Contrast,,73220,CPT,Facility,Outpatient,,,LT,3254,2765.9,747,3254,BlueCross BlueShield Minnesota,Medicare Advantage,1594.46,49,,percent of total billed charges,,
Mri Upper Extremity Lt Not Jt Wo W Contrast,,73220,CPT,Facility,Inpatient,,,LT,3254,2765.9,747,3254,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Mri Upper Extremity Lt Not Jt Wo W Contrast,,73220,CPT,Facility,Both,,,LT,3254,2765.9,747,3254,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,2882.0678,88.57,,percent of total billed charges,,
Mri Upper Extremity Lt Not Jt Wo W Contrast,,73220,CPT,Facility,Both,,,LT,3254,2765.9,747,3254,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,932.5964,28.66,,percent of total billed charges,,
Mri Upper Extremity Lt Not Jt Wo W Contrast,,73220,CPT,Facility,Outpatient,,,LT,3254,2765.9,747,3254,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1594.46,49,,percent of total billed charges,,
Mri Upper Extremity Lt Not Jt Wo W Contrast,,73220,CPT,Facility,Inpatient,,,LT,3254,2765.9,747,3254,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Mri Upper Extremity Lt Not Jt Wo W Contrast,,73220,CPT,Facility,Both,,,LT,3254,2765.9,747,3254,CorVel,Worker's Compensation,3254,100,,percent of total billed charges,,
Mri Upper Extremity Lt Not Jt Wo W Contrast,,73220,CPT,Facility,Both,,,LT,3254,2765.9,747,3254,First Health Group Corporation,First Health Network,3156.38,97,,percent of total billed charges,,
Mri Upper Extremity Lt Not Jt Wo W Contrast,,73220,CPT,Facility,Both,,,LT,3254,2765.9,747,3254,"Health Partners, Inc.",Commercial,3078.284,94.6,,percent of total billed charges,,
Mri Upper Extremity Lt Not Jt Wo W Contrast,,73220,CPT,Facility,Outpatient,,,LT,3254,2765.9,747,3254,"Health Partners, Inc.",Medicare Advantage,1594.46,49,,percent of total billed charges,,
Mri Upper Extremity Lt Not Jt Wo W Contrast,,73220,CPT,Facility,Inpatient,,,LT,3254,2765.9,747,3254,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mri Upper Extremity Lt Not Jt Wo W Contrast,,73220,CPT,Facility,Both,,,LT,3254,2765.9,747,3254,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1952.4,60,,percent of total billed charges,,
Mri Upper Extremity Lt Not Jt Wo W Contrast,,73220,CPT,Facility,Both,,,LT,3254,2765.9,747,3254,"Health Partners, Inc.",State of Minnesota Advantage Program,2652.01,81.5,,percent of total billed charges,,
Mri Upper Extremity Lt Not Jt Wo W Contrast,,73220,CPT,Facility,Both,,,LT,3254,2765.9,747,3254,"Health Partners, Inc.",State Public Programs,1627,50,,percent of total billed charges,,
Mri Upper Extremity Lt Not Jt Wo W Contrast,,73220,CPT,Facility,Both,,,LT,3254,2765.9,747,3254,Humana Insurance Company,Commercial PPO,3091.3,95,,percent of total billed charges,,
Mri Upper Extremity Lt Not Jt Wo W Contrast,,73220,CPT,Facility,Outpatient,,,LT,3254,2765.9,747,3254,Humana Insurance Company,Medicare PPO,1594.46,49,,percent of total billed charges,,
Mri Upper Extremity Lt Not Jt Wo W Contrast,,73220,CPT,Facility,Inpatient,,,LT,3254,2765.9,747,3254,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Mri Upper Extremity Lt Not Jt Wo W Contrast,,73220,CPT,Facility,Both,,,LT,3254,2765.9,747,3254,Medica,Individual & Family,3224.714,99.1,,percent of total billed charges,,
Mri Upper Extremity Lt Not Jt Wo W Contrast,,73220,CPT,Facility,Outpatient,,,LT,3254,2765.9,747,3254,Medica,Medica Advantage Solution,1620.492,49.8,,percent of total billed charges,,
Mri Upper Extremity Lt Not Jt Wo W Contrast,,73220,CPT,Facility,Inpatient,,,LT,3254,2765.9,747,3254,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Mri Upper Extremity Lt Not Jt Wo W Contrast,,73220,CPT,Facility,Outpatient,,,LT,3254,2765.9,747,3254,Medica,Medical Assistance,747,,,Other ,per vist,Pays in addition to all Outpatient Service Categories
Mri Upper Extremity Lt Not Jt Wo W Contrast,,73220,CPT,Facility,Inpatient,,,LT,3254,2765.9,747,3254,Medica,Medical Assistance,,,,,Included in per diem rate,
Mri Upper Extremity Lt Not Jt Wo W Contrast,,73220,CPT,Facility,Outpatient,,,LT,3254,2765.9,747,3254,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1620.492,49.8,,percent of total billed charges,,
Mri Upper Extremity Lt Not Jt Wo W Contrast,,73220,CPT,Facility,Inpatient,,,LT,3254,2765.9,747,3254,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Mri Upper Extremity Lt Not Jt Wo W Contrast,,73220,CPT,Facility,Both,,,LT,3254,2765.9,747,3254,"Multiplan, Inc.","Multiplan, Inc.",3058.76,94,,percent of total billed charges,,
Mri Upper Extremity Lt Not Jt Wo W Contrast,,73220,CPT,Facility,Outpatient,,,LT,3254,2765.9,747,3254,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1535,,,Other ,per scan,
Mri Upper Extremity Lt Not Jt Wo W Contrast,,73220,CPT,Facility,Inpatient,,,LT,3254,2765.9,747,3254,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Mri Upper Extremity Lt Not Jt Wo W Contrast,,73220,CPT,Facility,Both,,,LT,3254,2765.9,747,3254,"Preferred One Administrative Services, INC.",PPO,3208.444,98.6,,percent of total billed charges,,
Mri Upper Extremity Lt Not Jt Wo W Contrast,,73220,CPT,Facility,Outpatient,,,LT,3254,2765.9,747,3254,PrimeWest Health,Minnesota Senior Health Options (MSHO),1674.183,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Mri Upper Extremity Lt Not Jt Wo W Contrast,,73220,CPT,Facility,Inpatient,,,LT,3254,2765.9,747,3254,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mri Upper Extremity Lt Not Jt Wo W Contrast,,73220,CPT,Facility,Outpatient,,,LT,3254,2765.9,747,3254,PrimeWest Health,MinnesotaCare,1671.2544,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Mri Upper Extremity Lt Not Jt Wo W Contrast,,73220,CPT,Facility,Inpatient,,,LT,3254,2765.9,747,3254,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Mri Upper Extremity Lt Not Jt Wo W Contrast,,73220,CPT,Facility,Both,,,LT,3254,2765.9,747,3254,Sanford Health Plan,Sanford Health Plan,2993.68,92,,percent of total billed charges,,
Mri Upper Extremity Lt Not Jt Wo W Contrast,,73220,CPT,Facility,Outpatient,,,LT,3254,2765.9,747,3254,"UCare Health, Inc.",Individual & Family Plan,1833.629,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Mri Upper Extremity Lt Not Jt Wo W Contrast,,73220,CPT,Facility,Inpatient,,,LT,3254,2765.9,747,3254,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Mri Upper Extremity Lt Not Jt Wo W Contrast,,73220,CPT,Facility,Outpatient,,,LT,3254,2765.9,747,3254,"UCare Health, Inc.",Medical Assistance,1642.2938,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mri Upper Extremity Lt Not Jt Wo W Contrast,,73220,CPT,Facility,Inpatient,,,LT,3254,2765.9,747,3254,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Mri Upper Extremity Lt Not Jt Wo W Contrast,,73220,CPT,Facility,Outpatient,,,LT,3254,2765.9,747,3254,"UCare Health, Inc.",Medicare Advantage,1642.2938,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mri Upper Extremity Lt Not Jt Wo W Contrast,,73220,CPT,Facility,Inpatient,,,LT,3254,2765.9,747,3254,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mri Upper Extremity Lt Not Jt Wo W Contrast,,73220,CPT,Facility,Outpatient,,,LT,3254,2765.9,747,3254,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1642.2938,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mri Upper Extremity Lt Not Jt Wo W Contrast,,73220,CPT,Facility,Inpatient,,,LT,3254,2765.9,747,3254,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mri Upper Extremity Lt Not Jt Wo W Contrast,,73220,CPT,Facility,Both,,,LT,3254,2765.9,747,3254,UnitedHealthcare,Individual & Family,3058.76,94,,percent of total billed charges,,
Mri Upper Extremity Lt Not Jt Wo W Contrast,,73220,CPT,Facility,Outpatient,,,LT,3254,2765.9,747,3254,UnitedHealthcare,Medicare Advantage,1594.46,49,,percent of total billed charges,,
Mri Upper Extremity Lt Not Jt Wo W Contrast,,73220,CPT,Facility,Inpatient,,,LT,3254,2765.9,747,3254,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Mri Upper Extremity Lt Not Jt Wo W Contrast,,73220,CPT,Facility,Outpatient,,,LT,3254,2765.9,747,3254,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1561.92,48,,percent of total billed charges,,100% of DHS outpatient percentage
Mri Upper Extremity Lt Not Jt Wo W Contrast,,73220,CPT,Facility,Inpatient,,,LT,3254,2765.9,747,3254,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Mri Upper Extremity Lt Any Jt Wo Contrast,,73221,CPT,Facility,Both,,,LT,2339,1988.15,670.3574,2339,Aetna,Commercial,2151.88,92,,percent of total billed charges,,
Mri Upper Extremity Lt Any Jt Wo Contrast,,73221,CPT,Facility,Outpatient,,,LT,2339,1988.15,670.3574,2339,Aetna,Medicare Advantage,1146.11,49,,percent of total billed charges,,
Mri Upper Extremity Lt Any Jt Wo Contrast,,73221,CPT,Facility,Inpatient,,,LT,2339,1988.15,670.3574,2339,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Mri Upper Extremity Lt Any Jt Wo Contrast,,73221,CPT,Facility,Both,,,LT,2339,1988.15,670.3574,2339,Aetna,PPO,2175.27,93,,percent of total billed charges,,
Mri Upper Extremity Lt Any Jt Wo Contrast,,73221,CPT,Facility,Both,,,LT,2339,1988.15,670.3574,2339,America's PPO,America's PPO,2246.1417,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Mri Upper Extremity Lt Any Jt Wo Contrast,,73221,CPT,Facility,Both,,,LT,2339,1988.15,670.3574,2339,BlueCross BlueShield Minnesota, Federal Employee Program,2301.576,98.4,,percent of total billed charges,,
Mri Upper Extremity Lt Any Jt Wo Contrast,,73221,CPT,Facility,Both,,,LT,2339,1988.15,670.3574,2339,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,2339,100,,percent of total billed charges,,
Mri Upper Extremity Lt Any Jt Wo Contrast,,73221,CPT,Facility,Both,,,LT,2339,1988.15,670.3574,2339,BlueCross BlueShield Minnesota,High Value Network Plan,2105.1,90,,percent of total billed charges,,
Mri Upper Extremity Lt Any Jt Wo Contrast,,73221,CPT,Facility,Outpatient,,,LT,2339,1988.15,670.3574,2339,BlueCross BlueShield Minnesota,Medicare Advantage,1146.11,49,,percent of total billed charges,,
Mri Upper Extremity Lt Any Jt Wo Contrast,,73221,CPT,Facility,Inpatient,,,LT,2339,1988.15,670.3574,2339,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Mri Upper Extremity Lt Any Jt Wo Contrast,,73221,CPT,Facility,Both,,,LT,2339,1988.15,670.3574,2339,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,2071.6523,88.57,,percent of total billed charges,,
Mri Upper Extremity Lt Any Jt Wo Contrast,,73221,CPT,Facility,Both,,,LT,2339,1988.15,670.3574,2339,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,670.3574,28.66,,percent of total billed charges,,
Mri Upper Extremity Lt Any Jt Wo Contrast,,73221,CPT,Facility,Outpatient,,,LT,2339,1988.15,670.3574,2339,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1146.11,49,,percent of total billed charges,,
Mri Upper Extremity Lt Any Jt Wo Contrast,,73221,CPT,Facility,Inpatient,,,LT,2339,1988.15,670.3574,2339,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Mri Upper Extremity Lt Any Jt Wo Contrast,,73221,CPT,Facility,Both,,,LT,2339,1988.15,670.3574,2339,CorVel,Worker's Compensation,2339,100,,percent of total billed charges,,
Mri Upper Extremity Lt Any Jt Wo Contrast,,73221,CPT,Facility,Both,,,LT,2339,1988.15,670.3574,2339,First Health Group Corporation,First Health Network,2268.83,97,,percent of total billed charges,,
Mri Upper Extremity Lt Any Jt Wo Contrast,,73221,CPT,Facility,Both,,,LT,2339,1988.15,670.3574,2339,"Health Partners, Inc.",Commercial,2212.694,94.6,,percent of total billed charges,,
Mri Upper Extremity Lt Any Jt Wo Contrast,,73221,CPT,Facility,Outpatient,,,LT,2339,1988.15,670.3574,2339,"Health Partners, Inc.",Medicare Advantage,1146.11,49,,percent of total billed charges,,
Mri Upper Extremity Lt Any Jt Wo Contrast,,73221,CPT,Facility,Inpatient,,,LT,2339,1988.15,670.3574,2339,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mri Upper Extremity Lt Any Jt Wo Contrast,,73221,CPT,Facility,Both,,,LT,2339,1988.15,670.3574,2339,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1403.4,60,,percent of total billed charges,,
Mri Upper Extremity Lt Any Jt Wo Contrast,,73221,CPT,Facility,Both,,,LT,2339,1988.15,670.3574,2339,"Health Partners, Inc.",State of Minnesota Advantage Program,1906.285,81.5,,percent of total billed charges,,
Mri Upper Extremity Lt Any Jt Wo Contrast,,73221,CPT,Facility,Both,,,LT,2339,1988.15,670.3574,2339,"Health Partners, Inc.",State Public Programs,1169.5,50,,percent of total billed charges,,
Mri Upper Extremity Lt Any Jt Wo Contrast,,73221,CPT,Facility,Both,,,LT,2339,1988.15,670.3574,2339,Humana Insurance Company,Commercial PPO,2222.05,95,,percent of total billed charges,,
Mri Upper Extremity Lt Any Jt Wo Contrast,,73221,CPT,Facility,Outpatient,,,LT,2339,1988.15,670.3574,2339,Humana Insurance Company,Medicare PPO,1146.11,49,,percent of total billed charges,,
Mri Upper Extremity Lt Any Jt Wo Contrast,,73221,CPT,Facility,Inpatient,,,LT,2339,1988.15,670.3574,2339,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Mri Upper Extremity Lt Any Jt Wo Contrast,,73221,CPT,Facility,Both,,,LT,2339,1988.15,670.3574,2339,Medica,Individual & Family,2317.949,99.1,,percent of total billed charges,,
Mri Upper Extremity Lt Any Jt Wo Contrast,,73221,CPT,Facility,Outpatient,,,LT,2339,1988.15,670.3574,2339,Medica,Medica Advantage Solution,1164.822,49.8,,percent of total billed charges,,
Mri Upper Extremity Lt Any Jt Wo Contrast,,73221,CPT,Facility,Inpatient,,,LT,2339,1988.15,670.3574,2339,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Mri Upper Extremity Lt Any Jt Wo Contrast,,73221,CPT,Facility,Outpatient,,,LT,2339,1988.15,670.3574,2339,Medica,Medical Assistance,747,,,Other  ,per vist,Pays in addition to all Outpatient Service Categories
Mri Upper Extremity Lt Any Jt Wo Contrast,,73221,CPT,Facility,Inpatient,,,LT,2339,1988.15,670.3574,2339,Medica,Medical Assistance,,,,,Included in per diem rate,
Mri Upper Extremity Lt Any Jt Wo Contrast,,73221,CPT,Facility,Outpatient,,,LT,2339,1988.15,670.3574,2339,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1164.822,49.8,,percent of total billed charges,,
Mri Upper Extremity Lt Any Jt Wo Contrast,,73221,CPT,Facility,Inpatient,,,LT,2339,1988.15,670.3574,2339,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Mri Upper Extremity Lt Any Jt Wo Contrast,,73221,CPT,Facility,Both,,,LT,2339,1988.15,670.3574,2339,"Multiplan, Inc.","Multiplan, Inc.",2198.66,94,,percent of total billed charges,,
Mri Upper Extremity Lt Any Jt Wo Contrast,,73221,CPT,Facility,Outpatient,,,LT,2339,1988.15,670.3574,2339,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1535,,,Other ,per scan,
Mri Upper Extremity Lt Any Jt Wo Contrast,,73221,CPT,Facility,Inpatient,,,LT,2339,1988.15,670.3574,2339,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Mri Upper Extremity Lt Any Jt Wo Contrast,,73221,CPT,Facility,Both,,,LT,2339,1988.15,670.3574,2339,"Preferred One Administrative Services, INC.",PPO,2306.254,98.6,,percent of total billed charges,,
Mri Upper Extremity Lt Any Jt Wo Contrast,,73221,CPT,Facility,Outpatient,,,LT,2339,1988.15,670.3574,2339,PrimeWest Health,Minnesota Senior Health Options (MSHO),1203.4155,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Mri Upper Extremity Lt Any Jt Wo Contrast,,73221,CPT,Facility,Inpatient,,,LT,2339,1988.15,670.3574,2339,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mri Upper Extremity Lt Any Jt Wo Contrast,,73221,CPT,Facility,Outpatient,,,LT,2339,1988.15,670.3574,2339,PrimeWest Health,MinnesotaCare,1201.3104,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Mri Upper Extremity Lt Any Jt Wo Contrast,,73221,CPT,Facility,Inpatient,,,LT,2339,1988.15,670.3574,2339,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Mri Upper Extremity Lt Any Jt Wo Contrast,,73221,CPT,Facility,Both,,,LT,2339,1988.15,670.3574,2339,Sanford Health Plan,Sanford Health Plan,2151.88,92,,percent of total billed charges,,
Mri Upper Extremity Lt Any Jt Wo Contrast,,73221,CPT,Facility,Outpatient,,,LT,2339,1988.15,670.3574,2339,"UCare Health, Inc.",Individual & Family Plan,1318.0265,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Mri Upper Extremity Lt Any Jt Wo Contrast,,73221,CPT,Facility,Inpatient,,,LT,2339,1988.15,670.3574,2339,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Mri Upper Extremity Lt Any Jt Wo Contrast,,73221,CPT,Facility,Outpatient,,,LT,2339,1988.15,670.3574,2339,"UCare Health, Inc.",Medical Assistance,1180.4933,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mri Upper Extremity Lt Any Jt Wo Contrast,,73221,CPT,Facility,Inpatient,,,LT,2339,1988.15,670.3574,2339,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Mri Upper Extremity Lt Any Jt Wo Contrast,,73221,CPT,Facility,Outpatient,,,LT,2339,1988.15,670.3574,2339,"UCare Health, Inc.",Medicare Advantage,1180.4933,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mri Upper Extremity Lt Any Jt Wo Contrast,,73221,CPT,Facility,Inpatient,,,LT,2339,1988.15,670.3574,2339,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mri Upper Extremity Lt Any Jt Wo Contrast,,73221,CPT,Facility,Outpatient,,,LT,2339,1988.15,670.3574,2339,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1180.4933,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mri Upper Extremity Lt Any Jt Wo Contrast,,73221,CPT,Facility,Inpatient,,,LT,2339,1988.15,670.3574,2339,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mri Upper Extremity Lt Any Jt Wo Contrast,,73221,CPT,Facility,Both,,,LT,2339,1988.15,670.3574,2339,UnitedHealthcare,Individual & Family,2198.66,94,,percent of total billed charges,,
Mri Upper Extremity Lt Any Jt Wo Contrast,,73221,CPT,Facility,Outpatient,,,LT,2339,1988.15,670.3574,2339,UnitedHealthcare,Medicare Advantage,1146.11,49,,percent of total billed charges,,
Mri Upper Extremity Lt Any Jt Wo Contrast,,73221,CPT,Facility,Inpatient,,,LT,2339,1988.15,670.3574,2339,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Mri Upper Extremity Lt Any Jt Wo Contrast,,73221,CPT,Facility,Outpatient,,,LT,2339,1988.15,670.3574,2339,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1122.72,48,,percent of total billed charges,,100% of DHS outpatient percentage
Mri Upper Extremity Lt Any Jt Wo Contrast,,73221,CPT,Facility,Inpatient,,,LT,2339,1988.15,670.3574,2339,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Mri Upper Extremity Lt Any Jt W Contrast,,73222,CPT,Facility,Both,,,LT,2653,2255.05,747,2653,Aetna,Commercial,2440.76,92,,percent of total billed charges,,
Mri Upper Extremity Lt Any Jt W Contrast,,73222,CPT,Facility,Outpatient,,,LT,2653,2255.05,747,2653,Aetna,Medicare Advantage,1299.97,49,,percent of total billed charges,,
Mri Upper Extremity Lt Any Jt W Contrast,,73222,CPT,Facility,Inpatient,,,LT,2653,2255.05,747,2653,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Mri Upper Extremity Lt Any Jt W Contrast,,73222,CPT,Facility,Both,,,LT,2653,2255.05,747,2653,Aetna,PPO,2467.29,93,,percent of total billed charges,,
Mri Upper Extremity Lt Any Jt W Contrast,,73222,CPT,Facility,Both,,,LT,2653,2255.05,747,2653,America's PPO,America's PPO,2547.6759,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Mri Upper Extremity Lt Any Jt W Contrast,,73222,CPT,Facility,Both,,,LT,2653,2255.05,747,2653,BlueCross BlueShield Minnesota, Federal Employee Program,2610.552,98.4,,percent of total billed charges,,
Mri Upper Extremity Lt Any Jt W Contrast,,73222,CPT,Facility,Both,,,LT,2653,2255.05,747,2653,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,2653,100,,percent of total billed charges,,
Mri Upper Extremity Lt Any Jt W Contrast,,73222,CPT,Facility,Both,,,LT,2653,2255.05,747,2653,BlueCross BlueShield Minnesota,High Value Network Plan,2387.7,90,,percent of total billed charges,,
Mri Upper Extremity Lt Any Jt W Contrast,,73222,CPT,Facility,Outpatient,,,LT,2653,2255.05,747,2653,BlueCross BlueShield Minnesota,Medicare Advantage,1299.97,49,,percent of total billed charges,,
Mri Upper Extremity Lt Any Jt W Contrast,,73222,CPT,Facility,Inpatient,,,LT,2653,2255.05,747,2653,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Mri Upper Extremity Lt Any Jt W Contrast,,73222,CPT,Facility,Both,,,LT,2653,2255.05,747,2653,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,2349.7621,88.57,,percent of total billed charges,,
Mri Upper Extremity Lt Any Jt W Contrast,,73222,CPT,Facility,Both,,,LT,2653,2255.05,747,2653,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,760.3498,28.66,,percent of total billed charges,,
Mri Upper Extremity Lt Any Jt W Contrast,,73222,CPT,Facility,Outpatient,,,LT,2653,2255.05,747,2653,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1299.97,49,,percent of total billed charges,,
Mri Upper Extremity Lt Any Jt W Contrast,,73222,CPT,Facility,Inpatient,,,LT,2653,2255.05,747,2653,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Mri Upper Extremity Lt Any Jt W Contrast,,73222,CPT,Facility,Both,,,LT,2653,2255.05,747,2653,CorVel,Worker's Compensation,2653,100,,percent of total billed charges,,
Mri Upper Extremity Lt Any Jt W Contrast,,73222,CPT,Facility,Both,,,LT,2653,2255.05,747,2653,First Health Group Corporation,First Health Network,2573.41,97,,percent of total billed charges,,
Mri Upper Extremity Lt Any Jt W Contrast,,73222,CPT,Facility,Both,,,LT,2653,2255.05,747,2653,"Health Partners, Inc.",Commercial,2509.738,94.6,,percent of total billed charges,,
Mri Upper Extremity Lt Any Jt W Contrast,,73222,CPT,Facility,Outpatient,,,LT,2653,2255.05,747,2653,"Health Partners, Inc.",Medicare Advantage,1299.97,49,,percent of total billed charges,,
Mri Upper Extremity Lt Any Jt W Contrast,,73222,CPT,Facility,Inpatient,,,LT,2653,2255.05,747,2653,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mri Upper Extremity Lt Any Jt W Contrast,,73222,CPT,Facility,Both,,,LT,2653,2255.05,747,2653,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1591.8,60,,percent of total billed charges,,
Mri Upper Extremity Lt Any Jt W Contrast,,73222,CPT,Facility,Both,,,LT,2653,2255.05,747,2653,"Health Partners, Inc.",State of Minnesota Advantage Program,2162.195,81.5,,percent of total billed charges,,
Mri Upper Extremity Lt Any Jt W Contrast,,73222,CPT,Facility,Both,,,LT,2653,2255.05,747,2653,"Health Partners, Inc.",State Public Programs,1326.5,50,,percent of total billed charges,,
Mri Upper Extremity Lt Any Jt W Contrast,,73222,CPT,Facility,Both,,,LT,2653,2255.05,747,2653,Humana Insurance Company,Commercial PPO,2520.35,95,,percent of total billed charges,,
Mri Upper Extremity Lt Any Jt W Contrast,,73222,CPT,Facility,Outpatient,,,LT,2653,2255.05,747,2653,Humana Insurance Company,Medicare PPO,1299.97,49,,percent of total billed charges,,
Mri Upper Extremity Lt Any Jt W Contrast,,73222,CPT,Facility,Inpatient,,,LT,2653,2255.05,747,2653,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Mri Upper Extremity Lt Any Jt W Contrast,,73222,CPT,Facility,Both,,,LT,2653,2255.05,747,2653,Medica,Individual & Family,2629.123,99.1,,percent of total billed charges,,
Mri Upper Extremity Lt Any Jt W Contrast,,73222,CPT,Facility,Outpatient,,,LT,2653,2255.05,747,2653,Medica,Medica Advantage Solution,1321.194,49.8,,percent of total billed charges,,
Mri Upper Extremity Lt Any Jt W Contrast,,73222,CPT,Facility,Inpatient,,,LT,2653,2255.05,747,2653,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Mri Upper Extremity Lt Any Jt W Contrast,,73222,CPT,Facility,Outpatient,,,LT,2653,2255.05,747,2653,Medica,Medical Assistance,747,,,Other ,per vist,Pays in addition to all Outpatient Service Categories
Mri Upper Extremity Lt Any Jt W Contrast,,73222,CPT,Facility,Inpatient,,,LT,2653,2255.05,747,2653,Medica,Medical Assistance,,,,,Included in per diem rate,
Mri Upper Extremity Lt Any Jt W Contrast,,73222,CPT,Facility,Outpatient,,,LT,2653,2255.05,747,2653,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1321.194,49.8,,percent of total billed charges,,
Mri Upper Extremity Lt Any Jt W Contrast,,73222,CPT,Facility,Inpatient,,,LT,2653,2255.05,747,2653,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Mri Upper Extremity Lt Any Jt W Contrast,,73222,CPT,Facility,Both,,,LT,2653,2255.05,747,2653,"Multiplan, Inc.","Multiplan, Inc.",2493.82,94,,percent of total billed charges,,
Mri Upper Extremity Lt Any Jt W Contrast,,73222,CPT,Facility,Outpatient,,,LT,2653,2255.05,747,2653,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1535,,,Other ,per scan,
Mri Upper Extremity Lt Any Jt W Contrast,,73222,CPT,Facility,Inpatient,,,LT,2653,2255.05,747,2653,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Mri Upper Extremity Lt Any Jt W Contrast,,73222,CPT,Facility,Both,,,LT,2653,2255.05,747,2653,"Preferred One Administrative Services, INC.",PPO,2615.858,98.6,,percent of total billed charges,,
Mri Upper Extremity Lt Any Jt W Contrast,,73222,CPT,Facility,Outpatient,,,LT,2653,2255.05,747,2653,PrimeWest Health,Minnesota Senior Health Options (MSHO),1364.9685,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Mri Upper Extremity Lt Any Jt W Contrast,,73222,CPT,Facility,Inpatient,,,LT,2653,2255.05,747,2653,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mri Upper Extremity Lt Any Jt W Contrast,,73222,CPT,Facility,Outpatient,,,LT,2653,2255.05,747,2653,PrimeWest Health,MinnesotaCare,1362.5808,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Mri Upper Extremity Lt Any Jt W Contrast,,73222,CPT,Facility,Inpatient,,,LT,2653,2255.05,747,2653,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Mri Upper Extremity Lt Any Jt W Contrast,,73222,CPT,Facility,Both,,,LT,2653,2255.05,747,2653,Sanford Health Plan,Sanford Health Plan,2440.76,92,,percent of total billed charges,,
Mri Upper Extremity Lt Any Jt W Contrast,,73222,CPT,Facility,Outpatient,,,LT,2653,2255.05,747,2653,"UCare Health, Inc.",Individual & Family Plan,1494.9655,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Mri Upper Extremity Lt Any Jt W Contrast,,73222,CPT,Facility,Inpatient,,,LT,2653,2255.05,747,2653,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Mri Upper Extremity Lt Any Jt W Contrast,,73222,CPT,Facility,Outpatient,,,LT,2653,2255.05,747,2653,"UCare Health, Inc.",Medical Assistance,1338.9691,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mri Upper Extremity Lt Any Jt W Contrast,,73222,CPT,Facility,Inpatient,,,LT,2653,2255.05,747,2653,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Mri Upper Extremity Lt Any Jt W Contrast,,73222,CPT,Facility,Outpatient,,,LT,2653,2255.05,747,2653,"UCare Health, Inc.",Medicare Advantage,1338.9691,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mri Upper Extremity Lt Any Jt W Contrast,,73222,CPT,Facility,Inpatient,,,LT,2653,2255.05,747,2653,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mri Upper Extremity Lt Any Jt W Contrast,,73222,CPT,Facility,Outpatient,,,LT,2653,2255.05,747,2653,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1338.9691,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mri Upper Extremity Lt Any Jt W Contrast,,73222,CPT,Facility,Inpatient,,,LT,2653,2255.05,747,2653,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mri Upper Extremity Lt Any Jt W Contrast,,73222,CPT,Facility,Both,,,LT,2653,2255.05,747,2653,UnitedHealthcare,Individual & Family,2493.82,94,,percent of total billed charges,,
Mri Upper Extremity Lt Any Jt W Contrast,,73222,CPT,Facility,Outpatient,,,LT,2653,2255.05,747,2653,UnitedHealthcare,Medicare Advantage,1299.97,49,,percent of total billed charges,,
Mri Upper Extremity Lt Any Jt W Contrast,,73222,CPT,Facility,Inpatient,,,LT,2653,2255.05,747,2653,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Mri Upper Extremity Lt Any Jt W Contrast,,73222,CPT,Facility,Outpatient,,,LT,2653,2255.05,747,2653,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1273.44,48,,percent of total billed charges,,100% of DHS outpatient percentage
Mri Upper Extremity Lt Any Jt W Contrast,,73222,CPT,Facility,Inpatient,,,LT,2653,2255.05,747,2653,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Mri Upper Extremity Lt Any Jt Wo W Contrast,,73223,CPT,Facility,Both,,,LT,3254,2765.9,747,3254,Aetna,Commercial,2993.68,92,,percent of total billed charges,,
Mri Upper Extremity Lt Any Jt Wo W Contrast,,73223,CPT,Facility,Outpatient,,,LT,3254,2765.9,747,3254,Aetna,Medicare Advantage,1594.46,49,,percent of total billed charges,,
Mri Upper Extremity Lt Any Jt Wo W Contrast,,73223,CPT,Facility,Inpatient,,,LT,3254,2765.9,747,3254,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Mri Upper Extremity Lt Any Jt Wo W Contrast,,73223,CPT,Facility,Both,,,LT,3254,2765.9,747,3254,Aetna,PPO,3026.22,93,,percent of total billed charges,,
Mri Upper Extremity Lt Any Jt Wo W Contrast,,73223,CPT,Facility,Both,,,LT,3254,2765.9,747,3254,America's PPO,America's PPO,3124.8162,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Mri Upper Extremity Lt Any Jt Wo W Contrast,,73223,CPT,Facility,Both,,,LT,3254,2765.9,747,3254,BlueCross BlueShield Minnesota, Federal Employee Program,3201.936,98.4,,percent of total billed charges,,
Mri Upper Extremity Lt Any Jt Wo W Contrast,,73223,CPT,Facility,Both,,,LT,3254,2765.9,747,3254,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,3254,100,,percent of total billed charges,,
Mri Upper Extremity Lt Any Jt Wo W Contrast,,73223,CPT,Facility,Both,,,LT,3254,2765.9,747,3254,BlueCross BlueShield Minnesota,High Value Network Plan,2928.6,90,,percent of total billed charges,,
Mri Upper Extremity Lt Any Jt Wo W Contrast,,73223,CPT,Facility,Outpatient,,,LT,3254,2765.9,747,3254,BlueCross BlueShield Minnesota,Medicare Advantage,1594.46,49,,percent of total billed charges,,
Mri Upper Extremity Lt Any Jt Wo W Contrast,,73223,CPT,Facility,Inpatient,,,LT,3254,2765.9,747,3254,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Mri Upper Extremity Lt Any Jt Wo W Contrast,,73223,CPT,Facility,Both,,,LT,3254,2765.9,747,3254,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,2882.0678,88.57,,percent of total billed charges,,
Mri Upper Extremity Lt Any Jt Wo W Contrast,,73223,CPT,Facility,Both,,,LT,3254,2765.9,747,3254,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,932.5964,28.66,,percent of total billed charges,,
Mri Upper Extremity Lt Any Jt Wo W Contrast,,73223,CPT,Facility,Outpatient,,,LT,3254,2765.9,747,3254,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1594.46,49,,percent of total billed charges,,
Mri Upper Extremity Lt Any Jt Wo W Contrast,,73223,CPT,Facility,Inpatient,,,LT,3254,2765.9,747,3254,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Mri Upper Extremity Lt Any Jt Wo W Contrast,,73223,CPT,Facility,Both,,,LT,3254,2765.9,747,3254,CorVel,Worker's Compensation,3254,100,,percent of total billed charges,,
Mri Upper Extremity Lt Any Jt Wo W Contrast,,73223,CPT,Facility,Both,,,LT,3254,2765.9,747,3254,First Health Group Corporation,First Health Network,3156.38,97,,percent of total billed charges,,
Mri Upper Extremity Lt Any Jt Wo W Contrast,,73223,CPT,Facility,Both,,,LT,3254,2765.9,747,3254,"Health Partners, Inc.",Commercial,3078.284,94.6,,percent of total billed charges,,
Mri Upper Extremity Lt Any Jt Wo W Contrast,,73223,CPT,Facility,Outpatient,,,LT,3254,2765.9,747,3254,"Health Partners, Inc.",Medicare Advantage,1594.46,49,,percent of total billed charges,,
Mri Upper Extremity Lt Any Jt Wo W Contrast,,73223,CPT,Facility,Inpatient,,,LT,3254,2765.9,747,3254,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mri Upper Extremity Lt Any Jt Wo W Contrast,,73223,CPT,Facility,Both,,,LT,3254,2765.9,747,3254,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1952.4,60,,percent of total billed charges,,
Mri Upper Extremity Lt Any Jt Wo W Contrast,,73223,CPT,Facility,Both,,,LT,3254,2765.9,747,3254,"Health Partners, Inc.",State of Minnesota Advantage Program,2652.01,81.5,,percent of total billed charges,,
Mri Upper Extremity Lt Any Jt Wo W Contrast,,73223,CPT,Facility,Both,,,LT,3254,2765.9,747,3254,"Health Partners, Inc.",State Public Programs,1627,50,,percent of total billed charges,,
Mri Upper Extremity Lt Any Jt Wo W Contrast,,73223,CPT,Facility,Both,,,LT,3254,2765.9,747,3254,Humana Insurance Company,Commercial PPO,3091.3,95,,percent of total billed charges,,
Mri Upper Extremity Lt Any Jt Wo W Contrast,,73223,CPT,Facility,Outpatient,,,LT,3254,2765.9,747,3254,Humana Insurance Company,Medicare PPO,1594.46,49,,percent of total billed charges,,
Mri Upper Extremity Lt Any Jt Wo W Contrast,,73223,CPT,Facility,Inpatient,,,LT,3254,2765.9,747,3254,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Mri Upper Extremity Lt Any Jt Wo W Contrast,,73223,CPT,Facility,Both,,,LT,3254,2765.9,747,3254,Medica,Individual & Family,3224.714,99.1,,percent of total billed charges,,
Mri Upper Extremity Lt Any Jt Wo W Contrast,,73223,CPT,Facility,Outpatient,,,LT,3254,2765.9,747,3254,Medica,Medica Advantage Solution,1620.492,49.8,,percent of total billed charges,,
Mri Upper Extremity Lt Any Jt Wo W Contrast,,73223,CPT,Facility,Inpatient,,,LT,3254,2765.9,747,3254,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Mri Upper Extremity Lt Any Jt Wo W Contrast,,73223,CPT,Facility,Outpatient,,,LT,3254,2765.9,747,3254,Medica,Medical Assistance,747,,,Other ,per vist,Pays in addition to all Outpatient Service Categories
Mri Upper Extremity Lt Any Jt Wo W Contrast,,73223,CPT,Facility,Inpatient,,,LT,3254,2765.9,747,3254,Medica,Medical Assistance,,,,,Included in per diem rate,
Mri Upper Extremity Lt Any Jt Wo W Contrast,,73223,CPT,Facility,Outpatient,,,LT,3254,2765.9,747,3254,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1620.492,49.8,,percent of total billed charges,,
Mri Upper Extremity Lt Any Jt Wo W Contrast,,73223,CPT,Facility,Inpatient,,,LT,3254,2765.9,747,3254,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Mri Upper Extremity Lt Any Jt Wo W Contrast,,73223,CPT,Facility,Both,,,LT,3254,2765.9,747,3254,"Multiplan, Inc.","Multiplan, Inc.",3058.76,94,,percent of total billed charges,,
Mri Upper Extremity Lt Any Jt Wo W Contrast,,73223,CPT,Facility,Outpatient,,,LT,3254,2765.9,747,3254,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1535,,,Other ,per scan,
Mri Upper Extremity Lt Any Jt Wo W Contrast,,73223,CPT,Facility,Inpatient,,,LT,3254,2765.9,747,3254,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Mri Upper Extremity Lt Any Jt Wo W Contrast,,73223,CPT,Facility,Both,,,LT,3254,2765.9,747,3254,"Preferred One Administrative Services, INC.",PPO,3208.444,98.6,,percent of total billed charges,,
Mri Upper Extremity Lt Any Jt Wo W Contrast,,73223,CPT,Facility,Outpatient,,,LT,3254,2765.9,747,3254,PrimeWest Health,Minnesota Senior Health Options (MSHO),1674.183,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Mri Upper Extremity Lt Any Jt Wo W Contrast,,73223,CPT,Facility,Inpatient,,,LT,3254,2765.9,747,3254,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mri Upper Extremity Lt Any Jt Wo W Contrast,,73223,CPT,Facility,Outpatient,,,LT,3254,2765.9,747,3254,PrimeWest Health,MinnesotaCare,1671.2544,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Mri Upper Extremity Lt Any Jt Wo W Contrast,,73223,CPT,Facility,Inpatient,,,LT,3254,2765.9,747,3254,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Mri Upper Extremity Lt Any Jt Wo W Contrast,,73223,CPT,Facility,Both,,,LT,3254,2765.9,747,3254,Sanford Health Plan,Sanford Health Plan,2993.68,92,,percent of total billed charges,,
Mri Upper Extremity Lt Any Jt Wo W Contrast,,73223,CPT,Facility,Outpatient,,,LT,3254,2765.9,747,3254,"UCare Health, Inc.",Individual & Family Plan,1833.629,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Mri Upper Extremity Lt Any Jt Wo W Contrast,,73223,CPT,Facility,Inpatient,,,LT,3254,2765.9,747,3254,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Mri Upper Extremity Lt Any Jt Wo W Contrast,,73223,CPT,Facility,Outpatient,,,LT,3254,2765.9,747,3254,"UCare Health, Inc.",Medical Assistance,1642.2938,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mri Upper Extremity Lt Any Jt Wo W Contrast,,73223,CPT,Facility,Inpatient,,,LT,3254,2765.9,747,3254,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Mri Upper Extremity Lt Any Jt Wo W Contrast,,73223,CPT,Facility,Outpatient,,,LT,3254,2765.9,747,3254,"UCare Health, Inc.",Medicare Advantage,1642.2938,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mri Upper Extremity Lt Any Jt Wo W Contrast,,73223,CPT,Facility,Inpatient,,,LT,3254,2765.9,747,3254,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mri Upper Extremity Lt Any Jt Wo W Contrast,,73223,CPT,Facility,Outpatient,,,LT,3254,2765.9,747,3254,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1642.2938,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mri Upper Extremity Lt Any Jt Wo W Contrast,,73223,CPT,Facility,Inpatient,,,LT,3254,2765.9,747,3254,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mri Upper Extremity Lt Any Jt Wo W Contrast,,73223,CPT,Facility,Both,,,LT,3254,2765.9,747,3254,UnitedHealthcare,Individual & Family,3058.76,94,,percent of total billed charges,,
Mri Upper Extremity Lt Any Jt Wo W Contrast,,73223,CPT,Facility,Outpatient,,,LT,3254,2765.9,747,3254,UnitedHealthcare,Medicare Advantage,1594.46,49,,percent of total billed charges,,
Mri Upper Extremity Lt Any Jt Wo W Contrast,,73223,CPT,Facility,Inpatient,,,LT,3254,2765.9,747,3254,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Mri Upper Extremity Lt Any Jt Wo W Contrast,,73223,CPT,Facility,Outpatient,,,LT,3254,2765.9,747,3254,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1561.92,48,,percent of total billed charges,,100% of DHS outpatient percentage
Mri Upper Extremity Lt Any Jt Wo W Contrast,,73223,CPT,Facility,Inpatient,,,LT,3254,2765.9,747,3254,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Xr Hip Lt 1 View,,73501,CPT,Facility,Both,,,LT,235,199.75,67.351,235,Aetna,Commercial,216.2,92,,percent of total billed charges,,
Xr Hip Lt 1 View,,73501,CPT,Facility,Outpatient,,,LT,235,199.75,67.351,235,Aetna,Medicare Advantage,115.15,49,,percent of total billed charges,,
Xr Hip Lt 1 View,,73501,CPT,Facility,Inpatient,,,LT,235,199.75,67.351,235,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Xr Hip Lt 1 View,,73501,CPT,Facility,Both,,,LT,235,199.75,67.351,235,Aetna,PPO,218.55,93,,percent of total billed charges,,
Xr Hip Lt 1 View,,73501,CPT,Facility,Both,,,LT,235,199.75,67.351,235,America's PPO,America's PPO,225.6705,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Xr Hip Lt 1 View,,73501,CPT,Facility,Both,,,LT,235,199.75,67.351,235,BlueCross BlueShield Minnesota, Federal Employee Program,231.24,98.4,,percent of total billed charges,,
Xr Hip Lt 1 View,,73501,CPT,Facility,Both,,,LT,235,199.75,67.351,235,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,235,100,,percent of total billed charges,,
Xr Hip Lt 1 View,,73501,CPT,Facility,Both,,,LT,235,199.75,67.351,235,BlueCross BlueShield Minnesota,High Value Network Plan,211.5,90,,percent of total billed charges,,
Xr Hip Lt 1 View,,73501,CPT,Facility,Outpatient,,,LT,235,199.75,67.351,235,BlueCross BlueShield Minnesota,Medicare Advantage,115.15,49,,percent of total billed charges,,
Xr Hip Lt 1 View,,73501,CPT,Facility,Inpatient,,,LT,235,199.75,67.351,235,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Xr Hip Lt 1 View,,73501,CPT,Facility,Both,,,LT,235,199.75,67.351,235,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,208.1395,88.57,,percent of total billed charges,,
Xr Hip Lt 1 View,,73501,CPT,Facility,Both,,,LT,235,199.75,67.351,235,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,67.351,28.66,,percent of total billed charges,,
Xr Hip Lt 1 View,,73501,CPT,Facility,Outpatient,,,LT,235,199.75,67.351,235,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),115.15,49,,percent of total billed charges,,
Xr Hip Lt 1 View,,73501,CPT,Facility,Inpatient,,,LT,235,199.75,67.351,235,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Xr Hip Lt 1 View,,73501,CPT,Facility,Both,,,LT,235,199.75,67.351,235,CorVel,Worker's Compensation,235,100,,percent of total billed charges,,
Xr Hip Lt 1 View,,73501,CPT,Facility,Both,,,LT,235,199.75,67.351,235,First Health Group Corporation,First Health Network,227.95,97,,percent of total billed charges,,
Xr Hip Lt 1 View,,73501,CPT,Facility,Both,,,LT,235,199.75,67.351,235,"Health Partners, Inc.",Commercial,222.31,94.6,,percent of total billed charges,,
Xr Hip Lt 1 View,,73501,CPT,Facility,Outpatient,,,LT,235,199.75,67.351,235,"Health Partners, Inc.",Medicare Advantage,115.15,49,,percent of total billed charges,,
Xr Hip Lt 1 View,,73501,CPT,Facility,Inpatient,,,LT,235,199.75,67.351,235,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Hip Lt 1 View,,73501,CPT,Facility,Both,,,LT,235,199.75,67.351,235,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),141,60,,percent of total billed charges,,
Xr Hip Lt 1 View,,73501,CPT,Facility,Both,,,LT,235,199.75,67.351,235,"Health Partners, Inc.",State of Minnesota Advantage Program,191.525,81.5,,percent of total billed charges,,
Xr Hip Lt 1 View,,73501,CPT,Facility,Both,,,LT,235,199.75,67.351,235,"Health Partners, Inc.",State Public Programs,117.5,50,,percent of total billed charges,,
Xr Hip Lt 1 View,,73501,CPT,Facility,Both,,,LT,235,199.75,67.351,235,Humana Insurance Company,Commercial PPO,223.25,95,,percent of total billed charges,,
Xr Hip Lt 1 View,,73501,CPT,Facility,Outpatient,,,LT,235,199.75,67.351,235,Humana Insurance Company,Medicare PPO,115.15,49,,percent of total billed charges,,
Xr Hip Lt 1 View,,73501,CPT,Facility,Inpatient,,,LT,235,199.75,67.351,235,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Xr Hip Lt 1 View,,73501,CPT,Facility,Both,,,LT,235,199.75,67.351,235,Medica,Individual & Family,232.885,99.1,,percent of total billed charges,,
Xr Hip Lt 1 View,,73501,CPT,Facility,Outpatient,,,LT,235,199.75,67.351,235,Medica,Medica Advantage Solution,117.03,49.8,,percent of total billed charges,,
Xr Hip Lt 1 View,,73501,CPT,Facility,Inpatient,,,LT,235,199.75,67.351,235,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Xr Hip Lt 1 View,,73501,CPT,Facility,Outpatient,,,LT,235,199.75,67.351,235,Medica,Medical Assistance,104.81,44.6,,percent of total billed charges,,
Xr Hip Lt 1 View,,73501,CPT,Facility,Inpatient,,,LT,235,199.75,67.351,235,Medica,Medical Assistance,,,,,Included in per diem rate,
Xr Hip Lt 1 View,,73501,CPT,Facility,Outpatient,,,LT,235,199.75,67.351,235,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,117.03,49.8,,percent of total billed charges,,
Xr Hip Lt 1 View,,73501,CPT,Facility,Inpatient,,,LT,235,199.75,67.351,235,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Xr Hip Lt 1 View,,73501,CPT,Facility,Both,,,LT,235,199.75,67.351,235,"Multiplan, Inc.","Multiplan, Inc.",220.9,94,,percent of total billed charges,,
Xr Hip Lt 1 View,,73501,CPT,Facility,Outpatient,,,LT,235,199.75,67.351,235,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,211.735,90.1,,percent of total billed charges,,
Xr Hip Lt 1 View,,73501,CPT,Facility,Inpatient,,,LT,235,199.75,67.351,235,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Xr Hip Lt 1 View,,73501,CPT,Facility,Both,,,LT,235,199.75,67.351,235,"Preferred One Administrative Services, INC.",PPO,231.71,98.6,,percent of total billed charges,,
Xr Hip Lt 1 View,,73501,CPT,Facility,Outpatient,,,LT,235,199.75,67.351,235,PrimeWest Health,Minnesota Senior Health Options (MSHO),120.9075,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Xr Hip Lt 1 View,,73501,CPT,Facility,Inpatient,,,LT,235,199.75,67.351,235,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Hip Lt 1 View,,73501,CPT,Facility,Outpatient,,,LT,235,199.75,67.351,235,PrimeWest Health,MinnesotaCare,120.696,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Xr Hip Lt 1 View,,73501,CPT,Facility,Inpatient,,,LT,235,199.75,67.351,235,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Xr Hip Lt 1 View,,73501,CPT,Facility,Both,,,LT,235,199.75,67.351,235,Sanford Health Plan,Sanford Health Plan,216.2,92,,percent of total billed charges,,
Xr Hip Lt 1 View,,73501,CPT,Facility,Outpatient,,,LT,235,199.75,67.351,235,"UCare Health, Inc.",Individual & Family Plan,132.4225,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Xr Hip Lt 1 View,,73501,CPT,Facility,Inpatient,,,LT,235,199.75,67.351,235,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Xr Hip Lt 1 View,,73501,CPT,Facility,Outpatient,,,LT,235,199.75,67.351,235,"UCare Health, Inc.",Medical Assistance,118.6045,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Hip Lt 1 View,,73501,CPT,Facility,Inpatient,,,LT,235,199.75,67.351,235,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Xr Hip Lt 1 View,,73501,CPT,Facility,Outpatient,,,LT,235,199.75,67.351,235,"UCare Health, Inc.",Medicare Advantage,118.6045,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Hip Lt 1 View,,73501,CPT,Facility,Inpatient,,,LT,235,199.75,67.351,235,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Hip Lt 1 View,,73501,CPT,Facility,Outpatient,,,LT,235,199.75,67.351,235,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),118.6045,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Hip Lt 1 View,,73501,CPT,Facility,Inpatient,,,LT,235,199.75,67.351,235,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Hip Lt 1 View,,73501,CPT,Facility,Both,,,LT,235,199.75,67.351,235,UnitedHealthcare,Individual & Family,220.9,94,,percent of total billed charges,,
Xr Hip Lt 1 View,,73501,CPT,Facility,Outpatient,,,LT,235,199.75,67.351,235,UnitedHealthcare,Medicare Advantage,115.15,49,,percent of total billed charges,,
Xr Hip Lt 1 View,,73501,CPT,Facility,Inpatient,,,LT,235,199.75,67.351,235,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Xr Hip Lt 1 View,,73501,CPT,Facility,Outpatient,,,LT,235,199.75,67.351,235,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,112.8,48,,percent of total billed charges,,100% of DHS outpatient percentage
Xr Hip Lt 1 View,,73501,CPT,Facility,Inpatient,,,LT,235,199.75,67.351,235,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Xr Hip Lt 2 Views,,73502,CPT,Facility,Both,,,LT,255,216.75,73.083,255,Aetna,Commercial,234.6,92,,percent of total billed charges,,
Xr Hip Lt 2 Views,,73502,CPT,Facility,Outpatient,,,LT,255,216.75,73.083,255,Aetna,Medicare Advantage,124.95,49,,percent of total billed charges,,
Xr Hip Lt 2 Views,,73502,CPT,Facility,Inpatient,,,LT,255,216.75,73.083,255,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Xr Hip Lt 2 Views,,73502,CPT,Facility,Both,,,LT,255,216.75,73.083,255,Aetna,PPO,237.15,93,,percent of total billed charges,,
Xr Hip Lt 2 Views,,73502,CPT,Facility,Both,,,LT,255,216.75,73.083,255,America's PPO,America's PPO,244.8765,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Xr Hip Lt 2 Views,,73502,CPT,Facility,Both,,,LT,255,216.75,73.083,255,BlueCross BlueShield Minnesota, Federal Employee Program,250.92,98.4,,percent of total billed charges,,
Xr Hip Lt 2 Views,,73502,CPT,Facility,Both,,,LT,255,216.75,73.083,255,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,255,100,,percent of total billed charges,,
Xr Hip Lt 2 Views,,73502,CPT,Facility,Both,,,LT,255,216.75,73.083,255,BlueCross BlueShield Minnesota,High Value Network Plan,229.5,90,,percent of total billed charges,,
Xr Hip Lt 2 Views,,73502,CPT,Facility,Outpatient,,,LT,255,216.75,73.083,255,BlueCross BlueShield Minnesota,Medicare Advantage,124.95,49,,percent of total billed charges,,
Xr Hip Lt 2 Views,,73502,CPT,Facility,Inpatient,,,LT,255,216.75,73.083,255,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Xr Hip Lt 2 Views,,73502,CPT,Facility,Both,,,LT,255,216.75,73.083,255,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,225.8535,88.57,,percent of total billed charges,,
Xr Hip Lt 2 Views,,73502,CPT,Facility,Both,,,LT,255,216.75,73.083,255,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,73.083,28.66,,percent of total billed charges,,
Xr Hip Lt 2 Views,,73502,CPT,Facility,Outpatient,,,LT,255,216.75,73.083,255,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),124.95,49,,percent of total billed charges,,
Xr Hip Lt 2 Views,,73502,CPT,Facility,Inpatient,,,LT,255,216.75,73.083,255,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Xr Hip Lt 2 Views,,73502,CPT,Facility,Both,,,LT,255,216.75,73.083,255,CorVel,Worker's Compensation,255,100,,percent of total billed charges,,
Xr Hip Lt 2 Views,,73502,CPT,Facility,Both,,,LT,255,216.75,73.083,255,First Health Group Corporation,First Health Network,247.35,97,,percent of total billed charges,,
Xr Hip Lt 2 Views,,73502,CPT,Facility,Both,,,LT,255,216.75,73.083,255,"Health Partners, Inc.",Commercial,241.23,94.6,,percent of total billed charges,,
Xr Hip Lt 2 Views,,73502,CPT,Facility,Outpatient,,,LT,255,216.75,73.083,255,"Health Partners, Inc.",Medicare Advantage,124.95,49,,percent of total billed charges,,
Xr Hip Lt 2 Views,,73502,CPT,Facility,Inpatient,,,LT,255,216.75,73.083,255,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Hip Lt 2 Views,,73502,CPT,Facility,Both,,,LT,255,216.75,73.083,255,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),153,60,,percent of total billed charges,,
Xr Hip Lt 2 Views,,73502,CPT,Facility,Both,,,LT,255,216.75,73.083,255,"Health Partners, Inc.",State of Minnesota Advantage Program,207.825,81.5,,percent of total billed charges,,
Xr Hip Lt 2 Views,,73502,CPT,Facility,Both,,,LT,255,216.75,73.083,255,"Health Partners, Inc.",State Public Programs,127.5,50,,percent of total billed charges,,
Xr Hip Lt 2 Views,,73502,CPT,Facility,Both,,,LT,255,216.75,73.083,255,Humana Insurance Company,Commercial PPO,242.25,95,,percent of total billed charges,,
Xr Hip Lt 2 Views,,73502,CPT,Facility,Outpatient,,,LT,255,216.75,73.083,255,Humana Insurance Company,Medicare PPO,124.95,49,,percent of total billed charges,,
Xr Hip Lt 2 Views,,73502,CPT,Facility,Inpatient,,,LT,255,216.75,73.083,255,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Xr Hip Lt 2 Views,,73502,CPT,Facility,Both,,,LT,255,216.75,73.083,255,Medica,Individual & Family,252.705,99.1,,percent of total billed charges,,
Xr Hip Lt 2 Views,,73502,CPT,Facility,Outpatient,,,LT,255,216.75,73.083,255,Medica,Medica Advantage Solution,126.99,49.8,,percent of total billed charges,,
Xr Hip Lt 2 Views,,73502,CPT,Facility,Inpatient,,,LT,255,216.75,73.083,255,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Xr Hip Lt 2 Views,,73502,CPT,Facility,Outpatient,,,LT,255,216.75,73.083,255,Medica,Medical Assistance,113.73,44.6,,percent of total billed charges,,
Xr Hip Lt 2 Views,,73502,CPT,Facility,Inpatient,,,LT,255,216.75,73.083,255,Medica,Medical Assistance,,,,,Included in per diem rate,
Xr Hip Lt 2 Views,,73502,CPT,Facility,Outpatient,,,LT,255,216.75,73.083,255,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,126.99,49.8,,percent of total billed charges,,
Xr Hip Lt 2 Views,,73502,CPT,Facility,Inpatient,,,LT,255,216.75,73.083,255,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Xr Hip Lt 2 Views,,73502,CPT,Facility,Both,,,LT,255,216.75,73.083,255,"Multiplan, Inc.","Multiplan, Inc.",239.7,94,,percent of total billed charges,,
Xr Hip Lt 2 Views,,73502,CPT,Facility,Outpatient,,,LT,255,216.75,73.083,255,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,229.755,90.1,,percent of total billed charges,,
Xr Hip Lt 2 Views,,73502,CPT,Facility,Inpatient,,,LT,255,216.75,73.083,255,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Xr Hip Lt 2 Views,,73502,CPT,Facility,Both,,,LT,255,216.75,73.083,255,"Preferred One Administrative Services, INC.",PPO,251.43,98.6,,percent of total billed charges,,
Xr Hip Lt 2 Views,,73502,CPT,Facility,Outpatient,,,LT,255,216.75,73.083,255,PrimeWest Health,Minnesota Senior Health Options (MSHO),131.1975,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Xr Hip Lt 2 Views,,73502,CPT,Facility,Inpatient,,,LT,255,216.75,73.083,255,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Hip Lt 2 Views,,73502,CPT,Facility,Outpatient,,,LT,255,216.75,73.083,255,PrimeWest Health,MinnesotaCare,130.968,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Xr Hip Lt 2 Views,,73502,CPT,Facility,Inpatient,,,LT,255,216.75,73.083,255,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Xr Hip Lt 2 Views,,73502,CPT,Facility,Both,,,LT,255,216.75,73.083,255,Sanford Health Plan,Sanford Health Plan,234.6,92,,percent of total billed charges,,
Xr Hip Lt 2 Views,,73502,CPT,Facility,Outpatient,,,LT,255,216.75,73.083,255,"UCare Health, Inc.",Individual & Family Plan,143.6925,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Xr Hip Lt 2 Views,,73502,CPT,Facility,Inpatient,,,LT,255,216.75,73.083,255,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Xr Hip Lt 2 Views,,73502,CPT,Facility,Outpatient,,,LT,255,216.75,73.083,255,"UCare Health, Inc.",Medical Assistance,128.6985,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Hip Lt 2 Views,,73502,CPT,Facility,Inpatient,,,LT,255,216.75,73.083,255,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Xr Hip Lt 2 Views,,73502,CPT,Facility,Outpatient,,,LT,255,216.75,73.083,255,"UCare Health, Inc.",Medicare Advantage,128.6985,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Hip Lt 2 Views,,73502,CPT,Facility,Inpatient,,,LT,255,216.75,73.083,255,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Hip Lt 2 Views,,73502,CPT,Facility,Outpatient,,,LT,255,216.75,73.083,255,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),128.6985,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Hip Lt 2 Views,,73502,CPT,Facility,Inpatient,,,LT,255,216.75,73.083,255,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Hip Lt 2 Views,,73502,CPT,Facility,Both,,,LT,255,216.75,73.083,255,UnitedHealthcare,Individual & Family,239.7,94,,percent of total billed charges,,
Xr Hip Lt 2 Views,,73502,CPT,Facility,Outpatient,,,LT,255,216.75,73.083,255,UnitedHealthcare,Medicare Advantage,124.95,49,,percent of total billed charges,,
Xr Hip Lt 2 Views,,73502,CPT,Facility,Inpatient,,,LT,255,216.75,73.083,255,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Xr Hip Lt 2 Views,,73502,CPT,Facility,Outpatient,,,LT,255,216.75,73.083,255,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,122.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
Xr Hip Lt 2 Views,,73502,CPT,Facility,Inpatient,,,LT,255,216.75,73.083,255,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Xr Femur 1 View Lt,,73551,CPT,Facility,Both,,,LT,250,212.5,71.65,250,Aetna,Commercial,230,92,,percent of total billed charges,,
Xr Femur 1 View Lt,,73551,CPT,Facility,Outpatient,,,LT,250,212.5,71.65,250,Aetna,Medicare Advantage,122.5,49,,percent of total billed charges,,
Xr Femur 1 View Lt,,73551,CPT,Facility,Inpatient,,,LT,250,212.5,71.65,250,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Xr Femur 1 View Lt,,73551,CPT,Facility,Both,,,LT,250,212.5,71.65,250,Aetna,PPO,232.5,93,,percent of total billed charges,,
Xr Femur 1 View Lt,,73551,CPT,Facility,Both,,,LT,250,212.5,71.65,250,America's PPO,America's PPO,240.075,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Xr Femur 1 View Lt,,73551,CPT,Facility,Both,,,LT,250,212.5,71.65,250,BlueCross BlueShield Minnesota, Federal Employee Program,246,98.4,,percent of total billed charges,,
Xr Femur 1 View Lt,,73551,CPT,Facility,Both,,,LT,250,212.5,71.65,250,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,250,100,,percent of total billed charges,,
Xr Femur 1 View Lt,,73551,CPT,Facility,Both,,,LT,250,212.5,71.65,250,BlueCross BlueShield Minnesota,High Value Network Plan,225,90,,percent of total billed charges,,
Xr Femur 1 View Lt,,73551,CPT,Facility,Outpatient,,,LT,250,212.5,71.65,250,BlueCross BlueShield Minnesota,Medicare Advantage,122.5,49,,percent of total billed charges,,
Xr Femur 1 View Lt,,73551,CPT,Facility,Inpatient,,,LT,250,212.5,71.65,250,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Xr Femur 1 View Lt,,73551,CPT,Facility,Both,,,LT,250,212.5,71.65,250,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,221.425,88.57,,percent of total billed charges,,
Xr Femur 1 View Lt,,73551,CPT,Facility,Both,,,LT,250,212.5,71.65,250,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,71.65,28.66,,percent of total billed charges,,
Xr Femur 1 View Lt,,73551,CPT,Facility,Outpatient,,,LT,250,212.5,71.65,250,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),122.5,49,,percent of total billed charges,,
Xr Femur 1 View Lt,,73551,CPT,Facility,Inpatient,,,LT,250,212.5,71.65,250,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Xr Femur 1 View Lt,,73551,CPT,Facility,Both,,,LT,250,212.5,71.65,250,CorVel,Worker's Compensation,250,100,,percent of total billed charges,,
Xr Femur 1 View Lt,,73551,CPT,Facility,Both,,,LT,250,212.5,71.65,250,First Health Group Corporation,First Health Network,242.5,97,,percent of total billed charges,,
Xr Femur 1 View Lt,,73551,CPT,Facility,Both,,,LT,250,212.5,71.65,250,"Health Partners, Inc.",Commercial,236.5,94.6,,percent of total billed charges,,
Xr Femur 1 View Lt,,73551,CPT,Facility,Outpatient,,,LT,250,212.5,71.65,250,"Health Partners, Inc.",Medicare Advantage,122.5,49,,percent of total billed charges,,
Xr Femur 1 View Lt,,73551,CPT,Facility,Inpatient,,,LT,250,212.5,71.65,250,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Femur 1 View Lt,,73551,CPT,Facility,Both,,,LT,250,212.5,71.65,250,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),150,60,,percent of total billed charges,,
Xr Femur 1 View Lt,,73551,CPT,Facility,Both,,,LT,250,212.5,71.65,250,"Health Partners, Inc.",State of Minnesota Advantage Program,203.75,81.5,,percent of total billed charges,,
Xr Femur 1 View Lt,,73551,CPT,Facility,Both,,,LT,250,212.5,71.65,250,"Health Partners, Inc.",State Public Programs,125,50,,percent of total billed charges,,
Xr Femur 1 View Lt,,73551,CPT,Facility,Both,,,LT,250,212.5,71.65,250,Humana Insurance Company,Commercial PPO,237.5,95,,percent of total billed charges,,
Xr Femur 1 View Lt,,73551,CPT,Facility,Outpatient,,,LT,250,212.5,71.65,250,Humana Insurance Company,Medicare PPO,122.5,49,,percent of total billed charges,,
Xr Femur 1 View Lt,,73551,CPT,Facility,Inpatient,,,LT,250,212.5,71.65,250,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Xr Femur 1 View Lt,,73551,CPT,Facility,Both,,,LT,250,212.5,71.65,250,Medica,Individual & Family,247.75,99.1,,percent of total billed charges,,
Xr Femur 1 View Lt,,73551,CPT,Facility,Outpatient,,,LT,250,212.5,71.65,250,Medica,Medica Advantage Solution,124.5,49.8,,percent of total billed charges,,
Xr Femur 1 View Lt,,73551,CPT,Facility,Inpatient,,,LT,250,212.5,71.65,250,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Xr Femur 1 View Lt,,73551,CPT,Facility,Outpatient,,,LT,250,212.5,71.65,250,Medica,Medical Assistance,111.5,44.6,,percent of total billed charges,,
Xr Femur 1 View Lt,,73551,CPT,Facility,Inpatient,,,LT,250,212.5,71.65,250,Medica,Medical Assistance,,,,,Included in per diem rate,
Xr Femur 1 View Lt,,73551,CPT,Facility,Outpatient,,,LT,250,212.5,71.65,250,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,124.5,49.8,,percent of total billed charges,,
Xr Femur 1 View Lt,,73551,CPT,Facility,Inpatient,,,LT,250,212.5,71.65,250,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Xr Femur 1 View Lt,,73551,CPT,Facility,Both,,,LT,250,212.5,71.65,250,"Multiplan, Inc.","Multiplan, Inc.",235,94,,percent of total billed charges,,
Xr Femur 1 View Lt,,73551,CPT,Facility,Outpatient,,,LT,250,212.5,71.65,250,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,225.25,90.1,,percent of total billed charges,,
Xr Femur 1 View Lt,,73551,CPT,Facility,Inpatient,,,LT,250,212.5,71.65,250,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Xr Femur 1 View Lt,,73551,CPT,Facility,Both,,,LT,250,212.5,71.65,250,"Preferred One Administrative Services, INC.",PPO,246.5,98.6,,percent of total billed charges,,
Xr Femur 1 View Lt,,73551,CPT,Facility,Outpatient,,,LT,250,212.5,71.65,250,PrimeWest Health,Minnesota Senior Health Options (MSHO),128.625,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Xr Femur 1 View Lt,,73551,CPT,Facility,Inpatient,,,LT,250,212.5,71.65,250,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Femur 1 View Lt,,73551,CPT,Facility,Outpatient,,,LT,250,212.5,71.65,250,PrimeWest Health,MinnesotaCare,128.4,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Xr Femur 1 View Lt,,73551,CPT,Facility,Inpatient,,,LT,250,212.5,71.65,250,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Xr Femur 1 View Lt,,73551,CPT,Facility,Both,,,LT,250,212.5,71.65,250,Sanford Health Plan,Sanford Health Plan,230,92,,percent of total billed charges,,
Xr Femur 1 View Lt,,73551,CPT,Facility,Outpatient,,,LT,250,212.5,71.65,250,"UCare Health, Inc.",Individual & Family Plan,140.875,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Xr Femur 1 View Lt,,73551,CPT,Facility,Inpatient,,,LT,250,212.5,71.65,250,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Xr Femur 1 View Lt,,73551,CPT,Facility,Outpatient,,,LT,250,212.5,71.65,250,"UCare Health, Inc.",Medical Assistance,126.175,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Femur 1 View Lt,,73551,CPT,Facility,Inpatient,,,LT,250,212.5,71.65,250,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Xr Femur 1 View Lt,,73551,CPT,Facility,Outpatient,,,LT,250,212.5,71.65,250,"UCare Health, Inc.",Medicare Advantage,126.175,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Femur 1 View Lt,,73551,CPT,Facility,Inpatient,,,LT,250,212.5,71.65,250,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Femur 1 View Lt,,73551,CPT,Facility,Outpatient,,,LT,250,212.5,71.65,250,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),126.175,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Femur 1 View Lt,,73551,CPT,Facility,Inpatient,,,LT,250,212.5,71.65,250,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Femur 1 View Lt,,73551,CPT,Facility,Both,,,LT,250,212.5,71.65,250,UnitedHealthcare,Individual & Family,235,94,,percent of total billed charges,,
Xr Femur 1 View Lt,,73551,CPT,Facility,Outpatient,,,LT,250,212.5,71.65,250,UnitedHealthcare,Medicare Advantage,122.5,49,,percent of total billed charges,,
Xr Femur 1 View Lt,,73551,CPT,Facility,Inpatient,,,LT,250,212.5,71.65,250,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Xr Femur 1 View Lt,,73551,CPT,Facility,Outpatient,,,LT,250,212.5,71.65,250,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,120,48,,percent of total billed charges,,100% of DHS outpatient percentage
Xr Femur 1 View Lt,,73551,CPT,Facility,Inpatient,,,LT,250,212.5,71.65,250,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Xr Femur Lt 2 Views,,73552,CPT,Facility,Both,,,LT,270,229.5,77.382,270,Aetna,Commercial,248.4,92,,percent of total billed charges,,
Xr Femur Lt 2 Views,,73552,CPT,Facility,Outpatient,,,LT,270,229.5,77.382,270,Aetna,Medicare Advantage,132.3,49,,percent of total billed charges,,
Xr Femur Lt 2 Views,,73552,CPT,Facility,Inpatient,,,LT,270,229.5,77.382,270,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Xr Femur Lt 2 Views,,73552,CPT,Facility,Both,,,LT,270,229.5,77.382,270,Aetna,PPO,251.1,93,,percent of total billed charges,,
Xr Femur Lt 2 Views,,73552,CPT,Facility,Both,,,LT,270,229.5,77.382,270,America's PPO,America's PPO,259.281,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Xr Femur Lt 2 Views,,73552,CPT,Facility,Both,,,LT,270,229.5,77.382,270,BlueCross BlueShield Minnesota, Federal Employee Program,265.68,98.4,,percent of total billed charges,,
Xr Femur Lt 2 Views,,73552,CPT,Facility,Both,,,LT,270,229.5,77.382,270,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,270,100,,percent of total billed charges,,
Xr Femur Lt 2 Views,,73552,CPT,Facility,Both,,,LT,270,229.5,77.382,270,BlueCross BlueShield Minnesota,High Value Network Plan,243,90,,percent of total billed charges,,
Xr Femur Lt 2 Views,,73552,CPT,Facility,Outpatient,,,LT,270,229.5,77.382,270,BlueCross BlueShield Minnesota,Medicare Advantage,132.3,49,,percent of total billed charges,,
Xr Femur Lt 2 Views,,73552,CPT,Facility,Inpatient,,,LT,270,229.5,77.382,270,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Xr Femur Lt 2 Views,,73552,CPT,Facility,Both,,,LT,270,229.5,77.382,270,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,239.139,88.57,,percent of total billed charges,,
Xr Femur Lt 2 Views,,73552,CPT,Facility,Both,,,LT,270,229.5,77.382,270,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,77.382,28.66,,percent of total billed charges,,
Xr Femur Lt 2 Views,,73552,CPT,Facility,Outpatient,,,LT,270,229.5,77.382,270,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),132.3,49,,percent of total billed charges,,
Xr Femur Lt 2 Views,,73552,CPT,Facility,Inpatient,,,LT,270,229.5,77.382,270,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Xr Femur Lt 2 Views,,73552,CPT,Facility,Both,,,LT,270,229.5,77.382,270,CorVel,Worker's Compensation,270,100,,percent of total billed charges,,
Xr Femur Lt 2 Views,,73552,CPT,Facility,Both,,,LT,270,229.5,77.382,270,First Health Group Corporation,First Health Network,261.9,97,,percent of total billed charges,,
Xr Femur Lt 2 Views,,73552,CPT,Facility,Both,,,LT,270,229.5,77.382,270,"Health Partners, Inc.",Commercial,255.42,94.6,,percent of total billed charges,,
Xr Femur Lt 2 Views,,73552,CPT,Facility,Outpatient,,,LT,270,229.5,77.382,270,"Health Partners, Inc.",Medicare Advantage,132.3,49,,percent of total billed charges,,
Xr Femur Lt 2 Views,,73552,CPT,Facility,Inpatient,,,LT,270,229.5,77.382,270,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Femur Lt 2 Views,,73552,CPT,Facility,Both,,,LT,270,229.5,77.382,270,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),162,60,,percent of total billed charges,,
Xr Femur Lt 2 Views,,73552,CPT,Facility,Both,,,LT,270,229.5,77.382,270,"Health Partners, Inc.",State of Minnesota Advantage Program,220.05,81.5,,percent of total billed charges,,
Xr Femur Lt 2 Views,,73552,CPT,Facility,Both,,,LT,270,229.5,77.382,270,"Health Partners, Inc.",State Public Programs,135,50,,percent of total billed charges,,
Xr Femur Lt 2 Views,,73552,CPT,Facility,Both,,,LT,270,229.5,77.382,270,Humana Insurance Company,Commercial PPO,256.5,95,,percent of total billed charges,,
Xr Femur Lt 2 Views,,73552,CPT,Facility,Outpatient,,,LT,270,229.5,77.382,270,Humana Insurance Company,Medicare PPO,132.3,49,,percent of total billed charges,,
Xr Femur Lt 2 Views,,73552,CPT,Facility,Inpatient,,,LT,270,229.5,77.382,270,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Xr Femur Lt 2 Views,,73552,CPT,Facility,Both,,,LT,270,229.5,77.382,270,Medica,Individual & Family,267.57,99.1,,percent of total billed charges,,
Xr Femur Lt 2 Views,,73552,CPT,Facility,Outpatient,,,LT,270,229.5,77.382,270,Medica,Medica Advantage Solution,134.46,49.8,,percent of total billed charges,,
Xr Femur Lt 2 Views,,73552,CPT,Facility,Inpatient,,,LT,270,229.5,77.382,270,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Xr Femur Lt 2 Views,,73552,CPT,Facility,Outpatient,,,LT,270,229.5,77.382,270,Medica,Medical Assistance,120.42,44.6,,percent of total billed charges,,
Xr Femur Lt 2 Views,,73552,CPT,Facility,Inpatient,,,LT,270,229.5,77.382,270,Medica,Medical Assistance,,,,,Included in per diem rate,
Xr Femur Lt 2 Views,,73552,CPT,Facility,Outpatient,,,LT,270,229.5,77.382,270,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,134.46,49.8,,percent of total billed charges,,
Xr Femur Lt 2 Views,,73552,CPT,Facility,Inpatient,,,LT,270,229.5,77.382,270,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Xr Femur Lt 2 Views,,73552,CPT,Facility,Both,,,LT,270,229.5,77.382,270,"Multiplan, Inc.","Multiplan, Inc.",253.8,94,,percent of total billed charges,,
Xr Femur Lt 2 Views,,73552,CPT,Facility,Outpatient,,,LT,270,229.5,77.382,270,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,243.27,90.1,,percent of total billed charges,,
Xr Femur Lt 2 Views,,73552,CPT,Facility,Inpatient,,,LT,270,229.5,77.382,270,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Xr Femur Lt 2 Views,,73552,CPT,Facility,Both,,,LT,270,229.5,77.382,270,"Preferred One Administrative Services, INC.",PPO,266.22,98.6,,percent of total billed charges,,
Xr Femur Lt 2 Views,,73552,CPT,Facility,Outpatient,,,LT,270,229.5,77.382,270,PrimeWest Health,Minnesota Senior Health Options (MSHO),138.915,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Xr Femur Lt 2 Views,,73552,CPT,Facility,Inpatient,,,LT,270,229.5,77.382,270,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Femur Lt 2 Views,,73552,CPT,Facility,Outpatient,,,LT,270,229.5,77.382,270,PrimeWest Health,MinnesotaCare,138.672,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Xr Femur Lt 2 Views,,73552,CPT,Facility,Inpatient,,,LT,270,229.5,77.382,270,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Xr Femur Lt 2 Views,,73552,CPT,Facility,Both,,,LT,270,229.5,77.382,270,Sanford Health Plan,Sanford Health Plan,248.4,92,,percent of total billed charges,,
Xr Femur Lt 2 Views,,73552,CPT,Facility,Outpatient,,,LT,270,229.5,77.382,270,"UCare Health, Inc.",Individual & Family Plan,152.145,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Xr Femur Lt 2 Views,,73552,CPT,Facility,Inpatient,,,LT,270,229.5,77.382,270,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Xr Femur Lt 2 Views,,73552,CPT,Facility,Outpatient,,,LT,270,229.5,77.382,270,"UCare Health, Inc.",Medical Assistance,136.269,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Femur Lt 2 Views,,73552,CPT,Facility,Inpatient,,,LT,270,229.5,77.382,270,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Xr Femur Lt 2 Views,,73552,CPT,Facility,Outpatient,,,LT,270,229.5,77.382,270,"UCare Health, Inc.",Medicare Advantage,136.269,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Femur Lt 2 Views,,73552,CPT,Facility,Inpatient,,,LT,270,229.5,77.382,270,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Femur Lt 2 Views,,73552,CPT,Facility,Outpatient,,,LT,270,229.5,77.382,270,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),136.269,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Femur Lt 2 Views,,73552,CPT,Facility,Inpatient,,,LT,270,229.5,77.382,270,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Femur Lt 2 Views,,73552,CPT,Facility,Both,,,LT,270,229.5,77.382,270,UnitedHealthcare,Individual & Family,253.8,94,,percent of total billed charges,,
Xr Femur Lt 2 Views,,73552,CPT,Facility,Outpatient,,,LT,270,229.5,77.382,270,UnitedHealthcare,Medicare Advantage,132.3,49,,percent of total billed charges,,
Xr Femur Lt 2 Views,,73552,CPT,Facility,Inpatient,,,LT,270,229.5,77.382,270,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Xr Femur Lt 2 Views,,73552,CPT,Facility,Outpatient,,,LT,270,229.5,77.382,270,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,129.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
Xr Femur Lt 2 Views,,73552,CPT,Facility,Inpatient,,,LT,270,229.5,77.382,270,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Xr Knee Lt One View,,73560,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,Aetna,Commercial,237.36,92,,percent of total billed charges,,
Xr Knee Lt One View,,73560,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,Aetna,Medicare Advantage,126.42,49,,percent of total billed charges,,
Xr Knee Lt One View,,73560,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Xr Knee Lt One View,,73560,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,Aetna,PPO,239.94,93,,percent of total billed charges,,
Xr Knee Lt One View,,73560,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,America's PPO,America's PPO,247.7574,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Xr Knee Lt One View,,73560,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota, Federal Employee Program,253.872,98.4,,percent of total billed charges,,
Xr Knee Lt One View,,73560,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,258,100,,percent of total billed charges,,
Xr Knee Lt One View,,73560,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,High Value Network Plan,232.2,90,,percent of total billed charges,,
Xr Knee Lt One View,,73560,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,Medicare Advantage,126.42,49,,percent of total billed charges,,
Xr Knee Lt One View,,73560,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Xr Knee Lt One View,,73560,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,228.5106,88.57,,percent of total billed charges,,
Xr Knee Lt One View,,73560,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,73.9428,28.66,,percent of total billed charges,,
Xr Knee Lt One View,,73560,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),126.42,49,,percent of total billed charges,,
Xr Knee Lt One View,,73560,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Xr Knee Lt One View,,73560,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,CorVel,Worker's Compensation,258,100,,percent of total billed charges,,
Xr Knee Lt One View,,73560,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,First Health Group Corporation,First Health Network,250.26,97,,percent of total billed charges,,
Xr Knee Lt One View,,73560,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,"Health Partners, Inc.",Commercial,244.068,94.6,,percent of total billed charges,,
Xr Knee Lt One View,,73560,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,"Health Partners, Inc.",Medicare Advantage,126.42,49,,percent of total billed charges,,
Xr Knee Lt One View,,73560,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Knee Lt One View,,73560,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),154.8,60,,percent of total billed charges,,
Xr Knee Lt One View,,73560,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,"Health Partners, Inc.",State of Minnesota Advantage Program,210.27,81.5,,percent of total billed charges,,
Xr Knee Lt One View,,73560,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,"Health Partners, Inc.",State Public Programs,129,50,,percent of total billed charges,,
Xr Knee Lt One View,,73560,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,Humana Insurance Company,Commercial PPO,245.1,95,,percent of total billed charges,,
Xr Knee Lt One View,,73560,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,Humana Insurance Company,Medicare PPO,126.42,49,,percent of total billed charges,,
Xr Knee Lt One View,,73560,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Xr Knee Lt One View,,73560,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,Medica,Individual & Family,255.678,99.1,,percent of total billed charges,,
Xr Knee Lt One View,,73560,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,Medica,Medica Advantage Solution,128.484,49.8,,percent of total billed charges,,
Xr Knee Lt One View,,73560,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Xr Knee Lt One View,,73560,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,Medica,Medical Assistance,115.068,44.6,,percent of total billed charges,,
Xr Knee Lt One View,,73560,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,Medica,Medical Assistance,,,,,Included in per diem rate,
Xr Knee Lt One View,,73560,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,128.484,49.8,,percent of total billed charges,,
Xr Knee Lt One View,,73560,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Xr Knee Lt One View,,73560,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,"Multiplan, Inc.","Multiplan, Inc.",242.52,94,,percent of total billed charges,,
Xr Knee Lt One View,,73560,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,232.458,90.1,,percent of total billed charges,,
Xr Knee Lt One View,,73560,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Xr Knee Lt One View,,73560,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,"Preferred One Administrative Services, INC.",PPO,254.388,98.6,,percent of total billed charges,,
Xr Knee Lt One View,,73560,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,PrimeWest Health,Minnesota Senior Health Options (MSHO),132.741,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Xr Knee Lt One View,,73560,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Knee Lt One View,,73560,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,PrimeWest Health,MinnesotaCare,132.5088,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Xr Knee Lt One View,,73560,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Xr Knee Lt One View,,73560,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,Sanford Health Plan,Sanford Health Plan,237.36,92,,percent of total billed charges,,
Xr Knee Lt One View,,73560,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,"UCare Health, Inc.",Individual & Family Plan,145.383,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Xr Knee Lt One View,,73560,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Xr Knee Lt One View,,73560,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,"UCare Health, Inc.",Medical Assistance,130.2126,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Knee Lt One View,,73560,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Xr Knee Lt One View,,73560,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,"UCare Health, Inc.",Medicare Advantage,130.2126,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Knee Lt One View,,73560,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Knee Lt One View,,73560,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),130.2126,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Knee Lt One View,,73560,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Knee Lt One View,,73560,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,UnitedHealthcare,Individual & Family,242.52,94,,percent of total billed charges,,
Xr Knee Lt One View,,73560,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,UnitedHealthcare,Medicare Advantage,126.42,49,,percent of total billed charges,,
Xr Knee Lt One View,,73560,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Xr Knee Lt One View,,73560,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,123.84,48,,percent of total billed charges,,100% of DHS outpatient percentage
Xr Knee Lt One View,,73560,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Xr Knee Routine Lt 2 Views,,73560,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,Aetna,Commercial,237.36,92,,percent of total billed charges,,
Xr Knee Routine Lt 2 Views,,73560,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,Aetna,Medicare Advantage,126.42,49,,percent of total billed charges,,
Xr Knee Routine Lt 2 Views,,73560,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Xr Knee Routine Lt 2 Views,,73560,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,Aetna,PPO,239.94,93,,percent of total billed charges,,
Xr Knee Routine Lt 2 Views,,73560,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,America's PPO,America's PPO,247.7574,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Xr Knee Routine Lt 2 Views,,73560,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota, Federal Employee Program,253.872,98.4,,percent of total billed charges,,
Xr Knee Routine Lt 2 Views,,73560,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,258,100,,percent of total billed charges,,
Xr Knee Routine Lt 2 Views,,73560,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,High Value Network Plan,232.2,90,,percent of total billed charges,,
Xr Knee Routine Lt 2 Views,,73560,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,Medicare Advantage,126.42,49,,percent of total billed charges,,
Xr Knee Routine Lt 2 Views,,73560,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Xr Knee Routine Lt 2 Views,,73560,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,228.5106,88.57,,percent of total billed charges,,
Xr Knee Routine Lt 2 Views,,73560,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,73.9428,28.66,,percent of total billed charges,,
Xr Knee Routine Lt 2 Views,,73560,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),126.42,49,,percent of total billed charges,,
Xr Knee Routine Lt 2 Views,,73560,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Xr Knee Routine Lt 2 Views,,73560,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,CorVel,Worker's Compensation,258,100,,percent of total billed charges,,
Xr Knee Routine Lt 2 Views,,73560,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,First Health Group Corporation,First Health Network,250.26,97,,percent of total billed charges,,
Xr Knee Routine Lt 2 Views,,73560,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,"Health Partners, Inc.",Commercial,244.068,94.6,,percent of total billed charges,,
Xr Knee Routine Lt 2 Views,,73560,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,"Health Partners, Inc.",Medicare Advantage,126.42,49,,percent of total billed charges,,
Xr Knee Routine Lt 2 Views,,73560,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Knee Routine Lt 2 Views,,73560,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),154.8,60,,percent of total billed charges,,
Xr Knee Routine Lt 2 Views,,73560,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,"Health Partners, Inc.",State of Minnesota Advantage Program,210.27,81.5,,percent of total billed charges,,
Xr Knee Routine Lt 2 Views,,73560,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,"Health Partners, Inc.",State Public Programs,129,50,,percent of total billed charges,,
Xr Knee Routine Lt 2 Views,,73560,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,Humana Insurance Company,Commercial PPO,245.1,95,,percent of total billed charges,,
Xr Knee Routine Lt 2 Views,,73560,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,Humana Insurance Company,Medicare PPO,126.42,49,,percent of total billed charges,,
Xr Knee Routine Lt 2 Views,,73560,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Xr Knee Routine Lt 2 Views,,73560,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,Medica,Individual & Family,255.678,99.1,,percent of total billed charges,,
Xr Knee Routine Lt 2 Views,,73560,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,Medica,Medica Advantage Solution,128.484,49.8,,percent of total billed charges,,
Xr Knee Routine Lt 2 Views,,73560,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Xr Knee Routine Lt 2 Views,,73560,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,Medica,Medical Assistance,115.068,44.6,,percent of total billed charges,,
Xr Knee Routine Lt 2 Views,,73560,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,Medica,Medical Assistance,,,,,Included in per diem rate,
Xr Knee Routine Lt 2 Views,,73560,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,128.484,49.8,,percent of total billed charges,,
Xr Knee Routine Lt 2 Views,,73560,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Xr Knee Routine Lt 2 Views,,73560,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,"Multiplan, Inc.","Multiplan, Inc.",242.52,94,,percent of total billed charges,,
Xr Knee Routine Lt 2 Views,,73560,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,232.458,90.1,,percent of total billed charges,,
Xr Knee Routine Lt 2 Views,,73560,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Xr Knee Routine Lt 2 Views,,73560,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,"Preferred One Administrative Services, INC.",PPO,254.388,98.6,,percent of total billed charges,,
Xr Knee Routine Lt 2 Views,,73560,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,PrimeWest Health,Minnesota Senior Health Options (MSHO),132.741,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Xr Knee Routine Lt 2 Views,,73560,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Knee Routine Lt 2 Views,,73560,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,PrimeWest Health,MinnesotaCare,132.5088,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Xr Knee Routine Lt 2 Views,,73560,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Xr Knee Routine Lt 2 Views,,73560,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,Sanford Health Plan,Sanford Health Plan,237.36,92,,percent of total billed charges,,
Xr Knee Routine Lt 2 Views,,73560,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,"UCare Health, Inc.",Individual & Family Plan,145.383,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Xr Knee Routine Lt 2 Views,,73560,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Xr Knee Routine Lt 2 Views,,73560,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,"UCare Health, Inc.",Medical Assistance,130.2126,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Knee Routine Lt 2 Views,,73560,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Xr Knee Routine Lt 2 Views,,73560,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,"UCare Health, Inc.",Medicare Advantage,130.2126,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Knee Routine Lt 2 Views,,73560,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Knee Routine Lt 2 Views,,73560,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),130.2126,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Knee Routine Lt 2 Views,,73560,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Knee Routine Lt 2 Views,,73560,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,UnitedHealthcare,Individual & Family,242.52,94,,percent of total billed charges,,
Xr Knee Routine Lt 2 Views,,73560,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,UnitedHealthcare,Medicare Advantage,126.42,49,,percent of total billed charges,,
Xr Knee Routine Lt 2 Views,,73560,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Xr Knee Routine Lt 2 Views,,73560,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,123.84,48,,percent of total billed charges,,100% of DHS outpatient percentage
Xr Knee Routine Lt 2 Views,,73560,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Xr Patella Routine Lt 2 View,,73560,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,Aetna,Commercial,237.36,92,,percent of total billed charges,,
Xr Patella Routine Lt 2 View,,73560,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,Aetna,Medicare Advantage,126.42,49,,percent of total billed charges,,
Xr Patella Routine Lt 2 View,,73560,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Xr Patella Routine Lt 2 View,,73560,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,Aetna,PPO,239.94,93,,percent of total billed charges,,
Xr Patella Routine Lt 2 View,,73560,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,America's PPO,America's PPO,247.7574,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Xr Patella Routine Lt 2 View,,73560,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota, Federal Employee Program,253.872,98.4,,percent of total billed charges,,
Xr Patella Routine Lt 2 View,,73560,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,258,100,,percent of total billed charges,,
Xr Patella Routine Lt 2 View,,73560,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,High Value Network Plan,232.2,90,,percent of total billed charges,,
Xr Patella Routine Lt 2 View,,73560,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,Medicare Advantage,126.42,49,,percent of total billed charges,,
Xr Patella Routine Lt 2 View,,73560,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Xr Patella Routine Lt 2 View,,73560,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,228.5106,88.57,,percent of total billed charges,,
Xr Patella Routine Lt 2 View,,73560,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,73.9428,28.66,,percent of total billed charges,,
Xr Patella Routine Lt 2 View,,73560,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),126.42,49,,percent of total billed charges,,
Xr Patella Routine Lt 2 View,,73560,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Xr Patella Routine Lt 2 View,,73560,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,CorVel,Worker's Compensation,258,100,,percent of total billed charges,,
Xr Patella Routine Lt 2 View,,73560,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,First Health Group Corporation,First Health Network,250.26,97,,percent of total billed charges,,
Xr Patella Routine Lt 2 View,,73560,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,"Health Partners, Inc.",Commercial,244.068,94.6,,percent of total billed charges,,
Xr Patella Routine Lt 2 View,,73560,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,"Health Partners, Inc.",Medicare Advantage,126.42,49,,percent of total billed charges,,
Xr Patella Routine Lt 2 View,,73560,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Patella Routine Lt 2 View,,73560,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),154.8,60,,percent of total billed charges,,
Xr Patella Routine Lt 2 View,,73560,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,"Health Partners, Inc.",State of Minnesota Advantage Program,210.27,81.5,,percent of total billed charges,,
Xr Patella Routine Lt 2 View,,73560,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,"Health Partners, Inc.",State Public Programs,129,50,,percent of total billed charges,,
Xr Patella Routine Lt 2 View,,73560,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,Humana Insurance Company,Commercial PPO,245.1,95,,percent of total billed charges,,
Xr Patella Routine Lt 2 View,,73560,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,Humana Insurance Company,Medicare PPO,126.42,49,,percent of total billed charges,,
Xr Patella Routine Lt 2 View,,73560,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Xr Patella Routine Lt 2 View,,73560,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,Medica,Individual & Family,255.678,99.1,,percent of total billed charges,,
Xr Patella Routine Lt 2 View,,73560,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,Medica,Medica Advantage Solution,128.484,49.8,,percent of total billed charges,,
Xr Patella Routine Lt 2 View,,73560,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Xr Patella Routine Lt 2 View,,73560,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,Medica,Medical Assistance,115.068,44.6,,percent of total billed charges,,
Xr Patella Routine Lt 2 View,,73560,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,Medica,Medical Assistance,,,,,Included in per diem rate,
Xr Patella Routine Lt 2 View,,73560,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,128.484,49.8,,percent of total billed charges,,
Xr Patella Routine Lt 2 View,,73560,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Xr Patella Routine Lt 2 View,,73560,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,"Multiplan, Inc.","Multiplan, Inc.",242.52,94,,percent of total billed charges,,
Xr Patella Routine Lt 2 View,,73560,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,232.458,90.1,,percent of total billed charges,,
Xr Patella Routine Lt 2 View,,73560,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Xr Patella Routine Lt 2 View,,73560,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,"Preferred One Administrative Services, INC.",PPO,254.388,98.6,,percent of total billed charges,,
Xr Patella Routine Lt 2 View,,73560,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,PrimeWest Health,Minnesota Senior Health Options (MSHO),132.741,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Xr Patella Routine Lt 2 View,,73560,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Patella Routine Lt 2 View,,73560,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,PrimeWest Health,MinnesotaCare,132.5088,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Xr Patella Routine Lt 2 View,,73560,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Xr Patella Routine Lt 2 View,,73560,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,Sanford Health Plan,Sanford Health Plan,237.36,92,,percent of total billed charges,,
Xr Patella Routine Lt 2 View,,73560,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,"UCare Health, Inc.",Individual & Family Plan,145.383,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Xr Patella Routine Lt 2 View,,73560,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Xr Patella Routine Lt 2 View,,73560,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,"UCare Health, Inc.",Medical Assistance,130.2126,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Patella Routine Lt 2 View,,73560,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Xr Patella Routine Lt 2 View,,73560,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,"UCare Health, Inc.",Medicare Advantage,130.2126,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Patella Routine Lt 2 View,,73560,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Patella Routine Lt 2 View,,73560,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),130.2126,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Patella Routine Lt 2 View,,73560,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Patella Routine Lt 2 View,,73560,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,UnitedHealthcare,Individual & Family,242.52,94,,percent of total billed charges,,
Xr Patella Routine Lt 2 View,,73560,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,UnitedHealthcare,Medicare Advantage,126.42,49,,percent of total billed charges,,
Xr Patella Routine Lt 2 View,,73560,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Xr Patella Routine Lt 2 View,,73560,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,123.84,48,,percent of total billed charges,,100% of DHS outpatient percentage
Xr Patella Routine Lt 2 View,,73560,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Xr Knee And Patella Lt,,73562,CPT,Facility,Both,,,LT,270,229.5,77.382,270,Aetna,Commercial,248.4,92,,percent of total billed charges,,
Xr Knee And Patella Lt,,73562,CPT,Facility,Outpatient,,,LT,270,229.5,77.382,270,Aetna,Medicare Advantage,132.3,49,,percent of total billed charges,,
Xr Knee And Patella Lt,,73562,CPT,Facility,Inpatient,,,LT,270,229.5,77.382,270,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Xr Knee And Patella Lt,,73562,CPT,Facility,Both,,,LT,270,229.5,77.382,270,Aetna,PPO,251.1,93,,percent of total billed charges,,
Xr Knee And Patella Lt,,73562,CPT,Facility,Both,,,LT,270,229.5,77.382,270,America's PPO,America's PPO,259.281,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Xr Knee And Patella Lt,,73562,CPT,Facility,Both,,,LT,270,229.5,77.382,270,BlueCross BlueShield Minnesota, Federal Employee Program,265.68,98.4,,percent of total billed charges,,
Xr Knee And Patella Lt,,73562,CPT,Facility,Both,,,LT,270,229.5,77.382,270,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,270,100,,percent of total billed charges,,
Xr Knee And Patella Lt,,73562,CPT,Facility,Both,,,LT,270,229.5,77.382,270,BlueCross BlueShield Minnesota,High Value Network Plan,243,90,,percent of total billed charges,,
Xr Knee And Patella Lt,,73562,CPT,Facility,Outpatient,,,LT,270,229.5,77.382,270,BlueCross BlueShield Minnesota,Medicare Advantage,132.3,49,,percent of total billed charges,,
Xr Knee And Patella Lt,,73562,CPT,Facility,Inpatient,,,LT,270,229.5,77.382,270,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Xr Knee And Patella Lt,,73562,CPT,Facility,Both,,,LT,270,229.5,77.382,270,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,239.139,88.57,,percent of total billed charges,,
Xr Knee And Patella Lt,,73562,CPT,Facility,Both,,,LT,270,229.5,77.382,270,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,77.382,28.66,,percent of total billed charges,,
Xr Knee And Patella Lt,,73562,CPT,Facility,Outpatient,,,LT,270,229.5,77.382,270,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),132.3,49,,percent of total billed charges,,
Xr Knee And Patella Lt,,73562,CPT,Facility,Inpatient,,,LT,270,229.5,77.382,270,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Xr Knee And Patella Lt,,73562,CPT,Facility,Both,,,LT,270,229.5,77.382,270,CorVel,Worker's Compensation,270,100,,percent of total billed charges,,
Xr Knee And Patella Lt,,73562,CPT,Facility,Both,,,LT,270,229.5,77.382,270,First Health Group Corporation,First Health Network,261.9,97,,percent of total billed charges,,
Xr Knee And Patella Lt,,73562,CPT,Facility,Both,,,LT,270,229.5,77.382,270,"Health Partners, Inc.",Commercial,255.42,94.6,,percent of total billed charges,,
Xr Knee And Patella Lt,,73562,CPT,Facility,Outpatient,,,LT,270,229.5,77.382,270,"Health Partners, Inc.",Medicare Advantage,132.3,49,,percent of total billed charges,,
Xr Knee And Patella Lt,,73562,CPT,Facility,Inpatient,,,LT,270,229.5,77.382,270,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Knee And Patella Lt,,73562,CPT,Facility,Both,,,LT,270,229.5,77.382,270,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),162,60,,percent of total billed charges,,
Xr Knee And Patella Lt,,73562,CPT,Facility,Both,,,LT,270,229.5,77.382,270,"Health Partners, Inc.",State of Minnesota Advantage Program,220.05,81.5,,percent of total billed charges,,
Xr Knee And Patella Lt,,73562,CPT,Facility,Both,,,LT,270,229.5,77.382,270,"Health Partners, Inc.",State Public Programs,135,50,,percent of total billed charges,,
Xr Knee And Patella Lt,,73562,CPT,Facility,Both,,,LT,270,229.5,77.382,270,Humana Insurance Company,Commercial PPO,256.5,95,,percent of total billed charges,,
Xr Knee And Patella Lt,,73562,CPT,Facility,Outpatient,,,LT,270,229.5,77.382,270,Humana Insurance Company,Medicare PPO,132.3,49,,percent of total billed charges,,
Xr Knee And Patella Lt,,73562,CPT,Facility,Inpatient,,,LT,270,229.5,77.382,270,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Xr Knee And Patella Lt,,73562,CPT,Facility,Both,,,LT,270,229.5,77.382,270,Medica,Individual & Family,267.57,99.1,,percent of total billed charges,,
Xr Knee And Patella Lt,,73562,CPT,Facility,Outpatient,,,LT,270,229.5,77.382,270,Medica,Medica Advantage Solution,134.46,49.8,,percent of total billed charges,,
Xr Knee And Patella Lt,,73562,CPT,Facility,Inpatient,,,LT,270,229.5,77.382,270,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Xr Knee And Patella Lt,,73562,CPT,Facility,Outpatient,,,LT,270,229.5,77.382,270,Medica,Medical Assistance,120.42,44.6,,percent of total billed charges,,
Xr Knee And Patella Lt,,73562,CPT,Facility,Inpatient,,,LT,270,229.5,77.382,270,Medica,Medical Assistance,,,,,Included in per diem rate,
Xr Knee And Patella Lt,,73562,CPT,Facility,Outpatient,,,LT,270,229.5,77.382,270,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,134.46,49.8,,percent of total billed charges,,
Xr Knee And Patella Lt,,73562,CPT,Facility,Inpatient,,,LT,270,229.5,77.382,270,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Xr Knee And Patella Lt,,73562,CPT,Facility,Both,,,LT,270,229.5,77.382,270,"Multiplan, Inc.","Multiplan, Inc.",253.8,94,,percent of total billed charges,,
Xr Knee And Patella Lt,,73562,CPT,Facility,Outpatient,,,LT,270,229.5,77.382,270,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,243.27,90.1,,percent of total billed charges,,
Xr Knee And Patella Lt,,73562,CPT,Facility,Inpatient,,,LT,270,229.5,77.382,270,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Xr Knee And Patella Lt,,73562,CPT,Facility,Both,,,LT,270,229.5,77.382,270,"Preferred One Administrative Services, INC.",PPO,266.22,98.6,,percent of total billed charges,,
Xr Knee And Patella Lt,,73562,CPT,Facility,Outpatient,,,LT,270,229.5,77.382,270,PrimeWest Health,Minnesota Senior Health Options (MSHO),138.915,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Xr Knee And Patella Lt,,73562,CPT,Facility,Inpatient,,,LT,270,229.5,77.382,270,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Knee And Patella Lt,,73562,CPT,Facility,Outpatient,,,LT,270,229.5,77.382,270,PrimeWest Health,MinnesotaCare,138.672,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Xr Knee And Patella Lt,,73562,CPT,Facility,Inpatient,,,LT,270,229.5,77.382,270,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Xr Knee And Patella Lt,,73562,CPT,Facility,Both,,,LT,270,229.5,77.382,270,Sanford Health Plan,Sanford Health Plan,248.4,92,,percent of total billed charges,,
Xr Knee And Patella Lt,,73562,CPT,Facility,Outpatient,,,LT,270,229.5,77.382,270,"UCare Health, Inc.",Individual & Family Plan,152.145,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Xr Knee And Patella Lt,,73562,CPT,Facility,Inpatient,,,LT,270,229.5,77.382,270,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Xr Knee And Patella Lt,,73562,CPT,Facility,Outpatient,,,LT,270,229.5,77.382,270,"UCare Health, Inc.",Medical Assistance,136.269,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Knee And Patella Lt,,73562,CPT,Facility,Inpatient,,,LT,270,229.5,77.382,270,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Xr Knee And Patella Lt,,73562,CPT,Facility,Outpatient,,,LT,270,229.5,77.382,270,"UCare Health, Inc.",Medicare Advantage,136.269,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Knee And Patella Lt,,73562,CPT,Facility,Inpatient,,,LT,270,229.5,77.382,270,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Knee And Patella Lt,,73562,CPT,Facility,Outpatient,,,LT,270,229.5,77.382,270,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),136.269,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Knee And Patella Lt,,73562,CPT,Facility,Inpatient,,,LT,270,229.5,77.382,270,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Knee And Patella Lt,,73562,CPT,Facility,Both,,,LT,270,229.5,77.382,270,UnitedHealthcare,Individual & Family,253.8,94,,percent of total billed charges,,
Xr Knee And Patella Lt,,73562,CPT,Facility,Outpatient,,,LT,270,229.5,77.382,270,UnitedHealthcare,Medicare Advantage,132.3,49,,percent of total billed charges,,
Xr Knee And Patella Lt,,73562,CPT,Facility,Inpatient,,,LT,270,229.5,77.382,270,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Xr Knee And Patella Lt,,73562,CPT,Facility,Outpatient,,,LT,270,229.5,77.382,270,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,129.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
Xr Knee And Patella Lt,,73562,CPT,Facility,Inpatient,,,LT,270,229.5,77.382,270,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Xr Knee Lt 3 Views,,73562,CPT,Facility,Both,,,LT,270,229.5,77.382,270,Aetna,Commercial,248.4,92,,percent of total billed charges,,
Xr Knee Lt 3 Views,,73562,CPT,Facility,Outpatient,,,LT,270,229.5,77.382,270,Aetna,Medicare Advantage,132.3,49,,percent of total billed charges,,
Xr Knee Lt 3 Views,,73562,CPT,Facility,Inpatient,,,LT,270,229.5,77.382,270,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Xr Knee Lt 3 Views,,73562,CPT,Facility,Both,,,LT,270,229.5,77.382,270,Aetna,PPO,251.1,93,,percent of total billed charges,,
Xr Knee Lt 3 Views,,73562,CPT,Facility,Both,,,LT,270,229.5,77.382,270,America's PPO,America's PPO,259.281,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Xr Knee Lt 3 Views,,73562,CPT,Facility,Both,,,LT,270,229.5,77.382,270,BlueCross BlueShield Minnesota, Federal Employee Program,265.68,98.4,,percent of total billed charges,,
Xr Knee Lt 3 Views,,73562,CPT,Facility,Both,,,LT,270,229.5,77.382,270,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,270,100,,percent of total billed charges,,
Xr Knee Lt 3 Views,,73562,CPT,Facility,Both,,,LT,270,229.5,77.382,270,BlueCross BlueShield Minnesota,High Value Network Plan,243,90,,percent of total billed charges,,
Xr Knee Lt 3 Views,,73562,CPT,Facility,Outpatient,,,LT,270,229.5,77.382,270,BlueCross BlueShield Minnesota,Medicare Advantage,132.3,49,,percent of total billed charges,,
Xr Knee Lt 3 Views,,73562,CPT,Facility,Inpatient,,,LT,270,229.5,77.382,270,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Xr Knee Lt 3 Views,,73562,CPT,Facility,Both,,,LT,270,229.5,77.382,270,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,239.139,88.57,,percent of total billed charges,,
Xr Knee Lt 3 Views,,73562,CPT,Facility,Both,,,LT,270,229.5,77.382,270,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,77.382,28.66,,percent of total billed charges,,
Xr Knee Lt 3 Views,,73562,CPT,Facility,Outpatient,,,LT,270,229.5,77.382,270,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),132.3,49,,percent of total billed charges,,
Xr Knee Lt 3 Views,,73562,CPT,Facility,Inpatient,,,LT,270,229.5,77.382,270,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Xr Knee Lt 3 Views,,73562,CPT,Facility,Both,,,LT,270,229.5,77.382,270,CorVel,Worker's Compensation,270,100,,percent of total billed charges,,
Xr Knee Lt 3 Views,,73562,CPT,Facility,Both,,,LT,270,229.5,77.382,270,First Health Group Corporation,First Health Network,261.9,97,,percent of total billed charges,,
Xr Knee Lt 3 Views,,73562,CPT,Facility,Both,,,LT,270,229.5,77.382,270,"Health Partners, Inc.",Commercial,255.42,94.6,,percent of total billed charges,,
Xr Knee Lt 3 Views,,73562,CPT,Facility,Outpatient,,,LT,270,229.5,77.382,270,"Health Partners, Inc.",Medicare Advantage,132.3,49,,percent of total billed charges,,
Xr Knee Lt 3 Views,,73562,CPT,Facility,Inpatient,,,LT,270,229.5,77.382,270,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Knee Lt 3 Views,,73562,CPT,Facility,Both,,,LT,270,229.5,77.382,270,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),162,60,,percent of total billed charges,,
Xr Knee Lt 3 Views,,73562,CPT,Facility,Both,,,LT,270,229.5,77.382,270,"Health Partners, Inc.",State of Minnesota Advantage Program,220.05,81.5,,percent of total billed charges,,
Xr Knee Lt 3 Views,,73562,CPT,Facility,Both,,,LT,270,229.5,77.382,270,"Health Partners, Inc.",State Public Programs,135,50,,percent of total billed charges,,
Xr Knee Lt 3 Views,,73562,CPT,Facility,Both,,,LT,270,229.5,77.382,270,Humana Insurance Company,Commercial PPO,256.5,95,,percent of total billed charges,,
Xr Knee Lt 3 Views,,73562,CPT,Facility,Outpatient,,,LT,270,229.5,77.382,270,Humana Insurance Company,Medicare PPO,132.3,49,,percent of total billed charges,,
Xr Knee Lt 3 Views,,73562,CPT,Facility,Inpatient,,,LT,270,229.5,77.382,270,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Xr Knee Lt 3 Views,,73562,CPT,Facility,Both,,,LT,270,229.5,77.382,270,Medica,Individual & Family,267.57,99.1,,percent of total billed charges,,
Xr Knee Lt 3 Views,,73562,CPT,Facility,Outpatient,,,LT,270,229.5,77.382,270,Medica,Medica Advantage Solution,134.46,49.8,,percent of total billed charges,,
Xr Knee Lt 3 Views,,73562,CPT,Facility,Inpatient,,,LT,270,229.5,77.382,270,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Xr Knee Lt 3 Views,,73562,CPT,Facility,Outpatient,,,LT,270,229.5,77.382,270,Medica,Medical Assistance,120.42,44.6,,percent of total billed charges,,
Xr Knee Lt 3 Views,,73562,CPT,Facility,Inpatient,,,LT,270,229.5,77.382,270,Medica,Medical Assistance,,,,,Included in per diem rate,
Xr Knee Lt 3 Views,,73562,CPT,Facility,Outpatient,,,LT,270,229.5,77.382,270,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,134.46,49.8,,percent of total billed charges,,
Xr Knee Lt 3 Views,,73562,CPT,Facility,Inpatient,,,LT,270,229.5,77.382,270,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Xr Knee Lt 3 Views,,73562,CPT,Facility,Both,,,LT,270,229.5,77.382,270,"Multiplan, Inc.","Multiplan, Inc.",253.8,94,,percent of total billed charges,,
Xr Knee Lt 3 Views,,73562,CPT,Facility,Outpatient,,,LT,270,229.5,77.382,270,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,243.27,90.1,,percent of total billed charges,,
Xr Knee Lt 3 Views,,73562,CPT,Facility,Inpatient,,,LT,270,229.5,77.382,270,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Xr Knee Lt 3 Views,,73562,CPT,Facility,Both,,,LT,270,229.5,77.382,270,"Preferred One Administrative Services, INC.",PPO,266.22,98.6,,percent of total billed charges,,
Xr Knee Lt 3 Views,,73562,CPT,Facility,Outpatient,,,LT,270,229.5,77.382,270,PrimeWest Health,Minnesota Senior Health Options (MSHO),138.915,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Xr Knee Lt 3 Views,,73562,CPT,Facility,Inpatient,,,LT,270,229.5,77.382,270,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Knee Lt 3 Views,,73562,CPT,Facility,Outpatient,,,LT,270,229.5,77.382,270,PrimeWest Health,MinnesotaCare,138.672,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Xr Knee Lt 3 Views,,73562,CPT,Facility,Inpatient,,,LT,270,229.5,77.382,270,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Xr Knee Lt 3 Views,,73562,CPT,Facility,Both,,,LT,270,229.5,77.382,270,Sanford Health Plan,Sanford Health Plan,248.4,92,,percent of total billed charges,,
Xr Knee Lt 3 Views,,73562,CPT,Facility,Outpatient,,,LT,270,229.5,77.382,270,"UCare Health, Inc.",Individual & Family Plan,152.145,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Xr Knee Lt 3 Views,,73562,CPT,Facility,Inpatient,,,LT,270,229.5,77.382,270,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Xr Knee Lt 3 Views,,73562,CPT,Facility,Outpatient,,,LT,270,229.5,77.382,270,"UCare Health, Inc.",Medical Assistance,136.269,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Knee Lt 3 Views,,73562,CPT,Facility,Inpatient,,,LT,270,229.5,77.382,270,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Xr Knee Lt 3 Views,,73562,CPT,Facility,Outpatient,,,LT,270,229.5,77.382,270,"UCare Health, Inc.",Medicare Advantage,136.269,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Knee Lt 3 Views,,73562,CPT,Facility,Inpatient,,,LT,270,229.5,77.382,270,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Knee Lt 3 Views,,73562,CPT,Facility,Outpatient,,,LT,270,229.5,77.382,270,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),136.269,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Knee Lt 3 Views,,73562,CPT,Facility,Inpatient,,,LT,270,229.5,77.382,270,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Knee Lt 3 Views,,73562,CPT,Facility,Both,,,LT,270,229.5,77.382,270,UnitedHealthcare,Individual & Family,253.8,94,,percent of total billed charges,,
Xr Knee Lt 3 Views,,73562,CPT,Facility,Outpatient,,,LT,270,229.5,77.382,270,UnitedHealthcare,Medicare Advantage,132.3,49,,percent of total billed charges,,
Xr Knee Lt 3 Views,,73562,CPT,Facility,Inpatient,,,LT,270,229.5,77.382,270,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Xr Knee Lt 3 Views,,73562,CPT,Facility,Outpatient,,,LT,270,229.5,77.382,270,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,129.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
Xr Knee Lt 3 Views,,73562,CPT,Facility,Inpatient,,,LT,270,229.5,77.382,270,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Xr Knee Lt 4 Views Or More,,73564,CPT,Facility,Both,,,LT,306,260.1,87.6996,306,Aetna,Commercial,281.52,92,,percent of total billed charges,,
Xr Knee Lt 4 Views Or More,,73564,CPT,Facility,Outpatient,,,LT,306,260.1,87.6996,306,Aetna,Medicare Advantage,149.94,49,,percent of total billed charges,,
Xr Knee Lt 4 Views Or More,,73564,CPT,Facility,Inpatient,,,LT,306,260.1,87.6996,306,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Xr Knee Lt 4 Views Or More,,73564,CPT,Facility,Both,,,LT,306,260.1,87.6996,306,Aetna,PPO,284.58,93,,percent of total billed charges,,
Xr Knee Lt 4 Views Or More,,73564,CPT,Facility,Both,,,LT,306,260.1,87.6996,306,America's PPO,America's PPO,293.8518,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Xr Knee Lt 4 Views Or More,,73564,CPT,Facility,Both,,,LT,306,260.1,87.6996,306,BlueCross BlueShield Minnesota, Federal Employee Program,301.104,98.4,,percent of total billed charges,,
Xr Knee Lt 4 Views Or More,,73564,CPT,Facility,Both,,,LT,306,260.1,87.6996,306,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,306,100,,percent of total billed charges,,
Xr Knee Lt 4 Views Or More,,73564,CPT,Facility,Both,,,LT,306,260.1,87.6996,306,BlueCross BlueShield Minnesota,High Value Network Plan,275.4,90,,percent of total billed charges,,
Xr Knee Lt 4 Views Or More,,73564,CPT,Facility,Outpatient,,,LT,306,260.1,87.6996,306,BlueCross BlueShield Minnesota,Medicare Advantage,149.94,49,,percent of total billed charges,,
Xr Knee Lt 4 Views Or More,,73564,CPT,Facility,Inpatient,,,LT,306,260.1,87.6996,306,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Xr Knee Lt 4 Views Or More,,73564,CPT,Facility,Both,,,LT,306,260.1,87.6996,306,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,271.0242,88.57,,percent of total billed charges,,
Xr Knee Lt 4 Views Or More,,73564,CPT,Facility,Both,,,LT,306,260.1,87.6996,306,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,87.6996,28.66,,percent of total billed charges,,
Xr Knee Lt 4 Views Or More,,73564,CPT,Facility,Outpatient,,,LT,306,260.1,87.6996,306,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),149.94,49,,percent of total billed charges,,
Xr Knee Lt 4 Views Or More,,73564,CPT,Facility,Inpatient,,,LT,306,260.1,87.6996,306,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Xr Knee Lt 4 Views Or More,,73564,CPT,Facility,Both,,,LT,306,260.1,87.6996,306,CorVel,Worker's Compensation,306,100,,percent of total billed charges,,
Xr Knee Lt 4 Views Or More,,73564,CPT,Facility,Both,,,LT,306,260.1,87.6996,306,First Health Group Corporation,First Health Network,296.82,97,,percent of total billed charges,,
Xr Knee Lt 4 Views Or More,,73564,CPT,Facility,Both,,,LT,306,260.1,87.6996,306,"Health Partners, Inc.",Commercial,289.476,94.6,,percent of total billed charges,,
Xr Knee Lt 4 Views Or More,,73564,CPT,Facility,Outpatient,,,LT,306,260.1,87.6996,306,"Health Partners, Inc.",Medicare Advantage,149.94,49,,percent of total billed charges,,
Xr Knee Lt 4 Views Or More,,73564,CPT,Facility,Inpatient,,,LT,306,260.1,87.6996,306,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Knee Lt 4 Views Or More,,73564,CPT,Facility,Both,,,LT,306,260.1,87.6996,306,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),183.6,60,,percent of total billed charges,,
Xr Knee Lt 4 Views Or More,,73564,CPT,Facility,Both,,,LT,306,260.1,87.6996,306,"Health Partners, Inc.",State of Minnesota Advantage Program,249.39,81.5,,percent of total billed charges,,
Xr Knee Lt 4 Views Or More,,73564,CPT,Facility,Both,,,LT,306,260.1,87.6996,306,"Health Partners, Inc.",State Public Programs,153,50,,percent of total billed charges,,
Xr Knee Lt 4 Views Or More,,73564,CPT,Facility,Both,,,LT,306,260.1,87.6996,306,Humana Insurance Company,Commercial PPO,290.7,95,,percent of total billed charges,,
Xr Knee Lt 4 Views Or More,,73564,CPT,Facility,Outpatient,,,LT,306,260.1,87.6996,306,Humana Insurance Company,Medicare PPO,149.94,49,,percent of total billed charges,,
Xr Knee Lt 4 Views Or More,,73564,CPT,Facility,Inpatient,,,LT,306,260.1,87.6996,306,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Xr Knee Lt 4 Views Or More,,73564,CPT,Facility,Both,,,LT,306,260.1,87.6996,306,Medica,Individual & Family,303.246,99.1,,percent of total billed charges,,
Xr Knee Lt 4 Views Or More,,73564,CPT,Facility,Outpatient,,,LT,306,260.1,87.6996,306,Medica,Medica Advantage Solution,152.388,49.8,,percent of total billed charges,,
Xr Knee Lt 4 Views Or More,,73564,CPT,Facility,Inpatient,,,LT,306,260.1,87.6996,306,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Xr Knee Lt 4 Views Or More,,73564,CPT,Facility,Outpatient,,,LT,306,260.1,87.6996,306,Medica,Medical Assistance,136.476,44.6,,percent of total billed charges,,
Xr Knee Lt 4 Views Or More,,73564,CPT,Facility,Inpatient,,,LT,306,260.1,87.6996,306,Medica,Medical Assistance,,,,,Included in per diem rate,
Xr Knee Lt 4 Views Or More,,73564,CPT,Facility,Outpatient,,,LT,306,260.1,87.6996,306,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,152.388,49.8,,percent of total billed charges,,
Xr Knee Lt 4 Views Or More,,73564,CPT,Facility,Inpatient,,,LT,306,260.1,87.6996,306,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Xr Knee Lt 4 Views Or More,,73564,CPT,Facility,Both,,,LT,306,260.1,87.6996,306,"Multiplan, Inc.","Multiplan, Inc.",287.64,94,,percent of total billed charges,,
Xr Knee Lt 4 Views Or More,,73564,CPT,Facility,Outpatient,,,LT,306,260.1,87.6996,306,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,275.706,90.1,,percent of total billed charges,,
Xr Knee Lt 4 Views Or More,,73564,CPT,Facility,Inpatient,,,LT,306,260.1,87.6996,306,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Xr Knee Lt 4 Views Or More,,73564,CPT,Facility,Both,,,LT,306,260.1,87.6996,306,"Preferred One Administrative Services, INC.",PPO,301.716,98.6,,percent of total billed charges,,
Xr Knee Lt 4 Views Or More,,73564,CPT,Facility,Outpatient,,,LT,306,260.1,87.6996,306,PrimeWest Health,Minnesota Senior Health Options (MSHO),157.437,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Xr Knee Lt 4 Views Or More,,73564,CPT,Facility,Inpatient,,,LT,306,260.1,87.6996,306,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Knee Lt 4 Views Or More,,73564,CPT,Facility,Outpatient,,,LT,306,260.1,87.6996,306,PrimeWest Health,MinnesotaCare,157.1616,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Xr Knee Lt 4 Views Or More,,73564,CPT,Facility,Inpatient,,,LT,306,260.1,87.6996,306,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Xr Knee Lt 4 Views Or More,,73564,CPT,Facility,Both,,,LT,306,260.1,87.6996,306,Sanford Health Plan,Sanford Health Plan,281.52,92,,percent of total billed charges,,
Xr Knee Lt 4 Views Or More,,73564,CPT,Facility,Outpatient,,,LT,306,260.1,87.6996,306,"UCare Health, Inc.",Individual & Family Plan,172.431,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Xr Knee Lt 4 Views Or More,,73564,CPT,Facility,Inpatient,,,LT,306,260.1,87.6996,306,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Xr Knee Lt 4 Views Or More,,73564,CPT,Facility,Outpatient,,,LT,306,260.1,87.6996,306,"UCare Health, Inc.",Medical Assistance,154.4382,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Knee Lt 4 Views Or More,,73564,CPT,Facility,Inpatient,,,LT,306,260.1,87.6996,306,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Xr Knee Lt 4 Views Or More,,73564,CPT,Facility,Outpatient,,,LT,306,260.1,87.6996,306,"UCare Health, Inc.",Medicare Advantage,154.4382,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Knee Lt 4 Views Or More,,73564,CPT,Facility,Inpatient,,,LT,306,260.1,87.6996,306,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Knee Lt 4 Views Or More,,73564,CPT,Facility,Outpatient,,,LT,306,260.1,87.6996,306,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),154.4382,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Knee Lt 4 Views Or More,,73564,CPT,Facility,Inpatient,,,LT,306,260.1,87.6996,306,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Knee Lt 4 Views Or More,,73564,CPT,Facility,Both,,,LT,306,260.1,87.6996,306,UnitedHealthcare,Individual & Family,287.64,94,,percent of total billed charges,,
Xr Knee Lt 4 Views Or More,,73564,CPT,Facility,Outpatient,,,LT,306,260.1,87.6996,306,UnitedHealthcare,Medicare Advantage,149.94,49,,percent of total billed charges,,
Xr Knee Lt 4 Views Or More,,73564,CPT,Facility,Inpatient,,,LT,306,260.1,87.6996,306,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Xr Knee Lt 4 Views Or More,,73564,CPT,Facility,Outpatient,,,LT,306,260.1,87.6996,306,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,146.88,48,,percent of total billed charges,,100% of DHS outpatient percentage
Xr Knee Lt 4 Views Or More,,73564,CPT,Facility,Inpatient,,,LT,306,260.1,87.6996,306,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Xr Tibia Fibula Lt,,73590,CPT,Facility,Both,,,LT,270,229.5,77.382,270,Aetna,Commercial,248.4,92,,percent of total billed charges,,
Xr Tibia Fibula Lt,,73590,CPT,Facility,Outpatient,,,LT,270,229.5,77.382,270,Aetna,Medicare Advantage,132.3,49,,percent of total billed charges,,
Xr Tibia Fibula Lt,,73590,CPT,Facility,Inpatient,,,LT,270,229.5,77.382,270,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Xr Tibia Fibula Lt,,73590,CPT,Facility,Both,,,LT,270,229.5,77.382,270,Aetna,PPO,251.1,93,,percent of total billed charges,,
Xr Tibia Fibula Lt,,73590,CPT,Facility,Both,,,LT,270,229.5,77.382,270,America's PPO,America's PPO,259.281,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Xr Tibia Fibula Lt,,73590,CPT,Facility,Both,,,LT,270,229.5,77.382,270,BlueCross BlueShield Minnesota, Federal Employee Program,265.68,98.4,,percent of total billed charges,,
Xr Tibia Fibula Lt,,73590,CPT,Facility,Both,,,LT,270,229.5,77.382,270,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,270,100,,percent of total billed charges,,
Xr Tibia Fibula Lt,,73590,CPT,Facility,Both,,,LT,270,229.5,77.382,270,BlueCross BlueShield Minnesota,High Value Network Plan,243,90,,percent of total billed charges,,
Xr Tibia Fibula Lt,,73590,CPT,Facility,Outpatient,,,LT,270,229.5,77.382,270,BlueCross BlueShield Minnesota,Medicare Advantage,132.3,49,,percent of total billed charges,,
Xr Tibia Fibula Lt,,73590,CPT,Facility,Inpatient,,,LT,270,229.5,77.382,270,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Xr Tibia Fibula Lt,,73590,CPT,Facility,Both,,,LT,270,229.5,77.382,270,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,239.139,88.57,,percent of total billed charges,,
Xr Tibia Fibula Lt,,73590,CPT,Facility,Both,,,LT,270,229.5,77.382,270,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,77.382,28.66,,percent of total billed charges,,
Xr Tibia Fibula Lt,,73590,CPT,Facility,Outpatient,,,LT,270,229.5,77.382,270,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),132.3,49,,percent of total billed charges,,
Xr Tibia Fibula Lt,,73590,CPT,Facility,Inpatient,,,LT,270,229.5,77.382,270,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Xr Tibia Fibula Lt,,73590,CPT,Facility,Both,,,LT,270,229.5,77.382,270,CorVel,Worker's Compensation,270,100,,percent of total billed charges,,
Xr Tibia Fibula Lt,,73590,CPT,Facility,Both,,,LT,270,229.5,77.382,270,First Health Group Corporation,First Health Network,261.9,97,,percent of total billed charges,,
Xr Tibia Fibula Lt,,73590,CPT,Facility,Both,,,LT,270,229.5,77.382,270,"Health Partners, Inc.",Commercial,255.42,94.6,,percent of total billed charges,,
Xr Tibia Fibula Lt,,73590,CPT,Facility,Outpatient,,,LT,270,229.5,77.382,270,"Health Partners, Inc.",Medicare Advantage,132.3,49,,percent of total billed charges,,
Xr Tibia Fibula Lt,,73590,CPT,Facility,Inpatient,,,LT,270,229.5,77.382,270,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Tibia Fibula Lt,,73590,CPT,Facility,Both,,,LT,270,229.5,77.382,270,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),162,60,,percent of total billed charges,,
Xr Tibia Fibula Lt,,73590,CPT,Facility,Both,,,LT,270,229.5,77.382,270,"Health Partners, Inc.",State of Minnesota Advantage Program,220.05,81.5,,percent of total billed charges,,
Xr Tibia Fibula Lt,,73590,CPT,Facility,Both,,,LT,270,229.5,77.382,270,"Health Partners, Inc.",State Public Programs,135,50,,percent of total billed charges,,
Xr Tibia Fibula Lt,,73590,CPT,Facility,Both,,,LT,270,229.5,77.382,270,Humana Insurance Company,Commercial PPO,256.5,95,,percent of total billed charges,,
Xr Tibia Fibula Lt,,73590,CPT,Facility,Outpatient,,,LT,270,229.5,77.382,270,Humana Insurance Company,Medicare PPO,132.3,49,,percent of total billed charges,,
Xr Tibia Fibula Lt,,73590,CPT,Facility,Inpatient,,,LT,270,229.5,77.382,270,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Xr Tibia Fibula Lt,,73590,CPT,Facility,Both,,,LT,270,229.5,77.382,270,Medica,Individual & Family,267.57,99.1,,percent of total billed charges,,
Xr Tibia Fibula Lt,,73590,CPT,Facility,Outpatient,,,LT,270,229.5,77.382,270,Medica,Medica Advantage Solution,134.46,49.8,,percent of total billed charges,,
Xr Tibia Fibula Lt,,73590,CPT,Facility,Inpatient,,,LT,270,229.5,77.382,270,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Xr Tibia Fibula Lt,,73590,CPT,Facility,Outpatient,,,LT,270,229.5,77.382,270,Medica,Medical Assistance,120.42,44.6,,percent of total billed charges,,
Xr Tibia Fibula Lt,,73590,CPT,Facility,Inpatient,,,LT,270,229.5,77.382,270,Medica,Medical Assistance,,,,,Included in per diem rate,
Xr Tibia Fibula Lt,,73590,CPT,Facility,Outpatient,,,LT,270,229.5,77.382,270,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,134.46,49.8,,percent of total billed charges,,
Xr Tibia Fibula Lt,,73590,CPT,Facility,Inpatient,,,LT,270,229.5,77.382,270,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Xr Tibia Fibula Lt,,73590,CPT,Facility,Both,,,LT,270,229.5,77.382,270,"Multiplan, Inc.","Multiplan, Inc.",253.8,94,,percent of total billed charges,,
Xr Tibia Fibula Lt,,73590,CPT,Facility,Outpatient,,,LT,270,229.5,77.382,270,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,243.27,90.1,,percent of total billed charges,,
Xr Tibia Fibula Lt,,73590,CPT,Facility,Inpatient,,,LT,270,229.5,77.382,270,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Xr Tibia Fibula Lt,,73590,CPT,Facility,Both,,,LT,270,229.5,77.382,270,"Preferred One Administrative Services, INC.",PPO,266.22,98.6,,percent of total billed charges,,
Xr Tibia Fibula Lt,,73590,CPT,Facility,Outpatient,,,LT,270,229.5,77.382,270,PrimeWest Health,Minnesota Senior Health Options (MSHO),138.915,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Xr Tibia Fibula Lt,,73590,CPT,Facility,Inpatient,,,LT,270,229.5,77.382,270,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Tibia Fibula Lt,,73590,CPT,Facility,Outpatient,,,LT,270,229.5,77.382,270,PrimeWest Health,MinnesotaCare,138.672,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Xr Tibia Fibula Lt,,73590,CPT,Facility,Inpatient,,,LT,270,229.5,77.382,270,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Xr Tibia Fibula Lt,,73590,CPT,Facility,Both,,,LT,270,229.5,77.382,270,Sanford Health Plan,Sanford Health Plan,248.4,92,,percent of total billed charges,,
Xr Tibia Fibula Lt,,73590,CPT,Facility,Outpatient,,,LT,270,229.5,77.382,270,"UCare Health, Inc.",Individual & Family Plan,152.145,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Xr Tibia Fibula Lt,,73590,CPT,Facility,Inpatient,,,LT,270,229.5,77.382,270,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Xr Tibia Fibula Lt,,73590,CPT,Facility,Outpatient,,,LT,270,229.5,77.382,270,"UCare Health, Inc.",Medical Assistance,136.269,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Tibia Fibula Lt,,73590,CPT,Facility,Inpatient,,,LT,270,229.5,77.382,270,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Xr Tibia Fibula Lt,,73590,CPT,Facility,Outpatient,,,LT,270,229.5,77.382,270,"UCare Health, Inc.",Medicare Advantage,136.269,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Tibia Fibula Lt,,73590,CPT,Facility,Inpatient,,,LT,270,229.5,77.382,270,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Tibia Fibula Lt,,73590,CPT,Facility,Outpatient,,,LT,270,229.5,77.382,270,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),136.269,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Tibia Fibula Lt,,73590,CPT,Facility,Inpatient,,,LT,270,229.5,77.382,270,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Tibia Fibula Lt,,73590,CPT,Facility,Both,,,LT,270,229.5,77.382,270,UnitedHealthcare,Individual & Family,253.8,94,,percent of total billed charges,,
Xr Tibia Fibula Lt,,73590,CPT,Facility,Outpatient,,,LT,270,229.5,77.382,270,UnitedHealthcare,Medicare Advantage,132.3,49,,percent of total billed charges,,
Xr Tibia Fibula Lt,,73590,CPT,Facility,Inpatient,,,LT,270,229.5,77.382,270,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Xr Tibia Fibula Lt,,73590,CPT,Facility,Outpatient,,,LT,270,229.5,77.382,270,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,129.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
Xr Tibia Fibula Lt,,73590,CPT,Facility,Inpatient,,,LT,270,229.5,77.382,270,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Xr Lower Ext Lt Infant Min 2 Views,,73592,CPT,Facility,Both,,,LT,204,173.4,58.4664,204,Aetna,Commercial,187.68,92,,percent of total billed charges,,
Xr Lower Ext Lt Infant Min 2 Views,,73592,CPT,Facility,Outpatient,,,LT,204,173.4,58.4664,204,Aetna,Medicare Advantage,99.96,49,,percent of total billed charges,,
Xr Lower Ext Lt Infant Min 2 Views,,73592,CPT,Facility,Inpatient,,,LT,204,173.4,58.4664,204,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Xr Lower Ext Lt Infant Min 2 Views,,73592,CPT,Facility,Both,,,LT,204,173.4,58.4664,204,Aetna,PPO,189.72,93,,percent of total billed charges,,
Xr Lower Ext Lt Infant Min 2 Views,,73592,CPT,Facility,Both,,,LT,204,173.4,58.4664,204,America's PPO,America's PPO,195.9012,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Xr Lower Ext Lt Infant Min 2 Views,,73592,CPT,Facility,Both,,,LT,204,173.4,58.4664,204,BlueCross BlueShield Minnesota, Federal Employee Program,200.736,98.4,,percent of total billed charges,,
Xr Lower Ext Lt Infant Min 2 Views,,73592,CPT,Facility,Both,,,LT,204,173.4,58.4664,204,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,204,100,,percent of total billed charges,,
Xr Lower Ext Lt Infant Min 2 Views,,73592,CPT,Facility,Both,,,LT,204,173.4,58.4664,204,BlueCross BlueShield Minnesota,High Value Network Plan,183.6,90,,percent of total billed charges,,
Xr Lower Ext Lt Infant Min 2 Views,,73592,CPT,Facility,Outpatient,,,LT,204,173.4,58.4664,204,BlueCross BlueShield Minnesota,Medicare Advantage,99.96,49,,percent of total billed charges,,
Xr Lower Ext Lt Infant Min 2 Views,,73592,CPT,Facility,Inpatient,,,LT,204,173.4,58.4664,204,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Xr Lower Ext Lt Infant Min 2 Views,,73592,CPT,Facility,Both,,,LT,204,173.4,58.4664,204,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,180.6828,88.57,,percent of total billed charges,,
Xr Lower Ext Lt Infant Min 2 Views,,73592,CPT,Facility,Both,,,LT,204,173.4,58.4664,204,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,58.4664,28.66,,percent of total billed charges,,
Xr Lower Ext Lt Infant Min 2 Views,,73592,CPT,Facility,Outpatient,,,LT,204,173.4,58.4664,204,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),99.96,49,,percent of total billed charges,,
Xr Lower Ext Lt Infant Min 2 Views,,73592,CPT,Facility,Inpatient,,,LT,204,173.4,58.4664,204,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Xr Lower Ext Lt Infant Min 2 Views,,73592,CPT,Facility,Both,,,LT,204,173.4,58.4664,204,CorVel,Worker's Compensation,204,100,,percent of total billed charges,,
Xr Lower Ext Lt Infant Min 2 Views,,73592,CPT,Facility,Both,,,LT,204,173.4,58.4664,204,First Health Group Corporation,First Health Network,197.88,97,,percent of total billed charges,,
Xr Lower Ext Lt Infant Min 2 Views,,73592,CPT,Facility,Both,,,LT,204,173.4,58.4664,204,"Health Partners, Inc.",Commercial,192.984,94.6,,percent of total billed charges,,
Xr Lower Ext Lt Infant Min 2 Views,,73592,CPT,Facility,Outpatient,,,LT,204,173.4,58.4664,204,"Health Partners, Inc.",Medicare Advantage,99.96,49,,percent of total billed charges,,
Xr Lower Ext Lt Infant Min 2 Views,,73592,CPT,Facility,Inpatient,,,LT,204,173.4,58.4664,204,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Lower Ext Lt Infant Min 2 Views,,73592,CPT,Facility,Both,,,LT,204,173.4,58.4664,204,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),122.4,60,,percent of total billed charges,,
Xr Lower Ext Lt Infant Min 2 Views,,73592,CPT,Facility,Both,,,LT,204,173.4,58.4664,204,"Health Partners, Inc.",State of Minnesota Advantage Program,166.26,81.5,,percent of total billed charges,,
Xr Lower Ext Lt Infant Min 2 Views,,73592,CPT,Facility,Both,,,LT,204,173.4,58.4664,204,"Health Partners, Inc.",State Public Programs,102,50,,percent of total billed charges,,
Xr Lower Ext Lt Infant Min 2 Views,,73592,CPT,Facility,Both,,,LT,204,173.4,58.4664,204,Humana Insurance Company,Commercial PPO,193.8,95,,percent of total billed charges,,
Xr Lower Ext Lt Infant Min 2 Views,,73592,CPT,Facility,Outpatient,,,LT,204,173.4,58.4664,204,Humana Insurance Company,Medicare PPO,99.96,49,,percent of total billed charges,,
Xr Lower Ext Lt Infant Min 2 Views,,73592,CPT,Facility,Inpatient,,,LT,204,173.4,58.4664,204,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Xr Lower Ext Lt Infant Min 2 Views,,73592,CPT,Facility,Both,,,LT,204,173.4,58.4664,204,Medica,Individual & Family,202.164,99.1,,percent of total billed charges,,
Xr Lower Ext Lt Infant Min 2 Views,,73592,CPT,Facility,Outpatient,,,LT,204,173.4,58.4664,204,Medica,Medica Advantage Solution,101.592,49.8,,percent of total billed charges,,
Xr Lower Ext Lt Infant Min 2 Views,,73592,CPT,Facility,Inpatient,,,LT,204,173.4,58.4664,204,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Xr Lower Ext Lt Infant Min 2 Views,,73592,CPT,Facility,Outpatient,,,LT,204,173.4,58.4664,204,Medica,Medical Assistance,90.984,44.6,,percent of total billed charges,,
Xr Lower Ext Lt Infant Min 2 Views,,73592,CPT,Facility,Inpatient,,,LT,204,173.4,58.4664,204,Medica,Medical Assistance,,,,,Included in per diem rate,
Xr Lower Ext Lt Infant Min 2 Views,,73592,CPT,Facility,Outpatient,,,LT,204,173.4,58.4664,204,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,101.592,49.8,,percent of total billed charges,,
Xr Lower Ext Lt Infant Min 2 Views,,73592,CPT,Facility,Inpatient,,,LT,204,173.4,58.4664,204,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Xr Lower Ext Lt Infant Min 2 Views,,73592,CPT,Facility,Both,,,LT,204,173.4,58.4664,204,"Multiplan, Inc.","Multiplan, Inc.",191.76,94,,percent of total billed charges,,
Xr Lower Ext Lt Infant Min 2 Views,,73592,CPT,Facility,Outpatient,,,LT,204,173.4,58.4664,204,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,183.804,90.1,,percent of total billed charges,,
Xr Lower Ext Lt Infant Min 2 Views,,73592,CPT,Facility,Inpatient,,,LT,204,173.4,58.4664,204,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Xr Lower Ext Lt Infant Min 2 Views,,73592,CPT,Facility,Both,,,LT,204,173.4,58.4664,204,"Preferred One Administrative Services, INC.",PPO,201.144,98.6,,percent of total billed charges,,
Xr Lower Ext Lt Infant Min 2 Views,,73592,CPT,Facility,Outpatient,,,LT,204,173.4,58.4664,204,PrimeWest Health,Minnesota Senior Health Options (MSHO),104.958,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Xr Lower Ext Lt Infant Min 2 Views,,73592,CPT,Facility,Inpatient,,,LT,204,173.4,58.4664,204,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Lower Ext Lt Infant Min 2 Views,,73592,CPT,Facility,Outpatient,,,LT,204,173.4,58.4664,204,PrimeWest Health,MinnesotaCare,104.7744,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Xr Lower Ext Lt Infant Min 2 Views,,73592,CPT,Facility,Inpatient,,,LT,204,173.4,58.4664,204,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Xr Lower Ext Lt Infant Min 2 Views,,73592,CPT,Facility,Both,,,LT,204,173.4,58.4664,204,Sanford Health Plan,Sanford Health Plan,187.68,92,,percent of total billed charges,,
Xr Lower Ext Lt Infant Min 2 Views,,73592,CPT,Facility,Outpatient,,,LT,204,173.4,58.4664,204,"UCare Health, Inc.",Individual & Family Plan,114.954,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Xr Lower Ext Lt Infant Min 2 Views,,73592,CPT,Facility,Inpatient,,,LT,204,173.4,58.4664,204,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Xr Lower Ext Lt Infant Min 2 Views,,73592,CPT,Facility,Outpatient,,,LT,204,173.4,58.4664,204,"UCare Health, Inc.",Medical Assistance,102.9588,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Lower Ext Lt Infant Min 2 Views,,73592,CPT,Facility,Inpatient,,,LT,204,173.4,58.4664,204,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Xr Lower Ext Lt Infant Min 2 Views,,73592,CPT,Facility,Outpatient,,,LT,204,173.4,58.4664,204,"UCare Health, Inc.",Medicare Advantage,102.9588,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Lower Ext Lt Infant Min 2 Views,,73592,CPT,Facility,Inpatient,,,LT,204,173.4,58.4664,204,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Lower Ext Lt Infant Min 2 Views,,73592,CPT,Facility,Outpatient,,,LT,204,173.4,58.4664,204,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),102.9588,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Lower Ext Lt Infant Min 2 Views,,73592,CPT,Facility,Inpatient,,,LT,204,173.4,58.4664,204,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Lower Ext Lt Infant Min 2 Views,,73592,CPT,Facility,Both,,,LT,204,173.4,58.4664,204,UnitedHealthcare,Individual & Family,191.76,94,,percent of total billed charges,,
Xr Lower Ext Lt Infant Min 2 Views,,73592,CPT,Facility,Outpatient,,,LT,204,173.4,58.4664,204,UnitedHealthcare,Medicare Advantage,99.96,49,,percent of total billed charges,,
Xr Lower Ext Lt Infant Min 2 Views,,73592,CPT,Facility,Inpatient,,,LT,204,173.4,58.4664,204,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Xr Lower Ext Lt Infant Min 2 Views,,73592,CPT,Facility,Outpatient,,,LT,204,173.4,58.4664,204,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,97.92,48,,percent of total billed charges,,100% of DHS outpatient percentage
Xr Lower Ext Lt Infant Min 2 Views,,73592,CPT,Facility,Inpatient,,,LT,204,173.4,58.4664,204,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Xr Ankle Lt 2 Views,,73600,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,Aetna,Commercial,237.36,92,,percent of total billed charges,,
Xr Ankle Lt 2 Views,,73600,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,Aetna,Medicare Advantage,126.42,49,,percent of total billed charges,,
Xr Ankle Lt 2 Views,,73600,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Xr Ankle Lt 2 Views,,73600,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,Aetna,PPO,239.94,93,,percent of total billed charges,,
Xr Ankle Lt 2 Views,,73600,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,America's PPO,America's PPO,247.7574,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Xr Ankle Lt 2 Views,,73600,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota, Federal Employee Program,253.872,98.4,,percent of total billed charges,,
Xr Ankle Lt 2 Views,,73600,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,258,100,,percent of total billed charges,,
Xr Ankle Lt 2 Views,,73600,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,High Value Network Plan,232.2,90,,percent of total billed charges,,
Xr Ankle Lt 2 Views,,73600,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,Medicare Advantage,126.42,49,,percent of total billed charges,,
Xr Ankle Lt 2 Views,,73600,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Xr Ankle Lt 2 Views,,73600,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,228.5106,88.57,,percent of total billed charges,,
Xr Ankle Lt 2 Views,,73600,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,73.9428,28.66,,percent of total billed charges,,
Xr Ankle Lt 2 Views,,73600,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),126.42,49,,percent of total billed charges,,
Xr Ankle Lt 2 Views,,73600,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Xr Ankle Lt 2 Views,,73600,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,CorVel,Worker's Compensation,258,100,,percent of total billed charges,,
Xr Ankle Lt 2 Views,,73600,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,First Health Group Corporation,First Health Network,250.26,97,,percent of total billed charges,,
Xr Ankle Lt 2 Views,,73600,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,"Health Partners, Inc.",Commercial,244.068,94.6,,percent of total billed charges,,
Xr Ankle Lt 2 Views,,73600,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,"Health Partners, Inc.",Medicare Advantage,126.42,49,,percent of total billed charges,,
Xr Ankle Lt 2 Views,,73600,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Ankle Lt 2 Views,,73600,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),154.8,60,,percent of total billed charges,,
Xr Ankle Lt 2 Views,,73600,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,"Health Partners, Inc.",State of Minnesota Advantage Program,210.27,81.5,,percent of total billed charges,,
Xr Ankle Lt 2 Views,,73600,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,"Health Partners, Inc.",State Public Programs,129,50,,percent of total billed charges,,
Xr Ankle Lt 2 Views,,73600,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,Humana Insurance Company,Commercial PPO,245.1,95,,percent of total billed charges,,
Xr Ankle Lt 2 Views,,73600,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,Humana Insurance Company,Medicare PPO,126.42,49,,percent of total billed charges,,
Xr Ankle Lt 2 Views,,73600,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Xr Ankle Lt 2 Views,,73600,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,Medica,Individual & Family,255.678,99.1,,percent of total billed charges,,
Xr Ankle Lt 2 Views,,73600,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,Medica,Medica Advantage Solution,128.484,49.8,,percent of total billed charges,,
Xr Ankle Lt 2 Views,,73600,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Xr Ankle Lt 2 Views,,73600,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,Medica,Medical Assistance,115.068,44.6,,percent of total billed charges,,
Xr Ankle Lt 2 Views,,73600,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,Medica,Medical Assistance,,,,,Included in per diem rate,
Xr Ankle Lt 2 Views,,73600,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,128.484,49.8,,percent of total billed charges,,
Xr Ankle Lt 2 Views,,73600,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Xr Ankle Lt 2 Views,,73600,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,"Multiplan, Inc.","Multiplan, Inc.",242.52,94,,percent of total billed charges,,
Xr Ankle Lt 2 Views,,73600,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,232.458,90.1,,percent of total billed charges,,
Xr Ankle Lt 2 Views,,73600,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Xr Ankle Lt 2 Views,,73600,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,"Preferred One Administrative Services, INC.",PPO,254.388,98.6,,percent of total billed charges,,
Xr Ankle Lt 2 Views,,73600,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,PrimeWest Health,Minnesota Senior Health Options (MSHO),132.741,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Xr Ankle Lt 2 Views,,73600,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Ankle Lt 2 Views,,73600,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,PrimeWest Health,MinnesotaCare,132.5088,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Xr Ankle Lt 2 Views,,73600,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Xr Ankle Lt 2 Views,,73600,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,Sanford Health Plan,Sanford Health Plan,237.36,92,,percent of total billed charges,,
Xr Ankle Lt 2 Views,,73600,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,"UCare Health, Inc.",Individual & Family Plan,145.383,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Xr Ankle Lt 2 Views,,73600,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Xr Ankle Lt 2 Views,,73600,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,"UCare Health, Inc.",Medical Assistance,130.2126,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Ankle Lt 2 Views,,73600,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Xr Ankle Lt 2 Views,,73600,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,"UCare Health, Inc.",Medicare Advantage,130.2126,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Ankle Lt 2 Views,,73600,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Ankle Lt 2 Views,,73600,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),130.2126,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Ankle Lt 2 Views,,73600,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Ankle Lt 2 Views,,73600,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,UnitedHealthcare,Individual & Family,242.52,94,,percent of total billed charges,,
Xr Ankle Lt 2 Views,,73600,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,UnitedHealthcare,Medicare Advantage,126.42,49,,percent of total billed charges,,
Xr Ankle Lt 2 Views,,73600,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Xr Ankle Lt 2 Views,,73600,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,123.84,48,,percent of total billed charges,,100% of DHS outpatient percentage
Xr Ankle Lt 2 Views,,73600,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Xr Ankle Routine Lt 3 Views,,73610,CPT,Facility,Both,,,LT,280,238,80.248,280,Aetna,Commercial,257.6,92,,percent of total billed charges,,
Xr Ankle Routine Lt 3 Views,,73610,CPT,Facility,Outpatient,,,LT,280,238,80.248,280,Aetna,Medicare Advantage,137.2,49,,percent of total billed charges,,
Xr Ankle Routine Lt 3 Views,,73610,CPT,Facility,Inpatient,,,LT,280,238,80.248,280,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Xr Ankle Routine Lt 3 Views,,73610,CPT,Facility,Both,,,LT,280,238,80.248,280,Aetna,PPO,260.4,93,,percent of total billed charges,,
Xr Ankle Routine Lt 3 Views,,73610,CPT,Facility,Both,,,LT,280,238,80.248,280,America's PPO,America's PPO,268.884,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Xr Ankle Routine Lt 3 Views,,73610,CPT,Facility,Both,,,LT,280,238,80.248,280,BlueCross BlueShield Minnesota, Federal Employee Program,275.52,98.4,,percent of total billed charges,,
Xr Ankle Routine Lt 3 Views,,73610,CPT,Facility,Both,,,LT,280,238,80.248,280,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,280,100,,percent of total billed charges,,
Xr Ankle Routine Lt 3 Views,,73610,CPT,Facility,Both,,,LT,280,238,80.248,280,BlueCross BlueShield Minnesota,High Value Network Plan,252,90,,percent of total billed charges,,
Xr Ankle Routine Lt 3 Views,,73610,CPT,Facility,Outpatient,,,LT,280,238,80.248,280,BlueCross BlueShield Minnesota,Medicare Advantage,137.2,49,,percent of total billed charges,,
Xr Ankle Routine Lt 3 Views,,73610,CPT,Facility,Inpatient,,,LT,280,238,80.248,280,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Xr Ankle Routine Lt 3 Views,,73610,CPT,Facility,Both,,,LT,280,238,80.248,280,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,247.996,88.57,,percent of total billed charges,,
Xr Ankle Routine Lt 3 Views,,73610,CPT,Facility,Both,,,LT,280,238,80.248,280,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,80.248,28.66,,percent of total billed charges,,
Xr Ankle Routine Lt 3 Views,,73610,CPT,Facility,Outpatient,,,LT,280,238,80.248,280,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),137.2,49,,percent of total billed charges,,
Xr Ankle Routine Lt 3 Views,,73610,CPT,Facility,Inpatient,,,LT,280,238,80.248,280,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Xr Ankle Routine Lt 3 Views,,73610,CPT,Facility,Both,,,LT,280,238,80.248,280,CorVel,Worker's Compensation,280,100,,percent of total billed charges,,
Xr Ankle Routine Lt 3 Views,,73610,CPT,Facility,Both,,,LT,280,238,80.248,280,First Health Group Corporation,First Health Network,271.6,97,,percent of total billed charges,,
Xr Ankle Routine Lt 3 Views,,73610,CPT,Facility,Both,,,LT,280,238,80.248,280,"Health Partners, Inc.",Commercial,264.88,94.6,,percent of total billed charges,,
Xr Ankle Routine Lt 3 Views,,73610,CPT,Facility,Outpatient,,,LT,280,238,80.248,280,"Health Partners, Inc.",Medicare Advantage,137.2,49,,percent of total billed charges,,
Xr Ankle Routine Lt 3 Views,,73610,CPT,Facility,Inpatient,,,LT,280,238,80.248,280,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Ankle Routine Lt 3 Views,,73610,CPT,Facility,Both,,,LT,280,238,80.248,280,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),168,60,,percent of total billed charges,,
Xr Ankle Routine Lt 3 Views,,73610,CPT,Facility,Both,,,LT,280,238,80.248,280,"Health Partners, Inc.",State of Minnesota Advantage Program,228.2,81.5,,percent of total billed charges,,
Xr Ankle Routine Lt 3 Views,,73610,CPT,Facility,Both,,,LT,280,238,80.248,280,"Health Partners, Inc.",State Public Programs,140,50,,percent of total billed charges,,
Xr Ankle Routine Lt 3 Views,,73610,CPT,Facility,Both,,,LT,280,238,80.248,280,Humana Insurance Company,Commercial PPO,266,95,,percent of total billed charges,,
Xr Ankle Routine Lt 3 Views,,73610,CPT,Facility,Outpatient,,,LT,280,238,80.248,280,Humana Insurance Company,Medicare PPO,137.2,49,,percent of total billed charges,,
Xr Ankle Routine Lt 3 Views,,73610,CPT,Facility,Inpatient,,,LT,280,238,80.248,280,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Xr Ankle Routine Lt 3 Views,,73610,CPT,Facility,Both,,,LT,280,238,80.248,280,Medica,Individual & Family,277.48,99.1,,percent of total billed charges,,
Xr Ankle Routine Lt 3 Views,,73610,CPT,Facility,Outpatient,,,LT,280,238,80.248,280,Medica,Medica Advantage Solution,139.44,49.8,,percent of total billed charges,,
Xr Ankle Routine Lt 3 Views,,73610,CPT,Facility,Inpatient,,,LT,280,238,80.248,280,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Xr Ankle Routine Lt 3 Views,,73610,CPT,Facility,Outpatient,,,LT,280,238,80.248,280,Medica,Medical Assistance,124.88,44.6,,percent of total billed charges,,
Xr Ankle Routine Lt 3 Views,,73610,CPT,Facility,Inpatient,,,LT,280,238,80.248,280,Medica,Medical Assistance,,,,,Included in per diem rate,
Xr Ankle Routine Lt 3 Views,,73610,CPT,Facility,Outpatient,,,LT,280,238,80.248,280,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,139.44,49.8,,percent of total billed charges,,
Xr Ankle Routine Lt 3 Views,,73610,CPT,Facility,Inpatient,,,LT,280,238,80.248,280,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Xr Ankle Routine Lt 3 Views,,73610,CPT,Facility,Both,,,LT,280,238,80.248,280,"Multiplan, Inc.","Multiplan, Inc.",263.2,94,,percent of total billed charges,,
Xr Ankle Routine Lt 3 Views,,73610,CPT,Facility,Outpatient,,,LT,280,238,80.248,280,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,252.28,90.1,,percent of total billed charges,,
Xr Ankle Routine Lt 3 Views,,73610,CPT,Facility,Inpatient,,,LT,280,238,80.248,280,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Xr Ankle Routine Lt 3 Views,,73610,CPT,Facility,Both,,,LT,280,238,80.248,280,"Preferred One Administrative Services, INC.",PPO,276.08,98.6,,percent of total billed charges,,
Xr Ankle Routine Lt 3 Views,,73610,CPT,Facility,Outpatient,,,LT,280,238,80.248,280,PrimeWest Health,Minnesota Senior Health Options (MSHO),144.06,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Xr Ankle Routine Lt 3 Views,,73610,CPT,Facility,Inpatient,,,LT,280,238,80.248,280,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Ankle Routine Lt 3 Views,,73610,CPT,Facility,Outpatient,,,LT,280,238,80.248,280,PrimeWest Health,MinnesotaCare,143.808,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Xr Ankle Routine Lt 3 Views,,73610,CPT,Facility,Inpatient,,,LT,280,238,80.248,280,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Xr Ankle Routine Lt 3 Views,,73610,CPT,Facility,Both,,,LT,280,238,80.248,280,Sanford Health Plan,Sanford Health Plan,257.6,92,,percent of total billed charges,,
Xr Ankle Routine Lt 3 Views,,73610,CPT,Facility,Outpatient,,,LT,280,238,80.248,280,"UCare Health, Inc.",Individual & Family Plan,157.78,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Xr Ankle Routine Lt 3 Views,,73610,CPT,Facility,Inpatient,,,LT,280,238,80.248,280,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Xr Ankle Routine Lt 3 Views,,73610,CPT,Facility,Outpatient,,,LT,280,238,80.248,280,"UCare Health, Inc.",Medical Assistance,141.316,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Ankle Routine Lt 3 Views,,73610,CPT,Facility,Inpatient,,,LT,280,238,80.248,280,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Xr Ankle Routine Lt 3 Views,,73610,CPT,Facility,Outpatient,,,LT,280,238,80.248,280,"UCare Health, Inc.",Medicare Advantage,141.316,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Ankle Routine Lt 3 Views,,73610,CPT,Facility,Inpatient,,,LT,280,238,80.248,280,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Ankle Routine Lt 3 Views,,73610,CPT,Facility,Outpatient,,,LT,280,238,80.248,280,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),141.316,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Ankle Routine Lt 3 Views,,73610,CPT,Facility,Inpatient,,,LT,280,238,80.248,280,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Ankle Routine Lt 3 Views,,73610,CPT,Facility,Both,,,LT,280,238,80.248,280,UnitedHealthcare,Individual & Family,263.2,94,,percent of total billed charges,,
Xr Ankle Routine Lt 3 Views,,73610,CPT,Facility,Outpatient,,,LT,280,238,80.248,280,UnitedHealthcare,Medicare Advantage,137.2,49,,percent of total billed charges,,
Xr Ankle Routine Lt 3 Views,,73610,CPT,Facility,Inpatient,,,LT,280,238,80.248,280,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Xr Ankle Routine Lt 3 Views,,73610,CPT,Facility,Outpatient,,,LT,280,238,80.248,280,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,134.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
Xr Ankle Routine Lt 3 Views,,73610,CPT,Facility,Inpatient,,,LT,280,238,80.248,280,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Xr Foot Lt 2 Views,,73620,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,Aetna,Commercial,237.36,92,,percent of total billed charges,,
Xr Foot Lt 2 Views,,73620,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,Aetna,Medicare Advantage,126.42,49,,percent of total billed charges,,
Xr Foot Lt 2 Views,,73620,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Xr Foot Lt 2 Views,,73620,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,Aetna,PPO,239.94,93,,percent of total billed charges,,
Xr Foot Lt 2 Views,,73620,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,America's PPO,America's PPO,247.7574,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Xr Foot Lt 2 Views,,73620,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota, Federal Employee Program,253.872,98.4,,percent of total billed charges,,
Xr Foot Lt 2 Views,,73620,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,258,100,,percent of total billed charges,,
Xr Foot Lt 2 Views,,73620,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,High Value Network Plan,232.2,90,,percent of total billed charges,,
Xr Foot Lt 2 Views,,73620,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,Medicare Advantage,126.42,49,,percent of total billed charges,,
Xr Foot Lt 2 Views,,73620,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Xr Foot Lt 2 Views,,73620,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,228.5106,88.57,,percent of total billed charges,,
Xr Foot Lt 2 Views,,73620,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,73.9428,28.66,,percent of total billed charges,,
Xr Foot Lt 2 Views,,73620,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),126.42,49,,percent of total billed charges,,
Xr Foot Lt 2 Views,,73620,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Xr Foot Lt 2 Views,,73620,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,CorVel,Worker's Compensation,258,100,,percent of total billed charges,,
Xr Foot Lt 2 Views,,73620,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,First Health Group Corporation,First Health Network,250.26,97,,percent of total billed charges,,
Xr Foot Lt 2 Views,,73620,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,"Health Partners, Inc.",Commercial,244.068,94.6,,percent of total billed charges,,
Xr Foot Lt 2 Views,,73620,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,"Health Partners, Inc.",Medicare Advantage,126.42,49,,percent of total billed charges,,
Xr Foot Lt 2 Views,,73620,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Foot Lt 2 Views,,73620,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),154.8,60,,percent of total billed charges,,
Xr Foot Lt 2 Views,,73620,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,"Health Partners, Inc.",State of Minnesota Advantage Program,210.27,81.5,,percent of total billed charges,,
Xr Foot Lt 2 Views,,73620,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,"Health Partners, Inc.",State Public Programs,129,50,,percent of total billed charges,,
Xr Foot Lt 2 Views,,73620,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,Humana Insurance Company,Commercial PPO,245.1,95,,percent of total billed charges,,
Xr Foot Lt 2 Views,,73620,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,Humana Insurance Company,Medicare PPO,126.42,49,,percent of total billed charges,,
Xr Foot Lt 2 Views,,73620,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Xr Foot Lt 2 Views,,73620,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,Medica,Individual & Family,255.678,99.1,,percent of total billed charges,,
Xr Foot Lt 2 Views,,73620,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,Medica,Medica Advantage Solution,128.484,49.8,,percent of total billed charges,,
Xr Foot Lt 2 Views,,73620,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Xr Foot Lt 2 Views,,73620,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,Medica,Medical Assistance,115.068,44.6,,percent of total billed charges,,
Xr Foot Lt 2 Views,,73620,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,Medica,Medical Assistance,,,,,Included in per diem rate,
Xr Foot Lt 2 Views,,73620,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,128.484,49.8,,percent of total billed charges,,
Xr Foot Lt 2 Views,,73620,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Xr Foot Lt 2 Views,,73620,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,"Multiplan, Inc.","Multiplan, Inc.",242.52,94,,percent of total billed charges,,
Xr Foot Lt 2 Views,,73620,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,232.458,90.1,,percent of total billed charges,,
Xr Foot Lt 2 Views,,73620,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Xr Foot Lt 2 Views,,73620,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,"Preferred One Administrative Services, INC.",PPO,254.388,98.6,,percent of total billed charges,,
Xr Foot Lt 2 Views,,73620,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,PrimeWest Health,Minnesota Senior Health Options (MSHO),132.741,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Xr Foot Lt 2 Views,,73620,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Foot Lt 2 Views,,73620,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,PrimeWest Health,MinnesotaCare,132.5088,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Xr Foot Lt 2 Views,,73620,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Xr Foot Lt 2 Views,,73620,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,Sanford Health Plan,Sanford Health Plan,237.36,92,,percent of total billed charges,,
Xr Foot Lt 2 Views,,73620,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,"UCare Health, Inc.",Individual & Family Plan,145.383,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Xr Foot Lt 2 Views,,73620,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Xr Foot Lt 2 Views,,73620,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,"UCare Health, Inc.",Medical Assistance,130.2126,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Foot Lt 2 Views,,73620,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Xr Foot Lt 2 Views,,73620,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,"UCare Health, Inc.",Medicare Advantage,130.2126,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Foot Lt 2 Views,,73620,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Foot Lt 2 Views,,73620,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),130.2126,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Foot Lt 2 Views,,73620,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Foot Lt 2 Views,,73620,CPT,Facility,Both,,,LT,258,219.3,73.9428,258,UnitedHealthcare,Individual & Family,242.52,94,,percent of total billed charges,,
Xr Foot Lt 2 Views,,73620,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,UnitedHealthcare,Medicare Advantage,126.42,49,,percent of total billed charges,,
Xr Foot Lt 2 Views,,73620,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Xr Foot Lt 2 Views,,73620,CPT,Facility,Outpatient,,,LT,258,219.3,73.9428,258,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,123.84,48,,percent of total billed charges,,100% of DHS outpatient percentage
Xr Foot Lt 2 Views,,73620,CPT,Facility,Inpatient,,,LT,258,219.3,73.9428,258,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Xr Foot Routine Lt 3 Views,,73630,CPT,Facility,Both,,,LT,280,238,80.248,280,Aetna,Commercial,257.6,92,,percent of total billed charges,,
Xr Foot Routine Lt 3 Views,,73630,CPT,Facility,Outpatient,,,LT,280,238,80.248,280,Aetna,Medicare Advantage,137.2,49,,percent of total billed charges,,
Xr Foot Routine Lt 3 Views,,73630,CPT,Facility,Inpatient,,,LT,280,238,80.248,280,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Xr Foot Routine Lt 3 Views,,73630,CPT,Facility,Both,,,LT,280,238,80.248,280,Aetna,PPO,260.4,93,,percent of total billed charges,,
Xr Foot Routine Lt 3 Views,,73630,CPT,Facility,Both,,,LT,280,238,80.248,280,America's PPO,America's PPO,268.884,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Xr Foot Routine Lt 3 Views,,73630,CPT,Facility,Both,,,LT,280,238,80.248,280,BlueCross BlueShield Minnesota, Federal Employee Program,275.52,98.4,,percent of total billed charges,,
Xr Foot Routine Lt 3 Views,,73630,CPT,Facility,Both,,,LT,280,238,80.248,280,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,280,100,,percent of total billed charges,,
Xr Foot Routine Lt 3 Views,,73630,CPT,Facility,Both,,,LT,280,238,80.248,280,BlueCross BlueShield Minnesota,High Value Network Plan,252,90,,percent of total billed charges,,
Xr Foot Routine Lt 3 Views,,73630,CPT,Facility,Outpatient,,,LT,280,238,80.248,280,BlueCross BlueShield Minnesota,Medicare Advantage,137.2,49,,percent of total billed charges,,
Xr Foot Routine Lt 3 Views,,73630,CPT,Facility,Inpatient,,,LT,280,238,80.248,280,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Xr Foot Routine Lt 3 Views,,73630,CPT,Facility,Both,,,LT,280,238,80.248,280,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,247.996,88.57,,percent of total billed charges,,
Xr Foot Routine Lt 3 Views,,73630,CPT,Facility,Both,,,LT,280,238,80.248,280,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,80.248,28.66,,percent of total billed charges,,
Xr Foot Routine Lt 3 Views,,73630,CPT,Facility,Outpatient,,,LT,280,238,80.248,280,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),137.2,49,,percent of total billed charges,,
Xr Foot Routine Lt 3 Views,,73630,CPT,Facility,Inpatient,,,LT,280,238,80.248,280,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Xr Foot Routine Lt 3 Views,,73630,CPT,Facility,Both,,,LT,280,238,80.248,280,CorVel,Worker's Compensation,280,100,,percent of total billed charges,,
Xr Foot Routine Lt 3 Views,,73630,CPT,Facility,Both,,,LT,280,238,80.248,280,First Health Group Corporation,First Health Network,271.6,97,,percent of total billed charges,,
Xr Foot Routine Lt 3 Views,,73630,CPT,Facility,Both,,,LT,280,238,80.248,280,"Health Partners, Inc.",Commercial,264.88,94.6,,percent of total billed charges,,
Xr Foot Routine Lt 3 Views,,73630,CPT,Facility,Outpatient,,,LT,280,238,80.248,280,"Health Partners, Inc.",Medicare Advantage,137.2,49,,percent of total billed charges,,
Xr Foot Routine Lt 3 Views,,73630,CPT,Facility,Inpatient,,,LT,280,238,80.248,280,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Foot Routine Lt 3 Views,,73630,CPT,Facility,Both,,,LT,280,238,80.248,280,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),168,60,,percent of total billed charges,,
Xr Foot Routine Lt 3 Views,,73630,CPT,Facility,Both,,,LT,280,238,80.248,280,"Health Partners, Inc.",State of Minnesota Advantage Program,228.2,81.5,,percent of total billed charges,,
Xr Foot Routine Lt 3 Views,,73630,CPT,Facility,Both,,,LT,280,238,80.248,280,"Health Partners, Inc.",State Public Programs,140,50,,percent of total billed charges,,
Xr Foot Routine Lt 3 Views,,73630,CPT,Facility,Both,,,LT,280,238,80.248,280,Humana Insurance Company,Commercial PPO,266,95,,percent of total billed charges,,
Xr Foot Routine Lt 3 Views,,73630,CPT,Facility,Outpatient,,,LT,280,238,80.248,280,Humana Insurance Company,Medicare PPO,137.2,49,,percent of total billed charges,,
Xr Foot Routine Lt 3 Views,,73630,CPT,Facility,Inpatient,,,LT,280,238,80.248,280,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Xr Foot Routine Lt 3 Views,,73630,CPT,Facility,Both,,,LT,280,238,80.248,280,Medica,Individual & Family,277.48,99.1,,percent of total billed charges,,
Xr Foot Routine Lt 3 Views,,73630,CPT,Facility,Outpatient,,,LT,280,238,80.248,280,Medica,Medica Advantage Solution,139.44,49.8,,percent of total billed charges,,
Xr Foot Routine Lt 3 Views,,73630,CPT,Facility,Inpatient,,,LT,280,238,80.248,280,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Xr Foot Routine Lt 3 Views,,73630,CPT,Facility,Outpatient,,,LT,280,238,80.248,280,Medica,Medical Assistance,124.88,44.6,,percent of total billed charges,,
Xr Foot Routine Lt 3 Views,,73630,CPT,Facility,Inpatient,,,LT,280,238,80.248,280,Medica,Medical Assistance,,,,,Included in per diem rate,
Xr Foot Routine Lt 3 Views,,73630,CPT,Facility,Outpatient,,,LT,280,238,80.248,280,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,139.44,49.8,,percent of total billed charges,,
Xr Foot Routine Lt 3 Views,,73630,CPT,Facility,Inpatient,,,LT,280,238,80.248,280,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Xr Foot Routine Lt 3 Views,,73630,CPT,Facility,Both,,,LT,280,238,80.248,280,"Multiplan, Inc.","Multiplan, Inc.",263.2,94,,percent of total billed charges,,
Xr Foot Routine Lt 3 Views,,73630,CPT,Facility,Outpatient,,,LT,280,238,80.248,280,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,252.28,90.1,,percent of total billed charges,,
Xr Foot Routine Lt 3 Views,,73630,CPT,Facility,Inpatient,,,LT,280,238,80.248,280,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Xr Foot Routine Lt 3 Views,,73630,CPT,Facility,Both,,,LT,280,238,80.248,280,"Preferred One Administrative Services, INC.",PPO,276.08,98.6,,percent of total billed charges,,
Xr Foot Routine Lt 3 Views,,73630,CPT,Facility,Outpatient,,,LT,280,238,80.248,280,PrimeWest Health,Minnesota Senior Health Options (MSHO),144.06,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Xr Foot Routine Lt 3 Views,,73630,CPT,Facility,Inpatient,,,LT,280,238,80.248,280,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Foot Routine Lt 3 Views,,73630,CPT,Facility,Outpatient,,,LT,280,238,80.248,280,PrimeWest Health,MinnesotaCare,143.808,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Xr Foot Routine Lt 3 Views,,73630,CPT,Facility,Inpatient,,,LT,280,238,80.248,280,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Xr Foot Routine Lt 3 Views,,73630,CPT,Facility,Both,,,LT,280,238,80.248,280,Sanford Health Plan,Sanford Health Plan,257.6,92,,percent of total billed charges,,
Xr Foot Routine Lt 3 Views,,73630,CPT,Facility,Outpatient,,,LT,280,238,80.248,280,"UCare Health, Inc.",Individual & Family Plan,157.78,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Xr Foot Routine Lt 3 Views,,73630,CPT,Facility,Inpatient,,,LT,280,238,80.248,280,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Xr Foot Routine Lt 3 Views,,73630,CPT,Facility,Outpatient,,,LT,280,238,80.248,280,"UCare Health, Inc.",Medical Assistance,141.316,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Foot Routine Lt 3 Views,,73630,CPT,Facility,Inpatient,,,LT,280,238,80.248,280,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Xr Foot Routine Lt 3 Views,,73630,CPT,Facility,Outpatient,,,LT,280,238,80.248,280,"UCare Health, Inc.",Medicare Advantage,141.316,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Foot Routine Lt 3 Views,,73630,CPT,Facility,Inpatient,,,LT,280,238,80.248,280,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Foot Routine Lt 3 Views,,73630,CPT,Facility,Outpatient,,,LT,280,238,80.248,280,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),141.316,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Foot Routine Lt 3 Views,,73630,CPT,Facility,Inpatient,,,LT,280,238,80.248,280,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Foot Routine Lt 3 Views,,73630,CPT,Facility,Both,,,LT,280,238,80.248,280,UnitedHealthcare,Individual & Family,263.2,94,,percent of total billed charges,,
Xr Foot Routine Lt 3 Views,,73630,CPT,Facility,Outpatient,,,LT,280,238,80.248,280,UnitedHealthcare,Medicare Advantage,137.2,49,,percent of total billed charges,,
Xr Foot Routine Lt 3 Views,,73630,CPT,Facility,Inpatient,,,LT,280,238,80.248,280,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Xr Foot Routine Lt 3 Views,,73630,CPT,Facility,Outpatient,,,LT,280,238,80.248,280,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,134.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
Xr Foot Routine Lt 3 Views,,73630,CPT,Facility,Inpatient,,,LT,280,238,80.248,280,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Xr Os Calcis Lt Heel,,73650,CPT,Facility,Both,,,LT,270,229.5,77.382,270,Aetna,Commercial,248.4,92,,percent of total billed charges,,
Xr Os Calcis Lt Heel,,73650,CPT,Facility,Outpatient,,,LT,270,229.5,77.382,270,Aetna,Medicare Advantage,132.3,49,,percent of total billed charges,,
Xr Os Calcis Lt Heel,,73650,CPT,Facility,Inpatient,,,LT,270,229.5,77.382,270,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Xr Os Calcis Lt Heel,,73650,CPT,Facility,Both,,,LT,270,229.5,77.382,270,Aetna,PPO,251.1,93,,percent of total billed charges,,
Xr Os Calcis Lt Heel,,73650,CPT,Facility,Both,,,LT,270,229.5,77.382,270,America's PPO,America's PPO,259.281,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Xr Os Calcis Lt Heel,,73650,CPT,Facility,Both,,,LT,270,229.5,77.382,270,BlueCross BlueShield Minnesota, Federal Employee Program,265.68,98.4,,percent of total billed charges,,
Xr Os Calcis Lt Heel,,73650,CPT,Facility,Both,,,LT,270,229.5,77.382,270,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,270,100,,percent of total billed charges,,
Xr Os Calcis Lt Heel,,73650,CPT,Facility,Both,,,LT,270,229.5,77.382,270,BlueCross BlueShield Minnesota,High Value Network Plan,243,90,,percent of total billed charges,,
Xr Os Calcis Lt Heel,,73650,CPT,Facility,Outpatient,,,LT,270,229.5,77.382,270,BlueCross BlueShield Minnesota,Medicare Advantage,132.3,49,,percent of total billed charges,,
Xr Os Calcis Lt Heel,,73650,CPT,Facility,Inpatient,,,LT,270,229.5,77.382,270,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Xr Os Calcis Lt Heel,,73650,CPT,Facility,Both,,,LT,270,229.5,77.382,270,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,239.139,88.57,,percent of total billed charges,,
Xr Os Calcis Lt Heel,,73650,CPT,Facility,Both,,,LT,270,229.5,77.382,270,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,77.382,28.66,,percent of total billed charges,,
Xr Os Calcis Lt Heel,,73650,CPT,Facility,Outpatient,,,LT,270,229.5,77.382,270,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),132.3,49,,percent of total billed charges,,
Xr Os Calcis Lt Heel,,73650,CPT,Facility,Inpatient,,,LT,270,229.5,77.382,270,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Xr Os Calcis Lt Heel,,73650,CPT,Facility,Both,,,LT,270,229.5,77.382,270,CorVel,Worker's Compensation,270,100,,percent of total billed charges,,
Xr Os Calcis Lt Heel,,73650,CPT,Facility,Both,,,LT,270,229.5,77.382,270,First Health Group Corporation,First Health Network,261.9,97,,percent of total billed charges,,
Xr Os Calcis Lt Heel,,73650,CPT,Facility,Both,,,LT,270,229.5,77.382,270,"Health Partners, Inc.",Commercial,255.42,94.6,,percent of total billed charges,,
Xr Os Calcis Lt Heel,,73650,CPT,Facility,Outpatient,,,LT,270,229.5,77.382,270,"Health Partners, Inc.",Medicare Advantage,132.3,49,,percent of total billed charges,,
Xr Os Calcis Lt Heel,,73650,CPT,Facility,Inpatient,,,LT,270,229.5,77.382,270,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Os Calcis Lt Heel,,73650,CPT,Facility,Both,,,LT,270,229.5,77.382,270,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),162,60,,percent of total billed charges,,
Xr Os Calcis Lt Heel,,73650,CPT,Facility,Both,,,LT,270,229.5,77.382,270,"Health Partners, Inc.",State of Minnesota Advantage Program,220.05,81.5,,percent of total billed charges,,
Xr Os Calcis Lt Heel,,73650,CPT,Facility,Both,,,LT,270,229.5,77.382,270,"Health Partners, Inc.",State Public Programs,135,50,,percent of total billed charges,,
Xr Os Calcis Lt Heel,,73650,CPT,Facility,Both,,,LT,270,229.5,77.382,270,Humana Insurance Company,Commercial PPO,256.5,95,,percent of total billed charges,,
Xr Os Calcis Lt Heel,,73650,CPT,Facility,Outpatient,,,LT,270,229.5,77.382,270,Humana Insurance Company,Medicare PPO,132.3,49,,percent of total billed charges,,
Xr Os Calcis Lt Heel,,73650,CPT,Facility,Inpatient,,,LT,270,229.5,77.382,270,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Xr Os Calcis Lt Heel,,73650,CPT,Facility,Both,,,LT,270,229.5,77.382,270,Medica,Individual & Family,267.57,99.1,,percent of total billed charges,,
Xr Os Calcis Lt Heel,,73650,CPT,Facility,Outpatient,,,LT,270,229.5,77.382,270,Medica,Medica Advantage Solution,134.46,49.8,,percent of total billed charges,,
Xr Os Calcis Lt Heel,,73650,CPT,Facility,Inpatient,,,LT,270,229.5,77.382,270,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Xr Os Calcis Lt Heel,,73650,CPT,Facility,Outpatient,,,LT,270,229.5,77.382,270,Medica,Medical Assistance,120.42,44.6,,percent of total billed charges,,
Xr Os Calcis Lt Heel,,73650,CPT,Facility,Inpatient,,,LT,270,229.5,77.382,270,Medica,Medical Assistance,,,,,Included in per diem rate,
Xr Os Calcis Lt Heel,,73650,CPT,Facility,Outpatient,,,LT,270,229.5,77.382,270,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,134.46,49.8,,percent of total billed charges,,
Xr Os Calcis Lt Heel,,73650,CPT,Facility,Inpatient,,,LT,270,229.5,77.382,270,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Xr Os Calcis Lt Heel,,73650,CPT,Facility,Both,,,LT,270,229.5,77.382,270,"Multiplan, Inc.","Multiplan, Inc.",253.8,94,,percent of total billed charges,,
Xr Os Calcis Lt Heel,,73650,CPT,Facility,Outpatient,,,LT,270,229.5,77.382,270,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,243.27,90.1,,percent of total billed charges,,
Xr Os Calcis Lt Heel,,73650,CPT,Facility,Inpatient,,,LT,270,229.5,77.382,270,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Xr Os Calcis Lt Heel,,73650,CPT,Facility,Both,,,LT,270,229.5,77.382,270,"Preferred One Administrative Services, INC.",PPO,266.22,98.6,,percent of total billed charges,,
Xr Os Calcis Lt Heel,,73650,CPT,Facility,Outpatient,,,LT,270,229.5,77.382,270,PrimeWest Health,Minnesota Senior Health Options (MSHO),138.915,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Xr Os Calcis Lt Heel,,73650,CPT,Facility,Inpatient,,,LT,270,229.5,77.382,270,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Os Calcis Lt Heel,,73650,CPT,Facility,Outpatient,,,LT,270,229.5,77.382,270,PrimeWest Health,MinnesotaCare,138.672,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Xr Os Calcis Lt Heel,,73650,CPT,Facility,Inpatient,,,LT,270,229.5,77.382,270,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Xr Os Calcis Lt Heel,,73650,CPT,Facility,Both,,,LT,270,229.5,77.382,270,Sanford Health Plan,Sanford Health Plan,248.4,92,,percent of total billed charges,,
Xr Os Calcis Lt Heel,,73650,CPT,Facility,Outpatient,,,LT,270,229.5,77.382,270,"UCare Health, Inc.",Individual & Family Plan,152.145,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Xr Os Calcis Lt Heel,,73650,CPT,Facility,Inpatient,,,LT,270,229.5,77.382,270,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Xr Os Calcis Lt Heel,,73650,CPT,Facility,Outpatient,,,LT,270,229.5,77.382,270,"UCare Health, Inc.",Medical Assistance,136.269,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Os Calcis Lt Heel,,73650,CPT,Facility,Inpatient,,,LT,270,229.5,77.382,270,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Xr Os Calcis Lt Heel,,73650,CPT,Facility,Outpatient,,,LT,270,229.5,77.382,270,"UCare Health, Inc.",Medicare Advantage,136.269,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Os Calcis Lt Heel,,73650,CPT,Facility,Inpatient,,,LT,270,229.5,77.382,270,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Os Calcis Lt Heel,,73650,CPT,Facility,Outpatient,,,LT,270,229.5,77.382,270,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),136.269,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Os Calcis Lt Heel,,73650,CPT,Facility,Inpatient,,,LT,270,229.5,77.382,270,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Os Calcis Lt Heel,,73650,CPT,Facility,Both,,,LT,270,229.5,77.382,270,UnitedHealthcare,Individual & Family,253.8,94,,percent of total billed charges,,
Xr Os Calcis Lt Heel,,73650,CPT,Facility,Outpatient,,,LT,270,229.5,77.382,270,UnitedHealthcare,Medicare Advantage,132.3,49,,percent of total billed charges,,
Xr Os Calcis Lt Heel,,73650,CPT,Facility,Inpatient,,,LT,270,229.5,77.382,270,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Xr Os Calcis Lt Heel,,73650,CPT,Facility,Outpatient,,,LT,270,229.5,77.382,270,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,129.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
Xr Os Calcis Lt Heel,,73650,CPT,Facility,Inpatient,,,LT,270,229.5,77.382,270,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Cta Lower Extremity Left,,73706,CPT,Facility,Both,,,LT,2244,1907.4,499,2244,Aetna,Commercial,2064.48,92,,percent of total billed charges,,
Cta Lower Extremity Left,,73706,CPT,Facility,Outpatient,,,LT,2244,1907.4,499,2244,Aetna,Medicare Advantage,1099.56,49,,percent of total billed charges,,
Cta Lower Extremity Left,,73706,CPT,Facility,Inpatient,,,LT,2244,1907.4,499,2244,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Cta Lower Extremity Left,,73706,CPT,Facility,Both,,,LT,2244,1907.4,499,2244,Aetna,PPO,2086.92,93,,percent of total billed charges,,
Cta Lower Extremity Left,,73706,CPT,Facility,Both,,,LT,2244,1907.4,499,2244,America's PPO,America's PPO,2154.9132,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Cta Lower Extremity Left,,73706,CPT,Facility,Both,,,LT,2244,1907.4,499,2244,BlueCross BlueShield Minnesota, Federal Employee Program,2208.096,98.4,,percent of total billed charges,,
Cta Lower Extremity Left,,73706,CPT,Facility,Both,,,LT,2244,1907.4,499,2244,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,2244,100,,percent of total billed charges,,
Cta Lower Extremity Left,,73706,CPT,Facility,Both,,,LT,2244,1907.4,499,2244,BlueCross BlueShield Minnesota,High Value Network Plan,2019.6,90,,percent of total billed charges,,
Cta Lower Extremity Left,,73706,CPT,Facility,Outpatient,,,LT,2244,1907.4,499,2244,BlueCross BlueShield Minnesota,Medicare Advantage,1099.56,49,,percent of total billed charges,,
Cta Lower Extremity Left,,73706,CPT,Facility,Inpatient,,,LT,2244,1907.4,499,2244,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Cta Lower Extremity Left,,73706,CPT,Facility,Both,,,LT,2244,1907.4,499,2244,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1987.5108,88.57,,percent of total billed charges,,
Cta Lower Extremity Left,,73706,CPT,Facility,Both,,,LT,2244,1907.4,499,2244,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,643.1304,28.66,,percent of total billed charges,,
Cta Lower Extremity Left,,73706,CPT,Facility,Outpatient,,,LT,2244,1907.4,499,2244,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1099.56,49,,percent of total billed charges,,
Cta Lower Extremity Left,,73706,CPT,Facility,Inpatient,,,LT,2244,1907.4,499,2244,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Cta Lower Extremity Left,,73706,CPT,Facility,Both,,,LT,2244,1907.4,499,2244,CorVel,Worker's Compensation,2244,100,,percent of total billed charges,,
Cta Lower Extremity Left,,73706,CPT,Facility,Both,,,LT,2244,1907.4,499,2244,First Health Group Corporation,First Health Network,2176.68,97,,percent of total billed charges,,
Cta Lower Extremity Left,,73706,CPT,Facility,Both,,,LT,2244,1907.4,499,2244,"Health Partners, Inc.",Commercial,2122.824,94.6,,percent of total billed charges,,
Cta Lower Extremity Left,,73706,CPT,Facility,Outpatient,,,LT,2244,1907.4,499,2244,"Health Partners, Inc.",Medicare Advantage,1099.56,49,,percent of total billed charges,,
Cta Lower Extremity Left,,73706,CPT,Facility,Inpatient,,,LT,2244,1907.4,499,2244,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Cta Lower Extremity Left,,73706,CPT,Facility,Both,,,LT,2244,1907.4,499,2244,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1346.4,60,,percent of total billed charges,,
Cta Lower Extremity Left,,73706,CPT,Facility,Both,,,LT,2244,1907.4,499,2244,"Health Partners, Inc.",State of Minnesota Advantage Program,1828.86,81.5,,percent of total billed charges,,
Cta Lower Extremity Left,,73706,CPT,Facility,Both,,,LT,2244,1907.4,499,2244,"Health Partners, Inc.",State Public Programs,1122,50,,percent of total billed charges,,
Cta Lower Extremity Left,,73706,CPT,Facility,Both,,,LT,2244,1907.4,499,2244,Humana Insurance Company,Commercial PPO,2131.8,95,,percent of total billed charges,,
Cta Lower Extremity Left,,73706,CPT,Facility,Outpatient,,,LT,2244,1907.4,499,2244,Humana Insurance Company,Medicare PPO,1099.56,49,,percent of total billed charges,,
Cta Lower Extremity Left,,73706,CPT,Facility,Inpatient,,,LT,2244,1907.4,499,2244,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Cta Lower Extremity Left,,73706,CPT,Facility,Both,,,LT,2244,1907.4,499,2244,Medica,Individual & Family,2223.804,99.1,,percent of total billed charges,,
Cta Lower Extremity Left,,73706,CPT,Facility,Outpatient,,,LT,2244,1907.4,499,2244,Medica,Medica Advantage Solution,1117.512,49.8,,percent of total billed charges,,
Cta Lower Extremity Left,,73706,CPT,Facility,Inpatient,,,LT,2244,1907.4,499,2244,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Cta Lower Extremity Left,,73706,CPT,Facility,Outpatient,,,LT,2244,1907.4,499,2244,Medica,Medical Assistance,499,,,Other,Per visit,Pays in addition to all Outpatient Service Categories
Cta Lower Extremity Left,,73706,CPT,Facility,Inpatient,,,LT,2244,1907.4,499,2244,Medica,Medical Assistance,,,,,Included in per diem rate,
Cta Lower Extremity Left,,73706,CPT,Facility,Outpatient,,,LT,2244,1907.4,499,2244,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1117.512,49.8,,percent of total billed charges,,
Cta Lower Extremity Left,,73706,CPT,Facility,Inpatient,,,LT,2244,1907.4,499,2244,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Cta Lower Extremity Left,,73706,CPT,Facility,Both,,,LT,2244,1907.4,499,2244,"Multiplan, Inc.","Multiplan, Inc.",2109.36,94,,percent of total billed charges,,
Cta Lower Extremity Left,,73706,CPT,Facility,Outpatient,,,LT,2244,1907.4,499,2244,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1283,,,Other,Per scan,
Cta Lower Extremity Left,,73706,CPT,Facility,Inpatient,,,LT,2244,1907.4,499,2244,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Cta Lower Extremity Left,,73706,CPT,Facility,Both,,,LT,2244,1907.4,499,2244,"Preferred One Administrative Services, INC.",PPO,2212.584,98.6,,percent of total billed charges,,
Cta Lower Extremity Left,,73706,CPT,Facility,Outpatient,,,LT,2244,1907.4,499,2244,PrimeWest Health,Minnesota Senior Health Options (MSHO),1154.538,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Cta Lower Extremity Left,,73706,CPT,Facility,Inpatient,,,LT,2244,1907.4,499,2244,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Cta Lower Extremity Left,,73706,CPT,Facility,Outpatient,,,LT,2244,1907.4,499,2244,PrimeWest Health,MinnesotaCare,1152.5184,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Cta Lower Extremity Left,,73706,CPT,Facility,Inpatient,,,LT,2244,1907.4,499,2244,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Cta Lower Extremity Left,,73706,CPT,Facility,Both,,,LT,2244,1907.4,499,2244,Sanford Health Plan,Sanford Health Plan,2064.48,92,,percent of total billed charges,,
Cta Lower Extremity Left,,73706,CPT,Facility,Outpatient,,,LT,2244,1907.4,499,2244,"UCare Health, Inc.",Individual & Family Plan,1264.494,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Cta Lower Extremity Left,,73706,CPT,Facility,Inpatient,,,LT,2244,1907.4,499,2244,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Cta Lower Extremity Left,,73706,CPT,Facility,Outpatient,,,LT,2244,1907.4,499,2244,"UCare Health, Inc.",Medical Assistance,1132.5468,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Cta Lower Extremity Left,,73706,CPT,Facility,Inpatient,,,LT,2244,1907.4,499,2244,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Cta Lower Extremity Left,,73706,CPT,Facility,Outpatient,,,LT,2244,1907.4,499,2244,"UCare Health, Inc.",Medicare Advantage,1132.5468,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Cta Lower Extremity Left,,73706,CPT,Facility,Inpatient,,,LT,2244,1907.4,499,2244,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Cta Lower Extremity Left,,73706,CPT,Facility,Outpatient,,,LT,2244,1907.4,499,2244,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1132.5468,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Cta Lower Extremity Left,,73706,CPT,Facility,Inpatient,,,LT,2244,1907.4,499,2244,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Cta Lower Extremity Left,,73706,CPT,Facility,Both,,,LT,2244,1907.4,499,2244,UnitedHealthcare,Individual & Family,2109.36,94,,percent of total billed charges,,
Cta Lower Extremity Left,,73706,CPT,Facility,Outpatient,,,LT,2244,1907.4,499,2244,UnitedHealthcare,Medicare Advantage,1099.56,49,,percent of total billed charges,,
Cta Lower Extremity Left,,73706,CPT,Facility,Inpatient,,,LT,2244,1907.4,499,2244,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Cta Lower Extremity Left,,73706,CPT,Facility,Outpatient,,,LT,2244,1907.4,499,2244,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1077.12,48,,percent of total billed charges,,100% of DHS outpatient percentage
Cta Lower Extremity Left,,73706,CPT,Facility,Inpatient,,,LT,2244,1907.4,499,2244,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Mri Lower Extremity Lt Not Jt Wo Contrast,,73718,CPT,Facility,Both,,,LT,2339,1988.15,670.3574,2339,Aetna,Commercial,2151.88,92,,percent of total billed charges,,
Mri Lower Extremity Lt Not Jt Wo Contrast,,73718,CPT,Facility,Outpatient,,,LT,2339,1988.15,670.3574,2339,Aetna,Medicare Advantage,1146.11,49,,percent of total billed charges,,
Mri Lower Extremity Lt Not Jt Wo Contrast,,73718,CPT,Facility,Inpatient,,,LT,2339,1988.15,670.3574,2339,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Mri Lower Extremity Lt Not Jt Wo Contrast,,73718,CPT,Facility,Both,,,LT,2339,1988.15,670.3574,2339,Aetna,PPO,2175.27,93,,percent of total billed charges,,
Mri Lower Extremity Lt Not Jt Wo Contrast,,73718,CPT,Facility,Both,,,LT,2339,1988.15,670.3574,2339,America's PPO,America's PPO,2246.1417,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Mri Lower Extremity Lt Not Jt Wo Contrast,,73718,CPT,Facility,Both,,,LT,2339,1988.15,670.3574,2339,BlueCross BlueShield Minnesota, Federal Employee Program,2301.576,98.4,,percent of total billed charges,,
Mri Lower Extremity Lt Not Jt Wo Contrast,,73718,CPT,Facility,Both,,,LT,2339,1988.15,670.3574,2339,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,2339,100,,percent of total billed charges,,
Mri Lower Extremity Lt Not Jt Wo Contrast,,73718,CPT,Facility,Both,,,LT,2339,1988.15,670.3574,2339,BlueCross BlueShield Minnesota,High Value Network Plan,2105.1,90,,percent of total billed charges,,
Mri Lower Extremity Lt Not Jt Wo Contrast,,73718,CPT,Facility,Outpatient,,,LT,2339,1988.15,670.3574,2339,BlueCross BlueShield Minnesota,Medicare Advantage,1146.11,49,,percent of total billed charges,,
Mri Lower Extremity Lt Not Jt Wo Contrast,,73718,CPT,Facility,Inpatient,,,LT,2339,1988.15,670.3574,2339,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Mri Lower Extremity Lt Not Jt Wo Contrast,,73718,CPT,Facility,Both,,,LT,2339,1988.15,670.3574,2339,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,2071.6523,88.57,,percent of total billed charges,,
Mri Lower Extremity Lt Not Jt Wo Contrast,,73718,CPT,Facility,Both,,,LT,2339,1988.15,670.3574,2339,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,670.3574,28.66,,percent of total billed charges,,
Mri Lower Extremity Lt Not Jt Wo Contrast,,73718,CPT,Facility,Outpatient,,,LT,2339,1988.15,670.3574,2339,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1146.11,49,,percent of total billed charges,,
Mri Lower Extremity Lt Not Jt Wo Contrast,,73718,CPT,Facility,Inpatient,,,LT,2339,1988.15,670.3574,2339,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Mri Lower Extremity Lt Not Jt Wo Contrast,,73718,CPT,Facility,Both,,,LT,2339,1988.15,670.3574,2339,CorVel,Worker's Compensation,2339,100,,percent of total billed charges,,
Mri Lower Extremity Lt Not Jt Wo Contrast,,73718,CPT,Facility,Both,,,LT,2339,1988.15,670.3574,2339,First Health Group Corporation,First Health Network,2268.83,97,,percent of total billed charges,,
Mri Lower Extremity Lt Not Jt Wo Contrast,,73718,CPT,Facility,Both,,,LT,2339,1988.15,670.3574,2339,"Health Partners, Inc.",Commercial,2212.694,94.6,,percent of total billed charges,,
Mri Lower Extremity Lt Not Jt Wo Contrast,,73718,CPT,Facility,Outpatient,,,LT,2339,1988.15,670.3574,2339,"Health Partners, Inc.",Medicare Advantage,1146.11,49,,percent of total billed charges,,
Mri Lower Extremity Lt Not Jt Wo Contrast,,73718,CPT,Facility,Inpatient,,,LT,2339,1988.15,670.3574,2339,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mri Lower Extremity Lt Not Jt Wo Contrast,,73718,CPT,Facility,Both,,,LT,2339,1988.15,670.3574,2339,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1403.4,60,,percent of total billed charges,,
Mri Lower Extremity Lt Not Jt Wo Contrast,,73718,CPT,Facility,Both,,,LT,2339,1988.15,670.3574,2339,"Health Partners, Inc.",State of Minnesota Advantage Program,1906.285,81.5,,percent of total billed charges,,
Mri Lower Extremity Lt Not Jt Wo Contrast,,73718,CPT,Facility,Both,,,LT,2339,1988.15,670.3574,2339,"Health Partners, Inc.",State Public Programs,1169.5,50,,percent of total billed charges,,
Mri Lower Extremity Lt Not Jt Wo Contrast,,73718,CPT,Facility,Both,,,LT,2339,1988.15,670.3574,2339,Humana Insurance Company,Commercial PPO,2222.05,95,,percent of total billed charges,,
Mri Lower Extremity Lt Not Jt Wo Contrast,,73718,CPT,Facility,Outpatient,,,LT,2339,1988.15,670.3574,2339,Humana Insurance Company,Medicare PPO,1146.11,49,,percent of total billed charges,,
Mri Lower Extremity Lt Not Jt Wo Contrast,,73718,CPT,Facility,Inpatient,,,LT,2339,1988.15,670.3574,2339,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Mri Lower Extremity Lt Not Jt Wo Contrast,,73718,CPT,Facility,Both,,,LT,2339,1988.15,670.3574,2339,Medica,Individual & Family,2317.949,99.1,,percent of total billed charges,,
Mri Lower Extremity Lt Not Jt Wo Contrast,,73718,CPT,Facility,Outpatient,,,LT,2339,1988.15,670.3574,2339,Medica,Medica Advantage Solution,1164.822,49.8,,percent of total billed charges,,
Mri Lower Extremity Lt Not Jt Wo Contrast,,73718,CPT,Facility,Inpatient,,,LT,2339,1988.15,670.3574,2339,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Mri Lower Extremity Lt Not Jt Wo Contrast,,73718,CPT,Facility,Outpatient,,,LT,2339,1988.15,670.3574,2339,Medica,Medical Assistance,747,,,Other ,per vist,Pays in addition to all Outpatient Service Categories
Mri Lower Extremity Lt Not Jt Wo Contrast,,73718,CPT,Facility,Inpatient,,,LT,2339,1988.15,670.3574,2339,Medica,Medical Assistance,,,,,Included in per diem rate,
Mri Lower Extremity Lt Not Jt Wo Contrast,,73718,CPT,Facility,Outpatient,,,LT,2339,1988.15,670.3574,2339,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1164.822,49.8,,percent of total billed charges,,
Mri Lower Extremity Lt Not Jt Wo Contrast,,73718,CPT,Facility,Inpatient,,,LT,2339,1988.15,670.3574,2339,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Mri Lower Extremity Lt Not Jt Wo Contrast,,73718,CPT,Facility,Both,,,LT,2339,1988.15,670.3574,2339,"Multiplan, Inc.","Multiplan, Inc.",2198.66,94,,percent of total billed charges,,
Mri Lower Extremity Lt Not Jt Wo Contrast,,73718,CPT,Facility,Outpatient,,,LT,2339,1988.15,670.3574,2339,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1535,,,Other ,per scan,
Mri Lower Extremity Lt Not Jt Wo Contrast,,73718,CPT,Facility,Inpatient,,,LT,2339,1988.15,670.3574,2339,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Mri Lower Extremity Lt Not Jt Wo Contrast,,73718,CPT,Facility,Both,,,LT,2339,1988.15,670.3574,2339,"Preferred One Administrative Services, INC.",PPO,2306.254,98.6,,percent of total billed charges,,
Mri Lower Extremity Lt Not Jt Wo Contrast,,73718,CPT,Facility,Outpatient,,,LT,2339,1988.15,670.3574,2339,PrimeWest Health,Minnesota Senior Health Options (MSHO),1203.4155,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Mri Lower Extremity Lt Not Jt Wo Contrast,,73718,CPT,Facility,Inpatient,,,LT,2339,1988.15,670.3574,2339,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mri Lower Extremity Lt Not Jt Wo Contrast,,73718,CPT,Facility,Outpatient,,,LT,2339,1988.15,670.3574,2339,PrimeWest Health,MinnesotaCare,1201.3104,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Mri Lower Extremity Lt Not Jt Wo Contrast,,73718,CPT,Facility,Inpatient,,,LT,2339,1988.15,670.3574,2339,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Mri Lower Extremity Lt Not Jt Wo Contrast,,73718,CPT,Facility,Both,,,LT,2339,1988.15,670.3574,2339,Sanford Health Plan,Sanford Health Plan,2151.88,92,,percent of total billed charges,,
Mri Lower Extremity Lt Not Jt Wo Contrast,,73718,CPT,Facility,Outpatient,,,LT,2339,1988.15,670.3574,2339,"UCare Health, Inc.",Individual & Family Plan,1318.0265,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Mri Lower Extremity Lt Not Jt Wo Contrast,,73718,CPT,Facility,Inpatient,,,LT,2339,1988.15,670.3574,2339,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Mri Lower Extremity Lt Not Jt Wo Contrast,,73718,CPT,Facility,Outpatient,,,LT,2339,1988.15,670.3574,2339,"UCare Health, Inc.",Medical Assistance,1180.4933,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mri Lower Extremity Lt Not Jt Wo Contrast,,73718,CPT,Facility,Inpatient,,,LT,2339,1988.15,670.3574,2339,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Mri Lower Extremity Lt Not Jt Wo Contrast,,73718,CPT,Facility,Outpatient,,,LT,2339,1988.15,670.3574,2339,"UCare Health, Inc.",Medicare Advantage,1180.4933,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mri Lower Extremity Lt Not Jt Wo Contrast,,73718,CPT,Facility,Inpatient,,,LT,2339,1988.15,670.3574,2339,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mri Lower Extremity Lt Not Jt Wo Contrast,,73718,CPT,Facility,Outpatient,,,LT,2339,1988.15,670.3574,2339,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1180.4933,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mri Lower Extremity Lt Not Jt Wo Contrast,,73718,CPT,Facility,Inpatient,,,LT,2339,1988.15,670.3574,2339,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mri Lower Extremity Lt Not Jt Wo Contrast,,73718,CPT,Facility,Both,,,LT,2339,1988.15,670.3574,2339,UnitedHealthcare,Individual & Family,2198.66,94,,percent of total billed charges,,
Mri Lower Extremity Lt Not Jt Wo Contrast,,73718,CPT,Facility,Outpatient,,,LT,2339,1988.15,670.3574,2339,UnitedHealthcare,Medicare Advantage,1146.11,49,,percent of total billed charges,,
Mri Lower Extremity Lt Not Jt Wo Contrast,,73718,CPT,Facility,Inpatient,,,LT,2339,1988.15,670.3574,2339,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Mri Lower Extremity Lt Not Jt Wo Contrast,,73718,CPT,Facility,Outpatient,,,LT,2339,1988.15,670.3574,2339,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1122.72,48,,percent of total billed charges,,100% of DHS outpatient percentage
Mri Lower Extremity Lt Not Jt Wo Contrast,,73718,CPT,Facility,Inpatient,,,LT,2339,1988.15,670.3574,2339,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Mri Lower Extremity Lt Not Jt W Contrast,,73719,CPT,Facility,Both,,,LT,2653,2255.05,747,2653,Aetna,Commercial,2440.76,92,,percent of total billed charges,,
Mri Lower Extremity Lt Not Jt W Contrast,,73719,CPT,Facility,Outpatient,,,LT,2653,2255.05,747,2653,Aetna,Medicare Advantage,1299.97,49,,percent of total billed charges,,
Mri Lower Extremity Lt Not Jt W Contrast,,73719,CPT,Facility,Inpatient,,,LT,2653,2255.05,747,2653,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Mri Lower Extremity Lt Not Jt W Contrast,,73719,CPT,Facility,Both,,,LT,2653,2255.05,747,2653,Aetna,PPO,2467.29,93,,percent of total billed charges,,
Mri Lower Extremity Lt Not Jt W Contrast,,73719,CPT,Facility,Both,,,LT,2653,2255.05,747,2653,America's PPO,America's PPO,2547.6759,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Mri Lower Extremity Lt Not Jt W Contrast,,73719,CPT,Facility,Both,,,LT,2653,2255.05,747,2653,BlueCross BlueShield Minnesota, Federal Employee Program,2610.552,98.4,,percent of total billed charges,,
Mri Lower Extremity Lt Not Jt W Contrast,,73719,CPT,Facility,Both,,,LT,2653,2255.05,747,2653,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,2653,100,,percent of total billed charges,,
Mri Lower Extremity Lt Not Jt W Contrast,,73719,CPT,Facility,Both,,,LT,2653,2255.05,747,2653,BlueCross BlueShield Minnesota,High Value Network Plan,2387.7,90,,percent of total billed charges,,
Mri Lower Extremity Lt Not Jt W Contrast,,73719,CPT,Facility,Outpatient,,,LT,2653,2255.05,747,2653,BlueCross BlueShield Minnesota,Medicare Advantage,1299.97,49,,percent of total billed charges,,
Mri Lower Extremity Lt Not Jt W Contrast,,73719,CPT,Facility,Inpatient,,,LT,2653,2255.05,747,2653,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Mri Lower Extremity Lt Not Jt W Contrast,,73719,CPT,Facility,Both,,,LT,2653,2255.05,747,2653,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,2349.7621,88.57,,percent of total billed charges,,
Mri Lower Extremity Lt Not Jt W Contrast,,73719,CPT,Facility,Both,,,LT,2653,2255.05,747,2653,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,760.3498,28.66,,percent of total billed charges,,
Mri Lower Extremity Lt Not Jt W Contrast,,73719,CPT,Facility,Outpatient,,,LT,2653,2255.05,747,2653,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1299.97,49,,percent of total billed charges,,
Mri Lower Extremity Lt Not Jt W Contrast,,73719,CPT,Facility,Inpatient,,,LT,2653,2255.05,747,2653,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Mri Lower Extremity Lt Not Jt W Contrast,,73719,CPT,Facility,Both,,,LT,2653,2255.05,747,2653,CorVel,Worker's Compensation,2653,100,,percent of total billed charges,,
Mri Lower Extremity Lt Not Jt W Contrast,,73719,CPT,Facility,Both,,,LT,2653,2255.05,747,2653,First Health Group Corporation,First Health Network,2573.41,97,,percent of total billed charges,,
Mri Lower Extremity Lt Not Jt W Contrast,,73719,CPT,Facility,Both,,,LT,2653,2255.05,747,2653,"Health Partners, Inc.",Commercial,2509.738,94.6,,percent of total billed charges,,
Mri Lower Extremity Lt Not Jt W Contrast,,73719,CPT,Facility,Outpatient,,,LT,2653,2255.05,747,2653,"Health Partners, Inc.",Medicare Advantage,1299.97,49,,percent of total billed charges,,
Mri Lower Extremity Lt Not Jt W Contrast,,73719,CPT,Facility,Inpatient,,,LT,2653,2255.05,747,2653,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mri Lower Extremity Lt Not Jt W Contrast,,73719,CPT,Facility,Both,,,LT,2653,2255.05,747,2653,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1591.8,60,,percent of total billed charges,,
Mri Lower Extremity Lt Not Jt W Contrast,,73719,CPT,Facility,Both,,,LT,2653,2255.05,747,2653,"Health Partners, Inc.",State of Minnesota Advantage Program,2162.195,81.5,,percent of total billed charges,,
Mri Lower Extremity Lt Not Jt W Contrast,,73719,CPT,Facility,Both,,,LT,2653,2255.05,747,2653,"Health Partners, Inc.",State Public Programs,1326.5,50,,percent of total billed charges,,
Mri Lower Extremity Lt Not Jt W Contrast,,73719,CPT,Facility,Both,,,LT,2653,2255.05,747,2653,Humana Insurance Company,Commercial PPO,2520.35,95,,percent of total billed charges,,
Mri Lower Extremity Lt Not Jt W Contrast,,73719,CPT,Facility,Outpatient,,,LT,2653,2255.05,747,2653,Humana Insurance Company,Medicare PPO,1299.97,49,,percent of total billed charges,,
Mri Lower Extremity Lt Not Jt W Contrast,,73719,CPT,Facility,Inpatient,,,LT,2653,2255.05,747,2653,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Mri Lower Extremity Lt Not Jt W Contrast,,73719,CPT,Facility,Both,,,LT,2653,2255.05,747,2653,Medica,Individual & Family,2629.123,99.1,,percent of total billed charges,,
Mri Lower Extremity Lt Not Jt W Contrast,,73719,CPT,Facility,Outpatient,,,LT,2653,2255.05,747,2653,Medica,Medica Advantage Solution,1321.194,49.8,,percent of total billed charges,,
Mri Lower Extremity Lt Not Jt W Contrast,,73719,CPT,Facility,Inpatient,,,LT,2653,2255.05,747,2653,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Mri Lower Extremity Lt Not Jt W Contrast,,73719,CPT,Facility,Outpatient,,,LT,2653,2255.05,747,2653,Medica,Medical Assistance,747,,,Other ,per vist,Pays in addition to all Outpatient Service Categories
Mri Lower Extremity Lt Not Jt W Contrast,,73719,CPT,Facility,Inpatient,,,LT,2653,2255.05,747,2653,Medica,Medical Assistance,,,,,Included in per diem rate,
Mri Lower Extremity Lt Not Jt W Contrast,,73719,CPT,Facility,Outpatient,,,LT,2653,2255.05,747,2653,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1321.194,49.8,,percent of total billed charges,,
Mri Lower Extremity Lt Not Jt W Contrast,,73719,CPT,Facility,Inpatient,,,LT,2653,2255.05,747,2653,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Mri Lower Extremity Lt Not Jt W Contrast,,73719,CPT,Facility,Both,,,LT,2653,2255.05,747,2653,"Multiplan, Inc.","Multiplan, Inc.",2493.82,94,,percent of total billed charges,,
Mri Lower Extremity Lt Not Jt W Contrast,,73719,CPT,Facility,Outpatient,,,LT,2653,2255.05,747,2653,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1535,,,Other ,per scan,
Mri Lower Extremity Lt Not Jt W Contrast,,73719,CPT,Facility,Inpatient,,,LT,2653,2255.05,747,2653,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Mri Lower Extremity Lt Not Jt W Contrast,,73719,CPT,Facility,Both,,,LT,2653,2255.05,747,2653,"Preferred One Administrative Services, INC.",PPO,2615.858,98.6,,percent of total billed charges,,
Mri Lower Extremity Lt Not Jt W Contrast,,73719,CPT,Facility,Outpatient,,,LT,2653,2255.05,747,2653,PrimeWest Health,Minnesota Senior Health Options (MSHO),1364.9685,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Mri Lower Extremity Lt Not Jt W Contrast,,73719,CPT,Facility,Inpatient,,,LT,2653,2255.05,747,2653,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mri Lower Extremity Lt Not Jt W Contrast,,73719,CPT,Facility,Outpatient,,,LT,2653,2255.05,747,2653,PrimeWest Health,MinnesotaCare,1362.5808,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Mri Lower Extremity Lt Not Jt W Contrast,,73719,CPT,Facility,Inpatient,,,LT,2653,2255.05,747,2653,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Mri Lower Extremity Lt Not Jt W Contrast,,73719,CPT,Facility,Both,,,LT,2653,2255.05,747,2653,Sanford Health Plan,Sanford Health Plan,2440.76,92,,percent of total billed charges,,
Mri Lower Extremity Lt Not Jt W Contrast,,73719,CPT,Facility,Outpatient,,,LT,2653,2255.05,747,2653,"UCare Health, Inc.",Individual & Family Plan,1494.9655,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Mri Lower Extremity Lt Not Jt W Contrast,,73719,CPT,Facility,Inpatient,,,LT,2653,2255.05,747,2653,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Mri Lower Extremity Lt Not Jt W Contrast,,73719,CPT,Facility,Outpatient,,,LT,2653,2255.05,747,2653,"UCare Health, Inc.",Medical Assistance,1338.9691,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mri Lower Extremity Lt Not Jt W Contrast,,73719,CPT,Facility,Inpatient,,,LT,2653,2255.05,747,2653,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Mri Lower Extremity Lt Not Jt W Contrast,,73719,CPT,Facility,Outpatient,,,LT,2653,2255.05,747,2653,"UCare Health, Inc.",Medicare Advantage,1338.9691,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mri Lower Extremity Lt Not Jt W Contrast,,73719,CPT,Facility,Inpatient,,,LT,2653,2255.05,747,2653,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mri Lower Extremity Lt Not Jt W Contrast,,73719,CPT,Facility,Outpatient,,,LT,2653,2255.05,747,2653,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1338.9691,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mri Lower Extremity Lt Not Jt W Contrast,,73719,CPT,Facility,Inpatient,,,LT,2653,2255.05,747,2653,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mri Lower Extremity Lt Not Jt W Contrast,,73719,CPT,Facility,Both,,,LT,2653,2255.05,747,2653,UnitedHealthcare,Individual & Family,2493.82,94,,percent of total billed charges,,
Mri Lower Extremity Lt Not Jt W Contrast,,73719,CPT,Facility,Outpatient,,,LT,2653,2255.05,747,2653,UnitedHealthcare,Medicare Advantage,1299.97,49,,percent of total billed charges,,
Mri Lower Extremity Lt Not Jt W Contrast,,73719,CPT,Facility,Inpatient,,,LT,2653,2255.05,747,2653,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Mri Lower Extremity Lt Not Jt W Contrast,,73719,CPT,Facility,Outpatient,,,LT,2653,2255.05,747,2653,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1273.44,48,,percent of total billed charges,,100% of DHS outpatient percentage
Mri Lower Extremity Lt Not Jt W Contrast,,73719,CPT,Facility,Inpatient,,,LT,2653,2255.05,747,2653,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Mri Lower Extremity Lt Not Jt Wo W Contrast,,73720,CPT,Facility,Both,,,LT,3254,2765.9,747,3254,Aetna,Commercial,2993.68,92,,percent of total billed charges,,
Mri Lower Extremity Lt Not Jt Wo W Contrast,,73720,CPT,Facility,Outpatient,,,LT,3254,2765.9,747,3254,Aetna,Medicare Advantage,1594.46,49,,percent of total billed charges,,
Mri Lower Extremity Lt Not Jt Wo W Contrast,,73720,CPT,Facility,Inpatient,,,LT,3254,2765.9,747,3254,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Mri Lower Extremity Lt Not Jt Wo W Contrast,,73720,CPT,Facility,Both,,,LT,3254,2765.9,747,3254,Aetna,PPO,3026.22,93,,percent of total billed charges,,
Mri Lower Extremity Lt Not Jt Wo W Contrast,,73720,CPT,Facility,Both,,,LT,3254,2765.9,747,3254,America's PPO,America's PPO,3124.8162,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Mri Lower Extremity Lt Not Jt Wo W Contrast,,73720,CPT,Facility,Both,,,LT,3254,2765.9,747,3254,BlueCross BlueShield Minnesota, Federal Employee Program,3201.936,98.4,,percent of total billed charges,,
Mri Lower Extremity Lt Not Jt Wo W Contrast,,73720,CPT,Facility,Both,,,LT,3254,2765.9,747,3254,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,3254,100,,percent of total billed charges,,
Mri Lower Extremity Lt Not Jt Wo W Contrast,,73720,CPT,Facility,Both,,,LT,3254,2765.9,747,3254,BlueCross BlueShield Minnesota,High Value Network Plan,2928.6,90,,percent of total billed charges,,
Mri Lower Extremity Lt Not Jt Wo W Contrast,,73720,CPT,Facility,Outpatient,,,LT,3254,2765.9,747,3254,BlueCross BlueShield Minnesota,Medicare Advantage,1594.46,49,,percent of total billed charges,,
Mri Lower Extremity Lt Not Jt Wo W Contrast,,73720,CPT,Facility,Inpatient,,,LT,3254,2765.9,747,3254,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Mri Lower Extremity Lt Not Jt Wo W Contrast,,73720,CPT,Facility,Both,,,LT,3254,2765.9,747,3254,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,2882.0678,88.57,,percent of total billed charges,,
Mri Lower Extremity Lt Not Jt Wo W Contrast,,73720,CPT,Facility,Both,,,LT,3254,2765.9,747,3254,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,932.5964,28.66,,percent of total billed charges,,
Mri Lower Extremity Lt Not Jt Wo W Contrast,,73720,CPT,Facility,Outpatient,,,LT,3254,2765.9,747,3254,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1594.46,49,,percent of total billed charges,,
Mri Lower Extremity Lt Not Jt Wo W Contrast,,73720,CPT,Facility,Inpatient,,,LT,3254,2765.9,747,3254,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Mri Lower Extremity Lt Not Jt Wo W Contrast,,73720,CPT,Facility,Both,,,LT,3254,2765.9,747,3254,CorVel,Worker's Compensation,3254,100,,percent of total billed charges,,
Mri Lower Extremity Lt Not Jt Wo W Contrast,,73720,CPT,Facility,Both,,,LT,3254,2765.9,747,3254,First Health Group Corporation,First Health Network,3156.38,97,,percent of total billed charges,,
Mri Lower Extremity Lt Not Jt Wo W Contrast,,73720,CPT,Facility,Both,,,LT,3254,2765.9,747,3254,"Health Partners, Inc.",Commercial,3078.284,94.6,,percent of total billed charges,,
Mri Lower Extremity Lt Not Jt Wo W Contrast,,73720,CPT,Facility,Outpatient,,,LT,3254,2765.9,747,3254,"Health Partners, Inc.",Medicare Advantage,1594.46,49,,percent of total billed charges,,
Mri Lower Extremity Lt Not Jt Wo W Contrast,,73720,CPT,Facility,Inpatient,,,LT,3254,2765.9,747,3254,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mri Lower Extremity Lt Not Jt Wo W Contrast,,73720,CPT,Facility,Both,,,LT,3254,2765.9,747,3254,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1952.4,60,,percent of total billed charges,,
Mri Lower Extremity Lt Not Jt Wo W Contrast,,73720,CPT,Facility,Both,,,LT,3254,2765.9,747,3254,"Health Partners, Inc.",State of Minnesota Advantage Program,2652.01,81.5,,percent of total billed charges,,
Mri Lower Extremity Lt Not Jt Wo W Contrast,,73720,CPT,Facility,Both,,,LT,3254,2765.9,747,3254,"Health Partners, Inc.",State Public Programs,1627,50,,percent of total billed charges,,
Mri Lower Extremity Lt Not Jt Wo W Contrast,,73720,CPT,Facility,Both,,,LT,3254,2765.9,747,3254,Humana Insurance Company,Commercial PPO,3091.3,95,,percent of total billed charges,,
Mri Lower Extremity Lt Not Jt Wo W Contrast,,73720,CPT,Facility,Outpatient,,,LT,3254,2765.9,747,3254,Humana Insurance Company,Medicare PPO,1594.46,49,,percent of total billed charges,,
Mri Lower Extremity Lt Not Jt Wo W Contrast,,73720,CPT,Facility,Inpatient,,,LT,3254,2765.9,747,3254,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Mri Lower Extremity Lt Not Jt Wo W Contrast,,73720,CPT,Facility,Both,,,LT,3254,2765.9,747,3254,Medica,Individual & Family,3224.714,99.1,,percent of total billed charges,,
Mri Lower Extremity Lt Not Jt Wo W Contrast,,73720,CPT,Facility,Outpatient,,,LT,3254,2765.9,747,3254,Medica,Medica Advantage Solution,1620.492,49.8,,percent of total billed charges,,
Mri Lower Extremity Lt Not Jt Wo W Contrast,,73720,CPT,Facility,Inpatient,,,LT,3254,2765.9,747,3254,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Mri Lower Extremity Lt Not Jt Wo W Contrast,,73720,CPT,Facility,Outpatient,,,LT,3254,2765.9,747,3254,Medica,Medical Assistance,747,,,Other ,per vist,Pays in addition to all Outpatient Service Categories
Mri Lower Extremity Lt Not Jt Wo W Contrast,,73720,CPT,Facility,Inpatient,,,LT,3254,2765.9,747,3254,Medica,Medical Assistance,,,,,Included in per diem rate,
Mri Lower Extremity Lt Not Jt Wo W Contrast,,73720,CPT,Facility,Outpatient,,,LT,3254,2765.9,747,3254,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1620.492,49.8,,percent of total billed charges,,
Mri Lower Extremity Lt Not Jt Wo W Contrast,,73720,CPT,Facility,Inpatient,,,LT,3254,2765.9,747,3254,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Mri Lower Extremity Lt Not Jt Wo W Contrast,,73720,CPT,Facility,Both,,,LT,3254,2765.9,747,3254,"Multiplan, Inc.","Multiplan, Inc.",3058.76,94,,percent of total billed charges,,
Mri Lower Extremity Lt Not Jt Wo W Contrast,,73720,CPT,Facility,Outpatient,,,LT,3254,2765.9,747,3254,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1535,,,Other  ,per scan,
Mri Lower Extremity Lt Not Jt Wo W Contrast,,73720,CPT,Facility,Inpatient,,,LT,3254,2765.9,747,3254,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Mri Lower Extremity Lt Not Jt Wo W Contrast,,73720,CPT,Facility,Both,,,LT,3254,2765.9,747,3254,"Preferred One Administrative Services, INC.",PPO,3208.444,98.6,,percent of total billed charges,,
Mri Lower Extremity Lt Not Jt Wo W Contrast,,73720,CPT,Facility,Outpatient,,,LT,3254,2765.9,747,3254,PrimeWest Health,Minnesota Senior Health Options (MSHO),1674.183,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Mri Lower Extremity Lt Not Jt Wo W Contrast,,73720,CPT,Facility,Inpatient,,,LT,3254,2765.9,747,3254,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mri Lower Extremity Lt Not Jt Wo W Contrast,,73720,CPT,Facility,Outpatient,,,LT,3254,2765.9,747,3254,PrimeWest Health,MinnesotaCare,1671.2544,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Mri Lower Extremity Lt Not Jt Wo W Contrast,,73720,CPT,Facility,Inpatient,,,LT,3254,2765.9,747,3254,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Mri Lower Extremity Lt Not Jt Wo W Contrast,,73720,CPT,Facility,Both,,,LT,3254,2765.9,747,3254,Sanford Health Plan,Sanford Health Plan,2993.68,92,,percent of total billed charges,,
Mri Lower Extremity Lt Not Jt Wo W Contrast,,73720,CPT,Facility,Outpatient,,,LT,3254,2765.9,747,3254,"UCare Health, Inc.",Individual & Family Plan,1833.629,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Mri Lower Extremity Lt Not Jt Wo W Contrast,,73720,CPT,Facility,Inpatient,,,LT,3254,2765.9,747,3254,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Mri Lower Extremity Lt Not Jt Wo W Contrast,,73720,CPT,Facility,Outpatient,,,LT,3254,2765.9,747,3254,"UCare Health, Inc.",Medical Assistance,1642.2938,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mri Lower Extremity Lt Not Jt Wo W Contrast,,73720,CPT,Facility,Inpatient,,,LT,3254,2765.9,747,3254,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Mri Lower Extremity Lt Not Jt Wo W Contrast,,73720,CPT,Facility,Outpatient,,,LT,3254,2765.9,747,3254,"UCare Health, Inc.",Medicare Advantage,1642.2938,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mri Lower Extremity Lt Not Jt Wo W Contrast,,73720,CPT,Facility,Inpatient,,,LT,3254,2765.9,747,3254,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mri Lower Extremity Lt Not Jt Wo W Contrast,,73720,CPT,Facility,Outpatient,,,LT,3254,2765.9,747,3254,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1642.2938,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mri Lower Extremity Lt Not Jt Wo W Contrast,,73720,CPT,Facility,Inpatient,,,LT,3254,2765.9,747,3254,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mri Lower Extremity Lt Not Jt Wo W Contrast,,73720,CPT,Facility,Both,,,LT,3254,2765.9,747,3254,UnitedHealthcare,Individual & Family,3058.76,94,,percent of total billed charges,,
Mri Lower Extremity Lt Not Jt Wo W Contrast,,73720,CPT,Facility,Outpatient,,,LT,3254,2765.9,747,3254,UnitedHealthcare,Medicare Advantage,1594.46,49,,percent of total billed charges,,
Mri Lower Extremity Lt Not Jt Wo W Contrast,,73720,CPT,Facility,Inpatient,,,LT,3254,2765.9,747,3254,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Mri Lower Extremity Lt Not Jt Wo W Contrast,,73720,CPT,Facility,Outpatient,,,LT,3254,2765.9,747,3254,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1561.92,48,,percent of total billed charges,,100% of DHS outpatient percentage
Mri Lower Extremity Lt Not Jt Wo W Contrast,,73720,CPT,Facility,Inpatient,,,LT,3254,2765.9,747,3254,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Mri Lower Extremity Lt Any Jt Routine Wo Contrast,,73721,CPT,Facility,Both,,,LT,2447,2079.95,701.3102,2447,Aetna,Commercial,2251.24,92,,percent of total billed charges,,
Mri Lower Extremity Lt Any Jt Routine Wo Contrast,,73721,CPT,Facility,Outpatient,,,LT,2447,2079.95,701.3102,2447,Aetna,Medicare Advantage,1199.03,49,,percent of total billed charges,,
Mri Lower Extremity Lt Any Jt Routine Wo Contrast,,73721,CPT,Facility,Inpatient,,,LT,2447,2079.95,701.3102,2447,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Mri Lower Extremity Lt Any Jt Routine Wo Contrast,,73721,CPT,Facility,Both,,,LT,2447,2079.95,701.3102,2447,Aetna,PPO,2275.71,93,,percent of total billed charges,,
Mri Lower Extremity Lt Any Jt Routine Wo Contrast,,73721,CPT,Facility,Both,,,LT,2447,2079.95,701.3102,2447,America's PPO,America's PPO,2349.8541,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Mri Lower Extremity Lt Any Jt Routine Wo Contrast,,73721,CPT,Facility,Both,,,LT,2447,2079.95,701.3102,2447,BlueCross BlueShield Minnesota, Federal Employee Program,2407.848,98.4,,percent of total billed charges,,
Mri Lower Extremity Lt Any Jt Routine Wo Contrast,,73721,CPT,Facility,Both,,,LT,2447,2079.95,701.3102,2447,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,2447,100,,percent of total billed charges,,
Mri Lower Extremity Lt Any Jt Routine Wo Contrast,,73721,CPT,Facility,Both,,,LT,2447,2079.95,701.3102,2447,BlueCross BlueShield Minnesota,High Value Network Plan,2202.3,90,,percent of total billed charges,,
Mri Lower Extremity Lt Any Jt Routine Wo Contrast,,73721,CPT,Facility,Outpatient,,,LT,2447,2079.95,701.3102,2447,BlueCross BlueShield Minnesota,Medicare Advantage,1199.03,49,,percent of total billed charges,,
Mri Lower Extremity Lt Any Jt Routine Wo Contrast,,73721,CPT,Facility,Inpatient,,,LT,2447,2079.95,701.3102,2447,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Mri Lower Extremity Lt Any Jt Routine Wo Contrast,,73721,CPT,Facility,Both,,,LT,2447,2079.95,701.3102,2447,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,2167.3079,88.57,,percent of total billed charges,,
Mri Lower Extremity Lt Any Jt Routine Wo Contrast,,73721,CPT,Facility,Both,,,LT,2447,2079.95,701.3102,2447,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,701.3102,28.66,,percent of total billed charges,,
Mri Lower Extremity Lt Any Jt Routine Wo Contrast,,73721,CPT,Facility,Outpatient,,,LT,2447,2079.95,701.3102,2447,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1199.03,49,,percent of total billed charges,,
Mri Lower Extremity Lt Any Jt Routine Wo Contrast,,73721,CPT,Facility,Inpatient,,,LT,2447,2079.95,701.3102,2447,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Mri Lower Extremity Lt Any Jt Routine Wo Contrast,,73721,CPT,Facility,Both,,,LT,2447,2079.95,701.3102,2447,CorVel,Worker's Compensation,2447,100,,percent of total billed charges,,
Mri Lower Extremity Lt Any Jt Routine Wo Contrast,,73721,CPT,Facility,Both,,,LT,2447,2079.95,701.3102,2447,First Health Group Corporation,First Health Network,2373.59,97,,percent of total billed charges,,
Mri Lower Extremity Lt Any Jt Routine Wo Contrast,,73721,CPT,Facility,Both,,,LT,2447,2079.95,701.3102,2447,"Health Partners, Inc.",Commercial,2314.862,94.6,,percent of total billed charges,,
Mri Lower Extremity Lt Any Jt Routine Wo Contrast,,73721,CPT,Facility,Outpatient,,,LT,2447,2079.95,701.3102,2447,"Health Partners, Inc.",Medicare Advantage,1199.03,49,,percent of total billed charges,,
Mri Lower Extremity Lt Any Jt Routine Wo Contrast,,73721,CPT,Facility,Inpatient,,,LT,2447,2079.95,701.3102,2447,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mri Lower Extremity Lt Any Jt Routine Wo Contrast,,73721,CPT,Facility,Both,,,LT,2447,2079.95,701.3102,2447,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1468.2,60,,percent of total billed charges,,
Mri Lower Extremity Lt Any Jt Routine Wo Contrast,,73721,CPT,Facility,Both,,,LT,2447,2079.95,701.3102,2447,"Health Partners, Inc.",State of Minnesota Advantage Program,1994.305,81.5,,percent of total billed charges,,
Mri Lower Extremity Lt Any Jt Routine Wo Contrast,,73721,CPT,Facility,Both,,,LT,2447,2079.95,701.3102,2447,"Health Partners, Inc.",State Public Programs,1223.5,50,,percent of total billed charges,,
Mri Lower Extremity Lt Any Jt Routine Wo Contrast,,73721,CPT,Facility,Both,,,LT,2447,2079.95,701.3102,2447,Humana Insurance Company,Commercial PPO,2324.65,95,,percent of total billed charges,,
Mri Lower Extremity Lt Any Jt Routine Wo Contrast,,73721,CPT,Facility,Outpatient,,,LT,2447,2079.95,701.3102,2447,Humana Insurance Company,Medicare PPO,1199.03,49,,percent of total billed charges,,
Mri Lower Extremity Lt Any Jt Routine Wo Contrast,,73721,CPT,Facility,Inpatient,,,LT,2447,2079.95,701.3102,2447,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Mri Lower Extremity Lt Any Jt Routine Wo Contrast,,73721,CPT,Facility,Both,,,LT,2447,2079.95,701.3102,2447,Medica,Individual & Family,2424.977,99.1,,percent of total billed charges,,
Mri Lower Extremity Lt Any Jt Routine Wo Contrast,,73721,CPT,Facility,Outpatient,,,LT,2447,2079.95,701.3102,2447,Medica,Medica Advantage Solution,1218.606,49.8,,percent of total billed charges,,
Mri Lower Extremity Lt Any Jt Routine Wo Contrast,,73721,CPT,Facility,Inpatient,,,LT,2447,2079.95,701.3102,2447,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Mri Lower Extremity Lt Any Jt Routine Wo Contrast,,73721,CPT,Facility,Outpatient,,,LT,2447,2079.95,701.3102,2447,Medica,Medical Assistance,747,,,Other,per vist,Pays in addition to all Outpatient Service Categories
Mri Lower Extremity Lt Any Jt Routine Wo Contrast,,73721,CPT,Facility,Inpatient,,,LT,2447,2079.95,701.3102,2447,Medica,Medical Assistance,,,,,Included in per diem rate,
Mri Lower Extremity Lt Any Jt Routine Wo Contrast,,73721,CPT,Facility,Outpatient,,,LT,2447,2079.95,701.3102,2447,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1218.606,49.8,,percent of total billed charges,,
Mri Lower Extremity Lt Any Jt Routine Wo Contrast,,73721,CPT,Facility,Inpatient,,,LT,2447,2079.95,701.3102,2447,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Mri Lower Extremity Lt Any Jt Routine Wo Contrast,,73721,CPT,Facility,Both,,,LT,2447,2079.95,701.3102,2447,"Multiplan, Inc.","Multiplan, Inc.",2300.18,94,,percent of total billed charges,,
Mri Lower Extremity Lt Any Jt Routine Wo Contrast,,73721,CPT,Facility,Outpatient,,,LT,2447,2079.95,701.3102,2447,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1535,,,Other ,per scan,
Mri Lower Extremity Lt Any Jt Routine Wo Contrast,,73721,CPT,Facility,Inpatient,,,LT,2447,2079.95,701.3102,2447,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Mri Lower Extremity Lt Any Jt Routine Wo Contrast,,73721,CPT,Facility,Both,,,LT,2447,2079.95,701.3102,2447,"Preferred One Administrative Services, INC.",PPO,2412.742,98.6,,percent of total billed charges,,
Mri Lower Extremity Lt Any Jt Routine Wo Contrast,,73721,CPT,Facility,Outpatient,,,LT,2447,2079.95,701.3102,2447,PrimeWest Health,Minnesota Senior Health Options (MSHO),1258.9815,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Mri Lower Extremity Lt Any Jt Routine Wo Contrast,,73721,CPT,Facility,Inpatient,,,LT,2447,2079.95,701.3102,2447,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mri Lower Extremity Lt Any Jt Routine Wo Contrast,,73721,CPT,Facility,Outpatient,,,LT,2447,2079.95,701.3102,2447,PrimeWest Health,MinnesotaCare,1256.7792,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Mri Lower Extremity Lt Any Jt Routine Wo Contrast,,73721,CPT,Facility,Inpatient,,,LT,2447,2079.95,701.3102,2447,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Mri Lower Extremity Lt Any Jt Routine Wo Contrast,,73721,CPT,Facility,Both,,,LT,2447,2079.95,701.3102,2447,Sanford Health Plan,Sanford Health Plan,2251.24,92,,percent of total billed charges,,
Mri Lower Extremity Lt Any Jt Routine Wo Contrast,,73721,CPT,Facility,Outpatient,,,LT,2447,2079.95,701.3102,2447,"UCare Health, Inc.",Individual & Family Plan,1378.8845,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Mri Lower Extremity Lt Any Jt Routine Wo Contrast,,73721,CPT,Facility,Inpatient,,,LT,2447,2079.95,701.3102,2447,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Mri Lower Extremity Lt Any Jt Routine Wo Contrast,,73721,CPT,Facility,Outpatient,,,LT,2447,2079.95,701.3102,2447,"UCare Health, Inc.",Medical Assistance,1235.0009,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mri Lower Extremity Lt Any Jt Routine Wo Contrast,,73721,CPT,Facility,Inpatient,,,LT,2447,2079.95,701.3102,2447,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Mri Lower Extremity Lt Any Jt Routine Wo Contrast,,73721,CPT,Facility,Outpatient,,,LT,2447,2079.95,701.3102,2447,"UCare Health, Inc.",Medicare Advantage,1235.0009,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mri Lower Extremity Lt Any Jt Routine Wo Contrast,,73721,CPT,Facility,Inpatient,,,LT,2447,2079.95,701.3102,2447,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mri Lower Extremity Lt Any Jt Routine Wo Contrast,,73721,CPT,Facility,Outpatient,,,LT,2447,2079.95,701.3102,2447,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1235.0009,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mri Lower Extremity Lt Any Jt Routine Wo Contrast,,73721,CPT,Facility,Inpatient,,,LT,2447,2079.95,701.3102,2447,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mri Lower Extremity Lt Any Jt Routine Wo Contrast,,73721,CPT,Facility,Both,,,LT,2447,2079.95,701.3102,2447,UnitedHealthcare,Individual & Family,2300.18,94,,percent of total billed charges,,
Mri Lower Extremity Lt Any Jt Routine Wo Contrast,,73721,CPT,Facility,Outpatient,,,LT,2447,2079.95,701.3102,2447,UnitedHealthcare,Medicare Advantage,1199.03,49,,percent of total billed charges,,
Mri Lower Extremity Lt Any Jt Routine Wo Contrast,,73721,CPT,Facility,Inpatient,,,LT,2447,2079.95,701.3102,2447,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Mri Lower Extremity Lt Any Jt Routine Wo Contrast,,73721,CPT,Facility,Outpatient,,,LT,2447,2079.95,701.3102,2447,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1174.56,48,,percent of total billed charges,,100% of DHS outpatient percentage
Mri Lower Extremity Lt Any Jt Routine Wo Contrast,,73721,CPT,Facility,Inpatient,,,LT,2447,2079.95,701.3102,2447,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Mri Lower Extremity Lt Any Jt W Contrast,,73722,CPT,Facility,Both,,,LT,2653,2255.05,747,2653,Aetna,Commercial,2440.76,92,,percent of total billed charges,,
Mri Lower Extremity Lt Any Jt W Contrast,,73722,CPT,Facility,Outpatient,,,LT,2653,2255.05,747,2653,Aetna,Medicare Advantage,1299.97,49,,percent of total billed charges,,
Mri Lower Extremity Lt Any Jt W Contrast,,73722,CPT,Facility,Inpatient,,,LT,2653,2255.05,747,2653,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Mri Lower Extremity Lt Any Jt W Contrast,,73722,CPT,Facility,Both,,,LT,2653,2255.05,747,2653,Aetna,PPO,2467.29,93,,percent of total billed charges,,
Mri Lower Extremity Lt Any Jt W Contrast,,73722,CPT,Facility,Both,,,LT,2653,2255.05,747,2653,America's PPO,America's PPO,2547.6759,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Mri Lower Extremity Lt Any Jt W Contrast,,73722,CPT,Facility,Both,,,LT,2653,2255.05,747,2653,BlueCross BlueShield Minnesota, Federal Employee Program,2610.552,98.4,,percent of total billed charges,,
Mri Lower Extremity Lt Any Jt W Contrast,,73722,CPT,Facility,Both,,,LT,2653,2255.05,747,2653,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,2653,100,,percent of total billed charges,,
Mri Lower Extremity Lt Any Jt W Contrast,,73722,CPT,Facility,Both,,,LT,2653,2255.05,747,2653,BlueCross BlueShield Minnesota,High Value Network Plan,2387.7,90,,percent of total billed charges,,
Mri Lower Extremity Lt Any Jt W Contrast,,73722,CPT,Facility,Outpatient,,,LT,2653,2255.05,747,2653,BlueCross BlueShield Minnesota,Medicare Advantage,1299.97,49,,percent of total billed charges,,
Mri Lower Extremity Lt Any Jt W Contrast,,73722,CPT,Facility,Inpatient,,,LT,2653,2255.05,747,2653,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Mri Lower Extremity Lt Any Jt W Contrast,,73722,CPT,Facility,Both,,,LT,2653,2255.05,747,2653,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,2349.7621,88.57,,percent of total billed charges,,
Mri Lower Extremity Lt Any Jt W Contrast,,73722,CPT,Facility,Both,,,LT,2653,2255.05,747,2653,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,760.3498,28.66,,percent of total billed charges,,
Mri Lower Extremity Lt Any Jt W Contrast,,73722,CPT,Facility,Outpatient,,,LT,2653,2255.05,747,2653,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1299.97,49,,percent of total billed charges,,
Mri Lower Extremity Lt Any Jt W Contrast,,73722,CPT,Facility,Inpatient,,,LT,2653,2255.05,747,2653,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Mri Lower Extremity Lt Any Jt W Contrast,,73722,CPT,Facility,Both,,,LT,2653,2255.05,747,2653,CorVel,Worker's Compensation,2653,100,,percent of total billed charges,,
Mri Lower Extremity Lt Any Jt W Contrast,,73722,CPT,Facility,Both,,,LT,2653,2255.05,747,2653,First Health Group Corporation,First Health Network,2573.41,97,,percent of total billed charges,,
Mri Lower Extremity Lt Any Jt W Contrast,,73722,CPT,Facility,Both,,,LT,2653,2255.05,747,2653,"Health Partners, Inc.",Commercial,2509.738,94.6,,percent of total billed charges,,
Mri Lower Extremity Lt Any Jt W Contrast,,73722,CPT,Facility,Outpatient,,,LT,2653,2255.05,747,2653,"Health Partners, Inc.",Medicare Advantage,1299.97,49,,percent of total billed charges,,
Mri Lower Extremity Lt Any Jt W Contrast,,73722,CPT,Facility,Inpatient,,,LT,2653,2255.05,747,2653,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mri Lower Extremity Lt Any Jt W Contrast,,73722,CPT,Facility,Both,,,LT,2653,2255.05,747,2653,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1591.8,60,,percent of total billed charges,,
Mri Lower Extremity Lt Any Jt W Contrast,,73722,CPT,Facility,Both,,,LT,2653,2255.05,747,2653,"Health Partners, Inc.",State of Minnesota Advantage Program,2162.195,81.5,,percent of total billed charges,,
Mri Lower Extremity Lt Any Jt W Contrast,,73722,CPT,Facility,Both,,,LT,2653,2255.05,747,2653,"Health Partners, Inc.",State Public Programs,1326.5,50,,percent of total billed charges,,
Mri Lower Extremity Lt Any Jt W Contrast,,73722,CPT,Facility,Both,,,LT,2653,2255.05,747,2653,Humana Insurance Company,Commercial PPO,2520.35,95,,percent of total billed charges,,
Mri Lower Extremity Lt Any Jt W Contrast,,73722,CPT,Facility,Outpatient,,,LT,2653,2255.05,747,2653,Humana Insurance Company,Medicare PPO,1299.97,49,,percent of total billed charges,,
Mri Lower Extremity Lt Any Jt W Contrast,,73722,CPT,Facility,Inpatient,,,LT,2653,2255.05,747,2653,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Mri Lower Extremity Lt Any Jt W Contrast,,73722,CPT,Facility,Both,,,LT,2653,2255.05,747,2653,Medica,Individual & Family,2629.123,99.1,,percent of total billed charges,,
Mri Lower Extremity Lt Any Jt W Contrast,,73722,CPT,Facility,Outpatient,,,LT,2653,2255.05,747,2653,Medica,Medica Advantage Solution,1321.194,49.8,,percent of total billed charges,,
Mri Lower Extremity Lt Any Jt W Contrast,,73722,CPT,Facility,Inpatient,,,LT,2653,2255.05,747,2653,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Mri Lower Extremity Lt Any Jt W Contrast,,73722,CPT,Facility,Outpatient,,,LT,2653,2255.05,747,2653,Medica,Medical Assistance,747,,,Other ,per vist,Pays in addition to all Outpatient Service Categories
Mri Lower Extremity Lt Any Jt W Contrast,,73722,CPT,Facility,Inpatient,,,LT,2653,2255.05,747,2653,Medica,Medical Assistance,,,,,Included in per diem rate,
Mri Lower Extremity Lt Any Jt W Contrast,,73722,CPT,Facility,Outpatient,,,LT,2653,2255.05,747,2653,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1321.194,49.8,,percent of total billed charges,,
Mri Lower Extremity Lt Any Jt W Contrast,,73722,CPT,Facility,Inpatient,,,LT,2653,2255.05,747,2653,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Mri Lower Extremity Lt Any Jt W Contrast,,73722,CPT,Facility,Both,,,LT,2653,2255.05,747,2653,"Multiplan, Inc.","Multiplan, Inc.",2493.82,94,,percent of total billed charges,,
Mri Lower Extremity Lt Any Jt W Contrast,,73722,CPT,Facility,Outpatient,,,LT,2653,2255.05,747,2653,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1535,,,Other ,per scan,
Mri Lower Extremity Lt Any Jt W Contrast,,73722,CPT,Facility,Inpatient,,,LT,2653,2255.05,747,2653,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Mri Lower Extremity Lt Any Jt W Contrast,,73722,CPT,Facility,Both,,,LT,2653,2255.05,747,2653,"Preferred One Administrative Services, INC.",PPO,2615.858,98.6,,percent of total billed charges,,
Mri Lower Extremity Lt Any Jt W Contrast,,73722,CPT,Facility,Outpatient,,,LT,2653,2255.05,747,2653,PrimeWest Health,Minnesota Senior Health Options (MSHO),1364.9685,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Mri Lower Extremity Lt Any Jt W Contrast,,73722,CPT,Facility,Inpatient,,,LT,2653,2255.05,747,2653,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mri Lower Extremity Lt Any Jt W Contrast,,73722,CPT,Facility,Outpatient,,,LT,2653,2255.05,747,2653,PrimeWest Health,MinnesotaCare,1362.5808,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Mri Lower Extremity Lt Any Jt W Contrast,,73722,CPT,Facility,Inpatient,,,LT,2653,2255.05,747,2653,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Mri Lower Extremity Lt Any Jt W Contrast,,73722,CPT,Facility,Both,,,LT,2653,2255.05,747,2653,Sanford Health Plan,Sanford Health Plan,2440.76,92,,percent of total billed charges,,
Mri Lower Extremity Lt Any Jt W Contrast,,73722,CPT,Facility,Outpatient,,,LT,2653,2255.05,747,2653,"UCare Health, Inc.",Individual & Family Plan,1494.9655,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Mri Lower Extremity Lt Any Jt W Contrast,,73722,CPT,Facility,Inpatient,,,LT,2653,2255.05,747,2653,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Mri Lower Extremity Lt Any Jt W Contrast,,73722,CPT,Facility,Outpatient,,,LT,2653,2255.05,747,2653,"UCare Health, Inc.",Medical Assistance,1338.9691,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mri Lower Extremity Lt Any Jt W Contrast,,73722,CPT,Facility,Inpatient,,,LT,2653,2255.05,747,2653,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Mri Lower Extremity Lt Any Jt W Contrast,,73722,CPT,Facility,Outpatient,,,LT,2653,2255.05,747,2653,"UCare Health, Inc.",Medicare Advantage,1338.9691,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mri Lower Extremity Lt Any Jt W Contrast,,73722,CPT,Facility,Inpatient,,,LT,2653,2255.05,747,2653,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mri Lower Extremity Lt Any Jt W Contrast,,73722,CPT,Facility,Outpatient,,,LT,2653,2255.05,747,2653,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1338.9691,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mri Lower Extremity Lt Any Jt W Contrast,,73722,CPT,Facility,Inpatient,,,LT,2653,2255.05,747,2653,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mri Lower Extremity Lt Any Jt W Contrast,,73722,CPT,Facility,Both,,,LT,2653,2255.05,747,2653,UnitedHealthcare,Individual & Family,2493.82,94,,percent of total billed charges,,
Mri Lower Extremity Lt Any Jt W Contrast,,73722,CPT,Facility,Outpatient,,,LT,2653,2255.05,747,2653,UnitedHealthcare,Medicare Advantage,1299.97,49,,percent of total billed charges,,
Mri Lower Extremity Lt Any Jt W Contrast,,73722,CPT,Facility,Inpatient,,,LT,2653,2255.05,747,2653,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Mri Lower Extremity Lt Any Jt W Contrast,,73722,CPT,Facility,Outpatient,,,LT,2653,2255.05,747,2653,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1273.44,48,,percent of total billed charges,,100% of DHS outpatient percentage
Mri Lower Extremity Lt Any Jt W Contrast,,73722,CPT,Facility,Inpatient,,,LT,2653,2255.05,747,2653,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Mri Lower Extremity Lt Any Jt Wo W Contrast,,73723,CPT,Facility,Both,,,LT,3254,2765.9,747,3254,Aetna,Commercial,2993.68,92,,percent of total billed charges,,
Mri Lower Extremity Lt Any Jt Wo W Contrast,,73723,CPT,Facility,Outpatient,,,LT,3254,2765.9,747,3254,Aetna,Medicare Advantage,1594.46,49,,percent of total billed charges,,
Mri Lower Extremity Lt Any Jt Wo W Contrast,,73723,CPT,Facility,Inpatient,,,LT,3254,2765.9,747,3254,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Mri Lower Extremity Lt Any Jt Wo W Contrast,,73723,CPT,Facility,Both,,,LT,3254,2765.9,747,3254,Aetna,PPO,3026.22,93,,percent of total billed charges,,
Mri Lower Extremity Lt Any Jt Wo W Contrast,,73723,CPT,Facility,Both,,,LT,3254,2765.9,747,3254,America's PPO,America's PPO,3124.8162,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Mri Lower Extremity Lt Any Jt Wo W Contrast,,73723,CPT,Facility,Both,,,LT,3254,2765.9,747,3254,BlueCross BlueShield Minnesota, Federal Employee Program,3201.936,98.4,,percent of total billed charges,,
Mri Lower Extremity Lt Any Jt Wo W Contrast,,73723,CPT,Facility,Both,,,LT,3254,2765.9,747,3254,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,3254,100,,percent of total billed charges,,
Mri Lower Extremity Lt Any Jt Wo W Contrast,,73723,CPT,Facility,Both,,,LT,3254,2765.9,747,3254,BlueCross BlueShield Minnesota,High Value Network Plan,2928.6,90,,percent of total billed charges,,
Mri Lower Extremity Lt Any Jt Wo W Contrast,,73723,CPT,Facility,Outpatient,,,LT,3254,2765.9,747,3254,BlueCross BlueShield Minnesota,Medicare Advantage,1594.46,49,,percent of total billed charges,,
Mri Lower Extremity Lt Any Jt Wo W Contrast,,73723,CPT,Facility,Inpatient,,,LT,3254,2765.9,747,3254,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Mri Lower Extremity Lt Any Jt Wo W Contrast,,73723,CPT,Facility,Both,,,LT,3254,2765.9,747,3254,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,2882.0678,88.57,,percent of total billed charges,,
Mri Lower Extremity Lt Any Jt Wo W Contrast,,73723,CPT,Facility,Both,,,LT,3254,2765.9,747,3254,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,932.5964,28.66,,percent of total billed charges,,
Mri Lower Extremity Lt Any Jt Wo W Contrast,,73723,CPT,Facility,Outpatient,,,LT,3254,2765.9,747,3254,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1594.46,49,,percent of total billed charges,,
Mri Lower Extremity Lt Any Jt Wo W Contrast,,73723,CPT,Facility,Inpatient,,,LT,3254,2765.9,747,3254,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Mri Lower Extremity Lt Any Jt Wo W Contrast,,73723,CPT,Facility,Both,,,LT,3254,2765.9,747,3254,CorVel,Worker's Compensation,3254,100,,percent of total billed charges,,
Mri Lower Extremity Lt Any Jt Wo W Contrast,,73723,CPT,Facility,Both,,,LT,3254,2765.9,747,3254,First Health Group Corporation,First Health Network,3156.38,97,,percent of total billed charges,,
Mri Lower Extremity Lt Any Jt Wo W Contrast,,73723,CPT,Facility,Both,,,LT,3254,2765.9,747,3254,"Health Partners, Inc.",Commercial,3078.284,94.6,,percent of total billed charges,,
Mri Lower Extremity Lt Any Jt Wo W Contrast,,73723,CPT,Facility,Outpatient,,,LT,3254,2765.9,747,3254,"Health Partners, Inc.",Medicare Advantage,1594.46,49,,percent of total billed charges,,
Mri Lower Extremity Lt Any Jt Wo W Contrast,,73723,CPT,Facility,Inpatient,,,LT,3254,2765.9,747,3254,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mri Lower Extremity Lt Any Jt Wo W Contrast,,73723,CPT,Facility,Both,,,LT,3254,2765.9,747,3254,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1952.4,60,,percent of total billed charges,,
Mri Lower Extremity Lt Any Jt Wo W Contrast,,73723,CPT,Facility,Both,,,LT,3254,2765.9,747,3254,"Health Partners, Inc.",State of Minnesota Advantage Program,2652.01,81.5,,percent of total billed charges,,
Mri Lower Extremity Lt Any Jt Wo W Contrast,,73723,CPT,Facility,Both,,,LT,3254,2765.9,747,3254,"Health Partners, Inc.",State Public Programs,1627,50,,percent of total billed charges,,
Mri Lower Extremity Lt Any Jt Wo W Contrast,,73723,CPT,Facility,Both,,,LT,3254,2765.9,747,3254,Humana Insurance Company,Commercial PPO,3091.3,95,,percent of total billed charges,,
Mri Lower Extremity Lt Any Jt Wo W Contrast,,73723,CPT,Facility,Outpatient,,,LT,3254,2765.9,747,3254,Humana Insurance Company,Medicare PPO,1594.46,49,,percent of total billed charges,,
Mri Lower Extremity Lt Any Jt Wo W Contrast,,73723,CPT,Facility,Inpatient,,,LT,3254,2765.9,747,3254,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Mri Lower Extremity Lt Any Jt Wo W Contrast,,73723,CPT,Facility,Both,,,LT,3254,2765.9,747,3254,Medica,Individual & Family,3224.714,99.1,,percent of total billed charges,,
Mri Lower Extremity Lt Any Jt Wo W Contrast,,73723,CPT,Facility,Outpatient,,,LT,3254,2765.9,747,3254,Medica,Medica Advantage Solution,1620.492,49.8,,percent of total billed charges,,
Mri Lower Extremity Lt Any Jt Wo W Contrast,,73723,CPT,Facility,Inpatient,,,LT,3254,2765.9,747,3254,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Mri Lower Extremity Lt Any Jt Wo W Contrast,,73723,CPT,Facility,Outpatient,,,LT,3254,2765.9,747,3254,Medica,Medical Assistance,747,,,Other ,per vist,Pays in addition to all Outpatient Service Categories
Mri Lower Extremity Lt Any Jt Wo W Contrast,,73723,CPT,Facility,Inpatient,,,LT,3254,2765.9,747,3254,Medica,Medical Assistance,,,,,Included in per diem rate,
Mri Lower Extremity Lt Any Jt Wo W Contrast,,73723,CPT,Facility,Outpatient,,,LT,3254,2765.9,747,3254,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1620.492,49.8,,percent of total billed charges,,
Mri Lower Extremity Lt Any Jt Wo W Contrast,,73723,CPT,Facility,Inpatient,,,LT,3254,2765.9,747,3254,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Mri Lower Extremity Lt Any Jt Wo W Contrast,,73723,CPT,Facility,Both,,,LT,3254,2765.9,747,3254,"Multiplan, Inc.","Multiplan, Inc.",3058.76,94,,percent of total billed charges,,
Mri Lower Extremity Lt Any Jt Wo W Contrast,,73723,CPT,Facility,Outpatient,,,LT,3254,2765.9,747,3254,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1535,,,Other ,per scan,
Mri Lower Extremity Lt Any Jt Wo W Contrast,,73723,CPT,Facility,Inpatient,,,LT,3254,2765.9,747,3254,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Mri Lower Extremity Lt Any Jt Wo W Contrast,,73723,CPT,Facility,Both,,,LT,3254,2765.9,747,3254,"Preferred One Administrative Services, INC.",PPO,3208.444,98.6,,percent of total billed charges,,
Mri Lower Extremity Lt Any Jt Wo W Contrast,,73723,CPT,Facility,Outpatient,,,LT,3254,2765.9,747,3254,PrimeWest Health,Minnesota Senior Health Options (MSHO),1674.183,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Mri Lower Extremity Lt Any Jt Wo W Contrast,,73723,CPT,Facility,Inpatient,,,LT,3254,2765.9,747,3254,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mri Lower Extremity Lt Any Jt Wo W Contrast,,73723,CPT,Facility,Outpatient,,,LT,3254,2765.9,747,3254,PrimeWest Health,MinnesotaCare,1671.2544,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Mri Lower Extremity Lt Any Jt Wo W Contrast,,73723,CPT,Facility,Inpatient,,,LT,3254,2765.9,747,3254,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Mri Lower Extremity Lt Any Jt Wo W Contrast,,73723,CPT,Facility,Both,,,LT,3254,2765.9,747,3254,Sanford Health Plan,Sanford Health Plan,2993.68,92,,percent of total billed charges,,
Mri Lower Extremity Lt Any Jt Wo W Contrast,,73723,CPT,Facility,Outpatient,,,LT,3254,2765.9,747,3254,"UCare Health, Inc.",Individual & Family Plan,1833.629,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Mri Lower Extremity Lt Any Jt Wo W Contrast,,73723,CPT,Facility,Inpatient,,,LT,3254,2765.9,747,3254,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Mri Lower Extremity Lt Any Jt Wo W Contrast,,73723,CPT,Facility,Outpatient,,,LT,3254,2765.9,747,3254,"UCare Health, Inc.",Medical Assistance,1642.2938,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mri Lower Extremity Lt Any Jt Wo W Contrast,,73723,CPT,Facility,Inpatient,,,LT,3254,2765.9,747,3254,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Mri Lower Extremity Lt Any Jt Wo W Contrast,,73723,CPT,Facility,Outpatient,,,LT,3254,2765.9,747,3254,"UCare Health, Inc.",Medicare Advantage,1642.2938,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mri Lower Extremity Lt Any Jt Wo W Contrast,,73723,CPT,Facility,Inpatient,,,LT,3254,2765.9,747,3254,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mri Lower Extremity Lt Any Jt Wo W Contrast,,73723,CPT,Facility,Outpatient,,,LT,3254,2765.9,747,3254,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1642.2938,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mri Lower Extremity Lt Any Jt Wo W Contrast,,73723,CPT,Facility,Inpatient,,,LT,3254,2765.9,747,3254,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mri Lower Extremity Lt Any Jt Wo W Contrast,,73723,CPT,Facility,Both,,,LT,3254,2765.9,747,3254,UnitedHealthcare,Individual & Family,3058.76,94,,percent of total billed charges,,
Mri Lower Extremity Lt Any Jt Wo W Contrast,,73723,CPT,Facility,Outpatient,,,LT,3254,2765.9,747,3254,UnitedHealthcare,Medicare Advantage,1594.46,49,,percent of total billed charges,,
Mri Lower Extremity Lt Any Jt Wo W Contrast,,73723,CPT,Facility,Inpatient,,,LT,3254,2765.9,747,3254,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Mri Lower Extremity Lt Any Jt Wo W Contrast,,73723,CPT,Facility,Outpatient,,,LT,3254,2765.9,747,3254,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1561.92,48,,percent of total billed charges,,100% of DHS outpatient percentage
Mri Lower Extremity Lt Any Jt Wo W Contrast,,73723,CPT,Facility,Inpatient,,,LT,3254,2765.9,747,3254,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Us Carotid Ltd Lt,,93882,CPT,Facility,Both,,,LT,598,508.3,171.3868,598,Aetna,Commercial,550.16,92,,percent of total billed charges,,
Us Carotid Ltd Lt,,93882,CPT,Facility,Outpatient,,,LT,598,508.3,171.3868,598,Aetna,Medicare Advantage,293.02,49,,percent of total billed charges,,
Us Carotid Ltd Lt,,93882,CPT,Facility,Inpatient,,,LT,598,508.3,171.3868,598,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Us Carotid Ltd Lt,,93882,CPT,Facility,Both,,,LT,598,508.3,171.3868,598,Aetna,PPO,556.14,93,,percent of total billed charges,,
Us Carotid Ltd Lt,,93882,CPT,Facility,Both,,,LT,598,508.3,171.3868,598,America's PPO,America's PPO,574.2594,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Us Carotid Ltd Lt,,93882,CPT,Facility,Both,,,LT,598,508.3,171.3868,598,BlueCross BlueShield Minnesota, Federal Employee Program,588.432,98.4,,percent of total billed charges,,
Us Carotid Ltd Lt,,93882,CPT,Facility,Both,,,LT,598,508.3,171.3868,598,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,598,100,,percent of total billed charges,,
Us Carotid Ltd Lt,,93882,CPT,Facility,Both,,,LT,598,508.3,171.3868,598,BlueCross BlueShield Minnesota,High Value Network Plan,538.2,90,,percent of total billed charges,,
Us Carotid Ltd Lt,,93882,CPT,Facility,Outpatient,,,LT,598,508.3,171.3868,598,BlueCross BlueShield Minnesota,Medicare Advantage,293.02,49,,percent of total billed charges,,
Us Carotid Ltd Lt,,93882,CPT,Facility,Inpatient,,,LT,598,508.3,171.3868,598,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Us Carotid Ltd Lt,,93882,CPT,Facility,Both,,,LT,598,508.3,171.3868,598,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,529.6486,88.57,,percent of total billed charges,,
Us Carotid Ltd Lt,,93882,CPT,Facility,Both,,,LT,598,508.3,171.3868,598,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,171.3868,28.66,,percent of total billed charges,,
Us Carotid Ltd Lt,,93882,CPT,Facility,Outpatient,,,LT,598,508.3,171.3868,598,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),293.02,49,,percent of total billed charges,,
Us Carotid Ltd Lt,,93882,CPT,Facility,Inpatient,,,LT,598,508.3,171.3868,598,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Us Carotid Ltd Lt,,93882,CPT,Facility,Both,,,LT,598,508.3,171.3868,598,CorVel,Worker's Compensation,598,100,,percent of total billed charges,,
Us Carotid Ltd Lt,,93882,CPT,Facility,Both,,,LT,598,508.3,171.3868,598,First Health Group Corporation,First Health Network,580.06,97,,percent of total billed charges,,
Us Carotid Ltd Lt,,93882,CPT,Facility,Both,,,LT,598,508.3,171.3868,598,"Health Partners, Inc.",Commercial,565.708,94.6,,percent of total billed charges,,
Us Carotid Ltd Lt,,93882,CPT,Facility,Outpatient,,,LT,598,508.3,171.3868,598,"Health Partners, Inc.",Medicare Advantage,293.02,49,,percent of total billed charges,,
Us Carotid Ltd Lt,,93882,CPT,Facility,Inpatient,,,LT,598,508.3,171.3868,598,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Us Carotid Ltd Lt,,93882,CPT,Facility,Both,,,LT,598,508.3,171.3868,598,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),358.8,60,,percent of total billed charges,,
Us Carotid Ltd Lt,,93882,CPT,Facility,Both,,,LT,598,508.3,171.3868,598,"Health Partners, Inc.",State of Minnesota Advantage Program,487.37,81.5,,percent of total billed charges,,
Us Carotid Ltd Lt,,93882,CPT,Facility,Both,,,LT,598,508.3,171.3868,598,"Health Partners, Inc.",State Public Programs,299,50,,percent of total billed charges,,
Us Carotid Ltd Lt,,93882,CPT,Facility,Both,,,LT,598,508.3,171.3868,598,Humana Insurance Company,Commercial PPO,568.1,95,,percent of total billed charges,,
Us Carotid Ltd Lt,,93882,CPT,Facility,Outpatient,,,LT,598,508.3,171.3868,598,Humana Insurance Company,Medicare PPO,293.02,49,,percent of total billed charges,,
Us Carotid Ltd Lt,,93882,CPT,Facility,Inpatient,,,LT,598,508.3,171.3868,598,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Us Carotid Ltd Lt,,93882,CPT,Facility,Both,,,LT,598,508.3,171.3868,598,Medica,Individual & Family,592.618,99.1,,percent of total billed charges,,
Us Carotid Ltd Lt,,93882,CPT,Facility,Outpatient,,,LT,598,508.3,171.3868,598,Medica,Medica Advantage Solution,297.804,49.8,,percent of total billed charges,,
Us Carotid Ltd Lt,,93882,CPT,Facility,Inpatient,,,LT,598,508.3,171.3868,598,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Us Carotid Ltd Lt,,93882,CPT,Facility,Outpatient,,,LT,598,508.3,171.3868,598,Medica,Medical Assistance,266.708,44.6,,percent of total billed charges,,
Us Carotid Ltd Lt,,93882,CPT,Facility,Inpatient,,,LT,598,508.3,171.3868,598,Medica,Medical Assistance,,,,,Included in per diem rate,
Us Carotid Ltd Lt,,93882,CPT,Facility,Outpatient,,,LT,598,508.3,171.3868,598,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,297.804,49.8,,percent of total billed charges,,
Us Carotid Ltd Lt,,93882,CPT,Facility,Inpatient,,,LT,598,508.3,171.3868,598,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Us Carotid Ltd Lt,,93882,CPT,Facility,Both,,,LT,598,508.3,171.3868,598,"Multiplan, Inc.","Multiplan, Inc.",562.12,94,,percent of total billed charges,,
Us Carotid Ltd Lt,,93882,CPT,Facility,Outpatient,,,LT,598,508.3,171.3868,598,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,538.798,90.1,,percent of total billed charges,,
Us Carotid Ltd Lt,,93882,CPT,Facility,Inpatient,,,LT,598,508.3,171.3868,598,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Us Carotid Ltd Lt,,93882,CPT,Facility,Both,,,LT,598,508.3,171.3868,598,"Preferred One Administrative Services, INC.",PPO,589.628,98.6,,percent of total billed charges,,
Us Carotid Ltd Lt,,93882,CPT,Facility,Outpatient,,,LT,598,508.3,171.3868,598,PrimeWest Health,Minnesota Senior Health Options (MSHO),307.671,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Us Carotid Ltd Lt,,93882,CPT,Facility,Inpatient,,,LT,598,508.3,171.3868,598,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Us Carotid Ltd Lt,,93882,CPT,Facility,Outpatient,,,LT,598,508.3,171.3868,598,PrimeWest Health,MinnesotaCare,307.1328,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Us Carotid Ltd Lt,,93882,CPT,Facility,Inpatient,,,LT,598,508.3,171.3868,598,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Us Carotid Ltd Lt,,93882,CPT,Facility,Both,,,LT,598,508.3,171.3868,598,Sanford Health Plan,Sanford Health Plan,550.16,92,,percent of total billed charges,,
Us Carotid Ltd Lt,,93882,CPT,Facility,Outpatient,,,LT,598,508.3,171.3868,598,"UCare Health, Inc.",Individual & Family Plan,336.973,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Us Carotid Ltd Lt,,93882,CPT,Facility,Inpatient,,,LT,598,508.3,171.3868,598,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Us Carotid Ltd Lt,,93882,CPT,Facility,Outpatient,,,LT,598,508.3,171.3868,598,"UCare Health, Inc.",Medical Assistance,301.8106,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Carotid Ltd Lt,,93882,CPT,Facility,Inpatient,,,LT,598,508.3,171.3868,598,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Us Carotid Ltd Lt,,93882,CPT,Facility,Outpatient,,,LT,598,508.3,171.3868,598,"UCare Health, Inc.",Medicare Advantage,301.8106,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Carotid Ltd Lt,,93882,CPT,Facility,Inpatient,,,LT,598,508.3,171.3868,598,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Us Carotid Ltd Lt,,93882,CPT,Facility,Outpatient,,,LT,598,508.3,171.3868,598,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),301.8106,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Carotid Ltd Lt,,93882,CPT,Facility,Inpatient,,,LT,598,508.3,171.3868,598,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Us Carotid Ltd Lt,,93882,CPT,Facility,Both,,,LT,598,508.3,171.3868,598,UnitedHealthcare,Individual & Family,562.12,94,,percent of total billed charges,,
Us Carotid Ltd Lt,,93882,CPT,Facility,Outpatient,,,LT,598,508.3,171.3868,598,UnitedHealthcare,Medicare Advantage,293.02,49,,percent of total billed charges,,
Us Carotid Ltd Lt,,93882,CPT,Facility,Inpatient,,,LT,598,508.3,171.3868,598,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Us Carotid Ltd Lt,,93882,CPT,Facility,Outpatient,,,LT,598,508.3,171.3868,598,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,287.04,48,,percent of total billed charges,,100% of DHS outpatient percentage
Us Carotid Ltd Lt,,93882,CPT,Facility,Inpatient,,,LT,598,508.3,171.3868,598,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Us Dop Artery Leg Lt,,93926,CPT,Facility,Both,,,LT,636,540.6,182.2776,636,Aetna,Commercial,585.12,92,,percent of total billed charges,,
Us Dop Artery Leg Lt,,93926,CPT,Facility,Outpatient,,,LT,636,540.6,182.2776,636,Aetna,Medicare Advantage,311.64,49,,percent of total billed charges,,
Us Dop Artery Leg Lt,,93926,CPT,Facility,Inpatient,,,LT,636,540.6,182.2776,636,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Us Dop Artery Leg Lt,,93926,CPT,Facility,Both,,,LT,636,540.6,182.2776,636,Aetna,PPO,591.48,93,,percent of total billed charges,,
Us Dop Artery Leg Lt,,93926,CPT,Facility,Both,,,LT,636,540.6,182.2776,636,America's PPO,America's PPO,610.7508,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Us Dop Artery Leg Lt,,93926,CPT,Facility,Both,,,LT,636,540.6,182.2776,636,BlueCross BlueShield Minnesota, Federal Employee Program,625.824,98.4,,percent of total billed charges,,
Us Dop Artery Leg Lt,,93926,CPT,Facility,Both,,,LT,636,540.6,182.2776,636,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,636,100,,percent of total billed charges,,
Us Dop Artery Leg Lt,,93926,CPT,Facility,Both,,,LT,636,540.6,182.2776,636,BlueCross BlueShield Minnesota,High Value Network Plan,572.4,90,,percent of total billed charges,,
Us Dop Artery Leg Lt,,93926,CPT,Facility,Outpatient,,,LT,636,540.6,182.2776,636,BlueCross BlueShield Minnesota,Medicare Advantage,311.64,49,,percent of total billed charges,,
Us Dop Artery Leg Lt,,93926,CPT,Facility,Inpatient,,,LT,636,540.6,182.2776,636,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Us Dop Artery Leg Lt,,93926,CPT,Facility,Both,,,LT,636,540.6,182.2776,636,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,563.3052,88.57,,percent of total billed charges,,
Us Dop Artery Leg Lt,,93926,CPT,Facility,Both,,,LT,636,540.6,182.2776,636,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,182.2776,28.66,,percent of total billed charges,,
Us Dop Artery Leg Lt,,93926,CPT,Facility,Outpatient,,,LT,636,540.6,182.2776,636,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),311.64,49,,percent of total billed charges,,
Us Dop Artery Leg Lt,,93926,CPT,Facility,Inpatient,,,LT,636,540.6,182.2776,636,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Us Dop Artery Leg Lt,,93926,CPT,Facility,Both,,,LT,636,540.6,182.2776,636,CorVel,Worker's Compensation,636,100,,percent of total billed charges,,
Us Dop Artery Leg Lt,,93926,CPT,Facility,Both,,,LT,636,540.6,182.2776,636,First Health Group Corporation,First Health Network,616.92,97,,percent of total billed charges,,
Us Dop Artery Leg Lt,,93926,CPT,Facility,Both,,,LT,636,540.6,182.2776,636,"Health Partners, Inc.",Commercial,601.656,94.6,,percent of total billed charges,,
Us Dop Artery Leg Lt,,93926,CPT,Facility,Outpatient,,,LT,636,540.6,182.2776,636,"Health Partners, Inc.",Medicare Advantage,311.64,49,,percent of total billed charges,,
Us Dop Artery Leg Lt,,93926,CPT,Facility,Inpatient,,,LT,636,540.6,182.2776,636,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Us Dop Artery Leg Lt,,93926,CPT,Facility,Both,,,LT,636,540.6,182.2776,636,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),381.6,60,,percent of total billed charges,,
Us Dop Artery Leg Lt,,93926,CPT,Facility,Both,,,LT,636,540.6,182.2776,636,"Health Partners, Inc.",State of Minnesota Advantage Program,518.34,81.5,,percent of total billed charges,,
Us Dop Artery Leg Lt,,93926,CPT,Facility,Both,,,LT,636,540.6,182.2776,636,"Health Partners, Inc.",State Public Programs,318,50,,percent of total billed charges,,
Us Dop Artery Leg Lt,,93926,CPT,Facility,Both,,,LT,636,540.6,182.2776,636,Humana Insurance Company,Commercial PPO,604.2,95,,percent of total billed charges,,
Us Dop Artery Leg Lt,,93926,CPT,Facility,Outpatient,,,LT,636,540.6,182.2776,636,Humana Insurance Company,Medicare PPO,311.64,49,,percent of total billed charges,,
Us Dop Artery Leg Lt,,93926,CPT,Facility,Inpatient,,,LT,636,540.6,182.2776,636,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Us Dop Artery Leg Lt,,93926,CPT,Facility,Both,,,LT,636,540.6,182.2776,636,Medica,Individual & Family,630.276,99.1,,percent of total billed charges,,
Us Dop Artery Leg Lt,,93926,CPT,Facility,Outpatient,,,LT,636,540.6,182.2776,636,Medica,Medica Advantage Solution,316.728,49.8,,percent of total billed charges,,
Us Dop Artery Leg Lt,,93926,CPT,Facility,Inpatient,,,LT,636,540.6,182.2776,636,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Us Dop Artery Leg Lt,,93926,CPT,Facility,Outpatient,,,LT,636,540.6,182.2776,636,Medica,Medical Assistance,283.656,44.6,,percent of total billed charges,,
Us Dop Artery Leg Lt,,93926,CPT,Facility,Inpatient,,,LT,636,540.6,182.2776,636,Medica,Medical Assistance,,,,,Included in per diem rate,
Us Dop Artery Leg Lt,,93926,CPT,Facility,Outpatient,,,LT,636,540.6,182.2776,636,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,316.728,49.8,,percent of total billed charges,,
Us Dop Artery Leg Lt,,93926,CPT,Facility,Inpatient,,,LT,636,540.6,182.2776,636,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Us Dop Artery Leg Lt,,93926,CPT,Facility,Both,,,LT,636,540.6,182.2776,636,"Multiplan, Inc.","Multiplan, Inc.",597.84,94,,percent of total billed charges,,
Us Dop Artery Leg Lt,,93926,CPT,Facility,Outpatient,,,LT,636,540.6,182.2776,636,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,573.036,90.1,,percent of total billed charges,,
Us Dop Artery Leg Lt,,93926,CPT,Facility,Inpatient,,,LT,636,540.6,182.2776,636,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Us Dop Artery Leg Lt,,93926,CPT,Facility,Both,,,LT,636,540.6,182.2776,636,"Preferred One Administrative Services, INC.",PPO,627.096,98.6,,percent of total billed charges,,
Us Dop Artery Leg Lt,,93926,CPT,Facility,Outpatient,,,LT,636,540.6,182.2776,636,PrimeWest Health,Minnesota Senior Health Options (MSHO),327.222,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Us Dop Artery Leg Lt,,93926,CPT,Facility,Inpatient,,,LT,636,540.6,182.2776,636,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Us Dop Artery Leg Lt,,93926,CPT,Facility,Outpatient,,,LT,636,540.6,182.2776,636,PrimeWest Health,MinnesotaCare,326.6496,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Us Dop Artery Leg Lt,,93926,CPT,Facility,Inpatient,,,LT,636,540.6,182.2776,636,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Us Dop Artery Leg Lt,,93926,CPT,Facility,Both,,,LT,636,540.6,182.2776,636,Sanford Health Plan,Sanford Health Plan,585.12,92,,percent of total billed charges,,
Us Dop Artery Leg Lt,,93926,CPT,Facility,Outpatient,,,LT,636,540.6,182.2776,636,"UCare Health, Inc.",Individual & Family Plan,358.386,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Us Dop Artery Leg Lt,,93926,CPT,Facility,Inpatient,,,LT,636,540.6,182.2776,636,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Us Dop Artery Leg Lt,,93926,CPT,Facility,Outpatient,,,LT,636,540.6,182.2776,636,"UCare Health, Inc.",Medical Assistance,320.9892,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Dop Artery Leg Lt,,93926,CPT,Facility,Inpatient,,,LT,636,540.6,182.2776,636,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Us Dop Artery Leg Lt,,93926,CPT,Facility,Outpatient,,,LT,636,540.6,182.2776,636,"UCare Health, Inc.",Medicare Advantage,320.9892,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Dop Artery Leg Lt,,93926,CPT,Facility,Inpatient,,,LT,636,540.6,182.2776,636,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Us Dop Artery Leg Lt,,93926,CPT,Facility,Outpatient,,,LT,636,540.6,182.2776,636,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),320.9892,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Dop Artery Leg Lt,,93926,CPT,Facility,Inpatient,,,LT,636,540.6,182.2776,636,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Us Dop Artery Leg Lt,,93926,CPT,Facility,Both,,,LT,636,540.6,182.2776,636,UnitedHealthcare,Individual & Family,597.84,94,,percent of total billed charges,,
Us Dop Artery Leg Lt,,93926,CPT,Facility,Outpatient,,,LT,636,540.6,182.2776,636,UnitedHealthcare,Medicare Advantage,311.64,49,,percent of total billed charges,,
Us Dop Artery Leg Lt,,93926,CPT,Facility,Inpatient,,,LT,636,540.6,182.2776,636,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Us Dop Artery Leg Lt,,93926,CPT,Facility,Outpatient,,,LT,636,540.6,182.2776,636,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,305.28,48,,percent of total billed charges,,100% of DHS outpatient percentage
Us Dop Artery Leg Lt,,93926,CPT,Facility,Inpatient,,,LT,636,540.6,182.2776,636,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Us Dop Artery Arm Lt,,93931,CPT,Facility,Both,,,LT,606,515.1,173.6796,606,Aetna,Commercial,557.52,92,,percent of total billed charges,,
Us Dop Artery Arm Lt,,93931,CPT,Facility,Outpatient,,,LT,606,515.1,173.6796,606,Aetna,Medicare Advantage,296.94,49,,percent of total billed charges,,
Us Dop Artery Arm Lt,,93931,CPT,Facility,Inpatient,,,LT,606,515.1,173.6796,606,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Us Dop Artery Arm Lt,,93931,CPT,Facility,Both,,,LT,606,515.1,173.6796,606,Aetna,PPO,563.58,93,,percent of total billed charges,,
Us Dop Artery Arm Lt,,93931,CPT,Facility,Both,,,LT,606,515.1,173.6796,606,America's PPO,America's PPO,581.9418,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Us Dop Artery Arm Lt,,93931,CPT,Facility,Both,,,LT,606,515.1,173.6796,606,BlueCross BlueShield Minnesota, Federal Employee Program,596.304,98.4,,percent of total billed charges,,
Us Dop Artery Arm Lt,,93931,CPT,Facility,Both,,,LT,606,515.1,173.6796,606,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,606,100,,percent of total billed charges,,
Us Dop Artery Arm Lt,,93931,CPT,Facility,Both,,,LT,606,515.1,173.6796,606,BlueCross BlueShield Minnesota,High Value Network Plan,545.4,90,,percent of total billed charges,,
Us Dop Artery Arm Lt,,93931,CPT,Facility,Outpatient,,,LT,606,515.1,173.6796,606,BlueCross BlueShield Minnesota,Medicare Advantage,296.94,49,,percent of total billed charges,,
Us Dop Artery Arm Lt,,93931,CPT,Facility,Inpatient,,,LT,606,515.1,173.6796,606,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Us Dop Artery Arm Lt,,93931,CPT,Facility,Both,,,LT,606,515.1,173.6796,606,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,536.7342,88.57,,percent of total billed charges,,
Us Dop Artery Arm Lt,,93931,CPT,Facility,Both,,,LT,606,515.1,173.6796,606,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,173.6796,28.66,,percent of total billed charges,,
Us Dop Artery Arm Lt,,93931,CPT,Facility,Outpatient,,,LT,606,515.1,173.6796,606,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),296.94,49,,percent of total billed charges,,
Us Dop Artery Arm Lt,,93931,CPT,Facility,Inpatient,,,LT,606,515.1,173.6796,606,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Us Dop Artery Arm Lt,,93931,CPT,Facility,Both,,,LT,606,515.1,173.6796,606,CorVel,Worker's Compensation,606,100,,percent of total billed charges,,
Us Dop Artery Arm Lt,,93931,CPT,Facility,Both,,,LT,606,515.1,173.6796,606,First Health Group Corporation,First Health Network,587.82,97,,percent of total billed charges,,
Us Dop Artery Arm Lt,,93931,CPT,Facility,Both,,,LT,606,515.1,173.6796,606,"Health Partners, Inc.",Commercial,573.276,94.6,,percent of total billed charges,,
Us Dop Artery Arm Lt,,93931,CPT,Facility,Outpatient,,,LT,606,515.1,173.6796,606,"Health Partners, Inc.",Medicare Advantage,296.94,49,,percent of total billed charges,,
Us Dop Artery Arm Lt,,93931,CPT,Facility,Inpatient,,,LT,606,515.1,173.6796,606,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Us Dop Artery Arm Lt,,93931,CPT,Facility,Both,,,LT,606,515.1,173.6796,606,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),363.6,60,,percent of total billed charges,,
Us Dop Artery Arm Lt,,93931,CPT,Facility,Both,,,LT,606,515.1,173.6796,606,"Health Partners, Inc.",State of Minnesota Advantage Program,493.89,81.5,,percent of total billed charges,,
Us Dop Artery Arm Lt,,93931,CPT,Facility,Both,,,LT,606,515.1,173.6796,606,"Health Partners, Inc.",State Public Programs,303,50,,percent of total billed charges,,
Us Dop Artery Arm Lt,,93931,CPT,Facility,Both,,,LT,606,515.1,173.6796,606,Humana Insurance Company,Commercial PPO,575.7,95,,percent of total billed charges,,
Us Dop Artery Arm Lt,,93931,CPT,Facility,Outpatient,,,LT,606,515.1,173.6796,606,Humana Insurance Company,Medicare PPO,296.94,49,,percent of total billed charges,,
Us Dop Artery Arm Lt,,93931,CPT,Facility,Inpatient,,,LT,606,515.1,173.6796,606,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Us Dop Artery Arm Lt,,93931,CPT,Facility,Both,,,LT,606,515.1,173.6796,606,Medica,Individual & Family,600.546,99.1,,percent of total billed charges,,
Us Dop Artery Arm Lt,,93931,CPT,Facility,Outpatient,,,LT,606,515.1,173.6796,606,Medica,Medica Advantage Solution,301.788,49.8,,percent of total billed charges,,
Us Dop Artery Arm Lt,,93931,CPT,Facility,Inpatient,,,LT,606,515.1,173.6796,606,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Us Dop Artery Arm Lt,,93931,CPT,Facility,Outpatient,,,LT,606,515.1,173.6796,606,Medica,Medical Assistance,270.276,44.6,,percent of total billed charges,,
Us Dop Artery Arm Lt,,93931,CPT,Facility,Inpatient,,,LT,606,515.1,173.6796,606,Medica,Medical Assistance,,,,,Included in per diem rate,
Us Dop Artery Arm Lt,,93931,CPT,Facility,Outpatient,,,LT,606,515.1,173.6796,606,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,301.788,49.8,,percent of total billed charges,,
Us Dop Artery Arm Lt,,93931,CPT,Facility,Inpatient,,,LT,606,515.1,173.6796,606,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Us Dop Artery Arm Lt,,93931,CPT,Facility,Both,,,LT,606,515.1,173.6796,606,"Multiplan, Inc.","Multiplan, Inc.",569.64,94,,percent of total billed charges,,
Us Dop Artery Arm Lt,,93931,CPT,Facility,Outpatient,,,LT,606,515.1,173.6796,606,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,546.006,90.1,,percent of total billed charges,,
Us Dop Artery Arm Lt,,93931,CPT,Facility,Inpatient,,,LT,606,515.1,173.6796,606,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Us Dop Artery Arm Lt,,93931,CPT,Facility,Both,,,LT,606,515.1,173.6796,606,"Preferred One Administrative Services, INC.",PPO,597.516,98.6,,percent of total billed charges,,
Us Dop Artery Arm Lt,,93931,CPT,Facility,Outpatient,,,LT,606,515.1,173.6796,606,PrimeWest Health,Minnesota Senior Health Options (MSHO),311.787,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Us Dop Artery Arm Lt,,93931,CPT,Facility,Inpatient,,,LT,606,515.1,173.6796,606,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Us Dop Artery Arm Lt,,93931,CPT,Facility,Outpatient,,,LT,606,515.1,173.6796,606,PrimeWest Health,MinnesotaCare,311.2416,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Us Dop Artery Arm Lt,,93931,CPT,Facility,Inpatient,,,LT,606,515.1,173.6796,606,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Us Dop Artery Arm Lt,,93931,CPT,Facility,Both,,,LT,606,515.1,173.6796,606,Sanford Health Plan,Sanford Health Plan,557.52,92,,percent of total billed charges,,
Us Dop Artery Arm Lt,,93931,CPT,Facility,Outpatient,,,LT,606,515.1,173.6796,606,"UCare Health, Inc.",Individual & Family Plan,341.481,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Us Dop Artery Arm Lt,,93931,CPT,Facility,Inpatient,,,LT,606,515.1,173.6796,606,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Us Dop Artery Arm Lt,,93931,CPT,Facility,Outpatient,,,LT,606,515.1,173.6796,606,"UCare Health, Inc.",Medical Assistance,305.8482,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Dop Artery Arm Lt,,93931,CPT,Facility,Inpatient,,,LT,606,515.1,173.6796,606,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Us Dop Artery Arm Lt,,93931,CPT,Facility,Outpatient,,,LT,606,515.1,173.6796,606,"UCare Health, Inc.",Medicare Advantage,305.8482,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Dop Artery Arm Lt,,93931,CPT,Facility,Inpatient,,,LT,606,515.1,173.6796,606,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Us Dop Artery Arm Lt,,93931,CPT,Facility,Outpatient,,,LT,606,515.1,173.6796,606,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),305.8482,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Dop Artery Arm Lt,,93931,CPT,Facility,Inpatient,,,LT,606,515.1,173.6796,606,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Us Dop Artery Arm Lt,,93931,CPT,Facility,Both,,,LT,606,515.1,173.6796,606,UnitedHealthcare,Individual & Family,569.64,94,,percent of total billed charges,,
Us Dop Artery Arm Lt,,93931,CPT,Facility,Outpatient,,,LT,606,515.1,173.6796,606,UnitedHealthcare,Medicare Advantage,296.94,49,,percent of total billed charges,,
Us Dop Artery Arm Lt,,93931,CPT,Facility,Inpatient,,,LT,606,515.1,173.6796,606,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Us Dop Artery Arm Lt,,93931,CPT,Facility,Outpatient,,,LT,606,515.1,173.6796,606,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,290.88,48,,percent of total billed charges,,100% of DHS outpatient percentage
Us Dop Artery Arm Lt,,93931,CPT,Facility,Inpatient,,,LT,606,515.1,173.6796,606,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Us Dop Vein Arm Lt,,93971,CPT,Facility,Both,,,LT,626,532.1,179.4116,626,Aetna,Commercial,575.92,92,,percent of total billed charges,,
Us Dop Vein Arm Lt,,93971,CPT,Facility,Outpatient,,,LT,626,532.1,179.4116,626,Aetna,Medicare Advantage,306.74,49,,percent of total billed charges,,
Us Dop Vein Arm Lt,,93971,CPT,Facility,Inpatient,,,LT,626,532.1,179.4116,626,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Us Dop Vein Arm Lt,,93971,CPT,Facility,Both,,,LT,626,532.1,179.4116,626,Aetna,PPO,582.18,93,,percent of total billed charges,,
Us Dop Vein Arm Lt,,93971,CPT,Facility,Both,,,LT,626,532.1,179.4116,626,America's PPO,America's PPO,601.1478,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Us Dop Vein Arm Lt,,93971,CPT,Facility,Both,,,LT,626,532.1,179.4116,626,BlueCross BlueShield Minnesota, Federal Employee Program,615.984,98.4,,percent of total billed charges,,
Us Dop Vein Arm Lt,,93971,CPT,Facility,Both,,,LT,626,532.1,179.4116,626,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,626,100,,percent of total billed charges,,
Us Dop Vein Arm Lt,,93971,CPT,Facility,Both,,,LT,626,532.1,179.4116,626,BlueCross BlueShield Minnesota,High Value Network Plan,563.4,90,,percent of total billed charges,,
Us Dop Vein Arm Lt,,93971,CPT,Facility,Outpatient,,,LT,626,532.1,179.4116,626,BlueCross BlueShield Minnesota,Medicare Advantage,306.74,49,,percent of total billed charges,,
Us Dop Vein Arm Lt,,93971,CPT,Facility,Inpatient,,,LT,626,532.1,179.4116,626,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Us Dop Vein Arm Lt,,93971,CPT,Facility,Both,,,LT,626,532.1,179.4116,626,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,554.4482,88.57,,percent of total billed charges,,
Us Dop Vein Arm Lt,,93971,CPT,Facility,Both,,,LT,626,532.1,179.4116,626,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,179.4116,28.66,,percent of total billed charges,,
Us Dop Vein Arm Lt,,93971,CPT,Facility,Outpatient,,,LT,626,532.1,179.4116,626,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),306.74,49,,percent of total billed charges,,
Us Dop Vein Arm Lt,,93971,CPT,Facility,Inpatient,,,LT,626,532.1,179.4116,626,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Us Dop Vein Arm Lt,,93971,CPT,Facility,Both,,,LT,626,532.1,179.4116,626,CorVel,Worker's Compensation,626,100,,percent of total billed charges,,
Us Dop Vein Arm Lt,,93971,CPT,Facility,Both,,,LT,626,532.1,179.4116,626,First Health Group Corporation,First Health Network,607.22,97,,percent of total billed charges,,
Us Dop Vein Arm Lt,,93971,CPT,Facility,Both,,,LT,626,532.1,179.4116,626,"Health Partners, Inc.",Commercial,592.196,94.6,,percent of total billed charges,,
Us Dop Vein Arm Lt,,93971,CPT,Facility,Outpatient,,,LT,626,532.1,179.4116,626,"Health Partners, Inc.",Medicare Advantage,306.74,49,,percent of total billed charges,,
Us Dop Vein Arm Lt,,93971,CPT,Facility,Inpatient,,,LT,626,532.1,179.4116,626,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Us Dop Vein Arm Lt,,93971,CPT,Facility,Both,,,LT,626,532.1,179.4116,626,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),375.6,60,,percent of total billed charges,,
Us Dop Vein Arm Lt,,93971,CPT,Facility,Both,,,LT,626,532.1,179.4116,626,"Health Partners, Inc.",State of Minnesota Advantage Program,510.19,81.5,,percent of total billed charges,,
Us Dop Vein Arm Lt,,93971,CPT,Facility,Both,,,LT,626,532.1,179.4116,626,"Health Partners, Inc.",State Public Programs,313,50,,percent of total billed charges,,
Us Dop Vein Arm Lt,,93971,CPT,Facility,Both,,,LT,626,532.1,179.4116,626,Humana Insurance Company,Commercial PPO,594.7,95,,percent of total billed charges,,
Us Dop Vein Arm Lt,,93971,CPT,Facility,Outpatient,,,LT,626,532.1,179.4116,626,Humana Insurance Company,Medicare PPO,306.74,49,,percent of total billed charges,,
Us Dop Vein Arm Lt,,93971,CPT,Facility,Inpatient,,,LT,626,532.1,179.4116,626,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Us Dop Vein Arm Lt,,93971,CPT,Facility,Both,,,LT,626,532.1,179.4116,626,Medica,Individual & Family,620.366,99.1,,percent of total billed charges,,
Us Dop Vein Arm Lt,,93971,CPT,Facility,Outpatient,,,LT,626,532.1,179.4116,626,Medica,Medica Advantage Solution,311.748,49.8,,percent of total billed charges,,
Us Dop Vein Arm Lt,,93971,CPT,Facility,Inpatient,,,LT,626,532.1,179.4116,626,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Us Dop Vein Arm Lt,,93971,CPT,Facility,Outpatient,,,LT,626,532.1,179.4116,626,Medica,Medical Assistance,279.196,44.6,,percent of total billed charges,,
Us Dop Vein Arm Lt,,93971,CPT,Facility,Inpatient,,,LT,626,532.1,179.4116,626,Medica,Medical Assistance,,,,,Included in per diem rate,
Us Dop Vein Arm Lt,,93971,CPT,Facility,Outpatient,,,LT,626,532.1,179.4116,626,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,311.748,49.8,,percent of total billed charges,,
Us Dop Vein Arm Lt,,93971,CPT,Facility,Inpatient,,,LT,626,532.1,179.4116,626,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Us Dop Vein Arm Lt,,93971,CPT,Facility,Both,,,LT,626,532.1,179.4116,626,"Multiplan, Inc.","Multiplan, Inc.",588.44,94,,percent of total billed charges,,
Us Dop Vein Arm Lt,,93971,CPT,Facility,Outpatient,,,LT,626,532.1,179.4116,626,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,564.026,90.1,,percent of total billed charges,,
Us Dop Vein Arm Lt,,93971,CPT,Facility,Inpatient,,,LT,626,532.1,179.4116,626,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Us Dop Vein Arm Lt,,93971,CPT,Facility,Both,,,LT,626,532.1,179.4116,626,"Preferred One Administrative Services, INC.",PPO,617.236,98.6,,percent of total billed charges,,
Us Dop Vein Arm Lt,,93971,CPT,Facility,Outpatient,,,LT,626,532.1,179.4116,626,PrimeWest Health,Minnesota Senior Health Options (MSHO),322.077,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Us Dop Vein Arm Lt,,93971,CPT,Facility,Inpatient,,,LT,626,532.1,179.4116,626,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Us Dop Vein Arm Lt,,93971,CPT,Facility,Outpatient,,,LT,626,532.1,179.4116,626,PrimeWest Health,MinnesotaCare,321.5136,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Us Dop Vein Arm Lt,,93971,CPT,Facility,Inpatient,,,LT,626,532.1,179.4116,626,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Us Dop Vein Arm Lt,,93971,CPT,Facility,Both,,,LT,626,532.1,179.4116,626,Sanford Health Plan,Sanford Health Plan,575.92,92,,percent of total billed charges,,
Us Dop Vein Arm Lt,,93971,CPT,Facility,Outpatient,,,LT,626,532.1,179.4116,626,"UCare Health, Inc.",Individual & Family Plan,352.751,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Us Dop Vein Arm Lt,,93971,CPT,Facility,Inpatient,,,LT,626,532.1,179.4116,626,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Us Dop Vein Arm Lt,,93971,CPT,Facility,Outpatient,,,LT,626,532.1,179.4116,626,"UCare Health, Inc.",Medical Assistance,315.9422,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Dop Vein Arm Lt,,93971,CPT,Facility,Inpatient,,,LT,626,532.1,179.4116,626,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Us Dop Vein Arm Lt,,93971,CPT,Facility,Outpatient,,,LT,626,532.1,179.4116,626,"UCare Health, Inc.",Medicare Advantage,315.9422,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Dop Vein Arm Lt,,93971,CPT,Facility,Inpatient,,,LT,626,532.1,179.4116,626,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Us Dop Vein Arm Lt,,93971,CPT,Facility,Outpatient,,,LT,626,532.1,179.4116,626,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),315.9422,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Dop Vein Arm Lt,,93971,CPT,Facility,Inpatient,,,LT,626,532.1,179.4116,626,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Us Dop Vein Arm Lt,,93971,CPT,Facility,Both,,,LT,626,532.1,179.4116,626,UnitedHealthcare,Individual & Family,588.44,94,,percent of total billed charges,,
Us Dop Vein Arm Lt,,93971,CPT,Facility,Outpatient,,,LT,626,532.1,179.4116,626,UnitedHealthcare,Medicare Advantage,306.74,49,,percent of total billed charges,,
Us Dop Vein Arm Lt,,93971,CPT,Facility,Inpatient,,,LT,626,532.1,179.4116,626,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Us Dop Vein Arm Lt,,93971,CPT,Facility,Outpatient,,,LT,626,532.1,179.4116,626,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,300.48,48,,percent of total billed charges,,100% of DHS outpatient percentage
Us Dop Vein Arm Lt,,93971,CPT,Facility,Inpatient,,,LT,626,532.1,179.4116,626,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Us Dop Vein Leg Lt,,93971,CPT,Facility,Both,,,LT,626,532.1,179.4116,626,Aetna,Commercial,575.92,92,,percent of total billed charges,,
Us Dop Vein Leg Lt,,93971,CPT,Facility,Outpatient,,,LT,626,532.1,179.4116,626,Aetna,Medicare Advantage,306.74,49,,percent of total billed charges,,
Us Dop Vein Leg Lt,,93971,CPT,Facility,Inpatient,,,LT,626,532.1,179.4116,626,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Us Dop Vein Leg Lt,,93971,CPT,Facility,Both,,,LT,626,532.1,179.4116,626,Aetna,PPO,582.18,93,,percent of total billed charges,,
Us Dop Vein Leg Lt,,93971,CPT,Facility,Both,,,LT,626,532.1,179.4116,626,America's PPO,America's PPO,601.1478,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Us Dop Vein Leg Lt,,93971,CPT,Facility,Both,,,LT,626,532.1,179.4116,626,BlueCross BlueShield Minnesota, Federal Employee Program,615.984,98.4,,percent of total billed charges,,
Us Dop Vein Leg Lt,,93971,CPT,Facility,Both,,,LT,626,532.1,179.4116,626,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,626,100,,percent of total billed charges,,
Us Dop Vein Leg Lt,,93971,CPT,Facility,Both,,,LT,626,532.1,179.4116,626,BlueCross BlueShield Minnesota,High Value Network Plan,563.4,90,,percent of total billed charges,,
Us Dop Vein Leg Lt,,93971,CPT,Facility,Outpatient,,,LT,626,532.1,179.4116,626,BlueCross BlueShield Minnesota,Medicare Advantage,306.74,49,,percent of total billed charges,,
Us Dop Vein Leg Lt,,93971,CPT,Facility,Inpatient,,,LT,626,532.1,179.4116,626,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Us Dop Vein Leg Lt,,93971,CPT,Facility,Both,,,LT,626,532.1,179.4116,626,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,554.4482,88.57,,percent of total billed charges,,
Us Dop Vein Leg Lt,,93971,CPT,Facility,Both,,,LT,626,532.1,179.4116,626,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,179.4116,28.66,,percent of total billed charges,,
Us Dop Vein Leg Lt,,93971,CPT,Facility,Outpatient,,,LT,626,532.1,179.4116,626,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),306.74,49,,percent of total billed charges,,
Us Dop Vein Leg Lt,,93971,CPT,Facility,Inpatient,,,LT,626,532.1,179.4116,626,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Us Dop Vein Leg Lt,,93971,CPT,Facility,Both,,,LT,626,532.1,179.4116,626,CorVel,Worker's Compensation,626,100,,percent of total billed charges,,
Us Dop Vein Leg Lt,,93971,CPT,Facility,Both,,,LT,626,532.1,179.4116,626,First Health Group Corporation,First Health Network,607.22,97,,percent of total billed charges,,
Us Dop Vein Leg Lt,,93971,CPT,Facility,Both,,,LT,626,532.1,179.4116,626,"Health Partners, Inc.",Commercial,592.196,94.6,,percent of total billed charges,,
Us Dop Vein Leg Lt,,93971,CPT,Facility,Outpatient,,,LT,626,532.1,179.4116,626,"Health Partners, Inc.",Medicare Advantage,306.74,49,,percent of total billed charges,,
Us Dop Vein Leg Lt,,93971,CPT,Facility,Inpatient,,,LT,626,532.1,179.4116,626,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Us Dop Vein Leg Lt,,93971,CPT,Facility,Both,,,LT,626,532.1,179.4116,626,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),375.6,60,,percent of total billed charges,,
Us Dop Vein Leg Lt,,93971,CPT,Facility,Both,,,LT,626,532.1,179.4116,626,"Health Partners, Inc.",State of Minnesota Advantage Program,510.19,81.5,,percent of total billed charges,,
Us Dop Vein Leg Lt,,93971,CPT,Facility,Both,,,LT,626,532.1,179.4116,626,"Health Partners, Inc.",State Public Programs,313,50,,percent of total billed charges,,
Us Dop Vein Leg Lt,,93971,CPT,Facility,Both,,,LT,626,532.1,179.4116,626,Humana Insurance Company,Commercial PPO,594.7,95,,percent of total billed charges,,
Us Dop Vein Leg Lt,,93971,CPT,Facility,Outpatient,,,LT,626,532.1,179.4116,626,Humana Insurance Company,Medicare PPO,306.74,49,,percent of total billed charges,,
Us Dop Vein Leg Lt,,93971,CPT,Facility,Inpatient,,,LT,626,532.1,179.4116,626,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Us Dop Vein Leg Lt,,93971,CPT,Facility,Both,,,LT,626,532.1,179.4116,626,Medica,Individual & Family,620.366,99.1,,percent of total billed charges,,
Us Dop Vein Leg Lt,,93971,CPT,Facility,Outpatient,,,LT,626,532.1,179.4116,626,Medica,Medica Advantage Solution,311.748,49.8,,percent of total billed charges,,
Us Dop Vein Leg Lt,,93971,CPT,Facility,Inpatient,,,LT,626,532.1,179.4116,626,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Us Dop Vein Leg Lt,,93971,CPT,Facility,Outpatient,,,LT,626,532.1,179.4116,626,Medica,Medical Assistance,279.196,44.6,,percent of total billed charges,,
Us Dop Vein Leg Lt,,93971,CPT,Facility,Inpatient,,,LT,626,532.1,179.4116,626,Medica,Medical Assistance,,,,,Included in per diem rate,
Us Dop Vein Leg Lt,,93971,CPT,Facility,Outpatient,,,LT,626,532.1,179.4116,626,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,311.748,49.8,,percent of total billed charges,,
Us Dop Vein Leg Lt,,93971,CPT,Facility,Inpatient,,,LT,626,532.1,179.4116,626,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Us Dop Vein Leg Lt,,93971,CPT,Facility,Both,,,LT,626,532.1,179.4116,626,"Multiplan, Inc.","Multiplan, Inc.",588.44,94,,percent of total billed charges,,
Us Dop Vein Leg Lt,,93971,CPT,Facility,Outpatient,,,LT,626,532.1,179.4116,626,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,564.026,90.1,,percent of total billed charges,,
Us Dop Vein Leg Lt,,93971,CPT,Facility,Inpatient,,,LT,626,532.1,179.4116,626,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Us Dop Vein Leg Lt,,93971,CPT,Facility,Both,,,LT,626,532.1,179.4116,626,"Preferred One Administrative Services, INC.",PPO,617.236,98.6,,percent of total billed charges,,
Us Dop Vein Leg Lt,,93971,CPT,Facility,Outpatient,,,LT,626,532.1,179.4116,626,PrimeWest Health,Minnesota Senior Health Options (MSHO),322.077,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Us Dop Vein Leg Lt,,93971,CPT,Facility,Inpatient,,,LT,626,532.1,179.4116,626,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Us Dop Vein Leg Lt,,93971,CPT,Facility,Outpatient,,,LT,626,532.1,179.4116,626,PrimeWest Health,MinnesotaCare,321.5136,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Us Dop Vein Leg Lt,,93971,CPT,Facility,Inpatient,,,LT,626,532.1,179.4116,626,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Us Dop Vein Leg Lt,,93971,CPT,Facility,Both,,,LT,626,532.1,179.4116,626,Sanford Health Plan,Sanford Health Plan,575.92,92,,percent of total billed charges,,
Us Dop Vein Leg Lt,,93971,CPT,Facility,Outpatient,,,LT,626,532.1,179.4116,626,"UCare Health, Inc.",Individual & Family Plan,352.751,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Us Dop Vein Leg Lt,,93971,CPT,Facility,Inpatient,,,LT,626,532.1,179.4116,626,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Us Dop Vein Leg Lt,,93971,CPT,Facility,Outpatient,,,LT,626,532.1,179.4116,626,"UCare Health, Inc.",Medical Assistance,315.9422,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Dop Vein Leg Lt,,93971,CPT,Facility,Inpatient,,,LT,626,532.1,179.4116,626,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Us Dop Vein Leg Lt,,93971,CPT,Facility,Outpatient,,,LT,626,532.1,179.4116,626,"UCare Health, Inc.",Medicare Advantage,315.9422,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Dop Vein Leg Lt,,93971,CPT,Facility,Inpatient,,,LT,626,532.1,179.4116,626,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Us Dop Vein Leg Lt,,93971,CPT,Facility,Outpatient,,,LT,626,532.1,179.4116,626,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),315.9422,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Dop Vein Leg Lt,,93971,CPT,Facility,Inpatient,,,LT,626,532.1,179.4116,626,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Us Dop Vein Leg Lt,,93971,CPT,Facility,Both,,,LT,626,532.1,179.4116,626,UnitedHealthcare,Individual & Family,588.44,94,,percent of total billed charges,,
Us Dop Vein Leg Lt,,93971,CPT,Facility,Outpatient,,,LT,626,532.1,179.4116,626,UnitedHealthcare,Medicare Advantage,306.74,49,,percent of total billed charges,,
Us Dop Vein Leg Lt,,93971,CPT,Facility,Inpatient,,,LT,626,532.1,179.4116,626,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Us Dop Vein Leg Lt,,93971,CPT,Facility,Outpatient,,,LT,626,532.1,179.4116,626,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,300.48,48,,percent of total billed charges,,100% of DHS outpatient percentage
Us Dop Vein Leg Lt,,93971,CPT,Facility,Inpatient,,,LT,626,532.1,179.4116,626,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Us Vein Meas And Or Map Arm Lt,,93971,CPT,Facility,Both,,,LT,626,532.1,179.4116,626,Aetna,Commercial,575.92,92,,percent of total billed charges,,
Us Vein Meas And Or Map Arm Lt,,93971,CPT,Facility,Outpatient,,,LT,626,532.1,179.4116,626,Aetna,Medicare Advantage,306.74,49,,percent of total billed charges,,
Us Vein Meas And Or Map Arm Lt,,93971,CPT,Facility,Inpatient,,,LT,626,532.1,179.4116,626,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Us Vein Meas And Or Map Arm Lt,,93971,CPT,Facility,Both,,,LT,626,532.1,179.4116,626,Aetna,PPO,582.18,93,,percent of total billed charges,,
Us Vein Meas And Or Map Arm Lt,,93971,CPT,Facility,Both,,,LT,626,532.1,179.4116,626,America's PPO,America's PPO,601.1478,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Us Vein Meas And Or Map Arm Lt,,93971,CPT,Facility,Both,,,LT,626,532.1,179.4116,626,BlueCross BlueShield Minnesota, Federal Employee Program,615.984,98.4,,percent of total billed charges,,
Us Vein Meas And Or Map Arm Lt,,93971,CPT,Facility,Both,,,LT,626,532.1,179.4116,626,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,626,100,,percent of total billed charges,,
Us Vein Meas And Or Map Arm Lt,,93971,CPT,Facility,Both,,,LT,626,532.1,179.4116,626,BlueCross BlueShield Minnesota,High Value Network Plan,563.4,90,,percent of total billed charges,,
Us Vein Meas And Or Map Arm Lt,,93971,CPT,Facility,Outpatient,,,LT,626,532.1,179.4116,626,BlueCross BlueShield Minnesota,Medicare Advantage,306.74,49,,percent of total billed charges,,
Us Vein Meas And Or Map Arm Lt,,93971,CPT,Facility,Inpatient,,,LT,626,532.1,179.4116,626,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Us Vein Meas And Or Map Arm Lt,,93971,CPT,Facility,Both,,,LT,626,532.1,179.4116,626,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,554.4482,88.57,,percent of total billed charges,,
Us Vein Meas And Or Map Arm Lt,,93971,CPT,Facility,Both,,,LT,626,532.1,179.4116,626,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,179.4116,28.66,,percent of total billed charges,,
Us Vein Meas And Or Map Arm Lt,,93971,CPT,Facility,Outpatient,,,LT,626,532.1,179.4116,626,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),306.74,49,,percent of total billed charges,,
Us Vein Meas And Or Map Arm Lt,,93971,CPT,Facility,Inpatient,,,LT,626,532.1,179.4116,626,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Us Vein Meas And Or Map Arm Lt,,93971,CPT,Facility,Both,,,LT,626,532.1,179.4116,626,CorVel,Worker's Compensation,626,100,,percent of total billed charges,,
Us Vein Meas And Or Map Arm Lt,,93971,CPT,Facility,Both,,,LT,626,532.1,179.4116,626,First Health Group Corporation,First Health Network,607.22,97,,percent of total billed charges,,
Us Vein Meas And Or Map Arm Lt,,93971,CPT,Facility,Both,,,LT,626,532.1,179.4116,626,"Health Partners, Inc.",Commercial,592.196,94.6,,percent of total billed charges,,
Us Vein Meas And Or Map Arm Lt,,93971,CPT,Facility,Outpatient,,,LT,626,532.1,179.4116,626,"Health Partners, Inc.",Medicare Advantage,306.74,49,,percent of total billed charges,,
Us Vein Meas And Or Map Arm Lt,,93971,CPT,Facility,Inpatient,,,LT,626,532.1,179.4116,626,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Us Vein Meas And Or Map Arm Lt,,93971,CPT,Facility,Both,,,LT,626,532.1,179.4116,626,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),375.6,60,,percent of total billed charges,,
Us Vein Meas And Or Map Arm Lt,,93971,CPT,Facility,Both,,,LT,626,532.1,179.4116,626,"Health Partners, Inc.",State of Minnesota Advantage Program,510.19,81.5,,percent of total billed charges,,
Us Vein Meas And Or Map Arm Lt,,93971,CPT,Facility,Both,,,LT,626,532.1,179.4116,626,"Health Partners, Inc.",State Public Programs,313,50,,percent of total billed charges,,
Us Vein Meas And Or Map Arm Lt,,93971,CPT,Facility,Both,,,LT,626,532.1,179.4116,626,Humana Insurance Company,Commercial PPO,594.7,95,,percent of total billed charges,,
Us Vein Meas And Or Map Arm Lt,,93971,CPT,Facility,Outpatient,,,LT,626,532.1,179.4116,626,Humana Insurance Company,Medicare PPO,306.74,49,,percent of total billed charges,,
Us Vein Meas And Or Map Arm Lt,,93971,CPT,Facility,Inpatient,,,LT,626,532.1,179.4116,626,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Us Vein Meas And Or Map Arm Lt,,93971,CPT,Facility,Both,,,LT,626,532.1,179.4116,626,Medica,Individual & Family,620.366,99.1,,percent of total billed charges,,
Us Vein Meas And Or Map Arm Lt,,93971,CPT,Facility,Outpatient,,,LT,626,532.1,179.4116,626,Medica,Medica Advantage Solution,311.748,49.8,,percent of total billed charges,,
Us Vein Meas And Or Map Arm Lt,,93971,CPT,Facility,Inpatient,,,LT,626,532.1,179.4116,626,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Us Vein Meas And Or Map Arm Lt,,93971,CPT,Facility,Outpatient,,,LT,626,532.1,179.4116,626,Medica,Medical Assistance,279.196,44.6,,percent of total billed charges,,
Us Vein Meas And Or Map Arm Lt,,93971,CPT,Facility,Inpatient,,,LT,626,532.1,179.4116,626,Medica,Medical Assistance,,,,,Included in per diem rate,
Us Vein Meas And Or Map Arm Lt,,93971,CPT,Facility,Outpatient,,,LT,626,532.1,179.4116,626,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,311.748,49.8,,percent of total billed charges,,
Us Vein Meas And Or Map Arm Lt,,93971,CPT,Facility,Inpatient,,,LT,626,532.1,179.4116,626,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Us Vein Meas And Or Map Arm Lt,,93971,CPT,Facility,Both,,,LT,626,532.1,179.4116,626,"Multiplan, Inc.","Multiplan, Inc.",588.44,94,,percent of total billed charges,,
Us Vein Meas And Or Map Arm Lt,,93971,CPT,Facility,Outpatient,,,LT,626,532.1,179.4116,626,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,564.026,90.1,,percent of total billed charges,,
Us Vein Meas And Or Map Arm Lt,,93971,CPT,Facility,Inpatient,,,LT,626,532.1,179.4116,626,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Us Vein Meas And Or Map Arm Lt,,93971,CPT,Facility,Both,,,LT,626,532.1,179.4116,626,"Preferred One Administrative Services, INC.",PPO,617.236,98.6,,percent of total billed charges,,
Us Vein Meas And Or Map Arm Lt,,93971,CPT,Facility,Outpatient,,,LT,626,532.1,179.4116,626,PrimeWest Health,Minnesota Senior Health Options (MSHO),322.077,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Us Vein Meas And Or Map Arm Lt,,93971,CPT,Facility,Inpatient,,,LT,626,532.1,179.4116,626,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Us Vein Meas And Or Map Arm Lt,,93971,CPT,Facility,Outpatient,,,LT,626,532.1,179.4116,626,PrimeWest Health,MinnesotaCare,321.5136,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Us Vein Meas And Or Map Arm Lt,,93971,CPT,Facility,Inpatient,,,LT,626,532.1,179.4116,626,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Us Vein Meas And Or Map Arm Lt,,93971,CPT,Facility,Both,,,LT,626,532.1,179.4116,626,Sanford Health Plan,Sanford Health Plan,575.92,92,,percent of total billed charges,,
Us Vein Meas And Or Map Arm Lt,,93971,CPT,Facility,Outpatient,,,LT,626,532.1,179.4116,626,"UCare Health, Inc.",Individual & Family Plan,352.751,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Us Vein Meas And Or Map Arm Lt,,93971,CPT,Facility,Inpatient,,,LT,626,532.1,179.4116,626,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Us Vein Meas And Or Map Arm Lt,,93971,CPT,Facility,Outpatient,,,LT,626,532.1,179.4116,626,"UCare Health, Inc.",Medical Assistance,315.9422,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Vein Meas And Or Map Arm Lt,,93971,CPT,Facility,Inpatient,,,LT,626,532.1,179.4116,626,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Us Vein Meas And Or Map Arm Lt,,93971,CPT,Facility,Outpatient,,,LT,626,532.1,179.4116,626,"UCare Health, Inc.",Medicare Advantage,315.9422,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Vein Meas And Or Map Arm Lt,,93971,CPT,Facility,Inpatient,,,LT,626,532.1,179.4116,626,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Us Vein Meas And Or Map Arm Lt,,93971,CPT,Facility,Outpatient,,,LT,626,532.1,179.4116,626,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),315.9422,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Vein Meas And Or Map Arm Lt,,93971,CPT,Facility,Inpatient,,,LT,626,532.1,179.4116,626,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Us Vein Meas And Or Map Arm Lt,,93971,CPT,Facility,Both,,,LT,626,532.1,179.4116,626,UnitedHealthcare,Individual & Family,588.44,94,,percent of total billed charges,,
Us Vein Meas And Or Map Arm Lt,,93971,CPT,Facility,Outpatient,,,LT,626,532.1,179.4116,626,UnitedHealthcare,Medicare Advantage,306.74,49,,percent of total billed charges,,
Us Vein Meas And Or Map Arm Lt,,93971,CPT,Facility,Inpatient,,,LT,626,532.1,179.4116,626,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Us Vein Meas And Or Map Arm Lt,,93971,CPT,Facility,Outpatient,,,LT,626,532.1,179.4116,626,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,300.48,48,,percent of total billed charges,,100% of DHS outpatient percentage
Us Vein Meas And Or Map Arm Lt,,93971,CPT,Facility,Inpatient,,,LT,626,532.1,179.4116,626,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Us Vein Meas And Or Map Leg Lt,,93971,CPT,Facility,Both,,,LT,626,532.1,179.4116,626,Aetna,Commercial,575.92,92,,percent of total billed charges,,
Us Vein Meas And Or Map Leg Lt,,93971,CPT,Facility,Outpatient,,,LT,626,532.1,179.4116,626,Aetna,Medicare Advantage,306.74,49,,percent of total billed charges,,
Us Vein Meas And Or Map Leg Lt,,93971,CPT,Facility,Inpatient,,,LT,626,532.1,179.4116,626,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Us Vein Meas And Or Map Leg Lt,,93971,CPT,Facility,Both,,,LT,626,532.1,179.4116,626,Aetna,PPO,582.18,93,,percent of total billed charges,,
Us Vein Meas And Or Map Leg Lt,,93971,CPT,Facility,Both,,,LT,626,532.1,179.4116,626,America's PPO,America's PPO,601.1478,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Us Vein Meas And Or Map Leg Lt,,93971,CPT,Facility,Both,,,LT,626,532.1,179.4116,626,BlueCross BlueShield Minnesota, Federal Employee Program,615.984,98.4,,percent of total billed charges,,
Us Vein Meas And Or Map Leg Lt,,93971,CPT,Facility,Both,,,LT,626,532.1,179.4116,626,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,626,100,,percent of total billed charges,,
Us Vein Meas And Or Map Leg Lt,,93971,CPT,Facility,Both,,,LT,626,532.1,179.4116,626,BlueCross BlueShield Minnesota,High Value Network Plan,563.4,90,,percent of total billed charges,,
Us Vein Meas And Or Map Leg Lt,,93971,CPT,Facility,Outpatient,,,LT,626,532.1,179.4116,626,BlueCross BlueShield Minnesota,Medicare Advantage,306.74,49,,percent of total billed charges,,
Us Vein Meas And Or Map Leg Lt,,93971,CPT,Facility,Inpatient,,,LT,626,532.1,179.4116,626,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Us Vein Meas And Or Map Leg Lt,,93971,CPT,Facility,Both,,,LT,626,532.1,179.4116,626,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,554.4482,88.57,,percent of total billed charges,,
Us Vein Meas And Or Map Leg Lt,,93971,CPT,Facility,Both,,,LT,626,532.1,179.4116,626,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,179.4116,28.66,,percent of total billed charges,,
Us Vein Meas And Or Map Leg Lt,,93971,CPT,Facility,Outpatient,,,LT,626,532.1,179.4116,626,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),306.74,49,,percent of total billed charges,,
Us Vein Meas And Or Map Leg Lt,,93971,CPT,Facility,Inpatient,,,LT,626,532.1,179.4116,626,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Us Vein Meas And Or Map Leg Lt,,93971,CPT,Facility,Both,,,LT,626,532.1,179.4116,626,CorVel,Worker's Compensation,626,100,,percent of total billed charges,,
Us Vein Meas And Or Map Leg Lt,,93971,CPT,Facility,Both,,,LT,626,532.1,179.4116,626,First Health Group Corporation,First Health Network,607.22,97,,percent of total billed charges,,
Us Vein Meas And Or Map Leg Lt,,93971,CPT,Facility,Both,,,LT,626,532.1,179.4116,626,"Health Partners, Inc.",Commercial,592.196,94.6,,percent of total billed charges,,
Us Vein Meas And Or Map Leg Lt,,93971,CPT,Facility,Outpatient,,,LT,626,532.1,179.4116,626,"Health Partners, Inc.",Medicare Advantage,306.74,49,,percent of total billed charges,,
Us Vein Meas And Or Map Leg Lt,,93971,CPT,Facility,Inpatient,,,LT,626,532.1,179.4116,626,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Us Vein Meas And Or Map Leg Lt,,93971,CPT,Facility,Both,,,LT,626,532.1,179.4116,626,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),375.6,60,,percent of total billed charges,,
Us Vein Meas And Or Map Leg Lt,,93971,CPT,Facility,Both,,,LT,626,532.1,179.4116,626,"Health Partners, Inc.",State of Minnesota Advantage Program,510.19,81.5,,percent of total billed charges,,
Us Vein Meas And Or Map Leg Lt,,93971,CPT,Facility,Both,,,LT,626,532.1,179.4116,626,"Health Partners, Inc.",State Public Programs,313,50,,percent of total billed charges,,
Us Vein Meas And Or Map Leg Lt,,93971,CPT,Facility,Both,,,LT,626,532.1,179.4116,626,Humana Insurance Company,Commercial PPO,594.7,95,,percent of total billed charges,,
Us Vein Meas And Or Map Leg Lt,,93971,CPT,Facility,Outpatient,,,LT,626,532.1,179.4116,626,Humana Insurance Company,Medicare PPO,306.74,49,,percent of total billed charges,,
Us Vein Meas And Or Map Leg Lt,,93971,CPT,Facility,Inpatient,,,LT,626,532.1,179.4116,626,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Us Vein Meas And Or Map Leg Lt,,93971,CPT,Facility,Both,,,LT,626,532.1,179.4116,626,Medica,Individual & Family,620.366,99.1,,percent of total billed charges,,
Us Vein Meas And Or Map Leg Lt,,93971,CPT,Facility,Outpatient,,,LT,626,532.1,179.4116,626,Medica,Medica Advantage Solution,311.748,49.8,,percent of total billed charges,,
Us Vein Meas And Or Map Leg Lt,,93971,CPT,Facility,Inpatient,,,LT,626,532.1,179.4116,626,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Us Vein Meas And Or Map Leg Lt,,93971,CPT,Facility,Outpatient,,,LT,626,532.1,179.4116,626,Medica,Medical Assistance,279.196,44.6,,percent of total billed charges,,
Us Vein Meas And Or Map Leg Lt,,93971,CPT,Facility,Inpatient,,,LT,626,532.1,179.4116,626,Medica,Medical Assistance,,,,,Included in per diem rate,
Us Vein Meas And Or Map Leg Lt,,93971,CPT,Facility,Outpatient,,,LT,626,532.1,179.4116,626,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,311.748,49.8,,percent of total billed charges,,
Us Vein Meas And Or Map Leg Lt,,93971,CPT,Facility,Inpatient,,,LT,626,532.1,179.4116,626,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Us Vein Meas And Or Map Leg Lt,,93971,CPT,Facility,Both,,,LT,626,532.1,179.4116,626,"Multiplan, Inc.","Multiplan, Inc.",588.44,94,,percent of total billed charges,,
Us Vein Meas And Or Map Leg Lt,,93971,CPT,Facility,Outpatient,,,LT,626,532.1,179.4116,626,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,564.026,90.1,,percent of total billed charges,,
Us Vein Meas And Or Map Leg Lt,,93971,CPT,Facility,Inpatient,,,LT,626,532.1,179.4116,626,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Us Vein Meas And Or Map Leg Lt,,93971,CPT,Facility,Both,,,LT,626,532.1,179.4116,626,"Preferred One Administrative Services, INC.",PPO,617.236,98.6,,percent of total billed charges,,
Us Vein Meas And Or Map Leg Lt,,93971,CPT,Facility,Outpatient,,,LT,626,532.1,179.4116,626,PrimeWest Health,Minnesota Senior Health Options (MSHO),322.077,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Us Vein Meas And Or Map Leg Lt,,93971,CPT,Facility,Inpatient,,,LT,626,532.1,179.4116,626,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Us Vein Meas And Or Map Leg Lt,,93971,CPT,Facility,Outpatient,,,LT,626,532.1,179.4116,626,PrimeWest Health,MinnesotaCare,321.5136,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Us Vein Meas And Or Map Leg Lt,,93971,CPT,Facility,Inpatient,,,LT,626,532.1,179.4116,626,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Us Vein Meas And Or Map Leg Lt,,93971,CPT,Facility,Both,,,LT,626,532.1,179.4116,626,Sanford Health Plan,Sanford Health Plan,575.92,92,,percent of total billed charges,,
Us Vein Meas And Or Map Leg Lt,,93971,CPT,Facility,Outpatient,,,LT,626,532.1,179.4116,626,"UCare Health, Inc.",Individual & Family Plan,352.751,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Us Vein Meas And Or Map Leg Lt,,93971,CPT,Facility,Inpatient,,,LT,626,532.1,179.4116,626,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Us Vein Meas And Or Map Leg Lt,,93971,CPT,Facility,Outpatient,,,LT,626,532.1,179.4116,626,"UCare Health, Inc.",Medical Assistance,315.9422,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Vein Meas And Or Map Leg Lt,,93971,CPT,Facility,Inpatient,,,LT,626,532.1,179.4116,626,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Us Vein Meas And Or Map Leg Lt,,93971,CPT,Facility,Outpatient,,,LT,626,532.1,179.4116,626,"UCare Health, Inc.",Medicare Advantage,315.9422,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Vein Meas And Or Map Leg Lt,,93971,CPT,Facility,Inpatient,,,LT,626,532.1,179.4116,626,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Us Vein Meas And Or Map Leg Lt,,93971,CPT,Facility,Outpatient,,,LT,626,532.1,179.4116,626,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),315.9422,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Vein Meas And Or Map Leg Lt,,93971,CPT,Facility,Inpatient,,,LT,626,532.1,179.4116,626,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Us Vein Meas And Or Map Leg Lt,,93971,CPT,Facility,Both,,,LT,626,532.1,179.4116,626,UnitedHealthcare,Individual & Family,588.44,94,,percent of total billed charges,,
Us Vein Meas And Or Map Leg Lt,,93971,CPT,Facility,Outpatient,,,LT,626,532.1,179.4116,626,UnitedHealthcare,Medicare Advantage,306.74,49,,percent of total billed charges,,
Us Vein Meas And Or Map Leg Lt,,93971,CPT,Facility,Inpatient,,,LT,626,532.1,179.4116,626,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Us Vein Meas And Or Map Leg Lt,,93971,CPT,Facility,Outpatient,,,LT,626,532.1,179.4116,626,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,300.48,48,,percent of total billed charges,,100% of DHS outpatient percentage
Us Vein Meas And Or Map Leg Lt,,93971,CPT,Facility,Inpatient,,,LT,626,532.1,179.4116,626,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Battery Door DMEPOS Replacement Part,,V5249,HCPCS,Facility,Both,,,RB,8,6.8,2.2928,8,Aetna,Commercial,7.36,92,,percent of total billed charges,,
Battery Door DMEPOS Replacement Part,,V5249,HCPCS,Facility,Outpatient,,,RB,8,6.8,2.2928,8,Aetna,Medicare Advantage,3.92,49,,percent of total billed charges,,
Battery Door DMEPOS Replacement Part,,V5249,HCPCS,Facility,Inpatient,,,RB,8,6.8,2.2928,8,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Battery Door DMEPOS Replacement Part,,V5249,HCPCS,Facility,Both,,,RB,8,6.8,2.2928,8,Aetna,PPO,7.44,93,,percent of total billed charges,,
Battery Door DMEPOS Replacement Part,,V5249,HCPCS,Facility,Both,,,RB,8,6.8,2.2928,8,America's PPO,America's PPO,7.6824,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Battery Door DMEPOS Replacement Part,,V5249,HCPCS,Facility,Both,,,RB,8,6.8,2.2928,8,BlueCross BlueShield Minnesota, Federal Employee Program,7.872,98.4,,percent of total billed charges,,
Battery Door DMEPOS Replacement Part,,V5249,HCPCS,Facility,Both,,,RB,8,6.8,2.2928,8,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,8,100,,percent of total billed charges,,
Battery Door DMEPOS Replacement Part,,V5249,HCPCS,Facility,Both,,,RB,8,6.8,2.2928,8,BlueCross BlueShield Minnesota,High Value Network Plan,7.2,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
Battery Door DMEPOS Replacement Part,,V5249,HCPCS,Facility,Outpatient,,,RB,8,6.8,2.2928,8,BlueCross BlueShield Minnesota,Medicare Advantage,3.92,49,,percent of total billed charges,,
Battery Door DMEPOS Replacement Part,,V5249,HCPCS,Facility,Inpatient,,,RB,8,6.8,2.2928,8,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Battery Door DMEPOS Replacement Part,,V5249,HCPCS,Facility,Both,,,RB,8,6.8,2.2928,8,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,7.0856,88.57,,percent of total billed charges,,
Battery Door DMEPOS Replacement Part,,V5249,HCPCS,Facility,Both,,,RB,8,6.8,2.2928,8,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,2.2928,28.66,,percent of total billed charges,,
Battery Door DMEPOS Replacement Part,,V5249,HCPCS,Facility,Outpatient,,,RB,8,6.8,2.2928,8,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),3.92,49,,percent of total billed charges,,
Battery Door DMEPOS Replacement Part,,V5249,HCPCS,Facility,Inpatient,,,RB,8,6.8,2.2928,8,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Battery Door DMEPOS Replacement Part,,V5249,HCPCS,Facility,Both,,,RB,8,6.8,2.2928,8,CorVel,Worker's Compensation,8,100,,percent of total billed charges,,
Battery Door DMEPOS Replacement Part,,V5249,HCPCS,Facility,Both,,,RB,8,6.8,2.2928,8,First Health Group Corporation,First Health Network,7.76,97,,percent of total billed charges,,
Battery Door DMEPOS Replacement Part,,V5249,HCPCS,Facility,Both,,,RB,8,6.8,2.2928,8,"Health Partners, Inc.",Commercial,7.568,94.6,,percent of total billed charges,,
Battery Door DMEPOS Replacement Part,,V5249,HCPCS,Facility,Outpatient,,,RB,8,6.8,2.2928,8,"Health Partners, Inc.",Medicare Advantage,3.92,49,,percent of total billed charges,,
Battery Door DMEPOS Replacement Part,,V5249,HCPCS,Facility,Inpatient,,,RB,8,6.8,2.2928,8,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Battery Door DMEPOS Replacement Part,,V5249,HCPCS,Facility,Both,,,RB,8,6.8,2.2928,8,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),4.8,60,,percent of total billed charges,,
Battery Door DMEPOS Replacement Part,,V5249,HCPCS,Facility,Both,,,RB,8,6.8,2.2928,8,"Health Partners, Inc.",State of Minnesota Advantage Program,6.52,81.5,,percent of total billed charges,,
Battery Door DMEPOS Replacement Part,,V5249,HCPCS,Facility,Both,,,RB,8,6.8,2.2928,8,"Health Partners, Inc.",State Public Programs,4,50,,percent of total billed charges,,
Battery Door DMEPOS Replacement Part,,V5249,HCPCS,Facility,Both,,,RB,8,6.8,2.2928,8,Humana Insurance Company,Commercial PPO,7.6,95,,percent of total billed charges,,
Battery Door DMEPOS Replacement Part,,V5249,HCPCS,Facility,Outpatient,,,RB,8,6.8,2.2928,8,Humana Insurance Company,Medicare PPO,3.92,49,,percent of total billed charges,,
Battery Door DMEPOS Replacement Part,,V5249,HCPCS,Facility,Inpatient,,,RB,8,6.8,2.2928,8,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Battery Door DMEPOS Replacement Part,,V5249,HCPCS,Facility,Both,,,RB,8,6.8,2.2928,8,Medica,Individual & Family,7.928,99.1,,percent of total billed charges,,
Battery Door DMEPOS Replacement Part,,V5249,HCPCS,Facility,Outpatient,,,RB,8,6.8,2.2928,8,Medica,Medica Advantage Solution,3.984,49.8,,percent of total billed charges,,
Battery Door DMEPOS Replacement Part,,V5249,HCPCS,Facility,Inpatient,,,RB,8,6.8,2.2928,8,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Battery Door DMEPOS Replacement Part,,V5249,HCPCS,Facility,Outpatient,,,RB,8,6.8,2.2928,8,Medica,Medical Assistance,3.568,44.6,,percent of total billed charges,,
Battery Door DMEPOS Replacement Part,,V5249,HCPCS,Facility,Inpatient,,,RB,8,6.8,2.2928,8,Medica,Medical Assistance,,,,,Included in per diem rate,
Battery Door DMEPOS Replacement Part,,V5249,HCPCS,Facility,Outpatient,,,RB,8,6.8,2.2928,8,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,3.984,49.8,,percent of total billed charges,,
Battery Door DMEPOS Replacement Part,,V5249,HCPCS,Facility,Inpatient,,,RB,8,6.8,2.2928,8,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Battery Door DMEPOS Replacement Part,,V5249,HCPCS,Facility,Both,,,RB,8,6.8,2.2928,8,"Multiplan, Inc.","Multiplan, Inc.",7.52,94,,percent of total billed charges,,
Battery Door DMEPOS Replacement Part,,V5249,HCPCS,Facility,Outpatient,,,RB,8,6.8,2.2928,8,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,7.208,90.1,,percent of total billed charges,,
Battery Door DMEPOS Replacement Part,,V5249,HCPCS,Facility,Inpatient,,,RB,8,6.8,2.2928,8,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Battery Door DMEPOS Replacement Part,,V5249,HCPCS,Facility,Both,,,RB,8,6.8,2.2928,8,"Preferred One Administrative Services, INC.",PPO,7.888,98.6,,percent of total billed charges,,
Battery Door DMEPOS Replacement Part,,V5249,HCPCS,Facility,Outpatient,,,RB,8,6.8,2.2928,8,PrimeWest Health,Minnesota Senior Health Options (MSHO),4.116,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Battery Door DMEPOS Replacement Part,,V5249,HCPCS,Facility,Inpatient,,,RB,8,6.8,2.2928,8,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Battery Door DMEPOS Replacement Part,,V5249,HCPCS,Facility,Outpatient,,,RB,8,6.8,2.2928,8,PrimeWest Health,MinnesotaCare,4.1088,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Battery Door DMEPOS Replacement Part,,V5249,HCPCS,Facility,Inpatient,,,RB,8,6.8,2.2928,8,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Battery Door DMEPOS Replacement Part,,V5249,HCPCS,Facility,Both,,,RB,8,6.8,2.2928,8,Sanford Health Plan,Sanford Health Plan,7.36,92,,percent of total billed charges,,
Battery Door DMEPOS Replacement Part,,V5249,HCPCS,Facility,Outpatient,,,RB,8,6.8,2.2928,8,"UCare Health, Inc.",Individual & Family Plan,4.508,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Battery Door DMEPOS Replacement Part,,V5249,HCPCS,Facility,Inpatient,,,RB,8,6.8,2.2928,8,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Battery Door DMEPOS Replacement Part,,V5249,HCPCS,Facility,Outpatient,,,RB,8,6.8,2.2928,8,"UCare Health, Inc.",Medical Assistance,4.0376,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Battery Door DMEPOS Replacement Part,,V5249,HCPCS,Facility,Inpatient,,,RB,8,6.8,2.2928,8,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Battery Door DMEPOS Replacement Part,,V5249,HCPCS,Facility,Outpatient,,,RB,8,6.8,2.2928,8,"UCare Health, Inc.",Medicare Advantage,4.0376,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Battery Door DMEPOS Replacement Part,,V5249,HCPCS,Facility,Inpatient,,,RB,8,6.8,2.2928,8,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Battery Door DMEPOS Replacement Part,,V5249,HCPCS,Facility,Outpatient,,,RB,8,6.8,2.2928,8,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),4.0376,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Battery Door DMEPOS Replacement Part,,V5249,HCPCS,Facility,Inpatient,,,RB,8,6.8,2.2928,8,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Battery Door DMEPOS Replacement Part,,V5249,HCPCS,Facility,Both,,,RB,8,6.8,2.2928,8,UnitedHealthcare,Individual & Family,7.52,94,,percent of total billed charges,,
Battery Door DMEPOS Replacement Part,,V5249,HCPCS,Facility,Outpatient,,,RB,8,6.8,2.2928,8,UnitedHealthcare,Medicare Advantage,3.92,49,,percent of total billed charges,,
Battery Door DMEPOS Replacement Part,,V5249,HCPCS,Facility,Inpatient,,,RB,8,6.8,2.2928,8,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Battery Door DMEPOS Replacement Part,,V5249,HCPCS,Facility,Outpatient,,,RB,8,6.8,2.2928,8,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,3.84,48,,percent of total billed charges,,100% of DHS outpatient percentage
Battery Door DMEPOS Replacement Part,,V5249,HCPCS,Facility,Inpatient,,,RB,8,6.8,2.2928,8,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Xr Ribs Rt Unil,,71100,CPT,Facility,Both,,,RT,261,221.85,74.8026,261,Aetna,Commercial,240.12,92,,percent of total billed charges,,
Xr Ribs Rt Unil,,71100,CPT,Facility,Outpatient,,,RT,261,221.85,74.8026,261,Aetna,Medicare Advantage,127.89,49,,percent of total billed charges,,
Xr Ribs Rt Unil,,71100,CPT,Facility,Inpatient,,,RT,261,221.85,74.8026,261,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Xr Ribs Rt Unil,,71100,CPT,Facility,Both,,,RT,261,221.85,74.8026,261,Aetna,PPO,242.73,93,,percent of total billed charges,,
Xr Ribs Rt Unil,,71100,CPT,Facility,Both,,,RT,261,221.85,74.8026,261,America's PPO,America's PPO,250.6383,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Xr Ribs Rt Unil,,71100,CPT,Facility,Both,,,RT,261,221.85,74.8026,261,BlueCross BlueShield Minnesota, Federal Employee Program,256.824,98.4,,percent of total billed charges,,
Xr Ribs Rt Unil,,71100,CPT,Facility,Both,,,RT,261,221.85,74.8026,261,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,261,100,,percent of total billed charges,,
Xr Ribs Rt Unil,,71100,CPT,Facility,Both,,,RT,261,221.85,74.8026,261,BlueCross BlueShield Minnesota,High Value Network Plan,234.9,90,,percent of total billed charges,,
Xr Ribs Rt Unil,,71100,CPT,Facility,Outpatient,,,RT,261,221.85,74.8026,261,BlueCross BlueShield Minnesota,Medicare Advantage,127.89,49,,percent of total billed charges,,
Xr Ribs Rt Unil,,71100,CPT,Facility,Inpatient,,,RT,261,221.85,74.8026,261,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Xr Ribs Rt Unil,,71100,CPT,Facility,Both,,,RT,261,221.85,74.8026,261,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,231.1677,88.57,,percent of total billed charges,,
Xr Ribs Rt Unil,,71100,CPT,Facility,Both,,,RT,261,221.85,74.8026,261,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,74.8026,28.66,,percent of total billed charges,,
Xr Ribs Rt Unil,,71100,CPT,Facility,Outpatient,,,RT,261,221.85,74.8026,261,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),127.89,49,,percent of total billed charges,,
Xr Ribs Rt Unil,,71100,CPT,Facility,Inpatient,,,RT,261,221.85,74.8026,261,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Xr Ribs Rt Unil,,71100,CPT,Facility,Both,,,RT,261,221.85,74.8026,261,CorVel,Worker's Compensation,261,100,,percent of total billed charges,,
Xr Ribs Rt Unil,,71100,CPT,Facility,Both,,,RT,261,221.85,74.8026,261,First Health Group Corporation,First Health Network,253.17,97,,percent of total billed charges,,
Xr Ribs Rt Unil,,71100,CPT,Facility,Both,,,RT,261,221.85,74.8026,261,"Health Partners, Inc.",Commercial,246.906,94.6,,percent of total billed charges,,
Xr Ribs Rt Unil,,71100,CPT,Facility,Outpatient,,,RT,261,221.85,74.8026,261,"Health Partners, Inc.",Medicare Advantage,127.89,49,,percent of total billed charges,,
Xr Ribs Rt Unil,,71100,CPT,Facility,Inpatient,,,RT,261,221.85,74.8026,261,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Ribs Rt Unil,,71100,CPT,Facility,Both,,,RT,261,221.85,74.8026,261,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),156.6,60,,percent of total billed charges,,
Xr Ribs Rt Unil,,71100,CPT,Facility,Both,,,RT,261,221.85,74.8026,261,"Health Partners, Inc.",State of Minnesota Advantage Program,212.715,81.5,,percent of total billed charges,,
Xr Ribs Rt Unil,,71100,CPT,Facility,Both,,,RT,261,221.85,74.8026,261,"Health Partners, Inc.",State Public Programs,130.5,50,,percent of total billed charges,,
Xr Ribs Rt Unil,,71100,CPT,Facility,Both,,,RT,261,221.85,74.8026,261,Humana Insurance Company,Commercial PPO,247.95,95,,percent of total billed charges,,
Xr Ribs Rt Unil,,71100,CPT,Facility,Outpatient,,,RT,261,221.85,74.8026,261,Humana Insurance Company,Medicare PPO,127.89,49,,percent of total billed charges,,
Xr Ribs Rt Unil,,71100,CPT,Facility,Inpatient,,,RT,261,221.85,74.8026,261,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Xr Ribs Rt Unil,,71100,CPT,Facility,Both,,,RT,261,221.85,74.8026,261,Medica,Individual & Family,258.651,99.1,,percent of total billed charges,,
Xr Ribs Rt Unil,,71100,CPT,Facility,Outpatient,,,RT,261,221.85,74.8026,261,Medica,Medica Advantage Solution,129.978,49.8,,percent of total billed charges,,
Xr Ribs Rt Unil,,71100,CPT,Facility,Inpatient,,,RT,261,221.85,74.8026,261,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Xr Ribs Rt Unil,,71100,CPT,Facility,Outpatient,,,RT,261,221.85,74.8026,261,Medica,Medical Assistance,116.406,44.6,,percent of total billed charges,,
Xr Ribs Rt Unil,,71100,CPT,Facility,Inpatient,,,RT,261,221.85,74.8026,261,Medica,Medical Assistance,,,,,Included in per diem rate,
Xr Ribs Rt Unil,,71100,CPT,Facility,Outpatient,,,RT,261,221.85,74.8026,261,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,129.978,49.8,,percent of total billed charges,,
Xr Ribs Rt Unil,,71100,CPT,Facility,Inpatient,,,RT,261,221.85,74.8026,261,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Xr Ribs Rt Unil,,71100,CPT,Facility,Both,,,RT,261,221.85,74.8026,261,"Multiplan, Inc.","Multiplan, Inc.",245.34,94,,percent of total billed charges,,
Xr Ribs Rt Unil,,71100,CPT,Facility,Outpatient,,,RT,261,221.85,74.8026,261,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,235.161,90.1,,percent of total billed charges,,
Xr Ribs Rt Unil,,71100,CPT,Facility,Inpatient,,,RT,261,221.85,74.8026,261,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Xr Ribs Rt Unil,,71100,CPT,Facility,Both,,,RT,261,221.85,74.8026,261,"Preferred One Administrative Services, INC.",PPO,257.346,98.6,,percent of total billed charges,,
Xr Ribs Rt Unil,,71100,CPT,Facility,Outpatient,,,RT,261,221.85,74.8026,261,PrimeWest Health,Minnesota Senior Health Options (MSHO),134.2845,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Xr Ribs Rt Unil,,71100,CPT,Facility,Inpatient,,,RT,261,221.85,74.8026,261,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Ribs Rt Unil,,71100,CPT,Facility,Outpatient,,,RT,261,221.85,74.8026,261,PrimeWest Health,MinnesotaCare,134.0496,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Xr Ribs Rt Unil,,71100,CPT,Facility,Inpatient,,,RT,261,221.85,74.8026,261,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Xr Ribs Rt Unil,,71100,CPT,Facility,Both,,,RT,261,221.85,74.8026,261,Sanford Health Plan,Sanford Health Plan,240.12,92,,percent of total billed charges,,
Xr Ribs Rt Unil,,71100,CPT,Facility,Outpatient,,,RT,261,221.85,74.8026,261,"UCare Health, Inc.",Individual & Family Plan,147.0735,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Xr Ribs Rt Unil,,71100,CPT,Facility,Inpatient,,,RT,261,221.85,74.8026,261,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Xr Ribs Rt Unil,,71100,CPT,Facility,Outpatient,,,RT,261,221.85,74.8026,261,"UCare Health, Inc.",Medical Assistance,131.7267,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Ribs Rt Unil,,71100,CPT,Facility,Inpatient,,,RT,261,221.85,74.8026,261,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Xr Ribs Rt Unil,,71100,CPT,Facility,Outpatient,,,RT,261,221.85,74.8026,261,"UCare Health, Inc.",Medicare Advantage,131.7267,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Ribs Rt Unil,,71100,CPT,Facility,Inpatient,,,RT,261,221.85,74.8026,261,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Ribs Rt Unil,,71100,CPT,Facility,Outpatient,,,RT,261,221.85,74.8026,261,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),131.7267,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Ribs Rt Unil,,71100,CPT,Facility,Inpatient,,,RT,261,221.85,74.8026,261,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Ribs Rt Unil,,71100,CPT,Facility,Both,,,RT,261,221.85,74.8026,261,UnitedHealthcare,Individual & Family,245.34,94,,percent of total billed charges,,
Xr Ribs Rt Unil,,71100,CPT,Facility,Outpatient,,,RT,261,221.85,74.8026,261,UnitedHealthcare,Medicare Advantage,127.89,49,,percent of total billed charges,,
Xr Ribs Rt Unil,,71100,CPT,Facility,Inpatient,,,RT,261,221.85,74.8026,261,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Xr Ribs Rt Unil,,71100,CPT,Facility,Outpatient,,,RT,261,221.85,74.8026,261,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,125.28,48,,percent of total billed charges,,100% of DHS outpatient percentage
Xr Ribs Rt Unil,,71100,CPT,Facility,Inpatient,,,RT,261,221.85,74.8026,261,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Xr Ribs Rt Unil W Chest 1 View,,71101,CPT,Facility,Both,,,RT,377,320.45,108.0482,377,Aetna,Commercial,346.84,92,,percent of total billed charges,,
Xr Ribs Rt Unil W Chest 1 View,,71101,CPT,Facility,Outpatient,,,RT,377,320.45,108.0482,377,Aetna,Medicare Advantage,184.73,49,,percent of total billed charges,,
Xr Ribs Rt Unil W Chest 1 View,,71101,CPT,Facility,Inpatient,,,RT,377,320.45,108.0482,377,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Xr Ribs Rt Unil W Chest 1 View,,71101,CPT,Facility,Both,,,RT,377,320.45,108.0482,377,Aetna,PPO,350.61,93,,percent of total billed charges,,
Xr Ribs Rt Unil W Chest 1 View,,71101,CPT,Facility,Both,,,RT,377,320.45,108.0482,377,America's PPO,America's PPO,362.0331,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Xr Ribs Rt Unil W Chest 1 View,,71101,CPT,Facility,Both,,,RT,377,320.45,108.0482,377,BlueCross BlueShield Minnesota, Federal Employee Program,370.968,98.4,,percent of total billed charges,,
Xr Ribs Rt Unil W Chest 1 View,,71101,CPT,Facility,Both,,,RT,377,320.45,108.0482,377,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,377,100,,percent of total billed charges,,
Xr Ribs Rt Unil W Chest 1 View,,71101,CPT,Facility,Both,,,RT,377,320.45,108.0482,377,BlueCross BlueShield Minnesota,High Value Network Plan,339.3,90,,percent of total billed charges,,
Xr Ribs Rt Unil W Chest 1 View,,71101,CPT,Facility,Outpatient,,,RT,377,320.45,108.0482,377,BlueCross BlueShield Minnesota,Medicare Advantage,184.73,49,,percent of total billed charges,,
Xr Ribs Rt Unil W Chest 1 View,,71101,CPT,Facility,Inpatient,,,RT,377,320.45,108.0482,377,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Xr Ribs Rt Unil W Chest 1 View,,71101,CPT,Facility,Both,,,RT,377,320.45,108.0482,377,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,333.9089,88.57,,percent of total billed charges,,
Xr Ribs Rt Unil W Chest 1 View,,71101,CPT,Facility,Both,,,RT,377,320.45,108.0482,377,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,108.0482,28.66,,percent of total billed charges,,
Xr Ribs Rt Unil W Chest 1 View,,71101,CPT,Facility,Outpatient,,,RT,377,320.45,108.0482,377,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),184.73,49,,percent of total billed charges,,
Xr Ribs Rt Unil W Chest 1 View,,71101,CPT,Facility,Inpatient,,,RT,377,320.45,108.0482,377,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Xr Ribs Rt Unil W Chest 1 View,,71101,CPT,Facility,Both,,,RT,377,320.45,108.0482,377,CorVel,Worker's Compensation,377,100,,percent of total billed charges,,
Xr Ribs Rt Unil W Chest 1 View,,71101,CPT,Facility,Both,,,RT,377,320.45,108.0482,377,First Health Group Corporation,First Health Network,365.69,97,,percent of total billed charges,,
Xr Ribs Rt Unil W Chest 1 View,,71101,CPT,Facility,Both,,,RT,377,320.45,108.0482,377,"Health Partners, Inc.",Commercial,356.642,94.6,,percent of total billed charges,,
Xr Ribs Rt Unil W Chest 1 View,,71101,CPT,Facility,Outpatient,,,RT,377,320.45,108.0482,377,"Health Partners, Inc.",Medicare Advantage,184.73,49,,percent of total billed charges,,
Xr Ribs Rt Unil W Chest 1 View,,71101,CPT,Facility,Inpatient,,,RT,377,320.45,108.0482,377,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Ribs Rt Unil W Chest 1 View,,71101,CPT,Facility,Both,,,RT,377,320.45,108.0482,377,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),226.2,60,,percent of total billed charges,,
Xr Ribs Rt Unil W Chest 1 View,,71101,CPT,Facility,Both,,,RT,377,320.45,108.0482,377,"Health Partners, Inc.",State of Minnesota Advantage Program,307.255,81.5,,percent of total billed charges,,
Xr Ribs Rt Unil W Chest 1 View,,71101,CPT,Facility,Both,,,RT,377,320.45,108.0482,377,"Health Partners, Inc.",State Public Programs,188.5,50,,percent of total billed charges,,
Xr Ribs Rt Unil W Chest 1 View,,71101,CPT,Facility,Both,,,RT,377,320.45,108.0482,377,Humana Insurance Company,Commercial PPO,358.15,95,,percent of total billed charges,,
Xr Ribs Rt Unil W Chest 1 View,,71101,CPT,Facility,Outpatient,,,RT,377,320.45,108.0482,377,Humana Insurance Company,Medicare PPO,184.73,49,,percent of total billed charges,,
Xr Ribs Rt Unil W Chest 1 View,,71101,CPT,Facility,Inpatient,,,RT,377,320.45,108.0482,377,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Xr Ribs Rt Unil W Chest 1 View,,71101,CPT,Facility,Both,,,RT,377,320.45,108.0482,377,Medica,Individual & Family,373.607,99.1,,percent of total billed charges,,
Xr Ribs Rt Unil W Chest 1 View,,71101,CPT,Facility,Outpatient,,,RT,377,320.45,108.0482,377,Medica,Medica Advantage Solution,187.746,49.8,,percent of total billed charges,,
Xr Ribs Rt Unil W Chest 1 View,,71101,CPT,Facility,Inpatient,,,RT,377,320.45,108.0482,377,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Xr Ribs Rt Unil W Chest 1 View,,71101,CPT,Facility,Outpatient,,,RT,377,320.45,108.0482,377,Medica,Medical Assistance,168.142,44.6,,percent of total billed charges,,
Xr Ribs Rt Unil W Chest 1 View,,71101,CPT,Facility,Inpatient,,,RT,377,320.45,108.0482,377,Medica,Medical Assistance,,,,,Included in per diem rate,
Xr Ribs Rt Unil W Chest 1 View,,71101,CPT,Facility,Outpatient,,,RT,377,320.45,108.0482,377,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,187.746,49.8,,percent of total billed charges,,
Xr Ribs Rt Unil W Chest 1 View,,71101,CPT,Facility,Inpatient,,,RT,377,320.45,108.0482,377,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Xr Ribs Rt Unil W Chest 1 View,,71101,CPT,Facility,Both,,,RT,377,320.45,108.0482,377,"Multiplan, Inc.","Multiplan, Inc.",354.38,94,,percent of total billed charges,,
Xr Ribs Rt Unil W Chest 1 View,,71101,CPT,Facility,Outpatient,,,RT,377,320.45,108.0482,377,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,339.677,90.1,,percent of total billed charges,,
Xr Ribs Rt Unil W Chest 1 View,,71101,CPT,Facility,Inpatient,,,RT,377,320.45,108.0482,377,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Xr Ribs Rt Unil W Chest 1 View,,71101,CPT,Facility,Both,,,RT,377,320.45,108.0482,377,"Preferred One Administrative Services, INC.",PPO,371.722,98.6,,percent of total billed charges,,
Xr Ribs Rt Unil W Chest 1 View,,71101,CPT,Facility,Outpatient,,,RT,377,320.45,108.0482,377,PrimeWest Health,Minnesota Senior Health Options (MSHO),193.9665,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Xr Ribs Rt Unil W Chest 1 View,,71101,CPT,Facility,Inpatient,,,RT,377,320.45,108.0482,377,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Ribs Rt Unil W Chest 1 View,,71101,CPT,Facility,Outpatient,,,RT,377,320.45,108.0482,377,PrimeWest Health,MinnesotaCare,193.6272,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Xr Ribs Rt Unil W Chest 1 View,,71101,CPT,Facility,Inpatient,,,RT,377,320.45,108.0482,377,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Xr Ribs Rt Unil W Chest 1 View,,71101,CPT,Facility,Both,,,RT,377,320.45,108.0482,377,Sanford Health Plan,Sanford Health Plan,346.84,92,,percent of total billed charges,,
Xr Ribs Rt Unil W Chest 1 View,,71101,CPT,Facility,Outpatient,,,RT,377,320.45,108.0482,377,"UCare Health, Inc.",Individual & Family Plan,212.4395,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Xr Ribs Rt Unil W Chest 1 View,,71101,CPT,Facility,Inpatient,,,RT,377,320.45,108.0482,377,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Xr Ribs Rt Unil W Chest 1 View,,71101,CPT,Facility,Outpatient,,,RT,377,320.45,108.0482,377,"UCare Health, Inc.",Medical Assistance,190.2719,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Ribs Rt Unil W Chest 1 View,,71101,CPT,Facility,Inpatient,,,RT,377,320.45,108.0482,377,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Xr Ribs Rt Unil W Chest 1 View,,71101,CPT,Facility,Outpatient,,,RT,377,320.45,108.0482,377,"UCare Health, Inc.",Medicare Advantage,190.2719,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Ribs Rt Unil W Chest 1 View,,71101,CPT,Facility,Inpatient,,,RT,377,320.45,108.0482,377,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Ribs Rt Unil W Chest 1 View,,71101,CPT,Facility,Outpatient,,,RT,377,320.45,108.0482,377,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),190.2719,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Ribs Rt Unil W Chest 1 View,,71101,CPT,Facility,Inpatient,,,RT,377,320.45,108.0482,377,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Ribs Rt Unil W Chest 1 View,,71101,CPT,Facility,Both,,,RT,377,320.45,108.0482,377,UnitedHealthcare,Individual & Family,354.38,94,,percent of total billed charges,,
Xr Ribs Rt Unil W Chest 1 View,,71101,CPT,Facility,Outpatient,,,RT,377,320.45,108.0482,377,UnitedHealthcare,Medicare Advantage,184.73,49,,percent of total billed charges,,
Xr Ribs Rt Unil W Chest 1 View,,71101,CPT,Facility,Inpatient,,,RT,377,320.45,108.0482,377,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Xr Ribs Rt Unil W Chest 1 View,,71101,CPT,Facility,Outpatient,,,RT,377,320.45,108.0482,377,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,180.96,48,,percent of total billed charges,,100% of DHS outpatient percentage
Xr Ribs Rt Unil W Chest 1 View,,71101,CPT,Facility,Inpatient,,,RT,377,320.45,108.0482,377,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Xr Clavicle Rt,,73000,CPT,Facility,Both,,,RT,286,243.1,81.9676,286,Aetna,Commercial,263.12,92,,percent of total billed charges,,
Xr Clavicle Rt,,73000,CPT,Facility,Outpatient,,,RT,286,243.1,81.9676,286,Aetna,Medicare Advantage,140.14,49,,percent of total billed charges,,
Xr Clavicle Rt,,73000,CPT,Facility,Inpatient,,,RT,286,243.1,81.9676,286,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Xr Clavicle Rt,,73000,CPT,Facility,Both,,,RT,286,243.1,81.9676,286,Aetna,PPO,265.98,93,,percent of total billed charges,,
Xr Clavicle Rt,,73000,CPT,Facility,Both,,,RT,286,243.1,81.9676,286,America's PPO,America's PPO,274.6458,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Xr Clavicle Rt,,73000,CPT,Facility,Both,,,RT,286,243.1,81.9676,286,BlueCross BlueShield Minnesota, Federal Employee Program,281.424,98.4,,percent of total billed charges,,
Xr Clavicle Rt,,73000,CPT,Facility,Both,,,RT,286,243.1,81.9676,286,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,286,100,,percent of total billed charges,,
Xr Clavicle Rt,,73000,CPT,Facility,Both,,,RT,286,243.1,81.9676,286,BlueCross BlueShield Minnesota,High Value Network Plan,257.4,90,,percent of total billed charges,,
Xr Clavicle Rt,,73000,CPT,Facility,Outpatient,,,RT,286,243.1,81.9676,286,BlueCross BlueShield Minnesota,Medicare Advantage,140.14,49,,percent of total billed charges,,
Xr Clavicle Rt,,73000,CPT,Facility,Inpatient,,,RT,286,243.1,81.9676,286,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Xr Clavicle Rt,,73000,CPT,Facility,Both,,,RT,286,243.1,81.9676,286,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,253.3102,88.57,,percent of total billed charges,,
Xr Clavicle Rt,,73000,CPT,Facility,Both,,,RT,286,243.1,81.9676,286,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,81.9676,28.66,,percent of total billed charges,,
Xr Clavicle Rt,,73000,CPT,Facility,Outpatient,,,RT,286,243.1,81.9676,286,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),140.14,49,,percent of total billed charges,,
Xr Clavicle Rt,,73000,CPT,Facility,Inpatient,,,RT,286,243.1,81.9676,286,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Xr Clavicle Rt,,73000,CPT,Facility,Both,,,RT,286,243.1,81.9676,286,CorVel,Worker's Compensation,286,100,,percent of total billed charges,,
Xr Clavicle Rt,,73000,CPT,Facility,Both,,,RT,286,243.1,81.9676,286,First Health Group Corporation,First Health Network,277.42,97,,percent of total billed charges,,
Xr Clavicle Rt,,73000,CPT,Facility,Both,,,RT,286,243.1,81.9676,286,"Health Partners, Inc.",Commercial,270.556,94.6,,percent of total billed charges,,
Xr Clavicle Rt,,73000,CPT,Facility,Outpatient,,,RT,286,243.1,81.9676,286,"Health Partners, Inc.",Medicare Advantage,140.14,49,,percent of total billed charges,,
Xr Clavicle Rt,,73000,CPT,Facility,Inpatient,,,RT,286,243.1,81.9676,286,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Clavicle Rt,,73000,CPT,Facility,Both,,,RT,286,243.1,81.9676,286,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),171.6,60,,percent of total billed charges,,
Xr Clavicle Rt,,73000,CPT,Facility,Both,,,RT,286,243.1,81.9676,286,"Health Partners, Inc.",State of Minnesota Advantage Program,233.09,81.5,,percent of total billed charges,,
Xr Clavicle Rt,,73000,CPT,Facility,Both,,,RT,286,243.1,81.9676,286,"Health Partners, Inc.",State Public Programs,143,50,,percent of total billed charges,,
Xr Clavicle Rt,,73000,CPT,Facility,Both,,,RT,286,243.1,81.9676,286,Humana Insurance Company,Commercial PPO,271.7,95,,percent of total billed charges,,
Xr Clavicle Rt,,73000,CPT,Facility,Outpatient,,,RT,286,243.1,81.9676,286,Humana Insurance Company,Medicare PPO,140.14,49,,percent of total billed charges,,
Xr Clavicle Rt,,73000,CPT,Facility,Inpatient,,,RT,286,243.1,81.9676,286,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Xr Clavicle Rt,,73000,CPT,Facility,Both,,,RT,286,243.1,81.9676,286,Medica,Individual & Family,283.426,99.1,,percent of total billed charges,,
Xr Clavicle Rt,,73000,CPT,Facility,Outpatient,,,RT,286,243.1,81.9676,286,Medica,Medica Advantage Solution,142.428,49.8,,percent of total billed charges,,
Xr Clavicle Rt,,73000,CPT,Facility,Inpatient,,,RT,286,243.1,81.9676,286,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Xr Clavicle Rt,,73000,CPT,Facility,Outpatient,,,RT,286,243.1,81.9676,286,Medica,Medical Assistance,127.556,44.6,,percent of total billed charges,,
Xr Clavicle Rt,,73000,CPT,Facility,Inpatient,,,RT,286,243.1,81.9676,286,Medica,Medical Assistance,,,,,Included in per diem rate,
Xr Clavicle Rt,,73000,CPT,Facility,Outpatient,,,RT,286,243.1,81.9676,286,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,142.428,49.8,,percent of total billed charges,,
Xr Clavicle Rt,,73000,CPT,Facility,Inpatient,,,RT,286,243.1,81.9676,286,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Xr Clavicle Rt,,73000,CPT,Facility,Both,,,RT,286,243.1,81.9676,286,"Multiplan, Inc.","Multiplan, Inc.",268.84,94,,percent of total billed charges,,
Xr Clavicle Rt,,73000,CPT,Facility,Outpatient,,,RT,286,243.1,81.9676,286,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,257.686,90.1,,percent of total billed charges,,
Xr Clavicle Rt,,73000,CPT,Facility,Inpatient,,,RT,286,243.1,81.9676,286,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Xr Clavicle Rt,,73000,CPT,Facility,Both,,,RT,286,243.1,81.9676,286,"Preferred One Administrative Services, INC.",PPO,281.996,98.6,,percent of total billed charges,,
Xr Clavicle Rt,,73000,CPT,Facility,Outpatient,,,RT,286,243.1,81.9676,286,PrimeWest Health,Minnesota Senior Health Options (MSHO),147.147,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Xr Clavicle Rt,,73000,CPT,Facility,Inpatient,,,RT,286,243.1,81.9676,286,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Clavicle Rt,,73000,CPT,Facility,Outpatient,,,RT,286,243.1,81.9676,286,PrimeWest Health,MinnesotaCare,146.8896,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Xr Clavicle Rt,,73000,CPT,Facility,Inpatient,,,RT,286,243.1,81.9676,286,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Xr Clavicle Rt,,73000,CPT,Facility,Both,,,RT,286,243.1,81.9676,286,Sanford Health Plan,Sanford Health Plan,263.12,92,,percent of total billed charges,,
Xr Clavicle Rt,,73000,CPT,Facility,Outpatient,,,RT,286,243.1,81.9676,286,"UCare Health, Inc.",Individual & Family Plan,161.161,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Xr Clavicle Rt,,73000,CPT,Facility,Inpatient,,,RT,286,243.1,81.9676,286,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Xr Clavicle Rt,,73000,CPT,Facility,Outpatient,,,RT,286,243.1,81.9676,286,"UCare Health, Inc.",Medical Assistance,144.3442,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Clavicle Rt,,73000,CPT,Facility,Inpatient,,,RT,286,243.1,81.9676,286,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Xr Clavicle Rt,,73000,CPT,Facility,Outpatient,,,RT,286,243.1,81.9676,286,"UCare Health, Inc.",Medicare Advantage,144.3442,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Clavicle Rt,,73000,CPT,Facility,Inpatient,,,RT,286,243.1,81.9676,286,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Clavicle Rt,,73000,CPT,Facility,Outpatient,,,RT,286,243.1,81.9676,286,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),144.3442,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Clavicle Rt,,73000,CPT,Facility,Inpatient,,,RT,286,243.1,81.9676,286,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Clavicle Rt,,73000,CPT,Facility,Both,,,RT,286,243.1,81.9676,286,UnitedHealthcare,Individual & Family,268.84,94,,percent of total billed charges,,
Xr Clavicle Rt,,73000,CPT,Facility,Outpatient,,,RT,286,243.1,81.9676,286,UnitedHealthcare,Medicare Advantage,140.14,49,,percent of total billed charges,,
Xr Clavicle Rt,,73000,CPT,Facility,Inpatient,,,RT,286,243.1,81.9676,286,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Xr Clavicle Rt,,73000,CPT,Facility,Outpatient,,,RT,286,243.1,81.9676,286,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,137.28,48,,percent of total billed charges,,100% of DHS outpatient percentage
Xr Clavicle Rt,,73000,CPT,Facility,Inpatient,,,RT,286,243.1,81.9676,286,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Xr Scapula Rt,,73010,CPT,Facility,Both,,,RT,224,190.4,64.1984,224,Aetna,Commercial,206.08,92,,percent of total billed charges,,
Xr Scapula Rt,,73010,CPT,Facility,Outpatient,,,RT,224,190.4,64.1984,224,Aetna,Medicare Advantage,109.76,49,,percent of total billed charges,,
Xr Scapula Rt,,73010,CPT,Facility,Inpatient,,,RT,224,190.4,64.1984,224,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Xr Scapula Rt,,73010,CPT,Facility,Both,,,RT,224,190.4,64.1984,224,Aetna,PPO,208.32,93,,percent of total billed charges,,
Xr Scapula Rt,,73010,CPT,Facility,Both,,,RT,224,190.4,64.1984,224,America's PPO,America's PPO,215.1072,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Xr Scapula Rt,,73010,CPT,Facility,Both,,,RT,224,190.4,64.1984,224,BlueCross BlueShield Minnesota, Federal Employee Program,220.416,98.4,,percent of total billed charges,,
Xr Scapula Rt,,73010,CPT,Facility,Both,,,RT,224,190.4,64.1984,224,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,224,100,,percent of total billed charges,,
Xr Scapula Rt,,73010,CPT,Facility,Both,,,RT,224,190.4,64.1984,224,BlueCross BlueShield Minnesota,High Value Network Plan,201.6,90,,percent of total billed charges,,
Xr Scapula Rt,,73010,CPT,Facility,Outpatient,,,RT,224,190.4,64.1984,224,BlueCross BlueShield Minnesota,Medicare Advantage,109.76,49,,percent of total billed charges,,
Xr Scapula Rt,,73010,CPT,Facility,Inpatient,,,RT,224,190.4,64.1984,224,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Xr Scapula Rt,,73010,CPT,Facility,Both,,,RT,224,190.4,64.1984,224,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,198.3968,88.57,,percent of total billed charges,,
Xr Scapula Rt,,73010,CPT,Facility,Both,,,RT,224,190.4,64.1984,224,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,64.1984,28.66,,percent of total billed charges,,
Xr Scapula Rt,,73010,CPT,Facility,Outpatient,,,RT,224,190.4,64.1984,224,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),109.76,49,,percent of total billed charges,,
Xr Scapula Rt,,73010,CPT,Facility,Inpatient,,,RT,224,190.4,64.1984,224,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Xr Scapula Rt,,73010,CPT,Facility,Both,,,RT,224,190.4,64.1984,224,CorVel,Worker's Compensation,224,100,,percent of total billed charges,,
Xr Scapula Rt,,73010,CPT,Facility,Both,,,RT,224,190.4,64.1984,224,First Health Group Corporation,First Health Network,217.28,97,,percent of total billed charges,,
Xr Scapula Rt,,73010,CPT,Facility,Both,,,RT,224,190.4,64.1984,224,"Health Partners, Inc.",Commercial,211.904,94.6,,percent of total billed charges,,
Xr Scapula Rt,,73010,CPT,Facility,Outpatient,,,RT,224,190.4,64.1984,224,"Health Partners, Inc.",Medicare Advantage,109.76,49,,percent of total billed charges,,
Xr Scapula Rt,,73010,CPT,Facility,Inpatient,,,RT,224,190.4,64.1984,224,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Scapula Rt,,73010,CPT,Facility,Both,,,RT,224,190.4,64.1984,224,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),134.4,60,,percent of total billed charges,,
Xr Scapula Rt,,73010,CPT,Facility,Both,,,RT,224,190.4,64.1984,224,"Health Partners, Inc.",State of Minnesota Advantage Program,182.56,81.5,,percent of total billed charges,,
Xr Scapula Rt,,73010,CPT,Facility,Both,,,RT,224,190.4,64.1984,224,"Health Partners, Inc.",State Public Programs,112,50,,percent of total billed charges,,
Xr Scapula Rt,,73010,CPT,Facility,Both,,,RT,224,190.4,64.1984,224,Humana Insurance Company,Commercial PPO,212.8,95,,percent of total billed charges,,
Xr Scapula Rt,,73010,CPT,Facility,Outpatient,,,RT,224,190.4,64.1984,224,Humana Insurance Company,Medicare PPO,109.76,49,,percent of total billed charges,,
Xr Scapula Rt,,73010,CPT,Facility,Inpatient,,,RT,224,190.4,64.1984,224,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Xr Scapula Rt,,73010,CPT,Facility,Both,,,RT,224,190.4,64.1984,224,Medica,Individual & Family,221.984,99.1,,percent of total billed charges,,
Xr Scapula Rt,,73010,CPT,Facility,Outpatient,,,RT,224,190.4,64.1984,224,Medica,Medica Advantage Solution,111.552,49.8,,percent of total billed charges,,
Xr Scapula Rt,,73010,CPT,Facility,Inpatient,,,RT,224,190.4,64.1984,224,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Xr Scapula Rt,,73010,CPT,Facility,Outpatient,,,RT,224,190.4,64.1984,224,Medica,Medical Assistance,99.904,44.6,,percent of total billed charges,,
Xr Scapula Rt,,73010,CPT,Facility,Inpatient,,,RT,224,190.4,64.1984,224,Medica,Medical Assistance,,,,,Included in per diem rate,
Xr Scapula Rt,,73010,CPT,Facility,Outpatient,,,RT,224,190.4,64.1984,224,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,111.552,49.8,,percent of total billed charges,,
Xr Scapula Rt,,73010,CPT,Facility,Inpatient,,,RT,224,190.4,64.1984,224,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Xr Scapula Rt,,73010,CPT,Facility,Both,,,RT,224,190.4,64.1984,224,"Multiplan, Inc.","Multiplan, Inc.",210.56,94,,percent of total billed charges,,
Xr Scapula Rt,,73010,CPT,Facility,Outpatient,,,RT,224,190.4,64.1984,224,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,201.824,90.1,,percent of total billed charges,,
Xr Scapula Rt,,73010,CPT,Facility,Inpatient,,,RT,224,190.4,64.1984,224,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Xr Scapula Rt,,73010,CPT,Facility,Both,,,RT,224,190.4,64.1984,224,"Preferred One Administrative Services, INC.",PPO,220.864,98.6,,percent of total billed charges,,
Xr Scapula Rt,,73010,CPT,Facility,Outpatient,,,RT,224,190.4,64.1984,224,PrimeWest Health,Minnesota Senior Health Options (MSHO),115.248,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Xr Scapula Rt,,73010,CPT,Facility,Inpatient,,,RT,224,190.4,64.1984,224,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Scapula Rt,,73010,CPT,Facility,Outpatient,,,RT,224,190.4,64.1984,224,PrimeWest Health,MinnesotaCare,115.0464,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Xr Scapula Rt,,73010,CPT,Facility,Inpatient,,,RT,224,190.4,64.1984,224,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Xr Scapula Rt,,73010,CPT,Facility,Both,,,RT,224,190.4,64.1984,224,Sanford Health Plan,Sanford Health Plan,206.08,92,,percent of total billed charges,,
Xr Scapula Rt,,73010,CPT,Facility,Outpatient,,,RT,224,190.4,64.1984,224,"UCare Health, Inc.",Individual & Family Plan,126.224,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Xr Scapula Rt,,73010,CPT,Facility,Inpatient,,,RT,224,190.4,64.1984,224,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Xr Scapula Rt,,73010,CPT,Facility,Outpatient,,,RT,224,190.4,64.1984,224,"UCare Health, Inc.",Medical Assistance,113.0528,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Scapula Rt,,73010,CPT,Facility,Inpatient,,,RT,224,190.4,64.1984,224,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Xr Scapula Rt,,73010,CPT,Facility,Outpatient,,,RT,224,190.4,64.1984,224,"UCare Health, Inc.",Medicare Advantage,113.0528,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Scapula Rt,,73010,CPT,Facility,Inpatient,,,RT,224,190.4,64.1984,224,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Scapula Rt,,73010,CPT,Facility,Outpatient,,,RT,224,190.4,64.1984,224,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),113.0528,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Scapula Rt,,73010,CPT,Facility,Inpatient,,,RT,224,190.4,64.1984,224,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Scapula Rt,,73010,CPT,Facility,Both,,,RT,224,190.4,64.1984,224,UnitedHealthcare,Individual & Family,210.56,94,,percent of total billed charges,,
Xr Scapula Rt,,73010,CPT,Facility,Outpatient,,,RT,224,190.4,64.1984,224,UnitedHealthcare,Medicare Advantage,109.76,49,,percent of total billed charges,,
Xr Scapula Rt,,73010,CPT,Facility,Inpatient,,,RT,224,190.4,64.1984,224,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Xr Scapula Rt,,73010,CPT,Facility,Outpatient,,,RT,224,190.4,64.1984,224,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,107.52,48,,percent of total billed charges,,100% of DHS outpatient percentage
Xr Scapula Rt,,73010,CPT,Facility,Inpatient,,,RT,224,190.4,64.1984,224,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Xr Shoulder Rt 1 View,,73020,CPT,Facility,Both,,,RT,224,190.4,64.1984,224,Aetna,Commercial,206.08,92,,percent of total billed charges,,
Xr Shoulder Rt 1 View,,73020,CPT,Facility,Outpatient,,,RT,224,190.4,64.1984,224,Aetna,Medicare Advantage,109.76,49,,percent of total billed charges,,
Xr Shoulder Rt 1 View,,73020,CPT,Facility,Inpatient,,,RT,224,190.4,64.1984,224,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Xr Shoulder Rt 1 View,,73020,CPT,Facility,Both,,,RT,224,190.4,64.1984,224,Aetna,PPO,208.32,93,,percent of total billed charges,,
Xr Shoulder Rt 1 View,,73020,CPT,Facility,Both,,,RT,224,190.4,64.1984,224,America's PPO,America's PPO,215.1072,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Xr Shoulder Rt 1 View,,73020,CPT,Facility,Both,,,RT,224,190.4,64.1984,224,BlueCross BlueShield Minnesota, Federal Employee Program,220.416,98.4,,percent of total billed charges,,
Xr Shoulder Rt 1 View,,73020,CPT,Facility,Both,,,RT,224,190.4,64.1984,224,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,224,100,,percent of total billed charges,,
Xr Shoulder Rt 1 View,,73020,CPT,Facility,Both,,,RT,224,190.4,64.1984,224,BlueCross BlueShield Minnesota,High Value Network Plan,201.6,90,,percent of total billed charges,,
Xr Shoulder Rt 1 View,,73020,CPT,Facility,Outpatient,,,RT,224,190.4,64.1984,224,BlueCross BlueShield Minnesota,Medicare Advantage,109.76,49,,percent of total billed charges,,
Xr Shoulder Rt 1 View,,73020,CPT,Facility,Inpatient,,,RT,224,190.4,64.1984,224,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Xr Shoulder Rt 1 View,,73020,CPT,Facility,Both,,,RT,224,190.4,64.1984,224,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,198.3968,88.57,,percent of total billed charges,,
Xr Shoulder Rt 1 View,,73020,CPT,Facility,Both,,,RT,224,190.4,64.1984,224,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,64.1984,28.66,,percent of total billed charges,,
Xr Shoulder Rt 1 View,,73020,CPT,Facility,Outpatient,,,RT,224,190.4,64.1984,224,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),109.76,49,,percent of total billed charges,,
Xr Shoulder Rt 1 View,,73020,CPT,Facility,Inpatient,,,RT,224,190.4,64.1984,224,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Xr Shoulder Rt 1 View,,73020,CPT,Facility,Both,,,RT,224,190.4,64.1984,224,CorVel,Worker's Compensation,224,100,,percent of total billed charges,,
Xr Shoulder Rt 1 View,,73020,CPT,Facility,Both,,,RT,224,190.4,64.1984,224,First Health Group Corporation,First Health Network,217.28,97,,percent of total billed charges,,
Xr Shoulder Rt 1 View,,73020,CPT,Facility,Both,,,RT,224,190.4,64.1984,224,"Health Partners, Inc.",Commercial,211.904,94.6,,percent of total billed charges,,
Xr Shoulder Rt 1 View,,73020,CPT,Facility,Outpatient,,,RT,224,190.4,64.1984,224,"Health Partners, Inc.",Medicare Advantage,109.76,49,,percent of total billed charges,,
Xr Shoulder Rt 1 View,,73020,CPT,Facility,Inpatient,,,RT,224,190.4,64.1984,224,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Shoulder Rt 1 View,,73020,CPT,Facility,Both,,,RT,224,190.4,64.1984,224,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),134.4,60,,percent of total billed charges,,
Xr Shoulder Rt 1 View,,73020,CPT,Facility,Both,,,RT,224,190.4,64.1984,224,"Health Partners, Inc.",State of Minnesota Advantage Program,182.56,81.5,,percent of total billed charges,,
Xr Shoulder Rt 1 View,,73020,CPT,Facility,Both,,,RT,224,190.4,64.1984,224,"Health Partners, Inc.",State Public Programs,112,50,,percent of total billed charges,,
Xr Shoulder Rt 1 View,,73020,CPT,Facility,Both,,,RT,224,190.4,64.1984,224,Humana Insurance Company,Commercial PPO,212.8,95,,percent of total billed charges,,
Xr Shoulder Rt 1 View,,73020,CPT,Facility,Outpatient,,,RT,224,190.4,64.1984,224,Humana Insurance Company,Medicare PPO,109.76,49,,percent of total billed charges,,
Xr Shoulder Rt 1 View,,73020,CPT,Facility,Inpatient,,,RT,224,190.4,64.1984,224,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Xr Shoulder Rt 1 View,,73020,CPT,Facility,Both,,,RT,224,190.4,64.1984,224,Medica,Individual & Family,221.984,99.1,,percent of total billed charges,,
Xr Shoulder Rt 1 View,,73020,CPT,Facility,Outpatient,,,RT,224,190.4,64.1984,224,Medica,Medica Advantage Solution,111.552,49.8,,percent of total billed charges,,
Xr Shoulder Rt 1 View,,73020,CPT,Facility,Inpatient,,,RT,224,190.4,64.1984,224,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Xr Shoulder Rt 1 View,,73020,CPT,Facility,Outpatient,,,RT,224,190.4,64.1984,224,Medica,Medical Assistance,99.904,44.6,,percent of total billed charges,,
Xr Shoulder Rt 1 View,,73020,CPT,Facility,Inpatient,,,RT,224,190.4,64.1984,224,Medica,Medical Assistance,,,,,Included in per diem rate,
Xr Shoulder Rt 1 View,,73020,CPT,Facility,Outpatient,,,RT,224,190.4,64.1984,224,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,111.552,49.8,,percent of total billed charges,,
Xr Shoulder Rt 1 View,,73020,CPT,Facility,Inpatient,,,RT,224,190.4,64.1984,224,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Xr Shoulder Rt 1 View,,73020,CPT,Facility,Both,,,RT,224,190.4,64.1984,224,"Multiplan, Inc.","Multiplan, Inc.",210.56,94,,percent of total billed charges,,
Xr Shoulder Rt 1 View,,73020,CPT,Facility,Outpatient,,,RT,224,190.4,64.1984,224,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,201.824,90.1,,percent of total billed charges,,
Xr Shoulder Rt 1 View,,73020,CPT,Facility,Inpatient,,,RT,224,190.4,64.1984,224,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Xr Shoulder Rt 1 View,,73020,CPT,Facility,Both,,,RT,224,190.4,64.1984,224,"Preferred One Administrative Services, INC.",PPO,220.864,98.6,,percent of total billed charges,,
Xr Shoulder Rt 1 View,,73020,CPT,Facility,Outpatient,,,RT,224,190.4,64.1984,224,PrimeWest Health,Minnesota Senior Health Options (MSHO),115.248,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Xr Shoulder Rt 1 View,,73020,CPT,Facility,Inpatient,,,RT,224,190.4,64.1984,224,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Shoulder Rt 1 View,,73020,CPT,Facility,Outpatient,,,RT,224,190.4,64.1984,224,PrimeWest Health,MinnesotaCare,115.0464,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Xr Shoulder Rt 1 View,,73020,CPT,Facility,Inpatient,,,RT,224,190.4,64.1984,224,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Xr Shoulder Rt 1 View,,73020,CPT,Facility,Both,,,RT,224,190.4,64.1984,224,Sanford Health Plan,Sanford Health Plan,206.08,92,,percent of total billed charges,,
Xr Shoulder Rt 1 View,,73020,CPT,Facility,Outpatient,,,RT,224,190.4,64.1984,224,"UCare Health, Inc.",Individual & Family Plan,126.224,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Xr Shoulder Rt 1 View,,73020,CPT,Facility,Inpatient,,,RT,224,190.4,64.1984,224,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Xr Shoulder Rt 1 View,,73020,CPT,Facility,Outpatient,,,RT,224,190.4,64.1984,224,"UCare Health, Inc.",Medical Assistance,113.0528,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Shoulder Rt 1 View,,73020,CPT,Facility,Inpatient,,,RT,224,190.4,64.1984,224,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Xr Shoulder Rt 1 View,,73020,CPT,Facility,Outpatient,,,RT,224,190.4,64.1984,224,"UCare Health, Inc.",Medicare Advantage,113.0528,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Shoulder Rt 1 View,,73020,CPT,Facility,Inpatient,,,RT,224,190.4,64.1984,224,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Shoulder Rt 1 View,,73020,CPT,Facility,Outpatient,,,RT,224,190.4,64.1984,224,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),113.0528,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Shoulder Rt 1 View,,73020,CPT,Facility,Inpatient,,,RT,224,190.4,64.1984,224,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Shoulder Rt 1 View,,73020,CPT,Facility,Both,,,RT,224,190.4,64.1984,224,UnitedHealthcare,Individual & Family,210.56,94,,percent of total billed charges,,
Xr Shoulder Rt 1 View,,73020,CPT,Facility,Outpatient,,,RT,224,190.4,64.1984,224,UnitedHealthcare,Medicare Advantage,109.76,49,,percent of total billed charges,,
Xr Shoulder Rt 1 View,,73020,CPT,Facility,Inpatient,,,RT,224,190.4,64.1984,224,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Xr Shoulder Rt 1 View,,73020,CPT,Facility,Outpatient,,,RT,224,190.4,64.1984,224,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,107.52,48,,percent of total billed charges,,100% of DHS outpatient percentage
Xr Shoulder Rt 1 View,,73020,CPT,Facility,Inpatient,,,RT,224,190.4,64.1984,224,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Xr Shoulder Routine Rt 2 Or More Views,,73030,CPT,Facility,Both,,,RT,281,238.85,80.5346,281,Aetna,Commercial,258.52,92,,percent of total billed charges,,
Xr Shoulder Routine Rt 2 Or More Views,,73030,CPT,Facility,Outpatient,,,RT,281,238.85,80.5346,281,Aetna,Medicare Advantage,137.69,49,,percent of total billed charges,,
Xr Shoulder Routine Rt 2 Or More Views,,73030,CPT,Facility,Inpatient,,,RT,281,238.85,80.5346,281,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Xr Shoulder Routine Rt 2 Or More Views,,73030,CPT,Facility,Both,,,RT,281,238.85,80.5346,281,Aetna,PPO,261.33,93,,percent of total billed charges,,
Xr Shoulder Routine Rt 2 Or More Views,,73030,CPT,Facility,Both,,,RT,281,238.85,80.5346,281,America's PPO,America's PPO,269.8443,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Xr Shoulder Routine Rt 2 Or More Views,,73030,CPT,Facility,Both,,,RT,281,238.85,80.5346,281,BlueCross BlueShield Minnesota, Federal Employee Program,276.504,98.4,,percent of total billed charges,,
Xr Shoulder Routine Rt 2 Or More Views,,73030,CPT,Facility,Both,,,RT,281,238.85,80.5346,281,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,281,100,,percent of total billed charges,,
Xr Shoulder Routine Rt 2 Or More Views,,73030,CPT,Facility,Both,,,RT,281,238.85,80.5346,281,BlueCross BlueShield Minnesota,High Value Network Plan,252.9,90,,percent of total billed charges,,
Xr Shoulder Routine Rt 2 Or More Views,,73030,CPT,Facility,Outpatient,,,RT,281,238.85,80.5346,281,BlueCross BlueShield Minnesota,Medicare Advantage,137.69,49,,percent of total billed charges,,
Xr Shoulder Routine Rt 2 Or More Views,,73030,CPT,Facility,Inpatient,,,RT,281,238.85,80.5346,281,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Xr Shoulder Routine Rt 2 Or More Views,,73030,CPT,Facility,Both,,,RT,281,238.85,80.5346,281,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,248.8817,88.57,,percent of total billed charges,,
Xr Shoulder Routine Rt 2 Or More Views,,73030,CPT,Facility,Both,,,RT,281,238.85,80.5346,281,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,80.5346,28.66,,percent of total billed charges,,
Xr Shoulder Routine Rt 2 Or More Views,,73030,CPT,Facility,Outpatient,,,RT,281,238.85,80.5346,281,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),137.69,49,,percent of total billed charges,,
Xr Shoulder Routine Rt 2 Or More Views,,73030,CPT,Facility,Inpatient,,,RT,281,238.85,80.5346,281,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Xr Shoulder Routine Rt 2 Or More Views,,73030,CPT,Facility,Both,,,RT,281,238.85,80.5346,281,CorVel,Worker's Compensation,281,100,,percent of total billed charges,,
Xr Shoulder Routine Rt 2 Or More Views,,73030,CPT,Facility,Both,,,RT,281,238.85,80.5346,281,First Health Group Corporation,First Health Network,272.57,97,,percent of total billed charges,,
Xr Shoulder Routine Rt 2 Or More Views,,73030,CPT,Facility,Both,,,RT,281,238.85,80.5346,281,"Health Partners, Inc.",Commercial,265.826,94.6,,percent of total billed charges,,
Xr Shoulder Routine Rt 2 Or More Views,,73030,CPT,Facility,Outpatient,,,RT,281,238.85,80.5346,281,"Health Partners, Inc.",Medicare Advantage,137.69,49,,percent of total billed charges,,
Xr Shoulder Routine Rt 2 Or More Views,,73030,CPT,Facility,Inpatient,,,RT,281,238.85,80.5346,281,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Shoulder Routine Rt 2 Or More Views,,73030,CPT,Facility,Both,,,RT,281,238.85,80.5346,281,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),168.6,60,,percent of total billed charges,,
Xr Shoulder Routine Rt 2 Or More Views,,73030,CPT,Facility,Both,,,RT,281,238.85,80.5346,281,"Health Partners, Inc.",State of Minnesota Advantage Program,229.015,81.5,,percent of total billed charges,,
Xr Shoulder Routine Rt 2 Or More Views,,73030,CPT,Facility,Both,,,RT,281,238.85,80.5346,281,"Health Partners, Inc.",State Public Programs,140.5,50,,percent of total billed charges,,
Xr Shoulder Routine Rt 2 Or More Views,,73030,CPT,Facility,Both,,,RT,281,238.85,80.5346,281,Humana Insurance Company,Commercial PPO,266.95,95,,percent of total billed charges,,
Xr Shoulder Routine Rt 2 Or More Views,,73030,CPT,Facility,Outpatient,,,RT,281,238.85,80.5346,281,Humana Insurance Company,Medicare PPO,137.69,49,,percent of total billed charges,,
Xr Shoulder Routine Rt 2 Or More Views,,73030,CPT,Facility,Inpatient,,,RT,281,238.85,80.5346,281,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Xr Shoulder Routine Rt 2 Or More Views,,73030,CPT,Facility,Both,,,RT,281,238.85,80.5346,281,Medica,Individual & Family,278.471,99.1,,percent of total billed charges,,
Xr Shoulder Routine Rt 2 Or More Views,,73030,CPT,Facility,Outpatient,,,RT,281,238.85,80.5346,281,Medica,Medica Advantage Solution,139.938,49.8,,percent of total billed charges,,
Xr Shoulder Routine Rt 2 Or More Views,,73030,CPT,Facility,Inpatient,,,RT,281,238.85,80.5346,281,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Xr Shoulder Routine Rt 2 Or More Views,,73030,CPT,Facility,Outpatient,,,RT,281,238.85,80.5346,281,Medica,Medical Assistance,125.326,44.6,,percent of total billed charges,,
Xr Shoulder Routine Rt 2 Or More Views,,73030,CPT,Facility,Inpatient,,,RT,281,238.85,80.5346,281,Medica,Medical Assistance,,,,,Included in per diem rate,
Xr Shoulder Routine Rt 2 Or More Views,,73030,CPT,Facility,Outpatient,,,RT,281,238.85,80.5346,281,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,139.938,49.8,,percent of total billed charges,,
Xr Shoulder Routine Rt 2 Or More Views,,73030,CPT,Facility,Inpatient,,,RT,281,238.85,80.5346,281,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Xr Shoulder Routine Rt 2 Or More Views,,73030,CPT,Facility,Both,,,RT,281,238.85,80.5346,281,"Multiplan, Inc.","Multiplan, Inc.",264.14,94,,percent of total billed charges,,
Xr Shoulder Routine Rt 2 Or More Views,,73030,CPT,Facility,Outpatient,,,RT,281,238.85,80.5346,281,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,253.181,90.1,,percent of total billed charges,,
Xr Shoulder Routine Rt 2 Or More Views,,73030,CPT,Facility,Inpatient,,,RT,281,238.85,80.5346,281,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Xr Shoulder Routine Rt 2 Or More Views,,73030,CPT,Facility,Both,,,RT,281,238.85,80.5346,281,"Preferred One Administrative Services, INC.",PPO,277.066,98.6,,percent of total billed charges,,
Xr Shoulder Routine Rt 2 Or More Views,,73030,CPT,Facility,Outpatient,,,RT,281,238.85,80.5346,281,PrimeWest Health,Minnesota Senior Health Options (MSHO),144.5745,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Xr Shoulder Routine Rt 2 Or More Views,,73030,CPT,Facility,Inpatient,,,RT,281,238.85,80.5346,281,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Shoulder Routine Rt 2 Or More Views,,73030,CPT,Facility,Outpatient,,,RT,281,238.85,80.5346,281,PrimeWest Health,MinnesotaCare,144.3216,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Xr Shoulder Routine Rt 2 Or More Views,,73030,CPT,Facility,Inpatient,,,RT,281,238.85,80.5346,281,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Xr Shoulder Routine Rt 2 Or More Views,,73030,CPT,Facility,Both,,,RT,281,238.85,80.5346,281,Sanford Health Plan,Sanford Health Plan,258.52,92,,percent of total billed charges,,
Xr Shoulder Routine Rt 2 Or More Views,,73030,CPT,Facility,Outpatient,,,RT,281,238.85,80.5346,281,"UCare Health, Inc.",Individual & Family Plan,158.3435,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Xr Shoulder Routine Rt 2 Or More Views,,73030,CPT,Facility,Inpatient,,,RT,281,238.85,80.5346,281,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Xr Shoulder Routine Rt 2 Or More Views,,73030,CPT,Facility,Outpatient,,,RT,281,238.85,80.5346,281,"UCare Health, Inc.",Medical Assistance,141.8207,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Shoulder Routine Rt 2 Or More Views,,73030,CPT,Facility,Inpatient,,,RT,281,238.85,80.5346,281,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Xr Shoulder Routine Rt 2 Or More Views,,73030,CPT,Facility,Outpatient,,,RT,281,238.85,80.5346,281,"UCare Health, Inc.",Medicare Advantage,141.8207,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Shoulder Routine Rt 2 Or More Views,,73030,CPT,Facility,Inpatient,,,RT,281,238.85,80.5346,281,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Shoulder Routine Rt 2 Or More Views,,73030,CPT,Facility,Outpatient,,,RT,281,238.85,80.5346,281,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),141.8207,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Shoulder Routine Rt 2 Or More Views,,73030,CPT,Facility,Inpatient,,,RT,281,238.85,80.5346,281,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Shoulder Routine Rt 2 Or More Views,,73030,CPT,Facility,Both,,,RT,281,238.85,80.5346,281,UnitedHealthcare,Individual & Family,264.14,94,,percent of total billed charges,,
Xr Shoulder Routine Rt 2 Or More Views,,73030,CPT,Facility,Outpatient,,,RT,281,238.85,80.5346,281,UnitedHealthcare,Medicare Advantage,137.69,49,,percent of total billed charges,,
Xr Shoulder Routine Rt 2 Or More Views,,73030,CPT,Facility,Inpatient,,,RT,281,238.85,80.5346,281,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Xr Shoulder Routine Rt 2 Or More Views,,73030,CPT,Facility,Outpatient,,,RT,281,238.85,80.5346,281,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,134.88,48,,percent of total billed charges,,100% of DHS outpatient percentage
Xr Shoulder Routine Rt 2 Or More Views,,73030,CPT,Facility,Inpatient,,,RT,281,238.85,80.5346,281,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Xr Humerus Routine Rt 2 Views,,73060,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,Aetna,Commercial,237.36,92,,percent of total billed charges,,
Xr Humerus Routine Rt 2 Views,,73060,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,Aetna,Medicare Advantage,126.42,49,,percent of total billed charges,,
Xr Humerus Routine Rt 2 Views,,73060,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Xr Humerus Routine Rt 2 Views,,73060,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,Aetna,PPO,239.94,93,,percent of total billed charges,,
Xr Humerus Routine Rt 2 Views,,73060,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,America's PPO,America's PPO,247.7574,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Xr Humerus Routine Rt 2 Views,,73060,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota, Federal Employee Program,253.872,98.4,,percent of total billed charges,,
Xr Humerus Routine Rt 2 Views,,73060,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,258,100,,percent of total billed charges,,
Xr Humerus Routine Rt 2 Views,,73060,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,High Value Network Plan,232.2,90,,percent of total billed charges,,
Xr Humerus Routine Rt 2 Views,,73060,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,Medicare Advantage,126.42,49,,percent of total billed charges,,
Xr Humerus Routine Rt 2 Views,,73060,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Xr Humerus Routine Rt 2 Views,,73060,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,228.5106,88.57,,percent of total billed charges,,
Xr Humerus Routine Rt 2 Views,,73060,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,73.9428,28.66,,percent of total billed charges,,
Xr Humerus Routine Rt 2 Views,,73060,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),126.42,49,,percent of total billed charges,,
Xr Humerus Routine Rt 2 Views,,73060,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Xr Humerus Routine Rt 2 Views,,73060,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,CorVel,Worker's Compensation,258,100,,percent of total billed charges,,
Xr Humerus Routine Rt 2 Views,,73060,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,First Health Group Corporation,First Health Network,250.26,97,,percent of total billed charges,,
Xr Humerus Routine Rt 2 Views,,73060,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,"Health Partners, Inc.",Commercial,244.068,94.6,,percent of total billed charges,,
Xr Humerus Routine Rt 2 Views,,73060,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,"Health Partners, Inc.",Medicare Advantage,126.42,49,,percent of total billed charges,,
Xr Humerus Routine Rt 2 Views,,73060,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Humerus Routine Rt 2 Views,,73060,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),154.8,60,,percent of total billed charges,,
Xr Humerus Routine Rt 2 Views,,73060,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,"Health Partners, Inc.",State of Minnesota Advantage Program,210.27,81.5,,percent of total billed charges,,
Xr Humerus Routine Rt 2 Views,,73060,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,"Health Partners, Inc.",State Public Programs,129,50,,percent of total billed charges,,
Xr Humerus Routine Rt 2 Views,,73060,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,Humana Insurance Company,Commercial PPO,245.1,95,,percent of total billed charges,,
Xr Humerus Routine Rt 2 Views,,73060,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,Humana Insurance Company,Medicare PPO,126.42,49,,percent of total billed charges,,
Xr Humerus Routine Rt 2 Views,,73060,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Xr Humerus Routine Rt 2 Views,,73060,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,Medica,Individual & Family,255.678,99.1,,percent of total billed charges,,
Xr Humerus Routine Rt 2 Views,,73060,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,Medica,Medica Advantage Solution,128.484,49.8,,percent of total billed charges,,
Xr Humerus Routine Rt 2 Views,,73060,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Xr Humerus Routine Rt 2 Views,,73060,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,Medica,Medical Assistance,115.068,44.6,,percent of total billed charges,,
Xr Humerus Routine Rt 2 Views,,73060,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,Medica,Medical Assistance,,,,,Included in per diem rate,
Xr Humerus Routine Rt 2 Views,,73060,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,128.484,49.8,,percent of total billed charges,,
Xr Humerus Routine Rt 2 Views,,73060,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Xr Humerus Routine Rt 2 Views,,73060,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,"Multiplan, Inc.","Multiplan, Inc.",242.52,94,,percent of total billed charges,,
Xr Humerus Routine Rt 2 Views,,73060,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,232.458,90.1,,percent of total billed charges,,
Xr Humerus Routine Rt 2 Views,,73060,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Xr Humerus Routine Rt 2 Views,,73060,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,"Preferred One Administrative Services, INC.",PPO,254.388,98.6,,percent of total billed charges,,
Xr Humerus Routine Rt 2 Views,,73060,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,PrimeWest Health,Minnesota Senior Health Options (MSHO),132.741,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Xr Humerus Routine Rt 2 Views,,73060,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Humerus Routine Rt 2 Views,,73060,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,PrimeWest Health,MinnesotaCare,132.5088,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Xr Humerus Routine Rt 2 Views,,73060,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Xr Humerus Routine Rt 2 Views,,73060,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,Sanford Health Plan,Sanford Health Plan,237.36,92,,percent of total billed charges,,
Xr Humerus Routine Rt 2 Views,,73060,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,"UCare Health, Inc.",Individual & Family Plan,145.383,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Xr Humerus Routine Rt 2 Views,,73060,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Xr Humerus Routine Rt 2 Views,,73060,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,"UCare Health, Inc.",Medical Assistance,130.2126,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Humerus Routine Rt 2 Views,,73060,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Xr Humerus Routine Rt 2 Views,,73060,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,"UCare Health, Inc.",Medicare Advantage,130.2126,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Humerus Routine Rt 2 Views,,73060,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Humerus Routine Rt 2 Views,,73060,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),130.2126,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Humerus Routine Rt 2 Views,,73060,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Humerus Routine Rt 2 Views,,73060,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,UnitedHealthcare,Individual & Family,242.52,94,,percent of total billed charges,,
Xr Humerus Routine Rt 2 Views,,73060,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,UnitedHealthcare,Medicare Advantage,126.42,49,,percent of total billed charges,,
Xr Humerus Routine Rt 2 Views,,73060,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Xr Humerus Routine Rt 2 Views,,73060,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,123.84,48,,percent of total billed charges,,100% of DHS outpatient percentage
Xr Humerus Routine Rt 2 Views,,73060,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Xr Elbow Rt 2 Views,,73070,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,Aetna,Commercial,237.36,92,,percent of total billed charges,,
Xr Elbow Rt 2 Views,,73070,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,Aetna,Medicare Advantage,126.42,49,,percent of total billed charges,,
Xr Elbow Rt 2 Views,,73070,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Xr Elbow Rt 2 Views,,73070,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,Aetna,PPO,239.94,93,,percent of total billed charges,,
Xr Elbow Rt 2 Views,,73070,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,America's PPO,America's PPO,247.7574,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Xr Elbow Rt 2 Views,,73070,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota, Federal Employee Program,253.872,98.4,,percent of total billed charges,,
Xr Elbow Rt 2 Views,,73070,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,258,100,,percent of total billed charges,,
Xr Elbow Rt 2 Views,,73070,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,High Value Network Plan,232.2,90,,percent of total billed charges,,
Xr Elbow Rt 2 Views,,73070,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,Medicare Advantage,126.42,49,,percent of total billed charges,,
Xr Elbow Rt 2 Views,,73070,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Xr Elbow Rt 2 Views,,73070,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,228.5106,88.57,,percent of total billed charges,,
Xr Elbow Rt 2 Views,,73070,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,73.9428,28.66,,percent of total billed charges,,
Xr Elbow Rt 2 Views,,73070,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),126.42,49,,percent of total billed charges,,
Xr Elbow Rt 2 Views,,73070,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Xr Elbow Rt 2 Views,,73070,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,CorVel,Worker's Compensation,258,100,,percent of total billed charges,,
Xr Elbow Rt 2 Views,,73070,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,First Health Group Corporation,First Health Network,250.26,97,,percent of total billed charges,,
Xr Elbow Rt 2 Views,,73070,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,"Health Partners, Inc.",Commercial,244.068,94.6,,percent of total billed charges,,
Xr Elbow Rt 2 Views,,73070,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,"Health Partners, Inc.",Medicare Advantage,126.42,49,,percent of total billed charges,,
Xr Elbow Rt 2 Views,,73070,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Elbow Rt 2 Views,,73070,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),154.8,60,,percent of total billed charges,,
Xr Elbow Rt 2 Views,,73070,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,"Health Partners, Inc.",State of Minnesota Advantage Program,210.27,81.5,,percent of total billed charges,,
Xr Elbow Rt 2 Views,,73070,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,"Health Partners, Inc.",State Public Programs,129,50,,percent of total billed charges,,
Xr Elbow Rt 2 Views,,73070,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,Humana Insurance Company,Commercial PPO,245.1,95,,percent of total billed charges,,
Xr Elbow Rt 2 Views,,73070,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,Humana Insurance Company,Medicare PPO,126.42,49,,percent of total billed charges,,
Xr Elbow Rt 2 Views,,73070,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Xr Elbow Rt 2 Views,,73070,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,Medica,Individual & Family,255.678,99.1,,percent of total billed charges,,
Xr Elbow Rt 2 Views,,73070,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,Medica,Medica Advantage Solution,128.484,49.8,,percent of total billed charges,,
Xr Elbow Rt 2 Views,,73070,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Xr Elbow Rt 2 Views,,73070,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,Medica,Medical Assistance,115.068,44.6,,percent of total billed charges,,
Xr Elbow Rt 2 Views,,73070,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,Medica,Medical Assistance,,,,,Included in per diem rate,
Xr Elbow Rt 2 Views,,73070,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,128.484,49.8,,percent of total billed charges,,
Xr Elbow Rt 2 Views,,73070,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Xr Elbow Rt 2 Views,,73070,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,"Multiplan, Inc.","Multiplan, Inc.",242.52,94,,percent of total billed charges,,
Xr Elbow Rt 2 Views,,73070,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,232.458,90.1,,percent of total billed charges,,
Xr Elbow Rt 2 Views,,73070,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Xr Elbow Rt 2 Views,,73070,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,"Preferred One Administrative Services, INC.",PPO,254.388,98.6,,percent of total billed charges,,
Xr Elbow Rt 2 Views,,73070,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,PrimeWest Health,Minnesota Senior Health Options (MSHO),132.741,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Xr Elbow Rt 2 Views,,73070,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Elbow Rt 2 Views,,73070,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,PrimeWest Health,MinnesotaCare,132.5088,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Xr Elbow Rt 2 Views,,73070,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Xr Elbow Rt 2 Views,,73070,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,Sanford Health Plan,Sanford Health Plan,237.36,92,,percent of total billed charges,,
Xr Elbow Rt 2 Views,,73070,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,"UCare Health, Inc.",Individual & Family Plan,145.383,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Xr Elbow Rt 2 Views,,73070,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Xr Elbow Rt 2 Views,,73070,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,"UCare Health, Inc.",Medical Assistance,130.2126,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Elbow Rt 2 Views,,73070,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Xr Elbow Rt 2 Views,,73070,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,"UCare Health, Inc.",Medicare Advantage,130.2126,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Elbow Rt 2 Views,,73070,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Elbow Rt 2 Views,,73070,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),130.2126,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Elbow Rt 2 Views,,73070,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Elbow Rt 2 Views,,73070,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,UnitedHealthcare,Individual & Family,242.52,94,,percent of total billed charges,,
Xr Elbow Rt 2 Views,,73070,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,UnitedHealthcare,Medicare Advantage,126.42,49,,percent of total billed charges,,
Xr Elbow Rt 2 Views,,73070,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Xr Elbow Rt 2 Views,,73070,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,123.84,48,,percent of total billed charges,,100% of DHS outpatient percentage
Xr Elbow Rt 2 Views,,73070,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Xr Elbow Routine Rt 3 Views,,73080,CPT,Facility,Both,,,RT,281,238.85,80.5346,281,Aetna,Commercial,258.52,92,,percent of total billed charges,,
Xr Elbow Routine Rt 3 Views,,73080,CPT,Facility,Outpatient,,,RT,281,238.85,80.5346,281,Aetna,Medicare Advantage,137.69,49,,percent of total billed charges,,
Xr Elbow Routine Rt 3 Views,,73080,CPT,Facility,Inpatient,,,RT,281,238.85,80.5346,281,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Xr Elbow Routine Rt 3 Views,,73080,CPT,Facility,Both,,,RT,281,238.85,80.5346,281,Aetna,PPO,261.33,93,,percent of total billed charges,,
Xr Elbow Routine Rt 3 Views,,73080,CPT,Facility,Both,,,RT,281,238.85,80.5346,281,America's PPO,America's PPO,269.8443,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Xr Elbow Routine Rt 3 Views,,73080,CPT,Facility,Both,,,RT,281,238.85,80.5346,281,BlueCross BlueShield Minnesota, Federal Employee Program,276.504,98.4,,percent of total billed charges,,
Xr Elbow Routine Rt 3 Views,,73080,CPT,Facility,Both,,,RT,281,238.85,80.5346,281,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,281,100,,percent of total billed charges,,
Xr Elbow Routine Rt 3 Views,,73080,CPT,Facility,Both,,,RT,281,238.85,80.5346,281,BlueCross BlueShield Minnesota,High Value Network Plan,252.9,90,,percent of total billed charges,,
Xr Elbow Routine Rt 3 Views,,73080,CPT,Facility,Outpatient,,,RT,281,238.85,80.5346,281,BlueCross BlueShield Minnesota,Medicare Advantage,137.69,49,,percent of total billed charges,,
Xr Elbow Routine Rt 3 Views,,73080,CPT,Facility,Inpatient,,,RT,281,238.85,80.5346,281,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Xr Elbow Routine Rt 3 Views,,73080,CPT,Facility,Both,,,RT,281,238.85,80.5346,281,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,248.8817,88.57,,percent of total billed charges,,
Xr Elbow Routine Rt 3 Views,,73080,CPT,Facility,Both,,,RT,281,238.85,80.5346,281,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,80.5346,28.66,,percent of total billed charges,,
Xr Elbow Routine Rt 3 Views,,73080,CPT,Facility,Outpatient,,,RT,281,238.85,80.5346,281,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),137.69,49,,percent of total billed charges,,
Xr Elbow Routine Rt 3 Views,,73080,CPT,Facility,Inpatient,,,RT,281,238.85,80.5346,281,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Xr Elbow Routine Rt 3 Views,,73080,CPT,Facility,Both,,,RT,281,238.85,80.5346,281,CorVel,Worker's Compensation,281,100,,percent of total billed charges,,
Xr Elbow Routine Rt 3 Views,,73080,CPT,Facility,Both,,,RT,281,238.85,80.5346,281,First Health Group Corporation,First Health Network,272.57,97,,percent of total billed charges,,
Xr Elbow Routine Rt 3 Views,,73080,CPT,Facility,Both,,,RT,281,238.85,80.5346,281,"Health Partners, Inc.",Commercial,265.826,94.6,,percent of total billed charges,,
Xr Elbow Routine Rt 3 Views,,73080,CPT,Facility,Outpatient,,,RT,281,238.85,80.5346,281,"Health Partners, Inc.",Medicare Advantage,137.69,49,,percent of total billed charges,,
Xr Elbow Routine Rt 3 Views,,73080,CPT,Facility,Inpatient,,,RT,281,238.85,80.5346,281,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Elbow Routine Rt 3 Views,,73080,CPT,Facility,Both,,,RT,281,238.85,80.5346,281,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),168.6,60,,percent of total billed charges,,
Xr Elbow Routine Rt 3 Views,,73080,CPT,Facility,Both,,,RT,281,238.85,80.5346,281,"Health Partners, Inc.",State of Minnesota Advantage Program,229.015,81.5,,percent of total billed charges,,
Xr Elbow Routine Rt 3 Views,,73080,CPT,Facility,Both,,,RT,281,238.85,80.5346,281,"Health Partners, Inc.",State Public Programs,140.5,50,,percent of total billed charges,,
Xr Elbow Routine Rt 3 Views,,73080,CPT,Facility,Both,,,RT,281,238.85,80.5346,281,Humana Insurance Company,Commercial PPO,266.95,95,,percent of total billed charges,,
Xr Elbow Routine Rt 3 Views,,73080,CPT,Facility,Outpatient,,,RT,281,238.85,80.5346,281,Humana Insurance Company,Medicare PPO,137.69,49,,percent of total billed charges,,
Xr Elbow Routine Rt 3 Views,,73080,CPT,Facility,Inpatient,,,RT,281,238.85,80.5346,281,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Xr Elbow Routine Rt 3 Views,,73080,CPT,Facility,Both,,,RT,281,238.85,80.5346,281,Medica,Individual & Family,278.471,99.1,,percent of total billed charges,,
Xr Elbow Routine Rt 3 Views,,73080,CPT,Facility,Outpatient,,,RT,281,238.85,80.5346,281,Medica,Medica Advantage Solution,139.938,49.8,,percent of total billed charges,,
Xr Elbow Routine Rt 3 Views,,73080,CPT,Facility,Inpatient,,,RT,281,238.85,80.5346,281,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Xr Elbow Routine Rt 3 Views,,73080,CPT,Facility,Outpatient,,,RT,281,238.85,80.5346,281,Medica,Medical Assistance,125.326,44.6,,percent of total billed charges,,
Xr Elbow Routine Rt 3 Views,,73080,CPT,Facility,Inpatient,,,RT,281,238.85,80.5346,281,Medica,Medical Assistance,,,,,Included in per diem rate,
Xr Elbow Routine Rt 3 Views,,73080,CPT,Facility,Outpatient,,,RT,281,238.85,80.5346,281,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,139.938,49.8,,percent of total billed charges,,
Xr Elbow Routine Rt 3 Views,,73080,CPT,Facility,Inpatient,,,RT,281,238.85,80.5346,281,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Xr Elbow Routine Rt 3 Views,,73080,CPT,Facility,Both,,,RT,281,238.85,80.5346,281,"Multiplan, Inc.","Multiplan, Inc.",264.14,94,,percent of total billed charges,,
Xr Elbow Routine Rt 3 Views,,73080,CPT,Facility,Outpatient,,,RT,281,238.85,80.5346,281,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,253.181,90.1,,percent of total billed charges,,
Xr Elbow Routine Rt 3 Views,,73080,CPT,Facility,Inpatient,,,RT,281,238.85,80.5346,281,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Xr Elbow Routine Rt 3 Views,,73080,CPT,Facility,Both,,,RT,281,238.85,80.5346,281,"Preferred One Administrative Services, INC.",PPO,277.066,98.6,,percent of total billed charges,,
Xr Elbow Routine Rt 3 Views,,73080,CPT,Facility,Outpatient,,,RT,281,238.85,80.5346,281,PrimeWest Health,Minnesota Senior Health Options (MSHO),144.5745,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Xr Elbow Routine Rt 3 Views,,73080,CPT,Facility,Inpatient,,,RT,281,238.85,80.5346,281,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Elbow Routine Rt 3 Views,,73080,CPT,Facility,Outpatient,,,RT,281,238.85,80.5346,281,PrimeWest Health,MinnesotaCare,144.3216,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Xr Elbow Routine Rt 3 Views,,73080,CPT,Facility,Inpatient,,,RT,281,238.85,80.5346,281,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Xr Elbow Routine Rt 3 Views,,73080,CPT,Facility,Both,,,RT,281,238.85,80.5346,281,Sanford Health Plan,Sanford Health Plan,258.52,92,,percent of total billed charges,,
Xr Elbow Routine Rt 3 Views,,73080,CPT,Facility,Outpatient,,,RT,281,238.85,80.5346,281,"UCare Health, Inc.",Individual & Family Plan,158.3435,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Xr Elbow Routine Rt 3 Views,,73080,CPT,Facility,Inpatient,,,RT,281,238.85,80.5346,281,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Xr Elbow Routine Rt 3 Views,,73080,CPT,Facility,Outpatient,,,RT,281,238.85,80.5346,281,"UCare Health, Inc.",Medical Assistance,141.8207,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Elbow Routine Rt 3 Views,,73080,CPT,Facility,Inpatient,,,RT,281,238.85,80.5346,281,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Xr Elbow Routine Rt 3 Views,,73080,CPT,Facility,Outpatient,,,RT,281,238.85,80.5346,281,"UCare Health, Inc.",Medicare Advantage,141.8207,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Elbow Routine Rt 3 Views,,73080,CPT,Facility,Inpatient,,,RT,281,238.85,80.5346,281,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Elbow Routine Rt 3 Views,,73080,CPT,Facility,Outpatient,,,RT,281,238.85,80.5346,281,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),141.8207,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Elbow Routine Rt 3 Views,,73080,CPT,Facility,Inpatient,,,RT,281,238.85,80.5346,281,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Elbow Routine Rt 3 Views,,73080,CPT,Facility,Both,,,RT,281,238.85,80.5346,281,UnitedHealthcare,Individual & Family,264.14,94,,percent of total billed charges,,
Xr Elbow Routine Rt 3 Views,,73080,CPT,Facility,Outpatient,,,RT,281,238.85,80.5346,281,UnitedHealthcare,Medicare Advantage,137.69,49,,percent of total billed charges,,
Xr Elbow Routine Rt 3 Views,,73080,CPT,Facility,Inpatient,,,RT,281,238.85,80.5346,281,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Xr Elbow Routine Rt 3 Views,,73080,CPT,Facility,Outpatient,,,RT,281,238.85,80.5346,281,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,134.88,48,,percent of total billed charges,,100% of DHS outpatient percentage
Xr Elbow Routine Rt 3 Views,,73080,CPT,Facility,Inpatient,,,RT,281,238.85,80.5346,281,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Xr Forearm Routine Rt 2 Views,,73090,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,Aetna,Commercial,237.36,92,,percent of total billed charges,,
Xr Forearm Routine Rt 2 Views,,73090,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,Aetna,Medicare Advantage,126.42,49,,percent of total billed charges,,
Xr Forearm Routine Rt 2 Views,,73090,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Xr Forearm Routine Rt 2 Views,,73090,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,Aetna,PPO,239.94,93,,percent of total billed charges,,
Xr Forearm Routine Rt 2 Views,,73090,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,America's PPO,America's PPO,247.7574,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Xr Forearm Routine Rt 2 Views,,73090,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota, Federal Employee Program,253.872,98.4,,percent of total billed charges,,
Xr Forearm Routine Rt 2 Views,,73090,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,258,100,,percent of total billed charges,,
Xr Forearm Routine Rt 2 Views,,73090,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,High Value Network Plan,232.2,90,,percent of total billed charges,,
Xr Forearm Routine Rt 2 Views,,73090,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,Medicare Advantage,126.42,49,,percent of total billed charges,,
Xr Forearm Routine Rt 2 Views,,73090,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Xr Forearm Routine Rt 2 Views,,73090,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,228.5106,88.57,,percent of total billed charges,,
Xr Forearm Routine Rt 2 Views,,73090,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,73.9428,28.66,,percent of total billed charges,,
Xr Forearm Routine Rt 2 Views,,73090,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),126.42,49,,percent of total billed charges,,
Xr Forearm Routine Rt 2 Views,,73090,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Xr Forearm Routine Rt 2 Views,,73090,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,CorVel,Worker's Compensation,258,100,,percent of total billed charges,,
Xr Forearm Routine Rt 2 Views,,73090,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,First Health Group Corporation,First Health Network,250.26,97,,percent of total billed charges,,
Xr Forearm Routine Rt 2 Views,,73090,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,"Health Partners, Inc.",Commercial,244.068,94.6,,percent of total billed charges,,
Xr Forearm Routine Rt 2 Views,,73090,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,"Health Partners, Inc.",Medicare Advantage,126.42,49,,percent of total billed charges,,
Xr Forearm Routine Rt 2 Views,,73090,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Forearm Routine Rt 2 Views,,73090,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),154.8,60,,percent of total billed charges,,
Xr Forearm Routine Rt 2 Views,,73090,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,"Health Partners, Inc.",State of Minnesota Advantage Program,210.27,81.5,,percent of total billed charges,,
Xr Forearm Routine Rt 2 Views,,73090,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,"Health Partners, Inc.",State Public Programs,129,50,,percent of total billed charges,,
Xr Forearm Routine Rt 2 Views,,73090,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,Humana Insurance Company,Commercial PPO,245.1,95,,percent of total billed charges,,
Xr Forearm Routine Rt 2 Views,,73090,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,Humana Insurance Company,Medicare PPO,126.42,49,,percent of total billed charges,,
Xr Forearm Routine Rt 2 Views,,73090,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Xr Forearm Routine Rt 2 Views,,73090,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,Medica,Individual & Family,255.678,99.1,,percent of total billed charges,,
Xr Forearm Routine Rt 2 Views,,73090,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,Medica,Medica Advantage Solution,128.484,49.8,,percent of total billed charges,,
Xr Forearm Routine Rt 2 Views,,73090,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Xr Forearm Routine Rt 2 Views,,73090,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,Medica,Medical Assistance,115.068,44.6,,percent of total billed charges,,
Xr Forearm Routine Rt 2 Views,,73090,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,Medica,Medical Assistance,,,,,Included in per diem rate,
Xr Forearm Routine Rt 2 Views,,73090,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,128.484,49.8,,percent of total billed charges,,
Xr Forearm Routine Rt 2 Views,,73090,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Xr Forearm Routine Rt 2 Views,,73090,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,"Multiplan, Inc.","Multiplan, Inc.",242.52,94,,percent of total billed charges,,
Xr Forearm Routine Rt 2 Views,,73090,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,232.458,90.1,,percent of total billed charges,,
Xr Forearm Routine Rt 2 Views,,73090,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Xr Forearm Routine Rt 2 Views,,73090,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,"Preferred One Administrative Services, INC.",PPO,254.388,98.6,,percent of total billed charges,,
Xr Forearm Routine Rt 2 Views,,73090,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,PrimeWest Health,Minnesota Senior Health Options (MSHO),132.741,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Xr Forearm Routine Rt 2 Views,,73090,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Forearm Routine Rt 2 Views,,73090,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,PrimeWest Health,MinnesotaCare,132.5088,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Xr Forearm Routine Rt 2 Views,,73090,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Xr Forearm Routine Rt 2 Views,,73090,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,Sanford Health Plan,Sanford Health Plan,237.36,92,,percent of total billed charges,,
Xr Forearm Routine Rt 2 Views,,73090,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,"UCare Health, Inc.",Individual & Family Plan,145.383,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Xr Forearm Routine Rt 2 Views,,73090,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Xr Forearm Routine Rt 2 Views,,73090,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,"UCare Health, Inc.",Medical Assistance,130.2126,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Forearm Routine Rt 2 Views,,73090,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Xr Forearm Routine Rt 2 Views,,73090,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,"UCare Health, Inc.",Medicare Advantage,130.2126,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Forearm Routine Rt 2 Views,,73090,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Forearm Routine Rt 2 Views,,73090,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),130.2126,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Forearm Routine Rt 2 Views,,73090,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Forearm Routine Rt 2 Views,,73090,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,UnitedHealthcare,Individual & Family,242.52,94,,percent of total billed charges,,
Xr Forearm Routine Rt 2 Views,,73090,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,UnitedHealthcare,Medicare Advantage,126.42,49,,percent of total billed charges,,
Xr Forearm Routine Rt 2 Views,,73090,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Xr Forearm Routine Rt 2 Views,,73090,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,123.84,48,,percent of total billed charges,,100% of DHS outpatient percentage
Xr Forearm Routine Rt 2 Views,,73090,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Xr Upper Ext Rt Infant,,73092,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,Aetna,Commercial,237.36,92,,percent of total billed charges,,
Xr Upper Ext Rt Infant,,73092,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,Aetna,Medicare Advantage,126.42,49,,percent of total billed charges,,
Xr Upper Ext Rt Infant,,73092,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Xr Upper Ext Rt Infant,,73092,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,Aetna,PPO,239.94,93,,percent of total billed charges,,
Xr Upper Ext Rt Infant,,73092,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,America's PPO,America's PPO,247.7574,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Xr Upper Ext Rt Infant,,73092,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota, Federal Employee Program,253.872,98.4,,percent of total billed charges,,
Xr Upper Ext Rt Infant,,73092,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,258,100,,percent of total billed charges,,
Xr Upper Ext Rt Infant,,73092,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,High Value Network Plan,232.2,90,,percent of total billed charges,,
Xr Upper Ext Rt Infant,,73092,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,Medicare Advantage,126.42,49,,percent of total billed charges,,
Xr Upper Ext Rt Infant,,73092,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Xr Upper Ext Rt Infant,,73092,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,228.5106,88.57,,percent of total billed charges,,
Xr Upper Ext Rt Infant,,73092,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,73.9428,28.66,,percent of total billed charges,,
Xr Upper Ext Rt Infant,,73092,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),126.42,49,,percent of total billed charges,,
Xr Upper Ext Rt Infant,,73092,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Xr Upper Ext Rt Infant,,73092,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,CorVel,Worker's Compensation,258,100,,percent of total billed charges,,
Xr Upper Ext Rt Infant,,73092,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,First Health Group Corporation,First Health Network,250.26,97,,percent of total billed charges,,
Xr Upper Ext Rt Infant,,73092,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,"Health Partners, Inc.",Commercial,244.068,94.6,,percent of total billed charges,,
Xr Upper Ext Rt Infant,,73092,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,"Health Partners, Inc.",Medicare Advantage,126.42,49,,percent of total billed charges,,
Xr Upper Ext Rt Infant,,73092,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Upper Ext Rt Infant,,73092,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),154.8,60,,percent of total billed charges,,
Xr Upper Ext Rt Infant,,73092,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,"Health Partners, Inc.",State of Minnesota Advantage Program,210.27,81.5,,percent of total billed charges,,
Xr Upper Ext Rt Infant,,73092,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,"Health Partners, Inc.",State Public Programs,129,50,,percent of total billed charges,,
Xr Upper Ext Rt Infant,,73092,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,Humana Insurance Company,Commercial PPO,245.1,95,,percent of total billed charges,,
Xr Upper Ext Rt Infant,,73092,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,Humana Insurance Company,Medicare PPO,126.42,49,,percent of total billed charges,,
Xr Upper Ext Rt Infant,,73092,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Xr Upper Ext Rt Infant,,73092,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,Medica,Individual & Family,255.678,99.1,,percent of total billed charges,,
Xr Upper Ext Rt Infant,,73092,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,Medica,Medica Advantage Solution,128.484,49.8,,percent of total billed charges,,
Xr Upper Ext Rt Infant,,73092,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Xr Upper Ext Rt Infant,,73092,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,Medica,Medical Assistance,115.068,44.6,,percent of total billed charges,,
Xr Upper Ext Rt Infant,,73092,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,Medica,Medical Assistance,,,,,Included in per diem rate,
Xr Upper Ext Rt Infant,,73092,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,128.484,49.8,,percent of total billed charges,,
Xr Upper Ext Rt Infant,,73092,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Xr Upper Ext Rt Infant,,73092,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,"Multiplan, Inc.","Multiplan, Inc.",242.52,94,,percent of total billed charges,,
Xr Upper Ext Rt Infant,,73092,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,232.458,90.1,,percent of total billed charges,,
Xr Upper Ext Rt Infant,,73092,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Xr Upper Ext Rt Infant,,73092,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,"Preferred One Administrative Services, INC.",PPO,254.388,98.6,,percent of total billed charges,,
Xr Upper Ext Rt Infant,,73092,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,PrimeWest Health,Minnesota Senior Health Options (MSHO),132.741,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Xr Upper Ext Rt Infant,,73092,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Upper Ext Rt Infant,,73092,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,PrimeWest Health,MinnesotaCare,132.5088,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Xr Upper Ext Rt Infant,,73092,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Xr Upper Ext Rt Infant,,73092,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,Sanford Health Plan,Sanford Health Plan,237.36,92,,percent of total billed charges,,
Xr Upper Ext Rt Infant,,73092,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,"UCare Health, Inc.",Individual & Family Plan,145.383,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Xr Upper Ext Rt Infant,,73092,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Xr Upper Ext Rt Infant,,73092,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,"UCare Health, Inc.",Medical Assistance,130.2126,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Upper Ext Rt Infant,,73092,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Xr Upper Ext Rt Infant,,73092,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,"UCare Health, Inc.",Medicare Advantage,130.2126,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Upper Ext Rt Infant,,73092,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Upper Ext Rt Infant,,73092,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),130.2126,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Upper Ext Rt Infant,,73092,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Upper Ext Rt Infant,,73092,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,UnitedHealthcare,Individual & Family,242.52,94,,percent of total billed charges,,
Xr Upper Ext Rt Infant,,73092,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,UnitedHealthcare,Medicare Advantage,126.42,49,,percent of total billed charges,,
Xr Upper Ext Rt Infant,,73092,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Xr Upper Ext Rt Infant,,73092,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,123.84,48,,percent of total billed charges,,100% of DHS outpatient percentage
Xr Upper Ext Rt Infant,,73092,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Xr Wrist Rt 2 Views,,73100,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,Aetna,Commercial,237.36,92,,percent of total billed charges,,
Xr Wrist Rt 2 Views,,73100,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,Aetna,Medicare Advantage,126.42,49,,percent of total billed charges,,
Xr Wrist Rt 2 Views,,73100,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Xr Wrist Rt 2 Views,,73100,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,Aetna,PPO,239.94,93,,percent of total billed charges,,
Xr Wrist Rt 2 Views,,73100,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,America's PPO,America's PPO,247.7574,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Xr Wrist Rt 2 Views,,73100,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota, Federal Employee Program,253.872,98.4,,percent of total billed charges,,
Xr Wrist Rt 2 Views,,73100,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,258,100,,percent of total billed charges,,
Xr Wrist Rt 2 Views,,73100,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,High Value Network Plan,232.2,90,,percent of total billed charges,,
Xr Wrist Rt 2 Views,,73100,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,Medicare Advantage,126.42,49,,percent of total billed charges,,
Xr Wrist Rt 2 Views,,73100,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Xr Wrist Rt 2 Views,,73100,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,228.5106,88.57,,percent of total billed charges,,
Xr Wrist Rt 2 Views,,73100,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,73.9428,28.66,,percent of total billed charges,,
Xr Wrist Rt 2 Views,,73100,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),126.42,49,,percent of total billed charges,,
Xr Wrist Rt 2 Views,,73100,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Xr Wrist Rt 2 Views,,73100,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,CorVel,Worker's Compensation,258,100,,percent of total billed charges,,
Xr Wrist Rt 2 Views,,73100,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,First Health Group Corporation,First Health Network,250.26,97,,percent of total billed charges,,
Xr Wrist Rt 2 Views,,73100,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,"Health Partners, Inc.",Commercial,244.068,94.6,,percent of total billed charges,,
Xr Wrist Rt 2 Views,,73100,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,"Health Partners, Inc.",Medicare Advantage,126.42,49,,percent of total billed charges,,
Xr Wrist Rt 2 Views,,73100,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Wrist Rt 2 Views,,73100,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),154.8,60,,percent of total billed charges,,
Xr Wrist Rt 2 Views,,73100,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,"Health Partners, Inc.",State of Minnesota Advantage Program,210.27,81.5,,percent of total billed charges,,
Xr Wrist Rt 2 Views,,73100,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,"Health Partners, Inc.",State Public Programs,129,50,,percent of total billed charges,,
Xr Wrist Rt 2 Views,,73100,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,Humana Insurance Company,Commercial PPO,245.1,95,,percent of total billed charges,,
Xr Wrist Rt 2 Views,,73100,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,Humana Insurance Company,Medicare PPO,126.42,49,,percent of total billed charges,,
Xr Wrist Rt 2 Views,,73100,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Xr Wrist Rt 2 Views,,73100,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,Medica,Individual & Family,255.678,99.1,,percent of total billed charges,,
Xr Wrist Rt 2 Views,,73100,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,Medica,Medica Advantage Solution,128.484,49.8,,percent of total billed charges,,
Xr Wrist Rt 2 Views,,73100,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Xr Wrist Rt 2 Views,,73100,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,Medica,Medical Assistance,115.068,44.6,,percent of total billed charges,,
Xr Wrist Rt 2 Views,,73100,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,Medica,Medical Assistance,,,,,Included in per diem rate,
Xr Wrist Rt 2 Views,,73100,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,128.484,49.8,,percent of total billed charges,,
Xr Wrist Rt 2 Views,,73100,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Xr Wrist Rt 2 Views,,73100,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,"Multiplan, Inc.","Multiplan, Inc.",242.52,94,,percent of total billed charges,,
Xr Wrist Rt 2 Views,,73100,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,232.458,90.1,,percent of total billed charges,,
Xr Wrist Rt 2 Views,,73100,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Xr Wrist Rt 2 Views,,73100,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,"Preferred One Administrative Services, INC.",PPO,254.388,98.6,,percent of total billed charges,,
Xr Wrist Rt 2 Views,,73100,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,PrimeWest Health,Minnesota Senior Health Options (MSHO),132.741,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Xr Wrist Rt 2 Views,,73100,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Wrist Rt 2 Views,,73100,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,PrimeWest Health,MinnesotaCare,132.5088,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Xr Wrist Rt 2 Views,,73100,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Xr Wrist Rt 2 Views,,73100,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,Sanford Health Plan,Sanford Health Plan,237.36,92,,percent of total billed charges,,
Xr Wrist Rt 2 Views,,73100,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,"UCare Health, Inc.",Individual & Family Plan,145.383,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Xr Wrist Rt 2 Views,,73100,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Xr Wrist Rt 2 Views,,73100,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,"UCare Health, Inc.",Medical Assistance,130.2126,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Wrist Rt 2 Views,,73100,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Xr Wrist Rt 2 Views,,73100,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,"UCare Health, Inc.",Medicare Advantage,130.2126,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Wrist Rt 2 Views,,73100,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Wrist Rt 2 Views,,73100,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),130.2126,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Wrist Rt 2 Views,,73100,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Wrist Rt 2 Views,,73100,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,UnitedHealthcare,Individual & Family,242.52,94,,percent of total billed charges,,
Xr Wrist Rt 2 Views,,73100,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,UnitedHealthcare,Medicare Advantage,126.42,49,,percent of total billed charges,,
Xr Wrist Rt 2 Views,,73100,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Xr Wrist Rt 2 Views,,73100,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,123.84,48,,percent of total billed charges,,100% of DHS outpatient percentage
Xr Wrist Rt 2 Views,,73100,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Xr Wrist Routine Rt 3 Or More Views,,73110,CPT,Facility,Both,,,RT,270,229.5,77.382,270,Aetna,Commercial,248.4,92,,percent of total billed charges,,
Xr Wrist Routine Rt 3 Or More Views,,73110,CPT,Facility,Outpatient,,,RT,270,229.5,77.382,270,Aetna,Medicare Advantage,132.3,49,,percent of total billed charges,,
Xr Wrist Routine Rt 3 Or More Views,,73110,CPT,Facility,Inpatient,,,RT,270,229.5,77.382,270,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Xr Wrist Routine Rt 3 Or More Views,,73110,CPT,Facility,Both,,,RT,270,229.5,77.382,270,Aetna,PPO,251.1,93,,percent of total billed charges,,
Xr Wrist Routine Rt 3 Or More Views,,73110,CPT,Facility,Both,,,RT,270,229.5,77.382,270,America's PPO,America's PPO,259.281,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Xr Wrist Routine Rt 3 Or More Views,,73110,CPT,Facility,Both,,,RT,270,229.5,77.382,270,BlueCross BlueShield Minnesota, Federal Employee Program,265.68,98.4,,percent of total billed charges,,
Xr Wrist Routine Rt 3 Or More Views,,73110,CPT,Facility,Both,,,RT,270,229.5,77.382,270,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,270,100,,percent of total billed charges,,
Xr Wrist Routine Rt 3 Or More Views,,73110,CPT,Facility,Both,,,RT,270,229.5,77.382,270,BlueCross BlueShield Minnesota,High Value Network Plan,243,90,,percent of total billed charges,,
Xr Wrist Routine Rt 3 Or More Views,,73110,CPT,Facility,Outpatient,,,RT,270,229.5,77.382,270,BlueCross BlueShield Minnesota,Medicare Advantage,132.3,49,,percent of total billed charges,,
Xr Wrist Routine Rt 3 Or More Views,,73110,CPT,Facility,Inpatient,,,RT,270,229.5,77.382,270,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Xr Wrist Routine Rt 3 Or More Views,,73110,CPT,Facility,Both,,,RT,270,229.5,77.382,270,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,239.139,88.57,,percent of total billed charges,,
Xr Wrist Routine Rt 3 Or More Views,,73110,CPT,Facility,Both,,,RT,270,229.5,77.382,270,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,77.382,28.66,,percent of total billed charges,,
Xr Wrist Routine Rt 3 Or More Views,,73110,CPT,Facility,Outpatient,,,RT,270,229.5,77.382,270,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),132.3,49,,percent of total billed charges,,
Xr Wrist Routine Rt 3 Or More Views,,73110,CPT,Facility,Inpatient,,,RT,270,229.5,77.382,270,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Xr Wrist Routine Rt 3 Or More Views,,73110,CPT,Facility,Both,,,RT,270,229.5,77.382,270,CorVel,Worker's Compensation,270,100,,percent of total billed charges,,
Xr Wrist Routine Rt 3 Or More Views,,73110,CPT,Facility,Both,,,RT,270,229.5,77.382,270,First Health Group Corporation,First Health Network,261.9,97,,percent of total billed charges,,
Xr Wrist Routine Rt 3 Or More Views,,73110,CPT,Facility,Both,,,RT,270,229.5,77.382,270,"Health Partners, Inc.",Commercial,255.42,94.6,,percent of total billed charges,,
Xr Wrist Routine Rt 3 Or More Views,,73110,CPT,Facility,Outpatient,,,RT,270,229.5,77.382,270,"Health Partners, Inc.",Medicare Advantage,132.3,49,,percent of total billed charges,,
Xr Wrist Routine Rt 3 Or More Views,,73110,CPT,Facility,Inpatient,,,RT,270,229.5,77.382,270,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Wrist Routine Rt 3 Or More Views,,73110,CPT,Facility,Both,,,RT,270,229.5,77.382,270,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),162,60,,percent of total billed charges,,
Xr Wrist Routine Rt 3 Or More Views,,73110,CPT,Facility,Both,,,RT,270,229.5,77.382,270,"Health Partners, Inc.",State of Minnesota Advantage Program,220.05,81.5,,percent of total billed charges,,
Xr Wrist Routine Rt 3 Or More Views,,73110,CPT,Facility,Both,,,RT,270,229.5,77.382,270,"Health Partners, Inc.",State Public Programs,135,50,,percent of total billed charges,,
Xr Wrist Routine Rt 3 Or More Views,,73110,CPT,Facility,Both,,,RT,270,229.5,77.382,270,Humana Insurance Company,Commercial PPO,256.5,95,,percent of total billed charges,,
Xr Wrist Routine Rt 3 Or More Views,,73110,CPT,Facility,Outpatient,,,RT,270,229.5,77.382,270,Humana Insurance Company,Medicare PPO,132.3,49,,percent of total billed charges,,
Xr Wrist Routine Rt 3 Or More Views,,73110,CPT,Facility,Inpatient,,,RT,270,229.5,77.382,270,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Xr Wrist Routine Rt 3 Or More Views,,73110,CPT,Facility,Both,,,RT,270,229.5,77.382,270,Medica,Individual & Family,267.57,99.1,,percent of total billed charges,,
Xr Wrist Routine Rt 3 Or More Views,,73110,CPT,Facility,Outpatient,,,RT,270,229.5,77.382,270,Medica,Medica Advantage Solution,134.46,49.8,,percent of total billed charges,,
Xr Wrist Routine Rt 3 Or More Views,,73110,CPT,Facility,Inpatient,,,RT,270,229.5,77.382,270,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Xr Wrist Routine Rt 3 Or More Views,,73110,CPT,Facility,Outpatient,,,RT,270,229.5,77.382,270,Medica,Medical Assistance,120.42,44.6,,percent of total billed charges,,
Xr Wrist Routine Rt 3 Or More Views,,73110,CPT,Facility,Inpatient,,,RT,270,229.5,77.382,270,Medica,Medical Assistance,,,,,Included in per diem rate,
Xr Wrist Routine Rt 3 Or More Views,,73110,CPT,Facility,Outpatient,,,RT,270,229.5,77.382,270,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,134.46,49.8,,percent of total billed charges,,
Xr Wrist Routine Rt 3 Or More Views,,73110,CPT,Facility,Inpatient,,,RT,270,229.5,77.382,270,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Xr Wrist Routine Rt 3 Or More Views,,73110,CPT,Facility,Both,,,RT,270,229.5,77.382,270,"Multiplan, Inc.","Multiplan, Inc.",253.8,94,,percent of total billed charges,,
Xr Wrist Routine Rt 3 Or More Views,,73110,CPT,Facility,Outpatient,,,RT,270,229.5,77.382,270,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,243.27,90.1,,percent of total billed charges,,
Xr Wrist Routine Rt 3 Or More Views,,73110,CPT,Facility,Inpatient,,,RT,270,229.5,77.382,270,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Xr Wrist Routine Rt 3 Or More Views,,73110,CPT,Facility,Both,,,RT,270,229.5,77.382,270,"Preferred One Administrative Services, INC.",PPO,266.22,98.6,,percent of total billed charges,,
Xr Wrist Routine Rt 3 Or More Views,,73110,CPT,Facility,Outpatient,,,RT,270,229.5,77.382,270,PrimeWest Health,Minnesota Senior Health Options (MSHO),138.915,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Xr Wrist Routine Rt 3 Or More Views,,73110,CPT,Facility,Inpatient,,,RT,270,229.5,77.382,270,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Wrist Routine Rt 3 Or More Views,,73110,CPT,Facility,Outpatient,,,RT,270,229.5,77.382,270,PrimeWest Health,MinnesotaCare,138.672,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Xr Wrist Routine Rt 3 Or More Views,,73110,CPT,Facility,Inpatient,,,RT,270,229.5,77.382,270,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Xr Wrist Routine Rt 3 Or More Views,,73110,CPT,Facility,Both,,,RT,270,229.5,77.382,270,Sanford Health Plan,Sanford Health Plan,248.4,92,,percent of total billed charges,,
Xr Wrist Routine Rt 3 Or More Views,,73110,CPT,Facility,Outpatient,,,RT,270,229.5,77.382,270,"UCare Health, Inc.",Individual & Family Plan,152.145,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Xr Wrist Routine Rt 3 Or More Views,,73110,CPT,Facility,Inpatient,,,RT,270,229.5,77.382,270,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Xr Wrist Routine Rt 3 Or More Views,,73110,CPT,Facility,Outpatient,,,RT,270,229.5,77.382,270,"UCare Health, Inc.",Medical Assistance,136.269,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Wrist Routine Rt 3 Or More Views,,73110,CPT,Facility,Inpatient,,,RT,270,229.5,77.382,270,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Xr Wrist Routine Rt 3 Or More Views,,73110,CPT,Facility,Outpatient,,,RT,270,229.5,77.382,270,"UCare Health, Inc.",Medicare Advantage,136.269,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Wrist Routine Rt 3 Or More Views,,73110,CPT,Facility,Inpatient,,,RT,270,229.5,77.382,270,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Wrist Routine Rt 3 Or More Views,,73110,CPT,Facility,Outpatient,,,RT,270,229.5,77.382,270,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),136.269,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Wrist Routine Rt 3 Or More Views,,73110,CPT,Facility,Inpatient,,,RT,270,229.5,77.382,270,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Wrist Routine Rt 3 Or More Views,,73110,CPT,Facility,Both,,,RT,270,229.5,77.382,270,UnitedHealthcare,Individual & Family,253.8,94,,percent of total billed charges,,
Xr Wrist Routine Rt 3 Or More Views,,73110,CPT,Facility,Outpatient,,,RT,270,229.5,77.382,270,UnitedHealthcare,Medicare Advantage,132.3,49,,percent of total billed charges,,
Xr Wrist Routine Rt 3 Or More Views,,73110,CPT,Facility,Inpatient,,,RT,270,229.5,77.382,270,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Xr Wrist Routine Rt 3 Or More Views,,73110,CPT,Facility,Outpatient,,,RT,270,229.5,77.382,270,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,129.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
Xr Wrist Routine Rt 3 Or More Views,,73110,CPT,Facility,Inpatient,,,RT,270,229.5,77.382,270,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Xr Hand Rt 2 Views,,73120,CPT,Facility,Both,,,RT,270,229.5,77.382,270,Aetna,Commercial,248.4,92,,percent of total billed charges,,
Xr Hand Rt 2 Views,,73120,CPT,Facility,Outpatient,,,RT,270,229.5,77.382,270,Aetna,Medicare Advantage,132.3,49,,percent of total billed charges,,
Xr Hand Rt 2 Views,,73120,CPT,Facility,Inpatient,,,RT,270,229.5,77.382,270,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Xr Hand Rt 2 Views,,73120,CPT,Facility,Both,,,RT,270,229.5,77.382,270,Aetna,PPO,251.1,93,,percent of total billed charges,,
Xr Hand Rt 2 Views,,73120,CPT,Facility,Both,,,RT,270,229.5,77.382,270,America's PPO,America's PPO,259.281,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Xr Hand Rt 2 Views,,73120,CPT,Facility,Both,,,RT,270,229.5,77.382,270,BlueCross BlueShield Minnesota, Federal Employee Program,265.68,98.4,,percent of total billed charges,,
Xr Hand Rt 2 Views,,73120,CPT,Facility,Both,,,RT,270,229.5,77.382,270,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,270,100,,percent of total billed charges,,
Xr Hand Rt 2 Views,,73120,CPT,Facility,Both,,,RT,270,229.5,77.382,270,BlueCross BlueShield Minnesota,High Value Network Plan,243,90,,percent of total billed charges,,
Xr Hand Rt 2 Views,,73120,CPT,Facility,Outpatient,,,RT,270,229.5,77.382,270,BlueCross BlueShield Minnesota,Medicare Advantage,132.3,49,,percent of total billed charges,,
Xr Hand Rt 2 Views,,73120,CPT,Facility,Inpatient,,,RT,270,229.5,77.382,270,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Xr Hand Rt 2 Views,,73120,CPT,Facility,Both,,,RT,270,229.5,77.382,270,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,239.139,88.57,,percent of total billed charges,,
Xr Hand Rt 2 Views,,73120,CPT,Facility,Both,,,RT,270,229.5,77.382,270,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,77.382,28.66,,percent of total billed charges,,
Xr Hand Rt 2 Views,,73120,CPT,Facility,Outpatient,,,RT,270,229.5,77.382,270,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),132.3,49,,percent of total billed charges,,
Xr Hand Rt 2 Views,,73120,CPT,Facility,Inpatient,,,RT,270,229.5,77.382,270,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Xr Hand Rt 2 Views,,73120,CPT,Facility,Both,,,RT,270,229.5,77.382,270,CorVel,Worker's Compensation,270,100,,percent of total billed charges,,
Xr Hand Rt 2 Views,,73120,CPT,Facility,Both,,,RT,270,229.5,77.382,270,First Health Group Corporation,First Health Network,261.9,97,,percent of total billed charges,,
Xr Hand Rt 2 Views,,73120,CPT,Facility,Both,,,RT,270,229.5,77.382,270,"Health Partners, Inc.",Commercial,255.42,94.6,,percent of total billed charges,,
Xr Hand Rt 2 Views,,73120,CPT,Facility,Outpatient,,,RT,270,229.5,77.382,270,"Health Partners, Inc.",Medicare Advantage,132.3,49,,percent of total billed charges,,
Xr Hand Rt 2 Views,,73120,CPT,Facility,Inpatient,,,RT,270,229.5,77.382,270,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Hand Rt 2 Views,,73120,CPT,Facility,Both,,,RT,270,229.5,77.382,270,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),162,60,,percent of total billed charges,,
Xr Hand Rt 2 Views,,73120,CPT,Facility,Both,,,RT,270,229.5,77.382,270,"Health Partners, Inc.",State of Minnesota Advantage Program,220.05,81.5,,percent of total billed charges,,
Xr Hand Rt 2 Views,,73120,CPT,Facility,Both,,,RT,270,229.5,77.382,270,"Health Partners, Inc.",State Public Programs,135,50,,percent of total billed charges,,
Xr Hand Rt 2 Views,,73120,CPT,Facility,Both,,,RT,270,229.5,77.382,270,Humana Insurance Company,Commercial PPO,256.5,95,,percent of total billed charges,,
Xr Hand Rt 2 Views,,73120,CPT,Facility,Outpatient,,,RT,270,229.5,77.382,270,Humana Insurance Company,Medicare PPO,132.3,49,,percent of total billed charges,,
Xr Hand Rt 2 Views,,73120,CPT,Facility,Inpatient,,,RT,270,229.5,77.382,270,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Xr Hand Rt 2 Views,,73120,CPT,Facility,Both,,,RT,270,229.5,77.382,270,Medica,Individual & Family,267.57,99.1,,percent of total billed charges,,
Xr Hand Rt 2 Views,,73120,CPT,Facility,Outpatient,,,RT,270,229.5,77.382,270,Medica,Medica Advantage Solution,134.46,49.8,,percent of total billed charges,,
Xr Hand Rt 2 Views,,73120,CPT,Facility,Inpatient,,,RT,270,229.5,77.382,270,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Xr Hand Rt 2 Views,,73120,CPT,Facility,Outpatient,,,RT,270,229.5,77.382,270,Medica,Medical Assistance,120.42,44.6,,percent of total billed charges,,
Xr Hand Rt 2 Views,,73120,CPT,Facility,Inpatient,,,RT,270,229.5,77.382,270,Medica,Medical Assistance,,,,,Included in per diem rate,
Xr Hand Rt 2 Views,,73120,CPT,Facility,Outpatient,,,RT,270,229.5,77.382,270,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,134.46,49.8,,percent of total billed charges,,
Xr Hand Rt 2 Views,,73120,CPT,Facility,Inpatient,,,RT,270,229.5,77.382,270,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Xr Hand Rt 2 Views,,73120,CPT,Facility,Both,,,RT,270,229.5,77.382,270,"Multiplan, Inc.","Multiplan, Inc.",253.8,94,,percent of total billed charges,,
Xr Hand Rt 2 Views,,73120,CPT,Facility,Outpatient,,,RT,270,229.5,77.382,270,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,243.27,90.1,,percent of total billed charges,,
Xr Hand Rt 2 Views,,73120,CPT,Facility,Inpatient,,,RT,270,229.5,77.382,270,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Xr Hand Rt 2 Views,,73120,CPT,Facility,Both,,,RT,270,229.5,77.382,270,"Preferred One Administrative Services, INC.",PPO,266.22,98.6,,percent of total billed charges,,
Xr Hand Rt 2 Views,,73120,CPT,Facility,Outpatient,,,RT,270,229.5,77.382,270,PrimeWest Health,Minnesota Senior Health Options (MSHO),138.915,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Xr Hand Rt 2 Views,,73120,CPT,Facility,Inpatient,,,RT,270,229.5,77.382,270,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Hand Rt 2 Views,,73120,CPT,Facility,Outpatient,,,RT,270,229.5,77.382,270,PrimeWest Health,MinnesotaCare,138.672,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Xr Hand Rt 2 Views,,73120,CPT,Facility,Inpatient,,,RT,270,229.5,77.382,270,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Xr Hand Rt 2 Views,,73120,CPT,Facility,Both,,,RT,270,229.5,77.382,270,Sanford Health Plan,Sanford Health Plan,248.4,92,,percent of total billed charges,,
Xr Hand Rt 2 Views,,73120,CPT,Facility,Outpatient,,,RT,270,229.5,77.382,270,"UCare Health, Inc.",Individual & Family Plan,152.145,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Xr Hand Rt 2 Views,,73120,CPT,Facility,Inpatient,,,RT,270,229.5,77.382,270,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Xr Hand Rt 2 Views,,73120,CPT,Facility,Outpatient,,,RT,270,229.5,77.382,270,"UCare Health, Inc.",Medical Assistance,136.269,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Hand Rt 2 Views,,73120,CPT,Facility,Inpatient,,,RT,270,229.5,77.382,270,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Xr Hand Rt 2 Views,,73120,CPT,Facility,Outpatient,,,RT,270,229.5,77.382,270,"UCare Health, Inc.",Medicare Advantage,136.269,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Hand Rt 2 Views,,73120,CPT,Facility,Inpatient,,,RT,270,229.5,77.382,270,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Hand Rt 2 Views,,73120,CPT,Facility,Outpatient,,,RT,270,229.5,77.382,270,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),136.269,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Hand Rt 2 Views,,73120,CPT,Facility,Inpatient,,,RT,270,229.5,77.382,270,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Hand Rt 2 Views,,73120,CPT,Facility,Both,,,RT,270,229.5,77.382,270,UnitedHealthcare,Individual & Family,253.8,94,,percent of total billed charges,,
Xr Hand Rt 2 Views,,73120,CPT,Facility,Outpatient,,,RT,270,229.5,77.382,270,UnitedHealthcare,Medicare Advantage,132.3,49,,percent of total billed charges,,
Xr Hand Rt 2 Views,,73120,CPT,Facility,Inpatient,,,RT,270,229.5,77.382,270,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Xr Hand Rt 2 Views,,73120,CPT,Facility,Outpatient,,,RT,270,229.5,77.382,270,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,129.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
Xr Hand Rt 2 Views,,73120,CPT,Facility,Inpatient,,,RT,270,229.5,77.382,270,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Xr Hand Routine Rt 3 Views,,73130,CPT,Facility,Both,,,RT,281,238.85,80.5346,281,Aetna,Commercial,258.52,92,,percent of total billed charges,,
Xr Hand Routine Rt 3 Views,,73130,CPT,Facility,Outpatient,,,RT,281,238.85,80.5346,281,Aetna,Medicare Advantage,137.69,49,,percent of total billed charges,,
Xr Hand Routine Rt 3 Views,,73130,CPT,Facility,Inpatient,,,RT,281,238.85,80.5346,281,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Xr Hand Routine Rt 3 Views,,73130,CPT,Facility,Both,,,RT,281,238.85,80.5346,281,Aetna,PPO,261.33,93,,percent of total billed charges,,
Xr Hand Routine Rt 3 Views,,73130,CPT,Facility,Both,,,RT,281,238.85,80.5346,281,America's PPO,America's PPO,269.8443,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Xr Hand Routine Rt 3 Views,,73130,CPT,Facility,Both,,,RT,281,238.85,80.5346,281,BlueCross BlueShield Minnesota, Federal Employee Program,276.504,98.4,,percent of total billed charges,,
Xr Hand Routine Rt 3 Views,,73130,CPT,Facility,Both,,,RT,281,238.85,80.5346,281,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,281,100,,percent of total billed charges,,
Xr Hand Routine Rt 3 Views,,73130,CPT,Facility,Both,,,RT,281,238.85,80.5346,281,BlueCross BlueShield Minnesota,High Value Network Plan,252.9,90,,percent of total billed charges,,
Xr Hand Routine Rt 3 Views,,73130,CPT,Facility,Outpatient,,,RT,281,238.85,80.5346,281,BlueCross BlueShield Minnesota,Medicare Advantage,137.69,49,,percent of total billed charges,,
Xr Hand Routine Rt 3 Views,,73130,CPT,Facility,Inpatient,,,RT,281,238.85,80.5346,281,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Xr Hand Routine Rt 3 Views,,73130,CPT,Facility,Both,,,RT,281,238.85,80.5346,281,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,248.8817,88.57,,percent of total billed charges,,
Xr Hand Routine Rt 3 Views,,73130,CPT,Facility,Both,,,RT,281,238.85,80.5346,281,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,80.5346,28.66,,percent of total billed charges,,
Xr Hand Routine Rt 3 Views,,73130,CPT,Facility,Outpatient,,,RT,281,238.85,80.5346,281,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),137.69,49,,percent of total billed charges,,
Xr Hand Routine Rt 3 Views,,73130,CPT,Facility,Inpatient,,,RT,281,238.85,80.5346,281,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Xr Hand Routine Rt 3 Views,,73130,CPT,Facility,Both,,,RT,281,238.85,80.5346,281,CorVel,Worker's Compensation,281,100,,percent of total billed charges,,
Xr Hand Routine Rt 3 Views,,73130,CPT,Facility,Both,,,RT,281,238.85,80.5346,281,First Health Group Corporation,First Health Network,272.57,97,,percent of total billed charges,,
Xr Hand Routine Rt 3 Views,,73130,CPT,Facility,Both,,,RT,281,238.85,80.5346,281,"Health Partners, Inc.",Commercial,265.826,94.6,,percent of total billed charges,,
Xr Hand Routine Rt 3 Views,,73130,CPT,Facility,Outpatient,,,RT,281,238.85,80.5346,281,"Health Partners, Inc.",Medicare Advantage,137.69,49,,percent of total billed charges,,
Xr Hand Routine Rt 3 Views,,73130,CPT,Facility,Inpatient,,,RT,281,238.85,80.5346,281,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Hand Routine Rt 3 Views,,73130,CPT,Facility,Both,,,RT,281,238.85,80.5346,281,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),168.6,60,,percent of total billed charges,,
Xr Hand Routine Rt 3 Views,,73130,CPT,Facility,Both,,,RT,281,238.85,80.5346,281,"Health Partners, Inc.",State of Minnesota Advantage Program,229.015,81.5,,percent of total billed charges,,
Xr Hand Routine Rt 3 Views,,73130,CPT,Facility,Both,,,RT,281,238.85,80.5346,281,"Health Partners, Inc.",State Public Programs,140.5,50,,percent of total billed charges,,
Xr Hand Routine Rt 3 Views,,73130,CPT,Facility,Both,,,RT,281,238.85,80.5346,281,Humana Insurance Company,Commercial PPO,266.95,95,,percent of total billed charges,,
Xr Hand Routine Rt 3 Views,,73130,CPT,Facility,Outpatient,,,RT,281,238.85,80.5346,281,Humana Insurance Company,Medicare PPO,137.69,49,,percent of total billed charges,,
Xr Hand Routine Rt 3 Views,,73130,CPT,Facility,Inpatient,,,RT,281,238.85,80.5346,281,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Xr Hand Routine Rt 3 Views,,73130,CPT,Facility,Both,,,RT,281,238.85,80.5346,281,Medica,Individual & Family,278.471,99.1,,percent of total billed charges,,
Xr Hand Routine Rt 3 Views,,73130,CPT,Facility,Outpatient,,,RT,281,238.85,80.5346,281,Medica,Medica Advantage Solution,139.938,49.8,,percent of total billed charges,,
Xr Hand Routine Rt 3 Views,,73130,CPT,Facility,Inpatient,,,RT,281,238.85,80.5346,281,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Xr Hand Routine Rt 3 Views,,73130,CPT,Facility,Outpatient,,,RT,281,238.85,80.5346,281,Medica,Medical Assistance,125.326,44.6,,percent of total billed charges,,
Xr Hand Routine Rt 3 Views,,73130,CPT,Facility,Inpatient,,,RT,281,238.85,80.5346,281,Medica,Medical Assistance,,,,,Included in per diem rate,
Xr Hand Routine Rt 3 Views,,73130,CPT,Facility,Outpatient,,,RT,281,238.85,80.5346,281,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,139.938,49.8,,percent of total billed charges,,
Xr Hand Routine Rt 3 Views,,73130,CPT,Facility,Inpatient,,,RT,281,238.85,80.5346,281,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Xr Hand Routine Rt 3 Views,,73130,CPT,Facility,Both,,,RT,281,238.85,80.5346,281,"Multiplan, Inc.","Multiplan, Inc.",264.14,94,,percent of total billed charges,,
Xr Hand Routine Rt 3 Views,,73130,CPT,Facility,Outpatient,,,RT,281,238.85,80.5346,281,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,253.181,90.1,,percent of total billed charges,,
Xr Hand Routine Rt 3 Views,,73130,CPT,Facility,Inpatient,,,RT,281,238.85,80.5346,281,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Xr Hand Routine Rt 3 Views,,73130,CPT,Facility,Both,,,RT,281,238.85,80.5346,281,"Preferred One Administrative Services, INC.",PPO,277.066,98.6,,percent of total billed charges,,
Xr Hand Routine Rt 3 Views,,73130,CPT,Facility,Outpatient,,,RT,281,238.85,80.5346,281,PrimeWest Health,Minnesota Senior Health Options (MSHO),144.5745,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Xr Hand Routine Rt 3 Views,,73130,CPT,Facility,Inpatient,,,RT,281,238.85,80.5346,281,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Hand Routine Rt 3 Views,,73130,CPT,Facility,Outpatient,,,RT,281,238.85,80.5346,281,PrimeWest Health,MinnesotaCare,144.3216,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Xr Hand Routine Rt 3 Views,,73130,CPT,Facility,Inpatient,,,RT,281,238.85,80.5346,281,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Xr Hand Routine Rt 3 Views,,73130,CPT,Facility,Both,,,RT,281,238.85,80.5346,281,Sanford Health Plan,Sanford Health Plan,258.52,92,,percent of total billed charges,,
Xr Hand Routine Rt 3 Views,,73130,CPT,Facility,Outpatient,,,RT,281,238.85,80.5346,281,"UCare Health, Inc.",Individual & Family Plan,158.3435,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Xr Hand Routine Rt 3 Views,,73130,CPT,Facility,Inpatient,,,RT,281,238.85,80.5346,281,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Xr Hand Routine Rt 3 Views,,73130,CPT,Facility,Outpatient,,,RT,281,238.85,80.5346,281,"UCare Health, Inc.",Medical Assistance,141.8207,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Hand Routine Rt 3 Views,,73130,CPT,Facility,Inpatient,,,RT,281,238.85,80.5346,281,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Xr Hand Routine Rt 3 Views,,73130,CPT,Facility,Outpatient,,,RT,281,238.85,80.5346,281,"UCare Health, Inc.",Medicare Advantage,141.8207,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Hand Routine Rt 3 Views,,73130,CPT,Facility,Inpatient,,,RT,281,238.85,80.5346,281,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Hand Routine Rt 3 Views,,73130,CPT,Facility,Outpatient,,,RT,281,238.85,80.5346,281,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),141.8207,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Hand Routine Rt 3 Views,,73130,CPT,Facility,Inpatient,,,RT,281,238.85,80.5346,281,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Hand Routine Rt 3 Views,,73130,CPT,Facility,Both,,,RT,281,238.85,80.5346,281,UnitedHealthcare,Individual & Family,264.14,94,,percent of total billed charges,,
Xr Hand Routine Rt 3 Views,,73130,CPT,Facility,Outpatient,,,RT,281,238.85,80.5346,281,UnitedHealthcare,Medicare Advantage,137.69,49,,percent of total billed charges,,
Xr Hand Routine Rt 3 Views,,73130,CPT,Facility,Inpatient,,,RT,281,238.85,80.5346,281,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Xr Hand Routine Rt 3 Views,,73130,CPT,Facility,Outpatient,,,RT,281,238.85,80.5346,281,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,134.88,48,,percent of total billed charges,,100% of DHS outpatient percentage
Xr Hand Routine Rt 3 Views,,73130,CPT,Facility,Inpatient,,,RT,281,238.85,80.5346,281,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Cta Upper Extremity Right,,73206,CPT,Facility,Both,,,RT,2244,1907.4,499,2244,Aetna,Commercial,2064.48,92,,percent of total billed charges,,
Cta Upper Extremity Right,,73206,CPT,Facility,Outpatient,,,RT,2244,1907.4,499,2244,Aetna,Medicare Advantage,1099.56,49,,percent of total billed charges,,
Cta Upper Extremity Right,,73206,CPT,Facility,Inpatient,,,RT,2244,1907.4,499,2244,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Cta Upper Extremity Right,,73206,CPT,Facility,Both,,,RT,2244,1907.4,499,2244,Aetna,PPO,2086.92,93,,percent of total billed charges,,
Cta Upper Extremity Right,,73206,CPT,Facility,Both,,,RT,2244,1907.4,499,2244,America's PPO,America's PPO,2154.9132,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Cta Upper Extremity Right,,73206,CPT,Facility,Both,,,RT,2244,1907.4,499,2244,BlueCross BlueShield Minnesota, Federal Employee Program,2208.096,98.4,,percent of total billed charges,,
Cta Upper Extremity Right,,73206,CPT,Facility,Both,,,RT,2244,1907.4,499,2244,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,2244,100,,percent of total billed charges,,
Cta Upper Extremity Right,,73206,CPT,Facility,Both,,,RT,2244,1907.4,499,2244,BlueCross BlueShield Minnesota,High Value Network Plan,2019.6,90,,percent of total billed charges,,
Cta Upper Extremity Right,,73206,CPT,Facility,Outpatient,,,RT,2244,1907.4,499,2244,BlueCross BlueShield Minnesota,Medicare Advantage,1099.56,49,,percent of total billed charges,,
Cta Upper Extremity Right,,73206,CPT,Facility,Inpatient,,,RT,2244,1907.4,499,2244,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Cta Upper Extremity Right,,73206,CPT,Facility,Both,,,RT,2244,1907.4,499,2244,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1987.5108,88.57,,percent of total billed charges,,
Cta Upper Extremity Right,,73206,CPT,Facility,Both,,,RT,2244,1907.4,499,2244,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,643.1304,28.66,,percent of total billed charges,,
Cta Upper Extremity Right,,73206,CPT,Facility,Outpatient,,,RT,2244,1907.4,499,2244,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1099.56,49,,percent of total billed charges,,
Cta Upper Extremity Right,,73206,CPT,Facility,Inpatient,,,RT,2244,1907.4,499,2244,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Cta Upper Extremity Right,,73206,CPT,Facility,Both,,,RT,2244,1907.4,499,2244,CorVel,Worker's Compensation,2244,100,,percent of total billed charges,,
Cta Upper Extremity Right,,73206,CPT,Facility,Both,,,RT,2244,1907.4,499,2244,First Health Group Corporation,First Health Network,2176.68,97,,percent of total billed charges,,
Cta Upper Extremity Right,,73206,CPT,Facility,Both,,,RT,2244,1907.4,499,2244,"Health Partners, Inc.",Commercial,2122.824,94.6,,percent of total billed charges,,
Cta Upper Extremity Right,,73206,CPT,Facility,Outpatient,,,RT,2244,1907.4,499,2244,"Health Partners, Inc.",Medicare Advantage,1099.56,49,,percent of total billed charges,,
Cta Upper Extremity Right,,73206,CPT,Facility,Inpatient,,,RT,2244,1907.4,499,2244,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Cta Upper Extremity Right,,73206,CPT,Facility,Both,,,RT,2244,1907.4,499,2244,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1346.4,60,,percent of total billed charges,,
Cta Upper Extremity Right,,73206,CPT,Facility,Both,,,RT,2244,1907.4,499,2244,"Health Partners, Inc.",State of Minnesota Advantage Program,1828.86,81.5,,percent of total billed charges,,
Cta Upper Extremity Right,,73206,CPT,Facility,Both,,,RT,2244,1907.4,499,2244,"Health Partners, Inc.",State Public Programs,1122,50,,percent of total billed charges,,
Cta Upper Extremity Right,,73206,CPT,Facility,Both,,,RT,2244,1907.4,499,2244,Humana Insurance Company,Commercial PPO,2131.8,95,,percent of total billed charges,,
Cta Upper Extremity Right,,73206,CPT,Facility,Outpatient,,,RT,2244,1907.4,499,2244,Humana Insurance Company,Medicare PPO,1099.56,49,,percent of total billed charges,,
Cta Upper Extremity Right,,73206,CPT,Facility,Inpatient,,,RT,2244,1907.4,499,2244,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Cta Upper Extremity Right,,73206,CPT,Facility,Both,,,RT,2244,1907.4,499,2244,Medica,Individual & Family,2223.804,99.1,,percent of total billed charges,,
Cta Upper Extremity Right,,73206,CPT,Facility,Outpatient,,,RT,2244,1907.4,499,2244,Medica,Medica Advantage Solution,1117.512,49.8,,percent of total billed charges,,
Cta Upper Extremity Right,,73206,CPT,Facility,Inpatient,,,RT,2244,1907.4,499,2244,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Cta Upper Extremity Right,,73206,CPT,Facility,Outpatient,,,RT,2244,1907.4,499,2244,Medica,Medical Assistance,499,,,Other,Per visit,Pays in addition to all Outpatient Service Categories
Cta Upper Extremity Right,,73206,CPT,Facility,Inpatient,,,RT,2244,1907.4,499,2244,Medica,Medical Assistance,,,,,Included in per diem rate,
Cta Upper Extremity Right,,73206,CPT,Facility,Outpatient,,,RT,2244,1907.4,499,2244,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1117.512,49.8,,percent of total billed charges,,
Cta Upper Extremity Right,,73206,CPT,Facility,Inpatient,,,RT,2244,1907.4,499,2244,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Cta Upper Extremity Right,,73206,CPT,Facility,Both,,,RT,2244,1907.4,499,2244,"Multiplan, Inc.","Multiplan, Inc.",2109.36,94,,percent of total billed charges,,
Cta Upper Extremity Right,,73206,CPT,Facility,Outpatient,,,RT,2244,1907.4,499,2244,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1283,,,Other,Per scan,
Cta Upper Extremity Right,,73206,CPT,Facility,Inpatient,,,RT,2244,1907.4,499,2244,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Cta Upper Extremity Right,,73206,CPT,Facility,Both,,,RT,2244,1907.4,499,2244,"Preferred One Administrative Services, INC.",PPO,2212.584,98.6,,percent of total billed charges,,
Cta Upper Extremity Right,,73206,CPT,Facility,Outpatient,,,RT,2244,1907.4,499,2244,PrimeWest Health,Minnesota Senior Health Options (MSHO),1154.538,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Cta Upper Extremity Right,,73206,CPT,Facility,Inpatient,,,RT,2244,1907.4,499,2244,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Cta Upper Extremity Right,,73206,CPT,Facility,Outpatient,,,RT,2244,1907.4,499,2244,PrimeWest Health,MinnesotaCare,1152.5184,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Cta Upper Extremity Right,,73206,CPT,Facility,Inpatient,,,RT,2244,1907.4,499,2244,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Cta Upper Extremity Right,,73206,CPT,Facility,Both,,,RT,2244,1907.4,499,2244,Sanford Health Plan,Sanford Health Plan,2064.48,92,,percent of total billed charges,,
Cta Upper Extremity Right,,73206,CPT,Facility,Outpatient,,,RT,2244,1907.4,499,2244,"UCare Health, Inc.",Individual & Family Plan,1264.494,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Cta Upper Extremity Right,,73206,CPT,Facility,Inpatient,,,RT,2244,1907.4,499,2244,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Cta Upper Extremity Right,,73206,CPT,Facility,Outpatient,,,RT,2244,1907.4,499,2244,"UCare Health, Inc.",Medical Assistance,1132.5468,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Cta Upper Extremity Right,,73206,CPT,Facility,Inpatient,,,RT,2244,1907.4,499,2244,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Cta Upper Extremity Right,,73206,CPT,Facility,Outpatient,,,RT,2244,1907.4,499,2244,"UCare Health, Inc.",Medicare Advantage,1132.5468,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Cta Upper Extremity Right,,73206,CPT,Facility,Inpatient,,,RT,2244,1907.4,499,2244,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Cta Upper Extremity Right,,73206,CPT,Facility,Outpatient,,,RT,2244,1907.4,499,2244,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1132.5468,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Cta Upper Extremity Right,,73206,CPT,Facility,Inpatient,,,RT,2244,1907.4,499,2244,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Cta Upper Extremity Right,,73206,CPT,Facility,Both,,,RT,2244,1907.4,499,2244,UnitedHealthcare,Individual & Family,2109.36,94,,percent of total billed charges,,
Cta Upper Extremity Right,,73206,CPT,Facility,Outpatient,,,RT,2244,1907.4,499,2244,UnitedHealthcare,Medicare Advantage,1099.56,49,,percent of total billed charges,,
Cta Upper Extremity Right,,73206,CPT,Facility,Inpatient,,,RT,2244,1907.4,499,2244,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Cta Upper Extremity Right,,73206,CPT,Facility,Outpatient,,,RT,2244,1907.4,499,2244,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1077.12,48,,percent of total billed charges,,100% of DHS outpatient percentage
Cta Upper Extremity Right,,73206,CPT,Facility,Inpatient,,,RT,2244,1907.4,499,2244,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Mri Upper Extremity Rt Not Jt Wo Contrast,,73218,CPT,Facility,Both,,,RT,2339,1988.15,670.3574,2339,Aetna,Commercial,2151.88,92,,percent of total billed charges,,
Mri Upper Extremity Rt Not Jt Wo Contrast,,73218,CPT,Facility,Outpatient,,,RT,2339,1988.15,670.3574,2339,Aetna,Medicare Advantage,1146.11,49,,percent of total billed charges,,
Mri Upper Extremity Rt Not Jt Wo Contrast,,73218,CPT,Facility,Inpatient,,,RT,2339,1988.15,670.3574,2339,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Mri Upper Extremity Rt Not Jt Wo Contrast,,73218,CPT,Facility,Both,,,RT,2339,1988.15,670.3574,2339,Aetna,PPO,2175.27,93,,percent of total billed charges,,
Mri Upper Extremity Rt Not Jt Wo Contrast,,73218,CPT,Facility,Both,,,RT,2339,1988.15,670.3574,2339,America's PPO,America's PPO,2246.1417,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Mri Upper Extremity Rt Not Jt Wo Contrast,,73218,CPT,Facility,Both,,,RT,2339,1988.15,670.3574,2339,BlueCross BlueShield Minnesota, Federal Employee Program,2301.576,98.4,,percent of total billed charges,,
Mri Upper Extremity Rt Not Jt Wo Contrast,,73218,CPT,Facility,Both,,,RT,2339,1988.15,670.3574,2339,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,2339,100,,percent of total billed charges,,
Mri Upper Extremity Rt Not Jt Wo Contrast,,73218,CPT,Facility,Both,,,RT,2339,1988.15,670.3574,2339,BlueCross BlueShield Minnesota,High Value Network Plan,2105.1,90,,percent of total billed charges,,
Mri Upper Extremity Rt Not Jt Wo Contrast,,73218,CPT,Facility,Outpatient,,,RT,2339,1988.15,670.3574,2339,BlueCross BlueShield Minnesota,Medicare Advantage,1146.11,49,,percent of total billed charges,,
Mri Upper Extremity Rt Not Jt Wo Contrast,,73218,CPT,Facility,Inpatient,,,RT,2339,1988.15,670.3574,2339,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Mri Upper Extremity Rt Not Jt Wo Contrast,,73218,CPT,Facility,Both,,,RT,2339,1988.15,670.3574,2339,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,2071.6523,88.57,,percent of total billed charges,,
Mri Upper Extremity Rt Not Jt Wo Contrast,,73218,CPT,Facility,Both,,,RT,2339,1988.15,670.3574,2339,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,670.3574,28.66,,percent of total billed charges,,
Mri Upper Extremity Rt Not Jt Wo Contrast,,73218,CPT,Facility,Outpatient,,,RT,2339,1988.15,670.3574,2339,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1146.11,49,,percent of total billed charges,,
Mri Upper Extremity Rt Not Jt Wo Contrast,,73218,CPT,Facility,Inpatient,,,RT,2339,1988.15,670.3574,2339,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Mri Upper Extremity Rt Not Jt Wo Contrast,,73218,CPT,Facility,Both,,,RT,2339,1988.15,670.3574,2339,CorVel,Worker's Compensation,2339,100,,percent of total billed charges,,
Mri Upper Extremity Rt Not Jt Wo Contrast,,73218,CPT,Facility,Both,,,RT,2339,1988.15,670.3574,2339,First Health Group Corporation,First Health Network,2268.83,97,,percent of total billed charges,,
Mri Upper Extremity Rt Not Jt Wo Contrast,,73218,CPT,Facility,Both,,,RT,2339,1988.15,670.3574,2339,"Health Partners, Inc.",Commercial,2212.694,94.6,,percent of total billed charges,,
Mri Upper Extremity Rt Not Jt Wo Contrast,,73218,CPT,Facility,Outpatient,,,RT,2339,1988.15,670.3574,2339,"Health Partners, Inc.",Medicare Advantage,1146.11,49,,percent of total billed charges,,
Mri Upper Extremity Rt Not Jt Wo Contrast,,73218,CPT,Facility,Inpatient,,,RT,2339,1988.15,670.3574,2339,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mri Upper Extremity Rt Not Jt Wo Contrast,,73218,CPT,Facility,Both,,,RT,2339,1988.15,670.3574,2339,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1403.4,60,,percent of total billed charges,,
Mri Upper Extremity Rt Not Jt Wo Contrast,,73218,CPT,Facility,Both,,,RT,2339,1988.15,670.3574,2339,"Health Partners, Inc.",State of Minnesota Advantage Program,1906.285,81.5,,percent of total billed charges,,
Mri Upper Extremity Rt Not Jt Wo Contrast,,73218,CPT,Facility,Both,,,RT,2339,1988.15,670.3574,2339,"Health Partners, Inc.",State Public Programs,1169.5,50,,percent of total billed charges,,
Mri Upper Extremity Rt Not Jt Wo Contrast,,73218,CPT,Facility,Both,,,RT,2339,1988.15,670.3574,2339,Humana Insurance Company,Commercial PPO,2222.05,95,,percent of total billed charges,,
Mri Upper Extremity Rt Not Jt Wo Contrast,,73218,CPT,Facility,Outpatient,,,RT,2339,1988.15,670.3574,2339,Humana Insurance Company,Medicare PPO,1146.11,49,,percent of total billed charges,,
Mri Upper Extremity Rt Not Jt Wo Contrast,,73218,CPT,Facility,Inpatient,,,RT,2339,1988.15,670.3574,2339,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Mri Upper Extremity Rt Not Jt Wo Contrast,,73218,CPT,Facility,Both,,,RT,2339,1988.15,670.3574,2339,Medica,Individual & Family,2317.949,99.1,,percent of total billed charges,,
Mri Upper Extremity Rt Not Jt Wo Contrast,,73218,CPT,Facility,Outpatient,,,RT,2339,1988.15,670.3574,2339,Medica,Medica Advantage Solution,1164.822,49.8,,percent of total billed charges,,
Mri Upper Extremity Rt Not Jt Wo Contrast,,73218,CPT,Facility,Inpatient,,,RT,2339,1988.15,670.3574,2339,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Mri Upper Extremity Rt Not Jt Wo Contrast,,73218,CPT,Facility,Outpatient,,,RT,2339,1988.15,670.3574,2339,Medica,Medical Assistance,747,,,Other ,per vist,Pays in addition to all Outpatient Service Categories
Mri Upper Extremity Rt Not Jt Wo Contrast,,73218,CPT,Facility,Inpatient,,,RT,2339,1988.15,670.3574,2339,Medica,Medical Assistance,,,,,Included in per diem rate,
Mri Upper Extremity Rt Not Jt Wo Contrast,,73218,CPT,Facility,Outpatient,,,RT,2339,1988.15,670.3574,2339,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1164.822,49.8,,percent of total billed charges,,
Mri Upper Extremity Rt Not Jt Wo Contrast,,73218,CPT,Facility,Inpatient,,,RT,2339,1988.15,670.3574,2339,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Mri Upper Extremity Rt Not Jt Wo Contrast,,73218,CPT,Facility,Both,,,RT,2339,1988.15,670.3574,2339,"Multiplan, Inc.","Multiplan, Inc.",2198.66,94,,percent of total billed charges,,
Mri Upper Extremity Rt Not Jt Wo Contrast,,73218,CPT,Facility,Outpatient,,,RT,2339,1988.15,670.3574,2339,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1535,,,Other ,per scan,
Mri Upper Extremity Rt Not Jt Wo Contrast,,73218,CPT,Facility,Inpatient,,,RT,2339,1988.15,670.3574,2339,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Mri Upper Extremity Rt Not Jt Wo Contrast,,73218,CPT,Facility,Both,,,RT,2339,1988.15,670.3574,2339,"Preferred One Administrative Services, INC.",PPO,2306.254,98.6,,percent of total billed charges,,
Mri Upper Extremity Rt Not Jt Wo Contrast,,73218,CPT,Facility,Outpatient,,,RT,2339,1988.15,670.3574,2339,PrimeWest Health,Minnesota Senior Health Options (MSHO),1203.4155,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Mri Upper Extremity Rt Not Jt Wo Contrast,,73218,CPT,Facility,Inpatient,,,RT,2339,1988.15,670.3574,2339,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mri Upper Extremity Rt Not Jt Wo Contrast,,73218,CPT,Facility,Outpatient,,,RT,2339,1988.15,670.3574,2339,PrimeWest Health,MinnesotaCare,1201.3104,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Mri Upper Extremity Rt Not Jt Wo Contrast,,73218,CPT,Facility,Inpatient,,,RT,2339,1988.15,670.3574,2339,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Mri Upper Extremity Rt Not Jt Wo Contrast,,73218,CPT,Facility,Both,,,RT,2339,1988.15,670.3574,2339,Sanford Health Plan,Sanford Health Plan,2151.88,92,,percent of total billed charges,,
Mri Upper Extremity Rt Not Jt Wo Contrast,,73218,CPT,Facility,Outpatient,,,RT,2339,1988.15,670.3574,2339,"UCare Health, Inc.",Individual & Family Plan,1318.0265,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Mri Upper Extremity Rt Not Jt Wo Contrast,,73218,CPT,Facility,Inpatient,,,RT,2339,1988.15,670.3574,2339,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Mri Upper Extremity Rt Not Jt Wo Contrast,,73218,CPT,Facility,Outpatient,,,RT,2339,1988.15,670.3574,2339,"UCare Health, Inc.",Medical Assistance,1180.4933,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mri Upper Extremity Rt Not Jt Wo Contrast,,73218,CPT,Facility,Inpatient,,,RT,2339,1988.15,670.3574,2339,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Mri Upper Extremity Rt Not Jt Wo Contrast,,73218,CPT,Facility,Outpatient,,,RT,2339,1988.15,670.3574,2339,"UCare Health, Inc.",Medicare Advantage,1180.4933,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mri Upper Extremity Rt Not Jt Wo Contrast,,73218,CPT,Facility,Inpatient,,,RT,2339,1988.15,670.3574,2339,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mri Upper Extremity Rt Not Jt Wo Contrast,,73218,CPT,Facility,Outpatient,,,RT,2339,1988.15,670.3574,2339,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1180.4933,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mri Upper Extremity Rt Not Jt Wo Contrast,,73218,CPT,Facility,Inpatient,,,RT,2339,1988.15,670.3574,2339,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mri Upper Extremity Rt Not Jt Wo Contrast,,73218,CPT,Facility,Both,,,RT,2339,1988.15,670.3574,2339,UnitedHealthcare,Individual & Family,2198.66,94,,percent of total billed charges,,
Mri Upper Extremity Rt Not Jt Wo Contrast,,73218,CPT,Facility,Outpatient,,,RT,2339,1988.15,670.3574,2339,UnitedHealthcare,Medicare Advantage,1146.11,49,,percent of total billed charges,,
Mri Upper Extremity Rt Not Jt Wo Contrast,,73218,CPT,Facility,Inpatient,,,RT,2339,1988.15,670.3574,2339,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Mri Upper Extremity Rt Not Jt Wo Contrast,,73218,CPT,Facility,Outpatient,,,RT,2339,1988.15,670.3574,2339,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1122.72,48,,percent of total billed charges,,100% of DHS outpatient percentage
Mri Upper Extremity Rt Not Jt Wo Contrast,,73218,CPT,Facility,Inpatient,,,RT,2339,1988.15,670.3574,2339,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Mri Upper Extremity Rt Not Jt W Contrast,,73219,CPT,Facility,Both,,,RT,2917,2479.45,747,2917,Aetna,Commercial,2683.64,92,,percent of total billed charges,,
Mri Upper Extremity Rt Not Jt W Contrast,,73219,CPT,Facility,Outpatient,,,RT,2917,2479.45,747,2917,Aetna,Medicare Advantage,1429.33,49,,percent of total billed charges,,
Mri Upper Extremity Rt Not Jt W Contrast,,73219,CPT,Facility,Inpatient,,,RT,2917,2479.45,747,2917,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Mri Upper Extremity Rt Not Jt W Contrast,,73219,CPT,Facility,Both,,,RT,2917,2479.45,747,2917,Aetna,PPO,2712.81,93,,percent of total billed charges,,
Mri Upper Extremity Rt Not Jt W Contrast,,73219,CPT,Facility,Both,,,RT,2917,2479.45,747,2917,America's PPO,America's PPO,2801.1951,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Mri Upper Extremity Rt Not Jt W Contrast,,73219,CPT,Facility,Both,,,RT,2917,2479.45,747,2917,BlueCross BlueShield Minnesota, Federal Employee Program,2870.328,98.4,,percent of total billed charges,,
Mri Upper Extremity Rt Not Jt W Contrast,,73219,CPT,Facility,Both,,,RT,2917,2479.45,747,2917,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,2917,100,,percent of total billed charges,,
Mri Upper Extremity Rt Not Jt W Contrast,,73219,CPT,Facility,Both,,,RT,2917,2479.45,747,2917,BlueCross BlueShield Minnesota,High Value Network Plan,2625.3,90,,percent of total billed charges,,
Mri Upper Extremity Rt Not Jt W Contrast,,73219,CPT,Facility,Outpatient,,,RT,2917,2479.45,747,2917,BlueCross BlueShield Minnesota,Medicare Advantage,1429.33,49,,percent of total billed charges,,
Mri Upper Extremity Rt Not Jt W Contrast,,73219,CPT,Facility,Inpatient,,,RT,2917,2479.45,747,2917,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Mri Upper Extremity Rt Not Jt W Contrast,,73219,CPT,Facility,Both,,,RT,2917,2479.45,747,2917,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,2583.5869,88.57,,percent of total billed charges,,
Mri Upper Extremity Rt Not Jt W Contrast,,73219,CPT,Facility,Both,,,RT,2917,2479.45,747,2917,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,836.0122,28.66,,percent of total billed charges,,
Mri Upper Extremity Rt Not Jt W Contrast,,73219,CPT,Facility,Outpatient,,,RT,2917,2479.45,747,2917,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1429.33,49,,percent of total billed charges,,
Mri Upper Extremity Rt Not Jt W Contrast,,73219,CPT,Facility,Inpatient,,,RT,2917,2479.45,747,2917,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Mri Upper Extremity Rt Not Jt W Contrast,,73219,CPT,Facility,Both,,,RT,2917,2479.45,747,2917,CorVel,Worker's Compensation,2917,100,,percent of total billed charges,,
Mri Upper Extremity Rt Not Jt W Contrast,,73219,CPT,Facility,Both,,,RT,2917,2479.45,747,2917,First Health Group Corporation,First Health Network,2829.49,97,,percent of total billed charges,,
Mri Upper Extremity Rt Not Jt W Contrast,,73219,CPT,Facility,Both,,,RT,2917,2479.45,747,2917,"Health Partners, Inc.",Commercial,2759.482,94.6,,percent of total billed charges,,
Mri Upper Extremity Rt Not Jt W Contrast,,73219,CPT,Facility,Outpatient,,,RT,2917,2479.45,747,2917,"Health Partners, Inc.",Medicare Advantage,1429.33,49,,percent of total billed charges,,
Mri Upper Extremity Rt Not Jt W Contrast,,73219,CPT,Facility,Inpatient,,,RT,2917,2479.45,747,2917,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mri Upper Extremity Rt Not Jt W Contrast,,73219,CPT,Facility,Both,,,RT,2917,2479.45,747,2917,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1750.2,60,,percent of total billed charges,,
Mri Upper Extremity Rt Not Jt W Contrast,,73219,CPT,Facility,Both,,,RT,2917,2479.45,747,2917,"Health Partners, Inc.",State of Minnesota Advantage Program,2377.355,81.5,,percent of total billed charges,,
Mri Upper Extremity Rt Not Jt W Contrast,,73219,CPT,Facility,Both,,,RT,2917,2479.45,747,2917,"Health Partners, Inc.",State Public Programs,1458.5,50,,percent of total billed charges,,
Mri Upper Extremity Rt Not Jt W Contrast,,73219,CPT,Facility,Both,,,RT,2917,2479.45,747,2917,Humana Insurance Company,Commercial PPO,2771.15,95,,percent of total billed charges,,
Mri Upper Extremity Rt Not Jt W Contrast,,73219,CPT,Facility,Outpatient,,,RT,2917,2479.45,747,2917,Humana Insurance Company,Medicare PPO,1429.33,49,,percent of total billed charges,,
Mri Upper Extremity Rt Not Jt W Contrast,,73219,CPT,Facility,Inpatient,,,RT,2917,2479.45,747,2917,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Mri Upper Extremity Rt Not Jt W Contrast,,73219,CPT,Facility,Both,,,RT,2917,2479.45,747,2917,Medica,Individual & Family,2890.747,99.1,,percent of total billed charges,,
Mri Upper Extremity Rt Not Jt W Contrast,,73219,CPT,Facility,Outpatient,,,RT,2917,2479.45,747,2917,Medica,Medica Advantage Solution,1452.666,49.8,,percent of total billed charges,,
Mri Upper Extremity Rt Not Jt W Contrast,,73219,CPT,Facility,Inpatient,,,RT,2917,2479.45,747,2917,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Mri Upper Extremity Rt Not Jt W Contrast,,73219,CPT,Facility,Outpatient,,,RT,2917,2479.45,747,2917,Medica,Medical Assistance,747,,,Other ,per vist,Pays in addition to all Outpatient Service Categories
Mri Upper Extremity Rt Not Jt W Contrast,,73219,CPT,Facility,Inpatient,,,RT,2917,2479.45,747,2917,Medica,Medical Assistance,,,,,Included in per diem rate,
Mri Upper Extremity Rt Not Jt W Contrast,,73219,CPT,Facility,Outpatient,,,RT,2917,2479.45,747,2917,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1452.666,49.8,,percent of total billed charges,,
Mri Upper Extremity Rt Not Jt W Contrast,,73219,CPT,Facility,Inpatient,,,RT,2917,2479.45,747,2917,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Mri Upper Extremity Rt Not Jt W Contrast,,73219,CPT,Facility,Both,,,RT,2917,2479.45,747,2917,"Multiplan, Inc.","Multiplan, Inc.",2741.98,94,,percent of total billed charges,,
Mri Upper Extremity Rt Not Jt W Contrast,,73219,CPT,Facility,Outpatient,,,RT,2917,2479.45,747,2917,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1535,,,Other ,per scan,
Mri Upper Extremity Rt Not Jt W Contrast,,73219,CPT,Facility,Inpatient,,,RT,2917,2479.45,747,2917,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Mri Upper Extremity Rt Not Jt W Contrast,,73219,CPT,Facility,Both,,,RT,2917,2479.45,747,2917,"Preferred One Administrative Services, INC.",PPO,2876.162,98.6,,percent of total billed charges,,
Mri Upper Extremity Rt Not Jt W Contrast,,73219,CPT,Facility,Outpatient,,,RT,2917,2479.45,747,2917,PrimeWest Health,Minnesota Senior Health Options (MSHO),1500.7965,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Mri Upper Extremity Rt Not Jt W Contrast,,73219,CPT,Facility,Inpatient,,,RT,2917,2479.45,747,2917,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mri Upper Extremity Rt Not Jt W Contrast,,73219,CPT,Facility,Outpatient,,,RT,2917,2479.45,747,2917,PrimeWest Health,MinnesotaCare,1498.1712,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Mri Upper Extremity Rt Not Jt W Contrast,,73219,CPT,Facility,Inpatient,,,RT,2917,2479.45,747,2917,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Mri Upper Extremity Rt Not Jt W Contrast,,73219,CPT,Facility,Both,,,RT,2917,2479.45,747,2917,Sanford Health Plan,Sanford Health Plan,2683.64,92,,percent of total billed charges,,
Mri Upper Extremity Rt Not Jt W Contrast,,73219,CPT,Facility,Outpatient,,,RT,2917,2479.45,747,2917,"UCare Health, Inc.",Individual & Family Plan,1643.7295,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Mri Upper Extremity Rt Not Jt W Contrast,,73219,CPT,Facility,Inpatient,,,RT,2917,2479.45,747,2917,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Mri Upper Extremity Rt Not Jt W Contrast,,73219,CPT,Facility,Outpatient,,,RT,2917,2479.45,747,2917,"UCare Health, Inc.",Medical Assistance,1472.2099,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mri Upper Extremity Rt Not Jt W Contrast,,73219,CPT,Facility,Inpatient,,,RT,2917,2479.45,747,2917,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Mri Upper Extremity Rt Not Jt W Contrast,,73219,CPT,Facility,Outpatient,,,RT,2917,2479.45,747,2917,"UCare Health, Inc.",Medicare Advantage,1472.2099,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mri Upper Extremity Rt Not Jt W Contrast,,73219,CPT,Facility,Inpatient,,,RT,2917,2479.45,747,2917,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mri Upper Extremity Rt Not Jt W Contrast,,73219,CPT,Facility,Outpatient,,,RT,2917,2479.45,747,2917,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1472.2099,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mri Upper Extremity Rt Not Jt W Contrast,,73219,CPT,Facility,Inpatient,,,RT,2917,2479.45,747,2917,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mri Upper Extremity Rt Not Jt W Contrast,,73219,CPT,Facility,Both,,,RT,2917,2479.45,747,2917,UnitedHealthcare,Individual & Family,2741.98,94,,percent of total billed charges,,
Mri Upper Extremity Rt Not Jt W Contrast,,73219,CPT,Facility,Outpatient,,,RT,2917,2479.45,747,2917,UnitedHealthcare,Medicare Advantage,1429.33,49,,percent of total billed charges,,
Mri Upper Extremity Rt Not Jt W Contrast,,73219,CPT,Facility,Inpatient,,,RT,2917,2479.45,747,2917,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Mri Upper Extremity Rt Not Jt W Contrast,,73219,CPT,Facility,Outpatient,,,RT,2917,2479.45,747,2917,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1400.16,48,,percent of total billed charges,,100% of DHS outpatient percentage
Mri Upper Extremity Rt Not Jt W Contrast,,73219,CPT,Facility,Inpatient,,,RT,2917,2479.45,747,2917,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Mri Upper Extremity Rt Not Jt Wo W Contrast,,73220,CPT,Facility,Both,,,RT,3254,2765.9,747,3254,Aetna,Commercial,2993.68,92,,percent of total billed charges,,
Mri Upper Extremity Rt Not Jt Wo W Contrast,,73220,CPT,Facility,Outpatient,,,RT,3254,2765.9,747,3254,Aetna,Medicare Advantage,1594.46,49,,percent of total billed charges,,
Mri Upper Extremity Rt Not Jt Wo W Contrast,,73220,CPT,Facility,Inpatient,,,RT,3254,2765.9,747,3254,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Mri Upper Extremity Rt Not Jt Wo W Contrast,,73220,CPT,Facility,Both,,,RT,3254,2765.9,747,3254,Aetna,PPO,3026.22,93,,percent of total billed charges,,
Mri Upper Extremity Rt Not Jt Wo W Contrast,,73220,CPT,Facility,Both,,,RT,3254,2765.9,747,3254,America's PPO,America's PPO,3124.8162,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Mri Upper Extremity Rt Not Jt Wo W Contrast,,73220,CPT,Facility,Both,,,RT,3254,2765.9,747,3254,BlueCross BlueShield Minnesota, Federal Employee Program,3201.936,98.4,,percent of total billed charges,,
Mri Upper Extremity Rt Not Jt Wo W Contrast,,73220,CPT,Facility,Both,,,RT,3254,2765.9,747,3254,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,3254,100,,percent of total billed charges,,
Mri Upper Extremity Rt Not Jt Wo W Contrast,,73220,CPT,Facility,Both,,,RT,3254,2765.9,747,3254,BlueCross BlueShield Minnesota,High Value Network Plan,2928.6,90,,percent of total billed charges,,
Mri Upper Extremity Rt Not Jt Wo W Contrast,,73220,CPT,Facility,Outpatient,,,RT,3254,2765.9,747,3254,BlueCross BlueShield Minnesota,Medicare Advantage,1594.46,49,,percent of total billed charges,,
Mri Upper Extremity Rt Not Jt Wo W Contrast,,73220,CPT,Facility,Inpatient,,,RT,3254,2765.9,747,3254,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Mri Upper Extremity Rt Not Jt Wo W Contrast,,73220,CPT,Facility,Both,,,RT,3254,2765.9,747,3254,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,2882.0678,88.57,,percent of total billed charges,,
Mri Upper Extremity Rt Not Jt Wo W Contrast,,73220,CPT,Facility,Both,,,RT,3254,2765.9,747,3254,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,932.5964,28.66,,percent of total billed charges,,
Mri Upper Extremity Rt Not Jt Wo W Contrast,,73220,CPT,Facility,Outpatient,,,RT,3254,2765.9,747,3254,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1594.46,49,,percent of total billed charges,,
Mri Upper Extremity Rt Not Jt Wo W Contrast,,73220,CPT,Facility,Inpatient,,,RT,3254,2765.9,747,3254,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Mri Upper Extremity Rt Not Jt Wo W Contrast,,73220,CPT,Facility,Both,,,RT,3254,2765.9,747,3254,CorVel,Worker's Compensation,3254,100,,percent of total billed charges,,
Mri Upper Extremity Rt Not Jt Wo W Contrast,,73220,CPT,Facility,Both,,,RT,3254,2765.9,747,3254,First Health Group Corporation,First Health Network,3156.38,97,,percent of total billed charges,,
Mri Upper Extremity Rt Not Jt Wo W Contrast,,73220,CPT,Facility,Both,,,RT,3254,2765.9,747,3254,"Health Partners, Inc.",Commercial,3078.284,94.6,,percent of total billed charges,,
Mri Upper Extremity Rt Not Jt Wo W Contrast,,73220,CPT,Facility,Outpatient,,,RT,3254,2765.9,747,3254,"Health Partners, Inc.",Medicare Advantage,1594.46,49,,percent of total billed charges,,
Mri Upper Extremity Rt Not Jt Wo W Contrast,,73220,CPT,Facility,Inpatient,,,RT,3254,2765.9,747,3254,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mri Upper Extremity Rt Not Jt Wo W Contrast,,73220,CPT,Facility,Both,,,RT,3254,2765.9,747,3254,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1952.4,60,,percent of total billed charges,,
Mri Upper Extremity Rt Not Jt Wo W Contrast,,73220,CPT,Facility,Both,,,RT,3254,2765.9,747,3254,"Health Partners, Inc.",State of Minnesota Advantage Program,2652.01,81.5,,percent of total billed charges,,
Mri Upper Extremity Rt Not Jt Wo W Contrast,,73220,CPT,Facility,Both,,,RT,3254,2765.9,747,3254,"Health Partners, Inc.",State Public Programs,1627,50,,percent of total billed charges,,
Mri Upper Extremity Rt Not Jt Wo W Contrast,,73220,CPT,Facility,Both,,,RT,3254,2765.9,747,3254,Humana Insurance Company,Commercial PPO,3091.3,95,,percent of total billed charges,,
Mri Upper Extremity Rt Not Jt Wo W Contrast,,73220,CPT,Facility,Outpatient,,,RT,3254,2765.9,747,3254,Humana Insurance Company,Medicare PPO,1594.46,49,,percent of total billed charges,,
Mri Upper Extremity Rt Not Jt Wo W Contrast,,73220,CPT,Facility,Inpatient,,,RT,3254,2765.9,747,3254,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Mri Upper Extremity Rt Not Jt Wo W Contrast,,73220,CPT,Facility,Both,,,RT,3254,2765.9,747,3254,Medica,Individual & Family,3224.714,99.1,,percent of total billed charges,,
Mri Upper Extremity Rt Not Jt Wo W Contrast,,73220,CPT,Facility,Outpatient,,,RT,3254,2765.9,747,3254,Medica,Medica Advantage Solution,1620.492,49.8,,percent of total billed charges,,
Mri Upper Extremity Rt Not Jt Wo W Contrast,,73220,CPT,Facility,Inpatient,,,RT,3254,2765.9,747,3254,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Mri Upper Extremity Rt Not Jt Wo W Contrast,,73220,CPT,Facility,Outpatient,,,RT,3254,2765.9,747,3254,Medica,Medical Assistance,747,,,Other ,per vist,Pays in addition to all Outpatient Service Categories
Mri Upper Extremity Rt Not Jt Wo W Contrast,,73220,CPT,Facility,Inpatient,,,RT,3254,2765.9,747,3254,Medica,Medical Assistance,,,,,Included in per diem rate,
Mri Upper Extremity Rt Not Jt Wo W Contrast,,73220,CPT,Facility,Outpatient,,,RT,3254,2765.9,747,3254,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1620.492,49.8,,percent of total billed charges,,
Mri Upper Extremity Rt Not Jt Wo W Contrast,,73220,CPT,Facility,Inpatient,,,RT,3254,2765.9,747,3254,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Mri Upper Extremity Rt Not Jt Wo W Contrast,,73220,CPT,Facility,Both,,,RT,3254,2765.9,747,3254,"Multiplan, Inc.","Multiplan, Inc.",3058.76,94,,percent of total billed charges,,
Mri Upper Extremity Rt Not Jt Wo W Contrast,,73220,CPT,Facility,Outpatient,,,RT,3254,2765.9,747,3254,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1535,,,Other ,per scan,
Mri Upper Extremity Rt Not Jt Wo W Contrast,,73220,CPT,Facility,Inpatient,,,RT,3254,2765.9,747,3254,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Mri Upper Extremity Rt Not Jt Wo W Contrast,,73220,CPT,Facility,Both,,,RT,3254,2765.9,747,3254,"Preferred One Administrative Services, INC.",PPO,3208.444,98.6,,percent of total billed charges,,
Mri Upper Extremity Rt Not Jt Wo W Contrast,,73220,CPT,Facility,Outpatient,,,RT,3254,2765.9,747,3254,PrimeWest Health,Minnesota Senior Health Options (MSHO),1674.183,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Mri Upper Extremity Rt Not Jt Wo W Contrast,,73220,CPT,Facility,Inpatient,,,RT,3254,2765.9,747,3254,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mri Upper Extremity Rt Not Jt Wo W Contrast,,73220,CPT,Facility,Outpatient,,,RT,3254,2765.9,747,3254,PrimeWest Health,MinnesotaCare,1671.2544,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Mri Upper Extremity Rt Not Jt Wo W Contrast,,73220,CPT,Facility,Inpatient,,,RT,3254,2765.9,747,3254,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Mri Upper Extremity Rt Not Jt Wo W Contrast,,73220,CPT,Facility,Both,,,RT,3254,2765.9,747,3254,Sanford Health Plan,Sanford Health Plan,2993.68,92,,percent of total billed charges,,
Mri Upper Extremity Rt Not Jt Wo W Contrast,,73220,CPT,Facility,Outpatient,,,RT,3254,2765.9,747,3254,"UCare Health, Inc.",Individual & Family Plan,1833.629,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Mri Upper Extremity Rt Not Jt Wo W Contrast,,73220,CPT,Facility,Inpatient,,,RT,3254,2765.9,747,3254,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Mri Upper Extremity Rt Not Jt Wo W Contrast,,73220,CPT,Facility,Outpatient,,,RT,3254,2765.9,747,3254,"UCare Health, Inc.",Medical Assistance,1642.2938,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mri Upper Extremity Rt Not Jt Wo W Contrast,,73220,CPT,Facility,Inpatient,,,RT,3254,2765.9,747,3254,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Mri Upper Extremity Rt Not Jt Wo W Contrast,,73220,CPT,Facility,Outpatient,,,RT,3254,2765.9,747,3254,"UCare Health, Inc.",Medicare Advantage,1642.2938,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mri Upper Extremity Rt Not Jt Wo W Contrast,,73220,CPT,Facility,Inpatient,,,RT,3254,2765.9,747,3254,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mri Upper Extremity Rt Not Jt Wo W Contrast,,73220,CPT,Facility,Outpatient,,,RT,3254,2765.9,747,3254,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1642.2938,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mri Upper Extremity Rt Not Jt Wo W Contrast,,73220,CPT,Facility,Inpatient,,,RT,3254,2765.9,747,3254,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mri Upper Extremity Rt Not Jt Wo W Contrast,,73220,CPT,Facility,Both,,,RT,3254,2765.9,747,3254,UnitedHealthcare,Individual & Family,3058.76,94,,percent of total billed charges,,
Mri Upper Extremity Rt Not Jt Wo W Contrast,,73220,CPT,Facility,Outpatient,,,RT,3254,2765.9,747,3254,UnitedHealthcare,Medicare Advantage,1594.46,49,,percent of total billed charges,,
Mri Upper Extremity Rt Not Jt Wo W Contrast,,73220,CPT,Facility,Inpatient,,,RT,3254,2765.9,747,3254,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Mri Upper Extremity Rt Not Jt Wo W Contrast,,73220,CPT,Facility,Outpatient,,,RT,3254,2765.9,747,3254,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1561.92,48,,percent of total billed charges,,100% of DHS outpatient percentage
Mri Upper Extremity Rt Not Jt Wo W Contrast,,73220,CPT,Facility,Inpatient,,,RT,3254,2765.9,747,3254,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Mri Upper Extremity Rt Any Jt Wo Contrast,,73221,CPT,Facility,Both,,,RT,2339,1988.15,670.3574,2339,Aetna,Commercial,2151.88,92,,percent of total billed charges,,
Mri Upper Extremity Rt Any Jt Wo Contrast,,73221,CPT,Facility,Outpatient,,,RT,2339,1988.15,670.3574,2339,Aetna,Medicare Advantage,1146.11,49,,percent of total billed charges,,
Mri Upper Extremity Rt Any Jt Wo Contrast,,73221,CPT,Facility,Inpatient,,,RT,2339,1988.15,670.3574,2339,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Mri Upper Extremity Rt Any Jt Wo Contrast,,73221,CPT,Facility,Both,,,RT,2339,1988.15,670.3574,2339,Aetna,PPO,2175.27,93,,percent of total billed charges,,
Mri Upper Extremity Rt Any Jt Wo Contrast,,73221,CPT,Facility,Both,,,RT,2339,1988.15,670.3574,2339,America's PPO,America's PPO,2246.1417,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Mri Upper Extremity Rt Any Jt Wo Contrast,,73221,CPT,Facility,Both,,,RT,2339,1988.15,670.3574,2339,BlueCross BlueShield Minnesota, Federal Employee Program,2301.576,98.4,,percent of total billed charges,,
Mri Upper Extremity Rt Any Jt Wo Contrast,,73221,CPT,Facility,Both,,,RT,2339,1988.15,670.3574,2339,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,2339,100,,percent of total billed charges,,
Mri Upper Extremity Rt Any Jt Wo Contrast,,73221,CPT,Facility,Both,,,RT,2339,1988.15,670.3574,2339,BlueCross BlueShield Minnesota,High Value Network Plan,2105.1,90,,percent of total billed charges,,
Mri Upper Extremity Rt Any Jt Wo Contrast,,73221,CPT,Facility,Outpatient,,,RT,2339,1988.15,670.3574,2339,BlueCross BlueShield Minnesota,Medicare Advantage,1146.11,49,,percent of total billed charges,,
Mri Upper Extremity Rt Any Jt Wo Contrast,,73221,CPT,Facility,Inpatient,,,RT,2339,1988.15,670.3574,2339,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Mri Upper Extremity Rt Any Jt Wo Contrast,,73221,CPT,Facility,Both,,,RT,2339,1988.15,670.3574,2339,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,2071.6523,88.57,,percent of total billed charges,,
Mri Upper Extremity Rt Any Jt Wo Contrast,,73221,CPT,Facility,Both,,,RT,2339,1988.15,670.3574,2339,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,670.3574,28.66,,percent of total billed charges,,
Mri Upper Extremity Rt Any Jt Wo Contrast,,73221,CPT,Facility,Outpatient,,,RT,2339,1988.15,670.3574,2339,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1146.11,49,,percent of total billed charges,,
Mri Upper Extremity Rt Any Jt Wo Contrast,,73221,CPT,Facility,Inpatient,,,RT,2339,1988.15,670.3574,2339,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Mri Upper Extremity Rt Any Jt Wo Contrast,,73221,CPT,Facility,Both,,,RT,2339,1988.15,670.3574,2339,CorVel,Worker's Compensation,2339,100,,percent of total billed charges,,
Mri Upper Extremity Rt Any Jt Wo Contrast,,73221,CPT,Facility,Both,,,RT,2339,1988.15,670.3574,2339,First Health Group Corporation,First Health Network,2268.83,97,,percent of total billed charges,,
Mri Upper Extremity Rt Any Jt Wo Contrast,,73221,CPT,Facility,Both,,,RT,2339,1988.15,670.3574,2339,"Health Partners, Inc.",Commercial,2212.694,94.6,,percent of total billed charges,,
Mri Upper Extremity Rt Any Jt Wo Contrast,,73221,CPT,Facility,Outpatient,,,RT,2339,1988.15,670.3574,2339,"Health Partners, Inc.",Medicare Advantage,1146.11,49,,percent of total billed charges,,
Mri Upper Extremity Rt Any Jt Wo Contrast,,73221,CPT,Facility,Inpatient,,,RT,2339,1988.15,670.3574,2339,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mri Upper Extremity Rt Any Jt Wo Contrast,,73221,CPT,Facility,Both,,,RT,2339,1988.15,670.3574,2339,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1403.4,60,,percent of total billed charges,,
Mri Upper Extremity Rt Any Jt Wo Contrast,,73221,CPT,Facility,Both,,,RT,2339,1988.15,670.3574,2339,"Health Partners, Inc.",State of Minnesota Advantage Program,1906.285,81.5,,percent of total billed charges,,
Mri Upper Extremity Rt Any Jt Wo Contrast,,73221,CPT,Facility,Both,,,RT,2339,1988.15,670.3574,2339,"Health Partners, Inc.",State Public Programs,1169.5,50,,percent of total billed charges,,
Mri Upper Extremity Rt Any Jt Wo Contrast,,73221,CPT,Facility,Both,,,RT,2339,1988.15,670.3574,2339,Humana Insurance Company,Commercial PPO,2222.05,95,,percent of total billed charges,,
Mri Upper Extremity Rt Any Jt Wo Contrast,,73221,CPT,Facility,Outpatient,,,RT,2339,1988.15,670.3574,2339,Humana Insurance Company,Medicare PPO,1146.11,49,,percent of total billed charges,,
Mri Upper Extremity Rt Any Jt Wo Contrast,,73221,CPT,Facility,Inpatient,,,RT,2339,1988.15,670.3574,2339,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Mri Upper Extremity Rt Any Jt Wo Contrast,,73221,CPT,Facility,Both,,,RT,2339,1988.15,670.3574,2339,Medica,Individual & Family,2317.949,99.1,,percent of total billed charges,,
Mri Upper Extremity Rt Any Jt Wo Contrast,,73221,CPT,Facility,Outpatient,,,RT,2339,1988.15,670.3574,2339,Medica,Medica Advantage Solution,1164.822,49.8,,percent of total billed charges,,
Mri Upper Extremity Rt Any Jt Wo Contrast,,73221,CPT,Facility,Inpatient,,,RT,2339,1988.15,670.3574,2339,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Mri Upper Extremity Rt Any Jt Wo Contrast,,73221,CPT,Facility,Outpatient,,,RT,2339,1988.15,670.3574,2339,Medica,Medical Assistance,747,,,Other ,per vist,Pays in addition to all Outpatient Service Categories
Mri Upper Extremity Rt Any Jt Wo Contrast,,73221,CPT,Facility,Inpatient,,,RT,2339,1988.15,670.3574,2339,Medica,Medical Assistance,,,,,Included in per diem rate,
Mri Upper Extremity Rt Any Jt Wo Contrast,,73221,CPT,Facility,Outpatient,,,RT,2339,1988.15,670.3574,2339,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1164.822,49.8,,percent of total billed charges,,
Mri Upper Extremity Rt Any Jt Wo Contrast,,73221,CPT,Facility,Inpatient,,,RT,2339,1988.15,670.3574,2339,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Mri Upper Extremity Rt Any Jt Wo Contrast,,73221,CPT,Facility,Both,,,RT,2339,1988.15,670.3574,2339,"Multiplan, Inc.","Multiplan, Inc.",2198.66,94,,percent of total billed charges,,
Mri Upper Extremity Rt Any Jt Wo Contrast,,73221,CPT,Facility,Outpatient,,,RT,2339,1988.15,670.3574,2339,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1535,,,Other ,per scan,
Mri Upper Extremity Rt Any Jt Wo Contrast,,73221,CPT,Facility,Inpatient,,,RT,2339,1988.15,670.3574,2339,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Mri Upper Extremity Rt Any Jt Wo Contrast,,73221,CPT,Facility,Both,,,RT,2339,1988.15,670.3574,2339,"Preferred One Administrative Services, INC.",PPO,2306.254,98.6,,percent of total billed charges,,
Mri Upper Extremity Rt Any Jt Wo Contrast,,73221,CPT,Facility,Outpatient,,,RT,2339,1988.15,670.3574,2339,PrimeWest Health,Minnesota Senior Health Options (MSHO),1203.4155,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Mri Upper Extremity Rt Any Jt Wo Contrast,,73221,CPT,Facility,Inpatient,,,RT,2339,1988.15,670.3574,2339,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mri Upper Extremity Rt Any Jt Wo Contrast,,73221,CPT,Facility,Outpatient,,,RT,2339,1988.15,670.3574,2339,PrimeWest Health,MinnesotaCare,1201.3104,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Mri Upper Extremity Rt Any Jt Wo Contrast,,73221,CPT,Facility,Inpatient,,,RT,2339,1988.15,670.3574,2339,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Mri Upper Extremity Rt Any Jt Wo Contrast,,73221,CPT,Facility,Both,,,RT,2339,1988.15,670.3574,2339,Sanford Health Plan,Sanford Health Plan,2151.88,92,,percent of total billed charges,,
Mri Upper Extremity Rt Any Jt Wo Contrast,,73221,CPT,Facility,Outpatient,,,RT,2339,1988.15,670.3574,2339,"UCare Health, Inc.",Individual & Family Plan,1318.0265,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Mri Upper Extremity Rt Any Jt Wo Contrast,,73221,CPT,Facility,Inpatient,,,RT,2339,1988.15,670.3574,2339,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Mri Upper Extremity Rt Any Jt Wo Contrast,,73221,CPT,Facility,Outpatient,,,RT,2339,1988.15,670.3574,2339,"UCare Health, Inc.",Medical Assistance,1180.4933,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mri Upper Extremity Rt Any Jt Wo Contrast,,73221,CPT,Facility,Inpatient,,,RT,2339,1988.15,670.3574,2339,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Mri Upper Extremity Rt Any Jt Wo Contrast,,73221,CPT,Facility,Outpatient,,,RT,2339,1988.15,670.3574,2339,"UCare Health, Inc.",Medicare Advantage,1180.4933,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mri Upper Extremity Rt Any Jt Wo Contrast,,73221,CPT,Facility,Inpatient,,,RT,2339,1988.15,670.3574,2339,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mri Upper Extremity Rt Any Jt Wo Contrast,,73221,CPT,Facility,Outpatient,,,RT,2339,1988.15,670.3574,2339,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1180.4933,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mri Upper Extremity Rt Any Jt Wo Contrast,,73221,CPT,Facility,Inpatient,,,RT,2339,1988.15,670.3574,2339,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mri Upper Extremity Rt Any Jt Wo Contrast,,73221,CPT,Facility,Both,,,RT,2339,1988.15,670.3574,2339,UnitedHealthcare,Individual & Family,2198.66,94,,percent of total billed charges,,
Mri Upper Extremity Rt Any Jt Wo Contrast,,73221,CPT,Facility,Outpatient,,,RT,2339,1988.15,670.3574,2339,UnitedHealthcare,Medicare Advantage,1146.11,49,,percent of total billed charges,,
Mri Upper Extremity Rt Any Jt Wo Contrast,,73221,CPT,Facility,Inpatient,,,RT,2339,1988.15,670.3574,2339,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Mri Upper Extremity Rt Any Jt Wo Contrast,,73221,CPT,Facility,Outpatient,,,RT,2339,1988.15,670.3574,2339,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1122.72,48,,percent of total billed charges,,100% of DHS outpatient percentage
Mri Upper Extremity Rt Any Jt Wo Contrast,,73221,CPT,Facility,Inpatient,,,RT,2339,1988.15,670.3574,2339,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Mri Upper Extremity Rt Any Jt W Contrast,,73222,CPT,Facility,Both,,,RT,2598,2208.3,744.5868,2598,Aetna,Commercial,2390.16,92,,percent of total billed charges,,
Mri Upper Extremity Rt Any Jt W Contrast,,73222,CPT,Facility,Outpatient,,,RT,2598,2208.3,744.5868,2598,Aetna,Medicare Advantage,1273.02,49,,percent of total billed charges,,
Mri Upper Extremity Rt Any Jt W Contrast,,73222,CPT,Facility,Inpatient,,,RT,2598,2208.3,744.5868,2598,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Mri Upper Extremity Rt Any Jt W Contrast,,73222,CPT,Facility,Both,,,RT,2598,2208.3,744.5868,2598,Aetna,PPO,2416.14,93,,percent of total billed charges,,
Mri Upper Extremity Rt Any Jt W Contrast,,73222,CPT,Facility,Both,,,RT,2598,2208.3,744.5868,2598,America's PPO,America's PPO,2494.8594,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Mri Upper Extremity Rt Any Jt W Contrast,,73222,CPT,Facility,Both,,,RT,2598,2208.3,744.5868,2598,BlueCross BlueShield Minnesota, Federal Employee Program,2556.432,98.4,,percent of total billed charges,,
Mri Upper Extremity Rt Any Jt W Contrast,,73222,CPT,Facility,Both,,,RT,2598,2208.3,744.5868,2598,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,2598,100,,percent of total billed charges,,
Mri Upper Extremity Rt Any Jt W Contrast,,73222,CPT,Facility,Both,,,RT,2598,2208.3,744.5868,2598,BlueCross BlueShield Minnesota,High Value Network Plan,2338.2,90,,percent of total billed charges,,
Mri Upper Extremity Rt Any Jt W Contrast,,73222,CPT,Facility,Outpatient,,,RT,2598,2208.3,744.5868,2598,BlueCross BlueShield Minnesota,Medicare Advantage,1273.02,49,,percent of total billed charges,,
Mri Upper Extremity Rt Any Jt W Contrast,,73222,CPT,Facility,Inpatient,,,RT,2598,2208.3,744.5868,2598,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Mri Upper Extremity Rt Any Jt W Contrast,,73222,CPT,Facility,Both,,,RT,2598,2208.3,744.5868,2598,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,2301.0486,88.57,,percent of total billed charges,,
Mri Upper Extremity Rt Any Jt W Contrast,,73222,CPT,Facility,Both,,,RT,2598,2208.3,744.5868,2598,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,744.5868,28.66,,percent of total billed charges,,
Mri Upper Extremity Rt Any Jt W Contrast,,73222,CPT,Facility,Outpatient,,,RT,2598,2208.3,744.5868,2598,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1273.02,49,,percent of total billed charges,,
Mri Upper Extremity Rt Any Jt W Contrast,,73222,CPT,Facility,Inpatient,,,RT,2598,2208.3,744.5868,2598,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Mri Upper Extremity Rt Any Jt W Contrast,,73222,CPT,Facility,Both,,,RT,2598,2208.3,744.5868,2598,CorVel,Worker's Compensation,2598,100,,percent of total billed charges,,
Mri Upper Extremity Rt Any Jt W Contrast,,73222,CPT,Facility,Both,,,RT,2598,2208.3,744.5868,2598,First Health Group Corporation,First Health Network,2520.06,97,,percent of total billed charges,,
Mri Upper Extremity Rt Any Jt W Contrast,,73222,CPT,Facility,Both,,,RT,2598,2208.3,744.5868,2598,"Health Partners, Inc.",Commercial,2457.708,94.6,,percent of total billed charges,,
Mri Upper Extremity Rt Any Jt W Contrast,,73222,CPT,Facility,Outpatient,,,RT,2598,2208.3,744.5868,2598,"Health Partners, Inc.",Medicare Advantage,1273.02,49,,percent of total billed charges,,
Mri Upper Extremity Rt Any Jt W Contrast,,73222,CPT,Facility,Inpatient,,,RT,2598,2208.3,744.5868,2598,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mri Upper Extremity Rt Any Jt W Contrast,,73222,CPT,Facility,Both,,,RT,2598,2208.3,744.5868,2598,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1558.8,60,,percent of total billed charges,,
Mri Upper Extremity Rt Any Jt W Contrast,,73222,CPT,Facility,Both,,,RT,2598,2208.3,744.5868,2598,"Health Partners, Inc.",State of Minnesota Advantage Program,2117.37,81.5,,percent of total billed charges,,
Mri Upper Extremity Rt Any Jt W Contrast,,73222,CPT,Facility,Both,,,RT,2598,2208.3,744.5868,2598,"Health Partners, Inc.",State Public Programs,1299,50,,percent of total billed charges,,
Mri Upper Extremity Rt Any Jt W Contrast,,73222,CPT,Facility,Both,,,RT,2598,2208.3,744.5868,2598,Humana Insurance Company,Commercial PPO,2468.1,95,,percent of total billed charges,,
Mri Upper Extremity Rt Any Jt W Contrast,,73222,CPT,Facility,Outpatient,,,RT,2598,2208.3,744.5868,2598,Humana Insurance Company,Medicare PPO,1273.02,49,,percent of total billed charges,,
Mri Upper Extremity Rt Any Jt W Contrast,,73222,CPT,Facility,Inpatient,,,RT,2598,2208.3,744.5868,2598,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Mri Upper Extremity Rt Any Jt W Contrast,,73222,CPT,Facility,Both,,,RT,2598,2208.3,744.5868,2598,Medica,Individual & Family,2574.618,99.1,,percent of total billed charges,,
Mri Upper Extremity Rt Any Jt W Contrast,,73222,CPT,Facility,Outpatient,,,RT,2598,2208.3,744.5868,2598,Medica,Medica Advantage Solution,1293.804,49.8,,percent of total billed charges,,
Mri Upper Extremity Rt Any Jt W Contrast,,73222,CPT,Facility,Inpatient,,,RT,2598,2208.3,744.5868,2598,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Mri Upper Extremity Rt Any Jt W Contrast,,73222,CPT,Facility,Outpatient,,,RT,2598,2208.3,744.5868,2598,Medica,Medical Assistance,747,,,Other ,per vist,Pays in addition to all Outpatient Service Categories
Mri Upper Extremity Rt Any Jt W Contrast,,73222,CPT,Facility,Inpatient,,,RT,2598,2208.3,744.5868,2598,Medica,Medical Assistance,,,,,Included in per diem rate,
Mri Upper Extremity Rt Any Jt W Contrast,,73222,CPT,Facility,Outpatient,,,RT,2598,2208.3,744.5868,2598,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1293.804,49.8,,percent of total billed charges,,
Mri Upper Extremity Rt Any Jt W Contrast,,73222,CPT,Facility,Inpatient,,,RT,2598,2208.3,744.5868,2598,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Mri Upper Extremity Rt Any Jt W Contrast,,73222,CPT,Facility,Both,,,RT,2598,2208.3,744.5868,2598,"Multiplan, Inc.","Multiplan, Inc.",2442.12,94,,percent of total billed charges,,
Mri Upper Extremity Rt Any Jt W Contrast,,73222,CPT,Facility,Outpatient,,,RT,2598,2208.3,744.5868,2598,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1535,,,Other  ,per scan,
Mri Upper Extremity Rt Any Jt W Contrast,,73222,CPT,Facility,Inpatient,,,RT,2598,2208.3,744.5868,2598,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Mri Upper Extremity Rt Any Jt W Contrast,,73222,CPT,Facility,Both,,,RT,2598,2208.3,744.5868,2598,"Preferred One Administrative Services, INC.",PPO,2561.628,98.6,,percent of total billed charges,,
Mri Upper Extremity Rt Any Jt W Contrast,,73222,CPT,Facility,Outpatient,,,RT,2598,2208.3,744.5868,2598,PrimeWest Health,Minnesota Senior Health Options (MSHO),1336.671,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Mri Upper Extremity Rt Any Jt W Contrast,,73222,CPT,Facility,Inpatient,,,RT,2598,2208.3,744.5868,2598,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mri Upper Extremity Rt Any Jt W Contrast,,73222,CPT,Facility,Outpatient,,,RT,2598,2208.3,744.5868,2598,PrimeWest Health,MinnesotaCare,1334.3328,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Mri Upper Extremity Rt Any Jt W Contrast,,73222,CPT,Facility,Inpatient,,,RT,2598,2208.3,744.5868,2598,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Mri Upper Extremity Rt Any Jt W Contrast,,73222,CPT,Facility,Both,,,RT,2598,2208.3,744.5868,2598,Sanford Health Plan,Sanford Health Plan,2390.16,92,,percent of total billed charges,,
Mri Upper Extremity Rt Any Jt W Contrast,,73222,CPT,Facility,Outpatient,,,RT,2598,2208.3,744.5868,2598,"UCare Health, Inc.",Individual & Family Plan,1463.973,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Mri Upper Extremity Rt Any Jt W Contrast,,73222,CPT,Facility,Inpatient,,,RT,2598,2208.3,744.5868,2598,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Mri Upper Extremity Rt Any Jt W Contrast,,73222,CPT,Facility,Outpatient,,,RT,2598,2208.3,744.5868,2598,"UCare Health, Inc.",Medical Assistance,1311.2106,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mri Upper Extremity Rt Any Jt W Contrast,,73222,CPT,Facility,Inpatient,,,RT,2598,2208.3,744.5868,2598,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Mri Upper Extremity Rt Any Jt W Contrast,,73222,CPT,Facility,Outpatient,,,RT,2598,2208.3,744.5868,2598,"UCare Health, Inc.",Medicare Advantage,1311.2106,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mri Upper Extremity Rt Any Jt W Contrast,,73222,CPT,Facility,Inpatient,,,RT,2598,2208.3,744.5868,2598,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mri Upper Extremity Rt Any Jt W Contrast,,73222,CPT,Facility,Outpatient,,,RT,2598,2208.3,744.5868,2598,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1311.2106,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mri Upper Extremity Rt Any Jt W Contrast,,73222,CPT,Facility,Inpatient,,,RT,2598,2208.3,744.5868,2598,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mri Upper Extremity Rt Any Jt W Contrast,,73222,CPT,Facility,Both,,,RT,2598,2208.3,744.5868,2598,UnitedHealthcare,Individual & Family,2442.12,94,,percent of total billed charges,,
Mri Upper Extremity Rt Any Jt W Contrast,,73222,CPT,Facility,Outpatient,,,RT,2598,2208.3,744.5868,2598,UnitedHealthcare,Medicare Advantage,1273.02,49,,percent of total billed charges,,
Mri Upper Extremity Rt Any Jt W Contrast,,73222,CPT,Facility,Inpatient,,,RT,2598,2208.3,744.5868,2598,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Mri Upper Extremity Rt Any Jt W Contrast,,73222,CPT,Facility,Outpatient,,,RT,2598,2208.3,744.5868,2598,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1247.04,48,,percent of total billed charges,,100% of DHS outpatient percentage
Mri Upper Extremity Rt Any Jt W Contrast,,73222,CPT,Facility,Inpatient,,,RT,2598,2208.3,744.5868,2598,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Mri Upper Extremity Rt Any Jt Wo W Contrast,,73223,CPT,Facility,Both,,,RT,3254,2765.9,747,3254,Aetna,Commercial,2993.68,92,,percent of total billed charges,,
Mri Upper Extremity Rt Any Jt Wo W Contrast,,73223,CPT,Facility,Outpatient,,,RT,3254,2765.9,747,3254,Aetna,Medicare Advantage,1594.46,49,,percent of total billed charges,,
Mri Upper Extremity Rt Any Jt Wo W Contrast,,73223,CPT,Facility,Inpatient,,,RT,3254,2765.9,747,3254,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Mri Upper Extremity Rt Any Jt Wo W Contrast,,73223,CPT,Facility,Both,,,RT,3254,2765.9,747,3254,Aetna,PPO,3026.22,93,,percent of total billed charges,,
Mri Upper Extremity Rt Any Jt Wo W Contrast,,73223,CPT,Facility,Both,,,RT,3254,2765.9,747,3254,America's PPO,America's PPO,3124.8162,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Mri Upper Extremity Rt Any Jt Wo W Contrast,,73223,CPT,Facility,Both,,,RT,3254,2765.9,747,3254,BlueCross BlueShield Minnesota, Federal Employee Program,3201.936,98.4,,percent of total billed charges,,
Mri Upper Extremity Rt Any Jt Wo W Contrast,,73223,CPT,Facility,Both,,,RT,3254,2765.9,747,3254,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,3254,100,,percent of total billed charges,,
Mri Upper Extremity Rt Any Jt Wo W Contrast,,73223,CPT,Facility,Both,,,RT,3254,2765.9,747,3254,BlueCross BlueShield Minnesota,High Value Network Plan,2928.6,90,,percent of total billed charges,,
Mri Upper Extremity Rt Any Jt Wo W Contrast,,73223,CPT,Facility,Outpatient,,,RT,3254,2765.9,747,3254,BlueCross BlueShield Minnesota,Medicare Advantage,1594.46,49,,percent of total billed charges,,
Mri Upper Extremity Rt Any Jt Wo W Contrast,,73223,CPT,Facility,Inpatient,,,RT,3254,2765.9,747,3254,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Mri Upper Extremity Rt Any Jt Wo W Contrast,,73223,CPT,Facility,Both,,,RT,3254,2765.9,747,3254,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,2882.0678,88.57,,percent of total billed charges,,
Mri Upper Extremity Rt Any Jt Wo W Contrast,,73223,CPT,Facility,Both,,,RT,3254,2765.9,747,3254,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,932.5964,28.66,,percent of total billed charges,,
Mri Upper Extremity Rt Any Jt Wo W Contrast,,73223,CPT,Facility,Outpatient,,,RT,3254,2765.9,747,3254,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1594.46,49,,percent of total billed charges,,
Mri Upper Extremity Rt Any Jt Wo W Contrast,,73223,CPT,Facility,Inpatient,,,RT,3254,2765.9,747,3254,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Mri Upper Extremity Rt Any Jt Wo W Contrast,,73223,CPT,Facility,Both,,,RT,3254,2765.9,747,3254,CorVel,Worker's Compensation,3254,100,,percent of total billed charges,,
Mri Upper Extremity Rt Any Jt Wo W Contrast,,73223,CPT,Facility,Both,,,RT,3254,2765.9,747,3254,First Health Group Corporation,First Health Network,3156.38,97,,percent of total billed charges,,
Mri Upper Extremity Rt Any Jt Wo W Contrast,,73223,CPT,Facility,Both,,,RT,3254,2765.9,747,3254,"Health Partners, Inc.",Commercial,3078.284,94.6,,percent of total billed charges,,
Mri Upper Extremity Rt Any Jt Wo W Contrast,,73223,CPT,Facility,Outpatient,,,RT,3254,2765.9,747,3254,"Health Partners, Inc.",Medicare Advantage,1594.46,49,,percent of total billed charges,,
Mri Upper Extremity Rt Any Jt Wo W Contrast,,73223,CPT,Facility,Inpatient,,,RT,3254,2765.9,747,3254,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mri Upper Extremity Rt Any Jt Wo W Contrast,,73223,CPT,Facility,Both,,,RT,3254,2765.9,747,3254,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1952.4,60,,percent of total billed charges,,
Mri Upper Extremity Rt Any Jt Wo W Contrast,,73223,CPT,Facility,Both,,,RT,3254,2765.9,747,3254,"Health Partners, Inc.",State of Minnesota Advantage Program,2652.01,81.5,,percent of total billed charges,,
Mri Upper Extremity Rt Any Jt Wo W Contrast,,73223,CPT,Facility,Both,,,RT,3254,2765.9,747,3254,"Health Partners, Inc.",State Public Programs,1627,50,,percent of total billed charges,,
Mri Upper Extremity Rt Any Jt Wo W Contrast,,73223,CPT,Facility,Both,,,RT,3254,2765.9,747,3254,Humana Insurance Company,Commercial PPO,3091.3,95,,percent of total billed charges,,
Mri Upper Extremity Rt Any Jt Wo W Contrast,,73223,CPT,Facility,Outpatient,,,RT,3254,2765.9,747,3254,Humana Insurance Company,Medicare PPO,1594.46,49,,percent of total billed charges,,
Mri Upper Extremity Rt Any Jt Wo W Contrast,,73223,CPT,Facility,Inpatient,,,RT,3254,2765.9,747,3254,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Mri Upper Extremity Rt Any Jt Wo W Contrast,,73223,CPT,Facility,Both,,,RT,3254,2765.9,747,3254,Medica,Individual & Family,3224.714,99.1,,percent of total billed charges,,
Mri Upper Extremity Rt Any Jt Wo W Contrast,,73223,CPT,Facility,Outpatient,,,RT,3254,2765.9,747,3254,Medica,Medica Advantage Solution,1620.492,49.8,,percent of total billed charges,,
Mri Upper Extremity Rt Any Jt Wo W Contrast,,73223,CPT,Facility,Inpatient,,,RT,3254,2765.9,747,3254,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Mri Upper Extremity Rt Any Jt Wo W Contrast,,73223,CPT,Facility,Outpatient,,,RT,3254,2765.9,747,3254,Medica,Medical Assistance,747,,,Other ,per vist,Pays in addition to all Outpatient Service Categories
Mri Upper Extremity Rt Any Jt Wo W Contrast,,73223,CPT,Facility,Inpatient,,,RT,3254,2765.9,747,3254,Medica,Medical Assistance,,,,,Included in per diem rate,
Mri Upper Extremity Rt Any Jt Wo W Contrast,,73223,CPT,Facility,Outpatient,,,RT,3254,2765.9,747,3254,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1620.492,49.8,,percent of total billed charges,,
Mri Upper Extremity Rt Any Jt Wo W Contrast,,73223,CPT,Facility,Inpatient,,,RT,3254,2765.9,747,3254,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Mri Upper Extremity Rt Any Jt Wo W Contrast,,73223,CPT,Facility,Both,,,RT,3254,2765.9,747,3254,"Multiplan, Inc.","Multiplan, Inc.",3058.76,94,,percent of total billed charges,,
Mri Upper Extremity Rt Any Jt Wo W Contrast,,73223,CPT,Facility,Outpatient,,,RT,3254,2765.9,747,3254,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1535,,,Other ,per scan,
Mri Upper Extremity Rt Any Jt Wo W Contrast,,73223,CPT,Facility,Inpatient,,,RT,3254,2765.9,747,3254,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Mri Upper Extremity Rt Any Jt Wo W Contrast,,73223,CPT,Facility,Both,,,RT,3254,2765.9,747,3254,"Preferred One Administrative Services, INC.",PPO,3208.444,98.6,,percent of total billed charges,,
Mri Upper Extremity Rt Any Jt Wo W Contrast,,73223,CPT,Facility,Outpatient,,,RT,3254,2765.9,747,3254,PrimeWest Health,Minnesota Senior Health Options (MSHO),1674.183,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Mri Upper Extremity Rt Any Jt Wo W Contrast,,73223,CPT,Facility,Inpatient,,,RT,3254,2765.9,747,3254,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mri Upper Extremity Rt Any Jt Wo W Contrast,,73223,CPT,Facility,Outpatient,,,RT,3254,2765.9,747,3254,PrimeWest Health,MinnesotaCare,1671.2544,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Mri Upper Extremity Rt Any Jt Wo W Contrast,,73223,CPT,Facility,Inpatient,,,RT,3254,2765.9,747,3254,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Mri Upper Extremity Rt Any Jt Wo W Contrast,,73223,CPT,Facility,Both,,,RT,3254,2765.9,747,3254,Sanford Health Plan,Sanford Health Plan,2993.68,92,,percent of total billed charges,,
Mri Upper Extremity Rt Any Jt Wo W Contrast,,73223,CPT,Facility,Outpatient,,,RT,3254,2765.9,747,3254,"UCare Health, Inc.",Individual & Family Plan,1833.629,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Mri Upper Extremity Rt Any Jt Wo W Contrast,,73223,CPT,Facility,Inpatient,,,RT,3254,2765.9,747,3254,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Mri Upper Extremity Rt Any Jt Wo W Contrast,,73223,CPT,Facility,Outpatient,,,RT,3254,2765.9,747,3254,"UCare Health, Inc.",Medical Assistance,1642.2938,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mri Upper Extremity Rt Any Jt Wo W Contrast,,73223,CPT,Facility,Inpatient,,,RT,3254,2765.9,747,3254,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Mri Upper Extremity Rt Any Jt Wo W Contrast,,73223,CPT,Facility,Outpatient,,,RT,3254,2765.9,747,3254,"UCare Health, Inc.",Medicare Advantage,1642.2938,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mri Upper Extremity Rt Any Jt Wo W Contrast,,73223,CPT,Facility,Inpatient,,,RT,3254,2765.9,747,3254,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mri Upper Extremity Rt Any Jt Wo W Contrast,,73223,CPT,Facility,Outpatient,,,RT,3254,2765.9,747,3254,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1642.2938,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mri Upper Extremity Rt Any Jt Wo W Contrast,,73223,CPT,Facility,Inpatient,,,RT,3254,2765.9,747,3254,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mri Upper Extremity Rt Any Jt Wo W Contrast,,73223,CPT,Facility,Both,,,RT,3254,2765.9,747,3254,UnitedHealthcare,Individual & Family,3058.76,94,,percent of total billed charges,,
Mri Upper Extremity Rt Any Jt Wo W Contrast,,73223,CPT,Facility,Outpatient,,,RT,3254,2765.9,747,3254,UnitedHealthcare,Medicare Advantage,1594.46,49,,percent of total billed charges,,
Mri Upper Extremity Rt Any Jt Wo W Contrast,,73223,CPT,Facility,Inpatient,,,RT,3254,2765.9,747,3254,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Mri Upper Extremity Rt Any Jt Wo W Contrast,,73223,CPT,Facility,Outpatient,,,RT,3254,2765.9,747,3254,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1561.92,48,,percent of total billed charges,,100% of DHS outpatient percentage
Mri Upper Extremity Rt Any Jt Wo W Contrast,,73223,CPT,Facility,Inpatient,,,RT,3254,2765.9,747,3254,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Xr Hip Rt 1 View,,73501,CPT,Facility,Both,,,RT,235,199.75,67.351,235,Aetna,Commercial,216.2,92,,percent of total billed charges,,
Xr Hip Rt 1 View,,73501,CPT,Facility,Outpatient,,,RT,235,199.75,67.351,235,Aetna,Medicare Advantage,115.15,49,,percent of total billed charges,,
Xr Hip Rt 1 View,,73501,CPT,Facility,Inpatient,,,RT,235,199.75,67.351,235,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Xr Hip Rt 1 View,,73501,CPT,Facility,Both,,,RT,235,199.75,67.351,235,Aetna,PPO,218.55,93,,percent of total billed charges,,
Xr Hip Rt 1 View,,73501,CPT,Facility,Both,,,RT,235,199.75,67.351,235,America's PPO,America's PPO,225.6705,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Xr Hip Rt 1 View,,73501,CPT,Facility,Both,,,RT,235,199.75,67.351,235,BlueCross BlueShield Minnesota, Federal Employee Program,231.24,98.4,,percent of total billed charges,,
Xr Hip Rt 1 View,,73501,CPT,Facility,Both,,,RT,235,199.75,67.351,235,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,235,100,,percent of total billed charges,,
Xr Hip Rt 1 View,,73501,CPT,Facility,Both,,,RT,235,199.75,67.351,235,BlueCross BlueShield Minnesota,High Value Network Plan,211.5,90,,percent of total billed charges,,
Xr Hip Rt 1 View,,73501,CPT,Facility,Outpatient,,,RT,235,199.75,67.351,235,BlueCross BlueShield Minnesota,Medicare Advantage,115.15,49,,percent of total billed charges,,
Xr Hip Rt 1 View,,73501,CPT,Facility,Inpatient,,,RT,235,199.75,67.351,235,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Xr Hip Rt 1 View,,73501,CPT,Facility,Both,,,RT,235,199.75,67.351,235,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,208.1395,88.57,,percent of total billed charges,,
Xr Hip Rt 1 View,,73501,CPT,Facility,Both,,,RT,235,199.75,67.351,235,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,67.351,28.66,,percent of total billed charges,,
Xr Hip Rt 1 View,,73501,CPT,Facility,Outpatient,,,RT,235,199.75,67.351,235,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),115.15,49,,percent of total billed charges,,
Xr Hip Rt 1 View,,73501,CPT,Facility,Inpatient,,,RT,235,199.75,67.351,235,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Xr Hip Rt 1 View,,73501,CPT,Facility,Both,,,RT,235,199.75,67.351,235,CorVel,Worker's Compensation,235,100,,percent of total billed charges,,
Xr Hip Rt 1 View,,73501,CPT,Facility,Both,,,RT,235,199.75,67.351,235,First Health Group Corporation,First Health Network,227.95,97,,percent of total billed charges,,
Xr Hip Rt 1 View,,73501,CPT,Facility,Both,,,RT,235,199.75,67.351,235,"Health Partners, Inc.",Commercial,222.31,94.6,,percent of total billed charges,,
Xr Hip Rt 1 View,,73501,CPT,Facility,Outpatient,,,RT,235,199.75,67.351,235,"Health Partners, Inc.",Medicare Advantage,115.15,49,,percent of total billed charges,,
Xr Hip Rt 1 View,,73501,CPT,Facility,Inpatient,,,RT,235,199.75,67.351,235,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Hip Rt 1 View,,73501,CPT,Facility,Both,,,RT,235,199.75,67.351,235,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),141,60,,percent of total billed charges,,
Xr Hip Rt 1 View,,73501,CPT,Facility,Both,,,RT,235,199.75,67.351,235,"Health Partners, Inc.",State of Minnesota Advantage Program,191.525,81.5,,percent of total billed charges,,
Xr Hip Rt 1 View,,73501,CPT,Facility,Both,,,RT,235,199.75,67.351,235,"Health Partners, Inc.",State Public Programs,117.5,50,,percent of total billed charges,,
Xr Hip Rt 1 View,,73501,CPT,Facility,Both,,,RT,235,199.75,67.351,235,Humana Insurance Company,Commercial PPO,223.25,95,,percent of total billed charges,,
Xr Hip Rt 1 View,,73501,CPT,Facility,Outpatient,,,RT,235,199.75,67.351,235,Humana Insurance Company,Medicare PPO,115.15,49,,percent of total billed charges,,
Xr Hip Rt 1 View,,73501,CPT,Facility,Inpatient,,,RT,235,199.75,67.351,235,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Xr Hip Rt 1 View,,73501,CPT,Facility,Both,,,RT,235,199.75,67.351,235,Medica,Individual & Family,232.885,99.1,,percent of total billed charges,,
Xr Hip Rt 1 View,,73501,CPT,Facility,Outpatient,,,RT,235,199.75,67.351,235,Medica,Medica Advantage Solution,117.03,49.8,,percent of total billed charges,,
Xr Hip Rt 1 View,,73501,CPT,Facility,Inpatient,,,RT,235,199.75,67.351,235,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Xr Hip Rt 1 View,,73501,CPT,Facility,Outpatient,,,RT,235,199.75,67.351,235,Medica,Medical Assistance,104.81,44.6,,percent of total billed charges,,
Xr Hip Rt 1 View,,73501,CPT,Facility,Inpatient,,,RT,235,199.75,67.351,235,Medica,Medical Assistance,,,,,Included in per diem rate,
Xr Hip Rt 1 View,,73501,CPT,Facility,Outpatient,,,RT,235,199.75,67.351,235,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,117.03,49.8,,percent of total billed charges,,
Xr Hip Rt 1 View,,73501,CPT,Facility,Inpatient,,,RT,235,199.75,67.351,235,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Xr Hip Rt 1 View,,73501,CPT,Facility,Both,,,RT,235,199.75,67.351,235,"Multiplan, Inc.","Multiplan, Inc.",220.9,94,,percent of total billed charges,,
Xr Hip Rt 1 View,,73501,CPT,Facility,Outpatient,,,RT,235,199.75,67.351,235,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,211.735,90.1,,percent of total billed charges,,
Xr Hip Rt 1 View,,73501,CPT,Facility,Inpatient,,,RT,235,199.75,67.351,235,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Xr Hip Rt 1 View,,73501,CPT,Facility,Both,,,RT,235,199.75,67.351,235,"Preferred One Administrative Services, INC.",PPO,231.71,98.6,,percent of total billed charges,,
Xr Hip Rt 1 View,,73501,CPT,Facility,Outpatient,,,RT,235,199.75,67.351,235,PrimeWest Health,Minnesota Senior Health Options (MSHO),120.9075,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Xr Hip Rt 1 View,,73501,CPT,Facility,Inpatient,,,RT,235,199.75,67.351,235,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Hip Rt 1 View,,73501,CPT,Facility,Outpatient,,,RT,235,199.75,67.351,235,PrimeWest Health,MinnesotaCare,120.696,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Xr Hip Rt 1 View,,73501,CPT,Facility,Inpatient,,,RT,235,199.75,67.351,235,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Xr Hip Rt 1 View,,73501,CPT,Facility,Both,,,RT,235,199.75,67.351,235,Sanford Health Plan,Sanford Health Plan,216.2,92,,percent of total billed charges,,
Xr Hip Rt 1 View,,73501,CPT,Facility,Outpatient,,,RT,235,199.75,67.351,235,"UCare Health, Inc.",Individual & Family Plan,132.4225,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Xr Hip Rt 1 View,,73501,CPT,Facility,Inpatient,,,RT,235,199.75,67.351,235,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Xr Hip Rt 1 View,,73501,CPT,Facility,Outpatient,,,RT,235,199.75,67.351,235,"UCare Health, Inc.",Medical Assistance,118.6045,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Hip Rt 1 View,,73501,CPT,Facility,Inpatient,,,RT,235,199.75,67.351,235,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Xr Hip Rt 1 View,,73501,CPT,Facility,Outpatient,,,RT,235,199.75,67.351,235,"UCare Health, Inc.",Medicare Advantage,118.6045,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Hip Rt 1 View,,73501,CPT,Facility,Inpatient,,,RT,235,199.75,67.351,235,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Hip Rt 1 View,,73501,CPT,Facility,Outpatient,,,RT,235,199.75,67.351,235,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),118.6045,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Hip Rt 1 View,,73501,CPT,Facility,Inpatient,,,RT,235,199.75,67.351,235,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Hip Rt 1 View,,73501,CPT,Facility,Both,,,RT,235,199.75,67.351,235,UnitedHealthcare,Individual & Family,220.9,94,,percent of total billed charges,,
Xr Hip Rt 1 View,,73501,CPT,Facility,Outpatient,,,RT,235,199.75,67.351,235,UnitedHealthcare,Medicare Advantage,115.15,49,,percent of total billed charges,,
Xr Hip Rt 1 View,,73501,CPT,Facility,Inpatient,,,RT,235,199.75,67.351,235,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Xr Hip Rt 1 View,,73501,CPT,Facility,Outpatient,,,RT,235,199.75,67.351,235,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,112.8,48,,percent of total billed charges,,100% of DHS outpatient percentage
Xr Hip Rt 1 View,,73501,CPT,Facility,Inpatient,,,RT,235,199.75,67.351,235,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Xr Hip Rt 2 Views,,73502,CPT,Facility,Both,,,RT,255,216.75,73.083,255,Aetna,Commercial,234.6,92,,percent of total billed charges,,
Xr Hip Rt 2 Views,,73502,CPT,Facility,Outpatient,,,RT,255,216.75,73.083,255,Aetna,Medicare Advantage,124.95,49,,percent of total billed charges,,
Xr Hip Rt 2 Views,,73502,CPT,Facility,Inpatient,,,RT,255,216.75,73.083,255,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Xr Hip Rt 2 Views,,73502,CPT,Facility,Both,,,RT,255,216.75,73.083,255,Aetna,PPO,237.15,93,,percent of total billed charges,,
Xr Hip Rt 2 Views,,73502,CPT,Facility,Both,,,RT,255,216.75,73.083,255,America's PPO,America's PPO,244.8765,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Xr Hip Rt 2 Views,,73502,CPT,Facility,Both,,,RT,255,216.75,73.083,255,BlueCross BlueShield Minnesota, Federal Employee Program,250.92,98.4,,percent of total billed charges,,
Xr Hip Rt 2 Views,,73502,CPT,Facility,Both,,,RT,255,216.75,73.083,255,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,255,100,,percent of total billed charges,,
Xr Hip Rt 2 Views,,73502,CPT,Facility,Both,,,RT,255,216.75,73.083,255,BlueCross BlueShield Minnesota,High Value Network Plan,229.5,90,,percent of total billed charges,,
Xr Hip Rt 2 Views,,73502,CPT,Facility,Outpatient,,,RT,255,216.75,73.083,255,BlueCross BlueShield Minnesota,Medicare Advantage,124.95,49,,percent of total billed charges,,
Xr Hip Rt 2 Views,,73502,CPT,Facility,Inpatient,,,RT,255,216.75,73.083,255,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Xr Hip Rt 2 Views,,73502,CPT,Facility,Both,,,RT,255,216.75,73.083,255,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,225.8535,88.57,,percent of total billed charges,,
Xr Hip Rt 2 Views,,73502,CPT,Facility,Both,,,RT,255,216.75,73.083,255,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,73.083,28.66,,percent of total billed charges,,
Xr Hip Rt 2 Views,,73502,CPT,Facility,Outpatient,,,RT,255,216.75,73.083,255,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),124.95,49,,percent of total billed charges,,
Xr Hip Rt 2 Views,,73502,CPT,Facility,Inpatient,,,RT,255,216.75,73.083,255,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Xr Hip Rt 2 Views,,73502,CPT,Facility,Both,,,RT,255,216.75,73.083,255,CorVel,Worker's Compensation,255,100,,percent of total billed charges,,
Xr Hip Rt 2 Views,,73502,CPT,Facility,Both,,,RT,255,216.75,73.083,255,First Health Group Corporation,First Health Network,247.35,97,,percent of total billed charges,,
Xr Hip Rt 2 Views,,73502,CPT,Facility,Both,,,RT,255,216.75,73.083,255,"Health Partners, Inc.",Commercial,241.23,94.6,,percent of total billed charges,,
Xr Hip Rt 2 Views,,73502,CPT,Facility,Outpatient,,,RT,255,216.75,73.083,255,"Health Partners, Inc.",Medicare Advantage,124.95,49,,percent of total billed charges,,
Xr Hip Rt 2 Views,,73502,CPT,Facility,Inpatient,,,RT,255,216.75,73.083,255,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Hip Rt 2 Views,,73502,CPT,Facility,Both,,,RT,255,216.75,73.083,255,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),153,60,,percent of total billed charges,,
Xr Hip Rt 2 Views,,73502,CPT,Facility,Both,,,RT,255,216.75,73.083,255,"Health Partners, Inc.",State of Minnesota Advantage Program,207.825,81.5,,percent of total billed charges,,
Xr Hip Rt 2 Views,,73502,CPT,Facility,Both,,,RT,255,216.75,73.083,255,"Health Partners, Inc.",State Public Programs,127.5,50,,percent of total billed charges,,
Xr Hip Rt 2 Views,,73502,CPT,Facility,Both,,,RT,255,216.75,73.083,255,Humana Insurance Company,Commercial PPO,242.25,95,,percent of total billed charges,,
Xr Hip Rt 2 Views,,73502,CPT,Facility,Outpatient,,,RT,255,216.75,73.083,255,Humana Insurance Company,Medicare PPO,124.95,49,,percent of total billed charges,,
Xr Hip Rt 2 Views,,73502,CPT,Facility,Inpatient,,,RT,255,216.75,73.083,255,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Xr Hip Rt 2 Views,,73502,CPT,Facility,Both,,,RT,255,216.75,73.083,255,Medica,Individual & Family,252.705,99.1,,percent of total billed charges,,
Xr Hip Rt 2 Views,,73502,CPT,Facility,Outpatient,,,RT,255,216.75,73.083,255,Medica,Medica Advantage Solution,126.99,49.8,,percent of total billed charges,,
Xr Hip Rt 2 Views,,73502,CPT,Facility,Inpatient,,,RT,255,216.75,73.083,255,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Xr Hip Rt 2 Views,,73502,CPT,Facility,Outpatient,,,RT,255,216.75,73.083,255,Medica,Medical Assistance,113.73,44.6,,percent of total billed charges,,
Xr Hip Rt 2 Views,,73502,CPT,Facility,Inpatient,,,RT,255,216.75,73.083,255,Medica,Medical Assistance,,,,,Included in per diem rate,
Xr Hip Rt 2 Views,,73502,CPT,Facility,Outpatient,,,RT,255,216.75,73.083,255,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,126.99,49.8,,percent of total billed charges,,
Xr Hip Rt 2 Views,,73502,CPT,Facility,Inpatient,,,RT,255,216.75,73.083,255,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Xr Hip Rt 2 Views,,73502,CPT,Facility,Both,,,RT,255,216.75,73.083,255,"Multiplan, Inc.","Multiplan, Inc.",239.7,94,,percent of total billed charges,,
Xr Hip Rt 2 Views,,73502,CPT,Facility,Outpatient,,,RT,255,216.75,73.083,255,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,229.755,90.1,,percent of total billed charges,,
Xr Hip Rt 2 Views,,73502,CPT,Facility,Inpatient,,,RT,255,216.75,73.083,255,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Xr Hip Rt 2 Views,,73502,CPT,Facility,Both,,,RT,255,216.75,73.083,255,"Preferred One Administrative Services, INC.",PPO,251.43,98.6,,percent of total billed charges,,
Xr Hip Rt 2 Views,,73502,CPT,Facility,Outpatient,,,RT,255,216.75,73.083,255,PrimeWest Health,Minnesota Senior Health Options (MSHO),131.1975,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Xr Hip Rt 2 Views,,73502,CPT,Facility,Inpatient,,,RT,255,216.75,73.083,255,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Hip Rt 2 Views,,73502,CPT,Facility,Outpatient,,,RT,255,216.75,73.083,255,PrimeWest Health,MinnesotaCare,130.968,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Xr Hip Rt 2 Views,,73502,CPT,Facility,Inpatient,,,RT,255,216.75,73.083,255,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Xr Hip Rt 2 Views,,73502,CPT,Facility,Both,,,RT,255,216.75,73.083,255,Sanford Health Plan,Sanford Health Plan,234.6,92,,percent of total billed charges,,
Xr Hip Rt 2 Views,,73502,CPT,Facility,Outpatient,,,RT,255,216.75,73.083,255,"UCare Health, Inc.",Individual & Family Plan,143.6925,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Xr Hip Rt 2 Views,,73502,CPT,Facility,Inpatient,,,RT,255,216.75,73.083,255,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Xr Hip Rt 2 Views,,73502,CPT,Facility,Outpatient,,,RT,255,216.75,73.083,255,"UCare Health, Inc.",Medical Assistance,128.6985,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Hip Rt 2 Views,,73502,CPT,Facility,Inpatient,,,RT,255,216.75,73.083,255,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Xr Hip Rt 2 Views,,73502,CPT,Facility,Outpatient,,,RT,255,216.75,73.083,255,"UCare Health, Inc.",Medicare Advantage,128.6985,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Hip Rt 2 Views,,73502,CPT,Facility,Inpatient,,,RT,255,216.75,73.083,255,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Hip Rt 2 Views,,73502,CPT,Facility,Outpatient,,,RT,255,216.75,73.083,255,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),128.6985,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Hip Rt 2 Views,,73502,CPT,Facility,Inpatient,,,RT,255,216.75,73.083,255,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Hip Rt 2 Views,,73502,CPT,Facility,Both,,,RT,255,216.75,73.083,255,UnitedHealthcare,Individual & Family,239.7,94,,percent of total billed charges,,
Xr Hip Rt 2 Views,,73502,CPT,Facility,Outpatient,,,RT,255,216.75,73.083,255,UnitedHealthcare,Medicare Advantage,124.95,49,,percent of total billed charges,,
Xr Hip Rt 2 Views,,73502,CPT,Facility,Inpatient,,,RT,255,216.75,73.083,255,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Xr Hip Rt 2 Views,,73502,CPT,Facility,Outpatient,,,RT,255,216.75,73.083,255,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,122.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
Xr Hip Rt 2 Views,,73502,CPT,Facility,Inpatient,,,RT,255,216.75,73.083,255,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Xr Femur 1 View Rt,,73551,CPT,Facility,Both,,,RT,250,212.5,71.65,250,Aetna,Commercial,230,92,,percent of total billed charges,,
Xr Femur 1 View Rt,,73551,CPT,Facility,Outpatient,,,RT,250,212.5,71.65,250,Aetna,Medicare Advantage,122.5,49,,percent of total billed charges,,
Xr Femur 1 View Rt,,73551,CPT,Facility,Inpatient,,,RT,250,212.5,71.65,250,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Xr Femur 1 View Rt,,73551,CPT,Facility,Both,,,RT,250,212.5,71.65,250,Aetna,PPO,232.5,93,,percent of total billed charges,,
Xr Femur 1 View Rt,,73551,CPT,Facility,Both,,,RT,250,212.5,71.65,250,America's PPO,America's PPO,240.075,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Xr Femur 1 View Rt,,73551,CPT,Facility,Both,,,RT,250,212.5,71.65,250,BlueCross BlueShield Minnesota, Federal Employee Program,246,98.4,,percent of total billed charges,,
Xr Femur 1 View Rt,,73551,CPT,Facility,Both,,,RT,250,212.5,71.65,250,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,250,100,,percent of total billed charges,,
Xr Femur 1 View Rt,,73551,CPT,Facility,Both,,,RT,250,212.5,71.65,250,BlueCross BlueShield Minnesota,High Value Network Plan,225,90,,percent of total billed charges,,
Xr Femur 1 View Rt,,73551,CPT,Facility,Outpatient,,,RT,250,212.5,71.65,250,BlueCross BlueShield Minnesota,Medicare Advantage,122.5,49,,percent of total billed charges,,
Xr Femur 1 View Rt,,73551,CPT,Facility,Inpatient,,,RT,250,212.5,71.65,250,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Xr Femur 1 View Rt,,73551,CPT,Facility,Both,,,RT,250,212.5,71.65,250,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,221.425,88.57,,percent of total billed charges,,
Xr Femur 1 View Rt,,73551,CPT,Facility,Both,,,RT,250,212.5,71.65,250,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,71.65,28.66,,percent of total billed charges,,
Xr Femur 1 View Rt,,73551,CPT,Facility,Outpatient,,,RT,250,212.5,71.65,250,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),122.5,49,,percent of total billed charges,,
Xr Femur 1 View Rt,,73551,CPT,Facility,Inpatient,,,RT,250,212.5,71.65,250,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Xr Femur 1 View Rt,,73551,CPT,Facility,Both,,,RT,250,212.5,71.65,250,CorVel,Worker's Compensation,250,100,,percent of total billed charges,,
Xr Femur 1 View Rt,,73551,CPT,Facility,Both,,,RT,250,212.5,71.65,250,First Health Group Corporation,First Health Network,242.5,97,,percent of total billed charges,,
Xr Femur 1 View Rt,,73551,CPT,Facility,Both,,,RT,250,212.5,71.65,250,"Health Partners, Inc.",Commercial,236.5,94.6,,percent of total billed charges,,
Xr Femur 1 View Rt,,73551,CPT,Facility,Outpatient,,,RT,250,212.5,71.65,250,"Health Partners, Inc.",Medicare Advantage,122.5,49,,percent of total billed charges,,
Xr Femur 1 View Rt,,73551,CPT,Facility,Inpatient,,,RT,250,212.5,71.65,250,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Femur 1 View Rt,,73551,CPT,Facility,Both,,,RT,250,212.5,71.65,250,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),150,60,,percent of total billed charges,,
Xr Femur 1 View Rt,,73551,CPT,Facility,Both,,,RT,250,212.5,71.65,250,"Health Partners, Inc.",State of Minnesota Advantage Program,203.75,81.5,,percent of total billed charges,,
Xr Femur 1 View Rt,,73551,CPT,Facility,Both,,,RT,250,212.5,71.65,250,"Health Partners, Inc.",State Public Programs,125,50,,percent of total billed charges,,
Xr Femur 1 View Rt,,73551,CPT,Facility,Both,,,RT,250,212.5,71.65,250,Humana Insurance Company,Commercial PPO,237.5,95,,percent of total billed charges,,
Xr Femur 1 View Rt,,73551,CPT,Facility,Outpatient,,,RT,250,212.5,71.65,250,Humana Insurance Company,Medicare PPO,122.5,49,,percent of total billed charges,,
Xr Femur 1 View Rt,,73551,CPT,Facility,Inpatient,,,RT,250,212.5,71.65,250,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Xr Femur 1 View Rt,,73551,CPT,Facility,Both,,,RT,250,212.5,71.65,250,Medica,Individual & Family,247.75,99.1,,percent of total billed charges,,
Xr Femur 1 View Rt,,73551,CPT,Facility,Outpatient,,,RT,250,212.5,71.65,250,Medica,Medica Advantage Solution,124.5,49.8,,percent of total billed charges,,
Xr Femur 1 View Rt,,73551,CPT,Facility,Inpatient,,,RT,250,212.5,71.65,250,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Xr Femur 1 View Rt,,73551,CPT,Facility,Outpatient,,,RT,250,212.5,71.65,250,Medica,Medical Assistance,111.5,44.6,,percent of total billed charges,,
Xr Femur 1 View Rt,,73551,CPT,Facility,Inpatient,,,RT,250,212.5,71.65,250,Medica,Medical Assistance,,,,,Included in per diem rate,
Xr Femur 1 View Rt,,73551,CPT,Facility,Outpatient,,,RT,250,212.5,71.65,250,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,124.5,49.8,,percent of total billed charges,,
Xr Femur 1 View Rt,,73551,CPT,Facility,Inpatient,,,RT,250,212.5,71.65,250,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Xr Femur 1 View Rt,,73551,CPT,Facility,Both,,,RT,250,212.5,71.65,250,"Multiplan, Inc.","Multiplan, Inc.",235,94,,percent of total billed charges,,
Xr Femur 1 View Rt,,73551,CPT,Facility,Outpatient,,,RT,250,212.5,71.65,250,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,225.25,90.1,,percent of total billed charges,,
Xr Femur 1 View Rt,,73551,CPT,Facility,Inpatient,,,RT,250,212.5,71.65,250,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Xr Femur 1 View Rt,,73551,CPT,Facility,Both,,,RT,250,212.5,71.65,250,"Preferred One Administrative Services, INC.",PPO,246.5,98.6,,percent of total billed charges,,
Xr Femur 1 View Rt,,73551,CPT,Facility,Outpatient,,,RT,250,212.5,71.65,250,PrimeWest Health,Minnesota Senior Health Options (MSHO),128.625,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Xr Femur 1 View Rt,,73551,CPT,Facility,Inpatient,,,RT,250,212.5,71.65,250,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Femur 1 View Rt,,73551,CPT,Facility,Outpatient,,,RT,250,212.5,71.65,250,PrimeWest Health,MinnesotaCare,128.4,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Xr Femur 1 View Rt,,73551,CPT,Facility,Inpatient,,,RT,250,212.5,71.65,250,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Xr Femur 1 View Rt,,73551,CPT,Facility,Both,,,RT,250,212.5,71.65,250,Sanford Health Plan,Sanford Health Plan,230,92,,percent of total billed charges,,
Xr Femur 1 View Rt,,73551,CPT,Facility,Outpatient,,,RT,250,212.5,71.65,250,"UCare Health, Inc.",Individual & Family Plan,140.875,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Xr Femur 1 View Rt,,73551,CPT,Facility,Inpatient,,,RT,250,212.5,71.65,250,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Xr Femur 1 View Rt,,73551,CPT,Facility,Outpatient,,,RT,250,212.5,71.65,250,"UCare Health, Inc.",Medical Assistance,126.175,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Femur 1 View Rt,,73551,CPT,Facility,Inpatient,,,RT,250,212.5,71.65,250,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Xr Femur 1 View Rt,,73551,CPT,Facility,Outpatient,,,RT,250,212.5,71.65,250,"UCare Health, Inc.",Medicare Advantage,126.175,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Femur 1 View Rt,,73551,CPT,Facility,Inpatient,,,RT,250,212.5,71.65,250,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Femur 1 View Rt,,73551,CPT,Facility,Outpatient,,,RT,250,212.5,71.65,250,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),126.175,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Femur 1 View Rt,,73551,CPT,Facility,Inpatient,,,RT,250,212.5,71.65,250,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Femur 1 View Rt,,73551,CPT,Facility,Both,,,RT,250,212.5,71.65,250,UnitedHealthcare,Individual & Family,235,94,,percent of total billed charges,,
Xr Femur 1 View Rt,,73551,CPT,Facility,Outpatient,,,RT,250,212.5,71.65,250,UnitedHealthcare,Medicare Advantage,122.5,49,,percent of total billed charges,,
Xr Femur 1 View Rt,,73551,CPT,Facility,Inpatient,,,RT,250,212.5,71.65,250,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Xr Femur 1 View Rt,,73551,CPT,Facility,Outpatient,,,RT,250,212.5,71.65,250,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,120,48,,percent of total billed charges,,100% of DHS outpatient percentage
Xr Femur 1 View Rt,,73551,CPT,Facility,Inpatient,,,RT,250,212.5,71.65,250,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Xr Femur Rt 2 Views,,73552,CPT,Facility,Both,,,RT,270,229.5,77.382,270,Aetna,Commercial,248.4,92,,percent of total billed charges,,
Xr Femur Rt 2 Views,,73552,CPT,Facility,Outpatient,,,RT,270,229.5,77.382,270,Aetna,Medicare Advantage,132.3,49,,percent of total billed charges,,
Xr Femur Rt 2 Views,,73552,CPT,Facility,Inpatient,,,RT,270,229.5,77.382,270,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Xr Femur Rt 2 Views,,73552,CPT,Facility,Both,,,RT,270,229.5,77.382,270,Aetna,PPO,251.1,93,,percent of total billed charges,,
Xr Femur Rt 2 Views,,73552,CPT,Facility,Both,,,RT,270,229.5,77.382,270,America's PPO,America's PPO,259.281,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Xr Femur Rt 2 Views,,73552,CPT,Facility,Both,,,RT,270,229.5,77.382,270,BlueCross BlueShield Minnesota, Federal Employee Program,265.68,98.4,,percent of total billed charges,,
Xr Femur Rt 2 Views,,73552,CPT,Facility,Both,,,RT,270,229.5,77.382,270,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,270,100,,percent of total billed charges,,
Xr Femur Rt 2 Views,,73552,CPT,Facility,Both,,,RT,270,229.5,77.382,270,BlueCross BlueShield Minnesota,High Value Network Plan,243,90,,percent of total billed charges,,
Xr Femur Rt 2 Views,,73552,CPT,Facility,Outpatient,,,RT,270,229.5,77.382,270,BlueCross BlueShield Minnesota,Medicare Advantage,132.3,49,,percent of total billed charges,,
Xr Femur Rt 2 Views,,73552,CPT,Facility,Inpatient,,,RT,270,229.5,77.382,270,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Xr Femur Rt 2 Views,,73552,CPT,Facility,Both,,,RT,270,229.5,77.382,270,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,239.139,88.57,,percent of total billed charges,,
Xr Femur Rt 2 Views,,73552,CPT,Facility,Both,,,RT,270,229.5,77.382,270,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,77.382,28.66,,percent of total billed charges,,
Xr Femur Rt 2 Views,,73552,CPT,Facility,Outpatient,,,RT,270,229.5,77.382,270,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),132.3,49,,percent of total billed charges,,
Xr Femur Rt 2 Views,,73552,CPT,Facility,Inpatient,,,RT,270,229.5,77.382,270,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Xr Femur Rt 2 Views,,73552,CPT,Facility,Both,,,RT,270,229.5,77.382,270,CorVel,Worker's Compensation,270,100,,percent of total billed charges,,
Xr Femur Rt 2 Views,,73552,CPT,Facility,Both,,,RT,270,229.5,77.382,270,First Health Group Corporation,First Health Network,261.9,97,,percent of total billed charges,,
Xr Femur Rt 2 Views,,73552,CPT,Facility,Both,,,RT,270,229.5,77.382,270,"Health Partners, Inc.",Commercial,255.42,94.6,,percent of total billed charges,,
Xr Femur Rt 2 Views,,73552,CPT,Facility,Outpatient,,,RT,270,229.5,77.382,270,"Health Partners, Inc.",Medicare Advantage,132.3,49,,percent of total billed charges,,
Xr Femur Rt 2 Views,,73552,CPT,Facility,Inpatient,,,RT,270,229.5,77.382,270,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Femur Rt 2 Views,,73552,CPT,Facility,Both,,,RT,270,229.5,77.382,270,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),162,60,,percent of total billed charges,,
Xr Femur Rt 2 Views,,73552,CPT,Facility,Both,,,RT,270,229.5,77.382,270,"Health Partners, Inc.",State of Minnesota Advantage Program,220.05,81.5,,percent of total billed charges,,
Xr Femur Rt 2 Views,,73552,CPT,Facility,Both,,,RT,270,229.5,77.382,270,"Health Partners, Inc.",State Public Programs,135,50,,percent of total billed charges,,
Xr Femur Rt 2 Views,,73552,CPT,Facility,Both,,,RT,270,229.5,77.382,270,Humana Insurance Company,Commercial PPO,256.5,95,,percent of total billed charges,,
Xr Femur Rt 2 Views,,73552,CPT,Facility,Outpatient,,,RT,270,229.5,77.382,270,Humana Insurance Company,Medicare PPO,132.3,49,,percent of total billed charges,,
Xr Femur Rt 2 Views,,73552,CPT,Facility,Inpatient,,,RT,270,229.5,77.382,270,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Xr Femur Rt 2 Views,,73552,CPT,Facility,Both,,,RT,270,229.5,77.382,270,Medica,Individual & Family,267.57,99.1,,percent of total billed charges,,
Xr Femur Rt 2 Views,,73552,CPT,Facility,Outpatient,,,RT,270,229.5,77.382,270,Medica,Medica Advantage Solution,134.46,49.8,,percent of total billed charges,,
Xr Femur Rt 2 Views,,73552,CPT,Facility,Inpatient,,,RT,270,229.5,77.382,270,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Xr Femur Rt 2 Views,,73552,CPT,Facility,Outpatient,,,RT,270,229.5,77.382,270,Medica,Medical Assistance,120.42,44.6,,percent of total billed charges,,
Xr Femur Rt 2 Views,,73552,CPT,Facility,Inpatient,,,RT,270,229.5,77.382,270,Medica,Medical Assistance,,,,,Included in per diem rate,
Xr Femur Rt 2 Views,,73552,CPT,Facility,Outpatient,,,RT,270,229.5,77.382,270,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,134.46,49.8,,percent of total billed charges,,
Xr Femur Rt 2 Views,,73552,CPT,Facility,Inpatient,,,RT,270,229.5,77.382,270,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Xr Femur Rt 2 Views,,73552,CPT,Facility,Both,,,RT,270,229.5,77.382,270,"Multiplan, Inc.","Multiplan, Inc.",253.8,94,,percent of total billed charges,,
Xr Femur Rt 2 Views,,73552,CPT,Facility,Outpatient,,,RT,270,229.5,77.382,270,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,243.27,90.1,,percent of total billed charges,,
Xr Femur Rt 2 Views,,73552,CPT,Facility,Inpatient,,,RT,270,229.5,77.382,270,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Xr Femur Rt 2 Views,,73552,CPT,Facility,Both,,,RT,270,229.5,77.382,270,"Preferred One Administrative Services, INC.",PPO,266.22,98.6,,percent of total billed charges,,
Xr Femur Rt 2 Views,,73552,CPT,Facility,Outpatient,,,RT,270,229.5,77.382,270,PrimeWest Health,Minnesota Senior Health Options (MSHO),138.915,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Xr Femur Rt 2 Views,,73552,CPT,Facility,Inpatient,,,RT,270,229.5,77.382,270,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Femur Rt 2 Views,,73552,CPT,Facility,Outpatient,,,RT,270,229.5,77.382,270,PrimeWest Health,MinnesotaCare,138.672,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Xr Femur Rt 2 Views,,73552,CPT,Facility,Inpatient,,,RT,270,229.5,77.382,270,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Xr Femur Rt 2 Views,,73552,CPT,Facility,Both,,,RT,270,229.5,77.382,270,Sanford Health Plan,Sanford Health Plan,248.4,92,,percent of total billed charges,,
Xr Femur Rt 2 Views,,73552,CPT,Facility,Outpatient,,,RT,270,229.5,77.382,270,"UCare Health, Inc.",Individual & Family Plan,152.145,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Xr Femur Rt 2 Views,,73552,CPT,Facility,Inpatient,,,RT,270,229.5,77.382,270,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Xr Femur Rt 2 Views,,73552,CPT,Facility,Outpatient,,,RT,270,229.5,77.382,270,"UCare Health, Inc.",Medical Assistance,136.269,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Femur Rt 2 Views,,73552,CPT,Facility,Inpatient,,,RT,270,229.5,77.382,270,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Xr Femur Rt 2 Views,,73552,CPT,Facility,Outpatient,,,RT,270,229.5,77.382,270,"UCare Health, Inc.",Medicare Advantage,136.269,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Femur Rt 2 Views,,73552,CPT,Facility,Inpatient,,,RT,270,229.5,77.382,270,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Femur Rt 2 Views,,73552,CPT,Facility,Outpatient,,,RT,270,229.5,77.382,270,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),136.269,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Femur Rt 2 Views,,73552,CPT,Facility,Inpatient,,,RT,270,229.5,77.382,270,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Femur Rt 2 Views,,73552,CPT,Facility,Both,,,RT,270,229.5,77.382,270,UnitedHealthcare,Individual & Family,253.8,94,,percent of total billed charges,,
Xr Femur Rt 2 Views,,73552,CPT,Facility,Outpatient,,,RT,270,229.5,77.382,270,UnitedHealthcare,Medicare Advantage,132.3,49,,percent of total billed charges,,
Xr Femur Rt 2 Views,,73552,CPT,Facility,Inpatient,,,RT,270,229.5,77.382,270,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Xr Femur Rt 2 Views,,73552,CPT,Facility,Outpatient,,,RT,270,229.5,77.382,270,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,129.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
Xr Femur Rt 2 Views,,73552,CPT,Facility,Inpatient,,,RT,270,229.5,77.382,270,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Xr Knee Routine Rt 2 Views,,73560,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,Aetna,Commercial,237.36,92,,percent of total billed charges,,
Xr Knee Routine Rt 2 Views,,73560,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,Aetna,Medicare Advantage,126.42,49,,percent of total billed charges,,
Xr Knee Routine Rt 2 Views,,73560,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Xr Knee Routine Rt 2 Views,,73560,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,Aetna,PPO,239.94,93,,percent of total billed charges,,
Xr Knee Routine Rt 2 Views,,73560,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,America's PPO,America's PPO,247.7574,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Xr Knee Routine Rt 2 Views,,73560,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota, Federal Employee Program,253.872,98.4,,percent of total billed charges,,
Xr Knee Routine Rt 2 Views,,73560,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,258,100,,percent of total billed charges,,
Xr Knee Routine Rt 2 Views,,73560,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,High Value Network Plan,232.2,90,,percent of total billed charges,,
Xr Knee Routine Rt 2 Views,,73560,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,Medicare Advantage,126.42,49,,percent of total billed charges,,
Xr Knee Routine Rt 2 Views,,73560,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Xr Knee Routine Rt 2 Views,,73560,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,228.5106,88.57,,percent of total billed charges,,
Xr Knee Routine Rt 2 Views,,73560,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,73.9428,28.66,,percent of total billed charges,,
Xr Knee Routine Rt 2 Views,,73560,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),126.42,49,,percent of total billed charges,,
Xr Knee Routine Rt 2 Views,,73560,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Xr Knee Routine Rt 2 Views,,73560,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,CorVel,Worker's Compensation,258,100,,percent of total billed charges,,
Xr Knee Routine Rt 2 Views,,73560,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,First Health Group Corporation,First Health Network,250.26,97,,percent of total billed charges,,
Xr Knee Routine Rt 2 Views,,73560,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,"Health Partners, Inc.",Commercial,244.068,94.6,,percent of total billed charges,,
Xr Knee Routine Rt 2 Views,,73560,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,"Health Partners, Inc.",Medicare Advantage,126.42,49,,percent of total billed charges,,
Xr Knee Routine Rt 2 Views,,73560,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Knee Routine Rt 2 Views,,73560,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),154.8,60,,percent of total billed charges,,
Xr Knee Routine Rt 2 Views,,73560,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,"Health Partners, Inc.",State of Minnesota Advantage Program,210.27,81.5,,percent of total billed charges,,
Xr Knee Routine Rt 2 Views,,73560,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,"Health Partners, Inc.",State Public Programs,129,50,,percent of total billed charges,,
Xr Knee Routine Rt 2 Views,,73560,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,Humana Insurance Company,Commercial PPO,245.1,95,,percent of total billed charges,,
Xr Knee Routine Rt 2 Views,,73560,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,Humana Insurance Company,Medicare PPO,126.42,49,,percent of total billed charges,,
Xr Knee Routine Rt 2 Views,,73560,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Xr Knee Routine Rt 2 Views,,73560,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,Medica,Individual & Family,255.678,99.1,,percent of total billed charges,,
Xr Knee Routine Rt 2 Views,,73560,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,Medica,Medica Advantage Solution,128.484,49.8,,percent of total billed charges,,
Xr Knee Routine Rt 2 Views,,73560,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Xr Knee Routine Rt 2 Views,,73560,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,Medica,Medical Assistance,115.068,44.6,,percent of total billed charges,,
Xr Knee Routine Rt 2 Views,,73560,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,Medica,Medical Assistance,,,,,Included in per diem rate,
Xr Knee Routine Rt 2 Views,,73560,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,128.484,49.8,,percent of total billed charges,,
Xr Knee Routine Rt 2 Views,,73560,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Xr Knee Routine Rt 2 Views,,73560,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,"Multiplan, Inc.","Multiplan, Inc.",242.52,94,,percent of total billed charges,,
Xr Knee Routine Rt 2 Views,,73560,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,232.458,90.1,,percent of total billed charges,,
Xr Knee Routine Rt 2 Views,,73560,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Xr Knee Routine Rt 2 Views,,73560,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,"Preferred One Administrative Services, INC.",PPO,254.388,98.6,,percent of total billed charges,,
Xr Knee Routine Rt 2 Views,,73560,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,PrimeWest Health,Minnesota Senior Health Options (MSHO),132.741,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Xr Knee Routine Rt 2 Views,,73560,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Knee Routine Rt 2 Views,,73560,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,PrimeWest Health,MinnesotaCare,132.5088,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Xr Knee Routine Rt 2 Views,,73560,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Xr Knee Routine Rt 2 Views,,73560,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,Sanford Health Plan,Sanford Health Plan,237.36,92,,percent of total billed charges,,
Xr Knee Routine Rt 2 Views,,73560,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,"UCare Health, Inc.",Individual & Family Plan,145.383,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Xr Knee Routine Rt 2 Views,,73560,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Xr Knee Routine Rt 2 Views,,73560,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,"UCare Health, Inc.",Medical Assistance,130.2126,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Knee Routine Rt 2 Views,,73560,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Xr Knee Routine Rt 2 Views,,73560,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,"UCare Health, Inc.",Medicare Advantage,130.2126,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Knee Routine Rt 2 Views,,73560,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Knee Routine Rt 2 Views,,73560,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),130.2126,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Knee Routine Rt 2 Views,,73560,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Knee Routine Rt 2 Views,,73560,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,UnitedHealthcare,Individual & Family,242.52,94,,percent of total billed charges,,
Xr Knee Routine Rt 2 Views,,73560,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,UnitedHealthcare,Medicare Advantage,126.42,49,,percent of total billed charges,,
Xr Knee Routine Rt 2 Views,,73560,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Xr Knee Routine Rt 2 Views,,73560,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,123.84,48,,percent of total billed charges,,100% of DHS outpatient percentage
Xr Knee Routine Rt 2 Views,,73560,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Xr Knee Rt One View,,73560,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,Aetna,Commercial,237.36,92,,percent of total billed charges,,
Xr Knee Rt One View,,73560,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,Aetna,Medicare Advantage,126.42,49,,percent of total billed charges,,
Xr Knee Rt One View,,73560,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Xr Knee Rt One View,,73560,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,Aetna,PPO,239.94,93,,percent of total billed charges,,
Xr Knee Rt One View,,73560,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,America's PPO,America's PPO,247.7574,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Xr Knee Rt One View,,73560,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota, Federal Employee Program,253.872,98.4,,percent of total billed charges,,
Xr Knee Rt One View,,73560,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,258,100,,percent of total billed charges,,
Xr Knee Rt One View,,73560,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,High Value Network Plan,232.2,90,,percent of total billed charges,,
Xr Knee Rt One View,,73560,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,Medicare Advantage,126.42,49,,percent of total billed charges,,
Xr Knee Rt One View,,73560,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Xr Knee Rt One View,,73560,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,228.5106,88.57,,percent of total billed charges,,
Xr Knee Rt One View,,73560,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,73.9428,28.66,,percent of total billed charges,,
Xr Knee Rt One View,,73560,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),126.42,49,,percent of total billed charges,,
Xr Knee Rt One View,,73560,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Xr Knee Rt One View,,73560,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,CorVel,Worker's Compensation,258,100,,percent of total billed charges,,
Xr Knee Rt One View,,73560,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,First Health Group Corporation,First Health Network,250.26,97,,percent of total billed charges,,
Xr Knee Rt One View,,73560,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,"Health Partners, Inc.",Commercial,244.068,94.6,,percent of total billed charges,,
Xr Knee Rt One View,,73560,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,"Health Partners, Inc.",Medicare Advantage,126.42,49,,percent of total billed charges,,
Xr Knee Rt One View,,73560,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Knee Rt One View,,73560,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),154.8,60,,percent of total billed charges,,
Xr Knee Rt One View,,73560,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,"Health Partners, Inc.",State of Minnesota Advantage Program,210.27,81.5,,percent of total billed charges,,
Xr Knee Rt One View,,73560,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,"Health Partners, Inc.",State Public Programs,129,50,,percent of total billed charges,,
Xr Knee Rt One View,,73560,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,Humana Insurance Company,Commercial PPO,245.1,95,,percent of total billed charges,,
Xr Knee Rt One View,,73560,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,Humana Insurance Company,Medicare PPO,126.42,49,,percent of total billed charges,,
Xr Knee Rt One View,,73560,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Xr Knee Rt One View,,73560,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,Medica,Individual & Family,255.678,99.1,,percent of total billed charges,,
Xr Knee Rt One View,,73560,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,Medica,Medica Advantage Solution,128.484,49.8,,percent of total billed charges,,
Xr Knee Rt One View,,73560,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Xr Knee Rt One View,,73560,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,Medica,Medical Assistance,115.068,44.6,,percent of total billed charges,,
Xr Knee Rt One View,,73560,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,Medica,Medical Assistance,,,,,Included in per diem rate,
Xr Knee Rt One View,,73560,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,128.484,49.8,,percent of total billed charges,,
Xr Knee Rt One View,,73560,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Xr Knee Rt One View,,73560,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,"Multiplan, Inc.","Multiplan, Inc.",242.52,94,,percent of total billed charges,,
Xr Knee Rt One View,,73560,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,232.458,90.1,,percent of total billed charges,,
Xr Knee Rt One View,,73560,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Xr Knee Rt One View,,73560,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,"Preferred One Administrative Services, INC.",PPO,254.388,98.6,,percent of total billed charges,,
Xr Knee Rt One View,,73560,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,PrimeWest Health,Minnesota Senior Health Options (MSHO),132.741,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Xr Knee Rt One View,,73560,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Knee Rt One View,,73560,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,PrimeWest Health,MinnesotaCare,132.5088,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Xr Knee Rt One View,,73560,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Xr Knee Rt One View,,73560,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,Sanford Health Plan,Sanford Health Plan,237.36,92,,percent of total billed charges,,
Xr Knee Rt One View,,73560,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,"UCare Health, Inc.",Individual & Family Plan,145.383,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Xr Knee Rt One View,,73560,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Xr Knee Rt One View,,73560,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,"UCare Health, Inc.",Medical Assistance,130.2126,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Knee Rt One View,,73560,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Xr Knee Rt One View,,73560,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,"UCare Health, Inc.",Medicare Advantage,130.2126,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Knee Rt One View,,73560,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Knee Rt One View,,73560,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),130.2126,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Knee Rt One View,,73560,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Knee Rt One View,,73560,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,UnitedHealthcare,Individual & Family,242.52,94,,percent of total billed charges,,
Xr Knee Rt One View,,73560,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,UnitedHealthcare,Medicare Advantage,126.42,49,,percent of total billed charges,,
Xr Knee Rt One View,,73560,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Xr Knee Rt One View,,73560,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,123.84,48,,percent of total billed charges,,100% of DHS outpatient percentage
Xr Knee Rt One View,,73560,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Xr Patella Routine Rt 2 View,,73560,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,Aetna,Commercial,237.36,92,,percent of total billed charges,,
Xr Patella Routine Rt 2 View,,73560,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,Aetna,Medicare Advantage,126.42,49,,percent of total billed charges,,
Xr Patella Routine Rt 2 View,,73560,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Xr Patella Routine Rt 2 View,,73560,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,Aetna,PPO,239.94,93,,percent of total billed charges,,
Xr Patella Routine Rt 2 View,,73560,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,America's PPO,America's PPO,247.7574,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Xr Patella Routine Rt 2 View,,73560,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota, Federal Employee Program,253.872,98.4,,percent of total billed charges,,
Xr Patella Routine Rt 2 View,,73560,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,258,100,,percent of total billed charges,,
Xr Patella Routine Rt 2 View,,73560,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,High Value Network Plan,232.2,90,,percent of total billed charges,,
Xr Patella Routine Rt 2 View,,73560,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,Medicare Advantage,126.42,49,,percent of total billed charges,,
Xr Patella Routine Rt 2 View,,73560,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Xr Patella Routine Rt 2 View,,73560,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,228.5106,88.57,,percent of total billed charges,,
Xr Patella Routine Rt 2 View,,73560,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,73.9428,28.66,,percent of total billed charges,,
Xr Patella Routine Rt 2 View,,73560,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),126.42,49,,percent of total billed charges,,
Xr Patella Routine Rt 2 View,,73560,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Xr Patella Routine Rt 2 View,,73560,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,CorVel,Worker's Compensation,258,100,,percent of total billed charges,,
Xr Patella Routine Rt 2 View,,73560,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,First Health Group Corporation,First Health Network,250.26,97,,percent of total billed charges,,
Xr Patella Routine Rt 2 View,,73560,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,"Health Partners, Inc.",Commercial,244.068,94.6,,percent of total billed charges,,
Xr Patella Routine Rt 2 View,,73560,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,"Health Partners, Inc.",Medicare Advantage,126.42,49,,percent of total billed charges,,
Xr Patella Routine Rt 2 View,,73560,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Patella Routine Rt 2 View,,73560,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),154.8,60,,percent of total billed charges,,
Xr Patella Routine Rt 2 View,,73560,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,"Health Partners, Inc.",State of Minnesota Advantage Program,210.27,81.5,,percent of total billed charges,,
Xr Patella Routine Rt 2 View,,73560,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,"Health Partners, Inc.",State Public Programs,129,50,,percent of total billed charges,,
Xr Patella Routine Rt 2 View,,73560,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,Humana Insurance Company,Commercial PPO,245.1,95,,percent of total billed charges,,
Xr Patella Routine Rt 2 View,,73560,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,Humana Insurance Company,Medicare PPO,126.42,49,,percent of total billed charges,,
Xr Patella Routine Rt 2 View,,73560,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Xr Patella Routine Rt 2 View,,73560,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,Medica,Individual & Family,255.678,99.1,,percent of total billed charges,,
Xr Patella Routine Rt 2 View,,73560,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,Medica,Medica Advantage Solution,128.484,49.8,,percent of total billed charges,,
Xr Patella Routine Rt 2 View,,73560,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Xr Patella Routine Rt 2 View,,73560,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,Medica,Medical Assistance,115.068,44.6,,percent of total billed charges,,
Xr Patella Routine Rt 2 View,,73560,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,Medica,Medical Assistance,,,,,Included in per diem rate,
Xr Patella Routine Rt 2 View,,73560,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,128.484,49.8,,percent of total billed charges,,
Xr Patella Routine Rt 2 View,,73560,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Xr Patella Routine Rt 2 View,,73560,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,"Multiplan, Inc.","Multiplan, Inc.",242.52,94,,percent of total billed charges,,
Xr Patella Routine Rt 2 View,,73560,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,232.458,90.1,,percent of total billed charges,,
Xr Patella Routine Rt 2 View,,73560,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Xr Patella Routine Rt 2 View,,73560,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,"Preferred One Administrative Services, INC.",PPO,254.388,98.6,,percent of total billed charges,,
Xr Patella Routine Rt 2 View,,73560,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,PrimeWest Health,Minnesota Senior Health Options (MSHO),132.741,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Xr Patella Routine Rt 2 View,,73560,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Patella Routine Rt 2 View,,73560,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,PrimeWest Health,MinnesotaCare,132.5088,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Xr Patella Routine Rt 2 View,,73560,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Xr Patella Routine Rt 2 View,,73560,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,Sanford Health Plan,Sanford Health Plan,237.36,92,,percent of total billed charges,,
Xr Patella Routine Rt 2 View,,73560,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,"UCare Health, Inc.",Individual & Family Plan,145.383,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Xr Patella Routine Rt 2 View,,73560,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Xr Patella Routine Rt 2 View,,73560,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,"UCare Health, Inc.",Medical Assistance,130.2126,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Patella Routine Rt 2 View,,73560,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Xr Patella Routine Rt 2 View,,73560,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,"UCare Health, Inc.",Medicare Advantage,130.2126,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Patella Routine Rt 2 View,,73560,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Patella Routine Rt 2 View,,73560,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),130.2126,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Patella Routine Rt 2 View,,73560,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Patella Routine Rt 2 View,,73560,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,UnitedHealthcare,Individual & Family,242.52,94,,percent of total billed charges,,
Xr Patella Routine Rt 2 View,,73560,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,UnitedHealthcare,Medicare Advantage,126.42,49,,percent of total billed charges,,
Xr Patella Routine Rt 2 View,,73560,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Xr Patella Routine Rt 2 View,,73560,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,123.84,48,,percent of total billed charges,,100% of DHS outpatient percentage
Xr Patella Routine Rt 2 View,,73560,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Xr Knee And Patella Rt,,73562,CPT,Facility,Both,,,RT,270,229.5,77.382,270,Aetna,Commercial,248.4,92,,percent of total billed charges,,
Xr Knee And Patella Rt,,73562,CPT,Facility,Outpatient,,,RT,270,229.5,77.382,270,Aetna,Medicare Advantage,132.3,49,,percent of total billed charges,,
Xr Knee And Patella Rt,,73562,CPT,Facility,Inpatient,,,RT,270,229.5,77.382,270,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Xr Knee And Patella Rt,,73562,CPT,Facility,Both,,,RT,270,229.5,77.382,270,Aetna,PPO,251.1,93,,percent of total billed charges,,
Xr Knee And Patella Rt,,73562,CPT,Facility,Both,,,RT,270,229.5,77.382,270,America's PPO,America's PPO,259.281,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Xr Knee And Patella Rt,,73562,CPT,Facility,Both,,,RT,270,229.5,77.382,270,BlueCross BlueShield Minnesota, Federal Employee Program,265.68,98.4,,percent of total billed charges,,
Xr Knee And Patella Rt,,73562,CPT,Facility,Both,,,RT,270,229.5,77.382,270,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,270,100,,percent of total billed charges,,
Xr Knee And Patella Rt,,73562,CPT,Facility,Both,,,RT,270,229.5,77.382,270,BlueCross BlueShield Minnesota,High Value Network Plan,243,90,,percent of total billed charges,,
Xr Knee And Patella Rt,,73562,CPT,Facility,Outpatient,,,RT,270,229.5,77.382,270,BlueCross BlueShield Minnesota,Medicare Advantage,132.3,49,,percent of total billed charges,,
Xr Knee And Patella Rt,,73562,CPT,Facility,Inpatient,,,RT,270,229.5,77.382,270,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Xr Knee And Patella Rt,,73562,CPT,Facility,Both,,,RT,270,229.5,77.382,270,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,239.139,88.57,,percent of total billed charges,,
Xr Knee And Patella Rt,,73562,CPT,Facility,Both,,,RT,270,229.5,77.382,270,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,77.382,28.66,,percent of total billed charges,,
Xr Knee And Patella Rt,,73562,CPT,Facility,Outpatient,,,RT,270,229.5,77.382,270,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),132.3,49,,percent of total billed charges,,
Xr Knee And Patella Rt,,73562,CPT,Facility,Inpatient,,,RT,270,229.5,77.382,270,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Xr Knee And Patella Rt,,73562,CPT,Facility,Both,,,RT,270,229.5,77.382,270,CorVel,Worker's Compensation,270,100,,percent of total billed charges,,
Xr Knee And Patella Rt,,73562,CPT,Facility,Both,,,RT,270,229.5,77.382,270,First Health Group Corporation,First Health Network,261.9,97,,percent of total billed charges,,
Xr Knee And Patella Rt,,73562,CPT,Facility,Both,,,RT,270,229.5,77.382,270,"Health Partners, Inc.",Commercial,255.42,94.6,,percent of total billed charges,,
Xr Knee And Patella Rt,,73562,CPT,Facility,Outpatient,,,RT,270,229.5,77.382,270,"Health Partners, Inc.",Medicare Advantage,132.3,49,,percent of total billed charges,,
Xr Knee And Patella Rt,,73562,CPT,Facility,Inpatient,,,RT,270,229.5,77.382,270,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Knee And Patella Rt,,73562,CPT,Facility,Both,,,RT,270,229.5,77.382,270,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),162,60,,percent of total billed charges,,
Xr Knee And Patella Rt,,73562,CPT,Facility,Both,,,RT,270,229.5,77.382,270,"Health Partners, Inc.",State of Minnesota Advantage Program,220.05,81.5,,percent of total billed charges,,
Xr Knee And Patella Rt,,73562,CPT,Facility,Both,,,RT,270,229.5,77.382,270,"Health Partners, Inc.",State Public Programs,135,50,,percent of total billed charges,,
Xr Knee And Patella Rt,,73562,CPT,Facility,Both,,,RT,270,229.5,77.382,270,Humana Insurance Company,Commercial PPO,256.5,95,,percent of total billed charges,,
Xr Knee And Patella Rt,,73562,CPT,Facility,Outpatient,,,RT,270,229.5,77.382,270,Humana Insurance Company,Medicare PPO,132.3,49,,percent of total billed charges,,
Xr Knee And Patella Rt,,73562,CPT,Facility,Inpatient,,,RT,270,229.5,77.382,270,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Xr Knee And Patella Rt,,73562,CPT,Facility,Both,,,RT,270,229.5,77.382,270,Medica,Individual & Family,267.57,99.1,,percent of total billed charges,,
Xr Knee And Patella Rt,,73562,CPT,Facility,Outpatient,,,RT,270,229.5,77.382,270,Medica,Medica Advantage Solution,134.46,49.8,,percent of total billed charges,,
Xr Knee And Patella Rt,,73562,CPT,Facility,Inpatient,,,RT,270,229.5,77.382,270,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Xr Knee And Patella Rt,,73562,CPT,Facility,Outpatient,,,RT,270,229.5,77.382,270,Medica,Medical Assistance,120.42,44.6,,percent of total billed charges,,
Xr Knee And Patella Rt,,73562,CPT,Facility,Inpatient,,,RT,270,229.5,77.382,270,Medica,Medical Assistance,,,,,Included in per diem rate,
Xr Knee And Patella Rt,,73562,CPT,Facility,Outpatient,,,RT,270,229.5,77.382,270,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,134.46,49.8,,percent of total billed charges,,
Xr Knee And Patella Rt,,73562,CPT,Facility,Inpatient,,,RT,270,229.5,77.382,270,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Xr Knee And Patella Rt,,73562,CPT,Facility,Both,,,RT,270,229.5,77.382,270,"Multiplan, Inc.","Multiplan, Inc.",253.8,94,,percent of total billed charges,,
Xr Knee And Patella Rt,,73562,CPT,Facility,Outpatient,,,RT,270,229.5,77.382,270,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,243.27,90.1,,percent of total billed charges,,
Xr Knee And Patella Rt,,73562,CPT,Facility,Inpatient,,,RT,270,229.5,77.382,270,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Xr Knee And Patella Rt,,73562,CPT,Facility,Both,,,RT,270,229.5,77.382,270,"Preferred One Administrative Services, INC.",PPO,266.22,98.6,,percent of total billed charges,,
Xr Knee And Patella Rt,,73562,CPT,Facility,Outpatient,,,RT,270,229.5,77.382,270,PrimeWest Health,Minnesota Senior Health Options (MSHO),138.915,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Xr Knee And Patella Rt,,73562,CPT,Facility,Inpatient,,,RT,270,229.5,77.382,270,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Knee And Patella Rt,,73562,CPT,Facility,Outpatient,,,RT,270,229.5,77.382,270,PrimeWest Health,MinnesotaCare,138.672,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Xr Knee And Patella Rt,,73562,CPT,Facility,Inpatient,,,RT,270,229.5,77.382,270,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Xr Knee And Patella Rt,,73562,CPT,Facility,Both,,,RT,270,229.5,77.382,270,Sanford Health Plan,Sanford Health Plan,248.4,92,,percent of total billed charges,,
Xr Knee And Patella Rt,,73562,CPT,Facility,Outpatient,,,RT,270,229.5,77.382,270,"UCare Health, Inc.",Individual & Family Plan,152.145,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Xr Knee And Patella Rt,,73562,CPT,Facility,Inpatient,,,RT,270,229.5,77.382,270,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Xr Knee And Patella Rt,,73562,CPT,Facility,Outpatient,,,RT,270,229.5,77.382,270,"UCare Health, Inc.",Medical Assistance,136.269,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Knee And Patella Rt,,73562,CPT,Facility,Inpatient,,,RT,270,229.5,77.382,270,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Xr Knee And Patella Rt,,73562,CPT,Facility,Outpatient,,,RT,270,229.5,77.382,270,"UCare Health, Inc.",Medicare Advantage,136.269,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Knee And Patella Rt,,73562,CPT,Facility,Inpatient,,,RT,270,229.5,77.382,270,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Knee And Patella Rt,,73562,CPT,Facility,Outpatient,,,RT,270,229.5,77.382,270,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),136.269,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Knee And Patella Rt,,73562,CPT,Facility,Inpatient,,,RT,270,229.5,77.382,270,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Knee And Patella Rt,,73562,CPT,Facility,Both,,,RT,270,229.5,77.382,270,UnitedHealthcare,Individual & Family,253.8,94,,percent of total billed charges,,
Xr Knee And Patella Rt,,73562,CPT,Facility,Outpatient,,,RT,270,229.5,77.382,270,UnitedHealthcare,Medicare Advantage,132.3,49,,percent of total billed charges,,
Xr Knee And Patella Rt,,73562,CPT,Facility,Inpatient,,,RT,270,229.5,77.382,270,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Xr Knee And Patella Rt,,73562,CPT,Facility,Outpatient,,,RT,270,229.5,77.382,270,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,129.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
Xr Knee And Patella Rt,,73562,CPT,Facility,Inpatient,,,RT,270,229.5,77.382,270,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Xr Knee Rt 3 Views,,73562,CPT,Facility,Both,,,RT,270,229.5,77.382,270,Aetna,Commercial,248.4,92,,percent of total billed charges,,
Xr Knee Rt 3 Views,,73562,CPT,Facility,Outpatient,,,RT,270,229.5,77.382,270,Aetna,Medicare Advantage,132.3,49,,percent of total billed charges,,
Xr Knee Rt 3 Views,,73562,CPT,Facility,Inpatient,,,RT,270,229.5,77.382,270,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Xr Knee Rt 3 Views,,73562,CPT,Facility,Both,,,RT,270,229.5,77.382,270,Aetna,PPO,251.1,93,,percent of total billed charges,,
Xr Knee Rt 3 Views,,73562,CPT,Facility,Both,,,RT,270,229.5,77.382,270,America's PPO,America's PPO,259.281,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Xr Knee Rt 3 Views,,73562,CPT,Facility,Both,,,RT,270,229.5,77.382,270,BlueCross BlueShield Minnesota, Federal Employee Program,265.68,98.4,,percent of total billed charges,,
Xr Knee Rt 3 Views,,73562,CPT,Facility,Both,,,RT,270,229.5,77.382,270,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,270,100,,percent of total billed charges,,
Xr Knee Rt 3 Views,,73562,CPT,Facility,Both,,,RT,270,229.5,77.382,270,BlueCross BlueShield Minnesota,High Value Network Plan,243,90,,percent of total billed charges,,
Xr Knee Rt 3 Views,,73562,CPT,Facility,Outpatient,,,RT,270,229.5,77.382,270,BlueCross BlueShield Minnesota,Medicare Advantage,132.3,49,,percent of total billed charges,,
Xr Knee Rt 3 Views,,73562,CPT,Facility,Inpatient,,,RT,270,229.5,77.382,270,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Xr Knee Rt 3 Views,,73562,CPT,Facility,Both,,,RT,270,229.5,77.382,270,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,239.139,88.57,,percent of total billed charges,,
Xr Knee Rt 3 Views,,73562,CPT,Facility,Both,,,RT,270,229.5,77.382,270,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,77.382,28.66,,percent of total billed charges,,
Xr Knee Rt 3 Views,,73562,CPT,Facility,Outpatient,,,RT,270,229.5,77.382,270,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),132.3,49,,percent of total billed charges,,
Xr Knee Rt 3 Views,,73562,CPT,Facility,Inpatient,,,RT,270,229.5,77.382,270,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Xr Knee Rt 3 Views,,73562,CPT,Facility,Both,,,RT,270,229.5,77.382,270,CorVel,Worker's Compensation,270,100,,percent of total billed charges,,
Xr Knee Rt 3 Views,,73562,CPT,Facility,Both,,,RT,270,229.5,77.382,270,First Health Group Corporation,First Health Network,261.9,97,,percent of total billed charges,,
Xr Knee Rt 3 Views,,73562,CPT,Facility,Both,,,RT,270,229.5,77.382,270,"Health Partners, Inc.",Commercial,255.42,94.6,,percent of total billed charges,,
Xr Knee Rt 3 Views,,73562,CPT,Facility,Outpatient,,,RT,270,229.5,77.382,270,"Health Partners, Inc.",Medicare Advantage,132.3,49,,percent of total billed charges,,
Xr Knee Rt 3 Views,,73562,CPT,Facility,Inpatient,,,RT,270,229.5,77.382,270,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Knee Rt 3 Views,,73562,CPT,Facility,Both,,,RT,270,229.5,77.382,270,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),162,60,,percent of total billed charges,,
Xr Knee Rt 3 Views,,73562,CPT,Facility,Both,,,RT,270,229.5,77.382,270,"Health Partners, Inc.",State of Minnesota Advantage Program,220.05,81.5,,percent of total billed charges,,
Xr Knee Rt 3 Views,,73562,CPT,Facility,Both,,,RT,270,229.5,77.382,270,"Health Partners, Inc.",State Public Programs,135,50,,percent of total billed charges,,
Xr Knee Rt 3 Views,,73562,CPT,Facility,Both,,,RT,270,229.5,77.382,270,Humana Insurance Company,Commercial PPO,256.5,95,,percent of total billed charges,,
Xr Knee Rt 3 Views,,73562,CPT,Facility,Outpatient,,,RT,270,229.5,77.382,270,Humana Insurance Company,Medicare PPO,132.3,49,,percent of total billed charges,,
Xr Knee Rt 3 Views,,73562,CPT,Facility,Inpatient,,,RT,270,229.5,77.382,270,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Xr Knee Rt 3 Views,,73562,CPT,Facility,Both,,,RT,270,229.5,77.382,270,Medica,Individual & Family,267.57,99.1,,percent of total billed charges,,
Xr Knee Rt 3 Views,,73562,CPT,Facility,Outpatient,,,RT,270,229.5,77.382,270,Medica,Medica Advantage Solution,134.46,49.8,,percent of total billed charges,,
Xr Knee Rt 3 Views,,73562,CPT,Facility,Inpatient,,,RT,270,229.5,77.382,270,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Xr Knee Rt 3 Views,,73562,CPT,Facility,Outpatient,,,RT,270,229.5,77.382,270,Medica,Medical Assistance,120.42,44.6,,percent of total billed charges,,
Xr Knee Rt 3 Views,,73562,CPT,Facility,Inpatient,,,RT,270,229.5,77.382,270,Medica,Medical Assistance,,,,,Included in per diem rate,
Xr Knee Rt 3 Views,,73562,CPT,Facility,Outpatient,,,RT,270,229.5,77.382,270,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,134.46,49.8,,percent of total billed charges,,
Xr Knee Rt 3 Views,,73562,CPT,Facility,Inpatient,,,RT,270,229.5,77.382,270,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Xr Knee Rt 3 Views,,73562,CPT,Facility,Both,,,RT,270,229.5,77.382,270,"Multiplan, Inc.","Multiplan, Inc.",253.8,94,,percent of total billed charges,,
Xr Knee Rt 3 Views,,73562,CPT,Facility,Outpatient,,,RT,270,229.5,77.382,270,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,243.27,90.1,,percent of total billed charges,,
Xr Knee Rt 3 Views,,73562,CPT,Facility,Inpatient,,,RT,270,229.5,77.382,270,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Xr Knee Rt 3 Views,,73562,CPT,Facility,Both,,,RT,270,229.5,77.382,270,"Preferred One Administrative Services, INC.",PPO,266.22,98.6,,percent of total billed charges,,
Xr Knee Rt 3 Views,,73562,CPT,Facility,Outpatient,,,RT,270,229.5,77.382,270,PrimeWest Health,Minnesota Senior Health Options (MSHO),138.915,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Xr Knee Rt 3 Views,,73562,CPT,Facility,Inpatient,,,RT,270,229.5,77.382,270,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Knee Rt 3 Views,,73562,CPT,Facility,Outpatient,,,RT,270,229.5,77.382,270,PrimeWest Health,MinnesotaCare,138.672,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Xr Knee Rt 3 Views,,73562,CPT,Facility,Inpatient,,,RT,270,229.5,77.382,270,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Xr Knee Rt 3 Views,,73562,CPT,Facility,Both,,,RT,270,229.5,77.382,270,Sanford Health Plan,Sanford Health Plan,248.4,92,,percent of total billed charges,,
Xr Knee Rt 3 Views,,73562,CPT,Facility,Outpatient,,,RT,270,229.5,77.382,270,"UCare Health, Inc.",Individual & Family Plan,152.145,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Xr Knee Rt 3 Views,,73562,CPT,Facility,Inpatient,,,RT,270,229.5,77.382,270,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Xr Knee Rt 3 Views,,73562,CPT,Facility,Outpatient,,,RT,270,229.5,77.382,270,"UCare Health, Inc.",Medical Assistance,136.269,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Knee Rt 3 Views,,73562,CPT,Facility,Inpatient,,,RT,270,229.5,77.382,270,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Xr Knee Rt 3 Views,,73562,CPT,Facility,Outpatient,,,RT,270,229.5,77.382,270,"UCare Health, Inc.",Medicare Advantage,136.269,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Knee Rt 3 Views,,73562,CPT,Facility,Inpatient,,,RT,270,229.5,77.382,270,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Knee Rt 3 Views,,73562,CPT,Facility,Outpatient,,,RT,270,229.5,77.382,270,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),136.269,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Knee Rt 3 Views,,73562,CPT,Facility,Inpatient,,,RT,270,229.5,77.382,270,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Knee Rt 3 Views,,73562,CPT,Facility,Both,,,RT,270,229.5,77.382,270,UnitedHealthcare,Individual & Family,253.8,94,,percent of total billed charges,,
Xr Knee Rt 3 Views,,73562,CPT,Facility,Outpatient,,,RT,270,229.5,77.382,270,UnitedHealthcare,Medicare Advantage,132.3,49,,percent of total billed charges,,
Xr Knee Rt 3 Views,,73562,CPT,Facility,Inpatient,,,RT,270,229.5,77.382,270,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Xr Knee Rt 3 Views,,73562,CPT,Facility,Outpatient,,,RT,270,229.5,77.382,270,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,129.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
Xr Knee Rt 3 Views,,73562,CPT,Facility,Inpatient,,,RT,270,229.5,77.382,270,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Xr Knee Rt 4 Views Or More,,73564,CPT,Facility,Both,,,RT,306,260.1,87.6996,306,Aetna,Commercial,281.52,92,,percent of total billed charges,,
Xr Knee Rt 4 Views Or More,,73564,CPT,Facility,Outpatient,,,RT,306,260.1,87.6996,306,Aetna,Medicare Advantage,149.94,49,,percent of total billed charges,,
Xr Knee Rt 4 Views Or More,,73564,CPT,Facility,Inpatient,,,RT,306,260.1,87.6996,306,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Xr Knee Rt 4 Views Or More,,73564,CPT,Facility,Both,,,RT,306,260.1,87.6996,306,Aetna,PPO,284.58,93,,percent of total billed charges,,
Xr Knee Rt 4 Views Or More,,73564,CPT,Facility,Both,,,RT,306,260.1,87.6996,306,America's PPO,America's PPO,293.8518,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Xr Knee Rt 4 Views Or More,,73564,CPT,Facility,Both,,,RT,306,260.1,87.6996,306,BlueCross BlueShield Minnesota, Federal Employee Program,301.104,98.4,,percent of total billed charges,,
Xr Knee Rt 4 Views Or More,,73564,CPT,Facility,Both,,,RT,306,260.1,87.6996,306,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,306,100,,percent of total billed charges,,
Xr Knee Rt 4 Views Or More,,73564,CPT,Facility,Both,,,RT,306,260.1,87.6996,306,BlueCross BlueShield Minnesota,High Value Network Plan,275.4,90,,percent of total billed charges,,
Xr Knee Rt 4 Views Or More,,73564,CPT,Facility,Outpatient,,,RT,306,260.1,87.6996,306,BlueCross BlueShield Minnesota,Medicare Advantage,149.94,49,,percent of total billed charges,,
Xr Knee Rt 4 Views Or More,,73564,CPT,Facility,Inpatient,,,RT,306,260.1,87.6996,306,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Xr Knee Rt 4 Views Or More,,73564,CPT,Facility,Both,,,RT,306,260.1,87.6996,306,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,271.0242,88.57,,percent of total billed charges,,
Xr Knee Rt 4 Views Or More,,73564,CPT,Facility,Both,,,RT,306,260.1,87.6996,306,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,87.6996,28.66,,percent of total billed charges,,
Xr Knee Rt 4 Views Or More,,73564,CPT,Facility,Outpatient,,,RT,306,260.1,87.6996,306,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),149.94,49,,percent of total billed charges,,
Xr Knee Rt 4 Views Or More,,73564,CPT,Facility,Inpatient,,,RT,306,260.1,87.6996,306,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Xr Knee Rt 4 Views Or More,,73564,CPT,Facility,Both,,,RT,306,260.1,87.6996,306,CorVel,Worker's Compensation,306,100,,percent of total billed charges,,
Xr Knee Rt 4 Views Or More,,73564,CPT,Facility,Both,,,RT,306,260.1,87.6996,306,First Health Group Corporation,First Health Network,296.82,97,,percent of total billed charges,,
Xr Knee Rt 4 Views Or More,,73564,CPT,Facility,Both,,,RT,306,260.1,87.6996,306,"Health Partners, Inc.",Commercial,289.476,94.6,,percent of total billed charges,,
Xr Knee Rt 4 Views Or More,,73564,CPT,Facility,Outpatient,,,RT,306,260.1,87.6996,306,"Health Partners, Inc.",Medicare Advantage,149.94,49,,percent of total billed charges,,
Xr Knee Rt 4 Views Or More,,73564,CPT,Facility,Inpatient,,,RT,306,260.1,87.6996,306,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Knee Rt 4 Views Or More,,73564,CPT,Facility,Both,,,RT,306,260.1,87.6996,306,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),183.6,60,,percent of total billed charges,,
Xr Knee Rt 4 Views Or More,,73564,CPT,Facility,Both,,,RT,306,260.1,87.6996,306,"Health Partners, Inc.",State of Minnesota Advantage Program,249.39,81.5,,percent of total billed charges,,
Xr Knee Rt 4 Views Or More,,73564,CPT,Facility,Both,,,RT,306,260.1,87.6996,306,"Health Partners, Inc.",State Public Programs,153,50,,percent of total billed charges,,
Xr Knee Rt 4 Views Or More,,73564,CPT,Facility,Both,,,RT,306,260.1,87.6996,306,Humana Insurance Company,Commercial PPO,290.7,95,,percent of total billed charges,,
Xr Knee Rt 4 Views Or More,,73564,CPT,Facility,Outpatient,,,RT,306,260.1,87.6996,306,Humana Insurance Company,Medicare PPO,149.94,49,,percent of total billed charges,,
Xr Knee Rt 4 Views Or More,,73564,CPT,Facility,Inpatient,,,RT,306,260.1,87.6996,306,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Xr Knee Rt 4 Views Or More,,73564,CPT,Facility,Both,,,RT,306,260.1,87.6996,306,Medica,Individual & Family,303.246,99.1,,percent of total billed charges,,
Xr Knee Rt 4 Views Or More,,73564,CPT,Facility,Outpatient,,,RT,306,260.1,87.6996,306,Medica,Medica Advantage Solution,152.388,49.8,,percent of total billed charges,,
Xr Knee Rt 4 Views Or More,,73564,CPT,Facility,Inpatient,,,RT,306,260.1,87.6996,306,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Xr Knee Rt 4 Views Or More,,73564,CPT,Facility,Outpatient,,,RT,306,260.1,87.6996,306,Medica,Medical Assistance,136.476,44.6,,percent of total billed charges,,
Xr Knee Rt 4 Views Or More,,73564,CPT,Facility,Inpatient,,,RT,306,260.1,87.6996,306,Medica,Medical Assistance,,,,,Included in per diem rate,
Xr Knee Rt 4 Views Or More,,73564,CPT,Facility,Outpatient,,,RT,306,260.1,87.6996,306,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,152.388,49.8,,percent of total billed charges,,
Xr Knee Rt 4 Views Or More,,73564,CPT,Facility,Inpatient,,,RT,306,260.1,87.6996,306,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Xr Knee Rt 4 Views Or More,,73564,CPT,Facility,Both,,,RT,306,260.1,87.6996,306,"Multiplan, Inc.","Multiplan, Inc.",287.64,94,,percent of total billed charges,,
Xr Knee Rt 4 Views Or More,,73564,CPT,Facility,Outpatient,,,RT,306,260.1,87.6996,306,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,275.706,90.1,,percent of total billed charges,,
Xr Knee Rt 4 Views Or More,,73564,CPT,Facility,Inpatient,,,RT,306,260.1,87.6996,306,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Xr Knee Rt 4 Views Or More,,73564,CPT,Facility,Both,,,RT,306,260.1,87.6996,306,"Preferred One Administrative Services, INC.",PPO,301.716,98.6,,percent of total billed charges,,
Xr Knee Rt 4 Views Or More,,73564,CPT,Facility,Outpatient,,,RT,306,260.1,87.6996,306,PrimeWest Health,Minnesota Senior Health Options (MSHO),157.437,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Xr Knee Rt 4 Views Or More,,73564,CPT,Facility,Inpatient,,,RT,306,260.1,87.6996,306,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Knee Rt 4 Views Or More,,73564,CPT,Facility,Outpatient,,,RT,306,260.1,87.6996,306,PrimeWest Health,MinnesotaCare,157.1616,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Xr Knee Rt 4 Views Or More,,73564,CPT,Facility,Inpatient,,,RT,306,260.1,87.6996,306,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Xr Knee Rt 4 Views Or More,,73564,CPT,Facility,Both,,,RT,306,260.1,87.6996,306,Sanford Health Plan,Sanford Health Plan,281.52,92,,percent of total billed charges,,
Xr Knee Rt 4 Views Or More,,73564,CPT,Facility,Outpatient,,,RT,306,260.1,87.6996,306,"UCare Health, Inc.",Individual & Family Plan,172.431,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Xr Knee Rt 4 Views Or More,,73564,CPT,Facility,Inpatient,,,RT,306,260.1,87.6996,306,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Xr Knee Rt 4 Views Or More,,73564,CPT,Facility,Outpatient,,,RT,306,260.1,87.6996,306,"UCare Health, Inc.",Medical Assistance,154.4382,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Knee Rt 4 Views Or More,,73564,CPT,Facility,Inpatient,,,RT,306,260.1,87.6996,306,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Xr Knee Rt 4 Views Or More,,73564,CPT,Facility,Outpatient,,,RT,306,260.1,87.6996,306,"UCare Health, Inc.",Medicare Advantage,154.4382,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Knee Rt 4 Views Or More,,73564,CPT,Facility,Inpatient,,,RT,306,260.1,87.6996,306,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Knee Rt 4 Views Or More,,73564,CPT,Facility,Outpatient,,,RT,306,260.1,87.6996,306,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),154.4382,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Knee Rt 4 Views Or More,,73564,CPT,Facility,Inpatient,,,RT,306,260.1,87.6996,306,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Knee Rt 4 Views Or More,,73564,CPT,Facility,Both,,,RT,306,260.1,87.6996,306,UnitedHealthcare,Individual & Family,287.64,94,,percent of total billed charges,,
Xr Knee Rt 4 Views Or More,,73564,CPT,Facility,Outpatient,,,RT,306,260.1,87.6996,306,UnitedHealthcare,Medicare Advantage,149.94,49,,percent of total billed charges,,
Xr Knee Rt 4 Views Or More,,73564,CPT,Facility,Inpatient,,,RT,306,260.1,87.6996,306,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Xr Knee Rt 4 Views Or More,,73564,CPT,Facility,Outpatient,,,RT,306,260.1,87.6996,306,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,146.88,48,,percent of total billed charges,,100% of DHS outpatient percentage
Xr Knee Rt 4 Views Or More,,73564,CPT,Facility,Inpatient,,,RT,306,260.1,87.6996,306,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Xr Tibia Fibula Rt,,73590,CPT,Facility,Both,,,RT,270,229.5,77.382,270,Aetna,Commercial,248.4,92,,percent of total billed charges,,
Xr Tibia Fibula Rt,,73590,CPT,Facility,Outpatient,,,RT,270,229.5,77.382,270,Aetna,Medicare Advantage,132.3,49,,percent of total billed charges,,
Xr Tibia Fibula Rt,,73590,CPT,Facility,Inpatient,,,RT,270,229.5,77.382,270,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Xr Tibia Fibula Rt,,73590,CPT,Facility,Both,,,RT,270,229.5,77.382,270,Aetna,PPO,251.1,93,,percent of total billed charges,,
Xr Tibia Fibula Rt,,73590,CPT,Facility,Both,,,RT,270,229.5,77.382,270,America's PPO,America's PPO,259.281,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Xr Tibia Fibula Rt,,73590,CPT,Facility,Both,,,RT,270,229.5,77.382,270,BlueCross BlueShield Minnesota, Federal Employee Program,265.68,98.4,,percent of total billed charges,,
Xr Tibia Fibula Rt,,73590,CPT,Facility,Both,,,RT,270,229.5,77.382,270,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,270,100,,percent of total billed charges,,
Xr Tibia Fibula Rt,,73590,CPT,Facility,Both,,,RT,270,229.5,77.382,270,BlueCross BlueShield Minnesota,High Value Network Plan,243,90,,percent of total billed charges,,
Xr Tibia Fibula Rt,,73590,CPT,Facility,Outpatient,,,RT,270,229.5,77.382,270,BlueCross BlueShield Minnesota,Medicare Advantage,132.3,49,,percent of total billed charges,,
Xr Tibia Fibula Rt,,73590,CPT,Facility,Inpatient,,,RT,270,229.5,77.382,270,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Xr Tibia Fibula Rt,,73590,CPT,Facility,Both,,,RT,270,229.5,77.382,270,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,239.139,88.57,,percent of total billed charges,,
Xr Tibia Fibula Rt,,73590,CPT,Facility,Both,,,RT,270,229.5,77.382,270,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,77.382,28.66,,percent of total billed charges,,
Xr Tibia Fibula Rt,,73590,CPT,Facility,Outpatient,,,RT,270,229.5,77.382,270,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),132.3,49,,percent of total billed charges,,
Xr Tibia Fibula Rt,,73590,CPT,Facility,Inpatient,,,RT,270,229.5,77.382,270,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Xr Tibia Fibula Rt,,73590,CPT,Facility,Both,,,RT,270,229.5,77.382,270,CorVel,Worker's Compensation,270,100,,percent of total billed charges,,
Xr Tibia Fibula Rt,,73590,CPT,Facility,Both,,,RT,270,229.5,77.382,270,First Health Group Corporation,First Health Network,261.9,97,,percent of total billed charges,,
Xr Tibia Fibula Rt,,73590,CPT,Facility,Both,,,RT,270,229.5,77.382,270,"Health Partners, Inc.",Commercial,255.42,94.6,,percent of total billed charges,,
Xr Tibia Fibula Rt,,73590,CPT,Facility,Outpatient,,,RT,270,229.5,77.382,270,"Health Partners, Inc.",Medicare Advantage,132.3,49,,percent of total billed charges,,
Xr Tibia Fibula Rt,,73590,CPT,Facility,Inpatient,,,RT,270,229.5,77.382,270,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Tibia Fibula Rt,,73590,CPT,Facility,Both,,,RT,270,229.5,77.382,270,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),162,60,,percent of total billed charges,,
Xr Tibia Fibula Rt,,73590,CPT,Facility,Both,,,RT,270,229.5,77.382,270,"Health Partners, Inc.",State of Minnesota Advantage Program,220.05,81.5,,percent of total billed charges,,
Xr Tibia Fibula Rt,,73590,CPT,Facility,Both,,,RT,270,229.5,77.382,270,"Health Partners, Inc.",State Public Programs,135,50,,percent of total billed charges,,
Xr Tibia Fibula Rt,,73590,CPT,Facility,Both,,,RT,270,229.5,77.382,270,Humana Insurance Company,Commercial PPO,256.5,95,,percent of total billed charges,,
Xr Tibia Fibula Rt,,73590,CPT,Facility,Outpatient,,,RT,270,229.5,77.382,270,Humana Insurance Company,Medicare PPO,132.3,49,,percent of total billed charges,,
Xr Tibia Fibula Rt,,73590,CPT,Facility,Inpatient,,,RT,270,229.5,77.382,270,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Xr Tibia Fibula Rt,,73590,CPT,Facility,Both,,,RT,270,229.5,77.382,270,Medica,Individual & Family,267.57,99.1,,percent of total billed charges,,
Xr Tibia Fibula Rt,,73590,CPT,Facility,Outpatient,,,RT,270,229.5,77.382,270,Medica,Medica Advantage Solution,134.46,49.8,,percent of total billed charges,,
Xr Tibia Fibula Rt,,73590,CPT,Facility,Inpatient,,,RT,270,229.5,77.382,270,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Xr Tibia Fibula Rt,,73590,CPT,Facility,Outpatient,,,RT,270,229.5,77.382,270,Medica,Medical Assistance,120.42,44.6,,percent of total billed charges,,
Xr Tibia Fibula Rt,,73590,CPT,Facility,Inpatient,,,RT,270,229.5,77.382,270,Medica,Medical Assistance,,,,,Included in per diem rate,
Xr Tibia Fibula Rt,,73590,CPT,Facility,Outpatient,,,RT,270,229.5,77.382,270,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,134.46,49.8,,percent of total billed charges,,
Xr Tibia Fibula Rt,,73590,CPT,Facility,Inpatient,,,RT,270,229.5,77.382,270,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Xr Tibia Fibula Rt,,73590,CPT,Facility,Both,,,RT,270,229.5,77.382,270,"Multiplan, Inc.","Multiplan, Inc.",253.8,94,,percent of total billed charges,,
Xr Tibia Fibula Rt,,73590,CPT,Facility,Outpatient,,,RT,270,229.5,77.382,270,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,243.27,90.1,,percent of total billed charges,,
Xr Tibia Fibula Rt,,73590,CPT,Facility,Inpatient,,,RT,270,229.5,77.382,270,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Xr Tibia Fibula Rt,,73590,CPT,Facility,Both,,,RT,270,229.5,77.382,270,"Preferred One Administrative Services, INC.",PPO,266.22,98.6,,percent of total billed charges,,
Xr Tibia Fibula Rt,,73590,CPT,Facility,Outpatient,,,RT,270,229.5,77.382,270,PrimeWest Health,Minnesota Senior Health Options (MSHO),138.915,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Xr Tibia Fibula Rt,,73590,CPT,Facility,Inpatient,,,RT,270,229.5,77.382,270,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Tibia Fibula Rt,,73590,CPT,Facility,Outpatient,,,RT,270,229.5,77.382,270,PrimeWest Health,MinnesotaCare,138.672,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Xr Tibia Fibula Rt,,73590,CPT,Facility,Inpatient,,,RT,270,229.5,77.382,270,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Xr Tibia Fibula Rt,,73590,CPT,Facility,Both,,,RT,270,229.5,77.382,270,Sanford Health Plan,Sanford Health Plan,248.4,92,,percent of total billed charges,,
Xr Tibia Fibula Rt,,73590,CPT,Facility,Outpatient,,,RT,270,229.5,77.382,270,"UCare Health, Inc.",Individual & Family Plan,152.145,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Xr Tibia Fibula Rt,,73590,CPT,Facility,Inpatient,,,RT,270,229.5,77.382,270,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Xr Tibia Fibula Rt,,73590,CPT,Facility,Outpatient,,,RT,270,229.5,77.382,270,"UCare Health, Inc.",Medical Assistance,136.269,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Tibia Fibula Rt,,73590,CPT,Facility,Inpatient,,,RT,270,229.5,77.382,270,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Xr Tibia Fibula Rt,,73590,CPT,Facility,Outpatient,,,RT,270,229.5,77.382,270,"UCare Health, Inc.",Medicare Advantage,136.269,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Tibia Fibula Rt,,73590,CPT,Facility,Inpatient,,,RT,270,229.5,77.382,270,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Tibia Fibula Rt,,73590,CPT,Facility,Outpatient,,,RT,270,229.5,77.382,270,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),136.269,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Tibia Fibula Rt,,73590,CPT,Facility,Inpatient,,,RT,270,229.5,77.382,270,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Tibia Fibula Rt,,73590,CPT,Facility,Both,,,RT,270,229.5,77.382,270,UnitedHealthcare,Individual & Family,253.8,94,,percent of total billed charges,,
Xr Tibia Fibula Rt,,73590,CPT,Facility,Outpatient,,,RT,270,229.5,77.382,270,UnitedHealthcare,Medicare Advantage,132.3,49,,percent of total billed charges,,
Xr Tibia Fibula Rt,,73590,CPT,Facility,Inpatient,,,RT,270,229.5,77.382,270,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Xr Tibia Fibula Rt,,73590,CPT,Facility,Outpatient,,,RT,270,229.5,77.382,270,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,129.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
Xr Tibia Fibula Rt,,73590,CPT,Facility,Inpatient,,,RT,270,229.5,77.382,270,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Xr Lower Ext Rt Infant Min 2 Views,,73592,CPT,Facility,Both,,,RT,204,173.4,58.4664,204,Aetna,Commercial,187.68,92,,percent of total billed charges,,
Xr Lower Ext Rt Infant Min 2 Views,,73592,CPT,Facility,Outpatient,,,RT,204,173.4,58.4664,204,Aetna,Medicare Advantage,99.96,49,,percent of total billed charges,,
Xr Lower Ext Rt Infant Min 2 Views,,73592,CPT,Facility,Inpatient,,,RT,204,173.4,58.4664,204,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Xr Lower Ext Rt Infant Min 2 Views,,73592,CPT,Facility,Both,,,RT,204,173.4,58.4664,204,Aetna,PPO,189.72,93,,percent of total billed charges,,
Xr Lower Ext Rt Infant Min 2 Views,,73592,CPT,Facility,Both,,,RT,204,173.4,58.4664,204,America's PPO,America's PPO,195.9012,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Xr Lower Ext Rt Infant Min 2 Views,,73592,CPT,Facility,Both,,,RT,204,173.4,58.4664,204,BlueCross BlueShield Minnesota, Federal Employee Program,200.736,98.4,,percent of total billed charges,,
Xr Lower Ext Rt Infant Min 2 Views,,73592,CPT,Facility,Both,,,RT,204,173.4,58.4664,204,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,204,100,,percent of total billed charges,,
Xr Lower Ext Rt Infant Min 2 Views,,73592,CPT,Facility,Both,,,RT,204,173.4,58.4664,204,BlueCross BlueShield Minnesota,High Value Network Plan,183.6,90,,percent of total billed charges,,
Xr Lower Ext Rt Infant Min 2 Views,,73592,CPT,Facility,Outpatient,,,RT,204,173.4,58.4664,204,BlueCross BlueShield Minnesota,Medicare Advantage,99.96,49,,percent of total billed charges,,
Xr Lower Ext Rt Infant Min 2 Views,,73592,CPT,Facility,Inpatient,,,RT,204,173.4,58.4664,204,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Xr Lower Ext Rt Infant Min 2 Views,,73592,CPT,Facility,Both,,,RT,204,173.4,58.4664,204,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,180.6828,88.57,,percent of total billed charges,,
Xr Lower Ext Rt Infant Min 2 Views,,73592,CPT,Facility,Both,,,RT,204,173.4,58.4664,204,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,58.4664,28.66,,percent of total billed charges,,
Xr Lower Ext Rt Infant Min 2 Views,,73592,CPT,Facility,Outpatient,,,RT,204,173.4,58.4664,204,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),99.96,49,,percent of total billed charges,,
Xr Lower Ext Rt Infant Min 2 Views,,73592,CPT,Facility,Inpatient,,,RT,204,173.4,58.4664,204,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Xr Lower Ext Rt Infant Min 2 Views,,73592,CPT,Facility,Both,,,RT,204,173.4,58.4664,204,CorVel,Worker's Compensation,204,100,,percent of total billed charges,,
Xr Lower Ext Rt Infant Min 2 Views,,73592,CPT,Facility,Both,,,RT,204,173.4,58.4664,204,First Health Group Corporation,First Health Network,197.88,97,,percent of total billed charges,,
Xr Lower Ext Rt Infant Min 2 Views,,73592,CPT,Facility,Both,,,RT,204,173.4,58.4664,204,"Health Partners, Inc.",Commercial,192.984,94.6,,percent of total billed charges,,
Xr Lower Ext Rt Infant Min 2 Views,,73592,CPT,Facility,Outpatient,,,RT,204,173.4,58.4664,204,"Health Partners, Inc.",Medicare Advantage,99.96,49,,percent of total billed charges,,
Xr Lower Ext Rt Infant Min 2 Views,,73592,CPT,Facility,Inpatient,,,RT,204,173.4,58.4664,204,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Lower Ext Rt Infant Min 2 Views,,73592,CPT,Facility,Both,,,RT,204,173.4,58.4664,204,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),122.4,60,,percent of total billed charges,,
Xr Lower Ext Rt Infant Min 2 Views,,73592,CPT,Facility,Both,,,RT,204,173.4,58.4664,204,"Health Partners, Inc.",State of Minnesota Advantage Program,166.26,81.5,,percent of total billed charges,,
Xr Lower Ext Rt Infant Min 2 Views,,73592,CPT,Facility,Both,,,RT,204,173.4,58.4664,204,"Health Partners, Inc.",State Public Programs,102,50,,percent of total billed charges,,
Xr Lower Ext Rt Infant Min 2 Views,,73592,CPT,Facility,Both,,,RT,204,173.4,58.4664,204,Humana Insurance Company,Commercial PPO,193.8,95,,percent of total billed charges,,
Xr Lower Ext Rt Infant Min 2 Views,,73592,CPT,Facility,Outpatient,,,RT,204,173.4,58.4664,204,Humana Insurance Company,Medicare PPO,99.96,49,,percent of total billed charges,,
Xr Lower Ext Rt Infant Min 2 Views,,73592,CPT,Facility,Inpatient,,,RT,204,173.4,58.4664,204,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Xr Lower Ext Rt Infant Min 2 Views,,73592,CPT,Facility,Both,,,RT,204,173.4,58.4664,204,Medica,Individual & Family,202.164,99.1,,percent of total billed charges,,
Xr Lower Ext Rt Infant Min 2 Views,,73592,CPT,Facility,Outpatient,,,RT,204,173.4,58.4664,204,Medica,Medica Advantage Solution,101.592,49.8,,percent of total billed charges,,
Xr Lower Ext Rt Infant Min 2 Views,,73592,CPT,Facility,Inpatient,,,RT,204,173.4,58.4664,204,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Xr Lower Ext Rt Infant Min 2 Views,,73592,CPT,Facility,Outpatient,,,RT,204,173.4,58.4664,204,Medica,Medical Assistance,90.984,44.6,,percent of total billed charges,,
Xr Lower Ext Rt Infant Min 2 Views,,73592,CPT,Facility,Inpatient,,,RT,204,173.4,58.4664,204,Medica,Medical Assistance,,,,,Included in per diem rate,
Xr Lower Ext Rt Infant Min 2 Views,,73592,CPT,Facility,Outpatient,,,RT,204,173.4,58.4664,204,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,101.592,49.8,,percent of total billed charges,,
Xr Lower Ext Rt Infant Min 2 Views,,73592,CPT,Facility,Inpatient,,,RT,204,173.4,58.4664,204,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Xr Lower Ext Rt Infant Min 2 Views,,73592,CPT,Facility,Both,,,RT,204,173.4,58.4664,204,"Multiplan, Inc.","Multiplan, Inc.",191.76,94,,percent of total billed charges,,
Xr Lower Ext Rt Infant Min 2 Views,,73592,CPT,Facility,Outpatient,,,RT,204,173.4,58.4664,204,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,183.804,90.1,,percent of total billed charges,,
Xr Lower Ext Rt Infant Min 2 Views,,73592,CPT,Facility,Inpatient,,,RT,204,173.4,58.4664,204,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Xr Lower Ext Rt Infant Min 2 Views,,73592,CPT,Facility,Both,,,RT,204,173.4,58.4664,204,"Preferred One Administrative Services, INC.",PPO,201.144,98.6,,percent of total billed charges,,
Xr Lower Ext Rt Infant Min 2 Views,,73592,CPT,Facility,Outpatient,,,RT,204,173.4,58.4664,204,PrimeWest Health,Minnesota Senior Health Options (MSHO),104.958,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Xr Lower Ext Rt Infant Min 2 Views,,73592,CPT,Facility,Inpatient,,,RT,204,173.4,58.4664,204,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Lower Ext Rt Infant Min 2 Views,,73592,CPT,Facility,Outpatient,,,RT,204,173.4,58.4664,204,PrimeWest Health,MinnesotaCare,104.7744,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Xr Lower Ext Rt Infant Min 2 Views,,73592,CPT,Facility,Inpatient,,,RT,204,173.4,58.4664,204,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Xr Lower Ext Rt Infant Min 2 Views,,73592,CPT,Facility,Both,,,RT,204,173.4,58.4664,204,Sanford Health Plan,Sanford Health Plan,187.68,92,,percent of total billed charges,,
Xr Lower Ext Rt Infant Min 2 Views,,73592,CPT,Facility,Outpatient,,,RT,204,173.4,58.4664,204,"UCare Health, Inc.",Individual & Family Plan,114.954,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Xr Lower Ext Rt Infant Min 2 Views,,73592,CPT,Facility,Inpatient,,,RT,204,173.4,58.4664,204,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Xr Lower Ext Rt Infant Min 2 Views,,73592,CPT,Facility,Outpatient,,,RT,204,173.4,58.4664,204,"UCare Health, Inc.",Medical Assistance,102.9588,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Lower Ext Rt Infant Min 2 Views,,73592,CPT,Facility,Inpatient,,,RT,204,173.4,58.4664,204,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Xr Lower Ext Rt Infant Min 2 Views,,73592,CPT,Facility,Outpatient,,,RT,204,173.4,58.4664,204,"UCare Health, Inc.",Medicare Advantage,102.9588,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Lower Ext Rt Infant Min 2 Views,,73592,CPT,Facility,Inpatient,,,RT,204,173.4,58.4664,204,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Lower Ext Rt Infant Min 2 Views,,73592,CPT,Facility,Outpatient,,,RT,204,173.4,58.4664,204,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),102.9588,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Lower Ext Rt Infant Min 2 Views,,73592,CPT,Facility,Inpatient,,,RT,204,173.4,58.4664,204,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Lower Ext Rt Infant Min 2 Views,,73592,CPT,Facility,Both,,,RT,204,173.4,58.4664,204,UnitedHealthcare,Individual & Family,191.76,94,,percent of total billed charges,,
Xr Lower Ext Rt Infant Min 2 Views,,73592,CPT,Facility,Outpatient,,,RT,204,173.4,58.4664,204,UnitedHealthcare,Medicare Advantage,99.96,49,,percent of total billed charges,,
Xr Lower Ext Rt Infant Min 2 Views,,73592,CPT,Facility,Inpatient,,,RT,204,173.4,58.4664,204,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Xr Lower Ext Rt Infant Min 2 Views,,73592,CPT,Facility,Outpatient,,,RT,204,173.4,58.4664,204,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,97.92,48,,percent of total billed charges,,100% of DHS outpatient percentage
Xr Lower Ext Rt Infant Min 2 Views,,73592,CPT,Facility,Inpatient,,,RT,204,173.4,58.4664,204,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Xr Ankle Rt 2 Views,,73600,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,Aetna,Commercial,237.36,92,,percent of total billed charges,,
Xr Ankle Rt 2 Views,,73600,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,Aetna,Medicare Advantage,126.42,49,,percent of total billed charges,,
Xr Ankle Rt 2 Views,,73600,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Xr Ankle Rt 2 Views,,73600,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,Aetna,PPO,239.94,93,,percent of total billed charges,,
Xr Ankle Rt 2 Views,,73600,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,America's PPO,America's PPO,247.7574,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Xr Ankle Rt 2 Views,,73600,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota, Federal Employee Program,253.872,98.4,,percent of total billed charges,,
Xr Ankle Rt 2 Views,,73600,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,258,100,,percent of total billed charges,,
Xr Ankle Rt 2 Views,,73600,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,High Value Network Plan,232.2,90,,percent of total billed charges,,
Xr Ankle Rt 2 Views,,73600,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,Medicare Advantage,126.42,49,,percent of total billed charges,,
Xr Ankle Rt 2 Views,,73600,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Xr Ankle Rt 2 Views,,73600,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,228.5106,88.57,,percent of total billed charges,,
Xr Ankle Rt 2 Views,,73600,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,73.9428,28.66,,percent of total billed charges,,
Xr Ankle Rt 2 Views,,73600,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),126.42,49,,percent of total billed charges,,
Xr Ankle Rt 2 Views,,73600,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Xr Ankle Rt 2 Views,,73600,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,CorVel,Worker's Compensation,258,100,,percent of total billed charges,,
Xr Ankle Rt 2 Views,,73600,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,First Health Group Corporation,First Health Network,250.26,97,,percent of total billed charges,,
Xr Ankle Rt 2 Views,,73600,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,"Health Partners, Inc.",Commercial,244.068,94.6,,percent of total billed charges,,
Xr Ankle Rt 2 Views,,73600,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,"Health Partners, Inc.",Medicare Advantage,126.42,49,,percent of total billed charges,,
Xr Ankle Rt 2 Views,,73600,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Ankle Rt 2 Views,,73600,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),154.8,60,,percent of total billed charges,,
Xr Ankle Rt 2 Views,,73600,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,"Health Partners, Inc.",State of Minnesota Advantage Program,210.27,81.5,,percent of total billed charges,,
Xr Ankle Rt 2 Views,,73600,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,"Health Partners, Inc.",State Public Programs,129,50,,percent of total billed charges,,
Xr Ankle Rt 2 Views,,73600,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,Humana Insurance Company,Commercial PPO,245.1,95,,percent of total billed charges,,
Xr Ankle Rt 2 Views,,73600,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,Humana Insurance Company,Medicare PPO,126.42,49,,percent of total billed charges,,
Xr Ankle Rt 2 Views,,73600,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Xr Ankle Rt 2 Views,,73600,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,Medica,Individual & Family,255.678,99.1,,percent of total billed charges,,
Xr Ankle Rt 2 Views,,73600,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,Medica,Medica Advantage Solution,128.484,49.8,,percent of total billed charges,,
Xr Ankle Rt 2 Views,,73600,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Xr Ankle Rt 2 Views,,73600,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,Medica,Medical Assistance,115.068,44.6,,percent of total billed charges,,
Xr Ankle Rt 2 Views,,73600,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,Medica,Medical Assistance,,,,,Included in per diem rate,
Xr Ankle Rt 2 Views,,73600,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,128.484,49.8,,percent of total billed charges,,
Xr Ankle Rt 2 Views,,73600,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Xr Ankle Rt 2 Views,,73600,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,"Multiplan, Inc.","Multiplan, Inc.",242.52,94,,percent of total billed charges,,
Xr Ankle Rt 2 Views,,73600,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,232.458,90.1,,percent of total billed charges,,
Xr Ankle Rt 2 Views,,73600,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Xr Ankle Rt 2 Views,,73600,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,"Preferred One Administrative Services, INC.",PPO,254.388,98.6,,percent of total billed charges,,
Xr Ankle Rt 2 Views,,73600,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,PrimeWest Health,Minnesota Senior Health Options (MSHO),132.741,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Xr Ankle Rt 2 Views,,73600,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Ankle Rt 2 Views,,73600,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,PrimeWest Health,MinnesotaCare,132.5088,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Xr Ankle Rt 2 Views,,73600,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Xr Ankle Rt 2 Views,,73600,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,Sanford Health Plan,Sanford Health Plan,237.36,92,,percent of total billed charges,,
Xr Ankle Rt 2 Views,,73600,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,"UCare Health, Inc.",Individual & Family Plan,145.383,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Xr Ankle Rt 2 Views,,73600,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Xr Ankle Rt 2 Views,,73600,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,"UCare Health, Inc.",Medical Assistance,130.2126,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Ankle Rt 2 Views,,73600,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Xr Ankle Rt 2 Views,,73600,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,"UCare Health, Inc.",Medicare Advantage,130.2126,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Ankle Rt 2 Views,,73600,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Ankle Rt 2 Views,,73600,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),130.2126,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Ankle Rt 2 Views,,73600,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Ankle Rt 2 Views,,73600,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,UnitedHealthcare,Individual & Family,242.52,94,,percent of total billed charges,,
Xr Ankle Rt 2 Views,,73600,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,UnitedHealthcare,Medicare Advantage,126.42,49,,percent of total billed charges,,
Xr Ankle Rt 2 Views,,73600,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Xr Ankle Rt 2 Views,,73600,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,123.84,48,,percent of total billed charges,,100% of DHS outpatient percentage
Xr Ankle Rt 2 Views,,73600,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Xr Ankle Routine Rt 3 Views,,73610,CPT,Facility,Both,,,RT,280,238,80.248,280,Aetna,Commercial,257.6,92,,percent of total billed charges,,
Xr Ankle Routine Rt 3 Views,,73610,CPT,Facility,Outpatient,,,RT,280,238,80.248,280,Aetna,Medicare Advantage,137.2,49,,percent of total billed charges,,
Xr Ankle Routine Rt 3 Views,,73610,CPT,Facility,Inpatient,,,RT,280,238,80.248,280,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Xr Ankle Routine Rt 3 Views,,73610,CPT,Facility,Both,,,RT,280,238,80.248,280,Aetna,PPO,260.4,93,,percent of total billed charges,,
Xr Ankle Routine Rt 3 Views,,73610,CPT,Facility,Both,,,RT,280,238,80.248,280,America's PPO,America's PPO,268.884,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Xr Ankle Routine Rt 3 Views,,73610,CPT,Facility,Both,,,RT,280,238,80.248,280,BlueCross BlueShield Minnesota, Federal Employee Program,275.52,98.4,,percent of total billed charges,,
Xr Ankle Routine Rt 3 Views,,73610,CPT,Facility,Both,,,RT,280,238,80.248,280,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,280,100,,percent of total billed charges,,
Xr Ankle Routine Rt 3 Views,,73610,CPT,Facility,Both,,,RT,280,238,80.248,280,BlueCross BlueShield Minnesota,High Value Network Plan,252,90,,percent of total billed charges,,
Xr Ankle Routine Rt 3 Views,,73610,CPT,Facility,Outpatient,,,RT,280,238,80.248,280,BlueCross BlueShield Minnesota,Medicare Advantage,137.2,49,,percent of total billed charges,,
Xr Ankle Routine Rt 3 Views,,73610,CPT,Facility,Inpatient,,,RT,280,238,80.248,280,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Xr Ankle Routine Rt 3 Views,,73610,CPT,Facility,Both,,,RT,280,238,80.248,280,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,247.996,88.57,,percent of total billed charges,,
Xr Ankle Routine Rt 3 Views,,73610,CPT,Facility,Both,,,RT,280,238,80.248,280,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,80.248,28.66,,percent of total billed charges,,
Xr Ankle Routine Rt 3 Views,,73610,CPT,Facility,Outpatient,,,RT,280,238,80.248,280,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),137.2,49,,percent of total billed charges,,
Xr Ankle Routine Rt 3 Views,,73610,CPT,Facility,Inpatient,,,RT,280,238,80.248,280,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Xr Ankle Routine Rt 3 Views,,73610,CPT,Facility,Both,,,RT,280,238,80.248,280,CorVel,Worker's Compensation,280,100,,percent of total billed charges,,
Xr Ankle Routine Rt 3 Views,,73610,CPT,Facility,Both,,,RT,280,238,80.248,280,First Health Group Corporation,First Health Network,271.6,97,,percent of total billed charges,,
Xr Ankle Routine Rt 3 Views,,73610,CPT,Facility,Both,,,RT,280,238,80.248,280,"Health Partners, Inc.",Commercial,264.88,94.6,,percent of total billed charges,,
Xr Ankle Routine Rt 3 Views,,73610,CPT,Facility,Outpatient,,,RT,280,238,80.248,280,"Health Partners, Inc.",Medicare Advantage,137.2,49,,percent of total billed charges,,
Xr Ankle Routine Rt 3 Views,,73610,CPT,Facility,Inpatient,,,RT,280,238,80.248,280,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Ankle Routine Rt 3 Views,,73610,CPT,Facility,Both,,,RT,280,238,80.248,280,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),168,60,,percent of total billed charges,,
Xr Ankle Routine Rt 3 Views,,73610,CPT,Facility,Both,,,RT,280,238,80.248,280,"Health Partners, Inc.",State of Minnesota Advantage Program,228.2,81.5,,percent of total billed charges,,
Xr Ankle Routine Rt 3 Views,,73610,CPT,Facility,Both,,,RT,280,238,80.248,280,"Health Partners, Inc.",State Public Programs,140,50,,percent of total billed charges,,
Xr Ankle Routine Rt 3 Views,,73610,CPT,Facility,Both,,,RT,280,238,80.248,280,Humana Insurance Company,Commercial PPO,266,95,,percent of total billed charges,,
Xr Ankle Routine Rt 3 Views,,73610,CPT,Facility,Outpatient,,,RT,280,238,80.248,280,Humana Insurance Company,Medicare PPO,137.2,49,,percent of total billed charges,,
Xr Ankle Routine Rt 3 Views,,73610,CPT,Facility,Inpatient,,,RT,280,238,80.248,280,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Xr Ankle Routine Rt 3 Views,,73610,CPT,Facility,Both,,,RT,280,238,80.248,280,Medica,Individual & Family,277.48,99.1,,percent of total billed charges,,
Xr Ankle Routine Rt 3 Views,,73610,CPT,Facility,Outpatient,,,RT,280,238,80.248,280,Medica,Medica Advantage Solution,139.44,49.8,,percent of total billed charges,,
Xr Ankle Routine Rt 3 Views,,73610,CPT,Facility,Inpatient,,,RT,280,238,80.248,280,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Xr Ankle Routine Rt 3 Views,,73610,CPT,Facility,Outpatient,,,RT,280,238,80.248,280,Medica,Medical Assistance,124.88,44.6,,percent of total billed charges,,
Xr Ankle Routine Rt 3 Views,,73610,CPT,Facility,Inpatient,,,RT,280,238,80.248,280,Medica,Medical Assistance,,,,,Included in per diem rate,
Xr Ankle Routine Rt 3 Views,,73610,CPT,Facility,Outpatient,,,RT,280,238,80.248,280,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,139.44,49.8,,percent of total billed charges,,
Xr Ankle Routine Rt 3 Views,,73610,CPT,Facility,Inpatient,,,RT,280,238,80.248,280,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Xr Ankle Routine Rt 3 Views,,73610,CPT,Facility,Both,,,RT,280,238,80.248,280,"Multiplan, Inc.","Multiplan, Inc.",263.2,94,,percent of total billed charges,,
Xr Ankle Routine Rt 3 Views,,73610,CPT,Facility,Outpatient,,,RT,280,238,80.248,280,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,252.28,90.1,,percent of total billed charges,,
Xr Ankle Routine Rt 3 Views,,73610,CPT,Facility,Inpatient,,,RT,280,238,80.248,280,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Xr Ankle Routine Rt 3 Views,,73610,CPT,Facility,Both,,,RT,280,238,80.248,280,"Preferred One Administrative Services, INC.",PPO,276.08,98.6,,percent of total billed charges,,
Xr Ankle Routine Rt 3 Views,,73610,CPT,Facility,Outpatient,,,RT,280,238,80.248,280,PrimeWest Health,Minnesota Senior Health Options (MSHO),144.06,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Xr Ankle Routine Rt 3 Views,,73610,CPT,Facility,Inpatient,,,RT,280,238,80.248,280,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Ankle Routine Rt 3 Views,,73610,CPT,Facility,Outpatient,,,RT,280,238,80.248,280,PrimeWest Health,MinnesotaCare,143.808,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Xr Ankle Routine Rt 3 Views,,73610,CPT,Facility,Inpatient,,,RT,280,238,80.248,280,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Xr Ankle Routine Rt 3 Views,,73610,CPT,Facility,Both,,,RT,280,238,80.248,280,Sanford Health Plan,Sanford Health Plan,257.6,92,,percent of total billed charges,,
Xr Ankle Routine Rt 3 Views,,73610,CPT,Facility,Outpatient,,,RT,280,238,80.248,280,"UCare Health, Inc.",Individual & Family Plan,157.78,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Xr Ankle Routine Rt 3 Views,,73610,CPT,Facility,Inpatient,,,RT,280,238,80.248,280,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Xr Ankle Routine Rt 3 Views,,73610,CPT,Facility,Outpatient,,,RT,280,238,80.248,280,"UCare Health, Inc.",Medical Assistance,141.316,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Ankle Routine Rt 3 Views,,73610,CPT,Facility,Inpatient,,,RT,280,238,80.248,280,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Xr Ankle Routine Rt 3 Views,,73610,CPT,Facility,Outpatient,,,RT,280,238,80.248,280,"UCare Health, Inc.",Medicare Advantage,141.316,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Ankle Routine Rt 3 Views,,73610,CPT,Facility,Inpatient,,,RT,280,238,80.248,280,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Ankle Routine Rt 3 Views,,73610,CPT,Facility,Outpatient,,,RT,280,238,80.248,280,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),141.316,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Ankle Routine Rt 3 Views,,73610,CPT,Facility,Inpatient,,,RT,280,238,80.248,280,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Ankle Routine Rt 3 Views,,73610,CPT,Facility,Both,,,RT,280,238,80.248,280,UnitedHealthcare,Individual & Family,263.2,94,,percent of total billed charges,,
Xr Ankle Routine Rt 3 Views,,73610,CPT,Facility,Outpatient,,,RT,280,238,80.248,280,UnitedHealthcare,Medicare Advantage,137.2,49,,percent of total billed charges,,
Xr Ankle Routine Rt 3 Views,,73610,CPT,Facility,Inpatient,,,RT,280,238,80.248,280,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Xr Ankle Routine Rt 3 Views,,73610,CPT,Facility,Outpatient,,,RT,280,238,80.248,280,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,134.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
Xr Ankle Routine Rt 3 Views,,73610,CPT,Facility,Inpatient,,,RT,280,238,80.248,280,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Xr Foot Rt 2 Views,,73620,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,Aetna,Commercial,237.36,92,,percent of total billed charges,,
Xr Foot Rt 2 Views,,73620,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,Aetna,Medicare Advantage,126.42,49,,percent of total billed charges,,
Xr Foot Rt 2 Views,,73620,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Xr Foot Rt 2 Views,,73620,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,Aetna,PPO,239.94,93,,percent of total billed charges,,
Xr Foot Rt 2 Views,,73620,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,America's PPO,America's PPO,247.7574,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Xr Foot Rt 2 Views,,73620,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota, Federal Employee Program,253.872,98.4,,percent of total billed charges,,
Xr Foot Rt 2 Views,,73620,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,258,100,,percent of total billed charges,,
Xr Foot Rt 2 Views,,73620,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,High Value Network Plan,232.2,90,,percent of total billed charges,,
Xr Foot Rt 2 Views,,73620,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,Medicare Advantage,126.42,49,,percent of total billed charges,,
Xr Foot Rt 2 Views,,73620,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Xr Foot Rt 2 Views,,73620,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,228.5106,88.57,,percent of total billed charges,,
Xr Foot Rt 2 Views,,73620,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,73.9428,28.66,,percent of total billed charges,,
Xr Foot Rt 2 Views,,73620,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),126.42,49,,percent of total billed charges,,
Xr Foot Rt 2 Views,,73620,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Xr Foot Rt 2 Views,,73620,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,CorVel,Worker's Compensation,258,100,,percent of total billed charges,,
Xr Foot Rt 2 Views,,73620,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,First Health Group Corporation,First Health Network,250.26,97,,percent of total billed charges,,
Xr Foot Rt 2 Views,,73620,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,"Health Partners, Inc.",Commercial,244.068,94.6,,percent of total billed charges,,
Xr Foot Rt 2 Views,,73620,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,"Health Partners, Inc.",Medicare Advantage,126.42,49,,percent of total billed charges,,
Xr Foot Rt 2 Views,,73620,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Foot Rt 2 Views,,73620,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),154.8,60,,percent of total billed charges,,
Xr Foot Rt 2 Views,,73620,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,"Health Partners, Inc.",State of Minnesota Advantage Program,210.27,81.5,,percent of total billed charges,,
Xr Foot Rt 2 Views,,73620,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,"Health Partners, Inc.",State Public Programs,129,50,,percent of total billed charges,,
Xr Foot Rt 2 Views,,73620,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,Humana Insurance Company,Commercial PPO,245.1,95,,percent of total billed charges,,
Xr Foot Rt 2 Views,,73620,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,Humana Insurance Company,Medicare PPO,126.42,49,,percent of total billed charges,,
Xr Foot Rt 2 Views,,73620,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Xr Foot Rt 2 Views,,73620,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,Medica,Individual & Family,255.678,99.1,,percent of total billed charges,,
Xr Foot Rt 2 Views,,73620,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,Medica,Medica Advantage Solution,128.484,49.8,,percent of total billed charges,,
Xr Foot Rt 2 Views,,73620,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Xr Foot Rt 2 Views,,73620,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,Medica,Medical Assistance,115.068,44.6,,percent of total billed charges,,
Xr Foot Rt 2 Views,,73620,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,Medica,Medical Assistance,,,,,Included in per diem rate,
Xr Foot Rt 2 Views,,73620,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,128.484,49.8,,percent of total billed charges,,
Xr Foot Rt 2 Views,,73620,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Xr Foot Rt 2 Views,,73620,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,"Multiplan, Inc.","Multiplan, Inc.",242.52,94,,percent of total billed charges,,
Xr Foot Rt 2 Views,,73620,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,232.458,90.1,,percent of total billed charges,,
Xr Foot Rt 2 Views,,73620,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Xr Foot Rt 2 Views,,73620,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,"Preferred One Administrative Services, INC.",PPO,254.388,98.6,,percent of total billed charges,,
Xr Foot Rt 2 Views,,73620,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,PrimeWest Health,Minnesota Senior Health Options (MSHO),132.741,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Xr Foot Rt 2 Views,,73620,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Foot Rt 2 Views,,73620,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,PrimeWest Health,MinnesotaCare,132.5088,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Xr Foot Rt 2 Views,,73620,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Xr Foot Rt 2 Views,,73620,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,Sanford Health Plan,Sanford Health Plan,237.36,92,,percent of total billed charges,,
Xr Foot Rt 2 Views,,73620,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,"UCare Health, Inc.",Individual & Family Plan,145.383,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Xr Foot Rt 2 Views,,73620,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Xr Foot Rt 2 Views,,73620,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,"UCare Health, Inc.",Medical Assistance,130.2126,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Foot Rt 2 Views,,73620,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Xr Foot Rt 2 Views,,73620,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,"UCare Health, Inc.",Medicare Advantage,130.2126,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Foot Rt 2 Views,,73620,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Foot Rt 2 Views,,73620,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),130.2126,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Foot Rt 2 Views,,73620,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Foot Rt 2 Views,,73620,CPT,Facility,Both,,,RT,258,219.3,73.9428,258,UnitedHealthcare,Individual & Family,242.52,94,,percent of total billed charges,,
Xr Foot Rt 2 Views,,73620,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,UnitedHealthcare,Medicare Advantage,126.42,49,,percent of total billed charges,,
Xr Foot Rt 2 Views,,73620,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Xr Foot Rt 2 Views,,73620,CPT,Facility,Outpatient,,,RT,258,219.3,73.9428,258,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,123.84,48,,percent of total billed charges,,100% of DHS outpatient percentage
Xr Foot Rt 2 Views,,73620,CPT,Facility,Inpatient,,,RT,258,219.3,73.9428,258,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Xr Foot Routine Rt 3 Views,,73630,CPT,Facility,Both,,,RT,280,238,80.248,280,Aetna,Commercial,257.6,92,,percent of total billed charges,,
Xr Foot Routine Rt 3 Views,,73630,CPT,Facility,Outpatient,,,RT,280,238,80.248,280,Aetna,Medicare Advantage,137.2,49,,percent of total billed charges,,
Xr Foot Routine Rt 3 Views,,73630,CPT,Facility,Inpatient,,,RT,280,238,80.248,280,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Xr Foot Routine Rt 3 Views,,73630,CPT,Facility,Both,,,RT,280,238,80.248,280,Aetna,PPO,260.4,93,,percent of total billed charges,,
Xr Foot Routine Rt 3 Views,,73630,CPT,Facility,Both,,,RT,280,238,80.248,280,America's PPO,America's PPO,268.884,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Xr Foot Routine Rt 3 Views,,73630,CPT,Facility,Both,,,RT,280,238,80.248,280,BlueCross BlueShield Minnesota, Federal Employee Program,275.52,98.4,,percent of total billed charges,,
Xr Foot Routine Rt 3 Views,,73630,CPT,Facility,Both,,,RT,280,238,80.248,280,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,280,100,,percent of total billed charges,,
Xr Foot Routine Rt 3 Views,,73630,CPT,Facility,Both,,,RT,280,238,80.248,280,BlueCross BlueShield Minnesota,High Value Network Plan,252,90,,percent of total billed charges,,
Xr Foot Routine Rt 3 Views,,73630,CPT,Facility,Outpatient,,,RT,280,238,80.248,280,BlueCross BlueShield Minnesota,Medicare Advantage,137.2,49,,percent of total billed charges,,
Xr Foot Routine Rt 3 Views,,73630,CPT,Facility,Inpatient,,,RT,280,238,80.248,280,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Xr Foot Routine Rt 3 Views,,73630,CPT,Facility,Both,,,RT,280,238,80.248,280,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,247.996,88.57,,percent of total billed charges,,
Xr Foot Routine Rt 3 Views,,73630,CPT,Facility,Both,,,RT,280,238,80.248,280,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,80.248,28.66,,percent of total billed charges,,
Xr Foot Routine Rt 3 Views,,73630,CPT,Facility,Outpatient,,,RT,280,238,80.248,280,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),137.2,49,,percent of total billed charges,,
Xr Foot Routine Rt 3 Views,,73630,CPT,Facility,Inpatient,,,RT,280,238,80.248,280,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Xr Foot Routine Rt 3 Views,,73630,CPT,Facility,Both,,,RT,280,238,80.248,280,CorVel,Worker's Compensation,280,100,,percent of total billed charges,,
Xr Foot Routine Rt 3 Views,,73630,CPT,Facility,Both,,,RT,280,238,80.248,280,First Health Group Corporation,First Health Network,271.6,97,,percent of total billed charges,,
Xr Foot Routine Rt 3 Views,,73630,CPT,Facility,Both,,,RT,280,238,80.248,280,"Health Partners, Inc.",Commercial,264.88,94.6,,percent of total billed charges,,
Xr Foot Routine Rt 3 Views,,73630,CPT,Facility,Outpatient,,,RT,280,238,80.248,280,"Health Partners, Inc.",Medicare Advantage,137.2,49,,percent of total billed charges,,
Xr Foot Routine Rt 3 Views,,73630,CPT,Facility,Inpatient,,,RT,280,238,80.248,280,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Foot Routine Rt 3 Views,,73630,CPT,Facility,Both,,,RT,280,238,80.248,280,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),168,60,,percent of total billed charges,,
Xr Foot Routine Rt 3 Views,,73630,CPT,Facility,Both,,,RT,280,238,80.248,280,"Health Partners, Inc.",State of Minnesota Advantage Program,228.2,81.5,,percent of total billed charges,,
Xr Foot Routine Rt 3 Views,,73630,CPT,Facility,Both,,,RT,280,238,80.248,280,"Health Partners, Inc.",State Public Programs,140,50,,percent of total billed charges,,
Xr Foot Routine Rt 3 Views,,73630,CPT,Facility,Both,,,RT,280,238,80.248,280,Humana Insurance Company,Commercial PPO,266,95,,percent of total billed charges,,
Xr Foot Routine Rt 3 Views,,73630,CPT,Facility,Outpatient,,,RT,280,238,80.248,280,Humana Insurance Company,Medicare PPO,137.2,49,,percent of total billed charges,,
Xr Foot Routine Rt 3 Views,,73630,CPT,Facility,Inpatient,,,RT,280,238,80.248,280,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Xr Foot Routine Rt 3 Views,,73630,CPT,Facility,Both,,,RT,280,238,80.248,280,Medica,Individual & Family,277.48,99.1,,percent of total billed charges,,
Xr Foot Routine Rt 3 Views,,73630,CPT,Facility,Outpatient,,,RT,280,238,80.248,280,Medica,Medica Advantage Solution,139.44,49.8,,percent of total billed charges,,
Xr Foot Routine Rt 3 Views,,73630,CPT,Facility,Inpatient,,,RT,280,238,80.248,280,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Xr Foot Routine Rt 3 Views,,73630,CPT,Facility,Outpatient,,,RT,280,238,80.248,280,Medica,Medical Assistance,124.88,44.6,,percent of total billed charges,,
Xr Foot Routine Rt 3 Views,,73630,CPT,Facility,Inpatient,,,RT,280,238,80.248,280,Medica,Medical Assistance,,,,,Included in per diem rate,
Xr Foot Routine Rt 3 Views,,73630,CPT,Facility,Outpatient,,,RT,280,238,80.248,280,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,139.44,49.8,,percent of total billed charges,,
Xr Foot Routine Rt 3 Views,,73630,CPT,Facility,Inpatient,,,RT,280,238,80.248,280,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Xr Foot Routine Rt 3 Views,,73630,CPT,Facility,Both,,,RT,280,238,80.248,280,"Multiplan, Inc.","Multiplan, Inc.",263.2,94,,percent of total billed charges,,
Xr Foot Routine Rt 3 Views,,73630,CPT,Facility,Outpatient,,,RT,280,238,80.248,280,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,252.28,90.1,,percent of total billed charges,,
Xr Foot Routine Rt 3 Views,,73630,CPT,Facility,Inpatient,,,RT,280,238,80.248,280,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Xr Foot Routine Rt 3 Views,,73630,CPT,Facility,Both,,,RT,280,238,80.248,280,"Preferred One Administrative Services, INC.",PPO,276.08,98.6,,percent of total billed charges,,
Xr Foot Routine Rt 3 Views,,73630,CPT,Facility,Outpatient,,,RT,280,238,80.248,280,PrimeWest Health,Minnesota Senior Health Options (MSHO),144.06,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Xr Foot Routine Rt 3 Views,,73630,CPT,Facility,Inpatient,,,RT,280,238,80.248,280,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Foot Routine Rt 3 Views,,73630,CPT,Facility,Outpatient,,,RT,280,238,80.248,280,PrimeWest Health,MinnesotaCare,143.808,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Xr Foot Routine Rt 3 Views,,73630,CPT,Facility,Inpatient,,,RT,280,238,80.248,280,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Xr Foot Routine Rt 3 Views,,73630,CPT,Facility,Both,,,RT,280,238,80.248,280,Sanford Health Plan,Sanford Health Plan,257.6,92,,percent of total billed charges,,
Xr Foot Routine Rt 3 Views,,73630,CPT,Facility,Outpatient,,,RT,280,238,80.248,280,"UCare Health, Inc.",Individual & Family Plan,157.78,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Xr Foot Routine Rt 3 Views,,73630,CPT,Facility,Inpatient,,,RT,280,238,80.248,280,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Xr Foot Routine Rt 3 Views,,73630,CPT,Facility,Outpatient,,,RT,280,238,80.248,280,"UCare Health, Inc.",Medical Assistance,141.316,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Foot Routine Rt 3 Views,,73630,CPT,Facility,Inpatient,,,RT,280,238,80.248,280,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Xr Foot Routine Rt 3 Views,,73630,CPT,Facility,Outpatient,,,RT,280,238,80.248,280,"UCare Health, Inc.",Medicare Advantage,141.316,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Foot Routine Rt 3 Views,,73630,CPT,Facility,Inpatient,,,RT,280,238,80.248,280,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Foot Routine Rt 3 Views,,73630,CPT,Facility,Outpatient,,,RT,280,238,80.248,280,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),141.316,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Foot Routine Rt 3 Views,,73630,CPT,Facility,Inpatient,,,RT,280,238,80.248,280,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Foot Routine Rt 3 Views,,73630,CPT,Facility,Both,,,RT,280,238,80.248,280,UnitedHealthcare,Individual & Family,263.2,94,,percent of total billed charges,,
Xr Foot Routine Rt 3 Views,,73630,CPT,Facility,Outpatient,,,RT,280,238,80.248,280,UnitedHealthcare,Medicare Advantage,137.2,49,,percent of total billed charges,,
Xr Foot Routine Rt 3 Views,,73630,CPT,Facility,Inpatient,,,RT,280,238,80.248,280,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Xr Foot Routine Rt 3 Views,,73630,CPT,Facility,Outpatient,,,RT,280,238,80.248,280,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,134.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
Xr Foot Routine Rt 3 Views,,73630,CPT,Facility,Inpatient,,,RT,280,238,80.248,280,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Xr Os Calcis Rt Heel,,73650,CPT,Facility,Both,,,RT,270,229.5,77.382,270,Aetna,Commercial,248.4,92,,percent of total billed charges,,
Xr Os Calcis Rt Heel,,73650,CPT,Facility,Outpatient,,,RT,270,229.5,77.382,270,Aetna,Medicare Advantage,132.3,49,,percent of total billed charges,,
Xr Os Calcis Rt Heel,,73650,CPT,Facility,Inpatient,,,RT,270,229.5,77.382,270,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Xr Os Calcis Rt Heel,,73650,CPT,Facility,Both,,,RT,270,229.5,77.382,270,Aetna,PPO,251.1,93,,percent of total billed charges,,
Xr Os Calcis Rt Heel,,73650,CPT,Facility,Both,,,RT,270,229.5,77.382,270,America's PPO,America's PPO,259.281,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Xr Os Calcis Rt Heel,,73650,CPT,Facility,Both,,,RT,270,229.5,77.382,270,BlueCross BlueShield Minnesota, Federal Employee Program,265.68,98.4,,percent of total billed charges,,
Xr Os Calcis Rt Heel,,73650,CPT,Facility,Both,,,RT,270,229.5,77.382,270,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,270,100,,percent of total billed charges,,
Xr Os Calcis Rt Heel,,73650,CPT,Facility,Both,,,RT,270,229.5,77.382,270,BlueCross BlueShield Minnesota,High Value Network Plan,243,90,,percent of total billed charges,,
Xr Os Calcis Rt Heel,,73650,CPT,Facility,Outpatient,,,RT,270,229.5,77.382,270,BlueCross BlueShield Minnesota,Medicare Advantage,132.3,49,,percent of total billed charges,,
Xr Os Calcis Rt Heel,,73650,CPT,Facility,Inpatient,,,RT,270,229.5,77.382,270,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Xr Os Calcis Rt Heel,,73650,CPT,Facility,Both,,,RT,270,229.5,77.382,270,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,239.139,88.57,,percent of total billed charges,,
Xr Os Calcis Rt Heel,,73650,CPT,Facility,Both,,,RT,270,229.5,77.382,270,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,77.382,28.66,,percent of total billed charges,,
Xr Os Calcis Rt Heel,,73650,CPT,Facility,Outpatient,,,RT,270,229.5,77.382,270,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),132.3,49,,percent of total billed charges,,
Xr Os Calcis Rt Heel,,73650,CPT,Facility,Inpatient,,,RT,270,229.5,77.382,270,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Xr Os Calcis Rt Heel,,73650,CPT,Facility,Both,,,RT,270,229.5,77.382,270,CorVel,Worker's Compensation,270,100,,percent of total billed charges,,
Xr Os Calcis Rt Heel,,73650,CPT,Facility,Both,,,RT,270,229.5,77.382,270,First Health Group Corporation,First Health Network,261.9,97,,percent of total billed charges,,
Xr Os Calcis Rt Heel,,73650,CPT,Facility,Both,,,RT,270,229.5,77.382,270,"Health Partners, Inc.",Commercial,255.42,94.6,,percent of total billed charges,,
Xr Os Calcis Rt Heel,,73650,CPT,Facility,Outpatient,,,RT,270,229.5,77.382,270,"Health Partners, Inc.",Medicare Advantage,132.3,49,,percent of total billed charges,,
Xr Os Calcis Rt Heel,,73650,CPT,Facility,Inpatient,,,RT,270,229.5,77.382,270,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Os Calcis Rt Heel,,73650,CPT,Facility,Both,,,RT,270,229.5,77.382,270,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),162,60,,percent of total billed charges,,
Xr Os Calcis Rt Heel,,73650,CPT,Facility,Both,,,RT,270,229.5,77.382,270,"Health Partners, Inc.",State of Minnesota Advantage Program,220.05,81.5,,percent of total billed charges,,
Xr Os Calcis Rt Heel,,73650,CPT,Facility,Both,,,RT,270,229.5,77.382,270,"Health Partners, Inc.",State Public Programs,135,50,,percent of total billed charges,,
Xr Os Calcis Rt Heel,,73650,CPT,Facility,Both,,,RT,270,229.5,77.382,270,Humana Insurance Company,Commercial PPO,256.5,95,,percent of total billed charges,,
Xr Os Calcis Rt Heel,,73650,CPT,Facility,Outpatient,,,RT,270,229.5,77.382,270,Humana Insurance Company,Medicare PPO,132.3,49,,percent of total billed charges,,
Xr Os Calcis Rt Heel,,73650,CPT,Facility,Inpatient,,,RT,270,229.5,77.382,270,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Xr Os Calcis Rt Heel,,73650,CPT,Facility,Both,,,RT,270,229.5,77.382,270,Medica,Individual & Family,267.57,99.1,,percent of total billed charges,,
Xr Os Calcis Rt Heel,,73650,CPT,Facility,Outpatient,,,RT,270,229.5,77.382,270,Medica,Medica Advantage Solution,134.46,49.8,,percent of total billed charges,,
Xr Os Calcis Rt Heel,,73650,CPT,Facility,Inpatient,,,RT,270,229.5,77.382,270,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Xr Os Calcis Rt Heel,,73650,CPT,Facility,Outpatient,,,RT,270,229.5,77.382,270,Medica,Medical Assistance,120.42,44.6,,percent of total billed charges,,
Xr Os Calcis Rt Heel,,73650,CPT,Facility,Inpatient,,,RT,270,229.5,77.382,270,Medica,Medical Assistance,,,,,Included in per diem rate,
Xr Os Calcis Rt Heel,,73650,CPT,Facility,Outpatient,,,RT,270,229.5,77.382,270,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,134.46,49.8,,percent of total billed charges,,
Xr Os Calcis Rt Heel,,73650,CPT,Facility,Inpatient,,,RT,270,229.5,77.382,270,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Xr Os Calcis Rt Heel,,73650,CPT,Facility,Both,,,RT,270,229.5,77.382,270,"Multiplan, Inc.","Multiplan, Inc.",253.8,94,,percent of total billed charges,,
Xr Os Calcis Rt Heel,,73650,CPT,Facility,Outpatient,,,RT,270,229.5,77.382,270,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,243.27,90.1,,percent of total billed charges,,
Xr Os Calcis Rt Heel,,73650,CPT,Facility,Inpatient,,,RT,270,229.5,77.382,270,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Xr Os Calcis Rt Heel,,73650,CPT,Facility,Both,,,RT,270,229.5,77.382,270,"Preferred One Administrative Services, INC.",PPO,266.22,98.6,,percent of total billed charges,,
Xr Os Calcis Rt Heel,,73650,CPT,Facility,Outpatient,,,RT,270,229.5,77.382,270,PrimeWest Health,Minnesota Senior Health Options (MSHO),138.915,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Xr Os Calcis Rt Heel,,73650,CPT,Facility,Inpatient,,,RT,270,229.5,77.382,270,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Os Calcis Rt Heel,,73650,CPT,Facility,Outpatient,,,RT,270,229.5,77.382,270,PrimeWest Health,MinnesotaCare,138.672,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Xr Os Calcis Rt Heel,,73650,CPT,Facility,Inpatient,,,RT,270,229.5,77.382,270,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Xr Os Calcis Rt Heel,,73650,CPT,Facility,Both,,,RT,270,229.5,77.382,270,Sanford Health Plan,Sanford Health Plan,248.4,92,,percent of total billed charges,,
Xr Os Calcis Rt Heel,,73650,CPT,Facility,Outpatient,,,RT,270,229.5,77.382,270,"UCare Health, Inc.",Individual & Family Plan,152.145,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Xr Os Calcis Rt Heel,,73650,CPT,Facility,Inpatient,,,RT,270,229.5,77.382,270,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Xr Os Calcis Rt Heel,,73650,CPT,Facility,Outpatient,,,RT,270,229.5,77.382,270,"UCare Health, Inc.",Medical Assistance,136.269,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Os Calcis Rt Heel,,73650,CPT,Facility,Inpatient,,,RT,270,229.5,77.382,270,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Xr Os Calcis Rt Heel,,73650,CPT,Facility,Outpatient,,,RT,270,229.5,77.382,270,"UCare Health, Inc.",Medicare Advantage,136.269,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Os Calcis Rt Heel,,73650,CPT,Facility,Inpatient,,,RT,270,229.5,77.382,270,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Os Calcis Rt Heel,,73650,CPT,Facility,Outpatient,,,RT,270,229.5,77.382,270,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),136.269,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Os Calcis Rt Heel,,73650,CPT,Facility,Inpatient,,,RT,270,229.5,77.382,270,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Os Calcis Rt Heel,,73650,CPT,Facility,Both,,,RT,270,229.5,77.382,270,UnitedHealthcare,Individual & Family,253.8,94,,percent of total billed charges,,
Xr Os Calcis Rt Heel,,73650,CPT,Facility,Outpatient,,,RT,270,229.5,77.382,270,UnitedHealthcare,Medicare Advantage,132.3,49,,percent of total billed charges,,
Xr Os Calcis Rt Heel,,73650,CPT,Facility,Inpatient,,,RT,270,229.5,77.382,270,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Xr Os Calcis Rt Heel,,73650,CPT,Facility,Outpatient,,,RT,270,229.5,77.382,270,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,129.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
Xr Os Calcis Rt Heel,,73650,CPT,Facility,Inpatient,,,RT,270,229.5,77.382,270,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Cta Lower Extremity Right,,73706,CPT,Facility,Both,,,RT,2244,1907.4,499,2244,Aetna,Commercial,2064.48,92,,percent of total billed charges,,
Cta Lower Extremity Right,,73706,CPT,Facility,Outpatient,,,RT,2244,1907.4,499,2244,Aetna,Medicare Advantage,1099.56,49,,percent of total billed charges,,
Cta Lower Extremity Right,,73706,CPT,Facility,Inpatient,,,RT,2244,1907.4,499,2244,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Cta Lower Extremity Right,,73706,CPT,Facility,Both,,,RT,2244,1907.4,499,2244,Aetna,PPO,2086.92,93,,percent of total billed charges,,
Cta Lower Extremity Right,,73706,CPT,Facility,Both,,,RT,2244,1907.4,499,2244,America's PPO,America's PPO,2154.9132,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Cta Lower Extremity Right,,73706,CPT,Facility,Both,,,RT,2244,1907.4,499,2244,BlueCross BlueShield Minnesota, Federal Employee Program,2208.096,98.4,,percent of total billed charges,,
Cta Lower Extremity Right,,73706,CPT,Facility,Both,,,RT,2244,1907.4,499,2244,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,2244,100,,percent of total billed charges,,
Cta Lower Extremity Right,,73706,CPT,Facility,Both,,,RT,2244,1907.4,499,2244,BlueCross BlueShield Minnesota,High Value Network Plan,2019.6,90,,percent of total billed charges,,
Cta Lower Extremity Right,,73706,CPT,Facility,Outpatient,,,RT,2244,1907.4,499,2244,BlueCross BlueShield Minnesota,Medicare Advantage,1099.56,49,,percent of total billed charges,,
Cta Lower Extremity Right,,73706,CPT,Facility,Inpatient,,,RT,2244,1907.4,499,2244,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Cta Lower Extremity Right,,73706,CPT,Facility,Both,,,RT,2244,1907.4,499,2244,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1987.5108,88.57,,percent of total billed charges,,
Cta Lower Extremity Right,,73706,CPT,Facility,Both,,,RT,2244,1907.4,499,2244,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,643.1304,28.66,,percent of total billed charges,,
Cta Lower Extremity Right,,73706,CPT,Facility,Outpatient,,,RT,2244,1907.4,499,2244,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1099.56,49,,percent of total billed charges,,
Cta Lower Extremity Right,,73706,CPT,Facility,Inpatient,,,RT,2244,1907.4,499,2244,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Cta Lower Extremity Right,,73706,CPT,Facility,Both,,,RT,2244,1907.4,499,2244,CorVel,Worker's Compensation,2244,100,,percent of total billed charges,,
Cta Lower Extremity Right,,73706,CPT,Facility,Both,,,RT,2244,1907.4,499,2244,First Health Group Corporation,First Health Network,2176.68,97,,percent of total billed charges,,
Cta Lower Extremity Right,,73706,CPT,Facility,Both,,,RT,2244,1907.4,499,2244,"Health Partners, Inc.",Commercial,2122.824,94.6,,percent of total billed charges,,
Cta Lower Extremity Right,,73706,CPT,Facility,Outpatient,,,RT,2244,1907.4,499,2244,"Health Partners, Inc.",Medicare Advantage,1099.56,49,,percent of total billed charges,,
Cta Lower Extremity Right,,73706,CPT,Facility,Inpatient,,,RT,2244,1907.4,499,2244,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Cta Lower Extremity Right,,73706,CPT,Facility,Both,,,RT,2244,1907.4,499,2244,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1346.4,60,,percent of total billed charges,,
Cta Lower Extremity Right,,73706,CPT,Facility,Both,,,RT,2244,1907.4,499,2244,"Health Partners, Inc.",State of Minnesota Advantage Program,1828.86,81.5,,percent of total billed charges,,
Cta Lower Extremity Right,,73706,CPT,Facility,Both,,,RT,2244,1907.4,499,2244,"Health Partners, Inc.",State Public Programs,1122,50,,percent of total billed charges,,
Cta Lower Extremity Right,,73706,CPT,Facility,Both,,,RT,2244,1907.4,499,2244,Humana Insurance Company,Commercial PPO,2131.8,95,,percent of total billed charges,,
Cta Lower Extremity Right,,73706,CPT,Facility,Outpatient,,,RT,2244,1907.4,499,2244,Humana Insurance Company,Medicare PPO,1099.56,49,,percent of total billed charges,,
Cta Lower Extremity Right,,73706,CPT,Facility,Inpatient,,,RT,2244,1907.4,499,2244,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Cta Lower Extremity Right,,73706,CPT,Facility,Both,,,RT,2244,1907.4,499,2244,Medica,Individual & Family,2223.804,99.1,,percent of total billed charges,,
Cta Lower Extremity Right,,73706,CPT,Facility,Outpatient,,,RT,2244,1907.4,499,2244,Medica,Medica Advantage Solution,1117.512,49.8,,percent of total billed charges,,
Cta Lower Extremity Right,,73706,CPT,Facility,Inpatient,,,RT,2244,1907.4,499,2244,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Cta Lower Extremity Right,,73706,CPT,Facility,Outpatient,,,RT,2244,1907.4,499,2244,Medica,Medical Assistance,499,,,Other,Per visit,Pays in addition to all Outpatient Service Categories
Cta Lower Extremity Right,,73706,CPT,Facility,Inpatient,,,RT,2244,1907.4,499,2244,Medica,Medical Assistance,,,,,Included in per diem rate,
Cta Lower Extremity Right,,73706,CPT,Facility,Outpatient,,,RT,2244,1907.4,499,2244,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1117.512,49.8,,percent of total billed charges,,
Cta Lower Extremity Right,,73706,CPT,Facility,Inpatient,,,RT,2244,1907.4,499,2244,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Cta Lower Extremity Right,,73706,CPT,Facility,Both,,,RT,2244,1907.4,499,2244,"Multiplan, Inc.","Multiplan, Inc.",2109.36,94,,percent of total billed charges,,
Cta Lower Extremity Right,,73706,CPT,Facility,Outpatient,,,RT,2244,1907.4,499,2244,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1283,,,Other,Per scan,
Cta Lower Extremity Right,,73706,CPT,Facility,Inpatient,,,RT,2244,1907.4,499,2244,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Cta Lower Extremity Right,,73706,CPT,Facility,Both,,,RT,2244,1907.4,499,2244,"Preferred One Administrative Services, INC.",PPO,2212.584,98.6,,percent of total billed charges,,
Cta Lower Extremity Right,,73706,CPT,Facility,Outpatient,,,RT,2244,1907.4,499,2244,PrimeWest Health,Minnesota Senior Health Options (MSHO),1154.538,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Cta Lower Extremity Right,,73706,CPT,Facility,Inpatient,,,RT,2244,1907.4,499,2244,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Cta Lower Extremity Right,,73706,CPT,Facility,Outpatient,,,RT,2244,1907.4,499,2244,PrimeWest Health,MinnesotaCare,1152.5184,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Cta Lower Extremity Right,,73706,CPT,Facility,Inpatient,,,RT,2244,1907.4,499,2244,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Cta Lower Extremity Right,,73706,CPT,Facility,Both,,,RT,2244,1907.4,499,2244,Sanford Health Plan,Sanford Health Plan,2064.48,92,,percent of total billed charges,,
Cta Lower Extremity Right,,73706,CPT,Facility,Outpatient,,,RT,2244,1907.4,499,2244,"UCare Health, Inc.",Individual & Family Plan,1264.494,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Cta Lower Extremity Right,,73706,CPT,Facility,Inpatient,,,RT,2244,1907.4,499,2244,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Cta Lower Extremity Right,,73706,CPT,Facility,Outpatient,,,RT,2244,1907.4,499,2244,"UCare Health, Inc.",Medical Assistance,1132.5468,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Cta Lower Extremity Right,,73706,CPT,Facility,Inpatient,,,RT,2244,1907.4,499,2244,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Cta Lower Extremity Right,,73706,CPT,Facility,Outpatient,,,RT,2244,1907.4,499,2244,"UCare Health, Inc.",Medicare Advantage,1132.5468,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Cta Lower Extremity Right,,73706,CPT,Facility,Inpatient,,,RT,2244,1907.4,499,2244,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Cta Lower Extremity Right,,73706,CPT,Facility,Outpatient,,,RT,2244,1907.4,499,2244,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1132.5468,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Cta Lower Extremity Right,,73706,CPT,Facility,Inpatient,,,RT,2244,1907.4,499,2244,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Cta Lower Extremity Right,,73706,CPT,Facility,Both,,,RT,2244,1907.4,499,2244,UnitedHealthcare,Individual & Family,2109.36,94,,percent of total billed charges,,
Cta Lower Extremity Right,,73706,CPT,Facility,Outpatient,,,RT,2244,1907.4,499,2244,UnitedHealthcare,Medicare Advantage,1099.56,49,,percent of total billed charges,,
Cta Lower Extremity Right,,73706,CPT,Facility,Inpatient,,,RT,2244,1907.4,499,2244,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Cta Lower Extremity Right,,73706,CPT,Facility,Outpatient,,,RT,2244,1907.4,499,2244,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1077.12,48,,percent of total billed charges,,100% of DHS outpatient percentage
Cta Lower Extremity Right,,73706,CPT,Facility,Inpatient,,,RT,2244,1907.4,499,2244,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Mri Lower Extremity Rt Not Jt Wo Contrast,,73718,CPT,Facility,Both,,,RT,2339,1988.15,670.3574,2339,Aetna,Commercial,2151.88,92,,percent of total billed charges,,
Mri Lower Extremity Rt Not Jt Wo Contrast,,73718,CPT,Facility,Outpatient,,,RT,2339,1988.15,670.3574,2339,Aetna,Medicare Advantage,1146.11,49,,percent of total billed charges,,
Mri Lower Extremity Rt Not Jt Wo Contrast,,73718,CPT,Facility,Inpatient,,,RT,2339,1988.15,670.3574,2339,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Mri Lower Extremity Rt Not Jt Wo Contrast,,73718,CPT,Facility,Both,,,RT,2339,1988.15,670.3574,2339,Aetna,PPO,2175.27,93,,percent of total billed charges,,
Mri Lower Extremity Rt Not Jt Wo Contrast,,73718,CPT,Facility,Both,,,RT,2339,1988.15,670.3574,2339,America's PPO,America's PPO,2246.1417,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Mri Lower Extremity Rt Not Jt Wo Contrast,,73718,CPT,Facility,Both,,,RT,2339,1988.15,670.3574,2339,BlueCross BlueShield Minnesota, Federal Employee Program,2301.576,98.4,,percent of total billed charges,,
Mri Lower Extremity Rt Not Jt Wo Contrast,,73718,CPT,Facility,Both,,,RT,2339,1988.15,670.3574,2339,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,2339,100,,percent of total billed charges,,
Mri Lower Extremity Rt Not Jt Wo Contrast,,73718,CPT,Facility,Both,,,RT,2339,1988.15,670.3574,2339,BlueCross BlueShield Minnesota,High Value Network Plan,2105.1,90,,percent of total billed charges,,
Mri Lower Extremity Rt Not Jt Wo Contrast,,73718,CPT,Facility,Outpatient,,,RT,2339,1988.15,670.3574,2339,BlueCross BlueShield Minnesota,Medicare Advantage,1146.11,49,,percent of total billed charges,,
Mri Lower Extremity Rt Not Jt Wo Contrast,,73718,CPT,Facility,Inpatient,,,RT,2339,1988.15,670.3574,2339,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Mri Lower Extremity Rt Not Jt Wo Contrast,,73718,CPT,Facility,Both,,,RT,2339,1988.15,670.3574,2339,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,2071.6523,88.57,,percent of total billed charges,,
Mri Lower Extremity Rt Not Jt Wo Contrast,,73718,CPT,Facility,Both,,,RT,2339,1988.15,670.3574,2339,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,670.3574,28.66,,percent of total billed charges,,
Mri Lower Extremity Rt Not Jt Wo Contrast,,73718,CPT,Facility,Outpatient,,,RT,2339,1988.15,670.3574,2339,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1146.11,49,,percent of total billed charges,,
Mri Lower Extremity Rt Not Jt Wo Contrast,,73718,CPT,Facility,Inpatient,,,RT,2339,1988.15,670.3574,2339,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Mri Lower Extremity Rt Not Jt Wo Contrast,,73718,CPT,Facility,Both,,,RT,2339,1988.15,670.3574,2339,CorVel,Worker's Compensation,2339,100,,percent of total billed charges,,
Mri Lower Extremity Rt Not Jt Wo Contrast,,73718,CPT,Facility,Both,,,RT,2339,1988.15,670.3574,2339,First Health Group Corporation,First Health Network,2268.83,97,,percent of total billed charges,,
Mri Lower Extremity Rt Not Jt Wo Contrast,,73718,CPT,Facility,Both,,,RT,2339,1988.15,670.3574,2339,"Health Partners, Inc.",Commercial,2212.694,94.6,,percent of total billed charges,,
Mri Lower Extremity Rt Not Jt Wo Contrast,,73718,CPT,Facility,Outpatient,,,RT,2339,1988.15,670.3574,2339,"Health Partners, Inc.",Medicare Advantage,1146.11,49,,percent of total billed charges,,
Mri Lower Extremity Rt Not Jt Wo Contrast,,73718,CPT,Facility,Inpatient,,,RT,2339,1988.15,670.3574,2339,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mri Lower Extremity Rt Not Jt Wo Contrast,,73718,CPT,Facility,Both,,,RT,2339,1988.15,670.3574,2339,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1403.4,60,,percent of total billed charges,,
Mri Lower Extremity Rt Not Jt Wo Contrast,,73718,CPT,Facility,Both,,,RT,2339,1988.15,670.3574,2339,"Health Partners, Inc.",State of Minnesota Advantage Program,1906.285,81.5,,percent of total billed charges,,
Mri Lower Extremity Rt Not Jt Wo Contrast,,73718,CPT,Facility,Both,,,RT,2339,1988.15,670.3574,2339,"Health Partners, Inc.",State Public Programs,1169.5,50,,percent of total billed charges,,
Mri Lower Extremity Rt Not Jt Wo Contrast,,73718,CPT,Facility,Both,,,RT,2339,1988.15,670.3574,2339,Humana Insurance Company,Commercial PPO,2222.05,95,,percent of total billed charges,,
Mri Lower Extremity Rt Not Jt Wo Contrast,,73718,CPT,Facility,Outpatient,,,RT,2339,1988.15,670.3574,2339,Humana Insurance Company,Medicare PPO,1146.11,49,,percent of total billed charges,,
Mri Lower Extremity Rt Not Jt Wo Contrast,,73718,CPT,Facility,Inpatient,,,RT,2339,1988.15,670.3574,2339,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Mri Lower Extremity Rt Not Jt Wo Contrast,,73718,CPT,Facility,Both,,,RT,2339,1988.15,670.3574,2339,Medica,Individual & Family,2317.949,99.1,,percent of total billed charges,,
Mri Lower Extremity Rt Not Jt Wo Contrast,,73718,CPT,Facility,Outpatient,,,RT,2339,1988.15,670.3574,2339,Medica,Medica Advantage Solution,1164.822,49.8,,percent of total billed charges,,
Mri Lower Extremity Rt Not Jt Wo Contrast,,73718,CPT,Facility,Inpatient,,,RT,2339,1988.15,670.3574,2339,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Mri Lower Extremity Rt Not Jt Wo Contrast,,73718,CPT,Facility,Outpatient,,,RT,2339,1988.15,670.3574,2339,Medica,Medical Assistance,747,,,Other ,per vist,Pays in addition to all Outpatient Service Categories
Mri Lower Extremity Rt Not Jt Wo Contrast,,73718,CPT,Facility,Inpatient,,,RT,2339,1988.15,670.3574,2339,Medica,Medical Assistance,,,,,Included in per diem rate,
Mri Lower Extremity Rt Not Jt Wo Contrast,,73718,CPT,Facility,Outpatient,,,RT,2339,1988.15,670.3574,2339,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1164.822,49.8,,percent of total billed charges,,
Mri Lower Extremity Rt Not Jt Wo Contrast,,73718,CPT,Facility,Inpatient,,,RT,2339,1988.15,670.3574,2339,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Mri Lower Extremity Rt Not Jt Wo Contrast,,73718,CPT,Facility,Both,,,RT,2339,1988.15,670.3574,2339,"Multiplan, Inc.","Multiplan, Inc.",2198.66,94,,percent of total billed charges,,
Mri Lower Extremity Rt Not Jt Wo Contrast,,73718,CPT,Facility,Outpatient,,,RT,2339,1988.15,670.3574,2339,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1535,,,Other ,per scan,
Mri Lower Extremity Rt Not Jt Wo Contrast,,73718,CPT,Facility,Inpatient,,,RT,2339,1988.15,670.3574,2339,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Mri Lower Extremity Rt Not Jt Wo Contrast,,73718,CPT,Facility,Both,,,RT,2339,1988.15,670.3574,2339,"Preferred One Administrative Services, INC.",PPO,2306.254,98.6,,percent of total billed charges,,
Mri Lower Extremity Rt Not Jt Wo Contrast,,73718,CPT,Facility,Outpatient,,,RT,2339,1988.15,670.3574,2339,PrimeWest Health,Minnesota Senior Health Options (MSHO),1203.4155,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Mri Lower Extremity Rt Not Jt Wo Contrast,,73718,CPT,Facility,Inpatient,,,RT,2339,1988.15,670.3574,2339,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mri Lower Extremity Rt Not Jt Wo Contrast,,73718,CPT,Facility,Outpatient,,,RT,2339,1988.15,670.3574,2339,PrimeWest Health,MinnesotaCare,1201.3104,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Mri Lower Extremity Rt Not Jt Wo Contrast,,73718,CPT,Facility,Inpatient,,,RT,2339,1988.15,670.3574,2339,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Mri Lower Extremity Rt Not Jt Wo Contrast,,73718,CPT,Facility,Both,,,RT,2339,1988.15,670.3574,2339,Sanford Health Plan,Sanford Health Plan,2151.88,92,,percent of total billed charges,,
Mri Lower Extremity Rt Not Jt Wo Contrast,,73718,CPT,Facility,Outpatient,,,RT,2339,1988.15,670.3574,2339,"UCare Health, Inc.",Individual & Family Plan,1318.0265,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Mri Lower Extremity Rt Not Jt Wo Contrast,,73718,CPT,Facility,Inpatient,,,RT,2339,1988.15,670.3574,2339,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Mri Lower Extremity Rt Not Jt Wo Contrast,,73718,CPT,Facility,Outpatient,,,RT,2339,1988.15,670.3574,2339,"UCare Health, Inc.",Medical Assistance,1180.4933,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mri Lower Extremity Rt Not Jt Wo Contrast,,73718,CPT,Facility,Inpatient,,,RT,2339,1988.15,670.3574,2339,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Mri Lower Extremity Rt Not Jt Wo Contrast,,73718,CPT,Facility,Outpatient,,,RT,2339,1988.15,670.3574,2339,"UCare Health, Inc.",Medicare Advantage,1180.4933,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mri Lower Extremity Rt Not Jt Wo Contrast,,73718,CPT,Facility,Inpatient,,,RT,2339,1988.15,670.3574,2339,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mri Lower Extremity Rt Not Jt Wo Contrast,,73718,CPT,Facility,Outpatient,,,RT,2339,1988.15,670.3574,2339,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1180.4933,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mri Lower Extremity Rt Not Jt Wo Contrast,,73718,CPT,Facility,Inpatient,,,RT,2339,1988.15,670.3574,2339,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mri Lower Extremity Rt Not Jt Wo Contrast,,73718,CPT,Facility,Both,,,RT,2339,1988.15,670.3574,2339,UnitedHealthcare,Individual & Family,2198.66,94,,percent of total billed charges,,
Mri Lower Extremity Rt Not Jt Wo Contrast,,73718,CPT,Facility,Outpatient,,,RT,2339,1988.15,670.3574,2339,UnitedHealthcare,Medicare Advantage,1146.11,49,,percent of total billed charges,,
Mri Lower Extremity Rt Not Jt Wo Contrast,,73718,CPT,Facility,Inpatient,,,RT,2339,1988.15,670.3574,2339,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Mri Lower Extremity Rt Not Jt Wo Contrast,,73718,CPT,Facility,Outpatient,,,RT,2339,1988.15,670.3574,2339,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1122.72,48,,percent of total billed charges,,100% of DHS outpatient percentage
Mri Lower Extremity Rt Not Jt Wo Contrast,,73718,CPT,Facility,Inpatient,,,RT,2339,1988.15,670.3574,2339,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Mri Lower Extremity Rt Not Jt W Contrast,,73719,CPT,Facility,Both,,,RT,2653,2255.05,747,2653,Aetna,Commercial,2440.76,92,,percent of total billed charges,,
Mri Lower Extremity Rt Not Jt W Contrast,,73719,CPT,Facility,Outpatient,,,RT,2653,2255.05,747,2653,Aetna,Medicare Advantage,1299.97,49,,percent of total billed charges,,
Mri Lower Extremity Rt Not Jt W Contrast,,73719,CPT,Facility,Inpatient,,,RT,2653,2255.05,747,2653,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Mri Lower Extremity Rt Not Jt W Contrast,,73719,CPT,Facility,Both,,,RT,2653,2255.05,747,2653,Aetna,PPO,2467.29,93,,percent of total billed charges,,
Mri Lower Extremity Rt Not Jt W Contrast,,73719,CPT,Facility,Both,,,RT,2653,2255.05,747,2653,America's PPO,America's PPO,2547.6759,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Mri Lower Extremity Rt Not Jt W Contrast,,73719,CPT,Facility,Both,,,RT,2653,2255.05,747,2653,BlueCross BlueShield Minnesota, Federal Employee Program,2610.552,98.4,,percent of total billed charges,,
Mri Lower Extremity Rt Not Jt W Contrast,,73719,CPT,Facility,Both,,,RT,2653,2255.05,747,2653,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,2653,100,,percent of total billed charges,,
Mri Lower Extremity Rt Not Jt W Contrast,,73719,CPT,Facility,Both,,,RT,2653,2255.05,747,2653,BlueCross BlueShield Minnesota,High Value Network Plan,2387.7,90,,percent of total billed charges,,
Mri Lower Extremity Rt Not Jt W Contrast,,73719,CPT,Facility,Outpatient,,,RT,2653,2255.05,747,2653,BlueCross BlueShield Minnesota,Medicare Advantage,1299.97,49,,percent of total billed charges,,
Mri Lower Extremity Rt Not Jt W Contrast,,73719,CPT,Facility,Inpatient,,,RT,2653,2255.05,747,2653,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Mri Lower Extremity Rt Not Jt W Contrast,,73719,CPT,Facility,Both,,,RT,2653,2255.05,747,2653,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,2349.7621,88.57,,percent of total billed charges,,
Mri Lower Extremity Rt Not Jt W Contrast,,73719,CPT,Facility,Both,,,RT,2653,2255.05,747,2653,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,760.3498,28.66,,percent of total billed charges,,
Mri Lower Extremity Rt Not Jt W Contrast,,73719,CPT,Facility,Outpatient,,,RT,2653,2255.05,747,2653,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1299.97,49,,percent of total billed charges,,
Mri Lower Extremity Rt Not Jt W Contrast,,73719,CPT,Facility,Inpatient,,,RT,2653,2255.05,747,2653,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Mri Lower Extremity Rt Not Jt W Contrast,,73719,CPT,Facility,Both,,,RT,2653,2255.05,747,2653,CorVel,Worker's Compensation,2653,100,,percent of total billed charges,,
Mri Lower Extremity Rt Not Jt W Contrast,,73719,CPT,Facility,Both,,,RT,2653,2255.05,747,2653,First Health Group Corporation,First Health Network,2573.41,97,,percent of total billed charges,,
Mri Lower Extremity Rt Not Jt W Contrast,,73719,CPT,Facility,Both,,,RT,2653,2255.05,747,2653,"Health Partners, Inc.",Commercial,2509.738,94.6,,percent of total billed charges,,
Mri Lower Extremity Rt Not Jt W Contrast,,73719,CPT,Facility,Outpatient,,,RT,2653,2255.05,747,2653,"Health Partners, Inc.",Medicare Advantage,1299.97,49,,percent of total billed charges,,
Mri Lower Extremity Rt Not Jt W Contrast,,73719,CPT,Facility,Inpatient,,,RT,2653,2255.05,747,2653,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mri Lower Extremity Rt Not Jt W Contrast,,73719,CPT,Facility,Both,,,RT,2653,2255.05,747,2653,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1591.8,60,,percent of total billed charges,,
Mri Lower Extremity Rt Not Jt W Contrast,,73719,CPT,Facility,Both,,,RT,2653,2255.05,747,2653,"Health Partners, Inc.",State of Minnesota Advantage Program,2162.195,81.5,,percent of total billed charges,,
Mri Lower Extremity Rt Not Jt W Contrast,,73719,CPT,Facility,Both,,,RT,2653,2255.05,747,2653,"Health Partners, Inc.",State Public Programs,1326.5,50,,percent of total billed charges,,
Mri Lower Extremity Rt Not Jt W Contrast,,73719,CPT,Facility,Both,,,RT,2653,2255.05,747,2653,Humana Insurance Company,Commercial PPO,2520.35,95,,percent of total billed charges,,
Mri Lower Extremity Rt Not Jt W Contrast,,73719,CPT,Facility,Outpatient,,,RT,2653,2255.05,747,2653,Humana Insurance Company,Medicare PPO,1299.97,49,,percent of total billed charges,,
Mri Lower Extremity Rt Not Jt W Contrast,,73719,CPT,Facility,Inpatient,,,RT,2653,2255.05,747,2653,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Mri Lower Extremity Rt Not Jt W Contrast,,73719,CPT,Facility,Both,,,RT,2653,2255.05,747,2653,Medica,Individual & Family,2629.123,99.1,,percent of total billed charges,,
Mri Lower Extremity Rt Not Jt W Contrast,,73719,CPT,Facility,Outpatient,,,RT,2653,2255.05,747,2653,Medica,Medica Advantage Solution,1321.194,49.8,,percent of total billed charges,,
Mri Lower Extremity Rt Not Jt W Contrast,,73719,CPT,Facility,Inpatient,,,RT,2653,2255.05,747,2653,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Mri Lower Extremity Rt Not Jt W Contrast,,73719,CPT,Facility,Outpatient,,,RT,2653,2255.05,747,2653,Medica,Medical Assistance,747,,,Other ,per vist,Pays in addition to all Outpatient Service Categories
Mri Lower Extremity Rt Not Jt W Contrast,,73719,CPT,Facility,Inpatient,,,RT,2653,2255.05,747,2653,Medica,Medical Assistance,,,,,Included in per diem rate,
Mri Lower Extremity Rt Not Jt W Contrast,,73719,CPT,Facility,Outpatient,,,RT,2653,2255.05,747,2653,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1321.194,49.8,,percent of total billed charges,,
Mri Lower Extremity Rt Not Jt W Contrast,,73719,CPT,Facility,Inpatient,,,RT,2653,2255.05,747,2653,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Mri Lower Extremity Rt Not Jt W Contrast,,73719,CPT,Facility,Both,,,RT,2653,2255.05,747,2653,"Multiplan, Inc.","Multiplan, Inc.",2493.82,94,,percent of total billed charges,,
Mri Lower Extremity Rt Not Jt W Contrast,,73719,CPT,Facility,Outpatient,,,RT,2653,2255.05,747,2653,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1535,,,Other ,per scan,
Mri Lower Extremity Rt Not Jt W Contrast,,73719,CPT,Facility,Inpatient,,,RT,2653,2255.05,747,2653,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Mri Lower Extremity Rt Not Jt W Contrast,,73719,CPT,Facility,Both,,,RT,2653,2255.05,747,2653,"Preferred One Administrative Services, INC.",PPO,2615.858,98.6,,percent of total billed charges,,
Mri Lower Extremity Rt Not Jt W Contrast,,73719,CPT,Facility,Outpatient,,,RT,2653,2255.05,747,2653,PrimeWest Health,Minnesota Senior Health Options (MSHO),1364.9685,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Mri Lower Extremity Rt Not Jt W Contrast,,73719,CPT,Facility,Inpatient,,,RT,2653,2255.05,747,2653,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mri Lower Extremity Rt Not Jt W Contrast,,73719,CPT,Facility,Outpatient,,,RT,2653,2255.05,747,2653,PrimeWest Health,MinnesotaCare,1362.5808,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Mri Lower Extremity Rt Not Jt W Contrast,,73719,CPT,Facility,Inpatient,,,RT,2653,2255.05,747,2653,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Mri Lower Extremity Rt Not Jt W Contrast,,73719,CPT,Facility,Both,,,RT,2653,2255.05,747,2653,Sanford Health Plan,Sanford Health Plan,2440.76,92,,percent of total billed charges,,
Mri Lower Extremity Rt Not Jt W Contrast,,73719,CPT,Facility,Outpatient,,,RT,2653,2255.05,747,2653,"UCare Health, Inc.",Individual & Family Plan,1494.9655,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Mri Lower Extremity Rt Not Jt W Contrast,,73719,CPT,Facility,Inpatient,,,RT,2653,2255.05,747,2653,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Mri Lower Extremity Rt Not Jt W Contrast,,73719,CPT,Facility,Outpatient,,,RT,2653,2255.05,747,2653,"UCare Health, Inc.",Medical Assistance,1338.9691,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mri Lower Extremity Rt Not Jt W Contrast,,73719,CPT,Facility,Inpatient,,,RT,2653,2255.05,747,2653,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Mri Lower Extremity Rt Not Jt W Contrast,,73719,CPT,Facility,Outpatient,,,RT,2653,2255.05,747,2653,"UCare Health, Inc.",Medicare Advantage,1338.9691,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mri Lower Extremity Rt Not Jt W Contrast,,73719,CPT,Facility,Inpatient,,,RT,2653,2255.05,747,2653,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mri Lower Extremity Rt Not Jt W Contrast,,73719,CPT,Facility,Outpatient,,,RT,2653,2255.05,747,2653,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1338.9691,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mri Lower Extremity Rt Not Jt W Contrast,,73719,CPT,Facility,Inpatient,,,RT,2653,2255.05,747,2653,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mri Lower Extremity Rt Not Jt W Contrast,,73719,CPT,Facility,Both,,,RT,2653,2255.05,747,2653,UnitedHealthcare,Individual & Family,2493.82,94,,percent of total billed charges,,
Mri Lower Extremity Rt Not Jt W Contrast,,73719,CPT,Facility,Outpatient,,,RT,2653,2255.05,747,2653,UnitedHealthcare,Medicare Advantage,1299.97,49,,percent of total billed charges,,
Mri Lower Extremity Rt Not Jt W Contrast,,73719,CPT,Facility,Inpatient,,,RT,2653,2255.05,747,2653,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Mri Lower Extremity Rt Not Jt W Contrast,,73719,CPT,Facility,Outpatient,,,RT,2653,2255.05,747,2653,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1273.44,48,,percent of total billed charges,,100% of DHS outpatient percentage
Mri Lower Extremity Rt Not Jt W Contrast,,73719,CPT,Facility,Inpatient,,,RT,2653,2255.05,747,2653,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Mri Lower Extremity Rt Not Jt Wo W Contrast,,73720,CPT,Facility,Both,,,RT,3254,2765.9,747,3254,Aetna,Commercial,2993.68,92,,percent of total billed charges,,
Mri Lower Extremity Rt Not Jt Wo W Contrast,,73720,CPT,Facility,Outpatient,,,RT,3254,2765.9,747,3254,Aetna,Medicare Advantage,1594.46,49,,percent of total billed charges,,
Mri Lower Extremity Rt Not Jt Wo W Contrast,,73720,CPT,Facility,Inpatient,,,RT,3254,2765.9,747,3254,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Mri Lower Extremity Rt Not Jt Wo W Contrast,,73720,CPT,Facility,Both,,,RT,3254,2765.9,747,3254,Aetna,PPO,3026.22,93,,percent of total billed charges,,
Mri Lower Extremity Rt Not Jt Wo W Contrast,,73720,CPT,Facility,Both,,,RT,3254,2765.9,747,3254,America's PPO,America's PPO,3124.8162,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Mri Lower Extremity Rt Not Jt Wo W Contrast,,73720,CPT,Facility,Both,,,RT,3254,2765.9,747,3254,BlueCross BlueShield Minnesota, Federal Employee Program,3201.936,98.4,,percent of total billed charges,,
Mri Lower Extremity Rt Not Jt Wo W Contrast,,73720,CPT,Facility,Both,,,RT,3254,2765.9,747,3254,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,3254,100,,percent of total billed charges,,
Mri Lower Extremity Rt Not Jt Wo W Contrast,,73720,CPT,Facility,Both,,,RT,3254,2765.9,747,3254,BlueCross BlueShield Minnesota,High Value Network Plan,2928.6,90,,percent of total billed charges,,
Mri Lower Extremity Rt Not Jt Wo W Contrast,,73720,CPT,Facility,Outpatient,,,RT,3254,2765.9,747,3254,BlueCross BlueShield Minnesota,Medicare Advantage,1594.46,49,,percent of total billed charges,,
Mri Lower Extremity Rt Not Jt Wo W Contrast,,73720,CPT,Facility,Inpatient,,,RT,3254,2765.9,747,3254,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Mri Lower Extremity Rt Not Jt Wo W Contrast,,73720,CPT,Facility,Both,,,RT,3254,2765.9,747,3254,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,2882.0678,88.57,,percent of total billed charges,,
Mri Lower Extremity Rt Not Jt Wo W Contrast,,73720,CPT,Facility,Both,,,RT,3254,2765.9,747,3254,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,932.5964,28.66,,percent of total billed charges,,
Mri Lower Extremity Rt Not Jt Wo W Contrast,,73720,CPT,Facility,Outpatient,,,RT,3254,2765.9,747,3254,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1594.46,49,,percent of total billed charges,,
Mri Lower Extremity Rt Not Jt Wo W Contrast,,73720,CPT,Facility,Inpatient,,,RT,3254,2765.9,747,3254,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Mri Lower Extremity Rt Not Jt Wo W Contrast,,73720,CPT,Facility,Both,,,RT,3254,2765.9,747,3254,CorVel,Worker's Compensation,3254,100,,percent of total billed charges,,
Mri Lower Extremity Rt Not Jt Wo W Contrast,,73720,CPT,Facility,Both,,,RT,3254,2765.9,747,3254,First Health Group Corporation,First Health Network,3156.38,97,,percent of total billed charges,,
Mri Lower Extremity Rt Not Jt Wo W Contrast,,73720,CPT,Facility,Both,,,RT,3254,2765.9,747,3254,"Health Partners, Inc.",Commercial,3078.284,94.6,,percent of total billed charges,,
Mri Lower Extremity Rt Not Jt Wo W Contrast,,73720,CPT,Facility,Outpatient,,,RT,3254,2765.9,747,3254,"Health Partners, Inc.",Medicare Advantage,1594.46,49,,percent of total billed charges,,
Mri Lower Extremity Rt Not Jt Wo W Contrast,,73720,CPT,Facility,Inpatient,,,RT,3254,2765.9,747,3254,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mri Lower Extremity Rt Not Jt Wo W Contrast,,73720,CPT,Facility,Both,,,RT,3254,2765.9,747,3254,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1952.4,60,,percent of total billed charges,,
Mri Lower Extremity Rt Not Jt Wo W Contrast,,73720,CPT,Facility,Both,,,RT,3254,2765.9,747,3254,"Health Partners, Inc.",State of Minnesota Advantage Program,2652.01,81.5,,percent of total billed charges,,
Mri Lower Extremity Rt Not Jt Wo W Contrast,,73720,CPT,Facility,Both,,,RT,3254,2765.9,747,3254,"Health Partners, Inc.",State Public Programs,1627,50,,percent of total billed charges,,
Mri Lower Extremity Rt Not Jt Wo W Contrast,,73720,CPT,Facility,Both,,,RT,3254,2765.9,747,3254,Humana Insurance Company,Commercial PPO,3091.3,95,,percent of total billed charges,,
Mri Lower Extremity Rt Not Jt Wo W Contrast,,73720,CPT,Facility,Outpatient,,,RT,3254,2765.9,747,3254,Humana Insurance Company,Medicare PPO,1594.46,49,,percent of total billed charges,,
Mri Lower Extremity Rt Not Jt Wo W Contrast,,73720,CPT,Facility,Inpatient,,,RT,3254,2765.9,747,3254,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Mri Lower Extremity Rt Not Jt Wo W Contrast,,73720,CPT,Facility,Both,,,RT,3254,2765.9,747,3254,Medica,Individual & Family,3224.714,99.1,,percent of total billed charges,,
Mri Lower Extremity Rt Not Jt Wo W Contrast,,73720,CPT,Facility,Outpatient,,,RT,3254,2765.9,747,3254,Medica,Medica Advantage Solution,1620.492,49.8,,percent of total billed charges,,
Mri Lower Extremity Rt Not Jt Wo W Contrast,,73720,CPT,Facility,Inpatient,,,RT,3254,2765.9,747,3254,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Mri Lower Extremity Rt Not Jt Wo W Contrast,,73720,CPT,Facility,Outpatient,,,RT,3254,2765.9,747,3254,Medica,Medical Assistance,747,,,Other ,per vist,Pays in addition to all Outpatient Service Categories
Mri Lower Extremity Rt Not Jt Wo W Contrast,,73720,CPT,Facility,Inpatient,,,RT,3254,2765.9,747,3254,Medica,Medical Assistance,,,,,Included in per diem rate,
Mri Lower Extremity Rt Not Jt Wo W Contrast,,73720,CPT,Facility,Outpatient,,,RT,3254,2765.9,747,3254,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1620.492,49.8,,percent of total billed charges,,
Mri Lower Extremity Rt Not Jt Wo W Contrast,,73720,CPT,Facility,Inpatient,,,RT,3254,2765.9,747,3254,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Mri Lower Extremity Rt Not Jt Wo W Contrast,,73720,CPT,Facility,Both,,,RT,3254,2765.9,747,3254,"Multiplan, Inc.","Multiplan, Inc.",3058.76,94,,percent of total billed charges,,
Mri Lower Extremity Rt Not Jt Wo W Contrast,,73720,CPT,Facility,Outpatient,,,RT,3254,2765.9,747,3254,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1535,,,Other ,per scan,
Mri Lower Extremity Rt Not Jt Wo W Contrast,,73720,CPT,Facility,Inpatient,,,RT,3254,2765.9,747,3254,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Mri Lower Extremity Rt Not Jt Wo W Contrast,,73720,CPT,Facility,Both,,,RT,3254,2765.9,747,3254,"Preferred One Administrative Services, INC.",PPO,3208.444,98.6,,percent of total billed charges,,
Mri Lower Extremity Rt Not Jt Wo W Contrast,,73720,CPT,Facility,Outpatient,,,RT,3254,2765.9,747,3254,PrimeWest Health,Minnesota Senior Health Options (MSHO),1674.183,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Mri Lower Extremity Rt Not Jt Wo W Contrast,,73720,CPT,Facility,Inpatient,,,RT,3254,2765.9,747,3254,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mri Lower Extremity Rt Not Jt Wo W Contrast,,73720,CPT,Facility,Outpatient,,,RT,3254,2765.9,747,3254,PrimeWest Health,MinnesotaCare,1671.2544,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Mri Lower Extremity Rt Not Jt Wo W Contrast,,73720,CPT,Facility,Inpatient,,,RT,3254,2765.9,747,3254,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Mri Lower Extremity Rt Not Jt Wo W Contrast,,73720,CPT,Facility,Both,,,RT,3254,2765.9,747,3254,Sanford Health Plan,Sanford Health Plan,2993.68,92,,percent of total billed charges,,
Mri Lower Extremity Rt Not Jt Wo W Contrast,,73720,CPT,Facility,Outpatient,,,RT,3254,2765.9,747,3254,"UCare Health, Inc.",Individual & Family Plan,1833.629,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Mri Lower Extremity Rt Not Jt Wo W Contrast,,73720,CPT,Facility,Inpatient,,,RT,3254,2765.9,747,3254,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Mri Lower Extremity Rt Not Jt Wo W Contrast,,73720,CPT,Facility,Outpatient,,,RT,3254,2765.9,747,3254,"UCare Health, Inc.",Medical Assistance,1642.2938,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mri Lower Extremity Rt Not Jt Wo W Contrast,,73720,CPT,Facility,Inpatient,,,RT,3254,2765.9,747,3254,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Mri Lower Extremity Rt Not Jt Wo W Contrast,,73720,CPT,Facility,Outpatient,,,RT,3254,2765.9,747,3254,"UCare Health, Inc.",Medicare Advantage,1642.2938,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mri Lower Extremity Rt Not Jt Wo W Contrast,,73720,CPT,Facility,Inpatient,,,RT,3254,2765.9,747,3254,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mri Lower Extremity Rt Not Jt Wo W Contrast,,73720,CPT,Facility,Outpatient,,,RT,3254,2765.9,747,3254,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1642.2938,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mri Lower Extremity Rt Not Jt Wo W Contrast,,73720,CPT,Facility,Inpatient,,,RT,3254,2765.9,747,3254,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mri Lower Extremity Rt Not Jt Wo W Contrast,,73720,CPT,Facility,Both,,,RT,3254,2765.9,747,3254,UnitedHealthcare,Individual & Family,3058.76,94,,percent of total billed charges,,
Mri Lower Extremity Rt Not Jt Wo W Contrast,,73720,CPT,Facility,Outpatient,,,RT,3254,2765.9,747,3254,UnitedHealthcare,Medicare Advantage,1594.46,49,,percent of total billed charges,,
Mri Lower Extremity Rt Not Jt Wo W Contrast,,73720,CPT,Facility,Inpatient,,,RT,3254,2765.9,747,3254,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Mri Lower Extremity Rt Not Jt Wo W Contrast,,73720,CPT,Facility,Outpatient,,,RT,3254,2765.9,747,3254,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1561.92,48,,percent of total billed charges,,100% of DHS outpatient percentage
Mri Lower Extremity Rt Not Jt Wo W Contrast,,73720,CPT,Facility,Inpatient,,,RT,3254,2765.9,747,3254,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Mri Lower Extremity Rt Any Jt Routine Wo Contrast,,73721,CPT,Facility,Both,,,RT,2447,2079.95,701.3102,2447,Aetna,Commercial,2251.24,92,,percent of total billed charges,,
Mri Lower Extremity Rt Any Jt Routine Wo Contrast,,73721,CPT,Facility,Outpatient,,,RT,2447,2079.95,701.3102,2447,Aetna,Medicare Advantage,1199.03,49,,percent of total billed charges,,
Mri Lower Extremity Rt Any Jt Routine Wo Contrast,,73721,CPT,Facility,Inpatient,,,RT,2447,2079.95,701.3102,2447,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Mri Lower Extremity Rt Any Jt Routine Wo Contrast,,73721,CPT,Facility,Both,,,RT,2447,2079.95,701.3102,2447,Aetna,PPO,2275.71,93,,percent of total billed charges,,
Mri Lower Extremity Rt Any Jt Routine Wo Contrast,,73721,CPT,Facility,Both,,,RT,2447,2079.95,701.3102,2447,America's PPO,America's PPO,2349.8541,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Mri Lower Extremity Rt Any Jt Routine Wo Contrast,,73721,CPT,Facility,Both,,,RT,2447,2079.95,701.3102,2447,BlueCross BlueShield Minnesota, Federal Employee Program,2407.848,98.4,,percent of total billed charges,,
Mri Lower Extremity Rt Any Jt Routine Wo Contrast,,73721,CPT,Facility,Both,,,RT,2447,2079.95,701.3102,2447,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,2447,100,,percent of total billed charges,,
Mri Lower Extremity Rt Any Jt Routine Wo Contrast,,73721,CPT,Facility,Both,,,RT,2447,2079.95,701.3102,2447,BlueCross BlueShield Minnesota,High Value Network Plan,2202.3,90,,percent of total billed charges,,
Mri Lower Extremity Rt Any Jt Routine Wo Contrast,,73721,CPT,Facility,Outpatient,,,RT,2447,2079.95,701.3102,2447,BlueCross BlueShield Minnesota,Medicare Advantage,1199.03,49,,percent of total billed charges,,
Mri Lower Extremity Rt Any Jt Routine Wo Contrast,,73721,CPT,Facility,Inpatient,,,RT,2447,2079.95,701.3102,2447,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Mri Lower Extremity Rt Any Jt Routine Wo Contrast,,73721,CPT,Facility,Both,,,RT,2447,2079.95,701.3102,2447,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,2167.3079,88.57,,percent of total billed charges,,
Mri Lower Extremity Rt Any Jt Routine Wo Contrast,,73721,CPT,Facility,Both,,,RT,2447,2079.95,701.3102,2447,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,701.3102,28.66,,percent of total billed charges,,
Mri Lower Extremity Rt Any Jt Routine Wo Contrast,,73721,CPT,Facility,Outpatient,,,RT,2447,2079.95,701.3102,2447,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1199.03,49,,percent of total billed charges,,
Mri Lower Extremity Rt Any Jt Routine Wo Contrast,,73721,CPT,Facility,Inpatient,,,RT,2447,2079.95,701.3102,2447,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Mri Lower Extremity Rt Any Jt Routine Wo Contrast,,73721,CPT,Facility,Both,,,RT,2447,2079.95,701.3102,2447,CorVel,Worker's Compensation,2447,100,,percent of total billed charges,,
Mri Lower Extremity Rt Any Jt Routine Wo Contrast,,73721,CPT,Facility,Both,,,RT,2447,2079.95,701.3102,2447,First Health Group Corporation,First Health Network,2373.59,97,,percent of total billed charges,,
Mri Lower Extremity Rt Any Jt Routine Wo Contrast,,73721,CPT,Facility,Both,,,RT,2447,2079.95,701.3102,2447,"Health Partners, Inc.",Commercial,2314.862,94.6,,percent of total billed charges,,
Mri Lower Extremity Rt Any Jt Routine Wo Contrast,,73721,CPT,Facility,Outpatient,,,RT,2447,2079.95,701.3102,2447,"Health Partners, Inc.",Medicare Advantage,1199.03,49,,percent of total billed charges,,
Mri Lower Extremity Rt Any Jt Routine Wo Contrast,,73721,CPT,Facility,Inpatient,,,RT,2447,2079.95,701.3102,2447,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mri Lower Extremity Rt Any Jt Routine Wo Contrast,,73721,CPT,Facility,Both,,,RT,2447,2079.95,701.3102,2447,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1468.2,60,,percent of total billed charges,,
Mri Lower Extremity Rt Any Jt Routine Wo Contrast,,73721,CPT,Facility,Both,,,RT,2447,2079.95,701.3102,2447,"Health Partners, Inc.",State of Minnesota Advantage Program,1994.305,81.5,,percent of total billed charges,,
Mri Lower Extremity Rt Any Jt Routine Wo Contrast,,73721,CPT,Facility,Both,,,RT,2447,2079.95,701.3102,2447,"Health Partners, Inc.",State Public Programs,1223.5,50,,percent of total billed charges,,
Mri Lower Extremity Rt Any Jt Routine Wo Contrast,,73721,CPT,Facility,Both,,,RT,2447,2079.95,701.3102,2447,Humana Insurance Company,Commercial PPO,2324.65,95,,percent of total billed charges,,
Mri Lower Extremity Rt Any Jt Routine Wo Contrast,,73721,CPT,Facility,Outpatient,,,RT,2447,2079.95,701.3102,2447,Humana Insurance Company,Medicare PPO,1199.03,49,,percent of total billed charges,,
Mri Lower Extremity Rt Any Jt Routine Wo Contrast,,73721,CPT,Facility,Inpatient,,,RT,2447,2079.95,701.3102,2447,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Mri Lower Extremity Rt Any Jt Routine Wo Contrast,,73721,CPT,Facility,Both,,,RT,2447,2079.95,701.3102,2447,Medica,Individual & Family,2424.977,99.1,,percent of total billed charges,,
Mri Lower Extremity Rt Any Jt Routine Wo Contrast,,73721,CPT,Facility,Outpatient,,,RT,2447,2079.95,701.3102,2447,Medica,Medica Advantage Solution,1218.606,49.8,,percent of total billed charges,,
Mri Lower Extremity Rt Any Jt Routine Wo Contrast,,73721,CPT,Facility,Inpatient,,,RT,2447,2079.95,701.3102,2447,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Mri Lower Extremity Rt Any Jt Routine Wo Contrast,,73721,CPT,Facility,Outpatient,,,RT,2447,2079.95,701.3102,2447,Medica,Medical Assistance,747,,,Other ,per vist,Pays in addition to all Outpatient Service Categories
Mri Lower Extremity Rt Any Jt Routine Wo Contrast,,73721,CPT,Facility,Inpatient,,,RT,2447,2079.95,701.3102,2447,Medica,Medical Assistance,,,,,Included in per diem rate,
Mri Lower Extremity Rt Any Jt Routine Wo Contrast,,73721,CPT,Facility,Outpatient,,,RT,2447,2079.95,701.3102,2447,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1218.606,49.8,,percent of total billed charges,,
Mri Lower Extremity Rt Any Jt Routine Wo Contrast,,73721,CPT,Facility,Inpatient,,,RT,2447,2079.95,701.3102,2447,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Mri Lower Extremity Rt Any Jt Routine Wo Contrast,,73721,CPT,Facility,Both,,,RT,2447,2079.95,701.3102,2447,"Multiplan, Inc.","Multiplan, Inc.",2300.18,94,,percent of total billed charges,,
Mri Lower Extremity Rt Any Jt Routine Wo Contrast,,73721,CPT,Facility,Outpatient,,,RT,2447,2079.95,701.3102,2447,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1535,,,Other ,per scan,
Mri Lower Extremity Rt Any Jt Routine Wo Contrast,,73721,CPT,Facility,Inpatient,,,RT,2447,2079.95,701.3102,2447,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Mri Lower Extremity Rt Any Jt Routine Wo Contrast,,73721,CPT,Facility,Both,,,RT,2447,2079.95,701.3102,2447,"Preferred One Administrative Services, INC.",PPO,2412.742,98.6,,percent of total billed charges,,
Mri Lower Extremity Rt Any Jt Routine Wo Contrast,,73721,CPT,Facility,Outpatient,,,RT,2447,2079.95,701.3102,2447,PrimeWest Health,Minnesota Senior Health Options (MSHO),1258.9815,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Mri Lower Extremity Rt Any Jt Routine Wo Contrast,,73721,CPT,Facility,Inpatient,,,RT,2447,2079.95,701.3102,2447,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mri Lower Extremity Rt Any Jt Routine Wo Contrast,,73721,CPT,Facility,Outpatient,,,RT,2447,2079.95,701.3102,2447,PrimeWest Health,MinnesotaCare,1256.7792,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Mri Lower Extremity Rt Any Jt Routine Wo Contrast,,73721,CPT,Facility,Inpatient,,,RT,2447,2079.95,701.3102,2447,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Mri Lower Extremity Rt Any Jt Routine Wo Contrast,,73721,CPT,Facility,Both,,,RT,2447,2079.95,701.3102,2447,Sanford Health Plan,Sanford Health Plan,2251.24,92,,percent of total billed charges,,
Mri Lower Extremity Rt Any Jt Routine Wo Contrast,,73721,CPT,Facility,Outpatient,,,RT,2447,2079.95,701.3102,2447,"UCare Health, Inc.",Individual & Family Plan,1378.8845,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Mri Lower Extremity Rt Any Jt Routine Wo Contrast,,73721,CPT,Facility,Inpatient,,,RT,2447,2079.95,701.3102,2447,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Mri Lower Extremity Rt Any Jt Routine Wo Contrast,,73721,CPT,Facility,Outpatient,,,RT,2447,2079.95,701.3102,2447,"UCare Health, Inc.",Medical Assistance,1235.0009,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mri Lower Extremity Rt Any Jt Routine Wo Contrast,,73721,CPT,Facility,Inpatient,,,RT,2447,2079.95,701.3102,2447,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Mri Lower Extremity Rt Any Jt Routine Wo Contrast,,73721,CPT,Facility,Outpatient,,,RT,2447,2079.95,701.3102,2447,"UCare Health, Inc.",Medicare Advantage,1235.0009,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mri Lower Extremity Rt Any Jt Routine Wo Contrast,,73721,CPT,Facility,Inpatient,,,RT,2447,2079.95,701.3102,2447,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mri Lower Extremity Rt Any Jt Routine Wo Contrast,,73721,CPT,Facility,Outpatient,,,RT,2447,2079.95,701.3102,2447,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1235.0009,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mri Lower Extremity Rt Any Jt Routine Wo Contrast,,73721,CPT,Facility,Inpatient,,,RT,2447,2079.95,701.3102,2447,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mri Lower Extremity Rt Any Jt Routine Wo Contrast,,73721,CPT,Facility,Both,,,RT,2447,2079.95,701.3102,2447,UnitedHealthcare,Individual & Family,2300.18,94,,percent of total billed charges,,
Mri Lower Extremity Rt Any Jt Routine Wo Contrast,,73721,CPT,Facility,Outpatient,,,RT,2447,2079.95,701.3102,2447,UnitedHealthcare,Medicare Advantage,1199.03,49,,percent of total billed charges,,
Mri Lower Extremity Rt Any Jt Routine Wo Contrast,,73721,CPT,Facility,Inpatient,,,RT,2447,2079.95,701.3102,2447,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Mri Lower Extremity Rt Any Jt Routine Wo Contrast,,73721,CPT,Facility,Outpatient,,,RT,2447,2079.95,701.3102,2447,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1174.56,48,,percent of total billed charges,,100% of DHS outpatient percentage
Mri Lower Extremity Rt Any Jt Routine Wo Contrast,,73721,CPT,Facility,Inpatient,,,RT,2447,2079.95,701.3102,2447,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Mri Lower Extremity Rt Any Jt W Contrast,,73722,CPT,Facility,Both,,,RT,2653,2255.05,747,2653,Aetna,Commercial,2440.76,92,,percent of total billed charges,,
Mri Lower Extremity Rt Any Jt W Contrast,,73722,CPT,Facility,Outpatient,,,RT,2653,2255.05,747,2653,Aetna,Medicare Advantage,1299.97,49,,percent of total billed charges,,
Mri Lower Extremity Rt Any Jt W Contrast,,73722,CPT,Facility,Inpatient,,,RT,2653,2255.05,747,2653,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Mri Lower Extremity Rt Any Jt W Contrast,,73722,CPT,Facility,Both,,,RT,2653,2255.05,747,2653,Aetna,PPO,2467.29,93,,percent of total billed charges,,
Mri Lower Extremity Rt Any Jt W Contrast,,73722,CPT,Facility,Both,,,RT,2653,2255.05,747,2653,America's PPO,America's PPO,2547.6759,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Mri Lower Extremity Rt Any Jt W Contrast,,73722,CPT,Facility,Both,,,RT,2653,2255.05,747,2653,BlueCross BlueShield Minnesota, Federal Employee Program,2610.552,98.4,,percent of total billed charges,,
Mri Lower Extremity Rt Any Jt W Contrast,,73722,CPT,Facility,Both,,,RT,2653,2255.05,747,2653,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,2653,100,,percent of total billed charges,,
Mri Lower Extremity Rt Any Jt W Contrast,,73722,CPT,Facility,Both,,,RT,2653,2255.05,747,2653,BlueCross BlueShield Minnesota,High Value Network Plan,2387.7,90,,percent of total billed charges,,
Mri Lower Extremity Rt Any Jt W Contrast,,73722,CPT,Facility,Outpatient,,,RT,2653,2255.05,747,2653,BlueCross BlueShield Minnesota,Medicare Advantage,1299.97,49,,percent of total billed charges,,
Mri Lower Extremity Rt Any Jt W Contrast,,73722,CPT,Facility,Inpatient,,,RT,2653,2255.05,747,2653,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Mri Lower Extremity Rt Any Jt W Contrast,,73722,CPT,Facility,Both,,,RT,2653,2255.05,747,2653,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,2349.7621,88.57,,percent of total billed charges,,
Mri Lower Extremity Rt Any Jt W Contrast,,73722,CPT,Facility,Both,,,RT,2653,2255.05,747,2653,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,760.3498,28.66,,percent of total billed charges,,
Mri Lower Extremity Rt Any Jt W Contrast,,73722,CPT,Facility,Outpatient,,,RT,2653,2255.05,747,2653,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1299.97,49,,percent of total billed charges,,
Mri Lower Extremity Rt Any Jt W Contrast,,73722,CPT,Facility,Inpatient,,,RT,2653,2255.05,747,2653,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Mri Lower Extremity Rt Any Jt W Contrast,,73722,CPT,Facility,Both,,,RT,2653,2255.05,747,2653,CorVel,Worker's Compensation,2653,100,,percent of total billed charges,,
Mri Lower Extremity Rt Any Jt W Contrast,,73722,CPT,Facility,Both,,,RT,2653,2255.05,747,2653,First Health Group Corporation,First Health Network,2573.41,97,,percent of total billed charges,,
Mri Lower Extremity Rt Any Jt W Contrast,,73722,CPT,Facility,Both,,,RT,2653,2255.05,747,2653,"Health Partners, Inc.",Commercial,2509.738,94.6,,percent of total billed charges,,
Mri Lower Extremity Rt Any Jt W Contrast,,73722,CPT,Facility,Outpatient,,,RT,2653,2255.05,747,2653,"Health Partners, Inc.",Medicare Advantage,1299.97,49,,percent of total billed charges,,
Mri Lower Extremity Rt Any Jt W Contrast,,73722,CPT,Facility,Inpatient,,,RT,2653,2255.05,747,2653,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mri Lower Extremity Rt Any Jt W Contrast,,73722,CPT,Facility,Both,,,RT,2653,2255.05,747,2653,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1591.8,60,,percent of total billed charges,,
Mri Lower Extremity Rt Any Jt W Contrast,,73722,CPT,Facility,Both,,,RT,2653,2255.05,747,2653,"Health Partners, Inc.",State of Minnesota Advantage Program,2162.195,81.5,,percent of total billed charges,,
Mri Lower Extremity Rt Any Jt W Contrast,,73722,CPT,Facility,Both,,,RT,2653,2255.05,747,2653,"Health Partners, Inc.",State Public Programs,1326.5,50,,percent of total billed charges,,
Mri Lower Extremity Rt Any Jt W Contrast,,73722,CPT,Facility,Both,,,RT,2653,2255.05,747,2653,Humana Insurance Company,Commercial PPO,2520.35,95,,percent of total billed charges,,
Mri Lower Extremity Rt Any Jt W Contrast,,73722,CPT,Facility,Outpatient,,,RT,2653,2255.05,747,2653,Humana Insurance Company,Medicare PPO,1299.97,49,,percent of total billed charges,,
Mri Lower Extremity Rt Any Jt W Contrast,,73722,CPT,Facility,Inpatient,,,RT,2653,2255.05,747,2653,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Mri Lower Extremity Rt Any Jt W Contrast,,73722,CPT,Facility,Both,,,RT,2653,2255.05,747,2653,Medica,Individual & Family,2629.123,99.1,,percent of total billed charges,,
Mri Lower Extremity Rt Any Jt W Contrast,,73722,CPT,Facility,Outpatient,,,RT,2653,2255.05,747,2653,Medica,Medica Advantage Solution,1321.194,49.8,,percent of total billed charges,,
Mri Lower Extremity Rt Any Jt W Contrast,,73722,CPT,Facility,Inpatient,,,RT,2653,2255.05,747,2653,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Mri Lower Extremity Rt Any Jt W Contrast,,73722,CPT,Facility,Outpatient,,,RT,2653,2255.05,747,2653,Medica,Medical Assistance,747,,,Other ,per vist,Pays in addition to all Outpatient Service Categories
Mri Lower Extremity Rt Any Jt W Contrast,,73722,CPT,Facility,Inpatient,,,RT,2653,2255.05,747,2653,Medica,Medical Assistance,,,,,Included in per diem rate,
Mri Lower Extremity Rt Any Jt W Contrast,,73722,CPT,Facility,Outpatient,,,RT,2653,2255.05,747,2653,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1321.194,49.8,,percent of total billed charges,,
Mri Lower Extremity Rt Any Jt W Contrast,,73722,CPT,Facility,Inpatient,,,RT,2653,2255.05,747,2653,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Mri Lower Extremity Rt Any Jt W Contrast,,73722,CPT,Facility,Both,,,RT,2653,2255.05,747,2653,"Multiplan, Inc.","Multiplan, Inc.",2493.82,94,,percent of total billed charges,,
Mri Lower Extremity Rt Any Jt W Contrast,,73722,CPT,Facility,Outpatient,,,RT,2653,2255.05,747,2653,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1535,,,Other ,per scan,
Mri Lower Extremity Rt Any Jt W Contrast,,73722,CPT,Facility,Inpatient,,,RT,2653,2255.05,747,2653,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Mri Lower Extremity Rt Any Jt W Contrast,,73722,CPT,Facility,Both,,,RT,2653,2255.05,747,2653,"Preferred One Administrative Services, INC.",PPO,2615.858,98.6,,percent of total billed charges,,
Mri Lower Extremity Rt Any Jt W Contrast,,73722,CPT,Facility,Outpatient,,,RT,2653,2255.05,747,2653,PrimeWest Health,Minnesota Senior Health Options (MSHO),1364.9685,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Mri Lower Extremity Rt Any Jt W Contrast,,73722,CPT,Facility,Inpatient,,,RT,2653,2255.05,747,2653,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mri Lower Extremity Rt Any Jt W Contrast,,73722,CPT,Facility,Outpatient,,,RT,2653,2255.05,747,2653,PrimeWest Health,MinnesotaCare,1362.5808,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Mri Lower Extremity Rt Any Jt W Contrast,,73722,CPT,Facility,Inpatient,,,RT,2653,2255.05,747,2653,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Mri Lower Extremity Rt Any Jt W Contrast,,73722,CPT,Facility,Both,,,RT,2653,2255.05,747,2653,Sanford Health Plan,Sanford Health Plan,2440.76,92,,percent of total billed charges,,
Mri Lower Extremity Rt Any Jt W Contrast,,73722,CPT,Facility,Outpatient,,,RT,2653,2255.05,747,2653,"UCare Health, Inc.",Individual & Family Plan,1494.9655,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Mri Lower Extremity Rt Any Jt W Contrast,,73722,CPT,Facility,Inpatient,,,RT,2653,2255.05,747,2653,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Mri Lower Extremity Rt Any Jt W Contrast,,73722,CPT,Facility,Outpatient,,,RT,2653,2255.05,747,2653,"UCare Health, Inc.",Medical Assistance,1338.9691,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mri Lower Extremity Rt Any Jt W Contrast,,73722,CPT,Facility,Inpatient,,,RT,2653,2255.05,747,2653,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Mri Lower Extremity Rt Any Jt W Contrast,,73722,CPT,Facility,Outpatient,,,RT,2653,2255.05,747,2653,"UCare Health, Inc.",Medicare Advantage,1338.9691,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mri Lower Extremity Rt Any Jt W Contrast,,73722,CPT,Facility,Inpatient,,,RT,2653,2255.05,747,2653,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mri Lower Extremity Rt Any Jt W Contrast,,73722,CPT,Facility,Outpatient,,,RT,2653,2255.05,747,2653,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1338.9691,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mri Lower Extremity Rt Any Jt W Contrast,,73722,CPT,Facility,Inpatient,,,RT,2653,2255.05,747,2653,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mri Lower Extremity Rt Any Jt W Contrast,,73722,CPT,Facility,Both,,,RT,2653,2255.05,747,2653,UnitedHealthcare,Individual & Family,2493.82,94,,percent of total billed charges,,
Mri Lower Extremity Rt Any Jt W Contrast,,73722,CPT,Facility,Outpatient,,,RT,2653,2255.05,747,2653,UnitedHealthcare,Medicare Advantage,1299.97,49,,percent of total billed charges,,
Mri Lower Extremity Rt Any Jt W Contrast,,73722,CPT,Facility,Inpatient,,,RT,2653,2255.05,747,2653,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Mri Lower Extremity Rt Any Jt W Contrast,,73722,CPT,Facility,Outpatient,,,RT,2653,2255.05,747,2653,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1273.44,48,,percent of total billed charges,,100% of DHS outpatient percentage
Mri Lower Extremity Rt Any Jt W Contrast,,73722,CPT,Facility,Inpatient,,,RT,2653,2255.05,747,2653,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Mri Lower Extremity Rt Any Jt Wo W Contrast,,73723,CPT,Facility,Both,,,RT,3254,2765.9,747,3254,Aetna,Commercial,2993.68,92,,percent of total billed charges,,
Mri Lower Extremity Rt Any Jt Wo W Contrast,,73723,CPT,Facility,Outpatient,,,RT,3254,2765.9,747,3254,Aetna,Medicare Advantage,1594.46,49,,percent of total billed charges,,
Mri Lower Extremity Rt Any Jt Wo W Contrast,,73723,CPT,Facility,Inpatient,,,RT,3254,2765.9,747,3254,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Mri Lower Extremity Rt Any Jt Wo W Contrast,,73723,CPT,Facility,Both,,,RT,3254,2765.9,747,3254,Aetna,PPO,3026.22,93,,percent of total billed charges,,
Mri Lower Extremity Rt Any Jt Wo W Contrast,,73723,CPT,Facility,Both,,,RT,3254,2765.9,747,3254,America's PPO,America's PPO,3124.8162,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Mri Lower Extremity Rt Any Jt Wo W Contrast,,73723,CPT,Facility,Both,,,RT,3254,2765.9,747,3254,BlueCross BlueShield Minnesota, Federal Employee Program,3201.936,98.4,,percent of total billed charges,,
Mri Lower Extremity Rt Any Jt Wo W Contrast,,73723,CPT,Facility,Both,,,RT,3254,2765.9,747,3254,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,3254,100,,percent of total billed charges,,
Mri Lower Extremity Rt Any Jt Wo W Contrast,,73723,CPT,Facility,Both,,,RT,3254,2765.9,747,3254,BlueCross BlueShield Minnesota,High Value Network Plan,2928.6,90,,percent of total billed charges,,
Mri Lower Extremity Rt Any Jt Wo W Contrast,,73723,CPT,Facility,Outpatient,,,RT,3254,2765.9,747,3254,BlueCross BlueShield Minnesota,Medicare Advantage,1594.46,49,,percent of total billed charges,,
Mri Lower Extremity Rt Any Jt Wo W Contrast,,73723,CPT,Facility,Inpatient,,,RT,3254,2765.9,747,3254,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Mri Lower Extremity Rt Any Jt Wo W Contrast,,73723,CPT,Facility,Both,,,RT,3254,2765.9,747,3254,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,2882.0678,88.57,,percent of total billed charges,,
Mri Lower Extremity Rt Any Jt Wo W Contrast,,73723,CPT,Facility,Both,,,RT,3254,2765.9,747,3254,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,932.5964,28.66,,percent of total billed charges,,
Mri Lower Extremity Rt Any Jt Wo W Contrast,,73723,CPT,Facility,Outpatient,,,RT,3254,2765.9,747,3254,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1594.46,49,,percent of total billed charges,,
Mri Lower Extremity Rt Any Jt Wo W Contrast,,73723,CPT,Facility,Inpatient,,,RT,3254,2765.9,747,3254,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Mri Lower Extremity Rt Any Jt Wo W Contrast,,73723,CPT,Facility,Both,,,RT,3254,2765.9,747,3254,CorVel,Worker's Compensation,3254,100,,percent of total billed charges,,
Mri Lower Extremity Rt Any Jt Wo W Contrast,,73723,CPT,Facility,Both,,,RT,3254,2765.9,747,3254,First Health Group Corporation,First Health Network,3156.38,97,,percent of total billed charges,,
Mri Lower Extremity Rt Any Jt Wo W Contrast,,73723,CPT,Facility,Both,,,RT,3254,2765.9,747,3254,"Health Partners, Inc.",Commercial,3078.284,94.6,,percent of total billed charges,,
Mri Lower Extremity Rt Any Jt Wo W Contrast,,73723,CPT,Facility,Outpatient,,,RT,3254,2765.9,747,3254,"Health Partners, Inc.",Medicare Advantage,1594.46,49,,percent of total billed charges,,
Mri Lower Extremity Rt Any Jt Wo W Contrast,,73723,CPT,Facility,Inpatient,,,RT,3254,2765.9,747,3254,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mri Lower Extremity Rt Any Jt Wo W Contrast,,73723,CPT,Facility,Both,,,RT,3254,2765.9,747,3254,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1952.4,60,,percent of total billed charges,,
Mri Lower Extremity Rt Any Jt Wo W Contrast,,73723,CPT,Facility,Both,,,RT,3254,2765.9,747,3254,"Health Partners, Inc.",State of Minnesota Advantage Program,2652.01,81.5,,percent of total billed charges,,
Mri Lower Extremity Rt Any Jt Wo W Contrast,,73723,CPT,Facility,Both,,,RT,3254,2765.9,747,3254,"Health Partners, Inc.",State Public Programs,1627,50,,percent of total billed charges,,
Mri Lower Extremity Rt Any Jt Wo W Contrast,,73723,CPT,Facility,Both,,,RT,3254,2765.9,747,3254,Humana Insurance Company,Commercial PPO,3091.3,95,,percent of total billed charges,,
Mri Lower Extremity Rt Any Jt Wo W Contrast,,73723,CPT,Facility,Outpatient,,,RT,3254,2765.9,747,3254,Humana Insurance Company,Medicare PPO,1594.46,49,,percent of total billed charges,,
Mri Lower Extremity Rt Any Jt Wo W Contrast,,73723,CPT,Facility,Inpatient,,,RT,3254,2765.9,747,3254,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Mri Lower Extremity Rt Any Jt Wo W Contrast,,73723,CPT,Facility,Both,,,RT,3254,2765.9,747,3254,Medica,Individual & Family,3224.714,99.1,,percent of total billed charges,,
Mri Lower Extremity Rt Any Jt Wo W Contrast,,73723,CPT,Facility,Outpatient,,,RT,3254,2765.9,747,3254,Medica,Medica Advantage Solution,1620.492,49.8,,percent of total billed charges,,
Mri Lower Extremity Rt Any Jt Wo W Contrast,,73723,CPT,Facility,Inpatient,,,RT,3254,2765.9,747,3254,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Mri Lower Extremity Rt Any Jt Wo W Contrast,,73723,CPT,Facility,Outpatient,,,RT,3254,2765.9,747,3254,Medica,Medical Assistance,747,,,Other ,per vist,Pays in addition to all Outpatient Service Categories
Mri Lower Extremity Rt Any Jt Wo W Contrast,,73723,CPT,Facility,Inpatient,,,RT,3254,2765.9,747,3254,Medica,Medical Assistance,,,,,Included in per diem rate,
Mri Lower Extremity Rt Any Jt Wo W Contrast,,73723,CPT,Facility,Outpatient,,,RT,3254,2765.9,747,3254,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1620.492,49.8,,percent of total billed charges,,
Mri Lower Extremity Rt Any Jt Wo W Contrast,,73723,CPT,Facility,Inpatient,,,RT,3254,2765.9,747,3254,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Mri Lower Extremity Rt Any Jt Wo W Contrast,,73723,CPT,Facility,Both,,,RT,3254,2765.9,747,3254,"Multiplan, Inc.","Multiplan, Inc.",3058.76,94,,percent of total billed charges,,
Mri Lower Extremity Rt Any Jt Wo W Contrast,,73723,CPT,Facility,Outpatient,,,RT,3254,2765.9,747,3254,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1535,,,Other  ,per scan,
Mri Lower Extremity Rt Any Jt Wo W Contrast,,73723,CPT,Facility,Inpatient,,,RT,3254,2765.9,747,3254,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Mri Lower Extremity Rt Any Jt Wo W Contrast,,73723,CPT,Facility,Both,,,RT,3254,2765.9,747,3254,"Preferred One Administrative Services, INC.",PPO,3208.444,98.6,,percent of total billed charges,,
Mri Lower Extremity Rt Any Jt Wo W Contrast,,73723,CPT,Facility,Outpatient,,,RT,3254,2765.9,747,3254,PrimeWest Health,Minnesota Senior Health Options (MSHO),1674.183,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Mri Lower Extremity Rt Any Jt Wo W Contrast,,73723,CPT,Facility,Inpatient,,,RT,3254,2765.9,747,3254,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mri Lower Extremity Rt Any Jt Wo W Contrast,,73723,CPT,Facility,Outpatient,,,RT,3254,2765.9,747,3254,PrimeWest Health,MinnesotaCare,1671.2544,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Mri Lower Extremity Rt Any Jt Wo W Contrast,,73723,CPT,Facility,Inpatient,,,RT,3254,2765.9,747,3254,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Mri Lower Extremity Rt Any Jt Wo W Contrast,,73723,CPT,Facility,Both,,,RT,3254,2765.9,747,3254,Sanford Health Plan,Sanford Health Plan,2993.68,92,,percent of total billed charges,,
Mri Lower Extremity Rt Any Jt Wo W Contrast,,73723,CPT,Facility,Outpatient,,,RT,3254,2765.9,747,3254,"UCare Health, Inc.",Individual & Family Plan,1833.629,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Mri Lower Extremity Rt Any Jt Wo W Contrast,,73723,CPT,Facility,Inpatient,,,RT,3254,2765.9,747,3254,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Mri Lower Extremity Rt Any Jt Wo W Contrast,,73723,CPT,Facility,Outpatient,,,RT,3254,2765.9,747,3254,"UCare Health, Inc.",Medical Assistance,1642.2938,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mri Lower Extremity Rt Any Jt Wo W Contrast,,73723,CPT,Facility,Inpatient,,,RT,3254,2765.9,747,3254,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Mri Lower Extremity Rt Any Jt Wo W Contrast,,73723,CPT,Facility,Outpatient,,,RT,3254,2765.9,747,3254,"UCare Health, Inc.",Medicare Advantage,1642.2938,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mri Lower Extremity Rt Any Jt Wo W Contrast,,73723,CPT,Facility,Inpatient,,,RT,3254,2765.9,747,3254,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mri Lower Extremity Rt Any Jt Wo W Contrast,,73723,CPT,Facility,Outpatient,,,RT,3254,2765.9,747,3254,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1642.2938,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mri Lower Extremity Rt Any Jt Wo W Contrast,,73723,CPT,Facility,Inpatient,,,RT,3254,2765.9,747,3254,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mri Lower Extremity Rt Any Jt Wo W Contrast,,73723,CPT,Facility,Both,,,RT,3254,2765.9,747,3254,UnitedHealthcare,Individual & Family,3058.76,94,,percent of total billed charges,,
Mri Lower Extremity Rt Any Jt Wo W Contrast,,73723,CPT,Facility,Outpatient,,,RT,3254,2765.9,747,3254,UnitedHealthcare,Medicare Advantage,1594.46,49,,percent of total billed charges,,
Mri Lower Extremity Rt Any Jt Wo W Contrast,,73723,CPT,Facility,Inpatient,,,RT,3254,2765.9,747,3254,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Mri Lower Extremity Rt Any Jt Wo W Contrast,,73723,CPT,Facility,Outpatient,,,RT,3254,2765.9,747,3254,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1561.92,48,,percent of total billed charges,,100% of DHS outpatient percentage
Mri Lower Extremity Rt Any Jt Wo W Contrast,,73723,CPT,Facility,Inpatient,,,RT,3254,2765.9,747,3254,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Us Carotid Ltd Rt,,93882,CPT,Facility,Both,,,RT,598,508.3,171.3868,598,Aetna,Commercial,550.16,92,,percent of total billed charges,,
Us Carotid Ltd Rt,,93882,CPT,Facility,Outpatient,,,RT,598,508.3,171.3868,598,Aetna,Medicare Advantage,293.02,49,,percent of total billed charges,,
Us Carotid Ltd Rt,,93882,CPT,Facility,Inpatient,,,RT,598,508.3,171.3868,598,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Us Carotid Ltd Rt,,93882,CPT,Facility,Both,,,RT,598,508.3,171.3868,598,Aetna,PPO,556.14,93,,percent of total billed charges,,
Us Carotid Ltd Rt,,93882,CPT,Facility,Both,,,RT,598,508.3,171.3868,598,America's PPO,America's PPO,574.2594,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Us Carotid Ltd Rt,,93882,CPT,Facility,Both,,,RT,598,508.3,171.3868,598,BlueCross BlueShield Minnesota, Federal Employee Program,588.432,98.4,,percent of total billed charges,,
Us Carotid Ltd Rt,,93882,CPT,Facility,Both,,,RT,598,508.3,171.3868,598,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,598,100,,percent of total billed charges,,
Us Carotid Ltd Rt,,93882,CPT,Facility,Both,,,RT,598,508.3,171.3868,598,BlueCross BlueShield Minnesota,High Value Network Plan,538.2,90,,percent of total billed charges,,
Us Carotid Ltd Rt,,93882,CPT,Facility,Outpatient,,,RT,598,508.3,171.3868,598,BlueCross BlueShield Minnesota,Medicare Advantage,293.02,49,,percent of total billed charges,,
Us Carotid Ltd Rt,,93882,CPT,Facility,Inpatient,,,RT,598,508.3,171.3868,598,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Us Carotid Ltd Rt,,93882,CPT,Facility,Both,,,RT,598,508.3,171.3868,598,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,529.6486,88.57,,percent of total billed charges,,
Us Carotid Ltd Rt,,93882,CPT,Facility,Both,,,RT,598,508.3,171.3868,598,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,171.3868,28.66,,percent of total billed charges,,
Us Carotid Ltd Rt,,93882,CPT,Facility,Outpatient,,,RT,598,508.3,171.3868,598,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),293.02,49,,percent of total billed charges,,
Us Carotid Ltd Rt,,93882,CPT,Facility,Inpatient,,,RT,598,508.3,171.3868,598,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Us Carotid Ltd Rt,,93882,CPT,Facility,Both,,,RT,598,508.3,171.3868,598,CorVel,Worker's Compensation,598,100,,percent of total billed charges,,
Us Carotid Ltd Rt,,93882,CPT,Facility,Both,,,RT,598,508.3,171.3868,598,First Health Group Corporation,First Health Network,580.06,97,,percent of total billed charges,,
Us Carotid Ltd Rt,,93882,CPT,Facility,Both,,,RT,598,508.3,171.3868,598,"Health Partners, Inc.",Commercial,565.708,94.6,,percent of total billed charges,,
Us Carotid Ltd Rt,,93882,CPT,Facility,Outpatient,,,RT,598,508.3,171.3868,598,"Health Partners, Inc.",Medicare Advantage,293.02,49,,percent of total billed charges,,
Us Carotid Ltd Rt,,93882,CPT,Facility,Inpatient,,,RT,598,508.3,171.3868,598,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Us Carotid Ltd Rt,,93882,CPT,Facility,Both,,,RT,598,508.3,171.3868,598,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),358.8,60,,percent of total billed charges,,
Us Carotid Ltd Rt,,93882,CPT,Facility,Both,,,RT,598,508.3,171.3868,598,"Health Partners, Inc.",State of Minnesota Advantage Program,487.37,81.5,,percent of total billed charges,,
Us Carotid Ltd Rt,,93882,CPT,Facility,Both,,,RT,598,508.3,171.3868,598,"Health Partners, Inc.",State Public Programs,299,50,,percent of total billed charges,,
Us Carotid Ltd Rt,,93882,CPT,Facility,Both,,,RT,598,508.3,171.3868,598,Humana Insurance Company,Commercial PPO,568.1,95,,percent of total billed charges,,
Us Carotid Ltd Rt,,93882,CPT,Facility,Outpatient,,,RT,598,508.3,171.3868,598,Humana Insurance Company,Medicare PPO,293.02,49,,percent of total billed charges,,
Us Carotid Ltd Rt,,93882,CPT,Facility,Inpatient,,,RT,598,508.3,171.3868,598,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Us Carotid Ltd Rt,,93882,CPT,Facility,Both,,,RT,598,508.3,171.3868,598,Medica,Individual & Family,592.618,99.1,,percent of total billed charges,,
Us Carotid Ltd Rt,,93882,CPT,Facility,Outpatient,,,RT,598,508.3,171.3868,598,Medica,Medica Advantage Solution,297.804,49.8,,percent of total billed charges,,
Us Carotid Ltd Rt,,93882,CPT,Facility,Inpatient,,,RT,598,508.3,171.3868,598,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Us Carotid Ltd Rt,,93882,CPT,Facility,Outpatient,,,RT,598,508.3,171.3868,598,Medica,Medical Assistance,266.708,44.6,,percent of total billed charges,,
Us Carotid Ltd Rt,,93882,CPT,Facility,Inpatient,,,RT,598,508.3,171.3868,598,Medica,Medical Assistance,,,,,Included in per diem rate,
Us Carotid Ltd Rt,,93882,CPT,Facility,Outpatient,,,RT,598,508.3,171.3868,598,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,297.804,49.8,,percent of total billed charges,,
Us Carotid Ltd Rt,,93882,CPT,Facility,Inpatient,,,RT,598,508.3,171.3868,598,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Us Carotid Ltd Rt,,93882,CPT,Facility,Both,,,RT,598,508.3,171.3868,598,"Multiplan, Inc.","Multiplan, Inc.",562.12,94,,percent of total billed charges,,
Us Carotid Ltd Rt,,93882,CPT,Facility,Outpatient,,,RT,598,508.3,171.3868,598,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,538.798,90.1,,percent of total billed charges,,
Us Carotid Ltd Rt,,93882,CPT,Facility,Inpatient,,,RT,598,508.3,171.3868,598,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Us Carotid Ltd Rt,,93882,CPT,Facility,Both,,,RT,598,508.3,171.3868,598,"Preferred One Administrative Services, INC.",PPO,589.628,98.6,,percent of total billed charges,,
Us Carotid Ltd Rt,,93882,CPT,Facility,Outpatient,,,RT,598,508.3,171.3868,598,PrimeWest Health,Minnesota Senior Health Options (MSHO),307.671,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Us Carotid Ltd Rt,,93882,CPT,Facility,Inpatient,,,RT,598,508.3,171.3868,598,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Us Carotid Ltd Rt,,93882,CPT,Facility,Outpatient,,,RT,598,508.3,171.3868,598,PrimeWest Health,MinnesotaCare,307.1328,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Us Carotid Ltd Rt,,93882,CPT,Facility,Inpatient,,,RT,598,508.3,171.3868,598,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Us Carotid Ltd Rt,,93882,CPT,Facility,Both,,,RT,598,508.3,171.3868,598,Sanford Health Plan,Sanford Health Plan,550.16,92,,percent of total billed charges,,
Us Carotid Ltd Rt,,93882,CPT,Facility,Outpatient,,,RT,598,508.3,171.3868,598,"UCare Health, Inc.",Individual & Family Plan,336.973,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Us Carotid Ltd Rt,,93882,CPT,Facility,Inpatient,,,RT,598,508.3,171.3868,598,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Us Carotid Ltd Rt,,93882,CPT,Facility,Outpatient,,,RT,598,508.3,171.3868,598,"UCare Health, Inc.",Medical Assistance,301.8106,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Carotid Ltd Rt,,93882,CPT,Facility,Inpatient,,,RT,598,508.3,171.3868,598,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Us Carotid Ltd Rt,,93882,CPT,Facility,Outpatient,,,RT,598,508.3,171.3868,598,"UCare Health, Inc.",Medicare Advantage,301.8106,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Carotid Ltd Rt,,93882,CPT,Facility,Inpatient,,,RT,598,508.3,171.3868,598,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Us Carotid Ltd Rt,,93882,CPT,Facility,Outpatient,,,RT,598,508.3,171.3868,598,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),301.8106,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Carotid Ltd Rt,,93882,CPT,Facility,Inpatient,,,RT,598,508.3,171.3868,598,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Us Carotid Ltd Rt,,93882,CPT,Facility,Both,,,RT,598,508.3,171.3868,598,UnitedHealthcare,Individual & Family,562.12,94,,percent of total billed charges,,
Us Carotid Ltd Rt,,93882,CPT,Facility,Outpatient,,,RT,598,508.3,171.3868,598,UnitedHealthcare,Medicare Advantage,293.02,49,,percent of total billed charges,,
Us Carotid Ltd Rt,,93882,CPT,Facility,Inpatient,,,RT,598,508.3,171.3868,598,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Us Carotid Ltd Rt,,93882,CPT,Facility,Outpatient,,,RT,598,508.3,171.3868,598,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,287.04,48,,percent of total billed charges,,100% of DHS outpatient percentage
Us Carotid Ltd Rt,,93882,CPT,Facility,Inpatient,,,RT,598,508.3,171.3868,598,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Us Dop Artery Leg Rt,,93926,CPT,Facility,Both,,,RT,636,540.6,182.2776,636,Aetna,Commercial,585.12,92,,percent of total billed charges,,
Us Dop Artery Leg Rt,,93926,CPT,Facility,Outpatient,,,RT,636,540.6,182.2776,636,Aetna,Medicare Advantage,311.64,49,,percent of total billed charges,,
Us Dop Artery Leg Rt,,93926,CPT,Facility,Inpatient,,,RT,636,540.6,182.2776,636,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Us Dop Artery Leg Rt,,93926,CPT,Facility,Both,,,RT,636,540.6,182.2776,636,Aetna,PPO,591.48,93,,percent of total billed charges,,
Us Dop Artery Leg Rt,,93926,CPT,Facility,Both,,,RT,636,540.6,182.2776,636,America's PPO,America's PPO,610.7508,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Us Dop Artery Leg Rt,,93926,CPT,Facility,Both,,,RT,636,540.6,182.2776,636,BlueCross BlueShield Minnesota, Federal Employee Program,625.824,98.4,,percent of total billed charges,,
Us Dop Artery Leg Rt,,93926,CPT,Facility,Both,,,RT,636,540.6,182.2776,636,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,636,100,,percent of total billed charges,,
Us Dop Artery Leg Rt,,93926,CPT,Facility,Both,,,RT,636,540.6,182.2776,636,BlueCross BlueShield Minnesota,High Value Network Plan,572.4,90,,percent of total billed charges,,
Us Dop Artery Leg Rt,,93926,CPT,Facility,Outpatient,,,RT,636,540.6,182.2776,636,BlueCross BlueShield Minnesota,Medicare Advantage,311.64,49,,percent of total billed charges,,
Us Dop Artery Leg Rt,,93926,CPT,Facility,Inpatient,,,RT,636,540.6,182.2776,636,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Us Dop Artery Leg Rt,,93926,CPT,Facility,Both,,,RT,636,540.6,182.2776,636,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,563.3052,88.57,,percent of total billed charges,,
Us Dop Artery Leg Rt,,93926,CPT,Facility,Both,,,RT,636,540.6,182.2776,636,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,182.2776,28.66,,percent of total billed charges,,
Us Dop Artery Leg Rt,,93926,CPT,Facility,Outpatient,,,RT,636,540.6,182.2776,636,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),311.64,49,,percent of total billed charges,,
Us Dop Artery Leg Rt,,93926,CPT,Facility,Inpatient,,,RT,636,540.6,182.2776,636,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Us Dop Artery Leg Rt,,93926,CPT,Facility,Both,,,RT,636,540.6,182.2776,636,CorVel,Worker's Compensation,636,100,,percent of total billed charges,,
Us Dop Artery Leg Rt,,93926,CPT,Facility,Both,,,RT,636,540.6,182.2776,636,First Health Group Corporation,First Health Network,616.92,97,,percent of total billed charges,,
Us Dop Artery Leg Rt,,93926,CPT,Facility,Both,,,RT,636,540.6,182.2776,636,"Health Partners, Inc.",Commercial,601.656,94.6,,percent of total billed charges,,
Us Dop Artery Leg Rt,,93926,CPT,Facility,Outpatient,,,RT,636,540.6,182.2776,636,"Health Partners, Inc.",Medicare Advantage,311.64,49,,percent of total billed charges,,
Us Dop Artery Leg Rt,,93926,CPT,Facility,Inpatient,,,RT,636,540.6,182.2776,636,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Us Dop Artery Leg Rt,,93926,CPT,Facility,Both,,,RT,636,540.6,182.2776,636,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),381.6,60,,percent of total billed charges,,
Us Dop Artery Leg Rt,,93926,CPT,Facility,Both,,,RT,636,540.6,182.2776,636,"Health Partners, Inc.",State of Minnesota Advantage Program,518.34,81.5,,percent of total billed charges,,
Us Dop Artery Leg Rt,,93926,CPT,Facility,Both,,,RT,636,540.6,182.2776,636,"Health Partners, Inc.",State Public Programs,318,50,,percent of total billed charges,,
Us Dop Artery Leg Rt,,93926,CPT,Facility,Both,,,RT,636,540.6,182.2776,636,Humana Insurance Company,Commercial PPO,604.2,95,,percent of total billed charges,,
Us Dop Artery Leg Rt,,93926,CPT,Facility,Outpatient,,,RT,636,540.6,182.2776,636,Humana Insurance Company,Medicare PPO,311.64,49,,percent of total billed charges,,
Us Dop Artery Leg Rt,,93926,CPT,Facility,Inpatient,,,RT,636,540.6,182.2776,636,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Us Dop Artery Leg Rt,,93926,CPT,Facility,Both,,,RT,636,540.6,182.2776,636,Medica,Individual & Family,630.276,99.1,,percent of total billed charges,,
Us Dop Artery Leg Rt,,93926,CPT,Facility,Outpatient,,,RT,636,540.6,182.2776,636,Medica,Medica Advantage Solution,316.728,49.8,,percent of total billed charges,,
Us Dop Artery Leg Rt,,93926,CPT,Facility,Inpatient,,,RT,636,540.6,182.2776,636,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Us Dop Artery Leg Rt,,93926,CPT,Facility,Outpatient,,,RT,636,540.6,182.2776,636,Medica,Medical Assistance,283.656,44.6,,percent of total billed charges,,
Us Dop Artery Leg Rt,,93926,CPT,Facility,Inpatient,,,RT,636,540.6,182.2776,636,Medica,Medical Assistance,,,,,Included in per diem rate,
Us Dop Artery Leg Rt,,93926,CPT,Facility,Outpatient,,,RT,636,540.6,182.2776,636,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,316.728,49.8,,percent of total billed charges,,
Us Dop Artery Leg Rt,,93926,CPT,Facility,Inpatient,,,RT,636,540.6,182.2776,636,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Us Dop Artery Leg Rt,,93926,CPT,Facility,Both,,,RT,636,540.6,182.2776,636,"Multiplan, Inc.","Multiplan, Inc.",597.84,94,,percent of total billed charges,,
Us Dop Artery Leg Rt,,93926,CPT,Facility,Outpatient,,,RT,636,540.6,182.2776,636,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,573.036,90.1,,percent of total billed charges,,
Us Dop Artery Leg Rt,,93926,CPT,Facility,Inpatient,,,RT,636,540.6,182.2776,636,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Us Dop Artery Leg Rt,,93926,CPT,Facility,Both,,,RT,636,540.6,182.2776,636,"Preferred One Administrative Services, INC.",PPO,627.096,98.6,,percent of total billed charges,,
Us Dop Artery Leg Rt,,93926,CPT,Facility,Outpatient,,,RT,636,540.6,182.2776,636,PrimeWest Health,Minnesota Senior Health Options (MSHO),327.222,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Us Dop Artery Leg Rt,,93926,CPT,Facility,Inpatient,,,RT,636,540.6,182.2776,636,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Us Dop Artery Leg Rt,,93926,CPT,Facility,Outpatient,,,RT,636,540.6,182.2776,636,PrimeWest Health,MinnesotaCare,326.6496,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Us Dop Artery Leg Rt,,93926,CPT,Facility,Inpatient,,,RT,636,540.6,182.2776,636,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Us Dop Artery Leg Rt,,93926,CPT,Facility,Both,,,RT,636,540.6,182.2776,636,Sanford Health Plan,Sanford Health Plan,585.12,92,,percent of total billed charges,,
Us Dop Artery Leg Rt,,93926,CPT,Facility,Outpatient,,,RT,636,540.6,182.2776,636,"UCare Health, Inc.",Individual & Family Plan,358.386,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Us Dop Artery Leg Rt,,93926,CPT,Facility,Inpatient,,,RT,636,540.6,182.2776,636,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Us Dop Artery Leg Rt,,93926,CPT,Facility,Outpatient,,,RT,636,540.6,182.2776,636,"UCare Health, Inc.",Medical Assistance,320.9892,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Dop Artery Leg Rt,,93926,CPT,Facility,Inpatient,,,RT,636,540.6,182.2776,636,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Us Dop Artery Leg Rt,,93926,CPT,Facility,Outpatient,,,RT,636,540.6,182.2776,636,"UCare Health, Inc.",Medicare Advantage,320.9892,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Dop Artery Leg Rt,,93926,CPT,Facility,Inpatient,,,RT,636,540.6,182.2776,636,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Us Dop Artery Leg Rt,,93926,CPT,Facility,Outpatient,,,RT,636,540.6,182.2776,636,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),320.9892,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Dop Artery Leg Rt,,93926,CPT,Facility,Inpatient,,,RT,636,540.6,182.2776,636,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Us Dop Artery Leg Rt,,93926,CPT,Facility,Both,,,RT,636,540.6,182.2776,636,UnitedHealthcare,Individual & Family,597.84,94,,percent of total billed charges,,
Us Dop Artery Leg Rt,,93926,CPT,Facility,Outpatient,,,RT,636,540.6,182.2776,636,UnitedHealthcare,Medicare Advantage,311.64,49,,percent of total billed charges,,
Us Dop Artery Leg Rt,,93926,CPT,Facility,Inpatient,,,RT,636,540.6,182.2776,636,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Us Dop Artery Leg Rt,,93926,CPT,Facility,Outpatient,,,RT,636,540.6,182.2776,636,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,305.28,48,,percent of total billed charges,,100% of DHS outpatient percentage
Us Dop Artery Leg Rt,,93926,CPT,Facility,Inpatient,,,RT,636,540.6,182.2776,636,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Us Dop Artery Arm Rt,,93931,CPT,Facility,Both,,,RT,606,515.1,173.6796,606,Aetna,Commercial,557.52,92,,percent of total billed charges,,
Us Dop Artery Arm Rt,,93931,CPT,Facility,Outpatient,,,RT,606,515.1,173.6796,606,Aetna,Medicare Advantage,296.94,49,,percent of total billed charges,,
Us Dop Artery Arm Rt,,93931,CPT,Facility,Inpatient,,,RT,606,515.1,173.6796,606,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Us Dop Artery Arm Rt,,93931,CPT,Facility,Both,,,RT,606,515.1,173.6796,606,Aetna,PPO,563.58,93,,percent of total billed charges,,
Us Dop Artery Arm Rt,,93931,CPT,Facility,Both,,,RT,606,515.1,173.6796,606,America's PPO,America's PPO,581.9418,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Us Dop Artery Arm Rt,,93931,CPT,Facility,Both,,,RT,606,515.1,173.6796,606,BlueCross BlueShield Minnesota, Federal Employee Program,596.304,98.4,,percent of total billed charges,,
Us Dop Artery Arm Rt,,93931,CPT,Facility,Both,,,RT,606,515.1,173.6796,606,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,606,100,,percent of total billed charges,,
Us Dop Artery Arm Rt,,93931,CPT,Facility,Both,,,RT,606,515.1,173.6796,606,BlueCross BlueShield Minnesota,High Value Network Plan,545.4,90,,percent of total billed charges,,
Us Dop Artery Arm Rt,,93931,CPT,Facility,Outpatient,,,RT,606,515.1,173.6796,606,BlueCross BlueShield Minnesota,Medicare Advantage,296.94,49,,percent of total billed charges,,
Us Dop Artery Arm Rt,,93931,CPT,Facility,Inpatient,,,RT,606,515.1,173.6796,606,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Us Dop Artery Arm Rt,,93931,CPT,Facility,Both,,,RT,606,515.1,173.6796,606,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,536.7342,88.57,,percent of total billed charges,,
Us Dop Artery Arm Rt,,93931,CPT,Facility,Both,,,RT,606,515.1,173.6796,606,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,173.6796,28.66,,percent of total billed charges,,
Us Dop Artery Arm Rt,,93931,CPT,Facility,Outpatient,,,RT,606,515.1,173.6796,606,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),296.94,49,,percent of total billed charges,,
Us Dop Artery Arm Rt,,93931,CPT,Facility,Inpatient,,,RT,606,515.1,173.6796,606,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Us Dop Artery Arm Rt,,93931,CPT,Facility,Both,,,RT,606,515.1,173.6796,606,CorVel,Worker's Compensation,606,100,,percent of total billed charges,,
Us Dop Artery Arm Rt,,93931,CPT,Facility,Both,,,RT,606,515.1,173.6796,606,First Health Group Corporation,First Health Network,587.82,97,,percent of total billed charges,,
Us Dop Artery Arm Rt,,93931,CPT,Facility,Both,,,RT,606,515.1,173.6796,606,"Health Partners, Inc.",Commercial,573.276,94.6,,percent of total billed charges,,
Us Dop Artery Arm Rt,,93931,CPT,Facility,Outpatient,,,RT,606,515.1,173.6796,606,"Health Partners, Inc.",Medicare Advantage,296.94,49,,percent of total billed charges,,
Us Dop Artery Arm Rt,,93931,CPT,Facility,Inpatient,,,RT,606,515.1,173.6796,606,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Us Dop Artery Arm Rt,,93931,CPT,Facility,Both,,,RT,606,515.1,173.6796,606,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),363.6,60,,percent of total billed charges,,
Us Dop Artery Arm Rt,,93931,CPT,Facility,Both,,,RT,606,515.1,173.6796,606,"Health Partners, Inc.",State of Minnesota Advantage Program,493.89,81.5,,percent of total billed charges,,
Us Dop Artery Arm Rt,,93931,CPT,Facility,Both,,,RT,606,515.1,173.6796,606,"Health Partners, Inc.",State Public Programs,303,50,,percent of total billed charges,,
Us Dop Artery Arm Rt,,93931,CPT,Facility,Both,,,RT,606,515.1,173.6796,606,Humana Insurance Company,Commercial PPO,575.7,95,,percent of total billed charges,,
Us Dop Artery Arm Rt,,93931,CPT,Facility,Outpatient,,,RT,606,515.1,173.6796,606,Humana Insurance Company,Medicare PPO,296.94,49,,percent of total billed charges,,
Us Dop Artery Arm Rt,,93931,CPT,Facility,Inpatient,,,RT,606,515.1,173.6796,606,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Us Dop Artery Arm Rt,,93931,CPT,Facility,Both,,,RT,606,515.1,173.6796,606,Medica,Individual & Family,600.546,99.1,,percent of total billed charges,,
Us Dop Artery Arm Rt,,93931,CPT,Facility,Outpatient,,,RT,606,515.1,173.6796,606,Medica,Medica Advantage Solution,301.788,49.8,,percent of total billed charges,,
Us Dop Artery Arm Rt,,93931,CPT,Facility,Inpatient,,,RT,606,515.1,173.6796,606,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Us Dop Artery Arm Rt,,93931,CPT,Facility,Outpatient,,,RT,606,515.1,173.6796,606,Medica,Medical Assistance,270.276,44.6,,percent of total billed charges,,
Us Dop Artery Arm Rt,,93931,CPT,Facility,Inpatient,,,RT,606,515.1,173.6796,606,Medica,Medical Assistance,,,,,Included in per diem rate,
Us Dop Artery Arm Rt,,93931,CPT,Facility,Outpatient,,,RT,606,515.1,173.6796,606,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,301.788,49.8,,percent of total billed charges,,
Us Dop Artery Arm Rt,,93931,CPT,Facility,Inpatient,,,RT,606,515.1,173.6796,606,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Us Dop Artery Arm Rt,,93931,CPT,Facility,Both,,,RT,606,515.1,173.6796,606,"Multiplan, Inc.","Multiplan, Inc.",569.64,94,,percent of total billed charges,,
Us Dop Artery Arm Rt,,93931,CPT,Facility,Outpatient,,,RT,606,515.1,173.6796,606,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,546.006,90.1,,percent of total billed charges,,
Us Dop Artery Arm Rt,,93931,CPT,Facility,Inpatient,,,RT,606,515.1,173.6796,606,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Us Dop Artery Arm Rt,,93931,CPT,Facility,Both,,,RT,606,515.1,173.6796,606,"Preferred One Administrative Services, INC.",PPO,597.516,98.6,,percent of total billed charges,,
Us Dop Artery Arm Rt,,93931,CPT,Facility,Outpatient,,,RT,606,515.1,173.6796,606,PrimeWest Health,Minnesota Senior Health Options (MSHO),311.787,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Us Dop Artery Arm Rt,,93931,CPT,Facility,Inpatient,,,RT,606,515.1,173.6796,606,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Us Dop Artery Arm Rt,,93931,CPT,Facility,Outpatient,,,RT,606,515.1,173.6796,606,PrimeWest Health,MinnesotaCare,311.2416,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Us Dop Artery Arm Rt,,93931,CPT,Facility,Inpatient,,,RT,606,515.1,173.6796,606,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Us Dop Artery Arm Rt,,93931,CPT,Facility,Both,,,RT,606,515.1,173.6796,606,Sanford Health Plan,Sanford Health Plan,557.52,92,,percent of total billed charges,,
Us Dop Artery Arm Rt,,93931,CPT,Facility,Outpatient,,,RT,606,515.1,173.6796,606,"UCare Health, Inc.",Individual & Family Plan,341.481,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Us Dop Artery Arm Rt,,93931,CPT,Facility,Inpatient,,,RT,606,515.1,173.6796,606,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Us Dop Artery Arm Rt,,93931,CPT,Facility,Outpatient,,,RT,606,515.1,173.6796,606,"UCare Health, Inc.",Medical Assistance,305.8482,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Dop Artery Arm Rt,,93931,CPT,Facility,Inpatient,,,RT,606,515.1,173.6796,606,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Us Dop Artery Arm Rt,,93931,CPT,Facility,Outpatient,,,RT,606,515.1,173.6796,606,"UCare Health, Inc.",Medicare Advantage,305.8482,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Dop Artery Arm Rt,,93931,CPT,Facility,Inpatient,,,RT,606,515.1,173.6796,606,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Us Dop Artery Arm Rt,,93931,CPT,Facility,Outpatient,,,RT,606,515.1,173.6796,606,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),305.8482,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Dop Artery Arm Rt,,93931,CPT,Facility,Inpatient,,,RT,606,515.1,173.6796,606,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Us Dop Artery Arm Rt,,93931,CPT,Facility,Both,,,RT,606,515.1,173.6796,606,UnitedHealthcare,Individual & Family,569.64,94,,percent of total billed charges,,
Us Dop Artery Arm Rt,,93931,CPT,Facility,Outpatient,,,RT,606,515.1,173.6796,606,UnitedHealthcare,Medicare Advantage,296.94,49,,percent of total billed charges,,
Us Dop Artery Arm Rt,,93931,CPT,Facility,Inpatient,,,RT,606,515.1,173.6796,606,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Us Dop Artery Arm Rt,,93931,CPT,Facility,Outpatient,,,RT,606,515.1,173.6796,606,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,290.88,48,,percent of total billed charges,,100% of DHS outpatient percentage
Us Dop Artery Arm Rt,,93931,CPT,Facility,Inpatient,,,RT,606,515.1,173.6796,606,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Us Dop Vein Arm Rt,,93971,CPT,Facility,Both,,,RT,626,532.1,179.4116,626,Aetna,Commercial,575.92,92,,percent of total billed charges,,
Us Dop Vein Arm Rt,,93971,CPT,Facility,Outpatient,,,RT,626,532.1,179.4116,626,Aetna,Medicare Advantage,306.74,49,,percent of total billed charges,,
Us Dop Vein Arm Rt,,93971,CPT,Facility,Inpatient,,,RT,626,532.1,179.4116,626,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Us Dop Vein Arm Rt,,93971,CPT,Facility,Both,,,RT,626,532.1,179.4116,626,Aetna,PPO,582.18,93,,percent of total billed charges,,
Us Dop Vein Arm Rt,,93971,CPT,Facility,Both,,,RT,626,532.1,179.4116,626,America's PPO,America's PPO,601.1478,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Us Dop Vein Arm Rt,,93971,CPT,Facility,Both,,,RT,626,532.1,179.4116,626,BlueCross BlueShield Minnesota, Federal Employee Program,615.984,98.4,,percent of total billed charges,,
Us Dop Vein Arm Rt,,93971,CPT,Facility,Both,,,RT,626,532.1,179.4116,626,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,626,100,,percent of total billed charges,,
Us Dop Vein Arm Rt,,93971,CPT,Facility,Both,,,RT,626,532.1,179.4116,626,BlueCross BlueShield Minnesota,High Value Network Plan,563.4,90,,percent of total billed charges,,
Us Dop Vein Arm Rt,,93971,CPT,Facility,Outpatient,,,RT,626,532.1,179.4116,626,BlueCross BlueShield Minnesota,Medicare Advantage,306.74,49,,percent of total billed charges,,
Us Dop Vein Arm Rt,,93971,CPT,Facility,Inpatient,,,RT,626,532.1,179.4116,626,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Us Dop Vein Arm Rt,,93971,CPT,Facility,Both,,,RT,626,532.1,179.4116,626,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,554.4482,88.57,,percent of total billed charges,,
Us Dop Vein Arm Rt,,93971,CPT,Facility,Both,,,RT,626,532.1,179.4116,626,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,179.4116,28.66,,percent of total billed charges,,
Us Dop Vein Arm Rt,,93971,CPT,Facility,Outpatient,,,RT,626,532.1,179.4116,626,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),306.74,49,,percent of total billed charges,,
Us Dop Vein Arm Rt,,93971,CPT,Facility,Inpatient,,,RT,626,532.1,179.4116,626,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Us Dop Vein Arm Rt,,93971,CPT,Facility,Both,,,RT,626,532.1,179.4116,626,CorVel,Worker's Compensation,626,100,,percent of total billed charges,,
Us Dop Vein Arm Rt,,93971,CPT,Facility,Both,,,RT,626,532.1,179.4116,626,First Health Group Corporation,First Health Network,607.22,97,,percent of total billed charges,,
Us Dop Vein Arm Rt,,93971,CPT,Facility,Both,,,RT,626,532.1,179.4116,626,"Health Partners, Inc.",Commercial,592.196,94.6,,percent of total billed charges,,
Us Dop Vein Arm Rt,,93971,CPT,Facility,Outpatient,,,RT,626,532.1,179.4116,626,"Health Partners, Inc.",Medicare Advantage,306.74,49,,percent of total billed charges,,
Us Dop Vein Arm Rt,,93971,CPT,Facility,Inpatient,,,RT,626,532.1,179.4116,626,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Us Dop Vein Arm Rt,,93971,CPT,Facility,Both,,,RT,626,532.1,179.4116,626,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),375.6,60,,percent of total billed charges,,
Us Dop Vein Arm Rt,,93971,CPT,Facility,Both,,,RT,626,532.1,179.4116,626,"Health Partners, Inc.",State of Minnesota Advantage Program,510.19,81.5,,percent of total billed charges,,
Us Dop Vein Arm Rt,,93971,CPT,Facility,Both,,,RT,626,532.1,179.4116,626,"Health Partners, Inc.",State Public Programs,313,50,,percent of total billed charges,,
Us Dop Vein Arm Rt,,93971,CPT,Facility,Both,,,RT,626,532.1,179.4116,626,Humana Insurance Company,Commercial PPO,594.7,95,,percent of total billed charges,,
Us Dop Vein Arm Rt,,93971,CPT,Facility,Outpatient,,,RT,626,532.1,179.4116,626,Humana Insurance Company,Medicare PPO,306.74,49,,percent of total billed charges,,
Us Dop Vein Arm Rt,,93971,CPT,Facility,Inpatient,,,RT,626,532.1,179.4116,626,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Us Dop Vein Arm Rt,,93971,CPT,Facility,Both,,,RT,626,532.1,179.4116,626,Medica,Individual & Family,620.366,99.1,,percent of total billed charges,,
Us Dop Vein Arm Rt,,93971,CPT,Facility,Outpatient,,,RT,626,532.1,179.4116,626,Medica,Medica Advantage Solution,311.748,49.8,,percent of total billed charges,,
Us Dop Vein Arm Rt,,93971,CPT,Facility,Inpatient,,,RT,626,532.1,179.4116,626,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Us Dop Vein Arm Rt,,93971,CPT,Facility,Outpatient,,,RT,626,532.1,179.4116,626,Medica,Medical Assistance,279.196,44.6,,percent of total billed charges,,
Us Dop Vein Arm Rt,,93971,CPT,Facility,Inpatient,,,RT,626,532.1,179.4116,626,Medica,Medical Assistance,,,,,Included in per diem rate,
Us Dop Vein Arm Rt,,93971,CPT,Facility,Outpatient,,,RT,626,532.1,179.4116,626,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,311.748,49.8,,percent of total billed charges,,
Us Dop Vein Arm Rt,,93971,CPT,Facility,Inpatient,,,RT,626,532.1,179.4116,626,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Us Dop Vein Arm Rt,,93971,CPT,Facility,Both,,,RT,626,532.1,179.4116,626,"Multiplan, Inc.","Multiplan, Inc.",588.44,94,,percent of total billed charges,,
Us Dop Vein Arm Rt,,93971,CPT,Facility,Outpatient,,,RT,626,532.1,179.4116,626,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,564.026,90.1,,percent of total billed charges,,
Us Dop Vein Arm Rt,,93971,CPT,Facility,Inpatient,,,RT,626,532.1,179.4116,626,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Us Dop Vein Arm Rt,,93971,CPT,Facility,Both,,,RT,626,532.1,179.4116,626,"Preferred One Administrative Services, INC.",PPO,617.236,98.6,,percent of total billed charges,,
Us Dop Vein Arm Rt,,93971,CPT,Facility,Outpatient,,,RT,626,532.1,179.4116,626,PrimeWest Health,Minnesota Senior Health Options (MSHO),322.077,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Us Dop Vein Arm Rt,,93971,CPT,Facility,Inpatient,,,RT,626,532.1,179.4116,626,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Us Dop Vein Arm Rt,,93971,CPT,Facility,Outpatient,,,RT,626,532.1,179.4116,626,PrimeWest Health,MinnesotaCare,321.5136,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Us Dop Vein Arm Rt,,93971,CPT,Facility,Inpatient,,,RT,626,532.1,179.4116,626,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Us Dop Vein Arm Rt,,93971,CPT,Facility,Both,,,RT,626,532.1,179.4116,626,Sanford Health Plan,Sanford Health Plan,575.92,92,,percent of total billed charges,,
Us Dop Vein Arm Rt,,93971,CPT,Facility,Outpatient,,,RT,626,532.1,179.4116,626,"UCare Health, Inc.",Individual & Family Plan,352.751,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Us Dop Vein Arm Rt,,93971,CPT,Facility,Inpatient,,,RT,626,532.1,179.4116,626,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Us Dop Vein Arm Rt,,93971,CPT,Facility,Outpatient,,,RT,626,532.1,179.4116,626,"UCare Health, Inc.",Medical Assistance,315.9422,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Dop Vein Arm Rt,,93971,CPT,Facility,Inpatient,,,RT,626,532.1,179.4116,626,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Us Dop Vein Arm Rt,,93971,CPT,Facility,Outpatient,,,RT,626,532.1,179.4116,626,"UCare Health, Inc.",Medicare Advantage,315.9422,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Dop Vein Arm Rt,,93971,CPT,Facility,Inpatient,,,RT,626,532.1,179.4116,626,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Us Dop Vein Arm Rt,,93971,CPT,Facility,Outpatient,,,RT,626,532.1,179.4116,626,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),315.9422,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Dop Vein Arm Rt,,93971,CPT,Facility,Inpatient,,,RT,626,532.1,179.4116,626,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Us Dop Vein Arm Rt,,93971,CPT,Facility,Both,,,RT,626,532.1,179.4116,626,UnitedHealthcare,Individual & Family,588.44,94,,percent of total billed charges,,
Us Dop Vein Arm Rt,,93971,CPT,Facility,Outpatient,,,RT,626,532.1,179.4116,626,UnitedHealthcare,Medicare Advantage,306.74,49,,percent of total billed charges,,
Us Dop Vein Arm Rt,,93971,CPT,Facility,Inpatient,,,RT,626,532.1,179.4116,626,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Us Dop Vein Arm Rt,,93971,CPT,Facility,Outpatient,,,RT,626,532.1,179.4116,626,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,300.48,48,,percent of total billed charges,,100% of DHS outpatient percentage
Us Dop Vein Arm Rt,,93971,CPT,Facility,Inpatient,,,RT,626,532.1,179.4116,626,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Us Dop Vein Leg Rt,,93971,CPT,Facility,Both,,,RT,626,532.1,179.4116,626,Aetna,Commercial,575.92,92,,percent of total billed charges,,
Us Dop Vein Leg Rt,,93971,CPT,Facility,Outpatient,,,RT,626,532.1,179.4116,626,Aetna,Medicare Advantage,306.74,49,,percent of total billed charges,,
Us Dop Vein Leg Rt,,93971,CPT,Facility,Inpatient,,,RT,626,532.1,179.4116,626,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Us Dop Vein Leg Rt,,93971,CPT,Facility,Both,,,RT,626,532.1,179.4116,626,Aetna,PPO,582.18,93,,percent of total billed charges,,
Us Dop Vein Leg Rt,,93971,CPT,Facility,Both,,,RT,626,532.1,179.4116,626,America's PPO,America's PPO,601.1478,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Us Dop Vein Leg Rt,,93971,CPT,Facility,Both,,,RT,626,532.1,179.4116,626,BlueCross BlueShield Minnesota, Federal Employee Program,615.984,98.4,,percent of total billed charges,,
Us Dop Vein Leg Rt,,93971,CPT,Facility,Both,,,RT,626,532.1,179.4116,626,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,626,100,,percent of total billed charges,,
Us Dop Vein Leg Rt,,93971,CPT,Facility,Both,,,RT,626,532.1,179.4116,626,BlueCross BlueShield Minnesota,High Value Network Plan,563.4,90,,percent of total billed charges,,
Us Dop Vein Leg Rt,,93971,CPT,Facility,Outpatient,,,RT,626,532.1,179.4116,626,BlueCross BlueShield Minnesota,Medicare Advantage,306.74,49,,percent of total billed charges,,
Us Dop Vein Leg Rt,,93971,CPT,Facility,Inpatient,,,RT,626,532.1,179.4116,626,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Us Dop Vein Leg Rt,,93971,CPT,Facility,Both,,,RT,626,532.1,179.4116,626,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,554.4482,88.57,,percent of total billed charges,,
Us Dop Vein Leg Rt,,93971,CPT,Facility,Both,,,RT,626,532.1,179.4116,626,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,179.4116,28.66,,percent of total billed charges,,
Us Dop Vein Leg Rt,,93971,CPT,Facility,Outpatient,,,RT,626,532.1,179.4116,626,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),306.74,49,,percent of total billed charges,,
Us Dop Vein Leg Rt,,93971,CPT,Facility,Inpatient,,,RT,626,532.1,179.4116,626,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Us Dop Vein Leg Rt,,93971,CPT,Facility,Both,,,RT,626,532.1,179.4116,626,CorVel,Worker's Compensation,626,100,,percent of total billed charges,,
Us Dop Vein Leg Rt,,93971,CPT,Facility,Both,,,RT,626,532.1,179.4116,626,First Health Group Corporation,First Health Network,607.22,97,,percent of total billed charges,,
Us Dop Vein Leg Rt,,93971,CPT,Facility,Both,,,RT,626,532.1,179.4116,626,"Health Partners, Inc.",Commercial,592.196,94.6,,percent of total billed charges,,
Us Dop Vein Leg Rt,,93971,CPT,Facility,Outpatient,,,RT,626,532.1,179.4116,626,"Health Partners, Inc.",Medicare Advantage,306.74,49,,percent of total billed charges,,
Us Dop Vein Leg Rt,,93971,CPT,Facility,Inpatient,,,RT,626,532.1,179.4116,626,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Us Dop Vein Leg Rt,,93971,CPT,Facility,Both,,,RT,626,532.1,179.4116,626,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),375.6,60,,percent of total billed charges,,
Us Dop Vein Leg Rt,,93971,CPT,Facility,Both,,,RT,626,532.1,179.4116,626,"Health Partners, Inc.",State of Minnesota Advantage Program,510.19,81.5,,percent of total billed charges,,
Us Dop Vein Leg Rt,,93971,CPT,Facility,Both,,,RT,626,532.1,179.4116,626,"Health Partners, Inc.",State Public Programs,313,50,,percent of total billed charges,,
Us Dop Vein Leg Rt,,93971,CPT,Facility,Both,,,RT,626,532.1,179.4116,626,Humana Insurance Company,Commercial PPO,594.7,95,,percent of total billed charges,,
Us Dop Vein Leg Rt,,93971,CPT,Facility,Outpatient,,,RT,626,532.1,179.4116,626,Humana Insurance Company,Medicare PPO,306.74,49,,percent of total billed charges,,
Us Dop Vein Leg Rt,,93971,CPT,Facility,Inpatient,,,RT,626,532.1,179.4116,626,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Us Dop Vein Leg Rt,,93971,CPT,Facility,Both,,,RT,626,532.1,179.4116,626,Medica,Individual & Family,620.366,99.1,,percent of total billed charges,,
Us Dop Vein Leg Rt,,93971,CPT,Facility,Outpatient,,,RT,626,532.1,179.4116,626,Medica,Medica Advantage Solution,311.748,49.8,,percent of total billed charges,,
Us Dop Vein Leg Rt,,93971,CPT,Facility,Inpatient,,,RT,626,532.1,179.4116,626,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Us Dop Vein Leg Rt,,93971,CPT,Facility,Outpatient,,,RT,626,532.1,179.4116,626,Medica,Medical Assistance,279.196,44.6,,percent of total billed charges,,
Us Dop Vein Leg Rt,,93971,CPT,Facility,Inpatient,,,RT,626,532.1,179.4116,626,Medica,Medical Assistance,,,,,Included in per diem rate,
Us Dop Vein Leg Rt,,93971,CPT,Facility,Outpatient,,,RT,626,532.1,179.4116,626,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,311.748,49.8,,percent of total billed charges,,
Us Dop Vein Leg Rt,,93971,CPT,Facility,Inpatient,,,RT,626,532.1,179.4116,626,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Us Dop Vein Leg Rt,,93971,CPT,Facility,Both,,,RT,626,532.1,179.4116,626,"Multiplan, Inc.","Multiplan, Inc.",588.44,94,,percent of total billed charges,,
Us Dop Vein Leg Rt,,93971,CPT,Facility,Outpatient,,,RT,626,532.1,179.4116,626,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,564.026,90.1,,percent of total billed charges,,
Us Dop Vein Leg Rt,,93971,CPT,Facility,Inpatient,,,RT,626,532.1,179.4116,626,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Us Dop Vein Leg Rt,,93971,CPT,Facility,Both,,,RT,626,532.1,179.4116,626,"Preferred One Administrative Services, INC.",PPO,617.236,98.6,,percent of total billed charges,,
Us Dop Vein Leg Rt,,93971,CPT,Facility,Outpatient,,,RT,626,532.1,179.4116,626,PrimeWest Health,Minnesota Senior Health Options (MSHO),322.077,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Us Dop Vein Leg Rt,,93971,CPT,Facility,Inpatient,,,RT,626,532.1,179.4116,626,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Us Dop Vein Leg Rt,,93971,CPT,Facility,Outpatient,,,RT,626,532.1,179.4116,626,PrimeWest Health,MinnesotaCare,321.5136,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Us Dop Vein Leg Rt,,93971,CPT,Facility,Inpatient,,,RT,626,532.1,179.4116,626,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Us Dop Vein Leg Rt,,93971,CPT,Facility,Both,,,RT,626,532.1,179.4116,626,Sanford Health Plan,Sanford Health Plan,575.92,92,,percent of total billed charges,,
Us Dop Vein Leg Rt,,93971,CPT,Facility,Outpatient,,,RT,626,532.1,179.4116,626,"UCare Health, Inc.",Individual & Family Plan,352.751,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Us Dop Vein Leg Rt,,93971,CPT,Facility,Inpatient,,,RT,626,532.1,179.4116,626,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Us Dop Vein Leg Rt,,93971,CPT,Facility,Outpatient,,,RT,626,532.1,179.4116,626,"UCare Health, Inc.",Medical Assistance,315.9422,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Dop Vein Leg Rt,,93971,CPT,Facility,Inpatient,,,RT,626,532.1,179.4116,626,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Us Dop Vein Leg Rt,,93971,CPT,Facility,Outpatient,,,RT,626,532.1,179.4116,626,"UCare Health, Inc.",Medicare Advantage,315.9422,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Dop Vein Leg Rt,,93971,CPT,Facility,Inpatient,,,RT,626,532.1,179.4116,626,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Us Dop Vein Leg Rt,,93971,CPT,Facility,Outpatient,,,RT,626,532.1,179.4116,626,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),315.9422,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Dop Vein Leg Rt,,93971,CPT,Facility,Inpatient,,,RT,626,532.1,179.4116,626,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Us Dop Vein Leg Rt,,93971,CPT,Facility,Both,,,RT,626,532.1,179.4116,626,UnitedHealthcare,Individual & Family,588.44,94,,percent of total billed charges,,
Us Dop Vein Leg Rt,,93971,CPT,Facility,Outpatient,,,RT,626,532.1,179.4116,626,UnitedHealthcare,Medicare Advantage,306.74,49,,percent of total billed charges,,
Us Dop Vein Leg Rt,,93971,CPT,Facility,Inpatient,,,RT,626,532.1,179.4116,626,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Us Dop Vein Leg Rt,,93971,CPT,Facility,Outpatient,,,RT,626,532.1,179.4116,626,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,300.48,48,,percent of total billed charges,,100% of DHS outpatient percentage
Us Dop Vein Leg Rt,,93971,CPT,Facility,Inpatient,,,RT,626,532.1,179.4116,626,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Us Vein Meas And Or Map Arm Rt,,93971,CPT,Facility,Both,,,RT,626,532.1,179.4116,626,Aetna,Commercial,575.92,92,,percent of total billed charges,,
Us Vein Meas And Or Map Arm Rt,,93971,CPT,Facility,Outpatient,,,RT,626,532.1,179.4116,626,Aetna,Medicare Advantage,306.74,49,,percent of total billed charges,,
Us Vein Meas And Or Map Arm Rt,,93971,CPT,Facility,Inpatient,,,RT,626,532.1,179.4116,626,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Us Vein Meas And Or Map Arm Rt,,93971,CPT,Facility,Both,,,RT,626,532.1,179.4116,626,Aetna,PPO,582.18,93,,percent of total billed charges,,
Us Vein Meas And Or Map Arm Rt,,93971,CPT,Facility,Both,,,RT,626,532.1,179.4116,626,America's PPO,America's PPO,601.1478,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Us Vein Meas And Or Map Arm Rt,,93971,CPT,Facility,Both,,,RT,626,532.1,179.4116,626,BlueCross BlueShield Minnesota, Federal Employee Program,615.984,98.4,,percent of total billed charges,,
Us Vein Meas And Or Map Arm Rt,,93971,CPT,Facility,Both,,,RT,626,532.1,179.4116,626,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,626,100,,percent of total billed charges,,
Us Vein Meas And Or Map Arm Rt,,93971,CPT,Facility,Both,,,RT,626,532.1,179.4116,626,BlueCross BlueShield Minnesota,High Value Network Plan,563.4,90,,percent of total billed charges,,
Us Vein Meas And Or Map Arm Rt,,93971,CPT,Facility,Outpatient,,,RT,626,532.1,179.4116,626,BlueCross BlueShield Minnesota,Medicare Advantage,306.74,49,,percent of total billed charges,,
Us Vein Meas And Or Map Arm Rt,,93971,CPT,Facility,Inpatient,,,RT,626,532.1,179.4116,626,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Us Vein Meas And Or Map Arm Rt,,93971,CPT,Facility,Both,,,RT,626,532.1,179.4116,626,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,554.4482,88.57,,percent of total billed charges,,
Us Vein Meas And Or Map Arm Rt,,93971,CPT,Facility,Both,,,RT,626,532.1,179.4116,626,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,179.4116,28.66,,percent of total billed charges,,
Us Vein Meas And Or Map Arm Rt,,93971,CPT,Facility,Outpatient,,,RT,626,532.1,179.4116,626,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),306.74,49,,percent of total billed charges,,
Us Vein Meas And Or Map Arm Rt,,93971,CPT,Facility,Inpatient,,,RT,626,532.1,179.4116,626,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Us Vein Meas And Or Map Arm Rt,,93971,CPT,Facility,Both,,,RT,626,532.1,179.4116,626,CorVel,Worker's Compensation,626,100,,percent of total billed charges,,
Us Vein Meas And Or Map Arm Rt,,93971,CPT,Facility,Both,,,RT,626,532.1,179.4116,626,First Health Group Corporation,First Health Network,607.22,97,,percent of total billed charges,,
Us Vein Meas And Or Map Arm Rt,,93971,CPT,Facility,Both,,,RT,626,532.1,179.4116,626,"Health Partners, Inc.",Commercial,592.196,94.6,,percent of total billed charges,,
Us Vein Meas And Or Map Arm Rt,,93971,CPT,Facility,Outpatient,,,RT,626,532.1,179.4116,626,"Health Partners, Inc.",Medicare Advantage,306.74,49,,percent of total billed charges,,
Us Vein Meas And Or Map Arm Rt,,93971,CPT,Facility,Inpatient,,,RT,626,532.1,179.4116,626,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Us Vein Meas And Or Map Arm Rt,,93971,CPT,Facility,Both,,,RT,626,532.1,179.4116,626,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),375.6,60,,percent of total billed charges,,
Us Vein Meas And Or Map Arm Rt,,93971,CPT,Facility,Both,,,RT,626,532.1,179.4116,626,"Health Partners, Inc.",State of Minnesota Advantage Program,510.19,81.5,,percent of total billed charges,,
Us Vein Meas And Or Map Arm Rt,,93971,CPT,Facility,Both,,,RT,626,532.1,179.4116,626,"Health Partners, Inc.",State Public Programs,313,50,,percent of total billed charges,,
Us Vein Meas And Or Map Arm Rt,,93971,CPT,Facility,Both,,,RT,626,532.1,179.4116,626,Humana Insurance Company,Commercial PPO,594.7,95,,percent of total billed charges,,
Us Vein Meas And Or Map Arm Rt,,93971,CPT,Facility,Outpatient,,,RT,626,532.1,179.4116,626,Humana Insurance Company,Medicare PPO,306.74,49,,percent of total billed charges,,
Us Vein Meas And Or Map Arm Rt,,93971,CPT,Facility,Inpatient,,,RT,626,532.1,179.4116,626,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Us Vein Meas And Or Map Arm Rt,,93971,CPT,Facility,Both,,,RT,626,532.1,179.4116,626,Medica,Individual & Family,620.366,99.1,,percent of total billed charges,,
Us Vein Meas And Or Map Arm Rt,,93971,CPT,Facility,Outpatient,,,RT,626,532.1,179.4116,626,Medica,Medica Advantage Solution,311.748,49.8,,percent of total billed charges,,
Us Vein Meas And Or Map Arm Rt,,93971,CPT,Facility,Inpatient,,,RT,626,532.1,179.4116,626,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Us Vein Meas And Or Map Arm Rt,,93971,CPT,Facility,Outpatient,,,RT,626,532.1,179.4116,626,Medica,Medical Assistance,279.196,44.6,,percent of total billed charges,,
Us Vein Meas And Or Map Arm Rt,,93971,CPT,Facility,Inpatient,,,RT,626,532.1,179.4116,626,Medica,Medical Assistance,,,,,Included in per diem rate,
Us Vein Meas And Or Map Arm Rt,,93971,CPT,Facility,Outpatient,,,RT,626,532.1,179.4116,626,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,311.748,49.8,,percent of total billed charges,,
Us Vein Meas And Or Map Arm Rt,,93971,CPT,Facility,Inpatient,,,RT,626,532.1,179.4116,626,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Us Vein Meas And Or Map Arm Rt,,93971,CPT,Facility,Both,,,RT,626,532.1,179.4116,626,"Multiplan, Inc.","Multiplan, Inc.",588.44,94,,percent of total billed charges,,
Us Vein Meas And Or Map Arm Rt,,93971,CPT,Facility,Outpatient,,,RT,626,532.1,179.4116,626,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,564.026,90.1,,percent of total billed charges,,
Us Vein Meas And Or Map Arm Rt,,93971,CPT,Facility,Inpatient,,,RT,626,532.1,179.4116,626,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Us Vein Meas And Or Map Arm Rt,,93971,CPT,Facility,Both,,,RT,626,532.1,179.4116,626,"Preferred One Administrative Services, INC.",PPO,617.236,98.6,,percent of total billed charges,,
Us Vein Meas And Or Map Arm Rt,,93971,CPT,Facility,Outpatient,,,RT,626,532.1,179.4116,626,PrimeWest Health,Minnesota Senior Health Options (MSHO),322.077,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Us Vein Meas And Or Map Arm Rt,,93971,CPT,Facility,Inpatient,,,RT,626,532.1,179.4116,626,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Us Vein Meas And Or Map Arm Rt,,93971,CPT,Facility,Outpatient,,,RT,626,532.1,179.4116,626,PrimeWest Health,MinnesotaCare,321.5136,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Us Vein Meas And Or Map Arm Rt,,93971,CPT,Facility,Inpatient,,,RT,626,532.1,179.4116,626,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Us Vein Meas And Or Map Arm Rt,,93971,CPT,Facility,Both,,,RT,626,532.1,179.4116,626,Sanford Health Plan,Sanford Health Plan,575.92,92,,percent of total billed charges,,
Us Vein Meas And Or Map Arm Rt,,93971,CPT,Facility,Outpatient,,,RT,626,532.1,179.4116,626,"UCare Health, Inc.",Individual & Family Plan,352.751,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Us Vein Meas And Or Map Arm Rt,,93971,CPT,Facility,Inpatient,,,RT,626,532.1,179.4116,626,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Us Vein Meas And Or Map Arm Rt,,93971,CPT,Facility,Outpatient,,,RT,626,532.1,179.4116,626,"UCare Health, Inc.",Medical Assistance,315.9422,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Vein Meas And Or Map Arm Rt,,93971,CPT,Facility,Inpatient,,,RT,626,532.1,179.4116,626,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Us Vein Meas And Or Map Arm Rt,,93971,CPT,Facility,Outpatient,,,RT,626,532.1,179.4116,626,"UCare Health, Inc.",Medicare Advantage,315.9422,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Vein Meas And Or Map Arm Rt,,93971,CPT,Facility,Inpatient,,,RT,626,532.1,179.4116,626,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Us Vein Meas And Or Map Arm Rt,,93971,CPT,Facility,Outpatient,,,RT,626,532.1,179.4116,626,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),315.9422,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Vein Meas And Or Map Arm Rt,,93971,CPT,Facility,Inpatient,,,RT,626,532.1,179.4116,626,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Us Vein Meas And Or Map Arm Rt,,93971,CPT,Facility,Both,,,RT,626,532.1,179.4116,626,UnitedHealthcare,Individual & Family,588.44,94,,percent of total billed charges,,
Us Vein Meas And Or Map Arm Rt,,93971,CPT,Facility,Outpatient,,,RT,626,532.1,179.4116,626,UnitedHealthcare,Medicare Advantage,306.74,49,,percent of total billed charges,,
Us Vein Meas And Or Map Arm Rt,,93971,CPT,Facility,Inpatient,,,RT,626,532.1,179.4116,626,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Us Vein Meas And Or Map Arm Rt,,93971,CPT,Facility,Outpatient,,,RT,626,532.1,179.4116,626,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,300.48,48,,percent of total billed charges,,100% of DHS outpatient percentage
Us Vein Meas And Or Map Arm Rt,,93971,CPT,Facility,Inpatient,,,RT,626,532.1,179.4116,626,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Us Vein Meas And Or Map Leg Rt,,93971,CPT,Facility,Both,,,RT,626,532.1,179.4116,626,Aetna,Commercial,575.92,92,,percent of total billed charges,,
Us Vein Meas And Or Map Leg Rt,,93971,CPT,Facility,Outpatient,,,RT,626,532.1,179.4116,626,Aetna,Medicare Advantage,306.74,49,,percent of total billed charges,,
Us Vein Meas And Or Map Leg Rt,,93971,CPT,Facility,Inpatient,,,RT,626,532.1,179.4116,626,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Us Vein Meas And Or Map Leg Rt,,93971,CPT,Facility,Both,,,RT,626,532.1,179.4116,626,Aetna,PPO,582.18,93,,percent of total billed charges,,
Us Vein Meas And Or Map Leg Rt,,93971,CPT,Facility,Both,,,RT,626,532.1,179.4116,626,America's PPO,America's PPO,601.1478,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Us Vein Meas And Or Map Leg Rt,,93971,CPT,Facility,Both,,,RT,626,532.1,179.4116,626,BlueCross BlueShield Minnesota, Federal Employee Program,615.984,98.4,,percent of total billed charges,,
Us Vein Meas And Or Map Leg Rt,,93971,CPT,Facility,Both,,,RT,626,532.1,179.4116,626,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,626,100,,percent of total billed charges,,
Us Vein Meas And Or Map Leg Rt,,93971,CPT,Facility,Both,,,RT,626,532.1,179.4116,626,BlueCross BlueShield Minnesota,High Value Network Plan,563.4,90,,percent of total billed charges,,
Us Vein Meas And Or Map Leg Rt,,93971,CPT,Facility,Outpatient,,,RT,626,532.1,179.4116,626,BlueCross BlueShield Minnesota,Medicare Advantage,306.74,49,,percent of total billed charges,,
Us Vein Meas And Or Map Leg Rt,,93971,CPT,Facility,Inpatient,,,RT,626,532.1,179.4116,626,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Us Vein Meas And Or Map Leg Rt,,93971,CPT,Facility,Both,,,RT,626,532.1,179.4116,626,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,554.4482,88.57,,percent of total billed charges,,
Us Vein Meas And Or Map Leg Rt,,93971,CPT,Facility,Both,,,RT,626,532.1,179.4116,626,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,179.4116,28.66,,percent of total billed charges,,
Us Vein Meas And Or Map Leg Rt,,93971,CPT,Facility,Outpatient,,,RT,626,532.1,179.4116,626,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),306.74,49,,percent of total billed charges,,
Us Vein Meas And Or Map Leg Rt,,93971,CPT,Facility,Inpatient,,,RT,626,532.1,179.4116,626,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Us Vein Meas And Or Map Leg Rt,,93971,CPT,Facility,Both,,,RT,626,532.1,179.4116,626,CorVel,Worker's Compensation,626,100,,percent of total billed charges,,
Us Vein Meas And Or Map Leg Rt,,93971,CPT,Facility,Both,,,RT,626,532.1,179.4116,626,First Health Group Corporation,First Health Network,607.22,97,,percent of total billed charges,,
Us Vein Meas And Or Map Leg Rt,,93971,CPT,Facility,Both,,,RT,626,532.1,179.4116,626,"Health Partners, Inc.",Commercial,592.196,94.6,,percent of total billed charges,,
Us Vein Meas And Or Map Leg Rt,,93971,CPT,Facility,Outpatient,,,RT,626,532.1,179.4116,626,"Health Partners, Inc.",Medicare Advantage,306.74,49,,percent of total billed charges,,
Us Vein Meas And Or Map Leg Rt,,93971,CPT,Facility,Inpatient,,,RT,626,532.1,179.4116,626,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Us Vein Meas And Or Map Leg Rt,,93971,CPT,Facility,Both,,,RT,626,532.1,179.4116,626,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),375.6,60,,percent of total billed charges,,
Us Vein Meas And Or Map Leg Rt,,93971,CPT,Facility,Both,,,RT,626,532.1,179.4116,626,"Health Partners, Inc.",State of Minnesota Advantage Program,510.19,81.5,,percent of total billed charges,,
Us Vein Meas And Or Map Leg Rt,,93971,CPT,Facility,Both,,,RT,626,532.1,179.4116,626,"Health Partners, Inc.",State Public Programs,313,50,,percent of total billed charges,,
Us Vein Meas And Or Map Leg Rt,,93971,CPT,Facility,Both,,,RT,626,532.1,179.4116,626,Humana Insurance Company,Commercial PPO,594.7,95,,percent of total billed charges,,
Us Vein Meas And Or Map Leg Rt,,93971,CPT,Facility,Outpatient,,,RT,626,532.1,179.4116,626,Humana Insurance Company,Medicare PPO,306.74,49,,percent of total billed charges,,
Us Vein Meas And Or Map Leg Rt,,93971,CPT,Facility,Inpatient,,,RT,626,532.1,179.4116,626,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Us Vein Meas And Or Map Leg Rt,,93971,CPT,Facility,Both,,,RT,626,532.1,179.4116,626,Medica,Individual & Family,620.366,99.1,,percent of total billed charges,,
Us Vein Meas And Or Map Leg Rt,,93971,CPT,Facility,Outpatient,,,RT,626,532.1,179.4116,626,Medica,Medica Advantage Solution,311.748,49.8,,percent of total billed charges,,
Us Vein Meas And Or Map Leg Rt,,93971,CPT,Facility,Inpatient,,,RT,626,532.1,179.4116,626,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Us Vein Meas And Or Map Leg Rt,,93971,CPT,Facility,Outpatient,,,RT,626,532.1,179.4116,626,Medica,Medical Assistance,279.196,44.6,,percent of total billed charges,,
Us Vein Meas And Or Map Leg Rt,,93971,CPT,Facility,Inpatient,,,RT,626,532.1,179.4116,626,Medica,Medical Assistance,,,,,Included in per diem rate,
Us Vein Meas And Or Map Leg Rt,,93971,CPT,Facility,Outpatient,,,RT,626,532.1,179.4116,626,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,311.748,49.8,,percent of total billed charges,,
Us Vein Meas And Or Map Leg Rt,,93971,CPT,Facility,Inpatient,,,RT,626,532.1,179.4116,626,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Us Vein Meas And Or Map Leg Rt,,93971,CPT,Facility,Both,,,RT,626,532.1,179.4116,626,"Multiplan, Inc.","Multiplan, Inc.",588.44,94,,percent of total billed charges,,
Us Vein Meas And Or Map Leg Rt,,93971,CPT,Facility,Outpatient,,,RT,626,532.1,179.4116,626,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,564.026,90.1,,percent of total billed charges,,
Us Vein Meas And Or Map Leg Rt,,93971,CPT,Facility,Inpatient,,,RT,626,532.1,179.4116,626,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Us Vein Meas And Or Map Leg Rt,,93971,CPT,Facility,Both,,,RT,626,532.1,179.4116,626,"Preferred One Administrative Services, INC.",PPO,617.236,98.6,,percent of total billed charges,,
Us Vein Meas And Or Map Leg Rt,,93971,CPT,Facility,Outpatient,,,RT,626,532.1,179.4116,626,PrimeWest Health,Minnesota Senior Health Options (MSHO),322.077,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Us Vein Meas And Or Map Leg Rt,,93971,CPT,Facility,Inpatient,,,RT,626,532.1,179.4116,626,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Us Vein Meas And Or Map Leg Rt,,93971,CPT,Facility,Outpatient,,,RT,626,532.1,179.4116,626,PrimeWest Health,MinnesotaCare,321.5136,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Us Vein Meas And Or Map Leg Rt,,93971,CPT,Facility,Inpatient,,,RT,626,532.1,179.4116,626,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Us Vein Meas And Or Map Leg Rt,,93971,CPT,Facility,Both,,,RT,626,532.1,179.4116,626,Sanford Health Plan,Sanford Health Plan,575.92,92,,percent of total billed charges,,
Us Vein Meas And Or Map Leg Rt,,93971,CPT,Facility,Outpatient,,,RT,626,532.1,179.4116,626,"UCare Health, Inc.",Individual & Family Plan,352.751,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Us Vein Meas And Or Map Leg Rt,,93971,CPT,Facility,Inpatient,,,RT,626,532.1,179.4116,626,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Us Vein Meas And Or Map Leg Rt,,93971,CPT,Facility,Outpatient,,,RT,626,532.1,179.4116,626,"UCare Health, Inc.",Medical Assistance,315.9422,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Vein Meas And Or Map Leg Rt,,93971,CPT,Facility,Inpatient,,,RT,626,532.1,179.4116,626,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Us Vein Meas And Or Map Leg Rt,,93971,CPT,Facility,Outpatient,,,RT,626,532.1,179.4116,626,"UCare Health, Inc.",Medicare Advantage,315.9422,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Vein Meas And Or Map Leg Rt,,93971,CPT,Facility,Inpatient,,,RT,626,532.1,179.4116,626,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Us Vein Meas And Or Map Leg Rt,,93971,CPT,Facility,Outpatient,,,RT,626,532.1,179.4116,626,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),315.9422,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Vein Meas And Or Map Leg Rt,,93971,CPT,Facility,Inpatient,,,RT,626,532.1,179.4116,626,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Us Vein Meas And Or Map Leg Rt,,93971,CPT,Facility,Both,,,RT,626,532.1,179.4116,626,UnitedHealthcare,Individual & Family,588.44,94,,percent of total billed charges,,
Us Vein Meas And Or Map Leg Rt,,93971,CPT,Facility,Outpatient,,,RT,626,532.1,179.4116,626,UnitedHealthcare,Medicare Advantage,306.74,49,,percent of total billed charges,,
Us Vein Meas And Or Map Leg Rt,,93971,CPT,Facility,Inpatient,,,RT,626,532.1,179.4116,626,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Us Vein Meas And Or Map Leg Rt,,93971,CPT,Facility,Outpatient,,,RT,626,532.1,179.4116,626,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,300.48,48,,percent of total billed charges,,100% of DHS outpatient percentage
Us Vein Meas And Or Map Leg Rt,,93971,CPT,Facility,Inpatient,,,RT,626,532.1,179.4116,626,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Xr Toe Lt Second,,73660,CPT,Facility,Both,,,T1,258,219.3,73.9428,258,Aetna,Commercial,237.36,92,,percent of total billed charges,,
Xr Toe Lt Second,,73660,CPT,Facility,Outpatient,,,T1,258,219.3,73.9428,258,Aetna,Medicare Advantage,126.42,49,,percent of total billed charges,,
Xr Toe Lt Second,,73660,CPT,Facility,Inpatient,,,T1,258,219.3,73.9428,258,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Xr Toe Lt Second,,73660,CPT,Facility,Both,,,T1,258,219.3,73.9428,258,Aetna,PPO,239.94,93,,percent of total billed charges,,
Xr Toe Lt Second,,73660,CPT,Facility,Both,,,T1,258,219.3,73.9428,258,America's PPO,America's PPO,247.7574,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Xr Toe Lt Second,,73660,CPT,Facility,Both,,,T1,258,219.3,73.9428,258,BlueCross BlueShield Minnesota, Federal Employee Program,253.872,98.4,,percent of total billed charges,,
Xr Toe Lt Second,,73660,CPT,Facility,Both,,,T1,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,258,100,,percent of total billed charges,,
Xr Toe Lt Second,,73660,CPT,Facility,Both,,,T1,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,High Value Network Plan,232.2,90,,percent of total billed charges,,
Xr Toe Lt Second,,73660,CPT,Facility,Outpatient,,,T1,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,Medicare Advantage,126.42,49,,percent of total billed charges,,
Xr Toe Lt Second,,73660,CPT,Facility,Inpatient,,,T1,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Xr Toe Lt Second,,73660,CPT,Facility,Both,,,T1,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,228.5106,88.57,,percent of total billed charges,,
Xr Toe Lt Second,,73660,CPT,Facility,Both,,,T1,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,73.9428,28.66,,percent of total billed charges,,
Xr Toe Lt Second,,73660,CPT,Facility,Outpatient,,,T1,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),126.42,49,,percent of total billed charges,,
Xr Toe Lt Second,,73660,CPT,Facility,Inpatient,,,T1,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Xr Toe Lt Second,,73660,CPT,Facility,Both,,,T1,258,219.3,73.9428,258,CorVel,Worker's Compensation,258,100,,percent of total billed charges,,
Xr Toe Lt Second,,73660,CPT,Facility,Both,,,T1,258,219.3,73.9428,258,First Health Group Corporation,First Health Network,250.26,97,,percent of total billed charges,,
Xr Toe Lt Second,,73660,CPT,Facility,Both,,,T1,258,219.3,73.9428,258,"Health Partners, Inc.",Commercial,244.068,94.6,,percent of total billed charges,,
Xr Toe Lt Second,,73660,CPT,Facility,Outpatient,,,T1,258,219.3,73.9428,258,"Health Partners, Inc.",Medicare Advantage,126.42,49,,percent of total billed charges,,
Xr Toe Lt Second,,73660,CPT,Facility,Inpatient,,,T1,258,219.3,73.9428,258,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Toe Lt Second,,73660,CPT,Facility,Both,,,T1,258,219.3,73.9428,258,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),154.8,60,,percent of total billed charges,,
Xr Toe Lt Second,,73660,CPT,Facility,Both,,,T1,258,219.3,73.9428,258,"Health Partners, Inc.",State of Minnesota Advantage Program,210.27,81.5,,percent of total billed charges,,
Xr Toe Lt Second,,73660,CPT,Facility,Both,,,T1,258,219.3,73.9428,258,"Health Partners, Inc.",State Public Programs,129,50,,percent of total billed charges,,
Xr Toe Lt Second,,73660,CPT,Facility,Both,,,T1,258,219.3,73.9428,258,Humana Insurance Company,Commercial PPO,245.1,95,,percent of total billed charges,,
Xr Toe Lt Second,,73660,CPT,Facility,Outpatient,,,T1,258,219.3,73.9428,258,Humana Insurance Company,Medicare PPO,126.42,49,,percent of total billed charges,,
Xr Toe Lt Second,,73660,CPT,Facility,Inpatient,,,T1,258,219.3,73.9428,258,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Xr Toe Lt Second,,73660,CPT,Facility,Both,,,T1,258,219.3,73.9428,258,Medica,Individual & Family,255.678,99.1,,percent of total billed charges,,
Xr Toe Lt Second,,73660,CPT,Facility,Outpatient,,,T1,258,219.3,73.9428,258,Medica,Medica Advantage Solution,128.484,49.8,,percent of total billed charges,,
Xr Toe Lt Second,,73660,CPT,Facility,Inpatient,,,T1,258,219.3,73.9428,258,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Xr Toe Lt Second,,73660,CPT,Facility,Outpatient,,,T1,258,219.3,73.9428,258,Medica,Medical Assistance,115.068,44.6,,percent of total billed charges,,
Xr Toe Lt Second,,73660,CPT,Facility,Inpatient,,,T1,258,219.3,73.9428,258,Medica,Medical Assistance,,,,,Included in per diem rate,
Xr Toe Lt Second,,73660,CPT,Facility,Outpatient,,,T1,258,219.3,73.9428,258,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,128.484,49.8,,percent of total billed charges,,
Xr Toe Lt Second,,73660,CPT,Facility,Inpatient,,,T1,258,219.3,73.9428,258,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Xr Toe Lt Second,,73660,CPT,Facility,Both,,,T1,258,219.3,73.9428,258,"Multiplan, Inc.","Multiplan, Inc.",242.52,94,,percent of total billed charges,,
Xr Toe Lt Second,,73660,CPT,Facility,Outpatient,,,T1,258,219.3,73.9428,258,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,232.458,90.1,,percent of total billed charges,,
Xr Toe Lt Second,,73660,CPT,Facility,Inpatient,,,T1,258,219.3,73.9428,258,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Xr Toe Lt Second,,73660,CPT,Facility,Both,,,T1,258,219.3,73.9428,258,"Preferred One Administrative Services, INC.",PPO,254.388,98.6,,percent of total billed charges,,
Xr Toe Lt Second,,73660,CPT,Facility,Outpatient,,,T1,258,219.3,73.9428,258,PrimeWest Health,Minnesota Senior Health Options (MSHO),132.741,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Xr Toe Lt Second,,73660,CPT,Facility,Inpatient,,,T1,258,219.3,73.9428,258,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Toe Lt Second,,73660,CPT,Facility,Outpatient,,,T1,258,219.3,73.9428,258,PrimeWest Health,MinnesotaCare,132.5088,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Xr Toe Lt Second,,73660,CPT,Facility,Inpatient,,,T1,258,219.3,73.9428,258,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Xr Toe Lt Second,,73660,CPT,Facility,Both,,,T1,258,219.3,73.9428,258,Sanford Health Plan,Sanford Health Plan,237.36,92,,percent of total billed charges,,
Xr Toe Lt Second,,73660,CPT,Facility,Outpatient,,,T1,258,219.3,73.9428,258,"UCare Health, Inc.",Individual & Family Plan,145.383,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Xr Toe Lt Second,,73660,CPT,Facility,Inpatient,,,T1,258,219.3,73.9428,258,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Xr Toe Lt Second,,73660,CPT,Facility,Outpatient,,,T1,258,219.3,73.9428,258,"UCare Health, Inc.",Medical Assistance,130.2126,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Toe Lt Second,,73660,CPT,Facility,Inpatient,,,T1,258,219.3,73.9428,258,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Xr Toe Lt Second,,73660,CPT,Facility,Outpatient,,,T1,258,219.3,73.9428,258,"UCare Health, Inc.",Medicare Advantage,130.2126,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Toe Lt Second,,73660,CPT,Facility,Inpatient,,,T1,258,219.3,73.9428,258,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Toe Lt Second,,73660,CPT,Facility,Outpatient,,,T1,258,219.3,73.9428,258,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),130.2126,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Toe Lt Second,,73660,CPT,Facility,Inpatient,,,T1,258,219.3,73.9428,258,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Toe Lt Second,,73660,CPT,Facility,Both,,,T1,258,219.3,73.9428,258,UnitedHealthcare,Individual & Family,242.52,94,,percent of total billed charges,,
Xr Toe Lt Second,,73660,CPT,Facility,Outpatient,,,T1,258,219.3,73.9428,258,UnitedHealthcare,Medicare Advantage,126.42,49,,percent of total billed charges,,
Xr Toe Lt Second,,73660,CPT,Facility,Inpatient,,,T1,258,219.3,73.9428,258,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Xr Toe Lt Second,,73660,CPT,Facility,Outpatient,,,T1,258,219.3,73.9428,258,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,123.84,48,,percent of total billed charges,,100% of DHS outpatient percentage
Xr Toe Lt Second,,73660,CPT,Facility,Inpatient,,,T1,258,219.3,73.9428,258,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Xr Toe Lt Third,,73660,CPT,Facility,Both,,,T2,258,219.3,73.9428,258,Aetna,Commercial,237.36,92,,percent of total billed charges,,
Xr Toe Lt Third,,73660,CPT,Facility,Outpatient,,,T2,258,219.3,73.9428,258,Aetna,Medicare Advantage,126.42,49,,percent of total billed charges,,
Xr Toe Lt Third,,73660,CPT,Facility,Inpatient,,,T2,258,219.3,73.9428,258,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Xr Toe Lt Third,,73660,CPT,Facility,Both,,,T2,258,219.3,73.9428,258,Aetna,PPO,239.94,93,,percent of total billed charges,,
Xr Toe Lt Third,,73660,CPT,Facility,Both,,,T2,258,219.3,73.9428,258,America's PPO,America's PPO,247.7574,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Xr Toe Lt Third,,73660,CPT,Facility,Both,,,T2,258,219.3,73.9428,258,BlueCross BlueShield Minnesota, Federal Employee Program,253.872,98.4,,percent of total billed charges,,
Xr Toe Lt Third,,73660,CPT,Facility,Both,,,T2,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,258,100,,percent of total billed charges,,
Xr Toe Lt Third,,73660,CPT,Facility,Both,,,T2,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,High Value Network Plan,232.2,90,,percent of total billed charges,,
Xr Toe Lt Third,,73660,CPT,Facility,Outpatient,,,T2,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,Medicare Advantage,126.42,49,,percent of total billed charges,,
Xr Toe Lt Third,,73660,CPT,Facility,Inpatient,,,T2,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Xr Toe Lt Third,,73660,CPT,Facility,Both,,,T2,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,228.5106,88.57,,percent of total billed charges,,
Xr Toe Lt Third,,73660,CPT,Facility,Both,,,T2,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,73.9428,28.66,,percent of total billed charges,,
Xr Toe Lt Third,,73660,CPT,Facility,Outpatient,,,T2,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),126.42,49,,percent of total billed charges,,
Xr Toe Lt Third,,73660,CPT,Facility,Inpatient,,,T2,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Xr Toe Lt Third,,73660,CPT,Facility,Both,,,T2,258,219.3,73.9428,258,CorVel,Worker's Compensation,258,100,,percent of total billed charges,,
Xr Toe Lt Third,,73660,CPT,Facility,Both,,,T2,258,219.3,73.9428,258,First Health Group Corporation,First Health Network,250.26,97,,percent of total billed charges,,
Xr Toe Lt Third,,73660,CPT,Facility,Both,,,T2,258,219.3,73.9428,258,"Health Partners, Inc.",Commercial,244.068,94.6,,percent of total billed charges,,
Xr Toe Lt Third,,73660,CPT,Facility,Outpatient,,,T2,258,219.3,73.9428,258,"Health Partners, Inc.",Medicare Advantage,126.42,49,,percent of total billed charges,,
Xr Toe Lt Third,,73660,CPT,Facility,Inpatient,,,T2,258,219.3,73.9428,258,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Toe Lt Third,,73660,CPT,Facility,Both,,,T2,258,219.3,73.9428,258,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),154.8,60,,percent of total billed charges,,
Xr Toe Lt Third,,73660,CPT,Facility,Both,,,T2,258,219.3,73.9428,258,"Health Partners, Inc.",State of Minnesota Advantage Program,210.27,81.5,,percent of total billed charges,,
Xr Toe Lt Third,,73660,CPT,Facility,Both,,,T2,258,219.3,73.9428,258,"Health Partners, Inc.",State Public Programs,129,50,,percent of total billed charges,,
Xr Toe Lt Third,,73660,CPT,Facility,Both,,,T2,258,219.3,73.9428,258,Humana Insurance Company,Commercial PPO,245.1,95,,percent of total billed charges,,
Xr Toe Lt Third,,73660,CPT,Facility,Outpatient,,,T2,258,219.3,73.9428,258,Humana Insurance Company,Medicare PPO,126.42,49,,percent of total billed charges,,
Xr Toe Lt Third,,73660,CPT,Facility,Inpatient,,,T2,258,219.3,73.9428,258,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Xr Toe Lt Third,,73660,CPT,Facility,Both,,,T2,258,219.3,73.9428,258,Medica,Individual & Family,255.678,99.1,,percent of total billed charges,,
Xr Toe Lt Third,,73660,CPT,Facility,Outpatient,,,T2,258,219.3,73.9428,258,Medica,Medica Advantage Solution,128.484,49.8,,percent of total billed charges,,
Xr Toe Lt Third,,73660,CPT,Facility,Inpatient,,,T2,258,219.3,73.9428,258,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Xr Toe Lt Third,,73660,CPT,Facility,Outpatient,,,T2,258,219.3,73.9428,258,Medica,Medical Assistance,115.068,44.6,,percent of total billed charges,,
Xr Toe Lt Third,,73660,CPT,Facility,Inpatient,,,T2,258,219.3,73.9428,258,Medica,Medical Assistance,,,,,Included in per diem rate,
Xr Toe Lt Third,,73660,CPT,Facility,Outpatient,,,T2,258,219.3,73.9428,258,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,128.484,49.8,,percent of total billed charges,,
Xr Toe Lt Third,,73660,CPT,Facility,Inpatient,,,T2,258,219.3,73.9428,258,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Xr Toe Lt Third,,73660,CPT,Facility,Both,,,T2,258,219.3,73.9428,258,"Multiplan, Inc.","Multiplan, Inc.",242.52,94,,percent of total billed charges,,
Xr Toe Lt Third,,73660,CPT,Facility,Outpatient,,,T2,258,219.3,73.9428,258,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,232.458,90.1,,percent of total billed charges,,
Xr Toe Lt Third,,73660,CPT,Facility,Inpatient,,,T2,258,219.3,73.9428,258,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Xr Toe Lt Third,,73660,CPT,Facility,Both,,,T2,258,219.3,73.9428,258,"Preferred One Administrative Services, INC.",PPO,254.388,98.6,,percent of total billed charges,,
Xr Toe Lt Third,,73660,CPT,Facility,Outpatient,,,T2,258,219.3,73.9428,258,PrimeWest Health,Minnesota Senior Health Options (MSHO),132.741,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Xr Toe Lt Third,,73660,CPT,Facility,Inpatient,,,T2,258,219.3,73.9428,258,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Toe Lt Third,,73660,CPT,Facility,Outpatient,,,T2,258,219.3,73.9428,258,PrimeWest Health,MinnesotaCare,132.5088,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Xr Toe Lt Third,,73660,CPT,Facility,Inpatient,,,T2,258,219.3,73.9428,258,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Xr Toe Lt Third,,73660,CPT,Facility,Both,,,T2,258,219.3,73.9428,258,Sanford Health Plan,Sanford Health Plan,237.36,92,,percent of total billed charges,,
Xr Toe Lt Third,,73660,CPT,Facility,Outpatient,,,T2,258,219.3,73.9428,258,"UCare Health, Inc.",Individual & Family Plan,145.383,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Xr Toe Lt Third,,73660,CPT,Facility,Inpatient,,,T2,258,219.3,73.9428,258,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Xr Toe Lt Third,,73660,CPT,Facility,Outpatient,,,T2,258,219.3,73.9428,258,"UCare Health, Inc.",Medical Assistance,130.2126,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Toe Lt Third,,73660,CPT,Facility,Inpatient,,,T2,258,219.3,73.9428,258,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Xr Toe Lt Third,,73660,CPT,Facility,Outpatient,,,T2,258,219.3,73.9428,258,"UCare Health, Inc.",Medicare Advantage,130.2126,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Toe Lt Third,,73660,CPT,Facility,Inpatient,,,T2,258,219.3,73.9428,258,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Toe Lt Third,,73660,CPT,Facility,Outpatient,,,T2,258,219.3,73.9428,258,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),130.2126,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Toe Lt Third,,73660,CPT,Facility,Inpatient,,,T2,258,219.3,73.9428,258,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Toe Lt Third,,73660,CPT,Facility,Both,,,T2,258,219.3,73.9428,258,UnitedHealthcare,Individual & Family,242.52,94,,percent of total billed charges,,
Xr Toe Lt Third,,73660,CPT,Facility,Outpatient,,,T2,258,219.3,73.9428,258,UnitedHealthcare,Medicare Advantage,126.42,49,,percent of total billed charges,,
Xr Toe Lt Third,,73660,CPT,Facility,Inpatient,,,T2,258,219.3,73.9428,258,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Xr Toe Lt Third,,73660,CPT,Facility,Outpatient,,,T2,258,219.3,73.9428,258,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,123.84,48,,percent of total billed charges,,100% of DHS outpatient percentage
Xr Toe Lt Third,,73660,CPT,Facility,Inpatient,,,T2,258,219.3,73.9428,258,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Xr Toe Lt Fourth,,73660,CPT,Facility,Both,,,T3,258,219.3,73.9428,258,Aetna,Commercial,237.36,92,,percent of total billed charges,,
Xr Toe Lt Fourth,,73660,CPT,Facility,Outpatient,,,T3,258,219.3,73.9428,258,Aetna,Medicare Advantage,126.42,49,,percent of total billed charges,,
Xr Toe Lt Fourth,,73660,CPT,Facility,Inpatient,,,T3,258,219.3,73.9428,258,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Xr Toe Lt Fourth,,73660,CPT,Facility,Both,,,T3,258,219.3,73.9428,258,Aetna,PPO,239.94,93,,percent of total billed charges,,
Xr Toe Lt Fourth,,73660,CPT,Facility,Both,,,T3,258,219.3,73.9428,258,America's PPO,America's PPO,247.7574,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Xr Toe Lt Fourth,,73660,CPT,Facility,Both,,,T3,258,219.3,73.9428,258,BlueCross BlueShield Minnesota, Federal Employee Program,253.872,98.4,,percent of total billed charges,,
Xr Toe Lt Fourth,,73660,CPT,Facility,Both,,,T3,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,258,100,,percent of total billed charges,,
Xr Toe Lt Fourth,,73660,CPT,Facility,Both,,,T3,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,High Value Network Plan,232.2,90,,percent of total billed charges,,
Xr Toe Lt Fourth,,73660,CPT,Facility,Outpatient,,,T3,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,Medicare Advantage,126.42,49,,percent of total billed charges,,
Xr Toe Lt Fourth,,73660,CPT,Facility,Inpatient,,,T3,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Xr Toe Lt Fourth,,73660,CPT,Facility,Both,,,T3,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,228.5106,88.57,,percent of total billed charges,,
Xr Toe Lt Fourth,,73660,CPT,Facility,Both,,,T3,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,73.9428,28.66,,percent of total billed charges,,
Xr Toe Lt Fourth,,73660,CPT,Facility,Outpatient,,,T3,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),126.42,49,,percent of total billed charges,,
Xr Toe Lt Fourth,,73660,CPT,Facility,Inpatient,,,T3,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Xr Toe Lt Fourth,,73660,CPT,Facility,Both,,,T3,258,219.3,73.9428,258,CorVel,Worker's Compensation,258,100,,percent of total billed charges,,
Xr Toe Lt Fourth,,73660,CPT,Facility,Both,,,T3,258,219.3,73.9428,258,First Health Group Corporation,First Health Network,250.26,97,,percent of total billed charges,,
Xr Toe Lt Fourth,,73660,CPT,Facility,Both,,,T3,258,219.3,73.9428,258,"Health Partners, Inc.",Commercial,244.068,94.6,,percent of total billed charges,,
Xr Toe Lt Fourth,,73660,CPT,Facility,Outpatient,,,T3,258,219.3,73.9428,258,"Health Partners, Inc.",Medicare Advantage,126.42,49,,percent of total billed charges,,
Xr Toe Lt Fourth,,73660,CPT,Facility,Inpatient,,,T3,258,219.3,73.9428,258,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Toe Lt Fourth,,73660,CPT,Facility,Both,,,T3,258,219.3,73.9428,258,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),154.8,60,,percent of total billed charges,,
Xr Toe Lt Fourth,,73660,CPT,Facility,Both,,,T3,258,219.3,73.9428,258,"Health Partners, Inc.",State of Minnesota Advantage Program,210.27,81.5,,percent of total billed charges,,
Xr Toe Lt Fourth,,73660,CPT,Facility,Both,,,T3,258,219.3,73.9428,258,"Health Partners, Inc.",State Public Programs,129,50,,percent of total billed charges,,
Xr Toe Lt Fourth,,73660,CPT,Facility,Both,,,T3,258,219.3,73.9428,258,Humana Insurance Company,Commercial PPO,245.1,95,,percent of total billed charges,,
Xr Toe Lt Fourth,,73660,CPT,Facility,Outpatient,,,T3,258,219.3,73.9428,258,Humana Insurance Company,Medicare PPO,126.42,49,,percent of total billed charges,,
Xr Toe Lt Fourth,,73660,CPT,Facility,Inpatient,,,T3,258,219.3,73.9428,258,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Xr Toe Lt Fourth,,73660,CPT,Facility,Both,,,T3,258,219.3,73.9428,258,Medica,Individual & Family,255.678,99.1,,percent of total billed charges,,
Xr Toe Lt Fourth,,73660,CPT,Facility,Outpatient,,,T3,258,219.3,73.9428,258,Medica,Medica Advantage Solution,128.484,49.8,,percent of total billed charges,,
Xr Toe Lt Fourth,,73660,CPT,Facility,Inpatient,,,T3,258,219.3,73.9428,258,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Xr Toe Lt Fourth,,73660,CPT,Facility,Outpatient,,,T3,258,219.3,73.9428,258,Medica,Medical Assistance,115.068,44.6,,percent of total billed charges,,
Xr Toe Lt Fourth,,73660,CPT,Facility,Inpatient,,,T3,258,219.3,73.9428,258,Medica,Medical Assistance,,,,,Included in per diem rate,
Xr Toe Lt Fourth,,73660,CPT,Facility,Outpatient,,,T3,258,219.3,73.9428,258,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,128.484,49.8,,percent of total billed charges,,
Xr Toe Lt Fourth,,73660,CPT,Facility,Inpatient,,,T3,258,219.3,73.9428,258,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Xr Toe Lt Fourth,,73660,CPT,Facility,Both,,,T3,258,219.3,73.9428,258,"Multiplan, Inc.","Multiplan, Inc.",242.52,94,,percent of total billed charges,,
Xr Toe Lt Fourth,,73660,CPT,Facility,Outpatient,,,T3,258,219.3,73.9428,258,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,232.458,90.1,,percent of total billed charges,,
Xr Toe Lt Fourth,,73660,CPT,Facility,Inpatient,,,T3,258,219.3,73.9428,258,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Xr Toe Lt Fourth,,73660,CPT,Facility,Both,,,T3,258,219.3,73.9428,258,"Preferred One Administrative Services, INC.",PPO,254.388,98.6,,percent of total billed charges,,
Xr Toe Lt Fourth,,73660,CPT,Facility,Outpatient,,,T3,258,219.3,73.9428,258,PrimeWest Health,Minnesota Senior Health Options (MSHO),132.741,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Xr Toe Lt Fourth,,73660,CPT,Facility,Inpatient,,,T3,258,219.3,73.9428,258,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Toe Lt Fourth,,73660,CPT,Facility,Outpatient,,,T3,258,219.3,73.9428,258,PrimeWest Health,MinnesotaCare,132.5088,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Xr Toe Lt Fourth,,73660,CPT,Facility,Inpatient,,,T3,258,219.3,73.9428,258,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Xr Toe Lt Fourth,,73660,CPT,Facility,Both,,,T3,258,219.3,73.9428,258,Sanford Health Plan,Sanford Health Plan,237.36,92,,percent of total billed charges,,
Xr Toe Lt Fourth,,73660,CPT,Facility,Outpatient,,,T3,258,219.3,73.9428,258,"UCare Health, Inc.",Individual & Family Plan,145.383,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Xr Toe Lt Fourth,,73660,CPT,Facility,Inpatient,,,T3,258,219.3,73.9428,258,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Xr Toe Lt Fourth,,73660,CPT,Facility,Outpatient,,,T3,258,219.3,73.9428,258,"UCare Health, Inc.",Medical Assistance,130.2126,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Toe Lt Fourth,,73660,CPT,Facility,Inpatient,,,T3,258,219.3,73.9428,258,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Xr Toe Lt Fourth,,73660,CPT,Facility,Outpatient,,,T3,258,219.3,73.9428,258,"UCare Health, Inc.",Medicare Advantage,130.2126,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Toe Lt Fourth,,73660,CPT,Facility,Inpatient,,,T3,258,219.3,73.9428,258,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Toe Lt Fourth,,73660,CPT,Facility,Outpatient,,,T3,258,219.3,73.9428,258,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),130.2126,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Toe Lt Fourth,,73660,CPT,Facility,Inpatient,,,T3,258,219.3,73.9428,258,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Toe Lt Fourth,,73660,CPT,Facility,Both,,,T3,258,219.3,73.9428,258,UnitedHealthcare,Individual & Family,242.52,94,,percent of total billed charges,,
Xr Toe Lt Fourth,,73660,CPT,Facility,Outpatient,,,T3,258,219.3,73.9428,258,UnitedHealthcare,Medicare Advantage,126.42,49,,percent of total billed charges,,
Xr Toe Lt Fourth,,73660,CPT,Facility,Inpatient,,,T3,258,219.3,73.9428,258,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Xr Toe Lt Fourth,,73660,CPT,Facility,Outpatient,,,T3,258,219.3,73.9428,258,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,123.84,48,,percent of total billed charges,,100% of DHS outpatient percentage
Xr Toe Lt Fourth,,73660,CPT,Facility,Inpatient,,,T3,258,219.3,73.9428,258,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Xr Toe Lt Fifth,,73660,CPT,Facility,Both,,,T4,258,219.3,73.9428,258,Aetna,Commercial,237.36,92,,percent of total billed charges,,
Xr Toe Lt Fifth,,73660,CPT,Facility,Outpatient,,,T4,258,219.3,73.9428,258,Aetna,Medicare Advantage,126.42,49,,percent of total billed charges,,
Xr Toe Lt Fifth,,73660,CPT,Facility,Inpatient,,,T4,258,219.3,73.9428,258,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Xr Toe Lt Fifth,,73660,CPT,Facility,Both,,,T4,258,219.3,73.9428,258,Aetna,PPO,239.94,93,,percent of total billed charges,,
Xr Toe Lt Fifth,,73660,CPT,Facility,Both,,,T4,258,219.3,73.9428,258,America's PPO,America's PPO,247.7574,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Xr Toe Lt Fifth,,73660,CPT,Facility,Both,,,T4,258,219.3,73.9428,258,BlueCross BlueShield Minnesota, Federal Employee Program,253.872,98.4,,percent of total billed charges,,
Xr Toe Lt Fifth,,73660,CPT,Facility,Both,,,T4,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,258,100,,percent of total billed charges,,
Xr Toe Lt Fifth,,73660,CPT,Facility,Both,,,T4,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,High Value Network Plan,232.2,90,,percent of total billed charges,,
Xr Toe Lt Fifth,,73660,CPT,Facility,Outpatient,,,T4,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,Medicare Advantage,126.42,49,,percent of total billed charges,,
Xr Toe Lt Fifth,,73660,CPT,Facility,Inpatient,,,T4,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Xr Toe Lt Fifth,,73660,CPT,Facility,Both,,,T4,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,228.5106,88.57,,percent of total billed charges,,
Xr Toe Lt Fifth,,73660,CPT,Facility,Both,,,T4,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,73.9428,28.66,,percent of total billed charges,,
Xr Toe Lt Fifth,,73660,CPT,Facility,Outpatient,,,T4,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),126.42,49,,percent of total billed charges,,
Xr Toe Lt Fifth,,73660,CPT,Facility,Inpatient,,,T4,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Xr Toe Lt Fifth,,73660,CPT,Facility,Both,,,T4,258,219.3,73.9428,258,CorVel,Worker's Compensation,258,100,,percent of total billed charges,,
Xr Toe Lt Fifth,,73660,CPT,Facility,Both,,,T4,258,219.3,73.9428,258,First Health Group Corporation,First Health Network,250.26,97,,percent of total billed charges,,
Xr Toe Lt Fifth,,73660,CPT,Facility,Both,,,T4,258,219.3,73.9428,258,"Health Partners, Inc.",Commercial,244.068,94.6,,percent of total billed charges,,
Xr Toe Lt Fifth,,73660,CPT,Facility,Outpatient,,,T4,258,219.3,73.9428,258,"Health Partners, Inc.",Medicare Advantage,126.42,49,,percent of total billed charges,,
Xr Toe Lt Fifth,,73660,CPT,Facility,Inpatient,,,T4,258,219.3,73.9428,258,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Toe Lt Fifth,,73660,CPT,Facility,Both,,,T4,258,219.3,73.9428,258,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),154.8,60,,percent of total billed charges,,
Xr Toe Lt Fifth,,73660,CPT,Facility,Both,,,T4,258,219.3,73.9428,258,"Health Partners, Inc.",State of Minnesota Advantage Program,210.27,81.5,,percent of total billed charges,,
Xr Toe Lt Fifth,,73660,CPT,Facility,Both,,,T4,258,219.3,73.9428,258,"Health Partners, Inc.",State Public Programs,129,50,,percent of total billed charges,,
Xr Toe Lt Fifth,,73660,CPT,Facility,Both,,,T4,258,219.3,73.9428,258,Humana Insurance Company,Commercial PPO,245.1,95,,percent of total billed charges,,
Xr Toe Lt Fifth,,73660,CPT,Facility,Outpatient,,,T4,258,219.3,73.9428,258,Humana Insurance Company,Medicare PPO,126.42,49,,percent of total billed charges,,
Xr Toe Lt Fifth,,73660,CPT,Facility,Inpatient,,,T4,258,219.3,73.9428,258,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Xr Toe Lt Fifth,,73660,CPT,Facility,Both,,,T4,258,219.3,73.9428,258,Medica,Individual & Family,255.678,99.1,,percent of total billed charges,,
Xr Toe Lt Fifth,,73660,CPT,Facility,Outpatient,,,T4,258,219.3,73.9428,258,Medica,Medica Advantage Solution,128.484,49.8,,percent of total billed charges,,
Xr Toe Lt Fifth,,73660,CPT,Facility,Inpatient,,,T4,258,219.3,73.9428,258,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Xr Toe Lt Fifth,,73660,CPT,Facility,Outpatient,,,T4,258,219.3,73.9428,258,Medica,Medical Assistance,115.068,44.6,,percent of total billed charges,,
Xr Toe Lt Fifth,,73660,CPT,Facility,Inpatient,,,T4,258,219.3,73.9428,258,Medica,Medical Assistance,,,,,Included in per diem rate,
Xr Toe Lt Fifth,,73660,CPT,Facility,Outpatient,,,T4,258,219.3,73.9428,258,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,128.484,49.8,,percent of total billed charges,,
Xr Toe Lt Fifth,,73660,CPT,Facility,Inpatient,,,T4,258,219.3,73.9428,258,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Xr Toe Lt Fifth,,73660,CPT,Facility,Both,,,T4,258,219.3,73.9428,258,"Multiplan, Inc.","Multiplan, Inc.",242.52,94,,percent of total billed charges,,
Xr Toe Lt Fifth,,73660,CPT,Facility,Outpatient,,,T4,258,219.3,73.9428,258,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,232.458,90.1,,percent of total billed charges,,
Xr Toe Lt Fifth,,73660,CPT,Facility,Inpatient,,,T4,258,219.3,73.9428,258,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Xr Toe Lt Fifth,,73660,CPT,Facility,Both,,,T4,258,219.3,73.9428,258,"Preferred One Administrative Services, INC.",PPO,254.388,98.6,,percent of total billed charges,,
Xr Toe Lt Fifth,,73660,CPT,Facility,Outpatient,,,T4,258,219.3,73.9428,258,PrimeWest Health,Minnesota Senior Health Options (MSHO),132.741,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Xr Toe Lt Fifth,,73660,CPT,Facility,Inpatient,,,T4,258,219.3,73.9428,258,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Toe Lt Fifth,,73660,CPT,Facility,Outpatient,,,T4,258,219.3,73.9428,258,PrimeWest Health,MinnesotaCare,132.5088,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Xr Toe Lt Fifth,,73660,CPT,Facility,Inpatient,,,T4,258,219.3,73.9428,258,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Xr Toe Lt Fifth,,73660,CPT,Facility,Both,,,T4,258,219.3,73.9428,258,Sanford Health Plan,Sanford Health Plan,237.36,92,,percent of total billed charges,,
Xr Toe Lt Fifth,,73660,CPT,Facility,Outpatient,,,T4,258,219.3,73.9428,258,"UCare Health, Inc.",Individual & Family Plan,145.383,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Xr Toe Lt Fifth,,73660,CPT,Facility,Inpatient,,,T4,258,219.3,73.9428,258,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Xr Toe Lt Fifth,,73660,CPT,Facility,Outpatient,,,T4,258,219.3,73.9428,258,"UCare Health, Inc.",Medical Assistance,130.2126,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Toe Lt Fifth,,73660,CPT,Facility,Inpatient,,,T4,258,219.3,73.9428,258,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Xr Toe Lt Fifth,,73660,CPT,Facility,Outpatient,,,T4,258,219.3,73.9428,258,"UCare Health, Inc.",Medicare Advantage,130.2126,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Toe Lt Fifth,,73660,CPT,Facility,Inpatient,,,T4,258,219.3,73.9428,258,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Toe Lt Fifth,,73660,CPT,Facility,Outpatient,,,T4,258,219.3,73.9428,258,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),130.2126,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Toe Lt Fifth,,73660,CPT,Facility,Inpatient,,,T4,258,219.3,73.9428,258,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Toe Lt Fifth,,73660,CPT,Facility,Both,,,T4,258,219.3,73.9428,258,UnitedHealthcare,Individual & Family,242.52,94,,percent of total billed charges,,
Xr Toe Lt Fifth,,73660,CPT,Facility,Outpatient,,,T4,258,219.3,73.9428,258,UnitedHealthcare,Medicare Advantage,126.42,49,,percent of total billed charges,,
Xr Toe Lt Fifth,,73660,CPT,Facility,Inpatient,,,T4,258,219.3,73.9428,258,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Xr Toe Lt Fifth,,73660,CPT,Facility,Outpatient,,,T4,258,219.3,73.9428,258,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,123.84,48,,percent of total billed charges,,100% of DHS outpatient percentage
Xr Toe Lt Fifth,,73660,CPT,Facility,Inpatient,,,T4,258,219.3,73.9428,258,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Xr Toe Rt Great,,73660,CPT,Facility,Both,,,T5,258,219.3,73.9428,258,Aetna,Commercial,237.36,92,,percent of total billed charges,,
Xr Toe Rt Great,,73660,CPT,Facility,Outpatient,,,T5,258,219.3,73.9428,258,Aetna,Medicare Advantage,126.42,49,,percent of total billed charges,,
Xr Toe Rt Great,,73660,CPT,Facility,Inpatient,,,T5,258,219.3,73.9428,258,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Xr Toe Rt Great,,73660,CPT,Facility,Both,,,T5,258,219.3,73.9428,258,Aetna,PPO,239.94,93,,percent of total billed charges,,
Xr Toe Rt Great,,73660,CPT,Facility,Both,,,T5,258,219.3,73.9428,258,America's PPO,America's PPO,247.7574,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Xr Toe Rt Great,,73660,CPT,Facility,Both,,,T5,258,219.3,73.9428,258,BlueCross BlueShield Minnesota, Federal Employee Program,253.872,98.4,,percent of total billed charges,,
Xr Toe Rt Great,,73660,CPT,Facility,Both,,,T5,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,258,100,,percent of total billed charges,,
Xr Toe Rt Great,,73660,CPT,Facility,Both,,,T5,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,High Value Network Plan,232.2,90,,percent of total billed charges,,
Xr Toe Rt Great,,73660,CPT,Facility,Outpatient,,,T5,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,Medicare Advantage,126.42,49,,percent of total billed charges,,
Xr Toe Rt Great,,73660,CPT,Facility,Inpatient,,,T5,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Xr Toe Rt Great,,73660,CPT,Facility,Both,,,T5,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,228.5106,88.57,,percent of total billed charges,,
Xr Toe Rt Great,,73660,CPT,Facility,Both,,,T5,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,73.9428,28.66,,percent of total billed charges,,
Xr Toe Rt Great,,73660,CPT,Facility,Outpatient,,,T5,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),126.42,49,,percent of total billed charges,,
Xr Toe Rt Great,,73660,CPT,Facility,Inpatient,,,T5,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Xr Toe Rt Great,,73660,CPT,Facility,Both,,,T5,258,219.3,73.9428,258,CorVel,Worker's Compensation,258,100,,percent of total billed charges,,
Xr Toe Rt Great,,73660,CPT,Facility,Both,,,T5,258,219.3,73.9428,258,First Health Group Corporation,First Health Network,250.26,97,,percent of total billed charges,,
Xr Toe Rt Great,,73660,CPT,Facility,Both,,,T5,258,219.3,73.9428,258,"Health Partners, Inc.",Commercial,244.068,94.6,,percent of total billed charges,,
Xr Toe Rt Great,,73660,CPT,Facility,Outpatient,,,T5,258,219.3,73.9428,258,"Health Partners, Inc.",Medicare Advantage,126.42,49,,percent of total billed charges,,
Xr Toe Rt Great,,73660,CPT,Facility,Inpatient,,,T5,258,219.3,73.9428,258,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Toe Rt Great,,73660,CPT,Facility,Both,,,T5,258,219.3,73.9428,258,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),154.8,60,,percent of total billed charges,,
Xr Toe Rt Great,,73660,CPT,Facility,Both,,,T5,258,219.3,73.9428,258,"Health Partners, Inc.",State of Minnesota Advantage Program,210.27,81.5,,percent of total billed charges,,
Xr Toe Rt Great,,73660,CPT,Facility,Both,,,T5,258,219.3,73.9428,258,"Health Partners, Inc.",State Public Programs,129,50,,percent of total billed charges,,
Xr Toe Rt Great,,73660,CPT,Facility,Both,,,T5,258,219.3,73.9428,258,Humana Insurance Company,Commercial PPO,245.1,95,,percent of total billed charges,,
Xr Toe Rt Great,,73660,CPT,Facility,Outpatient,,,T5,258,219.3,73.9428,258,Humana Insurance Company,Medicare PPO,126.42,49,,percent of total billed charges,,
Xr Toe Rt Great,,73660,CPT,Facility,Inpatient,,,T5,258,219.3,73.9428,258,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Xr Toe Rt Great,,73660,CPT,Facility,Both,,,T5,258,219.3,73.9428,258,Medica,Individual & Family,255.678,99.1,,percent of total billed charges,,
Xr Toe Rt Great,,73660,CPT,Facility,Outpatient,,,T5,258,219.3,73.9428,258,Medica,Medica Advantage Solution,128.484,49.8,,percent of total billed charges,,
Xr Toe Rt Great,,73660,CPT,Facility,Inpatient,,,T5,258,219.3,73.9428,258,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Xr Toe Rt Great,,73660,CPT,Facility,Outpatient,,,T5,258,219.3,73.9428,258,Medica,Medical Assistance,115.068,44.6,,percent of total billed charges,,
Xr Toe Rt Great,,73660,CPT,Facility,Inpatient,,,T5,258,219.3,73.9428,258,Medica,Medical Assistance,,,,,Included in per diem rate,
Xr Toe Rt Great,,73660,CPT,Facility,Outpatient,,,T5,258,219.3,73.9428,258,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,128.484,49.8,,percent of total billed charges,,
Xr Toe Rt Great,,73660,CPT,Facility,Inpatient,,,T5,258,219.3,73.9428,258,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Xr Toe Rt Great,,73660,CPT,Facility,Both,,,T5,258,219.3,73.9428,258,"Multiplan, Inc.","Multiplan, Inc.",242.52,94,,percent of total billed charges,,
Xr Toe Rt Great,,73660,CPT,Facility,Outpatient,,,T5,258,219.3,73.9428,258,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,232.458,90.1,,percent of total billed charges,,
Xr Toe Rt Great,,73660,CPT,Facility,Inpatient,,,T5,258,219.3,73.9428,258,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Xr Toe Rt Great,,73660,CPT,Facility,Both,,,T5,258,219.3,73.9428,258,"Preferred One Administrative Services, INC.",PPO,254.388,98.6,,percent of total billed charges,,
Xr Toe Rt Great,,73660,CPT,Facility,Outpatient,,,T5,258,219.3,73.9428,258,PrimeWest Health,Minnesota Senior Health Options (MSHO),132.741,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Xr Toe Rt Great,,73660,CPT,Facility,Inpatient,,,T5,258,219.3,73.9428,258,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Toe Rt Great,,73660,CPT,Facility,Outpatient,,,T5,258,219.3,73.9428,258,PrimeWest Health,MinnesotaCare,132.5088,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Xr Toe Rt Great,,73660,CPT,Facility,Inpatient,,,T5,258,219.3,73.9428,258,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Xr Toe Rt Great,,73660,CPT,Facility,Both,,,T5,258,219.3,73.9428,258,Sanford Health Plan,Sanford Health Plan,237.36,92,,percent of total billed charges,,
Xr Toe Rt Great,,73660,CPT,Facility,Outpatient,,,T5,258,219.3,73.9428,258,"UCare Health, Inc.",Individual & Family Plan,145.383,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Xr Toe Rt Great,,73660,CPT,Facility,Inpatient,,,T5,258,219.3,73.9428,258,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Xr Toe Rt Great,,73660,CPT,Facility,Outpatient,,,T5,258,219.3,73.9428,258,"UCare Health, Inc.",Medical Assistance,130.2126,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Toe Rt Great,,73660,CPT,Facility,Inpatient,,,T5,258,219.3,73.9428,258,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Xr Toe Rt Great,,73660,CPT,Facility,Outpatient,,,T5,258,219.3,73.9428,258,"UCare Health, Inc.",Medicare Advantage,130.2126,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Toe Rt Great,,73660,CPT,Facility,Inpatient,,,T5,258,219.3,73.9428,258,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Toe Rt Great,,73660,CPT,Facility,Outpatient,,,T5,258,219.3,73.9428,258,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),130.2126,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Toe Rt Great,,73660,CPT,Facility,Inpatient,,,T5,258,219.3,73.9428,258,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Toe Rt Great,,73660,CPT,Facility,Both,,,T5,258,219.3,73.9428,258,UnitedHealthcare,Individual & Family,242.52,94,,percent of total billed charges,,
Xr Toe Rt Great,,73660,CPT,Facility,Outpatient,,,T5,258,219.3,73.9428,258,UnitedHealthcare,Medicare Advantage,126.42,49,,percent of total billed charges,,
Xr Toe Rt Great,,73660,CPT,Facility,Inpatient,,,T5,258,219.3,73.9428,258,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Xr Toe Rt Great,,73660,CPT,Facility,Outpatient,,,T5,258,219.3,73.9428,258,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,123.84,48,,percent of total billed charges,,100% of DHS outpatient percentage
Xr Toe Rt Great,,73660,CPT,Facility,Inpatient,,,T5,258,219.3,73.9428,258,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Xr Toe Rt Second,,73660,CPT,Facility,Both,,,T6,258,219.3,73.9428,258,Aetna,Commercial,237.36,92,,percent of total billed charges,,
Xr Toe Rt Second,,73660,CPT,Facility,Outpatient,,,T6,258,219.3,73.9428,258,Aetna,Medicare Advantage,126.42,49,,percent of total billed charges,,
Xr Toe Rt Second,,73660,CPT,Facility,Inpatient,,,T6,258,219.3,73.9428,258,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Xr Toe Rt Second,,73660,CPT,Facility,Both,,,T6,258,219.3,73.9428,258,Aetna,PPO,239.94,93,,percent of total billed charges,,
Xr Toe Rt Second,,73660,CPT,Facility,Both,,,T6,258,219.3,73.9428,258,America's PPO,America's PPO,247.7574,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Xr Toe Rt Second,,73660,CPT,Facility,Both,,,T6,258,219.3,73.9428,258,BlueCross BlueShield Minnesota, Federal Employee Program,253.872,98.4,,percent of total billed charges,,
Xr Toe Rt Second,,73660,CPT,Facility,Both,,,T6,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,258,100,,percent of total billed charges,,
Xr Toe Rt Second,,73660,CPT,Facility,Both,,,T6,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,High Value Network Plan,232.2,90,,percent of total billed charges,,
Xr Toe Rt Second,,73660,CPT,Facility,Outpatient,,,T6,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,Medicare Advantage,126.42,49,,percent of total billed charges,,
Xr Toe Rt Second,,73660,CPT,Facility,Inpatient,,,T6,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Xr Toe Rt Second,,73660,CPT,Facility,Both,,,T6,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,228.5106,88.57,,percent of total billed charges,,
Xr Toe Rt Second,,73660,CPT,Facility,Both,,,T6,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,73.9428,28.66,,percent of total billed charges,,
Xr Toe Rt Second,,73660,CPT,Facility,Outpatient,,,T6,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),126.42,49,,percent of total billed charges,,
Xr Toe Rt Second,,73660,CPT,Facility,Inpatient,,,T6,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Xr Toe Rt Second,,73660,CPT,Facility,Both,,,T6,258,219.3,73.9428,258,CorVel,Worker's Compensation,258,100,,percent of total billed charges,,
Xr Toe Rt Second,,73660,CPT,Facility,Both,,,T6,258,219.3,73.9428,258,First Health Group Corporation,First Health Network,250.26,97,,percent of total billed charges,,
Xr Toe Rt Second,,73660,CPT,Facility,Both,,,T6,258,219.3,73.9428,258,"Health Partners, Inc.",Commercial,244.068,94.6,,percent of total billed charges,,
Xr Toe Rt Second,,73660,CPT,Facility,Outpatient,,,T6,258,219.3,73.9428,258,"Health Partners, Inc.",Medicare Advantage,126.42,49,,percent of total billed charges,,
Xr Toe Rt Second,,73660,CPT,Facility,Inpatient,,,T6,258,219.3,73.9428,258,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Toe Rt Second,,73660,CPT,Facility,Both,,,T6,258,219.3,73.9428,258,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),154.8,60,,percent of total billed charges,,
Xr Toe Rt Second,,73660,CPT,Facility,Both,,,T6,258,219.3,73.9428,258,"Health Partners, Inc.",State of Minnesota Advantage Program,210.27,81.5,,percent of total billed charges,,
Xr Toe Rt Second,,73660,CPT,Facility,Both,,,T6,258,219.3,73.9428,258,"Health Partners, Inc.",State Public Programs,129,50,,percent of total billed charges,,
Xr Toe Rt Second,,73660,CPT,Facility,Both,,,T6,258,219.3,73.9428,258,Humana Insurance Company,Commercial PPO,245.1,95,,percent of total billed charges,,
Xr Toe Rt Second,,73660,CPT,Facility,Outpatient,,,T6,258,219.3,73.9428,258,Humana Insurance Company,Medicare PPO,126.42,49,,percent of total billed charges,,
Xr Toe Rt Second,,73660,CPT,Facility,Inpatient,,,T6,258,219.3,73.9428,258,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Xr Toe Rt Second,,73660,CPT,Facility,Both,,,T6,258,219.3,73.9428,258,Medica,Individual & Family,255.678,99.1,,percent of total billed charges,,
Xr Toe Rt Second,,73660,CPT,Facility,Outpatient,,,T6,258,219.3,73.9428,258,Medica,Medica Advantage Solution,128.484,49.8,,percent of total billed charges,,
Xr Toe Rt Second,,73660,CPT,Facility,Inpatient,,,T6,258,219.3,73.9428,258,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Xr Toe Rt Second,,73660,CPT,Facility,Outpatient,,,T6,258,219.3,73.9428,258,Medica,Medical Assistance,115.068,44.6,,percent of total billed charges,,
Xr Toe Rt Second,,73660,CPT,Facility,Inpatient,,,T6,258,219.3,73.9428,258,Medica,Medical Assistance,,,,,Included in per diem rate,
Xr Toe Rt Second,,73660,CPT,Facility,Outpatient,,,T6,258,219.3,73.9428,258,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,128.484,49.8,,percent of total billed charges,,
Xr Toe Rt Second,,73660,CPT,Facility,Inpatient,,,T6,258,219.3,73.9428,258,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Xr Toe Rt Second,,73660,CPT,Facility,Both,,,T6,258,219.3,73.9428,258,"Multiplan, Inc.","Multiplan, Inc.",242.52,94,,percent of total billed charges,,
Xr Toe Rt Second,,73660,CPT,Facility,Outpatient,,,T6,258,219.3,73.9428,258,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,232.458,90.1,,percent of total billed charges,,
Xr Toe Rt Second,,73660,CPT,Facility,Inpatient,,,T6,258,219.3,73.9428,258,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Xr Toe Rt Second,,73660,CPT,Facility,Both,,,T6,258,219.3,73.9428,258,"Preferred One Administrative Services, INC.",PPO,254.388,98.6,,percent of total billed charges,,
Xr Toe Rt Second,,73660,CPT,Facility,Outpatient,,,T6,258,219.3,73.9428,258,PrimeWest Health,Minnesota Senior Health Options (MSHO),132.741,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Xr Toe Rt Second,,73660,CPT,Facility,Inpatient,,,T6,258,219.3,73.9428,258,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Toe Rt Second,,73660,CPT,Facility,Outpatient,,,T6,258,219.3,73.9428,258,PrimeWest Health,MinnesotaCare,132.5088,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Xr Toe Rt Second,,73660,CPT,Facility,Inpatient,,,T6,258,219.3,73.9428,258,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Xr Toe Rt Second,,73660,CPT,Facility,Both,,,T6,258,219.3,73.9428,258,Sanford Health Plan,Sanford Health Plan,237.36,92,,percent of total billed charges,,
Xr Toe Rt Second,,73660,CPT,Facility,Outpatient,,,T6,258,219.3,73.9428,258,"UCare Health, Inc.",Individual & Family Plan,145.383,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Xr Toe Rt Second,,73660,CPT,Facility,Inpatient,,,T6,258,219.3,73.9428,258,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Xr Toe Rt Second,,73660,CPT,Facility,Outpatient,,,T6,258,219.3,73.9428,258,"UCare Health, Inc.",Medical Assistance,130.2126,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Toe Rt Second,,73660,CPT,Facility,Inpatient,,,T6,258,219.3,73.9428,258,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Xr Toe Rt Second,,73660,CPT,Facility,Outpatient,,,T6,258,219.3,73.9428,258,"UCare Health, Inc.",Medicare Advantage,130.2126,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Toe Rt Second,,73660,CPT,Facility,Inpatient,,,T6,258,219.3,73.9428,258,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Toe Rt Second,,73660,CPT,Facility,Outpatient,,,T6,258,219.3,73.9428,258,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),130.2126,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Toe Rt Second,,73660,CPT,Facility,Inpatient,,,T6,258,219.3,73.9428,258,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Toe Rt Second,,73660,CPT,Facility,Both,,,T6,258,219.3,73.9428,258,UnitedHealthcare,Individual & Family,242.52,94,,percent of total billed charges,,
Xr Toe Rt Second,,73660,CPT,Facility,Outpatient,,,T6,258,219.3,73.9428,258,UnitedHealthcare,Medicare Advantage,126.42,49,,percent of total billed charges,,
Xr Toe Rt Second,,73660,CPT,Facility,Inpatient,,,T6,258,219.3,73.9428,258,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Xr Toe Rt Second,,73660,CPT,Facility,Outpatient,,,T6,258,219.3,73.9428,258,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,123.84,48,,percent of total billed charges,,100% of DHS outpatient percentage
Xr Toe Rt Second,,73660,CPT,Facility,Inpatient,,,T6,258,219.3,73.9428,258,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Xr Toe Rt Third,,73660,CPT,Facility,Both,,,T7,258,219.3,73.9428,258,Aetna,Commercial,237.36,92,,percent of total billed charges,,
Xr Toe Rt Third,,73660,CPT,Facility,Outpatient,,,T7,258,219.3,73.9428,258,Aetna,Medicare Advantage,126.42,49,,percent of total billed charges,,
Xr Toe Rt Third,,73660,CPT,Facility,Inpatient,,,T7,258,219.3,73.9428,258,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Xr Toe Rt Third,,73660,CPT,Facility,Both,,,T7,258,219.3,73.9428,258,Aetna,PPO,239.94,93,,percent of total billed charges,,
Xr Toe Rt Third,,73660,CPT,Facility,Both,,,T7,258,219.3,73.9428,258,America's PPO,America's PPO,247.7574,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Xr Toe Rt Third,,73660,CPT,Facility,Both,,,T7,258,219.3,73.9428,258,BlueCross BlueShield Minnesota, Federal Employee Program,253.872,98.4,,percent of total billed charges,,
Xr Toe Rt Third,,73660,CPT,Facility,Both,,,T7,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,258,100,,percent of total billed charges,,
Xr Toe Rt Third,,73660,CPT,Facility,Both,,,T7,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,High Value Network Plan,232.2,90,,percent of total billed charges,,
Xr Toe Rt Third,,73660,CPT,Facility,Outpatient,,,T7,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,Medicare Advantage,126.42,49,,percent of total billed charges,,
Xr Toe Rt Third,,73660,CPT,Facility,Inpatient,,,T7,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Xr Toe Rt Third,,73660,CPT,Facility,Both,,,T7,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,228.5106,88.57,,percent of total billed charges,,
Xr Toe Rt Third,,73660,CPT,Facility,Both,,,T7,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,73.9428,28.66,,percent of total billed charges,,
Xr Toe Rt Third,,73660,CPT,Facility,Outpatient,,,T7,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),126.42,49,,percent of total billed charges,,
Xr Toe Rt Third,,73660,CPT,Facility,Inpatient,,,T7,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Xr Toe Rt Third,,73660,CPT,Facility,Both,,,T7,258,219.3,73.9428,258,CorVel,Worker's Compensation,258,100,,percent of total billed charges,,
Xr Toe Rt Third,,73660,CPT,Facility,Both,,,T7,258,219.3,73.9428,258,First Health Group Corporation,First Health Network,250.26,97,,percent of total billed charges,,
Xr Toe Rt Third,,73660,CPT,Facility,Both,,,T7,258,219.3,73.9428,258,"Health Partners, Inc.",Commercial,244.068,94.6,,percent of total billed charges,,
Xr Toe Rt Third,,73660,CPT,Facility,Outpatient,,,T7,258,219.3,73.9428,258,"Health Partners, Inc.",Medicare Advantage,126.42,49,,percent of total billed charges,,
Xr Toe Rt Third,,73660,CPT,Facility,Inpatient,,,T7,258,219.3,73.9428,258,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Toe Rt Third,,73660,CPT,Facility,Both,,,T7,258,219.3,73.9428,258,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),154.8,60,,percent of total billed charges,,
Xr Toe Rt Third,,73660,CPT,Facility,Both,,,T7,258,219.3,73.9428,258,"Health Partners, Inc.",State of Minnesota Advantage Program,210.27,81.5,,percent of total billed charges,,
Xr Toe Rt Third,,73660,CPT,Facility,Both,,,T7,258,219.3,73.9428,258,"Health Partners, Inc.",State Public Programs,129,50,,percent of total billed charges,,
Xr Toe Rt Third,,73660,CPT,Facility,Both,,,T7,258,219.3,73.9428,258,Humana Insurance Company,Commercial PPO,245.1,95,,percent of total billed charges,,
Xr Toe Rt Third,,73660,CPT,Facility,Outpatient,,,T7,258,219.3,73.9428,258,Humana Insurance Company,Medicare PPO,126.42,49,,percent of total billed charges,,
Xr Toe Rt Third,,73660,CPT,Facility,Inpatient,,,T7,258,219.3,73.9428,258,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Xr Toe Rt Third,,73660,CPT,Facility,Both,,,T7,258,219.3,73.9428,258,Medica,Individual & Family,255.678,99.1,,percent of total billed charges,,
Xr Toe Rt Third,,73660,CPT,Facility,Outpatient,,,T7,258,219.3,73.9428,258,Medica,Medica Advantage Solution,128.484,49.8,,percent of total billed charges,,
Xr Toe Rt Third,,73660,CPT,Facility,Inpatient,,,T7,258,219.3,73.9428,258,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Xr Toe Rt Third,,73660,CPT,Facility,Outpatient,,,T7,258,219.3,73.9428,258,Medica,Medical Assistance,115.068,44.6,,percent of total billed charges,,
Xr Toe Rt Third,,73660,CPT,Facility,Inpatient,,,T7,258,219.3,73.9428,258,Medica,Medical Assistance,,,,,Included in per diem rate,
Xr Toe Rt Third,,73660,CPT,Facility,Outpatient,,,T7,258,219.3,73.9428,258,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,128.484,49.8,,percent of total billed charges,,
Xr Toe Rt Third,,73660,CPT,Facility,Inpatient,,,T7,258,219.3,73.9428,258,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Xr Toe Rt Third,,73660,CPT,Facility,Both,,,T7,258,219.3,73.9428,258,"Multiplan, Inc.","Multiplan, Inc.",242.52,94,,percent of total billed charges,,
Xr Toe Rt Third,,73660,CPT,Facility,Outpatient,,,T7,258,219.3,73.9428,258,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,232.458,90.1,,percent of total billed charges,,
Xr Toe Rt Third,,73660,CPT,Facility,Inpatient,,,T7,258,219.3,73.9428,258,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Xr Toe Rt Third,,73660,CPT,Facility,Both,,,T7,258,219.3,73.9428,258,"Preferred One Administrative Services, INC.",PPO,254.388,98.6,,percent of total billed charges,,
Xr Toe Rt Third,,73660,CPT,Facility,Outpatient,,,T7,258,219.3,73.9428,258,PrimeWest Health,Minnesota Senior Health Options (MSHO),132.741,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Xr Toe Rt Third,,73660,CPT,Facility,Inpatient,,,T7,258,219.3,73.9428,258,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Toe Rt Third,,73660,CPT,Facility,Outpatient,,,T7,258,219.3,73.9428,258,PrimeWest Health,MinnesotaCare,132.5088,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Xr Toe Rt Third,,73660,CPT,Facility,Inpatient,,,T7,258,219.3,73.9428,258,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Xr Toe Rt Third,,73660,CPT,Facility,Both,,,T7,258,219.3,73.9428,258,Sanford Health Plan,Sanford Health Plan,237.36,92,,percent of total billed charges,,
Xr Toe Rt Third,,73660,CPT,Facility,Outpatient,,,T7,258,219.3,73.9428,258,"UCare Health, Inc.",Individual & Family Plan,145.383,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Xr Toe Rt Third,,73660,CPT,Facility,Inpatient,,,T7,258,219.3,73.9428,258,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Xr Toe Rt Third,,73660,CPT,Facility,Outpatient,,,T7,258,219.3,73.9428,258,"UCare Health, Inc.",Medical Assistance,130.2126,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Toe Rt Third,,73660,CPT,Facility,Inpatient,,,T7,258,219.3,73.9428,258,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Xr Toe Rt Third,,73660,CPT,Facility,Outpatient,,,T7,258,219.3,73.9428,258,"UCare Health, Inc.",Medicare Advantage,130.2126,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Toe Rt Third,,73660,CPT,Facility,Inpatient,,,T7,258,219.3,73.9428,258,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Toe Rt Third,,73660,CPT,Facility,Outpatient,,,T7,258,219.3,73.9428,258,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),130.2126,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Toe Rt Third,,73660,CPT,Facility,Inpatient,,,T7,258,219.3,73.9428,258,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Toe Rt Third,,73660,CPT,Facility,Both,,,T7,258,219.3,73.9428,258,UnitedHealthcare,Individual & Family,242.52,94,,percent of total billed charges,,
Xr Toe Rt Third,,73660,CPT,Facility,Outpatient,,,T7,258,219.3,73.9428,258,UnitedHealthcare,Medicare Advantage,126.42,49,,percent of total billed charges,,
Xr Toe Rt Third,,73660,CPT,Facility,Inpatient,,,T7,258,219.3,73.9428,258,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Xr Toe Rt Third,,73660,CPT,Facility,Outpatient,,,T7,258,219.3,73.9428,258,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,123.84,48,,percent of total billed charges,,100% of DHS outpatient percentage
Xr Toe Rt Third,,73660,CPT,Facility,Inpatient,,,T7,258,219.3,73.9428,258,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Xr Toe Rt Fourth,,73660,CPT,Facility,Both,,,T8,258,219.3,73.9428,258,Aetna,Commercial,237.36,92,,percent of total billed charges,,
Xr Toe Rt Fourth,,73660,CPT,Facility,Outpatient,,,T8,258,219.3,73.9428,258,Aetna,Medicare Advantage,126.42,49,,percent of total billed charges,,
Xr Toe Rt Fourth,,73660,CPT,Facility,Inpatient,,,T8,258,219.3,73.9428,258,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Xr Toe Rt Fourth,,73660,CPT,Facility,Both,,,T8,258,219.3,73.9428,258,Aetna,PPO,239.94,93,,percent of total billed charges,,
Xr Toe Rt Fourth,,73660,CPT,Facility,Both,,,T8,258,219.3,73.9428,258,America's PPO,America's PPO,247.7574,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Xr Toe Rt Fourth,,73660,CPT,Facility,Both,,,T8,258,219.3,73.9428,258,BlueCross BlueShield Minnesota, Federal Employee Program,253.872,98.4,,percent of total billed charges,,
Xr Toe Rt Fourth,,73660,CPT,Facility,Both,,,T8,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,258,100,,percent of total billed charges,,
Xr Toe Rt Fourth,,73660,CPT,Facility,Both,,,T8,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,High Value Network Plan,232.2,90,,percent of total billed charges,,
Xr Toe Rt Fourth,,73660,CPT,Facility,Outpatient,,,T8,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,Medicare Advantage,126.42,49,,percent of total billed charges,,
Xr Toe Rt Fourth,,73660,CPT,Facility,Inpatient,,,T8,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Xr Toe Rt Fourth,,73660,CPT,Facility,Both,,,T8,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,228.5106,88.57,,percent of total billed charges,,
Xr Toe Rt Fourth,,73660,CPT,Facility,Both,,,T8,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,73.9428,28.66,,percent of total billed charges,,
Xr Toe Rt Fourth,,73660,CPT,Facility,Outpatient,,,T8,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),126.42,49,,percent of total billed charges,,
Xr Toe Rt Fourth,,73660,CPT,Facility,Inpatient,,,T8,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Xr Toe Rt Fourth,,73660,CPT,Facility,Both,,,T8,258,219.3,73.9428,258,CorVel,Worker's Compensation,258,100,,percent of total billed charges,,
Xr Toe Rt Fourth,,73660,CPT,Facility,Both,,,T8,258,219.3,73.9428,258,First Health Group Corporation,First Health Network,250.26,97,,percent of total billed charges,,
Xr Toe Rt Fourth,,73660,CPT,Facility,Both,,,T8,258,219.3,73.9428,258,"Health Partners, Inc.",Commercial,244.068,94.6,,percent of total billed charges,,
Xr Toe Rt Fourth,,73660,CPT,Facility,Outpatient,,,T8,258,219.3,73.9428,258,"Health Partners, Inc.",Medicare Advantage,126.42,49,,percent of total billed charges,,
Xr Toe Rt Fourth,,73660,CPT,Facility,Inpatient,,,T8,258,219.3,73.9428,258,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Toe Rt Fourth,,73660,CPT,Facility,Both,,,T8,258,219.3,73.9428,258,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),154.8,60,,percent of total billed charges,,
Xr Toe Rt Fourth,,73660,CPT,Facility,Both,,,T8,258,219.3,73.9428,258,"Health Partners, Inc.",State of Minnesota Advantage Program,210.27,81.5,,percent of total billed charges,,
Xr Toe Rt Fourth,,73660,CPT,Facility,Both,,,T8,258,219.3,73.9428,258,"Health Partners, Inc.",State Public Programs,129,50,,percent of total billed charges,,
Xr Toe Rt Fourth,,73660,CPT,Facility,Both,,,T8,258,219.3,73.9428,258,Humana Insurance Company,Commercial PPO,245.1,95,,percent of total billed charges,,
Xr Toe Rt Fourth,,73660,CPT,Facility,Outpatient,,,T8,258,219.3,73.9428,258,Humana Insurance Company,Medicare PPO,126.42,49,,percent of total billed charges,,
Xr Toe Rt Fourth,,73660,CPT,Facility,Inpatient,,,T8,258,219.3,73.9428,258,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Xr Toe Rt Fourth,,73660,CPT,Facility,Both,,,T8,258,219.3,73.9428,258,Medica,Individual & Family,255.678,99.1,,percent of total billed charges,,
Xr Toe Rt Fourth,,73660,CPT,Facility,Outpatient,,,T8,258,219.3,73.9428,258,Medica,Medica Advantage Solution,128.484,49.8,,percent of total billed charges,,
Xr Toe Rt Fourth,,73660,CPT,Facility,Inpatient,,,T8,258,219.3,73.9428,258,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Xr Toe Rt Fourth,,73660,CPT,Facility,Outpatient,,,T8,258,219.3,73.9428,258,Medica,Medical Assistance,115.068,44.6,,percent of total billed charges,,
Xr Toe Rt Fourth,,73660,CPT,Facility,Inpatient,,,T8,258,219.3,73.9428,258,Medica,Medical Assistance,,,,,Included in per diem rate,
Xr Toe Rt Fourth,,73660,CPT,Facility,Outpatient,,,T8,258,219.3,73.9428,258,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,128.484,49.8,,percent of total billed charges,,
Xr Toe Rt Fourth,,73660,CPT,Facility,Inpatient,,,T8,258,219.3,73.9428,258,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Xr Toe Rt Fourth,,73660,CPT,Facility,Both,,,T8,258,219.3,73.9428,258,"Multiplan, Inc.","Multiplan, Inc.",242.52,94,,percent of total billed charges,,
Xr Toe Rt Fourth,,73660,CPT,Facility,Outpatient,,,T8,258,219.3,73.9428,258,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,232.458,90.1,,percent of total billed charges,,
Xr Toe Rt Fourth,,73660,CPT,Facility,Inpatient,,,T8,258,219.3,73.9428,258,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Xr Toe Rt Fourth,,73660,CPT,Facility,Both,,,T8,258,219.3,73.9428,258,"Preferred One Administrative Services, INC.",PPO,254.388,98.6,,percent of total billed charges,,
Xr Toe Rt Fourth,,73660,CPT,Facility,Outpatient,,,T8,258,219.3,73.9428,258,PrimeWest Health,Minnesota Senior Health Options (MSHO),132.741,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Xr Toe Rt Fourth,,73660,CPT,Facility,Inpatient,,,T8,258,219.3,73.9428,258,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Toe Rt Fourth,,73660,CPT,Facility,Outpatient,,,T8,258,219.3,73.9428,258,PrimeWest Health,MinnesotaCare,132.5088,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Xr Toe Rt Fourth,,73660,CPT,Facility,Inpatient,,,T8,258,219.3,73.9428,258,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Xr Toe Rt Fourth,,73660,CPT,Facility,Both,,,T8,258,219.3,73.9428,258,Sanford Health Plan,Sanford Health Plan,237.36,92,,percent of total billed charges,,
Xr Toe Rt Fourth,,73660,CPT,Facility,Outpatient,,,T8,258,219.3,73.9428,258,"UCare Health, Inc.",Individual & Family Plan,145.383,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Xr Toe Rt Fourth,,73660,CPT,Facility,Inpatient,,,T8,258,219.3,73.9428,258,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Xr Toe Rt Fourth,,73660,CPT,Facility,Outpatient,,,T8,258,219.3,73.9428,258,"UCare Health, Inc.",Medical Assistance,130.2126,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Toe Rt Fourth,,73660,CPT,Facility,Inpatient,,,T8,258,219.3,73.9428,258,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Xr Toe Rt Fourth,,73660,CPT,Facility,Outpatient,,,T8,258,219.3,73.9428,258,"UCare Health, Inc.",Medicare Advantage,130.2126,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Toe Rt Fourth,,73660,CPT,Facility,Inpatient,,,T8,258,219.3,73.9428,258,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Toe Rt Fourth,,73660,CPT,Facility,Outpatient,,,T8,258,219.3,73.9428,258,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),130.2126,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Toe Rt Fourth,,73660,CPT,Facility,Inpatient,,,T8,258,219.3,73.9428,258,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Toe Rt Fourth,,73660,CPT,Facility,Both,,,T8,258,219.3,73.9428,258,UnitedHealthcare,Individual & Family,242.52,94,,percent of total billed charges,,
Xr Toe Rt Fourth,,73660,CPT,Facility,Outpatient,,,T8,258,219.3,73.9428,258,UnitedHealthcare,Medicare Advantage,126.42,49,,percent of total billed charges,,
Xr Toe Rt Fourth,,73660,CPT,Facility,Inpatient,,,T8,258,219.3,73.9428,258,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Xr Toe Rt Fourth,,73660,CPT,Facility,Outpatient,,,T8,258,219.3,73.9428,258,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,123.84,48,,percent of total billed charges,,100% of DHS outpatient percentage
Xr Toe Rt Fourth,,73660,CPT,Facility,Inpatient,,,T8,258,219.3,73.9428,258,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Xr Toe Rt Fifth,,73660,CPT,Facility,Both,,,T9,258,219.3,73.9428,258,Aetna,Commercial,237.36,92,,percent of total billed charges,,
Xr Toe Rt Fifth,,73660,CPT,Facility,Outpatient,,,T9,258,219.3,73.9428,258,Aetna,Medicare Advantage,126.42,49,,percent of total billed charges,,
Xr Toe Rt Fifth,,73660,CPT,Facility,Inpatient,,,T9,258,219.3,73.9428,258,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Xr Toe Rt Fifth,,73660,CPT,Facility,Both,,,T9,258,219.3,73.9428,258,Aetna,PPO,239.94,93,,percent of total billed charges,,
Xr Toe Rt Fifth,,73660,CPT,Facility,Both,,,T9,258,219.3,73.9428,258,America's PPO,America's PPO,247.7574,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Xr Toe Rt Fifth,,73660,CPT,Facility,Both,,,T9,258,219.3,73.9428,258,BlueCross BlueShield Minnesota, Federal Employee Program,253.872,98.4,,percent of total billed charges,,
Xr Toe Rt Fifth,,73660,CPT,Facility,Both,,,T9,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,258,100,,percent of total billed charges,,
Xr Toe Rt Fifth,,73660,CPT,Facility,Both,,,T9,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,High Value Network Plan,232.2,90,,percent of total billed charges,,
Xr Toe Rt Fifth,,73660,CPT,Facility,Outpatient,,,T9,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,Medicare Advantage,126.42,49,,percent of total billed charges,,
Xr Toe Rt Fifth,,73660,CPT,Facility,Inpatient,,,T9,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Xr Toe Rt Fifth,,73660,CPT,Facility,Both,,,T9,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,228.5106,88.57,,percent of total billed charges,,
Xr Toe Rt Fifth,,73660,CPT,Facility,Both,,,T9,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,73.9428,28.66,,percent of total billed charges,,
Xr Toe Rt Fifth,,73660,CPT,Facility,Outpatient,,,T9,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),126.42,49,,percent of total billed charges,,
Xr Toe Rt Fifth,,73660,CPT,Facility,Inpatient,,,T9,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Xr Toe Rt Fifth,,73660,CPT,Facility,Both,,,T9,258,219.3,73.9428,258,CorVel,Worker's Compensation,258,100,,percent of total billed charges,,
Xr Toe Rt Fifth,,73660,CPT,Facility,Both,,,T9,258,219.3,73.9428,258,First Health Group Corporation,First Health Network,250.26,97,,percent of total billed charges,,
Xr Toe Rt Fifth,,73660,CPT,Facility,Both,,,T9,258,219.3,73.9428,258,"Health Partners, Inc.",Commercial,244.068,94.6,,percent of total billed charges,,
Xr Toe Rt Fifth,,73660,CPT,Facility,Outpatient,,,T9,258,219.3,73.9428,258,"Health Partners, Inc.",Medicare Advantage,126.42,49,,percent of total billed charges,,
Xr Toe Rt Fifth,,73660,CPT,Facility,Inpatient,,,T9,258,219.3,73.9428,258,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Toe Rt Fifth,,73660,CPT,Facility,Both,,,T9,258,219.3,73.9428,258,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),154.8,60,,percent of total billed charges,,
Xr Toe Rt Fifth,,73660,CPT,Facility,Both,,,T9,258,219.3,73.9428,258,"Health Partners, Inc.",State of Minnesota Advantage Program,210.27,81.5,,percent of total billed charges,,
Xr Toe Rt Fifth,,73660,CPT,Facility,Both,,,T9,258,219.3,73.9428,258,"Health Partners, Inc.",State Public Programs,129,50,,percent of total billed charges,,
Xr Toe Rt Fifth,,73660,CPT,Facility,Both,,,T9,258,219.3,73.9428,258,Humana Insurance Company,Commercial PPO,245.1,95,,percent of total billed charges,,
Xr Toe Rt Fifth,,73660,CPT,Facility,Outpatient,,,T9,258,219.3,73.9428,258,Humana Insurance Company,Medicare PPO,126.42,49,,percent of total billed charges,,
Xr Toe Rt Fifth,,73660,CPT,Facility,Inpatient,,,T9,258,219.3,73.9428,258,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Xr Toe Rt Fifth,,73660,CPT,Facility,Both,,,T9,258,219.3,73.9428,258,Medica,Individual & Family,255.678,99.1,,percent of total billed charges,,
Xr Toe Rt Fifth,,73660,CPT,Facility,Outpatient,,,T9,258,219.3,73.9428,258,Medica,Medica Advantage Solution,128.484,49.8,,percent of total billed charges,,
Xr Toe Rt Fifth,,73660,CPT,Facility,Inpatient,,,T9,258,219.3,73.9428,258,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Xr Toe Rt Fifth,,73660,CPT,Facility,Outpatient,,,T9,258,219.3,73.9428,258,Medica,Medical Assistance,115.068,44.6,,percent of total billed charges,,
Xr Toe Rt Fifth,,73660,CPT,Facility,Inpatient,,,T9,258,219.3,73.9428,258,Medica,Medical Assistance,,,,,Included in per diem rate,
Xr Toe Rt Fifth,,73660,CPT,Facility,Outpatient,,,T9,258,219.3,73.9428,258,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,128.484,49.8,,percent of total billed charges,,
Xr Toe Rt Fifth,,73660,CPT,Facility,Inpatient,,,T9,258,219.3,73.9428,258,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Xr Toe Rt Fifth,,73660,CPT,Facility,Both,,,T9,258,219.3,73.9428,258,"Multiplan, Inc.","Multiplan, Inc.",242.52,94,,percent of total billed charges,,
Xr Toe Rt Fifth,,73660,CPT,Facility,Outpatient,,,T9,258,219.3,73.9428,258,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,232.458,90.1,,percent of total billed charges,,
Xr Toe Rt Fifth,,73660,CPT,Facility,Inpatient,,,T9,258,219.3,73.9428,258,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Xr Toe Rt Fifth,,73660,CPT,Facility,Both,,,T9,258,219.3,73.9428,258,"Preferred One Administrative Services, INC.",PPO,254.388,98.6,,percent of total billed charges,,
Xr Toe Rt Fifth,,73660,CPT,Facility,Outpatient,,,T9,258,219.3,73.9428,258,PrimeWest Health,Minnesota Senior Health Options (MSHO),132.741,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Xr Toe Rt Fifth,,73660,CPT,Facility,Inpatient,,,T9,258,219.3,73.9428,258,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Toe Rt Fifth,,73660,CPT,Facility,Outpatient,,,T9,258,219.3,73.9428,258,PrimeWest Health,MinnesotaCare,132.5088,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Xr Toe Rt Fifth,,73660,CPT,Facility,Inpatient,,,T9,258,219.3,73.9428,258,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Xr Toe Rt Fifth,,73660,CPT,Facility,Both,,,T9,258,219.3,73.9428,258,Sanford Health Plan,Sanford Health Plan,237.36,92,,percent of total billed charges,,
Xr Toe Rt Fifth,,73660,CPT,Facility,Outpatient,,,T9,258,219.3,73.9428,258,"UCare Health, Inc.",Individual & Family Plan,145.383,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Xr Toe Rt Fifth,,73660,CPT,Facility,Inpatient,,,T9,258,219.3,73.9428,258,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Xr Toe Rt Fifth,,73660,CPT,Facility,Outpatient,,,T9,258,219.3,73.9428,258,"UCare Health, Inc.",Medical Assistance,130.2126,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Toe Rt Fifth,,73660,CPT,Facility,Inpatient,,,T9,258,219.3,73.9428,258,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Xr Toe Rt Fifth,,73660,CPT,Facility,Outpatient,,,T9,258,219.3,73.9428,258,"UCare Health, Inc.",Medicare Advantage,130.2126,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Toe Rt Fifth,,73660,CPT,Facility,Inpatient,,,T9,258,219.3,73.9428,258,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Toe Rt Fifth,,73660,CPT,Facility,Outpatient,,,T9,258,219.3,73.9428,258,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),130.2126,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Toe Rt Fifth,,73660,CPT,Facility,Inpatient,,,T9,258,219.3,73.9428,258,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Toe Rt Fifth,,73660,CPT,Facility,Both,,,T9,258,219.3,73.9428,258,UnitedHealthcare,Individual & Family,242.52,94,,percent of total billed charges,,
Xr Toe Rt Fifth,,73660,CPT,Facility,Outpatient,,,T9,258,219.3,73.9428,258,UnitedHealthcare,Medicare Advantage,126.42,49,,percent of total billed charges,,
Xr Toe Rt Fifth,,73660,CPT,Facility,Inpatient,,,T9,258,219.3,73.9428,258,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Xr Toe Rt Fifth,,73660,CPT,Facility,Outpatient,,,T9,258,219.3,73.9428,258,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,123.84,48,,percent of total billed charges,,100% of DHS outpatient percentage
Xr Toe Rt Fifth,,73660,CPT,Facility,Inpatient,,,T9,258,219.3,73.9428,258,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Xr Toe Lt Great,,73660,CPT,Facility,Both,,,TA,258,219.3,73.9428,258,Aetna,Commercial,237.36,92,,percent of total billed charges,,
Xr Toe Lt Great,,73660,CPT,Facility,Outpatient,,,TA,258,219.3,73.9428,258,Aetna,Medicare Advantage,126.42,49,,percent of total billed charges,,
Xr Toe Lt Great,,73660,CPT,Facility,Inpatient,,,TA,258,219.3,73.9428,258,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Xr Toe Lt Great,,73660,CPT,Facility,Both,,,TA,258,219.3,73.9428,258,Aetna,PPO,239.94,93,,percent of total billed charges,,
Xr Toe Lt Great,,73660,CPT,Facility,Both,,,TA,258,219.3,73.9428,258,America's PPO,America's PPO,247.7574,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Xr Toe Lt Great,,73660,CPT,Facility,Both,,,TA,258,219.3,73.9428,258,BlueCross BlueShield Minnesota, Federal Employee Program,253.872,98.4,,percent of total billed charges,,
Xr Toe Lt Great,,73660,CPT,Facility,Both,,,TA,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,258,100,,percent of total billed charges,,
Xr Toe Lt Great,,73660,CPT,Facility,Both,,,TA,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,High Value Network Plan,232.2,90,,percent of total billed charges,,
Xr Toe Lt Great,,73660,CPT,Facility,Outpatient,,,TA,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,Medicare Advantage,126.42,49,,percent of total billed charges,,
Xr Toe Lt Great,,73660,CPT,Facility,Inpatient,,,TA,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Xr Toe Lt Great,,73660,CPT,Facility,Both,,,TA,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,228.5106,88.57,,percent of total billed charges,,
Xr Toe Lt Great,,73660,CPT,Facility,Both,,,TA,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,73.9428,28.66,,percent of total billed charges,,
Xr Toe Lt Great,,73660,CPT,Facility,Outpatient,,,TA,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),126.42,49,,percent of total billed charges,,
Xr Toe Lt Great,,73660,CPT,Facility,Inpatient,,,TA,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Xr Toe Lt Great,,73660,CPT,Facility,Both,,,TA,258,219.3,73.9428,258,CorVel,Worker's Compensation,258,100,,percent of total billed charges,,
Xr Toe Lt Great,,73660,CPT,Facility,Both,,,TA,258,219.3,73.9428,258,First Health Group Corporation,First Health Network,250.26,97,,percent of total billed charges,,
Xr Toe Lt Great,,73660,CPT,Facility,Both,,,TA,258,219.3,73.9428,258,"Health Partners, Inc.",Commercial,244.068,94.6,,percent of total billed charges,,
Xr Toe Lt Great,,73660,CPT,Facility,Outpatient,,,TA,258,219.3,73.9428,258,"Health Partners, Inc.",Medicare Advantage,126.42,49,,percent of total billed charges,,
Xr Toe Lt Great,,73660,CPT,Facility,Inpatient,,,TA,258,219.3,73.9428,258,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Toe Lt Great,,73660,CPT,Facility,Both,,,TA,258,219.3,73.9428,258,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),154.8,60,,percent of total billed charges,,
Xr Toe Lt Great,,73660,CPT,Facility,Both,,,TA,258,219.3,73.9428,258,"Health Partners, Inc.",State of Minnesota Advantage Program,210.27,81.5,,percent of total billed charges,,
Xr Toe Lt Great,,73660,CPT,Facility,Both,,,TA,258,219.3,73.9428,258,"Health Partners, Inc.",State Public Programs,129,50,,percent of total billed charges,,
Xr Toe Lt Great,,73660,CPT,Facility,Both,,,TA,258,219.3,73.9428,258,Humana Insurance Company,Commercial PPO,245.1,95,,percent of total billed charges,,
Xr Toe Lt Great,,73660,CPT,Facility,Outpatient,,,TA,258,219.3,73.9428,258,Humana Insurance Company,Medicare PPO,126.42,49,,percent of total billed charges,,
Xr Toe Lt Great,,73660,CPT,Facility,Inpatient,,,TA,258,219.3,73.9428,258,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Xr Toe Lt Great,,73660,CPT,Facility,Both,,,TA,258,219.3,73.9428,258,Medica,Individual & Family,255.678,99.1,,percent of total billed charges,,
Xr Toe Lt Great,,73660,CPT,Facility,Outpatient,,,TA,258,219.3,73.9428,258,Medica,Medica Advantage Solution,128.484,49.8,,percent of total billed charges,,
Xr Toe Lt Great,,73660,CPT,Facility,Inpatient,,,TA,258,219.3,73.9428,258,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Xr Toe Lt Great,,73660,CPT,Facility,Outpatient,,,TA,258,219.3,73.9428,258,Medica,Medical Assistance,115.068,44.6,,percent of total billed charges,,
Xr Toe Lt Great,,73660,CPT,Facility,Inpatient,,,TA,258,219.3,73.9428,258,Medica,Medical Assistance,,,,,Included in per diem rate,
Xr Toe Lt Great,,73660,CPT,Facility,Outpatient,,,TA,258,219.3,73.9428,258,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,128.484,49.8,,percent of total billed charges,,
Xr Toe Lt Great,,73660,CPT,Facility,Inpatient,,,TA,258,219.3,73.9428,258,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Xr Toe Lt Great,,73660,CPT,Facility,Both,,,TA,258,219.3,73.9428,258,"Multiplan, Inc.","Multiplan, Inc.",242.52,94,,percent of total billed charges,,
Xr Toe Lt Great,,73660,CPT,Facility,Outpatient,,,TA,258,219.3,73.9428,258,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,232.458,90.1,,percent of total billed charges,,
Xr Toe Lt Great,,73660,CPT,Facility,Inpatient,,,TA,258,219.3,73.9428,258,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Xr Toe Lt Great,,73660,CPT,Facility,Both,,,TA,258,219.3,73.9428,258,"Preferred One Administrative Services, INC.",PPO,254.388,98.6,,percent of total billed charges,,
Xr Toe Lt Great,,73660,CPT,Facility,Outpatient,,,TA,258,219.3,73.9428,258,PrimeWest Health,Minnesota Senior Health Options (MSHO),132.741,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Xr Toe Lt Great,,73660,CPT,Facility,Inpatient,,,TA,258,219.3,73.9428,258,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Toe Lt Great,,73660,CPT,Facility,Outpatient,,,TA,258,219.3,73.9428,258,PrimeWest Health,MinnesotaCare,132.5088,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Xr Toe Lt Great,,73660,CPT,Facility,Inpatient,,,TA,258,219.3,73.9428,258,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Xr Toe Lt Great,,73660,CPT,Facility,Both,,,TA,258,219.3,73.9428,258,Sanford Health Plan,Sanford Health Plan,237.36,92,,percent of total billed charges,,
Xr Toe Lt Great,,73660,CPT,Facility,Outpatient,,,TA,258,219.3,73.9428,258,"UCare Health, Inc.",Individual & Family Plan,145.383,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Xr Toe Lt Great,,73660,CPT,Facility,Inpatient,,,TA,258,219.3,73.9428,258,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Xr Toe Lt Great,,73660,CPT,Facility,Outpatient,,,TA,258,219.3,73.9428,258,"UCare Health, Inc.",Medical Assistance,130.2126,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Toe Lt Great,,73660,CPT,Facility,Inpatient,,,TA,258,219.3,73.9428,258,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Xr Toe Lt Great,,73660,CPT,Facility,Outpatient,,,TA,258,219.3,73.9428,258,"UCare Health, Inc.",Medicare Advantage,130.2126,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Toe Lt Great,,73660,CPT,Facility,Inpatient,,,TA,258,219.3,73.9428,258,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Toe Lt Great,,73660,CPT,Facility,Outpatient,,,TA,258,219.3,73.9428,258,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),130.2126,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Toe Lt Great,,73660,CPT,Facility,Inpatient,,,TA,258,219.3,73.9428,258,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Toe Lt Great,,73660,CPT,Facility,Both,,,TA,258,219.3,73.9428,258,UnitedHealthcare,Individual & Family,242.52,94,,percent of total billed charges,,
Xr Toe Lt Great,,73660,CPT,Facility,Outpatient,,,TA,258,219.3,73.9428,258,UnitedHealthcare,Medicare Advantage,126.42,49,,percent of total billed charges,,
Xr Toe Lt Great,,73660,CPT,Facility,Inpatient,,,TA,258,219.3,73.9428,258,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Xr Toe Lt Great,,73660,CPT,Facility,Outpatient,,,TA,258,219.3,73.9428,258,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,123.84,48,,percent of total billed charges,,100% of DHS outpatient percentage
Xr Toe Lt Great,,73660,CPT,Facility,Inpatient,,,TA,258,219.3,73.9428,258,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Immunohistochemistry Or Immunocytochemistry, Per Specimen; Ea Adtl Single Antibody Stain Proc (Path)Technical Component ",,88341,CPT,Facility,Both,,,TC,172,146.2,49.2952,172,Aetna,Commercial,158.24,92,,percent of total billed charges,,
"Immunohistochemistry Or Immunocytochemistry, Per Specimen; Ea Adtl Single Antibody Stain Proc (Path)Technical Component ",,88341,CPT,Facility,Outpatient,,,TC,172,146.2,49.2952,172,Aetna,Medicare Advantage,84.28,49,,percent of total billed charges,,
"Immunohistochemistry Or Immunocytochemistry, Per Specimen; Ea Adtl Single Antibody Stain Proc (Path)Technical Component ",,88341,CPT,Facility,Inpatient,,,TC,172,146.2,49.2952,172,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Immunohistochemistry Or Immunocytochemistry, Per Specimen; Ea Adtl Single Antibody Stain Proc (Path)Technical Component ",,88341,CPT,Facility,Both,,,TC,172,146.2,49.2952,172,Aetna,PPO,159.96,93,,percent of total billed charges,,
"Immunohistochemistry Or Immunocytochemistry, Per Specimen; Ea Adtl Single Antibody Stain Proc (Path)Technical Component ",,88341,CPT,Facility,Both,,,TC,172,146.2,49.2952,172,America's PPO,America's PPO,165.1716,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Immunohistochemistry Or Immunocytochemistry, Per Specimen; Ea Adtl Single Antibody Stain Proc (Path)Technical Component ",,88341,CPT,Facility,Both,,,TC,172,146.2,49.2952,172,BlueCross BlueShield Minnesota, Federal Employee Program,169.248,98.4,,percent of total billed charges,,
"Immunohistochemistry Or Immunocytochemistry, Per Specimen; Ea Adtl Single Antibody Stain Proc (Path)Technical Component ",,88341,CPT,Facility,Both,,,TC,172,146.2,49.2952,172,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,172,100,,percent of total billed charges,,
"Immunohistochemistry Or Immunocytochemistry, Per Specimen; Ea Adtl Single Antibody Stain Proc (Path)Technical Component ",,88341,CPT,Facility,Both,,,TC,172,146.2,49.2952,172,BlueCross BlueShield Minnesota,High Value Network Plan,154.8,90,,percent of total billed charges,,
"Immunohistochemistry Or Immunocytochemistry, Per Specimen; Ea Adtl Single Antibody Stain Proc (Path)Technical Component ",,88341,CPT,Facility,Outpatient,,,TC,172,146.2,49.2952,172,BlueCross BlueShield Minnesota,Medicare Advantage,84.28,49,,percent of total billed charges,,
"Immunohistochemistry Or Immunocytochemistry, Per Specimen; Ea Adtl Single Antibody Stain Proc (Path)Technical Component ",,88341,CPT,Facility,Inpatient,,,TC,172,146.2,49.2952,172,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Immunohistochemistry Or Immunocytochemistry, Per Specimen; Ea Adtl Single Antibody Stain Proc (Path)Technical Component ",,88341,CPT,Facility,Both,,,TC,172,146.2,49.2952,172,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,152.3404,88.57,,percent of total billed charges,,
"Immunohistochemistry Or Immunocytochemistry, Per Specimen; Ea Adtl Single Antibody Stain Proc (Path)Technical Component ",,88341,CPT,Facility,Both,,,TC,172,146.2,49.2952,172,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,49.2952,28.66,,percent of total billed charges,,
"Immunohistochemistry Or Immunocytochemistry, Per Specimen; Ea Adtl Single Antibody Stain Proc (Path)Technical Component ",,88341,CPT,Facility,Outpatient,,,TC,172,146.2,49.2952,172,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),84.28,49,,percent of total billed charges,,
"Immunohistochemistry Or Immunocytochemistry, Per Specimen; Ea Adtl Single Antibody Stain Proc (Path)Technical Component ",,88341,CPT,Facility,Inpatient,,,TC,172,146.2,49.2952,172,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Immunohistochemistry Or Immunocytochemistry, Per Specimen; Ea Adtl Single Antibody Stain Proc (Path)Technical Component ",,88341,CPT,Facility,Both,,,TC,172,146.2,49.2952,172,CorVel,Worker's Compensation,172,100,,percent of total billed charges,,
"Immunohistochemistry Or Immunocytochemistry, Per Specimen; Ea Adtl Single Antibody Stain Proc (Path)Technical Component ",,88341,CPT,Facility,Both,,,TC,172,146.2,49.2952,172,First Health Group Corporation,First Health Network,166.84,97,,percent of total billed charges,,
"Immunohistochemistry Or Immunocytochemistry, Per Specimen; Ea Adtl Single Antibody Stain Proc (Path)Technical Component ",,88341,CPT,Facility,Both,,,TC,172,146.2,49.2952,172,"Health Partners, Inc.",Commercial,162.712,94.6,,percent of total billed charges,,
"Immunohistochemistry Or Immunocytochemistry, Per Specimen; Ea Adtl Single Antibody Stain Proc (Path)Technical Component ",,88341,CPT,Facility,Outpatient,,,TC,172,146.2,49.2952,172,"Health Partners, Inc.",Medicare Advantage,84.28,49,,percent of total billed charges,,
"Immunohistochemistry Or Immunocytochemistry, Per Specimen; Ea Adtl Single Antibody Stain Proc (Path)Technical Component ",,88341,CPT,Facility,Inpatient,,,TC,172,146.2,49.2952,172,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Immunohistochemistry Or Immunocytochemistry, Per Specimen; Ea Adtl Single Antibody Stain Proc (Path)Technical Component ",,88341,CPT,Facility,Both,,,TC,172,146.2,49.2952,172,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),103.2,60,,percent of total billed charges,,
"Immunohistochemistry Or Immunocytochemistry, Per Specimen; Ea Adtl Single Antibody Stain Proc (Path)Technical Component ",,88341,CPT,Facility,Both,,,TC,172,146.2,49.2952,172,"Health Partners, Inc.",State of Minnesota Advantage Program,140.18,81.5,,percent of total billed charges,,
"Immunohistochemistry Or Immunocytochemistry, Per Specimen; Ea Adtl Single Antibody Stain Proc (Path)Technical Component ",,88341,CPT,Facility,Both,,,TC,172,146.2,49.2952,172,"Health Partners, Inc.",State Public Programs,86,50,,percent of total billed charges,,
"Immunohistochemistry Or Immunocytochemistry, Per Specimen; Ea Adtl Single Antibody Stain Proc (Path)Technical Component ",,88341,CPT,Facility,Both,,,TC,172,146.2,49.2952,172,Humana Insurance Company,Commercial PPO,163.4,95,,percent of total billed charges,,
"Immunohistochemistry Or Immunocytochemistry, Per Specimen; Ea Adtl Single Antibody Stain Proc (Path)Technical Component ",,88341,CPT,Facility,Outpatient,,,TC,172,146.2,49.2952,172,Humana Insurance Company,Medicare PPO,84.28,49,,percent of total billed charges,,
"Immunohistochemistry Or Immunocytochemistry, Per Specimen; Ea Adtl Single Antibody Stain Proc (Path)Technical Component ",,88341,CPT,Facility,Inpatient,,,TC,172,146.2,49.2952,172,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Immunohistochemistry Or Immunocytochemistry, Per Specimen; Ea Adtl Single Antibody Stain Proc (Path)Technical Component ",,88341,CPT,Facility,Both,,,TC,172,146.2,49.2952,172,Medica,Individual & Family,170.452,99.1,,percent of total billed charges,,
"Immunohistochemistry Or Immunocytochemistry, Per Specimen; Ea Adtl Single Antibody Stain Proc (Path)Technical Component ",,88341,CPT,Facility,Outpatient,,,TC,172,146.2,49.2952,172,Medica,Medica Advantage Solution,85.656,49.8,,percent of total billed charges,,
"Immunohistochemistry Or Immunocytochemistry, Per Specimen; Ea Adtl Single Antibody Stain Proc (Path)Technical Component ",,88341,CPT,Facility,Inpatient,,,TC,172,146.2,49.2952,172,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Immunohistochemistry Or Immunocytochemistry, Per Specimen; Ea Adtl Single Antibody Stain Proc (Path)Technical Component ",,88341,CPT,Facility,Outpatient,,,TC,172,146.2,49.2952,172,Medica,Medical Assistance,76.712,44.6,,percent of total billed charges,,
"Immunohistochemistry Or Immunocytochemistry, Per Specimen; Ea Adtl Single Antibody Stain Proc (Path)Technical Component ",,88341,CPT,Facility,Inpatient,,,TC,172,146.2,49.2952,172,Medica,Medical Assistance,,,,,Included in per diem rate,
"Immunohistochemistry Or Immunocytochemistry, Per Specimen; Ea Adtl Single Antibody Stain Proc (Path)Technical Component ",,88341,CPT,Facility,Outpatient,,,TC,172,146.2,49.2952,172,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,85.656,49.8,,percent of total billed charges,,
"Immunohistochemistry Or Immunocytochemistry, Per Specimen; Ea Adtl Single Antibody Stain Proc (Path)Technical Component ",,88341,CPT,Facility,Inpatient,,,TC,172,146.2,49.2952,172,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Immunohistochemistry Or Immunocytochemistry, Per Specimen; Ea Adtl Single Antibody Stain Proc (Path)Technical Component ",,88341,CPT,Facility,Both,,,TC,172,146.2,49.2952,172,"Multiplan, Inc.","Multiplan, Inc.",161.68,94,,percent of total billed charges,,
"Immunohistochemistry Or Immunocytochemistry, Per Specimen; Ea Adtl Single Antibody Stain Proc (Path)Technical Component ",,88341,CPT,Facility,Outpatient,,,TC,172,146.2,49.2952,172,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,154.972,90.1,,percent of total billed charges,,
"Immunohistochemistry Or Immunocytochemistry, Per Specimen; Ea Adtl Single Antibody Stain Proc (Path)Technical Component ",,88341,CPT,Facility,Inpatient,,,TC,172,146.2,49.2952,172,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Immunohistochemistry Or Immunocytochemistry, Per Specimen; Ea Adtl Single Antibody Stain Proc (Path)Technical Component ",,88341,CPT,Facility,Both,,,TC,172,146.2,49.2952,172,"Preferred One Administrative Services, INC.",PPO,169.592,98.6,,percent of total billed charges,,
"Immunohistochemistry Or Immunocytochemistry, Per Specimen; Ea Adtl Single Antibody Stain Proc (Path)Technical Component ",,88341,CPT,Facility,Outpatient,,,TC,172,146.2,49.2952,172,PrimeWest Health,Minnesota Senior Health Options (MSHO),88.494,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Immunohistochemistry Or Immunocytochemistry, Per Specimen; Ea Adtl Single Antibody Stain Proc (Path)Technical Component ",,88341,CPT,Facility,Inpatient,,,TC,172,146.2,49.2952,172,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Immunohistochemistry Or Immunocytochemistry, Per Specimen; Ea Adtl Single Antibody Stain Proc (Path)Technical Component ",,88341,CPT,Facility,Outpatient,,,TC,172,146.2,49.2952,172,PrimeWest Health,MinnesotaCare,88.3392,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Immunohistochemistry Or Immunocytochemistry, Per Specimen; Ea Adtl Single Antibody Stain Proc (Path)Technical Component ",,88341,CPT,Facility,Inpatient,,,TC,172,146.2,49.2952,172,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Immunohistochemistry Or Immunocytochemistry, Per Specimen; Ea Adtl Single Antibody Stain Proc (Path)Technical Component ",,88341,CPT,Facility,Both,,,TC,172,146.2,49.2952,172,Sanford Health Plan,Sanford Health Plan,158.24,92,,percent of total billed charges,,
"Immunohistochemistry Or Immunocytochemistry, Per Specimen; Ea Adtl Single Antibody Stain Proc (Path)Technical Component ",,88341,CPT,Facility,Outpatient,,,TC,172,146.2,49.2952,172,"UCare Health, Inc.",Individual & Family Plan,96.922,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Immunohistochemistry Or Immunocytochemistry, Per Specimen; Ea Adtl Single Antibody Stain Proc (Path)Technical Component ",,88341,CPT,Facility,Inpatient,,,TC,172,146.2,49.2952,172,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Immunohistochemistry Or Immunocytochemistry, Per Specimen; Ea Adtl Single Antibody Stain Proc (Path)Technical Component ",,88341,CPT,Facility,Outpatient,,,TC,172,146.2,49.2952,172,"UCare Health, Inc.",Medical Assistance,86.8084,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Immunohistochemistry Or Immunocytochemistry, Per Specimen; Ea Adtl Single Antibody Stain Proc (Path)Technical Component ",,88341,CPT,Facility,Inpatient,,,TC,172,146.2,49.2952,172,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Immunohistochemistry Or Immunocytochemistry, Per Specimen; Ea Adtl Single Antibody Stain Proc (Path)Technical Component ",,88341,CPT,Facility,Outpatient,,,TC,172,146.2,49.2952,172,"UCare Health, Inc.",Medicare Advantage,86.8084,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Immunohistochemistry Or Immunocytochemistry, Per Specimen; Ea Adtl Single Antibody Stain Proc (Path)Technical Component ",,88341,CPT,Facility,Inpatient,,,TC,172,146.2,49.2952,172,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Immunohistochemistry Or Immunocytochemistry, Per Specimen; Ea Adtl Single Antibody Stain Proc (Path)Technical Component ",,88341,CPT,Facility,Outpatient,,,TC,172,146.2,49.2952,172,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),86.8084,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Immunohistochemistry Or Immunocytochemistry, Per Specimen; Ea Adtl Single Antibody Stain Proc (Path)Technical Component ",,88341,CPT,Facility,Inpatient,,,TC,172,146.2,49.2952,172,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Immunohistochemistry Or Immunocytochemistry, Per Specimen; Ea Adtl Single Antibody Stain Proc (Path)Technical Component ",,88341,CPT,Facility,Both,,,TC,172,146.2,49.2952,172,UnitedHealthcare,Individual & Family,161.68,94,,percent of total billed charges,,
"Immunohistochemistry Or Immunocytochemistry, Per Specimen; Ea Adtl Single Antibody Stain Proc (Path)Technical Component ",,88341,CPT,Facility,Outpatient,,,TC,172,146.2,49.2952,172,UnitedHealthcare,Medicare Advantage,84.28,49,,percent of total billed charges,,
"Immunohistochemistry Or Immunocytochemistry, Per Specimen; Ea Adtl Single Antibody Stain Proc (Path)Technical Component ",,88341,CPT,Facility,Inpatient,,,TC,172,146.2,49.2952,172,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Immunohistochemistry Or Immunocytochemistry, Per Specimen; Ea Adtl Single Antibody Stain Proc (Path)Technical Component ",,88341,CPT,Facility,Outpatient,,,TC,172,146.2,49.2952,172,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,82.56,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Immunohistochemistry Or Immunocytochemistry, Per Specimen; Ea Adtl Single Antibody Stain Proc (Path)Technical Component ",,88341,CPT,Facility,Inpatient,,,TC,172,146.2,49.2952,172,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Immunohistochemistry Or Immunocytochemistry, Per Specimen; Initial Single Antibody Stain Proc (Path)Technical Component ",,88342,CPT,Facility,Both,,,TC,172,146.2,49.2952,172,Aetna,Commercial,158.24,92,,percent of total billed charges,,
"Immunohistochemistry Or Immunocytochemistry, Per Specimen; Initial Single Antibody Stain Proc (Path)Technical Component ",,88342,CPT,Facility,Outpatient,,,TC,172,146.2,49.2952,172,Aetna,Medicare Advantage,84.28,49,,percent of total billed charges,,
"Immunohistochemistry Or Immunocytochemistry, Per Specimen; Initial Single Antibody Stain Proc (Path)Technical Component ",,88342,CPT,Facility,Inpatient,,,TC,172,146.2,49.2952,172,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Immunohistochemistry Or Immunocytochemistry, Per Specimen; Initial Single Antibody Stain Proc (Path)Technical Component ",,88342,CPT,Facility,Both,,,TC,172,146.2,49.2952,172,Aetna,PPO,159.96,93,,percent of total billed charges,,
"Immunohistochemistry Or Immunocytochemistry, Per Specimen; Initial Single Antibody Stain Proc (Path)Technical Component ",,88342,CPT,Facility,Both,,,TC,172,146.2,49.2952,172,America's PPO,America's PPO,165.1716,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Immunohistochemistry Or Immunocytochemistry, Per Specimen; Initial Single Antibody Stain Proc (Path)Technical Component ",,88342,CPT,Facility,Both,,,TC,172,146.2,49.2952,172,BlueCross BlueShield Minnesota, Federal Employee Program,169.248,98.4,,percent of total billed charges,,
"Immunohistochemistry Or Immunocytochemistry, Per Specimen; Initial Single Antibody Stain Proc (Path)Technical Component ",,88342,CPT,Facility,Both,,,TC,172,146.2,49.2952,172,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,172,100,,percent of total billed charges,,
"Immunohistochemistry Or Immunocytochemistry, Per Specimen; Initial Single Antibody Stain Proc (Path)Technical Component ",,88342,CPT,Facility,Both,,,TC,172,146.2,49.2952,172,BlueCross BlueShield Minnesota,High Value Network Plan,154.8,90,,percent of total billed charges,,
"Immunohistochemistry Or Immunocytochemistry, Per Specimen; Initial Single Antibody Stain Proc (Path)Technical Component ",,88342,CPT,Facility,Outpatient,,,TC,172,146.2,49.2952,172,BlueCross BlueShield Minnesota,Medicare Advantage,84.28,49,,percent of total billed charges,,
"Immunohistochemistry Or Immunocytochemistry, Per Specimen; Initial Single Antibody Stain Proc (Path)Technical Component ",,88342,CPT,Facility,Inpatient,,,TC,172,146.2,49.2952,172,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Immunohistochemistry Or Immunocytochemistry, Per Specimen; Initial Single Antibody Stain Proc (Path)Technical Component ",,88342,CPT,Facility,Both,,,TC,172,146.2,49.2952,172,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,152.3404,88.57,,percent of total billed charges,,
"Immunohistochemistry Or Immunocytochemistry, Per Specimen; Initial Single Antibody Stain Proc (Path)Technical Component ",,88342,CPT,Facility,Both,,,TC,172,146.2,49.2952,172,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,49.2952,28.66,,percent of total billed charges,,
"Immunohistochemistry Or Immunocytochemistry, Per Specimen; Initial Single Antibody Stain Proc (Path)Technical Component ",,88342,CPT,Facility,Outpatient,,,TC,172,146.2,49.2952,172,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),84.28,49,,percent of total billed charges,,
"Immunohistochemistry Or Immunocytochemistry, Per Specimen; Initial Single Antibody Stain Proc (Path)Technical Component ",,88342,CPT,Facility,Inpatient,,,TC,172,146.2,49.2952,172,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Immunohistochemistry Or Immunocytochemistry, Per Specimen; Initial Single Antibody Stain Proc (Path)Technical Component ",,88342,CPT,Facility,Both,,,TC,172,146.2,49.2952,172,CorVel,Worker's Compensation,172,100,,percent of total billed charges,,
"Immunohistochemistry Or Immunocytochemistry, Per Specimen; Initial Single Antibody Stain Proc (Path)Technical Component ",,88342,CPT,Facility,Both,,,TC,172,146.2,49.2952,172,First Health Group Corporation,First Health Network,166.84,97,,percent of total billed charges,,
"Immunohistochemistry Or Immunocytochemistry, Per Specimen; Initial Single Antibody Stain Proc (Path)Technical Component ",,88342,CPT,Facility,Both,,,TC,172,146.2,49.2952,172,"Health Partners, Inc.",Commercial,162.712,94.6,,percent of total billed charges,,
"Immunohistochemistry Or Immunocytochemistry, Per Specimen; Initial Single Antibody Stain Proc (Path)Technical Component ",,88342,CPT,Facility,Outpatient,,,TC,172,146.2,49.2952,172,"Health Partners, Inc.",Medicare Advantage,84.28,49,,percent of total billed charges,,
"Immunohistochemistry Or Immunocytochemistry, Per Specimen; Initial Single Antibody Stain Proc (Path)Technical Component ",,88342,CPT,Facility,Inpatient,,,TC,172,146.2,49.2952,172,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Immunohistochemistry Or Immunocytochemistry, Per Specimen; Initial Single Antibody Stain Proc (Path)Technical Component ",,88342,CPT,Facility,Both,,,TC,172,146.2,49.2952,172,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),103.2,60,,percent of total billed charges,,
"Immunohistochemistry Or Immunocytochemistry, Per Specimen; Initial Single Antibody Stain Proc (Path)Technical Component ",,88342,CPT,Facility,Both,,,TC,172,146.2,49.2952,172,"Health Partners, Inc.",State of Minnesota Advantage Program,140.18,81.5,,percent of total billed charges,,
"Immunohistochemistry Or Immunocytochemistry, Per Specimen; Initial Single Antibody Stain Proc (Path)Technical Component ",,88342,CPT,Facility,Both,,,TC,172,146.2,49.2952,172,"Health Partners, Inc.",State Public Programs,86,50,,percent of total billed charges,,
"Immunohistochemistry Or Immunocytochemistry, Per Specimen; Initial Single Antibody Stain Proc (Path)Technical Component ",,88342,CPT,Facility,Both,,,TC,172,146.2,49.2952,172,Humana Insurance Company,Commercial PPO,163.4,95,,percent of total billed charges,,
"Immunohistochemistry Or Immunocytochemistry, Per Specimen; Initial Single Antibody Stain Proc (Path)Technical Component ",,88342,CPT,Facility,Outpatient,,,TC,172,146.2,49.2952,172,Humana Insurance Company,Medicare PPO,84.28,49,,percent of total billed charges,,
"Immunohistochemistry Or Immunocytochemistry, Per Specimen; Initial Single Antibody Stain Proc (Path)Technical Component ",,88342,CPT,Facility,Inpatient,,,TC,172,146.2,49.2952,172,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Immunohistochemistry Or Immunocytochemistry, Per Specimen; Initial Single Antibody Stain Proc (Path)Technical Component ",,88342,CPT,Facility,Both,,,TC,172,146.2,49.2952,172,Medica,Individual & Family,170.452,99.1,,percent of total billed charges,,
"Immunohistochemistry Or Immunocytochemistry, Per Specimen; Initial Single Antibody Stain Proc (Path)Technical Component ",,88342,CPT,Facility,Outpatient,,,TC,172,146.2,49.2952,172,Medica,Medica Advantage Solution,85.656,49.8,,percent of total billed charges,,
"Immunohistochemistry Or Immunocytochemistry, Per Specimen; Initial Single Antibody Stain Proc (Path)Technical Component ",,88342,CPT,Facility,Inpatient,,,TC,172,146.2,49.2952,172,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Immunohistochemistry Or Immunocytochemistry, Per Specimen; Initial Single Antibody Stain Proc (Path)Technical Component ",,88342,CPT,Facility,Outpatient,,,TC,172,146.2,49.2952,172,Medica,Medical Assistance,76.712,44.6,,percent of total billed charges,,
"Immunohistochemistry Or Immunocytochemistry, Per Specimen; Initial Single Antibody Stain Proc (Path)Technical Component ",,88342,CPT,Facility,Inpatient,,,TC,172,146.2,49.2952,172,Medica,Medical Assistance,,,,,Included in per diem rate,
"Immunohistochemistry Or Immunocytochemistry, Per Specimen; Initial Single Antibody Stain Proc (Path)Technical Component ",,88342,CPT,Facility,Outpatient,,,TC,172,146.2,49.2952,172,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,85.656,49.8,,percent of total billed charges,,
"Immunohistochemistry Or Immunocytochemistry, Per Specimen; Initial Single Antibody Stain Proc (Path)Technical Component ",,88342,CPT,Facility,Inpatient,,,TC,172,146.2,49.2952,172,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Immunohistochemistry Or Immunocytochemistry, Per Specimen; Initial Single Antibody Stain Proc (Path)Technical Component ",,88342,CPT,Facility,Both,,,TC,172,146.2,49.2952,172,"Multiplan, Inc.","Multiplan, Inc.",161.68,94,,percent of total billed charges,,
"Immunohistochemistry Or Immunocytochemistry, Per Specimen; Initial Single Antibody Stain Proc (Path)Technical Component ",,88342,CPT,Facility,Outpatient,,,TC,172,146.2,49.2952,172,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,154.972,90.1,,percent of total billed charges,,
"Immunohistochemistry Or Immunocytochemistry, Per Specimen; Initial Single Antibody Stain Proc (Path)Technical Component ",,88342,CPT,Facility,Inpatient,,,TC,172,146.2,49.2952,172,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Immunohistochemistry Or Immunocytochemistry, Per Specimen; Initial Single Antibody Stain Proc (Path)Technical Component ",,88342,CPT,Facility,Both,,,TC,172,146.2,49.2952,172,"Preferred One Administrative Services, INC.",PPO,169.592,98.6,,percent of total billed charges,,
"Immunohistochemistry Or Immunocytochemistry, Per Specimen; Initial Single Antibody Stain Proc (Path)Technical Component ",,88342,CPT,Facility,Outpatient,,,TC,172,146.2,49.2952,172,PrimeWest Health,Minnesota Senior Health Options (MSHO),88.494,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Immunohistochemistry Or Immunocytochemistry, Per Specimen; Initial Single Antibody Stain Proc (Path)Technical Component ",,88342,CPT,Facility,Inpatient,,,TC,172,146.2,49.2952,172,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Immunohistochemistry Or Immunocytochemistry, Per Specimen; Initial Single Antibody Stain Proc (Path)Technical Component ",,88342,CPT,Facility,Outpatient,,,TC,172,146.2,49.2952,172,PrimeWest Health,MinnesotaCare,88.3392,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Immunohistochemistry Or Immunocytochemistry, Per Specimen; Initial Single Antibody Stain Proc (Path)Technical Component ",,88342,CPT,Facility,Inpatient,,,TC,172,146.2,49.2952,172,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Immunohistochemistry Or Immunocytochemistry, Per Specimen; Initial Single Antibody Stain Proc (Path)Technical Component ",,88342,CPT,Facility,Both,,,TC,172,146.2,49.2952,172,Sanford Health Plan,Sanford Health Plan,158.24,92,,percent of total billed charges,,
"Immunohistochemistry Or Immunocytochemistry, Per Specimen; Initial Single Antibody Stain Proc (Path)Technical Component ",,88342,CPT,Facility,Outpatient,,,TC,172,146.2,49.2952,172,"UCare Health, Inc.",Individual & Family Plan,96.922,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Immunohistochemistry Or Immunocytochemistry, Per Specimen; Initial Single Antibody Stain Proc (Path)Technical Component ",,88342,CPT,Facility,Inpatient,,,TC,172,146.2,49.2952,172,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Immunohistochemistry Or Immunocytochemistry, Per Specimen; Initial Single Antibody Stain Proc (Path)Technical Component ",,88342,CPT,Facility,Outpatient,,,TC,172,146.2,49.2952,172,"UCare Health, Inc.",Medical Assistance,86.8084,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Immunohistochemistry Or Immunocytochemistry, Per Specimen; Initial Single Antibody Stain Proc (Path)Technical Component ",,88342,CPT,Facility,Inpatient,,,TC,172,146.2,49.2952,172,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Immunohistochemistry Or Immunocytochemistry, Per Specimen; Initial Single Antibody Stain Proc (Path)Technical Component ",,88342,CPT,Facility,Outpatient,,,TC,172,146.2,49.2952,172,"UCare Health, Inc.",Medicare Advantage,86.8084,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Immunohistochemistry Or Immunocytochemistry, Per Specimen; Initial Single Antibody Stain Proc (Path)Technical Component ",,88342,CPT,Facility,Inpatient,,,TC,172,146.2,49.2952,172,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Immunohistochemistry Or Immunocytochemistry, Per Specimen; Initial Single Antibody Stain Proc (Path)Technical Component ",,88342,CPT,Facility,Outpatient,,,TC,172,146.2,49.2952,172,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),86.8084,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Immunohistochemistry Or Immunocytochemistry, Per Specimen; Initial Single Antibody Stain Proc (Path)Technical Component ",,88342,CPT,Facility,Inpatient,,,TC,172,146.2,49.2952,172,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Immunohistochemistry Or Immunocytochemistry, Per Specimen; Initial Single Antibody Stain Proc (Path)Technical Component ",,88342,CPT,Facility,Both,,,TC,172,146.2,49.2952,172,UnitedHealthcare,Individual & Family,161.68,94,,percent of total billed charges,,
"Immunohistochemistry Or Immunocytochemistry, Per Specimen; Initial Single Antibody Stain Proc (Path)Technical Component ",,88342,CPT,Facility,Outpatient,,,TC,172,146.2,49.2952,172,UnitedHealthcare,Medicare Advantage,84.28,49,,percent of total billed charges,,
"Immunohistochemistry Or Immunocytochemistry, Per Specimen; Initial Single Antibody Stain Proc (Path)Technical Component ",,88342,CPT,Facility,Inpatient,,,TC,172,146.2,49.2952,172,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Immunohistochemistry Or Immunocytochemistry, Per Specimen; Initial Single Antibody Stain Proc (Path)Technical Component ",,88342,CPT,Facility,Outpatient,,,TC,172,146.2,49.2952,172,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,82.56,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Immunohistochemistry Or Immunocytochemistry, Per Specimen; Initial Single Antibody Stain Proc (Path)Technical Component ",,88342,CPT,Facility,Inpatient,,,TC,172,146.2,49.2952,172,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
AFLIBERCEPT 2 MG/0.05 ML INTRAVITREAL SOLN,,J0178,HCPCS,Facility,Both,0.05,mL,,6660,5661,1908.756,6660,Aetna,Commercial,6127.2,92,,percent of total billed charges,,
AFLIBERCEPT 2 MG/0.05 ML INTRAVITREAL SOLN,,J0178,HCPCS,Facility,Outpatient,0.05,mL,,6660,5661,1908.756,6660,Aetna,Medicare Advantage,3263.4,49,,percent of total billed charges,,
AFLIBERCEPT 2 MG/0.05 ML INTRAVITREAL SOLN,,J0178,HCPCS,Facility,Inpatient,0.05,mL,,6660,5661,1908.756,6660,Aetna,Medicare Advantage,,,,,Included in per diem rate,
AFLIBERCEPT 2 MG/0.05 ML INTRAVITREAL SOLN,,J0178,HCPCS,Facility,Both,0.05,mL,,6660,5661,1908.756,6660,Aetna,PPO,6193.8,93,,percent of total billed charges,,
AFLIBERCEPT 2 MG/0.05 ML INTRAVITREAL SOLN,,J0178,HCPCS,Facility,Both,0.05,mL,,6660,5661,1908.756,6660,America's PPO,America's PPO,6395.598,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
AFLIBERCEPT 2 MG/0.05 ML INTRAVITREAL SOLN,,J0178,HCPCS,Facility,Both,0.05,mL,,6660,5661,1908.756,6660,BlueCross BlueShield Minnesota, Federal Employee Program,6553.44,98.4,,percent of total billed charges,,
AFLIBERCEPT 2 MG/0.05 ML INTRAVITREAL SOLN,,J0178,HCPCS,Facility,Both,0.05,mL,,6660,5661,1908.756,6660,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,6660,100,,percent of total billed charges,,
AFLIBERCEPT 2 MG/0.05 ML INTRAVITREAL SOLN,,J0178,HCPCS,Facility,Both,0.05,mL,,6660,5661,1908.756,6660,BlueCross BlueShield Minnesota,High Value Network Plan,5994,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
AFLIBERCEPT 2 MG/0.05 ML INTRAVITREAL SOLN,,J0178,HCPCS,Facility,Outpatient,0.05,mL,,6660,5661,1908.756,6660,BlueCross BlueShield Minnesota,Medicare Advantage,3263.4,49,,percent of total billed charges,,
AFLIBERCEPT 2 MG/0.05 ML INTRAVITREAL SOLN,,J0178,HCPCS,Facility,Inpatient,0.05,mL,,6660,5661,1908.756,6660,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
AFLIBERCEPT 2 MG/0.05 ML INTRAVITREAL SOLN,,J0178,HCPCS,Facility,Both,0.05,mL,,6660,5661,1908.756,6660,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,5898.762,88.57,,percent of total billed charges,,
AFLIBERCEPT 2 MG/0.05 ML INTRAVITREAL SOLN,,J0178,HCPCS,Facility,Both,0.05,mL,,6660,5661,1908.756,6660,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1908.756,28.66,,percent of total billed charges,,
AFLIBERCEPT 2 MG/0.05 ML INTRAVITREAL SOLN,,J0178,HCPCS,Facility,Outpatient,0.05,mL,,6660,5661,1908.756,6660,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),3263.4,49,,percent of total billed charges,,
AFLIBERCEPT 2 MG/0.05 ML INTRAVITREAL SOLN,,J0178,HCPCS,Facility,Inpatient,0.05,mL,,6660,5661,1908.756,6660,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
AFLIBERCEPT 2 MG/0.05 ML INTRAVITREAL SOLN,,J0178,HCPCS,Facility,Both,0.05,mL,,6660,5661,1908.756,6660,CorVel,Worker's Compensation,6660,100,,percent of total billed charges,,
AFLIBERCEPT 2 MG/0.05 ML INTRAVITREAL SOLN,,J0178,HCPCS,Facility,Both,0.05,mL,,6660,5661,1908.756,6660,First Health Group Corporation,First Health Network,6460.2,97,,percent of total billed charges,,
AFLIBERCEPT 2 MG/0.05 ML INTRAVITREAL SOLN,,J0178,HCPCS,Facility,Both,0.05,mL,,6660,5661,1908.756,6660,"Health Partners, Inc.",Commercial,6300.36,94.6,,percent of total billed charges,,
AFLIBERCEPT 2 MG/0.05 ML INTRAVITREAL SOLN,,J0178,HCPCS,Facility,Outpatient,0.05,mL,,6660,5661,1908.756,6660,"Health Partners, Inc.",Medicare Advantage,3263.4,49,,percent of total billed charges,,
AFLIBERCEPT 2 MG/0.05 ML INTRAVITREAL SOLN,,J0178,HCPCS,Facility,Inpatient,0.05,mL,,6660,5661,1908.756,6660,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
AFLIBERCEPT 2 MG/0.05 ML INTRAVITREAL SOLN,,J0178,HCPCS,Facility,Both,0.05,mL,,6660,5661,1908.756,6660,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3996,60,,percent of total billed charges,,
AFLIBERCEPT 2 MG/0.05 ML INTRAVITREAL SOLN,,J0178,HCPCS,Facility,Both,0.05,mL,,6660,5661,1908.756,6660,"Health Partners, Inc.",State of Minnesota Advantage Program,5427.9,81.5,,percent of total billed charges,,
AFLIBERCEPT 2 MG/0.05 ML INTRAVITREAL SOLN,,J0178,HCPCS,Facility,Both,0.05,mL,,6660,5661,1908.756,6660,"Health Partners, Inc.",State Public Programs,3330,50,,percent of total billed charges,,
AFLIBERCEPT 2 MG/0.05 ML INTRAVITREAL SOLN,,J0178,HCPCS,Facility,Both,0.05,mL,,6660,5661,1908.756,6660,Humana Insurance Company,Commercial PPO,6327,95,,percent of total billed charges,,
AFLIBERCEPT 2 MG/0.05 ML INTRAVITREAL SOLN,,J0178,HCPCS,Facility,Outpatient,0.05,mL,,6660,5661,1908.756,6660,Humana Insurance Company,Medicare PPO,3263.4,49,,percent of total billed charges,,
AFLIBERCEPT 2 MG/0.05 ML INTRAVITREAL SOLN,,J0178,HCPCS,Facility,Inpatient,0.05,mL,,6660,5661,1908.756,6660,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
AFLIBERCEPT 2 MG/0.05 ML INTRAVITREAL SOLN,,J0178,HCPCS,Facility,Both,0.05,mL,,6660,5661,1908.756,6660,Medica,Individual & Family,6600.06,99.1,,percent of total billed charges,,
AFLIBERCEPT 2 MG/0.05 ML INTRAVITREAL SOLN,,J0178,HCPCS,Facility,Outpatient,0.05,mL,,6660,5661,1908.756,6660,Medica,Medica Advantage Solution,3316.68,49.8,,percent of total billed charges,,
AFLIBERCEPT 2 MG/0.05 ML INTRAVITREAL SOLN,,J0178,HCPCS,Facility,Inpatient,0.05,mL,,6660,5661,1908.756,6660,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
AFLIBERCEPT 2 MG/0.05 ML INTRAVITREAL SOLN,,J0178,HCPCS,Facility,Outpatient,0.05,mL,,6660,5661,1908.756,6660,Medica,Medical Assistance,2970.36,44.6,,percent of total billed charges,,
AFLIBERCEPT 2 MG/0.05 ML INTRAVITREAL SOLN,,J0178,HCPCS,Facility,Inpatient,0.05,mL,,6660,5661,1908.756,6660,Medica,Medical Assistance,,,,,Included in per diem rate,
AFLIBERCEPT 2 MG/0.05 ML INTRAVITREAL SOLN,,J0178,HCPCS,Facility,Outpatient,0.05,mL,,6660,5661,1908.756,6660,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,3316.68,49.8,,percent of total billed charges,,
AFLIBERCEPT 2 MG/0.05 ML INTRAVITREAL SOLN,,J0178,HCPCS,Facility,Inpatient,0.05,mL,,6660,5661,1908.756,6660,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
AFLIBERCEPT 2 MG/0.05 ML INTRAVITREAL SOLN,,J0178,HCPCS,Facility,Both,0.05,mL,,6660,5661,1908.756,6660,"Multiplan, Inc.","Multiplan, Inc.",6260.4,94,,percent of total billed charges,,
AFLIBERCEPT 2 MG/0.05 ML INTRAVITREAL SOLN,,J0178,HCPCS,Facility,Outpatient,0.05,mL,,6660,5661,1908.756,6660,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,6000.66,90.1,,percent of total billed charges,,
AFLIBERCEPT 2 MG/0.05 ML INTRAVITREAL SOLN,,J0178,HCPCS,Facility,Inpatient,0.05,mL,,6660,5661,1908.756,6660,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
AFLIBERCEPT 2 MG/0.05 ML INTRAVITREAL SOLN,,J0178,HCPCS,Facility,Both,0.05,mL,,6660,5661,1908.756,6660,"Preferred One Administrative Services, INC.",PPO,6566.76,98.6,,percent of total billed charges,,
AFLIBERCEPT 2 MG/0.05 ML INTRAVITREAL SOLN,,J0178,HCPCS,Facility,Outpatient,0.05,mL,,6660,5661,1908.756,6660,PrimeWest Health,Minnesota Senior Health Options (MSHO),3426.57,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
AFLIBERCEPT 2 MG/0.05 ML INTRAVITREAL SOLN,,J0178,HCPCS,Facility,Inpatient,0.05,mL,,6660,5661,1908.756,6660,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
AFLIBERCEPT 2 MG/0.05 ML INTRAVITREAL SOLN,,J0178,HCPCS,Facility,Outpatient,0.05,mL,,6660,5661,1908.756,6660,PrimeWest Health,MinnesotaCare,3420.576,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
AFLIBERCEPT 2 MG/0.05 ML INTRAVITREAL SOLN,,J0178,HCPCS,Facility,Inpatient,0.05,mL,,6660,5661,1908.756,6660,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
AFLIBERCEPT 2 MG/0.05 ML INTRAVITREAL SOLN,,J0178,HCPCS,Facility,Both,0.05,mL,,6660,5661,1908.756,6660,Sanford Health Plan,Sanford Health Plan,6127.2,92,,percent of total billed charges,,
AFLIBERCEPT 2 MG/0.05 ML INTRAVITREAL SOLN,,J0178,HCPCS,Facility,Outpatient,0.05,mL,,6660,5661,1908.756,6660,"UCare Health, Inc.",Individual & Family Plan,3752.91,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
AFLIBERCEPT 2 MG/0.05 ML INTRAVITREAL SOLN,,J0178,HCPCS,Facility,Inpatient,0.05,mL,,6660,5661,1908.756,6660,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
AFLIBERCEPT 2 MG/0.05 ML INTRAVITREAL SOLN,,J0178,HCPCS,Facility,Outpatient,0.05,mL,,6660,5661,1908.756,6660,"UCare Health, Inc.",Medical Assistance,3361.302,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
AFLIBERCEPT 2 MG/0.05 ML INTRAVITREAL SOLN,,J0178,HCPCS,Facility,Inpatient,0.05,mL,,6660,5661,1908.756,6660,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
AFLIBERCEPT 2 MG/0.05 ML INTRAVITREAL SOLN,,J0178,HCPCS,Facility,Outpatient,0.05,mL,,6660,5661,1908.756,6660,"UCare Health, Inc.",Medicare Advantage,3361.302,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
AFLIBERCEPT 2 MG/0.05 ML INTRAVITREAL SOLN,,J0178,HCPCS,Facility,Inpatient,0.05,mL,,6660,5661,1908.756,6660,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
AFLIBERCEPT 2 MG/0.05 ML INTRAVITREAL SOLN,,J0178,HCPCS,Facility,Outpatient,0.05,mL,,6660,5661,1908.756,6660,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),3361.302,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
AFLIBERCEPT 2 MG/0.05 ML INTRAVITREAL SOLN,,J0178,HCPCS,Facility,Inpatient,0.05,mL,,6660,5661,1908.756,6660,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
AFLIBERCEPT 2 MG/0.05 ML INTRAVITREAL SOLN,,J0178,HCPCS,Facility,Both,0.05,mL,,6660,5661,1908.756,6660,UnitedHealthcare,Individual & Family,6260.4,94,,percent of total billed charges,,
AFLIBERCEPT 2 MG/0.05 ML INTRAVITREAL SOLN,,J0178,HCPCS,Facility,Outpatient,0.05,mL,,6660,5661,1908.756,6660,UnitedHealthcare,Medicare Advantage,3263.4,49,,percent of total billed charges,,
AFLIBERCEPT 2 MG/0.05 ML INTRAVITREAL SOLN,,J0178,HCPCS,Facility,Inpatient,0.05,mL,,6660,5661,1908.756,6660,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
AFLIBERCEPT 2 MG/0.05 ML INTRAVITREAL SOLN,,J0178,HCPCS,Facility,Outpatient,0.05,mL,,6660,5661,1908.756,6660,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,3196.8,48,,percent of total billed charges,,100% of DHS outpatient percentage
AFLIBERCEPT 2 MG/0.05 ML INTRAVITREAL SOLN,,J0178,HCPCS,Facility,Inpatient,0.05,mL,,6660,5661,1908.756,6660,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
DEGENERATIVE NERVOUS SYSTEM DISORDERS WITHOUT MCC,,57,MS-DRG,Facility,Inpatient,,,,12623.4,10729.89,11992.23,12122.25102,America's PPO,America's PPO,12122.25102,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
DEGENERATIVE NERVOUS SYSTEM DISORDERS WITHOUT MCC,,57,MS-DRG,Facility,Inpatient,,,,12623.4,10729.89,11992.23,12122.25102,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,11992.23,,,Other ,DRG,"DRG weight 1.3015 x WOO $13,372.00; Cap at 95% of charge; minimum of 90.1% of charge"
RANIBIZUMAB 0.3 MG/0.05 ML INTRAVITREAL SYRG,,J2778,HCPCS,Facility,Both,0.05,mL,,4212,3580.2,1207.1592,4212,Aetna,Commercial,3875.04,92,,percent of total billed charges,,
RANIBIZUMAB 0.3 MG/0.05 ML INTRAVITREAL SYRG,,J2778,HCPCS,Facility,Outpatient,0.05,mL,,4212,3580.2,1207.1592,4212,Aetna,Medicare Advantage,2063.88,49,,percent of total billed charges,,
RANIBIZUMAB 0.3 MG/0.05 ML INTRAVITREAL SYRG,,J2778,HCPCS,Facility,Inpatient,0.05,mL,,4212,3580.2,1207.1592,4212,Aetna,Medicare Advantage,,,,,Included in per diem rate,
RANIBIZUMAB 0.3 MG/0.05 ML INTRAVITREAL SYRG,,J2778,HCPCS,Facility,Both,0.05,mL,,4212,3580.2,1207.1592,4212,Aetna,PPO,3917.16,93,,percent of total billed charges,,
RANIBIZUMAB 0.3 MG/0.05 ML INTRAVITREAL SYRG,,J2778,HCPCS,Facility,Both,0.05,mL,,4212,3580.2,1207.1592,4212,America's PPO,America's PPO,4044.7836,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
RANIBIZUMAB 0.3 MG/0.05 ML INTRAVITREAL SYRG,,J2778,HCPCS,Facility,Both,0.05,mL,,4212,3580.2,1207.1592,4212,BlueCross BlueShield Minnesota, Federal Employee Program,4144.608,98.4,,percent of total billed charges,,
RANIBIZUMAB 0.3 MG/0.05 ML INTRAVITREAL SYRG,,J2778,HCPCS,Facility,Both,0.05,mL,,4212,3580.2,1207.1592,4212,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,4212,100,,percent of total billed charges,,
RANIBIZUMAB 0.3 MG/0.05 ML INTRAVITREAL SYRG,,J2778,HCPCS,Facility,Both,0.05,mL,,4212,3580.2,1207.1592,4212,BlueCross BlueShield Minnesota,High Value Network Plan,3790.8,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
RANIBIZUMAB 0.3 MG/0.05 ML INTRAVITREAL SYRG,,J2778,HCPCS,Facility,Outpatient,0.05,mL,,4212,3580.2,1207.1592,4212,BlueCross BlueShield Minnesota,Medicare Advantage,2063.88,49,,percent of total billed charges,,
RANIBIZUMAB 0.3 MG/0.05 ML INTRAVITREAL SYRG,,J2778,HCPCS,Facility,Inpatient,0.05,mL,,4212,3580.2,1207.1592,4212,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
RANIBIZUMAB 0.3 MG/0.05 ML INTRAVITREAL SYRG,,J2778,HCPCS,Facility,Both,0.05,mL,,4212,3580.2,1207.1592,4212,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,3730.5684,88.57,,percent of total billed charges,,
RANIBIZUMAB 0.3 MG/0.05 ML INTRAVITREAL SYRG,,J2778,HCPCS,Facility,Both,0.05,mL,,4212,3580.2,1207.1592,4212,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1207.1592,28.66,,percent of total billed charges,,
RANIBIZUMAB 0.3 MG/0.05 ML INTRAVITREAL SYRG,,J2778,HCPCS,Facility,Outpatient,0.05,mL,,4212,3580.2,1207.1592,4212,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2063.88,49,,percent of total billed charges,,
RANIBIZUMAB 0.3 MG/0.05 ML INTRAVITREAL SYRG,,J2778,HCPCS,Facility,Inpatient,0.05,mL,,4212,3580.2,1207.1592,4212,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
RANIBIZUMAB 0.3 MG/0.05 ML INTRAVITREAL SYRG,,J2778,HCPCS,Facility,Both,0.05,mL,,4212,3580.2,1207.1592,4212,CorVel,Worker's Compensation,4212,100,,percent of total billed charges,,
RANIBIZUMAB 0.3 MG/0.05 ML INTRAVITREAL SYRG,,J2778,HCPCS,Facility,Both,0.05,mL,,4212,3580.2,1207.1592,4212,First Health Group Corporation,First Health Network,4085.64,97,,percent of total billed charges,,
RANIBIZUMAB 0.3 MG/0.05 ML INTRAVITREAL SYRG,,J2778,HCPCS,Facility,Both,0.05,mL,,4212,3580.2,1207.1592,4212,"Health Partners, Inc.",Commercial,3984.552,94.6,,percent of total billed charges,,
RANIBIZUMAB 0.3 MG/0.05 ML INTRAVITREAL SYRG,,J2778,HCPCS,Facility,Outpatient,0.05,mL,,4212,3580.2,1207.1592,4212,"Health Partners, Inc.",Medicare Advantage,2063.88,49,,percent of total billed charges,,
RANIBIZUMAB 0.3 MG/0.05 ML INTRAVITREAL SYRG,,J2778,HCPCS,Facility,Inpatient,0.05,mL,,4212,3580.2,1207.1592,4212,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
RANIBIZUMAB 0.3 MG/0.05 ML INTRAVITREAL SYRG,,J2778,HCPCS,Facility,Both,0.05,mL,,4212,3580.2,1207.1592,4212,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),2527.2,60,,percent of total billed charges,,
RANIBIZUMAB 0.3 MG/0.05 ML INTRAVITREAL SYRG,,J2778,HCPCS,Facility,Both,0.05,mL,,4212,3580.2,1207.1592,4212,"Health Partners, Inc.",State of Minnesota Advantage Program,3432.78,81.5,,percent of total billed charges,,
RANIBIZUMAB 0.3 MG/0.05 ML INTRAVITREAL SYRG,,J2778,HCPCS,Facility,Both,0.05,mL,,4212,3580.2,1207.1592,4212,"Health Partners, Inc.",State Public Programs,2106,50,,percent of total billed charges,,
RANIBIZUMAB 0.3 MG/0.05 ML INTRAVITREAL SYRG,,J2778,HCPCS,Facility,Both,0.05,mL,,4212,3580.2,1207.1592,4212,Humana Insurance Company,Commercial PPO,4001.4,95,,percent of total billed charges,,
RANIBIZUMAB 0.3 MG/0.05 ML INTRAVITREAL SYRG,,J2778,HCPCS,Facility,Outpatient,0.05,mL,,4212,3580.2,1207.1592,4212,Humana Insurance Company,Medicare PPO,2063.88,49,,percent of total billed charges,,
RANIBIZUMAB 0.3 MG/0.05 ML INTRAVITREAL SYRG,,J2778,HCPCS,Facility,Inpatient,0.05,mL,,4212,3580.2,1207.1592,4212,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
RANIBIZUMAB 0.3 MG/0.05 ML INTRAVITREAL SYRG,,J2778,HCPCS,Facility,Both,0.05,mL,,4212,3580.2,1207.1592,4212,Medica,Individual & Family,4174.092,99.1,,percent of total billed charges,,
RANIBIZUMAB 0.3 MG/0.05 ML INTRAVITREAL SYRG,,J2778,HCPCS,Facility,Outpatient,0.05,mL,,4212,3580.2,1207.1592,4212,Medica,Medica Advantage Solution,2097.576,49.8,,percent of total billed charges,,
RANIBIZUMAB 0.3 MG/0.05 ML INTRAVITREAL SYRG,,J2778,HCPCS,Facility,Inpatient,0.05,mL,,4212,3580.2,1207.1592,4212,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
RANIBIZUMAB 0.3 MG/0.05 ML INTRAVITREAL SYRG,,J2778,HCPCS,Facility,Outpatient,0.05,mL,,4212,3580.2,1207.1592,4212,Medica,Medical Assistance,1878.552,44.6,,percent of total billed charges,,
RANIBIZUMAB 0.3 MG/0.05 ML INTRAVITREAL SYRG,,J2778,HCPCS,Facility,Inpatient,0.05,mL,,4212,3580.2,1207.1592,4212,Medica,Medical Assistance,,,,,Included in per diem rate,
RANIBIZUMAB 0.3 MG/0.05 ML INTRAVITREAL SYRG,,J2778,HCPCS,Facility,Outpatient,0.05,mL,,4212,3580.2,1207.1592,4212,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2097.576,49.8,,percent of total billed charges,,
RANIBIZUMAB 0.3 MG/0.05 ML INTRAVITREAL SYRG,,J2778,HCPCS,Facility,Inpatient,0.05,mL,,4212,3580.2,1207.1592,4212,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
RANIBIZUMAB 0.3 MG/0.05 ML INTRAVITREAL SYRG,,J2778,HCPCS,Facility,Both,0.05,mL,,4212,3580.2,1207.1592,4212,"Multiplan, Inc.","Multiplan, Inc.",3959.28,94,,percent of total billed charges,,
RANIBIZUMAB 0.3 MG/0.05 ML INTRAVITREAL SYRG,,J2778,HCPCS,Facility,Outpatient,0.05,mL,,4212,3580.2,1207.1592,4212,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,3795.012,90.1,,percent of total billed charges,,
RANIBIZUMAB 0.3 MG/0.05 ML INTRAVITREAL SYRG,,J2778,HCPCS,Facility,Inpatient,0.05,mL,,4212,3580.2,1207.1592,4212,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
RANIBIZUMAB 0.3 MG/0.05 ML INTRAVITREAL SYRG,,J2778,HCPCS,Facility,Both,0.05,mL,,4212,3580.2,1207.1592,4212,"Preferred One Administrative Services, INC.",PPO,4153.032,98.6,,percent of total billed charges,,
RANIBIZUMAB 0.3 MG/0.05 ML INTRAVITREAL SYRG,,J2778,HCPCS,Facility,Outpatient,0.05,mL,,4212,3580.2,1207.1592,4212,PrimeWest Health,Minnesota Senior Health Options (MSHO),2167.074,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
RANIBIZUMAB 0.3 MG/0.05 ML INTRAVITREAL SYRG,,J2778,HCPCS,Facility,Inpatient,0.05,mL,,4212,3580.2,1207.1592,4212,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
RANIBIZUMAB 0.3 MG/0.05 ML INTRAVITREAL SYRG,,J2778,HCPCS,Facility,Outpatient,0.05,mL,,4212,3580.2,1207.1592,4212,PrimeWest Health,MinnesotaCare,2163.2832,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
RANIBIZUMAB 0.3 MG/0.05 ML INTRAVITREAL SYRG,,J2778,HCPCS,Facility,Inpatient,0.05,mL,,4212,3580.2,1207.1592,4212,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
RANIBIZUMAB 0.3 MG/0.05 ML INTRAVITREAL SYRG,,J2778,HCPCS,Facility,Both,0.05,mL,,4212,3580.2,1207.1592,4212,Sanford Health Plan,Sanford Health Plan,3875.04,92,,percent of total billed charges,,
RANIBIZUMAB 0.3 MG/0.05 ML INTRAVITREAL SYRG,,J2778,HCPCS,Facility,Outpatient,0.05,mL,,4212,3580.2,1207.1592,4212,"UCare Health, Inc.",Individual & Family Plan,2373.462,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
RANIBIZUMAB 0.3 MG/0.05 ML INTRAVITREAL SYRG,,J2778,HCPCS,Facility,Inpatient,0.05,mL,,4212,3580.2,1207.1592,4212,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
RANIBIZUMAB 0.3 MG/0.05 ML INTRAVITREAL SYRG,,J2778,HCPCS,Facility,Outpatient,0.05,mL,,4212,3580.2,1207.1592,4212,"UCare Health, Inc.",Medical Assistance,2125.7964,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
RANIBIZUMAB 0.3 MG/0.05 ML INTRAVITREAL SYRG,,J2778,HCPCS,Facility,Inpatient,0.05,mL,,4212,3580.2,1207.1592,4212,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
RANIBIZUMAB 0.3 MG/0.05 ML INTRAVITREAL SYRG,,J2778,HCPCS,Facility,Outpatient,0.05,mL,,4212,3580.2,1207.1592,4212,"UCare Health, Inc.",Medicare Advantage,2125.7964,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
RANIBIZUMAB 0.3 MG/0.05 ML INTRAVITREAL SYRG,,J2778,HCPCS,Facility,Inpatient,0.05,mL,,4212,3580.2,1207.1592,4212,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
RANIBIZUMAB 0.3 MG/0.05 ML INTRAVITREAL SYRG,,J2778,HCPCS,Facility,Outpatient,0.05,mL,,4212,3580.2,1207.1592,4212,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2125.7964,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
RANIBIZUMAB 0.3 MG/0.05 ML INTRAVITREAL SYRG,,J2778,HCPCS,Facility,Inpatient,0.05,mL,,4212,3580.2,1207.1592,4212,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
RANIBIZUMAB 0.3 MG/0.05 ML INTRAVITREAL SYRG,,J2778,HCPCS,Facility,Both,0.05,mL,,4212,3580.2,1207.1592,4212,UnitedHealthcare,Individual & Family,3959.28,94,,percent of total billed charges,,
RANIBIZUMAB 0.3 MG/0.05 ML INTRAVITREAL SYRG,,J2778,HCPCS,Facility,Outpatient,0.05,mL,,4212,3580.2,1207.1592,4212,UnitedHealthcare,Medicare Advantage,2063.88,49,,percent of total billed charges,,
RANIBIZUMAB 0.3 MG/0.05 ML INTRAVITREAL SYRG,,J2778,HCPCS,Facility,Inpatient,0.05,mL,,4212,3580.2,1207.1592,4212,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
RANIBIZUMAB 0.3 MG/0.05 ML INTRAVITREAL SYRG,,J2778,HCPCS,Facility,Outpatient,0.05,mL,,4212,3580.2,1207.1592,4212,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2021.76,48,,percent of total billed charges,,100% of DHS outpatient percentage
RANIBIZUMAB 0.3 MG/0.05 ML INTRAVITREAL SYRG,,J2778,HCPCS,Facility,Inpatient,0.05,mL,,4212,3580.2,1207.1592,4212,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH CC OR TPA IN 24 HOURS,,65,MS-DRG,Facility,Inpatient,,,,11361.39,9657.1815,10793.3205,10910.34282,America's PPO,America's PPO,10910.34282,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH CC OR TPA IN 24 HOURS,,65,MS-DRG,Facility,Inpatient,,,,11361.39,9657.1815,10793.3205,10910.34282,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,10793.3205,,,Other ,DRG,"DRG weight 1.0164 x WOO $13,372.00; Cap at 95% of charge; minimum of 90.1% of charge"
TRANSIENT ISCHEMIA WITHOUT THROMBOLYTIC,,69,MS-DRG,Facility,Inpatient,,,,14219.5,12086.575,12811.7695,13654.98585,America's PPO,America's PPO,13654.98585,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
TRANSIENT ISCHEMIA WITHOUT THROMBOLYTIC,,69,MS-DRG,Facility,Inpatient,,,,14219.5,12086.575,12811.7695,13654.98585,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,12811.7695,,,Other ,DRG,"DRG weight 0.7979 x WOO $13,372.00; Cap at 95% of charge; minimum of 90.1% of charge"
NONSPECIFIC CEREBROVASCULAR DISORDERS WITH CC,,71,MS-DRG,Facility,Inpatient,,,,7318,6220.3,6952.1,7027.4754,America's PPO,America's PPO,7027.4754,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
NONSPECIFIC CEREBROVASCULAR DISORDERS WITH CC,,71,MS-DRG,Facility,Inpatient,,,,7318,6220.3,6952.1,7027.4754,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,6952.1,,,Other,DRG,"DRG weight 1.069 x WOO $13,372.00; Cap at 95% of charge; minimum of 90.1% of charge"
TRAUMATIC STUPOR AND COMA <1 HOUR WITH CC,,86,MS-DRG,Facility,Inpatient,,,,10294,8749.9,9779.3,9885.3282,America's PPO,America's PPO,9885.3282,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
TRAUMATIC STUPOR AND COMA <1 HOUR WITH CC,,86,MS-DRG,Facility,Inpatient,,,,10294,8749.9,9779.3,9885.3282,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,9779.3,,,Other ,DRG,"DRG weight 1.2997 x WOO $13,372.00; Cap at 95% of charge; minimum of 90.1% of charge"
CONCUSSION WITH CC,,89,MS-DRG,Facility,Inpatient,,,,8881,7548.85,8436.95,8528.4243,America's PPO,America's PPO,8528.4243,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
CONCUSSION WITH CC,,89,MS-DRG,Facility,Inpatient,,,,8881,7548.85,8436.95,8528.4243,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,8436.95,,,Other ,DRG,"DRG weight 1.1677 x WOO $13,372.00; Cap at 95% of charge; minimum of 90.1% of charge"
OTHER DISORDERS OF NERVOUS SYSTEM WITH MCC,,91,MS-DRG,Facility,Inpatient,,,,11451,9733.35,10878.45,10996.3953,America's PPO,America's PPO,10996.3953,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
OTHER DISORDERS OF NERVOUS SYSTEM WITH MCC,,91,MS-DRG,Facility,Inpatient,,,,11451,9733.35,10878.45,10996.3953,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,10878.45,,,Other ,DRG,"DRG weight 1.7274 x WOO $13,372.00; Cap at 95% of charge; minimum of 90.1% of charge"
OTHER DISORDERS OF NERVOUS SYSTEM WITH CC,,92,MS-DRG,Facility,Inpatient,,,,8641,7344.85,8208.95,8297.9523,America's PPO,America's PPO,8297.9523,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
OTHER DISORDERS OF NERVOUS SYSTEM WITH CC,,92,MS-DRG,Facility,Inpatient,,,,8641,7344.85,8208.95,8297.9523,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,8208.95,,,Other ,DRG,"DRG weight 0.9943 x WOO $13,372.00; Cap at 95% of charge; minimum of 90.1% of charge"
BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH CC,,95,MS-DRG,Facility,Inpatient,,,,18275.95,15534.5575,17362.1525,17550.39479,America's PPO,America's PPO,17550.39479,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH CC,,95,MS-DRG,Facility,Inpatient,,,,18275.95,15534.5575,17362.1525,17550.39479,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,17362.1525,,,Other ,DRG,"DRG weight 2.5568 x WOO $13,372.00; Cap at 95% of charge; minimum of 90.1% of charge"
RANIBIZUMAB 0.5 MG/0.05 ML INTRAVITREAL SYRG,,J2778,HCPCS,Facility,Both,0.05,mL,,7020,5967,2011.932,7020,Aetna,Commercial,6458.4,92,,percent of total billed charges,,
RANIBIZUMAB 0.5 MG/0.05 ML INTRAVITREAL SYRG,,J2778,HCPCS,Facility,Outpatient,0.05,mL,,7020,5967,2011.932,7020,Aetna,Medicare Advantage,3439.8,49,,percent of total billed charges,,
RANIBIZUMAB 0.5 MG/0.05 ML INTRAVITREAL SYRG,,J2778,HCPCS,Facility,Inpatient,0.05,mL,,7020,5967,2011.932,7020,Aetna,Medicare Advantage,,,,,Included in per diem rate,
RANIBIZUMAB 0.5 MG/0.05 ML INTRAVITREAL SYRG,,J2778,HCPCS,Facility,Both,0.05,mL,,7020,5967,2011.932,7020,Aetna,PPO,6528.6,93,,percent of total billed charges,,
RANIBIZUMAB 0.5 MG/0.05 ML INTRAVITREAL SYRG,,J2778,HCPCS,Facility,Both,0.05,mL,,7020,5967,2011.932,7020,America's PPO,America's PPO,6741.306,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
RANIBIZUMAB 0.5 MG/0.05 ML INTRAVITREAL SYRG,,J2778,HCPCS,Facility,Both,0.05,mL,,7020,5967,2011.932,7020,BlueCross BlueShield Minnesota, Federal Employee Program,6907.68,98.4,,percent of total billed charges,,
RANIBIZUMAB 0.5 MG/0.05 ML INTRAVITREAL SYRG,,J2778,HCPCS,Facility,Both,0.05,mL,,7020,5967,2011.932,7020,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,7020,100,,percent of total billed charges,,
RANIBIZUMAB 0.5 MG/0.05 ML INTRAVITREAL SYRG,,J2778,HCPCS,Facility,Both,0.05,mL,,7020,5967,2011.932,7020,BlueCross BlueShield Minnesota,High Value Network Plan,6318,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
RANIBIZUMAB 0.5 MG/0.05 ML INTRAVITREAL SYRG,,J2778,HCPCS,Facility,Outpatient,0.05,mL,,7020,5967,2011.932,7020,BlueCross BlueShield Minnesota,Medicare Advantage,3439.8,49,,percent of total billed charges,,
RANIBIZUMAB 0.5 MG/0.05 ML INTRAVITREAL SYRG,,J2778,HCPCS,Facility,Inpatient,0.05,mL,,7020,5967,2011.932,7020,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
RANIBIZUMAB 0.5 MG/0.05 ML INTRAVITREAL SYRG,,J2778,HCPCS,Facility,Both,0.05,mL,,7020,5967,2011.932,7020,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,6217.614,88.57,,percent of total billed charges,,
RANIBIZUMAB 0.5 MG/0.05 ML INTRAVITREAL SYRG,,J2778,HCPCS,Facility,Both,0.05,mL,,7020,5967,2011.932,7020,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,2011.932,28.66,,percent of total billed charges,,
RANIBIZUMAB 0.5 MG/0.05 ML INTRAVITREAL SYRG,,J2778,HCPCS,Facility,Outpatient,0.05,mL,,7020,5967,2011.932,7020,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),3439.8,49,,percent of total billed charges,,
RANIBIZUMAB 0.5 MG/0.05 ML INTRAVITREAL SYRG,,J2778,HCPCS,Facility,Inpatient,0.05,mL,,7020,5967,2011.932,7020,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
RANIBIZUMAB 0.5 MG/0.05 ML INTRAVITREAL SYRG,,J2778,HCPCS,Facility,Both,0.05,mL,,7020,5967,2011.932,7020,CorVel,Worker's Compensation,7020,100,,percent of total billed charges,,
RANIBIZUMAB 0.5 MG/0.05 ML INTRAVITREAL SYRG,,J2778,HCPCS,Facility,Both,0.05,mL,,7020,5967,2011.932,7020,First Health Group Corporation,First Health Network,6809.4,97,,percent of total billed charges,,
RANIBIZUMAB 0.5 MG/0.05 ML INTRAVITREAL SYRG,,J2778,HCPCS,Facility,Both,0.05,mL,,7020,5967,2011.932,7020,"Health Partners, Inc.",Commercial,6640.92,94.6,,percent of total billed charges,,
RANIBIZUMAB 0.5 MG/0.05 ML INTRAVITREAL SYRG,,J2778,HCPCS,Facility,Outpatient,0.05,mL,,7020,5967,2011.932,7020,"Health Partners, Inc.",Medicare Advantage,3439.8,49,,percent of total billed charges,,
RANIBIZUMAB 0.5 MG/0.05 ML INTRAVITREAL SYRG,,J2778,HCPCS,Facility,Inpatient,0.05,mL,,7020,5967,2011.932,7020,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
RANIBIZUMAB 0.5 MG/0.05 ML INTRAVITREAL SYRG,,J2778,HCPCS,Facility,Both,0.05,mL,,7020,5967,2011.932,7020,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),4212,60,,percent of total billed charges,,
RANIBIZUMAB 0.5 MG/0.05 ML INTRAVITREAL SYRG,,J2778,HCPCS,Facility,Both,0.05,mL,,7020,5967,2011.932,7020,"Health Partners, Inc.",State of Minnesota Advantage Program,5721.3,81.5,,percent of total billed charges,,
RANIBIZUMAB 0.5 MG/0.05 ML INTRAVITREAL SYRG,,J2778,HCPCS,Facility,Both,0.05,mL,,7020,5967,2011.932,7020,"Health Partners, Inc.",State Public Programs,3510,50,,percent of total billed charges,,
RANIBIZUMAB 0.5 MG/0.05 ML INTRAVITREAL SYRG,,J2778,HCPCS,Facility,Both,0.05,mL,,7020,5967,2011.932,7020,Humana Insurance Company,Commercial PPO,6669,95,,percent of total billed charges,,
RANIBIZUMAB 0.5 MG/0.05 ML INTRAVITREAL SYRG,,J2778,HCPCS,Facility,Outpatient,0.05,mL,,7020,5967,2011.932,7020,Humana Insurance Company,Medicare PPO,3439.8,49,,percent of total billed charges,,
RANIBIZUMAB 0.5 MG/0.05 ML INTRAVITREAL SYRG,,J2778,HCPCS,Facility,Inpatient,0.05,mL,,7020,5967,2011.932,7020,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
RANIBIZUMAB 0.5 MG/0.05 ML INTRAVITREAL SYRG,,J2778,HCPCS,Facility,Both,0.05,mL,,7020,5967,2011.932,7020,Medica,Individual & Family,6956.82,99.1,,percent of total billed charges,,
RANIBIZUMAB 0.5 MG/0.05 ML INTRAVITREAL SYRG,,J2778,HCPCS,Facility,Outpatient,0.05,mL,,7020,5967,2011.932,7020,Medica,Medica Advantage Solution,3495.96,49.8,,percent of total billed charges,,
RANIBIZUMAB 0.5 MG/0.05 ML INTRAVITREAL SYRG,,J2778,HCPCS,Facility,Inpatient,0.05,mL,,7020,5967,2011.932,7020,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
RANIBIZUMAB 0.5 MG/0.05 ML INTRAVITREAL SYRG,,J2778,HCPCS,Facility,Outpatient,0.05,mL,,7020,5967,2011.932,7020,Medica,Medical Assistance,3130.92,44.6,,percent of total billed charges,,
RANIBIZUMAB 0.5 MG/0.05 ML INTRAVITREAL SYRG,,J2778,HCPCS,Facility,Inpatient,0.05,mL,,7020,5967,2011.932,7020,Medica,Medical Assistance,,,,,Included in per diem rate,
RANIBIZUMAB 0.5 MG/0.05 ML INTRAVITREAL SYRG,,J2778,HCPCS,Facility,Outpatient,0.05,mL,,7020,5967,2011.932,7020,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,3495.96,49.8,,percent of total billed charges,,
RANIBIZUMAB 0.5 MG/0.05 ML INTRAVITREAL SYRG,,J2778,HCPCS,Facility,Inpatient,0.05,mL,,7020,5967,2011.932,7020,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
RANIBIZUMAB 0.5 MG/0.05 ML INTRAVITREAL SYRG,,J2778,HCPCS,Facility,Both,0.05,mL,,7020,5967,2011.932,7020,"Multiplan, Inc.","Multiplan, Inc.",6598.8,94,,percent of total billed charges,,
RANIBIZUMAB 0.5 MG/0.05 ML INTRAVITREAL SYRG,,J2778,HCPCS,Facility,Outpatient,0.05,mL,,7020,5967,2011.932,7020,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,6325.02,90.1,,percent of total billed charges,,
RANIBIZUMAB 0.5 MG/0.05 ML INTRAVITREAL SYRG,,J2778,HCPCS,Facility,Inpatient,0.05,mL,,7020,5967,2011.932,7020,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
RANIBIZUMAB 0.5 MG/0.05 ML INTRAVITREAL SYRG,,J2778,HCPCS,Facility,Both,0.05,mL,,7020,5967,2011.932,7020,"Preferred One Administrative Services, INC.",PPO,6921.72,98.6,,percent of total billed charges,,
RANIBIZUMAB 0.5 MG/0.05 ML INTRAVITREAL SYRG,,J2778,HCPCS,Facility,Outpatient,0.05,mL,,7020,5967,2011.932,7020,PrimeWest Health,Minnesota Senior Health Options (MSHO),3611.79,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
RANIBIZUMAB 0.5 MG/0.05 ML INTRAVITREAL SYRG,,J2778,HCPCS,Facility,Inpatient,0.05,mL,,7020,5967,2011.932,7020,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
RANIBIZUMAB 0.5 MG/0.05 ML INTRAVITREAL SYRG,,J2778,HCPCS,Facility,Outpatient,0.05,mL,,7020,5967,2011.932,7020,PrimeWest Health,MinnesotaCare,3605.472,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
RANIBIZUMAB 0.5 MG/0.05 ML INTRAVITREAL SYRG,,J2778,HCPCS,Facility,Inpatient,0.05,mL,,7020,5967,2011.932,7020,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
RANIBIZUMAB 0.5 MG/0.05 ML INTRAVITREAL SYRG,,J2778,HCPCS,Facility,Both,0.05,mL,,7020,5967,2011.932,7020,Sanford Health Plan,Sanford Health Plan,6458.4,92,,percent of total billed charges,,
RANIBIZUMAB 0.5 MG/0.05 ML INTRAVITREAL SYRG,,J2778,HCPCS,Facility,Outpatient,0.05,mL,,7020,5967,2011.932,7020,"UCare Health, Inc.",Individual & Family Plan,3955.77,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
RANIBIZUMAB 0.5 MG/0.05 ML INTRAVITREAL SYRG,,J2778,HCPCS,Facility,Inpatient,0.05,mL,,7020,5967,2011.932,7020,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
RANIBIZUMAB 0.5 MG/0.05 ML INTRAVITREAL SYRG,,J2778,HCPCS,Facility,Outpatient,0.05,mL,,7020,5967,2011.932,7020,"UCare Health, Inc.",Medical Assistance,3542.994,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
RANIBIZUMAB 0.5 MG/0.05 ML INTRAVITREAL SYRG,,J2778,HCPCS,Facility,Inpatient,0.05,mL,,7020,5967,2011.932,7020,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
RANIBIZUMAB 0.5 MG/0.05 ML INTRAVITREAL SYRG,,J2778,HCPCS,Facility,Outpatient,0.05,mL,,7020,5967,2011.932,7020,"UCare Health, Inc.",Medicare Advantage,3542.994,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
RANIBIZUMAB 0.5 MG/0.05 ML INTRAVITREAL SYRG,,J2778,HCPCS,Facility,Inpatient,0.05,mL,,7020,5967,2011.932,7020,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
RANIBIZUMAB 0.5 MG/0.05 ML INTRAVITREAL SYRG,,J2778,HCPCS,Facility,Outpatient,0.05,mL,,7020,5967,2011.932,7020,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),3542.994,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
RANIBIZUMAB 0.5 MG/0.05 ML INTRAVITREAL SYRG,,J2778,HCPCS,Facility,Inpatient,0.05,mL,,7020,5967,2011.932,7020,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
RANIBIZUMAB 0.5 MG/0.05 ML INTRAVITREAL SYRG,,J2778,HCPCS,Facility,Both,0.05,mL,,7020,5967,2011.932,7020,UnitedHealthcare,Individual & Family,6598.8,94,,percent of total billed charges,,
RANIBIZUMAB 0.5 MG/0.05 ML INTRAVITREAL SYRG,,J2778,HCPCS,Facility,Outpatient,0.05,mL,,7020,5967,2011.932,7020,UnitedHealthcare,Medicare Advantage,3439.8,49,,percent of total billed charges,,
RANIBIZUMAB 0.5 MG/0.05 ML INTRAVITREAL SYRG,,J2778,HCPCS,Facility,Inpatient,0.05,mL,,7020,5967,2011.932,7020,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
RANIBIZUMAB 0.5 MG/0.05 ML INTRAVITREAL SYRG,,J2778,HCPCS,Facility,Outpatient,0.05,mL,,7020,5967,2011.932,7020,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,3369.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
RANIBIZUMAB 0.5 MG/0.05 ML INTRAVITREAL SYRG,,J2778,HCPCS,Facility,Inpatient,0.05,mL,,7020,5967,2011.932,7020,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
DARBEPOETIN ALFA IN POLYSORBAT 150 MCG/0.3 ML INJ SYRG,,J0881,HCPCS,Facility,Both,0.3,mL,,4180,3553,1197.988,4180,Aetna,Commercial,3845.6,92,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 150 MCG/0.3 ML INJ SYRG,,J0881,HCPCS,Facility,Outpatient,0.3,mL,,4180,3553,1197.988,4180,Aetna,Medicare Advantage,2048.2,49,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 150 MCG/0.3 ML INJ SYRG,,J0881,HCPCS,Facility,Inpatient,0.3,mL,,4180,3553,1197.988,4180,Aetna,Medicare Advantage,,,,,Included in per diem rate,
DARBEPOETIN ALFA IN POLYSORBAT 150 MCG/0.3 ML INJ SYRG,,J0881,HCPCS,Facility,Both,0.3,mL,,4180,3553,1197.988,4180,Aetna,PPO,3887.4,93,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 150 MCG/0.3 ML INJ SYRG,,J0881,HCPCS,Facility,Both,0.3,mL,,4180,3553,1197.988,4180,America's PPO,America's PPO,4014.054,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
DARBEPOETIN ALFA IN POLYSORBAT 150 MCG/0.3 ML INJ SYRG,,J0881,HCPCS,Facility,Both,0.3,mL,,4180,3553,1197.988,4180,BlueCross BlueShield Minnesota, Federal Employee Program,4113.12,98.4,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 150 MCG/0.3 ML INJ SYRG,,J0881,HCPCS,Facility,Both,0.3,mL,,4180,3553,1197.988,4180,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,4180,100,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 150 MCG/0.3 ML INJ SYRG,,J0881,HCPCS,Facility,Both,0.3,mL,,4180,3553,1197.988,4180,BlueCross BlueShield Minnesota,High Value Network Plan,3762,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
DARBEPOETIN ALFA IN POLYSORBAT 150 MCG/0.3 ML INJ SYRG,,J0881,HCPCS,Facility,Outpatient,0.3,mL,,4180,3553,1197.988,4180,BlueCross BlueShield Minnesota,Medicare Advantage,2048.2,49,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 150 MCG/0.3 ML INJ SYRG,,J0881,HCPCS,Facility,Inpatient,0.3,mL,,4180,3553,1197.988,4180,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
DARBEPOETIN ALFA IN POLYSORBAT 150 MCG/0.3 ML INJ SYRG,,J0881,HCPCS,Facility,Both,0.3,mL,,4180,3553,1197.988,4180,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,3702.226,88.57,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 150 MCG/0.3 ML INJ SYRG,,J0881,HCPCS,Facility,Both,0.3,mL,,4180,3553,1197.988,4180,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1197.988,28.66,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 150 MCG/0.3 ML INJ SYRG,,J0881,HCPCS,Facility,Outpatient,0.3,mL,,4180,3553,1197.988,4180,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2048.2,49,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 150 MCG/0.3 ML INJ SYRG,,J0881,HCPCS,Facility,Inpatient,0.3,mL,,4180,3553,1197.988,4180,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
DARBEPOETIN ALFA IN POLYSORBAT 150 MCG/0.3 ML INJ SYRG,,J0881,HCPCS,Facility,Both,0.3,mL,,4180,3553,1197.988,4180,CorVel,Worker's Compensation,4180,100,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 150 MCG/0.3 ML INJ SYRG,,J0881,HCPCS,Facility,Both,0.3,mL,,4180,3553,1197.988,4180,First Health Group Corporation,First Health Network,4054.6,97,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 150 MCG/0.3 ML INJ SYRG,,J0881,HCPCS,Facility,Both,0.3,mL,,4180,3553,1197.988,4180,"Health Partners, Inc.",Commercial,3954.28,94.6,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 150 MCG/0.3 ML INJ SYRG,,J0881,HCPCS,Facility,Outpatient,0.3,mL,,4180,3553,1197.988,4180,"Health Partners, Inc.",Medicare Advantage,2048.2,49,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 150 MCG/0.3 ML INJ SYRG,,J0881,HCPCS,Facility,Inpatient,0.3,mL,,4180,3553,1197.988,4180,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DARBEPOETIN ALFA IN POLYSORBAT 150 MCG/0.3 ML INJ SYRG,,J0881,HCPCS,Facility,Both,0.3,mL,,4180,3553,1197.988,4180,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),2508,60,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 150 MCG/0.3 ML INJ SYRG,,J0881,HCPCS,Facility,Both,0.3,mL,,4180,3553,1197.988,4180,"Health Partners, Inc.",State of Minnesota Advantage Program,3406.7,81.5,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 150 MCG/0.3 ML INJ SYRG,,J0881,HCPCS,Facility,Both,0.3,mL,,4180,3553,1197.988,4180,"Health Partners, Inc.",State Public Programs,2090,50,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 150 MCG/0.3 ML INJ SYRG,,J0881,HCPCS,Facility,Both,0.3,mL,,4180,3553,1197.988,4180,Humana Insurance Company,Commercial PPO,3971,95,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 150 MCG/0.3 ML INJ SYRG,,J0881,HCPCS,Facility,Outpatient,0.3,mL,,4180,3553,1197.988,4180,Humana Insurance Company,Medicare PPO,2048.2,49,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 150 MCG/0.3 ML INJ SYRG,,J0881,HCPCS,Facility,Inpatient,0.3,mL,,4180,3553,1197.988,4180,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
DARBEPOETIN ALFA IN POLYSORBAT 150 MCG/0.3 ML INJ SYRG,,J0881,HCPCS,Facility,Both,0.3,mL,,4180,3553,1197.988,4180,Medica,Individual & Family,4142.38,99.1,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 150 MCG/0.3 ML INJ SYRG,,J0881,HCPCS,Facility,Outpatient,0.3,mL,,4180,3553,1197.988,4180,Medica,Medica Advantage Solution,2081.64,49.8,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 150 MCG/0.3 ML INJ SYRG,,J0881,HCPCS,Facility,Inpatient,0.3,mL,,4180,3553,1197.988,4180,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
DARBEPOETIN ALFA IN POLYSORBAT 150 MCG/0.3 ML INJ SYRG,,J0881,HCPCS,Facility,Outpatient,0.3,mL,,4180,3553,1197.988,4180,Medica,Medical Assistance,1864.28,44.6,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 150 MCG/0.3 ML INJ SYRG,,J0881,HCPCS,Facility,Inpatient,0.3,mL,,4180,3553,1197.988,4180,Medica,Medical Assistance,,,,,Included in per diem rate,
DARBEPOETIN ALFA IN POLYSORBAT 150 MCG/0.3 ML INJ SYRG,,J0881,HCPCS,Facility,Outpatient,0.3,mL,,4180,3553,1197.988,4180,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2081.64,49.8,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 150 MCG/0.3 ML INJ SYRG,,J0881,HCPCS,Facility,Inpatient,0.3,mL,,4180,3553,1197.988,4180,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
DARBEPOETIN ALFA IN POLYSORBAT 150 MCG/0.3 ML INJ SYRG,,J0881,HCPCS,Facility,Both,0.3,mL,,4180,3553,1197.988,4180,"Multiplan, Inc.","Multiplan, Inc.",3929.2,94,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 150 MCG/0.3 ML INJ SYRG,,J0881,HCPCS,Facility,Outpatient,0.3,mL,,4180,3553,1197.988,4180,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,3766.18,90.1,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 150 MCG/0.3 ML INJ SYRG,,J0881,HCPCS,Facility,Inpatient,0.3,mL,,4180,3553,1197.988,4180,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
DARBEPOETIN ALFA IN POLYSORBAT 150 MCG/0.3 ML INJ SYRG,,J0881,HCPCS,Facility,Both,0.3,mL,,4180,3553,1197.988,4180,"Preferred One Administrative Services, INC.",PPO,4121.48,98.6,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 150 MCG/0.3 ML INJ SYRG,,J0881,HCPCS,Facility,Outpatient,0.3,mL,,4180,3553,1197.988,4180,PrimeWest Health,Minnesota Senior Health Options (MSHO),2150.61,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
DARBEPOETIN ALFA IN POLYSORBAT 150 MCG/0.3 ML INJ SYRG,,J0881,HCPCS,Facility,Inpatient,0.3,mL,,4180,3553,1197.988,4180,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DARBEPOETIN ALFA IN POLYSORBAT 150 MCG/0.3 ML INJ SYRG,,J0881,HCPCS,Facility,Outpatient,0.3,mL,,4180,3553,1197.988,4180,PrimeWest Health,MinnesotaCare,2146.848,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
DARBEPOETIN ALFA IN POLYSORBAT 150 MCG/0.3 ML INJ SYRG,,J0881,HCPCS,Facility,Inpatient,0.3,mL,,4180,3553,1197.988,4180,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
DARBEPOETIN ALFA IN POLYSORBAT 150 MCG/0.3 ML INJ SYRG,,J0881,HCPCS,Facility,Both,0.3,mL,,4180,3553,1197.988,4180,Sanford Health Plan,Sanford Health Plan,3845.6,92,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 150 MCG/0.3 ML INJ SYRG,,J0881,HCPCS,Facility,Outpatient,0.3,mL,,4180,3553,1197.988,4180,"UCare Health, Inc.",Individual & Family Plan,2355.43,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
DARBEPOETIN ALFA IN POLYSORBAT 150 MCG/0.3 ML INJ SYRG,,J0881,HCPCS,Facility,Inpatient,0.3,mL,,4180,3553,1197.988,4180,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
DARBEPOETIN ALFA IN POLYSORBAT 150 MCG/0.3 ML INJ SYRG,,J0881,HCPCS,Facility,Outpatient,0.3,mL,,4180,3553,1197.988,4180,"UCare Health, Inc.",Medical Assistance,2109.646,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DARBEPOETIN ALFA IN POLYSORBAT 150 MCG/0.3 ML INJ SYRG,,J0881,HCPCS,Facility,Inpatient,0.3,mL,,4180,3553,1197.988,4180,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
DARBEPOETIN ALFA IN POLYSORBAT 150 MCG/0.3 ML INJ SYRG,,J0881,HCPCS,Facility,Outpatient,0.3,mL,,4180,3553,1197.988,4180,"UCare Health, Inc.",Medicare Advantage,2109.646,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DARBEPOETIN ALFA IN POLYSORBAT 150 MCG/0.3 ML INJ SYRG,,J0881,HCPCS,Facility,Inpatient,0.3,mL,,4180,3553,1197.988,4180,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DARBEPOETIN ALFA IN POLYSORBAT 150 MCG/0.3 ML INJ SYRG,,J0881,HCPCS,Facility,Outpatient,0.3,mL,,4180,3553,1197.988,4180,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2109.646,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DARBEPOETIN ALFA IN POLYSORBAT 150 MCG/0.3 ML INJ SYRG,,J0881,HCPCS,Facility,Inpatient,0.3,mL,,4180,3553,1197.988,4180,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DARBEPOETIN ALFA IN POLYSORBAT 150 MCG/0.3 ML INJ SYRG,,J0881,HCPCS,Facility,Both,0.3,mL,,4180,3553,1197.988,4180,UnitedHealthcare,Individual & Family,3929.2,94,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 150 MCG/0.3 ML INJ SYRG,,J0881,HCPCS,Facility,Outpatient,0.3,mL,,4180,3553,1197.988,4180,UnitedHealthcare,Medicare Advantage,2048.2,49,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 150 MCG/0.3 ML INJ SYRG,,J0881,HCPCS,Facility,Inpatient,0.3,mL,,4180,3553,1197.988,4180,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
DARBEPOETIN ALFA IN POLYSORBAT 150 MCG/0.3 ML INJ SYRG,,J0881,HCPCS,Facility,Outpatient,0.3,mL,,4180,3553,1197.988,4180,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2006.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
DARBEPOETIN ALFA IN POLYSORBAT 150 MCG/0.3 ML INJ SYRG,,J0881,HCPCS,Facility,Inpatient,0.3,mL,,4180,3553,1197.988,4180,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
OTITIS MEDIA AND URI WITHOUT MCC,,153,MS-DRG,Facility,Inpatient,,,,2311,1964.35,2195.45,2219.2533,America's PPO,America's PPO,2219.2533,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
OTITIS MEDIA AND URI WITHOUT MCC,,153,MS-DRG,Facility,Inpatient,,,,2311,1964.35,2195.45,2219.2533,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,2195.45,,,Other ,DRG,"DRG weight 0.6905 x WOO $13,372.00; Cap at 95% of charge; minimum of 90.1% of charge"
"OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITH CC",,155,MS-DRG,Facility,Inpatient,,,,10016,8513.6,9515.2,9618.3648,America's PPO,America's PPO,9618.3648,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITH CC",,155,MS-DRG,Facility,Inpatient,,,,10016,8513.6,9515.2,9618.3648,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,9515.2,,,Other ,DRG,"DRG weight 0.9193 x WOO $13,372.00; Cap at 95% of charge; minimum of 90.1% of charge"
DENTAL AND ORAL DISEASES WITH MCC,,157,MS-DRG,Facility,Inpatient,,,,20706,17600.1,19670.7,19883.9718,America's PPO,America's PPO,19883.9718,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
DENTAL AND ORAL DISEASES WITH MCC,,157,MS-DRG,Facility,Inpatient,,,,20706,17600.1,19670.7,19883.9718,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,19670.7,,,Other ,DRG,"DRG weight 1.6718 x WOO $13,372.00; Cap at 95% of charge; minimum of 90.1% of charge"
DARBEPOETIN ALFA IN POLYSORBAT 60 MCG/0.3 ML INJ SYRG,,J0881,HCPCS,Facility,Both,0.3,mL,,1840,1564,527.344,1840,Aetna,Commercial,1692.8,92,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 60 MCG/0.3 ML INJ SYRG,,J0881,HCPCS,Facility,Outpatient,0.3,mL,,1840,1564,527.344,1840,Aetna,Medicare Advantage,901.6,49,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 60 MCG/0.3 ML INJ SYRG,,J0881,HCPCS,Facility,Inpatient,0.3,mL,,1840,1564,527.344,1840,Aetna,Medicare Advantage,,,,,Included in per diem rate,
DARBEPOETIN ALFA IN POLYSORBAT 60 MCG/0.3 ML INJ SYRG,,J0881,HCPCS,Facility,Both,0.3,mL,,1840,1564,527.344,1840,Aetna,PPO,1711.2,93,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 60 MCG/0.3 ML INJ SYRG,,J0881,HCPCS,Facility,Both,0.3,mL,,1840,1564,527.344,1840,America's PPO,America's PPO,1766.952,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
DARBEPOETIN ALFA IN POLYSORBAT 60 MCG/0.3 ML INJ SYRG,,J0881,HCPCS,Facility,Both,0.3,mL,,1840,1564,527.344,1840,BlueCross BlueShield Minnesota, Federal Employee Program,1810.56,98.4,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 60 MCG/0.3 ML INJ SYRG,,J0881,HCPCS,Facility,Both,0.3,mL,,1840,1564,527.344,1840,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1840,100,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 60 MCG/0.3 ML INJ SYRG,,J0881,HCPCS,Facility,Both,0.3,mL,,1840,1564,527.344,1840,BlueCross BlueShield Minnesota,High Value Network Plan,1656,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
DARBEPOETIN ALFA IN POLYSORBAT 60 MCG/0.3 ML INJ SYRG,,J0881,HCPCS,Facility,Outpatient,0.3,mL,,1840,1564,527.344,1840,BlueCross BlueShield Minnesota,Medicare Advantage,901.6,49,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 60 MCG/0.3 ML INJ SYRG,,J0881,HCPCS,Facility,Inpatient,0.3,mL,,1840,1564,527.344,1840,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
DARBEPOETIN ALFA IN POLYSORBAT 60 MCG/0.3 ML INJ SYRG,,J0881,HCPCS,Facility,Both,0.3,mL,,1840,1564,527.344,1840,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1629.688,88.57,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 60 MCG/0.3 ML INJ SYRG,,J0881,HCPCS,Facility,Both,0.3,mL,,1840,1564,527.344,1840,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,527.344,28.66,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 60 MCG/0.3 ML INJ SYRG,,J0881,HCPCS,Facility,Outpatient,0.3,mL,,1840,1564,527.344,1840,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),901.6,49,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 60 MCG/0.3 ML INJ SYRG,,J0881,HCPCS,Facility,Inpatient,0.3,mL,,1840,1564,527.344,1840,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
DARBEPOETIN ALFA IN POLYSORBAT 60 MCG/0.3 ML INJ SYRG,,J0881,HCPCS,Facility,Both,0.3,mL,,1840,1564,527.344,1840,CorVel,Worker's Compensation,1840,100,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 60 MCG/0.3 ML INJ SYRG,,J0881,HCPCS,Facility,Both,0.3,mL,,1840,1564,527.344,1840,First Health Group Corporation,First Health Network,1784.8,97,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 60 MCG/0.3 ML INJ SYRG,,J0881,HCPCS,Facility,Both,0.3,mL,,1840,1564,527.344,1840,"Health Partners, Inc.",Commercial,1740.64,94.6,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 60 MCG/0.3 ML INJ SYRG,,J0881,HCPCS,Facility,Outpatient,0.3,mL,,1840,1564,527.344,1840,"Health Partners, Inc.",Medicare Advantage,901.6,49,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 60 MCG/0.3 ML INJ SYRG,,J0881,HCPCS,Facility,Inpatient,0.3,mL,,1840,1564,527.344,1840,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DARBEPOETIN ALFA IN POLYSORBAT 60 MCG/0.3 ML INJ SYRG,,J0881,HCPCS,Facility,Both,0.3,mL,,1840,1564,527.344,1840,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1104,60,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 60 MCG/0.3 ML INJ SYRG,,J0881,HCPCS,Facility,Both,0.3,mL,,1840,1564,527.344,1840,"Health Partners, Inc.",State of Minnesota Advantage Program,1499.6,81.5,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 60 MCG/0.3 ML INJ SYRG,,J0881,HCPCS,Facility,Both,0.3,mL,,1840,1564,527.344,1840,"Health Partners, Inc.",State Public Programs,920,50,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 60 MCG/0.3 ML INJ SYRG,,J0881,HCPCS,Facility,Both,0.3,mL,,1840,1564,527.344,1840,Humana Insurance Company,Commercial PPO,1748,95,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 60 MCG/0.3 ML INJ SYRG,,J0881,HCPCS,Facility,Outpatient,0.3,mL,,1840,1564,527.344,1840,Humana Insurance Company,Medicare PPO,901.6,49,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 60 MCG/0.3 ML INJ SYRG,,J0881,HCPCS,Facility,Inpatient,0.3,mL,,1840,1564,527.344,1840,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
DARBEPOETIN ALFA IN POLYSORBAT 60 MCG/0.3 ML INJ SYRG,,J0881,HCPCS,Facility,Both,0.3,mL,,1840,1564,527.344,1840,Medica,Individual & Family,1823.44,99.1,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 60 MCG/0.3 ML INJ SYRG,,J0881,HCPCS,Facility,Outpatient,0.3,mL,,1840,1564,527.344,1840,Medica,Medica Advantage Solution,916.32,49.8,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 60 MCG/0.3 ML INJ SYRG,,J0881,HCPCS,Facility,Inpatient,0.3,mL,,1840,1564,527.344,1840,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
DARBEPOETIN ALFA IN POLYSORBAT 60 MCG/0.3 ML INJ SYRG,,J0881,HCPCS,Facility,Outpatient,0.3,mL,,1840,1564,527.344,1840,Medica,Medical Assistance,820.64,44.6,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 60 MCG/0.3 ML INJ SYRG,,J0881,HCPCS,Facility,Inpatient,0.3,mL,,1840,1564,527.344,1840,Medica,Medical Assistance,,,,,Included in per diem rate,
DARBEPOETIN ALFA IN POLYSORBAT 60 MCG/0.3 ML INJ SYRG,,J0881,HCPCS,Facility,Outpatient,0.3,mL,,1840,1564,527.344,1840,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,916.32,49.8,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 60 MCG/0.3 ML INJ SYRG,,J0881,HCPCS,Facility,Inpatient,0.3,mL,,1840,1564,527.344,1840,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
DARBEPOETIN ALFA IN POLYSORBAT 60 MCG/0.3 ML INJ SYRG,,J0881,HCPCS,Facility,Both,0.3,mL,,1840,1564,527.344,1840,"Multiplan, Inc.","Multiplan, Inc.",1729.6,94,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 60 MCG/0.3 ML INJ SYRG,,J0881,HCPCS,Facility,Outpatient,0.3,mL,,1840,1564,527.344,1840,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1657.84,90.1,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 60 MCG/0.3 ML INJ SYRG,,J0881,HCPCS,Facility,Inpatient,0.3,mL,,1840,1564,527.344,1840,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
DARBEPOETIN ALFA IN POLYSORBAT 60 MCG/0.3 ML INJ SYRG,,J0881,HCPCS,Facility,Both,0.3,mL,,1840,1564,527.344,1840,"Preferred One Administrative Services, INC.",PPO,1814.24,98.6,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 60 MCG/0.3 ML INJ SYRG,,J0881,HCPCS,Facility,Outpatient,0.3,mL,,1840,1564,527.344,1840,PrimeWest Health,Minnesota Senior Health Options (MSHO),946.68,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
DARBEPOETIN ALFA IN POLYSORBAT 60 MCG/0.3 ML INJ SYRG,,J0881,HCPCS,Facility,Inpatient,0.3,mL,,1840,1564,527.344,1840,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DARBEPOETIN ALFA IN POLYSORBAT 60 MCG/0.3 ML INJ SYRG,,J0881,HCPCS,Facility,Outpatient,0.3,mL,,1840,1564,527.344,1840,PrimeWest Health,MinnesotaCare,945.024,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
DARBEPOETIN ALFA IN POLYSORBAT 60 MCG/0.3 ML INJ SYRG,,J0881,HCPCS,Facility,Inpatient,0.3,mL,,1840,1564,527.344,1840,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
DARBEPOETIN ALFA IN POLYSORBAT 60 MCG/0.3 ML INJ SYRG,,J0881,HCPCS,Facility,Both,0.3,mL,,1840,1564,527.344,1840,Sanford Health Plan,Sanford Health Plan,1692.8,92,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 60 MCG/0.3 ML INJ SYRG,,J0881,HCPCS,Facility,Outpatient,0.3,mL,,1840,1564,527.344,1840,"UCare Health, Inc.",Individual & Family Plan,1036.84,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
DARBEPOETIN ALFA IN POLYSORBAT 60 MCG/0.3 ML INJ SYRG,,J0881,HCPCS,Facility,Inpatient,0.3,mL,,1840,1564,527.344,1840,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
DARBEPOETIN ALFA IN POLYSORBAT 60 MCG/0.3 ML INJ SYRG,,J0881,HCPCS,Facility,Outpatient,0.3,mL,,1840,1564,527.344,1840,"UCare Health, Inc.",Medical Assistance,928.648,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DARBEPOETIN ALFA IN POLYSORBAT 60 MCG/0.3 ML INJ SYRG,,J0881,HCPCS,Facility,Inpatient,0.3,mL,,1840,1564,527.344,1840,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
DARBEPOETIN ALFA IN POLYSORBAT 60 MCG/0.3 ML INJ SYRG,,J0881,HCPCS,Facility,Outpatient,0.3,mL,,1840,1564,527.344,1840,"UCare Health, Inc.",Medicare Advantage,928.648,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DARBEPOETIN ALFA IN POLYSORBAT 60 MCG/0.3 ML INJ SYRG,,J0881,HCPCS,Facility,Inpatient,0.3,mL,,1840,1564,527.344,1840,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DARBEPOETIN ALFA IN POLYSORBAT 60 MCG/0.3 ML INJ SYRG,,J0881,HCPCS,Facility,Outpatient,0.3,mL,,1840,1564,527.344,1840,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),928.648,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DARBEPOETIN ALFA IN POLYSORBAT 60 MCG/0.3 ML INJ SYRG,,J0881,HCPCS,Facility,Inpatient,0.3,mL,,1840,1564,527.344,1840,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DARBEPOETIN ALFA IN POLYSORBAT 60 MCG/0.3 ML INJ SYRG,,J0881,HCPCS,Facility,Both,0.3,mL,,1840,1564,527.344,1840,UnitedHealthcare,Individual & Family,1729.6,94,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 60 MCG/0.3 ML INJ SYRG,,J0881,HCPCS,Facility,Outpatient,0.3,mL,,1840,1564,527.344,1840,UnitedHealthcare,Medicare Advantage,901.6,49,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 60 MCG/0.3 ML INJ SYRG,,J0881,HCPCS,Facility,Inpatient,0.3,mL,,1840,1564,527.344,1840,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
DARBEPOETIN ALFA IN POLYSORBAT 60 MCG/0.3 ML INJ SYRG,,J0881,HCPCS,Facility,Outpatient,0.3,mL,,1840,1564,527.344,1840,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,883.2,48,,percent of total billed charges,,100% of DHS outpatient percentage
DARBEPOETIN ALFA IN POLYSORBAT 60 MCG/0.3 ML INJ SYRG,,J0881,HCPCS,Facility,Inpatient,0.3,mL,,1840,1564,527.344,1840,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
ENOXAPARIN 30 MG/0.3 ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,0.3,mL,,17,14.45,4.8722,17,Aetna,Commercial,15.64,92,,percent of total billed charges,,
ENOXAPARIN 30 MG/0.3 ML SUBQ SYRG,,J1650,HCPCS,Facility,Outpatient,0.3,mL,,17,14.45,4.8722,17,Aetna,Medicare Advantage,8.33,49,,percent of total billed charges,,
ENOXAPARIN 30 MG/0.3 ML SUBQ SYRG,,J1650,HCPCS,Facility,Inpatient,0.3,mL,,17,14.45,4.8722,17,Aetna,Medicare Advantage,,,,,Included in per diem rate,
ENOXAPARIN 30 MG/0.3 ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,0.3,mL,,17,14.45,4.8722,17,Aetna,PPO,15.81,93,,percent of total billed charges,,
ENOXAPARIN 30 MG/0.3 ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,0.3,mL,,17,14.45,4.8722,17,America's PPO,America's PPO,16.3251,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
ENOXAPARIN 30 MG/0.3 ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,0.3,mL,,17,14.45,4.8722,17,BlueCross BlueShield Minnesota, Federal Employee Program,16.728,98.4,,percent of total billed charges,,
ENOXAPARIN 30 MG/0.3 ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,0.3,mL,,17,14.45,4.8722,17,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,17,100,,percent of total billed charges,,
ENOXAPARIN 30 MG/0.3 ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,0.3,mL,,17,14.45,4.8722,17,BlueCross BlueShield Minnesota,High Value Network Plan,15.3,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
ENOXAPARIN 30 MG/0.3 ML SUBQ SYRG,,J1650,HCPCS,Facility,Outpatient,0.3,mL,,17,14.45,4.8722,17,BlueCross BlueShield Minnesota,Medicare Advantage,8.33,49,,percent of total billed charges,,
ENOXAPARIN 30 MG/0.3 ML SUBQ SYRG,,J1650,HCPCS,Facility,Inpatient,0.3,mL,,17,14.45,4.8722,17,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
ENOXAPARIN 30 MG/0.3 ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,0.3,mL,,17,14.45,4.8722,17,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,15.0569,88.57,,percent of total billed charges,,
ENOXAPARIN 30 MG/0.3 ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,0.3,mL,,17,14.45,4.8722,17,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,4.8722,28.66,,percent of total billed charges,,
ENOXAPARIN 30 MG/0.3 ML SUBQ SYRG,,J1650,HCPCS,Facility,Outpatient,0.3,mL,,17,14.45,4.8722,17,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),8.33,49,,percent of total billed charges,,
ENOXAPARIN 30 MG/0.3 ML SUBQ SYRG,,J1650,HCPCS,Facility,Inpatient,0.3,mL,,17,14.45,4.8722,17,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
ENOXAPARIN 30 MG/0.3 ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,0.3,mL,,17,14.45,4.8722,17,CorVel,Worker's Compensation,17,100,,percent of total billed charges,,
ENOXAPARIN 30 MG/0.3 ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,0.3,mL,,17,14.45,4.8722,17,First Health Group Corporation,First Health Network,16.49,97,,percent of total billed charges,,
ENOXAPARIN 30 MG/0.3 ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,0.3,mL,,17,14.45,4.8722,17,"Health Partners, Inc.",Commercial,16.082,94.6,,percent of total billed charges,,
ENOXAPARIN 30 MG/0.3 ML SUBQ SYRG,,J1650,HCPCS,Facility,Outpatient,0.3,mL,,17,14.45,4.8722,17,"Health Partners, Inc.",Medicare Advantage,8.33,49,,percent of total billed charges,,
ENOXAPARIN 30 MG/0.3 ML SUBQ SYRG,,J1650,HCPCS,Facility,Inpatient,0.3,mL,,17,14.45,4.8722,17,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ENOXAPARIN 30 MG/0.3 ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,0.3,mL,,17,14.45,4.8722,17,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),10.2,60,,percent of total billed charges,,
ENOXAPARIN 30 MG/0.3 ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,0.3,mL,,17,14.45,4.8722,17,"Health Partners, Inc.",State of Minnesota Advantage Program,13.855,81.5,,percent of total billed charges,,
ENOXAPARIN 30 MG/0.3 ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,0.3,mL,,17,14.45,4.8722,17,"Health Partners, Inc.",State Public Programs,8.5,50,,percent of total billed charges,,
ENOXAPARIN 30 MG/0.3 ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,0.3,mL,,17,14.45,4.8722,17,Humana Insurance Company,Commercial PPO,16.15,95,,percent of total billed charges,,
ENOXAPARIN 30 MG/0.3 ML SUBQ SYRG,,J1650,HCPCS,Facility,Outpatient,0.3,mL,,17,14.45,4.8722,17,Humana Insurance Company,Medicare PPO,8.33,49,,percent of total billed charges,,
ENOXAPARIN 30 MG/0.3 ML SUBQ SYRG,,J1650,HCPCS,Facility,Inpatient,0.3,mL,,17,14.45,4.8722,17,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
ENOXAPARIN 30 MG/0.3 ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,0.3,mL,,17,14.45,4.8722,17,Medica,Individual & Family,16.847,99.1,,percent of total billed charges,,
ENOXAPARIN 30 MG/0.3 ML SUBQ SYRG,,J1650,HCPCS,Facility,Outpatient,0.3,mL,,17,14.45,4.8722,17,Medica,Medica Advantage Solution,8.466,49.8,,percent of total billed charges,,
ENOXAPARIN 30 MG/0.3 ML SUBQ SYRG,,J1650,HCPCS,Facility,Inpatient,0.3,mL,,17,14.45,4.8722,17,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
ENOXAPARIN 30 MG/0.3 ML SUBQ SYRG,,J1650,HCPCS,Facility,Outpatient,0.3,mL,,17,14.45,4.8722,17,Medica,Medical Assistance,7.582,44.6,,percent of total billed charges,,
ENOXAPARIN 30 MG/0.3 ML SUBQ SYRG,,J1650,HCPCS,Facility,Inpatient,0.3,mL,,17,14.45,4.8722,17,Medica,Medical Assistance,,,,,Included in per diem rate,
ENOXAPARIN 30 MG/0.3 ML SUBQ SYRG,,J1650,HCPCS,Facility,Outpatient,0.3,mL,,17,14.45,4.8722,17,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,8.466,49.8,,percent of total billed charges,,
ENOXAPARIN 30 MG/0.3 ML SUBQ SYRG,,J1650,HCPCS,Facility,Inpatient,0.3,mL,,17,14.45,4.8722,17,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
ENOXAPARIN 30 MG/0.3 ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,0.3,mL,,17,14.45,4.8722,17,"Multiplan, Inc.","Multiplan, Inc.",15.98,94,,percent of total billed charges,,
ENOXAPARIN 30 MG/0.3 ML SUBQ SYRG,,J1650,HCPCS,Facility,Outpatient,0.3,mL,,17,14.45,4.8722,17,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,15.317,90.1,,percent of total billed charges,,
ENOXAPARIN 30 MG/0.3 ML SUBQ SYRG,,J1650,HCPCS,Facility,Inpatient,0.3,mL,,17,14.45,4.8722,17,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
ENOXAPARIN 30 MG/0.3 ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,0.3,mL,,17,14.45,4.8722,17,"Preferred One Administrative Services, INC.",PPO,16.762,98.6,,percent of total billed charges,,
ENOXAPARIN 30 MG/0.3 ML SUBQ SYRG,,J1650,HCPCS,Facility,Outpatient,0.3,mL,,17,14.45,4.8722,17,PrimeWest Health,Minnesota Senior Health Options (MSHO),8.7465,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
ENOXAPARIN 30 MG/0.3 ML SUBQ SYRG,,J1650,HCPCS,Facility,Inpatient,0.3,mL,,17,14.45,4.8722,17,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ENOXAPARIN 30 MG/0.3 ML SUBQ SYRG,,J1650,HCPCS,Facility,Outpatient,0.3,mL,,17,14.45,4.8722,17,PrimeWest Health,MinnesotaCare,8.7312,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
ENOXAPARIN 30 MG/0.3 ML SUBQ SYRG,,J1650,HCPCS,Facility,Inpatient,0.3,mL,,17,14.45,4.8722,17,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
ENOXAPARIN 30 MG/0.3 ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,0.3,mL,,17,14.45,4.8722,17,Sanford Health Plan,Sanford Health Plan,15.64,92,,percent of total billed charges,,
ENOXAPARIN 30 MG/0.3 ML SUBQ SYRG,,J1650,HCPCS,Facility,Outpatient,0.3,mL,,17,14.45,4.8722,17,"UCare Health, Inc.",Individual & Family Plan,9.5795,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
ENOXAPARIN 30 MG/0.3 ML SUBQ SYRG,,J1650,HCPCS,Facility,Inpatient,0.3,mL,,17,14.45,4.8722,17,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
ENOXAPARIN 30 MG/0.3 ML SUBQ SYRG,,J1650,HCPCS,Facility,Outpatient,0.3,mL,,17,14.45,4.8722,17,"UCare Health, Inc.",Medical Assistance,8.5799,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ENOXAPARIN 30 MG/0.3 ML SUBQ SYRG,,J1650,HCPCS,Facility,Inpatient,0.3,mL,,17,14.45,4.8722,17,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
ENOXAPARIN 30 MG/0.3 ML SUBQ SYRG,,J1650,HCPCS,Facility,Outpatient,0.3,mL,,17,14.45,4.8722,17,"UCare Health, Inc.",Medicare Advantage,8.5799,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ENOXAPARIN 30 MG/0.3 ML SUBQ SYRG,,J1650,HCPCS,Facility,Inpatient,0.3,mL,,17,14.45,4.8722,17,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ENOXAPARIN 30 MG/0.3 ML SUBQ SYRG,,J1650,HCPCS,Facility,Outpatient,0.3,mL,,17,14.45,4.8722,17,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),8.5799,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ENOXAPARIN 30 MG/0.3 ML SUBQ SYRG,,J1650,HCPCS,Facility,Inpatient,0.3,mL,,17,14.45,4.8722,17,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ENOXAPARIN 30 MG/0.3 ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,0.3,mL,,17,14.45,4.8722,17,UnitedHealthcare,Individual & Family,15.98,94,,percent of total billed charges,,
ENOXAPARIN 30 MG/0.3 ML SUBQ SYRG,,J1650,HCPCS,Facility,Outpatient,0.3,mL,,17,14.45,4.8722,17,UnitedHealthcare,Medicare Advantage,8.33,49,,percent of total billed charges,,
ENOXAPARIN 30 MG/0.3 ML SUBQ SYRG,,J1650,HCPCS,Facility,Inpatient,0.3,mL,,17,14.45,4.8722,17,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
ENOXAPARIN 30 MG/0.3 ML SUBQ SYRG,,J1650,HCPCS,Facility,Outpatient,0.3,mL,,17,14.45,4.8722,17,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,8.16,48,,percent of total billed charges,,100% of DHS outpatient percentage
ENOXAPARIN 30 MG/0.3 ML SUBQ SYRG,,J1650,HCPCS,Facility,Inpatient,0.3,mL,,17,14.45,4.8722,17,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
PULMONARY EMBOLISM WITHOUT MCC,,176,MS-DRG,Facility,Inpatient,,,,38050,32342.5,34283.05,36539.415,America's PPO,America's PPO,36539.415,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
PULMONARY EMBOLISM WITHOUT MCC,,176,MS-DRG,Facility,Inpatient,,,,38050,32342.5,34283.05,36539.415,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,34283.05,,,Other ,DRG,"DRG weight 0.8176 x WOO $13,372.00; Cap at 95% of charge; minimum of 90.1% of charge"
RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH MCC,,177,MS-DRG,Facility,Inpatient,,,,22354.30385,19001.15827,21236.58865,21466.83798,America's PPO,America's PPO,21466.83798,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH MCC,,177,MS-DRG,Facility,Inpatient,,,,22354.30385,19001.15827,21236.58865,21466.83798,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,21236.58865,,,Other,DRG,"DRG weight 1.7799 x WOO $13,372.00; Cap at 95% of charge; minimum of 90.1% of charge"
RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH CC,,178,MS-DRG,Facility,Inpatient,,,,12228.41824,10394.1555,11616.99732,11742.95003,America's PPO,America's PPO,11742.95003,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH CC,,178,MS-DRG,Facility,Inpatient,,,,12228.41824,10394.1555,11616.99732,11742.95003,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,11616.99732,,,Other ,DRG,"DRG weight 1.087 x WOO $13,372.00; Cap at 95% of charge; minimum of 90.1% of charge"
RESPIRATORY INFECTIONS AND INFLAMMATIONS WITHOUT CC/MCC,,179,MS-DRG,Facility,Inpatient,,,,19421.13571,16507.96536,17498.44328,18650.11663,America's PPO,America's PPO,18650.11663,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
RESPIRATORY INFECTIONS AND INFLAMMATIONS WITHOUT CC/MCC,,179,MS-DRG,Facility,Inpatient,,,,19421.13571,16507.96536,17498.44328,18650.11663,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,17498.44328,,,Other,DRG,"DRG weight 0.7854 x WOO $13,372.00; Cap at 95% of charge; minimum of 90.1% of charge"
RESPIRATORY NEOPLASMS WITH MCC,,180,MS-DRG,Facility,Inpatient,,,,7986,6788.1,7586.7,7668.9558,America's PPO,America's PPO,7668.9558,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
RESPIRATORY NEOPLASMS WITH MCC,,180,MS-DRG,Facility,Inpatient,,,,7986,6788.1,7586.7,7668.9558,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,7586.7,,,Other ,DRG,"DRG weight 1.6939 x WOO $13,372.00; Cap at 95% of charge; minimum of 90.1% of charge"
PLEURAL EFFUSION WITH MCC,,186,MS-DRG,Facility,Inpatient,,,,9011,7659.35,8560.45,8653.2633,America's PPO,America's PPO,8653.2633,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
PLEURAL EFFUSION WITH MCC,,186,MS-DRG,Facility,Inpatient,,,,9011,7659.35,8560.45,8653.2633,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,8560.45,,,Other ,DRG,"DRG weight 1.5268 x WOO $13,372.00; Cap at 95% of charge; minimum of 90.1% of charge"
CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH MCC,,190,MS-DRG,Facility,Inpatient,,,,8152,6929.2,7744.4,7828.3656,America's PPO,America's PPO,7828.3656,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH MCC,,190,MS-DRG,Facility,Inpatient,,,,8152,6929.2,7744.4,7828.3656,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,7744.4,,,Other ,DRG,"DRG weight 1.0855 x WOO $13,372.00; Cap at 95% of charge; minimum of 90.1% of charge"
CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH CC,,191,MS-DRG,Facility,Inpatient,,,,18774,15957.9,16915.374,18028.6722,America's PPO,America's PPO,18028.6722,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH CC,,191,MS-DRG,Facility,Inpatient,,,,18774,15957.9,16915.374,18028.6722,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,16915.374,,,Other ,DRG,"DRG weight 0.8642 x WOO $13,372.00; Cap at 95% of charge; minimum of 90.1% of charge"
CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITHOUT CC/MCC,,192,MS-DRG,Facility,Inpatient,,,,9285,7892.25,8719.8812,8916.3855,America's PPO,America's PPO,8916.3855,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITHOUT CC/MCC,,192,MS-DRG,Facility,Inpatient,,,,9285,7892.25,8719.8812,8916.3855,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,8719.8812,,,Other ,DRG,"DRG weight 0.6521 x WOO $13,372.00; Cap at 95% of charge; minimum of 90.1% of charge"
SIMPLE PNEUMONIA AND PLEURISY WITH MCC,,193,MS-DRG,Facility,Inpatient,,,,15104.665,12838.96525,14349.43175,14505.0098,America's PPO,America's PPO,14505.0098,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SIMPLE PNEUMONIA AND PLEURISY WITH MCC,,193,MS-DRG,Facility,Inpatient,,,,15104.665,12838.96525,14349.43175,14505.0098,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,14349.43175,,,Other ,DRG,"DRG weight 1.2987 x WOO $13,372.00; Cap at 95% of charge; minimum of 90.1% of charge"
SIMPLE PNEUMONIA AND PLEURISY WITH CC,,194,MS-DRG,Facility,Inpatient,,,,10948.90684,9306.570816,10401.4615,10514.23524,America's PPO,America's PPO,10514.23524,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SIMPLE PNEUMONIA AND PLEURISY WITH CC,,194,MS-DRG,Facility,Inpatient,,,,10948.90684,9306.570816,10401.4615,10514.23524,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,10401.4615,,,Other ,DRG,"DRG weight 0.8402 x WOO $13,372.00; Cap at 95% of charge; minimum of 90.1% of charge"
SIMPLE PNEUMONIA AND PLEURISY WITHOUT CC/MCC,,195,MS-DRG,Facility,Inpatient,,,,10301.90286,8756.617429,9282.014474,9892.917314,America's PPO,America's PPO,9892.917314,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SIMPLE PNEUMONIA AND PLEURISY WITHOUT CC/MCC,,195,MS-DRG,Facility,Inpatient,,,,10301.90286,8756.617429,9282.014474,9892.917314,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,9282.014474,,,Other ,DRG,"DRG weight 0.6418 x WOO $13,372.00; Cap at 95% of charge; minimum of 90.1% of charge"
PNEUMOTHORAX WITH CC,,200,MS-DRG,Facility,Inpatient,,,,10114,8596.9,9608.3,9712.4742,America's PPO,America's PPO,9712.4742,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
PNEUMOTHORAX WITH CC,,200,MS-DRG,Facility,Inpatient,,,,10114,8596.9,9608.3,9712.4742,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,9608.3,,,Other ,DRG,"DRG weight 1.072 x WOO $13,372.00; Cap at 95% of charge; minimum of 90.1% of charge"
BRONCHITIS AND ASTHMA WITHOUT CC/MCC,,203,MS-DRG,Facility,Inpatient,,,,8324,7075.4,7907.8,7993.5372,America's PPO,America's PPO,7993.5372,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
BRONCHITIS AND ASTHMA WITHOUT CC/MCC,,203,MS-DRG,Facility,Inpatient,,,,8324,7075.4,7907.8,7993.5372,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,7907.8,,,Other,DRG,"DRG weight 0.6671 x WOO $13,372.00; Cap at 95% of charge; minimum of 90.1% of charge"
DARBEPOETIN ALFA IN POLYSORBAT 200 MCG/0.4 ML INJ SYRG,,J0881,HCPCS,Facility,Both,0.4,mL,,5573,4737.05,1597.2218,5573,Aetna,Commercial,5127.16,92,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 200 MCG/0.4 ML INJ SYRG,,J0881,HCPCS,Facility,Outpatient,0.4,mL,,5573,4737.05,1597.2218,5573,Aetna,Medicare Advantage,2730.77,49,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 200 MCG/0.4 ML INJ SYRG,,J0881,HCPCS,Facility,Inpatient,0.4,mL,,5573,4737.05,1597.2218,5573,Aetna,Medicare Advantage,,,,,Included in per diem rate,
DARBEPOETIN ALFA IN POLYSORBAT 200 MCG/0.4 ML INJ SYRG,,J0881,HCPCS,Facility,Both,0.4,mL,,5573,4737.05,1597.2218,5573,Aetna,PPO,5182.89,93,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 200 MCG/0.4 ML INJ SYRG,,J0881,HCPCS,Facility,Both,0.4,mL,,5573,4737.05,1597.2218,5573,America's PPO,America's PPO,5351.7519,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
DARBEPOETIN ALFA IN POLYSORBAT 200 MCG/0.4 ML INJ SYRG,,J0881,HCPCS,Facility,Both,0.4,mL,,5573,4737.05,1597.2218,5573,BlueCross BlueShield Minnesota, Federal Employee Program,5483.832,98.4,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 200 MCG/0.4 ML INJ SYRG,,J0881,HCPCS,Facility,Both,0.4,mL,,5573,4737.05,1597.2218,5573,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5573,100,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 200 MCG/0.4 ML INJ SYRG,,J0881,HCPCS,Facility,Both,0.4,mL,,5573,4737.05,1597.2218,5573,BlueCross BlueShield Minnesota,High Value Network Plan,5015.7,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
DARBEPOETIN ALFA IN POLYSORBAT 200 MCG/0.4 ML INJ SYRG,,J0881,HCPCS,Facility,Outpatient,0.4,mL,,5573,4737.05,1597.2218,5573,BlueCross BlueShield Minnesota,Medicare Advantage,2730.77,49,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 200 MCG/0.4 ML INJ SYRG,,J0881,HCPCS,Facility,Inpatient,0.4,mL,,5573,4737.05,1597.2218,5573,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
DARBEPOETIN ALFA IN POLYSORBAT 200 MCG/0.4 ML INJ SYRG,,J0881,HCPCS,Facility,Both,0.4,mL,,5573,4737.05,1597.2218,5573,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4936.0061,88.57,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 200 MCG/0.4 ML INJ SYRG,,J0881,HCPCS,Facility,Both,0.4,mL,,5573,4737.05,1597.2218,5573,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1597.2218,28.66,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 200 MCG/0.4 ML INJ SYRG,,J0881,HCPCS,Facility,Outpatient,0.4,mL,,5573,4737.05,1597.2218,5573,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2730.77,49,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 200 MCG/0.4 ML INJ SYRG,,J0881,HCPCS,Facility,Inpatient,0.4,mL,,5573,4737.05,1597.2218,5573,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
DARBEPOETIN ALFA IN POLYSORBAT 200 MCG/0.4 ML INJ SYRG,,J0881,HCPCS,Facility,Both,0.4,mL,,5573,4737.05,1597.2218,5573,CorVel,Worker's Compensation,5573,100,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 200 MCG/0.4 ML INJ SYRG,,J0881,HCPCS,Facility,Both,0.4,mL,,5573,4737.05,1597.2218,5573,First Health Group Corporation,First Health Network,5405.81,97,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 200 MCG/0.4 ML INJ SYRG,,J0881,HCPCS,Facility,Both,0.4,mL,,5573,4737.05,1597.2218,5573,"Health Partners, Inc.",Commercial,5272.058,94.6,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 200 MCG/0.4 ML INJ SYRG,,J0881,HCPCS,Facility,Outpatient,0.4,mL,,5573,4737.05,1597.2218,5573,"Health Partners, Inc.",Medicare Advantage,2730.77,49,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 200 MCG/0.4 ML INJ SYRG,,J0881,HCPCS,Facility,Inpatient,0.4,mL,,5573,4737.05,1597.2218,5573,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DARBEPOETIN ALFA IN POLYSORBAT 200 MCG/0.4 ML INJ SYRG,,J0881,HCPCS,Facility,Both,0.4,mL,,5573,4737.05,1597.2218,5573,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3343.8,60,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 200 MCG/0.4 ML INJ SYRG,,J0881,HCPCS,Facility,Both,0.4,mL,,5573,4737.05,1597.2218,5573,"Health Partners, Inc.",State of Minnesota Advantage Program,4541.995,81.5,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 200 MCG/0.4 ML INJ SYRG,,J0881,HCPCS,Facility,Both,0.4,mL,,5573,4737.05,1597.2218,5573,"Health Partners, Inc.",State Public Programs,2786.5,50,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 200 MCG/0.4 ML INJ SYRG,,J0881,HCPCS,Facility,Both,0.4,mL,,5573,4737.05,1597.2218,5573,Humana Insurance Company,Commercial PPO,5294.35,95,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 200 MCG/0.4 ML INJ SYRG,,J0881,HCPCS,Facility,Outpatient,0.4,mL,,5573,4737.05,1597.2218,5573,Humana Insurance Company,Medicare PPO,2730.77,49,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 200 MCG/0.4 ML INJ SYRG,,J0881,HCPCS,Facility,Inpatient,0.4,mL,,5573,4737.05,1597.2218,5573,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
DARBEPOETIN ALFA IN POLYSORBAT 200 MCG/0.4 ML INJ SYRG,,J0881,HCPCS,Facility,Both,0.4,mL,,5573,4737.05,1597.2218,5573,Medica,Individual & Family,5522.843,99.1,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 200 MCG/0.4 ML INJ SYRG,,J0881,HCPCS,Facility,Outpatient,0.4,mL,,5573,4737.05,1597.2218,5573,Medica,Medica Advantage Solution,2775.354,49.8,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 200 MCG/0.4 ML INJ SYRG,,J0881,HCPCS,Facility,Inpatient,0.4,mL,,5573,4737.05,1597.2218,5573,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
DARBEPOETIN ALFA IN POLYSORBAT 200 MCG/0.4 ML INJ SYRG,,J0881,HCPCS,Facility,Outpatient,0.4,mL,,5573,4737.05,1597.2218,5573,Medica,Medical Assistance,2485.558,44.6,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 200 MCG/0.4 ML INJ SYRG,,J0881,HCPCS,Facility,Inpatient,0.4,mL,,5573,4737.05,1597.2218,5573,Medica,Medical Assistance,,,,,Included in per diem rate,
DARBEPOETIN ALFA IN POLYSORBAT 200 MCG/0.4 ML INJ SYRG,,J0881,HCPCS,Facility,Outpatient,0.4,mL,,5573,4737.05,1597.2218,5573,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2775.354,49.8,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 200 MCG/0.4 ML INJ SYRG,,J0881,HCPCS,Facility,Inpatient,0.4,mL,,5573,4737.05,1597.2218,5573,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
DARBEPOETIN ALFA IN POLYSORBAT 200 MCG/0.4 ML INJ SYRG,,J0881,HCPCS,Facility,Both,0.4,mL,,5573,4737.05,1597.2218,5573,"Multiplan, Inc.","Multiplan, Inc.",5238.62,94,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 200 MCG/0.4 ML INJ SYRG,,J0881,HCPCS,Facility,Outpatient,0.4,mL,,5573,4737.05,1597.2218,5573,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,5021.273,90.1,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 200 MCG/0.4 ML INJ SYRG,,J0881,HCPCS,Facility,Inpatient,0.4,mL,,5573,4737.05,1597.2218,5573,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
DARBEPOETIN ALFA IN POLYSORBAT 200 MCG/0.4 ML INJ SYRG,,J0881,HCPCS,Facility,Both,0.4,mL,,5573,4737.05,1597.2218,5573,"Preferred One Administrative Services, INC.",PPO,5494.978,98.6,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 200 MCG/0.4 ML INJ SYRG,,J0881,HCPCS,Facility,Outpatient,0.4,mL,,5573,4737.05,1597.2218,5573,PrimeWest Health,Minnesota Senior Health Options (MSHO),2867.3085,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
DARBEPOETIN ALFA IN POLYSORBAT 200 MCG/0.4 ML INJ SYRG,,J0881,HCPCS,Facility,Inpatient,0.4,mL,,5573,4737.05,1597.2218,5573,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DARBEPOETIN ALFA IN POLYSORBAT 200 MCG/0.4 ML INJ SYRG,,J0881,HCPCS,Facility,Outpatient,0.4,mL,,5573,4737.05,1597.2218,5573,PrimeWest Health,MinnesotaCare,2862.2928,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
DARBEPOETIN ALFA IN POLYSORBAT 200 MCG/0.4 ML INJ SYRG,,J0881,HCPCS,Facility,Inpatient,0.4,mL,,5573,4737.05,1597.2218,5573,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
DARBEPOETIN ALFA IN POLYSORBAT 200 MCG/0.4 ML INJ SYRG,,J0881,HCPCS,Facility,Both,0.4,mL,,5573,4737.05,1597.2218,5573,Sanford Health Plan,Sanford Health Plan,5127.16,92,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 200 MCG/0.4 ML INJ SYRG,,J0881,HCPCS,Facility,Outpatient,0.4,mL,,5573,4737.05,1597.2218,5573,"UCare Health, Inc.",Individual & Family Plan,3140.3855,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
DARBEPOETIN ALFA IN POLYSORBAT 200 MCG/0.4 ML INJ SYRG,,J0881,HCPCS,Facility,Inpatient,0.4,mL,,5573,4737.05,1597.2218,5573,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
DARBEPOETIN ALFA IN POLYSORBAT 200 MCG/0.4 ML INJ SYRG,,J0881,HCPCS,Facility,Outpatient,0.4,mL,,5573,4737.05,1597.2218,5573,"UCare Health, Inc.",Medical Assistance,2812.6931,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DARBEPOETIN ALFA IN POLYSORBAT 200 MCG/0.4 ML INJ SYRG,,J0881,HCPCS,Facility,Inpatient,0.4,mL,,5573,4737.05,1597.2218,5573,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
DARBEPOETIN ALFA IN POLYSORBAT 200 MCG/0.4 ML INJ SYRG,,J0881,HCPCS,Facility,Outpatient,0.4,mL,,5573,4737.05,1597.2218,5573,"UCare Health, Inc.",Medicare Advantage,2812.6931,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DARBEPOETIN ALFA IN POLYSORBAT 200 MCG/0.4 ML INJ SYRG,,J0881,HCPCS,Facility,Inpatient,0.4,mL,,5573,4737.05,1597.2218,5573,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DARBEPOETIN ALFA IN POLYSORBAT 200 MCG/0.4 ML INJ SYRG,,J0881,HCPCS,Facility,Outpatient,0.4,mL,,5573,4737.05,1597.2218,5573,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2812.6931,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DARBEPOETIN ALFA IN POLYSORBAT 200 MCG/0.4 ML INJ SYRG,,J0881,HCPCS,Facility,Inpatient,0.4,mL,,5573,4737.05,1597.2218,5573,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DARBEPOETIN ALFA IN POLYSORBAT 200 MCG/0.4 ML INJ SYRG,,J0881,HCPCS,Facility,Both,0.4,mL,,5573,4737.05,1597.2218,5573,UnitedHealthcare,Individual & Family,5238.62,94,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 200 MCG/0.4 ML INJ SYRG,,J0881,HCPCS,Facility,Outpatient,0.4,mL,,5573,4737.05,1597.2218,5573,UnitedHealthcare,Medicare Advantage,2730.77,49,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 200 MCG/0.4 ML INJ SYRG,,J0881,HCPCS,Facility,Inpatient,0.4,mL,,5573,4737.05,1597.2218,5573,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
DARBEPOETIN ALFA IN POLYSORBAT 200 MCG/0.4 ML INJ SYRG,,J0881,HCPCS,Facility,Outpatient,0.4,mL,,5573,4737.05,1597.2218,5573,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2675.04,48,,percent of total billed charges,,100% of DHS outpatient percentage
DARBEPOETIN ALFA IN POLYSORBAT 200 MCG/0.4 ML INJ SYRG,,J0881,HCPCS,Facility,Inpatient,0.4,mL,,5573,4737.05,1597.2218,5573,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
RESPIRATORY SIGNS AND SYMPTOMS,,204,MS-DRG,Facility,Inpatient,,,,8033,6828.05,7631.35,7714.0899,America's PPO,America's PPO,7714.0899,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
RESPIRATORY SIGNS AND SYMPTOMS,,204,MS-DRG,Facility,Inpatient,,,,8033,6828.05,7631.35,7714.0899,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,7631.35,,,Other ,DRG,"DRG weight 0.8094 x WOO $13,372.00; Cap at 95% of charge; minimum of 90.1% of charge"
OTHER RESPIRATORY SYSTEM DIAGNOSES WITHOUT MCC,,206,MS-DRG,Facility,Inpatient,,,,8391,7132.35,7971.45,8057.8773,America's PPO,America's PPO,8057.8773,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
OTHER RESPIRATORY SYSTEM DIAGNOSES WITHOUT MCC,,206,MS-DRG,Facility,Inpatient,,,,8391,7132.35,7971.45,8057.8773,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,7971.45,,,Other ,DRG,"DRG weight 0.8934 x WOO $13,372.00; Cap at 95% of charge; minimum of 90.1% of charge"
"ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH MCC",,280,MS-DRG,Facility,Inpatient,,,,9570,8134.5,9091.5,9190.071,America's PPO,America's PPO,9190.071,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH MCC",,280,MS-DRG,Facility,Inpatient,,,,9570,8134.5,9091.5,9190.071,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,9091.5,,,Other,DRG,"DRG weight 1.6064 x WOO $13,372.00; Cap at 95% of charge; minimum of 90.1% of charge"
"ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH CC",,281,MS-DRG,Facility,Inpatient,,,,33282.95,28290.5075,29987.93795,31961.61689,America's PPO,America's PPO,31961.61689,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH CC",,281,MS-DRG,Facility,Inpatient,,,,33282.95,28290.5075,29987.93795,31961.61689,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,29987.93795,,,Other,DRG,"DRG weight 0.9186 x WOO $13,372.00; Cap at 95% of charge; minimum of 90.1% of charge"
"ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH MCC",,283,MS-DRG,Facility,Inpatient,,,,1843,1566.55,1750.85,1769.8329,America's PPO,America's PPO,1769.8329,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH MCC",,283,MS-DRG,Facility,Inpatient,,,,1843,1566.55,1750.85,1769.8329,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1750.85,,,Other,DRG,"DRG weight 1.9186 x WOO $13,372.00; Cap at 95% of charge; minimum of 90.1% of charge"
"ACUTE MYOCARDIAL INFARCTION, EXPIRED WITHOUT CC/MCC",,285,MS-DRG,Facility,Inpatient,,,,4587,3898.95,4357.65,4404.8961,America's PPO,America's PPO,4404.8961,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"ACUTE MYOCARDIAL INFARCTION, EXPIRED WITHOUT CC/MCC",,285,MS-DRG,Facility,Inpatient,,,,4587,3898.95,4357.65,4404.8961,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4357.65,,,Other,DRG,"DRG weight 0.5418 x WOO $13,372.00; Cap at 95% of charge; minimum of 90.1% of charge"
ENOXAPARIN 40 MG/0.4 ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,0.4,mL,,23,19.55,6.5918,23,Aetna,Commercial,21.16,92,,percent of total billed charges,,
ENOXAPARIN 40 MG/0.4 ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,0.4,mL,,23,19.55,6.5918,23,Aetna,Commercial,21.16,92,,percent of total billed charges,,
ENOXAPARIN 40 MG/0.4 ML SUBQ SYRG,,J1650,HCPCS,Facility,Outpatient,0.4,mL,,23,19.55,6.5918,23,Aetna,Medicare Advantage,11.27,49,,percent of total billed charges,,
ENOXAPARIN 40 MG/0.4 ML SUBQ SYRG,,J1650,HCPCS,Facility,Outpatient,0.4,mL,,23,19.55,6.5918,23,Aetna,Medicare Advantage,11.27,49,,percent of total billed charges,,
ENOXAPARIN 40 MG/0.4 ML SUBQ SYRG,,J1650,HCPCS,Facility,Inpatient,0.4,mL,,23,19.55,6.5918,23,Aetna,Medicare Advantage,,,,,Included in per diem rate,
ENOXAPARIN 40 MG/0.4 ML SUBQ SYRG,,J1650,HCPCS,Facility,Inpatient,0.4,mL,,23,19.55,6.5918,23,Aetna,Medicare Advantage,,,,,Included in per diem rate,
ENOXAPARIN 40 MG/0.4 ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,0.4,mL,,23,19.55,6.5918,23,Aetna,PPO,21.39,93,,percent of total billed charges,,
ENOXAPARIN 40 MG/0.4 ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,0.4,mL,,23,19.55,6.5918,23,Aetna,PPO,21.39,93,,percent of total billed charges,,
ENOXAPARIN 40 MG/0.4 ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,0.4,mL,,23,19.55,6.5918,23,America's PPO,America's PPO,22.0869,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
ENOXAPARIN 40 MG/0.4 ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,0.4,mL,,23,19.55,6.5918,23,America's PPO,America's PPO,22.0869,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
ENOXAPARIN 40 MG/0.4 ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,0.4,mL,,23,19.55,6.5918,23,BlueCross BlueShield Minnesota, Federal Employee Program,22.632,98.4,,percent of total billed charges,,
ENOXAPARIN 40 MG/0.4 ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,0.4,mL,,23,19.55,6.5918,23,BlueCross BlueShield Minnesota, Federal Employee Program,22.632,98.4,,percent of total billed charges,,
ENOXAPARIN 40 MG/0.4 ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,0.4,mL,,23,19.55,6.5918,23,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,23,100,,percent of total billed charges,,
ENOXAPARIN 40 MG/0.4 ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,0.4,mL,,23,19.55,6.5918,23,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,23,100,,percent of total billed charges,,
ENOXAPARIN 40 MG/0.4 ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,0.4,mL,,23,19.55,6.5918,23,BlueCross BlueShield Minnesota,High Value Network Plan,20.7,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
ENOXAPARIN 40 MG/0.4 ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,0.4,mL,,23,19.55,6.5918,23,BlueCross BlueShield Minnesota,High Value Network Plan,20.7,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
ENOXAPARIN 40 MG/0.4 ML SUBQ SYRG,,J1650,HCPCS,Facility,Outpatient,0.4,mL,,23,19.55,6.5918,23,BlueCross BlueShield Minnesota,Medicare Advantage,11.27,49,,percent of total billed charges,,
ENOXAPARIN 40 MG/0.4 ML SUBQ SYRG,,J1650,HCPCS,Facility,Outpatient,0.4,mL,,23,19.55,6.5918,23,BlueCross BlueShield Minnesota,Medicare Advantage,11.27,49,,percent of total billed charges,,
ENOXAPARIN 40 MG/0.4 ML SUBQ SYRG,,J1650,HCPCS,Facility,Inpatient,0.4,mL,,23,19.55,6.5918,23,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
ENOXAPARIN 40 MG/0.4 ML SUBQ SYRG,,J1650,HCPCS,Facility,Inpatient,0.4,mL,,23,19.55,6.5918,23,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
ENOXAPARIN 40 MG/0.4 ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,0.4,mL,,23,19.55,6.5918,23,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,20.3711,88.57,,percent of total billed charges,,
ENOXAPARIN 40 MG/0.4 ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,0.4,mL,,23,19.55,6.5918,23,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,20.3711,88.57,,percent of total billed charges,,
ENOXAPARIN 40 MG/0.4 ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,0.4,mL,,23,19.55,6.5918,23,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,6.5918,28.66,,percent of total billed charges,,
ENOXAPARIN 40 MG/0.4 ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,0.4,mL,,23,19.55,6.5918,23,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,6.5918,28.66,,percent of total billed charges,,
ENOXAPARIN 40 MG/0.4 ML SUBQ SYRG,,J1650,HCPCS,Facility,Outpatient,0.4,mL,,23,19.55,6.5918,23,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),11.27,49,,percent of total billed charges,,
ENOXAPARIN 40 MG/0.4 ML SUBQ SYRG,,J1650,HCPCS,Facility,Outpatient,0.4,mL,,23,19.55,6.5918,23,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),11.27,49,,percent of total billed charges,,
ENOXAPARIN 40 MG/0.4 ML SUBQ SYRG,,J1650,HCPCS,Facility,Inpatient,0.4,mL,,23,19.55,6.5918,23,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
ENOXAPARIN 40 MG/0.4 ML SUBQ SYRG,,J1650,HCPCS,Facility,Inpatient,0.4,mL,,23,19.55,6.5918,23,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
ENOXAPARIN 40 MG/0.4 ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,0.4,mL,,23,19.55,6.5918,23,CorVel,Worker's Compensation,23,100,,percent of total billed charges,,
ENOXAPARIN 40 MG/0.4 ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,0.4,mL,,23,19.55,6.5918,23,CorVel,Worker's Compensation,23,100,,percent of total billed charges,,
ENOXAPARIN 40 MG/0.4 ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,0.4,mL,,23,19.55,6.5918,23,First Health Group Corporation,First Health Network,22.31,97,,percent of total billed charges,,
ENOXAPARIN 40 MG/0.4 ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,0.4,mL,,23,19.55,6.5918,23,First Health Group Corporation,First Health Network,22.31,97,,percent of total billed charges,,
ENOXAPARIN 40 MG/0.4 ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,0.4,mL,,23,19.55,6.5918,23,"Health Partners, Inc.",Commercial,21.758,94.6,,percent of total billed charges,,
ENOXAPARIN 40 MG/0.4 ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,0.4,mL,,23,19.55,6.5918,23,"Health Partners, Inc.",Commercial,21.758,94.6,,percent of total billed charges,,
ENOXAPARIN 40 MG/0.4 ML SUBQ SYRG,,J1650,HCPCS,Facility,Outpatient,0.4,mL,,23,19.55,6.5918,23,"Health Partners, Inc.",Medicare Advantage,11.27,49,,percent of total billed charges,,
ENOXAPARIN 40 MG/0.4 ML SUBQ SYRG,,J1650,HCPCS,Facility,Outpatient,0.4,mL,,23,19.55,6.5918,23,"Health Partners, Inc.",Medicare Advantage,11.27,49,,percent of total billed charges,,
ENOXAPARIN 40 MG/0.4 ML SUBQ SYRG,,J1650,HCPCS,Facility,Inpatient,0.4,mL,,23,19.55,6.5918,23,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ENOXAPARIN 40 MG/0.4 ML SUBQ SYRG,,J1650,HCPCS,Facility,Inpatient,0.4,mL,,23,19.55,6.5918,23,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ENOXAPARIN 40 MG/0.4 ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,0.4,mL,,23,19.55,6.5918,23,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),13.8,60,,percent of total billed charges,,
ENOXAPARIN 40 MG/0.4 ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,0.4,mL,,23,19.55,6.5918,23,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),13.8,60,,percent of total billed charges,,
ENOXAPARIN 40 MG/0.4 ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,0.4,mL,,23,19.55,6.5918,23,"Health Partners, Inc.",State of Minnesota Advantage Program,18.745,81.5,,percent of total billed charges,,
ENOXAPARIN 40 MG/0.4 ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,0.4,mL,,23,19.55,6.5918,23,"Health Partners, Inc.",State of Minnesota Advantage Program,18.745,81.5,,percent of total billed charges,,
ENOXAPARIN 40 MG/0.4 ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,0.4,mL,,23,19.55,6.5918,23,"Health Partners, Inc.",State Public Programs,11.5,50,,percent of total billed charges,,
ENOXAPARIN 40 MG/0.4 ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,0.4,mL,,23,19.55,6.5918,23,"Health Partners, Inc.",State Public Programs,11.5,50,,percent of total billed charges,,
ENOXAPARIN 40 MG/0.4 ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,0.4,mL,,23,19.55,6.5918,23,Humana Insurance Company,Commercial PPO,21.85,95,,percent of total billed charges,,
ENOXAPARIN 40 MG/0.4 ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,0.4,mL,,23,19.55,6.5918,23,Humana Insurance Company,Commercial PPO,21.85,95,,percent of total billed charges,,
ENOXAPARIN 40 MG/0.4 ML SUBQ SYRG,,J1650,HCPCS,Facility,Outpatient,0.4,mL,,23,19.55,6.5918,23,Humana Insurance Company,Medicare PPO,11.27,49,,percent of total billed charges,,
ENOXAPARIN 40 MG/0.4 ML SUBQ SYRG,,J1650,HCPCS,Facility,Outpatient,0.4,mL,,23,19.55,6.5918,23,Humana Insurance Company,Medicare PPO,11.27,49,,percent of total billed charges,,
ENOXAPARIN 40 MG/0.4 ML SUBQ SYRG,,J1650,HCPCS,Facility,Inpatient,0.4,mL,,23,19.55,6.5918,23,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
ENOXAPARIN 40 MG/0.4 ML SUBQ SYRG,,J1650,HCPCS,Facility,Inpatient,0.4,mL,,23,19.55,6.5918,23,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
ENOXAPARIN 40 MG/0.4 ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,0.4,mL,,23,19.55,6.5918,23,Medica,Individual & Family,22.793,99.1,,percent of total billed charges,,
ENOXAPARIN 40 MG/0.4 ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,0.4,mL,,23,19.55,6.5918,23,Medica,Individual & Family,22.793,99.1,,percent of total billed charges,,
ENOXAPARIN 40 MG/0.4 ML SUBQ SYRG,,J1650,HCPCS,Facility,Outpatient,0.4,mL,,23,19.55,6.5918,23,Medica,Medica Advantage Solution,11.454,49.8,,percent of total billed charges,,
ENOXAPARIN 40 MG/0.4 ML SUBQ SYRG,,J1650,HCPCS,Facility,Outpatient,0.4,mL,,23,19.55,6.5918,23,Medica,Medica Advantage Solution,11.454,49.8,,percent of total billed charges,,
ACUTE AND SUBACUTE ENDOCARDITIS WITH CC,,289,MS-DRG,Facility,Inpatient,,,,14860,12631,14117,14270.058,America's PPO,America's PPO,14270.058,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
ACUTE AND SUBACUTE ENDOCARDITIS WITH CC,,289,MS-DRG,Facility,Inpatient,,,,14860,12631,14117,14270.058,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,14117,,,Other,DRG,"DRG weight 1.6071 x WOO $13,372.00; Cap at 95% of charge; minimum of 90.1% of charge"
HEART FAILURE AND SHOCK WITH MCC,,291,MS-DRG,Facility,Inpatient,,,,9876.759,8395.24515,9382.92105,9484.651668,America's PPO,America's PPO,9484.651668,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
HEART FAILURE AND SHOCK WITH MCC,,291,MS-DRG,Facility,Inpatient,,,,9876.759,8395.24515,9382.92105,9484.651668,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,9382.92105,,,Other,DRG,"DRG weight 1.2798 x WOO $13,372.00; Cap at 95% of charge; minimum of 90.1% of charge"
HEART FAILURE AND SHOCK WITH CC,,292,MS-DRG,Facility,Inpatient,,,,15877.99333,13496.29433,14306.07199,15247.637,America's PPO,America's PPO,15247.637,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
HEART FAILURE AND SHOCK WITH CC,,292,MS-DRG,Facility,Inpatient,,,,15877.99333,13496.29433,14306.07199,15247.637,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,14306.07199,,,Other ,DRG,"DRG weight 0.8628 x WOO $13,372.00; Cap at 95% of charge; minimum of 90.1% of charge"
HEART FAILURE AND SHOCK WITHOUT CC/MCC,,293,MS-DRG,Facility,Inpatient,,,,2639,2243.15,2507.05,2534.2317,America's PPO,America's PPO,2534.2317,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
HEART FAILURE AND SHOCK WITHOUT CC/MCC,,293,MS-DRG,Facility,Inpatient,,,,2639,2243.15,2507.05,2534.2317,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,2507.05,,,Other,DRG,"DRG weight 0.5603 x WOO $13,372.00; Cap at 95% of charge; minimum of 90.1% of charge"
HYPERTENSION WITHOUT MCC,,305,MS-DRG,Facility,Inpatient,,,,8336.5,7086.025,7919.675,8005.54095,America's PPO,America's PPO,8005.54095,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
HYPERTENSION WITHOUT MCC,,305,MS-DRG,Facility,Inpatient,,,,8336.5,7086.025,7919.675,8005.54095,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,7919.675,,,Other ,DRG,"DRG weight 0.7456 x WOO $13,372.00; Cap at 95% of charge; minimum of 90.1% of charge"
CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH MCC,,308,MS-DRG,Facility,Inpatient,,,,5238.5,4452.725,4976.575,5030.53155,America's PPO,America's PPO,5030.53155,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH MCC,,308,MS-DRG,Facility,Inpatient,,,,5238.5,4452.725,4976.575,5030.53155,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4976.575,,,Other,DRG,"DRG weight 1.1726 x WOO $13,372.00; Cap at 95% of charge; minimum of 90.1% of charge"
CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH CC,,309,MS-DRG,Facility,Inpatient,,,,9608.702222,8167.396889,9128.267111,9227.236744,America's PPO,America's PPO,9227.236744,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH CC,,309,MS-DRG,Facility,Inpatient,,,,9608.702222,8167.396889,9128.267111,9227.236744,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,9128.267111,,,Other,DRG,"DRG weight 0.7376 x WOO $13,372.00; Cap at 95% of charge; minimum of 90.1% of charge"
CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITHOUT CC/MCC,,310,MS-DRG,Facility,Inpatient,,,,3454.777778,2936.561111,3282.038889,3317.6231,America's PPO,America's PPO,3317.6231,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITHOUT CC/MCC,,310,MS-DRG,Facility,Inpatient,,,,3454.777778,2936.561111,3282.038889,3317.6231,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,3282.038889,,,Other ,DRG,"DRG weight 0.5512 x WOO $13,372.00; Cap at 95% of charge; minimum of 90.1% of charge"
OTHER CIRCULATORY SYSTEM DIAGNOSES WITH CC,,315,MS-DRG,Facility,Inpatient,,,,14276,12134.6,12950.782,13709.2428,America's PPO,America's PPO,13709.2428,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
OTHER CIRCULATORY SYSTEM DIAGNOSES WITH CC,,315,MS-DRG,Facility,Inpatient,,,,14276,12134.6,12950.782,13709.2428,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,12950.782,,,Other,DRG,"DRG weight 0.9685 x WOO $13,372.00; Cap at 95% of charge; minimum of 90.1% of charge"
MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITH CC,,372,MS-DRG,Facility,Inpatient,,,,9661.432,8212.2172,9178.3604,9277.87315,America's PPO,America's PPO,9277.87315,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITH CC,,372,MS-DRG,Facility,Inpatient,,,,9661.432,8212.2172,9178.3604,9277.87315,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,9178.3604,,,Other ,DRG,"DRG weight 1.018 x WOO $13,372.00; Cap at 95% of charge; minimum of 90.1% of charge"
GASTROINTESTINAL HEMORRHAGE WITH MCC,,377,MS-DRG,Facility,Inpatient,,,,7012.5,5960.625,6661.875,6734.10375,America's PPO,America's PPO,6734.10375,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
GASTROINTESTINAL HEMORRHAGE WITH MCC,,377,MS-DRG,Facility,Inpatient,,,,7012.5,5960.625,6661.875,6734.10375,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,6661.875,,,Other,DRG,"DRG weight 1.778 x WOO $13,372.00; Cap at 95% of charge; minimum of 90.1% of charge"
GASTROINTESTINAL HEMORRHAGE WITH CC,,378,MS-DRG,Facility,Inpatient,,,,6567.4,5582.29,6239.03,6306.67422,America's PPO,America's PPO,6306.67422,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
GASTROINTESTINAL HEMORRHAGE WITH CC,,378,MS-DRG,Facility,Inpatient,,,,6567.4,5582.29,6239.03,6306.67422,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,6239.03,,,Other ,DRG,"DRG weight 0.985 x WOO $13,372.00; Cap at 95% of charge; minimum of 90.1% of charge"
UNCOMPLICATED PEPTIC ULCER WITHOUT MCC,,384,MS-DRG,Facility,Inpatient,,,,13601,11560.85,12254.501,13061.0403,America's PPO,America's PPO,13061.0403,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
UNCOMPLICATED PEPTIC ULCER WITHOUT MCC,,384,MS-DRG,Facility,Inpatient,,,,13601,11560.85,12254.501,13061.0403,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,12254.501,,,Other ,DRG,"DRG weight 0.9016 x WOO $13,372.00; Cap at 95% of charge; minimum of 90.1% of charge"
GASTROINTESTINAL OBSTRUCTION WITH MCC,,388,MS-DRG,Facility,Inpatient,,,,18003,15302.55,17102.85,17288.2809,America's PPO,America's PPO,17288.2809,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
GASTROINTESTINAL OBSTRUCTION WITH MCC,,388,MS-DRG,Facility,Inpatient,,,,18003,15302.55,17102.85,17288.2809,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,17102.85,,,Other ,DRG,"DRG weight 1.4674 x WOO $13,372.00; Cap at 95% of charge; minimum of 90.1% of charge"
GASTROINTESTINAL OBSTRUCTION WITH CC,,389,MS-DRG,Facility,Inpatient,,,,8485,7212.25,8060.75,8148.1455,America's PPO,America's PPO,8148.1455,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
GASTROINTESTINAL OBSTRUCTION WITH CC,,389,MS-DRG,Facility,Inpatient,,,,8485,7212.25,8060.75,8148.1455,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,8060.75,,,Other ,DRG,"DRG weight 0.8071 x WOO $13,372.00; Cap at 95% of charge; minimum of 90.1% of charge"
GASTROINTESTINAL OBSTRUCTION WITHOUT CC/MCC,,390,MS-DRG,Facility,Inpatient,,,,13649.66667,11602.21667,12298.34967,13107.7749,America's PPO,America's PPO,13107.7749,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
GASTROINTESTINAL OBSTRUCTION WITHOUT CC/MCC,,390,MS-DRG,Facility,Inpatient,,,,13649.66667,11602.21667,12298.34967,13107.7749,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,12298.34967,,,Other,DRG,"DRG weight 0.5655 x WOO $13,372.00; Cap at 95% of charge; minimum of 90.1% of charge"
"ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITH MCC",,391,MS-DRG,Facility,Inpatient,,,,11823.33333,10049.83333,11232.16667,11353.947,America's PPO,America's PPO,11353.947,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITH MCC",,391,MS-DRG,Facility,Inpatient,,,,11823.33333,10049.83333,11232.16667,11353.947,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,11232.16667,,,Other ,DRG,"DRG weight 1.284 x WOO $13,372.00; Cap at 95% of charge; minimum of 90.1% of charge"
"ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITHOUT MCC",,392,MS-DRG,Facility,Inpatient,,,,9262.12,7872.802,8799.014,8894.413836,America's PPO,America's PPO,8894.413836,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITHOUT MCC",,392,MS-DRG,Facility,Inpatient,,,,9262.12,7872.802,8799.014,8894.413836,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,8799.014,,,Other ,DRG,"DRG weight 0.7876 x WOO $13,372.00; Cap at 95% of charge; minimum of 90.1% of charge"
OTHER DIGESTIVE SYSTEM DIAGNOSES WITH MCC,,393,MS-DRG,Facility,Inpatient,,,,3645,3098.25,3462.75,3500.2935,America's PPO,America's PPO,3500.2935,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
OTHER DIGESTIVE SYSTEM DIAGNOSES WITH MCC,,393,MS-DRG,Facility,Inpatient,,,,3645,3098.25,3462.75,3500.2935,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,3462.75,,,Other ,DRG,"DRG weight 1.6113 x WOO $13,372.00; Cap at 95% of charge; minimum of 90.1% of charge"
OTHER DIGESTIVE SYSTEM DIAGNOSES WITH CC,,394,MS-DRG,Facility,Inpatient,,,,6825,5801.25,6483.75,6554.0475,America's PPO,America's PPO,6554.0475,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
OTHER DIGESTIVE SYSTEM DIAGNOSES WITH CC,,394,MS-DRG,Facility,Inpatient,,,,6825,5801.25,6483.75,6554.0475,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,6483.75,,,Other ,DRG,"DRG weight 0.943 x WOO $13,372.00; Cap at 95% of charge; minimum of 90.1% of charge"
OTHER DIGESTIVE SYSTEM DIAGNOSES WITHOUT CC/MCC,,395,MS-DRG,Facility,Inpatient,,,,6151,5228.35,5843.45,5906.8053,America's PPO,America's PPO,5906.8053,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
OTHER DIGESTIVE SYSTEM DIAGNOSES WITHOUT CC/MCC,,395,MS-DRG,Facility,Inpatient,,,,6151,5228.35,5843.45,5906.8053,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,5843.45,,,Other ,DRG,"DRG weight 0.6449 x WOO $13,372.00; Cap at 95% of charge; minimum of 90.1% of charge"
ENOXAPARIN 40 MG/0.4 ML SUBQ SYRG,,J1650,HCPCS,Facility,Inpatient,0.4,mL,,23,19.55,6.5918,23,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
ENOXAPARIN 40 MG/0.4 ML SUBQ SYRG,,J1650,HCPCS,Facility,Inpatient,0.4,mL,,23,19.55,6.5918,23,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
ENOXAPARIN 40 MG/0.4 ML SUBQ SYRG,,J1650,HCPCS,Facility,Outpatient,0.4,mL,,23,19.55,6.5918,23,Medica,Medical Assistance,10.258,44.6,,percent of total billed charges,,
ENOXAPARIN 40 MG/0.4 ML SUBQ SYRG,,J1650,HCPCS,Facility,Outpatient,0.4,mL,,23,19.55,6.5918,23,Medica,Medical Assistance,10.258,44.6,,percent of total billed charges,,
ENOXAPARIN 40 MG/0.4 ML SUBQ SYRG,,J1650,HCPCS,Facility,Inpatient,0.4,mL,,23,19.55,6.5918,23,Medica,Medical Assistance,,,,,Included in per diem rate,
ENOXAPARIN 40 MG/0.4 ML SUBQ SYRG,,J1650,HCPCS,Facility,Inpatient,0.4,mL,,23,19.55,6.5918,23,Medica,Medical Assistance,,,,,Included in per diem rate,
ENOXAPARIN 40 MG/0.4 ML SUBQ SYRG,,J1650,HCPCS,Facility,Outpatient,0.4,mL,,23,19.55,6.5918,23,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,11.454,49.8,,percent of total billed charges,,
ENOXAPARIN 40 MG/0.4 ML SUBQ SYRG,,J1650,HCPCS,Facility,Outpatient,0.4,mL,,23,19.55,6.5918,23,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,11.454,49.8,,percent of total billed charges,,
ENOXAPARIN 40 MG/0.4 ML SUBQ SYRG,,J1650,HCPCS,Facility,Inpatient,0.4,mL,,23,19.55,6.5918,23,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
ENOXAPARIN 40 MG/0.4 ML SUBQ SYRG,,J1650,HCPCS,Facility,Inpatient,0.4,mL,,23,19.55,6.5918,23,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
ENOXAPARIN 40 MG/0.4 ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,0.4,mL,,23,19.55,6.5918,23,"Multiplan, Inc.","Multiplan, Inc.",21.62,94,,percent of total billed charges,,
ENOXAPARIN 40 MG/0.4 ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,0.4,mL,,23,19.55,6.5918,23,"Multiplan, Inc.","Multiplan, Inc.",21.62,94,,percent of total billed charges,,
ENOXAPARIN 40 MG/0.4 ML SUBQ SYRG,,J1650,HCPCS,Facility,Outpatient,0.4,mL,,23,19.55,6.5918,23,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,20.723,90.1,,percent of total billed charges,,
ENOXAPARIN 40 MG/0.4 ML SUBQ SYRG,,J1650,HCPCS,Facility,Outpatient,0.4,mL,,23,19.55,6.5918,23,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,20.723,90.1,,percent of total billed charges,,
ENOXAPARIN 40 MG/0.4 ML SUBQ SYRG,,J1650,HCPCS,Facility,Inpatient,0.4,mL,,23,19.55,6.5918,23,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
ENOXAPARIN 40 MG/0.4 ML SUBQ SYRG,,J1650,HCPCS,Facility,Inpatient,0.4,mL,,23,19.55,6.5918,23,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
ENOXAPARIN 40 MG/0.4 ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,0.4,mL,,23,19.55,6.5918,23,"Preferred One Administrative Services, INC.",PPO,22.678,98.6,,percent of total billed charges,,
ENOXAPARIN 40 MG/0.4 ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,0.4,mL,,23,19.55,6.5918,23,"Preferred One Administrative Services, INC.",PPO,22.678,98.6,,percent of total billed charges,,
ENOXAPARIN 40 MG/0.4 ML SUBQ SYRG,,J1650,HCPCS,Facility,Outpatient,0.4,mL,,23,19.55,6.5918,23,PrimeWest Health,Minnesota Senior Health Options (MSHO),11.8335,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
ENOXAPARIN 40 MG/0.4 ML SUBQ SYRG,,J1650,HCPCS,Facility,Outpatient,0.4,mL,,23,19.55,6.5918,23,PrimeWest Health,Minnesota Senior Health Options (MSHO),11.8335,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
ENOXAPARIN 40 MG/0.4 ML SUBQ SYRG,,J1650,HCPCS,Facility,Inpatient,0.4,mL,,23,19.55,6.5918,23,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ENOXAPARIN 40 MG/0.4 ML SUBQ SYRG,,J1650,HCPCS,Facility,Inpatient,0.4,mL,,23,19.55,6.5918,23,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ENOXAPARIN 40 MG/0.4 ML SUBQ SYRG,,J1650,HCPCS,Facility,Outpatient,0.4,mL,,23,19.55,6.5918,23,PrimeWest Health,MinnesotaCare,11.8128,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
ENOXAPARIN 40 MG/0.4 ML SUBQ SYRG,,J1650,HCPCS,Facility,Outpatient,0.4,mL,,23,19.55,6.5918,23,PrimeWest Health,MinnesotaCare,11.8128,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
ENOXAPARIN 40 MG/0.4 ML SUBQ SYRG,,J1650,HCPCS,Facility,Inpatient,0.4,mL,,23,19.55,6.5918,23,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
ENOXAPARIN 40 MG/0.4 ML SUBQ SYRG,,J1650,HCPCS,Facility,Inpatient,0.4,mL,,23,19.55,6.5918,23,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
ENOXAPARIN 40 MG/0.4 ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,0.4,mL,,23,19.55,6.5918,23,Sanford Health Plan,Sanford Health Plan,21.16,92,,percent of total billed charges,,
ENOXAPARIN 40 MG/0.4 ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,0.4,mL,,23,19.55,6.5918,23,Sanford Health Plan,Sanford Health Plan,21.16,92,,percent of total billed charges,,
ENOXAPARIN 40 MG/0.4 ML SUBQ SYRG,,J1650,HCPCS,Facility,Outpatient,0.4,mL,,23,19.55,6.5918,23,"UCare Health, Inc.",Individual & Family Plan,12.9605,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
ENOXAPARIN 40 MG/0.4 ML SUBQ SYRG,,J1650,HCPCS,Facility,Outpatient,0.4,mL,,23,19.55,6.5918,23,"UCare Health, Inc.",Individual & Family Plan,12.9605,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
ENOXAPARIN 40 MG/0.4 ML SUBQ SYRG,,J1650,HCPCS,Facility,Inpatient,0.4,mL,,23,19.55,6.5918,23,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
ENOXAPARIN 40 MG/0.4 ML SUBQ SYRG,,J1650,HCPCS,Facility,Inpatient,0.4,mL,,23,19.55,6.5918,23,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
ENOXAPARIN 40 MG/0.4 ML SUBQ SYRG,,J1650,HCPCS,Facility,Outpatient,0.4,mL,,23,19.55,6.5918,23,"UCare Health, Inc.",Medical Assistance,11.6081,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ENOXAPARIN 40 MG/0.4 ML SUBQ SYRG,,J1650,HCPCS,Facility,Outpatient,0.4,mL,,23,19.55,6.5918,23,"UCare Health, Inc.",Medical Assistance,11.6081,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ENOXAPARIN 40 MG/0.4 ML SUBQ SYRG,,J1650,HCPCS,Facility,Inpatient,0.4,mL,,23,19.55,6.5918,23,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
ENOXAPARIN 40 MG/0.4 ML SUBQ SYRG,,J1650,HCPCS,Facility,Inpatient,0.4,mL,,23,19.55,6.5918,23,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
ENOXAPARIN 40 MG/0.4 ML SUBQ SYRG,,J1650,HCPCS,Facility,Outpatient,0.4,mL,,23,19.55,6.5918,23,"UCare Health, Inc.",Medicare Advantage,11.6081,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ENOXAPARIN 40 MG/0.4 ML SUBQ SYRG,,J1650,HCPCS,Facility,Outpatient,0.4,mL,,23,19.55,6.5918,23,"UCare Health, Inc.",Medicare Advantage,11.6081,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ENOXAPARIN 40 MG/0.4 ML SUBQ SYRG,,J1650,HCPCS,Facility,Inpatient,0.4,mL,,23,19.55,6.5918,23,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ENOXAPARIN 40 MG/0.4 ML SUBQ SYRG,,J1650,HCPCS,Facility,Inpatient,0.4,mL,,23,19.55,6.5918,23,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ENOXAPARIN 40 MG/0.4 ML SUBQ SYRG,,J1650,HCPCS,Facility,Outpatient,0.4,mL,,23,19.55,6.5918,23,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),11.6081,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ENOXAPARIN 40 MG/0.4 ML SUBQ SYRG,,J1650,HCPCS,Facility,Outpatient,0.4,mL,,23,19.55,6.5918,23,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),11.6081,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ENOXAPARIN 40 MG/0.4 ML SUBQ SYRG,,J1650,HCPCS,Facility,Inpatient,0.4,mL,,23,19.55,6.5918,23,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ENOXAPARIN 40 MG/0.4 ML SUBQ SYRG,,J1650,HCPCS,Facility,Inpatient,0.4,mL,,23,19.55,6.5918,23,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ENOXAPARIN 40 MG/0.4 ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,0.4,mL,,23,19.55,6.5918,23,UnitedHealthcare,Individual & Family,21.62,94,,percent of total billed charges,,
ENOXAPARIN 40 MG/0.4 ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,0.4,mL,,23,19.55,6.5918,23,UnitedHealthcare,Individual & Family,21.62,94,,percent of total billed charges,,
ENOXAPARIN 40 MG/0.4 ML SUBQ SYRG,,J1650,HCPCS,Facility,Outpatient,0.4,mL,,23,19.55,6.5918,23,UnitedHealthcare,Medicare Advantage,11.27,49,,percent of total billed charges,,
ENOXAPARIN 40 MG/0.4 ML SUBQ SYRG,,J1650,HCPCS,Facility,Outpatient,0.4,mL,,23,19.55,6.5918,23,UnitedHealthcare,Medicare Advantage,11.27,49,,percent of total billed charges,,
ENOXAPARIN 40 MG/0.4 ML SUBQ SYRG,,J1650,HCPCS,Facility,Inpatient,0.4,mL,,23,19.55,6.5918,23,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
ENOXAPARIN 40 MG/0.4 ML SUBQ SYRG,,J1650,HCPCS,Facility,Inpatient,0.4,mL,,23,19.55,6.5918,23,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
ENOXAPARIN 40 MG/0.4 ML SUBQ SYRG,,J1650,HCPCS,Facility,Outpatient,0.4,mL,,23,19.55,6.5918,23,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,11.04,48,,percent of total billed charges,,100% of DHS outpatient percentage
ENOXAPARIN 40 MG/0.4 ML SUBQ SYRG,,J1650,HCPCS,Facility,Outpatient,0.4,mL,,23,19.55,6.5918,23,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,11.04,48,,percent of total billed charges,,100% of DHS outpatient percentage
ENOXAPARIN 40 MG/0.4 ML SUBQ SYRG,,J1650,HCPCS,Facility,Inpatient,0.4,mL,,23,19.55,6.5918,23,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
ENOXAPARIN 40 MG/0.4 ML SUBQ SYRG,,J1650,HCPCS,Facility,Inpatient,0.4,mL,,23,19.55,6.5918,23,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
TRYPAN BLUE 0.06 % IO SYRG,,39233,LOCAL,Facility,Both,0.5,mL,,312,265.2,89.4192,312,Aetna,Commercial,287.04,92,,percent of total billed charges,,
TRYPAN BLUE 0.06 % IO SYRG,,39233,LOCAL,Facility,Outpatient,0.5,mL,,312,265.2,89.4192,312,Aetna,Medicare Advantage,152.88,49,,percent of total billed charges,,
TRYPAN BLUE 0.06 % IO SYRG,,39233,LOCAL,Facility,Inpatient,0.5,mL,,312,265.2,89.4192,312,Aetna,Medicare Advantage,,,,,Included in per diem rate,
TRYPAN BLUE 0.06 % IO SYRG,,39233,LOCAL,Facility,Both,0.5,mL,,312,265.2,89.4192,312,Aetna,PPO,290.16,93,,percent of total billed charges,,
TRYPAN BLUE 0.06 % IO SYRG,,39233,LOCAL,Facility,Both,0.5,mL,,312,265.2,89.4192,312,America's PPO,America's PPO,299.6136,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
TRYPAN BLUE 0.06 % IO SYRG,,39233,LOCAL,Facility,Both,0.5,mL,,312,265.2,89.4192,312,BlueCross BlueShield Minnesota, Federal Employee Program,307.008,98.4,,percent of total billed charges,,
TRYPAN BLUE 0.06 % IO SYRG,,39233,LOCAL,Facility,Both,0.5,mL,,312,265.2,89.4192,312,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,312,100,,percent of total billed charges,,
TRYPAN BLUE 0.06 % IO SYRG,,39233,LOCAL,Facility,Both,0.5,mL,,312,265.2,89.4192,312,BlueCross BlueShield Minnesota,High Value Network Plan,280.8,90,,percent of total billed charges,,
TRYPAN BLUE 0.06 % IO SYRG,,39233,LOCAL,Facility,Outpatient,0.5,mL,,312,265.2,89.4192,312,BlueCross BlueShield Minnesota,Medicare Advantage,152.88,49,,percent of total billed charges,,
TRYPAN BLUE 0.06 % IO SYRG,,39233,LOCAL,Facility,Inpatient,0.5,mL,,312,265.2,89.4192,312,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
TRYPAN BLUE 0.06 % IO SYRG,,39233,LOCAL,Facility,Both,0.5,mL,,312,265.2,89.4192,312,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,276.3384,88.57,,percent of total billed charges,,
TRYPAN BLUE 0.06 % IO SYRG,,39233,LOCAL,Facility,Both,0.5,mL,,312,265.2,89.4192,312,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,89.4192,28.66,,percent of total billed charges,,
TRYPAN BLUE 0.06 % IO SYRG,,39233,LOCAL,Facility,Outpatient,0.5,mL,,312,265.2,89.4192,312,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),152.88,49,,percent of total billed charges,,
TRYPAN BLUE 0.06 % IO SYRG,,39233,LOCAL,Facility,Inpatient,0.5,mL,,312,265.2,89.4192,312,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
TRYPAN BLUE 0.06 % IO SYRG,,39233,LOCAL,Facility,Both,0.5,mL,,312,265.2,89.4192,312,CorVel,Worker's Compensation,312,100,,percent of total billed charges,,
TRYPAN BLUE 0.06 % IO SYRG,,39233,LOCAL,Facility,Both,0.5,mL,,312,265.2,89.4192,312,First Health Group Corporation,First Health Network,302.64,97,,percent of total billed charges,,
TRYPAN BLUE 0.06 % IO SYRG,,39233,LOCAL,Facility,Both,0.5,mL,,312,265.2,89.4192,312,"Health Partners, Inc.",Commercial,295.152,94.6,,percent of total billed charges,,
TRYPAN BLUE 0.06 % IO SYRG,,39233,LOCAL,Facility,Outpatient,0.5,mL,,312,265.2,89.4192,312,"Health Partners, Inc.",Medicare Advantage,152.88,49,,percent of total billed charges,,
TRYPAN BLUE 0.06 % IO SYRG,,39233,LOCAL,Facility,Inpatient,0.5,mL,,312,265.2,89.4192,312,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
TRYPAN BLUE 0.06 % IO SYRG,,39233,LOCAL,Facility,Both,0.5,mL,,312,265.2,89.4192,312,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),187.2,60,,percent of total billed charges,,
TRYPAN BLUE 0.06 % IO SYRG,,39233,LOCAL,Facility,Both,0.5,mL,,312,265.2,89.4192,312,"Health Partners, Inc.",State of Minnesota Advantage Program,254.28,81.5,,percent of total billed charges,,
TRYPAN BLUE 0.06 % IO SYRG,,39233,LOCAL,Facility,Both,0.5,mL,,312,265.2,89.4192,312,"Health Partners, Inc.",State Public Programs,156,50,,percent of total billed charges,,
TRYPAN BLUE 0.06 % IO SYRG,,39233,LOCAL,Facility,Both,0.5,mL,,312,265.2,89.4192,312,Humana Insurance Company,Commercial PPO,296.4,95,,percent of total billed charges,,
TRYPAN BLUE 0.06 % IO SYRG,,39233,LOCAL,Facility,Outpatient,0.5,mL,,312,265.2,89.4192,312,Humana Insurance Company,Medicare PPO,152.88,49,,percent of total billed charges,,
TRYPAN BLUE 0.06 % IO SYRG,,39233,LOCAL,Facility,Inpatient,0.5,mL,,312,265.2,89.4192,312,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
TRYPAN BLUE 0.06 % IO SYRG,,39233,LOCAL,Facility,Both,0.5,mL,,312,265.2,89.4192,312,Medica,Individual & Family,309.192,99.1,,percent of total billed charges,,
TRYPAN BLUE 0.06 % IO SYRG,,39233,LOCAL,Facility,Outpatient,0.5,mL,,312,265.2,89.4192,312,Medica,Medica Advantage Solution,155.376,49.8,,percent of total billed charges,,
TRYPAN BLUE 0.06 % IO SYRG,,39233,LOCAL,Facility,Inpatient,0.5,mL,,312,265.2,89.4192,312,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
TRYPAN BLUE 0.06 % IO SYRG,,39233,LOCAL,Facility,Outpatient,0.5,mL,,312,265.2,89.4192,312,Medica,Medical Assistance,139.152,44.6,,percent of total billed charges,,
TRYPAN BLUE 0.06 % IO SYRG,,39233,LOCAL,Facility,Inpatient,0.5,mL,,312,265.2,89.4192,312,Medica,Medical Assistance,,,,,Included in per diem rate,
TRYPAN BLUE 0.06 % IO SYRG,,39233,LOCAL,Facility,Outpatient,0.5,mL,,312,265.2,89.4192,312,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,155.376,49.8,,percent of total billed charges,,
TRYPAN BLUE 0.06 % IO SYRG,,39233,LOCAL,Facility,Inpatient,0.5,mL,,312,265.2,89.4192,312,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
TRYPAN BLUE 0.06 % IO SYRG,,39233,LOCAL,Facility,Both,0.5,mL,,312,265.2,89.4192,312,"Multiplan, Inc.","Multiplan, Inc.",293.28,94,,percent of total billed charges,,
TRYPAN BLUE 0.06 % IO SYRG,,39233,LOCAL,Facility,Outpatient,0.5,mL,,312,265.2,89.4192,312,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,281.112,90.1,,percent of total billed charges,,
TRYPAN BLUE 0.06 % IO SYRG,,39233,LOCAL,Facility,Inpatient,0.5,mL,,312,265.2,89.4192,312,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
TRYPAN BLUE 0.06 % IO SYRG,,39233,LOCAL,Facility,Both,0.5,mL,,312,265.2,89.4192,312,"Preferred One Administrative Services, INC.",PPO,307.632,98.6,,percent of total billed charges,,
TRYPAN BLUE 0.06 % IO SYRG,,39233,LOCAL,Facility,Outpatient,0.5,mL,,312,265.2,89.4192,312,PrimeWest Health,Minnesota Senior Health Options (MSHO),160.524,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
TRYPAN BLUE 0.06 % IO SYRG,,39233,LOCAL,Facility,Inpatient,0.5,mL,,312,265.2,89.4192,312,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
TRYPAN BLUE 0.06 % IO SYRG,,39233,LOCAL,Facility,Outpatient,0.5,mL,,312,265.2,89.4192,312,PrimeWest Health,MinnesotaCare,160.2432,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
TRYPAN BLUE 0.06 % IO SYRG,,39233,LOCAL,Facility,Inpatient,0.5,mL,,312,265.2,89.4192,312,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
TRYPAN BLUE 0.06 % IO SYRG,,39233,LOCAL,Facility,Both,0.5,mL,,312,265.2,89.4192,312,Sanford Health Plan,Sanford Health Plan,287.04,92,,percent of total billed charges,,
TRYPAN BLUE 0.06 % IO SYRG,,39233,LOCAL,Facility,Outpatient,0.5,mL,,312,265.2,89.4192,312,"UCare Health, Inc.",Individual & Family Plan,175.812,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
TRYPAN BLUE 0.06 % IO SYRG,,39233,LOCAL,Facility,Inpatient,0.5,mL,,312,265.2,89.4192,312,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
TRYPAN BLUE 0.06 % IO SYRG,,39233,LOCAL,Facility,Outpatient,0.5,mL,,312,265.2,89.4192,312,"UCare Health, Inc.",Medical Assistance,157.4664,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TRYPAN BLUE 0.06 % IO SYRG,,39233,LOCAL,Facility,Inpatient,0.5,mL,,312,265.2,89.4192,312,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
TRYPAN BLUE 0.06 % IO SYRG,,39233,LOCAL,Facility,Outpatient,0.5,mL,,312,265.2,89.4192,312,"UCare Health, Inc.",Medicare Advantage,157.4664,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TRYPAN BLUE 0.06 % IO SYRG,,39233,LOCAL,Facility,Inpatient,0.5,mL,,312,265.2,89.4192,312,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
TRYPAN BLUE 0.06 % IO SYRG,,39233,LOCAL,Facility,Outpatient,0.5,mL,,312,265.2,89.4192,312,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),157.4664,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TRYPAN BLUE 0.06 % IO SYRG,,39233,LOCAL,Facility,Inpatient,0.5,mL,,312,265.2,89.4192,312,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
TRYPAN BLUE 0.06 % IO SYRG,,39233,LOCAL,Facility,Both,0.5,mL,,312,265.2,89.4192,312,UnitedHealthcare,Individual & Family,293.28,94,,percent of total billed charges,,
TRYPAN BLUE 0.06 % IO SYRG,,39233,LOCAL,Facility,Outpatient,0.5,mL,,312,265.2,89.4192,312,UnitedHealthcare,Medicare Advantage,152.88,49,,percent of total billed charges,,
TRYPAN BLUE 0.06 % IO SYRG,,39233,LOCAL,Facility,Inpatient,0.5,mL,,312,265.2,89.4192,312,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
TRYPAN BLUE 0.06 % IO SYRG,,39233,LOCAL,Facility,Outpatient,0.5,mL,,312,265.2,89.4192,312,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,149.76,48,,percent of total billed charges,,100% of DHS outpatient percentage
TRYPAN BLUE 0.06 % IO SYRG,,39233,LOCAL,Facility,Inpatient,0.5,mL,,312,265.2,89.4192,312,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH CC,,433,MS-DRG,Facility,Inpatient,,,,7778.5,6611.725,7389.575,7469.69355,America's PPO,America's PPO,7469.69355,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH CC,,433,MS-DRG,Facility,Inpatient,,,,7778.5,6611.725,7389.575,7469.69355,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,7389.575,,,Other,DRG,"DRG weight 1.0398 x WOO $13,372.00; Cap at 95% of charge; minimum of 90.1% of charge"
MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH MCC,,435,MS-DRG,Facility,Inpatient,,,,10790,9171.5,10250.5,10361.637,America's PPO,America's PPO,10361.637,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH MCC,,435,MS-DRG,Facility,Inpatient,,,,10790,9171.5,10250.5,10361.637,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,10250.5,,,Other ,DRG,"DRG weight 1.7482 x WOO $13,372.00; Cap at 95% of charge; minimum of 90.1% of charge"
DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH CC,,439,MS-DRG,Facility,Inpatient,,,,12204,10373.4,11593.8,11719.5012,America's PPO,America's PPO,11719.5012,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH CC,,439,MS-DRG,Facility,Inpatient,,,,12204,10373.4,11593.8,11719.5012,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,11593.8,,,Other ,DRG,"DRG weight 0.8698 x WOO $13,372.00; Cap at 95% of charge; minimum of 90.1% of charge"
DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITHOUT CC/MCC,,440,MS-DRG,Facility,Inpatient,,,,8048,6840.8,7645.6,7728.4944,America's PPO,America's PPO,7728.4944,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITHOUT CC/MCC,,440,MS-DRG,Facility,Inpatient,,,,8048,6840.8,7645.6,7728.4944,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,7645.6,,,Other ,DRG,"DRG weight 0.6064 x WOO $13,372.00; Cap at 95% of charge; minimum of 90.1% of charge"
"DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH CC",,442,MS-DRG,Facility,Inpatient,,,,12466,10596.1,11842.7,11971.0998,America's PPO,America's PPO,11971.0998,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH CC",,442,MS-DRG,Facility,Inpatient,,,,12466,10596.1,11842.7,11971.0998,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,11842.7,,,Other ,DRG,"DRG weight 0.946 x WOO $13,372.00; Cap at 95% of charge; minimum of 90.1% of charge"
PNEUMOC 13-VAL CONJ-DIP CR(PF) 0.5 ML IM SYRG,,90670,CPT,Facility,Both,0.5,mL,,1057,898.45,302.9362,1057,Aetna,Commercial,972.44,92,,percent of total billed charges,,
PNEUMOC 13-VAL CONJ-DIP CR(PF) 0.5 ML IM SYRG,,90670,CPT,Facility,Outpatient,0.5,mL,,1057,898.45,302.9362,1057,Aetna,Medicare Advantage,517.93,49,,percent of total billed charges,,
PNEUMOC 13-VAL CONJ-DIP CR(PF) 0.5 ML IM SYRG,,90670,CPT,Facility,Inpatient,0.5,mL,,1057,898.45,302.9362,1057,Aetna,Medicare Advantage,,,,,Included in per diem rate,
PNEUMOC 13-VAL CONJ-DIP CR(PF) 0.5 ML IM SYRG,,90670,CPT,Facility,Both,0.5,mL,,1057,898.45,302.9362,1057,Aetna,PPO,983.01,93,,percent of total billed charges,,
PNEUMOC 13-VAL CONJ-DIP CR(PF) 0.5 ML IM SYRG,,90670,CPT,Facility,Both,0.5,mL,,1057,898.45,302.9362,1057,America's PPO,America's PPO,1015.0371,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
PNEUMOC 13-VAL CONJ-DIP CR(PF) 0.5 ML IM SYRG,,90670,CPT,Facility,Both,0.5,mL,,1057,898.45,302.9362,1057,BlueCross BlueShield Minnesota, Federal Employee Program,1040.088,98.4,,percent of total billed charges,,
PNEUMOC 13-VAL CONJ-DIP CR(PF) 0.5 ML IM SYRG,,90670,CPT,Facility,Both,0.5,mL,,1057,898.45,302.9362,1057,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1057,100,,percent of total billed charges,,
PNEUMOC 13-VAL CONJ-DIP CR(PF) 0.5 ML IM SYRG,,90670,CPT,Facility,Both,0.5,mL,,1057,898.45,302.9362,1057,BlueCross BlueShield Minnesota,High Value Network Plan,951.3,90,,percent of total billed charges,,
PNEUMOC 13-VAL CONJ-DIP CR(PF) 0.5 ML IM SYRG,,90670,CPT,Facility,Outpatient,0.5,mL,,1057,898.45,302.9362,1057,BlueCross BlueShield Minnesota,Medicare Advantage,517.93,49,,percent of total billed charges,,
PNEUMOC 13-VAL CONJ-DIP CR(PF) 0.5 ML IM SYRG,,90670,CPT,Facility,Inpatient,0.5,mL,,1057,898.45,302.9362,1057,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
PNEUMOC 13-VAL CONJ-DIP CR(PF) 0.5 ML IM SYRG,,90670,CPT,Facility,Both,0.5,mL,,1057,898.45,302.9362,1057,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,936.1849,88.57,,percent of total billed charges,,
PNEUMOC 13-VAL CONJ-DIP CR(PF) 0.5 ML IM SYRG,,90670,CPT,Facility,Both,0.5,mL,,1057,898.45,302.9362,1057,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,302.9362,28.66,,percent of total billed charges,,
PNEUMOC 13-VAL CONJ-DIP CR(PF) 0.5 ML IM SYRG,,90670,CPT,Facility,Outpatient,0.5,mL,,1057,898.45,302.9362,1057,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),517.93,49,,percent of total billed charges,,
PNEUMOC 13-VAL CONJ-DIP CR(PF) 0.5 ML IM SYRG,,90670,CPT,Facility,Inpatient,0.5,mL,,1057,898.45,302.9362,1057,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
PNEUMOC 13-VAL CONJ-DIP CR(PF) 0.5 ML IM SYRG,,90670,CPT,Facility,Both,0.5,mL,,1057,898.45,302.9362,1057,CorVel,Worker's Compensation,1057,100,,percent of total billed charges,,
PNEUMOC 13-VAL CONJ-DIP CR(PF) 0.5 ML IM SYRG,,90670,CPT,Facility,Both,0.5,mL,,1057,898.45,302.9362,1057,First Health Group Corporation,First Health Network,1025.29,97,,percent of total billed charges,,
PNEUMOC 13-VAL CONJ-DIP CR(PF) 0.5 ML IM SYRG,,90670,CPT,Facility,Both,0.5,mL,,1057,898.45,302.9362,1057,"Health Partners, Inc.",Commercial,999.922,94.6,,percent of total billed charges,,
PNEUMOC 13-VAL CONJ-DIP CR(PF) 0.5 ML IM SYRG,,90670,CPT,Facility,Outpatient,0.5,mL,,1057,898.45,302.9362,1057,"Health Partners, Inc.",Medicare Advantage,517.93,49,,percent of total billed charges,,
PNEUMOC 13-VAL CONJ-DIP CR(PF) 0.5 ML IM SYRG,,90670,CPT,Facility,Inpatient,0.5,mL,,1057,898.45,302.9362,1057,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PNEUMOC 13-VAL CONJ-DIP CR(PF) 0.5 ML IM SYRG,,90670,CPT,Facility,Both,0.5,mL,,1057,898.45,302.9362,1057,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),634.2,60,,percent of total billed charges,,
PNEUMOC 13-VAL CONJ-DIP CR(PF) 0.5 ML IM SYRG,,90670,CPT,Facility,Both,0.5,mL,,1057,898.45,302.9362,1057,"Health Partners, Inc.",State of Minnesota Advantage Program,861.455,81.5,,percent of total billed charges,,
PNEUMOC 13-VAL CONJ-DIP CR(PF) 0.5 ML IM SYRG,,90670,CPT,Facility,Both,0.5,mL,,1057,898.45,302.9362,1057,"Health Partners, Inc.",State Public Programs,528.5,50,,percent of total billed charges,,
PNEUMOC 13-VAL CONJ-DIP CR(PF) 0.5 ML IM SYRG,,90670,CPT,Facility,Both,0.5,mL,,1057,898.45,302.9362,1057,Humana Insurance Company,Commercial PPO,1004.15,95,,percent of total billed charges,,
PNEUMOC 13-VAL CONJ-DIP CR(PF) 0.5 ML IM SYRG,,90670,CPT,Facility,Outpatient,0.5,mL,,1057,898.45,302.9362,1057,Humana Insurance Company,Medicare PPO,517.93,49,,percent of total billed charges,,
PNEUMOC 13-VAL CONJ-DIP CR(PF) 0.5 ML IM SYRG,,90670,CPT,Facility,Inpatient,0.5,mL,,1057,898.45,302.9362,1057,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
PNEUMOC 13-VAL CONJ-DIP CR(PF) 0.5 ML IM SYRG,,90670,CPT,Facility,Both,0.5,mL,,1057,898.45,302.9362,1057,Medica,Individual & Family,1047.487,99.1,,percent of total billed charges,,
PNEUMOC 13-VAL CONJ-DIP CR(PF) 0.5 ML IM SYRG,,90670,CPT,Facility,Outpatient,0.5,mL,,1057,898.45,302.9362,1057,Medica,Medica Advantage Solution,526.386,49.8,,percent of total billed charges,,
PNEUMOC 13-VAL CONJ-DIP CR(PF) 0.5 ML IM SYRG,,90670,CPT,Facility,Inpatient,0.5,mL,,1057,898.45,302.9362,1057,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
PNEUMOC 13-VAL CONJ-DIP CR(PF) 0.5 ML IM SYRG,,90670,CPT,Facility,Outpatient,0.5,mL,,1057,898.45,302.9362,1057,Medica,Medical Assistance,471.422,44.6,,percent of total billed charges,,
PNEUMOC 13-VAL CONJ-DIP CR(PF) 0.5 ML IM SYRG,,90670,CPT,Facility,Inpatient,0.5,mL,,1057,898.45,302.9362,1057,Medica,Medical Assistance,,,,,Included in per diem rate,
PNEUMOC 13-VAL CONJ-DIP CR(PF) 0.5 ML IM SYRG,,90670,CPT,Facility,Outpatient,0.5,mL,,1057,898.45,302.9362,1057,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,526.386,49.8,,percent of total billed charges,,
PNEUMOC 13-VAL CONJ-DIP CR(PF) 0.5 ML IM SYRG,,90670,CPT,Facility,Inpatient,0.5,mL,,1057,898.45,302.9362,1057,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
PNEUMOC 13-VAL CONJ-DIP CR(PF) 0.5 ML IM SYRG,,90670,CPT,Facility,Both,0.5,mL,,1057,898.45,302.9362,1057,"Multiplan, Inc.","Multiplan, Inc.",993.58,94,,percent of total billed charges,,
PNEUMOC 13-VAL CONJ-DIP CR(PF) 0.5 ML IM SYRG,,90670,CPT,Facility,Outpatient,0.5,mL,,1057,898.45,302.9362,1057,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,952.357,90.1,,percent of total billed charges,,
PNEUMOC 13-VAL CONJ-DIP CR(PF) 0.5 ML IM SYRG,,90670,CPT,Facility,Inpatient,0.5,mL,,1057,898.45,302.9362,1057,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
PNEUMOC 13-VAL CONJ-DIP CR(PF) 0.5 ML IM SYRG,,90670,CPT,Facility,Both,0.5,mL,,1057,898.45,302.9362,1057,"Preferred One Administrative Services, INC.",PPO,1042.202,98.6,,percent of total billed charges,,
PNEUMOC 13-VAL CONJ-DIP CR(PF) 0.5 ML IM SYRG,,90670,CPT,Facility,Outpatient,0.5,mL,,1057,898.45,302.9362,1057,PrimeWest Health,Minnesota Senior Health Options (MSHO),543.8265,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
PNEUMOC 13-VAL CONJ-DIP CR(PF) 0.5 ML IM SYRG,,90670,CPT,Facility,Inpatient,0.5,mL,,1057,898.45,302.9362,1057,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PNEUMOC 13-VAL CONJ-DIP CR(PF) 0.5 ML IM SYRG,,90670,CPT,Facility,Outpatient,0.5,mL,,1057,898.45,302.9362,1057,PrimeWest Health,MinnesotaCare,542.8752,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
PNEUMOC 13-VAL CONJ-DIP CR(PF) 0.5 ML IM SYRG,,90670,CPT,Facility,Inpatient,0.5,mL,,1057,898.45,302.9362,1057,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
PNEUMOC 13-VAL CONJ-DIP CR(PF) 0.5 ML IM SYRG,,90670,CPT,Facility,Both,0.5,mL,,1057,898.45,302.9362,1057,Sanford Health Plan,Sanford Health Plan,972.44,92,,percent of total billed charges,,
PNEUMOC 13-VAL CONJ-DIP CR(PF) 0.5 ML IM SYRG,,90670,CPT,Facility,Outpatient,0.5,mL,,1057,898.45,302.9362,1057,"UCare Health, Inc.",Individual & Family Plan,595.6195,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
PNEUMOC 13-VAL CONJ-DIP CR(PF) 0.5 ML IM SYRG,,90670,CPT,Facility,Inpatient,0.5,mL,,1057,898.45,302.9362,1057,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
PNEUMOC 13-VAL CONJ-DIP CR(PF) 0.5 ML IM SYRG,,90670,CPT,Facility,Outpatient,0.5,mL,,1057,898.45,302.9362,1057,"UCare Health, Inc.",Medical Assistance,533.4679,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PNEUMOC 13-VAL CONJ-DIP CR(PF) 0.5 ML IM SYRG,,90670,CPT,Facility,Inpatient,0.5,mL,,1057,898.45,302.9362,1057,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
PNEUMOC 13-VAL CONJ-DIP CR(PF) 0.5 ML IM SYRG,,90670,CPT,Facility,Outpatient,0.5,mL,,1057,898.45,302.9362,1057,"UCare Health, Inc.",Medicare Advantage,533.4679,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PNEUMOC 13-VAL CONJ-DIP CR(PF) 0.5 ML IM SYRG,,90670,CPT,Facility,Inpatient,0.5,mL,,1057,898.45,302.9362,1057,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PNEUMOC 13-VAL CONJ-DIP CR(PF) 0.5 ML IM SYRG,,90670,CPT,Facility,Outpatient,0.5,mL,,1057,898.45,302.9362,1057,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),533.4679,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PNEUMOC 13-VAL CONJ-DIP CR(PF) 0.5 ML IM SYRG,,90670,CPT,Facility,Inpatient,0.5,mL,,1057,898.45,302.9362,1057,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PNEUMOC 13-VAL CONJ-DIP CR(PF) 0.5 ML IM SYRG,,90670,CPT,Facility,Both,0.5,mL,,1057,898.45,302.9362,1057,UnitedHealthcare,Individual & Family,993.58,94,,percent of total billed charges,,
PNEUMOC 13-VAL CONJ-DIP CR(PF) 0.5 ML IM SYRG,,90670,CPT,Facility,Outpatient,0.5,mL,,1057,898.45,302.9362,1057,UnitedHealthcare,Medicare Advantage,517.93,49,,percent of total billed charges,,
PNEUMOC 13-VAL CONJ-DIP CR(PF) 0.5 ML IM SYRG,,90670,CPT,Facility,Inpatient,0.5,mL,,1057,898.45,302.9362,1057,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
PNEUMOC 13-VAL CONJ-DIP CR(PF) 0.5 ML IM SYRG,,90670,CPT,Facility,Outpatient,0.5,mL,,1057,898.45,302.9362,1057,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,507.36,48,,percent of total billed charges,,100% of DHS outpatient percentage
PNEUMOC 13-VAL CONJ-DIP CR(PF) 0.5 ML IM SYRG,,90670,CPT,Facility,Inpatient,0.5,mL,,1057,898.45,302.9362,1057,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
DISORDERS OF THE BILIARY TRACT WITH CC,,445,MS-DRG,Facility,Inpatient,,,,27175,23098.75,24484.675,26096.1525,America's PPO,America's PPO,26096.1525,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
DISORDERS OF THE BILIARY TRACT WITH CC,,445,MS-DRG,Facility,Inpatient,,,,27175,23098.75,24484.675,26096.1525,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,24484.675,,,Other,DRG,"DRG weight 1.0996 x WOO $13,372.00; Cap at 95% of charge; minimum of 90.1% of charge"
MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITHOUT MCC,,470,MS-DRG,Facility,Inpatient,,,,10712,9105.2,10176.4,10286.7336,America's PPO,America's PPO,10286.7336,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITHOUT MCC,,470,MS-DRG,Facility,Inpatient,,,,10712,9105.2,10176.4,10286.7336,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,10176.4,,,Other,DRG,"DRG weight 1.9119 x WOO $13,372.00; Cap at 95% of charge; minimum of 90.1% of charge"
FLU VAC QV (18YR UP)RCM-PF 180 MCG (45 MCG X 4)/0.5 ML IM SYRG,,90682,CPT,Facility,Both,0.5,mL,,322,273.7,92.2852,322,Aetna,Commercial,296.24,92,,percent of total billed charges,,
FLU VAC QV (18YR UP)RCM-PF 180 MCG (45 MCG X 4)/0.5 ML IM SYRG,,90682,CPT,Facility,Outpatient,0.5,mL,,322,273.7,92.2852,322,Aetna,Medicare Advantage,157.78,49,,percent of total billed charges,,
FLU VAC QV (18YR UP)RCM-PF 180 MCG (45 MCG X 4)/0.5 ML IM SYRG,,90682,CPT,Facility,Inpatient,0.5,mL,,322,273.7,92.2852,322,Aetna,Medicare Advantage,,,,,Included in per diem rate,
FLU VAC QV (18YR UP)RCM-PF 180 MCG (45 MCG X 4)/0.5 ML IM SYRG,,90682,CPT,Facility,Both,0.5,mL,,322,273.7,92.2852,322,Aetna,PPO,299.46,93,,percent of total billed charges,,
FLU VAC QV (18YR UP)RCM-PF 180 MCG (45 MCG X 4)/0.5 ML IM SYRG,,90682,CPT,Facility,Both,0.5,mL,,322,273.7,92.2852,322,America's PPO,America's PPO,309.2166,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
FLU VAC QV (18YR UP)RCM-PF 180 MCG (45 MCG X 4)/0.5 ML IM SYRG,,90682,CPT,Facility,Both,0.5,mL,,322,273.7,92.2852,322,BlueCross BlueShield Minnesota, Federal Employee Program,316.848,98.4,,percent of total billed charges,,
FLU VAC QV (18YR UP)RCM-PF 180 MCG (45 MCG X 4)/0.5 ML IM SYRG,,90682,CPT,Facility,Both,0.5,mL,,322,273.7,92.2852,322,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,322,100,,percent of total billed charges,,
FLU VAC QV (18YR UP)RCM-PF 180 MCG (45 MCG X 4)/0.5 ML IM SYRG,,90682,CPT,Facility,Both,0.5,mL,,322,273.7,92.2852,322,BlueCross BlueShield Minnesota,High Value Network Plan,289.8,90,,percent of total billed charges,,
FLU VAC QV (18YR UP)RCM-PF 180 MCG (45 MCG X 4)/0.5 ML IM SYRG,,90682,CPT,Facility,Outpatient,0.5,mL,,322,273.7,92.2852,322,BlueCross BlueShield Minnesota,Medicare Advantage,157.78,49,,percent of total billed charges,,
FLU VAC QV (18YR UP)RCM-PF 180 MCG (45 MCG X 4)/0.5 ML IM SYRG,,90682,CPT,Facility,Inpatient,0.5,mL,,322,273.7,92.2852,322,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
FLU VAC QV (18YR UP)RCM-PF 180 MCG (45 MCG X 4)/0.5 ML IM SYRG,,90682,CPT,Facility,Both,0.5,mL,,322,273.7,92.2852,322,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,285.1954,88.57,,percent of total billed charges,,
FLU VAC QV (18YR UP)RCM-PF 180 MCG (45 MCG X 4)/0.5 ML IM SYRG,,90682,CPT,Facility,Both,0.5,mL,,322,273.7,92.2852,322,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,92.2852,28.66,,percent of total billed charges,,
FLU VAC QV (18YR UP)RCM-PF 180 MCG (45 MCG X 4)/0.5 ML IM SYRG,,90682,CPT,Facility,Outpatient,0.5,mL,,322,273.7,92.2852,322,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),157.78,49,,percent of total billed charges,,
FLU VAC QV (18YR UP)RCM-PF 180 MCG (45 MCG X 4)/0.5 ML IM SYRG,,90682,CPT,Facility,Inpatient,0.5,mL,,322,273.7,92.2852,322,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
FLU VAC QV (18YR UP)RCM-PF 180 MCG (45 MCG X 4)/0.5 ML IM SYRG,,90682,CPT,Facility,Both,0.5,mL,,322,273.7,92.2852,322,CorVel,Worker's Compensation,322,100,,percent of total billed charges,,
FLU VAC QV (18YR UP)RCM-PF 180 MCG (45 MCG X 4)/0.5 ML IM SYRG,,90682,CPT,Facility,Both,0.5,mL,,322,273.7,92.2852,322,First Health Group Corporation,First Health Network,312.34,97,,percent of total billed charges,,
FLU VAC QV (18YR UP)RCM-PF 180 MCG (45 MCG X 4)/0.5 ML IM SYRG,,90682,CPT,Facility,Both,0.5,mL,,322,273.7,92.2852,322,"Health Partners, Inc.",Commercial,304.612,94.6,,percent of total billed charges,,
FLU VAC QV (18YR UP)RCM-PF 180 MCG (45 MCG X 4)/0.5 ML IM SYRG,,90682,CPT,Facility,Outpatient,0.5,mL,,322,273.7,92.2852,322,"Health Partners, Inc.",Medicare Advantage,157.78,49,,percent of total billed charges,,
FLU VAC QV (18YR UP)RCM-PF 180 MCG (45 MCG X 4)/0.5 ML IM SYRG,,90682,CPT,Facility,Inpatient,0.5,mL,,322,273.7,92.2852,322,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
FLU VAC QV (18YR UP)RCM-PF 180 MCG (45 MCG X 4)/0.5 ML IM SYRG,,90682,CPT,Facility,Both,0.5,mL,,322,273.7,92.2852,322,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),193.2,60,,percent of total billed charges,,
FLU VAC QV (18YR UP)RCM-PF 180 MCG (45 MCG X 4)/0.5 ML IM SYRG,,90682,CPT,Facility,Both,0.5,mL,,322,273.7,92.2852,322,"Health Partners, Inc.",State of Minnesota Advantage Program,262.43,81.5,,percent of total billed charges,,
FLU VAC QV (18YR UP)RCM-PF 180 MCG (45 MCG X 4)/0.5 ML IM SYRG,,90682,CPT,Facility,Both,0.5,mL,,322,273.7,92.2852,322,"Health Partners, Inc.",State Public Programs,161,50,,percent of total billed charges,,
FLU VAC QV (18YR UP)RCM-PF 180 MCG (45 MCG X 4)/0.5 ML IM SYRG,,90682,CPT,Facility,Both,0.5,mL,,322,273.7,92.2852,322,Humana Insurance Company,Commercial PPO,305.9,95,,percent of total billed charges,,
FLU VAC QV (18YR UP)RCM-PF 180 MCG (45 MCG X 4)/0.5 ML IM SYRG,,90682,CPT,Facility,Outpatient,0.5,mL,,322,273.7,92.2852,322,Humana Insurance Company,Medicare PPO,157.78,49,,percent of total billed charges,,
FLU VAC QV (18YR UP)RCM-PF 180 MCG (45 MCG X 4)/0.5 ML IM SYRG,,90682,CPT,Facility,Inpatient,0.5,mL,,322,273.7,92.2852,322,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
FLU VAC QV (18YR UP)RCM-PF 180 MCG (45 MCG X 4)/0.5 ML IM SYRG,,90682,CPT,Facility,Both,0.5,mL,,322,273.7,92.2852,322,Medica,Individual & Family,319.102,99.1,,percent of total billed charges,,
FLU VAC QV (18YR UP)RCM-PF 180 MCG (45 MCG X 4)/0.5 ML IM SYRG,,90682,CPT,Facility,Outpatient,0.5,mL,,322,273.7,92.2852,322,Medica,Medica Advantage Solution,160.356,49.8,,percent of total billed charges,,
FLU VAC QV (18YR UP)RCM-PF 180 MCG (45 MCG X 4)/0.5 ML IM SYRG,,90682,CPT,Facility,Inpatient,0.5,mL,,322,273.7,92.2852,322,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
FLU VAC QV (18YR UP)RCM-PF 180 MCG (45 MCG X 4)/0.5 ML IM SYRG,,90682,CPT,Facility,Outpatient,0.5,mL,,322,273.7,92.2852,322,Medica,Medical Assistance,143.612,44.6,,percent of total billed charges,,
FLU VAC QV (18YR UP)RCM-PF 180 MCG (45 MCG X 4)/0.5 ML IM SYRG,,90682,CPT,Facility,Inpatient,0.5,mL,,322,273.7,92.2852,322,Medica,Medical Assistance,,,,,Included in per diem rate,
FLU VAC QV (18YR UP)RCM-PF 180 MCG (45 MCG X 4)/0.5 ML IM SYRG,,90682,CPT,Facility,Outpatient,0.5,mL,,322,273.7,92.2852,322,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,160.356,49.8,,percent of total billed charges,,
FLU VAC QV (18YR UP)RCM-PF 180 MCG (45 MCG X 4)/0.5 ML IM SYRG,,90682,CPT,Facility,Inpatient,0.5,mL,,322,273.7,92.2852,322,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
FLU VAC QV (18YR UP)RCM-PF 180 MCG (45 MCG X 4)/0.5 ML IM SYRG,,90682,CPT,Facility,Both,0.5,mL,,322,273.7,92.2852,322,"Multiplan, Inc.","Multiplan, Inc.",302.68,94,,percent of total billed charges,,
FLU VAC QV (18YR UP)RCM-PF 180 MCG (45 MCG X 4)/0.5 ML IM SYRG,,90682,CPT,Facility,Outpatient,0.5,mL,,322,273.7,92.2852,322,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,290.122,90.1,,percent of total billed charges,,
FLU VAC QV (18YR UP)RCM-PF 180 MCG (45 MCG X 4)/0.5 ML IM SYRG,,90682,CPT,Facility,Inpatient,0.5,mL,,322,273.7,92.2852,322,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
FLU VAC QV (18YR UP)RCM-PF 180 MCG (45 MCG X 4)/0.5 ML IM SYRG,,90682,CPT,Facility,Both,0.5,mL,,322,273.7,92.2852,322,"Preferred One Administrative Services, INC.",PPO,317.492,98.6,,percent of total billed charges,,
FLU VAC QV (18YR UP)RCM-PF 180 MCG (45 MCG X 4)/0.5 ML IM SYRG,,90682,CPT,Facility,Outpatient,0.5,mL,,322,273.7,92.2852,322,PrimeWest Health,Minnesota Senior Health Options (MSHO),165.669,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
FLU VAC QV (18YR UP)RCM-PF 180 MCG (45 MCG X 4)/0.5 ML IM SYRG,,90682,CPT,Facility,Inpatient,0.5,mL,,322,273.7,92.2852,322,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
FLU VAC QV (18YR UP)RCM-PF 180 MCG (45 MCG X 4)/0.5 ML IM SYRG,,90682,CPT,Facility,Outpatient,0.5,mL,,322,273.7,92.2852,322,PrimeWest Health,MinnesotaCare,165.3792,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
FLU VAC QV (18YR UP)RCM-PF 180 MCG (45 MCG X 4)/0.5 ML IM SYRG,,90682,CPT,Facility,Inpatient,0.5,mL,,322,273.7,92.2852,322,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
FLU VAC QV (18YR UP)RCM-PF 180 MCG (45 MCG X 4)/0.5 ML IM SYRG,,90682,CPT,Facility,Both,0.5,mL,,322,273.7,92.2852,322,Sanford Health Plan,Sanford Health Plan,296.24,92,,percent of total billed charges,,
FLU VAC QV (18YR UP)RCM-PF 180 MCG (45 MCG X 4)/0.5 ML IM SYRG,,90682,CPT,Facility,Outpatient,0.5,mL,,322,273.7,92.2852,322,"UCare Health, Inc.",Individual & Family Plan,181.447,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
FLU VAC QV (18YR UP)RCM-PF 180 MCG (45 MCG X 4)/0.5 ML IM SYRG,,90682,CPT,Facility,Inpatient,0.5,mL,,322,273.7,92.2852,322,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
FLU VAC QV (18YR UP)RCM-PF 180 MCG (45 MCG X 4)/0.5 ML IM SYRG,,90682,CPT,Facility,Outpatient,0.5,mL,,322,273.7,92.2852,322,"UCare Health, Inc.",Medical Assistance,162.5134,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FLU VAC QV (18YR UP)RCM-PF 180 MCG (45 MCG X 4)/0.5 ML IM SYRG,,90682,CPT,Facility,Inpatient,0.5,mL,,322,273.7,92.2852,322,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
FLU VAC QV (18YR UP)RCM-PF 180 MCG (45 MCG X 4)/0.5 ML IM SYRG,,90682,CPT,Facility,Outpatient,0.5,mL,,322,273.7,92.2852,322,"UCare Health, Inc.",Medicare Advantage,162.5134,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FLU VAC QV (18YR UP)RCM-PF 180 MCG (45 MCG X 4)/0.5 ML IM SYRG,,90682,CPT,Facility,Inpatient,0.5,mL,,322,273.7,92.2852,322,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
FLU VAC QV (18YR UP)RCM-PF 180 MCG (45 MCG X 4)/0.5 ML IM SYRG,,90682,CPT,Facility,Outpatient,0.5,mL,,322,273.7,92.2852,322,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),162.5134,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FLU VAC QV (18YR UP)RCM-PF 180 MCG (45 MCG X 4)/0.5 ML IM SYRG,,90682,CPT,Facility,Inpatient,0.5,mL,,322,273.7,92.2852,322,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
FLU VAC QV (18YR UP)RCM-PF 180 MCG (45 MCG X 4)/0.5 ML IM SYRG,,90682,CPT,Facility,Both,0.5,mL,,322,273.7,92.2852,322,UnitedHealthcare,Individual & Family,302.68,94,,percent of total billed charges,,
FLU VAC QV (18YR UP)RCM-PF 180 MCG (45 MCG X 4)/0.5 ML IM SYRG,,90682,CPT,Facility,Outpatient,0.5,mL,,322,273.7,92.2852,322,UnitedHealthcare,Medicare Advantage,157.78,49,,percent of total billed charges,,
FLU VAC QV (18YR UP)RCM-PF 180 MCG (45 MCG X 4)/0.5 ML IM SYRG,,90682,CPT,Facility,Inpatient,0.5,mL,,322,273.7,92.2852,322,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
FLU VAC QV (18YR UP)RCM-PF 180 MCG (45 MCG X 4)/0.5 ML IM SYRG,,90682,CPT,Facility,Outpatient,0.5,mL,,322,273.7,92.2852,322,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,154.56,48,,percent of total billed charges,,100% of DHS outpatient percentage
FLU VAC QV (18YR UP)RCM-PF 180 MCG (45 MCG X 4)/0.5 ML IM SYRG,,90682,CPT,Facility,Inpatient,0.5,mL,,322,273.7,92.2852,322,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
FLU VACC QS 6MOS UP(PF) 60 MCG (15 MCG X 4)/0.5 ML IM SYRG,,90686,CPT,Facility,Both,0.5,mL,,103,87.55,29.5198,103,Aetna,Commercial,94.76,92,,percent of total billed charges,,
FLU VACC QS 6MOS UP(PF) 60 MCG (15 MCG X 4)/0.5 ML IM SYRG,,90686,CPT,Facility,Outpatient,0.5,mL,,103,87.55,29.5198,103,Aetna,Medicare Advantage,50.47,49,,percent of total billed charges,,
FLU VACC QS 6MOS UP(PF) 60 MCG (15 MCG X 4)/0.5 ML IM SYRG,,90686,CPT,Facility,Inpatient,0.5,mL,,103,87.55,29.5198,103,Aetna,Medicare Advantage,,,,,Included in per diem rate,
FLU VACC QS 6MOS UP(PF) 60 MCG (15 MCG X 4)/0.5 ML IM SYRG,,90686,CPT,Facility,Both,0.5,mL,,103,87.55,29.5198,103,Aetna,PPO,95.79,93,,percent of total billed charges,,
FLU VACC QS 6MOS UP(PF) 60 MCG (15 MCG X 4)/0.5 ML IM SYRG,,90686,CPT,Facility,Both,0.5,mL,,103,87.55,29.5198,103,America's PPO,America's PPO,98.9109,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
FLU VACC QS 6MOS UP(PF) 60 MCG (15 MCG X 4)/0.5 ML IM SYRG,,90686,CPT,Facility,Both,0.5,mL,,103,87.55,29.5198,103,BlueCross BlueShield Minnesota, Federal Employee Program,101.352,98.4,,percent of total billed charges,,
FLU VACC QS 6MOS UP(PF) 60 MCG (15 MCG X 4)/0.5 ML IM SYRG,,90686,CPT,Facility,Both,0.5,mL,,103,87.55,29.5198,103,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,103,100,,percent of total billed charges,,
FLU VACC QS 6MOS UP(PF) 60 MCG (15 MCG X 4)/0.5 ML IM SYRG,,90686,CPT,Facility,Both,0.5,mL,,103,87.55,29.5198,103,BlueCross BlueShield Minnesota,High Value Network Plan,92.7,90,,percent of total billed charges,,
FLU VACC QS 6MOS UP(PF) 60 MCG (15 MCG X 4)/0.5 ML IM SYRG,,90686,CPT,Facility,Outpatient,0.5,mL,,103,87.55,29.5198,103,BlueCross BlueShield Minnesota,Medicare Advantage,50.47,49,,percent of total billed charges,,
FLU VACC QS 6MOS UP(PF) 60 MCG (15 MCG X 4)/0.5 ML IM SYRG,,90686,CPT,Facility,Inpatient,0.5,mL,,103,87.55,29.5198,103,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
FLU VACC QS 6MOS UP(PF) 60 MCG (15 MCG X 4)/0.5 ML IM SYRG,,90686,CPT,Facility,Both,0.5,mL,,103,87.55,29.5198,103,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,91.2271,88.57,,percent of total billed charges,,
FLU VACC QS 6MOS UP(PF) 60 MCG (15 MCG X 4)/0.5 ML IM SYRG,,90686,CPT,Facility,Both,0.5,mL,,103,87.55,29.5198,103,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,29.5198,28.66,,percent of total billed charges,,
FLU VACC QS 6MOS UP(PF) 60 MCG (15 MCG X 4)/0.5 ML IM SYRG,,90686,CPT,Facility,Outpatient,0.5,mL,,103,87.55,29.5198,103,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),50.47,49,,percent of total billed charges,,
FLU VACC QS 6MOS UP(PF) 60 MCG (15 MCG X 4)/0.5 ML IM SYRG,,90686,CPT,Facility,Inpatient,0.5,mL,,103,87.55,29.5198,103,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
FLU VACC QS 6MOS UP(PF) 60 MCG (15 MCG X 4)/0.5 ML IM SYRG,,90686,CPT,Facility,Both,0.5,mL,,103,87.55,29.5198,103,CorVel,Worker's Compensation,103,100,,percent of total billed charges,,
FLU VACC QS 6MOS UP(PF) 60 MCG (15 MCG X 4)/0.5 ML IM SYRG,,90686,CPT,Facility,Both,0.5,mL,,103,87.55,29.5198,103,First Health Group Corporation,First Health Network,99.91,97,,percent of total billed charges,,
FLU VACC QS 6MOS UP(PF) 60 MCG (15 MCG X 4)/0.5 ML IM SYRG,,90686,CPT,Facility,Both,0.5,mL,,103,87.55,29.5198,103,"Health Partners, Inc.",Commercial,97.438,94.6,,percent of total billed charges,,
FLU VACC QS 6MOS UP(PF) 60 MCG (15 MCG X 4)/0.5 ML IM SYRG,,90686,CPT,Facility,Outpatient,0.5,mL,,103,87.55,29.5198,103,"Health Partners, Inc.",Medicare Advantage,50.47,49,,percent of total billed charges,,
FLU VACC QS 6MOS UP(PF) 60 MCG (15 MCG X 4)/0.5 ML IM SYRG,,90686,CPT,Facility,Inpatient,0.5,mL,,103,87.55,29.5198,103,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
FLU VACC QS 6MOS UP(PF) 60 MCG (15 MCG X 4)/0.5 ML IM SYRG,,90686,CPT,Facility,Both,0.5,mL,,103,87.55,29.5198,103,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),61.8,60,,percent of total billed charges,,
FLU VACC QS 6MOS UP(PF) 60 MCG (15 MCG X 4)/0.5 ML IM SYRG,,90686,CPT,Facility,Both,0.5,mL,,103,87.55,29.5198,103,"Health Partners, Inc.",State of Minnesota Advantage Program,83.945,81.5,,percent of total billed charges,,
FLU VACC QS 6MOS UP(PF) 60 MCG (15 MCG X 4)/0.5 ML IM SYRG,,90686,CPT,Facility,Both,0.5,mL,,103,87.55,29.5198,103,"Health Partners, Inc.",State Public Programs,51.5,50,,percent of total billed charges,,
FLU VACC QS 6MOS UP(PF) 60 MCG (15 MCG X 4)/0.5 ML IM SYRG,,90686,CPT,Facility,Both,0.5,mL,,103,87.55,29.5198,103,Humana Insurance Company,Commercial PPO,97.85,95,,percent of total billed charges,,
FLU VACC QS 6MOS UP(PF) 60 MCG (15 MCG X 4)/0.5 ML IM SYRG,,90686,CPT,Facility,Outpatient,0.5,mL,,103,87.55,29.5198,103,Humana Insurance Company,Medicare PPO,50.47,49,,percent of total billed charges,,
FLU VACC QS 6MOS UP(PF) 60 MCG (15 MCG X 4)/0.5 ML IM SYRG,,90686,CPT,Facility,Inpatient,0.5,mL,,103,87.55,29.5198,103,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
FLU VACC QS 6MOS UP(PF) 60 MCG (15 MCG X 4)/0.5 ML IM SYRG,,90686,CPT,Facility,Both,0.5,mL,,103,87.55,29.5198,103,Medica,Individual & Family,102.073,99.1,,percent of total billed charges,,
FLU VACC QS 6MOS UP(PF) 60 MCG (15 MCG X 4)/0.5 ML IM SYRG,,90686,CPT,Facility,Outpatient,0.5,mL,,103,87.55,29.5198,103,Medica,Medica Advantage Solution,51.294,49.8,,percent of total billed charges,,
FLU VACC QS 6MOS UP(PF) 60 MCG (15 MCG X 4)/0.5 ML IM SYRG,,90686,CPT,Facility,Inpatient,0.5,mL,,103,87.55,29.5198,103,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
FLU VACC QS 6MOS UP(PF) 60 MCG (15 MCG X 4)/0.5 ML IM SYRG,,90686,CPT,Facility,Outpatient,0.5,mL,,103,87.55,29.5198,103,Medica,Medical Assistance,45.938,44.6,,percent of total billed charges,,
FLU VACC QS 6MOS UP(PF) 60 MCG (15 MCG X 4)/0.5 ML IM SYRG,,90686,CPT,Facility,Inpatient,0.5,mL,,103,87.55,29.5198,103,Medica,Medical Assistance,,,,,Included in per diem rate,
FLU VACC QS 6MOS UP(PF) 60 MCG (15 MCG X 4)/0.5 ML IM SYRG,,90686,CPT,Facility,Outpatient,0.5,mL,,103,87.55,29.5198,103,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,51.294,49.8,,percent of total billed charges,,
FLU VACC QS 6MOS UP(PF) 60 MCG (15 MCG X 4)/0.5 ML IM SYRG,,90686,CPT,Facility,Inpatient,0.5,mL,,103,87.55,29.5198,103,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
FLU VACC QS 6MOS UP(PF) 60 MCG (15 MCG X 4)/0.5 ML IM SYRG,,90686,CPT,Facility,Both,0.5,mL,,103,87.55,29.5198,103,"Multiplan, Inc.","Multiplan, Inc.",96.82,94,,percent of total billed charges,,
FLU VACC QS 6MOS UP(PF) 60 MCG (15 MCG X 4)/0.5 ML IM SYRG,,90686,CPT,Facility,Outpatient,0.5,mL,,103,87.55,29.5198,103,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,92.803,90.1,,percent of total billed charges,,
FLU VACC QS 6MOS UP(PF) 60 MCG (15 MCG X 4)/0.5 ML IM SYRG,,90686,CPT,Facility,Inpatient,0.5,mL,,103,87.55,29.5198,103,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
FLU VACC QS 6MOS UP(PF) 60 MCG (15 MCG X 4)/0.5 ML IM SYRG,,90686,CPT,Facility,Both,0.5,mL,,103,87.55,29.5198,103,"Preferred One Administrative Services, INC.",PPO,101.558,98.6,,percent of total billed charges,,
FLU VACC QS 6MOS UP(PF) 60 MCG (15 MCG X 4)/0.5 ML IM SYRG,,90686,CPT,Facility,Outpatient,0.5,mL,,103,87.55,29.5198,103,PrimeWest Health,Minnesota Senior Health Options (MSHO),52.9935,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
FLU VACC QS 6MOS UP(PF) 60 MCG (15 MCG X 4)/0.5 ML IM SYRG,,90686,CPT,Facility,Inpatient,0.5,mL,,103,87.55,29.5198,103,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
FLU VACC QS 6MOS UP(PF) 60 MCG (15 MCG X 4)/0.5 ML IM SYRG,,90686,CPT,Facility,Outpatient,0.5,mL,,103,87.55,29.5198,103,PrimeWest Health,MinnesotaCare,52.9008,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
FLU VACC QS 6MOS UP(PF) 60 MCG (15 MCG X 4)/0.5 ML IM SYRG,,90686,CPT,Facility,Inpatient,0.5,mL,,103,87.55,29.5198,103,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
FLU VACC QS 6MOS UP(PF) 60 MCG (15 MCG X 4)/0.5 ML IM SYRG,,90686,CPT,Facility,Both,0.5,mL,,103,87.55,29.5198,103,Sanford Health Plan,Sanford Health Plan,94.76,92,,percent of total billed charges,,
FLU VACC QS 6MOS UP(PF) 60 MCG (15 MCG X 4)/0.5 ML IM SYRG,,90686,CPT,Facility,Outpatient,0.5,mL,,103,87.55,29.5198,103,"UCare Health, Inc.",Individual & Family Plan,58.0405,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
FLU VACC QS 6MOS UP(PF) 60 MCG (15 MCG X 4)/0.5 ML IM SYRG,,90686,CPT,Facility,Inpatient,0.5,mL,,103,87.55,29.5198,103,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
FLU VACC QS 6MOS UP(PF) 60 MCG (15 MCG X 4)/0.5 ML IM SYRG,,90686,CPT,Facility,Outpatient,0.5,mL,,103,87.55,29.5198,103,"UCare Health, Inc.",Medical Assistance,51.9841,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FLU VACC QS 6MOS UP(PF) 60 MCG (15 MCG X 4)/0.5 ML IM SYRG,,90686,CPT,Facility,Inpatient,0.5,mL,,103,87.55,29.5198,103,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
FLU VACC QS 6MOS UP(PF) 60 MCG (15 MCG X 4)/0.5 ML IM SYRG,,90686,CPT,Facility,Outpatient,0.5,mL,,103,87.55,29.5198,103,"UCare Health, Inc.",Medicare Advantage,51.9841,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FLU VACC QS 6MOS UP(PF) 60 MCG (15 MCG X 4)/0.5 ML IM SYRG,,90686,CPT,Facility,Inpatient,0.5,mL,,103,87.55,29.5198,103,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
FLU VACC QS 6MOS UP(PF) 60 MCG (15 MCG X 4)/0.5 ML IM SYRG,,90686,CPT,Facility,Outpatient,0.5,mL,,103,87.55,29.5198,103,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),51.9841,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FLU VACC QS 6MOS UP(PF) 60 MCG (15 MCG X 4)/0.5 ML IM SYRG,,90686,CPT,Facility,Inpatient,0.5,mL,,103,87.55,29.5198,103,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
FLU VACC QS 6MOS UP(PF) 60 MCG (15 MCG X 4)/0.5 ML IM SYRG,,90686,CPT,Facility,Both,0.5,mL,,103,87.55,29.5198,103,UnitedHealthcare,Individual & Family,96.82,94,,percent of total billed charges,,
FLU VACC QS 6MOS UP(PF) 60 MCG (15 MCG X 4)/0.5 ML IM SYRG,,90686,CPT,Facility,Outpatient,0.5,mL,,103,87.55,29.5198,103,UnitedHealthcare,Medicare Advantage,50.47,49,,percent of total billed charges,,
FLU VACC QS 6MOS UP(PF) 60 MCG (15 MCG X 4)/0.5 ML IM SYRG,,90686,CPT,Facility,Inpatient,0.5,mL,,103,87.55,29.5198,103,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
FLU VACC QS 6MOS UP(PF) 60 MCG (15 MCG X 4)/0.5 ML IM SYRG,,90686,CPT,Facility,Outpatient,0.5,mL,,103,87.55,29.5198,103,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,49.44,48,,percent of total billed charges,,100% of DHS outpatient percentage
FLU VACC QS 6MOS UP(PF) 60 MCG (15 MCG X 4)/0.5 ML IM SYRG,,90686,CPT,Facility,Inpatient,0.5,mL,,103,87.55,29.5198,103,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"DIPH,PERTUS(ACEL),TET PED (PF) 15-10-5 LF-MCG-LF/0.5ML IM SUSP",,90700,CPT,Facility,Both,0.5,mL,,181,153.85,51.8746,181,Aetna,Commercial,166.52,92,,percent of total billed charges,,
"DIPH,PERTUS(ACEL),TET PED (PF) 15-10-5 LF-MCG-LF/0.5ML IM SUSP",,90700,CPT,Facility,Outpatient,0.5,mL,,181,153.85,51.8746,181,Aetna,Medicare Advantage,88.69,49,,percent of total billed charges,,
"DIPH,PERTUS(ACEL),TET PED (PF) 15-10-5 LF-MCG-LF/0.5ML IM SUSP",,90700,CPT,Facility,Inpatient,0.5,mL,,181,153.85,51.8746,181,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"DIPH,PERTUS(ACEL),TET PED (PF) 15-10-5 LF-MCG-LF/0.5ML IM SUSP",,90700,CPT,Facility,Both,0.5,mL,,181,153.85,51.8746,181,Aetna,PPO,168.33,93,,percent of total billed charges,,
"DIPH,PERTUS(ACEL),TET PED (PF) 15-10-5 LF-MCG-LF/0.5ML IM SUSP",,90700,CPT,Facility,Both,0.5,mL,,181,153.85,51.8746,181,America's PPO,America's PPO,173.8143,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"DIPH,PERTUS(ACEL),TET PED (PF) 15-10-5 LF-MCG-LF/0.5ML IM SUSP",,90700,CPT,Facility,Both,0.5,mL,,181,153.85,51.8746,181,BlueCross BlueShield Minnesota, Federal Employee Program,178.104,98.4,,percent of total billed charges,,
"DIPH,PERTUS(ACEL),TET PED (PF) 15-10-5 LF-MCG-LF/0.5ML IM SUSP",,90700,CPT,Facility,Both,0.5,mL,,181,153.85,51.8746,181,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,181,100,,percent of total billed charges,,
"DIPH,PERTUS(ACEL),TET PED (PF) 15-10-5 LF-MCG-LF/0.5ML IM SUSP",,90700,CPT,Facility,Both,0.5,mL,,181,153.85,51.8746,181,BlueCross BlueShield Minnesota,High Value Network Plan,162.9,90,,percent of total billed charges,,
"DIPH,PERTUS(ACEL),TET PED (PF) 15-10-5 LF-MCG-LF/0.5ML IM SUSP",,90700,CPT,Facility,Outpatient,0.5,mL,,181,153.85,51.8746,181,BlueCross BlueShield Minnesota,Medicare Advantage,88.69,49,,percent of total billed charges,,
"DIPH,PERTUS(ACEL),TET PED (PF) 15-10-5 LF-MCG-LF/0.5ML IM SUSP",,90700,CPT,Facility,Inpatient,0.5,mL,,181,153.85,51.8746,181,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"DIPH,PERTUS(ACEL),TET PED (PF) 15-10-5 LF-MCG-LF/0.5ML IM SUSP",,90700,CPT,Facility,Both,0.5,mL,,181,153.85,51.8746,181,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,160.3117,88.57,,percent of total billed charges,,
"DIPH,PERTUS(ACEL),TET PED (PF) 15-10-5 LF-MCG-LF/0.5ML IM SUSP",,90700,CPT,Facility,Both,0.5,mL,,181,153.85,51.8746,181,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,51.8746,28.66,,percent of total billed charges,,
"DIPH,PERTUS(ACEL),TET PED (PF) 15-10-5 LF-MCG-LF/0.5ML IM SUSP",,90700,CPT,Facility,Outpatient,0.5,mL,,181,153.85,51.8746,181,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),88.69,49,,percent of total billed charges,,
"DIPH,PERTUS(ACEL),TET PED (PF) 15-10-5 LF-MCG-LF/0.5ML IM SUSP",,90700,CPT,Facility,Inpatient,0.5,mL,,181,153.85,51.8746,181,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"DIPH,PERTUS(ACEL),TET PED (PF) 15-10-5 LF-MCG-LF/0.5ML IM SUSP",,90700,CPT,Facility,Both,0.5,mL,,181,153.85,51.8746,181,CorVel,Worker's Compensation,181,100,,percent of total billed charges,,
"DIPH,PERTUS(ACEL),TET PED (PF) 15-10-5 LF-MCG-LF/0.5ML IM SUSP",,90700,CPT,Facility,Both,0.5,mL,,181,153.85,51.8746,181,First Health Group Corporation,First Health Network,175.57,97,,percent of total billed charges,,
"DIPH,PERTUS(ACEL),TET PED (PF) 15-10-5 LF-MCG-LF/0.5ML IM SUSP",,90700,CPT,Facility,Both,0.5,mL,,181,153.85,51.8746,181,"Health Partners, Inc.",Commercial,171.226,94.6,,percent of total billed charges,,
"DIPH,PERTUS(ACEL),TET PED (PF) 15-10-5 LF-MCG-LF/0.5ML IM SUSP",,90700,CPT,Facility,Outpatient,0.5,mL,,181,153.85,51.8746,181,"Health Partners, Inc.",Medicare Advantage,88.69,49,,percent of total billed charges,,
"DIPH,PERTUS(ACEL),TET PED (PF) 15-10-5 LF-MCG-LF/0.5ML IM SUSP",,90700,CPT,Facility,Inpatient,0.5,mL,,181,153.85,51.8746,181,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"DIPH,PERTUS(ACEL),TET PED (PF) 15-10-5 LF-MCG-LF/0.5ML IM SUSP",,90700,CPT,Facility,Both,0.5,mL,,181,153.85,51.8746,181,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),108.6,60,,percent of total billed charges,,
"DIPH,PERTUS(ACEL),TET PED (PF) 15-10-5 LF-MCG-LF/0.5ML IM SUSP",,90700,CPT,Facility,Both,0.5,mL,,181,153.85,51.8746,181,"Health Partners, Inc.",State of Minnesota Advantage Program,147.515,81.5,,percent of total billed charges,,
"DIPH,PERTUS(ACEL),TET PED (PF) 15-10-5 LF-MCG-LF/0.5ML IM SUSP",,90700,CPT,Facility,Both,0.5,mL,,181,153.85,51.8746,181,"Health Partners, Inc.",State Public Programs,90.5,50,,percent of total billed charges,,
"DIPH,PERTUS(ACEL),TET PED (PF) 15-10-5 LF-MCG-LF/0.5ML IM SUSP",,90700,CPT,Facility,Both,0.5,mL,,181,153.85,51.8746,181,Humana Insurance Company,Commercial PPO,171.95,95,,percent of total billed charges,,
"DIPH,PERTUS(ACEL),TET PED (PF) 15-10-5 LF-MCG-LF/0.5ML IM SUSP",,90700,CPT,Facility,Outpatient,0.5,mL,,181,153.85,51.8746,181,Humana Insurance Company,Medicare PPO,88.69,49,,percent of total billed charges,,
"DIPH,PERTUS(ACEL),TET PED (PF) 15-10-5 LF-MCG-LF/0.5ML IM SUSP",,90700,CPT,Facility,Inpatient,0.5,mL,,181,153.85,51.8746,181,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"DIPH,PERTUS(ACEL),TET PED (PF) 15-10-5 LF-MCG-LF/0.5ML IM SUSP",,90700,CPT,Facility,Both,0.5,mL,,181,153.85,51.8746,181,Medica,Individual & Family,179.371,99.1,,percent of total billed charges,,
"DIPH,PERTUS(ACEL),TET PED (PF) 15-10-5 LF-MCG-LF/0.5ML IM SUSP",,90700,CPT,Facility,Outpatient,0.5,mL,,181,153.85,51.8746,181,Medica,Medica Advantage Solution,90.138,49.8,,percent of total billed charges,,
"DIPH,PERTUS(ACEL),TET PED (PF) 15-10-5 LF-MCG-LF/0.5ML IM SUSP",,90700,CPT,Facility,Inpatient,0.5,mL,,181,153.85,51.8746,181,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"DIPH,PERTUS(ACEL),TET PED (PF) 15-10-5 LF-MCG-LF/0.5ML IM SUSP",,90700,CPT,Facility,Outpatient,0.5,mL,,181,153.85,51.8746,181,Medica,Medical Assistance,80.726,44.6,,percent of total billed charges,,
"DIPH,PERTUS(ACEL),TET PED (PF) 15-10-5 LF-MCG-LF/0.5ML IM SUSP",,90700,CPT,Facility,Inpatient,0.5,mL,,181,153.85,51.8746,181,Medica,Medical Assistance,,,,,Included in per diem rate,
"DIPH,PERTUS(ACEL),TET PED (PF) 15-10-5 LF-MCG-LF/0.5ML IM SUSP",,90700,CPT,Facility,Outpatient,0.5,mL,,181,153.85,51.8746,181,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,90.138,49.8,,percent of total billed charges,,
"DIPH,PERTUS(ACEL),TET PED (PF) 15-10-5 LF-MCG-LF/0.5ML IM SUSP",,90700,CPT,Facility,Inpatient,0.5,mL,,181,153.85,51.8746,181,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"DIPH,PERTUS(ACEL),TET PED (PF) 15-10-5 LF-MCG-LF/0.5ML IM SUSP",,90700,CPT,Facility,Both,0.5,mL,,181,153.85,51.8746,181,"Multiplan, Inc.","Multiplan, Inc.",170.14,94,,percent of total billed charges,,
"DIPH,PERTUS(ACEL),TET PED (PF) 15-10-5 LF-MCG-LF/0.5ML IM SUSP",,90700,CPT,Facility,Outpatient,0.5,mL,,181,153.85,51.8746,181,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,163.081,90.1,,percent of total billed charges,,
"DIPH,PERTUS(ACEL),TET PED (PF) 15-10-5 LF-MCG-LF/0.5ML IM SUSP",,90700,CPT,Facility,Inpatient,0.5,mL,,181,153.85,51.8746,181,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"DIPH,PERTUS(ACEL),TET PED (PF) 15-10-5 LF-MCG-LF/0.5ML IM SUSP",,90700,CPT,Facility,Both,0.5,mL,,181,153.85,51.8746,181,"Preferred One Administrative Services, INC.",PPO,178.466,98.6,,percent of total billed charges,,
"DIPH,PERTUS(ACEL),TET PED (PF) 15-10-5 LF-MCG-LF/0.5ML IM SUSP",,90700,CPT,Facility,Outpatient,0.5,mL,,181,153.85,51.8746,181,PrimeWest Health,Minnesota Senior Health Options (MSHO),93.1245,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"DIPH,PERTUS(ACEL),TET PED (PF) 15-10-5 LF-MCG-LF/0.5ML IM SUSP",,90700,CPT,Facility,Inpatient,0.5,mL,,181,153.85,51.8746,181,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"DIPH,PERTUS(ACEL),TET PED (PF) 15-10-5 LF-MCG-LF/0.5ML IM SUSP",,90700,CPT,Facility,Outpatient,0.5,mL,,181,153.85,51.8746,181,PrimeWest Health,MinnesotaCare,92.9616,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"DIPH,PERTUS(ACEL),TET PED (PF) 15-10-5 LF-MCG-LF/0.5ML IM SUSP",,90700,CPT,Facility,Inpatient,0.5,mL,,181,153.85,51.8746,181,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"DIPH,PERTUS(ACEL),TET PED (PF) 15-10-5 LF-MCG-LF/0.5ML IM SUSP",,90700,CPT,Facility,Both,0.5,mL,,181,153.85,51.8746,181,Sanford Health Plan,Sanford Health Plan,166.52,92,,percent of total billed charges,,
"DIPH,PERTUS(ACEL),TET PED (PF) 15-10-5 LF-MCG-LF/0.5ML IM SUSP",,90700,CPT,Facility,Outpatient,0.5,mL,,181,153.85,51.8746,181,"UCare Health, Inc.",Individual & Family Plan,101.9935,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"DIPH,PERTUS(ACEL),TET PED (PF) 15-10-5 LF-MCG-LF/0.5ML IM SUSP",,90700,CPT,Facility,Inpatient,0.5,mL,,181,153.85,51.8746,181,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"DIPH,PERTUS(ACEL),TET PED (PF) 15-10-5 LF-MCG-LF/0.5ML IM SUSP",,90700,CPT,Facility,Outpatient,0.5,mL,,181,153.85,51.8746,181,"UCare Health, Inc.",Medical Assistance,91.3507,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"DIPH,PERTUS(ACEL),TET PED (PF) 15-10-5 LF-MCG-LF/0.5ML IM SUSP",,90700,CPT,Facility,Inpatient,0.5,mL,,181,153.85,51.8746,181,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"DIPH,PERTUS(ACEL),TET PED (PF) 15-10-5 LF-MCG-LF/0.5ML IM SUSP",,90700,CPT,Facility,Outpatient,0.5,mL,,181,153.85,51.8746,181,"UCare Health, Inc.",Medicare Advantage,91.3507,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"DIPH,PERTUS(ACEL),TET PED (PF) 15-10-5 LF-MCG-LF/0.5ML IM SUSP",,90700,CPT,Facility,Inpatient,0.5,mL,,181,153.85,51.8746,181,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"DIPH,PERTUS(ACEL),TET PED (PF) 15-10-5 LF-MCG-LF/0.5ML IM SUSP",,90700,CPT,Facility,Outpatient,0.5,mL,,181,153.85,51.8746,181,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),91.3507,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"DIPH,PERTUS(ACEL),TET PED (PF) 15-10-5 LF-MCG-LF/0.5ML IM SUSP",,90700,CPT,Facility,Inpatient,0.5,mL,,181,153.85,51.8746,181,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"DIPH,PERTUS(ACEL),TET PED (PF) 15-10-5 LF-MCG-LF/0.5ML IM SUSP",,90700,CPT,Facility,Both,0.5,mL,,181,153.85,51.8746,181,UnitedHealthcare,Individual & Family,170.14,94,,percent of total billed charges,,
"DIPH,PERTUS(ACEL),TET PED (PF) 15-10-5 LF-MCG-LF/0.5ML IM SUSP",,90700,CPT,Facility,Outpatient,0.5,mL,,181,153.85,51.8746,181,UnitedHealthcare,Medicare Advantage,88.69,49,,percent of total billed charges,,
"DIPH,PERTUS(ACEL),TET PED (PF) 15-10-5 LF-MCG-LF/0.5ML IM SUSP",,90700,CPT,Facility,Inpatient,0.5,mL,,181,153.85,51.8746,181,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"DIPH,PERTUS(ACEL),TET PED (PF) 15-10-5 LF-MCG-LF/0.5ML IM SUSP",,90700,CPT,Facility,Outpatient,0.5,mL,,181,153.85,51.8746,181,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,86.88,48,,percent of total billed charges,,100% of DHS outpatient percentage
"DIPH,PERTUS(ACEL),TET PED (PF) 15-10-5 LF-MCG-LF/0.5ML IM SUSP",,90700,CPT,Facility,Inpatient,0.5,mL,,181,153.85,51.8746,181,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
TETANUS AND DIPHTHER. TOX (PF) 5-2 LF UNIT/0.5 ML IM SYRG,,90714,CPT,Facility,Both,0.5,mL,,207,175.95,59.3262,207,Aetna,Commercial,190.44,92,,percent of total billed charges,,
TETANUS AND DIPHTHER. TOX (PF) 5-2 LF UNIT/0.5 ML IM SYRG,,90714,CPT,Facility,Outpatient,0.5,mL,,207,175.95,59.3262,207,Aetna,Medicare Advantage,101.43,49,,percent of total billed charges,,
TETANUS AND DIPHTHER. TOX (PF) 5-2 LF UNIT/0.5 ML IM SYRG,,90714,CPT,Facility,Inpatient,0.5,mL,,207,175.95,59.3262,207,Aetna,Medicare Advantage,,,,,Included in per diem rate,
TETANUS AND DIPHTHER. TOX (PF) 5-2 LF UNIT/0.5 ML IM SYRG,,90714,CPT,Facility,Both,0.5,mL,,207,175.95,59.3262,207,Aetna,PPO,192.51,93,,percent of total billed charges,,
TETANUS AND DIPHTHER. TOX (PF) 5-2 LF UNIT/0.5 ML IM SYRG,,90714,CPT,Facility,Both,0.5,mL,,207,175.95,59.3262,207,America's PPO,America's PPO,198.7821,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
TETANUS AND DIPHTHER. TOX (PF) 5-2 LF UNIT/0.5 ML IM SYRG,,90714,CPT,Facility,Both,0.5,mL,,207,175.95,59.3262,207,BlueCross BlueShield Minnesota, Federal Employee Program,203.688,98.4,,percent of total billed charges,,
TETANUS AND DIPHTHER. TOX (PF) 5-2 LF UNIT/0.5 ML IM SYRG,,90714,CPT,Facility,Both,0.5,mL,,207,175.95,59.3262,207,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,207,100,,percent of total billed charges,,
TETANUS AND DIPHTHER. TOX (PF) 5-2 LF UNIT/0.5 ML IM SYRG,,90714,CPT,Facility,Both,0.5,mL,,207,175.95,59.3262,207,BlueCross BlueShield Minnesota,High Value Network Plan,186.3,90,,percent of total billed charges,,
TETANUS AND DIPHTHER. TOX (PF) 5-2 LF UNIT/0.5 ML IM SYRG,,90714,CPT,Facility,Outpatient,0.5,mL,,207,175.95,59.3262,207,BlueCross BlueShield Minnesota,Medicare Advantage,101.43,49,,percent of total billed charges,,
TETANUS AND DIPHTHER. TOX (PF) 5-2 LF UNIT/0.5 ML IM SYRG,,90714,CPT,Facility,Inpatient,0.5,mL,,207,175.95,59.3262,207,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
TETANUS AND DIPHTHER. TOX (PF) 5-2 LF UNIT/0.5 ML IM SYRG,,90714,CPT,Facility,Both,0.5,mL,,207,175.95,59.3262,207,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,183.3399,88.57,,percent of total billed charges,,
TETANUS AND DIPHTHER. TOX (PF) 5-2 LF UNIT/0.5 ML IM SYRG,,90714,CPT,Facility,Both,0.5,mL,,207,175.95,59.3262,207,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,59.3262,28.66,,percent of total billed charges,,
TETANUS AND DIPHTHER. TOX (PF) 5-2 LF UNIT/0.5 ML IM SYRG,,90714,CPT,Facility,Outpatient,0.5,mL,,207,175.95,59.3262,207,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),101.43,49,,percent of total billed charges,,
TETANUS AND DIPHTHER. TOX (PF) 5-2 LF UNIT/0.5 ML IM SYRG,,90714,CPT,Facility,Inpatient,0.5,mL,,207,175.95,59.3262,207,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
TETANUS AND DIPHTHER. TOX (PF) 5-2 LF UNIT/0.5 ML IM SYRG,,90714,CPT,Facility,Both,0.5,mL,,207,175.95,59.3262,207,CorVel,Worker's Compensation,207,100,,percent of total billed charges,,
TETANUS AND DIPHTHER. TOX (PF) 5-2 LF UNIT/0.5 ML IM SYRG,,90714,CPT,Facility,Both,0.5,mL,,207,175.95,59.3262,207,First Health Group Corporation,First Health Network,200.79,97,,percent of total billed charges,,
TETANUS AND DIPHTHER. TOX (PF) 5-2 LF UNIT/0.5 ML IM SYRG,,90714,CPT,Facility,Both,0.5,mL,,207,175.95,59.3262,207,"Health Partners, Inc.",Commercial,195.822,94.6,,percent of total billed charges,,
TETANUS AND DIPHTHER. TOX (PF) 5-2 LF UNIT/0.5 ML IM SYRG,,90714,CPT,Facility,Outpatient,0.5,mL,,207,175.95,59.3262,207,"Health Partners, Inc.",Medicare Advantage,101.43,49,,percent of total billed charges,,
TETANUS AND DIPHTHER. TOX (PF) 5-2 LF UNIT/0.5 ML IM SYRG,,90714,CPT,Facility,Inpatient,0.5,mL,,207,175.95,59.3262,207,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
TETANUS AND DIPHTHER. TOX (PF) 5-2 LF UNIT/0.5 ML IM SYRG,,90714,CPT,Facility,Both,0.5,mL,,207,175.95,59.3262,207,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),124.2,60,,percent of total billed charges,,
TETANUS AND DIPHTHER. TOX (PF) 5-2 LF UNIT/0.5 ML IM SYRG,,90714,CPT,Facility,Both,0.5,mL,,207,175.95,59.3262,207,"Health Partners, Inc.",State of Minnesota Advantage Program,168.705,81.5,,percent of total billed charges,,
TETANUS AND DIPHTHER. TOX (PF) 5-2 LF UNIT/0.5 ML IM SYRG,,90714,CPT,Facility,Both,0.5,mL,,207,175.95,59.3262,207,"Health Partners, Inc.",State Public Programs,103.5,50,,percent of total billed charges,,
TETANUS AND DIPHTHER. TOX (PF) 5-2 LF UNIT/0.5 ML IM SYRG,,90714,CPT,Facility,Both,0.5,mL,,207,175.95,59.3262,207,Humana Insurance Company,Commercial PPO,196.65,95,,percent of total billed charges,,
TETANUS AND DIPHTHER. TOX (PF) 5-2 LF UNIT/0.5 ML IM SYRG,,90714,CPT,Facility,Outpatient,0.5,mL,,207,175.95,59.3262,207,Humana Insurance Company,Medicare PPO,101.43,49,,percent of total billed charges,,
TETANUS AND DIPHTHER. TOX (PF) 5-2 LF UNIT/0.5 ML IM SYRG,,90714,CPT,Facility,Inpatient,0.5,mL,,207,175.95,59.3262,207,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
TETANUS AND DIPHTHER. TOX (PF) 5-2 LF UNIT/0.5 ML IM SYRG,,90714,CPT,Facility,Both,0.5,mL,,207,175.95,59.3262,207,Medica,Individual & Family,205.137,99.1,,percent of total billed charges,,
TETANUS AND DIPHTHER. TOX (PF) 5-2 LF UNIT/0.5 ML IM SYRG,,90714,CPT,Facility,Outpatient,0.5,mL,,207,175.95,59.3262,207,Medica,Medica Advantage Solution,103.086,49.8,,percent of total billed charges,,
TETANUS AND DIPHTHER. TOX (PF) 5-2 LF UNIT/0.5 ML IM SYRG,,90714,CPT,Facility,Inpatient,0.5,mL,,207,175.95,59.3262,207,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
TETANUS AND DIPHTHER. TOX (PF) 5-2 LF UNIT/0.5 ML IM SYRG,,90714,CPT,Facility,Outpatient,0.5,mL,,207,175.95,59.3262,207,Medica,Medical Assistance,92.322,44.6,,percent of total billed charges,,
TETANUS AND DIPHTHER. TOX (PF) 5-2 LF UNIT/0.5 ML IM SYRG,,90714,CPT,Facility,Inpatient,0.5,mL,,207,175.95,59.3262,207,Medica,Medical Assistance,,,,,Included in per diem rate,
TETANUS AND DIPHTHER. TOX (PF) 5-2 LF UNIT/0.5 ML IM SYRG,,90714,CPT,Facility,Outpatient,0.5,mL,,207,175.95,59.3262,207,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,103.086,49.8,,percent of total billed charges,,
TETANUS AND DIPHTHER. TOX (PF) 5-2 LF UNIT/0.5 ML IM SYRG,,90714,CPT,Facility,Inpatient,0.5,mL,,207,175.95,59.3262,207,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
TETANUS AND DIPHTHER. TOX (PF) 5-2 LF UNIT/0.5 ML IM SYRG,,90714,CPT,Facility,Both,0.5,mL,,207,175.95,59.3262,207,"Multiplan, Inc.","Multiplan, Inc.",194.58,94,,percent of total billed charges,,
TETANUS AND DIPHTHER. TOX (PF) 5-2 LF UNIT/0.5 ML IM SYRG,,90714,CPT,Facility,Outpatient,0.5,mL,,207,175.95,59.3262,207,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,186.507,90.1,,percent of total billed charges,,
TETANUS AND DIPHTHER. TOX (PF) 5-2 LF UNIT/0.5 ML IM SYRG,,90714,CPT,Facility,Inpatient,0.5,mL,,207,175.95,59.3262,207,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
TETANUS AND DIPHTHER. TOX (PF) 5-2 LF UNIT/0.5 ML IM SYRG,,90714,CPT,Facility,Both,0.5,mL,,207,175.95,59.3262,207,"Preferred One Administrative Services, INC.",PPO,204.102,98.6,,percent of total billed charges,,
TETANUS AND DIPHTHER. TOX (PF) 5-2 LF UNIT/0.5 ML IM SYRG,,90714,CPT,Facility,Outpatient,0.5,mL,,207,175.95,59.3262,207,PrimeWest Health,Minnesota Senior Health Options (MSHO),106.5015,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
TETANUS AND DIPHTHER. TOX (PF) 5-2 LF UNIT/0.5 ML IM SYRG,,90714,CPT,Facility,Inpatient,0.5,mL,,207,175.95,59.3262,207,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
TETANUS AND DIPHTHER. TOX (PF) 5-2 LF UNIT/0.5 ML IM SYRG,,90714,CPT,Facility,Outpatient,0.5,mL,,207,175.95,59.3262,207,PrimeWest Health,MinnesotaCare,106.3152,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
TETANUS AND DIPHTHER. TOX (PF) 5-2 LF UNIT/0.5 ML IM SYRG,,90714,CPT,Facility,Inpatient,0.5,mL,,207,175.95,59.3262,207,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
TETANUS AND DIPHTHER. TOX (PF) 5-2 LF UNIT/0.5 ML IM SYRG,,90714,CPT,Facility,Both,0.5,mL,,207,175.95,59.3262,207,Sanford Health Plan,Sanford Health Plan,190.44,92,,percent of total billed charges,,
TETANUS AND DIPHTHER. TOX (PF) 5-2 LF UNIT/0.5 ML IM SYRG,,90714,CPT,Facility,Outpatient,0.5,mL,,207,175.95,59.3262,207,"UCare Health, Inc.",Individual & Family Plan,116.6445,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
TETANUS AND DIPHTHER. TOX (PF) 5-2 LF UNIT/0.5 ML IM SYRG,,90714,CPT,Facility,Inpatient,0.5,mL,,207,175.95,59.3262,207,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
TETANUS AND DIPHTHER. TOX (PF) 5-2 LF UNIT/0.5 ML IM SYRG,,90714,CPT,Facility,Outpatient,0.5,mL,,207,175.95,59.3262,207,"UCare Health, Inc.",Medical Assistance,104.4729,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TETANUS AND DIPHTHER. TOX (PF) 5-2 LF UNIT/0.5 ML IM SYRG,,90714,CPT,Facility,Inpatient,0.5,mL,,207,175.95,59.3262,207,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
TETANUS AND DIPHTHER. TOX (PF) 5-2 LF UNIT/0.5 ML IM SYRG,,90714,CPT,Facility,Outpatient,0.5,mL,,207,175.95,59.3262,207,"UCare Health, Inc.",Medicare Advantage,104.4729,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TETANUS AND DIPHTHER. TOX (PF) 5-2 LF UNIT/0.5 ML IM SYRG,,90714,CPT,Facility,Inpatient,0.5,mL,,207,175.95,59.3262,207,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
TETANUS AND DIPHTHER. TOX (PF) 5-2 LF UNIT/0.5 ML IM SYRG,,90714,CPT,Facility,Outpatient,0.5,mL,,207,175.95,59.3262,207,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),104.4729,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TETANUS AND DIPHTHER. TOX (PF) 5-2 LF UNIT/0.5 ML IM SYRG,,90714,CPT,Facility,Inpatient,0.5,mL,,207,175.95,59.3262,207,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
TETANUS AND DIPHTHER. TOX (PF) 5-2 LF UNIT/0.5 ML IM SYRG,,90714,CPT,Facility,Both,0.5,mL,,207,175.95,59.3262,207,UnitedHealthcare,Individual & Family,194.58,94,,percent of total billed charges,,
TETANUS AND DIPHTHER. TOX (PF) 5-2 LF UNIT/0.5 ML IM SYRG,,90714,CPT,Facility,Outpatient,0.5,mL,,207,175.95,59.3262,207,UnitedHealthcare,Medicare Advantage,101.43,49,,percent of total billed charges,,
TETANUS AND DIPHTHER. TOX (PF) 5-2 LF UNIT/0.5 ML IM SYRG,,90714,CPT,Facility,Inpatient,0.5,mL,,207,175.95,59.3262,207,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
TETANUS AND DIPHTHER. TOX (PF) 5-2 LF UNIT/0.5 ML IM SYRG,,90714,CPT,Facility,Outpatient,0.5,mL,,207,175.95,59.3262,207,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,99.36,48,,percent of total billed charges,,100% of DHS outpatient percentage
TETANUS AND DIPHTHER. TOX (PF) 5-2 LF UNIT/0.5 ML IM SYRG,,90714,CPT,Facility,Inpatient,0.5,mL,,207,175.95,59.3262,207,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"DIPH,PERTUSS(ACEL),TET VAC(PF) 2 LF-(2.5-5-3-5 MCG)-5LF/0.5 ML IM SYRG",,90715,CPT,Facility,Both,0.5,mL,,253,215.05,72.5098,253,Aetna,Commercial,232.76,92,,percent of total billed charges,,
"DIPH,PERTUSS(ACEL),TET VAC(PF) 2 LF-(2.5-5-3-5 MCG)-5LF/0.5 ML IM SYRG",,90715,CPT,Facility,Outpatient,0.5,mL,,253,215.05,72.5098,253,Aetna,Medicare Advantage,123.97,49,,percent of total billed charges,,
"DIPH,PERTUSS(ACEL),TET VAC(PF) 2 LF-(2.5-5-3-5 MCG)-5LF/0.5 ML IM SYRG",,90715,CPT,Facility,Inpatient,0.5,mL,,253,215.05,72.5098,253,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"DIPH,PERTUSS(ACEL),TET VAC(PF) 2 LF-(2.5-5-3-5 MCG)-5LF/0.5 ML IM SYRG",,90715,CPT,Facility,Both,0.5,mL,,253,215.05,72.5098,253,Aetna,PPO,235.29,93,,percent of total billed charges,,
"DIPH,PERTUSS(ACEL),TET VAC(PF) 2 LF-(2.5-5-3-5 MCG)-5LF/0.5 ML IM SYRG",,90715,CPT,Facility,Both,0.5,mL,,253,215.05,72.5098,253,America's PPO,America's PPO,242.9559,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"DIPH,PERTUSS(ACEL),TET VAC(PF) 2 LF-(2.5-5-3-5 MCG)-5LF/0.5 ML IM SYRG",,90715,CPT,Facility,Both,0.5,mL,,253,215.05,72.5098,253,BlueCross BlueShield Minnesota, Federal Employee Program,248.952,98.4,,percent of total billed charges,,
"DIPH,PERTUSS(ACEL),TET VAC(PF) 2 LF-(2.5-5-3-5 MCG)-5LF/0.5 ML IM SYRG",,90715,CPT,Facility,Both,0.5,mL,,253,215.05,72.5098,253,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,253,100,,percent of total billed charges,,
"DIPH,PERTUSS(ACEL),TET VAC(PF) 2 LF-(2.5-5-3-5 MCG)-5LF/0.5 ML IM SYRG",,90715,CPT,Facility,Both,0.5,mL,,253,215.05,72.5098,253,BlueCross BlueShield Minnesota,High Value Network Plan,227.7,90,,percent of total billed charges,,
"DIPH,PERTUSS(ACEL),TET VAC(PF) 2 LF-(2.5-5-3-5 MCG)-5LF/0.5 ML IM SYRG",,90715,CPT,Facility,Outpatient,0.5,mL,,253,215.05,72.5098,253,BlueCross BlueShield Minnesota,Medicare Advantage,123.97,49,,percent of total billed charges,,
"DIPH,PERTUSS(ACEL),TET VAC(PF) 2 LF-(2.5-5-3-5 MCG)-5LF/0.5 ML IM SYRG",,90715,CPT,Facility,Inpatient,0.5,mL,,253,215.05,72.5098,253,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"DIPH,PERTUSS(ACEL),TET VAC(PF) 2 LF-(2.5-5-3-5 MCG)-5LF/0.5 ML IM SYRG",,90715,CPT,Facility,Both,0.5,mL,,253,215.05,72.5098,253,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,224.0821,88.57,,percent of total billed charges,,
"DIPH,PERTUSS(ACEL),TET VAC(PF) 2 LF-(2.5-5-3-5 MCG)-5LF/0.5 ML IM SYRG",,90715,CPT,Facility,Both,0.5,mL,,253,215.05,72.5098,253,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,72.5098,28.66,,percent of total billed charges,,
"DIPH,PERTUSS(ACEL),TET VAC(PF) 2 LF-(2.5-5-3-5 MCG)-5LF/0.5 ML IM SYRG",,90715,CPT,Facility,Outpatient,0.5,mL,,253,215.05,72.5098,253,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),123.97,49,,percent of total billed charges,,
"DIPH,PERTUSS(ACEL),TET VAC(PF) 2 LF-(2.5-5-3-5 MCG)-5LF/0.5 ML IM SYRG",,90715,CPT,Facility,Inpatient,0.5,mL,,253,215.05,72.5098,253,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"DIPH,PERTUSS(ACEL),TET VAC(PF) 2 LF-(2.5-5-3-5 MCG)-5LF/0.5 ML IM SYRG",,90715,CPT,Facility,Both,0.5,mL,,253,215.05,72.5098,253,CorVel,Worker's Compensation,253,100,,percent of total billed charges,,
"DIPH,PERTUSS(ACEL),TET VAC(PF) 2 LF-(2.5-5-3-5 MCG)-5LF/0.5 ML IM SYRG",,90715,CPT,Facility,Both,0.5,mL,,253,215.05,72.5098,253,First Health Group Corporation,First Health Network,245.41,97,,percent of total billed charges,,
"DIPH,PERTUSS(ACEL),TET VAC(PF) 2 LF-(2.5-5-3-5 MCG)-5LF/0.5 ML IM SYRG",,90715,CPT,Facility,Both,0.5,mL,,253,215.05,72.5098,253,"Health Partners, Inc.",Commercial,239.338,94.6,,percent of total billed charges,,
"DIPH,PERTUSS(ACEL),TET VAC(PF) 2 LF-(2.5-5-3-5 MCG)-5LF/0.5 ML IM SYRG",,90715,CPT,Facility,Outpatient,0.5,mL,,253,215.05,72.5098,253,"Health Partners, Inc.",Medicare Advantage,123.97,49,,percent of total billed charges,,
"DIPH,PERTUSS(ACEL),TET VAC(PF) 2 LF-(2.5-5-3-5 MCG)-5LF/0.5 ML IM SYRG",,90715,CPT,Facility,Inpatient,0.5,mL,,253,215.05,72.5098,253,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"DIPH,PERTUSS(ACEL),TET VAC(PF) 2 LF-(2.5-5-3-5 MCG)-5LF/0.5 ML IM SYRG",,90715,CPT,Facility,Both,0.5,mL,,253,215.05,72.5098,253,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),151.8,60,,percent of total billed charges,,
"DIPH,PERTUSS(ACEL),TET VAC(PF) 2 LF-(2.5-5-3-5 MCG)-5LF/0.5 ML IM SYRG",,90715,CPT,Facility,Both,0.5,mL,,253,215.05,72.5098,253,"Health Partners, Inc.",State of Minnesota Advantage Program,206.195,81.5,,percent of total billed charges,,
"DIPH,PERTUSS(ACEL),TET VAC(PF) 2 LF-(2.5-5-3-5 MCG)-5LF/0.5 ML IM SYRG",,90715,CPT,Facility,Both,0.5,mL,,253,215.05,72.5098,253,"Health Partners, Inc.",State Public Programs,126.5,50,,percent of total billed charges,,
"DIPH,PERTUSS(ACEL),TET VAC(PF) 2 LF-(2.5-5-3-5 MCG)-5LF/0.5 ML IM SYRG",,90715,CPT,Facility,Both,0.5,mL,,253,215.05,72.5098,253,Humana Insurance Company,Commercial PPO,240.35,95,,percent of total billed charges,,
"DIPH,PERTUSS(ACEL),TET VAC(PF) 2 LF-(2.5-5-3-5 MCG)-5LF/0.5 ML IM SYRG",,90715,CPT,Facility,Outpatient,0.5,mL,,253,215.05,72.5098,253,Humana Insurance Company,Medicare PPO,123.97,49,,percent of total billed charges,,
"DIPH,PERTUSS(ACEL),TET VAC(PF) 2 LF-(2.5-5-3-5 MCG)-5LF/0.5 ML IM SYRG",,90715,CPT,Facility,Inpatient,0.5,mL,,253,215.05,72.5098,253,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"DIPH,PERTUSS(ACEL),TET VAC(PF) 2 LF-(2.5-5-3-5 MCG)-5LF/0.5 ML IM SYRG",,90715,CPT,Facility,Both,0.5,mL,,253,215.05,72.5098,253,Medica,Individual & Family,250.723,99.1,,percent of total billed charges,,
"DIPH,PERTUSS(ACEL),TET VAC(PF) 2 LF-(2.5-5-3-5 MCG)-5LF/0.5 ML IM SYRG",,90715,CPT,Facility,Outpatient,0.5,mL,,253,215.05,72.5098,253,Medica,Medica Advantage Solution,125.994,49.8,,percent of total billed charges,,
"DIPH,PERTUSS(ACEL),TET VAC(PF) 2 LF-(2.5-5-3-5 MCG)-5LF/0.5 ML IM SYRG",,90715,CPT,Facility,Inpatient,0.5,mL,,253,215.05,72.5098,253,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"DIPH,PERTUSS(ACEL),TET VAC(PF) 2 LF-(2.5-5-3-5 MCG)-5LF/0.5 ML IM SYRG",,90715,CPT,Facility,Outpatient,0.5,mL,,253,215.05,72.5098,253,Medica,Medical Assistance,112.838,44.6,,percent of total billed charges,,
"DIPH,PERTUSS(ACEL),TET VAC(PF) 2 LF-(2.5-5-3-5 MCG)-5LF/0.5 ML IM SYRG",,90715,CPT,Facility,Inpatient,0.5,mL,,253,215.05,72.5098,253,Medica,Medical Assistance,,,,,Included in per diem rate,
"DIPH,PERTUSS(ACEL),TET VAC(PF) 2 LF-(2.5-5-3-5 MCG)-5LF/0.5 ML IM SYRG",,90715,CPT,Facility,Outpatient,0.5,mL,,253,215.05,72.5098,253,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,125.994,49.8,,percent of total billed charges,,
"DIPH,PERTUSS(ACEL),TET VAC(PF) 2 LF-(2.5-5-3-5 MCG)-5LF/0.5 ML IM SYRG",,90715,CPT,Facility,Inpatient,0.5,mL,,253,215.05,72.5098,253,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"DIPH,PERTUSS(ACEL),TET VAC(PF) 2 LF-(2.5-5-3-5 MCG)-5LF/0.5 ML IM SYRG",,90715,CPT,Facility,Both,0.5,mL,,253,215.05,72.5098,253,"Multiplan, Inc.","Multiplan, Inc.",237.82,94,,percent of total billed charges,,
"DIPH,PERTUSS(ACEL),TET VAC(PF) 2 LF-(2.5-5-3-5 MCG)-5LF/0.5 ML IM SYRG",,90715,CPT,Facility,Outpatient,0.5,mL,,253,215.05,72.5098,253,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,227.953,90.1,,percent of total billed charges,,
"DIPH,PERTUSS(ACEL),TET VAC(PF) 2 LF-(2.5-5-3-5 MCG)-5LF/0.5 ML IM SYRG",,90715,CPT,Facility,Inpatient,0.5,mL,,253,215.05,72.5098,253,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"DIPH,PERTUSS(ACEL),TET VAC(PF) 2 LF-(2.5-5-3-5 MCG)-5LF/0.5 ML IM SYRG",,90715,CPT,Facility,Both,0.5,mL,,253,215.05,72.5098,253,"Preferred One Administrative Services, INC.",PPO,249.458,98.6,,percent of total billed charges,,
"DIPH,PERTUSS(ACEL),TET VAC(PF) 2 LF-(2.5-5-3-5 MCG)-5LF/0.5 ML IM SYRG",,90715,CPT,Facility,Outpatient,0.5,mL,,253,215.05,72.5098,253,PrimeWest Health,Minnesota Senior Health Options (MSHO),130.1685,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"DIPH,PERTUSS(ACEL),TET VAC(PF) 2 LF-(2.5-5-3-5 MCG)-5LF/0.5 ML IM SYRG",,90715,CPT,Facility,Inpatient,0.5,mL,,253,215.05,72.5098,253,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"DIPH,PERTUSS(ACEL),TET VAC(PF) 2 LF-(2.5-5-3-5 MCG)-5LF/0.5 ML IM SYRG",,90715,CPT,Facility,Outpatient,0.5,mL,,253,215.05,72.5098,253,PrimeWest Health,MinnesotaCare,129.9408,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"DIPH,PERTUSS(ACEL),TET VAC(PF) 2 LF-(2.5-5-3-5 MCG)-5LF/0.5 ML IM SYRG",,90715,CPT,Facility,Inpatient,0.5,mL,,253,215.05,72.5098,253,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"DIPH,PERTUSS(ACEL),TET VAC(PF) 2 LF-(2.5-5-3-5 MCG)-5LF/0.5 ML IM SYRG",,90715,CPT,Facility,Both,0.5,mL,,253,215.05,72.5098,253,Sanford Health Plan,Sanford Health Plan,232.76,92,,percent of total billed charges,,
"DIPH,PERTUSS(ACEL),TET VAC(PF) 2 LF-(2.5-5-3-5 MCG)-5LF/0.5 ML IM SYRG",,90715,CPT,Facility,Outpatient,0.5,mL,,253,215.05,72.5098,253,"UCare Health, Inc.",Individual & Family Plan,142.5655,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"DIPH,PERTUSS(ACEL),TET VAC(PF) 2 LF-(2.5-5-3-5 MCG)-5LF/0.5 ML IM SYRG",,90715,CPT,Facility,Inpatient,0.5,mL,,253,215.05,72.5098,253,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"DIPH,PERTUSS(ACEL),TET VAC(PF) 2 LF-(2.5-5-3-5 MCG)-5LF/0.5 ML IM SYRG",,90715,CPT,Facility,Outpatient,0.5,mL,,253,215.05,72.5098,253,"UCare Health, Inc.",Medical Assistance,127.6891,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"DIPH,PERTUSS(ACEL),TET VAC(PF) 2 LF-(2.5-5-3-5 MCG)-5LF/0.5 ML IM SYRG",,90715,CPT,Facility,Inpatient,0.5,mL,,253,215.05,72.5098,253,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"DIPH,PERTUSS(ACEL),TET VAC(PF) 2 LF-(2.5-5-3-5 MCG)-5LF/0.5 ML IM SYRG",,90715,CPT,Facility,Outpatient,0.5,mL,,253,215.05,72.5098,253,"UCare Health, Inc.",Medicare Advantage,127.6891,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"DIPH,PERTUSS(ACEL),TET VAC(PF) 2 LF-(2.5-5-3-5 MCG)-5LF/0.5 ML IM SYRG",,90715,CPT,Facility,Inpatient,0.5,mL,,253,215.05,72.5098,253,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"DIPH,PERTUSS(ACEL),TET VAC(PF) 2 LF-(2.5-5-3-5 MCG)-5LF/0.5 ML IM SYRG",,90715,CPT,Facility,Outpatient,0.5,mL,,253,215.05,72.5098,253,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),127.6891,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"DIPH,PERTUSS(ACEL),TET VAC(PF) 2 LF-(2.5-5-3-5 MCG)-5LF/0.5 ML IM SYRG",,90715,CPT,Facility,Inpatient,0.5,mL,,253,215.05,72.5098,253,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"DIPH,PERTUSS(ACEL),TET VAC(PF) 2 LF-(2.5-5-3-5 MCG)-5LF/0.5 ML IM SYRG",,90715,CPT,Facility,Both,0.5,mL,,253,215.05,72.5098,253,UnitedHealthcare,Individual & Family,237.82,94,,percent of total billed charges,,
"DIPH,PERTUSS(ACEL),TET VAC(PF) 2 LF-(2.5-5-3-5 MCG)-5LF/0.5 ML IM SYRG",,90715,CPT,Facility,Outpatient,0.5,mL,,253,215.05,72.5098,253,UnitedHealthcare,Medicare Advantage,123.97,49,,percent of total billed charges,,
"DIPH,PERTUSS(ACEL),TET VAC(PF) 2 LF-(2.5-5-3-5 MCG)-5LF/0.5 ML IM SYRG",,90715,CPT,Facility,Inpatient,0.5,mL,,253,215.05,72.5098,253,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"DIPH,PERTUSS(ACEL),TET VAC(PF) 2 LF-(2.5-5-3-5 MCG)-5LF/0.5 ML IM SYRG",,90715,CPT,Facility,Outpatient,0.5,mL,,253,215.05,72.5098,253,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,121.44,48,,percent of total billed charges,,100% of DHS outpatient percentage
"DIPH,PERTUSS(ACEL),TET VAC(PF) 2 LF-(2.5-5-3-5 MCG)-5LF/0.5 ML IM SYRG",,90715,CPT,Facility,Inpatient,0.5,mL,,253,215.05,72.5098,253,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
PNEUMOCOCCAL 23-VAL PS VACCINE 25 MCG/0.5 ML INJ SYRG,,90732,CPT,Facility,Both,0.5,mL,,548,465.8,157.0568,548,Aetna,Commercial,504.16,92,,percent of total billed charges,,
PNEUMOCOCCAL 23-VAL PS VACCINE 25 MCG/0.5 ML INJ SYRG,,90732,CPT,Facility,Outpatient,0.5,mL,,548,465.8,157.0568,548,Aetna,Medicare Advantage,268.52,49,,percent of total billed charges,,
PNEUMOCOCCAL 23-VAL PS VACCINE 25 MCG/0.5 ML INJ SYRG,,90732,CPT,Facility,Inpatient,0.5,mL,,548,465.8,157.0568,548,Aetna,Medicare Advantage,,,,,Included in per diem rate,
PNEUMOCOCCAL 23-VAL PS VACCINE 25 MCG/0.5 ML INJ SYRG,,90732,CPT,Facility,Both,0.5,mL,,548,465.8,157.0568,548,Aetna,PPO,509.64,93,,percent of total billed charges,,
PNEUMOCOCCAL 23-VAL PS VACCINE 25 MCG/0.5 ML INJ SYRG,,90732,CPT,Facility,Both,0.5,mL,,548,465.8,157.0568,548,America's PPO,America's PPO,526.2444,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
PNEUMOCOCCAL 23-VAL PS VACCINE 25 MCG/0.5 ML INJ SYRG,,90732,CPT,Facility,Both,0.5,mL,,548,465.8,157.0568,548,BlueCross BlueShield Minnesota, Federal Employee Program,539.232,98.4,,percent of total billed charges,,
PNEUMOCOCCAL 23-VAL PS VACCINE 25 MCG/0.5 ML INJ SYRG,,90732,CPT,Facility,Both,0.5,mL,,548,465.8,157.0568,548,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,548,100,,percent of total billed charges,,
PNEUMOCOCCAL 23-VAL PS VACCINE 25 MCG/0.5 ML INJ SYRG,,90732,CPT,Facility,Both,0.5,mL,,548,465.8,157.0568,548,BlueCross BlueShield Minnesota,High Value Network Plan,493.2,90,,percent of total billed charges,,
PNEUMOCOCCAL 23-VAL PS VACCINE 25 MCG/0.5 ML INJ SYRG,,90732,CPT,Facility,Outpatient,0.5,mL,,548,465.8,157.0568,548,BlueCross BlueShield Minnesota,Medicare Advantage,268.52,49,,percent of total billed charges,,
PNEUMOCOCCAL 23-VAL PS VACCINE 25 MCG/0.5 ML INJ SYRG,,90732,CPT,Facility,Inpatient,0.5,mL,,548,465.8,157.0568,548,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
PNEUMOCOCCAL 23-VAL PS VACCINE 25 MCG/0.5 ML INJ SYRG,,90732,CPT,Facility,Both,0.5,mL,,548,465.8,157.0568,548,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,485.3636,88.57,,percent of total billed charges,,
PNEUMOCOCCAL 23-VAL PS VACCINE 25 MCG/0.5 ML INJ SYRG,,90732,CPT,Facility,Both,0.5,mL,,548,465.8,157.0568,548,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,157.0568,28.66,,percent of total billed charges,,
PNEUMOCOCCAL 23-VAL PS VACCINE 25 MCG/0.5 ML INJ SYRG,,90732,CPT,Facility,Outpatient,0.5,mL,,548,465.8,157.0568,548,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),268.52,49,,percent of total billed charges,,
PNEUMOCOCCAL 23-VAL PS VACCINE 25 MCG/0.5 ML INJ SYRG,,90732,CPT,Facility,Inpatient,0.5,mL,,548,465.8,157.0568,548,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
PNEUMOCOCCAL 23-VAL PS VACCINE 25 MCG/0.5 ML INJ SYRG,,90732,CPT,Facility,Both,0.5,mL,,548,465.8,157.0568,548,CorVel,Worker's Compensation,548,100,,percent of total billed charges,,
PNEUMOCOCCAL 23-VAL PS VACCINE 25 MCG/0.5 ML INJ SYRG,,90732,CPT,Facility,Both,0.5,mL,,548,465.8,157.0568,548,First Health Group Corporation,First Health Network,531.56,97,,percent of total billed charges,,
PNEUMOCOCCAL 23-VAL PS VACCINE 25 MCG/0.5 ML INJ SYRG,,90732,CPT,Facility,Both,0.5,mL,,548,465.8,157.0568,548,"Health Partners, Inc.",Commercial,518.408,94.6,,percent of total billed charges,,
PNEUMOCOCCAL 23-VAL PS VACCINE 25 MCG/0.5 ML INJ SYRG,,90732,CPT,Facility,Outpatient,0.5,mL,,548,465.8,157.0568,548,"Health Partners, Inc.",Medicare Advantage,268.52,49,,percent of total billed charges,,
PNEUMOCOCCAL 23-VAL PS VACCINE 25 MCG/0.5 ML INJ SYRG,,90732,CPT,Facility,Inpatient,0.5,mL,,548,465.8,157.0568,548,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PNEUMOCOCCAL 23-VAL PS VACCINE 25 MCG/0.5 ML INJ SYRG,,90732,CPT,Facility,Both,0.5,mL,,548,465.8,157.0568,548,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),328.8,60,,percent of total billed charges,,
PNEUMOCOCCAL 23-VAL PS VACCINE 25 MCG/0.5 ML INJ SYRG,,90732,CPT,Facility,Both,0.5,mL,,548,465.8,157.0568,548,"Health Partners, Inc.",State of Minnesota Advantage Program,446.62,81.5,,percent of total billed charges,,
PNEUMOCOCCAL 23-VAL PS VACCINE 25 MCG/0.5 ML INJ SYRG,,90732,CPT,Facility,Both,0.5,mL,,548,465.8,157.0568,548,"Health Partners, Inc.",State Public Programs,274,50,,percent of total billed charges,,
PNEUMOCOCCAL 23-VAL PS VACCINE 25 MCG/0.5 ML INJ SYRG,,90732,CPT,Facility,Both,0.5,mL,,548,465.8,157.0568,548,Humana Insurance Company,Commercial PPO,520.6,95,,percent of total billed charges,,
PNEUMOCOCCAL 23-VAL PS VACCINE 25 MCG/0.5 ML INJ SYRG,,90732,CPT,Facility,Outpatient,0.5,mL,,548,465.8,157.0568,548,Humana Insurance Company,Medicare PPO,268.52,49,,percent of total billed charges,,
PNEUMOCOCCAL 23-VAL PS VACCINE 25 MCG/0.5 ML INJ SYRG,,90732,CPT,Facility,Inpatient,0.5,mL,,548,465.8,157.0568,548,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
PNEUMOCOCCAL 23-VAL PS VACCINE 25 MCG/0.5 ML INJ SYRG,,90732,CPT,Facility,Both,0.5,mL,,548,465.8,157.0568,548,Medica,Individual & Family,543.068,99.1,,percent of total billed charges,,
PNEUMOCOCCAL 23-VAL PS VACCINE 25 MCG/0.5 ML INJ SYRG,,90732,CPT,Facility,Outpatient,0.5,mL,,548,465.8,157.0568,548,Medica,Medica Advantage Solution,272.904,49.8,,percent of total billed charges,,
PNEUMOCOCCAL 23-VAL PS VACCINE 25 MCG/0.5 ML INJ SYRG,,90732,CPT,Facility,Inpatient,0.5,mL,,548,465.8,157.0568,548,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
PNEUMOCOCCAL 23-VAL PS VACCINE 25 MCG/0.5 ML INJ SYRG,,90732,CPT,Facility,Outpatient,0.5,mL,,548,465.8,157.0568,548,Medica,Medical Assistance,244.408,44.6,,percent of total billed charges,,
PNEUMOCOCCAL 23-VAL PS VACCINE 25 MCG/0.5 ML INJ SYRG,,90732,CPT,Facility,Inpatient,0.5,mL,,548,465.8,157.0568,548,Medica,Medical Assistance,,,,,Included in per diem rate,
PNEUMOCOCCAL 23-VAL PS VACCINE 25 MCG/0.5 ML INJ SYRG,,90732,CPT,Facility,Outpatient,0.5,mL,,548,465.8,157.0568,548,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,272.904,49.8,,percent of total billed charges,,
PNEUMOCOCCAL 23-VAL PS VACCINE 25 MCG/0.5 ML INJ SYRG,,90732,CPT,Facility,Inpatient,0.5,mL,,548,465.8,157.0568,548,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
PNEUMOCOCCAL 23-VAL PS VACCINE 25 MCG/0.5 ML INJ SYRG,,90732,CPT,Facility,Both,0.5,mL,,548,465.8,157.0568,548,"Multiplan, Inc.","Multiplan, Inc.",515.12,94,,percent of total billed charges,,
PNEUMOCOCCAL 23-VAL PS VACCINE 25 MCG/0.5 ML INJ SYRG,,90732,CPT,Facility,Outpatient,0.5,mL,,548,465.8,157.0568,548,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,493.748,90.1,,percent of total billed charges,,
PNEUMOCOCCAL 23-VAL PS VACCINE 25 MCG/0.5 ML INJ SYRG,,90732,CPT,Facility,Inpatient,0.5,mL,,548,465.8,157.0568,548,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
PNEUMOCOCCAL 23-VAL PS VACCINE 25 MCG/0.5 ML INJ SYRG,,90732,CPT,Facility,Both,0.5,mL,,548,465.8,157.0568,548,"Preferred One Administrative Services, INC.",PPO,540.328,98.6,,percent of total billed charges,,
PNEUMOCOCCAL 23-VAL PS VACCINE 25 MCG/0.5 ML INJ SYRG,,90732,CPT,Facility,Outpatient,0.5,mL,,548,465.8,157.0568,548,PrimeWest Health,Minnesota Senior Health Options (MSHO),281.946,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
PNEUMOCOCCAL 23-VAL PS VACCINE 25 MCG/0.5 ML INJ SYRG,,90732,CPT,Facility,Inpatient,0.5,mL,,548,465.8,157.0568,548,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PNEUMOCOCCAL 23-VAL PS VACCINE 25 MCG/0.5 ML INJ SYRG,,90732,CPT,Facility,Outpatient,0.5,mL,,548,465.8,157.0568,548,PrimeWest Health,MinnesotaCare,281.4528,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
PNEUMOCOCCAL 23-VAL PS VACCINE 25 MCG/0.5 ML INJ SYRG,,90732,CPT,Facility,Inpatient,0.5,mL,,548,465.8,157.0568,548,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
PNEUMOCOCCAL 23-VAL PS VACCINE 25 MCG/0.5 ML INJ SYRG,,90732,CPT,Facility,Both,0.5,mL,,548,465.8,157.0568,548,Sanford Health Plan,Sanford Health Plan,504.16,92,,percent of total billed charges,,
PNEUMOCOCCAL 23-VAL PS VACCINE 25 MCG/0.5 ML INJ SYRG,,90732,CPT,Facility,Outpatient,0.5,mL,,548,465.8,157.0568,548,"UCare Health, Inc.",Individual & Family Plan,308.798,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
PNEUMOCOCCAL 23-VAL PS VACCINE 25 MCG/0.5 ML INJ SYRG,,90732,CPT,Facility,Inpatient,0.5,mL,,548,465.8,157.0568,548,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
PNEUMOCOCCAL 23-VAL PS VACCINE 25 MCG/0.5 ML INJ SYRG,,90732,CPT,Facility,Outpatient,0.5,mL,,548,465.8,157.0568,548,"UCare Health, Inc.",Medical Assistance,276.5756,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PNEUMOCOCCAL 23-VAL PS VACCINE 25 MCG/0.5 ML INJ SYRG,,90732,CPT,Facility,Inpatient,0.5,mL,,548,465.8,157.0568,548,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
PNEUMOCOCCAL 23-VAL PS VACCINE 25 MCG/0.5 ML INJ SYRG,,90732,CPT,Facility,Outpatient,0.5,mL,,548,465.8,157.0568,548,"UCare Health, Inc.",Medicare Advantage,276.5756,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PNEUMOCOCCAL 23-VAL PS VACCINE 25 MCG/0.5 ML INJ SYRG,,90732,CPT,Facility,Inpatient,0.5,mL,,548,465.8,157.0568,548,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PNEUMOCOCCAL 23-VAL PS VACCINE 25 MCG/0.5 ML INJ SYRG,,90732,CPT,Facility,Outpatient,0.5,mL,,548,465.8,157.0568,548,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),276.5756,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PNEUMOCOCCAL 23-VAL PS VACCINE 25 MCG/0.5 ML INJ SYRG,,90732,CPT,Facility,Inpatient,0.5,mL,,548,465.8,157.0568,548,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PNEUMOCOCCAL 23-VAL PS VACCINE 25 MCG/0.5 ML INJ SYRG,,90732,CPT,Facility,Both,0.5,mL,,548,465.8,157.0568,548,UnitedHealthcare,Individual & Family,515.12,94,,percent of total billed charges,,
PNEUMOCOCCAL 23-VAL PS VACCINE 25 MCG/0.5 ML INJ SYRG,,90732,CPT,Facility,Outpatient,0.5,mL,,548,465.8,157.0568,548,UnitedHealthcare,Medicare Advantage,268.52,49,,percent of total billed charges,,
PNEUMOCOCCAL 23-VAL PS VACCINE 25 MCG/0.5 ML INJ SYRG,,90732,CPT,Facility,Inpatient,0.5,mL,,548,465.8,157.0568,548,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
PNEUMOCOCCAL 23-VAL PS VACCINE 25 MCG/0.5 ML INJ SYRG,,90732,CPT,Facility,Outpatient,0.5,mL,,548,465.8,157.0568,548,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,263.04,48,,percent of total billed charges,,100% of DHS outpatient percentage
PNEUMOCOCCAL 23-VAL PS VACCINE 25 MCG/0.5 ML INJ SYRG,,90732,CPT,Facility,Inpatient,0.5,mL,,548,465.8,157.0568,548,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"MENING VAC A,C,Y,W135 DIP (PF) 4 MCG/0.5 ML IM SOLN",,90734,CPT,Facility,Both,0.5,mL,,693,589.05,198.6138,693,Aetna,Commercial,637.56,92,,percent of total billed charges,,
"MENING VAC A,C,Y,W135 DIP (PF) 4 MCG/0.5 ML IM SOLN",,90734,CPT,Facility,Outpatient,0.5,mL,,693,589.05,198.6138,693,Aetna,Medicare Advantage,339.57,49,,percent of total billed charges,,
"MENING VAC A,C,Y,W135 DIP (PF) 4 MCG/0.5 ML IM SOLN",,90734,CPT,Facility,Inpatient,0.5,mL,,693,589.05,198.6138,693,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"MENING VAC A,C,Y,W135 DIP (PF) 4 MCG/0.5 ML IM SOLN",,90734,CPT,Facility,Both,0.5,mL,,693,589.05,198.6138,693,Aetna,PPO,644.49,93,,percent of total billed charges,,
"MENING VAC A,C,Y,W135 DIP (PF) 4 MCG/0.5 ML IM SOLN",,90734,CPT,Facility,Both,0.5,mL,,693,589.05,198.6138,693,America's PPO,America's PPO,665.4879,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"MENING VAC A,C,Y,W135 DIP (PF) 4 MCG/0.5 ML IM SOLN",,90734,CPT,Facility,Both,0.5,mL,,693,589.05,198.6138,693,BlueCross BlueShield Minnesota, Federal Employee Program,681.912,98.4,,percent of total billed charges,,
"MENING VAC A,C,Y,W135 DIP (PF) 4 MCG/0.5 ML IM SOLN",,90734,CPT,Facility,Both,0.5,mL,,693,589.05,198.6138,693,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,693,100,,percent of total billed charges,,
"MENING VAC A,C,Y,W135 DIP (PF) 4 MCG/0.5 ML IM SOLN",,90734,CPT,Facility,Both,0.5,mL,,693,589.05,198.6138,693,BlueCross BlueShield Minnesota,High Value Network Plan,623.7,90,,percent of total billed charges,,
"MENING VAC A,C,Y,W135 DIP (PF) 4 MCG/0.5 ML IM SOLN",,90734,CPT,Facility,Outpatient,0.5,mL,,693,589.05,198.6138,693,BlueCross BlueShield Minnesota,Medicare Advantage,339.57,49,,percent of total billed charges,,
"MENING VAC A,C,Y,W135 DIP (PF) 4 MCG/0.5 ML IM SOLN",,90734,CPT,Facility,Inpatient,0.5,mL,,693,589.05,198.6138,693,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"MENING VAC A,C,Y,W135 DIP (PF) 4 MCG/0.5 ML IM SOLN",,90734,CPT,Facility,Both,0.5,mL,,693,589.05,198.6138,693,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,613.7901,88.57,,percent of total billed charges,,
"MENING VAC A,C,Y,W135 DIP (PF) 4 MCG/0.5 ML IM SOLN",,90734,CPT,Facility,Both,0.5,mL,,693,589.05,198.6138,693,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,198.6138,28.66,,percent of total billed charges,,
"MENING VAC A,C,Y,W135 DIP (PF) 4 MCG/0.5 ML IM SOLN",,90734,CPT,Facility,Outpatient,0.5,mL,,693,589.05,198.6138,693,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),339.57,49,,percent of total billed charges,,
"MENING VAC A,C,Y,W135 DIP (PF) 4 MCG/0.5 ML IM SOLN",,90734,CPT,Facility,Inpatient,0.5,mL,,693,589.05,198.6138,693,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"MENING VAC A,C,Y,W135 DIP (PF) 4 MCG/0.5 ML IM SOLN",,90734,CPT,Facility,Both,0.5,mL,,693,589.05,198.6138,693,CorVel,Worker's Compensation,693,100,,percent of total billed charges,,
"MENING VAC A,C,Y,W135 DIP (PF) 4 MCG/0.5 ML IM SOLN",,90734,CPT,Facility,Both,0.5,mL,,693,589.05,198.6138,693,First Health Group Corporation,First Health Network,672.21,97,,percent of total billed charges,,
"MENING VAC A,C,Y,W135 DIP (PF) 4 MCG/0.5 ML IM SOLN",,90734,CPT,Facility,Both,0.5,mL,,693,589.05,198.6138,693,"Health Partners, Inc.",Commercial,655.578,94.6,,percent of total billed charges,,
"MENING VAC A,C,Y,W135 DIP (PF) 4 MCG/0.5 ML IM SOLN",,90734,CPT,Facility,Outpatient,0.5,mL,,693,589.05,198.6138,693,"Health Partners, Inc.",Medicare Advantage,339.57,49,,percent of total billed charges,,
"MENING VAC A,C,Y,W135 DIP (PF) 4 MCG/0.5 ML IM SOLN",,90734,CPT,Facility,Inpatient,0.5,mL,,693,589.05,198.6138,693,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"MENING VAC A,C,Y,W135 DIP (PF) 4 MCG/0.5 ML IM SOLN",,90734,CPT,Facility,Both,0.5,mL,,693,589.05,198.6138,693,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),415.8,60,,percent of total billed charges,,
"MENING VAC A,C,Y,W135 DIP (PF) 4 MCG/0.5 ML IM SOLN",,90734,CPT,Facility,Both,0.5,mL,,693,589.05,198.6138,693,"Health Partners, Inc.",State of Minnesota Advantage Program,564.795,81.5,,percent of total billed charges,,
"MENING VAC A,C,Y,W135 DIP (PF) 4 MCG/0.5 ML IM SOLN",,90734,CPT,Facility,Both,0.5,mL,,693,589.05,198.6138,693,"Health Partners, Inc.",State Public Programs,346.5,50,,percent of total billed charges,,
"MENING VAC A,C,Y,W135 DIP (PF) 4 MCG/0.5 ML IM SOLN",,90734,CPT,Facility,Both,0.5,mL,,693,589.05,198.6138,693,Humana Insurance Company,Commercial PPO,658.35,95,,percent of total billed charges,,
"MENING VAC A,C,Y,W135 DIP (PF) 4 MCG/0.5 ML IM SOLN",,90734,CPT,Facility,Outpatient,0.5,mL,,693,589.05,198.6138,693,Humana Insurance Company,Medicare PPO,339.57,49,,percent of total billed charges,,
"MENING VAC A,C,Y,W135 DIP (PF) 4 MCG/0.5 ML IM SOLN",,90734,CPT,Facility,Inpatient,0.5,mL,,693,589.05,198.6138,693,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"MENING VAC A,C,Y,W135 DIP (PF) 4 MCG/0.5 ML IM SOLN",,90734,CPT,Facility,Both,0.5,mL,,693,589.05,198.6138,693,Medica,Individual & Family,686.763,99.1,,percent of total billed charges,,
"MENING VAC A,C,Y,W135 DIP (PF) 4 MCG/0.5 ML IM SOLN",,90734,CPT,Facility,Outpatient,0.5,mL,,693,589.05,198.6138,693,Medica,Medica Advantage Solution,345.114,49.8,,percent of total billed charges,,
"MENING VAC A,C,Y,W135 DIP (PF) 4 MCG/0.5 ML IM SOLN",,90734,CPT,Facility,Inpatient,0.5,mL,,693,589.05,198.6138,693,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"MENING VAC A,C,Y,W135 DIP (PF) 4 MCG/0.5 ML IM SOLN",,90734,CPT,Facility,Outpatient,0.5,mL,,693,589.05,198.6138,693,Medica,Medical Assistance,309.078,44.6,,percent of total billed charges,,
"MENING VAC A,C,Y,W135 DIP (PF) 4 MCG/0.5 ML IM SOLN",,90734,CPT,Facility,Inpatient,0.5,mL,,693,589.05,198.6138,693,Medica,Medical Assistance,,,,,Included in per diem rate,
"MENING VAC A,C,Y,W135 DIP (PF) 4 MCG/0.5 ML IM SOLN",,90734,CPT,Facility,Outpatient,0.5,mL,,693,589.05,198.6138,693,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,345.114,49.8,,percent of total billed charges,,
"MENING VAC A,C,Y,W135 DIP (PF) 4 MCG/0.5 ML IM SOLN",,90734,CPT,Facility,Inpatient,0.5,mL,,693,589.05,198.6138,693,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"MENING VAC A,C,Y,W135 DIP (PF) 4 MCG/0.5 ML IM SOLN",,90734,CPT,Facility,Both,0.5,mL,,693,589.05,198.6138,693,"Multiplan, Inc.","Multiplan, Inc.",651.42,94,,percent of total billed charges,,
"MENING VAC A,C,Y,W135 DIP (PF) 4 MCG/0.5 ML IM SOLN",,90734,CPT,Facility,Outpatient,0.5,mL,,693,589.05,198.6138,693,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,624.393,90.1,,percent of total billed charges,,
"MENING VAC A,C,Y,W135 DIP (PF) 4 MCG/0.5 ML IM SOLN",,90734,CPT,Facility,Inpatient,0.5,mL,,693,589.05,198.6138,693,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"MENING VAC A,C,Y,W135 DIP (PF) 4 MCG/0.5 ML IM SOLN",,90734,CPT,Facility,Both,0.5,mL,,693,589.05,198.6138,693,"Preferred One Administrative Services, INC.",PPO,683.298,98.6,,percent of total billed charges,,
"MENING VAC A,C,Y,W135 DIP (PF) 4 MCG/0.5 ML IM SOLN",,90734,CPT,Facility,Outpatient,0.5,mL,,693,589.05,198.6138,693,PrimeWest Health,Minnesota Senior Health Options (MSHO),356.5485,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"MENING VAC A,C,Y,W135 DIP (PF) 4 MCG/0.5 ML IM SOLN",,90734,CPT,Facility,Inpatient,0.5,mL,,693,589.05,198.6138,693,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"MENING VAC A,C,Y,W135 DIP (PF) 4 MCG/0.5 ML IM SOLN",,90734,CPT,Facility,Outpatient,0.5,mL,,693,589.05,198.6138,693,PrimeWest Health,MinnesotaCare,355.9248,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"MENING VAC A,C,Y,W135 DIP (PF) 4 MCG/0.5 ML IM SOLN",,90734,CPT,Facility,Inpatient,0.5,mL,,693,589.05,198.6138,693,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"MENING VAC A,C,Y,W135 DIP (PF) 4 MCG/0.5 ML IM SOLN",,90734,CPT,Facility,Both,0.5,mL,,693,589.05,198.6138,693,Sanford Health Plan,Sanford Health Plan,637.56,92,,percent of total billed charges,,
"MENING VAC A,C,Y,W135 DIP (PF) 4 MCG/0.5 ML IM SOLN",,90734,CPT,Facility,Outpatient,0.5,mL,,693,589.05,198.6138,693,"UCare Health, Inc.",Individual & Family Plan,390.5055,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"MENING VAC A,C,Y,W135 DIP (PF) 4 MCG/0.5 ML IM SOLN",,90734,CPT,Facility,Inpatient,0.5,mL,,693,589.05,198.6138,693,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"MENING VAC A,C,Y,W135 DIP (PF) 4 MCG/0.5 ML IM SOLN",,90734,CPT,Facility,Outpatient,0.5,mL,,693,589.05,198.6138,693,"UCare Health, Inc.",Medical Assistance,349.7571,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"MENING VAC A,C,Y,W135 DIP (PF) 4 MCG/0.5 ML IM SOLN",,90734,CPT,Facility,Inpatient,0.5,mL,,693,589.05,198.6138,693,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"MENING VAC A,C,Y,W135 DIP (PF) 4 MCG/0.5 ML IM SOLN",,90734,CPT,Facility,Outpatient,0.5,mL,,693,589.05,198.6138,693,"UCare Health, Inc.",Medicare Advantage,349.7571,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"MENING VAC A,C,Y,W135 DIP (PF) 4 MCG/0.5 ML IM SOLN",,90734,CPT,Facility,Inpatient,0.5,mL,,693,589.05,198.6138,693,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"MENING VAC A,C,Y,W135 DIP (PF) 4 MCG/0.5 ML IM SOLN",,90734,CPT,Facility,Outpatient,0.5,mL,,693,589.05,198.6138,693,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),349.7571,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"MENING VAC A,C,Y,W135 DIP (PF) 4 MCG/0.5 ML IM SOLN",,90734,CPT,Facility,Inpatient,0.5,mL,,693,589.05,198.6138,693,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"MENING VAC A,C,Y,W135 DIP (PF) 4 MCG/0.5 ML IM SOLN",,90734,CPT,Facility,Both,0.5,mL,,693,589.05,198.6138,693,UnitedHealthcare,Individual & Family,651.42,94,,percent of total billed charges,,
"MENING VAC A,C,Y,W135 DIP (PF) 4 MCG/0.5 ML IM SOLN",,90734,CPT,Facility,Outpatient,0.5,mL,,693,589.05,198.6138,693,UnitedHealthcare,Medicare Advantage,339.57,49,,percent of total billed charges,,
"MENING VAC A,C,Y,W135 DIP (PF) 4 MCG/0.5 ML IM SOLN",,90734,CPT,Facility,Inpatient,0.5,mL,,693,589.05,198.6138,693,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"MENING VAC A,C,Y,W135 DIP (PF) 4 MCG/0.5 ML IM SOLN",,90734,CPT,Facility,Outpatient,0.5,mL,,693,589.05,198.6138,693,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,332.64,48,,percent of total billed charges,,100% of DHS outpatient percentage
"MENING VAC A,C,Y,W135 DIP (PF) 4 MCG/0.5 ML IM SOLN",,90734,CPT,Facility,Inpatient,0.5,mL,,693,589.05,198.6138,693,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
FRACTURES OF HIP AND PELVIS WITHOUT MCC,,536,MS-DRG,Facility,Inpatient,,,,7178.5,6101.725,6819.575,6893.51355,America's PPO,America's PPO,6893.51355,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
FRACTURES OF HIP AND PELVIS WITHOUT MCC,,536,MS-DRG,Facility,Inpatient,,,,7178.5,6101.725,6819.575,6893.51355,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,6819.575,,,Other ,DRG,"DRG weight 0.7771 x WOO $13,372.00; Cap at 95% of charge; minimum of 90.1% of charge"
"SPRAINS, STRAINS, AND DISLOCATIONS OF HIP, PELVIS AND THIGH WITHOUT CC/MCC",,538,MS-DRG,Facility,Inpatient,,,,4077.5,3465.875,3873.625,3915.62325,America's PPO,America's PPO,3915.62325,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"SPRAINS, STRAINS, AND DISLOCATIONS OF HIP, PELVIS AND THIGH WITHOUT CC/MCC",,538,MS-DRG,Facility,Inpatient,,,,4077.5,3465.875,3873.625,3915.62325,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,3873.625,,,Other,DRG,"DRG weight 0.6962 x WOO $13,372.00; Cap at 95% of charge; minimum of 90.1% of charge"
OSTEOMYELITIS WITH MCC,,539,MS-DRG,Facility,Inpatient,,,,31982,27184.7,28815.782,30712.3146,America's PPO,America's PPO,30712.3146,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
OSTEOMYELITIS WITH MCC,,539,MS-DRG,Facility,Inpatient,,,,31982,27184.7,28815.782,30712.3146,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,28815.782,,,Other ,DRG,"DRG weight 1.9959 x WOO $13,372.00; Cap at 95% of charge; minimum of 90.1% of charge"
OSTEOMYELITIS WITH CC,,540,MS-DRG,Facility,Inpatient,,,,11610.66667,9869.066667,11030.13333,11149.7232,America's PPO,America's PPO,11149.7232,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
OSTEOMYELITIS WITH CC,,540,MS-DRG,Facility,Inpatient,,,,11610.66667,9869.066667,11030.13333,11149.7232,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,11030.13333,,,Other ,DRG,"DRG weight 1.3466 x WOO $13,372.00; Cap at 95% of charge; minimum of 90.1% of charge"
PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITH MCC,,542,MS-DRG,Facility,Inpatient,,,,27904,23718.4,25141.504,26796.2112,America's PPO,America's PPO,26796.2112,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITH MCC,,542,MS-DRG,Facility,Inpatient,,,,27904,23718.4,25141.504,26796.2112,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,25141.504,,,Other ,DRG,"DRG weight 1.828 x WOO $13,372.00; Cap at 95% of charge; minimum of 90.1% of charge"
CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC,,547,MS-DRG,Facility,Inpatient,,,,3259,2770.15,3096.05,3129.6177,America's PPO,America's PPO,3129.6177,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC,,547,MS-DRG,Facility,Inpatient,,,,3259,2770.15,3096.05,3129.6177,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,3096.05,,,Other ,DRG,"DRG weight 0.9148 x WOO $13,372.00; Cap at 95% of charge; minimum of 90.1% of charge"
MEDICAL BACK PROBLEMS WITHOUT MCC,,552,MS-DRG,Facility,Inpatient,,,,12118.57143,10300.78571,11512.64286,11637.46414,America's PPO,America's PPO,11637.46414,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
MEDICAL BACK PROBLEMS WITHOUT MCC,,552,MS-DRG,Facility,Inpatient,,,,12118.57143,10300.78571,11512.64286,11637.46414,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,11512.64286,,,Other ,DRG,"DRG weight 0.9605 x WOO $13,372.00; Cap at 95% of charge; minimum of 90.1% of charge"
SIGNS AND SYMPTOMS OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT MCC,,556,MS-DRG,Facility,Inpatient,,,,10817,9194.45,10276.15,10387.5651,America's PPO,America's PPO,10387.5651,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SIGNS AND SYMPTOMS OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT MCC,,556,MS-DRG,Facility,Inpatient,,,,10817,9194.45,10276.15,10387.5651,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,10276.15,,,Other ,DRG,"DRG weight 0.808 x WOO $13,372.00; Cap at 95% of charge; minimum of 90.1% of charge"
"TENDONITIS, MYOSITIS AND BURSITIS WITHOUT MCC",,558,MS-DRG,Facility,Inpatient,,,,8312.5,7065.625,7896.875,7982.49375,America's PPO,America's PPO,7982.49375,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"TENDONITIS, MYOSITIS AND BURSITIS WITHOUT MCC",,558,MS-DRG,Facility,Inpatient,,,,8312.5,7065.625,7896.875,7982.49375,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,7896.875,,,Other ,DRG,"DRG weight 0.869 x WOO $13,372.00; Cap at 95% of charge; minimum of 90.1% of charge"
"AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC",,560,MS-DRG,Facility,Inpatient,,,,5153.5,4380.475,4895.825,4948.90605,America's PPO,America's PPO,4948.90605,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC",,560,MS-DRG,Facility,Inpatient,,,,5153.5,4380.475,4895.825,4948.90605,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4895.825,,,Other,DRG,"DRG weight 1.0956 x WOO $13,372.00; Cap at 95% of charge; minimum of 90.1% of charge"
"FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITH MCC",,562,MS-DRG,Facility,Inpatient,,,,10829,9204.65,10287.55,10399.0887,America's PPO,America's PPO,10399.0887,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITH MCC",,562,MS-DRG,Facility,Inpatient,,,,10829,9204.65,10287.55,10399.0887,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,10287.55,,,Other,DRG,"DRG weight 1.4628 x WOO $13,372.00; Cap at 95% of charge; minimum of 90.1% of charge"
"FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITHOUT MCC",,563,MS-DRG,Facility,Inpatient,,,,11017.75,9365.0875,10466.8625,10580.34533,America's PPO,America's PPO,10580.34533,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITHOUT MCC",,563,MS-DRG,Facility,Inpatient,,,,11017.75,9365.0875,10466.8625,10580.34533,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,10466.8625,,,Other,DRG,"DRG weight 0.8612 x WOO $13,372.00; Cap at 95% of charge; minimum of 90.1% of charge"
HEPATITIS B VIRUS VACC.REC(PF) 5 MCG/0.5 ML IM SUSP,,90740,CPT,Facility,Both,0.5,mL,,139,118.15,39.8374,139,Aetna,Commercial,127.88,92,,percent of total billed charges,,
HEPATITIS B VIRUS VACC.REC(PF) 5 MCG/0.5 ML IM SUSP,,90740,CPT,Facility,Outpatient,0.5,mL,,139,118.15,39.8374,139,Aetna,Medicare Advantage,68.11,49,,percent of total billed charges,,
HEPATITIS B VIRUS VACC.REC(PF) 5 MCG/0.5 ML IM SUSP,,90740,CPT,Facility,Inpatient,0.5,mL,,139,118.15,39.8374,139,Aetna,Medicare Advantage,,,,,Included in per diem rate,
HEPATITIS B VIRUS VACC.REC(PF) 5 MCG/0.5 ML IM SUSP,,90740,CPT,Facility,Both,0.5,mL,,139,118.15,39.8374,139,Aetna,PPO,129.27,93,,percent of total billed charges,,
HEPATITIS B VIRUS VACC.REC(PF) 5 MCG/0.5 ML IM SUSP,,90740,CPT,Facility,Both,0.5,mL,,139,118.15,39.8374,139,America's PPO,America's PPO,133.4817,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
HEPATITIS B VIRUS VACC.REC(PF) 5 MCG/0.5 ML IM SUSP,,90740,CPT,Facility,Both,0.5,mL,,139,118.15,39.8374,139,BlueCross BlueShield Minnesota, Federal Employee Program,136.776,98.4,,percent of total billed charges,,
HEPATITIS B VIRUS VACC.REC(PF) 5 MCG/0.5 ML IM SUSP,,90740,CPT,Facility,Both,0.5,mL,,139,118.15,39.8374,139,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,139,100,,percent of total billed charges,,
HEPATITIS B VIRUS VACC.REC(PF) 5 MCG/0.5 ML IM SUSP,,90740,CPT,Facility,Both,0.5,mL,,139,118.15,39.8374,139,BlueCross BlueShield Minnesota,High Value Network Plan,125.1,90,,percent of total billed charges,,
HEPATITIS B VIRUS VACC.REC(PF) 5 MCG/0.5 ML IM SUSP,,90740,CPT,Facility,Outpatient,0.5,mL,,139,118.15,39.8374,139,BlueCross BlueShield Minnesota,Medicare Advantage,68.11,49,,percent of total billed charges,,
HEPATITIS B VIRUS VACC.REC(PF) 5 MCG/0.5 ML IM SUSP,,90740,CPT,Facility,Inpatient,0.5,mL,,139,118.15,39.8374,139,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
HEPATITIS B VIRUS VACC.REC(PF) 5 MCG/0.5 ML IM SUSP,,90740,CPT,Facility,Both,0.5,mL,,139,118.15,39.8374,139,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,123.1123,88.57,,percent of total billed charges,,
HEPATITIS B VIRUS VACC.REC(PF) 5 MCG/0.5 ML IM SUSP,,90740,CPT,Facility,Both,0.5,mL,,139,118.15,39.8374,139,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,39.8374,28.66,,percent of total billed charges,,
HEPATITIS B VIRUS VACC.REC(PF) 5 MCG/0.5 ML IM SUSP,,90740,CPT,Facility,Outpatient,0.5,mL,,139,118.15,39.8374,139,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),68.11,49,,percent of total billed charges,,
HEPATITIS B VIRUS VACC.REC(PF) 5 MCG/0.5 ML IM SUSP,,90740,CPT,Facility,Inpatient,0.5,mL,,139,118.15,39.8374,139,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
HEPATITIS B VIRUS VACC.REC(PF) 5 MCG/0.5 ML IM SUSP,,90740,CPT,Facility,Both,0.5,mL,,139,118.15,39.8374,139,CorVel,Worker's Compensation,139,100,,percent of total billed charges,,
HEPATITIS B VIRUS VACC.REC(PF) 5 MCG/0.5 ML IM SUSP,,90740,CPT,Facility,Both,0.5,mL,,139,118.15,39.8374,139,First Health Group Corporation,First Health Network,134.83,97,,percent of total billed charges,,
HEPATITIS B VIRUS VACC.REC(PF) 5 MCG/0.5 ML IM SUSP,,90740,CPT,Facility,Both,0.5,mL,,139,118.15,39.8374,139,"Health Partners, Inc.",Commercial,131.494,94.6,,percent of total billed charges,,
HEPATITIS B VIRUS VACC.REC(PF) 5 MCG/0.5 ML IM SUSP,,90740,CPT,Facility,Outpatient,0.5,mL,,139,118.15,39.8374,139,"Health Partners, Inc.",Medicare Advantage,68.11,49,,percent of total billed charges,,
HEPATITIS B VIRUS VACC.REC(PF) 5 MCG/0.5 ML IM SUSP,,90740,CPT,Facility,Inpatient,0.5,mL,,139,118.15,39.8374,139,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
HEPATITIS B VIRUS VACC.REC(PF) 5 MCG/0.5 ML IM SUSP,,90740,CPT,Facility,Both,0.5,mL,,139,118.15,39.8374,139,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),83.4,60,,percent of total billed charges,,
HEPATITIS B VIRUS VACC.REC(PF) 5 MCG/0.5 ML IM SUSP,,90740,CPT,Facility,Both,0.5,mL,,139,118.15,39.8374,139,"Health Partners, Inc.",State of Minnesota Advantage Program,113.285,81.5,,percent of total billed charges,,
HEPATITIS B VIRUS VACC.REC(PF) 5 MCG/0.5 ML IM SUSP,,90740,CPT,Facility,Both,0.5,mL,,139,118.15,39.8374,139,"Health Partners, Inc.",State Public Programs,69.5,50,,percent of total billed charges,,
HEPATITIS B VIRUS VACC.REC(PF) 5 MCG/0.5 ML IM SUSP,,90740,CPT,Facility,Both,0.5,mL,,139,118.15,39.8374,139,Humana Insurance Company,Commercial PPO,132.05,95,,percent of total billed charges,,
HEPATITIS B VIRUS VACC.REC(PF) 5 MCG/0.5 ML IM SUSP,,90740,CPT,Facility,Outpatient,0.5,mL,,139,118.15,39.8374,139,Humana Insurance Company,Medicare PPO,68.11,49,,percent of total billed charges,,
HEPATITIS B VIRUS VACC.REC(PF) 5 MCG/0.5 ML IM SUSP,,90740,CPT,Facility,Inpatient,0.5,mL,,139,118.15,39.8374,139,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
HEPATITIS B VIRUS VACC.REC(PF) 5 MCG/0.5 ML IM SUSP,,90740,CPT,Facility,Both,0.5,mL,,139,118.15,39.8374,139,Medica,Individual & Family,137.749,99.1,,percent of total billed charges,,
HEPATITIS B VIRUS VACC.REC(PF) 5 MCG/0.5 ML IM SUSP,,90740,CPT,Facility,Outpatient,0.5,mL,,139,118.15,39.8374,139,Medica,Medica Advantage Solution,69.222,49.8,,percent of total billed charges,,
HEPATITIS B VIRUS VACC.REC(PF) 5 MCG/0.5 ML IM SUSP,,90740,CPT,Facility,Inpatient,0.5,mL,,139,118.15,39.8374,139,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
HEPATITIS B VIRUS VACC.REC(PF) 5 MCG/0.5 ML IM SUSP,,90740,CPT,Facility,Outpatient,0.5,mL,,139,118.15,39.8374,139,Medica,Medical Assistance,61.994,44.6,,percent of total billed charges,,
HEPATITIS B VIRUS VACC.REC(PF) 5 MCG/0.5 ML IM SUSP,,90740,CPT,Facility,Inpatient,0.5,mL,,139,118.15,39.8374,139,Medica,Medical Assistance,,,,,Included in per diem rate,
HEPATITIS B VIRUS VACC.REC(PF) 5 MCG/0.5 ML IM SUSP,,90740,CPT,Facility,Outpatient,0.5,mL,,139,118.15,39.8374,139,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,69.222,49.8,,percent of total billed charges,,
HEPATITIS B VIRUS VACC.REC(PF) 5 MCG/0.5 ML IM SUSP,,90740,CPT,Facility,Inpatient,0.5,mL,,139,118.15,39.8374,139,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
HEPATITIS B VIRUS VACC.REC(PF) 5 MCG/0.5 ML IM SUSP,,90740,CPT,Facility,Both,0.5,mL,,139,118.15,39.8374,139,"Multiplan, Inc.","Multiplan, Inc.",130.66,94,,percent of total billed charges,,
HEPATITIS B VIRUS VACC.REC(PF) 5 MCG/0.5 ML IM SUSP,,90740,CPT,Facility,Outpatient,0.5,mL,,139,118.15,39.8374,139,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,125.239,90.1,,percent of total billed charges,,
HEPATITIS B VIRUS VACC.REC(PF) 5 MCG/0.5 ML IM SUSP,,90740,CPT,Facility,Inpatient,0.5,mL,,139,118.15,39.8374,139,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
HEPATITIS B VIRUS VACC.REC(PF) 5 MCG/0.5 ML IM SUSP,,90740,CPT,Facility,Both,0.5,mL,,139,118.15,39.8374,139,"Preferred One Administrative Services, INC.",PPO,137.054,98.6,,percent of total billed charges,,
HEPATITIS B VIRUS VACC.REC(PF) 5 MCG/0.5 ML IM SUSP,,90740,CPT,Facility,Outpatient,0.5,mL,,139,118.15,39.8374,139,PrimeWest Health,Minnesota Senior Health Options (MSHO),71.5155,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
HEPATITIS B VIRUS VACC.REC(PF) 5 MCG/0.5 ML IM SUSP,,90740,CPT,Facility,Inpatient,0.5,mL,,139,118.15,39.8374,139,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
HEPATITIS B VIRUS VACC.REC(PF) 5 MCG/0.5 ML IM SUSP,,90740,CPT,Facility,Outpatient,0.5,mL,,139,118.15,39.8374,139,PrimeWest Health,MinnesotaCare,71.3904,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
HEPATITIS B VIRUS VACC.REC(PF) 5 MCG/0.5 ML IM SUSP,,90740,CPT,Facility,Inpatient,0.5,mL,,139,118.15,39.8374,139,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
HEPATITIS B VIRUS VACC.REC(PF) 5 MCG/0.5 ML IM SUSP,,90740,CPT,Facility,Both,0.5,mL,,139,118.15,39.8374,139,Sanford Health Plan,Sanford Health Plan,127.88,92,,percent of total billed charges,,
HEPATITIS B VIRUS VACC.REC(PF) 5 MCG/0.5 ML IM SUSP,,90740,CPT,Facility,Outpatient,0.5,mL,,139,118.15,39.8374,139,"UCare Health, Inc.",Individual & Family Plan,78.3265,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
HEPATITIS B VIRUS VACC.REC(PF) 5 MCG/0.5 ML IM SUSP,,90740,CPT,Facility,Inpatient,0.5,mL,,139,118.15,39.8374,139,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
HEPATITIS B VIRUS VACC.REC(PF) 5 MCG/0.5 ML IM SUSP,,90740,CPT,Facility,Outpatient,0.5,mL,,139,118.15,39.8374,139,"UCare Health, Inc.",Medical Assistance,70.1533,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
HEPATITIS B VIRUS VACC.REC(PF) 5 MCG/0.5 ML IM SUSP,,90740,CPT,Facility,Inpatient,0.5,mL,,139,118.15,39.8374,139,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
HEPATITIS B VIRUS VACC.REC(PF) 5 MCG/0.5 ML IM SUSP,,90740,CPT,Facility,Outpatient,0.5,mL,,139,118.15,39.8374,139,"UCare Health, Inc.",Medicare Advantage,70.1533,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
HEPATITIS B VIRUS VACC.REC(PF) 5 MCG/0.5 ML IM SUSP,,90740,CPT,Facility,Inpatient,0.5,mL,,139,118.15,39.8374,139,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
HEPATITIS B VIRUS VACC.REC(PF) 5 MCG/0.5 ML IM SUSP,,90740,CPT,Facility,Outpatient,0.5,mL,,139,118.15,39.8374,139,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),70.1533,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
HEPATITIS B VIRUS VACC.REC(PF) 5 MCG/0.5 ML IM SUSP,,90740,CPT,Facility,Inpatient,0.5,mL,,139,118.15,39.8374,139,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
HEPATITIS B VIRUS VACC.REC(PF) 5 MCG/0.5 ML IM SUSP,,90740,CPT,Facility,Both,0.5,mL,,139,118.15,39.8374,139,UnitedHealthcare,Individual & Family,130.66,94,,percent of total billed charges,,
HEPATITIS B VIRUS VACC.REC(PF) 5 MCG/0.5 ML IM SUSP,,90740,CPT,Facility,Outpatient,0.5,mL,,139,118.15,39.8374,139,UnitedHealthcare,Medicare Advantage,68.11,49,,percent of total billed charges,,
HEPATITIS B VIRUS VACC.REC(PF) 5 MCG/0.5 ML IM SUSP,,90740,CPT,Facility,Inpatient,0.5,mL,,139,118.15,39.8374,139,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
HEPATITIS B VIRUS VACC.REC(PF) 5 MCG/0.5 ML IM SUSP,,90740,CPT,Facility,Outpatient,0.5,mL,,139,118.15,39.8374,139,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,66.72,48,,percent of total billed charges,,100% of DHS outpatient percentage
HEPATITIS B VIRUS VACC.REC(PF) 5 MCG/0.5 ML IM SUSP,,90740,CPT,Facility,Inpatient,0.5,mL,,139,118.15,39.8374,139,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
CELLULITIS WITH MCC,,602,MS-DRG,Facility,Inpatient,,,,6696,5691.6,6361.2,6430.1688,America's PPO,America's PPO,6430.1688,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
CELLULITIS WITH MCC,,602,MS-DRG,Facility,Inpatient,,,,6696,5691.6,6361.2,6430.1688,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,6361.2,,,Other ,DRG,"DRG weight 1.4412 x WOO $13,372.00; Cap at 95% of charge; minimum of 90.1% of charge"
CELLULITIS WITHOUT MCC,,603,MS-DRG,Facility,Inpatient,,,,18537.66667,15757.01667,16702.43767,17801.7213,America's PPO,America's PPO,17801.7213,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
CELLULITIS WITHOUT MCC,,603,MS-DRG,Facility,Inpatient,,,,18537.66667,15757.01667,16702.43767,17801.7213,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,16702.43767,,,Other ,DRG,"DRG weight 0.8818 x WOO $13,372.00; Cap at 95% of charge; minimum of 90.1% of charge"
"TRAUMA TO THE SKIN, SUBCUTANEOUS TISSUE AND BREAST WITH MCC",,604,MS-DRG,Facility,Inpatient,,,,9253,7865.05,8790.35,8885.6559,America's PPO,America's PPO,8885.6559,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"TRAUMA TO THE SKIN, SUBCUTANEOUS TISSUE AND BREAST WITH MCC",,604,MS-DRG,Facility,Inpatient,,,,9253,7865.05,8790.35,8885.6559,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,8790.35,,,Other,DRG,"DRG weight 1.5092 x WOO $13,372.00; Cap at 95% of charge; minimum of 90.1% of charge"
"TRAUMA TO THE SKIN, SUBCUTANEOUS TISSUE AND BREAST WITHOUT MCC",,605,MS-DRG,Facility,Inpatient,,,,14023.16667,11919.69167,12634.87317,13466.44695,America's PPO,America's PPO,13466.44695,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"TRAUMA TO THE SKIN, SUBCUTANEOUS TISSUE AND BREAST WITHOUT MCC",,605,MS-DRG,Facility,Inpatient,,,,14023.16667,11919.69167,12634.87317,13466.44695,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,12634.87317,,,Other ,DRG,"DRG weight 0.9104 x WOO $13,372.00; Cap at 95% of charge; minimum of 90.1% of charge"
"MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITH MCC",,640,MS-DRG,Facility,Inpatient,,,,13579,11542.15,12900.05,13039.9137,America's PPO,America's PPO,13039.9137,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITH MCC",,640,MS-DRG,Facility,Inpatient,,,,13579,11542.15,12900.05,13039.9137,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,12900.05,,,Other,DRG,"DRG weight 1.2653 x WOO $13,372.00; Cap at 95% of charge; minimum of 90.1% of charge"
"MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITHOUT MCC",,641,MS-DRG,Facility,Inpatient,,,,12291.14286,10447.47143,11074.31971,11803.18449,America's PPO,America's PPO,11803.18449,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITHOUT MCC",,641,MS-DRG,Facility,Inpatient,,,,12291.14286,10447.47143,11074.31971,11803.18449,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,11074.31971,,,Other,DRG,"DRG weight 0.7702 x WOO $13,372.00; Cap at 95% of charge; minimum of 90.1% of charge"
HEPATITIS A VIRUS VACCINE (PF) 25 UNIT/0.5 ML IM SYRG,,102500,LOCAL,Facility,Both,0.5,mL,,194,164.9,55.6004,194,Aetna,Commercial,178.48,92,,percent of total billed charges,,
HEPATITIS A VIRUS VACCINE (PF) 25 UNIT/0.5 ML IM SYRG,,102500,LOCAL,Facility,Outpatient,0.5,mL,,194,164.9,55.6004,194,Aetna,Medicare Advantage,95.06,49,,percent of total billed charges,,
HEPATITIS A VIRUS VACCINE (PF) 25 UNIT/0.5 ML IM SYRG,,102500,LOCAL,Facility,Inpatient,0.5,mL,,194,164.9,55.6004,194,Aetna,Medicare Advantage,,,,,Included in per diem rate,
HEPATITIS A VIRUS VACCINE (PF) 25 UNIT/0.5 ML IM SYRG,,102500,LOCAL,Facility,Both,0.5,mL,,194,164.9,55.6004,194,Aetna,PPO,180.42,93,,percent of total billed charges,,
HEPATITIS A VIRUS VACCINE (PF) 25 UNIT/0.5 ML IM SYRG,,102500,LOCAL,Facility,Both,0.5,mL,,194,164.9,55.6004,194,America's PPO,America's PPO,186.2982,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
HEPATITIS A VIRUS VACCINE (PF) 25 UNIT/0.5 ML IM SYRG,,102500,LOCAL,Facility,Both,0.5,mL,,194,164.9,55.6004,194,BlueCross BlueShield Minnesota, Federal Employee Program,190.896,98.4,,percent of total billed charges,,
HEPATITIS A VIRUS VACCINE (PF) 25 UNIT/0.5 ML IM SYRG,,102500,LOCAL,Facility,Both,0.5,mL,,194,164.9,55.6004,194,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,194,100,,percent of total billed charges,,
HEPATITIS A VIRUS VACCINE (PF) 25 UNIT/0.5 ML IM SYRG,,102500,LOCAL,Facility,Both,0.5,mL,,194,164.9,55.6004,194,BlueCross BlueShield Minnesota,High Value Network Plan,174.6,90,,percent of total billed charges,,
HEPATITIS A VIRUS VACCINE (PF) 25 UNIT/0.5 ML IM SYRG,,102500,LOCAL,Facility,Outpatient,0.5,mL,,194,164.9,55.6004,194,BlueCross BlueShield Minnesota,Medicare Advantage,95.06,49,,percent of total billed charges,,
HEPATITIS A VIRUS VACCINE (PF) 25 UNIT/0.5 ML IM SYRG,,102500,LOCAL,Facility,Inpatient,0.5,mL,,194,164.9,55.6004,194,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
HEPATITIS A VIRUS VACCINE (PF) 25 UNIT/0.5 ML IM SYRG,,102500,LOCAL,Facility,Both,0.5,mL,,194,164.9,55.6004,194,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,171.8258,88.57,,percent of total billed charges,,
HEPATITIS A VIRUS VACCINE (PF) 25 UNIT/0.5 ML IM SYRG,,102500,LOCAL,Facility,Both,0.5,mL,,194,164.9,55.6004,194,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,55.6004,28.66,,percent of total billed charges,,
HEPATITIS A VIRUS VACCINE (PF) 25 UNIT/0.5 ML IM SYRG,,102500,LOCAL,Facility,Outpatient,0.5,mL,,194,164.9,55.6004,194,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),95.06,49,,percent of total billed charges,,
HEPATITIS A VIRUS VACCINE (PF) 25 UNIT/0.5 ML IM SYRG,,102500,LOCAL,Facility,Inpatient,0.5,mL,,194,164.9,55.6004,194,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
HEPATITIS A VIRUS VACCINE (PF) 25 UNIT/0.5 ML IM SYRG,,102500,LOCAL,Facility,Both,0.5,mL,,194,164.9,55.6004,194,CorVel,Worker's Compensation,194,100,,percent of total billed charges,,
HEPATITIS A VIRUS VACCINE (PF) 25 UNIT/0.5 ML IM SYRG,,102500,LOCAL,Facility,Both,0.5,mL,,194,164.9,55.6004,194,First Health Group Corporation,First Health Network,188.18,97,,percent of total billed charges,,
HEPATITIS A VIRUS VACCINE (PF) 25 UNIT/0.5 ML IM SYRG,,102500,LOCAL,Facility,Both,0.5,mL,,194,164.9,55.6004,194,"Health Partners, Inc.",Commercial,183.524,94.6,,percent of total billed charges,,
HEPATITIS A VIRUS VACCINE (PF) 25 UNIT/0.5 ML IM SYRG,,102500,LOCAL,Facility,Outpatient,0.5,mL,,194,164.9,55.6004,194,"Health Partners, Inc.",Medicare Advantage,95.06,49,,percent of total billed charges,,
HEPATITIS A VIRUS VACCINE (PF) 25 UNIT/0.5 ML IM SYRG,,102500,LOCAL,Facility,Inpatient,0.5,mL,,194,164.9,55.6004,194,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
HEPATITIS A VIRUS VACCINE (PF) 25 UNIT/0.5 ML IM SYRG,,102500,LOCAL,Facility,Both,0.5,mL,,194,164.9,55.6004,194,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),116.4,60,,percent of total billed charges,,
HEPATITIS A VIRUS VACCINE (PF) 25 UNIT/0.5 ML IM SYRG,,102500,LOCAL,Facility,Both,0.5,mL,,194,164.9,55.6004,194,"Health Partners, Inc.",State of Minnesota Advantage Program,158.11,81.5,,percent of total billed charges,,
HEPATITIS A VIRUS VACCINE (PF) 25 UNIT/0.5 ML IM SYRG,,102500,LOCAL,Facility,Both,0.5,mL,,194,164.9,55.6004,194,"Health Partners, Inc.",State Public Programs,97,50,,percent of total billed charges,,
HEPATITIS A VIRUS VACCINE (PF) 25 UNIT/0.5 ML IM SYRG,,102500,LOCAL,Facility,Both,0.5,mL,,194,164.9,55.6004,194,Humana Insurance Company,Commercial PPO,184.3,95,,percent of total billed charges,,
HEPATITIS A VIRUS VACCINE (PF) 25 UNIT/0.5 ML IM SYRG,,102500,LOCAL,Facility,Outpatient,0.5,mL,,194,164.9,55.6004,194,Humana Insurance Company,Medicare PPO,95.06,49,,percent of total billed charges,,
HEPATITIS A VIRUS VACCINE (PF) 25 UNIT/0.5 ML IM SYRG,,102500,LOCAL,Facility,Inpatient,0.5,mL,,194,164.9,55.6004,194,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
HEPATITIS A VIRUS VACCINE (PF) 25 UNIT/0.5 ML IM SYRG,,102500,LOCAL,Facility,Both,0.5,mL,,194,164.9,55.6004,194,Medica,Individual & Family,192.254,99.1,,percent of total billed charges,,
HEPATITIS A VIRUS VACCINE (PF) 25 UNIT/0.5 ML IM SYRG,,102500,LOCAL,Facility,Outpatient,0.5,mL,,194,164.9,55.6004,194,Medica,Medica Advantage Solution,96.612,49.8,,percent of total billed charges,,
HEPATITIS A VIRUS VACCINE (PF) 25 UNIT/0.5 ML IM SYRG,,102500,LOCAL,Facility,Inpatient,0.5,mL,,194,164.9,55.6004,194,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
HEPATITIS A VIRUS VACCINE (PF) 25 UNIT/0.5 ML IM SYRG,,102500,LOCAL,Facility,Outpatient,0.5,mL,,194,164.9,55.6004,194,Medica,Medical Assistance,86.524,44.6,,percent of total billed charges,,
HEPATITIS A VIRUS VACCINE (PF) 25 UNIT/0.5 ML IM SYRG,,102500,LOCAL,Facility,Inpatient,0.5,mL,,194,164.9,55.6004,194,Medica,Medical Assistance,,,,,Included in per diem rate,
HEPATITIS A VIRUS VACCINE (PF) 25 UNIT/0.5 ML IM SYRG,,102500,LOCAL,Facility,Outpatient,0.5,mL,,194,164.9,55.6004,194,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,96.612,49.8,,percent of total billed charges,,
HEPATITIS A VIRUS VACCINE (PF) 25 UNIT/0.5 ML IM SYRG,,102500,LOCAL,Facility,Inpatient,0.5,mL,,194,164.9,55.6004,194,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
HEPATITIS A VIRUS VACCINE (PF) 25 UNIT/0.5 ML IM SYRG,,102500,LOCAL,Facility,Both,0.5,mL,,194,164.9,55.6004,194,"Multiplan, Inc.","Multiplan, Inc.",182.36,94,,percent of total billed charges,,
HEPATITIS A VIRUS VACCINE (PF) 25 UNIT/0.5 ML IM SYRG,,102500,LOCAL,Facility,Outpatient,0.5,mL,,194,164.9,55.6004,194,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,174.794,90.1,,percent of total billed charges,,
HEPATITIS A VIRUS VACCINE (PF) 25 UNIT/0.5 ML IM SYRG,,102500,LOCAL,Facility,Inpatient,0.5,mL,,194,164.9,55.6004,194,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
HEPATITIS A VIRUS VACCINE (PF) 25 UNIT/0.5 ML IM SYRG,,102500,LOCAL,Facility,Both,0.5,mL,,194,164.9,55.6004,194,"Preferred One Administrative Services, INC.",PPO,191.284,98.6,,percent of total billed charges,,
HEPATITIS A VIRUS VACCINE (PF) 25 UNIT/0.5 ML IM SYRG,,102500,LOCAL,Facility,Outpatient,0.5,mL,,194,164.9,55.6004,194,PrimeWest Health,Minnesota Senior Health Options (MSHO),99.813,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
HEPATITIS A VIRUS VACCINE (PF) 25 UNIT/0.5 ML IM SYRG,,102500,LOCAL,Facility,Inpatient,0.5,mL,,194,164.9,55.6004,194,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
HEPATITIS A VIRUS VACCINE (PF) 25 UNIT/0.5 ML IM SYRG,,102500,LOCAL,Facility,Outpatient,0.5,mL,,194,164.9,55.6004,194,PrimeWest Health,MinnesotaCare,99.6384,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
HEPATITIS A VIRUS VACCINE (PF) 25 UNIT/0.5 ML IM SYRG,,102500,LOCAL,Facility,Inpatient,0.5,mL,,194,164.9,55.6004,194,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
HEPATITIS A VIRUS VACCINE (PF) 25 UNIT/0.5 ML IM SYRG,,102500,LOCAL,Facility,Both,0.5,mL,,194,164.9,55.6004,194,Sanford Health Plan,Sanford Health Plan,178.48,92,,percent of total billed charges,,
HEPATITIS A VIRUS VACCINE (PF) 25 UNIT/0.5 ML IM SYRG,,102500,LOCAL,Facility,Outpatient,0.5,mL,,194,164.9,55.6004,194,"UCare Health, Inc.",Individual & Family Plan,109.319,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
HEPATITIS A VIRUS VACCINE (PF) 25 UNIT/0.5 ML IM SYRG,,102500,LOCAL,Facility,Inpatient,0.5,mL,,194,164.9,55.6004,194,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
HEPATITIS A VIRUS VACCINE (PF) 25 UNIT/0.5 ML IM SYRG,,102500,LOCAL,Facility,Outpatient,0.5,mL,,194,164.9,55.6004,194,"UCare Health, Inc.",Medical Assistance,97.9118,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
HEPATITIS A VIRUS VACCINE (PF) 25 UNIT/0.5 ML IM SYRG,,102500,LOCAL,Facility,Inpatient,0.5,mL,,194,164.9,55.6004,194,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
HEPATITIS A VIRUS VACCINE (PF) 25 UNIT/0.5 ML IM SYRG,,102500,LOCAL,Facility,Outpatient,0.5,mL,,194,164.9,55.6004,194,"UCare Health, Inc.",Medicare Advantage,97.9118,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
HEPATITIS A VIRUS VACCINE (PF) 25 UNIT/0.5 ML IM SYRG,,102500,LOCAL,Facility,Inpatient,0.5,mL,,194,164.9,55.6004,194,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
HEPATITIS A VIRUS VACCINE (PF) 25 UNIT/0.5 ML IM SYRG,,102500,LOCAL,Facility,Outpatient,0.5,mL,,194,164.9,55.6004,194,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),97.9118,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
HEPATITIS A VIRUS VACCINE (PF) 25 UNIT/0.5 ML IM SYRG,,102500,LOCAL,Facility,Inpatient,0.5,mL,,194,164.9,55.6004,194,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
HEPATITIS A VIRUS VACCINE (PF) 25 UNIT/0.5 ML IM SYRG,,102500,LOCAL,Facility,Both,0.5,mL,,194,164.9,55.6004,194,UnitedHealthcare,Individual & Family,182.36,94,,percent of total billed charges,,
HEPATITIS A VIRUS VACCINE (PF) 25 UNIT/0.5 ML IM SYRG,,102500,LOCAL,Facility,Outpatient,0.5,mL,,194,164.9,55.6004,194,UnitedHealthcare,Medicare Advantage,95.06,49,,percent of total billed charges,,
HEPATITIS A VIRUS VACCINE (PF) 25 UNIT/0.5 ML IM SYRG,,102500,LOCAL,Facility,Inpatient,0.5,mL,,194,164.9,55.6004,194,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
HEPATITIS A VIRUS VACCINE (PF) 25 UNIT/0.5 ML IM SYRG,,102500,LOCAL,Facility,Outpatient,0.5,mL,,194,164.9,55.6004,194,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,93.12,48,,percent of total billed charges,,100% of DHS outpatient percentage
HEPATITIS A VIRUS VACCINE (PF) 25 UNIT/0.5 ML IM SYRG,,102500,LOCAL,Facility,Inpatient,0.5,mL,,194,164.9,55.6004,194,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
DARBEPOETIN ALFA IN POLYSORBAT 100 MCG/0.5 ML INJ SYRG,,J0881,HCPCS,Facility,Both,0.5,mL,,3066,2606.1,878.7156,3066,Aetna,Commercial,2820.72,92,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 100 MCG/0.5 ML INJ SYRG,,J0881,HCPCS,Facility,Outpatient,0.5,mL,,3066,2606.1,878.7156,3066,Aetna,Medicare Advantage,1502.34,49,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 100 MCG/0.5 ML INJ SYRG,,J0881,HCPCS,Facility,Inpatient,0.5,mL,,3066,2606.1,878.7156,3066,Aetna,Medicare Advantage,,,,,Included in per diem rate,
DARBEPOETIN ALFA IN POLYSORBAT 100 MCG/0.5 ML INJ SYRG,,J0881,HCPCS,Facility,Both,0.5,mL,,3066,2606.1,878.7156,3066,Aetna,PPO,2851.38,93,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 100 MCG/0.5 ML INJ SYRG,,J0881,HCPCS,Facility,Both,0.5,mL,,3066,2606.1,878.7156,3066,America's PPO,America's PPO,2944.2798,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
DARBEPOETIN ALFA IN POLYSORBAT 100 MCG/0.5 ML INJ SYRG,,J0881,HCPCS,Facility,Both,0.5,mL,,3066,2606.1,878.7156,3066,BlueCross BlueShield Minnesota, Federal Employee Program,3016.944,98.4,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 100 MCG/0.5 ML INJ SYRG,,J0881,HCPCS,Facility,Both,0.5,mL,,3066,2606.1,878.7156,3066,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,3066,100,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 100 MCG/0.5 ML INJ SYRG,,J0881,HCPCS,Facility,Both,0.5,mL,,3066,2606.1,878.7156,3066,BlueCross BlueShield Minnesota,High Value Network Plan,2759.4,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
DARBEPOETIN ALFA IN POLYSORBAT 100 MCG/0.5 ML INJ SYRG,,J0881,HCPCS,Facility,Outpatient,0.5,mL,,3066,2606.1,878.7156,3066,BlueCross BlueShield Minnesota,Medicare Advantage,1502.34,49,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 100 MCG/0.5 ML INJ SYRG,,J0881,HCPCS,Facility,Inpatient,0.5,mL,,3066,2606.1,878.7156,3066,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
DARBEPOETIN ALFA IN POLYSORBAT 100 MCG/0.5 ML INJ SYRG,,J0881,HCPCS,Facility,Both,0.5,mL,,3066,2606.1,878.7156,3066,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,2715.5562,88.57,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 100 MCG/0.5 ML INJ SYRG,,J0881,HCPCS,Facility,Both,0.5,mL,,3066,2606.1,878.7156,3066,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,878.7156,28.66,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 100 MCG/0.5 ML INJ SYRG,,J0881,HCPCS,Facility,Outpatient,0.5,mL,,3066,2606.1,878.7156,3066,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1502.34,49,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 100 MCG/0.5 ML INJ SYRG,,J0881,HCPCS,Facility,Inpatient,0.5,mL,,3066,2606.1,878.7156,3066,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
DARBEPOETIN ALFA IN POLYSORBAT 100 MCG/0.5 ML INJ SYRG,,J0881,HCPCS,Facility,Both,0.5,mL,,3066,2606.1,878.7156,3066,CorVel,Worker's Compensation,3066,100,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 100 MCG/0.5 ML INJ SYRG,,J0881,HCPCS,Facility,Both,0.5,mL,,3066,2606.1,878.7156,3066,First Health Group Corporation,First Health Network,2974.02,97,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 100 MCG/0.5 ML INJ SYRG,,J0881,HCPCS,Facility,Both,0.5,mL,,3066,2606.1,878.7156,3066,"Health Partners, Inc.",Commercial,2900.436,94.6,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 100 MCG/0.5 ML INJ SYRG,,J0881,HCPCS,Facility,Outpatient,0.5,mL,,3066,2606.1,878.7156,3066,"Health Partners, Inc.",Medicare Advantage,1502.34,49,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 100 MCG/0.5 ML INJ SYRG,,J0881,HCPCS,Facility,Inpatient,0.5,mL,,3066,2606.1,878.7156,3066,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DARBEPOETIN ALFA IN POLYSORBAT 100 MCG/0.5 ML INJ SYRG,,J0881,HCPCS,Facility,Both,0.5,mL,,3066,2606.1,878.7156,3066,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1839.6,60,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 100 MCG/0.5 ML INJ SYRG,,J0881,HCPCS,Facility,Both,0.5,mL,,3066,2606.1,878.7156,3066,"Health Partners, Inc.",State of Minnesota Advantage Program,2498.79,81.5,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 100 MCG/0.5 ML INJ SYRG,,J0881,HCPCS,Facility,Both,0.5,mL,,3066,2606.1,878.7156,3066,"Health Partners, Inc.",State Public Programs,1533,50,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 100 MCG/0.5 ML INJ SYRG,,J0881,HCPCS,Facility,Both,0.5,mL,,3066,2606.1,878.7156,3066,Humana Insurance Company,Commercial PPO,2912.7,95,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 100 MCG/0.5 ML INJ SYRG,,J0881,HCPCS,Facility,Outpatient,0.5,mL,,3066,2606.1,878.7156,3066,Humana Insurance Company,Medicare PPO,1502.34,49,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 100 MCG/0.5 ML INJ SYRG,,J0881,HCPCS,Facility,Inpatient,0.5,mL,,3066,2606.1,878.7156,3066,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
DARBEPOETIN ALFA IN POLYSORBAT 100 MCG/0.5 ML INJ SYRG,,J0881,HCPCS,Facility,Both,0.5,mL,,3066,2606.1,878.7156,3066,Medica,Individual & Family,3038.406,99.1,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 100 MCG/0.5 ML INJ SYRG,,J0881,HCPCS,Facility,Outpatient,0.5,mL,,3066,2606.1,878.7156,3066,Medica,Medica Advantage Solution,1526.868,49.8,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 100 MCG/0.5 ML INJ SYRG,,J0881,HCPCS,Facility,Inpatient,0.5,mL,,3066,2606.1,878.7156,3066,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
DARBEPOETIN ALFA IN POLYSORBAT 100 MCG/0.5 ML INJ SYRG,,J0881,HCPCS,Facility,Outpatient,0.5,mL,,3066,2606.1,878.7156,3066,Medica,Medical Assistance,1367.436,44.6,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 100 MCG/0.5 ML INJ SYRG,,J0881,HCPCS,Facility,Inpatient,0.5,mL,,3066,2606.1,878.7156,3066,Medica,Medical Assistance,,,,,Included in per diem rate,
DARBEPOETIN ALFA IN POLYSORBAT 100 MCG/0.5 ML INJ SYRG,,J0881,HCPCS,Facility,Outpatient,0.5,mL,,3066,2606.1,878.7156,3066,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1526.868,49.8,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 100 MCG/0.5 ML INJ SYRG,,J0881,HCPCS,Facility,Inpatient,0.5,mL,,3066,2606.1,878.7156,3066,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
DARBEPOETIN ALFA IN POLYSORBAT 100 MCG/0.5 ML INJ SYRG,,J0881,HCPCS,Facility,Both,0.5,mL,,3066,2606.1,878.7156,3066,"Multiplan, Inc.","Multiplan, Inc.",2882.04,94,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 100 MCG/0.5 ML INJ SYRG,,J0881,HCPCS,Facility,Outpatient,0.5,mL,,3066,2606.1,878.7156,3066,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,2762.466,90.1,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 100 MCG/0.5 ML INJ SYRG,,J0881,HCPCS,Facility,Inpatient,0.5,mL,,3066,2606.1,878.7156,3066,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
DARBEPOETIN ALFA IN POLYSORBAT 100 MCG/0.5 ML INJ SYRG,,J0881,HCPCS,Facility,Both,0.5,mL,,3066,2606.1,878.7156,3066,"Preferred One Administrative Services, INC.",PPO,3023.076,98.6,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 100 MCG/0.5 ML INJ SYRG,,J0881,HCPCS,Facility,Outpatient,0.5,mL,,3066,2606.1,878.7156,3066,PrimeWest Health,Minnesota Senior Health Options (MSHO),1577.457,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
DARBEPOETIN ALFA IN POLYSORBAT 100 MCG/0.5 ML INJ SYRG,,J0881,HCPCS,Facility,Inpatient,0.5,mL,,3066,2606.1,878.7156,3066,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DARBEPOETIN ALFA IN POLYSORBAT 100 MCG/0.5 ML INJ SYRG,,J0881,HCPCS,Facility,Outpatient,0.5,mL,,3066,2606.1,878.7156,3066,PrimeWest Health,MinnesotaCare,1574.6976,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
DARBEPOETIN ALFA IN POLYSORBAT 100 MCG/0.5 ML INJ SYRG,,J0881,HCPCS,Facility,Inpatient,0.5,mL,,3066,2606.1,878.7156,3066,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
DARBEPOETIN ALFA IN POLYSORBAT 100 MCG/0.5 ML INJ SYRG,,J0881,HCPCS,Facility,Both,0.5,mL,,3066,2606.1,878.7156,3066,Sanford Health Plan,Sanford Health Plan,2820.72,92,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 100 MCG/0.5 ML INJ SYRG,,J0881,HCPCS,Facility,Outpatient,0.5,mL,,3066,2606.1,878.7156,3066,"UCare Health, Inc.",Individual & Family Plan,1727.691,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
DARBEPOETIN ALFA IN POLYSORBAT 100 MCG/0.5 ML INJ SYRG,,J0881,HCPCS,Facility,Inpatient,0.5,mL,,3066,2606.1,878.7156,3066,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
DARBEPOETIN ALFA IN POLYSORBAT 100 MCG/0.5 ML INJ SYRG,,J0881,HCPCS,Facility,Outpatient,0.5,mL,,3066,2606.1,878.7156,3066,"UCare Health, Inc.",Medical Assistance,1547.4102,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DARBEPOETIN ALFA IN POLYSORBAT 100 MCG/0.5 ML INJ SYRG,,J0881,HCPCS,Facility,Inpatient,0.5,mL,,3066,2606.1,878.7156,3066,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
DARBEPOETIN ALFA IN POLYSORBAT 100 MCG/0.5 ML INJ SYRG,,J0881,HCPCS,Facility,Outpatient,0.5,mL,,3066,2606.1,878.7156,3066,"UCare Health, Inc.",Medicare Advantage,1547.4102,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DARBEPOETIN ALFA IN POLYSORBAT 100 MCG/0.5 ML INJ SYRG,,J0881,HCPCS,Facility,Inpatient,0.5,mL,,3066,2606.1,878.7156,3066,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DARBEPOETIN ALFA IN POLYSORBAT 100 MCG/0.5 ML INJ SYRG,,J0881,HCPCS,Facility,Outpatient,0.5,mL,,3066,2606.1,878.7156,3066,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1547.4102,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DARBEPOETIN ALFA IN POLYSORBAT 100 MCG/0.5 ML INJ SYRG,,J0881,HCPCS,Facility,Inpatient,0.5,mL,,3066,2606.1,878.7156,3066,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DARBEPOETIN ALFA IN POLYSORBAT 100 MCG/0.5 ML INJ SYRG,,J0881,HCPCS,Facility,Both,0.5,mL,,3066,2606.1,878.7156,3066,UnitedHealthcare,Individual & Family,2882.04,94,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 100 MCG/0.5 ML INJ SYRG,,J0881,HCPCS,Facility,Outpatient,0.5,mL,,3066,2606.1,878.7156,3066,UnitedHealthcare,Medicare Advantage,1502.34,49,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 100 MCG/0.5 ML INJ SYRG,,J0881,HCPCS,Facility,Inpatient,0.5,mL,,3066,2606.1,878.7156,3066,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
DARBEPOETIN ALFA IN POLYSORBAT 100 MCG/0.5 ML INJ SYRG,,J0881,HCPCS,Facility,Outpatient,0.5,mL,,3066,2606.1,878.7156,3066,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1471.68,48,,percent of total billed charges,,100% of DHS outpatient percentage
DARBEPOETIN ALFA IN POLYSORBAT 100 MCG/0.5 ML INJ SYRG,,J0881,HCPCS,Facility,Inpatient,0.5,mL,,3066,2606.1,878.7156,3066,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML INJ SOLN,,J3430,HCPCS,Facility,Both,0.5,mL,,29,24.65,8.3114,29,Aetna,Commercial,26.68,92,,percent of total billed charges,,
PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML INJ SOLN,,J3430,HCPCS,Facility,Outpatient,0.5,mL,,29,24.65,8.3114,29,Aetna,Medicare Advantage,14.21,49,,percent of total billed charges,,
PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML INJ SOLN,,J3430,HCPCS,Facility,Inpatient,0.5,mL,,29,24.65,8.3114,29,Aetna,Medicare Advantage,,,,,Included in per diem rate,
PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML INJ SOLN,,J3430,HCPCS,Facility,Both,0.5,mL,,29,24.65,8.3114,29,Aetna,PPO,26.97,93,,percent of total billed charges,,
PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML INJ SOLN,,J3430,HCPCS,Facility,Both,0.5,mL,,29,24.65,8.3114,29,America's PPO,America's PPO,27.8487,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML INJ SOLN,,J3430,HCPCS,Facility,Both,0.5,mL,,29,24.65,8.3114,29,BlueCross BlueShield Minnesota, Federal Employee Program,28.536,98.4,,percent of total billed charges,,
PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML INJ SOLN,,J3430,HCPCS,Facility,Both,0.5,mL,,29,24.65,8.3114,29,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,29,100,,percent of total billed charges,,
PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML INJ SOLN,,J3430,HCPCS,Facility,Both,0.5,mL,,29,24.65,8.3114,29,BlueCross BlueShield Minnesota,High Value Network Plan,26.1,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML INJ SOLN,,J3430,HCPCS,Facility,Outpatient,0.5,mL,,29,24.65,8.3114,29,BlueCross BlueShield Minnesota,Medicare Advantage,14.21,49,,percent of total billed charges,,
PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML INJ SOLN,,J3430,HCPCS,Facility,Inpatient,0.5,mL,,29,24.65,8.3114,29,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML INJ SOLN,,J3430,HCPCS,Facility,Both,0.5,mL,,29,24.65,8.3114,29,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,25.6853,88.57,,percent of total billed charges,,
PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML INJ SOLN,,J3430,HCPCS,Facility,Both,0.5,mL,,29,24.65,8.3114,29,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,8.3114,28.66,,percent of total billed charges,,
PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML INJ SOLN,,J3430,HCPCS,Facility,Outpatient,0.5,mL,,29,24.65,8.3114,29,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),14.21,49,,percent of total billed charges,,
PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML INJ SOLN,,J3430,HCPCS,Facility,Inpatient,0.5,mL,,29,24.65,8.3114,29,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML INJ SOLN,,J3430,HCPCS,Facility,Both,0.5,mL,,29,24.65,8.3114,29,CorVel,Worker's Compensation,29,100,,percent of total billed charges,,
PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML INJ SOLN,,J3430,HCPCS,Facility,Both,0.5,mL,,29,24.65,8.3114,29,First Health Group Corporation,First Health Network,28.13,97,,percent of total billed charges,,
PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML INJ SOLN,,J3430,HCPCS,Facility,Both,0.5,mL,,29,24.65,8.3114,29,"Health Partners, Inc.",Commercial,27.434,94.6,,percent of total billed charges,,
PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML INJ SOLN,,J3430,HCPCS,Facility,Outpatient,0.5,mL,,29,24.65,8.3114,29,"Health Partners, Inc.",Medicare Advantage,14.21,49,,percent of total billed charges,,
PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML INJ SOLN,,J3430,HCPCS,Facility,Inpatient,0.5,mL,,29,24.65,8.3114,29,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML INJ SOLN,,J3430,HCPCS,Facility,Both,0.5,mL,,29,24.65,8.3114,29,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),17.4,60,,percent of total billed charges,,
PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML INJ SOLN,,J3430,HCPCS,Facility,Both,0.5,mL,,29,24.65,8.3114,29,"Health Partners, Inc.",State of Minnesota Advantage Program,23.635,81.5,,percent of total billed charges,,
PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML INJ SOLN,,J3430,HCPCS,Facility,Both,0.5,mL,,29,24.65,8.3114,29,"Health Partners, Inc.",State Public Programs,14.5,50,,percent of total billed charges,,
PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML INJ SOLN,,J3430,HCPCS,Facility,Both,0.5,mL,,29,24.65,8.3114,29,Humana Insurance Company,Commercial PPO,27.55,95,,percent of total billed charges,,
PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML INJ SOLN,,J3430,HCPCS,Facility,Outpatient,0.5,mL,,29,24.65,8.3114,29,Humana Insurance Company,Medicare PPO,14.21,49,,percent of total billed charges,,
PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML INJ SOLN,,J3430,HCPCS,Facility,Inpatient,0.5,mL,,29,24.65,8.3114,29,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML INJ SOLN,,J3430,HCPCS,Facility,Both,0.5,mL,,29,24.65,8.3114,29,Medica,Individual & Family,28.739,99.1,,percent of total billed charges,,
PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML INJ SOLN,,J3430,HCPCS,Facility,Outpatient,0.5,mL,,29,24.65,8.3114,29,Medica,Medica Advantage Solution,14.442,49.8,,percent of total billed charges,,
PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML INJ SOLN,,J3430,HCPCS,Facility,Inpatient,0.5,mL,,29,24.65,8.3114,29,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML INJ SOLN,,J3430,HCPCS,Facility,Outpatient,0.5,mL,,29,24.65,8.3114,29,Medica,Medical Assistance,12.934,44.6,,percent of total billed charges,,
PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML INJ SOLN,,J3430,HCPCS,Facility,Inpatient,0.5,mL,,29,24.65,8.3114,29,Medica,Medical Assistance,,,,,Included in per diem rate,
PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML INJ SOLN,,J3430,HCPCS,Facility,Outpatient,0.5,mL,,29,24.65,8.3114,29,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,14.442,49.8,,percent of total billed charges,,
PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML INJ SOLN,,J3430,HCPCS,Facility,Inpatient,0.5,mL,,29,24.65,8.3114,29,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML INJ SOLN,,J3430,HCPCS,Facility,Both,0.5,mL,,29,24.65,8.3114,29,"Multiplan, Inc.","Multiplan, Inc.",27.26,94,,percent of total billed charges,,
PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML INJ SOLN,,J3430,HCPCS,Facility,Outpatient,0.5,mL,,29,24.65,8.3114,29,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,26.129,90.1,,percent of total billed charges,,
PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML INJ SOLN,,J3430,HCPCS,Facility,Inpatient,0.5,mL,,29,24.65,8.3114,29,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML INJ SOLN,,J3430,HCPCS,Facility,Both,0.5,mL,,29,24.65,8.3114,29,"Preferred One Administrative Services, INC.",PPO,28.594,98.6,,percent of total billed charges,,
PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML INJ SOLN,,J3430,HCPCS,Facility,Outpatient,0.5,mL,,29,24.65,8.3114,29,PrimeWest Health,Minnesota Senior Health Options (MSHO),14.9205,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML INJ SOLN,,J3430,HCPCS,Facility,Inpatient,0.5,mL,,29,24.65,8.3114,29,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML INJ SOLN,,J3430,HCPCS,Facility,Outpatient,0.5,mL,,29,24.65,8.3114,29,PrimeWest Health,MinnesotaCare,14.8944,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML INJ SOLN,,J3430,HCPCS,Facility,Inpatient,0.5,mL,,29,24.65,8.3114,29,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML INJ SOLN,,J3430,HCPCS,Facility,Both,0.5,mL,,29,24.65,8.3114,29,Sanford Health Plan,Sanford Health Plan,26.68,92,,percent of total billed charges,,
PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML INJ SOLN,,J3430,HCPCS,Facility,Outpatient,0.5,mL,,29,24.65,8.3114,29,"UCare Health, Inc.",Individual & Family Plan,16.3415,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML INJ SOLN,,J3430,HCPCS,Facility,Inpatient,0.5,mL,,29,24.65,8.3114,29,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML INJ SOLN,,J3430,HCPCS,Facility,Outpatient,0.5,mL,,29,24.65,8.3114,29,"UCare Health, Inc.",Medical Assistance,14.6363,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML INJ SOLN,,J3430,HCPCS,Facility,Inpatient,0.5,mL,,29,24.65,8.3114,29,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML INJ SOLN,,J3430,HCPCS,Facility,Outpatient,0.5,mL,,29,24.65,8.3114,29,"UCare Health, Inc.",Medicare Advantage,14.6363,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML INJ SOLN,,J3430,HCPCS,Facility,Inpatient,0.5,mL,,29,24.65,8.3114,29,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML INJ SOLN,,J3430,HCPCS,Facility,Outpatient,0.5,mL,,29,24.65,8.3114,29,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),14.6363,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML INJ SOLN,,J3430,HCPCS,Facility,Inpatient,0.5,mL,,29,24.65,8.3114,29,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML INJ SOLN,,J3430,HCPCS,Facility,Both,0.5,mL,,29,24.65,8.3114,29,UnitedHealthcare,Individual & Family,27.26,94,,percent of total billed charges,,
PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML INJ SOLN,,J3430,HCPCS,Facility,Outpatient,0.5,mL,,29,24.65,8.3114,29,UnitedHealthcare,Medicare Advantage,14.21,49,,percent of total billed charges,,
PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML INJ SOLN,,J3430,HCPCS,Facility,Inpatient,0.5,mL,,29,24.65,8.3114,29,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML INJ SOLN,,J3430,HCPCS,Facility,Outpatient,0.5,mL,,29,24.65,8.3114,29,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,13.92,48,,percent of total billed charges,,100% of DHS outpatient percentage
PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML INJ SOLN,,J3430,HCPCS,Facility,Inpatient,0.5,mL,,29,24.65,8.3114,29,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML INJ SYRG,,J3430,HCPCS,Facility,Both,0.5,mL,,134,113.9,38.4044,134,Aetna,Commercial,123.28,92,,percent of total billed charges,,
PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML INJ SYRG,,J3430,HCPCS,Facility,Outpatient,0.5,mL,,134,113.9,38.4044,134,Aetna,Medicare Advantage,65.66,49,,percent of total billed charges,,
PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML INJ SYRG,,J3430,HCPCS,Facility,Inpatient,0.5,mL,,134,113.9,38.4044,134,Aetna,Medicare Advantage,,,,,Included in per diem rate,
PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML INJ SYRG,,J3430,HCPCS,Facility,Both,0.5,mL,,134,113.9,38.4044,134,Aetna,PPO,124.62,93,,percent of total billed charges,,
PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML INJ SYRG,,J3430,HCPCS,Facility,Both,0.5,mL,,134,113.9,38.4044,134,America's PPO,America's PPO,128.6802,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML INJ SYRG,,J3430,HCPCS,Facility,Both,0.5,mL,,134,113.9,38.4044,134,BlueCross BlueShield Minnesota, Federal Employee Program,131.856,98.4,,percent of total billed charges,,
PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML INJ SYRG,,J3430,HCPCS,Facility,Both,0.5,mL,,134,113.9,38.4044,134,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,134,100,,percent of total billed charges,,
PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML INJ SYRG,,J3430,HCPCS,Facility,Both,0.5,mL,,134,113.9,38.4044,134,BlueCross BlueShield Minnesota,High Value Network Plan,120.6,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML INJ SYRG,,J3430,HCPCS,Facility,Outpatient,0.5,mL,,134,113.9,38.4044,134,BlueCross BlueShield Minnesota,Medicare Advantage,65.66,49,,percent of total billed charges,,
PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML INJ SYRG,,J3430,HCPCS,Facility,Inpatient,0.5,mL,,134,113.9,38.4044,134,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML INJ SYRG,,J3430,HCPCS,Facility,Both,0.5,mL,,134,113.9,38.4044,134,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,118.6838,88.57,,percent of total billed charges,,
PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML INJ SYRG,,J3430,HCPCS,Facility,Both,0.5,mL,,134,113.9,38.4044,134,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,38.4044,28.66,,percent of total billed charges,,
PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML INJ SYRG,,J3430,HCPCS,Facility,Outpatient,0.5,mL,,134,113.9,38.4044,134,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),65.66,49,,percent of total billed charges,,
PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML INJ SYRG,,J3430,HCPCS,Facility,Inpatient,0.5,mL,,134,113.9,38.4044,134,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML INJ SYRG,,J3430,HCPCS,Facility,Both,0.5,mL,,134,113.9,38.4044,134,CorVel,Worker's Compensation,134,100,,percent of total billed charges,,
PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML INJ SYRG,,J3430,HCPCS,Facility,Both,0.5,mL,,134,113.9,38.4044,134,First Health Group Corporation,First Health Network,129.98,97,,percent of total billed charges,,
PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML INJ SYRG,,J3430,HCPCS,Facility,Both,0.5,mL,,134,113.9,38.4044,134,"Health Partners, Inc.",Commercial,126.764,94.6,,percent of total billed charges,,
PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML INJ SYRG,,J3430,HCPCS,Facility,Outpatient,0.5,mL,,134,113.9,38.4044,134,"Health Partners, Inc.",Medicare Advantage,65.66,49,,percent of total billed charges,,
PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML INJ SYRG,,J3430,HCPCS,Facility,Inpatient,0.5,mL,,134,113.9,38.4044,134,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML INJ SYRG,,J3430,HCPCS,Facility,Both,0.5,mL,,134,113.9,38.4044,134,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),80.4,60,,percent of total billed charges,,
PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML INJ SYRG,,J3430,HCPCS,Facility,Both,0.5,mL,,134,113.9,38.4044,134,"Health Partners, Inc.",State of Minnesota Advantage Program,109.21,81.5,,percent of total billed charges,,
PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML INJ SYRG,,J3430,HCPCS,Facility,Both,0.5,mL,,134,113.9,38.4044,134,"Health Partners, Inc.",State Public Programs,67,50,,percent of total billed charges,,
PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML INJ SYRG,,J3430,HCPCS,Facility,Both,0.5,mL,,134,113.9,38.4044,134,Humana Insurance Company,Commercial PPO,127.3,95,,percent of total billed charges,,
PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML INJ SYRG,,J3430,HCPCS,Facility,Outpatient,0.5,mL,,134,113.9,38.4044,134,Humana Insurance Company,Medicare PPO,65.66,49,,percent of total billed charges,,
PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML INJ SYRG,,J3430,HCPCS,Facility,Inpatient,0.5,mL,,134,113.9,38.4044,134,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML INJ SYRG,,J3430,HCPCS,Facility,Both,0.5,mL,,134,113.9,38.4044,134,Medica,Individual & Family,132.794,99.1,,percent of total billed charges,,
PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML INJ SYRG,,J3430,HCPCS,Facility,Outpatient,0.5,mL,,134,113.9,38.4044,134,Medica,Medica Advantage Solution,66.732,49.8,,percent of total billed charges,,
PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML INJ SYRG,,J3430,HCPCS,Facility,Inpatient,0.5,mL,,134,113.9,38.4044,134,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML INJ SYRG,,J3430,HCPCS,Facility,Outpatient,0.5,mL,,134,113.9,38.4044,134,Medica,Medical Assistance,59.764,44.6,,percent of total billed charges,,
PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML INJ SYRG,,J3430,HCPCS,Facility,Inpatient,0.5,mL,,134,113.9,38.4044,134,Medica,Medical Assistance,,,,,Included in per diem rate,
PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML INJ SYRG,,J3430,HCPCS,Facility,Outpatient,0.5,mL,,134,113.9,38.4044,134,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,66.732,49.8,,percent of total billed charges,,
PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML INJ SYRG,,J3430,HCPCS,Facility,Inpatient,0.5,mL,,134,113.9,38.4044,134,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML INJ SYRG,,J3430,HCPCS,Facility,Both,0.5,mL,,134,113.9,38.4044,134,"Multiplan, Inc.","Multiplan, Inc.",125.96,94,,percent of total billed charges,,
PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML INJ SYRG,,J3430,HCPCS,Facility,Outpatient,0.5,mL,,134,113.9,38.4044,134,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,120.734,90.1,,percent of total billed charges,,
PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML INJ SYRG,,J3430,HCPCS,Facility,Inpatient,0.5,mL,,134,113.9,38.4044,134,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML INJ SYRG,,J3430,HCPCS,Facility,Both,0.5,mL,,134,113.9,38.4044,134,"Preferred One Administrative Services, INC.",PPO,132.124,98.6,,percent of total billed charges,,
PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML INJ SYRG,,J3430,HCPCS,Facility,Outpatient,0.5,mL,,134,113.9,38.4044,134,PrimeWest Health,Minnesota Senior Health Options (MSHO),68.943,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML INJ SYRG,,J3430,HCPCS,Facility,Inpatient,0.5,mL,,134,113.9,38.4044,134,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML INJ SYRG,,J3430,HCPCS,Facility,Outpatient,0.5,mL,,134,113.9,38.4044,134,PrimeWest Health,MinnesotaCare,68.8224,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML INJ SYRG,,J3430,HCPCS,Facility,Inpatient,0.5,mL,,134,113.9,38.4044,134,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML INJ SYRG,,J3430,HCPCS,Facility,Both,0.5,mL,,134,113.9,38.4044,134,Sanford Health Plan,Sanford Health Plan,123.28,92,,percent of total billed charges,,
PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML INJ SYRG,,J3430,HCPCS,Facility,Outpatient,0.5,mL,,134,113.9,38.4044,134,"UCare Health, Inc.",Individual & Family Plan,75.509,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML INJ SYRG,,J3430,HCPCS,Facility,Inpatient,0.5,mL,,134,113.9,38.4044,134,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML INJ SYRG,,J3430,HCPCS,Facility,Outpatient,0.5,mL,,134,113.9,38.4044,134,"UCare Health, Inc.",Medical Assistance,67.6298,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML INJ SYRG,,J3430,HCPCS,Facility,Inpatient,0.5,mL,,134,113.9,38.4044,134,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML INJ SYRG,,J3430,HCPCS,Facility,Outpatient,0.5,mL,,134,113.9,38.4044,134,"UCare Health, Inc.",Medicare Advantage,67.6298,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML INJ SYRG,,J3430,HCPCS,Facility,Inpatient,0.5,mL,,134,113.9,38.4044,134,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML INJ SYRG,,J3430,HCPCS,Facility,Outpatient,0.5,mL,,134,113.9,38.4044,134,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),67.6298,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML INJ SYRG,,J3430,HCPCS,Facility,Inpatient,0.5,mL,,134,113.9,38.4044,134,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML INJ SYRG,,J3430,HCPCS,Facility,Both,0.5,mL,,134,113.9,38.4044,134,UnitedHealthcare,Individual & Family,125.96,94,,percent of total billed charges,,
PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML INJ SYRG,,J3430,HCPCS,Facility,Outpatient,0.5,mL,,134,113.9,38.4044,134,UnitedHealthcare,Medicare Advantage,65.66,49,,percent of total billed charges,,
PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML INJ SYRG,,J3430,HCPCS,Facility,Inpatient,0.5,mL,,134,113.9,38.4044,134,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML INJ SYRG,,J3430,HCPCS,Facility,Outpatient,0.5,mL,,134,113.9,38.4044,134,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,64.32,48,,percent of total billed charges,,100% of DHS outpatient percentage
PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML INJ SYRG,,J3430,HCPCS,Facility,Inpatient,0.5,mL,,134,113.9,38.4044,134,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
DARBEPOETIN ALFA IN POLYSORBAT 300 MCG/0.6 ML INJ SYRG,,J0881,HCPCS,Facility,Both,0.6,mL,,8360,7106,2395.976,8360,Aetna,Commercial,7691.2,92,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 300 MCG/0.6 ML INJ SYRG,,J0881,HCPCS,Facility,Outpatient,0.6,mL,,8360,7106,2395.976,8360,Aetna,Medicare Advantage,4096.4,49,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 300 MCG/0.6 ML INJ SYRG,,J0881,HCPCS,Facility,Inpatient,0.6,mL,,8360,7106,2395.976,8360,Aetna,Medicare Advantage,,,,,Included in per diem rate,
DARBEPOETIN ALFA IN POLYSORBAT 300 MCG/0.6 ML INJ SYRG,,J0881,HCPCS,Facility,Both,0.6,mL,,8360,7106,2395.976,8360,Aetna,PPO,7774.8,93,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 300 MCG/0.6 ML INJ SYRG,,J0881,HCPCS,Facility,Both,0.6,mL,,8360,7106,2395.976,8360,America's PPO,America's PPO,8028.108,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
DARBEPOETIN ALFA IN POLYSORBAT 300 MCG/0.6 ML INJ SYRG,,J0881,HCPCS,Facility,Both,0.6,mL,,8360,7106,2395.976,8360,BlueCross BlueShield Minnesota, Federal Employee Program,8226.24,98.4,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 300 MCG/0.6 ML INJ SYRG,,J0881,HCPCS,Facility,Both,0.6,mL,,8360,7106,2395.976,8360,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,8360,100,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 300 MCG/0.6 ML INJ SYRG,,J0881,HCPCS,Facility,Both,0.6,mL,,8360,7106,2395.976,8360,BlueCross BlueShield Minnesota,High Value Network Plan,7524,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
DARBEPOETIN ALFA IN POLYSORBAT 300 MCG/0.6 ML INJ SYRG,,J0881,HCPCS,Facility,Outpatient,0.6,mL,,8360,7106,2395.976,8360,BlueCross BlueShield Minnesota,Medicare Advantage,4096.4,49,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 300 MCG/0.6 ML INJ SYRG,,J0881,HCPCS,Facility,Inpatient,0.6,mL,,8360,7106,2395.976,8360,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
DARBEPOETIN ALFA IN POLYSORBAT 300 MCG/0.6 ML INJ SYRG,,J0881,HCPCS,Facility,Both,0.6,mL,,8360,7106,2395.976,8360,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,7404.452,88.57,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 300 MCG/0.6 ML INJ SYRG,,J0881,HCPCS,Facility,Both,0.6,mL,,8360,7106,2395.976,8360,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,2395.976,28.66,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 300 MCG/0.6 ML INJ SYRG,,J0881,HCPCS,Facility,Outpatient,0.6,mL,,8360,7106,2395.976,8360,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),4096.4,49,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 300 MCG/0.6 ML INJ SYRG,,J0881,HCPCS,Facility,Inpatient,0.6,mL,,8360,7106,2395.976,8360,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
DARBEPOETIN ALFA IN POLYSORBAT 300 MCG/0.6 ML INJ SYRG,,J0881,HCPCS,Facility,Both,0.6,mL,,8360,7106,2395.976,8360,CorVel,Worker's Compensation,8360,100,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 300 MCG/0.6 ML INJ SYRG,,J0881,HCPCS,Facility,Both,0.6,mL,,8360,7106,2395.976,8360,First Health Group Corporation,First Health Network,8109.2,97,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 300 MCG/0.6 ML INJ SYRG,,J0881,HCPCS,Facility,Both,0.6,mL,,8360,7106,2395.976,8360,"Health Partners, Inc.",Commercial,7908.56,94.6,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 300 MCG/0.6 ML INJ SYRG,,J0881,HCPCS,Facility,Outpatient,0.6,mL,,8360,7106,2395.976,8360,"Health Partners, Inc.",Medicare Advantage,4096.4,49,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 300 MCG/0.6 ML INJ SYRG,,J0881,HCPCS,Facility,Inpatient,0.6,mL,,8360,7106,2395.976,8360,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DARBEPOETIN ALFA IN POLYSORBAT 300 MCG/0.6 ML INJ SYRG,,J0881,HCPCS,Facility,Both,0.6,mL,,8360,7106,2395.976,8360,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),5016,60,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 300 MCG/0.6 ML INJ SYRG,,J0881,HCPCS,Facility,Both,0.6,mL,,8360,7106,2395.976,8360,"Health Partners, Inc.",State of Minnesota Advantage Program,6813.4,81.5,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 300 MCG/0.6 ML INJ SYRG,,J0881,HCPCS,Facility,Both,0.6,mL,,8360,7106,2395.976,8360,"Health Partners, Inc.",State Public Programs,4180,50,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 300 MCG/0.6 ML INJ SYRG,,J0881,HCPCS,Facility,Both,0.6,mL,,8360,7106,2395.976,8360,Humana Insurance Company,Commercial PPO,7942,95,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 300 MCG/0.6 ML INJ SYRG,,J0881,HCPCS,Facility,Outpatient,0.6,mL,,8360,7106,2395.976,8360,Humana Insurance Company,Medicare PPO,4096.4,49,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 300 MCG/0.6 ML INJ SYRG,,J0881,HCPCS,Facility,Inpatient,0.6,mL,,8360,7106,2395.976,8360,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
DARBEPOETIN ALFA IN POLYSORBAT 300 MCG/0.6 ML INJ SYRG,,J0881,HCPCS,Facility,Both,0.6,mL,,8360,7106,2395.976,8360,Medica,Individual & Family,8284.76,99.1,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 300 MCG/0.6 ML INJ SYRG,,J0881,HCPCS,Facility,Outpatient,0.6,mL,,8360,7106,2395.976,8360,Medica,Medica Advantage Solution,4163.28,49.8,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 300 MCG/0.6 ML INJ SYRG,,J0881,HCPCS,Facility,Inpatient,0.6,mL,,8360,7106,2395.976,8360,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
DARBEPOETIN ALFA IN POLYSORBAT 300 MCG/0.6 ML INJ SYRG,,J0881,HCPCS,Facility,Outpatient,0.6,mL,,8360,7106,2395.976,8360,Medica,Medical Assistance,3728.56,44.6,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 300 MCG/0.6 ML INJ SYRG,,J0881,HCPCS,Facility,Inpatient,0.6,mL,,8360,7106,2395.976,8360,Medica,Medical Assistance,,,,,Included in per diem rate,
DARBEPOETIN ALFA IN POLYSORBAT 300 MCG/0.6 ML INJ SYRG,,J0881,HCPCS,Facility,Outpatient,0.6,mL,,8360,7106,2395.976,8360,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,4163.28,49.8,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 300 MCG/0.6 ML INJ SYRG,,J0881,HCPCS,Facility,Inpatient,0.6,mL,,8360,7106,2395.976,8360,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
DARBEPOETIN ALFA IN POLYSORBAT 300 MCG/0.6 ML INJ SYRG,,J0881,HCPCS,Facility,Both,0.6,mL,,8360,7106,2395.976,8360,"Multiplan, Inc.","Multiplan, Inc.",7858.4,94,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 300 MCG/0.6 ML INJ SYRG,,J0881,HCPCS,Facility,Outpatient,0.6,mL,,8360,7106,2395.976,8360,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,7532.36,90.1,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 300 MCG/0.6 ML INJ SYRG,,J0881,HCPCS,Facility,Inpatient,0.6,mL,,8360,7106,2395.976,8360,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
DARBEPOETIN ALFA IN POLYSORBAT 300 MCG/0.6 ML INJ SYRG,,J0881,HCPCS,Facility,Both,0.6,mL,,8360,7106,2395.976,8360,"Preferred One Administrative Services, INC.",PPO,8242.96,98.6,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 300 MCG/0.6 ML INJ SYRG,,J0881,HCPCS,Facility,Outpatient,0.6,mL,,8360,7106,2395.976,8360,PrimeWest Health,Minnesota Senior Health Options (MSHO),4301.22,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
DARBEPOETIN ALFA IN POLYSORBAT 300 MCG/0.6 ML INJ SYRG,,J0881,HCPCS,Facility,Inpatient,0.6,mL,,8360,7106,2395.976,8360,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DARBEPOETIN ALFA IN POLYSORBAT 300 MCG/0.6 ML INJ SYRG,,J0881,HCPCS,Facility,Outpatient,0.6,mL,,8360,7106,2395.976,8360,PrimeWest Health,MinnesotaCare,4293.696,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
DARBEPOETIN ALFA IN POLYSORBAT 300 MCG/0.6 ML INJ SYRG,,J0881,HCPCS,Facility,Inpatient,0.6,mL,,8360,7106,2395.976,8360,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
DARBEPOETIN ALFA IN POLYSORBAT 300 MCG/0.6 ML INJ SYRG,,J0881,HCPCS,Facility,Both,0.6,mL,,8360,7106,2395.976,8360,Sanford Health Plan,Sanford Health Plan,7691.2,92,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 300 MCG/0.6 ML INJ SYRG,,J0881,HCPCS,Facility,Outpatient,0.6,mL,,8360,7106,2395.976,8360,"UCare Health, Inc.",Individual & Family Plan,4710.86,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
DARBEPOETIN ALFA IN POLYSORBAT 300 MCG/0.6 ML INJ SYRG,,J0881,HCPCS,Facility,Inpatient,0.6,mL,,8360,7106,2395.976,8360,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
DARBEPOETIN ALFA IN POLYSORBAT 300 MCG/0.6 ML INJ SYRG,,J0881,HCPCS,Facility,Outpatient,0.6,mL,,8360,7106,2395.976,8360,"UCare Health, Inc.",Medical Assistance,4219.292,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DARBEPOETIN ALFA IN POLYSORBAT 300 MCG/0.6 ML INJ SYRG,,J0881,HCPCS,Facility,Inpatient,0.6,mL,,8360,7106,2395.976,8360,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
DARBEPOETIN ALFA IN POLYSORBAT 300 MCG/0.6 ML INJ SYRG,,J0881,HCPCS,Facility,Outpatient,0.6,mL,,8360,7106,2395.976,8360,"UCare Health, Inc.",Medicare Advantage,4219.292,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DARBEPOETIN ALFA IN POLYSORBAT 300 MCG/0.6 ML INJ SYRG,,J0881,HCPCS,Facility,Inpatient,0.6,mL,,8360,7106,2395.976,8360,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DARBEPOETIN ALFA IN POLYSORBAT 300 MCG/0.6 ML INJ SYRG,,J0881,HCPCS,Facility,Outpatient,0.6,mL,,8360,7106,2395.976,8360,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),4219.292,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DARBEPOETIN ALFA IN POLYSORBAT 300 MCG/0.6 ML INJ SYRG,,J0881,HCPCS,Facility,Inpatient,0.6,mL,,8360,7106,2395.976,8360,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DARBEPOETIN ALFA IN POLYSORBAT 300 MCG/0.6 ML INJ SYRG,,J0881,HCPCS,Facility,Both,0.6,mL,,8360,7106,2395.976,8360,UnitedHealthcare,Individual & Family,7858.4,94,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 300 MCG/0.6 ML INJ SYRG,,J0881,HCPCS,Facility,Outpatient,0.6,mL,,8360,7106,2395.976,8360,UnitedHealthcare,Medicare Advantage,4096.4,49,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 300 MCG/0.6 ML INJ SYRG,,J0881,HCPCS,Facility,Inpatient,0.6,mL,,8360,7106,2395.976,8360,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
DARBEPOETIN ALFA IN POLYSORBAT 300 MCG/0.6 ML INJ SYRG,,J0881,HCPCS,Facility,Outpatient,0.6,mL,,8360,7106,2395.976,8360,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,4012.8,48,,percent of total billed charges,,100% of DHS outpatient percentage
DARBEPOETIN ALFA IN POLYSORBAT 300 MCG/0.6 ML INJ SYRG,,J0881,HCPCS,Facility,Inpatient,0.6,mL,,8360,7106,2395.976,8360,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
RENAL FAILURE WITH CC,,683,MS-DRG,Facility,Inpatient,,,,8011,6809.35,7610.45,7692.9633,America's PPO,America's PPO,7692.9633,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
RENAL FAILURE WITH CC,,683,MS-DRG,Facility,Inpatient,,,,8011,6809.35,7610.45,7692.9633,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,7610.45,,,Other,DRG,"DRG weight 0.8949 x WOO $13,372.00; Cap at 95% of charge; minimum of 90.1% of charge"
RENAL FAILURE WITHOUT CC/MCC,,684,MS-DRG,Facility,Inpatient,,,,4527.5,3848.375,4301.125,4347.75825,America's PPO,America's PPO,4347.75825,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
RENAL FAILURE WITHOUT CC/MCC,,684,MS-DRG,Facility,Inpatient,,,,4527.5,3848.375,4301.125,4347.75825,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4301.125,,,Other ,DRG,"DRG weight 0.6048 x WOO $13,372.00; Cap at 95% of charge; minimum of 90.1% of charge"
KIDNEY AND URINARY TRACT INFECTIONS WITH MCC,,689,MS-DRG,Facility,Inpatient,,,,5591.477333,4752.755733,5311.903467,5369.495683,America's PPO,America's PPO,5369.495683,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
KIDNEY AND URINARY TRACT INFECTIONS WITH MCC,,689,MS-DRG,Facility,Inpatient,,,,5591.477333,4752.755733,5311.903467,5369.495683,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,5311.903467,,,Other,DRG,"DRG weight 1.1471 x WOO $13,372.00; Cap at 95% of charge; minimum of 90.1% of charge"
KIDNEY AND URINARY TRACT INFECTIONS WITHOUT MCC,,690,MS-DRG,Facility,Inpatient,,,,10916.6975,9279.192875,10370.86263,10483.30461,America's PPO,America's PPO,10483.30461,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
KIDNEY AND URINARY TRACT INFECTIONS WITHOUT MCC,,690,MS-DRG,Facility,Inpatient,,,,10916.6975,9279.192875,10370.86263,10483.30461,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,10370.86263,,,Other ,DRG,"DRG weight 0.7956 x WOO $13,372.00; Cap at 95% of charge; minimum of 90.1% of charge"
URINARY STONES WITHOUT MCC,,694,MS-DRG,Facility,Inpatient,,,,2583,2195.55,2453.85,2480.4549,America's PPO,America's PPO,2480.4549,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
URINARY STONES WITHOUT MCC,,694,MS-DRG,Facility,Inpatient,,,,2583,2195.55,2453.85,2480.4549,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,2453.85,,,Other ,DRG,"DRG weight 0.7971 x WOO $13,372.00; Cap at 95% of charge; minimum of 90.1% of charge"
KIDNEY AND URINARY TRACT SIGNS AND SYMPTOMS WITHOUT MCC,,696,MS-DRG,Facility,Inpatient,,,,7461.5,6342.275,7088.425,7165.27845,America's PPO,America's PPO,7165.27845,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
KIDNEY AND URINARY TRACT SIGNS AND SYMPTOMS WITHOUT MCC,,696,MS-DRG,Facility,Inpatient,,,,7461.5,6342.275,7088.425,7165.27845,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,7088.425,,,Other ,DRG,"DRG weight 0.693 x WOO $13,372.00; Cap at 95% of charge; minimum of 90.1% of charge"
OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH CC,,699,MS-DRG,Facility,Inpatient,,,,5899,5014.15,5604.05,5664.8097,America's PPO,America's PPO,5664.8097,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH CC,,699,MS-DRG,Facility,Inpatient,,,,5899,5014.15,5604.05,5664.8097,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,5604.05,,,Other ,DRG,"DRG weight 1.0121 x WOO $13,372.00; Cap at 95% of charge; minimum of 90.1% of charge"
ENOXAPARIN 60 MG/0.6 ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,0.6,mL,,81,68.85,23.2146,81,Aetna,Commercial,74.52,92,,percent of total billed charges,,
ENOXAPARIN 60 MG/0.6 ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,0.6,mL,,81,68.85,23.2146,81,Aetna,Commercial,74.52,92,,percent of total billed charges,,
ENOXAPARIN 60 MG/0.6 ML SUBQ SYRG,,J1650,HCPCS,Facility,Outpatient,0.6,mL,,81,68.85,23.2146,81,Aetna,Medicare Advantage,39.69,49,,percent of total billed charges,,
ENOXAPARIN 60 MG/0.6 ML SUBQ SYRG,,J1650,HCPCS,Facility,Outpatient,0.6,mL,,81,68.85,23.2146,81,Aetna,Medicare Advantage,39.69,49,,percent of total billed charges,,
ENOXAPARIN 60 MG/0.6 ML SUBQ SYRG,,J1650,HCPCS,Facility,Inpatient,0.6,mL,,81,68.85,23.2146,81,Aetna,Medicare Advantage,,,,,Included in per diem rate,
ENOXAPARIN 60 MG/0.6 ML SUBQ SYRG,,J1650,HCPCS,Facility,Inpatient,0.6,mL,,81,68.85,23.2146,81,Aetna,Medicare Advantage,,,,,Included in per diem rate,
ENOXAPARIN 60 MG/0.6 ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,0.6,mL,,81,68.85,23.2146,81,Aetna,PPO,75.33,93,,percent of total billed charges,,
ENOXAPARIN 60 MG/0.6 ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,0.6,mL,,81,68.85,23.2146,81,Aetna,PPO,75.33,93,,percent of total billed charges,,
ENOXAPARIN 60 MG/0.6 ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,0.6,mL,,81,68.85,23.2146,81,America's PPO,America's PPO,77.7843,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
ENOXAPARIN 60 MG/0.6 ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,0.6,mL,,81,68.85,23.2146,81,America's PPO,America's PPO,77.7843,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
ENOXAPARIN 60 MG/0.6 ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,0.6,mL,,81,68.85,23.2146,81,BlueCross BlueShield Minnesota, Federal Employee Program,79.704,98.4,,percent of total billed charges,,
ENOXAPARIN 60 MG/0.6 ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,0.6,mL,,81,68.85,23.2146,81,BlueCross BlueShield Minnesota, Federal Employee Program,79.704,98.4,,percent of total billed charges,,
ENOXAPARIN 60 MG/0.6 ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,0.6,mL,,81,68.85,23.2146,81,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,81,100,,percent of total billed charges,,
ENOXAPARIN 60 MG/0.6 ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,0.6,mL,,81,68.85,23.2146,81,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,81,100,,percent of total billed charges,,
ENOXAPARIN 60 MG/0.6 ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,0.6,mL,,81,68.85,23.2146,81,BlueCross BlueShield Minnesota,High Value Network Plan,72.9,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
ENOXAPARIN 60 MG/0.6 ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,0.6,mL,,81,68.85,23.2146,81,BlueCross BlueShield Minnesota,High Value Network Plan,72.9,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
ENOXAPARIN 60 MG/0.6 ML SUBQ SYRG,,J1650,HCPCS,Facility,Outpatient,0.6,mL,,81,68.85,23.2146,81,BlueCross BlueShield Minnesota,Medicare Advantage,39.69,49,,percent of total billed charges,,
ENOXAPARIN 60 MG/0.6 ML SUBQ SYRG,,J1650,HCPCS,Facility,Outpatient,0.6,mL,,81,68.85,23.2146,81,BlueCross BlueShield Minnesota,Medicare Advantage,39.69,49,,percent of total billed charges,,
ENOXAPARIN 60 MG/0.6 ML SUBQ SYRG,,J1650,HCPCS,Facility,Inpatient,0.6,mL,,81,68.85,23.2146,81,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
ENOXAPARIN 60 MG/0.6 ML SUBQ SYRG,,J1650,HCPCS,Facility,Inpatient,0.6,mL,,81,68.85,23.2146,81,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
ENOXAPARIN 60 MG/0.6 ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,0.6,mL,,81,68.85,23.2146,81,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,71.7417,88.57,,percent of total billed charges,,
ENOXAPARIN 60 MG/0.6 ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,0.6,mL,,81,68.85,23.2146,81,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,71.7417,88.57,,percent of total billed charges,,
ENOXAPARIN 60 MG/0.6 ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,0.6,mL,,81,68.85,23.2146,81,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,23.2146,28.66,,percent of total billed charges,,
ENOXAPARIN 60 MG/0.6 ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,0.6,mL,,81,68.85,23.2146,81,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,23.2146,28.66,,percent of total billed charges,,
ENOXAPARIN 60 MG/0.6 ML SUBQ SYRG,,J1650,HCPCS,Facility,Outpatient,0.6,mL,,81,68.85,23.2146,81,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),39.69,49,,percent of total billed charges,,
ENOXAPARIN 60 MG/0.6 ML SUBQ SYRG,,J1650,HCPCS,Facility,Outpatient,0.6,mL,,81,68.85,23.2146,81,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),39.69,49,,percent of total billed charges,,
ENOXAPARIN 60 MG/0.6 ML SUBQ SYRG,,J1650,HCPCS,Facility,Inpatient,0.6,mL,,81,68.85,23.2146,81,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
ENOXAPARIN 60 MG/0.6 ML SUBQ SYRG,,J1650,HCPCS,Facility,Inpatient,0.6,mL,,81,68.85,23.2146,81,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
ENOXAPARIN 60 MG/0.6 ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,0.6,mL,,81,68.85,23.2146,81,CorVel,Worker's Compensation,81,100,,percent of total billed charges,,
ENOXAPARIN 60 MG/0.6 ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,0.6,mL,,81,68.85,23.2146,81,CorVel,Worker's Compensation,81,100,,percent of total billed charges,,
ENOXAPARIN 60 MG/0.6 ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,0.6,mL,,81,68.85,23.2146,81,First Health Group Corporation,First Health Network,78.57,97,,percent of total billed charges,,
ENOXAPARIN 60 MG/0.6 ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,0.6,mL,,81,68.85,23.2146,81,First Health Group Corporation,First Health Network,78.57,97,,percent of total billed charges,,
ENOXAPARIN 60 MG/0.6 ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,0.6,mL,,81,68.85,23.2146,81,"Health Partners, Inc.",Commercial,76.626,94.6,,percent of total billed charges,,
ENOXAPARIN 60 MG/0.6 ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,0.6,mL,,81,68.85,23.2146,81,"Health Partners, Inc.",Commercial,76.626,94.6,,percent of total billed charges,,
ENOXAPARIN 60 MG/0.6 ML SUBQ SYRG,,J1650,HCPCS,Facility,Outpatient,0.6,mL,,81,68.85,23.2146,81,"Health Partners, Inc.",Medicare Advantage,39.69,49,,percent of total billed charges,,
ENOXAPARIN 60 MG/0.6 ML SUBQ SYRG,,J1650,HCPCS,Facility,Outpatient,0.6,mL,,81,68.85,23.2146,81,"Health Partners, Inc.",Medicare Advantage,39.69,49,,percent of total billed charges,,
ENOXAPARIN 60 MG/0.6 ML SUBQ SYRG,,J1650,HCPCS,Facility,Inpatient,0.6,mL,,81,68.85,23.2146,81,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ENOXAPARIN 60 MG/0.6 ML SUBQ SYRG,,J1650,HCPCS,Facility,Inpatient,0.6,mL,,81,68.85,23.2146,81,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ENOXAPARIN 60 MG/0.6 ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,0.6,mL,,81,68.85,23.2146,81,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),48.6,60,,percent of total billed charges,,
ENOXAPARIN 60 MG/0.6 ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,0.6,mL,,81,68.85,23.2146,81,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),48.6,60,,percent of total billed charges,,
ENOXAPARIN 60 MG/0.6 ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,0.6,mL,,81,68.85,23.2146,81,"Health Partners, Inc.",State of Minnesota Advantage Program,66.015,81.5,,percent of total billed charges,,
ENOXAPARIN 60 MG/0.6 ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,0.6,mL,,81,68.85,23.2146,81,"Health Partners, Inc.",State of Minnesota Advantage Program,66.015,81.5,,percent of total billed charges,,
ENOXAPARIN 60 MG/0.6 ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,0.6,mL,,81,68.85,23.2146,81,"Health Partners, Inc.",State Public Programs,40.5,50,,percent of total billed charges,,
ENOXAPARIN 60 MG/0.6 ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,0.6,mL,,81,68.85,23.2146,81,"Health Partners, Inc.",State Public Programs,40.5,50,,percent of total billed charges,,
ENOXAPARIN 60 MG/0.6 ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,0.6,mL,,81,68.85,23.2146,81,Humana Insurance Company,Commercial PPO,76.95,95,,percent of total billed charges,,
ENOXAPARIN 60 MG/0.6 ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,0.6,mL,,81,68.85,23.2146,81,Humana Insurance Company,Commercial PPO,76.95,95,,percent of total billed charges,,
ENOXAPARIN 60 MG/0.6 ML SUBQ SYRG,,J1650,HCPCS,Facility,Outpatient,0.6,mL,,81,68.85,23.2146,81,Humana Insurance Company,Medicare PPO,39.69,49,,percent of total billed charges,,
ENOXAPARIN 60 MG/0.6 ML SUBQ SYRG,,J1650,HCPCS,Facility,Outpatient,0.6,mL,,81,68.85,23.2146,81,Humana Insurance Company,Medicare PPO,39.69,49,,percent of total billed charges,,
ENOXAPARIN 60 MG/0.6 ML SUBQ SYRG,,J1650,HCPCS,Facility,Inpatient,0.6,mL,,81,68.85,23.2146,81,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
ENOXAPARIN 60 MG/0.6 ML SUBQ SYRG,,J1650,HCPCS,Facility,Inpatient,0.6,mL,,81,68.85,23.2146,81,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
ENOXAPARIN 60 MG/0.6 ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,0.6,mL,,81,68.85,23.2146,81,Medica,Individual & Family,80.271,99.1,,percent of total billed charges,,
ENOXAPARIN 60 MG/0.6 ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,0.6,mL,,81,68.85,23.2146,81,Medica,Individual & Family,80.271,99.1,,percent of total billed charges,,
ENOXAPARIN 60 MG/0.6 ML SUBQ SYRG,,J1650,HCPCS,Facility,Outpatient,0.6,mL,,81,68.85,23.2146,81,Medica,Medica Advantage Solution,40.338,49.8,,percent of total billed charges,,
ENOXAPARIN 60 MG/0.6 ML SUBQ SYRG,,J1650,HCPCS,Facility,Outpatient,0.6,mL,,81,68.85,23.2146,81,Medica,Medica Advantage Solution,40.338,49.8,,percent of total billed charges,,
POSTPARTUM AND POST ABORTION DIAGNOSES WITHOUT O.R. PROCEDURES,,776,MS-DRG,Facility,Inpatient,,,,8740,7429,8303,8393.022,America's PPO,America's PPO,8393.022,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
POSTPARTUM AND POST ABORTION DIAGNOSES WITHOUT O.R. PROCEDURES,,776,MS-DRG,Facility,Inpatient,,,,8740,7429,8303,8393.022,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,8303,,,Other ,DRG,"DRG weight 0.6971 x WOO $13,372.00; Cap at 95% of charge; minimum of 90.1% of charge"
ENOXAPARIN 60 MG/0.6 ML SUBQ SYRG,,J1650,HCPCS,Facility,Inpatient,0.6,mL,,81,68.85,23.2146,81,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
ENOXAPARIN 60 MG/0.6 ML SUBQ SYRG,,J1650,HCPCS,Facility,Inpatient,0.6,mL,,81,68.85,23.2146,81,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
ENOXAPARIN 60 MG/0.6 ML SUBQ SYRG,,J1650,HCPCS,Facility,Outpatient,0.6,mL,,81,68.85,23.2146,81,Medica,Medical Assistance,36.126,44.6,,percent of total billed charges,,
ENOXAPARIN 60 MG/0.6 ML SUBQ SYRG,,J1650,HCPCS,Facility,Outpatient,0.6,mL,,81,68.85,23.2146,81,Medica,Medical Assistance,36.126,44.6,,percent of total billed charges,,
ENOXAPARIN 60 MG/0.6 ML SUBQ SYRG,,J1650,HCPCS,Facility,Inpatient,0.6,mL,,81,68.85,23.2146,81,Medica,Medical Assistance,,,,,Included in per diem rate,
ENOXAPARIN 60 MG/0.6 ML SUBQ SYRG,,J1650,HCPCS,Facility,Inpatient,0.6,mL,,81,68.85,23.2146,81,Medica,Medical Assistance,,,,,Included in per diem rate,
ENOXAPARIN 60 MG/0.6 ML SUBQ SYRG,,J1650,HCPCS,Facility,Outpatient,0.6,mL,,81,68.85,23.2146,81,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,40.338,49.8,,percent of total billed charges,,
ENOXAPARIN 60 MG/0.6 ML SUBQ SYRG,,J1650,HCPCS,Facility,Outpatient,0.6,mL,,81,68.85,23.2146,81,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,40.338,49.8,,percent of total billed charges,,
ENOXAPARIN 60 MG/0.6 ML SUBQ SYRG,,J1650,HCPCS,Facility,Inpatient,0.6,mL,,81,68.85,23.2146,81,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
ENOXAPARIN 60 MG/0.6 ML SUBQ SYRG,,J1650,HCPCS,Facility,Inpatient,0.6,mL,,81,68.85,23.2146,81,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
ENOXAPARIN 60 MG/0.6 ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,0.6,mL,,81,68.85,23.2146,81,"Multiplan, Inc.","Multiplan, Inc.",76.14,94,,percent of total billed charges,,
ENOXAPARIN 60 MG/0.6 ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,0.6,mL,,81,68.85,23.2146,81,"Multiplan, Inc.","Multiplan, Inc.",76.14,94,,percent of total billed charges,,
ENOXAPARIN 60 MG/0.6 ML SUBQ SYRG,,J1650,HCPCS,Facility,Outpatient,0.6,mL,,81,68.85,23.2146,81,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,72.981,90.1,,percent of total billed charges,,
ENOXAPARIN 60 MG/0.6 ML SUBQ SYRG,,J1650,HCPCS,Facility,Outpatient,0.6,mL,,81,68.85,23.2146,81,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,72.981,90.1,,percent of total billed charges,,
ENOXAPARIN 60 MG/0.6 ML SUBQ SYRG,,J1650,HCPCS,Facility,Inpatient,0.6,mL,,81,68.85,23.2146,81,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
ENOXAPARIN 60 MG/0.6 ML SUBQ SYRG,,J1650,HCPCS,Facility,Inpatient,0.6,mL,,81,68.85,23.2146,81,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
ENOXAPARIN 60 MG/0.6 ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,0.6,mL,,81,68.85,23.2146,81,"Preferred One Administrative Services, INC.",PPO,79.866,98.6,,percent of total billed charges,,
ENOXAPARIN 60 MG/0.6 ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,0.6,mL,,81,68.85,23.2146,81,"Preferred One Administrative Services, INC.",PPO,79.866,98.6,,percent of total billed charges,,
ENOXAPARIN 60 MG/0.6 ML SUBQ SYRG,,J1650,HCPCS,Facility,Outpatient,0.6,mL,,81,68.85,23.2146,81,PrimeWest Health,Minnesota Senior Health Options (MSHO),41.6745,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
ENOXAPARIN 60 MG/0.6 ML SUBQ SYRG,,J1650,HCPCS,Facility,Outpatient,0.6,mL,,81,68.85,23.2146,81,PrimeWest Health,Minnesota Senior Health Options (MSHO),41.6745,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
ENOXAPARIN 60 MG/0.6 ML SUBQ SYRG,,J1650,HCPCS,Facility,Inpatient,0.6,mL,,81,68.85,23.2146,81,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ENOXAPARIN 60 MG/0.6 ML SUBQ SYRG,,J1650,HCPCS,Facility,Inpatient,0.6,mL,,81,68.85,23.2146,81,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ENOXAPARIN 60 MG/0.6 ML SUBQ SYRG,,J1650,HCPCS,Facility,Outpatient,0.6,mL,,81,68.85,23.2146,81,PrimeWest Health,MinnesotaCare,41.6016,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
ENOXAPARIN 60 MG/0.6 ML SUBQ SYRG,,J1650,HCPCS,Facility,Outpatient,0.6,mL,,81,68.85,23.2146,81,PrimeWest Health,MinnesotaCare,41.6016,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
ENOXAPARIN 60 MG/0.6 ML SUBQ SYRG,,J1650,HCPCS,Facility,Inpatient,0.6,mL,,81,68.85,23.2146,81,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
ENOXAPARIN 60 MG/0.6 ML SUBQ SYRG,,J1650,HCPCS,Facility,Inpatient,0.6,mL,,81,68.85,23.2146,81,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
ENOXAPARIN 60 MG/0.6 ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,0.6,mL,,81,68.85,23.2146,81,Sanford Health Plan,Sanford Health Plan,74.52,92,,percent of total billed charges,,
ENOXAPARIN 60 MG/0.6 ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,0.6,mL,,81,68.85,23.2146,81,Sanford Health Plan,Sanford Health Plan,74.52,92,,percent of total billed charges,,
ENOXAPARIN 60 MG/0.6 ML SUBQ SYRG,,J1650,HCPCS,Facility,Outpatient,0.6,mL,,81,68.85,23.2146,81,"UCare Health, Inc.",Individual & Family Plan,45.6435,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
ENOXAPARIN 60 MG/0.6 ML SUBQ SYRG,,J1650,HCPCS,Facility,Outpatient,0.6,mL,,81,68.85,23.2146,81,"UCare Health, Inc.",Individual & Family Plan,45.6435,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
ENOXAPARIN 60 MG/0.6 ML SUBQ SYRG,,J1650,HCPCS,Facility,Inpatient,0.6,mL,,81,68.85,23.2146,81,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
ENOXAPARIN 60 MG/0.6 ML SUBQ SYRG,,J1650,HCPCS,Facility,Inpatient,0.6,mL,,81,68.85,23.2146,81,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
ENOXAPARIN 60 MG/0.6 ML SUBQ SYRG,,J1650,HCPCS,Facility,Outpatient,0.6,mL,,81,68.85,23.2146,81,"UCare Health, Inc.",Medical Assistance,40.8807,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ENOXAPARIN 60 MG/0.6 ML SUBQ SYRG,,J1650,HCPCS,Facility,Outpatient,0.6,mL,,81,68.85,23.2146,81,"UCare Health, Inc.",Medical Assistance,40.8807,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ENOXAPARIN 60 MG/0.6 ML SUBQ SYRG,,J1650,HCPCS,Facility,Inpatient,0.6,mL,,81,68.85,23.2146,81,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
ENOXAPARIN 60 MG/0.6 ML SUBQ SYRG,,J1650,HCPCS,Facility,Inpatient,0.6,mL,,81,68.85,23.2146,81,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
ENOXAPARIN 60 MG/0.6 ML SUBQ SYRG,,J1650,HCPCS,Facility,Outpatient,0.6,mL,,81,68.85,23.2146,81,"UCare Health, Inc.",Medicare Advantage,40.8807,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ENOXAPARIN 60 MG/0.6 ML SUBQ SYRG,,J1650,HCPCS,Facility,Outpatient,0.6,mL,,81,68.85,23.2146,81,"UCare Health, Inc.",Medicare Advantage,40.8807,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ENOXAPARIN 60 MG/0.6 ML SUBQ SYRG,,J1650,HCPCS,Facility,Inpatient,0.6,mL,,81,68.85,23.2146,81,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ENOXAPARIN 60 MG/0.6 ML SUBQ SYRG,,J1650,HCPCS,Facility,Inpatient,0.6,mL,,81,68.85,23.2146,81,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ENOXAPARIN 60 MG/0.6 ML SUBQ SYRG,,J1650,HCPCS,Facility,Outpatient,0.6,mL,,81,68.85,23.2146,81,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),40.8807,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ENOXAPARIN 60 MG/0.6 ML SUBQ SYRG,,J1650,HCPCS,Facility,Outpatient,0.6,mL,,81,68.85,23.2146,81,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),40.8807,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ENOXAPARIN 60 MG/0.6 ML SUBQ SYRG,,J1650,HCPCS,Facility,Inpatient,0.6,mL,,81,68.85,23.2146,81,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ENOXAPARIN 60 MG/0.6 ML SUBQ SYRG,,J1650,HCPCS,Facility,Inpatient,0.6,mL,,81,68.85,23.2146,81,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ENOXAPARIN 60 MG/0.6 ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,0.6,mL,,81,68.85,23.2146,81,UnitedHealthcare,Individual & Family,76.14,94,,percent of total billed charges,,
ENOXAPARIN 60 MG/0.6 ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,0.6,mL,,81,68.85,23.2146,81,UnitedHealthcare,Individual & Family,76.14,94,,percent of total billed charges,,
ENOXAPARIN 60 MG/0.6 ML SUBQ SYRG,,J1650,HCPCS,Facility,Outpatient,0.6,mL,,81,68.85,23.2146,81,UnitedHealthcare,Medicare Advantage,39.69,49,,percent of total billed charges,,
ENOXAPARIN 60 MG/0.6 ML SUBQ SYRG,,J1650,HCPCS,Facility,Outpatient,0.6,mL,,81,68.85,23.2146,81,UnitedHealthcare,Medicare Advantage,39.69,49,,percent of total billed charges,,
ENOXAPARIN 60 MG/0.6 ML SUBQ SYRG,,J1650,HCPCS,Facility,Inpatient,0.6,mL,,81,68.85,23.2146,81,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
ENOXAPARIN 60 MG/0.6 ML SUBQ SYRG,,J1650,HCPCS,Facility,Inpatient,0.6,mL,,81,68.85,23.2146,81,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
ENOXAPARIN 60 MG/0.6 ML SUBQ SYRG,,J1650,HCPCS,Facility,Outpatient,0.6,mL,,81,68.85,23.2146,81,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,38.88,48,,percent of total billed charges,,100% of DHS outpatient percentage
ENOXAPARIN 60 MG/0.6 ML SUBQ SYRG,,J1650,HCPCS,Facility,Outpatient,0.6,mL,,81,68.85,23.2146,81,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,38.88,48,,percent of total billed charges,,100% of DHS outpatient percentage
ENOXAPARIN 60 MG/0.6 ML SUBQ SYRG,,J1650,HCPCS,Facility,Inpatient,0.6,mL,,81,68.85,23.2146,81,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
ENOXAPARIN 60 MG/0.6 ML SUBQ SYRG,,J1650,HCPCS,Facility,Inpatient,0.6,mL,,81,68.85,23.2146,81,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
PEGFILGRASTIM 6 MG/0.6 ML SUBQ SYRG,,J2506,HCPCS,Facility,Both,0.6,mL,,23105,19639.25,6621.893,23105,Aetna,Commercial,21256.6,92,,percent of total billed charges,,
PEGFILGRASTIM 6 MG/0.6 ML SUBQ SYRG,,J2506,HCPCS,Facility,Outpatient,0.6,mL,,23105,19639.25,6621.893,23105,Aetna,Medicare Advantage,11321.45,49,,percent of total billed charges,,
PEGFILGRASTIM 6 MG/0.6 ML SUBQ SYRG,,J2506,HCPCS,Facility,Inpatient,0.6,mL,,23105,19639.25,6621.893,23105,Aetna,Medicare Advantage,,,,,Included in per diem rate,
PEGFILGRASTIM 6 MG/0.6 ML SUBQ SYRG,,J2506,HCPCS,Facility,Both,0.6,mL,,23105,19639.25,6621.893,23105,Aetna,PPO,21487.65,93,,percent of total billed charges,,
PEGFILGRASTIM 6 MG/0.6 ML SUBQ SYRG,,J2506,HCPCS,Facility,Both,0.6,mL,,23105,19639.25,6621.893,23105,America's PPO,America's PPO,22187.7315,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
PEGFILGRASTIM 6 MG/0.6 ML SUBQ SYRG,,J2506,HCPCS,Facility,Both,0.6,mL,,23105,19639.25,6621.893,23105,BlueCross BlueShield Minnesota, Federal Employee Program,22735.32,98.4,,percent of total billed charges,,
PEGFILGRASTIM 6 MG/0.6 ML SUBQ SYRG,,J2506,HCPCS,Facility,Both,0.6,mL,,23105,19639.25,6621.893,23105,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,23105,100,,percent of total billed charges,,
PEGFILGRASTIM 6 MG/0.6 ML SUBQ SYRG,,J2506,HCPCS,Facility,Both,0.6,mL,,23105,19639.25,6621.893,23105,BlueCross BlueShield Minnesota,High Value Network Plan,20794.5,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
PEGFILGRASTIM 6 MG/0.6 ML SUBQ SYRG,,J2506,HCPCS,Facility,Outpatient,0.6,mL,,23105,19639.25,6621.893,23105,BlueCross BlueShield Minnesota,Medicare Advantage,11321.45,49,,percent of total billed charges,,
PEGFILGRASTIM 6 MG/0.6 ML SUBQ SYRG,,J2506,HCPCS,Facility,Inpatient,0.6,mL,,23105,19639.25,6621.893,23105,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
PEGFILGRASTIM 6 MG/0.6 ML SUBQ SYRG,,J2506,HCPCS,Facility,Both,0.6,mL,,23105,19639.25,6621.893,23105,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,20464.0985,88.57,,percent of total billed charges,,
PEGFILGRASTIM 6 MG/0.6 ML SUBQ SYRG,,J2506,HCPCS,Facility,Both,0.6,mL,,23105,19639.25,6621.893,23105,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,6621.893,28.66,,percent of total billed charges,,
PEGFILGRASTIM 6 MG/0.6 ML SUBQ SYRG,,J2506,HCPCS,Facility,Outpatient,0.6,mL,,23105,19639.25,6621.893,23105,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),11321.45,49,,percent of total billed charges,,
PEGFILGRASTIM 6 MG/0.6 ML SUBQ SYRG,,J2506,HCPCS,Facility,Inpatient,0.6,mL,,23105,19639.25,6621.893,23105,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
PEGFILGRASTIM 6 MG/0.6 ML SUBQ SYRG,,J2506,HCPCS,Facility,Both,0.6,mL,,23105,19639.25,6621.893,23105,CorVel,Worker's Compensation,23105,100,,percent of total billed charges,,
PEGFILGRASTIM 6 MG/0.6 ML SUBQ SYRG,,J2506,HCPCS,Facility,Both,0.6,mL,,23105,19639.25,6621.893,23105,First Health Group Corporation,First Health Network,22411.85,97,,percent of total billed charges,,
PEGFILGRASTIM 6 MG/0.6 ML SUBQ SYRG,,J2506,HCPCS,Facility,Both,0.6,mL,,23105,19639.25,6621.893,23105,"Health Partners, Inc.",Commercial,21857.33,94.6,,percent of total billed charges,,
PEGFILGRASTIM 6 MG/0.6 ML SUBQ SYRG,,J2506,HCPCS,Facility,Outpatient,0.6,mL,,23105,19639.25,6621.893,23105,"Health Partners, Inc.",Medicare Advantage,11321.45,49,,percent of total billed charges,,
PEGFILGRASTIM 6 MG/0.6 ML SUBQ SYRG,,J2506,HCPCS,Facility,Inpatient,0.6,mL,,23105,19639.25,6621.893,23105,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PEGFILGRASTIM 6 MG/0.6 ML SUBQ SYRG,,J2506,HCPCS,Facility,Both,0.6,mL,,23105,19639.25,6621.893,23105,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),13863,60,,percent of total billed charges,,
PEGFILGRASTIM 6 MG/0.6 ML SUBQ SYRG,,J2506,HCPCS,Facility,Both,0.6,mL,,23105,19639.25,6621.893,23105,"Health Partners, Inc.",State of Minnesota Advantage Program,18830.575,81.5,,percent of total billed charges,,
PEGFILGRASTIM 6 MG/0.6 ML SUBQ SYRG,,J2506,HCPCS,Facility,Both,0.6,mL,,23105,19639.25,6621.893,23105,"Health Partners, Inc.",State Public Programs,11552.5,50,,percent of total billed charges,,
PEGFILGRASTIM 6 MG/0.6 ML SUBQ SYRG,,J2506,HCPCS,Facility,Both,0.6,mL,,23105,19639.25,6621.893,23105,Humana Insurance Company,Commercial PPO,21949.75,95,,percent of total billed charges,,
PEGFILGRASTIM 6 MG/0.6 ML SUBQ SYRG,,J2506,HCPCS,Facility,Outpatient,0.6,mL,,23105,19639.25,6621.893,23105,Humana Insurance Company,Medicare PPO,11321.45,49,,percent of total billed charges,,
PEGFILGRASTIM 6 MG/0.6 ML SUBQ SYRG,,J2506,HCPCS,Facility,Inpatient,0.6,mL,,23105,19639.25,6621.893,23105,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
PEGFILGRASTIM 6 MG/0.6 ML SUBQ SYRG,,J2506,HCPCS,Facility,Both,0.6,mL,,23105,19639.25,6621.893,23105,Medica,Individual & Family,22897.055,99.1,,percent of total billed charges,,
PEGFILGRASTIM 6 MG/0.6 ML SUBQ SYRG,,J2506,HCPCS,Facility,Outpatient,0.6,mL,,23105,19639.25,6621.893,23105,Medica,Medica Advantage Solution,11506.29,49.8,,percent of total billed charges,,
PEGFILGRASTIM 6 MG/0.6 ML SUBQ SYRG,,J2506,HCPCS,Facility,Inpatient,0.6,mL,,23105,19639.25,6621.893,23105,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
PEGFILGRASTIM 6 MG/0.6 ML SUBQ SYRG,,J2506,HCPCS,Facility,Outpatient,0.6,mL,,23105,19639.25,6621.893,23105,Medica,Medical Assistance,10304.83,44.6,,percent of total billed charges,,
PEGFILGRASTIM 6 MG/0.6 ML SUBQ SYRG,,J2506,HCPCS,Facility,Inpatient,0.6,mL,,23105,19639.25,6621.893,23105,Medica,Medical Assistance,,,,,Included in per diem rate,
PEGFILGRASTIM 6 MG/0.6 ML SUBQ SYRG,,J2506,HCPCS,Facility,Outpatient,0.6,mL,,23105,19639.25,6621.893,23105,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,11506.29,49.8,,percent of total billed charges,,
PEGFILGRASTIM 6 MG/0.6 ML SUBQ SYRG,,J2506,HCPCS,Facility,Inpatient,0.6,mL,,23105,19639.25,6621.893,23105,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
PEGFILGRASTIM 6 MG/0.6 ML SUBQ SYRG,,J2506,HCPCS,Facility,Both,0.6,mL,,23105,19639.25,6621.893,23105,"Multiplan, Inc.","Multiplan, Inc.",21718.7,94,,percent of total billed charges,,
PEGFILGRASTIM 6 MG/0.6 ML SUBQ SYRG,,J2506,HCPCS,Facility,Outpatient,0.6,mL,,23105,19639.25,6621.893,23105,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,20817.605,90.1,,percent of total billed charges,,
PEGFILGRASTIM 6 MG/0.6 ML SUBQ SYRG,,J2506,HCPCS,Facility,Inpatient,0.6,mL,,23105,19639.25,6621.893,23105,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
PEGFILGRASTIM 6 MG/0.6 ML SUBQ SYRG,,J2506,HCPCS,Facility,Both,0.6,mL,,23105,19639.25,6621.893,23105,"Preferred One Administrative Services, INC.",PPO,22781.53,98.6,,percent of total billed charges,,
PEGFILGRASTIM 6 MG/0.6 ML SUBQ SYRG,,J2506,HCPCS,Facility,Outpatient,0.6,mL,,23105,19639.25,6621.893,23105,PrimeWest Health,Minnesota Senior Health Options (MSHO),11887.5225,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
PEGFILGRASTIM 6 MG/0.6 ML SUBQ SYRG,,J2506,HCPCS,Facility,Inpatient,0.6,mL,,23105,19639.25,6621.893,23105,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PEGFILGRASTIM 6 MG/0.6 ML SUBQ SYRG,,J2506,HCPCS,Facility,Outpatient,0.6,mL,,23105,19639.25,6621.893,23105,PrimeWest Health,MinnesotaCare,11866.728,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
PEGFILGRASTIM 6 MG/0.6 ML SUBQ SYRG,,J2506,HCPCS,Facility,Inpatient,0.6,mL,,23105,19639.25,6621.893,23105,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
PEGFILGRASTIM 6 MG/0.6 ML SUBQ SYRG,,J2506,HCPCS,Facility,Both,0.6,mL,,23105,19639.25,6621.893,23105,Sanford Health Plan,Sanford Health Plan,21256.6,92,,percent of total billed charges,,
PEGFILGRASTIM 6 MG/0.6 ML SUBQ SYRG,,J2506,HCPCS,Facility,Outpatient,0.6,mL,,23105,19639.25,6621.893,23105,"UCare Health, Inc.",Individual & Family Plan,13019.6675,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
PEGFILGRASTIM 6 MG/0.6 ML SUBQ SYRG,,J2506,HCPCS,Facility,Inpatient,0.6,mL,,23105,19639.25,6621.893,23105,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
PEGFILGRASTIM 6 MG/0.6 ML SUBQ SYRG,,J2506,HCPCS,Facility,Outpatient,0.6,mL,,23105,19639.25,6621.893,23105,"UCare Health, Inc.",Medical Assistance,11661.0935,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PEGFILGRASTIM 6 MG/0.6 ML SUBQ SYRG,,J2506,HCPCS,Facility,Inpatient,0.6,mL,,23105,19639.25,6621.893,23105,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
PEGFILGRASTIM 6 MG/0.6 ML SUBQ SYRG,,J2506,HCPCS,Facility,Outpatient,0.6,mL,,23105,19639.25,6621.893,23105,"UCare Health, Inc.",Medicare Advantage,11661.0935,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PEGFILGRASTIM 6 MG/0.6 ML SUBQ SYRG,,J2506,HCPCS,Facility,Inpatient,0.6,mL,,23105,19639.25,6621.893,23105,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PEGFILGRASTIM 6 MG/0.6 ML SUBQ SYRG,,J2506,HCPCS,Facility,Outpatient,0.6,mL,,23105,19639.25,6621.893,23105,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),11661.0935,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PEGFILGRASTIM 6 MG/0.6 ML SUBQ SYRG,,J2506,HCPCS,Facility,Inpatient,0.6,mL,,23105,19639.25,6621.893,23105,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PEGFILGRASTIM 6 MG/0.6 ML SUBQ SYRG,,J2506,HCPCS,Facility,Both,0.6,mL,,23105,19639.25,6621.893,23105,UnitedHealthcare,Individual & Family,21718.7,94,,percent of total billed charges,,
PEGFILGRASTIM 6 MG/0.6 ML SUBQ SYRG,,J2506,HCPCS,Facility,Outpatient,0.6,mL,,23105,19639.25,6621.893,23105,UnitedHealthcare,Medicare Advantage,11321.45,49,,percent of total billed charges,,
PEGFILGRASTIM 6 MG/0.6 ML SUBQ SYRG,,J2506,HCPCS,Facility,Inpatient,0.6,mL,,23105,19639.25,6621.893,23105,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
PEGFILGRASTIM 6 MG/0.6 ML SUBQ SYRG,,J2506,HCPCS,Facility,Outpatient,0.6,mL,,23105,19639.25,6621.893,23105,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,11090.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
PEGFILGRASTIM 6 MG/0.6 ML SUBQ SYRG,,J2506,HCPCS,Facility,Inpatient,0.6,mL,,23105,19639.25,6621.893,23105,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITH CC,,809,MS-DRG,Facility,Inpatient,,,,13286,11293.1,12621.7,12758.5458,America's PPO,America's PPO,12758.5458,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITH CC,,809,MS-DRG,Facility,Inpatient,,,,13286,11293.1,12621.7,12758.5458,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,12621.7,,,Other ,DRG,"DRG weight 1.2157 x WOO $13,372.00; Cap at 95% of charge; minimum of 90.1% of charge"
MEDROXYPROGESTERONE 104 MG/0.65 ML SUBQ SYRG,,J1050,HCPCS,Facility,Both,0.65,mL,,266,226.1,76.2356,266,Aetna,Commercial,244.72,92,,percent of total billed charges,,
MEDROXYPROGESTERONE 104 MG/0.65 ML SUBQ SYRG,,J1050,HCPCS,Facility,Outpatient,0.65,mL,,266,226.1,76.2356,266,Aetna,Medicare Advantage,130.34,49,,percent of total billed charges,,
MEDROXYPROGESTERONE 104 MG/0.65 ML SUBQ SYRG,,J1050,HCPCS,Facility,Inpatient,0.65,mL,,266,226.1,76.2356,266,Aetna,Medicare Advantage,,,,,Included in per diem rate,
MEDROXYPROGESTERONE 104 MG/0.65 ML SUBQ SYRG,,J1050,HCPCS,Facility,Both,0.65,mL,,266,226.1,76.2356,266,Aetna,PPO,247.38,93,,percent of total billed charges,,
MEDROXYPROGESTERONE 104 MG/0.65 ML SUBQ SYRG,,J1050,HCPCS,Facility,Both,0.65,mL,,266,226.1,76.2356,266,America's PPO,America's PPO,255.4398,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
MEDROXYPROGESTERONE 104 MG/0.65 ML SUBQ SYRG,,J1050,HCPCS,Facility,Both,0.65,mL,,266,226.1,76.2356,266,BlueCross BlueShield Minnesota, Federal Employee Program,261.744,98.4,,percent of total billed charges,,
MEDROXYPROGESTERONE 104 MG/0.65 ML SUBQ SYRG,,J1050,HCPCS,Facility,Both,0.65,mL,,266,226.1,76.2356,266,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,266,100,,percent of total billed charges,,
MEDROXYPROGESTERONE 104 MG/0.65 ML SUBQ SYRG,,J1050,HCPCS,Facility,Both,0.65,mL,,266,226.1,76.2356,266,BlueCross BlueShield Minnesota,High Value Network Plan,239.4,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
MEDROXYPROGESTERONE 104 MG/0.65 ML SUBQ SYRG,,J1050,HCPCS,Facility,Outpatient,0.65,mL,,266,226.1,76.2356,266,BlueCross BlueShield Minnesota,Medicare Advantage,130.34,49,,percent of total billed charges,,
MEDROXYPROGESTERONE 104 MG/0.65 ML SUBQ SYRG,,J1050,HCPCS,Facility,Inpatient,0.65,mL,,266,226.1,76.2356,266,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
MEDROXYPROGESTERONE 104 MG/0.65 ML SUBQ SYRG,,J1050,HCPCS,Facility,Both,0.65,mL,,266,226.1,76.2356,266,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,235.5962,88.57,,percent of total billed charges,,
MEDROXYPROGESTERONE 104 MG/0.65 ML SUBQ SYRG,,J1050,HCPCS,Facility,Both,0.65,mL,,266,226.1,76.2356,266,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,76.2356,28.66,,percent of total billed charges,,
MEDROXYPROGESTERONE 104 MG/0.65 ML SUBQ SYRG,,J1050,HCPCS,Facility,Outpatient,0.65,mL,,266,226.1,76.2356,266,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),130.34,49,,percent of total billed charges,,
MEDROXYPROGESTERONE 104 MG/0.65 ML SUBQ SYRG,,J1050,HCPCS,Facility,Inpatient,0.65,mL,,266,226.1,76.2356,266,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
MEDROXYPROGESTERONE 104 MG/0.65 ML SUBQ SYRG,,J1050,HCPCS,Facility,Both,0.65,mL,,266,226.1,76.2356,266,CorVel,Worker's Compensation,266,100,,percent of total billed charges,,
MEDROXYPROGESTERONE 104 MG/0.65 ML SUBQ SYRG,,J1050,HCPCS,Facility,Both,0.65,mL,,266,226.1,76.2356,266,First Health Group Corporation,First Health Network,258.02,97,,percent of total billed charges,,
MEDROXYPROGESTERONE 104 MG/0.65 ML SUBQ SYRG,,J1050,HCPCS,Facility,Both,0.65,mL,,266,226.1,76.2356,266,"Health Partners, Inc.",Commercial,251.636,94.6,,percent of total billed charges,,
MEDROXYPROGESTERONE 104 MG/0.65 ML SUBQ SYRG,,J1050,HCPCS,Facility,Outpatient,0.65,mL,,266,226.1,76.2356,266,"Health Partners, Inc.",Medicare Advantage,130.34,49,,percent of total billed charges,,
MEDROXYPROGESTERONE 104 MG/0.65 ML SUBQ SYRG,,J1050,HCPCS,Facility,Inpatient,0.65,mL,,266,226.1,76.2356,266,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
MEDROXYPROGESTERONE 104 MG/0.65 ML SUBQ SYRG,,J1050,HCPCS,Facility,Both,0.65,mL,,266,226.1,76.2356,266,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),159.6,60,,percent of total billed charges,,
MEDROXYPROGESTERONE 104 MG/0.65 ML SUBQ SYRG,,J1050,HCPCS,Facility,Both,0.65,mL,,266,226.1,76.2356,266,"Health Partners, Inc.",State of Minnesota Advantage Program,216.79,81.5,,percent of total billed charges,,
MEDROXYPROGESTERONE 104 MG/0.65 ML SUBQ SYRG,,J1050,HCPCS,Facility,Both,0.65,mL,,266,226.1,76.2356,266,"Health Partners, Inc.",State Public Programs,133,50,,percent of total billed charges,,
MEDROXYPROGESTERONE 104 MG/0.65 ML SUBQ SYRG,,J1050,HCPCS,Facility,Both,0.65,mL,,266,226.1,76.2356,266,Humana Insurance Company,Commercial PPO,252.7,95,,percent of total billed charges,,
MEDROXYPROGESTERONE 104 MG/0.65 ML SUBQ SYRG,,J1050,HCPCS,Facility,Outpatient,0.65,mL,,266,226.1,76.2356,266,Humana Insurance Company,Medicare PPO,130.34,49,,percent of total billed charges,,
MEDROXYPROGESTERONE 104 MG/0.65 ML SUBQ SYRG,,J1050,HCPCS,Facility,Inpatient,0.65,mL,,266,226.1,76.2356,266,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
MEDROXYPROGESTERONE 104 MG/0.65 ML SUBQ SYRG,,J1050,HCPCS,Facility,Both,0.65,mL,,266,226.1,76.2356,266,Medica,Individual & Family,263.606,99.1,,percent of total billed charges,,
MEDROXYPROGESTERONE 104 MG/0.65 ML SUBQ SYRG,,J1050,HCPCS,Facility,Outpatient,0.65,mL,,266,226.1,76.2356,266,Medica,Medica Advantage Solution,132.468,49.8,,percent of total billed charges,,
MEDROXYPROGESTERONE 104 MG/0.65 ML SUBQ SYRG,,J1050,HCPCS,Facility,Inpatient,0.65,mL,,266,226.1,76.2356,266,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
MEDROXYPROGESTERONE 104 MG/0.65 ML SUBQ SYRG,,J1050,HCPCS,Facility,Outpatient,0.65,mL,,266,226.1,76.2356,266,Medica,Medical Assistance,118.636,44.6,,percent of total billed charges,,
MEDROXYPROGESTERONE 104 MG/0.65 ML SUBQ SYRG,,J1050,HCPCS,Facility,Inpatient,0.65,mL,,266,226.1,76.2356,266,Medica,Medical Assistance,,,,,Included in per diem rate,
MEDROXYPROGESTERONE 104 MG/0.65 ML SUBQ SYRG,,J1050,HCPCS,Facility,Outpatient,0.65,mL,,266,226.1,76.2356,266,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,132.468,49.8,,percent of total billed charges,,
MEDROXYPROGESTERONE 104 MG/0.65 ML SUBQ SYRG,,J1050,HCPCS,Facility,Inpatient,0.65,mL,,266,226.1,76.2356,266,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
MEDROXYPROGESTERONE 104 MG/0.65 ML SUBQ SYRG,,J1050,HCPCS,Facility,Both,0.65,mL,,266,226.1,76.2356,266,"Multiplan, Inc.","Multiplan, Inc.",250.04,94,,percent of total billed charges,,
MEDROXYPROGESTERONE 104 MG/0.65 ML SUBQ SYRG,,J1050,HCPCS,Facility,Outpatient,0.65,mL,,266,226.1,76.2356,266,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,239.666,90.1,,percent of total billed charges,,
MEDROXYPROGESTERONE 104 MG/0.65 ML SUBQ SYRG,,J1050,HCPCS,Facility,Inpatient,0.65,mL,,266,226.1,76.2356,266,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
MEDROXYPROGESTERONE 104 MG/0.65 ML SUBQ SYRG,,J1050,HCPCS,Facility,Both,0.65,mL,,266,226.1,76.2356,266,"Preferred One Administrative Services, INC.",PPO,262.276,98.6,,percent of total billed charges,,
MEDROXYPROGESTERONE 104 MG/0.65 ML SUBQ SYRG,,J1050,HCPCS,Facility,Outpatient,0.65,mL,,266,226.1,76.2356,266,PrimeWest Health,Minnesota Senior Health Options (MSHO),136.857,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
MEDROXYPROGESTERONE 104 MG/0.65 ML SUBQ SYRG,,J1050,HCPCS,Facility,Inpatient,0.65,mL,,266,226.1,76.2356,266,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
MEDROXYPROGESTERONE 104 MG/0.65 ML SUBQ SYRG,,J1050,HCPCS,Facility,Outpatient,0.65,mL,,266,226.1,76.2356,266,PrimeWest Health,MinnesotaCare,136.6176,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
MEDROXYPROGESTERONE 104 MG/0.65 ML SUBQ SYRG,,J1050,HCPCS,Facility,Inpatient,0.65,mL,,266,226.1,76.2356,266,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
MEDROXYPROGESTERONE 104 MG/0.65 ML SUBQ SYRG,,J1050,HCPCS,Facility,Both,0.65,mL,,266,226.1,76.2356,266,Sanford Health Plan,Sanford Health Plan,244.72,92,,percent of total billed charges,,
MEDROXYPROGESTERONE 104 MG/0.65 ML SUBQ SYRG,,J1050,HCPCS,Facility,Outpatient,0.65,mL,,266,226.1,76.2356,266,"UCare Health, Inc.",Individual & Family Plan,149.891,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
MEDROXYPROGESTERONE 104 MG/0.65 ML SUBQ SYRG,,J1050,HCPCS,Facility,Inpatient,0.65,mL,,266,226.1,76.2356,266,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
MEDROXYPROGESTERONE 104 MG/0.65 ML SUBQ SYRG,,J1050,HCPCS,Facility,Outpatient,0.65,mL,,266,226.1,76.2356,266,"UCare Health, Inc.",Medical Assistance,134.2502,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MEDROXYPROGESTERONE 104 MG/0.65 ML SUBQ SYRG,,J1050,HCPCS,Facility,Inpatient,0.65,mL,,266,226.1,76.2356,266,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
MEDROXYPROGESTERONE 104 MG/0.65 ML SUBQ SYRG,,J1050,HCPCS,Facility,Outpatient,0.65,mL,,266,226.1,76.2356,266,"UCare Health, Inc.",Medicare Advantage,134.2502,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MEDROXYPROGESTERONE 104 MG/0.65 ML SUBQ SYRG,,J1050,HCPCS,Facility,Inpatient,0.65,mL,,266,226.1,76.2356,266,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
MEDROXYPROGESTERONE 104 MG/0.65 ML SUBQ SYRG,,J1050,HCPCS,Facility,Outpatient,0.65,mL,,266,226.1,76.2356,266,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),134.2502,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MEDROXYPROGESTERONE 104 MG/0.65 ML SUBQ SYRG,,J1050,HCPCS,Facility,Inpatient,0.65,mL,,266,226.1,76.2356,266,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
MEDROXYPROGESTERONE 104 MG/0.65 ML SUBQ SYRG,,J1050,HCPCS,Facility,Both,0.65,mL,,266,226.1,76.2356,266,UnitedHealthcare,Individual & Family,250.04,94,,percent of total billed charges,,
MEDROXYPROGESTERONE 104 MG/0.65 ML SUBQ SYRG,,J1050,HCPCS,Facility,Outpatient,0.65,mL,,266,226.1,76.2356,266,UnitedHealthcare,Medicare Advantage,130.34,49,,percent of total billed charges,,
MEDROXYPROGESTERONE 104 MG/0.65 ML SUBQ SYRG,,J1050,HCPCS,Facility,Inpatient,0.65,mL,,266,226.1,76.2356,266,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
MEDROXYPROGESTERONE 104 MG/0.65 ML SUBQ SYRG,,J1050,HCPCS,Facility,Outpatient,0.65,mL,,266,226.1,76.2356,266,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,127.68,48,,percent of total billed charges,,100% of DHS outpatient percentage
MEDROXYPROGESTERONE 104 MG/0.65 ML SUBQ SYRG,,J1050,HCPCS,Facility,Inpatient,0.65,mL,,266,226.1,76.2356,266,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
FLU VACC QS(65YR UP)-PF 240 MCG/0.7 ML IM SYRG,,90662,CPT,Facility,Both,0.7,mL,,322,273.7,92.2852,322,Aetna,Commercial,296.24,92,,percent of total billed charges,,
FLU VACC QS(65YR UP)-PF 240 MCG/0.7 ML IM SYRG,,90662,CPT,Facility,Outpatient,0.7,mL,,322,273.7,92.2852,322,Aetna,Medicare Advantage,157.78,49,,percent of total billed charges,,
FLU VACC QS(65YR UP)-PF 240 MCG/0.7 ML IM SYRG,,90662,CPT,Facility,Inpatient,0.7,mL,,322,273.7,92.2852,322,Aetna,Medicare Advantage,,,,,Included in per diem rate,
FLU VACC QS(65YR UP)-PF 240 MCG/0.7 ML IM SYRG,,90662,CPT,Facility,Both,0.7,mL,,322,273.7,92.2852,322,Aetna,PPO,299.46,93,,percent of total billed charges,,
FLU VACC QS(65YR UP)-PF 240 MCG/0.7 ML IM SYRG,,90662,CPT,Facility,Both,0.7,mL,,322,273.7,92.2852,322,America's PPO,America's PPO,309.2166,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
FLU VACC QS(65YR UP)-PF 240 MCG/0.7 ML IM SYRG,,90662,CPT,Facility,Both,0.7,mL,,322,273.7,92.2852,322,BlueCross BlueShield Minnesota, Federal Employee Program,316.848,98.4,,percent of total billed charges,,
FLU VACC QS(65YR UP)-PF 240 MCG/0.7 ML IM SYRG,,90662,CPT,Facility,Both,0.7,mL,,322,273.7,92.2852,322,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,322,100,,percent of total billed charges,,
FLU VACC QS(65YR UP)-PF 240 MCG/0.7 ML IM SYRG,,90662,CPT,Facility,Both,0.7,mL,,322,273.7,92.2852,322,BlueCross BlueShield Minnesota,High Value Network Plan,289.8,90,,percent of total billed charges,,
FLU VACC QS(65YR UP)-PF 240 MCG/0.7 ML IM SYRG,,90662,CPT,Facility,Outpatient,0.7,mL,,322,273.7,92.2852,322,BlueCross BlueShield Minnesota,Medicare Advantage,157.78,49,,percent of total billed charges,,
FLU VACC QS(65YR UP)-PF 240 MCG/0.7 ML IM SYRG,,90662,CPT,Facility,Inpatient,0.7,mL,,322,273.7,92.2852,322,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
FLU VACC QS(65YR UP)-PF 240 MCG/0.7 ML IM SYRG,,90662,CPT,Facility,Both,0.7,mL,,322,273.7,92.2852,322,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,285.1954,88.57,,percent of total billed charges,,
FLU VACC QS(65YR UP)-PF 240 MCG/0.7 ML IM SYRG,,90662,CPT,Facility,Both,0.7,mL,,322,273.7,92.2852,322,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,92.2852,28.66,,percent of total billed charges,,
FLU VACC QS(65YR UP)-PF 240 MCG/0.7 ML IM SYRG,,90662,CPT,Facility,Outpatient,0.7,mL,,322,273.7,92.2852,322,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),157.78,49,,percent of total billed charges,,
FLU VACC QS(65YR UP)-PF 240 MCG/0.7 ML IM SYRG,,90662,CPT,Facility,Inpatient,0.7,mL,,322,273.7,92.2852,322,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
FLU VACC QS(65YR UP)-PF 240 MCG/0.7 ML IM SYRG,,90662,CPT,Facility,Both,0.7,mL,,322,273.7,92.2852,322,CorVel,Worker's Compensation,322,100,,percent of total billed charges,,
FLU VACC QS(65YR UP)-PF 240 MCG/0.7 ML IM SYRG,,90662,CPT,Facility,Both,0.7,mL,,322,273.7,92.2852,322,First Health Group Corporation,First Health Network,312.34,97,,percent of total billed charges,,
FLU VACC QS(65YR UP)-PF 240 MCG/0.7 ML IM SYRG,,90662,CPT,Facility,Both,0.7,mL,,322,273.7,92.2852,322,"Health Partners, Inc.",Commercial,304.612,94.6,,percent of total billed charges,,
FLU VACC QS(65YR UP)-PF 240 MCG/0.7 ML IM SYRG,,90662,CPT,Facility,Outpatient,0.7,mL,,322,273.7,92.2852,322,"Health Partners, Inc.",Medicare Advantage,157.78,49,,percent of total billed charges,,
FLU VACC QS(65YR UP)-PF 240 MCG/0.7 ML IM SYRG,,90662,CPT,Facility,Inpatient,0.7,mL,,322,273.7,92.2852,322,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
FLU VACC QS(65YR UP)-PF 240 MCG/0.7 ML IM SYRG,,90662,CPT,Facility,Both,0.7,mL,,322,273.7,92.2852,322,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),193.2,60,,percent of total billed charges,,
FLU VACC QS(65YR UP)-PF 240 MCG/0.7 ML IM SYRG,,90662,CPT,Facility,Both,0.7,mL,,322,273.7,92.2852,322,"Health Partners, Inc.",State of Minnesota Advantage Program,262.43,81.5,,percent of total billed charges,,
FLU VACC QS(65YR UP)-PF 240 MCG/0.7 ML IM SYRG,,90662,CPT,Facility,Both,0.7,mL,,322,273.7,92.2852,322,"Health Partners, Inc.",State Public Programs,161,50,,percent of total billed charges,,
FLU VACC QS(65YR UP)-PF 240 MCG/0.7 ML IM SYRG,,90662,CPT,Facility,Both,0.7,mL,,322,273.7,92.2852,322,Humana Insurance Company,Commercial PPO,305.9,95,,percent of total billed charges,,
FLU VACC QS(65YR UP)-PF 240 MCG/0.7 ML IM SYRG,,90662,CPT,Facility,Outpatient,0.7,mL,,322,273.7,92.2852,322,Humana Insurance Company,Medicare PPO,157.78,49,,percent of total billed charges,,
FLU VACC QS(65YR UP)-PF 240 MCG/0.7 ML IM SYRG,,90662,CPT,Facility,Inpatient,0.7,mL,,322,273.7,92.2852,322,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
FLU VACC QS(65YR UP)-PF 240 MCG/0.7 ML IM SYRG,,90662,CPT,Facility,Both,0.7,mL,,322,273.7,92.2852,322,Medica,Individual & Family,319.102,99.1,,percent of total billed charges,,
FLU VACC QS(65YR UP)-PF 240 MCG/0.7 ML IM SYRG,,90662,CPT,Facility,Outpatient,0.7,mL,,322,273.7,92.2852,322,Medica,Medica Advantage Solution,160.356,49.8,,percent of total billed charges,,
FLU VACC QS(65YR UP)-PF 240 MCG/0.7 ML IM SYRG,,90662,CPT,Facility,Inpatient,0.7,mL,,322,273.7,92.2852,322,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
FLU VACC QS(65YR UP)-PF 240 MCG/0.7 ML IM SYRG,,90662,CPT,Facility,Outpatient,0.7,mL,,322,273.7,92.2852,322,Medica,Medical Assistance,143.612,44.6,,percent of total billed charges,,
FLU VACC QS(65YR UP)-PF 240 MCG/0.7 ML IM SYRG,,90662,CPT,Facility,Inpatient,0.7,mL,,322,273.7,92.2852,322,Medica,Medical Assistance,,,,,Included in per diem rate,
FLU VACC QS(65YR UP)-PF 240 MCG/0.7 ML IM SYRG,,90662,CPT,Facility,Outpatient,0.7,mL,,322,273.7,92.2852,322,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,160.356,49.8,,percent of total billed charges,,
FLU VACC QS(65YR UP)-PF 240 MCG/0.7 ML IM SYRG,,90662,CPT,Facility,Inpatient,0.7,mL,,322,273.7,92.2852,322,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
FLU VACC QS(65YR UP)-PF 240 MCG/0.7 ML IM SYRG,,90662,CPT,Facility,Both,0.7,mL,,322,273.7,92.2852,322,"Multiplan, Inc.","Multiplan, Inc.",302.68,94,,percent of total billed charges,,
FLU VACC QS(65YR UP)-PF 240 MCG/0.7 ML IM SYRG,,90662,CPT,Facility,Outpatient,0.7,mL,,322,273.7,92.2852,322,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,290.122,90.1,,percent of total billed charges,,
FLU VACC QS(65YR UP)-PF 240 MCG/0.7 ML IM SYRG,,90662,CPT,Facility,Inpatient,0.7,mL,,322,273.7,92.2852,322,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
FLU VACC QS(65YR UP)-PF 240 MCG/0.7 ML IM SYRG,,90662,CPT,Facility,Both,0.7,mL,,322,273.7,92.2852,322,"Preferred One Administrative Services, INC.",PPO,317.492,98.6,,percent of total billed charges,,
FLU VACC QS(65YR UP)-PF 240 MCG/0.7 ML IM SYRG,,90662,CPT,Facility,Outpatient,0.7,mL,,322,273.7,92.2852,322,PrimeWest Health,Minnesota Senior Health Options (MSHO),165.669,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
FLU VACC QS(65YR UP)-PF 240 MCG/0.7 ML IM SYRG,,90662,CPT,Facility,Inpatient,0.7,mL,,322,273.7,92.2852,322,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
FLU VACC QS(65YR UP)-PF 240 MCG/0.7 ML IM SYRG,,90662,CPT,Facility,Outpatient,0.7,mL,,322,273.7,92.2852,322,PrimeWest Health,MinnesotaCare,165.3792,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
FLU VACC QS(65YR UP)-PF 240 MCG/0.7 ML IM SYRG,,90662,CPT,Facility,Inpatient,0.7,mL,,322,273.7,92.2852,322,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
FLU VACC QS(65YR UP)-PF 240 MCG/0.7 ML IM SYRG,,90662,CPT,Facility,Both,0.7,mL,,322,273.7,92.2852,322,Sanford Health Plan,Sanford Health Plan,296.24,92,,percent of total billed charges,,
FLU VACC QS(65YR UP)-PF 240 MCG/0.7 ML IM SYRG,,90662,CPT,Facility,Outpatient,0.7,mL,,322,273.7,92.2852,322,"UCare Health, Inc.",Individual & Family Plan,181.447,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
FLU VACC QS(65YR UP)-PF 240 MCG/0.7 ML IM SYRG,,90662,CPT,Facility,Inpatient,0.7,mL,,322,273.7,92.2852,322,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
FLU VACC QS(65YR UP)-PF 240 MCG/0.7 ML IM SYRG,,90662,CPT,Facility,Outpatient,0.7,mL,,322,273.7,92.2852,322,"UCare Health, Inc.",Medical Assistance,162.5134,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FLU VACC QS(65YR UP)-PF 240 MCG/0.7 ML IM SYRG,,90662,CPT,Facility,Inpatient,0.7,mL,,322,273.7,92.2852,322,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
FLU VACC QS(65YR UP)-PF 240 MCG/0.7 ML IM SYRG,,90662,CPT,Facility,Outpatient,0.7,mL,,322,273.7,92.2852,322,"UCare Health, Inc.",Medicare Advantage,162.5134,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FLU VACC QS(65YR UP)-PF 240 MCG/0.7 ML IM SYRG,,90662,CPT,Facility,Inpatient,0.7,mL,,322,273.7,92.2852,322,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
FLU VACC QS(65YR UP)-PF 240 MCG/0.7 ML IM SYRG,,90662,CPT,Facility,Outpatient,0.7,mL,,322,273.7,92.2852,322,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),162.5134,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FLU VACC QS(65YR UP)-PF 240 MCG/0.7 ML IM SYRG,,90662,CPT,Facility,Inpatient,0.7,mL,,322,273.7,92.2852,322,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
FLU VACC QS(65YR UP)-PF 240 MCG/0.7 ML IM SYRG,,90662,CPT,Facility,Both,0.7,mL,,322,273.7,92.2852,322,UnitedHealthcare,Individual & Family,302.68,94,,percent of total billed charges,,
FLU VACC QS(65YR UP)-PF 240 MCG/0.7 ML IM SYRG,,90662,CPT,Facility,Outpatient,0.7,mL,,322,273.7,92.2852,322,UnitedHealthcare,Medicare Advantage,157.78,49,,percent of total billed charges,,
FLU VACC QS(65YR UP)-PF 240 MCG/0.7 ML IM SYRG,,90662,CPT,Facility,Inpatient,0.7,mL,,322,273.7,92.2852,322,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
FLU VACC QS(65YR UP)-PF 240 MCG/0.7 ML IM SYRG,,90662,CPT,Facility,Outpatient,0.7,mL,,322,273.7,92.2852,322,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,154.56,48,,percent of total billed charges,,100% of DHS outpatient percentage
FLU VACC QS(65YR UP)-PF 240 MCG/0.7 ML IM SYRG,,90662,CPT,Facility,Inpatient,0.7,mL,,322,273.7,92.2852,322,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
RED BLOOD CELL DISORDERS WITHOUT MCC,,812,MS-DRG,Facility,Inpatient,,,,6378.08,5421.368,6059.176,6124.870224,America's PPO,America's PPO,6124.870224,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
RED BLOOD CELL DISORDERS WITHOUT MCC,,812,MS-DRG,Facility,Inpatient,,,,6378.08,5421.368,6059.176,6124.870224,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,6059.176,,,Other ,DRG,"DRG weight 0.898 x WOO $13,372.00; Cap at 95% of charge; minimum of 90.1% of charge"
RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH CC,,815,MS-DRG,Facility,Inpatient,,,,1905,1619.25,1809.75,1829.3715,America's PPO,America's PPO,1829.3715,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH CC,,815,MS-DRG,Facility,Inpatient,,,,1905,1619.25,1809.75,1829.3715,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1809.75,,,Other ,DRG,"DRG weight 1.0311 x WOO $13,372.00; Cap at 95% of charge; minimum of 90.1% of charge"
PALIPERIDONE PALMITATE 117 MG/0.75 ML IM SYRG,,J2426,HCPCS,Facility,Both,0.75,mL,,6027,5122.95,1727.3382,6027,Aetna,Commercial,5544.84,92,,percent of total billed charges,,
PALIPERIDONE PALMITATE 117 MG/0.75 ML IM SYRG,,J2426,HCPCS,Facility,Outpatient,0.75,mL,,6027,5122.95,1727.3382,6027,Aetna,Medicare Advantage,2953.23,49,,percent of total billed charges,,
PALIPERIDONE PALMITATE 117 MG/0.75 ML IM SYRG,,J2426,HCPCS,Facility,Inpatient,0.75,mL,,6027,5122.95,1727.3382,6027,Aetna,Medicare Advantage,,,,,Included in per diem rate,
PALIPERIDONE PALMITATE 117 MG/0.75 ML IM SYRG,,J2426,HCPCS,Facility,Both,0.75,mL,,6027,5122.95,1727.3382,6027,Aetna,PPO,5605.11,93,,percent of total billed charges,,
PALIPERIDONE PALMITATE 117 MG/0.75 ML IM SYRG,,J2426,HCPCS,Facility,Both,0.75,mL,,6027,5122.95,1727.3382,6027,America's PPO,America's PPO,5787.7281,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
PALIPERIDONE PALMITATE 117 MG/0.75 ML IM SYRG,,J2426,HCPCS,Facility,Both,0.75,mL,,6027,5122.95,1727.3382,6027,BlueCross BlueShield Minnesota, Federal Employee Program,5930.568,98.4,,percent of total billed charges,,
PALIPERIDONE PALMITATE 117 MG/0.75 ML IM SYRG,,J2426,HCPCS,Facility,Both,0.75,mL,,6027,5122.95,1727.3382,6027,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,6027,100,,percent of total billed charges,,
PALIPERIDONE PALMITATE 117 MG/0.75 ML IM SYRG,,J2426,HCPCS,Facility,Both,0.75,mL,,6027,5122.95,1727.3382,6027,BlueCross BlueShield Minnesota,High Value Network Plan,5424.3,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
PALIPERIDONE PALMITATE 117 MG/0.75 ML IM SYRG,,J2426,HCPCS,Facility,Outpatient,0.75,mL,,6027,5122.95,1727.3382,6027,BlueCross BlueShield Minnesota,Medicare Advantage,2953.23,49,,percent of total billed charges,,
PALIPERIDONE PALMITATE 117 MG/0.75 ML IM SYRG,,J2426,HCPCS,Facility,Inpatient,0.75,mL,,6027,5122.95,1727.3382,6027,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
PALIPERIDONE PALMITATE 117 MG/0.75 ML IM SYRG,,J2426,HCPCS,Facility,Both,0.75,mL,,6027,5122.95,1727.3382,6027,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,5338.1139,88.57,,percent of total billed charges,,
PALIPERIDONE PALMITATE 117 MG/0.75 ML IM SYRG,,J2426,HCPCS,Facility,Both,0.75,mL,,6027,5122.95,1727.3382,6027,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1727.3382,28.66,,percent of total billed charges,,
PALIPERIDONE PALMITATE 117 MG/0.75 ML IM SYRG,,J2426,HCPCS,Facility,Outpatient,0.75,mL,,6027,5122.95,1727.3382,6027,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2953.23,49,,percent of total billed charges,,
PALIPERIDONE PALMITATE 117 MG/0.75 ML IM SYRG,,J2426,HCPCS,Facility,Inpatient,0.75,mL,,6027,5122.95,1727.3382,6027,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
PALIPERIDONE PALMITATE 117 MG/0.75 ML IM SYRG,,J2426,HCPCS,Facility,Both,0.75,mL,,6027,5122.95,1727.3382,6027,CorVel,Worker's Compensation,6027,100,,percent of total billed charges,,
PALIPERIDONE PALMITATE 117 MG/0.75 ML IM SYRG,,J2426,HCPCS,Facility,Both,0.75,mL,,6027,5122.95,1727.3382,6027,First Health Group Corporation,First Health Network,5846.19,97,,percent of total billed charges,,
PALIPERIDONE PALMITATE 117 MG/0.75 ML IM SYRG,,J2426,HCPCS,Facility,Both,0.75,mL,,6027,5122.95,1727.3382,6027,"Health Partners, Inc.",Commercial,5701.542,94.6,,percent of total billed charges,,
PALIPERIDONE PALMITATE 117 MG/0.75 ML IM SYRG,,J2426,HCPCS,Facility,Outpatient,0.75,mL,,6027,5122.95,1727.3382,6027,"Health Partners, Inc.",Medicare Advantage,2953.23,49,,percent of total billed charges,,
PALIPERIDONE PALMITATE 117 MG/0.75 ML IM SYRG,,J2426,HCPCS,Facility,Inpatient,0.75,mL,,6027,5122.95,1727.3382,6027,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PALIPERIDONE PALMITATE 117 MG/0.75 ML IM SYRG,,J2426,HCPCS,Facility,Both,0.75,mL,,6027,5122.95,1727.3382,6027,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3616.2,60,,percent of total billed charges,,
PALIPERIDONE PALMITATE 117 MG/0.75 ML IM SYRG,,J2426,HCPCS,Facility,Both,0.75,mL,,6027,5122.95,1727.3382,6027,"Health Partners, Inc.",State of Minnesota Advantage Program,4912.005,81.5,,percent of total billed charges,,
PALIPERIDONE PALMITATE 117 MG/0.75 ML IM SYRG,,J2426,HCPCS,Facility,Both,0.75,mL,,6027,5122.95,1727.3382,6027,"Health Partners, Inc.",State Public Programs,3013.5,50,,percent of total billed charges,,
PALIPERIDONE PALMITATE 117 MG/0.75 ML IM SYRG,,J2426,HCPCS,Facility,Both,0.75,mL,,6027,5122.95,1727.3382,6027,Humana Insurance Company,Commercial PPO,5725.65,95,,percent of total billed charges,,
PALIPERIDONE PALMITATE 117 MG/0.75 ML IM SYRG,,J2426,HCPCS,Facility,Outpatient,0.75,mL,,6027,5122.95,1727.3382,6027,Humana Insurance Company,Medicare PPO,2953.23,49,,percent of total billed charges,,
PALIPERIDONE PALMITATE 117 MG/0.75 ML IM SYRG,,J2426,HCPCS,Facility,Inpatient,0.75,mL,,6027,5122.95,1727.3382,6027,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
PALIPERIDONE PALMITATE 117 MG/0.75 ML IM SYRG,,J2426,HCPCS,Facility,Both,0.75,mL,,6027,5122.95,1727.3382,6027,Medica,Individual & Family,5972.757,99.1,,percent of total billed charges,,
PALIPERIDONE PALMITATE 117 MG/0.75 ML IM SYRG,,J2426,HCPCS,Facility,Outpatient,0.75,mL,,6027,5122.95,1727.3382,6027,Medica,Medica Advantage Solution,3001.446,49.8,,percent of total billed charges,,
PALIPERIDONE PALMITATE 117 MG/0.75 ML IM SYRG,,J2426,HCPCS,Facility,Inpatient,0.75,mL,,6027,5122.95,1727.3382,6027,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
PALIPERIDONE PALMITATE 117 MG/0.75 ML IM SYRG,,J2426,HCPCS,Facility,Outpatient,0.75,mL,,6027,5122.95,1727.3382,6027,Medica,Medical Assistance,2688.042,44.6,,percent of total billed charges,,
PALIPERIDONE PALMITATE 117 MG/0.75 ML IM SYRG,,J2426,HCPCS,Facility,Inpatient,0.75,mL,,6027,5122.95,1727.3382,6027,Medica,Medical Assistance,,,,,Included in per diem rate,
PALIPERIDONE PALMITATE 117 MG/0.75 ML IM SYRG,,J2426,HCPCS,Facility,Outpatient,0.75,mL,,6027,5122.95,1727.3382,6027,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,3001.446,49.8,,percent of total billed charges,,
PALIPERIDONE PALMITATE 117 MG/0.75 ML IM SYRG,,J2426,HCPCS,Facility,Inpatient,0.75,mL,,6027,5122.95,1727.3382,6027,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
PALIPERIDONE PALMITATE 117 MG/0.75 ML IM SYRG,,J2426,HCPCS,Facility,Both,0.75,mL,,6027,5122.95,1727.3382,6027,"Multiplan, Inc.","Multiplan, Inc.",5665.38,94,,percent of total billed charges,,
PALIPERIDONE PALMITATE 117 MG/0.75 ML IM SYRG,,J2426,HCPCS,Facility,Outpatient,0.75,mL,,6027,5122.95,1727.3382,6027,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,5430.327,90.1,,percent of total billed charges,,
PALIPERIDONE PALMITATE 117 MG/0.75 ML IM SYRG,,J2426,HCPCS,Facility,Inpatient,0.75,mL,,6027,5122.95,1727.3382,6027,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
PALIPERIDONE PALMITATE 117 MG/0.75 ML IM SYRG,,J2426,HCPCS,Facility,Both,0.75,mL,,6027,5122.95,1727.3382,6027,"Preferred One Administrative Services, INC.",PPO,5942.622,98.6,,percent of total billed charges,,
PALIPERIDONE PALMITATE 117 MG/0.75 ML IM SYRG,,J2426,HCPCS,Facility,Outpatient,0.75,mL,,6027,5122.95,1727.3382,6027,PrimeWest Health,Minnesota Senior Health Options (MSHO),3100.8915,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
PALIPERIDONE PALMITATE 117 MG/0.75 ML IM SYRG,,J2426,HCPCS,Facility,Inpatient,0.75,mL,,6027,5122.95,1727.3382,6027,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PALIPERIDONE PALMITATE 117 MG/0.75 ML IM SYRG,,J2426,HCPCS,Facility,Outpatient,0.75,mL,,6027,5122.95,1727.3382,6027,PrimeWest Health,MinnesotaCare,3095.4672,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
PALIPERIDONE PALMITATE 117 MG/0.75 ML IM SYRG,,J2426,HCPCS,Facility,Inpatient,0.75,mL,,6027,5122.95,1727.3382,6027,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
PALIPERIDONE PALMITATE 117 MG/0.75 ML IM SYRG,,J2426,HCPCS,Facility,Both,0.75,mL,,6027,5122.95,1727.3382,6027,Sanford Health Plan,Sanford Health Plan,5544.84,92,,percent of total billed charges,,
PALIPERIDONE PALMITATE 117 MG/0.75 ML IM SYRG,,J2426,HCPCS,Facility,Outpatient,0.75,mL,,6027,5122.95,1727.3382,6027,"UCare Health, Inc.",Individual & Family Plan,3396.2145,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
PALIPERIDONE PALMITATE 117 MG/0.75 ML IM SYRG,,J2426,HCPCS,Facility,Inpatient,0.75,mL,,6027,5122.95,1727.3382,6027,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
PALIPERIDONE PALMITATE 117 MG/0.75 ML IM SYRG,,J2426,HCPCS,Facility,Outpatient,0.75,mL,,6027,5122.95,1727.3382,6027,"UCare Health, Inc.",Medical Assistance,3041.8269,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PALIPERIDONE PALMITATE 117 MG/0.75 ML IM SYRG,,J2426,HCPCS,Facility,Inpatient,0.75,mL,,6027,5122.95,1727.3382,6027,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
PALIPERIDONE PALMITATE 117 MG/0.75 ML IM SYRG,,J2426,HCPCS,Facility,Outpatient,0.75,mL,,6027,5122.95,1727.3382,6027,"UCare Health, Inc.",Medicare Advantage,3041.8269,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PALIPERIDONE PALMITATE 117 MG/0.75 ML IM SYRG,,J2426,HCPCS,Facility,Inpatient,0.75,mL,,6027,5122.95,1727.3382,6027,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PALIPERIDONE PALMITATE 117 MG/0.75 ML IM SYRG,,J2426,HCPCS,Facility,Outpatient,0.75,mL,,6027,5122.95,1727.3382,6027,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),3041.8269,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PALIPERIDONE PALMITATE 117 MG/0.75 ML IM SYRG,,J2426,HCPCS,Facility,Inpatient,0.75,mL,,6027,5122.95,1727.3382,6027,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PALIPERIDONE PALMITATE 117 MG/0.75 ML IM SYRG,,J2426,HCPCS,Facility,Both,0.75,mL,,6027,5122.95,1727.3382,6027,UnitedHealthcare,Individual & Family,5665.38,94,,percent of total billed charges,,
PALIPERIDONE PALMITATE 117 MG/0.75 ML IM SYRG,,J2426,HCPCS,Facility,Outpatient,0.75,mL,,6027,5122.95,1727.3382,6027,UnitedHealthcare,Medicare Advantage,2953.23,49,,percent of total billed charges,,
PALIPERIDONE PALMITATE 117 MG/0.75 ML IM SYRG,,J2426,HCPCS,Facility,Inpatient,0.75,mL,,6027,5122.95,1727.3382,6027,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
PALIPERIDONE PALMITATE 117 MG/0.75 ML IM SYRG,,J2426,HCPCS,Facility,Outpatient,0.75,mL,,6027,5122.95,1727.3382,6027,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2892.96,48,,percent of total billed charges,,100% of DHS outpatient percentage
PALIPERIDONE PALMITATE 117 MG/0.75 ML IM SYRG,,J2426,HCPCS,Facility,Inpatient,0.75,mL,,6027,5122.95,1727.3382,6027,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH MCC,,831,MS-DRG,Facility,Inpatient,,,,29080,24718,26201.08,27925.524,America's PPO,America's PPO,27925.524,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH MCC,,831,MS-DRG,Facility,Inpatient,,,,29080,24718,26201.08,27925.524,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,26201.08,,,Other ,DRG,"DRG weight 1.1948 x WOO $13,372.00; Cap at 95% of charge; minimum of 90.1% of charge"
"MOXIFLOXACIN-SOD CHLOR,ISO(PF) 4 MG/0.8 ML IO SOLN",,138794,LOCAL,Facility,Both,0.8,mL,,125,106.25,35.825,125,Aetna,Commercial,115,92,,percent of total billed charges,,
"MOXIFLOXACIN-SOD CHLOR,ISO(PF) 4 MG/0.8 ML IO SOLN",,138794,LOCAL,Facility,Outpatient,0.8,mL,,125,106.25,35.825,125,Aetna,Medicare Advantage,61.25,49,,percent of total billed charges,,
"MOXIFLOXACIN-SOD CHLOR,ISO(PF) 4 MG/0.8 ML IO SOLN",,138794,LOCAL,Facility,Inpatient,0.8,mL,,125,106.25,35.825,125,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"MOXIFLOXACIN-SOD CHLOR,ISO(PF) 4 MG/0.8 ML IO SOLN",,138794,LOCAL,Facility,Both,0.8,mL,,125,106.25,35.825,125,Aetna,PPO,116.25,93,,percent of total billed charges,,
"MOXIFLOXACIN-SOD CHLOR,ISO(PF) 4 MG/0.8 ML IO SOLN",,138794,LOCAL,Facility,Both,0.8,mL,,125,106.25,35.825,125,America's PPO,America's PPO,120.0375,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"MOXIFLOXACIN-SOD CHLOR,ISO(PF) 4 MG/0.8 ML IO SOLN",,138794,LOCAL,Facility,Both,0.8,mL,,125,106.25,35.825,125,BlueCross BlueShield Minnesota, Federal Employee Program,123,98.4,,percent of total billed charges,,
"MOXIFLOXACIN-SOD CHLOR,ISO(PF) 4 MG/0.8 ML IO SOLN",,138794,LOCAL,Facility,Both,0.8,mL,,125,106.25,35.825,125,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,125,100,,percent of total billed charges,,
"MOXIFLOXACIN-SOD CHLOR,ISO(PF) 4 MG/0.8 ML IO SOLN",,138794,LOCAL,Facility,Both,0.8,mL,,125,106.25,35.825,125,BlueCross BlueShield Minnesota,High Value Network Plan,112.5,90,,percent of total billed charges,,
"MOXIFLOXACIN-SOD CHLOR,ISO(PF) 4 MG/0.8 ML IO SOLN",,138794,LOCAL,Facility,Outpatient,0.8,mL,,125,106.25,35.825,125,BlueCross BlueShield Minnesota,Medicare Advantage,61.25,49,,percent of total billed charges,,
"MOXIFLOXACIN-SOD CHLOR,ISO(PF) 4 MG/0.8 ML IO SOLN",,138794,LOCAL,Facility,Inpatient,0.8,mL,,125,106.25,35.825,125,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"MOXIFLOXACIN-SOD CHLOR,ISO(PF) 4 MG/0.8 ML IO SOLN",,138794,LOCAL,Facility,Both,0.8,mL,,125,106.25,35.825,125,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,110.7125,88.57,,percent of total billed charges,,
"MOXIFLOXACIN-SOD CHLOR,ISO(PF) 4 MG/0.8 ML IO SOLN",,138794,LOCAL,Facility,Both,0.8,mL,,125,106.25,35.825,125,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,35.825,28.66,,percent of total billed charges,,
"MOXIFLOXACIN-SOD CHLOR,ISO(PF) 4 MG/0.8 ML IO SOLN",,138794,LOCAL,Facility,Outpatient,0.8,mL,,125,106.25,35.825,125,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),61.25,49,,percent of total billed charges,,
"MOXIFLOXACIN-SOD CHLOR,ISO(PF) 4 MG/0.8 ML IO SOLN",,138794,LOCAL,Facility,Inpatient,0.8,mL,,125,106.25,35.825,125,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"MOXIFLOXACIN-SOD CHLOR,ISO(PF) 4 MG/0.8 ML IO SOLN",,138794,LOCAL,Facility,Both,0.8,mL,,125,106.25,35.825,125,CorVel,Worker's Compensation,125,100,,percent of total billed charges,,
"MOXIFLOXACIN-SOD CHLOR,ISO(PF) 4 MG/0.8 ML IO SOLN",,138794,LOCAL,Facility,Both,0.8,mL,,125,106.25,35.825,125,First Health Group Corporation,First Health Network,121.25,97,,percent of total billed charges,,
"MOXIFLOXACIN-SOD CHLOR,ISO(PF) 4 MG/0.8 ML IO SOLN",,138794,LOCAL,Facility,Both,0.8,mL,,125,106.25,35.825,125,"Health Partners, Inc.",Commercial,118.25,94.6,,percent of total billed charges,,
"MOXIFLOXACIN-SOD CHLOR,ISO(PF) 4 MG/0.8 ML IO SOLN",,138794,LOCAL,Facility,Outpatient,0.8,mL,,125,106.25,35.825,125,"Health Partners, Inc.",Medicare Advantage,61.25,49,,percent of total billed charges,,
"MOXIFLOXACIN-SOD CHLOR,ISO(PF) 4 MG/0.8 ML IO SOLN",,138794,LOCAL,Facility,Inpatient,0.8,mL,,125,106.25,35.825,125,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"MOXIFLOXACIN-SOD CHLOR,ISO(PF) 4 MG/0.8 ML IO SOLN",,138794,LOCAL,Facility,Both,0.8,mL,,125,106.25,35.825,125,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),75,60,,percent of total billed charges,,
"MOXIFLOXACIN-SOD CHLOR,ISO(PF) 4 MG/0.8 ML IO SOLN",,138794,LOCAL,Facility,Both,0.8,mL,,125,106.25,35.825,125,"Health Partners, Inc.",State of Minnesota Advantage Program,101.875,81.5,,percent of total billed charges,,
"MOXIFLOXACIN-SOD CHLOR,ISO(PF) 4 MG/0.8 ML IO SOLN",,138794,LOCAL,Facility,Both,0.8,mL,,125,106.25,35.825,125,"Health Partners, Inc.",State Public Programs,62.5,50,,percent of total billed charges,,
"MOXIFLOXACIN-SOD CHLOR,ISO(PF) 4 MG/0.8 ML IO SOLN",,138794,LOCAL,Facility,Both,0.8,mL,,125,106.25,35.825,125,Humana Insurance Company,Commercial PPO,118.75,95,,percent of total billed charges,,
"MOXIFLOXACIN-SOD CHLOR,ISO(PF) 4 MG/0.8 ML IO SOLN",,138794,LOCAL,Facility,Outpatient,0.8,mL,,125,106.25,35.825,125,Humana Insurance Company,Medicare PPO,61.25,49,,percent of total billed charges,,
"MOXIFLOXACIN-SOD CHLOR,ISO(PF) 4 MG/0.8 ML IO SOLN",,138794,LOCAL,Facility,Inpatient,0.8,mL,,125,106.25,35.825,125,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"MOXIFLOXACIN-SOD CHLOR,ISO(PF) 4 MG/0.8 ML IO SOLN",,138794,LOCAL,Facility,Both,0.8,mL,,125,106.25,35.825,125,Medica,Individual & Family,123.875,99.1,,percent of total billed charges,,
"MOXIFLOXACIN-SOD CHLOR,ISO(PF) 4 MG/0.8 ML IO SOLN",,138794,LOCAL,Facility,Outpatient,0.8,mL,,125,106.25,35.825,125,Medica,Medica Advantage Solution,62.25,49.8,,percent of total billed charges,,
"MOXIFLOXACIN-SOD CHLOR,ISO(PF) 4 MG/0.8 ML IO SOLN",,138794,LOCAL,Facility,Inpatient,0.8,mL,,125,106.25,35.825,125,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"MOXIFLOXACIN-SOD CHLOR,ISO(PF) 4 MG/0.8 ML IO SOLN",,138794,LOCAL,Facility,Outpatient,0.8,mL,,125,106.25,35.825,125,Medica,Medical Assistance,55.75,44.6,,percent of total billed charges,,
"MOXIFLOXACIN-SOD CHLOR,ISO(PF) 4 MG/0.8 ML IO SOLN",,138794,LOCAL,Facility,Inpatient,0.8,mL,,125,106.25,35.825,125,Medica,Medical Assistance,,,,,Included in per diem rate,
"MOXIFLOXACIN-SOD CHLOR,ISO(PF) 4 MG/0.8 ML IO SOLN",,138794,LOCAL,Facility,Outpatient,0.8,mL,,125,106.25,35.825,125,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,62.25,49.8,,percent of total billed charges,,
"MOXIFLOXACIN-SOD CHLOR,ISO(PF) 4 MG/0.8 ML IO SOLN",,138794,LOCAL,Facility,Inpatient,0.8,mL,,125,106.25,35.825,125,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"MOXIFLOXACIN-SOD CHLOR,ISO(PF) 4 MG/0.8 ML IO SOLN",,138794,LOCAL,Facility,Both,0.8,mL,,125,106.25,35.825,125,"Multiplan, Inc.","Multiplan, Inc.",117.5,94,,percent of total billed charges,,
"MOXIFLOXACIN-SOD CHLOR,ISO(PF) 4 MG/0.8 ML IO SOLN",,138794,LOCAL,Facility,Outpatient,0.8,mL,,125,106.25,35.825,125,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,112.625,90.1,,percent of total billed charges,,
"MOXIFLOXACIN-SOD CHLOR,ISO(PF) 4 MG/0.8 ML IO SOLN",,138794,LOCAL,Facility,Inpatient,0.8,mL,,125,106.25,35.825,125,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"MOXIFLOXACIN-SOD CHLOR,ISO(PF) 4 MG/0.8 ML IO SOLN",,138794,LOCAL,Facility,Both,0.8,mL,,125,106.25,35.825,125,"Preferred One Administrative Services, INC.",PPO,123.25,98.6,,percent of total billed charges,,
"MOXIFLOXACIN-SOD CHLOR,ISO(PF) 4 MG/0.8 ML IO SOLN",,138794,LOCAL,Facility,Outpatient,0.8,mL,,125,106.25,35.825,125,PrimeWest Health,Minnesota Senior Health Options (MSHO),64.3125,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"MOXIFLOXACIN-SOD CHLOR,ISO(PF) 4 MG/0.8 ML IO SOLN",,138794,LOCAL,Facility,Inpatient,0.8,mL,,125,106.25,35.825,125,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"MOXIFLOXACIN-SOD CHLOR,ISO(PF) 4 MG/0.8 ML IO SOLN",,138794,LOCAL,Facility,Outpatient,0.8,mL,,125,106.25,35.825,125,PrimeWest Health,MinnesotaCare,64.2,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"MOXIFLOXACIN-SOD CHLOR,ISO(PF) 4 MG/0.8 ML IO SOLN",,138794,LOCAL,Facility,Inpatient,0.8,mL,,125,106.25,35.825,125,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"MOXIFLOXACIN-SOD CHLOR,ISO(PF) 4 MG/0.8 ML IO SOLN",,138794,LOCAL,Facility,Both,0.8,mL,,125,106.25,35.825,125,Sanford Health Plan,Sanford Health Plan,115,92,,percent of total billed charges,,
"MOXIFLOXACIN-SOD CHLOR,ISO(PF) 4 MG/0.8 ML IO SOLN",,138794,LOCAL,Facility,Outpatient,0.8,mL,,125,106.25,35.825,125,"UCare Health, Inc.",Individual & Family Plan,70.4375,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"MOXIFLOXACIN-SOD CHLOR,ISO(PF) 4 MG/0.8 ML IO SOLN",,138794,LOCAL,Facility,Inpatient,0.8,mL,,125,106.25,35.825,125,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"MOXIFLOXACIN-SOD CHLOR,ISO(PF) 4 MG/0.8 ML IO SOLN",,138794,LOCAL,Facility,Outpatient,0.8,mL,,125,106.25,35.825,125,"UCare Health, Inc.",Medical Assistance,63.0875,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"MOXIFLOXACIN-SOD CHLOR,ISO(PF) 4 MG/0.8 ML IO SOLN",,138794,LOCAL,Facility,Inpatient,0.8,mL,,125,106.25,35.825,125,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"MOXIFLOXACIN-SOD CHLOR,ISO(PF) 4 MG/0.8 ML IO SOLN",,138794,LOCAL,Facility,Outpatient,0.8,mL,,125,106.25,35.825,125,"UCare Health, Inc.",Medicare Advantage,63.0875,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"MOXIFLOXACIN-SOD CHLOR,ISO(PF) 4 MG/0.8 ML IO SOLN",,138794,LOCAL,Facility,Inpatient,0.8,mL,,125,106.25,35.825,125,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"MOXIFLOXACIN-SOD CHLOR,ISO(PF) 4 MG/0.8 ML IO SOLN",,138794,LOCAL,Facility,Outpatient,0.8,mL,,125,106.25,35.825,125,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),63.0875,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"MOXIFLOXACIN-SOD CHLOR,ISO(PF) 4 MG/0.8 ML IO SOLN",,138794,LOCAL,Facility,Inpatient,0.8,mL,,125,106.25,35.825,125,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"MOXIFLOXACIN-SOD CHLOR,ISO(PF) 4 MG/0.8 ML IO SOLN",,138794,LOCAL,Facility,Both,0.8,mL,,125,106.25,35.825,125,UnitedHealthcare,Individual & Family,117.5,94,,percent of total billed charges,,
"MOXIFLOXACIN-SOD CHLOR,ISO(PF) 4 MG/0.8 ML IO SOLN",,138794,LOCAL,Facility,Outpatient,0.8,mL,,125,106.25,35.825,125,UnitedHealthcare,Medicare Advantage,61.25,49,,percent of total billed charges,,
"MOXIFLOXACIN-SOD CHLOR,ISO(PF) 4 MG/0.8 ML IO SOLN",,138794,LOCAL,Facility,Inpatient,0.8,mL,,125,106.25,35.825,125,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"MOXIFLOXACIN-SOD CHLOR,ISO(PF) 4 MG/0.8 ML IO SOLN",,138794,LOCAL,Facility,Outpatient,0.8,mL,,125,106.25,35.825,125,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,60,48,,percent of total billed charges,,100% of DHS outpatient percentage
"MOXIFLOXACIN-SOD CHLOR,ISO(PF) 4 MG/0.8 ML IO SOLN",,138794,LOCAL,Facility,Inpatient,0.8,mL,,125,106.25,35.825,125,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
ENOXAPARIN 80 MG/0.8 ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,0.8,mL,,101,85.85,28.9466,101,Aetna,Commercial,92.92,92,,percent of total billed charges,,
ENOXAPARIN 80 MG/0.8 ML SUBQ SYRG,,J1650,HCPCS,Facility,Outpatient,0.8,mL,,101,85.85,28.9466,101,Aetna,Medicare Advantage,49.49,49,,percent of total billed charges,,
ENOXAPARIN 80 MG/0.8 ML SUBQ SYRG,,J1650,HCPCS,Facility,Inpatient,0.8,mL,,101,85.85,28.9466,101,Aetna,Medicare Advantage,,,,,Included in per diem rate,
ENOXAPARIN 80 MG/0.8 ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,0.8,mL,,101,85.85,28.9466,101,Aetna,PPO,93.93,93,,percent of total billed charges,,
ENOXAPARIN 80 MG/0.8 ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,0.8,mL,,101,85.85,28.9466,101,America's PPO,America's PPO,96.9903,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
ENOXAPARIN 80 MG/0.8 ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,0.8,mL,,101,85.85,28.9466,101,BlueCross BlueShield Minnesota, Federal Employee Program,99.384,98.4,,percent of total billed charges,,
ENOXAPARIN 80 MG/0.8 ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,0.8,mL,,101,85.85,28.9466,101,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,101,100,,percent of total billed charges,,
ENOXAPARIN 80 MG/0.8 ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,0.8,mL,,101,85.85,28.9466,101,BlueCross BlueShield Minnesota,High Value Network Plan,90.9,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
ENOXAPARIN 80 MG/0.8 ML SUBQ SYRG,,J1650,HCPCS,Facility,Outpatient,0.8,mL,,101,85.85,28.9466,101,BlueCross BlueShield Minnesota,Medicare Advantage,49.49,49,,percent of total billed charges,,
ENOXAPARIN 80 MG/0.8 ML SUBQ SYRG,,J1650,HCPCS,Facility,Inpatient,0.8,mL,,101,85.85,28.9466,101,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
ENOXAPARIN 80 MG/0.8 ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,0.8,mL,,101,85.85,28.9466,101,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,89.4557,88.57,,percent of total billed charges,,
ENOXAPARIN 80 MG/0.8 ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,0.8,mL,,101,85.85,28.9466,101,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,28.9466,28.66,,percent of total billed charges,,
ENOXAPARIN 80 MG/0.8 ML SUBQ SYRG,,J1650,HCPCS,Facility,Outpatient,0.8,mL,,101,85.85,28.9466,101,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),49.49,49,,percent of total billed charges,,
ENOXAPARIN 80 MG/0.8 ML SUBQ SYRG,,J1650,HCPCS,Facility,Inpatient,0.8,mL,,101,85.85,28.9466,101,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
ENOXAPARIN 80 MG/0.8 ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,0.8,mL,,101,85.85,28.9466,101,CorVel,Worker's Compensation,101,100,,percent of total billed charges,,
ENOXAPARIN 80 MG/0.8 ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,0.8,mL,,101,85.85,28.9466,101,First Health Group Corporation,First Health Network,97.97,97,,percent of total billed charges,,
ENOXAPARIN 80 MG/0.8 ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,0.8,mL,,101,85.85,28.9466,101,"Health Partners, Inc.",Commercial,95.546,94.6,,percent of total billed charges,,
ENOXAPARIN 80 MG/0.8 ML SUBQ SYRG,,J1650,HCPCS,Facility,Outpatient,0.8,mL,,101,85.85,28.9466,101,"Health Partners, Inc.",Medicare Advantage,49.49,49,,percent of total billed charges,,
ENOXAPARIN 80 MG/0.8 ML SUBQ SYRG,,J1650,HCPCS,Facility,Inpatient,0.8,mL,,101,85.85,28.9466,101,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ENOXAPARIN 80 MG/0.8 ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,0.8,mL,,101,85.85,28.9466,101,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),60.6,60,,percent of total billed charges,,
ENOXAPARIN 80 MG/0.8 ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,0.8,mL,,101,85.85,28.9466,101,"Health Partners, Inc.",State of Minnesota Advantage Program,82.315,81.5,,percent of total billed charges,,
ENOXAPARIN 80 MG/0.8 ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,0.8,mL,,101,85.85,28.9466,101,"Health Partners, Inc.",State Public Programs,50.5,50,,percent of total billed charges,,
ENOXAPARIN 80 MG/0.8 ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,0.8,mL,,101,85.85,28.9466,101,Humana Insurance Company,Commercial PPO,95.95,95,,percent of total billed charges,,
ENOXAPARIN 80 MG/0.8 ML SUBQ SYRG,,J1650,HCPCS,Facility,Outpatient,0.8,mL,,101,85.85,28.9466,101,Humana Insurance Company,Medicare PPO,49.49,49,,percent of total billed charges,,
ENOXAPARIN 80 MG/0.8 ML SUBQ SYRG,,J1650,HCPCS,Facility,Inpatient,0.8,mL,,101,85.85,28.9466,101,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
ENOXAPARIN 80 MG/0.8 ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,0.8,mL,,101,85.85,28.9466,101,Medica,Individual & Family,100.091,99.1,,percent of total billed charges,,
ENOXAPARIN 80 MG/0.8 ML SUBQ SYRG,,J1650,HCPCS,Facility,Outpatient,0.8,mL,,101,85.85,28.9466,101,Medica,Medica Advantage Solution,50.298,49.8,,percent of total billed charges,,
ENOXAPARIN 80 MG/0.8 ML SUBQ SYRG,,J1650,HCPCS,Facility,Inpatient,0.8,mL,,101,85.85,28.9466,101,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
ENOXAPARIN 80 MG/0.8 ML SUBQ SYRG,,J1650,HCPCS,Facility,Outpatient,0.8,mL,,101,85.85,28.9466,101,Medica,Medical Assistance,45.046,44.6,,percent of total billed charges,,
ENOXAPARIN 80 MG/0.8 ML SUBQ SYRG,,J1650,HCPCS,Facility,Inpatient,0.8,mL,,101,85.85,28.9466,101,Medica,Medical Assistance,,,,,Included in per diem rate,
ENOXAPARIN 80 MG/0.8 ML SUBQ SYRG,,J1650,HCPCS,Facility,Outpatient,0.8,mL,,101,85.85,28.9466,101,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,50.298,49.8,,percent of total billed charges,,
ENOXAPARIN 80 MG/0.8 ML SUBQ SYRG,,J1650,HCPCS,Facility,Inpatient,0.8,mL,,101,85.85,28.9466,101,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
ENOXAPARIN 80 MG/0.8 ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,0.8,mL,,101,85.85,28.9466,101,"Multiplan, Inc.","Multiplan, Inc.",94.94,94,,percent of total billed charges,,
ENOXAPARIN 80 MG/0.8 ML SUBQ SYRG,,J1650,HCPCS,Facility,Outpatient,0.8,mL,,101,85.85,28.9466,101,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,91.001,90.1,,percent of total billed charges,,
ENOXAPARIN 80 MG/0.8 ML SUBQ SYRG,,J1650,HCPCS,Facility,Inpatient,0.8,mL,,101,85.85,28.9466,101,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
ENOXAPARIN 80 MG/0.8 ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,0.8,mL,,101,85.85,28.9466,101,"Preferred One Administrative Services, INC.",PPO,99.586,98.6,,percent of total billed charges,,
ENOXAPARIN 80 MG/0.8 ML SUBQ SYRG,,J1650,HCPCS,Facility,Outpatient,0.8,mL,,101,85.85,28.9466,101,PrimeWest Health,Minnesota Senior Health Options (MSHO),51.9645,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
ENOXAPARIN 80 MG/0.8 ML SUBQ SYRG,,J1650,HCPCS,Facility,Inpatient,0.8,mL,,101,85.85,28.9466,101,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ENOXAPARIN 80 MG/0.8 ML SUBQ SYRG,,J1650,HCPCS,Facility,Outpatient,0.8,mL,,101,85.85,28.9466,101,PrimeWest Health,MinnesotaCare,51.8736,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
ENOXAPARIN 80 MG/0.8 ML SUBQ SYRG,,J1650,HCPCS,Facility,Inpatient,0.8,mL,,101,85.85,28.9466,101,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
ENOXAPARIN 80 MG/0.8 ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,0.8,mL,,101,85.85,28.9466,101,Sanford Health Plan,Sanford Health Plan,92.92,92,,percent of total billed charges,,
ENOXAPARIN 80 MG/0.8 ML SUBQ SYRG,,J1650,HCPCS,Facility,Outpatient,0.8,mL,,101,85.85,28.9466,101,"UCare Health, Inc.",Individual & Family Plan,56.9135,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
ENOXAPARIN 80 MG/0.8 ML SUBQ SYRG,,J1650,HCPCS,Facility,Inpatient,0.8,mL,,101,85.85,28.9466,101,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
ENOXAPARIN 80 MG/0.8 ML SUBQ SYRG,,J1650,HCPCS,Facility,Outpatient,0.8,mL,,101,85.85,28.9466,101,"UCare Health, Inc.",Medical Assistance,50.9747,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ENOXAPARIN 80 MG/0.8 ML SUBQ SYRG,,J1650,HCPCS,Facility,Inpatient,0.8,mL,,101,85.85,28.9466,101,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
ENOXAPARIN 80 MG/0.8 ML SUBQ SYRG,,J1650,HCPCS,Facility,Outpatient,0.8,mL,,101,85.85,28.9466,101,"UCare Health, Inc.",Medicare Advantage,50.9747,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ENOXAPARIN 80 MG/0.8 ML SUBQ SYRG,,J1650,HCPCS,Facility,Inpatient,0.8,mL,,101,85.85,28.9466,101,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ENOXAPARIN 80 MG/0.8 ML SUBQ SYRG,,J1650,HCPCS,Facility,Outpatient,0.8,mL,,101,85.85,28.9466,101,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),50.9747,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ENOXAPARIN 80 MG/0.8 ML SUBQ SYRG,,J1650,HCPCS,Facility,Inpatient,0.8,mL,,101,85.85,28.9466,101,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ENOXAPARIN 80 MG/0.8 ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,0.8,mL,,101,85.85,28.9466,101,UnitedHealthcare,Individual & Family,94.94,94,,percent of total billed charges,,
ENOXAPARIN 80 MG/0.8 ML SUBQ SYRG,,J1650,HCPCS,Facility,Outpatient,0.8,mL,,101,85.85,28.9466,101,UnitedHealthcare,Medicare Advantage,49.49,49,,percent of total billed charges,,
ENOXAPARIN 80 MG/0.8 ML SUBQ SYRG,,J1650,HCPCS,Facility,Inpatient,0.8,mL,,101,85.85,28.9466,101,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
ENOXAPARIN 80 MG/0.8 ML SUBQ SYRG,,J1650,HCPCS,Facility,Outpatient,0.8,mL,,101,85.85,28.9466,101,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,48.48,48,,percent of total billed charges,,100% of DHS outpatient percentage
ENOXAPARIN 80 MG/0.8 ML SUBQ SYRG,,J1650,HCPCS,Facility,Inpatient,0.8,mL,,101,85.85,28.9466,101,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITH MCC,,871,MS-DRG,Facility,Inpatient,,,,10409.16,8847.786,9888.702,9995.916348,America's PPO,America's PPO,9995.916348,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITH MCC,,871,MS-DRG,Facility,Inpatient,,,,10409.16,8847.786,9888.702,9995.916348,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,9888.702,,,Other ,DRG,"DRG weight 1.9572 x WOO $13,372.00; Cap at 95% of charge; minimum of 90.1% of charge"
SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITHOUT MCC,,872,MS-DRG,Facility,Inpatient,,,,12820.04,10897.034,12179.038,12311.08441,America's PPO,America's PPO,12311.08441,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITHOUT MCC,,872,MS-DRG,Facility,Inpatient,,,,12820.04,10897.034,12179.038,12311.08441,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,12179.038,,,Other,DRG,"DRG weight 1.028 x WOO $13,372.00; Cap at 95% of charge; minimum of 90.1% of charge"
ACUTE ADJUSTMENT REACTION AND PSYCHOSOCIAL DYSFUNCTION,,880,MS-DRG,Facility,Inpatient,,,,5679,4827.15,5395.05,5453.5437,America's PPO,America's PPO,5453.5437,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
ACUTE ADJUSTMENT REACTION AND PSYCHOSOCIAL DYSFUNCTION,,880,MS-DRG,Facility,Inpatient,,,,5679,4827.15,5395.05,5453.5437,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,5395.05,,,Other,DRG,"DRG weight 0.9062 x WOO $13,372.00; Cap at 95% of charge; minimum of 90.1% of charge"
ORGANIC DISTURBANCES AND INTELLECTUAL DISABILITY,,884,MS-DRG,Facility,Inpatient,,,,14608,12416.8,13877.6,14028.0624,America's PPO,America's PPO,14028.0624,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
ORGANIC DISTURBANCES AND INTELLECTUAL DISABILITY,,884,MS-DRG,Facility,Inpatient,,,,14608,12416.8,13877.6,14028.0624,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,13877.6,,,Other ,DRG,"DRG weight 1.57 x WOO $13,372.00; Cap at 95% of charge; minimum of 90.1% of charge"
PSYCHOSES,,885,MS-DRG,Facility,Inpatient,,,,5450,4632.5,5177.5,5233.635,America's PPO,America's PPO,5233.635,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
PSYCHOSES,,885,MS-DRG,Facility,Inpatient,,,,5450,4632.5,5177.5,5233.635,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,5177.5,,,Other ,DRG,"DRG weight 1.2955 x WOO $13,372.00; Cap at 95% of charge; minimum of 90.1% of charge"
BEHAVIORAL AND DEVELOPMENTAL DISORDERS,,886,MS-DRG,Facility,Inpatient,,,,1800,1530,1710,1728.54,America's PPO,America's PPO,1728.54,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
BEHAVIORAL AND DEVELOPMENTAL DISORDERS,,886,MS-DRG,Facility,Inpatient,,,,1800,1530,1710,1728.54,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1710,,,Other ,DRG,"DRG weight 1.365 x WOO $13,372.00; Cap at 95% of charge; minimum of 90.1% of charge"
VERAPAMIL 120 MG ORAL TAB SR,,59,LOCAL,Facility,Both,1,EA,,6,5.1,1.7196,6,Aetna,Commercial,5.52,92,,percent of total billed charges,,
VERAPAMIL 120 MG ORAL TAB SR,,59,LOCAL,Facility,Outpatient,1,EA,,6,5.1,1.7196,6,Aetna,Medicare Advantage,2.94,49,,percent of total billed charges,,
VERAPAMIL 120 MG ORAL TAB SR,,59,LOCAL,Facility,Inpatient,1,EA,,6,5.1,1.7196,6,Aetna,Medicare Advantage,,,,,Included in per diem rate,
VERAPAMIL 120 MG ORAL TAB SR,,59,LOCAL,Facility,Both,1,EA,,6,5.1,1.7196,6,Aetna,PPO,5.58,93,,percent of total billed charges,,
VERAPAMIL 120 MG ORAL TAB SR,,59,LOCAL,Facility,Both,1,EA,,6,5.1,1.7196,6,America's PPO,America's PPO,5.7618,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
VERAPAMIL 120 MG ORAL TAB SR,,59,LOCAL,Facility,Both,1,EA,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota, Federal Employee Program,5.904,98.4,,percent of total billed charges,,
VERAPAMIL 120 MG ORAL TAB SR,,59,LOCAL,Facility,Both,1,EA,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,6,100,,percent of total billed charges,,
VERAPAMIL 120 MG ORAL TAB SR,,59,LOCAL,Facility,Both,1,EA,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota,High Value Network Plan,5.4,90,,percent of total billed charges,,
VERAPAMIL 120 MG ORAL TAB SR,,59,LOCAL,Facility,Outpatient,1,EA,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota,Medicare Advantage,2.94,49,,percent of total billed charges,,
VERAPAMIL 120 MG ORAL TAB SR,,59,LOCAL,Facility,Inpatient,1,EA,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
VERAPAMIL 120 MG ORAL TAB SR,,59,LOCAL,Facility,Both,1,EA,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,5.3142,88.57,,percent of total billed charges,,
VERAPAMIL 120 MG ORAL TAB SR,,59,LOCAL,Facility,Both,1,EA,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.7196,28.66,,percent of total billed charges,,
VERAPAMIL 120 MG ORAL TAB SR,,59,LOCAL,Facility,Outpatient,1,EA,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.94,49,,percent of total billed charges,,
VERAPAMIL 120 MG ORAL TAB SR,,59,LOCAL,Facility,Inpatient,1,EA,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
VERAPAMIL 120 MG ORAL TAB SR,,59,LOCAL,Facility,Both,1,EA,,6,5.1,1.7196,6,CorVel,Worker's Compensation,6,100,,percent of total billed charges,,
VERAPAMIL 120 MG ORAL TAB SR,,59,LOCAL,Facility,Both,1,EA,,6,5.1,1.7196,6,First Health Group Corporation,First Health Network,5.82,97,,percent of total billed charges,,
VERAPAMIL 120 MG ORAL TAB SR,,59,LOCAL,Facility,Both,1,EA,,6,5.1,1.7196,6,"Health Partners, Inc.",Commercial,5.676,94.6,,percent of total billed charges,,
VERAPAMIL 120 MG ORAL TAB SR,,59,LOCAL,Facility,Outpatient,1,EA,,6,5.1,1.7196,6,"Health Partners, Inc.",Medicare Advantage,2.94,49,,percent of total billed charges,,
VERAPAMIL 120 MG ORAL TAB SR,,59,LOCAL,Facility,Inpatient,1,EA,,6,5.1,1.7196,6,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
VERAPAMIL 120 MG ORAL TAB SR,,59,LOCAL,Facility,Both,1,EA,,6,5.1,1.7196,6,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3.6,60,,percent of total billed charges,,
VERAPAMIL 120 MG ORAL TAB SR,,59,LOCAL,Facility,Both,1,EA,,6,5.1,1.7196,6,"Health Partners, Inc.",State of Minnesota Advantage Program,4.89,81.5,,percent of total billed charges,,
VERAPAMIL 120 MG ORAL TAB SR,,59,LOCAL,Facility,Both,1,EA,,6,5.1,1.7196,6,"Health Partners, Inc.",State Public Programs,3,50,,percent of total billed charges,,
VERAPAMIL 120 MG ORAL TAB SR,,59,LOCAL,Facility,Both,1,EA,,6,5.1,1.7196,6,Humana Insurance Company,Commercial PPO,5.7,95,,percent of total billed charges,,
VERAPAMIL 120 MG ORAL TAB SR,,59,LOCAL,Facility,Outpatient,1,EA,,6,5.1,1.7196,6,Humana Insurance Company,Medicare PPO,2.94,49,,percent of total billed charges,,
VERAPAMIL 120 MG ORAL TAB SR,,59,LOCAL,Facility,Inpatient,1,EA,,6,5.1,1.7196,6,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
VERAPAMIL 120 MG ORAL TAB SR,,59,LOCAL,Facility,Both,1,EA,,6,5.1,1.7196,6,Medica,Individual & Family,5.946,99.1,,percent of total billed charges,,
VERAPAMIL 120 MG ORAL TAB SR,,59,LOCAL,Facility,Outpatient,1,EA,,6,5.1,1.7196,6,Medica,Medica Advantage Solution,2.988,49.8,,percent of total billed charges,,
VERAPAMIL 120 MG ORAL TAB SR,,59,LOCAL,Facility,Inpatient,1,EA,,6,5.1,1.7196,6,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
VERAPAMIL 120 MG ORAL TAB SR,,59,LOCAL,Facility,Outpatient,1,EA,,6,5.1,1.7196,6,Medica,Medical Assistance,2.676,44.6,,percent of total billed charges,,
VERAPAMIL 120 MG ORAL TAB SR,,59,LOCAL,Facility,Inpatient,1,EA,,6,5.1,1.7196,6,Medica,Medical Assistance,,,,,Included in per diem rate,
VERAPAMIL 120 MG ORAL TAB SR,,59,LOCAL,Facility,Outpatient,1,EA,,6,5.1,1.7196,6,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.988,49.8,,percent of total billed charges,,
VERAPAMIL 120 MG ORAL TAB SR,,59,LOCAL,Facility,Inpatient,1,EA,,6,5.1,1.7196,6,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
VERAPAMIL 120 MG ORAL TAB SR,,59,LOCAL,Facility,Both,1,EA,,6,5.1,1.7196,6,"Multiplan, Inc.","Multiplan, Inc.",5.64,94,,percent of total billed charges,,
VERAPAMIL 120 MG ORAL TAB SR,,59,LOCAL,Facility,Outpatient,1,EA,,6,5.1,1.7196,6,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,5.406,90.1,,percent of total billed charges,,
VERAPAMIL 120 MG ORAL TAB SR,,59,LOCAL,Facility,Inpatient,1,EA,,6,5.1,1.7196,6,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
VERAPAMIL 120 MG ORAL TAB SR,,59,LOCAL,Facility,Both,1,EA,,6,5.1,1.7196,6,"Preferred One Administrative Services, INC.",PPO,5.916,98.6,,percent of total billed charges,,
VERAPAMIL 120 MG ORAL TAB SR,,59,LOCAL,Facility,Outpatient,1,EA,,6,5.1,1.7196,6,PrimeWest Health,Minnesota Senior Health Options (MSHO),3.087,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
VERAPAMIL 120 MG ORAL TAB SR,,59,LOCAL,Facility,Inpatient,1,EA,,6,5.1,1.7196,6,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
VERAPAMIL 120 MG ORAL TAB SR,,59,LOCAL,Facility,Outpatient,1,EA,,6,5.1,1.7196,6,PrimeWest Health,MinnesotaCare,3.0816,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
VERAPAMIL 120 MG ORAL TAB SR,,59,LOCAL,Facility,Inpatient,1,EA,,6,5.1,1.7196,6,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
VERAPAMIL 120 MG ORAL TAB SR,,59,LOCAL,Facility,Both,1,EA,,6,5.1,1.7196,6,Sanford Health Plan,Sanford Health Plan,5.52,92,,percent of total billed charges,,
VERAPAMIL 120 MG ORAL TAB SR,,59,LOCAL,Facility,Outpatient,1,EA,,6,5.1,1.7196,6,"UCare Health, Inc.",Individual & Family Plan,3.381,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
VERAPAMIL 120 MG ORAL TAB SR,,59,LOCAL,Facility,Inpatient,1,EA,,6,5.1,1.7196,6,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
VERAPAMIL 120 MG ORAL TAB SR,,59,LOCAL,Facility,Outpatient,1,EA,,6,5.1,1.7196,6,"UCare Health, Inc.",Medical Assistance,3.0282,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
VERAPAMIL 120 MG ORAL TAB SR,,59,LOCAL,Facility,Inpatient,1,EA,,6,5.1,1.7196,6,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
VERAPAMIL 120 MG ORAL TAB SR,,59,LOCAL,Facility,Outpatient,1,EA,,6,5.1,1.7196,6,"UCare Health, Inc.",Medicare Advantage,3.0282,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
VERAPAMIL 120 MG ORAL TAB SR,,59,LOCAL,Facility,Inpatient,1,EA,,6,5.1,1.7196,6,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
VERAPAMIL 120 MG ORAL TAB SR,,59,LOCAL,Facility,Outpatient,1,EA,,6,5.1,1.7196,6,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),3.0282,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
VERAPAMIL 120 MG ORAL TAB SR,,59,LOCAL,Facility,Inpatient,1,EA,,6,5.1,1.7196,6,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
VERAPAMIL 120 MG ORAL TAB SR,,59,LOCAL,Facility,Both,1,EA,,6,5.1,1.7196,6,UnitedHealthcare,Individual & Family,5.64,94,,percent of total billed charges,,
VERAPAMIL 120 MG ORAL TAB SR,,59,LOCAL,Facility,Outpatient,1,EA,,6,5.1,1.7196,6,UnitedHealthcare,Medicare Advantage,2.94,49,,percent of total billed charges,,
VERAPAMIL 120 MG ORAL TAB SR,,59,LOCAL,Facility,Inpatient,1,EA,,6,5.1,1.7196,6,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
VERAPAMIL 120 MG ORAL TAB SR,,59,LOCAL,Facility,Outpatient,1,EA,,6,5.1,1.7196,6,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.88,48,,percent of total billed charges,,100% of DHS outpatient percentage
VERAPAMIL 120 MG ORAL TAB SR,,59,LOCAL,Facility,Inpatient,1,EA,,6,5.1,1.7196,6,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITHOUT MCC",,897,MS-DRG,Facility,Inpatient,,,,12182,10354.7,11383.5836,11698.3746,America's PPO,America's PPO,11698.3746,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITHOUT MCC",,897,MS-DRG,Facility,Inpatient,,,,12182,10354.7,11383.5836,11698.3746,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,11383.5836,,,Other,DRG,"DRG weight 0.8513 x WOO $13,372.00; Cap at 95% of charge; minimum of 90.1% of charge"
POISONING AND TOXIC EFFECTS OF DRUGS WITHOUT MCC,,918,MS-DRG,Facility,Inpatient,,,,14451,12283.35,13020.351,13877.2953,America's PPO,America's PPO,13877.2953,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
POISONING AND TOXIC EFFECTS OF DRUGS WITHOUT MCC,,918,MS-DRG,Facility,Inpatient,,,,14451,12283.35,13020.351,13877.2953,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,13020.351,,,Other ,DRG,"DRG weight 0.8177 x WOO $13,372.00; Cap at 95% of charge; minimum of 90.1% of charge"
SIGNS AND SYMPTOMS WITHOUT MCC,,948,MS-DRG,Facility,Inpatient,,,,8854.083333,7525.970833,8411.379167,8502.576225,America's PPO,America's PPO,8502.576225,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SIGNS AND SYMPTOMS WITHOUT MCC,,948,MS-DRG,Facility,Inpatient,,,,8854.083333,7525.970833,8411.379167,8502.576225,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,8411.379167,,,Other,DRG,"DRG weight 0.7776 x WOO $13,372.00; Cap at 95% of charge; minimum of 90.1% of charge"
AFTERCARE WITH CC/MCC,,949,MS-DRG,Facility,Inpatient,,,,7620,6477,7239,7317.486,America's PPO,America's PPO,7317.486,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
AFTERCARE WITH CC/MCC,,949,MS-DRG,Facility,Inpatient,,,,7620,6477,7239,7317.486,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,7239,,,Other,DRG,"DRG weight 1.192 x WOO $13,372.00; Cap at 95% of charge; minimum of 90.1% of charge"
EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC,,982,MS-DRG,Facility,Inpatient,,,,23669,20118.65,22485.55,22729.3407,America's PPO,America's PPO,22729.3407,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC,,982,MS-DRG,Facility,Inpatient,,,,23669,20118.65,22485.55,22729.3407,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,22485.55,,,Other ,DRG,"DRG weight 2.5082 x WOO $13,372.00; Cap at 95% of charge; minimum of 90.1% of charge"
LOSARTAN 50 MG ORAL TABLET,,103,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
LOSARTAN 50 MG ORAL TABLET,,103,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
LOSARTAN 50 MG ORAL TABLET,,103,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
LOSARTAN 50 MG ORAL TABLET,,103,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
LOSARTAN 50 MG ORAL TABLET,,103,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
LOSARTAN 50 MG ORAL TABLET,,103,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
LOSARTAN 50 MG ORAL TABLET,,103,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
LOSARTAN 50 MG ORAL TABLET,,103,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
LOSARTAN 50 MG ORAL TABLET,,103,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
LOSARTAN 50 MG ORAL TABLET,,103,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
LOSARTAN 50 MG ORAL TABLET,,103,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
LOSARTAN 50 MG ORAL TABLET,,103,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
LOSARTAN 50 MG ORAL TABLET,,103,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
LOSARTAN 50 MG ORAL TABLET,,103,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
LOSARTAN 50 MG ORAL TABLET,,103,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
LOSARTAN 50 MG ORAL TABLET,,103,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
LOSARTAN 50 MG ORAL TABLET,,103,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
LOSARTAN 50 MG ORAL TABLET,,103,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
LOSARTAN 50 MG ORAL TABLET,,103,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LOSARTAN 50 MG ORAL TABLET,,103,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
LOSARTAN 50 MG ORAL TABLET,,103,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
LOSARTAN 50 MG ORAL TABLET,,103,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
LOSARTAN 50 MG ORAL TABLET,,103,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
LOSARTAN 50 MG ORAL TABLET,,103,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
LOSARTAN 50 MG ORAL TABLET,,103,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
LOSARTAN 50 MG ORAL TABLET,,103,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
LOSARTAN 50 MG ORAL TABLET,,103,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
LOSARTAN 50 MG ORAL TABLET,,103,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
LOSARTAN 50 MG ORAL TABLET,,103,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
LOSARTAN 50 MG ORAL TABLET,,103,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
LOSARTAN 50 MG ORAL TABLET,,103,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
LOSARTAN 50 MG ORAL TABLET,,103,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
LOSARTAN 50 MG ORAL TABLET,,103,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
LOSARTAN 50 MG ORAL TABLET,,103,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
LOSARTAN 50 MG ORAL TABLET,,103,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
LOSARTAN 50 MG ORAL TABLET,,103,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
LOSARTAN 50 MG ORAL TABLET,,103,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
LOSARTAN 50 MG ORAL TABLET,,103,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LOSARTAN 50 MG ORAL TABLET,,103,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
LOSARTAN 50 MG ORAL TABLET,,103,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
LOSARTAN 50 MG ORAL TABLET,,103,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
LOSARTAN 50 MG ORAL TABLET,,103,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
LOSARTAN 50 MG ORAL TABLET,,103,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
LOSARTAN 50 MG ORAL TABLET,,103,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LOSARTAN 50 MG ORAL TABLET,,103,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
LOSARTAN 50 MG ORAL TABLET,,103,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LOSARTAN 50 MG ORAL TABLET,,103,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LOSARTAN 50 MG ORAL TABLET,,103,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LOSARTAN 50 MG ORAL TABLET,,103,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LOSARTAN 50 MG ORAL TABLET,,103,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
LOSARTAN 50 MG ORAL TABLET,,103,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
LOSARTAN 50 MG ORAL TABLET,,103,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
LOSARTAN 50 MG ORAL TABLET,,103,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
LOSARTAN 50 MG ORAL TABLET,,103,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
QUETIAPINE 25 MG ORAL TABLET,,133,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
QUETIAPINE 25 MG ORAL TABLET,,133,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
QUETIAPINE 25 MG ORAL TABLET,,133,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
QUETIAPINE 25 MG ORAL TABLET,,133,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
QUETIAPINE 25 MG ORAL TABLET,,133,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
QUETIAPINE 25 MG ORAL TABLET,,133,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
QUETIAPINE 25 MG ORAL TABLET,,133,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
QUETIAPINE 25 MG ORAL TABLET,,133,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
QUETIAPINE 25 MG ORAL TABLET,,133,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
QUETIAPINE 25 MG ORAL TABLET,,133,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
QUETIAPINE 25 MG ORAL TABLET,,133,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
QUETIAPINE 25 MG ORAL TABLET,,133,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
QUETIAPINE 25 MG ORAL TABLET,,133,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
QUETIAPINE 25 MG ORAL TABLET,,133,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
QUETIAPINE 25 MG ORAL TABLET,,133,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
QUETIAPINE 25 MG ORAL TABLET,,133,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
QUETIAPINE 25 MG ORAL TABLET,,133,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
QUETIAPINE 25 MG ORAL TABLET,,133,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
QUETIAPINE 25 MG ORAL TABLET,,133,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
QUETIAPINE 25 MG ORAL TABLET,,133,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
QUETIAPINE 25 MG ORAL TABLET,,133,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
QUETIAPINE 25 MG ORAL TABLET,,133,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
QUETIAPINE 25 MG ORAL TABLET,,133,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
QUETIAPINE 25 MG ORAL TABLET,,133,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
QUETIAPINE 25 MG ORAL TABLET,,133,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
QUETIAPINE 25 MG ORAL TABLET,,133,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
QUETIAPINE 25 MG ORAL TABLET,,133,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
QUETIAPINE 25 MG ORAL TABLET,,133,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
QUETIAPINE 25 MG ORAL TABLET,,133,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
QUETIAPINE 25 MG ORAL TABLET,,133,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
QUETIAPINE 25 MG ORAL TABLET,,133,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
QUETIAPINE 25 MG ORAL TABLET,,133,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
QUETIAPINE 25 MG ORAL TABLET,,133,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
QUETIAPINE 25 MG ORAL TABLET,,133,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
QUETIAPINE 25 MG ORAL TABLET,,133,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
QUETIAPINE 25 MG ORAL TABLET,,133,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
QUETIAPINE 25 MG ORAL TABLET,,133,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
QUETIAPINE 25 MG ORAL TABLET,,133,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
QUETIAPINE 25 MG ORAL TABLET,,133,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
QUETIAPINE 25 MG ORAL TABLET,,133,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
QUETIAPINE 25 MG ORAL TABLET,,133,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
QUETIAPINE 25 MG ORAL TABLET,,133,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
QUETIAPINE 25 MG ORAL TABLET,,133,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
QUETIAPINE 25 MG ORAL TABLET,,133,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
QUETIAPINE 25 MG ORAL TABLET,,133,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
QUETIAPINE 25 MG ORAL TABLET,,133,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
QUETIAPINE 25 MG ORAL TABLET,,133,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
QUETIAPINE 25 MG ORAL TABLET,,133,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
QUETIAPINE 25 MG ORAL TABLET,,133,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
QUETIAPINE 25 MG ORAL TABLET,,133,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
QUETIAPINE 25 MG ORAL TABLET,,133,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
QUETIAPINE 25 MG ORAL TABLET,,133,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
QUETIAPINE 25 MG ORAL TABLET,,133,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
QUETIAPINE 25 MG ORAL TABLET,,133,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
TOLTERODINE 2 MG ORAL CP24,,168,LOCAL,Facility,Both,1,EA,,41,34.85,11.7506,41,Aetna,Commercial,37.72,92,,percent of total billed charges,,
TOLTERODINE 2 MG ORAL CP24,,168,LOCAL,Facility,Outpatient,1,EA,,41,34.85,11.7506,41,Aetna,Medicare Advantage,20.09,49,,percent of total billed charges,,
TOLTERODINE 2 MG ORAL CP24,,168,LOCAL,Facility,Inpatient,1,EA,,41,34.85,11.7506,41,Aetna,Medicare Advantage,,,,,Included in per diem rate,
TOLTERODINE 2 MG ORAL CP24,,168,LOCAL,Facility,Both,1,EA,,41,34.85,11.7506,41,Aetna,PPO,38.13,93,,percent of total billed charges,,
TOLTERODINE 2 MG ORAL CP24,,168,LOCAL,Facility,Both,1,EA,,41,34.85,11.7506,41,America's PPO,America's PPO,39.3723,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
TOLTERODINE 2 MG ORAL CP24,,168,LOCAL,Facility,Both,1,EA,,41,34.85,11.7506,41,BlueCross BlueShield Minnesota, Federal Employee Program,40.344,98.4,,percent of total billed charges,,
TOLTERODINE 2 MG ORAL CP24,,168,LOCAL,Facility,Both,1,EA,,41,34.85,11.7506,41,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,41,100,,percent of total billed charges,,
TOLTERODINE 2 MG ORAL CP24,,168,LOCAL,Facility,Both,1,EA,,41,34.85,11.7506,41,BlueCross BlueShield Minnesota,High Value Network Plan,36.9,90,,percent of total billed charges,,
TOLTERODINE 2 MG ORAL CP24,,168,LOCAL,Facility,Outpatient,1,EA,,41,34.85,11.7506,41,BlueCross BlueShield Minnesota,Medicare Advantage,20.09,49,,percent of total billed charges,,
TOLTERODINE 2 MG ORAL CP24,,168,LOCAL,Facility,Inpatient,1,EA,,41,34.85,11.7506,41,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
TOLTERODINE 2 MG ORAL CP24,,168,LOCAL,Facility,Both,1,EA,,41,34.85,11.7506,41,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,36.3137,88.57,,percent of total billed charges,,
TOLTERODINE 2 MG ORAL CP24,,168,LOCAL,Facility,Both,1,EA,,41,34.85,11.7506,41,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,11.7506,28.66,,percent of total billed charges,,
TOLTERODINE 2 MG ORAL CP24,,168,LOCAL,Facility,Outpatient,1,EA,,41,34.85,11.7506,41,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),20.09,49,,percent of total billed charges,,
TOLTERODINE 2 MG ORAL CP24,,168,LOCAL,Facility,Inpatient,1,EA,,41,34.85,11.7506,41,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
TOLTERODINE 2 MG ORAL CP24,,168,LOCAL,Facility,Both,1,EA,,41,34.85,11.7506,41,CorVel,Worker's Compensation,41,100,,percent of total billed charges,,
TOLTERODINE 2 MG ORAL CP24,,168,LOCAL,Facility,Both,1,EA,,41,34.85,11.7506,41,First Health Group Corporation,First Health Network,39.77,97,,percent of total billed charges,,
TOLTERODINE 2 MG ORAL CP24,,168,LOCAL,Facility,Both,1,EA,,41,34.85,11.7506,41,"Health Partners, Inc.",Commercial,38.786,94.6,,percent of total billed charges,,
TOLTERODINE 2 MG ORAL CP24,,168,LOCAL,Facility,Outpatient,1,EA,,41,34.85,11.7506,41,"Health Partners, Inc.",Medicare Advantage,20.09,49,,percent of total billed charges,,
TOLTERODINE 2 MG ORAL CP24,,168,LOCAL,Facility,Inpatient,1,EA,,41,34.85,11.7506,41,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
TOLTERODINE 2 MG ORAL CP24,,168,LOCAL,Facility,Both,1,EA,,41,34.85,11.7506,41,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),24.6,60,,percent of total billed charges,,
TOLTERODINE 2 MG ORAL CP24,,168,LOCAL,Facility,Both,1,EA,,41,34.85,11.7506,41,"Health Partners, Inc.",State of Minnesota Advantage Program,33.415,81.5,,percent of total billed charges,,
TOLTERODINE 2 MG ORAL CP24,,168,LOCAL,Facility,Both,1,EA,,41,34.85,11.7506,41,"Health Partners, Inc.",State Public Programs,20.5,50,,percent of total billed charges,,
TOLTERODINE 2 MG ORAL CP24,,168,LOCAL,Facility,Both,1,EA,,41,34.85,11.7506,41,Humana Insurance Company,Commercial PPO,38.95,95,,percent of total billed charges,,
TOLTERODINE 2 MG ORAL CP24,,168,LOCAL,Facility,Outpatient,1,EA,,41,34.85,11.7506,41,Humana Insurance Company,Medicare PPO,20.09,49,,percent of total billed charges,,
TOLTERODINE 2 MG ORAL CP24,,168,LOCAL,Facility,Inpatient,1,EA,,41,34.85,11.7506,41,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
TOLTERODINE 2 MG ORAL CP24,,168,LOCAL,Facility,Both,1,EA,,41,34.85,11.7506,41,Medica,Individual & Family,40.631,99.1,,percent of total billed charges,,
TOLTERODINE 2 MG ORAL CP24,,168,LOCAL,Facility,Outpatient,1,EA,,41,34.85,11.7506,41,Medica,Medica Advantage Solution,20.418,49.8,,percent of total billed charges,,
TOLTERODINE 2 MG ORAL CP24,,168,LOCAL,Facility,Inpatient,1,EA,,41,34.85,11.7506,41,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
TOLTERODINE 2 MG ORAL CP24,,168,LOCAL,Facility,Outpatient,1,EA,,41,34.85,11.7506,41,Medica,Medical Assistance,18.286,44.6,,percent of total billed charges,,
TOLTERODINE 2 MG ORAL CP24,,168,LOCAL,Facility,Inpatient,1,EA,,41,34.85,11.7506,41,Medica,Medical Assistance,,,,,Included in per diem rate,
TOLTERODINE 2 MG ORAL CP24,,168,LOCAL,Facility,Outpatient,1,EA,,41,34.85,11.7506,41,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,20.418,49.8,,percent of total billed charges,,
TOLTERODINE 2 MG ORAL CP24,,168,LOCAL,Facility,Inpatient,1,EA,,41,34.85,11.7506,41,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
TOLTERODINE 2 MG ORAL CP24,,168,LOCAL,Facility,Both,1,EA,,41,34.85,11.7506,41,"Multiplan, Inc.","Multiplan, Inc.",38.54,94,,percent of total billed charges,,
TOLTERODINE 2 MG ORAL CP24,,168,LOCAL,Facility,Outpatient,1,EA,,41,34.85,11.7506,41,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,36.941,90.1,,percent of total billed charges,,
TOLTERODINE 2 MG ORAL CP24,,168,LOCAL,Facility,Inpatient,1,EA,,41,34.85,11.7506,41,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
TOLTERODINE 2 MG ORAL CP24,,168,LOCAL,Facility,Both,1,EA,,41,34.85,11.7506,41,"Preferred One Administrative Services, INC.",PPO,40.426,98.6,,percent of total billed charges,,
TOLTERODINE 2 MG ORAL CP24,,168,LOCAL,Facility,Outpatient,1,EA,,41,34.85,11.7506,41,PrimeWest Health,Minnesota Senior Health Options (MSHO),21.0945,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
TOLTERODINE 2 MG ORAL CP24,,168,LOCAL,Facility,Inpatient,1,EA,,41,34.85,11.7506,41,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
TOLTERODINE 2 MG ORAL CP24,,168,LOCAL,Facility,Outpatient,1,EA,,41,34.85,11.7506,41,PrimeWest Health,MinnesotaCare,21.0576,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
TOLTERODINE 2 MG ORAL CP24,,168,LOCAL,Facility,Inpatient,1,EA,,41,34.85,11.7506,41,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
TOLTERODINE 2 MG ORAL CP24,,168,LOCAL,Facility,Both,1,EA,,41,34.85,11.7506,41,Sanford Health Plan,Sanford Health Plan,37.72,92,,percent of total billed charges,,
TOLTERODINE 2 MG ORAL CP24,,168,LOCAL,Facility,Outpatient,1,EA,,41,34.85,11.7506,41,"UCare Health, Inc.",Individual & Family Plan,23.1035,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
TOLTERODINE 2 MG ORAL CP24,,168,LOCAL,Facility,Inpatient,1,EA,,41,34.85,11.7506,41,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
TOLTERODINE 2 MG ORAL CP24,,168,LOCAL,Facility,Outpatient,1,EA,,41,34.85,11.7506,41,"UCare Health, Inc.",Medical Assistance,20.6927,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TOLTERODINE 2 MG ORAL CP24,,168,LOCAL,Facility,Inpatient,1,EA,,41,34.85,11.7506,41,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
TOLTERODINE 2 MG ORAL CP24,,168,LOCAL,Facility,Outpatient,1,EA,,41,34.85,11.7506,41,"UCare Health, Inc.",Medicare Advantage,20.6927,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TOLTERODINE 2 MG ORAL CP24,,168,LOCAL,Facility,Inpatient,1,EA,,41,34.85,11.7506,41,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
TOLTERODINE 2 MG ORAL CP24,,168,LOCAL,Facility,Outpatient,1,EA,,41,34.85,11.7506,41,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),20.6927,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TOLTERODINE 2 MG ORAL CP24,,168,LOCAL,Facility,Inpatient,1,EA,,41,34.85,11.7506,41,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
TOLTERODINE 2 MG ORAL CP24,,168,LOCAL,Facility,Both,1,EA,,41,34.85,11.7506,41,UnitedHealthcare,Individual & Family,38.54,94,,percent of total billed charges,,
TOLTERODINE 2 MG ORAL CP24,,168,LOCAL,Facility,Outpatient,1,EA,,41,34.85,11.7506,41,UnitedHealthcare,Medicare Advantage,20.09,49,,percent of total billed charges,,
TOLTERODINE 2 MG ORAL CP24,,168,LOCAL,Facility,Inpatient,1,EA,,41,34.85,11.7506,41,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
TOLTERODINE 2 MG ORAL CP24,,168,LOCAL,Facility,Outpatient,1,EA,,41,34.85,11.7506,41,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,19.68,48,,percent of total billed charges,,100% of DHS outpatient percentage
TOLTERODINE 2 MG ORAL CP24,,168,LOCAL,Facility,Inpatient,1,EA,,41,34.85,11.7506,41,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
PENICILLIN V POTASSIUM 250 MG ORAL TABLET,,171,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
PENICILLIN V POTASSIUM 250 MG ORAL TABLET,,171,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
PENICILLIN V POTASSIUM 250 MG ORAL TABLET,,171,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
PENICILLIN V POTASSIUM 250 MG ORAL TABLET,,171,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
PENICILLIN V POTASSIUM 250 MG ORAL TABLET,,171,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
PENICILLIN V POTASSIUM 250 MG ORAL TABLET,,171,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
PENICILLIN V POTASSIUM 250 MG ORAL TABLET,,171,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
PENICILLIN V POTASSIUM 250 MG ORAL TABLET,,171,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
PENICILLIN V POTASSIUM 250 MG ORAL TABLET,,171,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
PENICILLIN V POTASSIUM 250 MG ORAL TABLET,,171,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
PENICILLIN V POTASSIUM 250 MG ORAL TABLET,,171,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
PENICILLIN V POTASSIUM 250 MG ORAL TABLET,,171,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
PENICILLIN V POTASSIUM 250 MG ORAL TABLET,,171,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
PENICILLIN V POTASSIUM 250 MG ORAL TABLET,,171,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
PENICILLIN V POTASSIUM 250 MG ORAL TABLET,,171,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
PENICILLIN V POTASSIUM 250 MG ORAL TABLET,,171,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
PENICILLIN V POTASSIUM 250 MG ORAL TABLET,,171,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
PENICILLIN V POTASSIUM 250 MG ORAL TABLET,,171,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
PENICILLIN V POTASSIUM 250 MG ORAL TABLET,,171,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PENICILLIN V POTASSIUM 250 MG ORAL TABLET,,171,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
PENICILLIN V POTASSIUM 250 MG ORAL TABLET,,171,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
PENICILLIN V POTASSIUM 250 MG ORAL TABLET,,171,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
PENICILLIN V POTASSIUM 250 MG ORAL TABLET,,171,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
PENICILLIN V POTASSIUM 250 MG ORAL TABLET,,171,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
PENICILLIN V POTASSIUM 250 MG ORAL TABLET,,171,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
PENICILLIN V POTASSIUM 250 MG ORAL TABLET,,171,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
PENICILLIN V POTASSIUM 250 MG ORAL TABLET,,171,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
PENICILLIN V POTASSIUM 250 MG ORAL TABLET,,171,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
PENICILLIN V POTASSIUM 250 MG ORAL TABLET,,171,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
PENICILLIN V POTASSIUM 250 MG ORAL TABLET,,171,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
PENICILLIN V POTASSIUM 250 MG ORAL TABLET,,171,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
PENICILLIN V POTASSIUM 250 MG ORAL TABLET,,171,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
PENICILLIN V POTASSIUM 250 MG ORAL TABLET,,171,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
PENICILLIN V POTASSIUM 250 MG ORAL TABLET,,171,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
PENICILLIN V POTASSIUM 250 MG ORAL TABLET,,171,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
PENICILLIN V POTASSIUM 250 MG ORAL TABLET,,171,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
PENICILLIN V POTASSIUM 250 MG ORAL TABLET,,171,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
PENICILLIN V POTASSIUM 250 MG ORAL TABLET,,171,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PENICILLIN V POTASSIUM 250 MG ORAL TABLET,,171,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
PENICILLIN V POTASSIUM 250 MG ORAL TABLET,,171,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
PENICILLIN V POTASSIUM 250 MG ORAL TABLET,,171,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
PENICILLIN V POTASSIUM 250 MG ORAL TABLET,,171,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
PENICILLIN V POTASSIUM 250 MG ORAL TABLET,,171,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
PENICILLIN V POTASSIUM 250 MG ORAL TABLET,,171,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PENICILLIN V POTASSIUM 250 MG ORAL TABLET,,171,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
PENICILLIN V POTASSIUM 250 MG ORAL TABLET,,171,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PENICILLIN V POTASSIUM 250 MG ORAL TABLET,,171,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PENICILLIN V POTASSIUM 250 MG ORAL TABLET,,171,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PENICILLIN V POTASSIUM 250 MG ORAL TABLET,,171,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PENICILLIN V POTASSIUM 250 MG ORAL TABLET,,171,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
PENICILLIN V POTASSIUM 250 MG ORAL TABLET,,171,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
PENICILLIN V POTASSIUM 250 MG ORAL TABLET,,171,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
PENICILLIN V POTASSIUM 250 MG ORAL TABLET,,171,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
PENICILLIN V POTASSIUM 250 MG ORAL TABLET,,171,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
CYCLOBENZAPRINE 10 MG ORAL TABLET,,285,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
CYCLOBENZAPRINE 10 MG ORAL TABLET,,285,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
CYCLOBENZAPRINE 10 MG ORAL TABLET,,285,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
CYCLOBENZAPRINE 10 MG ORAL TABLET,,285,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
CYCLOBENZAPRINE 10 MG ORAL TABLET,,285,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
CYCLOBENZAPRINE 10 MG ORAL TABLET,,285,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
CYCLOBENZAPRINE 10 MG ORAL TABLET,,285,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
CYCLOBENZAPRINE 10 MG ORAL TABLET,,285,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
CYCLOBENZAPRINE 10 MG ORAL TABLET,,285,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
CYCLOBENZAPRINE 10 MG ORAL TABLET,,285,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
CYCLOBENZAPRINE 10 MG ORAL TABLET,,285,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
CYCLOBENZAPRINE 10 MG ORAL TABLET,,285,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
CYCLOBENZAPRINE 10 MG ORAL TABLET,,285,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
CYCLOBENZAPRINE 10 MG ORAL TABLET,,285,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
CYCLOBENZAPRINE 10 MG ORAL TABLET,,285,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
CYCLOBENZAPRINE 10 MG ORAL TABLET,,285,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
CYCLOBENZAPRINE 10 MG ORAL TABLET,,285,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
CYCLOBENZAPRINE 10 MG ORAL TABLET,,285,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
CYCLOBENZAPRINE 10 MG ORAL TABLET,,285,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CYCLOBENZAPRINE 10 MG ORAL TABLET,,285,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
CYCLOBENZAPRINE 10 MG ORAL TABLET,,285,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
CYCLOBENZAPRINE 10 MG ORAL TABLET,,285,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
CYCLOBENZAPRINE 10 MG ORAL TABLET,,285,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
CYCLOBENZAPRINE 10 MG ORAL TABLET,,285,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
CYCLOBENZAPRINE 10 MG ORAL TABLET,,285,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
CYCLOBENZAPRINE 10 MG ORAL TABLET,,285,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
CYCLOBENZAPRINE 10 MG ORAL TABLET,,285,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
CYCLOBENZAPRINE 10 MG ORAL TABLET,,285,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
CYCLOBENZAPRINE 10 MG ORAL TABLET,,285,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
CYCLOBENZAPRINE 10 MG ORAL TABLET,,285,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
CYCLOBENZAPRINE 10 MG ORAL TABLET,,285,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
CYCLOBENZAPRINE 10 MG ORAL TABLET,,285,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
CYCLOBENZAPRINE 10 MG ORAL TABLET,,285,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
CYCLOBENZAPRINE 10 MG ORAL TABLET,,285,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
CYCLOBENZAPRINE 10 MG ORAL TABLET,,285,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
CYCLOBENZAPRINE 10 MG ORAL TABLET,,285,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
CYCLOBENZAPRINE 10 MG ORAL TABLET,,285,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
CYCLOBENZAPRINE 10 MG ORAL TABLET,,285,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CYCLOBENZAPRINE 10 MG ORAL TABLET,,285,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
CYCLOBENZAPRINE 10 MG ORAL TABLET,,285,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
CYCLOBENZAPRINE 10 MG ORAL TABLET,,285,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
CYCLOBENZAPRINE 10 MG ORAL TABLET,,285,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
CYCLOBENZAPRINE 10 MG ORAL TABLET,,285,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
CYCLOBENZAPRINE 10 MG ORAL TABLET,,285,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CYCLOBENZAPRINE 10 MG ORAL TABLET,,285,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
CYCLOBENZAPRINE 10 MG ORAL TABLET,,285,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CYCLOBENZAPRINE 10 MG ORAL TABLET,,285,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CYCLOBENZAPRINE 10 MG ORAL TABLET,,285,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CYCLOBENZAPRINE 10 MG ORAL TABLET,,285,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CYCLOBENZAPRINE 10 MG ORAL TABLET,,285,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
CYCLOBENZAPRINE 10 MG ORAL TABLET,,285,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
CYCLOBENZAPRINE 10 MG ORAL TABLET,,285,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
CYCLOBENZAPRINE 10 MG ORAL TABLET,,285,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
CYCLOBENZAPRINE 10 MG ORAL TABLET,,285,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
FUROSEMIDE 40 MG ORAL TABLET,,415,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
FUROSEMIDE 40 MG ORAL TABLET,,415,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
FUROSEMIDE 40 MG ORAL TABLET,,415,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
FUROSEMIDE 40 MG ORAL TABLET,,415,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
FUROSEMIDE 40 MG ORAL TABLET,,415,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
FUROSEMIDE 40 MG ORAL TABLET,,415,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
FUROSEMIDE 40 MG ORAL TABLET,,415,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
FUROSEMIDE 40 MG ORAL TABLET,,415,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
FUROSEMIDE 40 MG ORAL TABLET,,415,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
FUROSEMIDE 40 MG ORAL TABLET,,415,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
FUROSEMIDE 40 MG ORAL TABLET,,415,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
FUROSEMIDE 40 MG ORAL TABLET,,415,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
FUROSEMIDE 40 MG ORAL TABLET,,415,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
FUROSEMIDE 40 MG ORAL TABLET,,415,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
FUROSEMIDE 40 MG ORAL TABLET,,415,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
FUROSEMIDE 40 MG ORAL TABLET,,415,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
FUROSEMIDE 40 MG ORAL TABLET,,415,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
FUROSEMIDE 40 MG ORAL TABLET,,415,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
FUROSEMIDE 40 MG ORAL TABLET,,415,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
FUROSEMIDE 40 MG ORAL TABLET,,415,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
FUROSEMIDE 40 MG ORAL TABLET,,415,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
FUROSEMIDE 40 MG ORAL TABLET,,415,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
FUROSEMIDE 40 MG ORAL TABLET,,415,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
FUROSEMIDE 40 MG ORAL TABLET,,415,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
FUROSEMIDE 40 MG ORAL TABLET,,415,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
FUROSEMIDE 40 MG ORAL TABLET,,415,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
FUROSEMIDE 40 MG ORAL TABLET,,415,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
FUROSEMIDE 40 MG ORAL TABLET,,415,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
FUROSEMIDE 40 MG ORAL TABLET,,415,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
FUROSEMIDE 40 MG ORAL TABLET,,415,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
FUROSEMIDE 40 MG ORAL TABLET,,415,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
FUROSEMIDE 40 MG ORAL TABLET,,415,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
FUROSEMIDE 40 MG ORAL TABLET,,415,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
FUROSEMIDE 40 MG ORAL TABLET,,415,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
FUROSEMIDE 40 MG ORAL TABLET,,415,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
FUROSEMIDE 40 MG ORAL TABLET,,415,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
FUROSEMIDE 40 MG ORAL TABLET,,415,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
FUROSEMIDE 40 MG ORAL TABLET,,415,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
FUROSEMIDE 40 MG ORAL TABLET,,415,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
FUROSEMIDE 40 MG ORAL TABLET,,415,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
FUROSEMIDE 40 MG ORAL TABLET,,415,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
FUROSEMIDE 40 MG ORAL TABLET,,415,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
FUROSEMIDE 40 MG ORAL TABLET,,415,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
FUROSEMIDE 40 MG ORAL TABLET,,415,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FUROSEMIDE 40 MG ORAL TABLET,,415,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
FUROSEMIDE 40 MG ORAL TABLET,,415,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FUROSEMIDE 40 MG ORAL TABLET,,415,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
FUROSEMIDE 40 MG ORAL TABLET,,415,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FUROSEMIDE 40 MG ORAL TABLET,,415,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
FUROSEMIDE 40 MG ORAL TABLET,,415,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
FUROSEMIDE 40 MG ORAL TABLET,,415,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
FUROSEMIDE 40 MG ORAL TABLET,,415,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
FUROSEMIDE 40 MG ORAL TABLET,,415,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
FUROSEMIDE 40 MG ORAL TABLET,,415,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
HALOPERIDOL 0.5 MG ORAL TABLET,,444,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
HALOPERIDOL 0.5 MG ORAL TABLET,,444,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
HALOPERIDOL 0.5 MG ORAL TABLET,,444,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
HALOPERIDOL 0.5 MG ORAL TABLET,,444,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
HALOPERIDOL 0.5 MG ORAL TABLET,,444,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
HALOPERIDOL 0.5 MG ORAL TABLET,,444,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
HALOPERIDOL 0.5 MG ORAL TABLET,,444,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
HALOPERIDOL 0.5 MG ORAL TABLET,,444,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
HALOPERIDOL 0.5 MG ORAL TABLET,,444,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
HALOPERIDOL 0.5 MG ORAL TABLET,,444,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
HALOPERIDOL 0.5 MG ORAL TABLET,,444,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
HALOPERIDOL 0.5 MG ORAL TABLET,,444,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
HALOPERIDOL 0.5 MG ORAL TABLET,,444,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
HALOPERIDOL 0.5 MG ORAL TABLET,,444,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
HALOPERIDOL 0.5 MG ORAL TABLET,,444,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
HALOPERIDOL 0.5 MG ORAL TABLET,,444,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
HALOPERIDOL 0.5 MG ORAL TABLET,,444,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
HALOPERIDOL 0.5 MG ORAL TABLET,,444,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
HALOPERIDOL 0.5 MG ORAL TABLET,,444,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
HALOPERIDOL 0.5 MG ORAL TABLET,,444,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
HALOPERIDOL 0.5 MG ORAL TABLET,,444,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
HALOPERIDOL 0.5 MG ORAL TABLET,,444,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
HALOPERIDOL 0.5 MG ORAL TABLET,,444,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
HALOPERIDOL 0.5 MG ORAL TABLET,,444,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
HALOPERIDOL 0.5 MG ORAL TABLET,,444,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
HALOPERIDOL 0.5 MG ORAL TABLET,,444,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
HALOPERIDOL 0.5 MG ORAL TABLET,,444,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
HALOPERIDOL 0.5 MG ORAL TABLET,,444,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
HALOPERIDOL 0.5 MG ORAL TABLET,,444,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
HALOPERIDOL 0.5 MG ORAL TABLET,,444,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
HALOPERIDOL 0.5 MG ORAL TABLET,,444,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
HALOPERIDOL 0.5 MG ORAL TABLET,,444,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
HALOPERIDOL 0.5 MG ORAL TABLET,,444,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
HALOPERIDOL 0.5 MG ORAL TABLET,,444,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
HALOPERIDOL 0.5 MG ORAL TABLET,,444,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
HALOPERIDOL 0.5 MG ORAL TABLET,,444,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
HALOPERIDOL 0.5 MG ORAL TABLET,,444,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
HALOPERIDOL 0.5 MG ORAL TABLET,,444,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
HALOPERIDOL 0.5 MG ORAL TABLET,,444,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
HALOPERIDOL 0.5 MG ORAL TABLET,,444,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
HALOPERIDOL 0.5 MG ORAL TABLET,,444,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
HALOPERIDOL 0.5 MG ORAL TABLET,,444,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
HALOPERIDOL 0.5 MG ORAL TABLET,,444,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
HALOPERIDOL 0.5 MG ORAL TABLET,,444,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
HALOPERIDOL 0.5 MG ORAL TABLET,,444,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
HALOPERIDOL 0.5 MG ORAL TABLET,,444,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
HALOPERIDOL 0.5 MG ORAL TABLET,,444,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
HALOPERIDOL 0.5 MG ORAL TABLET,,444,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
HALOPERIDOL 0.5 MG ORAL TABLET,,444,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
HALOPERIDOL 0.5 MG ORAL TABLET,,444,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
HALOPERIDOL 0.5 MG ORAL TABLET,,444,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
HALOPERIDOL 0.5 MG ORAL TABLET,,444,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
HALOPERIDOL 0.5 MG ORAL TABLET,,444,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
HALOPERIDOL 0.5 MG ORAL TABLET,,444,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
METHOHEXITAL 500 MG INJ SOLR,,479,LOCAL,Facility,Both,1,EA,,433,368.05,124.0978,433,Aetna,Commercial,398.36,92,,percent of total billed charges,,
METHOHEXITAL 500 MG INJ SOLR,,479,LOCAL,Facility,Outpatient,1,EA,,433,368.05,124.0978,433,Aetna,Medicare Advantage,212.17,49,,percent of total billed charges,,
METHOHEXITAL 500 MG INJ SOLR,,479,LOCAL,Facility,Inpatient,1,EA,,433,368.05,124.0978,433,Aetna,Medicare Advantage,,,,,Included in per diem rate,
METHOHEXITAL 500 MG INJ SOLR,,479,LOCAL,Facility,Both,1,EA,,433,368.05,124.0978,433,Aetna,PPO,402.69,93,,percent of total billed charges,,
METHOHEXITAL 500 MG INJ SOLR,,479,LOCAL,Facility,Both,1,EA,,433,368.05,124.0978,433,America's PPO,America's PPO,415.8099,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
METHOHEXITAL 500 MG INJ SOLR,,479,LOCAL,Facility,Both,1,EA,,433,368.05,124.0978,433,BlueCross BlueShield Minnesota, Federal Employee Program,426.072,98.4,,percent of total billed charges,,
METHOHEXITAL 500 MG INJ SOLR,,479,LOCAL,Facility,Both,1,EA,,433,368.05,124.0978,433,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,433,100,,percent of total billed charges,,
METHOHEXITAL 500 MG INJ SOLR,,479,LOCAL,Facility,Both,1,EA,,433,368.05,124.0978,433,BlueCross BlueShield Minnesota,High Value Network Plan,389.7,90,,percent of total billed charges,,
METHOHEXITAL 500 MG INJ SOLR,,479,LOCAL,Facility,Outpatient,1,EA,,433,368.05,124.0978,433,BlueCross BlueShield Minnesota,Medicare Advantage,212.17,49,,percent of total billed charges,,
METHOHEXITAL 500 MG INJ SOLR,,479,LOCAL,Facility,Inpatient,1,EA,,433,368.05,124.0978,433,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
METHOHEXITAL 500 MG INJ SOLR,,479,LOCAL,Facility,Both,1,EA,,433,368.05,124.0978,433,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,383.5081,88.57,,percent of total billed charges,,
METHOHEXITAL 500 MG INJ SOLR,,479,LOCAL,Facility,Both,1,EA,,433,368.05,124.0978,433,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,124.0978,28.66,,percent of total billed charges,,
METHOHEXITAL 500 MG INJ SOLR,,479,LOCAL,Facility,Outpatient,1,EA,,433,368.05,124.0978,433,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),212.17,49,,percent of total billed charges,,
METHOHEXITAL 500 MG INJ SOLR,,479,LOCAL,Facility,Inpatient,1,EA,,433,368.05,124.0978,433,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
METHOHEXITAL 500 MG INJ SOLR,,479,LOCAL,Facility,Both,1,EA,,433,368.05,124.0978,433,CorVel,Worker's Compensation,433,100,,percent of total billed charges,,
METHOHEXITAL 500 MG INJ SOLR,,479,LOCAL,Facility,Both,1,EA,,433,368.05,124.0978,433,First Health Group Corporation,First Health Network,420.01,97,,percent of total billed charges,,
METHOHEXITAL 500 MG INJ SOLR,,479,LOCAL,Facility,Both,1,EA,,433,368.05,124.0978,433,"Health Partners, Inc.",Commercial,409.618,94.6,,percent of total billed charges,,
METHOHEXITAL 500 MG INJ SOLR,,479,LOCAL,Facility,Outpatient,1,EA,,433,368.05,124.0978,433,"Health Partners, Inc.",Medicare Advantage,212.17,49,,percent of total billed charges,,
METHOHEXITAL 500 MG INJ SOLR,,479,LOCAL,Facility,Inpatient,1,EA,,433,368.05,124.0978,433,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
METHOHEXITAL 500 MG INJ SOLR,,479,LOCAL,Facility,Both,1,EA,,433,368.05,124.0978,433,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),259.8,60,,percent of total billed charges,,
METHOHEXITAL 500 MG INJ SOLR,,479,LOCAL,Facility,Both,1,EA,,433,368.05,124.0978,433,"Health Partners, Inc.",State of Minnesota Advantage Program,352.895,81.5,,percent of total billed charges,,
METHOHEXITAL 500 MG INJ SOLR,,479,LOCAL,Facility,Both,1,EA,,433,368.05,124.0978,433,"Health Partners, Inc.",State Public Programs,216.5,50,,percent of total billed charges,,
METHOHEXITAL 500 MG INJ SOLR,,479,LOCAL,Facility,Both,1,EA,,433,368.05,124.0978,433,Humana Insurance Company,Commercial PPO,411.35,95,,percent of total billed charges,,
METHOHEXITAL 500 MG INJ SOLR,,479,LOCAL,Facility,Outpatient,1,EA,,433,368.05,124.0978,433,Humana Insurance Company,Medicare PPO,212.17,49,,percent of total billed charges,,
METHOHEXITAL 500 MG INJ SOLR,,479,LOCAL,Facility,Inpatient,1,EA,,433,368.05,124.0978,433,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
METHOHEXITAL 500 MG INJ SOLR,,479,LOCAL,Facility,Both,1,EA,,433,368.05,124.0978,433,Medica,Individual & Family,429.103,99.1,,percent of total billed charges,,
METHOHEXITAL 500 MG INJ SOLR,,479,LOCAL,Facility,Outpatient,1,EA,,433,368.05,124.0978,433,Medica,Medica Advantage Solution,215.634,49.8,,percent of total billed charges,,
METHOHEXITAL 500 MG INJ SOLR,,479,LOCAL,Facility,Inpatient,1,EA,,433,368.05,124.0978,433,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
METHOHEXITAL 500 MG INJ SOLR,,479,LOCAL,Facility,Outpatient,1,EA,,433,368.05,124.0978,433,Medica,Medical Assistance,193.118,44.6,,percent of total billed charges,,
METHOHEXITAL 500 MG INJ SOLR,,479,LOCAL,Facility,Inpatient,1,EA,,433,368.05,124.0978,433,Medica,Medical Assistance,,,,,Included in per diem rate,
METHOHEXITAL 500 MG INJ SOLR,,479,LOCAL,Facility,Outpatient,1,EA,,433,368.05,124.0978,433,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,215.634,49.8,,percent of total billed charges,,
METHOHEXITAL 500 MG INJ SOLR,,479,LOCAL,Facility,Inpatient,1,EA,,433,368.05,124.0978,433,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
METHOHEXITAL 500 MG INJ SOLR,,479,LOCAL,Facility,Both,1,EA,,433,368.05,124.0978,433,"Multiplan, Inc.","Multiplan, Inc.",407.02,94,,percent of total billed charges,,
METHOHEXITAL 500 MG INJ SOLR,,479,LOCAL,Facility,Outpatient,1,EA,,433,368.05,124.0978,433,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,390.133,90.1,,percent of total billed charges,,
METHOHEXITAL 500 MG INJ SOLR,,479,LOCAL,Facility,Inpatient,1,EA,,433,368.05,124.0978,433,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
METHOHEXITAL 500 MG INJ SOLR,,479,LOCAL,Facility,Both,1,EA,,433,368.05,124.0978,433,"Preferred One Administrative Services, INC.",PPO,426.938,98.6,,percent of total billed charges,,
METHOHEXITAL 500 MG INJ SOLR,,479,LOCAL,Facility,Outpatient,1,EA,,433,368.05,124.0978,433,PrimeWest Health,Minnesota Senior Health Options (MSHO),222.7785,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
METHOHEXITAL 500 MG INJ SOLR,,479,LOCAL,Facility,Inpatient,1,EA,,433,368.05,124.0978,433,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
METHOHEXITAL 500 MG INJ SOLR,,479,LOCAL,Facility,Outpatient,1,EA,,433,368.05,124.0978,433,PrimeWest Health,MinnesotaCare,222.3888,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
METHOHEXITAL 500 MG INJ SOLR,,479,LOCAL,Facility,Inpatient,1,EA,,433,368.05,124.0978,433,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
METHOHEXITAL 500 MG INJ SOLR,,479,LOCAL,Facility,Both,1,EA,,433,368.05,124.0978,433,Sanford Health Plan,Sanford Health Plan,398.36,92,,percent of total billed charges,,
METHOHEXITAL 500 MG INJ SOLR,,479,LOCAL,Facility,Outpatient,1,EA,,433,368.05,124.0978,433,"UCare Health, Inc.",Individual & Family Plan,243.9955,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
METHOHEXITAL 500 MG INJ SOLR,,479,LOCAL,Facility,Inpatient,1,EA,,433,368.05,124.0978,433,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
METHOHEXITAL 500 MG INJ SOLR,,479,LOCAL,Facility,Outpatient,1,EA,,433,368.05,124.0978,433,"UCare Health, Inc.",Medical Assistance,218.5351,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
METHOHEXITAL 500 MG INJ SOLR,,479,LOCAL,Facility,Inpatient,1,EA,,433,368.05,124.0978,433,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
METHOHEXITAL 500 MG INJ SOLR,,479,LOCAL,Facility,Outpatient,1,EA,,433,368.05,124.0978,433,"UCare Health, Inc.",Medicare Advantage,218.5351,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
METHOHEXITAL 500 MG INJ SOLR,,479,LOCAL,Facility,Inpatient,1,EA,,433,368.05,124.0978,433,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
METHOHEXITAL 500 MG INJ SOLR,,479,LOCAL,Facility,Outpatient,1,EA,,433,368.05,124.0978,433,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),218.5351,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
METHOHEXITAL 500 MG INJ SOLR,,479,LOCAL,Facility,Inpatient,1,EA,,433,368.05,124.0978,433,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
METHOHEXITAL 500 MG INJ SOLR,,479,LOCAL,Facility,Both,1,EA,,433,368.05,124.0978,433,UnitedHealthcare,Individual & Family,407.02,94,,percent of total billed charges,,
METHOHEXITAL 500 MG INJ SOLR,,479,LOCAL,Facility,Outpatient,1,EA,,433,368.05,124.0978,433,UnitedHealthcare,Medicare Advantage,212.17,49,,percent of total billed charges,,
METHOHEXITAL 500 MG INJ SOLR,,479,LOCAL,Facility,Inpatient,1,EA,,433,368.05,124.0978,433,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
METHOHEXITAL 500 MG INJ SOLR,,479,LOCAL,Facility,Outpatient,1,EA,,433,368.05,124.0978,433,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,207.84,48,,percent of total billed charges,,100% of DHS outpatient percentage
METHOHEXITAL 500 MG INJ SOLR,,479,LOCAL,Facility,Inpatient,1,EA,,433,368.05,124.0978,433,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
RIVASTIGMINE TARTRATE 1.5 MG ORAL CAP,,496,LOCAL,Facility,Both,1,EA,,24,20.4,6.8784,24,Aetna,Commercial,22.08,92,,percent of total billed charges,,
RIVASTIGMINE TARTRATE 1.5 MG ORAL CAP,,496,LOCAL,Facility,Outpatient,1,EA,,24,20.4,6.8784,24,Aetna,Medicare Advantage,11.76,49,,percent of total billed charges,,
RIVASTIGMINE TARTRATE 1.5 MG ORAL CAP,,496,LOCAL,Facility,Inpatient,1,EA,,24,20.4,6.8784,24,Aetna,Medicare Advantage,,,,,Included in per diem rate,
RIVASTIGMINE TARTRATE 1.5 MG ORAL CAP,,496,LOCAL,Facility,Both,1,EA,,24,20.4,6.8784,24,Aetna,PPO,22.32,93,,percent of total billed charges,,
RIVASTIGMINE TARTRATE 1.5 MG ORAL CAP,,496,LOCAL,Facility,Both,1,EA,,24,20.4,6.8784,24,America's PPO,America's PPO,23.0472,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
RIVASTIGMINE TARTRATE 1.5 MG ORAL CAP,,496,LOCAL,Facility,Both,1,EA,,24,20.4,6.8784,24,BlueCross BlueShield Minnesota, Federal Employee Program,23.616,98.4,,percent of total billed charges,,
RIVASTIGMINE TARTRATE 1.5 MG ORAL CAP,,496,LOCAL,Facility,Both,1,EA,,24,20.4,6.8784,24,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,24,100,,percent of total billed charges,,
RIVASTIGMINE TARTRATE 1.5 MG ORAL CAP,,496,LOCAL,Facility,Both,1,EA,,24,20.4,6.8784,24,BlueCross BlueShield Minnesota,High Value Network Plan,21.6,90,,percent of total billed charges,,
RIVASTIGMINE TARTRATE 1.5 MG ORAL CAP,,496,LOCAL,Facility,Outpatient,1,EA,,24,20.4,6.8784,24,BlueCross BlueShield Minnesota,Medicare Advantage,11.76,49,,percent of total billed charges,,
RIVASTIGMINE TARTRATE 1.5 MG ORAL CAP,,496,LOCAL,Facility,Inpatient,1,EA,,24,20.4,6.8784,24,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
RIVASTIGMINE TARTRATE 1.5 MG ORAL CAP,,496,LOCAL,Facility,Both,1,EA,,24,20.4,6.8784,24,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,21.2568,88.57,,percent of total billed charges,,
RIVASTIGMINE TARTRATE 1.5 MG ORAL CAP,,496,LOCAL,Facility,Both,1,EA,,24,20.4,6.8784,24,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,6.8784,28.66,,percent of total billed charges,,
RIVASTIGMINE TARTRATE 1.5 MG ORAL CAP,,496,LOCAL,Facility,Outpatient,1,EA,,24,20.4,6.8784,24,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),11.76,49,,percent of total billed charges,,
RIVASTIGMINE TARTRATE 1.5 MG ORAL CAP,,496,LOCAL,Facility,Inpatient,1,EA,,24,20.4,6.8784,24,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
RIVASTIGMINE TARTRATE 1.5 MG ORAL CAP,,496,LOCAL,Facility,Both,1,EA,,24,20.4,6.8784,24,CorVel,Worker's Compensation,24,100,,percent of total billed charges,,
RIVASTIGMINE TARTRATE 1.5 MG ORAL CAP,,496,LOCAL,Facility,Both,1,EA,,24,20.4,6.8784,24,First Health Group Corporation,First Health Network,23.28,97,,percent of total billed charges,,
RIVASTIGMINE TARTRATE 1.5 MG ORAL CAP,,496,LOCAL,Facility,Both,1,EA,,24,20.4,6.8784,24,"Health Partners, Inc.",Commercial,22.704,94.6,,percent of total billed charges,,
RIVASTIGMINE TARTRATE 1.5 MG ORAL CAP,,496,LOCAL,Facility,Outpatient,1,EA,,24,20.4,6.8784,24,"Health Partners, Inc.",Medicare Advantage,11.76,49,,percent of total billed charges,,
RIVASTIGMINE TARTRATE 1.5 MG ORAL CAP,,496,LOCAL,Facility,Inpatient,1,EA,,24,20.4,6.8784,24,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
RIVASTIGMINE TARTRATE 1.5 MG ORAL CAP,,496,LOCAL,Facility,Both,1,EA,,24,20.4,6.8784,24,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),14.4,60,,percent of total billed charges,,
RIVASTIGMINE TARTRATE 1.5 MG ORAL CAP,,496,LOCAL,Facility,Both,1,EA,,24,20.4,6.8784,24,"Health Partners, Inc.",State of Minnesota Advantage Program,19.56,81.5,,percent of total billed charges,,
RIVASTIGMINE TARTRATE 1.5 MG ORAL CAP,,496,LOCAL,Facility,Both,1,EA,,24,20.4,6.8784,24,"Health Partners, Inc.",State Public Programs,12,50,,percent of total billed charges,,
RIVASTIGMINE TARTRATE 1.5 MG ORAL CAP,,496,LOCAL,Facility,Both,1,EA,,24,20.4,6.8784,24,Humana Insurance Company,Commercial PPO,22.8,95,,percent of total billed charges,,
RIVASTIGMINE TARTRATE 1.5 MG ORAL CAP,,496,LOCAL,Facility,Outpatient,1,EA,,24,20.4,6.8784,24,Humana Insurance Company,Medicare PPO,11.76,49,,percent of total billed charges,,
RIVASTIGMINE TARTRATE 1.5 MG ORAL CAP,,496,LOCAL,Facility,Inpatient,1,EA,,24,20.4,6.8784,24,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
RIVASTIGMINE TARTRATE 1.5 MG ORAL CAP,,496,LOCAL,Facility,Both,1,EA,,24,20.4,6.8784,24,Medica,Individual & Family,23.784,99.1,,percent of total billed charges,,
RIVASTIGMINE TARTRATE 1.5 MG ORAL CAP,,496,LOCAL,Facility,Outpatient,1,EA,,24,20.4,6.8784,24,Medica,Medica Advantage Solution,11.952,49.8,,percent of total billed charges,,
RIVASTIGMINE TARTRATE 1.5 MG ORAL CAP,,496,LOCAL,Facility,Inpatient,1,EA,,24,20.4,6.8784,24,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
RIVASTIGMINE TARTRATE 1.5 MG ORAL CAP,,496,LOCAL,Facility,Outpatient,1,EA,,24,20.4,6.8784,24,Medica,Medical Assistance,10.704,44.6,,percent of total billed charges,,
RIVASTIGMINE TARTRATE 1.5 MG ORAL CAP,,496,LOCAL,Facility,Inpatient,1,EA,,24,20.4,6.8784,24,Medica,Medical Assistance,,,,,Included in per diem rate,
RIVASTIGMINE TARTRATE 1.5 MG ORAL CAP,,496,LOCAL,Facility,Outpatient,1,EA,,24,20.4,6.8784,24,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,11.952,49.8,,percent of total billed charges,,
RIVASTIGMINE TARTRATE 1.5 MG ORAL CAP,,496,LOCAL,Facility,Inpatient,1,EA,,24,20.4,6.8784,24,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
RIVASTIGMINE TARTRATE 1.5 MG ORAL CAP,,496,LOCAL,Facility,Both,1,EA,,24,20.4,6.8784,24,"Multiplan, Inc.","Multiplan, Inc.",22.56,94,,percent of total billed charges,,
RIVASTIGMINE TARTRATE 1.5 MG ORAL CAP,,496,LOCAL,Facility,Outpatient,1,EA,,24,20.4,6.8784,24,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,21.624,90.1,,percent of total billed charges,,
RIVASTIGMINE TARTRATE 1.5 MG ORAL CAP,,496,LOCAL,Facility,Inpatient,1,EA,,24,20.4,6.8784,24,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
RIVASTIGMINE TARTRATE 1.5 MG ORAL CAP,,496,LOCAL,Facility,Both,1,EA,,24,20.4,6.8784,24,"Preferred One Administrative Services, INC.",PPO,23.664,98.6,,percent of total billed charges,,
RIVASTIGMINE TARTRATE 1.5 MG ORAL CAP,,496,LOCAL,Facility,Outpatient,1,EA,,24,20.4,6.8784,24,PrimeWest Health,Minnesota Senior Health Options (MSHO),12.348,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
RIVASTIGMINE TARTRATE 1.5 MG ORAL CAP,,496,LOCAL,Facility,Inpatient,1,EA,,24,20.4,6.8784,24,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
RIVASTIGMINE TARTRATE 1.5 MG ORAL CAP,,496,LOCAL,Facility,Outpatient,1,EA,,24,20.4,6.8784,24,PrimeWest Health,MinnesotaCare,12.3264,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
RIVASTIGMINE TARTRATE 1.5 MG ORAL CAP,,496,LOCAL,Facility,Inpatient,1,EA,,24,20.4,6.8784,24,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
RIVASTIGMINE TARTRATE 1.5 MG ORAL CAP,,496,LOCAL,Facility,Both,1,EA,,24,20.4,6.8784,24,Sanford Health Plan,Sanford Health Plan,22.08,92,,percent of total billed charges,,
RIVASTIGMINE TARTRATE 1.5 MG ORAL CAP,,496,LOCAL,Facility,Outpatient,1,EA,,24,20.4,6.8784,24,"UCare Health, Inc.",Individual & Family Plan,13.524,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
RIVASTIGMINE TARTRATE 1.5 MG ORAL CAP,,496,LOCAL,Facility,Inpatient,1,EA,,24,20.4,6.8784,24,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
RIVASTIGMINE TARTRATE 1.5 MG ORAL CAP,,496,LOCAL,Facility,Outpatient,1,EA,,24,20.4,6.8784,24,"UCare Health, Inc.",Medical Assistance,12.1128,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
RIVASTIGMINE TARTRATE 1.5 MG ORAL CAP,,496,LOCAL,Facility,Inpatient,1,EA,,24,20.4,6.8784,24,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
RIVASTIGMINE TARTRATE 1.5 MG ORAL CAP,,496,LOCAL,Facility,Outpatient,1,EA,,24,20.4,6.8784,24,"UCare Health, Inc.",Medicare Advantage,12.1128,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
RIVASTIGMINE TARTRATE 1.5 MG ORAL CAP,,496,LOCAL,Facility,Inpatient,1,EA,,24,20.4,6.8784,24,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
RIVASTIGMINE TARTRATE 1.5 MG ORAL CAP,,496,LOCAL,Facility,Outpatient,1,EA,,24,20.4,6.8784,24,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),12.1128,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
RIVASTIGMINE TARTRATE 1.5 MG ORAL CAP,,496,LOCAL,Facility,Inpatient,1,EA,,24,20.4,6.8784,24,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
RIVASTIGMINE TARTRATE 1.5 MG ORAL CAP,,496,LOCAL,Facility,Both,1,EA,,24,20.4,6.8784,24,UnitedHealthcare,Individual & Family,22.56,94,,percent of total billed charges,,
RIVASTIGMINE TARTRATE 1.5 MG ORAL CAP,,496,LOCAL,Facility,Outpatient,1,EA,,24,20.4,6.8784,24,UnitedHealthcare,Medicare Advantage,11.76,49,,percent of total billed charges,,
RIVASTIGMINE TARTRATE 1.5 MG ORAL CAP,,496,LOCAL,Facility,Inpatient,1,EA,,24,20.4,6.8784,24,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
RIVASTIGMINE TARTRATE 1.5 MG ORAL CAP,,496,LOCAL,Facility,Outpatient,1,EA,,24,20.4,6.8784,24,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,11.52,48,,percent of total billed charges,,100% of DHS outpatient percentage
RIVASTIGMINE TARTRATE 1.5 MG ORAL CAP,,496,LOCAL,Facility,Inpatient,1,EA,,24,20.4,6.8784,24,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
TRACE ELEMENTS CR-CU-MN-ZN 10 MCG-1 MG- 0.5 MG-5 MG/ML IV SOLN,,507,LOCAL,Facility,Both,1,mL,,71,60.35,20.3486,71,Aetna,Commercial,65.32,92,,percent of total billed charges,,
TRACE ELEMENTS CR-CU-MN-ZN 10 MCG-1 MG- 0.5 MG-5 MG/ML IV SOLN,,507,LOCAL,Facility,Outpatient,1,mL,,71,60.35,20.3486,71,Aetna,Medicare Advantage,34.79,49,,percent of total billed charges,,
TRACE ELEMENTS CR-CU-MN-ZN 10 MCG-1 MG- 0.5 MG-5 MG/ML IV SOLN,,507,LOCAL,Facility,Inpatient,1,mL,,71,60.35,20.3486,71,Aetna,Medicare Advantage,,,,,Included in per diem rate,
TRACE ELEMENTS CR-CU-MN-ZN 10 MCG-1 MG- 0.5 MG-5 MG/ML IV SOLN,,507,LOCAL,Facility,Both,1,mL,,71,60.35,20.3486,71,Aetna,PPO,66.03,93,,percent of total billed charges,,
TRACE ELEMENTS CR-CU-MN-ZN 10 MCG-1 MG- 0.5 MG-5 MG/ML IV SOLN,,507,LOCAL,Facility,Both,1,mL,,71,60.35,20.3486,71,America's PPO,America's PPO,68.1813,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
TRACE ELEMENTS CR-CU-MN-ZN 10 MCG-1 MG- 0.5 MG-5 MG/ML IV SOLN,,507,LOCAL,Facility,Both,1,mL,,71,60.35,20.3486,71,BlueCross BlueShield Minnesota, Federal Employee Program,69.864,98.4,,percent of total billed charges,,
TRACE ELEMENTS CR-CU-MN-ZN 10 MCG-1 MG- 0.5 MG-5 MG/ML IV SOLN,,507,LOCAL,Facility,Both,1,mL,,71,60.35,20.3486,71,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,71,100,,percent of total billed charges,,
TRACE ELEMENTS CR-CU-MN-ZN 10 MCG-1 MG- 0.5 MG-5 MG/ML IV SOLN,,507,LOCAL,Facility,Both,1,mL,,71,60.35,20.3486,71,BlueCross BlueShield Minnesota,High Value Network Plan,63.9,90,,percent of total billed charges,,
TRACE ELEMENTS CR-CU-MN-ZN 10 MCG-1 MG- 0.5 MG-5 MG/ML IV SOLN,,507,LOCAL,Facility,Outpatient,1,mL,,71,60.35,20.3486,71,BlueCross BlueShield Minnesota,Medicare Advantage,34.79,49,,percent of total billed charges,,
TRACE ELEMENTS CR-CU-MN-ZN 10 MCG-1 MG- 0.5 MG-5 MG/ML IV SOLN,,507,LOCAL,Facility,Inpatient,1,mL,,71,60.35,20.3486,71,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
TRACE ELEMENTS CR-CU-MN-ZN 10 MCG-1 MG- 0.5 MG-5 MG/ML IV SOLN,,507,LOCAL,Facility,Both,1,mL,,71,60.35,20.3486,71,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,62.8847,88.57,,percent of total billed charges,,
TRACE ELEMENTS CR-CU-MN-ZN 10 MCG-1 MG- 0.5 MG-5 MG/ML IV SOLN,,507,LOCAL,Facility,Both,1,mL,,71,60.35,20.3486,71,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,20.3486,28.66,,percent of total billed charges,,
TRACE ELEMENTS CR-CU-MN-ZN 10 MCG-1 MG- 0.5 MG-5 MG/ML IV SOLN,,507,LOCAL,Facility,Outpatient,1,mL,,71,60.35,20.3486,71,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),34.79,49,,percent of total billed charges,,
TRACE ELEMENTS CR-CU-MN-ZN 10 MCG-1 MG- 0.5 MG-5 MG/ML IV SOLN,,507,LOCAL,Facility,Inpatient,1,mL,,71,60.35,20.3486,71,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
TRACE ELEMENTS CR-CU-MN-ZN 10 MCG-1 MG- 0.5 MG-5 MG/ML IV SOLN,,507,LOCAL,Facility,Both,1,mL,,71,60.35,20.3486,71,CorVel,Worker's Compensation,71,100,,percent of total billed charges,,
TRACE ELEMENTS CR-CU-MN-ZN 10 MCG-1 MG- 0.5 MG-5 MG/ML IV SOLN,,507,LOCAL,Facility,Both,1,mL,,71,60.35,20.3486,71,First Health Group Corporation,First Health Network,68.87,97,,percent of total billed charges,,
TRACE ELEMENTS CR-CU-MN-ZN 10 MCG-1 MG- 0.5 MG-5 MG/ML IV SOLN,,507,LOCAL,Facility,Both,1,mL,,71,60.35,20.3486,71,"Health Partners, Inc.",Commercial,67.166,94.6,,percent of total billed charges,,
TRACE ELEMENTS CR-CU-MN-ZN 10 MCG-1 MG- 0.5 MG-5 MG/ML IV SOLN,,507,LOCAL,Facility,Outpatient,1,mL,,71,60.35,20.3486,71,"Health Partners, Inc.",Medicare Advantage,34.79,49,,percent of total billed charges,,
TRACE ELEMENTS CR-CU-MN-ZN 10 MCG-1 MG- 0.5 MG-5 MG/ML IV SOLN,,507,LOCAL,Facility,Inpatient,1,mL,,71,60.35,20.3486,71,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
TRACE ELEMENTS CR-CU-MN-ZN 10 MCG-1 MG- 0.5 MG-5 MG/ML IV SOLN,,507,LOCAL,Facility,Both,1,mL,,71,60.35,20.3486,71,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),42.6,60,,percent of total billed charges,,
TRACE ELEMENTS CR-CU-MN-ZN 10 MCG-1 MG- 0.5 MG-5 MG/ML IV SOLN,,507,LOCAL,Facility,Both,1,mL,,71,60.35,20.3486,71,"Health Partners, Inc.",State of Minnesota Advantage Program,57.865,81.5,,percent of total billed charges,,
TRACE ELEMENTS CR-CU-MN-ZN 10 MCG-1 MG- 0.5 MG-5 MG/ML IV SOLN,,507,LOCAL,Facility,Both,1,mL,,71,60.35,20.3486,71,"Health Partners, Inc.",State Public Programs,35.5,50,,percent of total billed charges,,
TRACE ELEMENTS CR-CU-MN-ZN 10 MCG-1 MG- 0.5 MG-5 MG/ML IV SOLN,,507,LOCAL,Facility,Both,1,mL,,71,60.35,20.3486,71,Humana Insurance Company,Commercial PPO,67.45,95,,percent of total billed charges,,
TRACE ELEMENTS CR-CU-MN-ZN 10 MCG-1 MG- 0.5 MG-5 MG/ML IV SOLN,,507,LOCAL,Facility,Outpatient,1,mL,,71,60.35,20.3486,71,Humana Insurance Company,Medicare PPO,34.79,49,,percent of total billed charges,,
TRACE ELEMENTS CR-CU-MN-ZN 10 MCG-1 MG- 0.5 MG-5 MG/ML IV SOLN,,507,LOCAL,Facility,Inpatient,1,mL,,71,60.35,20.3486,71,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
TRACE ELEMENTS CR-CU-MN-ZN 10 MCG-1 MG- 0.5 MG-5 MG/ML IV SOLN,,507,LOCAL,Facility,Both,1,mL,,71,60.35,20.3486,71,Medica,Individual & Family,70.361,99.1,,percent of total billed charges,,
TRACE ELEMENTS CR-CU-MN-ZN 10 MCG-1 MG- 0.5 MG-5 MG/ML IV SOLN,,507,LOCAL,Facility,Outpatient,1,mL,,71,60.35,20.3486,71,Medica,Medica Advantage Solution,35.358,49.8,,percent of total billed charges,,
TRACE ELEMENTS CR-CU-MN-ZN 10 MCG-1 MG- 0.5 MG-5 MG/ML IV SOLN,,507,LOCAL,Facility,Inpatient,1,mL,,71,60.35,20.3486,71,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
TRACE ELEMENTS CR-CU-MN-ZN 10 MCG-1 MG- 0.5 MG-5 MG/ML IV SOLN,,507,LOCAL,Facility,Outpatient,1,mL,,71,60.35,20.3486,71,Medica,Medical Assistance,31.666,44.6,,percent of total billed charges,,
TRACE ELEMENTS CR-CU-MN-ZN 10 MCG-1 MG- 0.5 MG-5 MG/ML IV SOLN,,507,LOCAL,Facility,Inpatient,1,mL,,71,60.35,20.3486,71,Medica,Medical Assistance,,,,,Included in per diem rate,
TRACE ELEMENTS CR-CU-MN-ZN 10 MCG-1 MG- 0.5 MG-5 MG/ML IV SOLN,,507,LOCAL,Facility,Outpatient,1,mL,,71,60.35,20.3486,71,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,35.358,49.8,,percent of total billed charges,,
TRACE ELEMENTS CR-CU-MN-ZN 10 MCG-1 MG- 0.5 MG-5 MG/ML IV SOLN,,507,LOCAL,Facility,Inpatient,1,mL,,71,60.35,20.3486,71,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
TRACE ELEMENTS CR-CU-MN-ZN 10 MCG-1 MG- 0.5 MG-5 MG/ML IV SOLN,,507,LOCAL,Facility,Both,1,mL,,71,60.35,20.3486,71,"Multiplan, Inc.","Multiplan, Inc.",66.74,94,,percent of total billed charges,,
TRACE ELEMENTS CR-CU-MN-ZN 10 MCG-1 MG- 0.5 MG-5 MG/ML IV SOLN,,507,LOCAL,Facility,Outpatient,1,mL,,71,60.35,20.3486,71,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,63.971,90.1,,percent of total billed charges,,
TRACE ELEMENTS CR-CU-MN-ZN 10 MCG-1 MG- 0.5 MG-5 MG/ML IV SOLN,,507,LOCAL,Facility,Inpatient,1,mL,,71,60.35,20.3486,71,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
TRACE ELEMENTS CR-CU-MN-ZN 10 MCG-1 MG- 0.5 MG-5 MG/ML IV SOLN,,507,LOCAL,Facility,Both,1,mL,,71,60.35,20.3486,71,"Preferred One Administrative Services, INC.",PPO,70.006,98.6,,percent of total billed charges,,
TRACE ELEMENTS CR-CU-MN-ZN 10 MCG-1 MG- 0.5 MG-5 MG/ML IV SOLN,,507,LOCAL,Facility,Outpatient,1,mL,,71,60.35,20.3486,71,PrimeWest Health,Minnesota Senior Health Options (MSHO),36.5295,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
TRACE ELEMENTS CR-CU-MN-ZN 10 MCG-1 MG- 0.5 MG-5 MG/ML IV SOLN,,507,LOCAL,Facility,Inpatient,1,mL,,71,60.35,20.3486,71,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
TRACE ELEMENTS CR-CU-MN-ZN 10 MCG-1 MG- 0.5 MG-5 MG/ML IV SOLN,,507,LOCAL,Facility,Outpatient,1,mL,,71,60.35,20.3486,71,PrimeWest Health,MinnesotaCare,36.4656,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
TRACE ELEMENTS CR-CU-MN-ZN 10 MCG-1 MG- 0.5 MG-5 MG/ML IV SOLN,,507,LOCAL,Facility,Inpatient,1,mL,,71,60.35,20.3486,71,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
TRACE ELEMENTS CR-CU-MN-ZN 10 MCG-1 MG- 0.5 MG-5 MG/ML IV SOLN,,507,LOCAL,Facility,Both,1,mL,,71,60.35,20.3486,71,Sanford Health Plan,Sanford Health Plan,65.32,92,,percent of total billed charges,,
TRACE ELEMENTS CR-CU-MN-ZN 10 MCG-1 MG- 0.5 MG-5 MG/ML IV SOLN,,507,LOCAL,Facility,Outpatient,1,mL,,71,60.35,20.3486,71,"UCare Health, Inc.",Individual & Family Plan,40.0085,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
TRACE ELEMENTS CR-CU-MN-ZN 10 MCG-1 MG- 0.5 MG-5 MG/ML IV SOLN,,507,LOCAL,Facility,Inpatient,1,mL,,71,60.35,20.3486,71,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
TRACE ELEMENTS CR-CU-MN-ZN 10 MCG-1 MG- 0.5 MG-5 MG/ML IV SOLN,,507,LOCAL,Facility,Outpatient,1,mL,,71,60.35,20.3486,71,"UCare Health, Inc.",Medical Assistance,35.8337,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TRACE ELEMENTS CR-CU-MN-ZN 10 MCG-1 MG- 0.5 MG-5 MG/ML IV SOLN,,507,LOCAL,Facility,Inpatient,1,mL,,71,60.35,20.3486,71,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
TRACE ELEMENTS CR-CU-MN-ZN 10 MCG-1 MG- 0.5 MG-5 MG/ML IV SOLN,,507,LOCAL,Facility,Outpatient,1,mL,,71,60.35,20.3486,71,"UCare Health, Inc.",Medicare Advantage,35.8337,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TRACE ELEMENTS CR-CU-MN-ZN 10 MCG-1 MG- 0.5 MG-5 MG/ML IV SOLN,,507,LOCAL,Facility,Inpatient,1,mL,,71,60.35,20.3486,71,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
TRACE ELEMENTS CR-CU-MN-ZN 10 MCG-1 MG- 0.5 MG-5 MG/ML IV SOLN,,507,LOCAL,Facility,Outpatient,1,mL,,71,60.35,20.3486,71,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),35.8337,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TRACE ELEMENTS CR-CU-MN-ZN 10 MCG-1 MG- 0.5 MG-5 MG/ML IV SOLN,,507,LOCAL,Facility,Inpatient,1,mL,,71,60.35,20.3486,71,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
TRACE ELEMENTS CR-CU-MN-ZN 10 MCG-1 MG- 0.5 MG-5 MG/ML IV SOLN,,507,LOCAL,Facility,Both,1,mL,,71,60.35,20.3486,71,UnitedHealthcare,Individual & Family,66.74,94,,percent of total billed charges,,
TRACE ELEMENTS CR-CU-MN-ZN 10 MCG-1 MG- 0.5 MG-5 MG/ML IV SOLN,,507,LOCAL,Facility,Outpatient,1,mL,,71,60.35,20.3486,71,UnitedHealthcare,Medicare Advantage,34.79,49,,percent of total billed charges,,
TRACE ELEMENTS CR-CU-MN-ZN 10 MCG-1 MG- 0.5 MG-5 MG/ML IV SOLN,,507,LOCAL,Facility,Inpatient,1,mL,,71,60.35,20.3486,71,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
TRACE ELEMENTS CR-CU-MN-ZN 10 MCG-1 MG- 0.5 MG-5 MG/ML IV SOLN,,507,LOCAL,Facility,Outpatient,1,mL,,71,60.35,20.3486,71,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,34.08,48,,percent of total billed charges,,100% of DHS outpatient percentage
TRACE ELEMENTS CR-CU-MN-ZN 10 MCG-1 MG- 0.5 MG-5 MG/ML IV SOLN,,507,LOCAL,Facility,Inpatient,1,mL,,71,60.35,20.3486,71,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
METOLAZONE 2.5 MG ORAL TABLET,,518,LOCAL,Facility,Both,1,EA,,11,9.35,3.1526,11,Aetna,Commercial,10.12,92,,percent of total billed charges,,
METOLAZONE 2.5 MG ORAL TABLET,,518,LOCAL,Facility,Outpatient,1,EA,,11,9.35,3.1526,11,Aetna,Medicare Advantage,5.39,49,,percent of total billed charges,,
METOLAZONE 2.5 MG ORAL TABLET,,518,LOCAL,Facility,Inpatient,1,EA,,11,9.35,3.1526,11,Aetna,Medicare Advantage,,,,,Included in per diem rate,
METOLAZONE 2.5 MG ORAL TABLET,,518,LOCAL,Facility,Both,1,EA,,11,9.35,3.1526,11,Aetna,PPO,10.23,93,,percent of total billed charges,,
METOLAZONE 2.5 MG ORAL TABLET,,518,LOCAL,Facility,Both,1,EA,,11,9.35,3.1526,11,America's PPO,America's PPO,10.5633,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
METOLAZONE 2.5 MG ORAL TABLET,,518,LOCAL,Facility,Both,1,EA,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota, Federal Employee Program,10.824,98.4,,percent of total billed charges,,
METOLAZONE 2.5 MG ORAL TABLET,,518,LOCAL,Facility,Both,1,EA,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,11,100,,percent of total billed charges,,
METOLAZONE 2.5 MG ORAL TABLET,,518,LOCAL,Facility,Both,1,EA,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,High Value Network Plan,9.9,90,,percent of total billed charges,,
METOLAZONE 2.5 MG ORAL TABLET,,518,LOCAL,Facility,Outpatient,1,EA,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,Medicare Advantage,5.39,49,,percent of total billed charges,,
METOLAZONE 2.5 MG ORAL TABLET,,518,LOCAL,Facility,Inpatient,1,EA,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
METOLAZONE 2.5 MG ORAL TABLET,,518,LOCAL,Facility,Both,1,EA,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,9.7427,88.57,,percent of total billed charges,,
METOLAZONE 2.5 MG ORAL TABLET,,518,LOCAL,Facility,Both,1,EA,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,3.1526,28.66,,percent of total billed charges,,
METOLAZONE 2.5 MG ORAL TABLET,,518,LOCAL,Facility,Outpatient,1,EA,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),5.39,49,,percent of total billed charges,,
METOLAZONE 2.5 MG ORAL TABLET,,518,LOCAL,Facility,Inpatient,1,EA,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
METOLAZONE 2.5 MG ORAL TABLET,,518,LOCAL,Facility,Both,1,EA,,11,9.35,3.1526,11,CorVel,Worker's Compensation,11,100,,percent of total billed charges,,
METOLAZONE 2.5 MG ORAL TABLET,,518,LOCAL,Facility,Both,1,EA,,11,9.35,3.1526,11,First Health Group Corporation,First Health Network,10.67,97,,percent of total billed charges,,
METOLAZONE 2.5 MG ORAL TABLET,,518,LOCAL,Facility,Both,1,EA,,11,9.35,3.1526,11,"Health Partners, Inc.",Commercial,10.406,94.6,,percent of total billed charges,,
METOLAZONE 2.5 MG ORAL TABLET,,518,LOCAL,Facility,Outpatient,1,EA,,11,9.35,3.1526,11,"Health Partners, Inc.",Medicare Advantage,5.39,49,,percent of total billed charges,,
METOLAZONE 2.5 MG ORAL TABLET,,518,LOCAL,Facility,Inpatient,1,EA,,11,9.35,3.1526,11,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
METOLAZONE 2.5 MG ORAL TABLET,,518,LOCAL,Facility,Both,1,EA,,11,9.35,3.1526,11,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),6.6,60,,percent of total billed charges,,
METOLAZONE 2.5 MG ORAL TABLET,,518,LOCAL,Facility,Both,1,EA,,11,9.35,3.1526,11,"Health Partners, Inc.",State of Minnesota Advantage Program,8.965,81.5,,percent of total billed charges,,
METOLAZONE 2.5 MG ORAL TABLET,,518,LOCAL,Facility,Both,1,EA,,11,9.35,3.1526,11,"Health Partners, Inc.",State Public Programs,5.5,50,,percent of total billed charges,,
METOLAZONE 2.5 MG ORAL TABLET,,518,LOCAL,Facility,Both,1,EA,,11,9.35,3.1526,11,Humana Insurance Company,Commercial PPO,10.45,95,,percent of total billed charges,,
METOLAZONE 2.5 MG ORAL TABLET,,518,LOCAL,Facility,Outpatient,1,EA,,11,9.35,3.1526,11,Humana Insurance Company,Medicare PPO,5.39,49,,percent of total billed charges,,
METOLAZONE 2.5 MG ORAL TABLET,,518,LOCAL,Facility,Inpatient,1,EA,,11,9.35,3.1526,11,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
METOLAZONE 2.5 MG ORAL TABLET,,518,LOCAL,Facility,Both,1,EA,,11,9.35,3.1526,11,Medica,Individual & Family,10.901,99.1,,percent of total billed charges,,
METOLAZONE 2.5 MG ORAL TABLET,,518,LOCAL,Facility,Outpatient,1,EA,,11,9.35,3.1526,11,Medica,Medica Advantage Solution,5.478,49.8,,percent of total billed charges,,
METOLAZONE 2.5 MG ORAL TABLET,,518,LOCAL,Facility,Inpatient,1,EA,,11,9.35,3.1526,11,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
METOLAZONE 2.5 MG ORAL TABLET,,518,LOCAL,Facility,Outpatient,1,EA,,11,9.35,3.1526,11,Medica,Medical Assistance,4.906,44.6,,percent of total billed charges,,
METOLAZONE 2.5 MG ORAL TABLET,,518,LOCAL,Facility,Inpatient,1,EA,,11,9.35,3.1526,11,Medica,Medical Assistance,,,,,Included in per diem rate,
METOLAZONE 2.5 MG ORAL TABLET,,518,LOCAL,Facility,Outpatient,1,EA,,11,9.35,3.1526,11,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,5.478,49.8,,percent of total billed charges,,
METOLAZONE 2.5 MG ORAL TABLET,,518,LOCAL,Facility,Inpatient,1,EA,,11,9.35,3.1526,11,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
METOLAZONE 2.5 MG ORAL TABLET,,518,LOCAL,Facility,Both,1,EA,,11,9.35,3.1526,11,"Multiplan, Inc.","Multiplan, Inc.",10.34,94,,percent of total billed charges,,
METOLAZONE 2.5 MG ORAL TABLET,,518,LOCAL,Facility,Outpatient,1,EA,,11,9.35,3.1526,11,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,9.911,90.1,,percent of total billed charges,,
METOLAZONE 2.5 MG ORAL TABLET,,518,LOCAL,Facility,Inpatient,1,EA,,11,9.35,3.1526,11,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
METOLAZONE 2.5 MG ORAL TABLET,,518,LOCAL,Facility,Both,1,EA,,11,9.35,3.1526,11,"Preferred One Administrative Services, INC.",PPO,10.846,98.6,,percent of total billed charges,,
METOLAZONE 2.5 MG ORAL TABLET,,518,LOCAL,Facility,Outpatient,1,EA,,11,9.35,3.1526,11,PrimeWest Health,Minnesota Senior Health Options (MSHO),5.6595,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
METOLAZONE 2.5 MG ORAL TABLET,,518,LOCAL,Facility,Inpatient,1,EA,,11,9.35,3.1526,11,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
METOLAZONE 2.5 MG ORAL TABLET,,518,LOCAL,Facility,Outpatient,1,EA,,11,9.35,3.1526,11,PrimeWest Health,MinnesotaCare,5.6496,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
METOLAZONE 2.5 MG ORAL TABLET,,518,LOCAL,Facility,Inpatient,1,EA,,11,9.35,3.1526,11,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
METOLAZONE 2.5 MG ORAL TABLET,,518,LOCAL,Facility,Both,1,EA,,11,9.35,3.1526,11,Sanford Health Plan,Sanford Health Plan,10.12,92,,percent of total billed charges,,
METOLAZONE 2.5 MG ORAL TABLET,,518,LOCAL,Facility,Outpatient,1,EA,,11,9.35,3.1526,11,"UCare Health, Inc.",Individual & Family Plan,6.1985,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
METOLAZONE 2.5 MG ORAL TABLET,,518,LOCAL,Facility,Inpatient,1,EA,,11,9.35,3.1526,11,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
METOLAZONE 2.5 MG ORAL TABLET,,518,LOCAL,Facility,Outpatient,1,EA,,11,9.35,3.1526,11,"UCare Health, Inc.",Medical Assistance,5.5517,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
METOLAZONE 2.5 MG ORAL TABLET,,518,LOCAL,Facility,Inpatient,1,EA,,11,9.35,3.1526,11,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
METOLAZONE 2.5 MG ORAL TABLET,,518,LOCAL,Facility,Outpatient,1,EA,,11,9.35,3.1526,11,"UCare Health, Inc.",Medicare Advantage,5.5517,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
METOLAZONE 2.5 MG ORAL TABLET,,518,LOCAL,Facility,Inpatient,1,EA,,11,9.35,3.1526,11,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
METOLAZONE 2.5 MG ORAL TABLET,,518,LOCAL,Facility,Outpatient,1,EA,,11,9.35,3.1526,11,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),5.5517,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
METOLAZONE 2.5 MG ORAL TABLET,,518,LOCAL,Facility,Inpatient,1,EA,,11,9.35,3.1526,11,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
METOLAZONE 2.5 MG ORAL TABLET,,518,LOCAL,Facility,Both,1,EA,,11,9.35,3.1526,11,UnitedHealthcare,Individual & Family,10.34,94,,percent of total billed charges,,
METOLAZONE 2.5 MG ORAL TABLET,,518,LOCAL,Facility,Outpatient,1,EA,,11,9.35,3.1526,11,UnitedHealthcare,Medicare Advantage,5.39,49,,percent of total billed charges,,
METOLAZONE 2.5 MG ORAL TABLET,,518,LOCAL,Facility,Inpatient,1,EA,,11,9.35,3.1526,11,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
METOLAZONE 2.5 MG ORAL TABLET,,518,LOCAL,Facility,Outpatient,1,EA,,11,9.35,3.1526,11,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,5.28,48,,percent of total billed charges,,100% of DHS outpatient percentage
METOLAZONE 2.5 MG ORAL TABLET,,518,LOCAL,Facility,Inpatient,1,EA,,11,9.35,3.1526,11,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
ACETAMINOPHEN 325 MG RECT SUPP,,674,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
ACETAMINOPHEN 325 MG RECT SUPP,,674,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
ACETAMINOPHEN 325 MG RECT SUPP,,674,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
ACETAMINOPHEN 325 MG RECT SUPP,,674,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
ACETAMINOPHEN 325 MG RECT SUPP,,674,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
ACETAMINOPHEN 325 MG RECT SUPP,,674,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
ACETAMINOPHEN 325 MG RECT SUPP,,674,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
ACETAMINOPHEN 325 MG RECT SUPP,,674,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
ACETAMINOPHEN 325 MG RECT SUPP,,674,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
ACETAMINOPHEN 325 MG RECT SUPP,,674,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
ACETAMINOPHEN 325 MG RECT SUPP,,674,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
ACETAMINOPHEN 325 MG RECT SUPP,,674,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
ACETAMINOPHEN 325 MG RECT SUPP,,674,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
ACETAMINOPHEN 325 MG RECT SUPP,,674,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
ACETAMINOPHEN 325 MG RECT SUPP,,674,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
ACETAMINOPHEN 325 MG RECT SUPP,,674,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
ACETAMINOPHEN 325 MG RECT SUPP,,674,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
ACETAMINOPHEN 325 MG RECT SUPP,,674,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
ACETAMINOPHEN 325 MG RECT SUPP,,674,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ACETAMINOPHEN 325 MG RECT SUPP,,674,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
ACETAMINOPHEN 325 MG RECT SUPP,,674,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
ACETAMINOPHEN 325 MG RECT SUPP,,674,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
ACETAMINOPHEN 325 MG RECT SUPP,,674,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
ACETAMINOPHEN 325 MG RECT SUPP,,674,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
ACETAMINOPHEN 325 MG RECT SUPP,,674,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
ACETAMINOPHEN 325 MG RECT SUPP,,674,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
ACETAMINOPHEN 325 MG RECT SUPP,,674,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
ACETAMINOPHEN 325 MG RECT SUPP,,674,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
ACETAMINOPHEN 325 MG RECT SUPP,,674,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
ACETAMINOPHEN 325 MG RECT SUPP,,674,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
ACETAMINOPHEN 325 MG RECT SUPP,,674,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
ACETAMINOPHEN 325 MG RECT SUPP,,674,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
ACETAMINOPHEN 325 MG RECT SUPP,,674,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
ACETAMINOPHEN 325 MG RECT SUPP,,674,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
ACETAMINOPHEN 325 MG RECT SUPP,,674,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
ACETAMINOPHEN 325 MG RECT SUPP,,674,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
ACETAMINOPHEN 325 MG RECT SUPP,,674,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
ACETAMINOPHEN 325 MG RECT SUPP,,674,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ACETAMINOPHEN 325 MG RECT SUPP,,674,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
ACETAMINOPHEN 325 MG RECT SUPP,,674,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
ACETAMINOPHEN 325 MG RECT SUPP,,674,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
ACETAMINOPHEN 325 MG RECT SUPP,,674,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
ACETAMINOPHEN 325 MG RECT SUPP,,674,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
ACETAMINOPHEN 325 MG RECT SUPP,,674,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ACETAMINOPHEN 325 MG RECT SUPP,,674,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
ACETAMINOPHEN 325 MG RECT SUPP,,674,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ACETAMINOPHEN 325 MG RECT SUPP,,674,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ACETAMINOPHEN 325 MG RECT SUPP,,674,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ACETAMINOPHEN 325 MG RECT SUPP,,674,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ACETAMINOPHEN 325 MG RECT SUPP,,674,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
ACETAMINOPHEN 325 MG RECT SUPP,,674,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
ACETAMINOPHEN 325 MG RECT SUPP,,674,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
ACETAMINOPHEN 325 MG RECT SUPP,,674,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
ACETAMINOPHEN 325 MG RECT SUPP,,674,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
TERAZOSIN 5 MG ORAL CAP,,680,LOCAL,Facility,Both,1,EA,,9,7.65,2.5794,9,Aetna,Commercial,8.28,92,,percent of total billed charges,,
TERAZOSIN 5 MG ORAL CAP,,680,LOCAL,Facility,Outpatient,1,EA,,9,7.65,2.5794,9,Aetna,Medicare Advantage,4.41,49,,percent of total billed charges,,
TERAZOSIN 5 MG ORAL CAP,,680,LOCAL,Facility,Inpatient,1,EA,,9,7.65,2.5794,9,Aetna,Medicare Advantage,,,,,Included in per diem rate,
TERAZOSIN 5 MG ORAL CAP,,680,LOCAL,Facility,Both,1,EA,,9,7.65,2.5794,9,Aetna,PPO,8.37,93,,percent of total billed charges,,
TERAZOSIN 5 MG ORAL CAP,,680,LOCAL,Facility,Both,1,EA,,9,7.65,2.5794,9,America's PPO,America's PPO,8.6427,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
TERAZOSIN 5 MG ORAL CAP,,680,LOCAL,Facility,Both,1,EA,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota, Federal Employee Program,8.856,98.4,,percent of total billed charges,,
TERAZOSIN 5 MG ORAL CAP,,680,LOCAL,Facility,Both,1,EA,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,9,100,,percent of total billed charges,,
TERAZOSIN 5 MG ORAL CAP,,680,LOCAL,Facility,Both,1,EA,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota,High Value Network Plan,8.1,90,,percent of total billed charges,,
TERAZOSIN 5 MG ORAL CAP,,680,LOCAL,Facility,Outpatient,1,EA,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota,Medicare Advantage,4.41,49,,percent of total billed charges,,
TERAZOSIN 5 MG ORAL CAP,,680,LOCAL,Facility,Inpatient,1,EA,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
TERAZOSIN 5 MG ORAL CAP,,680,LOCAL,Facility,Both,1,EA,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,7.9713,88.57,,percent of total billed charges,,
TERAZOSIN 5 MG ORAL CAP,,680,LOCAL,Facility,Both,1,EA,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,2.5794,28.66,,percent of total billed charges,,
TERAZOSIN 5 MG ORAL CAP,,680,LOCAL,Facility,Outpatient,1,EA,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),4.41,49,,percent of total billed charges,,
TERAZOSIN 5 MG ORAL CAP,,680,LOCAL,Facility,Inpatient,1,EA,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
TERAZOSIN 5 MG ORAL CAP,,680,LOCAL,Facility,Both,1,EA,,9,7.65,2.5794,9,CorVel,Worker's Compensation,9,100,,percent of total billed charges,,
TERAZOSIN 5 MG ORAL CAP,,680,LOCAL,Facility,Both,1,EA,,9,7.65,2.5794,9,First Health Group Corporation,First Health Network,8.73,97,,percent of total billed charges,,
TERAZOSIN 5 MG ORAL CAP,,680,LOCAL,Facility,Both,1,EA,,9,7.65,2.5794,9,"Health Partners, Inc.",Commercial,8.514,94.6,,percent of total billed charges,,
TERAZOSIN 5 MG ORAL CAP,,680,LOCAL,Facility,Outpatient,1,EA,,9,7.65,2.5794,9,"Health Partners, Inc.",Medicare Advantage,4.41,49,,percent of total billed charges,,
TERAZOSIN 5 MG ORAL CAP,,680,LOCAL,Facility,Inpatient,1,EA,,9,7.65,2.5794,9,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
TERAZOSIN 5 MG ORAL CAP,,680,LOCAL,Facility,Both,1,EA,,9,7.65,2.5794,9,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),5.4,60,,percent of total billed charges,,
TERAZOSIN 5 MG ORAL CAP,,680,LOCAL,Facility,Both,1,EA,,9,7.65,2.5794,9,"Health Partners, Inc.",State of Minnesota Advantage Program,7.335,81.5,,percent of total billed charges,,
TERAZOSIN 5 MG ORAL CAP,,680,LOCAL,Facility,Both,1,EA,,9,7.65,2.5794,9,"Health Partners, Inc.",State Public Programs,4.5,50,,percent of total billed charges,,
TERAZOSIN 5 MG ORAL CAP,,680,LOCAL,Facility,Both,1,EA,,9,7.65,2.5794,9,Humana Insurance Company,Commercial PPO,8.55,95,,percent of total billed charges,,
TERAZOSIN 5 MG ORAL CAP,,680,LOCAL,Facility,Outpatient,1,EA,,9,7.65,2.5794,9,Humana Insurance Company,Medicare PPO,4.41,49,,percent of total billed charges,,
TERAZOSIN 5 MG ORAL CAP,,680,LOCAL,Facility,Inpatient,1,EA,,9,7.65,2.5794,9,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
TERAZOSIN 5 MG ORAL CAP,,680,LOCAL,Facility,Both,1,EA,,9,7.65,2.5794,9,Medica,Individual & Family,8.919,99.1,,percent of total billed charges,,
TERAZOSIN 5 MG ORAL CAP,,680,LOCAL,Facility,Outpatient,1,EA,,9,7.65,2.5794,9,Medica,Medica Advantage Solution,4.482,49.8,,percent of total billed charges,,
TERAZOSIN 5 MG ORAL CAP,,680,LOCAL,Facility,Inpatient,1,EA,,9,7.65,2.5794,9,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
TERAZOSIN 5 MG ORAL CAP,,680,LOCAL,Facility,Outpatient,1,EA,,9,7.65,2.5794,9,Medica,Medical Assistance,4.014,44.6,,percent of total billed charges,,
TERAZOSIN 5 MG ORAL CAP,,680,LOCAL,Facility,Inpatient,1,EA,,9,7.65,2.5794,9,Medica,Medical Assistance,,,,,Included in per diem rate,
TERAZOSIN 5 MG ORAL CAP,,680,LOCAL,Facility,Outpatient,1,EA,,9,7.65,2.5794,9,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,4.482,49.8,,percent of total billed charges,,
TERAZOSIN 5 MG ORAL CAP,,680,LOCAL,Facility,Inpatient,1,EA,,9,7.65,2.5794,9,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
TERAZOSIN 5 MG ORAL CAP,,680,LOCAL,Facility,Both,1,EA,,9,7.65,2.5794,9,"Multiplan, Inc.","Multiplan, Inc.",8.46,94,,percent of total billed charges,,
TERAZOSIN 5 MG ORAL CAP,,680,LOCAL,Facility,Outpatient,1,EA,,9,7.65,2.5794,9,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,8.109,90.1,,percent of total billed charges,,
TERAZOSIN 5 MG ORAL CAP,,680,LOCAL,Facility,Inpatient,1,EA,,9,7.65,2.5794,9,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
TERAZOSIN 5 MG ORAL CAP,,680,LOCAL,Facility,Both,1,EA,,9,7.65,2.5794,9,"Preferred One Administrative Services, INC.",PPO,8.874,98.6,,percent of total billed charges,,
TERAZOSIN 5 MG ORAL CAP,,680,LOCAL,Facility,Outpatient,1,EA,,9,7.65,2.5794,9,PrimeWest Health,Minnesota Senior Health Options (MSHO),4.6305,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
TERAZOSIN 5 MG ORAL CAP,,680,LOCAL,Facility,Inpatient,1,EA,,9,7.65,2.5794,9,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
TERAZOSIN 5 MG ORAL CAP,,680,LOCAL,Facility,Outpatient,1,EA,,9,7.65,2.5794,9,PrimeWest Health,MinnesotaCare,4.6224,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
TERAZOSIN 5 MG ORAL CAP,,680,LOCAL,Facility,Inpatient,1,EA,,9,7.65,2.5794,9,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
TERAZOSIN 5 MG ORAL CAP,,680,LOCAL,Facility,Both,1,EA,,9,7.65,2.5794,9,Sanford Health Plan,Sanford Health Plan,8.28,92,,percent of total billed charges,,
TERAZOSIN 5 MG ORAL CAP,,680,LOCAL,Facility,Outpatient,1,EA,,9,7.65,2.5794,9,"UCare Health, Inc.",Individual & Family Plan,5.0715,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
TERAZOSIN 5 MG ORAL CAP,,680,LOCAL,Facility,Inpatient,1,EA,,9,7.65,2.5794,9,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
TERAZOSIN 5 MG ORAL CAP,,680,LOCAL,Facility,Outpatient,1,EA,,9,7.65,2.5794,9,"UCare Health, Inc.",Medical Assistance,4.5423,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TERAZOSIN 5 MG ORAL CAP,,680,LOCAL,Facility,Inpatient,1,EA,,9,7.65,2.5794,9,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
TERAZOSIN 5 MG ORAL CAP,,680,LOCAL,Facility,Outpatient,1,EA,,9,7.65,2.5794,9,"UCare Health, Inc.",Medicare Advantage,4.5423,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TERAZOSIN 5 MG ORAL CAP,,680,LOCAL,Facility,Inpatient,1,EA,,9,7.65,2.5794,9,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
TERAZOSIN 5 MG ORAL CAP,,680,LOCAL,Facility,Outpatient,1,EA,,9,7.65,2.5794,9,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),4.5423,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TERAZOSIN 5 MG ORAL CAP,,680,LOCAL,Facility,Inpatient,1,EA,,9,7.65,2.5794,9,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
TERAZOSIN 5 MG ORAL CAP,,680,LOCAL,Facility,Both,1,EA,,9,7.65,2.5794,9,UnitedHealthcare,Individual & Family,8.46,94,,percent of total billed charges,,
TERAZOSIN 5 MG ORAL CAP,,680,LOCAL,Facility,Outpatient,1,EA,,9,7.65,2.5794,9,UnitedHealthcare,Medicare Advantage,4.41,49,,percent of total billed charges,,
TERAZOSIN 5 MG ORAL CAP,,680,LOCAL,Facility,Inpatient,1,EA,,9,7.65,2.5794,9,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
TERAZOSIN 5 MG ORAL CAP,,680,LOCAL,Facility,Outpatient,1,EA,,9,7.65,2.5794,9,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,4.32,48,,percent of total billed charges,,100% of DHS outpatient percentage
TERAZOSIN 5 MG ORAL CAP,,680,LOCAL,Facility,Inpatient,1,EA,,9,7.65,2.5794,9,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
PIOGLITAZONE 15 MG ORAL TABLET,,681,LOCAL,Facility,Both,1,EA,,36,30.6,10.3176,36,Aetna,Commercial,33.12,92,,percent of total billed charges,,
PIOGLITAZONE 15 MG ORAL TABLET,,681,LOCAL,Facility,Outpatient,1,EA,,36,30.6,10.3176,36,Aetna,Medicare Advantage,17.64,49,,percent of total billed charges,,
PIOGLITAZONE 15 MG ORAL TABLET,,681,LOCAL,Facility,Inpatient,1,EA,,36,30.6,10.3176,36,Aetna,Medicare Advantage,,,,,Included in per diem rate,
PIOGLITAZONE 15 MG ORAL TABLET,,681,LOCAL,Facility,Both,1,EA,,36,30.6,10.3176,36,Aetna,PPO,33.48,93,,percent of total billed charges,,
PIOGLITAZONE 15 MG ORAL TABLET,,681,LOCAL,Facility,Both,1,EA,,36,30.6,10.3176,36,America's PPO,America's PPO,34.5708,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
PIOGLITAZONE 15 MG ORAL TABLET,,681,LOCAL,Facility,Both,1,EA,,36,30.6,10.3176,36,BlueCross BlueShield Minnesota, Federal Employee Program,35.424,98.4,,percent of total billed charges,,
PIOGLITAZONE 15 MG ORAL TABLET,,681,LOCAL,Facility,Both,1,EA,,36,30.6,10.3176,36,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,36,100,,percent of total billed charges,,
PIOGLITAZONE 15 MG ORAL TABLET,,681,LOCAL,Facility,Both,1,EA,,36,30.6,10.3176,36,BlueCross BlueShield Minnesota,High Value Network Plan,32.4,90,,percent of total billed charges,,
PIOGLITAZONE 15 MG ORAL TABLET,,681,LOCAL,Facility,Outpatient,1,EA,,36,30.6,10.3176,36,BlueCross BlueShield Minnesota,Medicare Advantage,17.64,49,,percent of total billed charges,,
PIOGLITAZONE 15 MG ORAL TABLET,,681,LOCAL,Facility,Inpatient,1,EA,,36,30.6,10.3176,36,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
PIOGLITAZONE 15 MG ORAL TABLET,,681,LOCAL,Facility,Both,1,EA,,36,30.6,10.3176,36,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,31.8852,88.57,,percent of total billed charges,,
PIOGLITAZONE 15 MG ORAL TABLET,,681,LOCAL,Facility,Both,1,EA,,36,30.6,10.3176,36,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,10.3176,28.66,,percent of total billed charges,,
PIOGLITAZONE 15 MG ORAL TABLET,,681,LOCAL,Facility,Outpatient,1,EA,,36,30.6,10.3176,36,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),17.64,49,,percent of total billed charges,,
PIOGLITAZONE 15 MG ORAL TABLET,,681,LOCAL,Facility,Inpatient,1,EA,,36,30.6,10.3176,36,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
PIOGLITAZONE 15 MG ORAL TABLET,,681,LOCAL,Facility,Both,1,EA,,36,30.6,10.3176,36,CorVel,Worker's Compensation,36,100,,percent of total billed charges,,
PIOGLITAZONE 15 MG ORAL TABLET,,681,LOCAL,Facility,Both,1,EA,,36,30.6,10.3176,36,First Health Group Corporation,First Health Network,34.92,97,,percent of total billed charges,,
PIOGLITAZONE 15 MG ORAL TABLET,,681,LOCAL,Facility,Both,1,EA,,36,30.6,10.3176,36,"Health Partners, Inc.",Commercial,34.056,94.6,,percent of total billed charges,,
PIOGLITAZONE 15 MG ORAL TABLET,,681,LOCAL,Facility,Outpatient,1,EA,,36,30.6,10.3176,36,"Health Partners, Inc.",Medicare Advantage,17.64,49,,percent of total billed charges,,
PIOGLITAZONE 15 MG ORAL TABLET,,681,LOCAL,Facility,Inpatient,1,EA,,36,30.6,10.3176,36,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PIOGLITAZONE 15 MG ORAL TABLET,,681,LOCAL,Facility,Both,1,EA,,36,30.6,10.3176,36,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),21.6,60,,percent of total billed charges,,
PIOGLITAZONE 15 MG ORAL TABLET,,681,LOCAL,Facility,Both,1,EA,,36,30.6,10.3176,36,"Health Partners, Inc.",State of Minnesota Advantage Program,29.34,81.5,,percent of total billed charges,,
PIOGLITAZONE 15 MG ORAL TABLET,,681,LOCAL,Facility,Both,1,EA,,36,30.6,10.3176,36,"Health Partners, Inc.",State Public Programs,18,50,,percent of total billed charges,,
PIOGLITAZONE 15 MG ORAL TABLET,,681,LOCAL,Facility,Both,1,EA,,36,30.6,10.3176,36,Humana Insurance Company,Commercial PPO,34.2,95,,percent of total billed charges,,
PIOGLITAZONE 15 MG ORAL TABLET,,681,LOCAL,Facility,Outpatient,1,EA,,36,30.6,10.3176,36,Humana Insurance Company,Medicare PPO,17.64,49,,percent of total billed charges,,
PIOGLITAZONE 15 MG ORAL TABLET,,681,LOCAL,Facility,Inpatient,1,EA,,36,30.6,10.3176,36,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
PIOGLITAZONE 15 MG ORAL TABLET,,681,LOCAL,Facility,Both,1,EA,,36,30.6,10.3176,36,Medica,Individual & Family,35.676,99.1,,percent of total billed charges,,
PIOGLITAZONE 15 MG ORAL TABLET,,681,LOCAL,Facility,Outpatient,1,EA,,36,30.6,10.3176,36,Medica,Medica Advantage Solution,17.928,49.8,,percent of total billed charges,,
PIOGLITAZONE 15 MG ORAL TABLET,,681,LOCAL,Facility,Inpatient,1,EA,,36,30.6,10.3176,36,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
PIOGLITAZONE 15 MG ORAL TABLET,,681,LOCAL,Facility,Outpatient,1,EA,,36,30.6,10.3176,36,Medica,Medical Assistance,16.056,44.6,,percent of total billed charges,,
PIOGLITAZONE 15 MG ORAL TABLET,,681,LOCAL,Facility,Inpatient,1,EA,,36,30.6,10.3176,36,Medica,Medical Assistance,,,,,Included in per diem rate,
PIOGLITAZONE 15 MG ORAL TABLET,,681,LOCAL,Facility,Outpatient,1,EA,,36,30.6,10.3176,36,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,17.928,49.8,,percent of total billed charges,,
PIOGLITAZONE 15 MG ORAL TABLET,,681,LOCAL,Facility,Inpatient,1,EA,,36,30.6,10.3176,36,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
PIOGLITAZONE 15 MG ORAL TABLET,,681,LOCAL,Facility,Both,1,EA,,36,30.6,10.3176,36,"Multiplan, Inc.","Multiplan, Inc.",33.84,94,,percent of total billed charges,,
PIOGLITAZONE 15 MG ORAL TABLET,,681,LOCAL,Facility,Outpatient,1,EA,,36,30.6,10.3176,36,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,32.436,90.1,,percent of total billed charges,,
PIOGLITAZONE 15 MG ORAL TABLET,,681,LOCAL,Facility,Inpatient,1,EA,,36,30.6,10.3176,36,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
PIOGLITAZONE 15 MG ORAL TABLET,,681,LOCAL,Facility,Both,1,EA,,36,30.6,10.3176,36,"Preferred One Administrative Services, INC.",PPO,35.496,98.6,,percent of total billed charges,,
PIOGLITAZONE 15 MG ORAL TABLET,,681,LOCAL,Facility,Outpatient,1,EA,,36,30.6,10.3176,36,PrimeWest Health,Minnesota Senior Health Options (MSHO),18.522,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
PIOGLITAZONE 15 MG ORAL TABLET,,681,LOCAL,Facility,Inpatient,1,EA,,36,30.6,10.3176,36,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PIOGLITAZONE 15 MG ORAL TABLET,,681,LOCAL,Facility,Outpatient,1,EA,,36,30.6,10.3176,36,PrimeWest Health,MinnesotaCare,18.4896,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
PIOGLITAZONE 15 MG ORAL TABLET,,681,LOCAL,Facility,Inpatient,1,EA,,36,30.6,10.3176,36,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
PIOGLITAZONE 15 MG ORAL TABLET,,681,LOCAL,Facility,Both,1,EA,,36,30.6,10.3176,36,Sanford Health Plan,Sanford Health Plan,33.12,92,,percent of total billed charges,,
PIOGLITAZONE 15 MG ORAL TABLET,,681,LOCAL,Facility,Outpatient,1,EA,,36,30.6,10.3176,36,"UCare Health, Inc.",Individual & Family Plan,20.286,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
PIOGLITAZONE 15 MG ORAL TABLET,,681,LOCAL,Facility,Inpatient,1,EA,,36,30.6,10.3176,36,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
PIOGLITAZONE 15 MG ORAL TABLET,,681,LOCAL,Facility,Outpatient,1,EA,,36,30.6,10.3176,36,"UCare Health, Inc.",Medical Assistance,18.1692,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PIOGLITAZONE 15 MG ORAL TABLET,,681,LOCAL,Facility,Inpatient,1,EA,,36,30.6,10.3176,36,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
PIOGLITAZONE 15 MG ORAL TABLET,,681,LOCAL,Facility,Outpatient,1,EA,,36,30.6,10.3176,36,"UCare Health, Inc.",Medicare Advantage,18.1692,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PIOGLITAZONE 15 MG ORAL TABLET,,681,LOCAL,Facility,Inpatient,1,EA,,36,30.6,10.3176,36,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PIOGLITAZONE 15 MG ORAL TABLET,,681,LOCAL,Facility,Outpatient,1,EA,,36,30.6,10.3176,36,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),18.1692,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PIOGLITAZONE 15 MG ORAL TABLET,,681,LOCAL,Facility,Inpatient,1,EA,,36,30.6,10.3176,36,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PIOGLITAZONE 15 MG ORAL TABLET,,681,LOCAL,Facility,Both,1,EA,,36,30.6,10.3176,36,UnitedHealthcare,Individual & Family,33.84,94,,percent of total billed charges,,
PIOGLITAZONE 15 MG ORAL TABLET,,681,LOCAL,Facility,Outpatient,1,EA,,36,30.6,10.3176,36,UnitedHealthcare,Medicare Advantage,17.64,49,,percent of total billed charges,,
PIOGLITAZONE 15 MG ORAL TABLET,,681,LOCAL,Facility,Inpatient,1,EA,,36,30.6,10.3176,36,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
PIOGLITAZONE 15 MG ORAL TABLET,,681,LOCAL,Facility,Outpatient,1,EA,,36,30.6,10.3176,36,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,17.28,48,,percent of total billed charges,,100% of DHS outpatient percentage
PIOGLITAZONE 15 MG ORAL TABLET,,681,LOCAL,Facility,Inpatient,1,EA,,36,30.6,10.3176,36,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
FLUCONAZOLE 100 MG ORAL TABLET,,702,LOCAL,Facility,Both,1,EA,,45,38.25,12.897,45,Aetna,Commercial,41.4,92,,percent of total billed charges,,
FLUCONAZOLE 100 MG ORAL TABLET,,702,LOCAL,Facility,Outpatient,1,EA,,45,38.25,12.897,45,Aetna,Medicare Advantage,22.05,49,,percent of total billed charges,,
FLUCONAZOLE 100 MG ORAL TABLET,,702,LOCAL,Facility,Inpatient,1,EA,,45,38.25,12.897,45,Aetna,Medicare Advantage,,,,,Included in per diem rate,
FLUCONAZOLE 100 MG ORAL TABLET,,702,LOCAL,Facility,Both,1,EA,,45,38.25,12.897,45,Aetna,PPO,41.85,93,,percent of total billed charges,,
FLUCONAZOLE 100 MG ORAL TABLET,,702,LOCAL,Facility,Both,1,EA,,45,38.25,12.897,45,America's PPO,America's PPO,43.2135,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
FLUCONAZOLE 100 MG ORAL TABLET,,702,LOCAL,Facility,Both,1,EA,,45,38.25,12.897,45,BlueCross BlueShield Minnesota, Federal Employee Program,44.28,98.4,,percent of total billed charges,,
FLUCONAZOLE 100 MG ORAL TABLET,,702,LOCAL,Facility,Both,1,EA,,45,38.25,12.897,45,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,45,100,,percent of total billed charges,,
FLUCONAZOLE 100 MG ORAL TABLET,,702,LOCAL,Facility,Both,1,EA,,45,38.25,12.897,45,BlueCross BlueShield Minnesota,High Value Network Plan,40.5,90,,percent of total billed charges,,
FLUCONAZOLE 100 MG ORAL TABLET,,702,LOCAL,Facility,Outpatient,1,EA,,45,38.25,12.897,45,BlueCross BlueShield Minnesota,Medicare Advantage,22.05,49,,percent of total billed charges,,
FLUCONAZOLE 100 MG ORAL TABLET,,702,LOCAL,Facility,Inpatient,1,EA,,45,38.25,12.897,45,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
FLUCONAZOLE 100 MG ORAL TABLET,,702,LOCAL,Facility,Both,1,EA,,45,38.25,12.897,45,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,39.8565,88.57,,percent of total billed charges,,
FLUCONAZOLE 100 MG ORAL TABLET,,702,LOCAL,Facility,Both,1,EA,,45,38.25,12.897,45,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,12.897,28.66,,percent of total billed charges,,
FLUCONAZOLE 100 MG ORAL TABLET,,702,LOCAL,Facility,Outpatient,1,EA,,45,38.25,12.897,45,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),22.05,49,,percent of total billed charges,,
FLUCONAZOLE 100 MG ORAL TABLET,,702,LOCAL,Facility,Inpatient,1,EA,,45,38.25,12.897,45,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
FLUCONAZOLE 100 MG ORAL TABLET,,702,LOCAL,Facility,Both,1,EA,,45,38.25,12.897,45,CorVel,Worker's Compensation,45,100,,percent of total billed charges,,
FLUCONAZOLE 100 MG ORAL TABLET,,702,LOCAL,Facility,Both,1,EA,,45,38.25,12.897,45,First Health Group Corporation,First Health Network,43.65,97,,percent of total billed charges,,
FLUCONAZOLE 100 MG ORAL TABLET,,702,LOCAL,Facility,Both,1,EA,,45,38.25,12.897,45,"Health Partners, Inc.",Commercial,42.57,94.6,,percent of total billed charges,,
FLUCONAZOLE 100 MG ORAL TABLET,,702,LOCAL,Facility,Outpatient,1,EA,,45,38.25,12.897,45,"Health Partners, Inc.",Medicare Advantage,22.05,49,,percent of total billed charges,,
FLUCONAZOLE 100 MG ORAL TABLET,,702,LOCAL,Facility,Inpatient,1,EA,,45,38.25,12.897,45,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
FLUCONAZOLE 100 MG ORAL TABLET,,702,LOCAL,Facility,Both,1,EA,,45,38.25,12.897,45,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),27,60,,percent of total billed charges,,
FLUCONAZOLE 100 MG ORAL TABLET,,702,LOCAL,Facility,Both,1,EA,,45,38.25,12.897,45,"Health Partners, Inc.",State of Minnesota Advantage Program,36.675,81.5,,percent of total billed charges,,
FLUCONAZOLE 100 MG ORAL TABLET,,702,LOCAL,Facility,Both,1,EA,,45,38.25,12.897,45,"Health Partners, Inc.",State Public Programs,22.5,50,,percent of total billed charges,,
FLUCONAZOLE 100 MG ORAL TABLET,,702,LOCAL,Facility,Both,1,EA,,45,38.25,12.897,45,Humana Insurance Company,Commercial PPO,42.75,95,,percent of total billed charges,,
FLUCONAZOLE 100 MG ORAL TABLET,,702,LOCAL,Facility,Outpatient,1,EA,,45,38.25,12.897,45,Humana Insurance Company,Medicare PPO,22.05,49,,percent of total billed charges,,
FLUCONAZOLE 100 MG ORAL TABLET,,702,LOCAL,Facility,Inpatient,1,EA,,45,38.25,12.897,45,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
FLUCONAZOLE 100 MG ORAL TABLET,,702,LOCAL,Facility,Both,1,EA,,45,38.25,12.897,45,Medica,Individual & Family,44.595,99.1,,percent of total billed charges,,
FLUCONAZOLE 100 MG ORAL TABLET,,702,LOCAL,Facility,Outpatient,1,EA,,45,38.25,12.897,45,Medica,Medica Advantage Solution,22.41,49.8,,percent of total billed charges,,
FLUCONAZOLE 100 MG ORAL TABLET,,702,LOCAL,Facility,Inpatient,1,EA,,45,38.25,12.897,45,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
FLUCONAZOLE 100 MG ORAL TABLET,,702,LOCAL,Facility,Outpatient,1,EA,,45,38.25,12.897,45,Medica,Medical Assistance,20.07,44.6,,percent of total billed charges,,
FLUCONAZOLE 100 MG ORAL TABLET,,702,LOCAL,Facility,Inpatient,1,EA,,45,38.25,12.897,45,Medica,Medical Assistance,,,,,Included in per diem rate,
FLUCONAZOLE 100 MG ORAL TABLET,,702,LOCAL,Facility,Outpatient,1,EA,,45,38.25,12.897,45,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,22.41,49.8,,percent of total billed charges,,
FLUCONAZOLE 100 MG ORAL TABLET,,702,LOCAL,Facility,Inpatient,1,EA,,45,38.25,12.897,45,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
FLUCONAZOLE 100 MG ORAL TABLET,,702,LOCAL,Facility,Both,1,EA,,45,38.25,12.897,45,"Multiplan, Inc.","Multiplan, Inc.",42.3,94,,percent of total billed charges,,
FLUCONAZOLE 100 MG ORAL TABLET,,702,LOCAL,Facility,Outpatient,1,EA,,45,38.25,12.897,45,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,40.545,90.1,,percent of total billed charges,,
FLUCONAZOLE 100 MG ORAL TABLET,,702,LOCAL,Facility,Inpatient,1,EA,,45,38.25,12.897,45,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
FLUCONAZOLE 100 MG ORAL TABLET,,702,LOCAL,Facility,Both,1,EA,,45,38.25,12.897,45,"Preferred One Administrative Services, INC.",PPO,44.37,98.6,,percent of total billed charges,,
FLUCONAZOLE 100 MG ORAL TABLET,,702,LOCAL,Facility,Outpatient,1,EA,,45,38.25,12.897,45,PrimeWest Health,Minnesota Senior Health Options (MSHO),23.1525,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
FLUCONAZOLE 100 MG ORAL TABLET,,702,LOCAL,Facility,Inpatient,1,EA,,45,38.25,12.897,45,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
FLUCONAZOLE 100 MG ORAL TABLET,,702,LOCAL,Facility,Outpatient,1,EA,,45,38.25,12.897,45,PrimeWest Health,MinnesotaCare,23.112,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
FLUCONAZOLE 100 MG ORAL TABLET,,702,LOCAL,Facility,Inpatient,1,EA,,45,38.25,12.897,45,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
FLUCONAZOLE 100 MG ORAL TABLET,,702,LOCAL,Facility,Both,1,EA,,45,38.25,12.897,45,Sanford Health Plan,Sanford Health Plan,41.4,92,,percent of total billed charges,,
FLUCONAZOLE 100 MG ORAL TABLET,,702,LOCAL,Facility,Outpatient,1,EA,,45,38.25,12.897,45,"UCare Health, Inc.",Individual & Family Plan,25.3575,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
FLUCONAZOLE 100 MG ORAL TABLET,,702,LOCAL,Facility,Inpatient,1,EA,,45,38.25,12.897,45,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
FLUCONAZOLE 100 MG ORAL TABLET,,702,LOCAL,Facility,Outpatient,1,EA,,45,38.25,12.897,45,"UCare Health, Inc.",Medical Assistance,22.7115,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FLUCONAZOLE 100 MG ORAL TABLET,,702,LOCAL,Facility,Inpatient,1,EA,,45,38.25,12.897,45,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
FLUCONAZOLE 100 MG ORAL TABLET,,702,LOCAL,Facility,Outpatient,1,EA,,45,38.25,12.897,45,"UCare Health, Inc.",Medicare Advantage,22.7115,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FLUCONAZOLE 100 MG ORAL TABLET,,702,LOCAL,Facility,Inpatient,1,EA,,45,38.25,12.897,45,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
FLUCONAZOLE 100 MG ORAL TABLET,,702,LOCAL,Facility,Outpatient,1,EA,,45,38.25,12.897,45,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),22.7115,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FLUCONAZOLE 100 MG ORAL TABLET,,702,LOCAL,Facility,Inpatient,1,EA,,45,38.25,12.897,45,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
FLUCONAZOLE 100 MG ORAL TABLET,,702,LOCAL,Facility,Both,1,EA,,45,38.25,12.897,45,UnitedHealthcare,Individual & Family,42.3,94,,percent of total billed charges,,
FLUCONAZOLE 100 MG ORAL TABLET,,702,LOCAL,Facility,Outpatient,1,EA,,45,38.25,12.897,45,UnitedHealthcare,Medicare Advantage,22.05,49,,percent of total billed charges,,
FLUCONAZOLE 100 MG ORAL TABLET,,702,LOCAL,Facility,Inpatient,1,EA,,45,38.25,12.897,45,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
FLUCONAZOLE 100 MG ORAL TABLET,,702,LOCAL,Facility,Outpatient,1,EA,,45,38.25,12.897,45,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,21.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
FLUCONAZOLE 100 MG ORAL TABLET,,702,LOCAL,Facility,Inpatient,1,EA,,45,38.25,12.897,45,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
METFORMIN 500 MG ORAL TABLET,,811,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
METFORMIN 500 MG ORAL TABLET,,811,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
METFORMIN 500 MG ORAL TABLET,,811,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
METFORMIN 500 MG ORAL TABLET,,811,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
METFORMIN 500 MG ORAL TABLET,,811,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
METFORMIN 500 MG ORAL TABLET,,811,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
METFORMIN 500 MG ORAL TABLET,,811,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
METFORMIN 500 MG ORAL TABLET,,811,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
METFORMIN 500 MG ORAL TABLET,,811,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
METFORMIN 500 MG ORAL TABLET,,811,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
METFORMIN 500 MG ORAL TABLET,,811,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
METFORMIN 500 MG ORAL TABLET,,811,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
METFORMIN 500 MG ORAL TABLET,,811,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
METFORMIN 500 MG ORAL TABLET,,811,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
METFORMIN 500 MG ORAL TABLET,,811,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
METFORMIN 500 MG ORAL TABLET,,811,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
METFORMIN 500 MG ORAL TABLET,,811,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
METFORMIN 500 MG ORAL TABLET,,811,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
METFORMIN 500 MG ORAL TABLET,,811,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
METFORMIN 500 MG ORAL TABLET,,811,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
METFORMIN 500 MG ORAL TABLET,,811,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
METFORMIN 500 MG ORAL TABLET,,811,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
METFORMIN 500 MG ORAL TABLET,,811,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
METFORMIN 500 MG ORAL TABLET,,811,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
METFORMIN 500 MG ORAL TABLET,,811,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
METFORMIN 500 MG ORAL TABLET,,811,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
METFORMIN 500 MG ORAL TABLET,,811,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
METFORMIN 500 MG ORAL TABLET,,811,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
METFORMIN 500 MG ORAL TABLET,,811,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
METFORMIN 500 MG ORAL TABLET,,811,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
METFORMIN 500 MG ORAL TABLET,,811,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
METFORMIN 500 MG ORAL TABLET,,811,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
METFORMIN 500 MG ORAL TABLET,,811,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
METFORMIN 500 MG ORAL TABLET,,811,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
METFORMIN 500 MG ORAL TABLET,,811,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
METFORMIN 500 MG ORAL TABLET,,811,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
METFORMIN 500 MG ORAL TABLET,,811,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
METFORMIN 500 MG ORAL TABLET,,811,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
METFORMIN 500 MG ORAL TABLET,,811,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
METFORMIN 500 MG ORAL TABLET,,811,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
METFORMIN 500 MG ORAL TABLET,,811,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
METFORMIN 500 MG ORAL TABLET,,811,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
METFORMIN 500 MG ORAL TABLET,,811,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
METFORMIN 500 MG ORAL TABLET,,811,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
METFORMIN 500 MG ORAL TABLET,,811,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
METFORMIN 500 MG ORAL TABLET,,811,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
METFORMIN 500 MG ORAL TABLET,,811,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
METFORMIN 500 MG ORAL TABLET,,811,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
METFORMIN 500 MG ORAL TABLET,,811,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
METFORMIN 500 MG ORAL TABLET,,811,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
METFORMIN 500 MG ORAL TABLET,,811,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
METFORMIN 500 MG ORAL TABLET,,811,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
METFORMIN 500 MG ORAL TABLET,,811,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
METFORMIN 500 MG ORAL TABLET,,811,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
PROPAFENONE 150 MG ORAL TABLET,,817,LOCAL,Facility,Both,1,EA,,9,7.65,2.5794,9,Aetna,Commercial,8.28,92,,percent of total billed charges,,
PROPAFENONE 150 MG ORAL TABLET,,817,LOCAL,Facility,Outpatient,1,EA,,9,7.65,2.5794,9,Aetna,Medicare Advantage,4.41,49,,percent of total billed charges,,
PROPAFENONE 150 MG ORAL TABLET,,817,LOCAL,Facility,Inpatient,1,EA,,9,7.65,2.5794,9,Aetna,Medicare Advantage,,,,,Included in per diem rate,
PROPAFENONE 150 MG ORAL TABLET,,817,LOCAL,Facility,Both,1,EA,,9,7.65,2.5794,9,Aetna,PPO,8.37,93,,percent of total billed charges,,
PROPAFENONE 150 MG ORAL TABLET,,817,LOCAL,Facility,Both,1,EA,,9,7.65,2.5794,9,America's PPO,America's PPO,8.6427,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
PROPAFENONE 150 MG ORAL TABLET,,817,LOCAL,Facility,Both,1,EA,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota, Federal Employee Program,8.856,98.4,,percent of total billed charges,,
PROPAFENONE 150 MG ORAL TABLET,,817,LOCAL,Facility,Both,1,EA,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,9,100,,percent of total billed charges,,
PROPAFENONE 150 MG ORAL TABLET,,817,LOCAL,Facility,Both,1,EA,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota,High Value Network Plan,8.1,90,,percent of total billed charges,,
PROPAFENONE 150 MG ORAL TABLET,,817,LOCAL,Facility,Outpatient,1,EA,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota,Medicare Advantage,4.41,49,,percent of total billed charges,,
PROPAFENONE 150 MG ORAL TABLET,,817,LOCAL,Facility,Inpatient,1,EA,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
PROPAFENONE 150 MG ORAL TABLET,,817,LOCAL,Facility,Both,1,EA,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,7.9713,88.57,,percent of total billed charges,,
PROPAFENONE 150 MG ORAL TABLET,,817,LOCAL,Facility,Both,1,EA,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,2.5794,28.66,,percent of total billed charges,,
PROPAFENONE 150 MG ORAL TABLET,,817,LOCAL,Facility,Outpatient,1,EA,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),4.41,49,,percent of total billed charges,,
PROPAFENONE 150 MG ORAL TABLET,,817,LOCAL,Facility,Inpatient,1,EA,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
PROPAFENONE 150 MG ORAL TABLET,,817,LOCAL,Facility,Both,1,EA,,9,7.65,2.5794,9,CorVel,Worker's Compensation,9,100,,percent of total billed charges,,
PROPAFENONE 150 MG ORAL TABLET,,817,LOCAL,Facility,Both,1,EA,,9,7.65,2.5794,9,First Health Group Corporation,First Health Network,8.73,97,,percent of total billed charges,,
PROPAFENONE 150 MG ORAL TABLET,,817,LOCAL,Facility,Both,1,EA,,9,7.65,2.5794,9,"Health Partners, Inc.",Commercial,8.514,94.6,,percent of total billed charges,,
PROPAFENONE 150 MG ORAL TABLET,,817,LOCAL,Facility,Outpatient,1,EA,,9,7.65,2.5794,9,"Health Partners, Inc.",Medicare Advantage,4.41,49,,percent of total billed charges,,
PROPAFENONE 150 MG ORAL TABLET,,817,LOCAL,Facility,Inpatient,1,EA,,9,7.65,2.5794,9,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PROPAFENONE 150 MG ORAL TABLET,,817,LOCAL,Facility,Both,1,EA,,9,7.65,2.5794,9,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),5.4,60,,percent of total billed charges,,
PROPAFENONE 150 MG ORAL TABLET,,817,LOCAL,Facility,Both,1,EA,,9,7.65,2.5794,9,"Health Partners, Inc.",State of Minnesota Advantage Program,7.335,81.5,,percent of total billed charges,,
PROPAFENONE 150 MG ORAL TABLET,,817,LOCAL,Facility,Both,1,EA,,9,7.65,2.5794,9,"Health Partners, Inc.",State Public Programs,4.5,50,,percent of total billed charges,,
PROPAFENONE 150 MG ORAL TABLET,,817,LOCAL,Facility,Both,1,EA,,9,7.65,2.5794,9,Humana Insurance Company,Commercial PPO,8.55,95,,percent of total billed charges,,
PROPAFENONE 150 MG ORAL TABLET,,817,LOCAL,Facility,Outpatient,1,EA,,9,7.65,2.5794,9,Humana Insurance Company,Medicare PPO,4.41,49,,percent of total billed charges,,
PROPAFENONE 150 MG ORAL TABLET,,817,LOCAL,Facility,Inpatient,1,EA,,9,7.65,2.5794,9,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
PROPAFENONE 150 MG ORAL TABLET,,817,LOCAL,Facility,Both,1,EA,,9,7.65,2.5794,9,Medica,Individual & Family,8.919,99.1,,percent of total billed charges,,
PROPAFENONE 150 MG ORAL TABLET,,817,LOCAL,Facility,Outpatient,1,EA,,9,7.65,2.5794,9,Medica,Medica Advantage Solution,4.482,49.8,,percent of total billed charges,,
PROPAFENONE 150 MG ORAL TABLET,,817,LOCAL,Facility,Inpatient,1,EA,,9,7.65,2.5794,9,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
PROPAFENONE 150 MG ORAL TABLET,,817,LOCAL,Facility,Outpatient,1,EA,,9,7.65,2.5794,9,Medica,Medical Assistance,4.014,44.6,,percent of total billed charges,,
PROPAFENONE 150 MG ORAL TABLET,,817,LOCAL,Facility,Inpatient,1,EA,,9,7.65,2.5794,9,Medica,Medical Assistance,,,,,Included in per diem rate,
PROPAFENONE 150 MG ORAL TABLET,,817,LOCAL,Facility,Outpatient,1,EA,,9,7.65,2.5794,9,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,4.482,49.8,,percent of total billed charges,,
PROPAFENONE 150 MG ORAL TABLET,,817,LOCAL,Facility,Inpatient,1,EA,,9,7.65,2.5794,9,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
PROPAFENONE 150 MG ORAL TABLET,,817,LOCAL,Facility,Both,1,EA,,9,7.65,2.5794,9,"Multiplan, Inc.","Multiplan, Inc.",8.46,94,,percent of total billed charges,,
PROPAFENONE 150 MG ORAL TABLET,,817,LOCAL,Facility,Outpatient,1,EA,,9,7.65,2.5794,9,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,8.109,90.1,,percent of total billed charges,,
PROPAFENONE 150 MG ORAL TABLET,,817,LOCAL,Facility,Inpatient,1,EA,,9,7.65,2.5794,9,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
PROPAFENONE 150 MG ORAL TABLET,,817,LOCAL,Facility,Both,1,EA,,9,7.65,2.5794,9,"Preferred One Administrative Services, INC.",PPO,8.874,98.6,,percent of total billed charges,,
PROPAFENONE 150 MG ORAL TABLET,,817,LOCAL,Facility,Outpatient,1,EA,,9,7.65,2.5794,9,PrimeWest Health,Minnesota Senior Health Options (MSHO),4.6305,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
PROPAFENONE 150 MG ORAL TABLET,,817,LOCAL,Facility,Inpatient,1,EA,,9,7.65,2.5794,9,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PROPAFENONE 150 MG ORAL TABLET,,817,LOCAL,Facility,Outpatient,1,EA,,9,7.65,2.5794,9,PrimeWest Health,MinnesotaCare,4.6224,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
PROPAFENONE 150 MG ORAL TABLET,,817,LOCAL,Facility,Inpatient,1,EA,,9,7.65,2.5794,9,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
PROPAFENONE 150 MG ORAL TABLET,,817,LOCAL,Facility,Both,1,EA,,9,7.65,2.5794,9,Sanford Health Plan,Sanford Health Plan,8.28,92,,percent of total billed charges,,
PROPAFENONE 150 MG ORAL TABLET,,817,LOCAL,Facility,Outpatient,1,EA,,9,7.65,2.5794,9,"UCare Health, Inc.",Individual & Family Plan,5.0715,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
PROPAFENONE 150 MG ORAL TABLET,,817,LOCAL,Facility,Inpatient,1,EA,,9,7.65,2.5794,9,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
PROPAFENONE 150 MG ORAL TABLET,,817,LOCAL,Facility,Outpatient,1,EA,,9,7.65,2.5794,9,"UCare Health, Inc.",Medical Assistance,4.5423,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PROPAFENONE 150 MG ORAL TABLET,,817,LOCAL,Facility,Inpatient,1,EA,,9,7.65,2.5794,9,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
PROPAFENONE 150 MG ORAL TABLET,,817,LOCAL,Facility,Outpatient,1,EA,,9,7.65,2.5794,9,"UCare Health, Inc.",Medicare Advantage,4.5423,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PROPAFENONE 150 MG ORAL TABLET,,817,LOCAL,Facility,Inpatient,1,EA,,9,7.65,2.5794,9,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PROPAFENONE 150 MG ORAL TABLET,,817,LOCAL,Facility,Outpatient,1,EA,,9,7.65,2.5794,9,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),4.5423,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PROPAFENONE 150 MG ORAL TABLET,,817,LOCAL,Facility,Inpatient,1,EA,,9,7.65,2.5794,9,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PROPAFENONE 150 MG ORAL TABLET,,817,LOCAL,Facility,Both,1,EA,,9,7.65,2.5794,9,UnitedHealthcare,Individual & Family,8.46,94,,percent of total billed charges,,
PROPAFENONE 150 MG ORAL TABLET,,817,LOCAL,Facility,Outpatient,1,EA,,9,7.65,2.5794,9,UnitedHealthcare,Medicare Advantage,4.41,49,,percent of total billed charges,,
PROPAFENONE 150 MG ORAL TABLET,,817,LOCAL,Facility,Inpatient,1,EA,,9,7.65,2.5794,9,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
PROPAFENONE 150 MG ORAL TABLET,,817,LOCAL,Facility,Outpatient,1,EA,,9,7.65,2.5794,9,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,4.32,48,,percent of total billed charges,,100% of DHS outpatient percentage
PROPAFENONE 150 MG ORAL TABLET,,817,LOCAL,Facility,Inpatient,1,EA,,9,7.65,2.5794,9,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
FENTANYL 50 MCG/HR TD PT72,,848,LOCAL,Facility,Both,1,EA,,175,148.75,50.155,175,Aetna,Commercial,161,92,,percent of total billed charges,,
FENTANYL 50 MCG/HR TD PT72,,848,LOCAL,Facility,Outpatient,1,EA,,175,148.75,50.155,175,Aetna,Medicare Advantage,85.75,49,,percent of total billed charges,,
FENTANYL 50 MCG/HR TD PT72,,848,LOCAL,Facility,Inpatient,1,EA,,175,148.75,50.155,175,Aetna,Medicare Advantage,,,,,Included in per diem rate,
FENTANYL 50 MCG/HR TD PT72,,848,LOCAL,Facility,Both,1,EA,,175,148.75,50.155,175,Aetna,PPO,162.75,93,,percent of total billed charges,,
FENTANYL 50 MCG/HR TD PT72,,848,LOCAL,Facility,Both,1,EA,,175,148.75,50.155,175,America's PPO,America's PPO,168.0525,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
FENTANYL 50 MCG/HR TD PT72,,848,LOCAL,Facility,Both,1,EA,,175,148.75,50.155,175,BlueCross BlueShield Minnesota, Federal Employee Program,172.2,98.4,,percent of total billed charges,,
FENTANYL 50 MCG/HR TD PT72,,848,LOCAL,Facility,Both,1,EA,,175,148.75,50.155,175,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,175,100,,percent of total billed charges,,
FENTANYL 50 MCG/HR TD PT72,,848,LOCAL,Facility,Both,1,EA,,175,148.75,50.155,175,BlueCross BlueShield Minnesota,High Value Network Plan,157.5,90,,percent of total billed charges,,
FENTANYL 50 MCG/HR TD PT72,,848,LOCAL,Facility,Outpatient,1,EA,,175,148.75,50.155,175,BlueCross BlueShield Minnesota,Medicare Advantage,85.75,49,,percent of total billed charges,,
FENTANYL 50 MCG/HR TD PT72,,848,LOCAL,Facility,Inpatient,1,EA,,175,148.75,50.155,175,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
FENTANYL 50 MCG/HR TD PT72,,848,LOCAL,Facility,Both,1,EA,,175,148.75,50.155,175,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,154.9975,88.57,,percent of total billed charges,,
FENTANYL 50 MCG/HR TD PT72,,848,LOCAL,Facility,Both,1,EA,,175,148.75,50.155,175,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,50.155,28.66,,percent of total billed charges,,
FENTANYL 50 MCG/HR TD PT72,,848,LOCAL,Facility,Outpatient,1,EA,,175,148.75,50.155,175,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),85.75,49,,percent of total billed charges,,
FENTANYL 50 MCG/HR TD PT72,,848,LOCAL,Facility,Inpatient,1,EA,,175,148.75,50.155,175,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
FENTANYL 50 MCG/HR TD PT72,,848,LOCAL,Facility,Both,1,EA,,175,148.75,50.155,175,CorVel,Worker's Compensation,175,100,,percent of total billed charges,,
FENTANYL 50 MCG/HR TD PT72,,848,LOCAL,Facility,Both,1,EA,,175,148.75,50.155,175,First Health Group Corporation,First Health Network,169.75,97,,percent of total billed charges,,
FENTANYL 50 MCG/HR TD PT72,,848,LOCAL,Facility,Both,1,EA,,175,148.75,50.155,175,"Health Partners, Inc.",Commercial,165.55,94.6,,percent of total billed charges,,
FENTANYL 50 MCG/HR TD PT72,,848,LOCAL,Facility,Outpatient,1,EA,,175,148.75,50.155,175,"Health Partners, Inc.",Medicare Advantage,85.75,49,,percent of total billed charges,,
FENTANYL 50 MCG/HR TD PT72,,848,LOCAL,Facility,Inpatient,1,EA,,175,148.75,50.155,175,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
FENTANYL 50 MCG/HR TD PT72,,848,LOCAL,Facility,Both,1,EA,,175,148.75,50.155,175,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),105,60,,percent of total billed charges,,
FENTANYL 50 MCG/HR TD PT72,,848,LOCAL,Facility,Both,1,EA,,175,148.75,50.155,175,"Health Partners, Inc.",State of Minnesota Advantage Program,142.625,81.5,,percent of total billed charges,,
FENTANYL 50 MCG/HR TD PT72,,848,LOCAL,Facility,Both,1,EA,,175,148.75,50.155,175,"Health Partners, Inc.",State Public Programs,87.5,50,,percent of total billed charges,,
FENTANYL 50 MCG/HR TD PT72,,848,LOCAL,Facility,Both,1,EA,,175,148.75,50.155,175,Humana Insurance Company,Commercial PPO,166.25,95,,percent of total billed charges,,
FENTANYL 50 MCG/HR TD PT72,,848,LOCAL,Facility,Outpatient,1,EA,,175,148.75,50.155,175,Humana Insurance Company,Medicare PPO,85.75,49,,percent of total billed charges,,
FENTANYL 50 MCG/HR TD PT72,,848,LOCAL,Facility,Inpatient,1,EA,,175,148.75,50.155,175,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
FENTANYL 50 MCG/HR TD PT72,,848,LOCAL,Facility,Both,1,EA,,175,148.75,50.155,175,Medica,Individual & Family,173.425,99.1,,percent of total billed charges,,
FENTANYL 50 MCG/HR TD PT72,,848,LOCAL,Facility,Outpatient,1,EA,,175,148.75,50.155,175,Medica,Medica Advantage Solution,87.15,49.8,,percent of total billed charges,,
FENTANYL 50 MCG/HR TD PT72,,848,LOCAL,Facility,Inpatient,1,EA,,175,148.75,50.155,175,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
FENTANYL 50 MCG/HR TD PT72,,848,LOCAL,Facility,Outpatient,1,EA,,175,148.75,50.155,175,Medica,Medical Assistance,78.05,44.6,,percent of total billed charges,,
FENTANYL 50 MCG/HR TD PT72,,848,LOCAL,Facility,Inpatient,1,EA,,175,148.75,50.155,175,Medica,Medical Assistance,,,,,Included in per diem rate,
FENTANYL 50 MCG/HR TD PT72,,848,LOCAL,Facility,Outpatient,1,EA,,175,148.75,50.155,175,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,87.15,49.8,,percent of total billed charges,,
FENTANYL 50 MCG/HR TD PT72,,848,LOCAL,Facility,Inpatient,1,EA,,175,148.75,50.155,175,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
FENTANYL 50 MCG/HR TD PT72,,848,LOCAL,Facility,Both,1,EA,,175,148.75,50.155,175,"Multiplan, Inc.","Multiplan, Inc.",164.5,94,,percent of total billed charges,,
FENTANYL 50 MCG/HR TD PT72,,848,LOCAL,Facility,Outpatient,1,EA,,175,148.75,50.155,175,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,157.675,90.1,,percent of total billed charges,,
FENTANYL 50 MCG/HR TD PT72,,848,LOCAL,Facility,Inpatient,1,EA,,175,148.75,50.155,175,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
FENTANYL 50 MCG/HR TD PT72,,848,LOCAL,Facility,Both,1,EA,,175,148.75,50.155,175,"Preferred One Administrative Services, INC.",PPO,172.55,98.6,,percent of total billed charges,,
FENTANYL 50 MCG/HR TD PT72,,848,LOCAL,Facility,Outpatient,1,EA,,175,148.75,50.155,175,PrimeWest Health,Minnesota Senior Health Options (MSHO),90.0375,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
FENTANYL 50 MCG/HR TD PT72,,848,LOCAL,Facility,Inpatient,1,EA,,175,148.75,50.155,175,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
FENTANYL 50 MCG/HR TD PT72,,848,LOCAL,Facility,Outpatient,1,EA,,175,148.75,50.155,175,PrimeWest Health,MinnesotaCare,89.88,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
FENTANYL 50 MCG/HR TD PT72,,848,LOCAL,Facility,Inpatient,1,EA,,175,148.75,50.155,175,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
FENTANYL 50 MCG/HR TD PT72,,848,LOCAL,Facility,Both,1,EA,,175,148.75,50.155,175,Sanford Health Plan,Sanford Health Plan,161,92,,percent of total billed charges,,
FENTANYL 50 MCG/HR TD PT72,,848,LOCAL,Facility,Outpatient,1,EA,,175,148.75,50.155,175,"UCare Health, Inc.",Individual & Family Plan,98.6125,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
FENTANYL 50 MCG/HR TD PT72,,848,LOCAL,Facility,Inpatient,1,EA,,175,148.75,50.155,175,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
FENTANYL 50 MCG/HR TD PT72,,848,LOCAL,Facility,Outpatient,1,EA,,175,148.75,50.155,175,"UCare Health, Inc.",Medical Assistance,88.3225,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FENTANYL 50 MCG/HR TD PT72,,848,LOCAL,Facility,Inpatient,1,EA,,175,148.75,50.155,175,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
FENTANYL 50 MCG/HR TD PT72,,848,LOCAL,Facility,Outpatient,1,EA,,175,148.75,50.155,175,"UCare Health, Inc.",Medicare Advantage,88.3225,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FENTANYL 50 MCG/HR TD PT72,,848,LOCAL,Facility,Inpatient,1,EA,,175,148.75,50.155,175,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
FENTANYL 50 MCG/HR TD PT72,,848,LOCAL,Facility,Outpatient,1,EA,,175,148.75,50.155,175,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),88.3225,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FENTANYL 50 MCG/HR TD PT72,,848,LOCAL,Facility,Inpatient,1,EA,,175,148.75,50.155,175,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
FENTANYL 50 MCG/HR TD PT72,,848,LOCAL,Facility,Both,1,EA,,175,148.75,50.155,175,UnitedHealthcare,Individual & Family,164.5,94,,percent of total billed charges,,
FENTANYL 50 MCG/HR TD PT72,,848,LOCAL,Facility,Outpatient,1,EA,,175,148.75,50.155,175,UnitedHealthcare,Medicare Advantage,85.75,49,,percent of total billed charges,,
FENTANYL 50 MCG/HR TD PT72,,848,LOCAL,Facility,Inpatient,1,EA,,175,148.75,50.155,175,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
FENTANYL 50 MCG/HR TD PT72,,848,LOCAL,Facility,Outpatient,1,EA,,175,148.75,50.155,175,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,84,48,,percent of total billed charges,,100% of DHS outpatient percentage
FENTANYL 50 MCG/HR TD PT72,,848,LOCAL,Facility,Inpatient,1,EA,,175,148.75,50.155,175,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
ASPIRIN 300 MG RECT SUPP,,853,LOCAL,Facility,Both,1,EA,,8,6.8,2.2928,8,Aetna,Commercial,7.36,92,,percent of total billed charges,,
ASPIRIN 300 MG RECT SUPP,,853,LOCAL,Facility,Outpatient,1,EA,,8,6.8,2.2928,8,Aetna,Medicare Advantage,3.92,49,,percent of total billed charges,,
ASPIRIN 300 MG RECT SUPP,,853,LOCAL,Facility,Inpatient,1,EA,,8,6.8,2.2928,8,Aetna,Medicare Advantage,,,,,Included in per diem rate,
ASPIRIN 300 MG RECT SUPP,,853,LOCAL,Facility,Both,1,EA,,8,6.8,2.2928,8,Aetna,PPO,7.44,93,,percent of total billed charges,,
ASPIRIN 300 MG RECT SUPP,,853,LOCAL,Facility,Both,1,EA,,8,6.8,2.2928,8,America's PPO,America's PPO,7.6824,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
ASPIRIN 300 MG RECT SUPP,,853,LOCAL,Facility,Both,1,EA,,8,6.8,2.2928,8,BlueCross BlueShield Minnesota, Federal Employee Program,7.872,98.4,,percent of total billed charges,,
ASPIRIN 300 MG RECT SUPP,,853,LOCAL,Facility,Both,1,EA,,8,6.8,2.2928,8,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,8,100,,percent of total billed charges,,
ASPIRIN 300 MG RECT SUPP,,853,LOCAL,Facility,Both,1,EA,,8,6.8,2.2928,8,BlueCross BlueShield Minnesota,High Value Network Plan,7.2,90,,percent of total billed charges,,
ASPIRIN 300 MG RECT SUPP,,853,LOCAL,Facility,Outpatient,1,EA,,8,6.8,2.2928,8,BlueCross BlueShield Minnesota,Medicare Advantage,3.92,49,,percent of total billed charges,,
ASPIRIN 300 MG RECT SUPP,,853,LOCAL,Facility,Inpatient,1,EA,,8,6.8,2.2928,8,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
ASPIRIN 300 MG RECT SUPP,,853,LOCAL,Facility,Both,1,EA,,8,6.8,2.2928,8,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,7.0856,88.57,,percent of total billed charges,,
ASPIRIN 300 MG RECT SUPP,,853,LOCAL,Facility,Both,1,EA,,8,6.8,2.2928,8,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,2.2928,28.66,,percent of total billed charges,,
ASPIRIN 300 MG RECT SUPP,,853,LOCAL,Facility,Outpatient,1,EA,,8,6.8,2.2928,8,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),3.92,49,,percent of total billed charges,,
ASPIRIN 300 MG RECT SUPP,,853,LOCAL,Facility,Inpatient,1,EA,,8,6.8,2.2928,8,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
ASPIRIN 300 MG RECT SUPP,,853,LOCAL,Facility,Both,1,EA,,8,6.8,2.2928,8,CorVel,Worker's Compensation,8,100,,percent of total billed charges,,
ASPIRIN 300 MG RECT SUPP,,853,LOCAL,Facility,Both,1,EA,,8,6.8,2.2928,8,First Health Group Corporation,First Health Network,7.76,97,,percent of total billed charges,,
ASPIRIN 300 MG RECT SUPP,,853,LOCAL,Facility,Both,1,EA,,8,6.8,2.2928,8,"Health Partners, Inc.",Commercial,7.568,94.6,,percent of total billed charges,,
ASPIRIN 300 MG RECT SUPP,,853,LOCAL,Facility,Outpatient,1,EA,,8,6.8,2.2928,8,"Health Partners, Inc.",Medicare Advantage,3.92,49,,percent of total billed charges,,
ASPIRIN 300 MG RECT SUPP,,853,LOCAL,Facility,Inpatient,1,EA,,8,6.8,2.2928,8,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ASPIRIN 300 MG RECT SUPP,,853,LOCAL,Facility,Both,1,EA,,8,6.8,2.2928,8,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),4.8,60,,percent of total billed charges,,
ASPIRIN 300 MG RECT SUPP,,853,LOCAL,Facility,Both,1,EA,,8,6.8,2.2928,8,"Health Partners, Inc.",State of Minnesota Advantage Program,6.52,81.5,,percent of total billed charges,,
ASPIRIN 300 MG RECT SUPP,,853,LOCAL,Facility,Both,1,EA,,8,6.8,2.2928,8,"Health Partners, Inc.",State Public Programs,4,50,,percent of total billed charges,,
ASPIRIN 300 MG RECT SUPP,,853,LOCAL,Facility,Both,1,EA,,8,6.8,2.2928,8,Humana Insurance Company,Commercial PPO,7.6,95,,percent of total billed charges,,
ASPIRIN 300 MG RECT SUPP,,853,LOCAL,Facility,Outpatient,1,EA,,8,6.8,2.2928,8,Humana Insurance Company,Medicare PPO,3.92,49,,percent of total billed charges,,
ASPIRIN 300 MG RECT SUPP,,853,LOCAL,Facility,Inpatient,1,EA,,8,6.8,2.2928,8,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
ASPIRIN 300 MG RECT SUPP,,853,LOCAL,Facility,Both,1,EA,,8,6.8,2.2928,8,Medica,Individual & Family,7.928,99.1,,percent of total billed charges,,
ASPIRIN 300 MG RECT SUPP,,853,LOCAL,Facility,Outpatient,1,EA,,8,6.8,2.2928,8,Medica,Medica Advantage Solution,3.984,49.8,,percent of total billed charges,,
ASPIRIN 300 MG RECT SUPP,,853,LOCAL,Facility,Inpatient,1,EA,,8,6.8,2.2928,8,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
ASPIRIN 300 MG RECT SUPP,,853,LOCAL,Facility,Outpatient,1,EA,,8,6.8,2.2928,8,Medica,Medical Assistance,3.568,44.6,,percent of total billed charges,,
ASPIRIN 300 MG RECT SUPP,,853,LOCAL,Facility,Inpatient,1,EA,,8,6.8,2.2928,8,Medica,Medical Assistance,,,,,Included in per diem rate,
ASPIRIN 300 MG RECT SUPP,,853,LOCAL,Facility,Outpatient,1,EA,,8,6.8,2.2928,8,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,3.984,49.8,,percent of total billed charges,,
ASPIRIN 300 MG RECT SUPP,,853,LOCAL,Facility,Inpatient,1,EA,,8,6.8,2.2928,8,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
ASPIRIN 300 MG RECT SUPP,,853,LOCAL,Facility,Both,1,EA,,8,6.8,2.2928,8,"Multiplan, Inc.","Multiplan, Inc.",7.52,94,,percent of total billed charges,,
ASPIRIN 300 MG RECT SUPP,,853,LOCAL,Facility,Outpatient,1,EA,,8,6.8,2.2928,8,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,7.208,90.1,,percent of total billed charges,,
ASPIRIN 300 MG RECT SUPP,,853,LOCAL,Facility,Inpatient,1,EA,,8,6.8,2.2928,8,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
ASPIRIN 300 MG RECT SUPP,,853,LOCAL,Facility,Both,1,EA,,8,6.8,2.2928,8,"Preferred One Administrative Services, INC.",PPO,7.888,98.6,,percent of total billed charges,,
ASPIRIN 300 MG RECT SUPP,,853,LOCAL,Facility,Outpatient,1,EA,,8,6.8,2.2928,8,PrimeWest Health,Minnesota Senior Health Options (MSHO),4.116,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
ASPIRIN 300 MG RECT SUPP,,853,LOCAL,Facility,Inpatient,1,EA,,8,6.8,2.2928,8,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ASPIRIN 300 MG RECT SUPP,,853,LOCAL,Facility,Outpatient,1,EA,,8,6.8,2.2928,8,PrimeWest Health,MinnesotaCare,4.1088,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
ASPIRIN 300 MG RECT SUPP,,853,LOCAL,Facility,Inpatient,1,EA,,8,6.8,2.2928,8,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
ASPIRIN 300 MG RECT SUPP,,853,LOCAL,Facility,Both,1,EA,,8,6.8,2.2928,8,Sanford Health Plan,Sanford Health Plan,7.36,92,,percent of total billed charges,,
ASPIRIN 300 MG RECT SUPP,,853,LOCAL,Facility,Outpatient,1,EA,,8,6.8,2.2928,8,"UCare Health, Inc.",Individual & Family Plan,4.508,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
ASPIRIN 300 MG RECT SUPP,,853,LOCAL,Facility,Inpatient,1,EA,,8,6.8,2.2928,8,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
ASPIRIN 300 MG RECT SUPP,,853,LOCAL,Facility,Outpatient,1,EA,,8,6.8,2.2928,8,"UCare Health, Inc.",Medical Assistance,4.0376,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ASPIRIN 300 MG RECT SUPP,,853,LOCAL,Facility,Inpatient,1,EA,,8,6.8,2.2928,8,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
ASPIRIN 300 MG RECT SUPP,,853,LOCAL,Facility,Outpatient,1,EA,,8,6.8,2.2928,8,"UCare Health, Inc.",Medicare Advantage,4.0376,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ASPIRIN 300 MG RECT SUPP,,853,LOCAL,Facility,Inpatient,1,EA,,8,6.8,2.2928,8,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ASPIRIN 300 MG RECT SUPP,,853,LOCAL,Facility,Outpatient,1,EA,,8,6.8,2.2928,8,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),4.0376,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ASPIRIN 300 MG RECT SUPP,,853,LOCAL,Facility,Inpatient,1,EA,,8,6.8,2.2928,8,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ASPIRIN 300 MG RECT SUPP,,853,LOCAL,Facility,Both,1,EA,,8,6.8,2.2928,8,UnitedHealthcare,Individual & Family,7.52,94,,percent of total billed charges,,
ASPIRIN 300 MG RECT SUPP,,853,LOCAL,Facility,Outpatient,1,EA,,8,6.8,2.2928,8,UnitedHealthcare,Medicare Advantage,3.92,49,,percent of total billed charges,,
ASPIRIN 300 MG RECT SUPP,,853,LOCAL,Facility,Inpatient,1,EA,,8,6.8,2.2928,8,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
ASPIRIN 300 MG RECT SUPP,,853,LOCAL,Facility,Outpatient,1,EA,,8,6.8,2.2928,8,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,3.84,48,,percent of total billed charges,,100% of DHS outpatient percentage
ASPIRIN 300 MG RECT SUPP,,853,LOCAL,Facility,Inpatient,1,EA,,8,6.8,2.2928,8,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
HYDRALAZINE 10 MG ORAL TABLET,,889,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
HYDRALAZINE 10 MG ORAL TABLET,,889,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
HYDRALAZINE 10 MG ORAL TABLET,,889,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
HYDRALAZINE 10 MG ORAL TABLET,,889,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
HYDRALAZINE 10 MG ORAL TABLET,,889,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
HYDRALAZINE 10 MG ORAL TABLET,,889,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
HYDRALAZINE 10 MG ORAL TABLET,,889,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
HYDRALAZINE 10 MG ORAL TABLET,,889,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
HYDRALAZINE 10 MG ORAL TABLET,,889,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
HYDRALAZINE 10 MG ORAL TABLET,,889,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
HYDRALAZINE 10 MG ORAL TABLET,,889,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
HYDRALAZINE 10 MG ORAL TABLET,,889,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
HYDRALAZINE 10 MG ORAL TABLET,,889,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
HYDRALAZINE 10 MG ORAL TABLET,,889,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
HYDRALAZINE 10 MG ORAL TABLET,,889,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
HYDRALAZINE 10 MG ORAL TABLET,,889,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
HYDRALAZINE 10 MG ORAL TABLET,,889,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
HYDRALAZINE 10 MG ORAL TABLET,,889,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
HYDRALAZINE 10 MG ORAL TABLET,,889,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
HYDRALAZINE 10 MG ORAL TABLET,,889,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
HYDRALAZINE 10 MG ORAL TABLET,,889,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
HYDRALAZINE 10 MG ORAL TABLET,,889,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
HYDRALAZINE 10 MG ORAL TABLET,,889,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
HYDRALAZINE 10 MG ORAL TABLET,,889,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
HYDRALAZINE 10 MG ORAL TABLET,,889,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
HYDRALAZINE 10 MG ORAL TABLET,,889,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
HYDRALAZINE 10 MG ORAL TABLET,,889,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
HYDRALAZINE 10 MG ORAL TABLET,,889,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
HYDRALAZINE 10 MG ORAL TABLET,,889,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
HYDRALAZINE 10 MG ORAL TABLET,,889,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
HYDRALAZINE 10 MG ORAL TABLET,,889,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
HYDRALAZINE 10 MG ORAL TABLET,,889,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
HYDRALAZINE 10 MG ORAL TABLET,,889,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
HYDRALAZINE 10 MG ORAL TABLET,,889,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
HYDRALAZINE 10 MG ORAL TABLET,,889,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
HYDRALAZINE 10 MG ORAL TABLET,,889,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
HYDRALAZINE 10 MG ORAL TABLET,,889,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
HYDRALAZINE 10 MG ORAL TABLET,,889,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
HYDRALAZINE 10 MG ORAL TABLET,,889,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
HYDRALAZINE 10 MG ORAL TABLET,,889,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
HYDRALAZINE 10 MG ORAL TABLET,,889,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
HYDRALAZINE 10 MG ORAL TABLET,,889,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
HYDRALAZINE 10 MG ORAL TABLET,,889,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
HYDRALAZINE 10 MG ORAL TABLET,,889,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
HYDRALAZINE 10 MG ORAL TABLET,,889,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
HYDRALAZINE 10 MG ORAL TABLET,,889,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
HYDRALAZINE 10 MG ORAL TABLET,,889,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
HYDRALAZINE 10 MG ORAL TABLET,,889,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
HYDRALAZINE 10 MG ORAL TABLET,,889,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
HYDRALAZINE 10 MG ORAL TABLET,,889,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
HYDRALAZINE 10 MG ORAL TABLET,,889,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
HYDRALAZINE 10 MG ORAL TABLET,,889,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
HYDRALAZINE 10 MG ORAL TABLET,,889,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
HYDRALAZINE 10 MG ORAL TABLET,,889,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
PRIMIDONE 50 MG ORAL TABLET,,1088,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
PRIMIDONE 50 MG ORAL TABLET,,1088,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
PRIMIDONE 50 MG ORAL TABLET,,1088,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
PRIMIDONE 50 MG ORAL TABLET,,1088,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
PRIMIDONE 50 MG ORAL TABLET,,1088,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
PRIMIDONE 50 MG ORAL TABLET,,1088,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
PRIMIDONE 50 MG ORAL TABLET,,1088,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
PRIMIDONE 50 MG ORAL TABLET,,1088,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
PRIMIDONE 50 MG ORAL TABLET,,1088,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
PRIMIDONE 50 MG ORAL TABLET,,1088,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
PRIMIDONE 50 MG ORAL TABLET,,1088,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
PRIMIDONE 50 MG ORAL TABLET,,1088,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
PRIMIDONE 50 MG ORAL TABLET,,1088,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
PRIMIDONE 50 MG ORAL TABLET,,1088,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
PRIMIDONE 50 MG ORAL TABLET,,1088,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
PRIMIDONE 50 MG ORAL TABLET,,1088,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
PRIMIDONE 50 MG ORAL TABLET,,1088,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
PRIMIDONE 50 MG ORAL TABLET,,1088,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
PRIMIDONE 50 MG ORAL TABLET,,1088,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PRIMIDONE 50 MG ORAL TABLET,,1088,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
PRIMIDONE 50 MG ORAL TABLET,,1088,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
PRIMIDONE 50 MG ORAL TABLET,,1088,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
PRIMIDONE 50 MG ORAL TABLET,,1088,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
PRIMIDONE 50 MG ORAL TABLET,,1088,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
PRIMIDONE 50 MG ORAL TABLET,,1088,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
PRIMIDONE 50 MG ORAL TABLET,,1088,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
PRIMIDONE 50 MG ORAL TABLET,,1088,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
PRIMIDONE 50 MG ORAL TABLET,,1088,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
PRIMIDONE 50 MG ORAL TABLET,,1088,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
PRIMIDONE 50 MG ORAL TABLET,,1088,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
PRIMIDONE 50 MG ORAL TABLET,,1088,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
PRIMIDONE 50 MG ORAL TABLET,,1088,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
PRIMIDONE 50 MG ORAL TABLET,,1088,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
PRIMIDONE 50 MG ORAL TABLET,,1088,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
PRIMIDONE 50 MG ORAL TABLET,,1088,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
PRIMIDONE 50 MG ORAL TABLET,,1088,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
PRIMIDONE 50 MG ORAL TABLET,,1088,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
PRIMIDONE 50 MG ORAL TABLET,,1088,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PRIMIDONE 50 MG ORAL TABLET,,1088,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
PRIMIDONE 50 MG ORAL TABLET,,1088,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
PRIMIDONE 50 MG ORAL TABLET,,1088,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
PRIMIDONE 50 MG ORAL TABLET,,1088,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
PRIMIDONE 50 MG ORAL TABLET,,1088,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
PRIMIDONE 50 MG ORAL TABLET,,1088,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PRIMIDONE 50 MG ORAL TABLET,,1088,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
PRIMIDONE 50 MG ORAL TABLET,,1088,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PRIMIDONE 50 MG ORAL TABLET,,1088,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PRIMIDONE 50 MG ORAL TABLET,,1088,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PRIMIDONE 50 MG ORAL TABLET,,1088,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PRIMIDONE 50 MG ORAL TABLET,,1088,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
PRIMIDONE 50 MG ORAL TABLET,,1088,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
PRIMIDONE 50 MG ORAL TABLET,,1088,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
PRIMIDONE 50 MG ORAL TABLET,,1088,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
PRIMIDONE 50 MG ORAL TABLET,,1088,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
FLUTICASONE PROPION-SALMETEROL 250-50 MCG/DOSE INHL DSDV,,1172,LOCAL,Facility,Both,1,EA,,711,604.35,203.7726,711,Aetna,Commercial,654.12,92,,percent of total billed charges,,
FLUTICASONE PROPION-SALMETEROL 250-50 MCG/DOSE INHL DSDV,,1172,LOCAL,Facility,Outpatient,1,EA,,711,604.35,203.7726,711,Aetna,Medicare Advantage,348.39,49,,percent of total billed charges,,
FLUTICASONE PROPION-SALMETEROL 250-50 MCG/DOSE INHL DSDV,,1172,LOCAL,Facility,Inpatient,1,EA,,711,604.35,203.7726,711,Aetna,Medicare Advantage,,,,,Included in per diem rate,
FLUTICASONE PROPION-SALMETEROL 250-50 MCG/DOSE INHL DSDV,,1172,LOCAL,Facility,Both,1,EA,,711,604.35,203.7726,711,Aetna,PPO,661.23,93,,percent of total billed charges,,
FLUTICASONE PROPION-SALMETEROL 250-50 MCG/DOSE INHL DSDV,,1172,LOCAL,Facility,Both,1,EA,,711,604.35,203.7726,711,America's PPO,America's PPO,682.7733,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
FLUTICASONE PROPION-SALMETEROL 250-50 MCG/DOSE INHL DSDV,,1172,LOCAL,Facility,Both,1,EA,,711,604.35,203.7726,711,BlueCross BlueShield Minnesota, Federal Employee Program,699.624,98.4,,percent of total billed charges,,
FLUTICASONE PROPION-SALMETEROL 250-50 MCG/DOSE INHL DSDV,,1172,LOCAL,Facility,Both,1,EA,,711,604.35,203.7726,711,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,711,100,,percent of total billed charges,,
FLUTICASONE PROPION-SALMETEROL 250-50 MCG/DOSE INHL DSDV,,1172,LOCAL,Facility,Both,1,EA,,711,604.35,203.7726,711,BlueCross BlueShield Minnesota,High Value Network Plan,639.9,90,,percent of total billed charges,,
FLUTICASONE PROPION-SALMETEROL 250-50 MCG/DOSE INHL DSDV,,1172,LOCAL,Facility,Outpatient,1,EA,,711,604.35,203.7726,711,BlueCross BlueShield Minnesota,Medicare Advantage,348.39,49,,percent of total billed charges,,
FLUTICASONE PROPION-SALMETEROL 250-50 MCG/DOSE INHL DSDV,,1172,LOCAL,Facility,Inpatient,1,EA,,711,604.35,203.7726,711,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
FLUTICASONE PROPION-SALMETEROL 250-50 MCG/DOSE INHL DSDV,,1172,LOCAL,Facility,Both,1,EA,,711,604.35,203.7726,711,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,629.7327,88.57,,percent of total billed charges,,
FLUTICASONE PROPION-SALMETEROL 250-50 MCG/DOSE INHL DSDV,,1172,LOCAL,Facility,Both,1,EA,,711,604.35,203.7726,711,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,203.7726,28.66,,percent of total billed charges,,
FLUTICASONE PROPION-SALMETEROL 250-50 MCG/DOSE INHL DSDV,,1172,LOCAL,Facility,Outpatient,1,EA,,711,604.35,203.7726,711,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),348.39,49,,percent of total billed charges,,
FLUTICASONE PROPION-SALMETEROL 250-50 MCG/DOSE INHL DSDV,,1172,LOCAL,Facility,Inpatient,1,EA,,711,604.35,203.7726,711,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
FLUTICASONE PROPION-SALMETEROL 250-50 MCG/DOSE INHL DSDV,,1172,LOCAL,Facility,Both,1,EA,,711,604.35,203.7726,711,CorVel,Worker's Compensation,711,100,,percent of total billed charges,,
FLUTICASONE PROPION-SALMETEROL 250-50 MCG/DOSE INHL DSDV,,1172,LOCAL,Facility,Both,1,EA,,711,604.35,203.7726,711,First Health Group Corporation,First Health Network,689.67,97,,percent of total billed charges,,
FLUTICASONE PROPION-SALMETEROL 250-50 MCG/DOSE INHL DSDV,,1172,LOCAL,Facility,Both,1,EA,,711,604.35,203.7726,711,"Health Partners, Inc.",Commercial,672.606,94.6,,percent of total billed charges,,
FLUTICASONE PROPION-SALMETEROL 250-50 MCG/DOSE INHL DSDV,,1172,LOCAL,Facility,Outpatient,1,EA,,711,604.35,203.7726,711,"Health Partners, Inc.",Medicare Advantage,348.39,49,,percent of total billed charges,,
FLUTICASONE PROPION-SALMETEROL 250-50 MCG/DOSE INHL DSDV,,1172,LOCAL,Facility,Inpatient,1,EA,,711,604.35,203.7726,711,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
FLUTICASONE PROPION-SALMETEROL 250-50 MCG/DOSE INHL DSDV,,1172,LOCAL,Facility,Both,1,EA,,711,604.35,203.7726,711,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),426.6,60,,percent of total billed charges,,
FLUTICASONE PROPION-SALMETEROL 250-50 MCG/DOSE INHL DSDV,,1172,LOCAL,Facility,Both,1,EA,,711,604.35,203.7726,711,"Health Partners, Inc.",State of Minnesota Advantage Program,579.465,81.5,,percent of total billed charges,,
FLUTICASONE PROPION-SALMETEROL 250-50 MCG/DOSE INHL DSDV,,1172,LOCAL,Facility,Both,1,EA,,711,604.35,203.7726,711,"Health Partners, Inc.",State Public Programs,355.5,50,,percent of total billed charges,,
FLUTICASONE PROPION-SALMETEROL 250-50 MCG/DOSE INHL DSDV,,1172,LOCAL,Facility,Both,1,EA,,711,604.35,203.7726,711,Humana Insurance Company,Commercial PPO,675.45,95,,percent of total billed charges,,
FLUTICASONE PROPION-SALMETEROL 250-50 MCG/DOSE INHL DSDV,,1172,LOCAL,Facility,Outpatient,1,EA,,711,604.35,203.7726,711,Humana Insurance Company,Medicare PPO,348.39,49,,percent of total billed charges,,
FLUTICASONE PROPION-SALMETEROL 250-50 MCG/DOSE INHL DSDV,,1172,LOCAL,Facility,Inpatient,1,EA,,711,604.35,203.7726,711,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
FLUTICASONE PROPION-SALMETEROL 250-50 MCG/DOSE INHL DSDV,,1172,LOCAL,Facility,Both,1,EA,,711,604.35,203.7726,711,Medica,Individual & Family,704.601,99.1,,percent of total billed charges,,
FLUTICASONE PROPION-SALMETEROL 250-50 MCG/DOSE INHL DSDV,,1172,LOCAL,Facility,Outpatient,1,EA,,711,604.35,203.7726,711,Medica,Medica Advantage Solution,354.078,49.8,,percent of total billed charges,,
FLUTICASONE PROPION-SALMETEROL 250-50 MCG/DOSE INHL DSDV,,1172,LOCAL,Facility,Inpatient,1,EA,,711,604.35,203.7726,711,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
FLUTICASONE PROPION-SALMETEROL 250-50 MCG/DOSE INHL DSDV,,1172,LOCAL,Facility,Outpatient,1,EA,,711,604.35,203.7726,711,Medica,Medical Assistance,317.106,44.6,,percent of total billed charges,,
FLUTICASONE PROPION-SALMETEROL 250-50 MCG/DOSE INHL DSDV,,1172,LOCAL,Facility,Inpatient,1,EA,,711,604.35,203.7726,711,Medica,Medical Assistance,,,,,Included in per diem rate,
FLUTICASONE PROPION-SALMETEROL 250-50 MCG/DOSE INHL DSDV,,1172,LOCAL,Facility,Outpatient,1,EA,,711,604.35,203.7726,711,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,354.078,49.8,,percent of total billed charges,,
FLUTICASONE PROPION-SALMETEROL 250-50 MCG/DOSE INHL DSDV,,1172,LOCAL,Facility,Inpatient,1,EA,,711,604.35,203.7726,711,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
FLUTICASONE PROPION-SALMETEROL 250-50 MCG/DOSE INHL DSDV,,1172,LOCAL,Facility,Both,1,EA,,711,604.35,203.7726,711,"Multiplan, Inc.","Multiplan, Inc.",668.34,94,,percent of total billed charges,,
FLUTICASONE PROPION-SALMETEROL 250-50 MCG/DOSE INHL DSDV,,1172,LOCAL,Facility,Outpatient,1,EA,,711,604.35,203.7726,711,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,640.611,90.1,,percent of total billed charges,,
FLUTICASONE PROPION-SALMETEROL 250-50 MCG/DOSE INHL DSDV,,1172,LOCAL,Facility,Inpatient,1,EA,,711,604.35,203.7726,711,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
FLUTICASONE PROPION-SALMETEROL 250-50 MCG/DOSE INHL DSDV,,1172,LOCAL,Facility,Both,1,EA,,711,604.35,203.7726,711,"Preferred One Administrative Services, INC.",PPO,701.046,98.6,,percent of total billed charges,,
FLUTICASONE PROPION-SALMETEROL 250-50 MCG/DOSE INHL DSDV,,1172,LOCAL,Facility,Outpatient,1,EA,,711,604.35,203.7726,711,PrimeWest Health,Minnesota Senior Health Options (MSHO),365.8095,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
FLUTICASONE PROPION-SALMETEROL 250-50 MCG/DOSE INHL DSDV,,1172,LOCAL,Facility,Inpatient,1,EA,,711,604.35,203.7726,711,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
FLUTICASONE PROPION-SALMETEROL 250-50 MCG/DOSE INHL DSDV,,1172,LOCAL,Facility,Outpatient,1,EA,,711,604.35,203.7726,711,PrimeWest Health,MinnesotaCare,365.1696,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
FLUTICASONE PROPION-SALMETEROL 250-50 MCG/DOSE INHL DSDV,,1172,LOCAL,Facility,Inpatient,1,EA,,711,604.35,203.7726,711,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
FLUTICASONE PROPION-SALMETEROL 250-50 MCG/DOSE INHL DSDV,,1172,LOCAL,Facility,Both,1,EA,,711,604.35,203.7726,711,Sanford Health Plan,Sanford Health Plan,654.12,92,,percent of total billed charges,,
FLUTICASONE PROPION-SALMETEROL 250-50 MCG/DOSE INHL DSDV,,1172,LOCAL,Facility,Outpatient,1,EA,,711,604.35,203.7726,711,"UCare Health, Inc.",Individual & Family Plan,400.6485,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
FLUTICASONE PROPION-SALMETEROL 250-50 MCG/DOSE INHL DSDV,,1172,LOCAL,Facility,Inpatient,1,EA,,711,604.35,203.7726,711,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
FLUTICASONE PROPION-SALMETEROL 250-50 MCG/DOSE INHL DSDV,,1172,LOCAL,Facility,Outpatient,1,EA,,711,604.35,203.7726,711,"UCare Health, Inc.",Medical Assistance,358.8417,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FLUTICASONE PROPION-SALMETEROL 250-50 MCG/DOSE INHL DSDV,,1172,LOCAL,Facility,Inpatient,1,EA,,711,604.35,203.7726,711,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
FLUTICASONE PROPION-SALMETEROL 250-50 MCG/DOSE INHL DSDV,,1172,LOCAL,Facility,Outpatient,1,EA,,711,604.35,203.7726,711,"UCare Health, Inc.",Medicare Advantage,358.8417,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FLUTICASONE PROPION-SALMETEROL 250-50 MCG/DOSE INHL DSDV,,1172,LOCAL,Facility,Inpatient,1,EA,,711,604.35,203.7726,711,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
FLUTICASONE PROPION-SALMETEROL 250-50 MCG/DOSE INHL DSDV,,1172,LOCAL,Facility,Outpatient,1,EA,,711,604.35,203.7726,711,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),358.8417,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FLUTICASONE PROPION-SALMETEROL 250-50 MCG/DOSE INHL DSDV,,1172,LOCAL,Facility,Inpatient,1,EA,,711,604.35,203.7726,711,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
FLUTICASONE PROPION-SALMETEROL 250-50 MCG/DOSE INHL DSDV,,1172,LOCAL,Facility,Both,1,EA,,711,604.35,203.7726,711,UnitedHealthcare,Individual & Family,668.34,94,,percent of total billed charges,,
FLUTICASONE PROPION-SALMETEROL 250-50 MCG/DOSE INHL DSDV,,1172,LOCAL,Facility,Outpatient,1,EA,,711,604.35,203.7726,711,UnitedHealthcare,Medicare Advantage,348.39,49,,percent of total billed charges,,
FLUTICASONE PROPION-SALMETEROL 250-50 MCG/DOSE INHL DSDV,,1172,LOCAL,Facility,Inpatient,1,EA,,711,604.35,203.7726,711,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
FLUTICASONE PROPION-SALMETEROL 250-50 MCG/DOSE INHL DSDV,,1172,LOCAL,Facility,Outpatient,1,EA,,711,604.35,203.7726,711,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,341.28,48,,percent of total billed charges,,100% of DHS outpatient percentage
FLUTICASONE PROPION-SALMETEROL 250-50 MCG/DOSE INHL DSDV,,1172,LOCAL,Facility,Inpatient,1,EA,,711,604.35,203.7726,711,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
SENNOSIDES 8.6 MG ORAL TABLET,,1300,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
SENNOSIDES 8.6 MG ORAL TABLET,,1300,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
SENNOSIDES 8.6 MG ORAL TABLET,,1300,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
SENNOSIDES 8.6 MG ORAL TABLET,,1300,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
SENNOSIDES 8.6 MG ORAL TABLET,,1300,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SENNOSIDES 8.6 MG ORAL TABLET,,1300,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
SENNOSIDES 8.6 MG ORAL TABLET,,1300,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
SENNOSIDES 8.6 MG ORAL TABLET,,1300,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
SENNOSIDES 8.6 MG ORAL TABLET,,1300,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
SENNOSIDES 8.6 MG ORAL TABLET,,1300,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
SENNOSIDES 8.6 MG ORAL TABLET,,1300,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
SENNOSIDES 8.6 MG ORAL TABLET,,1300,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
SENNOSIDES 8.6 MG ORAL TABLET,,1300,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
SENNOSIDES 8.6 MG ORAL TABLET,,1300,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
SENNOSIDES 8.6 MG ORAL TABLET,,1300,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
SENNOSIDES 8.6 MG ORAL TABLET,,1300,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
SENNOSIDES 8.6 MG ORAL TABLET,,1300,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
SENNOSIDES 8.6 MG ORAL TABLET,,1300,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
SENNOSIDES 8.6 MG ORAL TABLET,,1300,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SENNOSIDES 8.6 MG ORAL TABLET,,1300,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
SENNOSIDES 8.6 MG ORAL TABLET,,1300,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
SENNOSIDES 8.6 MG ORAL TABLET,,1300,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
SENNOSIDES 8.6 MG ORAL TABLET,,1300,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
SENNOSIDES 8.6 MG ORAL TABLET,,1300,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
SENNOSIDES 8.6 MG ORAL TABLET,,1300,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
SENNOSIDES 8.6 MG ORAL TABLET,,1300,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
SENNOSIDES 8.6 MG ORAL TABLET,,1300,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
SENNOSIDES 8.6 MG ORAL TABLET,,1300,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
SENNOSIDES 8.6 MG ORAL TABLET,,1300,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
SENNOSIDES 8.6 MG ORAL TABLET,,1300,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
SENNOSIDES 8.6 MG ORAL TABLET,,1300,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
SENNOSIDES 8.6 MG ORAL TABLET,,1300,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
SENNOSIDES 8.6 MG ORAL TABLET,,1300,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
SENNOSIDES 8.6 MG ORAL TABLET,,1300,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
SENNOSIDES 8.6 MG ORAL TABLET,,1300,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
SENNOSIDES 8.6 MG ORAL TABLET,,1300,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
SENNOSIDES 8.6 MG ORAL TABLET,,1300,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
SENNOSIDES 8.6 MG ORAL TABLET,,1300,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SENNOSIDES 8.6 MG ORAL TABLET,,1300,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
SENNOSIDES 8.6 MG ORAL TABLET,,1300,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
SENNOSIDES 8.6 MG ORAL TABLET,,1300,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
SENNOSIDES 8.6 MG ORAL TABLET,,1300,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
SENNOSIDES 8.6 MG ORAL TABLET,,1300,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
SENNOSIDES 8.6 MG ORAL TABLET,,1300,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SENNOSIDES 8.6 MG ORAL TABLET,,1300,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
SENNOSIDES 8.6 MG ORAL TABLET,,1300,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SENNOSIDES 8.6 MG ORAL TABLET,,1300,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SENNOSIDES 8.6 MG ORAL TABLET,,1300,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SENNOSIDES 8.6 MG ORAL TABLET,,1300,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SENNOSIDES 8.6 MG ORAL TABLET,,1300,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
SENNOSIDES 8.6 MG ORAL TABLET,,1300,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
SENNOSIDES 8.6 MG ORAL TABLET,,1300,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
SENNOSIDES 8.6 MG ORAL TABLET,,1300,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
SENNOSIDES 8.6 MG ORAL TABLET,,1300,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
VENLAFAXINE 37.5 MG ORAL CP24,,1332,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
VENLAFAXINE 37.5 MG ORAL CP24,,1332,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
VENLAFAXINE 37.5 MG ORAL CP24,,1332,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
VENLAFAXINE 37.5 MG ORAL CP24,,1332,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
VENLAFAXINE 37.5 MG ORAL CP24,,1332,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
VENLAFAXINE 37.5 MG ORAL CP24,,1332,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
VENLAFAXINE 37.5 MG ORAL CP24,,1332,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
VENLAFAXINE 37.5 MG ORAL CP24,,1332,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
VENLAFAXINE 37.5 MG ORAL CP24,,1332,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
VENLAFAXINE 37.5 MG ORAL CP24,,1332,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
VENLAFAXINE 37.5 MG ORAL CP24,,1332,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
VENLAFAXINE 37.5 MG ORAL CP24,,1332,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
VENLAFAXINE 37.5 MG ORAL CP24,,1332,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
VENLAFAXINE 37.5 MG ORAL CP24,,1332,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
VENLAFAXINE 37.5 MG ORAL CP24,,1332,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
VENLAFAXINE 37.5 MG ORAL CP24,,1332,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
VENLAFAXINE 37.5 MG ORAL CP24,,1332,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
VENLAFAXINE 37.5 MG ORAL CP24,,1332,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
VENLAFAXINE 37.5 MG ORAL CP24,,1332,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
VENLAFAXINE 37.5 MG ORAL CP24,,1332,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
VENLAFAXINE 37.5 MG ORAL CP24,,1332,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
VENLAFAXINE 37.5 MG ORAL CP24,,1332,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
VENLAFAXINE 37.5 MG ORAL CP24,,1332,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
VENLAFAXINE 37.5 MG ORAL CP24,,1332,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
VENLAFAXINE 37.5 MG ORAL CP24,,1332,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
VENLAFAXINE 37.5 MG ORAL CP24,,1332,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
VENLAFAXINE 37.5 MG ORAL CP24,,1332,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
VENLAFAXINE 37.5 MG ORAL CP24,,1332,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
VENLAFAXINE 37.5 MG ORAL CP24,,1332,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
VENLAFAXINE 37.5 MG ORAL CP24,,1332,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
VENLAFAXINE 37.5 MG ORAL CP24,,1332,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
VENLAFAXINE 37.5 MG ORAL CP24,,1332,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
VENLAFAXINE 37.5 MG ORAL CP24,,1332,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
VENLAFAXINE 37.5 MG ORAL CP24,,1332,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
VENLAFAXINE 37.5 MG ORAL CP24,,1332,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
VENLAFAXINE 37.5 MG ORAL CP24,,1332,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
VENLAFAXINE 37.5 MG ORAL CP24,,1332,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
VENLAFAXINE 37.5 MG ORAL CP24,,1332,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
VENLAFAXINE 37.5 MG ORAL CP24,,1332,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
VENLAFAXINE 37.5 MG ORAL CP24,,1332,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
VENLAFAXINE 37.5 MG ORAL CP24,,1332,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
VENLAFAXINE 37.5 MG ORAL CP24,,1332,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
VENLAFAXINE 37.5 MG ORAL CP24,,1332,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
VENLAFAXINE 37.5 MG ORAL CP24,,1332,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
VENLAFAXINE 37.5 MG ORAL CP24,,1332,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
VENLAFAXINE 37.5 MG ORAL CP24,,1332,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
VENLAFAXINE 37.5 MG ORAL CP24,,1332,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
VENLAFAXINE 37.5 MG ORAL CP24,,1332,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
VENLAFAXINE 37.5 MG ORAL CP24,,1332,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
VENLAFAXINE 37.5 MG ORAL CP24,,1332,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
VENLAFAXINE 37.5 MG ORAL CP24,,1332,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
VENLAFAXINE 37.5 MG ORAL CP24,,1332,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
VENLAFAXINE 37.5 MG ORAL CP24,,1332,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
VENLAFAXINE 37.5 MG ORAL CP24,,1332,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
CLONIDINE HCL 0.1 MG ORAL TABLET,,1380,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
CLONIDINE HCL 0.1 MG ORAL TABLET,,1380,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
CLONIDINE HCL 0.1 MG ORAL TABLET,,1380,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
CLONIDINE HCL 0.1 MG ORAL TABLET,,1380,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
CLONIDINE HCL 0.1 MG ORAL TABLET,,1380,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
CLONIDINE HCL 0.1 MG ORAL TABLET,,1380,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
CLONIDINE HCL 0.1 MG ORAL TABLET,,1380,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
CLONIDINE HCL 0.1 MG ORAL TABLET,,1380,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
CLONIDINE HCL 0.1 MG ORAL TABLET,,1380,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
CLONIDINE HCL 0.1 MG ORAL TABLET,,1380,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
CLONIDINE HCL 0.1 MG ORAL TABLET,,1380,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
CLONIDINE HCL 0.1 MG ORAL TABLET,,1380,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
CLONIDINE HCL 0.1 MG ORAL TABLET,,1380,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
CLONIDINE HCL 0.1 MG ORAL TABLET,,1380,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
CLONIDINE HCL 0.1 MG ORAL TABLET,,1380,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
CLONIDINE HCL 0.1 MG ORAL TABLET,,1380,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
CLONIDINE HCL 0.1 MG ORAL TABLET,,1380,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
CLONIDINE HCL 0.1 MG ORAL TABLET,,1380,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
CLONIDINE HCL 0.1 MG ORAL TABLET,,1380,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CLONIDINE HCL 0.1 MG ORAL TABLET,,1380,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
CLONIDINE HCL 0.1 MG ORAL TABLET,,1380,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
CLONIDINE HCL 0.1 MG ORAL TABLET,,1380,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
CLONIDINE HCL 0.1 MG ORAL TABLET,,1380,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
CLONIDINE HCL 0.1 MG ORAL TABLET,,1380,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
CLONIDINE HCL 0.1 MG ORAL TABLET,,1380,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
CLONIDINE HCL 0.1 MG ORAL TABLET,,1380,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
CLONIDINE HCL 0.1 MG ORAL TABLET,,1380,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
CLONIDINE HCL 0.1 MG ORAL TABLET,,1380,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
CLONIDINE HCL 0.1 MG ORAL TABLET,,1380,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
CLONIDINE HCL 0.1 MG ORAL TABLET,,1380,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
CLONIDINE HCL 0.1 MG ORAL TABLET,,1380,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
CLONIDINE HCL 0.1 MG ORAL TABLET,,1380,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
CLONIDINE HCL 0.1 MG ORAL TABLET,,1380,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
CLONIDINE HCL 0.1 MG ORAL TABLET,,1380,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
CLONIDINE HCL 0.1 MG ORAL TABLET,,1380,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
CLONIDINE HCL 0.1 MG ORAL TABLET,,1380,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
CLONIDINE HCL 0.1 MG ORAL TABLET,,1380,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
CLONIDINE HCL 0.1 MG ORAL TABLET,,1380,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CLONIDINE HCL 0.1 MG ORAL TABLET,,1380,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
CLONIDINE HCL 0.1 MG ORAL TABLET,,1380,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
CLONIDINE HCL 0.1 MG ORAL TABLET,,1380,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
CLONIDINE HCL 0.1 MG ORAL TABLET,,1380,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
CLONIDINE HCL 0.1 MG ORAL TABLET,,1380,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
CLONIDINE HCL 0.1 MG ORAL TABLET,,1380,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CLONIDINE HCL 0.1 MG ORAL TABLET,,1380,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
CLONIDINE HCL 0.1 MG ORAL TABLET,,1380,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CLONIDINE HCL 0.1 MG ORAL TABLET,,1380,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CLONIDINE HCL 0.1 MG ORAL TABLET,,1380,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CLONIDINE HCL 0.1 MG ORAL TABLET,,1380,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CLONIDINE HCL 0.1 MG ORAL TABLET,,1380,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
CLONIDINE HCL 0.1 MG ORAL TABLET,,1380,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
CLONIDINE HCL 0.1 MG ORAL TABLET,,1380,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
CLONIDINE HCL 0.1 MG ORAL TABLET,,1380,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
CLONIDINE HCL 0.1 MG ORAL TABLET,,1380,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
ACETAMINOPHEN 325 MG ORAL TABLET,,1438,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
ACETAMINOPHEN 325 MG ORAL TABLET,,1438,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
ACETAMINOPHEN 325 MG ORAL TABLET,,1438,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
ACETAMINOPHEN 325 MG ORAL TABLET,,1438,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
ACETAMINOPHEN 325 MG ORAL TABLET,,1438,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
ACETAMINOPHEN 325 MG ORAL TABLET,,1438,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
ACETAMINOPHEN 325 MG ORAL TABLET,,1438,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
ACETAMINOPHEN 325 MG ORAL TABLET,,1438,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
ACETAMINOPHEN 325 MG ORAL TABLET,,1438,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
ACETAMINOPHEN 325 MG ORAL TABLET,,1438,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
ACETAMINOPHEN 325 MG ORAL TABLET,,1438,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
ACETAMINOPHEN 325 MG ORAL TABLET,,1438,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
ACETAMINOPHEN 325 MG ORAL TABLET,,1438,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
ACETAMINOPHEN 325 MG ORAL TABLET,,1438,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
ACETAMINOPHEN 325 MG ORAL TABLET,,1438,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
ACETAMINOPHEN 325 MG ORAL TABLET,,1438,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
ACETAMINOPHEN 325 MG ORAL TABLET,,1438,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
ACETAMINOPHEN 325 MG ORAL TABLET,,1438,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
ACETAMINOPHEN 325 MG ORAL TABLET,,1438,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ACETAMINOPHEN 325 MG ORAL TABLET,,1438,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
ACETAMINOPHEN 325 MG ORAL TABLET,,1438,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
ACETAMINOPHEN 325 MG ORAL TABLET,,1438,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
ACETAMINOPHEN 325 MG ORAL TABLET,,1438,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
ACETAMINOPHEN 325 MG ORAL TABLET,,1438,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
ACETAMINOPHEN 325 MG ORAL TABLET,,1438,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
ACETAMINOPHEN 325 MG ORAL TABLET,,1438,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
ACETAMINOPHEN 325 MG ORAL TABLET,,1438,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
ACETAMINOPHEN 325 MG ORAL TABLET,,1438,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
ACETAMINOPHEN 325 MG ORAL TABLET,,1438,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
ACETAMINOPHEN 325 MG ORAL TABLET,,1438,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
ACETAMINOPHEN 325 MG ORAL TABLET,,1438,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
ACETAMINOPHEN 325 MG ORAL TABLET,,1438,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
ACETAMINOPHEN 325 MG ORAL TABLET,,1438,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
ACETAMINOPHEN 325 MG ORAL TABLET,,1438,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
ACETAMINOPHEN 325 MG ORAL TABLET,,1438,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
ACETAMINOPHEN 325 MG ORAL TABLET,,1438,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
ACETAMINOPHEN 325 MG ORAL TABLET,,1438,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
ACETAMINOPHEN 325 MG ORAL TABLET,,1438,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ACETAMINOPHEN 325 MG ORAL TABLET,,1438,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
ACETAMINOPHEN 325 MG ORAL TABLET,,1438,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
ACETAMINOPHEN 325 MG ORAL TABLET,,1438,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
ACETAMINOPHEN 325 MG ORAL TABLET,,1438,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
ACETAMINOPHEN 325 MG ORAL TABLET,,1438,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
ACETAMINOPHEN 325 MG ORAL TABLET,,1438,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ACETAMINOPHEN 325 MG ORAL TABLET,,1438,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
ACETAMINOPHEN 325 MG ORAL TABLET,,1438,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ACETAMINOPHEN 325 MG ORAL TABLET,,1438,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ACETAMINOPHEN 325 MG ORAL TABLET,,1438,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ACETAMINOPHEN 325 MG ORAL TABLET,,1438,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ACETAMINOPHEN 325 MG ORAL TABLET,,1438,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
ACETAMINOPHEN 325 MG ORAL TABLET,,1438,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
ACETAMINOPHEN 325 MG ORAL TABLET,,1438,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
ACETAMINOPHEN 325 MG ORAL TABLET,,1438,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
ACETAMINOPHEN 325 MG ORAL TABLET,,1438,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
ACETAMINOPHEN 650 MG RECT SUPP,,1502,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
ACETAMINOPHEN 650 MG RECT SUPP,,1502,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
ACETAMINOPHEN 650 MG RECT SUPP,,1502,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
ACETAMINOPHEN 650 MG RECT SUPP,,1502,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
ACETAMINOPHEN 650 MG RECT SUPP,,1502,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
ACETAMINOPHEN 650 MG RECT SUPP,,1502,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
ACETAMINOPHEN 650 MG RECT SUPP,,1502,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
ACETAMINOPHEN 650 MG RECT SUPP,,1502,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
ACETAMINOPHEN 650 MG RECT SUPP,,1502,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
ACETAMINOPHEN 650 MG RECT SUPP,,1502,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
ACETAMINOPHEN 650 MG RECT SUPP,,1502,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
ACETAMINOPHEN 650 MG RECT SUPP,,1502,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
ACETAMINOPHEN 650 MG RECT SUPP,,1502,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
ACETAMINOPHEN 650 MG RECT SUPP,,1502,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
ACETAMINOPHEN 650 MG RECT SUPP,,1502,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
ACETAMINOPHEN 650 MG RECT SUPP,,1502,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
ACETAMINOPHEN 650 MG RECT SUPP,,1502,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
ACETAMINOPHEN 650 MG RECT SUPP,,1502,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
ACETAMINOPHEN 650 MG RECT SUPP,,1502,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ACETAMINOPHEN 650 MG RECT SUPP,,1502,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
ACETAMINOPHEN 650 MG RECT SUPP,,1502,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
ACETAMINOPHEN 650 MG RECT SUPP,,1502,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
ACETAMINOPHEN 650 MG RECT SUPP,,1502,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
ACETAMINOPHEN 650 MG RECT SUPP,,1502,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
ACETAMINOPHEN 650 MG RECT SUPP,,1502,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
ACETAMINOPHEN 650 MG RECT SUPP,,1502,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
ACETAMINOPHEN 650 MG RECT SUPP,,1502,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
ACETAMINOPHEN 650 MG RECT SUPP,,1502,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
ACETAMINOPHEN 650 MG RECT SUPP,,1502,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
ACETAMINOPHEN 650 MG RECT SUPP,,1502,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
ACETAMINOPHEN 650 MG RECT SUPP,,1502,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
ACETAMINOPHEN 650 MG RECT SUPP,,1502,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
ACETAMINOPHEN 650 MG RECT SUPP,,1502,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
ACETAMINOPHEN 650 MG RECT SUPP,,1502,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
ACETAMINOPHEN 650 MG RECT SUPP,,1502,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
ACETAMINOPHEN 650 MG RECT SUPP,,1502,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
ACETAMINOPHEN 650 MG RECT SUPP,,1502,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
ACETAMINOPHEN 650 MG RECT SUPP,,1502,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ACETAMINOPHEN 650 MG RECT SUPP,,1502,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
ACETAMINOPHEN 650 MG RECT SUPP,,1502,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
ACETAMINOPHEN 650 MG RECT SUPP,,1502,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
ACETAMINOPHEN 650 MG RECT SUPP,,1502,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
ACETAMINOPHEN 650 MG RECT SUPP,,1502,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
ACETAMINOPHEN 650 MG RECT SUPP,,1502,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ACETAMINOPHEN 650 MG RECT SUPP,,1502,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
ACETAMINOPHEN 650 MG RECT SUPP,,1502,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ACETAMINOPHEN 650 MG RECT SUPP,,1502,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ACETAMINOPHEN 650 MG RECT SUPP,,1502,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ACETAMINOPHEN 650 MG RECT SUPP,,1502,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ACETAMINOPHEN 650 MG RECT SUPP,,1502,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
ACETAMINOPHEN 650 MG RECT SUPP,,1502,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
ACETAMINOPHEN 650 MG RECT SUPP,,1502,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
ACETAMINOPHEN 650 MG RECT SUPP,,1502,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
ACETAMINOPHEN 650 MG RECT SUPP,,1502,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
CEFUROXIME AXETIL 250 MG ORAL TABLET,,1780,LOCAL,Facility,Both,1,EA,,22,18.7,6.3052,22,Aetna,Commercial,20.24,92,,percent of total billed charges,,
CEFUROXIME AXETIL 250 MG ORAL TABLET,,1780,LOCAL,Facility,Both,1,EA,,22,18.7,6.3052,22,Aetna,Commercial,20.24,92,,percent of total billed charges,,
CEFUROXIME AXETIL 250 MG ORAL TABLET,,1780,LOCAL,Facility,Outpatient,1,EA,,22,18.7,6.3052,22,Aetna,Medicare Advantage,10.78,49,,percent of total billed charges,,
CEFUROXIME AXETIL 250 MG ORAL TABLET,,1780,LOCAL,Facility,Outpatient,1,EA,,22,18.7,6.3052,22,Aetna,Medicare Advantage,10.78,49,,percent of total billed charges,,
CEFUROXIME AXETIL 250 MG ORAL TABLET,,1780,LOCAL,Facility,Inpatient,1,EA,,22,18.7,6.3052,22,Aetna,Medicare Advantage,,,,,Included in per diem rate,
CEFUROXIME AXETIL 250 MG ORAL TABLET,,1780,LOCAL,Facility,Inpatient,1,EA,,22,18.7,6.3052,22,Aetna,Medicare Advantage,,,,,Included in per diem rate,
CEFUROXIME AXETIL 250 MG ORAL TABLET,,1780,LOCAL,Facility,Both,1,EA,,22,18.7,6.3052,22,Aetna,PPO,20.46,93,,percent of total billed charges,,
CEFUROXIME AXETIL 250 MG ORAL TABLET,,1780,LOCAL,Facility,Both,1,EA,,22,18.7,6.3052,22,Aetna,PPO,20.46,93,,percent of total billed charges,,
CEFUROXIME AXETIL 250 MG ORAL TABLET,,1780,LOCAL,Facility,Both,1,EA,,22,18.7,6.3052,22,America's PPO,America's PPO,21.1266,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
CEFUROXIME AXETIL 250 MG ORAL TABLET,,1780,LOCAL,Facility,Both,1,EA,,22,18.7,6.3052,22,America's PPO,America's PPO,21.1266,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
CEFUROXIME AXETIL 250 MG ORAL TABLET,,1780,LOCAL,Facility,Both,1,EA,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota, Federal Employee Program,21.648,98.4,,percent of total billed charges,,
CEFUROXIME AXETIL 250 MG ORAL TABLET,,1780,LOCAL,Facility,Both,1,EA,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota, Federal Employee Program,21.648,98.4,,percent of total billed charges,,
CEFUROXIME AXETIL 250 MG ORAL TABLET,,1780,LOCAL,Facility,Both,1,EA,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,22,100,,percent of total billed charges,,
CEFUROXIME AXETIL 250 MG ORAL TABLET,,1780,LOCAL,Facility,Both,1,EA,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,22,100,,percent of total billed charges,,
CEFUROXIME AXETIL 250 MG ORAL TABLET,,1780,LOCAL,Facility,Both,1,EA,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota,High Value Network Plan,19.8,90,,percent of total billed charges,,
CEFUROXIME AXETIL 250 MG ORAL TABLET,,1780,LOCAL,Facility,Both,1,EA,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota,High Value Network Plan,19.8,90,,percent of total billed charges,,
CEFUROXIME AXETIL 250 MG ORAL TABLET,,1780,LOCAL,Facility,Outpatient,1,EA,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota,Medicare Advantage,10.78,49,,percent of total billed charges,,
CEFUROXIME AXETIL 250 MG ORAL TABLET,,1780,LOCAL,Facility,Outpatient,1,EA,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota,Medicare Advantage,10.78,49,,percent of total billed charges,,
CEFUROXIME AXETIL 250 MG ORAL TABLET,,1780,LOCAL,Facility,Inpatient,1,EA,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
CEFUROXIME AXETIL 250 MG ORAL TABLET,,1780,LOCAL,Facility,Inpatient,1,EA,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
CEFUROXIME AXETIL 250 MG ORAL TABLET,,1780,LOCAL,Facility,Both,1,EA,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,19.4854,88.57,,percent of total billed charges,,
CEFUROXIME AXETIL 250 MG ORAL TABLET,,1780,LOCAL,Facility,Both,1,EA,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,19.4854,88.57,,percent of total billed charges,,
CEFUROXIME AXETIL 250 MG ORAL TABLET,,1780,LOCAL,Facility,Both,1,EA,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,6.3052,28.66,,percent of total billed charges,,
CEFUROXIME AXETIL 250 MG ORAL TABLET,,1780,LOCAL,Facility,Both,1,EA,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,6.3052,28.66,,percent of total billed charges,,
CEFUROXIME AXETIL 250 MG ORAL TABLET,,1780,LOCAL,Facility,Outpatient,1,EA,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),10.78,49,,percent of total billed charges,,
CEFUROXIME AXETIL 250 MG ORAL TABLET,,1780,LOCAL,Facility,Outpatient,1,EA,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),10.78,49,,percent of total billed charges,,
CEFUROXIME AXETIL 250 MG ORAL TABLET,,1780,LOCAL,Facility,Inpatient,1,EA,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
CEFUROXIME AXETIL 250 MG ORAL TABLET,,1780,LOCAL,Facility,Inpatient,1,EA,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
CEFUROXIME AXETIL 250 MG ORAL TABLET,,1780,LOCAL,Facility,Both,1,EA,,22,18.7,6.3052,22,CorVel,Worker's Compensation,22,100,,percent of total billed charges,,
CEFUROXIME AXETIL 250 MG ORAL TABLET,,1780,LOCAL,Facility,Both,1,EA,,22,18.7,6.3052,22,CorVel,Worker's Compensation,22,100,,percent of total billed charges,,
CEFUROXIME AXETIL 250 MG ORAL TABLET,,1780,LOCAL,Facility,Both,1,EA,,22,18.7,6.3052,22,First Health Group Corporation,First Health Network,21.34,97,,percent of total billed charges,,
CEFUROXIME AXETIL 250 MG ORAL TABLET,,1780,LOCAL,Facility,Both,1,EA,,22,18.7,6.3052,22,First Health Group Corporation,First Health Network,21.34,97,,percent of total billed charges,,
CEFUROXIME AXETIL 250 MG ORAL TABLET,,1780,LOCAL,Facility,Both,1,EA,,22,18.7,6.3052,22,"Health Partners, Inc.",Commercial,20.812,94.6,,percent of total billed charges,,
CEFUROXIME AXETIL 250 MG ORAL TABLET,,1780,LOCAL,Facility,Both,1,EA,,22,18.7,6.3052,22,"Health Partners, Inc.",Commercial,20.812,94.6,,percent of total billed charges,,
CEFUROXIME AXETIL 250 MG ORAL TABLET,,1780,LOCAL,Facility,Outpatient,1,EA,,22,18.7,6.3052,22,"Health Partners, Inc.",Medicare Advantage,10.78,49,,percent of total billed charges,,
CEFUROXIME AXETIL 250 MG ORAL TABLET,,1780,LOCAL,Facility,Outpatient,1,EA,,22,18.7,6.3052,22,"Health Partners, Inc.",Medicare Advantage,10.78,49,,percent of total billed charges,,
CEFUROXIME AXETIL 250 MG ORAL TABLET,,1780,LOCAL,Facility,Inpatient,1,EA,,22,18.7,6.3052,22,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CEFUROXIME AXETIL 250 MG ORAL TABLET,,1780,LOCAL,Facility,Inpatient,1,EA,,22,18.7,6.3052,22,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CEFUROXIME AXETIL 250 MG ORAL TABLET,,1780,LOCAL,Facility,Both,1,EA,,22,18.7,6.3052,22,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),13.2,60,,percent of total billed charges,,
CEFUROXIME AXETIL 250 MG ORAL TABLET,,1780,LOCAL,Facility,Both,1,EA,,22,18.7,6.3052,22,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),13.2,60,,percent of total billed charges,,
CEFUROXIME AXETIL 250 MG ORAL TABLET,,1780,LOCAL,Facility,Both,1,EA,,22,18.7,6.3052,22,"Health Partners, Inc.",State of Minnesota Advantage Program,17.93,81.5,,percent of total billed charges,,
CEFUROXIME AXETIL 250 MG ORAL TABLET,,1780,LOCAL,Facility,Both,1,EA,,22,18.7,6.3052,22,"Health Partners, Inc.",State of Minnesota Advantage Program,17.93,81.5,,percent of total billed charges,,
CEFUROXIME AXETIL 250 MG ORAL TABLET,,1780,LOCAL,Facility,Both,1,EA,,22,18.7,6.3052,22,"Health Partners, Inc.",State Public Programs,11,50,,percent of total billed charges,,
CEFUROXIME AXETIL 250 MG ORAL TABLET,,1780,LOCAL,Facility,Both,1,EA,,22,18.7,6.3052,22,"Health Partners, Inc.",State Public Programs,11,50,,percent of total billed charges,,
CEFUROXIME AXETIL 250 MG ORAL TABLET,,1780,LOCAL,Facility,Both,1,EA,,22,18.7,6.3052,22,Humana Insurance Company,Commercial PPO,20.9,95,,percent of total billed charges,,
CEFUROXIME AXETIL 250 MG ORAL TABLET,,1780,LOCAL,Facility,Both,1,EA,,22,18.7,6.3052,22,Humana Insurance Company,Commercial PPO,20.9,95,,percent of total billed charges,,
CEFUROXIME AXETIL 250 MG ORAL TABLET,,1780,LOCAL,Facility,Outpatient,1,EA,,22,18.7,6.3052,22,Humana Insurance Company,Medicare PPO,10.78,49,,percent of total billed charges,,
CEFUROXIME AXETIL 250 MG ORAL TABLET,,1780,LOCAL,Facility,Outpatient,1,EA,,22,18.7,6.3052,22,Humana Insurance Company,Medicare PPO,10.78,49,,percent of total billed charges,,
CEFUROXIME AXETIL 250 MG ORAL TABLET,,1780,LOCAL,Facility,Inpatient,1,EA,,22,18.7,6.3052,22,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
CEFUROXIME AXETIL 250 MG ORAL TABLET,,1780,LOCAL,Facility,Inpatient,1,EA,,22,18.7,6.3052,22,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
CEFUROXIME AXETIL 250 MG ORAL TABLET,,1780,LOCAL,Facility,Both,1,EA,,22,18.7,6.3052,22,Medica,Individual & Family,21.802,99.1,,percent of total billed charges,,
CEFUROXIME AXETIL 250 MG ORAL TABLET,,1780,LOCAL,Facility,Both,1,EA,,22,18.7,6.3052,22,Medica,Individual & Family,21.802,99.1,,percent of total billed charges,,
CEFUROXIME AXETIL 250 MG ORAL TABLET,,1780,LOCAL,Facility,Outpatient,1,EA,,22,18.7,6.3052,22,Medica,Medica Advantage Solution,10.956,49.8,,percent of total billed charges,,
CEFUROXIME AXETIL 250 MG ORAL TABLET,,1780,LOCAL,Facility,Outpatient,1,EA,,22,18.7,6.3052,22,Medica,Medica Advantage Solution,10.956,49.8,,percent of total billed charges,,
CEFUROXIME AXETIL 250 MG ORAL TABLET,,1780,LOCAL,Facility,Inpatient,1,EA,,22,18.7,6.3052,22,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
CEFUROXIME AXETIL 250 MG ORAL TABLET,,1780,LOCAL,Facility,Inpatient,1,EA,,22,18.7,6.3052,22,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
CEFUROXIME AXETIL 250 MG ORAL TABLET,,1780,LOCAL,Facility,Outpatient,1,EA,,22,18.7,6.3052,22,Medica,Medical Assistance,9.812,44.6,,percent of total billed charges,,
CEFUROXIME AXETIL 250 MG ORAL TABLET,,1780,LOCAL,Facility,Outpatient,1,EA,,22,18.7,6.3052,22,Medica,Medical Assistance,9.812,44.6,,percent of total billed charges,,
CEFUROXIME AXETIL 250 MG ORAL TABLET,,1780,LOCAL,Facility,Inpatient,1,EA,,22,18.7,6.3052,22,Medica,Medical Assistance,,,,,Included in per diem rate,
CEFUROXIME AXETIL 250 MG ORAL TABLET,,1780,LOCAL,Facility,Inpatient,1,EA,,22,18.7,6.3052,22,Medica,Medical Assistance,,,,,Included in per diem rate,
CEFUROXIME AXETIL 250 MG ORAL TABLET,,1780,LOCAL,Facility,Outpatient,1,EA,,22,18.7,6.3052,22,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,10.956,49.8,,percent of total billed charges,,
CEFUROXIME AXETIL 250 MG ORAL TABLET,,1780,LOCAL,Facility,Outpatient,1,EA,,22,18.7,6.3052,22,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,10.956,49.8,,percent of total billed charges,,
CEFUROXIME AXETIL 250 MG ORAL TABLET,,1780,LOCAL,Facility,Inpatient,1,EA,,22,18.7,6.3052,22,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
CEFUROXIME AXETIL 250 MG ORAL TABLET,,1780,LOCAL,Facility,Inpatient,1,EA,,22,18.7,6.3052,22,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
CEFUROXIME AXETIL 250 MG ORAL TABLET,,1780,LOCAL,Facility,Both,1,EA,,22,18.7,6.3052,22,"Multiplan, Inc.","Multiplan, Inc.",20.68,94,,percent of total billed charges,,
CEFUROXIME AXETIL 250 MG ORAL TABLET,,1780,LOCAL,Facility,Both,1,EA,,22,18.7,6.3052,22,"Multiplan, Inc.","Multiplan, Inc.",20.68,94,,percent of total billed charges,,
CEFUROXIME AXETIL 250 MG ORAL TABLET,,1780,LOCAL,Facility,Outpatient,1,EA,,22,18.7,6.3052,22,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,19.822,90.1,,percent of total billed charges,,
CEFUROXIME AXETIL 250 MG ORAL TABLET,,1780,LOCAL,Facility,Outpatient,1,EA,,22,18.7,6.3052,22,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,19.822,90.1,,percent of total billed charges,,
CEFUROXIME AXETIL 250 MG ORAL TABLET,,1780,LOCAL,Facility,Inpatient,1,EA,,22,18.7,6.3052,22,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
CEFUROXIME AXETIL 250 MG ORAL TABLET,,1780,LOCAL,Facility,Inpatient,1,EA,,22,18.7,6.3052,22,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
CEFUROXIME AXETIL 250 MG ORAL TABLET,,1780,LOCAL,Facility,Both,1,EA,,22,18.7,6.3052,22,"Preferred One Administrative Services, INC.",PPO,21.692,98.6,,percent of total billed charges,,
CEFUROXIME AXETIL 250 MG ORAL TABLET,,1780,LOCAL,Facility,Both,1,EA,,22,18.7,6.3052,22,"Preferred One Administrative Services, INC.",PPO,21.692,98.6,,percent of total billed charges,,
CEFUROXIME AXETIL 250 MG ORAL TABLET,,1780,LOCAL,Facility,Outpatient,1,EA,,22,18.7,6.3052,22,PrimeWest Health,Minnesota Senior Health Options (MSHO),11.319,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
CEFUROXIME AXETIL 250 MG ORAL TABLET,,1780,LOCAL,Facility,Outpatient,1,EA,,22,18.7,6.3052,22,PrimeWest Health,Minnesota Senior Health Options (MSHO),11.319,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
CEFUROXIME AXETIL 250 MG ORAL TABLET,,1780,LOCAL,Facility,Inpatient,1,EA,,22,18.7,6.3052,22,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CEFUROXIME AXETIL 250 MG ORAL TABLET,,1780,LOCAL,Facility,Inpatient,1,EA,,22,18.7,6.3052,22,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CEFUROXIME AXETIL 250 MG ORAL TABLET,,1780,LOCAL,Facility,Outpatient,1,EA,,22,18.7,6.3052,22,PrimeWest Health,MinnesotaCare,11.2992,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
CEFUROXIME AXETIL 250 MG ORAL TABLET,,1780,LOCAL,Facility,Outpatient,1,EA,,22,18.7,6.3052,22,PrimeWest Health,MinnesotaCare,11.2992,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
CEFUROXIME AXETIL 250 MG ORAL TABLET,,1780,LOCAL,Facility,Inpatient,1,EA,,22,18.7,6.3052,22,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
CEFUROXIME AXETIL 250 MG ORAL TABLET,,1780,LOCAL,Facility,Inpatient,1,EA,,22,18.7,6.3052,22,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
CEFUROXIME AXETIL 250 MG ORAL TABLET,,1780,LOCAL,Facility,Both,1,EA,,22,18.7,6.3052,22,Sanford Health Plan,Sanford Health Plan,20.24,92,,percent of total billed charges,,
CEFUROXIME AXETIL 250 MG ORAL TABLET,,1780,LOCAL,Facility,Both,1,EA,,22,18.7,6.3052,22,Sanford Health Plan,Sanford Health Plan,20.24,92,,percent of total billed charges,,
CEFUROXIME AXETIL 250 MG ORAL TABLET,,1780,LOCAL,Facility,Outpatient,1,EA,,22,18.7,6.3052,22,"UCare Health, Inc.",Individual & Family Plan,12.397,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
CEFUROXIME AXETIL 250 MG ORAL TABLET,,1780,LOCAL,Facility,Outpatient,1,EA,,22,18.7,6.3052,22,"UCare Health, Inc.",Individual & Family Plan,12.397,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
CEFUROXIME AXETIL 250 MG ORAL TABLET,,1780,LOCAL,Facility,Inpatient,1,EA,,22,18.7,6.3052,22,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
CEFUROXIME AXETIL 250 MG ORAL TABLET,,1780,LOCAL,Facility,Inpatient,1,EA,,22,18.7,6.3052,22,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
CEFUROXIME AXETIL 250 MG ORAL TABLET,,1780,LOCAL,Facility,Outpatient,1,EA,,22,18.7,6.3052,22,"UCare Health, Inc.",Medical Assistance,11.1034,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CEFUROXIME AXETIL 250 MG ORAL TABLET,,1780,LOCAL,Facility,Outpatient,1,EA,,22,18.7,6.3052,22,"UCare Health, Inc.",Medical Assistance,11.1034,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CEFUROXIME AXETIL 250 MG ORAL TABLET,,1780,LOCAL,Facility,Inpatient,1,EA,,22,18.7,6.3052,22,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
CEFUROXIME AXETIL 250 MG ORAL TABLET,,1780,LOCAL,Facility,Inpatient,1,EA,,22,18.7,6.3052,22,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
CEFUROXIME AXETIL 250 MG ORAL TABLET,,1780,LOCAL,Facility,Outpatient,1,EA,,22,18.7,6.3052,22,"UCare Health, Inc.",Medicare Advantage,11.1034,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CEFUROXIME AXETIL 250 MG ORAL TABLET,,1780,LOCAL,Facility,Outpatient,1,EA,,22,18.7,6.3052,22,"UCare Health, Inc.",Medicare Advantage,11.1034,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CEFUROXIME AXETIL 250 MG ORAL TABLET,,1780,LOCAL,Facility,Inpatient,1,EA,,22,18.7,6.3052,22,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CEFUROXIME AXETIL 250 MG ORAL TABLET,,1780,LOCAL,Facility,Inpatient,1,EA,,22,18.7,6.3052,22,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CEFUROXIME AXETIL 250 MG ORAL TABLET,,1780,LOCAL,Facility,Outpatient,1,EA,,22,18.7,6.3052,22,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),11.1034,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CEFUROXIME AXETIL 250 MG ORAL TABLET,,1780,LOCAL,Facility,Outpatient,1,EA,,22,18.7,6.3052,22,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),11.1034,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CEFUROXIME AXETIL 250 MG ORAL TABLET,,1780,LOCAL,Facility,Inpatient,1,EA,,22,18.7,6.3052,22,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CEFUROXIME AXETIL 250 MG ORAL TABLET,,1780,LOCAL,Facility,Inpatient,1,EA,,22,18.7,6.3052,22,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CEFUROXIME AXETIL 250 MG ORAL TABLET,,1780,LOCAL,Facility,Both,1,EA,,22,18.7,6.3052,22,UnitedHealthcare,Individual & Family,20.68,94,,percent of total billed charges,,
CEFUROXIME AXETIL 250 MG ORAL TABLET,,1780,LOCAL,Facility,Both,1,EA,,22,18.7,6.3052,22,UnitedHealthcare,Individual & Family,20.68,94,,percent of total billed charges,,
CEFUROXIME AXETIL 250 MG ORAL TABLET,,1780,LOCAL,Facility,Outpatient,1,EA,,22,18.7,6.3052,22,UnitedHealthcare,Medicare Advantage,10.78,49,,percent of total billed charges,,
CEFUROXIME AXETIL 250 MG ORAL TABLET,,1780,LOCAL,Facility,Outpatient,1,EA,,22,18.7,6.3052,22,UnitedHealthcare,Medicare Advantage,10.78,49,,percent of total billed charges,,
CEFUROXIME AXETIL 250 MG ORAL TABLET,,1780,LOCAL,Facility,Inpatient,1,EA,,22,18.7,6.3052,22,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
CEFUROXIME AXETIL 250 MG ORAL TABLET,,1780,LOCAL,Facility,Inpatient,1,EA,,22,18.7,6.3052,22,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
CEFUROXIME AXETIL 250 MG ORAL TABLET,,1780,LOCAL,Facility,Outpatient,1,EA,,22,18.7,6.3052,22,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,10.56,48,,percent of total billed charges,,100% of DHS outpatient percentage
CEFUROXIME AXETIL 250 MG ORAL TABLET,,1780,LOCAL,Facility,Outpatient,1,EA,,22,18.7,6.3052,22,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,10.56,48,,percent of total billed charges,,100% of DHS outpatient percentage
CEFUROXIME AXETIL 250 MG ORAL TABLET,,1780,LOCAL,Facility,Inpatient,1,EA,,22,18.7,6.3052,22,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
CEFUROXIME AXETIL 250 MG ORAL TABLET,,1780,LOCAL,Facility,Inpatient,1,EA,,22,18.7,6.3052,22,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
CARVEDILOL 12.5 MG ORAL TABLET,,1830,LOCAL,Facility,Both,1,EA,,11,9.35,3.1526,11,Aetna,Commercial,10.12,92,,percent of total billed charges,,
CARVEDILOL 12.5 MG ORAL TABLET,,1830,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
CARVEDILOL 12.5 MG ORAL TABLET,,1830,LOCAL,Facility,Outpatient,1,EA,,11,9.35,3.1526,11,Aetna,Medicare Advantage,5.39,49,,percent of total billed charges,,
CARVEDILOL 12.5 MG ORAL TABLET,,1830,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
CARVEDILOL 12.5 MG ORAL TABLET,,1830,LOCAL,Facility,Inpatient,1,EA,,11,9.35,3.1526,11,Aetna,Medicare Advantage,,,,,Included in per diem rate,
CARVEDILOL 12.5 MG ORAL TABLET,,1830,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
CARVEDILOL 12.5 MG ORAL TABLET,,1830,LOCAL,Facility,Both,1,EA,,11,9.35,3.1526,11,Aetna,PPO,10.23,93,,percent of total billed charges,,
CARVEDILOL 12.5 MG ORAL TABLET,,1830,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
CARVEDILOL 12.5 MG ORAL TABLET,,1830,LOCAL,Facility,Both,1,EA,,11,9.35,3.1526,11,America's PPO,America's PPO,10.5633,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
CARVEDILOL 12.5 MG ORAL TABLET,,1830,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
CARVEDILOL 12.5 MG ORAL TABLET,,1830,LOCAL,Facility,Both,1,EA,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota, Federal Employee Program,10.824,98.4,,percent of total billed charges,,
CARVEDILOL 12.5 MG ORAL TABLET,,1830,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
CARVEDILOL 12.5 MG ORAL TABLET,,1830,LOCAL,Facility,Both,1,EA,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,11,100,,percent of total billed charges,,
CARVEDILOL 12.5 MG ORAL TABLET,,1830,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
CARVEDILOL 12.5 MG ORAL TABLET,,1830,LOCAL,Facility,Both,1,EA,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,High Value Network Plan,9.9,90,,percent of total billed charges,,
CARVEDILOL 12.5 MG ORAL TABLET,,1830,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
CARVEDILOL 12.5 MG ORAL TABLET,,1830,LOCAL,Facility,Outpatient,1,EA,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,Medicare Advantage,5.39,49,,percent of total billed charges,,
CARVEDILOL 12.5 MG ORAL TABLET,,1830,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
CARVEDILOL 12.5 MG ORAL TABLET,,1830,LOCAL,Facility,Inpatient,1,EA,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
CARVEDILOL 12.5 MG ORAL TABLET,,1830,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
CARVEDILOL 12.5 MG ORAL TABLET,,1830,LOCAL,Facility,Both,1,EA,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,9.7427,88.57,,percent of total billed charges,,
CARVEDILOL 12.5 MG ORAL TABLET,,1830,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
CARVEDILOL 12.5 MG ORAL TABLET,,1830,LOCAL,Facility,Both,1,EA,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,3.1526,28.66,,percent of total billed charges,,
CARVEDILOL 12.5 MG ORAL TABLET,,1830,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
CARVEDILOL 12.5 MG ORAL TABLET,,1830,LOCAL,Facility,Outpatient,1,EA,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),5.39,49,,percent of total billed charges,,
CARVEDILOL 12.5 MG ORAL TABLET,,1830,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
CARVEDILOL 12.5 MG ORAL TABLET,,1830,LOCAL,Facility,Inpatient,1,EA,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
CARVEDILOL 12.5 MG ORAL TABLET,,1830,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
CARVEDILOL 12.5 MG ORAL TABLET,,1830,LOCAL,Facility,Both,1,EA,,11,9.35,3.1526,11,CorVel,Worker's Compensation,11,100,,percent of total billed charges,,
CARVEDILOL 12.5 MG ORAL TABLET,,1830,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
CARVEDILOL 12.5 MG ORAL TABLET,,1830,LOCAL,Facility,Both,1,EA,,11,9.35,3.1526,11,First Health Group Corporation,First Health Network,10.67,97,,percent of total billed charges,,
CARVEDILOL 12.5 MG ORAL TABLET,,1830,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
CARVEDILOL 12.5 MG ORAL TABLET,,1830,LOCAL,Facility,Both,1,EA,,11,9.35,3.1526,11,"Health Partners, Inc.",Commercial,10.406,94.6,,percent of total billed charges,,
CARVEDILOL 12.5 MG ORAL TABLET,,1830,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
CARVEDILOL 12.5 MG ORAL TABLET,,1830,LOCAL,Facility,Outpatient,1,EA,,11,9.35,3.1526,11,"Health Partners, Inc.",Medicare Advantage,5.39,49,,percent of total billed charges,,
CARVEDILOL 12.5 MG ORAL TABLET,,1830,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
CARVEDILOL 12.5 MG ORAL TABLET,,1830,LOCAL,Facility,Inpatient,1,EA,,11,9.35,3.1526,11,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CARVEDILOL 12.5 MG ORAL TABLET,,1830,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CARVEDILOL 12.5 MG ORAL TABLET,,1830,LOCAL,Facility,Both,1,EA,,11,9.35,3.1526,11,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),6.6,60,,percent of total billed charges,,
CARVEDILOL 12.5 MG ORAL TABLET,,1830,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
CARVEDILOL 12.5 MG ORAL TABLET,,1830,LOCAL,Facility,Both,1,EA,,11,9.35,3.1526,11,"Health Partners, Inc.",State of Minnesota Advantage Program,8.965,81.5,,percent of total billed charges,,
CARVEDILOL 12.5 MG ORAL TABLET,,1830,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
CARVEDILOL 12.5 MG ORAL TABLET,,1830,LOCAL,Facility,Both,1,EA,,11,9.35,3.1526,11,"Health Partners, Inc.",State Public Programs,5.5,50,,percent of total billed charges,,
CARVEDILOL 12.5 MG ORAL TABLET,,1830,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
CARVEDILOL 12.5 MG ORAL TABLET,,1830,LOCAL,Facility,Both,1,EA,,11,9.35,3.1526,11,Humana Insurance Company,Commercial PPO,10.45,95,,percent of total billed charges,,
CARVEDILOL 12.5 MG ORAL TABLET,,1830,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
CARVEDILOL 12.5 MG ORAL TABLET,,1830,LOCAL,Facility,Outpatient,1,EA,,11,9.35,3.1526,11,Humana Insurance Company,Medicare PPO,5.39,49,,percent of total billed charges,,
CARVEDILOL 12.5 MG ORAL TABLET,,1830,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
CARVEDILOL 12.5 MG ORAL TABLET,,1830,LOCAL,Facility,Inpatient,1,EA,,11,9.35,3.1526,11,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
CARVEDILOL 12.5 MG ORAL TABLET,,1830,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
CARVEDILOL 12.5 MG ORAL TABLET,,1830,LOCAL,Facility,Both,1,EA,,11,9.35,3.1526,11,Medica,Individual & Family,10.901,99.1,,percent of total billed charges,,
CARVEDILOL 12.5 MG ORAL TABLET,,1830,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
CARVEDILOL 12.5 MG ORAL TABLET,,1830,LOCAL,Facility,Outpatient,1,EA,,11,9.35,3.1526,11,Medica,Medica Advantage Solution,5.478,49.8,,percent of total billed charges,,
CARVEDILOL 12.5 MG ORAL TABLET,,1830,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
CARVEDILOL 12.5 MG ORAL TABLET,,1830,LOCAL,Facility,Inpatient,1,EA,,11,9.35,3.1526,11,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
CARVEDILOL 12.5 MG ORAL TABLET,,1830,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
CARVEDILOL 12.5 MG ORAL TABLET,,1830,LOCAL,Facility,Outpatient,1,EA,,11,9.35,3.1526,11,Medica,Medical Assistance,4.906,44.6,,percent of total billed charges,,
CARVEDILOL 12.5 MG ORAL TABLET,,1830,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
CARVEDILOL 12.5 MG ORAL TABLET,,1830,LOCAL,Facility,Inpatient,1,EA,,11,9.35,3.1526,11,Medica,Medical Assistance,,,,,Included in per diem rate,
CARVEDILOL 12.5 MG ORAL TABLET,,1830,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
CARVEDILOL 12.5 MG ORAL TABLET,,1830,LOCAL,Facility,Outpatient,1,EA,,11,9.35,3.1526,11,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,5.478,49.8,,percent of total billed charges,,
CARVEDILOL 12.5 MG ORAL TABLET,,1830,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
CARVEDILOL 12.5 MG ORAL TABLET,,1830,LOCAL,Facility,Inpatient,1,EA,,11,9.35,3.1526,11,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
CARVEDILOL 12.5 MG ORAL TABLET,,1830,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
CARVEDILOL 12.5 MG ORAL TABLET,,1830,LOCAL,Facility,Both,1,EA,,11,9.35,3.1526,11,"Multiplan, Inc.","Multiplan, Inc.",10.34,94,,percent of total billed charges,,
CARVEDILOL 12.5 MG ORAL TABLET,,1830,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
CARVEDILOL 12.5 MG ORAL TABLET,,1830,LOCAL,Facility,Outpatient,1,EA,,11,9.35,3.1526,11,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,9.911,90.1,,percent of total billed charges,,
CARVEDILOL 12.5 MG ORAL TABLET,,1830,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
CARVEDILOL 12.5 MG ORAL TABLET,,1830,LOCAL,Facility,Inpatient,1,EA,,11,9.35,3.1526,11,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
CARVEDILOL 12.5 MG ORAL TABLET,,1830,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
CARVEDILOL 12.5 MG ORAL TABLET,,1830,LOCAL,Facility,Both,1,EA,,11,9.35,3.1526,11,"Preferred One Administrative Services, INC.",PPO,10.846,98.6,,percent of total billed charges,,
CARVEDILOL 12.5 MG ORAL TABLET,,1830,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
CARVEDILOL 12.5 MG ORAL TABLET,,1830,LOCAL,Facility,Outpatient,1,EA,,11,9.35,3.1526,11,PrimeWest Health,Minnesota Senior Health Options (MSHO),5.6595,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
CARVEDILOL 12.5 MG ORAL TABLET,,1830,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
CARVEDILOL 12.5 MG ORAL TABLET,,1830,LOCAL,Facility,Inpatient,1,EA,,11,9.35,3.1526,11,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CARVEDILOL 12.5 MG ORAL TABLET,,1830,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CARVEDILOL 12.5 MG ORAL TABLET,,1830,LOCAL,Facility,Outpatient,1,EA,,11,9.35,3.1526,11,PrimeWest Health,MinnesotaCare,5.6496,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
CARVEDILOL 12.5 MG ORAL TABLET,,1830,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
CARVEDILOL 12.5 MG ORAL TABLET,,1830,LOCAL,Facility,Inpatient,1,EA,,11,9.35,3.1526,11,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
CARVEDILOL 12.5 MG ORAL TABLET,,1830,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
CARVEDILOL 12.5 MG ORAL TABLET,,1830,LOCAL,Facility,Both,1,EA,,11,9.35,3.1526,11,Sanford Health Plan,Sanford Health Plan,10.12,92,,percent of total billed charges,,
CARVEDILOL 12.5 MG ORAL TABLET,,1830,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
CARVEDILOL 12.5 MG ORAL TABLET,,1830,LOCAL,Facility,Outpatient,1,EA,,11,9.35,3.1526,11,"UCare Health, Inc.",Individual & Family Plan,6.1985,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
CARVEDILOL 12.5 MG ORAL TABLET,,1830,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
CARVEDILOL 12.5 MG ORAL TABLET,,1830,LOCAL,Facility,Inpatient,1,EA,,11,9.35,3.1526,11,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
CARVEDILOL 12.5 MG ORAL TABLET,,1830,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
CARVEDILOL 12.5 MG ORAL TABLET,,1830,LOCAL,Facility,Outpatient,1,EA,,11,9.35,3.1526,11,"UCare Health, Inc.",Medical Assistance,5.5517,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CARVEDILOL 12.5 MG ORAL TABLET,,1830,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CARVEDILOL 12.5 MG ORAL TABLET,,1830,LOCAL,Facility,Inpatient,1,EA,,11,9.35,3.1526,11,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
CARVEDILOL 12.5 MG ORAL TABLET,,1830,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
CARVEDILOL 12.5 MG ORAL TABLET,,1830,LOCAL,Facility,Outpatient,1,EA,,11,9.35,3.1526,11,"UCare Health, Inc.",Medicare Advantage,5.5517,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CARVEDILOL 12.5 MG ORAL TABLET,,1830,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CARVEDILOL 12.5 MG ORAL TABLET,,1830,LOCAL,Facility,Inpatient,1,EA,,11,9.35,3.1526,11,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CARVEDILOL 12.5 MG ORAL TABLET,,1830,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CARVEDILOL 12.5 MG ORAL TABLET,,1830,LOCAL,Facility,Outpatient,1,EA,,11,9.35,3.1526,11,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),5.5517,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CARVEDILOL 12.5 MG ORAL TABLET,,1830,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CARVEDILOL 12.5 MG ORAL TABLET,,1830,LOCAL,Facility,Inpatient,1,EA,,11,9.35,3.1526,11,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CARVEDILOL 12.5 MG ORAL TABLET,,1830,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CARVEDILOL 12.5 MG ORAL TABLET,,1830,LOCAL,Facility,Both,1,EA,,11,9.35,3.1526,11,UnitedHealthcare,Individual & Family,10.34,94,,percent of total billed charges,,
CARVEDILOL 12.5 MG ORAL TABLET,,1830,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
CARVEDILOL 12.5 MG ORAL TABLET,,1830,LOCAL,Facility,Outpatient,1,EA,,11,9.35,3.1526,11,UnitedHealthcare,Medicare Advantage,5.39,49,,percent of total billed charges,,
CARVEDILOL 12.5 MG ORAL TABLET,,1830,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
CARVEDILOL 12.5 MG ORAL TABLET,,1830,LOCAL,Facility,Inpatient,1,EA,,11,9.35,3.1526,11,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
CARVEDILOL 12.5 MG ORAL TABLET,,1830,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
CARVEDILOL 12.5 MG ORAL TABLET,,1830,LOCAL,Facility,Outpatient,1,EA,,11,9.35,3.1526,11,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,5.28,48,,percent of total billed charges,,100% of DHS outpatient percentage
CARVEDILOL 12.5 MG ORAL TABLET,,1830,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
CARVEDILOL 12.5 MG ORAL TABLET,,1830,LOCAL,Facility,Inpatient,1,EA,,11,9.35,3.1526,11,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
CARVEDILOL 12.5 MG ORAL TABLET,,1830,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
NICOTINE 14 MG/24 HR TD PT24,,1923,LOCAL,Facility,Both,1,EA,,11,9.35,3.1526,11,Aetna,Commercial,10.12,92,,percent of total billed charges,,
NICOTINE 14 MG/24 HR TD PT24,,1923,LOCAL,Facility,Outpatient,1,EA,,11,9.35,3.1526,11,Aetna,Medicare Advantage,5.39,49,,percent of total billed charges,,
NICOTINE 14 MG/24 HR TD PT24,,1923,LOCAL,Facility,Inpatient,1,EA,,11,9.35,3.1526,11,Aetna,Medicare Advantage,,,,,Included in per diem rate,
NICOTINE 14 MG/24 HR TD PT24,,1923,LOCAL,Facility,Both,1,EA,,11,9.35,3.1526,11,Aetna,PPO,10.23,93,,percent of total billed charges,,
NICOTINE 14 MG/24 HR TD PT24,,1923,LOCAL,Facility,Both,1,EA,,11,9.35,3.1526,11,America's PPO,America's PPO,10.5633,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
NICOTINE 14 MG/24 HR TD PT24,,1923,LOCAL,Facility,Both,1,EA,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota, Federal Employee Program,10.824,98.4,,percent of total billed charges,,
NICOTINE 14 MG/24 HR TD PT24,,1923,LOCAL,Facility,Both,1,EA,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,11,100,,percent of total billed charges,,
NICOTINE 14 MG/24 HR TD PT24,,1923,LOCAL,Facility,Both,1,EA,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,High Value Network Plan,9.9,90,,percent of total billed charges,,
NICOTINE 14 MG/24 HR TD PT24,,1923,LOCAL,Facility,Outpatient,1,EA,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,Medicare Advantage,5.39,49,,percent of total billed charges,,
NICOTINE 14 MG/24 HR TD PT24,,1923,LOCAL,Facility,Inpatient,1,EA,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
NICOTINE 14 MG/24 HR TD PT24,,1923,LOCAL,Facility,Both,1,EA,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,9.7427,88.57,,percent of total billed charges,,
NICOTINE 14 MG/24 HR TD PT24,,1923,LOCAL,Facility,Both,1,EA,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,3.1526,28.66,,percent of total billed charges,,
NICOTINE 14 MG/24 HR TD PT24,,1923,LOCAL,Facility,Outpatient,1,EA,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),5.39,49,,percent of total billed charges,,
NICOTINE 14 MG/24 HR TD PT24,,1923,LOCAL,Facility,Inpatient,1,EA,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
NICOTINE 14 MG/24 HR TD PT24,,1923,LOCAL,Facility,Both,1,EA,,11,9.35,3.1526,11,CorVel,Worker's Compensation,11,100,,percent of total billed charges,,
NICOTINE 14 MG/24 HR TD PT24,,1923,LOCAL,Facility,Both,1,EA,,11,9.35,3.1526,11,First Health Group Corporation,First Health Network,10.67,97,,percent of total billed charges,,
NICOTINE 14 MG/24 HR TD PT24,,1923,LOCAL,Facility,Both,1,EA,,11,9.35,3.1526,11,"Health Partners, Inc.",Commercial,10.406,94.6,,percent of total billed charges,,
NICOTINE 14 MG/24 HR TD PT24,,1923,LOCAL,Facility,Outpatient,1,EA,,11,9.35,3.1526,11,"Health Partners, Inc.",Medicare Advantage,5.39,49,,percent of total billed charges,,
NICOTINE 14 MG/24 HR TD PT24,,1923,LOCAL,Facility,Inpatient,1,EA,,11,9.35,3.1526,11,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
NICOTINE 14 MG/24 HR TD PT24,,1923,LOCAL,Facility,Both,1,EA,,11,9.35,3.1526,11,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),6.6,60,,percent of total billed charges,,
NICOTINE 14 MG/24 HR TD PT24,,1923,LOCAL,Facility,Both,1,EA,,11,9.35,3.1526,11,"Health Partners, Inc.",State of Minnesota Advantage Program,8.965,81.5,,percent of total billed charges,,
NICOTINE 14 MG/24 HR TD PT24,,1923,LOCAL,Facility,Both,1,EA,,11,9.35,3.1526,11,"Health Partners, Inc.",State Public Programs,5.5,50,,percent of total billed charges,,
NICOTINE 14 MG/24 HR TD PT24,,1923,LOCAL,Facility,Both,1,EA,,11,9.35,3.1526,11,Humana Insurance Company,Commercial PPO,10.45,95,,percent of total billed charges,,
NICOTINE 14 MG/24 HR TD PT24,,1923,LOCAL,Facility,Outpatient,1,EA,,11,9.35,3.1526,11,Humana Insurance Company,Medicare PPO,5.39,49,,percent of total billed charges,,
NICOTINE 14 MG/24 HR TD PT24,,1923,LOCAL,Facility,Inpatient,1,EA,,11,9.35,3.1526,11,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
NICOTINE 14 MG/24 HR TD PT24,,1923,LOCAL,Facility,Both,1,EA,,11,9.35,3.1526,11,Medica,Individual & Family,10.901,99.1,,percent of total billed charges,,
NICOTINE 14 MG/24 HR TD PT24,,1923,LOCAL,Facility,Outpatient,1,EA,,11,9.35,3.1526,11,Medica,Medica Advantage Solution,5.478,49.8,,percent of total billed charges,,
NICOTINE 14 MG/24 HR TD PT24,,1923,LOCAL,Facility,Inpatient,1,EA,,11,9.35,3.1526,11,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
NICOTINE 14 MG/24 HR TD PT24,,1923,LOCAL,Facility,Outpatient,1,EA,,11,9.35,3.1526,11,Medica,Medical Assistance,4.906,44.6,,percent of total billed charges,,
NICOTINE 14 MG/24 HR TD PT24,,1923,LOCAL,Facility,Inpatient,1,EA,,11,9.35,3.1526,11,Medica,Medical Assistance,,,,,Included in per diem rate,
NICOTINE 14 MG/24 HR TD PT24,,1923,LOCAL,Facility,Outpatient,1,EA,,11,9.35,3.1526,11,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,5.478,49.8,,percent of total billed charges,,
NICOTINE 14 MG/24 HR TD PT24,,1923,LOCAL,Facility,Inpatient,1,EA,,11,9.35,3.1526,11,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
NICOTINE 14 MG/24 HR TD PT24,,1923,LOCAL,Facility,Both,1,EA,,11,9.35,3.1526,11,"Multiplan, Inc.","Multiplan, Inc.",10.34,94,,percent of total billed charges,,
NICOTINE 14 MG/24 HR TD PT24,,1923,LOCAL,Facility,Outpatient,1,EA,,11,9.35,3.1526,11,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,9.911,90.1,,percent of total billed charges,,
NICOTINE 14 MG/24 HR TD PT24,,1923,LOCAL,Facility,Inpatient,1,EA,,11,9.35,3.1526,11,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
NICOTINE 14 MG/24 HR TD PT24,,1923,LOCAL,Facility,Both,1,EA,,11,9.35,3.1526,11,"Preferred One Administrative Services, INC.",PPO,10.846,98.6,,percent of total billed charges,,
NICOTINE 14 MG/24 HR TD PT24,,1923,LOCAL,Facility,Outpatient,1,EA,,11,9.35,3.1526,11,PrimeWest Health,Minnesota Senior Health Options (MSHO),5.6595,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
NICOTINE 14 MG/24 HR TD PT24,,1923,LOCAL,Facility,Inpatient,1,EA,,11,9.35,3.1526,11,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
NICOTINE 14 MG/24 HR TD PT24,,1923,LOCAL,Facility,Outpatient,1,EA,,11,9.35,3.1526,11,PrimeWest Health,MinnesotaCare,5.6496,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
NICOTINE 14 MG/24 HR TD PT24,,1923,LOCAL,Facility,Inpatient,1,EA,,11,9.35,3.1526,11,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
NICOTINE 14 MG/24 HR TD PT24,,1923,LOCAL,Facility,Both,1,EA,,11,9.35,3.1526,11,Sanford Health Plan,Sanford Health Plan,10.12,92,,percent of total billed charges,,
NICOTINE 14 MG/24 HR TD PT24,,1923,LOCAL,Facility,Outpatient,1,EA,,11,9.35,3.1526,11,"UCare Health, Inc.",Individual & Family Plan,6.1985,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
NICOTINE 14 MG/24 HR TD PT24,,1923,LOCAL,Facility,Inpatient,1,EA,,11,9.35,3.1526,11,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
NICOTINE 14 MG/24 HR TD PT24,,1923,LOCAL,Facility,Outpatient,1,EA,,11,9.35,3.1526,11,"UCare Health, Inc.",Medical Assistance,5.5517,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
NICOTINE 14 MG/24 HR TD PT24,,1923,LOCAL,Facility,Inpatient,1,EA,,11,9.35,3.1526,11,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
NICOTINE 14 MG/24 HR TD PT24,,1923,LOCAL,Facility,Outpatient,1,EA,,11,9.35,3.1526,11,"UCare Health, Inc.",Medicare Advantage,5.5517,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
NICOTINE 14 MG/24 HR TD PT24,,1923,LOCAL,Facility,Inpatient,1,EA,,11,9.35,3.1526,11,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
NICOTINE 14 MG/24 HR TD PT24,,1923,LOCAL,Facility,Outpatient,1,EA,,11,9.35,3.1526,11,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),5.5517,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
NICOTINE 14 MG/24 HR TD PT24,,1923,LOCAL,Facility,Inpatient,1,EA,,11,9.35,3.1526,11,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
NICOTINE 14 MG/24 HR TD PT24,,1923,LOCAL,Facility,Both,1,EA,,11,9.35,3.1526,11,UnitedHealthcare,Individual & Family,10.34,94,,percent of total billed charges,,
NICOTINE 14 MG/24 HR TD PT24,,1923,LOCAL,Facility,Outpatient,1,EA,,11,9.35,3.1526,11,UnitedHealthcare,Medicare Advantage,5.39,49,,percent of total billed charges,,
NICOTINE 14 MG/24 HR TD PT24,,1923,LOCAL,Facility,Inpatient,1,EA,,11,9.35,3.1526,11,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
NICOTINE 14 MG/24 HR TD PT24,,1923,LOCAL,Facility,Outpatient,1,EA,,11,9.35,3.1526,11,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,5.28,48,,percent of total billed charges,,100% of DHS outpatient percentage
NICOTINE 14 MG/24 HR TD PT24,,1923,LOCAL,Facility,Inpatient,1,EA,,11,9.35,3.1526,11,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
HALOPERIDOL 5 MG ORAL TABLET,,2142,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
HALOPERIDOL 5 MG ORAL TABLET,,2142,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
HALOPERIDOL 5 MG ORAL TABLET,,2142,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
HALOPERIDOL 5 MG ORAL TABLET,,2142,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
HALOPERIDOL 5 MG ORAL TABLET,,2142,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
HALOPERIDOL 5 MG ORAL TABLET,,2142,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
HALOPERIDOL 5 MG ORAL TABLET,,2142,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
HALOPERIDOL 5 MG ORAL TABLET,,2142,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
HALOPERIDOL 5 MG ORAL TABLET,,2142,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
HALOPERIDOL 5 MG ORAL TABLET,,2142,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
HALOPERIDOL 5 MG ORAL TABLET,,2142,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
HALOPERIDOL 5 MG ORAL TABLET,,2142,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
HALOPERIDOL 5 MG ORAL TABLET,,2142,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
HALOPERIDOL 5 MG ORAL TABLET,,2142,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
HALOPERIDOL 5 MG ORAL TABLET,,2142,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
HALOPERIDOL 5 MG ORAL TABLET,,2142,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
HALOPERIDOL 5 MG ORAL TABLET,,2142,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
HALOPERIDOL 5 MG ORAL TABLET,,2142,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
HALOPERIDOL 5 MG ORAL TABLET,,2142,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
HALOPERIDOL 5 MG ORAL TABLET,,2142,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
HALOPERIDOL 5 MG ORAL TABLET,,2142,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
HALOPERIDOL 5 MG ORAL TABLET,,2142,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
HALOPERIDOL 5 MG ORAL TABLET,,2142,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
HALOPERIDOL 5 MG ORAL TABLET,,2142,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
HALOPERIDOL 5 MG ORAL TABLET,,2142,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
HALOPERIDOL 5 MG ORAL TABLET,,2142,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
HALOPERIDOL 5 MG ORAL TABLET,,2142,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
HALOPERIDOL 5 MG ORAL TABLET,,2142,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
HALOPERIDOL 5 MG ORAL TABLET,,2142,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
HALOPERIDOL 5 MG ORAL TABLET,,2142,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
HALOPERIDOL 5 MG ORAL TABLET,,2142,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
HALOPERIDOL 5 MG ORAL TABLET,,2142,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
HALOPERIDOL 5 MG ORAL TABLET,,2142,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
HALOPERIDOL 5 MG ORAL TABLET,,2142,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
HALOPERIDOL 5 MG ORAL TABLET,,2142,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
HALOPERIDOL 5 MG ORAL TABLET,,2142,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
HALOPERIDOL 5 MG ORAL TABLET,,2142,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
HALOPERIDOL 5 MG ORAL TABLET,,2142,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
HALOPERIDOL 5 MG ORAL TABLET,,2142,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
HALOPERIDOL 5 MG ORAL TABLET,,2142,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
HALOPERIDOL 5 MG ORAL TABLET,,2142,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
HALOPERIDOL 5 MG ORAL TABLET,,2142,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
HALOPERIDOL 5 MG ORAL TABLET,,2142,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
HALOPERIDOL 5 MG ORAL TABLET,,2142,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
HALOPERIDOL 5 MG ORAL TABLET,,2142,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
HALOPERIDOL 5 MG ORAL TABLET,,2142,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
HALOPERIDOL 5 MG ORAL TABLET,,2142,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
HALOPERIDOL 5 MG ORAL TABLET,,2142,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
HALOPERIDOL 5 MG ORAL TABLET,,2142,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
HALOPERIDOL 5 MG ORAL TABLET,,2142,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
HALOPERIDOL 5 MG ORAL TABLET,,2142,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
HALOPERIDOL 5 MG ORAL TABLET,,2142,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
HALOPERIDOL 5 MG ORAL TABLET,,2142,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
HALOPERIDOL 5 MG ORAL TABLET,,2142,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
NITROGLYCERIN 0.1 MG/HR TD PT24,,2145,LOCAL,Facility,Both,1,EA,,10,8.5,2.866,10,Aetna,Commercial,9.2,92,,percent of total billed charges,,
NITROGLYCERIN 0.1 MG/HR TD PT24,,2145,LOCAL,Facility,Outpatient,1,EA,,10,8.5,2.866,10,Aetna,Medicare Advantage,4.9,49,,percent of total billed charges,,
NITROGLYCERIN 0.1 MG/HR TD PT24,,2145,LOCAL,Facility,Inpatient,1,EA,,10,8.5,2.866,10,Aetna,Medicare Advantage,,,,,Included in per diem rate,
NITROGLYCERIN 0.1 MG/HR TD PT24,,2145,LOCAL,Facility,Both,1,EA,,10,8.5,2.866,10,Aetna,PPO,9.3,93,,percent of total billed charges,,
NITROGLYCERIN 0.1 MG/HR TD PT24,,2145,LOCAL,Facility,Both,1,EA,,10,8.5,2.866,10,America's PPO,America's PPO,9.603,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
NITROGLYCERIN 0.1 MG/HR TD PT24,,2145,LOCAL,Facility,Both,1,EA,,10,8.5,2.866,10,BlueCross BlueShield Minnesota, Federal Employee Program,9.84,98.4,,percent of total billed charges,,
NITROGLYCERIN 0.1 MG/HR TD PT24,,2145,LOCAL,Facility,Both,1,EA,,10,8.5,2.866,10,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,10,100,,percent of total billed charges,,
NITROGLYCERIN 0.1 MG/HR TD PT24,,2145,LOCAL,Facility,Both,1,EA,,10,8.5,2.866,10,BlueCross BlueShield Minnesota,High Value Network Plan,9,90,,percent of total billed charges,,
NITROGLYCERIN 0.1 MG/HR TD PT24,,2145,LOCAL,Facility,Outpatient,1,EA,,10,8.5,2.866,10,BlueCross BlueShield Minnesota,Medicare Advantage,4.9,49,,percent of total billed charges,,
NITROGLYCERIN 0.1 MG/HR TD PT24,,2145,LOCAL,Facility,Inpatient,1,EA,,10,8.5,2.866,10,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
NITROGLYCERIN 0.1 MG/HR TD PT24,,2145,LOCAL,Facility,Both,1,EA,,10,8.5,2.866,10,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,8.857,88.57,,percent of total billed charges,,
NITROGLYCERIN 0.1 MG/HR TD PT24,,2145,LOCAL,Facility,Both,1,EA,,10,8.5,2.866,10,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,2.866,28.66,,percent of total billed charges,,
NITROGLYCERIN 0.1 MG/HR TD PT24,,2145,LOCAL,Facility,Outpatient,1,EA,,10,8.5,2.866,10,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),4.9,49,,percent of total billed charges,,
NITROGLYCERIN 0.1 MG/HR TD PT24,,2145,LOCAL,Facility,Inpatient,1,EA,,10,8.5,2.866,10,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
NITROGLYCERIN 0.1 MG/HR TD PT24,,2145,LOCAL,Facility,Both,1,EA,,10,8.5,2.866,10,CorVel,Worker's Compensation,10,100,,percent of total billed charges,,
NITROGLYCERIN 0.1 MG/HR TD PT24,,2145,LOCAL,Facility,Both,1,EA,,10,8.5,2.866,10,First Health Group Corporation,First Health Network,9.7,97,,percent of total billed charges,,
NITROGLYCERIN 0.1 MG/HR TD PT24,,2145,LOCAL,Facility,Both,1,EA,,10,8.5,2.866,10,"Health Partners, Inc.",Commercial,9.46,94.6,,percent of total billed charges,,
NITROGLYCERIN 0.1 MG/HR TD PT24,,2145,LOCAL,Facility,Outpatient,1,EA,,10,8.5,2.866,10,"Health Partners, Inc.",Medicare Advantage,4.9,49,,percent of total billed charges,,
NITROGLYCERIN 0.1 MG/HR TD PT24,,2145,LOCAL,Facility,Inpatient,1,EA,,10,8.5,2.866,10,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
NITROGLYCERIN 0.1 MG/HR TD PT24,,2145,LOCAL,Facility,Both,1,EA,,10,8.5,2.866,10,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),6,60,,percent of total billed charges,,
NITROGLYCERIN 0.1 MG/HR TD PT24,,2145,LOCAL,Facility,Both,1,EA,,10,8.5,2.866,10,"Health Partners, Inc.",State of Minnesota Advantage Program,8.15,81.5,,percent of total billed charges,,
NITROGLYCERIN 0.1 MG/HR TD PT24,,2145,LOCAL,Facility,Both,1,EA,,10,8.5,2.866,10,"Health Partners, Inc.",State Public Programs,5,50,,percent of total billed charges,,
NITROGLYCERIN 0.1 MG/HR TD PT24,,2145,LOCAL,Facility,Both,1,EA,,10,8.5,2.866,10,Humana Insurance Company,Commercial PPO,9.5,95,,percent of total billed charges,,
NITROGLYCERIN 0.1 MG/HR TD PT24,,2145,LOCAL,Facility,Outpatient,1,EA,,10,8.5,2.866,10,Humana Insurance Company,Medicare PPO,4.9,49,,percent of total billed charges,,
NITROGLYCERIN 0.1 MG/HR TD PT24,,2145,LOCAL,Facility,Inpatient,1,EA,,10,8.5,2.866,10,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
NITROGLYCERIN 0.1 MG/HR TD PT24,,2145,LOCAL,Facility,Both,1,EA,,10,8.5,2.866,10,Medica,Individual & Family,9.91,99.1,,percent of total billed charges,,
NITROGLYCERIN 0.1 MG/HR TD PT24,,2145,LOCAL,Facility,Outpatient,1,EA,,10,8.5,2.866,10,Medica,Medica Advantage Solution,4.98,49.8,,percent of total billed charges,,
NITROGLYCERIN 0.1 MG/HR TD PT24,,2145,LOCAL,Facility,Inpatient,1,EA,,10,8.5,2.866,10,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
NITROGLYCERIN 0.1 MG/HR TD PT24,,2145,LOCAL,Facility,Outpatient,1,EA,,10,8.5,2.866,10,Medica,Medical Assistance,4.46,44.6,,percent of total billed charges,,
NITROGLYCERIN 0.1 MG/HR TD PT24,,2145,LOCAL,Facility,Inpatient,1,EA,,10,8.5,2.866,10,Medica,Medical Assistance,,,,,Included in per diem rate,
NITROGLYCERIN 0.1 MG/HR TD PT24,,2145,LOCAL,Facility,Outpatient,1,EA,,10,8.5,2.866,10,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,4.98,49.8,,percent of total billed charges,,
NITROGLYCERIN 0.1 MG/HR TD PT24,,2145,LOCAL,Facility,Inpatient,1,EA,,10,8.5,2.866,10,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
NITROGLYCERIN 0.1 MG/HR TD PT24,,2145,LOCAL,Facility,Both,1,EA,,10,8.5,2.866,10,"Multiplan, Inc.","Multiplan, Inc.",9.4,94,,percent of total billed charges,,
NITROGLYCERIN 0.1 MG/HR TD PT24,,2145,LOCAL,Facility,Outpatient,1,EA,,10,8.5,2.866,10,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,9.01,90.1,,percent of total billed charges,,
NITROGLYCERIN 0.1 MG/HR TD PT24,,2145,LOCAL,Facility,Inpatient,1,EA,,10,8.5,2.866,10,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
NITROGLYCERIN 0.1 MG/HR TD PT24,,2145,LOCAL,Facility,Both,1,EA,,10,8.5,2.866,10,"Preferred One Administrative Services, INC.",PPO,9.86,98.6,,percent of total billed charges,,
NITROGLYCERIN 0.1 MG/HR TD PT24,,2145,LOCAL,Facility,Outpatient,1,EA,,10,8.5,2.866,10,PrimeWest Health,Minnesota Senior Health Options (MSHO),5.145,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
NITROGLYCERIN 0.1 MG/HR TD PT24,,2145,LOCAL,Facility,Inpatient,1,EA,,10,8.5,2.866,10,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
NITROGLYCERIN 0.1 MG/HR TD PT24,,2145,LOCAL,Facility,Outpatient,1,EA,,10,8.5,2.866,10,PrimeWest Health,MinnesotaCare,5.136,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
NITROGLYCERIN 0.1 MG/HR TD PT24,,2145,LOCAL,Facility,Inpatient,1,EA,,10,8.5,2.866,10,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
NITROGLYCERIN 0.1 MG/HR TD PT24,,2145,LOCAL,Facility,Both,1,EA,,10,8.5,2.866,10,Sanford Health Plan,Sanford Health Plan,9.2,92,,percent of total billed charges,,
NITROGLYCERIN 0.1 MG/HR TD PT24,,2145,LOCAL,Facility,Outpatient,1,EA,,10,8.5,2.866,10,"UCare Health, Inc.",Individual & Family Plan,5.635,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
NITROGLYCERIN 0.1 MG/HR TD PT24,,2145,LOCAL,Facility,Inpatient,1,EA,,10,8.5,2.866,10,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
NITROGLYCERIN 0.1 MG/HR TD PT24,,2145,LOCAL,Facility,Outpatient,1,EA,,10,8.5,2.866,10,"UCare Health, Inc.",Medical Assistance,5.047,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
NITROGLYCERIN 0.1 MG/HR TD PT24,,2145,LOCAL,Facility,Inpatient,1,EA,,10,8.5,2.866,10,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
NITROGLYCERIN 0.1 MG/HR TD PT24,,2145,LOCAL,Facility,Outpatient,1,EA,,10,8.5,2.866,10,"UCare Health, Inc.",Medicare Advantage,5.047,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
NITROGLYCERIN 0.1 MG/HR TD PT24,,2145,LOCAL,Facility,Inpatient,1,EA,,10,8.5,2.866,10,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
NITROGLYCERIN 0.1 MG/HR TD PT24,,2145,LOCAL,Facility,Outpatient,1,EA,,10,8.5,2.866,10,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),5.047,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
NITROGLYCERIN 0.1 MG/HR TD PT24,,2145,LOCAL,Facility,Inpatient,1,EA,,10,8.5,2.866,10,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
NITROGLYCERIN 0.1 MG/HR TD PT24,,2145,LOCAL,Facility,Both,1,EA,,10,8.5,2.866,10,UnitedHealthcare,Individual & Family,9.4,94,,percent of total billed charges,,
NITROGLYCERIN 0.1 MG/HR TD PT24,,2145,LOCAL,Facility,Outpatient,1,EA,,10,8.5,2.866,10,UnitedHealthcare,Medicare Advantage,4.9,49,,percent of total billed charges,,
NITROGLYCERIN 0.1 MG/HR TD PT24,,2145,LOCAL,Facility,Inpatient,1,EA,,10,8.5,2.866,10,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
NITROGLYCERIN 0.1 MG/HR TD PT24,,2145,LOCAL,Facility,Outpatient,1,EA,,10,8.5,2.866,10,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,4.8,48,,percent of total billed charges,,100% of DHS outpatient percentage
NITROGLYCERIN 0.1 MG/HR TD PT24,,2145,LOCAL,Facility,Inpatient,1,EA,,10,8.5,2.866,10,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
TORSEMIDE 20 MG ORAL TABLET,,2154,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
TORSEMIDE 20 MG ORAL TABLET,,2154,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
TORSEMIDE 20 MG ORAL TABLET,,2154,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
TORSEMIDE 20 MG ORAL TABLET,,2154,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
TORSEMIDE 20 MG ORAL TABLET,,2154,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
TORSEMIDE 20 MG ORAL TABLET,,2154,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
TORSEMIDE 20 MG ORAL TABLET,,2154,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
TORSEMIDE 20 MG ORAL TABLET,,2154,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
TORSEMIDE 20 MG ORAL TABLET,,2154,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
TORSEMIDE 20 MG ORAL TABLET,,2154,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
TORSEMIDE 20 MG ORAL TABLET,,2154,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
TORSEMIDE 20 MG ORAL TABLET,,2154,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
TORSEMIDE 20 MG ORAL TABLET,,2154,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
TORSEMIDE 20 MG ORAL TABLET,,2154,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
TORSEMIDE 20 MG ORAL TABLET,,2154,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
TORSEMIDE 20 MG ORAL TABLET,,2154,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
TORSEMIDE 20 MG ORAL TABLET,,2154,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
TORSEMIDE 20 MG ORAL TABLET,,2154,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
TORSEMIDE 20 MG ORAL TABLET,,2154,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
TORSEMIDE 20 MG ORAL TABLET,,2154,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
TORSEMIDE 20 MG ORAL TABLET,,2154,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
TORSEMIDE 20 MG ORAL TABLET,,2154,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
TORSEMIDE 20 MG ORAL TABLET,,2154,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
TORSEMIDE 20 MG ORAL TABLET,,2154,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
TORSEMIDE 20 MG ORAL TABLET,,2154,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
TORSEMIDE 20 MG ORAL TABLET,,2154,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
TORSEMIDE 20 MG ORAL TABLET,,2154,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
TORSEMIDE 20 MG ORAL TABLET,,2154,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
TORSEMIDE 20 MG ORAL TABLET,,2154,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
TORSEMIDE 20 MG ORAL TABLET,,2154,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
TORSEMIDE 20 MG ORAL TABLET,,2154,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
TORSEMIDE 20 MG ORAL TABLET,,2154,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
TORSEMIDE 20 MG ORAL TABLET,,2154,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
TORSEMIDE 20 MG ORAL TABLET,,2154,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
TORSEMIDE 20 MG ORAL TABLET,,2154,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
TORSEMIDE 20 MG ORAL TABLET,,2154,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
TORSEMIDE 20 MG ORAL TABLET,,2154,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
TORSEMIDE 20 MG ORAL TABLET,,2154,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
TORSEMIDE 20 MG ORAL TABLET,,2154,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
TORSEMIDE 20 MG ORAL TABLET,,2154,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
TORSEMIDE 20 MG ORAL TABLET,,2154,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
TORSEMIDE 20 MG ORAL TABLET,,2154,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
TORSEMIDE 20 MG ORAL TABLET,,2154,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
TORSEMIDE 20 MG ORAL TABLET,,2154,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TORSEMIDE 20 MG ORAL TABLET,,2154,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
TORSEMIDE 20 MG ORAL TABLET,,2154,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TORSEMIDE 20 MG ORAL TABLET,,2154,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
TORSEMIDE 20 MG ORAL TABLET,,2154,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TORSEMIDE 20 MG ORAL TABLET,,2154,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
TORSEMIDE 20 MG ORAL TABLET,,2154,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
TORSEMIDE 20 MG ORAL TABLET,,2154,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
TORSEMIDE 20 MG ORAL TABLET,,2154,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
TORSEMIDE 20 MG ORAL TABLET,,2154,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
TORSEMIDE 20 MG ORAL TABLET,,2154,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
SULFASALAZINE 500 MG ORAL TABLET,,2193,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
SULFASALAZINE 500 MG ORAL TABLET,,2193,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
SULFASALAZINE 500 MG ORAL TABLET,,2193,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
SULFASALAZINE 500 MG ORAL TABLET,,2193,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
SULFASALAZINE 500 MG ORAL TABLET,,2193,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SULFASALAZINE 500 MG ORAL TABLET,,2193,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
SULFASALAZINE 500 MG ORAL TABLET,,2193,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
SULFASALAZINE 500 MG ORAL TABLET,,2193,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
SULFASALAZINE 500 MG ORAL TABLET,,2193,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
SULFASALAZINE 500 MG ORAL TABLET,,2193,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
SULFASALAZINE 500 MG ORAL TABLET,,2193,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
SULFASALAZINE 500 MG ORAL TABLET,,2193,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
SULFASALAZINE 500 MG ORAL TABLET,,2193,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
SULFASALAZINE 500 MG ORAL TABLET,,2193,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
SULFASALAZINE 500 MG ORAL TABLET,,2193,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
SULFASALAZINE 500 MG ORAL TABLET,,2193,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
SULFASALAZINE 500 MG ORAL TABLET,,2193,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
SULFASALAZINE 500 MG ORAL TABLET,,2193,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
SULFASALAZINE 500 MG ORAL TABLET,,2193,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SULFASALAZINE 500 MG ORAL TABLET,,2193,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
SULFASALAZINE 500 MG ORAL TABLET,,2193,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
SULFASALAZINE 500 MG ORAL TABLET,,2193,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
SULFASALAZINE 500 MG ORAL TABLET,,2193,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
SULFASALAZINE 500 MG ORAL TABLET,,2193,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
SULFASALAZINE 500 MG ORAL TABLET,,2193,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
SULFASALAZINE 500 MG ORAL TABLET,,2193,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
SULFASALAZINE 500 MG ORAL TABLET,,2193,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
SULFASALAZINE 500 MG ORAL TABLET,,2193,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
SULFASALAZINE 500 MG ORAL TABLET,,2193,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
SULFASALAZINE 500 MG ORAL TABLET,,2193,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
SULFASALAZINE 500 MG ORAL TABLET,,2193,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
SULFASALAZINE 500 MG ORAL TABLET,,2193,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
SULFASALAZINE 500 MG ORAL TABLET,,2193,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
SULFASALAZINE 500 MG ORAL TABLET,,2193,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
SULFASALAZINE 500 MG ORAL TABLET,,2193,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
SULFASALAZINE 500 MG ORAL TABLET,,2193,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
SULFASALAZINE 500 MG ORAL TABLET,,2193,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
SULFASALAZINE 500 MG ORAL TABLET,,2193,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SULFASALAZINE 500 MG ORAL TABLET,,2193,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
SULFASALAZINE 500 MG ORAL TABLET,,2193,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
SULFASALAZINE 500 MG ORAL TABLET,,2193,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
SULFASALAZINE 500 MG ORAL TABLET,,2193,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
SULFASALAZINE 500 MG ORAL TABLET,,2193,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
SULFASALAZINE 500 MG ORAL TABLET,,2193,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SULFASALAZINE 500 MG ORAL TABLET,,2193,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
SULFASALAZINE 500 MG ORAL TABLET,,2193,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SULFASALAZINE 500 MG ORAL TABLET,,2193,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SULFASALAZINE 500 MG ORAL TABLET,,2193,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SULFASALAZINE 500 MG ORAL TABLET,,2193,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SULFASALAZINE 500 MG ORAL TABLET,,2193,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
SULFASALAZINE 500 MG ORAL TABLET,,2193,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
SULFASALAZINE 500 MG ORAL TABLET,,2193,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
SULFASALAZINE 500 MG ORAL TABLET,,2193,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
SULFASALAZINE 500 MG ORAL TABLET,,2193,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
DIVALPROEX 250 MG ORAL TBEC,,2605,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
DIVALPROEX 250 MG ORAL TBEC,,2605,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
DIVALPROEX 250 MG ORAL TBEC,,2605,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
DIVALPROEX 250 MG ORAL TBEC,,2605,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
DIVALPROEX 250 MG ORAL TBEC,,2605,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
DIVALPROEX 250 MG ORAL TBEC,,2605,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
DIVALPROEX 250 MG ORAL TBEC,,2605,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
DIVALPROEX 250 MG ORAL TBEC,,2605,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
DIVALPROEX 250 MG ORAL TBEC,,2605,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
DIVALPROEX 250 MG ORAL TBEC,,2605,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
DIVALPROEX 250 MG ORAL TBEC,,2605,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
DIVALPROEX 250 MG ORAL TBEC,,2605,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
DIVALPROEX 250 MG ORAL TBEC,,2605,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
DIVALPROEX 250 MG ORAL TBEC,,2605,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
DIVALPROEX 250 MG ORAL TBEC,,2605,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
DIVALPROEX 250 MG ORAL TBEC,,2605,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
DIVALPROEX 250 MG ORAL TBEC,,2605,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
DIVALPROEX 250 MG ORAL TBEC,,2605,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
DIVALPROEX 250 MG ORAL TBEC,,2605,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DIVALPROEX 250 MG ORAL TBEC,,2605,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
DIVALPROEX 250 MG ORAL TBEC,,2605,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
DIVALPROEX 250 MG ORAL TBEC,,2605,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
DIVALPROEX 250 MG ORAL TBEC,,2605,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
DIVALPROEX 250 MG ORAL TBEC,,2605,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
DIVALPROEX 250 MG ORAL TBEC,,2605,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
DIVALPROEX 250 MG ORAL TBEC,,2605,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
DIVALPROEX 250 MG ORAL TBEC,,2605,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
DIVALPROEX 250 MG ORAL TBEC,,2605,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
DIVALPROEX 250 MG ORAL TBEC,,2605,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
DIVALPROEX 250 MG ORAL TBEC,,2605,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
DIVALPROEX 250 MG ORAL TBEC,,2605,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
DIVALPROEX 250 MG ORAL TBEC,,2605,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
DIVALPROEX 250 MG ORAL TBEC,,2605,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
DIVALPROEX 250 MG ORAL TBEC,,2605,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
DIVALPROEX 250 MG ORAL TBEC,,2605,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
DIVALPROEX 250 MG ORAL TBEC,,2605,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
DIVALPROEX 250 MG ORAL TBEC,,2605,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
DIVALPROEX 250 MG ORAL TBEC,,2605,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DIVALPROEX 250 MG ORAL TBEC,,2605,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
DIVALPROEX 250 MG ORAL TBEC,,2605,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
DIVALPROEX 250 MG ORAL TBEC,,2605,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
DIVALPROEX 250 MG ORAL TBEC,,2605,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
DIVALPROEX 250 MG ORAL TBEC,,2605,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
DIVALPROEX 250 MG ORAL TBEC,,2605,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DIVALPROEX 250 MG ORAL TBEC,,2605,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
DIVALPROEX 250 MG ORAL TBEC,,2605,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DIVALPROEX 250 MG ORAL TBEC,,2605,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DIVALPROEX 250 MG ORAL TBEC,,2605,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DIVALPROEX 250 MG ORAL TBEC,,2605,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DIVALPROEX 250 MG ORAL TBEC,,2605,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
DIVALPROEX 250 MG ORAL TBEC,,2605,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
DIVALPROEX 250 MG ORAL TBEC,,2605,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
DIVALPROEX 250 MG ORAL TBEC,,2605,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
DIVALPROEX 250 MG ORAL TBEC,,2605,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
CARBIDOPA-LEVODOPA 25-100 MG ORAL TAB SR,,2677,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
CARBIDOPA-LEVODOPA 25-100 MG ORAL TAB SR,,2677,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
CARBIDOPA-LEVODOPA 25-100 MG ORAL TAB SR,,2677,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
CARBIDOPA-LEVODOPA 25-100 MG ORAL TAB SR,,2677,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
CARBIDOPA-LEVODOPA 25-100 MG ORAL TAB SR,,2677,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
CARBIDOPA-LEVODOPA 25-100 MG ORAL TAB SR,,2677,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
CARBIDOPA-LEVODOPA 25-100 MG ORAL TAB SR,,2677,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
CARBIDOPA-LEVODOPA 25-100 MG ORAL TAB SR,,2677,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
CARBIDOPA-LEVODOPA 25-100 MG ORAL TAB SR,,2677,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
CARBIDOPA-LEVODOPA 25-100 MG ORAL TAB SR,,2677,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
CARBIDOPA-LEVODOPA 25-100 MG ORAL TAB SR,,2677,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
CARBIDOPA-LEVODOPA 25-100 MG ORAL TAB SR,,2677,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
CARBIDOPA-LEVODOPA 25-100 MG ORAL TAB SR,,2677,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
CARBIDOPA-LEVODOPA 25-100 MG ORAL TAB SR,,2677,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
CARBIDOPA-LEVODOPA 25-100 MG ORAL TAB SR,,2677,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
CARBIDOPA-LEVODOPA 25-100 MG ORAL TAB SR,,2677,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
CARBIDOPA-LEVODOPA 25-100 MG ORAL TAB SR,,2677,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
CARBIDOPA-LEVODOPA 25-100 MG ORAL TAB SR,,2677,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
CARBIDOPA-LEVODOPA 25-100 MG ORAL TAB SR,,2677,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CARBIDOPA-LEVODOPA 25-100 MG ORAL TAB SR,,2677,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
CARBIDOPA-LEVODOPA 25-100 MG ORAL TAB SR,,2677,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
CARBIDOPA-LEVODOPA 25-100 MG ORAL TAB SR,,2677,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
CARBIDOPA-LEVODOPA 25-100 MG ORAL TAB SR,,2677,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
CARBIDOPA-LEVODOPA 25-100 MG ORAL TAB SR,,2677,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
CARBIDOPA-LEVODOPA 25-100 MG ORAL TAB SR,,2677,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
CARBIDOPA-LEVODOPA 25-100 MG ORAL TAB SR,,2677,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
CARBIDOPA-LEVODOPA 25-100 MG ORAL TAB SR,,2677,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
CARBIDOPA-LEVODOPA 25-100 MG ORAL TAB SR,,2677,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
CARBIDOPA-LEVODOPA 25-100 MG ORAL TAB SR,,2677,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
CARBIDOPA-LEVODOPA 25-100 MG ORAL TAB SR,,2677,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
CARBIDOPA-LEVODOPA 25-100 MG ORAL TAB SR,,2677,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
CARBIDOPA-LEVODOPA 25-100 MG ORAL TAB SR,,2677,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
CARBIDOPA-LEVODOPA 25-100 MG ORAL TAB SR,,2677,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
CARBIDOPA-LEVODOPA 25-100 MG ORAL TAB SR,,2677,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
CARBIDOPA-LEVODOPA 25-100 MG ORAL TAB SR,,2677,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
CARBIDOPA-LEVODOPA 25-100 MG ORAL TAB SR,,2677,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
CARBIDOPA-LEVODOPA 25-100 MG ORAL TAB SR,,2677,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
CARBIDOPA-LEVODOPA 25-100 MG ORAL TAB SR,,2677,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CARBIDOPA-LEVODOPA 25-100 MG ORAL TAB SR,,2677,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
CARBIDOPA-LEVODOPA 25-100 MG ORAL TAB SR,,2677,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
CARBIDOPA-LEVODOPA 25-100 MG ORAL TAB SR,,2677,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
CARBIDOPA-LEVODOPA 25-100 MG ORAL TAB SR,,2677,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
CARBIDOPA-LEVODOPA 25-100 MG ORAL TAB SR,,2677,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
CARBIDOPA-LEVODOPA 25-100 MG ORAL TAB SR,,2677,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CARBIDOPA-LEVODOPA 25-100 MG ORAL TAB SR,,2677,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
CARBIDOPA-LEVODOPA 25-100 MG ORAL TAB SR,,2677,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CARBIDOPA-LEVODOPA 25-100 MG ORAL TAB SR,,2677,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CARBIDOPA-LEVODOPA 25-100 MG ORAL TAB SR,,2677,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CARBIDOPA-LEVODOPA 25-100 MG ORAL TAB SR,,2677,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CARBIDOPA-LEVODOPA 25-100 MG ORAL TAB SR,,2677,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
CARBIDOPA-LEVODOPA 25-100 MG ORAL TAB SR,,2677,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
CARBIDOPA-LEVODOPA 25-100 MG ORAL TAB SR,,2677,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
CARBIDOPA-LEVODOPA 25-100 MG ORAL TAB SR,,2677,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
CARBIDOPA-LEVODOPA 25-100 MG ORAL TAB SR,,2677,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
LOPERAMIDE 2 MG ORAL CAP,,2687,LOCAL,Facility,Both,1,EA,,7,5.95,2.0062,7,Aetna,Commercial,6.44,92,,percent of total billed charges,,
LOPERAMIDE 2 MG ORAL CAP,,2687,LOCAL,Facility,Outpatient,1,EA,,7,5.95,2.0062,7,Aetna,Medicare Advantage,3.43,49,,percent of total billed charges,,
LOPERAMIDE 2 MG ORAL CAP,,2687,LOCAL,Facility,Inpatient,1,EA,,7,5.95,2.0062,7,Aetna,Medicare Advantage,,,,,Included in per diem rate,
LOPERAMIDE 2 MG ORAL CAP,,2687,LOCAL,Facility,Both,1,EA,,7,5.95,2.0062,7,Aetna,PPO,6.51,93,,percent of total billed charges,,
LOPERAMIDE 2 MG ORAL CAP,,2687,LOCAL,Facility,Both,1,EA,,7,5.95,2.0062,7,America's PPO,America's PPO,6.7221,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
LOPERAMIDE 2 MG ORAL CAP,,2687,LOCAL,Facility,Both,1,EA,,7,5.95,2.0062,7,BlueCross BlueShield Minnesota, Federal Employee Program,6.888,98.4,,percent of total billed charges,,
LOPERAMIDE 2 MG ORAL CAP,,2687,LOCAL,Facility,Both,1,EA,,7,5.95,2.0062,7,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,7,100,,percent of total billed charges,,
LOPERAMIDE 2 MG ORAL CAP,,2687,LOCAL,Facility,Both,1,EA,,7,5.95,2.0062,7,BlueCross BlueShield Minnesota,High Value Network Plan,6.3,90,,percent of total billed charges,,
LOPERAMIDE 2 MG ORAL CAP,,2687,LOCAL,Facility,Outpatient,1,EA,,7,5.95,2.0062,7,BlueCross BlueShield Minnesota,Medicare Advantage,3.43,49,,percent of total billed charges,,
LOPERAMIDE 2 MG ORAL CAP,,2687,LOCAL,Facility,Inpatient,1,EA,,7,5.95,2.0062,7,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
LOPERAMIDE 2 MG ORAL CAP,,2687,LOCAL,Facility,Both,1,EA,,7,5.95,2.0062,7,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,6.1999,88.57,,percent of total billed charges,,
LOPERAMIDE 2 MG ORAL CAP,,2687,LOCAL,Facility,Both,1,EA,,7,5.95,2.0062,7,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,2.0062,28.66,,percent of total billed charges,,
LOPERAMIDE 2 MG ORAL CAP,,2687,LOCAL,Facility,Outpatient,1,EA,,7,5.95,2.0062,7,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),3.43,49,,percent of total billed charges,,
LOPERAMIDE 2 MG ORAL CAP,,2687,LOCAL,Facility,Inpatient,1,EA,,7,5.95,2.0062,7,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
LOPERAMIDE 2 MG ORAL CAP,,2687,LOCAL,Facility,Both,1,EA,,7,5.95,2.0062,7,CorVel,Worker's Compensation,7,100,,percent of total billed charges,,
LOPERAMIDE 2 MG ORAL CAP,,2687,LOCAL,Facility,Both,1,EA,,7,5.95,2.0062,7,First Health Group Corporation,First Health Network,6.79,97,,percent of total billed charges,,
LOPERAMIDE 2 MG ORAL CAP,,2687,LOCAL,Facility,Both,1,EA,,7,5.95,2.0062,7,"Health Partners, Inc.",Commercial,6.622,94.6,,percent of total billed charges,,
LOPERAMIDE 2 MG ORAL CAP,,2687,LOCAL,Facility,Outpatient,1,EA,,7,5.95,2.0062,7,"Health Partners, Inc.",Medicare Advantage,3.43,49,,percent of total billed charges,,
LOPERAMIDE 2 MG ORAL CAP,,2687,LOCAL,Facility,Inpatient,1,EA,,7,5.95,2.0062,7,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LOPERAMIDE 2 MG ORAL CAP,,2687,LOCAL,Facility,Both,1,EA,,7,5.95,2.0062,7,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),4.2,60,,percent of total billed charges,,
LOPERAMIDE 2 MG ORAL CAP,,2687,LOCAL,Facility,Both,1,EA,,7,5.95,2.0062,7,"Health Partners, Inc.",State of Minnesota Advantage Program,5.705,81.5,,percent of total billed charges,,
LOPERAMIDE 2 MG ORAL CAP,,2687,LOCAL,Facility,Both,1,EA,,7,5.95,2.0062,7,"Health Partners, Inc.",State Public Programs,3.5,50,,percent of total billed charges,,
LOPERAMIDE 2 MG ORAL CAP,,2687,LOCAL,Facility,Both,1,EA,,7,5.95,2.0062,7,Humana Insurance Company,Commercial PPO,6.65,95,,percent of total billed charges,,
LOPERAMIDE 2 MG ORAL CAP,,2687,LOCAL,Facility,Outpatient,1,EA,,7,5.95,2.0062,7,Humana Insurance Company,Medicare PPO,3.43,49,,percent of total billed charges,,
LOPERAMIDE 2 MG ORAL CAP,,2687,LOCAL,Facility,Inpatient,1,EA,,7,5.95,2.0062,7,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
LOPERAMIDE 2 MG ORAL CAP,,2687,LOCAL,Facility,Both,1,EA,,7,5.95,2.0062,7,Medica,Individual & Family,6.937,99.1,,percent of total billed charges,,
LOPERAMIDE 2 MG ORAL CAP,,2687,LOCAL,Facility,Outpatient,1,EA,,7,5.95,2.0062,7,Medica,Medica Advantage Solution,3.486,49.8,,percent of total billed charges,,
LOPERAMIDE 2 MG ORAL CAP,,2687,LOCAL,Facility,Inpatient,1,EA,,7,5.95,2.0062,7,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
LOPERAMIDE 2 MG ORAL CAP,,2687,LOCAL,Facility,Outpatient,1,EA,,7,5.95,2.0062,7,Medica,Medical Assistance,3.122,44.6,,percent of total billed charges,,
LOPERAMIDE 2 MG ORAL CAP,,2687,LOCAL,Facility,Inpatient,1,EA,,7,5.95,2.0062,7,Medica,Medical Assistance,,,,,Included in per diem rate,
LOPERAMIDE 2 MG ORAL CAP,,2687,LOCAL,Facility,Outpatient,1,EA,,7,5.95,2.0062,7,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,3.486,49.8,,percent of total billed charges,,
LOPERAMIDE 2 MG ORAL CAP,,2687,LOCAL,Facility,Inpatient,1,EA,,7,5.95,2.0062,7,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
LOPERAMIDE 2 MG ORAL CAP,,2687,LOCAL,Facility,Both,1,EA,,7,5.95,2.0062,7,"Multiplan, Inc.","Multiplan, Inc.",6.58,94,,percent of total billed charges,,
LOPERAMIDE 2 MG ORAL CAP,,2687,LOCAL,Facility,Outpatient,1,EA,,7,5.95,2.0062,7,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,6.307,90.1,,percent of total billed charges,,
LOPERAMIDE 2 MG ORAL CAP,,2687,LOCAL,Facility,Inpatient,1,EA,,7,5.95,2.0062,7,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
LOPERAMIDE 2 MG ORAL CAP,,2687,LOCAL,Facility,Both,1,EA,,7,5.95,2.0062,7,"Preferred One Administrative Services, INC.",PPO,6.902,98.6,,percent of total billed charges,,
LOPERAMIDE 2 MG ORAL CAP,,2687,LOCAL,Facility,Outpatient,1,EA,,7,5.95,2.0062,7,PrimeWest Health,Minnesota Senior Health Options (MSHO),3.6015,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
LOPERAMIDE 2 MG ORAL CAP,,2687,LOCAL,Facility,Inpatient,1,EA,,7,5.95,2.0062,7,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LOPERAMIDE 2 MG ORAL CAP,,2687,LOCAL,Facility,Outpatient,1,EA,,7,5.95,2.0062,7,PrimeWest Health,MinnesotaCare,3.5952,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
LOPERAMIDE 2 MG ORAL CAP,,2687,LOCAL,Facility,Inpatient,1,EA,,7,5.95,2.0062,7,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
LOPERAMIDE 2 MG ORAL CAP,,2687,LOCAL,Facility,Both,1,EA,,7,5.95,2.0062,7,Sanford Health Plan,Sanford Health Plan,6.44,92,,percent of total billed charges,,
LOPERAMIDE 2 MG ORAL CAP,,2687,LOCAL,Facility,Outpatient,1,EA,,7,5.95,2.0062,7,"UCare Health, Inc.",Individual & Family Plan,3.9445,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
LOPERAMIDE 2 MG ORAL CAP,,2687,LOCAL,Facility,Inpatient,1,EA,,7,5.95,2.0062,7,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
LOPERAMIDE 2 MG ORAL CAP,,2687,LOCAL,Facility,Outpatient,1,EA,,7,5.95,2.0062,7,"UCare Health, Inc.",Medical Assistance,3.5329,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LOPERAMIDE 2 MG ORAL CAP,,2687,LOCAL,Facility,Inpatient,1,EA,,7,5.95,2.0062,7,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
LOPERAMIDE 2 MG ORAL CAP,,2687,LOCAL,Facility,Outpatient,1,EA,,7,5.95,2.0062,7,"UCare Health, Inc.",Medicare Advantage,3.5329,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LOPERAMIDE 2 MG ORAL CAP,,2687,LOCAL,Facility,Inpatient,1,EA,,7,5.95,2.0062,7,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LOPERAMIDE 2 MG ORAL CAP,,2687,LOCAL,Facility,Outpatient,1,EA,,7,5.95,2.0062,7,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),3.5329,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LOPERAMIDE 2 MG ORAL CAP,,2687,LOCAL,Facility,Inpatient,1,EA,,7,5.95,2.0062,7,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LOPERAMIDE 2 MG ORAL CAP,,2687,LOCAL,Facility,Both,1,EA,,7,5.95,2.0062,7,UnitedHealthcare,Individual & Family,6.58,94,,percent of total billed charges,,
LOPERAMIDE 2 MG ORAL CAP,,2687,LOCAL,Facility,Outpatient,1,EA,,7,5.95,2.0062,7,UnitedHealthcare,Medicare Advantage,3.43,49,,percent of total billed charges,,
LOPERAMIDE 2 MG ORAL CAP,,2687,LOCAL,Facility,Inpatient,1,EA,,7,5.95,2.0062,7,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
LOPERAMIDE 2 MG ORAL CAP,,2687,LOCAL,Facility,Outpatient,1,EA,,7,5.95,2.0062,7,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,3.36,48,,percent of total billed charges,,100% of DHS outpatient percentage
LOPERAMIDE 2 MG ORAL CAP,,2687,LOCAL,Facility,Inpatient,1,EA,,7,5.95,2.0062,7,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
TRAZODONE 50 MG ORAL TABLET,,2724,LOCAL,Facility,Both,1,EA,,6,5.1,1.7196,6,Aetna,Commercial,5.52,92,,percent of total billed charges,,
TRAZODONE 50 MG ORAL TABLET,,2724,LOCAL,Facility,Outpatient,1,EA,,6,5.1,1.7196,6,Aetna,Medicare Advantage,2.94,49,,percent of total billed charges,,
TRAZODONE 50 MG ORAL TABLET,,2724,LOCAL,Facility,Inpatient,1,EA,,6,5.1,1.7196,6,Aetna,Medicare Advantage,,,,,Included in per diem rate,
TRAZODONE 50 MG ORAL TABLET,,2724,LOCAL,Facility,Both,1,EA,,6,5.1,1.7196,6,Aetna,PPO,5.58,93,,percent of total billed charges,,
TRAZODONE 50 MG ORAL TABLET,,2724,LOCAL,Facility,Both,1,EA,,6,5.1,1.7196,6,America's PPO,America's PPO,5.7618,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
TRAZODONE 50 MG ORAL TABLET,,2724,LOCAL,Facility,Both,1,EA,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota, Federal Employee Program,5.904,98.4,,percent of total billed charges,,
TRAZODONE 50 MG ORAL TABLET,,2724,LOCAL,Facility,Both,1,EA,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,6,100,,percent of total billed charges,,
TRAZODONE 50 MG ORAL TABLET,,2724,LOCAL,Facility,Both,1,EA,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota,High Value Network Plan,5.4,90,,percent of total billed charges,,
TRAZODONE 50 MG ORAL TABLET,,2724,LOCAL,Facility,Outpatient,1,EA,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota,Medicare Advantage,2.94,49,,percent of total billed charges,,
TRAZODONE 50 MG ORAL TABLET,,2724,LOCAL,Facility,Inpatient,1,EA,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
TRAZODONE 50 MG ORAL TABLET,,2724,LOCAL,Facility,Both,1,EA,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,5.3142,88.57,,percent of total billed charges,,
TRAZODONE 50 MG ORAL TABLET,,2724,LOCAL,Facility,Both,1,EA,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.7196,28.66,,percent of total billed charges,,
TRAZODONE 50 MG ORAL TABLET,,2724,LOCAL,Facility,Outpatient,1,EA,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.94,49,,percent of total billed charges,,
TRAZODONE 50 MG ORAL TABLET,,2724,LOCAL,Facility,Inpatient,1,EA,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
TRAZODONE 50 MG ORAL TABLET,,2724,LOCAL,Facility,Both,1,EA,,6,5.1,1.7196,6,CorVel,Worker's Compensation,6,100,,percent of total billed charges,,
TRAZODONE 50 MG ORAL TABLET,,2724,LOCAL,Facility,Both,1,EA,,6,5.1,1.7196,6,First Health Group Corporation,First Health Network,5.82,97,,percent of total billed charges,,
TRAZODONE 50 MG ORAL TABLET,,2724,LOCAL,Facility,Both,1,EA,,6,5.1,1.7196,6,"Health Partners, Inc.",Commercial,5.676,94.6,,percent of total billed charges,,
TRAZODONE 50 MG ORAL TABLET,,2724,LOCAL,Facility,Outpatient,1,EA,,6,5.1,1.7196,6,"Health Partners, Inc.",Medicare Advantage,2.94,49,,percent of total billed charges,,
TRAZODONE 50 MG ORAL TABLET,,2724,LOCAL,Facility,Inpatient,1,EA,,6,5.1,1.7196,6,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
TRAZODONE 50 MG ORAL TABLET,,2724,LOCAL,Facility,Both,1,EA,,6,5.1,1.7196,6,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3.6,60,,percent of total billed charges,,
TRAZODONE 50 MG ORAL TABLET,,2724,LOCAL,Facility,Both,1,EA,,6,5.1,1.7196,6,"Health Partners, Inc.",State of Minnesota Advantage Program,4.89,81.5,,percent of total billed charges,,
TRAZODONE 50 MG ORAL TABLET,,2724,LOCAL,Facility,Both,1,EA,,6,5.1,1.7196,6,"Health Partners, Inc.",State Public Programs,3,50,,percent of total billed charges,,
TRAZODONE 50 MG ORAL TABLET,,2724,LOCAL,Facility,Both,1,EA,,6,5.1,1.7196,6,Humana Insurance Company,Commercial PPO,5.7,95,,percent of total billed charges,,
TRAZODONE 50 MG ORAL TABLET,,2724,LOCAL,Facility,Outpatient,1,EA,,6,5.1,1.7196,6,Humana Insurance Company,Medicare PPO,2.94,49,,percent of total billed charges,,
TRAZODONE 50 MG ORAL TABLET,,2724,LOCAL,Facility,Inpatient,1,EA,,6,5.1,1.7196,6,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
TRAZODONE 50 MG ORAL TABLET,,2724,LOCAL,Facility,Both,1,EA,,6,5.1,1.7196,6,Medica,Individual & Family,5.946,99.1,,percent of total billed charges,,
TRAZODONE 50 MG ORAL TABLET,,2724,LOCAL,Facility,Outpatient,1,EA,,6,5.1,1.7196,6,Medica,Medica Advantage Solution,2.988,49.8,,percent of total billed charges,,
TRAZODONE 50 MG ORAL TABLET,,2724,LOCAL,Facility,Inpatient,1,EA,,6,5.1,1.7196,6,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
TRAZODONE 50 MG ORAL TABLET,,2724,LOCAL,Facility,Outpatient,1,EA,,6,5.1,1.7196,6,Medica,Medical Assistance,2.676,44.6,,percent of total billed charges,,
TRAZODONE 50 MG ORAL TABLET,,2724,LOCAL,Facility,Inpatient,1,EA,,6,5.1,1.7196,6,Medica,Medical Assistance,,,,,Included in per diem rate,
TRAZODONE 50 MG ORAL TABLET,,2724,LOCAL,Facility,Outpatient,1,EA,,6,5.1,1.7196,6,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.988,49.8,,percent of total billed charges,,
TRAZODONE 50 MG ORAL TABLET,,2724,LOCAL,Facility,Inpatient,1,EA,,6,5.1,1.7196,6,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
TRAZODONE 50 MG ORAL TABLET,,2724,LOCAL,Facility,Both,1,EA,,6,5.1,1.7196,6,"Multiplan, Inc.","Multiplan, Inc.",5.64,94,,percent of total billed charges,,
TRAZODONE 50 MG ORAL TABLET,,2724,LOCAL,Facility,Outpatient,1,EA,,6,5.1,1.7196,6,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,5.406,90.1,,percent of total billed charges,,
TRAZODONE 50 MG ORAL TABLET,,2724,LOCAL,Facility,Inpatient,1,EA,,6,5.1,1.7196,6,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
TRAZODONE 50 MG ORAL TABLET,,2724,LOCAL,Facility,Both,1,EA,,6,5.1,1.7196,6,"Preferred One Administrative Services, INC.",PPO,5.916,98.6,,percent of total billed charges,,
TRAZODONE 50 MG ORAL TABLET,,2724,LOCAL,Facility,Outpatient,1,EA,,6,5.1,1.7196,6,PrimeWest Health,Minnesota Senior Health Options (MSHO),3.087,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
TRAZODONE 50 MG ORAL TABLET,,2724,LOCAL,Facility,Inpatient,1,EA,,6,5.1,1.7196,6,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
TRAZODONE 50 MG ORAL TABLET,,2724,LOCAL,Facility,Outpatient,1,EA,,6,5.1,1.7196,6,PrimeWest Health,MinnesotaCare,3.0816,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
TRAZODONE 50 MG ORAL TABLET,,2724,LOCAL,Facility,Inpatient,1,EA,,6,5.1,1.7196,6,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
TRAZODONE 50 MG ORAL TABLET,,2724,LOCAL,Facility,Both,1,EA,,6,5.1,1.7196,6,Sanford Health Plan,Sanford Health Plan,5.52,92,,percent of total billed charges,,
TRAZODONE 50 MG ORAL TABLET,,2724,LOCAL,Facility,Outpatient,1,EA,,6,5.1,1.7196,6,"UCare Health, Inc.",Individual & Family Plan,3.381,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
TRAZODONE 50 MG ORAL TABLET,,2724,LOCAL,Facility,Inpatient,1,EA,,6,5.1,1.7196,6,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
TRAZODONE 50 MG ORAL TABLET,,2724,LOCAL,Facility,Outpatient,1,EA,,6,5.1,1.7196,6,"UCare Health, Inc.",Medical Assistance,3.0282,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TRAZODONE 50 MG ORAL TABLET,,2724,LOCAL,Facility,Inpatient,1,EA,,6,5.1,1.7196,6,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
TRAZODONE 50 MG ORAL TABLET,,2724,LOCAL,Facility,Outpatient,1,EA,,6,5.1,1.7196,6,"UCare Health, Inc.",Medicare Advantage,3.0282,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TRAZODONE 50 MG ORAL TABLET,,2724,LOCAL,Facility,Inpatient,1,EA,,6,5.1,1.7196,6,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
TRAZODONE 50 MG ORAL TABLET,,2724,LOCAL,Facility,Outpatient,1,EA,,6,5.1,1.7196,6,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),3.0282,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TRAZODONE 50 MG ORAL TABLET,,2724,LOCAL,Facility,Inpatient,1,EA,,6,5.1,1.7196,6,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
TRAZODONE 50 MG ORAL TABLET,,2724,LOCAL,Facility,Both,1,EA,,6,5.1,1.7196,6,UnitedHealthcare,Individual & Family,5.64,94,,percent of total billed charges,,
TRAZODONE 50 MG ORAL TABLET,,2724,LOCAL,Facility,Outpatient,1,EA,,6,5.1,1.7196,6,UnitedHealthcare,Medicare Advantage,2.94,49,,percent of total billed charges,,
TRAZODONE 50 MG ORAL TABLET,,2724,LOCAL,Facility,Inpatient,1,EA,,6,5.1,1.7196,6,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
TRAZODONE 50 MG ORAL TABLET,,2724,LOCAL,Facility,Outpatient,1,EA,,6,5.1,1.7196,6,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.88,48,,percent of total billed charges,,100% of DHS outpatient percentage
TRAZODONE 50 MG ORAL TABLET,,2724,LOCAL,Facility,Inpatient,1,EA,,6,5.1,1.7196,6,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
POLYETHYLENE GLYCOL 3350 17 GRAM ORAL PWPK,,2746,LOCAL,Facility,Both,1,EA,,10,8.5,2.866,10,Aetna,Commercial,9.2,92,,percent of total billed charges,,
POLYETHYLENE GLYCOL 3350 17 GRAM ORAL PWPK,,2746,LOCAL,Facility,Outpatient,1,EA,,10,8.5,2.866,10,Aetna,Medicare Advantage,4.9,49,,percent of total billed charges,,
POLYETHYLENE GLYCOL 3350 17 GRAM ORAL PWPK,,2746,LOCAL,Facility,Inpatient,1,EA,,10,8.5,2.866,10,Aetna,Medicare Advantage,,,,,Included in per diem rate,
POLYETHYLENE GLYCOL 3350 17 GRAM ORAL PWPK,,2746,LOCAL,Facility,Both,1,EA,,10,8.5,2.866,10,Aetna,PPO,9.3,93,,percent of total billed charges,,
POLYETHYLENE GLYCOL 3350 17 GRAM ORAL PWPK,,2746,LOCAL,Facility,Both,1,EA,,10,8.5,2.866,10,America's PPO,America's PPO,9.603,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
POLYETHYLENE GLYCOL 3350 17 GRAM ORAL PWPK,,2746,LOCAL,Facility,Both,1,EA,,10,8.5,2.866,10,BlueCross BlueShield Minnesota, Federal Employee Program,9.84,98.4,,percent of total billed charges,,
POLYETHYLENE GLYCOL 3350 17 GRAM ORAL PWPK,,2746,LOCAL,Facility,Both,1,EA,,10,8.5,2.866,10,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,10,100,,percent of total billed charges,,
POLYETHYLENE GLYCOL 3350 17 GRAM ORAL PWPK,,2746,LOCAL,Facility,Both,1,EA,,10,8.5,2.866,10,BlueCross BlueShield Minnesota,High Value Network Plan,9,90,,percent of total billed charges,,
POLYETHYLENE GLYCOL 3350 17 GRAM ORAL PWPK,,2746,LOCAL,Facility,Outpatient,1,EA,,10,8.5,2.866,10,BlueCross BlueShield Minnesota,Medicare Advantage,4.9,49,,percent of total billed charges,,
POLYETHYLENE GLYCOL 3350 17 GRAM ORAL PWPK,,2746,LOCAL,Facility,Inpatient,1,EA,,10,8.5,2.866,10,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
POLYETHYLENE GLYCOL 3350 17 GRAM ORAL PWPK,,2746,LOCAL,Facility,Both,1,EA,,10,8.5,2.866,10,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,8.857,88.57,,percent of total billed charges,,
POLYETHYLENE GLYCOL 3350 17 GRAM ORAL PWPK,,2746,LOCAL,Facility,Both,1,EA,,10,8.5,2.866,10,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,2.866,28.66,,percent of total billed charges,,
POLYETHYLENE GLYCOL 3350 17 GRAM ORAL PWPK,,2746,LOCAL,Facility,Outpatient,1,EA,,10,8.5,2.866,10,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),4.9,49,,percent of total billed charges,,
POLYETHYLENE GLYCOL 3350 17 GRAM ORAL PWPK,,2746,LOCAL,Facility,Inpatient,1,EA,,10,8.5,2.866,10,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
POLYETHYLENE GLYCOL 3350 17 GRAM ORAL PWPK,,2746,LOCAL,Facility,Both,1,EA,,10,8.5,2.866,10,CorVel,Worker's Compensation,10,100,,percent of total billed charges,,
POLYETHYLENE GLYCOL 3350 17 GRAM ORAL PWPK,,2746,LOCAL,Facility,Both,1,EA,,10,8.5,2.866,10,First Health Group Corporation,First Health Network,9.7,97,,percent of total billed charges,,
POLYETHYLENE GLYCOL 3350 17 GRAM ORAL PWPK,,2746,LOCAL,Facility,Both,1,EA,,10,8.5,2.866,10,"Health Partners, Inc.",Commercial,9.46,94.6,,percent of total billed charges,,
POLYETHYLENE GLYCOL 3350 17 GRAM ORAL PWPK,,2746,LOCAL,Facility,Outpatient,1,EA,,10,8.5,2.866,10,"Health Partners, Inc.",Medicare Advantage,4.9,49,,percent of total billed charges,,
POLYETHYLENE GLYCOL 3350 17 GRAM ORAL PWPK,,2746,LOCAL,Facility,Inpatient,1,EA,,10,8.5,2.866,10,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
POLYETHYLENE GLYCOL 3350 17 GRAM ORAL PWPK,,2746,LOCAL,Facility,Both,1,EA,,10,8.5,2.866,10,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),6,60,,percent of total billed charges,,
POLYETHYLENE GLYCOL 3350 17 GRAM ORAL PWPK,,2746,LOCAL,Facility,Both,1,EA,,10,8.5,2.866,10,"Health Partners, Inc.",State of Minnesota Advantage Program,8.15,81.5,,percent of total billed charges,,
POLYETHYLENE GLYCOL 3350 17 GRAM ORAL PWPK,,2746,LOCAL,Facility,Both,1,EA,,10,8.5,2.866,10,"Health Partners, Inc.",State Public Programs,5,50,,percent of total billed charges,,
POLYETHYLENE GLYCOL 3350 17 GRAM ORAL PWPK,,2746,LOCAL,Facility,Both,1,EA,,10,8.5,2.866,10,Humana Insurance Company,Commercial PPO,9.5,95,,percent of total billed charges,,
POLYETHYLENE GLYCOL 3350 17 GRAM ORAL PWPK,,2746,LOCAL,Facility,Outpatient,1,EA,,10,8.5,2.866,10,Humana Insurance Company,Medicare PPO,4.9,49,,percent of total billed charges,,
POLYETHYLENE GLYCOL 3350 17 GRAM ORAL PWPK,,2746,LOCAL,Facility,Inpatient,1,EA,,10,8.5,2.866,10,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
POLYETHYLENE GLYCOL 3350 17 GRAM ORAL PWPK,,2746,LOCAL,Facility,Both,1,EA,,10,8.5,2.866,10,Medica,Individual & Family,9.91,99.1,,percent of total billed charges,,
POLYETHYLENE GLYCOL 3350 17 GRAM ORAL PWPK,,2746,LOCAL,Facility,Outpatient,1,EA,,10,8.5,2.866,10,Medica,Medica Advantage Solution,4.98,49.8,,percent of total billed charges,,
POLYETHYLENE GLYCOL 3350 17 GRAM ORAL PWPK,,2746,LOCAL,Facility,Inpatient,1,EA,,10,8.5,2.866,10,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
POLYETHYLENE GLYCOL 3350 17 GRAM ORAL PWPK,,2746,LOCAL,Facility,Outpatient,1,EA,,10,8.5,2.866,10,Medica,Medical Assistance,4.46,44.6,,percent of total billed charges,,
POLYETHYLENE GLYCOL 3350 17 GRAM ORAL PWPK,,2746,LOCAL,Facility,Inpatient,1,EA,,10,8.5,2.866,10,Medica,Medical Assistance,,,,,Included in per diem rate,
POLYETHYLENE GLYCOL 3350 17 GRAM ORAL PWPK,,2746,LOCAL,Facility,Outpatient,1,EA,,10,8.5,2.866,10,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,4.98,49.8,,percent of total billed charges,,
POLYETHYLENE GLYCOL 3350 17 GRAM ORAL PWPK,,2746,LOCAL,Facility,Inpatient,1,EA,,10,8.5,2.866,10,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
POLYETHYLENE GLYCOL 3350 17 GRAM ORAL PWPK,,2746,LOCAL,Facility,Both,1,EA,,10,8.5,2.866,10,"Multiplan, Inc.","Multiplan, Inc.",9.4,94,,percent of total billed charges,,
POLYETHYLENE GLYCOL 3350 17 GRAM ORAL PWPK,,2746,LOCAL,Facility,Outpatient,1,EA,,10,8.5,2.866,10,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,9.01,90.1,,percent of total billed charges,,
POLYETHYLENE GLYCOL 3350 17 GRAM ORAL PWPK,,2746,LOCAL,Facility,Inpatient,1,EA,,10,8.5,2.866,10,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
POLYETHYLENE GLYCOL 3350 17 GRAM ORAL PWPK,,2746,LOCAL,Facility,Both,1,EA,,10,8.5,2.866,10,"Preferred One Administrative Services, INC.",PPO,9.86,98.6,,percent of total billed charges,,
POLYETHYLENE GLYCOL 3350 17 GRAM ORAL PWPK,,2746,LOCAL,Facility,Outpatient,1,EA,,10,8.5,2.866,10,PrimeWest Health,Minnesota Senior Health Options (MSHO),5.145,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
POLYETHYLENE GLYCOL 3350 17 GRAM ORAL PWPK,,2746,LOCAL,Facility,Inpatient,1,EA,,10,8.5,2.866,10,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
POLYETHYLENE GLYCOL 3350 17 GRAM ORAL PWPK,,2746,LOCAL,Facility,Outpatient,1,EA,,10,8.5,2.866,10,PrimeWest Health,MinnesotaCare,5.136,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
POLYETHYLENE GLYCOL 3350 17 GRAM ORAL PWPK,,2746,LOCAL,Facility,Inpatient,1,EA,,10,8.5,2.866,10,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
POLYETHYLENE GLYCOL 3350 17 GRAM ORAL PWPK,,2746,LOCAL,Facility,Both,1,EA,,10,8.5,2.866,10,Sanford Health Plan,Sanford Health Plan,9.2,92,,percent of total billed charges,,
POLYETHYLENE GLYCOL 3350 17 GRAM ORAL PWPK,,2746,LOCAL,Facility,Outpatient,1,EA,,10,8.5,2.866,10,"UCare Health, Inc.",Individual & Family Plan,5.635,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
POLYETHYLENE GLYCOL 3350 17 GRAM ORAL PWPK,,2746,LOCAL,Facility,Inpatient,1,EA,,10,8.5,2.866,10,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
POLYETHYLENE GLYCOL 3350 17 GRAM ORAL PWPK,,2746,LOCAL,Facility,Outpatient,1,EA,,10,8.5,2.866,10,"UCare Health, Inc.",Medical Assistance,5.047,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
POLYETHYLENE GLYCOL 3350 17 GRAM ORAL PWPK,,2746,LOCAL,Facility,Inpatient,1,EA,,10,8.5,2.866,10,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
POLYETHYLENE GLYCOL 3350 17 GRAM ORAL PWPK,,2746,LOCAL,Facility,Outpatient,1,EA,,10,8.5,2.866,10,"UCare Health, Inc.",Medicare Advantage,5.047,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
POLYETHYLENE GLYCOL 3350 17 GRAM ORAL PWPK,,2746,LOCAL,Facility,Inpatient,1,EA,,10,8.5,2.866,10,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
POLYETHYLENE GLYCOL 3350 17 GRAM ORAL PWPK,,2746,LOCAL,Facility,Outpatient,1,EA,,10,8.5,2.866,10,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),5.047,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
POLYETHYLENE GLYCOL 3350 17 GRAM ORAL PWPK,,2746,LOCAL,Facility,Inpatient,1,EA,,10,8.5,2.866,10,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
POLYETHYLENE GLYCOL 3350 17 GRAM ORAL PWPK,,2746,LOCAL,Facility,Both,1,EA,,10,8.5,2.866,10,UnitedHealthcare,Individual & Family,9.4,94,,percent of total billed charges,,
POLYETHYLENE GLYCOL 3350 17 GRAM ORAL PWPK,,2746,LOCAL,Facility,Outpatient,1,EA,,10,8.5,2.866,10,UnitedHealthcare,Medicare Advantage,4.9,49,,percent of total billed charges,,
POLYETHYLENE GLYCOL 3350 17 GRAM ORAL PWPK,,2746,LOCAL,Facility,Inpatient,1,EA,,10,8.5,2.866,10,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
POLYETHYLENE GLYCOL 3350 17 GRAM ORAL PWPK,,2746,LOCAL,Facility,Outpatient,1,EA,,10,8.5,2.866,10,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,4.8,48,,percent of total billed charges,,100% of DHS outpatient percentage
POLYETHYLENE GLYCOL 3350 17 GRAM ORAL PWPK,,2746,LOCAL,Facility,Inpatient,1,EA,,10,8.5,2.866,10,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
FEXOFENADINE 60 MG ORAL TABLET,,2823,LOCAL,Facility,Both,1,EA,,6,5.1,1.7196,6,Aetna,Commercial,5.52,92,,percent of total billed charges,,
FEXOFENADINE 60 MG ORAL TABLET,,2823,LOCAL,Facility,Outpatient,1,EA,,6,5.1,1.7196,6,Aetna,Medicare Advantage,2.94,49,,percent of total billed charges,,
FEXOFENADINE 60 MG ORAL TABLET,,2823,LOCAL,Facility,Inpatient,1,EA,,6,5.1,1.7196,6,Aetna,Medicare Advantage,,,,,Included in per diem rate,
FEXOFENADINE 60 MG ORAL TABLET,,2823,LOCAL,Facility,Both,1,EA,,6,5.1,1.7196,6,Aetna,PPO,5.58,93,,percent of total billed charges,,
FEXOFENADINE 60 MG ORAL TABLET,,2823,LOCAL,Facility,Both,1,EA,,6,5.1,1.7196,6,America's PPO,America's PPO,5.7618,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
FEXOFENADINE 60 MG ORAL TABLET,,2823,LOCAL,Facility,Both,1,EA,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota, Federal Employee Program,5.904,98.4,,percent of total billed charges,,
FEXOFENADINE 60 MG ORAL TABLET,,2823,LOCAL,Facility,Both,1,EA,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,6,100,,percent of total billed charges,,
FEXOFENADINE 60 MG ORAL TABLET,,2823,LOCAL,Facility,Both,1,EA,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota,High Value Network Plan,5.4,90,,percent of total billed charges,,
FEXOFENADINE 60 MG ORAL TABLET,,2823,LOCAL,Facility,Outpatient,1,EA,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota,Medicare Advantage,2.94,49,,percent of total billed charges,,
FEXOFENADINE 60 MG ORAL TABLET,,2823,LOCAL,Facility,Inpatient,1,EA,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
FEXOFENADINE 60 MG ORAL TABLET,,2823,LOCAL,Facility,Both,1,EA,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,5.3142,88.57,,percent of total billed charges,,
FEXOFENADINE 60 MG ORAL TABLET,,2823,LOCAL,Facility,Both,1,EA,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.7196,28.66,,percent of total billed charges,,
FEXOFENADINE 60 MG ORAL TABLET,,2823,LOCAL,Facility,Outpatient,1,EA,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.94,49,,percent of total billed charges,,
FEXOFENADINE 60 MG ORAL TABLET,,2823,LOCAL,Facility,Inpatient,1,EA,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
FEXOFENADINE 60 MG ORAL TABLET,,2823,LOCAL,Facility,Both,1,EA,,6,5.1,1.7196,6,CorVel,Worker's Compensation,6,100,,percent of total billed charges,,
FEXOFENADINE 60 MG ORAL TABLET,,2823,LOCAL,Facility,Both,1,EA,,6,5.1,1.7196,6,First Health Group Corporation,First Health Network,5.82,97,,percent of total billed charges,,
FEXOFENADINE 60 MG ORAL TABLET,,2823,LOCAL,Facility,Both,1,EA,,6,5.1,1.7196,6,"Health Partners, Inc.",Commercial,5.676,94.6,,percent of total billed charges,,
FEXOFENADINE 60 MG ORAL TABLET,,2823,LOCAL,Facility,Outpatient,1,EA,,6,5.1,1.7196,6,"Health Partners, Inc.",Medicare Advantage,2.94,49,,percent of total billed charges,,
FEXOFENADINE 60 MG ORAL TABLET,,2823,LOCAL,Facility,Inpatient,1,EA,,6,5.1,1.7196,6,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
FEXOFENADINE 60 MG ORAL TABLET,,2823,LOCAL,Facility,Both,1,EA,,6,5.1,1.7196,6,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3.6,60,,percent of total billed charges,,
FEXOFENADINE 60 MG ORAL TABLET,,2823,LOCAL,Facility,Both,1,EA,,6,5.1,1.7196,6,"Health Partners, Inc.",State of Minnesota Advantage Program,4.89,81.5,,percent of total billed charges,,
FEXOFENADINE 60 MG ORAL TABLET,,2823,LOCAL,Facility,Both,1,EA,,6,5.1,1.7196,6,"Health Partners, Inc.",State Public Programs,3,50,,percent of total billed charges,,
FEXOFENADINE 60 MG ORAL TABLET,,2823,LOCAL,Facility,Both,1,EA,,6,5.1,1.7196,6,Humana Insurance Company,Commercial PPO,5.7,95,,percent of total billed charges,,
FEXOFENADINE 60 MG ORAL TABLET,,2823,LOCAL,Facility,Outpatient,1,EA,,6,5.1,1.7196,6,Humana Insurance Company,Medicare PPO,2.94,49,,percent of total billed charges,,
FEXOFENADINE 60 MG ORAL TABLET,,2823,LOCAL,Facility,Inpatient,1,EA,,6,5.1,1.7196,6,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
FEXOFENADINE 60 MG ORAL TABLET,,2823,LOCAL,Facility,Both,1,EA,,6,5.1,1.7196,6,Medica,Individual & Family,5.946,99.1,,percent of total billed charges,,
FEXOFENADINE 60 MG ORAL TABLET,,2823,LOCAL,Facility,Outpatient,1,EA,,6,5.1,1.7196,6,Medica,Medica Advantage Solution,2.988,49.8,,percent of total billed charges,,
FEXOFENADINE 60 MG ORAL TABLET,,2823,LOCAL,Facility,Inpatient,1,EA,,6,5.1,1.7196,6,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
FEXOFENADINE 60 MG ORAL TABLET,,2823,LOCAL,Facility,Outpatient,1,EA,,6,5.1,1.7196,6,Medica,Medical Assistance,2.676,44.6,,percent of total billed charges,,
FEXOFENADINE 60 MG ORAL TABLET,,2823,LOCAL,Facility,Inpatient,1,EA,,6,5.1,1.7196,6,Medica,Medical Assistance,,,,,Included in per diem rate,
FEXOFENADINE 60 MG ORAL TABLET,,2823,LOCAL,Facility,Outpatient,1,EA,,6,5.1,1.7196,6,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.988,49.8,,percent of total billed charges,,
FEXOFENADINE 60 MG ORAL TABLET,,2823,LOCAL,Facility,Inpatient,1,EA,,6,5.1,1.7196,6,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
FEXOFENADINE 60 MG ORAL TABLET,,2823,LOCAL,Facility,Both,1,EA,,6,5.1,1.7196,6,"Multiplan, Inc.","Multiplan, Inc.",5.64,94,,percent of total billed charges,,
FEXOFENADINE 60 MG ORAL TABLET,,2823,LOCAL,Facility,Outpatient,1,EA,,6,5.1,1.7196,6,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,5.406,90.1,,percent of total billed charges,,
FEXOFENADINE 60 MG ORAL TABLET,,2823,LOCAL,Facility,Inpatient,1,EA,,6,5.1,1.7196,6,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
FEXOFENADINE 60 MG ORAL TABLET,,2823,LOCAL,Facility,Both,1,EA,,6,5.1,1.7196,6,"Preferred One Administrative Services, INC.",PPO,5.916,98.6,,percent of total billed charges,,
FEXOFENADINE 60 MG ORAL TABLET,,2823,LOCAL,Facility,Outpatient,1,EA,,6,5.1,1.7196,6,PrimeWest Health,Minnesota Senior Health Options (MSHO),3.087,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
FEXOFENADINE 60 MG ORAL TABLET,,2823,LOCAL,Facility,Inpatient,1,EA,,6,5.1,1.7196,6,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
FEXOFENADINE 60 MG ORAL TABLET,,2823,LOCAL,Facility,Outpatient,1,EA,,6,5.1,1.7196,6,PrimeWest Health,MinnesotaCare,3.0816,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
FEXOFENADINE 60 MG ORAL TABLET,,2823,LOCAL,Facility,Inpatient,1,EA,,6,5.1,1.7196,6,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
FEXOFENADINE 60 MG ORAL TABLET,,2823,LOCAL,Facility,Both,1,EA,,6,5.1,1.7196,6,Sanford Health Plan,Sanford Health Plan,5.52,92,,percent of total billed charges,,
FEXOFENADINE 60 MG ORAL TABLET,,2823,LOCAL,Facility,Outpatient,1,EA,,6,5.1,1.7196,6,"UCare Health, Inc.",Individual & Family Plan,3.381,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
FEXOFENADINE 60 MG ORAL TABLET,,2823,LOCAL,Facility,Inpatient,1,EA,,6,5.1,1.7196,6,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
FEXOFENADINE 60 MG ORAL TABLET,,2823,LOCAL,Facility,Outpatient,1,EA,,6,5.1,1.7196,6,"UCare Health, Inc.",Medical Assistance,3.0282,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FEXOFENADINE 60 MG ORAL TABLET,,2823,LOCAL,Facility,Inpatient,1,EA,,6,5.1,1.7196,6,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
FEXOFENADINE 60 MG ORAL TABLET,,2823,LOCAL,Facility,Outpatient,1,EA,,6,5.1,1.7196,6,"UCare Health, Inc.",Medicare Advantage,3.0282,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FEXOFENADINE 60 MG ORAL TABLET,,2823,LOCAL,Facility,Inpatient,1,EA,,6,5.1,1.7196,6,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
FEXOFENADINE 60 MG ORAL TABLET,,2823,LOCAL,Facility,Outpatient,1,EA,,6,5.1,1.7196,6,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),3.0282,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FEXOFENADINE 60 MG ORAL TABLET,,2823,LOCAL,Facility,Inpatient,1,EA,,6,5.1,1.7196,6,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
FEXOFENADINE 60 MG ORAL TABLET,,2823,LOCAL,Facility,Both,1,EA,,6,5.1,1.7196,6,UnitedHealthcare,Individual & Family,5.64,94,,percent of total billed charges,,
FEXOFENADINE 60 MG ORAL TABLET,,2823,LOCAL,Facility,Outpatient,1,EA,,6,5.1,1.7196,6,UnitedHealthcare,Medicare Advantage,2.94,49,,percent of total billed charges,,
FEXOFENADINE 60 MG ORAL TABLET,,2823,LOCAL,Facility,Inpatient,1,EA,,6,5.1,1.7196,6,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
FEXOFENADINE 60 MG ORAL TABLET,,2823,LOCAL,Facility,Outpatient,1,EA,,6,5.1,1.7196,6,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.88,48,,percent of total billed charges,,100% of DHS outpatient percentage
FEXOFENADINE 60 MG ORAL TABLET,,2823,LOCAL,Facility,Inpatient,1,EA,,6,5.1,1.7196,6,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
CETIRIZINE 10 MG ORAL TABLET,,2842,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
CETIRIZINE 10 MG ORAL TABLET,,2842,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
CETIRIZINE 10 MG ORAL TABLET,,2842,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
CETIRIZINE 10 MG ORAL TABLET,,2842,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
CETIRIZINE 10 MG ORAL TABLET,,2842,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
CETIRIZINE 10 MG ORAL TABLET,,2842,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
CETIRIZINE 10 MG ORAL TABLET,,2842,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
CETIRIZINE 10 MG ORAL TABLET,,2842,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
CETIRIZINE 10 MG ORAL TABLET,,2842,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
CETIRIZINE 10 MG ORAL TABLET,,2842,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
CETIRIZINE 10 MG ORAL TABLET,,2842,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
CETIRIZINE 10 MG ORAL TABLET,,2842,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
CETIRIZINE 10 MG ORAL TABLET,,2842,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
CETIRIZINE 10 MG ORAL TABLET,,2842,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
CETIRIZINE 10 MG ORAL TABLET,,2842,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
CETIRIZINE 10 MG ORAL TABLET,,2842,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
CETIRIZINE 10 MG ORAL TABLET,,2842,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
CETIRIZINE 10 MG ORAL TABLET,,2842,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
CETIRIZINE 10 MG ORAL TABLET,,2842,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CETIRIZINE 10 MG ORAL TABLET,,2842,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
CETIRIZINE 10 MG ORAL TABLET,,2842,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
CETIRIZINE 10 MG ORAL TABLET,,2842,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
CETIRIZINE 10 MG ORAL TABLET,,2842,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
CETIRIZINE 10 MG ORAL TABLET,,2842,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
CETIRIZINE 10 MG ORAL TABLET,,2842,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
CETIRIZINE 10 MG ORAL TABLET,,2842,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
CETIRIZINE 10 MG ORAL TABLET,,2842,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
CETIRIZINE 10 MG ORAL TABLET,,2842,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
CETIRIZINE 10 MG ORAL TABLET,,2842,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
CETIRIZINE 10 MG ORAL TABLET,,2842,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
CETIRIZINE 10 MG ORAL TABLET,,2842,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
CETIRIZINE 10 MG ORAL TABLET,,2842,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
CETIRIZINE 10 MG ORAL TABLET,,2842,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
CETIRIZINE 10 MG ORAL TABLET,,2842,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
CETIRIZINE 10 MG ORAL TABLET,,2842,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
CETIRIZINE 10 MG ORAL TABLET,,2842,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
CETIRIZINE 10 MG ORAL TABLET,,2842,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
CETIRIZINE 10 MG ORAL TABLET,,2842,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CETIRIZINE 10 MG ORAL TABLET,,2842,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
CETIRIZINE 10 MG ORAL TABLET,,2842,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
CETIRIZINE 10 MG ORAL TABLET,,2842,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
CETIRIZINE 10 MG ORAL TABLET,,2842,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
CETIRIZINE 10 MG ORAL TABLET,,2842,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
CETIRIZINE 10 MG ORAL TABLET,,2842,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CETIRIZINE 10 MG ORAL TABLET,,2842,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
CETIRIZINE 10 MG ORAL TABLET,,2842,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CETIRIZINE 10 MG ORAL TABLET,,2842,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CETIRIZINE 10 MG ORAL TABLET,,2842,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CETIRIZINE 10 MG ORAL TABLET,,2842,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CETIRIZINE 10 MG ORAL TABLET,,2842,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
CETIRIZINE 10 MG ORAL TABLET,,2842,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
CETIRIZINE 10 MG ORAL TABLET,,2842,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
CETIRIZINE 10 MG ORAL TABLET,,2842,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
CETIRIZINE 10 MG ORAL TABLET,,2842,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
ATORVASTATIN 10 MG ORAL TABLET,,2867,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
ATORVASTATIN 10 MG ORAL TABLET,,2867,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
ATORVASTATIN 10 MG ORAL TABLET,,2867,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
ATORVASTATIN 10 MG ORAL TABLET,,2867,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
ATORVASTATIN 10 MG ORAL TABLET,,2867,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
ATORVASTATIN 10 MG ORAL TABLET,,2867,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
ATORVASTATIN 10 MG ORAL TABLET,,2867,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
ATORVASTATIN 10 MG ORAL TABLET,,2867,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
ATORVASTATIN 10 MG ORAL TABLET,,2867,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
ATORVASTATIN 10 MG ORAL TABLET,,2867,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
ATORVASTATIN 10 MG ORAL TABLET,,2867,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
ATORVASTATIN 10 MG ORAL TABLET,,2867,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
ATORVASTATIN 10 MG ORAL TABLET,,2867,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
ATORVASTATIN 10 MG ORAL TABLET,,2867,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
ATORVASTATIN 10 MG ORAL TABLET,,2867,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
ATORVASTATIN 10 MG ORAL TABLET,,2867,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
ATORVASTATIN 10 MG ORAL TABLET,,2867,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
ATORVASTATIN 10 MG ORAL TABLET,,2867,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
ATORVASTATIN 10 MG ORAL TABLET,,2867,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ATORVASTATIN 10 MG ORAL TABLET,,2867,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
ATORVASTATIN 10 MG ORAL TABLET,,2867,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
ATORVASTATIN 10 MG ORAL TABLET,,2867,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
ATORVASTATIN 10 MG ORAL TABLET,,2867,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
ATORVASTATIN 10 MG ORAL TABLET,,2867,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
ATORVASTATIN 10 MG ORAL TABLET,,2867,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
ATORVASTATIN 10 MG ORAL TABLET,,2867,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
ATORVASTATIN 10 MG ORAL TABLET,,2867,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
ATORVASTATIN 10 MG ORAL TABLET,,2867,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
ATORVASTATIN 10 MG ORAL TABLET,,2867,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
ATORVASTATIN 10 MG ORAL TABLET,,2867,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
ATORVASTATIN 10 MG ORAL TABLET,,2867,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
ATORVASTATIN 10 MG ORAL TABLET,,2867,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
ATORVASTATIN 10 MG ORAL TABLET,,2867,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
ATORVASTATIN 10 MG ORAL TABLET,,2867,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
ATORVASTATIN 10 MG ORAL TABLET,,2867,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
ATORVASTATIN 10 MG ORAL TABLET,,2867,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
ATORVASTATIN 10 MG ORAL TABLET,,2867,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
ATORVASTATIN 10 MG ORAL TABLET,,2867,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ATORVASTATIN 10 MG ORAL TABLET,,2867,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
ATORVASTATIN 10 MG ORAL TABLET,,2867,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
ATORVASTATIN 10 MG ORAL TABLET,,2867,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
ATORVASTATIN 10 MG ORAL TABLET,,2867,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
ATORVASTATIN 10 MG ORAL TABLET,,2867,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
ATORVASTATIN 10 MG ORAL TABLET,,2867,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ATORVASTATIN 10 MG ORAL TABLET,,2867,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
ATORVASTATIN 10 MG ORAL TABLET,,2867,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ATORVASTATIN 10 MG ORAL TABLET,,2867,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ATORVASTATIN 10 MG ORAL TABLET,,2867,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ATORVASTATIN 10 MG ORAL TABLET,,2867,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ATORVASTATIN 10 MG ORAL TABLET,,2867,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
ATORVASTATIN 10 MG ORAL TABLET,,2867,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
ATORVASTATIN 10 MG ORAL TABLET,,2867,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
ATORVASTATIN 10 MG ORAL TABLET,,2867,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
ATORVASTATIN 10 MG ORAL TABLET,,2867,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
DOXAZOSIN 1 MG ORAL TABLET,,2905,LOCAL,Facility,Both,1,EA,,6,5.1,1.7196,6,Aetna,Commercial,5.52,92,,percent of total billed charges,,
DOXAZOSIN 1 MG ORAL TABLET,,2905,LOCAL,Facility,Outpatient,1,EA,,6,5.1,1.7196,6,Aetna,Medicare Advantage,2.94,49,,percent of total billed charges,,
DOXAZOSIN 1 MG ORAL TABLET,,2905,LOCAL,Facility,Inpatient,1,EA,,6,5.1,1.7196,6,Aetna,Medicare Advantage,,,,,Included in per diem rate,
DOXAZOSIN 1 MG ORAL TABLET,,2905,LOCAL,Facility,Both,1,EA,,6,5.1,1.7196,6,Aetna,PPO,5.58,93,,percent of total billed charges,,
DOXAZOSIN 1 MG ORAL TABLET,,2905,LOCAL,Facility,Both,1,EA,,6,5.1,1.7196,6,America's PPO,America's PPO,5.7618,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
DOXAZOSIN 1 MG ORAL TABLET,,2905,LOCAL,Facility,Both,1,EA,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota, Federal Employee Program,5.904,98.4,,percent of total billed charges,,
DOXAZOSIN 1 MG ORAL TABLET,,2905,LOCAL,Facility,Both,1,EA,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,6,100,,percent of total billed charges,,
DOXAZOSIN 1 MG ORAL TABLET,,2905,LOCAL,Facility,Both,1,EA,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota,High Value Network Plan,5.4,90,,percent of total billed charges,,
DOXAZOSIN 1 MG ORAL TABLET,,2905,LOCAL,Facility,Outpatient,1,EA,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota,Medicare Advantage,2.94,49,,percent of total billed charges,,
DOXAZOSIN 1 MG ORAL TABLET,,2905,LOCAL,Facility,Inpatient,1,EA,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
DOXAZOSIN 1 MG ORAL TABLET,,2905,LOCAL,Facility,Both,1,EA,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,5.3142,88.57,,percent of total billed charges,,
DOXAZOSIN 1 MG ORAL TABLET,,2905,LOCAL,Facility,Both,1,EA,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.7196,28.66,,percent of total billed charges,,
DOXAZOSIN 1 MG ORAL TABLET,,2905,LOCAL,Facility,Outpatient,1,EA,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.94,49,,percent of total billed charges,,
DOXAZOSIN 1 MG ORAL TABLET,,2905,LOCAL,Facility,Inpatient,1,EA,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
DOXAZOSIN 1 MG ORAL TABLET,,2905,LOCAL,Facility,Both,1,EA,,6,5.1,1.7196,6,CorVel,Worker's Compensation,6,100,,percent of total billed charges,,
DOXAZOSIN 1 MG ORAL TABLET,,2905,LOCAL,Facility,Both,1,EA,,6,5.1,1.7196,6,First Health Group Corporation,First Health Network,5.82,97,,percent of total billed charges,,
DOXAZOSIN 1 MG ORAL TABLET,,2905,LOCAL,Facility,Both,1,EA,,6,5.1,1.7196,6,"Health Partners, Inc.",Commercial,5.676,94.6,,percent of total billed charges,,
DOXAZOSIN 1 MG ORAL TABLET,,2905,LOCAL,Facility,Outpatient,1,EA,,6,5.1,1.7196,6,"Health Partners, Inc.",Medicare Advantage,2.94,49,,percent of total billed charges,,
DOXAZOSIN 1 MG ORAL TABLET,,2905,LOCAL,Facility,Inpatient,1,EA,,6,5.1,1.7196,6,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DOXAZOSIN 1 MG ORAL TABLET,,2905,LOCAL,Facility,Both,1,EA,,6,5.1,1.7196,6,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3.6,60,,percent of total billed charges,,
DOXAZOSIN 1 MG ORAL TABLET,,2905,LOCAL,Facility,Both,1,EA,,6,5.1,1.7196,6,"Health Partners, Inc.",State of Minnesota Advantage Program,4.89,81.5,,percent of total billed charges,,
DOXAZOSIN 1 MG ORAL TABLET,,2905,LOCAL,Facility,Both,1,EA,,6,5.1,1.7196,6,"Health Partners, Inc.",State Public Programs,3,50,,percent of total billed charges,,
DOXAZOSIN 1 MG ORAL TABLET,,2905,LOCAL,Facility,Both,1,EA,,6,5.1,1.7196,6,Humana Insurance Company,Commercial PPO,5.7,95,,percent of total billed charges,,
DOXAZOSIN 1 MG ORAL TABLET,,2905,LOCAL,Facility,Outpatient,1,EA,,6,5.1,1.7196,6,Humana Insurance Company,Medicare PPO,2.94,49,,percent of total billed charges,,
DOXAZOSIN 1 MG ORAL TABLET,,2905,LOCAL,Facility,Inpatient,1,EA,,6,5.1,1.7196,6,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
DOXAZOSIN 1 MG ORAL TABLET,,2905,LOCAL,Facility,Both,1,EA,,6,5.1,1.7196,6,Medica,Individual & Family,5.946,99.1,,percent of total billed charges,,
DOXAZOSIN 1 MG ORAL TABLET,,2905,LOCAL,Facility,Outpatient,1,EA,,6,5.1,1.7196,6,Medica,Medica Advantage Solution,2.988,49.8,,percent of total billed charges,,
DOXAZOSIN 1 MG ORAL TABLET,,2905,LOCAL,Facility,Inpatient,1,EA,,6,5.1,1.7196,6,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
DOXAZOSIN 1 MG ORAL TABLET,,2905,LOCAL,Facility,Outpatient,1,EA,,6,5.1,1.7196,6,Medica,Medical Assistance,2.676,44.6,,percent of total billed charges,,
DOXAZOSIN 1 MG ORAL TABLET,,2905,LOCAL,Facility,Inpatient,1,EA,,6,5.1,1.7196,6,Medica,Medical Assistance,,,,,Included in per diem rate,
DOXAZOSIN 1 MG ORAL TABLET,,2905,LOCAL,Facility,Outpatient,1,EA,,6,5.1,1.7196,6,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.988,49.8,,percent of total billed charges,,
DOXAZOSIN 1 MG ORAL TABLET,,2905,LOCAL,Facility,Inpatient,1,EA,,6,5.1,1.7196,6,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
DOXAZOSIN 1 MG ORAL TABLET,,2905,LOCAL,Facility,Both,1,EA,,6,5.1,1.7196,6,"Multiplan, Inc.","Multiplan, Inc.",5.64,94,,percent of total billed charges,,
DOXAZOSIN 1 MG ORAL TABLET,,2905,LOCAL,Facility,Outpatient,1,EA,,6,5.1,1.7196,6,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,5.406,90.1,,percent of total billed charges,,
DOXAZOSIN 1 MG ORAL TABLET,,2905,LOCAL,Facility,Inpatient,1,EA,,6,5.1,1.7196,6,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
DOXAZOSIN 1 MG ORAL TABLET,,2905,LOCAL,Facility,Both,1,EA,,6,5.1,1.7196,6,"Preferred One Administrative Services, INC.",PPO,5.916,98.6,,percent of total billed charges,,
DOXAZOSIN 1 MG ORAL TABLET,,2905,LOCAL,Facility,Outpatient,1,EA,,6,5.1,1.7196,6,PrimeWest Health,Minnesota Senior Health Options (MSHO),3.087,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
DOXAZOSIN 1 MG ORAL TABLET,,2905,LOCAL,Facility,Inpatient,1,EA,,6,5.1,1.7196,6,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DOXAZOSIN 1 MG ORAL TABLET,,2905,LOCAL,Facility,Outpatient,1,EA,,6,5.1,1.7196,6,PrimeWest Health,MinnesotaCare,3.0816,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
DOXAZOSIN 1 MG ORAL TABLET,,2905,LOCAL,Facility,Inpatient,1,EA,,6,5.1,1.7196,6,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
DOXAZOSIN 1 MG ORAL TABLET,,2905,LOCAL,Facility,Both,1,EA,,6,5.1,1.7196,6,Sanford Health Plan,Sanford Health Plan,5.52,92,,percent of total billed charges,,
DOXAZOSIN 1 MG ORAL TABLET,,2905,LOCAL,Facility,Outpatient,1,EA,,6,5.1,1.7196,6,"UCare Health, Inc.",Individual & Family Plan,3.381,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
DOXAZOSIN 1 MG ORAL TABLET,,2905,LOCAL,Facility,Inpatient,1,EA,,6,5.1,1.7196,6,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
DOXAZOSIN 1 MG ORAL TABLET,,2905,LOCAL,Facility,Outpatient,1,EA,,6,5.1,1.7196,6,"UCare Health, Inc.",Medical Assistance,3.0282,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DOXAZOSIN 1 MG ORAL TABLET,,2905,LOCAL,Facility,Inpatient,1,EA,,6,5.1,1.7196,6,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
DOXAZOSIN 1 MG ORAL TABLET,,2905,LOCAL,Facility,Outpatient,1,EA,,6,5.1,1.7196,6,"UCare Health, Inc.",Medicare Advantage,3.0282,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DOXAZOSIN 1 MG ORAL TABLET,,2905,LOCAL,Facility,Inpatient,1,EA,,6,5.1,1.7196,6,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DOXAZOSIN 1 MG ORAL TABLET,,2905,LOCAL,Facility,Outpatient,1,EA,,6,5.1,1.7196,6,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),3.0282,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DOXAZOSIN 1 MG ORAL TABLET,,2905,LOCAL,Facility,Inpatient,1,EA,,6,5.1,1.7196,6,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DOXAZOSIN 1 MG ORAL TABLET,,2905,LOCAL,Facility,Both,1,EA,,6,5.1,1.7196,6,UnitedHealthcare,Individual & Family,5.64,94,,percent of total billed charges,,
DOXAZOSIN 1 MG ORAL TABLET,,2905,LOCAL,Facility,Outpatient,1,EA,,6,5.1,1.7196,6,UnitedHealthcare,Medicare Advantage,2.94,49,,percent of total billed charges,,
DOXAZOSIN 1 MG ORAL TABLET,,2905,LOCAL,Facility,Inpatient,1,EA,,6,5.1,1.7196,6,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
DOXAZOSIN 1 MG ORAL TABLET,,2905,LOCAL,Facility,Outpatient,1,EA,,6,5.1,1.7196,6,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.88,48,,percent of total billed charges,,100% of DHS outpatient percentage
DOXAZOSIN 1 MG ORAL TABLET,,2905,LOCAL,Facility,Inpatient,1,EA,,6,5.1,1.7196,6,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
AZITHROMYCIN 250 MG ORAL TABLET,,3108,LOCAL,Facility,Both,1,EA,,10,8.5,2.866,10,Aetna,Commercial,9.2,92,,percent of total billed charges,,
AZITHROMYCIN 250 MG ORAL TABLET,,3108,LOCAL,Facility,Outpatient,1,EA,,10,8.5,2.866,10,Aetna,Medicare Advantage,4.9,49,,percent of total billed charges,,
AZITHROMYCIN 250 MG ORAL TABLET,,3108,LOCAL,Facility,Inpatient,1,EA,,10,8.5,2.866,10,Aetna,Medicare Advantage,,,,,Included in per diem rate,
AZITHROMYCIN 250 MG ORAL TABLET,,3108,LOCAL,Facility,Both,1,EA,,10,8.5,2.866,10,Aetna,PPO,9.3,93,,percent of total billed charges,,
AZITHROMYCIN 250 MG ORAL TABLET,,3108,LOCAL,Facility,Both,1,EA,,10,8.5,2.866,10,America's PPO,America's PPO,9.603,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
AZITHROMYCIN 250 MG ORAL TABLET,,3108,LOCAL,Facility,Both,1,EA,,10,8.5,2.866,10,BlueCross BlueShield Minnesota, Federal Employee Program,9.84,98.4,,percent of total billed charges,,
AZITHROMYCIN 250 MG ORAL TABLET,,3108,LOCAL,Facility,Both,1,EA,,10,8.5,2.866,10,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,10,100,,percent of total billed charges,,
AZITHROMYCIN 250 MG ORAL TABLET,,3108,LOCAL,Facility,Both,1,EA,,10,8.5,2.866,10,BlueCross BlueShield Minnesota,High Value Network Plan,9,90,,percent of total billed charges,,
AZITHROMYCIN 250 MG ORAL TABLET,,3108,LOCAL,Facility,Outpatient,1,EA,,10,8.5,2.866,10,BlueCross BlueShield Minnesota,Medicare Advantage,4.9,49,,percent of total billed charges,,
AZITHROMYCIN 250 MG ORAL TABLET,,3108,LOCAL,Facility,Inpatient,1,EA,,10,8.5,2.866,10,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
AZITHROMYCIN 250 MG ORAL TABLET,,3108,LOCAL,Facility,Both,1,EA,,10,8.5,2.866,10,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,8.857,88.57,,percent of total billed charges,,
AZITHROMYCIN 250 MG ORAL TABLET,,3108,LOCAL,Facility,Both,1,EA,,10,8.5,2.866,10,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,2.866,28.66,,percent of total billed charges,,
AZITHROMYCIN 250 MG ORAL TABLET,,3108,LOCAL,Facility,Outpatient,1,EA,,10,8.5,2.866,10,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),4.9,49,,percent of total billed charges,,
AZITHROMYCIN 250 MG ORAL TABLET,,3108,LOCAL,Facility,Inpatient,1,EA,,10,8.5,2.866,10,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
AZITHROMYCIN 250 MG ORAL TABLET,,3108,LOCAL,Facility,Both,1,EA,,10,8.5,2.866,10,CorVel,Worker's Compensation,10,100,,percent of total billed charges,,
AZITHROMYCIN 250 MG ORAL TABLET,,3108,LOCAL,Facility,Both,1,EA,,10,8.5,2.866,10,First Health Group Corporation,First Health Network,9.7,97,,percent of total billed charges,,
AZITHROMYCIN 250 MG ORAL TABLET,,3108,LOCAL,Facility,Both,1,EA,,10,8.5,2.866,10,"Health Partners, Inc.",Commercial,9.46,94.6,,percent of total billed charges,,
AZITHROMYCIN 250 MG ORAL TABLET,,3108,LOCAL,Facility,Outpatient,1,EA,,10,8.5,2.866,10,"Health Partners, Inc.",Medicare Advantage,4.9,49,,percent of total billed charges,,
AZITHROMYCIN 250 MG ORAL TABLET,,3108,LOCAL,Facility,Inpatient,1,EA,,10,8.5,2.866,10,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
AZITHROMYCIN 250 MG ORAL TABLET,,3108,LOCAL,Facility,Both,1,EA,,10,8.5,2.866,10,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),6,60,,percent of total billed charges,,
AZITHROMYCIN 250 MG ORAL TABLET,,3108,LOCAL,Facility,Both,1,EA,,10,8.5,2.866,10,"Health Partners, Inc.",State of Minnesota Advantage Program,8.15,81.5,,percent of total billed charges,,
AZITHROMYCIN 250 MG ORAL TABLET,,3108,LOCAL,Facility,Both,1,EA,,10,8.5,2.866,10,"Health Partners, Inc.",State Public Programs,5,50,,percent of total billed charges,,
AZITHROMYCIN 250 MG ORAL TABLET,,3108,LOCAL,Facility,Both,1,EA,,10,8.5,2.866,10,Humana Insurance Company,Commercial PPO,9.5,95,,percent of total billed charges,,
AZITHROMYCIN 250 MG ORAL TABLET,,3108,LOCAL,Facility,Outpatient,1,EA,,10,8.5,2.866,10,Humana Insurance Company,Medicare PPO,4.9,49,,percent of total billed charges,,
AZITHROMYCIN 250 MG ORAL TABLET,,3108,LOCAL,Facility,Inpatient,1,EA,,10,8.5,2.866,10,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
AZITHROMYCIN 250 MG ORAL TABLET,,3108,LOCAL,Facility,Both,1,EA,,10,8.5,2.866,10,Medica,Individual & Family,9.91,99.1,,percent of total billed charges,,
AZITHROMYCIN 250 MG ORAL TABLET,,3108,LOCAL,Facility,Outpatient,1,EA,,10,8.5,2.866,10,Medica,Medica Advantage Solution,4.98,49.8,,percent of total billed charges,,
AZITHROMYCIN 250 MG ORAL TABLET,,3108,LOCAL,Facility,Inpatient,1,EA,,10,8.5,2.866,10,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
AZITHROMYCIN 250 MG ORAL TABLET,,3108,LOCAL,Facility,Outpatient,1,EA,,10,8.5,2.866,10,Medica,Medical Assistance,4.46,44.6,,percent of total billed charges,,
AZITHROMYCIN 250 MG ORAL TABLET,,3108,LOCAL,Facility,Inpatient,1,EA,,10,8.5,2.866,10,Medica,Medical Assistance,,,,,Included in per diem rate,
AZITHROMYCIN 250 MG ORAL TABLET,,3108,LOCAL,Facility,Outpatient,1,EA,,10,8.5,2.866,10,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,4.98,49.8,,percent of total billed charges,,
AZITHROMYCIN 250 MG ORAL TABLET,,3108,LOCAL,Facility,Inpatient,1,EA,,10,8.5,2.866,10,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
AZITHROMYCIN 250 MG ORAL TABLET,,3108,LOCAL,Facility,Both,1,EA,,10,8.5,2.866,10,"Multiplan, Inc.","Multiplan, Inc.",9.4,94,,percent of total billed charges,,
AZITHROMYCIN 250 MG ORAL TABLET,,3108,LOCAL,Facility,Outpatient,1,EA,,10,8.5,2.866,10,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,9.01,90.1,,percent of total billed charges,,
AZITHROMYCIN 250 MG ORAL TABLET,,3108,LOCAL,Facility,Inpatient,1,EA,,10,8.5,2.866,10,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
AZITHROMYCIN 250 MG ORAL TABLET,,3108,LOCAL,Facility,Both,1,EA,,10,8.5,2.866,10,"Preferred One Administrative Services, INC.",PPO,9.86,98.6,,percent of total billed charges,,
AZITHROMYCIN 250 MG ORAL TABLET,,3108,LOCAL,Facility,Outpatient,1,EA,,10,8.5,2.866,10,PrimeWest Health,Minnesota Senior Health Options (MSHO),5.145,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
AZITHROMYCIN 250 MG ORAL TABLET,,3108,LOCAL,Facility,Inpatient,1,EA,,10,8.5,2.866,10,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
AZITHROMYCIN 250 MG ORAL TABLET,,3108,LOCAL,Facility,Outpatient,1,EA,,10,8.5,2.866,10,PrimeWest Health,MinnesotaCare,5.136,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
AZITHROMYCIN 250 MG ORAL TABLET,,3108,LOCAL,Facility,Inpatient,1,EA,,10,8.5,2.866,10,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
AZITHROMYCIN 250 MG ORAL TABLET,,3108,LOCAL,Facility,Both,1,EA,,10,8.5,2.866,10,Sanford Health Plan,Sanford Health Plan,9.2,92,,percent of total billed charges,,
AZITHROMYCIN 250 MG ORAL TABLET,,3108,LOCAL,Facility,Outpatient,1,EA,,10,8.5,2.866,10,"UCare Health, Inc.",Individual & Family Plan,5.635,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
AZITHROMYCIN 250 MG ORAL TABLET,,3108,LOCAL,Facility,Inpatient,1,EA,,10,8.5,2.866,10,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
AZITHROMYCIN 250 MG ORAL TABLET,,3108,LOCAL,Facility,Outpatient,1,EA,,10,8.5,2.866,10,"UCare Health, Inc.",Medical Assistance,5.047,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
AZITHROMYCIN 250 MG ORAL TABLET,,3108,LOCAL,Facility,Inpatient,1,EA,,10,8.5,2.866,10,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
AZITHROMYCIN 250 MG ORAL TABLET,,3108,LOCAL,Facility,Outpatient,1,EA,,10,8.5,2.866,10,"UCare Health, Inc.",Medicare Advantage,5.047,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
AZITHROMYCIN 250 MG ORAL TABLET,,3108,LOCAL,Facility,Inpatient,1,EA,,10,8.5,2.866,10,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
AZITHROMYCIN 250 MG ORAL TABLET,,3108,LOCAL,Facility,Outpatient,1,EA,,10,8.5,2.866,10,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),5.047,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
AZITHROMYCIN 250 MG ORAL TABLET,,3108,LOCAL,Facility,Inpatient,1,EA,,10,8.5,2.866,10,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
AZITHROMYCIN 250 MG ORAL TABLET,,3108,LOCAL,Facility,Both,1,EA,,10,8.5,2.866,10,UnitedHealthcare,Individual & Family,9.4,94,,percent of total billed charges,,
AZITHROMYCIN 250 MG ORAL TABLET,,3108,LOCAL,Facility,Outpatient,1,EA,,10,8.5,2.866,10,UnitedHealthcare,Medicare Advantage,4.9,49,,percent of total billed charges,,
AZITHROMYCIN 250 MG ORAL TABLET,,3108,LOCAL,Facility,Inpatient,1,EA,,10,8.5,2.866,10,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
AZITHROMYCIN 250 MG ORAL TABLET,,3108,LOCAL,Facility,Outpatient,1,EA,,10,8.5,2.866,10,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,4.8,48,,percent of total billed charges,,100% of DHS outpatient percentage
AZITHROMYCIN 250 MG ORAL TABLET,,3108,LOCAL,Facility,Inpatient,1,EA,,10,8.5,2.866,10,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
GLYBURIDE 5 MG ORAL TABLET,,3225,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
GLYBURIDE 5 MG ORAL TABLET,,3225,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
GLYBURIDE 5 MG ORAL TABLET,,3225,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
GLYBURIDE 5 MG ORAL TABLET,,3225,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
GLYBURIDE 5 MG ORAL TABLET,,3225,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
GLYBURIDE 5 MG ORAL TABLET,,3225,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
GLYBURIDE 5 MG ORAL TABLET,,3225,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
GLYBURIDE 5 MG ORAL TABLET,,3225,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
GLYBURIDE 5 MG ORAL TABLET,,3225,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
GLYBURIDE 5 MG ORAL TABLET,,3225,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
GLYBURIDE 5 MG ORAL TABLET,,3225,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
GLYBURIDE 5 MG ORAL TABLET,,3225,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
GLYBURIDE 5 MG ORAL TABLET,,3225,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
GLYBURIDE 5 MG ORAL TABLET,,3225,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
GLYBURIDE 5 MG ORAL TABLET,,3225,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
GLYBURIDE 5 MG ORAL TABLET,,3225,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
GLYBURIDE 5 MG ORAL TABLET,,3225,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
GLYBURIDE 5 MG ORAL TABLET,,3225,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
GLYBURIDE 5 MG ORAL TABLET,,3225,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
GLYBURIDE 5 MG ORAL TABLET,,3225,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
GLYBURIDE 5 MG ORAL TABLET,,3225,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
GLYBURIDE 5 MG ORAL TABLET,,3225,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
GLYBURIDE 5 MG ORAL TABLET,,3225,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
GLYBURIDE 5 MG ORAL TABLET,,3225,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
GLYBURIDE 5 MG ORAL TABLET,,3225,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
GLYBURIDE 5 MG ORAL TABLET,,3225,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
GLYBURIDE 5 MG ORAL TABLET,,3225,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
GLYBURIDE 5 MG ORAL TABLET,,3225,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
GLYBURIDE 5 MG ORAL TABLET,,3225,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
GLYBURIDE 5 MG ORAL TABLET,,3225,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
GLYBURIDE 5 MG ORAL TABLET,,3225,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
GLYBURIDE 5 MG ORAL TABLET,,3225,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
GLYBURIDE 5 MG ORAL TABLET,,3225,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
GLYBURIDE 5 MG ORAL TABLET,,3225,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
GLYBURIDE 5 MG ORAL TABLET,,3225,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
GLYBURIDE 5 MG ORAL TABLET,,3225,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
GLYBURIDE 5 MG ORAL TABLET,,3225,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
GLYBURIDE 5 MG ORAL TABLET,,3225,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
GLYBURIDE 5 MG ORAL TABLET,,3225,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
GLYBURIDE 5 MG ORAL TABLET,,3225,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
GLYBURIDE 5 MG ORAL TABLET,,3225,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
GLYBURIDE 5 MG ORAL TABLET,,3225,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
GLYBURIDE 5 MG ORAL TABLET,,3225,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
GLYBURIDE 5 MG ORAL TABLET,,3225,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
GLYBURIDE 5 MG ORAL TABLET,,3225,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
GLYBURIDE 5 MG ORAL TABLET,,3225,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
GLYBURIDE 5 MG ORAL TABLET,,3225,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
GLYBURIDE 5 MG ORAL TABLET,,3225,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
GLYBURIDE 5 MG ORAL TABLET,,3225,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
GLYBURIDE 5 MG ORAL TABLET,,3225,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
GLYBURIDE 5 MG ORAL TABLET,,3225,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
GLYBURIDE 5 MG ORAL TABLET,,3225,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
GLYBURIDE 5 MG ORAL TABLET,,3225,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
GLYBURIDE 5 MG ORAL TABLET,,3225,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
DILTIAZEM HCL 180 MG ORAL CP24,,3292,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
DILTIAZEM HCL 180 MG ORAL CP24,,3292,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
DILTIAZEM HCL 180 MG ORAL CP24,,3292,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
DILTIAZEM HCL 180 MG ORAL CP24,,3292,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
DILTIAZEM HCL 180 MG ORAL CP24,,3292,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
DILTIAZEM HCL 180 MG ORAL CP24,,3292,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
DILTIAZEM HCL 180 MG ORAL CP24,,3292,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
DILTIAZEM HCL 180 MG ORAL CP24,,3292,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
DILTIAZEM HCL 180 MG ORAL CP24,,3292,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
DILTIAZEM HCL 180 MG ORAL CP24,,3292,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
DILTIAZEM HCL 180 MG ORAL CP24,,3292,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
DILTIAZEM HCL 180 MG ORAL CP24,,3292,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
DILTIAZEM HCL 180 MG ORAL CP24,,3292,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
DILTIAZEM HCL 180 MG ORAL CP24,,3292,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
DILTIAZEM HCL 180 MG ORAL CP24,,3292,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
DILTIAZEM HCL 180 MG ORAL CP24,,3292,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
DILTIAZEM HCL 180 MG ORAL CP24,,3292,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
DILTIAZEM HCL 180 MG ORAL CP24,,3292,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
DILTIAZEM HCL 180 MG ORAL CP24,,3292,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DILTIAZEM HCL 180 MG ORAL CP24,,3292,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
DILTIAZEM HCL 180 MG ORAL CP24,,3292,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
DILTIAZEM HCL 180 MG ORAL CP24,,3292,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
DILTIAZEM HCL 180 MG ORAL CP24,,3292,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
DILTIAZEM HCL 180 MG ORAL CP24,,3292,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
DILTIAZEM HCL 180 MG ORAL CP24,,3292,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
DILTIAZEM HCL 180 MG ORAL CP24,,3292,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
DILTIAZEM HCL 180 MG ORAL CP24,,3292,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
DILTIAZEM HCL 180 MG ORAL CP24,,3292,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
DILTIAZEM HCL 180 MG ORAL CP24,,3292,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
DILTIAZEM HCL 180 MG ORAL CP24,,3292,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
DILTIAZEM HCL 180 MG ORAL CP24,,3292,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
DILTIAZEM HCL 180 MG ORAL CP24,,3292,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
DILTIAZEM HCL 180 MG ORAL CP24,,3292,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
DILTIAZEM HCL 180 MG ORAL CP24,,3292,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
DILTIAZEM HCL 180 MG ORAL CP24,,3292,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
DILTIAZEM HCL 180 MG ORAL CP24,,3292,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
DILTIAZEM HCL 180 MG ORAL CP24,,3292,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
DILTIAZEM HCL 180 MG ORAL CP24,,3292,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DILTIAZEM HCL 180 MG ORAL CP24,,3292,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
DILTIAZEM HCL 180 MG ORAL CP24,,3292,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
DILTIAZEM HCL 180 MG ORAL CP24,,3292,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
DILTIAZEM HCL 180 MG ORAL CP24,,3292,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
DILTIAZEM HCL 180 MG ORAL CP24,,3292,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
DILTIAZEM HCL 180 MG ORAL CP24,,3292,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DILTIAZEM HCL 180 MG ORAL CP24,,3292,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
DILTIAZEM HCL 180 MG ORAL CP24,,3292,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DILTIAZEM HCL 180 MG ORAL CP24,,3292,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DILTIAZEM HCL 180 MG ORAL CP24,,3292,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DILTIAZEM HCL 180 MG ORAL CP24,,3292,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DILTIAZEM HCL 180 MG ORAL CP24,,3292,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
DILTIAZEM HCL 180 MG ORAL CP24,,3292,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
DILTIAZEM HCL 180 MG ORAL CP24,,3292,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
DILTIAZEM HCL 180 MG ORAL CP24,,3292,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
DILTIAZEM HCL 180 MG ORAL CP24,,3292,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
CILOSTAZOL 50 MG ORAL TABLET,,3323,LOCAL,Facility,Both,1,EA,,10,8.5,2.866,10,Aetna,Commercial,9.2,92,,percent of total billed charges,,
CILOSTAZOL 50 MG ORAL TABLET,,3323,LOCAL,Facility,Outpatient,1,EA,,10,8.5,2.866,10,Aetna,Medicare Advantage,4.9,49,,percent of total billed charges,,
CILOSTAZOL 50 MG ORAL TABLET,,3323,LOCAL,Facility,Inpatient,1,EA,,10,8.5,2.866,10,Aetna,Medicare Advantage,,,,,Included in per diem rate,
CILOSTAZOL 50 MG ORAL TABLET,,3323,LOCAL,Facility,Both,1,EA,,10,8.5,2.866,10,Aetna,PPO,9.3,93,,percent of total billed charges,,
CILOSTAZOL 50 MG ORAL TABLET,,3323,LOCAL,Facility,Both,1,EA,,10,8.5,2.866,10,America's PPO,America's PPO,9.603,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
CILOSTAZOL 50 MG ORAL TABLET,,3323,LOCAL,Facility,Both,1,EA,,10,8.5,2.866,10,BlueCross BlueShield Minnesota, Federal Employee Program,9.84,98.4,,percent of total billed charges,,
CILOSTAZOL 50 MG ORAL TABLET,,3323,LOCAL,Facility,Both,1,EA,,10,8.5,2.866,10,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,10,100,,percent of total billed charges,,
CILOSTAZOL 50 MG ORAL TABLET,,3323,LOCAL,Facility,Both,1,EA,,10,8.5,2.866,10,BlueCross BlueShield Minnesota,High Value Network Plan,9,90,,percent of total billed charges,,
CILOSTAZOL 50 MG ORAL TABLET,,3323,LOCAL,Facility,Outpatient,1,EA,,10,8.5,2.866,10,BlueCross BlueShield Minnesota,Medicare Advantage,4.9,49,,percent of total billed charges,,
CILOSTAZOL 50 MG ORAL TABLET,,3323,LOCAL,Facility,Inpatient,1,EA,,10,8.5,2.866,10,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
CILOSTAZOL 50 MG ORAL TABLET,,3323,LOCAL,Facility,Both,1,EA,,10,8.5,2.866,10,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,8.857,88.57,,percent of total billed charges,,
CILOSTAZOL 50 MG ORAL TABLET,,3323,LOCAL,Facility,Both,1,EA,,10,8.5,2.866,10,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,2.866,28.66,,percent of total billed charges,,
CILOSTAZOL 50 MG ORAL TABLET,,3323,LOCAL,Facility,Outpatient,1,EA,,10,8.5,2.866,10,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),4.9,49,,percent of total billed charges,,
CILOSTAZOL 50 MG ORAL TABLET,,3323,LOCAL,Facility,Inpatient,1,EA,,10,8.5,2.866,10,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
CILOSTAZOL 50 MG ORAL TABLET,,3323,LOCAL,Facility,Both,1,EA,,10,8.5,2.866,10,CorVel,Worker's Compensation,10,100,,percent of total billed charges,,
CILOSTAZOL 50 MG ORAL TABLET,,3323,LOCAL,Facility,Both,1,EA,,10,8.5,2.866,10,First Health Group Corporation,First Health Network,9.7,97,,percent of total billed charges,,
CILOSTAZOL 50 MG ORAL TABLET,,3323,LOCAL,Facility,Both,1,EA,,10,8.5,2.866,10,"Health Partners, Inc.",Commercial,9.46,94.6,,percent of total billed charges,,
CILOSTAZOL 50 MG ORAL TABLET,,3323,LOCAL,Facility,Outpatient,1,EA,,10,8.5,2.866,10,"Health Partners, Inc.",Medicare Advantage,4.9,49,,percent of total billed charges,,
CILOSTAZOL 50 MG ORAL TABLET,,3323,LOCAL,Facility,Inpatient,1,EA,,10,8.5,2.866,10,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CILOSTAZOL 50 MG ORAL TABLET,,3323,LOCAL,Facility,Both,1,EA,,10,8.5,2.866,10,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),6,60,,percent of total billed charges,,
CILOSTAZOL 50 MG ORAL TABLET,,3323,LOCAL,Facility,Both,1,EA,,10,8.5,2.866,10,"Health Partners, Inc.",State of Minnesota Advantage Program,8.15,81.5,,percent of total billed charges,,
CILOSTAZOL 50 MG ORAL TABLET,,3323,LOCAL,Facility,Both,1,EA,,10,8.5,2.866,10,"Health Partners, Inc.",State Public Programs,5,50,,percent of total billed charges,,
CILOSTAZOL 50 MG ORAL TABLET,,3323,LOCAL,Facility,Both,1,EA,,10,8.5,2.866,10,Humana Insurance Company,Commercial PPO,9.5,95,,percent of total billed charges,,
CILOSTAZOL 50 MG ORAL TABLET,,3323,LOCAL,Facility,Outpatient,1,EA,,10,8.5,2.866,10,Humana Insurance Company,Medicare PPO,4.9,49,,percent of total billed charges,,
CILOSTAZOL 50 MG ORAL TABLET,,3323,LOCAL,Facility,Inpatient,1,EA,,10,8.5,2.866,10,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
CILOSTAZOL 50 MG ORAL TABLET,,3323,LOCAL,Facility,Both,1,EA,,10,8.5,2.866,10,Medica,Individual & Family,9.91,99.1,,percent of total billed charges,,
CILOSTAZOL 50 MG ORAL TABLET,,3323,LOCAL,Facility,Outpatient,1,EA,,10,8.5,2.866,10,Medica,Medica Advantage Solution,4.98,49.8,,percent of total billed charges,,
CILOSTAZOL 50 MG ORAL TABLET,,3323,LOCAL,Facility,Inpatient,1,EA,,10,8.5,2.866,10,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
CILOSTAZOL 50 MG ORAL TABLET,,3323,LOCAL,Facility,Outpatient,1,EA,,10,8.5,2.866,10,Medica,Medical Assistance,4.46,44.6,,percent of total billed charges,,
CILOSTAZOL 50 MG ORAL TABLET,,3323,LOCAL,Facility,Inpatient,1,EA,,10,8.5,2.866,10,Medica,Medical Assistance,,,,,Included in per diem rate,
CILOSTAZOL 50 MG ORAL TABLET,,3323,LOCAL,Facility,Outpatient,1,EA,,10,8.5,2.866,10,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,4.98,49.8,,percent of total billed charges,,
CILOSTAZOL 50 MG ORAL TABLET,,3323,LOCAL,Facility,Inpatient,1,EA,,10,8.5,2.866,10,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
CILOSTAZOL 50 MG ORAL TABLET,,3323,LOCAL,Facility,Both,1,EA,,10,8.5,2.866,10,"Multiplan, Inc.","Multiplan, Inc.",9.4,94,,percent of total billed charges,,
CILOSTAZOL 50 MG ORAL TABLET,,3323,LOCAL,Facility,Outpatient,1,EA,,10,8.5,2.866,10,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,9.01,90.1,,percent of total billed charges,,
CILOSTAZOL 50 MG ORAL TABLET,,3323,LOCAL,Facility,Inpatient,1,EA,,10,8.5,2.866,10,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
CILOSTAZOL 50 MG ORAL TABLET,,3323,LOCAL,Facility,Both,1,EA,,10,8.5,2.866,10,"Preferred One Administrative Services, INC.",PPO,9.86,98.6,,percent of total billed charges,,
CILOSTAZOL 50 MG ORAL TABLET,,3323,LOCAL,Facility,Outpatient,1,EA,,10,8.5,2.866,10,PrimeWest Health,Minnesota Senior Health Options (MSHO),5.145,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
CILOSTAZOL 50 MG ORAL TABLET,,3323,LOCAL,Facility,Inpatient,1,EA,,10,8.5,2.866,10,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CILOSTAZOL 50 MG ORAL TABLET,,3323,LOCAL,Facility,Outpatient,1,EA,,10,8.5,2.866,10,PrimeWest Health,MinnesotaCare,5.136,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
CILOSTAZOL 50 MG ORAL TABLET,,3323,LOCAL,Facility,Inpatient,1,EA,,10,8.5,2.866,10,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
CILOSTAZOL 50 MG ORAL TABLET,,3323,LOCAL,Facility,Both,1,EA,,10,8.5,2.866,10,Sanford Health Plan,Sanford Health Plan,9.2,92,,percent of total billed charges,,
CILOSTAZOL 50 MG ORAL TABLET,,3323,LOCAL,Facility,Outpatient,1,EA,,10,8.5,2.866,10,"UCare Health, Inc.",Individual & Family Plan,5.635,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
CILOSTAZOL 50 MG ORAL TABLET,,3323,LOCAL,Facility,Inpatient,1,EA,,10,8.5,2.866,10,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
CILOSTAZOL 50 MG ORAL TABLET,,3323,LOCAL,Facility,Outpatient,1,EA,,10,8.5,2.866,10,"UCare Health, Inc.",Medical Assistance,5.047,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CILOSTAZOL 50 MG ORAL TABLET,,3323,LOCAL,Facility,Inpatient,1,EA,,10,8.5,2.866,10,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
CILOSTAZOL 50 MG ORAL TABLET,,3323,LOCAL,Facility,Outpatient,1,EA,,10,8.5,2.866,10,"UCare Health, Inc.",Medicare Advantage,5.047,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CILOSTAZOL 50 MG ORAL TABLET,,3323,LOCAL,Facility,Inpatient,1,EA,,10,8.5,2.866,10,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CILOSTAZOL 50 MG ORAL TABLET,,3323,LOCAL,Facility,Outpatient,1,EA,,10,8.5,2.866,10,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),5.047,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CILOSTAZOL 50 MG ORAL TABLET,,3323,LOCAL,Facility,Inpatient,1,EA,,10,8.5,2.866,10,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CILOSTAZOL 50 MG ORAL TABLET,,3323,LOCAL,Facility,Both,1,EA,,10,8.5,2.866,10,UnitedHealthcare,Individual & Family,9.4,94,,percent of total billed charges,,
CILOSTAZOL 50 MG ORAL TABLET,,3323,LOCAL,Facility,Outpatient,1,EA,,10,8.5,2.866,10,UnitedHealthcare,Medicare Advantage,4.9,49,,percent of total billed charges,,
CILOSTAZOL 50 MG ORAL TABLET,,3323,LOCAL,Facility,Inpatient,1,EA,,10,8.5,2.866,10,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
CILOSTAZOL 50 MG ORAL TABLET,,3323,LOCAL,Facility,Outpatient,1,EA,,10,8.5,2.866,10,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,4.8,48,,percent of total billed charges,,100% of DHS outpatient percentage
CILOSTAZOL 50 MG ORAL TABLET,,3323,LOCAL,Facility,Inpatient,1,EA,,10,8.5,2.866,10,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
CLORAZEPATE DIPOTASSIUM 3.75 MG ORAL TABLET,,3394,LOCAL,Facility,Both,1,EA,,11,9.35,3.1526,11,Aetna,Commercial,10.12,92,,percent of total billed charges,,
CLORAZEPATE DIPOTASSIUM 3.75 MG ORAL TABLET,,3394,LOCAL,Facility,Outpatient,1,EA,,11,9.35,3.1526,11,Aetna,Medicare Advantage,5.39,49,,percent of total billed charges,,
CLORAZEPATE DIPOTASSIUM 3.75 MG ORAL TABLET,,3394,LOCAL,Facility,Inpatient,1,EA,,11,9.35,3.1526,11,Aetna,Medicare Advantage,,,,,Included in per diem rate,
CLORAZEPATE DIPOTASSIUM 3.75 MG ORAL TABLET,,3394,LOCAL,Facility,Both,1,EA,,11,9.35,3.1526,11,Aetna,PPO,10.23,93,,percent of total billed charges,,
CLORAZEPATE DIPOTASSIUM 3.75 MG ORAL TABLET,,3394,LOCAL,Facility,Both,1,EA,,11,9.35,3.1526,11,America's PPO,America's PPO,10.5633,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
CLORAZEPATE DIPOTASSIUM 3.75 MG ORAL TABLET,,3394,LOCAL,Facility,Both,1,EA,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota, Federal Employee Program,10.824,98.4,,percent of total billed charges,,
CLORAZEPATE DIPOTASSIUM 3.75 MG ORAL TABLET,,3394,LOCAL,Facility,Both,1,EA,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,11,100,,percent of total billed charges,,
CLORAZEPATE DIPOTASSIUM 3.75 MG ORAL TABLET,,3394,LOCAL,Facility,Both,1,EA,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,High Value Network Plan,9.9,90,,percent of total billed charges,,
CLORAZEPATE DIPOTASSIUM 3.75 MG ORAL TABLET,,3394,LOCAL,Facility,Outpatient,1,EA,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,Medicare Advantage,5.39,49,,percent of total billed charges,,
CLORAZEPATE DIPOTASSIUM 3.75 MG ORAL TABLET,,3394,LOCAL,Facility,Inpatient,1,EA,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
CLORAZEPATE DIPOTASSIUM 3.75 MG ORAL TABLET,,3394,LOCAL,Facility,Both,1,EA,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,9.7427,88.57,,percent of total billed charges,,
CLORAZEPATE DIPOTASSIUM 3.75 MG ORAL TABLET,,3394,LOCAL,Facility,Both,1,EA,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,3.1526,28.66,,percent of total billed charges,,
CLORAZEPATE DIPOTASSIUM 3.75 MG ORAL TABLET,,3394,LOCAL,Facility,Outpatient,1,EA,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),5.39,49,,percent of total billed charges,,
CLORAZEPATE DIPOTASSIUM 3.75 MG ORAL TABLET,,3394,LOCAL,Facility,Inpatient,1,EA,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
CLORAZEPATE DIPOTASSIUM 3.75 MG ORAL TABLET,,3394,LOCAL,Facility,Both,1,EA,,11,9.35,3.1526,11,CorVel,Worker's Compensation,11,100,,percent of total billed charges,,
CLORAZEPATE DIPOTASSIUM 3.75 MG ORAL TABLET,,3394,LOCAL,Facility,Both,1,EA,,11,9.35,3.1526,11,First Health Group Corporation,First Health Network,10.67,97,,percent of total billed charges,,
CLORAZEPATE DIPOTASSIUM 3.75 MG ORAL TABLET,,3394,LOCAL,Facility,Both,1,EA,,11,9.35,3.1526,11,"Health Partners, Inc.",Commercial,10.406,94.6,,percent of total billed charges,,
CLORAZEPATE DIPOTASSIUM 3.75 MG ORAL TABLET,,3394,LOCAL,Facility,Outpatient,1,EA,,11,9.35,3.1526,11,"Health Partners, Inc.",Medicare Advantage,5.39,49,,percent of total billed charges,,
CLORAZEPATE DIPOTASSIUM 3.75 MG ORAL TABLET,,3394,LOCAL,Facility,Inpatient,1,EA,,11,9.35,3.1526,11,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CLORAZEPATE DIPOTASSIUM 3.75 MG ORAL TABLET,,3394,LOCAL,Facility,Both,1,EA,,11,9.35,3.1526,11,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),6.6,60,,percent of total billed charges,,
CLORAZEPATE DIPOTASSIUM 3.75 MG ORAL TABLET,,3394,LOCAL,Facility,Both,1,EA,,11,9.35,3.1526,11,"Health Partners, Inc.",State of Minnesota Advantage Program,8.965,81.5,,percent of total billed charges,,
CLORAZEPATE DIPOTASSIUM 3.75 MG ORAL TABLET,,3394,LOCAL,Facility,Both,1,EA,,11,9.35,3.1526,11,"Health Partners, Inc.",State Public Programs,5.5,50,,percent of total billed charges,,
CLORAZEPATE DIPOTASSIUM 3.75 MG ORAL TABLET,,3394,LOCAL,Facility,Both,1,EA,,11,9.35,3.1526,11,Humana Insurance Company,Commercial PPO,10.45,95,,percent of total billed charges,,
CLORAZEPATE DIPOTASSIUM 3.75 MG ORAL TABLET,,3394,LOCAL,Facility,Outpatient,1,EA,,11,9.35,3.1526,11,Humana Insurance Company,Medicare PPO,5.39,49,,percent of total billed charges,,
CLORAZEPATE DIPOTASSIUM 3.75 MG ORAL TABLET,,3394,LOCAL,Facility,Inpatient,1,EA,,11,9.35,3.1526,11,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
CLORAZEPATE DIPOTASSIUM 3.75 MG ORAL TABLET,,3394,LOCAL,Facility,Both,1,EA,,11,9.35,3.1526,11,Medica,Individual & Family,10.901,99.1,,percent of total billed charges,,
CLORAZEPATE DIPOTASSIUM 3.75 MG ORAL TABLET,,3394,LOCAL,Facility,Outpatient,1,EA,,11,9.35,3.1526,11,Medica,Medica Advantage Solution,5.478,49.8,,percent of total billed charges,,
CLORAZEPATE DIPOTASSIUM 3.75 MG ORAL TABLET,,3394,LOCAL,Facility,Inpatient,1,EA,,11,9.35,3.1526,11,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
CLORAZEPATE DIPOTASSIUM 3.75 MG ORAL TABLET,,3394,LOCAL,Facility,Outpatient,1,EA,,11,9.35,3.1526,11,Medica,Medical Assistance,4.906,44.6,,percent of total billed charges,,
CLORAZEPATE DIPOTASSIUM 3.75 MG ORAL TABLET,,3394,LOCAL,Facility,Inpatient,1,EA,,11,9.35,3.1526,11,Medica,Medical Assistance,,,,,Included in per diem rate,
CLORAZEPATE DIPOTASSIUM 3.75 MG ORAL TABLET,,3394,LOCAL,Facility,Outpatient,1,EA,,11,9.35,3.1526,11,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,5.478,49.8,,percent of total billed charges,,
CLORAZEPATE DIPOTASSIUM 3.75 MG ORAL TABLET,,3394,LOCAL,Facility,Inpatient,1,EA,,11,9.35,3.1526,11,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
CLORAZEPATE DIPOTASSIUM 3.75 MG ORAL TABLET,,3394,LOCAL,Facility,Both,1,EA,,11,9.35,3.1526,11,"Multiplan, Inc.","Multiplan, Inc.",10.34,94,,percent of total billed charges,,
CLORAZEPATE DIPOTASSIUM 3.75 MG ORAL TABLET,,3394,LOCAL,Facility,Outpatient,1,EA,,11,9.35,3.1526,11,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,9.911,90.1,,percent of total billed charges,,
CLORAZEPATE DIPOTASSIUM 3.75 MG ORAL TABLET,,3394,LOCAL,Facility,Inpatient,1,EA,,11,9.35,3.1526,11,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
CLORAZEPATE DIPOTASSIUM 3.75 MG ORAL TABLET,,3394,LOCAL,Facility,Both,1,EA,,11,9.35,3.1526,11,"Preferred One Administrative Services, INC.",PPO,10.846,98.6,,percent of total billed charges,,
CLORAZEPATE DIPOTASSIUM 3.75 MG ORAL TABLET,,3394,LOCAL,Facility,Outpatient,1,EA,,11,9.35,3.1526,11,PrimeWest Health,Minnesota Senior Health Options (MSHO),5.6595,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
CLORAZEPATE DIPOTASSIUM 3.75 MG ORAL TABLET,,3394,LOCAL,Facility,Inpatient,1,EA,,11,9.35,3.1526,11,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CLORAZEPATE DIPOTASSIUM 3.75 MG ORAL TABLET,,3394,LOCAL,Facility,Outpatient,1,EA,,11,9.35,3.1526,11,PrimeWest Health,MinnesotaCare,5.6496,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
CLORAZEPATE DIPOTASSIUM 3.75 MG ORAL TABLET,,3394,LOCAL,Facility,Inpatient,1,EA,,11,9.35,3.1526,11,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
CLORAZEPATE DIPOTASSIUM 3.75 MG ORAL TABLET,,3394,LOCAL,Facility,Both,1,EA,,11,9.35,3.1526,11,Sanford Health Plan,Sanford Health Plan,10.12,92,,percent of total billed charges,,
CLORAZEPATE DIPOTASSIUM 3.75 MG ORAL TABLET,,3394,LOCAL,Facility,Outpatient,1,EA,,11,9.35,3.1526,11,"UCare Health, Inc.",Individual & Family Plan,6.1985,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
CLORAZEPATE DIPOTASSIUM 3.75 MG ORAL TABLET,,3394,LOCAL,Facility,Inpatient,1,EA,,11,9.35,3.1526,11,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
CLORAZEPATE DIPOTASSIUM 3.75 MG ORAL TABLET,,3394,LOCAL,Facility,Outpatient,1,EA,,11,9.35,3.1526,11,"UCare Health, Inc.",Medical Assistance,5.5517,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CLORAZEPATE DIPOTASSIUM 3.75 MG ORAL TABLET,,3394,LOCAL,Facility,Inpatient,1,EA,,11,9.35,3.1526,11,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
CLORAZEPATE DIPOTASSIUM 3.75 MG ORAL TABLET,,3394,LOCAL,Facility,Outpatient,1,EA,,11,9.35,3.1526,11,"UCare Health, Inc.",Medicare Advantage,5.5517,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CLORAZEPATE DIPOTASSIUM 3.75 MG ORAL TABLET,,3394,LOCAL,Facility,Inpatient,1,EA,,11,9.35,3.1526,11,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CLORAZEPATE DIPOTASSIUM 3.75 MG ORAL TABLET,,3394,LOCAL,Facility,Outpatient,1,EA,,11,9.35,3.1526,11,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),5.5517,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CLORAZEPATE DIPOTASSIUM 3.75 MG ORAL TABLET,,3394,LOCAL,Facility,Inpatient,1,EA,,11,9.35,3.1526,11,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CLORAZEPATE DIPOTASSIUM 3.75 MG ORAL TABLET,,3394,LOCAL,Facility,Both,1,EA,,11,9.35,3.1526,11,UnitedHealthcare,Individual & Family,10.34,94,,percent of total billed charges,,
CLORAZEPATE DIPOTASSIUM 3.75 MG ORAL TABLET,,3394,LOCAL,Facility,Outpatient,1,EA,,11,9.35,3.1526,11,UnitedHealthcare,Medicare Advantage,5.39,49,,percent of total billed charges,,
CLORAZEPATE DIPOTASSIUM 3.75 MG ORAL TABLET,,3394,LOCAL,Facility,Inpatient,1,EA,,11,9.35,3.1526,11,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
CLORAZEPATE DIPOTASSIUM 3.75 MG ORAL TABLET,,3394,LOCAL,Facility,Outpatient,1,EA,,11,9.35,3.1526,11,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,5.28,48,,percent of total billed charges,,100% of DHS outpatient percentage
CLORAZEPATE DIPOTASSIUM 3.75 MG ORAL TABLET,,3394,LOCAL,Facility,Inpatient,1,EA,,11,9.35,3.1526,11,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
AMIODARONE 200 MG ORAL TABLET,,3517,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
AMIODARONE 200 MG ORAL TABLET,,3517,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
AMIODARONE 200 MG ORAL TABLET,,3517,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
AMIODARONE 200 MG ORAL TABLET,,3517,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
AMIODARONE 200 MG ORAL TABLET,,3517,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
AMIODARONE 200 MG ORAL TABLET,,3517,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
AMIODARONE 200 MG ORAL TABLET,,3517,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
AMIODARONE 200 MG ORAL TABLET,,3517,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
AMIODARONE 200 MG ORAL TABLET,,3517,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
AMIODARONE 200 MG ORAL TABLET,,3517,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
AMIODARONE 200 MG ORAL TABLET,,3517,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
AMIODARONE 200 MG ORAL TABLET,,3517,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
AMIODARONE 200 MG ORAL TABLET,,3517,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
AMIODARONE 200 MG ORAL TABLET,,3517,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
AMIODARONE 200 MG ORAL TABLET,,3517,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
AMIODARONE 200 MG ORAL TABLET,,3517,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
AMIODARONE 200 MG ORAL TABLET,,3517,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
AMIODARONE 200 MG ORAL TABLET,,3517,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
AMIODARONE 200 MG ORAL TABLET,,3517,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
AMIODARONE 200 MG ORAL TABLET,,3517,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
AMIODARONE 200 MG ORAL TABLET,,3517,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
AMIODARONE 200 MG ORAL TABLET,,3517,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
AMIODARONE 200 MG ORAL TABLET,,3517,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
AMIODARONE 200 MG ORAL TABLET,,3517,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
AMIODARONE 200 MG ORAL TABLET,,3517,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
AMIODARONE 200 MG ORAL TABLET,,3517,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
AMIODARONE 200 MG ORAL TABLET,,3517,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
AMIODARONE 200 MG ORAL TABLET,,3517,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
AMIODARONE 200 MG ORAL TABLET,,3517,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
AMIODARONE 200 MG ORAL TABLET,,3517,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
AMIODARONE 200 MG ORAL TABLET,,3517,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
AMIODARONE 200 MG ORAL TABLET,,3517,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
AMIODARONE 200 MG ORAL TABLET,,3517,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
AMIODARONE 200 MG ORAL TABLET,,3517,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
AMIODARONE 200 MG ORAL TABLET,,3517,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
AMIODARONE 200 MG ORAL TABLET,,3517,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
AMIODARONE 200 MG ORAL TABLET,,3517,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
AMIODARONE 200 MG ORAL TABLET,,3517,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
AMIODARONE 200 MG ORAL TABLET,,3517,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
AMIODARONE 200 MG ORAL TABLET,,3517,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
AMIODARONE 200 MG ORAL TABLET,,3517,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
AMIODARONE 200 MG ORAL TABLET,,3517,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
AMIODARONE 200 MG ORAL TABLET,,3517,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
AMIODARONE 200 MG ORAL TABLET,,3517,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
AMIODARONE 200 MG ORAL TABLET,,3517,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
AMIODARONE 200 MG ORAL TABLET,,3517,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
AMIODARONE 200 MG ORAL TABLET,,3517,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
AMIODARONE 200 MG ORAL TABLET,,3517,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
AMIODARONE 200 MG ORAL TABLET,,3517,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
AMIODARONE 200 MG ORAL TABLET,,3517,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
AMIODARONE 200 MG ORAL TABLET,,3517,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
AMIODARONE 200 MG ORAL TABLET,,3517,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
AMIODARONE 200 MG ORAL TABLET,,3517,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
AMIODARONE 200 MG ORAL TABLET,,3517,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
METOPROLOL SUCCINATE 50 MG ORAL TB24,,3560,LOCAL,Facility,Both,1,EA,,6,5.1,1.7196,6,Aetna,Commercial,5.52,92,,percent of total billed charges,,
METOPROLOL SUCCINATE 50 MG ORAL TB24,,3560,LOCAL,Facility,Both,1,EA,,6,5.1,1.7196,6,Aetna,Commercial,5.52,92,,percent of total billed charges,,
METOPROLOL SUCCINATE 50 MG ORAL TB24,,3560,LOCAL,Facility,Outpatient,1,EA,,6,5.1,1.7196,6,Aetna,Medicare Advantage,2.94,49,,percent of total billed charges,,
METOPROLOL SUCCINATE 50 MG ORAL TB24,,3560,LOCAL,Facility,Outpatient,1,EA,,6,5.1,1.7196,6,Aetna,Medicare Advantage,2.94,49,,percent of total billed charges,,
METOPROLOL SUCCINATE 50 MG ORAL TB24,,3560,LOCAL,Facility,Inpatient,1,EA,,6,5.1,1.7196,6,Aetna,Medicare Advantage,,,,,Included in per diem rate,
METOPROLOL SUCCINATE 50 MG ORAL TB24,,3560,LOCAL,Facility,Inpatient,1,EA,,6,5.1,1.7196,6,Aetna,Medicare Advantage,,,,,Included in per diem rate,
METOPROLOL SUCCINATE 50 MG ORAL TB24,,3560,LOCAL,Facility,Both,1,EA,,6,5.1,1.7196,6,Aetna,PPO,5.58,93,,percent of total billed charges,,
METOPROLOL SUCCINATE 50 MG ORAL TB24,,3560,LOCAL,Facility,Both,1,EA,,6,5.1,1.7196,6,Aetna,PPO,5.58,93,,percent of total billed charges,,
METOPROLOL SUCCINATE 50 MG ORAL TB24,,3560,LOCAL,Facility,Both,1,EA,,6,5.1,1.7196,6,America's PPO,America's PPO,5.7618,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
METOPROLOL SUCCINATE 50 MG ORAL TB24,,3560,LOCAL,Facility,Both,1,EA,,6,5.1,1.7196,6,America's PPO,America's PPO,5.7618,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
METOPROLOL SUCCINATE 50 MG ORAL TB24,,3560,LOCAL,Facility,Both,1,EA,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota, Federal Employee Program,5.904,98.4,,percent of total billed charges,,
METOPROLOL SUCCINATE 50 MG ORAL TB24,,3560,LOCAL,Facility,Both,1,EA,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota, Federal Employee Program,5.904,98.4,,percent of total billed charges,,
METOPROLOL SUCCINATE 50 MG ORAL TB24,,3560,LOCAL,Facility,Both,1,EA,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,6,100,,percent of total billed charges,,
METOPROLOL SUCCINATE 50 MG ORAL TB24,,3560,LOCAL,Facility,Both,1,EA,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,6,100,,percent of total billed charges,,
METOPROLOL SUCCINATE 50 MG ORAL TB24,,3560,LOCAL,Facility,Both,1,EA,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota,High Value Network Plan,5.4,90,,percent of total billed charges,,
METOPROLOL SUCCINATE 50 MG ORAL TB24,,3560,LOCAL,Facility,Both,1,EA,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota,High Value Network Plan,5.4,90,,percent of total billed charges,,
METOPROLOL SUCCINATE 50 MG ORAL TB24,,3560,LOCAL,Facility,Outpatient,1,EA,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota,Medicare Advantage,2.94,49,,percent of total billed charges,,
METOPROLOL SUCCINATE 50 MG ORAL TB24,,3560,LOCAL,Facility,Outpatient,1,EA,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota,Medicare Advantage,2.94,49,,percent of total billed charges,,
METOPROLOL SUCCINATE 50 MG ORAL TB24,,3560,LOCAL,Facility,Inpatient,1,EA,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
METOPROLOL SUCCINATE 50 MG ORAL TB24,,3560,LOCAL,Facility,Inpatient,1,EA,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
METOPROLOL SUCCINATE 50 MG ORAL TB24,,3560,LOCAL,Facility,Both,1,EA,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,5.3142,88.57,,percent of total billed charges,,
METOPROLOL SUCCINATE 50 MG ORAL TB24,,3560,LOCAL,Facility,Both,1,EA,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,5.3142,88.57,,percent of total billed charges,,
METOPROLOL SUCCINATE 50 MG ORAL TB24,,3560,LOCAL,Facility,Both,1,EA,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.7196,28.66,,percent of total billed charges,,
METOPROLOL SUCCINATE 50 MG ORAL TB24,,3560,LOCAL,Facility,Both,1,EA,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.7196,28.66,,percent of total billed charges,,
METOPROLOL SUCCINATE 50 MG ORAL TB24,,3560,LOCAL,Facility,Outpatient,1,EA,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.94,49,,percent of total billed charges,,
METOPROLOL SUCCINATE 50 MG ORAL TB24,,3560,LOCAL,Facility,Outpatient,1,EA,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.94,49,,percent of total billed charges,,
METOPROLOL SUCCINATE 50 MG ORAL TB24,,3560,LOCAL,Facility,Inpatient,1,EA,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
METOPROLOL SUCCINATE 50 MG ORAL TB24,,3560,LOCAL,Facility,Inpatient,1,EA,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
METOPROLOL SUCCINATE 50 MG ORAL TB24,,3560,LOCAL,Facility,Both,1,EA,,6,5.1,1.7196,6,CorVel,Worker's Compensation,6,100,,percent of total billed charges,,
METOPROLOL SUCCINATE 50 MG ORAL TB24,,3560,LOCAL,Facility,Both,1,EA,,6,5.1,1.7196,6,CorVel,Worker's Compensation,6,100,,percent of total billed charges,,
METOPROLOL SUCCINATE 50 MG ORAL TB24,,3560,LOCAL,Facility,Both,1,EA,,6,5.1,1.7196,6,First Health Group Corporation,First Health Network,5.82,97,,percent of total billed charges,,
METOPROLOL SUCCINATE 50 MG ORAL TB24,,3560,LOCAL,Facility,Both,1,EA,,6,5.1,1.7196,6,First Health Group Corporation,First Health Network,5.82,97,,percent of total billed charges,,
METOPROLOL SUCCINATE 50 MG ORAL TB24,,3560,LOCAL,Facility,Both,1,EA,,6,5.1,1.7196,6,"Health Partners, Inc.",Commercial,5.676,94.6,,percent of total billed charges,,
METOPROLOL SUCCINATE 50 MG ORAL TB24,,3560,LOCAL,Facility,Both,1,EA,,6,5.1,1.7196,6,"Health Partners, Inc.",Commercial,5.676,94.6,,percent of total billed charges,,
METOPROLOL SUCCINATE 50 MG ORAL TB24,,3560,LOCAL,Facility,Outpatient,1,EA,,6,5.1,1.7196,6,"Health Partners, Inc.",Medicare Advantage,2.94,49,,percent of total billed charges,,
METOPROLOL SUCCINATE 50 MG ORAL TB24,,3560,LOCAL,Facility,Outpatient,1,EA,,6,5.1,1.7196,6,"Health Partners, Inc.",Medicare Advantage,2.94,49,,percent of total billed charges,,
METOPROLOL SUCCINATE 50 MG ORAL TB24,,3560,LOCAL,Facility,Inpatient,1,EA,,6,5.1,1.7196,6,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
METOPROLOL SUCCINATE 50 MG ORAL TB24,,3560,LOCAL,Facility,Inpatient,1,EA,,6,5.1,1.7196,6,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
METOPROLOL SUCCINATE 50 MG ORAL TB24,,3560,LOCAL,Facility,Both,1,EA,,6,5.1,1.7196,6,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3.6,60,,percent of total billed charges,,
METOPROLOL SUCCINATE 50 MG ORAL TB24,,3560,LOCAL,Facility,Both,1,EA,,6,5.1,1.7196,6,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3.6,60,,percent of total billed charges,,
METOPROLOL SUCCINATE 50 MG ORAL TB24,,3560,LOCAL,Facility,Both,1,EA,,6,5.1,1.7196,6,"Health Partners, Inc.",State of Minnesota Advantage Program,4.89,81.5,,percent of total billed charges,,
METOPROLOL SUCCINATE 50 MG ORAL TB24,,3560,LOCAL,Facility,Both,1,EA,,6,5.1,1.7196,6,"Health Partners, Inc.",State of Minnesota Advantage Program,4.89,81.5,,percent of total billed charges,,
METOPROLOL SUCCINATE 50 MG ORAL TB24,,3560,LOCAL,Facility,Both,1,EA,,6,5.1,1.7196,6,"Health Partners, Inc.",State Public Programs,3,50,,percent of total billed charges,,
METOPROLOL SUCCINATE 50 MG ORAL TB24,,3560,LOCAL,Facility,Both,1,EA,,6,5.1,1.7196,6,"Health Partners, Inc.",State Public Programs,3,50,,percent of total billed charges,,
METOPROLOL SUCCINATE 50 MG ORAL TB24,,3560,LOCAL,Facility,Both,1,EA,,6,5.1,1.7196,6,Humana Insurance Company,Commercial PPO,5.7,95,,percent of total billed charges,,
METOPROLOL SUCCINATE 50 MG ORAL TB24,,3560,LOCAL,Facility,Both,1,EA,,6,5.1,1.7196,6,Humana Insurance Company,Commercial PPO,5.7,95,,percent of total billed charges,,
METOPROLOL SUCCINATE 50 MG ORAL TB24,,3560,LOCAL,Facility,Outpatient,1,EA,,6,5.1,1.7196,6,Humana Insurance Company,Medicare PPO,2.94,49,,percent of total billed charges,,
METOPROLOL SUCCINATE 50 MG ORAL TB24,,3560,LOCAL,Facility,Outpatient,1,EA,,6,5.1,1.7196,6,Humana Insurance Company,Medicare PPO,2.94,49,,percent of total billed charges,,
METOPROLOL SUCCINATE 50 MG ORAL TB24,,3560,LOCAL,Facility,Inpatient,1,EA,,6,5.1,1.7196,6,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
METOPROLOL SUCCINATE 50 MG ORAL TB24,,3560,LOCAL,Facility,Inpatient,1,EA,,6,5.1,1.7196,6,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
METOPROLOL SUCCINATE 50 MG ORAL TB24,,3560,LOCAL,Facility,Both,1,EA,,6,5.1,1.7196,6,Medica,Individual & Family,5.946,99.1,,percent of total billed charges,,
METOPROLOL SUCCINATE 50 MG ORAL TB24,,3560,LOCAL,Facility,Both,1,EA,,6,5.1,1.7196,6,Medica,Individual & Family,5.946,99.1,,percent of total billed charges,,
METOPROLOL SUCCINATE 50 MG ORAL TB24,,3560,LOCAL,Facility,Outpatient,1,EA,,6,5.1,1.7196,6,Medica,Medica Advantage Solution,2.988,49.8,,percent of total billed charges,,
METOPROLOL SUCCINATE 50 MG ORAL TB24,,3560,LOCAL,Facility,Outpatient,1,EA,,6,5.1,1.7196,6,Medica,Medica Advantage Solution,2.988,49.8,,percent of total billed charges,,
METOPROLOL SUCCINATE 50 MG ORAL TB24,,3560,LOCAL,Facility,Inpatient,1,EA,,6,5.1,1.7196,6,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
METOPROLOL SUCCINATE 50 MG ORAL TB24,,3560,LOCAL,Facility,Inpatient,1,EA,,6,5.1,1.7196,6,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
METOPROLOL SUCCINATE 50 MG ORAL TB24,,3560,LOCAL,Facility,Outpatient,1,EA,,6,5.1,1.7196,6,Medica,Medical Assistance,2.676,44.6,,percent of total billed charges,,
METOPROLOL SUCCINATE 50 MG ORAL TB24,,3560,LOCAL,Facility,Outpatient,1,EA,,6,5.1,1.7196,6,Medica,Medical Assistance,2.676,44.6,,percent of total billed charges,,
METOPROLOL SUCCINATE 50 MG ORAL TB24,,3560,LOCAL,Facility,Inpatient,1,EA,,6,5.1,1.7196,6,Medica,Medical Assistance,,,,,Included in per diem rate,
METOPROLOL SUCCINATE 50 MG ORAL TB24,,3560,LOCAL,Facility,Inpatient,1,EA,,6,5.1,1.7196,6,Medica,Medical Assistance,,,,,Included in per diem rate,
METOPROLOL SUCCINATE 50 MG ORAL TB24,,3560,LOCAL,Facility,Outpatient,1,EA,,6,5.1,1.7196,6,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.988,49.8,,percent of total billed charges,,
METOPROLOL SUCCINATE 50 MG ORAL TB24,,3560,LOCAL,Facility,Outpatient,1,EA,,6,5.1,1.7196,6,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.988,49.8,,percent of total billed charges,,
METOPROLOL SUCCINATE 50 MG ORAL TB24,,3560,LOCAL,Facility,Inpatient,1,EA,,6,5.1,1.7196,6,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
METOPROLOL SUCCINATE 50 MG ORAL TB24,,3560,LOCAL,Facility,Inpatient,1,EA,,6,5.1,1.7196,6,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
METOPROLOL SUCCINATE 50 MG ORAL TB24,,3560,LOCAL,Facility,Both,1,EA,,6,5.1,1.7196,6,"Multiplan, Inc.","Multiplan, Inc.",5.64,94,,percent of total billed charges,,
METOPROLOL SUCCINATE 50 MG ORAL TB24,,3560,LOCAL,Facility,Both,1,EA,,6,5.1,1.7196,6,"Multiplan, Inc.","Multiplan, Inc.",5.64,94,,percent of total billed charges,,
METOPROLOL SUCCINATE 50 MG ORAL TB24,,3560,LOCAL,Facility,Outpatient,1,EA,,6,5.1,1.7196,6,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,5.406,90.1,,percent of total billed charges,,
METOPROLOL SUCCINATE 50 MG ORAL TB24,,3560,LOCAL,Facility,Outpatient,1,EA,,6,5.1,1.7196,6,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,5.406,90.1,,percent of total billed charges,,
METOPROLOL SUCCINATE 50 MG ORAL TB24,,3560,LOCAL,Facility,Inpatient,1,EA,,6,5.1,1.7196,6,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
METOPROLOL SUCCINATE 50 MG ORAL TB24,,3560,LOCAL,Facility,Inpatient,1,EA,,6,5.1,1.7196,6,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
METOPROLOL SUCCINATE 50 MG ORAL TB24,,3560,LOCAL,Facility,Both,1,EA,,6,5.1,1.7196,6,"Preferred One Administrative Services, INC.",PPO,5.916,98.6,,percent of total billed charges,,
METOPROLOL SUCCINATE 50 MG ORAL TB24,,3560,LOCAL,Facility,Both,1,EA,,6,5.1,1.7196,6,"Preferred One Administrative Services, INC.",PPO,5.916,98.6,,percent of total billed charges,,
METOPROLOL SUCCINATE 50 MG ORAL TB24,,3560,LOCAL,Facility,Outpatient,1,EA,,6,5.1,1.7196,6,PrimeWest Health,Minnesota Senior Health Options (MSHO),3.087,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
METOPROLOL SUCCINATE 50 MG ORAL TB24,,3560,LOCAL,Facility,Outpatient,1,EA,,6,5.1,1.7196,6,PrimeWest Health,Minnesota Senior Health Options (MSHO),3.087,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
METOPROLOL SUCCINATE 50 MG ORAL TB24,,3560,LOCAL,Facility,Inpatient,1,EA,,6,5.1,1.7196,6,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
METOPROLOL SUCCINATE 50 MG ORAL TB24,,3560,LOCAL,Facility,Inpatient,1,EA,,6,5.1,1.7196,6,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
METOPROLOL SUCCINATE 50 MG ORAL TB24,,3560,LOCAL,Facility,Outpatient,1,EA,,6,5.1,1.7196,6,PrimeWest Health,MinnesotaCare,3.0816,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
METOPROLOL SUCCINATE 50 MG ORAL TB24,,3560,LOCAL,Facility,Outpatient,1,EA,,6,5.1,1.7196,6,PrimeWest Health,MinnesotaCare,3.0816,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
METOPROLOL SUCCINATE 50 MG ORAL TB24,,3560,LOCAL,Facility,Inpatient,1,EA,,6,5.1,1.7196,6,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
METOPROLOL SUCCINATE 50 MG ORAL TB24,,3560,LOCAL,Facility,Inpatient,1,EA,,6,5.1,1.7196,6,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
METOPROLOL SUCCINATE 50 MG ORAL TB24,,3560,LOCAL,Facility,Both,1,EA,,6,5.1,1.7196,6,Sanford Health Plan,Sanford Health Plan,5.52,92,,percent of total billed charges,,
METOPROLOL SUCCINATE 50 MG ORAL TB24,,3560,LOCAL,Facility,Both,1,EA,,6,5.1,1.7196,6,Sanford Health Plan,Sanford Health Plan,5.52,92,,percent of total billed charges,,
METOPROLOL SUCCINATE 50 MG ORAL TB24,,3560,LOCAL,Facility,Outpatient,1,EA,,6,5.1,1.7196,6,"UCare Health, Inc.",Individual & Family Plan,3.381,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
METOPROLOL SUCCINATE 50 MG ORAL TB24,,3560,LOCAL,Facility,Outpatient,1,EA,,6,5.1,1.7196,6,"UCare Health, Inc.",Individual & Family Plan,3.381,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
METOPROLOL SUCCINATE 50 MG ORAL TB24,,3560,LOCAL,Facility,Inpatient,1,EA,,6,5.1,1.7196,6,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
METOPROLOL SUCCINATE 50 MG ORAL TB24,,3560,LOCAL,Facility,Inpatient,1,EA,,6,5.1,1.7196,6,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
METOPROLOL SUCCINATE 50 MG ORAL TB24,,3560,LOCAL,Facility,Outpatient,1,EA,,6,5.1,1.7196,6,"UCare Health, Inc.",Medical Assistance,3.0282,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
METOPROLOL SUCCINATE 50 MG ORAL TB24,,3560,LOCAL,Facility,Outpatient,1,EA,,6,5.1,1.7196,6,"UCare Health, Inc.",Medical Assistance,3.0282,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
METOPROLOL SUCCINATE 50 MG ORAL TB24,,3560,LOCAL,Facility,Inpatient,1,EA,,6,5.1,1.7196,6,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
METOPROLOL SUCCINATE 50 MG ORAL TB24,,3560,LOCAL,Facility,Inpatient,1,EA,,6,5.1,1.7196,6,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
METOPROLOL SUCCINATE 50 MG ORAL TB24,,3560,LOCAL,Facility,Outpatient,1,EA,,6,5.1,1.7196,6,"UCare Health, Inc.",Medicare Advantage,3.0282,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
METOPROLOL SUCCINATE 50 MG ORAL TB24,,3560,LOCAL,Facility,Outpatient,1,EA,,6,5.1,1.7196,6,"UCare Health, Inc.",Medicare Advantage,3.0282,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
METOPROLOL SUCCINATE 50 MG ORAL TB24,,3560,LOCAL,Facility,Inpatient,1,EA,,6,5.1,1.7196,6,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
METOPROLOL SUCCINATE 50 MG ORAL TB24,,3560,LOCAL,Facility,Inpatient,1,EA,,6,5.1,1.7196,6,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
METOPROLOL SUCCINATE 50 MG ORAL TB24,,3560,LOCAL,Facility,Outpatient,1,EA,,6,5.1,1.7196,6,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),3.0282,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
METOPROLOL SUCCINATE 50 MG ORAL TB24,,3560,LOCAL,Facility,Outpatient,1,EA,,6,5.1,1.7196,6,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),3.0282,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
METOPROLOL SUCCINATE 50 MG ORAL TB24,,3560,LOCAL,Facility,Inpatient,1,EA,,6,5.1,1.7196,6,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
METOPROLOL SUCCINATE 50 MG ORAL TB24,,3560,LOCAL,Facility,Inpatient,1,EA,,6,5.1,1.7196,6,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
METOPROLOL SUCCINATE 50 MG ORAL TB24,,3560,LOCAL,Facility,Both,1,EA,,6,5.1,1.7196,6,UnitedHealthcare,Individual & Family,5.64,94,,percent of total billed charges,,
METOPROLOL SUCCINATE 50 MG ORAL TB24,,3560,LOCAL,Facility,Both,1,EA,,6,5.1,1.7196,6,UnitedHealthcare,Individual & Family,5.64,94,,percent of total billed charges,,
METOPROLOL SUCCINATE 50 MG ORAL TB24,,3560,LOCAL,Facility,Outpatient,1,EA,,6,5.1,1.7196,6,UnitedHealthcare,Medicare Advantage,2.94,49,,percent of total billed charges,,
METOPROLOL SUCCINATE 50 MG ORAL TB24,,3560,LOCAL,Facility,Outpatient,1,EA,,6,5.1,1.7196,6,UnitedHealthcare,Medicare Advantage,2.94,49,,percent of total billed charges,,
METOPROLOL SUCCINATE 50 MG ORAL TB24,,3560,LOCAL,Facility,Inpatient,1,EA,,6,5.1,1.7196,6,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
METOPROLOL SUCCINATE 50 MG ORAL TB24,,3560,LOCAL,Facility,Inpatient,1,EA,,6,5.1,1.7196,6,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
METOPROLOL SUCCINATE 50 MG ORAL TB24,,3560,LOCAL,Facility,Outpatient,1,EA,,6,5.1,1.7196,6,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.88,48,,percent of total billed charges,,100% of DHS outpatient percentage
METOPROLOL SUCCINATE 50 MG ORAL TB24,,3560,LOCAL,Facility,Outpatient,1,EA,,6,5.1,1.7196,6,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.88,48,,percent of total billed charges,,100% of DHS outpatient percentage
METOPROLOL SUCCINATE 50 MG ORAL TB24,,3560,LOCAL,Facility,Inpatient,1,EA,,6,5.1,1.7196,6,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
METOPROLOL SUCCINATE 50 MG ORAL TB24,,3560,LOCAL,Facility,Inpatient,1,EA,,6,5.1,1.7196,6,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
AMPICILLIN 500 MG ORAL CAP,,3600,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
AMPICILLIN 500 MG ORAL CAP,,3600,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
AMPICILLIN 500 MG ORAL CAP,,3600,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
AMPICILLIN 500 MG ORAL CAP,,3600,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
AMPICILLIN 500 MG ORAL CAP,,3600,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
AMPICILLIN 500 MG ORAL CAP,,3600,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
AMPICILLIN 500 MG ORAL CAP,,3600,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
AMPICILLIN 500 MG ORAL CAP,,3600,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
AMPICILLIN 500 MG ORAL CAP,,3600,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
AMPICILLIN 500 MG ORAL CAP,,3600,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
AMPICILLIN 500 MG ORAL CAP,,3600,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
AMPICILLIN 500 MG ORAL CAP,,3600,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
AMPICILLIN 500 MG ORAL CAP,,3600,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
AMPICILLIN 500 MG ORAL CAP,,3600,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
AMPICILLIN 500 MG ORAL CAP,,3600,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
AMPICILLIN 500 MG ORAL CAP,,3600,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
AMPICILLIN 500 MG ORAL CAP,,3600,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
AMPICILLIN 500 MG ORAL CAP,,3600,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
AMPICILLIN 500 MG ORAL CAP,,3600,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
AMPICILLIN 500 MG ORAL CAP,,3600,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
AMPICILLIN 500 MG ORAL CAP,,3600,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
AMPICILLIN 500 MG ORAL CAP,,3600,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
AMPICILLIN 500 MG ORAL CAP,,3600,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
AMPICILLIN 500 MG ORAL CAP,,3600,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
AMPICILLIN 500 MG ORAL CAP,,3600,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
AMPICILLIN 500 MG ORAL CAP,,3600,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
AMPICILLIN 500 MG ORAL CAP,,3600,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
AMPICILLIN 500 MG ORAL CAP,,3600,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
AMPICILLIN 500 MG ORAL CAP,,3600,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
AMPICILLIN 500 MG ORAL CAP,,3600,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
AMPICILLIN 500 MG ORAL CAP,,3600,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
AMPICILLIN 500 MG ORAL CAP,,3600,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
AMPICILLIN 500 MG ORAL CAP,,3600,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
AMPICILLIN 500 MG ORAL CAP,,3600,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
AMPICILLIN 500 MG ORAL CAP,,3600,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
AMPICILLIN 500 MG ORAL CAP,,3600,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
AMPICILLIN 500 MG ORAL CAP,,3600,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
AMPICILLIN 500 MG ORAL CAP,,3600,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
AMPICILLIN 500 MG ORAL CAP,,3600,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
AMPICILLIN 500 MG ORAL CAP,,3600,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
AMPICILLIN 500 MG ORAL CAP,,3600,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
AMPICILLIN 500 MG ORAL CAP,,3600,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
AMPICILLIN 500 MG ORAL CAP,,3600,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
AMPICILLIN 500 MG ORAL CAP,,3600,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
AMPICILLIN 500 MG ORAL CAP,,3600,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
AMPICILLIN 500 MG ORAL CAP,,3600,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
AMPICILLIN 500 MG ORAL CAP,,3600,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
AMPICILLIN 500 MG ORAL CAP,,3600,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
AMPICILLIN 500 MG ORAL CAP,,3600,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
AMPICILLIN 500 MG ORAL CAP,,3600,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
AMPICILLIN 500 MG ORAL CAP,,3600,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
AMPICILLIN 500 MG ORAL CAP,,3600,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
AMPICILLIN 500 MG ORAL CAP,,3600,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
AMPICILLIN 500 MG ORAL CAP,,3600,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
LEVETIRACETAM 500 MG ORAL TABLET,,3614,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
LEVETIRACETAM 500 MG ORAL TABLET,,3614,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
LEVETIRACETAM 500 MG ORAL TABLET,,3614,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
LEVETIRACETAM 500 MG ORAL TABLET,,3614,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
LEVETIRACETAM 500 MG ORAL TABLET,,3614,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
LEVETIRACETAM 500 MG ORAL TABLET,,3614,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
LEVETIRACETAM 500 MG ORAL TABLET,,3614,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
LEVETIRACETAM 500 MG ORAL TABLET,,3614,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
LEVETIRACETAM 500 MG ORAL TABLET,,3614,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
LEVETIRACETAM 500 MG ORAL TABLET,,3614,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
LEVETIRACETAM 500 MG ORAL TABLET,,3614,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
LEVETIRACETAM 500 MG ORAL TABLET,,3614,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
LEVETIRACETAM 500 MG ORAL TABLET,,3614,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
LEVETIRACETAM 500 MG ORAL TABLET,,3614,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
LEVETIRACETAM 500 MG ORAL TABLET,,3614,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
LEVETIRACETAM 500 MG ORAL TABLET,,3614,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
LEVETIRACETAM 500 MG ORAL TABLET,,3614,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
LEVETIRACETAM 500 MG ORAL TABLET,,3614,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
LEVETIRACETAM 500 MG ORAL TABLET,,3614,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LEVETIRACETAM 500 MG ORAL TABLET,,3614,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
LEVETIRACETAM 500 MG ORAL TABLET,,3614,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
LEVETIRACETAM 500 MG ORAL TABLET,,3614,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
LEVETIRACETAM 500 MG ORAL TABLET,,3614,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
LEVETIRACETAM 500 MG ORAL TABLET,,3614,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
LEVETIRACETAM 500 MG ORAL TABLET,,3614,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
LEVETIRACETAM 500 MG ORAL TABLET,,3614,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
LEVETIRACETAM 500 MG ORAL TABLET,,3614,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
LEVETIRACETAM 500 MG ORAL TABLET,,3614,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
LEVETIRACETAM 500 MG ORAL TABLET,,3614,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
LEVETIRACETAM 500 MG ORAL TABLET,,3614,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
LEVETIRACETAM 500 MG ORAL TABLET,,3614,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
LEVETIRACETAM 500 MG ORAL TABLET,,3614,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
LEVETIRACETAM 500 MG ORAL TABLET,,3614,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
LEVETIRACETAM 500 MG ORAL TABLET,,3614,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
LEVETIRACETAM 500 MG ORAL TABLET,,3614,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
LEVETIRACETAM 500 MG ORAL TABLET,,3614,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
LEVETIRACETAM 500 MG ORAL TABLET,,3614,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
LEVETIRACETAM 500 MG ORAL TABLET,,3614,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LEVETIRACETAM 500 MG ORAL TABLET,,3614,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
LEVETIRACETAM 500 MG ORAL TABLET,,3614,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
LEVETIRACETAM 500 MG ORAL TABLET,,3614,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
LEVETIRACETAM 500 MG ORAL TABLET,,3614,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
LEVETIRACETAM 500 MG ORAL TABLET,,3614,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
LEVETIRACETAM 500 MG ORAL TABLET,,3614,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LEVETIRACETAM 500 MG ORAL TABLET,,3614,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
LEVETIRACETAM 500 MG ORAL TABLET,,3614,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LEVETIRACETAM 500 MG ORAL TABLET,,3614,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LEVETIRACETAM 500 MG ORAL TABLET,,3614,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LEVETIRACETAM 500 MG ORAL TABLET,,3614,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LEVETIRACETAM 500 MG ORAL TABLET,,3614,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
LEVETIRACETAM 500 MG ORAL TABLET,,3614,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
LEVETIRACETAM 500 MG ORAL TABLET,,3614,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
LEVETIRACETAM 500 MG ORAL TABLET,,3614,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
LEVETIRACETAM 500 MG ORAL TABLET,,3614,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
CITALOPRAM 10 MG ORAL TABLET,,3620,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
CITALOPRAM 10 MG ORAL TABLET,,3620,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
CITALOPRAM 10 MG ORAL TABLET,,3620,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
CITALOPRAM 10 MG ORAL TABLET,,3620,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
CITALOPRAM 10 MG ORAL TABLET,,3620,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
CITALOPRAM 10 MG ORAL TABLET,,3620,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
CITALOPRAM 10 MG ORAL TABLET,,3620,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
CITALOPRAM 10 MG ORAL TABLET,,3620,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
CITALOPRAM 10 MG ORAL TABLET,,3620,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
CITALOPRAM 10 MG ORAL TABLET,,3620,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
CITALOPRAM 10 MG ORAL TABLET,,3620,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
CITALOPRAM 10 MG ORAL TABLET,,3620,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
CITALOPRAM 10 MG ORAL TABLET,,3620,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
CITALOPRAM 10 MG ORAL TABLET,,3620,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
CITALOPRAM 10 MG ORAL TABLET,,3620,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
CITALOPRAM 10 MG ORAL TABLET,,3620,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
CITALOPRAM 10 MG ORAL TABLET,,3620,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
CITALOPRAM 10 MG ORAL TABLET,,3620,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
CITALOPRAM 10 MG ORAL TABLET,,3620,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CITALOPRAM 10 MG ORAL TABLET,,3620,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
CITALOPRAM 10 MG ORAL TABLET,,3620,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
CITALOPRAM 10 MG ORAL TABLET,,3620,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
CITALOPRAM 10 MG ORAL TABLET,,3620,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
CITALOPRAM 10 MG ORAL TABLET,,3620,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
CITALOPRAM 10 MG ORAL TABLET,,3620,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
CITALOPRAM 10 MG ORAL TABLET,,3620,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
CITALOPRAM 10 MG ORAL TABLET,,3620,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
CITALOPRAM 10 MG ORAL TABLET,,3620,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
CITALOPRAM 10 MG ORAL TABLET,,3620,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
CITALOPRAM 10 MG ORAL TABLET,,3620,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
CITALOPRAM 10 MG ORAL TABLET,,3620,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
CITALOPRAM 10 MG ORAL TABLET,,3620,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
CITALOPRAM 10 MG ORAL TABLET,,3620,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
CITALOPRAM 10 MG ORAL TABLET,,3620,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
CITALOPRAM 10 MG ORAL TABLET,,3620,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
CITALOPRAM 10 MG ORAL TABLET,,3620,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
CITALOPRAM 10 MG ORAL TABLET,,3620,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
CITALOPRAM 10 MG ORAL TABLET,,3620,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CITALOPRAM 10 MG ORAL TABLET,,3620,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
CITALOPRAM 10 MG ORAL TABLET,,3620,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
CITALOPRAM 10 MG ORAL TABLET,,3620,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
CITALOPRAM 10 MG ORAL TABLET,,3620,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
CITALOPRAM 10 MG ORAL TABLET,,3620,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
CITALOPRAM 10 MG ORAL TABLET,,3620,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CITALOPRAM 10 MG ORAL TABLET,,3620,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
CITALOPRAM 10 MG ORAL TABLET,,3620,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CITALOPRAM 10 MG ORAL TABLET,,3620,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CITALOPRAM 10 MG ORAL TABLET,,3620,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CITALOPRAM 10 MG ORAL TABLET,,3620,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CITALOPRAM 10 MG ORAL TABLET,,3620,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
CITALOPRAM 10 MG ORAL TABLET,,3620,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
CITALOPRAM 10 MG ORAL TABLET,,3620,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
CITALOPRAM 10 MG ORAL TABLET,,3620,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
CITALOPRAM 10 MG ORAL TABLET,,3620,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
CEPHALEXIN 250 MG ORAL CAP,,3856,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
CEPHALEXIN 250 MG ORAL CAP,,3856,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
CEPHALEXIN 250 MG ORAL CAP,,3856,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
CEPHALEXIN 250 MG ORAL CAP,,3856,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
CEPHALEXIN 250 MG ORAL CAP,,3856,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
CEPHALEXIN 250 MG ORAL CAP,,3856,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
CEPHALEXIN 250 MG ORAL CAP,,3856,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
CEPHALEXIN 250 MG ORAL CAP,,3856,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
CEPHALEXIN 250 MG ORAL CAP,,3856,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
CEPHALEXIN 250 MG ORAL CAP,,3856,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
CEPHALEXIN 250 MG ORAL CAP,,3856,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
CEPHALEXIN 250 MG ORAL CAP,,3856,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
CEPHALEXIN 250 MG ORAL CAP,,3856,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
CEPHALEXIN 250 MG ORAL CAP,,3856,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
CEPHALEXIN 250 MG ORAL CAP,,3856,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
CEPHALEXIN 250 MG ORAL CAP,,3856,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
CEPHALEXIN 250 MG ORAL CAP,,3856,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
CEPHALEXIN 250 MG ORAL CAP,,3856,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
CEPHALEXIN 250 MG ORAL CAP,,3856,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CEPHALEXIN 250 MG ORAL CAP,,3856,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
CEPHALEXIN 250 MG ORAL CAP,,3856,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
CEPHALEXIN 250 MG ORAL CAP,,3856,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
CEPHALEXIN 250 MG ORAL CAP,,3856,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
CEPHALEXIN 250 MG ORAL CAP,,3856,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
CEPHALEXIN 250 MG ORAL CAP,,3856,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
CEPHALEXIN 250 MG ORAL CAP,,3856,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
CEPHALEXIN 250 MG ORAL CAP,,3856,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
CEPHALEXIN 250 MG ORAL CAP,,3856,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
CEPHALEXIN 250 MG ORAL CAP,,3856,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
CEPHALEXIN 250 MG ORAL CAP,,3856,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
CEPHALEXIN 250 MG ORAL CAP,,3856,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
CEPHALEXIN 250 MG ORAL CAP,,3856,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
CEPHALEXIN 250 MG ORAL CAP,,3856,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
CEPHALEXIN 250 MG ORAL CAP,,3856,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
CEPHALEXIN 250 MG ORAL CAP,,3856,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
CEPHALEXIN 250 MG ORAL CAP,,3856,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
CEPHALEXIN 250 MG ORAL CAP,,3856,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
CEPHALEXIN 250 MG ORAL CAP,,3856,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CEPHALEXIN 250 MG ORAL CAP,,3856,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
CEPHALEXIN 250 MG ORAL CAP,,3856,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
CEPHALEXIN 250 MG ORAL CAP,,3856,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
CEPHALEXIN 250 MG ORAL CAP,,3856,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
CEPHALEXIN 250 MG ORAL CAP,,3856,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
CEPHALEXIN 250 MG ORAL CAP,,3856,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CEPHALEXIN 250 MG ORAL CAP,,3856,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
CEPHALEXIN 250 MG ORAL CAP,,3856,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CEPHALEXIN 250 MG ORAL CAP,,3856,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CEPHALEXIN 250 MG ORAL CAP,,3856,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CEPHALEXIN 250 MG ORAL CAP,,3856,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CEPHALEXIN 250 MG ORAL CAP,,3856,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
CEPHALEXIN 250 MG ORAL CAP,,3856,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
CEPHALEXIN 250 MG ORAL CAP,,3856,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
CEPHALEXIN 250 MG ORAL CAP,,3856,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
CEPHALEXIN 250 MG ORAL CAP,,3856,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
HYDROCODONE-ACETAMINOPHEN 5-325 MG ORAL TABLET,,3879,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
HYDROCODONE-ACETAMINOPHEN 5-325 MG ORAL TABLET,,3879,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
HYDROCODONE-ACETAMINOPHEN 5-325 MG ORAL TABLET,,3879,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
HYDROCODONE-ACETAMINOPHEN 5-325 MG ORAL TABLET,,3879,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
HYDROCODONE-ACETAMINOPHEN 5-325 MG ORAL TABLET,,3879,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
HYDROCODONE-ACETAMINOPHEN 5-325 MG ORAL TABLET,,3879,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
HYDROCODONE-ACETAMINOPHEN 5-325 MG ORAL TABLET,,3879,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
HYDROCODONE-ACETAMINOPHEN 5-325 MG ORAL TABLET,,3879,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
HYDROCODONE-ACETAMINOPHEN 5-325 MG ORAL TABLET,,3879,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
HYDROCODONE-ACETAMINOPHEN 5-325 MG ORAL TABLET,,3879,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
HYDROCODONE-ACETAMINOPHEN 5-325 MG ORAL TABLET,,3879,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
HYDROCODONE-ACETAMINOPHEN 5-325 MG ORAL TABLET,,3879,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
HYDROCODONE-ACETAMINOPHEN 5-325 MG ORAL TABLET,,3879,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
HYDROCODONE-ACETAMINOPHEN 5-325 MG ORAL TABLET,,3879,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
HYDROCODONE-ACETAMINOPHEN 5-325 MG ORAL TABLET,,3879,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
HYDROCODONE-ACETAMINOPHEN 5-325 MG ORAL TABLET,,3879,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
HYDROCODONE-ACETAMINOPHEN 5-325 MG ORAL TABLET,,3879,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
HYDROCODONE-ACETAMINOPHEN 5-325 MG ORAL TABLET,,3879,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
HYDROCODONE-ACETAMINOPHEN 5-325 MG ORAL TABLET,,3879,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
HYDROCODONE-ACETAMINOPHEN 5-325 MG ORAL TABLET,,3879,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
HYDROCODONE-ACETAMINOPHEN 5-325 MG ORAL TABLET,,3879,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
HYDROCODONE-ACETAMINOPHEN 5-325 MG ORAL TABLET,,3879,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
HYDROCODONE-ACETAMINOPHEN 5-325 MG ORAL TABLET,,3879,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
HYDROCODONE-ACETAMINOPHEN 5-325 MG ORAL TABLET,,3879,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
HYDROCODONE-ACETAMINOPHEN 5-325 MG ORAL TABLET,,3879,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
HYDROCODONE-ACETAMINOPHEN 5-325 MG ORAL TABLET,,3879,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
HYDROCODONE-ACETAMINOPHEN 5-325 MG ORAL TABLET,,3879,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
HYDROCODONE-ACETAMINOPHEN 5-325 MG ORAL TABLET,,3879,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
HYDROCODONE-ACETAMINOPHEN 5-325 MG ORAL TABLET,,3879,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
HYDROCODONE-ACETAMINOPHEN 5-325 MG ORAL TABLET,,3879,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
HYDROCODONE-ACETAMINOPHEN 5-325 MG ORAL TABLET,,3879,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
HYDROCODONE-ACETAMINOPHEN 5-325 MG ORAL TABLET,,3879,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
HYDROCODONE-ACETAMINOPHEN 5-325 MG ORAL TABLET,,3879,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
HYDROCODONE-ACETAMINOPHEN 5-325 MG ORAL TABLET,,3879,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
HYDROCODONE-ACETAMINOPHEN 5-325 MG ORAL TABLET,,3879,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
HYDROCODONE-ACETAMINOPHEN 5-325 MG ORAL TABLET,,3879,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
HYDROCODONE-ACETAMINOPHEN 5-325 MG ORAL TABLET,,3879,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
HYDROCODONE-ACETAMINOPHEN 5-325 MG ORAL TABLET,,3879,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
HYDROCODONE-ACETAMINOPHEN 5-325 MG ORAL TABLET,,3879,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
HYDROCODONE-ACETAMINOPHEN 5-325 MG ORAL TABLET,,3879,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
HYDROCODONE-ACETAMINOPHEN 5-325 MG ORAL TABLET,,3879,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
HYDROCODONE-ACETAMINOPHEN 5-325 MG ORAL TABLET,,3879,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
HYDROCODONE-ACETAMINOPHEN 5-325 MG ORAL TABLET,,3879,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
HYDROCODONE-ACETAMINOPHEN 5-325 MG ORAL TABLET,,3879,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
HYDROCODONE-ACETAMINOPHEN 5-325 MG ORAL TABLET,,3879,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
HYDROCODONE-ACETAMINOPHEN 5-325 MG ORAL TABLET,,3879,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
HYDROCODONE-ACETAMINOPHEN 5-325 MG ORAL TABLET,,3879,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
HYDROCODONE-ACETAMINOPHEN 5-325 MG ORAL TABLET,,3879,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
HYDROCODONE-ACETAMINOPHEN 5-325 MG ORAL TABLET,,3879,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
HYDROCODONE-ACETAMINOPHEN 5-325 MG ORAL TABLET,,3879,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
HYDROCODONE-ACETAMINOPHEN 5-325 MG ORAL TABLET,,3879,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
HYDROCODONE-ACETAMINOPHEN 5-325 MG ORAL TABLET,,3879,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
HYDROCODONE-ACETAMINOPHEN 5-325 MG ORAL TABLET,,3879,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
HYDROCODONE-ACETAMINOPHEN 5-325 MG ORAL TABLET,,3879,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
SOTALOL 80 MG ORAL TABLET,,3909,LOCAL,Facility,Both,1,EA,,13,11.05,3.7258,13,Aetna,Commercial,11.96,92,,percent of total billed charges,,
SOTALOL 80 MG ORAL TABLET,,3909,LOCAL,Facility,Outpatient,1,EA,,13,11.05,3.7258,13,Aetna,Medicare Advantage,6.37,49,,percent of total billed charges,,
SOTALOL 80 MG ORAL TABLET,,3909,LOCAL,Facility,Inpatient,1,EA,,13,11.05,3.7258,13,Aetna,Medicare Advantage,,,,,Included in per diem rate,
SOTALOL 80 MG ORAL TABLET,,3909,LOCAL,Facility,Both,1,EA,,13,11.05,3.7258,13,Aetna,PPO,12.09,93,,percent of total billed charges,,
SOTALOL 80 MG ORAL TABLET,,3909,LOCAL,Facility,Both,1,EA,,13,11.05,3.7258,13,America's PPO,America's PPO,12.4839,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SOTALOL 80 MG ORAL TABLET,,3909,LOCAL,Facility,Both,1,EA,,13,11.05,3.7258,13,BlueCross BlueShield Minnesota, Federal Employee Program,12.792,98.4,,percent of total billed charges,,
SOTALOL 80 MG ORAL TABLET,,3909,LOCAL,Facility,Both,1,EA,,13,11.05,3.7258,13,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,13,100,,percent of total billed charges,,
SOTALOL 80 MG ORAL TABLET,,3909,LOCAL,Facility,Both,1,EA,,13,11.05,3.7258,13,BlueCross BlueShield Minnesota,High Value Network Plan,11.7,90,,percent of total billed charges,,
SOTALOL 80 MG ORAL TABLET,,3909,LOCAL,Facility,Outpatient,1,EA,,13,11.05,3.7258,13,BlueCross BlueShield Minnesota,Medicare Advantage,6.37,49,,percent of total billed charges,,
SOTALOL 80 MG ORAL TABLET,,3909,LOCAL,Facility,Inpatient,1,EA,,13,11.05,3.7258,13,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
SOTALOL 80 MG ORAL TABLET,,3909,LOCAL,Facility,Both,1,EA,,13,11.05,3.7258,13,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,11.5141,88.57,,percent of total billed charges,,
SOTALOL 80 MG ORAL TABLET,,3909,LOCAL,Facility,Both,1,EA,,13,11.05,3.7258,13,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,3.7258,28.66,,percent of total billed charges,,
SOTALOL 80 MG ORAL TABLET,,3909,LOCAL,Facility,Outpatient,1,EA,,13,11.05,3.7258,13,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),6.37,49,,percent of total billed charges,,
SOTALOL 80 MG ORAL TABLET,,3909,LOCAL,Facility,Inpatient,1,EA,,13,11.05,3.7258,13,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
SOTALOL 80 MG ORAL TABLET,,3909,LOCAL,Facility,Both,1,EA,,13,11.05,3.7258,13,CorVel,Worker's Compensation,13,100,,percent of total billed charges,,
SOTALOL 80 MG ORAL TABLET,,3909,LOCAL,Facility,Both,1,EA,,13,11.05,3.7258,13,First Health Group Corporation,First Health Network,12.61,97,,percent of total billed charges,,
SOTALOL 80 MG ORAL TABLET,,3909,LOCAL,Facility,Both,1,EA,,13,11.05,3.7258,13,"Health Partners, Inc.",Commercial,12.298,94.6,,percent of total billed charges,,
SOTALOL 80 MG ORAL TABLET,,3909,LOCAL,Facility,Outpatient,1,EA,,13,11.05,3.7258,13,"Health Partners, Inc.",Medicare Advantage,6.37,49,,percent of total billed charges,,
SOTALOL 80 MG ORAL TABLET,,3909,LOCAL,Facility,Inpatient,1,EA,,13,11.05,3.7258,13,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SOTALOL 80 MG ORAL TABLET,,3909,LOCAL,Facility,Both,1,EA,,13,11.05,3.7258,13,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),7.8,60,,percent of total billed charges,,
SOTALOL 80 MG ORAL TABLET,,3909,LOCAL,Facility,Both,1,EA,,13,11.05,3.7258,13,"Health Partners, Inc.",State of Minnesota Advantage Program,10.595,81.5,,percent of total billed charges,,
SOTALOL 80 MG ORAL TABLET,,3909,LOCAL,Facility,Both,1,EA,,13,11.05,3.7258,13,"Health Partners, Inc.",State Public Programs,6.5,50,,percent of total billed charges,,
SOTALOL 80 MG ORAL TABLET,,3909,LOCAL,Facility,Both,1,EA,,13,11.05,3.7258,13,Humana Insurance Company,Commercial PPO,12.35,95,,percent of total billed charges,,
SOTALOL 80 MG ORAL TABLET,,3909,LOCAL,Facility,Outpatient,1,EA,,13,11.05,3.7258,13,Humana Insurance Company,Medicare PPO,6.37,49,,percent of total billed charges,,
SOTALOL 80 MG ORAL TABLET,,3909,LOCAL,Facility,Inpatient,1,EA,,13,11.05,3.7258,13,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
SOTALOL 80 MG ORAL TABLET,,3909,LOCAL,Facility,Both,1,EA,,13,11.05,3.7258,13,Medica,Individual & Family,12.883,99.1,,percent of total billed charges,,
SOTALOL 80 MG ORAL TABLET,,3909,LOCAL,Facility,Outpatient,1,EA,,13,11.05,3.7258,13,Medica,Medica Advantage Solution,6.474,49.8,,percent of total billed charges,,
SOTALOL 80 MG ORAL TABLET,,3909,LOCAL,Facility,Inpatient,1,EA,,13,11.05,3.7258,13,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
SOTALOL 80 MG ORAL TABLET,,3909,LOCAL,Facility,Outpatient,1,EA,,13,11.05,3.7258,13,Medica,Medical Assistance,5.798,44.6,,percent of total billed charges,,
SOTALOL 80 MG ORAL TABLET,,3909,LOCAL,Facility,Inpatient,1,EA,,13,11.05,3.7258,13,Medica,Medical Assistance,,,,,Included in per diem rate,
SOTALOL 80 MG ORAL TABLET,,3909,LOCAL,Facility,Outpatient,1,EA,,13,11.05,3.7258,13,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,6.474,49.8,,percent of total billed charges,,
SOTALOL 80 MG ORAL TABLET,,3909,LOCAL,Facility,Inpatient,1,EA,,13,11.05,3.7258,13,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
SOTALOL 80 MG ORAL TABLET,,3909,LOCAL,Facility,Both,1,EA,,13,11.05,3.7258,13,"Multiplan, Inc.","Multiplan, Inc.",12.22,94,,percent of total billed charges,,
SOTALOL 80 MG ORAL TABLET,,3909,LOCAL,Facility,Outpatient,1,EA,,13,11.05,3.7258,13,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,11.713,90.1,,percent of total billed charges,,
SOTALOL 80 MG ORAL TABLET,,3909,LOCAL,Facility,Inpatient,1,EA,,13,11.05,3.7258,13,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
SOTALOL 80 MG ORAL TABLET,,3909,LOCAL,Facility,Both,1,EA,,13,11.05,3.7258,13,"Preferred One Administrative Services, INC.",PPO,12.818,98.6,,percent of total billed charges,,
SOTALOL 80 MG ORAL TABLET,,3909,LOCAL,Facility,Outpatient,1,EA,,13,11.05,3.7258,13,PrimeWest Health,Minnesota Senior Health Options (MSHO),6.6885,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
SOTALOL 80 MG ORAL TABLET,,3909,LOCAL,Facility,Inpatient,1,EA,,13,11.05,3.7258,13,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SOTALOL 80 MG ORAL TABLET,,3909,LOCAL,Facility,Outpatient,1,EA,,13,11.05,3.7258,13,PrimeWest Health,MinnesotaCare,6.6768,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
SOTALOL 80 MG ORAL TABLET,,3909,LOCAL,Facility,Inpatient,1,EA,,13,11.05,3.7258,13,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
SOTALOL 80 MG ORAL TABLET,,3909,LOCAL,Facility,Both,1,EA,,13,11.05,3.7258,13,Sanford Health Plan,Sanford Health Plan,11.96,92,,percent of total billed charges,,
SOTALOL 80 MG ORAL TABLET,,3909,LOCAL,Facility,Outpatient,1,EA,,13,11.05,3.7258,13,"UCare Health, Inc.",Individual & Family Plan,7.3255,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
SOTALOL 80 MG ORAL TABLET,,3909,LOCAL,Facility,Inpatient,1,EA,,13,11.05,3.7258,13,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
SOTALOL 80 MG ORAL TABLET,,3909,LOCAL,Facility,Outpatient,1,EA,,13,11.05,3.7258,13,"UCare Health, Inc.",Medical Assistance,6.5611,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SOTALOL 80 MG ORAL TABLET,,3909,LOCAL,Facility,Inpatient,1,EA,,13,11.05,3.7258,13,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
SOTALOL 80 MG ORAL TABLET,,3909,LOCAL,Facility,Outpatient,1,EA,,13,11.05,3.7258,13,"UCare Health, Inc.",Medicare Advantage,6.5611,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SOTALOL 80 MG ORAL TABLET,,3909,LOCAL,Facility,Inpatient,1,EA,,13,11.05,3.7258,13,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SOTALOL 80 MG ORAL TABLET,,3909,LOCAL,Facility,Outpatient,1,EA,,13,11.05,3.7258,13,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),6.5611,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SOTALOL 80 MG ORAL TABLET,,3909,LOCAL,Facility,Inpatient,1,EA,,13,11.05,3.7258,13,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SOTALOL 80 MG ORAL TABLET,,3909,LOCAL,Facility,Both,1,EA,,13,11.05,3.7258,13,UnitedHealthcare,Individual & Family,12.22,94,,percent of total billed charges,,
SOTALOL 80 MG ORAL TABLET,,3909,LOCAL,Facility,Outpatient,1,EA,,13,11.05,3.7258,13,UnitedHealthcare,Medicare Advantage,6.37,49,,percent of total billed charges,,
SOTALOL 80 MG ORAL TABLET,,3909,LOCAL,Facility,Inpatient,1,EA,,13,11.05,3.7258,13,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
SOTALOL 80 MG ORAL TABLET,,3909,LOCAL,Facility,Outpatient,1,EA,,13,11.05,3.7258,13,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,6.24,48,,percent of total billed charges,,100% of DHS outpatient percentage
SOTALOL 80 MG ORAL TABLET,,3909,LOCAL,Facility,Inpatient,1,EA,,13,11.05,3.7258,13,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
NITROGLYCERIN 0.2 MG/HR TD PT24,,3924,LOCAL,Facility,Both,1,EA,,10,8.5,2.866,10,Aetna,Commercial,9.2,92,,percent of total billed charges,,
NITROGLYCERIN 0.2 MG/HR TD PT24,,3924,LOCAL,Facility,Outpatient,1,EA,,10,8.5,2.866,10,Aetna,Medicare Advantage,4.9,49,,percent of total billed charges,,
NITROGLYCERIN 0.2 MG/HR TD PT24,,3924,LOCAL,Facility,Inpatient,1,EA,,10,8.5,2.866,10,Aetna,Medicare Advantage,,,,,Included in per diem rate,
NITROGLYCERIN 0.2 MG/HR TD PT24,,3924,LOCAL,Facility,Both,1,EA,,10,8.5,2.866,10,Aetna,PPO,9.3,93,,percent of total billed charges,,
NITROGLYCERIN 0.2 MG/HR TD PT24,,3924,LOCAL,Facility,Both,1,EA,,10,8.5,2.866,10,America's PPO,America's PPO,9.603,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
NITROGLYCERIN 0.2 MG/HR TD PT24,,3924,LOCAL,Facility,Both,1,EA,,10,8.5,2.866,10,BlueCross BlueShield Minnesota, Federal Employee Program,9.84,98.4,,percent of total billed charges,,
NITROGLYCERIN 0.2 MG/HR TD PT24,,3924,LOCAL,Facility,Both,1,EA,,10,8.5,2.866,10,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,10,100,,percent of total billed charges,,
NITROGLYCERIN 0.2 MG/HR TD PT24,,3924,LOCAL,Facility,Both,1,EA,,10,8.5,2.866,10,BlueCross BlueShield Minnesota,High Value Network Plan,9,90,,percent of total billed charges,,
NITROGLYCERIN 0.2 MG/HR TD PT24,,3924,LOCAL,Facility,Outpatient,1,EA,,10,8.5,2.866,10,BlueCross BlueShield Minnesota,Medicare Advantage,4.9,49,,percent of total billed charges,,
NITROGLYCERIN 0.2 MG/HR TD PT24,,3924,LOCAL,Facility,Inpatient,1,EA,,10,8.5,2.866,10,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
NITROGLYCERIN 0.2 MG/HR TD PT24,,3924,LOCAL,Facility,Both,1,EA,,10,8.5,2.866,10,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,8.857,88.57,,percent of total billed charges,,
NITROGLYCERIN 0.2 MG/HR TD PT24,,3924,LOCAL,Facility,Both,1,EA,,10,8.5,2.866,10,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,2.866,28.66,,percent of total billed charges,,
NITROGLYCERIN 0.2 MG/HR TD PT24,,3924,LOCAL,Facility,Outpatient,1,EA,,10,8.5,2.866,10,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),4.9,49,,percent of total billed charges,,
NITROGLYCERIN 0.2 MG/HR TD PT24,,3924,LOCAL,Facility,Inpatient,1,EA,,10,8.5,2.866,10,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
NITROGLYCERIN 0.2 MG/HR TD PT24,,3924,LOCAL,Facility,Both,1,EA,,10,8.5,2.866,10,CorVel,Worker's Compensation,10,100,,percent of total billed charges,,
NITROGLYCERIN 0.2 MG/HR TD PT24,,3924,LOCAL,Facility,Both,1,EA,,10,8.5,2.866,10,First Health Group Corporation,First Health Network,9.7,97,,percent of total billed charges,,
NITROGLYCERIN 0.2 MG/HR TD PT24,,3924,LOCAL,Facility,Both,1,EA,,10,8.5,2.866,10,"Health Partners, Inc.",Commercial,9.46,94.6,,percent of total billed charges,,
NITROGLYCERIN 0.2 MG/HR TD PT24,,3924,LOCAL,Facility,Outpatient,1,EA,,10,8.5,2.866,10,"Health Partners, Inc.",Medicare Advantage,4.9,49,,percent of total billed charges,,
NITROGLYCERIN 0.2 MG/HR TD PT24,,3924,LOCAL,Facility,Inpatient,1,EA,,10,8.5,2.866,10,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
NITROGLYCERIN 0.2 MG/HR TD PT24,,3924,LOCAL,Facility,Both,1,EA,,10,8.5,2.866,10,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),6,60,,percent of total billed charges,,
NITROGLYCERIN 0.2 MG/HR TD PT24,,3924,LOCAL,Facility,Both,1,EA,,10,8.5,2.866,10,"Health Partners, Inc.",State of Minnesota Advantage Program,8.15,81.5,,percent of total billed charges,,
NITROGLYCERIN 0.2 MG/HR TD PT24,,3924,LOCAL,Facility,Both,1,EA,,10,8.5,2.866,10,"Health Partners, Inc.",State Public Programs,5,50,,percent of total billed charges,,
NITROGLYCERIN 0.2 MG/HR TD PT24,,3924,LOCAL,Facility,Both,1,EA,,10,8.5,2.866,10,Humana Insurance Company,Commercial PPO,9.5,95,,percent of total billed charges,,
NITROGLYCERIN 0.2 MG/HR TD PT24,,3924,LOCAL,Facility,Outpatient,1,EA,,10,8.5,2.866,10,Humana Insurance Company,Medicare PPO,4.9,49,,percent of total billed charges,,
NITROGLYCERIN 0.2 MG/HR TD PT24,,3924,LOCAL,Facility,Inpatient,1,EA,,10,8.5,2.866,10,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
NITROGLYCERIN 0.2 MG/HR TD PT24,,3924,LOCAL,Facility,Both,1,EA,,10,8.5,2.866,10,Medica,Individual & Family,9.91,99.1,,percent of total billed charges,,
NITROGLYCERIN 0.2 MG/HR TD PT24,,3924,LOCAL,Facility,Outpatient,1,EA,,10,8.5,2.866,10,Medica,Medica Advantage Solution,4.98,49.8,,percent of total billed charges,,
NITROGLYCERIN 0.2 MG/HR TD PT24,,3924,LOCAL,Facility,Inpatient,1,EA,,10,8.5,2.866,10,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
NITROGLYCERIN 0.2 MG/HR TD PT24,,3924,LOCAL,Facility,Outpatient,1,EA,,10,8.5,2.866,10,Medica,Medical Assistance,4.46,44.6,,percent of total billed charges,,
NITROGLYCERIN 0.2 MG/HR TD PT24,,3924,LOCAL,Facility,Inpatient,1,EA,,10,8.5,2.866,10,Medica,Medical Assistance,,,,,Included in per diem rate,
NITROGLYCERIN 0.2 MG/HR TD PT24,,3924,LOCAL,Facility,Outpatient,1,EA,,10,8.5,2.866,10,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,4.98,49.8,,percent of total billed charges,,
NITROGLYCERIN 0.2 MG/HR TD PT24,,3924,LOCAL,Facility,Inpatient,1,EA,,10,8.5,2.866,10,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
NITROGLYCERIN 0.2 MG/HR TD PT24,,3924,LOCAL,Facility,Both,1,EA,,10,8.5,2.866,10,"Multiplan, Inc.","Multiplan, Inc.",9.4,94,,percent of total billed charges,,
NITROGLYCERIN 0.2 MG/HR TD PT24,,3924,LOCAL,Facility,Outpatient,1,EA,,10,8.5,2.866,10,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,9.01,90.1,,percent of total billed charges,,
NITROGLYCERIN 0.2 MG/HR TD PT24,,3924,LOCAL,Facility,Inpatient,1,EA,,10,8.5,2.866,10,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
NITROGLYCERIN 0.2 MG/HR TD PT24,,3924,LOCAL,Facility,Both,1,EA,,10,8.5,2.866,10,"Preferred One Administrative Services, INC.",PPO,9.86,98.6,,percent of total billed charges,,
NITROGLYCERIN 0.2 MG/HR TD PT24,,3924,LOCAL,Facility,Outpatient,1,EA,,10,8.5,2.866,10,PrimeWest Health,Minnesota Senior Health Options (MSHO),5.145,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
NITROGLYCERIN 0.2 MG/HR TD PT24,,3924,LOCAL,Facility,Inpatient,1,EA,,10,8.5,2.866,10,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
NITROGLYCERIN 0.2 MG/HR TD PT24,,3924,LOCAL,Facility,Outpatient,1,EA,,10,8.5,2.866,10,PrimeWest Health,MinnesotaCare,5.136,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
NITROGLYCERIN 0.2 MG/HR TD PT24,,3924,LOCAL,Facility,Inpatient,1,EA,,10,8.5,2.866,10,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
NITROGLYCERIN 0.2 MG/HR TD PT24,,3924,LOCAL,Facility,Both,1,EA,,10,8.5,2.866,10,Sanford Health Plan,Sanford Health Plan,9.2,92,,percent of total billed charges,,
NITROGLYCERIN 0.2 MG/HR TD PT24,,3924,LOCAL,Facility,Outpatient,1,EA,,10,8.5,2.866,10,"UCare Health, Inc.",Individual & Family Plan,5.635,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
NITROGLYCERIN 0.2 MG/HR TD PT24,,3924,LOCAL,Facility,Inpatient,1,EA,,10,8.5,2.866,10,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
NITROGLYCERIN 0.2 MG/HR TD PT24,,3924,LOCAL,Facility,Outpatient,1,EA,,10,8.5,2.866,10,"UCare Health, Inc.",Medical Assistance,5.047,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
NITROGLYCERIN 0.2 MG/HR TD PT24,,3924,LOCAL,Facility,Inpatient,1,EA,,10,8.5,2.866,10,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
NITROGLYCERIN 0.2 MG/HR TD PT24,,3924,LOCAL,Facility,Outpatient,1,EA,,10,8.5,2.866,10,"UCare Health, Inc.",Medicare Advantage,5.047,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
NITROGLYCERIN 0.2 MG/HR TD PT24,,3924,LOCAL,Facility,Inpatient,1,EA,,10,8.5,2.866,10,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
NITROGLYCERIN 0.2 MG/HR TD PT24,,3924,LOCAL,Facility,Outpatient,1,EA,,10,8.5,2.866,10,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),5.047,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
NITROGLYCERIN 0.2 MG/HR TD PT24,,3924,LOCAL,Facility,Inpatient,1,EA,,10,8.5,2.866,10,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
NITROGLYCERIN 0.2 MG/HR TD PT24,,3924,LOCAL,Facility,Both,1,EA,,10,8.5,2.866,10,UnitedHealthcare,Individual & Family,9.4,94,,percent of total billed charges,,
NITROGLYCERIN 0.2 MG/HR TD PT24,,3924,LOCAL,Facility,Outpatient,1,EA,,10,8.5,2.866,10,UnitedHealthcare,Medicare Advantage,4.9,49,,percent of total billed charges,,
NITROGLYCERIN 0.2 MG/HR TD PT24,,3924,LOCAL,Facility,Inpatient,1,EA,,10,8.5,2.866,10,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
NITROGLYCERIN 0.2 MG/HR TD PT24,,3924,LOCAL,Facility,Outpatient,1,EA,,10,8.5,2.866,10,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,4.8,48,,percent of total billed charges,,100% of DHS outpatient percentage
NITROGLYCERIN 0.2 MG/HR TD PT24,,3924,LOCAL,Facility,Inpatient,1,EA,,10,8.5,2.866,10,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"BACITRACIN 50,000 UNIT IM SOLR",,4119,LOCAL,Facility,Both,1,EA,,45,38.25,12.897,45,Aetna,Commercial,41.4,92,,percent of total billed charges,,
"BACITRACIN 50,000 UNIT IM SOLR",,4119,LOCAL,Facility,Outpatient,1,EA,,45,38.25,12.897,45,Aetna,Medicare Advantage,22.05,49,,percent of total billed charges,,
"BACITRACIN 50,000 UNIT IM SOLR",,4119,LOCAL,Facility,Inpatient,1,EA,,45,38.25,12.897,45,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"BACITRACIN 50,000 UNIT IM SOLR",,4119,LOCAL,Facility,Both,1,EA,,45,38.25,12.897,45,Aetna,PPO,41.85,93,,percent of total billed charges,,
"BACITRACIN 50,000 UNIT IM SOLR",,4119,LOCAL,Facility,Both,1,EA,,45,38.25,12.897,45,America's PPO,America's PPO,43.2135,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"BACITRACIN 50,000 UNIT IM SOLR",,4119,LOCAL,Facility,Both,1,EA,,45,38.25,12.897,45,BlueCross BlueShield Minnesota, Federal Employee Program,44.28,98.4,,percent of total billed charges,,
"BACITRACIN 50,000 UNIT IM SOLR",,4119,LOCAL,Facility,Both,1,EA,,45,38.25,12.897,45,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,45,100,,percent of total billed charges,,
"BACITRACIN 50,000 UNIT IM SOLR",,4119,LOCAL,Facility,Both,1,EA,,45,38.25,12.897,45,BlueCross BlueShield Minnesota,High Value Network Plan,40.5,90,,percent of total billed charges,,
"BACITRACIN 50,000 UNIT IM SOLR",,4119,LOCAL,Facility,Outpatient,1,EA,,45,38.25,12.897,45,BlueCross BlueShield Minnesota,Medicare Advantage,22.05,49,,percent of total billed charges,,
"BACITRACIN 50,000 UNIT IM SOLR",,4119,LOCAL,Facility,Inpatient,1,EA,,45,38.25,12.897,45,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"BACITRACIN 50,000 UNIT IM SOLR",,4119,LOCAL,Facility,Both,1,EA,,45,38.25,12.897,45,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,39.8565,88.57,,percent of total billed charges,,
"BACITRACIN 50,000 UNIT IM SOLR",,4119,LOCAL,Facility,Both,1,EA,,45,38.25,12.897,45,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,12.897,28.66,,percent of total billed charges,,
"BACITRACIN 50,000 UNIT IM SOLR",,4119,LOCAL,Facility,Outpatient,1,EA,,45,38.25,12.897,45,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),22.05,49,,percent of total billed charges,,
"BACITRACIN 50,000 UNIT IM SOLR",,4119,LOCAL,Facility,Inpatient,1,EA,,45,38.25,12.897,45,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"BACITRACIN 50,000 UNIT IM SOLR",,4119,LOCAL,Facility,Both,1,EA,,45,38.25,12.897,45,CorVel,Worker's Compensation,45,100,,percent of total billed charges,,
"BACITRACIN 50,000 UNIT IM SOLR",,4119,LOCAL,Facility,Both,1,EA,,45,38.25,12.897,45,First Health Group Corporation,First Health Network,43.65,97,,percent of total billed charges,,
"BACITRACIN 50,000 UNIT IM SOLR",,4119,LOCAL,Facility,Both,1,EA,,45,38.25,12.897,45,"Health Partners, Inc.",Commercial,42.57,94.6,,percent of total billed charges,,
"BACITRACIN 50,000 UNIT IM SOLR",,4119,LOCAL,Facility,Outpatient,1,EA,,45,38.25,12.897,45,"Health Partners, Inc.",Medicare Advantage,22.05,49,,percent of total billed charges,,
"BACITRACIN 50,000 UNIT IM SOLR",,4119,LOCAL,Facility,Inpatient,1,EA,,45,38.25,12.897,45,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"BACITRACIN 50,000 UNIT IM SOLR",,4119,LOCAL,Facility,Both,1,EA,,45,38.25,12.897,45,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),27,60,,percent of total billed charges,,
"BACITRACIN 50,000 UNIT IM SOLR",,4119,LOCAL,Facility,Both,1,EA,,45,38.25,12.897,45,"Health Partners, Inc.",State of Minnesota Advantage Program,36.675,81.5,,percent of total billed charges,,
"BACITRACIN 50,000 UNIT IM SOLR",,4119,LOCAL,Facility,Both,1,EA,,45,38.25,12.897,45,"Health Partners, Inc.",State Public Programs,22.5,50,,percent of total billed charges,,
"BACITRACIN 50,000 UNIT IM SOLR",,4119,LOCAL,Facility,Both,1,EA,,45,38.25,12.897,45,Humana Insurance Company,Commercial PPO,42.75,95,,percent of total billed charges,,
"BACITRACIN 50,000 UNIT IM SOLR",,4119,LOCAL,Facility,Outpatient,1,EA,,45,38.25,12.897,45,Humana Insurance Company,Medicare PPO,22.05,49,,percent of total billed charges,,
"BACITRACIN 50,000 UNIT IM SOLR",,4119,LOCAL,Facility,Inpatient,1,EA,,45,38.25,12.897,45,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"BACITRACIN 50,000 UNIT IM SOLR",,4119,LOCAL,Facility,Both,1,EA,,45,38.25,12.897,45,Medica,Individual & Family,44.595,99.1,,percent of total billed charges,,
"BACITRACIN 50,000 UNIT IM SOLR",,4119,LOCAL,Facility,Outpatient,1,EA,,45,38.25,12.897,45,Medica,Medica Advantage Solution,22.41,49.8,,percent of total billed charges,,
"BACITRACIN 50,000 UNIT IM SOLR",,4119,LOCAL,Facility,Inpatient,1,EA,,45,38.25,12.897,45,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"BACITRACIN 50,000 UNIT IM SOLR",,4119,LOCAL,Facility,Outpatient,1,EA,,45,38.25,12.897,45,Medica,Medical Assistance,20.07,44.6,,percent of total billed charges,,
"BACITRACIN 50,000 UNIT IM SOLR",,4119,LOCAL,Facility,Inpatient,1,EA,,45,38.25,12.897,45,Medica,Medical Assistance,,,,,Included in per diem rate,
"BACITRACIN 50,000 UNIT IM SOLR",,4119,LOCAL,Facility,Outpatient,1,EA,,45,38.25,12.897,45,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,22.41,49.8,,percent of total billed charges,,
"BACITRACIN 50,000 UNIT IM SOLR",,4119,LOCAL,Facility,Inpatient,1,EA,,45,38.25,12.897,45,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"BACITRACIN 50,000 UNIT IM SOLR",,4119,LOCAL,Facility,Both,1,EA,,45,38.25,12.897,45,"Multiplan, Inc.","Multiplan, Inc.",42.3,94,,percent of total billed charges,,
"BACITRACIN 50,000 UNIT IM SOLR",,4119,LOCAL,Facility,Outpatient,1,EA,,45,38.25,12.897,45,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,40.545,90.1,,percent of total billed charges,,
"BACITRACIN 50,000 UNIT IM SOLR",,4119,LOCAL,Facility,Inpatient,1,EA,,45,38.25,12.897,45,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"BACITRACIN 50,000 UNIT IM SOLR",,4119,LOCAL,Facility,Both,1,EA,,45,38.25,12.897,45,"Preferred One Administrative Services, INC.",PPO,44.37,98.6,,percent of total billed charges,,
"BACITRACIN 50,000 UNIT IM SOLR",,4119,LOCAL,Facility,Outpatient,1,EA,,45,38.25,12.897,45,PrimeWest Health,Minnesota Senior Health Options (MSHO),23.1525,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"BACITRACIN 50,000 UNIT IM SOLR",,4119,LOCAL,Facility,Inpatient,1,EA,,45,38.25,12.897,45,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"BACITRACIN 50,000 UNIT IM SOLR",,4119,LOCAL,Facility,Outpatient,1,EA,,45,38.25,12.897,45,PrimeWest Health,MinnesotaCare,23.112,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"BACITRACIN 50,000 UNIT IM SOLR",,4119,LOCAL,Facility,Inpatient,1,EA,,45,38.25,12.897,45,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"BACITRACIN 50,000 UNIT IM SOLR",,4119,LOCAL,Facility,Both,1,EA,,45,38.25,12.897,45,Sanford Health Plan,Sanford Health Plan,41.4,92,,percent of total billed charges,,
"BACITRACIN 50,000 UNIT IM SOLR",,4119,LOCAL,Facility,Outpatient,1,EA,,45,38.25,12.897,45,"UCare Health, Inc.",Individual & Family Plan,25.3575,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"BACITRACIN 50,000 UNIT IM SOLR",,4119,LOCAL,Facility,Inpatient,1,EA,,45,38.25,12.897,45,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"BACITRACIN 50,000 UNIT IM SOLR",,4119,LOCAL,Facility,Outpatient,1,EA,,45,38.25,12.897,45,"UCare Health, Inc.",Medical Assistance,22.7115,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"BACITRACIN 50,000 UNIT IM SOLR",,4119,LOCAL,Facility,Inpatient,1,EA,,45,38.25,12.897,45,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"BACITRACIN 50,000 UNIT IM SOLR",,4119,LOCAL,Facility,Outpatient,1,EA,,45,38.25,12.897,45,"UCare Health, Inc.",Medicare Advantage,22.7115,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"BACITRACIN 50,000 UNIT IM SOLR",,4119,LOCAL,Facility,Inpatient,1,EA,,45,38.25,12.897,45,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"BACITRACIN 50,000 UNIT IM SOLR",,4119,LOCAL,Facility,Outpatient,1,EA,,45,38.25,12.897,45,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),22.7115,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"BACITRACIN 50,000 UNIT IM SOLR",,4119,LOCAL,Facility,Inpatient,1,EA,,45,38.25,12.897,45,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"BACITRACIN 50,000 UNIT IM SOLR",,4119,LOCAL,Facility,Both,1,EA,,45,38.25,12.897,45,UnitedHealthcare,Individual & Family,42.3,94,,percent of total billed charges,,
"BACITRACIN 50,000 UNIT IM SOLR",,4119,LOCAL,Facility,Outpatient,1,EA,,45,38.25,12.897,45,UnitedHealthcare,Medicare Advantage,22.05,49,,percent of total billed charges,,
"BACITRACIN 50,000 UNIT IM SOLR",,4119,LOCAL,Facility,Inpatient,1,EA,,45,38.25,12.897,45,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"BACITRACIN 50,000 UNIT IM SOLR",,4119,LOCAL,Facility,Outpatient,1,EA,,45,38.25,12.897,45,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,21.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
"BACITRACIN 50,000 UNIT IM SOLR",,4119,LOCAL,Facility,Inpatient,1,EA,,45,38.25,12.897,45,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
PROMETHAZINE 25 MG RECT SUPP,,4226,LOCAL,Facility,Both,1,EA,,85,72.25,24.361,85,Aetna,Commercial,78.2,92,,percent of total billed charges,,
PROMETHAZINE 25 MG RECT SUPP,,4226,LOCAL,Facility,Outpatient,1,EA,,85,72.25,24.361,85,Aetna,Medicare Advantage,41.65,49,,percent of total billed charges,,
PROMETHAZINE 25 MG RECT SUPP,,4226,LOCAL,Facility,Inpatient,1,EA,,85,72.25,24.361,85,Aetna,Medicare Advantage,,,,,Included in per diem rate,
PROMETHAZINE 25 MG RECT SUPP,,4226,LOCAL,Facility,Both,1,EA,,85,72.25,24.361,85,Aetna,PPO,79.05,93,,percent of total billed charges,,
PROMETHAZINE 25 MG RECT SUPP,,4226,LOCAL,Facility,Both,1,EA,,85,72.25,24.361,85,America's PPO,America's PPO,81.6255,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
PROMETHAZINE 25 MG RECT SUPP,,4226,LOCAL,Facility,Both,1,EA,,85,72.25,24.361,85,BlueCross BlueShield Minnesota, Federal Employee Program,83.64,98.4,,percent of total billed charges,,
PROMETHAZINE 25 MG RECT SUPP,,4226,LOCAL,Facility,Both,1,EA,,85,72.25,24.361,85,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,85,100,,percent of total billed charges,,
PROMETHAZINE 25 MG RECT SUPP,,4226,LOCAL,Facility,Both,1,EA,,85,72.25,24.361,85,BlueCross BlueShield Minnesota,High Value Network Plan,76.5,90,,percent of total billed charges,,
PROMETHAZINE 25 MG RECT SUPP,,4226,LOCAL,Facility,Outpatient,1,EA,,85,72.25,24.361,85,BlueCross BlueShield Minnesota,Medicare Advantage,41.65,49,,percent of total billed charges,,
PROMETHAZINE 25 MG RECT SUPP,,4226,LOCAL,Facility,Inpatient,1,EA,,85,72.25,24.361,85,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
PROMETHAZINE 25 MG RECT SUPP,,4226,LOCAL,Facility,Both,1,EA,,85,72.25,24.361,85,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,75.2845,88.57,,percent of total billed charges,,
PROMETHAZINE 25 MG RECT SUPP,,4226,LOCAL,Facility,Both,1,EA,,85,72.25,24.361,85,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,24.361,28.66,,percent of total billed charges,,
PROMETHAZINE 25 MG RECT SUPP,,4226,LOCAL,Facility,Outpatient,1,EA,,85,72.25,24.361,85,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),41.65,49,,percent of total billed charges,,
PROMETHAZINE 25 MG RECT SUPP,,4226,LOCAL,Facility,Inpatient,1,EA,,85,72.25,24.361,85,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
PROMETHAZINE 25 MG RECT SUPP,,4226,LOCAL,Facility,Both,1,EA,,85,72.25,24.361,85,CorVel,Worker's Compensation,85,100,,percent of total billed charges,,
PROMETHAZINE 25 MG RECT SUPP,,4226,LOCAL,Facility,Both,1,EA,,85,72.25,24.361,85,First Health Group Corporation,First Health Network,82.45,97,,percent of total billed charges,,
PROMETHAZINE 25 MG RECT SUPP,,4226,LOCAL,Facility,Both,1,EA,,85,72.25,24.361,85,"Health Partners, Inc.",Commercial,80.41,94.6,,percent of total billed charges,,
PROMETHAZINE 25 MG RECT SUPP,,4226,LOCAL,Facility,Outpatient,1,EA,,85,72.25,24.361,85,"Health Partners, Inc.",Medicare Advantage,41.65,49,,percent of total billed charges,,
PROMETHAZINE 25 MG RECT SUPP,,4226,LOCAL,Facility,Inpatient,1,EA,,85,72.25,24.361,85,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PROMETHAZINE 25 MG RECT SUPP,,4226,LOCAL,Facility,Both,1,EA,,85,72.25,24.361,85,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),51,60,,percent of total billed charges,,
PROMETHAZINE 25 MG RECT SUPP,,4226,LOCAL,Facility,Both,1,EA,,85,72.25,24.361,85,"Health Partners, Inc.",State of Minnesota Advantage Program,69.275,81.5,,percent of total billed charges,,
PROMETHAZINE 25 MG RECT SUPP,,4226,LOCAL,Facility,Both,1,EA,,85,72.25,24.361,85,"Health Partners, Inc.",State Public Programs,42.5,50,,percent of total billed charges,,
PROMETHAZINE 25 MG RECT SUPP,,4226,LOCAL,Facility,Both,1,EA,,85,72.25,24.361,85,Humana Insurance Company,Commercial PPO,80.75,95,,percent of total billed charges,,
PROMETHAZINE 25 MG RECT SUPP,,4226,LOCAL,Facility,Outpatient,1,EA,,85,72.25,24.361,85,Humana Insurance Company,Medicare PPO,41.65,49,,percent of total billed charges,,
PROMETHAZINE 25 MG RECT SUPP,,4226,LOCAL,Facility,Inpatient,1,EA,,85,72.25,24.361,85,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
PROMETHAZINE 25 MG RECT SUPP,,4226,LOCAL,Facility,Both,1,EA,,85,72.25,24.361,85,Medica,Individual & Family,84.235,99.1,,percent of total billed charges,,
PROMETHAZINE 25 MG RECT SUPP,,4226,LOCAL,Facility,Outpatient,1,EA,,85,72.25,24.361,85,Medica,Medica Advantage Solution,42.33,49.8,,percent of total billed charges,,
PROMETHAZINE 25 MG RECT SUPP,,4226,LOCAL,Facility,Inpatient,1,EA,,85,72.25,24.361,85,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
PROMETHAZINE 25 MG RECT SUPP,,4226,LOCAL,Facility,Outpatient,1,EA,,85,72.25,24.361,85,Medica,Medical Assistance,37.91,44.6,,percent of total billed charges,,
PROMETHAZINE 25 MG RECT SUPP,,4226,LOCAL,Facility,Inpatient,1,EA,,85,72.25,24.361,85,Medica,Medical Assistance,,,,,Included in per diem rate,
PROMETHAZINE 25 MG RECT SUPP,,4226,LOCAL,Facility,Outpatient,1,EA,,85,72.25,24.361,85,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,42.33,49.8,,percent of total billed charges,,
PROMETHAZINE 25 MG RECT SUPP,,4226,LOCAL,Facility,Inpatient,1,EA,,85,72.25,24.361,85,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
PROMETHAZINE 25 MG RECT SUPP,,4226,LOCAL,Facility,Both,1,EA,,85,72.25,24.361,85,"Multiplan, Inc.","Multiplan, Inc.",79.9,94,,percent of total billed charges,,
PROMETHAZINE 25 MG RECT SUPP,,4226,LOCAL,Facility,Outpatient,1,EA,,85,72.25,24.361,85,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,76.585,90.1,,percent of total billed charges,,
PROMETHAZINE 25 MG RECT SUPP,,4226,LOCAL,Facility,Inpatient,1,EA,,85,72.25,24.361,85,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
PROMETHAZINE 25 MG RECT SUPP,,4226,LOCAL,Facility,Both,1,EA,,85,72.25,24.361,85,"Preferred One Administrative Services, INC.",PPO,83.81,98.6,,percent of total billed charges,,
PROMETHAZINE 25 MG RECT SUPP,,4226,LOCAL,Facility,Outpatient,1,EA,,85,72.25,24.361,85,PrimeWest Health,Minnesota Senior Health Options (MSHO),43.7325,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
PROMETHAZINE 25 MG RECT SUPP,,4226,LOCAL,Facility,Inpatient,1,EA,,85,72.25,24.361,85,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PROMETHAZINE 25 MG RECT SUPP,,4226,LOCAL,Facility,Outpatient,1,EA,,85,72.25,24.361,85,PrimeWest Health,MinnesotaCare,43.656,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
PROMETHAZINE 25 MG RECT SUPP,,4226,LOCAL,Facility,Inpatient,1,EA,,85,72.25,24.361,85,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
PROMETHAZINE 25 MG RECT SUPP,,4226,LOCAL,Facility,Both,1,EA,,85,72.25,24.361,85,Sanford Health Plan,Sanford Health Plan,78.2,92,,percent of total billed charges,,
PROMETHAZINE 25 MG RECT SUPP,,4226,LOCAL,Facility,Outpatient,1,EA,,85,72.25,24.361,85,"UCare Health, Inc.",Individual & Family Plan,47.8975,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
PROMETHAZINE 25 MG RECT SUPP,,4226,LOCAL,Facility,Inpatient,1,EA,,85,72.25,24.361,85,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
PROMETHAZINE 25 MG RECT SUPP,,4226,LOCAL,Facility,Outpatient,1,EA,,85,72.25,24.361,85,"UCare Health, Inc.",Medical Assistance,42.8995,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PROMETHAZINE 25 MG RECT SUPP,,4226,LOCAL,Facility,Inpatient,1,EA,,85,72.25,24.361,85,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
PROMETHAZINE 25 MG RECT SUPP,,4226,LOCAL,Facility,Outpatient,1,EA,,85,72.25,24.361,85,"UCare Health, Inc.",Medicare Advantage,42.8995,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PROMETHAZINE 25 MG RECT SUPP,,4226,LOCAL,Facility,Inpatient,1,EA,,85,72.25,24.361,85,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PROMETHAZINE 25 MG RECT SUPP,,4226,LOCAL,Facility,Outpatient,1,EA,,85,72.25,24.361,85,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),42.8995,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PROMETHAZINE 25 MG RECT SUPP,,4226,LOCAL,Facility,Inpatient,1,EA,,85,72.25,24.361,85,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PROMETHAZINE 25 MG RECT SUPP,,4226,LOCAL,Facility,Both,1,EA,,85,72.25,24.361,85,UnitedHealthcare,Individual & Family,79.9,94,,percent of total billed charges,,
PROMETHAZINE 25 MG RECT SUPP,,4226,LOCAL,Facility,Outpatient,1,EA,,85,72.25,24.361,85,UnitedHealthcare,Medicare Advantage,41.65,49,,percent of total billed charges,,
PROMETHAZINE 25 MG RECT SUPP,,4226,LOCAL,Facility,Inpatient,1,EA,,85,72.25,24.361,85,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
PROMETHAZINE 25 MG RECT SUPP,,4226,LOCAL,Facility,Outpatient,1,EA,,85,72.25,24.361,85,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,40.8,48,,percent of total billed charges,,100% of DHS outpatient percentage
PROMETHAZINE 25 MG RECT SUPP,,4226,LOCAL,Facility,Inpatient,1,EA,,85,72.25,24.361,85,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
METHADONE 10 MG ORAL TABLET,,4342,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
METHADONE 10 MG ORAL TABLET,,4342,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
METHADONE 10 MG ORAL TABLET,,4342,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
METHADONE 10 MG ORAL TABLET,,4342,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
METHADONE 10 MG ORAL TABLET,,4342,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
METHADONE 10 MG ORAL TABLET,,4342,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
METHADONE 10 MG ORAL TABLET,,4342,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
METHADONE 10 MG ORAL TABLET,,4342,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
METHADONE 10 MG ORAL TABLET,,4342,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
METHADONE 10 MG ORAL TABLET,,4342,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
METHADONE 10 MG ORAL TABLET,,4342,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
METHADONE 10 MG ORAL TABLET,,4342,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
METHADONE 10 MG ORAL TABLET,,4342,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
METHADONE 10 MG ORAL TABLET,,4342,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
METHADONE 10 MG ORAL TABLET,,4342,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
METHADONE 10 MG ORAL TABLET,,4342,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
METHADONE 10 MG ORAL TABLET,,4342,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
METHADONE 10 MG ORAL TABLET,,4342,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
METHADONE 10 MG ORAL TABLET,,4342,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
METHADONE 10 MG ORAL TABLET,,4342,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
METHADONE 10 MG ORAL TABLET,,4342,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
METHADONE 10 MG ORAL TABLET,,4342,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
METHADONE 10 MG ORAL TABLET,,4342,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
METHADONE 10 MG ORAL TABLET,,4342,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
METHADONE 10 MG ORAL TABLET,,4342,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
METHADONE 10 MG ORAL TABLET,,4342,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
METHADONE 10 MG ORAL TABLET,,4342,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
METHADONE 10 MG ORAL TABLET,,4342,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
METHADONE 10 MG ORAL TABLET,,4342,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
METHADONE 10 MG ORAL TABLET,,4342,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
METHADONE 10 MG ORAL TABLET,,4342,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
METHADONE 10 MG ORAL TABLET,,4342,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
METHADONE 10 MG ORAL TABLET,,4342,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
METHADONE 10 MG ORAL TABLET,,4342,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
METHADONE 10 MG ORAL TABLET,,4342,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
METHADONE 10 MG ORAL TABLET,,4342,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
METHADONE 10 MG ORAL TABLET,,4342,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
METHADONE 10 MG ORAL TABLET,,4342,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
METHADONE 10 MG ORAL TABLET,,4342,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
METHADONE 10 MG ORAL TABLET,,4342,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
METHADONE 10 MG ORAL TABLET,,4342,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
METHADONE 10 MG ORAL TABLET,,4342,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
METHADONE 10 MG ORAL TABLET,,4342,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
METHADONE 10 MG ORAL TABLET,,4342,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
METHADONE 10 MG ORAL TABLET,,4342,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
METHADONE 10 MG ORAL TABLET,,4342,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
METHADONE 10 MG ORAL TABLET,,4342,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
METHADONE 10 MG ORAL TABLET,,4342,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
METHADONE 10 MG ORAL TABLET,,4342,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
METHADONE 10 MG ORAL TABLET,,4342,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
METHADONE 10 MG ORAL TABLET,,4342,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
METHADONE 10 MG ORAL TABLET,,4342,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
METHADONE 10 MG ORAL TABLET,,4342,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
METHADONE 10 MG ORAL TABLET,,4342,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
DILTIAZEM HCL 240 MG ORAL CP24,,4388,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
DILTIAZEM HCL 240 MG ORAL CP24,,4388,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
DILTIAZEM HCL 240 MG ORAL CP24,,4388,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
DILTIAZEM HCL 240 MG ORAL CP24,,4388,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
DILTIAZEM HCL 240 MG ORAL CP24,,4388,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
DILTIAZEM HCL 240 MG ORAL CP24,,4388,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
DILTIAZEM HCL 240 MG ORAL CP24,,4388,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
DILTIAZEM HCL 240 MG ORAL CP24,,4388,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
DILTIAZEM HCL 240 MG ORAL CP24,,4388,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
DILTIAZEM HCL 240 MG ORAL CP24,,4388,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
DILTIAZEM HCL 240 MG ORAL CP24,,4388,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
DILTIAZEM HCL 240 MG ORAL CP24,,4388,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
DILTIAZEM HCL 240 MG ORAL CP24,,4388,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
DILTIAZEM HCL 240 MG ORAL CP24,,4388,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
DILTIAZEM HCL 240 MG ORAL CP24,,4388,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
DILTIAZEM HCL 240 MG ORAL CP24,,4388,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
DILTIAZEM HCL 240 MG ORAL CP24,,4388,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
DILTIAZEM HCL 240 MG ORAL CP24,,4388,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
DILTIAZEM HCL 240 MG ORAL CP24,,4388,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DILTIAZEM HCL 240 MG ORAL CP24,,4388,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
DILTIAZEM HCL 240 MG ORAL CP24,,4388,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
DILTIAZEM HCL 240 MG ORAL CP24,,4388,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
DILTIAZEM HCL 240 MG ORAL CP24,,4388,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
DILTIAZEM HCL 240 MG ORAL CP24,,4388,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
DILTIAZEM HCL 240 MG ORAL CP24,,4388,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
DILTIAZEM HCL 240 MG ORAL CP24,,4388,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
DILTIAZEM HCL 240 MG ORAL CP24,,4388,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
DILTIAZEM HCL 240 MG ORAL CP24,,4388,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
DILTIAZEM HCL 240 MG ORAL CP24,,4388,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
DILTIAZEM HCL 240 MG ORAL CP24,,4388,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
DILTIAZEM HCL 240 MG ORAL CP24,,4388,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
DILTIAZEM HCL 240 MG ORAL CP24,,4388,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
DILTIAZEM HCL 240 MG ORAL CP24,,4388,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
DILTIAZEM HCL 240 MG ORAL CP24,,4388,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
DILTIAZEM HCL 240 MG ORAL CP24,,4388,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
DILTIAZEM HCL 240 MG ORAL CP24,,4388,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
DILTIAZEM HCL 240 MG ORAL CP24,,4388,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
DILTIAZEM HCL 240 MG ORAL CP24,,4388,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DILTIAZEM HCL 240 MG ORAL CP24,,4388,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
DILTIAZEM HCL 240 MG ORAL CP24,,4388,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
DILTIAZEM HCL 240 MG ORAL CP24,,4388,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
DILTIAZEM HCL 240 MG ORAL CP24,,4388,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
DILTIAZEM HCL 240 MG ORAL CP24,,4388,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
DILTIAZEM HCL 240 MG ORAL CP24,,4388,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DILTIAZEM HCL 240 MG ORAL CP24,,4388,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
DILTIAZEM HCL 240 MG ORAL CP24,,4388,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DILTIAZEM HCL 240 MG ORAL CP24,,4388,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DILTIAZEM HCL 240 MG ORAL CP24,,4388,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DILTIAZEM HCL 240 MG ORAL CP24,,4388,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DILTIAZEM HCL 240 MG ORAL CP24,,4388,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
DILTIAZEM HCL 240 MG ORAL CP24,,4388,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
DILTIAZEM HCL 240 MG ORAL CP24,,4388,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
DILTIAZEM HCL 240 MG ORAL CP24,,4388,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
DILTIAZEM HCL 240 MG ORAL CP24,,4388,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
DONEPEZIL 10 MG ORAL TABLET,,4431,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
DONEPEZIL 10 MG ORAL TABLET,,4431,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
DONEPEZIL 10 MG ORAL TABLET,,4431,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
DONEPEZIL 10 MG ORAL TABLET,,4431,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
DONEPEZIL 10 MG ORAL TABLET,,4431,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
DONEPEZIL 10 MG ORAL TABLET,,4431,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
DONEPEZIL 10 MG ORAL TABLET,,4431,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
DONEPEZIL 10 MG ORAL TABLET,,4431,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
DONEPEZIL 10 MG ORAL TABLET,,4431,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
DONEPEZIL 10 MG ORAL TABLET,,4431,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
DONEPEZIL 10 MG ORAL TABLET,,4431,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
DONEPEZIL 10 MG ORAL TABLET,,4431,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
DONEPEZIL 10 MG ORAL TABLET,,4431,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
DONEPEZIL 10 MG ORAL TABLET,,4431,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
DONEPEZIL 10 MG ORAL TABLET,,4431,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
DONEPEZIL 10 MG ORAL TABLET,,4431,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
DONEPEZIL 10 MG ORAL TABLET,,4431,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
DONEPEZIL 10 MG ORAL TABLET,,4431,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
DONEPEZIL 10 MG ORAL TABLET,,4431,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DONEPEZIL 10 MG ORAL TABLET,,4431,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
DONEPEZIL 10 MG ORAL TABLET,,4431,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
DONEPEZIL 10 MG ORAL TABLET,,4431,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
DONEPEZIL 10 MG ORAL TABLET,,4431,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
DONEPEZIL 10 MG ORAL TABLET,,4431,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
DONEPEZIL 10 MG ORAL TABLET,,4431,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
DONEPEZIL 10 MG ORAL TABLET,,4431,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
DONEPEZIL 10 MG ORAL TABLET,,4431,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
DONEPEZIL 10 MG ORAL TABLET,,4431,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
DONEPEZIL 10 MG ORAL TABLET,,4431,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
DONEPEZIL 10 MG ORAL TABLET,,4431,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
DONEPEZIL 10 MG ORAL TABLET,,4431,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
DONEPEZIL 10 MG ORAL TABLET,,4431,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
DONEPEZIL 10 MG ORAL TABLET,,4431,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
DONEPEZIL 10 MG ORAL TABLET,,4431,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
DONEPEZIL 10 MG ORAL TABLET,,4431,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
DONEPEZIL 10 MG ORAL TABLET,,4431,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
DONEPEZIL 10 MG ORAL TABLET,,4431,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
DONEPEZIL 10 MG ORAL TABLET,,4431,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DONEPEZIL 10 MG ORAL TABLET,,4431,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
DONEPEZIL 10 MG ORAL TABLET,,4431,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
DONEPEZIL 10 MG ORAL TABLET,,4431,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
DONEPEZIL 10 MG ORAL TABLET,,4431,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
DONEPEZIL 10 MG ORAL TABLET,,4431,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
DONEPEZIL 10 MG ORAL TABLET,,4431,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DONEPEZIL 10 MG ORAL TABLET,,4431,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
DONEPEZIL 10 MG ORAL TABLET,,4431,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DONEPEZIL 10 MG ORAL TABLET,,4431,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DONEPEZIL 10 MG ORAL TABLET,,4431,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DONEPEZIL 10 MG ORAL TABLET,,4431,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DONEPEZIL 10 MG ORAL TABLET,,4431,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
DONEPEZIL 10 MG ORAL TABLET,,4431,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
DONEPEZIL 10 MG ORAL TABLET,,4431,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
DONEPEZIL 10 MG ORAL TABLET,,4431,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
DONEPEZIL 10 MG ORAL TABLET,,4431,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
MELOXICAM 15 MG ORAL TABLET,,4443,LOCAL,Facility,Both,1,EA,,25,21.25,7.165,25,Aetna,Commercial,23,92,,percent of total billed charges,,
MELOXICAM 15 MG ORAL TABLET,,4443,LOCAL,Facility,Outpatient,1,EA,,25,21.25,7.165,25,Aetna,Medicare Advantage,12.25,49,,percent of total billed charges,,
MELOXICAM 15 MG ORAL TABLET,,4443,LOCAL,Facility,Inpatient,1,EA,,25,21.25,7.165,25,Aetna,Medicare Advantage,,,,,Included in per diem rate,
MELOXICAM 15 MG ORAL TABLET,,4443,LOCAL,Facility,Both,1,EA,,25,21.25,7.165,25,Aetna,PPO,23.25,93,,percent of total billed charges,,
MELOXICAM 15 MG ORAL TABLET,,4443,LOCAL,Facility,Both,1,EA,,25,21.25,7.165,25,America's PPO,America's PPO,24.0075,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
MELOXICAM 15 MG ORAL TABLET,,4443,LOCAL,Facility,Both,1,EA,,25,21.25,7.165,25,BlueCross BlueShield Minnesota, Federal Employee Program,24.6,98.4,,percent of total billed charges,,
MELOXICAM 15 MG ORAL TABLET,,4443,LOCAL,Facility,Both,1,EA,,25,21.25,7.165,25,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,25,100,,percent of total billed charges,,
MELOXICAM 15 MG ORAL TABLET,,4443,LOCAL,Facility,Both,1,EA,,25,21.25,7.165,25,BlueCross BlueShield Minnesota,High Value Network Plan,22.5,90,,percent of total billed charges,,
MELOXICAM 15 MG ORAL TABLET,,4443,LOCAL,Facility,Outpatient,1,EA,,25,21.25,7.165,25,BlueCross BlueShield Minnesota,Medicare Advantage,12.25,49,,percent of total billed charges,,
MELOXICAM 15 MG ORAL TABLET,,4443,LOCAL,Facility,Inpatient,1,EA,,25,21.25,7.165,25,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
MELOXICAM 15 MG ORAL TABLET,,4443,LOCAL,Facility,Both,1,EA,,25,21.25,7.165,25,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,22.1425,88.57,,percent of total billed charges,,
MELOXICAM 15 MG ORAL TABLET,,4443,LOCAL,Facility,Both,1,EA,,25,21.25,7.165,25,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,7.165,28.66,,percent of total billed charges,,
MELOXICAM 15 MG ORAL TABLET,,4443,LOCAL,Facility,Outpatient,1,EA,,25,21.25,7.165,25,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),12.25,49,,percent of total billed charges,,
MELOXICAM 15 MG ORAL TABLET,,4443,LOCAL,Facility,Inpatient,1,EA,,25,21.25,7.165,25,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
MELOXICAM 15 MG ORAL TABLET,,4443,LOCAL,Facility,Both,1,EA,,25,21.25,7.165,25,CorVel,Worker's Compensation,25,100,,percent of total billed charges,,
MELOXICAM 15 MG ORAL TABLET,,4443,LOCAL,Facility,Both,1,EA,,25,21.25,7.165,25,First Health Group Corporation,First Health Network,24.25,97,,percent of total billed charges,,
MELOXICAM 15 MG ORAL TABLET,,4443,LOCAL,Facility,Both,1,EA,,25,21.25,7.165,25,"Health Partners, Inc.",Commercial,23.65,94.6,,percent of total billed charges,,
MELOXICAM 15 MG ORAL TABLET,,4443,LOCAL,Facility,Outpatient,1,EA,,25,21.25,7.165,25,"Health Partners, Inc.",Medicare Advantage,12.25,49,,percent of total billed charges,,
MELOXICAM 15 MG ORAL TABLET,,4443,LOCAL,Facility,Inpatient,1,EA,,25,21.25,7.165,25,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
MELOXICAM 15 MG ORAL TABLET,,4443,LOCAL,Facility,Both,1,EA,,25,21.25,7.165,25,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),15,60,,percent of total billed charges,,
MELOXICAM 15 MG ORAL TABLET,,4443,LOCAL,Facility,Both,1,EA,,25,21.25,7.165,25,"Health Partners, Inc.",State of Minnesota Advantage Program,20.375,81.5,,percent of total billed charges,,
MELOXICAM 15 MG ORAL TABLET,,4443,LOCAL,Facility,Both,1,EA,,25,21.25,7.165,25,"Health Partners, Inc.",State Public Programs,12.5,50,,percent of total billed charges,,
MELOXICAM 15 MG ORAL TABLET,,4443,LOCAL,Facility,Both,1,EA,,25,21.25,7.165,25,Humana Insurance Company,Commercial PPO,23.75,95,,percent of total billed charges,,
MELOXICAM 15 MG ORAL TABLET,,4443,LOCAL,Facility,Outpatient,1,EA,,25,21.25,7.165,25,Humana Insurance Company,Medicare PPO,12.25,49,,percent of total billed charges,,
MELOXICAM 15 MG ORAL TABLET,,4443,LOCAL,Facility,Inpatient,1,EA,,25,21.25,7.165,25,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
MELOXICAM 15 MG ORAL TABLET,,4443,LOCAL,Facility,Both,1,EA,,25,21.25,7.165,25,Medica,Individual & Family,24.775,99.1,,percent of total billed charges,,
MELOXICAM 15 MG ORAL TABLET,,4443,LOCAL,Facility,Outpatient,1,EA,,25,21.25,7.165,25,Medica,Medica Advantage Solution,12.45,49.8,,percent of total billed charges,,
MELOXICAM 15 MG ORAL TABLET,,4443,LOCAL,Facility,Inpatient,1,EA,,25,21.25,7.165,25,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
MELOXICAM 15 MG ORAL TABLET,,4443,LOCAL,Facility,Outpatient,1,EA,,25,21.25,7.165,25,Medica,Medical Assistance,11.15,44.6,,percent of total billed charges,,
MELOXICAM 15 MG ORAL TABLET,,4443,LOCAL,Facility,Inpatient,1,EA,,25,21.25,7.165,25,Medica,Medical Assistance,,,,,Included in per diem rate,
MELOXICAM 15 MG ORAL TABLET,,4443,LOCAL,Facility,Outpatient,1,EA,,25,21.25,7.165,25,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,12.45,49.8,,percent of total billed charges,,
MELOXICAM 15 MG ORAL TABLET,,4443,LOCAL,Facility,Inpatient,1,EA,,25,21.25,7.165,25,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
MELOXICAM 15 MG ORAL TABLET,,4443,LOCAL,Facility,Both,1,EA,,25,21.25,7.165,25,"Multiplan, Inc.","Multiplan, Inc.",23.5,94,,percent of total billed charges,,
MELOXICAM 15 MG ORAL TABLET,,4443,LOCAL,Facility,Outpatient,1,EA,,25,21.25,7.165,25,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,22.525,90.1,,percent of total billed charges,,
MELOXICAM 15 MG ORAL TABLET,,4443,LOCAL,Facility,Inpatient,1,EA,,25,21.25,7.165,25,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
MELOXICAM 15 MG ORAL TABLET,,4443,LOCAL,Facility,Both,1,EA,,25,21.25,7.165,25,"Preferred One Administrative Services, INC.",PPO,24.65,98.6,,percent of total billed charges,,
MELOXICAM 15 MG ORAL TABLET,,4443,LOCAL,Facility,Outpatient,1,EA,,25,21.25,7.165,25,PrimeWest Health,Minnesota Senior Health Options (MSHO),12.8625,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
MELOXICAM 15 MG ORAL TABLET,,4443,LOCAL,Facility,Inpatient,1,EA,,25,21.25,7.165,25,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
MELOXICAM 15 MG ORAL TABLET,,4443,LOCAL,Facility,Outpatient,1,EA,,25,21.25,7.165,25,PrimeWest Health,MinnesotaCare,12.84,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
MELOXICAM 15 MG ORAL TABLET,,4443,LOCAL,Facility,Inpatient,1,EA,,25,21.25,7.165,25,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
MELOXICAM 15 MG ORAL TABLET,,4443,LOCAL,Facility,Both,1,EA,,25,21.25,7.165,25,Sanford Health Plan,Sanford Health Plan,23,92,,percent of total billed charges,,
MELOXICAM 15 MG ORAL TABLET,,4443,LOCAL,Facility,Outpatient,1,EA,,25,21.25,7.165,25,"UCare Health, Inc.",Individual & Family Plan,14.0875,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
MELOXICAM 15 MG ORAL TABLET,,4443,LOCAL,Facility,Inpatient,1,EA,,25,21.25,7.165,25,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
MELOXICAM 15 MG ORAL TABLET,,4443,LOCAL,Facility,Outpatient,1,EA,,25,21.25,7.165,25,"UCare Health, Inc.",Medical Assistance,12.6175,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MELOXICAM 15 MG ORAL TABLET,,4443,LOCAL,Facility,Inpatient,1,EA,,25,21.25,7.165,25,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
MELOXICAM 15 MG ORAL TABLET,,4443,LOCAL,Facility,Outpatient,1,EA,,25,21.25,7.165,25,"UCare Health, Inc.",Medicare Advantage,12.6175,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MELOXICAM 15 MG ORAL TABLET,,4443,LOCAL,Facility,Inpatient,1,EA,,25,21.25,7.165,25,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
MELOXICAM 15 MG ORAL TABLET,,4443,LOCAL,Facility,Outpatient,1,EA,,25,21.25,7.165,25,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),12.6175,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MELOXICAM 15 MG ORAL TABLET,,4443,LOCAL,Facility,Inpatient,1,EA,,25,21.25,7.165,25,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
MELOXICAM 15 MG ORAL TABLET,,4443,LOCAL,Facility,Both,1,EA,,25,21.25,7.165,25,UnitedHealthcare,Individual & Family,23.5,94,,percent of total billed charges,,
MELOXICAM 15 MG ORAL TABLET,,4443,LOCAL,Facility,Outpatient,1,EA,,25,21.25,7.165,25,UnitedHealthcare,Medicare Advantage,12.25,49,,percent of total billed charges,,
MELOXICAM 15 MG ORAL TABLET,,4443,LOCAL,Facility,Inpatient,1,EA,,25,21.25,7.165,25,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
MELOXICAM 15 MG ORAL TABLET,,4443,LOCAL,Facility,Outpatient,1,EA,,25,21.25,7.165,25,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,12,48,,percent of total billed charges,,100% of DHS outpatient percentage
MELOXICAM 15 MG ORAL TABLET,,4443,LOCAL,Facility,Inpatient,1,EA,,25,21.25,7.165,25,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
SUCRALFATE 1 GRAM ORAL TABLET,,4446,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
SUCRALFATE 1 GRAM ORAL TABLET,,4446,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
SUCRALFATE 1 GRAM ORAL TABLET,,4446,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
SUCRALFATE 1 GRAM ORAL TABLET,,4446,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
SUCRALFATE 1 GRAM ORAL TABLET,,4446,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SUCRALFATE 1 GRAM ORAL TABLET,,4446,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
SUCRALFATE 1 GRAM ORAL TABLET,,4446,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
SUCRALFATE 1 GRAM ORAL TABLET,,4446,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
SUCRALFATE 1 GRAM ORAL TABLET,,4446,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
SUCRALFATE 1 GRAM ORAL TABLET,,4446,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
SUCRALFATE 1 GRAM ORAL TABLET,,4446,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
SUCRALFATE 1 GRAM ORAL TABLET,,4446,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
SUCRALFATE 1 GRAM ORAL TABLET,,4446,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
SUCRALFATE 1 GRAM ORAL TABLET,,4446,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
SUCRALFATE 1 GRAM ORAL TABLET,,4446,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
SUCRALFATE 1 GRAM ORAL TABLET,,4446,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
SUCRALFATE 1 GRAM ORAL TABLET,,4446,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
SUCRALFATE 1 GRAM ORAL TABLET,,4446,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
SUCRALFATE 1 GRAM ORAL TABLET,,4446,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUCRALFATE 1 GRAM ORAL TABLET,,4446,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
SUCRALFATE 1 GRAM ORAL TABLET,,4446,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
SUCRALFATE 1 GRAM ORAL TABLET,,4446,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
SUCRALFATE 1 GRAM ORAL TABLET,,4446,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
SUCRALFATE 1 GRAM ORAL TABLET,,4446,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
SUCRALFATE 1 GRAM ORAL TABLET,,4446,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
SUCRALFATE 1 GRAM ORAL TABLET,,4446,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
SUCRALFATE 1 GRAM ORAL TABLET,,4446,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
SUCRALFATE 1 GRAM ORAL TABLET,,4446,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
SUCRALFATE 1 GRAM ORAL TABLET,,4446,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
SUCRALFATE 1 GRAM ORAL TABLET,,4446,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
SUCRALFATE 1 GRAM ORAL TABLET,,4446,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
SUCRALFATE 1 GRAM ORAL TABLET,,4446,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
SUCRALFATE 1 GRAM ORAL TABLET,,4446,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
SUCRALFATE 1 GRAM ORAL TABLET,,4446,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
SUCRALFATE 1 GRAM ORAL TABLET,,4446,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
SUCRALFATE 1 GRAM ORAL TABLET,,4446,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
SUCRALFATE 1 GRAM ORAL TABLET,,4446,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
SUCRALFATE 1 GRAM ORAL TABLET,,4446,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUCRALFATE 1 GRAM ORAL TABLET,,4446,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
SUCRALFATE 1 GRAM ORAL TABLET,,4446,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
SUCRALFATE 1 GRAM ORAL TABLET,,4446,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
SUCRALFATE 1 GRAM ORAL TABLET,,4446,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
SUCRALFATE 1 GRAM ORAL TABLET,,4446,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
SUCRALFATE 1 GRAM ORAL TABLET,,4446,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUCRALFATE 1 GRAM ORAL TABLET,,4446,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
SUCRALFATE 1 GRAM ORAL TABLET,,4446,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUCRALFATE 1 GRAM ORAL TABLET,,4446,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUCRALFATE 1 GRAM ORAL TABLET,,4446,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUCRALFATE 1 GRAM ORAL TABLET,,4446,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUCRALFATE 1 GRAM ORAL TABLET,,4446,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
SUCRALFATE 1 GRAM ORAL TABLET,,4446,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
SUCRALFATE 1 GRAM ORAL TABLET,,4446,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
SUCRALFATE 1 GRAM ORAL TABLET,,4446,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
SUCRALFATE 1 GRAM ORAL TABLET,,4446,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
ISOSORBIDE MONONITRATE 30 MG ORAL TB24,,4755,LOCAL,Facility,Both,1,EA,,17,14.45,4.8722,17,Aetna,Commercial,15.64,92,,percent of total billed charges,,
ISOSORBIDE MONONITRATE 30 MG ORAL TB24,,4755,LOCAL,Facility,Outpatient,1,EA,,17,14.45,4.8722,17,Aetna,Medicare Advantage,8.33,49,,percent of total billed charges,,
ISOSORBIDE MONONITRATE 30 MG ORAL TB24,,4755,LOCAL,Facility,Inpatient,1,EA,,17,14.45,4.8722,17,Aetna,Medicare Advantage,,,,,Included in per diem rate,
ISOSORBIDE MONONITRATE 30 MG ORAL TB24,,4755,LOCAL,Facility,Both,1,EA,,17,14.45,4.8722,17,Aetna,PPO,15.81,93,,percent of total billed charges,,
ISOSORBIDE MONONITRATE 30 MG ORAL TB24,,4755,LOCAL,Facility,Both,1,EA,,17,14.45,4.8722,17,America's PPO,America's PPO,16.3251,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
ISOSORBIDE MONONITRATE 30 MG ORAL TB24,,4755,LOCAL,Facility,Both,1,EA,,17,14.45,4.8722,17,BlueCross BlueShield Minnesota, Federal Employee Program,16.728,98.4,,percent of total billed charges,,
ISOSORBIDE MONONITRATE 30 MG ORAL TB24,,4755,LOCAL,Facility,Both,1,EA,,17,14.45,4.8722,17,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,17,100,,percent of total billed charges,,
ISOSORBIDE MONONITRATE 30 MG ORAL TB24,,4755,LOCAL,Facility,Both,1,EA,,17,14.45,4.8722,17,BlueCross BlueShield Minnesota,High Value Network Plan,15.3,90,,percent of total billed charges,,
ISOSORBIDE MONONITRATE 30 MG ORAL TB24,,4755,LOCAL,Facility,Outpatient,1,EA,,17,14.45,4.8722,17,BlueCross BlueShield Minnesota,Medicare Advantage,8.33,49,,percent of total billed charges,,
ISOSORBIDE MONONITRATE 30 MG ORAL TB24,,4755,LOCAL,Facility,Inpatient,1,EA,,17,14.45,4.8722,17,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
ISOSORBIDE MONONITRATE 30 MG ORAL TB24,,4755,LOCAL,Facility,Both,1,EA,,17,14.45,4.8722,17,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,15.0569,88.57,,percent of total billed charges,,
ISOSORBIDE MONONITRATE 30 MG ORAL TB24,,4755,LOCAL,Facility,Both,1,EA,,17,14.45,4.8722,17,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,4.8722,28.66,,percent of total billed charges,,
ISOSORBIDE MONONITRATE 30 MG ORAL TB24,,4755,LOCAL,Facility,Outpatient,1,EA,,17,14.45,4.8722,17,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),8.33,49,,percent of total billed charges,,
ISOSORBIDE MONONITRATE 30 MG ORAL TB24,,4755,LOCAL,Facility,Inpatient,1,EA,,17,14.45,4.8722,17,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
ISOSORBIDE MONONITRATE 30 MG ORAL TB24,,4755,LOCAL,Facility,Both,1,EA,,17,14.45,4.8722,17,CorVel,Worker's Compensation,17,100,,percent of total billed charges,,
ISOSORBIDE MONONITRATE 30 MG ORAL TB24,,4755,LOCAL,Facility,Both,1,EA,,17,14.45,4.8722,17,First Health Group Corporation,First Health Network,16.49,97,,percent of total billed charges,,
ISOSORBIDE MONONITRATE 30 MG ORAL TB24,,4755,LOCAL,Facility,Both,1,EA,,17,14.45,4.8722,17,"Health Partners, Inc.",Commercial,16.082,94.6,,percent of total billed charges,,
ISOSORBIDE MONONITRATE 30 MG ORAL TB24,,4755,LOCAL,Facility,Outpatient,1,EA,,17,14.45,4.8722,17,"Health Partners, Inc.",Medicare Advantage,8.33,49,,percent of total billed charges,,
ISOSORBIDE MONONITRATE 30 MG ORAL TB24,,4755,LOCAL,Facility,Inpatient,1,EA,,17,14.45,4.8722,17,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ISOSORBIDE MONONITRATE 30 MG ORAL TB24,,4755,LOCAL,Facility,Both,1,EA,,17,14.45,4.8722,17,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),10.2,60,,percent of total billed charges,,
ISOSORBIDE MONONITRATE 30 MG ORAL TB24,,4755,LOCAL,Facility,Both,1,EA,,17,14.45,4.8722,17,"Health Partners, Inc.",State of Minnesota Advantage Program,13.855,81.5,,percent of total billed charges,,
ISOSORBIDE MONONITRATE 30 MG ORAL TB24,,4755,LOCAL,Facility,Both,1,EA,,17,14.45,4.8722,17,"Health Partners, Inc.",State Public Programs,8.5,50,,percent of total billed charges,,
ISOSORBIDE MONONITRATE 30 MG ORAL TB24,,4755,LOCAL,Facility,Both,1,EA,,17,14.45,4.8722,17,Humana Insurance Company,Commercial PPO,16.15,95,,percent of total billed charges,,
ISOSORBIDE MONONITRATE 30 MG ORAL TB24,,4755,LOCAL,Facility,Outpatient,1,EA,,17,14.45,4.8722,17,Humana Insurance Company,Medicare PPO,8.33,49,,percent of total billed charges,,
ISOSORBIDE MONONITRATE 30 MG ORAL TB24,,4755,LOCAL,Facility,Inpatient,1,EA,,17,14.45,4.8722,17,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
ISOSORBIDE MONONITRATE 30 MG ORAL TB24,,4755,LOCAL,Facility,Both,1,EA,,17,14.45,4.8722,17,Medica,Individual & Family,16.847,99.1,,percent of total billed charges,,
ISOSORBIDE MONONITRATE 30 MG ORAL TB24,,4755,LOCAL,Facility,Outpatient,1,EA,,17,14.45,4.8722,17,Medica,Medica Advantage Solution,8.466,49.8,,percent of total billed charges,,
ISOSORBIDE MONONITRATE 30 MG ORAL TB24,,4755,LOCAL,Facility,Inpatient,1,EA,,17,14.45,4.8722,17,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
ISOSORBIDE MONONITRATE 30 MG ORAL TB24,,4755,LOCAL,Facility,Outpatient,1,EA,,17,14.45,4.8722,17,Medica,Medical Assistance,7.582,44.6,,percent of total billed charges,,
ISOSORBIDE MONONITRATE 30 MG ORAL TB24,,4755,LOCAL,Facility,Inpatient,1,EA,,17,14.45,4.8722,17,Medica,Medical Assistance,,,,,Included in per diem rate,
ISOSORBIDE MONONITRATE 30 MG ORAL TB24,,4755,LOCAL,Facility,Outpatient,1,EA,,17,14.45,4.8722,17,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,8.466,49.8,,percent of total billed charges,,
ISOSORBIDE MONONITRATE 30 MG ORAL TB24,,4755,LOCAL,Facility,Inpatient,1,EA,,17,14.45,4.8722,17,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
ISOSORBIDE MONONITRATE 30 MG ORAL TB24,,4755,LOCAL,Facility,Both,1,EA,,17,14.45,4.8722,17,"Multiplan, Inc.","Multiplan, Inc.",15.98,94,,percent of total billed charges,,
ISOSORBIDE MONONITRATE 30 MG ORAL TB24,,4755,LOCAL,Facility,Outpatient,1,EA,,17,14.45,4.8722,17,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,15.317,90.1,,percent of total billed charges,,
ISOSORBIDE MONONITRATE 30 MG ORAL TB24,,4755,LOCAL,Facility,Inpatient,1,EA,,17,14.45,4.8722,17,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
ISOSORBIDE MONONITRATE 30 MG ORAL TB24,,4755,LOCAL,Facility,Both,1,EA,,17,14.45,4.8722,17,"Preferred One Administrative Services, INC.",PPO,16.762,98.6,,percent of total billed charges,,
ISOSORBIDE MONONITRATE 30 MG ORAL TB24,,4755,LOCAL,Facility,Outpatient,1,EA,,17,14.45,4.8722,17,PrimeWest Health,Minnesota Senior Health Options (MSHO),8.7465,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
ISOSORBIDE MONONITRATE 30 MG ORAL TB24,,4755,LOCAL,Facility,Inpatient,1,EA,,17,14.45,4.8722,17,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ISOSORBIDE MONONITRATE 30 MG ORAL TB24,,4755,LOCAL,Facility,Outpatient,1,EA,,17,14.45,4.8722,17,PrimeWest Health,MinnesotaCare,8.7312,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
ISOSORBIDE MONONITRATE 30 MG ORAL TB24,,4755,LOCAL,Facility,Inpatient,1,EA,,17,14.45,4.8722,17,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
ISOSORBIDE MONONITRATE 30 MG ORAL TB24,,4755,LOCAL,Facility,Both,1,EA,,17,14.45,4.8722,17,Sanford Health Plan,Sanford Health Plan,15.64,92,,percent of total billed charges,,
ISOSORBIDE MONONITRATE 30 MG ORAL TB24,,4755,LOCAL,Facility,Outpatient,1,EA,,17,14.45,4.8722,17,"UCare Health, Inc.",Individual & Family Plan,9.5795,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
ISOSORBIDE MONONITRATE 30 MG ORAL TB24,,4755,LOCAL,Facility,Inpatient,1,EA,,17,14.45,4.8722,17,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
ISOSORBIDE MONONITRATE 30 MG ORAL TB24,,4755,LOCAL,Facility,Outpatient,1,EA,,17,14.45,4.8722,17,"UCare Health, Inc.",Medical Assistance,8.5799,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ISOSORBIDE MONONITRATE 30 MG ORAL TB24,,4755,LOCAL,Facility,Inpatient,1,EA,,17,14.45,4.8722,17,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
ISOSORBIDE MONONITRATE 30 MG ORAL TB24,,4755,LOCAL,Facility,Outpatient,1,EA,,17,14.45,4.8722,17,"UCare Health, Inc.",Medicare Advantage,8.5799,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ISOSORBIDE MONONITRATE 30 MG ORAL TB24,,4755,LOCAL,Facility,Inpatient,1,EA,,17,14.45,4.8722,17,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ISOSORBIDE MONONITRATE 30 MG ORAL TB24,,4755,LOCAL,Facility,Outpatient,1,EA,,17,14.45,4.8722,17,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),8.5799,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ISOSORBIDE MONONITRATE 30 MG ORAL TB24,,4755,LOCAL,Facility,Inpatient,1,EA,,17,14.45,4.8722,17,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ISOSORBIDE MONONITRATE 30 MG ORAL TB24,,4755,LOCAL,Facility,Both,1,EA,,17,14.45,4.8722,17,UnitedHealthcare,Individual & Family,15.98,94,,percent of total billed charges,,
ISOSORBIDE MONONITRATE 30 MG ORAL TB24,,4755,LOCAL,Facility,Outpatient,1,EA,,17,14.45,4.8722,17,UnitedHealthcare,Medicare Advantage,8.33,49,,percent of total billed charges,,
ISOSORBIDE MONONITRATE 30 MG ORAL TB24,,4755,LOCAL,Facility,Inpatient,1,EA,,17,14.45,4.8722,17,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
ISOSORBIDE MONONITRATE 30 MG ORAL TB24,,4755,LOCAL,Facility,Outpatient,1,EA,,17,14.45,4.8722,17,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,8.16,48,,percent of total billed charges,,100% of DHS outpatient percentage
ISOSORBIDE MONONITRATE 30 MG ORAL TB24,,4755,LOCAL,Facility,Inpatient,1,EA,,17,14.45,4.8722,17,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
ALENDRONATE 70 MG ORAL TABLET,,4756,LOCAL,Facility,Both,1,EA,,93,79.05,26.6538,93,Aetna,Commercial,85.56,92,,percent of total billed charges,,
ALENDRONATE 70 MG ORAL TABLET,,4756,LOCAL,Facility,Outpatient,1,EA,,93,79.05,26.6538,93,Aetna,Medicare Advantage,45.57,49,,percent of total billed charges,,
ALENDRONATE 70 MG ORAL TABLET,,4756,LOCAL,Facility,Inpatient,1,EA,,93,79.05,26.6538,93,Aetna,Medicare Advantage,,,,,Included in per diem rate,
ALENDRONATE 70 MG ORAL TABLET,,4756,LOCAL,Facility,Both,1,EA,,93,79.05,26.6538,93,Aetna,PPO,86.49,93,,percent of total billed charges,,
ALENDRONATE 70 MG ORAL TABLET,,4756,LOCAL,Facility,Both,1,EA,,93,79.05,26.6538,93,America's PPO,America's PPO,89.3079,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
ALENDRONATE 70 MG ORAL TABLET,,4756,LOCAL,Facility,Both,1,EA,,93,79.05,26.6538,93,BlueCross BlueShield Minnesota, Federal Employee Program,91.512,98.4,,percent of total billed charges,,
ALENDRONATE 70 MG ORAL TABLET,,4756,LOCAL,Facility,Both,1,EA,,93,79.05,26.6538,93,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,93,100,,percent of total billed charges,,
ALENDRONATE 70 MG ORAL TABLET,,4756,LOCAL,Facility,Both,1,EA,,93,79.05,26.6538,93,BlueCross BlueShield Minnesota,High Value Network Plan,83.7,90,,percent of total billed charges,,
ALENDRONATE 70 MG ORAL TABLET,,4756,LOCAL,Facility,Outpatient,1,EA,,93,79.05,26.6538,93,BlueCross BlueShield Minnesota,Medicare Advantage,45.57,49,,percent of total billed charges,,
ALENDRONATE 70 MG ORAL TABLET,,4756,LOCAL,Facility,Inpatient,1,EA,,93,79.05,26.6538,93,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
ALENDRONATE 70 MG ORAL TABLET,,4756,LOCAL,Facility,Both,1,EA,,93,79.05,26.6538,93,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,82.3701,88.57,,percent of total billed charges,,
ALENDRONATE 70 MG ORAL TABLET,,4756,LOCAL,Facility,Both,1,EA,,93,79.05,26.6538,93,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,26.6538,28.66,,percent of total billed charges,,
ALENDRONATE 70 MG ORAL TABLET,,4756,LOCAL,Facility,Outpatient,1,EA,,93,79.05,26.6538,93,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),45.57,49,,percent of total billed charges,,
ALENDRONATE 70 MG ORAL TABLET,,4756,LOCAL,Facility,Inpatient,1,EA,,93,79.05,26.6538,93,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
ALENDRONATE 70 MG ORAL TABLET,,4756,LOCAL,Facility,Both,1,EA,,93,79.05,26.6538,93,CorVel,Worker's Compensation,93,100,,percent of total billed charges,,
ALENDRONATE 70 MG ORAL TABLET,,4756,LOCAL,Facility,Both,1,EA,,93,79.05,26.6538,93,First Health Group Corporation,First Health Network,90.21,97,,percent of total billed charges,,
ALENDRONATE 70 MG ORAL TABLET,,4756,LOCAL,Facility,Both,1,EA,,93,79.05,26.6538,93,"Health Partners, Inc.",Commercial,87.978,94.6,,percent of total billed charges,,
ALENDRONATE 70 MG ORAL TABLET,,4756,LOCAL,Facility,Outpatient,1,EA,,93,79.05,26.6538,93,"Health Partners, Inc.",Medicare Advantage,45.57,49,,percent of total billed charges,,
ALENDRONATE 70 MG ORAL TABLET,,4756,LOCAL,Facility,Inpatient,1,EA,,93,79.05,26.6538,93,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ALENDRONATE 70 MG ORAL TABLET,,4756,LOCAL,Facility,Both,1,EA,,93,79.05,26.6538,93,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),55.8,60,,percent of total billed charges,,
ALENDRONATE 70 MG ORAL TABLET,,4756,LOCAL,Facility,Both,1,EA,,93,79.05,26.6538,93,"Health Partners, Inc.",State of Minnesota Advantage Program,75.795,81.5,,percent of total billed charges,,
ALENDRONATE 70 MG ORAL TABLET,,4756,LOCAL,Facility,Both,1,EA,,93,79.05,26.6538,93,"Health Partners, Inc.",State Public Programs,46.5,50,,percent of total billed charges,,
ALENDRONATE 70 MG ORAL TABLET,,4756,LOCAL,Facility,Both,1,EA,,93,79.05,26.6538,93,Humana Insurance Company,Commercial PPO,88.35,95,,percent of total billed charges,,
ALENDRONATE 70 MG ORAL TABLET,,4756,LOCAL,Facility,Outpatient,1,EA,,93,79.05,26.6538,93,Humana Insurance Company,Medicare PPO,45.57,49,,percent of total billed charges,,
ALENDRONATE 70 MG ORAL TABLET,,4756,LOCAL,Facility,Inpatient,1,EA,,93,79.05,26.6538,93,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
ALENDRONATE 70 MG ORAL TABLET,,4756,LOCAL,Facility,Both,1,EA,,93,79.05,26.6538,93,Medica,Individual & Family,92.163,99.1,,percent of total billed charges,,
ALENDRONATE 70 MG ORAL TABLET,,4756,LOCAL,Facility,Outpatient,1,EA,,93,79.05,26.6538,93,Medica,Medica Advantage Solution,46.314,49.8,,percent of total billed charges,,
ALENDRONATE 70 MG ORAL TABLET,,4756,LOCAL,Facility,Inpatient,1,EA,,93,79.05,26.6538,93,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
ALENDRONATE 70 MG ORAL TABLET,,4756,LOCAL,Facility,Outpatient,1,EA,,93,79.05,26.6538,93,Medica,Medical Assistance,41.478,44.6,,percent of total billed charges,,
ALENDRONATE 70 MG ORAL TABLET,,4756,LOCAL,Facility,Inpatient,1,EA,,93,79.05,26.6538,93,Medica,Medical Assistance,,,,,Included in per diem rate,
ALENDRONATE 70 MG ORAL TABLET,,4756,LOCAL,Facility,Outpatient,1,EA,,93,79.05,26.6538,93,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,46.314,49.8,,percent of total billed charges,,
ALENDRONATE 70 MG ORAL TABLET,,4756,LOCAL,Facility,Inpatient,1,EA,,93,79.05,26.6538,93,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
ALENDRONATE 70 MG ORAL TABLET,,4756,LOCAL,Facility,Both,1,EA,,93,79.05,26.6538,93,"Multiplan, Inc.","Multiplan, Inc.",87.42,94,,percent of total billed charges,,
ALENDRONATE 70 MG ORAL TABLET,,4756,LOCAL,Facility,Outpatient,1,EA,,93,79.05,26.6538,93,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,83.793,90.1,,percent of total billed charges,,
ALENDRONATE 70 MG ORAL TABLET,,4756,LOCAL,Facility,Inpatient,1,EA,,93,79.05,26.6538,93,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
ALENDRONATE 70 MG ORAL TABLET,,4756,LOCAL,Facility,Both,1,EA,,93,79.05,26.6538,93,"Preferred One Administrative Services, INC.",PPO,91.698,98.6,,percent of total billed charges,,
ALENDRONATE 70 MG ORAL TABLET,,4756,LOCAL,Facility,Outpatient,1,EA,,93,79.05,26.6538,93,PrimeWest Health,Minnesota Senior Health Options (MSHO),47.8485,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
ALENDRONATE 70 MG ORAL TABLET,,4756,LOCAL,Facility,Inpatient,1,EA,,93,79.05,26.6538,93,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ALENDRONATE 70 MG ORAL TABLET,,4756,LOCAL,Facility,Outpatient,1,EA,,93,79.05,26.6538,93,PrimeWest Health,MinnesotaCare,47.7648,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
ALENDRONATE 70 MG ORAL TABLET,,4756,LOCAL,Facility,Inpatient,1,EA,,93,79.05,26.6538,93,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
ALENDRONATE 70 MG ORAL TABLET,,4756,LOCAL,Facility,Both,1,EA,,93,79.05,26.6538,93,Sanford Health Plan,Sanford Health Plan,85.56,92,,percent of total billed charges,,
ALENDRONATE 70 MG ORAL TABLET,,4756,LOCAL,Facility,Outpatient,1,EA,,93,79.05,26.6538,93,"UCare Health, Inc.",Individual & Family Plan,52.4055,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
ALENDRONATE 70 MG ORAL TABLET,,4756,LOCAL,Facility,Inpatient,1,EA,,93,79.05,26.6538,93,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
ALENDRONATE 70 MG ORAL TABLET,,4756,LOCAL,Facility,Outpatient,1,EA,,93,79.05,26.6538,93,"UCare Health, Inc.",Medical Assistance,46.9371,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ALENDRONATE 70 MG ORAL TABLET,,4756,LOCAL,Facility,Inpatient,1,EA,,93,79.05,26.6538,93,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
ALENDRONATE 70 MG ORAL TABLET,,4756,LOCAL,Facility,Outpatient,1,EA,,93,79.05,26.6538,93,"UCare Health, Inc.",Medicare Advantage,46.9371,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ALENDRONATE 70 MG ORAL TABLET,,4756,LOCAL,Facility,Inpatient,1,EA,,93,79.05,26.6538,93,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ALENDRONATE 70 MG ORAL TABLET,,4756,LOCAL,Facility,Outpatient,1,EA,,93,79.05,26.6538,93,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),46.9371,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ALENDRONATE 70 MG ORAL TABLET,,4756,LOCAL,Facility,Inpatient,1,EA,,93,79.05,26.6538,93,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ALENDRONATE 70 MG ORAL TABLET,,4756,LOCAL,Facility,Both,1,EA,,93,79.05,26.6538,93,UnitedHealthcare,Individual & Family,87.42,94,,percent of total billed charges,,
ALENDRONATE 70 MG ORAL TABLET,,4756,LOCAL,Facility,Outpatient,1,EA,,93,79.05,26.6538,93,UnitedHealthcare,Medicare Advantage,45.57,49,,percent of total billed charges,,
ALENDRONATE 70 MG ORAL TABLET,,4756,LOCAL,Facility,Inpatient,1,EA,,93,79.05,26.6538,93,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
ALENDRONATE 70 MG ORAL TABLET,,4756,LOCAL,Facility,Outpatient,1,EA,,93,79.05,26.6538,93,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,44.64,48,,percent of total billed charges,,100% of DHS outpatient percentage
ALENDRONATE 70 MG ORAL TABLET,,4756,LOCAL,Facility,Inpatient,1,EA,,93,79.05,26.6538,93,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
CLONAZEPAM 0.5 MG ORAL TABLET,,4776,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
CLONAZEPAM 0.5 MG ORAL TABLET,,4776,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
CLONAZEPAM 0.5 MG ORAL TABLET,,4776,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
CLONAZEPAM 0.5 MG ORAL TABLET,,4776,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
CLONAZEPAM 0.5 MG ORAL TABLET,,4776,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
CLONAZEPAM 0.5 MG ORAL TABLET,,4776,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
CLONAZEPAM 0.5 MG ORAL TABLET,,4776,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
CLONAZEPAM 0.5 MG ORAL TABLET,,4776,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
CLONAZEPAM 0.5 MG ORAL TABLET,,4776,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
CLONAZEPAM 0.5 MG ORAL TABLET,,4776,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
CLONAZEPAM 0.5 MG ORAL TABLET,,4776,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
CLONAZEPAM 0.5 MG ORAL TABLET,,4776,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
CLONAZEPAM 0.5 MG ORAL TABLET,,4776,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
CLONAZEPAM 0.5 MG ORAL TABLET,,4776,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
CLONAZEPAM 0.5 MG ORAL TABLET,,4776,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
CLONAZEPAM 0.5 MG ORAL TABLET,,4776,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
CLONAZEPAM 0.5 MG ORAL TABLET,,4776,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
CLONAZEPAM 0.5 MG ORAL TABLET,,4776,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
CLONAZEPAM 0.5 MG ORAL TABLET,,4776,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CLONAZEPAM 0.5 MG ORAL TABLET,,4776,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
CLONAZEPAM 0.5 MG ORAL TABLET,,4776,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
CLONAZEPAM 0.5 MG ORAL TABLET,,4776,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
CLONAZEPAM 0.5 MG ORAL TABLET,,4776,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
CLONAZEPAM 0.5 MG ORAL TABLET,,4776,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
CLONAZEPAM 0.5 MG ORAL TABLET,,4776,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
CLONAZEPAM 0.5 MG ORAL TABLET,,4776,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
CLONAZEPAM 0.5 MG ORAL TABLET,,4776,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
CLONAZEPAM 0.5 MG ORAL TABLET,,4776,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
CLONAZEPAM 0.5 MG ORAL TABLET,,4776,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
CLONAZEPAM 0.5 MG ORAL TABLET,,4776,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
CLONAZEPAM 0.5 MG ORAL TABLET,,4776,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
CLONAZEPAM 0.5 MG ORAL TABLET,,4776,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
CLONAZEPAM 0.5 MG ORAL TABLET,,4776,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
CLONAZEPAM 0.5 MG ORAL TABLET,,4776,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
CLONAZEPAM 0.5 MG ORAL TABLET,,4776,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
CLONAZEPAM 0.5 MG ORAL TABLET,,4776,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
CLONAZEPAM 0.5 MG ORAL TABLET,,4776,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
CLONAZEPAM 0.5 MG ORAL TABLET,,4776,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CLONAZEPAM 0.5 MG ORAL TABLET,,4776,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
CLONAZEPAM 0.5 MG ORAL TABLET,,4776,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
CLONAZEPAM 0.5 MG ORAL TABLET,,4776,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
CLONAZEPAM 0.5 MG ORAL TABLET,,4776,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
CLONAZEPAM 0.5 MG ORAL TABLET,,4776,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
CLONAZEPAM 0.5 MG ORAL TABLET,,4776,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CLONAZEPAM 0.5 MG ORAL TABLET,,4776,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
CLONAZEPAM 0.5 MG ORAL TABLET,,4776,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CLONAZEPAM 0.5 MG ORAL TABLET,,4776,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CLONAZEPAM 0.5 MG ORAL TABLET,,4776,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CLONAZEPAM 0.5 MG ORAL TABLET,,4776,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CLONAZEPAM 0.5 MG ORAL TABLET,,4776,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
CLONAZEPAM 0.5 MG ORAL TABLET,,4776,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
CLONAZEPAM 0.5 MG ORAL TABLET,,4776,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
CLONAZEPAM 0.5 MG ORAL TABLET,,4776,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
CLONAZEPAM 0.5 MG ORAL TABLET,,4776,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
NITROGLYCERIN 0.3 MG/HR TD PT24,,4892,LOCAL,Facility,Both,1,EA,,268,227.8,76.8088,268,Aetna,Commercial,246.56,92,,percent of total billed charges,,
NITROGLYCERIN 0.3 MG/HR TD PT24,,4892,LOCAL,Facility,Outpatient,1,EA,,268,227.8,76.8088,268,Aetna,Medicare Advantage,131.32,49,,percent of total billed charges,,
NITROGLYCERIN 0.3 MG/HR TD PT24,,4892,LOCAL,Facility,Inpatient,1,EA,,268,227.8,76.8088,268,Aetna,Medicare Advantage,,,,,Included in per diem rate,
NITROGLYCERIN 0.3 MG/HR TD PT24,,4892,LOCAL,Facility,Both,1,EA,,268,227.8,76.8088,268,Aetna,PPO,249.24,93,,percent of total billed charges,,
NITROGLYCERIN 0.3 MG/HR TD PT24,,4892,LOCAL,Facility,Both,1,EA,,268,227.8,76.8088,268,America's PPO,America's PPO,257.3604,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
NITROGLYCERIN 0.3 MG/HR TD PT24,,4892,LOCAL,Facility,Both,1,EA,,268,227.8,76.8088,268,BlueCross BlueShield Minnesota, Federal Employee Program,263.712,98.4,,percent of total billed charges,,
NITROGLYCERIN 0.3 MG/HR TD PT24,,4892,LOCAL,Facility,Both,1,EA,,268,227.8,76.8088,268,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,268,100,,percent of total billed charges,,
NITROGLYCERIN 0.3 MG/HR TD PT24,,4892,LOCAL,Facility,Both,1,EA,,268,227.8,76.8088,268,BlueCross BlueShield Minnesota,High Value Network Plan,241.2,90,,percent of total billed charges,,
NITROGLYCERIN 0.3 MG/HR TD PT24,,4892,LOCAL,Facility,Outpatient,1,EA,,268,227.8,76.8088,268,BlueCross BlueShield Minnesota,Medicare Advantage,131.32,49,,percent of total billed charges,,
NITROGLYCERIN 0.3 MG/HR TD PT24,,4892,LOCAL,Facility,Inpatient,1,EA,,268,227.8,76.8088,268,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
NITROGLYCERIN 0.3 MG/HR TD PT24,,4892,LOCAL,Facility,Both,1,EA,,268,227.8,76.8088,268,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,237.3676,88.57,,percent of total billed charges,,
NITROGLYCERIN 0.3 MG/HR TD PT24,,4892,LOCAL,Facility,Both,1,EA,,268,227.8,76.8088,268,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,76.8088,28.66,,percent of total billed charges,,
NITROGLYCERIN 0.3 MG/HR TD PT24,,4892,LOCAL,Facility,Outpatient,1,EA,,268,227.8,76.8088,268,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),131.32,49,,percent of total billed charges,,
NITROGLYCERIN 0.3 MG/HR TD PT24,,4892,LOCAL,Facility,Inpatient,1,EA,,268,227.8,76.8088,268,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
NITROGLYCERIN 0.3 MG/HR TD PT24,,4892,LOCAL,Facility,Both,1,EA,,268,227.8,76.8088,268,CorVel,Worker's Compensation,268,100,,percent of total billed charges,,
NITROGLYCERIN 0.3 MG/HR TD PT24,,4892,LOCAL,Facility,Both,1,EA,,268,227.8,76.8088,268,First Health Group Corporation,First Health Network,259.96,97,,percent of total billed charges,,
NITROGLYCERIN 0.3 MG/HR TD PT24,,4892,LOCAL,Facility,Both,1,EA,,268,227.8,76.8088,268,"Health Partners, Inc.",Commercial,253.528,94.6,,percent of total billed charges,,
NITROGLYCERIN 0.3 MG/HR TD PT24,,4892,LOCAL,Facility,Outpatient,1,EA,,268,227.8,76.8088,268,"Health Partners, Inc.",Medicare Advantage,131.32,49,,percent of total billed charges,,
NITROGLYCERIN 0.3 MG/HR TD PT24,,4892,LOCAL,Facility,Inpatient,1,EA,,268,227.8,76.8088,268,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
NITROGLYCERIN 0.3 MG/HR TD PT24,,4892,LOCAL,Facility,Both,1,EA,,268,227.8,76.8088,268,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),160.8,60,,percent of total billed charges,,
NITROGLYCERIN 0.3 MG/HR TD PT24,,4892,LOCAL,Facility,Both,1,EA,,268,227.8,76.8088,268,"Health Partners, Inc.",State of Minnesota Advantage Program,218.42,81.5,,percent of total billed charges,,
NITROGLYCERIN 0.3 MG/HR TD PT24,,4892,LOCAL,Facility,Both,1,EA,,268,227.8,76.8088,268,"Health Partners, Inc.",State Public Programs,134,50,,percent of total billed charges,,
NITROGLYCERIN 0.3 MG/HR TD PT24,,4892,LOCAL,Facility,Both,1,EA,,268,227.8,76.8088,268,Humana Insurance Company,Commercial PPO,254.6,95,,percent of total billed charges,,
NITROGLYCERIN 0.3 MG/HR TD PT24,,4892,LOCAL,Facility,Outpatient,1,EA,,268,227.8,76.8088,268,Humana Insurance Company,Medicare PPO,131.32,49,,percent of total billed charges,,
NITROGLYCERIN 0.3 MG/HR TD PT24,,4892,LOCAL,Facility,Inpatient,1,EA,,268,227.8,76.8088,268,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
NITROGLYCERIN 0.3 MG/HR TD PT24,,4892,LOCAL,Facility,Both,1,EA,,268,227.8,76.8088,268,Medica,Individual & Family,265.588,99.1,,percent of total billed charges,,
NITROGLYCERIN 0.3 MG/HR TD PT24,,4892,LOCAL,Facility,Outpatient,1,EA,,268,227.8,76.8088,268,Medica,Medica Advantage Solution,133.464,49.8,,percent of total billed charges,,
NITROGLYCERIN 0.3 MG/HR TD PT24,,4892,LOCAL,Facility,Inpatient,1,EA,,268,227.8,76.8088,268,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
NITROGLYCERIN 0.3 MG/HR TD PT24,,4892,LOCAL,Facility,Outpatient,1,EA,,268,227.8,76.8088,268,Medica,Medical Assistance,119.528,44.6,,percent of total billed charges,,
NITROGLYCERIN 0.3 MG/HR TD PT24,,4892,LOCAL,Facility,Inpatient,1,EA,,268,227.8,76.8088,268,Medica,Medical Assistance,,,,,Included in per diem rate,
NITROGLYCERIN 0.3 MG/HR TD PT24,,4892,LOCAL,Facility,Outpatient,1,EA,,268,227.8,76.8088,268,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,133.464,49.8,,percent of total billed charges,,
NITROGLYCERIN 0.3 MG/HR TD PT24,,4892,LOCAL,Facility,Inpatient,1,EA,,268,227.8,76.8088,268,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
NITROGLYCERIN 0.3 MG/HR TD PT24,,4892,LOCAL,Facility,Both,1,EA,,268,227.8,76.8088,268,"Multiplan, Inc.","Multiplan, Inc.",251.92,94,,percent of total billed charges,,
NITROGLYCERIN 0.3 MG/HR TD PT24,,4892,LOCAL,Facility,Outpatient,1,EA,,268,227.8,76.8088,268,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,241.468,90.1,,percent of total billed charges,,
NITROGLYCERIN 0.3 MG/HR TD PT24,,4892,LOCAL,Facility,Inpatient,1,EA,,268,227.8,76.8088,268,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
NITROGLYCERIN 0.3 MG/HR TD PT24,,4892,LOCAL,Facility,Both,1,EA,,268,227.8,76.8088,268,"Preferred One Administrative Services, INC.",PPO,264.248,98.6,,percent of total billed charges,,
NITROGLYCERIN 0.3 MG/HR TD PT24,,4892,LOCAL,Facility,Outpatient,1,EA,,268,227.8,76.8088,268,PrimeWest Health,Minnesota Senior Health Options (MSHO),137.886,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
NITROGLYCERIN 0.3 MG/HR TD PT24,,4892,LOCAL,Facility,Inpatient,1,EA,,268,227.8,76.8088,268,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
NITROGLYCERIN 0.3 MG/HR TD PT24,,4892,LOCAL,Facility,Outpatient,1,EA,,268,227.8,76.8088,268,PrimeWest Health,MinnesotaCare,137.6448,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
NITROGLYCERIN 0.3 MG/HR TD PT24,,4892,LOCAL,Facility,Inpatient,1,EA,,268,227.8,76.8088,268,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
NITROGLYCERIN 0.3 MG/HR TD PT24,,4892,LOCAL,Facility,Both,1,EA,,268,227.8,76.8088,268,Sanford Health Plan,Sanford Health Plan,246.56,92,,percent of total billed charges,,
NITROGLYCERIN 0.3 MG/HR TD PT24,,4892,LOCAL,Facility,Outpatient,1,EA,,268,227.8,76.8088,268,"UCare Health, Inc.",Individual & Family Plan,151.018,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
NITROGLYCERIN 0.3 MG/HR TD PT24,,4892,LOCAL,Facility,Inpatient,1,EA,,268,227.8,76.8088,268,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
NITROGLYCERIN 0.3 MG/HR TD PT24,,4892,LOCAL,Facility,Outpatient,1,EA,,268,227.8,76.8088,268,"UCare Health, Inc.",Medical Assistance,135.2596,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
NITROGLYCERIN 0.3 MG/HR TD PT24,,4892,LOCAL,Facility,Inpatient,1,EA,,268,227.8,76.8088,268,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
NITROGLYCERIN 0.3 MG/HR TD PT24,,4892,LOCAL,Facility,Outpatient,1,EA,,268,227.8,76.8088,268,"UCare Health, Inc.",Medicare Advantage,135.2596,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
NITROGLYCERIN 0.3 MG/HR TD PT24,,4892,LOCAL,Facility,Inpatient,1,EA,,268,227.8,76.8088,268,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
NITROGLYCERIN 0.3 MG/HR TD PT24,,4892,LOCAL,Facility,Outpatient,1,EA,,268,227.8,76.8088,268,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),135.2596,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
NITROGLYCERIN 0.3 MG/HR TD PT24,,4892,LOCAL,Facility,Inpatient,1,EA,,268,227.8,76.8088,268,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
NITROGLYCERIN 0.3 MG/HR TD PT24,,4892,LOCAL,Facility,Both,1,EA,,268,227.8,76.8088,268,UnitedHealthcare,Individual & Family,251.92,94,,percent of total billed charges,,
NITROGLYCERIN 0.3 MG/HR TD PT24,,4892,LOCAL,Facility,Outpatient,1,EA,,268,227.8,76.8088,268,UnitedHealthcare,Medicare Advantage,131.32,49,,percent of total billed charges,,
NITROGLYCERIN 0.3 MG/HR TD PT24,,4892,LOCAL,Facility,Inpatient,1,EA,,268,227.8,76.8088,268,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
NITROGLYCERIN 0.3 MG/HR TD PT24,,4892,LOCAL,Facility,Outpatient,1,EA,,268,227.8,76.8088,268,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,128.64,48,,percent of total billed charges,,100% of DHS outpatient percentage
NITROGLYCERIN 0.3 MG/HR TD PT24,,4892,LOCAL,Facility,Inpatient,1,EA,,268,227.8,76.8088,268,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
ENALAPRIL MALEATE 2.5 MG ORAL TABLET,,5009,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
ENALAPRIL MALEATE 2.5 MG ORAL TABLET,,5009,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
ENALAPRIL MALEATE 2.5 MG ORAL TABLET,,5009,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
ENALAPRIL MALEATE 2.5 MG ORAL TABLET,,5009,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
ENALAPRIL MALEATE 2.5 MG ORAL TABLET,,5009,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
ENALAPRIL MALEATE 2.5 MG ORAL TABLET,,5009,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
ENALAPRIL MALEATE 2.5 MG ORAL TABLET,,5009,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
ENALAPRIL MALEATE 2.5 MG ORAL TABLET,,5009,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
ENALAPRIL MALEATE 2.5 MG ORAL TABLET,,5009,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
ENALAPRIL MALEATE 2.5 MG ORAL TABLET,,5009,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
ENALAPRIL MALEATE 2.5 MG ORAL TABLET,,5009,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
ENALAPRIL MALEATE 2.5 MG ORAL TABLET,,5009,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
ENALAPRIL MALEATE 2.5 MG ORAL TABLET,,5009,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
ENALAPRIL MALEATE 2.5 MG ORAL TABLET,,5009,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
ENALAPRIL MALEATE 2.5 MG ORAL TABLET,,5009,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
ENALAPRIL MALEATE 2.5 MG ORAL TABLET,,5009,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
ENALAPRIL MALEATE 2.5 MG ORAL TABLET,,5009,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
ENALAPRIL MALEATE 2.5 MG ORAL TABLET,,5009,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
ENALAPRIL MALEATE 2.5 MG ORAL TABLET,,5009,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ENALAPRIL MALEATE 2.5 MG ORAL TABLET,,5009,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
ENALAPRIL MALEATE 2.5 MG ORAL TABLET,,5009,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
ENALAPRIL MALEATE 2.5 MG ORAL TABLET,,5009,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
ENALAPRIL MALEATE 2.5 MG ORAL TABLET,,5009,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
ENALAPRIL MALEATE 2.5 MG ORAL TABLET,,5009,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
ENALAPRIL MALEATE 2.5 MG ORAL TABLET,,5009,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
ENALAPRIL MALEATE 2.5 MG ORAL TABLET,,5009,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
ENALAPRIL MALEATE 2.5 MG ORAL TABLET,,5009,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
ENALAPRIL MALEATE 2.5 MG ORAL TABLET,,5009,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
ENALAPRIL MALEATE 2.5 MG ORAL TABLET,,5009,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
ENALAPRIL MALEATE 2.5 MG ORAL TABLET,,5009,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
ENALAPRIL MALEATE 2.5 MG ORAL TABLET,,5009,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
ENALAPRIL MALEATE 2.5 MG ORAL TABLET,,5009,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
ENALAPRIL MALEATE 2.5 MG ORAL TABLET,,5009,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
ENALAPRIL MALEATE 2.5 MG ORAL TABLET,,5009,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
ENALAPRIL MALEATE 2.5 MG ORAL TABLET,,5009,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
ENALAPRIL MALEATE 2.5 MG ORAL TABLET,,5009,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
ENALAPRIL MALEATE 2.5 MG ORAL TABLET,,5009,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
ENALAPRIL MALEATE 2.5 MG ORAL TABLET,,5009,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ENALAPRIL MALEATE 2.5 MG ORAL TABLET,,5009,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
ENALAPRIL MALEATE 2.5 MG ORAL TABLET,,5009,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
ENALAPRIL MALEATE 2.5 MG ORAL TABLET,,5009,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
ENALAPRIL MALEATE 2.5 MG ORAL TABLET,,5009,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
ENALAPRIL MALEATE 2.5 MG ORAL TABLET,,5009,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
ENALAPRIL MALEATE 2.5 MG ORAL TABLET,,5009,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ENALAPRIL MALEATE 2.5 MG ORAL TABLET,,5009,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
ENALAPRIL MALEATE 2.5 MG ORAL TABLET,,5009,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ENALAPRIL MALEATE 2.5 MG ORAL TABLET,,5009,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ENALAPRIL MALEATE 2.5 MG ORAL TABLET,,5009,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ENALAPRIL MALEATE 2.5 MG ORAL TABLET,,5009,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ENALAPRIL MALEATE 2.5 MG ORAL TABLET,,5009,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
ENALAPRIL MALEATE 2.5 MG ORAL TABLET,,5009,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
ENALAPRIL MALEATE 2.5 MG ORAL TABLET,,5009,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
ENALAPRIL MALEATE 2.5 MG ORAL TABLET,,5009,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
ENALAPRIL MALEATE 2.5 MG ORAL TABLET,,5009,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
CARBIDOPA-LEVODOPA 50-200 MG ORAL TAB SR,,5049,LOCAL,Facility,Both,1,EA,,9,7.65,2.5794,9,Aetna,Commercial,8.28,92,,percent of total billed charges,,
CARBIDOPA-LEVODOPA 50-200 MG ORAL TAB SR,,5049,LOCAL,Facility,Outpatient,1,EA,,9,7.65,2.5794,9,Aetna,Medicare Advantage,4.41,49,,percent of total billed charges,,
CARBIDOPA-LEVODOPA 50-200 MG ORAL TAB SR,,5049,LOCAL,Facility,Inpatient,1,EA,,9,7.65,2.5794,9,Aetna,Medicare Advantage,,,,,Included in per diem rate,
CARBIDOPA-LEVODOPA 50-200 MG ORAL TAB SR,,5049,LOCAL,Facility,Both,1,EA,,9,7.65,2.5794,9,Aetna,PPO,8.37,93,,percent of total billed charges,,
CARBIDOPA-LEVODOPA 50-200 MG ORAL TAB SR,,5049,LOCAL,Facility,Both,1,EA,,9,7.65,2.5794,9,America's PPO,America's PPO,8.6427,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
CARBIDOPA-LEVODOPA 50-200 MG ORAL TAB SR,,5049,LOCAL,Facility,Both,1,EA,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota, Federal Employee Program,8.856,98.4,,percent of total billed charges,,
CARBIDOPA-LEVODOPA 50-200 MG ORAL TAB SR,,5049,LOCAL,Facility,Both,1,EA,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,9,100,,percent of total billed charges,,
CARBIDOPA-LEVODOPA 50-200 MG ORAL TAB SR,,5049,LOCAL,Facility,Both,1,EA,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota,High Value Network Plan,8.1,90,,percent of total billed charges,,
CARBIDOPA-LEVODOPA 50-200 MG ORAL TAB SR,,5049,LOCAL,Facility,Outpatient,1,EA,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota,Medicare Advantage,4.41,49,,percent of total billed charges,,
CARBIDOPA-LEVODOPA 50-200 MG ORAL TAB SR,,5049,LOCAL,Facility,Inpatient,1,EA,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
CARBIDOPA-LEVODOPA 50-200 MG ORAL TAB SR,,5049,LOCAL,Facility,Both,1,EA,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,7.9713,88.57,,percent of total billed charges,,
CARBIDOPA-LEVODOPA 50-200 MG ORAL TAB SR,,5049,LOCAL,Facility,Both,1,EA,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,2.5794,28.66,,percent of total billed charges,,
CARBIDOPA-LEVODOPA 50-200 MG ORAL TAB SR,,5049,LOCAL,Facility,Outpatient,1,EA,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),4.41,49,,percent of total billed charges,,
CARBIDOPA-LEVODOPA 50-200 MG ORAL TAB SR,,5049,LOCAL,Facility,Inpatient,1,EA,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
CARBIDOPA-LEVODOPA 50-200 MG ORAL TAB SR,,5049,LOCAL,Facility,Both,1,EA,,9,7.65,2.5794,9,CorVel,Worker's Compensation,9,100,,percent of total billed charges,,
CARBIDOPA-LEVODOPA 50-200 MG ORAL TAB SR,,5049,LOCAL,Facility,Both,1,EA,,9,7.65,2.5794,9,First Health Group Corporation,First Health Network,8.73,97,,percent of total billed charges,,
CARBIDOPA-LEVODOPA 50-200 MG ORAL TAB SR,,5049,LOCAL,Facility,Both,1,EA,,9,7.65,2.5794,9,"Health Partners, Inc.",Commercial,8.514,94.6,,percent of total billed charges,,
CARBIDOPA-LEVODOPA 50-200 MG ORAL TAB SR,,5049,LOCAL,Facility,Outpatient,1,EA,,9,7.65,2.5794,9,"Health Partners, Inc.",Medicare Advantage,4.41,49,,percent of total billed charges,,
CARBIDOPA-LEVODOPA 50-200 MG ORAL TAB SR,,5049,LOCAL,Facility,Inpatient,1,EA,,9,7.65,2.5794,9,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CARBIDOPA-LEVODOPA 50-200 MG ORAL TAB SR,,5049,LOCAL,Facility,Both,1,EA,,9,7.65,2.5794,9,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),5.4,60,,percent of total billed charges,,
CARBIDOPA-LEVODOPA 50-200 MG ORAL TAB SR,,5049,LOCAL,Facility,Both,1,EA,,9,7.65,2.5794,9,"Health Partners, Inc.",State of Minnesota Advantage Program,7.335,81.5,,percent of total billed charges,,
CARBIDOPA-LEVODOPA 50-200 MG ORAL TAB SR,,5049,LOCAL,Facility,Both,1,EA,,9,7.65,2.5794,9,"Health Partners, Inc.",State Public Programs,4.5,50,,percent of total billed charges,,
CARBIDOPA-LEVODOPA 50-200 MG ORAL TAB SR,,5049,LOCAL,Facility,Both,1,EA,,9,7.65,2.5794,9,Humana Insurance Company,Commercial PPO,8.55,95,,percent of total billed charges,,
CARBIDOPA-LEVODOPA 50-200 MG ORAL TAB SR,,5049,LOCAL,Facility,Outpatient,1,EA,,9,7.65,2.5794,9,Humana Insurance Company,Medicare PPO,4.41,49,,percent of total billed charges,,
CARBIDOPA-LEVODOPA 50-200 MG ORAL TAB SR,,5049,LOCAL,Facility,Inpatient,1,EA,,9,7.65,2.5794,9,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
CARBIDOPA-LEVODOPA 50-200 MG ORAL TAB SR,,5049,LOCAL,Facility,Both,1,EA,,9,7.65,2.5794,9,Medica,Individual & Family,8.919,99.1,,percent of total billed charges,,
CARBIDOPA-LEVODOPA 50-200 MG ORAL TAB SR,,5049,LOCAL,Facility,Outpatient,1,EA,,9,7.65,2.5794,9,Medica,Medica Advantage Solution,4.482,49.8,,percent of total billed charges,,
CARBIDOPA-LEVODOPA 50-200 MG ORAL TAB SR,,5049,LOCAL,Facility,Inpatient,1,EA,,9,7.65,2.5794,9,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
CARBIDOPA-LEVODOPA 50-200 MG ORAL TAB SR,,5049,LOCAL,Facility,Outpatient,1,EA,,9,7.65,2.5794,9,Medica,Medical Assistance,4.014,44.6,,percent of total billed charges,,
CARBIDOPA-LEVODOPA 50-200 MG ORAL TAB SR,,5049,LOCAL,Facility,Inpatient,1,EA,,9,7.65,2.5794,9,Medica,Medical Assistance,,,,,Included in per diem rate,
CARBIDOPA-LEVODOPA 50-200 MG ORAL TAB SR,,5049,LOCAL,Facility,Outpatient,1,EA,,9,7.65,2.5794,9,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,4.482,49.8,,percent of total billed charges,,
CARBIDOPA-LEVODOPA 50-200 MG ORAL TAB SR,,5049,LOCAL,Facility,Inpatient,1,EA,,9,7.65,2.5794,9,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
CARBIDOPA-LEVODOPA 50-200 MG ORAL TAB SR,,5049,LOCAL,Facility,Both,1,EA,,9,7.65,2.5794,9,"Multiplan, Inc.","Multiplan, Inc.",8.46,94,,percent of total billed charges,,
CARBIDOPA-LEVODOPA 50-200 MG ORAL TAB SR,,5049,LOCAL,Facility,Outpatient,1,EA,,9,7.65,2.5794,9,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,8.109,90.1,,percent of total billed charges,,
CARBIDOPA-LEVODOPA 50-200 MG ORAL TAB SR,,5049,LOCAL,Facility,Inpatient,1,EA,,9,7.65,2.5794,9,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
CARBIDOPA-LEVODOPA 50-200 MG ORAL TAB SR,,5049,LOCAL,Facility,Both,1,EA,,9,7.65,2.5794,9,"Preferred One Administrative Services, INC.",PPO,8.874,98.6,,percent of total billed charges,,
CARBIDOPA-LEVODOPA 50-200 MG ORAL TAB SR,,5049,LOCAL,Facility,Outpatient,1,EA,,9,7.65,2.5794,9,PrimeWest Health,Minnesota Senior Health Options (MSHO),4.6305,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
CARBIDOPA-LEVODOPA 50-200 MG ORAL TAB SR,,5049,LOCAL,Facility,Inpatient,1,EA,,9,7.65,2.5794,9,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CARBIDOPA-LEVODOPA 50-200 MG ORAL TAB SR,,5049,LOCAL,Facility,Outpatient,1,EA,,9,7.65,2.5794,9,PrimeWest Health,MinnesotaCare,4.6224,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
CARBIDOPA-LEVODOPA 50-200 MG ORAL TAB SR,,5049,LOCAL,Facility,Inpatient,1,EA,,9,7.65,2.5794,9,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
CARBIDOPA-LEVODOPA 50-200 MG ORAL TAB SR,,5049,LOCAL,Facility,Both,1,EA,,9,7.65,2.5794,9,Sanford Health Plan,Sanford Health Plan,8.28,92,,percent of total billed charges,,
CARBIDOPA-LEVODOPA 50-200 MG ORAL TAB SR,,5049,LOCAL,Facility,Outpatient,1,EA,,9,7.65,2.5794,9,"UCare Health, Inc.",Individual & Family Plan,5.0715,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
CARBIDOPA-LEVODOPA 50-200 MG ORAL TAB SR,,5049,LOCAL,Facility,Inpatient,1,EA,,9,7.65,2.5794,9,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
CARBIDOPA-LEVODOPA 50-200 MG ORAL TAB SR,,5049,LOCAL,Facility,Outpatient,1,EA,,9,7.65,2.5794,9,"UCare Health, Inc.",Medical Assistance,4.5423,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CARBIDOPA-LEVODOPA 50-200 MG ORAL TAB SR,,5049,LOCAL,Facility,Inpatient,1,EA,,9,7.65,2.5794,9,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
CARBIDOPA-LEVODOPA 50-200 MG ORAL TAB SR,,5049,LOCAL,Facility,Outpatient,1,EA,,9,7.65,2.5794,9,"UCare Health, Inc.",Medicare Advantage,4.5423,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CARBIDOPA-LEVODOPA 50-200 MG ORAL TAB SR,,5049,LOCAL,Facility,Inpatient,1,EA,,9,7.65,2.5794,9,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CARBIDOPA-LEVODOPA 50-200 MG ORAL TAB SR,,5049,LOCAL,Facility,Outpatient,1,EA,,9,7.65,2.5794,9,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),4.5423,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CARBIDOPA-LEVODOPA 50-200 MG ORAL TAB SR,,5049,LOCAL,Facility,Inpatient,1,EA,,9,7.65,2.5794,9,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CARBIDOPA-LEVODOPA 50-200 MG ORAL TAB SR,,5049,LOCAL,Facility,Both,1,EA,,9,7.65,2.5794,9,UnitedHealthcare,Individual & Family,8.46,94,,percent of total billed charges,,
CARBIDOPA-LEVODOPA 50-200 MG ORAL TAB SR,,5049,LOCAL,Facility,Outpatient,1,EA,,9,7.65,2.5794,9,UnitedHealthcare,Medicare Advantage,4.41,49,,percent of total billed charges,,
CARBIDOPA-LEVODOPA 50-200 MG ORAL TAB SR,,5049,LOCAL,Facility,Inpatient,1,EA,,9,7.65,2.5794,9,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
CARBIDOPA-LEVODOPA 50-200 MG ORAL TAB SR,,5049,LOCAL,Facility,Outpatient,1,EA,,9,7.65,2.5794,9,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,4.32,48,,percent of total billed charges,,100% of DHS outpatient percentage
CARBIDOPA-LEVODOPA 50-200 MG ORAL TAB SR,,5049,LOCAL,Facility,Inpatient,1,EA,,9,7.65,2.5794,9,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
SENNOSIDES-DOCUSATE SODIUM 8.6-50 MG ORAL TABLET,,5080,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
SENNOSIDES-DOCUSATE SODIUM 8.6-50 MG ORAL TABLET,,5080,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
SENNOSIDES-DOCUSATE SODIUM 8.6-50 MG ORAL TABLET,,5080,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
SENNOSIDES-DOCUSATE SODIUM 8.6-50 MG ORAL TABLET,,5080,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
SENNOSIDES-DOCUSATE SODIUM 8.6-50 MG ORAL TABLET,,5080,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SENNOSIDES-DOCUSATE SODIUM 8.6-50 MG ORAL TABLET,,5080,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
SENNOSIDES-DOCUSATE SODIUM 8.6-50 MG ORAL TABLET,,5080,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
SENNOSIDES-DOCUSATE SODIUM 8.6-50 MG ORAL TABLET,,5080,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
SENNOSIDES-DOCUSATE SODIUM 8.6-50 MG ORAL TABLET,,5080,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
SENNOSIDES-DOCUSATE SODIUM 8.6-50 MG ORAL TABLET,,5080,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
SENNOSIDES-DOCUSATE SODIUM 8.6-50 MG ORAL TABLET,,5080,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
SENNOSIDES-DOCUSATE SODIUM 8.6-50 MG ORAL TABLET,,5080,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
SENNOSIDES-DOCUSATE SODIUM 8.6-50 MG ORAL TABLET,,5080,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
SENNOSIDES-DOCUSATE SODIUM 8.6-50 MG ORAL TABLET,,5080,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
SENNOSIDES-DOCUSATE SODIUM 8.6-50 MG ORAL TABLET,,5080,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
SENNOSIDES-DOCUSATE SODIUM 8.6-50 MG ORAL TABLET,,5080,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
SENNOSIDES-DOCUSATE SODIUM 8.6-50 MG ORAL TABLET,,5080,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
SENNOSIDES-DOCUSATE SODIUM 8.6-50 MG ORAL TABLET,,5080,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
SENNOSIDES-DOCUSATE SODIUM 8.6-50 MG ORAL TABLET,,5080,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SENNOSIDES-DOCUSATE SODIUM 8.6-50 MG ORAL TABLET,,5080,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
SENNOSIDES-DOCUSATE SODIUM 8.6-50 MG ORAL TABLET,,5080,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
SENNOSIDES-DOCUSATE SODIUM 8.6-50 MG ORAL TABLET,,5080,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
SENNOSIDES-DOCUSATE SODIUM 8.6-50 MG ORAL TABLET,,5080,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
SENNOSIDES-DOCUSATE SODIUM 8.6-50 MG ORAL TABLET,,5080,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
SENNOSIDES-DOCUSATE SODIUM 8.6-50 MG ORAL TABLET,,5080,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
SENNOSIDES-DOCUSATE SODIUM 8.6-50 MG ORAL TABLET,,5080,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
SENNOSIDES-DOCUSATE SODIUM 8.6-50 MG ORAL TABLET,,5080,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
SENNOSIDES-DOCUSATE SODIUM 8.6-50 MG ORAL TABLET,,5080,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
SENNOSIDES-DOCUSATE SODIUM 8.6-50 MG ORAL TABLET,,5080,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
SENNOSIDES-DOCUSATE SODIUM 8.6-50 MG ORAL TABLET,,5080,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
SENNOSIDES-DOCUSATE SODIUM 8.6-50 MG ORAL TABLET,,5080,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
SENNOSIDES-DOCUSATE SODIUM 8.6-50 MG ORAL TABLET,,5080,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
SENNOSIDES-DOCUSATE SODIUM 8.6-50 MG ORAL TABLET,,5080,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
SENNOSIDES-DOCUSATE SODIUM 8.6-50 MG ORAL TABLET,,5080,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
SENNOSIDES-DOCUSATE SODIUM 8.6-50 MG ORAL TABLET,,5080,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
SENNOSIDES-DOCUSATE SODIUM 8.6-50 MG ORAL TABLET,,5080,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
SENNOSIDES-DOCUSATE SODIUM 8.6-50 MG ORAL TABLET,,5080,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
SENNOSIDES-DOCUSATE SODIUM 8.6-50 MG ORAL TABLET,,5080,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SENNOSIDES-DOCUSATE SODIUM 8.6-50 MG ORAL TABLET,,5080,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
SENNOSIDES-DOCUSATE SODIUM 8.6-50 MG ORAL TABLET,,5080,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
SENNOSIDES-DOCUSATE SODIUM 8.6-50 MG ORAL TABLET,,5080,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
SENNOSIDES-DOCUSATE SODIUM 8.6-50 MG ORAL TABLET,,5080,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
SENNOSIDES-DOCUSATE SODIUM 8.6-50 MG ORAL TABLET,,5080,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
SENNOSIDES-DOCUSATE SODIUM 8.6-50 MG ORAL TABLET,,5080,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SENNOSIDES-DOCUSATE SODIUM 8.6-50 MG ORAL TABLET,,5080,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
SENNOSIDES-DOCUSATE SODIUM 8.6-50 MG ORAL TABLET,,5080,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SENNOSIDES-DOCUSATE SODIUM 8.6-50 MG ORAL TABLET,,5080,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SENNOSIDES-DOCUSATE SODIUM 8.6-50 MG ORAL TABLET,,5080,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SENNOSIDES-DOCUSATE SODIUM 8.6-50 MG ORAL TABLET,,5080,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SENNOSIDES-DOCUSATE SODIUM 8.6-50 MG ORAL TABLET,,5080,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
SENNOSIDES-DOCUSATE SODIUM 8.6-50 MG ORAL TABLET,,5080,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
SENNOSIDES-DOCUSATE SODIUM 8.6-50 MG ORAL TABLET,,5080,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
SENNOSIDES-DOCUSATE SODIUM 8.6-50 MG ORAL TABLET,,5080,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
SENNOSIDES-DOCUSATE SODIUM 8.6-50 MG ORAL TABLET,,5080,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
SIMVASTATIN 10 MG ORAL TABLET,,5204,LOCAL,Facility,Both,1,EA,,15,12.75,4.299,15,Aetna,Commercial,13.8,92,,percent of total billed charges,,
SIMVASTATIN 10 MG ORAL TABLET,,5204,LOCAL,Facility,Outpatient,1,EA,,15,12.75,4.299,15,Aetna,Medicare Advantage,7.35,49,,percent of total billed charges,,
SIMVASTATIN 10 MG ORAL TABLET,,5204,LOCAL,Facility,Inpatient,1,EA,,15,12.75,4.299,15,Aetna,Medicare Advantage,,,,,Included in per diem rate,
SIMVASTATIN 10 MG ORAL TABLET,,5204,LOCAL,Facility,Both,1,EA,,15,12.75,4.299,15,Aetna,PPO,13.95,93,,percent of total billed charges,,
SIMVASTATIN 10 MG ORAL TABLET,,5204,LOCAL,Facility,Both,1,EA,,15,12.75,4.299,15,America's PPO,America's PPO,14.4045,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SIMVASTATIN 10 MG ORAL TABLET,,5204,LOCAL,Facility,Both,1,EA,,15,12.75,4.299,15,BlueCross BlueShield Minnesota, Federal Employee Program,14.76,98.4,,percent of total billed charges,,
SIMVASTATIN 10 MG ORAL TABLET,,5204,LOCAL,Facility,Both,1,EA,,15,12.75,4.299,15,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,15,100,,percent of total billed charges,,
SIMVASTATIN 10 MG ORAL TABLET,,5204,LOCAL,Facility,Both,1,EA,,15,12.75,4.299,15,BlueCross BlueShield Minnesota,High Value Network Plan,13.5,90,,percent of total billed charges,,
SIMVASTATIN 10 MG ORAL TABLET,,5204,LOCAL,Facility,Outpatient,1,EA,,15,12.75,4.299,15,BlueCross BlueShield Minnesota,Medicare Advantage,7.35,49,,percent of total billed charges,,
SIMVASTATIN 10 MG ORAL TABLET,,5204,LOCAL,Facility,Inpatient,1,EA,,15,12.75,4.299,15,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
SIMVASTATIN 10 MG ORAL TABLET,,5204,LOCAL,Facility,Both,1,EA,,15,12.75,4.299,15,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,13.2855,88.57,,percent of total billed charges,,
SIMVASTATIN 10 MG ORAL TABLET,,5204,LOCAL,Facility,Both,1,EA,,15,12.75,4.299,15,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,4.299,28.66,,percent of total billed charges,,
SIMVASTATIN 10 MG ORAL TABLET,,5204,LOCAL,Facility,Outpatient,1,EA,,15,12.75,4.299,15,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),7.35,49,,percent of total billed charges,,
SIMVASTATIN 10 MG ORAL TABLET,,5204,LOCAL,Facility,Inpatient,1,EA,,15,12.75,4.299,15,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
SIMVASTATIN 10 MG ORAL TABLET,,5204,LOCAL,Facility,Both,1,EA,,15,12.75,4.299,15,CorVel,Worker's Compensation,15,100,,percent of total billed charges,,
SIMVASTATIN 10 MG ORAL TABLET,,5204,LOCAL,Facility,Both,1,EA,,15,12.75,4.299,15,First Health Group Corporation,First Health Network,14.55,97,,percent of total billed charges,,
SIMVASTATIN 10 MG ORAL TABLET,,5204,LOCAL,Facility,Both,1,EA,,15,12.75,4.299,15,"Health Partners, Inc.",Commercial,14.19,94.6,,percent of total billed charges,,
SIMVASTATIN 10 MG ORAL TABLET,,5204,LOCAL,Facility,Outpatient,1,EA,,15,12.75,4.299,15,"Health Partners, Inc.",Medicare Advantage,7.35,49,,percent of total billed charges,,
SIMVASTATIN 10 MG ORAL TABLET,,5204,LOCAL,Facility,Inpatient,1,EA,,15,12.75,4.299,15,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SIMVASTATIN 10 MG ORAL TABLET,,5204,LOCAL,Facility,Both,1,EA,,15,12.75,4.299,15,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),9,60,,percent of total billed charges,,
SIMVASTATIN 10 MG ORAL TABLET,,5204,LOCAL,Facility,Both,1,EA,,15,12.75,4.299,15,"Health Partners, Inc.",State of Minnesota Advantage Program,12.225,81.5,,percent of total billed charges,,
SIMVASTATIN 10 MG ORAL TABLET,,5204,LOCAL,Facility,Both,1,EA,,15,12.75,4.299,15,"Health Partners, Inc.",State Public Programs,7.5,50,,percent of total billed charges,,
SIMVASTATIN 10 MG ORAL TABLET,,5204,LOCAL,Facility,Both,1,EA,,15,12.75,4.299,15,Humana Insurance Company,Commercial PPO,14.25,95,,percent of total billed charges,,
SIMVASTATIN 10 MG ORAL TABLET,,5204,LOCAL,Facility,Outpatient,1,EA,,15,12.75,4.299,15,Humana Insurance Company,Medicare PPO,7.35,49,,percent of total billed charges,,
SIMVASTATIN 10 MG ORAL TABLET,,5204,LOCAL,Facility,Inpatient,1,EA,,15,12.75,4.299,15,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
SIMVASTATIN 10 MG ORAL TABLET,,5204,LOCAL,Facility,Both,1,EA,,15,12.75,4.299,15,Medica,Individual & Family,14.865,99.1,,percent of total billed charges,,
SIMVASTATIN 10 MG ORAL TABLET,,5204,LOCAL,Facility,Outpatient,1,EA,,15,12.75,4.299,15,Medica,Medica Advantage Solution,7.47,49.8,,percent of total billed charges,,
SIMVASTATIN 10 MG ORAL TABLET,,5204,LOCAL,Facility,Inpatient,1,EA,,15,12.75,4.299,15,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
SIMVASTATIN 10 MG ORAL TABLET,,5204,LOCAL,Facility,Outpatient,1,EA,,15,12.75,4.299,15,Medica,Medical Assistance,6.69,44.6,,percent of total billed charges,,
SIMVASTATIN 10 MG ORAL TABLET,,5204,LOCAL,Facility,Inpatient,1,EA,,15,12.75,4.299,15,Medica,Medical Assistance,,,,,Included in per diem rate,
SIMVASTATIN 10 MG ORAL TABLET,,5204,LOCAL,Facility,Outpatient,1,EA,,15,12.75,4.299,15,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,7.47,49.8,,percent of total billed charges,,
SIMVASTATIN 10 MG ORAL TABLET,,5204,LOCAL,Facility,Inpatient,1,EA,,15,12.75,4.299,15,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
SIMVASTATIN 10 MG ORAL TABLET,,5204,LOCAL,Facility,Both,1,EA,,15,12.75,4.299,15,"Multiplan, Inc.","Multiplan, Inc.",14.1,94,,percent of total billed charges,,
SIMVASTATIN 10 MG ORAL TABLET,,5204,LOCAL,Facility,Outpatient,1,EA,,15,12.75,4.299,15,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,13.515,90.1,,percent of total billed charges,,
SIMVASTATIN 10 MG ORAL TABLET,,5204,LOCAL,Facility,Inpatient,1,EA,,15,12.75,4.299,15,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
SIMVASTATIN 10 MG ORAL TABLET,,5204,LOCAL,Facility,Both,1,EA,,15,12.75,4.299,15,"Preferred One Administrative Services, INC.",PPO,14.79,98.6,,percent of total billed charges,,
SIMVASTATIN 10 MG ORAL TABLET,,5204,LOCAL,Facility,Outpatient,1,EA,,15,12.75,4.299,15,PrimeWest Health,Minnesota Senior Health Options (MSHO),7.7175,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
SIMVASTATIN 10 MG ORAL TABLET,,5204,LOCAL,Facility,Inpatient,1,EA,,15,12.75,4.299,15,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SIMVASTATIN 10 MG ORAL TABLET,,5204,LOCAL,Facility,Outpatient,1,EA,,15,12.75,4.299,15,PrimeWest Health,MinnesotaCare,7.704,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
SIMVASTATIN 10 MG ORAL TABLET,,5204,LOCAL,Facility,Inpatient,1,EA,,15,12.75,4.299,15,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
SIMVASTATIN 10 MG ORAL TABLET,,5204,LOCAL,Facility,Both,1,EA,,15,12.75,4.299,15,Sanford Health Plan,Sanford Health Plan,13.8,92,,percent of total billed charges,,
SIMVASTATIN 10 MG ORAL TABLET,,5204,LOCAL,Facility,Outpatient,1,EA,,15,12.75,4.299,15,"UCare Health, Inc.",Individual & Family Plan,8.4525,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
SIMVASTATIN 10 MG ORAL TABLET,,5204,LOCAL,Facility,Inpatient,1,EA,,15,12.75,4.299,15,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
SIMVASTATIN 10 MG ORAL TABLET,,5204,LOCAL,Facility,Outpatient,1,EA,,15,12.75,4.299,15,"UCare Health, Inc.",Medical Assistance,7.5705,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SIMVASTATIN 10 MG ORAL TABLET,,5204,LOCAL,Facility,Inpatient,1,EA,,15,12.75,4.299,15,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
SIMVASTATIN 10 MG ORAL TABLET,,5204,LOCAL,Facility,Outpatient,1,EA,,15,12.75,4.299,15,"UCare Health, Inc.",Medicare Advantage,7.5705,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SIMVASTATIN 10 MG ORAL TABLET,,5204,LOCAL,Facility,Inpatient,1,EA,,15,12.75,4.299,15,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SIMVASTATIN 10 MG ORAL TABLET,,5204,LOCAL,Facility,Outpatient,1,EA,,15,12.75,4.299,15,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),7.5705,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SIMVASTATIN 10 MG ORAL TABLET,,5204,LOCAL,Facility,Inpatient,1,EA,,15,12.75,4.299,15,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SIMVASTATIN 10 MG ORAL TABLET,,5204,LOCAL,Facility,Both,1,EA,,15,12.75,4.299,15,UnitedHealthcare,Individual & Family,14.1,94,,percent of total billed charges,,
SIMVASTATIN 10 MG ORAL TABLET,,5204,LOCAL,Facility,Outpatient,1,EA,,15,12.75,4.299,15,UnitedHealthcare,Medicare Advantage,7.35,49,,percent of total billed charges,,
SIMVASTATIN 10 MG ORAL TABLET,,5204,LOCAL,Facility,Inpatient,1,EA,,15,12.75,4.299,15,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
SIMVASTATIN 10 MG ORAL TABLET,,5204,LOCAL,Facility,Outpatient,1,EA,,15,12.75,4.299,15,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,7.2,48,,percent of total billed charges,,100% of DHS outpatient percentage
SIMVASTATIN 10 MG ORAL TABLET,,5204,LOCAL,Facility,Inpatient,1,EA,,15,12.75,4.299,15,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
METFORMIN 850 MG ORAL TABLET,,5705,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
METFORMIN 850 MG ORAL TABLET,,5705,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
METFORMIN 850 MG ORAL TABLET,,5705,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
METFORMIN 850 MG ORAL TABLET,,5705,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
METFORMIN 850 MG ORAL TABLET,,5705,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
METFORMIN 850 MG ORAL TABLET,,5705,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
METFORMIN 850 MG ORAL TABLET,,5705,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
METFORMIN 850 MG ORAL TABLET,,5705,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
METFORMIN 850 MG ORAL TABLET,,5705,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
METFORMIN 850 MG ORAL TABLET,,5705,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
METFORMIN 850 MG ORAL TABLET,,5705,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
METFORMIN 850 MG ORAL TABLET,,5705,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
METFORMIN 850 MG ORAL TABLET,,5705,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
METFORMIN 850 MG ORAL TABLET,,5705,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
METFORMIN 850 MG ORAL TABLET,,5705,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
METFORMIN 850 MG ORAL TABLET,,5705,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
METFORMIN 850 MG ORAL TABLET,,5705,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
METFORMIN 850 MG ORAL TABLET,,5705,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
METFORMIN 850 MG ORAL TABLET,,5705,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
METFORMIN 850 MG ORAL TABLET,,5705,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
METFORMIN 850 MG ORAL TABLET,,5705,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
METFORMIN 850 MG ORAL TABLET,,5705,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
METFORMIN 850 MG ORAL TABLET,,5705,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
METFORMIN 850 MG ORAL TABLET,,5705,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
METFORMIN 850 MG ORAL TABLET,,5705,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
METFORMIN 850 MG ORAL TABLET,,5705,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
METFORMIN 850 MG ORAL TABLET,,5705,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
METFORMIN 850 MG ORAL TABLET,,5705,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
METFORMIN 850 MG ORAL TABLET,,5705,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
METFORMIN 850 MG ORAL TABLET,,5705,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
METFORMIN 850 MG ORAL TABLET,,5705,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
METFORMIN 850 MG ORAL TABLET,,5705,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
METFORMIN 850 MG ORAL TABLET,,5705,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
METFORMIN 850 MG ORAL TABLET,,5705,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
METFORMIN 850 MG ORAL TABLET,,5705,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
METFORMIN 850 MG ORAL TABLET,,5705,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
METFORMIN 850 MG ORAL TABLET,,5705,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
METFORMIN 850 MG ORAL TABLET,,5705,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
METFORMIN 850 MG ORAL TABLET,,5705,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
METFORMIN 850 MG ORAL TABLET,,5705,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
METFORMIN 850 MG ORAL TABLET,,5705,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
METFORMIN 850 MG ORAL TABLET,,5705,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
METFORMIN 850 MG ORAL TABLET,,5705,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
METFORMIN 850 MG ORAL TABLET,,5705,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
METFORMIN 850 MG ORAL TABLET,,5705,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
METFORMIN 850 MG ORAL TABLET,,5705,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
METFORMIN 850 MG ORAL TABLET,,5705,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
METFORMIN 850 MG ORAL TABLET,,5705,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
METFORMIN 850 MG ORAL TABLET,,5705,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
METFORMIN 850 MG ORAL TABLET,,5705,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
METFORMIN 850 MG ORAL TABLET,,5705,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
METFORMIN 850 MG ORAL TABLET,,5705,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
METFORMIN 850 MG ORAL TABLET,,5705,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
METFORMIN 850 MG ORAL TABLET,,5705,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
MOXIFLOXACIN 400 MG ORAL TABLET,,5801,LOCAL,Facility,Both,1,EA,,123,104.55,35.2518,123,Aetna,Commercial,113.16,92,,percent of total billed charges,,
MOXIFLOXACIN 400 MG ORAL TABLET,,5801,LOCAL,Facility,Outpatient,1,EA,,123,104.55,35.2518,123,Aetna,Medicare Advantage,60.27,49,,percent of total billed charges,,
MOXIFLOXACIN 400 MG ORAL TABLET,,5801,LOCAL,Facility,Inpatient,1,EA,,123,104.55,35.2518,123,Aetna,Medicare Advantage,,,,,Included in per diem rate,
MOXIFLOXACIN 400 MG ORAL TABLET,,5801,LOCAL,Facility,Both,1,EA,,123,104.55,35.2518,123,Aetna,PPO,114.39,93,,percent of total billed charges,,
MOXIFLOXACIN 400 MG ORAL TABLET,,5801,LOCAL,Facility,Both,1,EA,,123,104.55,35.2518,123,America's PPO,America's PPO,118.1169,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
MOXIFLOXACIN 400 MG ORAL TABLET,,5801,LOCAL,Facility,Both,1,EA,,123,104.55,35.2518,123,BlueCross BlueShield Minnesota, Federal Employee Program,121.032,98.4,,percent of total billed charges,,
MOXIFLOXACIN 400 MG ORAL TABLET,,5801,LOCAL,Facility,Both,1,EA,,123,104.55,35.2518,123,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,123,100,,percent of total billed charges,,
MOXIFLOXACIN 400 MG ORAL TABLET,,5801,LOCAL,Facility,Both,1,EA,,123,104.55,35.2518,123,BlueCross BlueShield Minnesota,High Value Network Plan,110.7,90,,percent of total billed charges,,
MOXIFLOXACIN 400 MG ORAL TABLET,,5801,LOCAL,Facility,Outpatient,1,EA,,123,104.55,35.2518,123,BlueCross BlueShield Minnesota,Medicare Advantage,60.27,49,,percent of total billed charges,,
MOXIFLOXACIN 400 MG ORAL TABLET,,5801,LOCAL,Facility,Inpatient,1,EA,,123,104.55,35.2518,123,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
MOXIFLOXACIN 400 MG ORAL TABLET,,5801,LOCAL,Facility,Both,1,EA,,123,104.55,35.2518,123,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,108.9411,88.57,,percent of total billed charges,,
MOXIFLOXACIN 400 MG ORAL TABLET,,5801,LOCAL,Facility,Both,1,EA,,123,104.55,35.2518,123,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,35.2518,28.66,,percent of total billed charges,,
MOXIFLOXACIN 400 MG ORAL TABLET,,5801,LOCAL,Facility,Outpatient,1,EA,,123,104.55,35.2518,123,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),60.27,49,,percent of total billed charges,,
MOXIFLOXACIN 400 MG ORAL TABLET,,5801,LOCAL,Facility,Inpatient,1,EA,,123,104.55,35.2518,123,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
MOXIFLOXACIN 400 MG ORAL TABLET,,5801,LOCAL,Facility,Both,1,EA,,123,104.55,35.2518,123,CorVel,Worker's Compensation,123,100,,percent of total billed charges,,
MOXIFLOXACIN 400 MG ORAL TABLET,,5801,LOCAL,Facility,Both,1,EA,,123,104.55,35.2518,123,First Health Group Corporation,First Health Network,119.31,97,,percent of total billed charges,,
MOXIFLOXACIN 400 MG ORAL TABLET,,5801,LOCAL,Facility,Both,1,EA,,123,104.55,35.2518,123,"Health Partners, Inc.",Commercial,116.358,94.6,,percent of total billed charges,,
MOXIFLOXACIN 400 MG ORAL TABLET,,5801,LOCAL,Facility,Outpatient,1,EA,,123,104.55,35.2518,123,"Health Partners, Inc.",Medicare Advantage,60.27,49,,percent of total billed charges,,
MOXIFLOXACIN 400 MG ORAL TABLET,,5801,LOCAL,Facility,Inpatient,1,EA,,123,104.55,35.2518,123,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
MOXIFLOXACIN 400 MG ORAL TABLET,,5801,LOCAL,Facility,Both,1,EA,,123,104.55,35.2518,123,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),73.8,60,,percent of total billed charges,,
MOXIFLOXACIN 400 MG ORAL TABLET,,5801,LOCAL,Facility,Both,1,EA,,123,104.55,35.2518,123,"Health Partners, Inc.",State of Minnesota Advantage Program,100.245,81.5,,percent of total billed charges,,
MOXIFLOXACIN 400 MG ORAL TABLET,,5801,LOCAL,Facility,Both,1,EA,,123,104.55,35.2518,123,"Health Partners, Inc.",State Public Programs,61.5,50,,percent of total billed charges,,
MOXIFLOXACIN 400 MG ORAL TABLET,,5801,LOCAL,Facility,Both,1,EA,,123,104.55,35.2518,123,Humana Insurance Company,Commercial PPO,116.85,95,,percent of total billed charges,,
MOXIFLOXACIN 400 MG ORAL TABLET,,5801,LOCAL,Facility,Outpatient,1,EA,,123,104.55,35.2518,123,Humana Insurance Company,Medicare PPO,60.27,49,,percent of total billed charges,,
MOXIFLOXACIN 400 MG ORAL TABLET,,5801,LOCAL,Facility,Inpatient,1,EA,,123,104.55,35.2518,123,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
MOXIFLOXACIN 400 MG ORAL TABLET,,5801,LOCAL,Facility,Both,1,EA,,123,104.55,35.2518,123,Medica,Individual & Family,121.893,99.1,,percent of total billed charges,,
MOXIFLOXACIN 400 MG ORAL TABLET,,5801,LOCAL,Facility,Outpatient,1,EA,,123,104.55,35.2518,123,Medica,Medica Advantage Solution,61.254,49.8,,percent of total billed charges,,
MOXIFLOXACIN 400 MG ORAL TABLET,,5801,LOCAL,Facility,Inpatient,1,EA,,123,104.55,35.2518,123,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
MOXIFLOXACIN 400 MG ORAL TABLET,,5801,LOCAL,Facility,Outpatient,1,EA,,123,104.55,35.2518,123,Medica,Medical Assistance,54.858,44.6,,percent of total billed charges,,
MOXIFLOXACIN 400 MG ORAL TABLET,,5801,LOCAL,Facility,Inpatient,1,EA,,123,104.55,35.2518,123,Medica,Medical Assistance,,,,,Included in per diem rate,
MOXIFLOXACIN 400 MG ORAL TABLET,,5801,LOCAL,Facility,Outpatient,1,EA,,123,104.55,35.2518,123,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,61.254,49.8,,percent of total billed charges,,
MOXIFLOXACIN 400 MG ORAL TABLET,,5801,LOCAL,Facility,Inpatient,1,EA,,123,104.55,35.2518,123,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
MOXIFLOXACIN 400 MG ORAL TABLET,,5801,LOCAL,Facility,Both,1,EA,,123,104.55,35.2518,123,"Multiplan, Inc.","Multiplan, Inc.",115.62,94,,percent of total billed charges,,
MOXIFLOXACIN 400 MG ORAL TABLET,,5801,LOCAL,Facility,Outpatient,1,EA,,123,104.55,35.2518,123,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,110.823,90.1,,percent of total billed charges,,
MOXIFLOXACIN 400 MG ORAL TABLET,,5801,LOCAL,Facility,Inpatient,1,EA,,123,104.55,35.2518,123,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
MOXIFLOXACIN 400 MG ORAL TABLET,,5801,LOCAL,Facility,Both,1,EA,,123,104.55,35.2518,123,"Preferred One Administrative Services, INC.",PPO,121.278,98.6,,percent of total billed charges,,
MOXIFLOXACIN 400 MG ORAL TABLET,,5801,LOCAL,Facility,Outpatient,1,EA,,123,104.55,35.2518,123,PrimeWest Health,Minnesota Senior Health Options (MSHO),63.2835,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
MOXIFLOXACIN 400 MG ORAL TABLET,,5801,LOCAL,Facility,Inpatient,1,EA,,123,104.55,35.2518,123,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
MOXIFLOXACIN 400 MG ORAL TABLET,,5801,LOCAL,Facility,Outpatient,1,EA,,123,104.55,35.2518,123,PrimeWest Health,MinnesotaCare,63.1728,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
MOXIFLOXACIN 400 MG ORAL TABLET,,5801,LOCAL,Facility,Inpatient,1,EA,,123,104.55,35.2518,123,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
MOXIFLOXACIN 400 MG ORAL TABLET,,5801,LOCAL,Facility,Both,1,EA,,123,104.55,35.2518,123,Sanford Health Plan,Sanford Health Plan,113.16,92,,percent of total billed charges,,
MOXIFLOXACIN 400 MG ORAL TABLET,,5801,LOCAL,Facility,Outpatient,1,EA,,123,104.55,35.2518,123,"UCare Health, Inc.",Individual & Family Plan,69.3105,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
MOXIFLOXACIN 400 MG ORAL TABLET,,5801,LOCAL,Facility,Inpatient,1,EA,,123,104.55,35.2518,123,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
MOXIFLOXACIN 400 MG ORAL TABLET,,5801,LOCAL,Facility,Outpatient,1,EA,,123,104.55,35.2518,123,"UCare Health, Inc.",Medical Assistance,62.0781,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MOXIFLOXACIN 400 MG ORAL TABLET,,5801,LOCAL,Facility,Inpatient,1,EA,,123,104.55,35.2518,123,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
MOXIFLOXACIN 400 MG ORAL TABLET,,5801,LOCAL,Facility,Outpatient,1,EA,,123,104.55,35.2518,123,"UCare Health, Inc.",Medicare Advantage,62.0781,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MOXIFLOXACIN 400 MG ORAL TABLET,,5801,LOCAL,Facility,Inpatient,1,EA,,123,104.55,35.2518,123,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
MOXIFLOXACIN 400 MG ORAL TABLET,,5801,LOCAL,Facility,Outpatient,1,EA,,123,104.55,35.2518,123,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),62.0781,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MOXIFLOXACIN 400 MG ORAL TABLET,,5801,LOCAL,Facility,Inpatient,1,EA,,123,104.55,35.2518,123,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
MOXIFLOXACIN 400 MG ORAL TABLET,,5801,LOCAL,Facility,Both,1,EA,,123,104.55,35.2518,123,UnitedHealthcare,Individual & Family,115.62,94,,percent of total billed charges,,
MOXIFLOXACIN 400 MG ORAL TABLET,,5801,LOCAL,Facility,Outpatient,1,EA,,123,104.55,35.2518,123,UnitedHealthcare,Medicare Advantage,60.27,49,,percent of total billed charges,,
MOXIFLOXACIN 400 MG ORAL TABLET,,5801,LOCAL,Facility,Inpatient,1,EA,,123,104.55,35.2518,123,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
MOXIFLOXACIN 400 MG ORAL TABLET,,5801,LOCAL,Facility,Outpatient,1,EA,,123,104.55,35.2518,123,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,59.04,48,,percent of total billed charges,,100% of DHS outpatient percentage
MOXIFLOXACIN 400 MG ORAL TABLET,,5801,LOCAL,Facility,Inpatient,1,EA,,123,104.55,35.2518,123,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
ATENOLOL 25 MG ORAL TABLET,,5816,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
ATENOLOL 25 MG ORAL TABLET,,5816,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
ATENOLOL 25 MG ORAL TABLET,,5816,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
ATENOLOL 25 MG ORAL TABLET,,5816,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
ATENOLOL 25 MG ORAL TABLET,,5816,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
ATENOLOL 25 MG ORAL TABLET,,5816,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
ATENOLOL 25 MG ORAL TABLET,,5816,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
ATENOLOL 25 MG ORAL TABLET,,5816,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
ATENOLOL 25 MG ORAL TABLET,,5816,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
ATENOLOL 25 MG ORAL TABLET,,5816,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
ATENOLOL 25 MG ORAL TABLET,,5816,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
ATENOLOL 25 MG ORAL TABLET,,5816,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
ATENOLOL 25 MG ORAL TABLET,,5816,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
ATENOLOL 25 MG ORAL TABLET,,5816,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
ATENOLOL 25 MG ORAL TABLET,,5816,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
ATENOLOL 25 MG ORAL TABLET,,5816,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
ATENOLOL 25 MG ORAL TABLET,,5816,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
ATENOLOL 25 MG ORAL TABLET,,5816,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
ATENOLOL 25 MG ORAL TABLET,,5816,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ATENOLOL 25 MG ORAL TABLET,,5816,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
ATENOLOL 25 MG ORAL TABLET,,5816,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
ATENOLOL 25 MG ORAL TABLET,,5816,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
ATENOLOL 25 MG ORAL TABLET,,5816,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
ATENOLOL 25 MG ORAL TABLET,,5816,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
ATENOLOL 25 MG ORAL TABLET,,5816,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
ATENOLOL 25 MG ORAL TABLET,,5816,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
ATENOLOL 25 MG ORAL TABLET,,5816,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
ATENOLOL 25 MG ORAL TABLET,,5816,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
ATENOLOL 25 MG ORAL TABLET,,5816,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
ATENOLOL 25 MG ORAL TABLET,,5816,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
ATENOLOL 25 MG ORAL TABLET,,5816,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
ATENOLOL 25 MG ORAL TABLET,,5816,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
ATENOLOL 25 MG ORAL TABLET,,5816,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
ATENOLOL 25 MG ORAL TABLET,,5816,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
ATENOLOL 25 MG ORAL TABLET,,5816,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
ATENOLOL 25 MG ORAL TABLET,,5816,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
ATENOLOL 25 MG ORAL TABLET,,5816,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
ATENOLOL 25 MG ORAL TABLET,,5816,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ATENOLOL 25 MG ORAL TABLET,,5816,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
ATENOLOL 25 MG ORAL TABLET,,5816,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
ATENOLOL 25 MG ORAL TABLET,,5816,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
ATENOLOL 25 MG ORAL TABLET,,5816,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
ATENOLOL 25 MG ORAL TABLET,,5816,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
ATENOLOL 25 MG ORAL TABLET,,5816,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ATENOLOL 25 MG ORAL TABLET,,5816,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
ATENOLOL 25 MG ORAL TABLET,,5816,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ATENOLOL 25 MG ORAL TABLET,,5816,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ATENOLOL 25 MG ORAL TABLET,,5816,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ATENOLOL 25 MG ORAL TABLET,,5816,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ATENOLOL 25 MG ORAL TABLET,,5816,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
ATENOLOL 25 MG ORAL TABLET,,5816,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
ATENOLOL 25 MG ORAL TABLET,,5816,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
ATENOLOL 25 MG ORAL TABLET,,5816,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
ATENOLOL 25 MG ORAL TABLET,,5816,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
ACETAZOLAMIDE 250 MG ORAL TABLET,,5945,LOCAL,Facility,Both,1,EA,,15,12.75,4.299,15,Aetna,Commercial,13.8,92,,percent of total billed charges,,
ACETAZOLAMIDE 250 MG ORAL TABLET,,5945,LOCAL,Facility,Outpatient,1,EA,,15,12.75,4.299,15,Aetna,Medicare Advantage,7.35,49,,percent of total billed charges,,
ACETAZOLAMIDE 250 MG ORAL TABLET,,5945,LOCAL,Facility,Inpatient,1,EA,,15,12.75,4.299,15,Aetna,Medicare Advantage,,,,,Included in per diem rate,
ACETAZOLAMIDE 250 MG ORAL TABLET,,5945,LOCAL,Facility,Both,1,EA,,15,12.75,4.299,15,Aetna,PPO,13.95,93,,percent of total billed charges,,
ACETAZOLAMIDE 250 MG ORAL TABLET,,5945,LOCAL,Facility,Both,1,EA,,15,12.75,4.299,15,America's PPO,America's PPO,14.4045,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
ACETAZOLAMIDE 250 MG ORAL TABLET,,5945,LOCAL,Facility,Both,1,EA,,15,12.75,4.299,15,BlueCross BlueShield Minnesota, Federal Employee Program,14.76,98.4,,percent of total billed charges,,
ACETAZOLAMIDE 250 MG ORAL TABLET,,5945,LOCAL,Facility,Both,1,EA,,15,12.75,4.299,15,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,15,100,,percent of total billed charges,,
ACETAZOLAMIDE 250 MG ORAL TABLET,,5945,LOCAL,Facility,Both,1,EA,,15,12.75,4.299,15,BlueCross BlueShield Minnesota,High Value Network Plan,13.5,90,,percent of total billed charges,,
ACETAZOLAMIDE 250 MG ORAL TABLET,,5945,LOCAL,Facility,Outpatient,1,EA,,15,12.75,4.299,15,BlueCross BlueShield Minnesota,Medicare Advantage,7.35,49,,percent of total billed charges,,
ACETAZOLAMIDE 250 MG ORAL TABLET,,5945,LOCAL,Facility,Inpatient,1,EA,,15,12.75,4.299,15,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
ACETAZOLAMIDE 250 MG ORAL TABLET,,5945,LOCAL,Facility,Both,1,EA,,15,12.75,4.299,15,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,13.2855,88.57,,percent of total billed charges,,
ACETAZOLAMIDE 250 MG ORAL TABLET,,5945,LOCAL,Facility,Both,1,EA,,15,12.75,4.299,15,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,4.299,28.66,,percent of total billed charges,,
ACETAZOLAMIDE 250 MG ORAL TABLET,,5945,LOCAL,Facility,Outpatient,1,EA,,15,12.75,4.299,15,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),7.35,49,,percent of total billed charges,,
ACETAZOLAMIDE 250 MG ORAL TABLET,,5945,LOCAL,Facility,Inpatient,1,EA,,15,12.75,4.299,15,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
ACETAZOLAMIDE 250 MG ORAL TABLET,,5945,LOCAL,Facility,Both,1,EA,,15,12.75,4.299,15,CorVel,Worker's Compensation,15,100,,percent of total billed charges,,
ACETAZOLAMIDE 250 MG ORAL TABLET,,5945,LOCAL,Facility,Both,1,EA,,15,12.75,4.299,15,First Health Group Corporation,First Health Network,14.55,97,,percent of total billed charges,,
ACETAZOLAMIDE 250 MG ORAL TABLET,,5945,LOCAL,Facility,Both,1,EA,,15,12.75,4.299,15,"Health Partners, Inc.",Commercial,14.19,94.6,,percent of total billed charges,,
ACETAZOLAMIDE 250 MG ORAL TABLET,,5945,LOCAL,Facility,Outpatient,1,EA,,15,12.75,4.299,15,"Health Partners, Inc.",Medicare Advantage,7.35,49,,percent of total billed charges,,
ACETAZOLAMIDE 250 MG ORAL TABLET,,5945,LOCAL,Facility,Inpatient,1,EA,,15,12.75,4.299,15,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ACETAZOLAMIDE 250 MG ORAL TABLET,,5945,LOCAL,Facility,Both,1,EA,,15,12.75,4.299,15,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),9,60,,percent of total billed charges,,
ACETAZOLAMIDE 250 MG ORAL TABLET,,5945,LOCAL,Facility,Both,1,EA,,15,12.75,4.299,15,"Health Partners, Inc.",State of Minnesota Advantage Program,12.225,81.5,,percent of total billed charges,,
ACETAZOLAMIDE 250 MG ORAL TABLET,,5945,LOCAL,Facility,Both,1,EA,,15,12.75,4.299,15,"Health Partners, Inc.",State Public Programs,7.5,50,,percent of total billed charges,,
ACETAZOLAMIDE 250 MG ORAL TABLET,,5945,LOCAL,Facility,Both,1,EA,,15,12.75,4.299,15,Humana Insurance Company,Commercial PPO,14.25,95,,percent of total billed charges,,
ACETAZOLAMIDE 250 MG ORAL TABLET,,5945,LOCAL,Facility,Outpatient,1,EA,,15,12.75,4.299,15,Humana Insurance Company,Medicare PPO,7.35,49,,percent of total billed charges,,
ACETAZOLAMIDE 250 MG ORAL TABLET,,5945,LOCAL,Facility,Inpatient,1,EA,,15,12.75,4.299,15,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
ACETAZOLAMIDE 250 MG ORAL TABLET,,5945,LOCAL,Facility,Both,1,EA,,15,12.75,4.299,15,Medica,Individual & Family,14.865,99.1,,percent of total billed charges,,
ACETAZOLAMIDE 250 MG ORAL TABLET,,5945,LOCAL,Facility,Outpatient,1,EA,,15,12.75,4.299,15,Medica,Medica Advantage Solution,7.47,49.8,,percent of total billed charges,,
ACETAZOLAMIDE 250 MG ORAL TABLET,,5945,LOCAL,Facility,Inpatient,1,EA,,15,12.75,4.299,15,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
ACETAZOLAMIDE 250 MG ORAL TABLET,,5945,LOCAL,Facility,Outpatient,1,EA,,15,12.75,4.299,15,Medica,Medical Assistance,6.69,44.6,,percent of total billed charges,,
ACETAZOLAMIDE 250 MG ORAL TABLET,,5945,LOCAL,Facility,Inpatient,1,EA,,15,12.75,4.299,15,Medica,Medical Assistance,,,,,Included in per diem rate,
ACETAZOLAMIDE 250 MG ORAL TABLET,,5945,LOCAL,Facility,Outpatient,1,EA,,15,12.75,4.299,15,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,7.47,49.8,,percent of total billed charges,,
ACETAZOLAMIDE 250 MG ORAL TABLET,,5945,LOCAL,Facility,Inpatient,1,EA,,15,12.75,4.299,15,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
ACETAZOLAMIDE 250 MG ORAL TABLET,,5945,LOCAL,Facility,Both,1,EA,,15,12.75,4.299,15,"Multiplan, Inc.","Multiplan, Inc.",14.1,94,,percent of total billed charges,,
ACETAZOLAMIDE 250 MG ORAL TABLET,,5945,LOCAL,Facility,Outpatient,1,EA,,15,12.75,4.299,15,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,13.515,90.1,,percent of total billed charges,,
ACETAZOLAMIDE 250 MG ORAL TABLET,,5945,LOCAL,Facility,Inpatient,1,EA,,15,12.75,4.299,15,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
ACETAZOLAMIDE 250 MG ORAL TABLET,,5945,LOCAL,Facility,Both,1,EA,,15,12.75,4.299,15,"Preferred One Administrative Services, INC.",PPO,14.79,98.6,,percent of total billed charges,,
ACETAZOLAMIDE 250 MG ORAL TABLET,,5945,LOCAL,Facility,Outpatient,1,EA,,15,12.75,4.299,15,PrimeWest Health,Minnesota Senior Health Options (MSHO),7.7175,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
ACETAZOLAMIDE 250 MG ORAL TABLET,,5945,LOCAL,Facility,Inpatient,1,EA,,15,12.75,4.299,15,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ACETAZOLAMIDE 250 MG ORAL TABLET,,5945,LOCAL,Facility,Outpatient,1,EA,,15,12.75,4.299,15,PrimeWest Health,MinnesotaCare,7.704,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
ACETAZOLAMIDE 250 MG ORAL TABLET,,5945,LOCAL,Facility,Inpatient,1,EA,,15,12.75,4.299,15,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
ACETAZOLAMIDE 250 MG ORAL TABLET,,5945,LOCAL,Facility,Both,1,EA,,15,12.75,4.299,15,Sanford Health Plan,Sanford Health Plan,13.8,92,,percent of total billed charges,,
ACETAZOLAMIDE 250 MG ORAL TABLET,,5945,LOCAL,Facility,Outpatient,1,EA,,15,12.75,4.299,15,"UCare Health, Inc.",Individual & Family Plan,8.4525,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
ACETAZOLAMIDE 250 MG ORAL TABLET,,5945,LOCAL,Facility,Inpatient,1,EA,,15,12.75,4.299,15,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
ACETAZOLAMIDE 250 MG ORAL TABLET,,5945,LOCAL,Facility,Outpatient,1,EA,,15,12.75,4.299,15,"UCare Health, Inc.",Medical Assistance,7.5705,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ACETAZOLAMIDE 250 MG ORAL TABLET,,5945,LOCAL,Facility,Inpatient,1,EA,,15,12.75,4.299,15,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
ACETAZOLAMIDE 250 MG ORAL TABLET,,5945,LOCAL,Facility,Outpatient,1,EA,,15,12.75,4.299,15,"UCare Health, Inc.",Medicare Advantage,7.5705,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ACETAZOLAMIDE 250 MG ORAL TABLET,,5945,LOCAL,Facility,Inpatient,1,EA,,15,12.75,4.299,15,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ACETAZOLAMIDE 250 MG ORAL TABLET,,5945,LOCAL,Facility,Outpatient,1,EA,,15,12.75,4.299,15,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),7.5705,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ACETAZOLAMIDE 250 MG ORAL TABLET,,5945,LOCAL,Facility,Inpatient,1,EA,,15,12.75,4.299,15,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ACETAZOLAMIDE 250 MG ORAL TABLET,,5945,LOCAL,Facility,Both,1,EA,,15,12.75,4.299,15,UnitedHealthcare,Individual & Family,14.1,94,,percent of total billed charges,,
ACETAZOLAMIDE 250 MG ORAL TABLET,,5945,LOCAL,Facility,Outpatient,1,EA,,15,12.75,4.299,15,UnitedHealthcare,Medicare Advantage,7.35,49,,percent of total billed charges,,
ACETAZOLAMIDE 250 MG ORAL TABLET,,5945,LOCAL,Facility,Inpatient,1,EA,,15,12.75,4.299,15,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
ACETAZOLAMIDE 250 MG ORAL TABLET,,5945,LOCAL,Facility,Outpatient,1,EA,,15,12.75,4.299,15,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,7.2,48,,percent of total billed charges,,100% of DHS outpatient percentage
ACETAZOLAMIDE 250 MG ORAL TABLET,,5945,LOCAL,Facility,Inpatient,1,EA,,15,12.75,4.299,15,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
CLINDAMYCIN HCL 150 MG ORAL CAP,,5985,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
CLINDAMYCIN HCL 150 MG ORAL CAP,,5985,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
CLINDAMYCIN HCL 150 MG ORAL CAP,,5985,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
CLINDAMYCIN HCL 150 MG ORAL CAP,,5985,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
CLINDAMYCIN HCL 150 MG ORAL CAP,,5985,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
CLINDAMYCIN HCL 150 MG ORAL CAP,,5985,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
CLINDAMYCIN HCL 150 MG ORAL CAP,,5985,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
CLINDAMYCIN HCL 150 MG ORAL CAP,,5985,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
CLINDAMYCIN HCL 150 MG ORAL CAP,,5985,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
CLINDAMYCIN HCL 150 MG ORAL CAP,,5985,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
CLINDAMYCIN HCL 150 MG ORAL CAP,,5985,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
CLINDAMYCIN HCL 150 MG ORAL CAP,,5985,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
CLINDAMYCIN HCL 150 MG ORAL CAP,,5985,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
CLINDAMYCIN HCL 150 MG ORAL CAP,,5985,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
CLINDAMYCIN HCL 150 MG ORAL CAP,,5985,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
CLINDAMYCIN HCL 150 MG ORAL CAP,,5985,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
CLINDAMYCIN HCL 150 MG ORAL CAP,,5985,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
CLINDAMYCIN HCL 150 MG ORAL CAP,,5985,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
CLINDAMYCIN HCL 150 MG ORAL CAP,,5985,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CLINDAMYCIN HCL 150 MG ORAL CAP,,5985,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
CLINDAMYCIN HCL 150 MG ORAL CAP,,5985,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
CLINDAMYCIN HCL 150 MG ORAL CAP,,5985,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
CLINDAMYCIN HCL 150 MG ORAL CAP,,5985,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
CLINDAMYCIN HCL 150 MG ORAL CAP,,5985,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
CLINDAMYCIN HCL 150 MG ORAL CAP,,5985,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
CLINDAMYCIN HCL 150 MG ORAL CAP,,5985,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
CLINDAMYCIN HCL 150 MG ORAL CAP,,5985,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
CLINDAMYCIN HCL 150 MG ORAL CAP,,5985,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
CLINDAMYCIN HCL 150 MG ORAL CAP,,5985,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
CLINDAMYCIN HCL 150 MG ORAL CAP,,5985,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
CLINDAMYCIN HCL 150 MG ORAL CAP,,5985,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
CLINDAMYCIN HCL 150 MG ORAL CAP,,5985,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
CLINDAMYCIN HCL 150 MG ORAL CAP,,5985,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
CLINDAMYCIN HCL 150 MG ORAL CAP,,5985,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
CLINDAMYCIN HCL 150 MG ORAL CAP,,5985,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
CLINDAMYCIN HCL 150 MG ORAL CAP,,5985,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
CLINDAMYCIN HCL 150 MG ORAL CAP,,5985,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
CLINDAMYCIN HCL 150 MG ORAL CAP,,5985,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CLINDAMYCIN HCL 150 MG ORAL CAP,,5985,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
CLINDAMYCIN HCL 150 MG ORAL CAP,,5985,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
CLINDAMYCIN HCL 150 MG ORAL CAP,,5985,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
CLINDAMYCIN HCL 150 MG ORAL CAP,,5985,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
CLINDAMYCIN HCL 150 MG ORAL CAP,,5985,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
CLINDAMYCIN HCL 150 MG ORAL CAP,,5985,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CLINDAMYCIN HCL 150 MG ORAL CAP,,5985,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
CLINDAMYCIN HCL 150 MG ORAL CAP,,5985,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CLINDAMYCIN HCL 150 MG ORAL CAP,,5985,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CLINDAMYCIN HCL 150 MG ORAL CAP,,5985,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CLINDAMYCIN HCL 150 MG ORAL CAP,,5985,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CLINDAMYCIN HCL 150 MG ORAL CAP,,5985,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
CLINDAMYCIN HCL 150 MG ORAL CAP,,5985,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
CLINDAMYCIN HCL 150 MG ORAL CAP,,5985,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
CLINDAMYCIN HCL 150 MG ORAL CAP,,5985,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
CLINDAMYCIN HCL 150 MG ORAL CAP,,5985,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
SUMATRIPTAN SUCCINATE 50 MG ORAL TABLET,,6009,LOCAL,Facility,Both,1,EA,,114,96.9,32.6724,114,Aetna,Commercial,104.88,92,,percent of total billed charges,,
SUMATRIPTAN SUCCINATE 50 MG ORAL TABLET,,6009,LOCAL,Facility,Outpatient,1,EA,,114,96.9,32.6724,114,Aetna,Medicare Advantage,55.86,49,,percent of total billed charges,,
SUMATRIPTAN SUCCINATE 50 MG ORAL TABLET,,6009,LOCAL,Facility,Inpatient,1,EA,,114,96.9,32.6724,114,Aetna,Medicare Advantage,,,,,Included in per diem rate,
SUMATRIPTAN SUCCINATE 50 MG ORAL TABLET,,6009,LOCAL,Facility,Both,1,EA,,114,96.9,32.6724,114,Aetna,PPO,106.02,93,,percent of total billed charges,,
SUMATRIPTAN SUCCINATE 50 MG ORAL TABLET,,6009,LOCAL,Facility,Both,1,EA,,114,96.9,32.6724,114,America's PPO,America's PPO,109.4742,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SUMATRIPTAN SUCCINATE 50 MG ORAL TABLET,,6009,LOCAL,Facility,Both,1,EA,,114,96.9,32.6724,114,BlueCross BlueShield Minnesota, Federal Employee Program,112.176,98.4,,percent of total billed charges,,
SUMATRIPTAN SUCCINATE 50 MG ORAL TABLET,,6009,LOCAL,Facility,Both,1,EA,,114,96.9,32.6724,114,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,114,100,,percent of total billed charges,,
SUMATRIPTAN SUCCINATE 50 MG ORAL TABLET,,6009,LOCAL,Facility,Both,1,EA,,114,96.9,32.6724,114,BlueCross BlueShield Minnesota,High Value Network Plan,102.6,90,,percent of total billed charges,,
SUMATRIPTAN SUCCINATE 50 MG ORAL TABLET,,6009,LOCAL,Facility,Outpatient,1,EA,,114,96.9,32.6724,114,BlueCross BlueShield Minnesota,Medicare Advantage,55.86,49,,percent of total billed charges,,
SUMATRIPTAN SUCCINATE 50 MG ORAL TABLET,,6009,LOCAL,Facility,Inpatient,1,EA,,114,96.9,32.6724,114,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
SUMATRIPTAN SUCCINATE 50 MG ORAL TABLET,,6009,LOCAL,Facility,Both,1,EA,,114,96.9,32.6724,114,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,100.9698,88.57,,percent of total billed charges,,
SUMATRIPTAN SUCCINATE 50 MG ORAL TABLET,,6009,LOCAL,Facility,Both,1,EA,,114,96.9,32.6724,114,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,32.6724,28.66,,percent of total billed charges,,
SUMATRIPTAN SUCCINATE 50 MG ORAL TABLET,,6009,LOCAL,Facility,Outpatient,1,EA,,114,96.9,32.6724,114,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),55.86,49,,percent of total billed charges,,
SUMATRIPTAN SUCCINATE 50 MG ORAL TABLET,,6009,LOCAL,Facility,Inpatient,1,EA,,114,96.9,32.6724,114,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
SUMATRIPTAN SUCCINATE 50 MG ORAL TABLET,,6009,LOCAL,Facility,Both,1,EA,,114,96.9,32.6724,114,CorVel,Worker's Compensation,114,100,,percent of total billed charges,,
SUMATRIPTAN SUCCINATE 50 MG ORAL TABLET,,6009,LOCAL,Facility,Both,1,EA,,114,96.9,32.6724,114,First Health Group Corporation,First Health Network,110.58,97,,percent of total billed charges,,
SUMATRIPTAN SUCCINATE 50 MG ORAL TABLET,,6009,LOCAL,Facility,Both,1,EA,,114,96.9,32.6724,114,"Health Partners, Inc.",Commercial,107.844,94.6,,percent of total billed charges,,
SUMATRIPTAN SUCCINATE 50 MG ORAL TABLET,,6009,LOCAL,Facility,Outpatient,1,EA,,114,96.9,32.6724,114,"Health Partners, Inc.",Medicare Advantage,55.86,49,,percent of total billed charges,,
SUMATRIPTAN SUCCINATE 50 MG ORAL TABLET,,6009,LOCAL,Facility,Inpatient,1,EA,,114,96.9,32.6724,114,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUMATRIPTAN SUCCINATE 50 MG ORAL TABLET,,6009,LOCAL,Facility,Both,1,EA,,114,96.9,32.6724,114,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),68.4,60,,percent of total billed charges,,
SUMATRIPTAN SUCCINATE 50 MG ORAL TABLET,,6009,LOCAL,Facility,Both,1,EA,,114,96.9,32.6724,114,"Health Partners, Inc.",State of Minnesota Advantage Program,92.91,81.5,,percent of total billed charges,,
SUMATRIPTAN SUCCINATE 50 MG ORAL TABLET,,6009,LOCAL,Facility,Both,1,EA,,114,96.9,32.6724,114,"Health Partners, Inc.",State Public Programs,57,50,,percent of total billed charges,,
SUMATRIPTAN SUCCINATE 50 MG ORAL TABLET,,6009,LOCAL,Facility,Both,1,EA,,114,96.9,32.6724,114,Humana Insurance Company,Commercial PPO,108.3,95,,percent of total billed charges,,
SUMATRIPTAN SUCCINATE 50 MG ORAL TABLET,,6009,LOCAL,Facility,Outpatient,1,EA,,114,96.9,32.6724,114,Humana Insurance Company,Medicare PPO,55.86,49,,percent of total billed charges,,
SUMATRIPTAN SUCCINATE 50 MG ORAL TABLET,,6009,LOCAL,Facility,Inpatient,1,EA,,114,96.9,32.6724,114,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
SUMATRIPTAN SUCCINATE 50 MG ORAL TABLET,,6009,LOCAL,Facility,Both,1,EA,,114,96.9,32.6724,114,Medica,Individual & Family,112.974,99.1,,percent of total billed charges,,
SUMATRIPTAN SUCCINATE 50 MG ORAL TABLET,,6009,LOCAL,Facility,Outpatient,1,EA,,114,96.9,32.6724,114,Medica,Medica Advantage Solution,56.772,49.8,,percent of total billed charges,,
SUMATRIPTAN SUCCINATE 50 MG ORAL TABLET,,6009,LOCAL,Facility,Inpatient,1,EA,,114,96.9,32.6724,114,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
SUMATRIPTAN SUCCINATE 50 MG ORAL TABLET,,6009,LOCAL,Facility,Outpatient,1,EA,,114,96.9,32.6724,114,Medica,Medical Assistance,50.844,44.6,,percent of total billed charges,,
SUMATRIPTAN SUCCINATE 50 MG ORAL TABLET,,6009,LOCAL,Facility,Inpatient,1,EA,,114,96.9,32.6724,114,Medica,Medical Assistance,,,,,Included in per diem rate,
SUMATRIPTAN SUCCINATE 50 MG ORAL TABLET,,6009,LOCAL,Facility,Outpatient,1,EA,,114,96.9,32.6724,114,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,56.772,49.8,,percent of total billed charges,,
SUMATRIPTAN SUCCINATE 50 MG ORAL TABLET,,6009,LOCAL,Facility,Inpatient,1,EA,,114,96.9,32.6724,114,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
SUMATRIPTAN SUCCINATE 50 MG ORAL TABLET,,6009,LOCAL,Facility,Both,1,EA,,114,96.9,32.6724,114,"Multiplan, Inc.","Multiplan, Inc.",107.16,94,,percent of total billed charges,,
SUMATRIPTAN SUCCINATE 50 MG ORAL TABLET,,6009,LOCAL,Facility,Outpatient,1,EA,,114,96.9,32.6724,114,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,102.714,90.1,,percent of total billed charges,,
SUMATRIPTAN SUCCINATE 50 MG ORAL TABLET,,6009,LOCAL,Facility,Inpatient,1,EA,,114,96.9,32.6724,114,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
SUMATRIPTAN SUCCINATE 50 MG ORAL TABLET,,6009,LOCAL,Facility,Both,1,EA,,114,96.9,32.6724,114,"Preferred One Administrative Services, INC.",PPO,112.404,98.6,,percent of total billed charges,,
SUMATRIPTAN SUCCINATE 50 MG ORAL TABLET,,6009,LOCAL,Facility,Outpatient,1,EA,,114,96.9,32.6724,114,PrimeWest Health,Minnesota Senior Health Options (MSHO),58.653,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
SUMATRIPTAN SUCCINATE 50 MG ORAL TABLET,,6009,LOCAL,Facility,Inpatient,1,EA,,114,96.9,32.6724,114,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUMATRIPTAN SUCCINATE 50 MG ORAL TABLET,,6009,LOCAL,Facility,Outpatient,1,EA,,114,96.9,32.6724,114,PrimeWest Health,MinnesotaCare,58.5504,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
SUMATRIPTAN SUCCINATE 50 MG ORAL TABLET,,6009,LOCAL,Facility,Inpatient,1,EA,,114,96.9,32.6724,114,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
SUMATRIPTAN SUCCINATE 50 MG ORAL TABLET,,6009,LOCAL,Facility,Both,1,EA,,114,96.9,32.6724,114,Sanford Health Plan,Sanford Health Plan,104.88,92,,percent of total billed charges,,
SUMATRIPTAN SUCCINATE 50 MG ORAL TABLET,,6009,LOCAL,Facility,Outpatient,1,EA,,114,96.9,32.6724,114,"UCare Health, Inc.",Individual & Family Plan,64.239,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
SUMATRIPTAN SUCCINATE 50 MG ORAL TABLET,,6009,LOCAL,Facility,Inpatient,1,EA,,114,96.9,32.6724,114,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
SUMATRIPTAN SUCCINATE 50 MG ORAL TABLET,,6009,LOCAL,Facility,Outpatient,1,EA,,114,96.9,32.6724,114,"UCare Health, Inc.",Medical Assistance,57.5358,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUMATRIPTAN SUCCINATE 50 MG ORAL TABLET,,6009,LOCAL,Facility,Inpatient,1,EA,,114,96.9,32.6724,114,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
SUMATRIPTAN SUCCINATE 50 MG ORAL TABLET,,6009,LOCAL,Facility,Outpatient,1,EA,,114,96.9,32.6724,114,"UCare Health, Inc.",Medicare Advantage,57.5358,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUMATRIPTAN SUCCINATE 50 MG ORAL TABLET,,6009,LOCAL,Facility,Inpatient,1,EA,,114,96.9,32.6724,114,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUMATRIPTAN SUCCINATE 50 MG ORAL TABLET,,6009,LOCAL,Facility,Outpatient,1,EA,,114,96.9,32.6724,114,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),57.5358,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUMATRIPTAN SUCCINATE 50 MG ORAL TABLET,,6009,LOCAL,Facility,Inpatient,1,EA,,114,96.9,32.6724,114,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUMATRIPTAN SUCCINATE 50 MG ORAL TABLET,,6009,LOCAL,Facility,Both,1,EA,,114,96.9,32.6724,114,UnitedHealthcare,Individual & Family,107.16,94,,percent of total billed charges,,
SUMATRIPTAN SUCCINATE 50 MG ORAL TABLET,,6009,LOCAL,Facility,Outpatient,1,EA,,114,96.9,32.6724,114,UnitedHealthcare,Medicare Advantage,55.86,49,,percent of total billed charges,,
SUMATRIPTAN SUCCINATE 50 MG ORAL TABLET,,6009,LOCAL,Facility,Inpatient,1,EA,,114,96.9,32.6724,114,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
SUMATRIPTAN SUCCINATE 50 MG ORAL TABLET,,6009,LOCAL,Facility,Outpatient,1,EA,,114,96.9,32.6724,114,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,54.72,48,,percent of total billed charges,,100% of DHS outpatient percentage
SUMATRIPTAN SUCCINATE 50 MG ORAL TABLET,,6009,LOCAL,Facility,Inpatient,1,EA,,114,96.9,32.6724,114,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
THIAMINE HCL (VITAMIN B1) 100 MG ORAL TABLET,,6067,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
THIAMINE HCL (VITAMIN B1) 100 MG ORAL TABLET,,6067,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
THIAMINE HCL (VITAMIN B1) 100 MG ORAL TABLET,,6067,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
THIAMINE HCL (VITAMIN B1) 100 MG ORAL TABLET,,6067,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
THIAMINE HCL (VITAMIN B1) 100 MG ORAL TABLET,,6067,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
THIAMINE HCL (VITAMIN B1) 100 MG ORAL TABLET,,6067,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
THIAMINE HCL (VITAMIN B1) 100 MG ORAL TABLET,,6067,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
THIAMINE HCL (VITAMIN B1) 100 MG ORAL TABLET,,6067,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
THIAMINE HCL (VITAMIN B1) 100 MG ORAL TABLET,,6067,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
THIAMINE HCL (VITAMIN B1) 100 MG ORAL TABLET,,6067,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
THIAMINE HCL (VITAMIN B1) 100 MG ORAL TABLET,,6067,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
THIAMINE HCL (VITAMIN B1) 100 MG ORAL TABLET,,6067,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
THIAMINE HCL (VITAMIN B1) 100 MG ORAL TABLET,,6067,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
THIAMINE HCL (VITAMIN B1) 100 MG ORAL TABLET,,6067,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
THIAMINE HCL (VITAMIN B1) 100 MG ORAL TABLET,,6067,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
THIAMINE HCL (VITAMIN B1) 100 MG ORAL TABLET,,6067,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
THIAMINE HCL (VITAMIN B1) 100 MG ORAL TABLET,,6067,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
THIAMINE HCL (VITAMIN B1) 100 MG ORAL TABLET,,6067,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
THIAMINE HCL (VITAMIN B1) 100 MG ORAL TABLET,,6067,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
THIAMINE HCL (VITAMIN B1) 100 MG ORAL TABLET,,6067,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
THIAMINE HCL (VITAMIN B1) 100 MG ORAL TABLET,,6067,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
THIAMINE HCL (VITAMIN B1) 100 MG ORAL TABLET,,6067,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
THIAMINE HCL (VITAMIN B1) 100 MG ORAL TABLET,,6067,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
THIAMINE HCL (VITAMIN B1) 100 MG ORAL TABLET,,6067,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
THIAMINE HCL (VITAMIN B1) 100 MG ORAL TABLET,,6067,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
THIAMINE HCL (VITAMIN B1) 100 MG ORAL TABLET,,6067,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
THIAMINE HCL (VITAMIN B1) 100 MG ORAL TABLET,,6067,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
THIAMINE HCL (VITAMIN B1) 100 MG ORAL TABLET,,6067,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
THIAMINE HCL (VITAMIN B1) 100 MG ORAL TABLET,,6067,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
THIAMINE HCL (VITAMIN B1) 100 MG ORAL TABLET,,6067,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
THIAMINE HCL (VITAMIN B1) 100 MG ORAL TABLET,,6067,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
THIAMINE HCL (VITAMIN B1) 100 MG ORAL TABLET,,6067,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
THIAMINE HCL (VITAMIN B1) 100 MG ORAL TABLET,,6067,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
THIAMINE HCL (VITAMIN B1) 100 MG ORAL TABLET,,6067,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
THIAMINE HCL (VITAMIN B1) 100 MG ORAL TABLET,,6067,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
THIAMINE HCL (VITAMIN B1) 100 MG ORAL TABLET,,6067,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
THIAMINE HCL (VITAMIN B1) 100 MG ORAL TABLET,,6067,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
THIAMINE HCL (VITAMIN B1) 100 MG ORAL TABLET,,6067,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
THIAMINE HCL (VITAMIN B1) 100 MG ORAL TABLET,,6067,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
THIAMINE HCL (VITAMIN B1) 100 MG ORAL TABLET,,6067,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
THIAMINE HCL (VITAMIN B1) 100 MG ORAL TABLET,,6067,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
THIAMINE HCL (VITAMIN B1) 100 MG ORAL TABLET,,6067,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
THIAMINE HCL (VITAMIN B1) 100 MG ORAL TABLET,,6067,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
THIAMINE HCL (VITAMIN B1) 100 MG ORAL TABLET,,6067,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
THIAMINE HCL (VITAMIN B1) 100 MG ORAL TABLET,,6067,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
THIAMINE HCL (VITAMIN B1) 100 MG ORAL TABLET,,6067,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
THIAMINE HCL (VITAMIN B1) 100 MG ORAL TABLET,,6067,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
THIAMINE HCL (VITAMIN B1) 100 MG ORAL TABLET,,6067,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
THIAMINE HCL (VITAMIN B1) 100 MG ORAL TABLET,,6067,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
THIAMINE HCL (VITAMIN B1) 100 MG ORAL TABLET,,6067,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
THIAMINE HCL (VITAMIN B1) 100 MG ORAL TABLET,,6067,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
THIAMINE HCL (VITAMIN B1) 100 MG ORAL TABLET,,6067,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
THIAMINE HCL (VITAMIN B1) 100 MG ORAL TABLET,,6067,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
THIAMINE HCL (VITAMIN B1) 100 MG ORAL TABLET,,6067,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
TORSEMIDE 10 MG ORAL TABLET,,6087,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
TORSEMIDE 10 MG ORAL TABLET,,6087,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
TORSEMIDE 10 MG ORAL TABLET,,6087,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
TORSEMIDE 10 MG ORAL TABLET,,6087,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
TORSEMIDE 10 MG ORAL TABLET,,6087,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
TORSEMIDE 10 MG ORAL TABLET,,6087,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
TORSEMIDE 10 MG ORAL TABLET,,6087,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
TORSEMIDE 10 MG ORAL TABLET,,6087,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
TORSEMIDE 10 MG ORAL TABLET,,6087,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
TORSEMIDE 10 MG ORAL TABLET,,6087,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
TORSEMIDE 10 MG ORAL TABLET,,6087,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
TORSEMIDE 10 MG ORAL TABLET,,6087,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
TORSEMIDE 10 MG ORAL TABLET,,6087,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
TORSEMIDE 10 MG ORAL TABLET,,6087,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
TORSEMIDE 10 MG ORAL TABLET,,6087,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
TORSEMIDE 10 MG ORAL TABLET,,6087,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
TORSEMIDE 10 MG ORAL TABLET,,6087,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
TORSEMIDE 10 MG ORAL TABLET,,6087,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
TORSEMIDE 10 MG ORAL TABLET,,6087,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
TORSEMIDE 10 MG ORAL TABLET,,6087,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
TORSEMIDE 10 MG ORAL TABLET,,6087,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
TORSEMIDE 10 MG ORAL TABLET,,6087,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
TORSEMIDE 10 MG ORAL TABLET,,6087,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
TORSEMIDE 10 MG ORAL TABLET,,6087,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
TORSEMIDE 10 MG ORAL TABLET,,6087,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
TORSEMIDE 10 MG ORAL TABLET,,6087,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
TORSEMIDE 10 MG ORAL TABLET,,6087,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
TORSEMIDE 10 MG ORAL TABLET,,6087,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
TORSEMIDE 10 MG ORAL TABLET,,6087,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
TORSEMIDE 10 MG ORAL TABLET,,6087,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
TORSEMIDE 10 MG ORAL TABLET,,6087,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
TORSEMIDE 10 MG ORAL TABLET,,6087,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
TORSEMIDE 10 MG ORAL TABLET,,6087,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
TORSEMIDE 10 MG ORAL TABLET,,6087,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
TORSEMIDE 10 MG ORAL TABLET,,6087,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
TORSEMIDE 10 MG ORAL TABLET,,6087,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
TORSEMIDE 10 MG ORAL TABLET,,6087,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
TORSEMIDE 10 MG ORAL TABLET,,6087,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
TORSEMIDE 10 MG ORAL TABLET,,6087,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
TORSEMIDE 10 MG ORAL TABLET,,6087,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
TORSEMIDE 10 MG ORAL TABLET,,6087,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
TORSEMIDE 10 MG ORAL TABLET,,6087,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
TORSEMIDE 10 MG ORAL TABLET,,6087,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
TORSEMIDE 10 MG ORAL TABLET,,6087,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TORSEMIDE 10 MG ORAL TABLET,,6087,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
TORSEMIDE 10 MG ORAL TABLET,,6087,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TORSEMIDE 10 MG ORAL TABLET,,6087,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
TORSEMIDE 10 MG ORAL TABLET,,6087,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TORSEMIDE 10 MG ORAL TABLET,,6087,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
TORSEMIDE 10 MG ORAL TABLET,,6087,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
TORSEMIDE 10 MG ORAL TABLET,,6087,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
TORSEMIDE 10 MG ORAL TABLET,,6087,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
TORSEMIDE 10 MG ORAL TABLET,,6087,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
TORSEMIDE 10 MG ORAL TABLET,,6087,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
WARFARIN 2.5 MG ORAL TABLET,,6237,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
WARFARIN 2.5 MG ORAL TABLET,,6237,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
WARFARIN 2.5 MG ORAL TABLET,,6237,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
WARFARIN 2.5 MG ORAL TABLET,,6237,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
WARFARIN 2.5 MG ORAL TABLET,,6237,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
WARFARIN 2.5 MG ORAL TABLET,,6237,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
WARFARIN 2.5 MG ORAL TABLET,,6237,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
WARFARIN 2.5 MG ORAL TABLET,,6237,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
WARFARIN 2.5 MG ORAL TABLET,,6237,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
WARFARIN 2.5 MG ORAL TABLET,,6237,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
WARFARIN 2.5 MG ORAL TABLET,,6237,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
WARFARIN 2.5 MG ORAL TABLET,,6237,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
WARFARIN 2.5 MG ORAL TABLET,,6237,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
WARFARIN 2.5 MG ORAL TABLET,,6237,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
WARFARIN 2.5 MG ORAL TABLET,,6237,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
WARFARIN 2.5 MG ORAL TABLET,,6237,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
WARFARIN 2.5 MG ORAL TABLET,,6237,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
WARFARIN 2.5 MG ORAL TABLET,,6237,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
WARFARIN 2.5 MG ORAL TABLET,,6237,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
WARFARIN 2.5 MG ORAL TABLET,,6237,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
WARFARIN 2.5 MG ORAL TABLET,,6237,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
WARFARIN 2.5 MG ORAL TABLET,,6237,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
WARFARIN 2.5 MG ORAL TABLET,,6237,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
WARFARIN 2.5 MG ORAL TABLET,,6237,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
WARFARIN 2.5 MG ORAL TABLET,,6237,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
WARFARIN 2.5 MG ORAL TABLET,,6237,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
WARFARIN 2.5 MG ORAL TABLET,,6237,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
WARFARIN 2.5 MG ORAL TABLET,,6237,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
WARFARIN 2.5 MG ORAL TABLET,,6237,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
WARFARIN 2.5 MG ORAL TABLET,,6237,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
WARFARIN 2.5 MG ORAL TABLET,,6237,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
WARFARIN 2.5 MG ORAL TABLET,,6237,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
WARFARIN 2.5 MG ORAL TABLET,,6237,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
WARFARIN 2.5 MG ORAL TABLET,,6237,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
WARFARIN 2.5 MG ORAL TABLET,,6237,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
WARFARIN 2.5 MG ORAL TABLET,,6237,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
WARFARIN 2.5 MG ORAL TABLET,,6237,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
WARFARIN 2.5 MG ORAL TABLET,,6237,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
WARFARIN 2.5 MG ORAL TABLET,,6237,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
WARFARIN 2.5 MG ORAL TABLET,,6237,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
WARFARIN 2.5 MG ORAL TABLET,,6237,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
WARFARIN 2.5 MG ORAL TABLET,,6237,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
WARFARIN 2.5 MG ORAL TABLET,,6237,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
WARFARIN 2.5 MG ORAL TABLET,,6237,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
WARFARIN 2.5 MG ORAL TABLET,,6237,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
WARFARIN 2.5 MG ORAL TABLET,,6237,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
WARFARIN 2.5 MG ORAL TABLET,,6237,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
WARFARIN 2.5 MG ORAL TABLET,,6237,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
WARFARIN 2.5 MG ORAL TABLET,,6237,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
WARFARIN 2.5 MG ORAL TABLET,,6237,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
WARFARIN 2.5 MG ORAL TABLET,,6237,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
WARFARIN 2.5 MG ORAL TABLET,,6237,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
WARFARIN 2.5 MG ORAL TABLET,,6237,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
WARFARIN 2.5 MG ORAL TABLET,,6237,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
DIPHENOXYLATE-ATROPINE 2.5-0.025 MG ORAL TABLET,,6262,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
DIPHENOXYLATE-ATROPINE 2.5-0.025 MG ORAL TABLET,,6262,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
DIPHENOXYLATE-ATROPINE 2.5-0.025 MG ORAL TABLET,,6262,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
DIPHENOXYLATE-ATROPINE 2.5-0.025 MG ORAL TABLET,,6262,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
DIPHENOXYLATE-ATROPINE 2.5-0.025 MG ORAL TABLET,,6262,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
DIPHENOXYLATE-ATROPINE 2.5-0.025 MG ORAL TABLET,,6262,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
DIPHENOXYLATE-ATROPINE 2.5-0.025 MG ORAL TABLET,,6262,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
DIPHENOXYLATE-ATROPINE 2.5-0.025 MG ORAL TABLET,,6262,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
DIPHENOXYLATE-ATROPINE 2.5-0.025 MG ORAL TABLET,,6262,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
DIPHENOXYLATE-ATROPINE 2.5-0.025 MG ORAL TABLET,,6262,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
DIPHENOXYLATE-ATROPINE 2.5-0.025 MG ORAL TABLET,,6262,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
DIPHENOXYLATE-ATROPINE 2.5-0.025 MG ORAL TABLET,,6262,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
DIPHENOXYLATE-ATROPINE 2.5-0.025 MG ORAL TABLET,,6262,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
DIPHENOXYLATE-ATROPINE 2.5-0.025 MG ORAL TABLET,,6262,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
DIPHENOXYLATE-ATROPINE 2.5-0.025 MG ORAL TABLET,,6262,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
DIPHENOXYLATE-ATROPINE 2.5-0.025 MG ORAL TABLET,,6262,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
DIPHENOXYLATE-ATROPINE 2.5-0.025 MG ORAL TABLET,,6262,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
DIPHENOXYLATE-ATROPINE 2.5-0.025 MG ORAL TABLET,,6262,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
DIPHENOXYLATE-ATROPINE 2.5-0.025 MG ORAL TABLET,,6262,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DIPHENOXYLATE-ATROPINE 2.5-0.025 MG ORAL TABLET,,6262,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
DIPHENOXYLATE-ATROPINE 2.5-0.025 MG ORAL TABLET,,6262,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
DIPHENOXYLATE-ATROPINE 2.5-0.025 MG ORAL TABLET,,6262,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
DIPHENOXYLATE-ATROPINE 2.5-0.025 MG ORAL TABLET,,6262,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
DIPHENOXYLATE-ATROPINE 2.5-0.025 MG ORAL TABLET,,6262,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
DIPHENOXYLATE-ATROPINE 2.5-0.025 MG ORAL TABLET,,6262,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
DIPHENOXYLATE-ATROPINE 2.5-0.025 MG ORAL TABLET,,6262,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
DIPHENOXYLATE-ATROPINE 2.5-0.025 MG ORAL TABLET,,6262,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
DIPHENOXYLATE-ATROPINE 2.5-0.025 MG ORAL TABLET,,6262,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
DIPHENOXYLATE-ATROPINE 2.5-0.025 MG ORAL TABLET,,6262,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
DIPHENOXYLATE-ATROPINE 2.5-0.025 MG ORAL TABLET,,6262,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
DIPHENOXYLATE-ATROPINE 2.5-0.025 MG ORAL TABLET,,6262,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
DIPHENOXYLATE-ATROPINE 2.5-0.025 MG ORAL TABLET,,6262,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
DIPHENOXYLATE-ATROPINE 2.5-0.025 MG ORAL TABLET,,6262,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
DIPHENOXYLATE-ATROPINE 2.5-0.025 MG ORAL TABLET,,6262,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
DIPHENOXYLATE-ATROPINE 2.5-0.025 MG ORAL TABLET,,6262,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
DIPHENOXYLATE-ATROPINE 2.5-0.025 MG ORAL TABLET,,6262,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
DIPHENOXYLATE-ATROPINE 2.5-0.025 MG ORAL TABLET,,6262,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
DIPHENOXYLATE-ATROPINE 2.5-0.025 MG ORAL TABLET,,6262,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DIPHENOXYLATE-ATROPINE 2.5-0.025 MG ORAL TABLET,,6262,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
DIPHENOXYLATE-ATROPINE 2.5-0.025 MG ORAL TABLET,,6262,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
DIPHENOXYLATE-ATROPINE 2.5-0.025 MG ORAL TABLET,,6262,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
DIPHENOXYLATE-ATROPINE 2.5-0.025 MG ORAL TABLET,,6262,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
DIPHENOXYLATE-ATROPINE 2.5-0.025 MG ORAL TABLET,,6262,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
DIPHENOXYLATE-ATROPINE 2.5-0.025 MG ORAL TABLET,,6262,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DIPHENOXYLATE-ATROPINE 2.5-0.025 MG ORAL TABLET,,6262,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
DIPHENOXYLATE-ATROPINE 2.5-0.025 MG ORAL TABLET,,6262,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DIPHENOXYLATE-ATROPINE 2.5-0.025 MG ORAL TABLET,,6262,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DIPHENOXYLATE-ATROPINE 2.5-0.025 MG ORAL TABLET,,6262,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DIPHENOXYLATE-ATROPINE 2.5-0.025 MG ORAL TABLET,,6262,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DIPHENOXYLATE-ATROPINE 2.5-0.025 MG ORAL TABLET,,6262,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
DIPHENOXYLATE-ATROPINE 2.5-0.025 MG ORAL TABLET,,6262,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
DIPHENOXYLATE-ATROPINE 2.5-0.025 MG ORAL TABLET,,6262,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
DIPHENOXYLATE-ATROPINE 2.5-0.025 MG ORAL TABLET,,6262,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
DIPHENOXYLATE-ATROPINE 2.5-0.025 MG ORAL TABLET,,6262,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
VALSARTAN 80 MG ORAL TABLET,,6288,LOCAL,Facility,Both,1,EA,,25,21.25,7.165,25,Aetna,Commercial,23,92,,percent of total billed charges,,
VALSARTAN 80 MG ORAL TABLET,,6288,LOCAL,Facility,Outpatient,1,EA,,25,21.25,7.165,25,Aetna,Medicare Advantage,12.25,49,,percent of total billed charges,,
VALSARTAN 80 MG ORAL TABLET,,6288,LOCAL,Facility,Inpatient,1,EA,,25,21.25,7.165,25,Aetna,Medicare Advantage,,,,,Included in per diem rate,
VALSARTAN 80 MG ORAL TABLET,,6288,LOCAL,Facility,Both,1,EA,,25,21.25,7.165,25,Aetna,PPO,23.25,93,,percent of total billed charges,,
VALSARTAN 80 MG ORAL TABLET,,6288,LOCAL,Facility,Both,1,EA,,25,21.25,7.165,25,America's PPO,America's PPO,24.0075,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
VALSARTAN 80 MG ORAL TABLET,,6288,LOCAL,Facility,Both,1,EA,,25,21.25,7.165,25,BlueCross BlueShield Minnesota, Federal Employee Program,24.6,98.4,,percent of total billed charges,,
VALSARTAN 80 MG ORAL TABLET,,6288,LOCAL,Facility,Both,1,EA,,25,21.25,7.165,25,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,25,100,,percent of total billed charges,,
VALSARTAN 80 MG ORAL TABLET,,6288,LOCAL,Facility,Both,1,EA,,25,21.25,7.165,25,BlueCross BlueShield Minnesota,High Value Network Plan,22.5,90,,percent of total billed charges,,
VALSARTAN 80 MG ORAL TABLET,,6288,LOCAL,Facility,Outpatient,1,EA,,25,21.25,7.165,25,BlueCross BlueShield Minnesota,Medicare Advantage,12.25,49,,percent of total billed charges,,
VALSARTAN 80 MG ORAL TABLET,,6288,LOCAL,Facility,Inpatient,1,EA,,25,21.25,7.165,25,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
VALSARTAN 80 MG ORAL TABLET,,6288,LOCAL,Facility,Both,1,EA,,25,21.25,7.165,25,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,22.1425,88.57,,percent of total billed charges,,
VALSARTAN 80 MG ORAL TABLET,,6288,LOCAL,Facility,Both,1,EA,,25,21.25,7.165,25,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,7.165,28.66,,percent of total billed charges,,
VALSARTAN 80 MG ORAL TABLET,,6288,LOCAL,Facility,Outpatient,1,EA,,25,21.25,7.165,25,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),12.25,49,,percent of total billed charges,,
VALSARTAN 80 MG ORAL TABLET,,6288,LOCAL,Facility,Inpatient,1,EA,,25,21.25,7.165,25,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
VALSARTAN 80 MG ORAL TABLET,,6288,LOCAL,Facility,Both,1,EA,,25,21.25,7.165,25,CorVel,Worker's Compensation,25,100,,percent of total billed charges,,
VALSARTAN 80 MG ORAL TABLET,,6288,LOCAL,Facility,Both,1,EA,,25,21.25,7.165,25,First Health Group Corporation,First Health Network,24.25,97,,percent of total billed charges,,
VALSARTAN 80 MG ORAL TABLET,,6288,LOCAL,Facility,Both,1,EA,,25,21.25,7.165,25,"Health Partners, Inc.",Commercial,23.65,94.6,,percent of total billed charges,,
VALSARTAN 80 MG ORAL TABLET,,6288,LOCAL,Facility,Outpatient,1,EA,,25,21.25,7.165,25,"Health Partners, Inc.",Medicare Advantage,12.25,49,,percent of total billed charges,,
VALSARTAN 80 MG ORAL TABLET,,6288,LOCAL,Facility,Inpatient,1,EA,,25,21.25,7.165,25,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
VALSARTAN 80 MG ORAL TABLET,,6288,LOCAL,Facility,Both,1,EA,,25,21.25,7.165,25,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),15,60,,percent of total billed charges,,
VALSARTAN 80 MG ORAL TABLET,,6288,LOCAL,Facility,Both,1,EA,,25,21.25,7.165,25,"Health Partners, Inc.",State of Minnesota Advantage Program,20.375,81.5,,percent of total billed charges,,
VALSARTAN 80 MG ORAL TABLET,,6288,LOCAL,Facility,Both,1,EA,,25,21.25,7.165,25,"Health Partners, Inc.",State Public Programs,12.5,50,,percent of total billed charges,,
VALSARTAN 80 MG ORAL TABLET,,6288,LOCAL,Facility,Both,1,EA,,25,21.25,7.165,25,Humana Insurance Company,Commercial PPO,23.75,95,,percent of total billed charges,,
VALSARTAN 80 MG ORAL TABLET,,6288,LOCAL,Facility,Outpatient,1,EA,,25,21.25,7.165,25,Humana Insurance Company,Medicare PPO,12.25,49,,percent of total billed charges,,
VALSARTAN 80 MG ORAL TABLET,,6288,LOCAL,Facility,Inpatient,1,EA,,25,21.25,7.165,25,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
VALSARTAN 80 MG ORAL TABLET,,6288,LOCAL,Facility,Both,1,EA,,25,21.25,7.165,25,Medica,Individual & Family,24.775,99.1,,percent of total billed charges,,
VALSARTAN 80 MG ORAL TABLET,,6288,LOCAL,Facility,Outpatient,1,EA,,25,21.25,7.165,25,Medica,Medica Advantage Solution,12.45,49.8,,percent of total billed charges,,
VALSARTAN 80 MG ORAL TABLET,,6288,LOCAL,Facility,Inpatient,1,EA,,25,21.25,7.165,25,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
VALSARTAN 80 MG ORAL TABLET,,6288,LOCAL,Facility,Outpatient,1,EA,,25,21.25,7.165,25,Medica,Medical Assistance,11.15,44.6,,percent of total billed charges,,
VALSARTAN 80 MG ORAL TABLET,,6288,LOCAL,Facility,Inpatient,1,EA,,25,21.25,7.165,25,Medica,Medical Assistance,,,,,Included in per diem rate,
VALSARTAN 80 MG ORAL TABLET,,6288,LOCAL,Facility,Outpatient,1,EA,,25,21.25,7.165,25,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,12.45,49.8,,percent of total billed charges,,
VALSARTAN 80 MG ORAL TABLET,,6288,LOCAL,Facility,Inpatient,1,EA,,25,21.25,7.165,25,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
VALSARTAN 80 MG ORAL TABLET,,6288,LOCAL,Facility,Both,1,EA,,25,21.25,7.165,25,"Multiplan, Inc.","Multiplan, Inc.",23.5,94,,percent of total billed charges,,
VALSARTAN 80 MG ORAL TABLET,,6288,LOCAL,Facility,Outpatient,1,EA,,25,21.25,7.165,25,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,22.525,90.1,,percent of total billed charges,,
VALSARTAN 80 MG ORAL TABLET,,6288,LOCAL,Facility,Inpatient,1,EA,,25,21.25,7.165,25,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
VALSARTAN 80 MG ORAL TABLET,,6288,LOCAL,Facility,Both,1,EA,,25,21.25,7.165,25,"Preferred One Administrative Services, INC.",PPO,24.65,98.6,,percent of total billed charges,,
VALSARTAN 80 MG ORAL TABLET,,6288,LOCAL,Facility,Outpatient,1,EA,,25,21.25,7.165,25,PrimeWest Health,Minnesota Senior Health Options (MSHO),12.8625,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
VALSARTAN 80 MG ORAL TABLET,,6288,LOCAL,Facility,Inpatient,1,EA,,25,21.25,7.165,25,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
VALSARTAN 80 MG ORAL TABLET,,6288,LOCAL,Facility,Outpatient,1,EA,,25,21.25,7.165,25,PrimeWest Health,MinnesotaCare,12.84,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
VALSARTAN 80 MG ORAL TABLET,,6288,LOCAL,Facility,Inpatient,1,EA,,25,21.25,7.165,25,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
VALSARTAN 80 MG ORAL TABLET,,6288,LOCAL,Facility,Both,1,EA,,25,21.25,7.165,25,Sanford Health Plan,Sanford Health Plan,23,92,,percent of total billed charges,,
VALSARTAN 80 MG ORAL TABLET,,6288,LOCAL,Facility,Outpatient,1,EA,,25,21.25,7.165,25,"UCare Health, Inc.",Individual & Family Plan,14.0875,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
VALSARTAN 80 MG ORAL TABLET,,6288,LOCAL,Facility,Inpatient,1,EA,,25,21.25,7.165,25,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
VALSARTAN 80 MG ORAL TABLET,,6288,LOCAL,Facility,Outpatient,1,EA,,25,21.25,7.165,25,"UCare Health, Inc.",Medical Assistance,12.6175,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
VALSARTAN 80 MG ORAL TABLET,,6288,LOCAL,Facility,Inpatient,1,EA,,25,21.25,7.165,25,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
VALSARTAN 80 MG ORAL TABLET,,6288,LOCAL,Facility,Outpatient,1,EA,,25,21.25,7.165,25,"UCare Health, Inc.",Medicare Advantage,12.6175,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
VALSARTAN 80 MG ORAL TABLET,,6288,LOCAL,Facility,Inpatient,1,EA,,25,21.25,7.165,25,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
VALSARTAN 80 MG ORAL TABLET,,6288,LOCAL,Facility,Outpatient,1,EA,,25,21.25,7.165,25,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),12.6175,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
VALSARTAN 80 MG ORAL TABLET,,6288,LOCAL,Facility,Inpatient,1,EA,,25,21.25,7.165,25,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
VALSARTAN 80 MG ORAL TABLET,,6288,LOCAL,Facility,Both,1,EA,,25,21.25,7.165,25,UnitedHealthcare,Individual & Family,23.5,94,,percent of total billed charges,,
VALSARTAN 80 MG ORAL TABLET,,6288,LOCAL,Facility,Outpatient,1,EA,,25,21.25,7.165,25,UnitedHealthcare,Medicare Advantage,12.25,49,,percent of total billed charges,,
VALSARTAN 80 MG ORAL TABLET,,6288,LOCAL,Facility,Inpatient,1,EA,,25,21.25,7.165,25,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
VALSARTAN 80 MG ORAL TABLET,,6288,LOCAL,Facility,Outpatient,1,EA,,25,21.25,7.165,25,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,12,48,,percent of total billed charges,,100% of DHS outpatient percentage
VALSARTAN 80 MG ORAL TABLET,,6288,LOCAL,Facility,Inpatient,1,EA,,25,21.25,7.165,25,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
TOPIRAMATE 25 MG ORAL TABLET,,6546,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
TOPIRAMATE 25 MG ORAL TABLET,,6546,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
TOPIRAMATE 25 MG ORAL TABLET,,6546,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
TOPIRAMATE 25 MG ORAL TABLET,,6546,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
TOPIRAMATE 25 MG ORAL TABLET,,6546,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
TOPIRAMATE 25 MG ORAL TABLET,,6546,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
TOPIRAMATE 25 MG ORAL TABLET,,6546,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
TOPIRAMATE 25 MG ORAL TABLET,,6546,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
TOPIRAMATE 25 MG ORAL TABLET,,6546,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
TOPIRAMATE 25 MG ORAL TABLET,,6546,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
TOPIRAMATE 25 MG ORAL TABLET,,6546,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
TOPIRAMATE 25 MG ORAL TABLET,,6546,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
TOPIRAMATE 25 MG ORAL TABLET,,6546,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
TOPIRAMATE 25 MG ORAL TABLET,,6546,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
TOPIRAMATE 25 MG ORAL TABLET,,6546,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
TOPIRAMATE 25 MG ORAL TABLET,,6546,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
TOPIRAMATE 25 MG ORAL TABLET,,6546,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
TOPIRAMATE 25 MG ORAL TABLET,,6546,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
TOPIRAMATE 25 MG ORAL TABLET,,6546,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
TOPIRAMATE 25 MG ORAL TABLET,,6546,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
TOPIRAMATE 25 MG ORAL TABLET,,6546,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
TOPIRAMATE 25 MG ORAL TABLET,,6546,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
TOPIRAMATE 25 MG ORAL TABLET,,6546,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
TOPIRAMATE 25 MG ORAL TABLET,,6546,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
TOPIRAMATE 25 MG ORAL TABLET,,6546,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
TOPIRAMATE 25 MG ORAL TABLET,,6546,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
TOPIRAMATE 25 MG ORAL TABLET,,6546,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
TOPIRAMATE 25 MG ORAL TABLET,,6546,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
TOPIRAMATE 25 MG ORAL TABLET,,6546,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
TOPIRAMATE 25 MG ORAL TABLET,,6546,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
TOPIRAMATE 25 MG ORAL TABLET,,6546,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
TOPIRAMATE 25 MG ORAL TABLET,,6546,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
TOPIRAMATE 25 MG ORAL TABLET,,6546,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
TOPIRAMATE 25 MG ORAL TABLET,,6546,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
TOPIRAMATE 25 MG ORAL TABLET,,6546,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
TOPIRAMATE 25 MG ORAL TABLET,,6546,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
TOPIRAMATE 25 MG ORAL TABLET,,6546,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
TOPIRAMATE 25 MG ORAL TABLET,,6546,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
TOPIRAMATE 25 MG ORAL TABLET,,6546,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
TOPIRAMATE 25 MG ORAL TABLET,,6546,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
TOPIRAMATE 25 MG ORAL TABLET,,6546,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
TOPIRAMATE 25 MG ORAL TABLET,,6546,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
TOPIRAMATE 25 MG ORAL TABLET,,6546,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
TOPIRAMATE 25 MG ORAL TABLET,,6546,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TOPIRAMATE 25 MG ORAL TABLET,,6546,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
TOPIRAMATE 25 MG ORAL TABLET,,6546,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TOPIRAMATE 25 MG ORAL TABLET,,6546,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
TOPIRAMATE 25 MG ORAL TABLET,,6546,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TOPIRAMATE 25 MG ORAL TABLET,,6546,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
TOPIRAMATE 25 MG ORAL TABLET,,6546,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
TOPIRAMATE 25 MG ORAL TABLET,,6546,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
TOPIRAMATE 25 MG ORAL TABLET,,6546,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
TOPIRAMATE 25 MG ORAL TABLET,,6546,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
TOPIRAMATE 25 MG ORAL TABLET,,6546,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
HYDRALAZINE 25 MG ORAL TABLET,,6605,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
HYDRALAZINE 25 MG ORAL TABLET,,6605,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
HYDRALAZINE 25 MG ORAL TABLET,,6605,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
HYDRALAZINE 25 MG ORAL TABLET,,6605,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
HYDRALAZINE 25 MG ORAL TABLET,,6605,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
HYDRALAZINE 25 MG ORAL TABLET,,6605,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
HYDRALAZINE 25 MG ORAL TABLET,,6605,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
HYDRALAZINE 25 MG ORAL TABLET,,6605,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
HYDRALAZINE 25 MG ORAL TABLET,,6605,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
HYDRALAZINE 25 MG ORAL TABLET,,6605,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
HYDRALAZINE 25 MG ORAL TABLET,,6605,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
HYDRALAZINE 25 MG ORAL TABLET,,6605,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
HYDRALAZINE 25 MG ORAL TABLET,,6605,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
HYDRALAZINE 25 MG ORAL TABLET,,6605,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
HYDRALAZINE 25 MG ORAL TABLET,,6605,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
HYDRALAZINE 25 MG ORAL TABLET,,6605,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
HYDRALAZINE 25 MG ORAL TABLET,,6605,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
HYDRALAZINE 25 MG ORAL TABLET,,6605,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
HYDRALAZINE 25 MG ORAL TABLET,,6605,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
HYDRALAZINE 25 MG ORAL TABLET,,6605,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
HYDRALAZINE 25 MG ORAL TABLET,,6605,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
HYDRALAZINE 25 MG ORAL TABLET,,6605,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
HYDRALAZINE 25 MG ORAL TABLET,,6605,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
HYDRALAZINE 25 MG ORAL TABLET,,6605,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
HYDRALAZINE 25 MG ORAL TABLET,,6605,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
HYDRALAZINE 25 MG ORAL TABLET,,6605,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
HYDRALAZINE 25 MG ORAL TABLET,,6605,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
HYDRALAZINE 25 MG ORAL TABLET,,6605,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
HYDRALAZINE 25 MG ORAL TABLET,,6605,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
HYDRALAZINE 25 MG ORAL TABLET,,6605,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
HYDRALAZINE 25 MG ORAL TABLET,,6605,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
HYDRALAZINE 25 MG ORAL TABLET,,6605,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
HYDRALAZINE 25 MG ORAL TABLET,,6605,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
HYDRALAZINE 25 MG ORAL TABLET,,6605,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
HYDRALAZINE 25 MG ORAL TABLET,,6605,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
HYDRALAZINE 25 MG ORAL TABLET,,6605,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
HYDRALAZINE 25 MG ORAL TABLET,,6605,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
HYDRALAZINE 25 MG ORAL TABLET,,6605,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
HYDRALAZINE 25 MG ORAL TABLET,,6605,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
HYDRALAZINE 25 MG ORAL TABLET,,6605,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
HYDRALAZINE 25 MG ORAL TABLET,,6605,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
HYDRALAZINE 25 MG ORAL TABLET,,6605,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
HYDRALAZINE 25 MG ORAL TABLET,,6605,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
HYDRALAZINE 25 MG ORAL TABLET,,6605,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
HYDRALAZINE 25 MG ORAL TABLET,,6605,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
HYDRALAZINE 25 MG ORAL TABLET,,6605,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
HYDRALAZINE 25 MG ORAL TABLET,,6605,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
HYDRALAZINE 25 MG ORAL TABLET,,6605,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
HYDRALAZINE 25 MG ORAL TABLET,,6605,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
HYDRALAZINE 25 MG ORAL TABLET,,6605,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
HYDRALAZINE 25 MG ORAL TABLET,,6605,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
HYDRALAZINE 25 MG ORAL TABLET,,6605,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
HYDRALAZINE 25 MG ORAL TABLET,,6605,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
HYDRALAZINE 25 MG ORAL TABLET,,6605,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
HYDRALAZINE 25 MG ORAL TABLET,,6605,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
HYDRALAZINE 25 MG ORAL TABLET,,6605,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
HYDRALAZINE 25 MG ORAL TABLET,,6605,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
HYDRALAZINE 25 MG ORAL TABLET,,6605,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
HYDRALAZINE 25 MG ORAL TABLET,,6605,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
HYDRALAZINE 25 MG ORAL TABLET,,6605,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
HYDRALAZINE 25 MG ORAL TABLET,,6605,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
HYDRALAZINE 25 MG ORAL TABLET,,6605,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
HYDRALAZINE 25 MG ORAL TABLET,,6605,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
HYDRALAZINE 25 MG ORAL TABLET,,6605,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
HYDRALAZINE 25 MG ORAL TABLET,,6605,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
HYDRALAZINE 25 MG ORAL TABLET,,6605,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
HYDRALAZINE 25 MG ORAL TABLET,,6605,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
HYDRALAZINE 25 MG ORAL TABLET,,6605,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
HYDRALAZINE 25 MG ORAL TABLET,,6605,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
HYDRALAZINE 25 MG ORAL TABLET,,6605,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
HYDRALAZINE 25 MG ORAL TABLET,,6605,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
HYDRALAZINE 25 MG ORAL TABLET,,6605,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
HYDRALAZINE 25 MG ORAL TABLET,,6605,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
HYDRALAZINE 25 MG ORAL TABLET,,6605,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
HYDRALAZINE 25 MG ORAL TABLET,,6605,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
HYDRALAZINE 25 MG ORAL TABLET,,6605,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
HYDRALAZINE 25 MG ORAL TABLET,,6605,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
HYDRALAZINE 25 MG ORAL TABLET,,6605,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
HYDRALAZINE 25 MG ORAL TABLET,,6605,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
HYDRALAZINE 25 MG ORAL TABLET,,6605,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
HYDRALAZINE 25 MG ORAL TABLET,,6605,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
HYDRALAZINE 25 MG ORAL TABLET,,6605,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
HYDRALAZINE 25 MG ORAL TABLET,,6605,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
HYDRALAZINE 25 MG ORAL TABLET,,6605,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
HYDRALAZINE 25 MG ORAL TABLET,,6605,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
HYDRALAZINE 25 MG ORAL TABLET,,6605,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
HYDRALAZINE 25 MG ORAL TABLET,,6605,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
HYDRALAZINE 25 MG ORAL TABLET,,6605,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
HYDRALAZINE 25 MG ORAL TABLET,,6605,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
HYDRALAZINE 25 MG ORAL TABLET,,6605,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
HYDRALAZINE 25 MG ORAL TABLET,,6605,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
HYDRALAZINE 25 MG ORAL TABLET,,6605,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
HYDRALAZINE 25 MG ORAL TABLET,,6605,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
HYDRALAZINE 25 MG ORAL TABLET,,6605,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
HYDRALAZINE 25 MG ORAL TABLET,,6605,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
HYDRALAZINE 25 MG ORAL TABLET,,6605,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
HYDRALAZINE 25 MG ORAL TABLET,,6605,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
HYDRALAZINE 25 MG ORAL TABLET,,6605,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
HYDRALAZINE 25 MG ORAL TABLET,,6605,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
HYDRALAZINE 25 MG ORAL TABLET,,6605,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
HYDRALAZINE 25 MG ORAL TABLET,,6605,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
HYDRALAZINE 25 MG ORAL TABLET,,6605,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
HYDRALAZINE 25 MG ORAL TABLET,,6605,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
HYDRALAZINE 25 MG ORAL TABLET,,6605,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
HYDRALAZINE 25 MG ORAL TABLET,,6605,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
HYDRALAZINE 25 MG ORAL TABLET,,6605,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
HYDRALAZINE 25 MG ORAL TABLET,,6605,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
HYDRALAZINE 25 MG ORAL TABLET,,6605,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
MECLIZINE 12.5 MG ORAL TABLET,,6621,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
MECLIZINE 12.5 MG ORAL TABLET,,6621,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
MECLIZINE 12.5 MG ORAL TABLET,,6621,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
MECLIZINE 12.5 MG ORAL TABLET,,6621,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
MECLIZINE 12.5 MG ORAL TABLET,,6621,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
MECLIZINE 12.5 MG ORAL TABLET,,6621,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
MECLIZINE 12.5 MG ORAL TABLET,,6621,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
MECLIZINE 12.5 MG ORAL TABLET,,6621,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
MECLIZINE 12.5 MG ORAL TABLET,,6621,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
MECLIZINE 12.5 MG ORAL TABLET,,6621,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
MECLIZINE 12.5 MG ORAL TABLET,,6621,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
MECLIZINE 12.5 MG ORAL TABLET,,6621,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
MECLIZINE 12.5 MG ORAL TABLET,,6621,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
MECLIZINE 12.5 MG ORAL TABLET,,6621,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
MECLIZINE 12.5 MG ORAL TABLET,,6621,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
MECLIZINE 12.5 MG ORAL TABLET,,6621,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
MECLIZINE 12.5 MG ORAL TABLET,,6621,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
MECLIZINE 12.5 MG ORAL TABLET,,6621,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
MECLIZINE 12.5 MG ORAL TABLET,,6621,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
MECLIZINE 12.5 MG ORAL TABLET,,6621,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
MECLIZINE 12.5 MG ORAL TABLET,,6621,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
MECLIZINE 12.5 MG ORAL TABLET,,6621,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
MECLIZINE 12.5 MG ORAL TABLET,,6621,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
MECLIZINE 12.5 MG ORAL TABLET,,6621,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
MECLIZINE 12.5 MG ORAL TABLET,,6621,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
MECLIZINE 12.5 MG ORAL TABLET,,6621,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
MECLIZINE 12.5 MG ORAL TABLET,,6621,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
MECLIZINE 12.5 MG ORAL TABLET,,6621,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
MECLIZINE 12.5 MG ORAL TABLET,,6621,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
MECLIZINE 12.5 MG ORAL TABLET,,6621,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
MECLIZINE 12.5 MG ORAL TABLET,,6621,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
MECLIZINE 12.5 MG ORAL TABLET,,6621,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
MECLIZINE 12.5 MG ORAL TABLET,,6621,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
MECLIZINE 12.5 MG ORAL TABLET,,6621,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
MECLIZINE 12.5 MG ORAL TABLET,,6621,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
MECLIZINE 12.5 MG ORAL TABLET,,6621,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
MECLIZINE 12.5 MG ORAL TABLET,,6621,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
MECLIZINE 12.5 MG ORAL TABLET,,6621,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
MECLIZINE 12.5 MG ORAL TABLET,,6621,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
MECLIZINE 12.5 MG ORAL TABLET,,6621,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
MECLIZINE 12.5 MG ORAL TABLET,,6621,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
MECLIZINE 12.5 MG ORAL TABLET,,6621,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
MECLIZINE 12.5 MG ORAL TABLET,,6621,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
MECLIZINE 12.5 MG ORAL TABLET,,6621,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MECLIZINE 12.5 MG ORAL TABLET,,6621,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
MECLIZINE 12.5 MG ORAL TABLET,,6621,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MECLIZINE 12.5 MG ORAL TABLET,,6621,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
MECLIZINE 12.5 MG ORAL TABLET,,6621,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MECLIZINE 12.5 MG ORAL TABLET,,6621,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
MECLIZINE 12.5 MG ORAL TABLET,,6621,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
MECLIZINE 12.5 MG ORAL TABLET,,6621,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
MECLIZINE 12.5 MG ORAL TABLET,,6621,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
MECLIZINE 12.5 MG ORAL TABLET,,6621,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
MECLIZINE 12.5 MG ORAL TABLET,,6621,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
AMLODIPINE 2.5 MG ORAL TABLET,,6783,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
AMLODIPINE 2.5 MG ORAL TABLET,,6783,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
AMLODIPINE 2.5 MG ORAL TABLET,,6783,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
AMLODIPINE 2.5 MG ORAL TABLET,,6783,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
AMLODIPINE 2.5 MG ORAL TABLET,,6783,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
AMLODIPINE 2.5 MG ORAL TABLET,,6783,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
AMLODIPINE 2.5 MG ORAL TABLET,,6783,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
AMLODIPINE 2.5 MG ORAL TABLET,,6783,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
AMLODIPINE 2.5 MG ORAL TABLET,,6783,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
AMLODIPINE 2.5 MG ORAL TABLET,,6783,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
AMLODIPINE 2.5 MG ORAL TABLET,,6783,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
AMLODIPINE 2.5 MG ORAL TABLET,,6783,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
AMLODIPINE 2.5 MG ORAL TABLET,,6783,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
AMLODIPINE 2.5 MG ORAL TABLET,,6783,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
AMLODIPINE 2.5 MG ORAL TABLET,,6783,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
AMLODIPINE 2.5 MG ORAL TABLET,,6783,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
AMLODIPINE 2.5 MG ORAL TABLET,,6783,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
AMLODIPINE 2.5 MG ORAL TABLET,,6783,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
AMLODIPINE 2.5 MG ORAL TABLET,,6783,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
AMLODIPINE 2.5 MG ORAL TABLET,,6783,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
AMLODIPINE 2.5 MG ORAL TABLET,,6783,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
AMLODIPINE 2.5 MG ORAL TABLET,,6783,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
AMLODIPINE 2.5 MG ORAL TABLET,,6783,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
AMLODIPINE 2.5 MG ORAL TABLET,,6783,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
AMLODIPINE 2.5 MG ORAL TABLET,,6783,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
AMLODIPINE 2.5 MG ORAL TABLET,,6783,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
AMLODIPINE 2.5 MG ORAL TABLET,,6783,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
AMLODIPINE 2.5 MG ORAL TABLET,,6783,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
AMLODIPINE 2.5 MG ORAL TABLET,,6783,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
AMLODIPINE 2.5 MG ORAL TABLET,,6783,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
AMLODIPINE 2.5 MG ORAL TABLET,,6783,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
AMLODIPINE 2.5 MG ORAL TABLET,,6783,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
AMLODIPINE 2.5 MG ORAL TABLET,,6783,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
AMLODIPINE 2.5 MG ORAL TABLET,,6783,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
AMLODIPINE 2.5 MG ORAL TABLET,,6783,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
AMLODIPINE 2.5 MG ORAL TABLET,,6783,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
AMLODIPINE 2.5 MG ORAL TABLET,,6783,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
AMLODIPINE 2.5 MG ORAL TABLET,,6783,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
AMLODIPINE 2.5 MG ORAL TABLET,,6783,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
AMLODIPINE 2.5 MG ORAL TABLET,,6783,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
AMLODIPINE 2.5 MG ORAL TABLET,,6783,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
AMLODIPINE 2.5 MG ORAL TABLET,,6783,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
AMLODIPINE 2.5 MG ORAL TABLET,,6783,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
AMLODIPINE 2.5 MG ORAL TABLET,,6783,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
AMLODIPINE 2.5 MG ORAL TABLET,,6783,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
AMLODIPINE 2.5 MG ORAL TABLET,,6783,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
AMLODIPINE 2.5 MG ORAL TABLET,,6783,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
AMLODIPINE 2.5 MG ORAL TABLET,,6783,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
AMLODIPINE 2.5 MG ORAL TABLET,,6783,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
AMLODIPINE 2.5 MG ORAL TABLET,,6783,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
AMLODIPINE 2.5 MG ORAL TABLET,,6783,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
AMLODIPINE 2.5 MG ORAL TABLET,,6783,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
AMLODIPINE 2.5 MG ORAL TABLET,,6783,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
AMLODIPINE 2.5 MG ORAL TABLET,,6783,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
METRONIDAZOLE 500 MG ORAL TABLET,,6813,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
METRONIDAZOLE 500 MG ORAL TABLET,,6813,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
METRONIDAZOLE 500 MG ORAL TABLET,,6813,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
METRONIDAZOLE 500 MG ORAL TABLET,,6813,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
METRONIDAZOLE 500 MG ORAL TABLET,,6813,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
METRONIDAZOLE 500 MG ORAL TABLET,,6813,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
METRONIDAZOLE 500 MG ORAL TABLET,,6813,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
METRONIDAZOLE 500 MG ORAL TABLET,,6813,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
METRONIDAZOLE 500 MG ORAL TABLET,,6813,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
METRONIDAZOLE 500 MG ORAL TABLET,,6813,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
METRONIDAZOLE 500 MG ORAL TABLET,,6813,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
METRONIDAZOLE 500 MG ORAL TABLET,,6813,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
METRONIDAZOLE 500 MG ORAL TABLET,,6813,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
METRONIDAZOLE 500 MG ORAL TABLET,,6813,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
METRONIDAZOLE 500 MG ORAL TABLET,,6813,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
METRONIDAZOLE 500 MG ORAL TABLET,,6813,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
METRONIDAZOLE 500 MG ORAL TABLET,,6813,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
METRONIDAZOLE 500 MG ORAL TABLET,,6813,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
METRONIDAZOLE 500 MG ORAL TABLET,,6813,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
METRONIDAZOLE 500 MG ORAL TABLET,,6813,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
METRONIDAZOLE 500 MG ORAL TABLET,,6813,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
METRONIDAZOLE 500 MG ORAL TABLET,,6813,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
METRONIDAZOLE 500 MG ORAL TABLET,,6813,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
METRONIDAZOLE 500 MG ORAL TABLET,,6813,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
METRONIDAZOLE 500 MG ORAL TABLET,,6813,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
METRONIDAZOLE 500 MG ORAL TABLET,,6813,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
METRONIDAZOLE 500 MG ORAL TABLET,,6813,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
METRONIDAZOLE 500 MG ORAL TABLET,,6813,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
METRONIDAZOLE 500 MG ORAL TABLET,,6813,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
METRONIDAZOLE 500 MG ORAL TABLET,,6813,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
METRONIDAZOLE 500 MG ORAL TABLET,,6813,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
METRONIDAZOLE 500 MG ORAL TABLET,,6813,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
METRONIDAZOLE 500 MG ORAL TABLET,,6813,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
METRONIDAZOLE 500 MG ORAL TABLET,,6813,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
METRONIDAZOLE 500 MG ORAL TABLET,,6813,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
METRONIDAZOLE 500 MG ORAL TABLET,,6813,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
METRONIDAZOLE 500 MG ORAL TABLET,,6813,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
METRONIDAZOLE 500 MG ORAL TABLET,,6813,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
METRONIDAZOLE 500 MG ORAL TABLET,,6813,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
METRONIDAZOLE 500 MG ORAL TABLET,,6813,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
METRONIDAZOLE 500 MG ORAL TABLET,,6813,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
METRONIDAZOLE 500 MG ORAL TABLET,,6813,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
METRONIDAZOLE 500 MG ORAL TABLET,,6813,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
METRONIDAZOLE 500 MG ORAL TABLET,,6813,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
METRONIDAZOLE 500 MG ORAL TABLET,,6813,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
METRONIDAZOLE 500 MG ORAL TABLET,,6813,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
METRONIDAZOLE 500 MG ORAL TABLET,,6813,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
METRONIDAZOLE 500 MG ORAL TABLET,,6813,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
METRONIDAZOLE 500 MG ORAL TABLET,,6813,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
METRONIDAZOLE 500 MG ORAL TABLET,,6813,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
METRONIDAZOLE 500 MG ORAL TABLET,,6813,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
METRONIDAZOLE 500 MG ORAL TABLET,,6813,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
METRONIDAZOLE 500 MG ORAL TABLET,,6813,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
METRONIDAZOLE 500 MG ORAL TABLET,,6813,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
CALCIUM CARBONATE 300 MG (750 MG) ORAL CHEW TAB,,6858,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
CALCIUM CARBONATE 300 MG (750 MG) ORAL CHEW TAB,,6858,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
CALCIUM CARBONATE 300 MG (750 MG) ORAL CHEW TAB,,6858,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
CALCIUM CARBONATE 300 MG (750 MG) ORAL CHEW TAB,,6858,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
CALCIUM CARBONATE 300 MG (750 MG) ORAL CHEW TAB,,6858,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
CALCIUM CARBONATE 300 MG (750 MG) ORAL CHEW TAB,,6858,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
CALCIUM CARBONATE 300 MG (750 MG) ORAL CHEW TAB,,6858,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
CALCIUM CARBONATE 300 MG (750 MG) ORAL CHEW TAB,,6858,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
CALCIUM CARBONATE 300 MG (750 MG) ORAL CHEW TAB,,6858,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
CALCIUM CARBONATE 300 MG (750 MG) ORAL CHEW TAB,,6858,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
CALCIUM CARBONATE 300 MG (750 MG) ORAL CHEW TAB,,6858,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
CALCIUM CARBONATE 300 MG (750 MG) ORAL CHEW TAB,,6858,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
CALCIUM CARBONATE 300 MG (750 MG) ORAL CHEW TAB,,6858,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
CALCIUM CARBONATE 300 MG (750 MG) ORAL CHEW TAB,,6858,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
CALCIUM CARBONATE 300 MG (750 MG) ORAL CHEW TAB,,6858,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
CALCIUM CARBONATE 300 MG (750 MG) ORAL CHEW TAB,,6858,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
CALCIUM CARBONATE 300 MG (750 MG) ORAL CHEW TAB,,6858,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
CALCIUM CARBONATE 300 MG (750 MG) ORAL CHEW TAB,,6858,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
CALCIUM CARBONATE 300 MG (750 MG) ORAL CHEW TAB,,6858,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CALCIUM CARBONATE 300 MG (750 MG) ORAL CHEW TAB,,6858,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
CALCIUM CARBONATE 300 MG (750 MG) ORAL CHEW TAB,,6858,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
CALCIUM CARBONATE 300 MG (750 MG) ORAL CHEW TAB,,6858,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
CALCIUM CARBONATE 300 MG (750 MG) ORAL CHEW TAB,,6858,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
CALCIUM CARBONATE 300 MG (750 MG) ORAL CHEW TAB,,6858,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
CALCIUM CARBONATE 300 MG (750 MG) ORAL CHEW TAB,,6858,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
CALCIUM CARBONATE 300 MG (750 MG) ORAL CHEW TAB,,6858,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
CALCIUM CARBONATE 300 MG (750 MG) ORAL CHEW TAB,,6858,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
CALCIUM CARBONATE 300 MG (750 MG) ORAL CHEW TAB,,6858,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
CALCIUM CARBONATE 300 MG (750 MG) ORAL CHEW TAB,,6858,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
CALCIUM CARBONATE 300 MG (750 MG) ORAL CHEW TAB,,6858,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
CALCIUM CARBONATE 300 MG (750 MG) ORAL CHEW TAB,,6858,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
CALCIUM CARBONATE 300 MG (750 MG) ORAL CHEW TAB,,6858,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
CALCIUM CARBONATE 300 MG (750 MG) ORAL CHEW TAB,,6858,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
CALCIUM CARBONATE 300 MG (750 MG) ORAL CHEW TAB,,6858,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
CALCIUM CARBONATE 300 MG (750 MG) ORAL CHEW TAB,,6858,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
CALCIUM CARBONATE 300 MG (750 MG) ORAL CHEW TAB,,6858,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
CALCIUM CARBONATE 300 MG (750 MG) ORAL CHEW TAB,,6858,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
CALCIUM CARBONATE 300 MG (750 MG) ORAL CHEW TAB,,6858,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CALCIUM CARBONATE 300 MG (750 MG) ORAL CHEW TAB,,6858,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
CALCIUM CARBONATE 300 MG (750 MG) ORAL CHEW TAB,,6858,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
CALCIUM CARBONATE 300 MG (750 MG) ORAL CHEW TAB,,6858,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
CALCIUM CARBONATE 300 MG (750 MG) ORAL CHEW TAB,,6858,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
CALCIUM CARBONATE 300 MG (750 MG) ORAL CHEW TAB,,6858,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
CALCIUM CARBONATE 300 MG (750 MG) ORAL CHEW TAB,,6858,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CALCIUM CARBONATE 300 MG (750 MG) ORAL CHEW TAB,,6858,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
CALCIUM CARBONATE 300 MG (750 MG) ORAL CHEW TAB,,6858,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CALCIUM CARBONATE 300 MG (750 MG) ORAL CHEW TAB,,6858,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CALCIUM CARBONATE 300 MG (750 MG) ORAL CHEW TAB,,6858,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CALCIUM CARBONATE 300 MG (750 MG) ORAL CHEW TAB,,6858,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CALCIUM CARBONATE 300 MG (750 MG) ORAL CHEW TAB,,6858,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
CALCIUM CARBONATE 300 MG (750 MG) ORAL CHEW TAB,,6858,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
CALCIUM CARBONATE 300 MG (750 MG) ORAL CHEW TAB,,6858,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
CALCIUM CARBONATE 300 MG (750 MG) ORAL CHEW TAB,,6858,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
CALCIUM CARBONATE 300 MG (750 MG) ORAL CHEW TAB,,6858,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
PHENYTOIN SODIUM EXTENDED 100 MG ORAL CAP,,6883,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
PHENYTOIN SODIUM EXTENDED 100 MG ORAL CAP,,6883,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
PHENYTOIN SODIUM EXTENDED 100 MG ORAL CAP,,6883,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
PHENYTOIN SODIUM EXTENDED 100 MG ORAL CAP,,6883,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
PHENYTOIN SODIUM EXTENDED 100 MG ORAL CAP,,6883,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
PHENYTOIN SODIUM EXTENDED 100 MG ORAL CAP,,6883,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
PHENYTOIN SODIUM EXTENDED 100 MG ORAL CAP,,6883,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
PHENYTOIN SODIUM EXTENDED 100 MG ORAL CAP,,6883,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
PHENYTOIN SODIUM EXTENDED 100 MG ORAL CAP,,6883,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
PHENYTOIN SODIUM EXTENDED 100 MG ORAL CAP,,6883,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
PHENYTOIN SODIUM EXTENDED 100 MG ORAL CAP,,6883,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
PHENYTOIN SODIUM EXTENDED 100 MG ORAL CAP,,6883,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
PHENYTOIN SODIUM EXTENDED 100 MG ORAL CAP,,6883,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
PHENYTOIN SODIUM EXTENDED 100 MG ORAL CAP,,6883,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
PHENYTOIN SODIUM EXTENDED 100 MG ORAL CAP,,6883,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
PHENYTOIN SODIUM EXTENDED 100 MG ORAL CAP,,6883,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
PHENYTOIN SODIUM EXTENDED 100 MG ORAL CAP,,6883,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
PHENYTOIN SODIUM EXTENDED 100 MG ORAL CAP,,6883,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
PHENYTOIN SODIUM EXTENDED 100 MG ORAL CAP,,6883,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PHENYTOIN SODIUM EXTENDED 100 MG ORAL CAP,,6883,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
PHENYTOIN SODIUM EXTENDED 100 MG ORAL CAP,,6883,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
PHENYTOIN SODIUM EXTENDED 100 MG ORAL CAP,,6883,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
PHENYTOIN SODIUM EXTENDED 100 MG ORAL CAP,,6883,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
PHENYTOIN SODIUM EXTENDED 100 MG ORAL CAP,,6883,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
PHENYTOIN SODIUM EXTENDED 100 MG ORAL CAP,,6883,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
PHENYTOIN SODIUM EXTENDED 100 MG ORAL CAP,,6883,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
PHENYTOIN SODIUM EXTENDED 100 MG ORAL CAP,,6883,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
PHENYTOIN SODIUM EXTENDED 100 MG ORAL CAP,,6883,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
PHENYTOIN SODIUM EXTENDED 100 MG ORAL CAP,,6883,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
PHENYTOIN SODIUM EXTENDED 100 MG ORAL CAP,,6883,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
PHENYTOIN SODIUM EXTENDED 100 MG ORAL CAP,,6883,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
PHENYTOIN SODIUM EXTENDED 100 MG ORAL CAP,,6883,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
PHENYTOIN SODIUM EXTENDED 100 MG ORAL CAP,,6883,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
PHENYTOIN SODIUM EXTENDED 100 MG ORAL CAP,,6883,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
PHENYTOIN SODIUM EXTENDED 100 MG ORAL CAP,,6883,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
PHENYTOIN SODIUM EXTENDED 100 MG ORAL CAP,,6883,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
PHENYTOIN SODIUM EXTENDED 100 MG ORAL CAP,,6883,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
PHENYTOIN SODIUM EXTENDED 100 MG ORAL CAP,,6883,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PHENYTOIN SODIUM EXTENDED 100 MG ORAL CAP,,6883,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
PHENYTOIN SODIUM EXTENDED 100 MG ORAL CAP,,6883,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
PHENYTOIN SODIUM EXTENDED 100 MG ORAL CAP,,6883,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
PHENYTOIN SODIUM EXTENDED 100 MG ORAL CAP,,6883,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
PHENYTOIN SODIUM EXTENDED 100 MG ORAL CAP,,6883,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
PHENYTOIN SODIUM EXTENDED 100 MG ORAL CAP,,6883,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PHENYTOIN SODIUM EXTENDED 100 MG ORAL CAP,,6883,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
PHENYTOIN SODIUM EXTENDED 100 MG ORAL CAP,,6883,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PHENYTOIN SODIUM EXTENDED 100 MG ORAL CAP,,6883,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PHENYTOIN SODIUM EXTENDED 100 MG ORAL CAP,,6883,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PHENYTOIN SODIUM EXTENDED 100 MG ORAL CAP,,6883,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PHENYTOIN SODIUM EXTENDED 100 MG ORAL CAP,,6883,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
PHENYTOIN SODIUM EXTENDED 100 MG ORAL CAP,,6883,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
PHENYTOIN SODIUM EXTENDED 100 MG ORAL CAP,,6883,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
PHENYTOIN SODIUM EXTENDED 100 MG ORAL CAP,,6883,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
PHENYTOIN SODIUM EXTENDED 100 MG ORAL CAP,,6883,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
MELATONIN 3 MG ORAL TABLET,,6917,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
MELATONIN 3 MG ORAL TABLET,,6917,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
MELATONIN 3 MG ORAL TABLET,,6917,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
MELATONIN 3 MG ORAL TABLET,,6917,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
MELATONIN 3 MG ORAL TABLET,,6917,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
MELATONIN 3 MG ORAL TABLET,,6917,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
MELATONIN 3 MG ORAL TABLET,,6917,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
MELATONIN 3 MG ORAL TABLET,,6917,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
MELATONIN 3 MG ORAL TABLET,,6917,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
MELATONIN 3 MG ORAL TABLET,,6917,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
MELATONIN 3 MG ORAL TABLET,,6917,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
MELATONIN 3 MG ORAL TABLET,,6917,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
MELATONIN 3 MG ORAL TABLET,,6917,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
MELATONIN 3 MG ORAL TABLET,,6917,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
MELATONIN 3 MG ORAL TABLET,,6917,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
MELATONIN 3 MG ORAL TABLET,,6917,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
MELATONIN 3 MG ORAL TABLET,,6917,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
MELATONIN 3 MG ORAL TABLET,,6917,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
MELATONIN 3 MG ORAL TABLET,,6917,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
MELATONIN 3 MG ORAL TABLET,,6917,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
MELATONIN 3 MG ORAL TABLET,,6917,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
MELATONIN 3 MG ORAL TABLET,,6917,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
MELATONIN 3 MG ORAL TABLET,,6917,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
MELATONIN 3 MG ORAL TABLET,,6917,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
MELATONIN 3 MG ORAL TABLET,,6917,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
MELATONIN 3 MG ORAL TABLET,,6917,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
MELATONIN 3 MG ORAL TABLET,,6917,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
MELATONIN 3 MG ORAL TABLET,,6917,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
MELATONIN 3 MG ORAL TABLET,,6917,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
MELATONIN 3 MG ORAL TABLET,,6917,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
MELATONIN 3 MG ORAL TABLET,,6917,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
MELATONIN 3 MG ORAL TABLET,,6917,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
MELATONIN 3 MG ORAL TABLET,,6917,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
MELATONIN 3 MG ORAL TABLET,,6917,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
MELATONIN 3 MG ORAL TABLET,,6917,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
MELATONIN 3 MG ORAL TABLET,,6917,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
MELATONIN 3 MG ORAL TABLET,,6917,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
MELATONIN 3 MG ORAL TABLET,,6917,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
MELATONIN 3 MG ORAL TABLET,,6917,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
MELATONIN 3 MG ORAL TABLET,,6917,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
MELATONIN 3 MG ORAL TABLET,,6917,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
MELATONIN 3 MG ORAL TABLET,,6917,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
MELATONIN 3 MG ORAL TABLET,,6917,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
MELATONIN 3 MG ORAL TABLET,,6917,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MELATONIN 3 MG ORAL TABLET,,6917,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
MELATONIN 3 MG ORAL TABLET,,6917,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MELATONIN 3 MG ORAL TABLET,,6917,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
MELATONIN 3 MG ORAL TABLET,,6917,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MELATONIN 3 MG ORAL TABLET,,6917,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
MELATONIN 3 MG ORAL TABLET,,6917,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
MELATONIN 3 MG ORAL TABLET,,6917,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
MELATONIN 3 MG ORAL TABLET,,6917,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
MELATONIN 3 MG ORAL TABLET,,6917,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
MELATONIN 3 MG ORAL TABLET,,6917,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
NIFEDIPINE 30 MG ORAL TAB SR,,6947,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
NIFEDIPINE 30 MG ORAL TAB SR,,6947,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
NIFEDIPINE 30 MG ORAL TAB SR,,6947,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
NIFEDIPINE 30 MG ORAL TAB SR,,6947,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
NIFEDIPINE 30 MG ORAL TAB SR,,6947,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
NIFEDIPINE 30 MG ORAL TAB SR,,6947,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
NIFEDIPINE 30 MG ORAL TAB SR,,6947,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
NIFEDIPINE 30 MG ORAL TAB SR,,6947,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
NIFEDIPINE 30 MG ORAL TAB SR,,6947,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
NIFEDIPINE 30 MG ORAL TAB SR,,6947,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
NIFEDIPINE 30 MG ORAL TAB SR,,6947,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
NIFEDIPINE 30 MG ORAL TAB SR,,6947,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
NIFEDIPINE 30 MG ORAL TAB SR,,6947,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
NIFEDIPINE 30 MG ORAL TAB SR,,6947,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
NIFEDIPINE 30 MG ORAL TAB SR,,6947,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
NIFEDIPINE 30 MG ORAL TAB SR,,6947,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
NIFEDIPINE 30 MG ORAL TAB SR,,6947,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
NIFEDIPINE 30 MG ORAL TAB SR,,6947,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
NIFEDIPINE 30 MG ORAL TAB SR,,6947,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
NIFEDIPINE 30 MG ORAL TAB SR,,6947,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
NIFEDIPINE 30 MG ORAL TAB SR,,6947,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
NIFEDIPINE 30 MG ORAL TAB SR,,6947,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
NIFEDIPINE 30 MG ORAL TAB SR,,6947,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
NIFEDIPINE 30 MG ORAL TAB SR,,6947,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
NIFEDIPINE 30 MG ORAL TAB SR,,6947,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
NIFEDIPINE 30 MG ORAL TAB SR,,6947,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
NIFEDIPINE 30 MG ORAL TAB SR,,6947,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
NIFEDIPINE 30 MG ORAL TAB SR,,6947,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
NIFEDIPINE 30 MG ORAL TAB SR,,6947,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
NIFEDIPINE 30 MG ORAL TAB SR,,6947,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
NIFEDIPINE 30 MG ORAL TAB SR,,6947,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
NIFEDIPINE 30 MG ORAL TAB SR,,6947,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
NIFEDIPINE 30 MG ORAL TAB SR,,6947,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
NIFEDIPINE 30 MG ORAL TAB SR,,6947,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
NIFEDIPINE 30 MG ORAL TAB SR,,6947,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
NIFEDIPINE 30 MG ORAL TAB SR,,6947,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
NIFEDIPINE 30 MG ORAL TAB SR,,6947,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
NIFEDIPINE 30 MG ORAL TAB SR,,6947,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
NIFEDIPINE 30 MG ORAL TAB SR,,6947,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
NIFEDIPINE 30 MG ORAL TAB SR,,6947,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
NIFEDIPINE 30 MG ORAL TAB SR,,6947,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
NIFEDIPINE 30 MG ORAL TAB SR,,6947,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
NIFEDIPINE 30 MG ORAL TAB SR,,6947,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
NIFEDIPINE 30 MG ORAL TAB SR,,6947,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
NIFEDIPINE 30 MG ORAL TAB SR,,6947,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
NIFEDIPINE 30 MG ORAL TAB SR,,6947,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
NIFEDIPINE 30 MG ORAL TAB SR,,6947,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
NIFEDIPINE 30 MG ORAL TAB SR,,6947,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
NIFEDIPINE 30 MG ORAL TAB SR,,6947,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
NIFEDIPINE 30 MG ORAL TAB SR,,6947,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
NIFEDIPINE 30 MG ORAL TAB SR,,6947,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
NIFEDIPINE 30 MG ORAL TAB SR,,6947,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
NIFEDIPINE 30 MG ORAL TAB SR,,6947,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
NIFEDIPINE 30 MG ORAL TAB SR,,6947,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
ACETAMINOPHEN-CODEINE 300-30 MG ORAL TABLET,,6970,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
ACETAMINOPHEN-CODEINE 300-30 MG ORAL TABLET,,6970,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
ACETAMINOPHEN-CODEINE 300-30 MG ORAL TABLET,,6970,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
ACETAMINOPHEN-CODEINE 300-30 MG ORAL TABLET,,6970,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
ACETAMINOPHEN-CODEINE 300-30 MG ORAL TABLET,,6970,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
ACETAMINOPHEN-CODEINE 300-30 MG ORAL TABLET,,6970,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
ACETAMINOPHEN-CODEINE 300-30 MG ORAL TABLET,,6970,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
ACETAMINOPHEN-CODEINE 300-30 MG ORAL TABLET,,6970,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
ACETAMINOPHEN-CODEINE 300-30 MG ORAL TABLET,,6970,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
ACETAMINOPHEN-CODEINE 300-30 MG ORAL TABLET,,6970,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
ACETAMINOPHEN-CODEINE 300-30 MG ORAL TABLET,,6970,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
ACETAMINOPHEN-CODEINE 300-30 MG ORAL TABLET,,6970,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
ACETAMINOPHEN-CODEINE 300-30 MG ORAL TABLET,,6970,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
ACETAMINOPHEN-CODEINE 300-30 MG ORAL TABLET,,6970,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
ACETAMINOPHEN-CODEINE 300-30 MG ORAL TABLET,,6970,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
ACETAMINOPHEN-CODEINE 300-30 MG ORAL TABLET,,6970,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
ACETAMINOPHEN-CODEINE 300-30 MG ORAL TABLET,,6970,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
ACETAMINOPHEN-CODEINE 300-30 MG ORAL TABLET,,6970,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
ACETAMINOPHEN-CODEINE 300-30 MG ORAL TABLET,,6970,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ACETAMINOPHEN-CODEINE 300-30 MG ORAL TABLET,,6970,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
ACETAMINOPHEN-CODEINE 300-30 MG ORAL TABLET,,6970,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
ACETAMINOPHEN-CODEINE 300-30 MG ORAL TABLET,,6970,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
ACETAMINOPHEN-CODEINE 300-30 MG ORAL TABLET,,6970,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
ACETAMINOPHEN-CODEINE 300-30 MG ORAL TABLET,,6970,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
ACETAMINOPHEN-CODEINE 300-30 MG ORAL TABLET,,6970,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
ACETAMINOPHEN-CODEINE 300-30 MG ORAL TABLET,,6970,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
ACETAMINOPHEN-CODEINE 300-30 MG ORAL TABLET,,6970,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
ACETAMINOPHEN-CODEINE 300-30 MG ORAL TABLET,,6970,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
ACETAMINOPHEN-CODEINE 300-30 MG ORAL TABLET,,6970,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
ACETAMINOPHEN-CODEINE 300-30 MG ORAL TABLET,,6970,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
ACETAMINOPHEN-CODEINE 300-30 MG ORAL TABLET,,6970,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
ACETAMINOPHEN-CODEINE 300-30 MG ORAL TABLET,,6970,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
ACETAMINOPHEN-CODEINE 300-30 MG ORAL TABLET,,6970,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
ACETAMINOPHEN-CODEINE 300-30 MG ORAL TABLET,,6970,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
ACETAMINOPHEN-CODEINE 300-30 MG ORAL TABLET,,6970,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
ACETAMINOPHEN-CODEINE 300-30 MG ORAL TABLET,,6970,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
ACETAMINOPHEN-CODEINE 300-30 MG ORAL TABLET,,6970,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
ACETAMINOPHEN-CODEINE 300-30 MG ORAL TABLET,,6970,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ACETAMINOPHEN-CODEINE 300-30 MG ORAL TABLET,,6970,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
ACETAMINOPHEN-CODEINE 300-30 MG ORAL TABLET,,6970,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
ACETAMINOPHEN-CODEINE 300-30 MG ORAL TABLET,,6970,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
ACETAMINOPHEN-CODEINE 300-30 MG ORAL TABLET,,6970,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
ACETAMINOPHEN-CODEINE 300-30 MG ORAL TABLET,,6970,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
ACETAMINOPHEN-CODEINE 300-30 MG ORAL TABLET,,6970,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ACETAMINOPHEN-CODEINE 300-30 MG ORAL TABLET,,6970,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
ACETAMINOPHEN-CODEINE 300-30 MG ORAL TABLET,,6970,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ACETAMINOPHEN-CODEINE 300-30 MG ORAL TABLET,,6970,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ACETAMINOPHEN-CODEINE 300-30 MG ORAL TABLET,,6970,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ACETAMINOPHEN-CODEINE 300-30 MG ORAL TABLET,,6970,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ACETAMINOPHEN-CODEINE 300-30 MG ORAL TABLET,,6970,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
ACETAMINOPHEN-CODEINE 300-30 MG ORAL TABLET,,6970,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
ACETAMINOPHEN-CODEINE 300-30 MG ORAL TABLET,,6970,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
ACETAMINOPHEN-CODEINE 300-30 MG ORAL TABLET,,6970,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
ACETAMINOPHEN-CODEINE 300-30 MG ORAL TABLET,,6970,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
CLOPIDOGREL 75 MG ORAL TABLET,,6987,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
CLOPIDOGREL 75 MG ORAL TABLET,,6987,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
CLOPIDOGREL 75 MG ORAL TABLET,,6987,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
CLOPIDOGREL 75 MG ORAL TABLET,,6987,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
CLOPIDOGREL 75 MG ORAL TABLET,,6987,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
CLOPIDOGREL 75 MG ORAL TABLET,,6987,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
CLOPIDOGREL 75 MG ORAL TABLET,,6987,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
CLOPIDOGREL 75 MG ORAL TABLET,,6987,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
CLOPIDOGREL 75 MG ORAL TABLET,,6987,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
CLOPIDOGREL 75 MG ORAL TABLET,,6987,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
CLOPIDOGREL 75 MG ORAL TABLET,,6987,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
CLOPIDOGREL 75 MG ORAL TABLET,,6987,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
CLOPIDOGREL 75 MG ORAL TABLET,,6987,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
CLOPIDOGREL 75 MG ORAL TABLET,,6987,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
CLOPIDOGREL 75 MG ORAL TABLET,,6987,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
CLOPIDOGREL 75 MG ORAL TABLET,,6987,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
CLOPIDOGREL 75 MG ORAL TABLET,,6987,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
CLOPIDOGREL 75 MG ORAL TABLET,,6987,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
CLOPIDOGREL 75 MG ORAL TABLET,,6987,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CLOPIDOGREL 75 MG ORAL TABLET,,6987,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
CLOPIDOGREL 75 MG ORAL TABLET,,6987,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
CLOPIDOGREL 75 MG ORAL TABLET,,6987,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
CLOPIDOGREL 75 MG ORAL TABLET,,6987,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
CLOPIDOGREL 75 MG ORAL TABLET,,6987,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
CLOPIDOGREL 75 MG ORAL TABLET,,6987,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
CLOPIDOGREL 75 MG ORAL TABLET,,6987,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
CLOPIDOGREL 75 MG ORAL TABLET,,6987,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
CLOPIDOGREL 75 MG ORAL TABLET,,6987,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
CLOPIDOGREL 75 MG ORAL TABLET,,6987,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
CLOPIDOGREL 75 MG ORAL TABLET,,6987,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
CLOPIDOGREL 75 MG ORAL TABLET,,6987,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
CLOPIDOGREL 75 MG ORAL TABLET,,6987,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
CLOPIDOGREL 75 MG ORAL TABLET,,6987,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
CLOPIDOGREL 75 MG ORAL TABLET,,6987,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
CLOPIDOGREL 75 MG ORAL TABLET,,6987,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
CLOPIDOGREL 75 MG ORAL TABLET,,6987,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
CLOPIDOGREL 75 MG ORAL TABLET,,6987,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
CLOPIDOGREL 75 MG ORAL TABLET,,6987,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CLOPIDOGREL 75 MG ORAL TABLET,,6987,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
CLOPIDOGREL 75 MG ORAL TABLET,,6987,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
CLOPIDOGREL 75 MG ORAL TABLET,,6987,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
CLOPIDOGREL 75 MG ORAL TABLET,,6987,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
CLOPIDOGREL 75 MG ORAL TABLET,,6987,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
CLOPIDOGREL 75 MG ORAL TABLET,,6987,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CLOPIDOGREL 75 MG ORAL TABLET,,6987,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
CLOPIDOGREL 75 MG ORAL TABLET,,6987,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CLOPIDOGREL 75 MG ORAL TABLET,,6987,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CLOPIDOGREL 75 MG ORAL TABLET,,6987,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CLOPIDOGREL 75 MG ORAL TABLET,,6987,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CLOPIDOGREL 75 MG ORAL TABLET,,6987,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
CLOPIDOGREL 75 MG ORAL TABLET,,6987,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
CLOPIDOGREL 75 MG ORAL TABLET,,6987,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
CLOPIDOGREL 75 MG ORAL TABLET,,6987,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
CLOPIDOGREL 75 MG ORAL TABLET,,6987,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
CHLORTHALIDONE 25 MG ORAL TABLET,,7011,LOCAL,Facility,Both,1,EA,,14,11.9,4.0124,14,Aetna,Commercial,12.88,92,,percent of total billed charges,,
CHLORTHALIDONE 25 MG ORAL TABLET,,7011,LOCAL,Facility,Outpatient,1,EA,,14,11.9,4.0124,14,Aetna,Medicare Advantage,6.86,49,,percent of total billed charges,,
CHLORTHALIDONE 25 MG ORAL TABLET,,7011,LOCAL,Facility,Inpatient,1,EA,,14,11.9,4.0124,14,Aetna,Medicare Advantage,,,,,Included in per diem rate,
CHLORTHALIDONE 25 MG ORAL TABLET,,7011,LOCAL,Facility,Both,1,EA,,14,11.9,4.0124,14,Aetna,PPO,13.02,93,,percent of total billed charges,,
CHLORTHALIDONE 25 MG ORAL TABLET,,7011,LOCAL,Facility,Both,1,EA,,14,11.9,4.0124,14,America's PPO,America's PPO,13.4442,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
CHLORTHALIDONE 25 MG ORAL TABLET,,7011,LOCAL,Facility,Both,1,EA,,14,11.9,4.0124,14,BlueCross BlueShield Minnesota, Federal Employee Program,13.776,98.4,,percent of total billed charges,,
CHLORTHALIDONE 25 MG ORAL TABLET,,7011,LOCAL,Facility,Both,1,EA,,14,11.9,4.0124,14,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,14,100,,percent of total billed charges,,
CHLORTHALIDONE 25 MG ORAL TABLET,,7011,LOCAL,Facility,Both,1,EA,,14,11.9,4.0124,14,BlueCross BlueShield Minnesota,High Value Network Plan,12.6,90,,percent of total billed charges,,
CHLORTHALIDONE 25 MG ORAL TABLET,,7011,LOCAL,Facility,Outpatient,1,EA,,14,11.9,4.0124,14,BlueCross BlueShield Minnesota,Medicare Advantage,6.86,49,,percent of total billed charges,,
CHLORTHALIDONE 25 MG ORAL TABLET,,7011,LOCAL,Facility,Inpatient,1,EA,,14,11.9,4.0124,14,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
CHLORTHALIDONE 25 MG ORAL TABLET,,7011,LOCAL,Facility,Both,1,EA,,14,11.9,4.0124,14,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,12.3998,88.57,,percent of total billed charges,,
CHLORTHALIDONE 25 MG ORAL TABLET,,7011,LOCAL,Facility,Both,1,EA,,14,11.9,4.0124,14,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,4.0124,28.66,,percent of total billed charges,,
CHLORTHALIDONE 25 MG ORAL TABLET,,7011,LOCAL,Facility,Outpatient,1,EA,,14,11.9,4.0124,14,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),6.86,49,,percent of total billed charges,,
CHLORTHALIDONE 25 MG ORAL TABLET,,7011,LOCAL,Facility,Inpatient,1,EA,,14,11.9,4.0124,14,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
CHLORTHALIDONE 25 MG ORAL TABLET,,7011,LOCAL,Facility,Both,1,EA,,14,11.9,4.0124,14,CorVel,Worker's Compensation,14,100,,percent of total billed charges,,
CHLORTHALIDONE 25 MG ORAL TABLET,,7011,LOCAL,Facility,Both,1,EA,,14,11.9,4.0124,14,First Health Group Corporation,First Health Network,13.58,97,,percent of total billed charges,,
CHLORTHALIDONE 25 MG ORAL TABLET,,7011,LOCAL,Facility,Both,1,EA,,14,11.9,4.0124,14,"Health Partners, Inc.",Commercial,13.244,94.6,,percent of total billed charges,,
CHLORTHALIDONE 25 MG ORAL TABLET,,7011,LOCAL,Facility,Outpatient,1,EA,,14,11.9,4.0124,14,"Health Partners, Inc.",Medicare Advantage,6.86,49,,percent of total billed charges,,
CHLORTHALIDONE 25 MG ORAL TABLET,,7011,LOCAL,Facility,Inpatient,1,EA,,14,11.9,4.0124,14,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CHLORTHALIDONE 25 MG ORAL TABLET,,7011,LOCAL,Facility,Both,1,EA,,14,11.9,4.0124,14,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),8.4,60,,percent of total billed charges,,
CHLORTHALIDONE 25 MG ORAL TABLET,,7011,LOCAL,Facility,Both,1,EA,,14,11.9,4.0124,14,"Health Partners, Inc.",State of Minnesota Advantage Program,11.41,81.5,,percent of total billed charges,,
CHLORTHALIDONE 25 MG ORAL TABLET,,7011,LOCAL,Facility,Both,1,EA,,14,11.9,4.0124,14,"Health Partners, Inc.",State Public Programs,7,50,,percent of total billed charges,,
CHLORTHALIDONE 25 MG ORAL TABLET,,7011,LOCAL,Facility,Both,1,EA,,14,11.9,4.0124,14,Humana Insurance Company,Commercial PPO,13.3,95,,percent of total billed charges,,
CHLORTHALIDONE 25 MG ORAL TABLET,,7011,LOCAL,Facility,Outpatient,1,EA,,14,11.9,4.0124,14,Humana Insurance Company,Medicare PPO,6.86,49,,percent of total billed charges,,
CHLORTHALIDONE 25 MG ORAL TABLET,,7011,LOCAL,Facility,Inpatient,1,EA,,14,11.9,4.0124,14,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
CHLORTHALIDONE 25 MG ORAL TABLET,,7011,LOCAL,Facility,Both,1,EA,,14,11.9,4.0124,14,Medica,Individual & Family,13.874,99.1,,percent of total billed charges,,
CHLORTHALIDONE 25 MG ORAL TABLET,,7011,LOCAL,Facility,Outpatient,1,EA,,14,11.9,4.0124,14,Medica,Medica Advantage Solution,6.972,49.8,,percent of total billed charges,,
CHLORTHALIDONE 25 MG ORAL TABLET,,7011,LOCAL,Facility,Inpatient,1,EA,,14,11.9,4.0124,14,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
CHLORTHALIDONE 25 MG ORAL TABLET,,7011,LOCAL,Facility,Outpatient,1,EA,,14,11.9,4.0124,14,Medica,Medical Assistance,6.244,44.6,,percent of total billed charges,,
CHLORTHALIDONE 25 MG ORAL TABLET,,7011,LOCAL,Facility,Inpatient,1,EA,,14,11.9,4.0124,14,Medica,Medical Assistance,,,,,Included in per diem rate,
CHLORTHALIDONE 25 MG ORAL TABLET,,7011,LOCAL,Facility,Outpatient,1,EA,,14,11.9,4.0124,14,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,6.972,49.8,,percent of total billed charges,,
CHLORTHALIDONE 25 MG ORAL TABLET,,7011,LOCAL,Facility,Inpatient,1,EA,,14,11.9,4.0124,14,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
CHLORTHALIDONE 25 MG ORAL TABLET,,7011,LOCAL,Facility,Both,1,EA,,14,11.9,4.0124,14,"Multiplan, Inc.","Multiplan, Inc.",13.16,94,,percent of total billed charges,,
CHLORTHALIDONE 25 MG ORAL TABLET,,7011,LOCAL,Facility,Outpatient,1,EA,,14,11.9,4.0124,14,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,12.614,90.1,,percent of total billed charges,,
CHLORTHALIDONE 25 MG ORAL TABLET,,7011,LOCAL,Facility,Inpatient,1,EA,,14,11.9,4.0124,14,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
CHLORTHALIDONE 25 MG ORAL TABLET,,7011,LOCAL,Facility,Both,1,EA,,14,11.9,4.0124,14,"Preferred One Administrative Services, INC.",PPO,13.804,98.6,,percent of total billed charges,,
CHLORTHALIDONE 25 MG ORAL TABLET,,7011,LOCAL,Facility,Outpatient,1,EA,,14,11.9,4.0124,14,PrimeWest Health,Minnesota Senior Health Options (MSHO),7.203,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
CHLORTHALIDONE 25 MG ORAL TABLET,,7011,LOCAL,Facility,Inpatient,1,EA,,14,11.9,4.0124,14,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CHLORTHALIDONE 25 MG ORAL TABLET,,7011,LOCAL,Facility,Outpatient,1,EA,,14,11.9,4.0124,14,PrimeWest Health,MinnesotaCare,7.1904,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
CHLORTHALIDONE 25 MG ORAL TABLET,,7011,LOCAL,Facility,Inpatient,1,EA,,14,11.9,4.0124,14,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
CHLORTHALIDONE 25 MG ORAL TABLET,,7011,LOCAL,Facility,Both,1,EA,,14,11.9,4.0124,14,Sanford Health Plan,Sanford Health Plan,12.88,92,,percent of total billed charges,,
CHLORTHALIDONE 25 MG ORAL TABLET,,7011,LOCAL,Facility,Outpatient,1,EA,,14,11.9,4.0124,14,"UCare Health, Inc.",Individual & Family Plan,7.889,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
CHLORTHALIDONE 25 MG ORAL TABLET,,7011,LOCAL,Facility,Inpatient,1,EA,,14,11.9,4.0124,14,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
CHLORTHALIDONE 25 MG ORAL TABLET,,7011,LOCAL,Facility,Outpatient,1,EA,,14,11.9,4.0124,14,"UCare Health, Inc.",Medical Assistance,7.0658,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CHLORTHALIDONE 25 MG ORAL TABLET,,7011,LOCAL,Facility,Inpatient,1,EA,,14,11.9,4.0124,14,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
CHLORTHALIDONE 25 MG ORAL TABLET,,7011,LOCAL,Facility,Outpatient,1,EA,,14,11.9,4.0124,14,"UCare Health, Inc.",Medicare Advantage,7.0658,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CHLORTHALIDONE 25 MG ORAL TABLET,,7011,LOCAL,Facility,Inpatient,1,EA,,14,11.9,4.0124,14,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CHLORTHALIDONE 25 MG ORAL TABLET,,7011,LOCAL,Facility,Outpatient,1,EA,,14,11.9,4.0124,14,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),7.0658,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CHLORTHALIDONE 25 MG ORAL TABLET,,7011,LOCAL,Facility,Inpatient,1,EA,,14,11.9,4.0124,14,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CHLORTHALIDONE 25 MG ORAL TABLET,,7011,LOCAL,Facility,Both,1,EA,,14,11.9,4.0124,14,UnitedHealthcare,Individual & Family,13.16,94,,percent of total billed charges,,
CHLORTHALIDONE 25 MG ORAL TABLET,,7011,LOCAL,Facility,Outpatient,1,EA,,14,11.9,4.0124,14,UnitedHealthcare,Medicare Advantage,6.86,49,,percent of total billed charges,,
CHLORTHALIDONE 25 MG ORAL TABLET,,7011,LOCAL,Facility,Inpatient,1,EA,,14,11.9,4.0124,14,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
CHLORTHALIDONE 25 MG ORAL TABLET,,7011,LOCAL,Facility,Outpatient,1,EA,,14,11.9,4.0124,14,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,6.72,48,,percent of total billed charges,,100% of DHS outpatient percentage
CHLORTHALIDONE 25 MG ORAL TABLET,,7011,LOCAL,Facility,Inpatient,1,EA,,14,11.9,4.0124,14,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
FEXOFENADINE 180 MG ORAL TABLET,,7035,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
FEXOFENADINE 180 MG ORAL TABLET,,7035,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
FEXOFENADINE 180 MG ORAL TABLET,,7035,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
FEXOFENADINE 180 MG ORAL TABLET,,7035,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
FEXOFENADINE 180 MG ORAL TABLET,,7035,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
FEXOFENADINE 180 MG ORAL TABLET,,7035,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
FEXOFENADINE 180 MG ORAL TABLET,,7035,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
FEXOFENADINE 180 MG ORAL TABLET,,7035,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
FEXOFENADINE 180 MG ORAL TABLET,,7035,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
FEXOFENADINE 180 MG ORAL TABLET,,7035,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
FEXOFENADINE 180 MG ORAL TABLET,,7035,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
FEXOFENADINE 180 MG ORAL TABLET,,7035,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
FEXOFENADINE 180 MG ORAL TABLET,,7035,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
FEXOFENADINE 180 MG ORAL TABLET,,7035,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
FEXOFENADINE 180 MG ORAL TABLET,,7035,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
FEXOFENADINE 180 MG ORAL TABLET,,7035,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
FEXOFENADINE 180 MG ORAL TABLET,,7035,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
FEXOFENADINE 180 MG ORAL TABLET,,7035,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
FEXOFENADINE 180 MG ORAL TABLET,,7035,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
FEXOFENADINE 180 MG ORAL TABLET,,7035,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
FEXOFENADINE 180 MG ORAL TABLET,,7035,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
FEXOFENADINE 180 MG ORAL TABLET,,7035,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
FEXOFENADINE 180 MG ORAL TABLET,,7035,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
FEXOFENADINE 180 MG ORAL TABLET,,7035,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
FEXOFENADINE 180 MG ORAL TABLET,,7035,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
FEXOFENADINE 180 MG ORAL TABLET,,7035,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
FEXOFENADINE 180 MG ORAL TABLET,,7035,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
FEXOFENADINE 180 MG ORAL TABLET,,7035,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
FEXOFENADINE 180 MG ORAL TABLET,,7035,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
FEXOFENADINE 180 MG ORAL TABLET,,7035,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
FEXOFENADINE 180 MG ORAL TABLET,,7035,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
FEXOFENADINE 180 MG ORAL TABLET,,7035,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
FEXOFENADINE 180 MG ORAL TABLET,,7035,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
FEXOFENADINE 180 MG ORAL TABLET,,7035,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
FEXOFENADINE 180 MG ORAL TABLET,,7035,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
FEXOFENADINE 180 MG ORAL TABLET,,7035,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
FEXOFENADINE 180 MG ORAL TABLET,,7035,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
FEXOFENADINE 180 MG ORAL TABLET,,7035,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
FEXOFENADINE 180 MG ORAL TABLET,,7035,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
FEXOFENADINE 180 MG ORAL TABLET,,7035,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
FEXOFENADINE 180 MG ORAL TABLET,,7035,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
FEXOFENADINE 180 MG ORAL TABLET,,7035,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
FEXOFENADINE 180 MG ORAL TABLET,,7035,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
FEXOFENADINE 180 MG ORAL TABLET,,7035,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FEXOFENADINE 180 MG ORAL TABLET,,7035,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
FEXOFENADINE 180 MG ORAL TABLET,,7035,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FEXOFENADINE 180 MG ORAL TABLET,,7035,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
FEXOFENADINE 180 MG ORAL TABLET,,7035,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FEXOFENADINE 180 MG ORAL TABLET,,7035,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
FEXOFENADINE 180 MG ORAL TABLET,,7035,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
FEXOFENADINE 180 MG ORAL TABLET,,7035,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
FEXOFENADINE 180 MG ORAL TABLET,,7035,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
FEXOFENADINE 180 MG ORAL TABLET,,7035,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
FEXOFENADINE 180 MG ORAL TABLET,,7035,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
CIPROFLOXACIN HCL 250 MG ORAL TABLET,,7044,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
CIPROFLOXACIN HCL 250 MG ORAL TABLET,,7044,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
CIPROFLOXACIN HCL 250 MG ORAL TABLET,,7044,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
CIPROFLOXACIN HCL 250 MG ORAL TABLET,,7044,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
CIPROFLOXACIN HCL 250 MG ORAL TABLET,,7044,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
CIPROFLOXACIN HCL 250 MG ORAL TABLET,,7044,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
CIPROFLOXACIN HCL 250 MG ORAL TABLET,,7044,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
CIPROFLOXACIN HCL 250 MG ORAL TABLET,,7044,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
CIPROFLOXACIN HCL 250 MG ORAL TABLET,,7044,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
CIPROFLOXACIN HCL 250 MG ORAL TABLET,,7044,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
CIPROFLOXACIN HCL 250 MG ORAL TABLET,,7044,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
CIPROFLOXACIN HCL 250 MG ORAL TABLET,,7044,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
CIPROFLOXACIN HCL 250 MG ORAL TABLET,,7044,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
CIPROFLOXACIN HCL 250 MG ORAL TABLET,,7044,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
CIPROFLOXACIN HCL 250 MG ORAL TABLET,,7044,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
CIPROFLOXACIN HCL 250 MG ORAL TABLET,,7044,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
CIPROFLOXACIN HCL 250 MG ORAL TABLET,,7044,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
CIPROFLOXACIN HCL 250 MG ORAL TABLET,,7044,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
CIPROFLOXACIN HCL 250 MG ORAL TABLET,,7044,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CIPROFLOXACIN HCL 250 MG ORAL TABLET,,7044,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
CIPROFLOXACIN HCL 250 MG ORAL TABLET,,7044,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
CIPROFLOXACIN HCL 250 MG ORAL TABLET,,7044,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
CIPROFLOXACIN HCL 250 MG ORAL TABLET,,7044,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
CIPROFLOXACIN HCL 250 MG ORAL TABLET,,7044,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
CIPROFLOXACIN HCL 250 MG ORAL TABLET,,7044,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
CIPROFLOXACIN HCL 250 MG ORAL TABLET,,7044,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
CIPROFLOXACIN HCL 250 MG ORAL TABLET,,7044,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
CIPROFLOXACIN HCL 250 MG ORAL TABLET,,7044,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
CIPROFLOXACIN HCL 250 MG ORAL TABLET,,7044,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
CIPROFLOXACIN HCL 250 MG ORAL TABLET,,7044,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
CIPROFLOXACIN HCL 250 MG ORAL TABLET,,7044,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
CIPROFLOXACIN HCL 250 MG ORAL TABLET,,7044,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
CIPROFLOXACIN HCL 250 MG ORAL TABLET,,7044,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
CIPROFLOXACIN HCL 250 MG ORAL TABLET,,7044,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
CIPROFLOXACIN HCL 250 MG ORAL TABLET,,7044,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
CIPROFLOXACIN HCL 250 MG ORAL TABLET,,7044,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
CIPROFLOXACIN HCL 250 MG ORAL TABLET,,7044,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
CIPROFLOXACIN HCL 250 MG ORAL TABLET,,7044,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CIPROFLOXACIN HCL 250 MG ORAL TABLET,,7044,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
CIPROFLOXACIN HCL 250 MG ORAL TABLET,,7044,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
CIPROFLOXACIN HCL 250 MG ORAL TABLET,,7044,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
CIPROFLOXACIN HCL 250 MG ORAL TABLET,,7044,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
CIPROFLOXACIN HCL 250 MG ORAL TABLET,,7044,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
CIPROFLOXACIN HCL 250 MG ORAL TABLET,,7044,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CIPROFLOXACIN HCL 250 MG ORAL TABLET,,7044,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
CIPROFLOXACIN HCL 250 MG ORAL TABLET,,7044,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CIPROFLOXACIN HCL 250 MG ORAL TABLET,,7044,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CIPROFLOXACIN HCL 250 MG ORAL TABLET,,7044,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CIPROFLOXACIN HCL 250 MG ORAL TABLET,,7044,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CIPROFLOXACIN HCL 250 MG ORAL TABLET,,7044,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
CIPROFLOXACIN HCL 250 MG ORAL TABLET,,7044,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
CIPROFLOXACIN HCL 250 MG ORAL TABLET,,7044,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
CIPROFLOXACIN HCL 250 MG ORAL TABLET,,7044,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
CIPROFLOXACIN HCL 250 MG ORAL TABLET,,7044,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
TERAZOSIN 1 MG ORAL CAP,,7161,LOCAL,Facility,Both,1,EA,,9,7.65,2.5794,9,Aetna,Commercial,8.28,92,,percent of total billed charges,,
TERAZOSIN 1 MG ORAL CAP,,7161,LOCAL,Facility,Outpatient,1,EA,,9,7.65,2.5794,9,Aetna,Medicare Advantage,4.41,49,,percent of total billed charges,,
TERAZOSIN 1 MG ORAL CAP,,7161,LOCAL,Facility,Inpatient,1,EA,,9,7.65,2.5794,9,Aetna,Medicare Advantage,,,,,Included in per diem rate,
TERAZOSIN 1 MG ORAL CAP,,7161,LOCAL,Facility,Both,1,EA,,9,7.65,2.5794,9,Aetna,PPO,8.37,93,,percent of total billed charges,,
TERAZOSIN 1 MG ORAL CAP,,7161,LOCAL,Facility,Both,1,EA,,9,7.65,2.5794,9,America's PPO,America's PPO,8.6427,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
TERAZOSIN 1 MG ORAL CAP,,7161,LOCAL,Facility,Both,1,EA,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota, Federal Employee Program,8.856,98.4,,percent of total billed charges,,
TERAZOSIN 1 MG ORAL CAP,,7161,LOCAL,Facility,Both,1,EA,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,9,100,,percent of total billed charges,,
TERAZOSIN 1 MG ORAL CAP,,7161,LOCAL,Facility,Both,1,EA,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota,High Value Network Plan,8.1,90,,percent of total billed charges,,
TERAZOSIN 1 MG ORAL CAP,,7161,LOCAL,Facility,Outpatient,1,EA,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota,Medicare Advantage,4.41,49,,percent of total billed charges,,
TERAZOSIN 1 MG ORAL CAP,,7161,LOCAL,Facility,Inpatient,1,EA,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
TERAZOSIN 1 MG ORAL CAP,,7161,LOCAL,Facility,Both,1,EA,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,7.9713,88.57,,percent of total billed charges,,
TERAZOSIN 1 MG ORAL CAP,,7161,LOCAL,Facility,Both,1,EA,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,2.5794,28.66,,percent of total billed charges,,
TERAZOSIN 1 MG ORAL CAP,,7161,LOCAL,Facility,Outpatient,1,EA,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),4.41,49,,percent of total billed charges,,
TERAZOSIN 1 MG ORAL CAP,,7161,LOCAL,Facility,Inpatient,1,EA,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
TERAZOSIN 1 MG ORAL CAP,,7161,LOCAL,Facility,Both,1,EA,,9,7.65,2.5794,9,CorVel,Worker's Compensation,9,100,,percent of total billed charges,,
TERAZOSIN 1 MG ORAL CAP,,7161,LOCAL,Facility,Both,1,EA,,9,7.65,2.5794,9,First Health Group Corporation,First Health Network,8.73,97,,percent of total billed charges,,
TERAZOSIN 1 MG ORAL CAP,,7161,LOCAL,Facility,Both,1,EA,,9,7.65,2.5794,9,"Health Partners, Inc.",Commercial,8.514,94.6,,percent of total billed charges,,
TERAZOSIN 1 MG ORAL CAP,,7161,LOCAL,Facility,Outpatient,1,EA,,9,7.65,2.5794,9,"Health Partners, Inc.",Medicare Advantage,4.41,49,,percent of total billed charges,,
TERAZOSIN 1 MG ORAL CAP,,7161,LOCAL,Facility,Inpatient,1,EA,,9,7.65,2.5794,9,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
TERAZOSIN 1 MG ORAL CAP,,7161,LOCAL,Facility,Both,1,EA,,9,7.65,2.5794,9,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),5.4,60,,percent of total billed charges,,
TERAZOSIN 1 MG ORAL CAP,,7161,LOCAL,Facility,Both,1,EA,,9,7.65,2.5794,9,"Health Partners, Inc.",State of Minnesota Advantage Program,7.335,81.5,,percent of total billed charges,,
TERAZOSIN 1 MG ORAL CAP,,7161,LOCAL,Facility,Both,1,EA,,9,7.65,2.5794,9,"Health Partners, Inc.",State Public Programs,4.5,50,,percent of total billed charges,,
TERAZOSIN 1 MG ORAL CAP,,7161,LOCAL,Facility,Both,1,EA,,9,7.65,2.5794,9,Humana Insurance Company,Commercial PPO,8.55,95,,percent of total billed charges,,
TERAZOSIN 1 MG ORAL CAP,,7161,LOCAL,Facility,Outpatient,1,EA,,9,7.65,2.5794,9,Humana Insurance Company,Medicare PPO,4.41,49,,percent of total billed charges,,
TERAZOSIN 1 MG ORAL CAP,,7161,LOCAL,Facility,Inpatient,1,EA,,9,7.65,2.5794,9,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
TERAZOSIN 1 MG ORAL CAP,,7161,LOCAL,Facility,Both,1,EA,,9,7.65,2.5794,9,Medica,Individual & Family,8.919,99.1,,percent of total billed charges,,
TERAZOSIN 1 MG ORAL CAP,,7161,LOCAL,Facility,Outpatient,1,EA,,9,7.65,2.5794,9,Medica,Medica Advantage Solution,4.482,49.8,,percent of total billed charges,,
TERAZOSIN 1 MG ORAL CAP,,7161,LOCAL,Facility,Inpatient,1,EA,,9,7.65,2.5794,9,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
TERAZOSIN 1 MG ORAL CAP,,7161,LOCAL,Facility,Outpatient,1,EA,,9,7.65,2.5794,9,Medica,Medical Assistance,4.014,44.6,,percent of total billed charges,,
TERAZOSIN 1 MG ORAL CAP,,7161,LOCAL,Facility,Inpatient,1,EA,,9,7.65,2.5794,9,Medica,Medical Assistance,,,,,Included in per diem rate,
TERAZOSIN 1 MG ORAL CAP,,7161,LOCAL,Facility,Outpatient,1,EA,,9,7.65,2.5794,9,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,4.482,49.8,,percent of total billed charges,,
TERAZOSIN 1 MG ORAL CAP,,7161,LOCAL,Facility,Inpatient,1,EA,,9,7.65,2.5794,9,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
TERAZOSIN 1 MG ORAL CAP,,7161,LOCAL,Facility,Both,1,EA,,9,7.65,2.5794,9,"Multiplan, Inc.","Multiplan, Inc.",8.46,94,,percent of total billed charges,,
TERAZOSIN 1 MG ORAL CAP,,7161,LOCAL,Facility,Outpatient,1,EA,,9,7.65,2.5794,9,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,8.109,90.1,,percent of total billed charges,,
TERAZOSIN 1 MG ORAL CAP,,7161,LOCAL,Facility,Inpatient,1,EA,,9,7.65,2.5794,9,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
TERAZOSIN 1 MG ORAL CAP,,7161,LOCAL,Facility,Both,1,EA,,9,7.65,2.5794,9,"Preferred One Administrative Services, INC.",PPO,8.874,98.6,,percent of total billed charges,,
TERAZOSIN 1 MG ORAL CAP,,7161,LOCAL,Facility,Outpatient,1,EA,,9,7.65,2.5794,9,PrimeWest Health,Minnesota Senior Health Options (MSHO),4.6305,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
TERAZOSIN 1 MG ORAL CAP,,7161,LOCAL,Facility,Inpatient,1,EA,,9,7.65,2.5794,9,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
TERAZOSIN 1 MG ORAL CAP,,7161,LOCAL,Facility,Outpatient,1,EA,,9,7.65,2.5794,9,PrimeWest Health,MinnesotaCare,4.6224,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
TERAZOSIN 1 MG ORAL CAP,,7161,LOCAL,Facility,Inpatient,1,EA,,9,7.65,2.5794,9,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
TERAZOSIN 1 MG ORAL CAP,,7161,LOCAL,Facility,Both,1,EA,,9,7.65,2.5794,9,Sanford Health Plan,Sanford Health Plan,8.28,92,,percent of total billed charges,,
TERAZOSIN 1 MG ORAL CAP,,7161,LOCAL,Facility,Outpatient,1,EA,,9,7.65,2.5794,9,"UCare Health, Inc.",Individual & Family Plan,5.0715,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
TERAZOSIN 1 MG ORAL CAP,,7161,LOCAL,Facility,Inpatient,1,EA,,9,7.65,2.5794,9,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
TERAZOSIN 1 MG ORAL CAP,,7161,LOCAL,Facility,Outpatient,1,EA,,9,7.65,2.5794,9,"UCare Health, Inc.",Medical Assistance,4.5423,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TERAZOSIN 1 MG ORAL CAP,,7161,LOCAL,Facility,Inpatient,1,EA,,9,7.65,2.5794,9,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
TERAZOSIN 1 MG ORAL CAP,,7161,LOCAL,Facility,Outpatient,1,EA,,9,7.65,2.5794,9,"UCare Health, Inc.",Medicare Advantage,4.5423,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TERAZOSIN 1 MG ORAL CAP,,7161,LOCAL,Facility,Inpatient,1,EA,,9,7.65,2.5794,9,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
TERAZOSIN 1 MG ORAL CAP,,7161,LOCAL,Facility,Outpatient,1,EA,,9,7.65,2.5794,9,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),4.5423,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TERAZOSIN 1 MG ORAL CAP,,7161,LOCAL,Facility,Inpatient,1,EA,,9,7.65,2.5794,9,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
TERAZOSIN 1 MG ORAL CAP,,7161,LOCAL,Facility,Both,1,EA,,9,7.65,2.5794,9,UnitedHealthcare,Individual & Family,8.46,94,,percent of total billed charges,,
TERAZOSIN 1 MG ORAL CAP,,7161,LOCAL,Facility,Outpatient,1,EA,,9,7.65,2.5794,9,UnitedHealthcare,Medicare Advantage,4.41,49,,percent of total billed charges,,
TERAZOSIN 1 MG ORAL CAP,,7161,LOCAL,Facility,Inpatient,1,EA,,9,7.65,2.5794,9,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
TERAZOSIN 1 MG ORAL CAP,,7161,LOCAL,Facility,Outpatient,1,EA,,9,7.65,2.5794,9,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,4.32,48,,percent of total billed charges,,100% of DHS outpatient percentage
TERAZOSIN 1 MG ORAL CAP,,7161,LOCAL,Facility,Inpatient,1,EA,,9,7.65,2.5794,9,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
LEVOFLOXACIN 250 MG ORAL TABLET,,7175,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
LEVOFLOXACIN 250 MG ORAL TABLET,,7175,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
LEVOFLOXACIN 250 MG ORAL TABLET,,7175,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
LEVOFLOXACIN 250 MG ORAL TABLET,,7175,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
LEVOFLOXACIN 250 MG ORAL TABLET,,7175,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
LEVOFLOXACIN 250 MG ORAL TABLET,,7175,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
LEVOFLOXACIN 250 MG ORAL TABLET,,7175,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
LEVOFLOXACIN 250 MG ORAL TABLET,,7175,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
LEVOFLOXACIN 250 MG ORAL TABLET,,7175,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
LEVOFLOXACIN 250 MG ORAL TABLET,,7175,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
LEVOFLOXACIN 250 MG ORAL TABLET,,7175,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
LEVOFLOXACIN 250 MG ORAL TABLET,,7175,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
LEVOFLOXACIN 250 MG ORAL TABLET,,7175,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
LEVOFLOXACIN 250 MG ORAL TABLET,,7175,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
LEVOFLOXACIN 250 MG ORAL TABLET,,7175,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
LEVOFLOXACIN 250 MG ORAL TABLET,,7175,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
LEVOFLOXACIN 250 MG ORAL TABLET,,7175,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
LEVOFLOXACIN 250 MG ORAL TABLET,,7175,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
LEVOFLOXACIN 250 MG ORAL TABLET,,7175,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LEVOFLOXACIN 250 MG ORAL TABLET,,7175,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
LEVOFLOXACIN 250 MG ORAL TABLET,,7175,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
LEVOFLOXACIN 250 MG ORAL TABLET,,7175,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
LEVOFLOXACIN 250 MG ORAL TABLET,,7175,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
LEVOFLOXACIN 250 MG ORAL TABLET,,7175,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
LEVOFLOXACIN 250 MG ORAL TABLET,,7175,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
LEVOFLOXACIN 250 MG ORAL TABLET,,7175,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
LEVOFLOXACIN 250 MG ORAL TABLET,,7175,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
LEVOFLOXACIN 250 MG ORAL TABLET,,7175,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
LEVOFLOXACIN 250 MG ORAL TABLET,,7175,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
LEVOFLOXACIN 250 MG ORAL TABLET,,7175,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
LEVOFLOXACIN 250 MG ORAL TABLET,,7175,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
LEVOFLOXACIN 250 MG ORAL TABLET,,7175,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
LEVOFLOXACIN 250 MG ORAL TABLET,,7175,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
LEVOFLOXACIN 250 MG ORAL TABLET,,7175,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
LEVOFLOXACIN 250 MG ORAL TABLET,,7175,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
LEVOFLOXACIN 250 MG ORAL TABLET,,7175,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
LEVOFLOXACIN 250 MG ORAL TABLET,,7175,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
LEVOFLOXACIN 250 MG ORAL TABLET,,7175,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LEVOFLOXACIN 250 MG ORAL TABLET,,7175,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
LEVOFLOXACIN 250 MG ORAL TABLET,,7175,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
LEVOFLOXACIN 250 MG ORAL TABLET,,7175,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
LEVOFLOXACIN 250 MG ORAL TABLET,,7175,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
LEVOFLOXACIN 250 MG ORAL TABLET,,7175,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
LEVOFLOXACIN 250 MG ORAL TABLET,,7175,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LEVOFLOXACIN 250 MG ORAL TABLET,,7175,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
LEVOFLOXACIN 250 MG ORAL TABLET,,7175,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LEVOFLOXACIN 250 MG ORAL TABLET,,7175,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LEVOFLOXACIN 250 MG ORAL TABLET,,7175,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LEVOFLOXACIN 250 MG ORAL TABLET,,7175,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LEVOFLOXACIN 250 MG ORAL TABLET,,7175,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
LEVOFLOXACIN 250 MG ORAL TABLET,,7175,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
LEVOFLOXACIN 250 MG ORAL TABLET,,7175,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
LEVOFLOXACIN 250 MG ORAL TABLET,,7175,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
LEVOFLOXACIN 250 MG ORAL TABLET,,7175,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
AMLODIPINE 5 MG ORAL TABLET,,7245,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
AMLODIPINE 5 MG ORAL TABLET,,7245,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
AMLODIPINE 5 MG ORAL TABLET,,7245,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
AMLODIPINE 5 MG ORAL TABLET,,7245,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
AMLODIPINE 5 MG ORAL TABLET,,7245,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
AMLODIPINE 5 MG ORAL TABLET,,7245,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
AMLODIPINE 5 MG ORAL TABLET,,7245,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
AMLODIPINE 5 MG ORAL TABLET,,7245,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
AMLODIPINE 5 MG ORAL TABLET,,7245,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
AMLODIPINE 5 MG ORAL TABLET,,7245,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
AMLODIPINE 5 MG ORAL TABLET,,7245,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
AMLODIPINE 5 MG ORAL TABLET,,7245,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
AMLODIPINE 5 MG ORAL TABLET,,7245,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
AMLODIPINE 5 MG ORAL TABLET,,7245,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
AMLODIPINE 5 MG ORAL TABLET,,7245,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
AMLODIPINE 5 MG ORAL TABLET,,7245,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
AMLODIPINE 5 MG ORAL TABLET,,7245,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
AMLODIPINE 5 MG ORAL TABLET,,7245,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
AMLODIPINE 5 MG ORAL TABLET,,7245,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
AMLODIPINE 5 MG ORAL TABLET,,7245,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
AMLODIPINE 5 MG ORAL TABLET,,7245,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
AMLODIPINE 5 MG ORAL TABLET,,7245,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
AMLODIPINE 5 MG ORAL TABLET,,7245,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
AMLODIPINE 5 MG ORAL TABLET,,7245,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
AMLODIPINE 5 MG ORAL TABLET,,7245,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
AMLODIPINE 5 MG ORAL TABLET,,7245,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
AMLODIPINE 5 MG ORAL TABLET,,7245,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
AMLODIPINE 5 MG ORAL TABLET,,7245,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
AMLODIPINE 5 MG ORAL TABLET,,7245,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
AMLODIPINE 5 MG ORAL TABLET,,7245,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
AMLODIPINE 5 MG ORAL TABLET,,7245,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
AMLODIPINE 5 MG ORAL TABLET,,7245,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
AMLODIPINE 5 MG ORAL TABLET,,7245,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
AMLODIPINE 5 MG ORAL TABLET,,7245,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
AMLODIPINE 5 MG ORAL TABLET,,7245,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
AMLODIPINE 5 MG ORAL TABLET,,7245,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
AMLODIPINE 5 MG ORAL TABLET,,7245,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
AMLODIPINE 5 MG ORAL TABLET,,7245,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
AMLODIPINE 5 MG ORAL TABLET,,7245,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
AMLODIPINE 5 MG ORAL TABLET,,7245,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
AMLODIPINE 5 MG ORAL TABLET,,7245,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
AMLODIPINE 5 MG ORAL TABLET,,7245,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
AMLODIPINE 5 MG ORAL TABLET,,7245,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
AMLODIPINE 5 MG ORAL TABLET,,7245,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
AMLODIPINE 5 MG ORAL TABLET,,7245,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
AMLODIPINE 5 MG ORAL TABLET,,7245,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
AMLODIPINE 5 MG ORAL TABLET,,7245,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
AMLODIPINE 5 MG ORAL TABLET,,7245,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
AMLODIPINE 5 MG ORAL TABLET,,7245,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
AMLODIPINE 5 MG ORAL TABLET,,7245,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
AMLODIPINE 5 MG ORAL TABLET,,7245,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
AMLODIPINE 5 MG ORAL TABLET,,7245,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
AMLODIPINE 5 MG ORAL TABLET,,7245,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
AMLODIPINE 5 MG ORAL TABLET,,7245,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
ACYCLOVIR 400 MG ORAL TABLET,,7347,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
ACYCLOVIR 400 MG ORAL TABLET,,7347,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
ACYCLOVIR 400 MG ORAL TABLET,,7347,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
ACYCLOVIR 400 MG ORAL TABLET,,7347,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
ACYCLOVIR 400 MG ORAL TABLET,,7347,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
ACYCLOVIR 400 MG ORAL TABLET,,7347,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
ACYCLOVIR 400 MG ORAL TABLET,,7347,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
ACYCLOVIR 400 MG ORAL TABLET,,7347,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
ACYCLOVIR 400 MG ORAL TABLET,,7347,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
ACYCLOVIR 400 MG ORAL TABLET,,7347,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
ACYCLOVIR 400 MG ORAL TABLET,,7347,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
ACYCLOVIR 400 MG ORAL TABLET,,7347,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
ACYCLOVIR 400 MG ORAL TABLET,,7347,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
ACYCLOVIR 400 MG ORAL TABLET,,7347,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
ACYCLOVIR 400 MG ORAL TABLET,,7347,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
ACYCLOVIR 400 MG ORAL TABLET,,7347,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
ACYCLOVIR 400 MG ORAL TABLET,,7347,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
ACYCLOVIR 400 MG ORAL TABLET,,7347,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
ACYCLOVIR 400 MG ORAL TABLET,,7347,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ACYCLOVIR 400 MG ORAL TABLET,,7347,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
ACYCLOVIR 400 MG ORAL TABLET,,7347,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
ACYCLOVIR 400 MG ORAL TABLET,,7347,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
ACYCLOVIR 400 MG ORAL TABLET,,7347,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
ACYCLOVIR 400 MG ORAL TABLET,,7347,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
ACYCLOVIR 400 MG ORAL TABLET,,7347,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
ACYCLOVIR 400 MG ORAL TABLET,,7347,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
ACYCLOVIR 400 MG ORAL TABLET,,7347,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
ACYCLOVIR 400 MG ORAL TABLET,,7347,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
ACYCLOVIR 400 MG ORAL TABLET,,7347,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
ACYCLOVIR 400 MG ORAL TABLET,,7347,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
ACYCLOVIR 400 MG ORAL TABLET,,7347,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
ACYCLOVIR 400 MG ORAL TABLET,,7347,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
ACYCLOVIR 400 MG ORAL TABLET,,7347,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
ACYCLOVIR 400 MG ORAL TABLET,,7347,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
ACYCLOVIR 400 MG ORAL TABLET,,7347,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
ACYCLOVIR 400 MG ORAL TABLET,,7347,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
ACYCLOVIR 400 MG ORAL TABLET,,7347,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
ACYCLOVIR 400 MG ORAL TABLET,,7347,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ACYCLOVIR 400 MG ORAL TABLET,,7347,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
ACYCLOVIR 400 MG ORAL TABLET,,7347,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
ACYCLOVIR 400 MG ORAL TABLET,,7347,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
ACYCLOVIR 400 MG ORAL TABLET,,7347,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
ACYCLOVIR 400 MG ORAL TABLET,,7347,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
ACYCLOVIR 400 MG ORAL TABLET,,7347,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ACYCLOVIR 400 MG ORAL TABLET,,7347,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
ACYCLOVIR 400 MG ORAL TABLET,,7347,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ACYCLOVIR 400 MG ORAL TABLET,,7347,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ACYCLOVIR 400 MG ORAL TABLET,,7347,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ACYCLOVIR 400 MG ORAL TABLET,,7347,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ACYCLOVIR 400 MG ORAL TABLET,,7347,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
ACYCLOVIR 400 MG ORAL TABLET,,7347,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
ACYCLOVIR 400 MG ORAL TABLET,,7347,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
ACYCLOVIR 400 MG ORAL TABLET,,7347,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
ACYCLOVIR 400 MG ORAL TABLET,,7347,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
ALLOPURINOL 100 MG ORAL TABLET,,7362,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
ALLOPURINOL 100 MG ORAL TABLET,,7362,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
ALLOPURINOL 100 MG ORAL TABLET,,7362,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
ALLOPURINOL 100 MG ORAL TABLET,,7362,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
ALLOPURINOL 100 MG ORAL TABLET,,7362,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
ALLOPURINOL 100 MG ORAL TABLET,,7362,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
ALLOPURINOL 100 MG ORAL TABLET,,7362,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
ALLOPURINOL 100 MG ORAL TABLET,,7362,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
ALLOPURINOL 100 MG ORAL TABLET,,7362,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
ALLOPURINOL 100 MG ORAL TABLET,,7362,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
ALLOPURINOL 100 MG ORAL TABLET,,7362,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
ALLOPURINOL 100 MG ORAL TABLET,,7362,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
ALLOPURINOL 100 MG ORAL TABLET,,7362,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
ALLOPURINOL 100 MG ORAL TABLET,,7362,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
ALLOPURINOL 100 MG ORAL TABLET,,7362,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
ALLOPURINOL 100 MG ORAL TABLET,,7362,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
ALLOPURINOL 100 MG ORAL TABLET,,7362,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
ALLOPURINOL 100 MG ORAL TABLET,,7362,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
ALLOPURINOL 100 MG ORAL TABLET,,7362,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ALLOPURINOL 100 MG ORAL TABLET,,7362,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
ALLOPURINOL 100 MG ORAL TABLET,,7362,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
ALLOPURINOL 100 MG ORAL TABLET,,7362,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
ALLOPURINOL 100 MG ORAL TABLET,,7362,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
ALLOPURINOL 100 MG ORAL TABLET,,7362,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
ALLOPURINOL 100 MG ORAL TABLET,,7362,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
ALLOPURINOL 100 MG ORAL TABLET,,7362,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
ALLOPURINOL 100 MG ORAL TABLET,,7362,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
ALLOPURINOL 100 MG ORAL TABLET,,7362,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
ALLOPURINOL 100 MG ORAL TABLET,,7362,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
ALLOPURINOL 100 MG ORAL TABLET,,7362,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
ALLOPURINOL 100 MG ORAL TABLET,,7362,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
ALLOPURINOL 100 MG ORAL TABLET,,7362,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
ALLOPURINOL 100 MG ORAL TABLET,,7362,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
ALLOPURINOL 100 MG ORAL TABLET,,7362,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
ALLOPURINOL 100 MG ORAL TABLET,,7362,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
ALLOPURINOL 100 MG ORAL TABLET,,7362,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
ALLOPURINOL 100 MG ORAL TABLET,,7362,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
ALLOPURINOL 100 MG ORAL TABLET,,7362,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ALLOPURINOL 100 MG ORAL TABLET,,7362,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
ALLOPURINOL 100 MG ORAL TABLET,,7362,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
ALLOPURINOL 100 MG ORAL TABLET,,7362,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
ALLOPURINOL 100 MG ORAL TABLET,,7362,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
ALLOPURINOL 100 MG ORAL TABLET,,7362,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
ALLOPURINOL 100 MG ORAL TABLET,,7362,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ALLOPURINOL 100 MG ORAL TABLET,,7362,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
ALLOPURINOL 100 MG ORAL TABLET,,7362,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ALLOPURINOL 100 MG ORAL TABLET,,7362,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ALLOPURINOL 100 MG ORAL TABLET,,7362,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ALLOPURINOL 100 MG ORAL TABLET,,7362,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ALLOPURINOL 100 MG ORAL TABLET,,7362,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
ALLOPURINOL 100 MG ORAL TABLET,,7362,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
ALLOPURINOL 100 MG ORAL TABLET,,7362,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
ALLOPURINOL 100 MG ORAL TABLET,,7362,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
ALLOPURINOL 100 MG ORAL TABLET,,7362,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
VALACYCLOVIR 500 MG ORAL TABLET,,7469,LOCAL,Facility,Both,1,EA,,37,31.45,10.6042,37,Aetna,Commercial,34.04,92,,percent of total billed charges,,
VALACYCLOVIR 500 MG ORAL TABLET,,7469,LOCAL,Facility,Outpatient,1,EA,,37,31.45,10.6042,37,Aetna,Medicare Advantage,18.13,49,,percent of total billed charges,,
VALACYCLOVIR 500 MG ORAL TABLET,,7469,LOCAL,Facility,Inpatient,1,EA,,37,31.45,10.6042,37,Aetna,Medicare Advantage,,,,,Included in per diem rate,
VALACYCLOVIR 500 MG ORAL TABLET,,7469,LOCAL,Facility,Both,1,EA,,37,31.45,10.6042,37,Aetna,PPO,34.41,93,,percent of total billed charges,,
VALACYCLOVIR 500 MG ORAL TABLET,,7469,LOCAL,Facility,Both,1,EA,,37,31.45,10.6042,37,America's PPO,America's PPO,35.5311,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
VALACYCLOVIR 500 MG ORAL TABLET,,7469,LOCAL,Facility,Both,1,EA,,37,31.45,10.6042,37,BlueCross BlueShield Minnesota, Federal Employee Program,36.408,98.4,,percent of total billed charges,,
VALACYCLOVIR 500 MG ORAL TABLET,,7469,LOCAL,Facility,Both,1,EA,,37,31.45,10.6042,37,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,37,100,,percent of total billed charges,,
VALACYCLOVIR 500 MG ORAL TABLET,,7469,LOCAL,Facility,Both,1,EA,,37,31.45,10.6042,37,BlueCross BlueShield Minnesota,High Value Network Plan,33.3,90,,percent of total billed charges,,
VALACYCLOVIR 500 MG ORAL TABLET,,7469,LOCAL,Facility,Outpatient,1,EA,,37,31.45,10.6042,37,BlueCross BlueShield Minnesota,Medicare Advantage,18.13,49,,percent of total billed charges,,
VALACYCLOVIR 500 MG ORAL TABLET,,7469,LOCAL,Facility,Inpatient,1,EA,,37,31.45,10.6042,37,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
VALACYCLOVIR 500 MG ORAL TABLET,,7469,LOCAL,Facility,Both,1,EA,,37,31.45,10.6042,37,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,32.7709,88.57,,percent of total billed charges,,
VALACYCLOVIR 500 MG ORAL TABLET,,7469,LOCAL,Facility,Both,1,EA,,37,31.45,10.6042,37,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,10.6042,28.66,,percent of total billed charges,,
VALACYCLOVIR 500 MG ORAL TABLET,,7469,LOCAL,Facility,Outpatient,1,EA,,37,31.45,10.6042,37,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),18.13,49,,percent of total billed charges,,
VALACYCLOVIR 500 MG ORAL TABLET,,7469,LOCAL,Facility,Inpatient,1,EA,,37,31.45,10.6042,37,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
VALACYCLOVIR 500 MG ORAL TABLET,,7469,LOCAL,Facility,Both,1,EA,,37,31.45,10.6042,37,CorVel,Worker's Compensation,37,100,,percent of total billed charges,,
VALACYCLOVIR 500 MG ORAL TABLET,,7469,LOCAL,Facility,Both,1,EA,,37,31.45,10.6042,37,First Health Group Corporation,First Health Network,35.89,97,,percent of total billed charges,,
VALACYCLOVIR 500 MG ORAL TABLET,,7469,LOCAL,Facility,Both,1,EA,,37,31.45,10.6042,37,"Health Partners, Inc.",Commercial,35.002,94.6,,percent of total billed charges,,
VALACYCLOVIR 500 MG ORAL TABLET,,7469,LOCAL,Facility,Outpatient,1,EA,,37,31.45,10.6042,37,"Health Partners, Inc.",Medicare Advantage,18.13,49,,percent of total billed charges,,
VALACYCLOVIR 500 MG ORAL TABLET,,7469,LOCAL,Facility,Inpatient,1,EA,,37,31.45,10.6042,37,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
VALACYCLOVIR 500 MG ORAL TABLET,,7469,LOCAL,Facility,Both,1,EA,,37,31.45,10.6042,37,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),22.2,60,,percent of total billed charges,,
VALACYCLOVIR 500 MG ORAL TABLET,,7469,LOCAL,Facility,Both,1,EA,,37,31.45,10.6042,37,"Health Partners, Inc.",State of Minnesota Advantage Program,30.155,81.5,,percent of total billed charges,,
VALACYCLOVIR 500 MG ORAL TABLET,,7469,LOCAL,Facility,Both,1,EA,,37,31.45,10.6042,37,"Health Partners, Inc.",State Public Programs,18.5,50,,percent of total billed charges,,
VALACYCLOVIR 500 MG ORAL TABLET,,7469,LOCAL,Facility,Both,1,EA,,37,31.45,10.6042,37,Humana Insurance Company,Commercial PPO,35.15,95,,percent of total billed charges,,
VALACYCLOVIR 500 MG ORAL TABLET,,7469,LOCAL,Facility,Outpatient,1,EA,,37,31.45,10.6042,37,Humana Insurance Company,Medicare PPO,18.13,49,,percent of total billed charges,,
VALACYCLOVIR 500 MG ORAL TABLET,,7469,LOCAL,Facility,Inpatient,1,EA,,37,31.45,10.6042,37,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
VALACYCLOVIR 500 MG ORAL TABLET,,7469,LOCAL,Facility,Both,1,EA,,37,31.45,10.6042,37,Medica,Individual & Family,36.667,99.1,,percent of total billed charges,,
VALACYCLOVIR 500 MG ORAL TABLET,,7469,LOCAL,Facility,Outpatient,1,EA,,37,31.45,10.6042,37,Medica,Medica Advantage Solution,18.426,49.8,,percent of total billed charges,,
VALACYCLOVIR 500 MG ORAL TABLET,,7469,LOCAL,Facility,Inpatient,1,EA,,37,31.45,10.6042,37,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
VALACYCLOVIR 500 MG ORAL TABLET,,7469,LOCAL,Facility,Outpatient,1,EA,,37,31.45,10.6042,37,Medica,Medical Assistance,16.502,44.6,,percent of total billed charges,,
VALACYCLOVIR 500 MG ORAL TABLET,,7469,LOCAL,Facility,Inpatient,1,EA,,37,31.45,10.6042,37,Medica,Medical Assistance,,,,,Included in per diem rate,
VALACYCLOVIR 500 MG ORAL TABLET,,7469,LOCAL,Facility,Outpatient,1,EA,,37,31.45,10.6042,37,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,18.426,49.8,,percent of total billed charges,,
VALACYCLOVIR 500 MG ORAL TABLET,,7469,LOCAL,Facility,Inpatient,1,EA,,37,31.45,10.6042,37,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
VALACYCLOVIR 500 MG ORAL TABLET,,7469,LOCAL,Facility,Both,1,EA,,37,31.45,10.6042,37,"Multiplan, Inc.","Multiplan, Inc.",34.78,94,,percent of total billed charges,,
VALACYCLOVIR 500 MG ORAL TABLET,,7469,LOCAL,Facility,Outpatient,1,EA,,37,31.45,10.6042,37,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,33.337,90.1,,percent of total billed charges,,
VALACYCLOVIR 500 MG ORAL TABLET,,7469,LOCAL,Facility,Inpatient,1,EA,,37,31.45,10.6042,37,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
VALACYCLOVIR 500 MG ORAL TABLET,,7469,LOCAL,Facility,Both,1,EA,,37,31.45,10.6042,37,"Preferred One Administrative Services, INC.",PPO,36.482,98.6,,percent of total billed charges,,
VALACYCLOVIR 500 MG ORAL TABLET,,7469,LOCAL,Facility,Outpatient,1,EA,,37,31.45,10.6042,37,PrimeWest Health,Minnesota Senior Health Options (MSHO),19.0365,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
VALACYCLOVIR 500 MG ORAL TABLET,,7469,LOCAL,Facility,Inpatient,1,EA,,37,31.45,10.6042,37,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
VALACYCLOVIR 500 MG ORAL TABLET,,7469,LOCAL,Facility,Outpatient,1,EA,,37,31.45,10.6042,37,PrimeWest Health,MinnesotaCare,19.0032,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
VALACYCLOVIR 500 MG ORAL TABLET,,7469,LOCAL,Facility,Inpatient,1,EA,,37,31.45,10.6042,37,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
VALACYCLOVIR 500 MG ORAL TABLET,,7469,LOCAL,Facility,Both,1,EA,,37,31.45,10.6042,37,Sanford Health Plan,Sanford Health Plan,34.04,92,,percent of total billed charges,,
VALACYCLOVIR 500 MG ORAL TABLET,,7469,LOCAL,Facility,Outpatient,1,EA,,37,31.45,10.6042,37,"UCare Health, Inc.",Individual & Family Plan,20.8495,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
VALACYCLOVIR 500 MG ORAL TABLET,,7469,LOCAL,Facility,Inpatient,1,EA,,37,31.45,10.6042,37,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
VALACYCLOVIR 500 MG ORAL TABLET,,7469,LOCAL,Facility,Outpatient,1,EA,,37,31.45,10.6042,37,"UCare Health, Inc.",Medical Assistance,18.6739,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
VALACYCLOVIR 500 MG ORAL TABLET,,7469,LOCAL,Facility,Inpatient,1,EA,,37,31.45,10.6042,37,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
VALACYCLOVIR 500 MG ORAL TABLET,,7469,LOCAL,Facility,Outpatient,1,EA,,37,31.45,10.6042,37,"UCare Health, Inc.",Medicare Advantage,18.6739,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
VALACYCLOVIR 500 MG ORAL TABLET,,7469,LOCAL,Facility,Inpatient,1,EA,,37,31.45,10.6042,37,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
VALACYCLOVIR 500 MG ORAL TABLET,,7469,LOCAL,Facility,Outpatient,1,EA,,37,31.45,10.6042,37,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),18.6739,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
VALACYCLOVIR 500 MG ORAL TABLET,,7469,LOCAL,Facility,Inpatient,1,EA,,37,31.45,10.6042,37,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
VALACYCLOVIR 500 MG ORAL TABLET,,7469,LOCAL,Facility,Both,1,EA,,37,31.45,10.6042,37,UnitedHealthcare,Individual & Family,34.78,94,,percent of total billed charges,,
VALACYCLOVIR 500 MG ORAL TABLET,,7469,LOCAL,Facility,Outpatient,1,EA,,37,31.45,10.6042,37,UnitedHealthcare,Medicare Advantage,18.13,49,,percent of total billed charges,,
VALACYCLOVIR 500 MG ORAL TABLET,,7469,LOCAL,Facility,Inpatient,1,EA,,37,31.45,10.6042,37,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
VALACYCLOVIR 500 MG ORAL TABLET,,7469,LOCAL,Facility,Outpatient,1,EA,,37,31.45,10.6042,37,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,17.76,48,,percent of total billed charges,,100% of DHS outpatient percentage
VALACYCLOVIR 500 MG ORAL TABLET,,7469,LOCAL,Facility,Inpatient,1,EA,,37,31.45,10.6042,37,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
CIPROFLOXACIN HCL 500 MG ORAL TABLET,,7507,LOCAL,Facility,Both,1,EA,,28,23.8,8.0248,28,Aetna,Commercial,25.76,92,,percent of total billed charges,,
CIPROFLOXACIN HCL 500 MG ORAL TABLET,,7507,LOCAL,Facility,Outpatient,1,EA,,28,23.8,8.0248,28,Aetna,Medicare Advantage,13.72,49,,percent of total billed charges,,
CIPROFLOXACIN HCL 500 MG ORAL TABLET,,7507,LOCAL,Facility,Inpatient,1,EA,,28,23.8,8.0248,28,Aetna,Medicare Advantage,,,,,Included in per diem rate,
CIPROFLOXACIN HCL 500 MG ORAL TABLET,,7507,LOCAL,Facility,Both,1,EA,,28,23.8,8.0248,28,Aetna,PPO,26.04,93,,percent of total billed charges,,
CIPROFLOXACIN HCL 500 MG ORAL TABLET,,7507,LOCAL,Facility,Both,1,EA,,28,23.8,8.0248,28,America's PPO,America's PPO,26.8884,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
CIPROFLOXACIN HCL 500 MG ORAL TABLET,,7507,LOCAL,Facility,Both,1,EA,,28,23.8,8.0248,28,BlueCross BlueShield Minnesota, Federal Employee Program,27.552,98.4,,percent of total billed charges,,
CIPROFLOXACIN HCL 500 MG ORAL TABLET,,7507,LOCAL,Facility,Both,1,EA,,28,23.8,8.0248,28,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,28,100,,percent of total billed charges,,
CIPROFLOXACIN HCL 500 MG ORAL TABLET,,7507,LOCAL,Facility,Both,1,EA,,28,23.8,8.0248,28,BlueCross BlueShield Minnesota,High Value Network Plan,25.2,90,,percent of total billed charges,,
CIPROFLOXACIN HCL 500 MG ORAL TABLET,,7507,LOCAL,Facility,Outpatient,1,EA,,28,23.8,8.0248,28,BlueCross BlueShield Minnesota,Medicare Advantage,13.72,49,,percent of total billed charges,,
CIPROFLOXACIN HCL 500 MG ORAL TABLET,,7507,LOCAL,Facility,Inpatient,1,EA,,28,23.8,8.0248,28,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
CIPROFLOXACIN HCL 500 MG ORAL TABLET,,7507,LOCAL,Facility,Both,1,EA,,28,23.8,8.0248,28,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,24.7996,88.57,,percent of total billed charges,,
CIPROFLOXACIN HCL 500 MG ORAL TABLET,,7507,LOCAL,Facility,Both,1,EA,,28,23.8,8.0248,28,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,8.0248,28.66,,percent of total billed charges,,
CIPROFLOXACIN HCL 500 MG ORAL TABLET,,7507,LOCAL,Facility,Outpatient,1,EA,,28,23.8,8.0248,28,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),13.72,49,,percent of total billed charges,,
CIPROFLOXACIN HCL 500 MG ORAL TABLET,,7507,LOCAL,Facility,Inpatient,1,EA,,28,23.8,8.0248,28,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
CIPROFLOXACIN HCL 500 MG ORAL TABLET,,7507,LOCAL,Facility,Both,1,EA,,28,23.8,8.0248,28,CorVel,Worker's Compensation,28,100,,percent of total billed charges,,
CIPROFLOXACIN HCL 500 MG ORAL TABLET,,7507,LOCAL,Facility,Both,1,EA,,28,23.8,8.0248,28,First Health Group Corporation,First Health Network,27.16,97,,percent of total billed charges,,
CIPROFLOXACIN HCL 500 MG ORAL TABLET,,7507,LOCAL,Facility,Both,1,EA,,28,23.8,8.0248,28,"Health Partners, Inc.",Commercial,26.488,94.6,,percent of total billed charges,,
CIPROFLOXACIN HCL 500 MG ORAL TABLET,,7507,LOCAL,Facility,Outpatient,1,EA,,28,23.8,8.0248,28,"Health Partners, Inc.",Medicare Advantage,13.72,49,,percent of total billed charges,,
CIPROFLOXACIN HCL 500 MG ORAL TABLET,,7507,LOCAL,Facility,Inpatient,1,EA,,28,23.8,8.0248,28,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CIPROFLOXACIN HCL 500 MG ORAL TABLET,,7507,LOCAL,Facility,Both,1,EA,,28,23.8,8.0248,28,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),16.8,60,,percent of total billed charges,,
CIPROFLOXACIN HCL 500 MG ORAL TABLET,,7507,LOCAL,Facility,Both,1,EA,,28,23.8,8.0248,28,"Health Partners, Inc.",State of Minnesota Advantage Program,22.82,81.5,,percent of total billed charges,,
CIPROFLOXACIN HCL 500 MG ORAL TABLET,,7507,LOCAL,Facility,Both,1,EA,,28,23.8,8.0248,28,"Health Partners, Inc.",State Public Programs,14,50,,percent of total billed charges,,
CIPROFLOXACIN HCL 500 MG ORAL TABLET,,7507,LOCAL,Facility,Both,1,EA,,28,23.8,8.0248,28,Humana Insurance Company,Commercial PPO,26.6,95,,percent of total billed charges,,
CIPROFLOXACIN HCL 500 MG ORAL TABLET,,7507,LOCAL,Facility,Outpatient,1,EA,,28,23.8,8.0248,28,Humana Insurance Company,Medicare PPO,13.72,49,,percent of total billed charges,,
CIPROFLOXACIN HCL 500 MG ORAL TABLET,,7507,LOCAL,Facility,Inpatient,1,EA,,28,23.8,8.0248,28,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
CIPROFLOXACIN HCL 500 MG ORAL TABLET,,7507,LOCAL,Facility,Both,1,EA,,28,23.8,8.0248,28,Medica,Individual & Family,27.748,99.1,,percent of total billed charges,,
CIPROFLOXACIN HCL 500 MG ORAL TABLET,,7507,LOCAL,Facility,Outpatient,1,EA,,28,23.8,8.0248,28,Medica,Medica Advantage Solution,13.944,49.8,,percent of total billed charges,,
CIPROFLOXACIN HCL 500 MG ORAL TABLET,,7507,LOCAL,Facility,Inpatient,1,EA,,28,23.8,8.0248,28,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
CIPROFLOXACIN HCL 500 MG ORAL TABLET,,7507,LOCAL,Facility,Outpatient,1,EA,,28,23.8,8.0248,28,Medica,Medical Assistance,12.488,44.6,,percent of total billed charges,,
CIPROFLOXACIN HCL 500 MG ORAL TABLET,,7507,LOCAL,Facility,Inpatient,1,EA,,28,23.8,8.0248,28,Medica,Medical Assistance,,,,,Included in per diem rate,
CIPROFLOXACIN HCL 500 MG ORAL TABLET,,7507,LOCAL,Facility,Outpatient,1,EA,,28,23.8,8.0248,28,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,13.944,49.8,,percent of total billed charges,,
CIPROFLOXACIN HCL 500 MG ORAL TABLET,,7507,LOCAL,Facility,Inpatient,1,EA,,28,23.8,8.0248,28,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
CIPROFLOXACIN HCL 500 MG ORAL TABLET,,7507,LOCAL,Facility,Both,1,EA,,28,23.8,8.0248,28,"Multiplan, Inc.","Multiplan, Inc.",26.32,94,,percent of total billed charges,,
CIPROFLOXACIN HCL 500 MG ORAL TABLET,,7507,LOCAL,Facility,Outpatient,1,EA,,28,23.8,8.0248,28,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,25.228,90.1,,percent of total billed charges,,
CIPROFLOXACIN HCL 500 MG ORAL TABLET,,7507,LOCAL,Facility,Inpatient,1,EA,,28,23.8,8.0248,28,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
CIPROFLOXACIN HCL 500 MG ORAL TABLET,,7507,LOCAL,Facility,Both,1,EA,,28,23.8,8.0248,28,"Preferred One Administrative Services, INC.",PPO,27.608,98.6,,percent of total billed charges,,
CIPROFLOXACIN HCL 500 MG ORAL TABLET,,7507,LOCAL,Facility,Outpatient,1,EA,,28,23.8,8.0248,28,PrimeWest Health,Minnesota Senior Health Options (MSHO),14.406,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
CIPROFLOXACIN HCL 500 MG ORAL TABLET,,7507,LOCAL,Facility,Inpatient,1,EA,,28,23.8,8.0248,28,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CIPROFLOXACIN HCL 500 MG ORAL TABLET,,7507,LOCAL,Facility,Outpatient,1,EA,,28,23.8,8.0248,28,PrimeWest Health,MinnesotaCare,14.3808,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
CIPROFLOXACIN HCL 500 MG ORAL TABLET,,7507,LOCAL,Facility,Inpatient,1,EA,,28,23.8,8.0248,28,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
CIPROFLOXACIN HCL 500 MG ORAL TABLET,,7507,LOCAL,Facility,Both,1,EA,,28,23.8,8.0248,28,Sanford Health Plan,Sanford Health Plan,25.76,92,,percent of total billed charges,,
CIPROFLOXACIN HCL 500 MG ORAL TABLET,,7507,LOCAL,Facility,Outpatient,1,EA,,28,23.8,8.0248,28,"UCare Health, Inc.",Individual & Family Plan,15.778,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
CIPROFLOXACIN HCL 500 MG ORAL TABLET,,7507,LOCAL,Facility,Inpatient,1,EA,,28,23.8,8.0248,28,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
CIPROFLOXACIN HCL 500 MG ORAL TABLET,,7507,LOCAL,Facility,Outpatient,1,EA,,28,23.8,8.0248,28,"UCare Health, Inc.",Medical Assistance,14.1316,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CIPROFLOXACIN HCL 500 MG ORAL TABLET,,7507,LOCAL,Facility,Inpatient,1,EA,,28,23.8,8.0248,28,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
CIPROFLOXACIN HCL 500 MG ORAL TABLET,,7507,LOCAL,Facility,Outpatient,1,EA,,28,23.8,8.0248,28,"UCare Health, Inc.",Medicare Advantage,14.1316,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CIPROFLOXACIN HCL 500 MG ORAL TABLET,,7507,LOCAL,Facility,Inpatient,1,EA,,28,23.8,8.0248,28,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CIPROFLOXACIN HCL 500 MG ORAL TABLET,,7507,LOCAL,Facility,Outpatient,1,EA,,28,23.8,8.0248,28,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),14.1316,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CIPROFLOXACIN HCL 500 MG ORAL TABLET,,7507,LOCAL,Facility,Inpatient,1,EA,,28,23.8,8.0248,28,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CIPROFLOXACIN HCL 500 MG ORAL TABLET,,7507,LOCAL,Facility,Both,1,EA,,28,23.8,8.0248,28,UnitedHealthcare,Individual & Family,26.32,94,,percent of total billed charges,,
CIPROFLOXACIN HCL 500 MG ORAL TABLET,,7507,LOCAL,Facility,Outpatient,1,EA,,28,23.8,8.0248,28,UnitedHealthcare,Medicare Advantage,13.72,49,,percent of total billed charges,,
CIPROFLOXACIN HCL 500 MG ORAL TABLET,,7507,LOCAL,Facility,Inpatient,1,EA,,28,23.8,8.0248,28,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
CIPROFLOXACIN HCL 500 MG ORAL TABLET,,7507,LOCAL,Facility,Outpatient,1,EA,,28,23.8,8.0248,28,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,13.44,48,,percent of total billed charges,,100% of DHS outpatient percentage
CIPROFLOXACIN HCL 500 MG ORAL TABLET,,7507,LOCAL,Facility,Inpatient,1,EA,,28,23.8,8.0248,28,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
FOLIC ACID 400 MCG ORAL TABLET,,7513,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
FOLIC ACID 400 MCG ORAL TABLET,,7513,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
FOLIC ACID 400 MCG ORAL TABLET,,7513,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
FOLIC ACID 400 MCG ORAL TABLET,,7513,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
FOLIC ACID 400 MCG ORAL TABLET,,7513,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
FOLIC ACID 400 MCG ORAL TABLET,,7513,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
FOLIC ACID 400 MCG ORAL TABLET,,7513,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
FOLIC ACID 400 MCG ORAL TABLET,,7513,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
FOLIC ACID 400 MCG ORAL TABLET,,7513,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
FOLIC ACID 400 MCG ORAL TABLET,,7513,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
FOLIC ACID 400 MCG ORAL TABLET,,7513,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
FOLIC ACID 400 MCG ORAL TABLET,,7513,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
FOLIC ACID 400 MCG ORAL TABLET,,7513,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
FOLIC ACID 400 MCG ORAL TABLET,,7513,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
FOLIC ACID 400 MCG ORAL TABLET,,7513,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
FOLIC ACID 400 MCG ORAL TABLET,,7513,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
FOLIC ACID 400 MCG ORAL TABLET,,7513,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
FOLIC ACID 400 MCG ORAL TABLET,,7513,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
FOLIC ACID 400 MCG ORAL TABLET,,7513,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
FOLIC ACID 400 MCG ORAL TABLET,,7513,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
FOLIC ACID 400 MCG ORAL TABLET,,7513,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
FOLIC ACID 400 MCG ORAL TABLET,,7513,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
FOLIC ACID 400 MCG ORAL TABLET,,7513,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
FOLIC ACID 400 MCG ORAL TABLET,,7513,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
FOLIC ACID 400 MCG ORAL TABLET,,7513,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
FOLIC ACID 400 MCG ORAL TABLET,,7513,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
FOLIC ACID 400 MCG ORAL TABLET,,7513,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
FOLIC ACID 400 MCG ORAL TABLET,,7513,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
FOLIC ACID 400 MCG ORAL TABLET,,7513,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
FOLIC ACID 400 MCG ORAL TABLET,,7513,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
FOLIC ACID 400 MCG ORAL TABLET,,7513,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
FOLIC ACID 400 MCG ORAL TABLET,,7513,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
FOLIC ACID 400 MCG ORAL TABLET,,7513,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
FOLIC ACID 400 MCG ORAL TABLET,,7513,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
FOLIC ACID 400 MCG ORAL TABLET,,7513,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
FOLIC ACID 400 MCG ORAL TABLET,,7513,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
FOLIC ACID 400 MCG ORAL TABLET,,7513,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
FOLIC ACID 400 MCG ORAL TABLET,,7513,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
FOLIC ACID 400 MCG ORAL TABLET,,7513,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
FOLIC ACID 400 MCG ORAL TABLET,,7513,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
FOLIC ACID 400 MCG ORAL TABLET,,7513,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
FOLIC ACID 400 MCG ORAL TABLET,,7513,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
FOLIC ACID 400 MCG ORAL TABLET,,7513,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
FOLIC ACID 400 MCG ORAL TABLET,,7513,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FOLIC ACID 400 MCG ORAL TABLET,,7513,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
FOLIC ACID 400 MCG ORAL TABLET,,7513,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FOLIC ACID 400 MCG ORAL TABLET,,7513,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
FOLIC ACID 400 MCG ORAL TABLET,,7513,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FOLIC ACID 400 MCG ORAL TABLET,,7513,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
FOLIC ACID 400 MCG ORAL TABLET,,7513,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
FOLIC ACID 400 MCG ORAL TABLET,,7513,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
FOLIC ACID 400 MCG ORAL TABLET,,7513,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
FOLIC ACID 400 MCG ORAL TABLET,,7513,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
FOLIC ACID 400 MCG ORAL TABLET,,7513,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
SULFAMETHOXAZOLE-TRIMETHOPRIM 800-160 MG ORAL TABLET,,7547,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
SULFAMETHOXAZOLE-TRIMETHOPRIM 800-160 MG ORAL TABLET,,7547,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
SULFAMETHOXAZOLE-TRIMETHOPRIM 800-160 MG ORAL TABLET,,7547,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
SULFAMETHOXAZOLE-TRIMETHOPRIM 800-160 MG ORAL TABLET,,7547,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
SULFAMETHOXAZOLE-TRIMETHOPRIM 800-160 MG ORAL TABLET,,7547,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SULFAMETHOXAZOLE-TRIMETHOPRIM 800-160 MG ORAL TABLET,,7547,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
SULFAMETHOXAZOLE-TRIMETHOPRIM 800-160 MG ORAL TABLET,,7547,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
SULFAMETHOXAZOLE-TRIMETHOPRIM 800-160 MG ORAL TABLET,,7547,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
SULFAMETHOXAZOLE-TRIMETHOPRIM 800-160 MG ORAL TABLET,,7547,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
SULFAMETHOXAZOLE-TRIMETHOPRIM 800-160 MG ORAL TABLET,,7547,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
SULFAMETHOXAZOLE-TRIMETHOPRIM 800-160 MG ORAL TABLET,,7547,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
SULFAMETHOXAZOLE-TRIMETHOPRIM 800-160 MG ORAL TABLET,,7547,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
SULFAMETHOXAZOLE-TRIMETHOPRIM 800-160 MG ORAL TABLET,,7547,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
SULFAMETHOXAZOLE-TRIMETHOPRIM 800-160 MG ORAL TABLET,,7547,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
SULFAMETHOXAZOLE-TRIMETHOPRIM 800-160 MG ORAL TABLET,,7547,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
SULFAMETHOXAZOLE-TRIMETHOPRIM 800-160 MG ORAL TABLET,,7547,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
SULFAMETHOXAZOLE-TRIMETHOPRIM 800-160 MG ORAL TABLET,,7547,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
SULFAMETHOXAZOLE-TRIMETHOPRIM 800-160 MG ORAL TABLET,,7547,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
SULFAMETHOXAZOLE-TRIMETHOPRIM 800-160 MG ORAL TABLET,,7547,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SULFAMETHOXAZOLE-TRIMETHOPRIM 800-160 MG ORAL TABLET,,7547,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
SULFAMETHOXAZOLE-TRIMETHOPRIM 800-160 MG ORAL TABLET,,7547,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
SULFAMETHOXAZOLE-TRIMETHOPRIM 800-160 MG ORAL TABLET,,7547,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
SULFAMETHOXAZOLE-TRIMETHOPRIM 800-160 MG ORAL TABLET,,7547,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
SULFAMETHOXAZOLE-TRIMETHOPRIM 800-160 MG ORAL TABLET,,7547,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
SULFAMETHOXAZOLE-TRIMETHOPRIM 800-160 MG ORAL TABLET,,7547,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
SULFAMETHOXAZOLE-TRIMETHOPRIM 800-160 MG ORAL TABLET,,7547,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
SULFAMETHOXAZOLE-TRIMETHOPRIM 800-160 MG ORAL TABLET,,7547,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
SULFAMETHOXAZOLE-TRIMETHOPRIM 800-160 MG ORAL TABLET,,7547,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
SULFAMETHOXAZOLE-TRIMETHOPRIM 800-160 MG ORAL TABLET,,7547,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
SULFAMETHOXAZOLE-TRIMETHOPRIM 800-160 MG ORAL TABLET,,7547,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
SULFAMETHOXAZOLE-TRIMETHOPRIM 800-160 MG ORAL TABLET,,7547,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
SULFAMETHOXAZOLE-TRIMETHOPRIM 800-160 MG ORAL TABLET,,7547,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
SULFAMETHOXAZOLE-TRIMETHOPRIM 800-160 MG ORAL TABLET,,7547,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
SULFAMETHOXAZOLE-TRIMETHOPRIM 800-160 MG ORAL TABLET,,7547,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
SULFAMETHOXAZOLE-TRIMETHOPRIM 800-160 MG ORAL TABLET,,7547,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
SULFAMETHOXAZOLE-TRIMETHOPRIM 800-160 MG ORAL TABLET,,7547,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
SULFAMETHOXAZOLE-TRIMETHOPRIM 800-160 MG ORAL TABLET,,7547,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
SULFAMETHOXAZOLE-TRIMETHOPRIM 800-160 MG ORAL TABLET,,7547,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SULFAMETHOXAZOLE-TRIMETHOPRIM 800-160 MG ORAL TABLET,,7547,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
SULFAMETHOXAZOLE-TRIMETHOPRIM 800-160 MG ORAL TABLET,,7547,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
SULFAMETHOXAZOLE-TRIMETHOPRIM 800-160 MG ORAL TABLET,,7547,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
SULFAMETHOXAZOLE-TRIMETHOPRIM 800-160 MG ORAL TABLET,,7547,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
SULFAMETHOXAZOLE-TRIMETHOPRIM 800-160 MG ORAL TABLET,,7547,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
SULFAMETHOXAZOLE-TRIMETHOPRIM 800-160 MG ORAL TABLET,,7547,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SULFAMETHOXAZOLE-TRIMETHOPRIM 800-160 MG ORAL TABLET,,7547,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
SULFAMETHOXAZOLE-TRIMETHOPRIM 800-160 MG ORAL TABLET,,7547,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SULFAMETHOXAZOLE-TRIMETHOPRIM 800-160 MG ORAL TABLET,,7547,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SULFAMETHOXAZOLE-TRIMETHOPRIM 800-160 MG ORAL TABLET,,7547,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SULFAMETHOXAZOLE-TRIMETHOPRIM 800-160 MG ORAL TABLET,,7547,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SULFAMETHOXAZOLE-TRIMETHOPRIM 800-160 MG ORAL TABLET,,7547,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
SULFAMETHOXAZOLE-TRIMETHOPRIM 800-160 MG ORAL TABLET,,7547,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
SULFAMETHOXAZOLE-TRIMETHOPRIM 800-160 MG ORAL TABLET,,7547,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
SULFAMETHOXAZOLE-TRIMETHOPRIM 800-160 MG ORAL TABLET,,7547,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
SULFAMETHOXAZOLE-TRIMETHOPRIM 800-160 MG ORAL TABLET,,7547,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
OLANZAPINE 2.5 MG ORAL TABLET,,7560,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
OLANZAPINE 2.5 MG ORAL TABLET,,7560,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
OLANZAPINE 2.5 MG ORAL TABLET,,7560,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
OLANZAPINE 2.5 MG ORAL TABLET,,7560,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
OLANZAPINE 2.5 MG ORAL TABLET,,7560,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
OLANZAPINE 2.5 MG ORAL TABLET,,7560,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
OLANZAPINE 2.5 MG ORAL TABLET,,7560,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
OLANZAPINE 2.5 MG ORAL TABLET,,7560,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
OLANZAPINE 2.5 MG ORAL TABLET,,7560,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
OLANZAPINE 2.5 MG ORAL TABLET,,7560,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
OLANZAPINE 2.5 MG ORAL TABLET,,7560,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
OLANZAPINE 2.5 MG ORAL TABLET,,7560,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
OLANZAPINE 2.5 MG ORAL TABLET,,7560,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
OLANZAPINE 2.5 MG ORAL TABLET,,7560,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
OLANZAPINE 2.5 MG ORAL TABLET,,7560,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
OLANZAPINE 2.5 MG ORAL TABLET,,7560,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
OLANZAPINE 2.5 MG ORAL TABLET,,7560,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
OLANZAPINE 2.5 MG ORAL TABLET,,7560,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
OLANZAPINE 2.5 MG ORAL TABLET,,7560,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
OLANZAPINE 2.5 MG ORAL TABLET,,7560,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
OLANZAPINE 2.5 MG ORAL TABLET,,7560,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
OLANZAPINE 2.5 MG ORAL TABLET,,7560,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
OLANZAPINE 2.5 MG ORAL TABLET,,7560,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
OLANZAPINE 2.5 MG ORAL TABLET,,7560,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
OLANZAPINE 2.5 MG ORAL TABLET,,7560,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
OLANZAPINE 2.5 MG ORAL TABLET,,7560,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
OLANZAPINE 2.5 MG ORAL TABLET,,7560,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
OLANZAPINE 2.5 MG ORAL TABLET,,7560,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
OLANZAPINE 2.5 MG ORAL TABLET,,7560,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
OLANZAPINE 2.5 MG ORAL TABLET,,7560,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
OLANZAPINE 2.5 MG ORAL TABLET,,7560,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
OLANZAPINE 2.5 MG ORAL TABLET,,7560,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
OLANZAPINE 2.5 MG ORAL TABLET,,7560,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
OLANZAPINE 2.5 MG ORAL TABLET,,7560,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
OLANZAPINE 2.5 MG ORAL TABLET,,7560,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
OLANZAPINE 2.5 MG ORAL TABLET,,7560,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
OLANZAPINE 2.5 MG ORAL TABLET,,7560,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
OLANZAPINE 2.5 MG ORAL TABLET,,7560,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
OLANZAPINE 2.5 MG ORAL TABLET,,7560,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
OLANZAPINE 2.5 MG ORAL TABLET,,7560,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
OLANZAPINE 2.5 MG ORAL TABLET,,7560,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
OLANZAPINE 2.5 MG ORAL TABLET,,7560,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
OLANZAPINE 2.5 MG ORAL TABLET,,7560,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
OLANZAPINE 2.5 MG ORAL TABLET,,7560,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
OLANZAPINE 2.5 MG ORAL TABLET,,7560,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
OLANZAPINE 2.5 MG ORAL TABLET,,7560,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
OLANZAPINE 2.5 MG ORAL TABLET,,7560,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
OLANZAPINE 2.5 MG ORAL TABLET,,7560,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
OLANZAPINE 2.5 MG ORAL TABLET,,7560,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
OLANZAPINE 2.5 MG ORAL TABLET,,7560,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
OLANZAPINE 2.5 MG ORAL TABLET,,7560,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
OLANZAPINE 2.5 MG ORAL TABLET,,7560,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
OLANZAPINE 2.5 MG ORAL TABLET,,7560,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
OLANZAPINE 2.5 MG ORAL TABLET,,7560,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
OMEPRAZOLE 40 MG ORAL CPDR,,7585,LOCAL,Facility,Both,1,EA,,37,31.45,10.6042,37,Aetna,Commercial,34.04,92,,percent of total billed charges,,
OMEPRAZOLE 40 MG ORAL CPDR,,7585,LOCAL,Facility,Outpatient,1,EA,,37,31.45,10.6042,37,Aetna,Medicare Advantage,18.13,49,,percent of total billed charges,,
OMEPRAZOLE 40 MG ORAL CPDR,,7585,LOCAL,Facility,Inpatient,1,EA,,37,31.45,10.6042,37,Aetna,Medicare Advantage,,,,,Included in per diem rate,
OMEPRAZOLE 40 MG ORAL CPDR,,7585,LOCAL,Facility,Both,1,EA,,37,31.45,10.6042,37,Aetna,PPO,34.41,93,,percent of total billed charges,,
OMEPRAZOLE 40 MG ORAL CPDR,,7585,LOCAL,Facility,Both,1,EA,,37,31.45,10.6042,37,America's PPO,America's PPO,35.5311,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
OMEPRAZOLE 40 MG ORAL CPDR,,7585,LOCAL,Facility,Both,1,EA,,37,31.45,10.6042,37,BlueCross BlueShield Minnesota, Federal Employee Program,36.408,98.4,,percent of total billed charges,,
OMEPRAZOLE 40 MG ORAL CPDR,,7585,LOCAL,Facility,Both,1,EA,,37,31.45,10.6042,37,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,37,100,,percent of total billed charges,,
OMEPRAZOLE 40 MG ORAL CPDR,,7585,LOCAL,Facility,Both,1,EA,,37,31.45,10.6042,37,BlueCross BlueShield Minnesota,High Value Network Plan,33.3,90,,percent of total billed charges,,
OMEPRAZOLE 40 MG ORAL CPDR,,7585,LOCAL,Facility,Outpatient,1,EA,,37,31.45,10.6042,37,BlueCross BlueShield Minnesota,Medicare Advantage,18.13,49,,percent of total billed charges,,
OMEPRAZOLE 40 MG ORAL CPDR,,7585,LOCAL,Facility,Inpatient,1,EA,,37,31.45,10.6042,37,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
OMEPRAZOLE 40 MG ORAL CPDR,,7585,LOCAL,Facility,Both,1,EA,,37,31.45,10.6042,37,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,32.7709,88.57,,percent of total billed charges,,
OMEPRAZOLE 40 MG ORAL CPDR,,7585,LOCAL,Facility,Both,1,EA,,37,31.45,10.6042,37,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,10.6042,28.66,,percent of total billed charges,,
OMEPRAZOLE 40 MG ORAL CPDR,,7585,LOCAL,Facility,Outpatient,1,EA,,37,31.45,10.6042,37,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),18.13,49,,percent of total billed charges,,
OMEPRAZOLE 40 MG ORAL CPDR,,7585,LOCAL,Facility,Inpatient,1,EA,,37,31.45,10.6042,37,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
OMEPRAZOLE 40 MG ORAL CPDR,,7585,LOCAL,Facility,Both,1,EA,,37,31.45,10.6042,37,CorVel,Worker's Compensation,37,100,,percent of total billed charges,,
OMEPRAZOLE 40 MG ORAL CPDR,,7585,LOCAL,Facility,Both,1,EA,,37,31.45,10.6042,37,First Health Group Corporation,First Health Network,35.89,97,,percent of total billed charges,,
OMEPRAZOLE 40 MG ORAL CPDR,,7585,LOCAL,Facility,Both,1,EA,,37,31.45,10.6042,37,"Health Partners, Inc.",Commercial,35.002,94.6,,percent of total billed charges,,
OMEPRAZOLE 40 MG ORAL CPDR,,7585,LOCAL,Facility,Outpatient,1,EA,,37,31.45,10.6042,37,"Health Partners, Inc.",Medicare Advantage,18.13,49,,percent of total billed charges,,
OMEPRAZOLE 40 MG ORAL CPDR,,7585,LOCAL,Facility,Inpatient,1,EA,,37,31.45,10.6042,37,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
OMEPRAZOLE 40 MG ORAL CPDR,,7585,LOCAL,Facility,Both,1,EA,,37,31.45,10.6042,37,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),22.2,60,,percent of total billed charges,,
OMEPRAZOLE 40 MG ORAL CPDR,,7585,LOCAL,Facility,Both,1,EA,,37,31.45,10.6042,37,"Health Partners, Inc.",State of Minnesota Advantage Program,30.155,81.5,,percent of total billed charges,,
OMEPRAZOLE 40 MG ORAL CPDR,,7585,LOCAL,Facility,Both,1,EA,,37,31.45,10.6042,37,"Health Partners, Inc.",State Public Programs,18.5,50,,percent of total billed charges,,
OMEPRAZOLE 40 MG ORAL CPDR,,7585,LOCAL,Facility,Both,1,EA,,37,31.45,10.6042,37,Humana Insurance Company,Commercial PPO,35.15,95,,percent of total billed charges,,
OMEPRAZOLE 40 MG ORAL CPDR,,7585,LOCAL,Facility,Outpatient,1,EA,,37,31.45,10.6042,37,Humana Insurance Company,Medicare PPO,18.13,49,,percent of total billed charges,,
OMEPRAZOLE 40 MG ORAL CPDR,,7585,LOCAL,Facility,Inpatient,1,EA,,37,31.45,10.6042,37,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
OMEPRAZOLE 40 MG ORAL CPDR,,7585,LOCAL,Facility,Both,1,EA,,37,31.45,10.6042,37,Medica,Individual & Family,36.667,99.1,,percent of total billed charges,,
OMEPRAZOLE 40 MG ORAL CPDR,,7585,LOCAL,Facility,Outpatient,1,EA,,37,31.45,10.6042,37,Medica,Medica Advantage Solution,18.426,49.8,,percent of total billed charges,,
OMEPRAZOLE 40 MG ORAL CPDR,,7585,LOCAL,Facility,Inpatient,1,EA,,37,31.45,10.6042,37,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
OMEPRAZOLE 40 MG ORAL CPDR,,7585,LOCAL,Facility,Outpatient,1,EA,,37,31.45,10.6042,37,Medica,Medical Assistance,16.502,44.6,,percent of total billed charges,,
OMEPRAZOLE 40 MG ORAL CPDR,,7585,LOCAL,Facility,Inpatient,1,EA,,37,31.45,10.6042,37,Medica,Medical Assistance,,,,,Included in per diem rate,
OMEPRAZOLE 40 MG ORAL CPDR,,7585,LOCAL,Facility,Outpatient,1,EA,,37,31.45,10.6042,37,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,18.426,49.8,,percent of total billed charges,,
OMEPRAZOLE 40 MG ORAL CPDR,,7585,LOCAL,Facility,Inpatient,1,EA,,37,31.45,10.6042,37,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
OMEPRAZOLE 40 MG ORAL CPDR,,7585,LOCAL,Facility,Both,1,EA,,37,31.45,10.6042,37,"Multiplan, Inc.","Multiplan, Inc.",34.78,94,,percent of total billed charges,,
OMEPRAZOLE 40 MG ORAL CPDR,,7585,LOCAL,Facility,Outpatient,1,EA,,37,31.45,10.6042,37,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,33.337,90.1,,percent of total billed charges,,
OMEPRAZOLE 40 MG ORAL CPDR,,7585,LOCAL,Facility,Inpatient,1,EA,,37,31.45,10.6042,37,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
OMEPRAZOLE 40 MG ORAL CPDR,,7585,LOCAL,Facility,Both,1,EA,,37,31.45,10.6042,37,"Preferred One Administrative Services, INC.",PPO,36.482,98.6,,percent of total billed charges,,
OMEPRAZOLE 40 MG ORAL CPDR,,7585,LOCAL,Facility,Outpatient,1,EA,,37,31.45,10.6042,37,PrimeWest Health,Minnesota Senior Health Options (MSHO),19.0365,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
OMEPRAZOLE 40 MG ORAL CPDR,,7585,LOCAL,Facility,Inpatient,1,EA,,37,31.45,10.6042,37,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
OMEPRAZOLE 40 MG ORAL CPDR,,7585,LOCAL,Facility,Outpatient,1,EA,,37,31.45,10.6042,37,PrimeWest Health,MinnesotaCare,19.0032,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
OMEPRAZOLE 40 MG ORAL CPDR,,7585,LOCAL,Facility,Inpatient,1,EA,,37,31.45,10.6042,37,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
OMEPRAZOLE 40 MG ORAL CPDR,,7585,LOCAL,Facility,Both,1,EA,,37,31.45,10.6042,37,Sanford Health Plan,Sanford Health Plan,34.04,92,,percent of total billed charges,,
OMEPRAZOLE 40 MG ORAL CPDR,,7585,LOCAL,Facility,Outpatient,1,EA,,37,31.45,10.6042,37,"UCare Health, Inc.",Individual & Family Plan,20.8495,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
OMEPRAZOLE 40 MG ORAL CPDR,,7585,LOCAL,Facility,Inpatient,1,EA,,37,31.45,10.6042,37,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
OMEPRAZOLE 40 MG ORAL CPDR,,7585,LOCAL,Facility,Outpatient,1,EA,,37,31.45,10.6042,37,"UCare Health, Inc.",Medical Assistance,18.6739,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
OMEPRAZOLE 40 MG ORAL CPDR,,7585,LOCAL,Facility,Inpatient,1,EA,,37,31.45,10.6042,37,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
OMEPRAZOLE 40 MG ORAL CPDR,,7585,LOCAL,Facility,Outpatient,1,EA,,37,31.45,10.6042,37,"UCare Health, Inc.",Medicare Advantage,18.6739,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
OMEPRAZOLE 40 MG ORAL CPDR,,7585,LOCAL,Facility,Inpatient,1,EA,,37,31.45,10.6042,37,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
OMEPRAZOLE 40 MG ORAL CPDR,,7585,LOCAL,Facility,Outpatient,1,EA,,37,31.45,10.6042,37,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),18.6739,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
OMEPRAZOLE 40 MG ORAL CPDR,,7585,LOCAL,Facility,Inpatient,1,EA,,37,31.45,10.6042,37,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
OMEPRAZOLE 40 MG ORAL CPDR,,7585,LOCAL,Facility,Both,1,EA,,37,31.45,10.6042,37,UnitedHealthcare,Individual & Family,34.78,94,,percent of total billed charges,,
OMEPRAZOLE 40 MG ORAL CPDR,,7585,LOCAL,Facility,Outpatient,1,EA,,37,31.45,10.6042,37,UnitedHealthcare,Medicare Advantage,18.13,49,,percent of total billed charges,,
OMEPRAZOLE 40 MG ORAL CPDR,,7585,LOCAL,Facility,Inpatient,1,EA,,37,31.45,10.6042,37,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
OMEPRAZOLE 40 MG ORAL CPDR,,7585,LOCAL,Facility,Outpatient,1,EA,,37,31.45,10.6042,37,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,17.76,48,,percent of total billed charges,,100% of DHS outpatient percentage
OMEPRAZOLE 40 MG ORAL CPDR,,7585,LOCAL,Facility,Inpatient,1,EA,,37,31.45,10.6042,37,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
LOVASTATIN 10 MG ORAL TABLET,,7649,LOCAL,Facility,Both,1,EA,,7,5.95,2.0062,7,Aetna,Commercial,6.44,92,,percent of total billed charges,,
LOVASTATIN 10 MG ORAL TABLET,,7649,LOCAL,Facility,Outpatient,1,EA,,7,5.95,2.0062,7,Aetna,Medicare Advantage,3.43,49,,percent of total billed charges,,
LOVASTATIN 10 MG ORAL TABLET,,7649,LOCAL,Facility,Inpatient,1,EA,,7,5.95,2.0062,7,Aetna,Medicare Advantage,,,,,Included in per diem rate,
LOVASTATIN 10 MG ORAL TABLET,,7649,LOCAL,Facility,Both,1,EA,,7,5.95,2.0062,7,Aetna,PPO,6.51,93,,percent of total billed charges,,
LOVASTATIN 10 MG ORAL TABLET,,7649,LOCAL,Facility,Both,1,EA,,7,5.95,2.0062,7,America's PPO,America's PPO,6.7221,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
LOVASTATIN 10 MG ORAL TABLET,,7649,LOCAL,Facility,Both,1,EA,,7,5.95,2.0062,7,BlueCross BlueShield Minnesota, Federal Employee Program,6.888,98.4,,percent of total billed charges,,
LOVASTATIN 10 MG ORAL TABLET,,7649,LOCAL,Facility,Both,1,EA,,7,5.95,2.0062,7,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,7,100,,percent of total billed charges,,
LOVASTATIN 10 MG ORAL TABLET,,7649,LOCAL,Facility,Both,1,EA,,7,5.95,2.0062,7,BlueCross BlueShield Minnesota,High Value Network Plan,6.3,90,,percent of total billed charges,,
LOVASTATIN 10 MG ORAL TABLET,,7649,LOCAL,Facility,Outpatient,1,EA,,7,5.95,2.0062,7,BlueCross BlueShield Minnesota,Medicare Advantage,3.43,49,,percent of total billed charges,,
LOVASTATIN 10 MG ORAL TABLET,,7649,LOCAL,Facility,Inpatient,1,EA,,7,5.95,2.0062,7,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
LOVASTATIN 10 MG ORAL TABLET,,7649,LOCAL,Facility,Both,1,EA,,7,5.95,2.0062,7,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,6.1999,88.57,,percent of total billed charges,,
LOVASTATIN 10 MG ORAL TABLET,,7649,LOCAL,Facility,Both,1,EA,,7,5.95,2.0062,7,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,2.0062,28.66,,percent of total billed charges,,
LOVASTATIN 10 MG ORAL TABLET,,7649,LOCAL,Facility,Outpatient,1,EA,,7,5.95,2.0062,7,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),3.43,49,,percent of total billed charges,,
LOVASTATIN 10 MG ORAL TABLET,,7649,LOCAL,Facility,Inpatient,1,EA,,7,5.95,2.0062,7,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
LOVASTATIN 10 MG ORAL TABLET,,7649,LOCAL,Facility,Both,1,EA,,7,5.95,2.0062,7,CorVel,Worker's Compensation,7,100,,percent of total billed charges,,
LOVASTATIN 10 MG ORAL TABLET,,7649,LOCAL,Facility,Both,1,EA,,7,5.95,2.0062,7,First Health Group Corporation,First Health Network,6.79,97,,percent of total billed charges,,
LOVASTATIN 10 MG ORAL TABLET,,7649,LOCAL,Facility,Both,1,EA,,7,5.95,2.0062,7,"Health Partners, Inc.",Commercial,6.622,94.6,,percent of total billed charges,,
LOVASTATIN 10 MG ORAL TABLET,,7649,LOCAL,Facility,Outpatient,1,EA,,7,5.95,2.0062,7,"Health Partners, Inc.",Medicare Advantage,3.43,49,,percent of total billed charges,,
LOVASTATIN 10 MG ORAL TABLET,,7649,LOCAL,Facility,Inpatient,1,EA,,7,5.95,2.0062,7,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LOVASTATIN 10 MG ORAL TABLET,,7649,LOCAL,Facility,Both,1,EA,,7,5.95,2.0062,7,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),4.2,60,,percent of total billed charges,,
LOVASTATIN 10 MG ORAL TABLET,,7649,LOCAL,Facility,Both,1,EA,,7,5.95,2.0062,7,"Health Partners, Inc.",State of Minnesota Advantage Program,5.705,81.5,,percent of total billed charges,,
LOVASTATIN 10 MG ORAL TABLET,,7649,LOCAL,Facility,Both,1,EA,,7,5.95,2.0062,7,"Health Partners, Inc.",State Public Programs,3.5,50,,percent of total billed charges,,
LOVASTATIN 10 MG ORAL TABLET,,7649,LOCAL,Facility,Both,1,EA,,7,5.95,2.0062,7,Humana Insurance Company,Commercial PPO,6.65,95,,percent of total billed charges,,
LOVASTATIN 10 MG ORAL TABLET,,7649,LOCAL,Facility,Outpatient,1,EA,,7,5.95,2.0062,7,Humana Insurance Company,Medicare PPO,3.43,49,,percent of total billed charges,,
LOVASTATIN 10 MG ORAL TABLET,,7649,LOCAL,Facility,Inpatient,1,EA,,7,5.95,2.0062,7,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
LOVASTATIN 10 MG ORAL TABLET,,7649,LOCAL,Facility,Both,1,EA,,7,5.95,2.0062,7,Medica,Individual & Family,6.937,99.1,,percent of total billed charges,,
LOVASTATIN 10 MG ORAL TABLET,,7649,LOCAL,Facility,Outpatient,1,EA,,7,5.95,2.0062,7,Medica,Medica Advantage Solution,3.486,49.8,,percent of total billed charges,,
LOVASTATIN 10 MG ORAL TABLET,,7649,LOCAL,Facility,Inpatient,1,EA,,7,5.95,2.0062,7,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
LOVASTATIN 10 MG ORAL TABLET,,7649,LOCAL,Facility,Outpatient,1,EA,,7,5.95,2.0062,7,Medica,Medical Assistance,3.122,44.6,,percent of total billed charges,,
LOVASTATIN 10 MG ORAL TABLET,,7649,LOCAL,Facility,Inpatient,1,EA,,7,5.95,2.0062,7,Medica,Medical Assistance,,,,,Included in per diem rate,
LOVASTATIN 10 MG ORAL TABLET,,7649,LOCAL,Facility,Outpatient,1,EA,,7,5.95,2.0062,7,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,3.486,49.8,,percent of total billed charges,,
LOVASTATIN 10 MG ORAL TABLET,,7649,LOCAL,Facility,Inpatient,1,EA,,7,5.95,2.0062,7,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
LOVASTATIN 10 MG ORAL TABLET,,7649,LOCAL,Facility,Both,1,EA,,7,5.95,2.0062,7,"Multiplan, Inc.","Multiplan, Inc.",6.58,94,,percent of total billed charges,,
LOVASTATIN 10 MG ORAL TABLET,,7649,LOCAL,Facility,Outpatient,1,EA,,7,5.95,2.0062,7,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,6.307,90.1,,percent of total billed charges,,
LOVASTATIN 10 MG ORAL TABLET,,7649,LOCAL,Facility,Inpatient,1,EA,,7,5.95,2.0062,7,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
LOVASTATIN 10 MG ORAL TABLET,,7649,LOCAL,Facility,Both,1,EA,,7,5.95,2.0062,7,"Preferred One Administrative Services, INC.",PPO,6.902,98.6,,percent of total billed charges,,
LOVASTATIN 10 MG ORAL TABLET,,7649,LOCAL,Facility,Outpatient,1,EA,,7,5.95,2.0062,7,PrimeWest Health,Minnesota Senior Health Options (MSHO),3.6015,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
LOVASTATIN 10 MG ORAL TABLET,,7649,LOCAL,Facility,Inpatient,1,EA,,7,5.95,2.0062,7,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LOVASTATIN 10 MG ORAL TABLET,,7649,LOCAL,Facility,Outpatient,1,EA,,7,5.95,2.0062,7,PrimeWest Health,MinnesotaCare,3.5952,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
LOVASTATIN 10 MG ORAL TABLET,,7649,LOCAL,Facility,Inpatient,1,EA,,7,5.95,2.0062,7,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
LOVASTATIN 10 MG ORAL TABLET,,7649,LOCAL,Facility,Both,1,EA,,7,5.95,2.0062,7,Sanford Health Plan,Sanford Health Plan,6.44,92,,percent of total billed charges,,
LOVASTATIN 10 MG ORAL TABLET,,7649,LOCAL,Facility,Outpatient,1,EA,,7,5.95,2.0062,7,"UCare Health, Inc.",Individual & Family Plan,3.9445,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
LOVASTATIN 10 MG ORAL TABLET,,7649,LOCAL,Facility,Inpatient,1,EA,,7,5.95,2.0062,7,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
LOVASTATIN 10 MG ORAL TABLET,,7649,LOCAL,Facility,Outpatient,1,EA,,7,5.95,2.0062,7,"UCare Health, Inc.",Medical Assistance,3.5329,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LOVASTATIN 10 MG ORAL TABLET,,7649,LOCAL,Facility,Inpatient,1,EA,,7,5.95,2.0062,7,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
LOVASTATIN 10 MG ORAL TABLET,,7649,LOCAL,Facility,Outpatient,1,EA,,7,5.95,2.0062,7,"UCare Health, Inc.",Medicare Advantage,3.5329,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LOVASTATIN 10 MG ORAL TABLET,,7649,LOCAL,Facility,Inpatient,1,EA,,7,5.95,2.0062,7,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LOVASTATIN 10 MG ORAL TABLET,,7649,LOCAL,Facility,Outpatient,1,EA,,7,5.95,2.0062,7,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),3.5329,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LOVASTATIN 10 MG ORAL TABLET,,7649,LOCAL,Facility,Inpatient,1,EA,,7,5.95,2.0062,7,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LOVASTATIN 10 MG ORAL TABLET,,7649,LOCAL,Facility,Both,1,EA,,7,5.95,2.0062,7,UnitedHealthcare,Individual & Family,6.58,94,,percent of total billed charges,,
LOVASTATIN 10 MG ORAL TABLET,,7649,LOCAL,Facility,Outpatient,1,EA,,7,5.95,2.0062,7,UnitedHealthcare,Medicare Advantage,3.43,49,,percent of total billed charges,,
LOVASTATIN 10 MG ORAL TABLET,,7649,LOCAL,Facility,Inpatient,1,EA,,7,5.95,2.0062,7,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
LOVASTATIN 10 MG ORAL TABLET,,7649,LOCAL,Facility,Outpatient,1,EA,,7,5.95,2.0062,7,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,3.36,48,,percent of total billed charges,,100% of DHS outpatient percentage
LOVASTATIN 10 MG ORAL TABLET,,7649,LOCAL,Facility,Inpatient,1,EA,,7,5.95,2.0062,7,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
ASPIRIN 81 MG ORAL TBEC,,7670,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
ASPIRIN 81 MG ORAL TBEC,,7670,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
ASPIRIN 81 MG ORAL TBEC,,7670,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
ASPIRIN 81 MG ORAL TBEC,,7670,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
ASPIRIN 81 MG ORAL TBEC,,7670,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
ASPIRIN 81 MG ORAL TBEC,,7670,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
ASPIRIN 81 MG ORAL TBEC,,7670,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
ASPIRIN 81 MG ORAL TBEC,,7670,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
ASPIRIN 81 MG ORAL TBEC,,7670,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
ASPIRIN 81 MG ORAL TBEC,,7670,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
ASPIRIN 81 MG ORAL TBEC,,7670,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
ASPIRIN 81 MG ORAL TBEC,,7670,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
ASPIRIN 81 MG ORAL TBEC,,7670,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
ASPIRIN 81 MG ORAL TBEC,,7670,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
ASPIRIN 81 MG ORAL TBEC,,7670,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
ASPIRIN 81 MG ORAL TBEC,,7670,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
ASPIRIN 81 MG ORAL TBEC,,7670,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
ASPIRIN 81 MG ORAL TBEC,,7670,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
ASPIRIN 81 MG ORAL TBEC,,7670,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ASPIRIN 81 MG ORAL TBEC,,7670,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
ASPIRIN 81 MG ORAL TBEC,,7670,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
ASPIRIN 81 MG ORAL TBEC,,7670,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
ASPIRIN 81 MG ORAL TBEC,,7670,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
ASPIRIN 81 MG ORAL TBEC,,7670,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
ASPIRIN 81 MG ORAL TBEC,,7670,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
ASPIRIN 81 MG ORAL TBEC,,7670,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
ASPIRIN 81 MG ORAL TBEC,,7670,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
ASPIRIN 81 MG ORAL TBEC,,7670,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
ASPIRIN 81 MG ORAL TBEC,,7670,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
ASPIRIN 81 MG ORAL TBEC,,7670,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
ASPIRIN 81 MG ORAL TBEC,,7670,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
ASPIRIN 81 MG ORAL TBEC,,7670,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
ASPIRIN 81 MG ORAL TBEC,,7670,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
ASPIRIN 81 MG ORAL TBEC,,7670,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
ASPIRIN 81 MG ORAL TBEC,,7670,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
ASPIRIN 81 MG ORAL TBEC,,7670,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
ASPIRIN 81 MG ORAL TBEC,,7670,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
ASPIRIN 81 MG ORAL TBEC,,7670,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ASPIRIN 81 MG ORAL TBEC,,7670,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
ASPIRIN 81 MG ORAL TBEC,,7670,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
ASPIRIN 81 MG ORAL TBEC,,7670,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
ASPIRIN 81 MG ORAL TBEC,,7670,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
ASPIRIN 81 MG ORAL TBEC,,7670,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
ASPIRIN 81 MG ORAL TBEC,,7670,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ASPIRIN 81 MG ORAL TBEC,,7670,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
ASPIRIN 81 MG ORAL TBEC,,7670,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ASPIRIN 81 MG ORAL TBEC,,7670,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ASPIRIN 81 MG ORAL TBEC,,7670,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ASPIRIN 81 MG ORAL TBEC,,7670,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ASPIRIN 81 MG ORAL TBEC,,7670,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
ASPIRIN 81 MG ORAL TBEC,,7670,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
ASPIRIN 81 MG ORAL TBEC,,7670,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
ASPIRIN 81 MG ORAL TBEC,,7670,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
ASPIRIN 81 MG ORAL TBEC,,7670,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
TRAMADOL 50 MG ORAL TABLET,,7744,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
TRAMADOL 50 MG ORAL TABLET,,7744,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
TRAMADOL 50 MG ORAL TABLET,,7744,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
TRAMADOL 50 MG ORAL TABLET,,7744,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
TRAMADOL 50 MG ORAL TABLET,,7744,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
TRAMADOL 50 MG ORAL TABLET,,7744,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
TRAMADOL 50 MG ORAL TABLET,,7744,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
TRAMADOL 50 MG ORAL TABLET,,7744,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
TRAMADOL 50 MG ORAL TABLET,,7744,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
TRAMADOL 50 MG ORAL TABLET,,7744,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
TRAMADOL 50 MG ORAL TABLET,,7744,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
TRAMADOL 50 MG ORAL TABLET,,7744,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
TRAMADOL 50 MG ORAL TABLET,,7744,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
TRAMADOL 50 MG ORAL TABLET,,7744,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
TRAMADOL 50 MG ORAL TABLET,,7744,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
TRAMADOL 50 MG ORAL TABLET,,7744,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
TRAMADOL 50 MG ORAL TABLET,,7744,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
TRAMADOL 50 MG ORAL TABLET,,7744,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
TRAMADOL 50 MG ORAL TABLET,,7744,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
TRAMADOL 50 MG ORAL TABLET,,7744,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
TRAMADOL 50 MG ORAL TABLET,,7744,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
TRAMADOL 50 MG ORAL TABLET,,7744,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
TRAMADOL 50 MG ORAL TABLET,,7744,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
TRAMADOL 50 MG ORAL TABLET,,7744,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
TRAMADOL 50 MG ORAL TABLET,,7744,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
TRAMADOL 50 MG ORAL TABLET,,7744,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
TRAMADOL 50 MG ORAL TABLET,,7744,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
TRAMADOL 50 MG ORAL TABLET,,7744,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
TRAMADOL 50 MG ORAL TABLET,,7744,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
TRAMADOL 50 MG ORAL TABLET,,7744,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
TRAMADOL 50 MG ORAL TABLET,,7744,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
TRAMADOL 50 MG ORAL TABLET,,7744,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
TRAMADOL 50 MG ORAL TABLET,,7744,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
TRAMADOL 50 MG ORAL TABLET,,7744,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
TRAMADOL 50 MG ORAL TABLET,,7744,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
TRAMADOL 50 MG ORAL TABLET,,7744,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
TRAMADOL 50 MG ORAL TABLET,,7744,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
TRAMADOL 50 MG ORAL TABLET,,7744,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
TRAMADOL 50 MG ORAL TABLET,,7744,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
TRAMADOL 50 MG ORAL TABLET,,7744,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
TRAMADOL 50 MG ORAL TABLET,,7744,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
TRAMADOL 50 MG ORAL TABLET,,7744,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
TRAMADOL 50 MG ORAL TABLET,,7744,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
TRAMADOL 50 MG ORAL TABLET,,7744,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TRAMADOL 50 MG ORAL TABLET,,7744,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
TRAMADOL 50 MG ORAL TABLET,,7744,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TRAMADOL 50 MG ORAL TABLET,,7744,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
TRAMADOL 50 MG ORAL TABLET,,7744,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TRAMADOL 50 MG ORAL TABLET,,7744,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
TRAMADOL 50 MG ORAL TABLET,,7744,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
TRAMADOL 50 MG ORAL TABLET,,7744,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
TRAMADOL 50 MG ORAL TABLET,,7744,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
TRAMADOL 50 MG ORAL TABLET,,7744,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
TRAMADOL 50 MG ORAL TABLET,,7744,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
QUETIAPINE 100 MG ORAL TABLET,,7770,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
QUETIAPINE 100 MG ORAL TABLET,,7770,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
QUETIAPINE 100 MG ORAL TABLET,,7770,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
QUETIAPINE 100 MG ORAL TABLET,,7770,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
QUETIAPINE 100 MG ORAL TABLET,,7770,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
QUETIAPINE 100 MG ORAL TABLET,,7770,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
QUETIAPINE 100 MG ORAL TABLET,,7770,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
QUETIAPINE 100 MG ORAL TABLET,,7770,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
QUETIAPINE 100 MG ORAL TABLET,,7770,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
QUETIAPINE 100 MG ORAL TABLET,,7770,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
QUETIAPINE 100 MG ORAL TABLET,,7770,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
QUETIAPINE 100 MG ORAL TABLET,,7770,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
QUETIAPINE 100 MG ORAL TABLET,,7770,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
QUETIAPINE 100 MG ORAL TABLET,,7770,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
QUETIAPINE 100 MG ORAL TABLET,,7770,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
QUETIAPINE 100 MG ORAL TABLET,,7770,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
QUETIAPINE 100 MG ORAL TABLET,,7770,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
QUETIAPINE 100 MG ORAL TABLET,,7770,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
QUETIAPINE 100 MG ORAL TABLET,,7770,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
QUETIAPINE 100 MG ORAL TABLET,,7770,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
QUETIAPINE 100 MG ORAL TABLET,,7770,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
QUETIAPINE 100 MG ORAL TABLET,,7770,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
QUETIAPINE 100 MG ORAL TABLET,,7770,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
QUETIAPINE 100 MG ORAL TABLET,,7770,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
QUETIAPINE 100 MG ORAL TABLET,,7770,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
QUETIAPINE 100 MG ORAL TABLET,,7770,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
QUETIAPINE 100 MG ORAL TABLET,,7770,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
QUETIAPINE 100 MG ORAL TABLET,,7770,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
QUETIAPINE 100 MG ORAL TABLET,,7770,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
QUETIAPINE 100 MG ORAL TABLET,,7770,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
QUETIAPINE 100 MG ORAL TABLET,,7770,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
QUETIAPINE 100 MG ORAL TABLET,,7770,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
QUETIAPINE 100 MG ORAL TABLET,,7770,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
QUETIAPINE 100 MG ORAL TABLET,,7770,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
QUETIAPINE 100 MG ORAL TABLET,,7770,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
QUETIAPINE 100 MG ORAL TABLET,,7770,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
QUETIAPINE 100 MG ORAL TABLET,,7770,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
QUETIAPINE 100 MG ORAL TABLET,,7770,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
QUETIAPINE 100 MG ORAL TABLET,,7770,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
QUETIAPINE 100 MG ORAL TABLET,,7770,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
QUETIAPINE 100 MG ORAL TABLET,,7770,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
QUETIAPINE 100 MG ORAL TABLET,,7770,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
QUETIAPINE 100 MG ORAL TABLET,,7770,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
QUETIAPINE 100 MG ORAL TABLET,,7770,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
QUETIAPINE 100 MG ORAL TABLET,,7770,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
QUETIAPINE 100 MG ORAL TABLET,,7770,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
QUETIAPINE 100 MG ORAL TABLET,,7770,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
QUETIAPINE 100 MG ORAL TABLET,,7770,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
QUETIAPINE 100 MG ORAL TABLET,,7770,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
QUETIAPINE 100 MG ORAL TABLET,,7770,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
QUETIAPINE 100 MG ORAL TABLET,,7770,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
QUETIAPINE 100 MG ORAL TABLET,,7770,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
QUETIAPINE 100 MG ORAL TABLET,,7770,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
QUETIAPINE 100 MG ORAL TABLET,,7770,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
ACETAMINOPHEN 500 MG ORAL TABLET,,7825,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
ACETAMINOPHEN 500 MG ORAL TABLET,,7825,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
ACETAMINOPHEN 500 MG ORAL TABLET,,7825,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
ACETAMINOPHEN 500 MG ORAL TABLET,,7825,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
ACETAMINOPHEN 500 MG ORAL TABLET,,7825,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
ACETAMINOPHEN 500 MG ORAL TABLET,,7825,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
ACETAMINOPHEN 500 MG ORAL TABLET,,7825,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
ACETAMINOPHEN 500 MG ORAL TABLET,,7825,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
ACETAMINOPHEN 500 MG ORAL TABLET,,7825,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
ACETAMINOPHEN 500 MG ORAL TABLET,,7825,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
ACETAMINOPHEN 500 MG ORAL TABLET,,7825,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
ACETAMINOPHEN 500 MG ORAL TABLET,,7825,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
ACETAMINOPHEN 500 MG ORAL TABLET,,7825,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
ACETAMINOPHEN 500 MG ORAL TABLET,,7825,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
ACETAMINOPHEN 500 MG ORAL TABLET,,7825,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
ACETAMINOPHEN 500 MG ORAL TABLET,,7825,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
ACETAMINOPHEN 500 MG ORAL TABLET,,7825,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
ACETAMINOPHEN 500 MG ORAL TABLET,,7825,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
ACETAMINOPHEN 500 MG ORAL TABLET,,7825,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ACETAMINOPHEN 500 MG ORAL TABLET,,7825,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
ACETAMINOPHEN 500 MG ORAL TABLET,,7825,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
ACETAMINOPHEN 500 MG ORAL TABLET,,7825,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
ACETAMINOPHEN 500 MG ORAL TABLET,,7825,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
ACETAMINOPHEN 500 MG ORAL TABLET,,7825,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
ACETAMINOPHEN 500 MG ORAL TABLET,,7825,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
ACETAMINOPHEN 500 MG ORAL TABLET,,7825,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
ACETAMINOPHEN 500 MG ORAL TABLET,,7825,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
ACETAMINOPHEN 500 MG ORAL TABLET,,7825,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
ACETAMINOPHEN 500 MG ORAL TABLET,,7825,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
ACETAMINOPHEN 500 MG ORAL TABLET,,7825,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
ACETAMINOPHEN 500 MG ORAL TABLET,,7825,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
ACETAMINOPHEN 500 MG ORAL TABLET,,7825,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
ACETAMINOPHEN 500 MG ORAL TABLET,,7825,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
ACETAMINOPHEN 500 MG ORAL TABLET,,7825,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
ACETAMINOPHEN 500 MG ORAL TABLET,,7825,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
ACETAMINOPHEN 500 MG ORAL TABLET,,7825,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
ACETAMINOPHEN 500 MG ORAL TABLET,,7825,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
ACETAMINOPHEN 500 MG ORAL TABLET,,7825,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ACETAMINOPHEN 500 MG ORAL TABLET,,7825,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
ACETAMINOPHEN 500 MG ORAL TABLET,,7825,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
ACETAMINOPHEN 500 MG ORAL TABLET,,7825,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
ACETAMINOPHEN 500 MG ORAL TABLET,,7825,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
ACETAMINOPHEN 500 MG ORAL TABLET,,7825,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
ACETAMINOPHEN 500 MG ORAL TABLET,,7825,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ACETAMINOPHEN 500 MG ORAL TABLET,,7825,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
ACETAMINOPHEN 500 MG ORAL TABLET,,7825,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ACETAMINOPHEN 500 MG ORAL TABLET,,7825,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ACETAMINOPHEN 500 MG ORAL TABLET,,7825,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ACETAMINOPHEN 500 MG ORAL TABLET,,7825,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ACETAMINOPHEN 500 MG ORAL TABLET,,7825,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
ACETAMINOPHEN 500 MG ORAL TABLET,,7825,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
ACETAMINOPHEN 500 MG ORAL TABLET,,7825,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
ACETAMINOPHEN 500 MG ORAL TABLET,,7825,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
ACETAMINOPHEN 500 MG ORAL TABLET,,7825,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
TRIAMTERENE-HYDROCHLOROTHIAZID 37.5-25 MG ORAL CAP,,7830,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
TRIAMTERENE-HYDROCHLOROTHIAZID 37.5-25 MG ORAL CAP,,7830,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
TRIAMTERENE-HYDROCHLOROTHIAZID 37.5-25 MG ORAL CAP,,7830,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
TRIAMTERENE-HYDROCHLOROTHIAZID 37.5-25 MG ORAL CAP,,7830,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
TRIAMTERENE-HYDROCHLOROTHIAZID 37.5-25 MG ORAL CAP,,7830,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
TRIAMTERENE-HYDROCHLOROTHIAZID 37.5-25 MG ORAL CAP,,7830,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
TRIAMTERENE-HYDROCHLOROTHIAZID 37.5-25 MG ORAL CAP,,7830,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
TRIAMTERENE-HYDROCHLOROTHIAZID 37.5-25 MG ORAL CAP,,7830,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
TRIAMTERENE-HYDROCHLOROTHIAZID 37.5-25 MG ORAL CAP,,7830,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
TRIAMTERENE-HYDROCHLOROTHIAZID 37.5-25 MG ORAL CAP,,7830,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
TRIAMTERENE-HYDROCHLOROTHIAZID 37.5-25 MG ORAL CAP,,7830,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
TRIAMTERENE-HYDROCHLOROTHIAZID 37.5-25 MG ORAL CAP,,7830,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
TRIAMTERENE-HYDROCHLOROTHIAZID 37.5-25 MG ORAL CAP,,7830,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
TRIAMTERENE-HYDROCHLOROTHIAZID 37.5-25 MG ORAL CAP,,7830,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
TRIAMTERENE-HYDROCHLOROTHIAZID 37.5-25 MG ORAL CAP,,7830,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
TRIAMTERENE-HYDROCHLOROTHIAZID 37.5-25 MG ORAL CAP,,7830,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
TRIAMTERENE-HYDROCHLOROTHIAZID 37.5-25 MG ORAL CAP,,7830,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
TRIAMTERENE-HYDROCHLOROTHIAZID 37.5-25 MG ORAL CAP,,7830,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
TRIAMTERENE-HYDROCHLOROTHIAZID 37.5-25 MG ORAL CAP,,7830,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
TRIAMTERENE-HYDROCHLOROTHIAZID 37.5-25 MG ORAL CAP,,7830,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
TRIAMTERENE-HYDROCHLOROTHIAZID 37.5-25 MG ORAL CAP,,7830,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
TRIAMTERENE-HYDROCHLOROTHIAZID 37.5-25 MG ORAL CAP,,7830,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
TRIAMTERENE-HYDROCHLOROTHIAZID 37.5-25 MG ORAL CAP,,7830,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
TRIAMTERENE-HYDROCHLOROTHIAZID 37.5-25 MG ORAL CAP,,7830,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
TRIAMTERENE-HYDROCHLOROTHIAZID 37.5-25 MG ORAL CAP,,7830,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
TRIAMTERENE-HYDROCHLOROTHIAZID 37.5-25 MG ORAL CAP,,7830,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
TRIAMTERENE-HYDROCHLOROTHIAZID 37.5-25 MG ORAL CAP,,7830,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
TRIAMTERENE-HYDROCHLOROTHIAZID 37.5-25 MG ORAL CAP,,7830,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
TRIAMTERENE-HYDROCHLOROTHIAZID 37.5-25 MG ORAL CAP,,7830,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
TRIAMTERENE-HYDROCHLOROTHIAZID 37.5-25 MG ORAL CAP,,7830,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
TRIAMTERENE-HYDROCHLOROTHIAZID 37.5-25 MG ORAL CAP,,7830,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
TRIAMTERENE-HYDROCHLOROTHIAZID 37.5-25 MG ORAL CAP,,7830,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
TRIAMTERENE-HYDROCHLOROTHIAZID 37.5-25 MG ORAL CAP,,7830,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
TRIAMTERENE-HYDROCHLOROTHIAZID 37.5-25 MG ORAL CAP,,7830,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
TRIAMTERENE-HYDROCHLOROTHIAZID 37.5-25 MG ORAL CAP,,7830,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
TRIAMTERENE-HYDROCHLOROTHIAZID 37.5-25 MG ORAL CAP,,7830,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
TRIAMTERENE-HYDROCHLOROTHIAZID 37.5-25 MG ORAL CAP,,7830,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
TRIAMTERENE-HYDROCHLOROTHIAZID 37.5-25 MG ORAL CAP,,7830,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
TRIAMTERENE-HYDROCHLOROTHIAZID 37.5-25 MG ORAL CAP,,7830,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
TRIAMTERENE-HYDROCHLOROTHIAZID 37.5-25 MG ORAL CAP,,7830,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
TRIAMTERENE-HYDROCHLOROTHIAZID 37.5-25 MG ORAL CAP,,7830,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
TRIAMTERENE-HYDROCHLOROTHIAZID 37.5-25 MG ORAL CAP,,7830,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
TRIAMTERENE-HYDROCHLOROTHIAZID 37.5-25 MG ORAL CAP,,7830,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
TRIAMTERENE-HYDROCHLOROTHIAZID 37.5-25 MG ORAL CAP,,7830,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TRIAMTERENE-HYDROCHLOROTHIAZID 37.5-25 MG ORAL CAP,,7830,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
TRIAMTERENE-HYDROCHLOROTHIAZID 37.5-25 MG ORAL CAP,,7830,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TRIAMTERENE-HYDROCHLOROTHIAZID 37.5-25 MG ORAL CAP,,7830,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
TRIAMTERENE-HYDROCHLOROTHIAZID 37.5-25 MG ORAL CAP,,7830,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TRIAMTERENE-HYDROCHLOROTHIAZID 37.5-25 MG ORAL CAP,,7830,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
TRIAMTERENE-HYDROCHLOROTHIAZID 37.5-25 MG ORAL CAP,,7830,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
TRIAMTERENE-HYDROCHLOROTHIAZID 37.5-25 MG ORAL CAP,,7830,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
TRIAMTERENE-HYDROCHLOROTHIAZID 37.5-25 MG ORAL CAP,,7830,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
TRIAMTERENE-HYDROCHLOROTHIAZID 37.5-25 MG ORAL CAP,,7830,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
TRIAMTERENE-HYDROCHLOROTHIAZID 37.5-25 MG ORAL CAP,,7830,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
SPIRONOLACTONE 25 MG ORAL TABLET,,8031,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
SPIRONOLACTONE 25 MG ORAL TABLET,,8031,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
SPIRONOLACTONE 25 MG ORAL TABLET,,8031,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
SPIRONOLACTONE 25 MG ORAL TABLET,,8031,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
SPIRONOLACTONE 25 MG ORAL TABLET,,8031,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SPIRONOLACTONE 25 MG ORAL TABLET,,8031,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
SPIRONOLACTONE 25 MG ORAL TABLET,,8031,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
SPIRONOLACTONE 25 MG ORAL TABLET,,8031,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
SPIRONOLACTONE 25 MG ORAL TABLET,,8031,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
SPIRONOLACTONE 25 MG ORAL TABLET,,8031,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
SPIRONOLACTONE 25 MG ORAL TABLET,,8031,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
SPIRONOLACTONE 25 MG ORAL TABLET,,8031,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
SPIRONOLACTONE 25 MG ORAL TABLET,,8031,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
SPIRONOLACTONE 25 MG ORAL TABLET,,8031,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
SPIRONOLACTONE 25 MG ORAL TABLET,,8031,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
SPIRONOLACTONE 25 MG ORAL TABLET,,8031,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
SPIRONOLACTONE 25 MG ORAL TABLET,,8031,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
SPIRONOLACTONE 25 MG ORAL TABLET,,8031,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
SPIRONOLACTONE 25 MG ORAL TABLET,,8031,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SPIRONOLACTONE 25 MG ORAL TABLET,,8031,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
SPIRONOLACTONE 25 MG ORAL TABLET,,8031,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
SPIRONOLACTONE 25 MG ORAL TABLET,,8031,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
SPIRONOLACTONE 25 MG ORAL TABLET,,8031,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
SPIRONOLACTONE 25 MG ORAL TABLET,,8031,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
SPIRONOLACTONE 25 MG ORAL TABLET,,8031,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
SPIRONOLACTONE 25 MG ORAL TABLET,,8031,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
SPIRONOLACTONE 25 MG ORAL TABLET,,8031,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
SPIRONOLACTONE 25 MG ORAL TABLET,,8031,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
SPIRONOLACTONE 25 MG ORAL TABLET,,8031,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
SPIRONOLACTONE 25 MG ORAL TABLET,,8031,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
SPIRONOLACTONE 25 MG ORAL TABLET,,8031,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
SPIRONOLACTONE 25 MG ORAL TABLET,,8031,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
SPIRONOLACTONE 25 MG ORAL TABLET,,8031,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
SPIRONOLACTONE 25 MG ORAL TABLET,,8031,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
SPIRONOLACTONE 25 MG ORAL TABLET,,8031,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
SPIRONOLACTONE 25 MG ORAL TABLET,,8031,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
SPIRONOLACTONE 25 MG ORAL TABLET,,8031,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
SPIRONOLACTONE 25 MG ORAL TABLET,,8031,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SPIRONOLACTONE 25 MG ORAL TABLET,,8031,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
SPIRONOLACTONE 25 MG ORAL TABLET,,8031,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
SPIRONOLACTONE 25 MG ORAL TABLET,,8031,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
SPIRONOLACTONE 25 MG ORAL TABLET,,8031,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
SPIRONOLACTONE 25 MG ORAL TABLET,,8031,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
SPIRONOLACTONE 25 MG ORAL TABLET,,8031,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SPIRONOLACTONE 25 MG ORAL TABLET,,8031,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
SPIRONOLACTONE 25 MG ORAL TABLET,,8031,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SPIRONOLACTONE 25 MG ORAL TABLET,,8031,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SPIRONOLACTONE 25 MG ORAL TABLET,,8031,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SPIRONOLACTONE 25 MG ORAL TABLET,,8031,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SPIRONOLACTONE 25 MG ORAL TABLET,,8031,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
SPIRONOLACTONE 25 MG ORAL TABLET,,8031,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
SPIRONOLACTONE 25 MG ORAL TABLET,,8031,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
SPIRONOLACTONE 25 MG ORAL TABLET,,8031,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
SPIRONOLACTONE 25 MG ORAL TABLET,,8031,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
VANCOMYCIN 125 MG ORAL CAP,,8132,LOCAL,Facility,Both,1,EA,,141,119.85,40.4106,141,Aetna,Commercial,129.72,92,,percent of total billed charges,,
VANCOMYCIN 125 MG ORAL CAP,,8132,LOCAL,Facility,Outpatient,1,EA,,141,119.85,40.4106,141,Aetna,Medicare Advantage,69.09,49,,percent of total billed charges,,
VANCOMYCIN 125 MG ORAL CAP,,8132,LOCAL,Facility,Inpatient,1,EA,,141,119.85,40.4106,141,Aetna,Medicare Advantage,,,,,Included in per diem rate,
VANCOMYCIN 125 MG ORAL CAP,,8132,LOCAL,Facility,Both,1,EA,,141,119.85,40.4106,141,Aetna,PPO,131.13,93,,percent of total billed charges,,
VANCOMYCIN 125 MG ORAL CAP,,8132,LOCAL,Facility,Both,1,EA,,141,119.85,40.4106,141,America's PPO,America's PPO,135.4023,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
VANCOMYCIN 125 MG ORAL CAP,,8132,LOCAL,Facility,Both,1,EA,,141,119.85,40.4106,141,BlueCross BlueShield Minnesota, Federal Employee Program,138.744,98.4,,percent of total billed charges,,
VANCOMYCIN 125 MG ORAL CAP,,8132,LOCAL,Facility,Both,1,EA,,141,119.85,40.4106,141,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,141,100,,percent of total billed charges,,
VANCOMYCIN 125 MG ORAL CAP,,8132,LOCAL,Facility,Both,1,EA,,141,119.85,40.4106,141,BlueCross BlueShield Minnesota,High Value Network Plan,126.9,90,,percent of total billed charges,,
VANCOMYCIN 125 MG ORAL CAP,,8132,LOCAL,Facility,Outpatient,1,EA,,141,119.85,40.4106,141,BlueCross BlueShield Minnesota,Medicare Advantage,69.09,49,,percent of total billed charges,,
VANCOMYCIN 125 MG ORAL CAP,,8132,LOCAL,Facility,Inpatient,1,EA,,141,119.85,40.4106,141,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
VANCOMYCIN 125 MG ORAL CAP,,8132,LOCAL,Facility,Both,1,EA,,141,119.85,40.4106,141,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,124.8837,88.57,,percent of total billed charges,,
VANCOMYCIN 125 MG ORAL CAP,,8132,LOCAL,Facility,Both,1,EA,,141,119.85,40.4106,141,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,40.4106,28.66,,percent of total billed charges,,
VANCOMYCIN 125 MG ORAL CAP,,8132,LOCAL,Facility,Outpatient,1,EA,,141,119.85,40.4106,141,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),69.09,49,,percent of total billed charges,,
VANCOMYCIN 125 MG ORAL CAP,,8132,LOCAL,Facility,Inpatient,1,EA,,141,119.85,40.4106,141,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
VANCOMYCIN 125 MG ORAL CAP,,8132,LOCAL,Facility,Both,1,EA,,141,119.85,40.4106,141,CorVel,Worker's Compensation,141,100,,percent of total billed charges,,
VANCOMYCIN 125 MG ORAL CAP,,8132,LOCAL,Facility,Both,1,EA,,141,119.85,40.4106,141,First Health Group Corporation,First Health Network,136.77,97,,percent of total billed charges,,
VANCOMYCIN 125 MG ORAL CAP,,8132,LOCAL,Facility,Both,1,EA,,141,119.85,40.4106,141,"Health Partners, Inc.",Commercial,133.386,94.6,,percent of total billed charges,,
VANCOMYCIN 125 MG ORAL CAP,,8132,LOCAL,Facility,Outpatient,1,EA,,141,119.85,40.4106,141,"Health Partners, Inc.",Medicare Advantage,69.09,49,,percent of total billed charges,,
VANCOMYCIN 125 MG ORAL CAP,,8132,LOCAL,Facility,Inpatient,1,EA,,141,119.85,40.4106,141,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
VANCOMYCIN 125 MG ORAL CAP,,8132,LOCAL,Facility,Both,1,EA,,141,119.85,40.4106,141,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),84.6,60,,percent of total billed charges,,
VANCOMYCIN 125 MG ORAL CAP,,8132,LOCAL,Facility,Both,1,EA,,141,119.85,40.4106,141,"Health Partners, Inc.",State of Minnesota Advantage Program,114.915,81.5,,percent of total billed charges,,
VANCOMYCIN 125 MG ORAL CAP,,8132,LOCAL,Facility,Both,1,EA,,141,119.85,40.4106,141,"Health Partners, Inc.",State Public Programs,70.5,50,,percent of total billed charges,,
VANCOMYCIN 125 MG ORAL CAP,,8132,LOCAL,Facility,Both,1,EA,,141,119.85,40.4106,141,Humana Insurance Company,Commercial PPO,133.95,95,,percent of total billed charges,,
VANCOMYCIN 125 MG ORAL CAP,,8132,LOCAL,Facility,Outpatient,1,EA,,141,119.85,40.4106,141,Humana Insurance Company,Medicare PPO,69.09,49,,percent of total billed charges,,
VANCOMYCIN 125 MG ORAL CAP,,8132,LOCAL,Facility,Inpatient,1,EA,,141,119.85,40.4106,141,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
VANCOMYCIN 125 MG ORAL CAP,,8132,LOCAL,Facility,Both,1,EA,,141,119.85,40.4106,141,Medica,Individual & Family,139.731,99.1,,percent of total billed charges,,
VANCOMYCIN 125 MG ORAL CAP,,8132,LOCAL,Facility,Outpatient,1,EA,,141,119.85,40.4106,141,Medica,Medica Advantage Solution,70.218,49.8,,percent of total billed charges,,
VANCOMYCIN 125 MG ORAL CAP,,8132,LOCAL,Facility,Inpatient,1,EA,,141,119.85,40.4106,141,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
VANCOMYCIN 125 MG ORAL CAP,,8132,LOCAL,Facility,Outpatient,1,EA,,141,119.85,40.4106,141,Medica,Medical Assistance,62.886,44.6,,percent of total billed charges,,
VANCOMYCIN 125 MG ORAL CAP,,8132,LOCAL,Facility,Inpatient,1,EA,,141,119.85,40.4106,141,Medica,Medical Assistance,,,,,Included in per diem rate,
VANCOMYCIN 125 MG ORAL CAP,,8132,LOCAL,Facility,Outpatient,1,EA,,141,119.85,40.4106,141,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,70.218,49.8,,percent of total billed charges,,
VANCOMYCIN 125 MG ORAL CAP,,8132,LOCAL,Facility,Inpatient,1,EA,,141,119.85,40.4106,141,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
VANCOMYCIN 125 MG ORAL CAP,,8132,LOCAL,Facility,Both,1,EA,,141,119.85,40.4106,141,"Multiplan, Inc.","Multiplan, Inc.",132.54,94,,percent of total billed charges,,
VANCOMYCIN 125 MG ORAL CAP,,8132,LOCAL,Facility,Outpatient,1,EA,,141,119.85,40.4106,141,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,127.041,90.1,,percent of total billed charges,,
VANCOMYCIN 125 MG ORAL CAP,,8132,LOCAL,Facility,Inpatient,1,EA,,141,119.85,40.4106,141,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
VANCOMYCIN 125 MG ORAL CAP,,8132,LOCAL,Facility,Both,1,EA,,141,119.85,40.4106,141,"Preferred One Administrative Services, INC.",PPO,139.026,98.6,,percent of total billed charges,,
VANCOMYCIN 125 MG ORAL CAP,,8132,LOCAL,Facility,Outpatient,1,EA,,141,119.85,40.4106,141,PrimeWest Health,Minnesota Senior Health Options (MSHO),72.5445,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
VANCOMYCIN 125 MG ORAL CAP,,8132,LOCAL,Facility,Inpatient,1,EA,,141,119.85,40.4106,141,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
VANCOMYCIN 125 MG ORAL CAP,,8132,LOCAL,Facility,Outpatient,1,EA,,141,119.85,40.4106,141,PrimeWest Health,MinnesotaCare,72.4176,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
VANCOMYCIN 125 MG ORAL CAP,,8132,LOCAL,Facility,Inpatient,1,EA,,141,119.85,40.4106,141,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
VANCOMYCIN 125 MG ORAL CAP,,8132,LOCAL,Facility,Both,1,EA,,141,119.85,40.4106,141,Sanford Health Plan,Sanford Health Plan,129.72,92,,percent of total billed charges,,
VANCOMYCIN 125 MG ORAL CAP,,8132,LOCAL,Facility,Outpatient,1,EA,,141,119.85,40.4106,141,"UCare Health, Inc.",Individual & Family Plan,79.4535,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
VANCOMYCIN 125 MG ORAL CAP,,8132,LOCAL,Facility,Inpatient,1,EA,,141,119.85,40.4106,141,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
VANCOMYCIN 125 MG ORAL CAP,,8132,LOCAL,Facility,Outpatient,1,EA,,141,119.85,40.4106,141,"UCare Health, Inc.",Medical Assistance,71.1627,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
VANCOMYCIN 125 MG ORAL CAP,,8132,LOCAL,Facility,Inpatient,1,EA,,141,119.85,40.4106,141,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
VANCOMYCIN 125 MG ORAL CAP,,8132,LOCAL,Facility,Outpatient,1,EA,,141,119.85,40.4106,141,"UCare Health, Inc.",Medicare Advantage,71.1627,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
VANCOMYCIN 125 MG ORAL CAP,,8132,LOCAL,Facility,Inpatient,1,EA,,141,119.85,40.4106,141,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
VANCOMYCIN 125 MG ORAL CAP,,8132,LOCAL,Facility,Outpatient,1,EA,,141,119.85,40.4106,141,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),71.1627,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
VANCOMYCIN 125 MG ORAL CAP,,8132,LOCAL,Facility,Inpatient,1,EA,,141,119.85,40.4106,141,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
VANCOMYCIN 125 MG ORAL CAP,,8132,LOCAL,Facility,Both,1,EA,,141,119.85,40.4106,141,UnitedHealthcare,Individual & Family,132.54,94,,percent of total billed charges,,
VANCOMYCIN 125 MG ORAL CAP,,8132,LOCAL,Facility,Outpatient,1,EA,,141,119.85,40.4106,141,UnitedHealthcare,Medicare Advantage,69.09,49,,percent of total billed charges,,
VANCOMYCIN 125 MG ORAL CAP,,8132,LOCAL,Facility,Inpatient,1,EA,,141,119.85,40.4106,141,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
VANCOMYCIN 125 MG ORAL CAP,,8132,LOCAL,Facility,Outpatient,1,EA,,141,119.85,40.4106,141,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,67.68,48,,percent of total billed charges,,100% of DHS outpatient percentage
VANCOMYCIN 125 MG ORAL CAP,,8132,LOCAL,Facility,Inpatient,1,EA,,141,119.85,40.4106,141,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
GLYCERIN (CHILD) RECT SUPP,,8183,LOCAL,Facility,Both,1,EA,,49,41.65,14.0434,49,Aetna,Commercial,45.08,92,,percent of total billed charges,,
GLYCERIN (CHILD) RECT SUPP,,8183,LOCAL,Facility,Outpatient,1,EA,,49,41.65,14.0434,49,Aetna,Medicare Advantage,24.01,49,,percent of total billed charges,,
GLYCERIN (CHILD) RECT SUPP,,8183,LOCAL,Facility,Inpatient,1,EA,,49,41.65,14.0434,49,Aetna,Medicare Advantage,,,,,Included in per diem rate,
GLYCERIN (CHILD) RECT SUPP,,8183,LOCAL,Facility,Both,1,EA,,49,41.65,14.0434,49,Aetna,PPO,45.57,93,,percent of total billed charges,,
GLYCERIN (CHILD) RECT SUPP,,8183,LOCAL,Facility,Both,1,EA,,49,41.65,14.0434,49,America's PPO,America's PPO,47.0547,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
GLYCERIN (CHILD) RECT SUPP,,8183,LOCAL,Facility,Both,1,EA,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota, Federal Employee Program,48.216,98.4,,percent of total billed charges,,
GLYCERIN (CHILD) RECT SUPP,,8183,LOCAL,Facility,Both,1,EA,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,49,100,,percent of total billed charges,,
GLYCERIN (CHILD) RECT SUPP,,8183,LOCAL,Facility,Both,1,EA,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,High Value Network Plan,44.1,90,,percent of total billed charges,,
GLYCERIN (CHILD) RECT SUPP,,8183,LOCAL,Facility,Outpatient,1,EA,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Medicare Advantage,24.01,49,,percent of total billed charges,,
GLYCERIN (CHILD) RECT SUPP,,8183,LOCAL,Facility,Inpatient,1,EA,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
GLYCERIN (CHILD) RECT SUPP,,8183,LOCAL,Facility,Both,1,EA,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,43.3993,88.57,,percent of total billed charges,,
GLYCERIN (CHILD) RECT SUPP,,8183,LOCAL,Facility,Both,1,EA,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,14.0434,28.66,,percent of total billed charges,,
GLYCERIN (CHILD) RECT SUPP,,8183,LOCAL,Facility,Outpatient,1,EA,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),24.01,49,,percent of total billed charges,,
GLYCERIN (CHILD) RECT SUPP,,8183,LOCAL,Facility,Inpatient,1,EA,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
GLYCERIN (CHILD) RECT SUPP,,8183,LOCAL,Facility,Both,1,EA,,49,41.65,14.0434,49,CorVel,Worker's Compensation,49,100,,percent of total billed charges,,
GLYCERIN (CHILD) RECT SUPP,,8183,LOCAL,Facility,Both,1,EA,,49,41.65,14.0434,49,First Health Group Corporation,First Health Network,47.53,97,,percent of total billed charges,,
GLYCERIN (CHILD) RECT SUPP,,8183,LOCAL,Facility,Both,1,EA,,49,41.65,14.0434,49,"Health Partners, Inc.",Commercial,46.354,94.6,,percent of total billed charges,,
GLYCERIN (CHILD) RECT SUPP,,8183,LOCAL,Facility,Outpatient,1,EA,,49,41.65,14.0434,49,"Health Partners, Inc.",Medicare Advantage,24.01,49,,percent of total billed charges,,
GLYCERIN (CHILD) RECT SUPP,,8183,LOCAL,Facility,Inpatient,1,EA,,49,41.65,14.0434,49,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
GLYCERIN (CHILD) RECT SUPP,,8183,LOCAL,Facility,Both,1,EA,,49,41.65,14.0434,49,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),29.4,60,,percent of total billed charges,,
GLYCERIN (CHILD) RECT SUPP,,8183,LOCAL,Facility,Both,1,EA,,49,41.65,14.0434,49,"Health Partners, Inc.",State of Minnesota Advantage Program,39.935,81.5,,percent of total billed charges,,
GLYCERIN (CHILD) RECT SUPP,,8183,LOCAL,Facility,Both,1,EA,,49,41.65,14.0434,49,"Health Partners, Inc.",State Public Programs,24.5,50,,percent of total billed charges,,
GLYCERIN (CHILD) RECT SUPP,,8183,LOCAL,Facility,Both,1,EA,,49,41.65,14.0434,49,Humana Insurance Company,Commercial PPO,46.55,95,,percent of total billed charges,,
GLYCERIN (CHILD) RECT SUPP,,8183,LOCAL,Facility,Outpatient,1,EA,,49,41.65,14.0434,49,Humana Insurance Company,Medicare PPO,24.01,49,,percent of total billed charges,,
GLYCERIN (CHILD) RECT SUPP,,8183,LOCAL,Facility,Inpatient,1,EA,,49,41.65,14.0434,49,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
GLYCERIN (CHILD) RECT SUPP,,8183,LOCAL,Facility,Both,1,EA,,49,41.65,14.0434,49,Medica,Individual & Family,48.559,99.1,,percent of total billed charges,,
GLYCERIN (CHILD) RECT SUPP,,8183,LOCAL,Facility,Outpatient,1,EA,,49,41.65,14.0434,49,Medica,Medica Advantage Solution,24.402,49.8,,percent of total billed charges,,
GLYCERIN (CHILD) RECT SUPP,,8183,LOCAL,Facility,Inpatient,1,EA,,49,41.65,14.0434,49,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
GLYCERIN (CHILD) RECT SUPP,,8183,LOCAL,Facility,Outpatient,1,EA,,49,41.65,14.0434,49,Medica,Medical Assistance,21.854,44.6,,percent of total billed charges,,
GLYCERIN (CHILD) RECT SUPP,,8183,LOCAL,Facility,Inpatient,1,EA,,49,41.65,14.0434,49,Medica,Medical Assistance,,,,,Included in per diem rate,
GLYCERIN (CHILD) RECT SUPP,,8183,LOCAL,Facility,Outpatient,1,EA,,49,41.65,14.0434,49,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,24.402,49.8,,percent of total billed charges,,
GLYCERIN (CHILD) RECT SUPP,,8183,LOCAL,Facility,Inpatient,1,EA,,49,41.65,14.0434,49,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
GLYCERIN (CHILD) RECT SUPP,,8183,LOCAL,Facility,Both,1,EA,,49,41.65,14.0434,49,"Multiplan, Inc.","Multiplan, Inc.",46.06,94,,percent of total billed charges,,
GLYCERIN (CHILD) RECT SUPP,,8183,LOCAL,Facility,Outpatient,1,EA,,49,41.65,14.0434,49,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,44.149,90.1,,percent of total billed charges,,
GLYCERIN (CHILD) RECT SUPP,,8183,LOCAL,Facility,Inpatient,1,EA,,49,41.65,14.0434,49,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
GLYCERIN (CHILD) RECT SUPP,,8183,LOCAL,Facility,Both,1,EA,,49,41.65,14.0434,49,"Preferred One Administrative Services, INC.",PPO,48.314,98.6,,percent of total billed charges,,
GLYCERIN (CHILD) RECT SUPP,,8183,LOCAL,Facility,Outpatient,1,EA,,49,41.65,14.0434,49,PrimeWest Health,Minnesota Senior Health Options (MSHO),25.2105,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
GLYCERIN (CHILD) RECT SUPP,,8183,LOCAL,Facility,Inpatient,1,EA,,49,41.65,14.0434,49,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
GLYCERIN (CHILD) RECT SUPP,,8183,LOCAL,Facility,Outpatient,1,EA,,49,41.65,14.0434,49,PrimeWest Health,MinnesotaCare,25.1664,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
GLYCERIN (CHILD) RECT SUPP,,8183,LOCAL,Facility,Inpatient,1,EA,,49,41.65,14.0434,49,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
GLYCERIN (CHILD) RECT SUPP,,8183,LOCAL,Facility,Both,1,EA,,49,41.65,14.0434,49,Sanford Health Plan,Sanford Health Plan,45.08,92,,percent of total billed charges,,
GLYCERIN (CHILD) RECT SUPP,,8183,LOCAL,Facility,Outpatient,1,EA,,49,41.65,14.0434,49,"UCare Health, Inc.",Individual & Family Plan,27.6115,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
GLYCERIN (CHILD) RECT SUPP,,8183,LOCAL,Facility,Inpatient,1,EA,,49,41.65,14.0434,49,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
GLYCERIN (CHILD) RECT SUPP,,8183,LOCAL,Facility,Outpatient,1,EA,,49,41.65,14.0434,49,"UCare Health, Inc.",Medical Assistance,24.7303,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
GLYCERIN (CHILD) RECT SUPP,,8183,LOCAL,Facility,Inpatient,1,EA,,49,41.65,14.0434,49,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
GLYCERIN (CHILD) RECT SUPP,,8183,LOCAL,Facility,Outpatient,1,EA,,49,41.65,14.0434,49,"UCare Health, Inc.",Medicare Advantage,24.7303,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
GLYCERIN (CHILD) RECT SUPP,,8183,LOCAL,Facility,Inpatient,1,EA,,49,41.65,14.0434,49,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
GLYCERIN (CHILD) RECT SUPP,,8183,LOCAL,Facility,Outpatient,1,EA,,49,41.65,14.0434,49,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),24.7303,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
GLYCERIN (CHILD) RECT SUPP,,8183,LOCAL,Facility,Inpatient,1,EA,,49,41.65,14.0434,49,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
GLYCERIN (CHILD) RECT SUPP,,8183,LOCAL,Facility,Both,1,EA,,49,41.65,14.0434,49,UnitedHealthcare,Individual & Family,46.06,94,,percent of total billed charges,,
GLYCERIN (CHILD) RECT SUPP,,8183,LOCAL,Facility,Outpatient,1,EA,,49,41.65,14.0434,49,UnitedHealthcare,Medicare Advantage,24.01,49,,percent of total billed charges,,
GLYCERIN (CHILD) RECT SUPP,,8183,LOCAL,Facility,Inpatient,1,EA,,49,41.65,14.0434,49,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
GLYCERIN (CHILD) RECT SUPP,,8183,LOCAL,Facility,Outpatient,1,EA,,49,41.65,14.0434,49,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,23.52,48,,percent of total billed charges,,100% of DHS outpatient percentage
GLYCERIN (CHILD) RECT SUPP,,8183,LOCAL,Facility,Inpatient,1,EA,,49,41.65,14.0434,49,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
GLIMEPIRIDE 2 MG ORAL TABLET,,8190,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
GLIMEPIRIDE 2 MG ORAL TABLET,,8190,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
GLIMEPIRIDE 2 MG ORAL TABLET,,8190,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
GLIMEPIRIDE 2 MG ORAL TABLET,,8190,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
GLIMEPIRIDE 2 MG ORAL TABLET,,8190,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
GLIMEPIRIDE 2 MG ORAL TABLET,,8190,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
GLIMEPIRIDE 2 MG ORAL TABLET,,8190,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
GLIMEPIRIDE 2 MG ORAL TABLET,,8190,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
GLIMEPIRIDE 2 MG ORAL TABLET,,8190,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
GLIMEPIRIDE 2 MG ORAL TABLET,,8190,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
GLIMEPIRIDE 2 MG ORAL TABLET,,8190,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
GLIMEPIRIDE 2 MG ORAL TABLET,,8190,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
GLIMEPIRIDE 2 MG ORAL TABLET,,8190,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
GLIMEPIRIDE 2 MG ORAL TABLET,,8190,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
GLIMEPIRIDE 2 MG ORAL TABLET,,8190,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
GLIMEPIRIDE 2 MG ORAL TABLET,,8190,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
GLIMEPIRIDE 2 MG ORAL TABLET,,8190,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
GLIMEPIRIDE 2 MG ORAL TABLET,,8190,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
GLIMEPIRIDE 2 MG ORAL TABLET,,8190,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
GLIMEPIRIDE 2 MG ORAL TABLET,,8190,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
GLIMEPIRIDE 2 MG ORAL TABLET,,8190,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
GLIMEPIRIDE 2 MG ORAL TABLET,,8190,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
GLIMEPIRIDE 2 MG ORAL TABLET,,8190,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
GLIMEPIRIDE 2 MG ORAL TABLET,,8190,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
GLIMEPIRIDE 2 MG ORAL TABLET,,8190,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
GLIMEPIRIDE 2 MG ORAL TABLET,,8190,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
GLIMEPIRIDE 2 MG ORAL TABLET,,8190,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
GLIMEPIRIDE 2 MG ORAL TABLET,,8190,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
GLIMEPIRIDE 2 MG ORAL TABLET,,8190,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
GLIMEPIRIDE 2 MG ORAL TABLET,,8190,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
GLIMEPIRIDE 2 MG ORAL TABLET,,8190,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
GLIMEPIRIDE 2 MG ORAL TABLET,,8190,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
GLIMEPIRIDE 2 MG ORAL TABLET,,8190,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
GLIMEPIRIDE 2 MG ORAL TABLET,,8190,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
GLIMEPIRIDE 2 MG ORAL TABLET,,8190,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
GLIMEPIRIDE 2 MG ORAL TABLET,,8190,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
GLIMEPIRIDE 2 MG ORAL TABLET,,8190,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
GLIMEPIRIDE 2 MG ORAL TABLET,,8190,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
GLIMEPIRIDE 2 MG ORAL TABLET,,8190,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
GLIMEPIRIDE 2 MG ORAL TABLET,,8190,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
GLIMEPIRIDE 2 MG ORAL TABLET,,8190,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
GLIMEPIRIDE 2 MG ORAL TABLET,,8190,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
GLIMEPIRIDE 2 MG ORAL TABLET,,8190,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
GLIMEPIRIDE 2 MG ORAL TABLET,,8190,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
GLIMEPIRIDE 2 MG ORAL TABLET,,8190,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
GLIMEPIRIDE 2 MG ORAL TABLET,,8190,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
GLIMEPIRIDE 2 MG ORAL TABLET,,8190,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
GLIMEPIRIDE 2 MG ORAL TABLET,,8190,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
GLIMEPIRIDE 2 MG ORAL TABLET,,8190,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
GLIMEPIRIDE 2 MG ORAL TABLET,,8190,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
GLIMEPIRIDE 2 MG ORAL TABLET,,8190,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
GLIMEPIRIDE 2 MG ORAL TABLET,,8190,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
GLIMEPIRIDE 2 MG ORAL TABLET,,8190,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
GLIMEPIRIDE 2 MG ORAL TABLET,,8190,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
CARVEDILOL 3.125 MG ORAL TABLET,,8199,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
CARVEDILOL 3.125 MG ORAL TABLET,,8199,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
CARVEDILOL 3.125 MG ORAL TABLET,,8199,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
CARVEDILOL 3.125 MG ORAL TABLET,,8199,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
CARVEDILOL 3.125 MG ORAL TABLET,,8199,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
CARVEDILOL 3.125 MG ORAL TABLET,,8199,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
CARVEDILOL 3.125 MG ORAL TABLET,,8199,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
CARVEDILOL 3.125 MG ORAL TABLET,,8199,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
CARVEDILOL 3.125 MG ORAL TABLET,,8199,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
CARVEDILOL 3.125 MG ORAL TABLET,,8199,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
CARVEDILOL 3.125 MG ORAL TABLET,,8199,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
CARVEDILOL 3.125 MG ORAL TABLET,,8199,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
CARVEDILOL 3.125 MG ORAL TABLET,,8199,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
CARVEDILOL 3.125 MG ORAL TABLET,,8199,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
CARVEDILOL 3.125 MG ORAL TABLET,,8199,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
CARVEDILOL 3.125 MG ORAL TABLET,,8199,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
CARVEDILOL 3.125 MG ORAL TABLET,,8199,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
CARVEDILOL 3.125 MG ORAL TABLET,,8199,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
CARVEDILOL 3.125 MG ORAL TABLET,,8199,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CARVEDILOL 3.125 MG ORAL TABLET,,8199,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
CARVEDILOL 3.125 MG ORAL TABLET,,8199,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
CARVEDILOL 3.125 MG ORAL TABLET,,8199,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
CARVEDILOL 3.125 MG ORAL TABLET,,8199,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
CARVEDILOL 3.125 MG ORAL TABLET,,8199,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
CARVEDILOL 3.125 MG ORAL TABLET,,8199,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
CARVEDILOL 3.125 MG ORAL TABLET,,8199,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
CARVEDILOL 3.125 MG ORAL TABLET,,8199,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
CARVEDILOL 3.125 MG ORAL TABLET,,8199,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
CARVEDILOL 3.125 MG ORAL TABLET,,8199,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
CARVEDILOL 3.125 MG ORAL TABLET,,8199,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
CARVEDILOL 3.125 MG ORAL TABLET,,8199,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
CARVEDILOL 3.125 MG ORAL TABLET,,8199,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
CARVEDILOL 3.125 MG ORAL TABLET,,8199,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
CARVEDILOL 3.125 MG ORAL TABLET,,8199,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
CARVEDILOL 3.125 MG ORAL TABLET,,8199,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
CARVEDILOL 3.125 MG ORAL TABLET,,8199,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
CARVEDILOL 3.125 MG ORAL TABLET,,8199,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
CARVEDILOL 3.125 MG ORAL TABLET,,8199,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CARVEDILOL 3.125 MG ORAL TABLET,,8199,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
CARVEDILOL 3.125 MG ORAL TABLET,,8199,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
CARVEDILOL 3.125 MG ORAL TABLET,,8199,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
CARVEDILOL 3.125 MG ORAL TABLET,,8199,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
CARVEDILOL 3.125 MG ORAL TABLET,,8199,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
CARVEDILOL 3.125 MG ORAL TABLET,,8199,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CARVEDILOL 3.125 MG ORAL TABLET,,8199,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
CARVEDILOL 3.125 MG ORAL TABLET,,8199,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CARVEDILOL 3.125 MG ORAL TABLET,,8199,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CARVEDILOL 3.125 MG ORAL TABLET,,8199,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CARVEDILOL 3.125 MG ORAL TABLET,,8199,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CARVEDILOL 3.125 MG ORAL TABLET,,8199,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
CARVEDILOL 3.125 MG ORAL TABLET,,8199,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
CARVEDILOL 3.125 MG ORAL TABLET,,8199,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
CARVEDILOL 3.125 MG ORAL TABLET,,8199,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
CARVEDILOL 3.125 MG ORAL TABLET,,8199,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
FLUORESCEIN 1 MG OPHT STRP,,8389,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
FLUORESCEIN 1 MG OPHT STRP,,8389,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
FLUORESCEIN 1 MG OPHT STRP,,8389,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
FLUORESCEIN 1 MG OPHT STRP,,8389,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
FLUORESCEIN 1 MG OPHT STRP,,8389,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
FLUORESCEIN 1 MG OPHT STRP,,8389,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
FLUORESCEIN 1 MG OPHT STRP,,8389,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
FLUORESCEIN 1 MG OPHT STRP,,8389,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
FLUORESCEIN 1 MG OPHT STRP,,8389,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
FLUORESCEIN 1 MG OPHT STRP,,8389,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
FLUORESCEIN 1 MG OPHT STRP,,8389,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
FLUORESCEIN 1 MG OPHT STRP,,8389,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
FLUORESCEIN 1 MG OPHT STRP,,8389,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
FLUORESCEIN 1 MG OPHT STRP,,8389,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
FLUORESCEIN 1 MG OPHT STRP,,8389,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
FLUORESCEIN 1 MG OPHT STRP,,8389,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
FLUORESCEIN 1 MG OPHT STRP,,8389,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
FLUORESCEIN 1 MG OPHT STRP,,8389,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
FLUORESCEIN 1 MG OPHT STRP,,8389,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
FLUORESCEIN 1 MG OPHT STRP,,8389,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
FLUORESCEIN 1 MG OPHT STRP,,8389,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
FLUORESCEIN 1 MG OPHT STRP,,8389,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
FLUORESCEIN 1 MG OPHT STRP,,8389,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
FLUORESCEIN 1 MG OPHT STRP,,8389,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
FLUORESCEIN 1 MG OPHT STRP,,8389,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
FLUORESCEIN 1 MG OPHT STRP,,8389,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
FLUORESCEIN 1 MG OPHT STRP,,8389,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
FLUORESCEIN 1 MG OPHT STRP,,8389,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
FLUORESCEIN 1 MG OPHT STRP,,8389,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
FLUORESCEIN 1 MG OPHT STRP,,8389,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
FLUORESCEIN 1 MG OPHT STRP,,8389,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
FLUORESCEIN 1 MG OPHT STRP,,8389,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
FLUORESCEIN 1 MG OPHT STRP,,8389,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
FLUORESCEIN 1 MG OPHT STRP,,8389,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
FLUORESCEIN 1 MG OPHT STRP,,8389,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
FLUORESCEIN 1 MG OPHT STRP,,8389,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
FLUORESCEIN 1 MG OPHT STRP,,8389,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
FLUORESCEIN 1 MG OPHT STRP,,8389,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
FLUORESCEIN 1 MG OPHT STRP,,8389,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
FLUORESCEIN 1 MG OPHT STRP,,8389,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
FLUORESCEIN 1 MG OPHT STRP,,8389,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
FLUORESCEIN 1 MG OPHT STRP,,8389,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
FLUORESCEIN 1 MG OPHT STRP,,8389,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
FLUORESCEIN 1 MG OPHT STRP,,8389,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FLUORESCEIN 1 MG OPHT STRP,,8389,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
FLUORESCEIN 1 MG OPHT STRP,,8389,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FLUORESCEIN 1 MG OPHT STRP,,8389,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
FLUORESCEIN 1 MG OPHT STRP,,8389,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FLUORESCEIN 1 MG OPHT STRP,,8389,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
FLUORESCEIN 1 MG OPHT STRP,,8389,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
FLUORESCEIN 1 MG OPHT STRP,,8389,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
FLUORESCEIN 1 MG OPHT STRP,,8389,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
FLUORESCEIN 1 MG OPHT STRP,,8389,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
FLUORESCEIN 1 MG OPHT STRP,,8389,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
LEVOTHYROXINE 25 MCG ORAL TABLET,,8398,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
LEVOTHYROXINE 25 MCG ORAL TABLET,,8398,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
LEVOTHYROXINE 25 MCG ORAL TABLET,,8398,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
LEVOTHYROXINE 25 MCG ORAL TABLET,,8398,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
LEVOTHYROXINE 25 MCG ORAL TABLET,,8398,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
LEVOTHYROXINE 25 MCG ORAL TABLET,,8398,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
LEVOTHYROXINE 25 MCG ORAL TABLET,,8398,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
LEVOTHYROXINE 25 MCG ORAL TABLET,,8398,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
LEVOTHYROXINE 25 MCG ORAL TABLET,,8398,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
LEVOTHYROXINE 25 MCG ORAL TABLET,,8398,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
LEVOTHYROXINE 25 MCG ORAL TABLET,,8398,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
LEVOTHYROXINE 25 MCG ORAL TABLET,,8398,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
LEVOTHYROXINE 25 MCG ORAL TABLET,,8398,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
LEVOTHYROXINE 25 MCG ORAL TABLET,,8398,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
LEVOTHYROXINE 25 MCG ORAL TABLET,,8398,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
LEVOTHYROXINE 25 MCG ORAL TABLET,,8398,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
LEVOTHYROXINE 25 MCG ORAL TABLET,,8398,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
LEVOTHYROXINE 25 MCG ORAL TABLET,,8398,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
LEVOTHYROXINE 25 MCG ORAL TABLET,,8398,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LEVOTHYROXINE 25 MCG ORAL TABLET,,8398,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
LEVOTHYROXINE 25 MCG ORAL TABLET,,8398,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
LEVOTHYROXINE 25 MCG ORAL TABLET,,8398,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
LEVOTHYROXINE 25 MCG ORAL TABLET,,8398,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
LEVOTHYROXINE 25 MCG ORAL TABLET,,8398,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
LEVOTHYROXINE 25 MCG ORAL TABLET,,8398,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
LEVOTHYROXINE 25 MCG ORAL TABLET,,8398,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
LEVOTHYROXINE 25 MCG ORAL TABLET,,8398,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
LEVOTHYROXINE 25 MCG ORAL TABLET,,8398,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
LEVOTHYROXINE 25 MCG ORAL TABLET,,8398,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
LEVOTHYROXINE 25 MCG ORAL TABLET,,8398,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
LEVOTHYROXINE 25 MCG ORAL TABLET,,8398,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
LEVOTHYROXINE 25 MCG ORAL TABLET,,8398,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
LEVOTHYROXINE 25 MCG ORAL TABLET,,8398,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
LEVOTHYROXINE 25 MCG ORAL TABLET,,8398,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
LEVOTHYROXINE 25 MCG ORAL TABLET,,8398,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
LEVOTHYROXINE 25 MCG ORAL TABLET,,8398,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
LEVOTHYROXINE 25 MCG ORAL TABLET,,8398,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
LEVOTHYROXINE 25 MCG ORAL TABLET,,8398,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LEVOTHYROXINE 25 MCG ORAL TABLET,,8398,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
LEVOTHYROXINE 25 MCG ORAL TABLET,,8398,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
LEVOTHYROXINE 25 MCG ORAL TABLET,,8398,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
LEVOTHYROXINE 25 MCG ORAL TABLET,,8398,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
LEVOTHYROXINE 25 MCG ORAL TABLET,,8398,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
LEVOTHYROXINE 25 MCG ORAL TABLET,,8398,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LEVOTHYROXINE 25 MCG ORAL TABLET,,8398,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
LEVOTHYROXINE 25 MCG ORAL TABLET,,8398,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LEVOTHYROXINE 25 MCG ORAL TABLET,,8398,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LEVOTHYROXINE 25 MCG ORAL TABLET,,8398,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LEVOTHYROXINE 25 MCG ORAL TABLET,,8398,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LEVOTHYROXINE 25 MCG ORAL TABLET,,8398,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
LEVOTHYROXINE 25 MCG ORAL TABLET,,8398,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
LEVOTHYROXINE 25 MCG ORAL TABLET,,8398,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
LEVOTHYROXINE 25 MCG ORAL TABLET,,8398,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
LEVOTHYROXINE 25 MCG ORAL TABLET,,8398,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
LAMOTRIGINE 25 MG ORAL TABLET,,8461,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
LAMOTRIGINE 25 MG ORAL TABLET,,8461,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
LAMOTRIGINE 25 MG ORAL TABLET,,8461,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
LAMOTRIGINE 25 MG ORAL TABLET,,8461,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
LAMOTRIGINE 25 MG ORAL TABLET,,8461,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
LAMOTRIGINE 25 MG ORAL TABLET,,8461,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
LAMOTRIGINE 25 MG ORAL TABLET,,8461,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
LAMOTRIGINE 25 MG ORAL TABLET,,8461,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
LAMOTRIGINE 25 MG ORAL TABLET,,8461,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
LAMOTRIGINE 25 MG ORAL TABLET,,8461,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
LAMOTRIGINE 25 MG ORAL TABLET,,8461,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
LAMOTRIGINE 25 MG ORAL TABLET,,8461,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
LAMOTRIGINE 25 MG ORAL TABLET,,8461,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
LAMOTRIGINE 25 MG ORAL TABLET,,8461,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
LAMOTRIGINE 25 MG ORAL TABLET,,8461,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
LAMOTRIGINE 25 MG ORAL TABLET,,8461,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
LAMOTRIGINE 25 MG ORAL TABLET,,8461,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
LAMOTRIGINE 25 MG ORAL TABLET,,8461,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
LAMOTRIGINE 25 MG ORAL TABLET,,8461,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LAMOTRIGINE 25 MG ORAL TABLET,,8461,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
LAMOTRIGINE 25 MG ORAL TABLET,,8461,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
LAMOTRIGINE 25 MG ORAL TABLET,,8461,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
LAMOTRIGINE 25 MG ORAL TABLET,,8461,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
LAMOTRIGINE 25 MG ORAL TABLET,,8461,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
LAMOTRIGINE 25 MG ORAL TABLET,,8461,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
LAMOTRIGINE 25 MG ORAL TABLET,,8461,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
LAMOTRIGINE 25 MG ORAL TABLET,,8461,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
LAMOTRIGINE 25 MG ORAL TABLET,,8461,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
LAMOTRIGINE 25 MG ORAL TABLET,,8461,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
LAMOTRIGINE 25 MG ORAL TABLET,,8461,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
LAMOTRIGINE 25 MG ORAL TABLET,,8461,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
LAMOTRIGINE 25 MG ORAL TABLET,,8461,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
LAMOTRIGINE 25 MG ORAL TABLET,,8461,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
LAMOTRIGINE 25 MG ORAL TABLET,,8461,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
LAMOTRIGINE 25 MG ORAL TABLET,,8461,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
LAMOTRIGINE 25 MG ORAL TABLET,,8461,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
LAMOTRIGINE 25 MG ORAL TABLET,,8461,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
LAMOTRIGINE 25 MG ORAL TABLET,,8461,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LAMOTRIGINE 25 MG ORAL TABLET,,8461,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
LAMOTRIGINE 25 MG ORAL TABLET,,8461,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
LAMOTRIGINE 25 MG ORAL TABLET,,8461,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
LAMOTRIGINE 25 MG ORAL TABLET,,8461,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
LAMOTRIGINE 25 MG ORAL TABLET,,8461,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
LAMOTRIGINE 25 MG ORAL TABLET,,8461,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LAMOTRIGINE 25 MG ORAL TABLET,,8461,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
LAMOTRIGINE 25 MG ORAL TABLET,,8461,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LAMOTRIGINE 25 MG ORAL TABLET,,8461,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LAMOTRIGINE 25 MG ORAL TABLET,,8461,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LAMOTRIGINE 25 MG ORAL TABLET,,8461,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LAMOTRIGINE 25 MG ORAL TABLET,,8461,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
LAMOTRIGINE 25 MG ORAL TABLET,,8461,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
LAMOTRIGINE 25 MG ORAL TABLET,,8461,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
LAMOTRIGINE 25 MG ORAL TABLET,,8461,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
LAMOTRIGINE 25 MG ORAL TABLET,,8461,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
DISULFIRAM 250 MG ORAL TABLET,,8512,LOCAL,Facility,Both,1,EA,,21,17.85,6.0186,21,Aetna,Commercial,19.32,92,,percent of total billed charges,,
DISULFIRAM 250 MG ORAL TABLET,,8512,LOCAL,Facility,Outpatient,1,EA,,21,17.85,6.0186,21,Aetna,Medicare Advantage,10.29,49,,percent of total billed charges,,
DISULFIRAM 250 MG ORAL TABLET,,8512,LOCAL,Facility,Inpatient,1,EA,,21,17.85,6.0186,21,Aetna,Medicare Advantage,,,,,Included in per diem rate,
DISULFIRAM 250 MG ORAL TABLET,,8512,LOCAL,Facility,Both,1,EA,,21,17.85,6.0186,21,Aetna,PPO,19.53,93,,percent of total billed charges,,
DISULFIRAM 250 MG ORAL TABLET,,8512,LOCAL,Facility,Both,1,EA,,21,17.85,6.0186,21,America's PPO,America's PPO,20.1663,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
DISULFIRAM 250 MG ORAL TABLET,,8512,LOCAL,Facility,Both,1,EA,,21,17.85,6.0186,21,BlueCross BlueShield Minnesota, Federal Employee Program,20.664,98.4,,percent of total billed charges,,
DISULFIRAM 250 MG ORAL TABLET,,8512,LOCAL,Facility,Both,1,EA,,21,17.85,6.0186,21,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,21,100,,percent of total billed charges,,
DISULFIRAM 250 MG ORAL TABLET,,8512,LOCAL,Facility,Both,1,EA,,21,17.85,6.0186,21,BlueCross BlueShield Minnesota,High Value Network Plan,18.9,90,,percent of total billed charges,,
DISULFIRAM 250 MG ORAL TABLET,,8512,LOCAL,Facility,Outpatient,1,EA,,21,17.85,6.0186,21,BlueCross BlueShield Minnesota,Medicare Advantage,10.29,49,,percent of total billed charges,,
DISULFIRAM 250 MG ORAL TABLET,,8512,LOCAL,Facility,Inpatient,1,EA,,21,17.85,6.0186,21,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
DISULFIRAM 250 MG ORAL TABLET,,8512,LOCAL,Facility,Both,1,EA,,21,17.85,6.0186,21,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,18.5997,88.57,,percent of total billed charges,,
DISULFIRAM 250 MG ORAL TABLET,,8512,LOCAL,Facility,Both,1,EA,,21,17.85,6.0186,21,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,6.0186,28.66,,percent of total billed charges,,
DISULFIRAM 250 MG ORAL TABLET,,8512,LOCAL,Facility,Outpatient,1,EA,,21,17.85,6.0186,21,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),10.29,49,,percent of total billed charges,,
DISULFIRAM 250 MG ORAL TABLET,,8512,LOCAL,Facility,Inpatient,1,EA,,21,17.85,6.0186,21,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
DISULFIRAM 250 MG ORAL TABLET,,8512,LOCAL,Facility,Both,1,EA,,21,17.85,6.0186,21,CorVel,Worker's Compensation,21,100,,percent of total billed charges,,
DISULFIRAM 250 MG ORAL TABLET,,8512,LOCAL,Facility,Both,1,EA,,21,17.85,6.0186,21,First Health Group Corporation,First Health Network,20.37,97,,percent of total billed charges,,
DISULFIRAM 250 MG ORAL TABLET,,8512,LOCAL,Facility,Both,1,EA,,21,17.85,6.0186,21,"Health Partners, Inc.",Commercial,19.866,94.6,,percent of total billed charges,,
DISULFIRAM 250 MG ORAL TABLET,,8512,LOCAL,Facility,Outpatient,1,EA,,21,17.85,6.0186,21,"Health Partners, Inc.",Medicare Advantage,10.29,49,,percent of total billed charges,,
DISULFIRAM 250 MG ORAL TABLET,,8512,LOCAL,Facility,Inpatient,1,EA,,21,17.85,6.0186,21,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DISULFIRAM 250 MG ORAL TABLET,,8512,LOCAL,Facility,Both,1,EA,,21,17.85,6.0186,21,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),12.6,60,,percent of total billed charges,,
DISULFIRAM 250 MG ORAL TABLET,,8512,LOCAL,Facility,Both,1,EA,,21,17.85,6.0186,21,"Health Partners, Inc.",State of Minnesota Advantage Program,17.115,81.5,,percent of total billed charges,,
DISULFIRAM 250 MG ORAL TABLET,,8512,LOCAL,Facility,Both,1,EA,,21,17.85,6.0186,21,"Health Partners, Inc.",State Public Programs,10.5,50,,percent of total billed charges,,
DISULFIRAM 250 MG ORAL TABLET,,8512,LOCAL,Facility,Both,1,EA,,21,17.85,6.0186,21,Humana Insurance Company,Commercial PPO,19.95,95,,percent of total billed charges,,
DISULFIRAM 250 MG ORAL TABLET,,8512,LOCAL,Facility,Outpatient,1,EA,,21,17.85,6.0186,21,Humana Insurance Company,Medicare PPO,10.29,49,,percent of total billed charges,,
DISULFIRAM 250 MG ORAL TABLET,,8512,LOCAL,Facility,Inpatient,1,EA,,21,17.85,6.0186,21,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
DISULFIRAM 250 MG ORAL TABLET,,8512,LOCAL,Facility,Both,1,EA,,21,17.85,6.0186,21,Medica,Individual & Family,20.811,99.1,,percent of total billed charges,,
DISULFIRAM 250 MG ORAL TABLET,,8512,LOCAL,Facility,Outpatient,1,EA,,21,17.85,6.0186,21,Medica,Medica Advantage Solution,10.458,49.8,,percent of total billed charges,,
DISULFIRAM 250 MG ORAL TABLET,,8512,LOCAL,Facility,Inpatient,1,EA,,21,17.85,6.0186,21,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
DISULFIRAM 250 MG ORAL TABLET,,8512,LOCAL,Facility,Outpatient,1,EA,,21,17.85,6.0186,21,Medica,Medical Assistance,9.366,44.6,,percent of total billed charges,,
DISULFIRAM 250 MG ORAL TABLET,,8512,LOCAL,Facility,Inpatient,1,EA,,21,17.85,6.0186,21,Medica,Medical Assistance,,,,,Included in per diem rate,
DISULFIRAM 250 MG ORAL TABLET,,8512,LOCAL,Facility,Outpatient,1,EA,,21,17.85,6.0186,21,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,10.458,49.8,,percent of total billed charges,,
DISULFIRAM 250 MG ORAL TABLET,,8512,LOCAL,Facility,Inpatient,1,EA,,21,17.85,6.0186,21,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
DISULFIRAM 250 MG ORAL TABLET,,8512,LOCAL,Facility,Both,1,EA,,21,17.85,6.0186,21,"Multiplan, Inc.","Multiplan, Inc.",19.74,94,,percent of total billed charges,,
DISULFIRAM 250 MG ORAL TABLET,,8512,LOCAL,Facility,Outpatient,1,EA,,21,17.85,6.0186,21,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,18.921,90.1,,percent of total billed charges,,
DISULFIRAM 250 MG ORAL TABLET,,8512,LOCAL,Facility,Inpatient,1,EA,,21,17.85,6.0186,21,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
DISULFIRAM 250 MG ORAL TABLET,,8512,LOCAL,Facility,Both,1,EA,,21,17.85,6.0186,21,"Preferred One Administrative Services, INC.",PPO,20.706,98.6,,percent of total billed charges,,
DISULFIRAM 250 MG ORAL TABLET,,8512,LOCAL,Facility,Outpatient,1,EA,,21,17.85,6.0186,21,PrimeWest Health,Minnesota Senior Health Options (MSHO),10.8045,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
DISULFIRAM 250 MG ORAL TABLET,,8512,LOCAL,Facility,Inpatient,1,EA,,21,17.85,6.0186,21,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DISULFIRAM 250 MG ORAL TABLET,,8512,LOCAL,Facility,Outpatient,1,EA,,21,17.85,6.0186,21,PrimeWest Health,MinnesotaCare,10.7856,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
DISULFIRAM 250 MG ORAL TABLET,,8512,LOCAL,Facility,Inpatient,1,EA,,21,17.85,6.0186,21,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
DISULFIRAM 250 MG ORAL TABLET,,8512,LOCAL,Facility,Both,1,EA,,21,17.85,6.0186,21,Sanford Health Plan,Sanford Health Plan,19.32,92,,percent of total billed charges,,
DISULFIRAM 250 MG ORAL TABLET,,8512,LOCAL,Facility,Outpatient,1,EA,,21,17.85,6.0186,21,"UCare Health, Inc.",Individual & Family Plan,11.8335,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
DISULFIRAM 250 MG ORAL TABLET,,8512,LOCAL,Facility,Inpatient,1,EA,,21,17.85,6.0186,21,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
DISULFIRAM 250 MG ORAL TABLET,,8512,LOCAL,Facility,Outpatient,1,EA,,21,17.85,6.0186,21,"UCare Health, Inc.",Medical Assistance,10.5987,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DISULFIRAM 250 MG ORAL TABLET,,8512,LOCAL,Facility,Inpatient,1,EA,,21,17.85,6.0186,21,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
DISULFIRAM 250 MG ORAL TABLET,,8512,LOCAL,Facility,Outpatient,1,EA,,21,17.85,6.0186,21,"UCare Health, Inc.",Medicare Advantage,10.5987,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DISULFIRAM 250 MG ORAL TABLET,,8512,LOCAL,Facility,Inpatient,1,EA,,21,17.85,6.0186,21,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DISULFIRAM 250 MG ORAL TABLET,,8512,LOCAL,Facility,Outpatient,1,EA,,21,17.85,6.0186,21,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),10.5987,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DISULFIRAM 250 MG ORAL TABLET,,8512,LOCAL,Facility,Inpatient,1,EA,,21,17.85,6.0186,21,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DISULFIRAM 250 MG ORAL TABLET,,8512,LOCAL,Facility,Both,1,EA,,21,17.85,6.0186,21,UnitedHealthcare,Individual & Family,19.74,94,,percent of total billed charges,,
DISULFIRAM 250 MG ORAL TABLET,,8512,LOCAL,Facility,Outpatient,1,EA,,21,17.85,6.0186,21,UnitedHealthcare,Medicare Advantage,10.29,49,,percent of total billed charges,,
DISULFIRAM 250 MG ORAL TABLET,,8512,LOCAL,Facility,Inpatient,1,EA,,21,17.85,6.0186,21,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
DISULFIRAM 250 MG ORAL TABLET,,8512,LOCAL,Facility,Outpatient,1,EA,,21,17.85,6.0186,21,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,10.08,48,,percent of total billed charges,,100% of DHS outpatient percentage
DISULFIRAM 250 MG ORAL TABLET,,8512,LOCAL,Facility,Inpatient,1,EA,,21,17.85,6.0186,21,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
HYDROCORTISONE ACETATE 25 MG RECT SUPP,,8626,LOCAL,Facility,Both,1,EA,,102,86.7,29.2332,102,Aetna,Commercial,93.84,92,,percent of total billed charges,,
HYDROCORTISONE ACETATE 25 MG RECT SUPP,,8626,LOCAL,Facility,Outpatient,1,EA,,102,86.7,29.2332,102,Aetna,Medicare Advantage,49.98,49,,percent of total billed charges,,
HYDROCORTISONE ACETATE 25 MG RECT SUPP,,8626,LOCAL,Facility,Inpatient,1,EA,,102,86.7,29.2332,102,Aetna,Medicare Advantage,,,,,Included in per diem rate,
HYDROCORTISONE ACETATE 25 MG RECT SUPP,,8626,LOCAL,Facility,Both,1,EA,,102,86.7,29.2332,102,Aetna,PPO,94.86,93,,percent of total billed charges,,
HYDROCORTISONE ACETATE 25 MG RECT SUPP,,8626,LOCAL,Facility,Both,1,EA,,102,86.7,29.2332,102,America's PPO,America's PPO,97.9506,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
HYDROCORTISONE ACETATE 25 MG RECT SUPP,,8626,LOCAL,Facility,Both,1,EA,,102,86.7,29.2332,102,BlueCross BlueShield Minnesota, Federal Employee Program,100.368,98.4,,percent of total billed charges,,
HYDROCORTISONE ACETATE 25 MG RECT SUPP,,8626,LOCAL,Facility,Both,1,EA,,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,102,100,,percent of total billed charges,,
HYDROCORTISONE ACETATE 25 MG RECT SUPP,,8626,LOCAL,Facility,Both,1,EA,,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,High Value Network Plan,91.8,90,,percent of total billed charges,,
HYDROCORTISONE ACETATE 25 MG RECT SUPP,,8626,LOCAL,Facility,Outpatient,1,EA,,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,Medicare Advantage,49.98,49,,percent of total billed charges,,
HYDROCORTISONE ACETATE 25 MG RECT SUPP,,8626,LOCAL,Facility,Inpatient,1,EA,,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
HYDROCORTISONE ACETATE 25 MG RECT SUPP,,8626,LOCAL,Facility,Both,1,EA,,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,90.3414,88.57,,percent of total billed charges,,
HYDROCORTISONE ACETATE 25 MG RECT SUPP,,8626,LOCAL,Facility,Both,1,EA,,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,29.2332,28.66,,percent of total billed charges,,
HYDROCORTISONE ACETATE 25 MG RECT SUPP,,8626,LOCAL,Facility,Outpatient,1,EA,,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),49.98,49,,percent of total billed charges,,
HYDROCORTISONE ACETATE 25 MG RECT SUPP,,8626,LOCAL,Facility,Inpatient,1,EA,,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
HYDROCORTISONE ACETATE 25 MG RECT SUPP,,8626,LOCAL,Facility,Both,1,EA,,102,86.7,29.2332,102,CorVel,Worker's Compensation,102,100,,percent of total billed charges,,
HYDROCORTISONE ACETATE 25 MG RECT SUPP,,8626,LOCAL,Facility,Both,1,EA,,102,86.7,29.2332,102,First Health Group Corporation,First Health Network,98.94,97,,percent of total billed charges,,
HYDROCORTISONE ACETATE 25 MG RECT SUPP,,8626,LOCAL,Facility,Both,1,EA,,102,86.7,29.2332,102,"Health Partners, Inc.",Commercial,96.492,94.6,,percent of total billed charges,,
HYDROCORTISONE ACETATE 25 MG RECT SUPP,,8626,LOCAL,Facility,Outpatient,1,EA,,102,86.7,29.2332,102,"Health Partners, Inc.",Medicare Advantage,49.98,49,,percent of total billed charges,,
HYDROCORTISONE ACETATE 25 MG RECT SUPP,,8626,LOCAL,Facility,Inpatient,1,EA,,102,86.7,29.2332,102,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
HYDROCORTISONE ACETATE 25 MG RECT SUPP,,8626,LOCAL,Facility,Both,1,EA,,102,86.7,29.2332,102,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),61.2,60,,percent of total billed charges,,
HYDROCORTISONE ACETATE 25 MG RECT SUPP,,8626,LOCAL,Facility,Both,1,EA,,102,86.7,29.2332,102,"Health Partners, Inc.",State of Minnesota Advantage Program,83.13,81.5,,percent of total billed charges,,
HYDROCORTISONE ACETATE 25 MG RECT SUPP,,8626,LOCAL,Facility,Both,1,EA,,102,86.7,29.2332,102,"Health Partners, Inc.",State Public Programs,51,50,,percent of total billed charges,,
HYDROCORTISONE ACETATE 25 MG RECT SUPP,,8626,LOCAL,Facility,Both,1,EA,,102,86.7,29.2332,102,Humana Insurance Company,Commercial PPO,96.9,95,,percent of total billed charges,,
HYDROCORTISONE ACETATE 25 MG RECT SUPP,,8626,LOCAL,Facility,Outpatient,1,EA,,102,86.7,29.2332,102,Humana Insurance Company,Medicare PPO,49.98,49,,percent of total billed charges,,
HYDROCORTISONE ACETATE 25 MG RECT SUPP,,8626,LOCAL,Facility,Inpatient,1,EA,,102,86.7,29.2332,102,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
HYDROCORTISONE ACETATE 25 MG RECT SUPP,,8626,LOCAL,Facility,Both,1,EA,,102,86.7,29.2332,102,Medica,Individual & Family,101.082,99.1,,percent of total billed charges,,
HYDROCORTISONE ACETATE 25 MG RECT SUPP,,8626,LOCAL,Facility,Outpatient,1,EA,,102,86.7,29.2332,102,Medica,Medica Advantage Solution,50.796,49.8,,percent of total billed charges,,
HYDROCORTISONE ACETATE 25 MG RECT SUPP,,8626,LOCAL,Facility,Inpatient,1,EA,,102,86.7,29.2332,102,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
HYDROCORTISONE ACETATE 25 MG RECT SUPP,,8626,LOCAL,Facility,Outpatient,1,EA,,102,86.7,29.2332,102,Medica,Medical Assistance,45.492,44.6,,percent of total billed charges,,
HYDROCORTISONE ACETATE 25 MG RECT SUPP,,8626,LOCAL,Facility,Inpatient,1,EA,,102,86.7,29.2332,102,Medica,Medical Assistance,,,,,Included in per diem rate,
HYDROCORTISONE ACETATE 25 MG RECT SUPP,,8626,LOCAL,Facility,Outpatient,1,EA,,102,86.7,29.2332,102,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,50.796,49.8,,percent of total billed charges,,
HYDROCORTISONE ACETATE 25 MG RECT SUPP,,8626,LOCAL,Facility,Inpatient,1,EA,,102,86.7,29.2332,102,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
HYDROCORTISONE ACETATE 25 MG RECT SUPP,,8626,LOCAL,Facility,Both,1,EA,,102,86.7,29.2332,102,"Multiplan, Inc.","Multiplan, Inc.",95.88,94,,percent of total billed charges,,
HYDROCORTISONE ACETATE 25 MG RECT SUPP,,8626,LOCAL,Facility,Outpatient,1,EA,,102,86.7,29.2332,102,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,91.902,90.1,,percent of total billed charges,,
HYDROCORTISONE ACETATE 25 MG RECT SUPP,,8626,LOCAL,Facility,Inpatient,1,EA,,102,86.7,29.2332,102,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
HYDROCORTISONE ACETATE 25 MG RECT SUPP,,8626,LOCAL,Facility,Both,1,EA,,102,86.7,29.2332,102,"Preferred One Administrative Services, INC.",PPO,100.572,98.6,,percent of total billed charges,,
HYDROCORTISONE ACETATE 25 MG RECT SUPP,,8626,LOCAL,Facility,Outpatient,1,EA,,102,86.7,29.2332,102,PrimeWest Health,Minnesota Senior Health Options (MSHO),52.479,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
HYDROCORTISONE ACETATE 25 MG RECT SUPP,,8626,LOCAL,Facility,Inpatient,1,EA,,102,86.7,29.2332,102,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
HYDROCORTISONE ACETATE 25 MG RECT SUPP,,8626,LOCAL,Facility,Outpatient,1,EA,,102,86.7,29.2332,102,PrimeWest Health,MinnesotaCare,52.3872,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
HYDROCORTISONE ACETATE 25 MG RECT SUPP,,8626,LOCAL,Facility,Inpatient,1,EA,,102,86.7,29.2332,102,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
HYDROCORTISONE ACETATE 25 MG RECT SUPP,,8626,LOCAL,Facility,Both,1,EA,,102,86.7,29.2332,102,Sanford Health Plan,Sanford Health Plan,93.84,92,,percent of total billed charges,,
HYDROCORTISONE ACETATE 25 MG RECT SUPP,,8626,LOCAL,Facility,Outpatient,1,EA,,102,86.7,29.2332,102,"UCare Health, Inc.",Individual & Family Plan,57.477,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
HYDROCORTISONE ACETATE 25 MG RECT SUPP,,8626,LOCAL,Facility,Inpatient,1,EA,,102,86.7,29.2332,102,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
HYDROCORTISONE ACETATE 25 MG RECT SUPP,,8626,LOCAL,Facility,Outpatient,1,EA,,102,86.7,29.2332,102,"UCare Health, Inc.",Medical Assistance,51.4794,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
HYDROCORTISONE ACETATE 25 MG RECT SUPP,,8626,LOCAL,Facility,Inpatient,1,EA,,102,86.7,29.2332,102,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
HYDROCORTISONE ACETATE 25 MG RECT SUPP,,8626,LOCAL,Facility,Outpatient,1,EA,,102,86.7,29.2332,102,"UCare Health, Inc.",Medicare Advantage,51.4794,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
HYDROCORTISONE ACETATE 25 MG RECT SUPP,,8626,LOCAL,Facility,Inpatient,1,EA,,102,86.7,29.2332,102,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
HYDROCORTISONE ACETATE 25 MG RECT SUPP,,8626,LOCAL,Facility,Outpatient,1,EA,,102,86.7,29.2332,102,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),51.4794,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
HYDROCORTISONE ACETATE 25 MG RECT SUPP,,8626,LOCAL,Facility,Inpatient,1,EA,,102,86.7,29.2332,102,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
HYDROCORTISONE ACETATE 25 MG RECT SUPP,,8626,LOCAL,Facility,Both,1,EA,,102,86.7,29.2332,102,UnitedHealthcare,Individual & Family,95.88,94,,percent of total billed charges,,
HYDROCORTISONE ACETATE 25 MG RECT SUPP,,8626,LOCAL,Facility,Outpatient,1,EA,,102,86.7,29.2332,102,UnitedHealthcare,Medicare Advantage,49.98,49,,percent of total billed charges,,
HYDROCORTISONE ACETATE 25 MG RECT SUPP,,8626,LOCAL,Facility,Inpatient,1,EA,,102,86.7,29.2332,102,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
HYDROCORTISONE ACETATE 25 MG RECT SUPP,,8626,LOCAL,Facility,Outpatient,1,EA,,102,86.7,29.2332,102,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,48.96,48,,percent of total billed charges,,100% of DHS outpatient percentage
HYDROCORTISONE ACETATE 25 MG RECT SUPP,,8626,LOCAL,Facility,Inpatient,1,EA,,102,86.7,29.2332,102,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
WARFARIN 3 MG ORAL TABLET,,8693,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
WARFARIN 3 MG ORAL TABLET,,8693,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
WARFARIN 3 MG ORAL TABLET,,8693,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
WARFARIN 3 MG ORAL TABLET,,8693,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
WARFARIN 3 MG ORAL TABLET,,8693,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
WARFARIN 3 MG ORAL TABLET,,8693,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
WARFARIN 3 MG ORAL TABLET,,8693,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
WARFARIN 3 MG ORAL TABLET,,8693,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
WARFARIN 3 MG ORAL TABLET,,8693,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
WARFARIN 3 MG ORAL TABLET,,8693,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
WARFARIN 3 MG ORAL TABLET,,8693,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
WARFARIN 3 MG ORAL TABLET,,8693,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
WARFARIN 3 MG ORAL TABLET,,8693,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
WARFARIN 3 MG ORAL TABLET,,8693,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
WARFARIN 3 MG ORAL TABLET,,8693,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
WARFARIN 3 MG ORAL TABLET,,8693,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
WARFARIN 3 MG ORAL TABLET,,8693,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
WARFARIN 3 MG ORAL TABLET,,8693,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
WARFARIN 3 MG ORAL TABLET,,8693,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
WARFARIN 3 MG ORAL TABLET,,8693,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
WARFARIN 3 MG ORAL TABLET,,8693,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
WARFARIN 3 MG ORAL TABLET,,8693,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
WARFARIN 3 MG ORAL TABLET,,8693,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
WARFARIN 3 MG ORAL TABLET,,8693,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
WARFARIN 3 MG ORAL TABLET,,8693,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
WARFARIN 3 MG ORAL TABLET,,8693,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
WARFARIN 3 MG ORAL TABLET,,8693,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
WARFARIN 3 MG ORAL TABLET,,8693,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
WARFARIN 3 MG ORAL TABLET,,8693,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
WARFARIN 3 MG ORAL TABLET,,8693,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
WARFARIN 3 MG ORAL TABLET,,8693,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
WARFARIN 3 MG ORAL TABLET,,8693,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
WARFARIN 3 MG ORAL TABLET,,8693,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
WARFARIN 3 MG ORAL TABLET,,8693,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
WARFARIN 3 MG ORAL TABLET,,8693,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
WARFARIN 3 MG ORAL TABLET,,8693,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
WARFARIN 3 MG ORAL TABLET,,8693,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
WARFARIN 3 MG ORAL TABLET,,8693,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
WARFARIN 3 MG ORAL TABLET,,8693,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
WARFARIN 3 MG ORAL TABLET,,8693,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
WARFARIN 3 MG ORAL TABLET,,8693,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
WARFARIN 3 MG ORAL TABLET,,8693,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
WARFARIN 3 MG ORAL TABLET,,8693,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
WARFARIN 3 MG ORAL TABLET,,8693,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
WARFARIN 3 MG ORAL TABLET,,8693,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
WARFARIN 3 MG ORAL TABLET,,8693,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
WARFARIN 3 MG ORAL TABLET,,8693,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
WARFARIN 3 MG ORAL TABLET,,8693,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
WARFARIN 3 MG ORAL TABLET,,8693,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
WARFARIN 3 MG ORAL TABLET,,8693,LOCAL,Facility,Both,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
WARFARIN 3 MG ORAL TABLET,,8693,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
WARFARIN 3 MG ORAL TABLET,,8693,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
WARFARIN 3 MG ORAL TABLET,,8693,LOCAL,Facility,Outpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
WARFARIN 3 MG ORAL TABLET,,8693,LOCAL,Facility,Inpatient,1,EA,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
KETOROLAC 10 MG ORAL TABLET,,8700,LOCAL,Facility,Both,1,EA,,11,9.35,3.1526,11,Aetna,Commercial,10.12,92,,percent of total billed charges,,
KETOROLAC 10 MG ORAL TABLET,,8700,LOCAL,Facility,Outpatient,1,EA,,11,9.35,3.1526,11,Aetna,Medicare Advantage,5.39,49,,percent of total billed charges,,
KETOROLAC 10 MG ORAL TABLET,,8700,LOCAL,Facility,Inpatient,1,EA,,11,9.35,3.1526,11,Aetna,Medicare Advantage,,,,,Included in per diem rate,
KETOROLAC 10 MG ORAL TABLET,,8700,LOCAL,Facility,Both,1,EA,,11,9.35,3.1526,11,Aetna,PPO,10.23,93,,percent of total billed charges,,
KETOROLAC 10 MG ORAL TABLET,,8700,LOCAL,Facility,Both,1,EA,,11,9.35,3.1526,11,America's PPO,America's PPO,10.5633,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
KETOROLAC 10 MG ORAL TABLET,,8700,LOCAL,Facility,Both,1,EA,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota, Federal Employee Program,10.824,98.4,,percent of total billed charges,,
KETOROLAC 10 MG ORAL TABLET,,8700,LOCAL,Facility,Both,1,EA,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,11,100,,percent of total billed charges,,
KETOROLAC 10 MG ORAL TABLET,,8700,LOCAL,Facility,Both,1,EA,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,High Value Network Plan,9.9,90,,percent of total billed charges,,
KETOROLAC 10 MG ORAL TABLET,,8700,LOCAL,Facility,Outpatient,1,EA,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,Medicare Advantage,5.39,49,,percent of total billed charges,,
KETOROLAC 10 MG ORAL TABLET,,8700,LOCAL,Facility,Inpatient,1,EA,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
KETOROLAC 10 MG ORAL TABLET,,8700,LOCAL,Facility,Both,1,EA,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,9.7427,88.57,,percent of total billed charges,,
KETOROLAC 10 MG ORAL TABLET,,8700,LOCAL,Facility,Both,1,EA,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,3.1526,28.66,,percent of total billed charges,,
KETOROLAC 10 MG ORAL TABLET,,8700,LOCAL,Facility,Outpatient,1,EA,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),5.39,49,,percent of total billed charges,,
KETOROLAC 10 MG ORAL TABLET,,8700,LOCAL,Facility,Inpatient,1,EA,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
KETOROLAC 10 MG ORAL TABLET,,8700,LOCAL,Facility,Both,1,EA,,11,9.35,3.1526,11,CorVel,Worker's Compensation,11,100,,percent of total billed charges,,
KETOROLAC 10 MG ORAL TABLET,,8700,LOCAL,Facility,Both,1,EA,,11,9.35,3.1526,11,First Health Group Corporation,First Health Network,10.67,97,,percent of total billed charges,,
KETOROLAC 10 MG ORAL TABLET,,8700,LOCAL,Facility,Both,1,EA,,11,9.35,3.1526,11,"Health Partners, Inc.",Commercial,10.406,94.6,,percent of total billed charges,,
KETOROLAC 10 MG ORAL TABLET,,8700,LOCAL,Facility,Outpatient,1,EA,,11,9.35,3.1526,11,"Health Partners, Inc.",Medicare Advantage,5.39,49,,percent of total billed charges,,
KETOROLAC 10 MG ORAL TABLET,,8700,LOCAL,Facility,Inpatient,1,EA,,11,9.35,3.1526,11,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
KETOROLAC 10 MG ORAL TABLET,,8700,LOCAL,Facility,Both,1,EA,,11,9.35,3.1526,11,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),6.6,60,,percent of total billed charges,,
KETOROLAC 10 MG ORAL TABLET,,8700,LOCAL,Facility,Both,1,EA,,11,9.35,3.1526,11,"Health Partners, Inc.",State of Minnesota Advantage Program,8.965,81.5,,percent of total billed charges,,
KETOROLAC 10 MG ORAL TABLET,,8700,LOCAL,Facility,Both,1,EA,,11,9.35,3.1526,11,"Health Partners, Inc.",State Public Programs,5.5,50,,percent of total billed charges,,
KETOROLAC 10 MG ORAL TABLET,,8700,LOCAL,Facility,Both,1,EA,,11,9.35,3.1526,11,Humana Insurance Company,Commercial PPO,10.45,95,,percent of total billed charges,,
KETOROLAC 10 MG ORAL TABLET,,8700,LOCAL,Facility,Outpatient,1,EA,,11,9.35,3.1526,11,Humana Insurance Company,Medicare PPO,5.39,49,,percent of total billed charges,,
KETOROLAC 10 MG ORAL TABLET,,8700,LOCAL,Facility,Inpatient,1,EA,,11,9.35,3.1526,11,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
KETOROLAC 10 MG ORAL TABLET,,8700,LOCAL,Facility,Both,1,EA,,11,9.35,3.1526,11,Medica,Individual & Family,10.901,99.1,,percent of total billed charges,,
KETOROLAC 10 MG ORAL TABLET,,8700,LOCAL,Facility,Outpatient,1,EA,,11,9.35,3.1526,11,Medica,Medica Advantage Solution,5.478,49.8,,percent of total billed charges,,
KETOROLAC 10 MG ORAL TABLET,,8700,LOCAL,Facility,Inpatient,1,EA,,11,9.35,3.1526,11,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
KETOROLAC 10 MG ORAL TABLET,,8700,LOCAL,Facility,Outpatient,1,EA,,11,9.35,3.1526,11,Medica,Medical Assistance,4.906,44.6,,percent of total billed charges,,
KETOROLAC 10 MG ORAL TABLET,,8700,LOCAL,Facility,Inpatient,1,EA,,11,9.35,3.1526,11,Medica,Medical Assistance,,,,,Included in per diem rate,
KETOROLAC 10 MG ORAL TABLET,,8700,LOCAL,Facility,Outpatient,1,EA,,11,9.35,3.1526,11,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,5.478,49.8,,percent of total billed charges,,
KETOROLAC 10 MG ORAL TABLET,,8700,LOCAL,Facility,Inpatient,1,EA,,11,9.35,3.1526,11,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
KETOROLAC 10 MG ORAL TABLET,,8700,LOCAL,Facility,Both,1,EA,,11,9.35,3.1526,11,"Multiplan, Inc.","Multiplan, Inc.",10.34,94,,percent of total billed charges,,
KETOROLAC 10 MG ORAL TABLET,,8700,LOCAL,Facility,Outpatient,1,EA,,11,9.35,3.1526,11,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,9.911,90.1,,percent of total billed charges,,
KETOROLAC 10 MG ORAL TABLET,,8700,LOCAL,Facility,Inpatient,1,EA,,11,9.35,3.1526,11,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
KETOROLAC 10 MG ORAL TABLET,,8700,LOCAL,Facility,Both,1,EA,,11,9.35,3.1526,11,"Preferred One Administrative Services, INC.",PPO,10.846,98.6,,percent of total billed charges,,
KETOROLAC 10 MG ORAL TABLET,,8700,LOCAL,Facility,Outpatient,1,EA,,11,9.35,3.1526,11,PrimeWest Health,Minnesota Senior Health Options (MSHO),5.6595,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
KETOROLAC 10 MG ORAL TABLET,,8700,LOCAL,Facility,Inpatient,1,EA,,11,9.35,3.1526,11,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
KETOROLAC 10 MG ORAL TABLET,,8700,LOCAL,Facility,Outpatient,1,Each,,11,9.35,3.1526,11,PrimeWest Health,MinnesotaCare,5.6496,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
KETOROLAC 10 MG ORAL TABLET,,8700,LOCAL,Facility,Inpatient,1,Each,,11,9.35,3.1526,11,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
KETOROLAC 10 MG ORAL TABLET,,8700,LOCAL,Facility,Both,1,Each,,11,9.35,3.1526,11,Sanford Health Plan,Sanford Health Plan,10.12,92,,percent of total billed charges,,
KETOROLAC 10 MG ORAL TABLET,,8700,LOCAL,Facility,Outpatient,1,Each,,11,9.35,3.1526,11,"UCare Health, Inc.",Individual & Family Plan,6.1985,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
KETOROLAC 10 MG ORAL TABLET,,8700,LOCAL,Facility,Inpatient,1,Each,,11,9.35,3.1526,11,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
KETOROLAC 10 MG ORAL TABLET,,8700,LOCAL,Facility,Outpatient,1,Each,,11,9.35,3.1526,11,"UCare Health, Inc.",Medical Assistance,5.5517,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
KETOROLAC 10 MG ORAL TABLET,,8700,LOCAL,Facility,Inpatient,1,Each,,11,9.35,3.1526,11,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
KETOROLAC 10 MG ORAL TABLET,,8700,LOCAL,Facility,Outpatient,1,Each,,11,9.35,3.1526,11,"UCare Health, Inc.",Medicare Advantage,5.5517,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
KETOROLAC 10 MG ORAL TABLET,,8700,LOCAL,Facility,Inpatient,1,Each,,11,9.35,3.1526,11,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
KETOROLAC 10 MG ORAL TABLET,,8700,LOCAL,Facility,Outpatient,1,Each,,11,9.35,3.1526,11,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),5.5517,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
KETOROLAC 10 MG ORAL TABLET,,8700,LOCAL,Facility,Inpatient,1,Each,,11,9.35,3.1526,11,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
KETOROLAC 10 MG ORAL TABLET,,8700,LOCAL,Facility,Both,1,Each,,11,9.35,3.1526,11,UnitedHealthcare,Individual & Family,10.34,94,,percent of total billed charges,,
KETOROLAC 10 MG ORAL TABLET,,8700,LOCAL,Facility,Outpatient,1,Each,,11,9.35,3.1526,11,UnitedHealthcare,Medicare Advantage,5.39,49,,percent of total billed charges,,
KETOROLAC 10 MG ORAL TABLET,,8700,LOCAL,Facility,Inpatient,1,Each,,11,9.35,3.1526,11,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
KETOROLAC 10 MG ORAL TABLET,,8700,LOCAL,Facility,Outpatient,1,Each,,11,9.35,3.1526,11,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,5.28,48,,percent of total billed charges,,100% of DHS outpatient percentage
KETOROLAC 10 MG ORAL TABLET,,8700,LOCAL,Facility,Inpatient,1,Each,,11,9.35,3.1526,11,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
PANTOPRAZOLE 20 MG ORAL TBEC,,8722,LOCAL,Facility,Both,1,Each,,19,16.15,5.4454,19,Aetna,Commercial,17.48,92,,percent of total billed charges,,
PANTOPRAZOLE 20 MG ORAL TBEC,,8722,LOCAL,Facility,Outpatient,1,Each,,19,16.15,5.4454,19,Aetna,Medicare Advantage,9.31,49,,percent of total billed charges,,
PANTOPRAZOLE 20 MG ORAL TBEC,,8722,LOCAL,Facility,Inpatient,1,Each,,19,16.15,5.4454,19,Aetna,Medicare Advantage,,,,,Included in per diem rate,
PANTOPRAZOLE 20 MG ORAL TBEC,,8722,LOCAL,Facility,Both,1,Each,,19,16.15,5.4454,19,Aetna,PPO,17.67,93,,percent of total billed charges,,
PANTOPRAZOLE 20 MG ORAL TBEC,,8722,LOCAL,Facility,Both,1,Each,,19,16.15,5.4454,19,America's PPO,America's PPO,18.2457,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
PANTOPRAZOLE 20 MG ORAL TBEC,,8722,LOCAL,Facility,Both,1,Each,,19,16.15,5.4454,19,BlueCross BlueShield Minnesota, Federal Employee Program,18.696,98.4,,percent of total billed charges,,
PANTOPRAZOLE 20 MG ORAL TBEC,,8722,LOCAL,Facility,Both,1,Each,,19,16.15,5.4454,19,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,19,100,,percent of total billed charges,,
PANTOPRAZOLE 20 MG ORAL TBEC,,8722,LOCAL,Facility,Both,1,Each,,19,16.15,5.4454,19,BlueCross BlueShield Minnesota,High Value Network Plan,17.1,90,,percent of total billed charges,,
PANTOPRAZOLE 20 MG ORAL TBEC,,8722,LOCAL,Facility,Outpatient,1,Each,,19,16.15,5.4454,19,BlueCross BlueShield Minnesota,Medicare Advantage,9.31,49,,percent of total billed charges,,
PANTOPRAZOLE 20 MG ORAL TBEC,,8722,LOCAL,Facility,Inpatient,1,Each,,19,16.15,5.4454,19,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
PANTOPRAZOLE 20 MG ORAL TBEC,,8722,LOCAL,Facility,Both,1,Each,,19,16.15,5.4454,19,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,16.8283,88.57,,percent of total billed charges,,
PANTOPRAZOLE 20 MG ORAL TBEC,,8722,LOCAL,Facility,Both,1,Each,,19,16.15,5.4454,19,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,5.4454,28.66,,percent of total billed charges,,
PANTOPRAZOLE 20 MG ORAL TBEC,,8722,LOCAL,Facility,Outpatient,1,Each,,19,16.15,5.4454,19,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),9.31,49,,percent of total billed charges,,
PANTOPRAZOLE 20 MG ORAL TBEC,,8722,LOCAL,Facility,Inpatient,1,Each,,19,16.15,5.4454,19,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
PANTOPRAZOLE 20 MG ORAL TBEC,,8722,LOCAL,Facility,Both,1,Each,,19,16.15,5.4454,19,CorVel,Worker's Compensation,19,100,,percent of total billed charges,,
PANTOPRAZOLE 20 MG ORAL TBEC,,8722,LOCAL,Facility,Both,1,Each,,19,16.15,5.4454,19,First Health Group Corporation,First Health Network,18.43,97,,percent of total billed charges,,
PANTOPRAZOLE 20 MG ORAL TBEC,,8722,LOCAL,Facility,Both,1,Each,,19,16.15,5.4454,19,"Health Partners, Inc.",Commercial,17.974,94.6,,percent of total billed charges,,
PANTOPRAZOLE 20 MG ORAL TBEC,,8722,LOCAL,Facility,Outpatient,1,Each,,19,16.15,5.4454,19,"Health Partners, Inc.",Medicare Advantage,9.31,49,,percent of total billed charges,,
PANTOPRAZOLE 20 MG ORAL TBEC,,8722,LOCAL,Facility,Inpatient,1,Each,,19,16.15,5.4454,19,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PANTOPRAZOLE 20 MG ORAL TBEC,,8722,LOCAL,Facility,Both,1,Each,,19,16.15,5.4454,19,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),11.4,60,,percent of total billed charges,,
PANTOPRAZOLE 20 MG ORAL TBEC,,8722,LOCAL,Facility,Both,1,Each,,19,16.15,5.4454,19,"Health Partners, Inc.",State of Minnesota Advantage Program,15.485,81.5,,percent of total billed charges,,
PANTOPRAZOLE 20 MG ORAL TBEC,,8722,LOCAL,Facility,Both,1,Each,,19,16.15,5.4454,19,"Health Partners, Inc.",State Public Programs,9.5,50,,percent of total billed charges,,
PANTOPRAZOLE 20 MG ORAL TBEC,,8722,LOCAL,Facility,Both,1,Each,,19,16.15,5.4454,19,Humana Insurance Company,Commercial PPO,18.05,95,,percent of total billed charges,,
PANTOPRAZOLE 20 MG ORAL TBEC,,8722,LOCAL,Facility,Outpatient,1,Each,,19,16.15,5.4454,19,Humana Insurance Company,Medicare PPO,9.31,49,,percent of total billed charges,,
PANTOPRAZOLE 20 MG ORAL TBEC,,8722,LOCAL,Facility,Inpatient,1,Each,,19,16.15,5.4454,19,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
PANTOPRAZOLE 20 MG ORAL TBEC,,8722,LOCAL,Facility,Both,1,Each,,19,16.15,5.4454,19,Medica,Individual & Family,18.829,99.1,,percent of total billed charges,,
PANTOPRAZOLE 20 MG ORAL TBEC,,8722,LOCAL,Facility,Outpatient,1,Each,,19,16.15,5.4454,19,Medica,Medica Advantage Solution,9.462,49.8,,percent of total billed charges,,
PANTOPRAZOLE 20 MG ORAL TBEC,,8722,LOCAL,Facility,Inpatient,1,Each,,19,16.15,5.4454,19,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
PANTOPRAZOLE 20 MG ORAL TBEC,,8722,LOCAL,Facility,Outpatient,1,Each,,19,16.15,5.4454,19,Medica,Medical Assistance,8.474,44.6,,percent of total billed charges,,
PANTOPRAZOLE 20 MG ORAL TBEC,,8722,LOCAL,Facility,Inpatient,1,Each,,19,16.15,5.4454,19,Medica,Medical Assistance,,,,,Included in per diem rate,
PANTOPRAZOLE 20 MG ORAL TBEC,,8722,LOCAL,Facility,Outpatient,1,Each,,19,16.15,5.4454,19,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,9.462,49.8,,percent of total billed charges,,
PANTOPRAZOLE 20 MG ORAL TBEC,,8722,LOCAL,Facility,Inpatient,1,Each,,19,16.15,5.4454,19,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
PANTOPRAZOLE 20 MG ORAL TBEC,,8722,LOCAL,Facility,Both,1,Each,,19,16.15,5.4454,19,"Multiplan, Inc.","Multiplan, Inc.",17.86,94,,percent of total billed charges,,
PANTOPRAZOLE 20 MG ORAL TBEC,,8722,LOCAL,Facility,Outpatient,1,Each,,19,16.15,5.4454,19,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,17.119,90.1,,percent of total billed charges,,
PANTOPRAZOLE 20 MG ORAL TBEC,,8722,LOCAL,Facility,Inpatient,1,Each,,19,16.15,5.4454,19,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
PANTOPRAZOLE 20 MG ORAL TBEC,,8722,LOCAL,Facility,Both,1,Each,,19,16.15,5.4454,19,"Preferred One Administrative Services, INC.",PPO,18.734,98.6,,percent of total billed charges,,
PANTOPRAZOLE 20 MG ORAL TBEC,,8722,LOCAL,Facility,Outpatient,1,Each,,19,16.15,5.4454,19,PrimeWest Health,Minnesota Senior Health Options (MSHO),9.7755,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
PANTOPRAZOLE 20 MG ORAL TBEC,,8722,LOCAL,Facility,Inpatient,1,Each,,19,16.15,5.4454,19,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PANTOPRAZOLE 20 MG ORAL TBEC,,8722,LOCAL,Facility,Outpatient,1,Each,,19,16.15,5.4454,19,PrimeWest Health,MinnesotaCare,9.7584,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
PANTOPRAZOLE 20 MG ORAL TBEC,,8722,LOCAL,Facility,Inpatient,1,Each,,19,16.15,5.4454,19,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
PANTOPRAZOLE 20 MG ORAL TBEC,,8722,LOCAL,Facility,Both,1,Each,,19,16.15,5.4454,19,Sanford Health Plan,Sanford Health Plan,17.48,92,,percent of total billed charges,,
PANTOPRAZOLE 20 MG ORAL TBEC,,8722,LOCAL,Facility,Outpatient,1,Each,,19,16.15,5.4454,19,"UCare Health, Inc.",Individual & Family Plan,10.7065,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
PANTOPRAZOLE 20 MG ORAL TBEC,,8722,LOCAL,Facility,Inpatient,1,Each,,19,16.15,5.4454,19,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
PANTOPRAZOLE 20 MG ORAL TBEC,,8722,LOCAL,Facility,Outpatient,1,Each,,19,16.15,5.4454,19,"UCare Health, Inc.",Medical Assistance,9.5893,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PANTOPRAZOLE 20 MG ORAL TBEC,,8722,LOCAL,Facility,Inpatient,1,Each,,19,16.15,5.4454,19,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
PANTOPRAZOLE 20 MG ORAL TBEC,,8722,LOCAL,Facility,Outpatient,1,Each,,19,16.15,5.4454,19,"UCare Health, Inc.",Medicare Advantage,9.5893,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PANTOPRAZOLE 20 MG ORAL TBEC,,8722,LOCAL,Facility,Inpatient,1,Each,,19,16.15,5.4454,19,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PANTOPRAZOLE 20 MG ORAL TBEC,,8722,LOCAL,Facility,Outpatient,1,Each,,19,16.15,5.4454,19,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),9.5893,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PANTOPRAZOLE 20 MG ORAL TBEC,,8722,LOCAL,Facility,Inpatient,1,Each,,19,16.15,5.4454,19,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PANTOPRAZOLE 20 MG ORAL TBEC,,8722,LOCAL,Facility,Both,1,Each,,19,16.15,5.4454,19,UnitedHealthcare,Individual & Family,17.86,94,,percent of total billed charges,,
PANTOPRAZOLE 20 MG ORAL TBEC,,8722,LOCAL,Facility,Outpatient,1,Each,,19,16.15,5.4454,19,UnitedHealthcare,Medicare Advantage,9.31,49,,percent of total billed charges,,
PANTOPRAZOLE 20 MG ORAL TBEC,,8722,LOCAL,Facility,Inpatient,1,Each,,19,16.15,5.4454,19,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
PANTOPRAZOLE 20 MG ORAL TBEC,,8722,LOCAL,Facility,Outpatient,1,Each,,19,16.15,5.4454,19,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,9.12,48,,percent of total billed charges,,100% of DHS outpatient percentage
PANTOPRAZOLE 20 MG ORAL TBEC,,8722,LOCAL,Facility,Inpatient,1,Each,,19,16.15,5.4454,19,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
BETHANECHOL CHLORIDE 25 MG ORAL TABLET,,8800,LOCAL,Facility,Both,1,Each,,14,11.9,4.0124,14,Aetna,Commercial,12.88,92,,percent of total billed charges,,
BETHANECHOL CHLORIDE 25 MG ORAL TABLET,,8800,LOCAL,Facility,Outpatient,1,Each,,14,11.9,4.0124,14,Aetna,Medicare Advantage,6.86,49,,percent of total billed charges,,
BETHANECHOL CHLORIDE 25 MG ORAL TABLET,,8800,LOCAL,Facility,Inpatient,1,Each,,14,11.9,4.0124,14,Aetna,Medicare Advantage,,,,,Included in per diem rate,
BETHANECHOL CHLORIDE 25 MG ORAL TABLET,,8800,LOCAL,Facility,Both,1,Each,,14,11.9,4.0124,14,Aetna,PPO,13.02,93,,percent of total billed charges,,
BETHANECHOL CHLORIDE 25 MG ORAL TABLET,,8800,LOCAL,Facility,Both,1,Each,,14,11.9,4.0124,14,America's PPO,America's PPO,13.4442,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
BETHANECHOL CHLORIDE 25 MG ORAL TABLET,,8800,LOCAL,Facility,Both,1,Each,,14,11.9,4.0124,14,BlueCross BlueShield Minnesota, Federal Employee Program,13.776,98.4,,percent of total billed charges,,
BETHANECHOL CHLORIDE 25 MG ORAL TABLET,,8800,LOCAL,Facility,Both,1,Each,,14,11.9,4.0124,14,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,14,100,,percent of total billed charges,,
BETHANECHOL CHLORIDE 25 MG ORAL TABLET,,8800,LOCAL,Facility,Both,1,Each,,14,11.9,4.0124,14,BlueCross BlueShield Minnesota,High Value Network Plan,12.6,90,,percent of total billed charges,,
BETHANECHOL CHLORIDE 25 MG ORAL TABLET,,8800,LOCAL,Facility,Outpatient,1,Each,,14,11.9,4.0124,14,BlueCross BlueShield Minnesota,Medicare Advantage,6.86,49,,percent of total billed charges,,
BETHANECHOL CHLORIDE 25 MG ORAL TABLET,,8800,LOCAL,Facility,Inpatient,1,Each,,14,11.9,4.0124,14,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
BETHANECHOL CHLORIDE 25 MG ORAL TABLET,,8800,LOCAL,Facility,Both,1,Each,,14,11.9,4.0124,14,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,12.3998,88.57,,percent of total billed charges,,
BETHANECHOL CHLORIDE 25 MG ORAL TABLET,,8800,LOCAL,Facility,Both,1,Each,,14,11.9,4.0124,14,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,4.0124,28.66,,percent of total billed charges,,
BETHANECHOL CHLORIDE 25 MG ORAL TABLET,,8800,LOCAL,Facility,Outpatient,1,Each,,14,11.9,4.0124,14,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),6.86,49,,percent of total billed charges,,
BETHANECHOL CHLORIDE 25 MG ORAL TABLET,,8800,LOCAL,Facility,Inpatient,1,Each,,14,11.9,4.0124,14,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
BETHANECHOL CHLORIDE 25 MG ORAL TABLET,,8800,LOCAL,Facility,Both,1,Each,,14,11.9,4.0124,14,CorVel,Worker's Compensation,14,100,,percent of total billed charges,,
BETHANECHOL CHLORIDE 25 MG ORAL TABLET,,8800,LOCAL,Facility,Both,1,Each,,14,11.9,4.0124,14,First Health Group Corporation,First Health Network,13.58,97,,percent of total billed charges,,
BETHANECHOL CHLORIDE 25 MG ORAL TABLET,,8800,LOCAL,Facility,Both,1,Each,,14,11.9,4.0124,14,"Health Partners, Inc.",Commercial,13.244,94.6,,percent of total billed charges,,
BETHANECHOL CHLORIDE 25 MG ORAL TABLET,,8800,LOCAL,Facility,Outpatient,1,Each,,14,11.9,4.0124,14,"Health Partners, Inc.",Medicare Advantage,6.86,49,,percent of total billed charges,,
BETHANECHOL CHLORIDE 25 MG ORAL TABLET,,8800,LOCAL,Facility,Inpatient,1,Each,,14,11.9,4.0124,14,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
BETHANECHOL CHLORIDE 25 MG ORAL TABLET,,8800,LOCAL,Facility,Both,1,Each,,14,11.9,4.0124,14,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),8.4,60,,percent of total billed charges,,
BETHANECHOL CHLORIDE 25 MG ORAL TABLET,,8800,LOCAL,Facility,Both,1,Each,,14,11.9,4.0124,14,"Health Partners, Inc.",State of Minnesota Advantage Program,11.41,81.5,,percent of total billed charges,,
BETHANECHOL CHLORIDE 25 MG ORAL TABLET,,8800,LOCAL,Facility,Both,1,Each,,14,11.9,4.0124,14,"Health Partners, Inc.",State Public Programs,7,50,,percent of total billed charges,,
BETHANECHOL CHLORIDE 25 MG ORAL TABLET,,8800,LOCAL,Facility,Both,1,Each,,14,11.9,4.0124,14,Humana Insurance Company,Commercial PPO,13.3,95,,percent of total billed charges,,
BETHANECHOL CHLORIDE 25 MG ORAL TABLET,,8800,LOCAL,Facility,Outpatient,1,Each,,14,11.9,4.0124,14,Humana Insurance Company,Medicare PPO,6.86,49,,percent of total billed charges,,
BETHANECHOL CHLORIDE 25 MG ORAL TABLET,,8800,LOCAL,Facility,Inpatient,1,Each,,14,11.9,4.0124,14,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
BETHANECHOL CHLORIDE 25 MG ORAL TABLET,,8800,LOCAL,Facility,Both,1,Each,,14,11.9,4.0124,14,Medica,Individual & Family,13.874,99.1,,percent of total billed charges,,
BETHANECHOL CHLORIDE 25 MG ORAL TABLET,,8800,LOCAL,Facility,Outpatient,1,Each,,14,11.9,4.0124,14,Medica,Medica Advantage Solution,6.972,49.8,,percent of total billed charges,,
BETHANECHOL CHLORIDE 25 MG ORAL TABLET,,8800,LOCAL,Facility,Inpatient,1,Each,,14,11.9,4.0124,14,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
BETHANECHOL CHLORIDE 25 MG ORAL TABLET,,8800,LOCAL,Facility,Outpatient,1,Each,,14,11.9,4.0124,14,Medica,Medical Assistance,6.244,44.6,,percent of total billed charges,,
BETHANECHOL CHLORIDE 25 MG ORAL TABLET,,8800,LOCAL,Facility,Inpatient,1,Each,,14,11.9,4.0124,14,Medica,Medical Assistance,,,,,Included in per diem rate,
BETHANECHOL CHLORIDE 25 MG ORAL TABLET,,8800,LOCAL,Facility,Outpatient,1,Each,,14,11.9,4.0124,14,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,6.972,49.8,,percent of total billed charges,,
BETHANECHOL CHLORIDE 25 MG ORAL TABLET,,8800,LOCAL,Facility,Inpatient,1,Each,,14,11.9,4.0124,14,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
BETHANECHOL CHLORIDE 25 MG ORAL TABLET,,8800,LOCAL,Facility,Both,1,Each,,14,11.9,4.0124,14,"Multiplan, Inc.","Multiplan, Inc.",13.16,94,,percent of total billed charges,,
BETHANECHOL CHLORIDE 25 MG ORAL TABLET,,8800,LOCAL,Facility,Outpatient,1,Each,,14,11.9,4.0124,14,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,12.614,90.1,,percent of total billed charges,,
BETHANECHOL CHLORIDE 25 MG ORAL TABLET,,8800,LOCAL,Facility,Inpatient,1,Each,,14,11.9,4.0124,14,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
BETHANECHOL CHLORIDE 25 MG ORAL TABLET,,8800,LOCAL,Facility,Both,1,Each,,14,11.9,4.0124,14,"Preferred One Administrative Services, INC.",PPO,13.804,98.6,,percent of total billed charges,,
BETHANECHOL CHLORIDE 25 MG ORAL TABLET,,8800,LOCAL,Facility,Outpatient,1,Each,,14,11.9,4.0124,14,PrimeWest Health,Minnesota Senior Health Options (MSHO),7.203,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
BETHANECHOL CHLORIDE 25 MG ORAL TABLET,,8800,LOCAL,Facility,Inpatient,1,Each,,14,11.9,4.0124,14,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
BETHANECHOL CHLORIDE 25 MG ORAL TABLET,,8800,LOCAL,Facility,Outpatient,1,Each,,14,11.9,4.0124,14,PrimeWest Health,MinnesotaCare,7.1904,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
BETHANECHOL CHLORIDE 25 MG ORAL TABLET,,8800,LOCAL,Facility,Inpatient,1,Each,,14,11.9,4.0124,14,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
BETHANECHOL CHLORIDE 25 MG ORAL TABLET,,8800,LOCAL,Facility,Both,1,Each,,14,11.9,4.0124,14,Sanford Health Plan,Sanford Health Plan,12.88,92,,percent of total billed charges,,
BETHANECHOL CHLORIDE 25 MG ORAL TABLET,,8800,LOCAL,Facility,Outpatient,1,Each,,14,11.9,4.0124,14,"UCare Health, Inc.",Individual & Family Plan,7.889,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
BETHANECHOL CHLORIDE 25 MG ORAL TABLET,,8800,LOCAL,Facility,Inpatient,1,Each,,14,11.9,4.0124,14,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
BETHANECHOL CHLORIDE 25 MG ORAL TABLET,,8800,LOCAL,Facility,Outpatient,1,Each,,14,11.9,4.0124,14,"UCare Health, Inc.",Medical Assistance,7.0658,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BETHANECHOL CHLORIDE 25 MG ORAL TABLET,,8800,LOCAL,Facility,Inpatient,1,Each,,14,11.9,4.0124,14,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
BETHANECHOL CHLORIDE 25 MG ORAL TABLET,,8800,LOCAL,Facility,Outpatient,1,Each,,14,11.9,4.0124,14,"UCare Health, Inc.",Medicare Advantage,7.0658,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BETHANECHOL CHLORIDE 25 MG ORAL TABLET,,8800,LOCAL,Facility,Inpatient,1,Each,,14,11.9,4.0124,14,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
BETHANECHOL CHLORIDE 25 MG ORAL TABLET,,8800,LOCAL,Facility,Outpatient,1,Each,,14,11.9,4.0124,14,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),7.0658,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BETHANECHOL CHLORIDE 25 MG ORAL TABLET,,8800,LOCAL,Facility,Inpatient,1,Each,,14,11.9,4.0124,14,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
BETHANECHOL CHLORIDE 25 MG ORAL TABLET,,8800,LOCAL,Facility,Both,1,Each,,14,11.9,4.0124,14,UnitedHealthcare,Individual & Family,13.16,94,,percent of total billed charges,,
BETHANECHOL CHLORIDE 25 MG ORAL TABLET,,8800,LOCAL,Facility,Outpatient,1,Each,,14,11.9,4.0124,14,UnitedHealthcare,Medicare Advantage,6.86,49,,percent of total billed charges,,
BETHANECHOL CHLORIDE 25 MG ORAL TABLET,,8800,LOCAL,Facility,Inpatient,1,Each,,14,11.9,4.0124,14,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
BETHANECHOL CHLORIDE 25 MG ORAL TABLET,,8800,LOCAL,Facility,Outpatient,1,Each,,14,11.9,4.0124,14,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,6.72,48,,percent of total billed charges,,100% of DHS outpatient percentage
BETHANECHOL CHLORIDE 25 MG ORAL TABLET,,8800,LOCAL,Facility,Inpatient,1,Each,,14,11.9,4.0124,14,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
NORTRIPTYLINE 25 MG ORAL CAP,,9064,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
NORTRIPTYLINE 25 MG ORAL CAP,,9064,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
NORTRIPTYLINE 25 MG ORAL CAP,,9064,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
NORTRIPTYLINE 25 MG ORAL CAP,,9064,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
NORTRIPTYLINE 25 MG ORAL CAP,,9064,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
NORTRIPTYLINE 25 MG ORAL CAP,,9064,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
NORTRIPTYLINE 25 MG ORAL CAP,,9064,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
NORTRIPTYLINE 25 MG ORAL CAP,,9064,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
NORTRIPTYLINE 25 MG ORAL CAP,,9064,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
NORTRIPTYLINE 25 MG ORAL CAP,,9064,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
NORTRIPTYLINE 25 MG ORAL CAP,,9064,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
NORTRIPTYLINE 25 MG ORAL CAP,,9064,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
NORTRIPTYLINE 25 MG ORAL CAP,,9064,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
NORTRIPTYLINE 25 MG ORAL CAP,,9064,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
NORTRIPTYLINE 25 MG ORAL CAP,,9064,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
NORTRIPTYLINE 25 MG ORAL CAP,,9064,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
NORTRIPTYLINE 25 MG ORAL CAP,,9064,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
NORTRIPTYLINE 25 MG ORAL CAP,,9064,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
NORTRIPTYLINE 25 MG ORAL CAP,,9064,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
NORTRIPTYLINE 25 MG ORAL CAP,,9064,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
NORTRIPTYLINE 25 MG ORAL CAP,,9064,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
NORTRIPTYLINE 25 MG ORAL CAP,,9064,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
NORTRIPTYLINE 25 MG ORAL CAP,,9064,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
NORTRIPTYLINE 25 MG ORAL CAP,,9064,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
NORTRIPTYLINE 25 MG ORAL CAP,,9064,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
NORTRIPTYLINE 25 MG ORAL CAP,,9064,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
NORTRIPTYLINE 25 MG ORAL CAP,,9064,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
NORTRIPTYLINE 25 MG ORAL CAP,,9064,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
NORTRIPTYLINE 25 MG ORAL CAP,,9064,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
NORTRIPTYLINE 25 MG ORAL CAP,,9064,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
NORTRIPTYLINE 25 MG ORAL CAP,,9064,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
NORTRIPTYLINE 25 MG ORAL CAP,,9064,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
NORTRIPTYLINE 25 MG ORAL CAP,,9064,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
NORTRIPTYLINE 25 MG ORAL CAP,,9064,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
NORTRIPTYLINE 25 MG ORAL CAP,,9064,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
NORTRIPTYLINE 25 MG ORAL CAP,,9064,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
NORTRIPTYLINE 25 MG ORAL CAP,,9064,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
NORTRIPTYLINE 25 MG ORAL CAP,,9064,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
NORTRIPTYLINE 25 MG ORAL CAP,,9064,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
NORTRIPTYLINE 25 MG ORAL CAP,,9064,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
NORTRIPTYLINE 25 MG ORAL CAP,,9064,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
NORTRIPTYLINE 25 MG ORAL CAP,,9064,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
NORTRIPTYLINE 25 MG ORAL CAP,,9064,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
NORTRIPTYLINE 25 MG ORAL CAP,,9064,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
NORTRIPTYLINE 25 MG ORAL CAP,,9064,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
NORTRIPTYLINE 25 MG ORAL CAP,,9064,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
NORTRIPTYLINE 25 MG ORAL CAP,,9064,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
NORTRIPTYLINE 25 MG ORAL CAP,,9064,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
NORTRIPTYLINE 25 MG ORAL CAP,,9064,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
NORTRIPTYLINE 25 MG ORAL CAP,,9064,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
NORTRIPTYLINE 25 MG ORAL CAP,,9064,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
NORTRIPTYLINE 25 MG ORAL CAP,,9064,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
NORTRIPTYLINE 25 MG ORAL CAP,,9064,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
NORTRIPTYLINE 25 MG ORAL CAP,,9064,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
CEFADROXIL 500 MG ORAL CAP,,9112,LOCAL,Facility,Both,1,Each,,19,16.15,5.4454,19,Aetna,Commercial,17.48,92,,percent of total billed charges,,
CEFADROXIL 500 MG ORAL CAP,,9112,LOCAL,Facility,Outpatient,1,Each,,19,16.15,5.4454,19,Aetna,Medicare Advantage,9.31,49,,percent of total billed charges,,
CEFADROXIL 500 MG ORAL CAP,,9112,LOCAL,Facility,Inpatient,1,Each,,19,16.15,5.4454,19,Aetna,Medicare Advantage,,,,,Included in per diem rate,
CEFADROXIL 500 MG ORAL CAP,,9112,LOCAL,Facility,Both,1,Each,,19,16.15,5.4454,19,Aetna,PPO,17.67,93,,percent of total billed charges,,
CEFADROXIL 500 MG ORAL CAP,,9112,LOCAL,Facility,Both,1,Each,,19,16.15,5.4454,19,America's PPO,America's PPO,18.2457,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
CEFADROXIL 500 MG ORAL CAP,,9112,LOCAL,Facility,Both,1,Each,,19,16.15,5.4454,19,BlueCross BlueShield Minnesota, Federal Employee Program,18.696,98.4,,percent of total billed charges,,
CEFADROXIL 500 MG ORAL CAP,,9112,LOCAL,Facility,Both,1,Each,,19,16.15,5.4454,19,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,19,100,,percent of total billed charges,,
CEFADROXIL 500 MG ORAL CAP,,9112,LOCAL,Facility,Both,1,Each,,19,16.15,5.4454,19,BlueCross BlueShield Minnesota,High Value Network Plan,17.1,90,,percent of total billed charges,,
CEFADROXIL 500 MG ORAL CAP,,9112,LOCAL,Facility,Outpatient,1,Each,,19,16.15,5.4454,19,BlueCross BlueShield Minnesota,Medicare Advantage,9.31,49,,percent of total billed charges,,
CEFADROXIL 500 MG ORAL CAP,,9112,LOCAL,Facility,Inpatient,1,Each,,19,16.15,5.4454,19,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
CEFADROXIL 500 MG ORAL CAP,,9112,LOCAL,Facility,Both,1,Each,,19,16.15,5.4454,19,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,16.8283,88.57,,percent of total billed charges,,
CEFADROXIL 500 MG ORAL CAP,,9112,LOCAL,Facility,Both,1,Each,,19,16.15,5.4454,19,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,5.4454,28.66,,percent of total billed charges,,
CEFADROXIL 500 MG ORAL CAP,,9112,LOCAL,Facility,Outpatient,1,Each,,19,16.15,5.4454,19,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),9.31,49,,percent of total billed charges,,
CEFADROXIL 500 MG ORAL CAP,,9112,LOCAL,Facility,Inpatient,1,Each,,19,16.15,5.4454,19,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
CEFADROXIL 500 MG ORAL CAP,,9112,LOCAL,Facility,Both,1,Each,,19,16.15,5.4454,19,CorVel,Worker's Compensation,19,100,,percent of total billed charges,,
CEFADROXIL 500 MG ORAL CAP,,9112,LOCAL,Facility,Both,1,Each,,19,16.15,5.4454,19,First Health Group Corporation,First Health Network,18.43,97,,percent of total billed charges,,
CEFADROXIL 500 MG ORAL CAP,,9112,LOCAL,Facility,Both,1,Each,,19,16.15,5.4454,19,"Health Partners, Inc.",Commercial,17.974,94.6,,percent of total billed charges,,
CEFADROXIL 500 MG ORAL CAP,,9112,LOCAL,Facility,Outpatient,1,Each,,19,16.15,5.4454,19,"Health Partners, Inc.",Medicare Advantage,9.31,49,,percent of total billed charges,,
CEFADROXIL 500 MG ORAL CAP,,9112,LOCAL,Facility,Inpatient,1,Each,,19,16.15,5.4454,19,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CEFADROXIL 500 MG ORAL CAP,,9112,LOCAL,Facility,Both,1,Each,,19,16.15,5.4454,19,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),11.4,60,,percent of total billed charges,,
CEFADROXIL 500 MG ORAL CAP,,9112,LOCAL,Facility,Both,1,Each,,19,16.15,5.4454,19,"Health Partners, Inc.",State of Minnesota Advantage Program,15.485,81.5,,percent of total billed charges,,
CEFADROXIL 500 MG ORAL CAP,,9112,LOCAL,Facility,Both,1,Each,,19,16.15,5.4454,19,"Health Partners, Inc.",State Public Programs,9.5,50,,percent of total billed charges,,
CEFADROXIL 500 MG ORAL CAP,,9112,LOCAL,Facility,Both,1,Each,,19,16.15,5.4454,19,Humana Insurance Company,Commercial PPO,18.05,95,,percent of total billed charges,,
CEFADROXIL 500 MG ORAL CAP,,9112,LOCAL,Facility,Outpatient,1,Each,,19,16.15,5.4454,19,Humana Insurance Company,Medicare PPO,9.31,49,,percent of total billed charges,,
CEFADROXIL 500 MG ORAL CAP,,9112,LOCAL,Facility,Inpatient,1,Each,,19,16.15,5.4454,19,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
CEFADROXIL 500 MG ORAL CAP,,9112,LOCAL,Facility,Both,1,Each,,19,16.15,5.4454,19,Medica,Individual & Family,18.829,99.1,,percent of total billed charges,,
CEFADROXIL 500 MG ORAL CAP,,9112,LOCAL,Facility,Outpatient,1,Each,,19,16.15,5.4454,19,Medica,Medica Advantage Solution,9.462,49.8,,percent of total billed charges,,
CEFADROXIL 500 MG ORAL CAP,,9112,LOCAL,Facility,Inpatient,1,Each,,19,16.15,5.4454,19,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
CEFADROXIL 500 MG ORAL CAP,,9112,LOCAL,Facility,Outpatient,1,Each,,19,16.15,5.4454,19,Medica,Medical Assistance,8.474,44.6,,percent of total billed charges,,
CEFADROXIL 500 MG ORAL CAP,,9112,LOCAL,Facility,Inpatient,1,Each,,19,16.15,5.4454,19,Medica,Medical Assistance,,,,,Included in per diem rate,
CEFADROXIL 500 MG ORAL CAP,,9112,LOCAL,Facility,Outpatient,1,Each,,19,16.15,5.4454,19,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,9.462,49.8,,percent of total billed charges,,
CEFADROXIL 500 MG ORAL CAP,,9112,LOCAL,Facility,Inpatient,1,Each,,19,16.15,5.4454,19,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
CEFADROXIL 500 MG ORAL CAP,,9112,LOCAL,Facility,Both,1,Each,,19,16.15,5.4454,19,"Multiplan, Inc.","Multiplan, Inc.",17.86,94,,percent of total billed charges,,
CEFADROXIL 500 MG ORAL CAP,,9112,LOCAL,Facility,Outpatient,1,Each,,19,16.15,5.4454,19,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,17.119,90.1,,percent of total billed charges,,
CEFADROXIL 500 MG ORAL CAP,,9112,LOCAL,Facility,Inpatient,1,Each,,19,16.15,5.4454,19,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
CEFADROXIL 500 MG ORAL CAP,,9112,LOCAL,Facility,Both,1,Each,,19,16.15,5.4454,19,"Preferred One Administrative Services, INC.",PPO,18.734,98.6,,percent of total billed charges,,
CEFADROXIL 500 MG ORAL CAP,,9112,LOCAL,Facility,Outpatient,1,Each,,19,16.15,5.4454,19,PrimeWest Health,Minnesota Senior Health Options (MSHO),9.7755,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
CEFADROXIL 500 MG ORAL CAP,,9112,LOCAL,Facility,Inpatient,1,Each,,19,16.15,5.4454,19,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CEFADROXIL 500 MG ORAL CAP,,9112,LOCAL,Facility,Outpatient,1,Each,,19,16.15,5.4454,19,PrimeWest Health,MinnesotaCare,9.7584,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
CEFADROXIL 500 MG ORAL CAP,,9112,LOCAL,Facility,Inpatient,1,Each,,19,16.15,5.4454,19,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
CEFADROXIL 500 MG ORAL CAP,,9112,LOCAL,Facility,Both,1,Each,,19,16.15,5.4454,19,Sanford Health Plan,Sanford Health Plan,17.48,92,,percent of total billed charges,,
CEFADROXIL 500 MG ORAL CAP,,9112,LOCAL,Facility,Outpatient,1,Each,,19,16.15,5.4454,19,"UCare Health, Inc.",Individual & Family Plan,10.7065,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
CEFADROXIL 500 MG ORAL CAP,,9112,LOCAL,Facility,Inpatient,1,Each,,19,16.15,5.4454,19,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
CEFADROXIL 500 MG ORAL CAP,,9112,LOCAL,Facility,Outpatient,1,Each,,19,16.15,5.4454,19,"UCare Health, Inc.",Medical Assistance,9.5893,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CEFADROXIL 500 MG ORAL CAP,,9112,LOCAL,Facility,Inpatient,1,Each,,19,16.15,5.4454,19,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
CEFADROXIL 500 MG ORAL CAP,,9112,LOCAL,Facility,Outpatient,1,Each,,19,16.15,5.4454,19,"UCare Health, Inc.",Medicare Advantage,9.5893,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CEFADROXIL 500 MG ORAL CAP,,9112,LOCAL,Facility,Inpatient,1,Each,,19,16.15,5.4454,19,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CEFADROXIL 500 MG ORAL CAP,,9112,LOCAL,Facility,Outpatient,1,Each,,19,16.15,5.4454,19,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),9.5893,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CEFADROXIL 500 MG ORAL CAP,,9112,LOCAL,Facility,Inpatient,1,Each,,19,16.15,5.4454,19,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CEFADROXIL 500 MG ORAL CAP,,9112,LOCAL,Facility,Both,1,Each,,19,16.15,5.4454,19,UnitedHealthcare,Individual & Family,17.86,94,,percent of total billed charges,,
CEFADROXIL 500 MG ORAL CAP,,9112,LOCAL,Facility,Outpatient,1,Each,,19,16.15,5.4454,19,UnitedHealthcare,Medicare Advantage,9.31,49,,percent of total billed charges,,
CEFADROXIL 500 MG ORAL CAP,,9112,LOCAL,Facility,Inpatient,1,Each,,19,16.15,5.4454,19,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
CEFADROXIL 500 MG ORAL CAP,,9112,LOCAL,Facility,Outpatient,1,Each,,19,16.15,5.4454,19,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,9.12,48,,percent of total billed charges,,100% of DHS outpatient percentage
CEFADROXIL 500 MG ORAL CAP,,9112,LOCAL,Facility,Inpatient,1,Each,,19,16.15,5.4454,19,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
LEVOTHYROXINE 100 MCG ORAL TABLET,,9230,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
LEVOTHYROXINE 100 MCG ORAL TABLET,,9230,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
LEVOTHYROXINE 100 MCG ORAL TABLET,,9230,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
LEVOTHYROXINE 100 MCG ORAL TABLET,,9230,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
LEVOTHYROXINE 100 MCG ORAL TABLET,,9230,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
LEVOTHYROXINE 100 MCG ORAL TABLET,,9230,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
LEVOTHYROXINE 100 MCG ORAL TABLET,,9230,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
LEVOTHYROXINE 100 MCG ORAL TABLET,,9230,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
LEVOTHYROXINE 100 MCG ORAL TABLET,,9230,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
LEVOTHYROXINE 100 MCG ORAL TABLET,,9230,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
LEVOTHYROXINE 100 MCG ORAL TABLET,,9230,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
LEVOTHYROXINE 100 MCG ORAL TABLET,,9230,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
LEVOTHYROXINE 100 MCG ORAL TABLET,,9230,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
LEVOTHYROXINE 100 MCG ORAL TABLET,,9230,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
LEVOTHYROXINE 100 MCG ORAL TABLET,,9230,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
LEVOTHYROXINE 100 MCG ORAL TABLET,,9230,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
LEVOTHYROXINE 100 MCG ORAL TABLET,,9230,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
LEVOTHYROXINE 100 MCG ORAL TABLET,,9230,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
LEVOTHYROXINE 100 MCG ORAL TABLET,,9230,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LEVOTHYROXINE 100 MCG ORAL TABLET,,9230,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
LEVOTHYROXINE 100 MCG ORAL TABLET,,9230,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
LEVOTHYROXINE 100 MCG ORAL TABLET,,9230,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
LEVOTHYROXINE 100 MCG ORAL TABLET,,9230,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
LEVOTHYROXINE 100 MCG ORAL TABLET,,9230,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
LEVOTHYROXINE 100 MCG ORAL TABLET,,9230,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
LEVOTHYROXINE 100 MCG ORAL TABLET,,9230,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
LEVOTHYROXINE 100 MCG ORAL TABLET,,9230,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
LEVOTHYROXINE 100 MCG ORAL TABLET,,9230,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
LEVOTHYROXINE 100 MCG ORAL TABLET,,9230,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
LEVOTHYROXINE 100 MCG ORAL TABLET,,9230,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
LEVOTHYROXINE 100 MCG ORAL TABLET,,9230,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
LEVOTHYROXINE 100 MCG ORAL TABLET,,9230,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
LEVOTHYROXINE 100 MCG ORAL TABLET,,9230,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
LEVOTHYROXINE 100 MCG ORAL TABLET,,9230,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
LEVOTHYROXINE 100 MCG ORAL TABLET,,9230,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
LEVOTHYROXINE 100 MCG ORAL TABLET,,9230,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
LEVOTHYROXINE 100 MCG ORAL TABLET,,9230,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
LEVOTHYROXINE 100 MCG ORAL TABLET,,9230,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LEVOTHYROXINE 100 MCG ORAL TABLET,,9230,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
LEVOTHYROXINE 100 MCG ORAL TABLET,,9230,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
LEVOTHYROXINE 100 MCG ORAL TABLET,,9230,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
LEVOTHYROXINE 100 MCG ORAL TABLET,,9230,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
LEVOTHYROXINE 100 MCG ORAL TABLET,,9230,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
LEVOTHYROXINE 100 MCG ORAL TABLET,,9230,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LEVOTHYROXINE 100 MCG ORAL TABLET,,9230,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
LEVOTHYROXINE 100 MCG ORAL TABLET,,9230,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LEVOTHYROXINE 100 MCG ORAL TABLET,,9230,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LEVOTHYROXINE 100 MCG ORAL TABLET,,9230,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LEVOTHYROXINE 100 MCG ORAL TABLET,,9230,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LEVOTHYROXINE 100 MCG ORAL TABLET,,9230,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
LEVOTHYROXINE 100 MCG ORAL TABLET,,9230,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
LEVOTHYROXINE 100 MCG ORAL TABLET,,9230,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
LEVOTHYROXINE 100 MCG ORAL TABLET,,9230,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
LEVOTHYROXINE 100 MCG ORAL TABLET,,9230,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
CARBAMAZEPINE 200 MG ORAL TABLET,,9349,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,Aetna,Commercial,5.52,92,,percent of total billed charges,,
CARBAMAZEPINE 200 MG ORAL TABLET,,9349,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,Aetna,Medicare Advantage,2.94,49,,percent of total billed charges,,
CARBAMAZEPINE 200 MG ORAL TABLET,,9349,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,Aetna,Medicare Advantage,,,,,Included in per diem rate,
CARBAMAZEPINE 200 MG ORAL TABLET,,9349,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,Aetna,PPO,5.58,93,,percent of total billed charges,,
CARBAMAZEPINE 200 MG ORAL TABLET,,9349,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,America's PPO,America's PPO,5.7618,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
CARBAMAZEPINE 200 MG ORAL TABLET,,9349,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota, Federal Employee Program,5.904,98.4,,percent of total billed charges,,
CARBAMAZEPINE 200 MG ORAL TABLET,,9349,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,6,100,,percent of total billed charges,,
CARBAMAZEPINE 200 MG ORAL TABLET,,9349,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota,High Value Network Plan,5.4,90,,percent of total billed charges,,
CARBAMAZEPINE 200 MG ORAL TABLET,,9349,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota,Medicare Advantage,2.94,49,,percent of total billed charges,,
CARBAMAZEPINE 200 MG ORAL TABLET,,9349,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
CARBAMAZEPINE 200 MG ORAL TABLET,,9349,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,5.3142,88.57,,percent of total billed charges,,
CARBAMAZEPINE 200 MG ORAL TABLET,,9349,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.7196,28.66,,percent of total billed charges,,
CARBAMAZEPINE 200 MG ORAL TABLET,,9349,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.94,49,,percent of total billed charges,,
CARBAMAZEPINE 200 MG ORAL TABLET,,9349,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
CARBAMAZEPINE 200 MG ORAL TABLET,,9349,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,CorVel,Worker's Compensation,6,100,,percent of total billed charges,,
CARBAMAZEPINE 200 MG ORAL TABLET,,9349,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,First Health Group Corporation,First Health Network,5.82,97,,percent of total billed charges,,
CARBAMAZEPINE 200 MG ORAL TABLET,,9349,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,"Health Partners, Inc.",Commercial,5.676,94.6,,percent of total billed charges,,
CARBAMAZEPINE 200 MG ORAL TABLET,,9349,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,"Health Partners, Inc.",Medicare Advantage,2.94,49,,percent of total billed charges,,
CARBAMAZEPINE 200 MG ORAL TABLET,,9349,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CARBAMAZEPINE 200 MG ORAL TABLET,,9349,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3.6,60,,percent of total billed charges,,
CARBAMAZEPINE 200 MG ORAL TABLET,,9349,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,"Health Partners, Inc.",State of Minnesota Advantage Program,4.89,81.5,,percent of total billed charges,,
CARBAMAZEPINE 200 MG ORAL TABLET,,9349,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,"Health Partners, Inc.",State Public Programs,3,50,,percent of total billed charges,,
CARBAMAZEPINE 200 MG ORAL TABLET,,9349,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,Humana Insurance Company,Commercial PPO,5.7,95,,percent of total billed charges,,
CARBAMAZEPINE 200 MG ORAL TABLET,,9349,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,Humana Insurance Company,Medicare PPO,2.94,49,,percent of total billed charges,,
CARBAMAZEPINE 200 MG ORAL TABLET,,9349,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
CARBAMAZEPINE 200 MG ORAL TABLET,,9349,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,Medica,Individual & Family,5.946,99.1,,percent of total billed charges,,
CARBAMAZEPINE 200 MG ORAL TABLET,,9349,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,Medica,Medica Advantage Solution,2.988,49.8,,percent of total billed charges,,
CARBAMAZEPINE 200 MG ORAL TABLET,,9349,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
CARBAMAZEPINE 200 MG ORAL TABLET,,9349,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,Medica,Medical Assistance,2.676,44.6,,percent of total billed charges,,
CARBAMAZEPINE 200 MG ORAL TABLET,,9349,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,Medica,Medical Assistance,,,,,Included in per diem rate,
CARBAMAZEPINE 200 MG ORAL TABLET,,9349,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.988,49.8,,percent of total billed charges,,
CARBAMAZEPINE 200 MG ORAL TABLET,,9349,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
CARBAMAZEPINE 200 MG ORAL TABLET,,9349,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,"Multiplan, Inc.","Multiplan, Inc.",5.64,94,,percent of total billed charges,,
CARBAMAZEPINE 200 MG ORAL TABLET,,9349,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,5.406,90.1,,percent of total billed charges,,
CARBAMAZEPINE 200 MG ORAL TABLET,,9349,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
CARBAMAZEPINE 200 MG ORAL TABLET,,9349,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,"Preferred One Administrative Services, INC.",PPO,5.916,98.6,,percent of total billed charges,,
CARBAMAZEPINE 200 MG ORAL TABLET,,9349,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,PrimeWest Health,Minnesota Senior Health Options (MSHO),3.087,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
CARBAMAZEPINE 200 MG ORAL TABLET,,9349,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CARBAMAZEPINE 200 MG ORAL TABLET,,9349,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,PrimeWest Health,MinnesotaCare,3.0816,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
CARBAMAZEPINE 200 MG ORAL TABLET,,9349,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
CARBAMAZEPINE 200 MG ORAL TABLET,,9349,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,Sanford Health Plan,Sanford Health Plan,5.52,92,,percent of total billed charges,,
CARBAMAZEPINE 200 MG ORAL TABLET,,9349,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,"UCare Health, Inc.",Individual & Family Plan,3.381,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
CARBAMAZEPINE 200 MG ORAL TABLET,,9349,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
CARBAMAZEPINE 200 MG ORAL TABLET,,9349,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,"UCare Health, Inc.",Medical Assistance,3.0282,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CARBAMAZEPINE 200 MG ORAL TABLET,,9349,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
CARBAMAZEPINE 200 MG ORAL TABLET,,9349,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,"UCare Health, Inc.",Medicare Advantage,3.0282,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CARBAMAZEPINE 200 MG ORAL TABLET,,9349,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CARBAMAZEPINE 200 MG ORAL TABLET,,9349,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),3.0282,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CARBAMAZEPINE 200 MG ORAL TABLET,,9349,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CARBAMAZEPINE 200 MG ORAL TABLET,,9349,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,UnitedHealthcare,Individual & Family,5.64,94,,percent of total billed charges,,
CARBAMAZEPINE 200 MG ORAL TABLET,,9349,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,UnitedHealthcare,Medicare Advantage,2.94,49,,percent of total billed charges,,
CARBAMAZEPINE 200 MG ORAL TABLET,,9349,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
CARBAMAZEPINE 200 MG ORAL TABLET,,9349,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.88,48,,percent of total billed charges,,100% of DHS outpatient percentage
CARBAMAZEPINE 200 MG ORAL TABLET,,9349,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
OXYCODONE-ACETAMINOPHEN 5-325 MG ORAL TABLET,,9469,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,Aetna,Commercial,6.44,92,,percent of total billed charges,,
OXYCODONE-ACETAMINOPHEN 5-325 MG ORAL TABLET,,9469,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,Aetna,Medicare Advantage,3.43,49,,percent of total billed charges,,
OXYCODONE-ACETAMINOPHEN 5-325 MG ORAL TABLET,,9469,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,Aetna,Medicare Advantage,,,,,Included in per diem rate,
OXYCODONE-ACETAMINOPHEN 5-325 MG ORAL TABLET,,9469,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,Aetna,PPO,6.51,93,,percent of total billed charges,,
OXYCODONE-ACETAMINOPHEN 5-325 MG ORAL TABLET,,9469,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,America's PPO,America's PPO,6.7221,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
OXYCODONE-ACETAMINOPHEN 5-325 MG ORAL TABLET,,9469,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,BlueCross BlueShield Minnesota, Federal Employee Program,6.888,98.4,,percent of total billed charges,,
OXYCODONE-ACETAMINOPHEN 5-325 MG ORAL TABLET,,9469,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,7,100,,percent of total billed charges,,
OXYCODONE-ACETAMINOPHEN 5-325 MG ORAL TABLET,,9469,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,BlueCross BlueShield Minnesota,High Value Network Plan,6.3,90,,percent of total billed charges,,
OXYCODONE-ACETAMINOPHEN 5-325 MG ORAL TABLET,,9469,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,BlueCross BlueShield Minnesota,Medicare Advantage,3.43,49,,percent of total billed charges,,
OXYCODONE-ACETAMINOPHEN 5-325 MG ORAL TABLET,,9469,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
OXYCODONE-ACETAMINOPHEN 5-325 MG ORAL TABLET,,9469,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,6.1999,88.57,,percent of total billed charges,,
OXYCODONE-ACETAMINOPHEN 5-325 MG ORAL TABLET,,9469,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,2.0062,28.66,,percent of total billed charges,,
OXYCODONE-ACETAMINOPHEN 5-325 MG ORAL TABLET,,9469,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),3.43,49,,percent of total billed charges,,
OXYCODONE-ACETAMINOPHEN 5-325 MG ORAL TABLET,,9469,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
OXYCODONE-ACETAMINOPHEN 5-325 MG ORAL TABLET,,9469,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,CorVel,Worker's Compensation,7,100,,percent of total billed charges,,
OXYCODONE-ACETAMINOPHEN 5-325 MG ORAL TABLET,,9469,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,First Health Group Corporation,First Health Network,6.79,97,,percent of total billed charges,,
OXYCODONE-ACETAMINOPHEN 5-325 MG ORAL TABLET,,9469,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,"Health Partners, Inc.",Commercial,6.622,94.6,,percent of total billed charges,,
OXYCODONE-ACETAMINOPHEN 5-325 MG ORAL TABLET,,9469,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,"Health Partners, Inc.",Medicare Advantage,3.43,49,,percent of total billed charges,,
OXYCODONE-ACETAMINOPHEN 5-325 MG ORAL TABLET,,9469,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
OXYCODONE-ACETAMINOPHEN 5-325 MG ORAL TABLET,,9469,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),4.2,60,,percent of total billed charges,,
OXYCODONE-ACETAMINOPHEN 5-325 MG ORAL TABLET,,9469,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,"Health Partners, Inc.",State of Minnesota Advantage Program,5.705,81.5,,percent of total billed charges,,
OXYCODONE-ACETAMINOPHEN 5-325 MG ORAL TABLET,,9469,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,"Health Partners, Inc.",State Public Programs,3.5,50,,percent of total billed charges,,
OXYCODONE-ACETAMINOPHEN 5-325 MG ORAL TABLET,,9469,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,Humana Insurance Company,Commercial PPO,6.65,95,,percent of total billed charges,,
OXYCODONE-ACETAMINOPHEN 5-325 MG ORAL TABLET,,9469,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,Humana Insurance Company,Medicare PPO,3.43,49,,percent of total billed charges,,
OXYCODONE-ACETAMINOPHEN 5-325 MG ORAL TABLET,,9469,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
OXYCODONE-ACETAMINOPHEN 5-325 MG ORAL TABLET,,9469,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,Medica,Individual & Family,6.937,99.1,,percent of total billed charges,,
OXYCODONE-ACETAMINOPHEN 5-325 MG ORAL TABLET,,9469,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,Medica,Medica Advantage Solution,3.486,49.8,,percent of total billed charges,,
OXYCODONE-ACETAMINOPHEN 5-325 MG ORAL TABLET,,9469,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
OXYCODONE-ACETAMINOPHEN 5-325 MG ORAL TABLET,,9469,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,Medica,Medical Assistance,3.122,44.6,,percent of total billed charges,,
OXYCODONE-ACETAMINOPHEN 5-325 MG ORAL TABLET,,9469,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,Medica,Medical Assistance,,,,,Included in per diem rate,
OXYCODONE-ACETAMINOPHEN 5-325 MG ORAL TABLET,,9469,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,3.486,49.8,,percent of total billed charges,,
OXYCODONE-ACETAMINOPHEN 5-325 MG ORAL TABLET,,9469,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
OXYCODONE-ACETAMINOPHEN 5-325 MG ORAL TABLET,,9469,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,"Multiplan, Inc.","Multiplan, Inc.",6.58,94,,percent of total billed charges,,
OXYCODONE-ACETAMINOPHEN 5-325 MG ORAL TABLET,,9469,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,6.307,90.1,,percent of total billed charges,,
OXYCODONE-ACETAMINOPHEN 5-325 MG ORAL TABLET,,9469,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
OXYCODONE-ACETAMINOPHEN 5-325 MG ORAL TABLET,,9469,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,"Preferred One Administrative Services, INC.",PPO,6.902,98.6,,percent of total billed charges,,
OXYCODONE-ACETAMINOPHEN 5-325 MG ORAL TABLET,,9469,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,PrimeWest Health,Minnesota Senior Health Options (MSHO),3.6015,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
OXYCODONE-ACETAMINOPHEN 5-325 MG ORAL TABLET,,9469,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
OXYCODONE-ACETAMINOPHEN 5-325 MG ORAL TABLET,,9469,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,PrimeWest Health,MinnesotaCare,3.5952,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
OXYCODONE-ACETAMINOPHEN 5-325 MG ORAL TABLET,,9469,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
OXYCODONE-ACETAMINOPHEN 5-325 MG ORAL TABLET,,9469,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,Sanford Health Plan,Sanford Health Plan,6.44,92,,percent of total billed charges,,
OXYCODONE-ACETAMINOPHEN 5-325 MG ORAL TABLET,,9469,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,"UCare Health, Inc.",Individual & Family Plan,3.9445,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
OXYCODONE-ACETAMINOPHEN 5-325 MG ORAL TABLET,,9469,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
OXYCODONE-ACETAMINOPHEN 5-325 MG ORAL TABLET,,9469,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,"UCare Health, Inc.",Medical Assistance,3.5329,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
OXYCODONE-ACETAMINOPHEN 5-325 MG ORAL TABLET,,9469,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
OXYCODONE-ACETAMINOPHEN 5-325 MG ORAL TABLET,,9469,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,"UCare Health, Inc.",Medicare Advantage,3.5329,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
OXYCODONE-ACETAMINOPHEN 5-325 MG ORAL TABLET,,9469,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
OXYCODONE-ACETAMINOPHEN 5-325 MG ORAL TABLET,,9469,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),3.5329,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
OXYCODONE-ACETAMINOPHEN 5-325 MG ORAL TABLET,,9469,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
OXYCODONE-ACETAMINOPHEN 5-325 MG ORAL TABLET,,9469,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,UnitedHealthcare,Individual & Family,6.58,94,,percent of total billed charges,,
OXYCODONE-ACETAMINOPHEN 5-325 MG ORAL TABLET,,9469,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,UnitedHealthcare,Medicare Advantage,3.43,49,,percent of total billed charges,,
OXYCODONE-ACETAMINOPHEN 5-325 MG ORAL TABLET,,9469,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
OXYCODONE-ACETAMINOPHEN 5-325 MG ORAL TABLET,,9469,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,3.36,48,,percent of total billed charges,,100% of DHS outpatient percentage
OXYCODONE-ACETAMINOPHEN 5-325 MG ORAL TABLET,,9469,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
ISOSORBIDE MONONITRATE 60 MG ORAL TB24,,9627,LOCAL,Facility,Both,1,Each,,10,8.5,2.866,10,Aetna,Commercial,9.2,92,,percent of total billed charges,,
ISOSORBIDE MONONITRATE 60 MG ORAL TB24,,9627,LOCAL,Facility,Outpatient,1,Each,,10,8.5,2.866,10,Aetna,Medicare Advantage,4.9,49,,percent of total billed charges,,
ISOSORBIDE MONONITRATE 60 MG ORAL TB24,,9627,LOCAL,Facility,Inpatient,1,Each,,10,8.5,2.866,10,Aetna,Medicare Advantage,,,,,Included in per diem rate,
ISOSORBIDE MONONITRATE 60 MG ORAL TB24,,9627,LOCAL,Facility,Both,1,Each,,10,8.5,2.866,10,Aetna,PPO,9.3,93,,percent of total billed charges,,
ISOSORBIDE MONONITRATE 60 MG ORAL TB24,,9627,LOCAL,Facility,Both,1,Each,,10,8.5,2.866,10,America's PPO,America's PPO,9.603,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
ISOSORBIDE MONONITRATE 60 MG ORAL TB24,,9627,LOCAL,Facility,Both,1,Each,,10,8.5,2.866,10,BlueCross BlueShield Minnesota, Federal Employee Program,9.84,98.4,,percent of total billed charges,,
ISOSORBIDE MONONITRATE 60 MG ORAL TB24,,9627,LOCAL,Facility,Both,1,Each,,10,8.5,2.866,10,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,10,100,,percent of total billed charges,,
ISOSORBIDE MONONITRATE 60 MG ORAL TB24,,9627,LOCAL,Facility,Both,1,Each,,10,8.5,2.866,10,BlueCross BlueShield Minnesota,High Value Network Plan,9,90,,percent of total billed charges,,
ISOSORBIDE MONONITRATE 60 MG ORAL TB24,,9627,LOCAL,Facility,Outpatient,1,Each,,10,8.5,2.866,10,BlueCross BlueShield Minnesota,Medicare Advantage,4.9,49,,percent of total billed charges,,
ISOSORBIDE MONONITRATE 60 MG ORAL TB24,,9627,LOCAL,Facility,Inpatient,1,Each,,10,8.5,2.866,10,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
ISOSORBIDE MONONITRATE 60 MG ORAL TB24,,9627,LOCAL,Facility,Both,1,Each,,10,8.5,2.866,10,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,8.857,88.57,,percent of total billed charges,,
ISOSORBIDE MONONITRATE 60 MG ORAL TB24,,9627,LOCAL,Facility,Both,1,Each,,10,8.5,2.866,10,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,2.866,28.66,,percent of total billed charges,,
ISOSORBIDE MONONITRATE 60 MG ORAL TB24,,9627,LOCAL,Facility,Outpatient,1,Each,,10,8.5,2.866,10,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),4.9,49,,percent of total billed charges,,
ISOSORBIDE MONONITRATE 60 MG ORAL TB24,,9627,LOCAL,Facility,Inpatient,1,Each,,10,8.5,2.866,10,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
ISOSORBIDE MONONITRATE 60 MG ORAL TB24,,9627,LOCAL,Facility,Both,1,Each,,10,8.5,2.866,10,CorVel,Worker's Compensation,10,100,,percent of total billed charges,,
ISOSORBIDE MONONITRATE 60 MG ORAL TB24,,9627,LOCAL,Facility,Both,1,Each,,10,8.5,2.866,10,First Health Group Corporation,First Health Network,9.7,97,,percent of total billed charges,,
ISOSORBIDE MONONITRATE 60 MG ORAL TB24,,9627,LOCAL,Facility,Both,1,Each,,10,8.5,2.866,10,"Health Partners, Inc.",Commercial,9.46,94.6,,percent of total billed charges,,
ISOSORBIDE MONONITRATE 60 MG ORAL TB24,,9627,LOCAL,Facility,Outpatient,1,Each,,10,8.5,2.866,10,"Health Partners, Inc.",Medicare Advantage,4.9,49,,percent of total billed charges,,
ISOSORBIDE MONONITRATE 60 MG ORAL TB24,,9627,LOCAL,Facility,Inpatient,1,Each,,10,8.5,2.866,10,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ISOSORBIDE MONONITRATE 60 MG ORAL TB24,,9627,LOCAL,Facility,Both,1,Each,,10,8.5,2.866,10,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),6,60,,percent of total billed charges,,
ISOSORBIDE MONONITRATE 60 MG ORAL TB24,,9627,LOCAL,Facility,Both,1,Each,,10,8.5,2.866,10,"Health Partners, Inc.",State of Minnesota Advantage Program,8.15,81.5,,percent of total billed charges,,
ISOSORBIDE MONONITRATE 60 MG ORAL TB24,,9627,LOCAL,Facility,Both,1,Each,,10,8.5,2.866,10,"Health Partners, Inc.",State Public Programs,5,50,,percent of total billed charges,,
ISOSORBIDE MONONITRATE 60 MG ORAL TB24,,9627,LOCAL,Facility,Both,1,Each,,10,8.5,2.866,10,Humana Insurance Company,Commercial PPO,9.5,95,,percent of total billed charges,,
ISOSORBIDE MONONITRATE 60 MG ORAL TB24,,9627,LOCAL,Facility,Outpatient,1,Each,,10,8.5,2.866,10,Humana Insurance Company,Medicare PPO,4.9,49,,percent of total billed charges,,
ISOSORBIDE MONONITRATE 60 MG ORAL TB24,,9627,LOCAL,Facility,Inpatient,1,Each,,10,8.5,2.866,10,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
ISOSORBIDE MONONITRATE 60 MG ORAL TB24,,9627,LOCAL,Facility,Both,1,Each,,10,8.5,2.866,10,Medica,Individual & Family,9.91,99.1,,percent of total billed charges,,
ISOSORBIDE MONONITRATE 60 MG ORAL TB24,,9627,LOCAL,Facility,Outpatient,1,Each,,10,8.5,2.866,10,Medica,Medica Advantage Solution,4.98,49.8,,percent of total billed charges,,
ISOSORBIDE MONONITRATE 60 MG ORAL TB24,,9627,LOCAL,Facility,Inpatient,1,Each,,10,8.5,2.866,10,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
ISOSORBIDE MONONITRATE 60 MG ORAL TB24,,9627,LOCAL,Facility,Outpatient,1,Each,,10,8.5,2.866,10,Medica,Medical Assistance,4.46,44.6,,percent of total billed charges,,
ISOSORBIDE MONONITRATE 60 MG ORAL TB24,,9627,LOCAL,Facility,Inpatient,1,Each,,10,8.5,2.866,10,Medica,Medical Assistance,,,,,Included in per diem rate,
ISOSORBIDE MONONITRATE 60 MG ORAL TB24,,9627,LOCAL,Facility,Outpatient,1,Each,,10,8.5,2.866,10,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,4.98,49.8,,percent of total billed charges,,
ISOSORBIDE MONONITRATE 60 MG ORAL TB24,,9627,LOCAL,Facility,Inpatient,1,Each,,10,8.5,2.866,10,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
ISOSORBIDE MONONITRATE 60 MG ORAL TB24,,9627,LOCAL,Facility,Both,1,Each,,10,8.5,2.866,10,"Multiplan, Inc.","Multiplan, Inc.",9.4,94,,percent of total billed charges,,
ISOSORBIDE MONONITRATE 60 MG ORAL TB24,,9627,LOCAL,Facility,Outpatient,1,Each,,10,8.5,2.866,10,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,9.01,90.1,,percent of total billed charges,,
ISOSORBIDE MONONITRATE 60 MG ORAL TB24,,9627,LOCAL,Facility,Inpatient,1,Each,,10,8.5,2.866,10,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
ISOSORBIDE MONONITRATE 60 MG ORAL TB24,,9627,LOCAL,Facility,Both,1,Each,,10,8.5,2.866,10,"Preferred One Administrative Services, INC.",PPO,9.86,98.6,,percent of total billed charges,,
ISOSORBIDE MONONITRATE 60 MG ORAL TB24,,9627,LOCAL,Facility,Outpatient,1,Each,,10,8.5,2.866,10,PrimeWest Health,Minnesota Senior Health Options (MSHO),5.145,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
ISOSORBIDE MONONITRATE 60 MG ORAL TB24,,9627,LOCAL,Facility,Inpatient,1,Each,,10,8.5,2.866,10,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ISOSORBIDE MONONITRATE 60 MG ORAL TB24,,9627,LOCAL,Facility,Outpatient,1,Each,,10,8.5,2.866,10,PrimeWest Health,MinnesotaCare,5.136,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
ISOSORBIDE MONONITRATE 60 MG ORAL TB24,,9627,LOCAL,Facility,Inpatient,1,Each,,10,8.5,2.866,10,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
ISOSORBIDE MONONITRATE 60 MG ORAL TB24,,9627,LOCAL,Facility,Both,1,Each,,10,8.5,2.866,10,Sanford Health Plan,Sanford Health Plan,9.2,92,,percent of total billed charges,,
ISOSORBIDE MONONITRATE 60 MG ORAL TB24,,9627,LOCAL,Facility,Outpatient,1,Each,,10,8.5,2.866,10,"UCare Health, Inc.",Individual & Family Plan,5.635,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
ISOSORBIDE MONONITRATE 60 MG ORAL TB24,,9627,LOCAL,Facility,Inpatient,1,Each,,10,8.5,2.866,10,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
ISOSORBIDE MONONITRATE 60 MG ORAL TB24,,9627,LOCAL,Facility,Outpatient,1,Each,,10,8.5,2.866,10,"UCare Health, Inc.",Medical Assistance,5.047,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ISOSORBIDE MONONITRATE 60 MG ORAL TB24,,9627,LOCAL,Facility,Inpatient,1,Each,,10,8.5,2.866,10,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
ISOSORBIDE MONONITRATE 60 MG ORAL TB24,,9627,LOCAL,Facility,Outpatient,1,Each,,10,8.5,2.866,10,"UCare Health, Inc.",Medicare Advantage,5.047,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ISOSORBIDE MONONITRATE 60 MG ORAL TB24,,9627,LOCAL,Facility,Inpatient,1,Each,,10,8.5,2.866,10,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ISOSORBIDE MONONITRATE 60 MG ORAL TB24,,9627,LOCAL,Facility,Outpatient,1,Each,,10,8.5,2.866,10,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),5.047,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ISOSORBIDE MONONITRATE 60 MG ORAL TB24,,9627,LOCAL,Facility,Inpatient,1,Each,,10,8.5,2.866,10,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ISOSORBIDE MONONITRATE 60 MG ORAL TB24,,9627,LOCAL,Facility,Both,1,Each,,10,8.5,2.866,10,UnitedHealthcare,Individual & Family,9.4,94,,percent of total billed charges,,
ISOSORBIDE MONONITRATE 60 MG ORAL TB24,,9627,LOCAL,Facility,Outpatient,1,Each,,10,8.5,2.866,10,UnitedHealthcare,Medicare Advantage,4.9,49,,percent of total billed charges,,
ISOSORBIDE MONONITRATE 60 MG ORAL TB24,,9627,LOCAL,Facility,Inpatient,1,Each,,10,8.5,2.866,10,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
ISOSORBIDE MONONITRATE 60 MG ORAL TB24,,9627,LOCAL,Facility,Outpatient,1,Each,,10,8.5,2.866,10,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,4.8,48,,percent of total billed charges,,100% of DHS outpatient percentage
ISOSORBIDE MONONITRATE 60 MG ORAL TB24,,9627,LOCAL,Facility,Inpatient,1,Each,,10,8.5,2.866,10,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
LEVOTHYROXINE 88 MCG ORAL TABLET,,9633,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
LEVOTHYROXINE 88 MCG ORAL TABLET,,9633,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
LEVOTHYROXINE 88 MCG ORAL TABLET,,9633,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
LEVOTHYROXINE 88 MCG ORAL TABLET,,9633,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
LEVOTHYROXINE 88 MCG ORAL TABLET,,9633,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
LEVOTHYROXINE 88 MCG ORAL TABLET,,9633,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
LEVOTHYROXINE 88 MCG ORAL TABLET,,9633,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
LEVOTHYROXINE 88 MCG ORAL TABLET,,9633,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
LEVOTHYROXINE 88 MCG ORAL TABLET,,9633,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
LEVOTHYROXINE 88 MCG ORAL TABLET,,9633,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
LEVOTHYROXINE 88 MCG ORAL TABLET,,9633,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
LEVOTHYROXINE 88 MCG ORAL TABLET,,9633,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
LEVOTHYROXINE 88 MCG ORAL TABLET,,9633,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
LEVOTHYROXINE 88 MCG ORAL TABLET,,9633,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
LEVOTHYROXINE 88 MCG ORAL TABLET,,9633,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
LEVOTHYROXINE 88 MCG ORAL TABLET,,9633,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
LEVOTHYROXINE 88 MCG ORAL TABLET,,9633,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
LEVOTHYROXINE 88 MCG ORAL TABLET,,9633,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
LEVOTHYROXINE 88 MCG ORAL TABLET,,9633,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LEVOTHYROXINE 88 MCG ORAL TABLET,,9633,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
LEVOTHYROXINE 88 MCG ORAL TABLET,,9633,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
LEVOTHYROXINE 88 MCG ORAL TABLET,,9633,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
LEVOTHYROXINE 88 MCG ORAL TABLET,,9633,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
LEVOTHYROXINE 88 MCG ORAL TABLET,,9633,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
LEVOTHYROXINE 88 MCG ORAL TABLET,,9633,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
LEVOTHYROXINE 88 MCG ORAL TABLET,,9633,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
LEVOTHYROXINE 88 MCG ORAL TABLET,,9633,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
LEVOTHYROXINE 88 MCG ORAL TABLET,,9633,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
LEVOTHYROXINE 88 MCG ORAL TABLET,,9633,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
LEVOTHYROXINE 88 MCG ORAL TABLET,,9633,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
LEVOTHYROXINE 88 MCG ORAL TABLET,,9633,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
LEVOTHYROXINE 88 MCG ORAL TABLET,,9633,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
LEVOTHYROXINE 88 MCG ORAL TABLET,,9633,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
LEVOTHYROXINE 88 MCG ORAL TABLET,,9633,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
LEVOTHYROXINE 88 MCG ORAL TABLET,,9633,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
LEVOTHYROXINE 88 MCG ORAL TABLET,,9633,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
LEVOTHYROXINE 88 MCG ORAL TABLET,,9633,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
LEVOTHYROXINE 88 MCG ORAL TABLET,,9633,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LEVOTHYROXINE 88 MCG ORAL TABLET,,9633,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
LEVOTHYROXINE 88 MCG ORAL TABLET,,9633,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
LEVOTHYROXINE 88 MCG ORAL TABLET,,9633,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
LEVOTHYROXINE 88 MCG ORAL TABLET,,9633,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
LEVOTHYROXINE 88 MCG ORAL TABLET,,9633,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
LEVOTHYROXINE 88 MCG ORAL TABLET,,9633,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LEVOTHYROXINE 88 MCG ORAL TABLET,,9633,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
LEVOTHYROXINE 88 MCG ORAL TABLET,,9633,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LEVOTHYROXINE 88 MCG ORAL TABLET,,9633,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LEVOTHYROXINE 88 MCG ORAL TABLET,,9633,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LEVOTHYROXINE 88 MCG ORAL TABLET,,9633,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LEVOTHYROXINE 88 MCG ORAL TABLET,,9633,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
LEVOTHYROXINE 88 MCG ORAL TABLET,,9633,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
LEVOTHYROXINE 88 MCG ORAL TABLET,,9633,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
LEVOTHYROXINE 88 MCG ORAL TABLET,,9633,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
LEVOTHYROXINE 88 MCG ORAL TABLET,,9633,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
RIFAMPIN 300 MG ORAL CAP,,9662,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,Aetna,Commercial,6.44,92,,percent of total billed charges,,
RIFAMPIN 300 MG ORAL CAP,,9662,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,Aetna,Medicare Advantage,3.43,49,,percent of total billed charges,,
RIFAMPIN 300 MG ORAL CAP,,9662,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,Aetna,Medicare Advantage,,,,,Included in per diem rate,
RIFAMPIN 300 MG ORAL CAP,,9662,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,Aetna,PPO,6.51,93,,percent of total billed charges,,
RIFAMPIN 300 MG ORAL CAP,,9662,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,America's PPO,America's PPO,6.7221,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
RIFAMPIN 300 MG ORAL CAP,,9662,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,BlueCross BlueShield Minnesota, Federal Employee Program,6.888,98.4,,percent of total billed charges,,
RIFAMPIN 300 MG ORAL CAP,,9662,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,7,100,,percent of total billed charges,,
RIFAMPIN 300 MG ORAL CAP,,9662,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,BlueCross BlueShield Minnesota,High Value Network Plan,6.3,90,,percent of total billed charges,,
RIFAMPIN 300 MG ORAL CAP,,9662,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,BlueCross BlueShield Minnesota,Medicare Advantage,3.43,49,,percent of total billed charges,,
RIFAMPIN 300 MG ORAL CAP,,9662,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
RIFAMPIN 300 MG ORAL CAP,,9662,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,6.1999,88.57,,percent of total billed charges,,
RIFAMPIN 300 MG ORAL CAP,,9662,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,2.0062,28.66,,percent of total billed charges,,
RIFAMPIN 300 MG ORAL CAP,,9662,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),3.43,49,,percent of total billed charges,,
RIFAMPIN 300 MG ORAL CAP,,9662,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
RIFAMPIN 300 MG ORAL CAP,,9662,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,CorVel,Worker's Compensation,7,100,,percent of total billed charges,,
RIFAMPIN 300 MG ORAL CAP,,9662,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,First Health Group Corporation,First Health Network,6.79,97,,percent of total billed charges,,
RIFAMPIN 300 MG ORAL CAP,,9662,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,"Health Partners, Inc.",Commercial,6.622,94.6,,percent of total billed charges,,
RIFAMPIN 300 MG ORAL CAP,,9662,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,"Health Partners, Inc.",Medicare Advantage,3.43,49,,percent of total billed charges,,
RIFAMPIN 300 MG ORAL CAP,,9662,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
RIFAMPIN 300 MG ORAL CAP,,9662,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),4.2,60,,percent of total billed charges,,
RIFAMPIN 300 MG ORAL CAP,,9662,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,"Health Partners, Inc.",State of Minnesota Advantage Program,5.705,81.5,,percent of total billed charges,,
RIFAMPIN 300 MG ORAL CAP,,9662,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,"Health Partners, Inc.",State Public Programs,3.5,50,,percent of total billed charges,,
RIFAMPIN 300 MG ORAL CAP,,9662,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,Humana Insurance Company,Commercial PPO,6.65,95,,percent of total billed charges,,
RIFAMPIN 300 MG ORAL CAP,,9662,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,Humana Insurance Company,Medicare PPO,3.43,49,,percent of total billed charges,,
RIFAMPIN 300 MG ORAL CAP,,9662,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
RIFAMPIN 300 MG ORAL CAP,,9662,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,Medica,Individual & Family,6.937,99.1,,percent of total billed charges,,
RIFAMPIN 300 MG ORAL CAP,,9662,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,Medica,Medica Advantage Solution,3.486,49.8,,percent of total billed charges,,
RIFAMPIN 300 MG ORAL CAP,,9662,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
RIFAMPIN 300 MG ORAL CAP,,9662,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,Medica,Medical Assistance,3.122,44.6,,percent of total billed charges,,
RIFAMPIN 300 MG ORAL CAP,,9662,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,Medica,Medical Assistance,,,,,Included in per diem rate,
RIFAMPIN 300 MG ORAL CAP,,9662,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,3.486,49.8,,percent of total billed charges,,
RIFAMPIN 300 MG ORAL CAP,,9662,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
RIFAMPIN 300 MG ORAL CAP,,9662,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,"Multiplan, Inc.","Multiplan, Inc.",6.58,94,,percent of total billed charges,,
RIFAMPIN 300 MG ORAL CAP,,9662,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,6.307,90.1,,percent of total billed charges,,
RIFAMPIN 300 MG ORAL CAP,,9662,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
RIFAMPIN 300 MG ORAL CAP,,9662,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,"Preferred One Administrative Services, INC.",PPO,6.902,98.6,,percent of total billed charges,,
RIFAMPIN 300 MG ORAL CAP,,9662,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,PrimeWest Health,Minnesota Senior Health Options (MSHO),3.6015,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
RIFAMPIN 300 MG ORAL CAP,,9662,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
RIFAMPIN 300 MG ORAL CAP,,9662,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,PrimeWest Health,MinnesotaCare,3.5952,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
RIFAMPIN 300 MG ORAL CAP,,9662,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
RIFAMPIN 300 MG ORAL CAP,,9662,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,Sanford Health Plan,Sanford Health Plan,6.44,92,,percent of total billed charges,,
RIFAMPIN 300 MG ORAL CAP,,9662,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,"UCare Health, Inc.",Individual & Family Plan,3.9445,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
RIFAMPIN 300 MG ORAL CAP,,9662,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
RIFAMPIN 300 MG ORAL CAP,,9662,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,"UCare Health, Inc.",Medical Assistance,3.5329,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
RIFAMPIN 300 MG ORAL CAP,,9662,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
RIFAMPIN 300 MG ORAL CAP,,9662,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,"UCare Health, Inc.",Medicare Advantage,3.5329,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
RIFAMPIN 300 MG ORAL CAP,,9662,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
RIFAMPIN 300 MG ORAL CAP,,9662,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),3.5329,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
RIFAMPIN 300 MG ORAL CAP,,9662,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
RIFAMPIN 300 MG ORAL CAP,,9662,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,UnitedHealthcare,Individual & Family,6.58,94,,percent of total billed charges,,
RIFAMPIN 300 MG ORAL CAP,,9662,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,UnitedHealthcare,Medicare Advantage,3.43,49,,percent of total billed charges,,
RIFAMPIN 300 MG ORAL CAP,,9662,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
RIFAMPIN 300 MG ORAL CAP,,9662,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,3.36,48,,percent of total billed charges,,100% of DHS outpatient percentage
RIFAMPIN 300 MG ORAL CAP,,9662,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
DOXYCYCLINE MONOHYDRATE 50 MG ORAL CAP,,9724,LOCAL,Facility,Both,1,Each,,8,6.8,2.2928,8,Aetna,Commercial,7.36,92,,percent of total billed charges,,
DOXYCYCLINE MONOHYDRATE 50 MG ORAL CAP,,9724,LOCAL,Facility,Outpatient,1,Each,,8,6.8,2.2928,8,Aetna,Medicare Advantage,3.92,49,,percent of total billed charges,,
DOXYCYCLINE MONOHYDRATE 50 MG ORAL CAP,,9724,LOCAL,Facility,Inpatient,1,Each,,8,6.8,2.2928,8,Aetna,Medicare Advantage,,,,,Included in per diem rate,
DOXYCYCLINE MONOHYDRATE 50 MG ORAL CAP,,9724,LOCAL,Facility,Both,1,Each,,8,6.8,2.2928,8,Aetna,PPO,7.44,93,,percent of total billed charges,,
DOXYCYCLINE MONOHYDRATE 50 MG ORAL CAP,,9724,LOCAL,Facility,Both,1,Each,,8,6.8,2.2928,8,America's PPO,America's PPO,7.6824,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
DOXYCYCLINE MONOHYDRATE 50 MG ORAL CAP,,9724,LOCAL,Facility,Both,1,Each,,8,6.8,2.2928,8,BlueCross BlueShield Minnesota, Federal Employee Program,7.872,98.4,,percent of total billed charges,,
DOXYCYCLINE MONOHYDRATE 50 MG ORAL CAP,,9724,LOCAL,Facility,Both,1,Each,,8,6.8,2.2928,8,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,8,100,,percent of total billed charges,,
DOXYCYCLINE MONOHYDRATE 50 MG ORAL CAP,,9724,LOCAL,Facility,Both,1,Each,,8,6.8,2.2928,8,BlueCross BlueShield Minnesota,High Value Network Plan,7.2,90,,percent of total billed charges,,
DOXYCYCLINE MONOHYDRATE 50 MG ORAL CAP,,9724,LOCAL,Facility,Outpatient,1,Each,,8,6.8,2.2928,8,BlueCross BlueShield Minnesota,Medicare Advantage,3.92,49,,percent of total billed charges,,
DOXYCYCLINE MONOHYDRATE 50 MG ORAL CAP,,9724,LOCAL,Facility,Inpatient,1,Each,,8,6.8,2.2928,8,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
DOXYCYCLINE MONOHYDRATE 50 MG ORAL CAP,,9724,LOCAL,Facility,Both,1,Each,,8,6.8,2.2928,8,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,7.0856,88.57,,percent of total billed charges,,
DOXYCYCLINE MONOHYDRATE 50 MG ORAL CAP,,9724,LOCAL,Facility,Both,1,Each,,8,6.8,2.2928,8,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,2.2928,28.66,,percent of total billed charges,,
DOXYCYCLINE MONOHYDRATE 50 MG ORAL CAP,,9724,LOCAL,Facility,Outpatient,1,Each,,8,6.8,2.2928,8,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),3.92,49,,percent of total billed charges,,
DOXYCYCLINE MONOHYDRATE 50 MG ORAL CAP,,9724,LOCAL,Facility,Inpatient,1,Each,,8,6.8,2.2928,8,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
DOXYCYCLINE MONOHYDRATE 50 MG ORAL CAP,,9724,LOCAL,Facility,Both,1,Each,,8,6.8,2.2928,8,CorVel,Worker's Compensation,8,100,,percent of total billed charges,,
DOXYCYCLINE MONOHYDRATE 50 MG ORAL CAP,,9724,LOCAL,Facility,Both,1,Each,,8,6.8,2.2928,8,First Health Group Corporation,First Health Network,7.76,97,,percent of total billed charges,,
DOXYCYCLINE MONOHYDRATE 50 MG ORAL CAP,,9724,LOCAL,Facility,Both,1,Each,,8,6.8,2.2928,8,"Health Partners, Inc.",Commercial,7.568,94.6,,percent of total billed charges,,
DOXYCYCLINE MONOHYDRATE 50 MG ORAL CAP,,9724,LOCAL,Facility,Outpatient,1,Each,,8,6.8,2.2928,8,"Health Partners, Inc.",Medicare Advantage,3.92,49,,percent of total billed charges,,
DOXYCYCLINE MONOHYDRATE 50 MG ORAL CAP,,9724,LOCAL,Facility,Inpatient,1,Each,,8,6.8,2.2928,8,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DOXYCYCLINE MONOHYDRATE 50 MG ORAL CAP,,9724,LOCAL,Facility,Both,1,Each,,8,6.8,2.2928,8,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),4.8,60,,percent of total billed charges,,
DOXYCYCLINE MONOHYDRATE 50 MG ORAL CAP,,9724,LOCAL,Facility,Both,1,Each,,8,6.8,2.2928,8,"Health Partners, Inc.",State of Minnesota Advantage Program,6.52,81.5,,percent of total billed charges,,
DOXYCYCLINE MONOHYDRATE 50 MG ORAL CAP,,9724,LOCAL,Facility,Both,1,Each,,8,6.8,2.2928,8,"Health Partners, Inc.",State Public Programs,4,50,,percent of total billed charges,,
DOXYCYCLINE MONOHYDRATE 50 MG ORAL CAP,,9724,LOCAL,Facility,Both,1,Each,,8,6.8,2.2928,8,Humana Insurance Company,Commercial PPO,7.6,95,,percent of total billed charges,,
DOXYCYCLINE MONOHYDRATE 50 MG ORAL CAP,,9724,LOCAL,Facility,Outpatient,1,Each,,8,6.8,2.2928,8,Humana Insurance Company,Medicare PPO,3.92,49,,percent of total billed charges,,
DOXYCYCLINE MONOHYDRATE 50 MG ORAL CAP,,9724,LOCAL,Facility,Inpatient,1,Each,,8,6.8,2.2928,8,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
DOXYCYCLINE MONOHYDRATE 50 MG ORAL CAP,,9724,LOCAL,Facility,Both,1,Each,,8,6.8,2.2928,8,Medica,Individual & Family,7.928,99.1,,percent of total billed charges,,
DOXYCYCLINE MONOHYDRATE 50 MG ORAL CAP,,9724,LOCAL,Facility,Outpatient,1,Each,,8,6.8,2.2928,8,Medica,Medica Advantage Solution,3.984,49.8,,percent of total billed charges,,
DOXYCYCLINE MONOHYDRATE 50 MG ORAL CAP,,9724,LOCAL,Facility,Inpatient,1,Each,,8,6.8,2.2928,8,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
DOXYCYCLINE MONOHYDRATE 50 MG ORAL CAP,,9724,LOCAL,Facility,Outpatient,1,Each,,8,6.8,2.2928,8,Medica,Medical Assistance,3.568,44.6,,percent of total billed charges,,
DOXYCYCLINE MONOHYDRATE 50 MG ORAL CAP,,9724,LOCAL,Facility,Inpatient,1,Each,,8,6.8,2.2928,8,Medica,Medical Assistance,,,,,Included in per diem rate,
DOXYCYCLINE MONOHYDRATE 50 MG ORAL CAP,,9724,LOCAL,Facility,Outpatient,1,Each,,8,6.8,2.2928,8,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,3.984,49.8,,percent of total billed charges,,
DOXYCYCLINE MONOHYDRATE 50 MG ORAL CAP,,9724,LOCAL,Facility,Inpatient,1,Each,,8,6.8,2.2928,8,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
DOXYCYCLINE MONOHYDRATE 50 MG ORAL CAP,,9724,LOCAL,Facility,Both,1,Each,,8,6.8,2.2928,8,"Multiplan, Inc.","Multiplan, Inc.",7.52,94,,percent of total billed charges,,
DOXYCYCLINE MONOHYDRATE 50 MG ORAL CAP,,9724,LOCAL,Facility,Outpatient,1,Each,,8,6.8,2.2928,8,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,7.208,90.1,,percent of total billed charges,,
DOXYCYCLINE MONOHYDRATE 50 MG ORAL CAP,,9724,LOCAL,Facility,Inpatient,1,Each,,8,6.8,2.2928,8,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
DOXYCYCLINE MONOHYDRATE 50 MG ORAL CAP,,9724,LOCAL,Facility,Both,1,Each,,8,6.8,2.2928,8,"Preferred One Administrative Services, INC.",PPO,7.888,98.6,,percent of total billed charges,,
DOXYCYCLINE MONOHYDRATE 50 MG ORAL CAP,,9724,LOCAL,Facility,Outpatient,1,Each,,8,6.8,2.2928,8,PrimeWest Health,Minnesota Senior Health Options (MSHO),4.116,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
DOXYCYCLINE MONOHYDRATE 50 MG ORAL CAP,,9724,LOCAL,Facility,Inpatient,1,Each,,8,6.8,2.2928,8,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DOXYCYCLINE MONOHYDRATE 50 MG ORAL CAP,,9724,LOCAL,Facility,Outpatient,1,Each,,8,6.8,2.2928,8,PrimeWest Health,MinnesotaCare,4.1088,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
DOXYCYCLINE MONOHYDRATE 50 MG ORAL CAP,,9724,LOCAL,Facility,Inpatient,1,Each,,8,6.8,2.2928,8,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
DOXYCYCLINE MONOHYDRATE 50 MG ORAL CAP,,9724,LOCAL,Facility,Both,1,Each,,8,6.8,2.2928,8,Sanford Health Plan,Sanford Health Plan,7.36,92,,percent of total billed charges,,
DOXYCYCLINE MONOHYDRATE 50 MG ORAL CAP,,9724,LOCAL,Facility,Outpatient,1,Each,,8,6.8,2.2928,8,"UCare Health, Inc.",Individual & Family Plan,4.508,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
DOXYCYCLINE MONOHYDRATE 50 MG ORAL CAP,,9724,LOCAL,Facility,Inpatient,1,Each,,8,6.8,2.2928,8,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
DOXYCYCLINE MONOHYDRATE 50 MG ORAL CAP,,9724,LOCAL,Facility,Outpatient,1,Each,,8,6.8,2.2928,8,"UCare Health, Inc.",Medical Assistance,4.0376,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DOXYCYCLINE MONOHYDRATE 50 MG ORAL CAP,,9724,LOCAL,Facility,Inpatient,1,Each,,8,6.8,2.2928,8,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
DOXYCYCLINE MONOHYDRATE 50 MG ORAL CAP,,9724,LOCAL,Facility,Outpatient,1,Each,,8,6.8,2.2928,8,"UCare Health, Inc.",Medicare Advantage,4.0376,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DOXYCYCLINE MONOHYDRATE 50 MG ORAL CAP,,9724,LOCAL,Facility,Inpatient,1,Each,,8,6.8,2.2928,8,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DOXYCYCLINE MONOHYDRATE 50 MG ORAL CAP,,9724,LOCAL,Facility,Outpatient,1,Each,,8,6.8,2.2928,8,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),4.0376,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DOXYCYCLINE MONOHYDRATE 50 MG ORAL CAP,,9724,LOCAL,Facility,Inpatient,1,Each,,8,6.8,2.2928,8,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DOXYCYCLINE MONOHYDRATE 50 MG ORAL CAP,,9724,LOCAL,Facility,Both,1,Each,,8,6.8,2.2928,8,UnitedHealthcare,Individual & Family,7.52,94,,percent of total billed charges,,
DOXYCYCLINE MONOHYDRATE 50 MG ORAL CAP,,9724,LOCAL,Facility,Outpatient,1,Each,,8,6.8,2.2928,8,UnitedHealthcare,Medicare Advantage,3.92,49,,percent of total billed charges,,
DOXYCYCLINE MONOHYDRATE 50 MG ORAL CAP,,9724,LOCAL,Facility,Inpatient,1,Each,,8,6.8,2.2928,8,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
DOXYCYCLINE MONOHYDRATE 50 MG ORAL CAP,,9724,LOCAL,Facility,Outpatient,1,Each,,8,6.8,2.2928,8,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,3.84,48,,percent of total billed charges,,100% of DHS outpatient percentage
DOXYCYCLINE MONOHYDRATE 50 MG ORAL CAP,,9724,LOCAL,Facility,Inpatient,1,Each,,8,6.8,2.2928,8,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
CHLORDIAZEPOXIDE HCL 5 MG ORAL CAP,,9824,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
CHLORDIAZEPOXIDE HCL 5 MG ORAL CAP,,9824,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
CHLORDIAZEPOXIDE HCL 5 MG ORAL CAP,,9824,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
CHLORDIAZEPOXIDE HCL 5 MG ORAL CAP,,9824,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
CHLORDIAZEPOXIDE HCL 5 MG ORAL CAP,,9824,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
CHLORDIAZEPOXIDE HCL 5 MG ORAL CAP,,9824,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
CHLORDIAZEPOXIDE HCL 5 MG ORAL CAP,,9824,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
CHLORDIAZEPOXIDE HCL 5 MG ORAL CAP,,9824,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
CHLORDIAZEPOXIDE HCL 5 MG ORAL CAP,,9824,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
CHLORDIAZEPOXIDE HCL 5 MG ORAL CAP,,9824,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
CHLORDIAZEPOXIDE HCL 5 MG ORAL CAP,,9824,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
CHLORDIAZEPOXIDE HCL 5 MG ORAL CAP,,9824,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
CHLORDIAZEPOXIDE HCL 5 MG ORAL CAP,,9824,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
CHLORDIAZEPOXIDE HCL 5 MG ORAL CAP,,9824,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
CHLORDIAZEPOXIDE HCL 5 MG ORAL CAP,,9824,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
CHLORDIAZEPOXIDE HCL 5 MG ORAL CAP,,9824,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
CHLORDIAZEPOXIDE HCL 5 MG ORAL CAP,,9824,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
CHLORDIAZEPOXIDE HCL 5 MG ORAL CAP,,9824,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
CHLORDIAZEPOXIDE HCL 5 MG ORAL CAP,,9824,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CHLORDIAZEPOXIDE HCL 5 MG ORAL CAP,,9824,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
CHLORDIAZEPOXIDE HCL 5 MG ORAL CAP,,9824,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
CHLORDIAZEPOXIDE HCL 5 MG ORAL CAP,,9824,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
CHLORDIAZEPOXIDE HCL 5 MG ORAL CAP,,9824,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
CHLORDIAZEPOXIDE HCL 5 MG ORAL CAP,,9824,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
CHLORDIAZEPOXIDE HCL 5 MG ORAL CAP,,9824,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
CHLORDIAZEPOXIDE HCL 5 MG ORAL CAP,,9824,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
CHLORDIAZEPOXIDE HCL 5 MG ORAL CAP,,9824,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
CHLORDIAZEPOXIDE HCL 5 MG ORAL CAP,,9824,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
CHLORDIAZEPOXIDE HCL 5 MG ORAL CAP,,9824,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
CHLORDIAZEPOXIDE HCL 5 MG ORAL CAP,,9824,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
CHLORDIAZEPOXIDE HCL 5 MG ORAL CAP,,9824,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
CHLORDIAZEPOXIDE HCL 5 MG ORAL CAP,,9824,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
CHLORDIAZEPOXIDE HCL 5 MG ORAL CAP,,9824,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
CHLORDIAZEPOXIDE HCL 5 MG ORAL CAP,,9824,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
CHLORDIAZEPOXIDE HCL 5 MG ORAL CAP,,9824,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
CHLORDIAZEPOXIDE HCL 5 MG ORAL CAP,,9824,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
CHLORDIAZEPOXIDE HCL 5 MG ORAL CAP,,9824,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
CHLORDIAZEPOXIDE HCL 5 MG ORAL CAP,,9824,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CHLORDIAZEPOXIDE HCL 5 MG ORAL CAP,,9824,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
CHLORDIAZEPOXIDE HCL 5 MG ORAL CAP,,9824,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
CHLORDIAZEPOXIDE HCL 5 MG ORAL CAP,,9824,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
CHLORDIAZEPOXIDE HCL 5 MG ORAL CAP,,9824,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
CHLORDIAZEPOXIDE HCL 5 MG ORAL CAP,,9824,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
CHLORDIAZEPOXIDE HCL 5 MG ORAL CAP,,9824,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CHLORDIAZEPOXIDE HCL 5 MG ORAL CAP,,9824,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
CHLORDIAZEPOXIDE HCL 5 MG ORAL CAP,,9824,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CHLORDIAZEPOXIDE HCL 5 MG ORAL CAP,,9824,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CHLORDIAZEPOXIDE HCL 5 MG ORAL CAP,,9824,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CHLORDIAZEPOXIDE HCL 5 MG ORAL CAP,,9824,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CHLORDIAZEPOXIDE HCL 5 MG ORAL CAP,,9824,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
CHLORDIAZEPOXIDE HCL 5 MG ORAL CAP,,9824,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
CHLORDIAZEPOXIDE HCL 5 MG ORAL CAP,,9824,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
CHLORDIAZEPOXIDE HCL 5 MG ORAL CAP,,9824,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
CHLORDIAZEPOXIDE HCL 5 MG ORAL CAP,,9824,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
POTASSIUM CHLORIDE 20 MEQ ORAL PACK,,9850,LOCAL,Facility,Both,1,Each,,52,44.2,14.9032,52,Aetna,Commercial,47.84,92,,percent of total billed charges,,
POTASSIUM CHLORIDE 20 MEQ ORAL PACK,,9850,LOCAL,Facility,Outpatient,1,Each,,52,44.2,14.9032,52,Aetna,Medicare Advantage,25.48,49,,percent of total billed charges,,
POTASSIUM CHLORIDE 20 MEQ ORAL PACK,,9850,LOCAL,Facility,Inpatient,1,Each,,52,44.2,14.9032,52,Aetna,Medicare Advantage,,,,,Included in per diem rate,
POTASSIUM CHLORIDE 20 MEQ ORAL PACK,,9850,LOCAL,Facility,Both,1,Each,,52,44.2,14.9032,52,Aetna,PPO,48.36,93,,percent of total billed charges,,
POTASSIUM CHLORIDE 20 MEQ ORAL PACK,,9850,LOCAL,Facility,Both,1,Each,,52,44.2,14.9032,52,America's PPO,America's PPO,49.9356,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
POTASSIUM CHLORIDE 20 MEQ ORAL PACK,,9850,LOCAL,Facility,Both,1,Each,,52,44.2,14.9032,52,BlueCross BlueShield Minnesota, Federal Employee Program,51.168,98.4,,percent of total billed charges,,
POTASSIUM CHLORIDE 20 MEQ ORAL PACK,,9850,LOCAL,Facility,Both,1,Each,,52,44.2,14.9032,52,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,52,100,,percent of total billed charges,,
POTASSIUM CHLORIDE 20 MEQ ORAL PACK,,9850,LOCAL,Facility,Both,1,Each,,52,44.2,14.9032,52,BlueCross BlueShield Minnesota,High Value Network Plan,46.8,90,,percent of total billed charges,,
POTASSIUM CHLORIDE 20 MEQ ORAL PACK,,9850,LOCAL,Facility,Outpatient,1,Each,,52,44.2,14.9032,52,BlueCross BlueShield Minnesota,Medicare Advantage,25.48,49,,percent of total billed charges,,
POTASSIUM CHLORIDE 20 MEQ ORAL PACK,,9850,LOCAL,Facility,Inpatient,1,Each,,52,44.2,14.9032,52,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
POTASSIUM CHLORIDE 20 MEQ ORAL PACK,,9850,LOCAL,Facility,Both,1,Each,,52,44.2,14.9032,52,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,46.0564,88.57,,percent of total billed charges,,
POTASSIUM CHLORIDE 20 MEQ ORAL PACK,,9850,LOCAL,Facility,Both,1,Each,,52,44.2,14.9032,52,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,14.9032,28.66,,percent of total billed charges,,
POTASSIUM CHLORIDE 20 MEQ ORAL PACK,,9850,LOCAL,Facility,Outpatient,1,Each,,52,44.2,14.9032,52,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),25.48,49,,percent of total billed charges,,
POTASSIUM CHLORIDE 20 MEQ ORAL PACK,,9850,LOCAL,Facility,Inpatient,1,Each,,52,44.2,14.9032,52,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
POTASSIUM CHLORIDE 20 MEQ ORAL PACK,,9850,LOCAL,Facility,Both,1,Each,,52,44.2,14.9032,52,CorVel,Worker's Compensation,52,100,,percent of total billed charges,,
POTASSIUM CHLORIDE 20 MEQ ORAL PACK,,9850,LOCAL,Facility,Both,1,Each,,52,44.2,14.9032,52,First Health Group Corporation,First Health Network,50.44,97,,percent of total billed charges,,
POTASSIUM CHLORIDE 20 MEQ ORAL PACK,,9850,LOCAL,Facility,Both,1,Each,,52,44.2,14.9032,52,"Health Partners, Inc.",Commercial,49.192,94.6,,percent of total billed charges,,
POTASSIUM CHLORIDE 20 MEQ ORAL PACK,,9850,LOCAL,Facility,Outpatient,1,Each,,52,44.2,14.9032,52,"Health Partners, Inc.",Medicare Advantage,25.48,49,,percent of total billed charges,,
POTASSIUM CHLORIDE 20 MEQ ORAL PACK,,9850,LOCAL,Facility,Inpatient,1,Each,,52,44.2,14.9032,52,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
POTASSIUM CHLORIDE 20 MEQ ORAL PACK,,9850,LOCAL,Facility,Both,1,Each,,52,44.2,14.9032,52,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),31.2,60,,percent of total billed charges,,
POTASSIUM CHLORIDE 20 MEQ ORAL PACK,,9850,LOCAL,Facility,Both,1,Each,,52,44.2,14.9032,52,"Health Partners, Inc.",State of Minnesota Advantage Program,42.38,81.5,,percent of total billed charges,,
POTASSIUM CHLORIDE 20 MEQ ORAL PACK,,9850,LOCAL,Facility,Both,1,Each,,52,44.2,14.9032,52,"Health Partners, Inc.",State Public Programs,26,50,,percent of total billed charges,,
POTASSIUM CHLORIDE 20 MEQ ORAL PACK,,9850,LOCAL,Facility,Both,1,Each,,52,44.2,14.9032,52,Humana Insurance Company,Commercial PPO,49.4,95,,percent of total billed charges,,
POTASSIUM CHLORIDE 20 MEQ ORAL PACK,,9850,LOCAL,Facility,Outpatient,1,Each,,52,44.2,14.9032,52,Humana Insurance Company,Medicare PPO,25.48,49,,percent of total billed charges,,
POTASSIUM CHLORIDE 20 MEQ ORAL PACK,,9850,LOCAL,Facility,Inpatient,1,Each,,52,44.2,14.9032,52,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
POTASSIUM CHLORIDE 20 MEQ ORAL PACK,,9850,LOCAL,Facility,Both,1,Each,,52,44.2,14.9032,52,Medica,Individual & Family,51.532,99.1,,percent of total billed charges,,
POTASSIUM CHLORIDE 20 MEQ ORAL PACK,,9850,LOCAL,Facility,Outpatient,1,Each,,52,44.2,14.9032,52,Medica,Medica Advantage Solution,25.896,49.8,,percent of total billed charges,,
POTASSIUM CHLORIDE 20 MEQ ORAL PACK,,9850,LOCAL,Facility,Inpatient,1,Each,,52,44.2,14.9032,52,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
POTASSIUM CHLORIDE 20 MEQ ORAL PACK,,9850,LOCAL,Facility,Outpatient,1,Each,,52,44.2,14.9032,52,Medica,Medical Assistance,23.192,44.6,,percent of total billed charges,,
POTASSIUM CHLORIDE 20 MEQ ORAL PACK,,9850,LOCAL,Facility,Inpatient,1,Each,,52,44.2,14.9032,52,Medica,Medical Assistance,,,,,Included in per diem rate,
POTASSIUM CHLORIDE 20 MEQ ORAL PACK,,9850,LOCAL,Facility,Outpatient,1,Each,,52,44.2,14.9032,52,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,25.896,49.8,,percent of total billed charges,,
POTASSIUM CHLORIDE 20 MEQ ORAL PACK,,9850,LOCAL,Facility,Inpatient,1,Each,,52,44.2,14.9032,52,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
POTASSIUM CHLORIDE 20 MEQ ORAL PACK,,9850,LOCAL,Facility,Both,1,Each,,52,44.2,14.9032,52,"Multiplan, Inc.","Multiplan, Inc.",48.88,94,,percent of total billed charges,,
POTASSIUM CHLORIDE 20 MEQ ORAL PACK,,9850,LOCAL,Facility,Outpatient,1,Each,,52,44.2,14.9032,52,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,46.852,90.1,,percent of total billed charges,,
POTASSIUM CHLORIDE 20 MEQ ORAL PACK,,9850,LOCAL,Facility,Inpatient,1,Each,,52,44.2,14.9032,52,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
POTASSIUM CHLORIDE 20 MEQ ORAL PACK,,9850,LOCAL,Facility,Both,1,Each,,52,44.2,14.9032,52,"Preferred One Administrative Services, INC.",PPO,51.272,98.6,,percent of total billed charges,,
POTASSIUM CHLORIDE 20 MEQ ORAL PACK,,9850,LOCAL,Facility,Outpatient,1,Each,,52,44.2,14.9032,52,PrimeWest Health,Minnesota Senior Health Options (MSHO),26.754,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
POTASSIUM CHLORIDE 20 MEQ ORAL PACK,,9850,LOCAL,Facility,Inpatient,1,Each,,52,44.2,14.9032,52,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
POTASSIUM CHLORIDE 20 MEQ ORAL PACK,,9850,LOCAL,Facility,Outpatient,1,Each,,52,44.2,14.9032,52,PrimeWest Health,MinnesotaCare,26.7072,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
POTASSIUM CHLORIDE 20 MEQ ORAL PACK,,9850,LOCAL,Facility,Inpatient,1,Each,,52,44.2,14.9032,52,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
POTASSIUM CHLORIDE 20 MEQ ORAL PACK,,9850,LOCAL,Facility,Both,1,Each,,52,44.2,14.9032,52,Sanford Health Plan,Sanford Health Plan,47.84,92,,percent of total billed charges,,
POTASSIUM CHLORIDE 20 MEQ ORAL PACK,,9850,LOCAL,Facility,Outpatient,1,Each,,52,44.2,14.9032,52,"UCare Health, Inc.",Individual & Family Plan,29.302,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
POTASSIUM CHLORIDE 20 MEQ ORAL PACK,,9850,LOCAL,Facility,Inpatient,1,Each,,52,44.2,14.9032,52,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
POTASSIUM CHLORIDE 20 MEQ ORAL PACK,,9850,LOCAL,Facility,Outpatient,1,Each,,52,44.2,14.9032,52,"UCare Health, Inc.",Medical Assistance,26.2444,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
POTASSIUM CHLORIDE 20 MEQ ORAL PACK,,9850,LOCAL,Facility,Inpatient,1,Each,,52,44.2,14.9032,52,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
POTASSIUM CHLORIDE 20 MEQ ORAL PACK,,9850,LOCAL,Facility,Outpatient,1,Each,,52,44.2,14.9032,52,"UCare Health, Inc.",Medicare Advantage,26.2444,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
POTASSIUM CHLORIDE 20 MEQ ORAL PACK,,9850,LOCAL,Facility,Inpatient,1,Each,,52,44.2,14.9032,52,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
POTASSIUM CHLORIDE 20 MEQ ORAL PACK,,9850,LOCAL,Facility,Outpatient,1,Each,,52,44.2,14.9032,52,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),26.2444,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
POTASSIUM CHLORIDE 20 MEQ ORAL PACK,,9850,LOCAL,Facility,Inpatient,1,Each,,52,44.2,14.9032,52,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
POTASSIUM CHLORIDE 20 MEQ ORAL PACK,,9850,LOCAL,Facility,Both,1,Each,,52,44.2,14.9032,52,UnitedHealthcare,Individual & Family,48.88,94,,percent of total billed charges,,
POTASSIUM CHLORIDE 20 MEQ ORAL PACK,,9850,LOCAL,Facility,Outpatient,1,Each,,52,44.2,14.9032,52,UnitedHealthcare,Medicare Advantage,25.48,49,,percent of total billed charges,,
POTASSIUM CHLORIDE 20 MEQ ORAL PACK,,9850,LOCAL,Facility,Inpatient,1,Each,,52,44.2,14.9032,52,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
POTASSIUM CHLORIDE 20 MEQ ORAL PACK,,9850,LOCAL,Facility,Outpatient,1,Each,,52,44.2,14.9032,52,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,24.96,48,,percent of total billed charges,,100% of DHS outpatient percentage
POTASSIUM CHLORIDE 20 MEQ ORAL PACK,,9850,LOCAL,Facility,Inpatient,1,Each,,52,44.2,14.9032,52,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
ALPRAZOLAM 0.25 MG ORAL TABLET,,9953,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
ALPRAZOLAM 0.25 MG ORAL TABLET,,9953,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
ALPRAZOLAM 0.25 MG ORAL TABLET,,9953,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
ALPRAZOLAM 0.25 MG ORAL TABLET,,9953,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
ALPRAZOLAM 0.25 MG ORAL TABLET,,9953,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
ALPRAZOLAM 0.25 MG ORAL TABLET,,9953,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
ALPRAZOLAM 0.25 MG ORAL TABLET,,9953,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
ALPRAZOLAM 0.25 MG ORAL TABLET,,9953,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
ALPRAZOLAM 0.25 MG ORAL TABLET,,9953,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
ALPRAZOLAM 0.25 MG ORAL TABLET,,9953,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
ALPRAZOLAM 0.25 MG ORAL TABLET,,9953,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
ALPRAZOLAM 0.25 MG ORAL TABLET,,9953,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
ALPRAZOLAM 0.25 MG ORAL TABLET,,9953,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
ALPRAZOLAM 0.25 MG ORAL TABLET,,9953,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
ALPRAZOLAM 0.25 MG ORAL TABLET,,9953,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
ALPRAZOLAM 0.25 MG ORAL TABLET,,9953,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
ALPRAZOLAM 0.25 MG ORAL TABLET,,9953,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
ALPRAZOLAM 0.25 MG ORAL TABLET,,9953,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
ALPRAZOLAM 0.25 MG ORAL TABLET,,9953,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ALPRAZOLAM 0.25 MG ORAL TABLET,,9953,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
ALPRAZOLAM 0.25 MG ORAL TABLET,,9953,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
ALPRAZOLAM 0.25 MG ORAL TABLET,,9953,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
ALPRAZOLAM 0.25 MG ORAL TABLET,,9953,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
ALPRAZOLAM 0.25 MG ORAL TABLET,,9953,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
ALPRAZOLAM 0.25 MG ORAL TABLET,,9953,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
ALPRAZOLAM 0.25 MG ORAL TABLET,,9953,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
ALPRAZOLAM 0.25 MG ORAL TABLET,,9953,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
ALPRAZOLAM 0.25 MG ORAL TABLET,,9953,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
ALPRAZOLAM 0.25 MG ORAL TABLET,,9953,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
ALPRAZOLAM 0.25 MG ORAL TABLET,,9953,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
ALPRAZOLAM 0.25 MG ORAL TABLET,,9953,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
ALPRAZOLAM 0.25 MG ORAL TABLET,,9953,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
ALPRAZOLAM 0.25 MG ORAL TABLET,,9953,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
ALPRAZOLAM 0.25 MG ORAL TABLET,,9953,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
ALPRAZOLAM 0.25 MG ORAL TABLET,,9953,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
ALPRAZOLAM 0.25 MG ORAL TABLET,,9953,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
ALPRAZOLAM 0.25 MG ORAL TABLET,,9953,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
ALPRAZOLAM 0.25 MG ORAL TABLET,,9953,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ALPRAZOLAM 0.25 MG ORAL TABLET,,9953,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
ALPRAZOLAM 0.25 MG ORAL TABLET,,9953,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
ALPRAZOLAM 0.25 MG ORAL TABLET,,9953,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
ALPRAZOLAM 0.25 MG ORAL TABLET,,9953,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
ALPRAZOLAM 0.25 MG ORAL TABLET,,9953,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
ALPRAZOLAM 0.25 MG ORAL TABLET,,9953,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ALPRAZOLAM 0.25 MG ORAL TABLET,,9953,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
ALPRAZOLAM 0.25 MG ORAL TABLET,,9953,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ALPRAZOLAM 0.25 MG ORAL TABLET,,9953,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ALPRAZOLAM 0.25 MG ORAL TABLET,,9953,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ALPRAZOLAM 0.25 MG ORAL TABLET,,9953,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ALPRAZOLAM 0.25 MG ORAL TABLET,,9953,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
ALPRAZOLAM 0.25 MG ORAL TABLET,,9953,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
ALPRAZOLAM 0.25 MG ORAL TABLET,,9953,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
ALPRAZOLAM 0.25 MG ORAL TABLET,,9953,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
ALPRAZOLAM 0.25 MG ORAL TABLET,,9953,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
CITALOPRAM 20 MG ORAL TABLET,,9999,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
CITALOPRAM 20 MG ORAL TABLET,,9999,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
CITALOPRAM 20 MG ORAL TABLET,,9999,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
CITALOPRAM 20 MG ORAL TABLET,,9999,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
CITALOPRAM 20 MG ORAL TABLET,,9999,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
CITALOPRAM 20 MG ORAL TABLET,,9999,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
CITALOPRAM 20 MG ORAL TABLET,,9999,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
CITALOPRAM 20 MG ORAL TABLET,,9999,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
CITALOPRAM 20 MG ORAL TABLET,,9999,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
CITALOPRAM 20 MG ORAL TABLET,,9999,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
CITALOPRAM 20 MG ORAL TABLET,,9999,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
CITALOPRAM 20 MG ORAL TABLET,,9999,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
CITALOPRAM 20 MG ORAL TABLET,,9999,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
CITALOPRAM 20 MG ORAL TABLET,,9999,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
CITALOPRAM 20 MG ORAL TABLET,,9999,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
CITALOPRAM 20 MG ORAL TABLET,,9999,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
CITALOPRAM 20 MG ORAL TABLET,,9999,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
CITALOPRAM 20 MG ORAL TABLET,,9999,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
CITALOPRAM 20 MG ORAL TABLET,,9999,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CITALOPRAM 20 MG ORAL TABLET,,9999,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
CITALOPRAM 20 MG ORAL TABLET,,9999,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
CITALOPRAM 20 MG ORAL TABLET,,9999,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
CITALOPRAM 20 MG ORAL TABLET,,9999,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
CITALOPRAM 20 MG ORAL TABLET,,9999,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
CITALOPRAM 20 MG ORAL TABLET,,9999,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
CITALOPRAM 20 MG ORAL TABLET,,9999,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
CITALOPRAM 20 MG ORAL TABLET,,9999,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
CITALOPRAM 20 MG ORAL TABLET,,9999,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
CITALOPRAM 20 MG ORAL TABLET,,9999,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
CITALOPRAM 20 MG ORAL TABLET,,9999,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
CITALOPRAM 20 MG ORAL TABLET,,9999,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
CITALOPRAM 20 MG ORAL TABLET,,9999,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
CITALOPRAM 20 MG ORAL TABLET,,9999,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
CITALOPRAM 20 MG ORAL TABLET,,9999,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
CITALOPRAM 20 MG ORAL TABLET,,9999,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
CITALOPRAM 20 MG ORAL TABLET,,9999,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
CITALOPRAM 20 MG ORAL TABLET,,9999,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
CITALOPRAM 20 MG ORAL TABLET,,9999,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CITALOPRAM 20 MG ORAL TABLET,,9999,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
CITALOPRAM 20 MG ORAL TABLET,,9999,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
CITALOPRAM 20 MG ORAL TABLET,,9999,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
CITALOPRAM 20 MG ORAL TABLET,,9999,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
CITALOPRAM 20 MG ORAL TABLET,,9999,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
CITALOPRAM 20 MG ORAL TABLET,,9999,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CITALOPRAM 20 MG ORAL TABLET,,9999,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
CITALOPRAM 20 MG ORAL TABLET,,9999,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CITALOPRAM 20 MG ORAL TABLET,,9999,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CITALOPRAM 20 MG ORAL TABLET,,9999,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CITALOPRAM 20 MG ORAL TABLET,,9999,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CITALOPRAM 20 MG ORAL TABLET,,9999,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
CITALOPRAM 20 MG ORAL TABLET,,9999,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
CITALOPRAM 20 MG ORAL TABLET,,9999,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
CITALOPRAM 20 MG ORAL TABLET,,9999,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
CITALOPRAM 20 MG ORAL TABLET,,9999,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
POTASSIUM CHLORIDE 20 MEQ ORAL TBTQ,,10076,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
POTASSIUM CHLORIDE 20 MEQ ORAL TBTQ,,10076,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
POTASSIUM CHLORIDE 20 MEQ ORAL TBTQ,,10076,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
POTASSIUM CHLORIDE 20 MEQ ORAL TBTQ,,10076,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
POTASSIUM CHLORIDE 20 MEQ ORAL TBTQ,,10076,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
POTASSIUM CHLORIDE 20 MEQ ORAL TBTQ,,10076,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
POTASSIUM CHLORIDE 20 MEQ ORAL TBTQ,,10076,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
POTASSIUM CHLORIDE 20 MEQ ORAL TBTQ,,10076,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
POTASSIUM CHLORIDE 20 MEQ ORAL TBTQ,,10076,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
POTASSIUM CHLORIDE 20 MEQ ORAL TBTQ,,10076,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
POTASSIUM CHLORIDE 20 MEQ ORAL TBTQ,,10076,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
POTASSIUM CHLORIDE 20 MEQ ORAL TBTQ,,10076,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
POTASSIUM CHLORIDE 20 MEQ ORAL TBTQ,,10076,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
POTASSIUM CHLORIDE 20 MEQ ORAL TBTQ,,10076,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
POTASSIUM CHLORIDE 20 MEQ ORAL TBTQ,,10076,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
POTASSIUM CHLORIDE 20 MEQ ORAL TBTQ,,10076,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
POTASSIUM CHLORIDE 20 MEQ ORAL TBTQ,,10076,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
POTASSIUM CHLORIDE 20 MEQ ORAL TBTQ,,10076,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
POTASSIUM CHLORIDE 20 MEQ ORAL TBTQ,,10076,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
POTASSIUM CHLORIDE 20 MEQ ORAL TBTQ,,10076,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
POTASSIUM CHLORIDE 20 MEQ ORAL TBTQ,,10076,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
POTASSIUM CHLORIDE 20 MEQ ORAL TBTQ,,10076,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
POTASSIUM CHLORIDE 20 MEQ ORAL TBTQ,,10076,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
POTASSIUM CHLORIDE 20 MEQ ORAL TBTQ,,10076,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
POTASSIUM CHLORIDE 20 MEQ ORAL TBTQ,,10076,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
POTASSIUM CHLORIDE 20 MEQ ORAL TBTQ,,10076,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
POTASSIUM CHLORIDE 20 MEQ ORAL TBTQ,,10076,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
POTASSIUM CHLORIDE 20 MEQ ORAL TBTQ,,10076,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
POTASSIUM CHLORIDE 20 MEQ ORAL TBTQ,,10076,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
POTASSIUM CHLORIDE 20 MEQ ORAL TBTQ,,10076,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
POTASSIUM CHLORIDE 20 MEQ ORAL TBTQ,,10076,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
POTASSIUM CHLORIDE 20 MEQ ORAL TBTQ,,10076,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
POTASSIUM CHLORIDE 20 MEQ ORAL TBTQ,,10076,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
POTASSIUM CHLORIDE 20 MEQ ORAL TBTQ,,10076,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
POTASSIUM CHLORIDE 20 MEQ ORAL TBTQ,,10076,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
POTASSIUM CHLORIDE 20 MEQ ORAL TBTQ,,10076,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
POTASSIUM CHLORIDE 20 MEQ ORAL TBTQ,,10076,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
POTASSIUM CHLORIDE 20 MEQ ORAL TBTQ,,10076,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
POTASSIUM CHLORIDE 20 MEQ ORAL TBTQ,,10076,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
POTASSIUM CHLORIDE 20 MEQ ORAL TBTQ,,10076,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
POTASSIUM CHLORIDE 20 MEQ ORAL TBTQ,,10076,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
POTASSIUM CHLORIDE 20 MEQ ORAL TBTQ,,10076,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
POTASSIUM CHLORIDE 20 MEQ ORAL TBTQ,,10076,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
POTASSIUM CHLORIDE 20 MEQ ORAL TBTQ,,10076,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
POTASSIUM CHLORIDE 20 MEQ ORAL TBTQ,,10076,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
POTASSIUM CHLORIDE 20 MEQ ORAL TBTQ,,10076,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
POTASSIUM CHLORIDE 20 MEQ ORAL TBTQ,,10076,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
POTASSIUM CHLORIDE 20 MEQ ORAL TBTQ,,10076,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
POTASSIUM CHLORIDE 20 MEQ ORAL TBTQ,,10076,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
POTASSIUM CHLORIDE 20 MEQ ORAL TBTQ,,10076,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
POTASSIUM CHLORIDE 20 MEQ ORAL TBTQ,,10076,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
POTASSIUM CHLORIDE 20 MEQ ORAL TBTQ,,10076,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
POTASSIUM CHLORIDE 20 MEQ ORAL TBTQ,,10076,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
POTASSIUM CHLORIDE 20 MEQ ORAL TBTQ,,10076,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
FAMOTIDINE 20 MG ORAL TABLET,,10104,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
FAMOTIDINE 20 MG ORAL TABLET,,10104,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
FAMOTIDINE 20 MG ORAL TABLET,,10104,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
FAMOTIDINE 20 MG ORAL TABLET,,10104,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
FAMOTIDINE 20 MG ORAL TABLET,,10104,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
FAMOTIDINE 20 MG ORAL TABLET,,10104,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
FAMOTIDINE 20 MG ORAL TABLET,,10104,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
FAMOTIDINE 20 MG ORAL TABLET,,10104,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
FAMOTIDINE 20 MG ORAL TABLET,,10104,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
FAMOTIDINE 20 MG ORAL TABLET,,10104,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
FAMOTIDINE 20 MG ORAL TABLET,,10104,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
FAMOTIDINE 20 MG ORAL TABLET,,10104,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
FAMOTIDINE 20 MG ORAL TABLET,,10104,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
FAMOTIDINE 20 MG ORAL TABLET,,10104,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
FAMOTIDINE 20 MG ORAL TABLET,,10104,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
FAMOTIDINE 20 MG ORAL TABLET,,10104,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
FAMOTIDINE 20 MG ORAL TABLET,,10104,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
FAMOTIDINE 20 MG ORAL TABLET,,10104,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
FAMOTIDINE 20 MG ORAL TABLET,,10104,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
FAMOTIDINE 20 MG ORAL TABLET,,10104,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
FAMOTIDINE 20 MG ORAL TABLET,,10104,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
FAMOTIDINE 20 MG ORAL TABLET,,10104,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
FAMOTIDINE 20 MG ORAL TABLET,,10104,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
FAMOTIDINE 20 MG ORAL TABLET,,10104,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
FAMOTIDINE 20 MG ORAL TABLET,,10104,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
FAMOTIDINE 20 MG ORAL TABLET,,10104,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
FAMOTIDINE 20 MG ORAL TABLET,,10104,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
FAMOTIDINE 20 MG ORAL TABLET,,10104,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
FAMOTIDINE 20 MG ORAL TABLET,,10104,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
FAMOTIDINE 20 MG ORAL TABLET,,10104,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
FAMOTIDINE 20 MG ORAL TABLET,,10104,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
FAMOTIDINE 20 MG ORAL TABLET,,10104,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
FAMOTIDINE 20 MG ORAL TABLET,,10104,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
FAMOTIDINE 20 MG ORAL TABLET,,10104,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
FAMOTIDINE 20 MG ORAL TABLET,,10104,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
FAMOTIDINE 20 MG ORAL TABLET,,10104,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
FAMOTIDINE 20 MG ORAL TABLET,,10104,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
FAMOTIDINE 20 MG ORAL TABLET,,10104,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
FAMOTIDINE 20 MG ORAL TABLET,,10104,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
FAMOTIDINE 20 MG ORAL TABLET,,10104,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
FAMOTIDINE 20 MG ORAL TABLET,,10104,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
FAMOTIDINE 20 MG ORAL TABLET,,10104,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
FAMOTIDINE 20 MG ORAL TABLET,,10104,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
FAMOTIDINE 20 MG ORAL TABLET,,10104,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FAMOTIDINE 20 MG ORAL TABLET,,10104,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
FAMOTIDINE 20 MG ORAL TABLET,,10104,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FAMOTIDINE 20 MG ORAL TABLET,,10104,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
FAMOTIDINE 20 MG ORAL TABLET,,10104,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FAMOTIDINE 20 MG ORAL TABLET,,10104,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
FAMOTIDINE 20 MG ORAL TABLET,,10104,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
FAMOTIDINE 20 MG ORAL TABLET,,10104,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
FAMOTIDINE 20 MG ORAL TABLET,,10104,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
FAMOTIDINE 20 MG ORAL TABLET,,10104,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
FAMOTIDINE 20 MG ORAL TABLET,,10104,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
AMITRIPTYLINE 25 MG ORAL TABLET,,10158,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
AMITRIPTYLINE 25 MG ORAL TABLET,,10158,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
AMITRIPTYLINE 25 MG ORAL TABLET,,10158,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
AMITRIPTYLINE 25 MG ORAL TABLET,,10158,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
AMITRIPTYLINE 25 MG ORAL TABLET,,10158,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
AMITRIPTYLINE 25 MG ORAL TABLET,,10158,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
AMITRIPTYLINE 25 MG ORAL TABLET,,10158,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
AMITRIPTYLINE 25 MG ORAL TABLET,,10158,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
AMITRIPTYLINE 25 MG ORAL TABLET,,10158,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
AMITRIPTYLINE 25 MG ORAL TABLET,,10158,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
AMITRIPTYLINE 25 MG ORAL TABLET,,10158,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
AMITRIPTYLINE 25 MG ORAL TABLET,,10158,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
AMITRIPTYLINE 25 MG ORAL TABLET,,10158,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
AMITRIPTYLINE 25 MG ORAL TABLET,,10158,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
AMITRIPTYLINE 25 MG ORAL TABLET,,10158,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
AMITRIPTYLINE 25 MG ORAL TABLET,,10158,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
AMITRIPTYLINE 25 MG ORAL TABLET,,10158,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
AMITRIPTYLINE 25 MG ORAL TABLET,,10158,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
AMITRIPTYLINE 25 MG ORAL TABLET,,10158,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
AMITRIPTYLINE 25 MG ORAL TABLET,,10158,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
AMITRIPTYLINE 25 MG ORAL TABLET,,10158,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
AMITRIPTYLINE 25 MG ORAL TABLET,,10158,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
AMITRIPTYLINE 25 MG ORAL TABLET,,10158,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
AMITRIPTYLINE 25 MG ORAL TABLET,,10158,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
AMITRIPTYLINE 25 MG ORAL TABLET,,10158,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
AMITRIPTYLINE 25 MG ORAL TABLET,,10158,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
AMITRIPTYLINE 25 MG ORAL TABLET,,10158,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
AMITRIPTYLINE 25 MG ORAL TABLET,,10158,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
AMITRIPTYLINE 25 MG ORAL TABLET,,10158,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
AMITRIPTYLINE 25 MG ORAL TABLET,,10158,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
AMITRIPTYLINE 25 MG ORAL TABLET,,10158,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
AMITRIPTYLINE 25 MG ORAL TABLET,,10158,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
AMITRIPTYLINE 25 MG ORAL TABLET,,10158,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
AMITRIPTYLINE 25 MG ORAL TABLET,,10158,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
AMITRIPTYLINE 25 MG ORAL TABLET,,10158,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
AMITRIPTYLINE 25 MG ORAL TABLET,,10158,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
AMITRIPTYLINE 25 MG ORAL TABLET,,10158,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
AMITRIPTYLINE 25 MG ORAL TABLET,,10158,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
AMITRIPTYLINE 25 MG ORAL TABLET,,10158,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
AMITRIPTYLINE 25 MG ORAL TABLET,,10158,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
AMITRIPTYLINE 25 MG ORAL TABLET,,10158,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
AMITRIPTYLINE 25 MG ORAL TABLET,,10158,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
AMITRIPTYLINE 25 MG ORAL TABLET,,10158,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
AMITRIPTYLINE 25 MG ORAL TABLET,,10158,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
AMITRIPTYLINE 25 MG ORAL TABLET,,10158,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
AMITRIPTYLINE 25 MG ORAL TABLET,,10158,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
AMITRIPTYLINE 25 MG ORAL TABLET,,10158,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
AMITRIPTYLINE 25 MG ORAL TABLET,,10158,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
AMITRIPTYLINE 25 MG ORAL TABLET,,10158,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
AMITRIPTYLINE 25 MG ORAL TABLET,,10158,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
AMITRIPTYLINE 25 MG ORAL TABLET,,10158,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
AMITRIPTYLINE 25 MG ORAL TABLET,,10158,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
AMITRIPTYLINE 25 MG ORAL TABLET,,10158,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
AMITRIPTYLINE 25 MG ORAL TABLET,,10158,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
PRIMIDONE 250 MG ORAL TABLET,,10170,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
PRIMIDONE 250 MG ORAL TABLET,,10170,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
PRIMIDONE 250 MG ORAL TABLET,,10170,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
PRIMIDONE 250 MG ORAL TABLET,,10170,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
PRIMIDONE 250 MG ORAL TABLET,,10170,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
PRIMIDONE 250 MG ORAL TABLET,,10170,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
PRIMIDONE 250 MG ORAL TABLET,,10170,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
PRIMIDONE 250 MG ORAL TABLET,,10170,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
PRIMIDONE 250 MG ORAL TABLET,,10170,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
PRIMIDONE 250 MG ORAL TABLET,,10170,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
PRIMIDONE 250 MG ORAL TABLET,,10170,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
PRIMIDONE 250 MG ORAL TABLET,,10170,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
PRIMIDONE 250 MG ORAL TABLET,,10170,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
PRIMIDONE 250 MG ORAL TABLET,,10170,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
PRIMIDONE 250 MG ORAL TABLET,,10170,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
PRIMIDONE 250 MG ORAL TABLET,,10170,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
PRIMIDONE 250 MG ORAL TABLET,,10170,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
PRIMIDONE 250 MG ORAL TABLET,,10170,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
PRIMIDONE 250 MG ORAL TABLET,,10170,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PRIMIDONE 250 MG ORAL TABLET,,10170,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
PRIMIDONE 250 MG ORAL TABLET,,10170,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
PRIMIDONE 250 MG ORAL TABLET,,10170,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
PRIMIDONE 250 MG ORAL TABLET,,10170,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
PRIMIDONE 250 MG ORAL TABLET,,10170,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
PRIMIDONE 250 MG ORAL TABLET,,10170,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
PRIMIDONE 250 MG ORAL TABLET,,10170,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
PRIMIDONE 250 MG ORAL TABLET,,10170,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
PRIMIDONE 250 MG ORAL TABLET,,10170,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
PRIMIDONE 250 MG ORAL TABLET,,10170,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
PRIMIDONE 250 MG ORAL TABLET,,10170,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
PRIMIDONE 250 MG ORAL TABLET,,10170,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
PRIMIDONE 250 MG ORAL TABLET,,10170,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
PRIMIDONE 250 MG ORAL TABLET,,10170,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
PRIMIDONE 250 MG ORAL TABLET,,10170,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
PRIMIDONE 250 MG ORAL TABLET,,10170,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
PRIMIDONE 250 MG ORAL TABLET,,10170,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
PRIMIDONE 250 MG ORAL TABLET,,10170,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
PRIMIDONE 250 MG ORAL TABLET,,10170,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PRIMIDONE 250 MG ORAL TABLET,,10170,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
PRIMIDONE 250 MG ORAL TABLET,,10170,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
PRIMIDONE 250 MG ORAL TABLET,,10170,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
PRIMIDONE 250 MG ORAL TABLET,,10170,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
PRIMIDONE 250 MG ORAL TABLET,,10170,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
PRIMIDONE 250 MG ORAL TABLET,,10170,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PRIMIDONE 250 MG ORAL TABLET,,10170,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
PRIMIDONE 250 MG ORAL TABLET,,10170,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PRIMIDONE 250 MG ORAL TABLET,,10170,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PRIMIDONE 250 MG ORAL TABLET,,10170,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PRIMIDONE 250 MG ORAL TABLET,,10170,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PRIMIDONE 250 MG ORAL TABLET,,10170,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
PRIMIDONE 250 MG ORAL TABLET,,10170,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
PRIMIDONE 250 MG ORAL TABLET,,10170,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
PRIMIDONE 250 MG ORAL TABLET,,10170,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
PRIMIDONE 250 MG ORAL TABLET,,10170,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) ORAL TABLET,,10200,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) ORAL TABLET,,10200,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) ORAL TABLET,,10200,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) ORAL TABLET,,10200,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) ORAL TABLET,,10200,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) ORAL TABLET,,10200,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) ORAL TABLET,,10200,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) ORAL TABLET,,10200,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) ORAL TABLET,,10200,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) ORAL TABLET,,10200,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) ORAL TABLET,,10200,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) ORAL TABLET,,10200,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) ORAL TABLET,,10200,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) ORAL TABLET,,10200,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) ORAL TABLET,,10200,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) ORAL TABLET,,10200,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) ORAL TABLET,,10200,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) ORAL TABLET,,10200,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) ORAL TABLET,,10200,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) ORAL TABLET,,10200,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) ORAL TABLET,,10200,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) ORAL TABLET,,10200,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) ORAL TABLET,,10200,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) ORAL TABLET,,10200,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) ORAL TABLET,,10200,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) ORAL TABLET,,10200,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) ORAL TABLET,,10200,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) ORAL TABLET,,10200,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) ORAL TABLET,,10200,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) ORAL TABLET,,10200,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) ORAL TABLET,,10200,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) ORAL TABLET,,10200,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) ORAL TABLET,,10200,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) ORAL TABLET,,10200,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) ORAL TABLET,,10200,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) ORAL TABLET,,10200,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) ORAL TABLET,,10200,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) ORAL TABLET,,10200,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) ORAL TABLET,,10200,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) ORAL TABLET,,10200,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) ORAL TABLET,,10200,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) ORAL TABLET,,10200,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) ORAL TABLET,,10200,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) ORAL TABLET,,10200,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) ORAL TABLET,,10200,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) ORAL TABLET,,10200,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) ORAL TABLET,,10200,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) ORAL TABLET,,10200,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) ORAL TABLET,,10200,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) ORAL TABLET,,10200,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) ORAL TABLET,,10200,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) ORAL TABLET,,10200,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) ORAL TABLET,,10200,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) ORAL TABLET,,10200,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
LORAZEPAM 0.5 MG ORAL TABLET,,10301,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
LORAZEPAM 0.5 MG ORAL TABLET,,10301,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
LORAZEPAM 0.5 MG ORAL TABLET,,10301,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
LORAZEPAM 0.5 MG ORAL TABLET,,10301,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
LORAZEPAM 0.5 MG ORAL TABLET,,10301,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
LORAZEPAM 0.5 MG ORAL TABLET,,10301,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
LORAZEPAM 0.5 MG ORAL TABLET,,10301,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
LORAZEPAM 0.5 MG ORAL TABLET,,10301,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
LORAZEPAM 0.5 MG ORAL TABLET,,10301,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
LORAZEPAM 0.5 MG ORAL TABLET,,10301,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
LORAZEPAM 0.5 MG ORAL TABLET,,10301,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
LORAZEPAM 0.5 MG ORAL TABLET,,10301,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
LORAZEPAM 0.5 MG ORAL TABLET,,10301,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
LORAZEPAM 0.5 MG ORAL TABLET,,10301,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
LORAZEPAM 0.5 MG ORAL TABLET,,10301,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
LORAZEPAM 0.5 MG ORAL TABLET,,10301,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
LORAZEPAM 0.5 MG ORAL TABLET,,10301,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
LORAZEPAM 0.5 MG ORAL TABLET,,10301,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
LORAZEPAM 0.5 MG ORAL TABLET,,10301,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
LORAZEPAM 0.5 MG ORAL TABLET,,10301,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
LORAZEPAM 0.5 MG ORAL TABLET,,10301,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
LORAZEPAM 0.5 MG ORAL TABLET,,10301,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
LORAZEPAM 0.5 MG ORAL TABLET,,10301,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
LORAZEPAM 0.5 MG ORAL TABLET,,10301,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
LORAZEPAM 0.5 MG ORAL TABLET,,10301,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
LORAZEPAM 0.5 MG ORAL TABLET,,10301,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
LORAZEPAM 0.5 MG ORAL TABLET,,10301,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
LORAZEPAM 0.5 MG ORAL TABLET,,10301,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
LORAZEPAM 0.5 MG ORAL TABLET,,10301,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
LORAZEPAM 0.5 MG ORAL TABLET,,10301,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
LORAZEPAM 0.5 MG ORAL TABLET,,10301,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
LORAZEPAM 0.5 MG ORAL TABLET,,10301,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
LORAZEPAM 0.5 MG ORAL TABLET,,10301,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
LORAZEPAM 0.5 MG ORAL TABLET,,10301,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
LORAZEPAM 0.5 MG ORAL TABLET,,10301,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
LORAZEPAM 0.5 MG ORAL TABLET,,10301,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
LORAZEPAM 0.5 MG ORAL TABLET,,10301,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
LORAZEPAM 0.5 MG ORAL TABLET,,10301,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
LORAZEPAM 0.5 MG ORAL TABLET,,10301,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
LORAZEPAM 0.5 MG ORAL TABLET,,10301,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
LORAZEPAM 0.5 MG ORAL TABLET,,10301,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
LORAZEPAM 0.5 MG ORAL TABLET,,10301,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
LORAZEPAM 0.5 MG ORAL TABLET,,10301,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
LORAZEPAM 0.5 MG ORAL TABLET,,10301,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
LORAZEPAM 0.5 MG ORAL TABLET,,10301,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
LORAZEPAM 0.5 MG ORAL TABLET,,10301,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
LORAZEPAM 0.5 MG ORAL TABLET,,10301,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
LORAZEPAM 0.5 MG ORAL TABLET,,10301,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
LORAZEPAM 0.5 MG ORAL TABLET,,10301,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
LORAZEPAM 0.5 MG ORAL TABLET,,10301,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
LORAZEPAM 0.5 MG ORAL TABLET,,10301,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
LORAZEPAM 0.5 MG ORAL TABLET,,10301,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
LORAZEPAM 0.5 MG ORAL TABLET,,10301,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
LORAZEPAM 0.5 MG ORAL TABLET,,10301,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
LORAZEPAM 0.5 MG ORAL TABLET,,10301,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LORAZEPAM 0.5 MG ORAL TABLET,,10301,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LORAZEPAM 0.5 MG ORAL TABLET,,10301,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LORAZEPAM 0.5 MG ORAL TABLET,,10301,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
LORAZEPAM 0.5 MG ORAL TABLET,,10301,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
LORAZEPAM 0.5 MG ORAL TABLET,,10301,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
LORAZEPAM 0.5 MG ORAL TABLET,,10301,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
LORAZEPAM 0.5 MG ORAL TABLET,,10301,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
LORAZEPAM 0.5 MG ORAL TABLET,,10301,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
LORAZEPAM 0.5 MG ORAL TABLET,,10301,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
LORAZEPAM 0.5 MG ORAL TABLET,,10301,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
LORAZEPAM 0.5 MG ORAL TABLET,,10301,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
LORAZEPAM 0.5 MG ORAL TABLET,,10301,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
LORAZEPAM 0.5 MG ORAL TABLET,,10301,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
LORAZEPAM 0.5 MG ORAL TABLET,,10301,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
LORAZEPAM 0.5 MG ORAL TABLET,,10301,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
LORAZEPAM 0.5 MG ORAL TABLET,,10301,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
LORAZEPAM 0.5 MG ORAL TABLET,,10301,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
LORAZEPAM 0.5 MG ORAL TABLET,,10301,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
LORAZEPAM 0.5 MG ORAL TABLET,,10301,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
LORAZEPAM 0.5 MG ORAL TABLET,,10301,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
LORAZEPAM 0.5 MG ORAL TABLET,,10301,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
LORAZEPAM 0.5 MG ORAL TABLET,,10301,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
LORAZEPAM 0.5 MG ORAL TABLET,,10301,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
LORAZEPAM 0.5 MG ORAL TABLET,,10301,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
LORAZEPAM 0.5 MG ORAL TABLET,,10301,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
LORAZEPAM 0.5 MG ORAL TABLET,,10301,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
LORAZEPAM 0.5 MG ORAL TABLET,,10301,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
LORAZEPAM 0.5 MG ORAL TABLET,,10301,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
LORAZEPAM 0.5 MG ORAL TABLET,,10301,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
LORAZEPAM 0.5 MG ORAL TABLET,,10301,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
LORAZEPAM 0.5 MG ORAL TABLET,,10301,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
LORAZEPAM 0.5 MG ORAL TABLET,,10301,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
LORAZEPAM 0.5 MG ORAL TABLET,,10301,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
LORAZEPAM 0.5 MG ORAL TABLET,,10301,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
LORAZEPAM 0.5 MG ORAL TABLET,,10301,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
LORAZEPAM 0.5 MG ORAL TABLET,,10301,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
LORAZEPAM 0.5 MG ORAL TABLET,,10301,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
LORAZEPAM 0.5 MG ORAL TABLET,,10301,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
LORAZEPAM 0.5 MG ORAL TABLET,,10301,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
LORAZEPAM 0.5 MG ORAL TABLET,,10301,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
LORAZEPAM 0.5 MG ORAL TABLET,,10301,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
LORAZEPAM 0.5 MG ORAL TABLET,,10301,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
LORAZEPAM 0.5 MG ORAL TABLET,,10301,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
LORAZEPAM 0.5 MG ORAL TABLET,,10301,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
LORAZEPAM 0.5 MG ORAL TABLET,,10301,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
LORAZEPAM 0.5 MG ORAL TABLET,,10301,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
LORAZEPAM 0.5 MG ORAL TABLET,,10301,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
LORAZEPAM 0.5 MG ORAL TABLET,,10301,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
LORAZEPAM 0.5 MG ORAL TABLET,,10301,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
LORAZEPAM 0.5 MG ORAL TABLET,,10301,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
LORAZEPAM 0.5 MG ORAL TABLET,,10301,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
LORAZEPAM 0.5 MG ORAL TABLET,,10301,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
LORAZEPAM 0.5 MG ORAL TABLET,,10301,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
LORAZEPAM 0.5 MG ORAL TABLET,,10301,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
LORAZEPAM 0.5 MG ORAL TABLET,,10301,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
LORAZEPAM 0.5 MG ORAL TABLET,,10301,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
LORAZEPAM 0.5 MG ORAL TABLET,,10301,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LORAZEPAM 0.5 MG ORAL TABLET,,10301,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LORAZEPAM 0.5 MG ORAL TABLET,,10301,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LORAZEPAM 0.5 MG ORAL TABLET,,10301,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
LORAZEPAM 0.5 MG ORAL TABLET,,10301,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
LORAZEPAM 0.5 MG ORAL TABLET,,10301,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
LORAZEPAM 0.5 MG ORAL TABLET,,10301,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
LORAZEPAM 0.5 MG ORAL TABLET,,10301,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
LORAZEPAM 0.5 MG ORAL TABLET,,10301,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
LORAZEPAM 0.5 MG ORAL TABLET,,10301,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
LORAZEPAM 0.5 MG ORAL TABLET,,10301,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
LORAZEPAM 0.5 MG ORAL TABLET,,10301,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
LORAZEPAM 0.5 MG ORAL TABLET,,10301,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
LORAZEPAM 0.5 MG ORAL TABLET,,10301,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
LORAZEPAM 0.5 MG ORAL TABLET,,10301,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
LORAZEPAM 0.5 MG ORAL TABLET,,10301,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
LORAZEPAM 0.5 MG ORAL TABLET,,10301,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
LORAZEPAM 0.5 MG ORAL TABLET,,10301,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
LORAZEPAM 0.5 MG ORAL TABLET,,10301,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LORAZEPAM 0.5 MG ORAL TABLET,,10301,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LORAZEPAM 0.5 MG ORAL TABLET,,10301,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LORAZEPAM 0.5 MG ORAL TABLET,,10301,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
LORAZEPAM 0.5 MG ORAL TABLET,,10301,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
LORAZEPAM 0.5 MG ORAL TABLET,,10301,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
LORAZEPAM 0.5 MG ORAL TABLET,,10301,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LORAZEPAM 0.5 MG ORAL TABLET,,10301,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LORAZEPAM 0.5 MG ORAL TABLET,,10301,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LORAZEPAM 0.5 MG ORAL TABLET,,10301,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LORAZEPAM 0.5 MG ORAL TABLET,,10301,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LORAZEPAM 0.5 MG ORAL TABLET,,10301,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LORAZEPAM 0.5 MG ORAL TABLET,,10301,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LORAZEPAM 0.5 MG ORAL TABLET,,10301,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LORAZEPAM 0.5 MG ORAL TABLET,,10301,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LORAZEPAM 0.5 MG ORAL TABLET,,10301,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LORAZEPAM 0.5 MG ORAL TABLET,,10301,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LORAZEPAM 0.5 MG ORAL TABLET,,10301,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LORAZEPAM 0.5 MG ORAL TABLET,,10301,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
LORAZEPAM 0.5 MG ORAL TABLET,,10301,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
LORAZEPAM 0.5 MG ORAL TABLET,,10301,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
LORAZEPAM 0.5 MG ORAL TABLET,,10301,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
LORAZEPAM 0.5 MG ORAL TABLET,,10301,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
LORAZEPAM 0.5 MG ORAL TABLET,,10301,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
LORAZEPAM 0.5 MG ORAL TABLET,,10301,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
LORAZEPAM 0.5 MG ORAL TABLET,,10301,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
LORAZEPAM 0.5 MG ORAL TABLET,,10301,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
LORAZEPAM 0.5 MG ORAL TABLET,,10301,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
LORAZEPAM 0.5 MG ORAL TABLET,,10301,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
LORAZEPAM 0.5 MG ORAL TABLET,,10301,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
LORAZEPAM 0.5 MG ORAL TABLET,,10301,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
LORAZEPAM 0.5 MG ORAL TABLET,,10301,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
LORAZEPAM 0.5 MG ORAL TABLET,,10301,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
ACETAMINOPHEN 120 MG RECT SUPP,,10341,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
ACETAMINOPHEN 120 MG RECT SUPP,,10341,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
ACETAMINOPHEN 120 MG RECT SUPP,,10341,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
ACETAMINOPHEN 120 MG RECT SUPP,,10341,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
ACETAMINOPHEN 120 MG RECT SUPP,,10341,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
ACETAMINOPHEN 120 MG RECT SUPP,,10341,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
ACETAMINOPHEN 120 MG RECT SUPP,,10341,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
ACETAMINOPHEN 120 MG RECT SUPP,,10341,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
ACETAMINOPHEN 120 MG RECT SUPP,,10341,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
ACETAMINOPHEN 120 MG RECT SUPP,,10341,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
ACETAMINOPHEN 120 MG RECT SUPP,,10341,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
ACETAMINOPHEN 120 MG RECT SUPP,,10341,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
ACETAMINOPHEN 120 MG RECT SUPP,,10341,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
ACETAMINOPHEN 120 MG RECT SUPP,,10341,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
ACETAMINOPHEN 120 MG RECT SUPP,,10341,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
ACETAMINOPHEN 120 MG RECT SUPP,,10341,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
ACETAMINOPHEN 120 MG RECT SUPP,,10341,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
ACETAMINOPHEN 120 MG RECT SUPP,,10341,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
ACETAMINOPHEN 120 MG RECT SUPP,,10341,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ACETAMINOPHEN 120 MG RECT SUPP,,10341,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
ACETAMINOPHEN 120 MG RECT SUPP,,10341,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
ACETAMINOPHEN 120 MG RECT SUPP,,10341,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
ACETAMINOPHEN 120 MG RECT SUPP,,10341,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
ACETAMINOPHEN 120 MG RECT SUPP,,10341,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
ACETAMINOPHEN 120 MG RECT SUPP,,10341,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
ACETAMINOPHEN 120 MG RECT SUPP,,10341,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
ACETAMINOPHEN 120 MG RECT SUPP,,10341,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
ACETAMINOPHEN 120 MG RECT SUPP,,10341,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
ACETAMINOPHEN 120 MG RECT SUPP,,10341,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
ACETAMINOPHEN 120 MG RECT SUPP,,10341,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
ACETAMINOPHEN 120 MG RECT SUPP,,10341,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
ACETAMINOPHEN 120 MG RECT SUPP,,10341,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
ACETAMINOPHEN 120 MG RECT SUPP,,10341,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
ACETAMINOPHEN 120 MG RECT SUPP,,10341,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
ACETAMINOPHEN 120 MG RECT SUPP,,10341,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
ACETAMINOPHEN 120 MG RECT SUPP,,10341,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
ACETAMINOPHEN 120 MG RECT SUPP,,10341,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
ACETAMINOPHEN 120 MG RECT SUPP,,10341,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ACETAMINOPHEN 120 MG RECT SUPP,,10341,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
ACETAMINOPHEN 120 MG RECT SUPP,,10341,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
ACETAMINOPHEN 120 MG RECT SUPP,,10341,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
ACETAMINOPHEN 120 MG RECT SUPP,,10341,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
ACETAMINOPHEN 120 MG RECT SUPP,,10341,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
ACETAMINOPHEN 120 MG RECT SUPP,,10341,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ACETAMINOPHEN 120 MG RECT SUPP,,10341,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
ACETAMINOPHEN 120 MG RECT SUPP,,10341,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ACETAMINOPHEN 120 MG RECT SUPP,,10341,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ACETAMINOPHEN 120 MG RECT SUPP,,10341,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ACETAMINOPHEN 120 MG RECT SUPP,,10341,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ACETAMINOPHEN 120 MG RECT SUPP,,10341,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
ACETAMINOPHEN 120 MG RECT SUPP,,10341,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
ACETAMINOPHEN 120 MG RECT SUPP,,10341,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
ACETAMINOPHEN 120 MG RECT SUPP,,10341,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
ACETAMINOPHEN 120 MG RECT SUPP,,10341,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
TEMAZEPAM 15 MG ORAL CAP,,10388,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
TEMAZEPAM 15 MG ORAL CAP,,10388,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
TEMAZEPAM 15 MG ORAL CAP,,10388,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
TEMAZEPAM 15 MG ORAL CAP,,10388,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
TEMAZEPAM 15 MG ORAL CAP,,10388,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
TEMAZEPAM 15 MG ORAL CAP,,10388,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
TEMAZEPAM 15 MG ORAL CAP,,10388,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
TEMAZEPAM 15 MG ORAL CAP,,10388,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
TEMAZEPAM 15 MG ORAL CAP,,10388,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
TEMAZEPAM 15 MG ORAL CAP,,10388,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
TEMAZEPAM 15 MG ORAL CAP,,10388,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
TEMAZEPAM 15 MG ORAL CAP,,10388,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
TEMAZEPAM 15 MG ORAL CAP,,10388,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
TEMAZEPAM 15 MG ORAL CAP,,10388,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
TEMAZEPAM 15 MG ORAL CAP,,10388,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
TEMAZEPAM 15 MG ORAL CAP,,10388,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
TEMAZEPAM 15 MG ORAL CAP,,10388,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
TEMAZEPAM 15 MG ORAL CAP,,10388,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
TEMAZEPAM 15 MG ORAL CAP,,10388,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
TEMAZEPAM 15 MG ORAL CAP,,10388,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
TEMAZEPAM 15 MG ORAL CAP,,10388,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
TEMAZEPAM 15 MG ORAL CAP,,10388,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
TEMAZEPAM 15 MG ORAL CAP,,10388,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
TEMAZEPAM 15 MG ORAL CAP,,10388,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
TEMAZEPAM 15 MG ORAL CAP,,10388,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
TEMAZEPAM 15 MG ORAL CAP,,10388,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
TEMAZEPAM 15 MG ORAL CAP,,10388,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
TEMAZEPAM 15 MG ORAL CAP,,10388,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
TEMAZEPAM 15 MG ORAL CAP,,10388,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
TEMAZEPAM 15 MG ORAL CAP,,10388,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
TEMAZEPAM 15 MG ORAL CAP,,10388,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
TEMAZEPAM 15 MG ORAL CAP,,10388,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
TEMAZEPAM 15 MG ORAL CAP,,10388,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
TEMAZEPAM 15 MG ORAL CAP,,10388,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
TEMAZEPAM 15 MG ORAL CAP,,10388,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
TEMAZEPAM 15 MG ORAL CAP,,10388,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
TEMAZEPAM 15 MG ORAL CAP,,10388,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
TEMAZEPAM 15 MG ORAL CAP,,10388,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
TEMAZEPAM 15 MG ORAL CAP,,10388,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
TEMAZEPAM 15 MG ORAL CAP,,10388,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
TEMAZEPAM 15 MG ORAL CAP,,10388,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
TEMAZEPAM 15 MG ORAL CAP,,10388,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
TEMAZEPAM 15 MG ORAL CAP,,10388,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
TEMAZEPAM 15 MG ORAL CAP,,10388,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TEMAZEPAM 15 MG ORAL CAP,,10388,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
TEMAZEPAM 15 MG ORAL CAP,,10388,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TEMAZEPAM 15 MG ORAL CAP,,10388,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
TEMAZEPAM 15 MG ORAL CAP,,10388,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TEMAZEPAM 15 MG ORAL CAP,,10388,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
TEMAZEPAM 15 MG ORAL CAP,,10388,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
TEMAZEPAM 15 MG ORAL CAP,,10388,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
TEMAZEPAM 15 MG ORAL CAP,,10388,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
TEMAZEPAM 15 MG ORAL CAP,,10388,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
TEMAZEPAM 15 MG ORAL CAP,,10388,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
TORSEMIDE 100 MG ORAL TABLET,,10420,LOCAL,Facility,Both,1,Each,,15,12.75,4.299,15,Aetna,Commercial,13.8,92,,percent of total billed charges,,
TORSEMIDE 100 MG ORAL TABLET,,10420,LOCAL,Facility,Outpatient,1,Each,,15,12.75,4.299,15,Aetna,Medicare Advantage,7.35,49,,percent of total billed charges,,
TORSEMIDE 100 MG ORAL TABLET,,10420,LOCAL,Facility,Inpatient,1,Each,,15,12.75,4.299,15,Aetna,Medicare Advantage,,,,,Included in per diem rate,
TORSEMIDE 100 MG ORAL TABLET,,10420,LOCAL,Facility,Both,1,Each,,15,12.75,4.299,15,Aetna,PPO,13.95,93,,percent of total billed charges,,
TORSEMIDE 100 MG ORAL TABLET,,10420,LOCAL,Facility,Both,1,Each,,15,12.75,4.299,15,America's PPO,America's PPO,14.4045,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
TORSEMIDE 100 MG ORAL TABLET,,10420,LOCAL,Facility,Both,1,Each,,15,12.75,4.299,15,BlueCross BlueShield Minnesota, Federal Employee Program,14.76,98.4,,percent of total billed charges,,
TORSEMIDE 100 MG ORAL TABLET,,10420,LOCAL,Facility,Both,1,Each,,15,12.75,4.299,15,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,15,100,,percent of total billed charges,,
TORSEMIDE 100 MG ORAL TABLET,,10420,LOCAL,Facility,Both,1,Each,,15,12.75,4.299,15,BlueCross BlueShield Minnesota,High Value Network Plan,13.5,90,,percent of total billed charges,,
TORSEMIDE 100 MG ORAL TABLET,,10420,LOCAL,Facility,Outpatient,1,Each,,15,12.75,4.299,15,BlueCross BlueShield Minnesota,Medicare Advantage,7.35,49,,percent of total billed charges,,
TORSEMIDE 100 MG ORAL TABLET,,10420,LOCAL,Facility,Inpatient,1,Each,,15,12.75,4.299,15,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
TORSEMIDE 100 MG ORAL TABLET,,10420,LOCAL,Facility,Both,1,Each,,15,12.75,4.299,15,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,13.2855,88.57,,percent of total billed charges,,
TORSEMIDE 100 MG ORAL TABLET,,10420,LOCAL,Facility,Both,1,Each,,15,12.75,4.299,15,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,4.299,28.66,,percent of total billed charges,,
TORSEMIDE 100 MG ORAL TABLET,,10420,LOCAL,Facility,Outpatient,1,Each,,15,12.75,4.299,15,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),7.35,49,,percent of total billed charges,,
TORSEMIDE 100 MG ORAL TABLET,,10420,LOCAL,Facility,Inpatient,1,Each,,15,12.75,4.299,15,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
TORSEMIDE 100 MG ORAL TABLET,,10420,LOCAL,Facility,Both,1,Each,,15,12.75,4.299,15,CorVel,Worker's Compensation,15,100,,percent of total billed charges,,
TORSEMIDE 100 MG ORAL TABLET,,10420,LOCAL,Facility,Both,1,Each,,15,12.75,4.299,15,First Health Group Corporation,First Health Network,14.55,97,,percent of total billed charges,,
TORSEMIDE 100 MG ORAL TABLET,,10420,LOCAL,Facility,Both,1,Each,,15,12.75,4.299,15,"Health Partners, Inc.",Commercial,14.19,94.6,,percent of total billed charges,,
TORSEMIDE 100 MG ORAL TABLET,,10420,LOCAL,Facility,Outpatient,1,Each,,15,12.75,4.299,15,"Health Partners, Inc.",Medicare Advantage,7.35,49,,percent of total billed charges,,
TORSEMIDE 100 MG ORAL TABLET,,10420,LOCAL,Facility,Inpatient,1,Each,,15,12.75,4.299,15,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
TORSEMIDE 100 MG ORAL TABLET,,10420,LOCAL,Facility,Both,1,Each,,15,12.75,4.299,15,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),9,60,,percent of total billed charges,,
TORSEMIDE 100 MG ORAL TABLET,,10420,LOCAL,Facility,Both,1,Each,,15,12.75,4.299,15,"Health Partners, Inc.",State of Minnesota Advantage Program,12.225,81.5,,percent of total billed charges,,
TORSEMIDE 100 MG ORAL TABLET,,10420,LOCAL,Facility,Both,1,Each,,15,12.75,4.299,15,"Health Partners, Inc.",State Public Programs,7.5,50,,percent of total billed charges,,
TORSEMIDE 100 MG ORAL TABLET,,10420,LOCAL,Facility,Both,1,Each,,15,12.75,4.299,15,Humana Insurance Company,Commercial PPO,14.25,95,,percent of total billed charges,,
TORSEMIDE 100 MG ORAL TABLET,,10420,LOCAL,Facility,Outpatient,1,Each,,15,12.75,4.299,15,Humana Insurance Company,Medicare PPO,7.35,49,,percent of total billed charges,,
TORSEMIDE 100 MG ORAL TABLET,,10420,LOCAL,Facility,Inpatient,1,Each,,15,12.75,4.299,15,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
TORSEMIDE 100 MG ORAL TABLET,,10420,LOCAL,Facility,Both,1,Each,,15,12.75,4.299,15,Medica,Individual & Family,14.865,99.1,,percent of total billed charges,,
TORSEMIDE 100 MG ORAL TABLET,,10420,LOCAL,Facility,Outpatient,1,Each,,15,12.75,4.299,15,Medica,Medica Advantage Solution,7.47,49.8,,percent of total billed charges,,
TORSEMIDE 100 MG ORAL TABLET,,10420,LOCAL,Facility,Inpatient,1,Each,,15,12.75,4.299,15,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
TORSEMIDE 100 MG ORAL TABLET,,10420,LOCAL,Facility,Outpatient,1,Each,,15,12.75,4.299,15,Medica,Medical Assistance,6.69,44.6,,percent of total billed charges,,
TORSEMIDE 100 MG ORAL TABLET,,10420,LOCAL,Facility,Inpatient,1,Each,,15,12.75,4.299,15,Medica,Medical Assistance,,,,,Included in per diem rate,
TORSEMIDE 100 MG ORAL TABLET,,10420,LOCAL,Facility,Outpatient,1,Each,,15,12.75,4.299,15,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,7.47,49.8,,percent of total billed charges,,
TORSEMIDE 100 MG ORAL TABLET,,10420,LOCAL,Facility,Inpatient,1,Each,,15,12.75,4.299,15,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
TORSEMIDE 100 MG ORAL TABLET,,10420,LOCAL,Facility,Both,1,Each,,15,12.75,4.299,15,"Multiplan, Inc.","Multiplan, Inc.",14.1,94,,percent of total billed charges,,
TORSEMIDE 100 MG ORAL TABLET,,10420,LOCAL,Facility,Outpatient,1,Each,,15,12.75,4.299,15,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,13.515,90.1,,percent of total billed charges,,
TORSEMIDE 100 MG ORAL TABLET,,10420,LOCAL,Facility,Inpatient,1,Each,,15,12.75,4.299,15,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
TORSEMIDE 100 MG ORAL TABLET,,10420,LOCAL,Facility,Both,1,Each,,15,12.75,4.299,15,"Preferred One Administrative Services, INC.",PPO,14.79,98.6,,percent of total billed charges,,
TORSEMIDE 100 MG ORAL TABLET,,10420,LOCAL,Facility,Outpatient,1,Each,,15,12.75,4.299,15,PrimeWest Health,Minnesota Senior Health Options (MSHO),7.7175,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
TORSEMIDE 100 MG ORAL TABLET,,10420,LOCAL,Facility,Inpatient,1,Each,,15,12.75,4.299,15,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
TORSEMIDE 100 MG ORAL TABLET,,10420,LOCAL,Facility,Outpatient,1,Each,,15,12.75,4.299,15,PrimeWest Health,MinnesotaCare,7.704,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
TORSEMIDE 100 MG ORAL TABLET,,10420,LOCAL,Facility,Inpatient,1,Each,,15,12.75,4.299,15,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
TORSEMIDE 100 MG ORAL TABLET,,10420,LOCAL,Facility,Both,1,Each,,15,12.75,4.299,15,Sanford Health Plan,Sanford Health Plan,13.8,92,,percent of total billed charges,,
TORSEMIDE 100 MG ORAL TABLET,,10420,LOCAL,Facility,Outpatient,1,Each,,15,12.75,4.299,15,"UCare Health, Inc.",Individual & Family Plan,8.4525,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
TORSEMIDE 100 MG ORAL TABLET,,10420,LOCAL,Facility,Inpatient,1,Each,,15,12.75,4.299,15,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
TORSEMIDE 100 MG ORAL TABLET,,10420,LOCAL,Facility,Outpatient,1,Each,,15,12.75,4.299,15,"UCare Health, Inc.",Medical Assistance,7.5705,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TORSEMIDE 100 MG ORAL TABLET,,10420,LOCAL,Facility,Inpatient,1,Each,,15,12.75,4.299,15,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
TORSEMIDE 100 MG ORAL TABLET,,10420,LOCAL,Facility,Outpatient,1,Each,,15,12.75,4.299,15,"UCare Health, Inc.",Medicare Advantage,7.5705,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TORSEMIDE 100 MG ORAL TABLET,,10420,LOCAL,Facility,Inpatient,1,Each,,15,12.75,4.299,15,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
TORSEMIDE 100 MG ORAL TABLET,,10420,LOCAL,Facility,Outpatient,1,Each,,15,12.75,4.299,15,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),7.5705,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TORSEMIDE 100 MG ORAL TABLET,,10420,LOCAL,Facility,Inpatient,1,Each,,15,12.75,4.299,15,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
TORSEMIDE 100 MG ORAL TABLET,,10420,LOCAL,Facility,Both,1,Each,,15,12.75,4.299,15,UnitedHealthcare,Individual & Family,14.1,94,,percent of total billed charges,,
TORSEMIDE 100 MG ORAL TABLET,,10420,LOCAL,Facility,Outpatient,1,Each,,15,12.75,4.299,15,UnitedHealthcare,Medicare Advantage,7.35,49,,percent of total billed charges,,
TORSEMIDE 100 MG ORAL TABLET,,10420,LOCAL,Facility,Inpatient,1,Each,,15,12.75,4.299,15,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
TORSEMIDE 100 MG ORAL TABLET,,10420,LOCAL,Facility,Outpatient,1,Each,,15,12.75,4.299,15,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,7.2,48,,percent of total billed charges,,100% of DHS outpatient percentage
TORSEMIDE 100 MG ORAL TABLET,,10420,LOCAL,Facility,Inpatient,1,Each,,15,12.75,4.299,15,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
CYANOCOBALAMIN (VITAMIN B-12) 500 MCG ORAL TABLET,,10443,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
CYANOCOBALAMIN (VITAMIN B-12) 500 MCG ORAL TABLET,,10443,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
CYANOCOBALAMIN (VITAMIN B-12) 500 MCG ORAL TABLET,,10443,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
CYANOCOBALAMIN (VITAMIN B-12) 500 MCG ORAL TABLET,,10443,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
CYANOCOBALAMIN (VITAMIN B-12) 500 MCG ORAL TABLET,,10443,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
CYANOCOBALAMIN (VITAMIN B-12) 500 MCG ORAL TABLET,,10443,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
CYANOCOBALAMIN (VITAMIN B-12) 500 MCG ORAL TABLET,,10443,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
CYANOCOBALAMIN (VITAMIN B-12) 500 MCG ORAL TABLET,,10443,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
CYANOCOBALAMIN (VITAMIN B-12) 500 MCG ORAL TABLET,,10443,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
CYANOCOBALAMIN (VITAMIN B-12) 500 MCG ORAL TABLET,,10443,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
CYANOCOBALAMIN (VITAMIN B-12) 500 MCG ORAL TABLET,,10443,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
CYANOCOBALAMIN (VITAMIN B-12) 500 MCG ORAL TABLET,,10443,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
CYANOCOBALAMIN (VITAMIN B-12) 500 MCG ORAL TABLET,,10443,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
CYANOCOBALAMIN (VITAMIN B-12) 500 MCG ORAL TABLET,,10443,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
CYANOCOBALAMIN (VITAMIN B-12) 500 MCG ORAL TABLET,,10443,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
CYANOCOBALAMIN (VITAMIN B-12) 500 MCG ORAL TABLET,,10443,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
CYANOCOBALAMIN (VITAMIN B-12) 500 MCG ORAL TABLET,,10443,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
CYANOCOBALAMIN (VITAMIN B-12) 500 MCG ORAL TABLET,,10443,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
CYANOCOBALAMIN (VITAMIN B-12) 500 MCG ORAL TABLET,,10443,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CYANOCOBALAMIN (VITAMIN B-12) 500 MCG ORAL TABLET,,10443,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
CYANOCOBALAMIN (VITAMIN B-12) 500 MCG ORAL TABLET,,10443,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
CYANOCOBALAMIN (VITAMIN B-12) 500 MCG ORAL TABLET,,10443,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
CYANOCOBALAMIN (VITAMIN B-12) 500 MCG ORAL TABLET,,10443,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
CYANOCOBALAMIN (VITAMIN B-12) 500 MCG ORAL TABLET,,10443,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
CYANOCOBALAMIN (VITAMIN B-12) 500 MCG ORAL TABLET,,10443,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
CYANOCOBALAMIN (VITAMIN B-12) 500 MCG ORAL TABLET,,10443,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
CYANOCOBALAMIN (VITAMIN B-12) 500 MCG ORAL TABLET,,10443,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
CYANOCOBALAMIN (VITAMIN B-12) 500 MCG ORAL TABLET,,10443,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
CYANOCOBALAMIN (VITAMIN B-12) 500 MCG ORAL TABLET,,10443,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
CYANOCOBALAMIN (VITAMIN B-12) 500 MCG ORAL TABLET,,10443,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
CYANOCOBALAMIN (VITAMIN B-12) 500 MCG ORAL TABLET,,10443,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
CYANOCOBALAMIN (VITAMIN B-12) 500 MCG ORAL TABLET,,10443,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
CYANOCOBALAMIN (VITAMIN B-12) 500 MCG ORAL TABLET,,10443,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
CYANOCOBALAMIN (VITAMIN B-12) 500 MCG ORAL TABLET,,10443,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
CYANOCOBALAMIN (VITAMIN B-12) 500 MCG ORAL TABLET,,10443,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
CYANOCOBALAMIN (VITAMIN B-12) 500 MCG ORAL TABLET,,10443,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
CYANOCOBALAMIN (VITAMIN B-12) 500 MCG ORAL TABLET,,10443,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
CYANOCOBALAMIN (VITAMIN B-12) 500 MCG ORAL TABLET,,10443,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CYANOCOBALAMIN (VITAMIN B-12) 500 MCG ORAL TABLET,,10443,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
CYANOCOBALAMIN (VITAMIN B-12) 500 MCG ORAL TABLET,,10443,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
CYANOCOBALAMIN (VITAMIN B-12) 500 MCG ORAL TABLET,,10443,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
CYANOCOBALAMIN (VITAMIN B-12) 500 MCG ORAL TABLET,,10443,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
CYANOCOBALAMIN (VITAMIN B-12) 500 MCG ORAL TABLET,,10443,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
CYANOCOBALAMIN (VITAMIN B-12) 500 MCG ORAL TABLET,,10443,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CYANOCOBALAMIN (VITAMIN B-12) 500 MCG ORAL TABLET,,10443,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
CYANOCOBALAMIN (VITAMIN B-12) 500 MCG ORAL TABLET,,10443,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CYANOCOBALAMIN (VITAMIN B-12) 500 MCG ORAL TABLET,,10443,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CYANOCOBALAMIN (VITAMIN B-12) 500 MCG ORAL TABLET,,10443,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CYANOCOBALAMIN (VITAMIN B-12) 500 MCG ORAL TABLET,,10443,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CYANOCOBALAMIN (VITAMIN B-12) 500 MCG ORAL TABLET,,10443,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
CYANOCOBALAMIN (VITAMIN B-12) 500 MCG ORAL TABLET,,10443,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
CYANOCOBALAMIN (VITAMIN B-12) 500 MCG ORAL TABLET,,10443,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
CYANOCOBALAMIN (VITAMIN B-12) 500 MCG ORAL TABLET,,10443,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
CYANOCOBALAMIN (VITAMIN B-12) 500 MCG ORAL TABLET,,10443,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
POTASSIUM CHLORIDE 8 MEQ ORAL TAB SR,,10463,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
POTASSIUM CHLORIDE 8 MEQ ORAL TAB SR,,10463,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
POTASSIUM CHLORIDE 8 MEQ ORAL TAB SR,,10463,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
POTASSIUM CHLORIDE 8 MEQ ORAL TAB SR,,10463,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
POTASSIUM CHLORIDE 8 MEQ ORAL TAB SR,,10463,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
POTASSIUM CHLORIDE 8 MEQ ORAL TAB SR,,10463,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
POTASSIUM CHLORIDE 8 MEQ ORAL TAB SR,,10463,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
POTASSIUM CHLORIDE 8 MEQ ORAL TAB SR,,10463,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
POTASSIUM CHLORIDE 8 MEQ ORAL TAB SR,,10463,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
POTASSIUM CHLORIDE 8 MEQ ORAL TAB SR,,10463,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
POTASSIUM CHLORIDE 8 MEQ ORAL TAB SR,,10463,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
POTASSIUM CHLORIDE 8 MEQ ORAL TAB SR,,10463,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
POTASSIUM CHLORIDE 8 MEQ ORAL TAB SR,,10463,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
POTASSIUM CHLORIDE 8 MEQ ORAL TAB SR,,10463,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
POTASSIUM CHLORIDE 8 MEQ ORAL TAB SR,,10463,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
POTASSIUM CHLORIDE 8 MEQ ORAL TAB SR,,10463,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
POTASSIUM CHLORIDE 8 MEQ ORAL TAB SR,,10463,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
POTASSIUM CHLORIDE 8 MEQ ORAL TAB SR,,10463,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
POTASSIUM CHLORIDE 8 MEQ ORAL TAB SR,,10463,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
POTASSIUM CHLORIDE 8 MEQ ORAL TAB SR,,10463,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
POTASSIUM CHLORIDE 8 MEQ ORAL TAB SR,,10463,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
POTASSIUM CHLORIDE 8 MEQ ORAL TAB SR,,10463,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
POTASSIUM CHLORIDE 8 MEQ ORAL TAB SR,,10463,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
POTASSIUM CHLORIDE 8 MEQ ORAL TAB SR,,10463,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
POTASSIUM CHLORIDE 8 MEQ ORAL TAB SR,,10463,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
POTASSIUM CHLORIDE 8 MEQ ORAL TAB SR,,10463,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
POTASSIUM CHLORIDE 8 MEQ ORAL TAB SR,,10463,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
POTASSIUM CHLORIDE 8 MEQ ORAL TAB SR,,10463,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
POTASSIUM CHLORIDE 8 MEQ ORAL TAB SR,,10463,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
POTASSIUM CHLORIDE 8 MEQ ORAL TAB SR,,10463,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
POTASSIUM CHLORIDE 8 MEQ ORAL TAB SR,,10463,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
POTASSIUM CHLORIDE 8 MEQ ORAL TAB SR,,10463,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
POTASSIUM CHLORIDE 8 MEQ ORAL TAB SR,,10463,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
POTASSIUM CHLORIDE 8 MEQ ORAL TAB SR,,10463,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
POTASSIUM CHLORIDE 8 MEQ ORAL TAB SR,,10463,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
POTASSIUM CHLORIDE 8 MEQ ORAL TAB SR,,10463,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
POTASSIUM CHLORIDE 8 MEQ ORAL TAB SR,,10463,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
POTASSIUM CHLORIDE 8 MEQ ORAL TAB SR,,10463,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
POTASSIUM CHLORIDE 8 MEQ ORAL TAB SR,,10463,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
POTASSIUM CHLORIDE 8 MEQ ORAL TAB SR,,10463,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
POTASSIUM CHLORIDE 8 MEQ ORAL TAB SR,,10463,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
POTASSIUM CHLORIDE 8 MEQ ORAL TAB SR,,10463,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
POTASSIUM CHLORIDE 8 MEQ ORAL TAB SR,,10463,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
POTASSIUM CHLORIDE 8 MEQ ORAL TAB SR,,10463,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
POTASSIUM CHLORIDE 8 MEQ ORAL TAB SR,,10463,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
POTASSIUM CHLORIDE 8 MEQ ORAL TAB SR,,10463,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
POTASSIUM CHLORIDE 8 MEQ ORAL TAB SR,,10463,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
POTASSIUM CHLORIDE 8 MEQ ORAL TAB SR,,10463,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
POTASSIUM CHLORIDE 8 MEQ ORAL TAB SR,,10463,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
POTASSIUM CHLORIDE 8 MEQ ORAL TAB SR,,10463,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
POTASSIUM CHLORIDE 8 MEQ ORAL TAB SR,,10463,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
POTASSIUM CHLORIDE 8 MEQ ORAL TAB SR,,10463,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
POTASSIUM CHLORIDE 8 MEQ ORAL TAB SR,,10463,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
POTASSIUM CHLORIDE 8 MEQ ORAL TAB SR,,10463,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"CALCIUM CARBONATE 500 MG CALCIUM (1,250 MG) ORAL TABLET",,10465,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
"CALCIUM CARBONATE 500 MG CALCIUM (1,250 MG) ORAL TABLET",,10465,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
"CALCIUM CARBONATE 500 MG CALCIUM (1,250 MG) ORAL TABLET",,10465,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"CALCIUM CARBONATE 500 MG CALCIUM (1,250 MG) ORAL TABLET",,10465,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
"CALCIUM CARBONATE 500 MG CALCIUM (1,250 MG) ORAL TABLET",,10465,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"CALCIUM CARBONATE 500 MG CALCIUM (1,250 MG) ORAL TABLET",,10465,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
"CALCIUM CARBONATE 500 MG CALCIUM (1,250 MG) ORAL TABLET",,10465,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
"CALCIUM CARBONATE 500 MG CALCIUM (1,250 MG) ORAL TABLET",,10465,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
"CALCIUM CARBONATE 500 MG CALCIUM (1,250 MG) ORAL TABLET",,10465,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
"CALCIUM CARBONATE 500 MG CALCIUM (1,250 MG) ORAL TABLET",,10465,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"CALCIUM CARBONATE 500 MG CALCIUM (1,250 MG) ORAL TABLET",,10465,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
"CALCIUM CARBONATE 500 MG CALCIUM (1,250 MG) ORAL TABLET",,10465,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
"CALCIUM CARBONATE 500 MG CALCIUM (1,250 MG) ORAL TABLET",,10465,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
"CALCIUM CARBONATE 500 MG CALCIUM (1,250 MG) ORAL TABLET",,10465,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"CALCIUM CARBONATE 500 MG CALCIUM (1,250 MG) ORAL TABLET",,10465,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
"CALCIUM CARBONATE 500 MG CALCIUM (1,250 MG) ORAL TABLET",,10465,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
"CALCIUM CARBONATE 500 MG CALCIUM (1,250 MG) ORAL TABLET",,10465,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
"CALCIUM CARBONATE 500 MG CALCIUM (1,250 MG) ORAL TABLET",,10465,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
"CALCIUM CARBONATE 500 MG CALCIUM (1,250 MG) ORAL TABLET",,10465,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"CALCIUM CARBONATE 500 MG CALCIUM (1,250 MG) ORAL TABLET",,10465,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
"CALCIUM CARBONATE 500 MG CALCIUM (1,250 MG) ORAL TABLET",,10465,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
"CALCIUM CARBONATE 500 MG CALCIUM (1,250 MG) ORAL TABLET",,10465,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
"CALCIUM CARBONATE 500 MG CALCIUM (1,250 MG) ORAL TABLET",,10465,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
"CALCIUM CARBONATE 500 MG CALCIUM (1,250 MG) ORAL TABLET",,10465,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
"CALCIUM CARBONATE 500 MG CALCIUM (1,250 MG) ORAL TABLET",,10465,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"CALCIUM CARBONATE 500 MG CALCIUM (1,250 MG) ORAL TABLET",,10465,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
"CALCIUM CARBONATE 500 MG CALCIUM (1,250 MG) ORAL TABLET",,10465,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
"CALCIUM CARBONATE 500 MG CALCIUM (1,250 MG) ORAL TABLET",,10465,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"CALCIUM CARBONATE 500 MG CALCIUM (1,250 MG) ORAL TABLET",,10465,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
"CALCIUM CARBONATE 500 MG CALCIUM (1,250 MG) ORAL TABLET",,10465,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
"CALCIUM CARBONATE 500 MG CALCIUM (1,250 MG) ORAL TABLET",,10465,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
"CALCIUM CARBONATE 500 MG CALCIUM (1,250 MG) ORAL TABLET",,10465,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"CALCIUM CARBONATE 500 MG CALCIUM (1,250 MG) ORAL TABLET",,10465,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
"CALCIUM CARBONATE 500 MG CALCIUM (1,250 MG) ORAL TABLET",,10465,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
"CALCIUM CARBONATE 500 MG CALCIUM (1,250 MG) ORAL TABLET",,10465,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"CALCIUM CARBONATE 500 MG CALCIUM (1,250 MG) ORAL TABLET",,10465,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
"CALCIUM CARBONATE 500 MG CALCIUM (1,250 MG) ORAL TABLET",,10465,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"CALCIUM CARBONATE 500 MG CALCIUM (1,250 MG) ORAL TABLET",,10465,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"CALCIUM CARBONATE 500 MG CALCIUM (1,250 MG) ORAL TABLET",,10465,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"CALCIUM CARBONATE 500 MG CALCIUM (1,250 MG) ORAL TABLET",,10465,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"CALCIUM CARBONATE 500 MG CALCIUM (1,250 MG) ORAL TABLET",,10465,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
"CALCIUM CARBONATE 500 MG CALCIUM (1,250 MG) ORAL TABLET",,10465,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"CALCIUM CARBONATE 500 MG CALCIUM (1,250 MG) ORAL TABLET",,10465,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"CALCIUM CARBONATE 500 MG CALCIUM (1,250 MG) ORAL TABLET",,10465,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"CALCIUM CARBONATE 500 MG CALCIUM (1,250 MG) ORAL TABLET",,10465,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"CALCIUM CARBONATE 500 MG CALCIUM (1,250 MG) ORAL TABLET",,10465,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"CALCIUM CARBONATE 500 MG CALCIUM (1,250 MG) ORAL TABLET",,10465,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"CALCIUM CARBONATE 500 MG CALCIUM (1,250 MG) ORAL TABLET",,10465,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"CALCIUM CARBONATE 500 MG CALCIUM (1,250 MG) ORAL TABLET",,10465,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"CALCIUM CARBONATE 500 MG CALCIUM (1,250 MG) ORAL TABLET",,10465,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
"CALCIUM CARBONATE 500 MG CALCIUM (1,250 MG) ORAL TABLET",,10465,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
"CALCIUM CARBONATE 500 MG CALCIUM (1,250 MG) ORAL TABLET",,10465,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"CALCIUM CARBONATE 500 MG CALCIUM (1,250 MG) ORAL TABLET",,10465,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
"CALCIUM CARBONATE 500 MG CALCIUM (1,250 MG) ORAL TABLET",,10465,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
ASCORBIC ACID (VITAMIN C) 500 MG ORAL TABLET,,10511,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
ASCORBIC ACID (VITAMIN C) 500 MG ORAL TABLET,,10511,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
ASCORBIC ACID (VITAMIN C) 500 MG ORAL TABLET,,10511,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
ASCORBIC ACID (VITAMIN C) 500 MG ORAL TABLET,,10511,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
ASCORBIC ACID (VITAMIN C) 500 MG ORAL TABLET,,10511,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
ASCORBIC ACID (VITAMIN C) 500 MG ORAL TABLET,,10511,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
ASCORBIC ACID (VITAMIN C) 500 MG ORAL TABLET,,10511,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
ASCORBIC ACID (VITAMIN C) 500 MG ORAL TABLET,,10511,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
ASCORBIC ACID (VITAMIN C) 500 MG ORAL TABLET,,10511,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
ASCORBIC ACID (VITAMIN C) 500 MG ORAL TABLET,,10511,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
ASCORBIC ACID (VITAMIN C) 500 MG ORAL TABLET,,10511,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
ASCORBIC ACID (VITAMIN C) 500 MG ORAL TABLET,,10511,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
ASCORBIC ACID (VITAMIN C) 500 MG ORAL TABLET,,10511,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
ASCORBIC ACID (VITAMIN C) 500 MG ORAL TABLET,,10511,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
ASCORBIC ACID (VITAMIN C) 500 MG ORAL TABLET,,10511,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
ASCORBIC ACID (VITAMIN C) 500 MG ORAL TABLET,,10511,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
ASCORBIC ACID (VITAMIN C) 500 MG ORAL TABLET,,10511,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
ASCORBIC ACID (VITAMIN C) 500 MG ORAL TABLET,,10511,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
ASCORBIC ACID (VITAMIN C) 500 MG ORAL TABLET,,10511,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ASCORBIC ACID (VITAMIN C) 500 MG ORAL TABLET,,10511,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
ASCORBIC ACID (VITAMIN C) 500 MG ORAL TABLET,,10511,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
ASCORBIC ACID (VITAMIN C) 500 MG ORAL TABLET,,10511,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
ASCORBIC ACID (VITAMIN C) 500 MG ORAL TABLET,,10511,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
ASCORBIC ACID (VITAMIN C) 500 MG ORAL TABLET,,10511,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
ASCORBIC ACID (VITAMIN C) 500 MG ORAL TABLET,,10511,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
ASCORBIC ACID (VITAMIN C) 500 MG ORAL TABLET,,10511,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
ASCORBIC ACID (VITAMIN C) 500 MG ORAL TABLET,,10511,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
ASCORBIC ACID (VITAMIN C) 500 MG ORAL TABLET,,10511,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
ASCORBIC ACID (VITAMIN C) 500 MG ORAL TABLET,,10511,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
ASCORBIC ACID (VITAMIN C) 500 MG ORAL TABLET,,10511,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
ASCORBIC ACID (VITAMIN C) 500 MG ORAL TABLET,,10511,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
ASCORBIC ACID (VITAMIN C) 500 MG ORAL TABLET,,10511,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
ASCORBIC ACID (VITAMIN C) 500 MG ORAL TABLET,,10511,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
ASCORBIC ACID (VITAMIN C) 500 MG ORAL TABLET,,10511,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
ASCORBIC ACID (VITAMIN C) 500 MG ORAL TABLET,,10511,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
ASCORBIC ACID (VITAMIN C) 500 MG ORAL TABLET,,10511,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
ASCORBIC ACID (VITAMIN C) 500 MG ORAL TABLET,,10511,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
ASCORBIC ACID (VITAMIN C) 500 MG ORAL TABLET,,10511,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ASCORBIC ACID (VITAMIN C) 500 MG ORAL TABLET,,10511,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
ASCORBIC ACID (VITAMIN C) 500 MG ORAL TABLET,,10511,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
ASCORBIC ACID (VITAMIN C) 500 MG ORAL TABLET,,10511,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
ASCORBIC ACID (VITAMIN C) 500 MG ORAL TABLET,,10511,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
ASCORBIC ACID (VITAMIN C) 500 MG ORAL TABLET,,10511,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
ASCORBIC ACID (VITAMIN C) 500 MG ORAL TABLET,,10511,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ASCORBIC ACID (VITAMIN C) 500 MG ORAL TABLET,,10511,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
ASCORBIC ACID (VITAMIN C) 500 MG ORAL TABLET,,10511,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ASCORBIC ACID (VITAMIN C) 500 MG ORAL TABLET,,10511,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ASCORBIC ACID (VITAMIN C) 500 MG ORAL TABLET,,10511,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ASCORBIC ACID (VITAMIN C) 500 MG ORAL TABLET,,10511,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ASCORBIC ACID (VITAMIN C) 500 MG ORAL TABLET,,10511,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
ASCORBIC ACID (VITAMIN C) 500 MG ORAL TABLET,,10511,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
ASCORBIC ACID (VITAMIN C) 500 MG ORAL TABLET,,10511,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
ASCORBIC ACID (VITAMIN C) 500 MG ORAL TABLET,,10511,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
ASCORBIC ACID (VITAMIN C) 500 MG ORAL TABLET,,10511,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
CAPTOPRIL 12.5 MG ORAL TABLET,,10639,LOCAL,Facility,Both,1,Each,,9,7.65,2.5794,9,Aetna,Commercial,8.28,92,,percent of total billed charges,,
CAPTOPRIL 12.5 MG ORAL TABLET,,10639,LOCAL,Facility,Both,1,Each,,9,7.65,2.5794,9,Aetna,Commercial,8.28,92,,percent of total billed charges,,
CAPTOPRIL 12.5 MG ORAL TABLET,,10639,LOCAL,Facility,Outpatient,1,Each,,9,7.65,2.5794,9,Aetna,Medicare Advantage,4.41,49,,percent of total billed charges,,
CAPTOPRIL 12.5 MG ORAL TABLET,,10639,LOCAL,Facility,Outpatient,1,Each,,9,7.65,2.5794,9,Aetna,Medicare Advantage,4.41,49,,percent of total billed charges,,
CAPTOPRIL 12.5 MG ORAL TABLET,,10639,LOCAL,Facility,Inpatient,1,Each,,9,7.65,2.5794,9,Aetna,Medicare Advantage,,,,,Included in per diem rate,
CAPTOPRIL 12.5 MG ORAL TABLET,,10639,LOCAL,Facility,Inpatient,1,Each,,9,7.65,2.5794,9,Aetna,Medicare Advantage,,,,,Included in per diem rate,
CAPTOPRIL 12.5 MG ORAL TABLET,,10639,LOCAL,Facility,Both,1,Each,,9,7.65,2.5794,9,Aetna,PPO,8.37,93,,percent of total billed charges,,
CAPTOPRIL 12.5 MG ORAL TABLET,,10639,LOCAL,Facility,Both,1,Each,,9,7.65,2.5794,9,Aetna,PPO,8.37,93,,percent of total billed charges,,
CAPTOPRIL 12.5 MG ORAL TABLET,,10639,LOCAL,Facility,Both,1,Each,,9,7.65,2.5794,9,America's PPO,America's PPO,8.6427,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
CAPTOPRIL 12.5 MG ORAL TABLET,,10639,LOCAL,Facility,Both,1,Each,,9,7.65,2.5794,9,America's PPO,America's PPO,8.6427,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
CAPTOPRIL 12.5 MG ORAL TABLET,,10639,LOCAL,Facility,Both,1,Each,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota, Federal Employee Program,8.856,98.4,,percent of total billed charges,,
CAPTOPRIL 12.5 MG ORAL TABLET,,10639,LOCAL,Facility,Both,1,Each,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota, Federal Employee Program,8.856,98.4,,percent of total billed charges,,
CAPTOPRIL 12.5 MG ORAL TABLET,,10639,LOCAL,Facility,Both,1,Each,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,9,100,,percent of total billed charges,,
CAPTOPRIL 12.5 MG ORAL TABLET,,10639,LOCAL,Facility,Both,1,Each,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,9,100,,percent of total billed charges,,
CAPTOPRIL 12.5 MG ORAL TABLET,,10639,LOCAL,Facility,Both,1,Each,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota,High Value Network Plan,8.1,90,,percent of total billed charges,,
CAPTOPRIL 12.5 MG ORAL TABLET,,10639,LOCAL,Facility,Both,1,Each,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota,High Value Network Plan,8.1,90,,percent of total billed charges,,
CAPTOPRIL 12.5 MG ORAL TABLET,,10639,LOCAL,Facility,Outpatient,1,Each,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota,Medicare Advantage,4.41,49,,percent of total billed charges,,
CAPTOPRIL 12.5 MG ORAL TABLET,,10639,LOCAL,Facility,Outpatient,1,Each,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota,Medicare Advantage,4.41,49,,percent of total billed charges,,
CAPTOPRIL 12.5 MG ORAL TABLET,,10639,LOCAL,Facility,Inpatient,1,Each,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
CAPTOPRIL 12.5 MG ORAL TABLET,,10639,LOCAL,Facility,Inpatient,1,Each,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
CAPTOPRIL 12.5 MG ORAL TABLET,,10639,LOCAL,Facility,Both,1,Each,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,7.9713,88.57,,percent of total billed charges,,
CAPTOPRIL 12.5 MG ORAL TABLET,,10639,LOCAL,Facility,Both,1,Each,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,7.9713,88.57,,percent of total billed charges,,
CAPTOPRIL 12.5 MG ORAL TABLET,,10639,LOCAL,Facility,Both,1,Each,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,2.5794,28.66,,percent of total billed charges,,
CAPTOPRIL 12.5 MG ORAL TABLET,,10639,LOCAL,Facility,Both,1,Each,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,2.5794,28.66,,percent of total billed charges,,
CAPTOPRIL 12.5 MG ORAL TABLET,,10639,LOCAL,Facility,Outpatient,1,Each,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),4.41,49,,percent of total billed charges,,
CAPTOPRIL 12.5 MG ORAL TABLET,,10639,LOCAL,Facility,Outpatient,1,Each,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),4.41,49,,percent of total billed charges,,
CAPTOPRIL 12.5 MG ORAL TABLET,,10639,LOCAL,Facility,Inpatient,1,Each,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
CAPTOPRIL 12.5 MG ORAL TABLET,,10639,LOCAL,Facility,Inpatient,1,Each,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
CAPTOPRIL 12.5 MG ORAL TABLET,,10639,LOCAL,Facility,Both,1,Each,,9,7.65,2.5794,9,CorVel,Worker's Compensation,9,100,,percent of total billed charges,,
CAPTOPRIL 12.5 MG ORAL TABLET,,10639,LOCAL,Facility,Both,1,Each,,9,7.65,2.5794,9,CorVel,Worker's Compensation,9,100,,percent of total billed charges,,
CAPTOPRIL 12.5 MG ORAL TABLET,,10639,LOCAL,Facility,Both,1,Each,,9,7.65,2.5794,9,First Health Group Corporation,First Health Network,8.73,97,,percent of total billed charges,,
CAPTOPRIL 12.5 MG ORAL TABLET,,10639,LOCAL,Facility,Both,1,Each,,9,7.65,2.5794,9,First Health Group Corporation,First Health Network,8.73,97,,percent of total billed charges,,
CAPTOPRIL 12.5 MG ORAL TABLET,,10639,LOCAL,Facility,Both,1,Each,,9,7.65,2.5794,9,"Health Partners, Inc.",Commercial,8.514,94.6,,percent of total billed charges,,
CAPTOPRIL 12.5 MG ORAL TABLET,,10639,LOCAL,Facility,Both,1,Each,,9,7.65,2.5794,9,"Health Partners, Inc.",Commercial,8.514,94.6,,percent of total billed charges,,
CAPTOPRIL 12.5 MG ORAL TABLET,,10639,LOCAL,Facility,Outpatient,1,Each,,9,7.65,2.5794,9,"Health Partners, Inc.",Medicare Advantage,4.41,49,,percent of total billed charges,,
CAPTOPRIL 12.5 MG ORAL TABLET,,10639,LOCAL,Facility,Outpatient,1,Each,,9,7.65,2.5794,9,"Health Partners, Inc.",Medicare Advantage,4.41,49,,percent of total billed charges,,
CAPTOPRIL 12.5 MG ORAL TABLET,,10639,LOCAL,Facility,Inpatient,1,Each,,9,7.65,2.5794,9,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CAPTOPRIL 12.5 MG ORAL TABLET,,10639,LOCAL,Facility,Inpatient,1,Each,,9,7.65,2.5794,9,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CAPTOPRIL 12.5 MG ORAL TABLET,,10639,LOCAL,Facility,Both,1,Each,,9,7.65,2.5794,9,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),5.4,60,,percent of total billed charges,,
CAPTOPRIL 12.5 MG ORAL TABLET,,10639,LOCAL,Facility,Both,1,Each,,9,7.65,2.5794,9,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),5.4,60,,percent of total billed charges,,
CAPTOPRIL 12.5 MG ORAL TABLET,,10639,LOCAL,Facility,Both,1,Each,,9,7.65,2.5794,9,"Health Partners, Inc.",State of Minnesota Advantage Program,7.335,81.5,,percent of total billed charges,,
CAPTOPRIL 12.5 MG ORAL TABLET,,10639,LOCAL,Facility,Both,1,Each,,9,7.65,2.5794,9,"Health Partners, Inc.",State of Minnesota Advantage Program,7.335,81.5,,percent of total billed charges,,
CAPTOPRIL 12.5 MG ORAL TABLET,,10639,LOCAL,Facility,Both,1,Each,,9,7.65,2.5794,9,"Health Partners, Inc.",State Public Programs,4.5,50,,percent of total billed charges,,
CAPTOPRIL 12.5 MG ORAL TABLET,,10639,LOCAL,Facility,Both,1,Each,,9,7.65,2.5794,9,"Health Partners, Inc.",State Public Programs,4.5,50,,percent of total billed charges,,
CAPTOPRIL 12.5 MG ORAL TABLET,,10639,LOCAL,Facility,Both,1,Each,,9,7.65,2.5794,9,Humana Insurance Company,Commercial PPO,8.55,95,,percent of total billed charges,,
CAPTOPRIL 12.5 MG ORAL TABLET,,10639,LOCAL,Facility,Both,1,Each,,9,7.65,2.5794,9,Humana Insurance Company,Commercial PPO,8.55,95,,percent of total billed charges,,
CAPTOPRIL 12.5 MG ORAL TABLET,,10639,LOCAL,Facility,Outpatient,1,Each,,9,7.65,2.5794,9,Humana Insurance Company,Medicare PPO,4.41,49,,percent of total billed charges,,
CAPTOPRIL 12.5 MG ORAL TABLET,,10639,LOCAL,Facility,Outpatient,1,Each,,9,7.65,2.5794,9,Humana Insurance Company,Medicare PPO,4.41,49,,percent of total billed charges,,
CAPTOPRIL 12.5 MG ORAL TABLET,,10639,LOCAL,Facility,Inpatient,1,Each,,9,7.65,2.5794,9,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
CAPTOPRIL 12.5 MG ORAL TABLET,,10639,LOCAL,Facility,Inpatient,1,Each,,9,7.65,2.5794,9,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
CAPTOPRIL 12.5 MG ORAL TABLET,,10639,LOCAL,Facility,Both,1,Each,,9,7.65,2.5794,9,Medica,Individual & Family,8.919,99.1,,percent of total billed charges,,
CAPTOPRIL 12.5 MG ORAL TABLET,,10639,LOCAL,Facility,Both,1,Each,,9,7.65,2.5794,9,Medica,Individual & Family,8.919,99.1,,percent of total billed charges,,
CAPTOPRIL 12.5 MG ORAL TABLET,,10639,LOCAL,Facility,Outpatient,1,Each,,9,7.65,2.5794,9,Medica,Medica Advantage Solution,4.482,49.8,,percent of total billed charges,,
CAPTOPRIL 12.5 MG ORAL TABLET,,10639,LOCAL,Facility,Outpatient,1,Each,,9,7.65,2.5794,9,Medica,Medica Advantage Solution,4.482,49.8,,percent of total billed charges,,
CAPTOPRIL 12.5 MG ORAL TABLET,,10639,LOCAL,Facility,Inpatient,1,Each,,9,7.65,2.5794,9,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
CAPTOPRIL 12.5 MG ORAL TABLET,,10639,LOCAL,Facility,Inpatient,1,Each,,9,7.65,2.5794,9,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
CAPTOPRIL 12.5 MG ORAL TABLET,,10639,LOCAL,Facility,Outpatient,1,Each,,9,7.65,2.5794,9,Medica,Medical Assistance,4.014,44.6,,percent of total billed charges,,
CAPTOPRIL 12.5 MG ORAL TABLET,,10639,LOCAL,Facility,Outpatient,1,Each,,9,7.65,2.5794,9,Medica,Medical Assistance,4.014,44.6,,percent of total billed charges,,
CAPTOPRIL 12.5 MG ORAL TABLET,,10639,LOCAL,Facility,Inpatient,1,Each,,9,7.65,2.5794,9,Medica,Medical Assistance,,,,,Included in per diem rate,
CAPTOPRIL 12.5 MG ORAL TABLET,,10639,LOCAL,Facility,Inpatient,1,Each,,9,7.65,2.5794,9,Medica,Medical Assistance,,,,,Included in per diem rate,
CAPTOPRIL 12.5 MG ORAL TABLET,,10639,LOCAL,Facility,Outpatient,1,Each,,9,7.65,2.5794,9,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,4.482,49.8,,percent of total billed charges,,
CAPTOPRIL 12.5 MG ORAL TABLET,,10639,LOCAL,Facility,Outpatient,1,Each,,9,7.65,2.5794,9,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,4.482,49.8,,percent of total billed charges,,
CAPTOPRIL 12.5 MG ORAL TABLET,,10639,LOCAL,Facility,Inpatient,1,Each,,9,7.65,2.5794,9,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
CAPTOPRIL 12.5 MG ORAL TABLET,,10639,LOCAL,Facility,Inpatient,1,Each,,9,7.65,2.5794,9,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
CAPTOPRIL 12.5 MG ORAL TABLET,,10639,LOCAL,Facility,Both,1,Each,,9,7.65,2.5794,9,"Multiplan, Inc.","Multiplan, Inc.",8.46,94,,percent of total billed charges,,
CAPTOPRIL 12.5 MG ORAL TABLET,,10639,LOCAL,Facility,Both,1,Each,,9,7.65,2.5794,9,"Multiplan, Inc.","Multiplan, Inc.",8.46,94,,percent of total billed charges,,
CAPTOPRIL 12.5 MG ORAL TABLET,,10639,LOCAL,Facility,Outpatient,1,Each,,9,7.65,2.5794,9,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,8.109,90.1,,percent of total billed charges,,
CAPTOPRIL 12.5 MG ORAL TABLET,,10639,LOCAL,Facility,Outpatient,1,Each,,9,7.65,2.5794,9,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,8.109,90.1,,percent of total billed charges,,
CAPTOPRIL 12.5 MG ORAL TABLET,,10639,LOCAL,Facility,Inpatient,1,Each,,9,7.65,2.5794,9,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
CAPTOPRIL 12.5 MG ORAL TABLET,,10639,LOCAL,Facility,Inpatient,1,Each,,9,7.65,2.5794,9,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
CAPTOPRIL 12.5 MG ORAL TABLET,,10639,LOCAL,Facility,Both,1,Each,,9,7.65,2.5794,9,"Preferred One Administrative Services, INC.",PPO,8.874,98.6,,percent of total billed charges,,
CAPTOPRIL 12.5 MG ORAL TABLET,,10639,LOCAL,Facility,Both,1,Each,,9,7.65,2.5794,9,"Preferred One Administrative Services, INC.",PPO,8.874,98.6,,percent of total billed charges,,
CAPTOPRIL 12.5 MG ORAL TABLET,,10639,LOCAL,Facility,Outpatient,1,Each,,9,7.65,2.5794,9,PrimeWest Health,Minnesota Senior Health Options (MSHO),4.6305,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
CAPTOPRIL 12.5 MG ORAL TABLET,,10639,LOCAL,Facility,Outpatient,1,Each,,9,7.65,2.5794,9,PrimeWest Health,Minnesota Senior Health Options (MSHO),4.6305,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
CAPTOPRIL 12.5 MG ORAL TABLET,,10639,LOCAL,Facility,Inpatient,1,Each,,9,7.65,2.5794,9,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CAPTOPRIL 12.5 MG ORAL TABLET,,10639,LOCAL,Facility,Inpatient,1,Each,,9,7.65,2.5794,9,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CAPTOPRIL 12.5 MG ORAL TABLET,,10639,LOCAL,Facility,Outpatient,1,Each,,9,7.65,2.5794,9,PrimeWest Health,MinnesotaCare,4.6224,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
CAPTOPRIL 12.5 MG ORAL TABLET,,10639,LOCAL,Facility,Outpatient,1,Each,,9,7.65,2.5794,9,PrimeWest Health,MinnesotaCare,4.6224,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
CAPTOPRIL 12.5 MG ORAL TABLET,,10639,LOCAL,Facility,Inpatient,1,Each,,9,7.65,2.5794,9,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
CAPTOPRIL 12.5 MG ORAL TABLET,,10639,LOCAL,Facility,Inpatient,1,Each,,9,7.65,2.5794,9,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
CAPTOPRIL 12.5 MG ORAL TABLET,,10639,LOCAL,Facility,Both,1,Each,,9,7.65,2.5794,9,Sanford Health Plan,Sanford Health Plan,8.28,92,,percent of total billed charges,,
CAPTOPRIL 12.5 MG ORAL TABLET,,10639,LOCAL,Facility,Both,1,Each,,9,7.65,2.5794,9,Sanford Health Plan,Sanford Health Plan,8.28,92,,percent of total billed charges,,
CAPTOPRIL 12.5 MG ORAL TABLET,,10639,LOCAL,Facility,Outpatient,1,Each,,9,7.65,2.5794,9,"UCare Health, Inc.",Individual & Family Plan,5.0715,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
CAPTOPRIL 12.5 MG ORAL TABLET,,10639,LOCAL,Facility,Outpatient,1,Each,,9,7.65,2.5794,9,"UCare Health, Inc.",Individual & Family Plan,5.0715,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
CAPTOPRIL 12.5 MG ORAL TABLET,,10639,LOCAL,Facility,Inpatient,1,Each,,9,7.65,2.5794,9,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
CAPTOPRIL 12.5 MG ORAL TABLET,,10639,LOCAL,Facility,Inpatient,1,Each,,9,7.65,2.5794,9,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
CAPTOPRIL 12.5 MG ORAL TABLET,,10639,LOCAL,Facility,Outpatient,1,Each,,9,7.65,2.5794,9,"UCare Health, Inc.",Medical Assistance,4.5423,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CAPTOPRIL 12.5 MG ORAL TABLET,,10639,LOCAL,Facility,Outpatient,1,Each,,9,7.65,2.5794,9,"UCare Health, Inc.",Medical Assistance,4.5423,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CAPTOPRIL 12.5 MG ORAL TABLET,,10639,LOCAL,Facility,Inpatient,1,Each,,9,7.65,2.5794,9,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
CAPTOPRIL 12.5 MG ORAL TABLET,,10639,LOCAL,Facility,Inpatient,1,Each,,9,7.65,2.5794,9,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
CAPTOPRIL 12.5 MG ORAL TABLET,,10639,LOCAL,Facility,Outpatient,1,Each,,9,7.65,2.5794,9,"UCare Health, Inc.",Medicare Advantage,4.5423,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CAPTOPRIL 12.5 MG ORAL TABLET,,10639,LOCAL,Facility,Outpatient,1,Each,,9,7.65,2.5794,9,"UCare Health, Inc.",Medicare Advantage,4.5423,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CAPTOPRIL 12.5 MG ORAL TABLET,,10639,LOCAL,Facility,Inpatient,1,Each,,9,7.65,2.5794,9,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CAPTOPRIL 12.5 MG ORAL TABLET,,10639,LOCAL,Facility,Inpatient,1,Each,,9,7.65,2.5794,9,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CAPTOPRIL 12.5 MG ORAL TABLET,,10639,LOCAL,Facility,Outpatient,1,Each,,9,7.65,2.5794,9,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),4.5423,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CAPTOPRIL 12.5 MG ORAL TABLET,,10639,LOCAL,Facility,Outpatient,1,Each,,9,7.65,2.5794,9,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),4.5423,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CAPTOPRIL 12.5 MG ORAL TABLET,,10639,LOCAL,Facility,Inpatient,1,Each,,9,7.65,2.5794,9,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CAPTOPRIL 12.5 MG ORAL TABLET,,10639,LOCAL,Facility,Inpatient,1,Each,,9,7.65,2.5794,9,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CAPTOPRIL 12.5 MG ORAL TABLET,,10639,LOCAL,Facility,Both,1,Each,,9,7.65,2.5794,9,UnitedHealthcare,Individual & Family,8.46,94,,percent of total billed charges,,
CAPTOPRIL 12.5 MG ORAL TABLET,,10639,LOCAL,Facility,Both,1,Each,,9,7.65,2.5794,9,UnitedHealthcare,Individual & Family,8.46,94,,percent of total billed charges,,
CAPTOPRIL 12.5 MG ORAL TABLET,,10639,LOCAL,Facility,Outpatient,1,Each,,9,7.65,2.5794,9,UnitedHealthcare,Medicare Advantage,4.41,49,,percent of total billed charges,,
CAPTOPRIL 12.5 MG ORAL TABLET,,10639,LOCAL,Facility,Outpatient,1,Each,,9,7.65,2.5794,9,UnitedHealthcare,Medicare Advantage,4.41,49,,percent of total billed charges,,
CAPTOPRIL 12.5 MG ORAL TABLET,,10639,LOCAL,Facility,Inpatient,1,Each,,9,7.65,2.5794,9,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
CAPTOPRIL 12.5 MG ORAL TABLET,,10639,LOCAL,Facility,Inpatient,1,Each,,9,7.65,2.5794,9,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
CAPTOPRIL 12.5 MG ORAL TABLET,,10639,LOCAL,Facility,Outpatient,1,Each,,9,7.65,2.5794,9,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,4.32,48,,percent of total billed charges,,100% of DHS outpatient percentage
CAPTOPRIL 12.5 MG ORAL TABLET,,10639,LOCAL,Facility,Outpatient,1,Each,,9,7.65,2.5794,9,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,4.32,48,,percent of total billed charges,,100% of DHS outpatient percentage
CAPTOPRIL 12.5 MG ORAL TABLET,,10639,LOCAL,Facility,Inpatient,1,Each,,9,7.65,2.5794,9,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
CAPTOPRIL 12.5 MG ORAL TABLET,,10639,LOCAL,Facility,Inpatient,1,Each,,9,7.65,2.5794,9,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
CHLORDIAZEPOXIDE HCL 25 MG ORAL CAP,,10642,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
CHLORDIAZEPOXIDE HCL 25 MG ORAL CAP,,10642,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
CHLORDIAZEPOXIDE HCL 25 MG ORAL CAP,,10642,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
CHLORDIAZEPOXIDE HCL 25 MG ORAL CAP,,10642,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
CHLORDIAZEPOXIDE HCL 25 MG ORAL CAP,,10642,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
CHLORDIAZEPOXIDE HCL 25 MG ORAL CAP,,10642,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
CHLORDIAZEPOXIDE HCL 25 MG ORAL CAP,,10642,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
CHLORDIAZEPOXIDE HCL 25 MG ORAL CAP,,10642,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
CHLORDIAZEPOXIDE HCL 25 MG ORAL CAP,,10642,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
CHLORDIAZEPOXIDE HCL 25 MG ORAL CAP,,10642,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
CHLORDIAZEPOXIDE HCL 25 MG ORAL CAP,,10642,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
CHLORDIAZEPOXIDE HCL 25 MG ORAL CAP,,10642,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
CHLORDIAZEPOXIDE HCL 25 MG ORAL CAP,,10642,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
CHLORDIAZEPOXIDE HCL 25 MG ORAL CAP,,10642,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
CHLORDIAZEPOXIDE HCL 25 MG ORAL CAP,,10642,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
CHLORDIAZEPOXIDE HCL 25 MG ORAL CAP,,10642,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
CHLORDIAZEPOXIDE HCL 25 MG ORAL CAP,,10642,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
CHLORDIAZEPOXIDE HCL 25 MG ORAL CAP,,10642,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
CHLORDIAZEPOXIDE HCL 25 MG ORAL CAP,,10642,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CHLORDIAZEPOXIDE HCL 25 MG ORAL CAP,,10642,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
CHLORDIAZEPOXIDE HCL 25 MG ORAL CAP,,10642,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
CHLORDIAZEPOXIDE HCL 25 MG ORAL CAP,,10642,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
CHLORDIAZEPOXIDE HCL 25 MG ORAL CAP,,10642,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
CHLORDIAZEPOXIDE HCL 25 MG ORAL CAP,,10642,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
CHLORDIAZEPOXIDE HCL 25 MG ORAL CAP,,10642,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
CHLORDIAZEPOXIDE HCL 25 MG ORAL CAP,,10642,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
CHLORDIAZEPOXIDE HCL 25 MG ORAL CAP,,10642,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
CHLORDIAZEPOXIDE HCL 25 MG ORAL CAP,,10642,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
CHLORDIAZEPOXIDE HCL 25 MG ORAL CAP,,10642,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
CHLORDIAZEPOXIDE HCL 25 MG ORAL CAP,,10642,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
CHLORDIAZEPOXIDE HCL 25 MG ORAL CAP,,10642,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
CHLORDIAZEPOXIDE HCL 25 MG ORAL CAP,,10642,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
CHLORDIAZEPOXIDE HCL 25 MG ORAL CAP,,10642,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
CHLORDIAZEPOXIDE HCL 25 MG ORAL CAP,,10642,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
CHLORDIAZEPOXIDE HCL 25 MG ORAL CAP,,10642,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
CHLORDIAZEPOXIDE HCL 25 MG ORAL CAP,,10642,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
CHLORDIAZEPOXIDE HCL 25 MG ORAL CAP,,10642,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
CHLORDIAZEPOXIDE HCL 25 MG ORAL CAP,,10642,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CHLORDIAZEPOXIDE HCL 25 MG ORAL CAP,,10642,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
CHLORDIAZEPOXIDE HCL 25 MG ORAL CAP,,10642,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
CHLORDIAZEPOXIDE HCL 25 MG ORAL CAP,,10642,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
CHLORDIAZEPOXIDE HCL 25 MG ORAL CAP,,10642,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
CHLORDIAZEPOXIDE HCL 25 MG ORAL CAP,,10642,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
CHLORDIAZEPOXIDE HCL 25 MG ORAL CAP,,10642,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CHLORDIAZEPOXIDE HCL 25 MG ORAL CAP,,10642,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
CHLORDIAZEPOXIDE HCL 25 MG ORAL CAP,,10642,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CHLORDIAZEPOXIDE HCL 25 MG ORAL CAP,,10642,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CHLORDIAZEPOXIDE HCL 25 MG ORAL CAP,,10642,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CHLORDIAZEPOXIDE HCL 25 MG ORAL CAP,,10642,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CHLORDIAZEPOXIDE HCL 25 MG ORAL CAP,,10642,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
CHLORDIAZEPOXIDE HCL 25 MG ORAL CAP,,10642,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
CHLORDIAZEPOXIDE HCL 25 MG ORAL CAP,,10642,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
CHLORDIAZEPOXIDE HCL 25 MG ORAL CAP,,10642,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
CHLORDIAZEPOXIDE HCL 25 MG ORAL CAP,,10642,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
NITROGLYCERIN 0.4 MG/HR TD PT24,,10665,LOCAL,Facility,Both,1,Each,,11,9.35,3.1526,11,Aetna,Commercial,10.12,92,,percent of total billed charges,,
NITROGLYCERIN 0.4 MG/HR TD PT24,,10665,LOCAL,Facility,Outpatient,1,Each,,11,9.35,3.1526,11,Aetna,Medicare Advantage,5.39,49,,percent of total billed charges,,
NITROGLYCERIN 0.4 MG/HR TD PT24,,10665,LOCAL,Facility,Inpatient,1,Each,,11,9.35,3.1526,11,Aetna,Medicare Advantage,,,,,Included in per diem rate,
NITROGLYCERIN 0.4 MG/HR TD PT24,,10665,LOCAL,Facility,Both,1,Each,,11,9.35,3.1526,11,Aetna,PPO,10.23,93,,percent of total billed charges,,
NITROGLYCERIN 0.4 MG/HR TD PT24,,10665,LOCAL,Facility,Both,1,Each,,11,9.35,3.1526,11,America's PPO,America's PPO,10.5633,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
NITROGLYCERIN 0.4 MG/HR TD PT24,,10665,LOCAL,Facility,Both,1,Each,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota, Federal Employee Program,10.824,98.4,,percent of total billed charges,,
NITROGLYCERIN 0.4 MG/HR TD PT24,,10665,LOCAL,Facility,Both,1,Each,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,11,100,,percent of total billed charges,,
NITROGLYCERIN 0.4 MG/HR TD PT24,,10665,LOCAL,Facility,Both,1,Each,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,High Value Network Plan,9.9,90,,percent of total billed charges,,
NITROGLYCERIN 0.4 MG/HR TD PT24,,10665,LOCAL,Facility,Outpatient,1,Each,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,Medicare Advantage,5.39,49,,percent of total billed charges,,
NITROGLYCERIN 0.4 MG/HR TD PT24,,10665,LOCAL,Facility,Inpatient,1,Each,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
NITROGLYCERIN 0.4 MG/HR TD PT24,,10665,LOCAL,Facility,Both,1,Each,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,9.7427,88.57,,percent of total billed charges,,
NITROGLYCERIN 0.4 MG/HR TD PT24,,10665,LOCAL,Facility,Both,1,Each,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,3.1526,28.66,,percent of total billed charges,,
NITROGLYCERIN 0.4 MG/HR TD PT24,,10665,LOCAL,Facility,Outpatient,1,Each,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),5.39,49,,percent of total billed charges,,
NITROGLYCERIN 0.4 MG/HR TD PT24,,10665,LOCAL,Facility,Inpatient,1,Each,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
NITROGLYCERIN 0.4 MG/HR TD PT24,,10665,LOCAL,Facility,Both,1,Each,,11,9.35,3.1526,11,CorVel,Worker's Compensation,11,100,,percent of total billed charges,,
NITROGLYCERIN 0.4 MG/HR TD PT24,,10665,LOCAL,Facility,Both,1,Each,,11,9.35,3.1526,11,First Health Group Corporation,First Health Network,10.67,97,,percent of total billed charges,,
NITROGLYCERIN 0.4 MG/HR TD PT24,,10665,LOCAL,Facility,Both,1,Each,,11,9.35,3.1526,11,"Health Partners, Inc.",Commercial,10.406,94.6,,percent of total billed charges,,
NITROGLYCERIN 0.4 MG/HR TD PT24,,10665,LOCAL,Facility,Outpatient,1,Each,,11,9.35,3.1526,11,"Health Partners, Inc.",Medicare Advantage,5.39,49,,percent of total billed charges,,
NITROGLYCERIN 0.4 MG/HR TD PT24,,10665,LOCAL,Facility,Inpatient,1,Each,,11,9.35,3.1526,11,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
NITROGLYCERIN 0.4 MG/HR TD PT24,,10665,LOCAL,Facility,Both,1,Each,,11,9.35,3.1526,11,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),6.6,60,,percent of total billed charges,,
NITROGLYCERIN 0.4 MG/HR TD PT24,,10665,LOCAL,Facility,Both,1,Each,,11,9.35,3.1526,11,"Health Partners, Inc.",State of Minnesota Advantage Program,8.965,81.5,,percent of total billed charges,,
NITROGLYCERIN 0.4 MG/HR TD PT24,,10665,LOCAL,Facility,Both,1,Each,,11,9.35,3.1526,11,"Health Partners, Inc.",State Public Programs,5.5,50,,percent of total billed charges,,
NITROGLYCERIN 0.4 MG/HR TD PT24,,10665,LOCAL,Facility,Both,1,Each,,11,9.35,3.1526,11,Humana Insurance Company,Commercial PPO,10.45,95,,percent of total billed charges,,
NITROGLYCERIN 0.4 MG/HR TD PT24,,10665,LOCAL,Facility,Outpatient,1,Each,,11,9.35,3.1526,11,Humana Insurance Company,Medicare PPO,5.39,49,,percent of total billed charges,,
NITROGLYCERIN 0.4 MG/HR TD PT24,,10665,LOCAL,Facility,Inpatient,1,Each,,11,9.35,3.1526,11,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
NITROGLYCERIN 0.4 MG/HR TD PT24,,10665,LOCAL,Facility,Both,1,Each,,11,9.35,3.1526,11,Medica,Individual & Family,10.901,99.1,,percent of total billed charges,,
NITROGLYCERIN 0.4 MG/HR TD PT24,,10665,LOCAL,Facility,Outpatient,1,Each,,11,9.35,3.1526,11,Medica,Medica Advantage Solution,5.478,49.8,,percent of total billed charges,,
NITROGLYCERIN 0.4 MG/HR TD PT24,,10665,LOCAL,Facility,Inpatient,1,Each,,11,9.35,3.1526,11,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
NITROGLYCERIN 0.4 MG/HR TD PT24,,10665,LOCAL,Facility,Outpatient,1,Each,,11,9.35,3.1526,11,Medica,Medical Assistance,4.906,44.6,,percent of total billed charges,,
NITROGLYCERIN 0.4 MG/HR TD PT24,,10665,LOCAL,Facility,Inpatient,1,Each,,11,9.35,3.1526,11,Medica,Medical Assistance,,,,,Included in per diem rate,
NITROGLYCERIN 0.4 MG/HR TD PT24,,10665,LOCAL,Facility,Outpatient,1,Each,,11,9.35,3.1526,11,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,5.478,49.8,,percent of total billed charges,,
NITROGLYCERIN 0.4 MG/HR TD PT24,,10665,LOCAL,Facility,Inpatient,1,Each,,11,9.35,3.1526,11,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
NITROGLYCERIN 0.4 MG/HR TD PT24,,10665,LOCAL,Facility,Both,1,Each,,11,9.35,3.1526,11,"Multiplan, Inc.","Multiplan, Inc.",10.34,94,,percent of total billed charges,,
NITROGLYCERIN 0.4 MG/HR TD PT24,,10665,LOCAL,Facility,Outpatient,1,Each,,11,9.35,3.1526,11,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,9.911,90.1,,percent of total billed charges,,
NITROGLYCERIN 0.4 MG/HR TD PT24,,10665,LOCAL,Facility,Inpatient,1,Each,,11,9.35,3.1526,11,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
NITROGLYCERIN 0.4 MG/HR TD PT24,,10665,LOCAL,Facility,Both,1,Each,,11,9.35,3.1526,11,"Preferred One Administrative Services, INC.",PPO,10.846,98.6,,percent of total billed charges,,
NITROGLYCERIN 0.4 MG/HR TD PT24,,10665,LOCAL,Facility,Outpatient,1,Each,,11,9.35,3.1526,11,PrimeWest Health,Minnesota Senior Health Options (MSHO),5.6595,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
NITROGLYCERIN 0.4 MG/HR TD PT24,,10665,LOCAL,Facility,Inpatient,1,Each,,11,9.35,3.1526,11,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
NITROGLYCERIN 0.4 MG/HR TD PT24,,10665,LOCAL,Facility,Outpatient,1,Each,,11,9.35,3.1526,11,PrimeWest Health,MinnesotaCare,5.6496,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
NITROGLYCERIN 0.4 MG/HR TD PT24,,10665,LOCAL,Facility,Inpatient,1,Each,,11,9.35,3.1526,11,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
NITROGLYCERIN 0.4 MG/HR TD PT24,,10665,LOCAL,Facility,Both,1,Each,,11,9.35,3.1526,11,Sanford Health Plan,Sanford Health Plan,10.12,92,,percent of total billed charges,,
NITROGLYCERIN 0.4 MG/HR TD PT24,,10665,LOCAL,Facility,Outpatient,1,Each,,11,9.35,3.1526,11,"UCare Health, Inc.",Individual & Family Plan,6.1985,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
NITROGLYCERIN 0.4 MG/HR TD PT24,,10665,LOCAL,Facility,Inpatient,1,Each,,11,9.35,3.1526,11,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
NITROGLYCERIN 0.4 MG/HR TD PT24,,10665,LOCAL,Facility,Outpatient,1,Each,,11,9.35,3.1526,11,"UCare Health, Inc.",Medical Assistance,5.5517,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
NITROGLYCERIN 0.4 MG/HR TD PT24,,10665,LOCAL,Facility,Inpatient,1,Each,,11,9.35,3.1526,11,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
NITROGLYCERIN 0.4 MG/HR TD PT24,,10665,LOCAL,Facility,Outpatient,1,Each,,11,9.35,3.1526,11,"UCare Health, Inc.",Medicare Advantage,5.5517,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
NITROGLYCERIN 0.4 MG/HR TD PT24,,10665,LOCAL,Facility,Inpatient,1,Each,,11,9.35,3.1526,11,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
NITROGLYCERIN 0.4 MG/HR TD PT24,,10665,LOCAL,Facility,Outpatient,1,Each,,11,9.35,3.1526,11,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),5.5517,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
NITROGLYCERIN 0.4 MG/HR TD PT24,,10665,LOCAL,Facility,Inpatient,1,Each,,11,9.35,3.1526,11,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
NITROGLYCERIN 0.4 MG/HR TD PT24,,10665,LOCAL,Facility,Both,1,Each,,11,9.35,3.1526,11,UnitedHealthcare,Individual & Family,10.34,94,,percent of total billed charges,,
NITROGLYCERIN 0.4 MG/HR TD PT24,,10665,LOCAL,Facility,Outpatient,1,Each,,11,9.35,3.1526,11,UnitedHealthcare,Medicare Advantage,5.39,49,,percent of total billed charges,,
NITROGLYCERIN 0.4 MG/HR TD PT24,,10665,LOCAL,Facility,Inpatient,1,Each,,11,9.35,3.1526,11,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
NITROGLYCERIN 0.4 MG/HR TD PT24,,10665,LOCAL,Facility,Outpatient,1,Each,,11,9.35,3.1526,11,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,5.28,48,,percent of total billed charges,,100% of DHS outpatient percentage
NITROGLYCERIN 0.4 MG/HR TD PT24,,10665,LOCAL,Facility,Inpatient,1,Each,,11,9.35,3.1526,11,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
ASPIRIN 325 MG ORAL TBEC,,10834,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
ASPIRIN 325 MG ORAL TBEC,,10834,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
ASPIRIN 325 MG ORAL TBEC,,10834,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
ASPIRIN 325 MG ORAL TBEC,,10834,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
ASPIRIN 325 MG ORAL TBEC,,10834,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
ASPIRIN 325 MG ORAL TBEC,,10834,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
ASPIRIN 325 MG ORAL TBEC,,10834,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
ASPIRIN 325 MG ORAL TBEC,,10834,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
ASPIRIN 325 MG ORAL TBEC,,10834,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
ASPIRIN 325 MG ORAL TBEC,,10834,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
ASPIRIN 325 MG ORAL TBEC,,10834,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
ASPIRIN 325 MG ORAL TBEC,,10834,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
ASPIRIN 325 MG ORAL TBEC,,10834,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
ASPIRIN 325 MG ORAL TBEC,,10834,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
ASPIRIN 325 MG ORAL TBEC,,10834,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
ASPIRIN 325 MG ORAL TBEC,,10834,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
ASPIRIN 325 MG ORAL TBEC,,10834,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
ASPIRIN 325 MG ORAL TBEC,,10834,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
ASPIRIN 325 MG ORAL TBEC,,10834,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ASPIRIN 325 MG ORAL TBEC,,10834,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
ASPIRIN 325 MG ORAL TBEC,,10834,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
ASPIRIN 325 MG ORAL TBEC,,10834,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
ASPIRIN 325 MG ORAL TBEC,,10834,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
ASPIRIN 325 MG ORAL TBEC,,10834,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
ASPIRIN 325 MG ORAL TBEC,,10834,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
ASPIRIN 325 MG ORAL TBEC,,10834,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
ASPIRIN 325 MG ORAL TBEC,,10834,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
ASPIRIN 325 MG ORAL TBEC,,10834,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
ASPIRIN 325 MG ORAL TBEC,,10834,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
ASPIRIN 325 MG ORAL TBEC,,10834,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
ASPIRIN 325 MG ORAL TBEC,,10834,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
ASPIRIN 325 MG ORAL TBEC,,10834,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
ASPIRIN 325 MG ORAL TBEC,,10834,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
ASPIRIN 325 MG ORAL TBEC,,10834,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
ASPIRIN 325 MG ORAL TBEC,,10834,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
ASPIRIN 325 MG ORAL TBEC,,10834,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
ASPIRIN 325 MG ORAL TBEC,,10834,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
ASPIRIN 325 MG ORAL TBEC,,10834,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ASPIRIN 325 MG ORAL TBEC,,10834,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
ASPIRIN 325 MG ORAL TBEC,,10834,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
ASPIRIN 325 MG ORAL TBEC,,10834,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
ASPIRIN 325 MG ORAL TBEC,,10834,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
ASPIRIN 325 MG ORAL TBEC,,10834,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
ASPIRIN 325 MG ORAL TBEC,,10834,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ASPIRIN 325 MG ORAL TBEC,,10834,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
ASPIRIN 325 MG ORAL TBEC,,10834,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ASPIRIN 325 MG ORAL TBEC,,10834,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ASPIRIN 325 MG ORAL TBEC,,10834,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ASPIRIN 325 MG ORAL TBEC,,10834,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ASPIRIN 325 MG ORAL TBEC,,10834,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
ASPIRIN 325 MG ORAL TBEC,,10834,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
ASPIRIN 325 MG ORAL TBEC,,10834,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
ASPIRIN 325 MG ORAL TBEC,,10834,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
ASPIRIN 325 MG ORAL TBEC,,10834,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
TAMSULOSIN 0.4 MG ORAL CAP,,10900,LOCAL,Facility,Both,1,Each,,22,18.7,6.3052,22,Aetna,Commercial,20.24,92,,percent of total billed charges,,
TAMSULOSIN 0.4 MG ORAL CAP,,10900,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
TAMSULOSIN 0.4 MG ORAL CAP,,10900,LOCAL,Facility,Outpatient,1,Each,,22,18.7,6.3052,22,Aetna,Medicare Advantage,10.78,49,,percent of total billed charges,,
TAMSULOSIN 0.4 MG ORAL CAP,,10900,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
TAMSULOSIN 0.4 MG ORAL CAP,,10900,LOCAL,Facility,Inpatient,1,Each,,22,18.7,6.3052,22,Aetna,Medicare Advantage,,,,,Included in per diem rate,
TAMSULOSIN 0.4 MG ORAL CAP,,10900,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
TAMSULOSIN 0.4 MG ORAL CAP,,10900,LOCAL,Facility,Both,1,Each,,22,18.7,6.3052,22,Aetna,PPO,20.46,93,,percent of total billed charges,,
TAMSULOSIN 0.4 MG ORAL CAP,,10900,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
TAMSULOSIN 0.4 MG ORAL CAP,,10900,LOCAL,Facility,Both,1,Each,,22,18.7,6.3052,22,America's PPO,America's PPO,21.1266,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
TAMSULOSIN 0.4 MG ORAL CAP,,10900,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
TAMSULOSIN 0.4 MG ORAL CAP,,10900,LOCAL,Facility,Both,1,Each,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota, Federal Employee Program,21.648,98.4,,percent of total billed charges,,
TAMSULOSIN 0.4 MG ORAL CAP,,10900,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
TAMSULOSIN 0.4 MG ORAL CAP,,10900,LOCAL,Facility,Both,1,Each,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,22,100,,percent of total billed charges,,
TAMSULOSIN 0.4 MG ORAL CAP,,10900,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
TAMSULOSIN 0.4 MG ORAL CAP,,10900,LOCAL,Facility,Both,1,Each,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota,High Value Network Plan,19.8,90,,percent of total billed charges,,
TAMSULOSIN 0.4 MG ORAL CAP,,10900,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
TAMSULOSIN 0.4 MG ORAL CAP,,10900,LOCAL,Facility,Outpatient,1,Each,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota,Medicare Advantage,10.78,49,,percent of total billed charges,,
TAMSULOSIN 0.4 MG ORAL CAP,,10900,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
TAMSULOSIN 0.4 MG ORAL CAP,,10900,LOCAL,Facility,Inpatient,1,Each,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
TAMSULOSIN 0.4 MG ORAL CAP,,10900,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
TAMSULOSIN 0.4 MG ORAL CAP,,10900,LOCAL,Facility,Both,1,Each,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,19.4854,88.57,,percent of total billed charges,,
TAMSULOSIN 0.4 MG ORAL CAP,,10900,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
TAMSULOSIN 0.4 MG ORAL CAP,,10900,LOCAL,Facility,Both,1,Each,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,6.3052,28.66,,percent of total billed charges,,
TAMSULOSIN 0.4 MG ORAL CAP,,10900,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
TAMSULOSIN 0.4 MG ORAL CAP,,10900,LOCAL,Facility,Outpatient,1,Each,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),10.78,49,,percent of total billed charges,,
TAMSULOSIN 0.4 MG ORAL CAP,,10900,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
TAMSULOSIN 0.4 MG ORAL CAP,,10900,LOCAL,Facility,Inpatient,1,Each,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
TAMSULOSIN 0.4 MG ORAL CAP,,10900,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
TAMSULOSIN 0.4 MG ORAL CAP,,10900,LOCAL,Facility,Both,1,Each,,22,18.7,6.3052,22,CorVel,Worker's Compensation,22,100,,percent of total billed charges,,
TAMSULOSIN 0.4 MG ORAL CAP,,10900,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
TAMSULOSIN 0.4 MG ORAL CAP,,10900,LOCAL,Facility,Both,1,Each,,22,18.7,6.3052,22,First Health Group Corporation,First Health Network,21.34,97,,percent of total billed charges,,
TAMSULOSIN 0.4 MG ORAL CAP,,10900,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
TAMSULOSIN 0.4 MG ORAL CAP,,10900,LOCAL,Facility,Both,1,Each,,22,18.7,6.3052,22,"Health Partners, Inc.",Commercial,20.812,94.6,,percent of total billed charges,,
TAMSULOSIN 0.4 MG ORAL CAP,,10900,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
TAMSULOSIN 0.4 MG ORAL CAP,,10900,LOCAL,Facility,Outpatient,1,Each,,22,18.7,6.3052,22,"Health Partners, Inc.",Medicare Advantage,10.78,49,,percent of total billed charges,,
TAMSULOSIN 0.4 MG ORAL CAP,,10900,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
TAMSULOSIN 0.4 MG ORAL CAP,,10900,LOCAL,Facility,Inpatient,1,Each,,22,18.7,6.3052,22,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
TAMSULOSIN 0.4 MG ORAL CAP,,10900,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
TAMSULOSIN 0.4 MG ORAL CAP,,10900,LOCAL,Facility,Both,1,Each,,22,18.7,6.3052,22,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),13.2,60,,percent of total billed charges,,
TAMSULOSIN 0.4 MG ORAL CAP,,10900,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
TAMSULOSIN 0.4 MG ORAL CAP,,10900,LOCAL,Facility,Both,1,Each,,22,18.7,6.3052,22,"Health Partners, Inc.",State of Minnesota Advantage Program,17.93,81.5,,percent of total billed charges,,
TAMSULOSIN 0.4 MG ORAL CAP,,10900,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
TAMSULOSIN 0.4 MG ORAL CAP,,10900,LOCAL,Facility,Both,1,Each,,22,18.7,6.3052,22,"Health Partners, Inc.",State Public Programs,11,50,,percent of total billed charges,,
TAMSULOSIN 0.4 MG ORAL CAP,,10900,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
TAMSULOSIN 0.4 MG ORAL CAP,,10900,LOCAL,Facility,Both,1,Each,,22,18.7,6.3052,22,Humana Insurance Company,Commercial PPO,20.9,95,,percent of total billed charges,,
TAMSULOSIN 0.4 MG ORAL CAP,,10900,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
TAMSULOSIN 0.4 MG ORAL CAP,,10900,LOCAL,Facility,Outpatient,1,Each,,22,18.7,6.3052,22,Humana Insurance Company,Medicare PPO,10.78,49,,percent of total billed charges,,
TAMSULOSIN 0.4 MG ORAL CAP,,10900,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
TAMSULOSIN 0.4 MG ORAL CAP,,10900,LOCAL,Facility,Inpatient,1,Each,,22,18.7,6.3052,22,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
TAMSULOSIN 0.4 MG ORAL CAP,,10900,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
TAMSULOSIN 0.4 MG ORAL CAP,,10900,LOCAL,Facility,Both,1,Each,,22,18.7,6.3052,22,Medica,Individual & Family,21.802,99.1,,percent of total billed charges,,
TAMSULOSIN 0.4 MG ORAL CAP,,10900,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
TAMSULOSIN 0.4 MG ORAL CAP,,10900,LOCAL,Facility,Outpatient,1,Each,,22,18.7,6.3052,22,Medica,Medica Advantage Solution,10.956,49.8,,percent of total billed charges,,
TAMSULOSIN 0.4 MG ORAL CAP,,10900,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
TAMSULOSIN 0.4 MG ORAL CAP,,10900,LOCAL,Facility,Inpatient,1,Each,,22,18.7,6.3052,22,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
TAMSULOSIN 0.4 MG ORAL CAP,,10900,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
TAMSULOSIN 0.4 MG ORAL CAP,,10900,LOCAL,Facility,Outpatient,1,Each,,22,18.7,6.3052,22,Medica,Medical Assistance,9.812,44.6,,percent of total billed charges,,
TAMSULOSIN 0.4 MG ORAL CAP,,10900,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
TAMSULOSIN 0.4 MG ORAL CAP,,10900,LOCAL,Facility,Inpatient,1,Each,,22,18.7,6.3052,22,Medica,Medical Assistance,,,,,Included in per diem rate,
TAMSULOSIN 0.4 MG ORAL CAP,,10900,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
TAMSULOSIN 0.4 MG ORAL CAP,,10900,LOCAL,Facility,Outpatient,1,Each,,22,18.7,6.3052,22,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,10.956,49.8,,percent of total billed charges,,
TAMSULOSIN 0.4 MG ORAL CAP,,10900,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
TAMSULOSIN 0.4 MG ORAL CAP,,10900,LOCAL,Facility,Inpatient,1,Each,,22,18.7,6.3052,22,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
TAMSULOSIN 0.4 MG ORAL CAP,,10900,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
TAMSULOSIN 0.4 MG ORAL CAP,,10900,LOCAL,Facility,Both,1,Each,,22,18.7,6.3052,22,"Multiplan, Inc.","Multiplan, Inc.",20.68,94,,percent of total billed charges,,
TAMSULOSIN 0.4 MG ORAL CAP,,10900,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
TAMSULOSIN 0.4 MG ORAL CAP,,10900,LOCAL,Facility,Outpatient,1,Each,,22,18.7,6.3052,22,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,19.822,90.1,,percent of total billed charges,,
TAMSULOSIN 0.4 MG ORAL CAP,,10900,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
TAMSULOSIN 0.4 MG ORAL CAP,,10900,LOCAL,Facility,Inpatient,1,Each,,22,18.7,6.3052,22,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
TAMSULOSIN 0.4 MG ORAL CAP,,10900,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
TAMSULOSIN 0.4 MG ORAL CAP,,10900,LOCAL,Facility,Both,1,Each,,22,18.7,6.3052,22,"Preferred One Administrative Services, INC.",PPO,21.692,98.6,,percent of total billed charges,,
TAMSULOSIN 0.4 MG ORAL CAP,,10900,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
TAMSULOSIN 0.4 MG ORAL CAP,,10900,LOCAL,Facility,Outpatient,1,Each,,22,18.7,6.3052,22,PrimeWest Health,Minnesota Senior Health Options (MSHO),11.319,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
TAMSULOSIN 0.4 MG ORAL CAP,,10900,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
TAMSULOSIN 0.4 MG ORAL CAP,,10900,LOCAL,Facility,Inpatient,1,Each,,22,18.7,6.3052,22,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
TAMSULOSIN 0.4 MG ORAL CAP,,10900,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
TAMSULOSIN 0.4 MG ORAL CAP,,10900,LOCAL,Facility,Outpatient,1,Each,,22,18.7,6.3052,22,PrimeWest Health,MinnesotaCare,11.2992,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
TAMSULOSIN 0.4 MG ORAL CAP,,10900,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
TAMSULOSIN 0.4 MG ORAL CAP,,10900,LOCAL,Facility,Inpatient,1,Each,,22,18.7,6.3052,22,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
TAMSULOSIN 0.4 MG ORAL CAP,,10900,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
TAMSULOSIN 0.4 MG ORAL CAP,,10900,LOCAL,Facility,Both,1,Each,,22,18.7,6.3052,22,Sanford Health Plan,Sanford Health Plan,20.24,92,,percent of total billed charges,,
TAMSULOSIN 0.4 MG ORAL CAP,,10900,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
TAMSULOSIN 0.4 MG ORAL CAP,,10900,LOCAL,Facility,Outpatient,1,Each,,22,18.7,6.3052,22,"UCare Health, Inc.",Individual & Family Plan,12.397,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
TAMSULOSIN 0.4 MG ORAL CAP,,10900,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
TAMSULOSIN 0.4 MG ORAL CAP,,10900,LOCAL,Facility,Inpatient,1,Each,,22,18.7,6.3052,22,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
TAMSULOSIN 0.4 MG ORAL CAP,,10900,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
TAMSULOSIN 0.4 MG ORAL CAP,,10900,LOCAL,Facility,Outpatient,1,Each,,22,18.7,6.3052,22,"UCare Health, Inc.",Medical Assistance,11.1034,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TAMSULOSIN 0.4 MG ORAL CAP,,10900,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TAMSULOSIN 0.4 MG ORAL CAP,,10900,LOCAL,Facility,Inpatient,1,Each,,22,18.7,6.3052,22,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
TAMSULOSIN 0.4 MG ORAL CAP,,10900,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
TAMSULOSIN 0.4 MG ORAL CAP,,10900,LOCAL,Facility,Outpatient,1,Each,,22,18.7,6.3052,22,"UCare Health, Inc.",Medicare Advantage,11.1034,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TAMSULOSIN 0.4 MG ORAL CAP,,10900,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TAMSULOSIN 0.4 MG ORAL CAP,,10900,LOCAL,Facility,Inpatient,1,Each,,22,18.7,6.3052,22,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
TAMSULOSIN 0.4 MG ORAL CAP,,10900,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
TAMSULOSIN 0.4 MG ORAL CAP,,10900,LOCAL,Facility,Outpatient,1,Each,,22,18.7,6.3052,22,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),11.1034,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TAMSULOSIN 0.4 MG ORAL CAP,,10900,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TAMSULOSIN 0.4 MG ORAL CAP,,10900,LOCAL,Facility,Inpatient,1,Each,,22,18.7,6.3052,22,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
TAMSULOSIN 0.4 MG ORAL CAP,,10900,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
TAMSULOSIN 0.4 MG ORAL CAP,,10900,LOCAL,Facility,Both,1,Each,,22,18.7,6.3052,22,UnitedHealthcare,Individual & Family,20.68,94,,percent of total billed charges,,
TAMSULOSIN 0.4 MG ORAL CAP,,10900,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
TAMSULOSIN 0.4 MG ORAL CAP,,10900,LOCAL,Facility,Outpatient,1,Each,,22,18.7,6.3052,22,UnitedHealthcare,Medicare Advantage,10.78,49,,percent of total billed charges,,
TAMSULOSIN 0.4 MG ORAL CAP,,10900,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
TAMSULOSIN 0.4 MG ORAL CAP,,10900,LOCAL,Facility,Inpatient,1,Each,,22,18.7,6.3052,22,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
TAMSULOSIN 0.4 MG ORAL CAP,,10900,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
TAMSULOSIN 0.4 MG ORAL CAP,,10900,LOCAL,Facility,Outpatient,1,Each,,22,18.7,6.3052,22,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,10.56,48,,percent of total billed charges,,100% of DHS outpatient percentage
TAMSULOSIN 0.4 MG ORAL CAP,,10900,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
TAMSULOSIN 0.4 MG ORAL CAP,,10900,LOCAL,Facility,Inpatient,1,Each,,22,18.7,6.3052,22,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
TAMSULOSIN 0.4 MG ORAL CAP,,10900,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
WITCH HAZEL-GLYCERIN (HAMAMEL) TOP PADM,,11226,LOCAL,Facility,Both,1,Each,,10,8.5,2.866,10,Aetna,Commercial,9.2,92,,percent of total billed charges,,
WITCH HAZEL-GLYCERIN (HAMAMEL) TOP PADM,,11226,LOCAL,Facility,Outpatient,1,Each,,10,8.5,2.866,10,Aetna,Medicare Advantage,4.9,49,,percent of total billed charges,,
WITCH HAZEL-GLYCERIN (HAMAMEL) TOP PADM,,11226,LOCAL,Facility,Inpatient,1,Each,,10,8.5,2.866,10,Aetna,Medicare Advantage,,,,,Included in per diem rate,
WITCH HAZEL-GLYCERIN (HAMAMEL) TOP PADM,,11226,LOCAL,Facility,Both,1,Each,,10,8.5,2.866,10,Aetna,PPO,9.3,93,,percent of total billed charges,,
WITCH HAZEL-GLYCERIN (HAMAMEL) TOP PADM,,11226,LOCAL,Facility,Both,1,Each,,10,8.5,2.866,10,America's PPO,America's PPO,9.603,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
WITCH HAZEL-GLYCERIN (HAMAMEL) TOP PADM,,11226,LOCAL,Facility,Both,1,Each,,10,8.5,2.866,10,BlueCross BlueShield Minnesota, Federal Employee Program,9.84,98.4,,percent of total billed charges,,
WITCH HAZEL-GLYCERIN (HAMAMEL) TOP PADM,,11226,LOCAL,Facility,Both,1,Each,,10,8.5,2.866,10,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,10,100,,percent of total billed charges,,
WITCH HAZEL-GLYCERIN (HAMAMEL) TOP PADM,,11226,LOCAL,Facility,Both,1,Each,,10,8.5,2.866,10,BlueCross BlueShield Minnesota,High Value Network Plan,9,90,,percent of total billed charges,,
WITCH HAZEL-GLYCERIN (HAMAMEL) TOP PADM,,11226,LOCAL,Facility,Outpatient,1,Each,,10,8.5,2.866,10,BlueCross BlueShield Minnesota,Medicare Advantage,4.9,49,,percent of total billed charges,,
WITCH HAZEL-GLYCERIN (HAMAMEL) TOP PADM,,11226,LOCAL,Facility,Inpatient,1,Each,,10,8.5,2.866,10,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
WITCH HAZEL-GLYCERIN (HAMAMEL) TOP PADM,,11226,LOCAL,Facility,Both,1,Each,,10,8.5,2.866,10,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,8.857,88.57,,percent of total billed charges,,
WITCH HAZEL-GLYCERIN (HAMAMEL) TOP PADM,,11226,LOCAL,Facility,Both,1,Each,,10,8.5,2.866,10,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,2.866,28.66,,percent of total billed charges,,
WITCH HAZEL-GLYCERIN (HAMAMEL) TOP PADM,,11226,LOCAL,Facility,Outpatient,1,Each,,10,8.5,2.866,10,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),4.9,49,,percent of total billed charges,,
WITCH HAZEL-GLYCERIN (HAMAMEL) TOP PADM,,11226,LOCAL,Facility,Inpatient,1,Each,,10,8.5,2.866,10,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
WITCH HAZEL-GLYCERIN (HAMAMEL) TOP PADM,,11226,LOCAL,Facility,Both,1,Each,,10,8.5,2.866,10,CorVel,Worker's Compensation,10,100,,percent of total billed charges,,
WITCH HAZEL-GLYCERIN (HAMAMEL) TOP PADM,,11226,LOCAL,Facility,Both,1,Each,,10,8.5,2.866,10,First Health Group Corporation,First Health Network,9.7,97,,percent of total billed charges,,
WITCH HAZEL-GLYCERIN (HAMAMEL) TOP PADM,,11226,LOCAL,Facility,Both,1,Each,,10,8.5,2.866,10,"Health Partners, Inc.",Commercial,9.46,94.6,,percent of total billed charges,,
WITCH HAZEL-GLYCERIN (HAMAMEL) TOP PADM,,11226,LOCAL,Facility,Outpatient,1,Each,,10,8.5,2.866,10,"Health Partners, Inc.",Medicare Advantage,4.9,49,,percent of total billed charges,,
WITCH HAZEL-GLYCERIN (HAMAMEL) TOP PADM,,11226,LOCAL,Facility,Inpatient,1,Each,,10,8.5,2.866,10,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
WITCH HAZEL-GLYCERIN (HAMAMEL) TOP PADM,,11226,LOCAL,Facility,Both,1,Each,,10,8.5,2.866,10,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),6,60,,percent of total billed charges,,
WITCH HAZEL-GLYCERIN (HAMAMEL) TOP PADM,,11226,LOCAL,Facility,Both,1,Each,,10,8.5,2.866,10,"Health Partners, Inc.",State of Minnesota Advantage Program,8.15,81.5,,percent of total billed charges,,
WITCH HAZEL-GLYCERIN (HAMAMEL) TOP PADM,,11226,LOCAL,Facility,Both,1,Each,,10,8.5,2.866,10,"Health Partners, Inc.",State Public Programs,5,50,,percent of total billed charges,,
WITCH HAZEL-GLYCERIN (HAMAMEL) TOP PADM,,11226,LOCAL,Facility,Both,1,Each,,10,8.5,2.866,10,Humana Insurance Company,Commercial PPO,9.5,95,,percent of total billed charges,,
WITCH HAZEL-GLYCERIN (HAMAMEL) TOP PADM,,11226,LOCAL,Facility,Outpatient,1,Each,,10,8.5,2.866,10,Humana Insurance Company,Medicare PPO,4.9,49,,percent of total billed charges,,
WITCH HAZEL-GLYCERIN (HAMAMEL) TOP PADM,,11226,LOCAL,Facility,Inpatient,1,Each,,10,8.5,2.866,10,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
WITCH HAZEL-GLYCERIN (HAMAMEL) TOP PADM,,11226,LOCAL,Facility,Both,1,Each,,10,8.5,2.866,10,Medica,Individual & Family,9.91,99.1,,percent of total billed charges,,
WITCH HAZEL-GLYCERIN (HAMAMEL) TOP PADM,,11226,LOCAL,Facility,Outpatient,1,Each,,10,8.5,2.866,10,Medica,Medica Advantage Solution,4.98,49.8,,percent of total billed charges,,
WITCH HAZEL-GLYCERIN (HAMAMEL) TOP PADM,,11226,LOCAL,Facility,Inpatient,1,Each,,10,8.5,2.866,10,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
WITCH HAZEL-GLYCERIN (HAMAMEL) TOP PADM,,11226,LOCAL,Facility,Outpatient,1,Each,,10,8.5,2.866,10,Medica,Medical Assistance,4.46,44.6,,percent of total billed charges,,
WITCH HAZEL-GLYCERIN (HAMAMEL) TOP PADM,,11226,LOCAL,Facility,Inpatient,1,Each,,10,8.5,2.866,10,Medica,Medical Assistance,,,,,Included in per diem rate,
WITCH HAZEL-GLYCERIN (HAMAMEL) TOP PADM,,11226,LOCAL,Facility,Outpatient,1,Each,,10,8.5,2.866,10,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,4.98,49.8,,percent of total billed charges,,
WITCH HAZEL-GLYCERIN (HAMAMEL) TOP PADM,,11226,LOCAL,Facility,Inpatient,1,Each,,10,8.5,2.866,10,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
WITCH HAZEL-GLYCERIN (HAMAMEL) TOP PADM,,11226,LOCAL,Facility,Both,1,Each,,10,8.5,2.866,10,"Multiplan, Inc.","Multiplan, Inc.",9.4,94,,percent of total billed charges,,
WITCH HAZEL-GLYCERIN (HAMAMEL) TOP PADM,,11226,LOCAL,Facility,Outpatient,1,Each,,10,8.5,2.866,10,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,9.01,90.1,,percent of total billed charges,,
WITCH HAZEL-GLYCERIN (HAMAMEL) TOP PADM,,11226,LOCAL,Facility,Inpatient,1,Each,,10,8.5,2.866,10,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
WITCH HAZEL-GLYCERIN (HAMAMEL) TOP PADM,,11226,LOCAL,Facility,Both,1,Each,,10,8.5,2.866,10,"Preferred One Administrative Services, INC.",PPO,9.86,98.6,,percent of total billed charges,,
WITCH HAZEL-GLYCERIN (HAMAMEL) TOP PADM,,11226,LOCAL,Facility,Outpatient,1,Each,,10,8.5,2.866,10,PrimeWest Health,Minnesota Senior Health Options (MSHO),5.145,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
WITCH HAZEL-GLYCERIN (HAMAMEL) TOP PADM,,11226,LOCAL,Facility,Inpatient,1,Each,,10,8.5,2.866,10,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
WITCH HAZEL-GLYCERIN (HAMAMEL) TOP PADM,,11226,LOCAL,Facility,Outpatient,1,Each,,10,8.5,2.866,10,PrimeWest Health,MinnesotaCare,5.136,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
WITCH HAZEL-GLYCERIN (HAMAMEL) TOP PADM,,11226,LOCAL,Facility,Inpatient,1,Each,,10,8.5,2.866,10,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
WITCH HAZEL-GLYCERIN (HAMAMEL) TOP PADM,,11226,LOCAL,Facility,Both,1,Each,,10,8.5,2.866,10,Sanford Health Plan,Sanford Health Plan,9.2,92,,percent of total billed charges,,
WITCH HAZEL-GLYCERIN (HAMAMEL) TOP PADM,,11226,LOCAL,Facility,Outpatient,1,Each,,10,8.5,2.866,10,"UCare Health, Inc.",Individual & Family Plan,5.635,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
WITCH HAZEL-GLYCERIN (HAMAMEL) TOP PADM,,11226,LOCAL,Facility,Inpatient,1,Each,,10,8.5,2.866,10,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
WITCH HAZEL-GLYCERIN (HAMAMEL) TOP PADM,,11226,LOCAL,Facility,Outpatient,1,Each,,10,8.5,2.866,10,"UCare Health, Inc.",Medical Assistance,5.047,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
WITCH HAZEL-GLYCERIN (HAMAMEL) TOP PADM,,11226,LOCAL,Facility,Inpatient,1,Each,,10,8.5,2.866,10,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
WITCH HAZEL-GLYCERIN (HAMAMEL) TOP PADM,,11226,LOCAL,Facility,Outpatient,1,Each,,10,8.5,2.866,10,"UCare Health, Inc.",Medicare Advantage,5.047,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
WITCH HAZEL-GLYCERIN (HAMAMEL) TOP PADM,,11226,LOCAL,Facility,Inpatient,1,Each,,10,8.5,2.866,10,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
WITCH HAZEL-GLYCERIN (HAMAMEL) TOP PADM,,11226,LOCAL,Facility,Outpatient,1,Each,,10,8.5,2.866,10,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),5.047,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
WITCH HAZEL-GLYCERIN (HAMAMEL) TOP PADM,,11226,LOCAL,Facility,Inpatient,1,Each,,10,8.5,2.866,10,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
WITCH HAZEL-GLYCERIN (HAMAMEL) TOP PADM,,11226,LOCAL,Facility,Both,1,Each,,10,8.5,2.866,10,UnitedHealthcare,Individual & Family,9.4,94,,percent of total billed charges,,
WITCH HAZEL-GLYCERIN (HAMAMEL) TOP PADM,,11226,LOCAL,Facility,Outpatient,1,Each,,10,8.5,2.866,10,UnitedHealthcare,Medicare Advantage,4.9,49,,percent of total billed charges,,
WITCH HAZEL-GLYCERIN (HAMAMEL) TOP PADM,,11226,LOCAL,Facility,Inpatient,1,Each,,10,8.5,2.866,10,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
WITCH HAZEL-GLYCERIN (HAMAMEL) TOP PADM,,11226,LOCAL,Facility,Outpatient,1,Each,,10,8.5,2.866,10,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,4.8,48,,percent of total billed charges,,100% of DHS outpatient percentage
WITCH HAZEL-GLYCERIN (HAMAMEL) TOP PADM,,11226,LOCAL,Facility,Inpatient,1,Each,,10,8.5,2.866,10,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
NIFEDIPINE 10 MG ORAL CAP,,11242,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,Aetna,Commercial,5.52,92,,percent of total billed charges,,
NIFEDIPINE 10 MG ORAL CAP,,11242,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,Aetna,Medicare Advantage,2.94,49,,percent of total billed charges,,
NIFEDIPINE 10 MG ORAL CAP,,11242,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,Aetna,Medicare Advantage,,,,,Included in per diem rate,
NIFEDIPINE 10 MG ORAL CAP,,11242,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,Aetna,PPO,5.58,93,,percent of total billed charges,,
NIFEDIPINE 10 MG ORAL CAP,,11242,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,America's PPO,America's PPO,5.7618,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
NIFEDIPINE 10 MG ORAL CAP,,11242,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota, Federal Employee Program,5.904,98.4,,percent of total billed charges,,
NIFEDIPINE 10 MG ORAL CAP,,11242,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,6,100,,percent of total billed charges,,
NIFEDIPINE 10 MG ORAL CAP,,11242,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota,High Value Network Plan,5.4,90,,percent of total billed charges,,
NIFEDIPINE 10 MG ORAL CAP,,11242,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota,Medicare Advantage,2.94,49,,percent of total billed charges,,
NIFEDIPINE 10 MG ORAL CAP,,11242,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
NIFEDIPINE 10 MG ORAL CAP,,11242,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,5.3142,88.57,,percent of total billed charges,,
NIFEDIPINE 10 MG ORAL CAP,,11242,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.7196,28.66,,percent of total billed charges,,
NIFEDIPINE 10 MG ORAL CAP,,11242,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.94,49,,percent of total billed charges,,
NIFEDIPINE 10 MG ORAL CAP,,11242,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
NIFEDIPINE 10 MG ORAL CAP,,11242,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,CorVel,Worker's Compensation,6,100,,percent of total billed charges,,
NIFEDIPINE 10 MG ORAL CAP,,11242,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,First Health Group Corporation,First Health Network,5.82,97,,percent of total billed charges,,
NIFEDIPINE 10 MG ORAL CAP,,11242,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,"Health Partners, Inc.",Commercial,5.676,94.6,,percent of total billed charges,,
NIFEDIPINE 10 MG ORAL CAP,,11242,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,"Health Partners, Inc.",Medicare Advantage,2.94,49,,percent of total billed charges,,
NIFEDIPINE 10 MG ORAL CAP,,11242,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
NIFEDIPINE 10 MG ORAL CAP,,11242,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3.6,60,,percent of total billed charges,,
NIFEDIPINE 10 MG ORAL CAP,,11242,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,"Health Partners, Inc.",State of Minnesota Advantage Program,4.89,81.5,,percent of total billed charges,,
NIFEDIPINE 10 MG ORAL CAP,,11242,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,"Health Partners, Inc.",State Public Programs,3,50,,percent of total billed charges,,
NIFEDIPINE 10 MG ORAL CAP,,11242,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,Humana Insurance Company,Commercial PPO,5.7,95,,percent of total billed charges,,
NIFEDIPINE 10 MG ORAL CAP,,11242,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,Humana Insurance Company,Medicare PPO,2.94,49,,percent of total billed charges,,
NIFEDIPINE 10 MG ORAL CAP,,11242,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
NIFEDIPINE 10 MG ORAL CAP,,11242,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,Medica,Individual & Family,5.946,99.1,,percent of total billed charges,,
NIFEDIPINE 10 MG ORAL CAP,,11242,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,Medica,Medica Advantage Solution,2.988,49.8,,percent of total billed charges,,
NIFEDIPINE 10 MG ORAL CAP,,11242,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
NIFEDIPINE 10 MG ORAL CAP,,11242,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,Medica,Medical Assistance,2.676,44.6,,percent of total billed charges,,
NIFEDIPINE 10 MG ORAL CAP,,11242,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,Medica,Medical Assistance,,,,,Included in per diem rate,
NIFEDIPINE 10 MG ORAL CAP,,11242,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.988,49.8,,percent of total billed charges,,
NIFEDIPINE 10 MG ORAL CAP,,11242,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
NIFEDIPINE 10 MG ORAL CAP,,11242,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,"Multiplan, Inc.","Multiplan, Inc.",5.64,94,,percent of total billed charges,,
NIFEDIPINE 10 MG ORAL CAP,,11242,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,5.406,90.1,,percent of total billed charges,,
NIFEDIPINE 10 MG ORAL CAP,,11242,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
NIFEDIPINE 10 MG ORAL CAP,,11242,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,"Preferred One Administrative Services, INC.",PPO,5.916,98.6,,percent of total billed charges,,
NIFEDIPINE 10 MG ORAL CAP,,11242,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,PrimeWest Health,Minnesota Senior Health Options (MSHO),3.087,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
NIFEDIPINE 10 MG ORAL CAP,,11242,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
NIFEDIPINE 10 MG ORAL CAP,,11242,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,PrimeWest Health,MinnesotaCare,3.0816,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
NIFEDIPINE 10 MG ORAL CAP,,11242,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
NIFEDIPINE 10 MG ORAL CAP,,11242,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,Sanford Health Plan,Sanford Health Plan,5.52,92,,percent of total billed charges,,
NIFEDIPINE 10 MG ORAL CAP,,11242,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,"UCare Health, Inc.",Individual & Family Plan,3.381,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
NIFEDIPINE 10 MG ORAL CAP,,11242,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
NIFEDIPINE 10 MG ORAL CAP,,11242,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,"UCare Health, Inc.",Medical Assistance,3.0282,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
NIFEDIPINE 10 MG ORAL CAP,,11242,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
NIFEDIPINE 10 MG ORAL CAP,,11242,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,"UCare Health, Inc.",Medicare Advantage,3.0282,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
NIFEDIPINE 10 MG ORAL CAP,,11242,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
NIFEDIPINE 10 MG ORAL CAP,,11242,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),3.0282,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
NIFEDIPINE 10 MG ORAL CAP,,11242,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
NIFEDIPINE 10 MG ORAL CAP,,11242,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,UnitedHealthcare,Individual & Family,5.64,94,,percent of total billed charges,,
NIFEDIPINE 10 MG ORAL CAP,,11242,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,UnitedHealthcare,Medicare Advantage,2.94,49,,percent of total billed charges,,
NIFEDIPINE 10 MG ORAL CAP,,11242,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
NIFEDIPINE 10 MG ORAL CAP,,11242,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.88,48,,percent of total billed charges,,100% of DHS outpatient percentage
NIFEDIPINE 10 MG ORAL CAP,,11242,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
IMIQUIMOD 5 % TOP CRPK,,11365,LOCAL,Facility,Both,1,Each,,85,72.25,24.361,85,Aetna,Commercial,78.2,92,,percent of total billed charges,,
IMIQUIMOD 5 % TOP CRPK,,11365,LOCAL,Facility,Outpatient,1,Each,,85,72.25,24.361,85,Aetna,Medicare Advantage,41.65,49,,percent of total billed charges,,
IMIQUIMOD 5 % TOP CRPK,,11365,LOCAL,Facility,Inpatient,1,Each,,85,72.25,24.361,85,Aetna,Medicare Advantage,,,,,Included in per diem rate,
IMIQUIMOD 5 % TOP CRPK,,11365,LOCAL,Facility,Both,1,Each,,85,72.25,24.361,85,Aetna,PPO,79.05,93,,percent of total billed charges,,
IMIQUIMOD 5 % TOP CRPK,,11365,LOCAL,Facility,Both,1,Each,,85,72.25,24.361,85,America's PPO,America's PPO,81.6255,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
IMIQUIMOD 5 % TOP CRPK,,11365,LOCAL,Facility,Both,1,Each,,85,72.25,24.361,85,BlueCross BlueShield Minnesota, Federal Employee Program,83.64,98.4,,percent of total billed charges,,
IMIQUIMOD 5 % TOP CRPK,,11365,LOCAL,Facility,Both,1,Each,,85,72.25,24.361,85,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,85,100,,percent of total billed charges,,
IMIQUIMOD 5 % TOP CRPK,,11365,LOCAL,Facility,Both,1,Each,,85,72.25,24.361,85,BlueCross BlueShield Minnesota,High Value Network Plan,76.5,90,,percent of total billed charges,,
IMIQUIMOD 5 % TOP CRPK,,11365,LOCAL,Facility,Outpatient,1,Each,,85,72.25,24.361,85,BlueCross BlueShield Minnesota,Medicare Advantage,41.65,49,,percent of total billed charges,,
IMIQUIMOD 5 % TOP CRPK,,11365,LOCAL,Facility,Inpatient,1,Each,,85,72.25,24.361,85,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
IMIQUIMOD 5 % TOP CRPK,,11365,LOCAL,Facility,Both,1,Each,,85,72.25,24.361,85,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,75.2845,88.57,,percent of total billed charges,,
IMIQUIMOD 5 % TOP CRPK,,11365,LOCAL,Facility,Both,1,Each,,85,72.25,24.361,85,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,24.361,28.66,,percent of total billed charges,,
IMIQUIMOD 5 % TOP CRPK,,11365,LOCAL,Facility,Outpatient,1,Each,,85,72.25,24.361,85,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),41.65,49,,percent of total billed charges,,
IMIQUIMOD 5 % TOP CRPK,,11365,LOCAL,Facility,Inpatient,1,Each,,85,72.25,24.361,85,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
IMIQUIMOD 5 % TOP CRPK,,11365,LOCAL,Facility,Both,1,Each,,85,72.25,24.361,85,CorVel,Worker's Compensation,85,100,,percent of total billed charges,,
IMIQUIMOD 5 % TOP CRPK,,11365,LOCAL,Facility,Both,1,Each,,85,72.25,24.361,85,First Health Group Corporation,First Health Network,82.45,97,,percent of total billed charges,,
IMIQUIMOD 5 % TOP CRPK,,11365,LOCAL,Facility,Both,1,Each,,85,72.25,24.361,85,"Health Partners, Inc.",Commercial,80.41,94.6,,percent of total billed charges,,
IMIQUIMOD 5 % TOP CRPK,,11365,LOCAL,Facility,Outpatient,1,Each,,85,72.25,24.361,85,"Health Partners, Inc.",Medicare Advantage,41.65,49,,percent of total billed charges,,
IMIQUIMOD 5 % TOP CRPK,,11365,LOCAL,Facility,Inpatient,1,Each,,85,72.25,24.361,85,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
IMIQUIMOD 5 % TOP CRPK,,11365,LOCAL,Facility,Both,1,Each,,85,72.25,24.361,85,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),51,60,,percent of total billed charges,,
IMIQUIMOD 5 % TOP CRPK,,11365,LOCAL,Facility,Both,1,Each,,85,72.25,24.361,85,"Health Partners, Inc.",State of Minnesota Advantage Program,69.275,81.5,,percent of total billed charges,,
IMIQUIMOD 5 % TOP CRPK,,11365,LOCAL,Facility,Both,1,Each,,85,72.25,24.361,85,"Health Partners, Inc.",State Public Programs,42.5,50,,percent of total billed charges,,
IMIQUIMOD 5 % TOP CRPK,,11365,LOCAL,Facility,Both,1,Each,,85,72.25,24.361,85,Humana Insurance Company,Commercial PPO,80.75,95,,percent of total billed charges,,
IMIQUIMOD 5 % TOP CRPK,,11365,LOCAL,Facility,Outpatient,1,Each,,85,72.25,24.361,85,Humana Insurance Company,Medicare PPO,41.65,49,,percent of total billed charges,,
IMIQUIMOD 5 % TOP CRPK,,11365,LOCAL,Facility,Inpatient,1,Each,,85,72.25,24.361,85,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
IMIQUIMOD 5 % TOP CRPK,,11365,LOCAL,Facility,Both,1,Each,,85,72.25,24.361,85,Medica,Individual & Family,84.235,99.1,,percent of total billed charges,,
IMIQUIMOD 5 % TOP CRPK,,11365,LOCAL,Facility,Outpatient,1,Each,,85,72.25,24.361,85,Medica,Medica Advantage Solution,42.33,49.8,,percent of total billed charges,,
IMIQUIMOD 5 % TOP CRPK,,11365,LOCAL,Facility,Inpatient,1,Each,,85,72.25,24.361,85,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
IMIQUIMOD 5 % TOP CRPK,,11365,LOCAL,Facility,Outpatient,1,Each,,85,72.25,24.361,85,Medica,Medical Assistance,37.91,44.6,,percent of total billed charges,,
IMIQUIMOD 5 % TOP CRPK,,11365,LOCAL,Facility,Inpatient,1,Each,,85,72.25,24.361,85,Medica,Medical Assistance,,,,,Included in per diem rate,
IMIQUIMOD 5 % TOP CRPK,,11365,LOCAL,Facility,Outpatient,1,Each,,85,72.25,24.361,85,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,42.33,49.8,,percent of total billed charges,,
IMIQUIMOD 5 % TOP CRPK,,11365,LOCAL,Facility,Inpatient,1,Each,,85,72.25,24.361,85,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
IMIQUIMOD 5 % TOP CRPK,,11365,LOCAL,Facility,Both,1,Each,,85,72.25,24.361,85,"Multiplan, Inc.","Multiplan, Inc.",79.9,94,,percent of total billed charges,,
IMIQUIMOD 5 % TOP CRPK,,11365,LOCAL,Facility,Outpatient,1,Each,,85,72.25,24.361,85,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,76.585,90.1,,percent of total billed charges,,
IMIQUIMOD 5 % TOP CRPK,,11365,LOCAL,Facility,Inpatient,1,Each,,85,72.25,24.361,85,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
IMIQUIMOD 5 % TOP CRPK,,11365,LOCAL,Facility,Both,1,Each,,85,72.25,24.361,85,"Preferred One Administrative Services, INC.",PPO,83.81,98.6,,percent of total billed charges,,
IMIQUIMOD 5 % TOP CRPK,,11365,LOCAL,Facility,Outpatient,1,Each,,85,72.25,24.361,85,PrimeWest Health,Minnesota Senior Health Options (MSHO),43.7325,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
IMIQUIMOD 5 % TOP CRPK,,11365,LOCAL,Facility,Inpatient,1,Each,,85,72.25,24.361,85,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
IMIQUIMOD 5 % TOP CRPK,,11365,LOCAL,Facility,Outpatient,1,Each,,85,72.25,24.361,85,PrimeWest Health,MinnesotaCare,43.656,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
IMIQUIMOD 5 % TOP CRPK,,11365,LOCAL,Facility,Inpatient,1,Each,,85,72.25,24.361,85,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
IMIQUIMOD 5 % TOP CRPK,,11365,LOCAL,Facility,Both,1,Each,,85,72.25,24.361,85,Sanford Health Plan,Sanford Health Plan,78.2,92,,percent of total billed charges,,
IMIQUIMOD 5 % TOP CRPK,,11365,LOCAL,Facility,Outpatient,1,Each,,85,72.25,24.361,85,"UCare Health, Inc.",Individual & Family Plan,47.8975,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
IMIQUIMOD 5 % TOP CRPK,,11365,LOCAL,Facility,Inpatient,1,Each,,85,72.25,24.361,85,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
IMIQUIMOD 5 % TOP CRPK,,11365,LOCAL,Facility,Outpatient,1,Each,,85,72.25,24.361,85,"UCare Health, Inc.",Medical Assistance,42.8995,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
IMIQUIMOD 5 % TOP CRPK,,11365,LOCAL,Facility,Inpatient,1,Each,,85,72.25,24.361,85,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
IMIQUIMOD 5 % TOP CRPK,,11365,LOCAL,Facility,Outpatient,1,Each,,85,72.25,24.361,85,"UCare Health, Inc.",Medicare Advantage,42.8995,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
IMIQUIMOD 5 % TOP CRPK,,11365,LOCAL,Facility,Inpatient,1,Each,,85,72.25,24.361,85,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
IMIQUIMOD 5 % TOP CRPK,,11365,LOCAL,Facility,Outpatient,1,Each,,85,72.25,24.361,85,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),42.8995,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
IMIQUIMOD 5 % TOP CRPK,,11365,LOCAL,Facility,Inpatient,1,Each,,85,72.25,24.361,85,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
IMIQUIMOD 5 % TOP CRPK,,11365,LOCAL,Facility,Both,1,Each,,85,72.25,24.361,85,UnitedHealthcare,Individual & Family,79.9,94,,percent of total billed charges,,
IMIQUIMOD 5 % TOP CRPK,,11365,LOCAL,Facility,Outpatient,1,Each,,85,72.25,24.361,85,UnitedHealthcare,Medicare Advantage,41.65,49,,percent of total billed charges,,
IMIQUIMOD 5 % TOP CRPK,,11365,LOCAL,Facility,Inpatient,1,Each,,85,72.25,24.361,85,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
IMIQUIMOD 5 % TOP CRPK,,11365,LOCAL,Facility,Outpatient,1,Each,,85,72.25,24.361,85,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,40.8,48,,percent of total billed charges,,100% of DHS outpatient percentage
IMIQUIMOD 5 % TOP CRPK,,11365,LOCAL,Facility,Inpatient,1,Each,,85,72.25,24.361,85,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
AMITRIPTYLINE 10 MG ORAL TABLET,,11430,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
AMITRIPTYLINE 10 MG ORAL TABLET,,11430,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
AMITRIPTYLINE 10 MG ORAL TABLET,,11430,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
AMITRIPTYLINE 10 MG ORAL TABLET,,11430,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
AMITRIPTYLINE 10 MG ORAL TABLET,,11430,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
AMITRIPTYLINE 10 MG ORAL TABLET,,11430,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
AMITRIPTYLINE 10 MG ORAL TABLET,,11430,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
AMITRIPTYLINE 10 MG ORAL TABLET,,11430,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
AMITRIPTYLINE 10 MG ORAL TABLET,,11430,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
AMITRIPTYLINE 10 MG ORAL TABLET,,11430,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
AMITRIPTYLINE 10 MG ORAL TABLET,,11430,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
AMITRIPTYLINE 10 MG ORAL TABLET,,11430,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
AMITRIPTYLINE 10 MG ORAL TABLET,,11430,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
AMITRIPTYLINE 10 MG ORAL TABLET,,11430,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
AMITRIPTYLINE 10 MG ORAL TABLET,,11430,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
AMITRIPTYLINE 10 MG ORAL TABLET,,11430,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
AMITRIPTYLINE 10 MG ORAL TABLET,,11430,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
AMITRIPTYLINE 10 MG ORAL TABLET,,11430,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
AMITRIPTYLINE 10 MG ORAL TABLET,,11430,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
AMITRIPTYLINE 10 MG ORAL TABLET,,11430,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
AMITRIPTYLINE 10 MG ORAL TABLET,,11430,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
AMITRIPTYLINE 10 MG ORAL TABLET,,11430,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
AMITRIPTYLINE 10 MG ORAL TABLET,,11430,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
AMITRIPTYLINE 10 MG ORAL TABLET,,11430,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
AMITRIPTYLINE 10 MG ORAL TABLET,,11430,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
AMITRIPTYLINE 10 MG ORAL TABLET,,11430,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
AMITRIPTYLINE 10 MG ORAL TABLET,,11430,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
AMITRIPTYLINE 10 MG ORAL TABLET,,11430,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
AMITRIPTYLINE 10 MG ORAL TABLET,,11430,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
AMITRIPTYLINE 10 MG ORAL TABLET,,11430,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
AMITRIPTYLINE 10 MG ORAL TABLET,,11430,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
AMITRIPTYLINE 10 MG ORAL TABLET,,11430,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
AMITRIPTYLINE 10 MG ORAL TABLET,,11430,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
AMITRIPTYLINE 10 MG ORAL TABLET,,11430,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
AMITRIPTYLINE 10 MG ORAL TABLET,,11430,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
AMITRIPTYLINE 10 MG ORAL TABLET,,11430,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
AMITRIPTYLINE 10 MG ORAL TABLET,,11430,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
AMITRIPTYLINE 10 MG ORAL TABLET,,11430,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
AMITRIPTYLINE 10 MG ORAL TABLET,,11430,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
AMITRIPTYLINE 10 MG ORAL TABLET,,11430,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
AMITRIPTYLINE 10 MG ORAL TABLET,,11430,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
AMITRIPTYLINE 10 MG ORAL TABLET,,11430,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
AMITRIPTYLINE 10 MG ORAL TABLET,,11430,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
AMITRIPTYLINE 10 MG ORAL TABLET,,11430,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
AMITRIPTYLINE 10 MG ORAL TABLET,,11430,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
AMITRIPTYLINE 10 MG ORAL TABLET,,11430,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
AMITRIPTYLINE 10 MG ORAL TABLET,,11430,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
AMITRIPTYLINE 10 MG ORAL TABLET,,11430,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
AMITRIPTYLINE 10 MG ORAL TABLET,,11430,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
AMITRIPTYLINE 10 MG ORAL TABLET,,11430,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
AMITRIPTYLINE 10 MG ORAL TABLET,,11430,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
AMITRIPTYLINE 10 MG ORAL TABLET,,11430,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
AMITRIPTYLINE 10 MG ORAL TABLET,,11430,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
AMITRIPTYLINE 10 MG ORAL TABLET,,11430,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
SODIUM BICARBONATE 650 MG ORAL TABLET,,11458,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
SODIUM BICARBONATE 650 MG ORAL TABLET,,11458,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
SODIUM BICARBONATE 650 MG ORAL TABLET,,11458,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
SODIUM BICARBONATE 650 MG ORAL TABLET,,11458,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
SODIUM BICARBONATE 650 MG ORAL TABLET,,11458,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SODIUM BICARBONATE 650 MG ORAL TABLET,,11458,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
SODIUM BICARBONATE 650 MG ORAL TABLET,,11458,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
SODIUM BICARBONATE 650 MG ORAL TABLET,,11458,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
SODIUM BICARBONATE 650 MG ORAL TABLET,,11458,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
SODIUM BICARBONATE 650 MG ORAL TABLET,,11458,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
SODIUM BICARBONATE 650 MG ORAL TABLET,,11458,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
SODIUM BICARBONATE 650 MG ORAL TABLET,,11458,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
SODIUM BICARBONATE 650 MG ORAL TABLET,,11458,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
SODIUM BICARBONATE 650 MG ORAL TABLET,,11458,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
SODIUM BICARBONATE 650 MG ORAL TABLET,,11458,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
SODIUM BICARBONATE 650 MG ORAL TABLET,,11458,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
SODIUM BICARBONATE 650 MG ORAL TABLET,,11458,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
SODIUM BICARBONATE 650 MG ORAL TABLET,,11458,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
SODIUM BICARBONATE 650 MG ORAL TABLET,,11458,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SODIUM BICARBONATE 650 MG ORAL TABLET,,11458,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
SODIUM BICARBONATE 650 MG ORAL TABLET,,11458,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
SODIUM BICARBONATE 650 MG ORAL TABLET,,11458,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
SODIUM BICARBONATE 650 MG ORAL TABLET,,11458,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
SODIUM BICARBONATE 650 MG ORAL TABLET,,11458,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
SODIUM BICARBONATE 650 MG ORAL TABLET,,11458,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
SODIUM BICARBONATE 650 MG ORAL TABLET,,11458,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
SODIUM BICARBONATE 650 MG ORAL TABLET,,11458,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
SODIUM BICARBONATE 650 MG ORAL TABLET,,11458,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
SODIUM BICARBONATE 650 MG ORAL TABLET,,11458,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
SODIUM BICARBONATE 650 MG ORAL TABLET,,11458,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
SODIUM BICARBONATE 650 MG ORAL TABLET,,11458,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
SODIUM BICARBONATE 650 MG ORAL TABLET,,11458,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
SODIUM BICARBONATE 650 MG ORAL TABLET,,11458,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
SODIUM BICARBONATE 650 MG ORAL TABLET,,11458,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
SODIUM BICARBONATE 650 MG ORAL TABLET,,11458,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
SODIUM BICARBONATE 650 MG ORAL TABLET,,11458,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
SODIUM BICARBONATE 650 MG ORAL TABLET,,11458,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
SODIUM BICARBONATE 650 MG ORAL TABLET,,11458,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SODIUM BICARBONATE 650 MG ORAL TABLET,,11458,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
SODIUM BICARBONATE 650 MG ORAL TABLET,,11458,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
SODIUM BICARBONATE 650 MG ORAL TABLET,,11458,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
SODIUM BICARBONATE 650 MG ORAL TABLET,,11458,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
SODIUM BICARBONATE 650 MG ORAL TABLET,,11458,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
SODIUM BICARBONATE 650 MG ORAL TABLET,,11458,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SODIUM BICARBONATE 650 MG ORAL TABLET,,11458,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
SODIUM BICARBONATE 650 MG ORAL TABLET,,11458,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SODIUM BICARBONATE 650 MG ORAL TABLET,,11458,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SODIUM BICARBONATE 650 MG ORAL TABLET,,11458,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SODIUM BICARBONATE 650 MG ORAL TABLET,,11458,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SODIUM BICARBONATE 650 MG ORAL TABLET,,11458,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
SODIUM BICARBONATE 650 MG ORAL TABLET,,11458,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
SODIUM BICARBONATE 650 MG ORAL TABLET,,11458,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
SODIUM BICARBONATE 650 MG ORAL TABLET,,11458,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
SODIUM BICARBONATE 650 MG ORAL TABLET,,11458,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
MECLIZINE 25 MG ORAL TABLET,,11494,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
MECLIZINE 25 MG ORAL TABLET,,11494,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
MECLIZINE 25 MG ORAL TABLET,,11494,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
MECLIZINE 25 MG ORAL TABLET,,11494,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
MECLIZINE 25 MG ORAL TABLET,,11494,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
MECLIZINE 25 MG ORAL TABLET,,11494,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
MECLIZINE 25 MG ORAL TABLET,,11494,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
MECLIZINE 25 MG ORAL TABLET,,11494,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
MECLIZINE 25 MG ORAL TABLET,,11494,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
MECLIZINE 25 MG ORAL TABLET,,11494,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
MECLIZINE 25 MG ORAL TABLET,,11494,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
MECLIZINE 25 MG ORAL TABLET,,11494,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
MECLIZINE 25 MG ORAL TABLET,,11494,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
MECLIZINE 25 MG ORAL TABLET,,11494,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
MECLIZINE 25 MG ORAL TABLET,,11494,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
MECLIZINE 25 MG ORAL TABLET,,11494,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
MECLIZINE 25 MG ORAL TABLET,,11494,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
MECLIZINE 25 MG ORAL TABLET,,11494,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
MECLIZINE 25 MG ORAL TABLET,,11494,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
MECLIZINE 25 MG ORAL TABLET,,11494,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
MECLIZINE 25 MG ORAL TABLET,,11494,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
MECLIZINE 25 MG ORAL TABLET,,11494,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
MECLIZINE 25 MG ORAL TABLET,,11494,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
MECLIZINE 25 MG ORAL TABLET,,11494,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
MECLIZINE 25 MG ORAL TABLET,,11494,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
MECLIZINE 25 MG ORAL TABLET,,11494,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
MECLIZINE 25 MG ORAL TABLET,,11494,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
MECLIZINE 25 MG ORAL TABLET,,11494,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
MECLIZINE 25 MG ORAL TABLET,,11494,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
MECLIZINE 25 MG ORAL TABLET,,11494,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
MECLIZINE 25 MG ORAL TABLET,,11494,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
MECLIZINE 25 MG ORAL TABLET,,11494,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
MECLIZINE 25 MG ORAL TABLET,,11494,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
MECLIZINE 25 MG ORAL TABLET,,11494,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
MECLIZINE 25 MG ORAL TABLET,,11494,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
MECLIZINE 25 MG ORAL TABLET,,11494,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
MECLIZINE 25 MG ORAL TABLET,,11494,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
MECLIZINE 25 MG ORAL TABLET,,11494,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
MECLIZINE 25 MG ORAL TABLET,,11494,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
MECLIZINE 25 MG ORAL TABLET,,11494,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
MECLIZINE 25 MG ORAL TABLET,,11494,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
MECLIZINE 25 MG ORAL TABLET,,11494,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
MECLIZINE 25 MG ORAL TABLET,,11494,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
MECLIZINE 25 MG ORAL TABLET,,11494,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MECLIZINE 25 MG ORAL TABLET,,11494,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
MECLIZINE 25 MG ORAL TABLET,,11494,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MECLIZINE 25 MG ORAL TABLET,,11494,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
MECLIZINE 25 MG ORAL TABLET,,11494,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MECLIZINE 25 MG ORAL TABLET,,11494,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
MECLIZINE 25 MG ORAL TABLET,,11494,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
MECLIZINE 25 MG ORAL TABLET,,11494,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
MECLIZINE 25 MG ORAL TABLET,,11494,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
MECLIZINE 25 MG ORAL TABLET,,11494,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
MECLIZINE 25 MG ORAL TABLET,,11494,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
DIAZEPAM 2 MG ORAL TABLET,,11511,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
DIAZEPAM 2 MG ORAL TABLET,,11511,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
DIAZEPAM 2 MG ORAL TABLET,,11511,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
DIAZEPAM 2 MG ORAL TABLET,,11511,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
DIAZEPAM 2 MG ORAL TABLET,,11511,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
DIAZEPAM 2 MG ORAL TABLET,,11511,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
DIAZEPAM 2 MG ORAL TABLET,,11511,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
DIAZEPAM 2 MG ORAL TABLET,,11511,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
DIAZEPAM 2 MG ORAL TABLET,,11511,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
DIAZEPAM 2 MG ORAL TABLET,,11511,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
DIAZEPAM 2 MG ORAL TABLET,,11511,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
DIAZEPAM 2 MG ORAL TABLET,,11511,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
DIAZEPAM 2 MG ORAL TABLET,,11511,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
DIAZEPAM 2 MG ORAL TABLET,,11511,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
DIAZEPAM 2 MG ORAL TABLET,,11511,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
DIAZEPAM 2 MG ORAL TABLET,,11511,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
DIAZEPAM 2 MG ORAL TABLET,,11511,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
DIAZEPAM 2 MG ORAL TABLET,,11511,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
DIAZEPAM 2 MG ORAL TABLET,,11511,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
DIAZEPAM 2 MG ORAL TABLET,,11511,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
DIAZEPAM 2 MG ORAL TABLET,,11511,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
DIAZEPAM 2 MG ORAL TABLET,,11511,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
DIAZEPAM 2 MG ORAL TABLET,,11511,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
DIAZEPAM 2 MG ORAL TABLET,,11511,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
DIAZEPAM 2 MG ORAL TABLET,,11511,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
DIAZEPAM 2 MG ORAL TABLET,,11511,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
DIAZEPAM 2 MG ORAL TABLET,,11511,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
DIAZEPAM 2 MG ORAL TABLET,,11511,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
DIAZEPAM 2 MG ORAL TABLET,,11511,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
DIAZEPAM 2 MG ORAL TABLET,,11511,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
DIAZEPAM 2 MG ORAL TABLET,,11511,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
DIAZEPAM 2 MG ORAL TABLET,,11511,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
DIAZEPAM 2 MG ORAL TABLET,,11511,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
DIAZEPAM 2 MG ORAL TABLET,,11511,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
DIAZEPAM 2 MG ORAL TABLET,,11511,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
DIAZEPAM 2 MG ORAL TABLET,,11511,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
DIAZEPAM 2 MG ORAL TABLET,,11511,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DIAZEPAM 2 MG ORAL TABLET,,11511,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DIAZEPAM 2 MG ORAL TABLET,,11511,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
DIAZEPAM 2 MG ORAL TABLET,,11511,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
DIAZEPAM 2 MG ORAL TABLET,,11511,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
DIAZEPAM 2 MG ORAL TABLET,,11511,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
DIAZEPAM 2 MG ORAL TABLET,,11511,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
DIAZEPAM 2 MG ORAL TABLET,,11511,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
DIAZEPAM 2 MG ORAL TABLET,,11511,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
DIAZEPAM 2 MG ORAL TABLET,,11511,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
DIAZEPAM 2 MG ORAL TABLET,,11511,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
DIAZEPAM 2 MG ORAL TABLET,,11511,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
DIAZEPAM 2 MG ORAL TABLET,,11511,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
DIAZEPAM 2 MG ORAL TABLET,,11511,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
DIAZEPAM 2 MG ORAL TABLET,,11511,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
DIAZEPAM 2 MG ORAL TABLET,,11511,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
DIAZEPAM 2 MG ORAL TABLET,,11511,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
DIAZEPAM 2 MG ORAL TABLET,,11511,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
DIAZEPAM 2 MG ORAL TABLET,,11511,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
DIAZEPAM 2 MG ORAL TABLET,,11511,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
DIAZEPAM 2 MG ORAL TABLET,,11511,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
DIAZEPAM 2 MG ORAL TABLET,,11511,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
DIAZEPAM 2 MG ORAL TABLET,,11511,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
DIAZEPAM 2 MG ORAL TABLET,,11511,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
DIAZEPAM 2 MG ORAL TABLET,,11511,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
DIAZEPAM 2 MG ORAL TABLET,,11511,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
DIAZEPAM 2 MG ORAL TABLET,,11511,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
DIAZEPAM 2 MG ORAL TABLET,,11511,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
DIAZEPAM 2 MG ORAL TABLET,,11511,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
DIAZEPAM 2 MG ORAL TABLET,,11511,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
DIAZEPAM 2 MG ORAL TABLET,,11511,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
DIAZEPAM 2 MG ORAL TABLET,,11511,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
DIAZEPAM 2 MG ORAL TABLET,,11511,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
DIAZEPAM 2 MG ORAL TABLET,,11511,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
DIAZEPAM 2 MG ORAL TABLET,,11511,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
DIAZEPAM 2 MG ORAL TABLET,,11511,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
DIAZEPAM 2 MG ORAL TABLET,,11511,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
DIAZEPAM 2 MG ORAL TABLET,,11511,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
DIAZEPAM 2 MG ORAL TABLET,,11511,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DIAZEPAM 2 MG ORAL TABLET,,11511,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DIAZEPAM 2 MG ORAL TABLET,,11511,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
DIAZEPAM 2 MG ORAL TABLET,,11511,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
DIAZEPAM 2 MG ORAL TABLET,,11511,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
DIAZEPAM 2 MG ORAL TABLET,,11511,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
DIAZEPAM 2 MG ORAL TABLET,,11511,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
DIAZEPAM 2 MG ORAL TABLET,,11511,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
DIAZEPAM 2 MG ORAL TABLET,,11511,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
DIAZEPAM 2 MG ORAL TABLET,,11511,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
DIAZEPAM 2 MG ORAL TABLET,,11511,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
DIAZEPAM 2 MG ORAL TABLET,,11511,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
DIAZEPAM 2 MG ORAL TABLET,,11511,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DIAZEPAM 2 MG ORAL TABLET,,11511,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DIAZEPAM 2 MG ORAL TABLET,,11511,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
DIAZEPAM 2 MG ORAL TABLET,,11511,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
DIAZEPAM 2 MG ORAL TABLET,,11511,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DIAZEPAM 2 MG ORAL TABLET,,11511,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DIAZEPAM 2 MG ORAL TABLET,,11511,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DIAZEPAM 2 MG ORAL TABLET,,11511,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DIAZEPAM 2 MG ORAL TABLET,,11511,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DIAZEPAM 2 MG ORAL TABLET,,11511,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DIAZEPAM 2 MG ORAL TABLET,,11511,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DIAZEPAM 2 MG ORAL TABLET,,11511,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DIAZEPAM 2 MG ORAL TABLET,,11511,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
DIAZEPAM 2 MG ORAL TABLET,,11511,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
DIAZEPAM 2 MG ORAL TABLET,,11511,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
DIAZEPAM 2 MG ORAL TABLET,,11511,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
DIAZEPAM 2 MG ORAL TABLET,,11511,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
DIAZEPAM 2 MG ORAL TABLET,,11511,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
DIAZEPAM 2 MG ORAL TABLET,,11511,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
DIAZEPAM 2 MG ORAL TABLET,,11511,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
DIAZEPAM 2 MG ORAL TABLET,,11511,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
DIAZEPAM 2 MG ORAL TABLET,,11511,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
CARBAMAZEPINE 200 MG ORAL TB12,,11576,LOCAL,Facility,Both,1,Each,,11,9.35,3.1526,11,Aetna,Commercial,10.12,92,,percent of total billed charges,,
CARBAMAZEPINE 200 MG ORAL TB12,,11576,LOCAL,Facility,Outpatient,1,Each,,11,9.35,3.1526,11,Aetna,Medicare Advantage,5.39,49,,percent of total billed charges,,
CARBAMAZEPINE 200 MG ORAL TB12,,11576,LOCAL,Facility,Inpatient,1,Each,,11,9.35,3.1526,11,Aetna,Medicare Advantage,,,,,Included in per diem rate,
CARBAMAZEPINE 200 MG ORAL TB12,,11576,LOCAL,Facility,Both,1,Each,,11,9.35,3.1526,11,Aetna,PPO,10.23,93,,percent of total billed charges,,
CARBAMAZEPINE 200 MG ORAL TB12,,11576,LOCAL,Facility,Both,1,Each,,11,9.35,3.1526,11,America's PPO,America's PPO,10.5633,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
CARBAMAZEPINE 200 MG ORAL TB12,,11576,LOCAL,Facility,Both,1,Each,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota, Federal Employee Program,10.824,98.4,,percent of total billed charges,,
CARBAMAZEPINE 200 MG ORAL TB12,,11576,LOCAL,Facility,Both,1,Each,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,11,100,,percent of total billed charges,,
CARBAMAZEPINE 200 MG ORAL TB12,,11576,LOCAL,Facility,Both,1,Each,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,High Value Network Plan,9.9,90,,percent of total billed charges,,
CARBAMAZEPINE 200 MG ORAL TB12,,11576,LOCAL,Facility,Outpatient,1,Each,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,Medicare Advantage,5.39,49,,percent of total billed charges,,
CARBAMAZEPINE 200 MG ORAL TB12,,11576,LOCAL,Facility,Inpatient,1,Each,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
CARBAMAZEPINE 200 MG ORAL TB12,,11576,LOCAL,Facility,Both,1,Each,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,9.7427,88.57,,percent of total billed charges,,
CARBAMAZEPINE 200 MG ORAL TB12,,11576,LOCAL,Facility,Both,1,Each,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,3.1526,28.66,,percent of total billed charges,,
CARBAMAZEPINE 200 MG ORAL TB12,,11576,LOCAL,Facility,Outpatient,1,Each,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),5.39,49,,percent of total billed charges,,
CARBAMAZEPINE 200 MG ORAL TB12,,11576,LOCAL,Facility,Inpatient,1,Each,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
CARBAMAZEPINE 200 MG ORAL TB12,,11576,LOCAL,Facility,Both,1,Each,,11,9.35,3.1526,11,CorVel,Worker's Compensation,11,100,,percent of total billed charges,,
CARBAMAZEPINE 200 MG ORAL TB12,,11576,LOCAL,Facility,Both,1,Each,,11,9.35,3.1526,11,First Health Group Corporation,First Health Network,10.67,97,,percent of total billed charges,,
CARBAMAZEPINE 200 MG ORAL TB12,,11576,LOCAL,Facility,Both,1,Each,,11,9.35,3.1526,11,"Health Partners, Inc.",Commercial,10.406,94.6,,percent of total billed charges,,
CARBAMAZEPINE 200 MG ORAL TB12,,11576,LOCAL,Facility,Outpatient,1,Each,,11,9.35,3.1526,11,"Health Partners, Inc.",Medicare Advantage,5.39,49,,percent of total billed charges,,
CARBAMAZEPINE 200 MG ORAL TB12,,11576,LOCAL,Facility,Inpatient,1,Each,,11,9.35,3.1526,11,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CARBAMAZEPINE 200 MG ORAL TB12,,11576,LOCAL,Facility,Both,1,Each,,11,9.35,3.1526,11,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),6.6,60,,percent of total billed charges,,
CARBAMAZEPINE 200 MG ORAL TB12,,11576,LOCAL,Facility,Both,1,Each,,11,9.35,3.1526,11,"Health Partners, Inc.",State of Minnesota Advantage Program,8.965,81.5,,percent of total billed charges,,
CARBAMAZEPINE 200 MG ORAL TB12,,11576,LOCAL,Facility,Both,1,Each,,11,9.35,3.1526,11,"Health Partners, Inc.",State Public Programs,5.5,50,,percent of total billed charges,,
CARBAMAZEPINE 200 MG ORAL TB12,,11576,LOCAL,Facility,Both,1,Each,,11,9.35,3.1526,11,Humana Insurance Company,Commercial PPO,10.45,95,,percent of total billed charges,,
CARBAMAZEPINE 200 MG ORAL TB12,,11576,LOCAL,Facility,Outpatient,1,Each,,11,9.35,3.1526,11,Humana Insurance Company,Medicare PPO,5.39,49,,percent of total billed charges,,
CARBAMAZEPINE 200 MG ORAL TB12,,11576,LOCAL,Facility,Inpatient,1,Each,,11,9.35,3.1526,11,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
CARBAMAZEPINE 200 MG ORAL TB12,,11576,LOCAL,Facility,Both,1,Each,,11,9.35,3.1526,11,Medica,Individual & Family,10.901,99.1,,percent of total billed charges,,
CARBAMAZEPINE 200 MG ORAL TB12,,11576,LOCAL,Facility,Outpatient,1,Each,,11,9.35,3.1526,11,Medica,Medica Advantage Solution,5.478,49.8,,percent of total billed charges,,
CARBAMAZEPINE 200 MG ORAL TB12,,11576,LOCAL,Facility,Inpatient,1,Each,,11,9.35,3.1526,11,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
CARBAMAZEPINE 200 MG ORAL TB12,,11576,LOCAL,Facility,Outpatient,1,Each,,11,9.35,3.1526,11,Medica,Medical Assistance,4.906,44.6,,percent of total billed charges,,
CARBAMAZEPINE 200 MG ORAL TB12,,11576,LOCAL,Facility,Inpatient,1,Each,,11,9.35,3.1526,11,Medica,Medical Assistance,,,,,Included in per diem rate,
CARBAMAZEPINE 200 MG ORAL TB12,,11576,LOCAL,Facility,Outpatient,1,Each,,11,9.35,3.1526,11,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,5.478,49.8,,percent of total billed charges,,
CARBAMAZEPINE 200 MG ORAL TB12,,11576,LOCAL,Facility,Inpatient,1,Each,,11,9.35,3.1526,11,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
CARBAMAZEPINE 200 MG ORAL TB12,,11576,LOCAL,Facility,Both,1,Each,,11,9.35,3.1526,11,"Multiplan, Inc.","Multiplan, Inc.",10.34,94,,percent of total billed charges,,
CARBAMAZEPINE 200 MG ORAL TB12,,11576,LOCAL,Facility,Outpatient,1,Each,,11,9.35,3.1526,11,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,9.911,90.1,,percent of total billed charges,,
CARBAMAZEPINE 200 MG ORAL TB12,,11576,LOCAL,Facility,Inpatient,1,Each,,11,9.35,3.1526,11,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
CARBAMAZEPINE 200 MG ORAL TB12,,11576,LOCAL,Facility,Both,1,Each,,11,9.35,3.1526,11,"Preferred One Administrative Services, INC.",PPO,10.846,98.6,,percent of total billed charges,,
CARBAMAZEPINE 200 MG ORAL TB12,,11576,LOCAL,Facility,Outpatient,1,Each,,11,9.35,3.1526,11,PrimeWest Health,Minnesota Senior Health Options (MSHO),5.6595,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
CARBAMAZEPINE 200 MG ORAL TB12,,11576,LOCAL,Facility,Inpatient,1,Each,,11,9.35,3.1526,11,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CARBAMAZEPINE 200 MG ORAL TB12,,11576,LOCAL,Facility,Outpatient,1,Each,,11,9.35,3.1526,11,PrimeWest Health,MinnesotaCare,5.6496,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
CARBAMAZEPINE 200 MG ORAL TB12,,11576,LOCAL,Facility,Inpatient,1,Each,,11,9.35,3.1526,11,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
CARBAMAZEPINE 200 MG ORAL TB12,,11576,LOCAL,Facility,Both,1,Each,,11,9.35,3.1526,11,Sanford Health Plan,Sanford Health Plan,10.12,92,,percent of total billed charges,,
CARBAMAZEPINE 200 MG ORAL TB12,,11576,LOCAL,Facility,Outpatient,1,Each,,11,9.35,3.1526,11,"UCare Health, Inc.",Individual & Family Plan,6.1985,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
CARBAMAZEPINE 200 MG ORAL TB12,,11576,LOCAL,Facility,Inpatient,1,Each,,11,9.35,3.1526,11,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
CARBAMAZEPINE 200 MG ORAL TB12,,11576,LOCAL,Facility,Outpatient,1,Each,,11,9.35,3.1526,11,"UCare Health, Inc.",Medical Assistance,5.5517,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CARBAMAZEPINE 200 MG ORAL TB12,,11576,LOCAL,Facility,Inpatient,1,Each,,11,9.35,3.1526,11,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
CARBAMAZEPINE 200 MG ORAL TB12,,11576,LOCAL,Facility,Outpatient,1,Each,,11,9.35,3.1526,11,"UCare Health, Inc.",Medicare Advantage,5.5517,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CARBAMAZEPINE 200 MG ORAL TB12,,11576,LOCAL,Facility,Inpatient,1,Each,,11,9.35,3.1526,11,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CARBAMAZEPINE 200 MG ORAL TB12,,11576,LOCAL,Facility,Outpatient,1,Each,,11,9.35,3.1526,11,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),5.5517,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CARBAMAZEPINE 200 MG ORAL TB12,,11576,LOCAL,Facility,Inpatient,1,Each,,11,9.35,3.1526,11,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CARBAMAZEPINE 200 MG ORAL TB12,,11576,LOCAL,Facility,Both,1,Each,,11,9.35,3.1526,11,UnitedHealthcare,Individual & Family,10.34,94,,percent of total billed charges,,
CARBAMAZEPINE 200 MG ORAL TB12,,11576,LOCAL,Facility,Outpatient,1,Each,,11,9.35,3.1526,11,UnitedHealthcare,Medicare Advantage,5.39,49,,percent of total billed charges,,
CARBAMAZEPINE 200 MG ORAL TB12,,11576,LOCAL,Facility,Inpatient,1,Each,,11,9.35,3.1526,11,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
CARBAMAZEPINE 200 MG ORAL TB12,,11576,LOCAL,Facility,Outpatient,1,Each,,11,9.35,3.1526,11,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,5.28,48,,percent of total billed charges,,100% of DHS outpatient percentage
CARBAMAZEPINE 200 MG ORAL TB12,,11576,LOCAL,Facility,Inpatient,1,Each,,11,9.35,3.1526,11,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
PROCHLORPERAZINE 25 MG RECT SUPP,,11590,LOCAL,Facility,Both,1,Each,,61,51.85,17.4826,61,Aetna,Commercial,56.12,92,,percent of total billed charges,,
PROCHLORPERAZINE 25 MG RECT SUPP,,11590,LOCAL,Facility,Outpatient,1,Each,,61,51.85,17.4826,61,Aetna,Medicare Advantage,29.89,49,,percent of total billed charges,,
PROCHLORPERAZINE 25 MG RECT SUPP,,11590,LOCAL,Facility,Inpatient,1,Each,,61,51.85,17.4826,61,Aetna,Medicare Advantage,,,,,Included in per diem rate,
PROCHLORPERAZINE 25 MG RECT SUPP,,11590,LOCAL,Facility,Both,1,Each,,61,51.85,17.4826,61,Aetna,PPO,56.73,93,,percent of total billed charges,,
PROCHLORPERAZINE 25 MG RECT SUPP,,11590,LOCAL,Facility,Both,1,Each,,61,51.85,17.4826,61,America's PPO,America's PPO,58.5783,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
PROCHLORPERAZINE 25 MG RECT SUPP,,11590,LOCAL,Facility,Both,1,Each,,61,51.85,17.4826,61,BlueCross BlueShield Minnesota, Federal Employee Program,60.024,98.4,,percent of total billed charges,,
PROCHLORPERAZINE 25 MG RECT SUPP,,11590,LOCAL,Facility,Both,1,Each,,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,61,100,,percent of total billed charges,,
PROCHLORPERAZINE 25 MG RECT SUPP,,11590,LOCAL,Facility,Both,1,Each,,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,High Value Network Plan,54.9,90,,percent of total billed charges,,
PROCHLORPERAZINE 25 MG RECT SUPP,,11590,LOCAL,Facility,Outpatient,1,Each,,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,Medicare Advantage,29.89,49,,percent of total billed charges,,
PROCHLORPERAZINE 25 MG RECT SUPP,,11590,LOCAL,Facility,Inpatient,1,Each,,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
PROCHLORPERAZINE 25 MG RECT SUPP,,11590,LOCAL,Facility,Both,1,Each,,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,54.0277,88.57,,percent of total billed charges,,
PROCHLORPERAZINE 25 MG RECT SUPP,,11590,LOCAL,Facility,Both,1,Each,,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,17.4826,28.66,,percent of total billed charges,,
PROCHLORPERAZINE 25 MG RECT SUPP,,11590,LOCAL,Facility,Outpatient,1,Each,,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),29.89,49,,percent of total billed charges,,
PROCHLORPERAZINE 25 MG RECT SUPP,,11590,LOCAL,Facility,Inpatient,1,Each,,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
PROCHLORPERAZINE 25 MG RECT SUPP,,11590,LOCAL,Facility,Both,1,Each,,61,51.85,17.4826,61,CorVel,Worker's Compensation,61,100,,percent of total billed charges,,
PROCHLORPERAZINE 25 MG RECT SUPP,,11590,LOCAL,Facility,Both,1,Each,,61,51.85,17.4826,61,First Health Group Corporation,First Health Network,59.17,97,,percent of total billed charges,,
PROCHLORPERAZINE 25 MG RECT SUPP,,11590,LOCAL,Facility,Both,1,Each,,61,51.85,17.4826,61,"Health Partners, Inc.",Commercial,57.706,94.6,,percent of total billed charges,,
PROCHLORPERAZINE 25 MG RECT SUPP,,11590,LOCAL,Facility,Outpatient,1,Each,,61,51.85,17.4826,61,"Health Partners, Inc.",Medicare Advantage,29.89,49,,percent of total billed charges,,
PROCHLORPERAZINE 25 MG RECT SUPP,,11590,LOCAL,Facility,Inpatient,1,Each,,61,51.85,17.4826,61,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PROCHLORPERAZINE 25 MG RECT SUPP,,11590,LOCAL,Facility,Both,1,Each,,61,51.85,17.4826,61,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),36.6,60,,percent of total billed charges,,
PROCHLORPERAZINE 25 MG RECT SUPP,,11590,LOCAL,Facility,Both,1,Each,,61,51.85,17.4826,61,"Health Partners, Inc.",State of Minnesota Advantage Program,49.715,81.5,,percent of total billed charges,,
PROCHLORPERAZINE 25 MG RECT SUPP,,11590,LOCAL,Facility,Both,1,Each,,61,51.85,17.4826,61,"Health Partners, Inc.",State Public Programs,30.5,50,,percent of total billed charges,,
PROCHLORPERAZINE 25 MG RECT SUPP,,11590,LOCAL,Facility,Both,1,Each,,61,51.85,17.4826,61,Humana Insurance Company,Commercial PPO,57.95,95,,percent of total billed charges,,
PROCHLORPERAZINE 25 MG RECT SUPP,,11590,LOCAL,Facility,Outpatient,1,Each,,61,51.85,17.4826,61,Humana Insurance Company,Medicare PPO,29.89,49,,percent of total billed charges,,
PROCHLORPERAZINE 25 MG RECT SUPP,,11590,LOCAL,Facility,Inpatient,1,Each,,61,51.85,17.4826,61,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
PROCHLORPERAZINE 25 MG RECT SUPP,,11590,LOCAL,Facility,Both,1,Each,,61,51.85,17.4826,61,Medica,Individual & Family,60.451,99.1,,percent of total billed charges,,
PROCHLORPERAZINE 25 MG RECT SUPP,,11590,LOCAL,Facility,Outpatient,1,Each,,61,51.85,17.4826,61,Medica,Medica Advantage Solution,30.378,49.8,,percent of total billed charges,,
PROCHLORPERAZINE 25 MG RECT SUPP,,11590,LOCAL,Facility,Inpatient,1,Each,,61,51.85,17.4826,61,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
PROCHLORPERAZINE 25 MG RECT SUPP,,11590,LOCAL,Facility,Outpatient,1,Each,,61,51.85,17.4826,61,Medica,Medical Assistance,27.206,44.6,,percent of total billed charges,,
PROCHLORPERAZINE 25 MG RECT SUPP,,11590,LOCAL,Facility,Inpatient,1,Each,,61,51.85,17.4826,61,Medica,Medical Assistance,,,,,Included in per diem rate,
PROCHLORPERAZINE 25 MG RECT SUPP,,11590,LOCAL,Facility,Outpatient,1,Each,,61,51.85,17.4826,61,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,30.378,49.8,,percent of total billed charges,,
PROCHLORPERAZINE 25 MG RECT SUPP,,11590,LOCAL,Facility,Inpatient,1,Each,,61,51.85,17.4826,61,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
PROCHLORPERAZINE 25 MG RECT SUPP,,11590,LOCAL,Facility,Both,1,Each,,61,51.85,17.4826,61,"Multiplan, Inc.","Multiplan, Inc.",57.34,94,,percent of total billed charges,,
PROCHLORPERAZINE 25 MG RECT SUPP,,11590,LOCAL,Facility,Outpatient,1,Each,,61,51.85,17.4826,61,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,54.961,90.1,,percent of total billed charges,,
PROCHLORPERAZINE 25 MG RECT SUPP,,11590,LOCAL,Facility,Inpatient,1,Each,,61,51.85,17.4826,61,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
PROCHLORPERAZINE 25 MG RECT SUPP,,11590,LOCAL,Facility,Both,1,Each,,61,51.85,17.4826,61,"Preferred One Administrative Services, INC.",PPO,60.146,98.6,,percent of total billed charges,,
PROCHLORPERAZINE 25 MG RECT SUPP,,11590,LOCAL,Facility,Outpatient,1,Each,,61,51.85,17.4826,61,PrimeWest Health,Minnesota Senior Health Options (MSHO),31.3845,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
PROCHLORPERAZINE 25 MG RECT SUPP,,11590,LOCAL,Facility,Inpatient,1,Each,,61,51.85,17.4826,61,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PROCHLORPERAZINE 25 MG RECT SUPP,,11590,LOCAL,Facility,Outpatient,1,Each,,61,51.85,17.4826,61,PrimeWest Health,MinnesotaCare,31.3296,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
PROCHLORPERAZINE 25 MG RECT SUPP,,11590,LOCAL,Facility,Inpatient,1,Each,,61,51.85,17.4826,61,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
PROCHLORPERAZINE 25 MG RECT SUPP,,11590,LOCAL,Facility,Both,1,Each,,61,51.85,17.4826,61,Sanford Health Plan,Sanford Health Plan,56.12,92,,percent of total billed charges,,
PROCHLORPERAZINE 25 MG RECT SUPP,,11590,LOCAL,Facility,Outpatient,1,Each,,61,51.85,17.4826,61,"UCare Health, Inc.",Individual & Family Plan,34.3735,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
PROCHLORPERAZINE 25 MG RECT SUPP,,11590,LOCAL,Facility,Inpatient,1,Each,,61,51.85,17.4826,61,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
PROCHLORPERAZINE 25 MG RECT SUPP,,11590,LOCAL,Facility,Outpatient,1,Each,,61,51.85,17.4826,61,"UCare Health, Inc.",Medical Assistance,30.7867,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PROCHLORPERAZINE 25 MG RECT SUPP,,11590,LOCAL,Facility,Inpatient,1,Each,,61,51.85,17.4826,61,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
PROCHLORPERAZINE 25 MG RECT SUPP,,11590,LOCAL,Facility,Outpatient,1,Each,,61,51.85,17.4826,61,"UCare Health, Inc.",Medicare Advantage,30.7867,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PROCHLORPERAZINE 25 MG RECT SUPP,,11590,LOCAL,Facility,Inpatient,1,Each,,61,51.85,17.4826,61,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PROCHLORPERAZINE 25 MG RECT SUPP,,11590,LOCAL,Facility,Outpatient,1,Each,,61,51.85,17.4826,61,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),30.7867,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PROCHLORPERAZINE 25 MG RECT SUPP,,11590,LOCAL,Facility,Inpatient,1,Each,,61,51.85,17.4826,61,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PROCHLORPERAZINE 25 MG RECT SUPP,,11590,LOCAL,Facility,Both,1,Each,,61,51.85,17.4826,61,UnitedHealthcare,Individual & Family,57.34,94,,percent of total billed charges,,
PROCHLORPERAZINE 25 MG RECT SUPP,,11590,LOCAL,Facility,Outpatient,1,Each,,61,51.85,17.4826,61,UnitedHealthcare,Medicare Advantage,29.89,49,,percent of total billed charges,,
PROCHLORPERAZINE 25 MG RECT SUPP,,11590,LOCAL,Facility,Inpatient,1,Each,,61,51.85,17.4826,61,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
PROCHLORPERAZINE 25 MG RECT SUPP,,11590,LOCAL,Facility,Outpatient,1,Each,,61,51.85,17.4826,61,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,29.28,48,,percent of total billed charges,,100% of DHS outpatient percentage
PROCHLORPERAZINE 25 MG RECT SUPP,,11590,LOCAL,Facility,Inpatient,1,Each,,61,51.85,17.4826,61,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
ETHAMBUTOL 400 MG ORAL TABLET,,11599,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
ETHAMBUTOL 400 MG ORAL TABLET,,11599,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
ETHAMBUTOL 400 MG ORAL TABLET,,11599,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
ETHAMBUTOL 400 MG ORAL TABLET,,11599,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
ETHAMBUTOL 400 MG ORAL TABLET,,11599,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
ETHAMBUTOL 400 MG ORAL TABLET,,11599,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
ETHAMBUTOL 400 MG ORAL TABLET,,11599,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
ETHAMBUTOL 400 MG ORAL TABLET,,11599,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
ETHAMBUTOL 400 MG ORAL TABLET,,11599,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
ETHAMBUTOL 400 MG ORAL TABLET,,11599,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
ETHAMBUTOL 400 MG ORAL TABLET,,11599,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
ETHAMBUTOL 400 MG ORAL TABLET,,11599,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
ETHAMBUTOL 400 MG ORAL TABLET,,11599,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
ETHAMBUTOL 400 MG ORAL TABLET,,11599,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
ETHAMBUTOL 400 MG ORAL TABLET,,11599,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
ETHAMBUTOL 400 MG ORAL TABLET,,11599,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
ETHAMBUTOL 400 MG ORAL TABLET,,11599,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
ETHAMBUTOL 400 MG ORAL TABLET,,11599,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
ETHAMBUTOL 400 MG ORAL TABLET,,11599,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ETHAMBUTOL 400 MG ORAL TABLET,,11599,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
ETHAMBUTOL 400 MG ORAL TABLET,,11599,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
ETHAMBUTOL 400 MG ORAL TABLET,,11599,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
ETHAMBUTOL 400 MG ORAL TABLET,,11599,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
ETHAMBUTOL 400 MG ORAL TABLET,,11599,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
ETHAMBUTOL 400 MG ORAL TABLET,,11599,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
ETHAMBUTOL 400 MG ORAL TABLET,,11599,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
ETHAMBUTOL 400 MG ORAL TABLET,,11599,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
ETHAMBUTOL 400 MG ORAL TABLET,,11599,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
ETHAMBUTOL 400 MG ORAL TABLET,,11599,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
ETHAMBUTOL 400 MG ORAL TABLET,,11599,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
ETHAMBUTOL 400 MG ORAL TABLET,,11599,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
ETHAMBUTOL 400 MG ORAL TABLET,,11599,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
ETHAMBUTOL 400 MG ORAL TABLET,,11599,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
ETHAMBUTOL 400 MG ORAL TABLET,,11599,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
ETHAMBUTOL 400 MG ORAL TABLET,,11599,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
ETHAMBUTOL 400 MG ORAL TABLET,,11599,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
ETHAMBUTOL 400 MG ORAL TABLET,,11599,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
ETHAMBUTOL 400 MG ORAL TABLET,,11599,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ETHAMBUTOL 400 MG ORAL TABLET,,11599,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
ETHAMBUTOL 400 MG ORAL TABLET,,11599,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
ETHAMBUTOL 400 MG ORAL TABLET,,11599,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
ETHAMBUTOL 400 MG ORAL TABLET,,11599,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
ETHAMBUTOL 400 MG ORAL TABLET,,11599,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
ETHAMBUTOL 400 MG ORAL TABLET,,11599,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ETHAMBUTOL 400 MG ORAL TABLET,,11599,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
ETHAMBUTOL 400 MG ORAL TABLET,,11599,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ETHAMBUTOL 400 MG ORAL TABLET,,11599,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ETHAMBUTOL 400 MG ORAL TABLET,,11599,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ETHAMBUTOL 400 MG ORAL TABLET,,11599,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ETHAMBUTOL 400 MG ORAL TABLET,,11599,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
ETHAMBUTOL 400 MG ORAL TABLET,,11599,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
ETHAMBUTOL 400 MG ORAL TABLET,,11599,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
ETHAMBUTOL 400 MG ORAL TABLET,,11599,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
ETHAMBUTOL 400 MG ORAL TABLET,,11599,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
BACLOFEN 10 MG ORAL TABLET,,11630,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
BACLOFEN 10 MG ORAL TABLET,,11630,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
BACLOFEN 10 MG ORAL TABLET,,11630,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
BACLOFEN 10 MG ORAL TABLET,,11630,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
BACLOFEN 10 MG ORAL TABLET,,11630,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
BACLOFEN 10 MG ORAL TABLET,,11630,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
BACLOFEN 10 MG ORAL TABLET,,11630,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
BACLOFEN 10 MG ORAL TABLET,,11630,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
BACLOFEN 10 MG ORAL TABLET,,11630,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
BACLOFEN 10 MG ORAL TABLET,,11630,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
BACLOFEN 10 MG ORAL TABLET,,11630,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
BACLOFEN 10 MG ORAL TABLET,,11630,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
BACLOFEN 10 MG ORAL TABLET,,11630,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
BACLOFEN 10 MG ORAL TABLET,,11630,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
BACLOFEN 10 MG ORAL TABLET,,11630,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
BACLOFEN 10 MG ORAL TABLET,,11630,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
BACLOFEN 10 MG ORAL TABLET,,11630,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
BACLOFEN 10 MG ORAL TABLET,,11630,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
BACLOFEN 10 MG ORAL TABLET,,11630,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
BACLOFEN 10 MG ORAL TABLET,,11630,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
BACLOFEN 10 MG ORAL TABLET,,11630,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
BACLOFEN 10 MG ORAL TABLET,,11630,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
BACLOFEN 10 MG ORAL TABLET,,11630,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
BACLOFEN 10 MG ORAL TABLET,,11630,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
BACLOFEN 10 MG ORAL TABLET,,11630,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
BACLOFEN 10 MG ORAL TABLET,,11630,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
BACLOFEN 10 MG ORAL TABLET,,11630,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
BACLOFEN 10 MG ORAL TABLET,,11630,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
BACLOFEN 10 MG ORAL TABLET,,11630,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
BACLOFEN 10 MG ORAL TABLET,,11630,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
BACLOFEN 10 MG ORAL TABLET,,11630,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
BACLOFEN 10 MG ORAL TABLET,,11630,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
BACLOFEN 10 MG ORAL TABLET,,11630,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
BACLOFEN 10 MG ORAL TABLET,,11630,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
BACLOFEN 10 MG ORAL TABLET,,11630,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
BACLOFEN 10 MG ORAL TABLET,,11630,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
BACLOFEN 10 MG ORAL TABLET,,11630,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
BACLOFEN 10 MG ORAL TABLET,,11630,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
BACLOFEN 10 MG ORAL TABLET,,11630,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
BACLOFEN 10 MG ORAL TABLET,,11630,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
BACLOFEN 10 MG ORAL TABLET,,11630,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
BACLOFEN 10 MG ORAL TABLET,,11630,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
BACLOFEN 10 MG ORAL TABLET,,11630,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
BACLOFEN 10 MG ORAL TABLET,,11630,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BACLOFEN 10 MG ORAL TABLET,,11630,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
BACLOFEN 10 MG ORAL TABLET,,11630,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BACLOFEN 10 MG ORAL TABLET,,11630,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
BACLOFEN 10 MG ORAL TABLET,,11630,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BACLOFEN 10 MG ORAL TABLET,,11630,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
BACLOFEN 10 MG ORAL TABLET,,11630,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
BACLOFEN 10 MG ORAL TABLET,,11630,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
BACLOFEN 10 MG ORAL TABLET,,11630,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
BACLOFEN 10 MG ORAL TABLET,,11630,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
BACLOFEN 10 MG ORAL TABLET,,11630,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
BENZONATATE 100 MG ORAL CAP,,11688,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
BENZONATATE 100 MG ORAL CAP,,11688,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
BENZONATATE 100 MG ORAL CAP,,11688,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
BENZONATATE 100 MG ORAL CAP,,11688,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
BENZONATATE 100 MG ORAL CAP,,11688,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
BENZONATATE 100 MG ORAL CAP,,11688,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
BENZONATATE 100 MG ORAL CAP,,11688,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
BENZONATATE 100 MG ORAL CAP,,11688,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
BENZONATATE 100 MG ORAL CAP,,11688,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
BENZONATATE 100 MG ORAL CAP,,11688,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
BENZONATATE 100 MG ORAL CAP,,11688,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
BENZONATATE 100 MG ORAL CAP,,11688,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
BENZONATATE 100 MG ORAL CAP,,11688,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
BENZONATATE 100 MG ORAL CAP,,11688,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
BENZONATATE 100 MG ORAL CAP,,11688,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
BENZONATATE 100 MG ORAL CAP,,11688,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
BENZONATATE 100 MG ORAL CAP,,11688,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
BENZONATATE 100 MG ORAL CAP,,11688,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
BENZONATATE 100 MG ORAL CAP,,11688,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
BENZONATATE 100 MG ORAL CAP,,11688,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
BENZONATATE 100 MG ORAL CAP,,11688,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
BENZONATATE 100 MG ORAL CAP,,11688,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
BENZONATATE 100 MG ORAL CAP,,11688,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
BENZONATATE 100 MG ORAL CAP,,11688,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
BENZONATATE 100 MG ORAL CAP,,11688,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
BENZONATATE 100 MG ORAL CAP,,11688,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
BENZONATATE 100 MG ORAL CAP,,11688,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
BENZONATATE 100 MG ORAL CAP,,11688,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
BENZONATATE 100 MG ORAL CAP,,11688,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
BENZONATATE 100 MG ORAL CAP,,11688,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
BENZONATATE 100 MG ORAL CAP,,11688,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
BENZONATATE 100 MG ORAL CAP,,11688,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
BENZONATATE 100 MG ORAL CAP,,11688,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
BENZONATATE 100 MG ORAL CAP,,11688,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
BENZONATATE 100 MG ORAL CAP,,11688,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
BENZONATATE 100 MG ORAL CAP,,11688,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
BENZONATATE 100 MG ORAL CAP,,11688,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
BENZONATATE 100 MG ORAL CAP,,11688,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
BENZONATATE 100 MG ORAL CAP,,11688,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
BENZONATATE 100 MG ORAL CAP,,11688,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
BENZONATATE 100 MG ORAL CAP,,11688,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
BENZONATATE 100 MG ORAL CAP,,11688,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
BENZONATATE 100 MG ORAL CAP,,11688,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
BENZONATATE 100 MG ORAL CAP,,11688,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BENZONATATE 100 MG ORAL CAP,,11688,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
BENZONATATE 100 MG ORAL CAP,,11688,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BENZONATATE 100 MG ORAL CAP,,11688,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
BENZONATATE 100 MG ORAL CAP,,11688,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BENZONATATE 100 MG ORAL CAP,,11688,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
BENZONATATE 100 MG ORAL CAP,,11688,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
BENZONATATE 100 MG ORAL CAP,,11688,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
BENZONATATE 100 MG ORAL CAP,,11688,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
BENZONATATE 100 MG ORAL CAP,,11688,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
BENZONATATE 100 MG ORAL CAP,,11688,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
GEMFIBROZIL 600 MG ORAL TABLET,,11786,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,Aetna,Commercial,5.52,92,,percent of total billed charges,,
GEMFIBROZIL 600 MG ORAL TABLET,,11786,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,Aetna,Medicare Advantage,2.94,49,,percent of total billed charges,,
GEMFIBROZIL 600 MG ORAL TABLET,,11786,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,Aetna,Medicare Advantage,,,,,Included in per diem rate,
GEMFIBROZIL 600 MG ORAL TABLET,,11786,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,Aetna,PPO,5.58,93,,percent of total billed charges,,
GEMFIBROZIL 600 MG ORAL TABLET,,11786,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,America's PPO,America's PPO,5.7618,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
GEMFIBROZIL 600 MG ORAL TABLET,,11786,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota, Federal Employee Program,5.904,98.4,,percent of total billed charges,,
GEMFIBROZIL 600 MG ORAL TABLET,,11786,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,6,100,,percent of total billed charges,,
GEMFIBROZIL 600 MG ORAL TABLET,,11786,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota,High Value Network Plan,5.4,90,,percent of total billed charges,,
GEMFIBROZIL 600 MG ORAL TABLET,,11786,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota,Medicare Advantage,2.94,49,,percent of total billed charges,,
GEMFIBROZIL 600 MG ORAL TABLET,,11786,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
GEMFIBROZIL 600 MG ORAL TABLET,,11786,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,5.3142,88.57,,percent of total billed charges,,
GEMFIBROZIL 600 MG ORAL TABLET,,11786,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.7196,28.66,,percent of total billed charges,,
GEMFIBROZIL 600 MG ORAL TABLET,,11786,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.94,49,,percent of total billed charges,,
GEMFIBROZIL 600 MG ORAL TABLET,,11786,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
GEMFIBROZIL 600 MG ORAL TABLET,,11786,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,CorVel,Worker's Compensation,6,100,,percent of total billed charges,,
GEMFIBROZIL 600 MG ORAL TABLET,,11786,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,First Health Group Corporation,First Health Network,5.82,97,,percent of total billed charges,,
GEMFIBROZIL 600 MG ORAL TABLET,,11786,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,"Health Partners, Inc.",Commercial,5.676,94.6,,percent of total billed charges,,
GEMFIBROZIL 600 MG ORAL TABLET,,11786,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,"Health Partners, Inc.",Medicare Advantage,2.94,49,,percent of total billed charges,,
GEMFIBROZIL 600 MG ORAL TABLET,,11786,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
GEMFIBROZIL 600 MG ORAL TABLET,,11786,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3.6,60,,percent of total billed charges,,
GEMFIBROZIL 600 MG ORAL TABLET,,11786,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,"Health Partners, Inc.",State of Minnesota Advantage Program,4.89,81.5,,percent of total billed charges,,
GEMFIBROZIL 600 MG ORAL TABLET,,11786,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,"Health Partners, Inc.",State Public Programs,3,50,,percent of total billed charges,,
GEMFIBROZIL 600 MG ORAL TABLET,,11786,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,Humana Insurance Company,Commercial PPO,5.7,95,,percent of total billed charges,,
GEMFIBROZIL 600 MG ORAL TABLET,,11786,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,Humana Insurance Company,Medicare PPO,2.94,49,,percent of total billed charges,,
GEMFIBROZIL 600 MG ORAL TABLET,,11786,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
GEMFIBROZIL 600 MG ORAL TABLET,,11786,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,Medica,Individual & Family,5.946,99.1,,percent of total billed charges,,
GEMFIBROZIL 600 MG ORAL TABLET,,11786,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,Medica,Medica Advantage Solution,2.988,49.8,,percent of total billed charges,,
GEMFIBROZIL 600 MG ORAL TABLET,,11786,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
GEMFIBROZIL 600 MG ORAL TABLET,,11786,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,Medica,Medical Assistance,2.676,44.6,,percent of total billed charges,,
GEMFIBROZIL 600 MG ORAL TABLET,,11786,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,Medica,Medical Assistance,,,,,Included in per diem rate,
GEMFIBROZIL 600 MG ORAL TABLET,,11786,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.988,49.8,,percent of total billed charges,,
GEMFIBROZIL 600 MG ORAL TABLET,,11786,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
GEMFIBROZIL 600 MG ORAL TABLET,,11786,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,"Multiplan, Inc.","Multiplan, Inc.",5.64,94,,percent of total billed charges,,
GEMFIBROZIL 600 MG ORAL TABLET,,11786,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,5.406,90.1,,percent of total billed charges,,
GEMFIBROZIL 600 MG ORAL TABLET,,11786,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
GEMFIBROZIL 600 MG ORAL TABLET,,11786,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,"Preferred One Administrative Services, INC.",PPO,5.916,98.6,,percent of total billed charges,,
GEMFIBROZIL 600 MG ORAL TABLET,,11786,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,PrimeWest Health,Minnesota Senior Health Options (MSHO),3.087,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
GEMFIBROZIL 600 MG ORAL TABLET,,11786,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
GEMFIBROZIL 600 MG ORAL TABLET,,11786,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,PrimeWest Health,MinnesotaCare,3.0816,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
GEMFIBROZIL 600 MG ORAL TABLET,,11786,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
GEMFIBROZIL 600 MG ORAL TABLET,,11786,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,Sanford Health Plan,Sanford Health Plan,5.52,92,,percent of total billed charges,,
GEMFIBROZIL 600 MG ORAL TABLET,,11786,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,"UCare Health, Inc.",Individual & Family Plan,3.381,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
GEMFIBROZIL 600 MG ORAL TABLET,,11786,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
GEMFIBROZIL 600 MG ORAL TABLET,,11786,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,"UCare Health, Inc.",Medical Assistance,3.0282,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
GEMFIBROZIL 600 MG ORAL TABLET,,11786,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
GEMFIBROZIL 600 MG ORAL TABLET,,11786,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,"UCare Health, Inc.",Medicare Advantage,3.0282,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
GEMFIBROZIL 600 MG ORAL TABLET,,11786,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
GEMFIBROZIL 600 MG ORAL TABLET,,11786,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),3.0282,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
GEMFIBROZIL 600 MG ORAL TABLET,,11786,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
GEMFIBROZIL 600 MG ORAL TABLET,,11786,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,UnitedHealthcare,Individual & Family,5.64,94,,percent of total billed charges,,
GEMFIBROZIL 600 MG ORAL TABLET,,11786,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,UnitedHealthcare,Medicare Advantage,2.94,49,,percent of total billed charges,,
GEMFIBROZIL 600 MG ORAL TABLET,,11786,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
GEMFIBROZIL 600 MG ORAL TABLET,,11786,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.88,48,,percent of total billed charges,,100% of DHS outpatient percentage
GEMFIBROZIL 600 MG ORAL TABLET,,11786,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
GLIPIZIDE 2.5 MG ORAL TR24,,11846,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,Aetna,Commercial,6.44,92,,percent of total billed charges,,
GLIPIZIDE 2.5 MG ORAL TR24,,11846,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,Aetna,Medicare Advantage,3.43,49,,percent of total billed charges,,
GLIPIZIDE 2.5 MG ORAL TR24,,11846,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,Aetna,Medicare Advantage,,,,,Included in per diem rate,
GLIPIZIDE 2.5 MG ORAL TR24,,11846,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,Aetna,PPO,6.51,93,,percent of total billed charges,,
GLIPIZIDE 2.5 MG ORAL TR24,,11846,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,America's PPO,America's PPO,6.7221,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
GLIPIZIDE 2.5 MG ORAL TR24,,11846,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,BlueCross BlueShield Minnesota, Federal Employee Program,6.888,98.4,,percent of total billed charges,,
GLIPIZIDE 2.5 MG ORAL TR24,,11846,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,7,100,,percent of total billed charges,,
GLIPIZIDE 2.5 MG ORAL TR24,,11846,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,BlueCross BlueShield Minnesota,High Value Network Plan,6.3,90,,percent of total billed charges,,
GLIPIZIDE 2.5 MG ORAL TR24,,11846,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,BlueCross BlueShield Minnesota,Medicare Advantage,3.43,49,,percent of total billed charges,,
GLIPIZIDE 2.5 MG ORAL TR24,,11846,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
GLIPIZIDE 2.5 MG ORAL TR24,,11846,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,6.1999,88.57,,percent of total billed charges,,
GLIPIZIDE 2.5 MG ORAL TR24,,11846,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,2.0062,28.66,,percent of total billed charges,,
GLIPIZIDE 2.5 MG ORAL TR24,,11846,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),3.43,49,,percent of total billed charges,,
GLIPIZIDE 2.5 MG ORAL TR24,,11846,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
GLIPIZIDE 2.5 MG ORAL TR24,,11846,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,CorVel,Worker's Compensation,7,100,,percent of total billed charges,,
GLIPIZIDE 2.5 MG ORAL TR24,,11846,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,First Health Group Corporation,First Health Network,6.79,97,,percent of total billed charges,,
GLIPIZIDE 2.5 MG ORAL TR24,,11846,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,"Health Partners, Inc.",Commercial,6.622,94.6,,percent of total billed charges,,
GLIPIZIDE 2.5 MG ORAL TR24,,11846,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,"Health Partners, Inc.",Medicare Advantage,3.43,49,,percent of total billed charges,,
GLIPIZIDE 2.5 MG ORAL TR24,,11846,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
GLIPIZIDE 2.5 MG ORAL TR24,,11846,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),4.2,60,,percent of total billed charges,,
GLIPIZIDE 2.5 MG ORAL TR24,,11846,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,"Health Partners, Inc.",State of Minnesota Advantage Program,5.705,81.5,,percent of total billed charges,,
GLIPIZIDE 2.5 MG ORAL TR24,,11846,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,"Health Partners, Inc.",State Public Programs,3.5,50,,percent of total billed charges,,
GLIPIZIDE 2.5 MG ORAL TR24,,11846,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,Humana Insurance Company,Commercial PPO,6.65,95,,percent of total billed charges,,
GLIPIZIDE 2.5 MG ORAL TR24,,11846,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,Humana Insurance Company,Medicare PPO,3.43,49,,percent of total billed charges,,
GLIPIZIDE 2.5 MG ORAL TR24,,11846,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
GLIPIZIDE 2.5 MG ORAL TR24,,11846,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,Medica,Individual & Family,6.937,99.1,,percent of total billed charges,,
GLIPIZIDE 2.5 MG ORAL TR24,,11846,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,Medica,Medica Advantage Solution,3.486,49.8,,percent of total billed charges,,
GLIPIZIDE 2.5 MG ORAL TR24,,11846,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
GLIPIZIDE 2.5 MG ORAL TR24,,11846,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,Medica,Medical Assistance,3.122,44.6,,percent of total billed charges,,
GLIPIZIDE 2.5 MG ORAL TR24,,11846,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,Medica,Medical Assistance,,,,,Included in per diem rate,
GLIPIZIDE 2.5 MG ORAL TR24,,11846,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,3.486,49.8,,percent of total billed charges,,
GLIPIZIDE 2.5 MG ORAL TR24,,11846,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
GLIPIZIDE 2.5 MG ORAL TR24,,11846,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,"Multiplan, Inc.","Multiplan, Inc.",6.58,94,,percent of total billed charges,,
GLIPIZIDE 2.5 MG ORAL TR24,,11846,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,6.307,90.1,,percent of total billed charges,,
GLIPIZIDE 2.5 MG ORAL TR24,,11846,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
GLIPIZIDE 2.5 MG ORAL TR24,,11846,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,"Preferred One Administrative Services, INC.",PPO,6.902,98.6,,percent of total billed charges,,
GLIPIZIDE 2.5 MG ORAL TR24,,11846,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,PrimeWest Health,Minnesota Senior Health Options (MSHO),3.6015,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
GLIPIZIDE 2.5 MG ORAL TR24,,11846,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
GLIPIZIDE 2.5 MG ORAL TR24,,11846,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,PrimeWest Health,MinnesotaCare,3.5952,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
GLIPIZIDE 2.5 MG ORAL TR24,,11846,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
GLIPIZIDE 2.5 MG ORAL TR24,,11846,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,Sanford Health Plan,Sanford Health Plan,6.44,92,,percent of total billed charges,,
GLIPIZIDE 2.5 MG ORAL TR24,,11846,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,"UCare Health, Inc.",Individual & Family Plan,3.9445,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
GLIPIZIDE 2.5 MG ORAL TR24,,11846,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
GLIPIZIDE 2.5 MG ORAL TR24,,11846,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,"UCare Health, Inc.",Medical Assistance,3.5329,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
GLIPIZIDE 2.5 MG ORAL TR24,,11846,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
GLIPIZIDE 2.5 MG ORAL TR24,,11846,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,"UCare Health, Inc.",Medicare Advantage,3.5329,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
GLIPIZIDE 2.5 MG ORAL TR24,,11846,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
GLIPIZIDE 2.5 MG ORAL TR24,,11846,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),3.5329,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
GLIPIZIDE 2.5 MG ORAL TR24,,11846,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
GLIPIZIDE 2.5 MG ORAL TR24,,11846,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,UnitedHealthcare,Individual & Family,6.58,94,,percent of total billed charges,,
GLIPIZIDE 2.5 MG ORAL TR24,,11846,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,UnitedHealthcare,Medicare Advantage,3.43,49,,percent of total billed charges,,
GLIPIZIDE 2.5 MG ORAL TR24,,11846,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
GLIPIZIDE 2.5 MG ORAL TR24,,11846,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,3.36,48,,percent of total billed charges,,100% of DHS outpatient percentage
GLIPIZIDE 2.5 MG ORAL TR24,,11846,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
LEVOTHYROXINE 50 MCG ORAL TABLET,,11961,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
LEVOTHYROXINE 50 MCG ORAL TABLET,,11961,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
LEVOTHYROXINE 50 MCG ORAL TABLET,,11961,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
LEVOTHYROXINE 50 MCG ORAL TABLET,,11961,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
LEVOTHYROXINE 50 MCG ORAL TABLET,,11961,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
LEVOTHYROXINE 50 MCG ORAL TABLET,,11961,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
LEVOTHYROXINE 50 MCG ORAL TABLET,,11961,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
LEVOTHYROXINE 50 MCG ORAL TABLET,,11961,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
LEVOTHYROXINE 50 MCG ORAL TABLET,,11961,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
LEVOTHYROXINE 50 MCG ORAL TABLET,,11961,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
LEVOTHYROXINE 50 MCG ORAL TABLET,,11961,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
LEVOTHYROXINE 50 MCG ORAL TABLET,,11961,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
LEVOTHYROXINE 50 MCG ORAL TABLET,,11961,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
LEVOTHYROXINE 50 MCG ORAL TABLET,,11961,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
LEVOTHYROXINE 50 MCG ORAL TABLET,,11961,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
LEVOTHYROXINE 50 MCG ORAL TABLET,,11961,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
LEVOTHYROXINE 50 MCG ORAL TABLET,,11961,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
LEVOTHYROXINE 50 MCG ORAL TABLET,,11961,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
LEVOTHYROXINE 50 MCG ORAL TABLET,,11961,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LEVOTHYROXINE 50 MCG ORAL TABLET,,11961,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
LEVOTHYROXINE 50 MCG ORAL TABLET,,11961,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
LEVOTHYROXINE 50 MCG ORAL TABLET,,11961,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
LEVOTHYROXINE 50 MCG ORAL TABLET,,11961,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
LEVOTHYROXINE 50 MCG ORAL TABLET,,11961,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
LEVOTHYROXINE 50 MCG ORAL TABLET,,11961,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
LEVOTHYROXINE 50 MCG ORAL TABLET,,11961,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
LEVOTHYROXINE 50 MCG ORAL TABLET,,11961,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
LEVOTHYROXINE 50 MCG ORAL TABLET,,11961,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
LEVOTHYROXINE 50 MCG ORAL TABLET,,11961,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
LEVOTHYROXINE 50 MCG ORAL TABLET,,11961,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
LEVOTHYROXINE 50 MCG ORAL TABLET,,11961,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
LEVOTHYROXINE 50 MCG ORAL TABLET,,11961,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
LEVOTHYROXINE 50 MCG ORAL TABLET,,11961,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
LEVOTHYROXINE 50 MCG ORAL TABLET,,11961,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
LEVOTHYROXINE 50 MCG ORAL TABLET,,11961,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
LEVOTHYROXINE 50 MCG ORAL TABLET,,11961,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
LEVOTHYROXINE 50 MCG ORAL TABLET,,11961,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
LEVOTHYROXINE 50 MCG ORAL TABLET,,11961,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LEVOTHYROXINE 50 MCG ORAL TABLET,,11961,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
LEVOTHYROXINE 50 MCG ORAL TABLET,,11961,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
LEVOTHYROXINE 50 MCG ORAL TABLET,,11961,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
LEVOTHYROXINE 50 MCG ORAL TABLET,,11961,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
LEVOTHYROXINE 50 MCG ORAL TABLET,,11961,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
LEVOTHYROXINE 50 MCG ORAL TABLET,,11961,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LEVOTHYROXINE 50 MCG ORAL TABLET,,11961,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
LEVOTHYROXINE 50 MCG ORAL TABLET,,11961,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LEVOTHYROXINE 50 MCG ORAL TABLET,,11961,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LEVOTHYROXINE 50 MCG ORAL TABLET,,11961,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LEVOTHYROXINE 50 MCG ORAL TABLET,,11961,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LEVOTHYROXINE 50 MCG ORAL TABLET,,11961,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
LEVOTHYROXINE 50 MCG ORAL TABLET,,11961,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
LEVOTHYROXINE 50 MCG ORAL TABLET,,11961,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
LEVOTHYROXINE 50 MCG ORAL TABLET,,11961,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
LEVOTHYROXINE 50 MCG ORAL TABLET,,11961,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
HYDROCODONE-ACETAMINOPHEN 7.5-325 MG ORAL TABLET,,11969,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
HYDROCODONE-ACETAMINOPHEN 7.5-325 MG ORAL TABLET,,11969,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
HYDROCODONE-ACETAMINOPHEN 7.5-325 MG ORAL TABLET,,11969,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
HYDROCODONE-ACETAMINOPHEN 7.5-325 MG ORAL TABLET,,11969,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
HYDROCODONE-ACETAMINOPHEN 7.5-325 MG ORAL TABLET,,11969,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
HYDROCODONE-ACETAMINOPHEN 7.5-325 MG ORAL TABLET,,11969,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
HYDROCODONE-ACETAMINOPHEN 7.5-325 MG ORAL TABLET,,11969,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
HYDROCODONE-ACETAMINOPHEN 7.5-325 MG ORAL TABLET,,11969,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
HYDROCODONE-ACETAMINOPHEN 7.5-325 MG ORAL TABLET,,11969,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
HYDROCODONE-ACETAMINOPHEN 7.5-325 MG ORAL TABLET,,11969,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
HYDROCODONE-ACETAMINOPHEN 7.5-325 MG ORAL TABLET,,11969,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
HYDROCODONE-ACETAMINOPHEN 7.5-325 MG ORAL TABLET,,11969,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
HYDROCODONE-ACETAMINOPHEN 7.5-325 MG ORAL TABLET,,11969,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
HYDROCODONE-ACETAMINOPHEN 7.5-325 MG ORAL TABLET,,11969,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
HYDROCODONE-ACETAMINOPHEN 7.5-325 MG ORAL TABLET,,11969,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
HYDROCODONE-ACETAMINOPHEN 7.5-325 MG ORAL TABLET,,11969,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
HYDROCODONE-ACETAMINOPHEN 7.5-325 MG ORAL TABLET,,11969,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
HYDROCODONE-ACETAMINOPHEN 7.5-325 MG ORAL TABLET,,11969,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
HYDROCODONE-ACETAMINOPHEN 7.5-325 MG ORAL TABLET,,11969,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
HYDROCODONE-ACETAMINOPHEN 7.5-325 MG ORAL TABLET,,11969,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
HYDROCODONE-ACETAMINOPHEN 7.5-325 MG ORAL TABLET,,11969,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
HYDROCODONE-ACETAMINOPHEN 7.5-325 MG ORAL TABLET,,11969,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
HYDROCODONE-ACETAMINOPHEN 7.5-325 MG ORAL TABLET,,11969,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
HYDROCODONE-ACETAMINOPHEN 7.5-325 MG ORAL TABLET,,11969,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
HYDROCODONE-ACETAMINOPHEN 7.5-325 MG ORAL TABLET,,11969,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
HYDROCODONE-ACETAMINOPHEN 7.5-325 MG ORAL TABLET,,11969,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
HYDROCODONE-ACETAMINOPHEN 7.5-325 MG ORAL TABLET,,11969,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
HYDROCODONE-ACETAMINOPHEN 7.5-325 MG ORAL TABLET,,11969,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
HYDROCODONE-ACETAMINOPHEN 7.5-325 MG ORAL TABLET,,11969,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
HYDROCODONE-ACETAMINOPHEN 7.5-325 MG ORAL TABLET,,11969,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
HYDROCODONE-ACETAMINOPHEN 7.5-325 MG ORAL TABLET,,11969,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
HYDROCODONE-ACETAMINOPHEN 7.5-325 MG ORAL TABLET,,11969,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
HYDROCODONE-ACETAMINOPHEN 7.5-325 MG ORAL TABLET,,11969,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
HYDROCODONE-ACETAMINOPHEN 7.5-325 MG ORAL TABLET,,11969,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
HYDROCODONE-ACETAMINOPHEN 7.5-325 MG ORAL TABLET,,11969,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
HYDROCODONE-ACETAMINOPHEN 7.5-325 MG ORAL TABLET,,11969,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
HYDROCODONE-ACETAMINOPHEN 7.5-325 MG ORAL TABLET,,11969,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
HYDROCODONE-ACETAMINOPHEN 7.5-325 MG ORAL TABLET,,11969,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
HYDROCODONE-ACETAMINOPHEN 7.5-325 MG ORAL TABLET,,11969,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
HYDROCODONE-ACETAMINOPHEN 7.5-325 MG ORAL TABLET,,11969,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
HYDROCODONE-ACETAMINOPHEN 7.5-325 MG ORAL TABLET,,11969,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
HYDROCODONE-ACETAMINOPHEN 7.5-325 MG ORAL TABLET,,11969,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
HYDROCODONE-ACETAMINOPHEN 7.5-325 MG ORAL TABLET,,11969,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
HYDROCODONE-ACETAMINOPHEN 7.5-325 MG ORAL TABLET,,11969,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
HYDROCODONE-ACETAMINOPHEN 7.5-325 MG ORAL TABLET,,11969,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
HYDROCODONE-ACETAMINOPHEN 7.5-325 MG ORAL TABLET,,11969,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
HYDROCODONE-ACETAMINOPHEN 7.5-325 MG ORAL TABLET,,11969,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
HYDROCODONE-ACETAMINOPHEN 7.5-325 MG ORAL TABLET,,11969,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
HYDROCODONE-ACETAMINOPHEN 7.5-325 MG ORAL TABLET,,11969,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
HYDROCODONE-ACETAMINOPHEN 7.5-325 MG ORAL TABLET,,11969,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
HYDROCODONE-ACETAMINOPHEN 7.5-325 MG ORAL TABLET,,11969,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
HYDROCODONE-ACETAMINOPHEN 7.5-325 MG ORAL TABLET,,11969,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
HYDROCODONE-ACETAMINOPHEN 7.5-325 MG ORAL TABLET,,11969,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
HYDROCODONE-ACETAMINOPHEN 7.5-325 MG ORAL TABLET,,11969,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
BISACODYL 10 MG RECT SUPP,,11988,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
BISACODYL 10 MG RECT SUPP,,11988,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
BISACODYL 10 MG RECT SUPP,,11988,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
BISACODYL 10 MG RECT SUPP,,11988,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
BISACODYL 10 MG RECT SUPP,,11988,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
BISACODYL 10 MG RECT SUPP,,11988,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
BISACODYL 10 MG RECT SUPP,,11988,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
BISACODYL 10 MG RECT SUPP,,11988,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
BISACODYL 10 MG RECT SUPP,,11988,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
BISACODYL 10 MG RECT SUPP,,11988,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
BISACODYL 10 MG RECT SUPP,,11988,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
BISACODYL 10 MG RECT SUPP,,11988,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
BISACODYL 10 MG RECT SUPP,,11988,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
BISACODYL 10 MG RECT SUPP,,11988,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
BISACODYL 10 MG RECT SUPP,,11988,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
BISACODYL 10 MG RECT SUPP,,11988,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
BISACODYL 10 MG RECT SUPP,,11988,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
BISACODYL 10 MG RECT SUPP,,11988,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
BISACODYL 10 MG RECT SUPP,,11988,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
BISACODYL 10 MG RECT SUPP,,11988,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
BISACODYL 10 MG RECT SUPP,,11988,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
BISACODYL 10 MG RECT SUPP,,11988,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
BISACODYL 10 MG RECT SUPP,,11988,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
BISACODYL 10 MG RECT SUPP,,11988,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
BISACODYL 10 MG RECT SUPP,,11988,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
BISACODYL 10 MG RECT SUPP,,11988,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
BISACODYL 10 MG RECT SUPP,,11988,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
BISACODYL 10 MG RECT SUPP,,11988,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
BISACODYL 10 MG RECT SUPP,,11988,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
BISACODYL 10 MG RECT SUPP,,11988,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
BISACODYL 10 MG RECT SUPP,,11988,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
BISACODYL 10 MG RECT SUPP,,11988,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
BISACODYL 10 MG RECT SUPP,,11988,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
BISACODYL 10 MG RECT SUPP,,11988,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
BISACODYL 10 MG RECT SUPP,,11988,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
BISACODYL 10 MG RECT SUPP,,11988,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
BISACODYL 10 MG RECT SUPP,,11988,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
BISACODYL 10 MG RECT SUPP,,11988,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
BISACODYL 10 MG RECT SUPP,,11988,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
BISACODYL 10 MG RECT SUPP,,11988,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
BISACODYL 10 MG RECT SUPP,,11988,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
BISACODYL 10 MG RECT SUPP,,11988,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
BISACODYL 10 MG RECT SUPP,,11988,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
BISACODYL 10 MG RECT SUPP,,11988,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BISACODYL 10 MG RECT SUPP,,11988,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
BISACODYL 10 MG RECT SUPP,,11988,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BISACODYL 10 MG RECT SUPP,,11988,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
BISACODYL 10 MG RECT SUPP,,11988,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BISACODYL 10 MG RECT SUPP,,11988,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
BISACODYL 10 MG RECT SUPP,,11988,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
BISACODYL 10 MG RECT SUPP,,11988,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
BISACODYL 10 MG RECT SUPP,,11988,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
BISACODYL 10 MG RECT SUPP,,11988,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
BISACODYL 10 MG RECT SUPP,,11988,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
PAROXETINE HCL 20 MG ORAL TABLET,,12032,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
PAROXETINE HCL 20 MG ORAL TABLET,,12032,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
PAROXETINE HCL 20 MG ORAL TABLET,,12032,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
PAROXETINE HCL 20 MG ORAL TABLET,,12032,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
PAROXETINE HCL 20 MG ORAL TABLET,,12032,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
PAROXETINE HCL 20 MG ORAL TABLET,,12032,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
PAROXETINE HCL 20 MG ORAL TABLET,,12032,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
PAROXETINE HCL 20 MG ORAL TABLET,,12032,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
PAROXETINE HCL 20 MG ORAL TABLET,,12032,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
PAROXETINE HCL 20 MG ORAL TABLET,,12032,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
PAROXETINE HCL 20 MG ORAL TABLET,,12032,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
PAROXETINE HCL 20 MG ORAL TABLET,,12032,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
PAROXETINE HCL 20 MG ORAL TABLET,,12032,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
PAROXETINE HCL 20 MG ORAL TABLET,,12032,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
PAROXETINE HCL 20 MG ORAL TABLET,,12032,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
PAROXETINE HCL 20 MG ORAL TABLET,,12032,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
PAROXETINE HCL 20 MG ORAL TABLET,,12032,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
PAROXETINE HCL 20 MG ORAL TABLET,,12032,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
PAROXETINE HCL 20 MG ORAL TABLET,,12032,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PAROXETINE HCL 20 MG ORAL TABLET,,12032,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
PAROXETINE HCL 20 MG ORAL TABLET,,12032,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
PAROXETINE HCL 20 MG ORAL TABLET,,12032,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
PAROXETINE HCL 20 MG ORAL TABLET,,12032,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
PAROXETINE HCL 20 MG ORAL TABLET,,12032,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
PAROXETINE HCL 20 MG ORAL TABLET,,12032,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
PAROXETINE HCL 20 MG ORAL TABLET,,12032,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
PAROXETINE HCL 20 MG ORAL TABLET,,12032,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
PAROXETINE HCL 20 MG ORAL TABLET,,12032,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
PAROXETINE HCL 20 MG ORAL TABLET,,12032,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
PAROXETINE HCL 20 MG ORAL TABLET,,12032,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
PAROXETINE HCL 20 MG ORAL TABLET,,12032,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
PAROXETINE HCL 20 MG ORAL TABLET,,12032,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
PAROXETINE HCL 20 MG ORAL TABLET,,12032,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
PAROXETINE HCL 20 MG ORAL TABLET,,12032,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
PAROXETINE HCL 20 MG ORAL TABLET,,12032,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
PAROXETINE HCL 20 MG ORAL TABLET,,12032,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
PAROXETINE HCL 20 MG ORAL TABLET,,12032,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
PAROXETINE HCL 20 MG ORAL TABLET,,12032,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PAROXETINE HCL 20 MG ORAL TABLET,,12032,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
PAROXETINE HCL 20 MG ORAL TABLET,,12032,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
PAROXETINE HCL 20 MG ORAL TABLET,,12032,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
PAROXETINE HCL 20 MG ORAL TABLET,,12032,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
PAROXETINE HCL 20 MG ORAL TABLET,,12032,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
PAROXETINE HCL 20 MG ORAL TABLET,,12032,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PAROXETINE HCL 20 MG ORAL TABLET,,12032,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
PAROXETINE HCL 20 MG ORAL TABLET,,12032,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PAROXETINE HCL 20 MG ORAL TABLET,,12032,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PAROXETINE HCL 20 MG ORAL TABLET,,12032,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PAROXETINE HCL 20 MG ORAL TABLET,,12032,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PAROXETINE HCL 20 MG ORAL TABLET,,12032,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
PAROXETINE HCL 20 MG ORAL TABLET,,12032,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
PAROXETINE HCL 20 MG ORAL TABLET,,12032,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
PAROXETINE HCL 20 MG ORAL TABLET,,12032,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
PAROXETINE HCL 20 MG ORAL TABLET,,12032,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
SIMVASTATIN 20 MG ORAL TABLET,,12097,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
SIMVASTATIN 20 MG ORAL TABLET,,12097,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
SIMVASTATIN 20 MG ORAL TABLET,,12097,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
SIMVASTATIN 20 MG ORAL TABLET,,12097,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
SIMVASTATIN 20 MG ORAL TABLET,,12097,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SIMVASTATIN 20 MG ORAL TABLET,,12097,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
SIMVASTATIN 20 MG ORAL TABLET,,12097,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
SIMVASTATIN 20 MG ORAL TABLET,,12097,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
SIMVASTATIN 20 MG ORAL TABLET,,12097,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
SIMVASTATIN 20 MG ORAL TABLET,,12097,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
SIMVASTATIN 20 MG ORAL TABLET,,12097,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
SIMVASTATIN 20 MG ORAL TABLET,,12097,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
SIMVASTATIN 20 MG ORAL TABLET,,12097,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
SIMVASTATIN 20 MG ORAL TABLET,,12097,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
SIMVASTATIN 20 MG ORAL TABLET,,12097,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
SIMVASTATIN 20 MG ORAL TABLET,,12097,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
SIMVASTATIN 20 MG ORAL TABLET,,12097,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
SIMVASTATIN 20 MG ORAL TABLET,,12097,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
SIMVASTATIN 20 MG ORAL TABLET,,12097,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SIMVASTATIN 20 MG ORAL TABLET,,12097,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
SIMVASTATIN 20 MG ORAL TABLET,,12097,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
SIMVASTATIN 20 MG ORAL TABLET,,12097,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
SIMVASTATIN 20 MG ORAL TABLET,,12097,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
SIMVASTATIN 20 MG ORAL TABLET,,12097,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
SIMVASTATIN 20 MG ORAL TABLET,,12097,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
SIMVASTATIN 20 MG ORAL TABLET,,12097,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
SIMVASTATIN 20 MG ORAL TABLET,,12097,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
SIMVASTATIN 20 MG ORAL TABLET,,12097,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
SIMVASTATIN 20 MG ORAL TABLET,,12097,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
SIMVASTATIN 20 MG ORAL TABLET,,12097,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
SIMVASTATIN 20 MG ORAL TABLET,,12097,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
SIMVASTATIN 20 MG ORAL TABLET,,12097,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
SIMVASTATIN 20 MG ORAL TABLET,,12097,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
SIMVASTATIN 20 MG ORAL TABLET,,12097,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
SIMVASTATIN 20 MG ORAL TABLET,,12097,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
SIMVASTATIN 20 MG ORAL TABLET,,12097,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
SIMVASTATIN 20 MG ORAL TABLET,,12097,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
SIMVASTATIN 20 MG ORAL TABLET,,12097,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SIMVASTATIN 20 MG ORAL TABLET,,12097,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
SIMVASTATIN 20 MG ORAL TABLET,,12097,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
SIMVASTATIN 20 MG ORAL TABLET,,12097,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
SIMVASTATIN 20 MG ORAL TABLET,,12097,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
SIMVASTATIN 20 MG ORAL TABLET,,12097,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
SIMVASTATIN 20 MG ORAL TABLET,,12097,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SIMVASTATIN 20 MG ORAL TABLET,,12097,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
SIMVASTATIN 20 MG ORAL TABLET,,12097,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SIMVASTATIN 20 MG ORAL TABLET,,12097,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SIMVASTATIN 20 MG ORAL TABLET,,12097,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SIMVASTATIN 20 MG ORAL TABLET,,12097,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SIMVASTATIN 20 MG ORAL TABLET,,12097,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
SIMVASTATIN 20 MG ORAL TABLET,,12097,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
SIMVASTATIN 20 MG ORAL TABLET,,12097,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
SIMVASTATIN 20 MG ORAL TABLET,,12097,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
SIMVASTATIN 20 MG ORAL TABLET,,12097,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
HYOSCYAMINE SULFATE 0.125 MG ORAL TABLET,,12136,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
HYOSCYAMINE SULFATE 0.125 MG ORAL TABLET,,12136,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
HYOSCYAMINE SULFATE 0.125 MG ORAL TABLET,,12136,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
HYOSCYAMINE SULFATE 0.125 MG ORAL TABLET,,12136,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
HYOSCYAMINE SULFATE 0.125 MG ORAL TABLET,,12136,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
HYOSCYAMINE SULFATE 0.125 MG ORAL TABLET,,12136,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
HYOSCYAMINE SULFATE 0.125 MG ORAL TABLET,,12136,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
HYOSCYAMINE SULFATE 0.125 MG ORAL TABLET,,12136,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
HYOSCYAMINE SULFATE 0.125 MG ORAL TABLET,,12136,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
HYOSCYAMINE SULFATE 0.125 MG ORAL TABLET,,12136,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
HYOSCYAMINE SULFATE 0.125 MG ORAL TABLET,,12136,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
HYOSCYAMINE SULFATE 0.125 MG ORAL TABLET,,12136,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
HYOSCYAMINE SULFATE 0.125 MG ORAL TABLET,,12136,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
HYOSCYAMINE SULFATE 0.125 MG ORAL TABLET,,12136,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
HYOSCYAMINE SULFATE 0.125 MG ORAL TABLET,,12136,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
HYOSCYAMINE SULFATE 0.125 MG ORAL TABLET,,12136,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
HYOSCYAMINE SULFATE 0.125 MG ORAL TABLET,,12136,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
HYOSCYAMINE SULFATE 0.125 MG ORAL TABLET,,12136,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
HYOSCYAMINE SULFATE 0.125 MG ORAL TABLET,,12136,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
HYOSCYAMINE SULFATE 0.125 MG ORAL TABLET,,12136,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
HYOSCYAMINE SULFATE 0.125 MG ORAL TABLET,,12136,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
HYOSCYAMINE SULFATE 0.125 MG ORAL TABLET,,12136,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
HYOSCYAMINE SULFATE 0.125 MG ORAL TABLET,,12136,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
HYOSCYAMINE SULFATE 0.125 MG ORAL TABLET,,12136,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
HYOSCYAMINE SULFATE 0.125 MG ORAL TABLET,,12136,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
HYOSCYAMINE SULFATE 0.125 MG ORAL TABLET,,12136,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
HYOSCYAMINE SULFATE 0.125 MG ORAL TABLET,,12136,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
HYOSCYAMINE SULFATE 0.125 MG ORAL TABLET,,12136,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
HYOSCYAMINE SULFATE 0.125 MG ORAL TABLET,,12136,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
HYOSCYAMINE SULFATE 0.125 MG ORAL TABLET,,12136,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
HYOSCYAMINE SULFATE 0.125 MG ORAL TABLET,,12136,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
HYOSCYAMINE SULFATE 0.125 MG ORAL TABLET,,12136,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
HYOSCYAMINE SULFATE 0.125 MG ORAL TABLET,,12136,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
HYOSCYAMINE SULFATE 0.125 MG ORAL TABLET,,12136,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
HYOSCYAMINE SULFATE 0.125 MG ORAL TABLET,,12136,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
HYOSCYAMINE SULFATE 0.125 MG ORAL TABLET,,12136,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
HYOSCYAMINE SULFATE 0.125 MG ORAL TABLET,,12136,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
HYOSCYAMINE SULFATE 0.125 MG ORAL TABLET,,12136,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
HYOSCYAMINE SULFATE 0.125 MG ORAL TABLET,,12136,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
HYOSCYAMINE SULFATE 0.125 MG ORAL TABLET,,12136,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
HYOSCYAMINE SULFATE 0.125 MG ORAL TABLET,,12136,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
HYOSCYAMINE SULFATE 0.125 MG ORAL TABLET,,12136,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
HYOSCYAMINE SULFATE 0.125 MG ORAL TABLET,,12136,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
HYOSCYAMINE SULFATE 0.125 MG ORAL TABLET,,12136,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
HYOSCYAMINE SULFATE 0.125 MG ORAL TABLET,,12136,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
HYOSCYAMINE SULFATE 0.125 MG ORAL TABLET,,12136,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
HYOSCYAMINE SULFATE 0.125 MG ORAL TABLET,,12136,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
HYOSCYAMINE SULFATE 0.125 MG ORAL TABLET,,12136,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
HYOSCYAMINE SULFATE 0.125 MG ORAL TABLET,,12136,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
HYOSCYAMINE SULFATE 0.125 MG ORAL TABLET,,12136,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
HYOSCYAMINE SULFATE 0.125 MG ORAL TABLET,,12136,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
HYOSCYAMINE SULFATE 0.125 MG ORAL TABLET,,12136,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
HYOSCYAMINE SULFATE 0.125 MG ORAL TABLET,,12136,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
HYOSCYAMINE SULFATE 0.125 MG ORAL TABLET,,12136,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
DIPHENHYDRAMINE HCL 25 MG ORAL CAP,,12165,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
DIPHENHYDRAMINE HCL 25 MG ORAL CAP,,12165,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
DIPHENHYDRAMINE HCL 25 MG ORAL CAP,,12165,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
DIPHENHYDRAMINE HCL 25 MG ORAL CAP,,12165,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
DIPHENHYDRAMINE HCL 25 MG ORAL CAP,,12165,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
DIPHENHYDRAMINE HCL 25 MG ORAL CAP,,12165,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
DIPHENHYDRAMINE HCL 25 MG ORAL CAP,,12165,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
DIPHENHYDRAMINE HCL 25 MG ORAL CAP,,12165,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
DIPHENHYDRAMINE HCL 25 MG ORAL CAP,,12165,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
DIPHENHYDRAMINE HCL 25 MG ORAL CAP,,12165,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
DIPHENHYDRAMINE HCL 25 MG ORAL CAP,,12165,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
DIPHENHYDRAMINE HCL 25 MG ORAL CAP,,12165,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
DIPHENHYDRAMINE HCL 25 MG ORAL CAP,,12165,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
DIPHENHYDRAMINE HCL 25 MG ORAL CAP,,12165,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
DIPHENHYDRAMINE HCL 25 MG ORAL CAP,,12165,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
DIPHENHYDRAMINE HCL 25 MG ORAL CAP,,12165,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
DIPHENHYDRAMINE HCL 25 MG ORAL CAP,,12165,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
DIPHENHYDRAMINE HCL 25 MG ORAL CAP,,12165,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
DIPHENHYDRAMINE HCL 25 MG ORAL CAP,,12165,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DIPHENHYDRAMINE HCL 25 MG ORAL CAP,,12165,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
DIPHENHYDRAMINE HCL 25 MG ORAL CAP,,12165,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
DIPHENHYDRAMINE HCL 25 MG ORAL CAP,,12165,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
DIPHENHYDRAMINE HCL 25 MG ORAL CAP,,12165,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
DIPHENHYDRAMINE HCL 25 MG ORAL CAP,,12165,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
DIPHENHYDRAMINE HCL 25 MG ORAL CAP,,12165,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
DIPHENHYDRAMINE HCL 25 MG ORAL CAP,,12165,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
DIPHENHYDRAMINE HCL 25 MG ORAL CAP,,12165,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
DIPHENHYDRAMINE HCL 25 MG ORAL CAP,,12165,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
DIPHENHYDRAMINE HCL 25 MG ORAL CAP,,12165,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
DIPHENHYDRAMINE HCL 25 MG ORAL CAP,,12165,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
DIPHENHYDRAMINE HCL 25 MG ORAL CAP,,12165,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
DIPHENHYDRAMINE HCL 25 MG ORAL CAP,,12165,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
DIPHENHYDRAMINE HCL 25 MG ORAL CAP,,12165,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
DIPHENHYDRAMINE HCL 25 MG ORAL CAP,,12165,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
DIPHENHYDRAMINE HCL 25 MG ORAL CAP,,12165,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
DIPHENHYDRAMINE HCL 25 MG ORAL CAP,,12165,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
DIPHENHYDRAMINE HCL 25 MG ORAL CAP,,12165,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
DIPHENHYDRAMINE HCL 25 MG ORAL CAP,,12165,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DIPHENHYDRAMINE HCL 25 MG ORAL CAP,,12165,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
DIPHENHYDRAMINE HCL 25 MG ORAL CAP,,12165,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
DIPHENHYDRAMINE HCL 25 MG ORAL CAP,,12165,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
DIPHENHYDRAMINE HCL 25 MG ORAL CAP,,12165,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
DIPHENHYDRAMINE HCL 25 MG ORAL CAP,,12165,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
DIPHENHYDRAMINE HCL 25 MG ORAL CAP,,12165,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DIPHENHYDRAMINE HCL 25 MG ORAL CAP,,12165,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
DIPHENHYDRAMINE HCL 25 MG ORAL CAP,,12165,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DIPHENHYDRAMINE HCL 25 MG ORAL CAP,,12165,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DIPHENHYDRAMINE HCL 25 MG ORAL CAP,,12165,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DIPHENHYDRAMINE HCL 25 MG ORAL CAP,,12165,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DIPHENHYDRAMINE HCL 25 MG ORAL CAP,,12165,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
DIPHENHYDRAMINE HCL 25 MG ORAL CAP,,12165,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
DIPHENHYDRAMINE HCL 25 MG ORAL CAP,,12165,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
DIPHENHYDRAMINE HCL 25 MG ORAL CAP,,12165,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
DIPHENHYDRAMINE HCL 25 MG ORAL CAP,,12165,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
MIRTAZAPINE 30 MG ORAL TABLET,,12176,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,Aetna,Commercial,6.44,92,,percent of total billed charges,,
MIRTAZAPINE 30 MG ORAL TABLET,,12176,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,Aetna,Medicare Advantage,3.43,49,,percent of total billed charges,,
MIRTAZAPINE 30 MG ORAL TABLET,,12176,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,Aetna,Medicare Advantage,,,,,Included in per diem rate,
MIRTAZAPINE 30 MG ORAL TABLET,,12176,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,Aetna,PPO,6.51,93,,percent of total billed charges,,
MIRTAZAPINE 30 MG ORAL TABLET,,12176,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,America's PPO,America's PPO,6.7221,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
MIRTAZAPINE 30 MG ORAL TABLET,,12176,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,BlueCross BlueShield Minnesota, Federal Employee Program,6.888,98.4,,percent of total billed charges,,
MIRTAZAPINE 30 MG ORAL TABLET,,12176,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,7,100,,percent of total billed charges,,
MIRTAZAPINE 30 MG ORAL TABLET,,12176,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,BlueCross BlueShield Minnesota,High Value Network Plan,6.3,90,,percent of total billed charges,,
MIRTAZAPINE 30 MG ORAL TABLET,,12176,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,BlueCross BlueShield Minnesota,Medicare Advantage,3.43,49,,percent of total billed charges,,
MIRTAZAPINE 30 MG ORAL TABLET,,12176,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
MIRTAZAPINE 30 MG ORAL TABLET,,12176,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,6.1999,88.57,,percent of total billed charges,,
MIRTAZAPINE 30 MG ORAL TABLET,,12176,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,2.0062,28.66,,percent of total billed charges,,
MIRTAZAPINE 30 MG ORAL TABLET,,12176,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),3.43,49,,percent of total billed charges,,
MIRTAZAPINE 30 MG ORAL TABLET,,12176,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
MIRTAZAPINE 30 MG ORAL TABLET,,12176,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,CorVel,Worker's Compensation,7,100,,percent of total billed charges,,
MIRTAZAPINE 30 MG ORAL TABLET,,12176,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,First Health Group Corporation,First Health Network,6.79,97,,percent of total billed charges,,
MIRTAZAPINE 30 MG ORAL TABLET,,12176,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,"Health Partners, Inc.",Commercial,6.622,94.6,,percent of total billed charges,,
MIRTAZAPINE 30 MG ORAL TABLET,,12176,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,"Health Partners, Inc.",Medicare Advantage,3.43,49,,percent of total billed charges,,
MIRTAZAPINE 30 MG ORAL TABLET,,12176,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
MIRTAZAPINE 30 MG ORAL TABLET,,12176,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),4.2,60,,percent of total billed charges,,
MIRTAZAPINE 30 MG ORAL TABLET,,12176,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,"Health Partners, Inc.",State of Minnesota Advantage Program,5.705,81.5,,percent of total billed charges,,
MIRTAZAPINE 30 MG ORAL TABLET,,12176,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,"Health Partners, Inc.",State Public Programs,3.5,50,,percent of total billed charges,,
MIRTAZAPINE 30 MG ORAL TABLET,,12176,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,Humana Insurance Company,Commercial PPO,6.65,95,,percent of total billed charges,,
MIRTAZAPINE 30 MG ORAL TABLET,,12176,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,Humana Insurance Company,Medicare PPO,3.43,49,,percent of total billed charges,,
MIRTAZAPINE 30 MG ORAL TABLET,,12176,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
MIRTAZAPINE 30 MG ORAL TABLET,,12176,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,Medica,Individual & Family,6.937,99.1,,percent of total billed charges,,
MIRTAZAPINE 30 MG ORAL TABLET,,12176,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,Medica,Medica Advantage Solution,3.486,49.8,,percent of total billed charges,,
MIRTAZAPINE 30 MG ORAL TABLET,,12176,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
MIRTAZAPINE 30 MG ORAL TABLET,,12176,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,Medica,Medical Assistance,3.122,44.6,,percent of total billed charges,,
MIRTAZAPINE 30 MG ORAL TABLET,,12176,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,Medica,Medical Assistance,,,,,Included in per diem rate,
MIRTAZAPINE 30 MG ORAL TABLET,,12176,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,3.486,49.8,,percent of total billed charges,,
MIRTAZAPINE 30 MG ORAL TABLET,,12176,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
MIRTAZAPINE 30 MG ORAL TABLET,,12176,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,"Multiplan, Inc.","Multiplan, Inc.",6.58,94,,percent of total billed charges,,
MIRTAZAPINE 30 MG ORAL TABLET,,12176,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,6.307,90.1,,percent of total billed charges,,
MIRTAZAPINE 30 MG ORAL TABLET,,12176,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
MIRTAZAPINE 30 MG ORAL TABLET,,12176,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,"Preferred One Administrative Services, INC.",PPO,6.902,98.6,,percent of total billed charges,,
MIRTAZAPINE 30 MG ORAL TABLET,,12176,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,PrimeWest Health,Minnesota Senior Health Options (MSHO),3.6015,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
MIRTAZAPINE 30 MG ORAL TABLET,,12176,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
MIRTAZAPINE 30 MG ORAL TABLET,,12176,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,PrimeWest Health,MinnesotaCare,3.5952,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
MIRTAZAPINE 30 MG ORAL TABLET,,12176,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
MIRTAZAPINE 30 MG ORAL TABLET,,12176,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,Sanford Health Plan,Sanford Health Plan,6.44,92,,percent of total billed charges,,
MIRTAZAPINE 30 MG ORAL TABLET,,12176,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,"UCare Health, Inc.",Individual & Family Plan,3.9445,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
MIRTAZAPINE 30 MG ORAL TABLET,,12176,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
MIRTAZAPINE 30 MG ORAL TABLET,,12176,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,"UCare Health, Inc.",Medical Assistance,3.5329,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MIRTAZAPINE 30 MG ORAL TABLET,,12176,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
MIRTAZAPINE 30 MG ORAL TABLET,,12176,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,"UCare Health, Inc.",Medicare Advantage,3.5329,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MIRTAZAPINE 30 MG ORAL TABLET,,12176,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
MIRTAZAPINE 30 MG ORAL TABLET,,12176,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),3.5329,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MIRTAZAPINE 30 MG ORAL TABLET,,12176,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
MIRTAZAPINE 30 MG ORAL TABLET,,12176,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,UnitedHealthcare,Individual & Family,6.58,94,,percent of total billed charges,,
MIRTAZAPINE 30 MG ORAL TABLET,,12176,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,UnitedHealthcare,Medicare Advantage,3.43,49,,percent of total billed charges,,
MIRTAZAPINE 30 MG ORAL TABLET,,12176,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
MIRTAZAPINE 30 MG ORAL TABLET,,12176,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,3.36,48,,percent of total billed charges,,100% of DHS outpatient percentage
MIRTAZAPINE 30 MG ORAL TABLET,,12176,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
NAPROXEN SODIUM 550 MG ORAL TABLET,,12220,LOCAL,Facility,Both,1,Each,,18,15.3,5.1588,18,Aetna,Commercial,16.56,92,,percent of total billed charges,,
NAPROXEN SODIUM 550 MG ORAL TABLET,,12220,LOCAL,Facility,Outpatient,1,Each,,18,15.3,5.1588,18,Aetna,Medicare Advantage,8.82,49,,percent of total billed charges,,
NAPROXEN SODIUM 550 MG ORAL TABLET,,12220,LOCAL,Facility,Inpatient,1,Each,,18,15.3,5.1588,18,Aetna,Medicare Advantage,,,,,Included in per diem rate,
NAPROXEN SODIUM 550 MG ORAL TABLET,,12220,LOCAL,Facility,Both,1,Each,,18,15.3,5.1588,18,Aetna,PPO,16.74,93,,percent of total billed charges,,
NAPROXEN SODIUM 550 MG ORAL TABLET,,12220,LOCAL,Facility,Both,1,Each,,18,15.3,5.1588,18,America's PPO,America's PPO,17.2854,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
NAPROXEN SODIUM 550 MG ORAL TABLET,,12220,LOCAL,Facility,Both,1,Each,,18,15.3,5.1588,18,BlueCross BlueShield Minnesota, Federal Employee Program,17.712,98.4,,percent of total billed charges,,
NAPROXEN SODIUM 550 MG ORAL TABLET,,12220,LOCAL,Facility,Both,1,Each,,18,15.3,5.1588,18,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,18,100,,percent of total billed charges,,
NAPROXEN SODIUM 550 MG ORAL TABLET,,12220,LOCAL,Facility,Both,1,Each,,18,15.3,5.1588,18,BlueCross BlueShield Minnesota,High Value Network Plan,16.2,90,,percent of total billed charges,,
NAPROXEN SODIUM 550 MG ORAL TABLET,,12220,LOCAL,Facility,Outpatient,1,Each,,18,15.3,5.1588,18,BlueCross BlueShield Minnesota,Medicare Advantage,8.82,49,,percent of total billed charges,,
NAPROXEN SODIUM 550 MG ORAL TABLET,,12220,LOCAL,Facility,Inpatient,1,Each,,18,15.3,5.1588,18,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
NAPROXEN SODIUM 550 MG ORAL TABLET,,12220,LOCAL,Facility,Both,1,Each,,18,15.3,5.1588,18,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,15.9426,88.57,,percent of total billed charges,,
NAPROXEN SODIUM 550 MG ORAL TABLET,,12220,LOCAL,Facility,Both,1,Each,,18,15.3,5.1588,18,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,5.1588,28.66,,percent of total billed charges,,
NAPROXEN SODIUM 550 MG ORAL TABLET,,12220,LOCAL,Facility,Outpatient,1,Each,,18,15.3,5.1588,18,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),8.82,49,,percent of total billed charges,,
NAPROXEN SODIUM 550 MG ORAL TABLET,,12220,LOCAL,Facility,Inpatient,1,Each,,18,15.3,5.1588,18,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
NAPROXEN SODIUM 550 MG ORAL TABLET,,12220,LOCAL,Facility,Both,1,Each,,18,15.3,5.1588,18,CorVel,Worker's Compensation,18,100,,percent of total billed charges,,
NAPROXEN SODIUM 550 MG ORAL TABLET,,12220,LOCAL,Facility,Both,1,Each,,18,15.3,5.1588,18,First Health Group Corporation,First Health Network,17.46,97,,percent of total billed charges,,
NAPROXEN SODIUM 550 MG ORAL TABLET,,12220,LOCAL,Facility,Both,1,Each,,18,15.3,5.1588,18,"Health Partners, Inc.",Commercial,17.028,94.6,,percent of total billed charges,,
NAPROXEN SODIUM 550 MG ORAL TABLET,,12220,LOCAL,Facility,Outpatient,1,Each,,18,15.3,5.1588,18,"Health Partners, Inc.",Medicare Advantage,8.82,49,,percent of total billed charges,,
NAPROXEN SODIUM 550 MG ORAL TABLET,,12220,LOCAL,Facility,Inpatient,1,Each,,18,15.3,5.1588,18,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
NAPROXEN SODIUM 550 MG ORAL TABLET,,12220,LOCAL,Facility,Both,1,Each,,18,15.3,5.1588,18,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),10.8,60,,percent of total billed charges,,
NAPROXEN SODIUM 550 MG ORAL TABLET,,12220,LOCAL,Facility,Both,1,Each,,18,15.3,5.1588,18,"Health Partners, Inc.",State of Minnesota Advantage Program,14.67,81.5,,percent of total billed charges,,
NAPROXEN SODIUM 550 MG ORAL TABLET,,12220,LOCAL,Facility,Both,1,Each,,18,15.3,5.1588,18,"Health Partners, Inc.",State Public Programs,9,50,,percent of total billed charges,,
NAPROXEN SODIUM 550 MG ORAL TABLET,,12220,LOCAL,Facility,Both,1,Each,,18,15.3,5.1588,18,Humana Insurance Company,Commercial PPO,17.1,95,,percent of total billed charges,,
NAPROXEN SODIUM 550 MG ORAL TABLET,,12220,LOCAL,Facility,Outpatient,1,Each,,18,15.3,5.1588,18,Humana Insurance Company,Medicare PPO,8.82,49,,percent of total billed charges,,
NAPROXEN SODIUM 550 MG ORAL TABLET,,12220,LOCAL,Facility,Inpatient,1,Each,,18,15.3,5.1588,18,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
NAPROXEN SODIUM 550 MG ORAL TABLET,,12220,LOCAL,Facility,Both,1,Each,,18,15.3,5.1588,18,Medica,Individual & Family,17.838,99.1,,percent of total billed charges,,
NAPROXEN SODIUM 550 MG ORAL TABLET,,12220,LOCAL,Facility,Outpatient,1,Each,,18,15.3,5.1588,18,Medica,Medica Advantage Solution,8.964,49.8,,percent of total billed charges,,
NAPROXEN SODIUM 550 MG ORAL TABLET,,12220,LOCAL,Facility,Inpatient,1,Each,,18,15.3,5.1588,18,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
NAPROXEN SODIUM 550 MG ORAL TABLET,,12220,LOCAL,Facility,Outpatient,1,Each,,18,15.3,5.1588,18,Medica,Medical Assistance,8.028,44.6,,percent of total billed charges,,
NAPROXEN SODIUM 550 MG ORAL TABLET,,12220,LOCAL,Facility,Inpatient,1,Each,,18,15.3,5.1588,18,Medica,Medical Assistance,,,,,Included in per diem rate,
NAPROXEN SODIUM 550 MG ORAL TABLET,,12220,LOCAL,Facility,Outpatient,1,Each,,18,15.3,5.1588,18,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,8.964,49.8,,percent of total billed charges,,
NAPROXEN SODIUM 550 MG ORAL TABLET,,12220,LOCAL,Facility,Inpatient,1,Each,,18,15.3,5.1588,18,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
NAPROXEN SODIUM 550 MG ORAL TABLET,,12220,LOCAL,Facility,Both,1,Each,,18,15.3,5.1588,18,"Multiplan, Inc.","Multiplan, Inc.",16.92,94,,percent of total billed charges,,
NAPROXEN SODIUM 550 MG ORAL TABLET,,12220,LOCAL,Facility,Outpatient,1,Each,,18,15.3,5.1588,18,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,16.218,90.1,,percent of total billed charges,,
NAPROXEN SODIUM 550 MG ORAL TABLET,,12220,LOCAL,Facility,Inpatient,1,Each,,18,15.3,5.1588,18,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
NAPROXEN SODIUM 550 MG ORAL TABLET,,12220,LOCAL,Facility,Both,1,Each,,18,15.3,5.1588,18,"Preferred One Administrative Services, INC.",PPO,17.748,98.6,,percent of total billed charges,,
NAPROXEN SODIUM 550 MG ORAL TABLET,,12220,LOCAL,Facility,Outpatient,1,Each,,18,15.3,5.1588,18,PrimeWest Health,Minnesota Senior Health Options (MSHO),9.261,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
NAPROXEN SODIUM 550 MG ORAL TABLET,,12220,LOCAL,Facility,Inpatient,1,Each,,18,15.3,5.1588,18,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
NAPROXEN SODIUM 550 MG ORAL TABLET,,12220,LOCAL,Facility,Outpatient,1,Each,,18,15.3,5.1588,18,PrimeWest Health,MinnesotaCare,9.2448,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
NAPROXEN SODIUM 550 MG ORAL TABLET,,12220,LOCAL,Facility,Inpatient,1,Each,,18,15.3,5.1588,18,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
NAPROXEN SODIUM 550 MG ORAL TABLET,,12220,LOCAL,Facility,Both,1,Each,,18,15.3,5.1588,18,Sanford Health Plan,Sanford Health Plan,16.56,92,,percent of total billed charges,,
NAPROXEN SODIUM 550 MG ORAL TABLET,,12220,LOCAL,Facility,Outpatient,1,Each,,18,15.3,5.1588,18,"UCare Health, Inc.",Individual & Family Plan,10.143,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
NAPROXEN SODIUM 550 MG ORAL TABLET,,12220,LOCAL,Facility,Inpatient,1,Each,,18,15.3,5.1588,18,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
NAPROXEN SODIUM 550 MG ORAL TABLET,,12220,LOCAL,Facility,Outpatient,1,Each,,18,15.3,5.1588,18,"UCare Health, Inc.",Medical Assistance,9.0846,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
NAPROXEN SODIUM 550 MG ORAL TABLET,,12220,LOCAL,Facility,Inpatient,1,Each,,18,15.3,5.1588,18,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
NAPROXEN SODIUM 550 MG ORAL TABLET,,12220,LOCAL,Facility,Outpatient,1,Each,,18,15.3,5.1588,18,"UCare Health, Inc.",Medicare Advantage,9.0846,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
NAPROXEN SODIUM 550 MG ORAL TABLET,,12220,LOCAL,Facility,Inpatient,1,Each,,18,15.3,5.1588,18,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
NAPROXEN SODIUM 550 MG ORAL TABLET,,12220,LOCAL,Facility,Outpatient,1,Each,,18,15.3,5.1588,18,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),9.0846,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
NAPROXEN SODIUM 550 MG ORAL TABLET,,12220,LOCAL,Facility,Inpatient,1,Each,,18,15.3,5.1588,18,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
NAPROXEN SODIUM 550 MG ORAL TABLET,,12220,LOCAL,Facility,Both,1,Each,,18,15.3,5.1588,18,UnitedHealthcare,Individual & Family,16.92,94,,percent of total billed charges,,
NAPROXEN SODIUM 550 MG ORAL TABLET,,12220,LOCAL,Facility,Outpatient,1,Each,,18,15.3,5.1588,18,UnitedHealthcare,Medicare Advantage,8.82,49,,percent of total billed charges,,
NAPROXEN SODIUM 550 MG ORAL TABLET,,12220,LOCAL,Facility,Inpatient,1,Each,,18,15.3,5.1588,18,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
NAPROXEN SODIUM 550 MG ORAL TABLET,,12220,LOCAL,Facility,Outpatient,1,Each,,18,15.3,5.1588,18,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,8.64,48,,percent of total billed charges,,100% of DHS outpatient percentage
NAPROXEN SODIUM 550 MG ORAL TABLET,,12220,LOCAL,Facility,Inpatient,1,Each,,18,15.3,5.1588,18,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
OSELTAMIVIR 75 MG ORAL CAP,,12248,LOCAL,Facility,Both,1,Each,,75,63.75,21.495,75,Aetna,Commercial,69,92,,percent of total billed charges,,
OSELTAMIVIR 75 MG ORAL CAP,,12248,LOCAL,Facility,Outpatient,1,Each,,75,63.75,21.495,75,Aetna,Medicare Advantage,36.75,49,,percent of total billed charges,,
OSELTAMIVIR 75 MG ORAL CAP,,12248,LOCAL,Facility,Inpatient,1,Each,,75,63.75,21.495,75,Aetna,Medicare Advantage,,,,,Included in per diem rate,
OSELTAMIVIR 75 MG ORAL CAP,,12248,LOCAL,Facility,Both,1,Each,,75,63.75,21.495,75,Aetna,PPO,69.75,93,,percent of total billed charges,,
OSELTAMIVIR 75 MG ORAL CAP,,12248,LOCAL,Facility,Both,1,Each,,75,63.75,21.495,75,America's PPO,America's PPO,72.0225,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
OSELTAMIVIR 75 MG ORAL CAP,,12248,LOCAL,Facility,Both,1,Each,,75,63.75,21.495,75,BlueCross BlueShield Minnesota, Federal Employee Program,73.8,98.4,,percent of total billed charges,,
OSELTAMIVIR 75 MG ORAL CAP,,12248,LOCAL,Facility,Both,1,Each,,75,63.75,21.495,75,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,75,100,,percent of total billed charges,,
OSELTAMIVIR 75 MG ORAL CAP,,12248,LOCAL,Facility,Both,1,Each,,75,63.75,21.495,75,BlueCross BlueShield Minnesota,High Value Network Plan,67.5,90,,percent of total billed charges,,
OSELTAMIVIR 75 MG ORAL CAP,,12248,LOCAL,Facility,Outpatient,1,Each,,75,63.75,21.495,75,BlueCross BlueShield Minnesota,Medicare Advantage,36.75,49,,percent of total billed charges,,
OSELTAMIVIR 75 MG ORAL CAP,,12248,LOCAL,Facility,Inpatient,1,Each,,75,63.75,21.495,75,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
OSELTAMIVIR 75 MG ORAL CAP,,12248,LOCAL,Facility,Both,1,Each,,75,63.75,21.495,75,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,66.4275,88.57,,percent of total billed charges,,
OSELTAMIVIR 75 MG ORAL CAP,,12248,LOCAL,Facility,Both,1,Each,,75,63.75,21.495,75,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,21.495,28.66,,percent of total billed charges,,
OSELTAMIVIR 75 MG ORAL CAP,,12248,LOCAL,Facility,Outpatient,1,Each,,75,63.75,21.495,75,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),36.75,49,,percent of total billed charges,,
OSELTAMIVIR 75 MG ORAL CAP,,12248,LOCAL,Facility,Inpatient,1,Each,,75,63.75,21.495,75,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
OSELTAMIVIR 75 MG ORAL CAP,,12248,LOCAL,Facility,Both,1,Each,,75,63.75,21.495,75,CorVel,Worker's Compensation,75,100,,percent of total billed charges,,
OSELTAMIVIR 75 MG ORAL CAP,,12248,LOCAL,Facility,Both,1,Each,,75,63.75,21.495,75,First Health Group Corporation,First Health Network,72.75,97,,percent of total billed charges,,
OSELTAMIVIR 75 MG ORAL CAP,,12248,LOCAL,Facility,Both,1,Each,,75,63.75,21.495,75,"Health Partners, Inc.",Commercial,70.95,94.6,,percent of total billed charges,,
OSELTAMIVIR 75 MG ORAL CAP,,12248,LOCAL,Facility,Outpatient,1,Each,,75,63.75,21.495,75,"Health Partners, Inc.",Medicare Advantage,36.75,49,,percent of total billed charges,,
OSELTAMIVIR 75 MG ORAL CAP,,12248,LOCAL,Facility,Inpatient,1,Each,,75,63.75,21.495,75,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
OSELTAMIVIR 75 MG ORAL CAP,,12248,LOCAL,Facility,Both,1,Each,,75,63.75,21.495,75,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),45,60,,percent of total billed charges,,
OSELTAMIVIR 75 MG ORAL CAP,,12248,LOCAL,Facility,Both,1,Each,,75,63.75,21.495,75,"Health Partners, Inc.",State of Minnesota Advantage Program,61.125,81.5,,percent of total billed charges,,
OSELTAMIVIR 75 MG ORAL CAP,,12248,LOCAL,Facility,Both,1,Each,,75,63.75,21.495,75,"Health Partners, Inc.",State Public Programs,37.5,50,,percent of total billed charges,,
OSELTAMIVIR 75 MG ORAL CAP,,12248,LOCAL,Facility,Both,1,Each,,75,63.75,21.495,75,Humana Insurance Company,Commercial PPO,71.25,95,,percent of total billed charges,,
OSELTAMIVIR 75 MG ORAL CAP,,12248,LOCAL,Facility,Outpatient,1,Each,,75,63.75,21.495,75,Humana Insurance Company,Medicare PPO,36.75,49,,percent of total billed charges,,
OSELTAMIVIR 75 MG ORAL CAP,,12248,LOCAL,Facility,Inpatient,1,Each,,75,63.75,21.495,75,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
OSELTAMIVIR 75 MG ORAL CAP,,12248,LOCAL,Facility,Both,1,Each,,75,63.75,21.495,75,Medica,Individual & Family,74.325,99.1,,percent of total billed charges,,
OSELTAMIVIR 75 MG ORAL CAP,,12248,LOCAL,Facility,Outpatient,1,Each,,75,63.75,21.495,75,Medica,Medica Advantage Solution,37.35,49.8,,percent of total billed charges,,
OSELTAMIVIR 75 MG ORAL CAP,,12248,LOCAL,Facility,Inpatient,1,Each,,75,63.75,21.495,75,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
OSELTAMIVIR 75 MG ORAL CAP,,12248,LOCAL,Facility,Outpatient,1,Each,,75,63.75,21.495,75,Medica,Medical Assistance,33.45,44.6,,percent of total billed charges,,
OSELTAMIVIR 75 MG ORAL CAP,,12248,LOCAL,Facility,Inpatient,1,Each,,75,63.75,21.495,75,Medica,Medical Assistance,,,,,Included in per diem rate,
OSELTAMIVIR 75 MG ORAL CAP,,12248,LOCAL,Facility,Outpatient,1,Each,,75,63.75,21.495,75,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,37.35,49.8,,percent of total billed charges,,
OSELTAMIVIR 75 MG ORAL CAP,,12248,LOCAL,Facility,Inpatient,1,Each,,75,63.75,21.495,75,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
OSELTAMIVIR 75 MG ORAL CAP,,12248,LOCAL,Facility,Both,1,Each,,75,63.75,21.495,75,"Multiplan, Inc.","Multiplan, Inc.",70.5,94,,percent of total billed charges,,
OSELTAMIVIR 75 MG ORAL CAP,,12248,LOCAL,Facility,Outpatient,1,Each,,75,63.75,21.495,75,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,67.575,90.1,,percent of total billed charges,,
OSELTAMIVIR 75 MG ORAL CAP,,12248,LOCAL,Facility,Inpatient,1,Each,,75,63.75,21.495,75,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
OSELTAMIVIR 75 MG ORAL CAP,,12248,LOCAL,Facility,Both,1,Each,,75,63.75,21.495,75,"Preferred One Administrative Services, INC.",PPO,73.95,98.6,,percent of total billed charges,,
OSELTAMIVIR 75 MG ORAL CAP,,12248,LOCAL,Facility,Outpatient,1,Each,,75,63.75,21.495,75,PrimeWest Health,Minnesota Senior Health Options (MSHO),38.5875,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
OSELTAMIVIR 75 MG ORAL CAP,,12248,LOCAL,Facility,Inpatient,1,Each,,75,63.75,21.495,75,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
OSELTAMIVIR 75 MG ORAL CAP,,12248,LOCAL,Facility,Outpatient,1,Each,,75,63.75,21.495,75,PrimeWest Health,MinnesotaCare,38.52,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
OSELTAMIVIR 75 MG ORAL CAP,,12248,LOCAL,Facility,Inpatient,1,Each,,75,63.75,21.495,75,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
OSELTAMIVIR 75 MG ORAL CAP,,12248,LOCAL,Facility,Both,1,Each,,75,63.75,21.495,75,Sanford Health Plan,Sanford Health Plan,69,92,,percent of total billed charges,,
OSELTAMIVIR 75 MG ORAL CAP,,12248,LOCAL,Facility,Outpatient,1,Each,,75,63.75,21.495,75,"UCare Health, Inc.",Individual & Family Plan,42.2625,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
OSELTAMIVIR 75 MG ORAL CAP,,12248,LOCAL,Facility,Inpatient,1,Each,,75,63.75,21.495,75,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
OSELTAMIVIR 75 MG ORAL CAP,,12248,LOCAL,Facility,Outpatient,1,Each,,75,63.75,21.495,75,"UCare Health, Inc.",Medical Assistance,37.8525,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
OSELTAMIVIR 75 MG ORAL CAP,,12248,LOCAL,Facility,Inpatient,1,Each,,75,63.75,21.495,75,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
OSELTAMIVIR 75 MG ORAL CAP,,12248,LOCAL,Facility,Outpatient,1,Each,,75,63.75,21.495,75,"UCare Health, Inc.",Medicare Advantage,37.8525,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
OSELTAMIVIR 75 MG ORAL CAP,,12248,LOCAL,Facility,Inpatient,1,Each,,75,63.75,21.495,75,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
OSELTAMIVIR 75 MG ORAL CAP,,12248,LOCAL,Facility,Outpatient,1,Each,,75,63.75,21.495,75,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),37.8525,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
OSELTAMIVIR 75 MG ORAL CAP,,12248,LOCAL,Facility,Inpatient,1,Each,,75,63.75,21.495,75,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
OSELTAMIVIR 75 MG ORAL CAP,,12248,LOCAL,Facility,Both,1,Each,,75,63.75,21.495,75,UnitedHealthcare,Individual & Family,70.5,94,,percent of total billed charges,,
OSELTAMIVIR 75 MG ORAL CAP,,12248,LOCAL,Facility,Outpatient,1,Each,,75,63.75,21.495,75,UnitedHealthcare,Medicare Advantage,36.75,49,,percent of total billed charges,,
OSELTAMIVIR 75 MG ORAL CAP,,12248,LOCAL,Facility,Inpatient,1,Each,,75,63.75,21.495,75,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
OSELTAMIVIR 75 MG ORAL CAP,,12248,LOCAL,Facility,Outpatient,1,Each,,75,63.75,21.495,75,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,36,48,,percent of total billed charges,,100% of DHS outpatient percentage
OSELTAMIVIR 75 MG ORAL CAP,,12248,LOCAL,Facility,Inpatient,1,Each,,75,63.75,21.495,75,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
TELMISARTAN 40 MG ORAL TABLET,,12280,LOCAL,Facility,Both,1,Each,,29,24.65,8.3114,29,Aetna,Commercial,26.68,92,,percent of total billed charges,,
TELMISARTAN 40 MG ORAL TABLET,,12280,LOCAL,Facility,Outpatient,1,Each,,29,24.65,8.3114,29,Aetna,Medicare Advantage,14.21,49,,percent of total billed charges,,
TELMISARTAN 40 MG ORAL TABLET,,12280,LOCAL,Facility,Inpatient,1,Each,,29,24.65,8.3114,29,Aetna,Medicare Advantage,,,,,Included in per diem rate,
TELMISARTAN 40 MG ORAL TABLET,,12280,LOCAL,Facility,Both,1,Each,,29,24.65,8.3114,29,Aetna,PPO,26.97,93,,percent of total billed charges,,
TELMISARTAN 40 MG ORAL TABLET,,12280,LOCAL,Facility,Both,1,Each,,29,24.65,8.3114,29,America's PPO,America's PPO,27.8487,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
TELMISARTAN 40 MG ORAL TABLET,,12280,LOCAL,Facility,Both,1,Each,,29,24.65,8.3114,29,BlueCross BlueShield Minnesota, Federal Employee Program,28.536,98.4,,percent of total billed charges,,
TELMISARTAN 40 MG ORAL TABLET,,12280,LOCAL,Facility,Both,1,Each,,29,24.65,8.3114,29,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,29,100,,percent of total billed charges,,
TELMISARTAN 40 MG ORAL TABLET,,12280,LOCAL,Facility,Both,1,Each,,29,24.65,8.3114,29,BlueCross BlueShield Minnesota,High Value Network Plan,26.1,90,,percent of total billed charges,,
TELMISARTAN 40 MG ORAL TABLET,,12280,LOCAL,Facility,Outpatient,1,Each,,29,24.65,8.3114,29,BlueCross BlueShield Minnesota,Medicare Advantage,14.21,49,,percent of total billed charges,,
TELMISARTAN 40 MG ORAL TABLET,,12280,LOCAL,Facility,Inpatient,1,Each,,29,24.65,8.3114,29,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
TELMISARTAN 40 MG ORAL TABLET,,12280,LOCAL,Facility,Both,1,Each,,29,24.65,8.3114,29,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,25.6853,88.57,,percent of total billed charges,,
TELMISARTAN 40 MG ORAL TABLET,,12280,LOCAL,Facility,Both,1,Each,,29,24.65,8.3114,29,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,8.3114,28.66,,percent of total billed charges,,
TELMISARTAN 40 MG ORAL TABLET,,12280,LOCAL,Facility,Outpatient,1,Each,,29,24.65,8.3114,29,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),14.21,49,,percent of total billed charges,,
TELMISARTAN 40 MG ORAL TABLET,,12280,LOCAL,Facility,Inpatient,1,Each,,29,24.65,8.3114,29,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
TELMISARTAN 40 MG ORAL TABLET,,12280,LOCAL,Facility,Both,1,Each,,29,24.65,8.3114,29,CorVel,Worker's Compensation,29,100,,percent of total billed charges,,
TELMISARTAN 40 MG ORAL TABLET,,12280,LOCAL,Facility,Both,1,Each,,29,24.65,8.3114,29,First Health Group Corporation,First Health Network,28.13,97,,percent of total billed charges,,
TELMISARTAN 40 MG ORAL TABLET,,12280,LOCAL,Facility,Both,1,Each,,29,24.65,8.3114,29,"Health Partners, Inc.",Commercial,27.434,94.6,,percent of total billed charges,,
TELMISARTAN 40 MG ORAL TABLET,,12280,LOCAL,Facility,Outpatient,1,Each,,29,24.65,8.3114,29,"Health Partners, Inc.",Medicare Advantage,14.21,49,,percent of total billed charges,,
TELMISARTAN 40 MG ORAL TABLET,,12280,LOCAL,Facility,Inpatient,1,Each,,29,24.65,8.3114,29,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
TELMISARTAN 40 MG ORAL TABLET,,12280,LOCAL,Facility,Both,1,Each,,29,24.65,8.3114,29,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),17.4,60,,percent of total billed charges,,
TELMISARTAN 40 MG ORAL TABLET,,12280,LOCAL,Facility,Both,1,Each,,29,24.65,8.3114,29,"Health Partners, Inc.",State of Minnesota Advantage Program,23.635,81.5,,percent of total billed charges,,
TELMISARTAN 40 MG ORAL TABLET,,12280,LOCAL,Facility,Both,1,Each,,29,24.65,8.3114,29,"Health Partners, Inc.",State Public Programs,14.5,50,,percent of total billed charges,,
TELMISARTAN 40 MG ORAL TABLET,,12280,LOCAL,Facility,Both,1,Each,,29,24.65,8.3114,29,Humana Insurance Company,Commercial PPO,27.55,95,,percent of total billed charges,,
TELMISARTAN 40 MG ORAL TABLET,,12280,LOCAL,Facility,Outpatient,1,Each,,29,24.65,8.3114,29,Humana Insurance Company,Medicare PPO,14.21,49,,percent of total billed charges,,
TELMISARTAN 40 MG ORAL TABLET,,12280,LOCAL,Facility,Inpatient,1,Each,,29,24.65,8.3114,29,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
TELMISARTAN 40 MG ORAL TABLET,,12280,LOCAL,Facility,Both,1,Each,,29,24.65,8.3114,29,Medica,Individual & Family,28.739,99.1,,percent of total billed charges,,
TELMISARTAN 40 MG ORAL TABLET,,12280,LOCAL,Facility,Outpatient,1,Each,,29,24.65,8.3114,29,Medica,Medica Advantage Solution,14.442,49.8,,percent of total billed charges,,
TELMISARTAN 40 MG ORAL TABLET,,12280,LOCAL,Facility,Inpatient,1,Each,,29,24.65,8.3114,29,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
TELMISARTAN 40 MG ORAL TABLET,,12280,LOCAL,Facility,Outpatient,1,Each,,29,24.65,8.3114,29,Medica,Medical Assistance,12.934,44.6,,percent of total billed charges,,
TELMISARTAN 40 MG ORAL TABLET,,12280,LOCAL,Facility,Inpatient,1,Each,,29,24.65,8.3114,29,Medica,Medical Assistance,,,,,Included in per diem rate,
TELMISARTAN 40 MG ORAL TABLET,,12280,LOCAL,Facility,Outpatient,1,Each,,29,24.65,8.3114,29,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,14.442,49.8,,percent of total billed charges,,
TELMISARTAN 40 MG ORAL TABLET,,12280,LOCAL,Facility,Inpatient,1,Each,,29,24.65,8.3114,29,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
TELMISARTAN 40 MG ORAL TABLET,,12280,LOCAL,Facility,Both,1,Each,,29,24.65,8.3114,29,"Multiplan, Inc.","Multiplan, Inc.",27.26,94,,percent of total billed charges,,
TELMISARTAN 40 MG ORAL TABLET,,12280,LOCAL,Facility,Outpatient,1,Each,,29,24.65,8.3114,29,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,26.129,90.1,,percent of total billed charges,,
TELMISARTAN 40 MG ORAL TABLET,,12280,LOCAL,Facility,Inpatient,1,Each,,29,24.65,8.3114,29,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
TELMISARTAN 40 MG ORAL TABLET,,12280,LOCAL,Facility,Both,1,Each,,29,24.65,8.3114,29,"Preferred One Administrative Services, INC.",PPO,28.594,98.6,,percent of total billed charges,,
TELMISARTAN 40 MG ORAL TABLET,,12280,LOCAL,Facility,Outpatient,1,Each,,29,24.65,8.3114,29,PrimeWest Health,Minnesota Senior Health Options (MSHO),14.9205,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
TELMISARTAN 40 MG ORAL TABLET,,12280,LOCAL,Facility,Inpatient,1,Each,,29,24.65,8.3114,29,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
TELMISARTAN 40 MG ORAL TABLET,,12280,LOCAL,Facility,Outpatient,1,Each,,29,24.65,8.3114,29,PrimeWest Health,MinnesotaCare,14.8944,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
TELMISARTAN 40 MG ORAL TABLET,,12280,LOCAL,Facility,Inpatient,1,Each,,29,24.65,8.3114,29,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
TELMISARTAN 40 MG ORAL TABLET,,12280,LOCAL,Facility,Both,1,Each,,29,24.65,8.3114,29,Sanford Health Plan,Sanford Health Plan,26.68,92,,percent of total billed charges,,
TELMISARTAN 40 MG ORAL TABLET,,12280,LOCAL,Facility,Outpatient,1,Each,,29,24.65,8.3114,29,"UCare Health, Inc.",Individual & Family Plan,16.3415,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
TELMISARTAN 40 MG ORAL TABLET,,12280,LOCAL,Facility,Inpatient,1,Each,,29,24.65,8.3114,29,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
TELMISARTAN 40 MG ORAL TABLET,,12280,LOCAL,Facility,Outpatient,1,Each,,29,24.65,8.3114,29,"UCare Health, Inc.",Medical Assistance,14.6363,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TELMISARTAN 40 MG ORAL TABLET,,12280,LOCAL,Facility,Inpatient,1,Each,,29,24.65,8.3114,29,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
TELMISARTAN 40 MG ORAL TABLET,,12280,LOCAL,Facility,Outpatient,1,Each,,29,24.65,8.3114,29,"UCare Health, Inc.",Medicare Advantage,14.6363,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TELMISARTAN 40 MG ORAL TABLET,,12280,LOCAL,Facility,Inpatient,1,Each,,29,24.65,8.3114,29,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
TELMISARTAN 40 MG ORAL TABLET,,12280,LOCAL,Facility,Outpatient,1,Each,,29,24.65,8.3114,29,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),14.6363,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TELMISARTAN 40 MG ORAL TABLET,,12280,LOCAL,Facility,Inpatient,1,Each,,29,24.65,8.3114,29,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
TELMISARTAN 40 MG ORAL TABLET,,12280,LOCAL,Facility,Both,1,Each,,29,24.65,8.3114,29,UnitedHealthcare,Individual & Family,27.26,94,,percent of total billed charges,,
TELMISARTAN 40 MG ORAL TABLET,,12280,LOCAL,Facility,Outpatient,1,Each,,29,24.65,8.3114,29,UnitedHealthcare,Medicare Advantage,14.21,49,,percent of total billed charges,,
TELMISARTAN 40 MG ORAL TABLET,,12280,LOCAL,Facility,Inpatient,1,Each,,29,24.65,8.3114,29,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
TELMISARTAN 40 MG ORAL TABLET,,12280,LOCAL,Facility,Outpatient,1,Each,,29,24.65,8.3114,29,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,13.92,48,,percent of total billed charges,,100% of DHS outpatient percentage
TELMISARTAN 40 MG ORAL TABLET,,12280,LOCAL,Facility,Inpatient,1,Each,,29,24.65,8.3114,29,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
ROPINIROLE 0.5 MG ORAL TABLET,,12641,LOCAL,Facility,Both,1,Each,,13,11.05,3.7258,13,Aetna,Commercial,11.96,92,,percent of total billed charges,,
ROPINIROLE 0.5 MG ORAL TABLET,,12641,LOCAL,Facility,Outpatient,1,Each,,13,11.05,3.7258,13,Aetna,Medicare Advantage,6.37,49,,percent of total billed charges,,
ROPINIROLE 0.5 MG ORAL TABLET,,12641,LOCAL,Facility,Inpatient,1,Each,,13,11.05,3.7258,13,Aetna,Medicare Advantage,,,,,Included in per diem rate,
ROPINIROLE 0.5 MG ORAL TABLET,,12641,LOCAL,Facility,Both,1,Each,,13,11.05,3.7258,13,Aetna,PPO,12.09,93,,percent of total billed charges,,
ROPINIROLE 0.5 MG ORAL TABLET,,12641,LOCAL,Facility,Both,1,Each,,13,11.05,3.7258,13,America's PPO,America's PPO,12.4839,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
ROPINIROLE 0.5 MG ORAL TABLET,,12641,LOCAL,Facility,Both,1,Each,,13,11.05,3.7258,13,BlueCross BlueShield Minnesota, Federal Employee Program,12.792,98.4,,percent of total billed charges,,
ROPINIROLE 0.5 MG ORAL TABLET,,12641,LOCAL,Facility,Both,1,Each,,13,11.05,3.7258,13,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,13,100,,percent of total billed charges,,
ROPINIROLE 0.5 MG ORAL TABLET,,12641,LOCAL,Facility,Both,1,Each,,13,11.05,3.7258,13,BlueCross BlueShield Minnesota,High Value Network Plan,11.7,90,,percent of total billed charges,,
ROPINIROLE 0.5 MG ORAL TABLET,,12641,LOCAL,Facility,Outpatient,1,Each,,13,11.05,3.7258,13,BlueCross BlueShield Minnesota,Medicare Advantage,6.37,49,,percent of total billed charges,,
ROPINIROLE 0.5 MG ORAL TABLET,,12641,LOCAL,Facility,Inpatient,1,Each,,13,11.05,3.7258,13,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
ROPINIROLE 0.5 MG ORAL TABLET,,12641,LOCAL,Facility,Both,1,Each,,13,11.05,3.7258,13,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,11.5141,88.57,,percent of total billed charges,,
ROPINIROLE 0.5 MG ORAL TABLET,,12641,LOCAL,Facility,Both,1,Each,,13,11.05,3.7258,13,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,3.7258,28.66,,percent of total billed charges,,
ROPINIROLE 0.5 MG ORAL TABLET,,12641,LOCAL,Facility,Outpatient,1,Each,,13,11.05,3.7258,13,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),6.37,49,,percent of total billed charges,,
ROPINIROLE 0.5 MG ORAL TABLET,,12641,LOCAL,Facility,Inpatient,1,Each,,13,11.05,3.7258,13,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
ROPINIROLE 0.5 MG ORAL TABLET,,12641,LOCAL,Facility,Both,1,Each,,13,11.05,3.7258,13,CorVel,Worker's Compensation,13,100,,percent of total billed charges,,
ROPINIROLE 0.5 MG ORAL TABLET,,12641,LOCAL,Facility,Both,1,Each,,13,11.05,3.7258,13,First Health Group Corporation,First Health Network,12.61,97,,percent of total billed charges,,
ROPINIROLE 0.5 MG ORAL TABLET,,12641,LOCAL,Facility,Both,1,Each,,13,11.05,3.7258,13,"Health Partners, Inc.",Commercial,12.298,94.6,,percent of total billed charges,,
ROPINIROLE 0.5 MG ORAL TABLET,,12641,LOCAL,Facility,Outpatient,1,Each,,13,11.05,3.7258,13,"Health Partners, Inc.",Medicare Advantage,6.37,49,,percent of total billed charges,,
ROPINIROLE 0.5 MG ORAL TABLET,,12641,LOCAL,Facility,Inpatient,1,Each,,13,11.05,3.7258,13,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ROPINIROLE 0.5 MG ORAL TABLET,,12641,LOCAL,Facility,Both,1,Each,,13,11.05,3.7258,13,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),7.8,60,,percent of total billed charges,,
ROPINIROLE 0.5 MG ORAL TABLET,,12641,LOCAL,Facility,Both,1,Each,,13,11.05,3.7258,13,"Health Partners, Inc.",State of Minnesota Advantage Program,10.595,81.5,,percent of total billed charges,,
ROPINIROLE 0.5 MG ORAL TABLET,,12641,LOCAL,Facility,Both,1,Each,,13,11.05,3.7258,13,"Health Partners, Inc.",State Public Programs,6.5,50,,percent of total billed charges,,
ROPINIROLE 0.5 MG ORAL TABLET,,12641,LOCAL,Facility,Both,1,Each,,13,11.05,3.7258,13,Humana Insurance Company,Commercial PPO,12.35,95,,percent of total billed charges,,
ROPINIROLE 0.5 MG ORAL TABLET,,12641,LOCAL,Facility,Outpatient,1,Each,,13,11.05,3.7258,13,Humana Insurance Company,Medicare PPO,6.37,49,,percent of total billed charges,,
ROPINIROLE 0.5 MG ORAL TABLET,,12641,LOCAL,Facility,Inpatient,1,Each,,13,11.05,3.7258,13,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
ROPINIROLE 0.5 MG ORAL TABLET,,12641,LOCAL,Facility,Both,1,Each,,13,11.05,3.7258,13,Medica,Individual & Family,12.883,99.1,,percent of total billed charges,,
ROPINIROLE 0.5 MG ORAL TABLET,,12641,LOCAL,Facility,Outpatient,1,Each,,13,11.05,3.7258,13,Medica,Medica Advantage Solution,6.474,49.8,,percent of total billed charges,,
ROPINIROLE 0.5 MG ORAL TABLET,,12641,LOCAL,Facility,Inpatient,1,Each,,13,11.05,3.7258,13,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
ROPINIROLE 0.5 MG ORAL TABLET,,12641,LOCAL,Facility,Outpatient,1,Each,,13,11.05,3.7258,13,Medica,Medical Assistance,5.798,44.6,,percent of total billed charges,,
ROPINIROLE 0.5 MG ORAL TABLET,,12641,LOCAL,Facility,Inpatient,1,Each,,13,11.05,3.7258,13,Medica,Medical Assistance,,,,,Included in per diem rate,
ROPINIROLE 0.5 MG ORAL TABLET,,12641,LOCAL,Facility,Outpatient,1,Each,,13,11.05,3.7258,13,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,6.474,49.8,,percent of total billed charges,,
ROPINIROLE 0.5 MG ORAL TABLET,,12641,LOCAL,Facility,Inpatient,1,Each,,13,11.05,3.7258,13,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
ROPINIROLE 0.5 MG ORAL TABLET,,12641,LOCAL,Facility,Both,1,Each,,13,11.05,3.7258,13,"Multiplan, Inc.","Multiplan, Inc.",12.22,94,,percent of total billed charges,,
ROPINIROLE 0.5 MG ORAL TABLET,,12641,LOCAL,Facility,Outpatient,1,Each,,13,11.05,3.7258,13,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,11.713,90.1,,percent of total billed charges,,
ROPINIROLE 0.5 MG ORAL TABLET,,12641,LOCAL,Facility,Inpatient,1,Each,,13,11.05,3.7258,13,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
ROPINIROLE 0.5 MG ORAL TABLET,,12641,LOCAL,Facility,Both,1,Each,,13,11.05,3.7258,13,"Preferred One Administrative Services, INC.",PPO,12.818,98.6,,percent of total billed charges,,
ROPINIROLE 0.5 MG ORAL TABLET,,12641,LOCAL,Facility,Outpatient,1,Each,,13,11.05,3.7258,13,PrimeWest Health,Minnesota Senior Health Options (MSHO),6.6885,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
ROPINIROLE 0.5 MG ORAL TABLET,,12641,LOCAL,Facility,Inpatient,1,Each,,13,11.05,3.7258,13,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ROPINIROLE 0.5 MG ORAL TABLET,,12641,LOCAL,Facility,Outpatient,1,Each,,13,11.05,3.7258,13,PrimeWest Health,MinnesotaCare,6.6768,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
ROPINIROLE 0.5 MG ORAL TABLET,,12641,LOCAL,Facility,Inpatient,1,Each,,13,11.05,3.7258,13,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
ROPINIROLE 0.5 MG ORAL TABLET,,12641,LOCAL,Facility,Both,1,Each,,13,11.05,3.7258,13,Sanford Health Plan,Sanford Health Plan,11.96,92,,percent of total billed charges,,
ROPINIROLE 0.5 MG ORAL TABLET,,12641,LOCAL,Facility,Outpatient,1,Each,,13,11.05,3.7258,13,"UCare Health, Inc.",Individual & Family Plan,7.3255,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
ROPINIROLE 0.5 MG ORAL TABLET,,12641,LOCAL,Facility,Inpatient,1,Each,,13,11.05,3.7258,13,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
ROPINIROLE 0.5 MG ORAL TABLET,,12641,LOCAL,Facility,Outpatient,1,Each,,13,11.05,3.7258,13,"UCare Health, Inc.",Medical Assistance,6.5611,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ROPINIROLE 0.5 MG ORAL TABLET,,12641,LOCAL,Facility,Inpatient,1,Each,,13,11.05,3.7258,13,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
ROPINIROLE 0.5 MG ORAL TABLET,,12641,LOCAL,Facility,Outpatient,1,Each,,13,11.05,3.7258,13,"UCare Health, Inc.",Medicare Advantage,6.5611,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ROPINIROLE 0.5 MG ORAL TABLET,,12641,LOCAL,Facility,Inpatient,1,Each,,13,11.05,3.7258,13,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ROPINIROLE 0.5 MG ORAL TABLET,,12641,LOCAL,Facility,Outpatient,1,Each,,13,11.05,3.7258,13,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),6.5611,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ROPINIROLE 0.5 MG ORAL TABLET,,12641,LOCAL,Facility,Inpatient,1,Each,,13,11.05,3.7258,13,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ROPINIROLE 0.5 MG ORAL TABLET,,12641,LOCAL,Facility,Both,1,Each,,13,11.05,3.7258,13,UnitedHealthcare,Individual & Family,12.22,94,,percent of total billed charges,,
ROPINIROLE 0.5 MG ORAL TABLET,,12641,LOCAL,Facility,Outpatient,1,Each,,13,11.05,3.7258,13,UnitedHealthcare,Medicare Advantage,6.37,49,,percent of total billed charges,,
ROPINIROLE 0.5 MG ORAL TABLET,,12641,LOCAL,Facility,Inpatient,1,Each,,13,11.05,3.7258,13,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
ROPINIROLE 0.5 MG ORAL TABLET,,12641,LOCAL,Facility,Outpatient,1,Each,,13,11.05,3.7258,13,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,6.24,48,,percent of total billed charges,,100% of DHS outpatient percentage
ROPINIROLE 0.5 MG ORAL TABLET,,12641,LOCAL,Facility,Inpatient,1,Each,,13,11.05,3.7258,13,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
ACETAMINOPHEN 80 MG ORAL CHEW TAB,,12919,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
ACETAMINOPHEN 80 MG ORAL CHEW TAB,,12919,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
ACETAMINOPHEN 80 MG ORAL CHEW TAB,,12919,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
ACETAMINOPHEN 80 MG ORAL CHEW TAB,,12919,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
ACETAMINOPHEN 80 MG ORAL CHEW TAB,,12919,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
ACETAMINOPHEN 80 MG ORAL CHEW TAB,,12919,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
ACETAMINOPHEN 80 MG ORAL CHEW TAB,,12919,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
ACETAMINOPHEN 80 MG ORAL CHEW TAB,,12919,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
ACETAMINOPHEN 80 MG ORAL CHEW TAB,,12919,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
ACETAMINOPHEN 80 MG ORAL CHEW TAB,,12919,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
ACETAMINOPHEN 80 MG ORAL CHEW TAB,,12919,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
ACETAMINOPHEN 80 MG ORAL CHEW TAB,,12919,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
ACETAMINOPHEN 80 MG ORAL CHEW TAB,,12919,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
ACETAMINOPHEN 80 MG ORAL CHEW TAB,,12919,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
ACETAMINOPHEN 80 MG ORAL CHEW TAB,,12919,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
ACETAMINOPHEN 80 MG ORAL CHEW TAB,,12919,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
ACETAMINOPHEN 80 MG ORAL CHEW TAB,,12919,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
ACETAMINOPHEN 80 MG ORAL CHEW TAB,,12919,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
ACETAMINOPHEN 80 MG ORAL CHEW TAB,,12919,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ACETAMINOPHEN 80 MG ORAL CHEW TAB,,12919,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
ACETAMINOPHEN 80 MG ORAL CHEW TAB,,12919,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
ACETAMINOPHEN 80 MG ORAL CHEW TAB,,12919,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
ACETAMINOPHEN 80 MG ORAL CHEW TAB,,12919,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
ACETAMINOPHEN 80 MG ORAL CHEW TAB,,12919,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
ACETAMINOPHEN 80 MG ORAL CHEW TAB,,12919,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
ACETAMINOPHEN 80 MG ORAL CHEW TAB,,12919,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
ACETAMINOPHEN 80 MG ORAL CHEW TAB,,12919,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
ACETAMINOPHEN 80 MG ORAL CHEW TAB,,12919,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
ACETAMINOPHEN 80 MG ORAL CHEW TAB,,12919,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
ACETAMINOPHEN 80 MG ORAL CHEW TAB,,12919,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
ACETAMINOPHEN 80 MG ORAL CHEW TAB,,12919,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
ACETAMINOPHEN 80 MG ORAL CHEW TAB,,12919,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
ACETAMINOPHEN 80 MG ORAL CHEW TAB,,12919,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
ACETAMINOPHEN 80 MG ORAL CHEW TAB,,12919,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
ACETAMINOPHEN 80 MG ORAL CHEW TAB,,12919,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
ACETAMINOPHEN 80 MG ORAL CHEW TAB,,12919,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
ACETAMINOPHEN 80 MG ORAL CHEW TAB,,12919,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
ACETAMINOPHEN 80 MG ORAL CHEW TAB,,12919,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ACETAMINOPHEN 80 MG ORAL CHEW TAB,,12919,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
ACETAMINOPHEN 80 MG ORAL CHEW TAB,,12919,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
ACETAMINOPHEN 80 MG ORAL CHEW TAB,,12919,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
ACETAMINOPHEN 80 MG ORAL CHEW TAB,,12919,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
ACETAMINOPHEN 80 MG ORAL CHEW TAB,,12919,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
ACETAMINOPHEN 80 MG ORAL CHEW TAB,,12919,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ACETAMINOPHEN 80 MG ORAL CHEW TAB,,12919,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
ACETAMINOPHEN 80 MG ORAL CHEW TAB,,12919,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ACETAMINOPHEN 80 MG ORAL CHEW TAB,,12919,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ACETAMINOPHEN 80 MG ORAL CHEW TAB,,12919,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ACETAMINOPHEN 80 MG ORAL CHEW TAB,,12919,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ACETAMINOPHEN 80 MG ORAL CHEW TAB,,12919,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
ACETAMINOPHEN 80 MG ORAL CHEW TAB,,12919,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
ACETAMINOPHEN 80 MG ORAL CHEW TAB,,12919,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
ACETAMINOPHEN 80 MG ORAL CHEW TAB,,12919,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
ACETAMINOPHEN 80 MG ORAL CHEW TAB,,12919,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
RAMIPRIL 2.5 MG ORAL CAP,,12972,LOCAL,Facility,Both,1,Each,,10,8.5,2.866,10,Aetna,Commercial,9.2,92,,percent of total billed charges,,
RAMIPRIL 2.5 MG ORAL CAP,,12972,LOCAL,Facility,Outpatient,1,Each,,10,8.5,2.866,10,Aetna,Medicare Advantage,4.9,49,,percent of total billed charges,,
RAMIPRIL 2.5 MG ORAL CAP,,12972,LOCAL,Facility,Inpatient,1,Each,,10,8.5,2.866,10,Aetna,Medicare Advantage,,,,,Included in per diem rate,
RAMIPRIL 2.5 MG ORAL CAP,,12972,LOCAL,Facility,Both,1,Each,,10,8.5,2.866,10,Aetna,PPO,9.3,93,,percent of total billed charges,,
RAMIPRIL 2.5 MG ORAL CAP,,12972,LOCAL,Facility,Both,1,Each,,10,8.5,2.866,10,America's PPO,America's PPO,9.603,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
RAMIPRIL 2.5 MG ORAL CAP,,12972,LOCAL,Facility,Both,1,Each,,10,8.5,2.866,10,BlueCross BlueShield Minnesota, Federal Employee Program,9.84,98.4,,percent of total billed charges,,
RAMIPRIL 2.5 MG ORAL CAP,,12972,LOCAL,Facility,Both,1,Each,,10,8.5,2.866,10,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,10,100,,percent of total billed charges,,
RAMIPRIL 2.5 MG ORAL CAP,,12972,LOCAL,Facility,Both,1,Each,,10,8.5,2.866,10,BlueCross BlueShield Minnesota,High Value Network Plan,9,90,,percent of total billed charges,,
RAMIPRIL 2.5 MG ORAL CAP,,12972,LOCAL,Facility,Outpatient,1,Each,,10,8.5,2.866,10,BlueCross BlueShield Minnesota,Medicare Advantage,4.9,49,,percent of total billed charges,,
RAMIPRIL 2.5 MG ORAL CAP,,12972,LOCAL,Facility,Inpatient,1,Each,,10,8.5,2.866,10,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
RAMIPRIL 2.5 MG ORAL CAP,,12972,LOCAL,Facility,Both,1,Each,,10,8.5,2.866,10,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,8.857,88.57,,percent of total billed charges,,
RAMIPRIL 2.5 MG ORAL CAP,,12972,LOCAL,Facility,Both,1,Each,,10,8.5,2.866,10,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,2.866,28.66,,percent of total billed charges,,
RAMIPRIL 2.5 MG ORAL CAP,,12972,LOCAL,Facility,Outpatient,1,Each,,10,8.5,2.866,10,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),4.9,49,,percent of total billed charges,,
RAMIPRIL 2.5 MG ORAL CAP,,12972,LOCAL,Facility,Inpatient,1,Each,,10,8.5,2.866,10,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
RAMIPRIL 2.5 MG ORAL CAP,,12972,LOCAL,Facility,Both,1,Each,,10,8.5,2.866,10,CorVel,Worker's Compensation,10,100,,percent of total billed charges,,
RAMIPRIL 2.5 MG ORAL CAP,,12972,LOCAL,Facility,Both,1,Each,,10,8.5,2.866,10,First Health Group Corporation,First Health Network,9.7,97,,percent of total billed charges,,
RAMIPRIL 2.5 MG ORAL CAP,,12972,LOCAL,Facility,Both,1,Each,,10,8.5,2.866,10,"Health Partners, Inc.",Commercial,9.46,94.6,,percent of total billed charges,,
RAMIPRIL 2.5 MG ORAL CAP,,12972,LOCAL,Facility,Outpatient,1,Each,,10,8.5,2.866,10,"Health Partners, Inc.",Medicare Advantage,4.9,49,,percent of total billed charges,,
RAMIPRIL 2.5 MG ORAL CAP,,12972,LOCAL,Facility,Inpatient,1,Each,,10,8.5,2.866,10,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
RAMIPRIL 2.5 MG ORAL CAP,,12972,LOCAL,Facility,Both,1,Each,,10,8.5,2.866,10,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),6,60,,percent of total billed charges,,
RAMIPRIL 2.5 MG ORAL CAP,,12972,LOCAL,Facility,Both,1,Each,,10,8.5,2.866,10,"Health Partners, Inc.",State of Minnesota Advantage Program,8.15,81.5,,percent of total billed charges,,
RAMIPRIL 2.5 MG ORAL CAP,,12972,LOCAL,Facility,Both,1,Each,,10,8.5,2.866,10,"Health Partners, Inc.",State Public Programs,5,50,,percent of total billed charges,,
RAMIPRIL 2.5 MG ORAL CAP,,12972,LOCAL,Facility,Both,1,Each,,10,8.5,2.866,10,Humana Insurance Company,Commercial PPO,9.5,95,,percent of total billed charges,,
RAMIPRIL 2.5 MG ORAL CAP,,12972,LOCAL,Facility,Outpatient,1,Each,,10,8.5,2.866,10,Humana Insurance Company,Medicare PPO,4.9,49,,percent of total billed charges,,
RAMIPRIL 2.5 MG ORAL CAP,,12972,LOCAL,Facility,Inpatient,1,Each,,10,8.5,2.866,10,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
RAMIPRIL 2.5 MG ORAL CAP,,12972,LOCAL,Facility,Both,1,Each,,10,8.5,2.866,10,Medica,Individual & Family,9.91,99.1,,percent of total billed charges,,
RAMIPRIL 2.5 MG ORAL CAP,,12972,LOCAL,Facility,Outpatient,1,Each,,10,8.5,2.866,10,Medica,Medica Advantage Solution,4.98,49.8,,percent of total billed charges,,
RAMIPRIL 2.5 MG ORAL CAP,,12972,LOCAL,Facility,Inpatient,1,Each,,10,8.5,2.866,10,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
RAMIPRIL 2.5 MG ORAL CAP,,12972,LOCAL,Facility,Outpatient,1,Each,,10,8.5,2.866,10,Medica,Medical Assistance,4.46,44.6,,percent of total billed charges,,
RAMIPRIL 2.5 MG ORAL CAP,,12972,LOCAL,Facility,Inpatient,1,Each,,10,8.5,2.866,10,Medica,Medical Assistance,,,,,Included in per diem rate,
RAMIPRIL 2.5 MG ORAL CAP,,12972,LOCAL,Facility,Outpatient,1,Each,,10,8.5,2.866,10,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,4.98,49.8,,percent of total billed charges,,
RAMIPRIL 2.5 MG ORAL CAP,,12972,LOCAL,Facility,Inpatient,1,Each,,10,8.5,2.866,10,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
RAMIPRIL 2.5 MG ORAL CAP,,12972,LOCAL,Facility,Both,1,Each,,10,8.5,2.866,10,"Multiplan, Inc.","Multiplan, Inc.",9.4,94,,percent of total billed charges,,
RAMIPRIL 2.5 MG ORAL CAP,,12972,LOCAL,Facility,Outpatient,1,Each,,10,8.5,2.866,10,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,9.01,90.1,,percent of total billed charges,,
RAMIPRIL 2.5 MG ORAL CAP,,12972,LOCAL,Facility,Inpatient,1,Each,,10,8.5,2.866,10,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
RAMIPRIL 2.5 MG ORAL CAP,,12972,LOCAL,Facility,Both,1,Each,,10,8.5,2.866,10,"Preferred One Administrative Services, INC.",PPO,9.86,98.6,,percent of total billed charges,,
RAMIPRIL 2.5 MG ORAL CAP,,12972,LOCAL,Facility,Outpatient,1,Each,,10,8.5,2.866,10,PrimeWest Health,Minnesota Senior Health Options (MSHO),5.145,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
RAMIPRIL 2.5 MG ORAL CAP,,12972,LOCAL,Facility,Inpatient,1,Each,,10,8.5,2.866,10,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
RAMIPRIL 2.5 MG ORAL CAP,,12972,LOCAL,Facility,Outpatient,1,Each,,10,8.5,2.866,10,PrimeWest Health,MinnesotaCare,5.136,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
RAMIPRIL 2.5 MG ORAL CAP,,12972,LOCAL,Facility,Inpatient,1,Each,,10,8.5,2.866,10,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
RAMIPRIL 2.5 MG ORAL CAP,,12972,LOCAL,Facility,Both,1,Each,,10,8.5,2.866,10,Sanford Health Plan,Sanford Health Plan,9.2,92,,percent of total billed charges,,
RAMIPRIL 2.5 MG ORAL CAP,,12972,LOCAL,Facility,Outpatient,1,Each,,10,8.5,2.866,10,"UCare Health, Inc.",Individual & Family Plan,5.635,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
RAMIPRIL 2.5 MG ORAL CAP,,12972,LOCAL,Facility,Inpatient,1,Each,,10,8.5,2.866,10,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
RAMIPRIL 2.5 MG ORAL CAP,,12972,LOCAL,Facility,Outpatient,1,Each,,10,8.5,2.866,10,"UCare Health, Inc.",Medical Assistance,5.047,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
RAMIPRIL 2.5 MG ORAL CAP,,12972,LOCAL,Facility,Inpatient,1,Each,,10,8.5,2.866,10,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
RAMIPRIL 2.5 MG ORAL CAP,,12972,LOCAL,Facility,Outpatient,1,Each,,10,8.5,2.866,10,"UCare Health, Inc.",Medicare Advantage,5.047,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
RAMIPRIL 2.5 MG ORAL CAP,,12972,LOCAL,Facility,Inpatient,1,Each,,10,8.5,2.866,10,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
RAMIPRIL 2.5 MG ORAL CAP,,12972,LOCAL,Facility,Outpatient,1,Each,,10,8.5,2.866,10,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),5.047,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
RAMIPRIL 2.5 MG ORAL CAP,,12972,LOCAL,Facility,Inpatient,1,Each,,10,8.5,2.866,10,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
RAMIPRIL 2.5 MG ORAL CAP,,12972,LOCAL,Facility,Both,1,Each,,10,8.5,2.866,10,UnitedHealthcare,Individual & Family,9.4,94,,percent of total billed charges,,
RAMIPRIL 2.5 MG ORAL CAP,,12972,LOCAL,Facility,Outpatient,1,Each,,10,8.5,2.866,10,UnitedHealthcare,Medicare Advantage,4.9,49,,percent of total billed charges,,
RAMIPRIL 2.5 MG ORAL CAP,,12972,LOCAL,Facility,Inpatient,1,Each,,10,8.5,2.866,10,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
RAMIPRIL 2.5 MG ORAL CAP,,12972,LOCAL,Facility,Outpatient,1,Each,,10,8.5,2.866,10,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,4.8,48,,percent of total billed charges,,100% of DHS outpatient percentage
RAMIPRIL 2.5 MG ORAL CAP,,12972,LOCAL,Facility,Inpatient,1,Each,,10,8.5,2.866,10,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
LISINOPRIL 10 MG ORAL TABLET,,13002,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
LISINOPRIL 10 MG ORAL TABLET,,13002,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
LISINOPRIL 10 MG ORAL TABLET,,13002,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
LISINOPRIL 10 MG ORAL TABLET,,13002,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
LISINOPRIL 10 MG ORAL TABLET,,13002,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
LISINOPRIL 10 MG ORAL TABLET,,13002,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
LISINOPRIL 10 MG ORAL TABLET,,13002,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
LISINOPRIL 10 MG ORAL TABLET,,13002,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
LISINOPRIL 10 MG ORAL TABLET,,13002,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
LISINOPRIL 10 MG ORAL TABLET,,13002,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
LISINOPRIL 10 MG ORAL TABLET,,13002,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
LISINOPRIL 10 MG ORAL TABLET,,13002,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
LISINOPRIL 10 MG ORAL TABLET,,13002,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
LISINOPRIL 10 MG ORAL TABLET,,13002,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
LISINOPRIL 10 MG ORAL TABLET,,13002,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
LISINOPRIL 10 MG ORAL TABLET,,13002,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
LISINOPRIL 10 MG ORAL TABLET,,13002,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
LISINOPRIL 10 MG ORAL TABLET,,13002,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
LISINOPRIL 10 MG ORAL TABLET,,13002,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LISINOPRIL 10 MG ORAL TABLET,,13002,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
LISINOPRIL 10 MG ORAL TABLET,,13002,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
LISINOPRIL 10 MG ORAL TABLET,,13002,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
LISINOPRIL 10 MG ORAL TABLET,,13002,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
LISINOPRIL 10 MG ORAL TABLET,,13002,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
LISINOPRIL 10 MG ORAL TABLET,,13002,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
LISINOPRIL 10 MG ORAL TABLET,,13002,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
LISINOPRIL 10 MG ORAL TABLET,,13002,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
LISINOPRIL 10 MG ORAL TABLET,,13002,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
LISINOPRIL 10 MG ORAL TABLET,,13002,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
LISINOPRIL 10 MG ORAL TABLET,,13002,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
LISINOPRIL 10 MG ORAL TABLET,,13002,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
LISINOPRIL 10 MG ORAL TABLET,,13002,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
LISINOPRIL 10 MG ORAL TABLET,,13002,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
LISINOPRIL 10 MG ORAL TABLET,,13002,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
LISINOPRIL 10 MG ORAL TABLET,,13002,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
LISINOPRIL 10 MG ORAL TABLET,,13002,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
LISINOPRIL 10 MG ORAL TABLET,,13002,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
LISINOPRIL 10 MG ORAL TABLET,,13002,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LISINOPRIL 10 MG ORAL TABLET,,13002,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
LISINOPRIL 10 MG ORAL TABLET,,13002,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
LISINOPRIL 10 MG ORAL TABLET,,13002,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
LISINOPRIL 10 MG ORAL TABLET,,13002,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
LISINOPRIL 10 MG ORAL TABLET,,13002,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
LISINOPRIL 10 MG ORAL TABLET,,13002,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LISINOPRIL 10 MG ORAL TABLET,,13002,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
LISINOPRIL 10 MG ORAL TABLET,,13002,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LISINOPRIL 10 MG ORAL TABLET,,13002,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LISINOPRIL 10 MG ORAL TABLET,,13002,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LISINOPRIL 10 MG ORAL TABLET,,13002,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LISINOPRIL 10 MG ORAL TABLET,,13002,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
LISINOPRIL 10 MG ORAL TABLET,,13002,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
LISINOPRIL 10 MG ORAL TABLET,,13002,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
LISINOPRIL 10 MG ORAL TABLET,,13002,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
LISINOPRIL 10 MG ORAL TABLET,,13002,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
WARFARIN 2 MG ORAL TABLET,,13121,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
WARFARIN 2 MG ORAL TABLET,,13121,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
WARFARIN 2 MG ORAL TABLET,,13121,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
WARFARIN 2 MG ORAL TABLET,,13121,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
WARFARIN 2 MG ORAL TABLET,,13121,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
WARFARIN 2 MG ORAL TABLET,,13121,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
WARFARIN 2 MG ORAL TABLET,,13121,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
WARFARIN 2 MG ORAL TABLET,,13121,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
WARFARIN 2 MG ORAL TABLET,,13121,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
WARFARIN 2 MG ORAL TABLET,,13121,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
WARFARIN 2 MG ORAL TABLET,,13121,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
WARFARIN 2 MG ORAL TABLET,,13121,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
WARFARIN 2 MG ORAL TABLET,,13121,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
WARFARIN 2 MG ORAL TABLET,,13121,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
WARFARIN 2 MG ORAL TABLET,,13121,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
WARFARIN 2 MG ORAL TABLET,,13121,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
WARFARIN 2 MG ORAL TABLET,,13121,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
WARFARIN 2 MG ORAL TABLET,,13121,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
WARFARIN 2 MG ORAL TABLET,,13121,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
WARFARIN 2 MG ORAL TABLET,,13121,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
WARFARIN 2 MG ORAL TABLET,,13121,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
WARFARIN 2 MG ORAL TABLET,,13121,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
WARFARIN 2 MG ORAL TABLET,,13121,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
WARFARIN 2 MG ORAL TABLET,,13121,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
WARFARIN 2 MG ORAL TABLET,,13121,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
WARFARIN 2 MG ORAL TABLET,,13121,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
WARFARIN 2 MG ORAL TABLET,,13121,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
WARFARIN 2 MG ORAL TABLET,,13121,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
WARFARIN 2 MG ORAL TABLET,,13121,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
WARFARIN 2 MG ORAL TABLET,,13121,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
WARFARIN 2 MG ORAL TABLET,,13121,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
WARFARIN 2 MG ORAL TABLET,,13121,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
WARFARIN 2 MG ORAL TABLET,,13121,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
WARFARIN 2 MG ORAL TABLET,,13121,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
WARFARIN 2 MG ORAL TABLET,,13121,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
WARFARIN 2 MG ORAL TABLET,,13121,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
WARFARIN 2 MG ORAL TABLET,,13121,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
WARFARIN 2 MG ORAL TABLET,,13121,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
WARFARIN 2 MG ORAL TABLET,,13121,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
WARFARIN 2 MG ORAL TABLET,,13121,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
WARFARIN 2 MG ORAL TABLET,,13121,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
WARFARIN 2 MG ORAL TABLET,,13121,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
WARFARIN 2 MG ORAL TABLET,,13121,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
WARFARIN 2 MG ORAL TABLET,,13121,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
WARFARIN 2 MG ORAL TABLET,,13121,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
WARFARIN 2 MG ORAL TABLET,,13121,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
WARFARIN 2 MG ORAL TABLET,,13121,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
WARFARIN 2 MG ORAL TABLET,,13121,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
WARFARIN 2 MG ORAL TABLET,,13121,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
WARFARIN 2 MG ORAL TABLET,,13121,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
WARFARIN 2 MG ORAL TABLET,,13121,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
WARFARIN 2 MG ORAL TABLET,,13121,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
WARFARIN 2 MG ORAL TABLET,,13121,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
WARFARIN 2 MG ORAL TABLET,,13121,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
NAPROXEN SODIUM 220 MG ORAL TABLET,,13166,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
NAPROXEN SODIUM 220 MG ORAL TABLET,,13166,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
NAPROXEN SODIUM 220 MG ORAL TABLET,,13166,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
NAPROXEN SODIUM 220 MG ORAL TABLET,,13166,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
NAPROXEN SODIUM 220 MG ORAL TABLET,,13166,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
NAPROXEN SODIUM 220 MG ORAL TABLET,,13166,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
NAPROXEN SODIUM 220 MG ORAL TABLET,,13166,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
NAPROXEN SODIUM 220 MG ORAL TABLET,,13166,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
NAPROXEN SODIUM 220 MG ORAL TABLET,,13166,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
NAPROXEN SODIUM 220 MG ORAL TABLET,,13166,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
NAPROXEN SODIUM 220 MG ORAL TABLET,,13166,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
NAPROXEN SODIUM 220 MG ORAL TABLET,,13166,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
NAPROXEN SODIUM 220 MG ORAL TABLET,,13166,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
NAPROXEN SODIUM 220 MG ORAL TABLET,,13166,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
NAPROXEN SODIUM 220 MG ORAL TABLET,,13166,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
NAPROXEN SODIUM 220 MG ORAL TABLET,,13166,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
NAPROXEN SODIUM 220 MG ORAL TABLET,,13166,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
NAPROXEN SODIUM 220 MG ORAL TABLET,,13166,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
NAPROXEN SODIUM 220 MG ORAL TABLET,,13166,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
NAPROXEN SODIUM 220 MG ORAL TABLET,,13166,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
NAPROXEN SODIUM 220 MG ORAL TABLET,,13166,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
NAPROXEN SODIUM 220 MG ORAL TABLET,,13166,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
NAPROXEN SODIUM 220 MG ORAL TABLET,,13166,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
NAPROXEN SODIUM 220 MG ORAL TABLET,,13166,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
NAPROXEN SODIUM 220 MG ORAL TABLET,,13166,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
NAPROXEN SODIUM 220 MG ORAL TABLET,,13166,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
NAPROXEN SODIUM 220 MG ORAL TABLET,,13166,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
NAPROXEN SODIUM 220 MG ORAL TABLET,,13166,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
NAPROXEN SODIUM 220 MG ORAL TABLET,,13166,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
NAPROXEN SODIUM 220 MG ORAL TABLET,,13166,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
NAPROXEN SODIUM 220 MG ORAL TABLET,,13166,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
NAPROXEN SODIUM 220 MG ORAL TABLET,,13166,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
NAPROXEN SODIUM 220 MG ORAL TABLET,,13166,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
NAPROXEN SODIUM 220 MG ORAL TABLET,,13166,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
NAPROXEN SODIUM 220 MG ORAL TABLET,,13166,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
NAPROXEN SODIUM 220 MG ORAL TABLET,,13166,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
NAPROXEN SODIUM 220 MG ORAL TABLET,,13166,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
NAPROXEN SODIUM 220 MG ORAL TABLET,,13166,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
NAPROXEN SODIUM 220 MG ORAL TABLET,,13166,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
NAPROXEN SODIUM 220 MG ORAL TABLET,,13166,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
NAPROXEN SODIUM 220 MG ORAL TABLET,,13166,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
NAPROXEN SODIUM 220 MG ORAL TABLET,,13166,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
NAPROXEN SODIUM 220 MG ORAL TABLET,,13166,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
NAPROXEN SODIUM 220 MG ORAL TABLET,,13166,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
NAPROXEN SODIUM 220 MG ORAL TABLET,,13166,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
NAPROXEN SODIUM 220 MG ORAL TABLET,,13166,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
NAPROXEN SODIUM 220 MG ORAL TABLET,,13166,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
NAPROXEN SODIUM 220 MG ORAL TABLET,,13166,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
NAPROXEN SODIUM 220 MG ORAL TABLET,,13166,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
NAPROXEN SODIUM 220 MG ORAL TABLET,,13166,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
NAPROXEN SODIUM 220 MG ORAL TABLET,,13166,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
NAPROXEN SODIUM 220 MG ORAL TABLET,,13166,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
NAPROXEN SODIUM 220 MG ORAL TABLET,,13166,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
NAPROXEN SODIUM 220 MG ORAL TABLET,,13166,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
LIDOCAINE 5 % TOP PTMD,,13187,LOCAL,Facility,Both,1,Each,,47,39.95,13.4702,47,Aetna,Commercial,43.24,92,,percent of total billed charges,,
LIDOCAINE 5 % TOP PTMD,,13187,LOCAL,Facility,Outpatient,1,Each,,47,39.95,13.4702,47,Aetna,Medicare Advantage,23.03,49,,percent of total billed charges,,
LIDOCAINE 5 % TOP PTMD,,13187,LOCAL,Facility,Inpatient,1,Each,,47,39.95,13.4702,47,Aetna,Medicare Advantage,,,,,Included in per diem rate,
LIDOCAINE 5 % TOP PTMD,,13187,LOCAL,Facility,Both,1,Each,,47,39.95,13.4702,47,Aetna,PPO,43.71,93,,percent of total billed charges,,
LIDOCAINE 5 % TOP PTMD,,13187,LOCAL,Facility,Both,1,Each,,47,39.95,13.4702,47,America's PPO,America's PPO,45.1341,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
LIDOCAINE 5 % TOP PTMD,,13187,LOCAL,Facility,Both,1,Each,,47,39.95,13.4702,47,BlueCross BlueShield Minnesota, Federal Employee Program,46.248,98.4,,percent of total billed charges,,
LIDOCAINE 5 % TOP PTMD,,13187,LOCAL,Facility,Both,1,Each,,47,39.95,13.4702,47,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,47,100,,percent of total billed charges,,
LIDOCAINE 5 % TOP PTMD,,13187,LOCAL,Facility,Both,1,Each,,47,39.95,13.4702,47,BlueCross BlueShield Minnesota,High Value Network Plan,42.3,90,,percent of total billed charges,,
LIDOCAINE 5 % TOP PTMD,,13187,LOCAL,Facility,Outpatient,1,Each,,47,39.95,13.4702,47,BlueCross BlueShield Minnesota,Medicare Advantage,23.03,49,,percent of total billed charges,,
LIDOCAINE 5 % TOP PTMD,,13187,LOCAL,Facility,Inpatient,1,Each,,47,39.95,13.4702,47,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
LIDOCAINE 5 % TOP PTMD,,13187,LOCAL,Facility,Both,1,Each,,47,39.95,13.4702,47,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,41.6279,88.57,,percent of total billed charges,,
LIDOCAINE 5 % TOP PTMD,,13187,LOCAL,Facility,Both,1,Each,,47,39.95,13.4702,47,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,13.4702,28.66,,percent of total billed charges,,
LIDOCAINE 5 % TOP PTMD,,13187,LOCAL,Facility,Outpatient,1,Each,,47,39.95,13.4702,47,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),23.03,49,,percent of total billed charges,,
LIDOCAINE 5 % TOP PTMD,,13187,LOCAL,Facility,Inpatient,1,Each,,47,39.95,13.4702,47,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
LIDOCAINE 5 % TOP PTMD,,13187,LOCAL,Facility,Both,1,Each,,47,39.95,13.4702,47,CorVel,Worker's Compensation,47,100,,percent of total billed charges,,
LIDOCAINE 5 % TOP PTMD,,13187,LOCAL,Facility,Both,1,Each,,47,39.95,13.4702,47,First Health Group Corporation,First Health Network,45.59,97,,percent of total billed charges,,
LIDOCAINE 5 % TOP PTMD,,13187,LOCAL,Facility,Both,1,Each,,47,39.95,13.4702,47,"Health Partners, Inc.",Commercial,44.462,94.6,,percent of total billed charges,,
LIDOCAINE 5 % TOP PTMD,,13187,LOCAL,Facility,Outpatient,1,Each,,47,39.95,13.4702,47,"Health Partners, Inc.",Medicare Advantage,23.03,49,,percent of total billed charges,,
LIDOCAINE 5 % TOP PTMD,,13187,LOCAL,Facility,Inpatient,1,Each,,47,39.95,13.4702,47,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LIDOCAINE 5 % TOP PTMD,,13187,LOCAL,Facility,Both,1,Each,,47,39.95,13.4702,47,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),28.2,60,,percent of total billed charges,,
LIDOCAINE 5 % TOP PTMD,,13187,LOCAL,Facility,Both,1,Each,,47,39.95,13.4702,47,"Health Partners, Inc.",State of Minnesota Advantage Program,38.305,81.5,,percent of total billed charges,,
LIDOCAINE 5 % TOP PTMD,,13187,LOCAL,Facility,Both,1,Each,,47,39.95,13.4702,47,"Health Partners, Inc.",State Public Programs,23.5,50,,percent of total billed charges,,
LIDOCAINE 5 % TOP PTMD,,13187,LOCAL,Facility,Both,1,Each,,47,39.95,13.4702,47,Humana Insurance Company,Commercial PPO,44.65,95,,percent of total billed charges,,
LIDOCAINE 5 % TOP PTMD,,13187,LOCAL,Facility,Outpatient,1,Each,,47,39.95,13.4702,47,Humana Insurance Company,Medicare PPO,23.03,49,,percent of total billed charges,,
LIDOCAINE 5 % TOP PTMD,,13187,LOCAL,Facility,Inpatient,1,Each,,47,39.95,13.4702,47,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
LIDOCAINE 5 % TOP PTMD,,13187,LOCAL,Facility,Both,1,Each,,47,39.95,13.4702,47,Medica,Individual & Family,46.577,99.1,,percent of total billed charges,,
LIDOCAINE 5 % TOP PTMD,,13187,LOCAL,Facility,Outpatient,1,Each,,47,39.95,13.4702,47,Medica,Medica Advantage Solution,23.406,49.8,,percent of total billed charges,,
LIDOCAINE 5 % TOP PTMD,,13187,LOCAL,Facility,Inpatient,1,Each,,47,39.95,13.4702,47,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
LIDOCAINE 5 % TOP PTMD,,13187,LOCAL,Facility,Outpatient,1,Each,,47,39.95,13.4702,47,Medica,Medical Assistance,20.962,44.6,,percent of total billed charges,,
LIDOCAINE 5 % TOP PTMD,,13187,LOCAL,Facility,Inpatient,1,Each,,47,39.95,13.4702,47,Medica,Medical Assistance,,,,,Included in per diem rate,
LIDOCAINE 5 % TOP PTMD,,13187,LOCAL,Facility,Outpatient,1,Each,,47,39.95,13.4702,47,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,23.406,49.8,,percent of total billed charges,,
LIDOCAINE 5 % TOP PTMD,,13187,LOCAL,Facility,Inpatient,1,Each,,47,39.95,13.4702,47,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
LIDOCAINE 5 % TOP PTMD,,13187,LOCAL,Facility,Both,1,Each,,47,39.95,13.4702,47,"Multiplan, Inc.","Multiplan, Inc.",44.18,94,,percent of total billed charges,,
LIDOCAINE 5 % TOP PTMD,,13187,LOCAL,Facility,Outpatient,1,Each,,47,39.95,13.4702,47,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,42.347,90.1,,percent of total billed charges,,
LIDOCAINE 5 % TOP PTMD,,13187,LOCAL,Facility,Inpatient,1,Each,,47,39.95,13.4702,47,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
LIDOCAINE 5 % TOP PTMD,,13187,LOCAL,Facility,Both,1,Each,,47,39.95,13.4702,47,"Preferred One Administrative Services, INC.",PPO,46.342,98.6,,percent of total billed charges,,
LIDOCAINE 5 % TOP PTMD,,13187,LOCAL,Facility,Outpatient,1,Each,,47,39.95,13.4702,47,PrimeWest Health,Minnesota Senior Health Options (MSHO),24.1815,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
LIDOCAINE 5 % TOP PTMD,,13187,LOCAL,Facility,Inpatient,1,Each,,47,39.95,13.4702,47,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LIDOCAINE 5 % TOP PTMD,,13187,LOCAL,Facility,Outpatient,1,Each,,47,39.95,13.4702,47,PrimeWest Health,MinnesotaCare,24.1392,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
LIDOCAINE 5 % TOP PTMD,,13187,LOCAL,Facility,Inpatient,1,Each,,47,39.95,13.4702,47,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
LIDOCAINE 5 % TOP PTMD,,13187,LOCAL,Facility,Both,1,Each,,47,39.95,13.4702,47,Sanford Health Plan,Sanford Health Plan,43.24,92,,percent of total billed charges,,
LIDOCAINE 5 % TOP PTMD,,13187,LOCAL,Facility,Outpatient,1,Each,,47,39.95,13.4702,47,"UCare Health, Inc.",Individual & Family Plan,26.4845,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
LIDOCAINE 5 % TOP PTMD,,13187,LOCAL,Facility,Inpatient,1,Each,,47,39.95,13.4702,47,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
LIDOCAINE 5 % TOP PTMD,,13187,LOCAL,Facility,Outpatient,1,Each,,47,39.95,13.4702,47,"UCare Health, Inc.",Medical Assistance,23.7209,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LIDOCAINE 5 % TOP PTMD,,13187,LOCAL,Facility,Inpatient,1,Each,,47,39.95,13.4702,47,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
LIDOCAINE 5 % TOP PTMD,,13187,LOCAL,Facility,Outpatient,1,Each,,47,39.95,13.4702,47,"UCare Health, Inc.",Medicare Advantage,23.7209,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LIDOCAINE 5 % TOP PTMD,,13187,LOCAL,Facility,Inpatient,1,Each,,47,39.95,13.4702,47,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LIDOCAINE 5 % TOP PTMD,,13187,LOCAL,Facility,Outpatient,1,Each,,47,39.95,13.4702,47,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),23.7209,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LIDOCAINE 5 % TOP PTMD,,13187,LOCAL,Facility,Inpatient,1,Each,,47,39.95,13.4702,47,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LIDOCAINE 5 % TOP PTMD,,13187,LOCAL,Facility,Both,1,Each,,47,39.95,13.4702,47,UnitedHealthcare,Individual & Family,44.18,94,,percent of total billed charges,,
LIDOCAINE 5 % TOP PTMD,,13187,LOCAL,Facility,Outpatient,1,Each,,47,39.95,13.4702,47,UnitedHealthcare,Medicare Advantage,23.03,49,,percent of total billed charges,,
LIDOCAINE 5 % TOP PTMD,,13187,LOCAL,Facility,Inpatient,1,Each,,47,39.95,13.4702,47,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
LIDOCAINE 5 % TOP PTMD,,13187,LOCAL,Facility,Outpatient,1,Each,,47,39.95,13.4702,47,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,22.56,48,,percent of total billed charges,,100% of DHS outpatient percentage
LIDOCAINE 5 % TOP PTMD,,13187,LOCAL,Facility,Inpatient,1,Each,,47,39.95,13.4702,47,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
PROPRANOLOL 80 MG ORAL CS24,,13234,LOCAL,Facility,Both,1,Each,,13,11.05,3.7258,13,Aetna,Commercial,11.96,92,,percent of total billed charges,,
PROPRANOLOL 80 MG ORAL CS24,,13234,LOCAL,Facility,Outpatient,1,Each,,13,11.05,3.7258,13,Aetna,Medicare Advantage,6.37,49,,percent of total billed charges,,
PROPRANOLOL 80 MG ORAL CS24,,13234,LOCAL,Facility,Inpatient,1,Each,,13,11.05,3.7258,13,Aetna,Medicare Advantage,,,,,Included in per diem rate,
PROPRANOLOL 80 MG ORAL CS24,,13234,LOCAL,Facility,Both,1,Each,,13,11.05,3.7258,13,Aetna,PPO,12.09,93,,percent of total billed charges,,
PROPRANOLOL 80 MG ORAL CS24,,13234,LOCAL,Facility,Both,1,Each,,13,11.05,3.7258,13,America's PPO,America's PPO,12.4839,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
PROPRANOLOL 80 MG ORAL CS24,,13234,LOCAL,Facility,Both,1,Each,,13,11.05,3.7258,13,BlueCross BlueShield Minnesota, Federal Employee Program,12.792,98.4,,percent of total billed charges,,
PROPRANOLOL 80 MG ORAL CS24,,13234,LOCAL,Facility,Both,1,Each,,13,11.05,3.7258,13,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,13,100,,percent of total billed charges,,
PROPRANOLOL 80 MG ORAL CS24,,13234,LOCAL,Facility,Both,1,Each,,13,11.05,3.7258,13,BlueCross BlueShield Minnesota,High Value Network Plan,11.7,90,,percent of total billed charges,,
PROPRANOLOL 80 MG ORAL CS24,,13234,LOCAL,Facility,Outpatient,1,Each,,13,11.05,3.7258,13,BlueCross BlueShield Minnesota,Medicare Advantage,6.37,49,,percent of total billed charges,,
PROPRANOLOL 80 MG ORAL CS24,,13234,LOCAL,Facility,Inpatient,1,Each,,13,11.05,3.7258,13,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
PROPRANOLOL 80 MG ORAL CS24,,13234,LOCAL,Facility,Both,1,Each,,13,11.05,3.7258,13,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,11.5141,88.57,,percent of total billed charges,,
PROPRANOLOL 80 MG ORAL CS24,,13234,LOCAL,Facility,Both,1,Each,,13,11.05,3.7258,13,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,3.7258,28.66,,percent of total billed charges,,
PROPRANOLOL 80 MG ORAL CS24,,13234,LOCAL,Facility,Outpatient,1,Each,,13,11.05,3.7258,13,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),6.37,49,,percent of total billed charges,,
PROPRANOLOL 80 MG ORAL CS24,,13234,LOCAL,Facility,Inpatient,1,Each,,13,11.05,3.7258,13,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
PROPRANOLOL 80 MG ORAL CS24,,13234,LOCAL,Facility,Both,1,Each,,13,11.05,3.7258,13,CorVel,Worker's Compensation,13,100,,percent of total billed charges,,
PROPRANOLOL 80 MG ORAL CS24,,13234,LOCAL,Facility,Both,1,Each,,13,11.05,3.7258,13,First Health Group Corporation,First Health Network,12.61,97,,percent of total billed charges,,
PROPRANOLOL 80 MG ORAL CS24,,13234,LOCAL,Facility,Both,1,Each,,13,11.05,3.7258,13,"Health Partners, Inc.",Commercial,12.298,94.6,,percent of total billed charges,,
PROPRANOLOL 80 MG ORAL CS24,,13234,LOCAL,Facility,Outpatient,1,Each,,13,11.05,3.7258,13,"Health Partners, Inc.",Medicare Advantage,6.37,49,,percent of total billed charges,,
PROPRANOLOL 80 MG ORAL CS24,,13234,LOCAL,Facility,Inpatient,1,Each,,13,11.05,3.7258,13,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PROPRANOLOL 80 MG ORAL CS24,,13234,LOCAL,Facility,Both,1,Each,,13,11.05,3.7258,13,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),7.8,60,,percent of total billed charges,,
PROPRANOLOL 80 MG ORAL CS24,,13234,LOCAL,Facility,Both,1,Each,,13,11.05,3.7258,13,"Health Partners, Inc.",State of Minnesota Advantage Program,10.595,81.5,,percent of total billed charges,,
PROPRANOLOL 80 MG ORAL CS24,,13234,LOCAL,Facility,Both,1,Each,,13,11.05,3.7258,13,"Health Partners, Inc.",State Public Programs,6.5,50,,percent of total billed charges,,
PROPRANOLOL 80 MG ORAL CS24,,13234,LOCAL,Facility,Both,1,Each,,13,11.05,3.7258,13,Humana Insurance Company,Commercial PPO,12.35,95,,percent of total billed charges,,
PROPRANOLOL 80 MG ORAL CS24,,13234,LOCAL,Facility,Outpatient,1,Each,,13,11.05,3.7258,13,Humana Insurance Company,Medicare PPO,6.37,49,,percent of total billed charges,,
PROPRANOLOL 80 MG ORAL CS24,,13234,LOCAL,Facility,Inpatient,1,Each,,13,11.05,3.7258,13,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
PROPRANOLOL 80 MG ORAL CS24,,13234,LOCAL,Facility,Both,1,Each,,13,11.05,3.7258,13,Medica,Individual & Family,12.883,99.1,,percent of total billed charges,,
PROPRANOLOL 80 MG ORAL CS24,,13234,LOCAL,Facility,Outpatient,1,Each,,13,11.05,3.7258,13,Medica,Medica Advantage Solution,6.474,49.8,,percent of total billed charges,,
PROPRANOLOL 80 MG ORAL CS24,,13234,LOCAL,Facility,Inpatient,1,Each,,13,11.05,3.7258,13,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
PROPRANOLOL 80 MG ORAL CS24,,13234,LOCAL,Facility,Outpatient,1,Each,,13,11.05,3.7258,13,Medica,Medical Assistance,5.798,44.6,,percent of total billed charges,,
PROPRANOLOL 80 MG ORAL CS24,,13234,LOCAL,Facility,Inpatient,1,Each,,13,11.05,3.7258,13,Medica,Medical Assistance,,,,,Included in per diem rate,
PROPRANOLOL 80 MG ORAL CS24,,13234,LOCAL,Facility,Outpatient,1,Each,,13,11.05,3.7258,13,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,6.474,49.8,,percent of total billed charges,,
PROPRANOLOL 80 MG ORAL CS24,,13234,LOCAL,Facility,Inpatient,1,Each,,13,11.05,3.7258,13,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
PROPRANOLOL 80 MG ORAL CS24,,13234,LOCAL,Facility,Both,1,Each,,13,11.05,3.7258,13,"Multiplan, Inc.","Multiplan, Inc.",12.22,94,,percent of total billed charges,,
PROPRANOLOL 80 MG ORAL CS24,,13234,LOCAL,Facility,Outpatient,1,Each,,13,11.05,3.7258,13,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,11.713,90.1,,percent of total billed charges,,
PROPRANOLOL 80 MG ORAL CS24,,13234,LOCAL,Facility,Inpatient,1,Each,,13,11.05,3.7258,13,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
PROPRANOLOL 80 MG ORAL CS24,,13234,LOCAL,Facility,Both,1,Each,,13,11.05,3.7258,13,"Preferred One Administrative Services, INC.",PPO,12.818,98.6,,percent of total billed charges,,
PROPRANOLOL 80 MG ORAL CS24,,13234,LOCAL,Facility,Outpatient,1,Each,,13,11.05,3.7258,13,PrimeWest Health,Minnesota Senior Health Options (MSHO),6.6885,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
PROPRANOLOL 80 MG ORAL CS24,,13234,LOCAL,Facility,Inpatient,1,Each,,13,11.05,3.7258,13,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PROPRANOLOL 80 MG ORAL CS24,,13234,LOCAL,Facility,Outpatient,1,Each,,13,11.05,3.7258,13,PrimeWest Health,MinnesotaCare,6.6768,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
PROPRANOLOL 80 MG ORAL CS24,,13234,LOCAL,Facility,Inpatient,1,Each,,13,11.05,3.7258,13,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
PROPRANOLOL 80 MG ORAL CS24,,13234,LOCAL,Facility,Both,1,Each,,13,11.05,3.7258,13,Sanford Health Plan,Sanford Health Plan,11.96,92,,percent of total billed charges,,
PROPRANOLOL 80 MG ORAL CS24,,13234,LOCAL,Facility,Outpatient,1,Each,,13,11.05,3.7258,13,"UCare Health, Inc.",Individual & Family Plan,7.3255,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
PROPRANOLOL 80 MG ORAL CS24,,13234,LOCAL,Facility,Inpatient,1,Each,,13,11.05,3.7258,13,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
PROPRANOLOL 80 MG ORAL CS24,,13234,LOCAL,Facility,Outpatient,1,Each,,13,11.05,3.7258,13,"UCare Health, Inc.",Medical Assistance,6.5611,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PROPRANOLOL 80 MG ORAL CS24,,13234,LOCAL,Facility,Inpatient,1,Each,,13,11.05,3.7258,13,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
PROPRANOLOL 80 MG ORAL CS24,,13234,LOCAL,Facility,Outpatient,1,Each,,13,11.05,3.7258,13,"UCare Health, Inc.",Medicare Advantage,6.5611,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PROPRANOLOL 80 MG ORAL CS24,,13234,LOCAL,Facility,Inpatient,1,Each,,13,11.05,3.7258,13,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PROPRANOLOL 80 MG ORAL CS24,,13234,LOCAL,Facility,Outpatient,1,Each,,13,11.05,3.7258,13,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),6.5611,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PROPRANOLOL 80 MG ORAL CS24,,13234,LOCAL,Facility,Inpatient,1,Each,,13,11.05,3.7258,13,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PROPRANOLOL 80 MG ORAL CS24,,13234,LOCAL,Facility,Both,1,Each,,13,11.05,3.7258,13,UnitedHealthcare,Individual & Family,12.22,94,,percent of total billed charges,,
PROPRANOLOL 80 MG ORAL CS24,,13234,LOCAL,Facility,Outpatient,1,Each,,13,11.05,3.7258,13,UnitedHealthcare,Medicare Advantage,6.37,49,,percent of total billed charges,,
PROPRANOLOL 80 MG ORAL CS24,,13234,LOCAL,Facility,Inpatient,1,Each,,13,11.05,3.7258,13,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
PROPRANOLOL 80 MG ORAL CS24,,13234,LOCAL,Facility,Outpatient,1,Each,,13,11.05,3.7258,13,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,6.24,48,,percent of total billed charges,,100% of DHS outpatient percentage
PROPRANOLOL 80 MG ORAL CS24,,13234,LOCAL,Facility,Inpatient,1,Each,,13,11.05,3.7258,13,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
PROMETHAZINE 25 MG ORAL TABLET,,13248,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
PROMETHAZINE 25 MG ORAL TABLET,,13248,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
PROMETHAZINE 25 MG ORAL TABLET,,13248,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
PROMETHAZINE 25 MG ORAL TABLET,,13248,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
PROMETHAZINE 25 MG ORAL TABLET,,13248,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
PROMETHAZINE 25 MG ORAL TABLET,,13248,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
PROMETHAZINE 25 MG ORAL TABLET,,13248,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
PROMETHAZINE 25 MG ORAL TABLET,,13248,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
PROMETHAZINE 25 MG ORAL TABLET,,13248,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
PROMETHAZINE 25 MG ORAL TABLET,,13248,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
PROMETHAZINE 25 MG ORAL TABLET,,13248,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
PROMETHAZINE 25 MG ORAL TABLET,,13248,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
PROMETHAZINE 25 MG ORAL TABLET,,13248,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
PROMETHAZINE 25 MG ORAL TABLET,,13248,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
PROMETHAZINE 25 MG ORAL TABLET,,13248,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
PROMETHAZINE 25 MG ORAL TABLET,,13248,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
PROMETHAZINE 25 MG ORAL TABLET,,13248,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
PROMETHAZINE 25 MG ORAL TABLET,,13248,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
PROMETHAZINE 25 MG ORAL TABLET,,13248,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PROMETHAZINE 25 MG ORAL TABLET,,13248,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
PROMETHAZINE 25 MG ORAL TABLET,,13248,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
PROMETHAZINE 25 MG ORAL TABLET,,13248,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
PROMETHAZINE 25 MG ORAL TABLET,,13248,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
PROMETHAZINE 25 MG ORAL TABLET,,13248,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
PROMETHAZINE 25 MG ORAL TABLET,,13248,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
PROMETHAZINE 25 MG ORAL TABLET,,13248,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
PROMETHAZINE 25 MG ORAL TABLET,,13248,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
PROMETHAZINE 25 MG ORAL TABLET,,13248,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
PROMETHAZINE 25 MG ORAL TABLET,,13248,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
PROMETHAZINE 25 MG ORAL TABLET,,13248,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
PROMETHAZINE 25 MG ORAL TABLET,,13248,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
PROMETHAZINE 25 MG ORAL TABLET,,13248,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
PROMETHAZINE 25 MG ORAL TABLET,,13248,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
PROMETHAZINE 25 MG ORAL TABLET,,13248,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
PROMETHAZINE 25 MG ORAL TABLET,,13248,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
PROMETHAZINE 25 MG ORAL TABLET,,13248,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
PROMETHAZINE 25 MG ORAL TABLET,,13248,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
PROMETHAZINE 25 MG ORAL TABLET,,13248,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PROMETHAZINE 25 MG ORAL TABLET,,13248,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
PROMETHAZINE 25 MG ORAL TABLET,,13248,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
PROMETHAZINE 25 MG ORAL TABLET,,13248,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
PROMETHAZINE 25 MG ORAL TABLET,,13248,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
PROMETHAZINE 25 MG ORAL TABLET,,13248,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
PROMETHAZINE 25 MG ORAL TABLET,,13248,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PROMETHAZINE 25 MG ORAL TABLET,,13248,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
PROMETHAZINE 25 MG ORAL TABLET,,13248,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PROMETHAZINE 25 MG ORAL TABLET,,13248,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PROMETHAZINE 25 MG ORAL TABLET,,13248,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PROMETHAZINE 25 MG ORAL TABLET,,13248,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PROMETHAZINE 25 MG ORAL TABLET,,13248,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
PROMETHAZINE 25 MG ORAL TABLET,,13248,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
PROMETHAZINE 25 MG ORAL TABLET,,13248,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
PROMETHAZINE 25 MG ORAL TABLET,,13248,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
PROMETHAZINE 25 MG ORAL TABLET,,13248,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
WARFARIN 5 MG ORAL TABLET,,13337,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
WARFARIN 5 MG ORAL TABLET,,13337,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
WARFARIN 5 MG ORAL TABLET,,13337,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
WARFARIN 5 MG ORAL TABLET,,13337,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
WARFARIN 5 MG ORAL TABLET,,13337,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
WARFARIN 5 MG ORAL TABLET,,13337,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
WARFARIN 5 MG ORAL TABLET,,13337,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
WARFARIN 5 MG ORAL TABLET,,13337,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
WARFARIN 5 MG ORAL TABLET,,13337,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
WARFARIN 5 MG ORAL TABLET,,13337,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
WARFARIN 5 MG ORAL TABLET,,13337,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
WARFARIN 5 MG ORAL TABLET,,13337,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
WARFARIN 5 MG ORAL TABLET,,13337,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
WARFARIN 5 MG ORAL TABLET,,13337,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
WARFARIN 5 MG ORAL TABLET,,13337,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
WARFARIN 5 MG ORAL TABLET,,13337,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
WARFARIN 5 MG ORAL TABLET,,13337,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
WARFARIN 5 MG ORAL TABLET,,13337,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
WARFARIN 5 MG ORAL TABLET,,13337,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
WARFARIN 5 MG ORAL TABLET,,13337,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
WARFARIN 5 MG ORAL TABLET,,13337,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
WARFARIN 5 MG ORAL TABLET,,13337,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
WARFARIN 5 MG ORAL TABLET,,13337,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
WARFARIN 5 MG ORAL TABLET,,13337,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
WARFARIN 5 MG ORAL TABLET,,13337,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
WARFARIN 5 MG ORAL TABLET,,13337,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
WARFARIN 5 MG ORAL TABLET,,13337,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
WARFARIN 5 MG ORAL TABLET,,13337,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
WARFARIN 5 MG ORAL TABLET,,13337,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
WARFARIN 5 MG ORAL TABLET,,13337,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
WARFARIN 5 MG ORAL TABLET,,13337,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
WARFARIN 5 MG ORAL TABLET,,13337,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
WARFARIN 5 MG ORAL TABLET,,13337,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
WARFARIN 5 MG ORAL TABLET,,13337,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
WARFARIN 5 MG ORAL TABLET,,13337,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
WARFARIN 5 MG ORAL TABLET,,13337,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
WARFARIN 5 MG ORAL TABLET,,13337,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
WARFARIN 5 MG ORAL TABLET,,13337,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
WARFARIN 5 MG ORAL TABLET,,13337,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
WARFARIN 5 MG ORAL TABLET,,13337,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
WARFARIN 5 MG ORAL TABLET,,13337,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
WARFARIN 5 MG ORAL TABLET,,13337,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
WARFARIN 5 MG ORAL TABLET,,13337,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
WARFARIN 5 MG ORAL TABLET,,13337,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
WARFARIN 5 MG ORAL TABLET,,13337,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
WARFARIN 5 MG ORAL TABLET,,13337,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
WARFARIN 5 MG ORAL TABLET,,13337,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
WARFARIN 5 MG ORAL TABLET,,13337,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
WARFARIN 5 MG ORAL TABLET,,13337,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
WARFARIN 5 MG ORAL TABLET,,13337,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
WARFARIN 5 MG ORAL TABLET,,13337,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
WARFARIN 5 MG ORAL TABLET,,13337,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
WARFARIN 5 MG ORAL TABLET,,13337,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
WARFARIN 5 MG ORAL TABLET,,13337,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
WARFARIN 5 MG ORAL TABLET,,13337,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
WARFARIN 5 MG ORAL TABLET,,13337,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
WARFARIN 5 MG ORAL TABLET,,13337,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
WARFARIN 5 MG ORAL TABLET,,13337,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
WARFARIN 5 MG ORAL TABLET,,13337,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
WARFARIN 5 MG ORAL TABLET,,13337,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
WARFARIN 5 MG ORAL TABLET,,13337,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
WARFARIN 5 MG ORAL TABLET,,13337,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
WARFARIN 5 MG ORAL TABLET,,13337,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
WARFARIN 5 MG ORAL TABLET,,13337,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
WARFARIN 5 MG ORAL TABLET,,13337,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
WARFARIN 5 MG ORAL TABLET,,13337,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
WARFARIN 5 MG ORAL TABLET,,13337,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
WARFARIN 5 MG ORAL TABLET,,13337,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
WARFARIN 5 MG ORAL TABLET,,13337,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
WARFARIN 5 MG ORAL TABLET,,13337,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
WARFARIN 5 MG ORAL TABLET,,13337,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
WARFARIN 5 MG ORAL TABLET,,13337,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
WARFARIN 5 MG ORAL TABLET,,13337,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
WARFARIN 5 MG ORAL TABLET,,13337,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
WARFARIN 5 MG ORAL TABLET,,13337,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
WARFARIN 5 MG ORAL TABLET,,13337,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
WARFARIN 5 MG ORAL TABLET,,13337,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
WARFARIN 5 MG ORAL TABLET,,13337,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
WARFARIN 5 MG ORAL TABLET,,13337,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
WARFARIN 5 MG ORAL TABLET,,13337,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
WARFARIN 5 MG ORAL TABLET,,13337,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
WARFARIN 5 MG ORAL TABLET,,13337,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
WARFARIN 5 MG ORAL TABLET,,13337,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
WARFARIN 5 MG ORAL TABLET,,13337,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
WARFARIN 5 MG ORAL TABLET,,13337,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
WARFARIN 5 MG ORAL TABLET,,13337,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
WARFARIN 5 MG ORAL TABLET,,13337,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
WARFARIN 5 MG ORAL TABLET,,13337,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
WARFARIN 5 MG ORAL TABLET,,13337,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
WARFARIN 5 MG ORAL TABLET,,13337,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
WARFARIN 5 MG ORAL TABLET,,13337,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
WARFARIN 5 MG ORAL TABLET,,13337,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
WARFARIN 5 MG ORAL TABLET,,13337,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
WARFARIN 5 MG ORAL TABLET,,13337,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
WARFARIN 5 MG ORAL TABLET,,13337,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
WARFARIN 5 MG ORAL TABLET,,13337,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
WARFARIN 5 MG ORAL TABLET,,13337,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
WARFARIN 5 MG ORAL TABLET,,13337,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
WARFARIN 5 MG ORAL TABLET,,13337,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
WARFARIN 5 MG ORAL TABLET,,13337,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
WARFARIN 5 MG ORAL TABLET,,13337,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
WARFARIN 5 MG ORAL TABLET,,13337,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
WARFARIN 5 MG ORAL TABLET,,13337,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
WARFARIN 5 MG ORAL TABLET,,13337,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
WARFARIN 5 MG ORAL TABLET,,13337,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
WARFARIN 5 MG ORAL TABLET,,13337,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
WARFARIN 5 MG ORAL TABLET,,13337,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
WARFARIN 5 MG ORAL TABLET,,13337,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
CANDESARTAN 16 MG ORAL TABLET,,13411,LOCAL,Facility,Both,1,Each,,27,22.95,7.7382,27,Aetna,Commercial,24.84,92,,percent of total billed charges,,
CANDESARTAN 16 MG ORAL TABLET,,13411,LOCAL,Facility,Outpatient,1,Each,,27,22.95,7.7382,27,Aetna,Medicare Advantage,13.23,49,,percent of total billed charges,,
CANDESARTAN 16 MG ORAL TABLET,,13411,LOCAL,Facility,Inpatient,1,Each,,27,22.95,7.7382,27,Aetna,Medicare Advantage,,,,,Included in per diem rate,
CANDESARTAN 16 MG ORAL TABLET,,13411,LOCAL,Facility,Both,1,Each,,27,22.95,7.7382,27,Aetna,PPO,25.11,93,,percent of total billed charges,,
CANDESARTAN 16 MG ORAL TABLET,,13411,LOCAL,Facility,Both,1,Each,,27,22.95,7.7382,27,America's PPO,America's PPO,25.9281,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
CANDESARTAN 16 MG ORAL TABLET,,13411,LOCAL,Facility,Both,1,Each,,27,22.95,7.7382,27,BlueCross BlueShield Minnesota, Federal Employee Program,26.568,98.4,,percent of total billed charges,,
CANDESARTAN 16 MG ORAL TABLET,,13411,LOCAL,Facility,Both,1,Each,,27,22.95,7.7382,27,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,27,100,,percent of total billed charges,,
CANDESARTAN 16 MG ORAL TABLET,,13411,LOCAL,Facility,Both,1,Each,,27,22.95,7.7382,27,BlueCross BlueShield Minnesota,High Value Network Plan,24.3,90,,percent of total billed charges,,
CANDESARTAN 16 MG ORAL TABLET,,13411,LOCAL,Facility,Outpatient,1,Each,,27,22.95,7.7382,27,BlueCross BlueShield Minnesota,Medicare Advantage,13.23,49,,percent of total billed charges,,
CANDESARTAN 16 MG ORAL TABLET,,13411,LOCAL,Facility,Inpatient,1,Each,,27,22.95,7.7382,27,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
CANDESARTAN 16 MG ORAL TABLET,,13411,LOCAL,Facility,Both,1,Each,,27,22.95,7.7382,27,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,23.9139,88.57,,percent of total billed charges,,
CANDESARTAN 16 MG ORAL TABLET,,13411,LOCAL,Facility,Both,1,Each,,27,22.95,7.7382,27,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,7.7382,28.66,,percent of total billed charges,,
CANDESARTAN 16 MG ORAL TABLET,,13411,LOCAL,Facility,Outpatient,1,Each,,27,22.95,7.7382,27,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),13.23,49,,percent of total billed charges,,
CANDESARTAN 16 MG ORAL TABLET,,13411,LOCAL,Facility,Inpatient,1,Each,,27,22.95,7.7382,27,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
CANDESARTAN 16 MG ORAL TABLET,,13411,LOCAL,Facility,Both,1,Each,,27,22.95,7.7382,27,CorVel,Worker's Compensation,27,100,,percent of total billed charges,,
CANDESARTAN 16 MG ORAL TABLET,,13411,LOCAL,Facility,Both,1,Each,,27,22.95,7.7382,27,First Health Group Corporation,First Health Network,26.19,97,,percent of total billed charges,,
CANDESARTAN 16 MG ORAL TABLET,,13411,LOCAL,Facility,Both,1,Each,,27,22.95,7.7382,27,"Health Partners, Inc.",Commercial,25.542,94.6,,percent of total billed charges,,
CANDESARTAN 16 MG ORAL TABLET,,13411,LOCAL,Facility,Outpatient,1,Each,,27,22.95,7.7382,27,"Health Partners, Inc.",Medicare Advantage,13.23,49,,percent of total billed charges,,
CANDESARTAN 16 MG ORAL TABLET,,13411,LOCAL,Facility,Inpatient,1,Each,,27,22.95,7.7382,27,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CANDESARTAN 16 MG ORAL TABLET,,13411,LOCAL,Facility,Both,1,Each,,27,22.95,7.7382,27,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),16.2,60,,percent of total billed charges,,
CANDESARTAN 16 MG ORAL TABLET,,13411,LOCAL,Facility,Both,1,Each,,27,22.95,7.7382,27,"Health Partners, Inc.",State of Minnesota Advantage Program,22.005,81.5,,percent of total billed charges,,
CANDESARTAN 16 MG ORAL TABLET,,13411,LOCAL,Facility,Both,1,Each,,27,22.95,7.7382,27,"Health Partners, Inc.",State Public Programs,13.5,50,,percent of total billed charges,,
CANDESARTAN 16 MG ORAL TABLET,,13411,LOCAL,Facility,Both,1,Each,,27,22.95,7.7382,27,Humana Insurance Company,Commercial PPO,25.65,95,,percent of total billed charges,,
CANDESARTAN 16 MG ORAL TABLET,,13411,LOCAL,Facility,Outpatient,1,Each,,27,22.95,7.7382,27,Humana Insurance Company,Medicare PPO,13.23,49,,percent of total billed charges,,
CANDESARTAN 16 MG ORAL TABLET,,13411,LOCAL,Facility,Inpatient,1,Each,,27,22.95,7.7382,27,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
CANDESARTAN 16 MG ORAL TABLET,,13411,LOCAL,Facility,Both,1,Each,,27,22.95,7.7382,27,Medica,Individual & Family,26.757,99.1,,percent of total billed charges,,
CANDESARTAN 16 MG ORAL TABLET,,13411,LOCAL,Facility,Outpatient,1,Each,,27,22.95,7.7382,27,Medica,Medica Advantage Solution,13.446,49.8,,percent of total billed charges,,
CANDESARTAN 16 MG ORAL TABLET,,13411,LOCAL,Facility,Inpatient,1,Each,,27,22.95,7.7382,27,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
CANDESARTAN 16 MG ORAL TABLET,,13411,LOCAL,Facility,Outpatient,1,Each,,27,22.95,7.7382,27,Medica,Medical Assistance,12.042,44.6,,percent of total billed charges,,
CANDESARTAN 16 MG ORAL TABLET,,13411,LOCAL,Facility,Inpatient,1,Each,,27,22.95,7.7382,27,Medica,Medical Assistance,,,,,Included in per diem rate,
CANDESARTAN 16 MG ORAL TABLET,,13411,LOCAL,Facility,Outpatient,1,Each,,27,22.95,7.7382,27,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,13.446,49.8,,percent of total billed charges,,
CANDESARTAN 16 MG ORAL TABLET,,13411,LOCAL,Facility,Inpatient,1,Each,,27,22.95,7.7382,27,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
CANDESARTAN 16 MG ORAL TABLET,,13411,LOCAL,Facility,Both,1,Each,,27,22.95,7.7382,27,"Multiplan, Inc.","Multiplan, Inc.",25.38,94,,percent of total billed charges,,
CANDESARTAN 16 MG ORAL TABLET,,13411,LOCAL,Facility,Outpatient,1,Each,,27,22.95,7.7382,27,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,24.327,90.1,,percent of total billed charges,,
CANDESARTAN 16 MG ORAL TABLET,,13411,LOCAL,Facility,Inpatient,1,Each,,27,22.95,7.7382,27,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
CANDESARTAN 16 MG ORAL TABLET,,13411,LOCAL,Facility,Both,1,Each,,27,22.95,7.7382,27,"Preferred One Administrative Services, INC.",PPO,26.622,98.6,,percent of total billed charges,,
CANDESARTAN 16 MG ORAL TABLET,,13411,LOCAL,Facility,Outpatient,1,Each,,27,22.95,7.7382,27,PrimeWest Health,Minnesota Senior Health Options (MSHO),13.8915,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
CANDESARTAN 16 MG ORAL TABLET,,13411,LOCAL,Facility,Inpatient,1,Each,,27,22.95,7.7382,27,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CANDESARTAN 16 MG ORAL TABLET,,13411,LOCAL,Facility,Outpatient,1,Each,,27,22.95,7.7382,27,PrimeWest Health,MinnesotaCare,13.8672,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
CANDESARTAN 16 MG ORAL TABLET,,13411,LOCAL,Facility,Inpatient,1,Each,,27,22.95,7.7382,27,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
CANDESARTAN 16 MG ORAL TABLET,,13411,LOCAL,Facility,Both,1,Each,,27,22.95,7.7382,27,Sanford Health Plan,Sanford Health Plan,24.84,92,,percent of total billed charges,,
CANDESARTAN 16 MG ORAL TABLET,,13411,LOCAL,Facility,Outpatient,1,Each,,27,22.95,7.7382,27,"UCare Health, Inc.",Individual & Family Plan,15.2145,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
CANDESARTAN 16 MG ORAL TABLET,,13411,LOCAL,Facility,Inpatient,1,Each,,27,22.95,7.7382,27,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
CANDESARTAN 16 MG ORAL TABLET,,13411,LOCAL,Facility,Outpatient,1,Each,,27,22.95,7.7382,27,"UCare Health, Inc.",Medical Assistance,13.6269,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CANDESARTAN 16 MG ORAL TABLET,,13411,LOCAL,Facility,Inpatient,1,Each,,27,22.95,7.7382,27,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
CANDESARTAN 16 MG ORAL TABLET,,13411,LOCAL,Facility,Outpatient,1,Each,,27,22.95,7.7382,27,"UCare Health, Inc.",Medicare Advantage,13.6269,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CANDESARTAN 16 MG ORAL TABLET,,13411,LOCAL,Facility,Inpatient,1,Each,,27,22.95,7.7382,27,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CANDESARTAN 16 MG ORAL TABLET,,13411,LOCAL,Facility,Outpatient,1,Each,,27,22.95,7.7382,27,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),13.6269,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CANDESARTAN 16 MG ORAL TABLET,,13411,LOCAL,Facility,Inpatient,1,Each,,27,22.95,7.7382,27,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CANDESARTAN 16 MG ORAL TABLET,,13411,LOCAL,Facility,Both,1,Each,,27,22.95,7.7382,27,UnitedHealthcare,Individual & Family,25.38,94,,percent of total billed charges,,
CANDESARTAN 16 MG ORAL TABLET,,13411,LOCAL,Facility,Outpatient,1,Each,,27,22.95,7.7382,27,UnitedHealthcare,Medicare Advantage,13.23,49,,percent of total billed charges,,
CANDESARTAN 16 MG ORAL TABLET,,13411,LOCAL,Facility,Inpatient,1,Each,,27,22.95,7.7382,27,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
CANDESARTAN 16 MG ORAL TABLET,,13411,LOCAL,Facility,Outpatient,1,Each,,27,22.95,7.7382,27,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,12.96,48,,percent of total billed charges,,100% of DHS outpatient percentage
CANDESARTAN 16 MG ORAL TABLET,,13411,LOCAL,Facility,Inpatient,1,Each,,27,22.95,7.7382,27,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
FLUTICASONE PROPION-SALMETEROL 500-50 MCG/DOSE INHL DSDV,,13523,LOCAL,Facility,Both,1,Each,,1158,984.3,331.8828,1158,Aetna,Commercial,1065.36,92,,percent of total billed charges,,
FLUTICASONE PROPION-SALMETEROL 500-50 MCG/DOSE INHL DSDV,,13523,LOCAL,Facility,Outpatient,1,Each,,1158,984.3,331.8828,1158,Aetna,Medicare Advantage,567.42,49,,percent of total billed charges,,
FLUTICASONE PROPION-SALMETEROL 500-50 MCG/DOSE INHL DSDV,,13523,LOCAL,Facility,Inpatient,1,Each,,1158,984.3,331.8828,1158,Aetna,Medicare Advantage,,,,,Included in per diem rate,
FLUTICASONE PROPION-SALMETEROL 500-50 MCG/DOSE INHL DSDV,,13523,LOCAL,Facility,Both,1,Each,,1158,984.3,331.8828,1158,Aetna,PPO,1076.94,93,,percent of total billed charges,,
FLUTICASONE PROPION-SALMETEROL 500-50 MCG/DOSE INHL DSDV,,13523,LOCAL,Facility,Both,1,Each,,1158,984.3,331.8828,1158,America's PPO,America's PPO,1112.0274,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
FLUTICASONE PROPION-SALMETEROL 500-50 MCG/DOSE INHL DSDV,,13523,LOCAL,Facility,Both,1,Each,,1158,984.3,331.8828,1158,BlueCross BlueShield Minnesota, Federal Employee Program,1139.472,98.4,,percent of total billed charges,,
FLUTICASONE PROPION-SALMETEROL 500-50 MCG/DOSE INHL DSDV,,13523,LOCAL,Facility,Both,1,Each,,1158,984.3,331.8828,1158,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1158,100,,percent of total billed charges,,
FLUTICASONE PROPION-SALMETEROL 500-50 MCG/DOSE INHL DSDV,,13523,LOCAL,Facility,Both,1,Each,,1158,984.3,331.8828,1158,BlueCross BlueShield Minnesota,High Value Network Plan,1042.2,90,,percent of total billed charges,,
FLUTICASONE PROPION-SALMETEROL 500-50 MCG/DOSE INHL DSDV,,13523,LOCAL,Facility,Outpatient,1,Each,,1158,984.3,331.8828,1158,BlueCross BlueShield Minnesota,Medicare Advantage,567.42,49,,percent of total billed charges,,
FLUTICASONE PROPION-SALMETEROL 500-50 MCG/DOSE INHL DSDV,,13523,LOCAL,Facility,Inpatient,1,Each,,1158,984.3,331.8828,1158,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
FLUTICASONE PROPION-SALMETEROL 500-50 MCG/DOSE INHL DSDV,,13523,LOCAL,Facility,Both,1,Each,,1158,984.3,331.8828,1158,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1025.6406,88.57,,percent of total billed charges,,
FLUTICASONE PROPION-SALMETEROL 500-50 MCG/DOSE INHL DSDV,,13523,LOCAL,Facility,Both,1,Each,,1158,984.3,331.8828,1158,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,331.8828,28.66,,percent of total billed charges,,
FLUTICASONE PROPION-SALMETEROL 500-50 MCG/DOSE INHL DSDV,,13523,LOCAL,Facility,Outpatient,1,Each,,1158,984.3,331.8828,1158,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),567.42,49,,percent of total billed charges,,
FLUTICASONE PROPION-SALMETEROL 500-50 MCG/DOSE INHL DSDV,,13523,LOCAL,Facility,Inpatient,1,Each,,1158,984.3,331.8828,1158,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
FLUTICASONE PROPION-SALMETEROL 500-50 MCG/DOSE INHL DSDV,,13523,LOCAL,Facility,Both,1,Each,,1158,984.3,331.8828,1158,CorVel,Worker's Compensation,1158,100,,percent of total billed charges,,
FLUTICASONE PROPION-SALMETEROL 500-50 MCG/DOSE INHL DSDV,,13523,LOCAL,Facility,Both,1,Each,,1158,984.3,331.8828,1158,First Health Group Corporation,First Health Network,1123.26,97,,percent of total billed charges,,
FLUTICASONE PROPION-SALMETEROL 500-50 MCG/DOSE INHL DSDV,,13523,LOCAL,Facility,Both,1,Each,,1158,984.3,331.8828,1158,"Health Partners, Inc.",Commercial,1095.468,94.6,,percent of total billed charges,,
FLUTICASONE PROPION-SALMETEROL 500-50 MCG/DOSE INHL DSDV,,13523,LOCAL,Facility,Outpatient,1,Each,,1158,984.3,331.8828,1158,"Health Partners, Inc.",Medicare Advantage,567.42,49,,percent of total billed charges,,
FLUTICASONE PROPION-SALMETEROL 500-50 MCG/DOSE INHL DSDV,,13523,LOCAL,Facility,Inpatient,1,Each,,1158,984.3,331.8828,1158,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
FLUTICASONE PROPION-SALMETEROL 500-50 MCG/DOSE INHL DSDV,,13523,LOCAL,Facility,Both,1,Each,,1158,984.3,331.8828,1158,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),694.8,60,,percent of total billed charges,,
FLUTICASONE PROPION-SALMETEROL 500-50 MCG/DOSE INHL DSDV,,13523,LOCAL,Facility,Both,1,Each,,1158,984.3,331.8828,1158,"Health Partners, Inc.",State of Minnesota Advantage Program,943.77,81.5,,percent of total billed charges,,
FLUTICASONE PROPION-SALMETEROL 500-50 MCG/DOSE INHL DSDV,,13523,LOCAL,Facility,Both,1,Each,,1158,984.3,331.8828,1158,"Health Partners, Inc.",State Public Programs,579,50,,percent of total billed charges,,
FLUTICASONE PROPION-SALMETEROL 500-50 MCG/DOSE INHL DSDV,,13523,LOCAL,Facility,Both,1,Each,,1158,984.3,331.8828,1158,Humana Insurance Company,Commercial PPO,1100.1,95,,percent of total billed charges,,
FLUTICASONE PROPION-SALMETEROL 500-50 MCG/DOSE INHL DSDV,,13523,LOCAL,Facility,Outpatient,1,Each,,1158,984.3,331.8828,1158,Humana Insurance Company,Medicare PPO,567.42,49,,percent of total billed charges,,
FLUTICASONE PROPION-SALMETEROL 500-50 MCG/DOSE INHL DSDV,,13523,LOCAL,Facility,Inpatient,1,Each,,1158,984.3,331.8828,1158,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
FLUTICASONE PROPION-SALMETEROL 500-50 MCG/DOSE INHL DSDV,,13523,LOCAL,Facility,Both,1,Each,,1158,984.3,331.8828,1158,Medica,Individual & Family,1147.578,99.1,,percent of total billed charges,,
FLUTICASONE PROPION-SALMETEROL 500-50 MCG/DOSE INHL DSDV,,13523,LOCAL,Facility,Outpatient,1,Each,,1158,984.3,331.8828,1158,Medica,Medica Advantage Solution,576.684,49.8,,percent of total billed charges,,
FLUTICASONE PROPION-SALMETEROL 500-50 MCG/DOSE INHL DSDV,,13523,LOCAL,Facility,Inpatient,1,Each,,1158,984.3,331.8828,1158,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
FLUTICASONE PROPION-SALMETEROL 500-50 MCG/DOSE INHL DSDV,,13523,LOCAL,Facility,Outpatient,1,Each,,1158,984.3,331.8828,1158,Medica,Medical Assistance,516.468,44.6,,percent of total billed charges,,
FLUTICASONE PROPION-SALMETEROL 500-50 MCG/DOSE INHL DSDV,,13523,LOCAL,Facility,Inpatient,1,Each,,1158,984.3,331.8828,1158,Medica,Medical Assistance,,,,,Included in per diem rate,
FLUTICASONE PROPION-SALMETEROL 500-50 MCG/DOSE INHL DSDV,,13523,LOCAL,Facility,Outpatient,1,Each,,1158,984.3,331.8828,1158,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,576.684,49.8,,percent of total billed charges,,
FLUTICASONE PROPION-SALMETEROL 500-50 MCG/DOSE INHL DSDV,,13523,LOCAL,Facility,Inpatient,1,Each,,1158,984.3,331.8828,1158,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
FLUTICASONE PROPION-SALMETEROL 500-50 MCG/DOSE INHL DSDV,,13523,LOCAL,Facility,Both,1,Each,,1158,984.3,331.8828,1158,"Multiplan, Inc.","Multiplan, Inc.",1088.52,94,,percent of total billed charges,,
FLUTICASONE PROPION-SALMETEROL 500-50 MCG/DOSE INHL DSDV,,13523,LOCAL,Facility,Outpatient,1,Each,,1158,984.3,331.8828,1158,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1043.358,90.1,,percent of total billed charges,,
FLUTICASONE PROPION-SALMETEROL 500-50 MCG/DOSE INHL DSDV,,13523,LOCAL,Facility,Inpatient,1,Each,,1158,984.3,331.8828,1158,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
FLUTICASONE PROPION-SALMETEROL 500-50 MCG/DOSE INHL DSDV,,13523,LOCAL,Facility,Both,1,Each,,1158,984.3,331.8828,1158,"Preferred One Administrative Services, INC.",PPO,1141.788,98.6,,percent of total billed charges,,
FLUTICASONE PROPION-SALMETEROL 500-50 MCG/DOSE INHL DSDV,,13523,LOCAL,Facility,Outpatient,1,Each,,1158,984.3,331.8828,1158,PrimeWest Health,Minnesota Senior Health Options (MSHO),595.791,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
FLUTICASONE PROPION-SALMETEROL 500-50 MCG/DOSE INHL DSDV,,13523,LOCAL,Facility,Inpatient,1,Each,,1158,984.3,331.8828,1158,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
FLUTICASONE PROPION-SALMETEROL 500-50 MCG/DOSE INHL DSDV,,13523,LOCAL,Facility,Outpatient,1,Each,,1158,984.3,331.8828,1158,PrimeWest Health,MinnesotaCare,594.7488,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
FLUTICASONE PROPION-SALMETEROL 500-50 MCG/DOSE INHL DSDV,,13523,LOCAL,Facility,Inpatient,1,Each,,1158,984.3,331.8828,1158,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
FLUTICASONE PROPION-SALMETEROL 500-50 MCG/DOSE INHL DSDV,,13523,LOCAL,Facility,Both,1,Each,,1158,984.3,331.8828,1158,Sanford Health Plan,Sanford Health Plan,1065.36,92,,percent of total billed charges,,
FLUTICASONE PROPION-SALMETEROL 500-50 MCG/DOSE INHL DSDV,,13523,LOCAL,Facility,Outpatient,1,Each,,1158,984.3,331.8828,1158,"UCare Health, Inc.",Individual & Family Plan,652.533,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
FLUTICASONE PROPION-SALMETEROL 500-50 MCG/DOSE INHL DSDV,,13523,LOCAL,Facility,Inpatient,1,Each,,1158,984.3,331.8828,1158,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
FLUTICASONE PROPION-SALMETEROL 500-50 MCG/DOSE INHL DSDV,,13523,LOCAL,Facility,Outpatient,1,Each,,1158,984.3,331.8828,1158,"UCare Health, Inc.",Medical Assistance,584.4426,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FLUTICASONE PROPION-SALMETEROL 500-50 MCG/DOSE INHL DSDV,,13523,LOCAL,Facility,Inpatient,1,Each,,1158,984.3,331.8828,1158,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
FLUTICASONE PROPION-SALMETEROL 500-50 MCG/DOSE INHL DSDV,,13523,LOCAL,Facility,Outpatient,1,Each,,1158,984.3,331.8828,1158,"UCare Health, Inc.",Medicare Advantage,584.4426,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FLUTICASONE PROPION-SALMETEROL 500-50 MCG/DOSE INHL DSDV,,13523,LOCAL,Facility,Inpatient,1,Each,,1158,984.3,331.8828,1158,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
FLUTICASONE PROPION-SALMETEROL 500-50 MCG/DOSE INHL DSDV,,13523,LOCAL,Facility,Outpatient,1,Each,,1158,984.3,331.8828,1158,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),584.4426,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FLUTICASONE PROPION-SALMETEROL 500-50 MCG/DOSE INHL DSDV,,13523,LOCAL,Facility,Inpatient,1,Each,,1158,984.3,331.8828,1158,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
FLUTICASONE PROPION-SALMETEROL 500-50 MCG/DOSE INHL DSDV,,13523,LOCAL,Facility,Both,1,Each,,1158,984.3,331.8828,1158,UnitedHealthcare,Individual & Family,1088.52,94,,percent of total billed charges,,
FLUTICASONE PROPION-SALMETEROL 500-50 MCG/DOSE INHL DSDV,,13523,LOCAL,Facility,Outpatient,1,Each,,1158,984.3,331.8828,1158,UnitedHealthcare,Medicare Advantage,567.42,49,,percent of total billed charges,,
FLUTICASONE PROPION-SALMETEROL 500-50 MCG/DOSE INHL DSDV,,13523,LOCAL,Facility,Inpatient,1,Each,,1158,984.3,331.8828,1158,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
FLUTICASONE PROPION-SALMETEROL 500-50 MCG/DOSE INHL DSDV,,13523,LOCAL,Facility,Outpatient,1,Each,,1158,984.3,331.8828,1158,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,555.84,48,,percent of total billed charges,,100% of DHS outpatient percentage
FLUTICASONE PROPION-SALMETEROL 500-50 MCG/DOSE INHL DSDV,,13523,LOCAL,Facility,Inpatient,1,Each,,1158,984.3,331.8828,1158,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
INDOMETHACIN 25 MG ORAL CAP,,13656,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
INDOMETHACIN 25 MG ORAL CAP,,13656,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
INDOMETHACIN 25 MG ORAL CAP,,13656,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
INDOMETHACIN 25 MG ORAL CAP,,13656,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
INDOMETHACIN 25 MG ORAL CAP,,13656,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
INDOMETHACIN 25 MG ORAL CAP,,13656,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
INDOMETHACIN 25 MG ORAL CAP,,13656,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
INDOMETHACIN 25 MG ORAL CAP,,13656,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
INDOMETHACIN 25 MG ORAL CAP,,13656,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
INDOMETHACIN 25 MG ORAL CAP,,13656,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
INDOMETHACIN 25 MG ORAL CAP,,13656,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
INDOMETHACIN 25 MG ORAL CAP,,13656,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
INDOMETHACIN 25 MG ORAL CAP,,13656,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
INDOMETHACIN 25 MG ORAL CAP,,13656,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
INDOMETHACIN 25 MG ORAL CAP,,13656,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
INDOMETHACIN 25 MG ORAL CAP,,13656,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
INDOMETHACIN 25 MG ORAL CAP,,13656,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
INDOMETHACIN 25 MG ORAL CAP,,13656,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
INDOMETHACIN 25 MG ORAL CAP,,13656,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
INDOMETHACIN 25 MG ORAL CAP,,13656,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
INDOMETHACIN 25 MG ORAL CAP,,13656,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
INDOMETHACIN 25 MG ORAL CAP,,13656,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
INDOMETHACIN 25 MG ORAL CAP,,13656,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
INDOMETHACIN 25 MG ORAL CAP,,13656,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
INDOMETHACIN 25 MG ORAL CAP,,13656,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
INDOMETHACIN 25 MG ORAL CAP,,13656,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
INDOMETHACIN 25 MG ORAL CAP,,13656,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
INDOMETHACIN 25 MG ORAL CAP,,13656,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
INDOMETHACIN 25 MG ORAL CAP,,13656,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
INDOMETHACIN 25 MG ORAL CAP,,13656,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
INDOMETHACIN 25 MG ORAL CAP,,13656,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
INDOMETHACIN 25 MG ORAL CAP,,13656,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
INDOMETHACIN 25 MG ORAL CAP,,13656,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
INDOMETHACIN 25 MG ORAL CAP,,13656,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
INDOMETHACIN 25 MG ORAL CAP,,13656,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
INDOMETHACIN 25 MG ORAL CAP,,13656,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
INDOMETHACIN 25 MG ORAL CAP,,13656,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
INDOMETHACIN 25 MG ORAL CAP,,13656,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
INDOMETHACIN 25 MG ORAL CAP,,13656,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
INDOMETHACIN 25 MG ORAL CAP,,13656,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
INDOMETHACIN 25 MG ORAL CAP,,13656,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
INDOMETHACIN 25 MG ORAL CAP,,13656,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
INDOMETHACIN 25 MG ORAL CAP,,13656,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
INDOMETHACIN 25 MG ORAL CAP,,13656,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
INDOMETHACIN 25 MG ORAL CAP,,13656,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
INDOMETHACIN 25 MG ORAL CAP,,13656,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
INDOMETHACIN 25 MG ORAL CAP,,13656,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
INDOMETHACIN 25 MG ORAL CAP,,13656,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
INDOMETHACIN 25 MG ORAL CAP,,13656,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
INDOMETHACIN 25 MG ORAL CAP,,13656,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
INDOMETHACIN 25 MG ORAL CAP,,13656,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
INDOMETHACIN 25 MG ORAL CAP,,13656,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
INDOMETHACIN 25 MG ORAL CAP,,13656,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
INDOMETHACIN 25 MG ORAL CAP,,13656,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
DIVALPROEX 125 MG ORAL TBEC,,13665,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
DIVALPROEX 125 MG ORAL TBEC,,13665,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
DIVALPROEX 125 MG ORAL TBEC,,13665,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
DIVALPROEX 125 MG ORAL TBEC,,13665,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
DIVALPROEX 125 MG ORAL TBEC,,13665,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
DIVALPROEX 125 MG ORAL TBEC,,13665,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
DIVALPROEX 125 MG ORAL TBEC,,13665,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
DIVALPROEX 125 MG ORAL TBEC,,13665,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
DIVALPROEX 125 MG ORAL TBEC,,13665,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
DIVALPROEX 125 MG ORAL TBEC,,13665,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
DIVALPROEX 125 MG ORAL TBEC,,13665,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
DIVALPROEX 125 MG ORAL TBEC,,13665,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
DIVALPROEX 125 MG ORAL TBEC,,13665,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
DIVALPROEX 125 MG ORAL TBEC,,13665,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
DIVALPROEX 125 MG ORAL TBEC,,13665,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
DIVALPROEX 125 MG ORAL TBEC,,13665,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
DIVALPROEX 125 MG ORAL TBEC,,13665,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
DIVALPROEX 125 MG ORAL TBEC,,13665,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
DIVALPROEX 125 MG ORAL TBEC,,13665,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DIVALPROEX 125 MG ORAL TBEC,,13665,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
DIVALPROEX 125 MG ORAL TBEC,,13665,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
DIVALPROEX 125 MG ORAL TBEC,,13665,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
DIVALPROEX 125 MG ORAL TBEC,,13665,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
DIVALPROEX 125 MG ORAL TBEC,,13665,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
DIVALPROEX 125 MG ORAL TBEC,,13665,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
DIVALPROEX 125 MG ORAL TBEC,,13665,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
DIVALPROEX 125 MG ORAL TBEC,,13665,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
DIVALPROEX 125 MG ORAL TBEC,,13665,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
DIVALPROEX 125 MG ORAL TBEC,,13665,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
DIVALPROEX 125 MG ORAL TBEC,,13665,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
DIVALPROEX 125 MG ORAL TBEC,,13665,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
DIVALPROEX 125 MG ORAL TBEC,,13665,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
DIVALPROEX 125 MG ORAL TBEC,,13665,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
DIVALPROEX 125 MG ORAL TBEC,,13665,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
DIVALPROEX 125 MG ORAL TBEC,,13665,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
DIVALPROEX 125 MG ORAL TBEC,,13665,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
DIVALPROEX 125 MG ORAL TBEC,,13665,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
DIVALPROEX 125 MG ORAL TBEC,,13665,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DIVALPROEX 125 MG ORAL TBEC,,13665,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
DIVALPROEX 125 MG ORAL TBEC,,13665,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
DIVALPROEX 125 MG ORAL TBEC,,13665,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
DIVALPROEX 125 MG ORAL TBEC,,13665,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
DIVALPROEX 125 MG ORAL TBEC,,13665,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
DIVALPROEX 125 MG ORAL TBEC,,13665,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DIVALPROEX 125 MG ORAL TBEC,,13665,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
DIVALPROEX 125 MG ORAL TBEC,,13665,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DIVALPROEX 125 MG ORAL TBEC,,13665,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DIVALPROEX 125 MG ORAL TBEC,,13665,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DIVALPROEX 125 MG ORAL TBEC,,13665,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DIVALPROEX 125 MG ORAL TBEC,,13665,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
DIVALPROEX 125 MG ORAL TBEC,,13665,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
DIVALPROEX 125 MG ORAL TBEC,,13665,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
DIVALPROEX 125 MG ORAL TBEC,,13665,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
DIVALPROEX 125 MG ORAL TBEC,,13665,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
CARBIDOPA-LEVODOPA 10-100 MG ORAL TABLET,,13736,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
CARBIDOPA-LEVODOPA 10-100 MG ORAL TABLET,,13736,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
CARBIDOPA-LEVODOPA 10-100 MG ORAL TABLET,,13736,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
CARBIDOPA-LEVODOPA 10-100 MG ORAL TABLET,,13736,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
CARBIDOPA-LEVODOPA 10-100 MG ORAL TABLET,,13736,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
CARBIDOPA-LEVODOPA 10-100 MG ORAL TABLET,,13736,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
CARBIDOPA-LEVODOPA 10-100 MG ORAL TABLET,,13736,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
CARBIDOPA-LEVODOPA 10-100 MG ORAL TABLET,,13736,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
CARBIDOPA-LEVODOPA 10-100 MG ORAL TABLET,,13736,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
CARBIDOPA-LEVODOPA 10-100 MG ORAL TABLET,,13736,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
CARBIDOPA-LEVODOPA 10-100 MG ORAL TABLET,,13736,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
CARBIDOPA-LEVODOPA 10-100 MG ORAL TABLET,,13736,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
CARBIDOPA-LEVODOPA 10-100 MG ORAL TABLET,,13736,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
CARBIDOPA-LEVODOPA 10-100 MG ORAL TABLET,,13736,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
CARBIDOPA-LEVODOPA 10-100 MG ORAL TABLET,,13736,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
CARBIDOPA-LEVODOPA 10-100 MG ORAL TABLET,,13736,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
CARBIDOPA-LEVODOPA 10-100 MG ORAL TABLET,,13736,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
CARBIDOPA-LEVODOPA 10-100 MG ORAL TABLET,,13736,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
CARBIDOPA-LEVODOPA 10-100 MG ORAL TABLET,,13736,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CARBIDOPA-LEVODOPA 10-100 MG ORAL TABLET,,13736,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
CARBIDOPA-LEVODOPA 10-100 MG ORAL TABLET,,13736,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
CARBIDOPA-LEVODOPA 10-100 MG ORAL TABLET,,13736,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
CARBIDOPA-LEVODOPA 10-100 MG ORAL TABLET,,13736,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
CARBIDOPA-LEVODOPA 10-100 MG ORAL TABLET,,13736,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
CARBIDOPA-LEVODOPA 10-100 MG ORAL TABLET,,13736,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
CARBIDOPA-LEVODOPA 10-100 MG ORAL TABLET,,13736,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
CARBIDOPA-LEVODOPA 10-100 MG ORAL TABLET,,13736,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
CARBIDOPA-LEVODOPA 10-100 MG ORAL TABLET,,13736,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
CARBIDOPA-LEVODOPA 10-100 MG ORAL TABLET,,13736,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
CARBIDOPA-LEVODOPA 10-100 MG ORAL TABLET,,13736,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
CARBIDOPA-LEVODOPA 10-100 MG ORAL TABLET,,13736,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
CARBIDOPA-LEVODOPA 10-100 MG ORAL TABLET,,13736,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
CARBIDOPA-LEVODOPA 10-100 MG ORAL TABLET,,13736,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
CARBIDOPA-LEVODOPA 10-100 MG ORAL TABLET,,13736,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
CARBIDOPA-LEVODOPA 10-100 MG ORAL TABLET,,13736,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
CARBIDOPA-LEVODOPA 10-100 MG ORAL TABLET,,13736,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
CARBIDOPA-LEVODOPA 10-100 MG ORAL TABLET,,13736,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
CARBIDOPA-LEVODOPA 10-100 MG ORAL TABLET,,13736,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CARBIDOPA-LEVODOPA 10-100 MG ORAL TABLET,,13736,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
CARBIDOPA-LEVODOPA 10-100 MG ORAL TABLET,,13736,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
CARBIDOPA-LEVODOPA 10-100 MG ORAL TABLET,,13736,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
CARBIDOPA-LEVODOPA 10-100 MG ORAL TABLET,,13736,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
CARBIDOPA-LEVODOPA 10-100 MG ORAL TABLET,,13736,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
CARBIDOPA-LEVODOPA 10-100 MG ORAL TABLET,,13736,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CARBIDOPA-LEVODOPA 10-100 MG ORAL TABLET,,13736,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
CARBIDOPA-LEVODOPA 10-100 MG ORAL TABLET,,13736,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CARBIDOPA-LEVODOPA 10-100 MG ORAL TABLET,,13736,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CARBIDOPA-LEVODOPA 10-100 MG ORAL TABLET,,13736,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CARBIDOPA-LEVODOPA 10-100 MG ORAL TABLET,,13736,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CARBIDOPA-LEVODOPA 10-100 MG ORAL TABLET,,13736,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
CARBIDOPA-LEVODOPA 10-100 MG ORAL TABLET,,13736,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
CARBIDOPA-LEVODOPA 10-100 MG ORAL TABLET,,13736,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
CARBIDOPA-LEVODOPA 10-100 MG ORAL TABLET,,13736,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
CARBIDOPA-LEVODOPA 10-100 MG ORAL TABLET,,13736,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
CALCIUM POLYCARBOPHIL 625 MG ORAL TABLET,,13771,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
CALCIUM POLYCARBOPHIL 625 MG ORAL TABLET,,13771,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
CALCIUM POLYCARBOPHIL 625 MG ORAL TABLET,,13771,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
CALCIUM POLYCARBOPHIL 625 MG ORAL TABLET,,13771,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
CALCIUM POLYCARBOPHIL 625 MG ORAL TABLET,,13771,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
CALCIUM POLYCARBOPHIL 625 MG ORAL TABLET,,13771,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
CALCIUM POLYCARBOPHIL 625 MG ORAL TABLET,,13771,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
CALCIUM POLYCARBOPHIL 625 MG ORAL TABLET,,13771,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
CALCIUM POLYCARBOPHIL 625 MG ORAL TABLET,,13771,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
CALCIUM POLYCARBOPHIL 625 MG ORAL TABLET,,13771,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
CALCIUM POLYCARBOPHIL 625 MG ORAL TABLET,,13771,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
CALCIUM POLYCARBOPHIL 625 MG ORAL TABLET,,13771,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
CALCIUM POLYCARBOPHIL 625 MG ORAL TABLET,,13771,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
CALCIUM POLYCARBOPHIL 625 MG ORAL TABLET,,13771,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
CALCIUM POLYCARBOPHIL 625 MG ORAL TABLET,,13771,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
CALCIUM POLYCARBOPHIL 625 MG ORAL TABLET,,13771,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
CALCIUM POLYCARBOPHIL 625 MG ORAL TABLET,,13771,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
CALCIUM POLYCARBOPHIL 625 MG ORAL TABLET,,13771,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
CALCIUM POLYCARBOPHIL 625 MG ORAL TABLET,,13771,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CALCIUM POLYCARBOPHIL 625 MG ORAL TABLET,,13771,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
CALCIUM POLYCARBOPHIL 625 MG ORAL TABLET,,13771,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
CALCIUM POLYCARBOPHIL 625 MG ORAL TABLET,,13771,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
CALCIUM POLYCARBOPHIL 625 MG ORAL TABLET,,13771,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
CALCIUM POLYCARBOPHIL 625 MG ORAL TABLET,,13771,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
CALCIUM POLYCARBOPHIL 625 MG ORAL TABLET,,13771,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
CALCIUM POLYCARBOPHIL 625 MG ORAL TABLET,,13771,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
CALCIUM POLYCARBOPHIL 625 MG ORAL TABLET,,13771,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
CALCIUM POLYCARBOPHIL 625 MG ORAL TABLET,,13771,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
CALCIUM POLYCARBOPHIL 625 MG ORAL TABLET,,13771,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
CALCIUM POLYCARBOPHIL 625 MG ORAL TABLET,,13771,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
CALCIUM POLYCARBOPHIL 625 MG ORAL TABLET,,13771,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
CALCIUM POLYCARBOPHIL 625 MG ORAL TABLET,,13771,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
CALCIUM POLYCARBOPHIL 625 MG ORAL TABLET,,13771,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
CALCIUM POLYCARBOPHIL 625 MG ORAL TABLET,,13771,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
CALCIUM POLYCARBOPHIL 625 MG ORAL TABLET,,13771,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
CALCIUM POLYCARBOPHIL 625 MG ORAL TABLET,,13771,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
CALCIUM POLYCARBOPHIL 625 MG ORAL TABLET,,13771,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
CALCIUM POLYCARBOPHIL 625 MG ORAL TABLET,,13771,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CALCIUM POLYCARBOPHIL 625 MG ORAL TABLET,,13771,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
CALCIUM POLYCARBOPHIL 625 MG ORAL TABLET,,13771,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
CALCIUM POLYCARBOPHIL 625 MG ORAL TABLET,,13771,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
CALCIUM POLYCARBOPHIL 625 MG ORAL TABLET,,13771,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
CALCIUM POLYCARBOPHIL 625 MG ORAL TABLET,,13771,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
CALCIUM POLYCARBOPHIL 625 MG ORAL TABLET,,13771,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CALCIUM POLYCARBOPHIL 625 MG ORAL TABLET,,13771,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
CALCIUM POLYCARBOPHIL 625 MG ORAL TABLET,,13771,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CALCIUM POLYCARBOPHIL 625 MG ORAL TABLET,,13771,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CALCIUM POLYCARBOPHIL 625 MG ORAL TABLET,,13771,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CALCIUM POLYCARBOPHIL 625 MG ORAL TABLET,,13771,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CALCIUM POLYCARBOPHIL 625 MG ORAL TABLET,,13771,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
CALCIUM POLYCARBOPHIL 625 MG ORAL TABLET,,13771,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
CALCIUM POLYCARBOPHIL 625 MG ORAL TABLET,,13771,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
CALCIUM POLYCARBOPHIL 625 MG ORAL TABLET,,13771,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
CALCIUM POLYCARBOPHIL 625 MG ORAL TABLET,,13771,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
IBUPROFEN 400 MG ORAL TABLET,,13785,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
IBUPROFEN 400 MG ORAL TABLET,,13785,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
IBUPROFEN 400 MG ORAL TABLET,,13785,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
IBUPROFEN 400 MG ORAL TABLET,,13785,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
IBUPROFEN 400 MG ORAL TABLET,,13785,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
IBUPROFEN 400 MG ORAL TABLET,,13785,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
IBUPROFEN 400 MG ORAL TABLET,,13785,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
IBUPROFEN 400 MG ORAL TABLET,,13785,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
IBUPROFEN 400 MG ORAL TABLET,,13785,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
IBUPROFEN 400 MG ORAL TABLET,,13785,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
IBUPROFEN 400 MG ORAL TABLET,,13785,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
IBUPROFEN 400 MG ORAL TABLET,,13785,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
IBUPROFEN 400 MG ORAL TABLET,,13785,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
IBUPROFEN 400 MG ORAL TABLET,,13785,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
IBUPROFEN 400 MG ORAL TABLET,,13785,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
IBUPROFEN 400 MG ORAL TABLET,,13785,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
IBUPROFEN 400 MG ORAL TABLET,,13785,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
IBUPROFEN 400 MG ORAL TABLET,,13785,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
IBUPROFEN 400 MG ORAL TABLET,,13785,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
IBUPROFEN 400 MG ORAL TABLET,,13785,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
IBUPROFEN 400 MG ORAL TABLET,,13785,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
IBUPROFEN 400 MG ORAL TABLET,,13785,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
IBUPROFEN 400 MG ORAL TABLET,,13785,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
IBUPROFEN 400 MG ORAL TABLET,,13785,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
IBUPROFEN 400 MG ORAL TABLET,,13785,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
IBUPROFEN 400 MG ORAL TABLET,,13785,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
IBUPROFEN 400 MG ORAL TABLET,,13785,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
IBUPROFEN 400 MG ORAL TABLET,,13785,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
IBUPROFEN 400 MG ORAL TABLET,,13785,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
IBUPROFEN 400 MG ORAL TABLET,,13785,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
IBUPROFEN 400 MG ORAL TABLET,,13785,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
IBUPROFEN 400 MG ORAL TABLET,,13785,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
IBUPROFEN 400 MG ORAL TABLET,,13785,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
IBUPROFEN 400 MG ORAL TABLET,,13785,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
IBUPROFEN 400 MG ORAL TABLET,,13785,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
IBUPROFEN 400 MG ORAL TABLET,,13785,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
IBUPROFEN 400 MG ORAL TABLET,,13785,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
IBUPROFEN 400 MG ORAL TABLET,,13785,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
IBUPROFEN 400 MG ORAL TABLET,,13785,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
IBUPROFEN 400 MG ORAL TABLET,,13785,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
IBUPROFEN 400 MG ORAL TABLET,,13785,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
IBUPROFEN 400 MG ORAL TABLET,,13785,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
IBUPROFEN 400 MG ORAL TABLET,,13785,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
IBUPROFEN 400 MG ORAL TABLET,,13785,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
IBUPROFEN 400 MG ORAL TABLET,,13785,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
IBUPROFEN 400 MG ORAL TABLET,,13785,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
IBUPROFEN 400 MG ORAL TABLET,,13785,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
IBUPROFEN 400 MG ORAL TABLET,,13785,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
IBUPROFEN 400 MG ORAL TABLET,,13785,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
IBUPROFEN 400 MG ORAL TABLET,,13785,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
IBUPROFEN 400 MG ORAL TABLET,,13785,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
IBUPROFEN 400 MG ORAL TABLET,,13785,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
IBUPROFEN 400 MG ORAL TABLET,,13785,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
IBUPROFEN 400 MG ORAL TABLET,,13785,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; First Lesion (Pbb)",,10005,CPT,Facility,Outpatient,,,,140,119,40.124,140,Aetna,Commercial,128.8,92,,percent of total billed charges,,
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; First Lesion (Pbb)",,10005,CPT,Professional,Outpatient,,,,230,195.5,45.15,230,Aetna,Commercial,195.5,85,,percent of total billed charges,,
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; First Lesion (Pbb)",,10005,CPT,Facility,Outpatient,,,,140,119,40.124,140,Aetna,Medicare Advantage,68.6,49,,percent of total billed charges,,
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; First Lesion (Pbb)",,10005,CPT,Professional,Outpatient,,,,230,195.5,45.15,230,Aetna,Medicare Advantage,70.46,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; First Lesion (Pbb)",,10005,CPT,Facility,Outpatient,,,,140,119,40.124,140,Aetna,PPO,130.2,93,,percent of total billed charges,,
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; First Lesion (Pbb)",,10005,CPT,Professional,Outpatient,,,,230,195.5,45.15,230,Aetna,PPO,213.9,93,,percent of total billed charges,,
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; First Lesion (Pbb)",,10005,CPT,Facility,Outpatient,,,,140,119,40.124,140,America's PPO,America's PPO,134.442,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; First Lesion (Pbb)",,10005,CPT,Professional,Outpatient,,,,230,195.5,45.15,230,America's PPO,America's PPO,196.512,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; First Lesion (Pbb)",,10005,CPT,Facility,Outpatient,,,,140,119,40.124,140,BlueCross BlueShield Minnesota, Federal Employee Program,137.76,98.4,,percent of total billed charges,,
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; First Lesion (Pbb)",,10005,CPT,Professional,Outpatient,,,,230,195.5,45.15,230,BlueCross BlueShield Minnesota, Federal Employee Program,150.11,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; First Lesion (Pbb)",,10005,CPT,Facility,Outpatient,,,,140,119,40.124,140,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,140,100,,percent of total billed charges,,
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; First Lesion (Pbb)",,10005,CPT,Professional,Outpatient,,,,230,195.5,45.15,230,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,152.51176,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; First Lesion (Pbb)",,10005,CPT,Facility,Outpatient,,,,140,119,40.124,140,BlueCross BlueShield Minnesota,High Value Network Plan,126,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; First Lesion (Pbb)",,10005,CPT,Professional,Outpatient,,,,230,195.5,45.15,230,BlueCross BlueShield Minnesota,High Value Network Plan,152.51176,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; First Lesion (Pbb)",,10005,CPT,Facility,Outpatient,,,,140,119,40.124,140,BlueCross BlueShield Minnesota,Medicare Advantage,68.6,49,,percent of total billed charges,,
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; First Lesion (Pbb)",,10005,CPT,Professional,Outpatient,,,,230,195.5,45.15,230,BlueCross BlueShield Minnesota,Medicare Advantage,80.9025,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; First Lesion (Pbb)",,10005,CPT,Professional,Outpatient,,,,230,195.5,45.15,230,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,152.51176,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; First Lesion (Pbb)",,10005,CPT,Facility,Outpatient,,,,140,119,40.124,140,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,40.124,28.66,,percent of total billed charges,,
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; First Lesion (Pbb)",,10005,CPT,Professional,Outpatient,,,,230,195.5,45.15,230,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,52.13096,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; First Lesion (Pbb)",,10005,CPT,Facility,Outpatient,,,,140,119,40.124,140,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),68.6,49,,percent of total billed charges,,
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; First Lesion (Pbb)",,10005,CPT,Professional,Outpatient,,,,230,195.5,45.15,230,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),80.9025,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; First Lesion (Pbb)",,10005,CPT,Facility,Outpatient,,,,140,119,40.124,140,CorVel,Worker's Compensation,140,100,,percent of total billed charges,,
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; First Lesion (Pbb)",,10005,CPT,Professional,Outpatient,,,,230,195.5,45.15,230,CorVel,Worker's Compensation,138.8424051,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; First Lesion (Pbb)",,10005,CPT,Facility,Outpatient,,,,140,119,40.124,140,First Health Group Corporation,First Health Network,135.8,97,,percent of total billed charges,,
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; First Lesion (Pbb)",,10005,CPT,Professional,Outpatient,,,,230,195.5,45.15,230,First Health Group Corporation,First Health Network,223.1,97,,percent of total billed charges,,
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; First Lesion (Pbb)",,10005,CPT,Facility,Outpatient,,,,140,119,40.124,140,"Health Partners, Inc.",Commercial,132.44,94.6,,percent of total billed charges,,
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; First Lesion (Pbb)",,10005,CPT,Professional,Outpatient,,,,230,195.5,45.15,230,"Health Partners, Inc.",Commercial,150.19,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; First Lesion (Pbb)",,10005,CPT,Facility,Outpatient,,,,140,119,40.124,140,"Health Partners, Inc.",Medicare Advantage,68.6,49,,percent of total billed charges,,
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; First Lesion (Pbb)",,10005,CPT,Professional,Outpatient,,,,230,195.5,45.15,230,"Health Partners, Inc.",Medicare Advantage,80.9025,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; First Lesion (Pbb)",,10005,CPT,Facility,Outpatient,,,,140,119,40.124,140,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),84,60,,percent of total billed charges,,
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; First Lesion (Pbb)",,10005,CPT,Professional,Outpatient,,,,230,195.5,45.15,230,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),70.49,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; First Lesion (Pbb)",,10005,CPT,Facility,Outpatient,,,,140,119,40.124,140,"Health Partners, Inc.",State of Minnesota Advantage Program,114.1,81.5,,percent of total billed charges,,
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; First Lesion (Pbb)",,10005,CPT,Professional,Outpatient,,,,230,195.5,45.15,230,"Health Partners, Inc.",State of Minnesota Advantage Program,129.388685,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; First Lesion (Pbb)",,10005,CPT,Facility,Outpatient,,,,140,119,40.124,140,"Health Partners, Inc.",State Public Programs,70,50,,percent of total billed charges,,
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; First Lesion (Pbb)",,10005,CPT,Professional,Outpatient,,,,230,195.5,45.15,230,"Health Partners, Inc.",State Public Programs,45.15,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; First Lesion (Pbb)",,10005,CPT,Facility,Outpatient,,,,140,119,40.124,140,Humana Insurance Company,Commercial PPO,133,95,,percent of total billed charges,,
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; First Lesion (Pbb)",,10005,CPT,Professional,Outpatient,,,,230,195.5,45.15,230,Humana Insurance Company,Commercial PPO,70.35,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; First Lesion (Pbb)",,10005,CPT,Facility,Outpatient,,,,140,119,40.124,140,Humana Insurance Company,Medicare PPO,68.6,49,,percent of total billed charges,,
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; First Lesion (Pbb)",,10005,CPT,Professional,Outpatient,,,,230,195.5,45.15,230,Humana Insurance Company,Medicare PPO,230,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; First Lesion (Pbb)",,10005,CPT,Facility,Outpatient,,,,140,119,40.124,140,Medica,Individual & Family,138.74,99.1,,percent of total billed charges,,
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; First Lesion (Pbb)",,10005,CPT,Professional,Outpatient,,,,230,195.5,45.15,230,Medica,Individual & Family,195.04,84.8,,percent of total billed charges,,
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; First Lesion (Pbb)",,10005,CPT,Facility,Outpatient,,,,140,119,40.124,140,Medica,Medica Advantage Solution,69.72,49.8,,percent of total billed charges,,
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; First Lesion (Pbb)",,10005,CPT,Professional,Outpatient,,,,230,195.5,45.15,230,Medica,Medica Advantage Solution,114.54,49.8,,percent of total billed charges,,
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; First Lesion (Pbb)",,10005,CPT,Facility,Outpatient,,,,140,119,40.124,140,Medica,Medical Assistance,62.44,44.6,,percent of total billed charges,,
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; First Lesion (Pbb)",,10005,CPT,Professional,Outpatient,,,,230,195.5,45.15,230,Medica,Medical Assistance,52.13,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; First Lesion (Pbb)",,10005,CPT,Facility,Outpatient,,,,140,119,40.124,140,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,69.72,49.8,,percent of total billed charges,,
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; First Lesion (Pbb)",,10005,CPT,Professional,Outpatient,,,,230,195.5,45.15,230,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,70.35,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; First Lesion (Pbb)",,10005,CPT,Facility,Outpatient,,,,140,119,40.124,140,"Multiplan, Inc.","Multiplan, Inc.",131.6,94,,percent of total billed charges,,
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; First Lesion (Pbb)",,10005,CPT,Professional,Outpatient,,,,230,195.5,45.15,230,"Multiplan, Inc.","Multiplan, Inc.",216.2,94,,percent of total billed charges,,
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; First Lesion (Pbb)",,10005,CPT,Facility,Outpatient,,,,140,119,40.124,140,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,126.14,90.1,,percent of total billed charges,,
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; First Lesion (Pbb)",,10005,CPT,Professional,Outpatient,,,,230,195.5,45.15,230,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,207.23,90.1,,percent of total billed charges,,
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; First Lesion (Pbb)",,10005,CPT,Facility,Outpatient,,,,140,119,40.124,140,"Preferred One Administrative Services, INC.",PPO,138.04,98.6,,percent of total billed charges,,
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; First Lesion (Pbb)",,10005,CPT,Professional,Outpatient,,,,230,195.5,45.15,230,"Preferred One Administrative Services, INC.",PPO,226.78,98.6,,percent of total billed charges,,
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; First Lesion (Pbb)",,10005,CPT,Facility,Outpatient,,,,140,119,40.124,140,PrimeWest Health,Minnesota Senior Health Options (MSHO),72.03,51.45,,percent of total billed charges,,
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; First Lesion (Pbb)",,10005,CPT,Professional,Outpatient,,,,230,195.5,45.15,230,PrimeWest Health,Minnesota Senior Health Options (MSHO),80.9025,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; First Lesion (Pbb)",,10005,CPT,Facility,Outpatient,,,,140,119,40.124,140,PrimeWest Health,MinnesotaCare,71.904,51.36,,percent of total billed charges,,
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; First Lesion (Pbb)",,10005,CPT,Professional,Outpatient,,,,230,195.5,45.15,230,PrimeWest Health,MinnesotaCare,55.7801272,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; First Lesion (Pbb)",,10005,CPT,Facility,Outpatient,,,,140,119,40.124,140,Sanford Health Plan,Sanford Health Plan,128.8,92,,percent of total billed charges,,
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; First Lesion (Pbb)",,10005,CPT,Professional,Outpatient,,,,230,195.5,45.15,230,Sanford Health Plan,Sanford Health Plan,202.4,88,,percent of total billed charges,,
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; First Lesion (Pbb)",,10005,CPT,Facility,Outpatient,,,,140,119,40.124,140,"UCare Health, Inc.",Individual & Family Plan,78.89,56.35,,percent of total billed charges,,
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; First Lesion (Pbb)",,10005,CPT,Professional,Outpatient,,,,230,195.5,45.15,230,"UCare Health, Inc.",Individual & Family Plan,114.36096,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; First Lesion (Pbb)",,10005,CPT,Facility,Outpatient,,,,140,119,40.124,140,"UCare Health, Inc.",Medical Assistance,70.658,50.47,,percent of total billed charges,,
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; First Lesion (Pbb)",,10005,CPT,Professional,Outpatient,,,,230,195.5,45.15,230,"UCare Health, Inc.",Medical Assistance,57.344056,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; First Lesion (Pbb)",,10005,CPT,Facility,Outpatient,,,,140,119,40.124,140,"UCare Health, Inc.",Medicare Advantage,70.658,50.47,,percent of total billed charges,,
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; First Lesion (Pbb)",,10005,CPT,Professional,Outpatient,,,,230,195.5,45.15,230,"UCare Health, Inc.",Medicare Advantage,80.9025,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; First Lesion (Pbb)",,10005,CPT,Facility,Outpatient,,,,140,119,40.124,140,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),70.658,50.47,,percent of total billed charges,,
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; First Lesion (Pbb)",,10005,CPT,Professional,Outpatient,,,,230,195.5,45.15,230,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),64.722,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; First Lesion (Pbb)",,10005,CPT,Facility,Outpatient,,,,140,119,40.124,140,UnitedHealthcare,Individual & Family,131.6,94,,percent of total billed charges,,
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; First Lesion (Pbb)",,10005,CPT,Professional,Outpatient,,,,230,195.5,45.15,230,UnitedHealthcare,Individual & Family,230,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; First Lesion (Pbb)",,10005,CPT,Facility,Outpatient,,,,140,119,40.124,140,UnitedHealthcare,Medicare Advantage,68.6,49,,percent of total billed charges,,
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; First Lesion (Pbb)",,10005,CPT,Professional,Outpatient,,,,230,195.5,45.15,230,UnitedHealthcare,Medicare Advantage,80.9025,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; First Lesion (Pbb)",,10005,CPT,Facility,Outpatient,,,,140,119,40.124,140,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,67.2,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; First Lesion (Pbb)",,10005,CPT,Professional,Outpatient,,,,230,195.5,45.15,230,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,52.13096,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; First Lesion (Pro Cah)",,10005,CPT,Professional,Both,,,,370,314.5,45.15,370,Aetna,Commercial,314.5,85,,percent of total billed charges,,
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; First Lesion (Pro Cah)",,10005,CPT,Professional,Both,,,,370,314.5,45.15,370,Aetna,Commercial,314.5,85,,percent of total billed charges,,
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; First Lesion (Pro Cah)",,10005,CPT,Professional,Both,,,,370,314.5,45.15,370,Aetna,Medicare Advantage,70.46,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; First Lesion (Pro Cah)",,10005,CPT,Professional,Both,,,,370,314.5,45.15,370,Aetna,Medicare Advantage,70.46,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; First Lesion (Pro Cah)",,10005,CPT,Professional,Both,,,,370,314.5,45.15,370,Aetna,PPO,344.1,93,,percent of total billed charges,,
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; First Lesion (Pro Cah)",,10005,CPT,Professional,Both,,,,370,314.5,45.15,370,Aetna,PPO,344.1,93,,percent of total billed charges,,
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; First Lesion (Pro Cah)",,10005,CPT,Professional,Both,,,,370,314.5,45.15,370,America's PPO,America's PPO,316.128,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; First Lesion (Pro Cah)",,10005,CPT,Professional,Both,,,,370,314.5,45.15,370,America's PPO,America's PPO,316.128,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; First Lesion (Pro Cah)",,10005,CPT,Professional,Both,,,,370,314.5,45.15,370,BlueCross BlueShield Minnesota, Federal Employee Program,150.11,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; First Lesion (Pro Cah)",,10005,CPT,Professional,Both,,,,370,314.5,45.15,370,BlueCross BlueShield Minnesota, Federal Employee Program,150.11,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; First Lesion (Pro Cah)",,10005,CPT,Professional,Both,,,,370,314.5,45.15,370,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,152.51176,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; First Lesion (Pro Cah)",,10005,CPT,Professional,Both,,,,370,314.5,45.15,370,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,152.51176,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; First Lesion (Pro Cah)",,10005,CPT,Professional,Both,,,,370,314.5,45.15,370,BlueCross BlueShield Minnesota,High Value Network Plan,152.51176,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; First Lesion (Pro Cah)",,10005,CPT,Professional,Both,,,,370,314.5,45.15,370,BlueCross BlueShield Minnesota,High Value Network Plan,152.51176,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; First Lesion (Pro Cah)",,10005,CPT,Professional,Both,,,,370,314.5,45.15,370,BlueCross BlueShield Minnesota,Medicare Advantage,80.9025,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; First Lesion (Pro Cah)",,10005,CPT,Professional,Both,,,,370,314.5,45.15,370,BlueCross BlueShield Minnesota,Medicare Advantage,80.9025,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; First Lesion (Pro Cah)",,10005,CPT,Professional,Both,,,,370,314.5,45.15,370,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,152.51176,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; First Lesion (Pro Cah)",,10005,CPT,Professional,Both,,,,370,314.5,45.15,370,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,152.51176,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; First Lesion (Pro Cah)",,10005,CPT,Professional,Both,,,,370,314.5,45.15,370,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,52.13096,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; First Lesion (Pro Cah)",,10005,CPT,Professional,Both,,,,370,314.5,45.15,370,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,52.13096,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; First Lesion (Pro Cah)",,10005,CPT,Professional,Both,,,,370,314.5,45.15,370,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),80.9025,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; First Lesion (Pro Cah)",,10005,CPT,Professional,Both,,,,370,314.5,45.15,370,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),80.9025,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; First Lesion (Pro Cah)",,10005,CPT,Professional,Both,,,,370,314.5,45.15,370,CorVel,Worker's Compensation,138.8424051,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; First Lesion (Pro Cah)",,10005,CPT,Professional,Both,,,,370,314.5,45.15,370,CorVel,Worker's Compensation,138.8424051,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; First Lesion (Pro Cah)",,10005,CPT,Professional,Both,,,,370,314.5,45.15,370,First Health Group Corporation,First Health Network,358.9,97,,percent of total billed charges,,
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; First Lesion (Pro Cah)",,10005,CPT,Professional,Both,,,,370,314.5,45.15,370,First Health Group Corporation,First Health Network,358.9,97,,percent of total billed charges,,
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; First Lesion (Pro Cah)",,10005,CPT,Professional,Both,,,,370,314.5,45.15,370,"Health Partners, Inc.",Commercial,150.19,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; First Lesion (Pro Cah)",,10005,CPT,Professional,Both,,,,370,314.5,45.15,370,"Health Partners, Inc.",Commercial,150.19,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; First Lesion (Pro Cah)",,10005,CPT,Professional,Both,,,,370,314.5,45.15,370,"Health Partners, Inc.",Medicare Advantage,80.9025,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; First Lesion (Pro Cah)",,10005,CPT,Professional,Both,,,,370,314.5,45.15,370,"Health Partners, Inc.",Medicare Advantage,80.9025,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; First Lesion (Pro Cah)",,10005,CPT,Professional,Both,,,,370,314.5,45.15,370,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),70.49,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; First Lesion (Pro Cah)",,10005,CPT,Professional,Both,,,,370,314.5,45.15,370,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),70.49,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; First Lesion (Pro Cah)",,10005,CPT,Professional,Both,,,,370,314.5,45.15,370,"Health Partners, Inc.",State of Minnesota Advantage Program,129.388685,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; First Lesion (Pro Cah)",,10005,CPT,Professional,Both,,,,370,314.5,45.15,370,"Health Partners, Inc.",State of Minnesota Advantage Program,129.388685,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; First Lesion (Pro Cah)",,10005,CPT,Professional,Both,,,,370,314.5,45.15,370,"Health Partners, Inc.",State Public Programs,45.15,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; First Lesion (Pro Cah)",,10005,CPT,Professional,Both,,,,370,314.5,45.15,370,"Health Partners, Inc.",State Public Programs,45.15,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; First Lesion (Pro Cah)",,10005,CPT,Professional,Both,,,,370,314.5,45.15,370,Humana Insurance Company,Commercial PPO,70.35,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; First Lesion (Pro Cah)",,10005,CPT,Professional,Both,,,,370,314.5,45.15,370,Humana Insurance Company,Commercial PPO,70.35,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; First Lesion (Pro Cah)",,10005,CPT,Professional,Both,,,,370,314.5,45.15,370,Humana Insurance Company,Medicare PPO,370,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; First Lesion (Pro Cah)",,10005,CPT,Professional,Both,,,,370,314.5,45.15,370,Humana Insurance Company,Medicare PPO,370,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; First Lesion (Pro Cah)",,10005,CPT,Professional,Both,,,,370,314.5,45.15,370,Medica,Individual & Family,313.76,84.8,,percent of total billed charges,,
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; First Lesion (Pro Cah)",,10005,CPT,Professional,Both,,,,370,314.5,45.15,370,Medica,Individual & Family,313.76,84.8,,percent of total billed charges,,
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; First Lesion (Pro Cah)",,10005,CPT,Professional,Both,,,,370,314.5,45.15,370,Medica,Medica Advantage Solution,184.26,49.8,,percent of total billed charges,,
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; First Lesion (Pro Cah)",,10005,CPT,Professional,Both,,,,370,314.5,45.15,370,Medica,Medica Advantage Solution,184.26,49.8,,percent of total billed charges,,
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; First Lesion (Pro Cah)",,10005,CPT,Professional,Both,,,,370,314.5,45.15,370,Medica,Medical Assistance,52.13,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; First Lesion (Pro Cah)",,10005,CPT,Professional,Both,,,,370,314.5,45.15,370,Medica,Medical Assistance,52.13,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; First Lesion (Pro Cah)",,10005,CPT,Professional,Both,,,,370,314.5,45.15,370,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,70.35,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; First Lesion (Pro Cah)",,10005,CPT,Professional,Both,,,,370,314.5,45.15,370,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,70.35,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; First Lesion (Pro Cah)",,10005,CPT,Professional,Both,,,,370,314.5,45.15,370,"Multiplan, Inc.","Multiplan, Inc.",347.8,94,,percent of total billed charges,,
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; First Lesion (Pro Cah)",,10005,CPT,Professional,Both,,,,370,314.5,45.15,370,"Multiplan, Inc.","Multiplan, Inc.",347.8,94,,percent of total billed charges,,
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; First Lesion (Pro Cah)",,10005,CPT,Professional,Both,,,,370,314.5,45.15,370,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,333.37,90.1,,percent of total billed charges,,
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; First Lesion (Pro Cah)",,10005,CPT,Professional,Both,,,,370,314.5,45.15,370,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,333.37,90.1,,percent of total billed charges,,
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; First Lesion (Pro Cah)",,10005,CPT,Professional,Both,,,,370,314.5,45.15,370,"Preferred One Administrative Services, INC.",PPO,364.82,98.6,,percent of total billed charges,,
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; First Lesion (Pro Cah)",,10005,CPT,Professional,Both,,,,370,314.5,45.15,370,"Preferred One Administrative Services, INC.",PPO,364.82,98.6,,percent of total billed charges,,
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; First Lesion (Pro Cah)",,10005,CPT,Professional,Both,,,,370,314.5,45.15,370,PrimeWest Health,Minnesota Senior Health Options (MSHO),80.9025,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; First Lesion (Pro Cah)",,10005,CPT,Professional,Both,,,,370,314.5,45.15,370,PrimeWest Health,Minnesota Senior Health Options (MSHO),80.9025,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; First Lesion (Pro Cah)",,10005,CPT,Professional,Both,,,,370,314.5,45.15,370,PrimeWest Health,MinnesotaCare,55.7801272,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; First Lesion (Pro Cah)",,10005,CPT,Professional,Both,,,,370,314.5,45.15,370,PrimeWest Health,MinnesotaCare,55.7801272,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; First Lesion (Pro Cah)",,10005,CPT,Professional,Both,,,,370,314.5,45.15,370,Sanford Health Plan,Sanford Health Plan,325.6,88,,percent of total billed charges,,
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; First Lesion (Pro Cah)",,10005,CPT,Professional,Both,,,,370,314.5,45.15,370,Sanford Health Plan,Sanford Health Plan,325.6,88,,percent of total billed charges,,
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; First Lesion (Pro Cah)",,10005,CPT,Professional,Both,,,,370,314.5,45.15,370,"UCare Health, Inc.",Individual & Family Plan,114.36096,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; First Lesion (Pro Cah)",,10005,CPT,Professional,Both,,,,370,314.5,45.15,370,"UCare Health, Inc.",Individual & Family Plan,114.36096,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; First Lesion (Pro Cah)",,10005,CPT,Professional,Both,,,,370,314.5,45.15,370,"UCare Health, Inc.",Medical Assistance,57.344056,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; First Lesion (Pro Cah)",,10005,CPT,Professional,Both,,,,370,314.5,45.15,370,"UCare Health, Inc.",Medical Assistance,57.344056,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; First Lesion (Pro Cah)",,10005,CPT,Professional,Both,,,,370,314.5,45.15,370,"UCare Health, Inc.",Medicare Advantage,80.9025,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; First Lesion (Pro Cah)",,10005,CPT,Professional,Both,,,,370,314.5,45.15,370,"UCare Health, Inc.",Medicare Advantage,80.9025,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; First Lesion (Pro Cah)",,10005,CPT,Professional,Both,,,,370,314.5,45.15,370,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),64.722,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; First Lesion (Pro Cah)",,10005,CPT,Professional,Both,,,,370,314.5,45.15,370,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),64.722,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; First Lesion (Pro Cah)",,10005,CPT,Professional,Both,,,,370,314.5,45.15,370,UnitedHealthcare,Individual & Family,370,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; First Lesion (Pro Cah)",,10005,CPT,Professional,Both,,,,370,314.5,45.15,370,UnitedHealthcare,Individual & Family,370,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; First Lesion (Pro Cah)",,10005,CPT,Professional,Both,,,,370,314.5,45.15,370,UnitedHealthcare,Medicare Advantage,80.9025,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; First Lesion (Pro Cah)",,10005,CPT,Professional,Both,,,,370,314.5,45.15,370,UnitedHealthcare,Medicare Advantage,80.9025,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; First Lesion (Pro Cah)",,10005,CPT,Professional,Both,,,,370,314.5,45.15,370,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,52.13096,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; First Lesion (Pro Cah)",,10005,CPT,Professional,Both,,,,370,314.5,45.15,370,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,52.13096,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Fine Needle Aspiration Biopsy, Ultrasound; First Lesion",,10005,CPT,Facility,Both,,,,215,182.75,61.619,215,Aetna,Commercial,197.8,92,,percent of total billed charges,,
"Fine Needle Aspiration Biopsy, Ultrasound; First Lesion",,10005,CPT,Facility,Outpatient,,,,215,182.75,61.619,215,Aetna,Medicare Advantage,105.35,49,,percent of total billed charges,,
"Fine Needle Aspiration Biopsy, Ultrasound; First Lesion",,10005,CPT,Facility,Inpatient,,,,215,182.75,61.619,215,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Fine Needle Aspiration Biopsy, Ultrasound; First Lesion",,10005,CPT,Facility,Both,,,,215,182.75,61.619,215,Aetna,PPO,199.95,93,,percent of total billed charges,,
"Fine Needle Aspiration Biopsy, Ultrasound; First Lesion",,10005,CPT,Facility,Both,,,,215,182.75,61.619,215,America's PPO,America's PPO,206.4645,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Fine Needle Aspiration Biopsy, Ultrasound; First Lesion",,10005,CPT,Facility,Both,,,,215,182.75,61.619,215,BlueCross BlueShield Minnesota, Federal Employee Program,211.56,98.4,,percent of total billed charges,,
"Fine Needle Aspiration Biopsy, Ultrasound; First Lesion",,10005,CPT,Facility,Both,,,,215,182.75,61.619,215,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,215,100,,percent of total billed charges,,
"Fine Needle Aspiration Biopsy, Ultrasound; First Lesion",,10005,CPT,Facility,Both,,,,215,182.75,61.619,215,BlueCross BlueShield Minnesota,High Value Network Plan,193.5,90,,percent of total billed charges,,
"Fine Needle Aspiration Biopsy, Ultrasound; First Lesion",,10005,CPT,Facility,Outpatient,,,,215,182.75,61.619,215,BlueCross BlueShield Minnesota,Medicare Advantage,105.35,49,,percent of total billed charges,,
"Fine Needle Aspiration Biopsy, Ultrasound; First Lesion",,10005,CPT,Facility,Inpatient,,,,215,182.75,61.619,215,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Fine Needle Aspiration Biopsy, Ultrasound; First Lesion",,10005,CPT,Facility,Both,,,,215,182.75,61.619,215,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,190.4255,88.57,,percent of total billed charges,,
"Fine Needle Aspiration Biopsy, Ultrasound; First Lesion",,10005,CPT,Facility,Both,,,,215,182.75,61.619,215,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,61.619,28.66,,percent of total billed charges,,
"Fine Needle Aspiration Biopsy, Ultrasound; First Lesion",,10005,CPT,Facility,Outpatient,,,,215,182.75,61.619,215,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),105.35,49,,percent of total billed charges,,
"Fine Needle Aspiration Biopsy, Ultrasound; First Lesion",,10005,CPT,Facility,Inpatient,,,,215,182.75,61.619,215,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Fine Needle Aspiration Biopsy, Ultrasound; First Lesion",,10005,CPT,Facility,Both,,,,215,182.75,61.619,215,CorVel,Worker's Compensation,215,100,,percent of total billed charges,,
"Fine Needle Aspiration Biopsy, Ultrasound; First Lesion",,10005,CPT,Facility,Both,,,,215,182.75,61.619,215,First Health Group Corporation,First Health Network,208.55,97,,percent of total billed charges,,
"Fine Needle Aspiration Biopsy, Ultrasound; First Lesion",,10005,CPT,Facility,Both,,,,215,182.75,61.619,215,"Health Partners, Inc.",Commercial,203.39,94.6,,percent of total billed charges,,
"Fine Needle Aspiration Biopsy, Ultrasound; First Lesion",,10005,CPT,Facility,Outpatient,,,,215,182.75,61.619,215,"Health Partners, Inc.",Medicare Advantage,105.35,49,,percent of total billed charges,,
"Fine Needle Aspiration Biopsy, Ultrasound; First Lesion",,10005,CPT,Facility,Inpatient,,,,215,182.75,61.619,215,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Fine Needle Aspiration Biopsy, Ultrasound; First Lesion",,10005,CPT,Facility,Both,,,,215,182.75,61.619,215,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),129,60,,percent of total billed charges,,
"Fine Needle Aspiration Biopsy, Ultrasound; First Lesion",,10005,CPT,Facility,Both,,,,215,182.75,61.619,215,"Health Partners, Inc.",State of Minnesota Advantage Program,175.225,81.5,,percent of total billed charges,,
"Fine Needle Aspiration Biopsy, Ultrasound; First Lesion",,10005,CPT,Facility,Both,,,,215,182.75,61.619,215,"Health Partners, Inc.",State Public Programs,107.5,50,,percent of total billed charges,,
"Fine Needle Aspiration Biopsy, Ultrasound; First Lesion",,10005,CPT,Facility,Both,,,,215,182.75,61.619,215,Humana Insurance Company,Commercial PPO,204.25,95,,percent of total billed charges,,
"Fine Needle Aspiration Biopsy, Ultrasound; First Lesion",,10005,CPT,Facility,Outpatient,,,,215,182.75,61.619,215,Humana Insurance Company,Medicare PPO,105.35,49,,percent of total billed charges,,
"Fine Needle Aspiration Biopsy, Ultrasound; First Lesion",,10005,CPT,Facility,Inpatient,,,,215,182.75,61.619,215,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Fine Needle Aspiration Biopsy, Ultrasound; First Lesion",,10005,CPT,Facility,Both,,,,215,182.75,61.619,215,Medica,Individual & Family,213.065,99.1,,percent of total billed charges,,
"Fine Needle Aspiration Biopsy, Ultrasound; First Lesion",,10005,CPT,Facility,Outpatient,,,,215,182.75,61.619,215,Medica,Medica Advantage Solution,107.07,49.8,,percent of total billed charges,,
"Fine Needle Aspiration Biopsy, Ultrasound; First Lesion",,10005,CPT,Facility,Inpatient,,,,215,182.75,61.619,215,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Fine Needle Aspiration Biopsy, Ultrasound; First Lesion",,10005,CPT,Facility,Outpatient,,,,215,182.75,61.619,215,Medica,Medical Assistance,95.89,44.6,,percent of total billed charges,,
"Fine Needle Aspiration Biopsy, Ultrasound; First Lesion",,10005,CPT,Facility,Inpatient,,,,215,182.75,61.619,215,Medica,Medical Assistance,,,,,Included in per diem rate,
"Fine Needle Aspiration Biopsy, Ultrasound; First Lesion",,10005,CPT,Facility,Outpatient,,,,215,182.75,61.619,215,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,107.07,49.8,,percent of total billed charges,,
"Fine Needle Aspiration Biopsy, Ultrasound; First Lesion",,10005,CPT,Facility,Inpatient,,,,215,182.75,61.619,215,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Fine Needle Aspiration Biopsy, Ultrasound; First Lesion",,10005,CPT,Facility,Both,,,,215,182.75,61.619,215,"Multiplan, Inc.","Multiplan, Inc.",202.1,94,,percent of total billed charges,,
"Fine Needle Aspiration Biopsy, Ultrasound; First Lesion",,10005,CPT,Facility,Outpatient,,,,215,182.75,61.619,215,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,193.715,90.1,,percent of total billed charges,,
"Fine Needle Aspiration Biopsy, Ultrasound; First Lesion",,10005,CPT,Facility,Inpatient,,,,215,182.75,61.619,215,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Fine Needle Aspiration Biopsy, Ultrasound; First Lesion",,10005,CPT,Facility,Both,,,,215,182.75,61.619,215,"Preferred One Administrative Services, INC.",PPO,211.99,98.6,,percent of total billed charges,,
"Fine Needle Aspiration Biopsy, Ultrasound; First Lesion",,10005,CPT,Facility,Outpatient,,,,215,182.75,61.619,215,PrimeWest Health,Minnesota Senior Health Options (MSHO),110.6175,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Fine Needle Aspiration Biopsy, Ultrasound; First Lesion",,10005,CPT,Facility,Inpatient,,,,215,182.75,61.619,215,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Fine Needle Aspiration Biopsy, Ultrasound; First Lesion",,10005,CPT,Facility,Outpatient,,,,215,182.75,61.619,215,PrimeWest Health,MinnesotaCare,110.424,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Fine Needle Aspiration Biopsy, Ultrasound; First Lesion",,10005,CPT,Facility,Inpatient,,,,215,182.75,61.619,215,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Fine Needle Aspiration Biopsy, Ultrasound; First Lesion",,10005,CPT,Facility,Both,,,,215,182.75,61.619,215,Sanford Health Plan,Sanford Health Plan,197.8,92,,percent of total billed charges,,
"Fine Needle Aspiration Biopsy, Ultrasound; First Lesion",,10005,CPT,Facility,Outpatient,,,,215,182.75,61.619,215,"UCare Health, Inc.",Individual & Family Plan,121.1525,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Fine Needle Aspiration Biopsy, Ultrasound; First Lesion",,10005,CPT,Facility,Inpatient,,,,215,182.75,61.619,215,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Fine Needle Aspiration Biopsy, Ultrasound; First Lesion",,10005,CPT,Facility,Outpatient,,,,215,182.75,61.619,215,"UCare Health, Inc.",Medical Assistance,108.5105,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Fine Needle Aspiration Biopsy, Ultrasound; First Lesion",,10005,CPT,Facility,Inpatient,,,,215,182.75,61.619,215,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Fine Needle Aspiration Biopsy, Ultrasound; First Lesion",,10005,CPT,Facility,Outpatient,,,,215,182.75,61.619,215,"UCare Health, Inc.",Medicare Advantage,108.5105,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Fine Needle Aspiration Biopsy, Ultrasound; First Lesion",,10005,CPT,Facility,Inpatient,,,,215,182.75,61.619,215,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Fine Needle Aspiration Biopsy, Ultrasound; First Lesion",,10005,CPT,Facility,Outpatient,,,,215,182.75,61.619,215,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),108.5105,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Fine Needle Aspiration Biopsy, Ultrasound; First Lesion",,10005,CPT,Facility,Inpatient,,,,215,182.75,61.619,215,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Fine Needle Aspiration Biopsy, Ultrasound; First Lesion",,10005,CPT,Facility,Both,,,,215,182.75,61.619,215,UnitedHealthcare,Individual & Family,202.1,94,,percent of total billed charges,,
"Fine Needle Aspiration Biopsy, Ultrasound; First Lesion",,10005,CPT,Facility,Outpatient,,,,215,182.75,61.619,215,UnitedHealthcare,Medicare Advantage,105.35,49,,percent of total billed charges,,
"Fine Needle Aspiration Biopsy, Ultrasound; First Lesion",,10005,CPT,Facility,Inpatient,,,,215,182.75,61.619,215,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Fine Needle Aspiration Biopsy, Ultrasound; First Lesion",,10005,CPT,Facility,Outpatient,,,,215,182.75,61.619,215,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,103.2,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Fine Needle Aspiration Biopsy, Ultrasound; First Lesion",,10005,CPT,Facility,Inpatient,,,,215,182.75,61.619,215,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; Each Additional Lesion (Pro Cah)",,10006,CPT,Professional,Both,,,,240,204,30.76,240,Aetna,Commercial,204,85,,percent of total billed charges,,
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; Each Additional Lesion (Pro Cah)",,10006,CPT,Professional,Both,,,,240,204,30.76,240,Aetna,Commercial,204,85,,percent of total billed charges,,
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; Each Additional Lesion (Pro Cah)",,10006,CPT,Professional,Both,,,,240,204,30.76,240,Aetna,Medicare Advantage,49.2,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; Each Additional Lesion (Pro Cah)",,10006,CPT,Professional,Both,,,,240,204,30.76,240,Aetna,Medicare Advantage,49.2,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; Each Additional Lesion (Pro Cah)",,10006,CPT,Professional,Both,,,,240,204,30.76,240,Aetna,PPO,223.2,93,,percent of total billed charges,,
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; Each Additional Lesion (Pro Cah)",,10006,CPT,Professional,Both,,,,240,204,30.76,240,Aetna,PPO,223.2,93,,percent of total billed charges,,
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; Each Additional Lesion (Pro Cah)",,10006,CPT,Professional,Both,,,,240,204,30.76,240,America's PPO,America's PPO,205.056,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; Each Additional Lesion (Pro Cah)",,10006,CPT,Professional,Both,,,,240,204,30.76,240,America's PPO,America's PPO,205.056,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; Each Additional Lesion (Pro Cah)",,10006,CPT,Professional,Both,,,,240,204,30.76,240,BlueCross BlueShield Minnesota, Federal Employee Program,101.91,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; Each Additional Lesion (Pro Cah)",,10006,CPT,Professional,Both,,,,240,204,30.76,240,BlueCross BlueShield Minnesota, Federal Employee Program,101.91,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; Each Additional Lesion (Pro Cah)",,10006,CPT,Professional,Both,,,,240,204,30.76,240,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,103.54056,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; Each Additional Lesion (Pro Cah)",,10006,CPT,Professional,Both,,,,240,204,30.76,240,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,103.54056,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; Each Additional Lesion (Pro Cah)",,10006,CPT,Professional,Both,,,,240,204,30.76,240,BlueCross BlueShield Minnesota,High Value Network Plan,103.54056,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; Each Additional Lesion (Pro Cah)",,10006,CPT,Professional,Both,,,,240,204,30.76,240,BlueCross BlueShield Minnesota,High Value Network Plan,103.54056,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; Each Additional Lesion (Pro Cah)",,10006,CPT,Professional,Both,,,,240,204,30.76,240,BlueCross BlueShield Minnesota,Medicare Advantage,55.3265,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; Each Additional Lesion (Pro Cah)",,10006,CPT,Professional,Both,,,,240,204,30.76,240,BlueCross BlueShield Minnesota,Medicare Advantage,55.3265,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; Each Additional Lesion (Pro Cah)",,10006,CPT,Professional,Both,,,,240,204,30.76,240,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,103.54056,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; Each Additional Lesion (Pro Cah)",,10006,CPT,Professional,Both,,,,240,204,30.76,240,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,103.54056,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; Each Additional Lesion (Pro Cah)",,10006,CPT,Professional,Both,,,,240,204,30.76,240,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,35.5092,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; Each Additional Lesion (Pro Cah)",,10006,CPT,Professional,Both,,,,240,204,30.76,240,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,35.5092,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; Each Additional Lesion (Pro Cah)",,10006,CPT,Professional,Both,,,,240,204,30.76,240,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),55.3265,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; Each Additional Lesion (Pro Cah)",,10006,CPT,Professional,Both,,,,240,204,30.76,240,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),55.3265,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; Each Additional Lesion (Pro Cah)",,10006,CPT,Professional,Both,,,,240,204,30.76,240,CorVel,Worker's Compensation,95.3975208,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; Each Additional Lesion (Pro Cah)",,10006,CPT,Professional,Both,,,,240,204,30.76,240,CorVel,Worker's Compensation,95.3975208,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; Each Additional Lesion (Pro Cah)",,10006,CPT,Professional,Both,,,,240,204,30.76,240,First Health Group Corporation,First Health Network,232.8,97,,percent of total billed charges,,
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; Each Additional Lesion (Pro Cah)",,10006,CPT,Professional,Both,,,,240,204,30.76,240,First Health Group Corporation,First Health Network,232.8,97,,percent of total billed charges,,
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; Each Additional Lesion (Pro Cah)",,10006,CPT,Professional,Both,,,,240,204,30.76,240,"Health Partners, Inc.",Commercial,103.02,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; Each Additional Lesion (Pro Cah)",,10006,CPT,Professional,Both,,,,240,204,30.76,240,"Health Partners, Inc.",Commercial,103.02,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; Each Additional Lesion (Pro Cah)",,10006,CPT,Professional,Both,,,,240,204,30.76,240,"Health Partners, Inc.",Medicare Advantage,55.3265,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; Each Additional Lesion (Pro Cah)",,10006,CPT,Professional,Both,,,,240,204,30.76,240,"Health Partners, Inc.",Medicare Advantage,55.3265,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; Each Additional Lesion (Pro Cah)",,10006,CPT,Professional,Both,,,,240,204,30.76,240,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),48.12,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; Each Additional Lesion (Pro Cah)",,10006,CPT,Professional,Both,,,,240,204,30.76,240,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),48.12,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; Each Additional Lesion (Pro Cah)",,10006,CPT,Professional,Both,,,,240,204,30.76,240,"Health Partners, Inc.",State of Minnesota Advantage Program,88.75173,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; Each Additional Lesion (Pro Cah)",,10006,CPT,Professional,Both,,,,240,204,30.76,240,"Health Partners, Inc.",State of Minnesota Advantage Program,88.75173,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; Each Additional Lesion (Pro Cah)",,10006,CPT,Professional,Both,,,,240,204,30.76,240,"Health Partners, Inc.",State Public Programs,30.76,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; Each Additional Lesion (Pro Cah)",,10006,CPT,Professional,Both,,,,240,204,30.76,240,"Health Partners, Inc.",State Public Programs,30.76,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; Each Additional Lesion (Pro Cah)",,10006,CPT,Professional,Both,,,,240,204,30.76,240,Humana Insurance Company,Commercial PPO,48.11,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; Each Additional Lesion (Pro Cah)",,10006,CPT,Professional,Both,,,,240,204,30.76,240,Humana Insurance Company,Commercial PPO,48.11,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; Each Additional Lesion (Pro Cah)",,10006,CPT,Professional,Both,,,,240,204,30.76,240,Humana Insurance Company,Medicare PPO,240,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; Each Additional Lesion (Pro Cah)",,10006,CPT,Professional,Both,,,,240,204,30.76,240,Humana Insurance Company,Medicare PPO,240,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; Each Additional Lesion (Pro Cah)",,10006,CPT,Professional,Both,,,,240,204,30.76,240,Medica,Individual & Family,203.52,84.8,,percent of total billed charges,,
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; Each Additional Lesion (Pro Cah)",,10006,CPT,Professional,Both,,,,240,204,30.76,240,Medica,Individual & Family,203.52,84.8,,percent of total billed charges,,
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; Each Additional Lesion (Pro Cah)",,10006,CPT,Professional,Both,,,,240,204,30.76,240,Medica,Medica Advantage Solution,119.52,49.8,,percent of total billed charges,,
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; Each Additional Lesion (Pro Cah)",,10006,CPT,Professional,Both,,,,240,204,30.76,240,Medica,Medica Advantage Solution,119.52,49.8,,percent of total billed charges,,
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; Each Additional Lesion (Pro Cah)",,10006,CPT,Professional,Both,,,,240,204,30.76,240,Medica,Medical Assistance,35.51,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; Each Additional Lesion (Pro Cah)",,10006,CPT,Professional,Both,,,,240,204,30.76,240,Medica,Medical Assistance,35.51,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; Each Additional Lesion (Pro Cah)",,10006,CPT,Professional,Both,,,,240,204,30.76,240,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,48.11,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; Each Additional Lesion (Pro Cah)",,10006,CPT,Professional,Both,,,,240,204,30.76,240,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,48.11,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; Each Additional Lesion (Pro Cah)",,10006,CPT,Professional,Both,,,,240,204,30.76,240,"Multiplan, Inc.","Multiplan, Inc.",225.6,94,,percent of total billed charges,,
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; Each Additional Lesion (Pro Cah)",,10006,CPT,Professional,Both,,,,240,204,30.76,240,"Multiplan, Inc.","Multiplan, Inc.",225.6,94,,percent of total billed charges,,
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; Each Additional Lesion (Pro Cah)",,10006,CPT,Professional,Both,,,,240,204,30.76,240,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,216.24,90.1,,percent of total billed charges,,
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; Each Additional Lesion (Pro Cah)",,10006,CPT,Professional,Both,,,,240,204,30.76,240,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,216.24,90.1,,percent of total billed charges,,
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; Each Additional Lesion (Pro Cah)",,10006,CPT,Professional,Both,,,,240,204,30.76,240,"Preferred One Administrative Services, INC.",PPO,236.64,98.6,,percent of total billed charges,,
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; Each Additional Lesion (Pro Cah)",,10006,CPT,Professional,Both,,,,240,204,30.76,240,"Preferred One Administrative Services, INC.",PPO,236.64,98.6,,percent of total billed charges,,
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; Each Additional Lesion (Pro Cah)",,10006,CPT,Professional,Both,,,,240,204,30.76,240,PrimeWest Health,Minnesota Senior Health Options (MSHO),55.3265,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; Each Additional Lesion (Pro Cah)",,10006,CPT,Professional,Both,,,,240,204,30.76,240,PrimeWest Health,Minnesota Senior Health Options (MSHO),55.3265,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; Each Additional Lesion (Pro Cah)",,10006,CPT,Professional,Both,,,,240,204,30.76,240,PrimeWest Health,MinnesotaCare,37.994844,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; Each Additional Lesion (Pro Cah)",,10006,CPT,Professional,Both,,,,240,204,30.76,240,PrimeWest Health,MinnesotaCare,37.994844,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; Each Additional Lesion (Pro Cah)",,10006,CPT,Professional,Both,,,,240,204,30.76,240,Sanford Health Plan,Sanford Health Plan,211.2,88,,percent of total billed charges,,
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; Each Additional Lesion (Pro Cah)",,10006,CPT,Professional,Both,,,,240,204,30.76,240,Sanford Health Plan,Sanford Health Plan,211.2,88,,percent of total billed charges,,
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; Each Additional Lesion (Pro Cah)",,10006,CPT,Professional,Both,,,,240,204,30.76,240,"UCare Health, Inc.",Individual & Family Plan,78.207616,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; Each Additional Lesion (Pro Cah)",,10006,CPT,Professional,Both,,,,240,204,30.76,240,"UCare Health, Inc.",Individual & Family Plan,78.207616,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; Each Additional Lesion (Pro Cah)",,10006,CPT,Professional,Both,,,,240,204,30.76,240,"UCare Health, Inc.",Medical Assistance,39.06012,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; Each Additional Lesion (Pro Cah)",,10006,CPT,Professional,Both,,,,240,204,30.76,240,"UCare Health, Inc.",Medical Assistance,39.06012,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; Each Additional Lesion (Pro Cah)",,10006,CPT,Professional,Both,,,,240,204,30.76,240,"UCare Health, Inc.",Medicare Advantage,55.3265,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; Each Additional Lesion (Pro Cah)",,10006,CPT,Professional,Both,,,,240,204,30.76,240,"UCare Health, Inc.",Medicare Advantage,55.3265,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; Each Additional Lesion (Pro Cah)",,10006,CPT,Professional,Both,,,,240,204,30.76,240,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),44.2612,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; Each Additional Lesion (Pro Cah)",,10006,CPT,Professional,Both,,,,240,204,30.76,240,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),44.2612,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; Each Additional Lesion (Pro Cah)",,10006,CPT,Professional,Both,,,,240,204,30.76,240,UnitedHealthcare,Individual & Family,240,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; Each Additional Lesion (Pro Cah)",,10006,CPT,Professional,Both,,,,240,204,30.76,240,UnitedHealthcare,Individual & Family,240,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; Each Additional Lesion (Pro Cah)",,10006,CPT,Professional,Both,,,,240,204,30.76,240,UnitedHealthcare,Medicare Advantage,55.3265,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; Each Additional Lesion (Pro Cah)",,10006,CPT,Professional,Both,,,,240,204,30.76,240,UnitedHealthcare,Medicare Advantage,55.3265,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; Each Additional Lesion (Pro Cah)",,10006,CPT,Professional,Both,,,,240,204,30.76,240,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,35.5092,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Fine Needle Aspiration Biopsy, Including Ultrasound Guidance; Each Additional Lesion (Pro Cah)",,10006,CPT,Professional,Both,,,,240,204,30.76,240,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,35.5092,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Fine Needle Aspiration Biopsy, Ultrasound; Each Additional Lesion",,10006,CPT,Facility,Both,,,,145,123.25,41.557,145,Aetna,Commercial,133.4,92,,percent of total billed charges,,
"Fine Needle Aspiration Biopsy, Ultrasound; Each Additional Lesion",,10006,CPT,Facility,Outpatient,,,,145,123.25,41.557,145,Aetna,Medicare Advantage,71.05,49,,percent of total billed charges,,
"Fine Needle Aspiration Biopsy, Ultrasound; Each Additional Lesion",,10006,CPT,Facility,Inpatient,,,,145,123.25,41.557,145,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Fine Needle Aspiration Biopsy, Ultrasound; Each Additional Lesion",,10006,CPT,Facility,Both,,,,145,123.25,41.557,145,Aetna,PPO,134.85,93,,percent of total billed charges,,
"Fine Needle Aspiration Biopsy, Ultrasound; Each Additional Lesion",,10006,CPT,Facility,Both,,,,145,123.25,41.557,145,America's PPO,America's PPO,139.2435,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Fine Needle Aspiration Biopsy, Ultrasound; Each Additional Lesion",,10006,CPT,Facility,Both,,,,145,123.25,41.557,145,BlueCross BlueShield Minnesota, Federal Employee Program,142.68,98.4,,percent of total billed charges,,
"Fine Needle Aspiration Biopsy, Ultrasound; Each Additional Lesion",,10006,CPT,Facility,Both,,,,145,123.25,41.557,145,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,145,100,,percent of total billed charges,,
"Fine Needle Aspiration Biopsy, Ultrasound; Each Additional Lesion",,10006,CPT,Facility,Both,,,,145,123.25,41.557,145,BlueCross BlueShield Minnesota,High Value Network Plan,130.5,90,,percent of total billed charges,,
"Fine Needle Aspiration Biopsy, Ultrasound; Each Additional Lesion",,10006,CPT,Facility,Outpatient,,,,145,123.25,41.557,145,BlueCross BlueShield Minnesota,Medicare Advantage,71.05,49,,percent of total billed charges,,
"Fine Needle Aspiration Biopsy, Ultrasound; Each Additional Lesion",,10006,CPT,Facility,Inpatient,,,,145,123.25,41.557,145,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Fine Needle Aspiration Biopsy, Ultrasound; Each Additional Lesion",,10006,CPT,Facility,Both,,,,145,123.25,41.557,145,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,128.4265,88.57,,percent of total billed charges,,
"Fine Needle Aspiration Biopsy, Ultrasound; Each Additional Lesion",,10006,CPT,Facility,Both,,,,145,123.25,41.557,145,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,41.557,28.66,,percent of total billed charges,,
"Fine Needle Aspiration Biopsy, Ultrasound; Each Additional Lesion",,10006,CPT,Facility,Outpatient,,,,145,123.25,41.557,145,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),71.05,49,,percent of total billed charges,,
"Fine Needle Aspiration Biopsy, Ultrasound; Each Additional Lesion",,10006,CPT,Facility,Inpatient,,,,145,123.25,41.557,145,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Fine Needle Aspiration Biopsy, Ultrasound; Each Additional Lesion",,10006,CPT,Facility,Both,,,,145,123.25,41.557,145,CorVel,Worker's Compensation,145,100,,percent of total billed charges,,
"Fine Needle Aspiration Biopsy, Ultrasound; Each Additional Lesion",,10006,CPT,Facility,Both,,,,145,123.25,41.557,145,First Health Group Corporation,First Health Network,140.65,97,,percent of total billed charges,,
"Fine Needle Aspiration Biopsy, Ultrasound; Each Additional Lesion",,10006,CPT,Facility,Both,,,,145,123.25,41.557,145,"Health Partners, Inc.",Commercial,137.17,94.6,,percent of total billed charges,,
"Fine Needle Aspiration Biopsy, Ultrasound; Each Additional Lesion",,10006,CPT,Facility,Outpatient,,,,145,123.25,41.557,145,"Health Partners, Inc.",Medicare Advantage,71.05,49,,percent of total billed charges,,
"Fine Needle Aspiration Biopsy, Ultrasound; Each Additional Lesion",,10006,CPT,Facility,Inpatient,,,,145,123.25,41.557,145,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Fine Needle Aspiration Biopsy, Ultrasound; Each Additional Lesion",,10006,CPT,Facility,Both,,,,145,123.25,41.557,145,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),87,60,,percent of total billed charges,,
"Fine Needle Aspiration Biopsy, Ultrasound; Each Additional Lesion",,10006,CPT,Facility,Both,,,,145,123.25,41.557,145,"Health Partners, Inc.",State of Minnesota Advantage Program,118.175,81.5,,percent of total billed charges,,
"Fine Needle Aspiration Biopsy, Ultrasound; Each Additional Lesion",,10006,CPT,Facility,Both,,,,145,123.25,41.557,145,"Health Partners, Inc.",State Public Programs,72.5,50,,percent of total billed charges,,
"Fine Needle Aspiration Biopsy, Ultrasound; Each Additional Lesion",,10006,CPT,Facility,Both,,,,145,123.25,41.557,145,Humana Insurance Company,Commercial PPO,137.75,95,,percent of total billed charges,,
"Fine Needle Aspiration Biopsy, Ultrasound; Each Additional Lesion",,10006,CPT,Facility,Outpatient,,,,145,123.25,41.557,145,Humana Insurance Company,Medicare PPO,71.05,49,,percent of total billed charges,,
"Fine Needle Aspiration Biopsy, Ultrasound; Each Additional Lesion",,10006,CPT,Facility,Inpatient,,,,145,123.25,41.557,145,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Fine Needle Aspiration Biopsy, Ultrasound; Each Additional Lesion",,10006,CPT,Facility,Both,,,,145,123.25,41.557,145,Medica,Individual & Family,143.695,99.1,,percent of total billed charges,,
"Fine Needle Aspiration Biopsy, Ultrasound; Each Additional Lesion",,10006,CPT,Facility,Outpatient,,,,145,123.25,41.557,145,Medica,Medica Advantage Solution,72.21,49.8,,percent of total billed charges,,
"Fine Needle Aspiration Biopsy, Ultrasound; Each Additional Lesion",,10006,CPT,Facility,Inpatient,,,,145,123.25,41.557,145,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Fine Needle Aspiration Biopsy, Ultrasound; Each Additional Lesion",,10006,CPT,Facility,Outpatient,,,,145,123.25,41.557,145,Medica,Medical Assistance,64.67,44.6,,percent of total billed charges,,
"Fine Needle Aspiration Biopsy, Ultrasound; Each Additional Lesion",,10006,CPT,Facility,Inpatient,,,,145,123.25,41.557,145,Medica,Medical Assistance,,,,,Included in per diem rate,
"Fine Needle Aspiration Biopsy, Ultrasound; Each Additional Lesion",,10006,CPT,Facility,Outpatient,,,,145,123.25,41.557,145,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,72.21,49.8,,percent of total billed charges,,
"Fine Needle Aspiration Biopsy, Ultrasound; Each Additional Lesion",,10006,CPT,Facility,Inpatient,,,,145,123.25,41.557,145,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Fine Needle Aspiration Biopsy, Ultrasound; Each Additional Lesion",,10006,CPT,Facility,Both,,,,145,123.25,41.557,145,"Multiplan, Inc.","Multiplan, Inc.",136.3,94,,percent of total billed charges,,
"Fine Needle Aspiration Biopsy, Ultrasound; Each Additional Lesion",,10006,CPT,Facility,Outpatient,,,,145,123.25,41.557,145,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,130.645,90.1,,percent of total billed charges,,
"Fine Needle Aspiration Biopsy, Ultrasound; Each Additional Lesion",,10006,CPT,Facility,Inpatient,,,,145,123.25,41.557,145,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Fine Needle Aspiration Biopsy, Ultrasound; Each Additional Lesion",,10006,CPT,Facility,Both,,,,145,123.25,41.557,145,"Preferred One Administrative Services, INC.",PPO,142.97,98.6,,percent of total billed charges,,
"Fine Needle Aspiration Biopsy, Ultrasound; Each Additional Lesion",,10006,CPT,Facility,Outpatient,,,,145,123.25,41.557,145,PrimeWest Health,Minnesota Senior Health Options (MSHO),74.6025,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Fine Needle Aspiration Biopsy, Ultrasound; Each Additional Lesion",,10006,CPT,Facility,Inpatient,,,,145,123.25,41.557,145,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Fine Needle Aspiration Biopsy, Ultrasound; Each Additional Lesion",,10006,CPT,Facility,Outpatient,,,,145,123.25,41.557,145,PrimeWest Health,MinnesotaCare,74.472,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Fine Needle Aspiration Biopsy, Ultrasound; Each Additional Lesion",,10006,CPT,Facility,Inpatient,,,,145,123.25,41.557,145,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Fine Needle Aspiration Biopsy, Ultrasound; Each Additional Lesion",,10006,CPT,Facility,Both,,,,145,123.25,41.557,145,Sanford Health Plan,Sanford Health Plan,133.4,92,,percent of total billed charges,,
"Fine Needle Aspiration Biopsy, Ultrasound; Each Additional Lesion",,10006,CPT,Facility,Outpatient,,,,145,123.25,41.557,145,"UCare Health, Inc.",Individual & Family Plan,81.7075,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Fine Needle Aspiration Biopsy, Ultrasound; Each Additional Lesion",,10006,CPT,Facility,Inpatient,,,,145,123.25,41.557,145,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Fine Needle Aspiration Biopsy, Ultrasound; Each Additional Lesion",,10006,CPT,Facility,Outpatient,,,,145,123.25,41.557,145,"UCare Health, Inc.",Medical Assistance,73.1815,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Fine Needle Aspiration Biopsy, Ultrasound; Each Additional Lesion",,10006,CPT,Facility,Inpatient,,,,145,123.25,41.557,145,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Fine Needle Aspiration Biopsy, Ultrasound; Each Additional Lesion",,10006,CPT,Facility,Outpatient,,,,145,123.25,41.557,145,"UCare Health, Inc.",Medicare Advantage,73.1815,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Fine Needle Aspiration Biopsy, Ultrasound; Each Additional Lesion",,10006,CPT,Facility,Inpatient,,,,145,123.25,41.557,145,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Fine Needle Aspiration Biopsy, Ultrasound; Each Additional Lesion",,10006,CPT,Facility,Outpatient,,,,145,123.25,41.557,145,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),73.1815,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Fine Needle Aspiration Biopsy, Ultrasound; Each Additional Lesion",,10006,CPT,Facility,Inpatient,,,,145,123.25,41.557,145,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Fine Needle Aspiration Biopsy, Ultrasound; Each Additional Lesion",,10006,CPT,Facility,Both,,,,145,123.25,41.557,145,UnitedHealthcare,Individual & Family,136.3,94,,percent of total billed charges,,
"Fine Needle Aspiration Biopsy, Ultrasound; Each Additional Lesion",,10006,CPT,Facility,Outpatient,,,,145,123.25,41.557,145,UnitedHealthcare,Medicare Advantage,71.05,49,,percent of total billed charges,,
"Fine Needle Aspiration Biopsy, Ultrasound; Each Additional Lesion",,10006,CPT,Facility,Inpatient,,,,145,123.25,41.557,145,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Fine Needle Aspiration Biopsy, Ultrasound; Each Additional Lesion",,10006,CPT,Facility,Outpatient,,,,145,123.25,41.557,145,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,69.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Fine Needle Aspiration Biopsy, Ultrasound; Each Additional Lesion",,10006,CPT,Facility,Inpatient,,,,145,123.25,41.557,145,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Fine Needle Aspiration Bx; Wo Imaging Guidance; First Lesion (Pro Cah),,10021,CPT,Professional,Both,,,,240,204,33.59,240,Aetna,Commercial,204,85,,percent of total billed charges,,
Fine Needle Aspiration Bx; Wo Imaging Guidance; First Lesion (Pro Cah),,10021,CPT,Professional,Both,,,,240,204,33.59,240,Aetna,Commercial,204,85,,percent of total billed charges,,
Fine Needle Aspiration Bx; Wo Imaging Guidance; First Lesion (Pro Cah),,10021,CPT,Professional,Both,,,,240,204,33.59,240,Aetna,Medicare Advantage,53.22,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Fine Needle Aspiration Bx; Wo Imaging Guidance; First Lesion (Pro Cah),,10021,CPT,Professional,Both,,,,240,204,33.59,240,Aetna,Medicare Advantage,53.22,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Fine Needle Aspiration Bx; Wo Imaging Guidance; First Lesion (Pro Cah),,10021,CPT,Professional,Both,,,,240,204,33.59,240,Aetna,PPO,223.2,93,,percent of total billed charges,,
Fine Needle Aspiration Bx; Wo Imaging Guidance; First Lesion (Pro Cah),,10021,CPT,Professional,Both,,,,240,204,33.59,240,Aetna,PPO,223.2,93,,percent of total billed charges,,
Fine Needle Aspiration Bx; Wo Imaging Guidance; First Lesion (Pro Cah),,10021,CPT,Professional,Both,,,,240,204,33.59,240,America's PPO,America's PPO,205.056,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Fine Needle Aspiration Bx; Wo Imaging Guidance; First Lesion (Pro Cah),,10021,CPT,Professional,Both,,,,240,204,33.59,240,America's PPO,America's PPO,205.056,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Fine Needle Aspiration Bx; Wo Imaging Guidance; First Lesion (Pro Cah),,10021,CPT,Professional,Both,,,,240,204,33.59,240,BlueCross BlueShield Minnesota, Federal Employee Program,112.24,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Fine Needle Aspiration Bx; Wo Imaging Guidance; First Lesion (Pro Cah),,10021,CPT,Professional,Both,,,,240,204,33.59,240,BlueCross BlueShield Minnesota, Federal Employee Program,112.24,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Fine Needle Aspiration Bx; Wo Imaging Guidance; First Lesion (Pro Cah),,10021,CPT,Professional,Both,,,,240,204,33.59,240,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,114.03584,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Fine Needle Aspiration Bx; Wo Imaging Guidance; First Lesion (Pro Cah),,10021,CPT,Professional,Both,,,,240,204,33.59,240,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,114.03584,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Fine Needle Aspiration Bx; Wo Imaging Guidance; First Lesion (Pro Cah),,10021,CPT,Professional,Both,,,,240,204,33.59,240,BlueCross BlueShield Minnesota,High Value Network Plan,114.03584,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Fine Needle Aspiration Bx; Wo Imaging Guidance; First Lesion (Pro Cah),,10021,CPT,Professional,Both,,,,240,204,33.59,240,BlueCross BlueShield Minnesota,High Value Network Plan,114.03584,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Fine Needle Aspiration Bx; Wo Imaging Guidance; First Lesion (Pro Cah),,10021,CPT,Professional,Both,,,,240,204,33.59,240,BlueCross BlueShield Minnesota,Medicare Advantage,60.1795,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Fine Needle Aspiration Bx; Wo Imaging Guidance; First Lesion (Pro Cah),,10021,CPT,Professional,Both,,,,240,204,33.59,240,BlueCross BlueShield Minnesota,Medicare Advantage,60.1795,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Fine Needle Aspiration Bx; Wo Imaging Guidance; First Lesion (Pro Cah),,10021,CPT,Professional,Both,,,,240,204,33.59,240,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,114.03584,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Fine Needle Aspiration Bx; Wo Imaging Guidance; First Lesion (Pro Cah),,10021,CPT,Professional,Both,,,,240,204,33.59,240,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,114.03584,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Fine Needle Aspiration Bx; Wo Imaging Guidance; First Lesion (Pro Cah),,10021,CPT,Professional,Both,,,,240,204,33.59,240,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,38.78072,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Fine Needle Aspiration Bx; Wo Imaging Guidance; First Lesion (Pro Cah),,10021,CPT,Professional,Both,,,,240,204,33.59,240,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,38.78072,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Fine Needle Aspiration Bx; Wo Imaging Guidance; First Lesion (Pro Cah),,10021,CPT,Professional,Both,,,,240,204,33.59,240,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),60.1795,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Fine Needle Aspiration Bx; Wo Imaging Guidance; First Lesion (Pro Cah),,10021,CPT,Professional,Both,,,,240,204,33.59,240,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),60.1795,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Fine Needle Aspiration Bx; Wo Imaging Guidance; First Lesion (Pro Cah),,10021,CPT,Professional,Both,,,,240,204,33.59,240,CorVel,Worker's Compensation,102.6498657,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Fine Needle Aspiration Bx; Wo Imaging Guidance; First Lesion (Pro Cah),,10021,CPT,Professional,Both,,,,240,204,33.59,240,CorVel,Worker's Compensation,102.6498657,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Fine Needle Aspiration Bx; Wo Imaging Guidance; First Lesion (Pro Cah),,10021,CPT,Professional,Both,,,,240,204,33.59,240,First Health Group Corporation,First Health Network,232.8,97,,percent of total billed charges,,
Fine Needle Aspiration Bx; Wo Imaging Guidance; First Lesion (Pro Cah),,10021,CPT,Professional,Both,,,,240,204,33.59,240,First Health Group Corporation,First Health Network,232.8,97,,percent of total billed charges,,
Fine Needle Aspiration Bx; Wo Imaging Guidance; First Lesion (Pro Cah),,10021,CPT,Professional,Both,,,,240,204,33.59,240,"Health Partners, Inc.",Commercial,111.01,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Fine Needle Aspiration Bx; Wo Imaging Guidance; First Lesion (Pro Cah),,10021,CPT,Professional,Both,,,,240,204,33.59,240,"Health Partners, Inc.",Commercial,111.01,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Fine Needle Aspiration Bx; Wo Imaging Guidance; First Lesion (Pro Cah),,10021,CPT,Professional,Both,,,,240,204,33.59,240,"Health Partners, Inc.",Medicare Advantage,60.1795,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Fine Needle Aspiration Bx; Wo Imaging Guidance; First Lesion (Pro Cah),,10021,CPT,Professional,Both,,,,240,204,33.59,240,"Health Partners, Inc.",Medicare Advantage,60.1795,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Fine Needle Aspiration Bx; Wo Imaging Guidance; First Lesion (Pro Cah),,10021,CPT,Professional,Both,,,,240,204,33.59,240,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),52.53,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Fine Needle Aspiration Bx; Wo Imaging Guidance; First Lesion (Pro Cah),,10021,CPT,Professional,Both,,,,240,204,33.59,240,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),52.53,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Fine Needle Aspiration Bx; Wo Imaging Guidance; First Lesion (Pro Cah),,10021,CPT,Professional,Both,,,,240,204,33.59,240,"Health Partners, Inc.",State of Minnesota Advantage Program,95.635115,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Fine Needle Aspiration Bx; Wo Imaging Guidance; First Lesion (Pro Cah),,10021,CPT,Professional,Both,,,,240,204,33.59,240,"Health Partners, Inc.",State of Minnesota Advantage Program,95.635115,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Fine Needle Aspiration Bx; Wo Imaging Guidance; First Lesion (Pro Cah),,10021,CPT,Professional,Both,,,,240,204,33.59,240,"Health Partners, Inc.",State Public Programs,33.59,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Fine Needle Aspiration Bx; Wo Imaging Guidance; First Lesion (Pro Cah),,10021,CPT,Professional,Both,,,,240,204,33.59,240,"Health Partners, Inc.",State Public Programs,33.59,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Fine Needle Aspiration Bx; Wo Imaging Guidance; First Lesion (Pro Cah),,10021,CPT,Professional,Both,,,,240,204,33.59,240,Humana Insurance Company,Commercial PPO,52.33,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Fine Needle Aspiration Bx; Wo Imaging Guidance; First Lesion (Pro Cah),,10021,CPT,Professional,Both,,,,240,204,33.59,240,Humana Insurance Company,Commercial PPO,52.33,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Fine Needle Aspiration Bx; Wo Imaging Guidance; First Lesion (Pro Cah),,10021,CPT,Professional,Both,,,,240,204,33.59,240,Humana Insurance Company,Medicare PPO,240,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Fine Needle Aspiration Bx; Wo Imaging Guidance; First Lesion (Pro Cah),,10021,CPT,Professional,Both,,,,240,204,33.59,240,Humana Insurance Company,Medicare PPO,240,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Fine Needle Aspiration Bx; Wo Imaging Guidance; First Lesion (Pro Cah),,10021,CPT,Professional,Both,,,,240,204,33.59,240,Medica,Individual & Family,203.52,84.8,,percent of total billed charges,,
Fine Needle Aspiration Bx; Wo Imaging Guidance; First Lesion (Pro Cah),,10021,CPT,Professional,Both,,,,240,204,33.59,240,Medica,Individual & Family,203.52,84.8,,percent of total billed charges,,
Fine Needle Aspiration Bx; Wo Imaging Guidance; First Lesion (Pro Cah),,10021,CPT,Professional,Both,,,,240,204,33.59,240,Medica,Medica Advantage Solution,119.52,49.8,,percent of total billed charges,,
Fine Needle Aspiration Bx; Wo Imaging Guidance; First Lesion (Pro Cah),,10021,CPT,Professional,Both,,,,240,204,33.59,240,Medica,Medica Advantage Solution,119.52,49.8,,percent of total billed charges,,
Fine Needle Aspiration Bx; Wo Imaging Guidance; First Lesion (Pro Cah),,10021,CPT,Professional,Both,,,,240,204,33.59,240,Medica,Medical Assistance,38.78,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Fine Needle Aspiration Bx; Wo Imaging Guidance; First Lesion (Pro Cah),,10021,CPT,Professional,Both,,,,240,204,33.59,240,Medica,Medical Assistance,38.78,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Fine Needle Aspiration Bx; Wo Imaging Guidance; First Lesion (Pro Cah),,10021,CPT,Professional,Both,,,,240,204,33.59,240,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,52.33,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Fine Needle Aspiration Bx; Wo Imaging Guidance; First Lesion (Pro Cah),,10021,CPT,Professional,Both,,,,240,204,33.59,240,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,52.33,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Fine Needle Aspiration Bx; Wo Imaging Guidance; First Lesion (Pro Cah),,10021,CPT,Professional,Both,,,,240,204,33.59,240,"Multiplan, Inc.","Multiplan, Inc.",225.6,94,,percent of total billed charges,,
Fine Needle Aspiration Bx; Wo Imaging Guidance; First Lesion (Pro Cah),,10021,CPT,Professional,Both,,,,240,204,33.59,240,"Multiplan, Inc.","Multiplan, Inc.",225.6,94,,percent of total billed charges,,
Fine Needle Aspiration Bx; Wo Imaging Guidance; First Lesion (Pro Cah),,10021,CPT,Professional,Both,,,,240,204,33.59,240,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,216.24,90.1,,percent of total billed charges,,
Fine Needle Aspiration Bx; Wo Imaging Guidance; First Lesion (Pro Cah),,10021,CPT,Professional,Both,,,,240,204,33.59,240,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,216.24,90.1,,percent of total billed charges,,
Fine Needle Aspiration Bx; Wo Imaging Guidance; First Lesion (Pro Cah),,10021,CPT,Professional,Both,,,,240,204,33.59,240,"Preferred One Administrative Services, INC.",PPO,236.64,98.6,,percent of total billed charges,,
Fine Needle Aspiration Bx; Wo Imaging Guidance; First Lesion (Pro Cah),,10021,CPT,Professional,Both,,,,240,204,33.59,240,"Preferred One Administrative Services, INC.",PPO,236.64,98.6,,percent of total billed charges,,
Fine Needle Aspiration Bx; Wo Imaging Guidance; First Lesion (Pro Cah),,10021,CPT,Professional,Both,,,,240,204,33.59,240,PrimeWest Health,Minnesota Senior Health Options (MSHO),60.1795,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Fine Needle Aspiration Bx; Wo Imaging Guidance; First Lesion (Pro Cah),,10021,CPT,Professional,Both,,,,240,204,33.59,240,PrimeWest Health,Minnesota Senior Health Options (MSHO),60.1795,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Fine Needle Aspiration Bx; Wo Imaging Guidance; First Lesion (Pro Cah),,10021,CPT,Professional,Both,,,,240,204,33.59,240,PrimeWest Health,MinnesotaCare,41.4953704,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Fine Needle Aspiration Bx; Wo Imaging Guidance; First Lesion (Pro Cah),,10021,CPT,Professional,Both,,,,240,204,33.59,240,PrimeWest Health,MinnesotaCare,41.4953704,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Fine Needle Aspiration Bx; Wo Imaging Guidance; First Lesion (Pro Cah),,10021,CPT,Professional,Both,,,,240,204,33.59,240,Sanford Health Plan,Sanford Health Plan,211.2,88,,percent of total billed charges,,
Fine Needle Aspiration Bx; Wo Imaging Guidance; First Lesion (Pro Cah),,10021,CPT,Professional,Both,,,,240,204,33.59,240,Sanford Health Plan,Sanford Health Plan,211.2,88,,percent of total billed charges,,
Fine Needle Aspiration Bx; Wo Imaging Guidance; First Lesion (Pro Cah),,10021,CPT,Professional,Both,,,,240,204,33.59,240,"UCare Health, Inc.",Individual & Family Plan,85.067648,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Fine Needle Aspiration Bx; Wo Imaging Guidance; First Lesion (Pro Cah),,10021,CPT,Professional,Both,,,,240,204,33.59,240,"UCare Health, Inc.",Individual & Family Plan,85.067648,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Fine Needle Aspiration Bx; Wo Imaging Guidance; First Lesion (Pro Cah),,10021,CPT,Professional,Both,,,,240,204,33.59,240,"UCare Health, Inc.",Medical Assistance,42.658792,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Fine Needle Aspiration Bx; Wo Imaging Guidance; First Lesion (Pro Cah),,10021,CPT,Professional,Both,,,,240,204,33.59,240,"UCare Health, Inc.",Medical Assistance,42.658792,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Fine Needle Aspiration Bx; Wo Imaging Guidance; First Lesion (Pro Cah),,10021,CPT,Professional,Both,,,,240,204,33.59,240,"UCare Health, Inc.",Medicare Advantage,60.1795,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Fine Needle Aspiration Bx; Wo Imaging Guidance; First Lesion (Pro Cah),,10021,CPT,Professional,Both,,,,240,204,33.59,240,"UCare Health, Inc.",Medicare Advantage,60.1795,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Fine Needle Aspiration Bx; Wo Imaging Guidance; First Lesion (Pro Cah),,10021,CPT,Professional,Both,,,,240,204,33.59,240,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),48.1436,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Fine Needle Aspiration Bx; Wo Imaging Guidance; First Lesion (Pro Cah),,10021,CPT,Professional,Both,,,,240,204,33.59,240,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),48.1436,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Fine Needle Aspiration Bx; Wo Imaging Guidance; First Lesion (Pro Cah),,10021,CPT,Professional,Both,,,,240,204,33.59,240,UnitedHealthcare,Individual & Family,240,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Fine Needle Aspiration Bx; Wo Imaging Guidance; First Lesion (Pro Cah),,10021,CPT,Professional,Both,,,,240,204,33.59,240,UnitedHealthcare,Individual & Family,240,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Fine Needle Aspiration Bx; Wo Imaging Guidance; First Lesion (Pro Cah),,10021,CPT,Professional,Both,,,,240,204,33.59,240,UnitedHealthcare,Medicare Advantage,60.1795,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Fine Needle Aspiration Bx; Wo Imaging Guidance; First Lesion (Pro Cah),,10021,CPT,Professional,Both,,,,240,204,33.59,240,UnitedHealthcare,Medicare Advantage,60.1795,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Fine Needle Aspiration Bx; Wo Imaging Guidance; First Lesion (Pro Cah),,10021,CPT,Professional,Both,,,,240,204,33.59,240,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,38.78072,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Fine Needle Aspiration Bx; Wo Imaging Guidance; First Lesion (Pro Cah),,10021,CPT,Professional,Both,,,,240,204,33.59,240,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,38.78072,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Fine Needle Aspiration; Without Imaging Guidance; First Lesion,,10021,CPT,Facility,Both,,,,145,123.25,41.557,299,Aetna,Commercial,133.4,92,,percent of total billed charges,,
Fine Needle Aspiration; Without Imaging Guidance; First Lesion,,10021,CPT,Facility,Outpatient,,,,145,123.25,41.557,299,Aetna,Medicare Advantage,71.05,49,,percent of total billed charges,,
Fine Needle Aspiration; Without Imaging Guidance; First Lesion,,10021,CPT,Facility,Inpatient,,,,145,123.25,41.557,299,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Fine Needle Aspiration; Without Imaging Guidance; First Lesion,,10021,CPT,Facility,Both,,,,145,123.25,41.557,299,Aetna,PPO,134.85,93,,percent of total billed charges,,
Fine Needle Aspiration; Without Imaging Guidance; First Lesion,,10021,CPT,Facility,Both,,,,145,123.25,41.557,299,America's PPO,America's PPO,139.2435,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Fine Needle Aspiration; Without Imaging Guidance; First Lesion,,10021,CPT,Facility,Both,,,,145,123.25,41.557,299,BlueCross BlueShield Minnesota, Federal Employee Program,142.68,98.4,,percent of total billed charges,,
Fine Needle Aspiration; Without Imaging Guidance; First Lesion,,10021,CPT,Facility,Both,,,,145,123.25,41.557,299,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,145,100,,percent of total billed charges,,
Fine Needle Aspiration; Without Imaging Guidance; First Lesion,,10021,CPT,Facility,Both,,,,145,123.25,41.557,299,BlueCross BlueShield Minnesota,High Value Network Plan,130.5,90,,percent of total billed charges,,
Fine Needle Aspiration; Without Imaging Guidance; First Lesion,,10021,CPT,Facility,Outpatient,,,,145,123.25,41.557,299,BlueCross BlueShield Minnesota,Medicare Advantage,71.05,49,,percent of total billed charges,,
Fine Needle Aspiration; Without Imaging Guidance; First Lesion,,10021,CPT,Facility,Inpatient,,,,145,123.25,41.557,299,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Fine Needle Aspiration; Without Imaging Guidance; First Lesion,,10021,CPT,Facility,Both,,,,145,123.25,41.557,299,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,128.4265,88.57,,percent of total billed charges,,
Fine Needle Aspiration; Without Imaging Guidance; First Lesion,,10021,CPT,Facility,Both,,,,145,123.25,41.557,299,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,41.557,28.66,,percent of total billed charges,,
Fine Needle Aspiration; Without Imaging Guidance; First Lesion,,10021,CPT,Facility,Outpatient,,,,145,123.25,41.557,299,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),71.05,49,,percent of total billed charges,,
Fine Needle Aspiration; Without Imaging Guidance; First Lesion,,10021,CPT,Facility,Inpatient,,,,145,123.25,41.557,299,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Fine Needle Aspiration; Without Imaging Guidance; First Lesion,,10021,CPT,Facility,Both,,,,145,123.25,41.557,299,CorVel,Worker's Compensation,145,100,,percent of total billed charges,,
Fine Needle Aspiration; Without Imaging Guidance; First Lesion,,10021,CPT,Facility,Both,,,,145,123.25,41.557,299,First Health Group Corporation,First Health Network,140.65,97,,percent of total billed charges,,
Fine Needle Aspiration; Without Imaging Guidance; First Lesion,,10021,CPT,Facility,Both,,,,145,123.25,41.557,299,"Health Partners, Inc.",Commercial,137.17,94.6,,percent of total billed charges,,
Fine Needle Aspiration; Without Imaging Guidance; First Lesion,,10021,CPT,Facility,Outpatient,,,,145,123.25,41.557,299,"Health Partners, Inc.",Medicare Advantage,71.05,49,,percent of total billed charges,,
Fine Needle Aspiration; Without Imaging Guidance; First Lesion,,10021,CPT,Facility,Inpatient,,,,145,123.25,41.557,299,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Fine Needle Aspiration; Without Imaging Guidance; First Lesion,,10021,CPT,Facility,Both,,,,145,123.25,41.557,299,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),87,60,,percent of total billed charges,,
Fine Needle Aspiration; Without Imaging Guidance; First Lesion,,10021,CPT,Facility,Both,,,,145,123.25,41.557,299,"Health Partners, Inc.",State of Minnesota Advantage Program,118.175,81.5,,percent of total billed charges,,
Fine Needle Aspiration; Without Imaging Guidance; First Lesion,,10021,CPT,Facility,Both,,,,145,123.25,41.557,299,"Health Partners, Inc.",State Public Programs,72.5,50,,percent of total billed charges,,
Fine Needle Aspiration; Without Imaging Guidance; First Lesion,,10021,CPT,Facility,Both,,,,145,123.25,41.557,299,Humana Insurance Company,Commercial PPO,137.75,95,,percent of total billed charges,,
Fine Needle Aspiration; Without Imaging Guidance; First Lesion,,10021,CPT,Facility,Outpatient,,,,145,123.25,41.557,299,Humana Insurance Company,Medicare PPO,71.05,49,,percent of total billed charges,,
Fine Needle Aspiration; Without Imaging Guidance; First Lesion,,10021,CPT,Facility,Inpatient,,,,145,123.25,41.557,299,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Fine Needle Aspiration; Without Imaging Guidance; First Lesion,,10021,CPT,Facility,Both,,,,145,123.25,41.557,299,Medica,Individual & Family,143.695,99.1,,percent of total billed charges,,
Fine Needle Aspiration; Without Imaging Guidance; First Lesion,,10021,CPT,Facility,Outpatient,,,,145,123.25,41.557,299,Medica,Medica Advantage Solution,72.21,49.8,,percent of total billed charges,,
Fine Needle Aspiration; Without Imaging Guidance; First Lesion,,10021,CPT,Facility,Inpatient,,,,145,123.25,41.557,299,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Fine Needle Aspiration; Without Imaging Guidance; First Lesion,,10021,CPT,Facility,Outpatient,,,,145,123.25,41.557,299,Medica,Medical Assistance,299,,,Other,Grouper,All inclusive per visit
Fine Needle Aspiration; Without Imaging Guidance; First Lesion,,10021,CPT,Facility,Inpatient,,,,145,123.25,41.557,299,Medica,Medical Assistance,,,,,Included in per diem rate,
Fine Needle Aspiration; Without Imaging Guidance; First Lesion,,10021,CPT,Facility,Outpatient,,,,145,123.25,41.557,299,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,72.21,49.8,,percent of total billed charges,,
Fine Needle Aspiration; Without Imaging Guidance; First Lesion,,10021,CPT,Facility,Inpatient,,,,145,123.25,41.557,299,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Fine Needle Aspiration; Without Imaging Guidance; First Lesion,,10021,CPT,Facility,Both,,,,145,123.25,41.557,299,"Multiplan, Inc.","Multiplan, Inc.",136.3,94,,percent of total billed charges,,
Fine Needle Aspiration; Without Imaging Guidance; First Lesion,,10021,CPT,Facility,Outpatient,,,,145,123.25,41.557,299,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,130.645,90.1,,percent of total billed charges,,
Fine Needle Aspiration; Without Imaging Guidance; First Lesion,,10021,CPT,Facility,Inpatient,,,,145,123.25,41.557,299,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Fine Needle Aspiration; Without Imaging Guidance; First Lesion,,10021,CPT,Facility,Both,,,,145,123.25,41.557,299,"Preferred One Administrative Services, INC.",PPO,142.97,98.6,,percent of total billed charges,,
Fine Needle Aspiration; Without Imaging Guidance; First Lesion,,10021,CPT,Facility,Outpatient,,,,145,123.25,41.557,299,PrimeWest Health,Minnesota Senior Health Options (MSHO),74.6025,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Fine Needle Aspiration; Without Imaging Guidance; First Lesion,,10021,CPT,Facility,Inpatient,,,,145,123.25,41.557,299,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Fine Needle Aspiration; Without Imaging Guidance; First Lesion,,10021,CPT,Facility,Outpatient,,,,145,123.25,41.557,299,PrimeWest Health,MinnesotaCare,74.472,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Fine Needle Aspiration; Without Imaging Guidance; First Lesion,,10021,CPT,Facility,Inpatient,,,,145,123.25,41.557,299,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Fine Needle Aspiration; Without Imaging Guidance; First Lesion,,10021,CPT,Facility,Both,,,,145,123.25,41.557,299,Sanford Health Plan,Sanford Health Plan,133.4,92,,percent of total billed charges,,
Fine Needle Aspiration; Without Imaging Guidance; First Lesion,,10021,CPT,Facility,Outpatient,,,,145,123.25,41.557,299,"UCare Health, Inc.",Individual & Family Plan,81.7075,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Fine Needle Aspiration; Without Imaging Guidance; First Lesion,,10021,CPT,Facility,Inpatient,,,,145,123.25,41.557,299,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Fine Needle Aspiration; Without Imaging Guidance; First Lesion,,10021,CPT,Facility,Outpatient,,,,145,123.25,41.557,299,"UCare Health, Inc.",Medical Assistance,73.1815,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Fine Needle Aspiration; Without Imaging Guidance; First Lesion,,10021,CPT,Facility,Inpatient,,,,145,123.25,41.557,299,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Fine Needle Aspiration; Without Imaging Guidance; First Lesion,,10021,CPT,Facility,Outpatient,,,,145,123.25,41.557,299,"UCare Health, Inc.",Medicare Advantage,73.1815,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Fine Needle Aspiration; Without Imaging Guidance; First Lesion,,10021,CPT,Facility,Inpatient,,,,145,123.25,41.557,299,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Fine Needle Aspiration; Without Imaging Guidance; First Lesion,,10021,CPT,Facility,Outpatient,,,,145,123.25,41.557,299,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),73.1815,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Fine Needle Aspiration; Without Imaging Guidance; First Lesion,,10021,CPT,Facility,Inpatient,,,,145,123.25,41.557,299,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Fine Needle Aspiration; Without Imaging Guidance; First Lesion,,10021,CPT,Facility,Both,,,,145,123.25,41.557,299,UnitedHealthcare,Individual & Family,136.3,94,,percent of total billed charges,,
Fine Needle Aspiration; Without Imaging Guidance; First Lesion,,10021,CPT,Facility,Outpatient,,,,145,123.25,41.557,299,UnitedHealthcare,Medicare Advantage,71.05,49,,percent of total billed charges,,
Fine Needle Aspiration; Without Imaging Guidance; First Lesion,,10021,CPT,Facility,Inpatient,,,,145,123.25,41.557,299,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Fine Needle Aspiration; Without Imaging Guidance; First Lesion,,10021,CPT,Facility,Outpatient,,,,145,123.25,41.557,299,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,69.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
Fine Needle Aspiration; Without Imaging Guidance; First Lesion,,10021,CPT,Facility,Inpatient,,,,145,123.25,41.557,299,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Incision And Drainage Of Abscess; Simple Or Single,,10060,CPT,Facility,Outpatient,,,,250,212.5,71.65,250,Aetna,Commercial,230,92,,percent of total billed charges,,
Incision And Drainage Of Abscess; Simple Or Single,,10060,CPT,Facility,Outpatient,,,,250,212.5,71.65,250,Aetna,Medicare Advantage,122.5,49,,percent of total billed charges,,
Incision And Drainage Of Abscess; Simple Or Single,,10060,CPT,Facility,Outpatient,,,,250,212.5,71.65,250,Aetna,PPO,232.5,93,,percent of total billed charges,,
Incision And Drainage Of Abscess; Simple Or Single,,10060,CPT,Facility,Outpatient,,,,250,212.5,71.65,250,America's PPO,America's PPO,240.075,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Incision And Drainage Of Abscess; Simple Or Single,,10060,CPT,Facility,Outpatient,,,,250,212.5,71.65,250,BlueCross BlueShield Minnesota, Federal Employee Program,246,98.4,,percent of total billed charges,,
Incision And Drainage Of Abscess; Simple Or Single,,10060,CPT,Facility,Outpatient,,,,250,212.5,71.65,250,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,250,100,,percent of total billed charges,,
Incision And Drainage Of Abscess; Simple Or Single,,10060,CPT,Facility,Outpatient,,,,250,212.5,71.65,250,BlueCross BlueShield Minnesota,High Value Network Plan,225,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
Incision And Drainage Of Abscess; Simple Or Single,,10060,CPT,Facility,Outpatient,,,,250,212.5,71.65,250,BlueCross BlueShield Minnesota,Medicare Advantage,122.5,49,,percent of total billed charges,,
Incision And Drainage Of Abscess; Simple Or Single,,10060,CPT,Facility,Outpatient,,,,250,212.5,71.65,250,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,71.65,28.66,,percent of total billed charges,,
Incision And Drainage Of Abscess; Simple Or Single,,10060,CPT,Facility,Outpatient,,,,250,212.5,71.65,250,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),122.5,49,,percent of total billed charges,,
Incision And Drainage Of Abscess; Simple Or Single,,10060,CPT,Facility,Outpatient,,,,250,212.5,71.65,250,CorVel,Worker's Compensation,250,100,,percent of total billed charges,,
Incision And Drainage Of Abscess; Simple Or Single,,10060,CPT,Facility,Outpatient,,,,250,212.5,71.65,250,First Health Group Corporation,First Health Network,242.5,97,,percent of total billed charges,,
Incision And Drainage Of Abscess; Simple Or Single,,10060,CPT,Facility,Outpatient,,,,250,212.5,71.65,250,"Health Partners, Inc.",Commercial,236.5,94.6,,percent of total billed charges,,
Incision And Drainage Of Abscess; Simple Or Single,,10060,CPT,Facility,Outpatient,,,,250,212.5,71.65,250,"Health Partners, Inc.",Medicare Advantage,122.5,49,,percent of total billed charges,,
Incision And Drainage Of Abscess; Simple Or Single,,10060,CPT,Facility,Outpatient,,,,250,212.5,71.65,250,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),150,60,,percent of total billed charges,,
Incision And Drainage Of Abscess; Simple Or Single,,10060,CPT,Facility,Outpatient,,,,250,212.5,71.65,250,"Health Partners, Inc.",State of Minnesota Advantage Program,203.75,81.5,,percent of total billed charges,,
Incision And Drainage Of Abscess; Simple Or Single,,10060,CPT,Facility,Outpatient,,,,250,212.5,71.65,250,"Health Partners, Inc.",State Public Programs,125,50,,percent of total billed charges,,
Incision And Drainage Of Abscess; Simple Or Single,,10060,CPT,Facility,Outpatient,,,,250,212.5,71.65,250,Humana Insurance Company,Commercial PPO,237.5,95,,percent of total billed charges,,
Incision And Drainage Of Abscess; Simple Or Single,,10060,CPT,Facility,Outpatient,,,,250,212.5,71.65,250,Humana Insurance Company,Medicare PPO,122.5,49,,percent of total billed charges,,
Incision And Drainage Of Abscess; Simple Or Single,,10060,CPT,Facility,Outpatient,,,,250,212.5,71.65,250,Medica,Individual & Family,233,93.2,,percent of total billed charges,,
Incision And Drainage Of Abscess; Simple Or Single,,10060,CPT,Facility,Outpatient,,,,250,212.5,71.65,250,Medica,Medica Advantage Solution,124.5,49.8,,percent of total billed charges,,
Incision And Drainage Of Abscess; Simple Or Single,,10060,CPT,Facility,Outpatient,,,,250,212.5,71.65,250,Medica,Medical Assistance,111.5,44.6,,percent of total billed charges,,
Incision And Drainage Of Abscess; Simple Or Single,,10060,CPT,Facility,Outpatient,,,,250,212.5,71.65,250,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,124.5,49.8,,percent of total billed charges,,
Incision And Drainage Of Abscess; Simple Or Single,,10060,CPT,Facility,Outpatient,,,,250,212.5,71.65,250,"Multiplan, Inc.","Multiplan, Inc.",235,94,,percent of total billed charges,,
Incision And Drainage Of Abscess; Simple Or Single,,10060,CPT,Facility,Outpatient,,,,250,212.5,71.65,250,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,225.25,90.1,,percent of total billed charges,,
Incision And Drainage Of Abscess; Simple Or Single,,10060,CPT,Facility,Outpatient,,,,250,212.5,71.65,250,"Preferred One Administrative Services, INC.",PPO,246.5,98.6,,percent of total billed charges,,
Incision And Drainage Of Abscess; Simple Or Single,,10060,CPT,Facility,Outpatient,,,,250,212.5,71.65,250,PrimeWest Health,Minnesota Senior Health Options (MSHO),128.625,51.45,,percent of total billed charges,,
Incision And Drainage Of Abscess; Simple Or Single,,10060,CPT,Facility,Outpatient,,,,250,212.5,71.65,250,PrimeWest Health,MinnesotaCare,128.4,51.36,,percent of total billed charges,,
Incision And Drainage Of Abscess; Simple Or Single,,10060,CPT,Facility,Outpatient,,,,250,212.5,71.65,250,Sanford Health Plan,Sanford Health Plan,230,92,,percent of total billed charges,,
Incision And Drainage Of Abscess; Simple Or Single,,10060,CPT,Facility,Outpatient,,,,250,212.5,71.65,250,"UCare Health, Inc.",Individual & Family Plan,140.875,56.35,,percent of total billed charges,,
Incision And Drainage Of Abscess; Simple Or Single,,10060,CPT,Facility,Outpatient,,,,250,212.5,71.65,250,"UCare Health, Inc.",Medical Assistance,126.175,50.47,,percent of total billed charges,,
Incision And Drainage Of Abscess; Simple Or Single,,10060,CPT,Facility,Outpatient,,,,250,212.5,71.65,250,"UCare Health, Inc.",Medicare Advantage,126.175,50.47,,percent of total billed charges,,
Incision And Drainage Of Abscess; Simple Or Single,,10060,CPT,Facility,Outpatient,,,,250,212.5,71.65,250,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),126.175,50.47,,percent of total billed charges,,
Incision And Drainage Of Abscess; Simple Or Single,,10060,CPT,Facility,Outpatient,,,,250,212.5,71.65,250,UnitedHealthcare,Individual & Family,235,94,,percent of total billed charges,,
Incision And Drainage Of Abscess; Simple Or Single,,10060,CPT,Facility,Outpatient,,,,250,212.5,71.65,250,UnitedHealthcare,Medicare Advantage,122.5,49,,percent of total billed charges,,
Incision And Drainage Of Abscess; Simple Or Single,,10060,CPT,Facility,Outpatient,,,,250,212.5,71.65,250,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,120,48,,percent of total billed charges,,100% of DHS outpatient percentage
Incision And Drainage Of Abscess; Simple Or Single (Pro Cah),,10060,CPT,Professional,Both,,,,322,273.7,73.15,322,Aetna,Commercial,273.7,85,,percent of total billed charges,,
Incision And Drainage Of Abscess; Simple Or Single (Pro Cah),,10060,CPT,Professional,Both,,,,322,273.7,73.15,322,Aetna,Medicare Advantage,102.85,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Incision And Drainage Of Abscess; Simple Or Single (Pro Cah),,10060,CPT,Professional,Both,,,,322,273.7,73.15,322,Aetna,PPO,299.46,93,,percent of total billed charges,,
Incision And Drainage Of Abscess; Simple Or Single (Pro Cah),,10060,CPT,Professional,Both,,,,322,273.7,73.15,322,America's PPO,America's PPO,275.1168,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Incision And Drainage Of Abscess; Simple Or Single (Pro Cah),,10060,CPT,Professional,Both,,,,322,273.7,73.15,322,BlueCross BlueShield Minnesota, Federal Employee Program,216.22,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Incision And Drainage Of Abscess; Simple Or Single (Pro Cah),,10060,CPT,Professional,Both,,,,322,273.7,73.15,322,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,219.67952,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Incision And Drainage Of Abscess; Simple Or Single (Pro Cah),,10060,CPT,Professional,Both,,,,322,273.7,73.15,322,BlueCross BlueShield Minnesota,High Value Network Plan,219.67952,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Incision And Drainage Of Abscess; Simple Or Single (Pro Cah),,10060,CPT,Professional,Both,,,,322,273.7,73.15,322,BlueCross BlueShield Minnesota,Medicare Advantage,120.543,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Incision And Drainage Of Abscess; Simple Or Single (Pro Cah),,10060,CPT,Professional,Both,,,,322,273.7,73.15,322,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,219.67952,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Incision And Drainage Of Abscess; Simple Or Single (Pro Cah),,10060,CPT,Professional,Both,,,,322,273.7,73.15,322,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,77.8256,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Incision And Drainage Of Abscess; Simple Or Single (Pro Cah),,10060,CPT,Professional,Both,,,,322,273.7,73.15,322,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),120.543,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Incision And Drainage Of Abscess; Simple Or Single (Pro Cah),,10060,CPT,Professional,Both,,,,322,273.7,73.15,322,CorVel,Worker's Compensation,203.1879066,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Incision And Drainage Of Abscess; Simple Or Single (Pro Cah),,10060,CPT,Professional,Both,,,,322,273.7,73.15,322,First Health Group Corporation,First Health Network,312.34,97,,percent of total billed charges,,
Incision And Drainage Of Abscess; Simple Or Single (Pro Cah),,10060,CPT,Professional,Both,,,,322,273.7,73.15,322,"Health Partners, Inc.",Commercial,219.11,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Incision And Drainage Of Abscess; Simple Or Single (Pro Cah),,10060,CPT,Professional,Both,,,,322,273.7,73.15,322,"Health Partners, Inc.",Medicare Advantage,120.543,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Incision And Drainage Of Abscess; Simple Or Single (Pro Cah),,10060,CPT,Professional,Both,,,,322,273.7,73.15,322,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),104.71,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Incision And Drainage Of Abscess; Simple Or Single (Pro Cah),,10060,CPT,Professional,Both,,,,322,273.7,73.15,322,"Health Partners, Inc.",State of Minnesota Advantage Program,188.763265,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Incision And Drainage Of Abscess; Simple Or Single (Pro Cah),,10060,CPT,Professional,Both,,,,322,273.7,73.15,322,"Health Partners, Inc.",State Public Programs,73.15,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Incision And Drainage Of Abscess; Simple Or Single (Pro Cah),,10060,CPT,Professional,Both,,,,322,273.7,73.15,322,Humana Insurance Company,Commercial PPO,104.82,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Incision And Drainage Of Abscess; Simple Or Single (Pro Cah),,10060,CPT,Professional,Both,,,,322,273.7,73.15,322,Humana Insurance Company,Medicare PPO,322,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Incision And Drainage Of Abscess; Simple Or Single (Pro Cah),,10060,CPT,Professional,Both,,,,322,273.7,73.15,322,Medica,Individual & Family,273.056,84.8,,percent of total billed charges,,
Incision And Drainage Of Abscess; Simple Or Single (Pro Cah),,10060,CPT,Professional,Both,,,,322,273.7,73.15,322,Medica,Medica Advantage Solution,160.356,49.8,,percent of total billed charges,,
Incision And Drainage Of Abscess; Simple Or Single (Pro Cah),,10060,CPT,Professional,Both,,,,322,273.7,73.15,322,Medica,Medical Assistance,77.83,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Incision And Drainage Of Abscess; Simple Or Single (Pro Cah),,10060,CPT,Professional,Both,,,,322,273.7,73.15,322,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,104.82,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Incision And Drainage Of Abscess; Simple Or Single (Pro Cah),,10060,CPT,Professional,Both,,,,322,273.7,73.15,322,"Multiplan, Inc.","Multiplan, Inc.",302.68,94,,percent of total billed charges,,
Incision And Drainage Of Abscess; Simple Or Single (Pro Cah),,10060,CPT,Professional,Both,,,,322,273.7,73.15,322,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,290.122,90.1,,percent of total billed charges,,
Incision And Drainage Of Abscess; Simple Or Single (Pro Cah),,10060,CPT,Professional,Both,,,,322,273.7,73.15,322,"Preferred One Administrative Services, INC.",PPO,317.492,98.6,,percent of total billed charges,,
Incision And Drainage Of Abscess; Simple Or Single (Pro Cah),,10060,CPT,Professional,Both,,,,322,273.7,73.15,322,PrimeWest Health,Minnesota Senior Health Options (MSHO),120.543,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Incision And Drainage Of Abscess; Simple Or Single (Pro Cah),,10060,CPT,Professional,Both,,,,322,273.7,73.15,322,PrimeWest Health,MinnesotaCare,83.273392,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Incision And Drainage Of Abscess; Simple Or Single (Pro Cah),,10060,CPT,Professional,Both,,,,322,273.7,73.15,322,Sanford Health Plan,Sanford Health Plan,283.36,88,,percent of total billed charges,,
Incision And Drainage Of Abscess; Simple Or Single (Pro Cah),,10060,CPT,Professional,Both,,,,322,273.7,73.15,322,"UCare Health, Inc.",Individual & Family Plan,170.395392,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Incision And Drainage Of Abscess; Simple Or Single (Pro Cah),,10060,CPT,Professional,Both,,,,322,273.7,73.15,322,"UCare Health, Inc.",Medical Assistance,85.60816,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Incision And Drainage Of Abscess; Simple Or Single (Pro Cah),,10060,CPT,Professional,Both,,,,322,273.7,73.15,322,"UCare Health, Inc.",Medicare Advantage,120.543,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Incision And Drainage Of Abscess; Simple Or Single (Pro Cah),,10060,CPT,Professional,Both,,,,322,273.7,73.15,322,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),96.4344,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Incision And Drainage Of Abscess; Simple Or Single (Pro Cah),,10060,CPT,Professional,Both,,,,322,273.7,73.15,322,UnitedHealthcare,Individual & Family,322,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Incision And Drainage Of Abscess; Simple Or Single (Pro Cah),,10060,CPT,Professional,Both,,,,322,273.7,73.15,322,UnitedHealthcare,Medicare Advantage,120.543,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Incision And Drainage Of Abscess; Simple Or Single (Pro Cah),,10060,CPT,Professional,Both,,,,322,273.7,73.15,322,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,77.8256,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Incision & Drainage Abscess; Complicated (Pbb),,10061,CPT,Facility,Outpatient,,,,413,351.05,118.3658,413,Aetna,Commercial,379.96,92,,percent of total billed charges,,
Incision & Drainage Abscess; Complicated (Pbb),,10061,CPT,Professional,Outpatient,,,,530,450.5,115.83,530,Aetna,Commercial,450.5,85,,percent of total billed charges,,
Incision & Drainage Abscess; Complicated (Pbb),,10061,CPT,Facility,Outpatient,,,,413,351.05,118.3658,413,Aetna,Medicare Advantage,202.37,49,,percent of total billed charges,,
Incision & Drainage Abscess; Complicated (Pbb),,10061,CPT,Professional,Outpatient,,,,530,450.5,115.83,530,Aetna,Medicare Advantage,180.15,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Incision & Drainage Abscess; Complicated (Pbb),,10061,CPT,Facility,Outpatient,,,,413,351.05,118.3658,413,Aetna,PPO,384.09,93,,percent of total billed charges,,
Incision & Drainage Abscess; Complicated (Pbb),,10061,CPT,Professional,Outpatient,,,,530,450.5,115.83,530,Aetna,PPO,492.9,93,,percent of total billed charges,,
Incision & Drainage Abscess; Complicated (Pbb),,10061,CPT,Facility,Outpatient,,,,413,351.05,118.3658,413,America's PPO,America's PPO,396.6039,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Incision & Drainage Abscess; Complicated (Pbb),,10061,CPT,Professional,Outpatient,,,,530,450.5,115.83,530,America's PPO,America's PPO,452.832,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Incision & Drainage Abscess; Complicated (Pbb),,10061,CPT,Facility,Outpatient,,,,413,351.05,118.3658,413,BlueCross BlueShield Minnesota, Federal Employee Program,406.392,98.4,,percent of total billed charges,,
Incision & Drainage Abscess; Complicated (Pbb),,10061,CPT,Professional,Outpatient,,,,530,450.5,115.83,530,BlueCross BlueShield Minnesota, Federal Employee Program,376.66,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Incision & Drainage Abscess; Complicated (Pbb),,10061,CPT,Facility,Outpatient,,,,413,351.05,118.3658,413,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,413,100,,percent of total billed charges,,
Incision & Drainage Abscess; Complicated (Pbb),,10061,CPT,Professional,Outpatient,,,,530,450.5,115.83,530,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,382.68656,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Incision & Drainage Abscess; Complicated (Pbb),,10061,CPT,Facility,Outpatient,,,,413,351.05,118.3658,413,BlueCross BlueShield Minnesota,High Value Network Plan,371.7,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
Incision & Drainage Abscess; Complicated (Pbb),,10061,CPT,Professional,Outpatient,,,,530,450.5,115.83,530,BlueCross BlueShield Minnesota,High Value Network Plan,382.68656,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Incision & Drainage Abscess; Complicated (Pbb),,10061,CPT,Facility,Outpatient,,,,413,351.05,118.3658,413,BlueCross BlueShield Minnesota,Medicare Advantage,202.37,49,,percent of total billed charges,,
Incision & Drainage Abscess; Complicated (Pbb),,10061,CPT,Professional,Outpatient,,,,530,450.5,115.83,530,BlueCross BlueShield Minnesota,Medicare Advantage,207.299,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Incision & Drainage Abscess; Complicated (Pbb),,10061,CPT,Professional,Outpatient,,,,530,450.5,115.83,530,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,382.68656,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Incision & Drainage Abscess; Complicated (Pbb),,10061,CPT,Facility,Outpatient,,,,413,351.05,118.3658,413,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,118.3658,28.66,,percent of total billed charges,,
Incision & Drainage Abscess; Complicated (Pbb),,10061,CPT,Professional,Outpatient,,,,530,450.5,115.83,530,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,133.73608,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Incision & Drainage Abscess; Complicated (Pbb),,10061,CPT,Facility,Outpatient,,,,413,351.05,118.3658,413,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),202.37,49,,percent of total billed charges,,
Incision & Drainage Abscess; Complicated (Pbb),,10061,CPT,Professional,Outpatient,,,,530,450.5,115.83,530,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),207.299,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Incision & Drainage Abscess; Complicated (Pbb),,10061,CPT,Facility,Outpatient,,,,413,351.05,118.3658,413,CorVel,Worker's Compensation,413,100,,percent of total billed charges,,
Incision & Drainage Abscess; Complicated (Pbb),,10061,CPT,Professional,Outpatient,,,,530,450.5,115.83,530,CorVel,Worker's Compensation,351.1076655,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Incision & Drainage Abscess; Complicated (Pbb),,10061,CPT,Facility,Outpatient,,,,413,351.05,118.3658,413,First Health Group Corporation,First Health Network,400.61,97,,percent of total billed charges,,
Incision & Drainage Abscess; Complicated (Pbb),,10061,CPT,Professional,Outpatient,,,,530,450.5,115.83,530,First Health Group Corporation,First Health Network,514.1,97,,percent of total billed charges,,
Incision & Drainage Abscess; Complicated (Pbb),,10061,CPT,Facility,Outpatient,,,,413,351.05,118.3658,413,"Health Partners, Inc.",Commercial,390.698,94.6,,percent of total billed charges,,
Incision & Drainage Abscess; Complicated (Pbb),,10061,CPT,Professional,Outpatient,,,,530,450.5,115.83,530,"Health Partners, Inc.",Commercial,378.72,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Incision & Drainage Abscess; Complicated (Pbb),,10061,CPT,Facility,Outpatient,,,,413,351.05,118.3658,413,"Health Partners, Inc.",Medicare Advantage,202.37,49,,percent of total billed charges,,
Incision & Drainage Abscess; Complicated (Pbb),,10061,CPT,Professional,Outpatient,,,,530,450.5,115.83,530,"Health Partners, Inc.",Medicare Advantage,207.299,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Incision & Drainage Abscess; Complicated (Pbb),,10061,CPT,Facility,Outpatient,,,,413,351.05,118.3658,413,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),247.8,60,,percent of total billed charges,,
Incision & Drainage Abscess; Complicated (Pbb),,10061,CPT,Professional,Outpatient,,,,530,450.5,115.83,530,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),180.28,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Incision & Drainage Abscess; Complicated (Pbb),,10061,CPT,Facility,Outpatient,,,,413,351.05,118.3658,413,"Health Partners, Inc.",State of Minnesota Advantage Program,336.595,81.5,,percent of total billed charges,,
Incision & Drainage Abscess; Complicated (Pbb),,10061,CPT,Professional,Outpatient,,,,530,450.5,115.83,530,"Health Partners, Inc.",State of Minnesota Advantage Program,326.26728,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Incision & Drainage Abscess; Complicated (Pbb),,10061,CPT,Facility,Outpatient,,,,413,351.05,118.3658,413,"Health Partners, Inc.",State Public Programs,206.5,50,,percent of total billed charges,,
Incision & Drainage Abscess; Complicated (Pbb),,10061,CPT,Professional,Outpatient,,,,530,450.5,115.83,530,"Health Partners, Inc.",State Public Programs,115.83,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Incision & Drainage Abscess; Complicated (Pbb),,10061,CPT,Facility,Outpatient,,,,413,351.05,118.3658,413,Humana Insurance Company,Commercial PPO,392.35,95,,percent of total billed charges,,
Incision & Drainage Abscess; Complicated (Pbb),,10061,CPT,Professional,Outpatient,,,,530,450.5,115.83,530,Humana Insurance Company,Commercial PPO,180.26,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Incision & Drainage Abscess; Complicated (Pbb),,10061,CPT,Facility,Outpatient,,,,413,351.05,118.3658,413,Humana Insurance Company,Medicare PPO,202.37,49,,percent of total billed charges,,
Incision & Drainage Abscess; Complicated (Pbb),,10061,CPT,Professional,Outpatient,,,,530,450.5,115.83,530,Humana Insurance Company,Medicare PPO,530,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Incision & Drainage Abscess; Complicated (Pbb),,10061,CPT,Facility,Outpatient,,,,413,351.05,118.3658,413,Medica,Individual & Family,409.283,99.1,,percent of total billed charges,,
Incision & Drainage Abscess; Complicated (Pbb),,10061,CPT,Professional,Outpatient,,,,530,450.5,115.83,530,Medica,Individual & Family,449.44,84.8,,percent of total billed charges,,
Incision & Drainage Abscess; Complicated (Pbb),,10061,CPT,Facility,Outpatient,,,,413,351.05,118.3658,413,Medica,Medica Advantage Solution,205.674,49.8,,percent of total billed charges,,
Incision & Drainage Abscess; Complicated (Pbb),,10061,CPT,Professional,Outpatient,,,,530,450.5,115.83,530,Medica,Medica Advantage Solution,263.94,49.8,,percent of total billed charges,,
Incision & Drainage Abscess; Complicated (Pbb),,10061,CPT,Facility,Outpatient,,,,413,351.05,118.3658,413,Medica,Medical Assistance,184.198,44.6,,percent of total billed charges,,
Incision & Drainage Abscess; Complicated (Pbb),,10061,CPT,Professional,Outpatient,,,,530,450.5,115.83,530,Medica,Medical Assistance,133.74,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Incision & Drainage Abscess; Complicated (Pbb),,10061,CPT,Facility,Outpatient,,,,413,351.05,118.3658,413,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,205.674,49.8,,percent of total billed charges,,
Incision & Drainage Abscess; Complicated (Pbb),,10061,CPT,Professional,Outpatient,,,,530,450.5,115.83,530,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,180.26,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Incision & Drainage Abscess; Complicated (Pbb),,10061,CPT,Facility,Outpatient,,,,413,351.05,118.3658,413,"Multiplan, Inc.","Multiplan, Inc.",388.22,94,,percent of total billed charges,,
Incision & Drainage Abscess; Complicated (Pbb),,10061,CPT,Professional,Outpatient,,,,530,450.5,115.83,530,"Multiplan, Inc.","Multiplan, Inc.",498.2,94,,percent of total billed charges,,
Incision & Drainage Abscess; Complicated (Pbb),,10061,CPT,Facility,Outpatient,,,,413,351.05,118.3658,413,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,372.113,90.1,,percent of total billed charges,,
Incision & Drainage Abscess; Complicated (Pbb),,10061,CPT,Professional,Outpatient,,,,530,450.5,115.83,530,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,477.53,90.1,,percent of total billed charges,,
Incision & Drainage Abscess; Complicated (Pbb),,10061,CPT,Facility,Outpatient,,,,413,351.05,118.3658,413,"Preferred One Administrative Services, INC.",PPO,407.218,98.6,,percent of total billed charges,,
Incision & Drainage Abscess; Complicated (Pbb),,10061,CPT,Professional,Outpatient,,,,530,450.5,115.83,530,"Preferred One Administrative Services, INC.",PPO,522.58,98.6,,percent of total billed charges,,
Incision & Drainage Abscess; Complicated (Pbb),,10061,CPT,Facility,Outpatient,,,,413,351.05,118.3658,413,PrimeWest Health,Minnesota Senior Health Options (MSHO),212.4885,51.45,,percent of total billed charges,,
Incision & Drainage Abscess; Complicated (Pbb),,10061,CPT,Professional,Outpatient,,,,530,450.5,115.83,530,PrimeWest Health,Minnesota Senior Health Options (MSHO),207.299,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Incision & Drainage Abscess; Complicated (Pbb),,10061,CPT,Facility,Outpatient,,,,413,351.05,118.3658,413,PrimeWest Health,MinnesotaCare,212.1168,51.36,,percent of total billed charges,,
Incision & Drainage Abscess; Complicated (Pbb),,10061,CPT,Professional,Outpatient,,,,530,450.5,115.83,530,PrimeWest Health,MinnesotaCare,143.0976056,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Incision & Drainage Abscess; Complicated (Pbb),,10061,CPT,Facility,Outpatient,,,,413,351.05,118.3658,413,Sanford Health Plan,Sanford Health Plan,379.96,92,,percent of total billed charges,,
Incision & Drainage Abscess; Complicated (Pbb),,10061,CPT,Professional,Outpatient,,,,530,450.5,115.83,530,Sanford Health Plan,Sanford Health Plan,466.4,88,,percent of total billed charges,,
Incision & Drainage Abscess; Complicated (Pbb),,10061,CPT,Facility,Outpatient,,,,413,351.05,118.3658,413,"UCare Health, Inc.",Individual & Family Plan,232.7255,56.35,,percent of total billed charges,,
Incision & Drainage Abscess; Complicated (Pbb),,10061,CPT,Professional,Outpatient,,,,530,450.5,115.83,530,"UCare Health, Inc.",Individual & Family Plan,293.030656,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Incision & Drainage Abscess; Complicated (Pbb),,10061,CPT,Facility,Outpatient,,,,413,351.05,118.3658,413,"UCare Health, Inc.",Medical Assistance,208.4411,50.47,,percent of total billed charges,,
Incision & Drainage Abscess; Complicated (Pbb),,10061,CPT,Professional,Outpatient,,,,530,450.5,115.83,530,"UCare Health, Inc.",Medical Assistance,147.109688,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Incision & Drainage Abscess; Complicated (Pbb),,10061,CPT,Facility,Outpatient,,,,413,351.05,118.3658,413,"UCare Health, Inc.",Medicare Advantage,208.4411,50.47,,percent of total billed charges,,
Incision & Drainage Abscess; Complicated (Pbb),,10061,CPT,Professional,Outpatient,,,,530,450.5,115.83,530,"UCare Health, Inc.",Medicare Advantage,207.299,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Incision & Drainage Abscess; Complicated (Pbb),,10061,CPT,Facility,Outpatient,,,,413,351.05,118.3658,413,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),208.4411,50.47,,percent of total billed charges,,
Incision & Drainage Abscess; Complicated (Pbb),,10061,CPT,Professional,Outpatient,,,,530,450.5,115.83,530,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),165.8392,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Incision & Drainage Abscess; Complicated (Pbb),,10061,CPT,Facility,Outpatient,,,,413,351.05,118.3658,413,UnitedHealthcare,Individual & Family,388.22,94,,percent of total billed charges,,
Incision & Drainage Abscess; Complicated (Pbb),,10061,CPT,Professional,Outpatient,,,,530,450.5,115.83,530,UnitedHealthcare,Individual & Family,530,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Incision & Drainage Abscess; Complicated (Pbb),,10061,CPT,Facility,Outpatient,,,,413,351.05,118.3658,413,UnitedHealthcare,Medicare Advantage,202.37,49,,percent of total billed charges,,
Incision & Drainage Abscess; Complicated (Pbb),,10061,CPT,Professional,Outpatient,,,,530,450.5,115.83,530,UnitedHealthcare,Medicare Advantage,207.299,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Incision & Drainage Abscess; Complicated (Pbb),,10061,CPT,Facility,Outpatient,,,,413,351.05,118.3658,413,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,198.24,48,,percent of total billed charges,,100% of DHS outpatient percentage
Incision & Drainage Abscess; Complicated (Pbb),,10061,CPT,Professional,Outpatient,,,,530,450.5,115.83,530,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,133.73608,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Incision And Drainage Of Abscess; Complicated Or Multiple (Pro Cah),,10061,CPT,Professional,Both,,,,943,801.55,115.83,943,Aetna,Commercial,801.55,85,,percent of total billed charges,,
Incision And Drainage Of Abscess; Complicated Or Multiple (Pro Cah),,10061,CPT,Professional,Both,,,,943,801.55,115.83,943,Aetna,Medicare Advantage,180.15,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Incision And Drainage Of Abscess; Complicated Or Multiple (Pro Cah),,10061,CPT,Professional,Both,,,,943,801.55,115.83,943,Aetna,PPO,876.99,93,,percent of total billed charges,,
Incision And Drainage Of Abscess; Complicated Or Multiple (Pro Cah),,10061,CPT,Professional,Both,,,,943,801.55,115.83,943,America's PPO,America's PPO,805.6992,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Incision And Drainage Of Abscess; Complicated Or Multiple (Pro Cah),,10061,CPT,Professional,Both,,,,943,801.55,115.83,943,BlueCross BlueShield Minnesota, Federal Employee Program,376.66,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Incision And Drainage Of Abscess; Complicated Or Multiple (Pro Cah),,10061,CPT,Professional,Both,,,,943,801.55,115.83,943,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,382.68656,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Incision And Drainage Of Abscess; Complicated Or Multiple (Pro Cah),,10061,CPT,Professional,Both,,,,943,801.55,115.83,943,BlueCross BlueShield Minnesota,High Value Network Plan,382.68656,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Incision And Drainage Of Abscess; Complicated Or Multiple (Pro Cah),,10061,CPT,Professional,Both,,,,943,801.55,115.83,943,BlueCross BlueShield Minnesota,Medicare Advantage,207.299,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Incision And Drainage Of Abscess; Complicated Or Multiple (Pro Cah),,10061,CPT,Professional,Both,,,,943,801.55,115.83,943,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,382.68656,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Incision And Drainage Of Abscess; Complicated Or Multiple (Pro Cah),,10061,CPT,Professional,Both,,,,943,801.55,115.83,943,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,133.73608,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Incision And Drainage Of Abscess; Complicated Or Multiple (Pro Cah),,10061,CPT,Professional,Both,,,,943,801.55,115.83,943,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),207.299,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Incision And Drainage Of Abscess; Complicated Or Multiple (Pro Cah),,10061,CPT,Professional,Both,,,,943,801.55,115.83,943,CorVel,Worker's Compensation,351.1076655,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Incision And Drainage Of Abscess; Complicated Or Multiple (Pro Cah),,10061,CPT,Professional,Both,,,,943,801.55,115.83,943,First Health Group Corporation,First Health Network,914.71,97,,percent of total billed charges,,
Incision And Drainage Of Abscess; Complicated Or Multiple (Pro Cah),,10061,CPT,Professional,Both,,,,943,801.55,115.83,943,"Health Partners, Inc.",Commercial,378.72,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Incision And Drainage Of Abscess; Complicated Or Multiple (Pro Cah),,10061,CPT,Professional,Both,,,,943,801.55,115.83,943,"Health Partners, Inc.",Medicare Advantage,207.299,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Incision And Drainage Of Abscess; Complicated Or Multiple (Pro Cah),,10061,CPT,Professional,Both,,,,943,801.55,115.83,943,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),180.28,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Incision And Drainage Of Abscess; Complicated Or Multiple (Pro Cah),,10061,CPT,Professional,Both,,,,943,801.55,115.83,943,"Health Partners, Inc.",State of Minnesota Advantage Program,326.26728,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Incision And Drainage Of Abscess; Complicated Or Multiple (Pro Cah),,10061,CPT,Professional,Both,,,,943,801.55,115.83,943,"Health Partners, Inc.",State Public Programs,115.83,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Incision And Drainage Of Abscess; Complicated Or Multiple (Pro Cah),,10061,CPT,Professional,Both,,,,943,801.55,115.83,943,Humana Insurance Company,Commercial PPO,180.26,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Incision And Drainage Of Abscess; Complicated Or Multiple (Pro Cah),,10061,CPT,Professional,Both,,,,943,801.55,115.83,943,Humana Insurance Company,Medicare PPO,943,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Incision And Drainage Of Abscess; Complicated Or Multiple (Pro Cah),,10061,CPT,Professional,Both,,,,943,801.55,115.83,943,Medica,Individual & Family,799.664,84.8,,percent of total billed charges,,
Incision And Drainage Of Abscess; Complicated Or Multiple (Pro Cah),,10061,CPT,Professional,Both,,,,943,801.55,115.83,943,Medica,Medica Advantage Solution,469.614,49.8,,percent of total billed charges,,
Incision And Drainage Of Abscess; Complicated Or Multiple (Pro Cah),,10061,CPT,Professional,Both,,,,943,801.55,115.83,943,Medica,Medical Assistance,133.74,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Incision And Drainage Of Abscess; Complicated Or Multiple (Pro Cah),,10061,CPT,Professional,Both,,,,943,801.55,115.83,943,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,180.26,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Incision And Drainage Of Abscess; Complicated Or Multiple (Pro Cah),,10061,CPT,Professional,Both,,,,943,801.55,115.83,943,"Multiplan, Inc.","Multiplan, Inc.",886.42,94,,percent of total billed charges,,
Incision And Drainage Of Abscess; Complicated Or Multiple (Pro Cah),,10061,CPT,Professional,Both,,,,943,801.55,115.83,943,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,849.643,90.1,,percent of total billed charges,,
Incision And Drainage Of Abscess; Complicated Or Multiple (Pro Cah),,10061,CPT,Professional,Both,,,,943,801.55,115.83,943,"Preferred One Administrative Services, INC.",PPO,929.798,98.6,,percent of total billed charges,,
Incision And Drainage Of Abscess; Complicated Or Multiple (Pro Cah),,10061,CPT,Professional,Both,,,,943,801.55,115.83,943,PrimeWest Health,Minnesota Senior Health Options (MSHO),207.299,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Incision And Drainage Of Abscess; Complicated Or Multiple (Pro Cah),,10061,CPT,Professional,Both,,,,943,801.55,115.83,943,PrimeWest Health,MinnesotaCare,143.0976056,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Incision And Drainage Of Abscess; Complicated Or Multiple (Pro Cah),,10061,CPT,Professional,Both,,,,943,801.55,115.83,943,Sanford Health Plan,Sanford Health Plan,829.84,88,,percent of total billed charges,,
Incision And Drainage Of Abscess; Complicated Or Multiple (Pro Cah),,10061,CPT,Professional,Both,,,,943,801.55,115.83,943,"UCare Health, Inc.",Individual & Family Plan,293.030656,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Incision And Drainage Of Abscess; Complicated Or Multiple (Pro Cah),,10061,CPT,Professional,Both,,,,943,801.55,115.83,943,"UCare Health, Inc.",Medical Assistance,147.109688,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Incision And Drainage Of Abscess; Complicated Or Multiple (Pro Cah),,10061,CPT,Professional,Both,,,,943,801.55,115.83,943,"UCare Health, Inc.",Medicare Advantage,207.299,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Incision And Drainage Of Abscess; Complicated Or Multiple (Pro Cah),,10061,CPT,Professional,Both,,,,943,801.55,115.83,943,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),165.8392,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Incision And Drainage Of Abscess; Complicated Or Multiple (Pro Cah),,10061,CPT,Professional,Both,,,,943,801.55,115.83,943,UnitedHealthcare,Individual & Family,943,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Incision And Drainage Of Abscess; Complicated Or Multiple (Pro Cah),,10061,CPT,Professional,Both,,,,943,801.55,115.83,943,UnitedHealthcare,Medicare Advantage,207.299,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Incision And Drainage Of Abscess; Complicated Or Multiple (Pro Cah),,10061,CPT,Professional,Both,,,,943,801.55,115.83,943,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,133.73608,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
NIACIN 250 MG ORAL TAB SR,,13790,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
NIACIN 250 MG ORAL TAB SR,,13790,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
NIACIN 250 MG ORAL TAB SR,,13790,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
NIACIN 250 MG ORAL TAB SR,,13790,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
NIACIN 250 MG ORAL TAB SR,,13790,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
NIACIN 250 MG ORAL TAB SR,,13790,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
NIACIN 250 MG ORAL TAB SR,,13790,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
NIACIN 250 MG ORAL TAB SR,,13790,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
NIACIN 250 MG ORAL TAB SR,,13790,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
NIACIN 250 MG ORAL TAB SR,,13790,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
NIACIN 250 MG ORAL TAB SR,,13790,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
NIACIN 250 MG ORAL TAB SR,,13790,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
NIACIN 250 MG ORAL TAB SR,,13790,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
NIACIN 250 MG ORAL TAB SR,,13790,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
NIACIN 250 MG ORAL TAB SR,,13790,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
NIACIN 250 MG ORAL TAB SR,,13790,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
NIACIN 250 MG ORAL TAB SR,,13790,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
NIACIN 250 MG ORAL TAB SR,,13790,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
NIACIN 250 MG ORAL TAB SR,,13790,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
NIACIN 250 MG ORAL TAB SR,,13790,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
NIACIN 250 MG ORAL TAB SR,,13790,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
NIACIN 250 MG ORAL TAB SR,,13790,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
NIACIN 250 MG ORAL TAB SR,,13790,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
NIACIN 250 MG ORAL TAB SR,,13790,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
NIACIN 250 MG ORAL TAB SR,,13790,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
NIACIN 250 MG ORAL TAB SR,,13790,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
NIACIN 250 MG ORAL TAB SR,,13790,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
NIACIN 250 MG ORAL TAB SR,,13790,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
NIACIN 250 MG ORAL TAB SR,,13790,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
NIACIN 250 MG ORAL TAB SR,,13790,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
NIACIN 250 MG ORAL TAB SR,,13790,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
NIACIN 250 MG ORAL TAB SR,,13790,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
NIACIN 250 MG ORAL TAB SR,,13790,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
NIACIN 250 MG ORAL TAB SR,,13790,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
NIACIN 250 MG ORAL TAB SR,,13790,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
NIACIN 250 MG ORAL TAB SR,,13790,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
NIACIN 250 MG ORAL TAB SR,,13790,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
NIACIN 250 MG ORAL TAB SR,,13790,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
NIACIN 250 MG ORAL TAB SR,,13790,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
NIACIN 250 MG ORAL TAB SR,,13790,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
NIACIN 250 MG ORAL TAB SR,,13790,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
NIACIN 250 MG ORAL TAB SR,,13790,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
NIACIN 250 MG ORAL TAB SR,,13790,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
NIACIN 250 MG ORAL TAB SR,,13790,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
NIACIN 250 MG ORAL TAB SR,,13790,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
NIACIN 250 MG ORAL TAB SR,,13790,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
NIACIN 250 MG ORAL TAB SR,,13790,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
NIACIN 250 MG ORAL TAB SR,,13790,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
NIACIN 250 MG ORAL TAB SR,,13790,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
NIACIN 250 MG ORAL TAB SR,,13790,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
NIACIN 250 MG ORAL TAB SR,,13790,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
NIACIN 250 MG ORAL TAB SR,,13790,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
NIACIN 250 MG ORAL TAB SR,,13790,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
NIACIN 250 MG ORAL TAB SR,,13790,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
I&D Of Pilonidal Cyst; Simple,,10080,CPT,Facility,Both,,,,150,127.5,42.99,449,Aetna,Commercial,138,92,,percent of total billed charges,,
I&D Of Pilonidal Cyst; Simple,,10080,CPT,Facility,Outpatient,,,,150,127.5,42.99,449,Aetna,Medicare Advantage,73.5,49,,percent of total billed charges,,
I&D Of Pilonidal Cyst; Simple,,10080,CPT,Facility,Inpatient,,,,150,127.5,42.99,449,Aetna,Medicare Advantage,,,,,Included in per diem rate,
I&D Of Pilonidal Cyst; Simple,,10080,CPT,Facility,Both,,,,150,127.5,42.99,449,Aetna,PPO,139.5,93,,percent of total billed charges,,
I&D Of Pilonidal Cyst; Simple,,10080,CPT,Facility,Both,,,,150,127.5,42.99,449,America's PPO,America's PPO,144.045,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
I&D Of Pilonidal Cyst; Simple,,10080,CPT,Facility,Both,,,,150,127.5,42.99,449,BlueCross BlueShield Minnesota, Federal Employee Program,147.6,98.4,,percent of total billed charges,,
I&D Of Pilonidal Cyst; Simple,,10080,CPT,Facility,Both,,,,150,127.5,42.99,449,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,150,100,,percent of total billed charges,,
I&D Of Pilonidal Cyst; Simple,,10080,CPT,Facility,Both,,,,150,127.5,42.99,449,BlueCross BlueShield Minnesota,High Value Network Plan,135,90,,percent of total billed charges,,
I&D Of Pilonidal Cyst; Simple,,10080,CPT,Facility,Outpatient,,,,150,127.5,42.99,449,BlueCross BlueShield Minnesota,Medicare Advantage,73.5,49,,percent of total billed charges,,
I&D Of Pilonidal Cyst; Simple,,10080,CPT,Facility,Inpatient,,,,150,127.5,42.99,449,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
I&D Of Pilonidal Cyst; Simple,,10080,CPT,Facility,Both,,,,150,127.5,42.99,449,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,132.855,88.57,,percent of total billed charges,,
I&D Of Pilonidal Cyst; Simple,,10080,CPT,Facility,Both,,,,150,127.5,42.99,449,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,42.99,28.66,,percent of total billed charges,,
I&D Of Pilonidal Cyst; Simple,,10080,CPT,Facility,Outpatient,,,,150,127.5,42.99,449,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),73.5,49,,percent of total billed charges,,
I&D Of Pilonidal Cyst; Simple,,10080,CPT,Facility,Inpatient,,,,150,127.5,42.99,449,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
I&D Of Pilonidal Cyst; Simple,,10080,CPT,Facility,Both,,,,150,127.5,42.99,449,CorVel,Worker's Compensation,150,100,,percent of total billed charges,,
I&D Of Pilonidal Cyst; Simple,,10080,CPT,Facility,Both,,,,150,127.5,42.99,449,First Health Group Corporation,First Health Network,145.5,97,,percent of total billed charges,,
I&D Of Pilonidal Cyst; Simple,,10080,CPT,Facility,Both,,,,150,127.5,42.99,449,"Health Partners, Inc.",Commercial,141.9,94.6,,percent of total billed charges,,
I&D Of Pilonidal Cyst; Simple,,10080,CPT,Facility,Outpatient,,,,150,127.5,42.99,449,"Health Partners, Inc.",Medicare Advantage,73.5,49,,percent of total billed charges,,
I&D Of Pilonidal Cyst; Simple,,10080,CPT,Facility,Inpatient,,,,150,127.5,42.99,449,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
I&D Of Pilonidal Cyst; Simple,,10080,CPT,Facility,Both,,,,150,127.5,42.99,449,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),90,60,,percent of total billed charges,,
I&D Of Pilonidal Cyst; Simple,,10080,CPT,Facility,Both,,,,150,127.5,42.99,449,"Health Partners, Inc.",State of Minnesota Advantage Program,122.25,81.5,,percent of total billed charges,,
I&D Of Pilonidal Cyst; Simple,,10080,CPT,Facility,Both,,,,150,127.5,42.99,449,"Health Partners, Inc.",State Public Programs,75,50,,percent of total billed charges,,
I&D Of Pilonidal Cyst; Simple,,10080,CPT,Facility,Both,,,,150,127.5,42.99,449,Humana Insurance Company,Commercial PPO,142.5,95,,percent of total billed charges,,
I&D Of Pilonidal Cyst; Simple,,10080,CPT,Facility,Outpatient,,,,150,127.5,42.99,449,Humana Insurance Company,Medicare PPO,73.5,49,,percent of total billed charges,,
I&D Of Pilonidal Cyst; Simple,,10080,CPT,Facility,Inpatient,,,,150,127.5,42.99,449,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
I&D Of Pilonidal Cyst; Simple,,10080,CPT,Facility,Both,,,,150,127.5,42.99,449,Medica,Individual & Family,148.65,99.1,,percent of total billed charges,,
I&D Of Pilonidal Cyst; Simple,,10080,CPT,Facility,Outpatient,,,,150,127.5,42.99,449,Medica,Medica Advantage Solution,74.7,49.8,,percent of total billed charges,,
I&D Of Pilonidal Cyst; Simple,,10080,CPT,Facility,Inpatient,,,,150,127.5,42.99,449,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
I&D Of Pilonidal Cyst; Simple,,10080,CPT,Facility,Outpatient,,,,150,127.5,42.99,449,Medica,Medical Assistance,449,,,Other,Grouper,All inclusive per visit
I&D Of Pilonidal Cyst; Simple,,10080,CPT,Facility,Inpatient,,,,150,127.5,42.99,449,Medica,Medical Assistance,,,,,Included in per diem rate,
I&D Of Pilonidal Cyst; Simple,,10080,CPT,Facility,Outpatient,,,,150,127.5,42.99,449,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,74.7,49.8,,percent of total billed charges,,
I&D Of Pilonidal Cyst; Simple,,10080,CPT,Facility,Inpatient,,,,150,127.5,42.99,449,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
I&D Of Pilonidal Cyst; Simple,,10080,CPT,Facility,Both,,,,150,127.5,42.99,449,"Multiplan, Inc.","Multiplan, Inc.",141,94,,percent of total billed charges,,
I&D Of Pilonidal Cyst; Simple,,10080,CPT,Facility,Outpatient,,,,150,127.5,42.99,449,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,135.15,90.1,,percent of total billed charges,,
I&D Of Pilonidal Cyst; Simple,,10080,CPT,Facility,Inpatient,,,,150,127.5,42.99,449,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
I&D Of Pilonidal Cyst; Simple,,10080,CPT,Facility,Both,,,,150,127.5,42.99,449,"Preferred One Administrative Services, INC.",PPO,147.9,98.6,,percent of total billed charges,,
I&D Of Pilonidal Cyst; Simple,,10080,CPT,Facility,Outpatient,,,,150,127.5,42.99,449,PrimeWest Health,Minnesota Senior Health Options (MSHO),77.175,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
I&D Of Pilonidal Cyst; Simple,,10080,CPT,Facility,Inpatient,,,,150,127.5,42.99,449,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
I&D Of Pilonidal Cyst; Simple,,10080,CPT,Facility,Outpatient,,,,150,127.5,42.99,449,PrimeWest Health,MinnesotaCare,77.04,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
I&D Of Pilonidal Cyst; Simple,,10080,CPT,Facility,Inpatient,,,,150,127.5,42.99,449,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
I&D Of Pilonidal Cyst; Simple,,10080,CPT,Facility,Both,,,,150,127.5,42.99,449,Sanford Health Plan,Sanford Health Plan,138,92,,percent of total billed charges,,
I&D Of Pilonidal Cyst; Simple,,10080,CPT,Facility,Outpatient,,,,150,127.5,42.99,449,"UCare Health, Inc.",Individual & Family Plan,84.525,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
I&D Of Pilonidal Cyst; Simple,,10080,CPT,Facility,Inpatient,,,,150,127.5,42.99,449,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
I&D Of Pilonidal Cyst; Simple,,10080,CPT,Facility,Outpatient,,,,150,127.5,42.99,449,"UCare Health, Inc.",Medical Assistance,75.705,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
I&D Of Pilonidal Cyst; Simple,,10080,CPT,Facility,Inpatient,,,,150,127.5,42.99,449,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
I&D Of Pilonidal Cyst; Simple,,10080,CPT,Facility,Outpatient,,,,150,127.5,42.99,449,"UCare Health, Inc.",Medicare Advantage,75.705,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
I&D Of Pilonidal Cyst; Simple,,10080,CPT,Facility,Inpatient,,,,150,127.5,42.99,449,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
I&D Of Pilonidal Cyst; Simple,,10080,CPT,Facility,Outpatient,,,,150,127.5,42.99,449,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),75.705,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
I&D Of Pilonidal Cyst; Simple,,10080,CPT,Facility,Inpatient,,,,150,127.5,42.99,449,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
I&D Of Pilonidal Cyst; Simple,,10080,CPT,Facility,Both,,,,150,127.5,42.99,449,UnitedHealthcare,Individual & Family,141,94,,percent of total billed charges,,
I&D Of Pilonidal Cyst; Simple,,10080,CPT,Facility,Outpatient,,,,150,127.5,42.99,449,UnitedHealthcare,Medicare Advantage,73.5,49,,percent of total billed charges,,
I&D Of Pilonidal Cyst; Simple,,10080,CPT,Facility,Inpatient,,,,150,127.5,42.99,449,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
I&D Of Pilonidal Cyst; Simple,,10080,CPT,Facility,Outpatient,,,,150,127.5,42.99,449,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,72,48,,percent of total billed charges,,100% of DHS outpatient percentage
I&D Of Pilonidal Cyst; Simple,,10080,CPT,Facility,Inpatient,,,,150,127.5,42.99,449,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Incision And Drainage Of Pilonidal Cyst; Simple (Pro Cah),,10080,CPT,Professional,Both,,,,482,409.7,65.88,482,Aetna,Commercial,409.7,85,,percent of total billed charges,,
Incision And Drainage Of Pilonidal Cyst; Simple (Pro Cah),,10080,CPT,Professional,Both,,,,482,409.7,65.88,482,Aetna,Medicare Advantage,103.23,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Incision And Drainage Of Pilonidal Cyst; Simple (Pro Cah),,10080,CPT,Professional,Both,,,,482,409.7,65.88,482,Aetna,PPO,448.26,93,,percent of total billed charges,,
Incision And Drainage Of Pilonidal Cyst; Simple (Pro Cah),,10080,CPT,Professional,Both,,,,482,409.7,65.88,482,America's PPO,America's PPO,411.8208,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Incision And Drainage Of Pilonidal Cyst; Simple (Pro Cah),,10080,CPT,Professional,Both,,,,482,409.7,65.88,482,BlueCross BlueShield Minnesota, Federal Employee Program,214.84,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Incision And Drainage Of Pilonidal Cyst; Simple (Pro Cah),,10080,CPT,Professional,Both,,,,482,409.7,65.88,482,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,218.27744,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Incision And Drainage Of Pilonidal Cyst; Simple (Pro Cah),,10080,CPT,Professional,Both,,,,482,409.7,65.88,482,BlueCross BlueShield Minnesota,High Value Network Plan,218.27744,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Incision And Drainage Of Pilonidal Cyst; Simple (Pro Cah),,10080,CPT,Professional,Both,,,,482,409.7,65.88,482,BlueCross BlueShield Minnesota,Medicare Advantage,117.8635,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Incision And Drainage Of Pilonidal Cyst; Simple (Pro Cah),,10080,CPT,Professional,Both,,,,482,409.7,65.88,482,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,218.27744,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Incision And Drainage Of Pilonidal Cyst; Simple (Pro Cah),,10080,CPT,Professional,Both,,,,482,409.7,65.88,482,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,76.05776,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Incision And Drainage Of Pilonidal Cyst; Simple (Pro Cah),,10080,CPT,Professional,Both,,,,482,409.7,65.88,482,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),117.8635,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Incision And Drainage Of Pilonidal Cyst; Simple (Pro Cah),,10080,CPT,Professional,Both,,,,482,409.7,65.88,482,CorVel,Worker's Compensation,200.3217627,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Incision And Drainage Of Pilonidal Cyst; Simple (Pro Cah),,10080,CPT,Professional,Both,,,,482,409.7,65.88,482,First Health Group Corporation,First Health Network,467.54,97,,percent of total billed charges,,
Incision And Drainage Of Pilonidal Cyst; Simple (Pro Cah),,10080,CPT,Professional,Both,,,,482,409.7,65.88,482,"Health Partners, Inc.",Commercial,216.2,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Incision And Drainage Of Pilonidal Cyst; Simple (Pro Cah),,10080,CPT,Professional,Both,,,,482,409.7,65.88,482,"Health Partners, Inc.",Medicare Advantage,117.8635,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Incision And Drainage Of Pilonidal Cyst; Simple (Pro Cah),,10080,CPT,Professional,Both,,,,482,409.7,65.88,482,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),102.34,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Incision And Drainage Of Pilonidal Cyst; Simple (Pro Cah),,10080,CPT,Professional,Both,,,,482,409.7,65.88,482,"Health Partners, Inc.",State of Minnesota Advantage Program,186.2563,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Incision And Drainage Of Pilonidal Cyst; Simple (Pro Cah),,10080,CPT,Professional,Both,,,,482,409.7,65.88,482,"Health Partners, Inc.",State Public Programs,65.88,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Incision And Drainage Of Pilonidal Cyst; Simple (Pro Cah),,10080,CPT,Professional,Both,,,,482,409.7,65.88,482,Humana Insurance Company,Commercial PPO,102.49,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Incision And Drainage Of Pilonidal Cyst; Simple (Pro Cah),,10080,CPT,Professional,Both,,,,482,409.7,65.88,482,Humana Insurance Company,Medicare PPO,482,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Incision And Drainage Of Pilonidal Cyst; Simple (Pro Cah),,10080,CPT,Professional,Both,,,,482,409.7,65.88,482,Medica,Individual & Family,408.736,84.8,,percent of total billed charges,,
Incision And Drainage Of Pilonidal Cyst; Simple (Pro Cah),,10080,CPT,Professional,Both,,,,482,409.7,65.88,482,Medica,Medica Advantage Solution,240.036,49.8,,percent of total billed charges,,
Incision And Drainage Of Pilonidal Cyst; Simple (Pro Cah),,10080,CPT,Professional,Both,,,,482,409.7,65.88,482,Medica,Medical Assistance,76.06,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Incision And Drainage Of Pilonidal Cyst; Simple (Pro Cah),,10080,CPT,Professional,Both,,,,482,409.7,65.88,482,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,102.49,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Incision And Drainage Of Pilonidal Cyst; Simple (Pro Cah),,10080,CPT,Professional,Both,,,,482,409.7,65.88,482,"Multiplan, Inc.","Multiplan, Inc.",453.08,94,,percent of total billed charges,,
Incision And Drainage Of Pilonidal Cyst; Simple (Pro Cah),,10080,CPT,Professional,Both,,,,482,409.7,65.88,482,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,434.282,90.1,,percent of total billed charges,,
Incision And Drainage Of Pilonidal Cyst; Simple (Pro Cah),,10080,CPT,Professional,Both,,,,482,409.7,65.88,482,"Preferred One Administrative Services, INC.",PPO,475.252,98.6,,percent of total billed charges,,
Incision And Drainage Of Pilonidal Cyst; Simple (Pro Cah),,10080,CPT,Professional,Both,,,,482,409.7,65.88,482,PrimeWest Health,Minnesota Senior Health Options (MSHO),117.8635,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Incision And Drainage Of Pilonidal Cyst; Simple (Pro Cah),,10080,CPT,Professional,Both,,,,482,409.7,65.88,482,PrimeWest Health,MinnesotaCare,81.3818032,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Incision And Drainage Of Pilonidal Cyst; Simple (Pro Cah),,10080,CPT,Professional,Both,,,,482,409.7,65.88,482,Sanford Health Plan,Sanford Health Plan,424.16,88,,percent of total billed charges,,
Incision And Drainage Of Pilonidal Cyst; Simple (Pro Cah),,10080,CPT,Professional,Both,,,,482,409.7,65.88,482,"UCare Health, Inc.",Individual & Family Plan,166.607744,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Incision And Drainage Of Pilonidal Cyst; Simple (Pro Cah),,10080,CPT,Professional,Both,,,,482,409.7,65.88,482,"UCare Health, Inc.",Medical Assistance,83.663536,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Incision And Drainage Of Pilonidal Cyst; Simple (Pro Cah),,10080,CPT,Professional,Both,,,,482,409.7,65.88,482,"UCare Health, Inc.",Medicare Advantage,117.8635,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Incision And Drainage Of Pilonidal Cyst; Simple (Pro Cah),,10080,CPT,Professional,Both,,,,482,409.7,65.88,482,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),94.2908,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Incision And Drainage Of Pilonidal Cyst; Simple (Pro Cah),,10080,CPT,Professional,Both,,,,482,409.7,65.88,482,UnitedHealthcare,Individual & Family,482,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Incision And Drainage Of Pilonidal Cyst; Simple (Pro Cah),,10080,CPT,Professional,Both,,,,482,409.7,65.88,482,UnitedHealthcare,Medicare Advantage,117.8635,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Incision And Drainage Of Pilonidal Cyst; Simple (Pro Cah),,10080,CPT,Professional,Both,,,,482,409.7,65.88,482,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,76.05776,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
METHAZOLAMIDE 25 MG ORAL TABLET,,13891,LOCAL,Facility,Both,1,Each,,26,22.1,7.4516,26,Aetna,Commercial,23.92,92,,percent of total billed charges,,
METHAZOLAMIDE 25 MG ORAL TABLET,,13891,LOCAL,Facility,Outpatient,1,Each,,26,22.1,7.4516,26,Aetna,Medicare Advantage,12.74,49,,percent of total billed charges,,
METHAZOLAMIDE 25 MG ORAL TABLET,,13891,LOCAL,Facility,Inpatient,1,Each,,26,22.1,7.4516,26,Aetna,Medicare Advantage,,,,,Included in per diem rate,
METHAZOLAMIDE 25 MG ORAL TABLET,,13891,LOCAL,Facility,Both,1,Each,,26,22.1,7.4516,26,Aetna,PPO,24.18,93,,percent of total billed charges,,
METHAZOLAMIDE 25 MG ORAL TABLET,,13891,LOCAL,Facility,Both,1,Each,,26,22.1,7.4516,26,America's PPO,America's PPO,24.9678,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
METHAZOLAMIDE 25 MG ORAL TABLET,,13891,LOCAL,Facility,Both,1,Each,,26,22.1,7.4516,26,BlueCross BlueShield Minnesota, Federal Employee Program,25.584,98.4,,percent of total billed charges,,
METHAZOLAMIDE 25 MG ORAL TABLET,,13891,LOCAL,Facility,Both,1,Each,,26,22.1,7.4516,26,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,26,100,,percent of total billed charges,,
METHAZOLAMIDE 25 MG ORAL TABLET,,13891,LOCAL,Facility,Both,1,Each,,26,22.1,7.4516,26,BlueCross BlueShield Minnesota,High Value Network Plan,23.4,90,,percent of total billed charges,,
METHAZOLAMIDE 25 MG ORAL TABLET,,13891,LOCAL,Facility,Outpatient,1,Each,,26,22.1,7.4516,26,BlueCross BlueShield Minnesota,Medicare Advantage,12.74,49,,percent of total billed charges,,
METHAZOLAMIDE 25 MG ORAL TABLET,,13891,LOCAL,Facility,Inpatient,1,Each,,26,22.1,7.4516,26,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
METHAZOLAMIDE 25 MG ORAL TABLET,,13891,LOCAL,Facility,Both,1,Each,,26,22.1,7.4516,26,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,23.0282,88.57,,percent of total billed charges,,
METHAZOLAMIDE 25 MG ORAL TABLET,,13891,LOCAL,Facility,Both,1,Each,,26,22.1,7.4516,26,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,7.4516,28.66,,percent of total billed charges,,
METHAZOLAMIDE 25 MG ORAL TABLET,,13891,LOCAL,Facility,Outpatient,1,Each,,26,22.1,7.4516,26,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),12.74,49,,percent of total billed charges,,
METHAZOLAMIDE 25 MG ORAL TABLET,,13891,LOCAL,Facility,Inpatient,1,Each,,26,22.1,7.4516,26,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
METHAZOLAMIDE 25 MG ORAL TABLET,,13891,LOCAL,Facility,Both,1,Each,,26,22.1,7.4516,26,CorVel,Worker's Compensation,26,100,,percent of total billed charges,,
METHAZOLAMIDE 25 MG ORAL TABLET,,13891,LOCAL,Facility,Both,1,Each,,26,22.1,7.4516,26,First Health Group Corporation,First Health Network,25.22,97,,percent of total billed charges,,
METHAZOLAMIDE 25 MG ORAL TABLET,,13891,LOCAL,Facility,Both,1,Each,,26,22.1,7.4516,26,"Health Partners, Inc.",Commercial,24.596,94.6,,percent of total billed charges,,
METHAZOLAMIDE 25 MG ORAL TABLET,,13891,LOCAL,Facility,Outpatient,1,Each,,26,22.1,7.4516,26,"Health Partners, Inc.",Medicare Advantage,12.74,49,,percent of total billed charges,,
METHAZOLAMIDE 25 MG ORAL TABLET,,13891,LOCAL,Facility,Inpatient,1,Each,,26,22.1,7.4516,26,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
METHAZOLAMIDE 25 MG ORAL TABLET,,13891,LOCAL,Facility,Both,1,Each,,26,22.1,7.4516,26,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),15.6,60,,percent of total billed charges,,
METHAZOLAMIDE 25 MG ORAL TABLET,,13891,LOCAL,Facility,Both,1,Each,,26,22.1,7.4516,26,"Health Partners, Inc.",State of Minnesota Advantage Program,21.19,81.5,,percent of total billed charges,,
METHAZOLAMIDE 25 MG ORAL TABLET,,13891,LOCAL,Facility,Both,1,Each,,26,22.1,7.4516,26,"Health Partners, Inc.",State Public Programs,13,50,,percent of total billed charges,,
METHAZOLAMIDE 25 MG ORAL TABLET,,13891,LOCAL,Facility,Both,1,Each,,26,22.1,7.4516,26,Humana Insurance Company,Commercial PPO,24.7,95,,percent of total billed charges,,
METHAZOLAMIDE 25 MG ORAL TABLET,,13891,LOCAL,Facility,Outpatient,1,Each,,26,22.1,7.4516,26,Humana Insurance Company,Medicare PPO,12.74,49,,percent of total billed charges,,
METHAZOLAMIDE 25 MG ORAL TABLET,,13891,LOCAL,Facility,Inpatient,1,Each,,26,22.1,7.4516,26,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
METHAZOLAMIDE 25 MG ORAL TABLET,,13891,LOCAL,Facility,Both,1,Each,,26,22.1,7.4516,26,Medica,Individual & Family,25.766,99.1,,percent of total billed charges,,
METHAZOLAMIDE 25 MG ORAL TABLET,,13891,LOCAL,Facility,Outpatient,1,Each,,26,22.1,7.4516,26,Medica,Medica Advantage Solution,12.948,49.8,,percent of total billed charges,,
METHAZOLAMIDE 25 MG ORAL TABLET,,13891,LOCAL,Facility,Inpatient,1,Each,,26,22.1,7.4516,26,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
METHAZOLAMIDE 25 MG ORAL TABLET,,13891,LOCAL,Facility,Outpatient,1,Each,,26,22.1,7.4516,26,Medica,Medical Assistance,11.596,44.6,,percent of total billed charges,,
METHAZOLAMIDE 25 MG ORAL TABLET,,13891,LOCAL,Facility,Inpatient,1,Each,,26,22.1,7.4516,26,Medica,Medical Assistance,,,,,Included in per diem rate,
METHAZOLAMIDE 25 MG ORAL TABLET,,13891,LOCAL,Facility,Outpatient,1,Each,,26,22.1,7.4516,26,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,12.948,49.8,,percent of total billed charges,,
METHAZOLAMIDE 25 MG ORAL TABLET,,13891,LOCAL,Facility,Inpatient,1,Each,,26,22.1,7.4516,26,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
METHAZOLAMIDE 25 MG ORAL TABLET,,13891,LOCAL,Facility,Both,1,Each,,26,22.1,7.4516,26,"Multiplan, Inc.","Multiplan, Inc.",24.44,94,,percent of total billed charges,,
METHAZOLAMIDE 25 MG ORAL TABLET,,13891,LOCAL,Facility,Outpatient,1,Each,,26,22.1,7.4516,26,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,23.426,90.1,,percent of total billed charges,,
METHAZOLAMIDE 25 MG ORAL TABLET,,13891,LOCAL,Facility,Inpatient,1,Each,,26,22.1,7.4516,26,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
METHAZOLAMIDE 25 MG ORAL TABLET,,13891,LOCAL,Facility,Both,1,Each,,26,22.1,7.4516,26,"Preferred One Administrative Services, INC.",PPO,25.636,98.6,,percent of total billed charges,,
METHAZOLAMIDE 25 MG ORAL TABLET,,13891,LOCAL,Facility,Outpatient,1,Each,,26,22.1,7.4516,26,PrimeWest Health,Minnesota Senior Health Options (MSHO),13.377,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
METHAZOLAMIDE 25 MG ORAL TABLET,,13891,LOCAL,Facility,Inpatient,1,Each,,26,22.1,7.4516,26,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
METHAZOLAMIDE 25 MG ORAL TABLET,,13891,LOCAL,Facility,Outpatient,1,Each,,26,22.1,7.4516,26,PrimeWest Health,MinnesotaCare,13.3536,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
METHAZOLAMIDE 25 MG ORAL TABLET,,13891,LOCAL,Facility,Inpatient,1,Each,,26,22.1,7.4516,26,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
METHAZOLAMIDE 25 MG ORAL TABLET,,13891,LOCAL,Facility,Both,1,Each,,26,22.1,7.4516,26,Sanford Health Plan,Sanford Health Plan,23.92,92,,percent of total billed charges,,
METHAZOLAMIDE 25 MG ORAL TABLET,,13891,LOCAL,Facility,Outpatient,1,Each,,26,22.1,7.4516,26,"UCare Health, Inc.",Individual & Family Plan,14.651,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
METHAZOLAMIDE 25 MG ORAL TABLET,,13891,LOCAL,Facility,Inpatient,1,Each,,26,22.1,7.4516,26,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
METHAZOLAMIDE 25 MG ORAL TABLET,,13891,LOCAL,Facility,Outpatient,1,Each,,26,22.1,7.4516,26,"UCare Health, Inc.",Medical Assistance,13.1222,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
METHAZOLAMIDE 25 MG ORAL TABLET,,13891,LOCAL,Facility,Inpatient,1,Each,,26,22.1,7.4516,26,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
METHAZOLAMIDE 25 MG ORAL TABLET,,13891,LOCAL,Facility,Outpatient,1,Each,,26,22.1,7.4516,26,"UCare Health, Inc.",Medicare Advantage,13.1222,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
METHAZOLAMIDE 25 MG ORAL TABLET,,13891,LOCAL,Facility,Inpatient,1,Each,,26,22.1,7.4516,26,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
METHAZOLAMIDE 25 MG ORAL TABLET,,13891,LOCAL,Facility,Outpatient,1,Each,,26,22.1,7.4516,26,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),13.1222,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
METHAZOLAMIDE 25 MG ORAL TABLET,,13891,LOCAL,Facility,Inpatient,1,Each,,26,22.1,7.4516,26,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
METHAZOLAMIDE 25 MG ORAL TABLET,,13891,LOCAL,Facility,Both,1,Each,,26,22.1,7.4516,26,UnitedHealthcare,Individual & Family,24.44,94,,percent of total billed charges,,
METHAZOLAMIDE 25 MG ORAL TABLET,,13891,LOCAL,Facility,Outpatient,1,Each,,26,22.1,7.4516,26,UnitedHealthcare,Medicare Advantage,12.74,49,,percent of total billed charges,,
METHAZOLAMIDE 25 MG ORAL TABLET,,13891,LOCAL,Facility,Inpatient,1,Each,,26,22.1,7.4516,26,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
METHAZOLAMIDE 25 MG ORAL TABLET,,13891,LOCAL,Facility,Outpatient,1,Each,,26,22.1,7.4516,26,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,12.48,48,,percent of total billed charges,,100% of DHS outpatient percentage
METHAZOLAMIDE 25 MG ORAL TABLET,,13891,LOCAL,Facility,Inpatient,1,Each,,26,22.1,7.4516,26,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Incision & Removal Fb, Subq Tissue; Simple (Pbb)",,10120,CPT,Facility,Outpatient,,,,240,204,68.784,240,Aetna,Commercial,220.8,92,,percent of total billed charges,,
"Incision & Removal Fb, Subq Tissue; Simple (Pbb)",,10120,CPT,Professional,Outpatient,,,,357,303.45,66.53,357,Aetna,Commercial,303.45,85,,percent of total billed charges,,
"Incision & Removal Fb, Subq Tissue; Simple (Pbb)",,10120,CPT,Facility,Outpatient,,,,240,204,68.784,240,Aetna,Medicare Advantage,117.6,49,,percent of total billed charges,,
"Incision & Removal Fb, Subq Tissue; Simple (Pbb)",,10120,CPT,Professional,Outpatient,,,,357,303.45,66.53,357,Aetna,Medicare Advantage,103.68,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Incision & Removal Fb, Subq Tissue; Simple (Pbb)",,10120,CPT,Facility,Outpatient,,,,240,204,68.784,240,Aetna,PPO,223.2,93,,percent of total billed charges,,
"Incision & Removal Fb, Subq Tissue; Simple (Pbb)",,10120,CPT,Professional,Outpatient,,,,357,303.45,66.53,357,Aetna,PPO,332.01,93,,percent of total billed charges,,
"Incision & Removal Fb, Subq Tissue; Simple (Pbb)",,10120,CPT,Facility,Outpatient,,,,240,204,68.784,240,America's PPO,America's PPO,230.472,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Incision & Removal Fb, Subq Tissue; Simple (Pbb)",,10120,CPT,Professional,Outpatient,,,,357,303.45,66.53,357,America's PPO,America's PPO,305.0208,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Incision & Removal Fb, Subq Tissue; Simple (Pbb)",,10120,CPT,Facility,Outpatient,,,,240,204,68.784,240,BlueCross BlueShield Minnesota, Federal Employee Program,236.16,98.4,,percent of total billed charges,,
"Incision & Removal Fb, Subq Tissue; Simple (Pbb)",,10120,CPT,Professional,Outpatient,,,,357,303.45,66.53,357,BlueCross BlueShield Minnesota, Federal Employee Program,216.22,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Incision & Removal Fb, Subq Tissue; Simple (Pbb)",,10120,CPT,Facility,Outpatient,,,,240,204,68.784,240,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,240,100,,percent of total billed charges,,
"Incision & Removal Fb, Subq Tissue; Simple (Pbb)",,10120,CPT,Professional,Outpatient,,,,357,303.45,66.53,357,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,219.67952,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Incision & Removal Fb, Subq Tissue; Simple (Pbb)",,10120,CPT,Facility,Outpatient,,,,240,204,68.784,240,BlueCross BlueShield Minnesota,High Value Network Plan,216,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
"Incision & Removal Fb, Subq Tissue; Simple (Pbb)",,10120,CPT,Professional,Outpatient,,,,357,303.45,66.53,357,BlueCross BlueShield Minnesota,High Value Network Plan,219.67952,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Incision & Removal Fb, Subq Tissue; Simple (Pbb)",,10120,CPT,Facility,Outpatient,,,,240,204,68.784,240,BlueCross BlueShield Minnesota,Medicare Advantage,117.6,49,,percent of total billed charges,,
"Incision & Removal Fb, Subq Tissue; Simple (Pbb)",,10120,CPT,Professional,Outpatient,,,,357,303.45,66.53,357,BlueCross BlueShield Minnesota,Medicare Advantage,119.1975,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Incision & Removal Fb, Subq Tissue; Simple (Pbb)",,10120,CPT,Professional,Outpatient,,,,357,303.45,66.53,357,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,219.67952,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Incision & Removal Fb, Subq Tissue; Simple (Pbb)",,10120,CPT,Facility,Outpatient,,,,240,204,68.784,240,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,68.784,28.66,,percent of total billed charges,,
"Incision & Removal Fb, Subq Tissue; Simple (Pbb)",,10120,CPT,Professional,Outpatient,,,,357,303.45,66.53,357,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,76.8096,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Incision & Removal Fb, Subq Tissue; Simple (Pbb)",,10120,CPT,Facility,Outpatient,,,,240,204,68.784,240,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),117.6,49,,percent of total billed charges,,
"Incision & Removal Fb, Subq Tissue; Simple (Pbb)",,10120,CPT,Professional,Outpatient,,,,357,303.45,66.53,357,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),119.1975,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Incision & Removal Fb, Subq Tissue; Simple (Pbb)",,10120,CPT,Facility,Outpatient,,,,240,204,68.784,240,CorVel,Worker's Compensation,240,100,,percent of total billed charges,,
"Incision & Removal Fb, Subq Tissue; Simple (Pbb)",,10120,CPT,Professional,Outpatient,,,,357,303.45,66.53,357,CorVel,Worker's Compensation,200.4661782,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Incision & Removal Fb, Subq Tissue; Simple (Pbb)",,10120,CPT,Facility,Outpatient,,,,240,204,68.784,240,First Health Group Corporation,First Health Network,232.8,97,,percent of total billed charges,,
"Incision & Removal Fb, Subq Tissue; Simple (Pbb)",,10120,CPT,Professional,Outpatient,,,,357,303.45,66.53,357,First Health Group Corporation,First Health Network,346.29,97,,percent of total billed charges,,
"Incision & Removal Fb, Subq Tissue; Simple (Pbb)",,10120,CPT,Facility,Outpatient,,,,240,204,68.784,240,"Health Partners, Inc.",Commercial,227.04,94.6,,percent of total billed charges,,
"Incision & Removal Fb, Subq Tissue; Simple (Pbb)",,10120,CPT,Professional,Outpatient,,,,357,303.45,66.53,357,"Health Partners, Inc.",Commercial,216.2,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Incision & Removal Fb, Subq Tissue; Simple (Pbb)",,10120,CPT,Facility,Outpatient,,,,240,204,68.784,240,"Health Partners, Inc.",Medicare Advantage,117.6,49,,percent of total billed charges,,
"Incision & Removal Fb, Subq Tissue; Simple (Pbb)",,10120,CPT,Professional,Outpatient,,,,357,303.45,66.53,357,"Health Partners, Inc.",Medicare Advantage,119.1975,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Incision & Removal Fb, Subq Tissue; Simple (Pbb)",,10120,CPT,Facility,Outpatient,,,,240,204,68.784,240,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),144,60,,percent of total billed charges,,
"Incision & Removal Fb, Subq Tissue; Simple (Pbb)",,10120,CPT,Professional,Outpatient,,,,357,303.45,66.53,357,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),103.69,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Incision & Removal Fb, Subq Tissue; Simple (Pbb)",,10120,CPT,Facility,Outpatient,,,,240,204,68.784,240,"Health Partners, Inc.",State of Minnesota Advantage Program,195.6,81.5,,percent of total billed charges,,
"Incision & Removal Fb, Subq Tissue; Simple (Pbb)",,10120,CPT,Professional,Outpatient,,,,357,303.45,66.53,357,"Health Partners, Inc.",State of Minnesota Advantage Program,186.2563,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Incision & Removal Fb, Subq Tissue; Simple (Pbb)",,10120,CPT,Facility,Outpatient,,,,240,204,68.784,240,"Health Partners, Inc.",State Public Programs,120,50,,percent of total billed charges,,
"Incision & Removal Fb, Subq Tissue; Simple (Pbb)",,10120,CPT,Professional,Outpatient,,,,357,303.45,66.53,357,"Health Partners, Inc.",State Public Programs,66.53,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Incision & Removal Fb, Subq Tissue; Simple (Pbb)",,10120,CPT,Facility,Outpatient,,,,240,204,68.784,240,Humana Insurance Company,Commercial PPO,228,95,,percent of total billed charges,,
"Incision & Removal Fb, Subq Tissue; Simple (Pbb)",,10120,CPT,Professional,Outpatient,,,,357,303.45,66.53,357,Humana Insurance Company,Commercial PPO,103.65,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Incision & Removal Fb, Subq Tissue; Simple (Pbb)",,10120,CPT,Facility,Outpatient,,,,240,204,68.784,240,Humana Insurance Company,Medicare PPO,117.6,49,,percent of total billed charges,,
"Incision & Removal Fb, Subq Tissue; Simple (Pbb)",,10120,CPT,Professional,Outpatient,,,,357,303.45,66.53,357,Humana Insurance Company,Medicare PPO,357,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Incision & Removal Fb, Subq Tissue; Simple (Pbb)",,10120,CPT,Facility,Outpatient,,,,240,204,68.784,240,Medica,Individual & Family,237.84,99.1,,percent of total billed charges,,
"Incision & Removal Fb, Subq Tissue; Simple (Pbb)",,10120,CPT,Professional,Outpatient,,,,357,303.45,66.53,357,Medica,Individual & Family,302.736,84.8,,percent of total billed charges,,
"Incision & Removal Fb, Subq Tissue; Simple (Pbb)",,10120,CPT,Facility,Outpatient,,,,240,204,68.784,240,Medica,Medica Advantage Solution,119.52,49.8,,percent of total billed charges,,
"Incision & Removal Fb, Subq Tissue; Simple (Pbb)",,10120,CPT,Professional,Outpatient,,,,357,303.45,66.53,357,Medica,Medica Advantage Solution,177.786,49.8,,percent of total billed charges,,
"Incision & Removal Fb, Subq Tissue; Simple (Pbb)",,10120,CPT,Facility,Outpatient,,,,240,204,68.784,240,Medica,Medical Assistance,107.04,44.6,,percent of total billed charges,,
"Incision & Removal Fb, Subq Tissue; Simple (Pbb)",,10120,CPT,Professional,Outpatient,,,,357,303.45,66.53,357,Medica,Medical Assistance,76.81,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Incision & Removal Fb, Subq Tissue; Simple (Pbb)",,10120,CPT,Facility,Outpatient,,,,240,204,68.784,240,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,119.52,49.8,,percent of total billed charges,,
"Incision & Removal Fb, Subq Tissue; Simple (Pbb)",,10120,CPT,Professional,Outpatient,,,,357,303.45,66.53,357,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,103.65,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Incision & Removal Fb, Subq Tissue; Simple (Pbb)",,10120,CPT,Facility,Outpatient,,,,240,204,68.784,240,"Multiplan, Inc.","Multiplan, Inc.",225.6,94,,percent of total billed charges,,
"Incision & Removal Fb, Subq Tissue; Simple (Pbb)",,10120,CPT,Professional,Outpatient,,,,357,303.45,66.53,357,"Multiplan, Inc.","Multiplan, Inc.",335.58,94,,percent of total billed charges,,
"Incision & Removal Fb, Subq Tissue; Simple (Pbb)",,10120,CPT,Facility,Outpatient,,,,240,204,68.784,240,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,216.24,90.1,,percent of total billed charges,,
"Incision & Removal Fb, Subq Tissue; Simple (Pbb)",,10120,CPT,Professional,Outpatient,,,,357,303.45,66.53,357,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,321.657,90.1,,percent of total billed charges,,
"Incision & Removal Fb, Subq Tissue; Simple (Pbb)",,10120,CPT,Facility,Outpatient,,,,240,204,68.784,240,"Preferred One Administrative Services, INC.",PPO,236.64,98.6,,percent of total billed charges,,
"Incision & Removal Fb, Subq Tissue; Simple (Pbb)",,10120,CPT,Professional,Outpatient,,,,357,303.45,66.53,357,"Preferred One Administrative Services, INC.",PPO,352.002,98.6,,percent of total billed charges,,
"Incision & Removal Fb, Subq Tissue; Simple (Pbb)",,10120,CPT,Facility,Outpatient,,,,240,204,68.784,240,PrimeWest Health,Minnesota Senior Health Options (MSHO),123.48,51.45,,percent of total billed charges,,
"Incision & Removal Fb, Subq Tissue; Simple (Pbb)",,10120,CPT,Professional,Outpatient,,,,357,303.45,66.53,357,PrimeWest Health,Minnesota Senior Health Options (MSHO),119.1975,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Incision & Removal Fb, Subq Tissue; Simple (Pbb)",,10120,CPT,Facility,Outpatient,,,,240,204,68.784,240,PrimeWest Health,MinnesotaCare,123.264,51.36,,percent of total billed charges,,
"Incision & Removal Fb, Subq Tissue; Simple (Pbb)",,10120,CPT,Professional,Outpatient,,,,357,303.45,66.53,357,PrimeWest Health,MinnesotaCare,82.186272,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Incision & Removal Fb, Subq Tissue; Simple (Pbb)",,10120,CPT,Facility,Outpatient,,,,240,204,68.784,240,Sanford Health Plan,Sanford Health Plan,220.8,92,,percent of total billed charges,,
"Incision & Removal Fb, Subq Tissue; Simple (Pbb)",,10120,CPT,Professional,Outpatient,,,,357,303.45,66.53,357,Sanford Health Plan,Sanford Health Plan,314.16,88,,percent of total billed charges,,
"Incision & Removal Fb, Subq Tissue; Simple (Pbb)",,10120,CPT,Facility,Outpatient,,,,240,204,68.784,240,"UCare Health, Inc.",Individual & Family Plan,135.24,56.35,,percent of total billed charges,,
"Incision & Removal Fb, Subq Tissue; Simple (Pbb)",,10120,CPT,Professional,Outpatient,,,,357,303.45,66.53,357,"UCare Health, Inc.",Individual & Family Plan,168.49344,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Incision & Removal Fb, Subq Tissue; Simple (Pbb)",,10120,CPT,Facility,Outpatient,,,,240,204,68.784,240,"UCare Health, Inc.",Medical Assistance,121.128,50.47,,percent of total billed charges,,
"Incision & Removal Fb, Subq Tissue; Simple (Pbb)",,10120,CPT,Professional,Outpatient,,,,357,303.45,66.53,357,"UCare Health, Inc.",Medical Assistance,84.49056,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Incision & Removal Fb, Subq Tissue; Simple (Pbb)",,10120,CPT,Facility,Outpatient,,,,240,204,68.784,240,"UCare Health, Inc.",Medicare Advantage,121.128,50.47,,percent of total billed charges,,
"Incision & Removal Fb, Subq Tissue; Simple (Pbb)",,10120,CPT,Professional,Outpatient,,,,357,303.45,66.53,357,"UCare Health, Inc.",Medicare Advantage,119.1975,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Incision & Removal Fb, Subq Tissue; Simple (Pbb)",,10120,CPT,Facility,Outpatient,,,,240,204,68.784,240,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),121.128,50.47,,percent of total billed charges,,
"Incision & Removal Fb, Subq Tissue; Simple (Pbb)",,10120,CPT,Professional,Outpatient,,,,357,303.45,66.53,357,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),95.358,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Incision & Removal Fb, Subq Tissue; Simple (Pbb)",,10120,CPT,Facility,Outpatient,,,,240,204,68.784,240,UnitedHealthcare,Individual & Family,225.6,94,,percent of total billed charges,,
"Incision & Removal Fb, Subq Tissue; Simple (Pbb)",,10120,CPT,Professional,Outpatient,,,,357,303.45,66.53,357,UnitedHealthcare,Individual & Family,357,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Incision & Removal Fb, Subq Tissue; Simple (Pbb)",,10120,CPT,Facility,Outpatient,,,,240,204,68.784,240,UnitedHealthcare,Medicare Advantage,117.6,49,,percent of total billed charges,,
"Incision & Removal Fb, Subq Tissue; Simple (Pbb)",,10120,CPT,Professional,Outpatient,,,,357,303.45,66.53,357,UnitedHealthcare,Medicare Advantage,119.1975,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Incision & Removal Fb, Subq Tissue; Simple (Pbb)",,10120,CPT,Facility,Outpatient,,,,240,204,68.784,240,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,115.2,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Incision & Removal Fb, Subq Tissue; Simple (Pbb)",,10120,CPT,Professional,Outpatient,,,,357,303.45,66.53,357,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,76.8096,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Incision And Removal Of Foreign Body, Subcutaneous Tissues; Simple (Pro Cah)",,10120,CPT,Professional,Both,,,,597,507.45,66.53,597,Aetna,Commercial,507.45,85,,percent of total billed charges,,
"Incision And Removal Of Foreign Body, Subcutaneous Tissues; Simple (Pro Cah)",,10120,CPT,Professional,Both,,,,597,507.45,66.53,597,Aetna,Medicare Advantage,103.68,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Incision And Removal Of Foreign Body, Subcutaneous Tissues; Simple (Pro Cah)",,10120,CPT,Professional,Both,,,,597,507.45,66.53,597,Aetna,PPO,555.21,93,,percent of total billed charges,,
"Incision And Removal Of Foreign Body, Subcutaneous Tissues; Simple (Pro Cah)",,10120,CPT,Professional,Both,,,,597,507.45,66.53,597,America's PPO,America's PPO,510.0768,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Incision And Removal Of Foreign Body, Subcutaneous Tissues; Simple (Pro Cah)",,10120,CPT,Professional,Both,,,,597,507.45,66.53,597,BlueCross BlueShield Minnesota, Federal Employee Program,216.22,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Incision And Removal Of Foreign Body, Subcutaneous Tissues; Simple (Pro Cah)",,10120,CPT,Professional,Both,,,,597,507.45,66.53,597,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,219.67952,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Incision And Removal Of Foreign Body, Subcutaneous Tissues; Simple (Pro Cah)",,10120,CPT,Professional,Both,,,,597,507.45,66.53,597,BlueCross BlueShield Minnesota,High Value Network Plan,219.67952,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Incision And Removal Of Foreign Body, Subcutaneous Tissues; Simple (Pro Cah)",,10120,CPT,Professional,Both,,,,597,507.45,66.53,597,BlueCross BlueShield Minnesota,Medicare Advantage,119.1975,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Incision And Removal Of Foreign Body, Subcutaneous Tissues; Simple (Pro Cah)",,10120,CPT,Professional,Both,,,,597,507.45,66.53,597,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,219.67952,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Incision And Removal Of Foreign Body, Subcutaneous Tissues; Simple (Pro Cah)",,10120,CPT,Professional,Both,,,,597,507.45,66.53,597,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,76.8096,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Incision And Removal Of Foreign Body, Subcutaneous Tissues; Simple (Pro Cah)",,10120,CPT,Professional,Both,,,,597,507.45,66.53,597,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),119.1975,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Incision And Removal Of Foreign Body, Subcutaneous Tissues; Simple (Pro Cah)",,10120,CPT,Professional,Both,,,,597,507.45,66.53,597,CorVel,Worker's Compensation,200.4661782,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Incision And Removal Of Foreign Body, Subcutaneous Tissues; Simple (Pro Cah)",,10120,CPT,Professional,Both,,,,597,507.45,66.53,597,First Health Group Corporation,First Health Network,579.09,97,,percent of total billed charges,,
"Incision And Removal Of Foreign Body, Subcutaneous Tissues; Simple (Pro Cah)",,10120,CPT,Professional,Both,,,,597,507.45,66.53,597,"Health Partners, Inc.",Commercial,216.2,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Incision And Removal Of Foreign Body, Subcutaneous Tissues; Simple (Pro Cah)",,10120,CPT,Professional,Both,,,,597,507.45,66.53,597,"Health Partners, Inc.",Medicare Advantage,119.1975,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Incision And Removal Of Foreign Body, Subcutaneous Tissues; Simple (Pro Cah)",,10120,CPT,Professional,Both,,,,597,507.45,66.53,597,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),103.69,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Incision And Removal Of Foreign Body, Subcutaneous Tissues; Simple (Pro Cah)",,10120,CPT,Professional,Both,,,,597,507.45,66.53,597,"Health Partners, Inc.",State of Minnesota Advantage Program,186.2563,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Incision And Removal Of Foreign Body, Subcutaneous Tissues; Simple (Pro Cah)",,10120,CPT,Professional,Both,,,,597,507.45,66.53,597,"Health Partners, Inc.",State Public Programs,66.53,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Incision And Removal Of Foreign Body, Subcutaneous Tissues; Simple (Pro Cah)",,10120,CPT,Professional,Both,,,,597,507.45,66.53,597,Humana Insurance Company,Commercial PPO,103.65,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Incision And Removal Of Foreign Body, Subcutaneous Tissues; Simple (Pro Cah)",,10120,CPT,Professional,Both,,,,597,507.45,66.53,597,Humana Insurance Company,Medicare PPO,597,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Incision And Removal Of Foreign Body, Subcutaneous Tissues; Simple (Pro Cah)",,10120,CPT,Professional,Both,,,,597,507.45,66.53,597,Medica,Individual & Family,506.256,84.8,,percent of total billed charges,,
"Incision And Removal Of Foreign Body, Subcutaneous Tissues; Simple (Pro Cah)",,10120,CPT,Professional,Both,,,,597,507.45,66.53,597,Medica,Medica Advantage Solution,297.306,49.8,,percent of total billed charges,,
"Incision And Removal Of Foreign Body, Subcutaneous Tissues; Simple (Pro Cah)",,10120,CPT,Professional,Both,,,,597,507.45,66.53,597,Medica,Medical Assistance,76.81,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Incision And Removal Of Foreign Body, Subcutaneous Tissues; Simple (Pro Cah)",,10120,CPT,Professional,Both,,,,597,507.45,66.53,597,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,103.65,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Incision And Removal Of Foreign Body, Subcutaneous Tissues; Simple (Pro Cah)",,10120,CPT,Professional,Both,,,,597,507.45,66.53,597,"Multiplan, Inc.","Multiplan, Inc.",561.18,94,,percent of total billed charges,,
"Incision And Removal Of Foreign Body, Subcutaneous Tissues; Simple (Pro Cah)",,10120,CPT,Professional,Both,,,,597,507.45,66.53,597,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,537.897,90.1,,percent of total billed charges,,
"Incision And Removal Of Foreign Body, Subcutaneous Tissues; Simple (Pro Cah)",,10120,CPT,Professional,Both,,,,597,507.45,66.53,597,"Preferred One Administrative Services, INC.",PPO,588.642,98.6,,percent of total billed charges,,
"Incision And Removal Of Foreign Body, Subcutaneous Tissues; Simple (Pro Cah)",,10120,CPT,Professional,Both,,,,597,507.45,66.53,597,PrimeWest Health,Minnesota Senior Health Options (MSHO),119.1975,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Incision And Removal Of Foreign Body, Subcutaneous Tissues; Simple (Pro Cah)",,10120,CPT,Professional,Both,,,,597,507.45,66.53,597,PrimeWest Health,MinnesotaCare,82.186272,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Incision And Removal Of Foreign Body, Subcutaneous Tissues; Simple (Pro Cah)",,10120,CPT,Professional,Both,,,,597,507.45,66.53,597,Sanford Health Plan,Sanford Health Plan,525.36,88,,percent of total billed charges,,
"Incision And Removal Of Foreign Body, Subcutaneous Tissues; Simple (Pro Cah)",,10120,CPT,Professional,Both,,,,597,507.45,66.53,597,"UCare Health, Inc.",Individual & Family Plan,168.49344,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Incision And Removal Of Foreign Body, Subcutaneous Tissues; Simple (Pro Cah)",,10120,CPT,Professional,Both,,,,597,507.45,66.53,597,"UCare Health, Inc.",Medical Assistance,84.49056,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Incision And Removal Of Foreign Body, Subcutaneous Tissues; Simple (Pro Cah)",,10120,CPT,Professional,Both,,,,597,507.45,66.53,597,"UCare Health, Inc.",Medicare Advantage,119.1975,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Incision And Removal Of Foreign Body, Subcutaneous Tissues; Simple (Pro Cah)",,10120,CPT,Professional,Both,,,,597,507.45,66.53,597,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),95.358,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Incision And Removal Of Foreign Body, Subcutaneous Tissues; Simple (Pro Cah)",,10120,CPT,Professional,Both,,,,597,507.45,66.53,597,UnitedHealthcare,Individual & Family,597,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Incision And Removal Of Foreign Body, Subcutaneous Tissues; Simple (Pro Cah)",,10120,CPT,Professional,Both,,,,597,507.45,66.53,597,UnitedHealthcare,Medicare Advantage,119.1975,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Incision And Removal Of Foreign Body, Subcutaneous Tissues; Simple (Pro Cah)",,10120,CPT,Professional,Both,,,,597,507.45,66.53,597,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,76.8096,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Incision And Removal Of Foreign Body, Subcutaneous Tissues; Complicated (Pro Cah)",,10121,CPT,Professional,Both,,,,536,455.6,114.52,536,Aetna,Commercial,455.6,85,,percent of total billed charges,,
"Incision And Removal Of Foreign Body, Subcutaneous Tissues; Complicated (Pro Cah)",,10121,CPT,Professional,Both,,,,536,455.6,114.52,536,Aetna,Medicare Advantage,180.65,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Incision And Removal Of Foreign Body, Subcutaneous Tissues; Complicated (Pro Cah)",,10121,CPT,Professional,Both,,,,536,455.6,114.52,536,Aetna,PPO,498.48,93,,percent of total billed charges,,
"Incision And Removal Of Foreign Body, Subcutaneous Tissues; Complicated (Pro Cah)",,10121,CPT,Professional,Both,,,,536,455.6,114.52,536,America's PPO,America's PPO,457.9584,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Incision And Removal Of Foreign Body, Subcutaneous Tissues; Complicated (Pro Cah)",,10121,CPT,Professional,Both,,,,536,455.6,114.52,536,BlueCross BlueShield Minnesota, Federal Employee Program,376.66,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Incision And Removal Of Foreign Body, Subcutaneous Tissues; Complicated (Pro Cah)",,10121,CPT,Professional,Both,,,,536,455.6,114.52,536,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,382.68656,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Incision And Removal Of Foreign Body, Subcutaneous Tissues; Complicated (Pro Cah)",,10121,CPT,Professional,Both,,,,536,455.6,114.52,536,BlueCross BlueShield Minnesota,High Value Network Plan,382.68656,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Incision And Removal Of Foreign Body, Subcutaneous Tissues; Complicated (Pro Cah)",,10121,CPT,Professional,Both,,,,536,455.6,114.52,536,BlueCross BlueShield Minnesota,Medicare Advantage,204.93,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Incision And Removal Of Foreign Body, Subcutaneous Tissues; Complicated (Pro Cah)",,10121,CPT,Professional,Both,,,,536,455.6,114.52,536,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,382.68656,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Incision And Removal Of Foreign Body, Subcutaneous Tissues; Complicated (Pro Cah)",,10121,CPT,Professional,Both,,,,536,455.6,114.52,536,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,132.22224,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Incision And Removal Of Foreign Body, Subcutaneous Tissues; Complicated (Pro Cah)",,10121,CPT,Professional,Both,,,,536,455.6,114.52,536,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),204.93,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Incision And Removal Of Foreign Body, Subcutaneous Tissues; Complicated (Pro Cah)",,10121,CPT,Professional,Both,,,,536,455.6,114.52,536,CorVel,Worker's Compensation,348.4316127,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Incision And Removal Of Foreign Body, Subcutaneous Tissues; Complicated (Pro Cah)",,10121,CPT,Professional,Both,,,,536,455.6,114.52,536,First Health Group Corporation,First Health Network,519.92,97,,percent of total billed charges,,
"Incision And Removal Of Foreign Body, Subcutaneous Tissues; Complicated (Pro Cah)",,10121,CPT,Professional,Both,,,,536,455.6,114.52,536,"Health Partners, Inc.",Commercial,376.55,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Incision And Removal Of Foreign Body, Subcutaneous Tissues; Complicated (Pro Cah)",,10121,CPT,Professional,Both,,,,536,455.6,114.52,536,"Health Partners, Inc.",Medicare Advantage,204.93,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Incision And Removal Of Foreign Body, Subcutaneous Tissues; Complicated (Pro Cah)",,10121,CPT,Professional,Both,,,,536,455.6,114.52,536,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),177.91,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Incision And Removal Of Foreign Body, Subcutaneous Tissues; Complicated (Pro Cah)",,10121,CPT,Professional,Both,,,,536,455.6,114.52,536,"Health Partners, Inc.",State of Minnesota Advantage Program,324.397825,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Incision And Removal Of Foreign Body, Subcutaneous Tissues; Complicated (Pro Cah)",,10121,CPT,Professional,Both,,,,536,455.6,114.52,536,"Health Partners, Inc.",State Public Programs,114.52,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Incision And Removal Of Foreign Body, Subcutaneous Tissues; Complicated (Pro Cah)",,10121,CPT,Professional,Both,,,,536,455.6,114.52,536,Humana Insurance Company,Commercial PPO,178.2,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Incision And Removal Of Foreign Body, Subcutaneous Tissues; Complicated (Pro Cah)",,10121,CPT,Professional,Both,,,,536,455.6,114.52,536,Humana Insurance Company,Medicare PPO,536,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Incision And Removal Of Foreign Body, Subcutaneous Tissues; Complicated (Pro Cah)",,10121,CPT,Professional,Both,,,,536,455.6,114.52,536,Medica,Individual & Family,454.528,84.8,,percent of total billed charges,,
"Incision And Removal Of Foreign Body, Subcutaneous Tissues; Complicated (Pro Cah)",,10121,CPT,Professional,Both,,,,536,455.6,114.52,536,Medica,Medica Advantage Solution,266.928,49.8,,percent of total billed charges,,
"Incision And Removal Of Foreign Body, Subcutaneous Tissues; Complicated (Pro Cah)",,10121,CPT,Professional,Both,,,,536,455.6,114.52,536,Medica,Medical Assistance,132.22,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Incision And Removal Of Foreign Body, Subcutaneous Tissues; Complicated (Pro Cah)",,10121,CPT,Professional,Both,,,,536,455.6,114.52,536,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,178.2,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Incision And Removal Of Foreign Body, Subcutaneous Tissues; Complicated (Pro Cah)",,10121,CPT,Professional,Both,,,,536,455.6,114.52,536,"Multiplan, Inc.","Multiplan, Inc.",503.84,94,,percent of total billed charges,,
"Incision And Removal Of Foreign Body, Subcutaneous Tissues; Complicated (Pro Cah)",,10121,CPT,Professional,Both,,,,536,455.6,114.52,536,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,482.936,90.1,,percent of total billed charges,,
"Incision And Removal Of Foreign Body, Subcutaneous Tissues; Complicated (Pro Cah)",,10121,CPT,Professional,Both,,,,536,455.6,114.52,536,"Preferred One Administrative Services, INC.",PPO,528.496,98.6,,percent of total billed charges,,
"Incision And Removal Of Foreign Body, Subcutaneous Tissues; Complicated (Pro Cah)",,10121,CPT,Professional,Both,,,,536,455.6,114.52,536,PrimeWest Health,Minnesota Senior Health Options (MSHO),204.93,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Incision And Removal Of Foreign Body, Subcutaneous Tissues; Complicated (Pro Cah)",,10121,CPT,Professional,Both,,,,536,455.6,114.52,536,PrimeWest Health,MinnesotaCare,141.4777968,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Incision And Removal Of Foreign Body, Subcutaneous Tissues; Complicated (Pro Cah)",,10121,CPT,Professional,Both,,,,536,455.6,114.52,536,Sanford Health Plan,Sanford Health Plan,471.68,88,,percent of total billed charges,,
"Incision And Removal Of Foreign Body, Subcutaneous Tissues; Complicated (Pro Cah)",,10121,CPT,Professional,Both,,,,536,455.6,114.52,536,"UCare Health, Inc.",Individual & Family Plan,289.68192,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Incision And Removal Of Foreign Body, Subcutaneous Tissues; Complicated (Pro Cah)",,10121,CPT,Professional,Both,,,,536,455.6,114.52,536,"UCare Health, Inc.",Medical Assistance,145.444464,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Incision And Removal Of Foreign Body, Subcutaneous Tissues; Complicated (Pro Cah)",,10121,CPT,Professional,Both,,,,536,455.6,114.52,536,"UCare Health, Inc.",Medicare Advantage,204.93,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Incision And Removal Of Foreign Body, Subcutaneous Tissues; Complicated (Pro Cah)",,10121,CPT,Professional,Both,,,,536,455.6,114.52,536,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),163.944,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Incision And Removal Of Foreign Body, Subcutaneous Tissues; Complicated (Pro Cah)",,10121,CPT,Professional,Both,,,,536,455.6,114.52,536,UnitedHealthcare,Individual & Family,536,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Incision And Removal Of Foreign Body, Subcutaneous Tissues; Complicated (Pro Cah)",,10121,CPT,Professional,Both,,,,536,455.6,114.52,536,UnitedHealthcare,Medicare Advantage,204.93,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Incision And Removal Of Foreign Body, Subcutaneous Tissues; Complicated (Pro Cah)",,10121,CPT,Professional,Both,,,,536,455.6,114.52,536,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,132.22224,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Incision & Drainage Hematoma, Seroma, Or Fluid Collection (Pbb)",,10140,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,Aetna,Commercial,234.6,92,,percent of total billed charges,,
"Incision & Drainage Hematoma, Seroma, Or Fluid Collection (Pbb)",,10140,CPT,Professional,Outpatient,,,,377,320.45,80.49,377,Aetna,Commercial,320.45,85,,percent of total billed charges,,
"Incision & Drainage Hematoma, Seroma, Or Fluid Collection (Pbb)",,10140,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,Aetna,Medicare Advantage,124.95,49,,percent of total billed charges,,
"Incision & Drainage Hematoma, Seroma, Or Fluid Collection (Pbb)",,10140,CPT,Professional,Outpatient,,,,377,320.45,80.49,377,Aetna,Medicare Advantage,116.75,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Incision & Drainage Hematoma, Seroma, Or Fluid Collection (Pbb)",,10140,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,Aetna,PPO,237.15,93,,percent of total billed charges,,
"Incision & Drainage Hematoma, Seroma, Or Fluid Collection (Pbb)",,10140,CPT,Professional,Outpatient,,,,377,320.45,80.49,377,Aetna,PPO,350.61,93,,percent of total billed charges,,
"Incision & Drainage Hematoma, Seroma, Or Fluid Collection (Pbb)",,10140,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,America's PPO,America's PPO,244.8765,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Incision & Drainage Hematoma, Seroma, Or Fluid Collection (Pbb)",,10140,CPT,Professional,Outpatient,,,,377,320.45,80.49,377,America's PPO,America's PPO,322.1088,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Incision & Drainage Hematoma, Seroma, Or Fluid Collection (Pbb)",,10140,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,BlueCross BlueShield Minnesota, Federal Employee Program,250.92,98.4,,percent of total billed charges,,
"Incision & Drainage Hematoma, Seroma, Or Fluid Collection (Pbb)",,10140,CPT,Professional,Outpatient,,,,377,320.45,80.49,377,BlueCross BlueShield Minnesota, Federal Employee Program,241.7,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Incision & Drainage Hematoma, Seroma, Or Fluid Collection (Pbb)",,10140,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,255,100,,percent of total billed charges,,
"Incision & Drainage Hematoma, Seroma, Or Fluid Collection (Pbb)",,10140,CPT,Professional,Outpatient,,,,377,320.45,80.49,377,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,245.5672,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Incision & Drainage Hematoma, Seroma, Or Fluid Collection (Pbb)",,10140,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,BlueCross BlueShield Minnesota,High Value Network Plan,229.5,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
"Incision & Drainage Hematoma, Seroma, Or Fluid Collection (Pbb)",,10140,CPT,Professional,Outpatient,,,,377,320.45,80.49,377,BlueCross BlueShield Minnesota,High Value Network Plan,245.5672,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Incision & Drainage Hematoma, Seroma, Or Fluid Collection (Pbb)",,10140,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,BlueCross BlueShield Minnesota,Medicare Advantage,124.95,49,,percent of total billed charges,,
"Incision & Drainage Hematoma, Seroma, Or Fluid Collection (Pbb)",,10140,CPT,Professional,Outpatient,,,,377,320.45,80.49,377,BlueCross BlueShield Minnesota,Medicare Advantage,132.8135,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Incision & Drainage Hematoma, Seroma, Or Fluid Collection (Pbb)",,10140,CPT,Professional,Outpatient,,,,377,320.45,80.49,377,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,245.5672,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Incision & Drainage Hematoma, Seroma, Or Fluid Collection (Pbb)",,10140,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,73.083,28.66,,percent of total billed charges,,
"Incision & Drainage Hematoma, Seroma, Or Fluid Collection (Pbb)",,10140,CPT,Professional,Outpatient,,,,377,320.45,80.49,377,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,85.62848,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Incision & Drainage Hematoma, Seroma, Or Fluid Collection (Pbb)",,10140,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),124.95,49,,percent of total billed charges,,
"Incision & Drainage Hematoma, Seroma, Or Fluid Collection (Pbb)",,10140,CPT,Professional,Outpatient,,,,377,320.45,80.49,377,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),132.8135,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Incision & Drainage Hematoma, Seroma, Or Fluid Collection (Pbb)",,10140,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,CorVel,Worker's Compensation,255,100,,percent of total billed charges,,
"Incision & Drainage Hematoma, Seroma, Or Fluid Collection (Pbb)",,10140,CPT,Professional,Outpatient,,,,377,320.45,80.49,377,CorVel,Worker's Compensation,225.4205049,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Incision & Drainage Hematoma, Seroma, Or Fluid Collection (Pbb)",,10140,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,First Health Group Corporation,First Health Network,247.35,97,,percent of total billed charges,,
"Incision & Drainage Hematoma, Seroma, Or Fluid Collection (Pbb)",,10140,CPT,Professional,Outpatient,,,,377,320.45,80.49,377,First Health Group Corporation,First Health Network,365.69,97,,percent of total billed charges,,
"Incision & Drainage Hematoma, Seroma, Or Fluid Collection (Pbb)",,10140,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,"Health Partners, Inc.",Commercial,241.23,94.6,,percent of total billed charges,,
"Incision & Drainage Hematoma, Seroma, Or Fluid Collection (Pbb)",,10140,CPT,Professional,Outpatient,,,,377,320.45,80.49,377,"Health Partners, Inc.",Commercial,243.05,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Incision & Drainage Hematoma, Seroma, Or Fluid Collection (Pbb)",,10140,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,"Health Partners, Inc.",Medicare Advantage,124.95,49,,percent of total billed charges,,
"Incision & Drainage Hematoma, Seroma, Or Fluid Collection (Pbb)",,10140,CPT,Professional,Outpatient,,,,377,320.45,80.49,377,"Health Partners, Inc.",Medicare Advantage,132.8135,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Incision & Drainage Hematoma, Seroma, Or Fluid Collection (Pbb)",,10140,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),153,60,,percent of total billed charges,,
"Incision & Drainage Hematoma, Seroma, Or Fluid Collection (Pbb)",,10140,CPT,Professional,Outpatient,,,,377,320.45,80.49,377,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),115.56,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Incision & Drainage Hematoma, Seroma, Or Fluid Collection (Pbb)",,10140,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,"Health Partners, Inc.",State of Minnesota Advantage Program,207.825,81.5,,percent of total billed charges,,
"Incision & Drainage Hematoma, Seroma, Or Fluid Collection (Pbb)",,10140,CPT,Professional,Outpatient,,,,377,320.45,80.49,377,"Health Partners, Inc.",State of Minnesota Advantage Program,209.387575,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Incision & Drainage Hematoma, Seroma, Or Fluid Collection (Pbb)",,10140,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,"Health Partners, Inc.",State Public Programs,127.5,50,,percent of total billed charges,,
"Incision & Drainage Hematoma, Seroma, Or Fluid Collection (Pbb)",,10140,CPT,Professional,Outpatient,,,,377,320.45,80.49,377,"Health Partners, Inc.",State Public Programs,80.49,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Incision & Drainage Hematoma, Seroma, Or Fluid Collection (Pbb)",,10140,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,Humana Insurance Company,Commercial PPO,242.25,95,,percent of total billed charges,,
"Incision & Drainage Hematoma, Seroma, Or Fluid Collection (Pbb)",,10140,CPT,Professional,Outpatient,,,,377,320.45,80.49,377,Humana Insurance Company,Commercial PPO,115.49,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Incision & Drainage Hematoma, Seroma, Or Fluid Collection (Pbb)",,10140,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,Humana Insurance Company,Medicare PPO,124.95,49,,percent of total billed charges,,
"Incision & Drainage Hematoma, Seroma, Or Fluid Collection (Pbb)",,10140,CPT,Professional,Outpatient,,,,377,320.45,80.49,377,Humana Insurance Company,Medicare PPO,377,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Incision & Drainage Hematoma, Seroma, Or Fluid Collection (Pbb)",,10140,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,Medica,Individual & Family,252.705,99.1,,percent of total billed charges,,
"Incision & Drainage Hematoma, Seroma, Or Fluid Collection (Pbb)",,10140,CPT,Professional,Outpatient,,,,377,320.45,80.49,377,Medica,Individual & Family,319.696,84.8,,percent of total billed charges,,
"Incision & Drainage Hematoma, Seroma, Or Fluid Collection (Pbb)",,10140,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,Medica,Medica Advantage Solution,126.99,49.8,,percent of total billed charges,,
"Incision & Drainage Hematoma, Seroma, Or Fluid Collection (Pbb)",,10140,CPT,Professional,Outpatient,,,,377,320.45,80.49,377,Medica,Medica Advantage Solution,187.746,49.8,,percent of total billed charges,,
"Incision & Drainage Hematoma, Seroma, Or Fluid Collection (Pbb)",,10140,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,Medica,Medical Assistance,113.73,44.6,,percent of total billed charges,,
"Incision & Drainage Hematoma, Seroma, Or Fluid Collection (Pbb)",,10140,CPT,Professional,Outpatient,,,,377,320.45,80.49,377,Medica,Medical Assistance,85.63,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Incision & Drainage Hematoma, Seroma, Or Fluid Collection (Pbb)",,10140,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,126.99,49.8,,percent of total billed charges,,
"Incision & Drainage Hematoma, Seroma, Or Fluid Collection (Pbb)",,10140,CPT,Professional,Outpatient,,,,377,320.45,80.49,377,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,115.49,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Incision & Drainage Hematoma, Seroma, Or Fluid Collection (Pbb)",,10140,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,"Multiplan, Inc.","Multiplan, Inc.",239.7,94,,percent of total billed charges,,
"Incision & Drainage Hematoma, Seroma, Or Fluid Collection (Pbb)",,10140,CPT,Professional,Outpatient,,,,377,320.45,80.49,377,"Multiplan, Inc.","Multiplan, Inc.",354.38,94,,percent of total billed charges,,
"Incision & Drainage Hematoma, Seroma, Or Fluid Collection (Pbb)",,10140,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,229.755,90.1,,percent of total billed charges,,
"Incision & Drainage Hematoma, Seroma, Or Fluid Collection (Pbb)",,10140,CPT,Professional,Outpatient,,,,377,320.45,80.49,377,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,339.677,90.1,,percent of total billed charges,,
"Incision & Drainage Hematoma, Seroma, Or Fluid Collection (Pbb)",,10140,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,"Preferred One Administrative Services, INC.",PPO,251.43,98.6,,percent of total billed charges,,
"Incision & Drainage Hematoma, Seroma, Or Fluid Collection (Pbb)",,10140,CPT,Professional,Outpatient,,,,377,320.45,80.49,377,"Preferred One Administrative Services, INC.",PPO,371.722,98.6,,percent of total billed charges,,
"Incision & Drainage Hematoma, Seroma, Or Fluid Collection (Pbb)",,10140,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,PrimeWest Health,Minnesota Senior Health Options (MSHO),131.1975,51.45,,percent of total billed charges,,
"Incision & Drainage Hematoma, Seroma, Or Fluid Collection (Pbb)",,10140,CPT,Professional,Outpatient,,,,377,320.45,80.49,377,PrimeWest Health,Minnesota Senior Health Options (MSHO),132.8135,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Incision & Drainage Hematoma, Seroma, Or Fluid Collection (Pbb)",,10140,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,PrimeWest Health,MinnesotaCare,130.968,51.36,,percent of total billed charges,,
"Incision & Drainage Hematoma, Seroma, Or Fluid Collection (Pbb)",,10140,CPT,Professional,Outpatient,,,,377,320.45,80.49,377,PrimeWest Health,MinnesotaCare,91.6224736,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Incision & Drainage Hematoma, Seroma, Or Fluid Collection (Pbb)",,10140,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,Sanford Health Plan,Sanford Health Plan,234.6,92,,percent of total billed charges,,
"Incision & Drainage Hematoma, Seroma, Or Fluid Collection (Pbb)",,10140,CPT,Professional,Outpatient,,,,377,320.45,80.49,377,Sanford Health Plan,Sanford Health Plan,331.76,88,,percent of total billed charges,,
"Incision & Drainage Hematoma, Seroma, Or Fluid Collection (Pbb)",,10140,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,"UCare Health, Inc.",Individual & Family Plan,143.6925,56.35,,percent of total billed charges,,
"Incision & Drainage Hematoma, Seroma, Or Fluid Collection (Pbb)",,10140,CPT,Professional,Outpatient,,,,377,320.45,80.49,377,"UCare Health, Inc.",Individual & Family Plan,187.740544,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Incision & Drainage Hematoma, Seroma, Or Fluid Collection (Pbb)",,10140,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,"UCare Health, Inc.",Medical Assistance,128.6985,50.47,,percent of total billed charges,,
"Incision & Drainage Hematoma, Seroma, Or Fluid Collection (Pbb)",,10140,CPT,Professional,Outpatient,,,,377,320.45,80.49,377,"UCare Health, Inc.",Medical Assistance,94.191328,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Incision & Drainage Hematoma, Seroma, Or Fluid Collection (Pbb)",,10140,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,"UCare Health, Inc.",Medicare Advantage,128.6985,50.47,,percent of total billed charges,,
"Incision & Drainage Hematoma, Seroma, Or Fluid Collection (Pbb)",,10140,CPT,Professional,Outpatient,,,,377,320.45,80.49,377,"UCare Health, Inc.",Medicare Advantage,132.8135,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Incision & Drainage Hematoma, Seroma, Or Fluid Collection (Pbb)",,10140,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),128.6985,50.47,,percent of total billed charges,,
"Incision & Drainage Hematoma, Seroma, Or Fluid Collection (Pbb)",,10140,CPT,Professional,Outpatient,,,,377,320.45,80.49,377,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),106.2508,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Incision & Drainage Hematoma, Seroma, Or Fluid Collection (Pbb)",,10140,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,UnitedHealthcare,Individual & Family,239.7,94,,percent of total billed charges,,
"Incision & Drainage Hematoma, Seroma, Or Fluid Collection (Pbb)",,10140,CPT,Professional,Outpatient,,,,377,320.45,80.49,377,UnitedHealthcare,Individual & Family,377,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Incision & Drainage Hematoma, Seroma, Or Fluid Collection (Pbb)",,10140,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,UnitedHealthcare,Medicare Advantage,124.95,49,,percent of total billed charges,,
"Incision & Drainage Hematoma, Seroma, Or Fluid Collection (Pbb)",,10140,CPT,Professional,Outpatient,,,,377,320.45,80.49,377,UnitedHealthcare,Medicare Advantage,132.8135,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Incision & Drainage Hematoma, Seroma, Or Fluid Collection (Pbb)",,10140,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,122.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Incision & Drainage Hematoma, Seroma, Or Fluid Collection (Pbb)",,10140,CPT,Professional,Outpatient,,,,377,320.45,80.49,377,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,85.62848,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Incision And Drainage Of Hematoma, Seroma Or Fluid Collection (Pro Cah)",,10140,CPT,Professional,Both,,,,632,537.2,80.49,632,Aetna,Commercial,537.2,85,,percent of total billed charges,,
"Incision And Drainage Of Hematoma, Seroma Or Fluid Collection (Pro Cah)",,10140,CPT,Professional,Both,,,,632,537.2,80.49,632,Aetna,Medicare Advantage,116.75,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Incision And Drainage Of Hematoma, Seroma Or Fluid Collection (Pro Cah)",,10140,CPT,Professional,Both,,,,632,537.2,80.49,632,Aetna,PPO,587.76,93,,percent of total billed charges,,
"Incision And Drainage Of Hematoma, Seroma Or Fluid Collection (Pro Cah)",,10140,CPT,Professional,Both,,,,632,537.2,80.49,632,America's PPO,America's PPO,539.9808,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Incision And Drainage Of Hematoma, Seroma Or Fluid Collection (Pro Cah)",,10140,CPT,Professional,Both,,,,632,537.2,80.49,632,BlueCross BlueShield Minnesota, Federal Employee Program,241.7,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Incision And Drainage Of Hematoma, Seroma Or Fluid Collection (Pro Cah)",,10140,CPT,Professional,Both,,,,632,537.2,80.49,632,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,245.5672,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Incision And Drainage Of Hematoma, Seroma Or Fluid Collection (Pro Cah)",,10140,CPT,Professional,Both,,,,632,537.2,80.49,632,BlueCross BlueShield Minnesota,High Value Network Plan,245.5672,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Incision And Drainage Of Hematoma, Seroma Or Fluid Collection (Pro Cah)",,10140,CPT,Professional,Both,,,,632,537.2,80.49,632,BlueCross BlueShield Minnesota,Medicare Advantage,132.8135,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Incision And Drainage Of Hematoma, Seroma Or Fluid Collection (Pro Cah)",,10140,CPT,Professional,Both,,,,632,537.2,80.49,632,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,245.5672,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Incision And Drainage Of Hematoma, Seroma Or Fluid Collection (Pro Cah)",,10140,CPT,Professional,Both,,,,632,537.2,80.49,632,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,85.62848,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Incision And Drainage Of Hematoma, Seroma Or Fluid Collection (Pro Cah)",,10140,CPT,Professional,Both,,,,632,537.2,80.49,632,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),132.8135,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Incision And Drainage Of Hematoma, Seroma Or Fluid Collection (Pro Cah)",,10140,CPT,Professional,Both,,,,632,537.2,80.49,632,CorVel,Worker's Compensation,225.4205049,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Incision And Drainage Of Hematoma, Seroma Or Fluid Collection (Pro Cah)",,10140,CPT,Professional,Both,,,,632,537.2,80.49,632,First Health Group Corporation,First Health Network,613.04,97,,percent of total billed charges,,
"Incision And Drainage Of Hematoma, Seroma Or Fluid Collection (Pro Cah)",,10140,CPT,Professional,Both,,,,632,537.2,80.49,632,"Health Partners, Inc.",Commercial,243.05,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Incision And Drainage Of Hematoma, Seroma Or Fluid Collection (Pro Cah)",,10140,CPT,Professional,Both,,,,632,537.2,80.49,632,"Health Partners, Inc.",Medicare Advantage,132.8135,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Incision And Drainage Of Hematoma, Seroma Or Fluid Collection (Pro Cah)",,10140,CPT,Professional,Both,,,,632,537.2,80.49,632,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),115.56,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Incision And Drainage Of Hematoma, Seroma Or Fluid Collection (Pro Cah)",,10140,CPT,Professional,Both,,,,632,537.2,80.49,632,"Health Partners, Inc.",State of Minnesota Advantage Program,209.387575,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Incision And Drainage Of Hematoma, Seroma Or Fluid Collection (Pro Cah)",,10140,CPT,Professional,Both,,,,632,537.2,80.49,632,"Health Partners, Inc.",State Public Programs,80.49,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Incision And Drainage Of Hematoma, Seroma Or Fluid Collection (Pro Cah)",,10140,CPT,Professional,Both,,,,632,537.2,80.49,632,Humana Insurance Company,Commercial PPO,115.49,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Incision And Drainage Of Hematoma, Seroma Or Fluid Collection (Pro Cah)",,10140,CPT,Professional,Both,,,,632,537.2,80.49,632,Humana Insurance Company,Medicare PPO,632,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Incision And Drainage Of Hematoma, Seroma Or Fluid Collection (Pro Cah)",,10140,CPT,Professional,Both,,,,632,537.2,80.49,632,Medica,Individual & Family,535.936,84.8,,percent of total billed charges,,
"Incision And Drainage Of Hematoma, Seroma Or Fluid Collection (Pro Cah)",,10140,CPT,Professional,Both,,,,632,537.2,80.49,632,Medica,Medica Advantage Solution,314.736,49.8,,percent of total billed charges,,
"Incision And Drainage Of Hematoma, Seroma Or Fluid Collection (Pro Cah)",,10140,CPT,Professional,Both,,,,632,537.2,80.49,632,Medica,Medical Assistance,85.63,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Incision And Drainage Of Hematoma, Seroma Or Fluid Collection (Pro Cah)",,10140,CPT,Professional,Both,,,,632,537.2,80.49,632,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,115.49,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Incision And Drainage Of Hematoma, Seroma Or Fluid Collection (Pro Cah)",,10140,CPT,Professional,Both,,,,632,537.2,80.49,632,"Multiplan, Inc.","Multiplan, Inc.",594.08,94,,percent of total billed charges,,
"Incision And Drainage Of Hematoma, Seroma Or Fluid Collection (Pro Cah)",,10140,CPT,Professional,Both,,,,632,537.2,80.49,632,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,569.432,90.1,,percent of total billed charges,,
"Incision And Drainage Of Hematoma, Seroma Or Fluid Collection (Pro Cah)",,10140,CPT,Professional,Both,,,,632,537.2,80.49,632,"Preferred One Administrative Services, INC.",PPO,623.152,98.6,,percent of total billed charges,,
"Incision And Drainage Of Hematoma, Seroma Or Fluid Collection (Pro Cah)",,10140,CPT,Professional,Both,,,,632,537.2,80.49,632,PrimeWest Health,Minnesota Senior Health Options (MSHO),132.8135,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Incision And Drainage Of Hematoma, Seroma Or Fluid Collection (Pro Cah)",,10140,CPT,Professional,Both,,,,632,537.2,80.49,632,PrimeWest Health,MinnesotaCare,91.6224736,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Incision And Drainage Of Hematoma, Seroma Or Fluid Collection (Pro Cah)",,10140,CPT,Professional,Both,,,,632,537.2,80.49,632,Sanford Health Plan,Sanford Health Plan,556.16,88,,percent of total billed charges,,
"Incision And Drainage Of Hematoma, Seroma Or Fluid Collection (Pro Cah)",,10140,CPT,Professional,Both,,,,632,537.2,80.49,632,"UCare Health, Inc.",Individual & Family Plan,187.740544,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Incision And Drainage Of Hematoma, Seroma Or Fluid Collection (Pro Cah)",,10140,CPT,Professional,Both,,,,632,537.2,80.49,632,"UCare Health, Inc.",Medical Assistance,94.191328,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Incision And Drainage Of Hematoma, Seroma Or Fluid Collection (Pro Cah)",,10140,CPT,Professional,Both,,,,632,537.2,80.49,632,"UCare Health, Inc.",Medicare Advantage,132.8135,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Incision And Drainage Of Hematoma, Seroma Or Fluid Collection (Pro Cah)",,10140,CPT,Professional,Both,,,,632,537.2,80.49,632,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),106.2508,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Incision And Drainage Of Hematoma, Seroma Or Fluid Collection (Pro Cah)",,10140,CPT,Professional,Both,,,,632,537.2,80.49,632,UnitedHealthcare,Individual & Family,632,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Incision And Drainage Of Hematoma, Seroma Or Fluid Collection (Pro Cah)",,10140,CPT,Professional,Both,,,,632,537.2,80.49,632,UnitedHealthcare,Medicare Advantage,132.8135,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Incision And Drainage Of Hematoma, Seroma Or Fluid Collection (Pro Cah)",,10140,CPT,Professional,Both,,,,632,537.2,80.49,632,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,85.62848,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
BENZTROPINE 1 MG ORAL TABLET,,13925,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
BENZTROPINE 1 MG ORAL TABLET,,13925,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
BENZTROPINE 1 MG ORAL TABLET,,13925,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
BENZTROPINE 1 MG ORAL TABLET,,13925,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
BENZTROPINE 1 MG ORAL TABLET,,13925,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
BENZTROPINE 1 MG ORAL TABLET,,13925,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
BENZTROPINE 1 MG ORAL TABLET,,13925,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
BENZTROPINE 1 MG ORAL TABLET,,13925,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
BENZTROPINE 1 MG ORAL TABLET,,13925,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
BENZTROPINE 1 MG ORAL TABLET,,13925,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
BENZTROPINE 1 MG ORAL TABLET,,13925,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
BENZTROPINE 1 MG ORAL TABLET,,13925,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
BENZTROPINE 1 MG ORAL TABLET,,13925,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
BENZTROPINE 1 MG ORAL TABLET,,13925,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
BENZTROPINE 1 MG ORAL TABLET,,13925,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
BENZTROPINE 1 MG ORAL TABLET,,13925,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
BENZTROPINE 1 MG ORAL TABLET,,13925,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
BENZTROPINE 1 MG ORAL TABLET,,13925,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
BENZTROPINE 1 MG ORAL TABLET,,13925,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
BENZTROPINE 1 MG ORAL TABLET,,13925,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
BENZTROPINE 1 MG ORAL TABLET,,13925,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
BENZTROPINE 1 MG ORAL TABLET,,13925,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
BENZTROPINE 1 MG ORAL TABLET,,13925,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
BENZTROPINE 1 MG ORAL TABLET,,13925,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
BENZTROPINE 1 MG ORAL TABLET,,13925,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
BENZTROPINE 1 MG ORAL TABLET,,13925,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
BENZTROPINE 1 MG ORAL TABLET,,13925,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
BENZTROPINE 1 MG ORAL TABLET,,13925,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
BENZTROPINE 1 MG ORAL TABLET,,13925,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
BENZTROPINE 1 MG ORAL TABLET,,13925,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
BENZTROPINE 1 MG ORAL TABLET,,13925,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
BENZTROPINE 1 MG ORAL TABLET,,13925,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
BENZTROPINE 1 MG ORAL TABLET,,13925,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
BENZTROPINE 1 MG ORAL TABLET,,13925,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
BENZTROPINE 1 MG ORAL TABLET,,13925,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
BENZTROPINE 1 MG ORAL TABLET,,13925,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
BENZTROPINE 1 MG ORAL TABLET,,13925,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
BENZTROPINE 1 MG ORAL TABLET,,13925,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
BENZTROPINE 1 MG ORAL TABLET,,13925,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
BENZTROPINE 1 MG ORAL TABLET,,13925,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
BENZTROPINE 1 MG ORAL TABLET,,13925,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
BENZTROPINE 1 MG ORAL TABLET,,13925,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
BENZTROPINE 1 MG ORAL TABLET,,13925,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
BENZTROPINE 1 MG ORAL TABLET,,13925,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BENZTROPINE 1 MG ORAL TABLET,,13925,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
BENZTROPINE 1 MG ORAL TABLET,,13925,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BENZTROPINE 1 MG ORAL TABLET,,13925,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
BENZTROPINE 1 MG ORAL TABLET,,13925,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BENZTROPINE 1 MG ORAL TABLET,,13925,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
BENZTROPINE 1 MG ORAL TABLET,,13925,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
BENZTROPINE 1 MG ORAL TABLET,,13925,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
BENZTROPINE 1 MG ORAL TABLET,,13925,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
BENZTROPINE 1 MG ORAL TABLET,,13925,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
BENZTROPINE 1 MG ORAL TABLET,,13925,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Puncture Aspiration Abscess, Hematoma, Bulla, Cyst (Pbb)",,10160,CPT,Facility,Outpatient,,,,214,181.9,61.3324,214,Aetna,Commercial,196.88,92,,percent of total billed charges,,
"Puncture Aspiration Abscess, Hematoma, Bulla, Cyst (Pbb)",,10160,CPT,Professional,Outpatient,,,,284,241.4,60.86,284,Aetna,Commercial,241.4,85,,percent of total billed charges,,
"Puncture Aspiration Abscess, Hematoma, Bulla, Cyst (Pbb)",,10160,CPT,Facility,Outpatient,,,,214,181.9,61.3324,214,Aetna,Medicare Advantage,104.86,49,,percent of total billed charges,,
"Puncture Aspiration Abscess, Hematoma, Bulla, Cyst (Pbb)",,10160,CPT,Professional,Outpatient,,,,284,241.4,60.86,284,Aetna,Medicare Advantage,93.89,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Puncture Aspiration Abscess, Hematoma, Bulla, Cyst (Pbb)",,10160,CPT,Facility,Outpatient,,,,214,181.9,61.3324,214,Aetna,PPO,199.02,93,,percent of total billed charges,,
"Puncture Aspiration Abscess, Hematoma, Bulla, Cyst (Pbb)",,10160,CPT,Professional,Outpatient,,,,284,241.4,60.86,284,Aetna,PPO,264.12,93,,percent of total billed charges,,
"Puncture Aspiration Abscess, Hematoma, Bulla, Cyst (Pbb)",,10160,CPT,Facility,Outpatient,,,,214,181.9,61.3324,214,America's PPO,America's PPO,205.5042,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Puncture Aspiration Abscess, Hematoma, Bulla, Cyst (Pbb)",,10160,CPT,Professional,Outpatient,,,,284,241.4,60.86,284,America's PPO,America's PPO,242.6496,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Puncture Aspiration Abscess, Hematoma, Bulla, Cyst (Pbb)",,10160,CPT,Facility,Outpatient,,,,214,181.9,61.3324,214,BlueCross BlueShield Minnesota, Federal Employee Program,210.576,98.4,,percent of total billed charges,,
"Puncture Aspiration Abscess, Hematoma, Bulla, Cyst (Pbb)",,10160,CPT,Professional,Outpatient,,,,284,241.4,60.86,284,BlueCross BlueShield Minnesota, Federal Employee Program,198.32,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Puncture Aspiration Abscess, Hematoma, Bulla, Cyst (Pbb)",,10160,CPT,Facility,Outpatient,,,,214,181.9,61.3324,214,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,214,100,,percent of total billed charges,,
"Puncture Aspiration Abscess, Hematoma, Bulla, Cyst (Pbb)",,10160,CPT,Professional,Outpatient,,,,284,241.4,60.86,284,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,201.49312,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Puncture Aspiration Abscess, Hematoma, Bulla, Cyst (Pbb)",,10160,CPT,Facility,Outpatient,,,,214,181.9,61.3324,214,BlueCross BlueShield Minnesota,High Value Network Plan,192.6,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
"Puncture Aspiration Abscess, Hematoma, Bulla, Cyst (Pbb)",,10160,CPT,Professional,Outpatient,,,,284,241.4,60.86,284,BlueCross BlueShield Minnesota,High Value Network Plan,201.49312,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Puncture Aspiration Abscess, Hematoma, Bulla, Cyst (Pbb)",,10160,CPT,Facility,Outpatient,,,,214,181.9,61.3324,214,BlueCross BlueShield Minnesota,Medicare Advantage,104.86,49,,percent of total billed charges,,
"Puncture Aspiration Abscess, Hematoma, Bulla, Cyst (Pbb)",,10160,CPT,Professional,Outpatient,,,,284,241.4,60.86,284,BlueCross BlueShield Minnesota,Medicare Advantage,108.8475,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Puncture Aspiration Abscess, Hematoma, Bulla, Cyst (Pbb)",,10160,CPT,Professional,Outpatient,,,,284,241.4,60.86,284,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,201.49312,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Puncture Aspiration Abscess, Hematoma, Bulla, Cyst (Pbb)",,10160,CPT,Facility,Outpatient,,,,214,181.9,61.3324,214,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,61.3324,28.66,,percent of total billed charges,,
"Puncture Aspiration Abscess, Hematoma, Bulla, Cyst (Pbb)",,10160,CPT,Professional,Outpatient,,,,284,241.4,60.86,284,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,70.26656,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Puncture Aspiration Abscess, Hematoma, Bulla, Cyst (Pbb)",,10160,CPT,Facility,Outpatient,,,,214,181.9,61.3324,214,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),104.86,49,,percent of total billed charges,,
"Puncture Aspiration Abscess, Hematoma, Bulla, Cyst (Pbb)",,10160,CPT,Professional,Outpatient,,,,284,241.4,60.86,284,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),108.8475,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Puncture Aspiration Abscess, Hematoma, Bulla, Cyst (Pbb)",,10160,CPT,Facility,Outpatient,,,,214,181.9,61.3324,214,CorVel,Worker's Compensation,214,100,,percent of total billed charges,,
"Puncture Aspiration Abscess, Hematoma, Bulla, Cyst (Pbb)",,10160,CPT,Professional,Outpatient,,,,284,241.4,60.86,284,CorVel,Worker's Compensation,182.5425354,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Puncture Aspiration Abscess, Hematoma, Bulla, Cyst (Pbb)",,10160,CPT,Facility,Outpatient,,,,214,181.9,61.3324,214,First Health Group Corporation,First Health Network,207.58,97,,percent of total billed charges,,
"Puncture Aspiration Abscess, Hematoma, Bulla, Cyst (Pbb)",,10160,CPT,Professional,Outpatient,,,,284,241.4,60.86,284,First Health Group Corporation,First Health Network,275.48,97,,percent of total billed charges,,
"Puncture Aspiration Abscess, Hematoma, Bulla, Cyst (Pbb)",,10160,CPT,Facility,Outpatient,,,,214,181.9,61.3324,214,"Health Partners, Inc.",Commercial,202.444,94.6,,percent of total billed charges,,
"Puncture Aspiration Abscess, Hematoma, Bulla, Cyst (Pbb)",,10160,CPT,Professional,Outpatient,,,,284,241.4,60.86,284,"Health Partners, Inc.",Commercial,197.35,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Puncture Aspiration Abscess, Hematoma, Bulla, Cyst (Pbb)",,10160,CPT,Facility,Outpatient,,,,214,181.9,61.3324,214,"Health Partners, Inc.",Medicare Advantage,104.86,49,,percent of total billed charges,,
"Puncture Aspiration Abscess, Hematoma, Bulla, Cyst (Pbb)",,10160,CPT,Professional,Outpatient,,,,284,241.4,60.86,284,"Health Partners, Inc.",Medicare Advantage,108.8475,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Puncture Aspiration Abscess, Hematoma, Bulla, Cyst (Pbb)",,10160,CPT,Facility,Outpatient,,,,214,181.9,61.3324,214,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),128.4,60,,percent of total billed charges,,
"Puncture Aspiration Abscess, Hematoma, Bulla, Cyst (Pbb)",,10160,CPT,Professional,Outpatient,,,,284,241.4,60.86,284,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),94.88,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Puncture Aspiration Abscess, Hematoma, Bulla, Cyst (Pbb)",,10160,CPT,Facility,Outpatient,,,,214,181.9,61.3324,214,"Health Partners, Inc.",State of Minnesota Advantage Program,174.41,81.5,,percent of total billed charges,,
"Puncture Aspiration Abscess, Hematoma, Bulla, Cyst (Pbb)",,10160,CPT,Professional,Outpatient,,,,284,241.4,60.86,284,"Health Partners, Inc.",State of Minnesota Advantage Program,170.017025,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Puncture Aspiration Abscess, Hematoma, Bulla, Cyst (Pbb)",,10160,CPT,Facility,Outpatient,,,,214,181.9,61.3324,214,"Health Partners, Inc.",State Public Programs,107,50,,percent of total billed charges,,
"Puncture Aspiration Abscess, Hematoma, Bulla, Cyst (Pbb)",,10160,CPT,Professional,Outpatient,,,,284,241.4,60.86,284,"Health Partners, Inc.",State Public Programs,60.86,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Puncture Aspiration Abscess, Hematoma, Bulla, Cyst (Pbb)",,10160,CPT,Facility,Outpatient,,,,214,181.9,61.3324,214,Humana Insurance Company,Commercial PPO,203.3,95,,percent of total billed charges,,
"Puncture Aspiration Abscess, Hematoma, Bulla, Cyst (Pbb)",,10160,CPT,Professional,Outpatient,,,,284,241.4,60.86,284,Humana Insurance Company,Commercial PPO,94.65,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Puncture Aspiration Abscess, Hematoma, Bulla, Cyst (Pbb)",,10160,CPT,Facility,Outpatient,,,,214,181.9,61.3324,214,Humana Insurance Company,Medicare PPO,104.86,49,,percent of total billed charges,,
"Puncture Aspiration Abscess, Hematoma, Bulla, Cyst (Pbb)",,10160,CPT,Professional,Outpatient,,,,284,241.4,60.86,284,Humana Insurance Company,Medicare PPO,284,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Puncture Aspiration Abscess, Hematoma, Bulla, Cyst (Pbb)",,10160,CPT,Facility,Outpatient,,,,214,181.9,61.3324,214,Medica,Individual & Family,212.074,99.1,,percent of total billed charges,,
"Puncture Aspiration Abscess, Hematoma, Bulla, Cyst (Pbb)",,10160,CPT,Professional,Outpatient,,,,284,241.4,60.86,284,Medica,Individual & Family,240.832,84.8,,percent of total billed charges,,
"Puncture Aspiration Abscess, Hematoma, Bulla, Cyst (Pbb)",,10160,CPT,Facility,Outpatient,,,,214,181.9,61.3324,214,Medica,Medica Advantage Solution,106.572,49.8,,percent of total billed charges,,
"Puncture Aspiration Abscess, Hematoma, Bulla, Cyst (Pbb)",,10160,CPT,Professional,Outpatient,,,,284,241.4,60.86,284,Medica,Medica Advantage Solution,141.432,49.8,,percent of total billed charges,,
"Puncture Aspiration Abscess, Hematoma, Bulla, Cyst (Pbb)",,10160,CPT,Facility,Outpatient,,,,214,181.9,61.3324,214,Medica,Medical Assistance,95.444,44.6,,percent of total billed charges,,
"Puncture Aspiration Abscess, Hematoma, Bulla, Cyst (Pbb)",,10160,CPT,Professional,Outpatient,,,,284,241.4,60.86,284,Medica,Medical Assistance,70.27,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Puncture Aspiration Abscess, Hematoma, Bulla, Cyst (Pbb)",,10160,CPT,Facility,Outpatient,,,,214,181.9,61.3324,214,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,106.572,49.8,,percent of total billed charges,,
"Puncture Aspiration Abscess, Hematoma, Bulla, Cyst (Pbb)",,10160,CPT,Professional,Outpatient,,,,284,241.4,60.86,284,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,94.65,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Puncture Aspiration Abscess, Hematoma, Bulla, Cyst (Pbb)",,10160,CPT,Facility,Outpatient,,,,214,181.9,61.3324,214,"Multiplan, Inc.","Multiplan, Inc.",201.16,94,,percent of total billed charges,,
"Puncture Aspiration Abscess, Hematoma, Bulla, Cyst (Pbb)",,10160,CPT,Professional,Outpatient,,,,284,241.4,60.86,284,"Multiplan, Inc.","Multiplan, Inc.",266.96,94,,percent of total billed charges,,
"Puncture Aspiration Abscess, Hematoma, Bulla, Cyst (Pbb)",,10160,CPT,Facility,Outpatient,,,,214,181.9,61.3324,214,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,192.814,90.1,,percent of total billed charges,,
"Puncture Aspiration Abscess, Hematoma, Bulla, Cyst (Pbb)",,10160,CPT,Professional,Outpatient,,,,284,241.4,60.86,284,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,255.884,90.1,,percent of total billed charges,,
"Puncture Aspiration Abscess, Hematoma, Bulla, Cyst (Pbb)",,10160,CPT,Facility,Outpatient,,,,214,181.9,61.3324,214,"Preferred One Administrative Services, INC.",PPO,211.004,98.6,,percent of total billed charges,,
"Puncture Aspiration Abscess, Hematoma, Bulla, Cyst (Pbb)",,10160,CPT,Professional,Outpatient,,,,284,241.4,60.86,284,"Preferred One Administrative Services, INC.",PPO,280.024,98.6,,percent of total billed charges,,
"Puncture Aspiration Abscess, Hematoma, Bulla, Cyst (Pbb)",,10160,CPT,Facility,Outpatient,,,,214,181.9,61.3324,214,PrimeWest Health,Minnesota Senior Health Options (MSHO),110.103,51.45,,percent of total billed charges,,
"Puncture Aspiration Abscess, Hematoma, Bulla, Cyst (Pbb)",,10160,CPT,Professional,Outpatient,,,,284,241.4,60.86,284,PrimeWest Health,Minnesota Senior Health Options (MSHO),108.8475,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Puncture Aspiration Abscess, Hematoma, Bulla, Cyst (Pbb)",,10160,CPT,Facility,Outpatient,,,,214,181.9,61.3324,214,PrimeWest Health,MinnesotaCare,109.9104,51.36,,percent of total billed charges,,
"Puncture Aspiration Abscess, Hematoma, Bulla, Cyst (Pbb)",,10160,CPT,Professional,Outpatient,,,,284,241.4,60.86,284,PrimeWest Health,MinnesotaCare,75.1852192,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Puncture Aspiration Abscess, Hematoma, Bulla, Cyst (Pbb)",,10160,CPT,Facility,Outpatient,,,,214,181.9,61.3324,214,Sanford Health Plan,Sanford Health Plan,196.88,92,,percent of total billed charges,,
"Puncture Aspiration Abscess, Hematoma, Bulla, Cyst (Pbb)",,10160,CPT,Professional,Outpatient,,,,284,241.4,60.86,284,Sanford Health Plan,Sanford Health Plan,249.92,88,,percent of total billed charges,,
"Puncture Aspiration Abscess, Hematoma, Bulla, Cyst (Pbb)",,10160,CPT,Facility,Outpatient,,,,214,181.9,61.3324,214,"UCare Health, Inc.",Individual & Family Plan,120.589,56.35,,percent of total billed charges,,
"Puncture Aspiration Abscess, Hematoma, Bulla, Cyst (Pbb)",,10160,CPT,Professional,Outpatient,,,,284,241.4,60.86,284,"UCare Health, Inc.",Individual & Family Plan,153.86304,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Puncture Aspiration Abscess, Hematoma, Bulla, Cyst (Pbb)",,10160,CPT,Facility,Outpatient,,,,214,181.9,61.3324,214,"UCare Health, Inc.",Medical Assistance,108.0058,50.47,,percent of total billed charges,,
"Puncture Aspiration Abscess, Hematoma, Bulla, Cyst (Pbb)",,10160,CPT,Professional,Outpatient,,,,284,241.4,60.86,284,"UCare Health, Inc.",Medical Assistance,77.293216,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Puncture Aspiration Abscess, Hematoma, Bulla, Cyst (Pbb)",,10160,CPT,Facility,Outpatient,,,,214,181.9,61.3324,214,"UCare Health, Inc.",Medicare Advantage,108.0058,50.47,,percent of total billed charges,,
"Puncture Aspiration Abscess, Hematoma, Bulla, Cyst (Pbb)",,10160,CPT,Professional,Outpatient,,,,284,241.4,60.86,284,"UCare Health, Inc.",Medicare Advantage,108.8475,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Puncture Aspiration Abscess, Hematoma, Bulla, Cyst (Pbb)",,10160,CPT,Facility,Outpatient,,,,214,181.9,61.3324,214,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),108.0058,50.47,,percent of total billed charges,,
"Puncture Aspiration Abscess, Hematoma, Bulla, Cyst (Pbb)",,10160,CPT,Professional,Outpatient,,,,284,241.4,60.86,284,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),87.078,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Puncture Aspiration Abscess, Hematoma, Bulla, Cyst (Pbb)",,10160,CPT,Facility,Outpatient,,,,214,181.9,61.3324,214,UnitedHealthcare,Individual & Family,201.16,94,,percent of total billed charges,,
"Puncture Aspiration Abscess, Hematoma, Bulla, Cyst (Pbb)",,10160,CPT,Professional,Outpatient,,,,284,241.4,60.86,284,UnitedHealthcare,Individual & Family,284,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Puncture Aspiration Abscess, Hematoma, Bulla, Cyst (Pbb)",,10160,CPT,Facility,Outpatient,,,,214,181.9,61.3324,214,UnitedHealthcare,Medicare Advantage,104.86,49,,percent of total billed charges,,
"Puncture Aspiration Abscess, Hematoma, Bulla, Cyst (Pbb)",,10160,CPT,Professional,Outpatient,,,,284,241.4,60.86,284,UnitedHealthcare,Medicare Advantage,108.8475,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Puncture Aspiration Abscess, Hematoma, Bulla, Cyst (Pbb)",,10160,CPT,Facility,Outpatient,,,,214,181.9,61.3324,214,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,102.72,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Puncture Aspiration Abscess, Hematoma, Bulla, Cyst (Pbb)",,10160,CPT,Professional,Outpatient,,,,284,241.4,60.86,284,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,70.26656,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Puncture Aspiration Of Abscess, Hematoma, Bulla, Or Cyst (Pro Cah)",,10160,CPT,Professional,Both,,,,498,423.3,60.86,498,Aetna,Commercial,423.3,85,,percent of total billed charges,,
"Puncture Aspiration Of Abscess, Hematoma, Bulla, Or Cyst (Pro Cah)",,10160,CPT,Professional,Both,,,,498,423.3,60.86,498,Aetna,Medicare Advantage,93.89,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Puncture Aspiration Of Abscess, Hematoma, Bulla, Or Cyst (Pro Cah)",,10160,CPT,Professional,Both,,,,498,423.3,60.86,498,Aetna,PPO,463.14,93,,percent of total billed charges,,
"Puncture Aspiration Of Abscess, Hematoma, Bulla, Or Cyst (Pro Cah)",,10160,CPT,Professional,Both,,,,498,423.3,60.86,498,America's PPO,America's PPO,425.4912,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Puncture Aspiration Of Abscess, Hematoma, Bulla, Or Cyst (Pro Cah)",,10160,CPT,Professional,Both,,,,498,423.3,60.86,498,BlueCross BlueShield Minnesota, Federal Employee Program,198.32,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Puncture Aspiration Of Abscess, Hematoma, Bulla, Or Cyst (Pro Cah)",,10160,CPT,Professional,Both,,,,498,423.3,60.86,498,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,201.49312,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Puncture Aspiration Of Abscess, Hematoma, Bulla, Or Cyst (Pro Cah)",,10160,CPT,Professional,Both,,,,498,423.3,60.86,498,BlueCross BlueShield Minnesota,High Value Network Plan,201.49312,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Puncture Aspiration Of Abscess, Hematoma, Bulla, Or Cyst (Pro Cah)",,10160,CPT,Professional,Both,,,,498,423.3,60.86,498,BlueCross BlueShield Minnesota,Medicare Advantage,108.8475,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Puncture Aspiration Of Abscess, Hematoma, Bulla, Or Cyst (Pro Cah)",,10160,CPT,Professional,Both,,,,498,423.3,60.86,498,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,201.49312,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Puncture Aspiration Of Abscess, Hematoma, Bulla, Or Cyst (Pro Cah)",,10160,CPT,Professional,Both,,,,498,423.3,60.86,498,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,70.26656,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Puncture Aspiration Of Abscess, Hematoma, Bulla, Or Cyst (Pro Cah)",,10160,CPT,Professional,Both,,,,498,423.3,60.86,498,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),108.8475,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Puncture Aspiration Of Abscess, Hematoma, Bulla, Or Cyst (Pro Cah)",,10160,CPT,Professional,Both,,,,498,423.3,60.86,498,CorVel,Worker's Compensation,182.5425354,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Puncture Aspiration Of Abscess, Hematoma, Bulla, Or Cyst (Pro Cah)",,10160,CPT,Professional,Both,,,,498,423.3,60.86,498,First Health Group Corporation,First Health Network,483.06,97,,percent of total billed charges,,
"Puncture Aspiration Of Abscess, Hematoma, Bulla, Or Cyst (Pro Cah)",,10160,CPT,Professional,Both,,,,498,423.3,60.86,498,"Health Partners, Inc.",Commercial,197.35,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Puncture Aspiration Of Abscess, Hematoma, Bulla, Or Cyst (Pro Cah)",,10160,CPT,Professional,Both,,,,498,423.3,60.86,498,"Health Partners, Inc.",Medicare Advantage,108.8475,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Puncture Aspiration Of Abscess, Hematoma, Bulla, Or Cyst (Pro Cah)",,10160,CPT,Professional,Both,,,,498,423.3,60.86,498,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),94.88,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Puncture Aspiration Of Abscess, Hematoma, Bulla, Or Cyst (Pro Cah)",,10160,CPT,Professional,Both,,,,498,423.3,60.86,498,"Health Partners, Inc.",State of Minnesota Advantage Program,170.017025,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Puncture Aspiration Of Abscess, Hematoma, Bulla, Or Cyst (Pro Cah)",,10160,CPT,Professional,Both,,,,498,423.3,60.86,498,"Health Partners, Inc.",State Public Programs,60.86,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Puncture Aspiration Of Abscess, Hematoma, Bulla, Or Cyst (Pro Cah)",,10160,CPT,Professional,Both,,,,498,423.3,60.86,498,Humana Insurance Company,Commercial PPO,94.65,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Puncture Aspiration Of Abscess, Hematoma, Bulla, Or Cyst (Pro Cah)",,10160,CPT,Professional,Both,,,,498,423.3,60.86,498,Humana Insurance Company,Medicare PPO,498,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Puncture Aspiration Of Abscess, Hematoma, Bulla, Or Cyst (Pro Cah)",,10160,CPT,Professional,Both,,,,498,423.3,60.86,498,Medica,Individual & Family,422.304,84.8,,percent of total billed charges,,
"Puncture Aspiration Of Abscess, Hematoma, Bulla, Or Cyst (Pro Cah)",,10160,CPT,Professional,Both,,,,498,423.3,60.86,498,Medica,Medica Advantage Solution,248.004,49.8,,percent of total billed charges,,
"Puncture Aspiration Of Abscess, Hematoma, Bulla, Or Cyst (Pro Cah)",,10160,CPT,Professional,Both,,,,498,423.3,60.86,498,Medica,Medical Assistance,70.27,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Puncture Aspiration Of Abscess, Hematoma, Bulla, Or Cyst (Pro Cah)",,10160,CPT,Professional,Both,,,,498,423.3,60.86,498,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,94.65,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Puncture Aspiration Of Abscess, Hematoma, Bulla, Or Cyst (Pro Cah)",,10160,CPT,Professional,Both,,,,498,423.3,60.86,498,"Multiplan, Inc.","Multiplan, Inc.",468.12,94,,percent of total billed charges,,
"Puncture Aspiration Of Abscess, Hematoma, Bulla, Or Cyst (Pro Cah)",,10160,CPT,Professional,Both,,,,498,423.3,60.86,498,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,448.698,90.1,,percent of total billed charges,,
"Puncture Aspiration Of Abscess, Hematoma, Bulla, Or Cyst (Pro Cah)",,10160,CPT,Professional,Both,,,,498,423.3,60.86,498,"Preferred One Administrative Services, INC.",PPO,491.028,98.6,,percent of total billed charges,,
"Puncture Aspiration Of Abscess, Hematoma, Bulla, Or Cyst (Pro Cah)",,10160,CPT,Professional,Both,,,,498,423.3,60.86,498,PrimeWest Health,Minnesota Senior Health Options (MSHO),108.8475,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Puncture Aspiration Of Abscess, Hematoma, Bulla, Or Cyst (Pro Cah)",,10160,CPT,Professional,Both,,,,498,423.3,60.86,498,PrimeWest Health,MinnesotaCare,75.1852192,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Puncture Aspiration Of Abscess, Hematoma, Bulla, Or Cyst (Pro Cah)",,10160,CPT,Professional,Both,,,,498,423.3,60.86,498,Sanford Health Plan,Sanford Health Plan,438.24,88,,percent of total billed charges,,
"Puncture Aspiration Of Abscess, Hematoma, Bulla, Or Cyst (Pro Cah)",,10160,CPT,Professional,Both,,,,498,423.3,60.86,498,"UCare Health, Inc.",Individual & Family Plan,153.86304,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Puncture Aspiration Of Abscess, Hematoma, Bulla, Or Cyst (Pro Cah)",,10160,CPT,Professional,Both,,,,498,423.3,60.86,498,"UCare Health, Inc.",Medical Assistance,77.293216,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Puncture Aspiration Of Abscess, Hematoma, Bulla, Or Cyst (Pro Cah)",,10160,CPT,Professional,Both,,,,498,423.3,60.86,498,"UCare Health, Inc.",Medicare Advantage,108.8475,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Puncture Aspiration Of Abscess, Hematoma, Bulla, Or Cyst (Pro Cah)",,10160,CPT,Professional,Both,,,,498,423.3,60.86,498,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),87.078,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Puncture Aspiration Of Abscess, Hematoma, Bulla, Or Cyst (Pro Cah)",,10160,CPT,Professional,Both,,,,498,423.3,60.86,498,UnitedHealthcare,Individual & Family,498,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Puncture Aspiration Of Abscess, Hematoma, Bulla, Or Cyst (Pro Cah)",,10160,CPT,Professional,Both,,,,498,423.3,60.86,498,UnitedHealthcare,Medicare Advantage,108.8475,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Puncture Aspiration Of Abscess, Hematoma, Bulla, Or Cyst (Pro Cah)",,10160,CPT,Professional,Both,,,,498,423.3,60.86,498,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,70.26656,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
METOPROLOL TARTRATE 50 MG ORAL TABLET,,13967,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
METOPROLOL TARTRATE 50 MG ORAL TABLET,,13967,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
METOPROLOL TARTRATE 50 MG ORAL TABLET,,13967,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
METOPROLOL TARTRATE 50 MG ORAL TABLET,,13967,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
METOPROLOL TARTRATE 50 MG ORAL TABLET,,13967,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
METOPROLOL TARTRATE 50 MG ORAL TABLET,,13967,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
METOPROLOL TARTRATE 50 MG ORAL TABLET,,13967,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
METOPROLOL TARTRATE 50 MG ORAL TABLET,,13967,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
METOPROLOL TARTRATE 50 MG ORAL TABLET,,13967,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
METOPROLOL TARTRATE 50 MG ORAL TABLET,,13967,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
METOPROLOL TARTRATE 50 MG ORAL TABLET,,13967,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
METOPROLOL TARTRATE 50 MG ORAL TABLET,,13967,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
METOPROLOL TARTRATE 50 MG ORAL TABLET,,13967,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
METOPROLOL TARTRATE 50 MG ORAL TABLET,,13967,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
METOPROLOL TARTRATE 50 MG ORAL TABLET,,13967,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
METOPROLOL TARTRATE 50 MG ORAL TABLET,,13967,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
METOPROLOL TARTRATE 50 MG ORAL TABLET,,13967,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
METOPROLOL TARTRATE 50 MG ORAL TABLET,,13967,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
METOPROLOL TARTRATE 50 MG ORAL TABLET,,13967,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
METOPROLOL TARTRATE 50 MG ORAL TABLET,,13967,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
METOPROLOL TARTRATE 50 MG ORAL TABLET,,13967,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
METOPROLOL TARTRATE 50 MG ORAL TABLET,,13967,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
METOPROLOL TARTRATE 50 MG ORAL TABLET,,13967,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
METOPROLOL TARTRATE 50 MG ORAL TABLET,,13967,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
METOPROLOL TARTRATE 50 MG ORAL TABLET,,13967,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
METOPROLOL TARTRATE 50 MG ORAL TABLET,,13967,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
METOPROLOL TARTRATE 50 MG ORAL TABLET,,13967,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
METOPROLOL TARTRATE 50 MG ORAL TABLET,,13967,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
METOPROLOL TARTRATE 50 MG ORAL TABLET,,13967,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
METOPROLOL TARTRATE 50 MG ORAL TABLET,,13967,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
METOPROLOL TARTRATE 50 MG ORAL TABLET,,13967,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
METOPROLOL TARTRATE 50 MG ORAL TABLET,,13967,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
METOPROLOL TARTRATE 50 MG ORAL TABLET,,13967,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
METOPROLOL TARTRATE 50 MG ORAL TABLET,,13967,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
METOPROLOL TARTRATE 50 MG ORAL TABLET,,13967,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
METOPROLOL TARTRATE 50 MG ORAL TABLET,,13967,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
METOPROLOL TARTRATE 50 MG ORAL TABLET,,13967,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
METOPROLOL TARTRATE 50 MG ORAL TABLET,,13967,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
METOPROLOL TARTRATE 50 MG ORAL TABLET,,13967,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
METOPROLOL TARTRATE 50 MG ORAL TABLET,,13967,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
METOPROLOL TARTRATE 50 MG ORAL TABLET,,13967,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
METOPROLOL TARTRATE 50 MG ORAL TABLET,,13967,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
METOPROLOL TARTRATE 50 MG ORAL TABLET,,13967,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
METOPROLOL TARTRATE 50 MG ORAL TABLET,,13967,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
METOPROLOL TARTRATE 50 MG ORAL TABLET,,13967,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
METOPROLOL TARTRATE 50 MG ORAL TABLET,,13967,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
METOPROLOL TARTRATE 50 MG ORAL TABLET,,13967,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
METOPROLOL TARTRATE 50 MG ORAL TABLET,,13967,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
METOPROLOL TARTRATE 50 MG ORAL TABLET,,13967,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
METOPROLOL TARTRATE 50 MG ORAL TABLET,,13967,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
METOPROLOL TARTRATE 50 MG ORAL TABLET,,13967,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
METOPROLOL TARTRATE 50 MG ORAL TABLET,,13967,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
METOPROLOL TARTRATE 50 MG ORAL TABLET,,13967,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
METOPROLOL TARTRATE 50 MG ORAL TABLET,,13967,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
NICOTINE 21 MG/24 HR TD PT24,,14014,LOCAL,Facility,Both,1,Each,,11,9.35,3.1526,11,Aetna,Commercial,10.12,92,,percent of total billed charges,,
NICOTINE 21 MG/24 HR TD PT24,,14014,LOCAL,Facility,Outpatient,1,Each,,11,9.35,3.1526,11,Aetna,Medicare Advantage,5.39,49,,percent of total billed charges,,
NICOTINE 21 MG/24 HR TD PT24,,14014,LOCAL,Facility,Inpatient,1,Each,,11,9.35,3.1526,11,Aetna,Medicare Advantage,,,,,Included in per diem rate,
NICOTINE 21 MG/24 HR TD PT24,,14014,LOCAL,Facility,Both,1,Each,,11,9.35,3.1526,11,Aetna,PPO,10.23,93,,percent of total billed charges,,
NICOTINE 21 MG/24 HR TD PT24,,14014,LOCAL,Facility,Both,1,Each,,11,9.35,3.1526,11,America's PPO,America's PPO,10.5633,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
NICOTINE 21 MG/24 HR TD PT24,,14014,LOCAL,Facility,Both,1,Each,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota, Federal Employee Program,10.824,98.4,,percent of total billed charges,,
NICOTINE 21 MG/24 HR TD PT24,,14014,LOCAL,Facility,Both,1,Each,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,11,100,,percent of total billed charges,,
NICOTINE 21 MG/24 HR TD PT24,,14014,LOCAL,Facility,Both,1,Each,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,High Value Network Plan,9.9,90,,percent of total billed charges,,
NICOTINE 21 MG/24 HR TD PT24,,14014,LOCAL,Facility,Outpatient,1,Each,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,Medicare Advantage,5.39,49,,percent of total billed charges,,
NICOTINE 21 MG/24 HR TD PT24,,14014,LOCAL,Facility,Inpatient,1,Each,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
NICOTINE 21 MG/24 HR TD PT24,,14014,LOCAL,Facility,Both,1,Each,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,9.7427,88.57,,percent of total billed charges,,
NICOTINE 21 MG/24 HR TD PT24,,14014,LOCAL,Facility,Both,1,Each,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,3.1526,28.66,,percent of total billed charges,,
NICOTINE 21 MG/24 HR TD PT24,,14014,LOCAL,Facility,Outpatient,1,Each,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),5.39,49,,percent of total billed charges,,
NICOTINE 21 MG/24 HR TD PT24,,14014,LOCAL,Facility,Inpatient,1,Each,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
NICOTINE 21 MG/24 HR TD PT24,,14014,LOCAL,Facility,Both,1,Each,,11,9.35,3.1526,11,CorVel,Worker's Compensation,11,100,,percent of total billed charges,,
NICOTINE 21 MG/24 HR TD PT24,,14014,LOCAL,Facility,Both,1,Each,,11,9.35,3.1526,11,First Health Group Corporation,First Health Network,10.67,97,,percent of total billed charges,,
NICOTINE 21 MG/24 HR TD PT24,,14014,LOCAL,Facility,Both,1,Each,,11,9.35,3.1526,11,"Health Partners, Inc.",Commercial,10.406,94.6,,percent of total billed charges,,
NICOTINE 21 MG/24 HR TD PT24,,14014,LOCAL,Facility,Outpatient,1,Each,,11,9.35,3.1526,11,"Health Partners, Inc.",Medicare Advantage,5.39,49,,percent of total billed charges,,
NICOTINE 21 MG/24 HR TD PT24,,14014,LOCAL,Facility,Inpatient,1,Each,,11,9.35,3.1526,11,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
NICOTINE 21 MG/24 HR TD PT24,,14014,LOCAL,Facility,Both,1,Each,,11,9.35,3.1526,11,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),6.6,60,,percent of total billed charges,,
NICOTINE 21 MG/24 HR TD PT24,,14014,LOCAL,Facility,Both,1,Each,,11,9.35,3.1526,11,"Health Partners, Inc.",State of Minnesota Advantage Program,8.965,81.5,,percent of total billed charges,,
NICOTINE 21 MG/24 HR TD PT24,,14014,LOCAL,Facility,Both,1,Each,,11,9.35,3.1526,11,"Health Partners, Inc.",State Public Programs,5.5,50,,percent of total billed charges,,
NICOTINE 21 MG/24 HR TD PT24,,14014,LOCAL,Facility,Both,1,Each,,11,9.35,3.1526,11,Humana Insurance Company,Commercial PPO,10.45,95,,percent of total billed charges,,
NICOTINE 21 MG/24 HR TD PT24,,14014,LOCAL,Facility,Outpatient,1,Each,,11,9.35,3.1526,11,Humana Insurance Company,Medicare PPO,5.39,49,,percent of total billed charges,,
NICOTINE 21 MG/24 HR TD PT24,,14014,LOCAL,Facility,Inpatient,1,Each,,11,9.35,3.1526,11,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
NICOTINE 21 MG/24 HR TD PT24,,14014,LOCAL,Facility,Both,1,Each,,11,9.35,3.1526,11,Medica,Individual & Family,10.901,99.1,,percent of total billed charges,,
NICOTINE 21 MG/24 HR TD PT24,,14014,LOCAL,Facility,Outpatient,1,Each,,11,9.35,3.1526,11,Medica,Medica Advantage Solution,5.478,49.8,,percent of total billed charges,,
NICOTINE 21 MG/24 HR TD PT24,,14014,LOCAL,Facility,Inpatient,1,Each,,11,9.35,3.1526,11,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
NICOTINE 21 MG/24 HR TD PT24,,14014,LOCAL,Facility,Outpatient,1,Each,,11,9.35,3.1526,11,Medica,Medical Assistance,4.906,44.6,,percent of total billed charges,,
NICOTINE 21 MG/24 HR TD PT24,,14014,LOCAL,Facility,Inpatient,1,Each,,11,9.35,3.1526,11,Medica,Medical Assistance,,,,,Included in per diem rate,
NICOTINE 21 MG/24 HR TD PT24,,14014,LOCAL,Facility,Outpatient,1,Each,,11,9.35,3.1526,11,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,5.478,49.8,,percent of total billed charges,,
NICOTINE 21 MG/24 HR TD PT24,,14014,LOCAL,Facility,Inpatient,1,Each,,11,9.35,3.1526,11,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
NICOTINE 21 MG/24 HR TD PT24,,14014,LOCAL,Facility,Both,1,Each,,11,9.35,3.1526,11,"Multiplan, Inc.","Multiplan, Inc.",10.34,94,,percent of total billed charges,,
NICOTINE 21 MG/24 HR TD PT24,,14014,LOCAL,Facility,Outpatient,1,Each,,11,9.35,3.1526,11,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,9.911,90.1,,percent of total billed charges,,
NICOTINE 21 MG/24 HR TD PT24,,14014,LOCAL,Facility,Inpatient,1,Each,,11,9.35,3.1526,11,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
NICOTINE 21 MG/24 HR TD PT24,,14014,LOCAL,Facility,Both,1,Each,,11,9.35,3.1526,11,"Preferred One Administrative Services, INC.",PPO,10.846,98.6,,percent of total billed charges,,
NICOTINE 21 MG/24 HR TD PT24,,14014,LOCAL,Facility,Outpatient,1,Each,,11,9.35,3.1526,11,PrimeWest Health,Minnesota Senior Health Options (MSHO),5.6595,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
NICOTINE 21 MG/24 HR TD PT24,,14014,LOCAL,Facility,Inpatient,1,Each,,11,9.35,3.1526,11,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
NICOTINE 21 MG/24 HR TD PT24,,14014,LOCAL,Facility,Outpatient,1,Each,,11,9.35,3.1526,11,PrimeWest Health,MinnesotaCare,5.6496,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
NICOTINE 21 MG/24 HR TD PT24,,14014,LOCAL,Facility,Inpatient,1,Each,,11,9.35,3.1526,11,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
NICOTINE 21 MG/24 HR TD PT24,,14014,LOCAL,Facility,Both,1,Each,,11,9.35,3.1526,11,Sanford Health Plan,Sanford Health Plan,10.12,92,,percent of total billed charges,,
NICOTINE 21 MG/24 HR TD PT24,,14014,LOCAL,Facility,Outpatient,1,Each,,11,9.35,3.1526,11,"UCare Health, Inc.",Individual & Family Plan,6.1985,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
NICOTINE 21 MG/24 HR TD PT24,,14014,LOCAL,Facility,Inpatient,1,Each,,11,9.35,3.1526,11,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
NICOTINE 21 MG/24 HR TD PT24,,14014,LOCAL,Facility,Outpatient,1,Each,,11,9.35,3.1526,11,"UCare Health, Inc.",Medical Assistance,5.5517,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
NICOTINE 21 MG/24 HR TD PT24,,14014,LOCAL,Facility,Inpatient,1,Each,,11,9.35,3.1526,11,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
NICOTINE 21 MG/24 HR TD PT24,,14014,LOCAL,Facility,Outpatient,1,Each,,11,9.35,3.1526,11,"UCare Health, Inc.",Medicare Advantage,5.5517,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
NICOTINE 21 MG/24 HR TD PT24,,14014,LOCAL,Facility,Inpatient,1,Each,,11,9.35,3.1526,11,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
NICOTINE 21 MG/24 HR TD PT24,,14014,LOCAL,Facility,Outpatient,1,Each,,11,9.35,3.1526,11,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),5.5517,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
NICOTINE 21 MG/24 HR TD PT24,,14014,LOCAL,Facility,Inpatient,1,Each,,11,9.35,3.1526,11,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
NICOTINE 21 MG/24 HR TD PT24,,14014,LOCAL,Facility,Both,1,Each,,11,9.35,3.1526,11,UnitedHealthcare,Individual & Family,10.34,94,,percent of total billed charges,,
NICOTINE 21 MG/24 HR TD PT24,,14014,LOCAL,Facility,Outpatient,1,Each,,11,9.35,3.1526,11,UnitedHealthcare,Medicare Advantage,5.39,49,,percent of total billed charges,,
NICOTINE 21 MG/24 HR TD PT24,,14014,LOCAL,Facility,Inpatient,1,Each,,11,9.35,3.1526,11,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
NICOTINE 21 MG/24 HR TD PT24,,14014,LOCAL,Facility,Outpatient,1,Each,,11,9.35,3.1526,11,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,5.28,48,,percent of total billed charges,,100% of DHS outpatient percentage
NICOTINE 21 MG/24 HR TD PT24,,14014,LOCAL,Facility,Inpatient,1,Each,,11,9.35,3.1526,11,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
GLUCOSAMINE SULFATE 500 MG ORAL CAP,,14302,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
GLUCOSAMINE SULFATE 500 MG ORAL CAP,,14302,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
GLUCOSAMINE SULFATE 500 MG ORAL CAP,,14302,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
GLUCOSAMINE SULFATE 500 MG ORAL CAP,,14302,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
GLUCOSAMINE SULFATE 500 MG ORAL CAP,,14302,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
GLUCOSAMINE SULFATE 500 MG ORAL CAP,,14302,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
GLUCOSAMINE SULFATE 500 MG ORAL CAP,,14302,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
GLUCOSAMINE SULFATE 500 MG ORAL CAP,,14302,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
GLUCOSAMINE SULFATE 500 MG ORAL CAP,,14302,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
GLUCOSAMINE SULFATE 500 MG ORAL CAP,,14302,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
GLUCOSAMINE SULFATE 500 MG ORAL CAP,,14302,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
GLUCOSAMINE SULFATE 500 MG ORAL CAP,,14302,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
GLUCOSAMINE SULFATE 500 MG ORAL CAP,,14302,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
GLUCOSAMINE SULFATE 500 MG ORAL CAP,,14302,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
GLUCOSAMINE SULFATE 500 MG ORAL CAP,,14302,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
GLUCOSAMINE SULFATE 500 MG ORAL CAP,,14302,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
GLUCOSAMINE SULFATE 500 MG ORAL CAP,,14302,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
GLUCOSAMINE SULFATE 500 MG ORAL CAP,,14302,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
GLUCOSAMINE SULFATE 500 MG ORAL CAP,,14302,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
GLUCOSAMINE SULFATE 500 MG ORAL CAP,,14302,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
GLUCOSAMINE SULFATE 500 MG ORAL CAP,,14302,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
GLUCOSAMINE SULFATE 500 MG ORAL CAP,,14302,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
GLUCOSAMINE SULFATE 500 MG ORAL CAP,,14302,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
GLUCOSAMINE SULFATE 500 MG ORAL CAP,,14302,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
GLUCOSAMINE SULFATE 500 MG ORAL CAP,,14302,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
GLUCOSAMINE SULFATE 500 MG ORAL CAP,,14302,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
GLUCOSAMINE SULFATE 500 MG ORAL CAP,,14302,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
GLUCOSAMINE SULFATE 500 MG ORAL CAP,,14302,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
GLUCOSAMINE SULFATE 500 MG ORAL CAP,,14302,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
GLUCOSAMINE SULFATE 500 MG ORAL CAP,,14302,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
GLUCOSAMINE SULFATE 500 MG ORAL CAP,,14302,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
GLUCOSAMINE SULFATE 500 MG ORAL CAP,,14302,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
GLUCOSAMINE SULFATE 500 MG ORAL CAP,,14302,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
GLUCOSAMINE SULFATE 500 MG ORAL CAP,,14302,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
GLUCOSAMINE SULFATE 500 MG ORAL CAP,,14302,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
GLUCOSAMINE SULFATE 500 MG ORAL CAP,,14302,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
GLUCOSAMINE SULFATE 500 MG ORAL CAP,,14302,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
GLUCOSAMINE SULFATE 500 MG ORAL CAP,,14302,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
GLUCOSAMINE SULFATE 500 MG ORAL CAP,,14302,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
GLUCOSAMINE SULFATE 500 MG ORAL CAP,,14302,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
GLUCOSAMINE SULFATE 500 MG ORAL CAP,,14302,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
GLUCOSAMINE SULFATE 500 MG ORAL CAP,,14302,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
GLUCOSAMINE SULFATE 500 MG ORAL CAP,,14302,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
GLUCOSAMINE SULFATE 500 MG ORAL CAP,,14302,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
GLUCOSAMINE SULFATE 500 MG ORAL CAP,,14302,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
GLUCOSAMINE SULFATE 500 MG ORAL CAP,,14302,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
GLUCOSAMINE SULFATE 500 MG ORAL CAP,,14302,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
GLUCOSAMINE SULFATE 500 MG ORAL CAP,,14302,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
GLUCOSAMINE SULFATE 500 MG ORAL CAP,,14302,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
GLUCOSAMINE SULFATE 500 MG ORAL CAP,,14302,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
GLUCOSAMINE SULFATE 500 MG ORAL CAP,,14302,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
GLUCOSAMINE SULFATE 500 MG ORAL CAP,,14302,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
GLUCOSAMINE SULFATE 500 MG ORAL CAP,,14302,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
GLUCOSAMINE SULFATE 500 MG ORAL CAP,,14302,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
MISOPROSTOL 100 MCG ORAL TABLET,,14385,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
MISOPROSTOL 100 MCG ORAL TABLET,,14385,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
MISOPROSTOL 100 MCG ORAL TABLET,,14385,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
MISOPROSTOL 100 MCG ORAL TABLET,,14385,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
MISOPROSTOL 100 MCG ORAL TABLET,,14385,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
MISOPROSTOL 100 MCG ORAL TABLET,,14385,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
MISOPROSTOL 100 MCG ORAL TABLET,,14385,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
MISOPROSTOL 100 MCG ORAL TABLET,,14385,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
MISOPROSTOL 100 MCG ORAL TABLET,,14385,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
MISOPROSTOL 100 MCG ORAL TABLET,,14385,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
MISOPROSTOL 100 MCG ORAL TABLET,,14385,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
MISOPROSTOL 100 MCG ORAL TABLET,,14385,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
MISOPROSTOL 100 MCG ORAL TABLET,,14385,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
MISOPROSTOL 100 MCG ORAL TABLET,,14385,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
MISOPROSTOL 100 MCG ORAL TABLET,,14385,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
MISOPROSTOL 100 MCG ORAL TABLET,,14385,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
MISOPROSTOL 100 MCG ORAL TABLET,,14385,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
MISOPROSTOL 100 MCG ORAL TABLET,,14385,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
MISOPROSTOL 100 MCG ORAL TABLET,,14385,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
MISOPROSTOL 100 MCG ORAL TABLET,,14385,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
MISOPROSTOL 100 MCG ORAL TABLET,,14385,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
MISOPROSTOL 100 MCG ORAL TABLET,,14385,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
MISOPROSTOL 100 MCG ORAL TABLET,,14385,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
MISOPROSTOL 100 MCG ORAL TABLET,,14385,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
MISOPROSTOL 100 MCG ORAL TABLET,,14385,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
MISOPROSTOL 100 MCG ORAL TABLET,,14385,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
MISOPROSTOL 100 MCG ORAL TABLET,,14385,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
MISOPROSTOL 100 MCG ORAL TABLET,,14385,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
MISOPROSTOL 100 MCG ORAL TABLET,,14385,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
MISOPROSTOL 100 MCG ORAL TABLET,,14385,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
MISOPROSTOL 100 MCG ORAL TABLET,,14385,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
MISOPROSTOL 100 MCG ORAL TABLET,,14385,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
MISOPROSTOL 100 MCG ORAL TABLET,,14385,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
MISOPROSTOL 100 MCG ORAL TABLET,,14385,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
MISOPROSTOL 100 MCG ORAL TABLET,,14385,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
MISOPROSTOL 100 MCG ORAL TABLET,,14385,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
MISOPROSTOL 100 MCG ORAL TABLET,,14385,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
MISOPROSTOL 100 MCG ORAL TABLET,,14385,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
MISOPROSTOL 100 MCG ORAL TABLET,,14385,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
MISOPROSTOL 100 MCG ORAL TABLET,,14385,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
MISOPROSTOL 100 MCG ORAL TABLET,,14385,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
MISOPROSTOL 100 MCG ORAL TABLET,,14385,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
MISOPROSTOL 100 MCG ORAL TABLET,,14385,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
MISOPROSTOL 100 MCG ORAL TABLET,,14385,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MISOPROSTOL 100 MCG ORAL TABLET,,14385,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
MISOPROSTOL 100 MCG ORAL TABLET,,14385,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MISOPROSTOL 100 MCG ORAL TABLET,,14385,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
MISOPROSTOL 100 MCG ORAL TABLET,,14385,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MISOPROSTOL 100 MCG ORAL TABLET,,14385,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
MISOPROSTOL 100 MCG ORAL TABLET,,14385,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
MISOPROSTOL 100 MCG ORAL TABLET,,14385,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
MISOPROSTOL 100 MCG ORAL TABLET,,14385,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
MISOPROSTOL 100 MCG ORAL TABLET,,14385,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
MISOPROSTOL 100 MCG ORAL TABLET,,14385,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
FLUOXETINE 10 MG ORAL CAP,,14413,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
FLUOXETINE 10 MG ORAL CAP,,14413,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
FLUOXETINE 10 MG ORAL CAP,,14413,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
FLUOXETINE 10 MG ORAL CAP,,14413,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
FLUOXETINE 10 MG ORAL CAP,,14413,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
FLUOXETINE 10 MG ORAL CAP,,14413,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
FLUOXETINE 10 MG ORAL CAP,,14413,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
FLUOXETINE 10 MG ORAL CAP,,14413,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
FLUOXETINE 10 MG ORAL CAP,,14413,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
FLUOXETINE 10 MG ORAL CAP,,14413,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
FLUOXETINE 10 MG ORAL CAP,,14413,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
FLUOXETINE 10 MG ORAL CAP,,14413,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
FLUOXETINE 10 MG ORAL CAP,,14413,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
FLUOXETINE 10 MG ORAL CAP,,14413,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
FLUOXETINE 10 MG ORAL CAP,,14413,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
FLUOXETINE 10 MG ORAL CAP,,14413,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
FLUOXETINE 10 MG ORAL CAP,,14413,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
FLUOXETINE 10 MG ORAL CAP,,14413,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
FLUOXETINE 10 MG ORAL CAP,,14413,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
FLUOXETINE 10 MG ORAL CAP,,14413,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
FLUOXETINE 10 MG ORAL CAP,,14413,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
FLUOXETINE 10 MG ORAL CAP,,14413,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
FLUOXETINE 10 MG ORAL CAP,,14413,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
FLUOXETINE 10 MG ORAL CAP,,14413,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
FLUOXETINE 10 MG ORAL CAP,,14413,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
FLUOXETINE 10 MG ORAL CAP,,14413,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
FLUOXETINE 10 MG ORAL CAP,,14413,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
FLUOXETINE 10 MG ORAL CAP,,14413,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
FLUOXETINE 10 MG ORAL CAP,,14413,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
FLUOXETINE 10 MG ORAL CAP,,14413,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
FLUOXETINE 10 MG ORAL CAP,,14413,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
FLUOXETINE 10 MG ORAL CAP,,14413,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
FLUOXETINE 10 MG ORAL CAP,,14413,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
FLUOXETINE 10 MG ORAL CAP,,14413,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
FLUOXETINE 10 MG ORAL CAP,,14413,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
FLUOXETINE 10 MG ORAL CAP,,14413,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
FLUOXETINE 10 MG ORAL CAP,,14413,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
FLUOXETINE 10 MG ORAL CAP,,14413,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
FLUOXETINE 10 MG ORAL CAP,,14413,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
FLUOXETINE 10 MG ORAL CAP,,14413,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
FLUOXETINE 10 MG ORAL CAP,,14413,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
FLUOXETINE 10 MG ORAL CAP,,14413,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
FLUOXETINE 10 MG ORAL CAP,,14413,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
FLUOXETINE 10 MG ORAL CAP,,14413,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FLUOXETINE 10 MG ORAL CAP,,14413,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
FLUOXETINE 10 MG ORAL CAP,,14413,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FLUOXETINE 10 MG ORAL CAP,,14413,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
FLUOXETINE 10 MG ORAL CAP,,14413,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FLUOXETINE 10 MG ORAL CAP,,14413,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
FLUOXETINE 10 MG ORAL CAP,,14413,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
FLUOXETINE 10 MG ORAL CAP,,14413,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
FLUOXETINE 10 MG ORAL CAP,,14413,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
FLUOXETINE 10 MG ORAL CAP,,14413,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
FLUOXETINE 10 MG ORAL CAP,,14413,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
NITROGLYCERIN 0.4 MG SL SUBL,,14592,LOCAL,Facility,Both,1,Each,,125,106.25,35.825,125,Aetna,Commercial,115,92,,percent of total billed charges,,
NITROGLYCERIN 0.4 MG SL SUBL,,14592,LOCAL,Facility,Outpatient,1,Each,,125,106.25,35.825,125,Aetna,Medicare Advantage,61.25,49,,percent of total billed charges,,
NITROGLYCERIN 0.4 MG SL SUBL,,14592,LOCAL,Facility,Inpatient,1,Each,,125,106.25,35.825,125,Aetna,Medicare Advantage,,,,,Included in per diem rate,
NITROGLYCERIN 0.4 MG SL SUBL,,14592,LOCAL,Facility,Both,1,Each,,125,106.25,35.825,125,Aetna,PPO,116.25,93,,percent of total billed charges,,
NITROGLYCERIN 0.4 MG SL SUBL,,14592,LOCAL,Facility,Both,1,Each,,125,106.25,35.825,125,America's PPO,America's PPO,120.0375,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
NITROGLYCERIN 0.4 MG SL SUBL,,14592,LOCAL,Facility,Both,1,Each,,125,106.25,35.825,125,BlueCross BlueShield Minnesota, Federal Employee Program,123,98.4,,percent of total billed charges,,
NITROGLYCERIN 0.4 MG SL SUBL,,14592,LOCAL,Facility,Both,1,Each,,125,106.25,35.825,125,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,125,100,,percent of total billed charges,,
NITROGLYCERIN 0.4 MG SL SUBL,,14592,LOCAL,Facility,Both,1,Each,,125,106.25,35.825,125,BlueCross BlueShield Minnesota,High Value Network Plan,112.5,90,,percent of total billed charges,,
NITROGLYCERIN 0.4 MG SL SUBL,,14592,LOCAL,Facility,Outpatient,1,Each,,125,106.25,35.825,125,BlueCross BlueShield Minnesota,Medicare Advantage,61.25,49,,percent of total billed charges,,
NITROGLYCERIN 0.4 MG SL SUBL,,14592,LOCAL,Facility,Inpatient,1,Each,,125,106.25,35.825,125,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
NITROGLYCERIN 0.4 MG SL SUBL,,14592,LOCAL,Facility,Both,1,Each,,125,106.25,35.825,125,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,110.7125,88.57,,percent of total billed charges,,
NITROGLYCERIN 0.4 MG SL SUBL,,14592,LOCAL,Facility,Both,1,Each,,125,106.25,35.825,125,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,35.825,28.66,,percent of total billed charges,,
NITROGLYCERIN 0.4 MG SL SUBL,,14592,LOCAL,Facility,Outpatient,1,Each,,125,106.25,35.825,125,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),61.25,49,,percent of total billed charges,,
NITROGLYCERIN 0.4 MG SL SUBL,,14592,LOCAL,Facility,Inpatient,1,Each,,125,106.25,35.825,125,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
NITROGLYCERIN 0.4 MG SL SUBL,,14592,LOCAL,Facility,Both,1,Each,,125,106.25,35.825,125,CorVel,Worker's Compensation,125,100,,percent of total billed charges,,
NITROGLYCERIN 0.4 MG SL SUBL,,14592,LOCAL,Facility,Both,1,Each,,125,106.25,35.825,125,First Health Group Corporation,First Health Network,121.25,97,,percent of total billed charges,,
NITROGLYCERIN 0.4 MG SL SUBL,,14592,LOCAL,Facility,Both,1,Each,,125,106.25,35.825,125,"Health Partners, Inc.",Commercial,118.25,94.6,,percent of total billed charges,,
NITROGLYCERIN 0.4 MG SL SUBL,,14592,LOCAL,Facility,Outpatient,1,Each,,125,106.25,35.825,125,"Health Partners, Inc.",Medicare Advantage,61.25,49,,percent of total billed charges,,
NITROGLYCERIN 0.4 MG SL SUBL,,14592,LOCAL,Facility,Inpatient,1,Each,,125,106.25,35.825,125,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
NITROGLYCERIN 0.4 MG SL SUBL,,14592,LOCAL,Facility,Both,1,Each,,125,106.25,35.825,125,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),75,60,,percent of total billed charges,,
NITROGLYCERIN 0.4 MG SL SUBL,,14592,LOCAL,Facility,Both,1,Each,,125,106.25,35.825,125,"Health Partners, Inc.",State of Minnesota Advantage Program,101.875,81.5,,percent of total billed charges,,
NITROGLYCERIN 0.4 MG SL SUBL,,14592,LOCAL,Facility,Both,1,Each,,125,106.25,35.825,125,"Health Partners, Inc.",State Public Programs,62.5,50,,percent of total billed charges,,
NITROGLYCERIN 0.4 MG SL SUBL,,14592,LOCAL,Facility,Both,1,Each,,125,106.25,35.825,125,Humana Insurance Company,Commercial PPO,118.75,95,,percent of total billed charges,,
NITROGLYCERIN 0.4 MG SL SUBL,,14592,LOCAL,Facility,Outpatient,1,Each,,125,106.25,35.825,125,Humana Insurance Company,Medicare PPO,61.25,49,,percent of total billed charges,,
NITROGLYCERIN 0.4 MG SL SUBL,,14592,LOCAL,Facility,Inpatient,1,Each,,125,106.25,35.825,125,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
NITROGLYCERIN 0.4 MG SL SUBL,,14592,LOCAL,Facility,Both,1,Each,,125,106.25,35.825,125,Medica,Individual & Family,123.875,99.1,,percent of total billed charges,,
NITROGLYCERIN 0.4 MG SL SUBL,,14592,LOCAL,Facility,Outpatient,1,Each,,125,106.25,35.825,125,Medica,Medica Advantage Solution,62.25,49.8,,percent of total billed charges,,
NITROGLYCERIN 0.4 MG SL SUBL,,14592,LOCAL,Facility,Inpatient,1,Each,,125,106.25,35.825,125,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
NITROGLYCERIN 0.4 MG SL SUBL,,14592,LOCAL,Facility,Outpatient,1,Each,,125,106.25,35.825,125,Medica,Medical Assistance,55.75,44.6,,percent of total billed charges,,
NITROGLYCERIN 0.4 MG SL SUBL,,14592,LOCAL,Facility,Inpatient,1,Each,,125,106.25,35.825,125,Medica,Medical Assistance,,,,,Included in per diem rate,
NITROGLYCERIN 0.4 MG SL SUBL,,14592,LOCAL,Facility,Outpatient,1,Each,,125,106.25,35.825,125,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,62.25,49.8,,percent of total billed charges,,
NITROGLYCERIN 0.4 MG SL SUBL,,14592,LOCAL,Facility,Inpatient,1,Each,,125,106.25,35.825,125,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
NITROGLYCERIN 0.4 MG SL SUBL,,14592,LOCAL,Facility,Both,1,Each,,125,106.25,35.825,125,"Multiplan, Inc.","Multiplan, Inc.",117.5,94,,percent of total billed charges,,
NITROGLYCERIN 0.4 MG SL SUBL,,14592,LOCAL,Facility,Outpatient,1,Each,,125,106.25,35.825,125,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,112.625,90.1,,percent of total billed charges,,
NITROGLYCERIN 0.4 MG SL SUBL,,14592,LOCAL,Facility,Inpatient,1,Each,,125,106.25,35.825,125,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
NITROGLYCERIN 0.4 MG SL SUBL,,14592,LOCAL,Facility,Both,1,Each,,125,106.25,35.825,125,"Preferred One Administrative Services, INC.",PPO,123.25,98.6,,percent of total billed charges,,
NITROGLYCERIN 0.4 MG SL SUBL,,14592,LOCAL,Facility,Outpatient,1,Each,,125,106.25,35.825,125,PrimeWest Health,Minnesota Senior Health Options (MSHO),64.3125,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
NITROGLYCERIN 0.4 MG SL SUBL,,14592,LOCAL,Facility,Inpatient,1,Each,,125,106.25,35.825,125,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
NITROGLYCERIN 0.4 MG SL SUBL,,14592,LOCAL,Facility,Outpatient,1,Each,,125,106.25,35.825,125,PrimeWest Health,MinnesotaCare,64.2,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
NITROGLYCERIN 0.4 MG SL SUBL,,14592,LOCAL,Facility,Inpatient,1,Each,,125,106.25,35.825,125,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
NITROGLYCERIN 0.4 MG SL SUBL,,14592,LOCAL,Facility,Both,1,Each,,125,106.25,35.825,125,Sanford Health Plan,Sanford Health Plan,115,92,,percent of total billed charges,,
NITROGLYCERIN 0.4 MG SL SUBL,,14592,LOCAL,Facility,Outpatient,1,Each,,125,106.25,35.825,125,"UCare Health, Inc.",Individual & Family Plan,70.4375,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
NITROGLYCERIN 0.4 MG SL SUBL,,14592,LOCAL,Facility,Inpatient,1,Each,,125,106.25,35.825,125,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
NITROGLYCERIN 0.4 MG SL SUBL,,14592,LOCAL,Facility,Outpatient,1,Each,,125,106.25,35.825,125,"UCare Health, Inc.",Medical Assistance,63.0875,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
NITROGLYCERIN 0.4 MG SL SUBL,,14592,LOCAL,Facility,Inpatient,1,Each,,125,106.25,35.825,125,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
NITROGLYCERIN 0.4 MG SL SUBL,,14592,LOCAL,Facility,Outpatient,1,Each,,125,106.25,35.825,125,"UCare Health, Inc.",Medicare Advantage,63.0875,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
NITROGLYCERIN 0.4 MG SL SUBL,,14592,LOCAL,Facility,Inpatient,1,Each,,125,106.25,35.825,125,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
NITROGLYCERIN 0.4 MG SL SUBL,,14592,LOCAL,Facility,Outpatient,1,Each,,125,106.25,35.825,125,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),63.0875,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
NITROGLYCERIN 0.4 MG SL SUBL,,14592,LOCAL,Facility,Inpatient,1,Each,,125,106.25,35.825,125,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
NITROGLYCERIN 0.4 MG SL SUBL,,14592,LOCAL,Facility,Both,1,Each,,125,106.25,35.825,125,UnitedHealthcare,Individual & Family,117.5,94,,percent of total billed charges,,
NITROGLYCERIN 0.4 MG SL SUBL,,14592,LOCAL,Facility,Outpatient,1,Each,,125,106.25,35.825,125,UnitedHealthcare,Medicare Advantage,61.25,49,,percent of total billed charges,,
NITROGLYCERIN 0.4 MG SL SUBL,,14592,LOCAL,Facility,Inpatient,1,Each,,125,106.25,35.825,125,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
NITROGLYCERIN 0.4 MG SL SUBL,,14592,LOCAL,Facility,Outpatient,1,Each,,125,106.25,35.825,125,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,60,48,,percent of total billed charges,,100% of DHS outpatient percentage
NITROGLYCERIN 0.4 MG SL SUBL,,14592,LOCAL,Facility,Inpatient,1,Each,,125,106.25,35.825,125,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
ACETYLCHOLINE CHLORIDE 1 % (10 MG/ML) IO KIT,,14781,LOCAL,Facility,Both,1,Each,,568,482.8,162.7888,568,Aetna,Commercial,522.56,92,,percent of total billed charges,,
ACETYLCHOLINE CHLORIDE 1 % (10 MG/ML) IO KIT,,14781,LOCAL,Facility,Outpatient,1,Each,,568,482.8,162.7888,568,Aetna,Medicare Advantage,278.32,49,,percent of total billed charges,,
ACETYLCHOLINE CHLORIDE 1 % (10 MG/ML) IO KIT,,14781,LOCAL,Facility,Inpatient,1,Each,,568,482.8,162.7888,568,Aetna,Medicare Advantage,,,,,Included in per diem rate,
ACETYLCHOLINE CHLORIDE 1 % (10 MG/ML) IO KIT,,14781,LOCAL,Facility,Both,1,Each,,568,482.8,162.7888,568,Aetna,PPO,528.24,93,,percent of total billed charges,,
ACETYLCHOLINE CHLORIDE 1 % (10 MG/ML) IO KIT,,14781,LOCAL,Facility,Both,1,Each,,568,482.8,162.7888,568,America's PPO,America's PPO,545.4504,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
ACETYLCHOLINE CHLORIDE 1 % (10 MG/ML) IO KIT,,14781,LOCAL,Facility,Both,1,Each,,568,482.8,162.7888,568,BlueCross BlueShield Minnesota, Federal Employee Program,558.912,98.4,,percent of total billed charges,,
ACETYLCHOLINE CHLORIDE 1 % (10 MG/ML) IO KIT,,14781,LOCAL,Facility,Both,1,Each,,568,482.8,162.7888,568,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,568,100,,percent of total billed charges,,
ACETYLCHOLINE CHLORIDE 1 % (10 MG/ML) IO KIT,,14781,LOCAL,Facility,Both,1,Each,,568,482.8,162.7888,568,BlueCross BlueShield Minnesota,High Value Network Plan,511.2,90,,percent of total billed charges,,
ACETYLCHOLINE CHLORIDE 1 % (10 MG/ML) IO KIT,,14781,LOCAL,Facility,Outpatient,1,Each,,568,482.8,162.7888,568,BlueCross BlueShield Minnesota,Medicare Advantage,278.32,49,,percent of total billed charges,,
ACETYLCHOLINE CHLORIDE 1 % (10 MG/ML) IO KIT,,14781,LOCAL,Facility,Inpatient,1,Each,,568,482.8,162.7888,568,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
ACETYLCHOLINE CHLORIDE 1 % (10 MG/ML) IO KIT,,14781,LOCAL,Facility,Both,1,Each,,568,482.8,162.7888,568,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,503.0776,88.57,,percent of total billed charges,,
ACETYLCHOLINE CHLORIDE 1 % (10 MG/ML) IO KIT,,14781,LOCAL,Facility,Both,1,Each,,568,482.8,162.7888,568,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,162.7888,28.66,,percent of total billed charges,,
ACETYLCHOLINE CHLORIDE 1 % (10 MG/ML) IO KIT,,14781,LOCAL,Facility,Outpatient,1,Each,,568,482.8,162.7888,568,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),278.32,49,,percent of total billed charges,,
ACETYLCHOLINE CHLORIDE 1 % (10 MG/ML) IO KIT,,14781,LOCAL,Facility,Inpatient,1,Each,,568,482.8,162.7888,568,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
ACETYLCHOLINE CHLORIDE 1 % (10 MG/ML) IO KIT,,14781,LOCAL,Facility,Both,1,Each,,568,482.8,162.7888,568,CorVel,Worker's Compensation,568,100,,percent of total billed charges,,
ACETYLCHOLINE CHLORIDE 1 % (10 MG/ML) IO KIT,,14781,LOCAL,Facility,Both,1,Each,,568,482.8,162.7888,568,First Health Group Corporation,First Health Network,550.96,97,,percent of total billed charges,,
ACETYLCHOLINE CHLORIDE 1 % (10 MG/ML) IO KIT,,14781,LOCAL,Facility,Both,1,Each,,568,482.8,162.7888,568,"Health Partners, Inc.",Commercial,537.328,94.6,,percent of total billed charges,,
ACETYLCHOLINE CHLORIDE 1 % (10 MG/ML) IO KIT,,14781,LOCAL,Facility,Outpatient,1,Each,,568,482.8,162.7888,568,"Health Partners, Inc.",Medicare Advantage,278.32,49,,percent of total billed charges,,
ACETYLCHOLINE CHLORIDE 1 % (10 MG/ML) IO KIT,,14781,LOCAL,Facility,Inpatient,1,Each,,568,482.8,162.7888,568,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ACETYLCHOLINE CHLORIDE 1 % (10 MG/ML) IO KIT,,14781,LOCAL,Facility,Both,1,Each,,568,482.8,162.7888,568,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),340.8,60,,percent of total billed charges,,
ACETYLCHOLINE CHLORIDE 1 % (10 MG/ML) IO KIT,,14781,LOCAL,Facility,Both,1,Each,,568,482.8,162.7888,568,"Health Partners, Inc.",State of Minnesota Advantage Program,462.92,81.5,,percent of total billed charges,,
ACETYLCHOLINE CHLORIDE 1 % (10 MG/ML) IO KIT,,14781,LOCAL,Facility,Both,1,Each,,568,482.8,162.7888,568,"Health Partners, Inc.",State Public Programs,284,50,,percent of total billed charges,,
ACETYLCHOLINE CHLORIDE 1 % (10 MG/ML) IO KIT,,14781,LOCAL,Facility,Both,1,Each,,568,482.8,162.7888,568,Humana Insurance Company,Commercial PPO,539.6,95,,percent of total billed charges,,
ACETYLCHOLINE CHLORIDE 1 % (10 MG/ML) IO KIT,,14781,LOCAL,Facility,Outpatient,1,Each,,568,482.8,162.7888,568,Humana Insurance Company,Medicare PPO,278.32,49,,percent of total billed charges,,
ACETYLCHOLINE CHLORIDE 1 % (10 MG/ML) IO KIT,,14781,LOCAL,Facility,Inpatient,1,Each,,568,482.8,162.7888,568,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
ACETYLCHOLINE CHLORIDE 1 % (10 MG/ML) IO KIT,,14781,LOCAL,Facility,Both,1,Each,,568,482.8,162.7888,568,Medica,Individual & Family,562.888,99.1,,percent of total billed charges,,
ACETYLCHOLINE CHLORIDE 1 % (10 MG/ML) IO KIT,,14781,LOCAL,Facility,Outpatient,1,Each,,568,482.8,162.7888,568,Medica,Medica Advantage Solution,282.864,49.8,,percent of total billed charges,,
ACETYLCHOLINE CHLORIDE 1 % (10 MG/ML) IO KIT,,14781,LOCAL,Facility,Inpatient,1,Each,,568,482.8,162.7888,568,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
ACETYLCHOLINE CHLORIDE 1 % (10 MG/ML) IO KIT,,14781,LOCAL,Facility,Outpatient,1,Each,,568,482.8,162.7888,568,Medica,Medical Assistance,253.328,44.6,,percent of total billed charges,,
ACETYLCHOLINE CHLORIDE 1 % (10 MG/ML) IO KIT,,14781,LOCAL,Facility,Inpatient,1,Each,,568,482.8,162.7888,568,Medica,Medical Assistance,,,,,Included in per diem rate,
ACETYLCHOLINE CHLORIDE 1 % (10 MG/ML) IO KIT,,14781,LOCAL,Facility,Outpatient,1,Each,,568,482.8,162.7888,568,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,282.864,49.8,,percent of total billed charges,,
ACETYLCHOLINE CHLORIDE 1 % (10 MG/ML) IO KIT,,14781,LOCAL,Facility,Inpatient,1,Each,,568,482.8,162.7888,568,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
ACETYLCHOLINE CHLORIDE 1 % (10 MG/ML) IO KIT,,14781,LOCAL,Facility,Both,1,Each,,568,482.8,162.7888,568,"Multiplan, Inc.","Multiplan, Inc.",533.92,94,,percent of total billed charges,,
ACETYLCHOLINE CHLORIDE 1 % (10 MG/ML) IO KIT,,14781,LOCAL,Facility,Outpatient,1,Each,,568,482.8,162.7888,568,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,511.768,90.1,,percent of total billed charges,,
ACETYLCHOLINE CHLORIDE 1 % (10 MG/ML) IO KIT,,14781,LOCAL,Facility,Inpatient,1,Each,,568,482.8,162.7888,568,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
ACETYLCHOLINE CHLORIDE 1 % (10 MG/ML) IO KIT,,14781,LOCAL,Facility,Both,1,Each,,568,482.8,162.7888,568,"Preferred One Administrative Services, INC.",PPO,560.048,98.6,,percent of total billed charges,,
ACETYLCHOLINE CHLORIDE 1 % (10 MG/ML) IO KIT,,14781,LOCAL,Facility,Outpatient,1,Each,,568,482.8,162.7888,568,PrimeWest Health,Minnesota Senior Health Options (MSHO),292.236,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
ACETYLCHOLINE CHLORIDE 1 % (10 MG/ML) IO KIT,,14781,LOCAL,Facility,Inpatient,1,Each,,568,482.8,162.7888,568,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ACETYLCHOLINE CHLORIDE 1 % (10 MG/ML) IO KIT,,14781,LOCAL,Facility,Outpatient,1,Each,,568,482.8,162.7888,568,PrimeWest Health,MinnesotaCare,291.7248,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
ACETYLCHOLINE CHLORIDE 1 % (10 MG/ML) IO KIT,,14781,LOCAL,Facility,Inpatient,1,Each,,568,482.8,162.7888,568,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
ACETYLCHOLINE CHLORIDE 1 % (10 MG/ML) IO KIT,,14781,LOCAL,Facility,Both,1,Each,,568,482.8,162.7888,568,Sanford Health Plan,Sanford Health Plan,522.56,92,,percent of total billed charges,,
ACETYLCHOLINE CHLORIDE 1 % (10 MG/ML) IO KIT,,14781,LOCAL,Facility,Outpatient,1,Each,,568,482.8,162.7888,568,"UCare Health, Inc.",Individual & Family Plan,320.068,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
ACETYLCHOLINE CHLORIDE 1 % (10 MG/ML) IO KIT,,14781,LOCAL,Facility,Inpatient,1,Each,,568,482.8,162.7888,568,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
ACETYLCHOLINE CHLORIDE 1 % (10 MG/ML) IO KIT,,14781,LOCAL,Facility,Outpatient,1,Each,,568,482.8,162.7888,568,"UCare Health, Inc.",Medical Assistance,286.6696,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ACETYLCHOLINE CHLORIDE 1 % (10 MG/ML) IO KIT,,14781,LOCAL,Facility,Inpatient,1,Each,,568,482.8,162.7888,568,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
ACETYLCHOLINE CHLORIDE 1 % (10 MG/ML) IO KIT,,14781,LOCAL,Facility,Outpatient,1,Each,,568,482.8,162.7888,568,"UCare Health, Inc.",Medicare Advantage,286.6696,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ACETYLCHOLINE CHLORIDE 1 % (10 MG/ML) IO KIT,,14781,LOCAL,Facility,Inpatient,1,Each,,568,482.8,162.7888,568,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ACETYLCHOLINE CHLORIDE 1 % (10 MG/ML) IO KIT,,14781,LOCAL,Facility,Outpatient,1,Each,,568,482.8,162.7888,568,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),286.6696,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ACETYLCHOLINE CHLORIDE 1 % (10 MG/ML) IO KIT,,14781,LOCAL,Facility,Inpatient,1,Each,,568,482.8,162.7888,568,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ACETYLCHOLINE CHLORIDE 1 % (10 MG/ML) IO KIT,,14781,LOCAL,Facility,Both,1,Each,,568,482.8,162.7888,568,UnitedHealthcare,Individual & Family,533.92,94,,percent of total billed charges,,
ACETYLCHOLINE CHLORIDE 1 % (10 MG/ML) IO KIT,,14781,LOCAL,Facility,Outpatient,1,Each,,568,482.8,162.7888,568,UnitedHealthcare,Medicare Advantage,278.32,49,,percent of total billed charges,,
ACETYLCHOLINE CHLORIDE 1 % (10 MG/ML) IO KIT,,14781,LOCAL,Facility,Inpatient,1,Each,,568,482.8,162.7888,568,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
ACETYLCHOLINE CHLORIDE 1 % (10 MG/ML) IO KIT,,14781,LOCAL,Facility,Outpatient,1,Each,,568,482.8,162.7888,568,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,272.64,48,,percent of total billed charges,,100% of DHS outpatient percentage
ACETYLCHOLINE CHLORIDE 1 % (10 MG/ML) IO KIT,,14781,LOCAL,Facility,Inpatient,1,Each,,568,482.8,162.7888,568,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
CRANBERRY 400 MG ORAL CAP,,14824,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
CRANBERRY 400 MG ORAL CAP,,14824,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
CRANBERRY 400 MG ORAL CAP,,14824,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
CRANBERRY 400 MG ORAL CAP,,14824,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
CRANBERRY 400 MG ORAL CAP,,14824,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
CRANBERRY 400 MG ORAL CAP,,14824,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
CRANBERRY 400 MG ORAL CAP,,14824,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
CRANBERRY 400 MG ORAL CAP,,14824,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
CRANBERRY 400 MG ORAL CAP,,14824,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
CRANBERRY 400 MG ORAL CAP,,14824,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
CRANBERRY 400 MG ORAL CAP,,14824,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
CRANBERRY 400 MG ORAL CAP,,14824,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
CRANBERRY 400 MG ORAL CAP,,14824,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
CRANBERRY 400 MG ORAL CAP,,14824,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
CRANBERRY 400 MG ORAL CAP,,14824,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
CRANBERRY 400 MG ORAL CAP,,14824,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
CRANBERRY 400 MG ORAL CAP,,14824,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
CRANBERRY 400 MG ORAL CAP,,14824,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
CRANBERRY 400 MG ORAL CAP,,14824,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CRANBERRY 400 MG ORAL CAP,,14824,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
CRANBERRY 400 MG ORAL CAP,,14824,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
CRANBERRY 400 MG ORAL CAP,,14824,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
CRANBERRY 400 MG ORAL CAP,,14824,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
CRANBERRY 400 MG ORAL CAP,,14824,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
CRANBERRY 400 MG ORAL CAP,,14824,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
CRANBERRY 400 MG ORAL CAP,,14824,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
CRANBERRY 400 MG ORAL CAP,,14824,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
CRANBERRY 400 MG ORAL CAP,,14824,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
CRANBERRY 400 MG ORAL CAP,,14824,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
CRANBERRY 400 MG ORAL CAP,,14824,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
CRANBERRY 400 MG ORAL CAP,,14824,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
CRANBERRY 400 MG ORAL CAP,,14824,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
CRANBERRY 400 MG ORAL CAP,,14824,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
CRANBERRY 400 MG ORAL CAP,,14824,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
CRANBERRY 400 MG ORAL CAP,,14824,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
CRANBERRY 400 MG ORAL CAP,,14824,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
CRANBERRY 400 MG ORAL CAP,,14824,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
CRANBERRY 400 MG ORAL CAP,,14824,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CRANBERRY 400 MG ORAL CAP,,14824,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
CRANBERRY 400 MG ORAL CAP,,14824,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
CRANBERRY 400 MG ORAL CAP,,14824,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
CRANBERRY 400 MG ORAL CAP,,14824,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
CRANBERRY 400 MG ORAL CAP,,14824,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
CRANBERRY 400 MG ORAL CAP,,14824,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CRANBERRY 400 MG ORAL CAP,,14824,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
CRANBERRY 400 MG ORAL CAP,,14824,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CRANBERRY 400 MG ORAL CAP,,14824,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CRANBERRY 400 MG ORAL CAP,,14824,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CRANBERRY 400 MG ORAL CAP,,14824,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CRANBERRY 400 MG ORAL CAP,,14824,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
CRANBERRY 400 MG ORAL CAP,,14824,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
CRANBERRY 400 MG ORAL CAP,,14824,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
CRANBERRY 400 MG ORAL CAP,,14824,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
CRANBERRY 400 MG ORAL CAP,,14824,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
DOCUSATE SODIUM 100 MG ORAL CAP,,14825,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
DOCUSATE SODIUM 100 MG ORAL CAP,,14825,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
DOCUSATE SODIUM 100 MG ORAL CAP,,14825,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
DOCUSATE SODIUM 100 MG ORAL CAP,,14825,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
DOCUSATE SODIUM 100 MG ORAL CAP,,14825,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
DOCUSATE SODIUM 100 MG ORAL CAP,,14825,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
DOCUSATE SODIUM 100 MG ORAL CAP,,14825,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
DOCUSATE SODIUM 100 MG ORAL CAP,,14825,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
DOCUSATE SODIUM 100 MG ORAL CAP,,14825,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
DOCUSATE SODIUM 100 MG ORAL CAP,,14825,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
DOCUSATE SODIUM 100 MG ORAL CAP,,14825,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
DOCUSATE SODIUM 100 MG ORAL CAP,,14825,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
DOCUSATE SODIUM 100 MG ORAL CAP,,14825,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
DOCUSATE SODIUM 100 MG ORAL CAP,,14825,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
DOCUSATE SODIUM 100 MG ORAL CAP,,14825,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
DOCUSATE SODIUM 100 MG ORAL CAP,,14825,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
DOCUSATE SODIUM 100 MG ORAL CAP,,14825,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
DOCUSATE SODIUM 100 MG ORAL CAP,,14825,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
DOCUSATE SODIUM 100 MG ORAL CAP,,14825,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DOCUSATE SODIUM 100 MG ORAL CAP,,14825,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
DOCUSATE SODIUM 100 MG ORAL CAP,,14825,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
DOCUSATE SODIUM 100 MG ORAL CAP,,14825,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
DOCUSATE SODIUM 100 MG ORAL CAP,,14825,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
DOCUSATE SODIUM 100 MG ORAL CAP,,14825,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
DOCUSATE SODIUM 100 MG ORAL CAP,,14825,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
DOCUSATE SODIUM 100 MG ORAL CAP,,14825,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
DOCUSATE SODIUM 100 MG ORAL CAP,,14825,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
DOCUSATE SODIUM 100 MG ORAL CAP,,14825,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
DOCUSATE SODIUM 100 MG ORAL CAP,,14825,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
DOCUSATE SODIUM 100 MG ORAL CAP,,14825,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
DOCUSATE SODIUM 100 MG ORAL CAP,,14825,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
DOCUSATE SODIUM 100 MG ORAL CAP,,14825,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
DOCUSATE SODIUM 100 MG ORAL CAP,,14825,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
DOCUSATE SODIUM 100 MG ORAL CAP,,14825,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
DOCUSATE SODIUM 100 MG ORAL CAP,,14825,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
DOCUSATE SODIUM 100 MG ORAL CAP,,14825,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
DOCUSATE SODIUM 100 MG ORAL CAP,,14825,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
DOCUSATE SODIUM 100 MG ORAL CAP,,14825,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DOCUSATE SODIUM 100 MG ORAL CAP,,14825,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
DOCUSATE SODIUM 100 MG ORAL CAP,,14825,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
DOCUSATE SODIUM 100 MG ORAL CAP,,14825,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
DOCUSATE SODIUM 100 MG ORAL CAP,,14825,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
DOCUSATE SODIUM 100 MG ORAL CAP,,14825,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
DOCUSATE SODIUM 100 MG ORAL CAP,,14825,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DOCUSATE SODIUM 100 MG ORAL CAP,,14825,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
DOCUSATE SODIUM 100 MG ORAL CAP,,14825,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DOCUSATE SODIUM 100 MG ORAL CAP,,14825,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DOCUSATE SODIUM 100 MG ORAL CAP,,14825,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DOCUSATE SODIUM 100 MG ORAL CAP,,14825,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DOCUSATE SODIUM 100 MG ORAL CAP,,14825,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
DOCUSATE SODIUM 100 MG ORAL CAP,,14825,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
DOCUSATE SODIUM 100 MG ORAL CAP,,14825,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
DOCUSATE SODIUM 100 MG ORAL CAP,,14825,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
DOCUSATE SODIUM 100 MG ORAL CAP,,14825,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
OXYBUTYNIN CHLORIDE 5 MG ORAL TR24,,14839,LOCAL,Facility,Both,1,Each,,21,17.85,6.0186,21,Aetna,Commercial,19.32,92,,percent of total billed charges,,
OXYBUTYNIN CHLORIDE 5 MG ORAL TR24,,14839,LOCAL,Facility,Outpatient,1,Each,,21,17.85,6.0186,21,Aetna,Medicare Advantage,10.29,49,,percent of total billed charges,,
OXYBUTYNIN CHLORIDE 5 MG ORAL TR24,,14839,LOCAL,Facility,Inpatient,1,Each,,21,17.85,6.0186,21,Aetna,Medicare Advantage,,,,,Included in per diem rate,
OXYBUTYNIN CHLORIDE 5 MG ORAL TR24,,14839,LOCAL,Facility,Both,1,Each,,21,17.85,6.0186,21,Aetna,PPO,19.53,93,,percent of total billed charges,,
OXYBUTYNIN CHLORIDE 5 MG ORAL TR24,,14839,LOCAL,Facility,Both,1,Each,,21,17.85,6.0186,21,America's PPO,America's PPO,20.1663,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
OXYBUTYNIN CHLORIDE 5 MG ORAL TR24,,14839,LOCAL,Facility,Both,1,Each,,21,17.85,6.0186,21,BlueCross BlueShield Minnesota, Federal Employee Program,20.664,98.4,,percent of total billed charges,,
OXYBUTYNIN CHLORIDE 5 MG ORAL TR24,,14839,LOCAL,Facility,Both,1,Each,,21,17.85,6.0186,21,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,21,100,,percent of total billed charges,,
OXYBUTYNIN CHLORIDE 5 MG ORAL TR24,,14839,LOCAL,Facility,Both,1,Each,,21,17.85,6.0186,21,BlueCross BlueShield Minnesota,High Value Network Plan,18.9,90,,percent of total billed charges,,
OXYBUTYNIN CHLORIDE 5 MG ORAL TR24,,14839,LOCAL,Facility,Outpatient,1,Each,,21,17.85,6.0186,21,BlueCross BlueShield Minnesota,Medicare Advantage,10.29,49,,percent of total billed charges,,
OXYBUTYNIN CHLORIDE 5 MG ORAL TR24,,14839,LOCAL,Facility,Inpatient,1,Each,,21,17.85,6.0186,21,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
OXYBUTYNIN CHLORIDE 5 MG ORAL TR24,,14839,LOCAL,Facility,Both,1,Each,,21,17.85,6.0186,21,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,18.5997,88.57,,percent of total billed charges,,
OXYBUTYNIN CHLORIDE 5 MG ORAL TR24,,14839,LOCAL,Facility,Both,1,Each,,21,17.85,6.0186,21,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,6.0186,28.66,,percent of total billed charges,,
OXYBUTYNIN CHLORIDE 5 MG ORAL TR24,,14839,LOCAL,Facility,Outpatient,1,Each,,21,17.85,6.0186,21,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),10.29,49,,percent of total billed charges,,
OXYBUTYNIN CHLORIDE 5 MG ORAL TR24,,14839,LOCAL,Facility,Inpatient,1,Each,,21,17.85,6.0186,21,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
OXYBUTYNIN CHLORIDE 5 MG ORAL TR24,,14839,LOCAL,Facility,Both,1,Each,,21,17.85,6.0186,21,CorVel,Worker's Compensation,21,100,,percent of total billed charges,,
OXYBUTYNIN CHLORIDE 5 MG ORAL TR24,,14839,LOCAL,Facility,Both,1,Each,,21,17.85,6.0186,21,First Health Group Corporation,First Health Network,20.37,97,,percent of total billed charges,,
OXYBUTYNIN CHLORIDE 5 MG ORAL TR24,,14839,LOCAL,Facility,Both,1,Each,,21,17.85,6.0186,21,"Health Partners, Inc.",Commercial,19.866,94.6,,percent of total billed charges,,
OXYBUTYNIN CHLORIDE 5 MG ORAL TR24,,14839,LOCAL,Facility,Outpatient,1,Each,,21,17.85,6.0186,21,"Health Partners, Inc.",Medicare Advantage,10.29,49,,percent of total billed charges,,
OXYBUTYNIN CHLORIDE 5 MG ORAL TR24,,14839,LOCAL,Facility,Inpatient,1,Each,,21,17.85,6.0186,21,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
OXYBUTYNIN CHLORIDE 5 MG ORAL TR24,,14839,LOCAL,Facility,Both,1,Each,,21,17.85,6.0186,21,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),12.6,60,,percent of total billed charges,,
OXYBUTYNIN CHLORIDE 5 MG ORAL TR24,,14839,LOCAL,Facility,Both,1,Each,,21,17.85,6.0186,21,"Health Partners, Inc.",State of Minnesota Advantage Program,17.115,81.5,,percent of total billed charges,,
OXYBUTYNIN CHLORIDE 5 MG ORAL TR24,,14839,LOCAL,Facility,Both,1,Each,,21,17.85,6.0186,21,"Health Partners, Inc.",State Public Programs,10.5,50,,percent of total billed charges,,
OXYBUTYNIN CHLORIDE 5 MG ORAL TR24,,14839,LOCAL,Facility,Both,1,Each,,21,17.85,6.0186,21,Humana Insurance Company,Commercial PPO,19.95,95,,percent of total billed charges,,
OXYBUTYNIN CHLORIDE 5 MG ORAL TR24,,14839,LOCAL,Facility,Outpatient,1,Each,,21,17.85,6.0186,21,Humana Insurance Company,Medicare PPO,10.29,49,,percent of total billed charges,,
OXYBUTYNIN CHLORIDE 5 MG ORAL TR24,,14839,LOCAL,Facility,Inpatient,1,Each,,21,17.85,6.0186,21,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
OXYBUTYNIN CHLORIDE 5 MG ORAL TR24,,14839,LOCAL,Facility,Both,1,Each,,21,17.85,6.0186,21,Medica,Individual & Family,20.811,99.1,,percent of total billed charges,,
OXYBUTYNIN CHLORIDE 5 MG ORAL TR24,,14839,LOCAL,Facility,Outpatient,1,Each,,21,17.85,6.0186,21,Medica,Medica Advantage Solution,10.458,49.8,,percent of total billed charges,,
OXYBUTYNIN CHLORIDE 5 MG ORAL TR24,,14839,LOCAL,Facility,Inpatient,1,Each,,21,17.85,6.0186,21,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
OXYBUTYNIN CHLORIDE 5 MG ORAL TR24,,14839,LOCAL,Facility,Outpatient,1,Each,,21,17.85,6.0186,21,Medica,Medical Assistance,9.366,44.6,,percent of total billed charges,,
OXYBUTYNIN CHLORIDE 5 MG ORAL TR24,,14839,LOCAL,Facility,Inpatient,1,Each,,21,17.85,6.0186,21,Medica,Medical Assistance,,,,,Included in per diem rate,
OXYBUTYNIN CHLORIDE 5 MG ORAL TR24,,14839,LOCAL,Facility,Outpatient,1,Each,,21,17.85,6.0186,21,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,10.458,49.8,,percent of total billed charges,,
OXYBUTYNIN CHLORIDE 5 MG ORAL TR24,,14839,LOCAL,Facility,Inpatient,1,Each,,21,17.85,6.0186,21,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
OXYBUTYNIN CHLORIDE 5 MG ORAL TR24,,14839,LOCAL,Facility,Both,1,Each,,21,17.85,6.0186,21,"Multiplan, Inc.","Multiplan, Inc.",19.74,94,,percent of total billed charges,,
OXYBUTYNIN CHLORIDE 5 MG ORAL TR24,,14839,LOCAL,Facility,Outpatient,1,Each,,21,17.85,6.0186,21,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,18.921,90.1,,percent of total billed charges,,
OXYBUTYNIN CHLORIDE 5 MG ORAL TR24,,14839,LOCAL,Facility,Inpatient,1,Each,,21,17.85,6.0186,21,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
OXYBUTYNIN CHLORIDE 5 MG ORAL TR24,,14839,LOCAL,Facility,Both,1,Each,,21,17.85,6.0186,21,"Preferred One Administrative Services, INC.",PPO,20.706,98.6,,percent of total billed charges,,
OXYBUTYNIN CHLORIDE 5 MG ORAL TR24,,14839,LOCAL,Facility,Outpatient,1,Each,,21,17.85,6.0186,21,PrimeWest Health,Minnesota Senior Health Options (MSHO),10.8045,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
OXYBUTYNIN CHLORIDE 5 MG ORAL TR24,,14839,LOCAL,Facility,Inpatient,1,Each,,21,17.85,6.0186,21,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
OXYBUTYNIN CHLORIDE 5 MG ORAL TR24,,14839,LOCAL,Facility,Outpatient,1,Each,,21,17.85,6.0186,21,PrimeWest Health,MinnesotaCare,10.7856,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
OXYBUTYNIN CHLORIDE 5 MG ORAL TR24,,14839,LOCAL,Facility,Inpatient,1,Each,,21,17.85,6.0186,21,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
OXYBUTYNIN CHLORIDE 5 MG ORAL TR24,,14839,LOCAL,Facility,Both,1,Each,,21,17.85,6.0186,21,Sanford Health Plan,Sanford Health Plan,19.32,92,,percent of total billed charges,,
OXYBUTYNIN CHLORIDE 5 MG ORAL TR24,,14839,LOCAL,Facility,Outpatient,1,Each,,21,17.85,6.0186,21,"UCare Health, Inc.",Individual & Family Plan,11.8335,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
OXYBUTYNIN CHLORIDE 5 MG ORAL TR24,,14839,LOCAL,Facility,Inpatient,1,Each,,21,17.85,6.0186,21,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
OXYBUTYNIN CHLORIDE 5 MG ORAL TR24,,14839,LOCAL,Facility,Outpatient,1,Each,,21,17.85,6.0186,21,"UCare Health, Inc.",Medical Assistance,10.5987,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
OXYBUTYNIN CHLORIDE 5 MG ORAL TR24,,14839,LOCAL,Facility,Inpatient,1,Each,,21,17.85,6.0186,21,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
OXYBUTYNIN CHLORIDE 5 MG ORAL TR24,,14839,LOCAL,Facility,Outpatient,1,Each,,21,17.85,6.0186,21,"UCare Health, Inc.",Medicare Advantage,10.5987,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
OXYBUTYNIN CHLORIDE 5 MG ORAL TR24,,14839,LOCAL,Facility,Inpatient,1,Each,,21,17.85,6.0186,21,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
OXYBUTYNIN CHLORIDE 5 MG ORAL TR24,,14839,LOCAL,Facility,Outpatient,1,Each,,21,17.85,6.0186,21,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),10.5987,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
OXYBUTYNIN CHLORIDE 5 MG ORAL TR24,,14839,LOCAL,Facility,Inpatient,1,Each,,21,17.85,6.0186,21,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
OXYBUTYNIN CHLORIDE 5 MG ORAL TR24,,14839,LOCAL,Facility,Both,1,Each,,21,17.85,6.0186,21,UnitedHealthcare,Individual & Family,19.74,94,,percent of total billed charges,,
OXYBUTYNIN CHLORIDE 5 MG ORAL TR24,,14839,LOCAL,Facility,Outpatient,1,Each,,21,17.85,6.0186,21,UnitedHealthcare,Medicare Advantage,10.29,49,,percent of total billed charges,,
OXYBUTYNIN CHLORIDE 5 MG ORAL TR24,,14839,LOCAL,Facility,Inpatient,1,Each,,21,17.85,6.0186,21,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
OXYBUTYNIN CHLORIDE 5 MG ORAL TR24,,14839,LOCAL,Facility,Outpatient,1,Each,,21,17.85,6.0186,21,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,10.08,48,,percent of total billed charges,,100% of DHS outpatient percentage
OXYBUTYNIN CHLORIDE 5 MG ORAL TR24,,14839,LOCAL,Facility,Inpatient,1,Each,,21,17.85,6.0186,21,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
PRAMIPEXOLE 0.25 MG ORAL TABLET,,14845,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
PRAMIPEXOLE 0.25 MG ORAL TABLET,,14845,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
PRAMIPEXOLE 0.25 MG ORAL TABLET,,14845,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
PRAMIPEXOLE 0.25 MG ORAL TABLET,,14845,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
PRAMIPEXOLE 0.25 MG ORAL TABLET,,14845,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
PRAMIPEXOLE 0.25 MG ORAL TABLET,,14845,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
PRAMIPEXOLE 0.25 MG ORAL TABLET,,14845,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
PRAMIPEXOLE 0.25 MG ORAL TABLET,,14845,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
PRAMIPEXOLE 0.25 MG ORAL TABLET,,14845,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
PRAMIPEXOLE 0.25 MG ORAL TABLET,,14845,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
PRAMIPEXOLE 0.25 MG ORAL TABLET,,14845,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
PRAMIPEXOLE 0.25 MG ORAL TABLET,,14845,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
PRAMIPEXOLE 0.25 MG ORAL TABLET,,14845,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
PRAMIPEXOLE 0.25 MG ORAL TABLET,,14845,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
PRAMIPEXOLE 0.25 MG ORAL TABLET,,14845,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
PRAMIPEXOLE 0.25 MG ORAL TABLET,,14845,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
PRAMIPEXOLE 0.25 MG ORAL TABLET,,14845,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
PRAMIPEXOLE 0.25 MG ORAL TABLET,,14845,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
PRAMIPEXOLE 0.25 MG ORAL TABLET,,14845,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PRAMIPEXOLE 0.25 MG ORAL TABLET,,14845,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
PRAMIPEXOLE 0.25 MG ORAL TABLET,,14845,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
PRAMIPEXOLE 0.25 MG ORAL TABLET,,14845,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
PRAMIPEXOLE 0.25 MG ORAL TABLET,,14845,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
PRAMIPEXOLE 0.25 MG ORAL TABLET,,14845,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
PRAMIPEXOLE 0.25 MG ORAL TABLET,,14845,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
PRAMIPEXOLE 0.25 MG ORAL TABLET,,14845,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
PRAMIPEXOLE 0.25 MG ORAL TABLET,,14845,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
PRAMIPEXOLE 0.25 MG ORAL TABLET,,14845,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
PRAMIPEXOLE 0.25 MG ORAL TABLET,,14845,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
PRAMIPEXOLE 0.25 MG ORAL TABLET,,14845,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
PRAMIPEXOLE 0.25 MG ORAL TABLET,,14845,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
PRAMIPEXOLE 0.25 MG ORAL TABLET,,14845,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
PRAMIPEXOLE 0.25 MG ORAL TABLET,,14845,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
PRAMIPEXOLE 0.25 MG ORAL TABLET,,14845,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
PRAMIPEXOLE 0.25 MG ORAL TABLET,,14845,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
PRAMIPEXOLE 0.25 MG ORAL TABLET,,14845,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
PRAMIPEXOLE 0.25 MG ORAL TABLET,,14845,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
PRAMIPEXOLE 0.25 MG ORAL TABLET,,14845,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PRAMIPEXOLE 0.25 MG ORAL TABLET,,14845,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
PRAMIPEXOLE 0.25 MG ORAL TABLET,,14845,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
PRAMIPEXOLE 0.25 MG ORAL TABLET,,14845,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
PRAMIPEXOLE 0.25 MG ORAL TABLET,,14845,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
PRAMIPEXOLE 0.25 MG ORAL TABLET,,14845,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
PRAMIPEXOLE 0.25 MG ORAL TABLET,,14845,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PRAMIPEXOLE 0.25 MG ORAL TABLET,,14845,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
PRAMIPEXOLE 0.25 MG ORAL TABLET,,14845,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PRAMIPEXOLE 0.25 MG ORAL TABLET,,14845,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PRAMIPEXOLE 0.25 MG ORAL TABLET,,14845,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PRAMIPEXOLE 0.25 MG ORAL TABLET,,14845,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PRAMIPEXOLE 0.25 MG ORAL TABLET,,14845,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
PRAMIPEXOLE 0.25 MG ORAL TABLET,,14845,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
PRAMIPEXOLE 0.25 MG ORAL TABLET,,14845,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
PRAMIPEXOLE 0.25 MG ORAL TABLET,,14845,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
PRAMIPEXOLE 0.25 MG ORAL TABLET,,14845,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
GABAPENTIN 300 MG ORAL CAP,,14928,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
GABAPENTIN 300 MG ORAL CAP,,14928,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
GABAPENTIN 300 MG ORAL CAP,,14928,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
GABAPENTIN 300 MG ORAL CAP,,14928,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
GABAPENTIN 300 MG ORAL CAP,,14928,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
GABAPENTIN 300 MG ORAL CAP,,14928,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
GABAPENTIN 300 MG ORAL CAP,,14928,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
GABAPENTIN 300 MG ORAL CAP,,14928,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
GABAPENTIN 300 MG ORAL CAP,,14928,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
GABAPENTIN 300 MG ORAL CAP,,14928,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
GABAPENTIN 300 MG ORAL CAP,,14928,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
GABAPENTIN 300 MG ORAL CAP,,14928,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
GABAPENTIN 300 MG ORAL CAP,,14928,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
GABAPENTIN 300 MG ORAL CAP,,14928,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
GABAPENTIN 300 MG ORAL CAP,,14928,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
GABAPENTIN 300 MG ORAL CAP,,14928,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
GABAPENTIN 300 MG ORAL CAP,,14928,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
GABAPENTIN 300 MG ORAL CAP,,14928,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
GABAPENTIN 300 MG ORAL CAP,,14928,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
GABAPENTIN 300 MG ORAL CAP,,14928,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
GABAPENTIN 300 MG ORAL CAP,,14928,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
GABAPENTIN 300 MG ORAL CAP,,14928,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
GABAPENTIN 300 MG ORAL CAP,,14928,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
GABAPENTIN 300 MG ORAL CAP,,14928,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
GABAPENTIN 300 MG ORAL CAP,,14928,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
GABAPENTIN 300 MG ORAL CAP,,14928,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
GABAPENTIN 300 MG ORAL CAP,,14928,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
GABAPENTIN 300 MG ORAL CAP,,14928,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
GABAPENTIN 300 MG ORAL CAP,,14928,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
GABAPENTIN 300 MG ORAL CAP,,14928,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
GABAPENTIN 300 MG ORAL CAP,,14928,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
GABAPENTIN 300 MG ORAL CAP,,14928,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
GABAPENTIN 300 MG ORAL CAP,,14928,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
GABAPENTIN 300 MG ORAL CAP,,14928,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
GABAPENTIN 300 MG ORAL CAP,,14928,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
GABAPENTIN 300 MG ORAL CAP,,14928,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
GABAPENTIN 300 MG ORAL CAP,,14928,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
GABAPENTIN 300 MG ORAL CAP,,14928,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
GABAPENTIN 300 MG ORAL CAP,,14928,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
GABAPENTIN 300 MG ORAL CAP,,14928,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
GABAPENTIN 300 MG ORAL CAP,,14928,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
GABAPENTIN 300 MG ORAL CAP,,14928,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
GABAPENTIN 300 MG ORAL CAP,,14928,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
GABAPENTIN 300 MG ORAL CAP,,14928,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
GABAPENTIN 300 MG ORAL CAP,,14928,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
GABAPENTIN 300 MG ORAL CAP,,14928,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
GABAPENTIN 300 MG ORAL CAP,,14928,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
GABAPENTIN 300 MG ORAL CAP,,14928,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
GABAPENTIN 300 MG ORAL CAP,,14928,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
GABAPENTIN 300 MG ORAL CAP,,14928,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
GABAPENTIN 300 MG ORAL CAP,,14928,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
GABAPENTIN 300 MG ORAL CAP,,14928,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
GABAPENTIN 300 MG ORAL CAP,,14928,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
GABAPENTIN 300 MG ORAL CAP,,14928,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
BISMUTH SUBSALICYLATE 262 MG ORAL CHEW TAB,,15007,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
BISMUTH SUBSALICYLATE 262 MG ORAL CHEW TAB,,15007,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
BISMUTH SUBSALICYLATE 262 MG ORAL CHEW TAB,,15007,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
BISMUTH SUBSALICYLATE 262 MG ORAL CHEW TAB,,15007,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
BISMUTH SUBSALICYLATE 262 MG ORAL CHEW TAB,,15007,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
BISMUTH SUBSALICYLATE 262 MG ORAL CHEW TAB,,15007,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
BISMUTH SUBSALICYLATE 262 MG ORAL CHEW TAB,,15007,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
BISMUTH SUBSALICYLATE 262 MG ORAL CHEW TAB,,15007,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
BISMUTH SUBSALICYLATE 262 MG ORAL CHEW TAB,,15007,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
BISMUTH SUBSALICYLATE 262 MG ORAL CHEW TAB,,15007,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
BISMUTH SUBSALICYLATE 262 MG ORAL CHEW TAB,,15007,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
BISMUTH SUBSALICYLATE 262 MG ORAL CHEW TAB,,15007,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
BISMUTH SUBSALICYLATE 262 MG ORAL CHEW TAB,,15007,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
BISMUTH SUBSALICYLATE 262 MG ORAL CHEW TAB,,15007,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
BISMUTH SUBSALICYLATE 262 MG ORAL CHEW TAB,,15007,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
BISMUTH SUBSALICYLATE 262 MG ORAL CHEW TAB,,15007,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
BISMUTH SUBSALICYLATE 262 MG ORAL CHEW TAB,,15007,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
BISMUTH SUBSALICYLATE 262 MG ORAL CHEW TAB,,15007,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
BISMUTH SUBSALICYLATE 262 MG ORAL CHEW TAB,,15007,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
BISMUTH SUBSALICYLATE 262 MG ORAL CHEW TAB,,15007,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
BISMUTH SUBSALICYLATE 262 MG ORAL CHEW TAB,,15007,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
BISMUTH SUBSALICYLATE 262 MG ORAL CHEW TAB,,15007,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
BISMUTH SUBSALICYLATE 262 MG ORAL CHEW TAB,,15007,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
BISMUTH SUBSALICYLATE 262 MG ORAL CHEW TAB,,15007,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
BISMUTH SUBSALICYLATE 262 MG ORAL CHEW TAB,,15007,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
BISMUTH SUBSALICYLATE 262 MG ORAL CHEW TAB,,15007,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
BISMUTH SUBSALICYLATE 262 MG ORAL CHEW TAB,,15007,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
BISMUTH SUBSALICYLATE 262 MG ORAL CHEW TAB,,15007,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
BISMUTH SUBSALICYLATE 262 MG ORAL CHEW TAB,,15007,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
BISMUTH SUBSALICYLATE 262 MG ORAL CHEW TAB,,15007,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
BISMUTH SUBSALICYLATE 262 MG ORAL CHEW TAB,,15007,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
BISMUTH SUBSALICYLATE 262 MG ORAL CHEW TAB,,15007,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
BISMUTH SUBSALICYLATE 262 MG ORAL CHEW TAB,,15007,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
BISMUTH SUBSALICYLATE 262 MG ORAL CHEW TAB,,15007,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
BISMUTH SUBSALICYLATE 262 MG ORAL CHEW TAB,,15007,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
BISMUTH SUBSALICYLATE 262 MG ORAL CHEW TAB,,15007,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
BISMUTH SUBSALICYLATE 262 MG ORAL CHEW TAB,,15007,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
BISMUTH SUBSALICYLATE 262 MG ORAL CHEW TAB,,15007,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
BISMUTH SUBSALICYLATE 262 MG ORAL CHEW TAB,,15007,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
BISMUTH SUBSALICYLATE 262 MG ORAL CHEW TAB,,15007,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
BISMUTH SUBSALICYLATE 262 MG ORAL CHEW TAB,,15007,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
BISMUTH SUBSALICYLATE 262 MG ORAL CHEW TAB,,15007,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
BISMUTH SUBSALICYLATE 262 MG ORAL CHEW TAB,,15007,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
BISMUTH SUBSALICYLATE 262 MG ORAL CHEW TAB,,15007,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BISMUTH SUBSALICYLATE 262 MG ORAL CHEW TAB,,15007,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
BISMUTH SUBSALICYLATE 262 MG ORAL CHEW TAB,,15007,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BISMUTH SUBSALICYLATE 262 MG ORAL CHEW TAB,,15007,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
BISMUTH SUBSALICYLATE 262 MG ORAL CHEW TAB,,15007,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BISMUTH SUBSALICYLATE 262 MG ORAL CHEW TAB,,15007,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
BISMUTH SUBSALICYLATE 262 MG ORAL CHEW TAB,,15007,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
BISMUTH SUBSALICYLATE 262 MG ORAL CHEW TAB,,15007,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
BISMUTH SUBSALICYLATE 262 MG ORAL CHEW TAB,,15007,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
BISMUTH SUBSALICYLATE 262 MG ORAL CHEW TAB,,15007,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
BISMUTH SUBSALICYLATE 262 MG ORAL CHEW TAB,,15007,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
OMEPRAZOLE 20 MG ORAL CPDR,,15038,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
OMEPRAZOLE 20 MG ORAL CPDR,,15038,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
OMEPRAZOLE 20 MG ORAL CPDR,,15038,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
OMEPRAZOLE 20 MG ORAL CPDR,,15038,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
OMEPRAZOLE 20 MG ORAL CPDR,,15038,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
OMEPRAZOLE 20 MG ORAL CPDR,,15038,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
OMEPRAZOLE 20 MG ORAL CPDR,,15038,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
OMEPRAZOLE 20 MG ORAL CPDR,,15038,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
OMEPRAZOLE 20 MG ORAL CPDR,,15038,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
OMEPRAZOLE 20 MG ORAL CPDR,,15038,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
OMEPRAZOLE 20 MG ORAL CPDR,,15038,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
OMEPRAZOLE 20 MG ORAL CPDR,,15038,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
OMEPRAZOLE 20 MG ORAL CPDR,,15038,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
OMEPRAZOLE 20 MG ORAL CPDR,,15038,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
OMEPRAZOLE 20 MG ORAL CPDR,,15038,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
OMEPRAZOLE 20 MG ORAL CPDR,,15038,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
OMEPRAZOLE 20 MG ORAL CPDR,,15038,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
OMEPRAZOLE 20 MG ORAL CPDR,,15038,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
OMEPRAZOLE 20 MG ORAL CPDR,,15038,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
OMEPRAZOLE 20 MG ORAL CPDR,,15038,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
OMEPRAZOLE 20 MG ORAL CPDR,,15038,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
OMEPRAZOLE 20 MG ORAL CPDR,,15038,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
OMEPRAZOLE 20 MG ORAL CPDR,,15038,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
OMEPRAZOLE 20 MG ORAL CPDR,,15038,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
OMEPRAZOLE 20 MG ORAL CPDR,,15038,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
OMEPRAZOLE 20 MG ORAL CPDR,,15038,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
OMEPRAZOLE 20 MG ORAL CPDR,,15038,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
OMEPRAZOLE 20 MG ORAL CPDR,,15038,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
OMEPRAZOLE 20 MG ORAL CPDR,,15038,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
OMEPRAZOLE 20 MG ORAL CPDR,,15038,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
OMEPRAZOLE 20 MG ORAL CPDR,,15038,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
OMEPRAZOLE 20 MG ORAL CPDR,,15038,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
OMEPRAZOLE 20 MG ORAL CPDR,,15038,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
OMEPRAZOLE 20 MG ORAL CPDR,,15038,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
OMEPRAZOLE 20 MG ORAL CPDR,,15038,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
OMEPRAZOLE 20 MG ORAL CPDR,,15038,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
OMEPRAZOLE 20 MG ORAL CPDR,,15038,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
OMEPRAZOLE 20 MG ORAL CPDR,,15038,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
OMEPRAZOLE 20 MG ORAL CPDR,,15038,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
OMEPRAZOLE 20 MG ORAL CPDR,,15038,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
OMEPRAZOLE 20 MG ORAL CPDR,,15038,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
OMEPRAZOLE 20 MG ORAL CPDR,,15038,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
OMEPRAZOLE 20 MG ORAL CPDR,,15038,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
OMEPRAZOLE 20 MG ORAL CPDR,,15038,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
OMEPRAZOLE 20 MG ORAL CPDR,,15038,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
OMEPRAZOLE 20 MG ORAL CPDR,,15038,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
OMEPRAZOLE 20 MG ORAL CPDR,,15038,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
OMEPRAZOLE 20 MG ORAL CPDR,,15038,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
OMEPRAZOLE 20 MG ORAL CPDR,,15038,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
OMEPRAZOLE 20 MG ORAL CPDR,,15038,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
OMEPRAZOLE 20 MG ORAL CPDR,,15038,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
OMEPRAZOLE 20 MG ORAL CPDR,,15038,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
OMEPRAZOLE 20 MG ORAL CPDR,,15038,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
OMEPRAZOLE 20 MG ORAL CPDR,,15038,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
ASPIRIN 81 MG ORAL CHEW TAB,,15287,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
ASPIRIN 81 MG ORAL CHEW TAB,,15287,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
ASPIRIN 81 MG ORAL CHEW TAB,,15287,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
ASPIRIN 81 MG ORAL CHEW TAB,,15287,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
ASPIRIN 81 MG ORAL CHEW TAB,,15287,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
ASPIRIN 81 MG ORAL CHEW TAB,,15287,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
ASPIRIN 81 MG ORAL CHEW TAB,,15287,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
ASPIRIN 81 MG ORAL CHEW TAB,,15287,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
ASPIRIN 81 MG ORAL CHEW TAB,,15287,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
ASPIRIN 81 MG ORAL CHEW TAB,,15287,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
ASPIRIN 81 MG ORAL CHEW TAB,,15287,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
ASPIRIN 81 MG ORAL CHEW TAB,,15287,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
ASPIRIN 81 MG ORAL CHEW TAB,,15287,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
ASPIRIN 81 MG ORAL CHEW TAB,,15287,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
ASPIRIN 81 MG ORAL CHEW TAB,,15287,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
ASPIRIN 81 MG ORAL CHEW TAB,,15287,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
ASPIRIN 81 MG ORAL CHEW TAB,,15287,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
ASPIRIN 81 MG ORAL CHEW TAB,,15287,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
ASPIRIN 81 MG ORAL CHEW TAB,,15287,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ASPIRIN 81 MG ORAL CHEW TAB,,15287,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
ASPIRIN 81 MG ORAL CHEW TAB,,15287,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
ASPIRIN 81 MG ORAL CHEW TAB,,15287,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
ASPIRIN 81 MG ORAL CHEW TAB,,15287,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
ASPIRIN 81 MG ORAL CHEW TAB,,15287,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
ASPIRIN 81 MG ORAL CHEW TAB,,15287,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
ASPIRIN 81 MG ORAL CHEW TAB,,15287,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
ASPIRIN 81 MG ORAL CHEW TAB,,15287,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
ASPIRIN 81 MG ORAL CHEW TAB,,15287,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
ASPIRIN 81 MG ORAL CHEW TAB,,15287,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
ASPIRIN 81 MG ORAL CHEW TAB,,15287,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
ASPIRIN 81 MG ORAL CHEW TAB,,15287,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
ASPIRIN 81 MG ORAL CHEW TAB,,15287,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
ASPIRIN 81 MG ORAL CHEW TAB,,15287,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
ASPIRIN 81 MG ORAL CHEW TAB,,15287,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
ASPIRIN 81 MG ORAL CHEW TAB,,15287,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
ASPIRIN 81 MG ORAL CHEW TAB,,15287,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
ASPIRIN 81 MG ORAL CHEW TAB,,15287,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
ASPIRIN 81 MG ORAL CHEW TAB,,15287,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ASPIRIN 81 MG ORAL CHEW TAB,,15287,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
ASPIRIN 81 MG ORAL CHEW TAB,,15287,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
ASPIRIN 81 MG ORAL CHEW TAB,,15287,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
ASPIRIN 81 MG ORAL CHEW TAB,,15287,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
ASPIRIN 81 MG ORAL CHEW TAB,,15287,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
ASPIRIN 81 MG ORAL CHEW TAB,,15287,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ASPIRIN 81 MG ORAL CHEW TAB,,15287,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
ASPIRIN 81 MG ORAL CHEW TAB,,15287,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ASPIRIN 81 MG ORAL CHEW TAB,,15287,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ASPIRIN 81 MG ORAL CHEW TAB,,15287,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ASPIRIN 81 MG ORAL CHEW TAB,,15287,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ASPIRIN 81 MG ORAL CHEW TAB,,15287,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
ASPIRIN 81 MG ORAL CHEW TAB,,15287,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
ASPIRIN 81 MG ORAL CHEW TAB,,15287,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
ASPIRIN 81 MG ORAL CHEW TAB,,15287,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
ASPIRIN 81 MG ORAL CHEW TAB,,15287,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
RALOXIFENE 60 MG ORAL TABLET,,15307,LOCAL,Facility,Both,1,Each,,37,31.45,10.6042,37,Aetna,Commercial,34.04,92,,percent of total billed charges,,
RALOXIFENE 60 MG ORAL TABLET,,15307,LOCAL,Facility,Outpatient,1,Each,,37,31.45,10.6042,37,Aetna,Medicare Advantage,18.13,49,,percent of total billed charges,,
RALOXIFENE 60 MG ORAL TABLET,,15307,LOCAL,Facility,Inpatient,1,Each,,37,31.45,10.6042,37,Aetna,Medicare Advantage,,,,,Included in per diem rate,
RALOXIFENE 60 MG ORAL TABLET,,15307,LOCAL,Facility,Both,1,Each,,37,31.45,10.6042,37,Aetna,PPO,34.41,93,,percent of total billed charges,,
RALOXIFENE 60 MG ORAL TABLET,,15307,LOCAL,Facility,Both,1,Each,,37,31.45,10.6042,37,America's PPO,America's PPO,35.5311,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
RALOXIFENE 60 MG ORAL TABLET,,15307,LOCAL,Facility,Both,1,Each,,37,31.45,10.6042,37,BlueCross BlueShield Minnesota, Federal Employee Program,36.408,98.4,,percent of total billed charges,,
RALOXIFENE 60 MG ORAL TABLET,,15307,LOCAL,Facility,Both,1,Each,,37,31.45,10.6042,37,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,37,100,,percent of total billed charges,,
RALOXIFENE 60 MG ORAL TABLET,,15307,LOCAL,Facility,Both,1,Each,,37,31.45,10.6042,37,BlueCross BlueShield Minnesota,High Value Network Plan,33.3,90,,percent of total billed charges,,
RALOXIFENE 60 MG ORAL TABLET,,15307,LOCAL,Facility,Outpatient,1,Each,,37,31.45,10.6042,37,BlueCross BlueShield Minnesota,Medicare Advantage,18.13,49,,percent of total billed charges,,
RALOXIFENE 60 MG ORAL TABLET,,15307,LOCAL,Facility,Inpatient,1,Each,,37,31.45,10.6042,37,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
RALOXIFENE 60 MG ORAL TABLET,,15307,LOCAL,Facility,Both,1,Each,,37,31.45,10.6042,37,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,32.7709,88.57,,percent of total billed charges,,
RALOXIFENE 60 MG ORAL TABLET,,15307,LOCAL,Facility,Both,1,Each,,37,31.45,10.6042,37,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,10.6042,28.66,,percent of total billed charges,,
RALOXIFENE 60 MG ORAL TABLET,,15307,LOCAL,Facility,Outpatient,1,Each,,37,31.45,10.6042,37,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),18.13,49,,percent of total billed charges,,
RALOXIFENE 60 MG ORAL TABLET,,15307,LOCAL,Facility,Inpatient,1,Each,,37,31.45,10.6042,37,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
RALOXIFENE 60 MG ORAL TABLET,,15307,LOCAL,Facility,Both,1,Each,,37,31.45,10.6042,37,CorVel,Worker's Compensation,37,100,,percent of total billed charges,,
RALOXIFENE 60 MG ORAL TABLET,,15307,LOCAL,Facility,Both,1,Each,,37,31.45,10.6042,37,First Health Group Corporation,First Health Network,35.89,97,,percent of total billed charges,,
RALOXIFENE 60 MG ORAL TABLET,,15307,LOCAL,Facility,Both,1,Each,,37,31.45,10.6042,37,"Health Partners, Inc.",Commercial,35.002,94.6,,percent of total billed charges,,
RALOXIFENE 60 MG ORAL TABLET,,15307,LOCAL,Facility,Outpatient,1,Each,,37,31.45,10.6042,37,"Health Partners, Inc.",Medicare Advantage,18.13,49,,percent of total billed charges,,
RALOXIFENE 60 MG ORAL TABLET,,15307,LOCAL,Facility,Inpatient,1,Each,,37,31.45,10.6042,37,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
RALOXIFENE 60 MG ORAL TABLET,,15307,LOCAL,Facility,Both,1,Each,,37,31.45,10.6042,37,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),22.2,60,,percent of total billed charges,,
RALOXIFENE 60 MG ORAL TABLET,,15307,LOCAL,Facility,Both,1,Each,,37,31.45,10.6042,37,"Health Partners, Inc.",State of Minnesota Advantage Program,30.155,81.5,,percent of total billed charges,,
RALOXIFENE 60 MG ORAL TABLET,,15307,LOCAL,Facility,Both,1,Each,,37,31.45,10.6042,37,"Health Partners, Inc.",State Public Programs,18.5,50,,percent of total billed charges,,
RALOXIFENE 60 MG ORAL TABLET,,15307,LOCAL,Facility,Both,1,Each,,37,31.45,10.6042,37,Humana Insurance Company,Commercial PPO,35.15,95,,percent of total billed charges,,
RALOXIFENE 60 MG ORAL TABLET,,15307,LOCAL,Facility,Outpatient,1,Each,,37,31.45,10.6042,37,Humana Insurance Company,Medicare PPO,18.13,49,,percent of total billed charges,,
RALOXIFENE 60 MG ORAL TABLET,,15307,LOCAL,Facility,Inpatient,1,Each,,37,31.45,10.6042,37,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
RALOXIFENE 60 MG ORAL TABLET,,15307,LOCAL,Facility,Both,1,Each,,37,31.45,10.6042,37,Medica,Individual & Family,36.667,99.1,,percent of total billed charges,,
RALOXIFENE 60 MG ORAL TABLET,,15307,LOCAL,Facility,Outpatient,1,Each,,37,31.45,10.6042,37,Medica,Medica Advantage Solution,18.426,49.8,,percent of total billed charges,,
RALOXIFENE 60 MG ORAL TABLET,,15307,LOCAL,Facility,Inpatient,1,Each,,37,31.45,10.6042,37,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
RALOXIFENE 60 MG ORAL TABLET,,15307,LOCAL,Facility,Outpatient,1,Each,,37,31.45,10.6042,37,Medica,Medical Assistance,16.502,44.6,,percent of total billed charges,,
RALOXIFENE 60 MG ORAL TABLET,,15307,LOCAL,Facility,Inpatient,1,Each,,37,31.45,10.6042,37,Medica,Medical Assistance,,,,,Included in per diem rate,
RALOXIFENE 60 MG ORAL TABLET,,15307,LOCAL,Facility,Outpatient,1,Each,,37,31.45,10.6042,37,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,18.426,49.8,,percent of total billed charges,,
RALOXIFENE 60 MG ORAL TABLET,,15307,LOCAL,Facility,Inpatient,1,Each,,37,31.45,10.6042,37,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
RALOXIFENE 60 MG ORAL TABLET,,15307,LOCAL,Facility,Both,1,Each,,37,31.45,10.6042,37,"Multiplan, Inc.","Multiplan, Inc.",34.78,94,,percent of total billed charges,,
RALOXIFENE 60 MG ORAL TABLET,,15307,LOCAL,Facility,Outpatient,1,Each,,37,31.45,10.6042,37,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,33.337,90.1,,percent of total billed charges,,
RALOXIFENE 60 MG ORAL TABLET,,15307,LOCAL,Facility,Inpatient,1,Each,,37,31.45,10.6042,37,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
RALOXIFENE 60 MG ORAL TABLET,,15307,LOCAL,Facility,Both,1,Each,,37,31.45,10.6042,37,"Preferred One Administrative Services, INC.",PPO,36.482,98.6,,percent of total billed charges,,
RALOXIFENE 60 MG ORAL TABLET,,15307,LOCAL,Facility,Outpatient,1,Each,,37,31.45,10.6042,37,PrimeWest Health,Minnesota Senior Health Options (MSHO),19.0365,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
RALOXIFENE 60 MG ORAL TABLET,,15307,LOCAL,Facility,Inpatient,1,Each,,37,31.45,10.6042,37,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
RALOXIFENE 60 MG ORAL TABLET,,15307,LOCAL,Facility,Outpatient,1,Each,,37,31.45,10.6042,37,PrimeWest Health,MinnesotaCare,19.0032,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
RALOXIFENE 60 MG ORAL TABLET,,15307,LOCAL,Facility,Inpatient,1,Each,,37,31.45,10.6042,37,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
RALOXIFENE 60 MG ORAL TABLET,,15307,LOCAL,Facility,Both,1,Each,,37,31.45,10.6042,37,Sanford Health Plan,Sanford Health Plan,34.04,92,,percent of total billed charges,,
RALOXIFENE 60 MG ORAL TABLET,,15307,LOCAL,Facility,Outpatient,1,Each,,37,31.45,10.6042,37,"UCare Health, Inc.",Individual & Family Plan,20.8495,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
RALOXIFENE 60 MG ORAL TABLET,,15307,LOCAL,Facility,Inpatient,1,Each,,37,31.45,10.6042,37,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
RALOXIFENE 60 MG ORAL TABLET,,15307,LOCAL,Facility,Outpatient,1,Each,,37,31.45,10.6042,37,"UCare Health, Inc.",Medical Assistance,18.6739,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
RALOXIFENE 60 MG ORAL TABLET,,15307,LOCAL,Facility,Inpatient,1,Each,,37,31.45,10.6042,37,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
RALOXIFENE 60 MG ORAL TABLET,,15307,LOCAL,Facility,Outpatient,1,Each,,37,31.45,10.6042,37,"UCare Health, Inc.",Medicare Advantage,18.6739,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
RALOXIFENE 60 MG ORAL TABLET,,15307,LOCAL,Facility,Inpatient,1,Each,,37,31.45,10.6042,37,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
RALOXIFENE 60 MG ORAL TABLET,,15307,LOCAL,Facility,Outpatient,1,Each,,37,31.45,10.6042,37,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),18.6739,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
RALOXIFENE 60 MG ORAL TABLET,,15307,LOCAL,Facility,Inpatient,1,Each,,37,31.45,10.6042,37,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
RALOXIFENE 60 MG ORAL TABLET,,15307,LOCAL,Facility,Both,1,Each,,37,31.45,10.6042,37,UnitedHealthcare,Individual & Family,34.78,94,,percent of total billed charges,,
RALOXIFENE 60 MG ORAL TABLET,,15307,LOCAL,Facility,Outpatient,1,Each,,37,31.45,10.6042,37,UnitedHealthcare,Medicare Advantage,18.13,49,,percent of total billed charges,,
RALOXIFENE 60 MG ORAL TABLET,,15307,LOCAL,Facility,Inpatient,1,Each,,37,31.45,10.6042,37,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
RALOXIFENE 60 MG ORAL TABLET,,15307,LOCAL,Facility,Outpatient,1,Each,,37,31.45,10.6042,37,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,17.76,48,,percent of total billed charges,,100% of DHS outpatient percentage
RALOXIFENE 60 MG ORAL TABLET,,15307,LOCAL,Facility,Inpatient,1,Each,,37,31.45,10.6042,37,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
DILTIAZEM HCL 120 MG ORAL CP24,,15623,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
DILTIAZEM HCL 120 MG ORAL CP24,,15623,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
DILTIAZEM HCL 120 MG ORAL CP24,,15623,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
DILTIAZEM HCL 120 MG ORAL CP24,,15623,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
DILTIAZEM HCL 120 MG ORAL CP24,,15623,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
DILTIAZEM HCL 120 MG ORAL CP24,,15623,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
DILTIAZEM HCL 120 MG ORAL CP24,,15623,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
DILTIAZEM HCL 120 MG ORAL CP24,,15623,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
DILTIAZEM HCL 120 MG ORAL CP24,,15623,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
DILTIAZEM HCL 120 MG ORAL CP24,,15623,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
DILTIAZEM HCL 120 MG ORAL CP24,,15623,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
DILTIAZEM HCL 120 MG ORAL CP24,,15623,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
DILTIAZEM HCL 120 MG ORAL CP24,,15623,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
DILTIAZEM HCL 120 MG ORAL CP24,,15623,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
DILTIAZEM HCL 120 MG ORAL CP24,,15623,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
DILTIAZEM HCL 120 MG ORAL CP24,,15623,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
DILTIAZEM HCL 120 MG ORAL CP24,,15623,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
DILTIAZEM HCL 120 MG ORAL CP24,,15623,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
DILTIAZEM HCL 120 MG ORAL CP24,,15623,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DILTIAZEM HCL 120 MG ORAL CP24,,15623,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
DILTIAZEM HCL 120 MG ORAL CP24,,15623,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
DILTIAZEM HCL 120 MG ORAL CP24,,15623,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
DILTIAZEM HCL 120 MG ORAL CP24,,15623,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
DILTIAZEM HCL 120 MG ORAL CP24,,15623,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
DILTIAZEM HCL 120 MG ORAL CP24,,15623,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
DILTIAZEM HCL 120 MG ORAL CP24,,15623,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
DILTIAZEM HCL 120 MG ORAL CP24,,15623,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
DILTIAZEM HCL 120 MG ORAL CP24,,15623,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
DILTIAZEM HCL 120 MG ORAL CP24,,15623,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
DILTIAZEM HCL 120 MG ORAL CP24,,15623,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
DILTIAZEM HCL 120 MG ORAL CP24,,15623,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
DILTIAZEM HCL 120 MG ORAL CP24,,15623,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
DILTIAZEM HCL 120 MG ORAL CP24,,15623,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
DILTIAZEM HCL 120 MG ORAL CP24,,15623,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
DILTIAZEM HCL 120 MG ORAL CP24,,15623,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
DILTIAZEM HCL 120 MG ORAL CP24,,15623,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
DILTIAZEM HCL 120 MG ORAL CP24,,15623,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
DILTIAZEM HCL 120 MG ORAL CP24,,15623,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DILTIAZEM HCL 120 MG ORAL CP24,,15623,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
DILTIAZEM HCL 120 MG ORAL CP24,,15623,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
DILTIAZEM HCL 120 MG ORAL CP24,,15623,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
DILTIAZEM HCL 120 MG ORAL CP24,,15623,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
DILTIAZEM HCL 120 MG ORAL CP24,,15623,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
DILTIAZEM HCL 120 MG ORAL CP24,,15623,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DILTIAZEM HCL 120 MG ORAL CP24,,15623,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
DILTIAZEM HCL 120 MG ORAL CP24,,15623,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DILTIAZEM HCL 120 MG ORAL CP24,,15623,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DILTIAZEM HCL 120 MG ORAL CP24,,15623,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DILTIAZEM HCL 120 MG ORAL CP24,,15623,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DILTIAZEM HCL 120 MG ORAL CP24,,15623,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
DILTIAZEM HCL 120 MG ORAL CP24,,15623,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
DILTIAZEM HCL 120 MG ORAL CP24,,15623,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
DILTIAZEM HCL 120 MG ORAL CP24,,15623,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
DILTIAZEM HCL 120 MG ORAL CP24,,15623,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
BUMETANIDE 1 MG ORAL TABLET,,15650,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,Aetna,Commercial,6.44,92,,percent of total billed charges,,
BUMETANIDE 1 MG ORAL TABLET,,15650,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,Aetna,Medicare Advantage,3.43,49,,percent of total billed charges,,
BUMETANIDE 1 MG ORAL TABLET,,15650,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,Aetna,Medicare Advantage,,,,,Included in per diem rate,
BUMETANIDE 1 MG ORAL TABLET,,15650,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,Aetna,PPO,6.51,93,,percent of total billed charges,,
BUMETANIDE 1 MG ORAL TABLET,,15650,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,America's PPO,America's PPO,6.7221,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
BUMETANIDE 1 MG ORAL TABLET,,15650,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,BlueCross BlueShield Minnesota, Federal Employee Program,6.888,98.4,,percent of total billed charges,,
BUMETANIDE 1 MG ORAL TABLET,,15650,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,7,100,,percent of total billed charges,,
BUMETANIDE 1 MG ORAL TABLET,,15650,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,BlueCross BlueShield Minnesota,High Value Network Plan,6.3,90,,percent of total billed charges,,
BUMETANIDE 1 MG ORAL TABLET,,15650,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,BlueCross BlueShield Minnesota,Medicare Advantage,3.43,49,,percent of total billed charges,,
BUMETANIDE 1 MG ORAL TABLET,,15650,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
BUMETANIDE 1 MG ORAL TABLET,,15650,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,6.1999,88.57,,percent of total billed charges,,
BUMETANIDE 1 MG ORAL TABLET,,15650,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,2.0062,28.66,,percent of total billed charges,,
BUMETANIDE 1 MG ORAL TABLET,,15650,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),3.43,49,,percent of total billed charges,,
BUMETANIDE 1 MG ORAL TABLET,,15650,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
BUMETANIDE 1 MG ORAL TABLET,,15650,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,CorVel,Worker's Compensation,7,100,,percent of total billed charges,,
BUMETANIDE 1 MG ORAL TABLET,,15650,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,First Health Group Corporation,First Health Network,6.79,97,,percent of total billed charges,,
BUMETANIDE 1 MG ORAL TABLET,,15650,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,"Health Partners, Inc.",Commercial,6.622,94.6,,percent of total billed charges,,
BUMETANIDE 1 MG ORAL TABLET,,15650,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,"Health Partners, Inc.",Medicare Advantage,3.43,49,,percent of total billed charges,,
BUMETANIDE 1 MG ORAL TABLET,,15650,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
BUMETANIDE 1 MG ORAL TABLET,,15650,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),4.2,60,,percent of total billed charges,,
BUMETANIDE 1 MG ORAL TABLET,,15650,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,"Health Partners, Inc.",State of Minnesota Advantage Program,5.705,81.5,,percent of total billed charges,,
BUMETANIDE 1 MG ORAL TABLET,,15650,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,"Health Partners, Inc.",State Public Programs,3.5,50,,percent of total billed charges,,
BUMETANIDE 1 MG ORAL TABLET,,15650,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,Humana Insurance Company,Commercial PPO,6.65,95,,percent of total billed charges,,
BUMETANIDE 1 MG ORAL TABLET,,15650,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,Humana Insurance Company,Medicare PPO,3.43,49,,percent of total billed charges,,
BUMETANIDE 1 MG ORAL TABLET,,15650,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
BUMETANIDE 1 MG ORAL TABLET,,15650,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,Medica,Individual & Family,6.937,99.1,,percent of total billed charges,,
BUMETANIDE 1 MG ORAL TABLET,,15650,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,Medica,Medica Advantage Solution,3.486,49.8,,percent of total billed charges,,
BUMETANIDE 1 MG ORAL TABLET,,15650,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
BUMETANIDE 1 MG ORAL TABLET,,15650,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,Medica,Medical Assistance,3.122,44.6,,percent of total billed charges,,
BUMETANIDE 1 MG ORAL TABLET,,15650,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,Medica,Medical Assistance,,,,,Included in per diem rate,
BUMETANIDE 1 MG ORAL TABLET,,15650,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,3.486,49.8,,percent of total billed charges,,
BUMETANIDE 1 MG ORAL TABLET,,15650,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
BUMETANIDE 1 MG ORAL TABLET,,15650,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,"Multiplan, Inc.","Multiplan, Inc.",6.58,94,,percent of total billed charges,,
BUMETANIDE 1 MG ORAL TABLET,,15650,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,6.307,90.1,,percent of total billed charges,,
BUMETANIDE 1 MG ORAL TABLET,,15650,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
BUMETANIDE 1 MG ORAL TABLET,,15650,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,"Preferred One Administrative Services, INC.",PPO,6.902,98.6,,percent of total billed charges,,
BUMETANIDE 1 MG ORAL TABLET,,15650,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,PrimeWest Health,Minnesota Senior Health Options (MSHO),3.6015,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
BUMETANIDE 1 MG ORAL TABLET,,15650,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
BUMETANIDE 1 MG ORAL TABLET,,15650,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,PrimeWest Health,MinnesotaCare,3.5952,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
BUMETANIDE 1 MG ORAL TABLET,,15650,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
BUMETANIDE 1 MG ORAL TABLET,,15650,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,Sanford Health Plan,Sanford Health Plan,6.44,92,,percent of total billed charges,,
BUMETANIDE 1 MG ORAL TABLET,,15650,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,"UCare Health, Inc.",Individual & Family Plan,3.9445,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
BUMETANIDE 1 MG ORAL TABLET,,15650,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
BUMETANIDE 1 MG ORAL TABLET,,15650,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,"UCare Health, Inc.",Medical Assistance,3.5329,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BUMETANIDE 1 MG ORAL TABLET,,15650,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
BUMETANIDE 1 MG ORAL TABLET,,15650,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,"UCare Health, Inc.",Medicare Advantage,3.5329,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BUMETANIDE 1 MG ORAL TABLET,,15650,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
BUMETANIDE 1 MG ORAL TABLET,,15650,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),3.5329,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BUMETANIDE 1 MG ORAL TABLET,,15650,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
BUMETANIDE 1 MG ORAL TABLET,,15650,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,UnitedHealthcare,Individual & Family,6.58,94,,percent of total billed charges,,
BUMETANIDE 1 MG ORAL TABLET,,15650,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,UnitedHealthcare,Medicare Advantage,3.43,49,,percent of total billed charges,,
BUMETANIDE 1 MG ORAL TABLET,,15650,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
BUMETANIDE 1 MG ORAL TABLET,,15650,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,3.36,48,,percent of total billed charges,,100% of DHS outpatient percentage
BUMETANIDE 1 MG ORAL TABLET,,15650,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"SOD PHOS DI, MONO-K PHOS MONO 250 MG ORAL TABLET",,15690,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
"SOD PHOS DI, MONO-K PHOS MONO 250 MG ORAL TABLET",,15690,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
"SOD PHOS DI, MONO-K PHOS MONO 250 MG ORAL TABLET",,15690,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"SOD PHOS DI, MONO-K PHOS MONO 250 MG ORAL TABLET",,15690,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
"SOD PHOS DI, MONO-K PHOS MONO 250 MG ORAL TABLET",,15690,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"SOD PHOS DI, MONO-K PHOS MONO 250 MG ORAL TABLET",,15690,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
"SOD PHOS DI, MONO-K PHOS MONO 250 MG ORAL TABLET",,15690,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
"SOD PHOS DI, MONO-K PHOS MONO 250 MG ORAL TABLET",,15690,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
"SOD PHOS DI, MONO-K PHOS MONO 250 MG ORAL TABLET",,15690,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
"SOD PHOS DI, MONO-K PHOS MONO 250 MG ORAL TABLET",,15690,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"SOD PHOS DI, MONO-K PHOS MONO 250 MG ORAL TABLET",,15690,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
"SOD PHOS DI, MONO-K PHOS MONO 250 MG ORAL TABLET",,15690,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
"SOD PHOS DI, MONO-K PHOS MONO 250 MG ORAL TABLET",,15690,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
"SOD PHOS DI, MONO-K PHOS MONO 250 MG ORAL TABLET",,15690,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"SOD PHOS DI, MONO-K PHOS MONO 250 MG ORAL TABLET",,15690,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
"SOD PHOS DI, MONO-K PHOS MONO 250 MG ORAL TABLET",,15690,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
"SOD PHOS DI, MONO-K PHOS MONO 250 MG ORAL TABLET",,15690,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
"SOD PHOS DI, MONO-K PHOS MONO 250 MG ORAL TABLET",,15690,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
"SOD PHOS DI, MONO-K PHOS MONO 250 MG ORAL TABLET",,15690,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"SOD PHOS DI, MONO-K PHOS MONO 250 MG ORAL TABLET",,15690,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
"SOD PHOS DI, MONO-K PHOS MONO 250 MG ORAL TABLET",,15690,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
"SOD PHOS DI, MONO-K PHOS MONO 250 MG ORAL TABLET",,15690,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
"SOD PHOS DI, MONO-K PHOS MONO 250 MG ORAL TABLET",,15690,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
"SOD PHOS DI, MONO-K PHOS MONO 250 MG ORAL TABLET",,15690,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
"SOD PHOS DI, MONO-K PHOS MONO 250 MG ORAL TABLET",,15690,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"SOD PHOS DI, MONO-K PHOS MONO 250 MG ORAL TABLET",,15690,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
"SOD PHOS DI, MONO-K PHOS MONO 250 MG ORAL TABLET",,15690,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
"SOD PHOS DI, MONO-K PHOS MONO 250 MG ORAL TABLET",,15690,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"SOD PHOS DI, MONO-K PHOS MONO 250 MG ORAL TABLET",,15690,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
"SOD PHOS DI, MONO-K PHOS MONO 250 MG ORAL TABLET",,15690,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
"SOD PHOS DI, MONO-K PHOS MONO 250 MG ORAL TABLET",,15690,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
"SOD PHOS DI, MONO-K PHOS MONO 250 MG ORAL TABLET",,15690,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"SOD PHOS DI, MONO-K PHOS MONO 250 MG ORAL TABLET",,15690,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
"SOD PHOS DI, MONO-K PHOS MONO 250 MG ORAL TABLET",,15690,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
"SOD PHOS DI, MONO-K PHOS MONO 250 MG ORAL TABLET",,15690,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"SOD PHOS DI, MONO-K PHOS MONO 250 MG ORAL TABLET",,15690,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
"SOD PHOS DI, MONO-K PHOS MONO 250 MG ORAL TABLET",,15690,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"SOD PHOS DI, MONO-K PHOS MONO 250 MG ORAL TABLET",,15690,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"SOD PHOS DI, MONO-K PHOS MONO 250 MG ORAL TABLET",,15690,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"SOD PHOS DI, MONO-K PHOS MONO 250 MG ORAL TABLET",,15690,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"SOD PHOS DI, MONO-K PHOS MONO 250 MG ORAL TABLET",,15690,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
"SOD PHOS DI, MONO-K PHOS MONO 250 MG ORAL TABLET",,15690,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"SOD PHOS DI, MONO-K PHOS MONO 250 MG ORAL TABLET",,15690,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"SOD PHOS DI, MONO-K PHOS MONO 250 MG ORAL TABLET",,15690,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"SOD PHOS DI, MONO-K PHOS MONO 250 MG ORAL TABLET",,15690,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"SOD PHOS DI, MONO-K PHOS MONO 250 MG ORAL TABLET",,15690,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"SOD PHOS DI, MONO-K PHOS MONO 250 MG ORAL TABLET",,15690,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"SOD PHOS DI, MONO-K PHOS MONO 250 MG ORAL TABLET",,15690,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"SOD PHOS DI, MONO-K PHOS MONO 250 MG ORAL TABLET",,15690,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"SOD PHOS DI, MONO-K PHOS MONO 250 MG ORAL TABLET",,15690,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
"SOD PHOS DI, MONO-K PHOS MONO 250 MG ORAL TABLET",,15690,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
"SOD PHOS DI, MONO-K PHOS MONO 250 MG ORAL TABLET",,15690,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"SOD PHOS DI, MONO-K PHOS MONO 250 MG ORAL TABLET",,15690,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
"SOD PHOS DI, MONO-K PHOS MONO 250 MG ORAL TABLET",,15690,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
FOLIC ACID 1 MG ORAL TABLET,,15774,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
FOLIC ACID 1 MG ORAL TABLET,,15774,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
FOLIC ACID 1 MG ORAL TABLET,,15774,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
FOLIC ACID 1 MG ORAL TABLET,,15774,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
FOLIC ACID 1 MG ORAL TABLET,,15774,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
FOLIC ACID 1 MG ORAL TABLET,,15774,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
FOLIC ACID 1 MG ORAL TABLET,,15774,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
FOLIC ACID 1 MG ORAL TABLET,,15774,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
FOLIC ACID 1 MG ORAL TABLET,,15774,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
FOLIC ACID 1 MG ORAL TABLET,,15774,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
FOLIC ACID 1 MG ORAL TABLET,,15774,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
FOLIC ACID 1 MG ORAL TABLET,,15774,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
FOLIC ACID 1 MG ORAL TABLET,,15774,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
FOLIC ACID 1 MG ORAL TABLET,,15774,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
FOLIC ACID 1 MG ORAL TABLET,,15774,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
FOLIC ACID 1 MG ORAL TABLET,,15774,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
FOLIC ACID 1 MG ORAL TABLET,,15774,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
FOLIC ACID 1 MG ORAL TABLET,,15774,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
FOLIC ACID 1 MG ORAL TABLET,,15774,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
FOLIC ACID 1 MG ORAL TABLET,,15774,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
FOLIC ACID 1 MG ORAL TABLET,,15774,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
FOLIC ACID 1 MG ORAL TABLET,,15774,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
FOLIC ACID 1 MG ORAL TABLET,,15774,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
FOLIC ACID 1 MG ORAL TABLET,,15774,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
FOLIC ACID 1 MG ORAL TABLET,,15774,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
FOLIC ACID 1 MG ORAL TABLET,,15774,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
FOLIC ACID 1 MG ORAL TABLET,,15774,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
FOLIC ACID 1 MG ORAL TABLET,,15774,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
FOLIC ACID 1 MG ORAL TABLET,,15774,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
FOLIC ACID 1 MG ORAL TABLET,,15774,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
FOLIC ACID 1 MG ORAL TABLET,,15774,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
FOLIC ACID 1 MG ORAL TABLET,,15774,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
FOLIC ACID 1 MG ORAL TABLET,,15774,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
FOLIC ACID 1 MG ORAL TABLET,,15774,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
FOLIC ACID 1 MG ORAL TABLET,,15774,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
FOLIC ACID 1 MG ORAL TABLET,,15774,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
FOLIC ACID 1 MG ORAL TABLET,,15774,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
FOLIC ACID 1 MG ORAL TABLET,,15774,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
FOLIC ACID 1 MG ORAL TABLET,,15774,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
FOLIC ACID 1 MG ORAL TABLET,,15774,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
FOLIC ACID 1 MG ORAL TABLET,,15774,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
FOLIC ACID 1 MG ORAL TABLET,,15774,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
FOLIC ACID 1 MG ORAL TABLET,,15774,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
FOLIC ACID 1 MG ORAL TABLET,,15774,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FOLIC ACID 1 MG ORAL TABLET,,15774,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
FOLIC ACID 1 MG ORAL TABLET,,15774,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FOLIC ACID 1 MG ORAL TABLET,,15774,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
FOLIC ACID 1 MG ORAL TABLET,,15774,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FOLIC ACID 1 MG ORAL TABLET,,15774,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
FOLIC ACID 1 MG ORAL TABLET,,15774,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
FOLIC ACID 1 MG ORAL TABLET,,15774,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
FOLIC ACID 1 MG ORAL TABLET,,15774,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
FOLIC ACID 1 MG ORAL TABLET,,15774,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
FOLIC ACID 1 MG ORAL TABLET,,15774,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
AMOXICILLIN 250 MG ORAL CAP,,15803,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
AMOXICILLIN 250 MG ORAL CAP,,15803,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
AMOXICILLIN 250 MG ORAL CAP,,15803,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
AMOXICILLIN 250 MG ORAL CAP,,15803,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
AMOXICILLIN 250 MG ORAL CAP,,15803,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
AMOXICILLIN 250 MG ORAL CAP,,15803,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
AMOXICILLIN 250 MG ORAL CAP,,15803,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
AMOXICILLIN 250 MG ORAL CAP,,15803,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
AMOXICILLIN 250 MG ORAL CAP,,15803,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
AMOXICILLIN 250 MG ORAL CAP,,15803,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
AMOXICILLIN 250 MG ORAL CAP,,15803,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
AMOXICILLIN 250 MG ORAL CAP,,15803,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
AMOXICILLIN 250 MG ORAL CAP,,15803,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
AMOXICILLIN 250 MG ORAL CAP,,15803,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
AMOXICILLIN 250 MG ORAL CAP,,15803,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
AMOXICILLIN 250 MG ORAL CAP,,15803,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
AMOXICILLIN 250 MG ORAL CAP,,15803,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
AMOXICILLIN 250 MG ORAL CAP,,15803,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
AMOXICILLIN 250 MG ORAL CAP,,15803,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
AMOXICILLIN 250 MG ORAL CAP,,15803,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
AMOXICILLIN 250 MG ORAL CAP,,15803,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
AMOXICILLIN 250 MG ORAL CAP,,15803,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
AMOXICILLIN 250 MG ORAL CAP,,15803,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
AMOXICILLIN 250 MG ORAL CAP,,15803,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
AMOXICILLIN 250 MG ORAL CAP,,15803,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
AMOXICILLIN 250 MG ORAL CAP,,15803,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
AMOXICILLIN 250 MG ORAL CAP,,15803,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
AMOXICILLIN 250 MG ORAL CAP,,15803,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
AMOXICILLIN 250 MG ORAL CAP,,15803,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
AMOXICILLIN 250 MG ORAL CAP,,15803,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
AMOXICILLIN 250 MG ORAL CAP,,15803,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
AMOXICILLIN 250 MG ORAL CAP,,15803,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
AMOXICILLIN 250 MG ORAL CAP,,15803,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
AMOXICILLIN 250 MG ORAL CAP,,15803,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
AMOXICILLIN 250 MG ORAL CAP,,15803,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
AMOXICILLIN 250 MG ORAL CAP,,15803,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
AMOXICILLIN 250 MG ORAL CAP,,15803,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
AMOXICILLIN 250 MG ORAL CAP,,15803,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
AMOXICILLIN 250 MG ORAL CAP,,15803,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
AMOXICILLIN 250 MG ORAL CAP,,15803,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
AMOXICILLIN 250 MG ORAL CAP,,15803,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
AMOXICILLIN 250 MG ORAL CAP,,15803,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
AMOXICILLIN 250 MG ORAL CAP,,15803,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
AMOXICILLIN 250 MG ORAL CAP,,15803,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
AMOXICILLIN 250 MG ORAL CAP,,15803,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
AMOXICILLIN 250 MG ORAL CAP,,15803,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
AMOXICILLIN 250 MG ORAL CAP,,15803,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
AMOXICILLIN 250 MG ORAL CAP,,15803,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
AMOXICILLIN 250 MG ORAL CAP,,15803,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
AMOXICILLIN 250 MG ORAL CAP,,15803,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
AMOXICILLIN 250 MG ORAL CAP,,15803,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
AMOXICILLIN 250 MG ORAL CAP,,15803,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
AMOXICILLIN 250 MG ORAL CAP,,15803,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
AMOXICILLIN 250 MG ORAL CAP,,15803,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
PSEUDOEPHEDRINE HCL 30 MG ORAL TABLET,,15835,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
PSEUDOEPHEDRINE HCL 30 MG ORAL TABLET,,15835,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
PSEUDOEPHEDRINE HCL 30 MG ORAL TABLET,,15835,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
PSEUDOEPHEDRINE HCL 30 MG ORAL TABLET,,15835,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
PSEUDOEPHEDRINE HCL 30 MG ORAL TABLET,,15835,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
PSEUDOEPHEDRINE HCL 30 MG ORAL TABLET,,15835,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
PSEUDOEPHEDRINE HCL 30 MG ORAL TABLET,,15835,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
PSEUDOEPHEDRINE HCL 30 MG ORAL TABLET,,15835,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
PSEUDOEPHEDRINE HCL 30 MG ORAL TABLET,,15835,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
PSEUDOEPHEDRINE HCL 30 MG ORAL TABLET,,15835,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
PSEUDOEPHEDRINE HCL 30 MG ORAL TABLET,,15835,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
PSEUDOEPHEDRINE HCL 30 MG ORAL TABLET,,15835,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
PSEUDOEPHEDRINE HCL 30 MG ORAL TABLET,,15835,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
PSEUDOEPHEDRINE HCL 30 MG ORAL TABLET,,15835,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
PSEUDOEPHEDRINE HCL 30 MG ORAL TABLET,,15835,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
PSEUDOEPHEDRINE HCL 30 MG ORAL TABLET,,15835,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
PSEUDOEPHEDRINE HCL 30 MG ORAL TABLET,,15835,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
PSEUDOEPHEDRINE HCL 30 MG ORAL TABLET,,15835,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
PSEUDOEPHEDRINE HCL 30 MG ORAL TABLET,,15835,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PSEUDOEPHEDRINE HCL 30 MG ORAL TABLET,,15835,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
PSEUDOEPHEDRINE HCL 30 MG ORAL TABLET,,15835,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
PSEUDOEPHEDRINE HCL 30 MG ORAL TABLET,,15835,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
PSEUDOEPHEDRINE HCL 30 MG ORAL TABLET,,15835,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
PSEUDOEPHEDRINE HCL 30 MG ORAL TABLET,,15835,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
PSEUDOEPHEDRINE HCL 30 MG ORAL TABLET,,15835,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
PSEUDOEPHEDRINE HCL 30 MG ORAL TABLET,,15835,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
PSEUDOEPHEDRINE HCL 30 MG ORAL TABLET,,15835,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
PSEUDOEPHEDRINE HCL 30 MG ORAL TABLET,,15835,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
PSEUDOEPHEDRINE HCL 30 MG ORAL TABLET,,15835,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
PSEUDOEPHEDRINE HCL 30 MG ORAL TABLET,,15835,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
PSEUDOEPHEDRINE HCL 30 MG ORAL TABLET,,15835,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
PSEUDOEPHEDRINE HCL 30 MG ORAL TABLET,,15835,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
PSEUDOEPHEDRINE HCL 30 MG ORAL TABLET,,15835,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
PSEUDOEPHEDRINE HCL 30 MG ORAL TABLET,,15835,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
PSEUDOEPHEDRINE HCL 30 MG ORAL TABLET,,15835,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
PSEUDOEPHEDRINE HCL 30 MG ORAL TABLET,,15835,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
PSEUDOEPHEDRINE HCL 30 MG ORAL TABLET,,15835,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
PSEUDOEPHEDRINE HCL 30 MG ORAL TABLET,,15835,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PSEUDOEPHEDRINE HCL 30 MG ORAL TABLET,,15835,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
PSEUDOEPHEDRINE HCL 30 MG ORAL TABLET,,15835,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
PSEUDOEPHEDRINE HCL 30 MG ORAL TABLET,,15835,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
PSEUDOEPHEDRINE HCL 30 MG ORAL TABLET,,15835,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
PSEUDOEPHEDRINE HCL 30 MG ORAL TABLET,,15835,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
PSEUDOEPHEDRINE HCL 30 MG ORAL TABLET,,15835,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PSEUDOEPHEDRINE HCL 30 MG ORAL TABLET,,15835,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
PSEUDOEPHEDRINE HCL 30 MG ORAL TABLET,,15835,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PSEUDOEPHEDRINE HCL 30 MG ORAL TABLET,,15835,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PSEUDOEPHEDRINE HCL 30 MG ORAL TABLET,,15835,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PSEUDOEPHEDRINE HCL 30 MG ORAL TABLET,,15835,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PSEUDOEPHEDRINE HCL 30 MG ORAL TABLET,,15835,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
PSEUDOEPHEDRINE HCL 30 MG ORAL TABLET,,15835,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
PSEUDOEPHEDRINE HCL 30 MG ORAL TABLET,,15835,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
PSEUDOEPHEDRINE HCL 30 MG ORAL TABLET,,15835,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
PSEUDOEPHEDRINE HCL 30 MG ORAL TABLET,,15835,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
MONTELUKAST 10 MG ORAL TABLET,,15866,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
MONTELUKAST 10 MG ORAL TABLET,,15866,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
MONTELUKAST 10 MG ORAL TABLET,,15866,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
MONTELUKAST 10 MG ORAL TABLET,,15866,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
MONTELUKAST 10 MG ORAL TABLET,,15866,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
MONTELUKAST 10 MG ORAL TABLET,,15866,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
MONTELUKAST 10 MG ORAL TABLET,,15866,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
MONTELUKAST 10 MG ORAL TABLET,,15866,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
MONTELUKAST 10 MG ORAL TABLET,,15866,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
MONTELUKAST 10 MG ORAL TABLET,,15866,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
MONTELUKAST 10 MG ORAL TABLET,,15866,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
MONTELUKAST 10 MG ORAL TABLET,,15866,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
MONTELUKAST 10 MG ORAL TABLET,,15866,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
MONTELUKAST 10 MG ORAL TABLET,,15866,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
MONTELUKAST 10 MG ORAL TABLET,,15866,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
MONTELUKAST 10 MG ORAL TABLET,,15866,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
MONTELUKAST 10 MG ORAL TABLET,,15866,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
MONTELUKAST 10 MG ORAL TABLET,,15866,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
MONTELUKAST 10 MG ORAL TABLET,,15866,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
MONTELUKAST 10 MG ORAL TABLET,,15866,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
MONTELUKAST 10 MG ORAL TABLET,,15866,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
MONTELUKAST 10 MG ORAL TABLET,,15866,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
MONTELUKAST 10 MG ORAL TABLET,,15866,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
MONTELUKAST 10 MG ORAL TABLET,,15866,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
MONTELUKAST 10 MG ORAL TABLET,,15866,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
MONTELUKAST 10 MG ORAL TABLET,,15866,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
MONTELUKAST 10 MG ORAL TABLET,,15866,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
MONTELUKAST 10 MG ORAL TABLET,,15866,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
MONTELUKAST 10 MG ORAL TABLET,,15866,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
MONTELUKAST 10 MG ORAL TABLET,,15866,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
MONTELUKAST 10 MG ORAL TABLET,,15866,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
MONTELUKAST 10 MG ORAL TABLET,,15866,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
MONTELUKAST 10 MG ORAL TABLET,,15866,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
MONTELUKAST 10 MG ORAL TABLET,,15866,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
MONTELUKAST 10 MG ORAL TABLET,,15866,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
MONTELUKAST 10 MG ORAL TABLET,,15866,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
MONTELUKAST 10 MG ORAL TABLET,,15866,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
MONTELUKAST 10 MG ORAL TABLET,,15866,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
MONTELUKAST 10 MG ORAL TABLET,,15866,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
MONTELUKAST 10 MG ORAL TABLET,,15866,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
MONTELUKAST 10 MG ORAL TABLET,,15866,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
MONTELUKAST 10 MG ORAL TABLET,,15866,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
MONTELUKAST 10 MG ORAL TABLET,,15866,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
MONTELUKAST 10 MG ORAL TABLET,,15866,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MONTELUKAST 10 MG ORAL TABLET,,15866,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
MONTELUKAST 10 MG ORAL TABLET,,15866,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MONTELUKAST 10 MG ORAL TABLET,,15866,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
MONTELUKAST 10 MG ORAL TABLET,,15866,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MONTELUKAST 10 MG ORAL TABLET,,15866,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
MONTELUKAST 10 MG ORAL TABLET,,15866,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
MONTELUKAST 10 MG ORAL TABLET,,15866,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
MONTELUKAST 10 MG ORAL TABLET,,15866,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
MONTELUKAST 10 MG ORAL TABLET,,15866,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
MONTELUKAST 10 MG ORAL TABLET,,15866,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
MORPHINE 15 MG ORAL TAB SR,,15909,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,Aetna,Commercial,6.44,92,,percent of total billed charges,,
MORPHINE 15 MG ORAL TAB SR,,15909,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,Aetna,Medicare Advantage,3.43,49,,percent of total billed charges,,
MORPHINE 15 MG ORAL TAB SR,,15909,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,Aetna,Medicare Advantage,,,,,Included in per diem rate,
MORPHINE 15 MG ORAL TAB SR,,15909,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,Aetna,PPO,6.51,93,,percent of total billed charges,,
MORPHINE 15 MG ORAL TAB SR,,15909,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,America's PPO,America's PPO,6.7221,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
MORPHINE 15 MG ORAL TAB SR,,15909,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,BlueCross BlueShield Minnesota, Federal Employee Program,6.888,98.4,,percent of total billed charges,,
MORPHINE 15 MG ORAL TAB SR,,15909,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,7,100,,percent of total billed charges,,
MORPHINE 15 MG ORAL TAB SR,,15909,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,BlueCross BlueShield Minnesota,High Value Network Plan,6.3,90,,percent of total billed charges,,
MORPHINE 15 MG ORAL TAB SR,,15909,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,BlueCross BlueShield Minnesota,Medicare Advantage,3.43,49,,percent of total billed charges,,
MORPHINE 15 MG ORAL TAB SR,,15909,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
MORPHINE 15 MG ORAL TAB SR,,15909,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,6.1999,88.57,,percent of total billed charges,,
MORPHINE 15 MG ORAL TAB SR,,15909,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,2.0062,28.66,,percent of total billed charges,,
MORPHINE 15 MG ORAL TAB SR,,15909,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),3.43,49,,percent of total billed charges,,
MORPHINE 15 MG ORAL TAB SR,,15909,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
MORPHINE 15 MG ORAL TAB SR,,15909,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,CorVel,Worker's Compensation,7,100,,percent of total billed charges,,
MORPHINE 15 MG ORAL TAB SR,,15909,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,First Health Group Corporation,First Health Network,6.79,97,,percent of total billed charges,,
MORPHINE 15 MG ORAL TAB SR,,15909,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,"Health Partners, Inc.",Commercial,6.622,94.6,,percent of total billed charges,,
MORPHINE 15 MG ORAL TAB SR,,15909,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,"Health Partners, Inc.",Medicare Advantage,3.43,49,,percent of total billed charges,,
MORPHINE 15 MG ORAL TAB SR,,15909,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
MORPHINE 15 MG ORAL TAB SR,,15909,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),4.2,60,,percent of total billed charges,,
MORPHINE 15 MG ORAL TAB SR,,15909,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,"Health Partners, Inc.",State of Minnesota Advantage Program,5.705,81.5,,percent of total billed charges,,
MORPHINE 15 MG ORAL TAB SR,,15909,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,"Health Partners, Inc.",State Public Programs,3.5,50,,percent of total billed charges,,
MORPHINE 15 MG ORAL TAB SR,,15909,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,Humana Insurance Company,Commercial PPO,6.65,95,,percent of total billed charges,,
MORPHINE 15 MG ORAL TAB SR,,15909,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,Humana Insurance Company,Medicare PPO,3.43,49,,percent of total billed charges,,
MORPHINE 15 MG ORAL TAB SR,,15909,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
MORPHINE 15 MG ORAL TAB SR,,15909,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,Medica,Individual & Family,6.937,99.1,,percent of total billed charges,,
MORPHINE 15 MG ORAL TAB SR,,15909,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,Medica,Medica Advantage Solution,3.486,49.8,,percent of total billed charges,,
MORPHINE 15 MG ORAL TAB SR,,15909,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
MORPHINE 15 MG ORAL TAB SR,,15909,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,Medica,Medical Assistance,3.122,44.6,,percent of total billed charges,,
MORPHINE 15 MG ORAL TAB SR,,15909,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,Medica,Medical Assistance,,,,,Included in per diem rate,
MORPHINE 15 MG ORAL TAB SR,,15909,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,3.486,49.8,,percent of total billed charges,,
MORPHINE 15 MG ORAL TAB SR,,15909,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
MORPHINE 15 MG ORAL TAB SR,,15909,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,"Multiplan, Inc.","Multiplan, Inc.",6.58,94,,percent of total billed charges,,
MORPHINE 15 MG ORAL TAB SR,,15909,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,6.307,90.1,,percent of total billed charges,,
MORPHINE 15 MG ORAL TAB SR,,15909,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
MORPHINE 15 MG ORAL TAB SR,,15909,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,"Preferred One Administrative Services, INC.",PPO,6.902,98.6,,percent of total billed charges,,
MORPHINE 15 MG ORAL TAB SR,,15909,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,PrimeWest Health,Minnesota Senior Health Options (MSHO),3.6015,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
MORPHINE 15 MG ORAL TAB SR,,15909,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
MORPHINE 15 MG ORAL TAB SR,,15909,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,PrimeWest Health,MinnesotaCare,3.5952,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
MORPHINE 15 MG ORAL TAB SR,,15909,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
MORPHINE 15 MG ORAL TAB SR,,15909,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,Sanford Health Plan,Sanford Health Plan,6.44,92,,percent of total billed charges,,
MORPHINE 15 MG ORAL TAB SR,,15909,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,"UCare Health, Inc.",Individual & Family Plan,3.9445,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
MORPHINE 15 MG ORAL TAB SR,,15909,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
MORPHINE 15 MG ORAL TAB SR,,15909,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,"UCare Health, Inc.",Medical Assistance,3.5329,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MORPHINE 15 MG ORAL TAB SR,,15909,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
MORPHINE 15 MG ORAL TAB SR,,15909,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,"UCare Health, Inc.",Medicare Advantage,3.5329,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MORPHINE 15 MG ORAL TAB SR,,15909,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
MORPHINE 15 MG ORAL TAB SR,,15909,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),3.5329,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MORPHINE 15 MG ORAL TAB SR,,15909,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
MORPHINE 15 MG ORAL TAB SR,,15909,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,UnitedHealthcare,Individual & Family,6.58,94,,percent of total billed charges,,
MORPHINE 15 MG ORAL TAB SR,,15909,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,UnitedHealthcare,Medicare Advantage,3.43,49,,percent of total billed charges,,
MORPHINE 15 MG ORAL TAB SR,,15909,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
MORPHINE 15 MG ORAL TAB SR,,15909,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,3.36,48,,percent of total billed charges,,100% of DHS outpatient percentage
MORPHINE 15 MG ORAL TAB SR,,15909,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
ISOSORBIDE MONONITRATE 10 MG ORAL TABLET,,15916,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
ISOSORBIDE MONONITRATE 10 MG ORAL TABLET,,15916,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
ISOSORBIDE MONONITRATE 10 MG ORAL TABLET,,15916,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
ISOSORBIDE MONONITRATE 10 MG ORAL TABLET,,15916,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
ISOSORBIDE MONONITRATE 10 MG ORAL TABLET,,15916,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
ISOSORBIDE MONONITRATE 10 MG ORAL TABLET,,15916,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
ISOSORBIDE MONONITRATE 10 MG ORAL TABLET,,15916,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
ISOSORBIDE MONONITRATE 10 MG ORAL TABLET,,15916,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
ISOSORBIDE MONONITRATE 10 MG ORAL TABLET,,15916,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
ISOSORBIDE MONONITRATE 10 MG ORAL TABLET,,15916,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
ISOSORBIDE MONONITRATE 10 MG ORAL TABLET,,15916,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
ISOSORBIDE MONONITRATE 10 MG ORAL TABLET,,15916,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
ISOSORBIDE MONONITRATE 10 MG ORAL TABLET,,15916,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
ISOSORBIDE MONONITRATE 10 MG ORAL TABLET,,15916,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
ISOSORBIDE MONONITRATE 10 MG ORAL TABLET,,15916,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
ISOSORBIDE MONONITRATE 10 MG ORAL TABLET,,15916,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
ISOSORBIDE MONONITRATE 10 MG ORAL TABLET,,15916,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
ISOSORBIDE MONONITRATE 10 MG ORAL TABLET,,15916,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
ISOSORBIDE MONONITRATE 10 MG ORAL TABLET,,15916,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ISOSORBIDE MONONITRATE 10 MG ORAL TABLET,,15916,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
ISOSORBIDE MONONITRATE 10 MG ORAL TABLET,,15916,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
ISOSORBIDE MONONITRATE 10 MG ORAL TABLET,,15916,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
ISOSORBIDE MONONITRATE 10 MG ORAL TABLET,,15916,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
ISOSORBIDE MONONITRATE 10 MG ORAL TABLET,,15916,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
ISOSORBIDE MONONITRATE 10 MG ORAL TABLET,,15916,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
ISOSORBIDE MONONITRATE 10 MG ORAL TABLET,,15916,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
ISOSORBIDE MONONITRATE 10 MG ORAL TABLET,,15916,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
ISOSORBIDE MONONITRATE 10 MG ORAL TABLET,,15916,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
ISOSORBIDE MONONITRATE 10 MG ORAL TABLET,,15916,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
ISOSORBIDE MONONITRATE 10 MG ORAL TABLET,,15916,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
ISOSORBIDE MONONITRATE 10 MG ORAL TABLET,,15916,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
ISOSORBIDE MONONITRATE 10 MG ORAL TABLET,,15916,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
ISOSORBIDE MONONITRATE 10 MG ORAL TABLET,,15916,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
ISOSORBIDE MONONITRATE 10 MG ORAL TABLET,,15916,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
ISOSORBIDE MONONITRATE 10 MG ORAL TABLET,,15916,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
ISOSORBIDE MONONITRATE 10 MG ORAL TABLET,,15916,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
ISOSORBIDE MONONITRATE 10 MG ORAL TABLET,,15916,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
ISOSORBIDE MONONITRATE 10 MG ORAL TABLET,,15916,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ISOSORBIDE MONONITRATE 10 MG ORAL TABLET,,15916,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
ISOSORBIDE MONONITRATE 10 MG ORAL TABLET,,15916,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
ISOSORBIDE MONONITRATE 10 MG ORAL TABLET,,15916,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
ISOSORBIDE MONONITRATE 10 MG ORAL TABLET,,15916,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
ISOSORBIDE MONONITRATE 10 MG ORAL TABLET,,15916,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
ISOSORBIDE MONONITRATE 10 MG ORAL TABLET,,15916,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ISOSORBIDE MONONITRATE 10 MG ORAL TABLET,,15916,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
ISOSORBIDE MONONITRATE 10 MG ORAL TABLET,,15916,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ISOSORBIDE MONONITRATE 10 MG ORAL TABLET,,15916,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ISOSORBIDE MONONITRATE 10 MG ORAL TABLET,,15916,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ISOSORBIDE MONONITRATE 10 MG ORAL TABLET,,15916,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ISOSORBIDE MONONITRATE 10 MG ORAL TABLET,,15916,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
ISOSORBIDE MONONITRATE 10 MG ORAL TABLET,,15916,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
ISOSORBIDE MONONITRATE 10 MG ORAL TABLET,,15916,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
ISOSORBIDE MONONITRATE 10 MG ORAL TABLET,,15916,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
ISOSORBIDE MONONITRATE 10 MG ORAL TABLET,,15916,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
BISACODYL 5 MG ORAL TBEC,,16122,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
BISACODYL 5 MG ORAL TBEC,,16122,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
BISACODYL 5 MG ORAL TBEC,,16122,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
BISACODYL 5 MG ORAL TBEC,,16122,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
BISACODYL 5 MG ORAL TBEC,,16122,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
BISACODYL 5 MG ORAL TBEC,,16122,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
BISACODYL 5 MG ORAL TBEC,,16122,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
BISACODYL 5 MG ORAL TBEC,,16122,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
BISACODYL 5 MG ORAL TBEC,,16122,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
BISACODYL 5 MG ORAL TBEC,,16122,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
BISACODYL 5 MG ORAL TBEC,,16122,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
BISACODYL 5 MG ORAL TBEC,,16122,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
BISACODYL 5 MG ORAL TBEC,,16122,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
BISACODYL 5 MG ORAL TBEC,,16122,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
BISACODYL 5 MG ORAL TBEC,,16122,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
BISACODYL 5 MG ORAL TBEC,,16122,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
BISACODYL 5 MG ORAL TBEC,,16122,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
BISACODYL 5 MG ORAL TBEC,,16122,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
BISACODYL 5 MG ORAL TBEC,,16122,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
BISACODYL 5 MG ORAL TBEC,,16122,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
BISACODYL 5 MG ORAL TBEC,,16122,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
BISACODYL 5 MG ORAL TBEC,,16122,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
BISACODYL 5 MG ORAL TBEC,,16122,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
BISACODYL 5 MG ORAL TBEC,,16122,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
BISACODYL 5 MG ORAL TBEC,,16122,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
BISACODYL 5 MG ORAL TBEC,,16122,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
BISACODYL 5 MG ORAL TBEC,,16122,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
BISACODYL 5 MG ORAL TBEC,,16122,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
BISACODYL 5 MG ORAL TBEC,,16122,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
BISACODYL 5 MG ORAL TBEC,,16122,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
BISACODYL 5 MG ORAL TBEC,,16122,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
BISACODYL 5 MG ORAL TBEC,,16122,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
BISACODYL 5 MG ORAL TBEC,,16122,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
BISACODYL 5 MG ORAL TBEC,,16122,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
BISACODYL 5 MG ORAL TBEC,,16122,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
BISACODYL 5 MG ORAL TBEC,,16122,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
BISACODYL 5 MG ORAL TBEC,,16122,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
BISACODYL 5 MG ORAL TBEC,,16122,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
BISACODYL 5 MG ORAL TBEC,,16122,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
BISACODYL 5 MG ORAL TBEC,,16122,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
BISACODYL 5 MG ORAL TBEC,,16122,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
BISACODYL 5 MG ORAL TBEC,,16122,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
BISACODYL 5 MG ORAL TBEC,,16122,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
BISACODYL 5 MG ORAL TBEC,,16122,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BISACODYL 5 MG ORAL TBEC,,16122,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
BISACODYL 5 MG ORAL TBEC,,16122,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BISACODYL 5 MG ORAL TBEC,,16122,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
BISACODYL 5 MG ORAL TBEC,,16122,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BISACODYL 5 MG ORAL TBEC,,16122,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
BISACODYL 5 MG ORAL TBEC,,16122,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
BISACODYL 5 MG ORAL TBEC,,16122,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
BISACODYL 5 MG ORAL TBEC,,16122,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
BISACODYL 5 MG ORAL TBEC,,16122,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
BISACODYL 5 MG ORAL TBEC,,16122,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
PRAVASTATIN 20 MG ORAL TABLET,,16244,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
PRAVASTATIN 20 MG ORAL TABLET,,16244,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
PRAVASTATIN 20 MG ORAL TABLET,,16244,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
PRAVASTATIN 20 MG ORAL TABLET,,16244,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
PRAVASTATIN 20 MG ORAL TABLET,,16244,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
PRAVASTATIN 20 MG ORAL TABLET,,16244,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
PRAVASTATIN 20 MG ORAL TABLET,,16244,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
PRAVASTATIN 20 MG ORAL TABLET,,16244,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
PRAVASTATIN 20 MG ORAL TABLET,,16244,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
PRAVASTATIN 20 MG ORAL TABLET,,16244,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
PRAVASTATIN 20 MG ORAL TABLET,,16244,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
PRAVASTATIN 20 MG ORAL TABLET,,16244,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
PRAVASTATIN 20 MG ORAL TABLET,,16244,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
PRAVASTATIN 20 MG ORAL TABLET,,16244,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
PRAVASTATIN 20 MG ORAL TABLET,,16244,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
PRAVASTATIN 20 MG ORAL TABLET,,16244,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
PRAVASTATIN 20 MG ORAL TABLET,,16244,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
PRAVASTATIN 20 MG ORAL TABLET,,16244,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
PRAVASTATIN 20 MG ORAL TABLET,,16244,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PRAVASTATIN 20 MG ORAL TABLET,,16244,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
PRAVASTATIN 20 MG ORAL TABLET,,16244,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
PRAVASTATIN 20 MG ORAL TABLET,,16244,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
PRAVASTATIN 20 MG ORAL TABLET,,16244,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
PRAVASTATIN 20 MG ORAL TABLET,,16244,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
PRAVASTATIN 20 MG ORAL TABLET,,16244,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
PRAVASTATIN 20 MG ORAL TABLET,,16244,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
PRAVASTATIN 20 MG ORAL TABLET,,16244,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
PRAVASTATIN 20 MG ORAL TABLET,,16244,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
PRAVASTATIN 20 MG ORAL TABLET,,16244,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
PRAVASTATIN 20 MG ORAL TABLET,,16244,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
PRAVASTATIN 20 MG ORAL TABLET,,16244,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
PRAVASTATIN 20 MG ORAL TABLET,,16244,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
PRAVASTATIN 20 MG ORAL TABLET,,16244,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
PRAVASTATIN 20 MG ORAL TABLET,,16244,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
PRAVASTATIN 20 MG ORAL TABLET,,16244,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
PRAVASTATIN 20 MG ORAL TABLET,,16244,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
PRAVASTATIN 20 MG ORAL TABLET,,16244,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
PRAVASTATIN 20 MG ORAL TABLET,,16244,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PRAVASTATIN 20 MG ORAL TABLET,,16244,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
PRAVASTATIN 20 MG ORAL TABLET,,16244,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
PRAVASTATIN 20 MG ORAL TABLET,,16244,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
PRAVASTATIN 20 MG ORAL TABLET,,16244,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
PRAVASTATIN 20 MG ORAL TABLET,,16244,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
PRAVASTATIN 20 MG ORAL TABLET,,16244,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PRAVASTATIN 20 MG ORAL TABLET,,16244,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
PRAVASTATIN 20 MG ORAL TABLET,,16244,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PRAVASTATIN 20 MG ORAL TABLET,,16244,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PRAVASTATIN 20 MG ORAL TABLET,,16244,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PRAVASTATIN 20 MG ORAL TABLET,,16244,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PRAVASTATIN 20 MG ORAL TABLET,,16244,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
PRAVASTATIN 20 MG ORAL TABLET,,16244,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
PRAVASTATIN 20 MG ORAL TABLET,,16244,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
PRAVASTATIN 20 MG ORAL TABLET,,16244,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
PRAVASTATIN 20 MG ORAL TABLET,,16244,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Debridment Extensive Eczematous Or Infected Skin Up To 10% Of Body Surface,,11000,CPT,Facility,Both,,,,54,45.9,15.4764,54,Aetna,Commercial,49.68,92,,percent of total billed charges,,
Debridment Extensive Eczematous Or Infected Skin Up To 10% Of Body Surface,,11000,CPT,Facility,Outpatient,,,,54,45.9,15.4764,54,Aetna,Medicare Advantage,26.46,49,,percent of total billed charges,,
Debridment Extensive Eczematous Or Infected Skin Up To 10% Of Body Surface,,11000,CPT,Facility,Inpatient,,,,54,45.9,15.4764,54,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Debridment Extensive Eczematous Or Infected Skin Up To 10% Of Body Surface,,11000,CPT,Facility,Both,,,,54,45.9,15.4764,54,Aetna,PPO,50.22,93,,percent of total billed charges,,
Debridment Extensive Eczematous Or Infected Skin Up To 10% Of Body Surface,,11000,CPT,Facility,Both,,,,54,45.9,15.4764,54,America's PPO,America's PPO,51.8562,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Debridment Extensive Eczematous Or Infected Skin Up To 10% Of Body Surface,,11000,CPT,Facility,Both,,,,54,45.9,15.4764,54,BlueCross BlueShield Minnesota, Federal Employee Program,53.136,98.4,,percent of total billed charges,,
Debridment Extensive Eczematous Or Infected Skin Up To 10% Of Body Surface,,11000,CPT,Facility,Both,,,,54,45.9,15.4764,54,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,54,100,,percent of total billed charges,,
Debridment Extensive Eczematous Or Infected Skin Up To 10% Of Body Surface,,11000,CPT,Facility,Both,,,,54,45.9,15.4764,54,BlueCross BlueShield Minnesota,High Value Network Plan,48.6,90,,percent of total billed charges,,
Debridment Extensive Eczematous Or Infected Skin Up To 10% Of Body Surface,,11000,CPT,Facility,Outpatient,,,,54,45.9,15.4764,54,BlueCross BlueShield Minnesota,Medicare Advantage,26.46,49,,percent of total billed charges,,
Debridment Extensive Eczematous Or Infected Skin Up To 10% Of Body Surface,,11000,CPT,Facility,Inpatient,,,,54,45.9,15.4764,54,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Debridment Extensive Eczematous Or Infected Skin Up To 10% Of Body Surface,,11000,CPT,Facility,Both,,,,54,45.9,15.4764,54,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,47.8278,88.57,,percent of total billed charges,,
Debridment Extensive Eczematous Or Infected Skin Up To 10% Of Body Surface,,11000,CPT,Facility,Both,,,,54,45.9,15.4764,54,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,15.4764,28.66,,percent of total billed charges,,
Debridment Extensive Eczematous Or Infected Skin Up To 10% Of Body Surface,,11000,CPT,Facility,Outpatient,,,,54,45.9,15.4764,54,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),26.46,49,,percent of total billed charges,,
Debridment Extensive Eczematous Or Infected Skin Up To 10% Of Body Surface,,11000,CPT,Facility,Inpatient,,,,54,45.9,15.4764,54,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Debridment Extensive Eczematous Or Infected Skin Up To 10% Of Body Surface,,11000,CPT,Facility,Both,,,,54,45.9,15.4764,54,CorVel,Worker's Compensation,54,100,,percent of total billed charges,,
Debridment Extensive Eczematous Or Infected Skin Up To 10% Of Body Surface,,11000,CPT,Facility,Both,,,,54,45.9,15.4764,54,First Health Group Corporation,First Health Network,52.38,97,,percent of total billed charges,,
Debridment Extensive Eczematous Or Infected Skin Up To 10% Of Body Surface,,11000,CPT,Facility,Both,,,,54,45.9,15.4764,54,"Health Partners, Inc.",Commercial,51.084,94.6,,percent of total billed charges,,
Debridment Extensive Eczematous Or Infected Skin Up To 10% Of Body Surface,,11000,CPT,Facility,Outpatient,,,,54,45.9,15.4764,54,"Health Partners, Inc.",Medicare Advantage,26.46,49,,percent of total billed charges,,
Debridment Extensive Eczematous Or Infected Skin Up To 10% Of Body Surface,,11000,CPT,Facility,Inpatient,,,,54,45.9,15.4764,54,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Debridment Extensive Eczematous Or Infected Skin Up To 10% Of Body Surface,,11000,CPT,Facility,Both,,,,54,45.9,15.4764,54,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),32.4,60,,percent of total billed charges,,
Debridment Extensive Eczematous Or Infected Skin Up To 10% Of Body Surface,,11000,CPT,Facility,Both,,,,54,45.9,15.4764,54,"Health Partners, Inc.",State of Minnesota Advantage Program,44.01,81.5,,percent of total billed charges,,
Debridment Extensive Eczematous Or Infected Skin Up To 10% Of Body Surface,,11000,CPT,Facility,Both,,,,54,45.9,15.4764,54,"Health Partners, Inc.",State Public Programs,27,50,,percent of total billed charges,,
Debridment Extensive Eczematous Or Infected Skin Up To 10% Of Body Surface,,11000,CPT,Facility,Both,,,,54,45.9,15.4764,54,Humana Insurance Company,Commercial PPO,51.3,95,,percent of total billed charges,,
Debridment Extensive Eczematous Or Infected Skin Up To 10% Of Body Surface,,11000,CPT,Facility,Outpatient,,,,54,45.9,15.4764,54,Humana Insurance Company,Medicare PPO,26.46,49,,percent of total billed charges,,
Debridment Extensive Eczematous Or Infected Skin Up To 10% Of Body Surface,,11000,CPT,Facility,Inpatient,,,,54,45.9,15.4764,54,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Debridment Extensive Eczematous Or Infected Skin Up To 10% Of Body Surface,,11000,CPT,Facility,Both,,,,54,45.9,15.4764,54,Medica,Individual & Family,53.514,99.1,,percent of total billed charges,,
Debridment Extensive Eczematous Or Infected Skin Up To 10% Of Body Surface,,11000,CPT,Facility,Outpatient,,,,54,45.9,15.4764,54,Medica,Medica Advantage Solution,26.892,49.8,,percent of total billed charges,,
Debridment Extensive Eczematous Or Infected Skin Up To 10% Of Body Surface,,11000,CPT,Facility,Inpatient,,,,54,45.9,15.4764,54,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Debridment Extensive Eczematous Or Infected Skin Up To 10% Of Body Surface,,11000,CPT,Facility,Outpatient,,,,54,45.9,15.4764,54,Medica,Medical Assistance,24.084,44.6,,percent of total billed charges,,
Debridment Extensive Eczematous Or Infected Skin Up To 10% Of Body Surface,,11000,CPT,Facility,Inpatient,,,,54,45.9,15.4764,54,Medica,Medical Assistance,,,,,Included in per diem rate,
Debridment Extensive Eczematous Or Infected Skin Up To 10% Of Body Surface,,11000,CPT,Facility,Outpatient,,,,54,45.9,15.4764,54,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,26.892,49.8,,percent of total billed charges,,
Debridment Extensive Eczematous Or Infected Skin Up To 10% Of Body Surface,,11000,CPT,Facility,Inpatient,,,,54,45.9,15.4764,54,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Debridment Extensive Eczematous Or Infected Skin Up To 10% Of Body Surface,,11000,CPT,Facility,Both,,,,54,45.9,15.4764,54,"Multiplan, Inc.","Multiplan, Inc.",50.76,94,,percent of total billed charges,,
Debridment Extensive Eczematous Or Infected Skin Up To 10% Of Body Surface,,11000,CPT,Facility,Outpatient,,,,54,45.9,15.4764,54,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,48.654,90.1,,percent of total billed charges,,
Debridment Extensive Eczematous Or Infected Skin Up To 10% Of Body Surface,,11000,CPT,Facility,Inpatient,,,,54,45.9,15.4764,54,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Debridment Extensive Eczematous Or Infected Skin Up To 10% Of Body Surface,,11000,CPT,Facility,Both,,,,54,45.9,15.4764,54,"Preferred One Administrative Services, INC.",PPO,53.244,98.6,,percent of total billed charges,,
Debridment Extensive Eczematous Or Infected Skin Up To 10% Of Body Surface,,11000,CPT,Facility,Outpatient,,,,54,45.9,15.4764,54,PrimeWest Health,Minnesota Senior Health Options (MSHO),27.783,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Debridment Extensive Eczematous Or Infected Skin Up To 10% Of Body Surface,,11000,CPT,Facility,Inpatient,,,,54,45.9,15.4764,54,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Debridment Extensive Eczematous Or Infected Skin Up To 10% Of Body Surface,,11000,CPT,Facility,Outpatient,,,,54,45.9,15.4764,54,PrimeWest Health,MinnesotaCare,27.7344,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Debridment Extensive Eczematous Or Infected Skin Up To 10% Of Body Surface,,11000,CPT,Facility,Inpatient,,,,54,45.9,15.4764,54,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Debridment Extensive Eczematous Or Infected Skin Up To 10% Of Body Surface,,11000,CPT,Facility,Both,,,,54,45.9,15.4764,54,Sanford Health Plan,Sanford Health Plan,49.68,92,,percent of total billed charges,,
Debridment Extensive Eczematous Or Infected Skin Up To 10% Of Body Surface,,11000,CPT,Facility,Outpatient,,,,54,45.9,15.4764,54,"UCare Health, Inc.",Individual & Family Plan,30.429,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Debridment Extensive Eczematous Or Infected Skin Up To 10% Of Body Surface,,11000,CPT,Facility,Inpatient,,,,54,45.9,15.4764,54,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Debridment Extensive Eczematous Or Infected Skin Up To 10% Of Body Surface,,11000,CPT,Facility,Outpatient,,,,54,45.9,15.4764,54,"UCare Health, Inc.",Medical Assistance,27.2538,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Debridment Extensive Eczematous Or Infected Skin Up To 10% Of Body Surface,,11000,CPT,Facility,Inpatient,,,,54,45.9,15.4764,54,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Debridment Extensive Eczematous Or Infected Skin Up To 10% Of Body Surface,,11000,CPT,Facility,Outpatient,,,,54,45.9,15.4764,54,"UCare Health, Inc.",Medicare Advantage,27.2538,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Debridment Extensive Eczematous Or Infected Skin Up To 10% Of Body Surface,,11000,CPT,Facility,Inpatient,,,,54,45.9,15.4764,54,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Debridment Extensive Eczematous Or Infected Skin Up To 10% Of Body Surface,,11000,CPT,Facility,Outpatient,,,,54,45.9,15.4764,54,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),27.2538,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Debridment Extensive Eczematous Or Infected Skin Up To 10% Of Body Surface,,11000,CPT,Facility,Inpatient,,,,54,45.9,15.4764,54,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Debridment Extensive Eczematous Or Infected Skin Up To 10% Of Body Surface,,11000,CPT,Facility,Both,,,,54,45.9,15.4764,54,UnitedHealthcare,Individual & Family,50.76,94,,percent of total billed charges,,
Debridment Extensive Eczematous Or Infected Skin Up To 10% Of Body Surface,,11000,CPT,Facility,Outpatient,,,,54,45.9,15.4764,54,UnitedHealthcare,Medicare Advantage,26.46,49,,percent of total billed charges,,
Debridment Extensive Eczematous Or Infected Skin Up To 10% Of Body Surface,,11000,CPT,Facility,Inpatient,,,,54,45.9,15.4764,54,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Debridment Extensive Eczematous Or Infected Skin Up To 10% Of Body Surface,,11000,CPT,Facility,Outpatient,,,,54,45.9,15.4764,54,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,25.92,48,,percent of total billed charges,,100% of DHS outpatient percentage
Debridment Extensive Eczematous Or Infected Skin Up To 10% Of Body Surface,,11000,CPT,Facility,Inpatient,,,,54,45.9,15.4764,54,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Debridement Extensive Eczematous Or Infected Skin; Each Addt 10% Of Body,,11001,CPT,Facility,Both,,,,33,28.05,9.4578,33,Aetna,Commercial,30.36,92,,percent of total billed charges,,
Debridement Extensive Eczematous Or Infected Skin; Each Addt 10% Of Body,,11001,CPT,Facility,Outpatient,,,,33,28.05,9.4578,33,Aetna,Medicare Advantage,16.17,49,,percent of total billed charges,,
Debridement Extensive Eczematous Or Infected Skin; Each Addt 10% Of Body,,11001,CPT,Facility,Inpatient,,,,33,28.05,9.4578,33,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Debridement Extensive Eczematous Or Infected Skin; Each Addt 10% Of Body,,11001,CPT,Facility,Both,,,,33,28.05,9.4578,33,Aetna,PPO,30.69,93,,percent of total billed charges,,
Debridement Extensive Eczematous Or Infected Skin; Each Addt 10% Of Body,,11001,CPT,Facility,Both,,,,33,28.05,9.4578,33,America's PPO,America's PPO,31.6899,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Debridement Extensive Eczematous Or Infected Skin; Each Addt 10% Of Body,,11001,CPT,Facility,Both,,,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota, Federal Employee Program,32.472,98.4,,percent of total billed charges,,
Debridement Extensive Eczematous Or Infected Skin; Each Addt 10% Of Body,,11001,CPT,Facility,Both,,,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,33,100,,percent of total billed charges,,
Debridement Extensive Eczematous Or Infected Skin; Each Addt 10% Of Body,,11001,CPT,Facility,Both,,,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota,High Value Network Plan,29.7,90,,percent of total billed charges,,
Debridement Extensive Eczematous Or Infected Skin; Each Addt 10% Of Body,,11001,CPT,Facility,Outpatient,,,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota,Medicare Advantage,16.17,49,,percent of total billed charges,,
Debridement Extensive Eczematous Or Infected Skin; Each Addt 10% Of Body,,11001,CPT,Facility,Inpatient,,,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Debridement Extensive Eczematous Or Infected Skin; Each Addt 10% Of Body,,11001,CPT,Facility,Both,,,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,29.2281,88.57,,percent of total billed charges,,
Debridement Extensive Eczematous Or Infected Skin; Each Addt 10% Of Body,,11001,CPT,Facility,Both,,,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,9.4578,28.66,,percent of total billed charges,,
Debridement Extensive Eczematous Or Infected Skin; Each Addt 10% Of Body,,11001,CPT,Facility,Outpatient,,,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),16.17,49,,percent of total billed charges,,
Debridement Extensive Eczematous Or Infected Skin; Each Addt 10% Of Body,,11001,CPT,Facility,Inpatient,,,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Debridement Extensive Eczematous Or Infected Skin; Each Addt 10% Of Body,,11001,CPT,Facility,Both,,,,33,28.05,9.4578,33,CorVel,Worker's Compensation,33,100,,percent of total billed charges,,
Debridement Extensive Eczematous Or Infected Skin; Each Addt 10% Of Body,,11001,CPT,Facility,Both,,,,33,28.05,9.4578,33,First Health Group Corporation,First Health Network,32.01,97,,percent of total billed charges,,
Debridement Extensive Eczematous Or Infected Skin; Each Addt 10% Of Body,,11001,CPT,Facility,Both,,,,33,28.05,9.4578,33,"Health Partners, Inc.",Commercial,31.218,94.6,,percent of total billed charges,,
Debridement Extensive Eczematous Or Infected Skin; Each Addt 10% Of Body,,11001,CPT,Facility,Outpatient,,,,33,28.05,9.4578,33,"Health Partners, Inc.",Medicare Advantage,16.17,49,,percent of total billed charges,,
Debridement Extensive Eczematous Or Infected Skin; Each Addt 10% Of Body,,11001,CPT,Facility,Inpatient,,,,33,28.05,9.4578,33,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Debridement Extensive Eczematous Or Infected Skin; Each Addt 10% Of Body,,11001,CPT,Facility,Both,,,,33,28.05,9.4578,33,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),19.8,60,,percent of total billed charges,,
Debridement Extensive Eczematous Or Infected Skin; Each Addt 10% Of Body,,11001,CPT,Facility,Both,,,,33,28.05,9.4578,33,"Health Partners, Inc.",State of Minnesota Advantage Program,26.895,81.5,,percent of total billed charges,,
Debridement Extensive Eczematous Or Infected Skin; Each Addt 10% Of Body,,11001,CPT,Facility,Both,,,,33,28.05,9.4578,33,"Health Partners, Inc.",State Public Programs,16.5,50,,percent of total billed charges,,
Debridement Extensive Eczematous Or Infected Skin; Each Addt 10% Of Body,,11001,CPT,Facility,Both,,,,33,28.05,9.4578,33,Humana Insurance Company,Commercial PPO,31.35,95,,percent of total billed charges,,
Debridement Extensive Eczematous Or Infected Skin; Each Addt 10% Of Body,,11001,CPT,Facility,Outpatient,,,,33,28.05,9.4578,33,Humana Insurance Company,Medicare PPO,16.17,49,,percent of total billed charges,,
Debridement Extensive Eczematous Or Infected Skin; Each Addt 10% Of Body,,11001,CPT,Facility,Inpatient,,,,33,28.05,9.4578,33,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Debridement Extensive Eczematous Or Infected Skin; Each Addt 10% Of Body,,11001,CPT,Facility,Both,,,,33,28.05,9.4578,33,Medica,Individual & Family,32.703,99.1,,percent of total billed charges,,
Debridement Extensive Eczematous Or Infected Skin; Each Addt 10% Of Body,,11001,CPT,Facility,Outpatient,,,,33,28.05,9.4578,33,Medica,Medica Advantage Solution,16.434,49.8,,percent of total billed charges,,
Debridement Extensive Eczematous Or Infected Skin; Each Addt 10% Of Body,,11001,CPT,Facility,Inpatient,,,,33,28.05,9.4578,33,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Debridement Extensive Eczematous Or Infected Skin; Each Addt 10% Of Body,,11001,CPT,Facility,Outpatient,,,,33,28.05,9.4578,33,Medica,Medical Assistance,14.718,44.6,,percent of total billed charges,,
Debridement Extensive Eczematous Or Infected Skin; Each Addt 10% Of Body,,11001,CPT,Facility,Inpatient,,,,33,28.05,9.4578,33,Medica,Medical Assistance,,,,,Included in per diem rate,
Debridement Extensive Eczematous Or Infected Skin; Each Addt 10% Of Body,,11001,CPT,Facility,Outpatient,,,,33,28.05,9.4578,33,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,16.434,49.8,,percent of total billed charges,,
Debridement Extensive Eczematous Or Infected Skin; Each Addt 10% Of Body,,11001,CPT,Facility,Inpatient,,,,33,28.05,9.4578,33,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Debridement Extensive Eczematous Or Infected Skin; Each Addt 10% Of Body,,11001,CPT,Facility,Both,,,,33,28.05,9.4578,33,"Multiplan, Inc.","Multiplan, Inc.",31.02,94,,percent of total billed charges,,
Debridement Extensive Eczematous Or Infected Skin; Each Addt 10% Of Body,,11001,CPT,Facility,Outpatient,,,,33,28.05,9.4578,33,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,29.733,90.1,,percent of total billed charges,,
Debridement Extensive Eczematous Or Infected Skin; Each Addt 10% Of Body,,11001,CPT,Facility,Inpatient,,,,33,28.05,9.4578,33,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Debridement Extensive Eczematous Or Infected Skin; Each Addt 10% Of Body,,11001,CPT,Facility,Both,,,,33,28.05,9.4578,33,"Preferred One Administrative Services, INC.",PPO,32.538,98.6,,percent of total billed charges,,
Debridement Extensive Eczematous Or Infected Skin; Each Addt 10% Of Body,,11001,CPT,Facility,Outpatient,,,,33,28.05,9.4578,33,PrimeWest Health,Minnesota Senior Health Options (MSHO),16.9785,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Debridement Extensive Eczematous Or Infected Skin; Each Addt 10% Of Body,,11001,CPT,Facility,Inpatient,,,,33,28.05,9.4578,33,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Debridement Extensive Eczematous Or Infected Skin; Each Addt 10% Of Body,,11001,CPT,Facility,Outpatient,,,,33,28.05,9.4578,33,PrimeWest Health,MinnesotaCare,16.9488,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Debridement Extensive Eczematous Or Infected Skin; Each Addt 10% Of Body,,11001,CPT,Facility,Inpatient,,,,33,28.05,9.4578,33,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Debridement Extensive Eczematous Or Infected Skin; Each Addt 10% Of Body,,11001,CPT,Facility,Both,,,,33,28.05,9.4578,33,Sanford Health Plan,Sanford Health Plan,30.36,92,,percent of total billed charges,,
Debridement Extensive Eczematous Or Infected Skin; Each Addt 10% Of Body,,11001,CPT,Facility,Outpatient,,,,33,28.05,9.4578,33,"UCare Health, Inc.",Individual & Family Plan,18.5955,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Debridement Extensive Eczematous Or Infected Skin; Each Addt 10% Of Body,,11001,CPT,Facility,Inpatient,,,,33,28.05,9.4578,33,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Debridement Extensive Eczematous Or Infected Skin; Each Addt 10% Of Body,,11001,CPT,Facility,Outpatient,,,,33,28.05,9.4578,33,"UCare Health, Inc.",Medical Assistance,16.6551,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Debridement Extensive Eczematous Or Infected Skin; Each Addt 10% Of Body,,11001,CPT,Facility,Inpatient,,,,33,28.05,9.4578,33,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Debridement Extensive Eczematous Or Infected Skin; Each Addt 10% Of Body,,11001,CPT,Facility,Outpatient,,,,33,28.05,9.4578,33,"UCare Health, Inc.",Medicare Advantage,16.6551,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Debridement Extensive Eczematous Or Infected Skin; Each Addt 10% Of Body,,11001,CPT,Facility,Inpatient,,,,33,28.05,9.4578,33,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Debridement Extensive Eczematous Or Infected Skin; Each Addt 10% Of Body,,11001,CPT,Facility,Outpatient,,,,33,28.05,9.4578,33,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),16.6551,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Debridement Extensive Eczematous Or Infected Skin; Each Addt 10% Of Body,,11001,CPT,Facility,Inpatient,,,,33,28.05,9.4578,33,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Debridement Extensive Eczematous Or Infected Skin; Each Addt 10% Of Body,,11001,CPT,Facility,Both,,,,33,28.05,9.4578,33,UnitedHealthcare,Individual & Family,31.02,94,,percent of total billed charges,,
Debridement Extensive Eczematous Or Infected Skin; Each Addt 10% Of Body,,11001,CPT,Facility,Outpatient,,,,33,28.05,9.4578,33,UnitedHealthcare,Medicare Advantage,16.17,49,,percent of total billed charges,,
Debridement Extensive Eczematous Or Infected Skin; Each Addt 10% Of Body,,11001,CPT,Facility,Inpatient,,,,33,28.05,9.4578,33,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Debridement Extensive Eczematous Or Infected Skin; Each Addt 10% Of Body,,11001,CPT,Facility,Outpatient,,,,33,28.05,9.4578,33,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,15.84,48,,percent of total billed charges,,100% of DHS outpatient percentage
Debridement Extensive Eczematous Or Infected Skin; Each Addt 10% Of Body,,11001,CPT,Facility,Inpatient,,,,33,28.05,9.4578,33,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Debride Skin, Subq Tiss, Musc/Fascia Necrotizing Sf Tiss Infect; Abdo Wall, W/Wo Fasc Clos (Pro Cah)",,11005,CPT,Professional,Both,,,,4780,4063,452.88,4780,Aetna,Commercial,4063,85,,percent of total billed charges,,
"Debride Skin, Subq Tiss, Musc/Fascia Necrotizing Sf Tiss Infect; Abdo Wall, W/Wo Fasc Clos (Pro Cah)",,11005,CPT,Professional,Both,,,,4780,4063,452.88,4780,Aetna,Medicare Advantage,726.01,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Debride Skin, Subq Tiss, Musc/Fascia Necrotizing Sf Tiss Infect; Abdo Wall, W/Wo Fasc Clos (Pro Cah)",,11005,CPT,Professional,Both,,,,4780,4063,452.88,4780,Aetna,PPO,4445.4,93,,percent of total billed charges,,
"Debride Skin, Subq Tiss, Musc/Fascia Necrotizing Sf Tiss Infect; Abdo Wall, W/Wo Fasc Clos (Pro Cah)",,11005,CPT,Professional,Both,,,,4780,4063,452.88,4780,America's PPO,America's PPO,4084.032,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Debride Skin, Subq Tiss, Musc/Fascia Necrotizing Sf Tiss Infect; Abdo Wall, W/Wo Fasc Clos (Pro Cah)",,11005,CPT,Professional,Both,,,,4780,4063,452.88,4780,BlueCross BlueShield Minnesota, Federal Employee Program,1576.89,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Debride Skin, Subq Tiss, Musc/Fascia Necrotizing Sf Tiss Infect; Abdo Wall, W/Wo Fasc Clos (Pro Cah)",,11005,CPT,Professional,Both,,,,4780,4063,452.88,4780,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1602.12024,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Debride Skin, Subq Tiss, Musc/Fascia Necrotizing Sf Tiss Infect; Abdo Wall, W/Wo Fasc Clos (Pro Cah)",,11005,CPT,Professional,Both,,,,4780,4063,452.88,4780,BlueCross BlueShield Minnesota,High Value Network Plan,1602.12024,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Debride Skin, Subq Tiss, Musc/Fascia Necrotizing Sf Tiss Infect; Abdo Wall, W/Wo Fasc Clos (Pro Cah)",,11005,CPT,Professional,Both,,,,4780,4063,452.88,4780,BlueCross BlueShield Minnesota,Medicare Advantage,809.048,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Debride Skin, Subq Tiss, Musc/Fascia Necrotizing Sf Tiss Infect; Abdo Wall, W/Wo Fasc Clos (Pro Cah)",,11005,CPT,Professional,Both,,,,4780,4063,452.88,4780,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1602.12024,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Debride Skin, Subq Tiss, Musc/Fascia Necrotizing Sf Tiss Infect; Abdo Wall, W/Wo Fasc Clos (Pro Cah)",,11005,CPT,Professional,Both,,,,4780,4063,452.88,4780,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,522.87424,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Debride Skin, Subq Tiss, Musc/Fascia Necrotizing Sf Tiss Infect; Abdo Wall, W/Wo Fasc Clos (Pro Cah)",,11005,CPT,Professional,Both,,,,4780,4063,452.88,4780,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),809.048,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Debride Skin, Subq Tiss, Musc/Fascia Necrotizing Sf Tiss Infect; Abdo Wall, W/Wo Fasc Clos (Pro Cah)",,11005,CPT,Professional,Both,,,,4780,4063,452.88,4780,CorVel,Worker's Compensation,1400.850501,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Debride Skin, Subq Tiss, Musc/Fascia Necrotizing Sf Tiss Infect; Abdo Wall, W/Wo Fasc Clos (Pro Cah)",,11005,CPT,Professional,Both,,,,4780,4063,452.88,4780,First Health Group Corporation,First Health Network,4636.6,97,,percent of total billed charges,,
"Debride Skin, Subq Tiss, Musc/Fascia Necrotizing Sf Tiss Infect; Abdo Wall, W/Wo Fasc Clos (Pro Cah)",,11005,CPT,Professional,Both,,,,4780,4063,452.88,4780,"Health Partners, Inc.",Commercial,1513.44,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Debride Skin, Subq Tiss, Musc/Fascia Necrotizing Sf Tiss Infect; Abdo Wall, W/Wo Fasc Clos (Pro Cah)",,11005,CPT,Professional,Both,,,,4780,4063,452.88,4780,"Health Partners, Inc.",Medicare Advantage,809.048,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Debride Skin, Subq Tiss, Musc/Fascia Necrotizing Sf Tiss Infect; Abdo Wall, W/Wo Fasc Clos (Pro Cah)",,11005,CPT,Professional,Both,,,,4780,4063,452.88,4780,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),703.5,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Debride Skin, Subq Tiss, Musc/Fascia Necrotizing Sf Tiss Infect; Abdo Wall, W/Wo Fasc Clos (Pro Cah)",,11005,CPT,Professional,Both,,,,4780,4063,452.88,4780,"Health Partners, Inc.",State of Minnesota Advantage Program,1303.82856,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Debride Skin, Subq Tiss, Musc/Fascia Necrotizing Sf Tiss Infect; Abdo Wall, W/Wo Fasc Clos (Pro Cah)",,11005,CPT,Professional,Both,,,,4780,4063,452.88,4780,"Health Partners, Inc.",State Public Programs,452.88,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Debride Skin, Subq Tiss, Musc/Fascia Necrotizing Sf Tiss Infect; Abdo Wall, W/Wo Fasc Clos (Pro Cah)",,11005,CPT,Professional,Both,,,,4780,4063,452.88,4780,Humana Insurance Company,Commercial PPO,703.52,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Debride Skin, Subq Tiss, Musc/Fascia Necrotizing Sf Tiss Infect; Abdo Wall, W/Wo Fasc Clos (Pro Cah)",,11005,CPT,Professional,Both,,,,4780,4063,452.88,4780,Humana Insurance Company,Medicare PPO,4780,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Debride Skin, Subq Tiss, Musc/Fascia Necrotizing Sf Tiss Infect; Abdo Wall, W/Wo Fasc Clos (Pro Cah)",,11005,CPT,Professional,Both,,,,4780,4063,452.88,4780,Medica,Individual & Family,4053.44,84.8,,percent of total billed charges,,
"Debride Skin, Subq Tiss, Musc/Fascia Necrotizing Sf Tiss Infect; Abdo Wall, W/Wo Fasc Clos (Pro Cah)",,11005,CPT,Professional,Both,,,,4780,4063,452.88,4780,Medica,Medica Advantage Solution,2380.44,49.8,,percent of total billed charges,,
"Debride Skin, Subq Tiss, Musc/Fascia Necrotizing Sf Tiss Infect; Abdo Wall, W/Wo Fasc Clos (Pro Cah)",,11005,CPT,Professional,Both,,,,4780,4063,452.88,4780,Medica,Medical Assistance,522.87,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Debride Skin, Subq Tiss, Musc/Fascia Necrotizing Sf Tiss Infect; Abdo Wall, W/Wo Fasc Clos (Pro Cah)",,11005,CPT,Professional,Both,,,,4780,4063,452.88,4780,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,703.52,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Debride Skin, Subq Tiss, Musc/Fascia Necrotizing Sf Tiss Infect; Abdo Wall, W/Wo Fasc Clos (Pro Cah)",,11005,CPT,Professional,Both,,,,4780,4063,452.88,4780,"Multiplan, Inc.","Multiplan, Inc.",4493.2,94,,percent of total billed charges,,
"Debride Skin, Subq Tiss, Musc/Fascia Necrotizing Sf Tiss Infect; Abdo Wall, W/Wo Fasc Clos (Pro Cah)",,11005,CPT,Professional,Both,,,,4780,4063,452.88,4780,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4306.78,90.1,,percent of total billed charges,,
"Debride Skin, Subq Tiss, Musc/Fascia Necrotizing Sf Tiss Infect; Abdo Wall, W/Wo Fasc Clos (Pro Cah)",,11005,CPT,Professional,Both,,,,4780,4063,452.88,4780,"Preferred One Administrative Services, INC.",PPO,4713.08,98.6,,percent of total billed charges,,
"Debride Skin, Subq Tiss, Musc/Fascia Necrotizing Sf Tiss Infect; Abdo Wall, W/Wo Fasc Clos (Pro Cah)",,11005,CPT,Professional,Both,,,,4780,4063,452.88,4780,PrimeWest Health,Minnesota Senior Health Options (MSHO),809.048,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Debride Skin, Subq Tiss, Musc/Fascia Necrotizing Sf Tiss Infect; Abdo Wall, W/Wo Fasc Clos (Pro Cah)",,11005,CPT,Professional,Both,,,,4780,4063,452.88,4780,PrimeWest Health,MinnesotaCare,559.4754368,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Debride Skin, Subq Tiss, Musc/Fascia Necrotizing Sf Tiss Infect; Abdo Wall, W/Wo Fasc Clos (Pro Cah)",,11005,CPT,Professional,Both,,,,4780,4063,452.88,4780,Sanford Health Plan,Sanford Health Plan,4206.4,88,,percent of total billed charges,,
"Debride Skin, Subq Tiss, Musc/Fascia Necrotizing Sf Tiss Infect; Abdo Wall, W/Wo Fasc Clos (Pro Cah)",,11005,CPT,Professional,Both,,,,4780,4063,452.88,4780,"UCare Health, Inc.",Individual & Family Plan,1143.642112,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Debride Skin, Subq Tiss, Musc/Fascia Necrotizing Sf Tiss Infect; Abdo Wall, W/Wo Fasc Clos (Pro Cah)",,11005,CPT,Professional,Both,,,,4780,4063,452.88,4780,"UCare Health, Inc.",Medical Assistance,575.161664,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Debride Skin, Subq Tiss, Musc/Fascia Necrotizing Sf Tiss Infect; Abdo Wall, W/Wo Fasc Clos (Pro Cah)",,11005,CPT,Professional,Both,,,,4780,4063,452.88,4780,"UCare Health, Inc.",Medicare Advantage,809.048,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Debride Skin, Subq Tiss, Musc/Fascia Necrotizing Sf Tiss Infect; Abdo Wall, W/Wo Fasc Clos (Pro Cah)",,11005,CPT,Professional,Both,,,,4780,4063,452.88,4780,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),647.2384,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Debride Skin, Subq Tiss, Musc/Fascia Necrotizing Sf Tiss Infect; Abdo Wall, W/Wo Fasc Clos (Pro Cah)",,11005,CPT,Professional,Both,,,,4780,4063,452.88,4780,UnitedHealthcare,Individual & Family,4780,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Debride Skin, Subq Tiss, Musc/Fascia Necrotizing Sf Tiss Infect; Abdo Wall, W/Wo Fasc Clos (Pro Cah)",,11005,CPT,Professional,Both,,,,4780,4063,452.88,4780,UnitedHealthcare,Medicare Advantage,809.048,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Debride Skin, Subq Tiss, Musc/Fascia Necrotizing Sf Tiss Infect; Abdo Wall, W/Wo Fasc Clos (Pro Cah)",,11005,CPT,Professional,Both,,,,4780,4063,452.88,4780,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,522.87424,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Debridment Of Skin, Subq Tissue, Muscle And Fascia Soft Tissue Infection; Abdominal Wall (Pbb)",,11005,CPT,Facility,Outpatient,,,,2380,2023,682.108,2380,Aetna,Commercial,2189.6,92,,percent of total billed charges,,
"Debridment Of Skin, Subq Tissue, Muscle And Fascia Soft Tissue Infection; Abdominal Wall (Pbb)",,11005,CPT,Professional,Outpatient,,,,2400,2040,452.88,2400,Aetna,Commercial,2040,85,,percent of total billed charges,,
"Debridment Of Skin, Subq Tissue, Muscle And Fascia Soft Tissue Infection; Abdominal Wall (Pbb)",,11005,CPT,Facility,Outpatient,,,,2380,2023,682.108,2380,Aetna,Medicare Advantage,1166.2,49,,percent of total billed charges,,
"Debridment Of Skin, Subq Tissue, Muscle And Fascia Soft Tissue Infection; Abdominal Wall (Pbb)",,11005,CPT,Professional,Outpatient,,,,2400,2040,452.88,2400,Aetna,Medicare Advantage,726.01,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Debridment Of Skin, Subq Tissue, Muscle And Fascia Soft Tissue Infection; Abdominal Wall (Pbb)",,11005,CPT,Facility,Outpatient,,,,2380,2023,682.108,2380,Aetna,PPO,2213.4,93,,percent of total billed charges,,
"Debridment Of Skin, Subq Tissue, Muscle And Fascia Soft Tissue Infection; Abdominal Wall (Pbb)",,11005,CPT,Professional,Outpatient,,,,2400,2040,452.88,2400,Aetna,PPO,2232,93,,percent of total billed charges,,
"Debridment Of Skin, Subq Tissue, Muscle And Fascia Soft Tissue Infection; Abdominal Wall (Pbb)",,11005,CPT,Facility,Outpatient,,,,2380,2023,682.108,2380,America's PPO,America's PPO,2285.514,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Debridment Of Skin, Subq Tissue, Muscle And Fascia Soft Tissue Infection; Abdominal Wall (Pbb)",,11005,CPT,Professional,Outpatient,,,,2400,2040,452.88,2400,America's PPO,America's PPO,2050.56,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Debridment Of Skin, Subq Tissue, Muscle And Fascia Soft Tissue Infection; Abdominal Wall (Pbb)",,11005,CPT,Facility,Outpatient,,,,2380,2023,682.108,2380,BlueCross BlueShield Minnesota, Federal Employee Program,2341.92,98.4,,percent of total billed charges,,
"Debridment Of Skin, Subq Tissue, Muscle And Fascia Soft Tissue Infection; Abdominal Wall (Pbb)",,11005,CPT,Professional,Outpatient,,,,2400,2040,452.88,2400,BlueCross BlueShield Minnesota, Federal Employee Program,1576.89,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Debridment Of Skin, Subq Tissue, Muscle And Fascia Soft Tissue Infection; Abdominal Wall (Pbb)",,11005,CPT,Facility,Outpatient,,,,2380,2023,682.108,2380,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,2380,100,,percent of total billed charges,,
"Debridment Of Skin, Subq Tissue, Muscle And Fascia Soft Tissue Infection; Abdominal Wall (Pbb)",,11005,CPT,Professional,Outpatient,,,,2400,2040,452.88,2400,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1602.12024,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Debridment Of Skin, Subq Tissue, Muscle And Fascia Soft Tissue Infection; Abdominal Wall (Pbb)",,11005,CPT,Facility,Outpatient,,,,2380,2023,682.108,2380,BlueCross BlueShield Minnesota,High Value Network Plan,2142,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
"Debridment Of Skin, Subq Tissue, Muscle And Fascia Soft Tissue Infection; Abdominal Wall (Pbb)",,11005,CPT,Professional,Outpatient,,,,2400,2040,452.88,2400,BlueCross BlueShield Minnesota,High Value Network Plan,1602.12024,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Debridment Of Skin, Subq Tissue, Muscle And Fascia Soft Tissue Infection; Abdominal Wall (Pbb)",,11005,CPT,Facility,Outpatient,,,,2380,2023,682.108,2380,BlueCross BlueShield Minnesota,Medicare Advantage,1166.2,49,,percent of total billed charges,,
"Debridment Of Skin, Subq Tissue, Muscle And Fascia Soft Tissue Infection; Abdominal Wall (Pbb)",,11005,CPT,Professional,Outpatient,,,,2400,2040,452.88,2400,BlueCross BlueShield Minnesota,Medicare Advantage,809.048,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Debridment Of Skin, Subq Tissue, Muscle And Fascia Soft Tissue Infection; Abdominal Wall (Pbb)",,11005,CPT,Professional,Outpatient,,,,2400,2040,452.88,2400,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1602.12024,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Debridment Of Skin, Subq Tissue, Muscle And Fascia Soft Tissue Infection; Abdominal Wall (Pbb)",,11005,CPT,Facility,Outpatient,,,,2380,2023,682.108,2380,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,682.108,28.66,,percent of total billed charges,,
"Debridment Of Skin, Subq Tissue, Muscle And Fascia Soft Tissue Infection; Abdominal Wall (Pbb)",,11005,CPT,Professional,Outpatient,,,,2400,2040,452.88,2400,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,522.87424,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Debridment Of Skin, Subq Tissue, Muscle And Fascia Soft Tissue Infection; Abdominal Wall (Pbb)",,11005,CPT,Facility,Outpatient,,,,2380,2023,682.108,2380,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1166.2,49,,percent of total billed charges,,
"Debridment Of Skin, Subq Tissue, Muscle And Fascia Soft Tissue Infection; Abdominal Wall (Pbb)",,11005,CPT,Professional,Outpatient,,,,2400,2040,452.88,2400,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),809.048,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Debridment Of Skin, Subq Tissue, Muscle And Fascia Soft Tissue Infection; Abdominal Wall (Pbb)",,11005,CPT,Facility,Outpatient,,,,2380,2023,682.108,2380,CorVel,Worker's Compensation,2380,100,,percent of total billed charges,,
"Debridment Of Skin, Subq Tissue, Muscle And Fascia Soft Tissue Infection; Abdominal Wall (Pbb)",,11005,CPT,Professional,Outpatient,,,,2400,2040,452.88,2400,CorVel,Worker's Compensation,1400.850501,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Debridment Of Skin, Subq Tissue, Muscle And Fascia Soft Tissue Infection; Abdominal Wall (Pbb)",,11005,CPT,Facility,Outpatient,,,,2380,2023,682.108,2380,First Health Group Corporation,First Health Network,2308.6,97,,percent of total billed charges,,
"Debridment Of Skin, Subq Tissue, Muscle And Fascia Soft Tissue Infection; Abdominal Wall (Pbb)",,11005,CPT,Professional,Outpatient,,,,2400,2040,452.88,2400,First Health Group Corporation,First Health Network,2328,97,,percent of total billed charges,,
"Debridment Of Skin, Subq Tissue, Muscle And Fascia Soft Tissue Infection; Abdominal Wall (Pbb)",,11005,CPT,Facility,Outpatient,,,,2380,2023,682.108,2380,"Health Partners, Inc.",Commercial,2251.48,94.6,,percent of total billed charges,,
"Debridment Of Skin, Subq Tissue, Muscle And Fascia Soft Tissue Infection; Abdominal Wall (Pbb)",,11005,CPT,Professional,Outpatient,,,,2400,2040,452.88,2400,"Health Partners, Inc.",Commercial,1513.44,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Debridment Of Skin, Subq Tissue, Muscle And Fascia Soft Tissue Infection; Abdominal Wall (Pbb)",,11005,CPT,Facility,Outpatient,,,,2380,2023,682.108,2380,"Health Partners, Inc.",Medicare Advantage,1166.2,49,,percent of total billed charges,,
"Debridment Of Skin, Subq Tissue, Muscle And Fascia Soft Tissue Infection; Abdominal Wall (Pbb)",,11005,CPT,Professional,Outpatient,,,,2400,2040,452.88,2400,"Health Partners, Inc.",Medicare Advantage,809.048,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Debridment Of Skin, Subq Tissue, Muscle And Fascia Soft Tissue Infection; Abdominal Wall (Pbb)",,11005,CPT,Facility,Outpatient,,,,2380,2023,682.108,2380,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1428,60,,percent of total billed charges,,
"Debridment Of Skin, Subq Tissue, Muscle And Fascia Soft Tissue Infection; Abdominal Wall (Pbb)",,11005,CPT,Professional,Outpatient,,,,2400,2040,452.88,2400,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),703.5,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Debridment Of Skin, Subq Tissue, Muscle And Fascia Soft Tissue Infection; Abdominal Wall (Pbb)",,11005,CPT,Facility,Outpatient,,,,2380,2023,682.108,2380,"Health Partners, Inc.",State of Minnesota Advantage Program,1939.7,81.5,,percent of total billed charges,,
"Debridment Of Skin, Subq Tissue, Muscle And Fascia Soft Tissue Infection; Abdominal Wall (Pbb)",,11005,CPT,Professional,Outpatient,,,,2400,2040,452.88,2400,"Health Partners, Inc.",State of Minnesota Advantage Program,1303.82856,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Debridment Of Skin, Subq Tissue, Muscle And Fascia Soft Tissue Infection; Abdominal Wall (Pbb)",,11005,CPT,Facility,Outpatient,,,,2380,2023,682.108,2380,"Health Partners, Inc.",State Public Programs,1190,50,,percent of total billed charges,,
"Debridment Of Skin, Subq Tissue, Muscle And Fascia Soft Tissue Infection; Abdominal Wall (Pbb)",,11005,CPT,Professional,Outpatient,,,,2400,2040,452.88,2400,"Health Partners, Inc.",State Public Programs,452.88,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Debridment Of Skin, Subq Tissue, Muscle And Fascia Soft Tissue Infection; Abdominal Wall (Pbb)",,11005,CPT,Facility,Outpatient,,,,2380,2023,682.108,2380,Humana Insurance Company,Commercial PPO,2261,95,,percent of total billed charges,,
"Debridment Of Skin, Subq Tissue, Muscle And Fascia Soft Tissue Infection; Abdominal Wall (Pbb)",,11005,CPT,Professional,Outpatient,,,,2400,2040,452.88,2400,Humana Insurance Company,Commercial PPO,703.52,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Debridment Of Skin, Subq Tissue, Muscle And Fascia Soft Tissue Infection; Abdominal Wall (Pbb)",,11005,CPT,Facility,Outpatient,,,,2380,2023,682.108,2380,Humana Insurance Company,Medicare PPO,1166.2,49,,percent of total billed charges,,
"Debridment Of Skin, Subq Tissue, Muscle And Fascia Soft Tissue Infection; Abdominal Wall (Pbb)",,11005,CPT,Professional,Outpatient,,,,2400,2040,452.88,2400,Humana Insurance Company,Medicare PPO,2400,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Debridment Of Skin, Subq Tissue, Muscle And Fascia Soft Tissue Infection; Abdominal Wall (Pbb)",,11005,CPT,Facility,Outpatient,,,,2380,2023,682.108,2380,Medica,Individual & Family,2358.58,99.1,,percent of total billed charges,,
"Debridment Of Skin, Subq Tissue, Muscle And Fascia Soft Tissue Infection; Abdominal Wall (Pbb)",,11005,CPT,Professional,Outpatient,,,,2400,2040,452.88,2400,Medica,Individual & Family,2035.2,84.8,,percent of total billed charges,,
"Debridment Of Skin, Subq Tissue, Muscle And Fascia Soft Tissue Infection; Abdominal Wall (Pbb)",,11005,CPT,Facility,Outpatient,,,,2380,2023,682.108,2380,Medica,Medica Advantage Solution,1185.24,49.8,,percent of total billed charges,,
"Debridment Of Skin, Subq Tissue, Muscle And Fascia Soft Tissue Infection; Abdominal Wall (Pbb)",,11005,CPT,Professional,Outpatient,,,,2400,2040,452.88,2400,Medica,Medica Advantage Solution,1195.2,49.8,,percent of total billed charges,,
"Debridment Of Skin, Subq Tissue, Muscle And Fascia Soft Tissue Infection; Abdominal Wall (Pbb)",,11005,CPT,Facility,Outpatient,,,,2380,2023,682.108,2380,Medica,Medical Assistance,1061.48,44.6,,percent of total billed charges,,
"Debridment Of Skin, Subq Tissue, Muscle And Fascia Soft Tissue Infection; Abdominal Wall (Pbb)",,11005,CPT,Professional,Outpatient,,,,2400,2040,452.88,2400,Medica,Medical Assistance,522.87,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Debridment Of Skin, Subq Tissue, Muscle And Fascia Soft Tissue Infection; Abdominal Wall (Pbb)",,11005,CPT,Facility,Outpatient,,,,2380,2023,682.108,2380,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1185.24,49.8,,percent of total billed charges,,
"Debridment Of Skin, Subq Tissue, Muscle And Fascia Soft Tissue Infection; Abdominal Wall (Pbb)",,11005,CPT,Professional,Outpatient,,,,2400,2040,452.88,2400,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,703.52,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Debridment Of Skin, Subq Tissue, Muscle And Fascia Soft Tissue Infection; Abdominal Wall (Pbb)",,11005,CPT,Facility,Outpatient,,,,2380,2023,682.108,2380,"Multiplan, Inc.","Multiplan, Inc.",2237.2,94,,percent of total billed charges,,
"Debridment Of Skin, Subq Tissue, Muscle And Fascia Soft Tissue Infection; Abdominal Wall (Pbb)",,11005,CPT,Professional,Outpatient,,,,2400,2040,452.88,2400,"Multiplan, Inc.","Multiplan, Inc.",2256,94,,percent of total billed charges,,
"Debridment Of Skin, Subq Tissue, Muscle And Fascia Soft Tissue Infection; Abdominal Wall (Pbb)",,11005,CPT,Facility,Outpatient,,,,2380,2023,682.108,2380,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,2144.38,90.1,,percent of total billed charges,,
"Debridment Of Skin, Subq Tissue, Muscle And Fascia Soft Tissue Infection; Abdominal Wall (Pbb)",,11005,CPT,Professional,Outpatient,,,,2400,2040,452.88,2400,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,2162.4,90.1,,percent of total billed charges,,
"Debridment Of Skin, Subq Tissue, Muscle And Fascia Soft Tissue Infection; Abdominal Wall (Pbb)",,11005,CPT,Facility,Outpatient,,,,2380,2023,682.108,2380,"Preferred One Administrative Services, INC.",PPO,2346.68,98.6,,percent of total billed charges,,
"Debridment Of Skin, Subq Tissue, Muscle And Fascia Soft Tissue Infection; Abdominal Wall (Pbb)",,11005,CPT,Professional,Outpatient,,,,2400,2040,452.88,2400,"Preferred One Administrative Services, INC.",PPO,2366.4,98.6,,percent of total billed charges,,
"Debridment Of Skin, Subq Tissue, Muscle And Fascia Soft Tissue Infection; Abdominal Wall (Pbb)",,11005,CPT,Facility,Outpatient,,,,2380,2023,682.108,2380,PrimeWest Health,Minnesota Senior Health Options (MSHO),1224.51,51.45,,percent of total billed charges,,
"Debridment Of Skin, Subq Tissue, Muscle And Fascia Soft Tissue Infection; Abdominal Wall (Pbb)",,11005,CPT,Professional,Outpatient,,,,2400,2040,452.88,2400,PrimeWest Health,Minnesota Senior Health Options (MSHO),809.048,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Debridment Of Skin, Subq Tissue, Muscle And Fascia Soft Tissue Infection; Abdominal Wall (Pbb)",,11005,CPT,Facility,Outpatient,,,,2380,2023,682.108,2380,PrimeWest Health,MinnesotaCare,1222.368,51.36,,percent of total billed charges,,
"Debridment Of Skin, Subq Tissue, Muscle And Fascia Soft Tissue Infection; Abdominal Wall (Pbb)",,11005,CPT,Professional,Outpatient,,,,2400,2040,452.88,2400,PrimeWest Health,MinnesotaCare,559.4754368,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Debridment Of Skin, Subq Tissue, Muscle And Fascia Soft Tissue Infection; Abdominal Wall (Pbb)",,11005,CPT,Facility,Outpatient,,,,2380,2023,682.108,2380,Sanford Health Plan,Sanford Health Plan,2189.6,92,,percent of total billed charges,,
"Debridment Of Skin, Subq Tissue, Muscle And Fascia Soft Tissue Infection; Abdominal Wall (Pbb)",,11005,CPT,Professional,Outpatient,,,,2400,2040,452.88,2400,Sanford Health Plan,Sanford Health Plan,2112,88,,percent of total billed charges,,
"Debridment Of Skin, Subq Tissue, Muscle And Fascia Soft Tissue Infection; Abdominal Wall (Pbb)",,11005,CPT,Facility,Outpatient,,,,2380,2023,682.108,2380,"UCare Health, Inc.",Individual & Family Plan,1341.13,56.35,,percent of total billed charges,,
"Debridment Of Skin, Subq Tissue, Muscle And Fascia Soft Tissue Infection; Abdominal Wall (Pbb)",,11005,CPT,Professional,Outpatient,,,,2400,2040,452.88,2400,"UCare Health, Inc.",Individual & Family Plan,1143.642112,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Debridment Of Skin, Subq Tissue, Muscle And Fascia Soft Tissue Infection; Abdominal Wall (Pbb)",,11005,CPT,Facility,Outpatient,,,,2380,2023,682.108,2380,"UCare Health, Inc.",Medical Assistance,1201.186,50.47,,percent of total billed charges,,
"Debridment Of Skin, Subq Tissue, Muscle And Fascia Soft Tissue Infection; Abdominal Wall (Pbb)",,11005,CPT,Professional,Outpatient,,,,2400,2040,452.88,2400,"UCare Health, Inc.",Medical Assistance,575.161664,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Debridment Of Skin, Subq Tissue, Muscle And Fascia Soft Tissue Infection; Abdominal Wall (Pbb)",,11005,CPT,Facility,Outpatient,,,,2380,2023,682.108,2380,"UCare Health, Inc.",Medicare Advantage,1201.186,50.47,,percent of total billed charges,,
"Debridment Of Skin, Subq Tissue, Muscle And Fascia Soft Tissue Infection; Abdominal Wall (Pbb)",,11005,CPT,Professional,Outpatient,,,,2400,2040,452.88,2400,"UCare Health, Inc.",Medicare Advantage,809.048,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Debridment Of Skin, Subq Tissue, Muscle And Fascia Soft Tissue Infection; Abdominal Wall (Pbb)",,11005,CPT,Facility,Outpatient,,,,2380,2023,682.108,2380,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1201.186,50.47,,percent of total billed charges,,
"Debridment Of Skin, Subq Tissue, Muscle And Fascia Soft Tissue Infection; Abdominal Wall (Pbb)",,11005,CPT,Professional,Outpatient,,,,2400,2040,452.88,2400,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),647.2384,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Debridment Of Skin, Subq Tissue, Muscle And Fascia Soft Tissue Infection; Abdominal Wall (Pbb)",,11005,CPT,Facility,Outpatient,,,,2380,2023,682.108,2380,UnitedHealthcare,Individual & Family,2237.2,94,,percent of total billed charges,,
"Debridment Of Skin, Subq Tissue, Muscle And Fascia Soft Tissue Infection; Abdominal Wall (Pbb)",,11005,CPT,Professional,Outpatient,,,,2400,2040,452.88,2400,UnitedHealthcare,Individual & Family,2400,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Debridment Of Skin, Subq Tissue, Muscle And Fascia Soft Tissue Infection; Abdominal Wall (Pbb)",,11005,CPT,Facility,Outpatient,,,,2380,2023,682.108,2380,UnitedHealthcare,Medicare Advantage,1166.2,49,,percent of total billed charges,,
"Debridment Of Skin, Subq Tissue, Muscle And Fascia Soft Tissue Infection; Abdominal Wall (Pbb)",,11005,CPT,Professional,Outpatient,,,,2400,2040,452.88,2400,UnitedHealthcare,Medicare Advantage,809.048,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Debridment Of Skin, Subq Tissue, Muscle And Fascia Soft Tissue Infection; Abdominal Wall (Pbb)",,11005,CPT,Facility,Outpatient,,,,2380,2023,682.108,2380,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1142.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Debridment Of Skin, Subq Tissue, Muscle And Fascia Soft Tissue Infection; Abdominal Wall (Pbb)",,11005,CPT,Professional,Outpatient,,,,2400,2040,452.88,2400,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,522.87424,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Debridement Subq Tissue; 1St 20Cm Or Less (Pbb),,11042,CPT,Facility,Outpatient,,,,377,320.45,108.0482,377,Aetna,Commercial,346.84,92,,percent of total billed charges,,
Debridement Subq Tissue; 1St 20Cm Or Less (Pbb),,11042,CPT,Professional,Outpatient,,,,338,287.3,37.08,338,Aetna,Commercial,287.3,85,,percent of total billed charges,,
Debridement Subq Tissue; 1St 20Cm Or Less (Pbb),,11042,CPT,Facility,Outpatient,,,,377,320.45,108.0482,377,Aetna,Medicare Advantage,184.73,49,,percent of total billed charges,,
Debridement Subq Tissue; 1St 20Cm Or Less (Pbb),,11042,CPT,Professional,Outpatient,,,,338,287.3,37.08,338,Aetna,Medicare Advantage,58.76,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Debridement Subq Tissue; 1St 20Cm Or Less (Pbb),,11042,CPT,Facility,Outpatient,,,,377,320.45,108.0482,377,Aetna,PPO,350.61,93,,percent of total billed charges,,
Debridement Subq Tissue; 1St 20Cm Or Less (Pbb),,11042,CPT,Professional,Outpatient,,,,338,287.3,37.08,338,Aetna,PPO,314.34,93,,percent of total billed charges,,
Debridement Subq Tissue; 1St 20Cm Or Less (Pbb),,11042,CPT,Facility,Outpatient,,,,377,320.45,108.0482,377,America's PPO,America's PPO,362.0331,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Debridement Subq Tissue; 1St 20Cm Or Less (Pbb),,11042,CPT,Professional,Outpatient,,,,338,287.3,37.08,338,America's PPO,America's PPO,288.7872,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Debridement Subq Tissue; 1St 20Cm Or Less (Pbb),,11042,CPT,Facility,Outpatient,,,,377,320.45,108.0482,377,BlueCross BlueShield Minnesota, Federal Employee Program,370.968,98.4,,percent of total billed charges,,
Debridement Subq Tissue; 1St 20Cm Or Less (Pbb),,11042,CPT,Professional,Outpatient,,,,338,287.3,37.08,338,BlueCross BlueShield Minnesota, Federal Employee Program,121.88,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Debridement Subq Tissue; 1St 20Cm Or Less (Pbb),,11042,CPT,Facility,Outpatient,,,,377,320.45,108.0482,377,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,377,100,,percent of total billed charges,,
Debridement Subq Tissue; 1St 20Cm Or Less (Pbb),,11042,CPT,Professional,Outpatient,,,,338,287.3,37.08,338,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,123.83008,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Debridement Subq Tissue; 1St 20Cm Or Less (Pbb),,11042,CPT,Facility,Outpatient,,,,377,320.45,108.0482,377,BlueCross BlueShield Minnesota,High Value Network Plan,339.3,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
Debridement Subq Tissue; 1St 20Cm Or Less (Pbb),,11042,CPT,Professional,Outpatient,,,,338,287.3,37.08,338,BlueCross BlueShield Minnesota,High Value Network Plan,123.83008,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Debridement Subq Tissue; 1St 20Cm Or Less (Pbb),,11042,CPT,Facility,Outpatient,,,,377,320.45,108.0482,377,BlueCross BlueShield Minnesota,Medicare Advantage,184.73,49,,percent of total billed charges,,
Debridement Subq Tissue; 1St 20Cm Or Less (Pbb),,11042,CPT,Professional,Outpatient,,,,338,287.3,37.08,338,BlueCross BlueShield Minnesota,Medicare Advantage,66.2975,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Debridement Subq Tissue; 1St 20Cm Or Less (Pbb),,11042,CPT,Professional,Outpatient,,,,338,287.3,37.08,338,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,123.83008,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Debridement Subq Tissue; 1St 20Cm Or Less (Pbb),,11042,CPT,Facility,Outpatient,,,,377,320.45,108.0482,377,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,108.0482,28.66,,percent of total billed charges,,
Debridement Subq Tissue; 1St 20Cm Or Less (Pbb),,11042,CPT,Professional,Outpatient,,,,338,287.3,37.08,338,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,42.81424,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Debridement Subq Tissue; 1St 20Cm Or Less (Pbb),,11042,CPT,Facility,Outpatient,,,,377,320.45,108.0482,377,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),184.73,49,,percent of total billed charges,,
Debridement Subq Tissue; 1St 20Cm Or Less (Pbb),,11042,CPT,Professional,Outpatient,,,,338,287.3,37.08,338,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),66.2975,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Debridement Subq Tissue; 1St 20Cm Or Less (Pbb),,11042,CPT,Facility,Outpatient,,,,377,320.45,108.0482,377,CorVel,Worker's Compensation,377,100,,percent of total billed charges,,
Debridement Subq Tissue; 1St 20Cm Or Less (Pbb),,11042,CPT,Professional,Outpatient,,,,338,287.3,37.08,338,CorVel,Worker's Compensation,113.5542435,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Debridement Subq Tissue; 1St 20Cm Or Less (Pbb),,11042,CPT,Facility,Outpatient,,,,377,320.45,108.0482,377,First Health Group Corporation,First Health Network,365.69,97,,percent of total billed charges,,
Debridement Subq Tissue; 1St 20Cm Or Less (Pbb),,11042,CPT,Professional,Outpatient,,,,338,287.3,37.08,338,First Health Group Corporation,First Health Network,327.86,97,,percent of total billed charges,,
Debridement Subq Tissue; 1St 20Cm Or Less (Pbb),,11042,CPT,Facility,Outpatient,,,,377,320.45,108.0482,377,"Health Partners, Inc.",Commercial,356.642,94.6,,percent of total billed charges,,
Debridement Subq Tissue; 1St 20Cm Or Less (Pbb),,11042,CPT,Professional,Outpatient,,,,338,287.3,37.08,338,"Health Partners, Inc.",Commercial,122.61,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Debridement Subq Tissue; 1St 20Cm Or Less (Pbb),,11042,CPT,Facility,Outpatient,,,,377,320.45,108.0482,377,"Health Partners, Inc.",Medicare Advantage,184.73,49,,percent of total billed charges,,
Debridement Subq Tissue; 1St 20Cm Or Less (Pbb),,11042,CPT,Professional,Outpatient,,,,338,287.3,37.08,338,"Health Partners, Inc.",Medicare Advantage,66.2975,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Debridement Subq Tissue; 1St 20Cm Or Less (Pbb),,11042,CPT,Facility,Outpatient,,,,377,320.45,108.0482,377,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),226.2,60,,percent of total billed charges,,
Debridement Subq Tissue; 1St 20Cm Or Less (Pbb),,11042,CPT,Professional,Outpatient,,,,338,287.3,37.08,338,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),57.61,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Debridement Subq Tissue; 1St 20Cm Or Less (Pbb),,11042,CPT,Facility,Outpatient,,,,377,320.45,108.0482,377,"Health Partners, Inc.",State of Minnesota Advantage Program,307.255,81.5,,percent of total billed charges,,
Debridement Subq Tissue; 1St 20Cm Or Less (Pbb),,11042,CPT,Professional,Outpatient,,,,338,287.3,37.08,338,"Health Partners, Inc.",State of Minnesota Advantage Program,105.628515,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Debridement Subq Tissue; 1St 20Cm Or Less (Pbb),,11042,CPT,Facility,Outpatient,,,,377,320.45,108.0482,377,"Health Partners, Inc.",State Public Programs,188.5,50,,percent of total billed charges,,
Debridement Subq Tissue; 1St 20Cm Or Less (Pbb),,11042,CPT,Professional,Outpatient,,,,338,287.3,37.08,338,"Health Partners, Inc.",State Public Programs,37.08,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Debridement Subq Tissue; 1St 20Cm Or Less (Pbb),,11042,CPT,Facility,Outpatient,,,,377,320.45,108.0482,377,Humana Insurance Company,Commercial PPO,358.15,95,,percent of total billed charges,,
Debridement Subq Tissue; 1St 20Cm Or Less (Pbb),,11042,CPT,Professional,Outpatient,,,,338,287.3,37.08,338,Humana Insurance Company,Commercial PPO,57.65,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Debridement Subq Tissue; 1St 20Cm Or Less (Pbb),,11042,CPT,Facility,Outpatient,,,,377,320.45,108.0482,377,Humana Insurance Company,Medicare PPO,184.73,49,,percent of total billed charges,,
Debridement Subq Tissue; 1St 20Cm Or Less (Pbb),,11042,CPT,Professional,Outpatient,,,,338,287.3,37.08,338,Humana Insurance Company,Medicare PPO,338,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Debridement Subq Tissue; 1St 20Cm Or Less (Pbb),,11042,CPT,Facility,Outpatient,,,,377,320.45,108.0482,377,Medica,Individual & Family,373.607,99.1,,percent of total billed charges,,
Debridement Subq Tissue; 1St 20Cm Or Less (Pbb),,11042,CPT,Professional,Outpatient,,,,338,287.3,37.08,338,Medica,Individual & Family,286.624,84.8,,percent of total billed charges,,
Debridement Subq Tissue; 1St 20Cm Or Less (Pbb),,11042,CPT,Facility,Outpatient,,,,377,320.45,108.0482,377,Medica,Medica Advantage Solution,187.746,49.8,,percent of total billed charges,,
Debridement Subq Tissue; 1St 20Cm Or Less (Pbb),,11042,CPT,Professional,Outpatient,,,,338,287.3,37.08,338,Medica,Medica Advantage Solution,168.324,49.8,,percent of total billed charges,,
Debridement Subq Tissue; 1St 20Cm Or Less (Pbb),,11042,CPT,Facility,Outpatient,,,,377,320.45,108.0482,377,Medica,Medical Assistance,168.142,44.6,,percent of total billed charges,,
Debridement Subq Tissue; 1St 20Cm Or Less (Pbb),,11042,CPT,Professional,Outpatient,,,,338,287.3,37.08,338,Medica,Medical Assistance,42.81,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Debridement Subq Tissue; 1St 20Cm Or Less (Pbb),,11042,CPT,Facility,Outpatient,,,,377,320.45,108.0482,377,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,187.746,49.8,,percent of total billed charges,,
Debridement Subq Tissue; 1St 20Cm Or Less (Pbb),,11042,CPT,Professional,Outpatient,,,,338,287.3,37.08,338,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,57.65,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Debridement Subq Tissue; 1St 20Cm Or Less (Pbb),,11042,CPT,Facility,Outpatient,,,,377,320.45,108.0482,377,"Multiplan, Inc.","Multiplan, Inc.",354.38,94,,percent of total billed charges,,
Debridement Subq Tissue; 1St 20Cm Or Less (Pbb),,11042,CPT,Professional,Outpatient,,,,338,287.3,37.08,338,"Multiplan, Inc.","Multiplan, Inc.",317.72,94,,percent of total billed charges,,
Debridement Subq Tissue; 1St 20Cm Or Less (Pbb),,11042,CPT,Facility,Outpatient,,,,377,320.45,108.0482,377,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,339.677,90.1,,percent of total billed charges,,
Debridement Subq Tissue; 1St 20Cm Or Less (Pbb),,11042,CPT,Professional,Outpatient,,,,338,287.3,37.08,338,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,304.538,90.1,,percent of total billed charges,,
Debridement Subq Tissue; 1St 20Cm Or Less (Pbb),,11042,CPT,Facility,Outpatient,,,,377,320.45,108.0482,377,"Preferred One Administrative Services, INC.",PPO,371.722,98.6,,percent of total billed charges,,
Debridement Subq Tissue; 1St 20Cm Or Less (Pbb),,11042,CPT,Professional,Outpatient,,,,338,287.3,37.08,338,"Preferred One Administrative Services, INC.",PPO,333.268,98.6,,percent of total billed charges,,
Debridement Subq Tissue; 1St 20Cm Or Less (Pbb),,11042,CPT,Facility,Outpatient,,,,377,320.45,108.0482,377,PrimeWest Health,Minnesota Senior Health Options (MSHO),193.9665,51.45,,percent of total billed charges,,
Debridement Subq Tissue; 1St 20Cm Or Less (Pbb),,11042,CPT,Professional,Outpatient,,,,338,287.3,37.08,338,PrimeWest Health,Minnesota Senior Health Options (MSHO),66.2975,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Debridement Subq Tissue; 1St 20Cm Or Less (Pbb),,11042,CPT,Facility,Outpatient,,,,377,320.45,108.0482,377,PrimeWest Health,MinnesotaCare,193.6272,51.36,,percent of total billed charges,,
Debridement Subq Tissue; 1St 20Cm Or Less (Pbb),,11042,CPT,Professional,Outpatient,,,,338,287.3,37.08,338,PrimeWest Health,MinnesotaCare,45.8112368,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Debridement Subq Tissue; 1St 20Cm Or Less (Pbb),,11042,CPT,Facility,Outpatient,,,,377,320.45,108.0482,377,Sanford Health Plan,Sanford Health Plan,346.84,92,,percent of total billed charges,,
Debridement Subq Tissue; 1St 20Cm Or Less (Pbb),,11042,CPT,Professional,Outpatient,,,,338,287.3,37.08,338,Sanford Health Plan,Sanford Health Plan,297.44,88,,percent of total billed charges,,
Debridement Subq Tissue; 1St 20Cm Or Less (Pbb),,11042,CPT,Facility,Outpatient,,,,377,320.45,108.0482,377,"UCare Health, Inc.",Individual & Family Plan,212.4395,56.35,,percent of total billed charges,,
Debridement Subq Tissue; 1St 20Cm Or Less (Pbb),,11042,CPT,Professional,Outpatient,,,,338,287.3,37.08,338,"UCare Health, Inc.",Individual & Family Plan,93.71584,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Debridement Subq Tissue; 1St 20Cm Or Less (Pbb),,11042,CPT,Facility,Outpatient,,,,377,320.45,108.0482,377,"UCare Health, Inc.",Medical Assistance,190.2719,50.47,,percent of total billed charges,,
Debridement Subq Tissue; 1St 20Cm Or Less (Pbb),,11042,CPT,Professional,Outpatient,,,,338,287.3,37.08,338,"UCare Health, Inc.",Medical Assistance,47.095664,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Debridement Subq Tissue; 1St 20Cm Or Less (Pbb),,11042,CPT,Facility,Outpatient,,,,377,320.45,108.0482,377,"UCare Health, Inc.",Medicare Advantage,190.2719,50.47,,percent of total billed charges,,
Debridement Subq Tissue; 1St 20Cm Or Less (Pbb),,11042,CPT,Professional,Outpatient,,,,338,287.3,37.08,338,"UCare Health, Inc.",Medicare Advantage,66.2975,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Debridement Subq Tissue; 1St 20Cm Or Less (Pbb),,11042,CPT,Facility,Outpatient,,,,377,320.45,108.0482,377,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),190.2719,50.47,,percent of total billed charges,,
Debridement Subq Tissue; 1St 20Cm Or Less (Pbb),,11042,CPT,Professional,Outpatient,,,,338,287.3,37.08,338,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),53.038,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Debridement Subq Tissue; 1St 20Cm Or Less (Pbb),,11042,CPT,Facility,Outpatient,,,,377,320.45,108.0482,377,UnitedHealthcare,Individual & Family,354.38,94,,percent of total billed charges,,
Debridement Subq Tissue; 1St 20Cm Or Less (Pbb),,11042,CPT,Professional,Outpatient,,,,338,287.3,37.08,338,UnitedHealthcare,Individual & Family,338,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Debridement Subq Tissue; 1St 20Cm Or Less (Pbb),,11042,CPT,Facility,Outpatient,,,,377,320.45,108.0482,377,UnitedHealthcare,Medicare Advantage,184.73,49,,percent of total billed charges,,
Debridement Subq Tissue; 1St 20Cm Or Less (Pbb),,11042,CPT,Professional,Outpatient,,,,338,287.3,37.08,338,UnitedHealthcare,Medicare Advantage,66.2975,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Debridement Subq Tissue; 1St 20Cm Or Less (Pbb),,11042,CPT,Facility,Outpatient,,,,377,320.45,108.0482,377,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,180.96,48,,percent of total billed charges,,100% of DHS outpatient percentage
Debridement Subq Tissue; 1St 20Cm Or Less (Pbb),,11042,CPT,Professional,Outpatient,,,,338,287.3,37.08,338,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,42.81424,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Debridement, Subcutaneous Tissue; First 20 Sq Cm Or Less (Pro Cah)",,11042,CPT,Professional,Both,,,,715,607.75,37.08,715,Aetna,Commercial,607.75,85,,percent of total billed charges,,
"Debridement, Subcutaneous Tissue; First 20 Sq Cm Or Less (Pro Cah)",,11042,CPT,Professional,Both,,,,715,607.75,37.08,715,Aetna,Medicare Advantage,58.76,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Debridement, Subcutaneous Tissue; First 20 Sq Cm Or Less (Pro Cah)",,11042,CPT,Professional,Both,,,,715,607.75,37.08,715,Aetna,PPO,664.95,93,,percent of total billed charges,,
"Debridement, Subcutaneous Tissue; First 20 Sq Cm Or Less (Pro Cah)",,11042,CPT,Professional,Both,,,,715,607.75,37.08,715,America's PPO,America's PPO,610.896,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Debridement, Subcutaneous Tissue; First 20 Sq Cm Or Less (Pro Cah)",,11042,CPT,Professional,Both,,,,715,607.75,37.08,715,BlueCross BlueShield Minnesota, Federal Employee Program,121.88,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Debridement, Subcutaneous Tissue; First 20 Sq Cm Or Less (Pro Cah)",,11042,CPT,Professional,Both,,,,715,607.75,37.08,715,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,123.83008,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Debridement, Subcutaneous Tissue; First 20 Sq Cm Or Less (Pro Cah)",,11042,CPT,Professional,Both,,,,715,607.75,37.08,715,BlueCross BlueShield Minnesota,High Value Network Plan,123.83008,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Debridement, Subcutaneous Tissue; First 20 Sq Cm Or Less (Pro Cah)",,11042,CPT,Professional,Both,,,,715,607.75,37.08,715,BlueCross BlueShield Minnesota,Medicare Advantage,66.2975,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Debridement, Subcutaneous Tissue; First 20 Sq Cm Or Less (Pro Cah)",,11042,CPT,Professional,Both,,,,715,607.75,37.08,715,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,123.83008,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Debridement, Subcutaneous Tissue; First 20 Sq Cm Or Less (Pro Cah)",,11042,CPT,Professional,Both,,,,715,607.75,37.08,715,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,42.81424,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Debridement, Subcutaneous Tissue; First 20 Sq Cm Or Less (Pro Cah)",,11042,CPT,Professional,Both,,,,715,607.75,37.08,715,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),66.2975,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Debridement, Subcutaneous Tissue; First 20 Sq Cm Or Less (Pro Cah)",,11042,CPT,Professional,Both,,,,715,607.75,37.08,715,CorVel,Worker's Compensation,113.5542435,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Debridement, Subcutaneous Tissue; First 20 Sq Cm Or Less (Pro Cah)",,11042,CPT,Professional,Both,,,,715,607.75,37.08,715,First Health Group Corporation,First Health Network,693.55,97,,percent of total billed charges,,
"Debridement, Subcutaneous Tissue; First 20 Sq Cm Or Less (Pro Cah)",,11042,CPT,Professional,Both,,,,715,607.75,37.08,715,"Health Partners, Inc.",Commercial,122.61,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Debridement, Subcutaneous Tissue; First 20 Sq Cm Or Less (Pro Cah)",,11042,CPT,Professional,Both,,,,715,607.75,37.08,715,"Health Partners, Inc.",Medicare Advantage,66.2975,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Debridement, Subcutaneous Tissue; First 20 Sq Cm Or Less (Pro Cah)",,11042,CPT,Professional,Both,,,,715,607.75,37.08,715,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),57.61,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Debridement, Subcutaneous Tissue; First 20 Sq Cm Or Less (Pro Cah)",,11042,CPT,Professional,Both,,,,715,607.75,37.08,715,"Health Partners, Inc.",State of Minnesota Advantage Program,105.628515,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Debridement, Subcutaneous Tissue; First 20 Sq Cm Or Less (Pro Cah)",,11042,CPT,Professional,Both,,,,715,607.75,37.08,715,"Health Partners, Inc.",State Public Programs,37.08,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Debridement, Subcutaneous Tissue; First 20 Sq Cm Or Less (Pro Cah)",,11042,CPT,Professional,Both,,,,715,607.75,37.08,715,Humana Insurance Company,Commercial PPO,57.65,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Debridement, Subcutaneous Tissue; First 20 Sq Cm Or Less (Pro Cah)",,11042,CPT,Professional,Both,,,,715,607.75,37.08,715,Humana Insurance Company,Medicare PPO,715,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Debridement, Subcutaneous Tissue; First 20 Sq Cm Or Less (Pro Cah)",,11042,CPT,Professional,Both,,,,715,607.75,37.08,715,Medica,Individual & Family,606.32,84.8,,percent of total billed charges,,
"Debridement, Subcutaneous Tissue; First 20 Sq Cm Or Less (Pro Cah)",,11042,CPT,Professional,Both,,,,715,607.75,37.08,715,Medica,Medica Advantage Solution,356.07,49.8,,percent of total billed charges,,
"Debridement, Subcutaneous Tissue; First 20 Sq Cm Or Less (Pro Cah)",,11042,CPT,Professional,Both,,,,715,607.75,37.08,715,Medica,Medical Assistance,42.81,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Debridement, Subcutaneous Tissue; First 20 Sq Cm Or Less (Pro Cah)",,11042,CPT,Professional,Both,,,,715,607.75,37.08,715,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,57.65,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Debridement, Subcutaneous Tissue; First 20 Sq Cm Or Less (Pro Cah)",,11042,CPT,Professional,Both,,,,715,607.75,37.08,715,"Multiplan, Inc.","Multiplan, Inc.",672.1,94,,percent of total billed charges,,
"Debridement, Subcutaneous Tissue; First 20 Sq Cm Or Less (Pro Cah)",,11042,CPT,Professional,Both,,,,715,607.75,37.08,715,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,644.215,90.1,,percent of total billed charges,,
"Debridement, Subcutaneous Tissue; First 20 Sq Cm Or Less (Pro Cah)",,11042,CPT,Professional,Both,,,,715,607.75,37.08,715,"Preferred One Administrative Services, INC.",PPO,704.99,98.6,,percent of total billed charges,,
"Debridement, Subcutaneous Tissue; First 20 Sq Cm Or Less (Pro Cah)",,11042,CPT,Professional,Both,,,,715,607.75,37.08,715,PrimeWest Health,Minnesota Senior Health Options (MSHO),66.2975,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Debridement, Subcutaneous Tissue; First 20 Sq Cm Or Less (Pro Cah)",,11042,CPT,Professional,Both,,,,715,607.75,37.08,715,PrimeWest Health,MinnesotaCare,45.8112368,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Debridement, Subcutaneous Tissue; First 20 Sq Cm Or Less (Pro Cah)",,11042,CPT,Professional,Both,,,,715,607.75,37.08,715,Sanford Health Plan,Sanford Health Plan,629.2,88,,percent of total billed charges,,
"Debridement, Subcutaneous Tissue; First 20 Sq Cm Or Less (Pro Cah)",,11042,CPT,Professional,Both,,,,715,607.75,37.08,715,"UCare Health, Inc.",Individual & Family Plan,93.71584,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Debridement, Subcutaneous Tissue; First 20 Sq Cm Or Less (Pro Cah)",,11042,CPT,Professional,Both,,,,715,607.75,37.08,715,"UCare Health, Inc.",Medical Assistance,47.095664,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Debridement, Subcutaneous Tissue; First 20 Sq Cm Or Less (Pro Cah)",,11042,CPT,Professional,Both,,,,715,607.75,37.08,715,"UCare Health, Inc.",Medicare Advantage,66.2975,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Debridement, Subcutaneous Tissue; First 20 Sq Cm Or Less (Pro Cah)",,11042,CPT,Professional,Both,,,,715,607.75,37.08,715,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),53.038,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Debridement, Subcutaneous Tissue; First 20 Sq Cm Or Less (Pro Cah)",,11042,CPT,Professional,Both,,,,715,607.75,37.08,715,UnitedHealthcare,Individual & Family,715,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Debridement, Subcutaneous Tissue; First 20 Sq Cm Or Less (Pro Cah)",,11042,CPT,Professional,Both,,,,715,607.75,37.08,715,UnitedHealthcare,Medicare Advantage,66.2975,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Debridement, Subcutaneous Tissue; First 20 Sq Cm Or Less (Pro Cah)",,11042,CPT,Professional,Both,,,,715,607.75,37.08,715,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,42.81424,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Skin Debridement Subq Tissue 1St 20Cm2,,11042,CPT,Facility,Both,,,,156,132.6,44.7096,156,Aetna,Commercial,143.52,92,,percent of total billed charges,,
Skin Debridement Subq Tissue 1St 20Cm2,,11042,CPT,Facility,Outpatient,,,,156,132.6,44.7096,156,Aetna,Medicare Advantage,76.44,49,,percent of total billed charges,,
Skin Debridement Subq Tissue 1St 20Cm2,,11042,CPT,Facility,Inpatient,,,,156,132.6,44.7096,156,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Skin Debridement Subq Tissue 1St 20Cm2,,11042,CPT,Facility,Both,,,,156,132.6,44.7096,156,Aetna,PPO,145.08,93,,percent of total billed charges,,
Skin Debridement Subq Tissue 1St 20Cm2,,11042,CPT,Facility,Both,,,,156,132.6,44.7096,156,America's PPO,America's PPO,149.8068,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Skin Debridement Subq Tissue 1St 20Cm2,,11042,CPT,Facility,Both,,,,156,132.6,44.7096,156,BlueCross BlueShield Minnesota, Federal Employee Program,153.504,98.4,,percent of total billed charges,,
Skin Debridement Subq Tissue 1St 20Cm2,,11042,CPT,Facility,Both,,,,156,132.6,44.7096,156,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,156,100,,percent of total billed charges,,
Skin Debridement Subq Tissue 1St 20Cm2,,11042,CPT,Facility,Both,,,,156,132.6,44.7096,156,BlueCross BlueShield Minnesota,High Value Network Plan,140.4,90,,percent of total billed charges,,
Skin Debridement Subq Tissue 1St 20Cm2,,11042,CPT,Facility,Outpatient,,,,156,132.6,44.7096,156,BlueCross BlueShield Minnesota,Medicare Advantage,76.44,49,,percent of total billed charges,,
Skin Debridement Subq Tissue 1St 20Cm2,,11042,CPT,Facility,Inpatient,,,,156,132.6,44.7096,156,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Skin Debridement Subq Tissue 1St 20Cm2,,11042,CPT,Facility,Both,,,,156,132.6,44.7096,156,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,138.1692,88.57,,percent of total billed charges,,
Skin Debridement Subq Tissue 1St 20Cm2,,11042,CPT,Facility,Both,,,,156,132.6,44.7096,156,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,44.7096,28.66,,percent of total billed charges,,
Skin Debridement Subq Tissue 1St 20Cm2,,11042,CPT,Facility,Outpatient,,,,156,132.6,44.7096,156,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),76.44,49,,percent of total billed charges,,
Skin Debridement Subq Tissue 1St 20Cm2,,11042,CPT,Facility,Inpatient,,,,156,132.6,44.7096,156,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Skin Debridement Subq Tissue 1St 20Cm2,,11042,CPT,Facility,Both,,,,156,132.6,44.7096,156,CorVel,Worker's Compensation,156,100,,percent of total billed charges,,
Skin Debridement Subq Tissue 1St 20Cm2,,11042,CPT,Facility,Both,,,,156,132.6,44.7096,156,First Health Group Corporation,First Health Network,151.32,97,,percent of total billed charges,,
Skin Debridement Subq Tissue 1St 20Cm2,,11042,CPT,Facility,Both,,,,156,132.6,44.7096,156,"Health Partners, Inc.",Commercial,147.576,94.6,,percent of total billed charges,,
Skin Debridement Subq Tissue 1St 20Cm2,,11042,CPT,Facility,Outpatient,,,,156,132.6,44.7096,156,"Health Partners, Inc.",Medicare Advantage,76.44,49,,percent of total billed charges,,
Skin Debridement Subq Tissue 1St 20Cm2,,11042,CPT,Facility,Inpatient,,,,156,132.6,44.7096,156,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Skin Debridement Subq Tissue 1St 20Cm2,,11042,CPT,Facility,Both,,,,156,132.6,44.7096,156,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),93.6,60,,percent of total billed charges,,
Skin Debridement Subq Tissue 1St 20Cm2,,11042,CPT,Facility,Both,,,,156,132.6,44.7096,156,"Health Partners, Inc.",State of Minnesota Advantage Program,127.14,81.5,,percent of total billed charges,,
Skin Debridement Subq Tissue 1St 20Cm2,,11042,CPT,Facility,Both,,,,156,132.6,44.7096,156,"Health Partners, Inc.",State Public Programs,78,50,,percent of total billed charges,,
Skin Debridement Subq Tissue 1St 20Cm2,,11042,CPT,Facility,Both,,,,156,132.6,44.7096,156,Humana Insurance Company,Commercial PPO,148.2,95,,percent of total billed charges,,
Skin Debridement Subq Tissue 1St 20Cm2,,11042,CPT,Facility,Outpatient,,,,156,132.6,44.7096,156,Humana Insurance Company,Medicare PPO,76.44,49,,percent of total billed charges,,
Skin Debridement Subq Tissue 1St 20Cm2,,11042,CPT,Facility,Inpatient,,,,156,132.6,44.7096,156,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Skin Debridement Subq Tissue 1St 20Cm2,,11042,CPT,Facility,Both,,,,156,132.6,44.7096,156,Medica,Individual & Family,154.596,99.1,,percent of total billed charges,,
Skin Debridement Subq Tissue 1St 20Cm2,,11042,CPT,Facility,Outpatient,,,,156,132.6,44.7096,156,Medica,Medica Advantage Solution,77.688,49.8,,percent of total billed charges,,
Skin Debridement Subq Tissue 1St 20Cm2,,11042,CPT,Facility,Inpatient,,,,156,132.6,44.7096,156,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Skin Debridement Subq Tissue 1St 20Cm2,,11042,CPT,Facility,Outpatient,,,,156,132.6,44.7096,156,Medica,Medical Assistance,69.576,44.6,,percent of total billed charges,,
Skin Debridement Subq Tissue 1St 20Cm2,,11042,CPT,Facility,Inpatient,,,,156,132.6,44.7096,156,Medica,Medical Assistance,,,,,Included in per diem rate,
Skin Debridement Subq Tissue 1St 20Cm2,,11042,CPT,Facility,Outpatient,,,,156,132.6,44.7096,156,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,77.688,49.8,,percent of total billed charges,,
Skin Debridement Subq Tissue 1St 20Cm2,,11042,CPT,Facility,Inpatient,,,,156,132.6,44.7096,156,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Skin Debridement Subq Tissue 1St 20Cm2,,11042,CPT,Facility,Both,,,,156,132.6,44.7096,156,"Multiplan, Inc.","Multiplan, Inc.",146.64,94,,percent of total billed charges,,
Skin Debridement Subq Tissue 1St 20Cm2,,11042,CPT,Facility,Outpatient,,,,156,132.6,44.7096,156,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,140.556,90.1,,percent of total billed charges,,
Skin Debridement Subq Tissue 1St 20Cm2,,11042,CPT,Facility,Inpatient,,,,156,132.6,44.7096,156,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Skin Debridement Subq Tissue 1St 20Cm2,,11042,CPT,Facility,Both,,,,156,132.6,44.7096,156,"Preferred One Administrative Services, INC.",PPO,153.816,98.6,,percent of total billed charges,,
Skin Debridement Subq Tissue 1St 20Cm2,,11042,CPT,Facility,Outpatient,,,,156,132.6,44.7096,156,PrimeWest Health,Minnesota Senior Health Options (MSHO),80.262,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Skin Debridement Subq Tissue 1St 20Cm2,,11042,CPT,Facility,Inpatient,,,,156,132.6,44.7096,156,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Skin Debridement Subq Tissue 1St 20Cm2,,11042,CPT,Facility,Outpatient,,,,156,132.6,44.7096,156,PrimeWest Health,MinnesotaCare,80.1216,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Skin Debridement Subq Tissue 1St 20Cm2,,11042,CPT,Facility,Inpatient,,,,156,132.6,44.7096,156,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Skin Debridement Subq Tissue 1St 20Cm2,,11042,CPT,Facility,Both,,,,156,132.6,44.7096,156,Sanford Health Plan,Sanford Health Plan,143.52,92,,percent of total billed charges,,
Skin Debridement Subq Tissue 1St 20Cm2,,11042,CPT,Facility,Outpatient,,,,156,132.6,44.7096,156,"UCare Health, Inc.",Individual & Family Plan,87.906,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Skin Debridement Subq Tissue 1St 20Cm2,,11042,CPT,Facility,Inpatient,,,,156,132.6,44.7096,156,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Skin Debridement Subq Tissue 1St 20Cm2,,11042,CPT,Facility,Outpatient,,,,156,132.6,44.7096,156,"UCare Health, Inc.",Medical Assistance,78.7332,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Skin Debridement Subq Tissue 1St 20Cm2,,11042,CPT,Facility,Inpatient,,,,156,132.6,44.7096,156,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Skin Debridement Subq Tissue 1St 20Cm2,,11042,CPT,Facility,Outpatient,,,,156,132.6,44.7096,156,"UCare Health, Inc.",Medicare Advantage,78.7332,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Skin Debridement Subq Tissue 1St 20Cm2,,11042,CPT,Facility,Inpatient,,,,156,132.6,44.7096,156,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Skin Debridement Subq Tissue 1St 20Cm2,,11042,CPT,Facility,Outpatient,,,,156,132.6,44.7096,156,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),78.7332,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Skin Debridement Subq Tissue 1St 20Cm2,,11042,CPT,Facility,Inpatient,,,,156,132.6,44.7096,156,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Skin Debridement Subq Tissue 1St 20Cm2,,11042,CPT,Facility,Both,,,,156,132.6,44.7096,156,UnitedHealthcare,Individual & Family,146.64,94,,percent of total billed charges,,
Skin Debridement Subq Tissue 1St 20Cm2,,11042,CPT,Facility,Outpatient,,,,156,132.6,44.7096,156,UnitedHealthcare,Medicare Advantage,76.44,49,,percent of total billed charges,,
Skin Debridement Subq Tissue 1St 20Cm2,,11042,CPT,Facility,Inpatient,,,,156,132.6,44.7096,156,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Skin Debridement Subq Tissue 1St 20Cm2,,11042,CPT,Facility,Outpatient,,,,156,132.6,44.7096,156,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,74.88,48,,percent of total billed charges,,100% of DHS outpatient percentage
Skin Debridement Subq Tissue 1St 20Cm2,,11042,CPT,Facility,Inpatient,,,,156,132.6,44.7096,156,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Debridement Muscle/Fascia; 1St 20Sq Cm Or Less (Pbb),,11043,CPT,Facility,Outpatient,,,,617,524.45,176.8322,617,Aetna,Commercial,567.64,92,,percent of total billed charges,,
Debridement Muscle/Fascia; 1St 20Sq Cm Or Less (Pbb),,11043,CPT,Professional,Outpatient,,,,890,756.5,93.8,890,Aetna,Commercial,756.5,85,,percent of total billed charges,,
Debridement Muscle/Fascia; 1St 20Sq Cm Or Less (Pbb),,11043,CPT,Facility,Outpatient,,,,617,524.45,176.8322,617,Aetna,Medicare Advantage,302.33,49,,percent of total billed charges,,
Debridement Muscle/Fascia; 1St 20Sq Cm Or Less (Pbb),,11043,CPT,Professional,Outpatient,,,,890,756.5,93.8,890,Aetna,Medicare Advantage,148.87,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Debridement Muscle/Fascia; 1St 20Sq Cm Or Less (Pbb),,11043,CPT,Facility,Outpatient,,,,617,524.45,176.8322,617,Aetna,PPO,573.81,93,,percent of total billed charges,,
Debridement Muscle/Fascia; 1St 20Sq Cm Or Less (Pbb),,11043,CPT,Professional,Outpatient,,,,890,756.5,93.8,890,Aetna,PPO,827.7,93,,percent of total billed charges,,
Debridement Muscle/Fascia; 1St 20Sq Cm Or Less (Pbb),,11043,CPT,Facility,Outpatient,,,,617,524.45,176.8322,617,America's PPO,America's PPO,592.5051,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Debridement Muscle/Fascia; 1St 20Sq Cm Or Less (Pbb),,11043,CPT,Professional,Outpatient,,,,890,756.5,93.8,890,America's PPO,America's PPO,760.416,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Debridement Muscle/Fascia; 1St 20Sq Cm Or Less (Pbb),,11043,CPT,Facility,Outpatient,,,,617,524.45,176.8322,617,BlueCross BlueShield Minnesota, Federal Employee Program,607.128,98.4,,percent of total billed charges,,
Debridement Muscle/Fascia; 1St 20Sq Cm Or Less (Pbb),,11043,CPT,Professional,Outpatient,,,,890,756.5,93.8,890,BlueCross BlueShield Minnesota, Federal Employee Program,313.31,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Debridement Muscle/Fascia; 1St 20Sq Cm Or Less (Pbb),,11043,CPT,Facility,Outpatient,,,,617,524.45,176.8322,617,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,617,100,,percent of total billed charges,,
Debridement Muscle/Fascia; 1St 20Sq Cm Or Less (Pbb),,11043,CPT,Professional,Outpatient,,,,890,756.5,93.8,890,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,318.32296,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Debridement Muscle/Fascia; 1St 20Sq Cm Or Less (Pbb),,11043,CPT,Facility,Outpatient,,,,617,524.45,176.8322,617,BlueCross BlueShield Minnesota,High Value Network Plan,555.3,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
Debridement Muscle/Fascia; 1St 20Sq Cm Or Less (Pbb),,11043,CPT,Professional,Outpatient,,,,890,756.5,93.8,890,BlueCross BlueShield Minnesota,High Value Network Plan,318.32296,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Debridement Muscle/Fascia; 1St 20Sq Cm Or Less (Pbb),,11043,CPT,Facility,Outpatient,,,,617,524.45,176.8322,617,BlueCross BlueShield Minnesota,Medicare Advantage,302.33,49,,percent of total billed charges,,
Debridement Muscle/Fascia; 1St 20Sq Cm Or Less (Pbb),,11043,CPT,Professional,Outpatient,,,,890,756.5,93.8,890,BlueCross BlueShield Minnesota,Medicare Advantage,167.877,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Debridement Muscle/Fascia; 1St 20Sq Cm Or Less (Pbb),,11043,CPT,Professional,Outpatient,,,,890,756.5,93.8,890,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,318.32296,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Debridement Muscle/Fascia; 1St 20Sq Cm Or Less (Pbb),,11043,CPT,Facility,Outpatient,,,,617,524.45,176.8322,617,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,176.8322,28.66,,percent of total billed charges,,
Debridement Muscle/Fascia; 1St 20Sq Cm Or Less (Pbb),,11043,CPT,Professional,Outpatient,,,,890,756.5,93.8,890,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,108.29544,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Debridement Muscle/Fascia; 1St 20Sq Cm Or Less (Pbb),,11043,CPT,Facility,Outpatient,,,,617,524.45,176.8322,617,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),302.33,49,,percent of total billed charges,,
Debridement Muscle/Fascia; 1St 20Sq Cm Or Less (Pbb),,11043,CPT,Professional,Outpatient,,,,890,756.5,93.8,890,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),167.877,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Debridement Muscle/Fascia; 1St 20Sq Cm Or Less (Pbb),,11043,CPT,Facility,Outpatient,,,,617,524.45,176.8322,617,CorVel,Worker's Compensation,617,100,,percent of total billed charges,,
Debridement Muscle/Fascia; 1St 20Sq Cm Or Less (Pbb),,11043,CPT,Professional,Outpatient,,,,890,756.5,93.8,890,CorVel,Worker's Compensation,286.3410081,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Debridement Muscle/Fascia; 1St 20Sq Cm Or Less (Pbb),,11043,CPT,Facility,Outpatient,,,,617,524.45,176.8322,617,First Health Group Corporation,First Health Network,598.49,97,,percent of total billed charges,,
Debridement Muscle/Fascia; 1St 20Sq Cm Or Less (Pbb),,11043,CPT,Professional,Outpatient,,,,890,756.5,93.8,890,First Health Group Corporation,First Health Network,863.3,97,,percent of total billed charges,,
Debridement Muscle/Fascia; 1St 20Sq Cm Or Less (Pbb),,11043,CPT,Facility,Outpatient,,,,617,524.45,176.8322,617,"Health Partners, Inc.",Commercial,583.682,94.6,,percent of total billed charges,,
Debridement Muscle/Fascia; 1St 20Sq Cm Or Less (Pbb),,11043,CPT,Professional,Outpatient,,,,890,756.5,93.8,890,"Health Partners, Inc.",Commercial,309.08,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Debridement Muscle/Fascia; 1St 20Sq Cm Or Less (Pbb),,11043,CPT,Facility,Outpatient,,,,617,524.45,176.8322,617,"Health Partners, Inc.",Medicare Advantage,302.33,49,,percent of total billed charges,,
Debridement Muscle/Fascia; 1St 20Sq Cm Or Less (Pbb),,11043,CPT,Professional,Outpatient,,,,890,756.5,93.8,890,"Health Partners, Inc.",Medicare Advantage,167.877,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Debridement Muscle/Fascia; 1St 20Sq Cm Or Less (Pbb),,11043,CPT,Facility,Outpatient,,,,617,524.45,176.8322,617,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),370.2,60,,percent of total billed charges,,
Debridement Muscle/Fascia; 1St 20Sq Cm Or Less (Pbb),,11043,CPT,Professional,Outpatient,,,,890,756.5,93.8,890,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),146.05,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Debridement Muscle/Fascia; 1St 20Sq Cm Or Less (Pbb),,11043,CPT,Facility,Outpatient,,,,617,524.45,176.8322,617,"Health Partners, Inc.",State of Minnesota Advantage Program,502.855,81.5,,percent of total billed charges,,
Debridement Muscle/Fascia; 1St 20Sq Cm Or Less (Pbb),,11043,CPT,Professional,Outpatient,,,,890,756.5,93.8,890,"Health Partners, Inc.",State of Minnesota Advantage Program,266.27242,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Debridement Muscle/Fascia; 1St 20Sq Cm Or Less (Pbb),,11043,CPT,Facility,Outpatient,,,,617,524.45,176.8322,617,"Health Partners, Inc.",State Public Programs,308.5,50,,percent of total billed charges,,
Debridement Muscle/Fascia; 1St 20Sq Cm Or Less (Pbb),,11043,CPT,Professional,Outpatient,,,,890,756.5,93.8,890,"Health Partners, Inc.",State Public Programs,93.8,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Debridement Muscle/Fascia; 1St 20Sq Cm Or Less (Pbb),,11043,CPT,Facility,Outpatient,,,,617,524.45,176.8322,617,Humana Insurance Company,Commercial PPO,586.15,95,,percent of total billed charges,,
Debridement Muscle/Fascia; 1St 20Sq Cm Or Less (Pbb),,11043,CPT,Professional,Outpatient,,,,890,756.5,93.8,890,Humana Insurance Company,Commercial PPO,145.98,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Debridement Muscle/Fascia; 1St 20Sq Cm Or Less (Pbb),,11043,CPT,Facility,Outpatient,,,,617,524.45,176.8322,617,Humana Insurance Company,Medicare PPO,302.33,49,,percent of total billed charges,,
Debridement Muscle/Fascia; 1St 20Sq Cm Or Less (Pbb),,11043,CPT,Professional,Outpatient,,,,890,756.5,93.8,890,Humana Insurance Company,Medicare PPO,890,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Debridement Muscle/Fascia; 1St 20Sq Cm Or Less (Pbb),,11043,CPT,Facility,Outpatient,,,,617,524.45,176.8322,617,Medica,Individual & Family,611.447,99.1,,percent of total billed charges,,
Debridement Muscle/Fascia; 1St 20Sq Cm Or Less (Pbb),,11043,CPT,Professional,Outpatient,,,,890,756.5,93.8,890,Medica,Individual & Family,754.72,84.8,,percent of total billed charges,,
Debridement Muscle/Fascia; 1St 20Sq Cm Or Less (Pbb),,11043,CPT,Facility,Outpatient,,,,617,524.45,176.8322,617,Medica,Medica Advantage Solution,307.266,49.8,,percent of total billed charges,,
Debridement Muscle/Fascia; 1St 20Sq Cm Or Less (Pbb),,11043,CPT,Professional,Outpatient,,,,890,756.5,93.8,890,Medica,Medica Advantage Solution,443.22,49.8,,percent of total billed charges,,
Debridement Muscle/Fascia; 1St 20Sq Cm Or Less (Pbb),,11043,CPT,Facility,Outpatient,,,,617,524.45,176.8322,617,Medica,Medical Assistance,275.182,44.6,,percent of total billed charges,,
Debridement Muscle/Fascia; 1St 20Sq Cm Or Less (Pbb),,11043,CPT,Professional,Outpatient,,,,890,756.5,93.8,890,Medica,Medical Assistance,108.3,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Debridement Muscle/Fascia; 1St 20Sq Cm Or Less (Pbb),,11043,CPT,Facility,Outpatient,,,,617,524.45,176.8322,617,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,307.266,49.8,,percent of total billed charges,,
Debridement Muscle/Fascia; 1St 20Sq Cm Or Less (Pbb),,11043,CPT,Professional,Outpatient,,,,890,756.5,93.8,890,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,145.98,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Debridement Muscle/Fascia; 1St 20Sq Cm Or Less (Pbb),,11043,CPT,Facility,Outpatient,,,,617,524.45,176.8322,617,"Multiplan, Inc.","Multiplan, Inc.",579.98,94,,percent of total billed charges,,
Debridement Muscle/Fascia; 1St 20Sq Cm Or Less (Pbb),,11043,CPT,Professional,Outpatient,,,,890,756.5,93.8,890,"Multiplan, Inc.","Multiplan, Inc.",836.6,94,,percent of total billed charges,,
Debridement Muscle/Fascia; 1St 20Sq Cm Or Less (Pbb),,11043,CPT,Facility,Outpatient,,,,617,524.45,176.8322,617,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,555.917,90.1,,percent of total billed charges,,
Debridement Muscle/Fascia; 1St 20Sq Cm Or Less (Pbb),,11043,CPT,Professional,Outpatient,,,,890,756.5,93.8,890,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,801.89,90.1,,percent of total billed charges,,
Debridement Muscle/Fascia; 1St 20Sq Cm Or Less (Pbb),,11043,CPT,Facility,Outpatient,,,,617,524.45,176.8322,617,"Preferred One Administrative Services, INC.",PPO,608.362,98.6,,percent of total billed charges,,
Debridement Muscle/Fascia; 1St 20Sq Cm Or Less (Pbb),,11043,CPT,Professional,Outpatient,,,,890,756.5,93.8,890,"Preferred One Administrative Services, INC.",PPO,877.54,98.6,,percent of total billed charges,,
Debridement Muscle/Fascia; 1St 20Sq Cm Or Less (Pbb),,11043,CPT,Facility,Outpatient,,,,617,524.45,176.8322,617,PrimeWest Health,Minnesota Senior Health Options (MSHO),317.4465,51.45,,percent of total billed charges,,
Debridement Muscle/Fascia; 1St 20Sq Cm Or Less (Pbb),,11043,CPT,Professional,Outpatient,,,,890,756.5,93.8,890,PrimeWest Health,Minnesota Senior Health Options (MSHO),167.877,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Debridement Muscle/Fascia; 1St 20Sq Cm Or Less (Pbb),,11043,CPT,Facility,Outpatient,,,,617,524.45,176.8322,617,PrimeWest Health,MinnesotaCare,316.8912,51.36,,percent of total billed charges,,
Debridement Muscle/Fascia; 1St 20Sq Cm Or Less (Pbb),,11043,CPT,Professional,Outpatient,,,,890,756.5,93.8,890,PrimeWest Health,MinnesotaCare,115.8761208,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Debridement Muscle/Fascia; 1St 20Sq Cm Or Less (Pbb),,11043,CPT,Facility,Outpatient,,,,617,524.45,176.8322,617,Sanford Health Plan,Sanford Health Plan,567.64,92,,percent of total billed charges,,
Debridement Muscle/Fascia; 1St 20Sq Cm Or Less (Pbb),,11043,CPT,Professional,Outpatient,,,,890,756.5,93.8,890,Sanford Health Plan,Sanford Health Plan,783.2,88,,percent of total billed charges,,
Debridement Muscle/Fascia; 1St 20Sq Cm Or Less (Pbb),,11043,CPT,Facility,Outpatient,,,,617,524.45,176.8322,617,"UCare Health, Inc.",Individual & Family Plan,347.6795,56.35,,percent of total billed charges,,
Debridement Muscle/Fascia; 1St 20Sq Cm Or Less (Pbb),,11043,CPT,Professional,Outpatient,,,,890,756.5,93.8,890,"UCare Health, Inc.",Individual & Family Plan,237.305088,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Debridement Muscle/Fascia; 1St 20Sq Cm Or Less (Pbb),,11043,CPT,Facility,Outpatient,,,,617,524.45,176.8322,617,"UCare Health, Inc.",Medical Assistance,311.3999,50.47,,percent of total billed charges,,
Debridement Muscle/Fascia; 1St 20Sq Cm Or Less (Pbb),,11043,CPT,Professional,Outpatient,,,,890,756.5,93.8,890,"UCare Health, Inc.",Medical Assistance,119.124984,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Debridement Muscle/Fascia; 1St 20Sq Cm Or Less (Pbb),,11043,CPT,Facility,Outpatient,,,,617,524.45,176.8322,617,"UCare Health, Inc.",Medicare Advantage,311.3999,50.47,,percent of total billed charges,,
Debridement Muscle/Fascia; 1St 20Sq Cm Or Less (Pbb),,11043,CPT,Professional,Outpatient,,,,890,756.5,93.8,890,"UCare Health, Inc.",Medicare Advantage,167.877,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Debridement Muscle/Fascia; 1St 20Sq Cm Or Less (Pbb),,11043,CPT,Facility,Outpatient,,,,617,524.45,176.8322,617,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),311.3999,50.47,,percent of total billed charges,,
Debridement Muscle/Fascia; 1St 20Sq Cm Or Less (Pbb),,11043,CPT,Professional,Outpatient,,,,890,756.5,93.8,890,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),134.3016,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Debridement Muscle/Fascia; 1St 20Sq Cm Or Less (Pbb),,11043,CPT,Facility,Outpatient,,,,617,524.45,176.8322,617,UnitedHealthcare,Individual & Family,579.98,94,,percent of total billed charges,,
Debridement Muscle/Fascia; 1St 20Sq Cm Or Less (Pbb),,11043,CPT,Professional,Outpatient,,,,890,756.5,93.8,890,UnitedHealthcare,Individual & Family,890,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Debridement Muscle/Fascia; 1St 20Sq Cm Or Less (Pbb),,11043,CPT,Facility,Outpatient,,,,617,524.45,176.8322,617,UnitedHealthcare,Medicare Advantage,302.33,49,,percent of total billed charges,,
Debridement Muscle/Fascia; 1St 20Sq Cm Or Less (Pbb),,11043,CPT,Professional,Outpatient,,,,890,756.5,93.8,890,UnitedHealthcare,Medicare Advantage,167.877,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Debridement Muscle/Fascia; 1St 20Sq Cm Or Less (Pbb),,11043,CPT,Facility,Outpatient,,,,617,524.45,176.8322,617,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,296.16,48,,percent of total billed charges,,100% of DHS outpatient percentage
Debridement Muscle/Fascia; 1St 20Sq Cm Or Less (Pbb),,11043,CPT,Professional,Outpatient,,,,890,756.5,93.8,890,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,108.29544,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Debridement, Muscle And/Or Fascia; First 20 Sq Cm Or Less (Pro Cah)",,11043,CPT,Professional,Both,,,,1507,1280.95,93.8,1507,Aetna,Commercial,1280.95,85,,percent of total billed charges,,
"Debridement, Muscle And/Or Fascia; First 20 Sq Cm Or Less (Pro Cah)",,11043,CPT,Professional,Both,,,,1507,1280.95,93.8,1507,Aetna,Medicare Advantage,148.87,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Debridement, Muscle And/Or Fascia; First 20 Sq Cm Or Less (Pro Cah)",,11043,CPT,Professional,Both,,,,1507,1280.95,93.8,1507,Aetna,PPO,1401.51,93,,percent of total billed charges,,
"Debridement, Muscle And/Or Fascia; First 20 Sq Cm Or Less (Pro Cah)",,11043,CPT,Professional,Both,,,,1507,1280.95,93.8,1507,America's PPO,America's PPO,1287.5808,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Debridement, Muscle And/Or Fascia; First 20 Sq Cm Or Less (Pro Cah)",,11043,CPT,Professional,Both,,,,1507,1280.95,93.8,1507,BlueCross BlueShield Minnesota, Federal Employee Program,313.31,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Debridement, Muscle And/Or Fascia; First 20 Sq Cm Or Less (Pro Cah)",,11043,CPT,Professional,Both,,,,1507,1280.95,93.8,1507,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,318.32296,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Debridement, Muscle And/Or Fascia; First 20 Sq Cm Or Less (Pro Cah)",,11043,CPT,Professional,Both,,,,1507,1280.95,93.8,1507,BlueCross BlueShield Minnesota,High Value Network Plan,318.32296,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Debridement, Muscle And/Or Fascia; First 20 Sq Cm Or Less (Pro Cah)",,11043,CPT,Professional,Both,,,,1507,1280.95,93.8,1507,BlueCross BlueShield Minnesota,Medicare Advantage,167.877,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Debridement, Muscle And/Or Fascia; First 20 Sq Cm Or Less (Pro Cah)",,11043,CPT,Professional,Both,,,,1507,1280.95,93.8,1507,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,318.32296,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Debridement, Muscle And/Or Fascia; First 20 Sq Cm Or Less (Pro Cah)",,11043,CPT,Professional,Both,,,,1507,1280.95,93.8,1507,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,108.29544,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Debridement, Muscle And/Or Fascia; First 20 Sq Cm Or Less (Pro Cah)",,11043,CPT,Professional,Both,,,,1507,1280.95,93.8,1507,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),167.877,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Debridement, Muscle And/Or Fascia; First 20 Sq Cm Or Less (Pro Cah)",,11043,CPT,Professional,Both,,,,1507,1280.95,93.8,1507,CorVel,Worker's Compensation,286.3410081,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Debridement, Muscle And/Or Fascia; First 20 Sq Cm Or Less (Pro Cah)",,11043,CPT,Professional,Both,,,,1507,1280.95,93.8,1507,First Health Group Corporation,First Health Network,1461.79,97,,percent of total billed charges,,
"Debridement, Muscle And/Or Fascia; First 20 Sq Cm Or Less (Pro Cah)",,11043,CPT,Professional,Both,,,,1507,1280.95,93.8,1507,"Health Partners, Inc.",Commercial,309.08,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Debridement, Muscle And/Or Fascia; First 20 Sq Cm Or Less (Pro Cah)",,11043,CPT,Professional,Both,,,,1507,1280.95,93.8,1507,"Health Partners, Inc.",Medicare Advantage,167.877,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Debridement, Muscle And/Or Fascia; First 20 Sq Cm Or Less (Pro Cah)",,11043,CPT,Professional,Both,,,,1507,1280.95,93.8,1507,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),146.05,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Debridement, Muscle And/Or Fascia; First 20 Sq Cm Or Less (Pro Cah)",,11043,CPT,Professional,Both,,,,1507,1280.95,93.8,1507,"Health Partners, Inc.",State of Minnesota Advantage Program,266.27242,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Debridement, Muscle And/Or Fascia; First 20 Sq Cm Or Less (Pro Cah)",,11043,CPT,Professional,Both,,,,1507,1280.95,93.8,1507,"Health Partners, Inc.",State Public Programs,93.8,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Debridement, Muscle And/Or Fascia; First 20 Sq Cm Or Less (Pro Cah)",,11043,CPT,Professional,Both,,,,1507,1280.95,93.8,1507,Humana Insurance Company,Commercial PPO,145.98,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Debridement, Muscle And/Or Fascia; First 20 Sq Cm Or Less (Pro Cah)",,11043,CPT,Professional,Both,,,,1507,1280.95,93.8,1507,Humana Insurance Company,Medicare PPO,1507,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Debridement, Muscle And/Or Fascia; First 20 Sq Cm Or Less (Pro Cah)",,11043,CPT,Professional,Both,,,,1507,1280.95,93.8,1507,Medica,Individual & Family,1277.936,84.8,,percent of total billed charges,,
"Debridement, Muscle And/Or Fascia; First 20 Sq Cm Or Less (Pro Cah)",,11043,CPT,Professional,Both,,,,1507,1280.95,93.8,1507,Medica,Medica Advantage Solution,750.486,49.8,,percent of total billed charges,,
"Debridement, Muscle And/Or Fascia; First 20 Sq Cm Or Less (Pro Cah)",,11043,CPT,Professional,Both,,,,1507,1280.95,93.8,1507,Medica,Medical Assistance,108.3,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Debridement, Muscle And/Or Fascia; First 20 Sq Cm Or Less (Pro Cah)",,11043,CPT,Professional,Both,,,,1507,1280.95,93.8,1507,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,145.98,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Debridement, Muscle And/Or Fascia; First 20 Sq Cm Or Less (Pro Cah)",,11043,CPT,Professional,Both,,,,1507,1280.95,93.8,1507,"Multiplan, Inc.","Multiplan, Inc.",1416.58,94,,percent of total billed charges,,
"Debridement, Muscle And/Or Fascia; First 20 Sq Cm Or Less (Pro Cah)",,11043,CPT,Professional,Both,,,,1507,1280.95,93.8,1507,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1357.807,90.1,,percent of total billed charges,,
"Debridement, Muscle And/Or Fascia; First 20 Sq Cm Or Less (Pro Cah)",,11043,CPT,Professional,Both,,,,1507,1280.95,93.8,1507,"Preferred One Administrative Services, INC.",PPO,1485.902,98.6,,percent of total billed charges,,
"Debridement, Muscle And/Or Fascia; First 20 Sq Cm Or Less (Pro Cah)",,11043,CPT,Professional,Both,,,,1507,1280.95,93.8,1507,PrimeWest Health,Minnesota Senior Health Options (MSHO),167.877,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Debridement, Muscle And/Or Fascia; First 20 Sq Cm Or Less (Pro Cah)",,11043,CPT,Professional,Both,,,,1507,1280.95,93.8,1507,PrimeWest Health,MinnesotaCare,115.8761208,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Debridement, Muscle And/Or Fascia; First 20 Sq Cm Or Less (Pro Cah)",,11043,CPT,Professional,Both,,,,1507,1280.95,93.8,1507,Sanford Health Plan,Sanford Health Plan,1326.16,88,,percent of total billed charges,,
"Debridement, Muscle And/Or Fascia; First 20 Sq Cm Or Less (Pro Cah)",,11043,CPT,Professional,Both,,,,1507,1280.95,93.8,1507,"UCare Health, Inc.",Individual & Family Plan,237.305088,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Debridement, Muscle And/Or Fascia; First 20 Sq Cm Or Less (Pro Cah)",,11043,CPT,Professional,Both,,,,1507,1280.95,93.8,1507,"UCare Health, Inc.",Medical Assistance,119.124984,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Debridement, Muscle And/Or Fascia; First 20 Sq Cm Or Less (Pro Cah)",,11043,CPT,Professional,Both,,,,1507,1280.95,93.8,1507,"UCare Health, Inc.",Medicare Advantage,167.877,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Debridement, Muscle And/Or Fascia; First 20 Sq Cm Or Less (Pro Cah)",,11043,CPT,Professional,Both,,,,1507,1280.95,93.8,1507,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),134.3016,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Debridement, Muscle And/Or Fascia; First 20 Sq Cm Or Less (Pro Cah)",,11043,CPT,Professional,Both,,,,1507,1280.95,93.8,1507,UnitedHealthcare,Individual & Family,1507,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Debridement, Muscle And/Or Fascia; First 20 Sq Cm Or Less (Pro Cah)",,11043,CPT,Professional,Both,,,,1507,1280.95,93.8,1507,UnitedHealthcare,Medicare Advantage,167.877,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Debridement, Muscle And/Or Fascia; First 20 Sq Cm Or Less (Pro Cah)",,11043,CPT,Professional,Both,,,,1507,1280.95,93.8,1507,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,108.29544,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Skin Debridement Subq Tissue/Muscle 1St 20Cm2,,11043,CPT,Facility,Both,,,,259,220.15,74.2294,259,Aetna,Commercial,238.28,92,,percent of total billed charges,,
Skin Debridement Subq Tissue/Muscle 1St 20Cm2,,11043,CPT,Facility,Outpatient,,,,259,220.15,74.2294,259,Aetna,Medicare Advantage,126.91,49,,percent of total billed charges,,
Skin Debridement Subq Tissue/Muscle 1St 20Cm2,,11043,CPT,Facility,Inpatient,,,,259,220.15,74.2294,259,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Skin Debridement Subq Tissue/Muscle 1St 20Cm2,,11043,CPT,Facility,Both,,,,259,220.15,74.2294,259,Aetna,PPO,240.87,93,,percent of total billed charges,,
Skin Debridement Subq Tissue/Muscle 1St 20Cm2,,11043,CPT,Facility,Both,,,,259,220.15,74.2294,259,America's PPO,America's PPO,248.7177,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Skin Debridement Subq Tissue/Muscle 1St 20Cm2,,11043,CPT,Facility,Both,,,,259,220.15,74.2294,259,BlueCross BlueShield Minnesota, Federal Employee Program,254.856,98.4,,percent of total billed charges,,
Skin Debridement Subq Tissue/Muscle 1St 20Cm2,,11043,CPT,Facility,Both,,,,259,220.15,74.2294,259,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,259,100,,percent of total billed charges,,
Skin Debridement Subq Tissue/Muscle 1St 20Cm2,,11043,CPT,Facility,Both,,,,259,220.15,74.2294,259,BlueCross BlueShield Minnesota,High Value Network Plan,233.1,90,,percent of total billed charges,,
Skin Debridement Subq Tissue/Muscle 1St 20Cm2,,11043,CPT,Facility,Outpatient,,,,259,220.15,74.2294,259,BlueCross BlueShield Minnesota,Medicare Advantage,126.91,49,,percent of total billed charges,,
Skin Debridement Subq Tissue/Muscle 1St 20Cm2,,11043,CPT,Facility,Inpatient,,,,259,220.15,74.2294,259,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Skin Debridement Subq Tissue/Muscle 1St 20Cm2,,11043,CPT,Facility,Both,,,,259,220.15,74.2294,259,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,229.3963,88.57,,percent of total billed charges,,
Skin Debridement Subq Tissue/Muscle 1St 20Cm2,,11043,CPT,Facility,Both,,,,259,220.15,74.2294,259,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,74.2294,28.66,,percent of total billed charges,,
Skin Debridement Subq Tissue/Muscle 1St 20Cm2,,11043,CPT,Facility,Outpatient,,,,259,220.15,74.2294,259,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),126.91,49,,percent of total billed charges,,
Skin Debridement Subq Tissue/Muscle 1St 20Cm2,,11043,CPT,Facility,Inpatient,,,,259,220.15,74.2294,259,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Skin Debridement Subq Tissue/Muscle 1St 20Cm2,,11043,CPT,Facility,Both,,,,259,220.15,74.2294,259,CorVel,Worker's Compensation,259,100,,percent of total billed charges,,
Skin Debridement Subq Tissue/Muscle 1St 20Cm2,,11043,CPT,Facility,Both,,,,259,220.15,74.2294,259,First Health Group Corporation,First Health Network,251.23,97,,percent of total billed charges,,
Skin Debridement Subq Tissue/Muscle 1St 20Cm2,,11043,CPT,Facility,Both,,,,259,220.15,74.2294,259,"Health Partners, Inc.",Commercial,245.014,94.6,,percent of total billed charges,,
Skin Debridement Subq Tissue/Muscle 1St 20Cm2,,11043,CPT,Facility,Outpatient,,,,259,220.15,74.2294,259,"Health Partners, Inc.",Medicare Advantage,126.91,49,,percent of total billed charges,,
Skin Debridement Subq Tissue/Muscle 1St 20Cm2,,11043,CPT,Facility,Inpatient,,,,259,220.15,74.2294,259,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Skin Debridement Subq Tissue/Muscle 1St 20Cm2,,11043,CPT,Facility,Both,,,,259,220.15,74.2294,259,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),155.4,60,,percent of total billed charges,,
Skin Debridement Subq Tissue/Muscle 1St 20Cm2,,11043,CPT,Facility,Both,,,,259,220.15,74.2294,259,"Health Partners, Inc.",State of Minnesota Advantage Program,211.085,81.5,,percent of total billed charges,,
Skin Debridement Subq Tissue/Muscle 1St 20Cm2,,11043,CPT,Facility,Both,,,,259,220.15,74.2294,259,"Health Partners, Inc.",State Public Programs,129.5,50,,percent of total billed charges,,
Skin Debridement Subq Tissue/Muscle 1St 20Cm2,,11043,CPT,Facility,Both,,,,259,220.15,74.2294,259,Humana Insurance Company,Commercial PPO,246.05,95,,percent of total billed charges,,
Skin Debridement Subq Tissue/Muscle 1St 20Cm2,,11043,CPT,Facility,Outpatient,,,,259,220.15,74.2294,259,Humana Insurance Company,Medicare PPO,126.91,49,,percent of total billed charges,,
Skin Debridement Subq Tissue/Muscle 1St 20Cm2,,11043,CPT,Facility,Inpatient,,,,259,220.15,74.2294,259,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Skin Debridement Subq Tissue/Muscle 1St 20Cm2,,11043,CPT,Facility,Both,,,,259,220.15,74.2294,259,Medica,Individual & Family,256.669,99.1,,percent of total billed charges,,
Skin Debridement Subq Tissue/Muscle 1St 20Cm2,,11043,CPT,Facility,Outpatient,,,,259,220.15,74.2294,259,Medica,Medica Advantage Solution,128.982,49.8,,percent of total billed charges,,
Skin Debridement Subq Tissue/Muscle 1St 20Cm2,,11043,CPT,Facility,Inpatient,,,,259,220.15,74.2294,259,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Skin Debridement Subq Tissue/Muscle 1St 20Cm2,,11043,CPT,Facility,Outpatient,,,,259,220.15,74.2294,259,Medica,Medical Assistance,115.514,44.6,,percent of total billed charges,,
Skin Debridement Subq Tissue/Muscle 1St 20Cm2,,11043,CPT,Facility,Inpatient,,,,259,220.15,74.2294,259,Medica,Medical Assistance,,,,,Included in per diem rate,
Skin Debridement Subq Tissue/Muscle 1St 20Cm2,,11043,CPT,Facility,Outpatient,,,,259,220.15,74.2294,259,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,128.982,49.8,,percent of total billed charges,,
Skin Debridement Subq Tissue/Muscle 1St 20Cm2,,11043,CPT,Facility,Inpatient,,,,259,220.15,74.2294,259,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Skin Debridement Subq Tissue/Muscle 1St 20Cm2,,11043,CPT,Facility,Both,,,,259,220.15,74.2294,259,"Multiplan, Inc.","Multiplan, Inc.",243.46,94,,percent of total billed charges,,
Skin Debridement Subq Tissue/Muscle 1St 20Cm2,,11043,CPT,Facility,Outpatient,,,,259,220.15,74.2294,259,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,233.359,90.1,,percent of total billed charges,,
Skin Debridement Subq Tissue/Muscle 1St 20Cm2,,11043,CPT,Facility,Inpatient,,,,259,220.15,74.2294,259,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Skin Debridement Subq Tissue/Muscle 1St 20Cm2,,11043,CPT,Facility,Both,,,,259,220.15,74.2294,259,"Preferred One Administrative Services, INC.",PPO,255.374,98.6,,percent of total billed charges,,
Skin Debridement Subq Tissue/Muscle 1St 20Cm2,,11043,CPT,Facility,Outpatient,,,,259,220.15,74.2294,259,PrimeWest Health,Minnesota Senior Health Options (MSHO),133.2555,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Skin Debridement Subq Tissue/Muscle 1St 20Cm2,,11043,CPT,Facility,Inpatient,,,,259,220.15,74.2294,259,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Skin Debridement Subq Tissue/Muscle 1St 20Cm2,,11043,CPT,Facility,Outpatient,,,,259,220.15,74.2294,259,PrimeWest Health,MinnesotaCare,133.0224,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Skin Debridement Subq Tissue/Muscle 1St 20Cm2,,11043,CPT,Facility,Inpatient,,,,259,220.15,74.2294,259,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Skin Debridement Subq Tissue/Muscle 1St 20Cm2,,11043,CPT,Facility,Both,,,,259,220.15,74.2294,259,Sanford Health Plan,Sanford Health Plan,238.28,92,,percent of total billed charges,,
Skin Debridement Subq Tissue/Muscle 1St 20Cm2,,11043,CPT,Facility,Outpatient,,,,259,220.15,74.2294,259,"UCare Health, Inc.",Individual & Family Plan,145.9465,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Skin Debridement Subq Tissue/Muscle 1St 20Cm2,,11043,CPT,Facility,Inpatient,,,,259,220.15,74.2294,259,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Skin Debridement Subq Tissue/Muscle 1St 20Cm2,,11043,CPT,Facility,Outpatient,,,,259,220.15,74.2294,259,"UCare Health, Inc.",Medical Assistance,130.7173,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Skin Debridement Subq Tissue/Muscle 1St 20Cm2,,11043,CPT,Facility,Inpatient,,,,259,220.15,74.2294,259,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Skin Debridement Subq Tissue/Muscle 1St 20Cm2,,11043,CPT,Facility,Outpatient,,,,259,220.15,74.2294,259,"UCare Health, Inc.",Medicare Advantage,130.7173,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Skin Debridement Subq Tissue/Muscle 1St 20Cm2,,11043,CPT,Facility,Inpatient,,,,259,220.15,74.2294,259,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Skin Debridement Subq Tissue/Muscle 1St 20Cm2,,11043,CPT,Facility,Outpatient,,,,259,220.15,74.2294,259,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),130.7173,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Skin Debridement Subq Tissue/Muscle 1St 20Cm2,,11043,CPT,Facility,Inpatient,,,,259,220.15,74.2294,259,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Skin Debridement Subq Tissue/Muscle 1St 20Cm2,,11043,CPT,Facility,Both,,,,259,220.15,74.2294,259,UnitedHealthcare,Individual & Family,243.46,94,,percent of total billed charges,,
Skin Debridement Subq Tissue/Muscle 1St 20Cm2,,11043,CPT,Facility,Outpatient,,,,259,220.15,74.2294,259,UnitedHealthcare,Medicare Advantage,126.91,49,,percent of total billed charges,,
Skin Debridement Subq Tissue/Muscle 1St 20Cm2,,11043,CPT,Facility,Inpatient,,,,259,220.15,74.2294,259,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Skin Debridement Subq Tissue/Muscle 1St 20Cm2,,11043,CPT,Facility,Outpatient,,,,259,220.15,74.2294,259,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,124.32,48,,percent of total billed charges,,100% of DHS outpatient percentage
Skin Debridement Subq Tissue/Muscle 1St 20Cm2,,11043,CPT,Facility,Inpatient,,,,259,220.15,74.2294,259,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Debridement, Bone; First 20 Sq Cm Or Less (Pro Cah)",,11044,CPT,Professional,Both,,,,821,697.85,136.56,821,Aetna,Commercial,697.85,85,,percent of total billed charges,,
"Debridement, Bone; First 20 Sq Cm Or Less (Pro Cah)",,11044,CPT,Professional,Both,,,,821,697.85,136.56,821,Aetna,Medicare Advantage,215.63,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Debridement, Bone; First 20 Sq Cm Or Less (Pro Cah)",,11044,CPT,Professional,Both,,,,821,697.85,136.56,821,Aetna,PPO,763.53,93,,percent of total billed charges,,
"Debridement, Bone; First 20 Sq Cm Or Less (Pro Cah)",,11044,CPT,Professional,Both,,,,821,697.85,136.56,821,America's PPO,America's PPO,701.4624,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Debridement, Bone; First 20 Sq Cm Or Less (Pro Cah)",,11044,CPT,Professional,Both,,,,821,697.85,136.56,821,BlueCross BlueShield Minnesota, Federal Employee Program,459.3,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Debridement, Bone; First 20 Sq Cm Or Less (Pro Cah)",,11044,CPT,Professional,Both,,,,821,697.85,136.56,821,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,466.6488,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Debridement, Bone; First 20 Sq Cm Or Less (Pro Cah)",,11044,CPT,Professional,Both,,,,821,697.85,136.56,821,BlueCross BlueShield Minnesota,High Value Network Plan,466.6488,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Debridement, Bone; First 20 Sq Cm Or Less (Pro Cah)",,11044,CPT,Professional,Both,,,,821,697.85,136.56,821,BlueCross BlueShield Minnesota,Medicare Advantage,244.283,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Debridement, Bone; First 20 Sq Cm Or Less (Pro Cah)",,11044,CPT,Professional,Both,,,,821,697.85,136.56,821,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,466.6488,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Debridement, Bone; First 20 Sq Cm Or Less (Pro Cah)",,11044,CPT,Professional,Both,,,,821,697.85,136.56,821,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,157.66288,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Debridement, Bone; First 20 Sq Cm Or Less (Pro Cah)",,11044,CPT,Professional,Both,,,,821,697.85,136.56,821,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),244.283,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Debridement, Bone; First 20 Sq Cm Or Less (Pro Cah)",,11044,CPT,Professional,Both,,,,821,697.85,136.56,821,CorVel,Worker's Compensation,416.689095,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Debridement, Bone; First 20 Sq Cm Or Less (Pro Cah)",,11044,CPT,Professional,Both,,,,821,697.85,136.56,821,First Health Group Corporation,First Health Network,796.37,97,,percent of total billed charges,,
"Debridement, Bone; First 20 Sq Cm Or Less (Pro Cah)",,11044,CPT,Professional,Both,,,,821,697.85,136.56,821,"Health Partners, Inc.",Commercial,449.82,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Debridement, Bone; First 20 Sq Cm Or Less (Pro Cah)",,11044,CPT,Professional,Both,,,,821,697.85,136.56,821,"Health Partners, Inc.",Medicare Advantage,244.283,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Debridement, Bone; First 20 Sq Cm Or Less (Pro Cah)",,11044,CPT,Professional,Both,,,,821,697.85,136.56,821,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),212.47,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Debridement, Bone; First 20 Sq Cm Or Less (Pro Cah)",,11044,CPT,Professional,Both,,,,821,697.85,136.56,821,"Health Partners, Inc.",State of Minnesota Advantage Program,387.51993,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Debridement, Bone; First 20 Sq Cm Or Less (Pro Cah)",,11044,CPT,Professional,Both,,,,821,697.85,136.56,821,"Health Partners, Inc.",State Public Programs,136.56,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Debridement, Bone; First 20 Sq Cm Or Less (Pro Cah)",,11044,CPT,Professional,Both,,,,821,697.85,136.56,821,Humana Insurance Company,Commercial PPO,212.42,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Debridement, Bone; First 20 Sq Cm Or Less (Pro Cah)",,11044,CPT,Professional,Both,,,,821,697.85,136.56,821,Humana Insurance Company,Medicare PPO,821,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Debridement, Bone; First 20 Sq Cm Or Less (Pro Cah)",,11044,CPT,Professional,Both,,,,821,697.85,136.56,821,Medica,Individual & Family,696.208,84.8,,percent of total billed charges,,
"Debridement, Bone; First 20 Sq Cm Or Less (Pro Cah)",,11044,CPT,Professional,Both,,,,821,697.85,136.56,821,Medica,Medica Advantage Solution,408.858,49.8,,percent of total billed charges,,
"Debridement, Bone; First 20 Sq Cm Or Less (Pro Cah)",,11044,CPT,Professional,Both,,,,821,697.85,136.56,821,Medica,Medical Assistance,157.66,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Debridement, Bone; First 20 Sq Cm Or Less (Pro Cah)",,11044,CPT,Professional,Both,,,,821,697.85,136.56,821,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,212.42,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Debridement, Bone; First 20 Sq Cm Or Less (Pro Cah)",,11044,CPT,Professional,Both,,,,821,697.85,136.56,821,"Multiplan, Inc.","Multiplan, Inc.",771.74,94,,percent of total billed charges,,
"Debridement, Bone; First 20 Sq Cm Or Less (Pro Cah)",,11044,CPT,Professional,Both,,,,821,697.85,136.56,821,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,739.721,90.1,,percent of total billed charges,,
"Debridement, Bone; First 20 Sq Cm Or Less (Pro Cah)",,11044,CPT,Professional,Both,,,,821,697.85,136.56,821,"Preferred One Administrative Services, INC.",PPO,809.506,98.6,,percent of total billed charges,,
"Debridement, Bone; First 20 Sq Cm Or Less (Pro Cah)",,11044,CPT,Professional,Both,,,,821,697.85,136.56,821,PrimeWest Health,Minnesota Senior Health Options (MSHO),244.283,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Debridement, Bone; First 20 Sq Cm Or Less (Pro Cah)",,11044,CPT,Professional,Both,,,,821,697.85,136.56,821,PrimeWest Health,MinnesotaCare,168.6992816,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Debridement, Bone; First 20 Sq Cm Or Less (Pro Cah)",,11044,CPT,Professional,Both,,,,821,697.85,136.56,821,Sanford Health Plan,Sanford Health Plan,722.48,88,,percent of total billed charges,,
"Debridement, Bone; First 20 Sq Cm Or Less (Pro Cah)",,11044,CPT,Professional,Both,,,,821,697.85,136.56,821,"UCare Health, Inc.",Individual & Family Plan,345.309952,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Debridement, Bone; First 20 Sq Cm Or Less (Pro Cah)",,11044,CPT,Professional,Both,,,,821,697.85,136.56,821,"UCare Health, Inc.",Medical Assistance,173.429168,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Debridement, Bone; First 20 Sq Cm Or Less (Pro Cah)",,11044,CPT,Professional,Both,,,,821,697.85,136.56,821,"UCare Health, Inc.",Medicare Advantage,244.283,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Debridement, Bone; First 20 Sq Cm Or Less (Pro Cah)",,11044,CPT,Professional,Both,,,,821,697.85,136.56,821,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),195.4264,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Debridement, Bone; First 20 Sq Cm Or Less (Pro Cah)",,11044,CPT,Professional,Both,,,,821,697.85,136.56,821,UnitedHealthcare,Individual & Family,821,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Debridement, Bone; First 20 Sq Cm Or Less (Pro Cah)",,11044,CPT,Professional,Both,,,,821,697.85,136.56,821,UnitedHealthcare,Medicare Advantage,244.283,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Debridement, Bone; First 20 Sq Cm Or Less (Pro Cah)",,11044,CPT,Professional,Both,,,,821,697.85,136.56,821,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,157.66288,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Removal Of Skin And Bone First 20 Sq Cm Or Less,,11044,CPT,Facility,Both,,,,505,429.25,144.733,505,Aetna,Commercial,464.6,92,,percent of total billed charges,,
Removal Of Skin And Bone First 20 Sq Cm Or Less,,11044,CPT,Facility,Outpatient,,,,505,429.25,144.733,505,Aetna,Medicare Advantage,247.45,49,,percent of total billed charges,,
Removal Of Skin And Bone First 20 Sq Cm Or Less,,11044,CPT,Facility,Inpatient,,,,505,429.25,144.733,505,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Removal Of Skin And Bone First 20 Sq Cm Or Less,,11044,CPT,Facility,Both,,,,505,429.25,144.733,505,Aetna,PPO,469.65,93,,percent of total billed charges,,
Removal Of Skin And Bone First 20 Sq Cm Or Less,,11044,CPT,Facility,Both,,,,505,429.25,144.733,505,America's PPO,America's PPO,484.9515,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Removal Of Skin And Bone First 20 Sq Cm Or Less,,11044,CPT,Facility,Both,,,,505,429.25,144.733,505,BlueCross BlueShield Minnesota, Federal Employee Program,496.92,98.4,,percent of total billed charges,,
Removal Of Skin And Bone First 20 Sq Cm Or Less,,11044,CPT,Facility,Both,,,,505,429.25,144.733,505,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,505,100,,percent of total billed charges,,
Removal Of Skin And Bone First 20 Sq Cm Or Less,,11044,CPT,Facility,Both,,,,505,429.25,144.733,505,BlueCross BlueShield Minnesota,High Value Network Plan,454.5,90,,percent of total billed charges,,
Removal Of Skin And Bone First 20 Sq Cm Or Less,,11044,CPT,Facility,Outpatient,,,,505,429.25,144.733,505,BlueCross BlueShield Minnesota,Medicare Advantage,247.45,49,,percent of total billed charges,,
Removal Of Skin And Bone First 20 Sq Cm Or Less,,11044,CPT,Facility,Inpatient,,,,505,429.25,144.733,505,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Removal Of Skin And Bone First 20 Sq Cm Or Less,,11044,CPT,Facility,Both,,,,505,429.25,144.733,505,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,447.2785,88.57,,percent of total billed charges,,
Removal Of Skin And Bone First 20 Sq Cm Or Less,,11044,CPT,Facility,Both,,,,505,429.25,144.733,505,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,144.733,28.66,,percent of total billed charges,,
Removal Of Skin And Bone First 20 Sq Cm Or Less,,11044,CPT,Facility,Outpatient,,,,505,429.25,144.733,505,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),247.45,49,,percent of total billed charges,,
Removal Of Skin And Bone First 20 Sq Cm Or Less,,11044,CPT,Facility,Inpatient,,,,505,429.25,144.733,505,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Removal Of Skin And Bone First 20 Sq Cm Or Less,,11044,CPT,Facility,Both,,,,505,429.25,144.733,505,CorVel,Worker's Compensation,505,100,,percent of total billed charges,,
Removal Of Skin And Bone First 20 Sq Cm Or Less,,11044,CPT,Facility,Both,,,,505,429.25,144.733,505,First Health Group Corporation,First Health Network,489.85,97,,percent of total billed charges,,
Removal Of Skin And Bone First 20 Sq Cm Or Less,,11044,CPT,Facility,Both,,,,505,429.25,144.733,505,"Health Partners, Inc.",Commercial,477.73,94.6,,percent of total billed charges,,
Removal Of Skin And Bone First 20 Sq Cm Or Less,,11044,CPT,Facility,Outpatient,,,,505,429.25,144.733,505,"Health Partners, Inc.",Medicare Advantage,247.45,49,,percent of total billed charges,,
Removal Of Skin And Bone First 20 Sq Cm Or Less,,11044,CPT,Facility,Inpatient,,,,505,429.25,144.733,505,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Removal Of Skin And Bone First 20 Sq Cm Or Less,,11044,CPT,Facility,Both,,,,505,429.25,144.733,505,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),303,60,,percent of total billed charges,,
Removal Of Skin And Bone First 20 Sq Cm Or Less,,11044,CPT,Facility,Both,,,,505,429.25,144.733,505,"Health Partners, Inc.",State of Minnesota Advantage Program,411.575,81.5,,percent of total billed charges,,
Removal Of Skin And Bone First 20 Sq Cm Or Less,,11044,CPT,Facility,Both,,,,505,429.25,144.733,505,"Health Partners, Inc.",State Public Programs,252.5,50,,percent of total billed charges,,
Removal Of Skin And Bone First 20 Sq Cm Or Less,,11044,CPT,Facility,Both,,,,505,429.25,144.733,505,Humana Insurance Company,Commercial PPO,479.75,95,,percent of total billed charges,,
Removal Of Skin And Bone First 20 Sq Cm Or Less,,11044,CPT,Facility,Outpatient,,,,505,429.25,144.733,505,Humana Insurance Company,Medicare PPO,247.45,49,,percent of total billed charges,,
Removal Of Skin And Bone First 20 Sq Cm Or Less,,11044,CPT,Facility,Inpatient,,,,505,429.25,144.733,505,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Removal Of Skin And Bone First 20 Sq Cm Or Less,,11044,CPT,Facility,Both,,,,505,429.25,144.733,505,Medica,Individual & Family,500.455,99.1,,percent of total billed charges,,
Removal Of Skin And Bone First 20 Sq Cm Or Less,,11044,CPT,Facility,Outpatient,,,,505,429.25,144.733,505,Medica,Medica Advantage Solution,251.49,49.8,,percent of total billed charges,,
Removal Of Skin And Bone First 20 Sq Cm Or Less,,11044,CPT,Facility,Inpatient,,,,505,429.25,144.733,505,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Removal Of Skin And Bone First 20 Sq Cm Or Less,,11044,CPT,Facility,Outpatient,,,,505,429.25,144.733,505,Medica,Medical Assistance,449,,,Other,Grouper,All inclusive per visit
Removal Of Skin And Bone First 20 Sq Cm Or Less,,11044,CPT,Facility,Inpatient,,,,505,429.25,144.733,505,Medica,Medical Assistance,,,,,Included in per diem rate,
Removal Of Skin And Bone First 20 Sq Cm Or Less,,11044,CPT,Facility,Outpatient,,,,505,429.25,144.733,505,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,251.49,49.8,,percent of total billed charges,,
Removal Of Skin And Bone First 20 Sq Cm Or Less,,11044,CPT,Facility,Inpatient,,,,505,429.25,144.733,505,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Removal Of Skin And Bone First 20 Sq Cm Or Less,,11044,CPT,Facility,Both,,,,505,429.25,144.733,505,"Multiplan, Inc.","Multiplan, Inc.",474.7,94,,percent of total billed charges,,
Removal Of Skin And Bone First 20 Sq Cm Or Less,,11044,CPT,Facility,Outpatient,,,,505,429.25,144.733,505,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,455.005,90.1,,percent of total billed charges,,
Removal Of Skin And Bone First 20 Sq Cm Or Less,,11044,CPT,Facility,Inpatient,,,,505,429.25,144.733,505,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Removal Of Skin And Bone First 20 Sq Cm Or Less,,11044,CPT,Facility,Both,,,,505,429.25,144.733,505,"Preferred One Administrative Services, INC.",PPO,497.93,98.6,,percent of total billed charges,,
Removal Of Skin And Bone First 20 Sq Cm Or Less,,11044,CPT,Facility,Outpatient,,,,505,429.25,144.733,505,PrimeWest Health,Minnesota Senior Health Options (MSHO),259.8225,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Removal Of Skin And Bone First 20 Sq Cm Or Less,,11044,CPT,Facility,Inpatient,,,,505,429.25,144.733,505,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Removal Of Skin And Bone First 20 Sq Cm Or Less,,11044,CPT,Facility,Outpatient,,,,505,429.25,144.733,505,PrimeWest Health,MinnesotaCare,259.368,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Removal Of Skin And Bone First 20 Sq Cm Or Less,,11044,CPT,Facility,Inpatient,,,,505,429.25,144.733,505,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Removal Of Skin And Bone First 20 Sq Cm Or Less,,11044,CPT,Facility,Both,,,,505,429.25,144.733,505,Sanford Health Plan,Sanford Health Plan,464.6,92,,percent of total billed charges,,
Removal Of Skin And Bone First 20 Sq Cm Or Less,,11044,CPT,Facility,Outpatient,,,,505,429.25,144.733,505,"UCare Health, Inc.",Individual & Family Plan,284.5675,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Removal Of Skin And Bone First 20 Sq Cm Or Less,,11044,CPT,Facility,Inpatient,,,,505,429.25,144.733,505,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Removal Of Skin And Bone First 20 Sq Cm Or Less,,11044,CPT,Facility,Outpatient,,,,505,429.25,144.733,505,"UCare Health, Inc.",Medical Assistance,254.8735,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Removal Of Skin And Bone First 20 Sq Cm Or Less,,11044,CPT,Facility,Inpatient,,,,505,429.25,144.733,505,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Removal Of Skin And Bone First 20 Sq Cm Or Less,,11044,CPT,Facility,Outpatient,,,,505,429.25,144.733,505,"UCare Health, Inc.",Medicare Advantage,254.8735,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Removal Of Skin And Bone First 20 Sq Cm Or Less,,11044,CPT,Facility,Inpatient,,,,505,429.25,144.733,505,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Removal Of Skin And Bone First 20 Sq Cm Or Less,,11044,CPT,Facility,Outpatient,,,,505,429.25,144.733,505,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),254.8735,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Removal Of Skin And Bone First 20 Sq Cm Or Less,,11044,CPT,Facility,Inpatient,,,,505,429.25,144.733,505,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Removal Of Skin And Bone First 20 Sq Cm Or Less,,11044,CPT,Facility,Both,,,,505,429.25,144.733,505,UnitedHealthcare,Individual & Family,474.7,94,,percent of total billed charges,,
Removal Of Skin And Bone First 20 Sq Cm Or Less,,11044,CPT,Facility,Outpatient,,,,505,429.25,144.733,505,UnitedHealthcare,Medicare Advantage,247.45,49,,percent of total billed charges,,
Removal Of Skin And Bone First 20 Sq Cm Or Less,,11044,CPT,Facility,Inpatient,,,,505,429.25,144.733,505,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Removal Of Skin And Bone First 20 Sq Cm Or Less,,11044,CPT,Facility,Outpatient,,,,505,429.25,144.733,505,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,242.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
Removal Of Skin And Bone First 20 Sq Cm Or Less,,11044,CPT,Facility,Inpatient,,,,505,429.25,144.733,505,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Skin Debridement Subq Tissue Ea Addl 20Cm2,,11045,CPT,Facility,Both,,,,53,45.05,15.1898,53,Aetna,Commercial,48.76,92,,percent of total billed charges,,
Skin Debridement Subq Tissue Ea Addl 20Cm2,,11045,CPT,Facility,Outpatient,,,,53,45.05,15.1898,53,Aetna,Medicare Advantage,25.97,49,,percent of total billed charges,,
Skin Debridement Subq Tissue Ea Addl 20Cm2,,11045,CPT,Facility,Inpatient,,,,53,45.05,15.1898,53,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Skin Debridement Subq Tissue Ea Addl 20Cm2,,11045,CPT,Facility,Both,,,,53,45.05,15.1898,53,Aetna,PPO,49.29,93,,percent of total billed charges,,
Skin Debridement Subq Tissue Ea Addl 20Cm2,,11045,CPT,Facility,Both,,,,53,45.05,15.1898,53,America's PPO,America's PPO,50.8959,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Skin Debridement Subq Tissue Ea Addl 20Cm2,,11045,CPT,Facility,Both,,,,53,45.05,15.1898,53,BlueCross BlueShield Minnesota, Federal Employee Program,52.152,98.4,,percent of total billed charges,,
Skin Debridement Subq Tissue Ea Addl 20Cm2,,11045,CPT,Facility,Both,,,,53,45.05,15.1898,53,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,53,100,,percent of total billed charges,,
Skin Debridement Subq Tissue Ea Addl 20Cm2,,11045,CPT,Facility,Both,,,,53,45.05,15.1898,53,BlueCross BlueShield Minnesota,High Value Network Plan,47.7,90,,percent of total billed charges,,
Skin Debridement Subq Tissue Ea Addl 20Cm2,,11045,CPT,Facility,Outpatient,,,,53,45.05,15.1898,53,BlueCross BlueShield Minnesota,Medicare Advantage,25.97,49,,percent of total billed charges,,
Skin Debridement Subq Tissue Ea Addl 20Cm2,,11045,CPT,Facility,Inpatient,,,,53,45.05,15.1898,53,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Skin Debridement Subq Tissue Ea Addl 20Cm2,,11045,CPT,Facility,Both,,,,53,45.05,15.1898,53,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,46.9421,88.57,,percent of total billed charges,,
Skin Debridement Subq Tissue Ea Addl 20Cm2,,11045,CPT,Facility,Both,,,,53,45.05,15.1898,53,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,15.1898,28.66,,percent of total billed charges,,
Skin Debridement Subq Tissue Ea Addl 20Cm2,,11045,CPT,Facility,Outpatient,,,,53,45.05,15.1898,53,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),25.97,49,,percent of total billed charges,,
Skin Debridement Subq Tissue Ea Addl 20Cm2,,11045,CPT,Facility,Inpatient,,,,53,45.05,15.1898,53,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Skin Debridement Subq Tissue Ea Addl 20Cm2,,11045,CPT,Facility,Both,,,,53,45.05,15.1898,53,CorVel,Worker's Compensation,53,100,,percent of total billed charges,,
Skin Debridement Subq Tissue Ea Addl 20Cm2,,11045,CPT,Facility,Both,,,,53,45.05,15.1898,53,First Health Group Corporation,First Health Network,51.41,97,,percent of total billed charges,,
Skin Debridement Subq Tissue Ea Addl 20Cm2,,11045,CPT,Facility,Both,,,,53,45.05,15.1898,53,"Health Partners, Inc.",Commercial,50.138,94.6,,percent of total billed charges,,
Skin Debridement Subq Tissue Ea Addl 20Cm2,,11045,CPT,Facility,Outpatient,,,,53,45.05,15.1898,53,"Health Partners, Inc.",Medicare Advantage,25.97,49,,percent of total billed charges,,
Skin Debridement Subq Tissue Ea Addl 20Cm2,,11045,CPT,Facility,Inpatient,,,,53,45.05,15.1898,53,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Skin Debridement Subq Tissue Ea Addl 20Cm2,,11045,CPT,Facility,Both,,,,53,45.05,15.1898,53,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),31.8,60,,percent of total billed charges,,
Skin Debridement Subq Tissue Ea Addl 20Cm2,,11045,CPT,Facility,Both,,,,53,45.05,15.1898,53,"Health Partners, Inc.",State of Minnesota Advantage Program,43.195,81.5,,percent of total billed charges,,
Skin Debridement Subq Tissue Ea Addl 20Cm2,,11045,CPT,Facility,Both,,,,53,45.05,15.1898,53,"Health Partners, Inc.",State Public Programs,26.5,50,,percent of total billed charges,,
Skin Debridement Subq Tissue Ea Addl 20Cm2,,11045,CPT,Facility,Both,,,,53,45.05,15.1898,53,Humana Insurance Company,Commercial PPO,50.35,95,,percent of total billed charges,,
Skin Debridement Subq Tissue Ea Addl 20Cm2,,11045,CPT,Facility,Outpatient,,,,53,45.05,15.1898,53,Humana Insurance Company,Medicare PPO,25.97,49,,percent of total billed charges,,
Skin Debridement Subq Tissue Ea Addl 20Cm2,,11045,CPT,Facility,Inpatient,,,,53,45.05,15.1898,53,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Skin Debridement Subq Tissue Ea Addl 20Cm2,,11045,CPT,Facility,Both,,,,53,45.05,15.1898,53,Medica,Individual & Family,52.523,99.1,,percent of total billed charges,,
Skin Debridement Subq Tissue Ea Addl 20Cm2,,11045,CPT,Facility,Outpatient,,,,53,45.05,15.1898,53,Medica,Medica Advantage Solution,26.394,49.8,,percent of total billed charges,,
Skin Debridement Subq Tissue Ea Addl 20Cm2,,11045,CPT,Facility,Inpatient,,,,53,45.05,15.1898,53,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Skin Debridement Subq Tissue Ea Addl 20Cm2,,11045,CPT,Facility,Outpatient,,,,53,45.05,15.1898,53,Medica,Medical Assistance,23.638,44.6,,percent of total billed charges,,
Skin Debridement Subq Tissue Ea Addl 20Cm2,,11045,CPT,Facility,Inpatient,,,,53,45.05,15.1898,53,Medica,Medical Assistance,,,,,Included in per diem rate,
Skin Debridement Subq Tissue Ea Addl 20Cm2,,11045,CPT,Facility,Outpatient,,,,53,45.05,15.1898,53,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,26.394,49.8,,percent of total billed charges,,
Skin Debridement Subq Tissue Ea Addl 20Cm2,,11045,CPT,Facility,Inpatient,,,,53,45.05,15.1898,53,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Skin Debridement Subq Tissue Ea Addl 20Cm2,,11045,CPT,Facility,Both,,,,53,45.05,15.1898,53,"Multiplan, Inc.","Multiplan, Inc.",49.82,94,,percent of total billed charges,,
Skin Debridement Subq Tissue Ea Addl 20Cm2,,11045,CPT,Facility,Outpatient,,,,53,45.05,15.1898,53,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,47.753,90.1,,percent of total billed charges,,
Skin Debridement Subq Tissue Ea Addl 20Cm2,,11045,CPT,Facility,Inpatient,,,,53,45.05,15.1898,53,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Skin Debridement Subq Tissue Ea Addl 20Cm2,,11045,CPT,Facility,Both,,,,53,45.05,15.1898,53,"Preferred One Administrative Services, INC.",PPO,52.258,98.6,,percent of total billed charges,,
Skin Debridement Subq Tissue Ea Addl 20Cm2,,11045,CPT,Facility,Outpatient,,,,53,45.05,15.1898,53,PrimeWest Health,Minnesota Senior Health Options (MSHO),27.2685,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Skin Debridement Subq Tissue Ea Addl 20Cm2,,11045,CPT,Facility,Inpatient,,,,53,45.05,15.1898,53,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Skin Debridement Subq Tissue Ea Addl 20Cm2,,11045,CPT,Facility,Outpatient,,,,53,45.05,15.1898,53,PrimeWest Health,MinnesotaCare,27.2208,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Skin Debridement Subq Tissue Ea Addl 20Cm2,,11045,CPT,Facility,Inpatient,,,,53,45.05,15.1898,53,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Skin Debridement Subq Tissue Ea Addl 20Cm2,,11045,CPT,Facility,Both,,,,53,45.05,15.1898,53,Sanford Health Plan,Sanford Health Plan,48.76,92,,percent of total billed charges,,
Skin Debridement Subq Tissue Ea Addl 20Cm2,,11045,CPT,Facility,Outpatient,,,,53,45.05,15.1898,53,"UCare Health, Inc.",Individual & Family Plan,29.8655,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Skin Debridement Subq Tissue Ea Addl 20Cm2,,11045,CPT,Facility,Inpatient,,,,53,45.05,15.1898,53,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Skin Debridement Subq Tissue Ea Addl 20Cm2,,11045,CPT,Facility,Outpatient,,,,53,45.05,15.1898,53,"UCare Health, Inc.",Medical Assistance,26.7491,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Skin Debridement Subq Tissue Ea Addl 20Cm2,,11045,CPT,Facility,Inpatient,,,,53,45.05,15.1898,53,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Skin Debridement Subq Tissue Ea Addl 20Cm2,,11045,CPT,Facility,Outpatient,,,,53,45.05,15.1898,53,"UCare Health, Inc.",Medicare Advantage,26.7491,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Skin Debridement Subq Tissue Ea Addl 20Cm2,,11045,CPT,Facility,Inpatient,,,,53,45.05,15.1898,53,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Skin Debridement Subq Tissue Ea Addl 20Cm2,,11045,CPT,Facility,Outpatient,,,,53,45.05,15.1898,53,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),26.7491,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Skin Debridement Subq Tissue Ea Addl 20Cm2,,11045,CPT,Facility,Inpatient,,,,53,45.05,15.1898,53,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Skin Debridement Subq Tissue Ea Addl 20Cm2,,11045,CPT,Facility,Both,,,,53,45.05,15.1898,53,UnitedHealthcare,Individual & Family,49.82,94,,percent of total billed charges,,
Skin Debridement Subq Tissue Ea Addl 20Cm2,,11045,CPT,Facility,Outpatient,,,,53,45.05,15.1898,53,UnitedHealthcare,Medicare Advantage,25.97,49,,percent of total billed charges,,
Skin Debridement Subq Tissue Ea Addl 20Cm2,,11045,CPT,Facility,Inpatient,,,,53,45.05,15.1898,53,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Skin Debridement Subq Tissue Ea Addl 20Cm2,,11045,CPT,Facility,Outpatient,,,,53,45.05,15.1898,53,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,25.44,48,,percent of total billed charges,,100% of DHS outpatient percentage
Skin Debridement Subq Tissue Ea Addl 20Cm2,,11045,CPT,Facility,Inpatient,,,,53,45.05,15.1898,53,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Debridement, Muscle And/Or Facia;Ea Addl 20 Sq Cm (Pbb)",,11046,CPT,Facility,Outpatient,,,,196,166.6,56.1736,196,Aetna,Commercial,180.32,92,,percent of total billed charges,,
"Debridement, Muscle And/Or Facia;Ea Addl 20 Sq Cm (Pbb)",,11046,CPT,Professional,Outpatient,,,,306,260.1,32.5,306,Aetna,Commercial,260.1,85,,percent of total billed charges,,
"Debridement, Muscle And/Or Facia;Ea Addl 20 Sq Cm (Pbb)",,11046,CPT,Facility,Outpatient,,,,196,166.6,56.1736,196,Aetna,Medicare Advantage,96.04,49,,percent of total billed charges,,
"Debridement, Muscle And/Or Facia;Ea Addl 20 Sq Cm (Pbb)",,11046,CPT,Professional,Outpatient,,,,306,260.1,32.5,306,Aetna,Medicare Advantage,52.54,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Debridement, Muscle And/Or Facia;Ea Addl 20 Sq Cm (Pbb)",,11046,CPT,Facility,Outpatient,,,,196,166.6,56.1736,196,Aetna,PPO,182.28,93,,percent of total billed charges,,
"Debridement, Muscle And/Or Facia;Ea Addl 20 Sq Cm (Pbb)",,11046,CPT,Professional,Outpatient,,,,306,260.1,32.5,306,Aetna,PPO,284.58,93,,percent of total billed charges,,
"Debridement, Muscle And/Or Facia;Ea Addl 20 Sq Cm (Pbb)",,11046,CPT,Facility,Outpatient,,,,196,166.6,56.1736,196,America's PPO,America's PPO,188.2188,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Debridement, Muscle And/Or Facia;Ea Addl 20 Sq Cm (Pbb)",,11046,CPT,Professional,Outpatient,,,,306,260.1,32.5,306,America's PPO,America's PPO,261.4464,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Debridement, Muscle And/Or Facia;Ea Addl 20 Sq Cm (Pbb)",,11046,CPT,Facility,Outpatient,,,,196,166.6,56.1736,196,BlueCross BlueShield Minnesota, Federal Employee Program,192.864,98.4,,percent of total billed charges,,
"Debridement, Muscle And/Or Facia;Ea Addl 20 Sq Cm (Pbb)",,11046,CPT,Professional,Outpatient,,,,306,260.1,32.5,306,BlueCross BlueShield Minnesota, Federal Employee Program,111.55,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Debridement, Muscle And/Or Facia;Ea Addl 20 Sq Cm (Pbb)",,11046,CPT,Facility,Outpatient,,,,196,166.6,56.1736,196,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,196,100,,percent of total billed charges,,
"Debridement, Muscle And/Or Facia;Ea Addl 20 Sq Cm (Pbb)",,11046,CPT,Professional,Outpatient,,,,306,260.1,32.5,306,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,113.3348,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Debridement, Muscle And/Or Facia;Ea Addl 20 Sq Cm (Pbb)",,11046,CPT,Facility,Outpatient,,,,196,166.6,56.1736,196,BlueCross BlueShield Minnesota,High Value Network Plan,176.4,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
"Debridement, Muscle And/Or Facia;Ea Addl 20 Sq Cm (Pbb)",,11046,CPT,Professional,Outpatient,,,,306,260.1,32.5,306,BlueCross BlueShield Minnesota,High Value Network Plan,113.3348,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Debridement, Muscle And/Or Facia;Ea Addl 20 Sq Cm (Pbb)",,11046,CPT,Facility,Outpatient,,,,196,166.6,56.1736,196,BlueCross BlueShield Minnesota,Medicare Advantage,96.04,49,,percent of total billed charges,,
"Debridement, Muscle And/Or Facia;Ea Addl 20 Sq Cm (Pbb)",,11046,CPT,Professional,Outpatient,,,,306,260.1,32.5,306,BlueCross BlueShield Minnesota,Medicare Advantage,58.443,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Debridement, Muscle And/Or Facia;Ea Addl 20 Sq Cm (Pbb)",,11046,CPT,Professional,Outpatient,,,,306,260.1,32.5,306,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,113.3348,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Debridement, Muscle And/Or Facia;Ea Addl 20 Sq Cm (Pbb)",,11046,CPT,Facility,Outpatient,,,,196,166.6,56.1736,196,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,56.1736,28.66,,percent of total billed charges,,
"Debridement, Muscle And/Or Facia;Ea Addl 20 Sq Cm (Pbb)",,11046,CPT,Professional,Outpatient,,,,306,260.1,32.5,306,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,37.52088,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Debridement, Muscle And/Or Facia;Ea Addl 20 Sq Cm (Pbb)",,11046,CPT,Facility,Outpatient,,,,196,166.6,56.1736,196,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),96.04,49,,percent of total billed charges,,
"Debridement, Muscle And/Or Facia;Ea Addl 20 Sq Cm (Pbb)",,11046,CPT,Professional,Outpatient,,,,306,260.1,32.5,306,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),58.443,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Debridement, Muscle And/Or Facia;Ea Addl 20 Sq Cm (Pbb)",,11046,CPT,Facility,Outpatient,,,,196,166.6,56.1736,196,CorVel,Worker's Compensation,196,100,,percent of total billed charges,,
"Debridement, Muscle And/Or Facia;Ea Addl 20 Sq Cm (Pbb)",,11046,CPT,Professional,Outpatient,,,,306,260.1,32.5,306,CorVel,Worker's Compensation,101.144586,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Debridement, Muscle And/Or Facia;Ea Addl 20 Sq Cm (Pbb)",,11046,CPT,Facility,Outpatient,,,,196,166.6,56.1736,196,First Health Group Corporation,First Health Network,190.12,97,,percent of total billed charges,,
"Debridement, Muscle And/Or Facia;Ea Addl 20 Sq Cm (Pbb)",,11046,CPT,Professional,Outpatient,,,,306,260.1,32.5,306,First Health Group Corporation,First Health Network,296.82,97,,percent of total billed charges,,
"Debridement, Muscle And/Or Facia;Ea Addl 20 Sq Cm (Pbb)",,11046,CPT,Facility,Outpatient,,,,196,166.6,56.1736,196,"Health Partners, Inc.",Commercial,185.416,94.6,,percent of total billed charges,,
"Debridement, Muscle And/Or Facia;Ea Addl 20 Sq Cm (Pbb)",,11046,CPT,Professional,Outpatient,,,,306,260.1,32.5,306,"Health Partners, Inc.",Commercial,109.56,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Debridement, Muscle And/Or Facia;Ea Addl 20 Sq Cm (Pbb)",,11046,CPT,Facility,Outpatient,,,,196,166.6,56.1736,196,"Health Partners, Inc.",Medicare Advantage,96.04,49,,percent of total billed charges,,
"Debridement, Muscle And/Or Facia;Ea Addl 20 Sq Cm (Pbb)",,11046,CPT,Professional,Outpatient,,,,306,260.1,32.5,306,"Health Partners, Inc.",Medicare Advantage,58.443,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Debridement, Muscle And/Or Facia;Ea Addl 20 Sq Cm (Pbb)",,11046,CPT,Facility,Outpatient,,,,196,166.6,56.1736,196,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),117.6,60,,percent of total billed charges,,
"Debridement, Muscle And/Or Facia;Ea Addl 20 Sq Cm (Pbb)",,11046,CPT,Professional,Outpatient,,,,306,260.1,32.5,306,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),50.83,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Debridement, Muscle And/Or Facia;Ea Addl 20 Sq Cm (Pbb)",,11046,CPT,Facility,Outpatient,,,,196,166.6,56.1736,196,"Health Partners, Inc.",State of Minnesota Advantage Program,159.74,81.5,,percent of total billed charges,,
"Debridement, Muscle And/Or Facia;Ea Addl 20 Sq Cm (Pbb)",,11046,CPT,Professional,Outpatient,,,,306,260.1,32.5,306,"Health Partners, Inc.",State of Minnesota Advantage Program,94.38594,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Debridement, Muscle And/Or Facia;Ea Addl 20 Sq Cm (Pbb)",,11046,CPT,Facility,Outpatient,,,,196,166.6,56.1736,196,"Health Partners, Inc.",State Public Programs,98,50,,percent of total billed charges,,
"Debridement, Muscle And/Or Facia;Ea Addl 20 Sq Cm (Pbb)",,11046,CPT,Professional,Outpatient,,,,306,260.1,32.5,306,"Health Partners, Inc.",State Public Programs,32.5,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Debridement, Muscle And/Or Facia;Ea Addl 20 Sq Cm (Pbb)",,11046,CPT,Facility,Outpatient,,,,196,166.6,56.1736,196,Humana Insurance Company,Commercial PPO,186.2,95,,percent of total billed charges,,
"Debridement, Muscle And/Or Facia;Ea Addl 20 Sq Cm (Pbb)",,11046,CPT,Professional,Outpatient,,,,306,260.1,32.5,306,Humana Insurance Company,Commercial PPO,50.82,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Debridement, Muscle And/Or Facia;Ea Addl 20 Sq Cm (Pbb)",,11046,CPT,Facility,Outpatient,,,,196,166.6,56.1736,196,Humana Insurance Company,Medicare PPO,96.04,49,,percent of total billed charges,,
"Debridement, Muscle And/Or Facia;Ea Addl 20 Sq Cm (Pbb)",,11046,CPT,Professional,Outpatient,,,,306,260.1,32.5,306,Humana Insurance Company,Medicare PPO,306,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Debridement, Muscle And/Or Facia;Ea Addl 20 Sq Cm (Pbb)",,11046,CPT,Facility,Outpatient,,,,196,166.6,56.1736,196,Medica,Individual & Family,194.236,99.1,,percent of total billed charges,,
"Debridement, Muscle And/Or Facia;Ea Addl 20 Sq Cm (Pbb)",,11046,CPT,Professional,Outpatient,,,,306,260.1,32.5,306,Medica,Individual & Family,259.488,84.8,,percent of total billed charges,,
"Debridement, Muscle And/Or Facia;Ea Addl 20 Sq Cm (Pbb)",,11046,CPT,Facility,Outpatient,,,,196,166.6,56.1736,196,Medica,Medica Advantage Solution,97.608,49.8,,percent of total billed charges,,
"Debridement, Muscle And/Or Facia;Ea Addl 20 Sq Cm (Pbb)",,11046,CPT,Professional,Outpatient,,,,306,260.1,32.5,306,Medica,Medica Advantage Solution,152.388,49.8,,percent of total billed charges,,
"Debridement, Muscle And/Or Facia;Ea Addl 20 Sq Cm (Pbb)",,11046,CPT,Facility,Outpatient,,,,196,166.6,56.1736,196,Medica,Medical Assistance,87.416,44.6,,percent of total billed charges,,
"Debridement, Muscle And/Or Facia;Ea Addl 20 Sq Cm (Pbb)",,11046,CPT,Professional,Outpatient,,,,306,260.1,32.5,306,Medica,Medical Assistance,37.52,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Debridement, Muscle And/Or Facia;Ea Addl 20 Sq Cm (Pbb)",,11046,CPT,Facility,Outpatient,,,,196,166.6,56.1736,196,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,97.608,49.8,,percent of total billed charges,,
"Debridement, Muscle And/Or Facia;Ea Addl 20 Sq Cm (Pbb)",,11046,CPT,Professional,Outpatient,,,,306,260.1,32.5,306,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,50.82,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Debridement, Muscle And/Or Facia;Ea Addl 20 Sq Cm (Pbb)",,11046,CPT,Facility,Outpatient,,,,196,166.6,56.1736,196,"Multiplan, Inc.","Multiplan, Inc.",184.24,94,,percent of total billed charges,,
"Debridement, Muscle And/Or Facia;Ea Addl 20 Sq Cm (Pbb)",,11046,CPT,Professional,Outpatient,,,,306,260.1,32.5,306,"Multiplan, Inc.","Multiplan, Inc.",287.64,94,,percent of total billed charges,,
"Debridement, Muscle And/Or Facia;Ea Addl 20 Sq Cm (Pbb)",,11046,CPT,Facility,Outpatient,,,,196,166.6,56.1736,196,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,176.596,90.1,,percent of total billed charges,,
"Debridement, Muscle And/Or Facia;Ea Addl 20 Sq Cm (Pbb)",,11046,CPT,Professional,Outpatient,,,,306,260.1,32.5,306,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,275.706,90.1,,percent of total billed charges,,
"Debridement, Muscle And/Or Facia;Ea Addl 20 Sq Cm (Pbb)",,11046,CPT,Facility,Outpatient,,,,196,166.6,56.1736,196,"Preferred One Administrative Services, INC.",PPO,193.256,98.6,,percent of total billed charges,,
"Debridement, Muscle And/Or Facia;Ea Addl 20 Sq Cm (Pbb)",,11046,CPT,Professional,Outpatient,,,,306,260.1,32.5,306,"Preferred One Administrative Services, INC.",PPO,301.716,98.6,,percent of total billed charges,,
"Debridement, Muscle And/Or Facia;Ea Addl 20 Sq Cm (Pbb)",,11046,CPT,Facility,Outpatient,,,,196,166.6,56.1736,196,PrimeWest Health,Minnesota Senior Health Options (MSHO),100.842,51.45,,percent of total billed charges,,
"Debridement, Muscle And/Or Facia;Ea Addl 20 Sq Cm (Pbb)",,11046,CPT,Professional,Outpatient,,,,306,260.1,32.5,306,PrimeWest Health,Minnesota Senior Health Options (MSHO),58.443,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Debridement, Muscle And/Or Facia;Ea Addl 20 Sq Cm (Pbb)",,11046,CPT,Facility,Outpatient,,,,196,166.6,56.1736,196,PrimeWest Health,MinnesotaCare,100.6656,51.36,,percent of total billed charges,,
"Debridement, Muscle And/Or Facia;Ea Addl 20 Sq Cm (Pbb)",,11046,CPT,Professional,Outpatient,,,,306,260.1,32.5,306,PrimeWest Health,MinnesotaCare,40.1473416,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Debridement, Muscle And/Or Facia;Ea Addl 20 Sq Cm (Pbb)",,11046,CPT,Facility,Outpatient,,,,196,166.6,56.1736,196,Sanford Health Plan,Sanford Health Plan,180.32,92,,percent of total billed charges,,
"Debridement, Muscle And/Or Facia;Ea Addl 20 Sq Cm (Pbb)",,11046,CPT,Professional,Outpatient,,,,306,260.1,32.5,306,Sanford Health Plan,Sanford Health Plan,269.28,88,,percent of total billed charges,,
"Debridement, Muscle And/Or Facia;Ea Addl 20 Sq Cm (Pbb)",,11046,CPT,Facility,Outpatient,,,,196,166.6,56.1736,196,"UCare Health, Inc.",Individual & Family Plan,110.446,56.35,,percent of total billed charges,,
"Debridement, Muscle And/Or Facia;Ea Addl 20 Sq Cm (Pbb)",,11046,CPT,Professional,Outpatient,,,,306,260.1,32.5,306,"UCare Health, Inc.",Individual & Family Plan,82.612992,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Debridement, Muscle And/Or Facia;Ea Addl 20 Sq Cm (Pbb)",,11046,CPT,Facility,Outpatient,,,,196,166.6,56.1736,196,"UCare Health, Inc.",Medical Assistance,98.9212,50.47,,percent of total billed charges,,
"Debridement, Muscle And/Or Facia;Ea Addl 20 Sq Cm (Pbb)",,11046,CPT,Professional,Outpatient,,,,306,260.1,32.5,306,"UCare Health, Inc.",Medical Assistance,41.272968,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Debridement, Muscle And/Or Facia;Ea Addl 20 Sq Cm (Pbb)",,11046,CPT,Facility,Outpatient,,,,196,166.6,56.1736,196,"UCare Health, Inc.",Medicare Advantage,98.9212,50.47,,percent of total billed charges,,
"Debridement, Muscle And/Or Facia;Ea Addl 20 Sq Cm (Pbb)",,11046,CPT,Professional,Outpatient,,,,306,260.1,32.5,306,"UCare Health, Inc.",Medicare Advantage,58.443,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Debridement, Muscle And/Or Facia;Ea Addl 20 Sq Cm (Pbb)",,11046,CPT,Facility,Outpatient,,,,196,166.6,56.1736,196,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),98.9212,50.47,,percent of total billed charges,,
"Debridement, Muscle And/Or Facia;Ea Addl 20 Sq Cm (Pbb)",,11046,CPT,Professional,Outpatient,,,,306,260.1,32.5,306,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),46.7544,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Debridement, Muscle And/Or Facia;Ea Addl 20 Sq Cm (Pbb)",,11046,CPT,Facility,Outpatient,,,,196,166.6,56.1736,196,UnitedHealthcare,Individual & Family,184.24,94,,percent of total billed charges,,
"Debridement, Muscle And/Or Facia;Ea Addl 20 Sq Cm (Pbb)",,11046,CPT,Professional,Outpatient,,,,306,260.1,32.5,306,UnitedHealthcare,Individual & Family,306,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Debridement, Muscle And/Or Facia;Ea Addl 20 Sq Cm (Pbb)",,11046,CPT,Facility,Outpatient,,,,196,166.6,56.1736,196,UnitedHealthcare,Medicare Advantage,96.04,49,,percent of total billed charges,,
"Debridement, Muscle And/Or Facia;Ea Addl 20 Sq Cm (Pbb)",,11046,CPT,Professional,Outpatient,,,,306,260.1,32.5,306,UnitedHealthcare,Medicare Advantage,58.443,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Debridement, Muscle And/Or Facia;Ea Addl 20 Sq Cm (Pbb)",,11046,CPT,Facility,Outpatient,,,,196,166.6,56.1736,196,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,94.08,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Debridement, Muscle And/Or Facia;Ea Addl 20 Sq Cm (Pbb)",,11046,CPT,Professional,Outpatient,,,,306,260.1,32.5,306,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,37.52088,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Debridement, Muscle And/Or Fascia; Each Additional 20 Sq Cm, Or Part Thereof (Pro Cah)",,11046,CPT,Professional,Both,,,,502,426.7,32.5,502,Aetna,Commercial,426.7,85,,percent of total billed charges,,
"Debridement, Muscle And/Or Fascia; Each Additional 20 Sq Cm, Or Part Thereof (Pro Cah)",,11046,CPT,Professional,Both,,,,502,426.7,32.5,502,Aetna,Medicare Advantage,52.54,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Debridement, Muscle And/Or Fascia; Each Additional 20 Sq Cm, Or Part Thereof (Pro Cah)",,11046,CPT,Professional,Both,,,,502,426.7,32.5,502,Aetna,PPO,466.86,93,,percent of total billed charges,,
"Debridement, Muscle And/Or Fascia; Each Additional 20 Sq Cm, Or Part Thereof (Pro Cah)",,11046,CPT,Professional,Both,,,,502,426.7,32.5,502,America's PPO,America's PPO,428.9088,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Debridement, Muscle And/Or Fascia; Each Additional 20 Sq Cm, Or Part Thereof (Pro Cah)",,11046,CPT,Professional,Both,,,,502,426.7,32.5,502,BlueCross BlueShield Minnesota, Federal Employee Program,111.55,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Debridement, Muscle And/Or Fascia; Each Additional 20 Sq Cm, Or Part Thereof (Pro Cah)",,11046,CPT,Professional,Both,,,,502,426.7,32.5,502,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,113.3348,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Debridement, Muscle And/Or Fascia; Each Additional 20 Sq Cm, Or Part Thereof (Pro Cah)",,11046,CPT,Professional,Both,,,,502,426.7,32.5,502,BlueCross BlueShield Minnesota,High Value Network Plan,113.3348,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Debridement, Muscle And/Or Fascia; Each Additional 20 Sq Cm, Or Part Thereof (Pro Cah)",,11046,CPT,Professional,Both,,,,502,426.7,32.5,502,BlueCross BlueShield Minnesota,Medicare Advantage,58.443,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Debridement, Muscle And/Or Fascia; Each Additional 20 Sq Cm, Or Part Thereof (Pro Cah)",,11046,CPT,Professional,Both,,,,502,426.7,32.5,502,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,113.3348,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Debridement, Muscle And/Or Fascia; Each Additional 20 Sq Cm, Or Part Thereof (Pro Cah)",,11046,CPT,Professional,Both,,,,502,426.7,32.5,502,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,37.52088,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Debridement, Muscle And/Or Fascia; Each Additional 20 Sq Cm, Or Part Thereof (Pro Cah)",,11046,CPT,Professional,Both,,,,502,426.7,32.5,502,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),58.443,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Debridement, Muscle And/Or Fascia; Each Additional 20 Sq Cm, Or Part Thereof (Pro Cah)",,11046,CPT,Professional,Both,,,,502,426.7,32.5,502,CorVel,Worker's Compensation,101.144586,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Debridement, Muscle And/Or Fascia; Each Additional 20 Sq Cm, Or Part Thereof (Pro Cah)",,11046,CPT,Professional,Both,,,,502,426.7,32.5,502,First Health Group Corporation,First Health Network,486.94,97,,percent of total billed charges,,
"Debridement, Muscle And/Or Fascia; Each Additional 20 Sq Cm, Or Part Thereof (Pro Cah)",,11046,CPT,Professional,Both,,,,502,426.7,32.5,502,"Health Partners, Inc.",Commercial,109.56,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Debridement, Muscle And/Or Fascia; Each Additional 20 Sq Cm, Or Part Thereof (Pro Cah)",,11046,CPT,Professional,Both,,,,502,426.7,32.5,502,"Health Partners, Inc.",Medicare Advantage,58.443,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Debridement, Muscle And/Or Fascia; Each Additional 20 Sq Cm, Or Part Thereof (Pro Cah)",,11046,CPT,Professional,Both,,,,502,426.7,32.5,502,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),50.83,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Debridement, Muscle And/Or Fascia; Each Additional 20 Sq Cm, Or Part Thereof (Pro Cah)",,11046,CPT,Professional,Both,,,,502,426.7,32.5,502,"Health Partners, Inc.",State of Minnesota Advantage Program,94.38594,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Debridement, Muscle And/Or Fascia; Each Additional 20 Sq Cm, Or Part Thereof (Pro Cah)",,11046,CPT,Professional,Both,,,,502,426.7,32.5,502,"Health Partners, Inc.",State Public Programs,32.5,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Debridement, Muscle And/Or Fascia; Each Additional 20 Sq Cm, Or Part Thereof (Pro Cah)",,11046,CPT,Professional,Both,,,,502,426.7,32.5,502,Humana Insurance Company,Commercial PPO,50.82,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Debridement, Muscle And/Or Fascia; Each Additional 20 Sq Cm, Or Part Thereof (Pro Cah)",,11046,CPT,Professional,Both,,,,502,426.7,32.5,502,Humana Insurance Company,Medicare PPO,502,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Debridement, Muscle And/Or Fascia; Each Additional 20 Sq Cm, Or Part Thereof (Pro Cah)",,11046,CPT,Professional,Both,,,,502,426.7,32.5,502,Medica,Individual & Family,425.696,84.8,,percent of total billed charges,,
"Debridement, Muscle And/Or Fascia; Each Additional 20 Sq Cm, Or Part Thereof (Pro Cah)",,11046,CPT,Professional,Both,,,,502,426.7,32.5,502,Medica,Medica Advantage Solution,249.996,49.8,,percent of total billed charges,,
"Debridement, Muscle And/Or Fascia; Each Additional 20 Sq Cm, Or Part Thereof (Pro Cah)",,11046,CPT,Professional,Both,,,,502,426.7,32.5,502,Medica,Medical Assistance,37.52,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Debridement, Muscle And/Or Fascia; Each Additional 20 Sq Cm, Or Part Thereof (Pro Cah)",,11046,CPT,Professional,Both,,,,502,426.7,32.5,502,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,50.82,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Debridement, Muscle And/Or Fascia; Each Additional 20 Sq Cm, Or Part Thereof (Pro Cah)",,11046,CPT,Professional,Both,,,,502,426.7,32.5,502,"Multiplan, Inc.","Multiplan, Inc.",471.88,94,,percent of total billed charges,,
"Debridement, Muscle And/Or Fascia; Each Additional 20 Sq Cm, Or Part Thereof (Pro Cah)",,11046,CPT,Professional,Both,,,,502,426.7,32.5,502,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,452.302,90.1,,percent of total billed charges,,
"Debridement, Muscle And/Or Fascia; Each Additional 20 Sq Cm, Or Part Thereof (Pro Cah)",,11046,CPT,Professional,Both,,,,502,426.7,32.5,502,"Preferred One Administrative Services, INC.",PPO,494.972,98.6,,percent of total billed charges,,
"Debridement, Muscle And/Or Fascia; Each Additional 20 Sq Cm, Or Part Thereof (Pro Cah)",,11046,CPT,Professional,Both,,,,502,426.7,32.5,502,PrimeWest Health,Minnesota Senior Health Options (MSHO),58.443,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Debridement, Muscle And/Or Fascia; Each Additional 20 Sq Cm, Or Part Thereof (Pro Cah)",,11046,CPT,Professional,Both,,,,502,426.7,32.5,502,PrimeWest Health,MinnesotaCare,40.1473416,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Debridement, Muscle And/Or Fascia; Each Additional 20 Sq Cm, Or Part Thereof (Pro Cah)",,11046,CPT,Professional,Both,,,,502,426.7,32.5,502,Sanford Health Plan,Sanford Health Plan,441.76,88,,percent of total billed charges,,
"Debridement, Muscle And/Or Fascia; Each Additional 20 Sq Cm, Or Part Thereof (Pro Cah)",,11046,CPT,Professional,Both,,,,502,426.7,32.5,502,"UCare Health, Inc.",Individual & Family Plan,82.612992,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Debridement, Muscle And/Or Fascia; Each Additional 20 Sq Cm, Or Part Thereof (Pro Cah)",,11046,CPT,Professional,Both,,,,502,426.7,32.5,502,"UCare Health, Inc.",Medical Assistance,41.272968,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Debridement, Muscle And/Or Fascia; Each Additional 20 Sq Cm, Or Part Thereof (Pro Cah)",,11046,CPT,Professional,Both,,,,502,426.7,32.5,502,"UCare Health, Inc.",Medicare Advantage,58.443,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Debridement, Muscle And/Or Fascia; Each Additional 20 Sq Cm, Or Part Thereof (Pro Cah)",,11046,CPT,Professional,Both,,,,502,426.7,32.5,502,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),46.7544,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Debridement, Muscle And/Or Fascia; Each Additional 20 Sq Cm, Or Part Thereof (Pro Cah)",,11046,CPT,Professional,Both,,,,502,426.7,32.5,502,UnitedHealthcare,Individual & Family,502,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Debridement, Muscle And/Or Fascia; Each Additional 20 Sq Cm, Or Part Thereof (Pro Cah)",,11046,CPT,Professional,Both,,,,502,426.7,32.5,502,UnitedHealthcare,Medicare Advantage,58.443,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Debridement, Muscle And/Or Fascia; Each Additional 20 Sq Cm, Or Part Thereof (Pro Cah)",,11046,CPT,Professional,Both,,,,502,426.7,32.5,502,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,37.52088,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Skin Debridement Subq Tissue/Muscle Ea Addl 20Cm2,,11046,CPT,Facility,Both,,,,84,71.4,24.0744,84,Aetna,Commercial,77.28,92,,percent of total billed charges,,
Skin Debridement Subq Tissue/Muscle Ea Addl 20Cm2,,11046,CPT,Facility,Outpatient,,,,84,71.4,24.0744,84,Aetna,Medicare Advantage,41.16,49,,percent of total billed charges,,
Skin Debridement Subq Tissue/Muscle Ea Addl 20Cm2,,11046,CPT,Facility,Inpatient,,,,84,71.4,24.0744,84,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Skin Debridement Subq Tissue/Muscle Ea Addl 20Cm2,,11046,CPT,Facility,Both,,,,84,71.4,24.0744,84,Aetna,PPO,78.12,93,,percent of total billed charges,,
Skin Debridement Subq Tissue/Muscle Ea Addl 20Cm2,,11046,CPT,Facility,Both,,,,84,71.4,24.0744,84,America's PPO,America's PPO,80.6652,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Skin Debridement Subq Tissue/Muscle Ea Addl 20Cm2,,11046,CPT,Facility,Both,,,,84,71.4,24.0744,84,BlueCross BlueShield Minnesota, Federal Employee Program,82.656,98.4,,percent of total billed charges,,
Skin Debridement Subq Tissue/Muscle Ea Addl 20Cm2,,11046,CPT,Facility,Both,,,,84,71.4,24.0744,84,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,84,100,,percent of total billed charges,,
Skin Debridement Subq Tissue/Muscle Ea Addl 20Cm2,,11046,CPT,Facility,Both,,,,84,71.4,24.0744,84,BlueCross BlueShield Minnesota,High Value Network Plan,75.6,90,,percent of total billed charges,,
Skin Debridement Subq Tissue/Muscle Ea Addl 20Cm2,,11046,CPT,Facility,Outpatient,,,,84,71.4,24.0744,84,BlueCross BlueShield Minnesota,Medicare Advantage,41.16,49,,percent of total billed charges,,
Skin Debridement Subq Tissue/Muscle Ea Addl 20Cm2,,11046,CPT,Facility,Inpatient,,,,84,71.4,24.0744,84,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Skin Debridement Subq Tissue/Muscle Ea Addl 20Cm2,,11046,CPT,Facility,Both,,,,84,71.4,24.0744,84,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,74.3988,88.57,,percent of total billed charges,,
Skin Debridement Subq Tissue/Muscle Ea Addl 20Cm2,,11046,CPT,Facility,Both,,,,84,71.4,24.0744,84,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,24.0744,28.66,,percent of total billed charges,,
Skin Debridement Subq Tissue/Muscle Ea Addl 20Cm2,,11046,CPT,Facility,Outpatient,,,,84,71.4,24.0744,84,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),41.16,49,,percent of total billed charges,,
Skin Debridement Subq Tissue/Muscle Ea Addl 20Cm2,,11046,CPT,Facility,Inpatient,,,,84,71.4,24.0744,84,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Skin Debridement Subq Tissue/Muscle Ea Addl 20Cm2,,11046,CPT,Facility,Both,,,,84,71.4,24.0744,84,CorVel,Worker's Compensation,84,100,,percent of total billed charges,,
Skin Debridement Subq Tissue/Muscle Ea Addl 20Cm2,,11046,CPT,Facility,Both,,,,84,71.4,24.0744,84,First Health Group Corporation,First Health Network,81.48,97,,percent of total billed charges,,
Skin Debridement Subq Tissue/Muscle Ea Addl 20Cm2,,11046,CPT,Facility,Both,,,,84,71.4,24.0744,84,"Health Partners, Inc.",Commercial,79.464,94.6,,percent of total billed charges,,
Skin Debridement Subq Tissue/Muscle Ea Addl 20Cm2,,11046,CPT,Facility,Outpatient,,,,84,71.4,24.0744,84,"Health Partners, Inc.",Medicare Advantage,41.16,49,,percent of total billed charges,,
Skin Debridement Subq Tissue/Muscle Ea Addl 20Cm2,,11046,CPT,Facility,Inpatient,,,,84,71.4,24.0744,84,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Skin Debridement Subq Tissue/Muscle Ea Addl 20Cm2,,11046,CPT,Facility,Both,,,,84,71.4,24.0744,84,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),50.4,60,,percent of total billed charges,,
Skin Debridement Subq Tissue/Muscle Ea Addl 20Cm2,,11046,CPT,Facility,Both,,,,84,71.4,24.0744,84,"Health Partners, Inc.",State of Minnesota Advantage Program,68.46,81.5,,percent of total billed charges,,
Skin Debridement Subq Tissue/Muscle Ea Addl 20Cm2,,11046,CPT,Facility,Both,,,,84,71.4,24.0744,84,"Health Partners, Inc.",State Public Programs,42,50,,percent of total billed charges,,
Skin Debridement Subq Tissue/Muscle Ea Addl 20Cm2,,11046,CPT,Facility,Both,,,,84,71.4,24.0744,84,Humana Insurance Company,Commercial PPO,79.8,95,,percent of total billed charges,,
Skin Debridement Subq Tissue/Muscle Ea Addl 20Cm2,,11046,CPT,Facility,Outpatient,,,,84,71.4,24.0744,84,Humana Insurance Company,Medicare PPO,41.16,49,,percent of total billed charges,,
Skin Debridement Subq Tissue/Muscle Ea Addl 20Cm2,,11046,CPT,Facility,Inpatient,,,,84,71.4,24.0744,84,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Skin Debridement Subq Tissue/Muscle Ea Addl 20Cm2,,11046,CPT,Facility,Both,,,,84,71.4,24.0744,84,Medica,Individual & Family,83.244,99.1,,percent of total billed charges,,
Skin Debridement Subq Tissue/Muscle Ea Addl 20Cm2,,11046,CPT,Facility,Outpatient,,,,84,71.4,24.0744,84,Medica,Medica Advantage Solution,41.832,49.8,,percent of total billed charges,,
Skin Debridement Subq Tissue/Muscle Ea Addl 20Cm2,,11046,CPT,Facility,Inpatient,,,,84,71.4,24.0744,84,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Skin Debridement Subq Tissue/Muscle Ea Addl 20Cm2,,11046,CPT,Facility,Outpatient,,,,84,71.4,24.0744,84,Medica,Medical Assistance,37.464,44.6,,percent of total billed charges,,
Skin Debridement Subq Tissue/Muscle Ea Addl 20Cm2,,11046,CPT,Facility,Inpatient,,,,84,71.4,24.0744,84,Medica,Medical Assistance,,,,,Included in per diem rate,
Skin Debridement Subq Tissue/Muscle Ea Addl 20Cm2,,11046,CPT,Facility,Outpatient,,,,84,71.4,24.0744,84,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,41.832,49.8,,percent of total billed charges,,
Skin Debridement Subq Tissue/Muscle Ea Addl 20Cm2,,11046,CPT,Facility,Inpatient,,,,84,71.4,24.0744,84,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Skin Debridement Subq Tissue/Muscle Ea Addl 20Cm2,,11046,CPT,Facility,Both,,,,84,71.4,24.0744,84,"Multiplan, Inc.","Multiplan, Inc.",78.96,94,,percent of total billed charges,,
Skin Debridement Subq Tissue/Muscle Ea Addl 20Cm2,,11046,CPT,Facility,Outpatient,,,,84,71.4,24.0744,84,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,75.684,90.1,,percent of total billed charges,,
Skin Debridement Subq Tissue/Muscle Ea Addl 20Cm2,,11046,CPT,Facility,Inpatient,,,,84,71.4,24.0744,84,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Skin Debridement Subq Tissue/Muscle Ea Addl 20Cm2,,11046,CPT,Facility,Both,,,,84,71.4,24.0744,84,"Preferred One Administrative Services, INC.",PPO,82.824,98.6,,percent of total billed charges,,
Skin Debridement Subq Tissue/Muscle Ea Addl 20Cm2,,11046,CPT,Facility,Outpatient,,,,84,71.4,24.0744,84,PrimeWest Health,Minnesota Senior Health Options (MSHO),43.218,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Skin Debridement Subq Tissue/Muscle Ea Addl 20Cm2,,11046,CPT,Facility,Inpatient,,,,84,71.4,24.0744,84,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Skin Debridement Subq Tissue/Muscle Ea Addl 20Cm2,,11046,CPT,Facility,Outpatient,,,,84,71.4,24.0744,84,PrimeWest Health,MinnesotaCare,43.1424,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Skin Debridement Subq Tissue/Muscle Ea Addl 20Cm2,,11046,CPT,Facility,Inpatient,,,,84,71.4,24.0744,84,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Skin Debridement Subq Tissue/Muscle Ea Addl 20Cm2,,11046,CPT,Facility,Both,,,,84,71.4,24.0744,84,Sanford Health Plan,Sanford Health Plan,77.28,92,,percent of total billed charges,,
Skin Debridement Subq Tissue/Muscle Ea Addl 20Cm2,,11046,CPT,Facility,Outpatient,,,,84,71.4,24.0744,84,"UCare Health, Inc.",Individual & Family Plan,47.334,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Skin Debridement Subq Tissue/Muscle Ea Addl 20Cm2,,11046,CPT,Facility,Inpatient,,,,84,71.4,24.0744,84,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Skin Debridement Subq Tissue/Muscle Ea Addl 20Cm2,,11046,CPT,Facility,Outpatient,,,,84,71.4,24.0744,84,"UCare Health, Inc.",Medical Assistance,42.3948,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Skin Debridement Subq Tissue/Muscle Ea Addl 20Cm2,,11046,CPT,Facility,Inpatient,,,,84,71.4,24.0744,84,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Skin Debridement Subq Tissue/Muscle Ea Addl 20Cm2,,11046,CPT,Facility,Outpatient,,,,84,71.4,24.0744,84,"UCare Health, Inc.",Medicare Advantage,42.3948,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Skin Debridement Subq Tissue/Muscle Ea Addl 20Cm2,,11046,CPT,Facility,Inpatient,,,,84,71.4,24.0744,84,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Skin Debridement Subq Tissue/Muscle Ea Addl 20Cm2,,11046,CPT,Facility,Outpatient,,,,84,71.4,24.0744,84,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),42.3948,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Skin Debridement Subq Tissue/Muscle Ea Addl 20Cm2,,11046,CPT,Facility,Inpatient,,,,84,71.4,24.0744,84,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Skin Debridement Subq Tissue/Muscle Ea Addl 20Cm2,,11046,CPT,Facility,Both,,,,84,71.4,24.0744,84,UnitedHealthcare,Individual & Family,78.96,94,,percent of total billed charges,,
Skin Debridement Subq Tissue/Muscle Ea Addl 20Cm2,,11046,CPT,Facility,Outpatient,,,,84,71.4,24.0744,84,UnitedHealthcare,Medicare Advantage,41.16,49,,percent of total billed charges,,
Skin Debridement Subq Tissue/Muscle Ea Addl 20Cm2,,11046,CPT,Facility,Inpatient,,,,84,71.4,24.0744,84,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Skin Debridement Subq Tissue/Muscle Ea Addl 20Cm2,,11046,CPT,Facility,Outpatient,,,,84,71.4,24.0744,84,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,40.32,48,,percent of total billed charges,,100% of DHS outpatient percentage
Skin Debridement Subq Tissue/Muscle Ea Addl 20Cm2,,11046,CPT,Facility,Inpatient,,,,84,71.4,24.0744,84,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
LISINOPRIL 5 MG ORAL TABLET,,16325,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
LISINOPRIL 5 MG ORAL TABLET,,16325,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
LISINOPRIL 5 MG ORAL TABLET,,16325,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
LISINOPRIL 5 MG ORAL TABLET,,16325,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
LISINOPRIL 5 MG ORAL TABLET,,16325,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
LISINOPRIL 5 MG ORAL TABLET,,16325,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
LISINOPRIL 5 MG ORAL TABLET,,16325,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
LISINOPRIL 5 MG ORAL TABLET,,16325,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
LISINOPRIL 5 MG ORAL TABLET,,16325,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
LISINOPRIL 5 MG ORAL TABLET,,16325,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
LISINOPRIL 5 MG ORAL TABLET,,16325,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
LISINOPRIL 5 MG ORAL TABLET,,16325,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
LISINOPRIL 5 MG ORAL TABLET,,16325,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
LISINOPRIL 5 MG ORAL TABLET,,16325,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
LISINOPRIL 5 MG ORAL TABLET,,16325,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
LISINOPRIL 5 MG ORAL TABLET,,16325,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
LISINOPRIL 5 MG ORAL TABLET,,16325,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
LISINOPRIL 5 MG ORAL TABLET,,16325,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
LISINOPRIL 5 MG ORAL TABLET,,16325,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LISINOPRIL 5 MG ORAL TABLET,,16325,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
LISINOPRIL 5 MG ORAL TABLET,,16325,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
LISINOPRIL 5 MG ORAL TABLET,,16325,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
LISINOPRIL 5 MG ORAL TABLET,,16325,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
LISINOPRIL 5 MG ORAL TABLET,,16325,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
LISINOPRIL 5 MG ORAL TABLET,,16325,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
LISINOPRIL 5 MG ORAL TABLET,,16325,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
LISINOPRIL 5 MG ORAL TABLET,,16325,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
LISINOPRIL 5 MG ORAL TABLET,,16325,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
LISINOPRIL 5 MG ORAL TABLET,,16325,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
LISINOPRIL 5 MG ORAL TABLET,,16325,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
LISINOPRIL 5 MG ORAL TABLET,,16325,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
LISINOPRIL 5 MG ORAL TABLET,,16325,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
LISINOPRIL 5 MG ORAL TABLET,,16325,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
LISINOPRIL 5 MG ORAL TABLET,,16325,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
LISINOPRIL 5 MG ORAL TABLET,,16325,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
LISINOPRIL 5 MG ORAL TABLET,,16325,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
LISINOPRIL 5 MG ORAL TABLET,,16325,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
LISINOPRIL 5 MG ORAL TABLET,,16325,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LISINOPRIL 5 MG ORAL TABLET,,16325,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
LISINOPRIL 5 MG ORAL TABLET,,16325,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
LISINOPRIL 5 MG ORAL TABLET,,16325,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
LISINOPRIL 5 MG ORAL TABLET,,16325,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
LISINOPRIL 5 MG ORAL TABLET,,16325,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
LISINOPRIL 5 MG ORAL TABLET,,16325,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LISINOPRIL 5 MG ORAL TABLET,,16325,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
LISINOPRIL 5 MG ORAL TABLET,,16325,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LISINOPRIL 5 MG ORAL TABLET,,16325,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LISINOPRIL 5 MG ORAL TABLET,,16325,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LISINOPRIL 5 MG ORAL TABLET,,16325,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LISINOPRIL 5 MG ORAL TABLET,,16325,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
LISINOPRIL 5 MG ORAL TABLET,,16325,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
LISINOPRIL 5 MG ORAL TABLET,,16325,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
LISINOPRIL 5 MG ORAL TABLET,,16325,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
LISINOPRIL 5 MG ORAL TABLET,,16325,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette); Single Lesion",,11102,CPT,Facility,Both,,,,114,96.9,32.6724,299,Aetna,Commercial,104.88,92,,percent of total billed charges,,
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette); Single Lesion",,11102,CPT,Facility,Outpatient,,,,114,96.9,32.6724,299,Aetna,Medicare Advantage,55.86,49,,percent of total billed charges,,
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette); Single Lesion",,11102,CPT,Facility,Inpatient,,,,114,96.9,32.6724,299,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette); Single Lesion",,11102,CPT,Facility,Both,,,,114,96.9,32.6724,299,Aetna,PPO,106.02,93,,percent of total billed charges,,
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette); Single Lesion",,11102,CPT,Facility,Both,,,,114,96.9,32.6724,299,America's PPO,America's PPO,109.4742,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette); Single Lesion",,11102,CPT,Facility,Both,,,,114,96.9,32.6724,299,BlueCross BlueShield Minnesota, Federal Employee Program,112.176,98.4,,percent of total billed charges,,
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette); Single Lesion",,11102,CPT,Facility,Both,,,,114,96.9,32.6724,299,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,114,100,,percent of total billed charges,,
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette); Single Lesion",,11102,CPT,Facility,Both,,,,114,96.9,32.6724,299,BlueCross BlueShield Minnesota,High Value Network Plan,102.6,90,,percent of total billed charges,,
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette); Single Lesion",,11102,CPT,Facility,Outpatient,,,,114,96.9,32.6724,299,BlueCross BlueShield Minnesota,Medicare Advantage,55.86,49,,percent of total billed charges,,
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette); Single Lesion",,11102,CPT,Facility,Inpatient,,,,114,96.9,32.6724,299,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette); Single Lesion",,11102,CPT,Facility,Both,,,,114,96.9,32.6724,299,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,100.9698,88.57,,percent of total billed charges,,
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette); Single Lesion",,11102,CPT,Facility,Both,,,,114,96.9,32.6724,299,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,32.6724,28.66,,percent of total billed charges,,
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette); Single Lesion",,11102,CPT,Facility,Outpatient,,,,114,96.9,32.6724,299,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),55.86,49,,percent of total billed charges,,
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette); Single Lesion",,11102,CPT,Facility,Inpatient,,,,114,96.9,32.6724,299,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette); Single Lesion",,11102,CPT,Facility,Both,,,,114,96.9,32.6724,299,CorVel,Worker's Compensation,114,100,,percent of total billed charges,,
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette); Single Lesion",,11102,CPT,Facility,Both,,,,114,96.9,32.6724,299,First Health Group Corporation,First Health Network,110.58,97,,percent of total billed charges,,
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette); Single Lesion",,11102,CPT,Facility,Both,,,,114,96.9,32.6724,299,"Health Partners, Inc.",Commercial,107.844,94.6,,percent of total billed charges,,
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette); Single Lesion",,11102,CPT,Facility,Outpatient,,,,114,96.9,32.6724,299,"Health Partners, Inc.",Medicare Advantage,55.86,49,,percent of total billed charges,,
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette); Single Lesion",,11102,CPT,Facility,Inpatient,,,,114,96.9,32.6724,299,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette); Single Lesion",,11102,CPT,Facility,Both,,,,114,96.9,32.6724,299,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),68.4,60,,percent of total billed charges,,
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette); Single Lesion",,11102,CPT,Facility,Both,,,,114,96.9,32.6724,299,"Health Partners, Inc.",State of Minnesota Advantage Program,92.91,81.5,,percent of total billed charges,,
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette); Single Lesion",,11102,CPT,Facility,Both,,,,114,96.9,32.6724,299,"Health Partners, Inc.",State Public Programs,57,50,,percent of total billed charges,,
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette); Single Lesion",,11102,CPT,Facility,Both,,,,114,96.9,32.6724,299,Humana Insurance Company,Commercial PPO,108.3,95,,percent of total billed charges,,
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette); Single Lesion",,11102,CPT,Facility,Outpatient,,,,114,96.9,32.6724,299,Humana Insurance Company,Medicare PPO,55.86,49,,percent of total billed charges,,
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette); Single Lesion",,11102,CPT,Facility,Inpatient,,,,114,96.9,32.6724,299,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette); Single Lesion",,11102,CPT,Facility,Both,,,,114,96.9,32.6724,299,Medica,Individual & Family,112.974,99.1,,percent of total billed charges,,
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette); Single Lesion",,11102,CPT,Facility,Outpatient,,,,114,96.9,32.6724,299,Medica,Medica Advantage Solution,56.772,49.8,,percent of total billed charges,,
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette); Single Lesion",,11102,CPT,Facility,Inpatient,,,,114,96.9,32.6724,299,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette); Single Lesion",,11102,CPT,Facility,Outpatient,,,,114,96.9,32.6724,299,Medica,Medical Assistance,299,,,Other,Grouper,All inclusive per visit
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette); Single Lesion",,11102,CPT,Facility,Inpatient,,,,114,96.9,32.6724,299,Medica,Medical Assistance,,,,,Included in per diem rate,
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette); Single Lesion",,11102,CPT,Facility,Outpatient,,,,114,96.9,32.6724,299,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,56.772,49.8,,percent of total billed charges,,
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette); Single Lesion",,11102,CPT,Facility,Inpatient,,,,114,96.9,32.6724,299,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette); Single Lesion",,11102,CPT,Facility,Both,,,,114,96.9,32.6724,299,"Multiplan, Inc.","Multiplan, Inc.",107.16,94,,percent of total billed charges,,
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette); Single Lesion",,11102,CPT,Facility,Outpatient,,,,114,96.9,32.6724,299,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,102.714,90.1,,percent of total billed charges,,
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette); Single Lesion",,11102,CPT,Facility,Inpatient,,,,114,96.9,32.6724,299,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette); Single Lesion",,11102,CPT,Facility,Both,,,,114,96.9,32.6724,299,"Preferred One Administrative Services, INC.",PPO,112.404,98.6,,percent of total billed charges,,
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette); Single Lesion",,11102,CPT,Facility,Outpatient,,,,114,96.9,32.6724,299,PrimeWest Health,Minnesota Senior Health Options (MSHO),58.653,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette); Single Lesion",,11102,CPT,Facility,Inpatient,,,,114,96.9,32.6724,299,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette); Single Lesion",,11102,CPT,Facility,Outpatient,,,,114,96.9,32.6724,299,PrimeWest Health,MinnesotaCare,58.5504,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette); Single Lesion",,11102,CPT,Facility,Inpatient,,,,114,96.9,32.6724,299,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette); Single Lesion",,11102,CPT,Facility,Both,,,,114,96.9,32.6724,299,Sanford Health Plan,Sanford Health Plan,104.88,92,,percent of total billed charges,,
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette); Single Lesion",,11102,CPT,Facility,Outpatient,,,,114,96.9,32.6724,299,"UCare Health, Inc.",Individual & Family Plan,64.239,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette); Single Lesion",,11102,CPT,Facility,Inpatient,,,,114,96.9,32.6724,299,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette); Single Lesion",,11102,CPT,Facility,Outpatient,,,,114,96.9,32.6724,299,"UCare Health, Inc.",Medical Assistance,57.5358,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette); Single Lesion",,11102,CPT,Facility,Inpatient,,,,114,96.9,32.6724,299,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette); Single Lesion",,11102,CPT,Facility,Outpatient,,,,114,96.9,32.6724,299,"UCare Health, Inc.",Medicare Advantage,57.5358,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette); Single Lesion",,11102,CPT,Facility,Inpatient,,,,114,96.9,32.6724,299,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette); Single Lesion",,11102,CPT,Facility,Outpatient,,,,114,96.9,32.6724,299,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),57.5358,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette); Single Lesion",,11102,CPT,Facility,Inpatient,,,,114,96.9,32.6724,299,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette); Single Lesion",,11102,CPT,Facility,Both,,,,114,96.9,32.6724,299,UnitedHealthcare,Individual & Family,107.16,94,,percent of total billed charges,,
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette); Single Lesion",,11102,CPT,Facility,Outpatient,,,,114,96.9,32.6724,299,UnitedHealthcare,Medicare Advantage,55.86,49,,percent of total billed charges,,
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette); Single Lesion",,11102,CPT,Facility,Inpatient,,,,114,96.9,32.6724,299,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette); Single Lesion",,11102,CPT,Facility,Outpatient,,,,114,96.9,32.6724,299,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,54.72,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette); Single Lesion",,11102,CPT,Facility,Inpatient,,,,114,96.9,32.6724,299,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette); Single Lesion (Pro Cah)",,11102,CPT,Professional,Both,,,,170,144.5,23.56,170,Aetna,Commercial,144.5,85,,percent of total billed charges,,
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette); Single Lesion (Pro Cah)",,11102,CPT,Professional,Both,,,,170,144.5,23.56,170,Aetna,Medicare Advantage,37.08,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette); Single Lesion (Pro Cah)",,11102,CPT,Professional,Both,,,,170,144.5,23.56,170,Aetna,PPO,158.1,93,,percent of total billed charges,,
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette); Single Lesion (Pro Cah)",,11102,CPT,Professional,Both,,,,170,144.5,23.56,170,America's PPO,America's PPO,145.248,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette); Single Lesion (Pro Cah)",,11102,CPT,Professional,Both,,,,170,144.5,23.56,170,BlueCross BlueShield Minnesota, Federal Employee Program,77.12,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette); Single Lesion (Pro Cah)",,11102,CPT,Professional,Both,,,,170,144.5,23.56,170,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,78.35392,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette); Single Lesion (Pro Cah)",,11102,CPT,Professional,Both,,,,170,144.5,23.56,170,BlueCross BlueShield Minnesota,High Value Network Plan,78.35392,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette); Single Lesion (Pro Cah)",,11102,CPT,Professional,Both,,,,170,144.5,23.56,170,BlueCross BlueShield Minnesota,Medicare Advantage,42.1015,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette); Single Lesion (Pro Cah)",,11102,CPT,Professional,Both,,,,170,144.5,23.56,170,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,78.35392,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette); Single Lesion (Pro Cah)",,11102,CPT,Professional,Both,,,,170,144.5,23.56,170,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,27.19832,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette); Single Lesion (Pro Cah)",,11102,CPT,Professional,Both,,,,170,144.5,23.56,170,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),42.1015,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette); Single Lesion (Pro Cah)",,11102,CPT,Professional,Both,,,,170,144.5,23.56,170,CorVel,Worker's Compensation,71.1679584,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette); Single Lesion (Pro Cah)",,11102,CPT,Professional,Both,,,,170,144.5,23.56,170,First Health Group Corporation,First Health Network,164.9,97,,percent of total billed charges,,
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette); Single Lesion (Pro Cah)",,11102,CPT,Professional,Both,,,,170,144.5,23.56,170,"Health Partners, Inc.",Commercial,76.18,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette); Single Lesion (Pro Cah)",,11102,CPT,Professional,Both,,,,170,144.5,23.56,170,"Health Partners, Inc.",Medicare Advantage,42.1015,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette); Single Lesion (Pro Cah)",,11102,CPT,Professional,Both,,,,170,144.5,23.56,170,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),36.6,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette); Single Lesion (Pro Cah)",,11102,CPT,Professional,Both,,,,170,144.5,23.56,170,"Health Partners, Inc.",State of Minnesota Advantage Program,65.62907,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette); Single Lesion (Pro Cah)",,11102,CPT,Professional,Both,,,,170,144.5,23.56,170,"Health Partners, Inc.",State Public Programs,23.56,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette); Single Lesion (Pro Cah)",,11102,CPT,Professional,Both,,,,170,144.5,23.56,170,Humana Insurance Company,Commercial PPO,36.61,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette); Single Lesion (Pro Cah)",,11102,CPT,Professional,Both,,,,170,144.5,23.56,170,Humana Insurance Company,Medicare PPO,170,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette); Single Lesion (Pro Cah)",,11102,CPT,Professional,Both,,,,170,144.5,23.56,170,Medica,Individual & Family,144.16,84.8,,percent of total billed charges,,
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette); Single Lesion (Pro Cah)",,11102,CPT,Professional,Both,,,,170,144.5,23.56,170,Medica,Medica Advantage Solution,84.66,49.8,,percent of total billed charges,,
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette); Single Lesion (Pro Cah)",,11102,CPT,Professional,Both,,,,170,144.5,23.56,170,Medica,Medical Assistance,27.2,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette); Single Lesion (Pro Cah)",,11102,CPT,Professional,Both,,,,170,144.5,23.56,170,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,36.61,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette); Single Lesion (Pro Cah)",,11102,CPT,Professional,Both,,,,170,144.5,23.56,170,"Multiplan, Inc.","Multiplan, Inc.",159.8,94,,percent of total billed charges,,
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette); Single Lesion (Pro Cah)",,11102,CPT,Professional,Both,,,,170,144.5,23.56,170,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,153.17,90.1,,percent of total billed charges,,
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette); Single Lesion (Pro Cah)",,11102,CPT,Professional,Both,,,,170,144.5,23.56,170,"Preferred One Administrative Services, INC.",PPO,167.62,98.6,,percent of total billed charges,,
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette); Single Lesion (Pro Cah)",,11102,CPT,Professional,Both,,,,170,144.5,23.56,170,PrimeWest Health,Minnesota Senior Health Options (MSHO),42.1015,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette); Single Lesion (Pro Cah)",,11102,CPT,Professional,Both,,,,170,144.5,23.56,170,PrimeWest Health,MinnesotaCare,29.1022024,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette); Single Lesion (Pro Cah)",,11102,CPT,Professional,Both,,,,170,144.5,23.56,170,Sanford Health Plan,Sanford Health Plan,149.6,88,,percent of total billed charges,,
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette); Single Lesion (Pro Cah)",,11102,CPT,Professional,Both,,,,170,144.5,23.56,170,"UCare Health, Inc.",Individual & Family Plan,59.513216,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette); Single Lesion (Pro Cah)",,11102,CPT,Professional,Both,,,,170,144.5,23.56,170,"UCare Health, Inc.",Medical Assistance,29.918152,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette); Single Lesion (Pro Cah)",,11102,CPT,Professional,Both,,,,170,144.5,23.56,170,"UCare Health, Inc.",Medicare Advantage,42.1015,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette); Single Lesion (Pro Cah)",,11102,CPT,Professional,Both,,,,170,144.5,23.56,170,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),33.6812,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette); Single Lesion (Pro Cah)",,11102,CPT,Professional,Both,,,,170,144.5,23.56,170,UnitedHealthcare,Individual & Family,170,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette); Single Lesion (Pro Cah)",,11102,CPT,Professional,Both,,,,170,144.5,23.56,170,UnitedHealthcare,Medicare Advantage,42.1015,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette); Single Lesion (Pro Cah)",,11102,CPT,Professional,Both,,,,170,144.5,23.56,170,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,27.19832,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette); Each Separate/Additional Lesion",,11103,CPT,Facility,Both,,,,65,55.25,18.629,299,Aetna,Commercial,59.8,92,,percent of total billed charges,,
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette); Each Separate/Additional Lesion",,11103,CPT,Facility,Outpatient,,,,65,55.25,18.629,299,Aetna,Medicare Advantage,31.85,49,,percent of total billed charges,,
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette); Each Separate/Additional Lesion",,11103,CPT,Facility,Inpatient,,,,65,55.25,18.629,299,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette); Each Separate/Additional Lesion",,11103,CPT,Facility,Both,,,,65,55.25,18.629,299,Aetna,PPO,60.45,93,,percent of total billed charges,,
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette); Each Separate/Additional Lesion",,11103,CPT,Facility,Both,,,,65,55.25,18.629,299,America's PPO,America's PPO,62.4195,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette); Each Separate/Additional Lesion",,11103,CPT,Facility,Both,,,,65,55.25,18.629,299,BlueCross BlueShield Minnesota, Federal Employee Program,63.96,98.4,,percent of total billed charges,,
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette); Each Separate/Additional Lesion",,11103,CPT,Facility,Both,,,,65,55.25,18.629,299,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,65,100,,percent of total billed charges,,
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette); Each Separate/Additional Lesion",,11103,CPT,Facility,Both,,,,65,55.25,18.629,299,BlueCross BlueShield Minnesota,High Value Network Plan,58.5,90,,percent of total billed charges,,
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette); Each Separate/Additional Lesion",,11103,CPT,Facility,Outpatient,,,,65,55.25,18.629,299,BlueCross BlueShield Minnesota,Medicare Advantage,31.85,49,,percent of total billed charges,,
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette); Each Separate/Additional Lesion",,11103,CPT,Facility,Inpatient,,,,65,55.25,18.629,299,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette); Each Separate/Additional Lesion",,11103,CPT,Facility,Both,,,,65,55.25,18.629,299,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,57.5705,88.57,,percent of total billed charges,,
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette); Each Separate/Additional Lesion",,11103,CPT,Facility,Both,,,,65,55.25,18.629,299,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,18.629,28.66,,percent of total billed charges,,
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette); Each Separate/Additional Lesion",,11103,CPT,Facility,Outpatient,,,,65,55.25,18.629,299,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),31.85,49,,percent of total billed charges,,
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette); Each Separate/Additional Lesion",,11103,CPT,Facility,Inpatient,,,,65,55.25,18.629,299,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette); Each Separate/Additional Lesion",,11103,CPT,Facility,Both,,,,65,55.25,18.629,299,CorVel,Worker's Compensation,65,100,,percent of total billed charges,,
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette); Each Separate/Additional Lesion",,11103,CPT,Facility,Both,,,,65,55.25,18.629,299,First Health Group Corporation,First Health Network,63.05,97,,percent of total billed charges,,
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette); Each Separate/Additional Lesion",,11103,CPT,Facility,Both,,,,65,55.25,18.629,299,"Health Partners, Inc.",Commercial,61.49,94.6,,percent of total billed charges,,
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette); Each Separate/Additional Lesion",,11103,CPT,Facility,Outpatient,,,,65,55.25,18.629,299,"Health Partners, Inc.",Medicare Advantage,31.85,49,,percent of total billed charges,,
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette); Each Separate/Additional Lesion",,11103,CPT,Facility,Inpatient,,,,65,55.25,18.629,299,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette); Each Separate/Additional Lesion",,11103,CPT,Facility,Both,,,,65,55.25,18.629,299,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),39,60,,percent of total billed charges,,
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette); Each Separate/Additional Lesion",,11103,CPT,Facility,Both,,,,65,55.25,18.629,299,"Health Partners, Inc.",State of Minnesota Advantage Program,52.975,81.5,,percent of total billed charges,,
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette); Each Separate/Additional Lesion",,11103,CPT,Facility,Both,,,,65,55.25,18.629,299,"Health Partners, Inc.",State Public Programs,32.5,50,,percent of total billed charges,,
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette); Each Separate/Additional Lesion",,11103,CPT,Facility,Both,,,,65,55.25,18.629,299,Humana Insurance Company,Commercial PPO,61.75,95,,percent of total billed charges,,
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette); Each Separate/Additional Lesion",,11103,CPT,Facility,Outpatient,,,,65,55.25,18.629,299,Humana Insurance Company,Medicare PPO,31.85,49,,percent of total billed charges,,
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette); Each Separate/Additional Lesion",,11103,CPT,Facility,Inpatient,,,,65,55.25,18.629,299,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette); Each Separate/Additional Lesion",,11103,CPT,Facility,Both,,,,65,55.25,18.629,299,Medica,Individual & Family,64.415,99.1,,percent of total billed charges,,
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette); Each Separate/Additional Lesion",,11103,CPT,Facility,Outpatient,,,,65,55.25,18.629,299,Medica,Medica Advantage Solution,32.37,49.8,,percent of total billed charges,,
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette); Each Separate/Additional Lesion",,11103,CPT,Facility,Inpatient,,,,65,55.25,18.629,299,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette); Each Separate/Additional Lesion",,11103,CPT,Facility,Outpatient,,,,65,55.25,18.629,299,Medica,Medical Assistance,299,,,Other,Grouper,All inclusive per visit
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette); Each Separate/Additional Lesion",,11103,CPT,Facility,Inpatient,,,,65,55.25,18.629,299,Medica,Medical Assistance,,,,,Included in per diem rate,
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette); Each Separate/Additional Lesion",,11103,CPT,Facility,Outpatient,,,,65,55.25,18.629,299,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,32.37,49.8,,percent of total billed charges,,
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette); Each Separate/Additional Lesion",,11103,CPT,Facility,Inpatient,,,,65,55.25,18.629,299,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette); Each Separate/Additional Lesion",,11103,CPT,Facility,Both,,,,65,55.25,18.629,299,"Multiplan, Inc.","Multiplan, Inc.",61.1,94,,percent of total billed charges,,
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette); Each Separate/Additional Lesion",,11103,CPT,Facility,Outpatient,,,,65,55.25,18.629,299,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,58.565,90.1,,percent of total billed charges,,
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette); Each Separate/Additional Lesion",,11103,CPT,Facility,Inpatient,,,,65,55.25,18.629,299,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette); Each Separate/Additional Lesion",,11103,CPT,Facility,Both,,,,65,55.25,18.629,299,"Preferred One Administrative Services, INC.",PPO,64.09,98.6,,percent of total billed charges,,
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette); Each Separate/Additional Lesion",,11103,CPT,Facility,Outpatient,,,,65,55.25,18.629,299,PrimeWest Health,Minnesota Senior Health Options (MSHO),33.4425,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette); Each Separate/Additional Lesion",,11103,CPT,Facility,Inpatient,,,,65,55.25,18.629,299,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette); Each Separate/Additional Lesion",,11103,CPT,Facility,Outpatient,,,,65,55.25,18.629,299,PrimeWest Health,MinnesotaCare,33.384,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette); Each Separate/Additional Lesion",,11103,CPT,Facility,Inpatient,,,,65,55.25,18.629,299,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette); Each Separate/Additional Lesion",,11103,CPT,Facility,Both,,,,65,55.25,18.629,299,Sanford Health Plan,Sanford Health Plan,59.8,92,,percent of total billed charges,,
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette); Each Separate/Additional Lesion",,11103,CPT,Facility,Outpatient,,,,65,55.25,18.629,299,"UCare Health, Inc.",Individual & Family Plan,36.6275,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette); Each Separate/Additional Lesion",,11103,CPT,Facility,Inpatient,,,,65,55.25,18.629,299,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette); Each Separate/Additional Lesion",,11103,CPT,Facility,Outpatient,,,,65,55.25,18.629,299,"UCare Health, Inc.",Medical Assistance,32.8055,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette); Each Separate/Additional Lesion",,11103,CPT,Facility,Inpatient,,,,65,55.25,18.629,299,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette); Each Separate/Additional Lesion",,11103,CPT,Facility,Outpatient,,,,65,55.25,18.629,299,"UCare Health, Inc.",Medicare Advantage,32.8055,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette); Each Separate/Additional Lesion",,11103,CPT,Facility,Inpatient,,,,65,55.25,18.629,299,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette); Each Separate/Additional Lesion",,11103,CPT,Facility,Outpatient,,,,65,55.25,18.629,299,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),32.8055,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette); Each Separate/Additional Lesion",,11103,CPT,Facility,Inpatient,,,,65,55.25,18.629,299,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette); Each Separate/Additional Lesion",,11103,CPT,Facility,Both,,,,65,55.25,18.629,299,UnitedHealthcare,Individual & Family,61.1,94,,percent of total billed charges,,
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette); Each Separate/Additional Lesion",,11103,CPT,Facility,Outpatient,,,,65,55.25,18.629,299,UnitedHealthcare,Medicare Advantage,31.85,49,,percent of total billed charges,,
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette); Each Separate/Additional Lesion",,11103,CPT,Facility,Inpatient,,,,65,55.25,18.629,299,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette); Each Separate/Additional Lesion",,11103,CPT,Facility,Outpatient,,,,65,55.25,18.629,299,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,31.2,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette); Each Separate/Additional Lesion",,11103,CPT,Facility,Inpatient,,,,65,55.25,18.629,299,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette);Ea Separate/Addl Lesion (Pro Cah)",,11103,CPT,Professional,Both,,,,95,80.75,13.31,95,Aetna,Commercial,80.75,85,,percent of total billed charges,,
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette);Ea Separate/Addl Lesion (Pro Cah)",,11103,CPT,Professional,Both,,,,95,80.75,13.31,95,Aetna,Medicare Advantage,21.53,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette);Ea Separate/Addl Lesion (Pro Cah)",,11103,CPT,Professional,Both,,,,95,80.75,13.31,95,Aetna,PPO,88.35,93,,percent of total billed charges,,
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette);Ea Separate/Addl Lesion (Pro Cah)",,11103,CPT,Professional,Both,,,,95,80.75,13.31,95,America's PPO,America's PPO,81.168,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette);Ea Separate/Addl Lesion (Pro Cah)",,11103,CPT,Professional,Both,,,,95,80.75,13.31,95,BlueCross BlueShield Minnesota, Federal Employee Program,44.07,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette);Ea Separate/Addl Lesion (Pro Cah)",,11103,CPT,Professional,Both,,,,95,80.75,13.31,95,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,44.77512,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette);Ea Separate/Addl Lesion (Pro Cah)",,11103,CPT,Professional,Both,,,,95,80.75,13.31,95,BlueCross BlueShield Minnesota,High Value Network Plan,44.77512,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette);Ea Separate/Addl Lesion (Pro Cah)",,11103,CPT,Professional,Both,,,,95,80.75,13.31,95,BlueCross BlueShield Minnesota,Medicare Advantage,24.058,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette);Ea Separate/Addl Lesion (Pro Cah)",,11103,CPT,Professional,Both,,,,95,80.75,13.31,95,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,44.77512,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette);Ea Separate/Addl Lesion (Pro Cah)",,11103,CPT,Professional,Both,,,,95,80.75,13.31,95,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,15.36192,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette);Ea Separate/Addl Lesion (Pro Cah)",,11103,CPT,Professional,Both,,,,95,80.75,13.31,95,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),24.058,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette);Ea Separate/Addl Lesion (Pro Cah)",,11103,CPT,Professional,Both,,,,95,80.75,13.31,95,CorVel,Worker's Compensation,41.4425466,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette);Ea Separate/Addl Lesion (Pro Cah)",,11103,CPT,Professional,Both,,,,95,80.75,13.31,95,First Health Group Corporation,First Health Network,92.15,97,,percent of total billed charges,,
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette);Ea Separate/Addl Lesion (Pro Cah)",,11103,CPT,Professional,Both,,,,95,80.75,13.31,95,"Health Partners, Inc.",Commercial,44.26,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette);Ea Separate/Addl Lesion (Pro Cah)",,11103,CPT,Professional,Both,,,,95,80.75,13.31,95,"Health Partners, Inc.",Medicare Advantage,24.058,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette);Ea Separate/Addl Lesion (Pro Cah)",,11103,CPT,Professional,Both,,,,95,80.75,13.31,95,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),20.67,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette);Ea Separate/Addl Lesion (Pro Cah)",,11103,CPT,Professional,Both,,,,95,80.75,13.31,95,"Health Partners, Inc.",State of Minnesota Advantage Program,38.12999,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette);Ea Separate/Addl Lesion (Pro Cah)",,11103,CPT,Professional,Both,,,,95,80.75,13.31,95,"Health Partners, Inc.",State Public Programs,13.31,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette);Ea Separate/Addl Lesion (Pro Cah)",,11103,CPT,Professional,Both,,,,95,80.75,13.31,95,Humana Insurance Company,Commercial PPO,20.92,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette);Ea Separate/Addl Lesion (Pro Cah)",,11103,CPT,Professional,Both,,,,95,80.75,13.31,95,Humana Insurance Company,Medicare PPO,95,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette);Ea Separate/Addl Lesion (Pro Cah)",,11103,CPT,Professional,Both,,,,95,80.75,13.31,95,Medica,Individual & Family,80.56,84.8,,percent of total billed charges,,
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette);Ea Separate/Addl Lesion (Pro Cah)",,11103,CPT,Professional,Both,,,,95,80.75,13.31,95,Medica,Medica Advantage Solution,47.31,49.8,,percent of total billed charges,,
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette);Ea Separate/Addl Lesion (Pro Cah)",,11103,CPT,Professional,Both,,,,95,80.75,13.31,95,Medica,Medical Assistance,15.36,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette);Ea Separate/Addl Lesion (Pro Cah)",,11103,CPT,Professional,Both,,,,95,80.75,13.31,95,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,20.92,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette);Ea Separate/Addl Lesion (Pro Cah)",,11103,CPT,Professional,Both,,,,95,80.75,13.31,95,"Multiplan, Inc.","Multiplan, Inc.",89.3,94,,percent of total billed charges,,
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette);Ea Separate/Addl Lesion (Pro Cah)",,11103,CPT,Professional,Both,,,,95,80.75,13.31,95,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,85.595,90.1,,percent of total billed charges,,
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette);Ea Separate/Addl Lesion (Pro Cah)",,11103,CPT,Professional,Both,,,,95,80.75,13.31,95,"Preferred One Administrative Services, INC.",PPO,93.67,98.6,,percent of total billed charges,,
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette);Ea Separate/Addl Lesion (Pro Cah)",,11103,CPT,Professional,Both,,,,95,80.75,13.31,95,PrimeWest Health,Minnesota Senior Health Options (MSHO),24.058,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette);Ea Separate/Addl Lesion (Pro Cah)",,11103,CPT,Professional,Both,,,,95,80.75,13.31,95,PrimeWest Health,MinnesotaCare,16.4372544,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette);Ea Separate/Addl Lesion (Pro Cah)",,11103,CPT,Professional,Both,,,,95,80.75,13.31,95,Sanford Health Plan,Sanford Health Plan,83.6,88,,percent of total billed charges,,
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette);Ea Separate/Addl Lesion (Pro Cah)",,11103,CPT,Professional,Both,,,,95,80.75,13.31,95,"UCare Health, Inc.",Individual & Family Plan,34.007552,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette);Ea Separate/Addl Lesion (Pro Cah)",,11103,CPT,Professional,Both,,,,95,80.75,13.31,95,"UCare Health, Inc.",Medical Assistance,16.898112,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette);Ea Separate/Addl Lesion (Pro Cah)",,11103,CPT,Professional,Both,,,,95,80.75,13.31,95,"UCare Health, Inc.",Medicare Advantage,24.058,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette);Ea Separate/Addl Lesion (Pro Cah)",,11103,CPT,Professional,Both,,,,95,80.75,13.31,95,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),19.2464,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette);Ea Separate/Addl Lesion (Pro Cah)",,11103,CPT,Professional,Both,,,,95,80.75,13.31,95,UnitedHealthcare,Individual & Family,95,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette);Ea Separate/Addl Lesion (Pro Cah)",,11103,CPT,Professional,Both,,,,95,80.75,13.31,95,UnitedHealthcare,Medicare Advantage,24.058,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Tangential Biopsy Of Skin (Eg, Shave, Scoop, Saucerize, Curette);Ea Separate/Addl Lesion (Pro Cah)",,11103,CPT,Professional,Both,,,,95,80.75,13.31,95,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,15.36192,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Single Lesion (Pbb)",,11104,CPT,Facility,Outpatient,,,,80,68,22.928,80,Aetna,Commercial,73.6,92,,percent of total billed charges,,
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Single Lesion (Pbb)",,11104,CPT,Professional,Outpatient,,,,135,114.75,29.01,135,Aetna,Commercial,114.75,85,,percent of total billed charges,,
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Single Lesion (Pbb)",,11104,CPT,Facility,Outpatient,,,,80,68,22.928,80,Aetna,Medicare Advantage,39.2,49,,percent of total billed charges,,
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Single Lesion (Pbb)",,11104,CPT,Professional,Outpatient,,,,135,114.75,29.01,135,Aetna,Medicare Advantage,46.33,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Single Lesion (Pbb)",,11104,CPT,Facility,Outpatient,,,,80,68,22.928,80,Aetna,PPO,74.4,93,,percent of total billed charges,,
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Single Lesion (Pbb)",,11104,CPT,Professional,Outpatient,,,,135,114.75,29.01,135,Aetna,PPO,125.55,93,,percent of total billed charges,,
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Single Lesion (Pbb)",,11104,CPT,Facility,Outpatient,,,,80,68,22.928,80,America's PPO,America's PPO,76.824,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Single Lesion (Pbb)",,11104,CPT,Professional,Outpatient,,,,135,114.75,29.01,135,America's PPO,America's PPO,115.344,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Single Lesion (Pbb)",,11104,CPT,Facility,Outpatient,,,,80,68,22.928,80,BlueCross BlueShield Minnesota, Federal Employee Program,78.72,98.4,,percent of total billed charges,,
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Single Lesion (Pbb)",,11104,CPT,Professional,Outpatient,,,,135,114.75,29.01,135,BlueCross BlueShield Minnesota, Federal Employee Program,95.72,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Single Lesion (Pbb)",,11104,CPT,Facility,Outpatient,,,,80,68,22.928,80,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,80,100,,percent of total billed charges,,
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Single Lesion (Pbb)",,11104,CPT,Professional,Outpatient,,,,135,114.75,29.01,135,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,97.25152,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Single Lesion (Pbb)",,11104,CPT,Facility,Outpatient,,,,80,68,22.928,80,BlueCross BlueShield Minnesota,High Value Network Plan,72,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Single Lesion (Pbb)",,11104,CPT,Professional,Outpatient,,,,135,114.75,29.01,135,BlueCross BlueShield Minnesota,High Value Network Plan,97.25152,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Single Lesion (Pbb)",,11104,CPT,Facility,Outpatient,,,,80,68,22.928,80,BlueCross BlueShield Minnesota,Medicare Advantage,39.2,49,,percent of total billed charges,,
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Single Lesion (Pbb)",,11104,CPT,Professional,Outpatient,,,,135,114.75,29.01,135,BlueCross BlueShield Minnesota,Medicare Advantage,51.888,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Single Lesion (Pbb)",,11104,CPT,Professional,Outpatient,,,,135,114.75,29.01,135,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,97.25152,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Single Lesion (Pbb)",,11104,CPT,Facility,Outpatient,,,,80,68,22.928,80,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,22.928,28.66,,percent of total billed charges,,
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Single Lesion (Pbb)",,11104,CPT,Professional,Outpatient,,,,135,114.75,29.01,135,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,33.49752,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Single Lesion (Pbb)",,11104,CPT,Facility,Outpatient,,,,80,68,22.928,80,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),39.2,49,,percent of total billed charges,,
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Single Lesion (Pbb)",,11104,CPT,Professional,Outpatient,,,,135,114.75,29.01,135,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),51.888,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Single Lesion (Pbb)",,11104,CPT,Facility,Outpatient,,,,80,68,22.928,80,CorVel,Worker's Compensation,80,100,,percent of total billed charges,,
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Single Lesion (Pbb)",,11104,CPT,Professional,Outpatient,,,,135,114.75,29.01,135,CorVel,Worker's Compensation,88.5045354,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Single Lesion (Pbb)",,11104,CPT,Facility,Outpatient,,,,80,68,22.928,80,First Health Group Corporation,First Health Network,77.6,97,,percent of total billed charges,,
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Single Lesion (Pbb)",,11104,CPT,Professional,Outpatient,,,,135,114.75,29.01,135,First Health Group Corporation,First Health Network,130.95,97,,percent of total billed charges,,
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Single Lesion (Pbb)",,11104,CPT,Facility,Outpatient,,,,80,68,22.928,80,"Health Partners, Inc.",Commercial,75.68,94.6,,percent of total billed charges,,
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Single Lesion (Pbb)",,11104,CPT,Professional,Outpatient,,,,135,114.75,29.01,135,"Health Partners, Inc.",Commercial,95.77,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Single Lesion (Pbb)",,11104,CPT,Facility,Outpatient,,,,80,68,22.928,80,"Health Partners, Inc.",Medicare Advantage,39.2,49,,percent of total billed charges,,
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Single Lesion (Pbb)",,11104,CPT,Professional,Outpatient,,,,135,114.75,29.01,135,"Health Partners, Inc.",Medicare Advantage,51.888,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Single Lesion (Pbb)",,11104,CPT,Facility,Outpatient,,,,80,68,22.928,80,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),48,60,,percent of total billed charges,,
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Single Lesion (Pbb)",,11104,CPT,Professional,Outpatient,,,,135,114.75,29.01,135,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),45.07,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Single Lesion (Pbb)",,11104,CPT,Facility,Outpatient,,,,80,68,22.928,80,"Health Partners, Inc.",State of Minnesota Advantage Program,65.2,81.5,,percent of total billed charges,,
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Single Lesion (Pbb)",,11104,CPT,Professional,Outpatient,,,,135,114.75,29.01,135,"Health Partners, Inc.",State of Minnesota Advantage Program,82.505855,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Single Lesion (Pbb)",,11104,CPT,Facility,Outpatient,,,,80,68,22.928,80,"Health Partners, Inc.",State Public Programs,40,50,,percent of total billed charges,,
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Single Lesion (Pbb)",,11104,CPT,Professional,Outpatient,,,,135,114.75,29.01,135,"Health Partners, Inc.",State Public Programs,29.01,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Single Lesion (Pbb)",,11104,CPT,Facility,Outpatient,,,,80,68,22.928,80,Humana Insurance Company,Commercial PPO,76,95,,percent of total billed charges,,
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Single Lesion (Pbb)",,11104,CPT,Professional,Outpatient,,,,135,114.75,29.01,135,Humana Insurance Company,Commercial PPO,45.12,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Single Lesion (Pbb)",,11104,CPT,Facility,Outpatient,,,,80,68,22.928,80,Humana Insurance Company,Medicare PPO,39.2,49,,percent of total billed charges,,
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Single Lesion (Pbb)",,11104,CPT,Professional,Outpatient,,,,135,114.75,29.01,135,Humana Insurance Company,Medicare PPO,135,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Single Lesion (Pbb)",,11104,CPT,Facility,Outpatient,,,,80,68,22.928,80,Medica,Individual & Family,79.28,99.1,,percent of total billed charges,,
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Single Lesion (Pbb)",,11104,CPT,Professional,Outpatient,,,,135,114.75,29.01,135,Medica,Individual & Family,114.48,84.8,,percent of total billed charges,,
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Single Lesion (Pbb)",,11104,CPT,Facility,Outpatient,,,,80,68,22.928,80,Medica,Medica Advantage Solution,39.84,49.8,,percent of total billed charges,,
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Single Lesion (Pbb)",,11104,CPT,Professional,Outpatient,,,,135,114.75,29.01,135,Medica,Medica Advantage Solution,67.23,49.8,,percent of total billed charges,,
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Single Lesion (Pbb)",,11104,CPT,Facility,Outpatient,,,,80,68,22.928,80,Medica,Medical Assistance,35.68,44.6,,percent of total billed charges,,
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Single Lesion (Pbb)",,11104,CPT,Professional,Outpatient,,,,135,114.75,29.01,135,Medica,Medical Assistance,33.5,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Single Lesion (Pbb)",,11104,CPT,Facility,Outpatient,,,,80,68,22.928,80,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,39.84,49.8,,percent of total billed charges,,
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Single Lesion (Pbb)",,11104,CPT,Professional,Outpatient,,,,135,114.75,29.01,135,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,45.12,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Single Lesion (Pbb)",,11104,CPT,Facility,Outpatient,,,,80,68,22.928,80,"Multiplan, Inc.","Multiplan, Inc.",75.2,94,,percent of total billed charges,,
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Single Lesion (Pbb)",,11104,CPT,Professional,Outpatient,,,,135,114.75,29.01,135,"Multiplan, Inc.","Multiplan, Inc.",126.9,94,,percent of total billed charges,,
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Single Lesion (Pbb)",,11104,CPT,Facility,Outpatient,,,,80,68,22.928,80,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,72.08,90.1,,percent of total billed charges,,
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Single Lesion (Pbb)",,11104,CPT,Professional,Outpatient,,,,135,114.75,29.01,135,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,121.635,90.1,,percent of total billed charges,,
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Single Lesion (Pbb)",,11104,CPT,Facility,Outpatient,,,,80,68,22.928,80,"Preferred One Administrative Services, INC.",PPO,78.88,98.6,,percent of total billed charges,,
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Single Lesion (Pbb)",,11104,CPT,Professional,Outpatient,,,,135,114.75,29.01,135,"Preferred One Administrative Services, INC.",PPO,133.11,98.6,,percent of total billed charges,,
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Single Lesion (Pbb)",,11104,CPT,Facility,Outpatient,,,,80,68,22.928,80,PrimeWest Health,Minnesota Senior Health Options (MSHO),41.16,51.45,,percent of total billed charges,,
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Single Lesion (Pbb)",,11104,CPT,Professional,Outpatient,,,,135,114.75,29.01,135,PrimeWest Health,Minnesota Senior Health Options (MSHO),51.888,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Single Lesion (Pbb)",,11104,CPT,Facility,Outpatient,,,,80,68,22.928,80,PrimeWest Health,MinnesotaCare,41.088,51.36,,percent of total billed charges,,
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Single Lesion (Pbb)",,11104,CPT,Professional,Outpatient,,,,135,114.75,29.01,135,PrimeWest Health,MinnesotaCare,35.8423464,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Single Lesion (Pbb)",,11104,CPT,Facility,Outpatient,,,,80,68,22.928,80,Sanford Health Plan,Sanford Health Plan,73.6,92,,percent of total billed charges,,
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Single Lesion (Pbb)",,11104,CPT,Professional,Outpatient,,,,135,114.75,29.01,135,Sanford Health Plan,Sanford Health Plan,118.8,88,,percent of total billed charges,,
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Single Lesion (Pbb)",,11104,CPT,Facility,Outpatient,,,,80,68,22.928,80,"UCare Health, Inc.",Individual & Family Plan,45.08,56.35,,percent of total billed charges,,
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Single Lesion (Pbb)",,11104,CPT,Professional,Outpatient,,,,135,114.75,29.01,135,"UCare Health, Inc.",Individual & Family Plan,73.347072,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Single Lesion (Pbb)",,11104,CPT,Facility,Outpatient,,,,80,68,22.928,80,"UCare Health, Inc.",Medical Assistance,40.376,50.47,,percent of total billed charges,,
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Single Lesion (Pbb)",,11104,CPT,Professional,Outpatient,,,,135,114.75,29.01,135,"UCare Health, Inc.",Medical Assistance,36.847272,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Single Lesion (Pbb)",,11104,CPT,Facility,Outpatient,,,,80,68,22.928,80,"UCare Health, Inc.",Medicare Advantage,40.376,50.47,,percent of total billed charges,,
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Single Lesion (Pbb)",,11104,CPT,Professional,Outpatient,,,,135,114.75,29.01,135,"UCare Health, Inc.",Medicare Advantage,51.888,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Single Lesion (Pbb)",,11104,CPT,Facility,Outpatient,,,,80,68,22.928,80,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),40.376,50.47,,percent of total billed charges,,
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Single Lesion (Pbb)",,11104,CPT,Professional,Outpatient,,,,135,114.75,29.01,135,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),41.5104,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Single Lesion (Pbb)",,11104,CPT,Facility,Outpatient,,,,80,68,22.928,80,UnitedHealthcare,Individual & Family,75.2,94,,percent of total billed charges,,
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Single Lesion (Pbb)",,11104,CPT,Professional,Outpatient,,,,135,114.75,29.01,135,UnitedHealthcare,Individual & Family,135,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Single Lesion (Pbb)",,11104,CPT,Facility,Outpatient,,,,80,68,22.928,80,UnitedHealthcare,Medicare Advantage,39.2,49,,percent of total billed charges,,
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Single Lesion (Pbb)",,11104,CPT,Professional,Outpatient,,,,135,114.75,29.01,135,UnitedHealthcare,Medicare Advantage,51.888,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Single Lesion (Pbb)",,11104,CPT,Facility,Outpatient,,,,80,68,22.928,80,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,38.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Single Lesion (Pbb)",,11104,CPT,Professional,Outpatient,,,,135,114.75,29.01,135,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,33.49752,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Single Lesion (Pro Cah)",,11104,CPT,Professional,Both,,,,215,182.75,29.01,215,Aetna,Commercial,182.75,85,,percent of total billed charges,,
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Single Lesion (Pro Cah)",,11104,CPT,Professional,Both,,,,215,182.75,29.01,215,Aetna,Commercial,182.75,85,,percent of total billed charges,,
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Single Lesion (Pro Cah)",,11104,CPT,Professional,Both,,,,215,182.75,29.01,215,Aetna,Medicare Advantage,46.33,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Single Lesion (Pro Cah)",,11104,CPT,Professional,Both,,,,215,182.75,29.01,215,Aetna,Medicare Advantage,46.33,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Single Lesion (Pro Cah)",,11104,CPT,Professional,Both,,,,215,182.75,29.01,215,Aetna,PPO,199.95,93,,percent of total billed charges,,
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Single Lesion (Pro Cah)",,11104,CPT,Professional,Both,,,,215,182.75,29.01,215,Aetna,PPO,199.95,93,,percent of total billed charges,,
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Single Lesion (Pro Cah)",,11104,CPT,Professional,Both,,,,215,182.75,29.01,215,America's PPO,America's PPO,183.696,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Single Lesion (Pro Cah)",,11104,CPT,Professional,Both,,,,215,182.75,29.01,215,America's PPO,America's PPO,183.696,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Single Lesion (Pro Cah)",,11104,CPT,Professional,Both,,,,215,182.75,29.01,215,BlueCross BlueShield Minnesota, Federal Employee Program,95.72,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Single Lesion (Pro Cah)",,11104,CPT,Professional,Both,,,,215,182.75,29.01,215,BlueCross BlueShield Minnesota, Federal Employee Program,95.72,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Single Lesion (Pro Cah)",,11104,CPT,Professional,Both,,,,215,182.75,29.01,215,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,97.25152,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Single Lesion (Pro Cah)",,11104,CPT,Professional,Both,,,,215,182.75,29.01,215,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,97.25152,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Single Lesion (Pro Cah)",,11104,CPT,Professional,Both,,,,215,182.75,29.01,215,BlueCross BlueShield Minnesota,High Value Network Plan,97.25152,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Single Lesion (Pro Cah)",,11104,CPT,Professional,Both,,,,215,182.75,29.01,215,BlueCross BlueShield Minnesota,High Value Network Plan,97.25152,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Single Lesion (Pro Cah)",,11104,CPT,Professional,Both,,,,215,182.75,29.01,215,BlueCross BlueShield Minnesota,Medicare Advantage,51.888,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Single Lesion (Pro Cah)",,11104,CPT,Professional,Both,,,,215,182.75,29.01,215,BlueCross BlueShield Minnesota,Medicare Advantage,51.888,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Single Lesion (Pro Cah)",,11104,CPT,Professional,Both,,,,215,182.75,29.01,215,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,97.25152,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Single Lesion (Pro Cah)",,11104,CPT,Professional,Both,,,,215,182.75,29.01,215,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,97.25152,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Single Lesion (Pro Cah)",,11104,CPT,Professional,Both,,,,215,182.75,29.01,215,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,33.49752,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Single Lesion (Pro Cah)",,11104,CPT,Professional,Both,,,,215,182.75,29.01,215,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,33.49752,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Single Lesion (Pro Cah)",,11104,CPT,Professional,Both,,,,215,182.75,29.01,215,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),51.888,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Single Lesion (Pro Cah)",,11104,CPT,Professional,Both,,,,215,182.75,29.01,215,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),51.888,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Single Lesion (Pro Cah)",,11104,CPT,Professional,Both,,,,215,182.75,29.01,215,CorVel,Worker's Compensation,88.5045354,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Single Lesion (Pro Cah)",,11104,CPT,Professional,Both,,,,215,182.75,29.01,215,CorVel,Worker's Compensation,88.5045354,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Single Lesion (Pro Cah)",,11104,CPT,Professional,Both,,,,215,182.75,29.01,215,First Health Group Corporation,First Health Network,208.55,97,,percent of total billed charges,,
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Single Lesion (Pro Cah)",,11104,CPT,Professional,Both,,,,215,182.75,29.01,215,First Health Group Corporation,First Health Network,208.55,97,,percent of total billed charges,,
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Single Lesion (Pro Cah)",,11104,CPT,Professional,Both,,,,215,182.75,29.01,215,"Health Partners, Inc.",Commercial,95.77,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Single Lesion (Pro Cah)",,11104,CPT,Professional,Both,,,,215,182.75,29.01,215,"Health Partners, Inc.",Commercial,95.77,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Single Lesion (Pro Cah)",,11104,CPT,Professional,Both,,,,215,182.75,29.01,215,"Health Partners, Inc.",Medicare Advantage,51.888,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Single Lesion (Pro Cah)",,11104,CPT,Professional,Both,,,,215,182.75,29.01,215,"Health Partners, Inc.",Medicare Advantage,51.888,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Single Lesion (Pro Cah)",,11104,CPT,Professional,Both,,,,215,182.75,29.01,215,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),45.07,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Single Lesion (Pro Cah)",,11104,CPT,Professional,Both,,,,215,182.75,29.01,215,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),45.07,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Single Lesion (Pro Cah)",,11104,CPT,Professional,Both,,,,215,182.75,29.01,215,"Health Partners, Inc.",State of Minnesota Advantage Program,82.505855,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Single Lesion (Pro Cah)",,11104,CPT,Professional,Both,,,,215,182.75,29.01,215,"Health Partners, Inc.",State of Minnesota Advantage Program,82.505855,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Single Lesion (Pro Cah)",,11104,CPT,Professional,Both,,,,215,182.75,29.01,215,"Health Partners, Inc.",State Public Programs,29.01,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Single Lesion (Pro Cah)",,11104,CPT,Professional,Both,,,,215,182.75,29.01,215,"Health Partners, Inc.",State Public Programs,29.01,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Single Lesion (Pro Cah)",,11104,CPT,Professional,Both,,,,215,182.75,29.01,215,Humana Insurance Company,Commercial PPO,45.12,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Single Lesion (Pro Cah)",,11104,CPT,Professional,Both,,,,215,182.75,29.01,215,Humana Insurance Company,Commercial PPO,45.12,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Single Lesion (Pro Cah)",,11104,CPT,Professional,Both,,,,215,182.75,29.01,215,Humana Insurance Company,Medicare PPO,215,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Single Lesion (Pro Cah)",,11104,CPT,Professional,Both,,,,215,182.75,29.01,215,Humana Insurance Company,Medicare PPO,215,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Single Lesion (Pro Cah)",,11104,CPT,Professional,Both,,,,215,182.75,29.01,215,Medica,Individual & Family,182.32,84.8,,percent of total billed charges,,
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Single Lesion (Pro Cah)",,11104,CPT,Professional,Both,,,,215,182.75,29.01,215,Medica,Individual & Family,182.32,84.8,,percent of total billed charges,,
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Single Lesion (Pro Cah)",,11104,CPT,Professional,Both,,,,215,182.75,29.01,215,Medica,Medica Advantage Solution,107.07,49.8,,percent of total billed charges,,
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Single Lesion (Pro Cah)",,11104,CPT,Professional,Both,,,,215,182.75,29.01,215,Medica,Medica Advantage Solution,107.07,49.8,,percent of total billed charges,,
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Single Lesion (Pro Cah)",,11104,CPT,Professional,Both,,,,215,182.75,29.01,215,Medica,Medical Assistance,33.5,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Single Lesion (Pro Cah)",,11104,CPT,Professional,Both,,,,215,182.75,29.01,215,Medica,Medical Assistance,33.5,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Single Lesion (Pro Cah)",,11104,CPT,Professional,Both,,,,215,182.75,29.01,215,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,45.12,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Single Lesion (Pro Cah)",,11104,CPT,Professional,Both,,,,215,182.75,29.01,215,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,45.12,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Single Lesion (Pro Cah)",,11104,CPT,Professional,Both,,,,215,182.75,29.01,215,"Multiplan, Inc.","Multiplan, Inc.",202.1,94,,percent of total billed charges,,
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Single Lesion (Pro Cah)",,11104,CPT,Professional,Both,,,,215,182.75,29.01,215,"Multiplan, Inc.","Multiplan, Inc.",202.1,94,,percent of total billed charges,,
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Single Lesion (Pro Cah)",,11104,CPT,Professional,Both,,,,215,182.75,29.01,215,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,193.715,90.1,,percent of total billed charges,,
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Single Lesion (Pro Cah)",,11104,CPT,Professional,Both,,,,215,182.75,29.01,215,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,193.715,90.1,,percent of total billed charges,,
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Single Lesion (Pro Cah)",,11104,CPT,Professional,Both,,,,215,182.75,29.01,215,"Preferred One Administrative Services, INC.",PPO,211.99,98.6,,percent of total billed charges,,
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Single Lesion (Pro Cah)",,11104,CPT,Professional,Both,,,,215,182.75,29.01,215,"Preferred One Administrative Services, INC.",PPO,211.99,98.6,,percent of total billed charges,,
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Single Lesion (Pro Cah)",,11104,CPT,Professional,Both,,,,215,182.75,29.01,215,PrimeWest Health,Minnesota Senior Health Options (MSHO),51.888,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Single Lesion (Pro Cah)",,11104,CPT,Professional,Both,,,,215,182.75,29.01,215,PrimeWest Health,Minnesota Senior Health Options (MSHO),51.888,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Single Lesion (Pro Cah)",,11104,CPT,Professional,Both,,,,215,182.75,29.01,215,PrimeWest Health,MinnesotaCare,35.8423464,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Single Lesion (Pro Cah)",,11104,CPT,Professional,Both,,,,215,182.75,29.01,215,PrimeWest Health,MinnesotaCare,35.8423464,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Single Lesion (Pro Cah)",,11104,CPT,Professional,Both,,,,215,182.75,29.01,215,Sanford Health Plan,Sanford Health Plan,189.2,88,,percent of total billed charges,,
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Single Lesion (Pro Cah)",,11104,CPT,Professional,Both,,,,215,182.75,29.01,215,Sanford Health Plan,Sanford Health Plan,189.2,88,,percent of total billed charges,,
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Single Lesion (Pro Cah)",,11104,CPT,Professional,Both,,,,215,182.75,29.01,215,"UCare Health, Inc.",Individual & Family Plan,73.347072,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Single Lesion (Pro Cah)",,11104,CPT,Professional,Both,,,,215,182.75,29.01,215,"UCare Health, Inc.",Individual & Family Plan,73.347072,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Single Lesion (Pro Cah)",,11104,CPT,Professional,Both,,,,215,182.75,29.01,215,"UCare Health, Inc.",Medical Assistance,36.847272,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Single Lesion (Pro Cah)",,11104,CPT,Professional,Both,,,,215,182.75,29.01,215,"UCare Health, Inc.",Medical Assistance,36.847272,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Single Lesion (Pro Cah)",,11104,CPT,Professional,Both,,,,215,182.75,29.01,215,"UCare Health, Inc.",Medicare Advantage,51.888,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Single Lesion (Pro Cah)",,11104,CPT,Professional,Both,,,,215,182.75,29.01,215,"UCare Health, Inc.",Medicare Advantage,51.888,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Single Lesion (Pro Cah)",,11104,CPT,Professional,Both,,,,215,182.75,29.01,215,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),41.5104,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Single Lesion (Pro Cah)",,11104,CPT,Professional,Both,,,,215,182.75,29.01,215,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),41.5104,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Single Lesion (Pro Cah)",,11104,CPT,Professional,Both,,,,215,182.75,29.01,215,UnitedHealthcare,Individual & Family,215,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Single Lesion (Pro Cah)",,11104,CPT,Professional,Both,,,,215,182.75,29.01,215,UnitedHealthcare,Individual & Family,215,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Single Lesion (Pro Cah)",,11104,CPT,Professional,Both,,,,215,182.75,29.01,215,UnitedHealthcare,Medicare Advantage,51.888,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Single Lesion (Pro Cah)",,11104,CPT,Professional,Both,,,,215,182.75,29.01,215,UnitedHealthcare,Medicare Advantage,51.888,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Single Lesion (Pro Cah)",,11104,CPT,Professional,Both,,,,215,182.75,29.01,215,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,33.49752,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Single Lesion (Pro Cah)",,11104,CPT,Professional,Both,,,,215,182.75,29.01,215,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,33.49752,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Punch Biopsy Of Skin; Single Lesion,,11104,CPT,Facility,Both,,,,125,106.25,35.825,125,Aetna,Commercial,115,92,,percent of total billed charges,,
Punch Biopsy Of Skin; Single Lesion,,11104,CPT,Facility,Outpatient,,,,125,106.25,35.825,125,Aetna,Medicare Advantage,61.25,49,,percent of total billed charges,,
Punch Biopsy Of Skin; Single Lesion,,11104,CPT,Facility,Inpatient,,,,125,106.25,35.825,125,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Punch Biopsy Of Skin; Single Lesion,,11104,CPT,Facility,Both,,,,125,106.25,35.825,125,Aetna,PPO,116.25,93,,percent of total billed charges,,
Punch Biopsy Of Skin; Single Lesion,,11104,CPT,Facility,Both,,,,125,106.25,35.825,125,America's PPO,America's PPO,120.0375,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Punch Biopsy Of Skin; Single Lesion,,11104,CPT,Facility,Both,,,,125,106.25,35.825,125,BlueCross BlueShield Minnesota, Federal Employee Program,123,98.4,,percent of total billed charges,,
Punch Biopsy Of Skin; Single Lesion,,11104,CPT,Facility,Both,,,,125,106.25,35.825,125,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,125,100,,percent of total billed charges,,
Punch Biopsy Of Skin; Single Lesion,,11104,CPT,Facility,Both,,,,125,106.25,35.825,125,BlueCross BlueShield Minnesota,High Value Network Plan,112.5,90,,percent of total billed charges,,
Punch Biopsy Of Skin; Single Lesion,,11104,CPT,Facility,Outpatient,,,,125,106.25,35.825,125,BlueCross BlueShield Minnesota,Medicare Advantage,61.25,49,,percent of total billed charges,,
Punch Biopsy Of Skin; Single Lesion,,11104,CPT,Facility,Inpatient,,,,125,106.25,35.825,125,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Punch Biopsy Of Skin; Single Lesion,,11104,CPT,Facility,Both,,,,125,106.25,35.825,125,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,110.7125,88.57,,percent of total billed charges,,
Punch Biopsy Of Skin; Single Lesion,,11104,CPT,Facility,Both,,,,125,106.25,35.825,125,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,35.825,28.66,,percent of total billed charges,,
Punch Biopsy Of Skin; Single Lesion,,11104,CPT,Facility,Outpatient,,,,125,106.25,35.825,125,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),61.25,49,,percent of total billed charges,,
Punch Biopsy Of Skin; Single Lesion,,11104,CPT,Facility,Inpatient,,,,125,106.25,35.825,125,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Punch Biopsy Of Skin; Single Lesion,,11104,CPT,Facility,Both,,,,125,106.25,35.825,125,CorVel,Worker's Compensation,125,100,,percent of total billed charges,,
Punch Biopsy Of Skin; Single Lesion,,11104,CPT,Facility,Both,,,,125,106.25,35.825,125,First Health Group Corporation,First Health Network,121.25,97,,percent of total billed charges,,
Punch Biopsy Of Skin; Single Lesion,,11104,CPT,Facility,Both,,,,125,106.25,35.825,125,"Health Partners, Inc.",Commercial,118.25,94.6,,percent of total billed charges,,
Punch Biopsy Of Skin; Single Lesion,,11104,CPT,Facility,Outpatient,,,,125,106.25,35.825,125,"Health Partners, Inc.",Medicare Advantage,61.25,49,,percent of total billed charges,,
Punch Biopsy Of Skin; Single Lesion,,11104,CPT,Facility,Inpatient,,,,125,106.25,35.825,125,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Punch Biopsy Of Skin; Single Lesion,,11104,CPT,Facility,Both,,,,125,106.25,35.825,125,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),75,60,,percent of total billed charges,,
Punch Biopsy Of Skin; Single Lesion,,11104,CPT,Facility,Both,,,,125,106.25,35.825,125,"Health Partners, Inc.",State of Minnesota Advantage Program,101.875,81.5,,percent of total billed charges,,
Punch Biopsy Of Skin; Single Lesion,,11104,CPT,Facility,Both,,,,125,106.25,35.825,125,"Health Partners, Inc.",State Public Programs,62.5,50,,percent of total billed charges,,
Punch Biopsy Of Skin; Single Lesion,,11104,CPT,Facility,Both,,,,125,106.25,35.825,125,Humana Insurance Company,Commercial PPO,118.75,95,,percent of total billed charges,,
Punch Biopsy Of Skin; Single Lesion,,11104,CPT,Facility,Outpatient,,,,125,106.25,35.825,125,Humana Insurance Company,Medicare PPO,61.25,49,,percent of total billed charges,,
Punch Biopsy Of Skin; Single Lesion,,11104,CPT,Facility,Inpatient,,,,125,106.25,35.825,125,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Punch Biopsy Of Skin; Single Lesion,,11104,CPT,Facility,Both,,,,125,106.25,35.825,125,Medica,Individual & Family,123.875,99.1,,percent of total billed charges,,
Punch Biopsy Of Skin; Single Lesion,,11104,CPT,Facility,Outpatient,,,,125,106.25,35.825,125,Medica,Medica Advantage Solution,62.25,49.8,,percent of total billed charges,,
Punch Biopsy Of Skin; Single Lesion,,11104,CPT,Facility,Inpatient,,,,125,106.25,35.825,125,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Punch Biopsy Of Skin; Single Lesion,,11104,CPT,Facility,Outpatient,,,,125,106.25,35.825,125,Medica,Medical Assistance,55.75,44.6,,percent of total billed charges,,
Punch Biopsy Of Skin; Single Lesion,,11104,CPT,Facility,Inpatient,,,,125,106.25,35.825,125,Medica,Medical Assistance,,,,,Included in per diem rate,
Punch Biopsy Of Skin; Single Lesion,,11104,CPT,Facility,Outpatient,,,,125,106.25,35.825,125,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,62.25,49.8,,percent of total billed charges,,
Punch Biopsy Of Skin; Single Lesion,,11104,CPT,Facility,Inpatient,,,,125,106.25,35.825,125,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Punch Biopsy Of Skin; Single Lesion,,11104,CPT,Facility,Both,,,,125,106.25,35.825,125,"Multiplan, Inc.","Multiplan, Inc.",117.5,94,,percent of total billed charges,,
Punch Biopsy Of Skin; Single Lesion,,11104,CPT,Facility,Outpatient,,,,125,106.25,35.825,125,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,112.625,90.1,,percent of total billed charges,,
Punch Biopsy Of Skin; Single Lesion,,11104,CPT,Facility,Inpatient,,,,125,106.25,35.825,125,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Punch Biopsy Of Skin; Single Lesion,,11104,CPT,Facility,Both,,,,125,106.25,35.825,125,"Preferred One Administrative Services, INC.",PPO,123.25,98.6,,percent of total billed charges,,
Punch Biopsy Of Skin; Single Lesion,,11104,CPT,Facility,Outpatient,,,,125,106.25,35.825,125,PrimeWest Health,Minnesota Senior Health Options (MSHO),64.3125,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Punch Biopsy Of Skin; Single Lesion,,11104,CPT,Facility,Inpatient,,,,125,106.25,35.825,125,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Punch Biopsy Of Skin; Single Lesion,,11104,CPT,Facility,Outpatient,,,,125,106.25,35.825,125,PrimeWest Health,MinnesotaCare,64.2,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Punch Biopsy Of Skin; Single Lesion,,11104,CPT,Facility,Inpatient,,,,125,106.25,35.825,125,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Punch Biopsy Of Skin; Single Lesion,,11104,CPT,Facility,Both,,,,125,106.25,35.825,125,Sanford Health Plan,Sanford Health Plan,115,92,,percent of total billed charges,,
Punch Biopsy Of Skin; Single Lesion,,11104,CPT,Facility,Outpatient,,,,125,106.25,35.825,125,"UCare Health, Inc.",Individual & Family Plan,70.4375,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Punch Biopsy Of Skin; Single Lesion,,11104,CPT,Facility,Inpatient,,,,125,106.25,35.825,125,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Punch Biopsy Of Skin; Single Lesion,,11104,CPT,Facility,Outpatient,,,,125,106.25,35.825,125,"UCare Health, Inc.",Medical Assistance,63.0875,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Punch Biopsy Of Skin; Single Lesion,,11104,CPT,Facility,Inpatient,,,,125,106.25,35.825,125,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Punch Biopsy Of Skin; Single Lesion,,11104,CPT,Facility,Outpatient,,,,125,106.25,35.825,125,"UCare Health, Inc.",Medicare Advantage,63.0875,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Punch Biopsy Of Skin; Single Lesion,,11104,CPT,Facility,Inpatient,,,,125,106.25,35.825,125,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Punch Biopsy Of Skin; Single Lesion,,11104,CPT,Facility,Outpatient,,,,125,106.25,35.825,125,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),63.0875,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Punch Biopsy Of Skin; Single Lesion,,11104,CPT,Facility,Inpatient,,,,125,106.25,35.825,125,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Punch Biopsy Of Skin; Single Lesion,,11104,CPT,Facility,Both,,,,125,106.25,35.825,125,UnitedHealthcare,Individual & Family,117.5,94,,percent of total billed charges,,
Punch Biopsy Of Skin; Single Lesion,,11104,CPT,Facility,Outpatient,,,,125,106.25,35.825,125,UnitedHealthcare,Medicare Advantage,61.25,49,,percent of total billed charges,,
Punch Biopsy Of Skin; Single Lesion,,11104,CPT,Facility,Inpatient,,,,125,106.25,35.825,125,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Punch Biopsy Of Skin; Single Lesion,,11104,CPT,Facility,Outpatient,,,,125,106.25,35.825,125,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,60,48,,percent of total billed charges,,100% of DHS outpatient percentage
Punch Biopsy Of Skin; Single Lesion,,11104,CPT,Facility,Inpatient,,,,125,106.25,35.825,125,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Each Separate/Additional Lesion (Pro Cah)",,11105,CPT,Professional,Both,,,,112,95.2,15.7,112,Aetna,Commercial,95.2,85,,percent of total billed charges,,
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Each Separate/Additional Lesion (Pro Cah)",,11105,CPT,Professional,Both,,,,112,95.2,15.7,112,Aetna,Medicare Advantage,25.15,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Each Separate/Additional Lesion (Pro Cah)",,11105,CPT,Professional,Both,,,,112,95.2,15.7,112,Aetna,PPO,104.16,93,,percent of total billed charges,,
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Each Separate/Additional Lesion (Pro Cah)",,11105,CPT,Professional,Both,,,,112,95.2,15.7,112,America's PPO,America's PPO,95.6928,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Each Separate/Additional Lesion (Pro Cah)",,11105,CPT,Professional,Both,,,,112,95.2,15.7,112,BlueCross BlueShield Minnesota, Federal Employee Program,52.33,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Each Separate/Additional Lesion (Pro Cah)",,11105,CPT,Professional,Both,,,,112,95.2,15.7,112,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,53.16728,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Each Separate/Additional Lesion (Pro Cah)",,11105,CPT,Professional,Both,,,,112,95.2,15.7,112,BlueCross BlueShield Minnesota,High Value Network Plan,53.16728,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Each Separate/Additional Lesion (Pro Cah)",,11105,CPT,Professional,Both,,,,112,95.2,15.7,112,BlueCross BlueShield Minnesota,Medicare Advantage,28.221,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Each Separate/Additional Lesion (Pro Cah)",,11105,CPT,Professional,Both,,,,112,95.2,15.7,112,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,53.16728,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Each Separate/Additional Lesion (Pro Cah)",,11105,CPT,Professional,Both,,,,112,95.2,15.7,112,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,18.12544,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Each Separate/Additional Lesion (Pro Cah)",,11105,CPT,Professional,Both,,,,112,95.2,15.7,112,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),28.221,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Each Separate/Additional Lesion (Pro Cah)",,11105,CPT,Professional,Both,,,,112,95.2,15.7,112,CorVel,Worker's Compensation,48.422853,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Each Separate/Additional Lesion (Pro Cah)",,11105,CPT,Professional,Both,,,,112,95.2,15.7,112,First Health Group Corporation,First Health Network,108.64,97,,percent of total billed charges,,
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Each Separate/Additional Lesion (Pro Cah)",,11105,CPT,Professional,Both,,,,112,95.2,15.7,112,"Health Partners, Inc.",Commercial,52.24,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Each Separate/Additional Lesion (Pro Cah)",,11105,CPT,Professional,Both,,,,112,95.2,15.7,112,"Health Partners, Inc.",Medicare Advantage,28.221,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Each Separate/Additional Lesion (Pro Cah)",,11105,CPT,Professional,Both,,,,112,95.2,15.7,112,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),24.4,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Each Separate/Additional Lesion (Pro Cah)",,11105,CPT,Professional,Both,,,,112,95.2,15.7,112,"Health Partners, Inc.",State of Minnesota Advantage Program,45.00476,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Each Separate/Additional Lesion (Pro Cah)",,11105,CPT,Professional,Both,,,,112,95.2,15.7,112,"Health Partners, Inc.",State Public Programs,15.7,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Each Separate/Additional Lesion (Pro Cah)",,11105,CPT,Professional,Both,,,,112,95.2,15.7,112,Humana Insurance Company,Commercial PPO,24.54,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Each Separate/Additional Lesion (Pro Cah)",,11105,CPT,Professional,Both,,,,112,95.2,15.7,112,Humana Insurance Company,Medicare PPO,112,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Each Separate/Additional Lesion (Pro Cah)",,11105,CPT,Professional,Both,,,,112,95.2,15.7,112,Medica,Individual & Family,94.976,84.8,,percent of total billed charges,,
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Each Separate/Additional Lesion (Pro Cah)",,11105,CPT,Professional,Both,,,,112,95.2,15.7,112,Medica,Medica Advantage Solution,55.776,49.8,,percent of total billed charges,,
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Each Separate/Additional Lesion (Pro Cah)",,11105,CPT,Professional,Both,,,,112,95.2,15.7,112,Medica,Medical Assistance,18.13,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Each Separate/Additional Lesion (Pro Cah)",,11105,CPT,Professional,Both,,,,112,95.2,15.7,112,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,24.54,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Each Separate/Additional Lesion (Pro Cah)",,11105,CPT,Professional,Both,,,,112,95.2,15.7,112,"Multiplan, Inc.","Multiplan, Inc.",105.28,94,,percent of total billed charges,,
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Each Separate/Additional Lesion (Pro Cah)",,11105,CPT,Professional,Both,,,,112,95.2,15.7,112,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,100.912,90.1,,percent of total billed charges,,
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Each Separate/Additional Lesion (Pro Cah)",,11105,CPT,Professional,Both,,,,112,95.2,15.7,112,"Preferred One Administrative Services, INC.",PPO,110.432,98.6,,percent of total billed charges,,
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Each Separate/Additional Lesion (Pro Cah)",,11105,CPT,Professional,Both,,,,112,95.2,15.7,112,PrimeWest Health,Minnesota Senior Health Options (MSHO),28.221,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Each Separate/Additional Lesion (Pro Cah)",,11105,CPT,Professional,Both,,,,112,95.2,15.7,112,PrimeWest Health,MinnesotaCare,19.3942208,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Each Separate/Additional Lesion (Pro Cah)",,11105,CPT,Professional,Both,,,,112,95.2,15.7,112,Sanford Health Plan,Sanford Health Plan,98.56,88,,percent of total billed charges,,
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Each Separate/Additional Lesion (Pro Cah)",,11105,CPT,Professional,Both,,,,112,95.2,15.7,112,"UCare Health, Inc.",Individual & Family Plan,39.892224,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Each Separate/Additional Lesion (Pro Cah)",,11105,CPT,Professional,Both,,,,112,95.2,15.7,112,"UCare Health, Inc.",Medical Assistance,19.937984,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Each Separate/Additional Lesion (Pro Cah)",,11105,CPT,Professional,Both,,,,112,95.2,15.7,112,"UCare Health, Inc.",Medicare Advantage,28.221,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Each Separate/Additional Lesion (Pro Cah)",,11105,CPT,Professional,Both,,,,112,95.2,15.7,112,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),22.5768,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Each Separate/Additional Lesion (Pro Cah)",,11105,CPT,Professional,Both,,,,112,95.2,15.7,112,UnitedHealthcare,Individual & Family,112,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Each Separate/Additional Lesion (Pro Cah)",,11105,CPT,Professional,Both,,,,112,95.2,15.7,112,UnitedHealthcare,Medicare Advantage,28.221,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Punch Biopsy Of Skin (Including Simple Closure, When Performed); Each Separate/Additional Lesion (Pro Cah)",,11105,CPT,Professional,Both,,,,112,95.2,15.7,112,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,18.12544,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Punch Biopsy Of Skin; Ea Separate/Additional Lesion,,11105,CPT,Facility,Both,,,,68,57.8,19.4888,68,Aetna,Commercial,62.56,92,,percent of total billed charges,,
Punch Biopsy Of Skin; Ea Separate/Additional Lesion,,11105,CPT,Facility,Outpatient,,,,68,57.8,19.4888,68,Aetna,Medicare Advantage,33.32,49,,percent of total billed charges,,
Punch Biopsy Of Skin; Ea Separate/Additional Lesion,,11105,CPT,Facility,Inpatient,,,,68,57.8,19.4888,68,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Punch Biopsy Of Skin; Ea Separate/Additional Lesion,,11105,CPT,Facility,Both,,,,68,57.8,19.4888,68,Aetna,PPO,63.24,93,,percent of total billed charges,,
Punch Biopsy Of Skin; Ea Separate/Additional Lesion,,11105,CPT,Facility,Both,,,,68,57.8,19.4888,68,America's PPO,America's PPO,65.3004,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Punch Biopsy Of Skin; Ea Separate/Additional Lesion,,11105,CPT,Facility,Both,,,,68,57.8,19.4888,68,BlueCross BlueShield Minnesota, Federal Employee Program,66.912,98.4,,percent of total billed charges,,
Punch Biopsy Of Skin; Ea Separate/Additional Lesion,,11105,CPT,Facility,Both,,,,68,57.8,19.4888,68,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,68,100,,percent of total billed charges,,
Punch Biopsy Of Skin; Ea Separate/Additional Lesion,,11105,CPT,Facility,Both,,,,68,57.8,19.4888,68,BlueCross BlueShield Minnesota,High Value Network Plan,61.2,90,,percent of total billed charges,,
Punch Biopsy Of Skin; Ea Separate/Additional Lesion,,11105,CPT,Facility,Outpatient,,,,68,57.8,19.4888,68,BlueCross BlueShield Minnesota,Medicare Advantage,33.32,49,,percent of total billed charges,,
Punch Biopsy Of Skin; Ea Separate/Additional Lesion,,11105,CPT,Facility,Inpatient,,,,68,57.8,19.4888,68,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Punch Biopsy Of Skin; Ea Separate/Additional Lesion,,11105,CPT,Facility,Both,,,,68,57.8,19.4888,68,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,60.2276,88.57,,percent of total billed charges,,
Punch Biopsy Of Skin; Ea Separate/Additional Lesion,,11105,CPT,Facility,Both,,,,68,57.8,19.4888,68,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,19.4888,28.66,,percent of total billed charges,,
Punch Biopsy Of Skin; Ea Separate/Additional Lesion,,11105,CPT,Facility,Outpatient,,,,68,57.8,19.4888,68,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),33.32,49,,percent of total billed charges,,
Punch Biopsy Of Skin; Ea Separate/Additional Lesion,,11105,CPT,Facility,Inpatient,,,,68,57.8,19.4888,68,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Punch Biopsy Of Skin; Ea Separate/Additional Lesion,,11105,CPT,Facility,Both,,,,68,57.8,19.4888,68,CorVel,Worker's Compensation,68,100,,percent of total billed charges,,
Punch Biopsy Of Skin; Ea Separate/Additional Lesion,,11105,CPT,Facility,Both,,,,68,57.8,19.4888,68,First Health Group Corporation,First Health Network,65.96,97,,percent of total billed charges,,
Punch Biopsy Of Skin; Ea Separate/Additional Lesion,,11105,CPT,Facility,Both,,,,68,57.8,19.4888,68,"Health Partners, Inc.",Commercial,64.328,94.6,,percent of total billed charges,,
Punch Biopsy Of Skin; Ea Separate/Additional Lesion,,11105,CPT,Facility,Outpatient,,,,68,57.8,19.4888,68,"Health Partners, Inc.",Medicare Advantage,33.32,49,,percent of total billed charges,,
Punch Biopsy Of Skin; Ea Separate/Additional Lesion,,11105,CPT,Facility,Inpatient,,,,68,57.8,19.4888,68,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Punch Biopsy Of Skin; Ea Separate/Additional Lesion,,11105,CPT,Facility,Both,,,,68,57.8,19.4888,68,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),40.8,60,,percent of total billed charges,,
Punch Biopsy Of Skin; Ea Separate/Additional Lesion,,11105,CPT,Facility,Both,,,,68,57.8,19.4888,68,"Health Partners, Inc.",State of Minnesota Advantage Program,55.42,81.5,,percent of total billed charges,,
Punch Biopsy Of Skin; Ea Separate/Additional Lesion,,11105,CPT,Facility,Both,,,,68,57.8,19.4888,68,"Health Partners, Inc.",State Public Programs,34,50,,percent of total billed charges,,
Punch Biopsy Of Skin; Ea Separate/Additional Lesion,,11105,CPT,Facility,Both,,,,68,57.8,19.4888,68,Humana Insurance Company,Commercial PPO,64.6,95,,percent of total billed charges,,
Punch Biopsy Of Skin; Ea Separate/Additional Lesion,,11105,CPT,Facility,Outpatient,,,,68,57.8,19.4888,68,Humana Insurance Company,Medicare PPO,33.32,49,,percent of total billed charges,,
Punch Biopsy Of Skin; Ea Separate/Additional Lesion,,11105,CPT,Facility,Inpatient,,,,68,57.8,19.4888,68,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Punch Biopsy Of Skin; Ea Separate/Additional Lesion,,11105,CPT,Facility,Both,,,,68,57.8,19.4888,68,Medica,Individual & Family,67.388,99.1,,percent of total billed charges,,
Punch Biopsy Of Skin; Ea Separate/Additional Lesion,,11105,CPT,Facility,Outpatient,,,,68,57.8,19.4888,68,Medica,Medica Advantage Solution,33.864,49.8,,percent of total billed charges,,
Punch Biopsy Of Skin; Ea Separate/Additional Lesion,,11105,CPT,Facility,Inpatient,,,,68,57.8,19.4888,68,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Punch Biopsy Of Skin; Ea Separate/Additional Lesion,,11105,CPT,Facility,Outpatient,,,,68,57.8,19.4888,68,Medica,Medical Assistance,30.328,44.6,,percent of total billed charges,,
Punch Biopsy Of Skin; Ea Separate/Additional Lesion,,11105,CPT,Facility,Inpatient,,,,68,57.8,19.4888,68,Medica,Medical Assistance,,,,,Included in per diem rate,
Punch Biopsy Of Skin; Ea Separate/Additional Lesion,,11105,CPT,Facility,Outpatient,,,,68,57.8,19.4888,68,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,33.864,49.8,,percent of total billed charges,,
Punch Biopsy Of Skin; Ea Separate/Additional Lesion,,11105,CPT,Facility,Inpatient,,,,68,57.8,19.4888,68,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Punch Biopsy Of Skin; Ea Separate/Additional Lesion,,11105,CPT,Facility,Both,,,,68,57.8,19.4888,68,"Multiplan, Inc.","Multiplan, Inc.",63.92,94,,percent of total billed charges,,
Punch Biopsy Of Skin; Ea Separate/Additional Lesion,,11105,CPT,Facility,Outpatient,,,,68,57.8,19.4888,68,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,61.268,90.1,,percent of total billed charges,,
Punch Biopsy Of Skin; Ea Separate/Additional Lesion,,11105,CPT,Facility,Inpatient,,,,68,57.8,19.4888,68,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Punch Biopsy Of Skin; Ea Separate/Additional Lesion,,11105,CPT,Facility,Both,,,,68,57.8,19.4888,68,"Preferred One Administrative Services, INC.",PPO,67.048,98.6,,percent of total billed charges,,
Punch Biopsy Of Skin; Ea Separate/Additional Lesion,,11105,CPT,Facility,Outpatient,,,,68,57.8,19.4888,68,PrimeWest Health,Minnesota Senior Health Options (MSHO),34.986,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Punch Biopsy Of Skin; Ea Separate/Additional Lesion,,11105,CPT,Facility,Inpatient,,,,68,57.8,19.4888,68,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Punch Biopsy Of Skin; Ea Separate/Additional Lesion,,11105,CPT,Facility,Outpatient,,,,68,57.8,19.4888,68,PrimeWest Health,MinnesotaCare,34.9248,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Punch Biopsy Of Skin; Ea Separate/Additional Lesion,,11105,CPT,Facility,Inpatient,,,,68,57.8,19.4888,68,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Punch Biopsy Of Skin; Ea Separate/Additional Lesion,,11105,CPT,Facility,Both,,,,68,57.8,19.4888,68,Sanford Health Plan,Sanford Health Plan,62.56,92,,percent of total billed charges,,
Punch Biopsy Of Skin; Ea Separate/Additional Lesion,,11105,CPT,Facility,Outpatient,,,,68,57.8,19.4888,68,"UCare Health, Inc.",Individual & Family Plan,38.318,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Punch Biopsy Of Skin; Ea Separate/Additional Lesion,,11105,CPT,Facility,Inpatient,,,,68,57.8,19.4888,68,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Punch Biopsy Of Skin; Ea Separate/Additional Lesion,,11105,CPT,Facility,Outpatient,,,,68,57.8,19.4888,68,"UCare Health, Inc.",Medical Assistance,34.3196,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Punch Biopsy Of Skin; Ea Separate/Additional Lesion,,11105,CPT,Facility,Inpatient,,,,68,57.8,19.4888,68,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Punch Biopsy Of Skin; Ea Separate/Additional Lesion,,11105,CPT,Facility,Outpatient,,,,68,57.8,19.4888,68,"UCare Health, Inc.",Medicare Advantage,34.3196,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Punch Biopsy Of Skin; Ea Separate/Additional Lesion,,11105,CPT,Facility,Inpatient,,,,68,57.8,19.4888,68,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Punch Biopsy Of Skin; Ea Separate/Additional Lesion,,11105,CPT,Facility,Outpatient,,,,68,57.8,19.4888,68,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),34.3196,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Punch Biopsy Of Skin; Ea Separate/Additional Lesion,,11105,CPT,Facility,Inpatient,,,,68,57.8,19.4888,68,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Punch Biopsy Of Skin; Ea Separate/Additional Lesion,,11105,CPT,Facility,Both,,,,68,57.8,19.4888,68,UnitedHealthcare,Individual & Family,63.92,94,,percent of total billed charges,,
Punch Biopsy Of Skin; Ea Separate/Additional Lesion,,11105,CPT,Facility,Outpatient,,,,68,57.8,19.4888,68,UnitedHealthcare,Medicare Advantage,33.32,49,,percent of total billed charges,,
Punch Biopsy Of Skin; Ea Separate/Additional Lesion,,11105,CPT,Facility,Inpatient,,,,68,57.8,19.4888,68,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Punch Biopsy Of Skin; Ea Separate/Additional Lesion,,11105,CPT,Facility,Outpatient,,,,68,57.8,19.4888,68,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,32.64,48,,percent of total billed charges,,100% of DHS outpatient percentage
Punch Biopsy Of Skin; Ea Separate/Additional Lesion,,11105,CPT,Facility,Inpatient,,,,68,57.8,19.4888,68,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
HYDROCHLOROTHIAZIDE 25 MG ORAL TABLET,,16381,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
HYDROCHLOROTHIAZIDE 25 MG ORAL TABLET,,16381,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
HYDROCHLOROTHIAZIDE 25 MG ORAL TABLET,,16381,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
HYDROCHLOROTHIAZIDE 25 MG ORAL TABLET,,16381,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
HYDROCHLOROTHIAZIDE 25 MG ORAL TABLET,,16381,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
HYDROCHLOROTHIAZIDE 25 MG ORAL TABLET,,16381,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
HYDROCHLOROTHIAZIDE 25 MG ORAL TABLET,,16381,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
HYDROCHLOROTHIAZIDE 25 MG ORAL TABLET,,16381,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
HYDROCHLOROTHIAZIDE 25 MG ORAL TABLET,,16381,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
HYDROCHLOROTHIAZIDE 25 MG ORAL TABLET,,16381,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
HYDROCHLOROTHIAZIDE 25 MG ORAL TABLET,,16381,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
HYDROCHLOROTHIAZIDE 25 MG ORAL TABLET,,16381,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
HYDROCHLOROTHIAZIDE 25 MG ORAL TABLET,,16381,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
HYDROCHLOROTHIAZIDE 25 MG ORAL TABLET,,16381,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
HYDROCHLOROTHIAZIDE 25 MG ORAL TABLET,,16381,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
HYDROCHLOROTHIAZIDE 25 MG ORAL TABLET,,16381,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
HYDROCHLOROTHIAZIDE 25 MG ORAL TABLET,,16381,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
HYDROCHLOROTHIAZIDE 25 MG ORAL TABLET,,16381,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
HYDROCHLOROTHIAZIDE 25 MG ORAL TABLET,,16381,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
HYDROCHLOROTHIAZIDE 25 MG ORAL TABLET,,16381,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
HYDROCHLOROTHIAZIDE 25 MG ORAL TABLET,,16381,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
HYDROCHLOROTHIAZIDE 25 MG ORAL TABLET,,16381,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
HYDROCHLOROTHIAZIDE 25 MG ORAL TABLET,,16381,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
HYDROCHLOROTHIAZIDE 25 MG ORAL TABLET,,16381,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
HYDROCHLOROTHIAZIDE 25 MG ORAL TABLET,,16381,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
HYDROCHLOROTHIAZIDE 25 MG ORAL TABLET,,16381,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
HYDROCHLOROTHIAZIDE 25 MG ORAL TABLET,,16381,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
HYDROCHLOROTHIAZIDE 25 MG ORAL TABLET,,16381,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
HYDROCHLOROTHIAZIDE 25 MG ORAL TABLET,,16381,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
HYDROCHLOROTHIAZIDE 25 MG ORAL TABLET,,16381,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
HYDROCHLOROTHIAZIDE 25 MG ORAL TABLET,,16381,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
HYDROCHLOROTHIAZIDE 25 MG ORAL TABLET,,16381,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
HYDROCHLOROTHIAZIDE 25 MG ORAL TABLET,,16381,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
HYDROCHLOROTHIAZIDE 25 MG ORAL TABLET,,16381,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
HYDROCHLOROTHIAZIDE 25 MG ORAL TABLET,,16381,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
HYDROCHLOROTHIAZIDE 25 MG ORAL TABLET,,16381,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
HYDROCHLOROTHIAZIDE 25 MG ORAL TABLET,,16381,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
HYDROCHLOROTHIAZIDE 25 MG ORAL TABLET,,16381,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
HYDROCHLOROTHIAZIDE 25 MG ORAL TABLET,,16381,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
HYDROCHLOROTHIAZIDE 25 MG ORAL TABLET,,16381,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
HYDROCHLOROTHIAZIDE 25 MG ORAL TABLET,,16381,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
HYDROCHLOROTHIAZIDE 25 MG ORAL TABLET,,16381,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
HYDROCHLOROTHIAZIDE 25 MG ORAL TABLET,,16381,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
HYDROCHLOROTHIAZIDE 25 MG ORAL TABLET,,16381,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
HYDROCHLOROTHIAZIDE 25 MG ORAL TABLET,,16381,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
HYDROCHLOROTHIAZIDE 25 MG ORAL TABLET,,16381,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
HYDROCHLOROTHIAZIDE 25 MG ORAL TABLET,,16381,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
HYDROCHLOROTHIAZIDE 25 MG ORAL TABLET,,16381,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
HYDROCHLOROTHIAZIDE 25 MG ORAL TABLET,,16381,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
HYDROCHLOROTHIAZIDE 25 MG ORAL TABLET,,16381,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
HYDROCHLOROTHIAZIDE 25 MG ORAL TABLET,,16381,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
HYDROCHLOROTHIAZIDE 25 MG ORAL TABLET,,16381,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
HYDROCHLOROTHIAZIDE 25 MG ORAL TABLET,,16381,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
HYDROCHLOROTHIAZIDE 25 MG ORAL TABLET,,16381,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Removal Of Skin Tags, Multiple Fibrocutaneous Tags, Any Area; Up To And Inc 15 Lesions (Pro Cah)",,11200,CPT,Professional,Both,,,,163,138.55,48.65,163,Aetna,Commercial,138.55,85,,percent of total billed charges,,
"Removal Of Skin Tags, Multiple Fibrocutaneous Tags, Any Area; Up To And Inc 15 Lesions (Pro Cah)",,11200,CPT,Professional,Both,,,,174,147.9,48.65,174,Aetna,Commercial,147.9,85,,percent of total billed charges,,
"Removal Of Skin Tags, Multiple Fibrocutaneous Tags, Any Area; Up To And Inc 15 Lesions (Pro Cah)",,11200,CPT,Professional,Both,,,,163,138.55,48.65,163,Aetna,Medicare Advantage,74.61,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Removal Of Skin Tags, Multiple Fibrocutaneous Tags, Any Area; Up To And Inc 15 Lesions (Pro Cah)",,11200,CPT,Professional,Both,,,,174,147.9,48.65,174,Aetna,Medicare Advantage,74.61,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Removal Of Skin Tags, Multiple Fibrocutaneous Tags, Any Area; Up To And Inc 15 Lesions (Pro Cah)",,11200,CPT,Professional,Both,,,,163,138.55,48.65,163,Aetna,PPO,151.59,93,,percent of total billed charges,,
"Removal Of Skin Tags, Multiple Fibrocutaneous Tags, Any Area; Up To And Inc 15 Lesions (Pro Cah)",,11200,CPT,Professional,Both,,,,174,147.9,48.65,174,Aetna,PPO,161.82,93,,percent of total billed charges,,
"Removal Of Skin Tags, Multiple Fibrocutaneous Tags, Any Area; Up To And Inc 15 Lesions (Pro Cah)",,11200,CPT,Professional,Both,,,,163,138.55,48.65,163,America's PPO,America's PPO,139.2672,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Removal Of Skin Tags, Multiple Fibrocutaneous Tags, Any Area; Up To And Inc 15 Lesions (Pro Cah)",,11200,CPT,Professional,Both,,,,174,147.9,48.65,174,America's PPO,America's PPO,148.6656,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Removal Of Skin Tags, Multiple Fibrocutaneous Tags, Any Area; Up To And Inc 15 Lesions (Pro Cah)",,11200,CPT,Professional,Both,,,,163,138.55,48.65,163,BlueCross BlueShield Minnesota, Federal Employee Program,157,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Removal Of Skin Tags, Multiple Fibrocutaneous Tags, Any Area; Up To And Inc 15 Lesions (Pro Cah)",,11200,CPT,Professional,Both,,,,174,147.9,48.65,174,BlueCross BlueShield Minnesota, Federal Employee Program,157,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Removal Of Skin Tags, Multiple Fibrocutaneous Tags, Any Area; Up To And Inc 15 Lesions (Pro Cah)",,11200,CPT,Professional,Both,,,,163,138.55,48.65,163,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,159.512,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Removal Of Skin Tags, Multiple Fibrocutaneous Tags, Any Area; Up To And Inc 15 Lesions (Pro Cah)",,11200,CPT,Professional,Both,,,,174,147.9,48.65,174,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,159.512,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Removal Of Skin Tags, Multiple Fibrocutaneous Tags, Any Area; Up To And Inc 15 Lesions (Pro Cah)",,11200,CPT,Professional,Both,,,,163,138.55,48.65,163,BlueCross BlueShield Minnesota,High Value Network Plan,159.512,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Removal Of Skin Tags, Multiple Fibrocutaneous Tags, Any Area; Up To And Inc 15 Lesions (Pro Cah)",,11200,CPT,Professional,Both,,,,174,147.9,48.65,174,BlueCross BlueShield Minnesota,High Value Network Plan,159.512,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Removal Of Skin Tags, Multiple Fibrocutaneous Tags, Any Area; Up To And Inc 15 Lesions (Pro Cah)",,11200,CPT,Professional,Both,,,,163,138.55,48.65,163,BlueCross BlueShield Minnesota,Medicare Advantage,87.2275,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Removal Of Skin Tags, Multiple Fibrocutaneous Tags, Any Area; Up To And Inc 15 Lesions (Pro Cah)",,11200,CPT,Professional,Both,,,,174,147.9,48.65,174,BlueCross BlueShield Minnesota,Medicare Advantage,87.2275,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Removal Of Skin Tags, Multiple Fibrocutaneous Tags, Any Area; Up To And Inc 15 Lesions (Pro Cah)",,11200,CPT,Professional,Both,,,,163,138.55,48.65,163,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,159.512,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Removal Of Skin Tags, Multiple Fibrocutaneous Tags, Any Area; Up To And Inc 15 Lesions (Pro Cah)",,11200,CPT,Professional,Both,,,,174,147.9,48.65,174,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,159.512,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Removal Of Skin Tags, Multiple Fibrocutaneous Tags, Any Area; Up To And Inc 15 Lesions (Pro Cah)",,11200,CPT,Professional,Both,,,,163,138.55,48.65,163,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,56.16448,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Removal Of Skin Tags, Multiple Fibrocutaneous Tags, Any Area; Up To And Inc 15 Lesions (Pro Cah)",,11200,CPT,Professional,Both,,,,174,147.9,48.65,174,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,56.16448,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Removal Of Skin Tags, Multiple Fibrocutaneous Tags, Any Area; Up To And Inc 15 Lesions (Pro Cah)",,11200,CPT,Professional,Both,,,,163,138.55,48.65,163,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),87.2275,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Removal Of Skin Tags, Multiple Fibrocutaneous Tags, Any Area; Up To And Inc 15 Lesions (Pro Cah)",,11200,CPT,Professional,Both,,,,174,147.9,48.65,174,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),87.2275,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Removal Of Skin Tags, Multiple Fibrocutaneous Tags, Any Area; Up To And Inc 15 Lesions (Pro Cah)",,11200,CPT,Professional,Both,,,,163,138.55,48.65,163,CorVel,Worker's Compensation,146.349996,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Removal Of Skin Tags, Multiple Fibrocutaneous Tags, Any Area; Up To And Inc 15 Lesions (Pro Cah)",,11200,CPT,Professional,Both,,,,174,147.9,48.65,174,CorVel,Worker's Compensation,146.349996,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Removal Of Skin Tags, Multiple Fibrocutaneous Tags, Any Area; Up To And Inc 15 Lesions (Pro Cah)",,11200,CPT,Professional,Both,,,,163,138.55,48.65,163,First Health Group Corporation,First Health Network,158.11,97,,percent of total billed charges,,
"Removal Of Skin Tags, Multiple Fibrocutaneous Tags, Any Area; Up To And Inc 15 Lesions (Pro Cah)",,11200,CPT,Professional,Both,,,,174,147.9,48.65,174,First Health Group Corporation,First Health Network,168.78,97,,percent of total billed charges,,
"Removal Of Skin Tags, Multiple Fibrocutaneous Tags, Any Area; Up To And Inc 15 Lesions (Pro Cah)",,11200,CPT,Professional,Both,,,,163,138.55,48.65,163,"Health Partners, Inc.",Commercial,158.16,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Removal Of Skin Tags, Multiple Fibrocutaneous Tags, Any Area; Up To And Inc 15 Lesions (Pro Cah)",,11200,CPT,Professional,Both,,,,174,147.9,48.65,174,"Health Partners, Inc.",Commercial,158.16,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Removal Of Skin Tags, Multiple Fibrocutaneous Tags, Any Area; Up To And Inc 15 Lesions (Pro Cah)",,11200,CPT,Professional,Both,,,,163,138.55,48.65,163,"Health Partners, Inc.",Medicare Advantage,87.2275,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Removal Of Skin Tags, Multiple Fibrocutaneous Tags, Any Area; Up To And Inc 15 Lesions (Pro Cah)",,11200,CPT,Professional,Both,,,,174,147.9,48.65,174,"Health Partners, Inc.",Medicare Advantage,87.2275,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Removal Of Skin Tags, Multiple Fibrocutaneous Tags, Any Area; Up To And Inc 15 Lesions (Pro Cah)",,11200,CPT,Professional,Both,,,,163,138.55,48.65,163,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),75.91,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Removal Of Skin Tags, Multiple Fibrocutaneous Tags, Any Area; Up To And Inc 15 Lesions (Pro Cah)",,11200,CPT,Professional,Both,,,,174,147.9,48.65,174,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),75.91,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Removal Of Skin Tags, Multiple Fibrocutaneous Tags, Any Area; Up To And Inc 15 Lesions (Pro Cah)",,11200,CPT,Professional,Both,,,,163,138.55,48.65,163,"Health Partners, Inc.",State of Minnesota Advantage Program,136.25484,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Removal Of Skin Tags, Multiple Fibrocutaneous Tags, Any Area; Up To And Inc 15 Lesions (Pro Cah)",,11200,CPT,Professional,Both,,,,174,147.9,48.65,174,"Health Partners, Inc.",State of Minnesota Advantage Program,136.25484,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Removal Of Skin Tags, Multiple Fibrocutaneous Tags, Any Area; Up To And Inc 15 Lesions (Pro Cah)",,11200,CPT,Professional,Both,,,,163,138.55,48.65,163,"Health Partners, Inc.",State Public Programs,48.65,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Removal Of Skin Tags, Multiple Fibrocutaneous Tags, Any Area; Up To And Inc 15 Lesions (Pro Cah)",,11200,CPT,Professional,Both,,,,174,147.9,48.65,174,"Health Partners, Inc.",State Public Programs,48.65,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Removal Of Skin Tags, Multiple Fibrocutaneous Tags, Any Area; Up To And Inc 15 Lesions (Pro Cah)",,11200,CPT,Professional,Both,,,,163,138.55,48.65,163,Humana Insurance Company,Commercial PPO,75.85,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Removal Of Skin Tags, Multiple Fibrocutaneous Tags, Any Area; Up To And Inc 15 Lesions (Pro Cah)",,11200,CPT,Professional,Both,,,,174,147.9,48.65,174,Humana Insurance Company,Commercial PPO,75.85,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Removal Of Skin Tags, Multiple Fibrocutaneous Tags, Any Area; Up To And Inc 15 Lesions (Pro Cah)",,11200,CPT,Professional,Both,,,,163,138.55,48.65,163,Humana Insurance Company,Medicare PPO,163,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Removal Of Skin Tags, Multiple Fibrocutaneous Tags, Any Area; Up To And Inc 15 Lesions (Pro Cah)",,11200,CPT,Professional,Both,,,,174,147.9,48.65,174,Humana Insurance Company,Medicare PPO,174,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Removal Of Skin Tags, Multiple Fibrocutaneous Tags, Any Area; Up To And Inc 15 Lesions (Pro Cah)",,11200,CPT,Professional,Both,,,,163,138.55,48.65,163,Medica,Individual & Family,138.224,84.8,,percent of total billed charges,,
"Removal Of Skin Tags, Multiple Fibrocutaneous Tags, Any Area; Up To And Inc 15 Lesions (Pro Cah)",,11200,CPT,Professional,Both,,,,174,147.9,48.65,174,Medica,Individual & Family,147.552,84.8,,percent of total billed charges,,
"Removal Of Skin Tags, Multiple Fibrocutaneous Tags, Any Area; Up To And Inc 15 Lesions (Pro Cah)",,11200,CPT,Professional,Both,,,,163,138.55,48.65,163,Medica,Medica Advantage Solution,81.174,49.8,,percent of total billed charges,,
"Removal Of Skin Tags, Multiple Fibrocutaneous Tags, Any Area; Up To And Inc 15 Lesions (Pro Cah)",,11200,CPT,Professional,Both,,,,174,147.9,48.65,174,Medica,Medica Advantage Solution,86.652,49.8,,percent of total billed charges,,
"Removal Of Skin Tags, Multiple Fibrocutaneous Tags, Any Area; Up To And Inc 15 Lesions (Pro Cah)",,11200,CPT,Professional,Both,,,,163,138.55,48.65,163,Medica,Medical Assistance,56.16,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Removal Of Skin Tags, Multiple Fibrocutaneous Tags, Any Area; Up To And Inc 15 Lesions (Pro Cah)",,11200,CPT,Professional,Both,,,,174,147.9,48.65,174,Medica,Medical Assistance,56.16,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Removal Of Skin Tags, Multiple Fibrocutaneous Tags, Any Area; Up To And Inc 15 Lesions (Pro Cah)",,11200,CPT,Professional,Both,,,,163,138.55,48.65,163,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,75.85,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Removal Of Skin Tags, Multiple Fibrocutaneous Tags, Any Area; Up To And Inc 15 Lesions (Pro Cah)",,11200,CPT,Professional,Both,,,,174,147.9,48.65,174,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,75.85,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Removal Of Skin Tags, Multiple Fibrocutaneous Tags, Any Area; Up To And Inc 15 Lesions (Pro Cah)",,11200,CPT,Professional,Both,,,,163,138.55,48.65,163,"Multiplan, Inc.","Multiplan, Inc.",153.22,94,,percent of total billed charges,,
"Removal Of Skin Tags, Multiple Fibrocutaneous Tags, Any Area; Up To And Inc 15 Lesions (Pro Cah)",,11200,CPT,Professional,Both,,,,174,147.9,48.65,174,"Multiplan, Inc.","Multiplan, Inc.",163.56,94,,percent of total billed charges,,
"Removal Of Skin Tags, Multiple Fibrocutaneous Tags, Any Area; Up To And Inc 15 Lesions (Pro Cah)",,11200,CPT,Professional,Both,,,,163,138.55,48.65,163,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,146.863,90.1,,percent of total billed charges,,
"Removal Of Skin Tags, Multiple Fibrocutaneous Tags, Any Area; Up To And Inc 15 Lesions (Pro Cah)",,11200,CPT,Professional,Both,,,,174,147.9,48.65,174,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,156.774,90.1,,percent of total billed charges,,
"Removal Of Skin Tags, Multiple Fibrocutaneous Tags, Any Area; Up To And Inc 15 Lesions (Pro Cah)",,11200,CPT,Professional,Both,,,,163,138.55,48.65,163,"Preferred One Administrative Services, INC.",PPO,160.718,98.6,,percent of total billed charges,,
"Removal Of Skin Tags, Multiple Fibrocutaneous Tags, Any Area; Up To And Inc 15 Lesions (Pro Cah)",,11200,CPT,Professional,Both,,,,174,147.9,48.65,174,"Preferred One Administrative Services, INC.",PPO,171.564,98.6,,percent of total billed charges,,
"Removal Of Skin Tags, Multiple Fibrocutaneous Tags, Any Area; Up To And Inc 15 Lesions (Pro Cah)",,11200,CPT,Professional,Both,,,,163,138.55,48.65,163,PrimeWest Health,Minnesota Senior Health Options (MSHO),87.2275,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Removal Of Skin Tags, Multiple Fibrocutaneous Tags, Any Area; Up To And Inc 15 Lesions (Pro Cah)",,11200,CPT,Professional,Both,,,,174,147.9,48.65,174,PrimeWest Health,Minnesota Senior Health Options (MSHO),87.2275,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Removal Of Skin Tags, Multiple Fibrocutaneous Tags, Any Area; Up To And Inc 15 Lesions (Pro Cah)",,11200,CPT,Professional,Both,,,,163,138.55,48.65,163,PrimeWest Health,MinnesotaCare,60.0959936,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Removal Of Skin Tags, Multiple Fibrocutaneous Tags, Any Area; Up To And Inc 15 Lesions (Pro Cah)",,11200,CPT,Professional,Both,,,,174,147.9,48.65,174,PrimeWest Health,MinnesotaCare,60.0959936,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Removal Of Skin Tags, Multiple Fibrocutaneous Tags, Any Area; Up To And Inc 15 Lesions (Pro Cah)",,11200,CPT,Professional,Both,,,,163,138.55,48.65,163,Sanford Health Plan,Sanford Health Plan,143.44,88,,percent of total billed charges,,
"Removal Of Skin Tags, Multiple Fibrocutaneous Tags, Any Area; Up To And Inc 15 Lesions (Pro Cah)",,11200,CPT,Professional,Both,,,,174,147.9,48.65,174,Sanford Health Plan,Sanford Health Plan,153.12,88,,percent of total billed charges,,
"Removal Of Skin Tags, Multiple Fibrocutaneous Tags, Any Area; Up To And Inc 15 Lesions (Pro Cah)",,11200,CPT,Professional,Both,,,,163,138.55,48.65,163,"UCare Health, Inc.",Individual & Family Plan,123.30176,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Removal Of Skin Tags, Multiple Fibrocutaneous Tags, Any Area; Up To And Inc 15 Lesions (Pro Cah)",,11200,CPT,Professional,Both,,,,174,147.9,48.65,174,"UCare Health, Inc.",Individual & Family Plan,123.30176,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Removal Of Skin Tags, Multiple Fibrocutaneous Tags, Any Area; Up To And Inc 15 Lesions (Pro Cah)",,11200,CPT,Professional,Both,,,,163,138.55,48.65,163,"UCare Health, Inc.",Medical Assistance,61.780928,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Removal Of Skin Tags, Multiple Fibrocutaneous Tags, Any Area; Up To And Inc 15 Lesions (Pro Cah)",,11200,CPT,Professional,Both,,,,174,147.9,48.65,174,"UCare Health, Inc.",Medical Assistance,61.780928,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Removal Of Skin Tags, Multiple Fibrocutaneous Tags, Any Area; Up To And Inc 15 Lesions (Pro Cah)",,11200,CPT,Professional,Both,,,,163,138.55,48.65,163,"UCare Health, Inc.",Medicare Advantage,87.2275,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Removal Of Skin Tags, Multiple Fibrocutaneous Tags, Any Area; Up To And Inc 15 Lesions (Pro Cah)",,11200,CPT,Professional,Both,,,,174,147.9,48.65,174,"UCare Health, Inc.",Medicare Advantage,87.2275,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Removal Of Skin Tags, Multiple Fibrocutaneous Tags, Any Area; Up To And Inc 15 Lesions (Pro Cah)",,11200,CPT,Professional,Both,,,,163,138.55,48.65,163,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),69.782,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Removal Of Skin Tags, Multiple Fibrocutaneous Tags, Any Area; Up To And Inc 15 Lesions (Pro Cah)",,11200,CPT,Professional,Both,,,,174,147.9,48.65,174,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),69.782,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Removal Of Skin Tags, Multiple Fibrocutaneous Tags, Any Area; Up To And Inc 15 Lesions (Pro Cah)",,11200,CPT,Professional,Both,,,,163,138.55,48.65,163,UnitedHealthcare,Individual & Family,163,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Removal Of Skin Tags, Multiple Fibrocutaneous Tags, Any Area; Up To And Inc 15 Lesions (Pro Cah)",,11200,CPT,Professional,Both,,,,174,147.9,48.65,174,UnitedHealthcare,Individual & Family,174,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Removal Of Skin Tags, Multiple Fibrocutaneous Tags, Any Area; Up To And Inc 15 Lesions (Pro Cah)",,11200,CPT,Professional,Both,,,,163,138.55,48.65,163,UnitedHealthcare,Medicare Advantage,87.2275,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Removal Of Skin Tags, Multiple Fibrocutaneous Tags, Any Area; Up To And Inc 15 Lesions (Pro Cah)",,11200,CPT,Professional,Both,,,,174,147.9,48.65,174,UnitedHealthcare,Medicare Advantage,87.2275,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Removal Of Skin Tags, Multiple Fibrocutaneous Tags, Any Area; Up To And Inc 15 Lesions (Pro Cah)",,11200,CPT,Professional,Both,,,,163,138.55,48.65,163,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,56.16448,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Removal Of Skin Tags, Multiple Fibrocutaneous Tags, Any Area; Up To And Inc 15 Lesions (Pro Cah)",,11200,CPT,Professional,Both,,,,174,147.9,48.65,174,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,56.16448,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Removal Skin Tags, Multiple Fibrocutaneous Tags; Up To And Including 15 Lesions",,11200,CPT,Facility,Both,,,,112,95.2,32.0992,299,Aetna,Commercial,103.04,92,,percent of total billed charges,,
"Removal Skin Tags, Multiple Fibrocutaneous Tags; Up To And Including 15 Lesions",,11200,CPT,Facility,Outpatient,,,,112,95.2,32.0992,299,Aetna,Medicare Advantage,54.88,49,,percent of total billed charges,,
"Removal Skin Tags, Multiple Fibrocutaneous Tags; Up To And Including 15 Lesions",,11200,CPT,Facility,Inpatient,,,,112,95.2,32.0992,299,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Removal Skin Tags, Multiple Fibrocutaneous Tags; Up To And Including 15 Lesions",,11200,CPT,Facility,Both,,,,112,95.2,32.0992,299,Aetna,PPO,104.16,93,,percent of total billed charges,,
"Removal Skin Tags, Multiple Fibrocutaneous Tags; Up To And Including 15 Lesions",,11200,CPT,Facility,Both,,,,112,95.2,32.0992,299,America's PPO,America's PPO,107.5536,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Removal Skin Tags, Multiple Fibrocutaneous Tags; Up To And Including 15 Lesions",,11200,CPT,Facility,Both,,,,112,95.2,32.0992,299,BlueCross BlueShield Minnesota, Federal Employee Program,110.208,98.4,,percent of total billed charges,,
"Removal Skin Tags, Multiple Fibrocutaneous Tags; Up To And Including 15 Lesions",,11200,CPT,Facility,Both,,,,112,95.2,32.0992,299,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,112,100,,percent of total billed charges,,
"Removal Skin Tags, Multiple Fibrocutaneous Tags; Up To And Including 15 Lesions",,11200,CPT,Facility,Both,,,,112,95.2,32.0992,299,BlueCross BlueShield Minnesota,High Value Network Plan,100.8,90,,percent of total billed charges,,
"Removal Skin Tags, Multiple Fibrocutaneous Tags; Up To And Including 15 Lesions",,11200,CPT,Facility,Outpatient,,,,112,95.2,32.0992,299,BlueCross BlueShield Minnesota,Medicare Advantage,54.88,49,,percent of total billed charges,,
"Removal Skin Tags, Multiple Fibrocutaneous Tags; Up To And Including 15 Lesions",,11200,CPT,Facility,Inpatient,,,,112,95.2,32.0992,299,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Removal Skin Tags, Multiple Fibrocutaneous Tags; Up To And Including 15 Lesions",,11200,CPT,Facility,Both,,,,112,95.2,32.0992,299,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,99.1984,88.57,,percent of total billed charges,,
"Removal Skin Tags, Multiple Fibrocutaneous Tags; Up To And Including 15 Lesions",,11200,CPT,Facility,Both,,,,112,95.2,32.0992,299,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,32.0992,28.66,,percent of total billed charges,,
"Removal Skin Tags, Multiple Fibrocutaneous Tags; Up To And Including 15 Lesions",,11200,CPT,Facility,Outpatient,,,,112,95.2,32.0992,299,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),54.88,49,,percent of total billed charges,,
"Removal Skin Tags, Multiple Fibrocutaneous Tags; Up To And Including 15 Lesions",,11200,CPT,Facility,Inpatient,,,,112,95.2,32.0992,299,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Removal Skin Tags, Multiple Fibrocutaneous Tags; Up To And Including 15 Lesions",,11200,CPT,Facility,Both,,,,112,95.2,32.0992,299,CorVel,Worker's Compensation,112,100,,percent of total billed charges,,
"Removal Skin Tags, Multiple Fibrocutaneous Tags; Up To And Including 15 Lesions",,11200,CPT,Facility,Both,,,,112,95.2,32.0992,299,First Health Group Corporation,First Health Network,108.64,97,,percent of total billed charges,,
"Removal Skin Tags, Multiple Fibrocutaneous Tags; Up To And Including 15 Lesions",,11200,CPT,Facility,Both,,,,112,95.2,32.0992,299,"Health Partners, Inc.",Commercial,105.952,94.6,,percent of total billed charges,,
"Removal Skin Tags, Multiple Fibrocutaneous Tags; Up To And Including 15 Lesions",,11200,CPT,Facility,Outpatient,,,,112,95.2,32.0992,299,"Health Partners, Inc.",Medicare Advantage,54.88,49,,percent of total billed charges,,
"Removal Skin Tags, Multiple Fibrocutaneous Tags; Up To And Including 15 Lesions",,11200,CPT,Facility,Inpatient,,,,112,95.2,32.0992,299,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Removal Skin Tags, Multiple Fibrocutaneous Tags; Up To And Including 15 Lesions",,11200,CPT,Facility,Both,,,,112,95.2,32.0992,299,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),67.2,60,,percent of total billed charges,,
"Removal Skin Tags, Multiple Fibrocutaneous Tags; Up To And Including 15 Lesions",,11200,CPT,Facility,Both,,,,112,95.2,32.0992,299,"Health Partners, Inc.",State of Minnesota Advantage Program,91.28,81.5,,percent of total billed charges,,
"Removal Skin Tags, Multiple Fibrocutaneous Tags; Up To And Including 15 Lesions",,11200,CPT,Facility,Both,,,,112,95.2,32.0992,299,"Health Partners, Inc.",State Public Programs,56,50,,percent of total billed charges,,
"Removal Skin Tags, Multiple Fibrocutaneous Tags; Up To And Including 15 Lesions",,11200,CPT,Facility,Both,,,,112,95.2,32.0992,299,Humana Insurance Company,Commercial PPO,106.4,95,,percent of total billed charges,,
"Removal Skin Tags, Multiple Fibrocutaneous Tags; Up To And Including 15 Lesions",,11200,CPT,Facility,Outpatient,,,,112,95.2,32.0992,299,Humana Insurance Company,Medicare PPO,54.88,49,,percent of total billed charges,,
"Removal Skin Tags, Multiple Fibrocutaneous Tags; Up To And Including 15 Lesions",,11200,CPT,Facility,Inpatient,,,,112,95.2,32.0992,299,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Removal Skin Tags, Multiple Fibrocutaneous Tags; Up To And Including 15 Lesions",,11200,CPT,Facility,Both,,,,112,95.2,32.0992,299,Medica,Individual & Family,110.992,99.1,,percent of total billed charges,,
"Removal Skin Tags, Multiple Fibrocutaneous Tags; Up To And Including 15 Lesions",,11200,CPT,Facility,Outpatient,,,,112,95.2,32.0992,299,Medica,Medica Advantage Solution,55.776,49.8,,percent of total billed charges,,
"Removal Skin Tags, Multiple Fibrocutaneous Tags; Up To And Including 15 Lesions",,11200,CPT,Facility,Inpatient,,,,112,95.2,32.0992,299,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Removal Skin Tags, Multiple Fibrocutaneous Tags; Up To And Including 15 Lesions",,11200,CPT,Facility,Outpatient,,,,112,95.2,32.0992,299,Medica,Medical Assistance,299,,,Other,Grouper,All inclusive per visit
"Removal Skin Tags, Multiple Fibrocutaneous Tags; Up To And Including 15 Lesions",,11200,CPT,Facility,Inpatient,,,,112,95.2,32.0992,299,Medica,Medical Assistance,,,,,Included in per diem rate,
"Removal Skin Tags, Multiple Fibrocutaneous Tags; Up To And Including 15 Lesions",,11200,CPT,Facility,Outpatient,,,,112,95.2,32.0992,299,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,55.776,49.8,,percent of total billed charges,,
"Removal Skin Tags, Multiple Fibrocutaneous Tags; Up To And Including 15 Lesions",,11200,CPT,Facility,Inpatient,,,,112,95.2,32.0992,299,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Removal Skin Tags, Multiple Fibrocutaneous Tags; Up To And Including 15 Lesions",,11200,CPT,Facility,Both,,,,112,95.2,32.0992,299,"Multiplan, Inc.","Multiplan, Inc.",105.28,94,,percent of total billed charges,,
"Removal Skin Tags, Multiple Fibrocutaneous Tags; Up To And Including 15 Lesions",,11200,CPT,Facility,Outpatient,,,,112,95.2,32.0992,299,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,100.912,90.1,,percent of total billed charges,,
"Removal Skin Tags, Multiple Fibrocutaneous Tags; Up To And Including 15 Lesions",,11200,CPT,Facility,Inpatient,,,,112,95.2,32.0992,299,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Removal Skin Tags, Multiple Fibrocutaneous Tags; Up To And Including 15 Lesions",,11200,CPT,Facility,Both,,,,112,95.2,32.0992,299,"Preferred One Administrative Services, INC.",PPO,110.432,98.6,,percent of total billed charges,,
"Removal Skin Tags, Multiple Fibrocutaneous Tags; Up To And Including 15 Lesions",,11200,CPT,Facility,Outpatient,,,,112,95.2,32.0992,299,PrimeWest Health,Minnesota Senior Health Options (MSHO),57.624,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Removal Skin Tags, Multiple Fibrocutaneous Tags; Up To And Including 15 Lesions",,11200,CPT,Facility,Inpatient,,,,112,95.2,32.0992,299,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Removal Skin Tags, Multiple Fibrocutaneous Tags; Up To And Including 15 Lesions",,11200,CPT,Facility,Outpatient,,,,112,95.2,32.0992,299,PrimeWest Health,MinnesotaCare,57.5232,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Removal Skin Tags, Multiple Fibrocutaneous Tags; Up To And Including 15 Lesions",,11200,CPT,Facility,Inpatient,,,,112,95.2,32.0992,299,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Removal Skin Tags, Multiple Fibrocutaneous Tags; Up To And Including 15 Lesions",,11200,CPT,Facility,Both,,,,112,95.2,32.0992,299,Sanford Health Plan,Sanford Health Plan,103.04,92,,percent of total billed charges,,
"Removal Skin Tags, Multiple Fibrocutaneous Tags; Up To And Including 15 Lesions",,11200,CPT,Facility,Outpatient,,,,112,95.2,32.0992,299,"UCare Health, Inc.",Individual & Family Plan,63.112,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Removal Skin Tags, Multiple Fibrocutaneous Tags; Up To And Including 15 Lesions",,11200,CPT,Facility,Inpatient,,,,112,95.2,32.0992,299,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Removal Skin Tags, Multiple Fibrocutaneous Tags; Up To And Including 15 Lesions",,11200,CPT,Facility,Outpatient,,,,112,95.2,32.0992,299,"UCare Health, Inc.",Medical Assistance,56.5264,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Removal Skin Tags, Multiple Fibrocutaneous Tags; Up To And Including 15 Lesions",,11200,CPT,Facility,Inpatient,,,,112,95.2,32.0992,299,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Removal Skin Tags, Multiple Fibrocutaneous Tags; Up To And Including 15 Lesions",,11200,CPT,Facility,Outpatient,,,,112,95.2,32.0992,299,"UCare Health, Inc.",Medicare Advantage,56.5264,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Removal Skin Tags, Multiple Fibrocutaneous Tags; Up To And Including 15 Lesions",,11200,CPT,Facility,Inpatient,,,,112,95.2,32.0992,299,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Removal Skin Tags, Multiple Fibrocutaneous Tags; Up To And Including 15 Lesions",,11200,CPT,Facility,Outpatient,,,,112,95.2,32.0992,299,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),56.5264,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Removal Skin Tags, Multiple Fibrocutaneous Tags; Up To And Including 15 Lesions",,11200,CPT,Facility,Inpatient,,,,112,95.2,32.0992,299,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Removal Skin Tags, Multiple Fibrocutaneous Tags; Up To And Including 15 Lesions",,11200,CPT,Facility,Both,,,,112,95.2,32.0992,299,UnitedHealthcare,Individual & Family,105.28,94,,percent of total billed charges,,
"Removal Skin Tags, Multiple Fibrocutaneous Tags; Up To And Including 15 Lesions",,11200,CPT,Facility,Outpatient,,,,112,95.2,32.0992,299,UnitedHealthcare,Medicare Advantage,54.88,49,,percent of total billed charges,,
"Removal Skin Tags, Multiple Fibrocutaneous Tags; Up To And Including 15 Lesions",,11200,CPT,Facility,Inpatient,,,,112,95.2,32.0992,299,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Removal Skin Tags, Multiple Fibrocutaneous Tags; Up To And Including 15 Lesions",,11200,CPT,Facility,Outpatient,,,,112,95.2,32.0992,299,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,53.76,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Removal Skin Tags, Multiple Fibrocutaneous Tags; Up To And Including 15 Lesions",,11200,CPT,Facility,Inpatient,,,,112,95.2,32.0992,299,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
DIGOXIN 125 MCG (0.125 MG) ORAL TABLET,,16423,LOCAL,Facility,Both,1,Each,,9,7.65,2.5794,9,Aetna,Commercial,8.28,92,,percent of total billed charges,,
DIGOXIN 125 MCG (0.125 MG) ORAL TABLET,,16423,LOCAL,Facility,Outpatient,1,Each,,9,7.65,2.5794,9,Aetna,Medicare Advantage,4.41,49,,percent of total billed charges,,
DIGOXIN 125 MCG (0.125 MG) ORAL TABLET,,16423,LOCAL,Facility,Inpatient,1,Each,,9,7.65,2.5794,9,Aetna,Medicare Advantage,,,,,Included in per diem rate,
DIGOXIN 125 MCG (0.125 MG) ORAL TABLET,,16423,LOCAL,Facility,Both,1,Each,,9,7.65,2.5794,9,Aetna,PPO,8.37,93,,percent of total billed charges,,
DIGOXIN 125 MCG (0.125 MG) ORAL TABLET,,16423,LOCAL,Facility,Both,1,Each,,9,7.65,2.5794,9,America's PPO,America's PPO,8.6427,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
DIGOXIN 125 MCG (0.125 MG) ORAL TABLET,,16423,LOCAL,Facility,Both,1,Each,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota, Federal Employee Program,8.856,98.4,,percent of total billed charges,,
DIGOXIN 125 MCG (0.125 MG) ORAL TABLET,,16423,LOCAL,Facility,Both,1,Each,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,9,100,,percent of total billed charges,,
DIGOXIN 125 MCG (0.125 MG) ORAL TABLET,,16423,LOCAL,Facility,Both,1,Each,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota,High Value Network Plan,8.1,90,,percent of total billed charges,,
DIGOXIN 125 MCG (0.125 MG) ORAL TABLET,,16423,LOCAL,Facility,Outpatient,1,Each,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota,Medicare Advantage,4.41,49,,percent of total billed charges,,
DIGOXIN 125 MCG (0.125 MG) ORAL TABLET,,16423,LOCAL,Facility,Inpatient,1,Each,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
DIGOXIN 125 MCG (0.125 MG) ORAL TABLET,,16423,LOCAL,Facility,Both,1,Each,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,7.9713,88.57,,percent of total billed charges,,
DIGOXIN 125 MCG (0.125 MG) ORAL TABLET,,16423,LOCAL,Facility,Both,1,Each,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,2.5794,28.66,,percent of total billed charges,,
DIGOXIN 125 MCG (0.125 MG) ORAL TABLET,,16423,LOCAL,Facility,Outpatient,1,Each,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),4.41,49,,percent of total billed charges,,
DIGOXIN 125 MCG (0.125 MG) ORAL TABLET,,16423,LOCAL,Facility,Inpatient,1,Each,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
DIGOXIN 125 MCG (0.125 MG) ORAL TABLET,,16423,LOCAL,Facility,Both,1,Each,,9,7.65,2.5794,9,CorVel,Worker's Compensation,9,100,,percent of total billed charges,,
DIGOXIN 125 MCG (0.125 MG) ORAL TABLET,,16423,LOCAL,Facility,Both,1,Each,,9,7.65,2.5794,9,First Health Group Corporation,First Health Network,8.73,97,,percent of total billed charges,,
DIGOXIN 125 MCG (0.125 MG) ORAL TABLET,,16423,LOCAL,Facility,Both,1,Each,,9,7.65,2.5794,9,"Health Partners, Inc.",Commercial,8.514,94.6,,percent of total billed charges,,
DIGOXIN 125 MCG (0.125 MG) ORAL TABLET,,16423,LOCAL,Facility,Outpatient,1,Each,,9,7.65,2.5794,9,"Health Partners, Inc.",Medicare Advantage,4.41,49,,percent of total billed charges,,
DIGOXIN 125 MCG (0.125 MG) ORAL TABLET,,16423,LOCAL,Facility,Inpatient,1,Each,,9,7.65,2.5794,9,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DIGOXIN 125 MCG (0.125 MG) ORAL TABLET,,16423,LOCAL,Facility,Both,1,Each,,9,7.65,2.5794,9,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),5.4,60,,percent of total billed charges,,
DIGOXIN 125 MCG (0.125 MG) ORAL TABLET,,16423,LOCAL,Facility,Both,1,Each,,9,7.65,2.5794,9,"Health Partners, Inc.",State of Minnesota Advantage Program,7.335,81.5,,percent of total billed charges,,
DIGOXIN 125 MCG (0.125 MG) ORAL TABLET,,16423,LOCAL,Facility,Both,1,Each,,9,7.65,2.5794,9,"Health Partners, Inc.",State Public Programs,4.5,50,,percent of total billed charges,,
DIGOXIN 125 MCG (0.125 MG) ORAL TABLET,,16423,LOCAL,Facility,Both,1,Each,,9,7.65,2.5794,9,Humana Insurance Company,Commercial PPO,8.55,95,,percent of total billed charges,,
DIGOXIN 125 MCG (0.125 MG) ORAL TABLET,,16423,LOCAL,Facility,Outpatient,1,Each,,9,7.65,2.5794,9,Humana Insurance Company,Medicare PPO,4.41,49,,percent of total billed charges,,
DIGOXIN 125 MCG (0.125 MG) ORAL TABLET,,16423,LOCAL,Facility,Inpatient,1,Each,,9,7.65,2.5794,9,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
DIGOXIN 125 MCG (0.125 MG) ORAL TABLET,,16423,LOCAL,Facility,Both,1,Each,,9,7.65,2.5794,9,Medica,Individual & Family,8.919,99.1,,percent of total billed charges,,
DIGOXIN 125 MCG (0.125 MG) ORAL TABLET,,16423,LOCAL,Facility,Outpatient,1,Each,,9,7.65,2.5794,9,Medica,Medica Advantage Solution,4.482,49.8,,percent of total billed charges,,
DIGOXIN 125 MCG (0.125 MG) ORAL TABLET,,16423,LOCAL,Facility,Inpatient,1,Each,,9,7.65,2.5794,9,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
DIGOXIN 125 MCG (0.125 MG) ORAL TABLET,,16423,LOCAL,Facility,Outpatient,1,Each,,9,7.65,2.5794,9,Medica,Medical Assistance,4.014,44.6,,percent of total billed charges,,
DIGOXIN 125 MCG (0.125 MG) ORAL TABLET,,16423,LOCAL,Facility,Inpatient,1,Each,,9,7.65,2.5794,9,Medica,Medical Assistance,,,,,Included in per diem rate,
DIGOXIN 125 MCG (0.125 MG) ORAL TABLET,,16423,LOCAL,Facility,Outpatient,1,Each,,9,7.65,2.5794,9,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,4.482,49.8,,percent of total billed charges,,
DIGOXIN 125 MCG (0.125 MG) ORAL TABLET,,16423,LOCAL,Facility,Inpatient,1,Each,,9,7.65,2.5794,9,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
DIGOXIN 125 MCG (0.125 MG) ORAL TABLET,,16423,LOCAL,Facility,Both,1,Each,,9,7.65,2.5794,9,"Multiplan, Inc.","Multiplan, Inc.",8.46,94,,percent of total billed charges,,
DIGOXIN 125 MCG (0.125 MG) ORAL TABLET,,16423,LOCAL,Facility,Outpatient,1,Each,,9,7.65,2.5794,9,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,8.109,90.1,,percent of total billed charges,,
DIGOXIN 125 MCG (0.125 MG) ORAL TABLET,,16423,LOCAL,Facility,Inpatient,1,Each,,9,7.65,2.5794,9,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
DIGOXIN 125 MCG (0.125 MG) ORAL TABLET,,16423,LOCAL,Facility,Both,1,Each,,9,7.65,2.5794,9,"Preferred One Administrative Services, INC.",PPO,8.874,98.6,,percent of total billed charges,,
DIGOXIN 125 MCG (0.125 MG) ORAL TABLET,,16423,LOCAL,Facility,Outpatient,1,Each,,9,7.65,2.5794,9,PrimeWest Health,Minnesota Senior Health Options (MSHO),4.6305,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
DIGOXIN 125 MCG (0.125 MG) ORAL TABLET,,16423,LOCAL,Facility,Inpatient,1,Each,,9,7.65,2.5794,9,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DIGOXIN 125 MCG (0.125 MG) ORAL TABLET,,16423,LOCAL,Facility,Outpatient,1,Each,,9,7.65,2.5794,9,PrimeWest Health,MinnesotaCare,4.6224,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
DIGOXIN 125 MCG (0.125 MG) ORAL TABLET,,16423,LOCAL,Facility,Inpatient,1,Each,,9,7.65,2.5794,9,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
DIGOXIN 125 MCG (0.125 MG) ORAL TABLET,,16423,LOCAL,Facility,Both,1,Each,,9,7.65,2.5794,9,Sanford Health Plan,Sanford Health Plan,8.28,92,,percent of total billed charges,,
DIGOXIN 125 MCG (0.125 MG) ORAL TABLET,,16423,LOCAL,Facility,Outpatient,1,Each,,9,7.65,2.5794,9,"UCare Health, Inc.",Individual & Family Plan,5.0715,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
DIGOXIN 125 MCG (0.125 MG) ORAL TABLET,,16423,LOCAL,Facility,Inpatient,1,Each,,9,7.65,2.5794,9,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
DIGOXIN 125 MCG (0.125 MG) ORAL TABLET,,16423,LOCAL,Facility,Outpatient,1,Each,,9,7.65,2.5794,9,"UCare Health, Inc.",Medical Assistance,4.5423,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DIGOXIN 125 MCG (0.125 MG) ORAL TABLET,,16423,LOCAL,Facility,Inpatient,1,Each,,9,7.65,2.5794,9,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
DIGOXIN 125 MCG (0.125 MG) ORAL TABLET,,16423,LOCAL,Facility,Outpatient,1,Each,,9,7.65,2.5794,9,"UCare Health, Inc.",Medicare Advantage,4.5423,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DIGOXIN 125 MCG (0.125 MG) ORAL TABLET,,16423,LOCAL,Facility,Inpatient,1,Each,,9,7.65,2.5794,9,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DIGOXIN 125 MCG (0.125 MG) ORAL TABLET,,16423,LOCAL,Facility,Outpatient,1,Each,,9,7.65,2.5794,9,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),4.5423,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DIGOXIN 125 MCG (0.125 MG) ORAL TABLET,,16423,LOCAL,Facility,Inpatient,1,Each,,9,7.65,2.5794,9,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DIGOXIN 125 MCG (0.125 MG) ORAL TABLET,,16423,LOCAL,Facility,Both,1,Each,,9,7.65,2.5794,9,UnitedHealthcare,Individual & Family,8.46,94,,percent of total billed charges,,
DIGOXIN 125 MCG (0.125 MG) ORAL TABLET,,16423,LOCAL,Facility,Outpatient,1,Each,,9,7.65,2.5794,9,UnitedHealthcare,Medicare Advantage,4.41,49,,percent of total billed charges,,
DIGOXIN 125 MCG (0.125 MG) ORAL TABLET,,16423,LOCAL,Facility,Inpatient,1,Each,,9,7.65,2.5794,9,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
DIGOXIN 125 MCG (0.125 MG) ORAL TABLET,,16423,LOCAL,Facility,Outpatient,1,Each,,9,7.65,2.5794,9,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,4.32,48,,percent of total billed charges,,100% of DHS outpatient percentage
DIGOXIN 125 MCG (0.125 MG) ORAL TABLET,,16423,LOCAL,Facility,Inpatient,1,Each,,9,7.65,2.5794,9,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
ZOLPIDEM 5 MG ORAL TABLET,,16481,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
ZOLPIDEM 5 MG ORAL TABLET,,16481,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
ZOLPIDEM 5 MG ORAL TABLET,,16481,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
ZOLPIDEM 5 MG ORAL TABLET,,16481,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
ZOLPIDEM 5 MG ORAL TABLET,,16481,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
ZOLPIDEM 5 MG ORAL TABLET,,16481,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
ZOLPIDEM 5 MG ORAL TABLET,,16481,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
ZOLPIDEM 5 MG ORAL TABLET,,16481,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
ZOLPIDEM 5 MG ORAL TABLET,,16481,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
ZOLPIDEM 5 MG ORAL TABLET,,16481,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
ZOLPIDEM 5 MG ORAL TABLET,,16481,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
ZOLPIDEM 5 MG ORAL TABLET,,16481,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
ZOLPIDEM 5 MG ORAL TABLET,,16481,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
ZOLPIDEM 5 MG ORAL TABLET,,16481,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
ZOLPIDEM 5 MG ORAL TABLET,,16481,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
ZOLPIDEM 5 MG ORAL TABLET,,16481,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
ZOLPIDEM 5 MG ORAL TABLET,,16481,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
ZOLPIDEM 5 MG ORAL TABLET,,16481,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
ZOLPIDEM 5 MG ORAL TABLET,,16481,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ZOLPIDEM 5 MG ORAL TABLET,,16481,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
ZOLPIDEM 5 MG ORAL TABLET,,16481,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
ZOLPIDEM 5 MG ORAL TABLET,,16481,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
ZOLPIDEM 5 MG ORAL TABLET,,16481,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
ZOLPIDEM 5 MG ORAL TABLET,,16481,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
ZOLPIDEM 5 MG ORAL TABLET,,16481,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
ZOLPIDEM 5 MG ORAL TABLET,,16481,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
ZOLPIDEM 5 MG ORAL TABLET,,16481,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
ZOLPIDEM 5 MG ORAL TABLET,,16481,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
ZOLPIDEM 5 MG ORAL TABLET,,16481,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
ZOLPIDEM 5 MG ORAL TABLET,,16481,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
ZOLPIDEM 5 MG ORAL TABLET,,16481,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
ZOLPIDEM 5 MG ORAL TABLET,,16481,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
ZOLPIDEM 5 MG ORAL TABLET,,16481,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
ZOLPIDEM 5 MG ORAL TABLET,,16481,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
ZOLPIDEM 5 MG ORAL TABLET,,16481,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
ZOLPIDEM 5 MG ORAL TABLET,,16481,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
ZOLPIDEM 5 MG ORAL TABLET,,16481,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
ZOLPIDEM 5 MG ORAL TABLET,,16481,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ZOLPIDEM 5 MG ORAL TABLET,,16481,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
ZOLPIDEM 5 MG ORAL TABLET,,16481,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
ZOLPIDEM 5 MG ORAL TABLET,,16481,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
ZOLPIDEM 5 MG ORAL TABLET,,16481,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
ZOLPIDEM 5 MG ORAL TABLET,,16481,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
ZOLPIDEM 5 MG ORAL TABLET,,16481,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ZOLPIDEM 5 MG ORAL TABLET,,16481,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
ZOLPIDEM 5 MG ORAL TABLET,,16481,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ZOLPIDEM 5 MG ORAL TABLET,,16481,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ZOLPIDEM 5 MG ORAL TABLET,,16481,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ZOLPIDEM 5 MG ORAL TABLET,,16481,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ZOLPIDEM 5 MG ORAL TABLET,,16481,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
ZOLPIDEM 5 MG ORAL TABLET,,16481,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
ZOLPIDEM 5 MG ORAL TABLET,,16481,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
ZOLPIDEM 5 MG ORAL TABLET,,16481,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
ZOLPIDEM 5 MG ORAL TABLET,,16481,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
FUROSEMIDE 20 MG ORAL TABLET,,16494,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
FUROSEMIDE 20 MG ORAL TABLET,,16494,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
FUROSEMIDE 20 MG ORAL TABLET,,16494,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
FUROSEMIDE 20 MG ORAL TABLET,,16494,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
FUROSEMIDE 20 MG ORAL TABLET,,16494,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
FUROSEMIDE 20 MG ORAL TABLET,,16494,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
FUROSEMIDE 20 MG ORAL TABLET,,16494,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
FUROSEMIDE 20 MG ORAL TABLET,,16494,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
FUROSEMIDE 20 MG ORAL TABLET,,16494,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
FUROSEMIDE 20 MG ORAL TABLET,,16494,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
FUROSEMIDE 20 MG ORAL TABLET,,16494,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
FUROSEMIDE 20 MG ORAL TABLET,,16494,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
FUROSEMIDE 20 MG ORAL TABLET,,16494,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
FUROSEMIDE 20 MG ORAL TABLET,,16494,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
FUROSEMIDE 20 MG ORAL TABLET,,16494,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
FUROSEMIDE 20 MG ORAL TABLET,,16494,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
FUROSEMIDE 20 MG ORAL TABLET,,16494,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
FUROSEMIDE 20 MG ORAL TABLET,,16494,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
FUROSEMIDE 20 MG ORAL TABLET,,16494,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
FUROSEMIDE 20 MG ORAL TABLET,,16494,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
FUROSEMIDE 20 MG ORAL TABLET,,16494,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
FUROSEMIDE 20 MG ORAL TABLET,,16494,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
FUROSEMIDE 20 MG ORAL TABLET,,16494,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
FUROSEMIDE 20 MG ORAL TABLET,,16494,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
FUROSEMIDE 20 MG ORAL TABLET,,16494,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
FUROSEMIDE 20 MG ORAL TABLET,,16494,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
FUROSEMIDE 20 MG ORAL TABLET,,16494,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
FUROSEMIDE 20 MG ORAL TABLET,,16494,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
FUROSEMIDE 20 MG ORAL TABLET,,16494,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
FUROSEMIDE 20 MG ORAL TABLET,,16494,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
FUROSEMIDE 20 MG ORAL TABLET,,16494,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
FUROSEMIDE 20 MG ORAL TABLET,,16494,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
FUROSEMIDE 20 MG ORAL TABLET,,16494,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
FUROSEMIDE 20 MG ORAL TABLET,,16494,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
FUROSEMIDE 20 MG ORAL TABLET,,16494,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
FUROSEMIDE 20 MG ORAL TABLET,,16494,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
FUROSEMIDE 20 MG ORAL TABLET,,16494,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
FUROSEMIDE 20 MG ORAL TABLET,,16494,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
FUROSEMIDE 20 MG ORAL TABLET,,16494,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
FUROSEMIDE 20 MG ORAL TABLET,,16494,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
FUROSEMIDE 20 MG ORAL TABLET,,16494,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
FUROSEMIDE 20 MG ORAL TABLET,,16494,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
FUROSEMIDE 20 MG ORAL TABLET,,16494,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
FUROSEMIDE 20 MG ORAL TABLET,,16494,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FUROSEMIDE 20 MG ORAL TABLET,,16494,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
FUROSEMIDE 20 MG ORAL TABLET,,16494,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FUROSEMIDE 20 MG ORAL TABLET,,16494,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
FUROSEMIDE 20 MG ORAL TABLET,,16494,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FUROSEMIDE 20 MG ORAL TABLET,,16494,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
FUROSEMIDE 20 MG ORAL TABLET,,16494,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
FUROSEMIDE 20 MG ORAL TABLET,,16494,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
FUROSEMIDE 20 MG ORAL TABLET,,16494,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
FUROSEMIDE 20 MG ORAL TABLET,,16494,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
FUROSEMIDE 20 MG ORAL TABLET,,16494,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
LOPERAMIDE-SIMETHICONE 2-125 MG ORAL TABLET,,16512,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
LOPERAMIDE-SIMETHICONE 2-125 MG ORAL TABLET,,16512,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
LOPERAMIDE-SIMETHICONE 2-125 MG ORAL TABLET,,16512,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
LOPERAMIDE-SIMETHICONE 2-125 MG ORAL TABLET,,16512,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
LOPERAMIDE-SIMETHICONE 2-125 MG ORAL TABLET,,16512,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
LOPERAMIDE-SIMETHICONE 2-125 MG ORAL TABLET,,16512,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
LOPERAMIDE-SIMETHICONE 2-125 MG ORAL TABLET,,16512,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
LOPERAMIDE-SIMETHICONE 2-125 MG ORAL TABLET,,16512,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
LOPERAMIDE-SIMETHICONE 2-125 MG ORAL TABLET,,16512,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
LOPERAMIDE-SIMETHICONE 2-125 MG ORAL TABLET,,16512,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
LOPERAMIDE-SIMETHICONE 2-125 MG ORAL TABLET,,16512,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
LOPERAMIDE-SIMETHICONE 2-125 MG ORAL TABLET,,16512,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
LOPERAMIDE-SIMETHICONE 2-125 MG ORAL TABLET,,16512,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
LOPERAMIDE-SIMETHICONE 2-125 MG ORAL TABLET,,16512,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
LOPERAMIDE-SIMETHICONE 2-125 MG ORAL TABLET,,16512,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
LOPERAMIDE-SIMETHICONE 2-125 MG ORAL TABLET,,16512,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
LOPERAMIDE-SIMETHICONE 2-125 MG ORAL TABLET,,16512,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
LOPERAMIDE-SIMETHICONE 2-125 MG ORAL TABLET,,16512,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
LOPERAMIDE-SIMETHICONE 2-125 MG ORAL TABLET,,16512,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LOPERAMIDE-SIMETHICONE 2-125 MG ORAL TABLET,,16512,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
LOPERAMIDE-SIMETHICONE 2-125 MG ORAL TABLET,,16512,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
LOPERAMIDE-SIMETHICONE 2-125 MG ORAL TABLET,,16512,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
LOPERAMIDE-SIMETHICONE 2-125 MG ORAL TABLET,,16512,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
LOPERAMIDE-SIMETHICONE 2-125 MG ORAL TABLET,,16512,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
LOPERAMIDE-SIMETHICONE 2-125 MG ORAL TABLET,,16512,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
LOPERAMIDE-SIMETHICONE 2-125 MG ORAL TABLET,,16512,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
LOPERAMIDE-SIMETHICONE 2-125 MG ORAL TABLET,,16512,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
LOPERAMIDE-SIMETHICONE 2-125 MG ORAL TABLET,,16512,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
LOPERAMIDE-SIMETHICONE 2-125 MG ORAL TABLET,,16512,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
LOPERAMIDE-SIMETHICONE 2-125 MG ORAL TABLET,,16512,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
LOPERAMIDE-SIMETHICONE 2-125 MG ORAL TABLET,,16512,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
LOPERAMIDE-SIMETHICONE 2-125 MG ORAL TABLET,,16512,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
LOPERAMIDE-SIMETHICONE 2-125 MG ORAL TABLET,,16512,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
LOPERAMIDE-SIMETHICONE 2-125 MG ORAL TABLET,,16512,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
LOPERAMIDE-SIMETHICONE 2-125 MG ORAL TABLET,,16512,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
LOPERAMIDE-SIMETHICONE 2-125 MG ORAL TABLET,,16512,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
LOPERAMIDE-SIMETHICONE 2-125 MG ORAL TABLET,,16512,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
LOPERAMIDE-SIMETHICONE 2-125 MG ORAL TABLET,,16512,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LOPERAMIDE-SIMETHICONE 2-125 MG ORAL TABLET,,16512,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
LOPERAMIDE-SIMETHICONE 2-125 MG ORAL TABLET,,16512,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
LOPERAMIDE-SIMETHICONE 2-125 MG ORAL TABLET,,16512,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
LOPERAMIDE-SIMETHICONE 2-125 MG ORAL TABLET,,16512,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
LOPERAMIDE-SIMETHICONE 2-125 MG ORAL TABLET,,16512,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
LOPERAMIDE-SIMETHICONE 2-125 MG ORAL TABLET,,16512,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LOPERAMIDE-SIMETHICONE 2-125 MG ORAL TABLET,,16512,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
LOPERAMIDE-SIMETHICONE 2-125 MG ORAL TABLET,,16512,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LOPERAMIDE-SIMETHICONE 2-125 MG ORAL TABLET,,16512,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LOPERAMIDE-SIMETHICONE 2-125 MG ORAL TABLET,,16512,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LOPERAMIDE-SIMETHICONE 2-125 MG ORAL TABLET,,16512,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LOPERAMIDE-SIMETHICONE 2-125 MG ORAL TABLET,,16512,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
LOPERAMIDE-SIMETHICONE 2-125 MG ORAL TABLET,,16512,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
LOPERAMIDE-SIMETHICONE 2-125 MG ORAL TABLET,,16512,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
LOPERAMIDE-SIMETHICONE 2-125 MG ORAL TABLET,,16512,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
LOPERAMIDE-SIMETHICONE 2-125 MG ORAL TABLET,,16512,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
PYRIDOXINE (VITAMIN B6) 100 MG ORAL TABLET,,16613,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
PYRIDOXINE (VITAMIN B6) 100 MG ORAL TABLET,,16613,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
PYRIDOXINE (VITAMIN B6) 100 MG ORAL TABLET,,16613,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
PYRIDOXINE (VITAMIN B6) 100 MG ORAL TABLET,,16613,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
PYRIDOXINE (VITAMIN B6) 100 MG ORAL TABLET,,16613,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
PYRIDOXINE (VITAMIN B6) 100 MG ORAL TABLET,,16613,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
PYRIDOXINE (VITAMIN B6) 100 MG ORAL TABLET,,16613,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
PYRIDOXINE (VITAMIN B6) 100 MG ORAL TABLET,,16613,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
PYRIDOXINE (VITAMIN B6) 100 MG ORAL TABLET,,16613,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
PYRIDOXINE (VITAMIN B6) 100 MG ORAL TABLET,,16613,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
PYRIDOXINE (VITAMIN B6) 100 MG ORAL TABLET,,16613,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
PYRIDOXINE (VITAMIN B6) 100 MG ORAL TABLET,,16613,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
PYRIDOXINE (VITAMIN B6) 100 MG ORAL TABLET,,16613,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
PYRIDOXINE (VITAMIN B6) 100 MG ORAL TABLET,,16613,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
PYRIDOXINE (VITAMIN B6) 100 MG ORAL TABLET,,16613,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
PYRIDOXINE (VITAMIN B6) 100 MG ORAL TABLET,,16613,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
PYRIDOXINE (VITAMIN B6) 100 MG ORAL TABLET,,16613,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
PYRIDOXINE (VITAMIN B6) 100 MG ORAL TABLET,,16613,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
PYRIDOXINE (VITAMIN B6) 100 MG ORAL TABLET,,16613,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PYRIDOXINE (VITAMIN B6) 100 MG ORAL TABLET,,16613,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
PYRIDOXINE (VITAMIN B6) 100 MG ORAL TABLET,,16613,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
PYRIDOXINE (VITAMIN B6) 100 MG ORAL TABLET,,16613,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
PYRIDOXINE (VITAMIN B6) 100 MG ORAL TABLET,,16613,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
PYRIDOXINE (VITAMIN B6) 100 MG ORAL TABLET,,16613,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
PYRIDOXINE (VITAMIN B6) 100 MG ORAL TABLET,,16613,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
PYRIDOXINE (VITAMIN B6) 100 MG ORAL TABLET,,16613,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
PYRIDOXINE (VITAMIN B6) 100 MG ORAL TABLET,,16613,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
PYRIDOXINE (VITAMIN B6) 100 MG ORAL TABLET,,16613,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
PYRIDOXINE (VITAMIN B6) 100 MG ORAL TABLET,,16613,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
PYRIDOXINE (VITAMIN B6) 100 MG ORAL TABLET,,16613,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
PYRIDOXINE (VITAMIN B6) 100 MG ORAL TABLET,,16613,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
PYRIDOXINE (VITAMIN B6) 100 MG ORAL TABLET,,16613,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
PYRIDOXINE (VITAMIN B6) 100 MG ORAL TABLET,,16613,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
PYRIDOXINE (VITAMIN B6) 100 MG ORAL TABLET,,16613,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
PYRIDOXINE (VITAMIN B6) 100 MG ORAL TABLET,,16613,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
PYRIDOXINE (VITAMIN B6) 100 MG ORAL TABLET,,16613,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
PYRIDOXINE (VITAMIN B6) 100 MG ORAL TABLET,,16613,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
PYRIDOXINE (VITAMIN B6) 100 MG ORAL TABLET,,16613,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PYRIDOXINE (VITAMIN B6) 100 MG ORAL TABLET,,16613,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
PYRIDOXINE (VITAMIN B6) 100 MG ORAL TABLET,,16613,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
PYRIDOXINE (VITAMIN B6) 100 MG ORAL TABLET,,16613,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
PYRIDOXINE (VITAMIN B6) 100 MG ORAL TABLET,,16613,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
PYRIDOXINE (VITAMIN B6) 100 MG ORAL TABLET,,16613,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
PYRIDOXINE (VITAMIN B6) 100 MG ORAL TABLET,,16613,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PYRIDOXINE (VITAMIN B6) 100 MG ORAL TABLET,,16613,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
PYRIDOXINE (VITAMIN B6) 100 MG ORAL TABLET,,16613,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PYRIDOXINE (VITAMIN B6) 100 MG ORAL TABLET,,16613,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PYRIDOXINE (VITAMIN B6) 100 MG ORAL TABLET,,16613,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PYRIDOXINE (VITAMIN B6) 100 MG ORAL TABLET,,16613,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PYRIDOXINE (VITAMIN B6) 100 MG ORAL TABLET,,16613,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
PYRIDOXINE (VITAMIN B6) 100 MG ORAL TABLET,,16613,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
PYRIDOXINE (VITAMIN B6) 100 MG ORAL TABLET,,16613,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
PYRIDOXINE (VITAMIN B6) 100 MG ORAL TABLET,,16613,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
PYRIDOXINE (VITAMIN B6) 100 MG ORAL TABLET,,16613,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
MIRTAZAPINE 15 MG ORAL TABLET,,16625,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
MIRTAZAPINE 15 MG ORAL TABLET,,16625,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
MIRTAZAPINE 15 MG ORAL TABLET,,16625,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
MIRTAZAPINE 15 MG ORAL TABLET,,16625,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
MIRTAZAPINE 15 MG ORAL TABLET,,16625,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
MIRTAZAPINE 15 MG ORAL TABLET,,16625,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
MIRTAZAPINE 15 MG ORAL TABLET,,16625,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
MIRTAZAPINE 15 MG ORAL TABLET,,16625,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
MIRTAZAPINE 15 MG ORAL TABLET,,16625,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
MIRTAZAPINE 15 MG ORAL TABLET,,16625,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
MIRTAZAPINE 15 MG ORAL TABLET,,16625,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
MIRTAZAPINE 15 MG ORAL TABLET,,16625,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
MIRTAZAPINE 15 MG ORAL TABLET,,16625,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
MIRTAZAPINE 15 MG ORAL TABLET,,16625,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
MIRTAZAPINE 15 MG ORAL TABLET,,16625,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
MIRTAZAPINE 15 MG ORAL TABLET,,16625,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
MIRTAZAPINE 15 MG ORAL TABLET,,16625,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
MIRTAZAPINE 15 MG ORAL TABLET,,16625,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
MIRTAZAPINE 15 MG ORAL TABLET,,16625,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
MIRTAZAPINE 15 MG ORAL TABLET,,16625,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
MIRTAZAPINE 15 MG ORAL TABLET,,16625,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
MIRTAZAPINE 15 MG ORAL TABLET,,16625,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
MIRTAZAPINE 15 MG ORAL TABLET,,16625,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
MIRTAZAPINE 15 MG ORAL TABLET,,16625,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
MIRTAZAPINE 15 MG ORAL TABLET,,16625,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
MIRTAZAPINE 15 MG ORAL TABLET,,16625,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
MIRTAZAPINE 15 MG ORAL TABLET,,16625,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
MIRTAZAPINE 15 MG ORAL TABLET,,16625,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
MIRTAZAPINE 15 MG ORAL TABLET,,16625,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
MIRTAZAPINE 15 MG ORAL TABLET,,16625,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
MIRTAZAPINE 15 MG ORAL TABLET,,16625,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
MIRTAZAPINE 15 MG ORAL TABLET,,16625,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
MIRTAZAPINE 15 MG ORAL TABLET,,16625,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
MIRTAZAPINE 15 MG ORAL TABLET,,16625,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
MIRTAZAPINE 15 MG ORAL TABLET,,16625,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
MIRTAZAPINE 15 MG ORAL TABLET,,16625,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
MIRTAZAPINE 15 MG ORAL TABLET,,16625,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
MIRTAZAPINE 15 MG ORAL TABLET,,16625,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
MIRTAZAPINE 15 MG ORAL TABLET,,16625,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
MIRTAZAPINE 15 MG ORAL TABLET,,16625,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
MIRTAZAPINE 15 MG ORAL TABLET,,16625,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
MIRTAZAPINE 15 MG ORAL TABLET,,16625,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
MIRTAZAPINE 15 MG ORAL TABLET,,16625,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
MIRTAZAPINE 15 MG ORAL TABLET,,16625,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MIRTAZAPINE 15 MG ORAL TABLET,,16625,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
MIRTAZAPINE 15 MG ORAL TABLET,,16625,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MIRTAZAPINE 15 MG ORAL TABLET,,16625,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
MIRTAZAPINE 15 MG ORAL TABLET,,16625,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MIRTAZAPINE 15 MG ORAL TABLET,,16625,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
MIRTAZAPINE 15 MG ORAL TABLET,,16625,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
MIRTAZAPINE 15 MG ORAL TABLET,,16625,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
MIRTAZAPINE 15 MG ORAL TABLET,,16625,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
MIRTAZAPINE 15 MG ORAL TABLET,,16625,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
MIRTAZAPINE 15 MG ORAL TABLET,,16625,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
GABAPENTIN 100 MG ORAL CAP,,16635,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
GABAPENTIN 100 MG ORAL CAP,,16635,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
GABAPENTIN 100 MG ORAL CAP,,16635,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
GABAPENTIN 100 MG ORAL CAP,,16635,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
GABAPENTIN 100 MG ORAL CAP,,16635,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
GABAPENTIN 100 MG ORAL CAP,,16635,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
GABAPENTIN 100 MG ORAL CAP,,16635,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
GABAPENTIN 100 MG ORAL CAP,,16635,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
GABAPENTIN 100 MG ORAL CAP,,16635,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
GABAPENTIN 100 MG ORAL CAP,,16635,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
GABAPENTIN 100 MG ORAL CAP,,16635,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
GABAPENTIN 100 MG ORAL CAP,,16635,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
GABAPENTIN 100 MG ORAL CAP,,16635,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
GABAPENTIN 100 MG ORAL CAP,,16635,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
GABAPENTIN 100 MG ORAL CAP,,16635,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
GABAPENTIN 100 MG ORAL CAP,,16635,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
GABAPENTIN 100 MG ORAL CAP,,16635,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
GABAPENTIN 100 MG ORAL CAP,,16635,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
GABAPENTIN 100 MG ORAL CAP,,16635,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
GABAPENTIN 100 MG ORAL CAP,,16635,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
GABAPENTIN 100 MG ORAL CAP,,16635,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
GABAPENTIN 100 MG ORAL CAP,,16635,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
GABAPENTIN 100 MG ORAL CAP,,16635,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
GABAPENTIN 100 MG ORAL CAP,,16635,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
GABAPENTIN 100 MG ORAL CAP,,16635,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
GABAPENTIN 100 MG ORAL CAP,,16635,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
GABAPENTIN 100 MG ORAL CAP,,16635,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
GABAPENTIN 100 MG ORAL CAP,,16635,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
GABAPENTIN 100 MG ORAL CAP,,16635,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
GABAPENTIN 100 MG ORAL CAP,,16635,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
GABAPENTIN 100 MG ORAL CAP,,16635,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
GABAPENTIN 100 MG ORAL CAP,,16635,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
GABAPENTIN 100 MG ORAL CAP,,16635,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
GABAPENTIN 100 MG ORAL CAP,,16635,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
GABAPENTIN 100 MG ORAL CAP,,16635,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
GABAPENTIN 100 MG ORAL CAP,,16635,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
GABAPENTIN 100 MG ORAL CAP,,16635,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
GABAPENTIN 100 MG ORAL CAP,,16635,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
GABAPENTIN 100 MG ORAL CAP,,16635,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
GABAPENTIN 100 MG ORAL CAP,,16635,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
GABAPENTIN 100 MG ORAL CAP,,16635,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
GABAPENTIN 100 MG ORAL CAP,,16635,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
GABAPENTIN 100 MG ORAL CAP,,16635,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
GABAPENTIN 100 MG ORAL CAP,,16635,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
GABAPENTIN 100 MG ORAL CAP,,16635,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
GABAPENTIN 100 MG ORAL CAP,,16635,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
GABAPENTIN 100 MG ORAL CAP,,16635,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
GABAPENTIN 100 MG ORAL CAP,,16635,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
GABAPENTIN 100 MG ORAL CAP,,16635,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
GABAPENTIN 100 MG ORAL CAP,,16635,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
GABAPENTIN 100 MG ORAL CAP,,16635,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
GABAPENTIN 100 MG ORAL CAP,,16635,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
GABAPENTIN 100 MG ORAL CAP,,16635,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
GABAPENTIN 100 MG ORAL CAP,,16635,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
GABAPENTIN 100 MG ORAL CAP,,16635,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
GABAPENTIN 100 MG ORAL CAP,,16635,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
GABAPENTIN 100 MG ORAL CAP,,16635,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
GABAPENTIN 100 MG ORAL CAP,,16635,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
GABAPENTIN 100 MG ORAL CAP,,16635,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
GABAPENTIN 100 MG ORAL CAP,,16635,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
GABAPENTIN 100 MG ORAL CAP,,16635,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
GABAPENTIN 100 MG ORAL CAP,,16635,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
GABAPENTIN 100 MG ORAL CAP,,16635,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
GABAPENTIN 100 MG ORAL CAP,,16635,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
GABAPENTIN 100 MG ORAL CAP,,16635,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
GABAPENTIN 100 MG ORAL CAP,,16635,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
GABAPENTIN 100 MG ORAL CAP,,16635,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
GABAPENTIN 100 MG ORAL CAP,,16635,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
GABAPENTIN 100 MG ORAL CAP,,16635,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
GABAPENTIN 100 MG ORAL CAP,,16635,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
GABAPENTIN 100 MG ORAL CAP,,16635,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
GABAPENTIN 100 MG ORAL CAP,,16635,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
GABAPENTIN 100 MG ORAL CAP,,16635,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
GABAPENTIN 100 MG ORAL CAP,,16635,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
GABAPENTIN 100 MG ORAL CAP,,16635,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
GABAPENTIN 100 MG ORAL CAP,,16635,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
GABAPENTIN 100 MG ORAL CAP,,16635,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
GABAPENTIN 100 MG ORAL CAP,,16635,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
GABAPENTIN 100 MG ORAL CAP,,16635,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
GABAPENTIN 100 MG ORAL CAP,,16635,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
GABAPENTIN 100 MG ORAL CAP,,16635,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
GABAPENTIN 100 MG ORAL CAP,,16635,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
GABAPENTIN 100 MG ORAL CAP,,16635,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
GABAPENTIN 100 MG ORAL CAP,,16635,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
GABAPENTIN 100 MG ORAL CAP,,16635,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
GABAPENTIN 100 MG ORAL CAP,,16635,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
GABAPENTIN 100 MG ORAL CAP,,16635,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
GABAPENTIN 100 MG ORAL CAP,,16635,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
GABAPENTIN 100 MG ORAL CAP,,16635,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
GABAPENTIN 100 MG ORAL CAP,,16635,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
GABAPENTIN 100 MG ORAL CAP,,16635,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
GABAPENTIN 100 MG ORAL CAP,,16635,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
GABAPENTIN 100 MG ORAL CAP,,16635,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
GABAPENTIN 100 MG ORAL CAP,,16635,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
GABAPENTIN 100 MG ORAL CAP,,16635,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
GABAPENTIN 100 MG ORAL CAP,,16635,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
GABAPENTIN 100 MG ORAL CAP,,16635,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
GABAPENTIN 100 MG ORAL CAP,,16635,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
GABAPENTIN 100 MG ORAL CAP,,16635,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
GABAPENTIN 100 MG ORAL CAP,,16635,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
GABAPENTIN 100 MG ORAL CAP,,16635,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
GABAPENTIN 100 MG ORAL CAP,,16635,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
GABAPENTIN 100 MG ORAL CAP,,16635,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
GABAPENTIN 100 MG ORAL CAP,,16635,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
GABAPENTIN 100 MG ORAL CAP,,16635,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
GABAPENTIN 100 MG ORAL CAP,,16635,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
GABAPENTIN 100 MG ORAL CAP,,16635,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
GABAPENTIN 100 MG ORAL CAP,,16635,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Excision, Benign Lesion Incl Marg,Except Skin Tag,Trunk,Arm/Leg;Excised Dia 0.5 Cm Or Less (Pro Cah)",,11400,CPT,Professional,Both,,,,235,199.75,53.44,235,Aetna,Commercial,199.75,85,,percent of total billed charges,,
"Excision, Benign Lesion Incl Marg,Except Skin Tag,Trunk,Arm/Leg;Excised Dia 0.5 Cm Or Less (Pro Cah)",,11400,CPT,Professional,Both,,,,235,199.75,53.44,235,Aetna,Commercial,199.75,85,,percent of total billed charges,,
"Excision, Benign Lesion Incl Marg,Except Skin Tag,Trunk,Arm/Leg;Excised Dia 0.5 Cm Or Less (Pro Cah)",,11400,CPT,Professional,Both,,,,235,199.75,53.44,235,Aetna,Medicare Advantage,82.6,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Benign Lesion Incl Marg,Except Skin Tag,Trunk,Arm/Leg;Excised Dia 0.5 Cm Or Less (Pro Cah)",,11400,CPT,Professional,Both,,,,235,199.75,53.44,235,Aetna,Medicare Advantage,82.6,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Benign Lesion Incl Marg,Except Skin Tag,Trunk,Arm/Leg;Excised Dia 0.5 Cm Or Less (Pro Cah)",,11400,CPT,Professional,Both,,,,235,199.75,53.44,235,Aetna,PPO,218.55,93,,percent of total billed charges,,
"Excision, Benign Lesion Incl Marg,Except Skin Tag,Trunk,Arm/Leg;Excised Dia 0.5 Cm Or Less (Pro Cah)",,11400,CPT,Professional,Both,,,,235,199.75,53.44,235,Aetna,PPO,218.55,93,,percent of total billed charges,,
"Excision, Benign Lesion Incl Marg,Except Skin Tag,Trunk,Arm/Leg;Excised Dia 0.5 Cm Or Less (Pro Cah)",,11400,CPT,Professional,Both,,,,235,199.75,53.44,235,America's PPO,America's PPO,200.784,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Excision, Benign Lesion Incl Marg,Except Skin Tag,Trunk,Arm/Leg;Excised Dia 0.5 Cm Or Less (Pro Cah)",,11400,CPT,Professional,Both,,,,235,199.75,53.44,235,America's PPO,America's PPO,200.784,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Excision, Benign Lesion Incl Marg,Except Skin Tag,Trunk,Arm/Leg;Excised Dia 0.5 Cm Or Less (Pro Cah)",,11400,CPT,Professional,Both,,,,235,199.75,53.44,235,BlueCross BlueShield Minnesota, Federal Employee Program,172.84,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Excision, Benign Lesion Incl Marg,Except Skin Tag,Trunk,Arm/Leg;Excised Dia 0.5 Cm Or Less (Pro Cah)",,11400,CPT,Professional,Both,,,,235,199.75,53.44,235,BlueCross BlueShield Minnesota, Federal Employee Program,172.84,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Excision, Benign Lesion Incl Marg,Except Skin Tag,Trunk,Arm/Leg;Excised Dia 0.5 Cm Or Less (Pro Cah)",,11400,CPT,Professional,Both,,,,235,199.75,53.44,235,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,175.60544,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Benign Lesion Incl Marg,Except Skin Tag,Trunk,Arm/Leg;Excised Dia 0.5 Cm Or Less (Pro Cah)",,11400,CPT,Professional,Both,,,,235,199.75,53.44,235,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,175.60544,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Benign Lesion Incl Marg,Except Skin Tag,Trunk,Arm/Leg;Excised Dia 0.5 Cm Or Less (Pro Cah)",,11400,CPT,Professional,Both,,,,235,199.75,53.44,235,BlueCross BlueShield Minnesota,High Value Network Plan,175.60544,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Benign Lesion Incl Marg,Except Skin Tag,Trunk,Arm/Leg;Excised Dia 0.5 Cm Or Less (Pro Cah)",,11400,CPT,Professional,Both,,,,235,199.75,53.44,235,BlueCross BlueShield Minnesota,High Value Network Plan,175.60544,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Benign Lesion Incl Marg,Except Skin Tag,Trunk,Arm/Leg;Excised Dia 0.5 Cm Or Less (Pro Cah)",,11400,CPT,Professional,Both,,,,235,199.75,53.44,235,BlueCross BlueShield Minnesota,Medicare Advantage,95.772,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Benign Lesion Incl Marg,Except Skin Tag,Trunk,Arm/Leg;Excised Dia 0.5 Cm Or Less (Pro Cah)",,11400,CPT,Professional,Both,,,,235,199.75,53.44,235,BlueCross BlueShield Minnesota,Medicare Advantage,95.772,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Benign Lesion Incl Marg,Except Skin Tag,Trunk,Arm/Leg;Excised Dia 0.5 Cm Or Less (Pro Cah)",,11400,CPT,Professional,Both,,,,235,199.75,53.44,235,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,175.60544,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Benign Lesion Incl Marg,Except Skin Tag,Trunk,Arm/Leg;Excised Dia 0.5 Cm Or Less (Pro Cah)",,11400,CPT,Professional,Both,,,,235,199.75,53.44,235,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,175.60544,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Benign Lesion Incl Marg,Except Skin Tag,Trunk,Arm/Leg;Excised Dia 0.5 Cm Or Less (Pro Cah)",,11400,CPT,Professional,Both,,,,235,199.75,53.44,235,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,61.70168,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision, Benign Lesion Incl Marg,Except Skin Tag,Trunk,Arm/Leg;Excised Dia 0.5 Cm Or Less (Pro Cah)",,11400,CPT,Professional,Both,,,,235,199.75,53.44,235,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,61.70168,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision, Benign Lesion Incl Marg,Except Skin Tag,Trunk,Arm/Leg;Excised Dia 0.5 Cm Or Less (Pro Cah)",,11400,CPT,Professional,Both,,,,235,199.75,53.44,235,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),95.772,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Benign Lesion Incl Marg,Except Skin Tag,Trunk,Arm/Leg;Excised Dia 0.5 Cm Or Less (Pro Cah)",,11400,CPT,Professional,Both,,,,235,199.75,53.44,235,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),95.772,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Benign Lesion Incl Marg,Except Skin Tag,Trunk,Arm/Leg;Excised Dia 0.5 Cm Or Less (Pro Cah)",,11400,CPT,Professional,Both,,,,235,199.75,53.44,235,CorVel,Worker's Compensation,161.0434335,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Excision, Benign Lesion Incl Marg,Except Skin Tag,Trunk,Arm/Leg;Excised Dia 0.5 Cm Or Less (Pro Cah)",,11400,CPT,Professional,Both,,,,235,199.75,53.44,235,CorVel,Worker's Compensation,161.0434335,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Excision, Benign Lesion Incl Marg,Except Skin Tag,Trunk,Arm/Leg;Excised Dia 0.5 Cm Or Less (Pro Cah)",,11400,CPT,Professional,Both,,,,235,199.75,53.44,235,First Health Group Corporation,First Health Network,227.95,97,,percent of total billed charges,,
"Excision, Benign Lesion Incl Marg,Except Skin Tag,Trunk,Arm/Leg;Excised Dia 0.5 Cm Or Less (Pro Cah)",,11400,CPT,Professional,Both,,,,235,199.75,53.44,235,First Health Group Corporation,First Health Network,227.95,97,,percent of total billed charges,,
"Excision, Benign Lesion Incl Marg,Except Skin Tag,Trunk,Arm/Leg;Excised Dia 0.5 Cm Or Less (Pro Cah)",,11400,CPT,Professional,Both,,,,235,199.75,53.44,235,"Health Partners, Inc.",Commercial,174.12,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision, Benign Lesion Incl Marg,Except Skin Tag,Trunk,Arm/Leg;Excised Dia 0.5 Cm Or Less (Pro Cah)",,11400,CPT,Professional,Both,,,,235,199.75,53.44,235,"Health Partners, Inc.",Commercial,174.12,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision, Benign Lesion Incl Marg,Except Skin Tag,Trunk,Arm/Leg;Excised Dia 0.5 Cm Or Less (Pro Cah)",,11400,CPT,Professional,Both,,,,235,199.75,53.44,235,"Health Partners, Inc.",Medicare Advantage,95.772,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Benign Lesion Incl Marg,Except Skin Tag,Trunk,Arm/Leg;Excised Dia 0.5 Cm Or Less (Pro Cah)",,11400,CPT,Professional,Both,,,,235,199.75,53.44,235,"Health Partners, Inc.",Medicare Advantage,95.772,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Benign Lesion Incl Marg,Except Skin Tag,Trunk,Arm/Leg;Excised Dia 0.5 Cm Or Less (Pro Cah)",,11400,CPT,Professional,Both,,,,235,199.75,53.44,235,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),83.36,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Excision, Benign Lesion Incl Marg,Except Skin Tag,Trunk,Arm/Leg;Excised Dia 0.5 Cm Or Less (Pro Cah)",,11400,CPT,Professional,Both,,,,235,199.75,53.44,235,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),83.36,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Excision, Benign Lesion Incl Marg,Except Skin Tag,Trunk,Arm/Leg;Excised Dia 0.5 Cm Or Less (Pro Cah)",,11400,CPT,Professional,Both,,,,235,199.75,53.44,235,"Health Partners, Inc.",State of Minnesota Advantage Program,150.00438,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision, Benign Lesion Incl Marg,Except Skin Tag,Trunk,Arm/Leg;Excised Dia 0.5 Cm Or Less (Pro Cah)",,11400,CPT,Professional,Both,,,,235,199.75,53.44,235,"Health Partners, Inc.",State of Minnesota Advantage Program,150.00438,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision, Benign Lesion Incl Marg,Except Skin Tag,Trunk,Arm/Leg;Excised Dia 0.5 Cm Or Less (Pro Cah)",,11400,CPT,Professional,Both,,,,235,199.75,53.44,235,"Health Partners, Inc.",State Public Programs,53.44,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Excision, Benign Lesion Incl Marg,Except Skin Tag,Trunk,Arm/Leg;Excised Dia 0.5 Cm Or Less (Pro Cah)",,11400,CPT,Professional,Both,,,,235,199.75,53.44,235,"Health Partners, Inc.",State Public Programs,53.44,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Excision, Benign Lesion Incl Marg,Except Skin Tag,Trunk,Arm/Leg;Excised Dia 0.5 Cm Or Less (Pro Cah)",,11400,CPT,Professional,Both,,,,235,199.75,53.44,235,Humana Insurance Company,Commercial PPO,83.28,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Excision, Benign Lesion Incl Marg,Except Skin Tag,Trunk,Arm/Leg;Excised Dia 0.5 Cm Or Less (Pro Cah)",,11400,CPT,Professional,Both,,,,235,199.75,53.44,235,Humana Insurance Company,Commercial PPO,83.28,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Excision, Benign Lesion Incl Marg,Except Skin Tag,Trunk,Arm/Leg;Excised Dia 0.5 Cm Or Less (Pro Cah)",,11400,CPT,Professional,Both,,,,235,199.75,53.44,235,Humana Insurance Company,Medicare PPO,235,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Excision, Benign Lesion Incl Marg,Except Skin Tag,Trunk,Arm/Leg;Excised Dia 0.5 Cm Or Less (Pro Cah)",,11400,CPT,Professional,Both,,,,235,199.75,53.44,235,Humana Insurance Company,Medicare PPO,235,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Excision, Benign Lesion Incl Marg,Except Skin Tag,Trunk,Arm/Leg;Excised Dia 0.5 Cm Or Less (Pro Cah)",,11400,CPT,Professional,Both,,,,235,199.75,53.44,235,Medica,Individual & Family,199.28,84.8,,percent of total billed charges,,
"Excision, Benign Lesion Incl Marg,Except Skin Tag,Trunk,Arm/Leg;Excised Dia 0.5 Cm Or Less (Pro Cah)",,11400,CPT,Professional,Both,,,,235,199.75,53.44,235,Medica,Individual & Family,199.28,84.8,,percent of total billed charges,,
"Excision, Benign Lesion Incl Marg,Except Skin Tag,Trunk,Arm/Leg;Excised Dia 0.5 Cm Or Less (Pro Cah)",,11400,CPT,Professional,Both,,,,235,199.75,53.44,235,Medica,Medica Advantage Solution,117.03,49.8,,percent of total billed charges,,
"Excision, Benign Lesion Incl Marg,Except Skin Tag,Trunk,Arm/Leg;Excised Dia 0.5 Cm Or Less (Pro Cah)",,11400,CPT,Professional,Both,,,,235,199.75,53.44,235,Medica,Medica Advantage Solution,117.03,49.8,,percent of total billed charges,,
"Excision, Benign Lesion Incl Marg,Except Skin Tag,Trunk,Arm/Leg;Excised Dia 0.5 Cm Or Less (Pro Cah)",,11400,CPT,Professional,Both,,,,235,199.75,53.44,235,Medica,Medical Assistance,61.7,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Excision, Benign Lesion Incl Marg,Except Skin Tag,Trunk,Arm/Leg;Excised Dia 0.5 Cm Or Less (Pro Cah)",,11400,CPT,Professional,Both,,,,235,199.75,53.44,235,Medica,Medical Assistance,61.7,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Excision, Benign Lesion Incl Marg,Except Skin Tag,Trunk,Arm/Leg;Excised Dia 0.5 Cm Or Less (Pro Cah)",,11400,CPT,Professional,Both,,,,235,199.75,53.44,235,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,83.28,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Excision, Benign Lesion Incl Marg,Except Skin Tag,Trunk,Arm/Leg;Excised Dia 0.5 Cm Or Less (Pro Cah)",,11400,CPT,Professional,Both,,,,235,199.75,53.44,235,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,83.28,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Excision, Benign Lesion Incl Marg,Except Skin Tag,Trunk,Arm/Leg;Excised Dia 0.5 Cm Or Less (Pro Cah)",,11400,CPT,Professional,Both,,,,235,199.75,53.44,235,"Multiplan, Inc.","Multiplan, Inc.",220.9,94,,percent of total billed charges,,
"Excision, Benign Lesion Incl Marg,Except Skin Tag,Trunk,Arm/Leg;Excised Dia 0.5 Cm Or Less (Pro Cah)",,11400,CPT,Professional,Both,,,,235,199.75,53.44,235,"Multiplan, Inc.","Multiplan, Inc.",220.9,94,,percent of total billed charges,,
"Excision, Benign Lesion Incl Marg,Except Skin Tag,Trunk,Arm/Leg;Excised Dia 0.5 Cm Or Less (Pro Cah)",,11400,CPT,Professional,Both,,,,235,199.75,53.44,235,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,211.735,90.1,,percent of total billed charges,,
"Excision, Benign Lesion Incl Marg,Except Skin Tag,Trunk,Arm/Leg;Excised Dia 0.5 Cm Or Less (Pro Cah)",,11400,CPT,Professional,Both,,,,235,199.75,53.44,235,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,211.735,90.1,,percent of total billed charges,,
"Excision, Benign Lesion Incl Marg,Except Skin Tag,Trunk,Arm/Leg;Excised Dia 0.5 Cm Or Less (Pro Cah)",,11400,CPT,Professional,Both,,,,235,199.75,53.44,235,"Preferred One Administrative Services, INC.",PPO,231.71,98.6,,percent of total billed charges,,
"Excision, Benign Lesion Incl Marg,Except Skin Tag,Trunk,Arm/Leg;Excised Dia 0.5 Cm Or Less (Pro Cah)",,11400,CPT,Professional,Both,,,,235,199.75,53.44,235,"Preferred One Administrative Services, INC.",PPO,231.71,98.6,,percent of total billed charges,,
"Excision, Benign Lesion Incl Marg,Except Skin Tag,Trunk,Arm/Leg;Excised Dia 0.5 Cm Or Less (Pro Cah)",,11400,CPT,Professional,Both,,,,235,199.75,53.44,235,PrimeWest Health,Minnesota Senior Health Options (MSHO),95.772,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Benign Lesion Incl Marg,Except Skin Tag,Trunk,Arm/Leg;Excised Dia 0.5 Cm Or Less (Pro Cah)",,11400,CPT,Professional,Both,,,,235,199.75,53.44,235,PrimeWest Health,Minnesota Senior Health Options (MSHO),95.772,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Benign Lesion Incl Marg,Except Skin Tag,Trunk,Arm/Leg;Excised Dia 0.5 Cm Or Less (Pro Cah)",,11400,CPT,Professional,Both,,,,235,199.75,53.44,235,PrimeWest Health,MinnesotaCare,66.0207976,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision, Benign Lesion Incl Marg,Except Skin Tag,Trunk,Arm/Leg;Excised Dia 0.5 Cm Or Less (Pro Cah)",,11400,CPT,Professional,Both,,,,235,199.75,53.44,235,PrimeWest Health,MinnesotaCare,66.0207976,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision, Benign Lesion Incl Marg,Except Skin Tag,Trunk,Arm/Leg;Excised Dia 0.5 Cm Or Less (Pro Cah)",,11400,CPT,Professional,Both,,,,235,199.75,53.44,235,Sanford Health Plan,Sanford Health Plan,206.8,88,,percent of total billed charges,,
"Excision, Benign Lesion Incl Marg,Except Skin Tag,Trunk,Arm/Leg;Excised Dia 0.5 Cm Or Less (Pro Cah)",,11400,CPT,Professional,Both,,,,235,199.75,53.44,235,Sanford Health Plan,Sanford Health Plan,206.8,88,,percent of total billed charges,,
"Excision, Benign Lesion Incl Marg,Except Skin Tag,Trunk,Arm/Leg;Excised Dia 0.5 Cm Or Less (Pro Cah)",,11400,CPT,Professional,Both,,,,235,199.75,53.44,235,"UCare Health, Inc.",Individual & Family Plan,135.379968,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Excision, Benign Lesion Incl Marg,Except Skin Tag,Trunk,Arm/Leg;Excised Dia 0.5 Cm Or Less (Pro Cah)",,11400,CPT,Professional,Both,,,,235,199.75,53.44,235,"UCare Health, Inc.",Individual & Family Plan,135.379968,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Excision, Benign Lesion Incl Marg,Except Skin Tag,Trunk,Arm/Leg;Excised Dia 0.5 Cm Or Less (Pro Cah)",,11400,CPT,Professional,Both,,,,235,199.75,53.44,235,"UCare Health, Inc.",Medical Assistance,67.871848,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Excision, Benign Lesion Incl Marg,Except Skin Tag,Trunk,Arm/Leg;Excised Dia 0.5 Cm Or Less (Pro Cah)",,11400,CPT,Professional,Both,,,,235,199.75,53.44,235,"UCare Health, Inc.",Medical Assistance,67.871848,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Excision, Benign Lesion Incl Marg,Except Skin Tag,Trunk,Arm/Leg;Excised Dia 0.5 Cm Or Less (Pro Cah)",,11400,CPT,Professional,Both,,,,235,199.75,53.44,235,"UCare Health, Inc.",Medicare Advantage,95.772,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Excision, Benign Lesion Incl Marg,Except Skin Tag,Trunk,Arm/Leg;Excised Dia 0.5 Cm Or Less (Pro Cah)",,11400,CPT,Professional,Both,,,,235,199.75,53.44,235,"UCare Health, Inc.",Medicare Advantage,95.772,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Excision, Benign Lesion Incl Marg,Except Skin Tag,Trunk,Arm/Leg;Excised Dia 0.5 Cm Or Less (Pro Cah)",,11400,CPT,Professional,Both,,,,235,199.75,53.44,235,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),76.6176,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Excision, Benign Lesion Incl Marg,Except Skin Tag,Trunk,Arm/Leg;Excised Dia 0.5 Cm Or Less (Pro Cah)",,11400,CPT,Professional,Both,,,,235,199.75,53.44,235,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),76.6176,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Excision, Benign Lesion Incl Marg,Except Skin Tag,Trunk,Arm/Leg;Excised Dia 0.5 Cm Or Less (Pro Cah)",,11400,CPT,Professional,Both,,,,235,199.75,53.44,235,UnitedHealthcare,Individual & Family,235,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Excision, Benign Lesion Incl Marg,Except Skin Tag,Trunk,Arm/Leg;Excised Dia 0.5 Cm Or Less (Pro Cah)",,11400,CPT,Professional,Both,,,,235,199.75,53.44,235,UnitedHealthcare,Individual & Family,235,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Excision, Benign Lesion Incl Marg,Except Skin Tag,Trunk,Arm/Leg;Excised Dia 0.5 Cm Or Less (Pro Cah)",,11400,CPT,Professional,Both,,,,235,199.75,53.44,235,UnitedHealthcare,Medicare Advantage,95.772,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Benign Lesion Incl Marg,Except Skin Tag,Trunk,Arm/Leg;Excised Dia 0.5 Cm Or Less (Pro Cah)",,11400,CPT,Professional,Both,,,,235,199.75,53.44,235,UnitedHealthcare,Medicare Advantage,95.772,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Benign Lesion Incl Marg,Except Skin Tag,Trunk,Arm/Leg;Excised Dia 0.5 Cm Or Less (Pro Cah)",,11400,CPT,Professional,Both,,,,235,199.75,53.44,235,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,61.70168,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision, Benign Lesion Incl Marg,Except Skin Tag,Trunk,Arm/Leg;Excised Dia 0.5 Cm Or Less (Pro Cah)",,11400,CPT,Professional,Both,,,,235,199.75,53.44,235,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,61.70168,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision, Benign Lesion Incl Margins Trunk/Arm/Leg 0.5Cm Or Less",,11400,CPT,Facility,Both,,,,140,119,40.124,140,Aetna,Commercial,128.8,92,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margins Trunk/Arm/Leg 0.5Cm Or Less",,11400,CPT,Facility,Outpatient,,,,140,119,40.124,140,Aetna,Medicare Advantage,68.6,49,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margins Trunk/Arm/Leg 0.5Cm Or Less",,11400,CPT,Facility,Inpatient,,,,140,119,40.124,140,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Excision, Benign Lesion Incl Margins Trunk/Arm/Leg 0.5Cm Or Less",,11400,CPT,Facility,Both,,,,140,119,40.124,140,Aetna,PPO,130.2,93,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margins Trunk/Arm/Leg 0.5Cm Or Less",,11400,CPT,Facility,Both,,,,140,119,40.124,140,America's PPO,America's PPO,134.442,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Excision, Benign Lesion Incl Margins Trunk/Arm/Leg 0.5Cm Or Less",,11400,CPT,Facility,Both,,,,140,119,40.124,140,BlueCross BlueShield Minnesota, Federal Employee Program,137.76,98.4,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margins Trunk/Arm/Leg 0.5Cm Or Less",,11400,CPT,Facility,Both,,,,140,119,40.124,140,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,140,100,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margins Trunk/Arm/Leg 0.5Cm Or Less",,11400,CPT,Facility,Both,,,,140,119,40.124,140,BlueCross BlueShield Minnesota,High Value Network Plan,126,90,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margins Trunk/Arm/Leg 0.5Cm Or Less",,11400,CPT,Facility,Outpatient,,,,140,119,40.124,140,BlueCross BlueShield Minnesota,Medicare Advantage,68.6,49,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margins Trunk/Arm/Leg 0.5Cm Or Less",,11400,CPT,Facility,Inpatient,,,,140,119,40.124,140,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Excision, Benign Lesion Incl Margins Trunk/Arm/Leg 0.5Cm Or Less",,11400,CPT,Facility,Both,,,,140,119,40.124,140,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,123.998,88.57,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margins Trunk/Arm/Leg 0.5Cm Or Less",,11400,CPT,Facility,Both,,,,140,119,40.124,140,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,40.124,28.66,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margins Trunk/Arm/Leg 0.5Cm Or Less",,11400,CPT,Facility,Outpatient,,,,140,119,40.124,140,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),68.6,49,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margins Trunk/Arm/Leg 0.5Cm Or Less",,11400,CPT,Facility,Inpatient,,,,140,119,40.124,140,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Excision, Benign Lesion Incl Margins Trunk/Arm/Leg 0.5Cm Or Less",,11400,CPT,Facility,Both,,,,140,119,40.124,140,CorVel,Worker's Compensation,140,100,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margins Trunk/Arm/Leg 0.5Cm Or Less",,11400,CPT,Facility,Both,,,,140,119,40.124,140,First Health Group Corporation,First Health Network,135.8,97,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margins Trunk/Arm/Leg 0.5Cm Or Less",,11400,CPT,Facility,Both,,,,140,119,40.124,140,"Health Partners, Inc.",Commercial,132.44,94.6,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margins Trunk/Arm/Leg 0.5Cm Or Less",,11400,CPT,Facility,Outpatient,,,,140,119,40.124,140,"Health Partners, Inc.",Medicare Advantage,68.6,49,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margins Trunk/Arm/Leg 0.5Cm Or Less",,11400,CPT,Facility,Inpatient,,,,140,119,40.124,140,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Excision, Benign Lesion Incl Margins Trunk/Arm/Leg 0.5Cm Or Less",,11400,CPT,Facility,Both,,,,140,119,40.124,140,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),84,60,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margins Trunk/Arm/Leg 0.5Cm Or Less",,11400,CPT,Facility,Both,,,,140,119,40.124,140,"Health Partners, Inc.",State of Minnesota Advantage Program,114.1,81.5,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margins Trunk/Arm/Leg 0.5Cm Or Less",,11400,CPT,Facility,Both,,,,140,119,40.124,140,"Health Partners, Inc.",State Public Programs,70,50,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margins Trunk/Arm/Leg 0.5Cm Or Less",,11400,CPT,Facility,Both,,,,140,119,40.124,140,Humana Insurance Company,Commercial PPO,133,95,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margins Trunk/Arm/Leg 0.5Cm Or Less",,11400,CPT,Facility,Outpatient,,,,140,119,40.124,140,Humana Insurance Company,Medicare PPO,68.6,49,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margins Trunk/Arm/Leg 0.5Cm Or Less",,11400,CPT,Facility,Inpatient,,,,140,119,40.124,140,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Excision, Benign Lesion Incl Margins Trunk/Arm/Leg 0.5Cm Or Less",,11400,CPT,Facility,Both,,,,140,119,40.124,140,Medica,Individual & Family,138.74,99.1,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margins Trunk/Arm/Leg 0.5Cm Or Less",,11400,CPT,Facility,Outpatient,,,,140,119,40.124,140,Medica,Medica Advantage Solution,69.72,49.8,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margins Trunk/Arm/Leg 0.5Cm Or Less",,11400,CPT,Facility,Inpatient,,,,140,119,40.124,140,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Excision, Benign Lesion Incl Margins Trunk/Arm/Leg 0.5Cm Or Less",,11400,CPT,Facility,Outpatient,,,,140,119,40.124,140,Medica,Medical Assistance,62.44,44.6,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margins Trunk/Arm/Leg 0.5Cm Or Less",,11400,CPT,Facility,Inpatient,,,,140,119,40.124,140,Medica,Medical Assistance,,,,,Included in per diem rate,
"Excision, Benign Lesion Incl Margins Trunk/Arm/Leg 0.5Cm Or Less",,11400,CPT,Facility,Outpatient,,,,140,119,40.124,140,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,69.72,49.8,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margins Trunk/Arm/Leg 0.5Cm Or Less",,11400,CPT,Facility,Inpatient,,,,140,119,40.124,140,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Excision, Benign Lesion Incl Margins Trunk/Arm/Leg 0.5Cm Or Less",,11400,CPT,Facility,Both,,,,140,119,40.124,140,"Multiplan, Inc.","Multiplan, Inc.",131.6,94,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margins Trunk/Arm/Leg 0.5Cm Or Less",,11400,CPT,Facility,Outpatient,,,,140,119,40.124,140,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,126.14,90.1,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margins Trunk/Arm/Leg 0.5Cm Or Less",,11400,CPT,Facility,Inpatient,,,,140,119,40.124,140,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Excision, Benign Lesion Incl Margins Trunk/Arm/Leg 0.5Cm Or Less",,11400,CPT,Facility,Both,,,,140,119,40.124,140,"Preferred One Administrative Services, INC.",PPO,138.04,98.6,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margins Trunk/Arm/Leg 0.5Cm Or Less",,11400,CPT,Facility,Outpatient,,,,140,119,40.124,140,PrimeWest Health,Minnesota Senior Health Options (MSHO),72.03,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Excision, Benign Lesion Incl Margins Trunk/Arm/Leg 0.5Cm Or Less",,11400,CPT,Facility,Inpatient,,,,140,119,40.124,140,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Excision, Benign Lesion Incl Margins Trunk/Arm/Leg 0.5Cm Or Less",,11400,CPT,Facility,Outpatient,,,,140,119,40.124,140,PrimeWest Health,MinnesotaCare,71.904,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Excision, Benign Lesion Incl Margins Trunk/Arm/Leg 0.5Cm Or Less",,11400,CPT,Facility,Inpatient,,,,140,119,40.124,140,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Excision, Benign Lesion Incl Margins Trunk/Arm/Leg 0.5Cm Or Less",,11400,CPT,Facility,Both,,,,140,119,40.124,140,Sanford Health Plan,Sanford Health Plan,128.8,92,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margins Trunk/Arm/Leg 0.5Cm Or Less",,11400,CPT,Facility,Outpatient,,,,140,119,40.124,140,"UCare Health, Inc.",Individual & Family Plan,78.89,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Excision, Benign Lesion Incl Margins Trunk/Arm/Leg 0.5Cm Or Less",,11400,CPT,Facility,Inpatient,,,,140,119,40.124,140,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Excision, Benign Lesion Incl Margins Trunk/Arm/Leg 0.5Cm Or Less",,11400,CPT,Facility,Outpatient,,,,140,119,40.124,140,"UCare Health, Inc.",Medical Assistance,70.658,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Excision, Benign Lesion Incl Margins Trunk/Arm/Leg 0.5Cm Or Less",,11400,CPT,Facility,Inpatient,,,,140,119,40.124,140,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Excision, Benign Lesion Incl Margins Trunk/Arm/Leg 0.5Cm Or Less",,11400,CPT,Facility,Outpatient,,,,140,119,40.124,140,"UCare Health, Inc.",Medicare Advantage,70.658,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Excision, Benign Lesion Incl Margins Trunk/Arm/Leg 0.5Cm Or Less",,11400,CPT,Facility,Inpatient,,,,140,119,40.124,140,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Excision, Benign Lesion Incl Margins Trunk/Arm/Leg 0.5Cm Or Less",,11400,CPT,Facility,Outpatient,,,,140,119,40.124,140,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),70.658,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Excision, Benign Lesion Incl Margins Trunk/Arm/Leg 0.5Cm Or Less",,11400,CPT,Facility,Inpatient,,,,140,119,40.124,140,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Excision, Benign Lesion Incl Margins Trunk/Arm/Leg 0.5Cm Or Less",,11400,CPT,Facility,Both,,,,140,119,40.124,140,UnitedHealthcare,Individual & Family,131.6,94,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margins Trunk/Arm/Leg 0.5Cm Or Less",,11400,CPT,Facility,Outpatient,,,,140,119,40.124,140,UnitedHealthcare,Medicare Advantage,68.6,49,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margins Trunk/Arm/Leg 0.5Cm Or Less",,11400,CPT,Facility,Inpatient,,,,140,119,40.124,140,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Excision, Benign Lesion Incl Margins Trunk/Arm/Leg 0.5Cm Or Less",,11400,CPT,Facility,Outpatient,,,,140,119,40.124,140,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,67.2,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Excision, Benign Lesion Incl Margins Trunk/Arm/Leg 0.5Cm Or Less",,11400,CPT,Facility,Inpatient,,,,140,119,40.124,140,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Excision,Benign,Lesion Trunk/Arm/Leg; .5 Cm Or Less (Pbb)",,11400,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,Aetna,Commercial,82.8,92,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; .5 Cm Or Less (Pbb)",,11400,CPT,Professional,Outpatient,,,,145,123.25,53.44,145,Aetna,Commercial,123.25,85,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; .5 Cm Or Less (Pbb)",,11400,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,Aetna,Medicare Advantage,44.1,49,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; .5 Cm Or Less (Pbb)",,11400,CPT,Professional,Outpatient,,,,145,123.25,53.44,145,Aetna,Medicare Advantage,82.6,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision,Benign,Lesion Trunk/Arm/Leg; .5 Cm Or Less (Pbb)",,11400,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,Aetna,PPO,83.7,93,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; .5 Cm Or Less (Pbb)",,11400,CPT,Professional,Outpatient,,,,145,123.25,53.44,145,Aetna,PPO,134.85,93,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; .5 Cm Or Less (Pbb)",,11400,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,America's PPO,America's PPO,86.427,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Excision,Benign,Lesion Trunk/Arm/Leg; .5 Cm Or Less (Pbb)",,11400,CPT,Professional,Outpatient,,,,145,123.25,53.44,145,America's PPO,America's PPO,123.888,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Excision,Benign,Lesion Trunk/Arm/Leg; .5 Cm Or Less (Pbb)",,11400,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,BlueCross BlueShield Minnesota, Federal Employee Program,88.56,98.4,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; .5 Cm Or Less (Pbb)",,11400,CPT,Professional,Outpatient,,,,145,123.25,53.44,145,BlueCross BlueShield Minnesota, Federal Employee Program,145,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Excision,Benign,Lesion Trunk/Arm/Leg; .5 Cm Or Less (Pbb)",,11400,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,90,100,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; .5 Cm Or Less (Pbb)",,11400,CPT,Professional,Outpatient,,,,145,123.25,53.44,145,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,145,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision,Benign,Lesion Trunk/Arm/Leg; .5 Cm Or Less (Pbb)",,11400,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,BlueCross BlueShield Minnesota,High Value Network Plan,81,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
"Excision,Benign,Lesion Trunk/Arm/Leg; .5 Cm Or Less (Pbb)",,11400,CPT,Professional,Outpatient,,,,145,123.25,53.44,145,BlueCross BlueShield Minnesota,High Value Network Plan,145,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision,Benign,Lesion Trunk/Arm/Leg; .5 Cm Or Less (Pbb)",,11400,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,BlueCross BlueShield Minnesota,Medicare Advantage,44.1,49,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; .5 Cm Or Less (Pbb)",,11400,CPT,Professional,Outpatient,,,,145,123.25,53.44,145,BlueCross BlueShield Minnesota,Medicare Advantage,95.772,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision,Benign,Lesion Trunk/Arm/Leg; .5 Cm Or Less (Pbb)",,11400,CPT,Professional,Outpatient,,,,145,123.25,53.44,145,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,145,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision,Benign,Lesion Trunk/Arm/Leg; .5 Cm Or Less (Pbb)",,11400,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,25.794,28.66,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; .5 Cm Or Less (Pbb)",,11400,CPT,Professional,Outpatient,,,,145,123.25,53.44,145,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,61.70168,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision,Benign,Lesion Trunk/Arm/Leg; .5 Cm Or Less (Pbb)",,11400,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),44.1,49,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; .5 Cm Or Less (Pbb)",,11400,CPT,Professional,Outpatient,,,,145,123.25,53.44,145,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),95.772,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision,Benign,Lesion Trunk/Arm/Leg; .5 Cm Or Less (Pbb)",,11400,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,CorVel,Worker's Compensation,90,100,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; .5 Cm Or Less (Pbb)",,11400,CPT,Professional,Outpatient,,,,145,123.25,53.44,145,CorVel,Worker's Compensation,145,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Excision,Benign,Lesion Trunk/Arm/Leg; .5 Cm Or Less (Pbb)",,11400,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,First Health Group Corporation,First Health Network,87.3,97,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; .5 Cm Or Less (Pbb)",,11400,CPT,Professional,Outpatient,,,,145,123.25,53.44,145,First Health Group Corporation,First Health Network,140.65,97,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; .5 Cm Or Less (Pbb)",,11400,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,"Health Partners, Inc.",Commercial,85.14,94.6,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; .5 Cm Or Less (Pbb)",,11400,CPT,Professional,Outpatient,,,,145,123.25,53.44,145,"Health Partners, Inc.",Commercial,145,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision,Benign,Lesion Trunk/Arm/Leg; .5 Cm Or Less (Pbb)",,11400,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,"Health Partners, Inc.",Medicare Advantage,44.1,49,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; .5 Cm Or Less (Pbb)",,11400,CPT,Professional,Outpatient,,,,145,123.25,53.44,145,"Health Partners, Inc.",Medicare Advantage,95.772,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision,Benign,Lesion Trunk/Arm/Leg; .5 Cm Or Less (Pbb)",,11400,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),54,60,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; .5 Cm Or Less (Pbb)",,11400,CPT,Professional,Outpatient,,,,145,123.25,53.44,145,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),83.36,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Excision,Benign,Lesion Trunk/Arm/Leg; .5 Cm Or Less (Pbb)",,11400,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,"Health Partners, Inc.",State of Minnesota Advantage Program,73.35,81.5,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; .5 Cm Or Less (Pbb)",,11400,CPT,Professional,Outpatient,,,,145,123.25,53.44,145,"Health Partners, Inc.",State of Minnesota Advantage Program,145,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision,Benign,Lesion Trunk/Arm/Leg; .5 Cm Or Less (Pbb)",,11400,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,"Health Partners, Inc.",State Public Programs,45,50,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; .5 Cm Or Less (Pbb)",,11400,CPT,Professional,Outpatient,,,,145,123.25,53.44,145,"Health Partners, Inc.",State Public Programs,53.44,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Excision,Benign,Lesion Trunk/Arm/Leg; .5 Cm Or Less (Pbb)",,11400,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,Humana Insurance Company,Commercial PPO,85.5,95,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; .5 Cm Or Less (Pbb)",,11400,CPT,Professional,Outpatient,,,,145,123.25,53.44,145,Humana Insurance Company,Commercial PPO,83.28,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Excision,Benign,Lesion Trunk/Arm/Leg; .5 Cm Or Less (Pbb)",,11400,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,Humana Insurance Company,Medicare PPO,44.1,49,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; .5 Cm Or Less (Pbb)",,11400,CPT,Professional,Outpatient,,,,145,123.25,53.44,145,Humana Insurance Company,Medicare PPO,145,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Excision,Benign,Lesion Trunk/Arm/Leg; .5 Cm Or Less (Pbb)",,11400,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,Medica,Individual & Family,89.19,99.1,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; .5 Cm Or Less (Pbb)",,11400,CPT,Professional,Outpatient,,,,145,123.25,53.44,145,Medica,Individual & Family,122.96,84.8,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; .5 Cm Or Less (Pbb)",,11400,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,Medica,Medica Advantage Solution,44.82,49.8,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; .5 Cm Or Less (Pbb)",,11400,CPT,Professional,Outpatient,,,,145,123.25,53.44,145,Medica,Medica Advantage Solution,72.21,49.8,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; .5 Cm Or Less (Pbb)",,11400,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,Medica,Medical Assistance,40.14,44.6,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; .5 Cm Or Less (Pbb)",,11400,CPT,Professional,Outpatient,,,,145,123.25,53.44,145,Medica,Medical Assistance,61.7,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Excision,Benign,Lesion Trunk/Arm/Leg; .5 Cm Or Less (Pbb)",,11400,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,44.82,49.8,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; .5 Cm Or Less (Pbb)",,11400,CPT,Professional,Outpatient,,,,145,123.25,53.44,145,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,83.28,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Excision,Benign,Lesion Trunk/Arm/Leg; .5 Cm Or Less (Pbb)",,11400,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,"Multiplan, Inc.","Multiplan, Inc.",84.6,94,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; .5 Cm Or Less (Pbb)",,11400,CPT,Professional,Outpatient,,,,145,123.25,53.44,145,"Multiplan, Inc.","Multiplan, Inc.",136.3,94,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; .5 Cm Or Less (Pbb)",,11400,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,81.09,90.1,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; .5 Cm Or Less (Pbb)",,11400,CPT,Professional,Outpatient,,,,145,123.25,53.44,145,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,130.645,90.1,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; .5 Cm Or Less (Pbb)",,11400,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,"Preferred One Administrative Services, INC.",PPO,88.74,98.6,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; .5 Cm Or Less (Pbb)",,11400,CPT,Professional,Outpatient,,,,145,123.25,53.44,145,"Preferred One Administrative Services, INC.",PPO,142.97,98.6,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; .5 Cm Or Less (Pbb)",,11400,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,PrimeWest Health,Minnesota Senior Health Options (MSHO),46.305,51.45,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; .5 Cm Or Less (Pbb)",,11400,CPT,Professional,Outpatient,,,,145,123.25,53.44,145,PrimeWest Health,Minnesota Senior Health Options (MSHO),95.772,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision,Benign,Lesion Trunk/Arm/Leg; .5 Cm Or Less (Pbb)",,11400,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,PrimeWest Health,MinnesotaCare,46.224,51.36,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; .5 Cm Or Less (Pbb)",,11400,CPT,Professional,Outpatient,,,,145,123.25,53.44,145,PrimeWest Health,MinnesotaCare,66.0207976,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision,Benign,Lesion Trunk/Arm/Leg; .5 Cm Or Less (Pbb)",,11400,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,Sanford Health Plan,Sanford Health Plan,82.8,92,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; .5 Cm Or Less (Pbb)",,11400,CPT,Professional,Outpatient,,,,145,123.25,53.44,145,Sanford Health Plan,Sanford Health Plan,127.6,88,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; .5 Cm Or Less (Pbb)",,11400,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,"UCare Health, Inc.",Individual & Family Plan,50.715,56.35,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; .5 Cm Or Less (Pbb)",,11400,CPT,Professional,Outpatient,,,,145,123.25,53.44,145,"UCare Health, Inc.",Individual & Family Plan,135.379968,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Excision,Benign,Lesion Trunk/Arm/Leg; .5 Cm Or Less (Pbb)",,11400,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,"UCare Health, Inc.",Medical Assistance,45.423,50.47,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; .5 Cm Or Less (Pbb)",,11400,CPT,Professional,Outpatient,,,,145,123.25,53.44,145,"UCare Health, Inc.",Medical Assistance,67.871848,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Excision,Benign,Lesion Trunk/Arm/Leg; .5 Cm Or Less (Pbb)",,11400,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,"UCare Health, Inc.",Medicare Advantage,45.423,50.47,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; .5 Cm Or Less (Pbb)",,11400,CPT,Professional,Outpatient,,,,145,123.25,53.44,145,"UCare Health, Inc.",Medicare Advantage,95.772,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Excision,Benign,Lesion Trunk/Arm/Leg; .5 Cm Or Less (Pbb)",,11400,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),45.423,50.47,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; .5 Cm Or Less (Pbb)",,11400,CPT,Professional,Outpatient,,,,145,123.25,53.44,145,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),76.6176,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Excision,Benign,Lesion Trunk/Arm/Leg; .5 Cm Or Less (Pbb)",,11400,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,UnitedHealthcare,Individual & Family,84.6,94,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; .5 Cm Or Less (Pbb)",,11400,CPT,Professional,Outpatient,,,,145,123.25,53.44,145,UnitedHealthcare,Individual & Family,145,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Excision,Benign,Lesion Trunk/Arm/Leg; .5 Cm Or Less (Pbb)",,11400,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,UnitedHealthcare,Medicare Advantage,44.1,49,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; .5 Cm Or Less (Pbb)",,11400,CPT,Professional,Outpatient,,,,145,123.25,53.44,145,UnitedHealthcare,Medicare Advantage,95.772,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision,Benign,Lesion Trunk/Arm/Leg; .5 Cm Or Less (Pbb)",,11400,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,43.2,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Excision,Benign,Lesion Trunk/Arm/Leg; .5 Cm Or Less (Pbb)",,11400,CPT,Professional,Outpatient,,,,145,123.25,53.44,145,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,61.70168,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision Benign Lesion Including Margins, Except Skin Tags:Trunk, Arms, Or Legs(Unless Listed Elsewhere),.6 To 1.0 Cm",,11401,CPT,Facility,Both,,,,170,144.5,48.722,170,Aetna,Commercial,156.4,92,,percent of total billed charges,,
"Excision Benign Lesion Including Margins, Except Skin Tags:Trunk, Arms, Or Legs(Unless Listed Elsewhere),.6 To 1.0 Cm",,11401,CPT,Facility,Outpatient,,,,170,144.5,48.722,170,Aetna,Medicare Advantage,83.3,49,,percent of total billed charges,,
"Excision Benign Lesion Including Margins, Except Skin Tags:Trunk, Arms, Or Legs(Unless Listed Elsewhere),.6 To 1.0 Cm",,11401,CPT,Facility,Inpatient,,,,170,144.5,48.722,170,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Excision Benign Lesion Including Margins, Except Skin Tags:Trunk, Arms, Or Legs(Unless Listed Elsewhere),.6 To 1.0 Cm",,11401,CPT,Facility,Both,,,,170,144.5,48.722,170,Aetna,PPO,158.1,93,,percent of total billed charges,,
"Excision Benign Lesion Including Margins, Except Skin Tags:Trunk, Arms, Or Legs(Unless Listed Elsewhere),.6 To 1.0 Cm",,11401,CPT,Facility,Both,,,,170,144.5,48.722,170,America's PPO,America's PPO,163.251,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Excision Benign Lesion Including Margins, Except Skin Tags:Trunk, Arms, Or Legs(Unless Listed Elsewhere),.6 To 1.0 Cm",,11401,CPT,Facility,Both,,,,170,144.5,48.722,170,BlueCross BlueShield Minnesota, Federal Employee Program,167.28,98.4,,percent of total billed charges,,
"Excision Benign Lesion Including Margins, Except Skin Tags:Trunk, Arms, Or Legs(Unless Listed Elsewhere),.6 To 1.0 Cm",,11401,CPT,Facility,Both,,,,170,144.5,48.722,170,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,170,100,,percent of total billed charges,,
"Excision Benign Lesion Including Margins, Except Skin Tags:Trunk, Arms, Or Legs(Unless Listed Elsewhere),.6 To 1.0 Cm",,11401,CPT,Facility,Both,,,,170,144.5,48.722,170,BlueCross BlueShield Minnesota,High Value Network Plan,153,90,,percent of total billed charges,,
"Excision Benign Lesion Including Margins, Except Skin Tags:Trunk, Arms, Or Legs(Unless Listed Elsewhere),.6 To 1.0 Cm",,11401,CPT,Facility,Outpatient,,,,170,144.5,48.722,170,BlueCross BlueShield Minnesota,Medicare Advantage,83.3,49,,percent of total billed charges,,
"Excision Benign Lesion Including Margins, Except Skin Tags:Trunk, Arms, Or Legs(Unless Listed Elsewhere),.6 To 1.0 Cm",,11401,CPT,Facility,Inpatient,,,,170,144.5,48.722,170,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Excision Benign Lesion Including Margins, Except Skin Tags:Trunk, Arms, Or Legs(Unless Listed Elsewhere),.6 To 1.0 Cm",,11401,CPT,Facility,Both,,,,170,144.5,48.722,170,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,150.569,88.57,,percent of total billed charges,,
"Excision Benign Lesion Including Margins, Except Skin Tags:Trunk, Arms, Or Legs(Unless Listed Elsewhere),.6 To 1.0 Cm",,11401,CPT,Facility,Both,,,,170,144.5,48.722,170,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,48.722,28.66,,percent of total billed charges,,
"Excision Benign Lesion Including Margins, Except Skin Tags:Trunk, Arms, Or Legs(Unless Listed Elsewhere),.6 To 1.0 Cm",,11401,CPT,Facility,Outpatient,,,,170,144.5,48.722,170,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),83.3,49,,percent of total billed charges,,
"Excision Benign Lesion Including Margins, Except Skin Tags:Trunk, Arms, Or Legs(Unless Listed Elsewhere),.6 To 1.0 Cm",,11401,CPT,Facility,Inpatient,,,,170,144.5,48.722,170,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Excision Benign Lesion Including Margins, Except Skin Tags:Trunk, Arms, Or Legs(Unless Listed Elsewhere),.6 To 1.0 Cm",,11401,CPT,Facility,Both,,,,170,144.5,48.722,170,CorVel,Worker's Compensation,170,100,,percent of total billed charges,,
"Excision Benign Lesion Including Margins, Except Skin Tags:Trunk, Arms, Or Legs(Unless Listed Elsewhere),.6 To 1.0 Cm",,11401,CPT,Facility,Both,,,,170,144.5,48.722,170,First Health Group Corporation,First Health Network,164.9,97,,percent of total billed charges,,
"Excision Benign Lesion Including Margins, Except Skin Tags:Trunk, Arms, Or Legs(Unless Listed Elsewhere),.6 To 1.0 Cm",,11401,CPT,Facility,Both,,,,170,144.5,48.722,170,"Health Partners, Inc.",Commercial,160.82,94.6,,percent of total billed charges,,
"Excision Benign Lesion Including Margins, Except Skin Tags:Trunk, Arms, Or Legs(Unless Listed Elsewhere),.6 To 1.0 Cm",,11401,CPT,Facility,Outpatient,,,,170,144.5,48.722,170,"Health Partners, Inc.",Medicare Advantage,83.3,49,,percent of total billed charges,,
"Excision Benign Lesion Including Margins, Except Skin Tags:Trunk, Arms, Or Legs(Unless Listed Elsewhere),.6 To 1.0 Cm",,11401,CPT,Facility,Inpatient,,,,170,144.5,48.722,170,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Excision Benign Lesion Including Margins, Except Skin Tags:Trunk, Arms, Or Legs(Unless Listed Elsewhere),.6 To 1.0 Cm",,11401,CPT,Facility,Both,,,,170,144.5,48.722,170,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),102,60,,percent of total billed charges,,
"Excision Benign Lesion Including Margins, Except Skin Tags:Trunk, Arms, Or Legs(Unless Listed Elsewhere),.6 To 1.0 Cm",,11401,CPT,Facility,Both,,,,170,144.5,48.722,170,"Health Partners, Inc.",State of Minnesota Advantage Program,138.55,81.5,,percent of total billed charges,,
"Excision Benign Lesion Including Margins, Except Skin Tags:Trunk, Arms, Or Legs(Unless Listed Elsewhere),.6 To 1.0 Cm",,11401,CPT,Facility,Both,,,,170,144.5,48.722,170,"Health Partners, Inc.",State Public Programs,85,50,,percent of total billed charges,,
"Excision Benign Lesion Including Margins, Except Skin Tags:Trunk, Arms, Or Legs(Unless Listed Elsewhere),.6 To 1.0 Cm",,11401,CPT,Facility,Both,,,,170,144.5,48.722,170,Humana Insurance Company,Commercial PPO,161.5,95,,percent of total billed charges,,
"Excision Benign Lesion Including Margins, Except Skin Tags:Trunk, Arms, Or Legs(Unless Listed Elsewhere),.6 To 1.0 Cm",,11401,CPT,Facility,Outpatient,,,,170,144.5,48.722,170,Humana Insurance Company,Medicare PPO,83.3,49,,percent of total billed charges,,
"Excision Benign Lesion Including Margins, Except Skin Tags:Trunk, Arms, Or Legs(Unless Listed Elsewhere),.6 To 1.0 Cm",,11401,CPT,Facility,Inpatient,,,,170,144.5,48.722,170,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Excision Benign Lesion Including Margins, Except Skin Tags:Trunk, Arms, Or Legs(Unless Listed Elsewhere),.6 To 1.0 Cm",,11401,CPT,Facility,Both,,,,170,144.5,48.722,170,Medica,Individual & Family,168.47,99.1,,percent of total billed charges,,
"Excision Benign Lesion Including Margins, Except Skin Tags:Trunk, Arms, Or Legs(Unless Listed Elsewhere),.6 To 1.0 Cm",,11401,CPT,Facility,Outpatient,,,,170,144.5,48.722,170,Medica,Medica Advantage Solution,84.66,49.8,,percent of total billed charges,,
"Excision Benign Lesion Including Margins, Except Skin Tags:Trunk, Arms, Or Legs(Unless Listed Elsewhere),.6 To 1.0 Cm",,11401,CPT,Facility,Inpatient,,,,170,144.5,48.722,170,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Excision Benign Lesion Including Margins, Except Skin Tags:Trunk, Arms, Or Legs(Unless Listed Elsewhere),.6 To 1.0 Cm",,11401,CPT,Facility,Outpatient,,,,170,144.5,48.722,170,Medica,Medical Assistance,75.82,44.6,,percent of total billed charges,,
"Excision Benign Lesion Including Margins, Except Skin Tags:Trunk, Arms, Or Legs(Unless Listed Elsewhere),.6 To 1.0 Cm",,11401,CPT,Facility,Inpatient,,,,170,144.5,48.722,170,Medica,Medical Assistance,,,,,Included in per diem rate,
"Excision Benign Lesion Including Margins, Except Skin Tags:Trunk, Arms, Or Legs(Unless Listed Elsewhere),.6 To 1.0 Cm",,11401,CPT,Facility,Outpatient,,,,170,144.5,48.722,170,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,84.66,49.8,,percent of total billed charges,,
"Excision Benign Lesion Including Margins, Except Skin Tags:Trunk, Arms, Or Legs(Unless Listed Elsewhere),.6 To 1.0 Cm",,11401,CPT,Facility,Inpatient,,,,170,144.5,48.722,170,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Excision Benign Lesion Including Margins, Except Skin Tags:Trunk, Arms, Or Legs(Unless Listed Elsewhere),.6 To 1.0 Cm",,11401,CPT,Facility,Both,,,,170,144.5,48.722,170,"Multiplan, Inc.","Multiplan, Inc.",159.8,94,,percent of total billed charges,,
"Excision Benign Lesion Including Margins, Except Skin Tags:Trunk, Arms, Or Legs(Unless Listed Elsewhere),.6 To 1.0 Cm",,11401,CPT,Facility,Outpatient,,,,170,144.5,48.722,170,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,153.17,90.1,,percent of total billed charges,,
"Excision Benign Lesion Including Margins, Except Skin Tags:Trunk, Arms, Or Legs(Unless Listed Elsewhere),.6 To 1.0 Cm",,11401,CPT,Facility,Inpatient,,,,170,144.5,48.722,170,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Excision Benign Lesion Including Margins, Except Skin Tags:Trunk, Arms, Or Legs(Unless Listed Elsewhere),.6 To 1.0 Cm",,11401,CPT,Facility,Both,,,,170,144.5,48.722,170,"Preferred One Administrative Services, INC.",PPO,167.62,98.6,,percent of total billed charges,,
"Excision Benign Lesion Including Margins, Except Skin Tags:Trunk, Arms, Or Legs(Unless Listed Elsewhere),.6 To 1.0 Cm",,11401,CPT,Facility,Outpatient,,,,170,144.5,48.722,170,PrimeWest Health,Minnesota Senior Health Options (MSHO),87.465,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Excision Benign Lesion Including Margins, Except Skin Tags:Trunk, Arms, Or Legs(Unless Listed Elsewhere),.6 To 1.0 Cm",,11401,CPT,Facility,Inpatient,,,,170,144.5,48.722,170,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Excision Benign Lesion Including Margins, Except Skin Tags:Trunk, Arms, Or Legs(Unless Listed Elsewhere),.6 To 1.0 Cm",,11401,CPT,Facility,Outpatient,,,,170,144.5,48.722,170,PrimeWest Health,MinnesotaCare,87.312,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Excision Benign Lesion Including Margins, Except Skin Tags:Trunk, Arms, Or Legs(Unless Listed Elsewhere),.6 To 1.0 Cm",,11401,CPT,Facility,Inpatient,,,,170,144.5,48.722,170,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Excision Benign Lesion Including Margins, Except Skin Tags:Trunk, Arms, Or Legs(Unless Listed Elsewhere),.6 To 1.0 Cm",,11401,CPT,Facility,Both,,,,170,144.5,48.722,170,Sanford Health Plan,Sanford Health Plan,156.4,92,,percent of total billed charges,,
"Excision Benign Lesion Including Margins, Except Skin Tags:Trunk, Arms, Or Legs(Unless Listed Elsewhere),.6 To 1.0 Cm",,11401,CPT,Facility,Outpatient,,,,170,144.5,48.722,170,"UCare Health, Inc.",Individual & Family Plan,95.795,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Excision Benign Lesion Including Margins, Except Skin Tags:Trunk, Arms, Or Legs(Unless Listed Elsewhere),.6 To 1.0 Cm",,11401,CPT,Facility,Inpatient,,,,170,144.5,48.722,170,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Excision Benign Lesion Including Margins, Except Skin Tags:Trunk, Arms, Or Legs(Unless Listed Elsewhere),.6 To 1.0 Cm",,11401,CPT,Facility,Outpatient,,,,170,144.5,48.722,170,"UCare Health, Inc.",Medical Assistance,85.799,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Excision Benign Lesion Including Margins, Except Skin Tags:Trunk, Arms, Or Legs(Unless Listed Elsewhere),.6 To 1.0 Cm",,11401,CPT,Facility,Inpatient,,,,170,144.5,48.722,170,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Excision Benign Lesion Including Margins, Except Skin Tags:Trunk, Arms, Or Legs(Unless Listed Elsewhere),.6 To 1.0 Cm",,11401,CPT,Facility,Outpatient,,,,170,144.5,48.722,170,"UCare Health, Inc.",Medicare Advantage,85.799,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Excision Benign Lesion Including Margins, Except Skin Tags:Trunk, Arms, Or Legs(Unless Listed Elsewhere),.6 To 1.0 Cm",,11401,CPT,Facility,Inpatient,,,,170,144.5,48.722,170,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Excision Benign Lesion Including Margins, Except Skin Tags:Trunk, Arms, Or Legs(Unless Listed Elsewhere),.6 To 1.0 Cm",,11401,CPT,Facility,Outpatient,,,,170,144.5,48.722,170,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),85.799,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Excision Benign Lesion Including Margins, Except Skin Tags:Trunk, Arms, Or Legs(Unless Listed Elsewhere),.6 To 1.0 Cm",,11401,CPT,Facility,Inpatient,,,,170,144.5,48.722,170,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Excision Benign Lesion Including Margins, Except Skin Tags:Trunk, Arms, Or Legs(Unless Listed Elsewhere),.6 To 1.0 Cm",,11401,CPT,Facility,Both,,,,170,144.5,48.722,170,UnitedHealthcare,Individual & Family,159.8,94,,percent of total billed charges,,
"Excision Benign Lesion Including Margins, Except Skin Tags:Trunk, Arms, Or Legs(Unless Listed Elsewhere),.6 To 1.0 Cm",,11401,CPT,Facility,Outpatient,,,,170,144.5,48.722,170,UnitedHealthcare,Medicare Advantage,83.3,49,,percent of total billed charges,,
"Excision Benign Lesion Including Margins, Except Skin Tags:Trunk, Arms, Or Legs(Unless Listed Elsewhere),.6 To 1.0 Cm",,11401,CPT,Facility,Inpatient,,,,170,144.5,48.722,170,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Excision Benign Lesion Including Margins, Except Skin Tags:Trunk, Arms, Or Legs(Unless Listed Elsewhere),.6 To 1.0 Cm",,11401,CPT,Facility,Outpatient,,,,170,144.5,48.722,170,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,81.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Excision Benign Lesion Including Margins, Except Skin Tags:Trunk, Arms, Or Legs(Unless Listed Elsewhere),.6 To 1.0 Cm",,11401,CPT,Facility,Inpatient,,,,170,144.5,48.722,170,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Excision, Benign Lesion Incl Margins, Except Skin Tag/Trunk/Arms/Legs; Exc Dia 0.6-1.0 Cm (Pro Cah)",,11401,CPT,Professional,Both,,,,647,549.95,67.19,647,Aetna,Commercial,549.95,85,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margins, Except Skin Tag/Trunk/Arms/Legs; Exc Dia 0.6-1.0 Cm (Pro Cah)",,11401,CPT,Professional,Both,,,,300,255,67.19,300,Aetna,Commercial,255,85,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margins, Except Skin Tag/Trunk/Arms/Legs; Exc Dia 0.6-1.0 Cm (Pro Cah)",,11401,CPT,Professional,Both,,,,647,549.95,67.19,647,Aetna,Medicare Advantage,103.77,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Benign Lesion Incl Margins, Except Skin Tag/Trunk/Arms/Legs; Exc Dia 0.6-1.0 Cm (Pro Cah)",,11401,CPT,Professional,Both,,,,300,255,67.19,300,Aetna,Medicare Advantage,103.77,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Benign Lesion Incl Margins, Except Skin Tag/Trunk/Arms/Legs; Exc Dia 0.6-1.0 Cm (Pro Cah)",,11401,CPT,Professional,Both,,,,647,549.95,67.19,647,Aetna,PPO,601.71,93,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margins, Except Skin Tag/Trunk/Arms/Legs; Exc Dia 0.6-1.0 Cm (Pro Cah)",,11401,CPT,Professional,Both,,,,300,255,67.19,300,Aetna,PPO,279,93,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margins, Except Skin Tag/Trunk/Arms/Legs; Exc Dia 0.6-1.0 Cm (Pro Cah)",,11401,CPT,Professional,Both,,,,647,549.95,67.19,647,America's PPO,America's PPO,552.7968,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Excision, Benign Lesion Incl Margins, Except Skin Tag/Trunk/Arms/Legs; Exc Dia 0.6-1.0 Cm (Pro Cah)",,11401,CPT,Professional,Both,,,,300,255,67.19,300,America's PPO,America's PPO,256.32,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Excision, Benign Lesion Incl Margins, Except Skin Tag/Trunk/Arms/Legs; Exc Dia 0.6-1.0 Cm (Pro Cah)",,11401,CPT,Professional,Both,,,,647,549.95,67.19,647,BlueCross BlueShield Minnesota, Federal Employee Program,218.29,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Excision, Benign Lesion Incl Margins, Except Skin Tag/Trunk/Arms/Legs; Exc Dia 0.6-1.0 Cm (Pro Cah)",,11401,CPT,Professional,Both,,,,300,255,67.19,300,BlueCross BlueShield Minnesota, Federal Employee Program,218.29,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Excision, Benign Lesion Incl Margins, Except Skin Tag/Trunk/Arms/Legs; Exc Dia 0.6-1.0 Cm (Pro Cah)",,11401,CPT,Professional,Both,,,,647,549.95,67.19,647,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,221.78264,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Benign Lesion Incl Margins, Except Skin Tag/Trunk/Arms/Legs; Exc Dia 0.6-1.0 Cm (Pro Cah)",,11401,CPT,Professional,Both,,,,300,255,67.19,300,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,221.78264,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Benign Lesion Incl Margins, Except Skin Tag/Trunk/Arms/Legs; Exc Dia 0.6-1.0 Cm (Pro Cah)",,11401,CPT,Professional,Both,,,,647,549.95,67.19,647,BlueCross BlueShield Minnesota,High Value Network Plan,221.78264,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Benign Lesion Incl Margins, Except Skin Tag/Trunk/Arms/Legs; Exc Dia 0.6-1.0 Cm (Pro Cah)",,11401,CPT,Professional,Both,,,,300,255,67.19,300,BlueCross BlueShield Minnesota,High Value Network Plan,221.78264,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Benign Lesion Incl Margins, Except Skin Tag/Trunk/Arms/Legs; Exc Dia 0.6-1.0 Cm (Pro Cah)",,11401,CPT,Professional,Both,,,,647,549.95,67.19,647,BlueCross BlueShield Minnesota,Medicare Advantage,120.0715,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Benign Lesion Incl Margins, Except Skin Tag/Trunk/Arms/Legs; Exc Dia 0.6-1.0 Cm (Pro Cah)",,11401,CPT,Professional,Both,,,,300,255,67.19,300,BlueCross BlueShield Minnesota,Medicare Advantage,120.0715,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Benign Lesion Incl Margins, Except Skin Tag/Trunk/Arms/Legs; Exc Dia 0.6-1.0 Cm (Pro Cah)",,11401,CPT,Professional,Both,,,,647,549.95,67.19,647,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,221.78264,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Benign Lesion Incl Margins, Except Skin Tag/Trunk/Arms/Legs; Exc Dia 0.6-1.0 Cm (Pro Cah)",,11401,CPT,Professional,Both,,,,300,255,67.19,300,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,221.78264,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Benign Lesion Incl Margins, Except Skin Tag/Trunk/Arms/Legs; Exc Dia 0.6-1.0 Cm (Pro Cah)",,11401,CPT,Professional,Both,,,,647,549.95,67.19,647,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,77.5716,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision, Benign Lesion Incl Margins, Except Skin Tag/Trunk/Arms/Legs; Exc Dia 0.6-1.0 Cm (Pro Cah)",,11401,CPT,Professional,Both,,,,300,255,67.19,300,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,77.5716,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision, Benign Lesion Incl Margins, Except Skin Tag/Trunk/Arms/Legs; Exc Dia 0.6-1.0 Cm (Pro Cah)",,11401,CPT,Professional,Both,,,,647,549.95,67.19,647,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),120.0715,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Benign Lesion Incl Margins, Except Skin Tag/Trunk/Arms/Legs; Exc Dia 0.6-1.0 Cm (Pro Cah)",,11401,CPT,Professional,Both,,,,300,255,67.19,300,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),120.0715,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Benign Lesion Incl Margins, Except Skin Tag/Trunk/Arms/Legs; Exc Dia 0.6-1.0 Cm (Pro Cah)",,11401,CPT,Professional,Both,,,,647,549.95,67.19,647,CorVel,Worker's Compensation,202.2797682,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Excision, Benign Lesion Incl Margins, Except Skin Tag/Trunk/Arms/Legs; Exc Dia 0.6-1.0 Cm (Pro Cah)",,11401,CPT,Professional,Both,,,,300,255,67.19,300,CorVel,Worker's Compensation,202.2797682,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Excision, Benign Lesion Incl Margins, Except Skin Tag/Trunk/Arms/Legs; Exc Dia 0.6-1.0 Cm (Pro Cah)",,11401,CPT,Professional,Both,,,,647,549.95,67.19,647,First Health Group Corporation,First Health Network,627.59,97,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margins, Except Skin Tag/Trunk/Arms/Legs; Exc Dia 0.6-1.0 Cm (Pro Cah)",,11401,CPT,Professional,Both,,,,300,255,67.19,300,First Health Group Corporation,First Health Network,291,97,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margins, Except Skin Tag/Trunk/Arms/Legs; Exc Dia 0.6-1.0 Cm (Pro Cah)",,11401,CPT,Professional,Both,,,,647,549.95,67.19,647,"Health Partners, Inc.",Commercial,218.38,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision, Benign Lesion Incl Margins, Except Skin Tag/Trunk/Arms/Legs; Exc Dia 0.6-1.0 Cm (Pro Cah)",,11401,CPT,Professional,Both,,,,300,255,67.19,300,"Health Partners, Inc.",Commercial,218.38,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision, Benign Lesion Incl Margins, Except Skin Tag/Trunk/Arms/Legs; Exc Dia 0.6-1.0 Cm (Pro Cah)",,11401,CPT,Professional,Both,,,,647,549.95,67.19,647,"Health Partners, Inc.",Medicare Advantage,120.0715,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Benign Lesion Incl Margins, Except Skin Tag/Trunk/Arms/Legs; Exc Dia 0.6-1.0 Cm (Pro Cah)",,11401,CPT,Professional,Both,,,,300,255,67.19,300,"Health Partners, Inc.",Medicare Advantage,120.0715,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Benign Lesion Incl Margins, Except Skin Tag/Trunk/Arms/Legs; Exc Dia 0.6-1.0 Cm (Pro Cah)",,11401,CPT,Professional,Both,,,,647,549.95,67.19,647,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),104.37,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Excision, Benign Lesion Incl Margins, Except Skin Tag/Trunk/Arms/Legs; Exc Dia 0.6-1.0 Cm (Pro Cah)",,11401,CPT,Professional,Both,,,,300,255,67.19,300,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),104.37,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Excision, Benign Lesion Incl Margins, Except Skin Tag/Trunk/Arms/Legs; Exc Dia 0.6-1.0 Cm (Pro Cah)",,11401,CPT,Professional,Both,,,,647,549.95,67.19,647,"Health Partners, Inc.",State of Minnesota Advantage Program,188.13437,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision, Benign Lesion Incl Margins, Except Skin Tag/Trunk/Arms/Legs; Exc Dia 0.6-1.0 Cm (Pro Cah)",,11401,CPT,Professional,Both,,,,300,255,67.19,300,"Health Partners, Inc.",State of Minnesota Advantage Program,188.13437,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision, Benign Lesion Incl Margins, Except Skin Tag/Trunk/Arms/Legs; Exc Dia 0.6-1.0 Cm (Pro Cah)",,11401,CPT,Professional,Both,,,,647,549.95,67.19,647,"Health Partners, Inc.",State Public Programs,67.19,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Excision, Benign Lesion Incl Margins, Except Skin Tag/Trunk/Arms/Legs; Exc Dia 0.6-1.0 Cm (Pro Cah)",,11401,CPT,Professional,Both,,,,300,255,67.19,300,"Health Partners, Inc.",State Public Programs,67.19,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Excision, Benign Lesion Incl Margins, Except Skin Tag/Trunk/Arms/Legs; Exc Dia 0.6-1.0 Cm (Pro Cah)",,11401,CPT,Professional,Both,,,,647,549.95,67.19,647,Humana Insurance Company,Commercial PPO,104.41,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Excision, Benign Lesion Incl Margins, Except Skin Tag/Trunk/Arms/Legs; Exc Dia 0.6-1.0 Cm (Pro Cah)",,11401,CPT,Professional,Both,,,,300,255,67.19,300,Humana Insurance Company,Commercial PPO,104.41,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Excision, Benign Lesion Incl Margins, Except Skin Tag/Trunk/Arms/Legs; Exc Dia 0.6-1.0 Cm (Pro Cah)",,11401,CPT,Professional,Both,,,,647,549.95,67.19,647,Humana Insurance Company,Medicare PPO,647,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Excision, Benign Lesion Incl Margins, Except Skin Tag/Trunk/Arms/Legs; Exc Dia 0.6-1.0 Cm (Pro Cah)",,11401,CPT,Professional,Both,,,,300,255,67.19,300,Humana Insurance Company,Medicare PPO,300,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Excision, Benign Lesion Incl Margins, Except Skin Tag/Trunk/Arms/Legs; Exc Dia 0.6-1.0 Cm (Pro Cah)",,11401,CPT,Professional,Both,,,,647,549.95,67.19,647,Medica,Individual & Family,548.656,84.8,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margins, Except Skin Tag/Trunk/Arms/Legs; Exc Dia 0.6-1.0 Cm (Pro Cah)",,11401,CPT,Professional,Both,,,,300,255,67.19,300,Medica,Individual & Family,254.4,84.8,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margins, Except Skin Tag/Trunk/Arms/Legs; Exc Dia 0.6-1.0 Cm (Pro Cah)",,11401,CPT,Professional,Both,,,,647,549.95,67.19,647,Medica,Medica Advantage Solution,322.206,49.8,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margins, Except Skin Tag/Trunk/Arms/Legs; Exc Dia 0.6-1.0 Cm (Pro Cah)",,11401,CPT,Professional,Both,,,,300,255,67.19,300,Medica,Medica Advantage Solution,149.4,49.8,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margins, Except Skin Tag/Trunk/Arms/Legs; Exc Dia 0.6-1.0 Cm (Pro Cah)",,11401,CPT,Professional,Both,,,,647,549.95,67.19,647,Medica,Medical Assistance,77.57,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Excision, Benign Lesion Incl Margins, Except Skin Tag/Trunk/Arms/Legs; Exc Dia 0.6-1.0 Cm (Pro Cah)",,11401,CPT,Professional,Both,,,,300,255,67.19,300,Medica,Medical Assistance,77.57,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Excision, Benign Lesion Incl Margins, Except Skin Tag/Trunk/Arms/Legs; Exc Dia 0.6-1.0 Cm (Pro Cah)",,11401,CPT,Professional,Both,,,,647,549.95,67.19,647,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,104.41,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Excision, Benign Lesion Incl Margins, Except Skin Tag/Trunk/Arms/Legs; Exc Dia 0.6-1.0 Cm (Pro Cah)",,11401,CPT,Professional,Both,,,,300,255,67.19,300,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,104.41,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Excision, Benign Lesion Incl Margins, Except Skin Tag/Trunk/Arms/Legs; Exc Dia 0.6-1.0 Cm (Pro Cah)",,11401,CPT,Professional,Both,,,,647,549.95,67.19,647,"Multiplan, Inc.","Multiplan, Inc.",608.18,94,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margins, Except Skin Tag/Trunk/Arms/Legs; Exc Dia 0.6-1.0 Cm (Pro Cah)",,11401,CPT,Professional,Both,,,,300,255,67.19,300,"Multiplan, Inc.","Multiplan, Inc.",282,94,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margins, Except Skin Tag/Trunk/Arms/Legs; Exc Dia 0.6-1.0 Cm (Pro Cah)",,11401,CPT,Professional,Both,,,,647,549.95,67.19,647,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,582.947,90.1,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margins, Except Skin Tag/Trunk/Arms/Legs; Exc Dia 0.6-1.0 Cm (Pro Cah)",,11401,CPT,Professional,Both,,,,300,255,67.19,300,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,270.3,90.1,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margins, Except Skin Tag/Trunk/Arms/Legs; Exc Dia 0.6-1.0 Cm (Pro Cah)",,11401,CPT,Professional,Both,,,,647,549.95,67.19,647,"Preferred One Administrative Services, INC.",PPO,637.942,98.6,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margins, Except Skin Tag/Trunk/Arms/Legs; Exc Dia 0.6-1.0 Cm (Pro Cah)",,11401,CPT,Professional,Both,,,,300,255,67.19,300,"Preferred One Administrative Services, INC.",PPO,295.8,98.6,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margins, Except Skin Tag/Trunk/Arms/Legs; Exc Dia 0.6-1.0 Cm (Pro Cah)",,11401,CPT,Professional,Both,,,,647,549.95,67.19,647,PrimeWest Health,Minnesota Senior Health Options (MSHO),120.0715,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Benign Lesion Incl Margins, Except Skin Tag/Trunk/Arms/Legs; Exc Dia 0.6-1.0 Cm (Pro Cah)",,11401,CPT,Professional,Both,,,,300,255,67.19,300,PrimeWest Health,Minnesota Senior Health Options (MSHO),120.0715,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Benign Lesion Incl Margins, Except Skin Tag/Trunk/Arms/Legs; Exc Dia 0.6-1.0 Cm (Pro Cah)",,11401,CPT,Professional,Both,,,,647,549.95,67.19,647,PrimeWest Health,MinnesotaCare,83.001612,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision, Benign Lesion Incl Margins, Except Skin Tag/Trunk/Arms/Legs; Exc Dia 0.6-1.0 Cm (Pro Cah)",,11401,CPT,Professional,Both,,,,300,255,67.19,300,PrimeWest Health,MinnesotaCare,83.001612,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision, Benign Lesion Incl Margins, Except Skin Tag/Trunk/Arms/Legs; Exc Dia 0.6-1.0 Cm (Pro Cah)",,11401,CPT,Professional,Both,,,,647,549.95,67.19,647,Sanford Health Plan,Sanford Health Plan,569.36,88,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margins, Except Skin Tag/Trunk/Arms/Legs; Exc Dia 0.6-1.0 Cm (Pro Cah)",,11401,CPT,Professional,Both,,,,300,255,67.19,300,Sanford Health Plan,Sanford Health Plan,264,88,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margins, Except Skin Tag/Trunk/Arms/Legs; Exc Dia 0.6-1.0 Cm (Pro Cah)",,11401,CPT,Professional,Both,,,,647,549.95,67.19,647,"UCare Health, Inc.",Individual & Family Plan,169.728896,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Excision, Benign Lesion Incl Margins, Except Skin Tag/Trunk/Arms/Legs; Exc Dia 0.6-1.0 Cm (Pro Cah)",,11401,CPT,Professional,Both,,,,300,255,67.19,300,"UCare Health, Inc.",Individual & Family Plan,169.728896,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Excision, Benign Lesion Incl Margins, Except Skin Tag/Trunk/Arms/Legs; Exc Dia 0.6-1.0 Cm (Pro Cah)",,11401,CPT,Professional,Both,,,,647,549.95,67.19,647,"UCare Health, Inc.",Medical Assistance,85.32876,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Excision, Benign Lesion Incl Margins, Except Skin Tag/Trunk/Arms/Legs; Exc Dia 0.6-1.0 Cm (Pro Cah)",,11401,CPT,Professional,Both,,,,300,255,67.19,300,"UCare Health, Inc.",Medical Assistance,85.32876,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Excision, Benign Lesion Incl Margins, Except Skin Tag/Trunk/Arms/Legs; Exc Dia 0.6-1.0 Cm (Pro Cah)",,11401,CPT,Professional,Both,,,,647,549.95,67.19,647,"UCare Health, Inc.",Medicare Advantage,120.0715,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Excision, Benign Lesion Incl Margins, Except Skin Tag/Trunk/Arms/Legs; Exc Dia 0.6-1.0 Cm (Pro Cah)",,11401,CPT,Professional,Both,,,,300,255,67.19,300,"UCare Health, Inc.",Medicare Advantage,120.0715,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Excision, Benign Lesion Incl Margins, Except Skin Tag/Trunk/Arms/Legs; Exc Dia 0.6-1.0 Cm (Pro Cah)",,11401,CPT,Professional,Both,,,,647,549.95,67.19,647,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),96.0572,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Excision, Benign Lesion Incl Margins, Except Skin Tag/Trunk/Arms/Legs; Exc Dia 0.6-1.0 Cm (Pro Cah)",,11401,CPT,Professional,Both,,,,300,255,67.19,300,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),96.0572,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Excision, Benign Lesion Incl Margins, Except Skin Tag/Trunk/Arms/Legs; Exc Dia 0.6-1.0 Cm (Pro Cah)",,11401,CPT,Professional,Both,,,,647,549.95,67.19,647,UnitedHealthcare,Individual & Family,647,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Excision, Benign Lesion Incl Margins, Except Skin Tag/Trunk/Arms/Legs; Exc Dia 0.6-1.0 Cm (Pro Cah)",,11401,CPT,Professional,Both,,,,300,255,67.19,300,UnitedHealthcare,Individual & Family,300,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Excision, Benign Lesion Incl Margins, Except Skin Tag/Trunk/Arms/Legs; Exc Dia 0.6-1.0 Cm (Pro Cah)",,11401,CPT,Professional,Both,,,,647,549.95,67.19,647,UnitedHealthcare,Medicare Advantage,120.0715,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Benign Lesion Incl Margins, Except Skin Tag/Trunk/Arms/Legs; Exc Dia 0.6-1.0 Cm (Pro Cah)",,11401,CPT,Professional,Both,,,,300,255,67.19,300,UnitedHealthcare,Medicare Advantage,120.0715,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Benign Lesion Incl Margins, Except Skin Tag/Trunk/Arms/Legs; Exc Dia 0.6-1.0 Cm (Pro Cah)",,11401,CPT,Professional,Both,,,,647,549.95,67.19,647,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,77.5716,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision, Benign Lesion Incl Margins, Except Skin Tag/Trunk/Arms/Legs; Exc Dia 0.6-1.0 Cm (Pro Cah)",,11401,CPT,Professional,Both,,,,300,255,67.19,300,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,77.5716,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision,Benign,Lesion Trunkk/Arm/Leg; .6-1.0 Cm (Pbb)",,11401,CPT,Facility,Outpatient,,,,306,260.1,87.6996,306,Aetna,Commercial,281.52,92,,percent of total billed charges,,
"Excision,Benign,Lesion Trunkk/Arm/Leg; .6-1.0 Cm (Pbb)",,11401,CPT,Professional,Outpatient,,,,341,289.85,67.19,341,Aetna,Commercial,289.85,85,,percent of total billed charges,,
"Excision,Benign,Lesion Trunkk/Arm/Leg; .6-1.0 Cm (Pbb)",,11401,CPT,Facility,Outpatient,,,,306,260.1,87.6996,306,Aetna,Medicare Advantage,149.94,49,,percent of total billed charges,,
"Excision,Benign,Lesion Trunkk/Arm/Leg; .6-1.0 Cm (Pbb)",,11401,CPT,Professional,Outpatient,,,,341,289.85,67.19,341,Aetna,Medicare Advantage,103.77,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision,Benign,Lesion Trunkk/Arm/Leg; .6-1.0 Cm (Pbb)",,11401,CPT,Facility,Outpatient,,,,306,260.1,87.6996,306,Aetna,PPO,284.58,93,,percent of total billed charges,,
"Excision,Benign,Lesion Trunkk/Arm/Leg; .6-1.0 Cm (Pbb)",,11401,CPT,Professional,Outpatient,,,,341,289.85,67.19,341,Aetna,PPO,317.13,93,,percent of total billed charges,,
"Excision,Benign,Lesion Trunkk/Arm/Leg; .6-1.0 Cm (Pbb)",,11401,CPT,Facility,Outpatient,,,,306,260.1,87.6996,306,America's PPO,America's PPO,293.8518,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Excision,Benign,Lesion Trunkk/Arm/Leg; .6-1.0 Cm (Pbb)",,11401,CPT,Professional,Outpatient,,,,341,289.85,67.19,341,America's PPO,America's PPO,291.3504,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Excision,Benign,Lesion Trunkk/Arm/Leg; .6-1.0 Cm (Pbb)",,11401,CPT,Facility,Outpatient,,,,306,260.1,87.6996,306,BlueCross BlueShield Minnesota, Federal Employee Program,301.104,98.4,,percent of total billed charges,,
"Excision,Benign,Lesion Trunkk/Arm/Leg; .6-1.0 Cm (Pbb)",,11401,CPT,Professional,Outpatient,,,,341,289.85,67.19,341,BlueCross BlueShield Minnesota, Federal Employee Program,218.29,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Excision,Benign,Lesion Trunkk/Arm/Leg; .6-1.0 Cm (Pbb)",,11401,CPT,Facility,Outpatient,,,,306,260.1,87.6996,306,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,306,100,,percent of total billed charges,,
"Excision,Benign,Lesion Trunkk/Arm/Leg; .6-1.0 Cm (Pbb)",,11401,CPT,Professional,Outpatient,,,,341,289.85,67.19,341,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,221.78264,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision,Benign,Lesion Trunkk/Arm/Leg; .6-1.0 Cm (Pbb)",,11401,CPT,Facility,Outpatient,,,,306,260.1,87.6996,306,BlueCross BlueShield Minnesota,High Value Network Plan,275.4,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
"Excision,Benign,Lesion Trunkk/Arm/Leg; .6-1.0 Cm (Pbb)",,11401,CPT,Professional,Outpatient,,,,341,289.85,67.19,341,BlueCross BlueShield Minnesota,High Value Network Plan,221.78264,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision,Benign,Lesion Trunkk/Arm/Leg; .6-1.0 Cm (Pbb)",,11401,CPT,Facility,Outpatient,,,,306,260.1,87.6996,306,BlueCross BlueShield Minnesota,Medicare Advantage,149.94,49,,percent of total billed charges,,
"Excision,Benign,Lesion Trunkk/Arm/Leg; .6-1.0 Cm (Pbb)",,11401,CPT,Professional,Outpatient,,,,341,289.85,67.19,341,BlueCross BlueShield Minnesota,Medicare Advantage,120.0715,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision,Benign,Lesion Trunkk/Arm/Leg; .6-1.0 Cm (Pbb)",,11401,CPT,Professional,Outpatient,,,,341,289.85,67.19,341,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,221.78264,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision,Benign,Lesion Trunkk/Arm/Leg; .6-1.0 Cm (Pbb)",,11401,CPT,Facility,Outpatient,,,,306,260.1,87.6996,306,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,87.6996,28.66,,percent of total billed charges,,
"Excision,Benign,Lesion Trunkk/Arm/Leg; .6-1.0 Cm (Pbb)",,11401,CPT,Professional,Outpatient,,,,341,289.85,67.19,341,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,77.5716,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision,Benign,Lesion Trunkk/Arm/Leg; .6-1.0 Cm (Pbb)",,11401,CPT,Facility,Outpatient,,,,306,260.1,87.6996,306,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),149.94,49,,percent of total billed charges,,
"Excision,Benign,Lesion Trunkk/Arm/Leg; .6-1.0 Cm (Pbb)",,11401,CPT,Professional,Outpatient,,,,341,289.85,67.19,341,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),120.0715,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision,Benign,Lesion Trunkk/Arm/Leg; .6-1.0 Cm (Pbb)",,11401,CPT,Facility,Outpatient,,,,306,260.1,87.6996,306,CorVel,Worker's Compensation,306,100,,percent of total billed charges,,
"Excision,Benign,Lesion Trunkk/Arm/Leg; .6-1.0 Cm (Pbb)",,11401,CPT,Professional,Outpatient,,,,341,289.85,67.19,341,CorVel,Worker's Compensation,202.2797682,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Excision,Benign,Lesion Trunkk/Arm/Leg; .6-1.0 Cm (Pbb)",,11401,CPT,Facility,Outpatient,,,,306,260.1,87.6996,306,First Health Group Corporation,First Health Network,296.82,97,,percent of total billed charges,,
"Excision,Benign,Lesion Trunkk/Arm/Leg; .6-1.0 Cm (Pbb)",,11401,CPT,Professional,Outpatient,,,,341,289.85,67.19,341,First Health Group Corporation,First Health Network,330.77,97,,percent of total billed charges,,
"Excision,Benign,Lesion Trunkk/Arm/Leg; .6-1.0 Cm (Pbb)",,11401,CPT,Facility,Outpatient,,,,306,260.1,87.6996,306,"Health Partners, Inc.",Commercial,289.476,94.6,,percent of total billed charges,,
"Excision,Benign,Lesion Trunkk/Arm/Leg; .6-1.0 Cm (Pbb)",,11401,CPT,Professional,Outpatient,,,,341,289.85,67.19,341,"Health Partners, Inc.",Commercial,218.38,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision,Benign,Lesion Trunkk/Arm/Leg; .6-1.0 Cm (Pbb)",,11401,CPT,Facility,Outpatient,,,,306,260.1,87.6996,306,"Health Partners, Inc.",Medicare Advantage,149.94,49,,percent of total billed charges,,
"Excision,Benign,Lesion Trunkk/Arm/Leg; .6-1.0 Cm (Pbb)",,11401,CPT,Professional,Outpatient,,,,341,289.85,67.19,341,"Health Partners, Inc.",Medicare Advantage,120.0715,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision,Benign,Lesion Trunkk/Arm/Leg; .6-1.0 Cm (Pbb)",,11401,CPT,Facility,Outpatient,,,,306,260.1,87.6996,306,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),183.6,60,,percent of total billed charges,,
"Excision,Benign,Lesion Trunkk/Arm/Leg; .6-1.0 Cm (Pbb)",,11401,CPT,Professional,Outpatient,,,,341,289.85,67.19,341,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),104.37,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Excision,Benign,Lesion Trunkk/Arm/Leg; .6-1.0 Cm (Pbb)",,11401,CPT,Facility,Outpatient,,,,306,260.1,87.6996,306,"Health Partners, Inc.",State of Minnesota Advantage Program,249.39,81.5,,percent of total billed charges,,
"Excision,Benign,Lesion Trunkk/Arm/Leg; .6-1.0 Cm (Pbb)",,11401,CPT,Professional,Outpatient,,,,341,289.85,67.19,341,"Health Partners, Inc.",State of Minnesota Advantage Program,188.13437,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision,Benign,Lesion Trunkk/Arm/Leg; .6-1.0 Cm (Pbb)",,11401,CPT,Facility,Outpatient,,,,306,260.1,87.6996,306,"Health Partners, Inc.",State Public Programs,153,50,,percent of total billed charges,,
"Excision,Benign,Lesion Trunkk/Arm/Leg; .6-1.0 Cm (Pbb)",,11401,CPT,Professional,Outpatient,,,,341,289.85,67.19,341,"Health Partners, Inc.",State Public Programs,67.19,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Excision,Benign,Lesion Trunkk/Arm/Leg; .6-1.0 Cm (Pbb)",,11401,CPT,Facility,Outpatient,,,,306,260.1,87.6996,306,Humana Insurance Company,Commercial PPO,290.7,95,,percent of total billed charges,,
"Excision,Benign,Lesion Trunkk/Arm/Leg; .6-1.0 Cm (Pbb)",,11401,CPT,Professional,Outpatient,,,,341,289.85,67.19,341,Humana Insurance Company,Commercial PPO,104.41,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Excision,Benign,Lesion Trunkk/Arm/Leg; .6-1.0 Cm (Pbb)",,11401,CPT,Facility,Outpatient,,,,306,260.1,87.6996,306,Humana Insurance Company,Medicare PPO,149.94,49,,percent of total billed charges,,
"Excision,Benign,Lesion Trunkk/Arm/Leg; .6-1.0 Cm (Pbb)",,11401,CPT,Professional,Outpatient,,,,341,289.85,67.19,341,Humana Insurance Company,Medicare PPO,341,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Excision,Benign,Lesion Trunkk/Arm/Leg; .6-1.0 Cm (Pbb)",,11401,CPT,Facility,Outpatient,,,,306,260.1,87.6996,306,Medica,Individual & Family,303.246,99.1,,percent of total billed charges,,
"Excision,Benign,Lesion Trunkk/Arm/Leg; .6-1.0 Cm (Pbb)",,11401,CPT,Professional,Outpatient,,,,341,289.85,67.19,341,Medica,Individual & Family,289.168,84.8,,percent of total billed charges,,
"Excision,Benign,Lesion Trunkk/Arm/Leg; .6-1.0 Cm (Pbb)",,11401,CPT,Facility,Outpatient,,,,306,260.1,87.6996,306,Medica,Medica Advantage Solution,152.388,49.8,,percent of total billed charges,,
"Excision,Benign,Lesion Trunkk/Arm/Leg; .6-1.0 Cm (Pbb)",,11401,CPT,Professional,Outpatient,,,,341,289.85,67.19,341,Medica,Medica Advantage Solution,169.818,49.8,,percent of total billed charges,,
"Excision,Benign,Lesion Trunkk/Arm/Leg; .6-1.0 Cm (Pbb)",,11401,CPT,Facility,Outpatient,,,,306,260.1,87.6996,306,Medica,Medical Assistance,136.476,44.6,,percent of total billed charges,,
"Excision,Benign,Lesion Trunkk/Arm/Leg; .6-1.0 Cm (Pbb)",,11401,CPT,Professional,Outpatient,,,,341,289.85,67.19,341,Medica,Medical Assistance,77.57,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Excision,Benign,Lesion Trunkk/Arm/Leg; .6-1.0 Cm (Pbb)",,11401,CPT,Facility,Outpatient,,,,306,260.1,87.6996,306,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,152.388,49.8,,percent of total billed charges,,
"Excision,Benign,Lesion Trunkk/Arm/Leg; .6-1.0 Cm (Pbb)",,11401,CPT,Professional,Outpatient,,,,341,289.85,67.19,341,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,104.41,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Excision,Benign,Lesion Trunkk/Arm/Leg; .6-1.0 Cm (Pbb)",,11401,CPT,Facility,Outpatient,,,,306,260.1,87.6996,306,"Multiplan, Inc.","Multiplan, Inc.",287.64,94,,percent of total billed charges,,
"Excision,Benign,Lesion Trunkk/Arm/Leg; .6-1.0 Cm (Pbb)",,11401,CPT,Professional,Outpatient,,,,341,289.85,67.19,341,"Multiplan, Inc.","Multiplan, Inc.",320.54,94,,percent of total billed charges,,
"Excision,Benign,Lesion Trunkk/Arm/Leg; .6-1.0 Cm (Pbb)",,11401,CPT,Facility,Outpatient,,,,306,260.1,87.6996,306,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,275.706,90.1,,percent of total billed charges,,
"Excision,Benign,Lesion Trunkk/Arm/Leg; .6-1.0 Cm (Pbb)",,11401,CPT,Professional,Outpatient,,,,341,289.85,67.19,341,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,307.241,90.1,,percent of total billed charges,,
"Excision,Benign,Lesion Trunkk/Arm/Leg; .6-1.0 Cm (Pbb)",,11401,CPT,Facility,Outpatient,,,,306,260.1,87.6996,306,"Preferred One Administrative Services, INC.",PPO,301.716,98.6,,percent of total billed charges,,
"Excision,Benign,Lesion Trunkk/Arm/Leg; .6-1.0 Cm (Pbb)",,11401,CPT,Professional,Outpatient,,,,341,289.85,67.19,341,"Preferred One Administrative Services, INC.",PPO,336.226,98.6,,percent of total billed charges,,
"Excision,Benign,Lesion Trunkk/Arm/Leg; .6-1.0 Cm (Pbb)",,11401,CPT,Facility,Outpatient,,,,306,260.1,87.6996,306,PrimeWest Health,Minnesota Senior Health Options (MSHO),157.437,51.45,,percent of total billed charges,,
"Excision,Benign,Lesion Trunkk/Arm/Leg; .6-1.0 Cm (Pbb)",,11401,CPT,Professional,Outpatient,,,,341,289.85,67.19,341,PrimeWest Health,Minnesota Senior Health Options (MSHO),120.0715,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision,Benign,Lesion Trunkk/Arm/Leg; .6-1.0 Cm (Pbb)",,11401,CPT,Facility,Outpatient,,,,306,260.1,87.6996,306,PrimeWest Health,MinnesotaCare,157.1616,51.36,,percent of total billed charges,,
"Excision,Benign,Lesion Trunkk/Arm/Leg; .6-1.0 Cm (Pbb)",,11401,CPT,Professional,Outpatient,,,,341,289.85,67.19,341,PrimeWest Health,MinnesotaCare,83.001612,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision,Benign,Lesion Trunkk/Arm/Leg; .6-1.0 Cm (Pbb)",,11401,CPT,Facility,Outpatient,,,,306,260.1,87.6996,306,Sanford Health Plan,Sanford Health Plan,281.52,92,,percent of total billed charges,,
"Excision,Benign,Lesion Trunkk/Arm/Leg; .6-1.0 Cm (Pbb)",,11401,CPT,Professional,Outpatient,,,,341,289.85,67.19,341,Sanford Health Plan,Sanford Health Plan,300.08,88,,percent of total billed charges,,
"Excision,Benign,Lesion Trunkk/Arm/Leg; .6-1.0 Cm (Pbb)",,11401,CPT,Facility,Outpatient,,,,306,260.1,87.6996,306,"UCare Health, Inc.",Individual & Family Plan,172.431,56.35,,percent of total billed charges,,
"Excision,Benign,Lesion Trunkk/Arm/Leg; .6-1.0 Cm (Pbb)",,11401,CPT,Professional,Outpatient,,,,341,289.85,67.19,341,"UCare Health, Inc.",Individual & Family Plan,169.728896,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Excision,Benign,Lesion Trunkk/Arm/Leg; .6-1.0 Cm (Pbb)",,11401,CPT,Facility,Outpatient,,,,306,260.1,87.6996,306,"UCare Health, Inc.",Medical Assistance,154.4382,50.47,,percent of total billed charges,,
"Excision,Benign,Lesion Trunkk/Arm/Leg; .6-1.0 Cm (Pbb)",,11401,CPT,Professional,Outpatient,,,,341,289.85,67.19,341,"UCare Health, Inc.",Medical Assistance,85.32876,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Excision,Benign,Lesion Trunkk/Arm/Leg; .6-1.0 Cm (Pbb)",,11401,CPT,Facility,Outpatient,,,,306,260.1,87.6996,306,"UCare Health, Inc.",Medicare Advantage,154.4382,50.47,,percent of total billed charges,,
"Excision,Benign,Lesion Trunkk/Arm/Leg; .6-1.0 Cm (Pbb)",,11401,CPT,Professional,Outpatient,,,,341,289.85,67.19,341,"UCare Health, Inc.",Medicare Advantage,120.0715,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Excision,Benign,Lesion Trunkk/Arm/Leg; .6-1.0 Cm (Pbb)",,11401,CPT,Facility,Outpatient,,,,306,260.1,87.6996,306,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),154.4382,50.47,,percent of total billed charges,,
"Excision,Benign,Lesion Trunkk/Arm/Leg; .6-1.0 Cm (Pbb)",,11401,CPT,Professional,Outpatient,,,,341,289.85,67.19,341,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),96.0572,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Excision,Benign,Lesion Trunkk/Arm/Leg; .6-1.0 Cm (Pbb)",,11401,CPT,Facility,Outpatient,,,,306,260.1,87.6996,306,UnitedHealthcare,Individual & Family,287.64,94,,percent of total billed charges,,
"Excision,Benign,Lesion Trunkk/Arm/Leg; .6-1.0 Cm (Pbb)",,11401,CPT,Professional,Outpatient,,,,341,289.85,67.19,341,UnitedHealthcare,Individual & Family,341,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Excision,Benign,Lesion Trunkk/Arm/Leg; .6-1.0 Cm (Pbb)",,11401,CPT,Facility,Outpatient,,,,306,260.1,87.6996,306,UnitedHealthcare,Medicare Advantage,149.94,49,,percent of total billed charges,,
"Excision,Benign,Lesion Trunkk/Arm/Leg; .6-1.0 Cm (Pbb)",,11401,CPT,Professional,Outpatient,,,,341,289.85,67.19,341,UnitedHealthcare,Medicare Advantage,120.0715,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision,Benign,Lesion Trunkk/Arm/Leg; .6-1.0 Cm (Pbb)",,11401,CPT,Facility,Outpatient,,,,306,260.1,87.6996,306,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,146.88,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Excision,Benign,Lesion Trunkk/Arm/Leg; .6-1.0 Cm (Pbb)",,11401,CPT,Professional,Outpatient,,,,341,289.85,67.19,341,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,77.5716,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision, Benign Lesion Inc Margins, Except Skintag, Trk, Arms Or Legs; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11402,CPT,Professional,Both,,,,718,610.3,73.08,718,Aetna,Commercial,610.3,85,,percent of total billed charges,,
"Excision, Benign Lesion Inc Margins, Except Skintag, Trk, Arms Or Legs; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11402,CPT,Professional,Both,,,,360,306,73.08,360,Aetna,Commercial,306,85,,percent of total billed charges,,
"Excision, Benign Lesion Inc Margins, Except Skintag, Trk, Arms Or Legs; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11402,CPT,Professional,Both,,,,718,610.3,73.08,718,Aetna,Medicare Advantage,113.73,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Benign Lesion Inc Margins, Except Skintag, Trk, Arms Or Legs; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11402,CPT,Professional,Both,,,,360,306,73.08,360,Aetna,Medicare Advantage,113.73,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Benign Lesion Inc Margins, Except Skintag, Trk, Arms Or Legs; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11402,CPT,Professional,Both,,,,718,610.3,73.08,718,Aetna,PPO,667.74,93,,percent of total billed charges,,
"Excision, Benign Lesion Inc Margins, Except Skintag, Trk, Arms Or Legs; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11402,CPT,Professional,Both,,,,360,306,73.08,360,Aetna,PPO,334.8,93,,percent of total billed charges,,
"Excision, Benign Lesion Inc Margins, Except Skintag, Trk, Arms Or Legs; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11402,CPT,Professional,Both,,,,718,610.3,73.08,718,America's PPO,America's PPO,613.4592,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Excision, Benign Lesion Inc Margins, Except Skintag, Trk, Arms Or Legs; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11402,CPT,Professional,Both,,,,360,306,73.08,360,America's PPO,America's PPO,307.584,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Excision, Benign Lesion Inc Margins, Except Skintag, Trk, Arms Or Legs; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11402,CPT,Professional,Both,,,,718,610.3,73.08,718,BlueCross BlueShield Minnesota, Federal Employee Program,237.57,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Excision, Benign Lesion Inc Margins, Except Skintag, Trk, Arms Or Legs; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11402,CPT,Professional,Both,,,,360,306,73.08,360,BlueCross BlueShield Minnesota, Federal Employee Program,237.57,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Excision, Benign Lesion Inc Margins, Except Skintag, Trk, Arms Or Legs; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11402,CPT,Professional,Both,,,,718,610.3,73.08,718,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,241.37112,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Benign Lesion Inc Margins, Except Skintag, Trk, Arms Or Legs; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11402,CPT,Professional,Both,,,,360,306,73.08,360,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,241.37112,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Benign Lesion Inc Margins, Except Skintag, Trk, Arms Or Legs; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11402,CPT,Professional,Both,,,,718,610.3,73.08,718,BlueCross BlueShield Minnesota,High Value Network Plan,241.37112,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Benign Lesion Inc Margins, Except Skintag, Trk, Arms Or Legs; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11402,CPT,Professional,Both,,,,360,306,73.08,360,BlueCross BlueShield Minnesota,High Value Network Plan,241.37112,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Benign Lesion Inc Margins, Except Skintag, Trk, Arms Or Legs; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11402,CPT,Professional,Both,,,,718,610.3,73.08,718,BlueCross BlueShield Minnesota,Medicare Advantage,130.801,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Benign Lesion Inc Margins, Except Skintag, Trk, Arms Or Legs; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11402,CPT,Professional,Both,,,,360,306,73.08,360,BlueCross BlueShield Minnesota,Medicare Advantage,130.801,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Benign Lesion Inc Margins, Except Skintag, Trk, Arms Or Legs; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11402,CPT,Professional,Both,,,,718,610.3,73.08,718,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,241.37112,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Benign Lesion Inc Margins, Except Skintag, Trk, Arms Or Legs; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11402,CPT,Professional,Both,,,,360,306,73.08,360,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,241.37112,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Benign Lesion Inc Margins, Except Skintag, Trk, Arms Or Legs; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11402,CPT,Professional,Both,,,,718,610.3,73.08,718,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,84.36864,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision, Benign Lesion Inc Margins, Except Skintag, Trk, Arms Or Legs; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11402,CPT,Professional,Both,,,,360,306,73.08,360,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,84.36864,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision, Benign Lesion Inc Margins, Except Skintag, Trk, Arms Or Legs; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11402,CPT,Professional,Both,,,,718,610.3,73.08,718,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),130.801,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Benign Lesion Inc Margins, Except Skintag, Trk, Arms Or Legs; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11402,CPT,Professional,Both,,,,360,306,73.08,360,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),130.801,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Benign Lesion Inc Margins, Except Skintag, Trk, Arms Or Legs; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11402,CPT,Professional,Both,,,,718,610.3,73.08,718,CorVel,Worker's Compensation,221.2143195,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Excision, Benign Lesion Inc Margins, Except Skintag, Trk, Arms Or Legs; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11402,CPT,Professional,Both,,,,360,306,73.08,360,CorVel,Worker's Compensation,221.2143195,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Excision, Benign Lesion Inc Margins, Except Skintag, Trk, Arms Or Legs; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11402,CPT,Professional,Both,,,,718,610.3,73.08,718,First Health Group Corporation,First Health Network,696.46,97,,percent of total billed charges,,
"Excision, Benign Lesion Inc Margins, Except Skintag, Trk, Arms Or Legs; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11402,CPT,Professional,Both,,,,360,306,73.08,360,First Health Group Corporation,First Health Network,349.2,97,,percent of total billed charges,,
"Excision, Benign Lesion Inc Margins, Except Skintag, Trk, Arms Or Legs; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11402,CPT,Professional,Both,,,,718,610.3,73.08,718,"Health Partners, Inc.",Commercial,238.7,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision, Benign Lesion Inc Margins, Except Skintag, Trk, Arms Or Legs; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11402,CPT,Professional,Both,,,,360,306,73.08,360,"Health Partners, Inc.",Commercial,238.7,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision, Benign Lesion Inc Margins, Except Skintag, Trk, Arms Or Legs; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11402,CPT,Professional,Both,,,,718,610.3,73.08,718,"Health Partners, Inc.",Medicare Advantage,130.801,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Benign Lesion Inc Margins, Except Skintag, Trk, Arms Or Legs; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11402,CPT,Professional,Both,,,,360,306,73.08,360,"Health Partners, Inc.",Medicare Advantage,130.801,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Benign Lesion Inc Margins, Except Skintag, Trk, Arms Or Legs; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11402,CPT,Professional,Both,,,,718,610.3,73.08,718,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),113.52,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Excision, Benign Lesion Inc Margins, Except Skintag, Trk, Arms Or Legs; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11402,CPT,Professional,Both,,,,360,306,73.08,360,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),113.52,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Excision, Benign Lesion Inc Margins, Except Skintag, Trk, Arms Or Legs; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11402,CPT,Professional,Both,,,,718,610.3,73.08,718,"Health Partners, Inc.",State of Minnesota Advantage Program,205.64005,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision, Benign Lesion Inc Margins, Except Skintag, Trk, Arms Or Legs; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11402,CPT,Professional,Both,,,,360,306,73.08,360,"Health Partners, Inc.",State of Minnesota Advantage Program,205.64005,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision, Benign Lesion Inc Margins, Except Skintag, Trk, Arms Or Legs; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11402,CPT,Professional,Both,,,,718,610.3,73.08,718,"Health Partners, Inc.",State Public Programs,73.08,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Excision, Benign Lesion Inc Margins, Except Skintag, Trk, Arms Or Legs; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11402,CPT,Professional,Both,,,,360,306,73.08,360,"Health Partners, Inc.",State Public Programs,73.08,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Excision, Benign Lesion Inc Margins, Except Skintag, Trk, Arms Or Legs; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11402,CPT,Professional,Both,,,,718,610.3,73.08,718,Humana Insurance Company,Commercial PPO,113.74,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Excision, Benign Lesion Inc Margins, Except Skintag, Trk, Arms Or Legs; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11402,CPT,Professional,Both,,,,360,306,73.08,360,Humana Insurance Company,Commercial PPO,113.74,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Excision, Benign Lesion Inc Margins, Except Skintag, Trk, Arms Or Legs; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11402,CPT,Professional,Both,,,,718,610.3,73.08,718,Humana Insurance Company,Medicare PPO,718,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Excision, Benign Lesion Inc Margins, Except Skintag, Trk, Arms Or Legs; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11402,CPT,Professional,Both,,,,360,306,73.08,360,Humana Insurance Company,Medicare PPO,360,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Excision, Benign Lesion Inc Margins, Except Skintag, Trk, Arms Or Legs; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11402,CPT,Professional,Both,,,,718,610.3,73.08,718,Medica,Individual & Family,608.864,84.8,,percent of total billed charges,,
"Excision, Benign Lesion Inc Margins, Except Skintag, Trk, Arms Or Legs; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11402,CPT,Professional,Both,,,,360,306,73.08,360,Medica,Individual & Family,305.28,84.8,,percent of total billed charges,,
"Excision, Benign Lesion Inc Margins, Except Skintag, Trk, Arms Or Legs; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11402,CPT,Professional,Both,,,,718,610.3,73.08,718,Medica,Medica Advantage Solution,357.564,49.8,,percent of total billed charges,,
"Excision, Benign Lesion Inc Margins, Except Skintag, Trk, Arms Or Legs; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11402,CPT,Professional,Both,,,,360,306,73.08,360,Medica,Medica Advantage Solution,179.28,49.8,,percent of total billed charges,,
"Excision, Benign Lesion Inc Margins, Except Skintag, Trk, Arms Or Legs; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11402,CPT,Professional,Both,,,,718,610.3,73.08,718,Medica,Medical Assistance,84.37,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Excision, Benign Lesion Inc Margins, Except Skintag, Trk, Arms Or Legs; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11402,CPT,Professional,Both,,,,360,306,73.08,360,Medica,Medical Assistance,84.37,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Excision, Benign Lesion Inc Margins, Except Skintag, Trk, Arms Or Legs; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11402,CPT,Professional,Both,,,,718,610.3,73.08,718,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,113.74,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Excision, Benign Lesion Inc Margins, Except Skintag, Trk, Arms Or Legs; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11402,CPT,Professional,Both,,,,360,306,73.08,360,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,113.74,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Excision, Benign Lesion Inc Margins, Except Skintag, Trk, Arms Or Legs; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11402,CPT,Professional,Both,,,,718,610.3,73.08,718,"Multiplan, Inc.","Multiplan, Inc.",674.92,94,,percent of total billed charges,,
"Excision, Benign Lesion Inc Margins, Except Skintag, Trk, Arms Or Legs; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11402,CPT,Professional,Both,,,,360,306,73.08,360,"Multiplan, Inc.","Multiplan, Inc.",338.4,94,,percent of total billed charges,,
"Excision, Benign Lesion Inc Margins, Except Skintag, Trk, Arms Or Legs; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11402,CPT,Professional,Both,,,,718,610.3,73.08,718,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,646.918,90.1,,percent of total billed charges,,
"Excision, Benign Lesion Inc Margins, Except Skintag, Trk, Arms Or Legs; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11402,CPT,Professional,Both,,,,360,306,73.08,360,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,324.36,90.1,,percent of total billed charges,,
"Excision, Benign Lesion Inc Margins, Except Skintag, Trk, Arms Or Legs; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11402,CPT,Professional,Both,,,,718,610.3,73.08,718,"Preferred One Administrative Services, INC.",PPO,707.948,98.6,,percent of total billed charges,,
"Excision, Benign Lesion Inc Margins, Except Skintag, Trk, Arms Or Legs; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11402,CPT,Professional,Both,,,,360,306,73.08,360,"Preferred One Administrative Services, INC.",PPO,354.96,98.6,,percent of total billed charges,,
"Excision, Benign Lesion Inc Margins, Except Skintag, Trk, Arms Or Legs; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11402,CPT,Professional,Both,,,,718,610.3,73.08,718,PrimeWest Health,Minnesota Senior Health Options (MSHO),130.801,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Benign Lesion Inc Margins, Except Skintag, Trk, Arms Or Legs; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11402,CPT,Professional,Both,,,,360,306,73.08,360,PrimeWest Health,Minnesota Senior Health Options (MSHO),130.801,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Benign Lesion Inc Margins, Except Skintag, Trk, Arms Or Legs; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11402,CPT,Professional,Both,,,,718,610.3,73.08,718,PrimeWest Health,MinnesotaCare,90.2744448,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision, Benign Lesion Inc Margins, Except Skintag, Trk, Arms Or Legs; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11402,CPT,Professional,Both,,,,360,306,73.08,360,PrimeWest Health,MinnesotaCare,90.2744448,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision, Benign Lesion Inc Margins, Except Skintag, Trk, Arms Or Legs; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11402,CPT,Professional,Both,,,,718,610.3,73.08,718,Sanford Health Plan,Sanford Health Plan,631.84,88,,percent of total billed charges,,
"Excision, Benign Lesion Inc Margins, Except Skintag, Trk, Arms Or Legs; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11402,CPT,Professional,Both,,,,360,306,73.08,360,Sanford Health Plan,Sanford Health Plan,316.8,88,,percent of total billed charges,,
"Excision, Benign Lesion Inc Margins, Except Skintag, Trk, Arms Or Legs; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11402,CPT,Professional,Both,,,,718,610.3,73.08,718,"UCare Health, Inc.",Individual & Family Plan,184.895744,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Excision, Benign Lesion Inc Margins, Except Skintag, Trk, Arms Or Legs; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11402,CPT,Professional,Both,,,,360,306,73.08,360,"UCare Health, Inc.",Individual & Family Plan,184.895744,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Excision, Benign Lesion Inc Margins, Except Skintag, Trk, Arms Or Legs; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11402,CPT,Professional,Both,,,,718,610.3,73.08,718,"UCare Health, Inc.",Medical Assistance,92.805504,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Excision, Benign Lesion Inc Margins, Except Skintag, Trk, Arms Or Legs; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11402,CPT,Professional,Both,,,,360,306,73.08,360,"UCare Health, Inc.",Medical Assistance,92.805504,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Excision, Benign Lesion Inc Margins, Except Skintag, Trk, Arms Or Legs; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11402,CPT,Professional,Both,,,,718,610.3,73.08,718,"UCare Health, Inc.",Medicare Advantage,130.801,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Excision, Benign Lesion Inc Margins, Except Skintag, Trk, Arms Or Legs; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11402,CPT,Professional,Both,,,,360,306,73.08,360,"UCare Health, Inc.",Medicare Advantage,130.801,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Excision, Benign Lesion Inc Margins, Except Skintag, Trk, Arms Or Legs; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11402,CPT,Professional,Both,,,,718,610.3,73.08,718,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),104.6408,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Excision, Benign Lesion Inc Margins, Except Skintag, Trk, Arms Or Legs; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11402,CPT,Professional,Both,,,,360,306,73.08,360,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),104.6408,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Excision, Benign Lesion Inc Margins, Except Skintag, Trk, Arms Or Legs; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11402,CPT,Professional,Both,,,,718,610.3,73.08,718,UnitedHealthcare,Individual & Family,718,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Excision, Benign Lesion Inc Margins, Except Skintag, Trk, Arms Or Legs; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11402,CPT,Professional,Both,,,,360,306,73.08,360,UnitedHealthcare,Individual & Family,360,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Excision, Benign Lesion Inc Margins, Except Skintag, Trk, Arms Or Legs; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11402,CPT,Professional,Both,,,,718,610.3,73.08,718,UnitedHealthcare,Medicare Advantage,130.801,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Benign Lesion Inc Margins, Except Skintag, Trk, Arms Or Legs; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11402,CPT,Professional,Both,,,,360,306,73.08,360,UnitedHealthcare,Medicare Advantage,130.801,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Benign Lesion Inc Margins, Except Skintag, Trk, Arms Or Legs; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11402,CPT,Professional,Both,,,,718,610.3,73.08,718,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,84.36864,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision, Benign Lesion Inc Margins, Except Skintag, Trk, Arms Or Legs; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11402,CPT,Professional,Both,,,,360,306,73.08,360,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,84.36864,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision, Benign Lesion Incl Margins, Except Skin Tag, Trunk, Arms, Legs; Excised Dia 1.1 To 2.0 Cm",,11402,CPT,Facility,Both,,,,210,178.5,60.186,449,Aetna,Commercial,193.2,92,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margins, Except Skin Tag, Trunk, Arms, Legs; Excised Dia 1.1 To 2.0 Cm",,11402,CPT,Facility,Outpatient,,,,210,178.5,60.186,449,Aetna,Medicare Advantage,102.9,49,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margins, Except Skin Tag, Trunk, Arms, Legs; Excised Dia 1.1 To 2.0 Cm",,11402,CPT,Facility,Inpatient,,,,210,178.5,60.186,449,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Excision, Benign Lesion Incl Margins, Except Skin Tag, Trunk, Arms, Legs; Excised Dia 1.1 To 2.0 Cm",,11402,CPT,Facility,Both,,,,210,178.5,60.186,449,Aetna,PPO,195.3,93,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margins, Except Skin Tag, Trunk, Arms, Legs; Excised Dia 1.1 To 2.0 Cm",,11402,CPT,Facility,Both,,,,210,178.5,60.186,449,America's PPO,America's PPO,201.663,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Excision, Benign Lesion Incl Margins, Except Skin Tag, Trunk, Arms, Legs; Excised Dia 1.1 To 2.0 Cm",,11402,CPT,Facility,Both,,,,210,178.5,60.186,449,BlueCross BlueShield Minnesota, Federal Employee Program,206.64,98.4,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margins, Except Skin Tag, Trunk, Arms, Legs; Excised Dia 1.1 To 2.0 Cm",,11402,CPT,Facility,Both,,,,210,178.5,60.186,449,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,210,100,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margins, Except Skin Tag, Trunk, Arms, Legs; Excised Dia 1.1 To 2.0 Cm",,11402,CPT,Facility,Both,,,,210,178.5,60.186,449,BlueCross BlueShield Minnesota,High Value Network Plan,189,90,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margins, Except Skin Tag, Trunk, Arms, Legs; Excised Dia 1.1 To 2.0 Cm",,11402,CPT,Facility,Outpatient,,,,210,178.5,60.186,449,BlueCross BlueShield Minnesota,Medicare Advantage,102.9,49,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margins, Except Skin Tag, Trunk, Arms, Legs; Excised Dia 1.1 To 2.0 Cm",,11402,CPT,Facility,Inpatient,,,,210,178.5,60.186,449,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Excision, Benign Lesion Incl Margins, Except Skin Tag, Trunk, Arms, Legs; Excised Dia 1.1 To 2.0 Cm",,11402,CPT,Facility,Both,,,,210,178.5,60.186,449,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,185.997,88.57,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margins, Except Skin Tag, Trunk, Arms, Legs; Excised Dia 1.1 To 2.0 Cm",,11402,CPT,Facility,Both,,,,210,178.5,60.186,449,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,60.186,28.66,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margins, Except Skin Tag, Trunk, Arms, Legs; Excised Dia 1.1 To 2.0 Cm",,11402,CPT,Facility,Outpatient,,,,210,178.5,60.186,449,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),102.9,49,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margins, Except Skin Tag, Trunk, Arms, Legs; Excised Dia 1.1 To 2.0 Cm",,11402,CPT,Facility,Inpatient,,,,210,178.5,60.186,449,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Excision, Benign Lesion Incl Margins, Except Skin Tag, Trunk, Arms, Legs; Excised Dia 1.1 To 2.0 Cm",,11402,CPT,Facility,Both,,,,210,178.5,60.186,449,CorVel,Worker's Compensation,210,100,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margins, Except Skin Tag, Trunk, Arms, Legs; Excised Dia 1.1 To 2.0 Cm",,11402,CPT,Facility,Both,,,,210,178.5,60.186,449,First Health Group Corporation,First Health Network,203.7,97,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margins, Except Skin Tag, Trunk, Arms, Legs; Excised Dia 1.1 To 2.0 Cm",,11402,CPT,Facility,Both,,,,210,178.5,60.186,449,"Health Partners, Inc.",Commercial,198.66,94.6,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margins, Except Skin Tag, Trunk, Arms, Legs; Excised Dia 1.1 To 2.0 Cm",,11402,CPT,Facility,Outpatient,,,,210,178.5,60.186,449,"Health Partners, Inc.",Medicare Advantage,102.9,49,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margins, Except Skin Tag, Trunk, Arms, Legs; Excised Dia 1.1 To 2.0 Cm",,11402,CPT,Facility,Inpatient,,,,210,178.5,60.186,449,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Excision, Benign Lesion Incl Margins, Except Skin Tag, Trunk, Arms, Legs; Excised Dia 1.1 To 2.0 Cm",,11402,CPT,Facility,Both,,,,210,178.5,60.186,449,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),126,60,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margins, Except Skin Tag, Trunk, Arms, Legs; Excised Dia 1.1 To 2.0 Cm",,11402,CPT,Facility,Both,,,,210,178.5,60.186,449,"Health Partners, Inc.",State of Minnesota Advantage Program,171.15,81.5,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margins, Except Skin Tag, Trunk, Arms, Legs; Excised Dia 1.1 To 2.0 Cm",,11402,CPT,Facility,Both,,,,210,178.5,60.186,449,"Health Partners, Inc.",State Public Programs,105,50,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margins, Except Skin Tag, Trunk, Arms, Legs; Excised Dia 1.1 To 2.0 Cm",,11402,CPT,Facility,Both,,,,210,178.5,60.186,449,Humana Insurance Company,Commercial PPO,199.5,95,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margins, Except Skin Tag, Trunk, Arms, Legs; Excised Dia 1.1 To 2.0 Cm",,11402,CPT,Facility,Outpatient,,,,210,178.5,60.186,449,Humana Insurance Company,Medicare PPO,102.9,49,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margins, Except Skin Tag, Trunk, Arms, Legs; Excised Dia 1.1 To 2.0 Cm",,11402,CPT,Facility,Inpatient,,,,210,178.5,60.186,449,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Excision, Benign Lesion Incl Margins, Except Skin Tag, Trunk, Arms, Legs; Excised Dia 1.1 To 2.0 Cm",,11402,CPT,Facility,Both,,,,210,178.5,60.186,449,Medica,Individual & Family,208.11,99.1,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margins, Except Skin Tag, Trunk, Arms, Legs; Excised Dia 1.1 To 2.0 Cm",,11402,CPT,Facility,Outpatient,,,,210,178.5,60.186,449,Medica,Medica Advantage Solution,104.58,49.8,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margins, Except Skin Tag, Trunk, Arms, Legs; Excised Dia 1.1 To 2.0 Cm",,11402,CPT,Facility,Inpatient,,,,210,178.5,60.186,449,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Excision, Benign Lesion Incl Margins, Except Skin Tag, Trunk, Arms, Legs; Excised Dia 1.1 To 2.0 Cm",,11402,CPT,Facility,Outpatient,,,,210,178.5,60.186,449,Medica,Medical Assistance,449,,,Other,Grouper,All inclusive per visit
"Excision, Benign Lesion Incl Margins, Except Skin Tag, Trunk, Arms, Legs; Excised Dia 1.1 To 2.0 Cm",,11402,CPT,Facility,Inpatient,,,,210,178.5,60.186,449,Medica,Medical Assistance,,,,,Included in per diem rate,
"Excision, Benign Lesion Incl Margins, Except Skin Tag, Trunk, Arms, Legs; Excised Dia 1.1 To 2.0 Cm",,11402,CPT,Facility,Outpatient,,,,210,178.5,60.186,449,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,104.58,49.8,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margins, Except Skin Tag, Trunk, Arms, Legs; Excised Dia 1.1 To 2.0 Cm",,11402,CPT,Facility,Inpatient,,,,210,178.5,60.186,449,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Excision, Benign Lesion Incl Margins, Except Skin Tag, Trunk, Arms, Legs; Excised Dia 1.1 To 2.0 Cm",,11402,CPT,Facility,Both,,,,210,178.5,60.186,449,"Multiplan, Inc.","Multiplan, Inc.",197.4,94,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margins, Except Skin Tag, Trunk, Arms, Legs; Excised Dia 1.1 To 2.0 Cm",,11402,CPT,Facility,Outpatient,,,,210,178.5,60.186,449,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,189.21,90.1,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margins, Except Skin Tag, Trunk, Arms, Legs; Excised Dia 1.1 To 2.0 Cm",,11402,CPT,Facility,Inpatient,,,,210,178.5,60.186,449,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Excision, Benign Lesion Incl Margins, Except Skin Tag, Trunk, Arms, Legs; Excised Dia 1.1 To 2.0 Cm",,11402,CPT,Facility,Both,,,,210,178.5,60.186,449,"Preferred One Administrative Services, INC.",PPO,207.06,98.6,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margins, Except Skin Tag, Trunk, Arms, Legs; Excised Dia 1.1 To 2.0 Cm",,11402,CPT,Facility,Outpatient,,,,210,178.5,60.186,449,PrimeWest Health,Minnesota Senior Health Options (MSHO),108.045,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Excision, Benign Lesion Incl Margins, Except Skin Tag, Trunk, Arms, Legs; Excised Dia 1.1 To 2.0 Cm",,11402,CPT,Facility,Inpatient,,,,210,178.5,60.186,449,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Excision, Benign Lesion Incl Margins, Except Skin Tag, Trunk, Arms, Legs; Excised Dia 1.1 To 2.0 Cm",,11402,CPT,Facility,Outpatient,,,,210,178.5,60.186,449,PrimeWest Health,MinnesotaCare,107.856,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Excision, Benign Lesion Incl Margins, Except Skin Tag, Trunk, Arms, Legs; Excised Dia 1.1 To 2.0 Cm",,11402,CPT,Facility,Inpatient,,,,210,178.5,60.186,449,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Excision, Benign Lesion Incl Margins, Except Skin Tag, Trunk, Arms, Legs; Excised Dia 1.1 To 2.0 Cm",,11402,CPT,Facility,Both,,,,210,178.5,60.186,449,Sanford Health Plan,Sanford Health Plan,193.2,92,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margins, Except Skin Tag, Trunk, Arms, Legs; Excised Dia 1.1 To 2.0 Cm",,11402,CPT,Facility,Outpatient,,,,210,178.5,60.186,449,"UCare Health, Inc.",Individual & Family Plan,118.335,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Excision, Benign Lesion Incl Margins, Except Skin Tag, Trunk, Arms, Legs; Excised Dia 1.1 To 2.0 Cm",,11402,CPT,Facility,Inpatient,,,,210,178.5,60.186,449,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Excision, Benign Lesion Incl Margins, Except Skin Tag, Trunk, Arms, Legs; Excised Dia 1.1 To 2.0 Cm",,11402,CPT,Facility,Outpatient,,,,210,178.5,60.186,449,"UCare Health, Inc.",Medical Assistance,105.987,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Excision, Benign Lesion Incl Margins, Except Skin Tag, Trunk, Arms, Legs; Excised Dia 1.1 To 2.0 Cm",,11402,CPT,Facility,Inpatient,,,,210,178.5,60.186,449,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Excision, Benign Lesion Incl Margins, Except Skin Tag, Trunk, Arms, Legs; Excised Dia 1.1 To 2.0 Cm",,11402,CPT,Facility,Outpatient,,,,210,178.5,60.186,449,"UCare Health, Inc.",Medicare Advantage,105.987,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Excision, Benign Lesion Incl Margins, Except Skin Tag, Trunk, Arms, Legs; Excised Dia 1.1 To 2.0 Cm",,11402,CPT,Facility,Inpatient,,,,210,178.5,60.186,449,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Excision, Benign Lesion Incl Margins, Except Skin Tag, Trunk, Arms, Legs; Excised Dia 1.1 To 2.0 Cm",,11402,CPT,Facility,Outpatient,,,,210,178.5,60.186,449,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),105.987,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Excision, Benign Lesion Incl Margins, Except Skin Tag, Trunk, Arms, Legs; Excised Dia 1.1 To 2.0 Cm",,11402,CPT,Facility,Inpatient,,,,210,178.5,60.186,449,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Excision, Benign Lesion Incl Margins, Except Skin Tag, Trunk, Arms, Legs; Excised Dia 1.1 To 2.0 Cm",,11402,CPT,Facility,Both,,,,210,178.5,60.186,449,UnitedHealthcare,Individual & Family,197.4,94,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margins, Except Skin Tag, Trunk, Arms, Legs; Excised Dia 1.1 To 2.0 Cm",,11402,CPT,Facility,Outpatient,,,,210,178.5,60.186,449,UnitedHealthcare,Medicare Advantage,102.9,49,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margins, Except Skin Tag, Trunk, Arms, Legs; Excised Dia 1.1 To 2.0 Cm",,11402,CPT,Facility,Inpatient,,,,210,178.5,60.186,449,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Excision, Benign Lesion Incl Margins, Except Skin Tag, Trunk, Arms, Legs; Excised Dia 1.1 To 2.0 Cm",,11402,CPT,Facility,Outpatient,,,,210,178.5,60.186,449,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,100.8,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Excision, Benign Lesion Incl Margins, Except Skin Tag, Trunk, Arms, Legs; Excised Dia 1.1 To 2.0 Cm",,11402,CPT,Facility,Inpatient,,,,210,178.5,60.186,449,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Excision,Benign,Lesion Trunk/Arm/Leg; 1.1-2.0 Cm (Pbb)",,11402,CPT,Facility,Outpatient,,,,357,303.45,102.3162,357,Aetna,Commercial,328.44,92,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; 1.1-2.0 Cm (Pbb)",,11402,CPT,Professional,Outpatient,,,,361,306.85,73.08,361,Aetna,Commercial,306.85,85,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; 1.1-2.0 Cm (Pbb)",,11402,CPT,Facility,Outpatient,,,,357,303.45,102.3162,357,Aetna,Medicare Advantage,174.93,49,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; 1.1-2.0 Cm (Pbb)",,11402,CPT,Professional,Outpatient,,,,361,306.85,73.08,361,Aetna,Medicare Advantage,113.73,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision,Benign,Lesion Trunk/Arm/Leg; 1.1-2.0 Cm (Pbb)",,11402,CPT,Facility,Outpatient,,,,357,303.45,102.3162,357,Aetna,PPO,332.01,93,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; 1.1-2.0 Cm (Pbb)",,11402,CPT,Professional,Outpatient,,,,361,306.85,73.08,361,Aetna,PPO,335.73,93,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; 1.1-2.0 Cm (Pbb)",,11402,CPT,Facility,Outpatient,,,,357,303.45,102.3162,357,America's PPO,America's PPO,342.8271,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Excision,Benign,Lesion Trunk/Arm/Leg; 1.1-2.0 Cm (Pbb)",,11402,CPT,Professional,Outpatient,,,,361,306.85,73.08,361,America's PPO,America's PPO,308.4384,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Excision,Benign,Lesion Trunk/Arm/Leg; 1.1-2.0 Cm (Pbb)",,11402,CPT,Facility,Outpatient,,,,357,303.45,102.3162,357,BlueCross BlueShield Minnesota, Federal Employee Program,351.288,98.4,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; 1.1-2.0 Cm (Pbb)",,11402,CPT,Professional,Outpatient,,,,361,306.85,73.08,361,BlueCross BlueShield Minnesota, Federal Employee Program,237.57,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Excision,Benign,Lesion Trunk/Arm/Leg; 1.1-2.0 Cm (Pbb)",,11402,CPT,Facility,Outpatient,,,,357,303.45,102.3162,357,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,357,100,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; 1.1-2.0 Cm (Pbb)",,11402,CPT,Professional,Outpatient,,,,361,306.85,73.08,361,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,241.37112,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision,Benign,Lesion Trunk/Arm/Leg; 1.1-2.0 Cm (Pbb)",,11402,CPT,Facility,Outpatient,,,,357,303.45,102.3162,357,BlueCross BlueShield Minnesota,High Value Network Plan,321.3,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
"Excision,Benign,Lesion Trunk/Arm/Leg; 1.1-2.0 Cm (Pbb)",,11402,CPT,Professional,Outpatient,,,,361,306.85,73.08,361,BlueCross BlueShield Minnesota,High Value Network Plan,241.37112,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision,Benign,Lesion Trunk/Arm/Leg; 1.1-2.0 Cm (Pbb)",,11402,CPT,Facility,Outpatient,,,,357,303.45,102.3162,357,BlueCross BlueShield Minnesota,Medicare Advantage,174.93,49,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; 1.1-2.0 Cm (Pbb)",,11402,CPT,Professional,Outpatient,,,,361,306.85,73.08,361,BlueCross BlueShield Minnesota,Medicare Advantage,130.801,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision,Benign,Lesion Trunk/Arm/Leg; 1.1-2.0 Cm (Pbb)",,11402,CPT,Professional,Outpatient,,,,361,306.85,73.08,361,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,241.37112,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision,Benign,Lesion Trunk/Arm/Leg; 1.1-2.0 Cm (Pbb)",,11402,CPT,Facility,Outpatient,,,,357,303.45,102.3162,357,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,102.3162,28.66,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; 1.1-2.0 Cm (Pbb)",,11402,CPT,Professional,Outpatient,,,,361,306.85,73.08,361,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,84.36864,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision,Benign,Lesion Trunk/Arm/Leg; 1.1-2.0 Cm (Pbb)",,11402,CPT,Facility,Outpatient,,,,357,303.45,102.3162,357,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),174.93,49,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; 1.1-2.0 Cm (Pbb)",,11402,CPT,Professional,Outpatient,,,,361,306.85,73.08,361,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),130.801,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision,Benign,Lesion Trunk/Arm/Leg; 1.1-2.0 Cm (Pbb)",,11402,CPT,Facility,Outpatient,,,,357,303.45,102.3162,357,CorVel,Worker's Compensation,357,100,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; 1.1-2.0 Cm (Pbb)",,11402,CPT,Professional,Outpatient,,,,361,306.85,73.08,361,CorVel,Worker's Compensation,221.2143195,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Excision,Benign,Lesion Trunk/Arm/Leg; 1.1-2.0 Cm (Pbb)",,11402,CPT,Facility,Outpatient,,,,357,303.45,102.3162,357,First Health Group Corporation,First Health Network,346.29,97,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; 1.1-2.0 Cm (Pbb)",,11402,CPT,Professional,Outpatient,,,,361,306.85,73.08,361,First Health Group Corporation,First Health Network,350.17,97,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; 1.1-2.0 Cm (Pbb)",,11402,CPT,Facility,Outpatient,,,,357,303.45,102.3162,357,"Health Partners, Inc.",Commercial,337.722,94.6,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; 1.1-2.0 Cm (Pbb)",,11402,CPT,Professional,Outpatient,,,,361,306.85,73.08,361,"Health Partners, Inc.",Commercial,238.7,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision,Benign,Lesion Trunk/Arm/Leg; 1.1-2.0 Cm (Pbb)",,11402,CPT,Facility,Outpatient,,,,357,303.45,102.3162,357,"Health Partners, Inc.",Medicare Advantage,174.93,49,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; 1.1-2.0 Cm (Pbb)",,11402,CPT,Professional,Outpatient,,,,361,306.85,73.08,361,"Health Partners, Inc.",Medicare Advantage,130.801,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision,Benign,Lesion Trunk/Arm/Leg; 1.1-2.0 Cm (Pbb)",,11402,CPT,Facility,Outpatient,,,,357,303.45,102.3162,357,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),214.2,60,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; 1.1-2.0 Cm (Pbb)",,11402,CPT,Professional,Outpatient,,,,361,306.85,73.08,361,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),113.52,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Excision,Benign,Lesion Trunk/Arm/Leg; 1.1-2.0 Cm (Pbb)",,11402,CPT,Facility,Outpatient,,,,357,303.45,102.3162,357,"Health Partners, Inc.",State of Minnesota Advantage Program,290.955,81.5,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; 1.1-2.0 Cm (Pbb)",,11402,CPT,Professional,Outpatient,,,,361,306.85,73.08,361,"Health Partners, Inc.",State of Minnesota Advantage Program,205.64005,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision,Benign,Lesion Trunk/Arm/Leg; 1.1-2.0 Cm (Pbb)",,11402,CPT,Facility,Outpatient,,,,357,303.45,102.3162,357,"Health Partners, Inc.",State Public Programs,178.5,50,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; 1.1-2.0 Cm (Pbb)",,11402,CPT,Professional,Outpatient,,,,361,306.85,73.08,361,"Health Partners, Inc.",State Public Programs,73.08,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Excision,Benign,Lesion Trunk/Arm/Leg; 1.1-2.0 Cm (Pbb)",,11402,CPT,Facility,Outpatient,,,,357,303.45,102.3162,357,Humana Insurance Company,Commercial PPO,339.15,95,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; 1.1-2.0 Cm (Pbb)",,11402,CPT,Professional,Outpatient,,,,361,306.85,73.08,361,Humana Insurance Company,Commercial PPO,113.74,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Excision,Benign,Lesion Trunk/Arm/Leg; 1.1-2.0 Cm (Pbb)",,11402,CPT,Facility,Outpatient,,,,357,303.45,102.3162,357,Humana Insurance Company,Medicare PPO,174.93,49,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; 1.1-2.0 Cm (Pbb)",,11402,CPT,Professional,Outpatient,,,,361,306.85,73.08,361,Humana Insurance Company,Medicare PPO,361,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Excision,Benign,Lesion Trunk/Arm/Leg; 1.1-2.0 Cm (Pbb)",,11402,CPT,Facility,Outpatient,,,,357,303.45,102.3162,357,Medica,Individual & Family,353.787,99.1,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; 1.1-2.0 Cm (Pbb)",,11402,CPT,Professional,Outpatient,,,,361,306.85,73.08,361,Medica,Individual & Family,306.128,84.8,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; 1.1-2.0 Cm (Pbb)",,11402,CPT,Facility,Outpatient,,,,357,303.45,102.3162,357,Medica,Medica Advantage Solution,177.786,49.8,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; 1.1-2.0 Cm (Pbb)",,11402,CPT,Professional,Outpatient,,,,361,306.85,73.08,361,Medica,Medica Advantage Solution,179.778,49.8,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; 1.1-2.0 Cm (Pbb)",,11402,CPT,Facility,Outpatient,,,,357,303.45,102.3162,357,Medica,Medical Assistance,159.222,44.6,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; 1.1-2.0 Cm (Pbb)",,11402,CPT,Professional,Outpatient,,,,361,306.85,73.08,361,Medica,Medical Assistance,84.37,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Excision,Benign,Lesion Trunk/Arm/Leg; 1.1-2.0 Cm (Pbb)",,11402,CPT,Facility,Outpatient,,,,357,303.45,102.3162,357,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,177.786,49.8,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; 1.1-2.0 Cm (Pbb)",,11402,CPT,Professional,Outpatient,,,,361,306.85,73.08,361,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,113.74,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Excision,Benign,Lesion Trunk/Arm/Leg; 1.1-2.0 Cm (Pbb)",,11402,CPT,Facility,Outpatient,,,,357,303.45,102.3162,357,"Multiplan, Inc.","Multiplan, Inc.",335.58,94,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; 1.1-2.0 Cm (Pbb)",,11402,CPT,Professional,Outpatient,,,,361,306.85,73.08,361,"Multiplan, Inc.","Multiplan, Inc.",339.34,94,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; 1.1-2.0 Cm (Pbb)",,11402,CPT,Facility,Outpatient,,,,357,303.45,102.3162,357,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,321.657,90.1,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; 1.1-2.0 Cm (Pbb)",,11402,CPT,Professional,Outpatient,,,,361,306.85,73.08,361,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,325.261,90.1,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; 1.1-2.0 Cm (Pbb)",,11402,CPT,Facility,Outpatient,,,,357,303.45,102.3162,357,"Preferred One Administrative Services, INC.",PPO,352.002,98.6,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; 1.1-2.0 Cm (Pbb)",,11402,CPT,Professional,Outpatient,,,,361,306.85,73.08,361,"Preferred One Administrative Services, INC.",PPO,355.946,98.6,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; 1.1-2.0 Cm (Pbb)",,11402,CPT,Facility,Outpatient,,,,357,303.45,102.3162,357,PrimeWest Health,Minnesota Senior Health Options (MSHO),183.6765,51.45,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; 1.1-2.0 Cm (Pbb)",,11402,CPT,Professional,Outpatient,,,,361,306.85,73.08,361,PrimeWest Health,Minnesota Senior Health Options (MSHO),130.801,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision,Benign,Lesion Trunk/Arm/Leg; 1.1-2.0 Cm (Pbb)",,11402,CPT,Facility,Outpatient,,,,357,303.45,102.3162,357,PrimeWest Health,MinnesotaCare,183.3552,51.36,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; 1.1-2.0 Cm (Pbb)",,11402,CPT,Professional,Outpatient,,,,361,306.85,73.08,361,PrimeWest Health,MinnesotaCare,90.2744448,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision,Benign,Lesion Trunk/Arm/Leg; 1.1-2.0 Cm (Pbb)",,11402,CPT,Facility,Outpatient,,,,357,303.45,102.3162,357,Sanford Health Plan,Sanford Health Plan,328.44,92,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; 1.1-2.0 Cm (Pbb)",,11402,CPT,Professional,Outpatient,,,,361,306.85,73.08,361,Sanford Health Plan,Sanford Health Plan,317.68,88,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; 1.1-2.0 Cm (Pbb)",,11402,CPT,Facility,Outpatient,,,,357,303.45,102.3162,357,"UCare Health, Inc.",Individual & Family Plan,201.1695,56.35,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; 1.1-2.0 Cm (Pbb)",,11402,CPT,Professional,Outpatient,,,,361,306.85,73.08,361,"UCare Health, Inc.",Individual & Family Plan,184.895744,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Excision,Benign,Lesion Trunk/Arm/Leg; 1.1-2.0 Cm (Pbb)",,11402,CPT,Facility,Outpatient,,,,357,303.45,102.3162,357,"UCare Health, Inc.",Medical Assistance,180.1779,50.47,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; 1.1-2.0 Cm (Pbb)",,11402,CPT,Professional,Outpatient,,,,361,306.85,73.08,361,"UCare Health, Inc.",Medical Assistance,92.805504,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Excision,Benign,Lesion Trunk/Arm/Leg; 1.1-2.0 Cm (Pbb)",,11402,CPT,Facility,Outpatient,,,,357,303.45,102.3162,357,"UCare Health, Inc.",Medicare Advantage,180.1779,50.47,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; 1.1-2.0 Cm (Pbb)",,11402,CPT,Professional,Outpatient,,,,361,306.85,73.08,361,"UCare Health, Inc.",Medicare Advantage,130.801,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Excision,Benign,Lesion Trunk/Arm/Leg; 1.1-2.0 Cm (Pbb)",,11402,CPT,Facility,Outpatient,,,,357,303.45,102.3162,357,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),180.1779,50.47,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; 1.1-2.0 Cm (Pbb)",,11402,CPT,Professional,Outpatient,,,,361,306.85,73.08,361,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),104.6408,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Excision,Benign,Lesion Trunk/Arm/Leg; 1.1-2.0 Cm (Pbb)",,11402,CPT,Facility,Outpatient,,,,357,303.45,102.3162,357,UnitedHealthcare,Individual & Family,335.58,94,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; 1.1-2.0 Cm (Pbb)",,11402,CPT,Professional,Outpatient,,,,361,306.85,73.08,361,UnitedHealthcare,Individual & Family,361,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Excision,Benign,Lesion Trunk/Arm/Leg; 1.1-2.0 Cm (Pbb)",,11402,CPT,Facility,Outpatient,,,,357,303.45,102.3162,357,UnitedHealthcare,Medicare Advantage,174.93,49,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; 1.1-2.0 Cm (Pbb)",,11402,CPT,Professional,Outpatient,,,,361,306.85,73.08,361,UnitedHealthcare,Medicare Advantage,130.801,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision,Benign,Lesion Trunk/Arm/Leg; 1.1-2.0 Cm (Pbb)",,11402,CPT,Facility,Outpatient,,,,357,303.45,102.3162,357,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,171.36,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Excision,Benign,Lesion Trunk/Arm/Leg; 1.1-2.0 Cm (Pbb)",,11402,CPT,Professional,Outpatient,,,,361,306.85,73.08,361,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,84.36864,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision, Benign Lesion Inc Margins, Except Skin Tag,Trunk,Arms Or Legs;Exc Dia 2.1-3.0 Cm",,11403,CPT,Facility,Both,,,,275,233.75,78.815,275,Aetna,Commercial,253,92,,percent of total billed charges,,
"Excision, Benign Lesion Inc Margins, Except Skin Tag,Trunk,Arms Or Legs;Exc Dia 2.1-3.0 Cm",,11403,CPT,Facility,Outpatient,,,,275,233.75,78.815,275,Aetna,Medicare Advantage,134.75,49,,percent of total billed charges,,
"Excision, Benign Lesion Inc Margins, Except Skin Tag,Trunk,Arms Or Legs;Exc Dia 2.1-3.0 Cm",,11403,CPT,Facility,Inpatient,,,,275,233.75,78.815,275,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Excision, Benign Lesion Inc Margins, Except Skin Tag,Trunk,Arms Or Legs;Exc Dia 2.1-3.0 Cm",,11403,CPT,Facility,Both,,,,275,233.75,78.815,275,Aetna,PPO,255.75,93,,percent of total billed charges,,
"Excision, Benign Lesion Inc Margins, Except Skin Tag,Trunk,Arms Or Legs;Exc Dia 2.1-3.0 Cm",,11403,CPT,Facility,Both,,,,275,233.75,78.815,275,America's PPO,America's PPO,264.0825,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Excision, Benign Lesion Inc Margins, Except Skin Tag,Trunk,Arms Or Legs;Exc Dia 2.1-3.0 Cm",,11403,CPT,Facility,Both,,,,275,233.75,78.815,275,BlueCross BlueShield Minnesota, Federal Employee Program,270.6,98.4,,percent of total billed charges,,
"Excision, Benign Lesion Inc Margins, Except Skin Tag,Trunk,Arms Or Legs;Exc Dia 2.1-3.0 Cm",,11403,CPT,Facility,Both,,,,275,233.75,78.815,275,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,275,100,,percent of total billed charges,,
"Excision, Benign Lesion Inc Margins, Except Skin Tag,Trunk,Arms Or Legs;Exc Dia 2.1-3.0 Cm",,11403,CPT,Facility,Both,,,,275,233.75,78.815,275,BlueCross BlueShield Minnesota,High Value Network Plan,247.5,90,,percent of total billed charges,,
"Excision, Benign Lesion Inc Margins, Except Skin Tag,Trunk,Arms Or Legs;Exc Dia 2.1-3.0 Cm",,11403,CPT,Facility,Outpatient,,,,275,233.75,78.815,275,BlueCross BlueShield Minnesota,Medicare Advantage,134.75,49,,percent of total billed charges,,
"Excision, Benign Lesion Inc Margins, Except Skin Tag,Trunk,Arms Or Legs;Exc Dia 2.1-3.0 Cm",,11403,CPT,Facility,Inpatient,,,,275,233.75,78.815,275,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Excision, Benign Lesion Inc Margins, Except Skin Tag,Trunk,Arms Or Legs;Exc Dia 2.1-3.0 Cm",,11403,CPT,Facility,Both,,,,275,233.75,78.815,275,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,243.5675,88.57,,percent of total billed charges,,
"Excision, Benign Lesion Inc Margins, Except Skin Tag,Trunk,Arms Or Legs;Exc Dia 2.1-3.0 Cm",,11403,CPT,Facility,Both,,,,275,233.75,78.815,275,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,78.815,28.66,,percent of total billed charges,,
"Excision, Benign Lesion Inc Margins, Except Skin Tag,Trunk,Arms Or Legs;Exc Dia 2.1-3.0 Cm",,11403,CPT,Facility,Outpatient,,,,275,233.75,78.815,275,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),134.75,49,,percent of total billed charges,,
"Excision, Benign Lesion Inc Margins, Except Skin Tag,Trunk,Arms Or Legs;Exc Dia 2.1-3.0 Cm",,11403,CPT,Facility,Inpatient,,,,275,233.75,78.815,275,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Excision, Benign Lesion Inc Margins, Except Skin Tag,Trunk,Arms Or Legs;Exc Dia 2.1-3.0 Cm",,11403,CPT,Facility,Both,,,,275,233.75,78.815,275,CorVel,Worker's Compensation,275,100,,percent of total billed charges,,
"Excision, Benign Lesion Inc Margins, Except Skin Tag,Trunk,Arms Or Legs;Exc Dia 2.1-3.0 Cm",,11403,CPT,Facility,Both,,,,275,233.75,78.815,275,First Health Group Corporation,First Health Network,266.75,97,,percent of total billed charges,,
"Excision, Benign Lesion Inc Margins, Except Skin Tag,Trunk,Arms Or Legs;Exc Dia 2.1-3.0 Cm",,11403,CPT,Facility,Both,,,,275,233.75,78.815,275,"Health Partners, Inc.",Commercial,260.15,94.6,,percent of total billed charges,,
"Excision, Benign Lesion Inc Margins, Except Skin Tag,Trunk,Arms Or Legs;Exc Dia 2.1-3.0 Cm",,11403,CPT,Facility,Outpatient,,,,275,233.75,78.815,275,"Health Partners, Inc.",Medicare Advantage,134.75,49,,percent of total billed charges,,
"Excision, Benign Lesion Inc Margins, Except Skin Tag,Trunk,Arms Or Legs;Exc Dia 2.1-3.0 Cm",,11403,CPT,Facility,Inpatient,,,,275,233.75,78.815,275,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Excision, Benign Lesion Inc Margins, Except Skin Tag,Trunk,Arms Or Legs;Exc Dia 2.1-3.0 Cm",,11403,CPT,Facility,Both,,,,275,233.75,78.815,275,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),165,60,,percent of total billed charges,,
"Excision, Benign Lesion Inc Margins, Except Skin Tag,Trunk,Arms Or Legs;Exc Dia 2.1-3.0 Cm",,11403,CPT,Facility,Both,,,,275,233.75,78.815,275,"Health Partners, Inc.",State of Minnesota Advantage Program,224.125,81.5,,percent of total billed charges,,
"Excision, Benign Lesion Inc Margins, Except Skin Tag,Trunk,Arms Or Legs;Exc Dia 2.1-3.0 Cm",,11403,CPT,Facility,Both,,,,275,233.75,78.815,275,"Health Partners, Inc.",State Public Programs,137.5,50,,percent of total billed charges,,
"Excision, Benign Lesion Inc Margins, Except Skin Tag,Trunk,Arms Or Legs;Exc Dia 2.1-3.0 Cm",,11403,CPT,Facility,Both,,,,275,233.75,78.815,275,Humana Insurance Company,Commercial PPO,261.25,95,,percent of total billed charges,,
"Excision, Benign Lesion Inc Margins, Except Skin Tag,Trunk,Arms Or Legs;Exc Dia 2.1-3.0 Cm",,11403,CPT,Facility,Outpatient,,,,275,233.75,78.815,275,Humana Insurance Company,Medicare PPO,134.75,49,,percent of total billed charges,,
"Excision, Benign Lesion Inc Margins, Except Skin Tag,Trunk,Arms Or Legs;Exc Dia 2.1-3.0 Cm",,11403,CPT,Facility,Inpatient,,,,275,233.75,78.815,275,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Excision, Benign Lesion Inc Margins, Except Skin Tag,Trunk,Arms Or Legs;Exc Dia 2.1-3.0 Cm",,11403,CPT,Facility,Both,,,,275,233.75,78.815,275,Medica,Individual & Family,272.525,99.1,,percent of total billed charges,,
"Excision, Benign Lesion Inc Margins, Except Skin Tag,Trunk,Arms Or Legs;Exc Dia 2.1-3.0 Cm",,11403,CPT,Facility,Outpatient,,,,275,233.75,78.815,275,Medica,Medica Advantage Solution,136.95,49.8,,percent of total billed charges,,
"Excision, Benign Lesion Inc Margins, Except Skin Tag,Trunk,Arms Or Legs;Exc Dia 2.1-3.0 Cm",,11403,CPT,Facility,Inpatient,,,,275,233.75,78.815,275,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Excision, Benign Lesion Inc Margins, Except Skin Tag,Trunk,Arms Or Legs;Exc Dia 2.1-3.0 Cm",,11403,CPT,Facility,Outpatient,,,,275,233.75,78.815,275,Medica,Medical Assistance,122.65,44.6,,percent of total billed charges,,
"Excision, Benign Lesion Inc Margins, Except Skin Tag,Trunk,Arms Or Legs;Exc Dia 2.1-3.0 Cm",,11403,CPT,Facility,Inpatient,,,,275,233.75,78.815,275,Medica,Medical Assistance,,,,,Included in per diem rate,
"Excision, Benign Lesion Inc Margins, Except Skin Tag,Trunk,Arms Or Legs;Exc Dia 2.1-3.0 Cm",,11403,CPT,Facility,Outpatient,,,,275,233.75,78.815,275,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,136.95,49.8,,percent of total billed charges,,
"Excision, Benign Lesion Inc Margins, Except Skin Tag,Trunk,Arms Or Legs;Exc Dia 2.1-3.0 Cm",,11403,CPT,Facility,Inpatient,,,,275,233.75,78.815,275,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Excision, Benign Lesion Inc Margins, Except Skin Tag,Trunk,Arms Or Legs;Exc Dia 2.1-3.0 Cm",,11403,CPT,Facility,Both,,,,275,233.75,78.815,275,"Multiplan, Inc.","Multiplan, Inc.",258.5,94,,percent of total billed charges,,
"Excision, Benign Lesion Inc Margins, Except Skin Tag,Trunk,Arms Or Legs;Exc Dia 2.1-3.0 Cm",,11403,CPT,Facility,Outpatient,,,,275,233.75,78.815,275,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,247.775,90.1,,percent of total billed charges,,
"Excision, Benign Lesion Inc Margins, Except Skin Tag,Trunk,Arms Or Legs;Exc Dia 2.1-3.0 Cm",,11403,CPT,Facility,Inpatient,,,,275,233.75,78.815,275,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Excision, Benign Lesion Inc Margins, Except Skin Tag,Trunk,Arms Or Legs;Exc Dia 2.1-3.0 Cm",,11403,CPT,Facility,Both,,,,275,233.75,78.815,275,"Preferred One Administrative Services, INC.",PPO,271.15,98.6,,percent of total billed charges,,
"Excision, Benign Lesion Inc Margins, Except Skin Tag,Trunk,Arms Or Legs;Exc Dia 2.1-3.0 Cm",,11403,CPT,Facility,Outpatient,,,,275,233.75,78.815,275,PrimeWest Health,Minnesota Senior Health Options (MSHO),141.4875,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Excision, Benign Lesion Inc Margins, Except Skin Tag,Trunk,Arms Or Legs;Exc Dia 2.1-3.0 Cm",,11403,CPT,Facility,Inpatient,,,,275,233.75,78.815,275,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Excision, Benign Lesion Inc Margins, Except Skin Tag,Trunk,Arms Or Legs;Exc Dia 2.1-3.0 Cm",,11403,CPT,Facility,Outpatient,,,,275,233.75,78.815,275,PrimeWest Health,MinnesotaCare,141.24,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Excision, Benign Lesion Inc Margins, Except Skin Tag,Trunk,Arms Or Legs;Exc Dia 2.1-3.0 Cm",,11403,CPT,Facility,Inpatient,,,,275,233.75,78.815,275,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Excision, Benign Lesion Inc Margins, Except Skin Tag,Trunk,Arms Or Legs;Exc Dia 2.1-3.0 Cm",,11403,CPT,Facility,Both,,,,275,233.75,78.815,275,Sanford Health Plan,Sanford Health Plan,253,92,,percent of total billed charges,,
"Excision, Benign Lesion Inc Margins, Except Skin Tag,Trunk,Arms Or Legs;Exc Dia 2.1-3.0 Cm",,11403,CPT,Facility,Outpatient,,,,275,233.75,78.815,275,"UCare Health, Inc.",Individual & Family Plan,154.9625,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Excision, Benign Lesion Inc Margins, Except Skin Tag,Trunk,Arms Or Legs;Exc Dia 2.1-3.0 Cm",,11403,CPT,Facility,Inpatient,,,,275,233.75,78.815,275,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Excision, Benign Lesion Inc Margins, Except Skin Tag,Trunk,Arms Or Legs;Exc Dia 2.1-3.0 Cm",,11403,CPT,Facility,Outpatient,,,,275,233.75,78.815,275,"UCare Health, Inc.",Medical Assistance,138.7925,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Excision, Benign Lesion Inc Margins, Except Skin Tag,Trunk,Arms Or Legs;Exc Dia 2.1-3.0 Cm",,11403,CPT,Facility,Inpatient,,,,275,233.75,78.815,275,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Excision, Benign Lesion Inc Margins, Except Skin Tag,Trunk,Arms Or Legs;Exc Dia 2.1-3.0 Cm",,11403,CPT,Facility,Outpatient,,,,275,233.75,78.815,275,"UCare Health, Inc.",Medicare Advantage,138.7925,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Excision, Benign Lesion Inc Margins, Except Skin Tag,Trunk,Arms Or Legs;Exc Dia 2.1-3.0 Cm",,11403,CPT,Facility,Inpatient,,,,275,233.75,78.815,275,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Excision, Benign Lesion Inc Margins, Except Skin Tag,Trunk,Arms Or Legs;Exc Dia 2.1-3.0 Cm",,11403,CPT,Facility,Outpatient,,,,275,233.75,78.815,275,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),138.7925,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Excision, Benign Lesion Inc Margins, Except Skin Tag,Trunk,Arms Or Legs;Exc Dia 2.1-3.0 Cm",,11403,CPT,Facility,Inpatient,,,,275,233.75,78.815,275,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Excision, Benign Lesion Inc Margins, Except Skin Tag,Trunk,Arms Or Legs;Exc Dia 2.1-3.0 Cm",,11403,CPT,Facility,Both,,,,275,233.75,78.815,275,UnitedHealthcare,Individual & Family,258.5,94,,percent of total billed charges,,
"Excision, Benign Lesion Inc Margins, Except Skin Tag,Trunk,Arms Or Legs;Exc Dia 2.1-3.0 Cm",,11403,CPT,Facility,Outpatient,,,,275,233.75,78.815,275,UnitedHealthcare,Medicare Advantage,134.75,49,,percent of total billed charges,,
"Excision, Benign Lesion Inc Margins, Except Skin Tag,Trunk,Arms Or Legs;Exc Dia 2.1-3.0 Cm",,11403,CPT,Facility,Inpatient,,,,275,233.75,78.815,275,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Excision, Benign Lesion Inc Margins, Except Skin Tag,Trunk,Arms Or Legs;Exc Dia 2.1-3.0 Cm",,11403,CPT,Facility,Outpatient,,,,275,233.75,78.815,275,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,132,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Excision, Benign Lesion Inc Margins, Except Skin Tag,Trunk,Arms Or Legs;Exc Dia 2.1-3.0 Cm",,11403,CPT,Facility,Inpatient,,,,275,233.75,78.815,275,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Excision, Benign Lesion Inc Margins, Except Skin Tag,Trunk,Arms Or Legs;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11403,CPT,Professional,Both,,,,858,729.3,94.02,858,Aetna,Commercial,729.3,85,,percent of total billed charges,,
"Excision, Benign Lesion Inc Margins, Except Skin Tag,Trunk,Arms Or Legs;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11403,CPT,Professional,Both,,,,415,352.75,94.02,415,Aetna,Commercial,352.75,85,,percent of total billed charges,,
"Excision, Benign Lesion Inc Margins, Except Skin Tag,Trunk,Arms Or Legs;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11403,CPT,Professional,Both,,,,858,729.3,94.02,858,Aetna,Medicare Advantage,145.52,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Benign Lesion Inc Margins, Except Skin Tag,Trunk,Arms Or Legs;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11403,CPT,Professional,Both,,,,415,352.75,94.02,415,Aetna,Medicare Advantage,145.52,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Benign Lesion Inc Margins, Except Skin Tag,Trunk,Arms Or Legs;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11403,CPT,Professional,Both,,,,858,729.3,94.02,858,Aetna,PPO,797.94,93,,percent of total billed charges,,
"Excision, Benign Lesion Inc Margins, Except Skin Tag,Trunk,Arms Or Legs;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11403,CPT,Professional,Both,,,,415,352.75,94.02,415,Aetna,PPO,385.95,93,,percent of total billed charges,,
"Excision, Benign Lesion Inc Margins, Except Skin Tag,Trunk,Arms Or Legs;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11403,CPT,Professional,Both,,,,858,729.3,94.02,858,America's PPO,America's PPO,733.0752,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Excision, Benign Lesion Inc Margins, Except Skin Tag,Trunk,Arms Or Legs;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11403,CPT,Professional,Both,,,,415,352.75,94.02,415,America's PPO,America's PPO,354.576,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Excision, Benign Lesion Inc Margins, Except Skin Tag,Trunk,Arms Or Legs;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11403,CPT,Professional,Both,,,,858,729.3,94.02,858,BlueCross BlueShield Minnesota, Federal Employee Program,306.43,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Excision, Benign Lesion Inc Margins, Except Skin Tag,Trunk,Arms Or Legs;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11403,CPT,Professional,Both,,,,415,352.75,94.02,415,BlueCross BlueShield Minnesota, Federal Employee Program,306.43,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Excision, Benign Lesion Inc Margins, Except Skin Tag,Trunk,Arms Or Legs;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11403,CPT,Professional,Both,,,,858,729.3,94.02,858,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,311.33288,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Benign Lesion Inc Margins, Except Skin Tag,Trunk,Arms Or Legs;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11403,CPT,Professional,Both,,,,415,352.75,94.02,415,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,311.33288,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Benign Lesion Inc Margins, Except Skin Tag,Trunk,Arms Or Legs;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11403,CPT,Professional,Both,,,,858,729.3,94.02,858,BlueCross BlueShield Minnesota,High Value Network Plan,311.33288,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Benign Lesion Inc Margins, Except Skin Tag,Trunk,Arms Or Legs;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11403,CPT,Professional,Both,,,,415,352.75,94.02,415,BlueCross BlueShield Minnesota,High Value Network Plan,311.33288,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Benign Lesion Inc Margins, Except Skin Tag,Trunk,Arms Or Legs;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11403,CPT,Professional,Both,,,,858,729.3,94.02,858,BlueCross BlueShield Minnesota,Medicare Advantage,168.061,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Benign Lesion Inc Margins, Except Skin Tag,Trunk,Arms Or Legs;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11403,CPT,Professional,Both,,,,415,352.75,94.02,415,BlueCross BlueShield Minnesota,Medicare Advantage,168.061,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Benign Lesion Inc Margins, Except Skin Tag,Trunk,Arms Or Legs;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11403,CPT,Professional,Both,,,,858,729.3,94.02,858,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,311.33288,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Benign Lesion Inc Margins, Except Skin Tag,Trunk,Arms Or Legs;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11403,CPT,Professional,Both,,,,415,352.75,94.02,415,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,311.33288,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Benign Lesion Inc Margins, Except Skin Tag,Trunk,Arms Or Legs;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11403,CPT,Professional,Both,,,,858,729.3,94.02,858,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,108.54944,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision, Benign Lesion Inc Margins, Except Skin Tag,Trunk,Arms Or Legs;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11403,CPT,Professional,Both,,,,415,352.75,94.02,415,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,108.54944,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision, Benign Lesion Inc Margins, Except Skin Tag,Trunk,Arms Or Legs;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11403,CPT,Professional,Both,,,,858,729.3,94.02,858,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),168.061,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Benign Lesion Inc Margins, Except Skin Tag,Trunk,Arms Or Legs;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11403,CPT,Professional,Both,,,,415,352.75,94.02,415,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),168.061,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Benign Lesion Inc Margins, Except Skin Tag,Trunk,Arms Or Legs;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11403,CPT,Professional,Both,,,,858,729.3,94.02,858,CorVel,Worker's Compensation,283.2982071,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Excision, Benign Lesion Inc Margins, Except Skin Tag,Trunk,Arms Or Legs;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11403,CPT,Professional,Both,,,,415,352.75,94.02,415,CorVel,Worker's Compensation,283.2982071,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Excision, Benign Lesion Inc Margins, Except Skin Tag,Trunk,Arms Or Legs;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11403,CPT,Professional,Both,,,,858,729.3,94.02,858,First Health Group Corporation,First Health Network,832.26,97,,percent of total billed charges,,
"Excision, Benign Lesion Inc Margins, Except Skin Tag,Trunk,Arms Or Legs;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11403,CPT,Professional,Both,,,,415,352.75,94.02,415,First Health Group Corporation,First Health Network,402.55,97,,percent of total billed charges,,
"Excision, Benign Lesion Inc Margins, Except Skin Tag,Trunk,Arms Or Legs;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11403,CPT,Professional,Both,,,,858,729.3,94.02,858,"Health Partners, Inc.",Commercial,306.17,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision, Benign Lesion Inc Margins, Except Skin Tag,Trunk,Arms Or Legs;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11403,CPT,Professional,Both,,,,415,352.75,94.02,415,"Health Partners, Inc.",Commercial,306.17,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision, Benign Lesion Inc Margins, Except Skin Tag,Trunk,Arms Or Legs;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11403,CPT,Professional,Both,,,,858,729.3,94.02,858,"Health Partners, Inc.",Medicare Advantage,168.061,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Benign Lesion Inc Margins, Except Skin Tag,Trunk,Arms Or Legs;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11403,CPT,Professional,Both,,,,415,352.75,94.02,415,"Health Partners, Inc.",Medicare Advantage,168.061,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Benign Lesion Inc Margins, Except Skin Tag,Trunk,Arms Or Legs;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11403,CPT,Professional,Both,,,,858,729.3,94.02,858,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),146.05,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Excision, Benign Lesion Inc Margins, Except Skin Tag,Trunk,Arms Or Legs;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11403,CPT,Professional,Both,,,,415,352.75,94.02,415,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),146.05,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Excision, Benign Lesion Inc Margins, Except Skin Tag,Trunk,Arms Or Legs;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11403,CPT,Professional,Both,,,,858,729.3,94.02,858,"Health Partners, Inc.",State of Minnesota Advantage Program,263.765455,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision, Benign Lesion Inc Margins, Except Skin Tag,Trunk,Arms Or Legs;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11403,CPT,Professional,Both,,,,415,352.75,94.02,415,"Health Partners, Inc.",State of Minnesota Advantage Program,263.765455,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision, Benign Lesion Inc Margins, Except Skin Tag,Trunk,Arms Or Legs;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11403,CPT,Professional,Both,,,,858,729.3,94.02,858,"Health Partners, Inc.",State Public Programs,94.02,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Excision, Benign Lesion Inc Margins, Except Skin Tag,Trunk,Arms Or Legs;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11403,CPT,Professional,Both,,,,415,352.75,94.02,415,"Health Partners, Inc.",State Public Programs,94.02,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Excision, Benign Lesion Inc Margins, Except Skin Tag,Trunk,Arms Or Legs;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11403,CPT,Professional,Both,,,,858,729.3,94.02,858,Humana Insurance Company,Commercial PPO,146.14,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Excision, Benign Lesion Inc Margins, Except Skin Tag,Trunk,Arms Or Legs;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11403,CPT,Professional,Both,,,,415,352.75,94.02,415,Humana Insurance Company,Commercial PPO,146.14,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Excision, Benign Lesion Inc Margins, Except Skin Tag,Trunk,Arms Or Legs;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11403,CPT,Professional,Both,,,,858,729.3,94.02,858,Humana Insurance Company,Medicare PPO,858,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Excision, Benign Lesion Inc Margins, Except Skin Tag,Trunk,Arms Or Legs;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11403,CPT,Professional,Both,,,,415,352.75,94.02,415,Humana Insurance Company,Medicare PPO,415,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Excision, Benign Lesion Inc Margins, Except Skin Tag,Trunk,Arms Or Legs;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11403,CPT,Professional,Both,,,,858,729.3,94.02,858,Medica,Individual & Family,727.584,84.8,,percent of total billed charges,,
"Excision, Benign Lesion Inc Margins, Except Skin Tag,Trunk,Arms Or Legs;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11403,CPT,Professional,Both,,,,415,352.75,94.02,415,Medica,Individual & Family,351.92,84.8,,percent of total billed charges,,
"Excision, Benign Lesion Inc Margins, Except Skin Tag,Trunk,Arms Or Legs;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11403,CPT,Professional,Both,,,,858,729.3,94.02,858,Medica,Medica Advantage Solution,427.284,49.8,,percent of total billed charges,,
"Excision, Benign Lesion Inc Margins, Except Skin Tag,Trunk,Arms Or Legs;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11403,CPT,Professional,Both,,,,415,352.75,94.02,415,Medica,Medica Advantage Solution,206.67,49.8,,percent of total billed charges,,
"Excision, Benign Lesion Inc Margins, Except Skin Tag,Trunk,Arms Or Legs;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11403,CPT,Professional,Both,,,,858,729.3,94.02,858,Medica,Medical Assistance,108.55,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Excision, Benign Lesion Inc Margins, Except Skin Tag,Trunk,Arms Or Legs;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11403,CPT,Professional,Both,,,,415,352.75,94.02,415,Medica,Medical Assistance,108.55,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Excision, Benign Lesion Inc Margins, Except Skin Tag,Trunk,Arms Or Legs;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11403,CPT,Professional,Both,,,,858,729.3,94.02,858,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,146.14,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Excision, Benign Lesion Inc Margins, Except Skin Tag,Trunk,Arms Or Legs;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11403,CPT,Professional,Both,,,,415,352.75,94.02,415,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,146.14,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Excision, Benign Lesion Inc Margins, Except Skin Tag,Trunk,Arms Or Legs;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11403,CPT,Professional,Both,,,,858,729.3,94.02,858,"Multiplan, Inc.","Multiplan, Inc.",806.52,94,,percent of total billed charges,,
"Excision, Benign Lesion Inc Margins, Except Skin Tag,Trunk,Arms Or Legs;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11403,CPT,Professional,Both,,,,415,352.75,94.02,415,"Multiplan, Inc.","Multiplan, Inc.",390.1,94,,percent of total billed charges,,
"Excision, Benign Lesion Inc Margins, Except Skin Tag,Trunk,Arms Or Legs;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11403,CPT,Professional,Both,,,,858,729.3,94.02,858,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,773.058,90.1,,percent of total billed charges,,
"Excision, Benign Lesion Inc Margins, Except Skin Tag,Trunk,Arms Or Legs;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11403,CPT,Professional,Both,,,,415,352.75,94.02,415,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,373.915,90.1,,percent of total billed charges,,
"Excision, Benign Lesion Inc Margins, Except Skin Tag,Trunk,Arms Or Legs;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11403,CPT,Professional,Both,,,,858,729.3,94.02,858,"Preferred One Administrative Services, INC.",PPO,845.988,98.6,,percent of total billed charges,,
"Excision, Benign Lesion Inc Margins, Except Skin Tag,Trunk,Arms Or Legs;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11403,CPT,Professional,Both,,,,415,352.75,94.02,415,"Preferred One Administrative Services, INC.",PPO,409.19,98.6,,percent of total billed charges,,
"Excision, Benign Lesion Inc Margins, Except Skin Tag,Trunk,Arms Or Legs;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11403,CPT,Professional,Both,,,,858,729.3,94.02,858,PrimeWest Health,Minnesota Senior Health Options (MSHO),168.061,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Benign Lesion Inc Margins, Except Skin Tag,Trunk,Arms Or Legs;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11403,CPT,Professional,Both,,,,415,352.75,94.02,415,PrimeWest Health,Minnesota Senior Health Options (MSHO),168.061,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Benign Lesion Inc Margins, Except Skin Tag,Trunk,Arms Or Legs;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11403,CPT,Professional,Both,,,,858,729.3,94.02,858,PrimeWest Health,MinnesotaCare,116.1479008,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision, Benign Lesion Inc Margins, Except Skin Tag,Trunk,Arms Or Legs;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11403,CPT,Professional,Both,,,,415,352.75,94.02,415,PrimeWest Health,MinnesotaCare,116.1479008,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision, Benign Lesion Inc Margins, Except Skin Tag,Trunk,Arms Or Legs;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11403,CPT,Professional,Both,,,,858,729.3,94.02,858,Sanford Health Plan,Sanford Health Plan,755.04,88,,percent of total billed charges,,
"Excision, Benign Lesion Inc Margins, Except Skin Tag,Trunk,Arms Or Legs;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11403,CPT,Professional,Both,,,,415,352.75,94.02,415,Sanford Health Plan,Sanford Health Plan,365.2,88,,percent of total billed charges,,
"Excision, Benign Lesion Inc Margins, Except Skin Tag,Trunk,Arms Or Legs;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11403,CPT,Professional,Both,,,,858,729.3,94.02,858,"UCare Health, Inc.",Individual & Family Plan,237.565184,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Excision, Benign Lesion Inc Margins, Except Skin Tag,Trunk,Arms Or Legs;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11403,CPT,Professional,Both,,,,415,352.75,94.02,415,"UCare Health, Inc.",Individual & Family Plan,237.565184,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Excision, Benign Lesion Inc Margins, Except Skin Tag,Trunk,Arms Or Legs;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11403,CPT,Professional,Both,,,,858,729.3,94.02,858,"UCare Health, Inc.",Medical Assistance,119.404384,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Excision, Benign Lesion Inc Margins, Except Skin Tag,Trunk,Arms Or Legs;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11403,CPT,Professional,Both,,,,415,352.75,94.02,415,"UCare Health, Inc.",Medical Assistance,119.404384,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Excision, Benign Lesion Inc Margins, Except Skin Tag,Trunk,Arms Or Legs;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11403,CPT,Professional,Both,,,,858,729.3,94.02,858,"UCare Health, Inc.",Medicare Advantage,168.061,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Excision, Benign Lesion Inc Margins, Except Skin Tag,Trunk,Arms Or Legs;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11403,CPT,Professional,Both,,,,415,352.75,94.02,415,"UCare Health, Inc.",Medicare Advantage,168.061,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Excision, Benign Lesion Inc Margins, Except Skin Tag,Trunk,Arms Or Legs;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11403,CPT,Professional,Both,,,,858,729.3,94.02,858,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),134.4488,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Excision, Benign Lesion Inc Margins, Except Skin Tag,Trunk,Arms Or Legs;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11403,CPT,Professional,Both,,,,415,352.75,94.02,415,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),134.4488,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Excision, Benign Lesion Inc Margins, Except Skin Tag,Trunk,Arms Or Legs;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11403,CPT,Professional,Both,,,,858,729.3,94.02,858,UnitedHealthcare,Individual & Family,858,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Excision, Benign Lesion Inc Margins, Except Skin Tag,Trunk,Arms Or Legs;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11403,CPT,Professional,Both,,,,415,352.75,94.02,415,UnitedHealthcare,Individual & Family,415,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Excision, Benign Lesion Inc Margins, Except Skin Tag,Trunk,Arms Or Legs;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11403,CPT,Professional,Both,,,,858,729.3,94.02,858,UnitedHealthcare,Medicare Advantage,168.061,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Benign Lesion Inc Margins, Except Skin Tag,Trunk,Arms Or Legs;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11403,CPT,Professional,Both,,,,415,352.75,94.02,415,UnitedHealthcare,Medicare Advantage,168.061,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Benign Lesion Inc Margins, Except Skin Tag,Trunk,Arms Or Legs;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11403,CPT,Professional,Both,,,,858,729.3,94.02,858,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,108.54944,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision, Benign Lesion Inc Margins, Except Skin Tag,Trunk,Arms Or Legs;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11403,CPT,Professional,Both,,,,415,352.75,94.02,415,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,108.54944,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision,Benign,Lesion Trunk/Arm/Leg; 2.1-3.0 Cm (Pbb)",,11403,CPT,Facility,Outpatient,,,,413,351.05,118.3658,413,Aetna,Commercial,379.96,92,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; 2.1-3.0 Cm (Pbb)",,11403,CPT,Professional,Outpatient,,,,445,378.25,94.02,445,Aetna,Commercial,378.25,85,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; 2.1-3.0 Cm (Pbb)",,11403,CPT,Facility,Outpatient,,,,413,351.05,118.3658,413,Aetna,Medicare Advantage,202.37,49,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; 2.1-3.0 Cm (Pbb)",,11403,CPT,Professional,Outpatient,,,,445,378.25,94.02,445,Aetna,Medicare Advantage,145.52,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision,Benign,Lesion Trunk/Arm/Leg; 2.1-3.0 Cm (Pbb)",,11403,CPT,Facility,Outpatient,,,,413,351.05,118.3658,413,Aetna,PPO,384.09,93,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; 2.1-3.0 Cm (Pbb)",,11403,CPT,Professional,Outpatient,,,,445,378.25,94.02,445,Aetna,PPO,413.85,93,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; 2.1-3.0 Cm (Pbb)",,11403,CPT,Facility,Outpatient,,,,413,351.05,118.3658,413,America's PPO,America's PPO,396.6039,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Excision,Benign,Lesion Trunk/Arm/Leg; 2.1-3.0 Cm (Pbb)",,11403,CPT,Professional,Outpatient,,,,445,378.25,94.02,445,America's PPO,America's PPO,380.208,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Excision,Benign,Lesion Trunk/Arm/Leg; 2.1-3.0 Cm (Pbb)",,11403,CPT,Facility,Outpatient,,,,413,351.05,118.3658,413,BlueCross BlueShield Minnesota, Federal Employee Program,406.392,98.4,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; 2.1-3.0 Cm (Pbb)",,11403,CPT,Professional,Outpatient,,,,445,378.25,94.02,445,BlueCross BlueShield Minnesota, Federal Employee Program,306.43,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Excision,Benign,Lesion Trunk/Arm/Leg; 2.1-3.0 Cm (Pbb)",,11403,CPT,Facility,Outpatient,,,,413,351.05,118.3658,413,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,413,100,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; 2.1-3.0 Cm (Pbb)",,11403,CPT,Professional,Outpatient,,,,445,378.25,94.02,445,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,311.33288,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision,Benign,Lesion Trunk/Arm/Leg; 2.1-3.0 Cm (Pbb)",,11403,CPT,Facility,Outpatient,,,,413,351.05,118.3658,413,BlueCross BlueShield Minnesota,High Value Network Plan,371.7,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
"Excision,Benign,Lesion Trunk/Arm/Leg; 2.1-3.0 Cm (Pbb)",,11403,CPT,Professional,Outpatient,,,,445,378.25,94.02,445,BlueCross BlueShield Minnesota,High Value Network Plan,311.33288,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision,Benign,Lesion Trunk/Arm/Leg; 2.1-3.0 Cm (Pbb)",,11403,CPT,Facility,Outpatient,,,,413,351.05,118.3658,413,BlueCross BlueShield Minnesota,Medicare Advantage,202.37,49,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; 2.1-3.0 Cm (Pbb)",,11403,CPT,Professional,Outpatient,,,,445,378.25,94.02,445,BlueCross BlueShield Minnesota,Medicare Advantage,168.061,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision,Benign,Lesion Trunk/Arm/Leg; 2.1-3.0 Cm (Pbb)",,11403,CPT,Professional,Outpatient,,,,445,378.25,94.02,445,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,311.33288,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision,Benign,Lesion Trunk/Arm/Leg; 2.1-3.0 Cm (Pbb)",,11403,CPT,Facility,Outpatient,,,,413,351.05,118.3658,413,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,118.3658,28.66,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; 2.1-3.0 Cm (Pbb)",,11403,CPT,Professional,Outpatient,,,,445,378.25,94.02,445,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,108.54944,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision,Benign,Lesion Trunk/Arm/Leg; 2.1-3.0 Cm (Pbb)",,11403,CPT,Facility,Outpatient,,,,413,351.05,118.3658,413,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),202.37,49,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; 2.1-3.0 Cm (Pbb)",,11403,CPT,Professional,Outpatient,,,,445,378.25,94.02,445,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),168.061,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision,Benign,Lesion Trunk/Arm/Leg; 2.1-3.0 Cm (Pbb)",,11403,CPT,Facility,Outpatient,,,,413,351.05,118.3658,413,CorVel,Worker's Compensation,413,100,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; 2.1-3.0 Cm (Pbb)",,11403,CPT,Professional,Outpatient,,,,445,378.25,94.02,445,CorVel,Worker's Compensation,283.2982071,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Excision,Benign,Lesion Trunk/Arm/Leg; 2.1-3.0 Cm (Pbb)",,11403,CPT,Facility,Outpatient,,,,413,351.05,118.3658,413,First Health Group Corporation,First Health Network,400.61,97,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; 2.1-3.0 Cm (Pbb)",,11403,CPT,Professional,Outpatient,,,,445,378.25,94.02,445,First Health Group Corporation,First Health Network,431.65,97,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; 2.1-3.0 Cm (Pbb)",,11403,CPT,Facility,Outpatient,,,,413,351.05,118.3658,413,"Health Partners, Inc.",Commercial,390.698,94.6,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; 2.1-3.0 Cm (Pbb)",,11403,CPT,Professional,Outpatient,,,,445,378.25,94.02,445,"Health Partners, Inc.",Commercial,306.17,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision,Benign,Lesion Trunk/Arm/Leg; 2.1-3.0 Cm (Pbb)",,11403,CPT,Facility,Outpatient,,,,413,351.05,118.3658,413,"Health Partners, Inc.",Medicare Advantage,202.37,49,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; 2.1-3.0 Cm (Pbb)",,11403,CPT,Professional,Outpatient,,,,445,378.25,94.02,445,"Health Partners, Inc.",Medicare Advantage,168.061,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision,Benign,Lesion Trunk/Arm/Leg; 2.1-3.0 Cm (Pbb)",,11403,CPT,Facility,Outpatient,,,,413,351.05,118.3658,413,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),247.8,60,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; 2.1-3.0 Cm (Pbb)",,11403,CPT,Professional,Outpatient,,,,445,378.25,94.02,445,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),146.05,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Excision,Benign,Lesion Trunk/Arm/Leg; 2.1-3.0 Cm (Pbb)",,11403,CPT,Facility,Outpatient,,,,413,351.05,118.3658,413,"Health Partners, Inc.",State of Minnesota Advantage Program,336.595,81.5,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; 2.1-3.0 Cm (Pbb)",,11403,CPT,Professional,Outpatient,,,,445,378.25,94.02,445,"Health Partners, Inc.",State of Minnesota Advantage Program,263.765455,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision,Benign,Lesion Trunk/Arm/Leg; 2.1-3.0 Cm (Pbb)",,11403,CPT,Facility,Outpatient,,,,413,351.05,118.3658,413,"Health Partners, Inc.",State Public Programs,206.5,50,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; 2.1-3.0 Cm (Pbb)",,11403,CPT,Professional,Outpatient,,,,445,378.25,94.02,445,"Health Partners, Inc.",State Public Programs,94.02,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Excision,Benign,Lesion Trunk/Arm/Leg; 2.1-3.0 Cm (Pbb)",,11403,CPT,Facility,Outpatient,,,,413,351.05,118.3658,413,Humana Insurance Company,Commercial PPO,392.35,95,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; 2.1-3.0 Cm (Pbb)",,11403,CPT,Professional,Outpatient,,,,445,378.25,94.02,445,Humana Insurance Company,Commercial PPO,146.14,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Excision,Benign,Lesion Trunk/Arm/Leg; 2.1-3.0 Cm (Pbb)",,11403,CPT,Facility,Outpatient,,,,413,351.05,118.3658,413,Humana Insurance Company,Medicare PPO,202.37,49,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; 2.1-3.0 Cm (Pbb)",,11403,CPT,Professional,Outpatient,,,,445,378.25,94.02,445,Humana Insurance Company,Medicare PPO,445,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Excision,Benign,Lesion Trunk/Arm/Leg; 2.1-3.0 Cm (Pbb)",,11403,CPT,Facility,Outpatient,,,,413,351.05,118.3658,413,Medica,Individual & Family,409.283,99.1,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; 2.1-3.0 Cm (Pbb)",,11403,CPT,Professional,Outpatient,,,,445,378.25,94.02,445,Medica,Individual & Family,377.36,84.8,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; 2.1-3.0 Cm (Pbb)",,11403,CPT,Facility,Outpatient,,,,413,351.05,118.3658,413,Medica,Medica Advantage Solution,205.674,49.8,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; 2.1-3.0 Cm (Pbb)",,11403,CPT,Professional,Outpatient,,,,445,378.25,94.02,445,Medica,Medica Advantage Solution,221.61,49.8,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; 2.1-3.0 Cm (Pbb)",,11403,CPT,Facility,Outpatient,,,,413,351.05,118.3658,413,Medica,Medical Assistance,184.198,44.6,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; 2.1-3.0 Cm (Pbb)",,11403,CPT,Professional,Outpatient,,,,445,378.25,94.02,445,Medica,Medical Assistance,108.55,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Excision,Benign,Lesion Trunk/Arm/Leg; 2.1-3.0 Cm (Pbb)",,11403,CPT,Facility,Outpatient,,,,413,351.05,118.3658,413,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,205.674,49.8,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; 2.1-3.0 Cm (Pbb)",,11403,CPT,Professional,Outpatient,,,,445,378.25,94.02,445,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,146.14,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Excision,Benign,Lesion Trunk/Arm/Leg; 2.1-3.0 Cm (Pbb)",,11403,CPT,Facility,Outpatient,,,,413,351.05,118.3658,413,"Multiplan, Inc.","Multiplan, Inc.",388.22,94,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; 2.1-3.0 Cm (Pbb)",,11403,CPT,Professional,Outpatient,,,,445,378.25,94.02,445,"Multiplan, Inc.","Multiplan, Inc.",418.3,94,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; 2.1-3.0 Cm (Pbb)",,11403,CPT,Facility,Outpatient,,,,413,351.05,118.3658,413,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,372.113,90.1,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; 2.1-3.0 Cm (Pbb)",,11403,CPT,Professional,Outpatient,,,,445,378.25,94.02,445,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,400.945,90.1,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; 2.1-3.0 Cm (Pbb)",,11403,CPT,Facility,Outpatient,,,,413,351.05,118.3658,413,"Preferred One Administrative Services, INC.",PPO,407.218,98.6,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; 2.1-3.0 Cm (Pbb)",,11403,CPT,Professional,Outpatient,,,,445,378.25,94.02,445,"Preferred One Administrative Services, INC.",PPO,438.77,98.6,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; 2.1-3.0 Cm (Pbb)",,11403,CPT,Facility,Outpatient,,,,413,351.05,118.3658,413,PrimeWest Health,Minnesota Senior Health Options (MSHO),212.4885,51.45,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; 2.1-3.0 Cm (Pbb)",,11403,CPT,Professional,Outpatient,,,,445,378.25,94.02,445,PrimeWest Health,Minnesota Senior Health Options (MSHO),168.061,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision,Benign,Lesion Trunk/Arm/Leg; 2.1-3.0 Cm (Pbb)",,11403,CPT,Facility,Outpatient,,,,413,351.05,118.3658,413,PrimeWest Health,MinnesotaCare,212.1168,51.36,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; 2.1-3.0 Cm (Pbb)",,11403,CPT,Professional,Outpatient,,,,445,378.25,94.02,445,PrimeWest Health,MinnesotaCare,116.1479008,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision,Benign,Lesion Trunk/Arm/Leg; 2.1-3.0 Cm (Pbb)",,11403,CPT,Facility,Outpatient,,,,413,351.05,118.3658,413,Sanford Health Plan,Sanford Health Plan,379.96,92,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; 2.1-3.0 Cm (Pbb)",,11403,CPT,Professional,Outpatient,,,,445,378.25,94.02,445,Sanford Health Plan,Sanford Health Plan,391.6,88,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; 2.1-3.0 Cm (Pbb)",,11403,CPT,Facility,Outpatient,,,,413,351.05,118.3658,413,"UCare Health, Inc.",Individual & Family Plan,232.7255,56.35,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; 2.1-3.0 Cm (Pbb)",,11403,CPT,Professional,Outpatient,,,,445,378.25,94.02,445,"UCare Health, Inc.",Individual & Family Plan,237.565184,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Excision,Benign,Lesion Trunk/Arm/Leg; 2.1-3.0 Cm (Pbb)",,11403,CPT,Facility,Outpatient,,,,413,351.05,118.3658,413,"UCare Health, Inc.",Medical Assistance,208.4411,50.47,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; 2.1-3.0 Cm (Pbb)",,11403,CPT,Professional,Outpatient,,,,445,378.25,94.02,445,"UCare Health, Inc.",Medical Assistance,119.404384,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Excision,Benign,Lesion Trunk/Arm/Leg; 2.1-3.0 Cm (Pbb)",,11403,CPT,Facility,Outpatient,,,,413,351.05,118.3658,413,"UCare Health, Inc.",Medicare Advantage,208.4411,50.47,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; 2.1-3.0 Cm (Pbb)",,11403,CPT,Professional,Outpatient,,,,445,378.25,94.02,445,"UCare Health, Inc.",Medicare Advantage,168.061,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Excision,Benign,Lesion Trunk/Arm/Leg; 2.1-3.0 Cm (Pbb)",,11403,CPT,Facility,Outpatient,,,,413,351.05,118.3658,413,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),208.4411,50.47,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; 2.1-3.0 Cm (Pbb)",,11403,CPT,Professional,Outpatient,,,,445,378.25,94.02,445,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),134.4488,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Excision,Benign,Lesion Trunk/Arm/Leg; 2.1-3.0 Cm (Pbb)",,11403,CPT,Facility,Outpatient,,,,413,351.05,118.3658,413,UnitedHealthcare,Individual & Family,388.22,94,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; 2.1-3.0 Cm (Pbb)",,11403,CPT,Professional,Outpatient,,,,445,378.25,94.02,445,UnitedHealthcare,Individual & Family,445,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Excision,Benign,Lesion Trunk/Arm/Leg; 2.1-3.0 Cm (Pbb)",,11403,CPT,Facility,Outpatient,,,,413,351.05,118.3658,413,UnitedHealthcare,Medicare Advantage,202.37,49,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; 2.1-3.0 Cm (Pbb)",,11403,CPT,Professional,Outpatient,,,,445,378.25,94.02,445,UnitedHealthcare,Medicare Advantage,168.061,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision,Benign,Lesion Trunk/Arm/Leg; 2.1-3.0 Cm (Pbb)",,11403,CPT,Facility,Outpatient,,,,413,351.05,118.3658,413,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,198.24,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Excision,Benign,Lesion Trunk/Arm/Leg; 2.1-3.0 Cm (Pbb)",,11403,CPT,Professional,Outpatient,,,,445,378.25,94.02,445,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,108.54944,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision, Benign Lesion Inc Margins, Except Skintag, Trk, Arms Or Legs; Exc Dia 3.1-4.0 Cm",,11404,CPT,Facility,Both,,,,355,301.75,101.743,355,Aetna,Commercial,326.6,92,,percent of total billed charges,,
"Excision, Benign Lesion Inc Margins, Except Skintag, Trk, Arms Or Legs; Exc Dia 3.1-4.0 Cm",,11404,CPT,Facility,Outpatient,,,,355,301.75,101.743,355,Aetna,Medicare Advantage,173.95,49,,percent of total billed charges,,
"Excision, Benign Lesion Inc Margins, Except Skintag, Trk, Arms Or Legs; Exc Dia 3.1-4.0 Cm",,11404,CPT,Facility,Inpatient,,,,355,301.75,101.743,355,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Excision, Benign Lesion Inc Margins, Except Skintag, Trk, Arms Or Legs; Exc Dia 3.1-4.0 Cm",,11404,CPT,Facility,Both,,,,355,301.75,101.743,355,Aetna,PPO,330.15,93,,percent of total billed charges,,
"Excision, Benign Lesion Inc Margins, Except Skintag, Trk, Arms Or Legs; Exc Dia 3.1-4.0 Cm",,11404,CPT,Facility,Both,,,,355,301.75,101.743,355,America's PPO,America's PPO,340.9065,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Excision, Benign Lesion Inc Margins, Except Skintag, Trk, Arms Or Legs; Exc Dia 3.1-4.0 Cm",,11404,CPT,Facility,Both,,,,355,301.75,101.743,355,BlueCross BlueShield Minnesota, Federal Employee Program,349.32,98.4,,percent of total billed charges,,
"Excision, Benign Lesion Inc Margins, Except Skintag, Trk, Arms Or Legs; Exc Dia 3.1-4.0 Cm",,11404,CPT,Facility,Both,,,,355,301.75,101.743,355,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,355,100,,percent of total billed charges,,
"Excision, Benign Lesion Inc Margins, Except Skintag, Trk, Arms Or Legs; Exc Dia 3.1-4.0 Cm",,11404,CPT,Facility,Both,,,,355,301.75,101.743,355,BlueCross BlueShield Minnesota,High Value Network Plan,319.5,90,,percent of total billed charges,,
"Excision, Benign Lesion Inc Margins, Except Skintag, Trk, Arms Or Legs; Exc Dia 3.1-4.0 Cm",,11404,CPT,Facility,Outpatient,,,,355,301.75,101.743,355,BlueCross BlueShield Minnesota,Medicare Advantage,173.95,49,,percent of total billed charges,,
"Excision, Benign Lesion Inc Margins, Except Skintag, Trk, Arms Or Legs; Exc Dia 3.1-4.0 Cm",,11404,CPT,Facility,Inpatient,,,,355,301.75,101.743,355,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Excision, Benign Lesion Inc Margins, Except Skintag, Trk, Arms Or Legs; Exc Dia 3.1-4.0 Cm",,11404,CPT,Facility,Both,,,,355,301.75,101.743,355,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,314.4235,88.57,,percent of total billed charges,,
"Excision, Benign Lesion Inc Margins, Except Skintag, Trk, Arms Or Legs; Exc Dia 3.1-4.0 Cm",,11404,CPT,Facility,Both,,,,355,301.75,101.743,355,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,101.743,28.66,,percent of total billed charges,,
"Excision, Benign Lesion Inc Margins, Except Skintag, Trk, Arms Or Legs; Exc Dia 3.1-4.0 Cm",,11404,CPT,Facility,Outpatient,,,,355,301.75,101.743,355,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),173.95,49,,percent of total billed charges,,
"Excision, Benign Lesion Inc Margins, Except Skintag, Trk, Arms Or Legs; Exc Dia 3.1-4.0 Cm",,11404,CPT,Facility,Inpatient,,,,355,301.75,101.743,355,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Excision, Benign Lesion Inc Margins, Except Skintag, Trk, Arms Or Legs; Exc Dia 3.1-4.0 Cm",,11404,CPT,Facility,Both,,,,355,301.75,101.743,355,CorVel,Worker's Compensation,355,100,,percent of total billed charges,,
"Excision, Benign Lesion Inc Margins, Except Skintag, Trk, Arms Or Legs; Exc Dia 3.1-4.0 Cm",,11404,CPT,Facility,Both,,,,355,301.75,101.743,355,First Health Group Corporation,First Health Network,344.35,97,,percent of total billed charges,,
"Excision, Benign Lesion Inc Margins, Except Skintag, Trk, Arms Or Legs; Exc Dia 3.1-4.0 Cm",,11404,CPT,Facility,Both,,,,355,301.75,101.743,355,"Health Partners, Inc.",Commercial,335.83,94.6,,percent of total billed charges,,
"Excision, Benign Lesion Inc Margins, Except Skintag, Trk, Arms Or Legs; Exc Dia 3.1-4.0 Cm",,11404,CPT,Facility,Outpatient,,,,355,301.75,101.743,355,"Health Partners, Inc.",Medicare Advantage,173.95,49,,percent of total billed charges,,
"Excision, Benign Lesion Inc Margins, Except Skintag, Trk, Arms Or Legs; Exc Dia 3.1-4.0 Cm",,11404,CPT,Facility,Inpatient,,,,355,301.75,101.743,355,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Excision, Benign Lesion Inc Margins, Except Skintag, Trk, Arms Or Legs; Exc Dia 3.1-4.0 Cm",,11404,CPT,Facility,Both,,,,355,301.75,101.743,355,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),213,60,,percent of total billed charges,,
"Excision, Benign Lesion Inc Margins, Except Skintag, Trk, Arms Or Legs; Exc Dia 3.1-4.0 Cm",,11404,CPT,Facility,Both,,,,355,301.75,101.743,355,"Health Partners, Inc.",State of Minnesota Advantage Program,289.325,81.5,,percent of total billed charges,,
"Excision, Benign Lesion Inc Margins, Except Skintag, Trk, Arms Or Legs; Exc Dia 3.1-4.0 Cm",,11404,CPT,Facility,Both,,,,355,301.75,101.743,355,"Health Partners, Inc.",State Public Programs,177.5,50,,percent of total billed charges,,
"Excision, Benign Lesion Inc Margins, Except Skintag, Trk, Arms Or Legs; Exc Dia 3.1-4.0 Cm",,11404,CPT,Facility,Both,,,,355,301.75,101.743,355,Humana Insurance Company,Commercial PPO,337.25,95,,percent of total billed charges,,
"Excision, Benign Lesion Inc Margins, Except Skintag, Trk, Arms Or Legs; Exc Dia 3.1-4.0 Cm",,11404,CPT,Facility,Outpatient,,,,355,301.75,101.743,355,Humana Insurance Company,Medicare PPO,173.95,49,,percent of total billed charges,,
"Excision, Benign Lesion Inc Margins, Except Skintag, Trk, Arms Or Legs; Exc Dia 3.1-4.0 Cm",,11404,CPT,Facility,Inpatient,,,,355,301.75,101.743,355,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Excision, Benign Lesion Inc Margins, Except Skintag, Trk, Arms Or Legs; Exc Dia 3.1-4.0 Cm",,11404,CPT,Facility,Both,,,,355,301.75,101.743,355,Medica,Individual & Family,351.805,99.1,,percent of total billed charges,,
"Excision, Benign Lesion Inc Margins, Except Skintag, Trk, Arms Or Legs; Exc Dia 3.1-4.0 Cm",,11404,CPT,Facility,Outpatient,,,,355,301.75,101.743,355,Medica,Medica Advantage Solution,176.79,49.8,,percent of total billed charges,,
"Excision, Benign Lesion Inc Margins, Except Skintag, Trk, Arms Or Legs; Exc Dia 3.1-4.0 Cm",,11404,CPT,Facility,Inpatient,,,,355,301.75,101.743,355,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Excision, Benign Lesion Inc Margins, Except Skintag, Trk, Arms Or Legs; Exc Dia 3.1-4.0 Cm",,11404,CPT,Facility,Outpatient,,,,355,301.75,101.743,355,Medica,Medical Assistance,158.33,44.6,,percent of total billed charges,,
"Excision, Benign Lesion Inc Margins, Except Skintag, Trk, Arms Or Legs; Exc Dia 3.1-4.0 Cm",,11404,CPT,Facility,Inpatient,,,,355,301.75,101.743,355,Medica,Medical Assistance,,,,,Included in per diem rate,
"Excision, Benign Lesion Inc Margins, Except Skintag, Trk, Arms Or Legs; Exc Dia 3.1-4.0 Cm",,11404,CPT,Facility,Outpatient,,,,355,301.75,101.743,355,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,176.79,49.8,,percent of total billed charges,,
"Excision, Benign Lesion Inc Margins, Except Skintag, Trk, Arms Or Legs; Exc Dia 3.1-4.0 Cm",,11404,CPT,Facility,Inpatient,,,,355,301.75,101.743,355,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Excision, Benign Lesion Inc Margins, Except Skintag, Trk, Arms Or Legs; Exc Dia 3.1-4.0 Cm",,11404,CPT,Facility,Both,,,,355,301.75,101.743,355,"Multiplan, Inc.","Multiplan, Inc.",333.7,94,,percent of total billed charges,,
"Excision, Benign Lesion Inc Margins, Except Skintag, Trk, Arms Or Legs; Exc Dia 3.1-4.0 Cm",,11404,CPT,Facility,Outpatient,,,,355,301.75,101.743,355,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,319.855,90.1,,percent of total billed charges,,
"Excision, Benign Lesion Inc Margins, Except Skintag, Trk, Arms Or Legs; Exc Dia 3.1-4.0 Cm",,11404,CPT,Facility,Inpatient,,,,355,301.75,101.743,355,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Excision, Benign Lesion Inc Margins, Except Skintag, Trk, Arms Or Legs; Exc Dia 3.1-4.0 Cm",,11404,CPT,Facility,Both,,,,355,301.75,101.743,355,"Preferred One Administrative Services, INC.",PPO,350.03,98.6,,percent of total billed charges,,
"Excision, Benign Lesion Inc Margins, Except Skintag, Trk, Arms Or Legs; Exc Dia 3.1-4.0 Cm",,11404,CPT,Facility,Outpatient,,,,355,301.75,101.743,355,PrimeWest Health,Minnesota Senior Health Options (MSHO),182.6475,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Excision, Benign Lesion Inc Margins, Except Skintag, Trk, Arms Or Legs; Exc Dia 3.1-4.0 Cm",,11404,CPT,Facility,Inpatient,,,,355,301.75,101.743,355,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Excision, Benign Lesion Inc Margins, Except Skintag, Trk, Arms Or Legs; Exc Dia 3.1-4.0 Cm",,11404,CPT,Facility,Outpatient,,,,355,301.75,101.743,355,PrimeWest Health,MinnesotaCare,182.328,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Excision, Benign Lesion Inc Margins, Except Skintag, Trk, Arms Or Legs; Exc Dia 3.1-4.0 Cm",,11404,CPT,Facility,Inpatient,,,,355,301.75,101.743,355,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Excision, Benign Lesion Inc Margins, Except Skintag, Trk, Arms Or Legs; Exc Dia 3.1-4.0 Cm",,11404,CPT,Facility,Both,,,,355,301.75,101.743,355,Sanford Health Plan,Sanford Health Plan,326.6,92,,percent of total billed charges,,
"Excision, Benign Lesion Inc Margins, Except Skintag, Trk, Arms Or Legs; Exc Dia 3.1-4.0 Cm",,11404,CPT,Facility,Outpatient,,,,355,301.75,101.743,355,"UCare Health, Inc.",Individual & Family Plan,200.0425,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Excision, Benign Lesion Inc Margins, Except Skintag, Trk, Arms Or Legs; Exc Dia 3.1-4.0 Cm",,11404,CPT,Facility,Inpatient,,,,355,301.75,101.743,355,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Excision, Benign Lesion Inc Margins, Except Skintag, Trk, Arms Or Legs; Exc Dia 3.1-4.0 Cm",,11404,CPT,Facility,Outpatient,,,,355,301.75,101.743,355,"UCare Health, Inc.",Medical Assistance,179.1685,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Excision, Benign Lesion Inc Margins, Except Skintag, Trk, Arms Or Legs; Exc Dia 3.1-4.0 Cm",,11404,CPT,Facility,Inpatient,,,,355,301.75,101.743,355,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Excision, Benign Lesion Inc Margins, Except Skintag, Trk, Arms Or Legs; Exc Dia 3.1-4.0 Cm",,11404,CPT,Facility,Outpatient,,,,355,301.75,101.743,355,"UCare Health, Inc.",Medicare Advantage,179.1685,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Excision, Benign Lesion Inc Margins, Except Skintag, Trk, Arms Or Legs; Exc Dia 3.1-4.0 Cm",,11404,CPT,Facility,Inpatient,,,,355,301.75,101.743,355,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Excision, Benign Lesion Inc Margins, Except Skintag, Trk, Arms Or Legs; Exc Dia 3.1-4.0 Cm",,11404,CPT,Facility,Outpatient,,,,355,301.75,101.743,355,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),179.1685,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Excision, Benign Lesion Inc Margins, Except Skintag, Trk, Arms Or Legs; Exc Dia 3.1-4.0 Cm",,11404,CPT,Facility,Inpatient,,,,355,301.75,101.743,355,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Excision, Benign Lesion Inc Margins, Except Skintag, Trk, Arms Or Legs; Exc Dia 3.1-4.0 Cm",,11404,CPT,Facility,Both,,,,355,301.75,101.743,355,UnitedHealthcare,Individual & Family,333.7,94,,percent of total billed charges,,
"Excision, Benign Lesion Inc Margins, Except Skintag, Trk, Arms Or Legs; Exc Dia 3.1-4.0 Cm",,11404,CPT,Facility,Outpatient,,,,355,301.75,101.743,355,UnitedHealthcare,Medicare Advantage,173.95,49,,percent of total billed charges,,
"Excision, Benign Lesion Inc Margins, Except Skintag, Trk, Arms Or Legs; Exc Dia 3.1-4.0 Cm",,11404,CPT,Facility,Inpatient,,,,355,301.75,101.743,355,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Excision, Benign Lesion Inc Margins, Except Skintag, Trk, Arms Or Legs; Exc Dia 3.1-4.0 Cm",,11404,CPT,Facility,Outpatient,,,,355,301.75,101.743,355,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,170.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Excision, Benign Lesion Inc Margins, Except Skintag, Trk, Arms Or Legs; Exc Dia 3.1-4.0 Cm",,11404,CPT,Facility,Inpatient,,,,355,301.75,101.743,355,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Excision, Benign Lesion Inc Margins, Except Skintag, Trk, Arms Or Legs; Exc Dia 3.1-4.0 Cm (Pro Cah)",,11404,CPT,Professional,Both,,,,535,454.75,102.96,535,Aetna,Commercial,454.75,85,,percent of total billed charges,,
"Excision, Benign Lesion Inc Margins, Except Skintag, Trk, Arms Or Legs; Exc Dia 3.1-4.0 Cm (Pro Cah)",,11404,CPT,Professional,Both,,,,535,454.75,102.96,535,Aetna,Medicare Advantage,159.46,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Benign Lesion Inc Margins, Except Skintag, Trk, Arms Or Legs; Exc Dia 3.1-4.0 Cm (Pro Cah)",,11404,CPT,Professional,Both,,,,535,454.75,102.96,535,Aetna,PPO,497.55,93,,percent of total billed charges,,
"Excision, Benign Lesion Inc Margins, Except Skintag, Trk, Arms Or Legs; Exc Dia 3.1-4.0 Cm (Pro Cah)",,11404,CPT,Professional,Both,,,,535,454.75,102.96,535,America's PPO,America's PPO,457.104,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Excision, Benign Lesion Inc Margins, Except Skintag, Trk, Arms Or Legs; Exc Dia 3.1-4.0 Cm (Pro Cah)",,11404,CPT,Professional,Both,,,,535,454.75,102.96,535,BlueCross BlueShield Minnesota, Federal Employee Program,338.1,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Excision, Benign Lesion Inc Margins, Except Skintag, Trk, Arms Or Legs; Exc Dia 3.1-4.0 Cm (Pro Cah)",,11404,CPT,Professional,Both,,,,535,454.75,102.96,535,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,343.5096,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Benign Lesion Inc Margins, Except Skintag, Trk, Arms Or Legs; Exc Dia 3.1-4.0 Cm (Pro Cah)",,11404,CPT,Professional,Both,,,,535,454.75,102.96,535,BlueCross BlueShield Minnesota,High Value Network Plan,343.5096,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Benign Lesion Inc Margins, Except Skintag, Trk, Arms Or Legs; Exc Dia 3.1-4.0 Cm (Pro Cah)",,11404,CPT,Professional,Both,,,,535,454.75,102.96,535,BlueCross BlueShield Minnesota,Medicare Advantage,183.9655,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Benign Lesion Inc Margins, Except Skintag, Trk, Arms Or Legs; Exc Dia 3.1-4.0 Cm (Pro Cah)",,11404,CPT,Professional,Both,,,,535,454.75,102.96,535,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,343.5096,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Benign Lesion Inc Margins, Except Skintag, Trk, Arms Or Legs; Exc Dia 3.1-4.0 Cm (Pro Cah)",,11404,CPT,Professional,Both,,,,535,454.75,102.96,535,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,118.872,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision, Benign Lesion Inc Margins, Except Skintag, Trk, Arms Or Legs; Exc Dia 3.1-4.0 Cm (Pro Cah)",,11404,CPT,Professional,Both,,,,535,454.75,102.96,535,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),183.9655,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Benign Lesion Inc Margins, Except Skintag, Trk, Arms Or Legs; Exc Dia 3.1-4.0 Cm (Pro Cah)",,11404,CPT,Professional,Both,,,,535,454.75,102.96,535,CorVel,Worker's Compensation,311.0528511,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Excision, Benign Lesion Inc Margins, Except Skintag, Trk, Arms Or Legs; Exc Dia 3.1-4.0 Cm (Pro Cah)",,11404,CPT,Professional,Both,,,,535,454.75,102.96,535,First Health Group Corporation,First Health Network,518.95,97,,percent of total billed charges,,
"Excision, Benign Lesion Inc Margins, Except Skintag, Trk, Arms Or Legs; Exc Dia 3.1-4.0 Cm (Pro Cah)",,11404,CPT,Professional,Both,,,,535,454.75,102.96,535,"Health Partners, Inc.",Commercial,335.92,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision, Benign Lesion Inc Margins, Except Skintag, Trk, Arms Or Legs; Exc Dia 3.1-4.0 Cm (Pro Cah)",,11404,CPT,Professional,Both,,,,535,454.75,102.96,535,"Health Partners, Inc.",Medicare Advantage,183.9655,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Benign Lesion Inc Margins, Except Skintag, Trk, Arms Or Legs; Exc Dia 3.1-4.0 Cm (Pro Cah)",,11404,CPT,Professional,Both,,,,535,454.75,102.96,535,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),159.95,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Excision, Benign Lesion Inc Margins, Except Skintag, Trk, Arms Or Legs; Exc Dia 3.1-4.0 Cm (Pro Cah)",,11404,CPT,Professional,Both,,,,535,454.75,102.96,535,"Health Partners, Inc.",State of Minnesota Advantage Program,289.39508,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision, Benign Lesion Inc Margins, Except Skintag, Trk, Arms Or Legs; Exc Dia 3.1-4.0 Cm (Pro Cah)",,11404,CPT,Professional,Both,,,,535,454.75,102.96,535,"Health Partners, Inc.",State Public Programs,102.96,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Excision, Benign Lesion Inc Margins, Except Skintag, Trk, Arms Or Legs; Exc Dia 3.1-4.0 Cm (Pro Cah)",,11404,CPT,Professional,Both,,,,535,454.75,102.96,535,Humana Insurance Company,Commercial PPO,159.97,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Excision, Benign Lesion Inc Margins, Except Skintag, Trk, Arms Or Legs; Exc Dia 3.1-4.0 Cm (Pro Cah)",,11404,CPT,Professional,Both,,,,535,454.75,102.96,535,Humana Insurance Company,Medicare PPO,535,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Excision, Benign Lesion Inc Margins, Except Skintag, Trk, Arms Or Legs; Exc Dia 3.1-4.0 Cm (Pro Cah)",,11404,CPT,Professional,Both,,,,535,454.75,102.96,535,Medica,Individual & Family,453.68,84.8,,percent of total billed charges,,
"Excision, Benign Lesion Inc Margins, Except Skintag, Trk, Arms Or Legs; Exc Dia 3.1-4.0 Cm (Pro Cah)",,11404,CPT,Professional,Both,,,,535,454.75,102.96,535,Medica,Medica Advantage Solution,266.43,49.8,,percent of total billed charges,,
"Excision, Benign Lesion Inc Margins, Except Skintag, Trk, Arms Or Legs; Exc Dia 3.1-4.0 Cm (Pro Cah)",,11404,CPT,Professional,Both,,,,535,454.75,102.96,535,Medica,Medical Assistance,118.87,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Excision, Benign Lesion Inc Margins, Except Skintag, Trk, Arms Or Legs; Exc Dia 3.1-4.0 Cm (Pro Cah)",,11404,CPT,Professional,Both,,,,535,454.75,102.96,535,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,159.97,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Excision, Benign Lesion Inc Margins, Except Skintag, Trk, Arms Or Legs; Exc Dia 3.1-4.0 Cm (Pro Cah)",,11404,CPT,Professional,Both,,,,535,454.75,102.96,535,"Multiplan, Inc.","Multiplan, Inc.",502.9,94,,percent of total billed charges,,
"Excision, Benign Lesion Inc Margins, Except Skintag, Trk, Arms Or Legs; Exc Dia 3.1-4.0 Cm (Pro Cah)",,11404,CPT,Professional,Both,,,,535,454.75,102.96,535,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,482.035,90.1,,percent of total billed charges,,
"Excision, Benign Lesion Inc Margins, Except Skintag, Trk, Arms Or Legs; Exc Dia 3.1-4.0 Cm (Pro Cah)",,11404,CPT,Professional,Both,,,,535,454.75,102.96,535,"Preferred One Administrative Services, INC.",PPO,527.51,98.6,,percent of total billed charges,,
"Excision, Benign Lesion Inc Margins, Except Skintag, Trk, Arms Or Legs; Exc Dia 3.1-4.0 Cm (Pro Cah)",,11404,CPT,Professional,Both,,,,535,454.75,102.96,535,PrimeWest Health,Minnesota Senior Health Options (MSHO),183.9655,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Benign Lesion Inc Margins, Except Skintag, Trk, Arms Or Legs; Exc Dia 3.1-4.0 Cm (Pro Cah)",,11404,CPT,Professional,Both,,,,535,454.75,102.96,535,PrimeWest Health,MinnesotaCare,127.19304,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision, Benign Lesion Inc Margins, Except Skintag, Trk, Arms Or Legs; Exc Dia 3.1-4.0 Cm (Pro Cah)",,11404,CPT,Professional,Both,,,,535,454.75,102.96,535,Sanford Health Plan,Sanford Health Plan,470.8,88,,percent of total billed charges,,
"Excision, Benign Lesion Inc Margins, Except Skintag, Trk, Arms Or Legs; Exc Dia 3.1-4.0 Cm (Pro Cah)",,11404,CPT,Professional,Both,,,,535,454.75,102.96,535,"UCare Health, Inc.",Individual & Family Plan,260.047232,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Excision, Benign Lesion Inc Margins, Except Skintag, Trk, Arms Or Legs; Exc Dia 3.1-4.0 Cm (Pro Cah)",,11404,CPT,Professional,Both,,,,535,454.75,102.96,535,"UCare Health, Inc.",Medical Assistance,130.7592,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Excision, Benign Lesion Inc Margins, Except Skintag, Trk, Arms Or Legs; Exc Dia 3.1-4.0 Cm (Pro Cah)",,11404,CPT,Professional,Both,,,,535,454.75,102.96,535,"UCare Health, Inc.",Medicare Advantage,183.9655,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Excision, Benign Lesion Inc Margins, Except Skintag, Trk, Arms Or Legs; Exc Dia 3.1-4.0 Cm (Pro Cah)",,11404,CPT,Professional,Both,,,,535,454.75,102.96,535,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),147.1724,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Excision, Benign Lesion Inc Margins, Except Skintag, Trk, Arms Or Legs; Exc Dia 3.1-4.0 Cm (Pro Cah)",,11404,CPT,Professional,Both,,,,535,454.75,102.96,535,UnitedHealthcare,Individual & Family,535,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Excision, Benign Lesion Inc Margins, Except Skintag, Trk, Arms Or Legs; Exc Dia 3.1-4.0 Cm (Pro Cah)",,11404,CPT,Professional,Both,,,,535,454.75,102.96,535,UnitedHealthcare,Medicare Advantage,183.9655,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Benign Lesion Inc Margins, Except Skintag, Trk, Arms Or Legs; Exc Dia 3.1-4.0 Cm (Pro Cah)",,11404,CPT,Professional,Both,,,,535,454.75,102.96,535,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,118.872,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision, Benign Lesion Including Margins, Except Skin Tag, Trunk, Arms Or Legs; Excised Dia Over 4.0 Cm",,11406,CPT,Facility,Both,,,,430,365.5,123.238,724,Aetna,Commercial,395.6,92,,percent of total billed charges,,
"Excision, Benign Lesion Including Margins, Except Skin Tag, Trunk, Arms Or Legs; Excised Dia Over 4.0 Cm",,11406,CPT,Facility,Outpatient,,,,430,365.5,123.238,724,Aetna,Medicare Advantage,210.7,49,,percent of total billed charges,,
"Excision, Benign Lesion Including Margins, Except Skin Tag, Trunk, Arms Or Legs; Excised Dia Over 4.0 Cm",,11406,CPT,Facility,Inpatient,,,,430,365.5,123.238,724,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Excision, Benign Lesion Including Margins, Except Skin Tag, Trunk, Arms Or Legs; Excised Dia Over 4.0 Cm",,11406,CPT,Facility,Both,,,,430,365.5,123.238,724,Aetna,PPO,399.9,93,,percent of total billed charges,,
"Excision, Benign Lesion Including Margins, Except Skin Tag, Trunk, Arms Or Legs; Excised Dia Over 4.0 Cm",,11406,CPT,Facility,Both,,,,430,365.5,123.238,724,America's PPO,America's PPO,412.929,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Excision, Benign Lesion Including Margins, Except Skin Tag, Trunk, Arms Or Legs; Excised Dia Over 4.0 Cm",,11406,CPT,Facility,Both,,,,430,365.5,123.238,724,BlueCross BlueShield Minnesota, Federal Employee Program,423.12,98.4,,percent of total billed charges,,
"Excision, Benign Lesion Including Margins, Except Skin Tag, Trunk, Arms Or Legs; Excised Dia Over 4.0 Cm",,11406,CPT,Facility,Both,,,,430,365.5,123.238,724,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,430,100,,percent of total billed charges,,
"Excision, Benign Lesion Including Margins, Except Skin Tag, Trunk, Arms Or Legs; Excised Dia Over 4.0 Cm",,11406,CPT,Facility,Both,,,,430,365.5,123.238,724,BlueCross BlueShield Minnesota,High Value Network Plan,387,90,,percent of total billed charges,,
"Excision, Benign Lesion Including Margins, Except Skin Tag, Trunk, Arms Or Legs; Excised Dia Over 4.0 Cm",,11406,CPT,Facility,Outpatient,,,,430,365.5,123.238,724,BlueCross BlueShield Minnesota,Medicare Advantage,210.7,49,,percent of total billed charges,,
"Excision, Benign Lesion Including Margins, Except Skin Tag, Trunk, Arms Or Legs; Excised Dia Over 4.0 Cm",,11406,CPT,Facility,Inpatient,,,,430,365.5,123.238,724,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Excision, Benign Lesion Including Margins, Except Skin Tag, Trunk, Arms Or Legs; Excised Dia Over 4.0 Cm",,11406,CPT,Facility,Both,,,,430,365.5,123.238,724,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,380.851,88.57,,percent of total billed charges,,
"Excision, Benign Lesion Including Margins, Except Skin Tag, Trunk, Arms Or Legs; Excised Dia Over 4.0 Cm",,11406,CPT,Facility,Both,,,,430,365.5,123.238,724,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,123.238,28.66,,percent of total billed charges,,
"Excision, Benign Lesion Including Margins, Except Skin Tag, Trunk, Arms Or Legs; Excised Dia Over 4.0 Cm",,11406,CPT,Facility,Outpatient,,,,430,365.5,123.238,724,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),210.7,49,,percent of total billed charges,,
"Excision, Benign Lesion Including Margins, Except Skin Tag, Trunk, Arms Or Legs; Excised Dia Over 4.0 Cm",,11406,CPT,Facility,Inpatient,,,,430,365.5,123.238,724,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Excision, Benign Lesion Including Margins, Except Skin Tag, Trunk, Arms Or Legs; Excised Dia Over 4.0 Cm",,11406,CPT,Facility,Both,,,,430,365.5,123.238,724,CorVel,Worker's Compensation,430,100,,percent of total billed charges,,
"Excision, Benign Lesion Including Margins, Except Skin Tag, Trunk, Arms Or Legs; Excised Dia Over 4.0 Cm",,11406,CPT,Facility,Both,,,,430,365.5,123.238,724,First Health Group Corporation,First Health Network,417.1,97,,percent of total billed charges,,
"Excision, Benign Lesion Including Margins, Except Skin Tag, Trunk, Arms Or Legs; Excised Dia Over 4.0 Cm",,11406,CPT,Facility,Both,,,,430,365.5,123.238,724,"Health Partners, Inc.",Commercial,406.78,94.6,,percent of total billed charges,,
"Excision, Benign Lesion Including Margins, Except Skin Tag, Trunk, Arms Or Legs; Excised Dia Over 4.0 Cm",,11406,CPT,Facility,Outpatient,,,,430,365.5,123.238,724,"Health Partners, Inc.",Medicare Advantage,210.7,49,,percent of total billed charges,,
"Excision, Benign Lesion Including Margins, Except Skin Tag, Trunk, Arms Or Legs; Excised Dia Over 4.0 Cm",,11406,CPT,Facility,Inpatient,,,,430,365.5,123.238,724,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Excision, Benign Lesion Including Margins, Except Skin Tag, Trunk, Arms Or Legs; Excised Dia Over 4.0 Cm",,11406,CPT,Facility,Both,,,,430,365.5,123.238,724,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),258,60,,percent of total billed charges,,
"Excision, Benign Lesion Including Margins, Except Skin Tag, Trunk, Arms Or Legs; Excised Dia Over 4.0 Cm",,11406,CPT,Facility,Both,,,,430,365.5,123.238,724,"Health Partners, Inc.",State of Minnesota Advantage Program,350.45,81.5,,percent of total billed charges,,
"Excision, Benign Lesion Including Margins, Except Skin Tag, Trunk, Arms Or Legs; Excised Dia Over 4.0 Cm",,11406,CPT,Facility,Both,,,,430,365.5,123.238,724,"Health Partners, Inc.",State Public Programs,215,50,,percent of total billed charges,,
"Excision, Benign Lesion Including Margins, Except Skin Tag, Trunk, Arms Or Legs; Excised Dia Over 4.0 Cm",,11406,CPT,Facility,Both,,,,430,365.5,123.238,724,Humana Insurance Company,Commercial PPO,408.5,95,,percent of total billed charges,,
"Excision, Benign Lesion Including Margins, Except Skin Tag, Trunk, Arms Or Legs; Excised Dia Over 4.0 Cm",,11406,CPT,Facility,Outpatient,,,,430,365.5,123.238,724,Humana Insurance Company,Medicare PPO,210.7,49,,percent of total billed charges,,
"Excision, Benign Lesion Including Margins, Except Skin Tag, Trunk, Arms Or Legs; Excised Dia Over 4.0 Cm",,11406,CPT,Facility,Inpatient,,,,430,365.5,123.238,724,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Excision, Benign Lesion Including Margins, Except Skin Tag, Trunk, Arms Or Legs; Excised Dia Over 4.0 Cm",,11406,CPT,Facility,Both,,,,430,365.5,123.238,724,Medica,Individual & Family,426.13,99.1,,percent of total billed charges,,
"Excision, Benign Lesion Including Margins, Except Skin Tag, Trunk, Arms Or Legs; Excised Dia Over 4.0 Cm",,11406,CPT,Facility,Outpatient,,,,430,365.5,123.238,724,Medica,Medica Advantage Solution,214.14,49.8,,percent of total billed charges,,
"Excision, Benign Lesion Including Margins, Except Skin Tag, Trunk, Arms Or Legs; Excised Dia Over 4.0 Cm",,11406,CPT,Facility,Inpatient,,,,430,365.5,123.238,724,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Excision, Benign Lesion Including Margins, Except Skin Tag, Trunk, Arms Or Legs; Excised Dia Over 4.0 Cm",,11406,CPT,Facility,Outpatient,,,,430,365.5,123.238,724,Medica,Medical Assistance,724,,,Other,Grouper,All inclusive per visit
"Excision, Benign Lesion Including Margins, Except Skin Tag, Trunk, Arms Or Legs; Excised Dia Over 4.0 Cm",,11406,CPT,Facility,Inpatient,,,,430,365.5,123.238,724,Medica,Medical Assistance,,,,,Included in per diem rate,
"Excision, Benign Lesion Including Margins, Except Skin Tag, Trunk, Arms Or Legs; Excised Dia Over 4.0 Cm",,11406,CPT,Facility,Outpatient,,,,430,365.5,123.238,724,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,214.14,49.8,,percent of total billed charges,,
"Excision, Benign Lesion Including Margins, Except Skin Tag, Trunk, Arms Or Legs; Excised Dia Over 4.0 Cm",,11406,CPT,Facility,Inpatient,,,,430,365.5,123.238,724,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Excision, Benign Lesion Including Margins, Except Skin Tag, Trunk, Arms Or Legs; Excised Dia Over 4.0 Cm",,11406,CPT,Facility,Both,,,,430,365.5,123.238,724,"Multiplan, Inc.","Multiplan, Inc.",404.2,94,,percent of total billed charges,,
"Excision, Benign Lesion Including Margins, Except Skin Tag, Trunk, Arms Or Legs; Excised Dia Over 4.0 Cm",,11406,CPT,Facility,Outpatient,,,,430,365.5,123.238,724,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,387.43,90.1,,percent of total billed charges,,
"Excision, Benign Lesion Including Margins, Except Skin Tag, Trunk, Arms Or Legs; Excised Dia Over 4.0 Cm",,11406,CPT,Facility,Inpatient,,,,430,365.5,123.238,724,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Excision, Benign Lesion Including Margins, Except Skin Tag, Trunk, Arms Or Legs; Excised Dia Over 4.0 Cm",,11406,CPT,Facility,Both,,,,430,365.5,123.238,724,"Preferred One Administrative Services, INC.",PPO,423.98,98.6,,percent of total billed charges,,
"Excision, Benign Lesion Including Margins, Except Skin Tag, Trunk, Arms Or Legs; Excised Dia Over 4.0 Cm",,11406,CPT,Facility,Outpatient,,,,430,365.5,123.238,724,PrimeWest Health,Minnesota Senior Health Options (MSHO),221.235,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Excision, Benign Lesion Including Margins, Except Skin Tag, Trunk, Arms Or Legs; Excised Dia Over 4.0 Cm",,11406,CPT,Facility,Inpatient,,,,430,365.5,123.238,724,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Excision, Benign Lesion Including Margins, Except Skin Tag, Trunk, Arms Or Legs; Excised Dia Over 4.0 Cm",,11406,CPT,Facility,Outpatient,,,,430,365.5,123.238,724,PrimeWest Health,MinnesotaCare,220.848,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Excision, Benign Lesion Including Margins, Except Skin Tag, Trunk, Arms Or Legs; Excised Dia Over 4.0 Cm",,11406,CPT,Facility,Inpatient,,,,430,365.5,123.238,724,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Excision, Benign Lesion Including Margins, Except Skin Tag, Trunk, Arms Or Legs; Excised Dia Over 4.0 Cm",,11406,CPT,Facility,Both,,,,430,365.5,123.238,724,Sanford Health Plan,Sanford Health Plan,395.6,92,,percent of total billed charges,,
"Excision, Benign Lesion Including Margins, Except Skin Tag, Trunk, Arms Or Legs; Excised Dia Over 4.0 Cm",,11406,CPT,Facility,Outpatient,,,,430,365.5,123.238,724,"UCare Health, Inc.",Individual & Family Plan,242.305,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Excision, Benign Lesion Including Margins, Except Skin Tag, Trunk, Arms Or Legs; Excised Dia Over 4.0 Cm",,11406,CPT,Facility,Inpatient,,,,430,365.5,123.238,724,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Excision, Benign Lesion Including Margins, Except Skin Tag, Trunk, Arms Or Legs; Excised Dia Over 4.0 Cm",,11406,CPT,Facility,Outpatient,,,,430,365.5,123.238,724,"UCare Health, Inc.",Medical Assistance,217.021,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Excision, Benign Lesion Including Margins, Except Skin Tag, Trunk, Arms Or Legs; Excised Dia Over 4.0 Cm",,11406,CPT,Facility,Inpatient,,,,430,365.5,123.238,724,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Excision, Benign Lesion Including Margins, Except Skin Tag, Trunk, Arms Or Legs; Excised Dia Over 4.0 Cm",,11406,CPT,Facility,Outpatient,,,,430,365.5,123.238,724,"UCare Health, Inc.",Medicare Advantage,217.021,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Excision, Benign Lesion Including Margins, Except Skin Tag, Trunk, Arms Or Legs; Excised Dia Over 4.0 Cm",,11406,CPT,Facility,Inpatient,,,,430,365.5,123.238,724,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Excision, Benign Lesion Including Margins, Except Skin Tag, Trunk, Arms Or Legs; Excised Dia Over 4.0 Cm",,11406,CPT,Facility,Outpatient,,,,430,365.5,123.238,724,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),217.021,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Excision, Benign Lesion Including Margins, Except Skin Tag, Trunk, Arms Or Legs; Excised Dia Over 4.0 Cm",,11406,CPT,Facility,Inpatient,,,,430,365.5,123.238,724,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Excision, Benign Lesion Including Margins, Except Skin Tag, Trunk, Arms Or Legs; Excised Dia Over 4.0 Cm",,11406,CPT,Facility,Both,,,,430,365.5,123.238,724,UnitedHealthcare,Individual & Family,404.2,94,,percent of total billed charges,,
"Excision, Benign Lesion Including Margins, Except Skin Tag, Trunk, Arms Or Legs; Excised Dia Over 4.0 Cm",,11406,CPT,Facility,Outpatient,,,,430,365.5,123.238,724,UnitedHealthcare,Medicare Advantage,210.7,49,,percent of total billed charges,,
"Excision, Benign Lesion Including Margins, Except Skin Tag, Trunk, Arms Or Legs; Excised Dia Over 4.0 Cm",,11406,CPT,Facility,Inpatient,,,,430,365.5,123.238,724,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Excision, Benign Lesion Including Margins, Except Skin Tag, Trunk, Arms Or Legs; Excised Dia Over 4.0 Cm",,11406,CPT,Facility,Outpatient,,,,430,365.5,123.238,724,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,206.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Excision, Benign Lesion Including Margins, Except Skin Tag, Trunk, Arms Or Legs; Excised Dia Over 4.0 Cm",,11406,CPT,Facility,Inpatient,,,,430,365.5,123.238,724,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Excision, Benign Lesion Including Margins, Except Skin Tag, Trunk, Arms Or Legs; Excised Diameter Over 4.0 Cm (Pro Cah)",,11406,CPT,Professional,Both,,,,1496,1271.6,153.14,1496,Aetna,Commercial,1271.6,85,,percent of total billed charges,,
"Excision, Benign Lesion Including Margins, Except Skin Tag, Trunk, Arms Or Legs; Excised Diameter Over 4.0 Cm (Pro Cah)",,11406,CPT,Professional,Both,,,,745,633.25,153.14,745,Aetna,Commercial,633.25,85,,percent of total billed charges,,
"Excision, Benign Lesion Including Margins, Except Skin Tag, Trunk, Arms Or Legs; Excised Diameter Over 4.0 Cm (Pro Cah)",,11406,CPT,Professional,Both,,,,1496,1271.6,153.14,1496,Aetna,Medicare Advantage,239.34,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Benign Lesion Including Margins, Except Skin Tag, Trunk, Arms Or Legs; Excised Diameter Over 4.0 Cm (Pro Cah)",,11406,CPT,Professional,Both,,,,745,633.25,153.14,745,Aetna,Medicare Advantage,239.34,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Benign Lesion Including Margins, Except Skin Tag, Trunk, Arms Or Legs; Excised Diameter Over 4.0 Cm (Pro Cah)",,11406,CPT,Professional,Both,,,,1496,1271.6,153.14,1496,Aetna,PPO,1391.28,93,,percent of total billed charges,,
"Excision, Benign Lesion Including Margins, Except Skin Tag, Trunk, Arms Or Legs; Excised Diameter Over 4.0 Cm (Pro Cah)",,11406,CPT,Professional,Both,,,,745,633.25,153.14,745,Aetna,PPO,692.85,93,,percent of total billed charges,,
"Excision, Benign Lesion Including Margins, Except Skin Tag, Trunk, Arms Or Legs; Excised Diameter Over 4.0 Cm (Pro Cah)",,11406,CPT,Professional,Both,,,,1496,1271.6,153.14,1496,America's PPO,America's PPO,1278.1824,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Excision, Benign Lesion Including Margins, Except Skin Tag, Trunk, Arms Or Legs; Excised Diameter Over 4.0 Cm (Pro Cah)",,11406,CPT,Professional,Both,,,,745,633.25,153.14,745,America's PPO,America's PPO,636.528,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Excision, Benign Lesion Including Margins, Except Skin Tag, Trunk, Arms Or Legs; Excised Diameter Over 4.0 Cm (Pro Cah)",,11406,CPT,Professional,Both,,,,1496,1271.6,153.14,1496,BlueCross BlueShield Minnesota, Federal Employee Program,509.56,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Excision, Benign Lesion Including Margins, Except Skin Tag, Trunk, Arms Or Legs; Excised Diameter Over 4.0 Cm (Pro Cah)",,11406,CPT,Professional,Both,,,,745,633.25,153.14,745,BlueCross BlueShield Minnesota, Federal Employee Program,509.56,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Excision, Benign Lesion Including Margins, Except Skin Tag, Trunk, Arms Or Legs; Excised Diameter Over 4.0 Cm (Pro Cah)",,11406,CPT,Professional,Both,,,,1496,1271.6,153.14,1496,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,517.71296,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Benign Lesion Including Margins, Except Skin Tag, Trunk, Arms Or Legs; Excised Diameter Over 4.0 Cm (Pro Cah)",,11406,CPT,Professional,Both,,,,745,633.25,153.14,745,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,517.71296,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Benign Lesion Including Margins, Except Skin Tag, Trunk, Arms Or Legs; Excised Diameter Over 4.0 Cm (Pro Cah)",,11406,CPT,Professional,Both,,,,1496,1271.6,153.14,1496,BlueCross BlueShield Minnesota,High Value Network Plan,517.71296,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Benign Lesion Including Margins, Except Skin Tag, Trunk, Arms Or Legs; Excised Diameter Over 4.0 Cm (Pro Cah)",,11406,CPT,Professional,Both,,,,745,633.25,153.14,745,BlueCross BlueShield Minnesota,High Value Network Plan,517.71296,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Benign Lesion Including Margins, Except Skin Tag, Trunk, Arms Or Legs; Excised Diameter Over 4.0 Cm (Pro Cah)",,11406,CPT,Professional,Both,,,,1496,1271.6,153.14,1496,BlueCross BlueShield Minnesota,Medicare Advantage,273.2975,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Benign Lesion Including Margins, Except Skin Tag, Trunk, Arms Or Legs; Excised Diameter Over 4.0 Cm (Pro Cah)",,11406,CPT,Professional,Both,,,,745,633.25,153.14,745,BlueCross BlueShield Minnesota,Medicare Advantage,273.2975,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Benign Lesion Including Margins, Except Skin Tag, Trunk, Arms Or Legs; Excised Diameter Over 4.0 Cm (Pro Cah)",,11406,CPT,Professional,Both,,,,1496,1271.6,153.14,1496,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,517.71296,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Benign Lesion Including Margins, Except Skin Tag, Trunk, Arms Or Legs; Excised Diameter Over 4.0 Cm (Pro Cah)",,11406,CPT,Professional,Both,,,,745,633.25,153.14,745,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,517.71296,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Benign Lesion Including Margins, Except Skin Tag, Trunk, Arms Or Legs; Excised Diameter Over 4.0 Cm (Pro Cah)",,11406,CPT,Professional,Both,,,,1496,1271.6,153.14,1496,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,176.80432,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision, Benign Lesion Including Margins, Except Skin Tag, Trunk, Arms Or Legs; Excised Diameter Over 4.0 Cm (Pro Cah)",,11406,CPT,Professional,Both,,,,745,633.25,153.14,745,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,176.80432,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision, Benign Lesion Including Margins, Except Skin Tag, Trunk, Arms Or Legs; Excised Diameter Over 4.0 Cm (Pro Cah)",,11406,CPT,Professional,Both,,,,1496,1271.6,153.14,1496,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),273.2975,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Benign Lesion Including Margins, Except Skin Tag, Trunk, Arms Or Legs; Excised Diameter Over 4.0 Cm (Pro Cah)",,11406,CPT,Professional,Both,,,,745,633.25,153.14,745,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),273.2975,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Benign Lesion Including Margins, Except Skin Tag, Trunk, Arms Or Legs; Excised Diameter Over 4.0 Cm (Pro Cah)",,11406,CPT,Professional,Both,,,,1496,1271.6,153.14,1496,CorVel,Worker's Compensation,465.5062359,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Excision, Benign Lesion Including Margins, Except Skin Tag, Trunk, Arms Or Legs; Excised Diameter Over 4.0 Cm (Pro Cah)",,11406,CPT,Professional,Both,,,,745,633.25,153.14,745,CorVel,Worker's Compensation,465.5062359,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Excision, Benign Lesion Including Margins, Except Skin Tag, Trunk, Arms Or Legs; Excised Diameter Over 4.0 Cm (Pro Cah)",,11406,CPT,Professional,Both,,,,1496,1271.6,153.14,1496,First Health Group Corporation,First Health Network,1451.12,97,,percent of total billed charges,,
"Excision, Benign Lesion Including Margins, Except Skin Tag, Trunk, Arms Or Legs; Excised Diameter Over 4.0 Cm (Pro Cah)",,11406,CPT,Professional,Both,,,,745,633.25,153.14,745,First Health Group Corporation,First Health Network,722.65,97,,percent of total billed charges,,
"Excision, Benign Lesion Including Margins, Except Skin Tag, Trunk, Arms Or Legs; Excised Diameter Over 4.0 Cm (Pro Cah)",,11406,CPT,Professional,Both,,,,1496,1271.6,153.14,1496,"Health Partners, Inc.",Commercial,502.79,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision, Benign Lesion Including Margins, Except Skin Tag, Trunk, Arms Or Legs; Excised Diameter Over 4.0 Cm (Pro Cah)",,11406,CPT,Professional,Both,,,,745,633.25,153.14,745,"Health Partners, Inc.",Commercial,502.79,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision, Benign Lesion Including Margins, Except Skin Tag, Trunk, Arms Or Legs; Excised Diameter Over 4.0 Cm (Pro Cah)",,11406,CPT,Professional,Both,,,,1496,1271.6,153.14,1496,"Health Partners, Inc.",Medicare Advantage,273.2975,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Benign Lesion Including Margins, Except Skin Tag, Trunk, Arms Or Legs; Excised Diameter Over 4.0 Cm (Pro Cah)",,11406,CPT,Professional,Both,,,,745,633.25,153.14,745,"Health Partners, Inc.",Medicare Advantage,273.2975,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Benign Lesion Including Margins, Except Skin Tag, Trunk, Arms Or Legs; Excised Diameter Over 4.0 Cm (Pro Cah)",,11406,CPT,Professional,Both,,,,1496,1271.6,153.14,1496,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),237.55,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Excision, Benign Lesion Including Margins, Except Skin Tag, Trunk, Arms Or Legs; Excised Diameter Over 4.0 Cm (Pro Cah)",,11406,CPT,Professional,Both,,,,745,633.25,153.14,745,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),237.55,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Excision, Benign Lesion Including Margins, Except Skin Tag, Trunk, Arms Or Legs; Excised Diameter Over 4.0 Cm (Pro Cah)",,11406,CPT,Professional,Both,,,,1496,1271.6,153.14,1496,"Health Partners, Inc.",State of Minnesota Advantage Program,433.153585,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision, Benign Lesion Including Margins, Except Skin Tag, Trunk, Arms Or Legs; Excised Diameter Over 4.0 Cm (Pro Cah)",,11406,CPT,Professional,Both,,,,745,633.25,153.14,745,"Health Partners, Inc.",State of Minnesota Advantage Program,433.153585,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision, Benign Lesion Including Margins, Except Skin Tag, Trunk, Arms Or Legs; Excised Diameter Over 4.0 Cm (Pro Cah)",,11406,CPT,Professional,Both,,,,1496,1271.6,153.14,1496,"Health Partners, Inc.",State Public Programs,153.14,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Excision, Benign Lesion Including Margins, Except Skin Tag, Trunk, Arms Or Legs; Excised Diameter Over 4.0 Cm (Pro Cah)",,11406,CPT,Professional,Both,,,,745,633.25,153.14,745,"Health Partners, Inc.",State Public Programs,153.14,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Excision, Benign Lesion Including Margins, Except Skin Tag, Trunk, Arms Or Legs; Excised Diameter Over 4.0 Cm (Pro Cah)",,11406,CPT,Professional,Both,,,,1496,1271.6,153.14,1496,Humana Insurance Company,Commercial PPO,237.65,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Excision, Benign Lesion Including Margins, Except Skin Tag, Trunk, Arms Or Legs; Excised Diameter Over 4.0 Cm (Pro Cah)",,11406,CPT,Professional,Both,,,,745,633.25,153.14,745,Humana Insurance Company,Commercial PPO,237.65,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Excision, Benign Lesion Including Margins, Except Skin Tag, Trunk, Arms Or Legs; Excised Diameter Over 4.0 Cm (Pro Cah)",,11406,CPT,Professional,Both,,,,1496,1271.6,153.14,1496,Humana Insurance Company,Medicare PPO,1496,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Excision, Benign Lesion Including Margins, Except Skin Tag, Trunk, Arms Or Legs; Excised Diameter Over 4.0 Cm (Pro Cah)",,11406,CPT,Professional,Both,,,,745,633.25,153.14,745,Humana Insurance Company,Medicare PPO,745,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Excision, Benign Lesion Including Margins, Except Skin Tag, Trunk, Arms Or Legs; Excised Diameter Over 4.0 Cm (Pro Cah)",,11406,CPT,Professional,Both,,,,1496,1271.6,153.14,1496,Medica,Individual & Family,1268.608,84.8,,percent of total billed charges,,
"Excision, Benign Lesion Including Margins, Except Skin Tag, Trunk, Arms Or Legs; Excised Diameter Over 4.0 Cm (Pro Cah)",,11406,CPT,Professional,Both,,,,745,633.25,153.14,745,Medica,Individual & Family,631.76,84.8,,percent of total billed charges,,
"Excision, Benign Lesion Including Margins, Except Skin Tag, Trunk, Arms Or Legs; Excised Diameter Over 4.0 Cm (Pro Cah)",,11406,CPT,Professional,Both,,,,1496,1271.6,153.14,1496,Medica,Medica Advantage Solution,745.008,49.8,,percent of total billed charges,,
"Excision, Benign Lesion Including Margins, Except Skin Tag, Trunk, Arms Or Legs; Excised Diameter Over 4.0 Cm (Pro Cah)",,11406,CPT,Professional,Both,,,,745,633.25,153.14,745,Medica,Medica Advantage Solution,371.01,49.8,,percent of total billed charges,,
"Excision, Benign Lesion Including Margins, Except Skin Tag, Trunk, Arms Or Legs; Excised Diameter Over 4.0 Cm (Pro Cah)",,11406,CPT,Professional,Both,,,,1496,1271.6,153.14,1496,Medica,Medical Assistance,176.8,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Excision, Benign Lesion Including Margins, Except Skin Tag, Trunk, Arms Or Legs; Excised Diameter Over 4.0 Cm (Pro Cah)",,11406,CPT,Professional,Both,,,,745,633.25,153.14,745,Medica,Medical Assistance,176.8,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Excision, Benign Lesion Including Margins, Except Skin Tag, Trunk, Arms Or Legs; Excised Diameter Over 4.0 Cm (Pro Cah)",,11406,CPT,Professional,Both,,,,1496,1271.6,153.14,1496,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,237.65,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Excision, Benign Lesion Including Margins, Except Skin Tag, Trunk, Arms Or Legs; Excised Diameter Over 4.0 Cm (Pro Cah)",,11406,CPT,Professional,Both,,,,745,633.25,153.14,745,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,237.65,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Excision, Benign Lesion Including Margins, Except Skin Tag, Trunk, Arms Or Legs; Excised Diameter Over 4.0 Cm (Pro Cah)",,11406,CPT,Professional,Both,,,,1496,1271.6,153.14,1496,"Multiplan, Inc.","Multiplan, Inc.",1406.24,94,,percent of total billed charges,,
"Excision, Benign Lesion Including Margins, Except Skin Tag, Trunk, Arms Or Legs; Excised Diameter Over 4.0 Cm (Pro Cah)",,11406,CPT,Professional,Both,,,,745,633.25,153.14,745,"Multiplan, Inc.","Multiplan, Inc.",700.3,94,,percent of total billed charges,,
"Excision, Benign Lesion Including Margins, Except Skin Tag, Trunk, Arms Or Legs; Excised Diameter Over 4.0 Cm (Pro Cah)",,11406,CPT,Professional,Both,,,,1496,1271.6,153.14,1496,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1347.896,90.1,,percent of total billed charges,,
"Excision, Benign Lesion Including Margins, Except Skin Tag, Trunk, Arms Or Legs; Excised Diameter Over 4.0 Cm (Pro Cah)",,11406,CPT,Professional,Both,,,,745,633.25,153.14,745,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,671.245,90.1,,percent of total billed charges,,
"Excision, Benign Lesion Including Margins, Except Skin Tag, Trunk, Arms Or Legs; Excised Diameter Over 4.0 Cm (Pro Cah)",,11406,CPT,Professional,Both,,,,1496,1271.6,153.14,1496,"Preferred One Administrative Services, INC.",PPO,1475.056,98.6,,percent of total billed charges,,
"Excision, Benign Lesion Including Margins, Except Skin Tag, Trunk, Arms Or Legs; Excised Diameter Over 4.0 Cm (Pro Cah)",,11406,CPT,Professional,Both,,,,745,633.25,153.14,745,"Preferred One Administrative Services, INC.",PPO,734.57,98.6,,percent of total billed charges,,
"Excision, Benign Lesion Including Margins, Except Skin Tag, Trunk, Arms Or Legs; Excised Diameter Over 4.0 Cm (Pro Cah)",,11406,CPT,Professional,Both,,,,1496,1271.6,153.14,1496,PrimeWest Health,Minnesota Senior Health Options (MSHO),273.2975,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Benign Lesion Including Margins, Except Skin Tag, Trunk, Arms Or Legs; Excised Diameter Over 4.0 Cm (Pro Cah)",,11406,CPT,Professional,Both,,,,745,633.25,153.14,745,PrimeWest Health,Minnesota Senior Health Options (MSHO),273.2975,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Benign Lesion Including Margins, Except Skin Tag, Trunk, Arms Or Legs; Excised Diameter Over 4.0 Cm (Pro Cah)",,11406,CPT,Professional,Both,,,,1496,1271.6,153.14,1496,PrimeWest Health,MinnesotaCare,189.1806224,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision, Benign Lesion Including Margins, Except Skin Tag, Trunk, Arms Or Legs; Excised Diameter Over 4.0 Cm (Pro Cah)",,11406,CPT,Professional,Both,,,,745,633.25,153.14,745,PrimeWest Health,MinnesotaCare,189.1806224,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision, Benign Lesion Including Margins, Except Skin Tag, Trunk, Arms Or Legs; Excised Diameter Over 4.0 Cm (Pro Cah)",,11406,CPT,Professional,Both,,,,1496,1271.6,153.14,1496,Sanford Health Plan,Sanford Health Plan,1316.48,88,,percent of total billed charges,,
"Excision, Benign Lesion Including Margins, Except Skin Tag, Trunk, Arms Or Legs; Excised Diameter Over 4.0 Cm (Pro Cah)",,11406,CPT,Professional,Both,,,,745,633.25,153.14,745,Sanford Health Plan,Sanford Health Plan,655.6,88,,percent of total billed charges,,
"Excision, Benign Lesion Including Margins, Except Skin Tag, Trunk, Arms Or Legs; Excised Diameter Over 4.0 Cm (Pro Cah)",,11406,CPT,Professional,Both,,,,1496,1271.6,153.14,1496,"UCare Health, Inc.",Individual & Family Plan,386.32384,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Excision, Benign Lesion Including Margins, Except Skin Tag, Trunk, Arms Or Legs; Excised Diameter Over 4.0 Cm (Pro Cah)",,11406,CPT,Professional,Both,,,,745,633.25,153.14,745,"UCare Health, Inc.",Individual & Family Plan,386.32384,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Excision, Benign Lesion Including Margins, Except Skin Tag, Trunk, Arms Or Legs; Excised Diameter Over 4.0 Cm (Pro Cah)",,11406,CPT,Professional,Both,,,,1496,1271.6,153.14,1496,"UCare Health, Inc.",Medical Assistance,194.484752,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Excision, Benign Lesion Including Margins, Except Skin Tag, Trunk, Arms Or Legs; Excised Diameter Over 4.0 Cm (Pro Cah)",,11406,CPT,Professional,Both,,,,745,633.25,153.14,745,"UCare Health, Inc.",Medical Assistance,194.484752,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Excision, Benign Lesion Including Margins, Except Skin Tag, Trunk, Arms Or Legs; Excised Diameter Over 4.0 Cm (Pro Cah)",,11406,CPT,Professional,Both,,,,1496,1271.6,153.14,1496,"UCare Health, Inc.",Medicare Advantage,273.2975,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Excision, Benign Lesion Including Margins, Except Skin Tag, Trunk, Arms Or Legs; Excised Diameter Over 4.0 Cm (Pro Cah)",,11406,CPT,Professional,Both,,,,745,633.25,153.14,745,"UCare Health, Inc.",Medicare Advantage,273.2975,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Excision, Benign Lesion Including Margins, Except Skin Tag, Trunk, Arms Or Legs; Excised Diameter Over 4.0 Cm (Pro Cah)",,11406,CPT,Professional,Both,,,,1496,1271.6,153.14,1496,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),218.638,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Excision, Benign Lesion Including Margins, Except Skin Tag, Trunk, Arms Or Legs; Excised Diameter Over 4.0 Cm (Pro Cah)",,11406,CPT,Professional,Both,,,,745,633.25,153.14,745,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),218.638,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Excision, Benign Lesion Including Margins, Except Skin Tag, Trunk, Arms Or Legs; Excised Diameter Over 4.0 Cm (Pro Cah)",,11406,CPT,Professional,Both,,,,1496,1271.6,153.14,1496,UnitedHealthcare,Individual & Family,1496,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Excision, Benign Lesion Including Margins, Except Skin Tag, Trunk, Arms Or Legs; Excised Diameter Over 4.0 Cm (Pro Cah)",,11406,CPT,Professional,Both,,,,745,633.25,153.14,745,UnitedHealthcare,Individual & Family,745,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Excision, Benign Lesion Including Margins, Except Skin Tag, Trunk, Arms Or Legs; Excised Diameter Over 4.0 Cm (Pro Cah)",,11406,CPT,Professional,Both,,,,1496,1271.6,153.14,1496,UnitedHealthcare,Medicare Advantage,273.2975,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Benign Lesion Including Margins, Except Skin Tag, Trunk, Arms Or Legs; Excised Diameter Over 4.0 Cm (Pro Cah)",,11406,CPT,Professional,Both,,,,745,633.25,153.14,745,UnitedHealthcare,Medicare Advantage,273.2975,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Benign Lesion Including Margins, Except Skin Tag, Trunk, Arms Or Legs; Excised Diameter Over 4.0 Cm (Pro Cah)",,11406,CPT,Professional,Both,,,,1496,1271.6,153.14,1496,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,176.80432,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision, Benign Lesion Including Margins, Except Skin Tag, Trunk, Arms Or Legs; Excised Diameter Over 4.0 Cm (Pro Cah)",,11406,CPT,Professional,Both,,,,745,633.25,153.14,745,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,176.80432,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision,Benign,Lesion Trunk/Arm/Leg; 4.0 Cm And Over (Pbb)",,11406,CPT,Facility,Outpatient,,,,745,633.25,213.517,745,Aetna,Commercial,685.4,92,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; 4.0 Cm And Over (Pbb)",,11406,CPT,Professional,Outpatient,,,,751,638.35,153.14,751,Aetna,Commercial,638.35,85,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; 4.0 Cm And Over (Pbb)",,11406,CPT,Facility,Outpatient,,,,745,633.25,213.517,745,Aetna,Medicare Advantage,365.05,49,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; 4.0 Cm And Over (Pbb)",,11406,CPT,Professional,Outpatient,,,,751,638.35,153.14,751,Aetna,Medicare Advantage,239.34,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision,Benign,Lesion Trunk/Arm/Leg; 4.0 Cm And Over (Pbb)",,11406,CPT,Facility,Outpatient,,,,745,633.25,213.517,745,Aetna,PPO,692.85,93,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; 4.0 Cm And Over (Pbb)",,11406,CPT,Professional,Outpatient,,,,751,638.35,153.14,751,Aetna,PPO,698.43,93,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; 4.0 Cm And Over (Pbb)",,11406,CPT,Facility,Outpatient,,,,745,633.25,213.517,745,America's PPO,America's PPO,715.4235,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Excision,Benign,Lesion Trunk/Arm/Leg; 4.0 Cm And Over (Pbb)",,11406,CPT,Professional,Outpatient,,,,751,638.35,153.14,751,America's PPO,America's PPO,641.6544,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Excision,Benign,Lesion Trunk/Arm/Leg; 4.0 Cm And Over (Pbb)",,11406,CPT,Facility,Outpatient,,,,745,633.25,213.517,745,BlueCross BlueShield Minnesota, Federal Employee Program,733.08,98.4,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; 4.0 Cm And Over (Pbb)",,11406,CPT,Professional,Outpatient,,,,751,638.35,153.14,751,BlueCross BlueShield Minnesota, Federal Employee Program,509.56,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Excision,Benign,Lesion Trunk/Arm/Leg; 4.0 Cm And Over (Pbb)",,11406,CPT,Facility,Outpatient,,,,745,633.25,213.517,745,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,745,100,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; 4.0 Cm And Over (Pbb)",,11406,CPT,Professional,Outpatient,,,,751,638.35,153.14,751,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,517.71296,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision,Benign,Lesion Trunk/Arm/Leg; 4.0 Cm And Over (Pbb)",,11406,CPT,Facility,Outpatient,,,,745,633.25,213.517,745,BlueCross BlueShield Minnesota,High Value Network Plan,670.5,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
"Excision,Benign,Lesion Trunk/Arm/Leg; 4.0 Cm And Over (Pbb)",,11406,CPT,Professional,Outpatient,,,,751,638.35,153.14,751,BlueCross BlueShield Minnesota,High Value Network Plan,517.71296,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision,Benign,Lesion Trunk/Arm/Leg; 4.0 Cm And Over (Pbb)",,11406,CPT,Facility,Outpatient,,,,745,633.25,213.517,745,BlueCross BlueShield Minnesota,Medicare Advantage,365.05,49,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; 4.0 Cm And Over (Pbb)",,11406,CPT,Professional,Outpatient,,,,751,638.35,153.14,751,BlueCross BlueShield Minnesota,Medicare Advantage,273.2975,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision,Benign,Lesion Trunk/Arm/Leg; 4.0 Cm And Over (Pbb)",,11406,CPT,Professional,Outpatient,,,,751,638.35,153.14,751,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,517.71296,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision,Benign,Lesion Trunk/Arm/Leg; 4.0 Cm And Over (Pbb)",,11406,CPT,Facility,Outpatient,,,,745,633.25,213.517,745,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,213.517,28.66,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; 4.0 Cm And Over (Pbb)",,11406,CPT,Professional,Outpatient,,,,751,638.35,153.14,751,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,176.80432,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision,Benign,Lesion Trunk/Arm/Leg; 4.0 Cm And Over (Pbb)",,11406,CPT,Facility,Outpatient,,,,745,633.25,213.517,745,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),365.05,49,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; 4.0 Cm And Over (Pbb)",,11406,CPT,Professional,Outpatient,,,,751,638.35,153.14,751,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),273.2975,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision,Benign,Lesion Trunk/Arm/Leg; 4.0 Cm And Over (Pbb)",,11406,CPT,Facility,Outpatient,,,,745,633.25,213.517,745,CorVel,Worker's Compensation,745,100,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; 4.0 Cm And Over (Pbb)",,11406,CPT,Professional,Outpatient,,,,751,638.35,153.14,751,CorVel,Worker's Compensation,465.5062359,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Excision,Benign,Lesion Trunk/Arm/Leg; 4.0 Cm And Over (Pbb)",,11406,CPT,Facility,Outpatient,,,,745,633.25,213.517,745,First Health Group Corporation,First Health Network,722.65,97,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; 4.0 Cm And Over (Pbb)",,11406,CPT,Professional,Outpatient,,,,751,638.35,153.14,751,First Health Group Corporation,First Health Network,728.47,97,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; 4.0 Cm And Over (Pbb)",,11406,CPT,Facility,Outpatient,,,,745,633.25,213.517,745,"Health Partners, Inc.",Commercial,704.77,94.6,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; 4.0 Cm And Over (Pbb)",,11406,CPT,Professional,Outpatient,,,,751,638.35,153.14,751,"Health Partners, Inc.",Commercial,502.79,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision,Benign,Lesion Trunk/Arm/Leg; 4.0 Cm And Over (Pbb)",,11406,CPT,Facility,Outpatient,,,,745,633.25,213.517,745,"Health Partners, Inc.",Medicare Advantage,365.05,49,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; 4.0 Cm And Over (Pbb)",,11406,CPT,Professional,Outpatient,,,,751,638.35,153.14,751,"Health Partners, Inc.",Medicare Advantage,273.2975,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision,Benign,Lesion Trunk/Arm/Leg; 4.0 Cm And Over (Pbb)",,11406,CPT,Facility,Outpatient,,,,745,633.25,213.517,745,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),447,60,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; 4.0 Cm And Over (Pbb)",,11406,CPT,Professional,Outpatient,,,,751,638.35,153.14,751,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),237.55,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Excision,Benign,Lesion Trunk/Arm/Leg; 4.0 Cm And Over (Pbb)",,11406,CPT,Facility,Outpatient,,,,745,633.25,213.517,745,"Health Partners, Inc.",State of Minnesota Advantage Program,607.175,81.5,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; 4.0 Cm And Over (Pbb)",,11406,CPT,Professional,Outpatient,,,,751,638.35,153.14,751,"Health Partners, Inc.",State of Minnesota Advantage Program,433.153585,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision,Benign,Lesion Trunk/Arm/Leg; 4.0 Cm And Over (Pbb)",,11406,CPT,Facility,Outpatient,,,,745,633.25,213.517,745,"Health Partners, Inc.",State Public Programs,372.5,50,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; 4.0 Cm And Over (Pbb)",,11406,CPT,Professional,Outpatient,,,,751,638.35,153.14,751,"Health Partners, Inc.",State Public Programs,153.14,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Excision,Benign,Lesion Trunk/Arm/Leg; 4.0 Cm And Over (Pbb)",,11406,CPT,Facility,Outpatient,,,,745,633.25,213.517,745,Humana Insurance Company,Commercial PPO,707.75,95,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; 4.0 Cm And Over (Pbb)",,11406,CPT,Professional,Outpatient,,,,751,638.35,153.14,751,Humana Insurance Company,Commercial PPO,237.65,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Excision,Benign,Lesion Trunk/Arm/Leg; 4.0 Cm And Over (Pbb)",,11406,CPT,Facility,Outpatient,,,,745,633.25,213.517,745,Humana Insurance Company,Medicare PPO,365.05,49,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; 4.0 Cm And Over (Pbb)",,11406,CPT,Professional,Outpatient,,,,751,638.35,153.14,751,Humana Insurance Company,Medicare PPO,751,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Excision,Benign,Lesion Trunk/Arm/Leg; 4.0 Cm And Over (Pbb)",,11406,CPT,Facility,Outpatient,,,,745,633.25,213.517,745,Medica,Individual & Family,738.295,99.1,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; 4.0 Cm And Over (Pbb)",,11406,CPT,Professional,Outpatient,,,,751,638.35,153.14,751,Medica,Individual & Family,636.848,84.8,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; 4.0 Cm And Over (Pbb)",,11406,CPT,Facility,Outpatient,,,,745,633.25,213.517,745,Medica,Medica Advantage Solution,371.01,49.8,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; 4.0 Cm And Over (Pbb)",,11406,CPT,Professional,Outpatient,,,,751,638.35,153.14,751,Medica,Medica Advantage Solution,373.998,49.8,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; 4.0 Cm And Over (Pbb)",,11406,CPT,Facility,Outpatient,,,,745,633.25,213.517,745,Medica,Medical Assistance,332.27,44.6,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; 4.0 Cm And Over (Pbb)",,11406,CPT,Professional,Outpatient,,,,751,638.35,153.14,751,Medica,Medical Assistance,176.8,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Excision,Benign,Lesion Trunk/Arm/Leg; 4.0 Cm And Over (Pbb)",,11406,CPT,Facility,Outpatient,,,,745,633.25,213.517,745,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,371.01,49.8,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; 4.0 Cm And Over (Pbb)",,11406,CPT,Professional,Outpatient,,,,751,638.35,153.14,751,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,237.65,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Excision,Benign,Lesion Trunk/Arm/Leg; 4.0 Cm And Over (Pbb)",,11406,CPT,Facility,Outpatient,,,,745,633.25,213.517,745,"Multiplan, Inc.","Multiplan, Inc.",700.3,94,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; 4.0 Cm And Over (Pbb)",,11406,CPT,Professional,Outpatient,,,,751,638.35,153.14,751,"Multiplan, Inc.","Multiplan, Inc.",705.94,94,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; 4.0 Cm And Over (Pbb)",,11406,CPT,Facility,Outpatient,,,,745,633.25,213.517,745,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,671.245,90.1,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; 4.0 Cm And Over (Pbb)",,11406,CPT,Professional,Outpatient,,,,751,638.35,153.14,751,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,676.651,90.1,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; 4.0 Cm And Over (Pbb)",,11406,CPT,Facility,Outpatient,,,,745,633.25,213.517,745,"Preferred One Administrative Services, INC.",PPO,734.57,98.6,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; 4.0 Cm And Over (Pbb)",,11406,CPT,Professional,Outpatient,,,,751,638.35,153.14,751,"Preferred One Administrative Services, INC.",PPO,740.486,98.6,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; 4.0 Cm And Over (Pbb)",,11406,CPT,Facility,Outpatient,,,,745,633.25,213.517,745,PrimeWest Health,Minnesota Senior Health Options (MSHO),383.3025,51.45,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; 4.0 Cm And Over (Pbb)",,11406,CPT,Professional,Outpatient,,,,751,638.35,153.14,751,PrimeWest Health,Minnesota Senior Health Options (MSHO),273.2975,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision,Benign,Lesion Trunk/Arm/Leg; 4.0 Cm And Over (Pbb)",,11406,CPT,Facility,Outpatient,,,,745,633.25,213.517,745,PrimeWest Health,MinnesotaCare,382.632,51.36,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; 4.0 Cm And Over (Pbb)",,11406,CPT,Professional,Outpatient,,,,751,638.35,153.14,751,PrimeWest Health,MinnesotaCare,189.1806224,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision,Benign,Lesion Trunk/Arm/Leg; 4.0 Cm And Over (Pbb)",,11406,CPT,Facility,Outpatient,,,,745,633.25,213.517,745,Sanford Health Plan,Sanford Health Plan,685.4,92,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; 4.0 Cm And Over (Pbb)",,11406,CPT,Professional,Outpatient,,,,751,638.35,153.14,751,Sanford Health Plan,Sanford Health Plan,660.88,88,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; 4.0 Cm And Over (Pbb)",,11406,CPT,Facility,Outpatient,,,,745,633.25,213.517,745,"UCare Health, Inc.",Individual & Family Plan,419.8075,56.35,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; 4.0 Cm And Over (Pbb)",,11406,CPT,Professional,Outpatient,,,,751,638.35,153.14,751,"UCare Health, Inc.",Individual & Family Plan,386.32384,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Excision,Benign,Lesion Trunk/Arm/Leg; 4.0 Cm And Over (Pbb)",,11406,CPT,Facility,Outpatient,,,,745,633.25,213.517,745,"UCare Health, Inc.",Medical Assistance,376.0015,50.47,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; 4.0 Cm And Over (Pbb)",,11406,CPT,Professional,Outpatient,,,,751,638.35,153.14,751,"UCare Health, Inc.",Medical Assistance,194.484752,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Excision,Benign,Lesion Trunk/Arm/Leg; 4.0 Cm And Over (Pbb)",,11406,CPT,Facility,Outpatient,,,,745,633.25,213.517,745,"UCare Health, Inc.",Medicare Advantage,376.0015,50.47,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; 4.0 Cm And Over (Pbb)",,11406,CPT,Professional,Outpatient,,,,751,638.35,153.14,751,"UCare Health, Inc.",Medicare Advantage,273.2975,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Excision,Benign,Lesion Trunk/Arm/Leg; 4.0 Cm And Over (Pbb)",,11406,CPT,Facility,Outpatient,,,,745,633.25,213.517,745,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),376.0015,50.47,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; 4.0 Cm And Over (Pbb)",,11406,CPT,Professional,Outpatient,,,,751,638.35,153.14,751,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),218.638,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Excision,Benign,Lesion Trunk/Arm/Leg; 4.0 Cm And Over (Pbb)",,11406,CPT,Facility,Outpatient,,,,745,633.25,213.517,745,UnitedHealthcare,Individual & Family,700.3,94,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; 4.0 Cm And Over (Pbb)",,11406,CPT,Professional,Outpatient,,,,751,638.35,153.14,751,UnitedHealthcare,Individual & Family,751,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Excision,Benign,Lesion Trunk/Arm/Leg; 4.0 Cm And Over (Pbb)",,11406,CPT,Facility,Outpatient,,,,745,633.25,213.517,745,UnitedHealthcare,Medicare Advantage,365.05,49,,percent of total billed charges,,
"Excision,Benign,Lesion Trunk/Arm/Leg; 4.0 Cm And Over (Pbb)",,11406,CPT,Professional,Outpatient,,,,751,638.35,153.14,751,UnitedHealthcare,Medicare Advantage,273.2975,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision,Benign,Lesion Trunk/Arm/Leg; 4.0 Cm And Over (Pbb)",,11406,CPT,Facility,Outpatient,,,,745,633.25,213.517,745,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,357.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Excision,Benign,Lesion Trunk/Arm/Leg; 4.0 Cm And Over (Pbb)",,11406,CPT,Professional,Outpatient,,,,751,638.35,153.14,751,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,176.80432,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Excision Cyst/Lipoma,,11420,CPT,Facility,Both,,,,140,119,40.124,140,Aetna,Commercial,128.8,92,,percent of total billed charges,,
Excision Cyst/Lipoma,,11420,CPT,Facility,Outpatient,,,,140,119,40.124,140,Aetna,Medicare Advantage,68.6,49,,percent of total billed charges,,
Excision Cyst/Lipoma,,11420,CPT,Facility,Inpatient,,,,140,119,40.124,140,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Excision Cyst/Lipoma,,11420,CPT,Facility,Both,,,,140,119,40.124,140,Aetna,PPO,130.2,93,,percent of total billed charges,,
Excision Cyst/Lipoma,,11420,CPT,Facility,Both,,,,140,119,40.124,140,America's PPO,America's PPO,134.442,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Excision Cyst/Lipoma,,11420,CPT,Facility,Both,,,,140,119,40.124,140,BlueCross BlueShield Minnesota, Federal Employee Program,137.76,98.4,,percent of total billed charges,,
Excision Cyst/Lipoma,,11420,CPT,Facility,Both,,,,140,119,40.124,140,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,140,100,,percent of total billed charges,,
Excision Cyst/Lipoma,,11420,CPT,Facility,Both,,,,140,119,40.124,140,BlueCross BlueShield Minnesota,High Value Network Plan,126,90,,percent of total billed charges,,
Excision Cyst/Lipoma,,11420,CPT,Facility,Outpatient,,,,140,119,40.124,140,BlueCross BlueShield Minnesota,Medicare Advantage,68.6,49,,percent of total billed charges,,
Excision Cyst/Lipoma,,11420,CPT,Facility,Inpatient,,,,140,119,40.124,140,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Excision Cyst/Lipoma,,11420,CPT,Facility,Both,,,,140,119,40.124,140,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,123.998,88.57,,percent of total billed charges,,
Excision Cyst/Lipoma,,11420,CPT,Facility,Both,,,,140,119,40.124,140,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,40.124,28.66,,percent of total billed charges,,
Excision Cyst/Lipoma,,11420,CPT,Facility,Outpatient,,,,140,119,40.124,140,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),68.6,49,,percent of total billed charges,,
Excision Cyst/Lipoma,,11420,CPT,Facility,Inpatient,,,,140,119,40.124,140,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Excision Cyst/Lipoma,,11420,CPT,Facility,Both,,,,140,119,40.124,140,CorVel,Worker's Compensation,140,100,,percent of total billed charges,,
Excision Cyst/Lipoma,,11420,CPT,Facility,Both,,,,140,119,40.124,140,First Health Group Corporation,First Health Network,135.8,97,,percent of total billed charges,,
Excision Cyst/Lipoma,,11420,CPT,Facility,Both,,,,140,119,40.124,140,"Health Partners, Inc.",Commercial,132.44,94.6,,percent of total billed charges,,
Excision Cyst/Lipoma,,11420,CPT,Facility,Outpatient,,,,140,119,40.124,140,"Health Partners, Inc.",Medicare Advantage,68.6,49,,percent of total billed charges,,
Excision Cyst/Lipoma,,11420,CPT,Facility,Inpatient,,,,140,119,40.124,140,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Excision Cyst/Lipoma,,11420,CPT,Facility,Both,,,,140,119,40.124,140,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),84,60,,percent of total billed charges,,
Excision Cyst/Lipoma,,11420,CPT,Facility,Both,,,,140,119,40.124,140,"Health Partners, Inc.",State of Minnesota Advantage Program,114.1,81.5,,percent of total billed charges,,
Excision Cyst/Lipoma,,11420,CPT,Facility,Both,,,,140,119,40.124,140,"Health Partners, Inc.",State Public Programs,70,50,,percent of total billed charges,,
Excision Cyst/Lipoma,,11420,CPT,Facility,Both,,,,140,119,40.124,140,Humana Insurance Company,Commercial PPO,133,95,,percent of total billed charges,,
Excision Cyst/Lipoma,,11420,CPT,Facility,Outpatient,,,,140,119,40.124,140,Humana Insurance Company,Medicare PPO,68.6,49,,percent of total billed charges,,
Excision Cyst/Lipoma,,11420,CPT,Facility,Inpatient,,,,140,119,40.124,140,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Excision Cyst/Lipoma,,11420,CPT,Facility,Both,,,,140,119,40.124,140,Medica,Individual & Family,138.74,99.1,,percent of total billed charges,,
Excision Cyst/Lipoma,,11420,CPT,Facility,Outpatient,,,,140,119,40.124,140,Medica,Medica Advantage Solution,69.72,49.8,,percent of total billed charges,,
Excision Cyst/Lipoma,,11420,CPT,Facility,Inpatient,,,,140,119,40.124,140,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Excision Cyst/Lipoma,,11420,CPT,Facility,Outpatient,,,,140,119,40.124,140,Medica,Medical Assistance,62.44,44.6,,percent of total billed charges,,
Excision Cyst/Lipoma,,11420,CPT,Facility,Inpatient,,,,140,119,40.124,140,Medica,Medical Assistance,,,,,Included in per diem rate,
Excision Cyst/Lipoma,,11420,CPT,Facility,Outpatient,,,,140,119,40.124,140,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,69.72,49.8,,percent of total billed charges,,
Excision Cyst/Lipoma,,11420,CPT,Facility,Inpatient,,,,140,119,40.124,140,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Excision Cyst/Lipoma,,11420,CPT,Facility,Both,,,,140,119,40.124,140,"Multiplan, Inc.","Multiplan, Inc.",131.6,94,,percent of total billed charges,,
Excision Cyst/Lipoma,,11420,CPT,Facility,Outpatient,,,,140,119,40.124,140,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,126.14,90.1,,percent of total billed charges,,
Excision Cyst/Lipoma,,11420,CPT,Facility,Inpatient,,,,140,119,40.124,140,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Excision Cyst/Lipoma,,11420,CPT,Facility,Both,,,,140,119,40.124,140,"Preferred One Administrative Services, INC.",PPO,138.04,98.6,,percent of total billed charges,,
Excision Cyst/Lipoma,,11420,CPT,Facility,Outpatient,,,,140,119,40.124,140,PrimeWest Health,Minnesota Senior Health Options (MSHO),72.03,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Excision Cyst/Lipoma,,11420,CPT,Facility,Inpatient,,,,140,119,40.124,140,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Excision Cyst/Lipoma,,11420,CPT,Facility,Outpatient,,,,140,119,40.124,140,PrimeWest Health,MinnesotaCare,71.904,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Excision Cyst/Lipoma,,11420,CPT,Facility,Inpatient,,,,140,119,40.124,140,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Excision Cyst/Lipoma,,11420,CPT,Facility,Both,,,,140,119,40.124,140,Sanford Health Plan,Sanford Health Plan,128.8,92,,percent of total billed charges,,
Excision Cyst/Lipoma,,11420,CPT,Facility,Outpatient,,,,140,119,40.124,140,"UCare Health, Inc.",Individual & Family Plan,78.89,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Excision Cyst/Lipoma,,11420,CPT,Facility,Inpatient,,,,140,119,40.124,140,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Excision Cyst/Lipoma,,11420,CPT,Facility,Outpatient,,,,140,119,40.124,140,"UCare Health, Inc.",Medical Assistance,70.658,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Excision Cyst/Lipoma,,11420,CPT,Facility,Inpatient,,,,140,119,40.124,140,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Excision Cyst/Lipoma,,11420,CPT,Facility,Outpatient,,,,140,119,40.124,140,"UCare Health, Inc.",Medicare Advantage,70.658,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Excision Cyst/Lipoma,,11420,CPT,Facility,Inpatient,,,,140,119,40.124,140,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Excision Cyst/Lipoma,,11420,CPT,Facility,Outpatient,,,,140,119,40.124,140,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),70.658,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Excision Cyst/Lipoma,,11420,CPT,Facility,Inpatient,,,,140,119,40.124,140,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Excision Cyst/Lipoma,,11420,CPT,Facility,Both,,,,140,119,40.124,140,UnitedHealthcare,Individual & Family,131.6,94,,percent of total billed charges,,
Excision Cyst/Lipoma,,11420,CPT,Facility,Outpatient,,,,140,119,40.124,140,UnitedHealthcare,Medicare Advantage,68.6,49,,percent of total billed charges,,
Excision Cyst/Lipoma,,11420,CPT,Facility,Inpatient,,,,140,119,40.124,140,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Excision Cyst/Lipoma,,11420,CPT,Facility,Outpatient,,,,140,119,40.124,140,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,67.2,48,,percent of total billed charges,,100% of DHS outpatient percentage
Excision Cyst/Lipoma,,11420,CPT,Facility,Inpatient,,,,140,119,40.124,140,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Excision, Benign Lesion Incl Margins, Except Skin Tag, Scalp, Nck, Hnds, Ft, Genital; Excised Dia 0.5 Cm Or Less (Pro Cah)",,11420,CPT,Professional,Both,,,,235,199.75,52.35,235,Aetna,Commercial,199.75,85,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margins, Except Skin Tag, Scalp, Nck, Hnds, Ft, Genital; Excised Dia 0.5 Cm Or Less (Pro Cah)",,11420,CPT,Professional,Both,,,,235,199.75,52.35,235,Aetna,Commercial,199.75,85,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margins, Except Skin Tag, Scalp, Nck, Hnds, Ft, Genital; Excised Dia 0.5 Cm Or Less (Pro Cah)",,11420,CPT,Professional,Both,,,,235,199.75,52.35,235,Aetna,Medicare Advantage,81.48,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Benign Lesion Incl Margins, Except Skin Tag, Scalp, Nck, Hnds, Ft, Genital; Excised Dia 0.5 Cm Or Less (Pro Cah)",,11420,CPT,Professional,Both,,,,235,199.75,52.35,235,Aetna,Medicare Advantage,81.48,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Benign Lesion Incl Margins, Except Skin Tag, Scalp, Nck, Hnds, Ft, Genital; Excised Dia 0.5 Cm Or Less (Pro Cah)",,11420,CPT,Professional,Both,,,,235,199.75,52.35,235,Aetna,PPO,218.55,93,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margins, Except Skin Tag, Scalp, Nck, Hnds, Ft, Genital; Excised Dia 0.5 Cm Or Less (Pro Cah)",,11420,CPT,Professional,Both,,,,235,199.75,52.35,235,Aetna,PPO,218.55,93,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margins, Except Skin Tag, Scalp, Nck, Hnds, Ft, Genital; Excised Dia 0.5 Cm Or Less (Pro Cah)",,11420,CPT,Professional,Both,,,,235,199.75,52.35,235,America's PPO,America's PPO,200.784,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Excision, Benign Lesion Incl Margins, Except Skin Tag, Scalp, Nck, Hnds, Ft, Genital; Excised Dia 0.5 Cm Or Less (Pro Cah)",,11420,CPT,Professional,Both,,,,235,199.75,52.35,235,America's PPO,America's PPO,200.784,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Excision, Benign Lesion Incl Margins, Except Skin Tag, Scalp, Nck, Hnds, Ft, Genital; Excised Dia 0.5 Cm Or Less (Pro Cah)",,11420,CPT,Professional,Both,,,,235,199.75,52.35,235,BlueCross BlueShield Minnesota, Federal Employee Program,168.71,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Excision, Benign Lesion Incl Margins, Except Skin Tag, Scalp, Nck, Hnds, Ft, Genital; Excised Dia 0.5 Cm Or Less (Pro Cah)",,11420,CPT,Professional,Both,,,,235,199.75,52.35,235,BlueCross BlueShield Minnesota, Federal Employee Program,168.71,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Excision, Benign Lesion Incl Margins, Except Skin Tag, Scalp, Nck, Hnds, Ft, Genital; Excised Dia 0.5 Cm Or Less (Pro Cah)",,11420,CPT,Professional,Both,,,,235,199.75,52.35,235,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,171.40936,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Benign Lesion Incl Margins, Except Skin Tag, Scalp, Nck, Hnds, Ft, Genital; Excised Dia 0.5 Cm Or Less (Pro Cah)",,11420,CPT,Professional,Both,,,,235,199.75,52.35,235,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,171.40936,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Benign Lesion Incl Margins, Except Skin Tag, Scalp, Nck, Hnds, Ft, Genital; Excised Dia 0.5 Cm Or Less (Pro Cah)",,11420,CPT,Professional,Both,,,,235,199.75,52.35,235,BlueCross BlueShield Minnesota,High Value Network Plan,171.40936,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Benign Lesion Incl Margins, Except Skin Tag, Scalp, Nck, Hnds, Ft, Genital; Excised Dia 0.5 Cm Or Less (Pro Cah)",,11420,CPT,Professional,Both,,,,235,199.75,52.35,235,BlueCross BlueShield Minnesota,High Value Network Plan,171.40936,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Benign Lesion Incl Margins, Except Skin Tag, Scalp, Nck, Hnds, Ft, Genital; Excised Dia 0.5 Cm Or Less (Pro Cah)",,11420,CPT,Professional,Both,,,,235,199.75,52.35,235,BlueCross BlueShield Minnesota,Medicare Advantage,93.5525,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Benign Lesion Incl Margins, Except Skin Tag, Scalp, Nck, Hnds, Ft, Genital; Excised Dia 0.5 Cm Or Less (Pro Cah)",,11420,CPT,Professional,Both,,,,235,199.75,52.35,235,BlueCross BlueShield Minnesota,Medicare Advantage,93.5525,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Benign Lesion Incl Margins, Except Skin Tag, Scalp, Nck, Hnds, Ft, Genital; Excised Dia 0.5 Cm Or Less (Pro Cah)",,11420,CPT,Professional,Both,,,,235,199.75,52.35,235,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,171.40936,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Benign Lesion Incl Margins, Except Skin Tag, Scalp, Nck, Hnds, Ft, Genital; Excised Dia 0.5 Cm Or Less (Pro Cah)",,11420,CPT,Professional,Both,,,,235,199.75,52.35,235,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,171.40936,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Benign Lesion Incl Margins, Except Skin Tag, Scalp, Nck, Hnds, Ft, Genital; Excised Dia 0.5 Cm Or Less (Pro Cah)",,11420,CPT,Professional,Both,,,,235,199.75,52.35,235,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,60.44184,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision, Benign Lesion Incl Margins, Except Skin Tag, Scalp, Nck, Hnds, Ft, Genital; Excised Dia 0.5 Cm Or Less (Pro Cah)",,11420,CPT,Professional,Both,,,,235,199.75,52.35,235,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,60.44184,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision, Benign Lesion Incl Margins, Except Skin Tag, Scalp, Nck, Hnds, Ft, Genital; Excised Dia 0.5 Cm Or Less (Pro Cah)",,11420,CPT,Professional,Both,,,,235,199.75,52.35,235,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),93.5525,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Benign Lesion Incl Margins, Except Skin Tag, Scalp, Nck, Hnds, Ft, Genital; Excised Dia 0.5 Cm Or Less (Pro Cah)",,11420,CPT,Professional,Both,,,,235,199.75,52.35,235,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),93.5525,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Benign Lesion Incl Margins, Except Skin Tag, Scalp, Nck, Hnds, Ft, Genital; Excised Dia 0.5 Cm Or Less (Pro Cah)",,11420,CPT,Professional,Both,,,,235,199.75,52.35,235,CorVel,Worker's Compensation,158.6515098,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Excision, Benign Lesion Incl Margins, Except Skin Tag, Scalp, Nck, Hnds, Ft, Genital; Excised Dia 0.5 Cm Or Less (Pro Cah)",,11420,CPT,Professional,Both,,,,235,199.75,52.35,235,CorVel,Worker's Compensation,158.6515098,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Excision, Benign Lesion Incl Margins, Except Skin Tag, Scalp, Nck, Hnds, Ft, Genital; Excised Dia 0.5 Cm Or Less (Pro Cah)",,11420,CPT,Professional,Both,,,,235,199.75,52.35,235,First Health Group Corporation,First Health Network,227.95,97,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margins, Except Skin Tag, Scalp, Nck, Hnds, Ft, Genital; Excised Dia 0.5 Cm Or Less (Pro Cah)",,11420,CPT,Professional,Both,,,,235,199.75,52.35,235,First Health Group Corporation,First Health Network,227.95,97,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margins, Except Skin Tag, Scalp, Nck, Hnds, Ft, Genital; Excised Dia 0.5 Cm Or Less (Pro Cah)",,11420,CPT,Professional,Both,,,,235,199.75,52.35,235,"Health Partners, Inc.",Commercial,171.95,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision, Benign Lesion Incl Margins, Except Skin Tag, Scalp, Nck, Hnds, Ft, Genital; Excised Dia 0.5 Cm Or Less (Pro Cah)",,11420,CPT,Professional,Both,,,,235,199.75,52.35,235,"Health Partners, Inc.",Commercial,171.95,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision, Benign Lesion Incl Margins, Except Skin Tag, Scalp, Nck, Hnds, Ft, Genital; Excised Dia 0.5 Cm Or Less (Pro Cah)",,11420,CPT,Professional,Both,,,,235,199.75,52.35,235,"Health Partners, Inc.",Medicare Advantage,93.5525,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Benign Lesion Incl Margins, Except Skin Tag, Scalp, Nck, Hnds, Ft, Genital; Excised Dia 0.5 Cm Or Less (Pro Cah)",,11420,CPT,Professional,Both,,,,235,199.75,52.35,235,"Health Partners, Inc.",Medicare Advantage,93.5525,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Benign Lesion Incl Margins, Except Skin Tag, Scalp, Nck, Hnds, Ft, Genital; Excised Dia 0.5 Cm Or Less (Pro Cah)",,11420,CPT,Professional,Both,,,,235,199.75,52.35,235,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),81.33,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Excision, Benign Lesion Incl Margins, Except Skin Tag, Scalp, Nck, Hnds, Ft, Genital; Excised Dia 0.5 Cm Or Less (Pro Cah)",,11420,CPT,Professional,Both,,,,235,199.75,52.35,235,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),81.33,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Excision, Benign Lesion Incl Margins, Except Skin Tag, Scalp, Nck, Hnds, Ft, Genital; Excised Dia 0.5 Cm Or Less (Pro Cah)",,11420,CPT,Professional,Both,,,,235,199.75,52.35,235,"Health Partners, Inc.",State of Minnesota Advantage Program,148.134925,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision, Benign Lesion Incl Margins, Except Skin Tag, Scalp, Nck, Hnds, Ft, Genital; Excised Dia 0.5 Cm Or Less (Pro Cah)",,11420,CPT,Professional,Both,,,,235,199.75,52.35,235,"Health Partners, Inc.",State of Minnesota Advantage Program,148.134925,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision, Benign Lesion Incl Margins, Except Skin Tag, Scalp, Nck, Hnds, Ft, Genital; Excised Dia 0.5 Cm Or Less (Pro Cah)",,11420,CPT,Professional,Both,,,,235,199.75,52.35,235,"Health Partners, Inc.",State Public Programs,52.35,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Excision, Benign Lesion Incl Margins, Except Skin Tag, Scalp, Nck, Hnds, Ft, Genital; Excised Dia 0.5 Cm Or Less (Pro Cah)",,11420,CPT,Professional,Both,,,,235,199.75,52.35,235,"Health Partners, Inc.",State Public Programs,52.35,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Excision, Benign Lesion Incl Margins, Except Skin Tag, Scalp, Nck, Hnds, Ft, Genital; Excised Dia 0.5 Cm Or Less (Pro Cah)",,11420,CPT,Professional,Both,,,,235,199.75,52.35,235,Humana Insurance Company,Commercial PPO,81.35,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Excision, Benign Lesion Incl Margins, Except Skin Tag, Scalp, Nck, Hnds, Ft, Genital; Excised Dia 0.5 Cm Or Less (Pro Cah)",,11420,CPT,Professional,Both,,,,235,199.75,52.35,235,Humana Insurance Company,Commercial PPO,81.35,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Excision, Benign Lesion Incl Margins, Except Skin Tag, Scalp, Nck, Hnds, Ft, Genital; Excised Dia 0.5 Cm Or Less (Pro Cah)",,11420,CPT,Professional,Both,,,,235,199.75,52.35,235,Humana Insurance Company,Medicare PPO,235,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Excision, Benign Lesion Incl Margins, Except Skin Tag, Scalp, Nck, Hnds, Ft, Genital; Excised Dia 0.5 Cm Or Less (Pro Cah)",,11420,CPT,Professional,Both,,,,235,199.75,52.35,235,Humana Insurance Company,Medicare PPO,235,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Excision, Benign Lesion Incl Margins, Except Skin Tag, Scalp, Nck, Hnds, Ft, Genital; Excised Dia 0.5 Cm Or Less (Pro Cah)",,11420,CPT,Professional,Both,,,,235,199.75,52.35,235,Medica,Individual & Family,199.28,84.8,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margins, Except Skin Tag, Scalp, Nck, Hnds, Ft, Genital; Excised Dia 0.5 Cm Or Less (Pro Cah)",,11420,CPT,Professional,Both,,,,235,199.75,52.35,235,Medica,Individual & Family,199.28,84.8,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margins, Except Skin Tag, Scalp, Nck, Hnds, Ft, Genital; Excised Dia 0.5 Cm Or Less (Pro Cah)",,11420,CPT,Professional,Both,,,,235,199.75,52.35,235,Medica,Medica Advantage Solution,117.03,49.8,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margins, Except Skin Tag, Scalp, Nck, Hnds, Ft, Genital; Excised Dia 0.5 Cm Or Less (Pro Cah)",,11420,CPT,Professional,Both,,,,235,199.75,52.35,235,Medica,Medica Advantage Solution,117.03,49.8,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margins, Except Skin Tag, Scalp, Nck, Hnds, Ft, Genital; Excised Dia 0.5 Cm Or Less (Pro Cah)",,11420,CPT,Professional,Both,,,,235,199.75,52.35,235,Medica,Medical Assistance,60.44,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Excision, Benign Lesion Incl Margins, Except Skin Tag, Scalp, Nck, Hnds, Ft, Genital; Excised Dia 0.5 Cm Or Less (Pro Cah)",,11420,CPT,Professional,Both,,,,235,199.75,52.35,235,Medica,Medical Assistance,60.44,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Excision, Benign Lesion Incl Margins, Except Skin Tag, Scalp, Nck, Hnds, Ft, Genital; Excised Dia 0.5 Cm Or Less (Pro Cah)",,11420,CPT,Professional,Both,,,,235,199.75,52.35,235,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,81.35,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Excision, Benign Lesion Incl Margins, Except Skin Tag, Scalp, Nck, Hnds, Ft, Genital; Excised Dia 0.5 Cm Or Less (Pro Cah)",,11420,CPT,Professional,Both,,,,235,199.75,52.35,235,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,81.35,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Excision, Benign Lesion Incl Margins, Except Skin Tag, Scalp, Nck, Hnds, Ft, Genital; Excised Dia 0.5 Cm Or Less (Pro Cah)",,11420,CPT,Professional,Both,,,,235,199.75,52.35,235,"Multiplan, Inc.","Multiplan, Inc.",220.9,94,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margins, Except Skin Tag, Scalp, Nck, Hnds, Ft, Genital; Excised Dia 0.5 Cm Or Less (Pro Cah)",,11420,CPT,Professional,Both,,,,235,199.75,52.35,235,"Multiplan, Inc.","Multiplan, Inc.",220.9,94,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margins, Except Skin Tag, Scalp, Nck, Hnds, Ft, Genital; Excised Dia 0.5 Cm Or Less (Pro Cah)",,11420,CPT,Professional,Both,,,,235,199.75,52.35,235,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,211.735,90.1,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margins, Except Skin Tag, Scalp, Nck, Hnds, Ft, Genital; Excised Dia 0.5 Cm Or Less (Pro Cah)",,11420,CPT,Professional,Both,,,,235,199.75,52.35,235,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,211.735,90.1,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margins, Except Skin Tag, Scalp, Nck, Hnds, Ft, Genital; Excised Dia 0.5 Cm Or Less (Pro Cah)",,11420,CPT,Professional,Both,,,,235,199.75,52.35,235,"Preferred One Administrative Services, INC.",PPO,231.71,98.6,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margins, Except Skin Tag, Scalp, Nck, Hnds, Ft, Genital; Excised Dia 0.5 Cm Or Less (Pro Cah)",,11420,CPT,Professional,Both,,,,235,199.75,52.35,235,"Preferred One Administrative Services, INC.",PPO,231.71,98.6,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margins, Except Skin Tag, Scalp, Nck, Hnds, Ft, Genital; Excised Dia 0.5 Cm Or Less (Pro Cah)",,11420,CPT,Professional,Both,,,,235,199.75,52.35,235,PrimeWest Health,Minnesota Senior Health Options (MSHO),93.5525,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Benign Lesion Incl Margins, Except Skin Tag, Scalp, Nck, Hnds, Ft, Genital; Excised Dia 0.5 Cm Or Less (Pro Cah)",,11420,CPT,Professional,Both,,,,235,199.75,52.35,235,PrimeWest Health,Minnesota Senior Health Options (MSHO),93.5525,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Benign Lesion Incl Margins, Except Skin Tag, Scalp, Nck, Hnds, Ft, Genital; Excised Dia 0.5 Cm Or Less (Pro Cah)",,11420,CPT,Professional,Both,,,,235,199.75,52.35,235,PrimeWest Health,MinnesotaCare,64.6727688,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision, Benign Lesion Incl Margins, Except Skin Tag, Scalp, Nck, Hnds, Ft, Genital; Excised Dia 0.5 Cm Or Less (Pro Cah)",,11420,CPT,Professional,Both,,,,235,199.75,52.35,235,PrimeWest Health,MinnesotaCare,64.6727688,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision, Benign Lesion Incl Margins, Except Skin Tag, Scalp, Nck, Hnds, Ft, Genital; Excised Dia 0.5 Cm Or Less (Pro Cah)",,11420,CPT,Professional,Both,,,,235,199.75,52.35,235,Sanford Health Plan,Sanford Health Plan,206.8,88,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margins, Except Skin Tag, Scalp, Nck, Hnds, Ft, Genital; Excised Dia 0.5 Cm Or Less (Pro Cah)",,11420,CPT,Professional,Both,,,,235,199.75,52.35,235,Sanford Health Plan,Sanford Health Plan,206.8,88,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margins, Except Skin Tag, Scalp, Nck, Hnds, Ft, Genital; Excised Dia 0.5 Cm Or Less (Pro Cah)",,11420,CPT,Professional,Both,,,,235,199.75,52.35,235,"UCare Health, Inc.",Individual & Family Plan,132.24256,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Excision, Benign Lesion Incl Margins, Except Skin Tag, Scalp, Nck, Hnds, Ft, Genital; Excised Dia 0.5 Cm Or Less (Pro Cah)",,11420,CPT,Professional,Both,,,,235,199.75,52.35,235,"UCare Health, Inc.",Individual & Family Plan,132.24256,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Excision, Benign Lesion Incl Margins, Except Skin Tag, Scalp, Nck, Hnds, Ft, Genital; Excised Dia 0.5 Cm Or Less (Pro Cah)",,11420,CPT,Professional,Both,,,,235,199.75,52.35,235,"UCare Health, Inc.",Medical Assistance,66.486024,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Excision, Benign Lesion Incl Margins, Except Skin Tag, Scalp, Nck, Hnds, Ft, Genital; Excised Dia 0.5 Cm Or Less (Pro Cah)",,11420,CPT,Professional,Both,,,,235,199.75,52.35,235,"UCare Health, Inc.",Medical Assistance,66.486024,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Excision, Benign Lesion Incl Margins, Except Skin Tag, Scalp, Nck, Hnds, Ft, Genital; Excised Dia 0.5 Cm Or Less (Pro Cah)",,11420,CPT,Professional,Both,,,,235,199.75,52.35,235,"UCare Health, Inc.",Medicare Advantage,93.5525,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Excision, Benign Lesion Incl Margins, Except Skin Tag, Scalp, Nck, Hnds, Ft, Genital; Excised Dia 0.5 Cm Or Less (Pro Cah)",,11420,CPT,Professional,Both,,,,235,199.75,52.35,235,"UCare Health, Inc.",Medicare Advantage,93.5525,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Excision, Benign Lesion Incl Margins, Except Skin Tag, Scalp, Nck, Hnds, Ft, Genital; Excised Dia 0.5 Cm Or Less (Pro Cah)",,11420,CPT,Professional,Both,,,,235,199.75,52.35,235,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),74.842,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Excision, Benign Lesion Incl Margins, Except Skin Tag, Scalp, Nck, Hnds, Ft, Genital; Excised Dia 0.5 Cm Or Less (Pro Cah)",,11420,CPT,Professional,Both,,,,235,199.75,52.35,235,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),74.842,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Excision, Benign Lesion Incl Margins, Except Skin Tag, Scalp, Nck, Hnds, Ft, Genital; Excised Dia 0.5 Cm Or Less (Pro Cah)",,11420,CPT,Professional,Both,,,,235,199.75,52.35,235,UnitedHealthcare,Individual & Family,235,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Excision, Benign Lesion Incl Margins, Except Skin Tag, Scalp, Nck, Hnds, Ft, Genital; Excised Dia 0.5 Cm Or Less (Pro Cah)",,11420,CPT,Professional,Both,,,,235,199.75,52.35,235,UnitedHealthcare,Individual & Family,235,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Excision, Benign Lesion Incl Margins, Except Skin Tag, Scalp, Nck, Hnds, Ft, Genital; Excised Dia 0.5 Cm Or Less (Pro Cah)",,11420,CPT,Professional,Both,,,,235,199.75,52.35,235,UnitedHealthcare,Medicare Advantage,93.5525,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Benign Lesion Incl Margins, Except Skin Tag, Scalp, Nck, Hnds, Ft, Genital; Excised Dia 0.5 Cm Or Less (Pro Cah)",,11420,CPT,Professional,Both,,,,235,199.75,52.35,235,UnitedHealthcare,Medicare Advantage,93.5525,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Benign Lesion Incl Margins, Except Skin Tag, Scalp, Nck, Hnds, Ft, Genital; Excised Dia 0.5 Cm Or Less (Pro Cah)",,11420,CPT,Professional,Both,,,,235,199.75,52.35,235,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,60.44184,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision, Benign Lesion Incl Margins, Except Skin Tag, Scalp, Nck, Hnds, Ft, Genital; Excised Dia 0.5 Cm Or Less (Pro Cah)",,11420,CPT,Professional,Both,,,,235,199.75,52.35,235,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,60.44184,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision, Benign Lesion Incl Margins Sclp/Nck/Hnd/Ft/Gen 0.6Cm-1.0Cm",,11421,CPT,Facility,Both,,,,195,165.75,55.887,195,Aetna,Commercial,179.4,92,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margins Sclp/Nck/Hnd/Ft/Gen 0.6Cm-1.0Cm",,11421,CPT,Facility,Outpatient,,,,195,165.75,55.887,195,Aetna,Medicare Advantage,95.55,49,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margins Sclp/Nck/Hnd/Ft/Gen 0.6Cm-1.0Cm",,11421,CPT,Facility,Inpatient,,,,195,165.75,55.887,195,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Excision, Benign Lesion Incl Margins Sclp/Nck/Hnd/Ft/Gen 0.6Cm-1.0Cm",,11421,CPT,Facility,Both,,,,195,165.75,55.887,195,Aetna,PPO,181.35,93,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margins Sclp/Nck/Hnd/Ft/Gen 0.6Cm-1.0Cm",,11421,CPT,Facility,Both,,,,195,165.75,55.887,195,America's PPO,America's PPO,187.2585,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Excision, Benign Lesion Incl Margins Sclp/Nck/Hnd/Ft/Gen 0.6Cm-1.0Cm",,11421,CPT,Facility,Both,,,,195,165.75,55.887,195,BlueCross BlueShield Minnesota, Federal Employee Program,191.88,98.4,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margins Sclp/Nck/Hnd/Ft/Gen 0.6Cm-1.0Cm",,11421,CPT,Facility,Both,,,,195,165.75,55.887,195,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,195,100,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margins Sclp/Nck/Hnd/Ft/Gen 0.6Cm-1.0Cm",,11421,CPT,Facility,Both,,,,195,165.75,55.887,195,BlueCross BlueShield Minnesota,High Value Network Plan,175.5,90,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margins Sclp/Nck/Hnd/Ft/Gen 0.6Cm-1.0Cm",,11421,CPT,Facility,Outpatient,,,,195,165.75,55.887,195,BlueCross BlueShield Minnesota,Medicare Advantage,95.55,49,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margins Sclp/Nck/Hnd/Ft/Gen 0.6Cm-1.0Cm",,11421,CPT,Facility,Inpatient,,,,195,165.75,55.887,195,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Excision, Benign Lesion Incl Margins Sclp/Nck/Hnd/Ft/Gen 0.6Cm-1.0Cm",,11421,CPT,Facility,Both,,,,195,165.75,55.887,195,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,172.7115,88.57,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margins Sclp/Nck/Hnd/Ft/Gen 0.6Cm-1.0Cm",,11421,CPT,Facility,Both,,,,195,165.75,55.887,195,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,55.887,28.66,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margins Sclp/Nck/Hnd/Ft/Gen 0.6Cm-1.0Cm",,11421,CPT,Facility,Outpatient,,,,195,165.75,55.887,195,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),95.55,49,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margins Sclp/Nck/Hnd/Ft/Gen 0.6Cm-1.0Cm",,11421,CPT,Facility,Inpatient,,,,195,165.75,55.887,195,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Excision, Benign Lesion Incl Margins Sclp/Nck/Hnd/Ft/Gen 0.6Cm-1.0Cm",,11421,CPT,Facility,Both,,,,195,165.75,55.887,195,CorVel,Worker's Compensation,195,100,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margins Sclp/Nck/Hnd/Ft/Gen 0.6Cm-1.0Cm",,11421,CPT,Facility,Both,,,,195,165.75,55.887,195,First Health Group Corporation,First Health Network,189.15,97,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margins Sclp/Nck/Hnd/Ft/Gen 0.6Cm-1.0Cm",,11421,CPT,Facility,Both,,,,195,165.75,55.887,195,"Health Partners, Inc.",Commercial,184.47,94.6,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margins Sclp/Nck/Hnd/Ft/Gen 0.6Cm-1.0Cm",,11421,CPT,Facility,Outpatient,,,,195,165.75,55.887,195,"Health Partners, Inc.",Medicare Advantage,95.55,49,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margins Sclp/Nck/Hnd/Ft/Gen 0.6Cm-1.0Cm",,11421,CPT,Facility,Inpatient,,,,195,165.75,55.887,195,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Excision, Benign Lesion Incl Margins Sclp/Nck/Hnd/Ft/Gen 0.6Cm-1.0Cm",,11421,CPT,Facility,Both,,,,195,165.75,55.887,195,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),117,60,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margins Sclp/Nck/Hnd/Ft/Gen 0.6Cm-1.0Cm",,11421,CPT,Facility,Both,,,,195,165.75,55.887,195,"Health Partners, Inc.",State of Minnesota Advantage Program,158.925,81.5,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margins Sclp/Nck/Hnd/Ft/Gen 0.6Cm-1.0Cm",,11421,CPT,Facility,Both,,,,195,165.75,55.887,195,"Health Partners, Inc.",State Public Programs,97.5,50,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margins Sclp/Nck/Hnd/Ft/Gen 0.6Cm-1.0Cm",,11421,CPT,Facility,Both,,,,195,165.75,55.887,195,Humana Insurance Company,Commercial PPO,185.25,95,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margins Sclp/Nck/Hnd/Ft/Gen 0.6Cm-1.0Cm",,11421,CPT,Facility,Outpatient,,,,195,165.75,55.887,195,Humana Insurance Company,Medicare PPO,95.55,49,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margins Sclp/Nck/Hnd/Ft/Gen 0.6Cm-1.0Cm",,11421,CPT,Facility,Inpatient,,,,195,165.75,55.887,195,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Excision, Benign Lesion Incl Margins Sclp/Nck/Hnd/Ft/Gen 0.6Cm-1.0Cm",,11421,CPT,Facility,Both,,,,195,165.75,55.887,195,Medica,Individual & Family,193.245,99.1,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margins Sclp/Nck/Hnd/Ft/Gen 0.6Cm-1.0Cm",,11421,CPT,Facility,Outpatient,,,,195,165.75,55.887,195,Medica,Medica Advantage Solution,97.11,49.8,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margins Sclp/Nck/Hnd/Ft/Gen 0.6Cm-1.0Cm",,11421,CPT,Facility,Inpatient,,,,195,165.75,55.887,195,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Excision, Benign Lesion Incl Margins Sclp/Nck/Hnd/Ft/Gen 0.6Cm-1.0Cm",,11421,CPT,Facility,Outpatient,,,,195,165.75,55.887,195,Medica,Medical Assistance,86.97,44.6,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margins Sclp/Nck/Hnd/Ft/Gen 0.6Cm-1.0Cm",,11421,CPT,Facility,Inpatient,,,,195,165.75,55.887,195,Medica,Medical Assistance,,,,,Included in per diem rate,
"Excision, Benign Lesion Incl Margins Sclp/Nck/Hnd/Ft/Gen 0.6Cm-1.0Cm",,11421,CPT,Facility,Outpatient,,,,195,165.75,55.887,195,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,97.11,49.8,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margins Sclp/Nck/Hnd/Ft/Gen 0.6Cm-1.0Cm",,11421,CPT,Facility,Inpatient,,,,195,165.75,55.887,195,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Excision, Benign Lesion Incl Margins Sclp/Nck/Hnd/Ft/Gen 0.6Cm-1.0Cm",,11421,CPT,Facility,Both,,,,195,165.75,55.887,195,"Multiplan, Inc.","Multiplan, Inc.",183.3,94,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margins Sclp/Nck/Hnd/Ft/Gen 0.6Cm-1.0Cm",,11421,CPT,Facility,Outpatient,,,,195,165.75,55.887,195,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,175.695,90.1,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margins Sclp/Nck/Hnd/Ft/Gen 0.6Cm-1.0Cm",,11421,CPT,Facility,Inpatient,,,,195,165.75,55.887,195,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Excision, Benign Lesion Incl Margins Sclp/Nck/Hnd/Ft/Gen 0.6Cm-1.0Cm",,11421,CPT,Facility,Both,,,,195,165.75,55.887,195,"Preferred One Administrative Services, INC.",PPO,192.27,98.6,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margins Sclp/Nck/Hnd/Ft/Gen 0.6Cm-1.0Cm",,11421,CPT,Facility,Outpatient,,,,195,165.75,55.887,195,PrimeWest Health,Minnesota Senior Health Options (MSHO),100.3275,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Excision, Benign Lesion Incl Margins Sclp/Nck/Hnd/Ft/Gen 0.6Cm-1.0Cm",,11421,CPT,Facility,Inpatient,,,,195,165.75,55.887,195,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Excision, Benign Lesion Incl Margins Sclp/Nck/Hnd/Ft/Gen 0.6Cm-1.0Cm",,11421,CPT,Facility,Outpatient,,,,195,165.75,55.887,195,PrimeWest Health,MinnesotaCare,100.152,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Excision, Benign Lesion Incl Margins Sclp/Nck/Hnd/Ft/Gen 0.6Cm-1.0Cm",,11421,CPT,Facility,Inpatient,,,,195,165.75,55.887,195,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Excision, Benign Lesion Incl Margins Sclp/Nck/Hnd/Ft/Gen 0.6Cm-1.0Cm",,11421,CPT,Facility,Both,,,,195,165.75,55.887,195,Sanford Health Plan,Sanford Health Plan,179.4,92,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margins Sclp/Nck/Hnd/Ft/Gen 0.6Cm-1.0Cm",,11421,CPT,Facility,Outpatient,,,,195,165.75,55.887,195,"UCare Health, Inc.",Individual & Family Plan,109.8825,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Excision, Benign Lesion Incl Margins Sclp/Nck/Hnd/Ft/Gen 0.6Cm-1.0Cm",,11421,CPT,Facility,Inpatient,,,,195,165.75,55.887,195,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Excision, Benign Lesion Incl Margins Sclp/Nck/Hnd/Ft/Gen 0.6Cm-1.0Cm",,11421,CPT,Facility,Outpatient,,,,195,165.75,55.887,195,"UCare Health, Inc.",Medical Assistance,98.4165,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Excision, Benign Lesion Incl Margins Sclp/Nck/Hnd/Ft/Gen 0.6Cm-1.0Cm",,11421,CPT,Facility,Inpatient,,,,195,165.75,55.887,195,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Excision, Benign Lesion Incl Margins Sclp/Nck/Hnd/Ft/Gen 0.6Cm-1.0Cm",,11421,CPT,Facility,Outpatient,,,,195,165.75,55.887,195,"UCare Health, Inc.",Medicare Advantage,98.4165,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Excision, Benign Lesion Incl Margins Sclp/Nck/Hnd/Ft/Gen 0.6Cm-1.0Cm",,11421,CPT,Facility,Inpatient,,,,195,165.75,55.887,195,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Excision, Benign Lesion Incl Margins Sclp/Nck/Hnd/Ft/Gen 0.6Cm-1.0Cm",,11421,CPT,Facility,Outpatient,,,,195,165.75,55.887,195,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),98.4165,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Excision, Benign Lesion Incl Margins Sclp/Nck/Hnd/Ft/Gen 0.6Cm-1.0Cm",,11421,CPT,Facility,Inpatient,,,,195,165.75,55.887,195,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Excision, Benign Lesion Incl Margins Sclp/Nck/Hnd/Ft/Gen 0.6Cm-1.0Cm",,11421,CPT,Facility,Both,,,,195,165.75,55.887,195,UnitedHealthcare,Individual & Family,183.3,94,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margins Sclp/Nck/Hnd/Ft/Gen 0.6Cm-1.0Cm",,11421,CPT,Facility,Outpatient,,,,195,165.75,55.887,195,UnitedHealthcare,Medicare Advantage,95.55,49,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margins Sclp/Nck/Hnd/Ft/Gen 0.6Cm-1.0Cm",,11421,CPT,Facility,Inpatient,,,,195,165.75,55.887,195,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Excision, Benign Lesion Incl Margins Sclp/Nck/Hnd/Ft/Gen 0.6Cm-1.0Cm",,11421,CPT,Facility,Outpatient,,,,195,165.75,55.887,195,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,93.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Excision, Benign Lesion Incl Margins Sclp/Nck/Hnd/Ft/Gen 0.6Cm-1.0Cm",,11421,CPT,Facility,Inpatient,,,,195,165.75,55.887,195,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Excision, Benign Lesion Incl Margins, Except Sktag,Sclp,Nk,Hnd,Ft,Genit;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11421,CPT,Professional,Both,,,,661,561.85,69.15,661,Aetna,Commercial,561.85,85,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margins, Except Sktag,Sclp,Nk,Hnd,Ft,Genit;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11421,CPT,Professional,Both,,,,330,280.5,69.15,330,Aetna,Commercial,280.5,85,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margins, Except Sktag,Sclp,Nk,Hnd,Ft,Genit;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11421,CPT,Professional,Both,,,,661,561.85,69.15,661,Aetna,Medicare Advantage,107.7,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Benign Lesion Incl Margins, Except Sktag,Sclp,Nk,Hnd,Ft,Genit;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11421,CPT,Professional,Both,,,,330,280.5,69.15,330,Aetna,Medicare Advantage,107.7,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Benign Lesion Incl Margins, Except Sktag,Sclp,Nk,Hnd,Ft,Genit;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11421,CPT,Professional,Both,,,,661,561.85,69.15,661,Aetna,PPO,614.73,93,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margins, Except Sktag,Sclp,Nk,Hnd,Ft,Genit;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11421,CPT,Professional,Both,,,,330,280.5,69.15,330,Aetna,PPO,306.9,93,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margins, Except Sktag,Sclp,Nk,Hnd,Ft,Genit;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11421,CPT,Professional,Both,,,,661,561.85,69.15,661,America's PPO,America's PPO,564.7584,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Excision, Benign Lesion Incl Margins, Except Sktag,Sclp,Nk,Hnd,Ft,Genit;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11421,CPT,Professional,Both,,,,330,280.5,69.15,330,America's PPO,America's PPO,281.952,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Excision, Benign Lesion Incl Margins, Except Sktag,Sclp,Nk,Hnd,Ft,Genit;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11421,CPT,Professional,Both,,,,661,561.85,69.15,661,BlueCross BlueShield Minnesota, Federal Employee Program,225.17,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Excision, Benign Lesion Incl Margins, Except Sktag,Sclp,Nk,Hnd,Ft,Genit;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11421,CPT,Professional,Both,,,,330,280.5,69.15,330,BlueCross BlueShield Minnesota, Federal Employee Program,225.17,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Excision, Benign Lesion Incl Margins, Except Sktag,Sclp,Nk,Hnd,Ft,Genit;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11421,CPT,Professional,Both,,,,661,561.85,69.15,661,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,228.77272,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Benign Lesion Incl Margins, Except Sktag,Sclp,Nk,Hnd,Ft,Genit;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11421,CPT,Professional,Both,,,,330,280.5,69.15,330,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,228.77272,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Benign Lesion Incl Margins, Except Sktag,Sclp,Nk,Hnd,Ft,Genit;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11421,CPT,Professional,Both,,,,661,561.85,69.15,661,BlueCross BlueShield Minnesota,High Value Network Plan,228.77272,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Benign Lesion Incl Margins, Except Sktag,Sclp,Nk,Hnd,Ft,Genit;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11421,CPT,Professional,Both,,,,330,280.5,69.15,330,BlueCross BlueShield Minnesota,High Value Network Plan,228.77272,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Benign Lesion Incl Margins, Except Sktag,Sclp,Nk,Hnd,Ft,Genit;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11421,CPT,Professional,Both,,,,661,561.85,69.15,661,BlueCross BlueShield Minnesota,Medicare Advantage,123.901,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Benign Lesion Incl Margins, Except Sktag,Sclp,Nk,Hnd,Ft,Genit;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11421,CPT,Professional,Both,,,,330,280.5,69.15,330,BlueCross BlueShield Minnesota,Medicare Advantage,123.901,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Benign Lesion Incl Margins, Except Sktag,Sclp,Nk,Hnd,Ft,Genit;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11421,CPT,Professional,Both,,,,661,561.85,69.15,661,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,228.77272,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Benign Lesion Incl Margins, Except Sktag,Sclp,Nk,Hnd,Ft,Genit;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11421,CPT,Professional,Both,,,,330,280.5,69.15,330,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,228.77272,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Benign Lesion Incl Margins, Except Sktag,Sclp,Nk,Hnd,Ft,Genit;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11421,CPT,Professional,Both,,,,661,561.85,69.15,661,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,79.83728,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision, Benign Lesion Incl Margins, Except Sktag,Sclp,Nk,Hnd,Ft,Genit;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11421,CPT,Professional,Both,,,,330,280.5,69.15,330,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,79.83728,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision, Benign Lesion Incl Margins, Except Sktag,Sclp,Nk,Hnd,Ft,Genit;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11421,CPT,Professional,Both,,,,661,561.85,69.15,661,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),123.901,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Benign Lesion Incl Margins, Except Sktag,Sclp,Nk,Hnd,Ft,Genit;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11421,CPT,Professional,Both,,,,330,280.5,69.15,330,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),123.901,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Benign Lesion Incl Margins, Except Sktag,Sclp,Nk,Hnd,Ft,Genit;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11421,CPT,Professional,Both,,,,661,561.85,69.15,661,CorVel,Worker's Compensation,208.9181793,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Excision, Benign Lesion Incl Margins, Except Sktag,Sclp,Nk,Hnd,Ft,Genit;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11421,CPT,Professional,Both,,,,330,280.5,69.15,330,CorVel,Worker's Compensation,208.9181793,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Excision, Benign Lesion Incl Margins, Except Sktag,Sclp,Nk,Hnd,Ft,Genit;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11421,CPT,Professional,Both,,,,661,561.85,69.15,661,First Health Group Corporation,First Health Network,641.17,97,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margins, Except Sktag,Sclp,Nk,Hnd,Ft,Genit;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11421,CPT,Professional,Both,,,,330,280.5,69.15,330,First Health Group Corporation,First Health Network,320.1,97,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margins, Except Sktag,Sclp,Nk,Hnd,Ft,Genit;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11421,CPT,Professional,Both,,,,661,561.85,69.15,661,"Health Partners, Inc.",Commercial,225.64,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision, Benign Lesion Incl Margins, Except Sktag,Sclp,Nk,Hnd,Ft,Genit;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11421,CPT,Professional,Both,,,,330,280.5,69.15,330,"Health Partners, Inc.",Commercial,225.64,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision, Benign Lesion Incl Margins, Except Sktag,Sclp,Nk,Hnd,Ft,Genit;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11421,CPT,Professional,Both,,,,661,561.85,69.15,661,"Health Partners, Inc.",Medicare Advantage,123.901,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Benign Lesion Incl Margins, Except Sktag,Sclp,Nk,Hnd,Ft,Genit;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11421,CPT,Professional,Both,,,,330,280.5,69.15,330,"Health Partners, Inc.",Medicare Advantage,123.901,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Benign Lesion Incl Margins, Except Sktag,Sclp,Nk,Hnd,Ft,Genit;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11421,CPT,Professional,Both,,,,661,561.85,69.15,661,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),107.76,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Excision, Benign Lesion Incl Margins, Except Sktag,Sclp,Nk,Hnd,Ft,Genit;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11421,CPT,Professional,Both,,,,330,280.5,69.15,330,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),107.76,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Excision, Benign Lesion Incl Margins, Except Sktag,Sclp,Nk,Hnd,Ft,Genit;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11421,CPT,Professional,Both,,,,661,561.85,69.15,661,"Health Partners, Inc.",State of Minnesota Advantage Program,194.38886,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision, Benign Lesion Incl Margins, Except Sktag,Sclp,Nk,Hnd,Ft,Genit;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11421,CPT,Professional,Both,,,,330,280.5,69.15,330,"Health Partners, Inc.",State of Minnesota Advantage Program,194.38886,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision, Benign Lesion Incl Margins, Except Sktag,Sclp,Nk,Hnd,Ft,Genit;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11421,CPT,Professional,Both,,,,661,561.85,69.15,661,"Health Partners, Inc.",State Public Programs,69.15,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Excision, Benign Lesion Incl Margins, Except Sktag,Sclp,Nk,Hnd,Ft,Genit;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11421,CPT,Professional,Both,,,,330,280.5,69.15,330,"Health Partners, Inc.",State Public Programs,69.15,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Excision, Benign Lesion Incl Margins, Except Sktag,Sclp,Nk,Hnd,Ft,Genit;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11421,CPT,Professional,Both,,,,661,561.85,69.15,661,Humana Insurance Company,Commercial PPO,107.74,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Excision, Benign Lesion Incl Margins, Except Sktag,Sclp,Nk,Hnd,Ft,Genit;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11421,CPT,Professional,Both,,,,330,280.5,69.15,330,Humana Insurance Company,Commercial PPO,107.74,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Excision, Benign Lesion Incl Margins, Except Sktag,Sclp,Nk,Hnd,Ft,Genit;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11421,CPT,Professional,Both,,,,661,561.85,69.15,661,Humana Insurance Company,Medicare PPO,661,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Excision, Benign Lesion Incl Margins, Except Sktag,Sclp,Nk,Hnd,Ft,Genit;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11421,CPT,Professional,Both,,,,330,280.5,69.15,330,Humana Insurance Company,Medicare PPO,330,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Excision, Benign Lesion Incl Margins, Except Sktag,Sclp,Nk,Hnd,Ft,Genit;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11421,CPT,Professional,Both,,,,661,561.85,69.15,661,Medica,Individual & Family,560.528,84.8,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margins, Except Sktag,Sclp,Nk,Hnd,Ft,Genit;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11421,CPT,Professional,Both,,,,330,280.5,69.15,330,Medica,Individual & Family,279.84,84.8,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margins, Except Sktag,Sclp,Nk,Hnd,Ft,Genit;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11421,CPT,Professional,Both,,,,661,561.85,69.15,661,Medica,Medica Advantage Solution,329.178,49.8,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margins, Except Sktag,Sclp,Nk,Hnd,Ft,Genit;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11421,CPT,Professional,Both,,,,330,280.5,69.15,330,Medica,Medica Advantage Solution,164.34,49.8,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margins, Except Sktag,Sclp,Nk,Hnd,Ft,Genit;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11421,CPT,Professional,Both,,,,661,561.85,69.15,661,Medica,Medical Assistance,79.84,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Excision, Benign Lesion Incl Margins, Except Sktag,Sclp,Nk,Hnd,Ft,Genit;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11421,CPT,Professional,Both,,,,330,280.5,69.15,330,Medica,Medical Assistance,79.84,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Excision, Benign Lesion Incl Margins, Except Sktag,Sclp,Nk,Hnd,Ft,Genit;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11421,CPT,Professional,Both,,,,661,561.85,69.15,661,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,107.74,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Excision, Benign Lesion Incl Margins, Except Sktag,Sclp,Nk,Hnd,Ft,Genit;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11421,CPT,Professional,Both,,,,330,280.5,69.15,330,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,107.74,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Excision, Benign Lesion Incl Margins, Except Sktag,Sclp,Nk,Hnd,Ft,Genit;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11421,CPT,Professional,Both,,,,661,561.85,69.15,661,"Multiplan, Inc.","Multiplan, Inc.",621.34,94,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margins, Except Sktag,Sclp,Nk,Hnd,Ft,Genit;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11421,CPT,Professional,Both,,,,330,280.5,69.15,330,"Multiplan, Inc.","Multiplan, Inc.",310.2,94,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margins, Except Sktag,Sclp,Nk,Hnd,Ft,Genit;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11421,CPT,Professional,Both,,,,661,561.85,69.15,661,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,595.561,90.1,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margins, Except Sktag,Sclp,Nk,Hnd,Ft,Genit;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11421,CPT,Professional,Both,,,,330,280.5,69.15,330,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,297.33,90.1,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margins, Except Sktag,Sclp,Nk,Hnd,Ft,Genit;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11421,CPT,Professional,Both,,,,661,561.85,69.15,661,"Preferred One Administrative Services, INC.",PPO,651.746,98.6,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margins, Except Sktag,Sclp,Nk,Hnd,Ft,Genit;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11421,CPT,Professional,Both,,,,330,280.5,69.15,330,"Preferred One Administrative Services, INC.",PPO,325.38,98.6,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margins, Except Sktag,Sclp,Nk,Hnd,Ft,Genit;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11421,CPT,Professional,Both,,,,661,561.85,69.15,661,PrimeWest Health,Minnesota Senior Health Options (MSHO),123.901,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Benign Lesion Incl Margins, Except Sktag,Sclp,Nk,Hnd,Ft,Genit;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11421,CPT,Professional,Both,,,,330,280.5,69.15,330,PrimeWest Health,Minnesota Senior Health Options (MSHO),123.901,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Benign Lesion Incl Margins, Except Sktag,Sclp,Nk,Hnd,Ft,Genit;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11421,CPT,Professional,Both,,,,661,561.85,69.15,661,PrimeWest Health,MinnesotaCare,85.4258896,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision, Benign Lesion Incl Margins, Except Sktag,Sclp,Nk,Hnd,Ft,Genit;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11421,CPT,Professional,Both,,,,330,280.5,69.15,330,PrimeWest Health,MinnesotaCare,85.4258896,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision, Benign Lesion Incl Margins, Except Sktag,Sclp,Nk,Hnd,Ft,Genit;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11421,CPT,Professional,Both,,,,661,561.85,69.15,661,Sanford Health Plan,Sanford Health Plan,581.68,88,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margins, Except Sktag,Sclp,Nk,Hnd,Ft,Genit;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11421,CPT,Professional,Both,,,,330,280.5,69.15,330,Sanford Health Plan,Sanford Health Plan,290.4,88,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margins, Except Sktag,Sclp,Nk,Hnd,Ft,Genit;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11421,CPT,Professional,Both,,,,661,561.85,69.15,661,"UCare Health, Inc.",Individual & Family Plan,175.142144,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Excision, Benign Lesion Incl Margins, Except Sktag,Sclp,Nk,Hnd,Ft,Genit;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11421,CPT,Professional,Both,,,,330,280.5,69.15,330,"UCare Health, Inc.",Individual & Family Plan,175.142144,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Excision, Benign Lesion Incl Margins, Except Sktag,Sclp,Nk,Hnd,Ft,Genit;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11421,CPT,Professional,Both,,,,661,561.85,69.15,661,"UCare Health, Inc.",Medical Assistance,87.821008,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Excision, Benign Lesion Incl Margins, Except Sktag,Sclp,Nk,Hnd,Ft,Genit;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11421,CPT,Professional,Both,,,,330,280.5,69.15,330,"UCare Health, Inc.",Medical Assistance,87.821008,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Excision, Benign Lesion Incl Margins, Except Sktag,Sclp,Nk,Hnd,Ft,Genit;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11421,CPT,Professional,Both,,,,661,561.85,69.15,661,"UCare Health, Inc.",Medicare Advantage,123.901,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Excision, Benign Lesion Incl Margins, Except Sktag,Sclp,Nk,Hnd,Ft,Genit;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11421,CPT,Professional,Both,,,,330,280.5,69.15,330,"UCare Health, Inc.",Medicare Advantage,123.901,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Excision, Benign Lesion Incl Margins, Except Sktag,Sclp,Nk,Hnd,Ft,Genit;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11421,CPT,Professional,Both,,,,661,561.85,69.15,661,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),99.1208,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Excision, Benign Lesion Incl Margins, Except Sktag,Sclp,Nk,Hnd,Ft,Genit;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11421,CPT,Professional,Both,,,,330,280.5,69.15,330,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),99.1208,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Excision, Benign Lesion Incl Margins, Except Sktag,Sclp,Nk,Hnd,Ft,Genit;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11421,CPT,Professional,Both,,,,661,561.85,69.15,661,UnitedHealthcare,Individual & Family,661,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Excision, Benign Lesion Incl Margins, Except Sktag,Sclp,Nk,Hnd,Ft,Genit;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11421,CPT,Professional,Both,,,,330,280.5,69.15,330,UnitedHealthcare,Individual & Family,330,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Excision, Benign Lesion Incl Margins, Except Sktag,Sclp,Nk,Hnd,Ft,Genit;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11421,CPT,Professional,Both,,,,661,561.85,69.15,661,UnitedHealthcare,Medicare Advantage,123.901,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Benign Lesion Incl Margins, Except Sktag,Sclp,Nk,Hnd,Ft,Genit;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11421,CPT,Professional,Both,,,,330,280.5,69.15,330,UnitedHealthcare,Medicare Advantage,123.901,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Benign Lesion Incl Margins, Except Sktag,Sclp,Nk,Hnd,Ft,Genit;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11421,CPT,Professional,Both,,,,661,561.85,69.15,661,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,79.83728,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision, Benign Lesion Incl Margins, Except Sktag,Sclp,Nk,Hnd,Ft,Genit;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11421,CPT,Professional,Both,,,,330,280.5,69.15,330,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,79.83728,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision,Benign,Lesion Scalp,Neck,Hands; .6-1.0 Cm (Pbb)",,11421,CPT,Facility,Outpatient,,,,326,277.1,93.4316,326,Aetna,Commercial,299.92,92,,percent of total billed charges,,
"Excision,Benign,Lesion Scalp,Neck,Hands; .6-1.0 Cm (Pbb)",,11421,CPT,Professional,Outpatient,,,,335,284.75,69.15,335,Aetna,Commercial,284.75,85,,percent of total billed charges,,
"Excision,Benign,Lesion Scalp,Neck,Hands; .6-1.0 Cm (Pbb)",,11421,CPT,Facility,Outpatient,,,,326,277.1,93.4316,326,Aetna,Medicare Advantage,159.74,49,,percent of total billed charges,,
"Excision,Benign,Lesion Scalp,Neck,Hands; .6-1.0 Cm (Pbb)",,11421,CPT,Professional,Outpatient,,,,335,284.75,69.15,335,Aetna,Medicare Advantage,107.7,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision,Benign,Lesion Scalp,Neck,Hands; .6-1.0 Cm (Pbb)",,11421,CPT,Facility,Outpatient,,,,326,277.1,93.4316,326,Aetna,PPO,303.18,93,,percent of total billed charges,,
"Excision,Benign,Lesion Scalp,Neck,Hands; .6-1.0 Cm (Pbb)",,11421,CPT,Professional,Outpatient,,,,335,284.75,69.15,335,Aetna,PPO,311.55,93,,percent of total billed charges,,
"Excision,Benign,Lesion Scalp,Neck,Hands; .6-1.0 Cm (Pbb)",,11421,CPT,Facility,Outpatient,,,,326,277.1,93.4316,326,America's PPO,America's PPO,313.0578,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Excision,Benign,Lesion Scalp,Neck,Hands; .6-1.0 Cm (Pbb)",,11421,CPT,Professional,Outpatient,,,,335,284.75,69.15,335,America's PPO,America's PPO,286.224,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Excision,Benign,Lesion Scalp,Neck,Hands; .6-1.0 Cm (Pbb)",,11421,CPT,Facility,Outpatient,,,,326,277.1,93.4316,326,BlueCross BlueShield Minnesota, Federal Employee Program,320.784,98.4,,percent of total billed charges,,
"Excision,Benign,Lesion Scalp,Neck,Hands; .6-1.0 Cm (Pbb)",,11421,CPT,Professional,Outpatient,,,,335,284.75,69.15,335,BlueCross BlueShield Minnesota, Federal Employee Program,225.17,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Excision,Benign,Lesion Scalp,Neck,Hands; .6-1.0 Cm (Pbb)",,11421,CPT,Facility,Outpatient,,,,326,277.1,93.4316,326,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,326,100,,percent of total billed charges,,
"Excision,Benign,Lesion Scalp,Neck,Hands; .6-1.0 Cm (Pbb)",,11421,CPT,Professional,Outpatient,,,,335,284.75,69.15,335,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,228.77272,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision,Benign,Lesion Scalp,Neck,Hands; .6-1.0 Cm (Pbb)",,11421,CPT,Facility,Outpatient,,,,326,277.1,93.4316,326,BlueCross BlueShield Minnesota,High Value Network Plan,293.4,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
"Excision,Benign,Lesion Scalp,Neck,Hands; .6-1.0 Cm (Pbb)",,11421,CPT,Professional,Outpatient,,,,335,284.75,69.15,335,BlueCross BlueShield Minnesota,High Value Network Plan,228.77272,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision,Benign,Lesion Scalp,Neck,Hands; .6-1.0 Cm (Pbb)",,11421,CPT,Facility,Outpatient,,,,326,277.1,93.4316,326,BlueCross BlueShield Minnesota,Medicare Advantage,159.74,49,,percent of total billed charges,,
"Excision,Benign,Lesion Scalp,Neck,Hands; .6-1.0 Cm (Pbb)",,11421,CPT,Professional,Outpatient,,,,335,284.75,69.15,335,BlueCross BlueShield Minnesota,Medicare Advantage,123.901,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision,Benign,Lesion Scalp,Neck,Hands; .6-1.0 Cm (Pbb)",,11421,CPT,Professional,Outpatient,,,,335,284.75,69.15,335,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,228.77272,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision,Benign,Lesion Scalp,Neck,Hands; .6-1.0 Cm (Pbb)",,11421,CPT,Facility,Outpatient,,,,326,277.1,93.4316,326,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,93.4316,28.66,,percent of total billed charges,,
"Excision,Benign,Lesion Scalp,Neck,Hands; .6-1.0 Cm (Pbb)",,11421,CPT,Professional,Outpatient,,,,335,284.75,69.15,335,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,79.83728,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision,Benign,Lesion Scalp,Neck,Hands; .6-1.0 Cm (Pbb)",,11421,CPT,Facility,Outpatient,,,,326,277.1,93.4316,326,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),159.74,49,,percent of total billed charges,,
"Excision,Benign,Lesion Scalp,Neck,Hands; .6-1.0 Cm (Pbb)",,11421,CPT,Professional,Outpatient,,,,335,284.75,69.15,335,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),123.901,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision,Benign,Lesion Scalp,Neck,Hands; .6-1.0 Cm (Pbb)",,11421,CPT,Facility,Outpatient,,,,326,277.1,93.4316,326,CorVel,Worker's Compensation,326,100,,percent of total billed charges,,
"Excision,Benign,Lesion Scalp,Neck,Hands; .6-1.0 Cm (Pbb)",,11421,CPT,Professional,Outpatient,,,,335,284.75,69.15,335,CorVel,Worker's Compensation,208.9181793,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Excision,Benign,Lesion Scalp,Neck,Hands; .6-1.0 Cm (Pbb)",,11421,CPT,Facility,Outpatient,,,,326,277.1,93.4316,326,First Health Group Corporation,First Health Network,316.22,97,,percent of total billed charges,,
"Excision,Benign,Lesion Scalp,Neck,Hands; .6-1.0 Cm (Pbb)",,11421,CPT,Professional,Outpatient,,,,335,284.75,69.15,335,First Health Group Corporation,First Health Network,324.95,97,,percent of total billed charges,,
"Excision,Benign,Lesion Scalp,Neck,Hands; .6-1.0 Cm (Pbb)",,11421,CPT,Facility,Outpatient,,,,326,277.1,93.4316,326,"Health Partners, Inc.",Commercial,308.396,94.6,,percent of total billed charges,,
"Excision,Benign,Lesion Scalp,Neck,Hands; .6-1.0 Cm (Pbb)",,11421,CPT,Professional,Outpatient,,,,335,284.75,69.15,335,"Health Partners, Inc.",Commercial,225.64,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision,Benign,Lesion Scalp,Neck,Hands; .6-1.0 Cm (Pbb)",,11421,CPT,Facility,Outpatient,,,,326,277.1,93.4316,326,"Health Partners, Inc.",Medicare Advantage,159.74,49,,percent of total billed charges,,
"Excision,Benign,Lesion Scalp,Neck,Hands; .6-1.0 Cm (Pbb)",,11421,CPT,Professional,Outpatient,,,,335,284.75,69.15,335,"Health Partners, Inc.",Medicare Advantage,123.901,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision,Benign,Lesion Scalp,Neck,Hands; .6-1.0 Cm (Pbb)",,11421,CPT,Facility,Outpatient,,,,326,277.1,93.4316,326,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),195.6,60,,percent of total billed charges,,
"Excision,Benign,Lesion Scalp,Neck,Hands; .6-1.0 Cm (Pbb)",,11421,CPT,Professional,Outpatient,,,,335,284.75,69.15,335,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),107.76,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Excision,Benign,Lesion Scalp,Neck,Hands; .6-1.0 Cm (Pbb)",,11421,CPT,Facility,Outpatient,,,,326,277.1,93.4316,326,"Health Partners, Inc.",State of Minnesota Advantage Program,265.69,81.5,,percent of total billed charges,,
"Excision,Benign,Lesion Scalp,Neck,Hands; .6-1.0 Cm (Pbb)",,11421,CPT,Professional,Outpatient,,,,335,284.75,69.15,335,"Health Partners, Inc.",State of Minnesota Advantage Program,194.38886,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision,Benign,Lesion Scalp,Neck,Hands; .6-1.0 Cm (Pbb)",,11421,CPT,Facility,Outpatient,,,,326,277.1,93.4316,326,"Health Partners, Inc.",State Public Programs,163,50,,percent of total billed charges,,
"Excision,Benign,Lesion Scalp,Neck,Hands; .6-1.0 Cm (Pbb)",,11421,CPT,Professional,Outpatient,,,,335,284.75,69.15,335,"Health Partners, Inc.",State Public Programs,69.15,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Excision,Benign,Lesion Scalp,Neck,Hands; .6-1.0 Cm (Pbb)",,11421,CPT,Facility,Outpatient,,,,326,277.1,93.4316,326,Humana Insurance Company,Commercial PPO,309.7,95,,percent of total billed charges,,
"Excision,Benign,Lesion Scalp,Neck,Hands; .6-1.0 Cm (Pbb)",,11421,CPT,Professional,Outpatient,,,,335,284.75,69.15,335,Humana Insurance Company,Commercial PPO,107.74,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Excision,Benign,Lesion Scalp,Neck,Hands; .6-1.0 Cm (Pbb)",,11421,CPT,Facility,Outpatient,,,,326,277.1,93.4316,326,Humana Insurance Company,Medicare PPO,159.74,49,,percent of total billed charges,,
"Excision,Benign,Lesion Scalp,Neck,Hands; .6-1.0 Cm (Pbb)",,11421,CPT,Professional,Outpatient,,,,335,284.75,69.15,335,Humana Insurance Company,Medicare PPO,335,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Excision,Benign,Lesion Scalp,Neck,Hands; .6-1.0 Cm (Pbb)",,11421,CPT,Facility,Outpatient,,,,326,277.1,93.4316,326,Medica,Individual & Family,323.066,99.1,,percent of total billed charges,,
"Excision,Benign,Lesion Scalp,Neck,Hands; .6-1.0 Cm (Pbb)",,11421,CPT,Professional,Outpatient,,,,335,284.75,69.15,335,Medica,Individual & Family,284.08,84.8,,percent of total billed charges,,
"Excision,Benign,Lesion Scalp,Neck,Hands; .6-1.0 Cm (Pbb)",,11421,CPT,Facility,Outpatient,,,,326,277.1,93.4316,326,Medica,Medica Advantage Solution,162.348,49.8,,percent of total billed charges,,
"Excision,Benign,Lesion Scalp,Neck,Hands; .6-1.0 Cm (Pbb)",,11421,CPT,Professional,Outpatient,,,,335,284.75,69.15,335,Medica,Medica Advantage Solution,166.83,49.8,,percent of total billed charges,,
"Excision,Benign,Lesion Scalp,Neck,Hands; .6-1.0 Cm (Pbb)",,11421,CPT,Facility,Outpatient,,,,326,277.1,93.4316,326,Medica,Medical Assistance,145.396,44.6,,percent of total billed charges,,
"Excision,Benign,Lesion Scalp,Neck,Hands; .6-1.0 Cm (Pbb)",,11421,CPT,Professional,Outpatient,,,,335,284.75,69.15,335,Medica,Medical Assistance,79.84,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Excision,Benign,Lesion Scalp,Neck,Hands; .6-1.0 Cm (Pbb)",,11421,CPT,Facility,Outpatient,,,,326,277.1,93.4316,326,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,162.348,49.8,,percent of total billed charges,,
"Excision,Benign,Lesion Scalp,Neck,Hands; .6-1.0 Cm (Pbb)",,11421,CPT,Professional,Outpatient,,,,335,284.75,69.15,335,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,107.74,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Excision,Benign,Lesion Scalp,Neck,Hands; .6-1.0 Cm (Pbb)",,11421,CPT,Facility,Outpatient,,,,326,277.1,93.4316,326,"Multiplan, Inc.","Multiplan, Inc.",306.44,94,,percent of total billed charges,,
"Excision,Benign,Lesion Scalp,Neck,Hands; .6-1.0 Cm (Pbb)",,11421,CPT,Professional,Outpatient,,,,335,284.75,69.15,335,"Multiplan, Inc.","Multiplan, Inc.",314.9,94,,percent of total billed charges,,
"Excision,Benign,Lesion Scalp,Neck,Hands; .6-1.0 Cm (Pbb)",,11421,CPT,Facility,Outpatient,,,,326,277.1,93.4316,326,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,293.726,90.1,,percent of total billed charges,,
"Excision,Benign,Lesion Scalp,Neck,Hands; .6-1.0 Cm (Pbb)",,11421,CPT,Professional,Outpatient,,,,335,284.75,69.15,335,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,301.835,90.1,,percent of total billed charges,,
"Excision,Benign,Lesion Scalp,Neck,Hands; .6-1.0 Cm (Pbb)",,11421,CPT,Facility,Outpatient,,,,326,277.1,93.4316,326,"Preferred One Administrative Services, INC.",PPO,321.436,98.6,,percent of total billed charges,,
"Excision,Benign,Lesion Scalp,Neck,Hands; .6-1.0 Cm (Pbb)",,11421,CPT,Professional,Outpatient,,,,335,284.75,69.15,335,"Preferred One Administrative Services, INC.",PPO,330.31,98.6,,percent of total billed charges,,
"Excision,Benign,Lesion Scalp,Neck,Hands; .6-1.0 Cm (Pbb)",,11421,CPT,Facility,Outpatient,,,,326,277.1,93.4316,326,PrimeWest Health,Minnesota Senior Health Options (MSHO),167.727,51.45,,percent of total billed charges,,
"Excision,Benign,Lesion Scalp,Neck,Hands; .6-1.0 Cm (Pbb)",,11421,CPT,Professional,Outpatient,,,,335,284.75,69.15,335,PrimeWest Health,Minnesota Senior Health Options (MSHO),123.901,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision,Benign,Lesion Scalp,Neck,Hands; .6-1.0 Cm (Pbb)",,11421,CPT,Facility,Outpatient,,,,326,277.1,93.4316,326,PrimeWest Health,MinnesotaCare,167.4336,51.36,,percent of total billed charges,,
"Excision,Benign,Lesion Scalp,Neck,Hands; .6-1.0 Cm (Pbb)",,11421,CPT,Professional,Outpatient,,,,335,284.75,69.15,335,PrimeWest Health,MinnesotaCare,85.4258896,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision,Benign,Lesion Scalp,Neck,Hands; .6-1.0 Cm (Pbb)",,11421,CPT,Facility,Outpatient,,,,326,277.1,93.4316,326,Sanford Health Plan,Sanford Health Plan,299.92,92,,percent of total billed charges,,
"Excision,Benign,Lesion Scalp,Neck,Hands; .6-1.0 Cm (Pbb)",,11421,CPT,Professional,Outpatient,,,,335,284.75,69.15,335,Sanford Health Plan,Sanford Health Plan,294.8,88,,percent of total billed charges,,
"Excision,Benign,Lesion Scalp,Neck,Hands; .6-1.0 Cm (Pbb)",,11421,CPT,Facility,Outpatient,,,,326,277.1,93.4316,326,"UCare Health, Inc.",Individual & Family Plan,183.701,56.35,,percent of total billed charges,,
"Excision,Benign,Lesion Scalp,Neck,Hands; .6-1.0 Cm (Pbb)",,11421,CPT,Professional,Outpatient,,,,335,284.75,69.15,335,"UCare Health, Inc.",Individual & Family Plan,175.142144,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Excision,Benign,Lesion Scalp,Neck,Hands; .6-1.0 Cm (Pbb)",,11421,CPT,Facility,Outpatient,,,,326,277.1,93.4316,326,"UCare Health, Inc.",Medical Assistance,164.5322,50.47,,percent of total billed charges,,
"Excision,Benign,Lesion Scalp,Neck,Hands; .6-1.0 Cm (Pbb)",,11421,CPT,Professional,Outpatient,,,,335,284.75,69.15,335,"UCare Health, Inc.",Medical Assistance,87.821008,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Excision,Benign,Lesion Scalp,Neck,Hands; .6-1.0 Cm (Pbb)",,11421,CPT,Facility,Outpatient,,,,326,277.1,93.4316,326,"UCare Health, Inc.",Medicare Advantage,164.5322,50.47,,percent of total billed charges,,
"Excision,Benign,Lesion Scalp,Neck,Hands; .6-1.0 Cm (Pbb)",,11421,CPT,Professional,Outpatient,,,,335,284.75,69.15,335,"UCare Health, Inc.",Medicare Advantage,123.901,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Excision,Benign,Lesion Scalp,Neck,Hands; .6-1.0 Cm (Pbb)",,11421,CPT,Facility,Outpatient,,,,326,277.1,93.4316,326,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),164.5322,50.47,,percent of total billed charges,,
"Excision,Benign,Lesion Scalp,Neck,Hands; .6-1.0 Cm (Pbb)",,11421,CPT,Professional,Outpatient,,,,335,284.75,69.15,335,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),99.1208,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Excision,Benign,Lesion Scalp,Neck,Hands; .6-1.0 Cm (Pbb)",,11421,CPT,Facility,Outpatient,,,,326,277.1,93.4316,326,UnitedHealthcare,Individual & Family,306.44,94,,percent of total billed charges,,
"Excision,Benign,Lesion Scalp,Neck,Hands; .6-1.0 Cm (Pbb)",,11421,CPT,Professional,Outpatient,,,,335,284.75,69.15,335,UnitedHealthcare,Individual & Family,335,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Excision,Benign,Lesion Scalp,Neck,Hands; .6-1.0 Cm (Pbb)",,11421,CPT,Facility,Outpatient,,,,326,277.1,93.4316,326,UnitedHealthcare,Medicare Advantage,159.74,49,,percent of total billed charges,,
"Excision,Benign,Lesion Scalp,Neck,Hands; .6-1.0 Cm (Pbb)",,11421,CPT,Professional,Outpatient,,,,335,284.75,69.15,335,UnitedHealthcare,Medicare Advantage,123.901,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision,Benign,Lesion Scalp,Neck,Hands; .6-1.0 Cm (Pbb)",,11421,CPT,Facility,Outpatient,,,,326,277.1,93.4316,326,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,156.48,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Excision,Benign,Lesion Scalp,Neck,Hands; .6-1.0 Cm (Pbb)",,11421,CPT,Professional,Outpatient,,,,335,284.75,69.15,335,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,79.83728,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision, Benign Lesion Incl Margin, Except Skin Tg,Scalp,Nk,Hnd,Ft,Genital;Excised Dia 1.1 - 2.0 Cm",,11422,CPT,Facility,Both,,,,210,178.5,60.186,449,Aetna,Commercial,193.2,92,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margin, Except Skin Tg,Scalp,Nk,Hnd,Ft,Genital;Excised Dia 1.1 - 2.0 Cm",,11422,CPT,Facility,Outpatient,,,,210,178.5,60.186,449,Aetna,Medicare Advantage,102.9,49,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margin, Except Skin Tg,Scalp,Nk,Hnd,Ft,Genital;Excised Dia 1.1 - 2.0 Cm",,11422,CPT,Facility,Inpatient,,,,210,178.5,60.186,449,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Excision, Benign Lesion Incl Margin, Except Skin Tg,Scalp,Nk,Hnd,Ft,Genital;Excised Dia 1.1 - 2.0 Cm",,11422,CPT,Facility,Both,,,,210,178.5,60.186,449,Aetna,PPO,195.3,93,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margin, Except Skin Tg,Scalp,Nk,Hnd,Ft,Genital;Excised Dia 1.1 - 2.0 Cm",,11422,CPT,Facility,Both,,,,210,178.5,60.186,449,America's PPO,America's PPO,201.663,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Excision, Benign Lesion Incl Margin, Except Skin Tg,Scalp,Nk,Hnd,Ft,Genital;Excised Dia 1.1 - 2.0 Cm",,11422,CPT,Facility,Both,,,,210,178.5,60.186,449,BlueCross BlueShield Minnesota, Federal Employee Program,206.64,98.4,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margin, Except Skin Tg,Scalp,Nk,Hnd,Ft,Genital;Excised Dia 1.1 - 2.0 Cm",,11422,CPT,Facility,Both,,,,210,178.5,60.186,449,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,210,100,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margin, Except Skin Tg,Scalp,Nk,Hnd,Ft,Genital;Excised Dia 1.1 - 2.0 Cm",,11422,CPT,Facility,Both,,,,210,178.5,60.186,449,BlueCross BlueShield Minnesota,High Value Network Plan,189,90,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margin, Except Skin Tg,Scalp,Nk,Hnd,Ft,Genital;Excised Dia 1.1 - 2.0 Cm",,11422,CPT,Facility,Outpatient,,,,210,178.5,60.186,449,BlueCross BlueShield Minnesota,Medicare Advantage,102.9,49,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margin, Except Skin Tg,Scalp,Nk,Hnd,Ft,Genital;Excised Dia 1.1 - 2.0 Cm",,11422,CPT,Facility,Inpatient,,,,210,178.5,60.186,449,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Excision, Benign Lesion Incl Margin, Except Skin Tg,Scalp,Nk,Hnd,Ft,Genital;Excised Dia 1.1 - 2.0 Cm",,11422,CPT,Facility,Both,,,,210,178.5,60.186,449,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,185.997,88.57,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margin, Except Skin Tg,Scalp,Nk,Hnd,Ft,Genital;Excised Dia 1.1 - 2.0 Cm",,11422,CPT,Facility,Both,,,,210,178.5,60.186,449,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,60.186,28.66,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margin, Except Skin Tg,Scalp,Nk,Hnd,Ft,Genital;Excised Dia 1.1 - 2.0 Cm",,11422,CPT,Facility,Outpatient,,,,210,178.5,60.186,449,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),102.9,49,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margin, Except Skin Tg,Scalp,Nk,Hnd,Ft,Genital;Excised Dia 1.1 - 2.0 Cm",,11422,CPT,Facility,Inpatient,,,,210,178.5,60.186,449,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Excision, Benign Lesion Incl Margin, Except Skin Tg,Scalp,Nk,Hnd,Ft,Genital;Excised Dia 1.1 - 2.0 Cm",,11422,CPT,Facility,Both,,,,210,178.5,60.186,449,CorVel,Worker's Compensation,210,100,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margin, Except Skin Tg,Scalp,Nk,Hnd,Ft,Genital;Excised Dia 1.1 - 2.0 Cm",,11422,CPT,Facility,Both,,,,210,178.5,60.186,449,First Health Group Corporation,First Health Network,203.7,97,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margin, Except Skin Tg,Scalp,Nk,Hnd,Ft,Genital;Excised Dia 1.1 - 2.0 Cm",,11422,CPT,Facility,Both,,,,210,178.5,60.186,449,"Health Partners, Inc.",Commercial,198.66,94.6,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margin, Except Skin Tg,Scalp,Nk,Hnd,Ft,Genital;Excised Dia 1.1 - 2.0 Cm",,11422,CPT,Facility,Outpatient,,,,210,178.5,60.186,449,"Health Partners, Inc.",Medicare Advantage,102.9,49,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margin, Except Skin Tg,Scalp,Nk,Hnd,Ft,Genital;Excised Dia 1.1 - 2.0 Cm",,11422,CPT,Facility,Inpatient,,,,210,178.5,60.186,449,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Excision, Benign Lesion Incl Margin, Except Skin Tg,Scalp,Nk,Hnd,Ft,Genital;Excised Dia 1.1 - 2.0 Cm",,11422,CPT,Facility,Both,,,,210,178.5,60.186,449,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),126,60,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margin, Except Skin Tg,Scalp,Nk,Hnd,Ft,Genital;Excised Dia 1.1 - 2.0 Cm",,11422,CPT,Facility,Both,,,,210,178.5,60.186,449,"Health Partners, Inc.",State of Minnesota Advantage Program,171.15,81.5,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margin, Except Skin Tg,Scalp,Nk,Hnd,Ft,Genital;Excised Dia 1.1 - 2.0 Cm",,11422,CPT,Facility,Both,,,,210,178.5,60.186,449,"Health Partners, Inc.",State Public Programs,105,50,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margin, Except Skin Tg,Scalp,Nk,Hnd,Ft,Genital;Excised Dia 1.1 - 2.0 Cm",,11422,CPT,Facility,Both,,,,210,178.5,60.186,449,Humana Insurance Company,Commercial PPO,199.5,95,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margin, Except Skin Tg,Scalp,Nk,Hnd,Ft,Genital;Excised Dia 1.1 - 2.0 Cm",,11422,CPT,Facility,Outpatient,,,,210,178.5,60.186,449,Humana Insurance Company,Medicare PPO,102.9,49,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margin, Except Skin Tg,Scalp,Nk,Hnd,Ft,Genital;Excised Dia 1.1 - 2.0 Cm",,11422,CPT,Facility,Inpatient,,,,210,178.5,60.186,449,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Excision, Benign Lesion Incl Margin, Except Skin Tg,Scalp,Nk,Hnd,Ft,Genital;Excised Dia 1.1 - 2.0 Cm",,11422,CPT,Facility,Both,,,,210,178.5,60.186,449,Medica,Individual & Family,208.11,99.1,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margin, Except Skin Tg,Scalp,Nk,Hnd,Ft,Genital;Excised Dia 1.1 - 2.0 Cm",,11422,CPT,Facility,Outpatient,,,,210,178.5,60.186,449,Medica,Medica Advantage Solution,104.58,49.8,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margin, Except Skin Tg,Scalp,Nk,Hnd,Ft,Genital;Excised Dia 1.1 - 2.0 Cm",,11422,CPT,Facility,Inpatient,,,,210,178.5,60.186,449,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Excision, Benign Lesion Incl Margin, Except Skin Tg,Scalp,Nk,Hnd,Ft,Genital;Excised Dia 1.1 - 2.0 Cm",,11422,CPT,Facility,Outpatient,,,,210,178.5,60.186,449,Medica,Medical Assistance,449,,,Other,Grouper,All inclusive per visit
"Excision, Benign Lesion Incl Margin, Except Skin Tg,Scalp,Nk,Hnd,Ft,Genital;Excised Dia 1.1 - 2.0 Cm",,11422,CPT,Facility,Inpatient,,,,210,178.5,60.186,449,Medica,Medical Assistance,,,,,Included in per diem rate,
"Excision, Benign Lesion Incl Margin, Except Skin Tg,Scalp,Nk,Hnd,Ft,Genital;Excised Dia 1.1 - 2.0 Cm",,11422,CPT,Facility,Outpatient,,,,210,178.5,60.186,449,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,104.58,49.8,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margin, Except Skin Tg,Scalp,Nk,Hnd,Ft,Genital;Excised Dia 1.1 - 2.0 Cm",,11422,CPT,Facility,Inpatient,,,,210,178.5,60.186,449,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Excision, Benign Lesion Incl Margin, Except Skin Tg,Scalp,Nk,Hnd,Ft,Genital;Excised Dia 1.1 - 2.0 Cm",,11422,CPT,Facility,Both,,,,210,178.5,60.186,449,"Multiplan, Inc.","Multiplan, Inc.",197.4,94,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margin, Except Skin Tg,Scalp,Nk,Hnd,Ft,Genital;Excised Dia 1.1 - 2.0 Cm",,11422,CPT,Facility,Outpatient,,,,210,178.5,60.186,449,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,189.21,90.1,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margin, Except Skin Tg,Scalp,Nk,Hnd,Ft,Genital;Excised Dia 1.1 - 2.0 Cm",,11422,CPT,Facility,Inpatient,,,,210,178.5,60.186,449,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Excision, Benign Lesion Incl Margin, Except Skin Tg,Scalp,Nk,Hnd,Ft,Genital;Excised Dia 1.1 - 2.0 Cm",,11422,CPT,Facility,Both,,,,210,178.5,60.186,449,"Preferred One Administrative Services, INC.",PPO,207.06,98.6,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margin, Except Skin Tg,Scalp,Nk,Hnd,Ft,Genital;Excised Dia 1.1 - 2.0 Cm",,11422,CPT,Facility,Outpatient,,,,210,178.5,60.186,449,PrimeWest Health,Minnesota Senior Health Options (MSHO),108.045,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Excision, Benign Lesion Incl Margin, Except Skin Tg,Scalp,Nk,Hnd,Ft,Genital;Excised Dia 1.1 - 2.0 Cm",,11422,CPT,Facility,Inpatient,,,,210,178.5,60.186,449,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Excision, Benign Lesion Incl Margin, Except Skin Tg,Scalp,Nk,Hnd,Ft,Genital;Excised Dia 1.1 - 2.0 Cm",,11422,CPT,Facility,Outpatient,,,,210,178.5,60.186,449,PrimeWest Health,MinnesotaCare,107.856,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Excision, Benign Lesion Incl Margin, Except Skin Tg,Scalp,Nk,Hnd,Ft,Genital;Excised Dia 1.1 - 2.0 Cm",,11422,CPT,Facility,Inpatient,,,,210,178.5,60.186,449,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Excision, Benign Lesion Incl Margin, Except Skin Tg,Scalp,Nk,Hnd,Ft,Genital;Excised Dia 1.1 - 2.0 Cm",,11422,CPT,Facility,Both,,,,210,178.5,60.186,449,Sanford Health Plan,Sanford Health Plan,193.2,92,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margin, Except Skin Tg,Scalp,Nk,Hnd,Ft,Genital;Excised Dia 1.1 - 2.0 Cm",,11422,CPT,Facility,Outpatient,,,,210,178.5,60.186,449,"UCare Health, Inc.",Individual & Family Plan,118.335,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Excision, Benign Lesion Incl Margin, Except Skin Tg,Scalp,Nk,Hnd,Ft,Genital;Excised Dia 1.1 - 2.0 Cm",,11422,CPT,Facility,Inpatient,,,,210,178.5,60.186,449,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Excision, Benign Lesion Incl Margin, Except Skin Tg,Scalp,Nk,Hnd,Ft,Genital;Excised Dia 1.1 - 2.0 Cm",,11422,CPT,Facility,Outpatient,,,,210,178.5,60.186,449,"UCare Health, Inc.",Medical Assistance,105.987,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Excision, Benign Lesion Incl Margin, Except Skin Tg,Scalp,Nk,Hnd,Ft,Genital;Excised Dia 1.1 - 2.0 Cm",,11422,CPT,Facility,Inpatient,,,,210,178.5,60.186,449,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Excision, Benign Lesion Incl Margin, Except Skin Tg,Scalp,Nk,Hnd,Ft,Genital;Excised Dia 1.1 - 2.0 Cm",,11422,CPT,Facility,Outpatient,,,,210,178.5,60.186,449,"UCare Health, Inc.",Medicare Advantage,105.987,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Excision, Benign Lesion Incl Margin, Except Skin Tg,Scalp,Nk,Hnd,Ft,Genital;Excised Dia 1.1 - 2.0 Cm",,11422,CPT,Facility,Inpatient,,,,210,178.5,60.186,449,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Excision, Benign Lesion Incl Margin, Except Skin Tg,Scalp,Nk,Hnd,Ft,Genital;Excised Dia 1.1 - 2.0 Cm",,11422,CPT,Facility,Outpatient,,,,210,178.5,60.186,449,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),105.987,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Excision, Benign Lesion Incl Margin, Except Skin Tg,Scalp,Nk,Hnd,Ft,Genital;Excised Dia 1.1 - 2.0 Cm",,11422,CPT,Facility,Inpatient,,,,210,178.5,60.186,449,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Excision, Benign Lesion Incl Margin, Except Skin Tg,Scalp,Nk,Hnd,Ft,Genital;Excised Dia 1.1 - 2.0 Cm",,11422,CPT,Facility,Both,,,,210,178.5,60.186,449,UnitedHealthcare,Individual & Family,197.4,94,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margin, Except Skin Tg,Scalp,Nk,Hnd,Ft,Genital;Excised Dia 1.1 - 2.0 Cm",,11422,CPT,Facility,Outpatient,,,,210,178.5,60.186,449,UnitedHealthcare,Medicare Advantage,102.9,49,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margin, Except Skin Tg,Scalp,Nk,Hnd,Ft,Genital;Excised Dia 1.1 - 2.0 Cm",,11422,CPT,Facility,Inpatient,,,,210,178.5,60.186,449,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Excision, Benign Lesion Incl Margin, Except Skin Tg,Scalp,Nk,Hnd,Ft,Genital;Excised Dia 1.1 - 2.0 Cm",,11422,CPT,Facility,Outpatient,,,,210,178.5,60.186,449,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,100.8,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Excision, Benign Lesion Incl Margin, Except Skin Tg,Scalp,Nk,Hnd,Ft,Genital;Excised Dia 1.1 - 2.0 Cm",,11422,CPT,Facility,Inpatient,,,,210,178.5,60.186,449,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Excision, Benign Lesion Incl Margins,Except Skin Tag,Scalp,Nk,Hnds,Ft, Genital;Excised Dia 1.1-2.0 Cm (Pro Cah)",,11422,CPT,Professional,Both,,,,355,301.75,85.95,355,Aetna,Commercial,301.75,85,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margins,Except Skin Tag,Scalp,Nk,Hnds,Ft, Genital;Excised Dia 1.1-2.0 Cm (Pro Cah)",,11422,CPT,Professional,Both,,,,355,301.75,85.95,355,Aetna,Commercial,301.75,85,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margins,Except Skin Tag,Scalp,Nk,Hnds,Ft, Genital;Excised Dia 1.1-2.0 Cm (Pro Cah)",,11422,CPT,Professional,Both,,,,355,301.75,85.95,355,Aetna,Medicare Advantage,133.31,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Benign Lesion Incl Margins,Except Skin Tag,Scalp,Nk,Hnds,Ft, Genital;Excised Dia 1.1-2.0 Cm (Pro Cah)",,11422,CPT,Professional,Both,,,,355,301.75,85.95,355,Aetna,Medicare Advantage,133.31,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Benign Lesion Incl Margins,Except Skin Tag,Scalp,Nk,Hnds,Ft, Genital;Excised Dia 1.1-2.0 Cm (Pro Cah)",,11422,CPT,Professional,Both,,,,355,301.75,85.95,355,Aetna,PPO,330.15,93,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margins,Except Skin Tag,Scalp,Nk,Hnds,Ft, Genital;Excised Dia 1.1-2.0 Cm (Pro Cah)",,11422,CPT,Professional,Both,,,,355,301.75,85.95,355,Aetna,PPO,330.15,93,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margins,Except Skin Tag,Scalp,Nk,Hnds,Ft, Genital;Excised Dia 1.1-2.0 Cm (Pro Cah)",,11422,CPT,Professional,Both,,,,355,301.75,85.95,355,America's PPO,America's PPO,303.312,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Excision, Benign Lesion Incl Margins,Except Skin Tag,Scalp,Nk,Hnds,Ft, Genital;Excised Dia 1.1-2.0 Cm (Pro Cah)",,11422,CPT,Professional,Both,,,,355,301.75,85.95,355,America's PPO,America's PPO,303.312,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Excision, Benign Lesion Incl Margins,Except Skin Tag,Scalp,Nk,Hnds,Ft, Genital;Excised Dia 1.1-2.0 Cm (Pro Cah)",,11422,CPT,Professional,Both,,,,355,301.75,85.95,355,BlueCross BlueShield Minnesota, Federal Employee Program,278.88,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Excision, Benign Lesion Incl Margins,Except Skin Tag,Scalp,Nk,Hnds,Ft, Genital;Excised Dia 1.1-2.0 Cm (Pro Cah)",,11422,CPT,Professional,Both,,,,355,301.75,85.95,355,BlueCross BlueShield Minnesota, Federal Employee Program,278.88,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Excision, Benign Lesion Incl Margins,Except Skin Tag,Scalp,Nk,Hnds,Ft, Genital;Excised Dia 1.1-2.0 Cm (Pro Cah)",,11422,CPT,Professional,Both,,,,355,301.75,85.95,355,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,283.34208,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Benign Lesion Incl Margins,Except Skin Tag,Scalp,Nk,Hnds,Ft, Genital;Excised Dia 1.1-2.0 Cm (Pro Cah)",,11422,CPT,Professional,Both,,,,355,301.75,85.95,355,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,283.34208,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Benign Lesion Incl Margins,Except Skin Tag,Scalp,Nk,Hnds,Ft, Genital;Excised Dia 1.1-2.0 Cm (Pro Cah)",,11422,CPT,Professional,Both,,,,355,301.75,85.95,355,BlueCross BlueShield Minnesota,High Value Network Plan,283.34208,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Benign Lesion Incl Margins,Except Skin Tag,Scalp,Nk,Hnds,Ft, Genital;Excised Dia 1.1-2.0 Cm (Pro Cah)",,11422,CPT,Professional,Both,,,,355,301.75,85.95,355,BlueCross BlueShield Minnesota,High Value Network Plan,283.34208,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Benign Lesion Incl Margins,Except Skin Tag,Scalp,Nk,Hnds,Ft, Genital;Excised Dia 1.1-2.0 Cm (Pro Cah)",,11422,CPT,Professional,Both,,,,355,301.75,85.95,355,BlueCross BlueShield Minnesota,Medicare Advantage,153.64,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Benign Lesion Incl Margins,Except Skin Tag,Scalp,Nk,Hnds,Ft, Genital;Excised Dia 1.1-2.0 Cm (Pro Cah)",,11422,CPT,Professional,Both,,,,355,301.75,85.95,355,BlueCross BlueShield Minnesota,Medicare Advantage,153.64,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Benign Lesion Incl Margins,Except Skin Tag,Scalp,Nk,Hnds,Ft, Genital;Excised Dia 1.1-2.0 Cm (Pro Cah)",,11422,CPT,Professional,Both,,,,355,301.75,85.95,355,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,283.34208,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Benign Lesion Incl Margins,Except Skin Tag,Scalp,Nk,Hnds,Ft, Genital;Excised Dia 1.1-2.0 Cm (Pro Cah)",,11422,CPT,Professional,Both,,,,355,301.75,85.95,355,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,283.34208,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Benign Lesion Incl Margins,Except Skin Tag,Scalp,Nk,Hnds,Ft, Genital;Excised Dia 1.1-2.0 Cm (Pro Cah)",,11422,CPT,Professional,Both,,,,355,301.75,85.95,355,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,99.23272,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision, Benign Lesion Incl Margins,Except Skin Tag,Scalp,Nk,Hnds,Ft, Genital;Excised Dia 1.1-2.0 Cm (Pro Cah)",,11422,CPT,Professional,Both,,,,355,301.75,85.95,355,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,99.23272,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision, Benign Lesion Incl Margins,Except Skin Tag,Scalp,Nk,Hnds,Ft, Genital;Excised Dia 1.1-2.0 Cm (Pro Cah)",,11422,CPT,Professional,Both,,,,355,301.75,85.95,355,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),153.64,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Benign Lesion Incl Margins,Except Skin Tag,Scalp,Nk,Hnds,Ft, Genital;Excised Dia 1.1-2.0 Cm (Pro Cah)",,11422,CPT,Professional,Both,,,,355,301.75,85.95,355,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),153.64,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Benign Lesion Incl Margins,Except Skin Tag,Scalp,Nk,Hnds,Ft, Genital;Excised Dia 1.1-2.0 Cm (Pro Cah)",,11422,CPT,Professional,Both,,,,355,301.75,85.95,355,CorVel,Worker's Compensation,259.3547889,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Excision, Benign Lesion Incl Margins,Except Skin Tag,Scalp,Nk,Hnds,Ft, Genital;Excised Dia 1.1-2.0 Cm (Pro Cah)",,11422,CPT,Professional,Both,,,,355,301.75,85.95,355,CorVel,Worker's Compensation,259.3547889,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Excision, Benign Lesion Incl Margins,Except Skin Tag,Scalp,Nk,Hnds,Ft, Genital;Excised Dia 1.1-2.0 Cm (Pro Cah)",,11422,CPT,Professional,Both,,,,355,301.75,85.95,355,First Health Group Corporation,First Health Network,344.35,97,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margins,Except Skin Tag,Scalp,Nk,Hnds,Ft, Genital;Excised Dia 1.1-2.0 Cm (Pro Cah)",,11422,CPT,Professional,Both,,,,355,301.75,85.95,355,First Health Group Corporation,First Health Network,344.35,97,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margins,Except Skin Tag,Scalp,Nk,Hnds,Ft, Genital;Excised Dia 1.1-2.0 Cm (Pro Cah)",,11422,CPT,Professional,Both,,,,355,301.75,85.95,355,"Health Partners, Inc.",Commercial,280.05,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision, Benign Lesion Incl Margins,Except Skin Tag,Scalp,Nk,Hnds,Ft, Genital;Excised Dia 1.1-2.0 Cm (Pro Cah)",,11422,CPT,Professional,Both,,,,355,301.75,85.95,355,"Health Partners, Inc.",Commercial,280.05,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision, Benign Lesion Incl Margins,Except Skin Tag,Scalp,Nk,Hnds,Ft, Genital;Excised Dia 1.1-2.0 Cm (Pro Cah)",,11422,CPT,Professional,Both,,,,355,301.75,85.95,355,"Health Partners, Inc.",Medicare Advantage,153.64,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Benign Lesion Incl Margins,Except Skin Tag,Scalp,Nk,Hnds,Ft, Genital;Excised Dia 1.1-2.0 Cm (Pro Cah)",,11422,CPT,Professional,Both,,,,355,301.75,85.95,355,"Health Partners, Inc.",Medicare Advantage,153.64,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Benign Lesion Incl Margins,Except Skin Tag,Scalp,Nk,Hnds,Ft, Genital;Excised Dia 1.1-2.0 Cm (Pro Cah)",,11422,CPT,Professional,Both,,,,355,301.75,85.95,355,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),133.52,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Excision, Benign Lesion Incl Margins,Except Skin Tag,Scalp,Nk,Hnds,Ft, Genital;Excised Dia 1.1-2.0 Cm (Pro Cah)",,11422,CPT,Professional,Both,,,,355,301.75,85.95,355,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),133.52,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Excision, Benign Lesion Incl Margins,Except Skin Tag,Scalp,Nk,Hnds,Ft, Genital;Excised Dia 1.1-2.0 Cm (Pro Cah)",,11422,CPT,Professional,Both,,,,355,301.75,85.95,355,"Health Partners, Inc.",State of Minnesota Advantage Program,241.263075,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision, Benign Lesion Incl Margins,Except Skin Tag,Scalp,Nk,Hnds,Ft, Genital;Excised Dia 1.1-2.0 Cm (Pro Cah)",,11422,CPT,Professional,Both,,,,355,301.75,85.95,355,"Health Partners, Inc.",State of Minnesota Advantage Program,241.263075,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision, Benign Lesion Incl Margins,Except Skin Tag,Scalp,Nk,Hnds,Ft, Genital;Excised Dia 1.1-2.0 Cm (Pro Cah)",,11422,CPT,Professional,Both,,,,355,301.75,85.95,355,"Health Partners, Inc.",State Public Programs,85.95,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Excision, Benign Lesion Incl Margins,Except Skin Tag,Scalp,Nk,Hnds,Ft, Genital;Excised Dia 1.1-2.0 Cm (Pro Cah)",,11422,CPT,Professional,Both,,,,355,301.75,85.95,355,"Health Partners, Inc.",State Public Programs,85.95,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Excision, Benign Lesion Incl Margins,Except Skin Tag,Scalp,Nk,Hnds,Ft, Genital;Excised Dia 1.1-2.0 Cm (Pro Cah)",,11422,CPT,Professional,Both,,,,355,301.75,85.95,355,Humana Insurance Company,Commercial PPO,133.6,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Excision, Benign Lesion Incl Margins,Except Skin Tag,Scalp,Nk,Hnds,Ft, Genital;Excised Dia 1.1-2.0 Cm (Pro Cah)",,11422,CPT,Professional,Both,,,,355,301.75,85.95,355,Humana Insurance Company,Commercial PPO,133.6,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Excision, Benign Lesion Incl Margins,Except Skin Tag,Scalp,Nk,Hnds,Ft, Genital;Excised Dia 1.1-2.0 Cm (Pro Cah)",,11422,CPT,Professional,Both,,,,355,301.75,85.95,355,Humana Insurance Company,Medicare PPO,355,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Excision, Benign Lesion Incl Margins,Except Skin Tag,Scalp,Nk,Hnds,Ft, Genital;Excised Dia 1.1-2.0 Cm (Pro Cah)",,11422,CPT,Professional,Both,,,,355,301.75,85.95,355,Humana Insurance Company,Medicare PPO,355,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Excision, Benign Lesion Incl Margins,Except Skin Tag,Scalp,Nk,Hnds,Ft, Genital;Excised Dia 1.1-2.0 Cm (Pro Cah)",,11422,CPT,Professional,Both,,,,355,301.75,85.95,355,Medica,Individual & Family,301.04,84.8,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margins,Except Skin Tag,Scalp,Nk,Hnds,Ft, Genital;Excised Dia 1.1-2.0 Cm (Pro Cah)",,11422,CPT,Professional,Both,,,,355,301.75,85.95,355,Medica,Individual & Family,301.04,84.8,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margins,Except Skin Tag,Scalp,Nk,Hnds,Ft, Genital;Excised Dia 1.1-2.0 Cm (Pro Cah)",,11422,CPT,Professional,Both,,,,355,301.75,85.95,355,Medica,Medica Advantage Solution,176.79,49.8,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margins,Except Skin Tag,Scalp,Nk,Hnds,Ft, Genital;Excised Dia 1.1-2.0 Cm (Pro Cah)",,11422,CPT,Professional,Both,,,,355,301.75,85.95,355,Medica,Medica Advantage Solution,176.79,49.8,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margins,Except Skin Tag,Scalp,Nk,Hnds,Ft, Genital;Excised Dia 1.1-2.0 Cm (Pro Cah)",,11422,CPT,Professional,Both,,,,355,301.75,85.95,355,Medica,Medical Assistance,99.23,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Excision, Benign Lesion Incl Margins,Except Skin Tag,Scalp,Nk,Hnds,Ft, Genital;Excised Dia 1.1-2.0 Cm (Pro Cah)",,11422,CPT,Professional,Both,,,,355,301.75,85.95,355,Medica,Medical Assistance,99.23,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Excision, Benign Lesion Incl Margins,Except Skin Tag,Scalp,Nk,Hnds,Ft, Genital;Excised Dia 1.1-2.0 Cm (Pro Cah)",,11422,CPT,Professional,Both,,,,355,301.75,85.95,355,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,133.6,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Excision, Benign Lesion Incl Margins,Except Skin Tag,Scalp,Nk,Hnds,Ft, Genital;Excised Dia 1.1-2.0 Cm (Pro Cah)",,11422,CPT,Professional,Both,,,,355,301.75,85.95,355,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,133.6,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Excision, Benign Lesion Incl Margins,Except Skin Tag,Scalp,Nk,Hnds,Ft, Genital;Excised Dia 1.1-2.0 Cm (Pro Cah)",,11422,CPT,Professional,Both,,,,355,301.75,85.95,355,"Multiplan, Inc.","Multiplan, Inc.",333.7,94,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margins,Except Skin Tag,Scalp,Nk,Hnds,Ft, Genital;Excised Dia 1.1-2.0 Cm (Pro Cah)",,11422,CPT,Professional,Both,,,,355,301.75,85.95,355,"Multiplan, Inc.","Multiplan, Inc.",333.7,94,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margins,Except Skin Tag,Scalp,Nk,Hnds,Ft, Genital;Excised Dia 1.1-2.0 Cm (Pro Cah)",,11422,CPT,Professional,Both,,,,355,301.75,85.95,355,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,319.855,90.1,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margins,Except Skin Tag,Scalp,Nk,Hnds,Ft, Genital;Excised Dia 1.1-2.0 Cm (Pro Cah)",,11422,CPT,Professional,Both,,,,355,301.75,85.95,355,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,319.855,90.1,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margins,Except Skin Tag,Scalp,Nk,Hnds,Ft, Genital;Excised Dia 1.1-2.0 Cm (Pro Cah)",,11422,CPT,Professional,Both,,,,355,301.75,85.95,355,"Preferred One Administrative Services, INC.",PPO,350.03,98.6,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margins,Except Skin Tag,Scalp,Nk,Hnds,Ft, Genital;Excised Dia 1.1-2.0 Cm (Pro Cah)",,11422,CPT,Professional,Both,,,,355,301.75,85.95,355,"Preferred One Administrative Services, INC.",PPO,350.03,98.6,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margins,Except Skin Tag,Scalp,Nk,Hnds,Ft, Genital;Excised Dia 1.1-2.0 Cm (Pro Cah)",,11422,CPT,Professional,Both,,,,355,301.75,85.95,355,PrimeWest Health,Minnesota Senior Health Options (MSHO),153.64,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Benign Lesion Incl Margins,Except Skin Tag,Scalp,Nk,Hnds,Ft, Genital;Excised Dia 1.1-2.0 Cm (Pro Cah)",,11422,CPT,Professional,Both,,,,355,301.75,85.95,355,PrimeWest Health,Minnesota Senior Health Options (MSHO),153.64,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Benign Lesion Incl Margins,Except Skin Tag,Scalp,Nk,Hnds,Ft, Genital;Excised Dia 1.1-2.0 Cm (Pro Cah)",,11422,CPT,Professional,Both,,,,355,301.75,85.95,355,PrimeWest Health,MinnesotaCare,106.1790104,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision, Benign Lesion Incl Margins,Except Skin Tag,Scalp,Nk,Hnds,Ft, Genital;Excised Dia 1.1-2.0 Cm (Pro Cah)",,11422,CPT,Professional,Both,,,,355,301.75,85.95,355,PrimeWest Health,MinnesotaCare,106.1790104,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision, Benign Lesion Incl Margins,Except Skin Tag,Scalp,Nk,Hnds,Ft, Genital;Excised Dia 1.1-2.0 Cm (Pro Cah)",,11422,CPT,Professional,Both,,,,355,301.75,85.95,355,Sanford Health Plan,Sanford Health Plan,312.4,88,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margins,Except Skin Tag,Scalp,Nk,Hnds,Ft, Genital;Excised Dia 1.1-2.0 Cm (Pro Cah)",,11422,CPT,Professional,Both,,,,355,301.75,85.95,355,Sanford Health Plan,Sanford Health Plan,312.4,88,,percent of total billed charges,,
"Excision, Benign Lesion Incl Margins,Except Skin Tag,Scalp,Nk,Hnds,Ft, Genital;Excised Dia 1.1-2.0 Cm (Pro Cah)",,11422,CPT,Professional,Both,,,,355,301.75,85.95,355,"UCare Health, Inc.",Individual & Family Plan,217.18016,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Excision, Benign Lesion Incl Margins,Except Skin Tag,Scalp,Nk,Hnds,Ft, Genital;Excised Dia 1.1-2.0 Cm (Pro Cah)",,11422,CPT,Professional,Both,,,,355,301.75,85.95,355,"UCare Health, Inc.",Individual & Family Plan,217.18016,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Excision, Benign Lesion Incl Margins,Except Skin Tag,Scalp,Nk,Hnds,Ft, Genital;Excised Dia 1.1-2.0 Cm (Pro Cah)",,11422,CPT,Professional,Both,,,,355,301.75,85.95,355,"UCare Health, Inc.",Medical Assistance,109.155992,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Excision, Benign Lesion Incl Margins,Except Skin Tag,Scalp,Nk,Hnds,Ft, Genital;Excised Dia 1.1-2.0 Cm (Pro Cah)",,11422,CPT,Professional,Both,,,,355,301.75,85.95,355,"UCare Health, Inc.",Medical Assistance,109.155992,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Excision, Benign Lesion Incl Margins,Except Skin Tag,Scalp,Nk,Hnds,Ft, Genital;Excised Dia 1.1-2.0 Cm (Pro Cah)",,11422,CPT,Professional,Both,,,,355,301.75,85.95,355,"UCare Health, Inc.",Medicare Advantage,153.64,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Excision, Benign Lesion Incl Margins,Except Skin Tag,Scalp,Nk,Hnds,Ft, Genital;Excised Dia 1.1-2.0 Cm (Pro Cah)",,11422,CPT,Professional,Both,,,,355,301.75,85.95,355,"UCare Health, Inc.",Medicare Advantage,153.64,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Excision, Benign Lesion Incl Margins,Except Skin Tag,Scalp,Nk,Hnds,Ft, Genital;Excised Dia 1.1-2.0 Cm (Pro Cah)",,11422,CPT,Professional,Both,,,,355,301.75,85.95,355,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),122.912,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Excision, Benign Lesion Incl Margins,Except Skin Tag,Scalp,Nk,Hnds,Ft, Genital;Excised Dia 1.1-2.0 Cm (Pro Cah)",,11422,CPT,Professional,Both,,,,355,301.75,85.95,355,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),122.912,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Excision, Benign Lesion Incl Margins,Except Skin Tag,Scalp,Nk,Hnds,Ft, Genital;Excised Dia 1.1-2.0 Cm (Pro Cah)",,11422,CPT,Professional,Both,,,,355,301.75,85.95,355,UnitedHealthcare,Individual & Family,355,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Excision, Benign Lesion Incl Margins,Except Skin Tag,Scalp,Nk,Hnds,Ft, Genital;Excised Dia 1.1-2.0 Cm (Pro Cah)",,11422,CPT,Professional,Both,,,,355,301.75,85.95,355,UnitedHealthcare,Individual & Family,355,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Excision, Benign Lesion Incl Margins,Except Skin Tag,Scalp,Nk,Hnds,Ft, Genital;Excised Dia 1.1-2.0 Cm (Pro Cah)",,11422,CPT,Professional,Both,,,,355,301.75,85.95,355,UnitedHealthcare,Medicare Advantage,153.64,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Benign Lesion Incl Margins,Except Skin Tag,Scalp,Nk,Hnds,Ft, Genital;Excised Dia 1.1-2.0 Cm (Pro Cah)",,11422,CPT,Professional,Both,,,,355,301.75,85.95,355,UnitedHealthcare,Medicare Advantage,153.64,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Benign Lesion Incl Margins,Except Skin Tag,Scalp,Nk,Hnds,Ft, Genital;Excised Dia 1.1-2.0 Cm (Pro Cah)",,11422,CPT,Professional,Both,,,,355,301.75,85.95,355,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,99.23272,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision, Benign Lesion Incl Margins,Except Skin Tag,Scalp,Nk,Hnds,Ft, Genital;Excised Dia 1.1-2.0 Cm (Pro Cah)",,11422,CPT,Professional,Both,,,,355,301.75,85.95,355,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,99.23272,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision, Benign Lesion Inc Margins,Except Sktag,Sclp,Nk,Hds,Ft,Genit; Exc Dia 2.1-3.0 Cm",,11423,CPT,Facility,Both,,,,315,267.75,90.279,315,Aetna,Commercial,289.8,92,,percent of total billed charges,,
"Excision, Benign Lesion Inc Margins,Except Sktag,Sclp,Nk,Hds,Ft,Genit; Exc Dia 2.1-3.0 Cm",,11423,CPT,Facility,Outpatient,,,,315,267.75,90.279,315,Aetna,Medicare Advantage,154.35,49,,percent of total billed charges,,
"Excision, Benign Lesion Inc Margins,Except Sktag,Sclp,Nk,Hds,Ft,Genit; Exc Dia 2.1-3.0 Cm",,11423,CPT,Facility,Inpatient,,,,315,267.75,90.279,315,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Excision, Benign Lesion Inc Margins,Except Sktag,Sclp,Nk,Hds,Ft,Genit; Exc Dia 2.1-3.0 Cm",,11423,CPT,Facility,Both,,,,315,267.75,90.279,315,Aetna,PPO,292.95,93,,percent of total billed charges,,
"Excision, Benign Lesion Inc Margins,Except Sktag,Sclp,Nk,Hds,Ft,Genit; Exc Dia 2.1-3.0 Cm",,11423,CPT,Facility,Both,,,,315,267.75,90.279,315,America's PPO,America's PPO,302.4945,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Excision, Benign Lesion Inc Margins,Except Sktag,Sclp,Nk,Hds,Ft,Genit; Exc Dia 2.1-3.0 Cm",,11423,CPT,Facility,Both,,,,315,267.75,90.279,315,BlueCross BlueShield Minnesota, Federal Employee Program,309.96,98.4,,percent of total billed charges,,
"Excision, Benign Lesion Inc Margins,Except Sktag,Sclp,Nk,Hds,Ft,Genit; Exc Dia 2.1-3.0 Cm",,11423,CPT,Facility,Both,,,,315,267.75,90.279,315,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,315,100,,percent of total billed charges,,
"Excision, Benign Lesion Inc Margins,Except Sktag,Sclp,Nk,Hds,Ft,Genit; Exc Dia 2.1-3.0 Cm",,11423,CPT,Facility,Both,,,,315,267.75,90.279,315,BlueCross BlueShield Minnesota,High Value Network Plan,283.5,90,,percent of total billed charges,,
"Excision, Benign Lesion Inc Margins,Except Sktag,Sclp,Nk,Hds,Ft,Genit; Exc Dia 2.1-3.0 Cm",,11423,CPT,Facility,Outpatient,,,,315,267.75,90.279,315,BlueCross BlueShield Minnesota,Medicare Advantage,154.35,49,,percent of total billed charges,,
"Excision, Benign Lesion Inc Margins,Except Sktag,Sclp,Nk,Hds,Ft,Genit; Exc Dia 2.1-3.0 Cm",,11423,CPT,Facility,Inpatient,,,,315,267.75,90.279,315,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Excision, Benign Lesion Inc Margins,Except Sktag,Sclp,Nk,Hds,Ft,Genit; Exc Dia 2.1-3.0 Cm",,11423,CPT,Facility,Both,,,,315,267.75,90.279,315,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,278.9955,88.57,,percent of total billed charges,,
"Excision, Benign Lesion Inc Margins,Except Sktag,Sclp,Nk,Hds,Ft,Genit; Exc Dia 2.1-3.0 Cm",,11423,CPT,Facility,Both,,,,315,267.75,90.279,315,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,90.279,28.66,,percent of total billed charges,,
"Excision, Benign Lesion Inc Margins,Except Sktag,Sclp,Nk,Hds,Ft,Genit; Exc Dia 2.1-3.0 Cm",,11423,CPT,Facility,Outpatient,,,,315,267.75,90.279,315,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),154.35,49,,percent of total billed charges,,
"Excision, Benign Lesion Inc Margins,Except Sktag,Sclp,Nk,Hds,Ft,Genit; Exc Dia 2.1-3.0 Cm",,11423,CPT,Facility,Inpatient,,,,315,267.75,90.279,315,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Excision, Benign Lesion Inc Margins,Except Sktag,Sclp,Nk,Hds,Ft,Genit; Exc Dia 2.1-3.0 Cm",,11423,CPT,Facility,Both,,,,315,267.75,90.279,315,CorVel,Worker's Compensation,315,100,,percent of total billed charges,,
"Excision, Benign Lesion Inc Margins,Except Sktag,Sclp,Nk,Hds,Ft,Genit; Exc Dia 2.1-3.0 Cm",,11423,CPT,Facility,Both,,,,315,267.75,90.279,315,First Health Group Corporation,First Health Network,305.55,97,,percent of total billed charges,,
"Excision, Benign Lesion Inc Margins,Except Sktag,Sclp,Nk,Hds,Ft,Genit; Exc Dia 2.1-3.0 Cm",,11423,CPT,Facility,Both,,,,315,267.75,90.279,315,"Health Partners, Inc.",Commercial,297.99,94.6,,percent of total billed charges,,
"Excision, Benign Lesion Inc Margins,Except Sktag,Sclp,Nk,Hds,Ft,Genit; Exc Dia 2.1-3.0 Cm",,11423,CPT,Facility,Outpatient,,,,315,267.75,90.279,315,"Health Partners, Inc.",Medicare Advantage,154.35,49,,percent of total billed charges,,
"Excision, Benign Lesion Inc Margins,Except Sktag,Sclp,Nk,Hds,Ft,Genit; Exc Dia 2.1-3.0 Cm",,11423,CPT,Facility,Inpatient,,,,315,267.75,90.279,315,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Excision, Benign Lesion Inc Margins,Except Sktag,Sclp,Nk,Hds,Ft,Genit; Exc Dia 2.1-3.0 Cm",,11423,CPT,Facility,Both,,,,315,267.75,90.279,315,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),189,60,,percent of total billed charges,,
"Excision, Benign Lesion Inc Margins,Except Sktag,Sclp,Nk,Hds,Ft,Genit; Exc Dia 2.1-3.0 Cm",,11423,CPT,Facility,Both,,,,315,267.75,90.279,315,"Health Partners, Inc.",State of Minnesota Advantage Program,256.725,81.5,,percent of total billed charges,,
"Excision, Benign Lesion Inc Margins,Except Sktag,Sclp,Nk,Hds,Ft,Genit; Exc Dia 2.1-3.0 Cm",,11423,CPT,Facility,Both,,,,315,267.75,90.279,315,"Health Partners, Inc.",State Public Programs,157.5,50,,percent of total billed charges,,
"Excision, Benign Lesion Inc Margins,Except Sktag,Sclp,Nk,Hds,Ft,Genit; Exc Dia 2.1-3.0 Cm",,11423,CPT,Facility,Both,,,,315,267.75,90.279,315,Humana Insurance Company,Commercial PPO,299.25,95,,percent of total billed charges,,
"Excision, Benign Lesion Inc Margins,Except Sktag,Sclp,Nk,Hds,Ft,Genit; Exc Dia 2.1-3.0 Cm",,11423,CPT,Facility,Outpatient,,,,315,267.75,90.279,315,Humana Insurance Company,Medicare PPO,154.35,49,,percent of total billed charges,,
"Excision, Benign Lesion Inc Margins,Except Sktag,Sclp,Nk,Hds,Ft,Genit; Exc Dia 2.1-3.0 Cm",,11423,CPT,Facility,Inpatient,,,,315,267.75,90.279,315,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Excision, Benign Lesion Inc Margins,Except Sktag,Sclp,Nk,Hds,Ft,Genit; Exc Dia 2.1-3.0 Cm",,11423,CPT,Facility,Both,,,,315,267.75,90.279,315,Medica,Individual & Family,312.165,99.1,,percent of total billed charges,,
"Excision, Benign Lesion Inc Margins,Except Sktag,Sclp,Nk,Hds,Ft,Genit; Exc Dia 2.1-3.0 Cm",,11423,CPT,Facility,Outpatient,,,,315,267.75,90.279,315,Medica,Medica Advantage Solution,156.87,49.8,,percent of total billed charges,,
"Excision, Benign Lesion Inc Margins,Except Sktag,Sclp,Nk,Hds,Ft,Genit; Exc Dia 2.1-3.0 Cm",,11423,CPT,Facility,Inpatient,,,,315,267.75,90.279,315,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Excision, Benign Lesion Inc Margins,Except Sktag,Sclp,Nk,Hds,Ft,Genit; Exc Dia 2.1-3.0 Cm",,11423,CPT,Facility,Outpatient,,,,315,267.75,90.279,315,Medica,Medical Assistance,140.49,44.6,,percent of total billed charges,,
"Excision, Benign Lesion Inc Margins,Except Sktag,Sclp,Nk,Hds,Ft,Genit; Exc Dia 2.1-3.0 Cm",,11423,CPT,Facility,Inpatient,,,,315,267.75,90.279,315,Medica,Medical Assistance,,,,,Included in per diem rate,
"Excision, Benign Lesion Inc Margins,Except Sktag,Sclp,Nk,Hds,Ft,Genit; Exc Dia 2.1-3.0 Cm",,11423,CPT,Facility,Outpatient,,,,315,267.75,90.279,315,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,156.87,49.8,,percent of total billed charges,,
"Excision, Benign Lesion Inc Margins,Except Sktag,Sclp,Nk,Hds,Ft,Genit; Exc Dia 2.1-3.0 Cm",,11423,CPT,Facility,Inpatient,,,,315,267.75,90.279,315,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Excision, Benign Lesion Inc Margins,Except Sktag,Sclp,Nk,Hds,Ft,Genit; Exc Dia 2.1-3.0 Cm",,11423,CPT,Facility,Both,,,,315,267.75,90.279,315,"Multiplan, Inc.","Multiplan, Inc.",296.1,94,,percent of total billed charges,,
"Excision, Benign Lesion Inc Margins,Except Sktag,Sclp,Nk,Hds,Ft,Genit; Exc Dia 2.1-3.0 Cm",,11423,CPT,Facility,Outpatient,,,,315,267.75,90.279,315,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,283.815,90.1,,percent of total billed charges,,
"Excision, Benign Lesion Inc Margins,Except Sktag,Sclp,Nk,Hds,Ft,Genit; Exc Dia 2.1-3.0 Cm",,11423,CPT,Facility,Inpatient,,,,315,267.75,90.279,315,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Excision, Benign Lesion Inc Margins,Except Sktag,Sclp,Nk,Hds,Ft,Genit; Exc Dia 2.1-3.0 Cm",,11423,CPT,Facility,Both,,,,315,267.75,90.279,315,"Preferred One Administrative Services, INC.",PPO,310.59,98.6,,percent of total billed charges,,
"Excision, Benign Lesion Inc Margins,Except Sktag,Sclp,Nk,Hds,Ft,Genit; Exc Dia 2.1-3.0 Cm",,11423,CPT,Facility,Outpatient,,,,315,267.75,90.279,315,PrimeWest Health,Minnesota Senior Health Options (MSHO),162.0675,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Excision, Benign Lesion Inc Margins,Except Sktag,Sclp,Nk,Hds,Ft,Genit; Exc Dia 2.1-3.0 Cm",,11423,CPT,Facility,Inpatient,,,,315,267.75,90.279,315,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Excision, Benign Lesion Inc Margins,Except Sktag,Sclp,Nk,Hds,Ft,Genit; Exc Dia 2.1-3.0 Cm",,11423,CPT,Facility,Outpatient,,,,315,267.75,90.279,315,PrimeWest Health,MinnesotaCare,161.784,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Excision, Benign Lesion Inc Margins,Except Sktag,Sclp,Nk,Hds,Ft,Genit; Exc Dia 2.1-3.0 Cm",,11423,CPT,Facility,Inpatient,,,,315,267.75,90.279,315,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Excision, Benign Lesion Inc Margins,Except Sktag,Sclp,Nk,Hds,Ft,Genit; Exc Dia 2.1-3.0 Cm",,11423,CPT,Facility,Both,,,,315,267.75,90.279,315,Sanford Health Plan,Sanford Health Plan,289.8,92,,percent of total billed charges,,
"Excision, Benign Lesion Inc Margins,Except Sktag,Sclp,Nk,Hds,Ft,Genit; Exc Dia 2.1-3.0 Cm",,11423,CPT,Facility,Outpatient,,,,315,267.75,90.279,315,"UCare Health, Inc.",Individual & Family Plan,177.5025,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Excision, Benign Lesion Inc Margins,Except Sktag,Sclp,Nk,Hds,Ft,Genit; Exc Dia 2.1-3.0 Cm",,11423,CPT,Facility,Inpatient,,,,315,267.75,90.279,315,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Excision, Benign Lesion Inc Margins,Except Sktag,Sclp,Nk,Hds,Ft,Genit; Exc Dia 2.1-3.0 Cm",,11423,CPT,Facility,Outpatient,,,,315,267.75,90.279,315,"UCare Health, Inc.",Medical Assistance,158.9805,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Excision, Benign Lesion Inc Margins,Except Sktag,Sclp,Nk,Hds,Ft,Genit; Exc Dia 2.1-3.0 Cm",,11423,CPT,Facility,Inpatient,,,,315,267.75,90.279,315,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Excision, Benign Lesion Inc Margins,Except Sktag,Sclp,Nk,Hds,Ft,Genit; Exc Dia 2.1-3.0 Cm",,11423,CPT,Facility,Outpatient,,,,315,267.75,90.279,315,"UCare Health, Inc.",Medicare Advantage,158.9805,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Excision, Benign Lesion Inc Margins,Except Sktag,Sclp,Nk,Hds,Ft,Genit; Exc Dia 2.1-3.0 Cm",,11423,CPT,Facility,Inpatient,,,,315,267.75,90.279,315,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Excision, Benign Lesion Inc Margins,Except Sktag,Sclp,Nk,Hds,Ft,Genit; Exc Dia 2.1-3.0 Cm",,11423,CPT,Facility,Outpatient,,,,315,267.75,90.279,315,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),158.9805,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Excision, Benign Lesion Inc Margins,Except Sktag,Sclp,Nk,Hds,Ft,Genit; Exc Dia 2.1-3.0 Cm",,11423,CPT,Facility,Inpatient,,,,315,267.75,90.279,315,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Excision, Benign Lesion Inc Margins,Except Sktag,Sclp,Nk,Hds,Ft,Genit; Exc Dia 2.1-3.0 Cm",,11423,CPT,Facility,Both,,,,315,267.75,90.279,315,UnitedHealthcare,Individual & Family,296.1,94,,percent of total billed charges,,
"Excision, Benign Lesion Inc Margins,Except Sktag,Sclp,Nk,Hds,Ft,Genit; Exc Dia 2.1-3.0 Cm",,11423,CPT,Facility,Outpatient,,,,315,267.75,90.279,315,UnitedHealthcare,Medicare Advantage,154.35,49,,percent of total billed charges,,
"Excision, Benign Lesion Inc Margins,Except Sktag,Sclp,Nk,Hds,Ft,Genit; Exc Dia 2.1-3.0 Cm",,11423,CPT,Facility,Inpatient,,,,315,267.75,90.279,315,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Excision, Benign Lesion Inc Margins,Except Sktag,Sclp,Nk,Hds,Ft,Genit; Exc Dia 2.1-3.0 Cm",,11423,CPT,Facility,Outpatient,,,,315,267.75,90.279,315,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,151.2,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Excision, Benign Lesion Inc Margins,Except Sktag,Sclp,Nk,Hds,Ft,Genit; Exc Dia 2.1-3.0 Cm",,11423,CPT,Facility,Inpatient,,,,315,267.75,90.279,315,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Excision, Benign Lesion Inc Margins,Except Sktag,Sclp,Nk,Hds,Ft,Genit; Exc Dia 2.1-3.0 Cm (Pro Cah)",,11423,CPT,Professional,Both,,,,475,403.75,98.6,475,Aetna,Commercial,403.75,85,,percent of total billed charges,,
"Excision, Benign Lesion Inc Margins,Except Sktag,Sclp,Nk,Hds,Ft,Genit; Exc Dia 2.1-3.0 Cm (Pro Cah)",,11423,CPT,Professional,Both,,,,475,403.75,98.6,475,Aetna,Medicare Advantage,152.61,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Benign Lesion Inc Margins,Except Sktag,Sclp,Nk,Hds,Ft,Genit; Exc Dia 2.1-3.0 Cm (Pro Cah)",,11423,CPT,Professional,Both,,,,475,403.75,98.6,475,Aetna,PPO,441.75,93,,percent of total billed charges,,
"Excision, Benign Lesion Inc Margins,Except Sktag,Sclp,Nk,Hds,Ft,Genit; Exc Dia 2.1-3.0 Cm (Pro Cah)",,11423,CPT,Professional,Both,,,,475,403.75,98.6,475,America's PPO,America's PPO,405.84,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Excision, Benign Lesion Inc Margins,Except Sktag,Sclp,Nk,Hds,Ft,Genit; Exc Dia 2.1-3.0 Cm (Pro Cah)",,11423,CPT,Professional,Both,,,,475,403.75,98.6,475,BlueCross BlueShield Minnesota, Federal Employee Program,320.89,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Excision, Benign Lesion Inc Margins,Except Sktag,Sclp,Nk,Hds,Ft,Genit; Exc Dia 2.1-3.0 Cm (Pro Cah)",,11423,CPT,Professional,Both,,,,475,403.75,98.6,475,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,326.02424,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Benign Lesion Inc Margins,Except Sktag,Sclp,Nk,Hds,Ft,Genit; Exc Dia 2.1-3.0 Cm (Pro Cah)",,11423,CPT,Professional,Both,,,,475,403.75,98.6,475,BlueCross BlueShield Minnesota,High Value Network Plan,326.02424,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Benign Lesion Inc Margins,Except Sktag,Sclp,Nk,Hds,Ft,Genit; Exc Dia 2.1-3.0 Cm (Pro Cah)",,11423,CPT,Professional,Both,,,,475,403.75,98.6,475,BlueCross BlueShield Minnesota,Medicare Advantage,176.2375,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Benign Lesion Inc Margins,Except Sktag,Sclp,Nk,Hds,Ft,Genit; Exc Dia 2.1-3.0 Cm (Pro Cah)",,11423,CPT,Professional,Both,,,,475,403.75,98.6,475,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,326.02424,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Benign Lesion Inc Margins,Except Sktag,Sclp,Nk,Hds,Ft,Genit; Exc Dia 2.1-3.0 Cm (Pro Cah)",,11423,CPT,Professional,Both,,,,475,403.75,98.6,475,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,113.8428,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision, Benign Lesion Inc Margins,Except Sktag,Sclp,Nk,Hds,Ft,Genit; Exc Dia 2.1-3.0 Cm (Pro Cah)",,11423,CPT,Professional,Both,,,,475,403.75,98.6,475,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),176.2375,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Benign Lesion Inc Margins,Except Sktag,Sclp,Nk,Hds,Ft,Genit; Exc Dia 2.1-3.0 Cm (Pro Cah)",,11423,CPT,Professional,Both,,,,475,403.75,98.6,475,CorVel,Worker's Compensation,296.508531,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Excision, Benign Lesion Inc Margins,Except Sktag,Sclp,Nk,Hds,Ft,Genit; Exc Dia 2.1-3.0 Cm (Pro Cah)",,11423,CPT,Professional,Both,,,,475,403.75,98.6,475,First Health Group Corporation,First Health Network,460.75,97,,percent of total billed charges,,
"Excision, Benign Lesion Inc Margins,Except Sktag,Sclp,Nk,Hds,Ft,Genit; Exc Dia 2.1-3.0 Cm (Pro Cah)",,11423,CPT,Professional,Both,,,,475,403.75,98.6,475,"Health Partners, Inc.",Commercial,320.68,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision, Benign Lesion Inc Margins,Except Sktag,Sclp,Nk,Hds,Ft,Genit; Exc Dia 2.1-3.0 Cm (Pro Cah)",,11423,CPT,Professional,Both,,,,475,403.75,98.6,475,"Health Partners, Inc.",Medicare Advantage,176.2375,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Benign Lesion Inc Margins,Except Sktag,Sclp,Nk,Hds,Ft,Genit; Exc Dia 2.1-3.0 Cm (Pro Cah)",,11423,CPT,Professional,Both,,,,475,403.75,98.6,475,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),153.17,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Excision, Benign Lesion Inc Margins,Except Sktag,Sclp,Nk,Hds,Ft,Genit; Exc Dia 2.1-3.0 Cm (Pro Cah)",,11423,CPT,Professional,Both,,,,475,403.75,98.6,475,"Health Partners, Inc.",State of Minnesota Advantage Program,276.26582,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision, Benign Lesion Inc Margins,Except Sktag,Sclp,Nk,Hds,Ft,Genit; Exc Dia 2.1-3.0 Cm (Pro Cah)",,11423,CPT,Professional,Both,,,,475,403.75,98.6,475,"Health Partners, Inc.",State Public Programs,98.6,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Excision, Benign Lesion Inc Margins,Except Sktag,Sclp,Nk,Hds,Ft,Genit; Exc Dia 2.1-3.0 Cm (Pro Cah)",,11423,CPT,Professional,Both,,,,475,403.75,98.6,475,Humana Insurance Company,Commercial PPO,153.25,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Excision, Benign Lesion Inc Margins,Except Sktag,Sclp,Nk,Hds,Ft,Genit; Exc Dia 2.1-3.0 Cm (Pro Cah)",,11423,CPT,Professional,Both,,,,475,403.75,98.6,475,Humana Insurance Company,Medicare PPO,475,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Excision, Benign Lesion Inc Margins,Except Sktag,Sclp,Nk,Hds,Ft,Genit; Exc Dia 2.1-3.0 Cm (Pro Cah)",,11423,CPT,Professional,Both,,,,475,403.75,98.6,475,Medica,Individual & Family,402.8,84.8,,percent of total billed charges,,
"Excision, Benign Lesion Inc Margins,Except Sktag,Sclp,Nk,Hds,Ft,Genit; Exc Dia 2.1-3.0 Cm (Pro Cah)",,11423,CPT,Professional,Both,,,,475,403.75,98.6,475,Medica,Medica Advantage Solution,236.55,49.8,,percent of total billed charges,,
"Excision, Benign Lesion Inc Margins,Except Sktag,Sclp,Nk,Hds,Ft,Genit; Exc Dia 2.1-3.0 Cm (Pro Cah)",,11423,CPT,Professional,Both,,,,475,403.75,98.6,475,Medica,Medical Assistance,113.84,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Excision, Benign Lesion Inc Margins,Except Sktag,Sclp,Nk,Hds,Ft,Genit; Exc Dia 2.1-3.0 Cm (Pro Cah)",,11423,CPT,Professional,Both,,,,475,403.75,98.6,475,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,153.25,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Excision, Benign Lesion Inc Margins,Except Sktag,Sclp,Nk,Hds,Ft,Genit; Exc Dia 2.1-3.0 Cm (Pro Cah)",,11423,CPT,Professional,Both,,,,475,403.75,98.6,475,"Multiplan, Inc.","Multiplan, Inc.",446.5,94,,percent of total billed charges,,
"Excision, Benign Lesion Inc Margins,Except Sktag,Sclp,Nk,Hds,Ft,Genit; Exc Dia 2.1-3.0 Cm (Pro Cah)",,11423,CPT,Professional,Both,,,,475,403.75,98.6,475,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,427.975,90.1,,percent of total billed charges,,
"Excision, Benign Lesion Inc Margins,Except Sktag,Sclp,Nk,Hds,Ft,Genit; Exc Dia 2.1-3.0 Cm (Pro Cah)",,11423,CPT,Professional,Both,,,,475,403.75,98.6,475,"Preferred One Administrative Services, INC.",PPO,468.35,98.6,,percent of total billed charges,,
"Excision, Benign Lesion Inc Margins,Except Sktag,Sclp,Nk,Hds,Ft,Genit; Exc Dia 2.1-3.0 Cm (Pro Cah)",,11423,CPT,Professional,Both,,,,475,403.75,98.6,475,PrimeWest Health,Minnesota Senior Health Options (MSHO),176.2375,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Benign Lesion Inc Margins,Except Sktag,Sclp,Nk,Hds,Ft,Genit; Exc Dia 2.1-3.0 Cm (Pro Cah)",,11423,CPT,Professional,Both,,,,475,403.75,98.6,475,PrimeWest Health,MinnesotaCare,121.811796,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision, Benign Lesion Inc Margins,Except Sktag,Sclp,Nk,Hds,Ft,Genit; Exc Dia 2.1-3.0 Cm (Pro Cah)",,11423,CPT,Professional,Both,,,,475,403.75,98.6,475,Sanford Health Plan,Sanford Health Plan,418,88,,percent of total billed charges,,
"Excision, Benign Lesion Inc Margins,Except Sktag,Sclp,Nk,Hds,Ft,Genit; Exc Dia 2.1-3.0 Cm (Pro Cah)",,11423,CPT,Professional,Both,,,,475,403.75,98.6,475,"UCare Health, Inc.",Individual & Family Plan,249.1232,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Excision, Benign Lesion Inc Margins,Except Sktag,Sclp,Nk,Hds,Ft,Genit; Exc Dia 2.1-3.0 Cm (Pro Cah)",,11423,CPT,Professional,Both,,,,475,403.75,98.6,475,"UCare Health, Inc.",Medical Assistance,125.22708,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Excision, Benign Lesion Inc Margins,Except Sktag,Sclp,Nk,Hds,Ft,Genit; Exc Dia 2.1-3.0 Cm (Pro Cah)",,11423,CPT,Professional,Both,,,,475,403.75,98.6,475,"UCare Health, Inc.",Medicare Advantage,176.2375,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Excision, Benign Lesion Inc Margins,Except Sktag,Sclp,Nk,Hds,Ft,Genit; Exc Dia 2.1-3.0 Cm (Pro Cah)",,11423,CPT,Professional,Both,,,,475,403.75,98.6,475,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),140.99,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Excision, Benign Lesion Inc Margins,Except Sktag,Sclp,Nk,Hds,Ft,Genit; Exc Dia 2.1-3.0 Cm (Pro Cah)",,11423,CPT,Professional,Both,,,,475,403.75,98.6,475,UnitedHealthcare,Individual & Family,475,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Excision, Benign Lesion Inc Margins,Except Sktag,Sclp,Nk,Hds,Ft,Genit; Exc Dia 2.1-3.0 Cm (Pro Cah)",,11423,CPT,Professional,Both,,,,475,403.75,98.6,475,UnitedHealthcare,Medicare Advantage,176.2375,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Benign Lesion Inc Margins,Except Sktag,Sclp,Nk,Hds,Ft,Genit; Exc Dia 2.1-3.0 Cm (Pro Cah)",,11423,CPT,Professional,Both,,,,475,403.75,98.6,475,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,113.8428,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision,Benign,Lesion Scalp,Neck,Hands; 3.1-4.0 Cm",,11424,CPT,Facility,Both,,,,435,369.75,124.671,435,Aetna,Commercial,400.2,92,,percent of total billed charges,,
"Excision,Benign,Lesion Scalp,Neck,Hands; 3.1-4.0 Cm",,11424,CPT,Facility,Outpatient,,,,435,369.75,124.671,435,Aetna,Medicare Advantage,213.15,49,,percent of total billed charges,,
"Excision,Benign,Lesion Scalp,Neck,Hands; 3.1-4.0 Cm",,11424,CPT,Facility,Inpatient,,,,435,369.75,124.671,435,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Excision,Benign,Lesion Scalp,Neck,Hands; 3.1-4.0 Cm",,11424,CPT,Facility,Both,,,,435,369.75,124.671,435,Aetna,PPO,404.55,93,,percent of total billed charges,,
"Excision,Benign,Lesion Scalp,Neck,Hands; 3.1-4.0 Cm",,11424,CPT,Facility,Both,,,,435,369.75,124.671,435,America's PPO,America's PPO,417.7305,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Excision,Benign,Lesion Scalp,Neck,Hands; 3.1-4.0 Cm",,11424,CPT,Facility,Both,,,,435,369.75,124.671,435,BlueCross BlueShield Minnesota, Federal Employee Program,428.04,98.4,,percent of total billed charges,,
"Excision,Benign,Lesion Scalp,Neck,Hands; 3.1-4.0 Cm",,11424,CPT,Facility,Both,,,,435,369.75,124.671,435,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,435,100,,percent of total billed charges,,
"Excision,Benign,Lesion Scalp,Neck,Hands; 3.1-4.0 Cm",,11424,CPT,Facility,Both,,,,435,369.75,124.671,435,BlueCross BlueShield Minnesota,High Value Network Plan,391.5,90,,percent of total billed charges,,
"Excision,Benign,Lesion Scalp,Neck,Hands; 3.1-4.0 Cm",,11424,CPT,Facility,Outpatient,,,,435,369.75,124.671,435,BlueCross BlueShield Minnesota,Medicare Advantage,213.15,49,,percent of total billed charges,,
"Excision,Benign,Lesion Scalp,Neck,Hands; 3.1-4.0 Cm",,11424,CPT,Facility,Inpatient,,,,435,369.75,124.671,435,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Excision,Benign,Lesion Scalp,Neck,Hands; 3.1-4.0 Cm",,11424,CPT,Facility,Both,,,,435,369.75,124.671,435,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,385.2795,88.57,,percent of total billed charges,,
"Excision,Benign,Lesion Scalp,Neck,Hands; 3.1-4.0 Cm",,11424,CPT,Facility,Both,,,,435,369.75,124.671,435,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,124.671,28.66,,percent of total billed charges,,
"Excision,Benign,Lesion Scalp,Neck,Hands; 3.1-4.0 Cm",,11424,CPT,Facility,Outpatient,,,,435,369.75,124.671,435,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),213.15,49,,percent of total billed charges,,
"Excision,Benign,Lesion Scalp,Neck,Hands; 3.1-4.0 Cm",,11424,CPT,Facility,Inpatient,,,,435,369.75,124.671,435,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Excision,Benign,Lesion Scalp,Neck,Hands; 3.1-4.0 Cm",,11424,CPT,Facility,Both,,,,435,369.75,124.671,435,CorVel,Worker's Compensation,435,100,,percent of total billed charges,,
"Excision,Benign,Lesion Scalp,Neck,Hands; 3.1-4.0 Cm",,11424,CPT,Facility,Both,,,,435,369.75,124.671,435,First Health Group Corporation,First Health Network,421.95,97,,percent of total billed charges,,
"Excision,Benign,Lesion Scalp,Neck,Hands; 3.1-4.0 Cm",,11424,CPT,Facility,Both,,,,435,369.75,124.671,435,"Health Partners, Inc.",Commercial,411.51,94.6,,percent of total billed charges,,
"Excision,Benign,Lesion Scalp,Neck,Hands; 3.1-4.0 Cm",,11424,CPT,Facility,Outpatient,,,,435,369.75,124.671,435,"Health Partners, Inc.",Medicare Advantage,213.15,49,,percent of total billed charges,,
"Excision,Benign,Lesion Scalp,Neck,Hands; 3.1-4.0 Cm",,11424,CPT,Facility,Inpatient,,,,435,369.75,124.671,435,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Excision,Benign,Lesion Scalp,Neck,Hands; 3.1-4.0 Cm",,11424,CPT,Facility,Both,,,,435,369.75,124.671,435,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),261,60,,percent of total billed charges,,
"Excision,Benign,Lesion Scalp,Neck,Hands; 3.1-4.0 Cm",,11424,CPT,Facility,Both,,,,435,369.75,124.671,435,"Health Partners, Inc.",State of Minnesota Advantage Program,354.525,81.5,,percent of total billed charges,,
"Excision,Benign,Lesion Scalp,Neck,Hands; 3.1-4.0 Cm",,11424,CPT,Facility,Both,,,,435,369.75,124.671,435,"Health Partners, Inc.",State Public Programs,217.5,50,,percent of total billed charges,,
"Excision,Benign,Lesion Scalp,Neck,Hands; 3.1-4.0 Cm",,11424,CPT,Facility,Both,,,,435,369.75,124.671,435,Humana Insurance Company,Commercial PPO,413.25,95,,percent of total billed charges,,
"Excision,Benign,Lesion Scalp,Neck,Hands; 3.1-4.0 Cm",,11424,CPT,Facility,Outpatient,,,,435,369.75,124.671,435,Humana Insurance Company,Medicare PPO,213.15,49,,percent of total billed charges,,
"Excision,Benign,Lesion Scalp,Neck,Hands; 3.1-4.0 Cm",,11424,CPT,Facility,Inpatient,,,,435,369.75,124.671,435,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Excision,Benign,Lesion Scalp,Neck,Hands; 3.1-4.0 Cm",,11424,CPT,Facility,Both,,,,435,369.75,124.671,435,Medica,Individual & Family,431.085,99.1,,percent of total billed charges,,
"Excision,Benign,Lesion Scalp,Neck,Hands; 3.1-4.0 Cm",,11424,CPT,Facility,Outpatient,,,,435,369.75,124.671,435,Medica,Medica Advantage Solution,216.63,49.8,,percent of total billed charges,,
"Excision,Benign,Lesion Scalp,Neck,Hands; 3.1-4.0 Cm",,11424,CPT,Facility,Inpatient,,,,435,369.75,124.671,435,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Excision,Benign,Lesion Scalp,Neck,Hands; 3.1-4.0 Cm",,11424,CPT,Facility,Outpatient,,,,435,369.75,124.671,435,Medica,Medical Assistance,194.01,44.6,,percent of total billed charges,,
"Excision,Benign,Lesion Scalp,Neck,Hands; 3.1-4.0 Cm",,11424,CPT,Facility,Inpatient,,,,435,369.75,124.671,435,Medica,Medical Assistance,,,,,Included in per diem rate,
"Excision,Benign,Lesion Scalp,Neck,Hands; 3.1-4.0 Cm",,11424,CPT,Facility,Outpatient,,,,435,369.75,124.671,435,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,216.63,49.8,,percent of total billed charges,,
"Excision,Benign,Lesion Scalp,Neck,Hands; 3.1-4.0 Cm",,11424,CPT,Facility,Inpatient,,,,435,369.75,124.671,435,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Excision,Benign,Lesion Scalp,Neck,Hands; 3.1-4.0 Cm",,11424,CPT,Facility,Both,,,,435,369.75,124.671,435,"Multiplan, Inc.","Multiplan, Inc.",408.9,94,,percent of total billed charges,,
"Excision,Benign,Lesion Scalp,Neck,Hands; 3.1-4.0 Cm",,11424,CPT,Facility,Outpatient,,,,435,369.75,124.671,435,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,391.935,90.1,,percent of total billed charges,,
"Excision,Benign,Lesion Scalp,Neck,Hands; 3.1-4.0 Cm",,11424,CPT,Facility,Inpatient,,,,435,369.75,124.671,435,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Excision,Benign,Lesion Scalp,Neck,Hands; 3.1-4.0 Cm",,11424,CPT,Facility,Both,,,,435,369.75,124.671,435,"Preferred One Administrative Services, INC.",PPO,428.91,98.6,,percent of total billed charges,,
"Excision,Benign,Lesion Scalp,Neck,Hands; 3.1-4.0 Cm",,11424,CPT,Facility,Outpatient,,,,435,369.75,124.671,435,PrimeWest Health,Minnesota Senior Health Options (MSHO),223.8075,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Excision,Benign,Lesion Scalp,Neck,Hands; 3.1-4.0 Cm",,11424,CPT,Facility,Inpatient,,,,435,369.75,124.671,435,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Excision,Benign,Lesion Scalp,Neck,Hands; 3.1-4.0 Cm",,11424,CPT,Facility,Outpatient,,,,435,369.75,124.671,435,PrimeWest Health,MinnesotaCare,223.416,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Excision,Benign,Lesion Scalp,Neck,Hands; 3.1-4.0 Cm",,11424,CPT,Facility,Inpatient,,,,435,369.75,124.671,435,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Excision,Benign,Lesion Scalp,Neck,Hands; 3.1-4.0 Cm",,11424,CPT,Facility,Both,,,,435,369.75,124.671,435,Sanford Health Plan,Sanford Health Plan,400.2,92,,percent of total billed charges,,
"Excision,Benign,Lesion Scalp,Neck,Hands; 3.1-4.0 Cm",,11424,CPT,Facility,Outpatient,,,,435,369.75,124.671,435,"UCare Health, Inc.",Individual & Family Plan,245.1225,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Excision,Benign,Lesion Scalp,Neck,Hands; 3.1-4.0 Cm",,11424,CPT,Facility,Inpatient,,,,435,369.75,124.671,435,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Excision,Benign,Lesion Scalp,Neck,Hands; 3.1-4.0 Cm",,11424,CPT,Facility,Outpatient,,,,435,369.75,124.671,435,"UCare Health, Inc.",Medical Assistance,219.5445,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Excision,Benign,Lesion Scalp,Neck,Hands; 3.1-4.0 Cm",,11424,CPT,Facility,Inpatient,,,,435,369.75,124.671,435,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Excision,Benign,Lesion Scalp,Neck,Hands; 3.1-4.0 Cm",,11424,CPT,Facility,Outpatient,,,,435,369.75,124.671,435,"UCare Health, Inc.",Medicare Advantage,219.5445,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Excision,Benign,Lesion Scalp,Neck,Hands; 3.1-4.0 Cm",,11424,CPT,Facility,Inpatient,,,,435,369.75,124.671,435,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Excision,Benign,Lesion Scalp,Neck,Hands; 3.1-4.0 Cm",,11424,CPT,Facility,Outpatient,,,,435,369.75,124.671,435,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),219.5445,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Excision,Benign,Lesion Scalp,Neck,Hands; 3.1-4.0 Cm",,11424,CPT,Facility,Inpatient,,,,435,369.75,124.671,435,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Excision,Benign,Lesion Scalp,Neck,Hands; 3.1-4.0 Cm",,11424,CPT,Facility,Both,,,,435,369.75,124.671,435,UnitedHealthcare,Individual & Family,408.9,94,,percent of total billed charges,,
"Excision,Benign,Lesion Scalp,Neck,Hands; 3.1-4.0 Cm",,11424,CPT,Facility,Outpatient,,,,435,369.75,124.671,435,UnitedHealthcare,Medicare Advantage,213.15,49,,percent of total billed charges,,
"Excision,Benign,Lesion Scalp,Neck,Hands; 3.1-4.0 Cm",,11424,CPT,Facility,Inpatient,,,,435,369.75,124.671,435,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Excision,Benign,Lesion Scalp,Neck,Hands; 3.1-4.0 Cm",,11424,CPT,Facility,Outpatient,,,,435,369.75,124.671,435,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,208.8,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Excision,Benign,Lesion Scalp,Neck,Hands; 3.1-4.0 Cm",,11424,CPT,Facility,Inpatient,,,,435,369.75,124.671,435,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Excision,Benign,Lesion Scalp,Neck,Hands; 3.1-4.0 Cm (Pro Cah)",,11424,CPT,Professional,Both,,,,680,578,112.13,680,Aetna,Commercial,578,85,,percent of total billed charges,,
"Excision,Benign,Lesion Scalp,Neck,Hands; 3.1-4.0 Cm (Pro Cah)",,11424,CPT,Professional,Both,,,,680,578,112.13,680,Aetna,Medicare Advantage,172.97,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision,Benign,Lesion Scalp,Neck,Hands; 3.1-4.0 Cm (Pro Cah)",,11424,CPT,Professional,Both,,,,680,578,112.13,680,Aetna,PPO,632.4,93,,percent of total billed charges,,
"Excision,Benign,Lesion Scalp,Neck,Hands; 3.1-4.0 Cm (Pro Cah)",,11424,CPT,Professional,Both,,,,680,578,112.13,680,America's PPO,America's PPO,580.992,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Excision,Benign,Lesion Scalp,Neck,Hands; 3.1-4.0 Cm (Pro Cah)",,11424,CPT,Professional,Both,,,,680,578,112.13,680,BlueCross BlueShield Minnesota, Federal Employee Program,367.02,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Excision,Benign,Lesion Scalp,Neck,Hands; 3.1-4.0 Cm (Pro Cah)",,11424,CPT,Professional,Both,,,,680,578,112.13,680,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,372.89232,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision,Benign,Lesion Scalp,Neck,Hands; 3.1-4.0 Cm (Pro Cah)",,11424,CPT,Professional,Both,,,,680,578,112.13,680,BlueCross BlueShield Minnesota,High Value Network Plan,372.89232,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision,Benign,Lesion Scalp,Neck,Hands; 3.1-4.0 Cm (Pro Cah)",,11424,CPT,Professional,Both,,,,680,578,112.13,680,BlueCross BlueShield Minnesota,Medicare Advantage,199.9735,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision,Benign,Lesion Scalp,Neck,Hands; 3.1-4.0 Cm (Pro Cah)",,11424,CPT,Professional,Both,,,,680,578,112.13,680,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,372.89232,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision,Benign,Lesion Scalp,Neck,Hands; 3.1-4.0 Cm (Pro Cah)",,11424,CPT,Professional,Both,,,,680,578,112.13,680,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,129.45872,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision,Benign,Lesion Scalp,Neck,Hands; 3.1-4.0 Cm (Pro Cah)",,11424,CPT,Professional,Both,,,,680,578,112.13,680,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),199.9735,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision,Benign,Lesion Scalp,Neck,Hands; 3.1-4.0 Cm (Pro Cah)",,11424,CPT,Professional,Both,,,,680,578,112.13,680,CorVel,Worker's Compensation,336.8232933,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Excision,Benign,Lesion Scalp,Neck,Hands; 3.1-4.0 Cm (Pro Cah)",,11424,CPT,Professional,Both,,,,680,578,112.13,680,First Health Group Corporation,First Health Network,659.6,97,,percent of total billed charges,,
"Excision,Benign,Lesion Scalp,Neck,Hands; 3.1-4.0 Cm (Pro Cah)",,11424,CPT,Professional,Both,,,,680,578,112.13,680,"Health Partners, Inc.",Commercial,363.48,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision,Benign,Lesion Scalp,Neck,Hands; 3.1-4.0 Cm (Pro Cah)",,11424,CPT,Professional,Both,,,,680,578,112.13,680,"Health Partners, Inc.",Medicare Advantage,199.9735,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision,Benign,Lesion Scalp,Neck,Hands; 3.1-4.0 Cm (Pro Cah)",,11424,CPT,Professional,Both,,,,680,578,112.13,680,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),173.84,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Excision,Benign,Lesion Scalp,Neck,Hands; 3.1-4.0 Cm (Pro Cah)",,11424,CPT,Professional,Both,,,,680,578,112.13,680,"Health Partners, Inc.",State of Minnesota Advantage Program,313.13802,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision,Benign,Lesion Scalp,Neck,Hands; 3.1-4.0 Cm (Pro Cah)",,11424,CPT,Professional,Both,,,,680,578,112.13,680,"Health Partners, Inc.",State Public Programs,112.13,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Excision,Benign,Lesion Scalp,Neck,Hands; 3.1-4.0 Cm (Pro Cah)",,11424,CPT,Professional,Both,,,,680,578,112.13,680,Humana Insurance Company,Commercial PPO,173.89,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Excision,Benign,Lesion Scalp,Neck,Hands; 3.1-4.0 Cm (Pro Cah)",,11424,CPT,Professional,Both,,,,680,578,112.13,680,Humana Insurance Company,Medicare PPO,680,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Excision,Benign,Lesion Scalp,Neck,Hands; 3.1-4.0 Cm (Pro Cah)",,11424,CPT,Professional,Both,,,,680,578,112.13,680,Medica,Individual & Family,576.64,84.8,,percent of total billed charges,,
"Excision,Benign,Lesion Scalp,Neck,Hands; 3.1-4.0 Cm (Pro Cah)",,11424,CPT,Professional,Both,,,,680,578,112.13,680,Medica,Medica Advantage Solution,338.64,49.8,,percent of total billed charges,,
"Excision,Benign,Lesion Scalp,Neck,Hands; 3.1-4.0 Cm (Pro Cah)",,11424,CPT,Professional,Both,,,,680,578,112.13,680,Medica,Medical Assistance,129.46,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Excision,Benign,Lesion Scalp,Neck,Hands; 3.1-4.0 Cm (Pro Cah)",,11424,CPT,Professional,Both,,,,680,578,112.13,680,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,173.89,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Excision,Benign,Lesion Scalp,Neck,Hands; 3.1-4.0 Cm (Pro Cah)",,11424,CPT,Professional,Both,,,,680,578,112.13,680,"Multiplan, Inc.","Multiplan, Inc.",639.2,94,,percent of total billed charges,,
"Excision,Benign,Lesion Scalp,Neck,Hands; 3.1-4.0 Cm (Pro Cah)",,11424,CPT,Professional,Both,,,,680,578,112.13,680,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,612.68,90.1,,percent of total billed charges,,
"Excision,Benign,Lesion Scalp,Neck,Hands; 3.1-4.0 Cm (Pro Cah)",,11424,CPT,Professional,Both,,,,680,578,112.13,680,"Preferred One Administrative Services, INC.",PPO,670.48,98.6,,percent of total billed charges,,
"Excision,Benign,Lesion Scalp,Neck,Hands; 3.1-4.0 Cm (Pro Cah)",,11424,CPT,Professional,Both,,,,680,578,112.13,680,PrimeWest Health,Minnesota Senior Health Options (MSHO),199.9735,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision,Benign,Lesion Scalp,Neck,Hands; 3.1-4.0 Cm (Pro Cah)",,11424,CPT,Professional,Both,,,,680,578,112.13,680,PrimeWest Health,MinnesotaCare,138.5208304,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision,Benign,Lesion Scalp,Neck,Hands; 3.1-4.0 Cm (Pro Cah)",,11424,CPT,Professional,Both,,,,680,578,112.13,680,Sanford Health Plan,Sanford Health Plan,598.4,88,,percent of total billed charges,,
"Excision,Benign,Lesion Scalp,Neck,Hands; 3.1-4.0 Cm (Pro Cah)",,11424,CPT,Professional,Both,,,,680,578,112.13,680,"UCare Health, Inc.",Individual & Family Plan,282.675584,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Excision,Benign,Lesion Scalp,Neck,Hands; 3.1-4.0 Cm (Pro Cah)",,11424,CPT,Professional,Both,,,,680,578,112.13,680,"UCare Health, Inc.",Medical Assistance,142.404592,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Excision,Benign,Lesion Scalp,Neck,Hands; 3.1-4.0 Cm (Pro Cah)",,11424,CPT,Professional,Both,,,,680,578,112.13,680,"UCare Health, Inc.",Medicare Advantage,199.9735,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Excision,Benign,Lesion Scalp,Neck,Hands; 3.1-4.0 Cm (Pro Cah)",,11424,CPT,Professional,Both,,,,680,578,112.13,680,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),159.9788,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Excision,Benign,Lesion Scalp,Neck,Hands; 3.1-4.0 Cm (Pro Cah)",,11424,CPT,Professional,Both,,,,680,578,112.13,680,UnitedHealthcare,Individual & Family,680,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Excision,Benign,Lesion Scalp,Neck,Hands; 3.1-4.0 Cm (Pro Cah)",,11424,CPT,Professional,Both,,,,680,578,112.13,680,UnitedHealthcare,Medicare Advantage,199.9735,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision,Benign,Lesion Scalp,Neck,Hands; 3.1-4.0 Cm (Pro Cah)",,11424,CPT,Professional,Both,,,,680,578,112.13,680,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,129.45872,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision,Benign Lesion Inc Margin,Except Skintag/Sclp/Nk/Hnd/Ft/Genit;Exc Dia Over 4.0 Cm",,11426,CPT,Facility,Both,,,,510,433.5,146.166,510,Aetna,Commercial,469.2,92,,percent of total billed charges,,
"Excision,Benign Lesion Inc Margin,Except Skintag/Sclp/Nk/Hnd/Ft/Genit;Exc Dia Over 4.0 Cm",,11426,CPT,Facility,Outpatient,,,,510,433.5,146.166,510,Aetna,Medicare Advantage,249.9,49,,percent of total billed charges,,
"Excision,Benign Lesion Inc Margin,Except Skintag/Sclp/Nk/Hnd/Ft/Genit;Exc Dia Over 4.0 Cm",,11426,CPT,Facility,Inpatient,,,,510,433.5,146.166,510,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Excision,Benign Lesion Inc Margin,Except Skintag/Sclp/Nk/Hnd/Ft/Genit;Exc Dia Over 4.0 Cm",,11426,CPT,Facility,Both,,,,510,433.5,146.166,510,Aetna,PPO,474.3,93,,percent of total billed charges,,
"Excision,Benign Lesion Inc Margin,Except Skintag/Sclp/Nk/Hnd/Ft/Genit;Exc Dia Over 4.0 Cm",,11426,CPT,Facility,Both,,,,510,433.5,146.166,510,America's PPO,America's PPO,489.753,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Excision,Benign Lesion Inc Margin,Except Skintag/Sclp/Nk/Hnd/Ft/Genit;Exc Dia Over 4.0 Cm",,11426,CPT,Facility,Both,,,,510,433.5,146.166,510,BlueCross BlueShield Minnesota, Federal Employee Program,501.84,98.4,,percent of total billed charges,,
"Excision,Benign Lesion Inc Margin,Except Skintag/Sclp/Nk/Hnd/Ft/Genit;Exc Dia Over 4.0 Cm",,11426,CPT,Facility,Both,,,,510,433.5,146.166,510,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,510,100,,percent of total billed charges,,
"Excision,Benign Lesion Inc Margin,Except Skintag/Sclp/Nk/Hnd/Ft/Genit;Exc Dia Over 4.0 Cm",,11426,CPT,Facility,Both,,,,510,433.5,146.166,510,BlueCross BlueShield Minnesota,High Value Network Plan,459,90,,percent of total billed charges,,
"Excision,Benign Lesion Inc Margin,Except Skintag/Sclp/Nk/Hnd/Ft/Genit;Exc Dia Over 4.0 Cm",,11426,CPT,Facility,Outpatient,,,,510,433.5,146.166,510,BlueCross BlueShield Minnesota,Medicare Advantage,249.9,49,,percent of total billed charges,,
"Excision,Benign Lesion Inc Margin,Except Skintag/Sclp/Nk/Hnd/Ft/Genit;Exc Dia Over 4.0 Cm",,11426,CPT,Facility,Inpatient,,,,510,433.5,146.166,510,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Excision,Benign Lesion Inc Margin,Except Skintag/Sclp/Nk/Hnd/Ft/Genit;Exc Dia Over 4.0 Cm",,11426,CPT,Facility,Both,,,,510,433.5,146.166,510,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,451.707,88.57,,percent of total billed charges,,
"Excision,Benign Lesion Inc Margin,Except Skintag/Sclp/Nk/Hnd/Ft/Genit;Exc Dia Over 4.0 Cm",,11426,CPT,Facility,Both,,,,510,433.5,146.166,510,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,146.166,28.66,,percent of total billed charges,,
"Excision,Benign Lesion Inc Margin,Except Skintag/Sclp/Nk/Hnd/Ft/Genit;Exc Dia Over 4.0 Cm",,11426,CPT,Facility,Outpatient,,,,510,433.5,146.166,510,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),249.9,49,,percent of total billed charges,,
"Excision,Benign Lesion Inc Margin,Except Skintag/Sclp/Nk/Hnd/Ft/Genit;Exc Dia Over 4.0 Cm",,11426,CPT,Facility,Inpatient,,,,510,433.5,146.166,510,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Excision,Benign Lesion Inc Margin,Except Skintag/Sclp/Nk/Hnd/Ft/Genit;Exc Dia Over 4.0 Cm",,11426,CPT,Facility,Both,,,,510,433.5,146.166,510,CorVel,Worker's Compensation,510,100,,percent of total billed charges,,
"Excision,Benign Lesion Inc Margin,Except Skintag/Sclp/Nk/Hnd/Ft/Genit;Exc Dia Over 4.0 Cm",,11426,CPT,Facility,Both,,,,510,433.5,146.166,510,First Health Group Corporation,First Health Network,494.7,97,,percent of total billed charges,,
"Excision,Benign Lesion Inc Margin,Except Skintag/Sclp/Nk/Hnd/Ft/Genit;Exc Dia Over 4.0 Cm",,11426,CPT,Facility,Both,,,,510,433.5,146.166,510,"Health Partners, Inc.",Commercial,482.46,94.6,,percent of total billed charges,,
"Excision,Benign Lesion Inc Margin,Except Skintag/Sclp/Nk/Hnd/Ft/Genit;Exc Dia Over 4.0 Cm",,11426,CPT,Facility,Outpatient,,,,510,433.5,146.166,510,"Health Partners, Inc.",Medicare Advantage,249.9,49,,percent of total billed charges,,
"Excision,Benign Lesion Inc Margin,Except Skintag/Sclp/Nk/Hnd/Ft/Genit;Exc Dia Over 4.0 Cm",,11426,CPT,Facility,Inpatient,,,,510,433.5,146.166,510,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Excision,Benign Lesion Inc Margin,Except Skintag/Sclp/Nk/Hnd/Ft/Genit;Exc Dia Over 4.0 Cm",,11426,CPT,Facility,Both,,,,510,433.5,146.166,510,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),306,60,,percent of total billed charges,,
"Excision,Benign Lesion Inc Margin,Except Skintag/Sclp/Nk/Hnd/Ft/Genit;Exc Dia Over 4.0 Cm",,11426,CPT,Facility,Both,,,,510,433.5,146.166,510,"Health Partners, Inc.",State of Minnesota Advantage Program,415.65,81.5,,percent of total billed charges,,
"Excision,Benign Lesion Inc Margin,Except Skintag/Sclp/Nk/Hnd/Ft/Genit;Exc Dia Over 4.0 Cm",,11426,CPT,Facility,Both,,,,510,433.5,146.166,510,"Health Partners, Inc.",State Public Programs,255,50,,percent of total billed charges,,
"Excision,Benign Lesion Inc Margin,Except Skintag/Sclp/Nk/Hnd/Ft/Genit;Exc Dia Over 4.0 Cm",,11426,CPT,Facility,Both,,,,510,433.5,146.166,510,Humana Insurance Company,Commercial PPO,484.5,95,,percent of total billed charges,,
"Excision,Benign Lesion Inc Margin,Except Skintag/Sclp/Nk/Hnd/Ft/Genit;Exc Dia Over 4.0 Cm",,11426,CPT,Facility,Outpatient,,,,510,433.5,146.166,510,Humana Insurance Company,Medicare PPO,249.9,49,,percent of total billed charges,,
"Excision,Benign Lesion Inc Margin,Except Skintag/Sclp/Nk/Hnd/Ft/Genit;Exc Dia Over 4.0 Cm",,11426,CPT,Facility,Inpatient,,,,510,433.5,146.166,510,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Excision,Benign Lesion Inc Margin,Except Skintag/Sclp/Nk/Hnd/Ft/Genit;Exc Dia Over 4.0 Cm",,11426,CPT,Facility,Both,,,,510,433.5,146.166,510,Medica,Individual & Family,505.41,99.1,,percent of total billed charges,,
"Excision,Benign Lesion Inc Margin,Except Skintag/Sclp/Nk/Hnd/Ft/Genit;Exc Dia Over 4.0 Cm",,11426,CPT,Facility,Outpatient,,,,510,433.5,146.166,510,Medica,Medica Advantage Solution,253.98,49.8,,percent of total billed charges,,
"Excision,Benign Lesion Inc Margin,Except Skintag/Sclp/Nk/Hnd/Ft/Genit;Exc Dia Over 4.0 Cm",,11426,CPT,Facility,Inpatient,,,,510,433.5,146.166,510,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Excision,Benign Lesion Inc Margin,Except Skintag/Sclp/Nk/Hnd/Ft/Genit;Exc Dia Over 4.0 Cm",,11426,CPT,Facility,Outpatient,,,,510,433.5,146.166,510,Medica,Medical Assistance,227.46,44.6,,percent of total billed charges,,
"Excision,Benign Lesion Inc Margin,Except Skintag/Sclp/Nk/Hnd/Ft/Genit;Exc Dia Over 4.0 Cm",,11426,CPT,Facility,Inpatient,,,,510,433.5,146.166,510,Medica,Medical Assistance,,,,,Included in per diem rate,
"Excision,Benign Lesion Inc Margin,Except Skintag/Sclp/Nk/Hnd/Ft/Genit;Exc Dia Over 4.0 Cm",,11426,CPT,Facility,Outpatient,,,,510,433.5,146.166,510,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,253.98,49.8,,percent of total billed charges,,
"Excision,Benign Lesion Inc Margin,Except Skintag/Sclp/Nk/Hnd/Ft/Genit;Exc Dia Over 4.0 Cm",,11426,CPT,Facility,Inpatient,,,,510,433.5,146.166,510,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Excision,Benign Lesion Inc Margin,Except Skintag/Sclp/Nk/Hnd/Ft/Genit;Exc Dia Over 4.0 Cm",,11426,CPT,Facility,Both,,,,510,433.5,146.166,510,"Multiplan, Inc.","Multiplan, Inc.",479.4,94,,percent of total billed charges,,
"Excision,Benign Lesion Inc Margin,Except Skintag/Sclp/Nk/Hnd/Ft/Genit;Exc Dia Over 4.0 Cm",,11426,CPT,Facility,Outpatient,,,,510,433.5,146.166,510,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,459.51,90.1,,percent of total billed charges,,
"Excision,Benign Lesion Inc Margin,Except Skintag/Sclp/Nk/Hnd/Ft/Genit;Exc Dia Over 4.0 Cm",,11426,CPT,Facility,Inpatient,,,,510,433.5,146.166,510,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Excision,Benign Lesion Inc Margin,Except Skintag/Sclp/Nk/Hnd/Ft/Genit;Exc Dia Over 4.0 Cm",,11426,CPT,Facility,Both,,,,510,433.5,146.166,510,"Preferred One Administrative Services, INC.",PPO,502.86,98.6,,percent of total billed charges,,
"Excision,Benign Lesion Inc Margin,Except Skintag/Sclp/Nk/Hnd/Ft/Genit;Exc Dia Over 4.0 Cm",,11426,CPT,Facility,Outpatient,,,,510,433.5,146.166,510,PrimeWest Health,Minnesota Senior Health Options (MSHO),262.395,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Excision,Benign Lesion Inc Margin,Except Skintag/Sclp/Nk/Hnd/Ft/Genit;Exc Dia Over 4.0 Cm",,11426,CPT,Facility,Inpatient,,,,510,433.5,146.166,510,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Excision,Benign Lesion Inc Margin,Except Skintag/Sclp/Nk/Hnd/Ft/Genit;Exc Dia Over 4.0 Cm",,11426,CPT,Facility,Outpatient,,,,510,433.5,146.166,510,PrimeWest Health,MinnesotaCare,261.936,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Excision,Benign Lesion Inc Margin,Except Skintag/Sclp/Nk/Hnd/Ft/Genit;Exc Dia Over 4.0 Cm",,11426,CPT,Facility,Inpatient,,,,510,433.5,146.166,510,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Excision,Benign Lesion Inc Margin,Except Skintag/Sclp/Nk/Hnd/Ft/Genit;Exc Dia Over 4.0 Cm",,11426,CPT,Facility,Both,,,,510,433.5,146.166,510,Sanford Health Plan,Sanford Health Plan,469.2,92,,percent of total billed charges,,
"Excision,Benign Lesion Inc Margin,Except Skintag/Sclp/Nk/Hnd/Ft/Genit;Exc Dia Over 4.0 Cm",,11426,CPT,Facility,Outpatient,,,,510,433.5,146.166,510,"UCare Health, Inc.",Individual & Family Plan,287.385,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Excision,Benign Lesion Inc Margin,Except Skintag/Sclp/Nk/Hnd/Ft/Genit;Exc Dia Over 4.0 Cm",,11426,CPT,Facility,Inpatient,,,,510,433.5,146.166,510,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Excision,Benign Lesion Inc Margin,Except Skintag/Sclp/Nk/Hnd/Ft/Genit;Exc Dia Over 4.0 Cm",,11426,CPT,Facility,Outpatient,,,,510,433.5,146.166,510,"UCare Health, Inc.",Medical Assistance,257.397,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Excision,Benign Lesion Inc Margin,Except Skintag/Sclp/Nk/Hnd/Ft/Genit;Exc Dia Over 4.0 Cm",,11426,CPT,Facility,Inpatient,,,,510,433.5,146.166,510,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Excision,Benign Lesion Inc Margin,Except Skintag/Sclp/Nk/Hnd/Ft/Genit;Exc Dia Over 4.0 Cm",,11426,CPT,Facility,Outpatient,,,,510,433.5,146.166,510,"UCare Health, Inc.",Medicare Advantage,257.397,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Excision,Benign Lesion Inc Margin,Except Skintag/Sclp/Nk/Hnd/Ft/Genit;Exc Dia Over 4.0 Cm",,11426,CPT,Facility,Inpatient,,,,510,433.5,146.166,510,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Excision,Benign Lesion Inc Margin,Except Skintag/Sclp/Nk/Hnd/Ft/Genit;Exc Dia Over 4.0 Cm",,11426,CPT,Facility,Outpatient,,,,510,433.5,146.166,510,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),257.397,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Excision,Benign Lesion Inc Margin,Except Skintag/Sclp/Nk/Hnd/Ft/Genit;Exc Dia Over 4.0 Cm",,11426,CPT,Facility,Inpatient,,,,510,433.5,146.166,510,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Excision,Benign Lesion Inc Margin,Except Skintag/Sclp/Nk/Hnd/Ft/Genit;Exc Dia Over 4.0 Cm",,11426,CPT,Facility,Both,,,,510,433.5,146.166,510,UnitedHealthcare,Individual & Family,479.4,94,,percent of total billed charges,,
"Excision,Benign Lesion Inc Margin,Except Skintag/Sclp/Nk/Hnd/Ft/Genit;Exc Dia Over 4.0 Cm",,11426,CPT,Facility,Outpatient,,,,510,433.5,146.166,510,UnitedHealthcare,Medicare Advantage,249.9,49,,percent of total billed charges,,
"Excision,Benign Lesion Inc Margin,Except Skintag/Sclp/Nk/Hnd/Ft/Genit;Exc Dia Over 4.0 Cm",,11426,CPT,Facility,Inpatient,,,,510,433.5,146.166,510,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Excision,Benign Lesion Inc Margin,Except Skintag/Sclp/Nk/Hnd/Ft/Genit;Exc Dia Over 4.0 Cm",,11426,CPT,Facility,Outpatient,,,,510,433.5,146.166,510,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,244.8,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Excision,Benign Lesion Inc Margin,Except Skintag/Sclp/Nk/Hnd/Ft/Genit;Exc Dia Over 4.0 Cm",,11426,CPT,Facility,Inpatient,,,,510,433.5,146.166,510,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Excision,Benign Lesion Inc Margin,Except Skintag/Sclp/Nk/Hnd/Ft/Genit;Exc Dia Over 4.0 Cm (Pro Cah)",,11426,CPT,Professional,Both,,,,1737,1476.45,167.1,1737,Aetna,Commercial,1476.45,85,,percent of total billed charges,,
"Excision,Benign Lesion Inc Margin,Except Skintag/Sclp/Nk/Hnd/Ft/Genit;Exc Dia Over 4.0 Cm (Pro Cah)",,11426,CPT,Professional,Both,,,,870,739.5,167.1,870,Aetna,Commercial,739.5,85,,percent of total billed charges,,
"Excision,Benign Lesion Inc Margin,Except Skintag/Sclp/Nk/Hnd/Ft/Genit;Exc Dia Over 4.0 Cm (Pro Cah)",,11426,CPT,Professional,Both,,,,1737,1476.45,167.1,1737,Aetna,Medicare Advantage,265.72,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision,Benign Lesion Inc Margin,Except Skintag/Sclp/Nk/Hnd/Ft/Genit;Exc Dia Over 4.0 Cm (Pro Cah)",,11426,CPT,Professional,Both,,,,870,739.5,167.1,870,Aetna,Medicare Advantage,265.72,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision,Benign Lesion Inc Margin,Except Skintag/Sclp/Nk/Hnd/Ft/Genit;Exc Dia Over 4.0 Cm (Pro Cah)",,11426,CPT,Professional,Both,,,,1737,1476.45,167.1,1737,Aetna,PPO,1615.41,93,,percent of total billed charges,,
"Excision,Benign Lesion Inc Margin,Except Skintag/Sclp/Nk/Hnd/Ft/Genit;Exc Dia Over 4.0 Cm (Pro Cah)",,11426,CPT,Professional,Both,,,,870,739.5,167.1,870,Aetna,PPO,809.1,93,,percent of total billed charges,,
"Excision,Benign Lesion Inc Margin,Except Skintag/Sclp/Nk/Hnd/Ft/Genit;Exc Dia Over 4.0 Cm (Pro Cah)",,11426,CPT,Professional,Both,,,,1737,1476.45,167.1,1737,America's PPO,America's PPO,1484.0928,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Excision,Benign Lesion Inc Margin,Except Skintag/Sclp/Nk/Hnd/Ft/Genit;Exc Dia Over 4.0 Cm (Pro Cah)",,11426,CPT,Professional,Both,,,,870,739.5,167.1,870,America's PPO,America's PPO,743.328,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Excision,Benign Lesion Inc Margin,Except Skintag/Sclp/Nk/Hnd/Ft/Genit;Exc Dia Over 4.0 Cm (Pro Cah)",,11426,CPT,Professional,Both,,,,1737,1476.45,167.1,1737,BlueCross BlueShield Minnesota, Federal Employee Program,553.63,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Excision,Benign Lesion Inc Margin,Except Skintag/Sclp/Nk/Hnd/Ft/Genit;Exc Dia Over 4.0 Cm (Pro Cah)",,11426,CPT,Professional,Both,,,,870,739.5,167.1,870,BlueCross BlueShield Minnesota, Federal Employee Program,553.63,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Excision,Benign Lesion Inc Margin,Except Skintag/Sclp/Nk/Hnd/Ft/Genit;Exc Dia Over 4.0 Cm (Pro Cah)",,11426,CPT,Professional,Both,,,,1737,1476.45,167.1,1737,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,562.48808,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision,Benign Lesion Inc Margin,Except Skintag/Sclp/Nk/Hnd/Ft/Genit;Exc Dia Over 4.0 Cm (Pro Cah)",,11426,CPT,Professional,Both,,,,870,739.5,167.1,870,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,562.48808,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision,Benign Lesion Inc Margin,Except Skintag/Sclp/Nk/Hnd/Ft/Genit;Exc Dia Over 4.0 Cm (Pro Cah)",,11426,CPT,Professional,Both,,,,1737,1476.45,167.1,1737,BlueCross BlueShield Minnesota,High Value Network Plan,562.48808,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision,Benign Lesion Inc Margin,Except Skintag/Sclp/Nk/Hnd/Ft/Genit;Exc Dia Over 4.0 Cm (Pro Cah)",,11426,CPT,Professional,Both,,,,870,739.5,167.1,870,BlueCross BlueShield Minnesota,High Value Network Plan,562.48808,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision,Benign Lesion Inc Margin,Except Skintag/Sclp/Nk/Hnd/Ft/Genit;Exc Dia Over 4.0 Cm (Pro Cah)",,11426,CPT,Professional,Both,,,,1737,1476.45,167.1,1737,BlueCross BlueShield Minnesota,Medicare Advantage,298.6895,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision,Benign Lesion Inc Margin,Except Skintag/Sclp/Nk/Hnd/Ft/Genit;Exc Dia Over 4.0 Cm (Pro Cah)",,11426,CPT,Professional,Both,,,,870,739.5,167.1,870,BlueCross BlueShield Minnesota,Medicare Advantage,298.6895,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision,Benign Lesion Inc Margin,Except Skintag/Sclp/Nk/Hnd/Ft/Genit;Exc Dia Over 4.0 Cm (Pro Cah)",,11426,CPT,Professional,Both,,,,1737,1476.45,167.1,1737,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,562.48808,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision,Benign Lesion Inc Margin,Except Skintag/Sclp/Nk/Hnd/Ft/Genit;Exc Dia Over 4.0 Cm (Pro Cah)",,11426,CPT,Professional,Both,,,,870,739.5,167.1,870,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,562.48808,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision,Benign Lesion Inc Margin,Except Skintag/Sclp/Nk/Hnd/Ft/Genit;Exc Dia Over 4.0 Cm (Pro Cah)",,11426,CPT,Professional,Both,,,,1737,1476.45,167.1,1737,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,192.92824,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision,Benign Lesion Inc Margin,Except Skintag/Sclp/Nk/Hnd/Ft/Genit;Exc Dia Over 4.0 Cm (Pro Cah)",,11426,CPT,Professional,Both,,,,870,739.5,167.1,870,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,192.92824,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision,Benign Lesion Inc Margin,Except Skintag/Sclp/Nk/Hnd/Ft/Genit;Exc Dia Over 4.0 Cm (Pro Cah)",,11426,CPT,Professional,Both,,,,1737,1476.45,167.1,1737,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),298.6895,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision,Benign Lesion Inc Margin,Except Skintag/Sclp/Nk/Hnd/Ft/Genit;Exc Dia Over 4.0 Cm (Pro Cah)",,11426,CPT,Professional,Both,,,,870,739.5,167.1,870,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),298.6895,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision,Benign Lesion Inc Margin,Except Skintag/Sclp/Nk/Hnd/Ft/Genit;Exc Dia Over 4.0 Cm (Pro Cah)",,11426,CPT,Professional,Both,,,,1737,1476.45,167.1,1737,CorVel,Worker's Compensation,511.9583211,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Excision,Benign Lesion Inc Margin,Except Skintag/Sclp/Nk/Hnd/Ft/Genit;Exc Dia Over 4.0 Cm (Pro Cah)",,11426,CPT,Professional,Both,,,,870,739.5,167.1,870,CorVel,Worker's Compensation,511.9583211,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Excision,Benign Lesion Inc Margin,Except Skintag/Sclp/Nk/Hnd/Ft/Genit;Exc Dia Over 4.0 Cm (Pro Cah)",,11426,CPT,Professional,Both,,,,1737,1476.45,167.1,1737,First Health Group Corporation,First Health Network,1684.89,97,,percent of total billed charges,,
"Excision,Benign Lesion Inc Margin,Except Skintag/Sclp/Nk/Hnd/Ft/Genit;Exc Dia Over 4.0 Cm (Pro Cah)",,11426,CPT,Professional,Both,,,,870,739.5,167.1,870,First Health Group Corporation,First Health Network,843.9,97,,percent of total billed charges,,
"Excision,Benign Lesion Inc Margin,Except Skintag/Sclp/Nk/Hnd/Ft/Genit;Exc Dia Over 4.0 Cm (Pro Cah)",,11426,CPT,Professional,Both,,,,1737,1476.45,167.1,1737,"Health Partners, Inc.",Commercial,552.85,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision,Benign Lesion Inc Margin,Except Skintag/Sclp/Nk/Hnd/Ft/Genit;Exc Dia Over 4.0 Cm (Pro Cah)",,11426,CPT,Professional,Both,,,,870,739.5,167.1,870,"Health Partners, Inc.",Commercial,552.85,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision,Benign Lesion Inc Margin,Except Skintag/Sclp/Nk/Hnd/Ft/Genit;Exc Dia Over 4.0 Cm (Pro Cah)",,11426,CPT,Professional,Both,,,,1737,1476.45,167.1,1737,"Health Partners, Inc.",Medicare Advantage,298.6895,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision,Benign Lesion Inc Margin,Except Skintag/Sclp/Nk/Hnd/Ft/Genit;Exc Dia Over 4.0 Cm (Pro Cah)",,11426,CPT,Professional,Both,,,,870,739.5,167.1,870,"Health Partners, Inc.",Medicare Advantage,298.6895,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision,Benign Lesion Inc Margin,Except Skintag/Sclp/Nk/Hnd/Ft/Genit;Exc Dia Over 4.0 Cm (Pro Cah)",,11426,CPT,Professional,Both,,,,1737,1476.45,167.1,1737,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),259.58,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Excision,Benign Lesion Inc Margin,Except Skintag/Sclp/Nk/Hnd/Ft/Genit;Exc Dia Over 4.0 Cm (Pro Cah)",,11426,CPT,Professional,Both,,,,870,739.5,167.1,870,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),259.58,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Excision,Benign Lesion Inc Margin,Except Skintag/Sclp/Nk/Hnd/Ft/Genit;Exc Dia Over 4.0 Cm (Pro Cah)",,11426,CPT,Professional,Both,,,,1737,1476.45,167.1,1737,"Health Partners, Inc.",State of Minnesota Advantage Program,476.280275,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision,Benign Lesion Inc Margin,Except Skintag/Sclp/Nk/Hnd/Ft/Genit;Exc Dia Over 4.0 Cm (Pro Cah)",,11426,CPT,Professional,Both,,,,870,739.5,167.1,870,"Health Partners, Inc.",State of Minnesota Advantage Program,476.280275,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision,Benign Lesion Inc Margin,Except Skintag/Sclp/Nk/Hnd/Ft/Genit;Exc Dia Over 4.0 Cm (Pro Cah)",,11426,CPT,Professional,Both,,,,1737,1476.45,167.1,1737,"Health Partners, Inc.",State Public Programs,167.1,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Excision,Benign Lesion Inc Margin,Except Skintag/Sclp/Nk/Hnd/Ft/Genit;Exc Dia Over 4.0 Cm (Pro Cah)",,11426,CPT,Professional,Both,,,,870,739.5,167.1,870,"Health Partners, Inc.",State Public Programs,167.1,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Excision,Benign Lesion Inc Margin,Except Skintag/Sclp/Nk/Hnd/Ft/Genit;Exc Dia Over 4.0 Cm (Pro Cah)",,11426,CPT,Professional,Both,,,,1737,1476.45,167.1,1737,Humana Insurance Company,Commercial PPO,259.73,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Excision,Benign Lesion Inc Margin,Except Skintag/Sclp/Nk/Hnd/Ft/Genit;Exc Dia Over 4.0 Cm (Pro Cah)",,11426,CPT,Professional,Both,,,,870,739.5,167.1,870,Humana Insurance Company,Commercial PPO,259.73,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Excision,Benign Lesion Inc Margin,Except Skintag/Sclp/Nk/Hnd/Ft/Genit;Exc Dia Over 4.0 Cm (Pro Cah)",,11426,CPT,Professional,Both,,,,1737,1476.45,167.1,1737,Humana Insurance Company,Medicare PPO,1737,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Excision,Benign Lesion Inc Margin,Except Skintag/Sclp/Nk/Hnd/Ft/Genit;Exc Dia Over 4.0 Cm (Pro Cah)",,11426,CPT,Professional,Both,,,,870,739.5,167.1,870,Humana Insurance Company,Medicare PPO,870,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Excision,Benign Lesion Inc Margin,Except Skintag/Sclp/Nk/Hnd/Ft/Genit;Exc Dia Over 4.0 Cm (Pro Cah)",,11426,CPT,Professional,Both,,,,1737,1476.45,167.1,1737,Medica,Individual & Family,1472.976,84.8,,percent of total billed charges,,
"Excision,Benign Lesion Inc Margin,Except Skintag/Sclp/Nk/Hnd/Ft/Genit;Exc Dia Over 4.0 Cm (Pro Cah)",,11426,CPT,Professional,Both,,,,870,739.5,167.1,870,Medica,Individual & Family,737.76,84.8,,percent of total billed charges,,
"Excision,Benign Lesion Inc Margin,Except Skintag/Sclp/Nk/Hnd/Ft/Genit;Exc Dia Over 4.0 Cm (Pro Cah)",,11426,CPT,Professional,Both,,,,1737,1476.45,167.1,1737,Medica,Medica Advantage Solution,865.026,49.8,,percent of total billed charges,,
"Excision,Benign Lesion Inc Margin,Except Skintag/Sclp/Nk/Hnd/Ft/Genit;Exc Dia Over 4.0 Cm (Pro Cah)",,11426,CPT,Professional,Both,,,,870,739.5,167.1,870,Medica,Medica Advantage Solution,433.26,49.8,,percent of total billed charges,,
"Excision,Benign Lesion Inc Margin,Except Skintag/Sclp/Nk/Hnd/Ft/Genit;Exc Dia Over 4.0 Cm (Pro Cah)",,11426,CPT,Professional,Both,,,,1737,1476.45,167.1,1737,Medica,Medical Assistance,192.93,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Excision,Benign Lesion Inc Margin,Except Skintag/Sclp/Nk/Hnd/Ft/Genit;Exc Dia Over 4.0 Cm (Pro Cah)",,11426,CPT,Professional,Both,,,,870,739.5,167.1,870,Medica,Medical Assistance,192.93,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Excision,Benign Lesion Inc Margin,Except Skintag/Sclp/Nk/Hnd/Ft/Genit;Exc Dia Over 4.0 Cm (Pro Cah)",,11426,CPT,Professional,Both,,,,1737,1476.45,167.1,1737,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,259.73,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Excision,Benign Lesion Inc Margin,Except Skintag/Sclp/Nk/Hnd/Ft/Genit;Exc Dia Over 4.0 Cm (Pro Cah)",,11426,CPT,Professional,Both,,,,870,739.5,167.1,870,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,259.73,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Excision,Benign Lesion Inc Margin,Except Skintag/Sclp/Nk/Hnd/Ft/Genit;Exc Dia Over 4.0 Cm (Pro Cah)",,11426,CPT,Professional,Both,,,,1737,1476.45,167.1,1737,"Multiplan, Inc.","Multiplan, Inc.",1632.78,94,,percent of total billed charges,,
"Excision,Benign Lesion Inc Margin,Except Skintag/Sclp/Nk/Hnd/Ft/Genit;Exc Dia Over 4.0 Cm (Pro Cah)",,11426,CPT,Professional,Both,,,,870,739.5,167.1,870,"Multiplan, Inc.","Multiplan, Inc.",817.8,94,,percent of total billed charges,,
"Excision,Benign Lesion Inc Margin,Except Skintag/Sclp/Nk/Hnd/Ft/Genit;Exc Dia Over 4.0 Cm (Pro Cah)",,11426,CPT,Professional,Both,,,,1737,1476.45,167.1,1737,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1565.037,90.1,,percent of total billed charges,,
"Excision,Benign Lesion Inc Margin,Except Skintag/Sclp/Nk/Hnd/Ft/Genit;Exc Dia Over 4.0 Cm (Pro Cah)",,11426,CPT,Professional,Both,,,,870,739.5,167.1,870,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,783.87,90.1,,percent of total billed charges,,
"Excision,Benign Lesion Inc Margin,Except Skintag/Sclp/Nk/Hnd/Ft/Genit;Exc Dia Over 4.0 Cm (Pro Cah)",,11426,CPT,Professional,Both,,,,1737,1476.45,167.1,1737,"Preferred One Administrative Services, INC.",PPO,1712.682,98.6,,percent of total billed charges,,
"Excision,Benign Lesion Inc Margin,Except Skintag/Sclp/Nk/Hnd/Ft/Genit;Exc Dia Over 4.0 Cm (Pro Cah)",,11426,CPT,Professional,Both,,,,870,739.5,167.1,870,"Preferred One Administrative Services, INC.",PPO,857.82,98.6,,percent of total billed charges,,
"Excision,Benign Lesion Inc Margin,Except Skintag/Sclp/Nk/Hnd/Ft/Genit;Exc Dia Over 4.0 Cm (Pro Cah)",,11426,CPT,Professional,Both,,,,1737,1476.45,167.1,1737,PrimeWest Health,Minnesota Senior Health Options (MSHO),298.6895,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision,Benign Lesion Inc Margin,Except Skintag/Sclp/Nk/Hnd/Ft/Genit;Exc Dia Over 4.0 Cm (Pro Cah)",,11426,CPT,Professional,Both,,,,870,739.5,167.1,870,PrimeWest Health,Minnesota Senior Health Options (MSHO),298.6895,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision,Benign Lesion Inc Margin,Except Skintag/Sclp/Nk/Hnd/Ft/Genit;Exc Dia Over 4.0 Cm (Pro Cah)",,11426,CPT,Professional,Both,,,,1737,1476.45,167.1,1737,PrimeWest Health,MinnesotaCare,206.4332168,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision,Benign Lesion Inc Margin,Except Skintag/Sclp/Nk/Hnd/Ft/Genit;Exc Dia Over 4.0 Cm (Pro Cah)",,11426,CPT,Professional,Both,,,,870,739.5,167.1,870,PrimeWest Health,MinnesotaCare,206.4332168,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision,Benign Lesion Inc Margin,Except Skintag/Sclp/Nk/Hnd/Ft/Genit;Exc Dia Over 4.0 Cm (Pro Cah)",,11426,CPT,Professional,Both,,,,1737,1476.45,167.1,1737,Sanford Health Plan,Sanford Health Plan,1528.56,88,,percent of total billed charges,,
"Excision,Benign Lesion Inc Margin,Except Skintag/Sclp/Nk/Hnd/Ft/Genit;Exc Dia Over 4.0 Cm (Pro Cah)",,11426,CPT,Professional,Both,,,,870,739.5,167.1,870,Sanford Health Plan,Sanford Health Plan,765.6,88,,percent of total billed charges,,
"Excision,Benign Lesion Inc Margin,Except Skintag/Sclp/Nk/Hnd/Ft/Genit;Exc Dia Over 4.0 Cm (Pro Cah)",,11426,CPT,Professional,Both,,,,1737,1476.45,167.1,1737,"UCare Health, Inc.",Individual & Family Plan,422.217088,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Excision,Benign Lesion Inc Margin,Except Skintag/Sclp/Nk/Hnd/Ft/Genit;Exc Dia Over 4.0 Cm (Pro Cah)",,11426,CPT,Professional,Both,,,,870,739.5,167.1,870,"UCare Health, Inc.",Individual & Family Plan,422.217088,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Excision,Benign Lesion Inc Margin,Except Skintag/Sclp/Nk/Hnd/Ft/Genit;Exc Dia Over 4.0 Cm (Pro Cah)",,11426,CPT,Professional,Both,,,,1737,1476.45,167.1,1737,"UCare Health, Inc.",Medical Assistance,212.221064,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Excision,Benign Lesion Inc Margin,Except Skintag/Sclp/Nk/Hnd/Ft/Genit;Exc Dia Over 4.0 Cm (Pro Cah)",,11426,CPT,Professional,Both,,,,870,739.5,167.1,870,"UCare Health, Inc.",Medical Assistance,212.221064,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Excision,Benign Lesion Inc Margin,Except Skintag/Sclp/Nk/Hnd/Ft/Genit;Exc Dia Over 4.0 Cm (Pro Cah)",,11426,CPT,Professional,Both,,,,1737,1476.45,167.1,1737,"UCare Health, Inc.",Medicare Advantage,298.6895,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Excision,Benign Lesion Inc Margin,Except Skintag/Sclp/Nk/Hnd/Ft/Genit;Exc Dia Over 4.0 Cm (Pro Cah)",,11426,CPT,Professional,Both,,,,870,739.5,167.1,870,"UCare Health, Inc.",Medicare Advantage,298.6895,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Excision,Benign Lesion Inc Margin,Except Skintag/Sclp/Nk/Hnd/Ft/Genit;Exc Dia Over 4.0 Cm (Pro Cah)",,11426,CPT,Professional,Both,,,,1737,1476.45,167.1,1737,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),238.9516,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Excision,Benign Lesion Inc Margin,Except Skintag/Sclp/Nk/Hnd/Ft/Genit;Exc Dia Over 4.0 Cm (Pro Cah)",,11426,CPT,Professional,Both,,,,870,739.5,167.1,870,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),238.9516,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Excision,Benign Lesion Inc Margin,Except Skintag/Sclp/Nk/Hnd/Ft/Genit;Exc Dia Over 4.0 Cm (Pro Cah)",,11426,CPT,Professional,Both,,,,1737,1476.45,167.1,1737,UnitedHealthcare,Individual & Family,1737,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Excision,Benign Lesion Inc Margin,Except Skintag/Sclp/Nk/Hnd/Ft/Genit;Exc Dia Over 4.0 Cm (Pro Cah)",,11426,CPT,Professional,Both,,,,870,739.5,167.1,870,UnitedHealthcare,Individual & Family,870,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Excision,Benign Lesion Inc Margin,Except Skintag/Sclp/Nk/Hnd/Ft/Genit;Exc Dia Over 4.0 Cm (Pro Cah)",,11426,CPT,Professional,Both,,,,1737,1476.45,167.1,1737,UnitedHealthcare,Medicare Advantage,298.6895,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision,Benign Lesion Inc Margin,Except Skintag/Sclp/Nk/Hnd/Ft/Genit;Exc Dia Over 4.0 Cm (Pro Cah)",,11426,CPT,Professional,Both,,,,870,739.5,167.1,870,UnitedHealthcare,Medicare Advantage,298.6895,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision,Benign Lesion Inc Margin,Except Skintag/Sclp/Nk/Hnd/Ft/Genit;Exc Dia Over 4.0 Cm (Pro Cah)",,11426,CPT,Professional,Both,,,,1737,1476.45,167.1,1737,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,192.92824,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision,Benign Lesion Inc Margin,Except Skintag/Sclp/Nk/Hnd/Ft/Genit;Exc Dia Over 4.0 Cm (Pro Cah)",,11426,CPT,Professional,Both,,,,870,739.5,167.1,870,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,192.92824,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision,Benign,Lesion Scalp,Neck,Hands; 4.0 Cm And Over (Pbb)",,11426,CPT,Facility,Outpatient,,,,882,749.7,252.7812,882,Aetna,Commercial,811.44,92,,percent of total billed charges,,
"Excision,Benign,Lesion Scalp,Neck,Hands; 4.0 Cm And Over (Pbb)",,11426,CPT,Professional,Outpatient,,,,855,726.75,167.1,855,Aetna,Commercial,726.75,85,,percent of total billed charges,,
"Excision,Benign,Lesion Scalp,Neck,Hands; 4.0 Cm And Over (Pbb)",,11426,CPT,Facility,Outpatient,,,,882,749.7,252.7812,882,Aetna,Medicare Advantage,432.18,49,,percent of total billed charges,,
"Excision,Benign,Lesion Scalp,Neck,Hands; 4.0 Cm And Over (Pbb)",,11426,CPT,Professional,Outpatient,,,,855,726.75,167.1,855,Aetna,Medicare Advantage,265.72,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision,Benign,Lesion Scalp,Neck,Hands; 4.0 Cm And Over (Pbb)",,11426,CPT,Facility,Outpatient,,,,882,749.7,252.7812,882,Aetna,PPO,820.26,93,,percent of total billed charges,,
"Excision,Benign,Lesion Scalp,Neck,Hands; 4.0 Cm And Over (Pbb)",,11426,CPT,Professional,Outpatient,,,,855,726.75,167.1,855,Aetna,PPO,795.15,93,,percent of total billed charges,,
"Excision,Benign,Lesion Scalp,Neck,Hands; 4.0 Cm And Over (Pbb)",,11426,CPT,Facility,Outpatient,,,,882,749.7,252.7812,882,America's PPO,America's PPO,846.9846,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Excision,Benign,Lesion Scalp,Neck,Hands; 4.0 Cm And Over (Pbb)",,11426,CPT,Professional,Outpatient,,,,855,726.75,167.1,855,America's PPO,America's PPO,730.512,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Excision,Benign,Lesion Scalp,Neck,Hands; 4.0 Cm And Over (Pbb)",,11426,CPT,Facility,Outpatient,,,,882,749.7,252.7812,882,BlueCross BlueShield Minnesota, Federal Employee Program,867.888,98.4,,percent of total billed charges,,
"Excision,Benign,Lesion Scalp,Neck,Hands; 4.0 Cm And Over (Pbb)",,11426,CPT,Professional,Outpatient,,,,855,726.75,167.1,855,BlueCross BlueShield Minnesota, Federal Employee Program,553.63,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Excision,Benign,Lesion Scalp,Neck,Hands; 4.0 Cm And Over (Pbb)",,11426,CPT,Facility,Outpatient,,,,882,749.7,252.7812,882,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,882,100,,percent of total billed charges,,
"Excision,Benign,Lesion Scalp,Neck,Hands; 4.0 Cm And Over (Pbb)",,11426,CPT,Professional,Outpatient,,,,855,726.75,167.1,855,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,562.48808,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision,Benign,Lesion Scalp,Neck,Hands; 4.0 Cm And Over (Pbb)",,11426,CPT,Facility,Outpatient,,,,882,749.7,252.7812,882,BlueCross BlueShield Minnesota,High Value Network Plan,793.8,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
"Excision,Benign,Lesion Scalp,Neck,Hands; 4.0 Cm And Over (Pbb)",,11426,CPT,Professional,Outpatient,,,,855,726.75,167.1,855,BlueCross BlueShield Minnesota,High Value Network Plan,562.48808,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision,Benign,Lesion Scalp,Neck,Hands; 4.0 Cm And Over (Pbb)",,11426,CPT,Facility,Outpatient,,,,882,749.7,252.7812,882,BlueCross BlueShield Minnesota,Medicare Advantage,432.18,49,,percent of total billed charges,,
"Excision,Benign,Lesion Scalp,Neck,Hands; 4.0 Cm And Over (Pbb)",,11426,CPT,Professional,Outpatient,,,,855,726.75,167.1,855,BlueCross BlueShield Minnesota,Medicare Advantage,298.6895,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision,Benign,Lesion Scalp,Neck,Hands; 4.0 Cm And Over (Pbb)",,11426,CPT,Professional,Outpatient,,,,855,726.75,167.1,855,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,562.48808,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision,Benign,Lesion Scalp,Neck,Hands; 4.0 Cm And Over (Pbb)",,11426,CPT,Facility,Outpatient,,,,882,749.7,252.7812,882,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,252.7812,28.66,,percent of total billed charges,,
"Excision,Benign,Lesion Scalp,Neck,Hands; 4.0 Cm And Over (Pbb)",,11426,CPT,Professional,Outpatient,,,,855,726.75,167.1,855,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,192.92824,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision,Benign,Lesion Scalp,Neck,Hands; 4.0 Cm And Over (Pbb)",,11426,CPT,Facility,Outpatient,,,,882,749.7,252.7812,882,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),432.18,49,,percent of total billed charges,,
"Excision,Benign,Lesion Scalp,Neck,Hands; 4.0 Cm And Over (Pbb)",,11426,CPT,Professional,Outpatient,,,,855,726.75,167.1,855,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),298.6895,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision,Benign,Lesion Scalp,Neck,Hands; 4.0 Cm And Over (Pbb)",,11426,CPT,Facility,Outpatient,,,,882,749.7,252.7812,882,CorVel,Worker's Compensation,882,100,,percent of total billed charges,,
"Excision,Benign,Lesion Scalp,Neck,Hands; 4.0 Cm And Over (Pbb)",,11426,CPT,Professional,Outpatient,,,,855,726.75,167.1,855,CorVel,Worker's Compensation,511.9583211,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Excision,Benign,Lesion Scalp,Neck,Hands; 4.0 Cm And Over (Pbb)",,11426,CPT,Facility,Outpatient,,,,882,749.7,252.7812,882,First Health Group Corporation,First Health Network,855.54,97,,percent of total billed charges,,
"Excision,Benign,Lesion Scalp,Neck,Hands; 4.0 Cm And Over (Pbb)",,11426,CPT,Professional,Outpatient,,,,855,726.75,167.1,855,First Health Group Corporation,First Health Network,829.35,97,,percent of total billed charges,,
"Excision,Benign,Lesion Scalp,Neck,Hands; 4.0 Cm And Over (Pbb)",,11426,CPT,Facility,Outpatient,,,,882,749.7,252.7812,882,"Health Partners, Inc.",Commercial,834.372,94.6,,percent of total billed charges,,
"Excision,Benign,Lesion Scalp,Neck,Hands; 4.0 Cm And Over (Pbb)",,11426,CPT,Professional,Outpatient,,,,855,726.75,167.1,855,"Health Partners, Inc.",Commercial,552.85,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision,Benign,Lesion Scalp,Neck,Hands; 4.0 Cm And Over (Pbb)",,11426,CPT,Facility,Outpatient,,,,882,749.7,252.7812,882,"Health Partners, Inc.",Medicare Advantage,432.18,49,,percent of total billed charges,,
"Excision,Benign,Lesion Scalp,Neck,Hands; 4.0 Cm And Over (Pbb)",,11426,CPT,Professional,Outpatient,,,,855,726.75,167.1,855,"Health Partners, Inc.",Medicare Advantage,298.6895,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision,Benign,Lesion Scalp,Neck,Hands; 4.0 Cm And Over (Pbb)",,11426,CPT,Facility,Outpatient,,,,882,749.7,252.7812,882,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),529.2,60,,percent of total billed charges,,
"Excision,Benign,Lesion Scalp,Neck,Hands; 4.0 Cm And Over (Pbb)",,11426,CPT,Professional,Outpatient,,,,855,726.75,167.1,855,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),259.58,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Excision,Benign,Lesion Scalp,Neck,Hands; 4.0 Cm And Over (Pbb)",,11426,CPT,Facility,Outpatient,,,,882,749.7,252.7812,882,"Health Partners, Inc.",State of Minnesota Advantage Program,718.83,81.5,,percent of total billed charges,,
"Excision,Benign,Lesion Scalp,Neck,Hands; 4.0 Cm And Over (Pbb)",,11426,CPT,Professional,Outpatient,,,,855,726.75,167.1,855,"Health Partners, Inc.",State of Minnesota Advantage Program,476.280275,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision,Benign,Lesion Scalp,Neck,Hands; 4.0 Cm And Over (Pbb)",,11426,CPT,Facility,Outpatient,,,,882,749.7,252.7812,882,"Health Partners, Inc.",State Public Programs,441,50,,percent of total billed charges,,
"Excision,Benign,Lesion Scalp,Neck,Hands; 4.0 Cm And Over (Pbb)",,11426,CPT,Professional,Outpatient,,,,855,726.75,167.1,855,"Health Partners, Inc.",State Public Programs,167.1,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Excision,Benign,Lesion Scalp,Neck,Hands; 4.0 Cm And Over (Pbb)",,11426,CPT,Facility,Outpatient,,,,882,749.7,252.7812,882,Humana Insurance Company,Commercial PPO,837.9,95,,percent of total billed charges,,
"Excision,Benign,Lesion Scalp,Neck,Hands; 4.0 Cm And Over (Pbb)",,11426,CPT,Professional,Outpatient,,,,855,726.75,167.1,855,Humana Insurance Company,Commercial PPO,259.73,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Excision,Benign,Lesion Scalp,Neck,Hands; 4.0 Cm And Over (Pbb)",,11426,CPT,Facility,Outpatient,,,,882,749.7,252.7812,882,Humana Insurance Company,Medicare PPO,432.18,49,,percent of total billed charges,,
"Excision,Benign,Lesion Scalp,Neck,Hands; 4.0 Cm And Over (Pbb)",,11426,CPT,Professional,Outpatient,,,,855,726.75,167.1,855,Humana Insurance Company,Medicare PPO,855,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Excision,Benign,Lesion Scalp,Neck,Hands; 4.0 Cm And Over (Pbb)",,11426,CPT,Facility,Outpatient,,,,882,749.7,252.7812,882,Medica,Individual & Family,874.062,99.1,,percent of total billed charges,,
"Excision,Benign,Lesion Scalp,Neck,Hands; 4.0 Cm And Over (Pbb)",,11426,CPT,Professional,Outpatient,,,,855,726.75,167.1,855,Medica,Individual & Family,725.04,84.8,,percent of total billed charges,,
"Excision,Benign,Lesion Scalp,Neck,Hands; 4.0 Cm And Over (Pbb)",,11426,CPT,Facility,Outpatient,,,,882,749.7,252.7812,882,Medica,Medica Advantage Solution,439.236,49.8,,percent of total billed charges,,
"Excision,Benign,Lesion Scalp,Neck,Hands; 4.0 Cm And Over (Pbb)",,11426,CPT,Professional,Outpatient,,,,855,726.75,167.1,855,Medica,Medica Advantage Solution,425.79,49.8,,percent of total billed charges,,
"Excision,Benign,Lesion Scalp,Neck,Hands; 4.0 Cm And Over (Pbb)",,11426,CPT,Facility,Outpatient,,,,882,749.7,252.7812,882,Medica,Medical Assistance,393.372,44.6,,percent of total billed charges,,
"Excision,Benign,Lesion Scalp,Neck,Hands; 4.0 Cm And Over (Pbb)",,11426,CPT,Professional,Outpatient,,,,855,726.75,167.1,855,Medica,Medical Assistance,192.93,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Excision,Benign,Lesion Scalp,Neck,Hands; 4.0 Cm And Over (Pbb)",,11426,CPT,Facility,Outpatient,,,,882,749.7,252.7812,882,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,439.236,49.8,,percent of total billed charges,,
"Excision,Benign,Lesion Scalp,Neck,Hands; 4.0 Cm And Over (Pbb)",,11426,CPT,Professional,Outpatient,,,,855,726.75,167.1,855,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,259.73,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Excision,Benign,Lesion Scalp,Neck,Hands; 4.0 Cm And Over (Pbb)",,11426,CPT,Facility,Outpatient,,,,882,749.7,252.7812,882,"Multiplan, Inc.","Multiplan, Inc.",829.08,94,,percent of total billed charges,,
"Excision,Benign,Lesion Scalp,Neck,Hands; 4.0 Cm And Over (Pbb)",,11426,CPT,Professional,Outpatient,,,,855,726.75,167.1,855,"Multiplan, Inc.","Multiplan, Inc.",803.7,94,,percent of total billed charges,,
"Excision,Benign,Lesion Scalp,Neck,Hands; 4.0 Cm And Over (Pbb)",,11426,CPT,Facility,Outpatient,,,,882,749.7,252.7812,882,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,794.682,90.1,,percent of total billed charges,,
"Excision,Benign,Lesion Scalp,Neck,Hands; 4.0 Cm And Over (Pbb)",,11426,CPT,Professional,Outpatient,,,,855,726.75,167.1,855,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,770.355,90.1,,percent of total billed charges,,
"Excision,Benign,Lesion Scalp,Neck,Hands; 4.0 Cm And Over (Pbb)",,11426,CPT,Facility,Outpatient,,,,882,749.7,252.7812,882,"Preferred One Administrative Services, INC.",PPO,869.652,98.6,,percent of total billed charges,,
"Excision,Benign,Lesion Scalp,Neck,Hands; 4.0 Cm And Over (Pbb)",,11426,CPT,Professional,Outpatient,,,,855,726.75,167.1,855,"Preferred One Administrative Services, INC.",PPO,843.03,98.6,,percent of total billed charges,,
"Excision,Benign,Lesion Scalp,Neck,Hands; 4.0 Cm And Over (Pbb)",,11426,CPT,Facility,Outpatient,,,,882,749.7,252.7812,882,PrimeWest Health,Minnesota Senior Health Options (MSHO),453.789,51.45,,percent of total billed charges,,
"Excision,Benign,Lesion Scalp,Neck,Hands; 4.0 Cm And Over (Pbb)",,11426,CPT,Professional,Outpatient,,,,855,726.75,167.1,855,PrimeWest Health,Minnesota Senior Health Options (MSHO),298.6895,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision,Benign,Lesion Scalp,Neck,Hands; 4.0 Cm And Over (Pbb)",,11426,CPT,Facility,Outpatient,,,,882,749.7,252.7812,882,PrimeWest Health,MinnesotaCare,452.9952,51.36,,percent of total billed charges,,
"Excision,Benign,Lesion Scalp,Neck,Hands; 4.0 Cm And Over (Pbb)",,11426,CPT,Professional,Outpatient,,,,855,726.75,167.1,855,PrimeWest Health,MinnesotaCare,206.4332168,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision,Benign,Lesion Scalp,Neck,Hands; 4.0 Cm And Over (Pbb)",,11426,CPT,Facility,Outpatient,,,,882,749.7,252.7812,882,Sanford Health Plan,Sanford Health Plan,811.44,92,,percent of total billed charges,,
"Excision,Benign,Lesion Scalp,Neck,Hands; 4.0 Cm And Over (Pbb)",,11426,CPT,Professional,Outpatient,,,,855,726.75,167.1,855,Sanford Health Plan,Sanford Health Plan,752.4,88,,percent of total billed charges,,
"Excision,Benign,Lesion Scalp,Neck,Hands; 4.0 Cm And Over (Pbb)",,11426,CPT,Facility,Outpatient,,,,882,749.7,252.7812,882,"UCare Health, Inc.",Individual & Family Plan,497.007,56.35,,percent of total billed charges,,
"Excision,Benign,Lesion Scalp,Neck,Hands; 4.0 Cm And Over (Pbb)",,11426,CPT,Professional,Outpatient,,,,855,726.75,167.1,855,"UCare Health, Inc.",Individual & Family Plan,422.217088,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Excision,Benign,Lesion Scalp,Neck,Hands; 4.0 Cm And Over (Pbb)",,11426,CPT,Facility,Outpatient,,,,882,749.7,252.7812,882,"UCare Health, Inc.",Medical Assistance,445.1454,50.47,,percent of total billed charges,,
"Excision,Benign,Lesion Scalp,Neck,Hands; 4.0 Cm And Over (Pbb)",,11426,CPT,Professional,Outpatient,,,,855,726.75,167.1,855,"UCare Health, Inc.",Medical Assistance,212.221064,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Excision,Benign,Lesion Scalp,Neck,Hands; 4.0 Cm And Over (Pbb)",,11426,CPT,Facility,Outpatient,,,,882,749.7,252.7812,882,"UCare Health, Inc.",Medicare Advantage,445.1454,50.47,,percent of total billed charges,,
"Excision,Benign,Lesion Scalp,Neck,Hands; 4.0 Cm And Over (Pbb)",,11426,CPT,Professional,Outpatient,,,,855,726.75,167.1,855,"UCare Health, Inc.",Medicare Advantage,298.6895,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Excision,Benign,Lesion Scalp,Neck,Hands; 4.0 Cm And Over (Pbb)",,11426,CPT,Facility,Outpatient,,,,882,749.7,252.7812,882,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),445.1454,50.47,,percent of total billed charges,,
"Excision,Benign,Lesion Scalp,Neck,Hands; 4.0 Cm And Over (Pbb)",,11426,CPT,Professional,Outpatient,,,,855,726.75,167.1,855,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),238.9516,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Excision,Benign,Lesion Scalp,Neck,Hands; 4.0 Cm And Over (Pbb)",,11426,CPT,Facility,Outpatient,,,,882,749.7,252.7812,882,UnitedHealthcare,Individual & Family,829.08,94,,percent of total billed charges,,
"Excision,Benign,Lesion Scalp,Neck,Hands; 4.0 Cm And Over (Pbb)",,11426,CPT,Professional,Outpatient,,,,855,726.75,167.1,855,UnitedHealthcare,Individual & Family,855,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Excision,Benign,Lesion Scalp,Neck,Hands; 4.0 Cm And Over (Pbb)",,11426,CPT,Facility,Outpatient,,,,882,749.7,252.7812,882,UnitedHealthcare,Medicare Advantage,432.18,49,,percent of total billed charges,,
"Excision,Benign,Lesion Scalp,Neck,Hands; 4.0 Cm And Over (Pbb)",,11426,CPT,Professional,Outpatient,,,,855,726.75,167.1,855,UnitedHealthcare,Medicare Advantage,298.6895,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision,Benign,Lesion Scalp,Neck,Hands; 4.0 Cm And Over (Pbb)",,11426,CPT,Facility,Outpatient,,,,882,749.7,252.7812,882,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,423.36,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Excision,Benign,Lesion Scalp,Neck,Hands; 4.0 Cm And Over (Pbb)",,11426,CPT,Professional,Outpatient,,,,855,726.75,167.1,855,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,192.92824,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
METOPROLOL SUCCINATE 25 MG ORAL TB24,,16697,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,Aetna,Commercial,5.52,92,,percent of total billed charges,,
METOPROLOL SUCCINATE 25 MG ORAL TB24,,16697,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,Aetna,Medicare Advantage,2.94,49,,percent of total billed charges,,
METOPROLOL SUCCINATE 25 MG ORAL TB24,,16697,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,Aetna,Medicare Advantage,,,,,Included in per diem rate,
METOPROLOL SUCCINATE 25 MG ORAL TB24,,16697,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,Aetna,PPO,5.58,93,,percent of total billed charges,,
METOPROLOL SUCCINATE 25 MG ORAL TB24,,16697,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,America's PPO,America's PPO,5.7618,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
METOPROLOL SUCCINATE 25 MG ORAL TB24,,16697,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota, Federal Employee Program,5.904,98.4,,percent of total billed charges,,
METOPROLOL SUCCINATE 25 MG ORAL TB24,,16697,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,6,100,,percent of total billed charges,,
METOPROLOL SUCCINATE 25 MG ORAL TB24,,16697,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota,High Value Network Plan,5.4,90,,percent of total billed charges,,
METOPROLOL SUCCINATE 25 MG ORAL TB24,,16697,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota,Medicare Advantage,2.94,49,,percent of total billed charges,,
METOPROLOL SUCCINATE 25 MG ORAL TB24,,16697,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
METOPROLOL SUCCINATE 25 MG ORAL TB24,,16697,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,5.3142,88.57,,percent of total billed charges,,
METOPROLOL SUCCINATE 25 MG ORAL TB24,,16697,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.7196,28.66,,percent of total billed charges,,
METOPROLOL SUCCINATE 25 MG ORAL TB24,,16697,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.94,49,,percent of total billed charges,,
METOPROLOL SUCCINATE 25 MG ORAL TB24,,16697,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
METOPROLOL SUCCINATE 25 MG ORAL TB24,,16697,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,CorVel,Worker's Compensation,6,100,,percent of total billed charges,,
METOPROLOL SUCCINATE 25 MG ORAL TB24,,16697,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,First Health Group Corporation,First Health Network,5.82,97,,percent of total billed charges,,
METOPROLOL SUCCINATE 25 MG ORAL TB24,,16697,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,"Health Partners, Inc.",Commercial,5.676,94.6,,percent of total billed charges,,
METOPROLOL SUCCINATE 25 MG ORAL TB24,,16697,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,"Health Partners, Inc.",Medicare Advantage,2.94,49,,percent of total billed charges,,
METOPROLOL SUCCINATE 25 MG ORAL TB24,,16697,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
METOPROLOL SUCCINATE 25 MG ORAL TB24,,16697,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3.6,60,,percent of total billed charges,,
METOPROLOL SUCCINATE 25 MG ORAL TB24,,16697,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,"Health Partners, Inc.",State of Minnesota Advantage Program,4.89,81.5,,percent of total billed charges,,
METOPROLOL SUCCINATE 25 MG ORAL TB24,,16697,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,"Health Partners, Inc.",State Public Programs,3,50,,percent of total billed charges,,
METOPROLOL SUCCINATE 25 MG ORAL TB24,,16697,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,Humana Insurance Company,Commercial PPO,5.7,95,,percent of total billed charges,,
METOPROLOL SUCCINATE 25 MG ORAL TB24,,16697,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,Humana Insurance Company,Medicare PPO,2.94,49,,percent of total billed charges,,
METOPROLOL SUCCINATE 25 MG ORAL TB24,,16697,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
METOPROLOL SUCCINATE 25 MG ORAL TB24,,16697,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,Medica,Individual & Family,5.946,99.1,,percent of total billed charges,,
METOPROLOL SUCCINATE 25 MG ORAL TB24,,16697,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,Medica,Medica Advantage Solution,2.988,49.8,,percent of total billed charges,,
METOPROLOL SUCCINATE 25 MG ORAL TB24,,16697,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
METOPROLOL SUCCINATE 25 MG ORAL TB24,,16697,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,Medica,Medical Assistance,2.676,44.6,,percent of total billed charges,,
METOPROLOL SUCCINATE 25 MG ORAL TB24,,16697,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,Medica,Medical Assistance,,,,,Included in per diem rate,
METOPROLOL SUCCINATE 25 MG ORAL TB24,,16697,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.988,49.8,,percent of total billed charges,,
METOPROLOL SUCCINATE 25 MG ORAL TB24,,16697,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
METOPROLOL SUCCINATE 25 MG ORAL TB24,,16697,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,"Multiplan, Inc.","Multiplan, Inc.",5.64,94,,percent of total billed charges,,
METOPROLOL SUCCINATE 25 MG ORAL TB24,,16697,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,5.406,90.1,,percent of total billed charges,,
METOPROLOL SUCCINATE 25 MG ORAL TB24,,16697,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
METOPROLOL SUCCINATE 25 MG ORAL TB24,,16697,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,"Preferred One Administrative Services, INC.",PPO,5.916,98.6,,percent of total billed charges,,
METOPROLOL SUCCINATE 25 MG ORAL TB24,,16697,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,PrimeWest Health,Minnesota Senior Health Options (MSHO),3.087,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
METOPROLOL SUCCINATE 25 MG ORAL TB24,,16697,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
METOPROLOL SUCCINATE 25 MG ORAL TB24,,16697,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,PrimeWest Health,MinnesotaCare,3.0816,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
METOPROLOL SUCCINATE 25 MG ORAL TB24,,16697,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
METOPROLOL SUCCINATE 25 MG ORAL TB24,,16697,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,Sanford Health Plan,Sanford Health Plan,5.52,92,,percent of total billed charges,,
METOPROLOL SUCCINATE 25 MG ORAL TB24,,16697,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,"UCare Health, Inc.",Individual & Family Plan,3.381,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
METOPROLOL SUCCINATE 25 MG ORAL TB24,,16697,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
METOPROLOL SUCCINATE 25 MG ORAL TB24,,16697,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,"UCare Health, Inc.",Medical Assistance,3.0282,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
METOPROLOL SUCCINATE 25 MG ORAL TB24,,16697,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
METOPROLOL SUCCINATE 25 MG ORAL TB24,,16697,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,"UCare Health, Inc.",Medicare Advantage,3.0282,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
METOPROLOL SUCCINATE 25 MG ORAL TB24,,16697,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
METOPROLOL SUCCINATE 25 MG ORAL TB24,,16697,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),3.0282,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
METOPROLOL SUCCINATE 25 MG ORAL TB24,,16697,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
METOPROLOL SUCCINATE 25 MG ORAL TB24,,16697,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,UnitedHealthcare,Individual & Family,5.64,94,,percent of total billed charges,,
METOPROLOL SUCCINATE 25 MG ORAL TB24,,16697,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,UnitedHealthcare,Medicare Advantage,2.94,49,,percent of total billed charges,,
METOPROLOL SUCCINATE 25 MG ORAL TB24,,16697,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
METOPROLOL SUCCINATE 25 MG ORAL TB24,,16697,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.88,48,,percent of total billed charges,,100% of DHS outpatient percentage
METOPROLOL SUCCINATE 25 MG ORAL TB24,,16697,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Excision, Other Benign Lesion, Except Sktag,F,E,Eyelid,N,L,Muc Memb;Exc Dia 0.5 Cm Or Less",,11440,CPT,Facility,Both,,,,210,178.5,60.186,449,Aetna,Commercial,193.2,92,,percent of total billed charges,,
"Excision, Other Benign Lesion, Except Sktag,F,E,Eyelid,N,L,Muc Memb;Exc Dia 0.5 Cm Or Less",,11440,CPT,Facility,Outpatient,,,,210,178.5,60.186,449,Aetna,Medicare Advantage,102.9,49,,percent of total billed charges,,
"Excision, Other Benign Lesion, Except Sktag,F,E,Eyelid,N,L,Muc Memb;Exc Dia 0.5 Cm Or Less",,11440,CPT,Facility,Inpatient,,,,210,178.5,60.186,449,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Excision, Other Benign Lesion, Except Sktag,F,E,Eyelid,N,L,Muc Memb;Exc Dia 0.5 Cm Or Less",,11440,CPT,Facility,Both,,,,210,178.5,60.186,449,Aetna,PPO,195.3,93,,percent of total billed charges,,
"Excision, Other Benign Lesion, Except Sktag,F,E,Eyelid,N,L,Muc Memb;Exc Dia 0.5 Cm Or Less",,11440,CPT,Facility,Both,,,,210,178.5,60.186,449,America's PPO,America's PPO,201.663,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Excision, Other Benign Lesion, Except Sktag,F,E,Eyelid,N,L,Muc Memb;Exc Dia 0.5 Cm Or Less",,11440,CPT,Facility,Both,,,,210,178.5,60.186,449,BlueCross BlueShield Minnesota, Federal Employee Program,206.64,98.4,,percent of total billed charges,,
"Excision, Other Benign Lesion, Except Sktag,F,E,Eyelid,N,L,Muc Memb;Exc Dia 0.5 Cm Or Less",,11440,CPT,Facility,Both,,,,210,178.5,60.186,449,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,210,100,,percent of total billed charges,,
"Excision, Other Benign Lesion, Except Sktag,F,E,Eyelid,N,L,Muc Memb;Exc Dia 0.5 Cm Or Less",,11440,CPT,Facility,Both,,,,210,178.5,60.186,449,BlueCross BlueShield Minnesota,High Value Network Plan,189,90,,percent of total billed charges,,
"Excision, Other Benign Lesion, Except Sktag,F,E,Eyelid,N,L,Muc Memb;Exc Dia 0.5 Cm Or Less",,11440,CPT,Facility,Outpatient,,,,210,178.5,60.186,449,BlueCross BlueShield Minnesota,Medicare Advantage,102.9,49,,percent of total billed charges,,
"Excision, Other Benign Lesion, Except Sktag,F,E,Eyelid,N,L,Muc Memb;Exc Dia 0.5 Cm Or Less",,11440,CPT,Facility,Inpatient,,,,210,178.5,60.186,449,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Excision, Other Benign Lesion, Except Sktag,F,E,Eyelid,N,L,Muc Memb;Exc Dia 0.5 Cm Or Less",,11440,CPT,Facility,Both,,,,210,178.5,60.186,449,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,185.997,88.57,,percent of total billed charges,,
"Excision, Other Benign Lesion, Except Sktag,F,E,Eyelid,N,L,Muc Memb;Exc Dia 0.5 Cm Or Less",,11440,CPT,Facility,Both,,,,210,178.5,60.186,449,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,60.186,28.66,,percent of total billed charges,,
"Excision, Other Benign Lesion, Except Sktag,F,E,Eyelid,N,L,Muc Memb;Exc Dia 0.5 Cm Or Less",,11440,CPT,Facility,Outpatient,,,,210,178.5,60.186,449,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),102.9,49,,percent of total billed charges,,
"Excision, Other Benign Lesion, Except Sktag,F,E,Eyelid,N,L,Muc Memb;Exc Dia 0.5 Cm Or Less",,11440,CPT,Facility,Inpatient,,,,210,178.5,60.186,449,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Excision, Other Benign Lesion, Except Sktag,F,E,Eyelid,N,L,Muc Memb;Exc Dia 0.5 Cm Or Less",,11440,CPT,Facility,Both,,,,210,178.5,60.186,449,CorVel,Worker's Compensation,210,100,,percent of total billed charges,,
"Excision, Other Benign Lesion, Except Sktag,F,E,Eyelid,N,L,Muc Memb;Exc Dia 0.5 Cm Or Less",,11440,CPT,Facility,Both,,,,210,178.5,60.186,449,First Health Group Corporation,First Health Network,203.7,97,,percent of total billed charges,,
"Excision, Other Benign Lesion, Except Sktag,F,E,Eyelid,N,L,Muc Memb;Exc Dia 0.5 Cm Or Less",,11440,CPT,Facility,Both,,,,210,178.5,60.186,449,"Health Partners, Inc.",Commercial,198.66,94.6,,percent of total billed charges,,
"Excision, Other Benign Lesion, Except Sktag,F,E,Eyelid,N,L,Muc Memb;Exc Dia 0.5 Cm Or Less",,11440,CPT,Facility,Outpatient,,,,210,178.5,60.186,449,"Health Partners, Inc.",Medicare Advantage,102.9,49,,percent of total billed charges,,
"Excision, Other Benign Lesion, Except Sktag,F,E,Eyelid,N,L,Muc Memb;Exc Dia 0.5 Cm Or Less",,11440,CPT,Facility,Inpatient,,,,210,178.5,60.186,449,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Excision, Other Benign Lesion, Except Sktag,F,E,Eyelid,N,L,Muc Memb;Exc Dia 0.5 Cm Or Less",,11440,CPT,Facility,Both,,,,210,178.5,60.186,449,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),126,60,,percent of total billed charges,,
"Excision, Other Benign Lesion, Except Sktag,F,E,Eyelid,N,L,Muc Memb;Exc Dia 0.5 Cm Or Less",,11440,CPT,Facility,Both,,,,210,178.5,60.186,449,"Health Partners, Inc.",State of Minnesota Advantage Program,171.15,81.5,,percent of total billed charges,,
"Excision, Other Benign Lesion, Except Sktag,F,E,Eyelid,N,L,Muc Memb;Exc Dia 0.5 Cm Or Less",,11440,CPT,Facility,Both,,,,210,178.5,60.186,449,"Health Partners, Inc.",State Public Programs,105,50,,percent of total billed charges,,
"Excision, Other Benign Lesion, Except Sktag,F,E,Eyelid,N,L,Muc Memb;Exc Dia 0.5 Cm Or Less",,11440,CPT,Facility,Both,,,,210,178.5,60.186,449,Humana Insurance Company,Commercial PPO,199.5,95,,percent of total billed charges,,
"Excision, Other Benign Lesion, Except Sktag,F,E,Eyelid,N,L,Muc Memb;Exc Dia 0.5 Cm Or Less",,11440,CPT,Facility,Outpatient,,,,210,178.5,60.186,449,Humana Insurance Company,Medicare PPO,102.9,49,,percent of total billed charges,,
"Excision, Other Benign Lesion, Except Sktag,F,E,Eyelid,N,L,Muc Memb;Exc Dia 0.5 Cm Or Less",,11440,CPT,Facility,Inpatient,,,,210,178.5,60.186,449,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Excision, Other Benign Lesion, Except Sktag,F,E,Eyelid,N,L,Muc Memb;Exc Dia 0.5 Cm Or Less",,11440,CPT,Facility,Both,,,,210,178.5,60.186,449,Medica,Individual & Family,208.11,99.1,,percent of total billed charges,,
"Excision, Other Benign Lesion, Except Sktag,F,E,Eyelid,N,L,Muc Memb;Exc Dia 0.5 Cm Or Less",,11440,CPT,Facility,Outpatient,,,,210,178.5,60.186,449,Medica,Medica Advantage Solution,104.58,49.8,,percent of total billed charges,,
"Excision, Other Benign Lesion, Except Sktag,F,E,Eyelid,N,L,Muc Memb;Exc Dia 0.5 Cm Or Less",,11440,CPT,Facility,Inpatient,,,,210,178.5,60.186,449,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Excision, Other Benign Lesion, Except Sktag,F,E,Eyelid,N,L,Muc Memb;Exc Dia 0.5 Cm Or Less",,11440,CPT,Facility,Outpatient,,,,210,178.5,60.186,449,Medica,Medical Assistance,449,,,Other,Grouper,All inclusive per visit
"Excision, Other Benign Lesion, Except Sktag,F,E,Eyelid,N,L,Muc Memb;Exc Dia 0.5 Cm Or Less",,11440,CPT,Facility,Inpatient,,,,210,178.5,60.186,449,Medica,Medical Assistance,,,,,Included in per diem rate,
"Excision, Other Benign Lesion, Except Sktag,F,E,Eyelid,N,L,Muc Memb;Exc Dia 0.5 Cm Or Less",,11440,CPT,Facility,Outpatient,,,,210,178.5,60.186,449,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,104.58,49.8,,percent of total billed charges,,
"Excision, Other Benign Lesion, Except Sktag,F,E,Eyelid,N,L,Muc Memb;Exc Dia 0.5 Cm Or Less",,11440,CPT,Facility,Inpatient,,,,210,178.5,60.186,449,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Excision, Other Benign Lesion, Except Sktag,F,E,Eyelid,N,L,Muc Memb;Exc Dia 0.5 Cm Or Less",,11440,CPT,Facility,Both,,,,210,178.5,60.186,449,"Multiplan, Inc.","Multiplan, Inc.",197.4,94,,percent of total billed charges,,
"Excision, Other Benign Lesion, Except Sktag,F,E,Eyelid,N,L,Muc Memb;Exc Dia 0.5 Cm Or Less",,11440,CPT,Facility,Outpatient,,,,210,178.5,60.186,449,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,189.21,90.1,,percent of total billed charges,,
"Excision, Other Benign Lesion, Except Sktag,F,E,Eyelid,N,L,Muc Memb;Exc Dia 0.5 Cm Or Less",,11440,CPT,Facility,Inpatient,,,,210,178.5,60.186,449,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Excision, Other Benign Lesion, Except Sktag,F,E,Eyelid,N,L,Muc Memb;Exc Dia 0.5 Cm Or Less",,11440,CPT,Facility,Both,,,,210,178.5,60.186,449,"Preferred One Administrative Services, INC.",PPO,207.06,98.6,,percent of total billed charges,,
"Excision, Other Benign Lesion, Except Sktag,F,E,Eyelid,N,L,Muc Memb;Exc Dia 0.5 Cm Or Less",,11440,CPT,Facility,Outpatient,,,,210,178.5,60.186,449,PrimeWest Health,Minnesota Senior Health Options (MSHO),108.045,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Excision, Other Benign Lesion, Except Sktag,F,E,Eyelid,N,L,Muc Memb;Exc Dia 0.5 Cm Or Less",,11440,CPT,Facility,Inpatient,,,,210,178.5,60.186,449,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Excision, Other Benign Lesion, Except Sktag,F,E,Eyelid,N,L,Muc Memb;Exc Dia 0.5 Cm Or Less",,11440,CPT,Facility,Outpatient,,,,210,178.5,60.186,449,PrimeWest Health,MinnesotaCare,107.856,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Excision, Other Benign Lesion, Except Sktag,F,E,Eyelid,N,L,Muc Memb;Exc Dia 0.5 Cm Or Less",,11440,CPT,Facility,Inpatient,,,,210,178.5,60.186,449,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Excision, Other Benign Lesion, Except Sktag,F,E,Eyelid,N,L,Muc Memb;Exc Dia 0.5 Cm Or Less",,11440,CPT,Facility,Both,,,,210,178.5,60.186,449,Sanford Health Plan,Sanford Health Plan,193.2,92,,percent of total billed charges,,
"Excision, Other Benign Lesion, Except Sktag,F,E,Eyelid,N,L,Muc Memb;Exc Dia 0.5 Cm Or Less",,11440,CPT,Facility,Outpatient,,,,210,178.5,60.186,449,"UCare Health, Inc.",Individual & Family Plan,118.335,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Excision, Other Benign Lesion, Except Sktag,F,E,Eyelid,N,L,Muc Memb;Exc Dia 0.5 Cm Or Less",,11440,CPT,Facility,Inpatient,,,,210,178.5,60.186,449,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Excision, Other Benign Lesion, Except Sktag,F,E,Eyelid,N,L,Muc Memb;Exc Dia 0.5 Cm Or Less",,11440,CPT,Facility,Outpatient,,,,210,178.5,60.186,449,"UCare Health, Inc.",Medical Assistance,105.987,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Excision, Other Benign Lesion, Except Sktag,F,E,Eyelid,N,L,Muc Memb;Exc Dia 0.5 Cm Or Less",,11440,CPT,Facility,Inpatient,,,,210,178.5,60.186,449,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Excision, Other Benign Lesion, Except Sktag,F,E,Eyelid,N,L,Muc Memb;Exc Dia 0.5 Cm Or Less",,11440,CPT,Facility,Outpatient,,,,210,178.5,60.186,449,"UCare Health, Inc.",Medicare Advantage,105.987,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Excision, Other Benign Lesion, Except Sktag,F,E,Eyelid,N,L,Muc Memb;Exc Dia 0.5 Cm Or Less",,11440,CPT,Facility,Inpatient,,,,210,178.5,60.186,449,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Excision, Other Benign Lesion, Except Sktag,F,E,Eyelid,N,L,Muc Memb;Exc Dia 0.5 Cm Or Less",,11440,CPT,Facility,Outpatient,,,,210,178.5,60.186,449,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),105.987,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Excision, Other Benign Lesion, Except Sktag,F,E,Eyelid,N,L,Muc Memb;Exc Dia 0.5 Cm Or Less",,11440,CPT,Facility,Inpatient,,,,210,178.5,60.186,449,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Excision, Other Benign Lesion, Except Sktag,F,E,Eyelid,N,L,Muc Memb;Exc Dia 0.5 Cm Or Less",,11440,CPT,Facility,Both,,,,210,178.5,60.186,449,UnitedHealthcare,Individual & Family,197.4,94,,percent of total billed charges,,
"Excision, Other Benign Lesion, Except Sktag,F,E,Eyelid,N,L,Muc Memb;Exc Dia 0.5 Cm Or Less",,11440,CPT,Facility,Outpatient,,,,210,178.5,60.186,449,UnitedHealthcare,Medicare Advantage,102.9,49,,percent of total billed charges,,
"Excision, Other Benign Lesion, Except Sktag,F,E,Eyelid,N,L,Muc Memb;Exc Dia 0.5 Cm Or Less",,11440,CPT,Facility,Inpatient,,,,210,178.5,60.186,449,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Excision, Other Benign Lesion, Except Sktag,F,E,Eyelid,N,L,Muc Memb;Exc Dia 0.5 Cm Or Less",,11440,CPT,Facility,Outpatient,,,,210,178.5,60.186,449,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,100.8,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Excision, Other Benign Lesion, Except Sktag,F,E,Eyelid,N,L,Muc Memb;Exc Dia 0.5 Cm Or Less",,11440,CPT,Facility,Inpatient,,,,210,178.5,60.186,449,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Excision, Other Benign Lesion, Except Sktag,F,E,Eyelid,N,L,Muc Memb;Exc Dia 0.5 Cm Or Less (Pro Cah)",,11440,CPT,Professional,Both,,,,300,255,68.28,300,Aetna,Commercial,255,85,,percent of total billed charges,,
"Excision, Other Benign Lesion, Except Sktag,F,E,Eyelid,N,L,Muc Memb;Exc Dia 0.5 Cm Or Less (Pro Cah)",,11440,CPT,Professional,Both,,,,300,255,68.28,300,Aetna,Medicare Advantage,104.09,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Other Benign Lesion, Except Sktag,F,E,Eyelid,N,L,Muc Memb;Exc Dia 0.5 Cm Or Less (Pro Cah)",,11440,CPT,Professional,Both,,,,300,255,68.28,300,Aetna,PPO,279,93,,percent of total billed charges,,
"Excision, Other Benign Lesion, Except Sktag,F,E,Eyelid,N,L,Muc Memb;Exc Dia 0.5 Cm Or Less (Pro Cah)",,11440,CPT,Professional,Both,,,,300,255,68.28,300,America's PPO,America's PPO,256.32,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Excision, Other Benign Lesion, Except Sktag,F,E,Eyelid,N,L,Muc Memb;Exc Dia 0.5 Cm Or Less (Pro Cah)",,11440,CPT,Professional,Both,,,,300,255,68.28,300,BlueCross BlueShield Minnesota, Federal Employee Program,218.29,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Excision, Other Benign Lesion, Except Sktag,F,E,Eyelid,N,L,Muc Memb;Exc Dia 0.5 Cm Or Less (Pro Cah)",,11440,CPT,Professional,Both,,,,300,255,68.28,300,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,221.78264,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Other Benign Lesion, Except Sktag,F,E,Eyelid,N,L,Muc Memb;Exc Dia 0.5 Cm Or Less (Pro Cah)",,11440,CPT,Professional,Both,,,,300,255,68.28,300,BlueCross BlueShield Minnesota,High Value Network Plan,221.78264,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Other Benign Lesion, Except Sktag,F,E,Eyelid,N,L,Muc Memb;Exc Dia 0.5 Cm Or Less (Pro Cah)",,11440,CPT,Professional,Both,,,,300,255,68.28,300,BlueCross BlueShield Minnesota,Medicare Advantage,122.13,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Other Benign Lesion, Except Sktag,F,E,Eyelid,N,L,Muc Memb;Exc Dia 0.5 Cm Or Less (Pro Cah)",,11440,CPT,Professional,Both,,,,300,255,68.28,300,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,221.78264,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Other Benign Lesion, Except Sktag,F,E,Eyelid,N,L,Muc Memb;Exc Dia 0.5 Cm Or Less (Pro Cah)",,11440,CPT,Professional,Both,,,,300,255,68.28,300,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,78.83144,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision, Other Benign Lesion, Except Sktag,F,E,Eyelid,N,L,Muc Memb;Exc Dia 0.5 Cm Or Less (Pro Cah)",,11440,CPT,Professional,Both,,,,300,255,68.28,300,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),122.13,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Other Benign Lesion, Except Sktag,F,E,Eyelid,N,L,Muc Memb;Exc Dia 0.5 Cm Or Less (Pro Cah)",,11440,CPT,Professional,Both,,,,300,255,68.28,300,CorVel,Worker's Compensation,204.4601064,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Excision, Other Benign Lesion, Except Sktag,F,E,Eyelid,N,L,Muc Memb;Exc Dia 0.5 Cm Or Less (Pro Cah)",,11440,CPT,Professional,Both,,,,300,255,68.28,300,First Health Group Corporation,First Health Network,291,97,,percent of total billed charges,,
"Excision, Other Benign Lesion, Except Sktag,F,E,Eyelid,N,L,Muc Memb;Exc Dia 0.5 Cm Or Less (Pro Cah)",,11440,CPT,Professional,Both,,,,300,255,68.28,300,"Health Partners, Inc.",Commercial,221.28,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision, Other Benign Lesion, Except Sktag,F,E,Eyelid,N,L,Muc Memb;Exc Dia 0.5 Cm Or Less (Pro Cah)",,11440,CPT,Professional,Both,,,,300,255,68.28,300,"Health Partners, Inc.",Medicare Advantage,122.13,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Other Benign Lesion, Except Sktag,F,E,Eyelid,N,L,Muc Memb;Exc Dia 0.5 Cm Or Less (Pro Cah)",,11440,CPT,Professional,Both,,,,300,255,68.28,300,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),106.41,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Excision, Other Benign Lesion, Except Sktag,F,E,Eyelid,N,L,Muc Memb;Exc Dia 0.5 Cm Or Less (Pro Cah)",,11440,CPT,Professional,Both,,,,300,255,68.28,300,"Health Partners, Inc.",State of Minnesota Advantage Program,190.63272,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision, Other Benign Lesion, Except Sktag,F,E,Eyelid,N,L,Muc Memb;Exc Dia 0.5 Cm Or Less (Pro Cah)",,11440,CPT,Professional,Both,,,,300,255,68.28,300,"Health Partners, Inc.",State Public Programs,68.28,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Excision, Other Benign Lesion, Except Sktag,F,E,Eyelid,N,L,Muc Memb;Exc Dia 0.5 Cm Or Less (Pro Cah)",,11440,CPT,Professional,Both,,,,300,255,68.28,300,Humana Insurance Company,Commercial PPO,106.2,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Excision, Other Benign Lesion, Except Sktag,F,E,Eyelid,N,L,Muc Memb;Exc Dia 0.5 Cm Or Less (Pro Cah)",,11440,CPT,Professional,Both,,,,300,255,68.28,300,Humana Insurance Company,Medicare PPO,300,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Excision, Other Benign Lesion, Except Sktag,F,E,Eyelid,N,L,Muc Memb;Exc Dia 0.5 Cm Or Less (Pro Cah)",,11440,CPT,Professional,Both,,,,300,255,68.28,300,Medica,Individual & Family,254.4,84.8,,percent of total billed charges,,
"Excision, Other Benign Lesion, Except Sktag,F,E,Eyelid,N,L,Muc Memb;Exc Dia 0.5 Cm Or Less (Pro Cah)",,11440,CPT,Professional,Both,,,,300,255,68.28,300,Medica,Medica Advantage Solution,149.4,49.8,,percent of total billed charges,,
"Excision, Other Benign Lesion, Except Sktag,F,E,Eyelid,N,L,Muc Memb;Exc Dia 0.5 Cm Or Less (Pro Cah)",,11440,CPT,Professional,Both,,,,300,255,68.28,300,Medica,Medical Assistance,78.83,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Excision, Other Benign Lesion, Except Sktag,F,E,Eyelid,N,L,Muc Memb;Exc Dia 0.5 Cm Or Less (Pro Cah)",,11440,CPT,Professional,Both,,,,300,255,68.28,300,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,106.2,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Excision, Other Benign Lesion, Except Sktag,F,E,Eyelid,N,L,Muc Memb;Exc Dia 0.5 Cm Or Less (Pro Cah)",,11440,CPT,Professional,Both,,,,300,255,68.28,300,"Multiplan, Inc.","Multiplan, Inc.",282,94,,percent of total billed charges,,
"Excision, Other Benign Lesion, Except Sktag,F,E,Eyelid,N,L,Muc Memb;Exc Dia 0.5 Cm Or Less (Pro Cah)",,11440,CPT,Professional,Both,,,,300,255,68.28,300,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,270.3,90.1,,percent of total billed charges,,
"Excision, Other Benign Lesion, Except Sktag,F,E,Eyelid,N,L,Muc Memb;Exc Dia 0.5 Cm Or Less (Pro Cah)",,11440,CPT,Professional,Both,,,,300,255,68.28,300,"Preferred One Administrative Services, INC.",PPO,295.8,98.6,,percent of total billed charges,,
"Excision, Other Benign Lesion, Except Sktag,F,E,Eyelid,N,L,Muc Memb;Exc Dia 0.5 Cm Or Less (Pro Cah)",,11440,CPT,Professional,Both,,,,300,255,68.28,300,PrimeWest Health,Minnesota Senior Health Options (MSHO),122.13,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Other Benign Lesion, Except Sktag,F,E,Eyelid,N,L,Muc Memb;Exc Dia 0.5 Cm Or Less (Pro Cah)",,11440,CPT,Professional,Both,,,,300,255,68.28,300,PrimeWest Health,MinnesotaCare,84.3496408,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision, Other Benign Lesion, Except Sktag,F,E,Eyelid,N,L,Muc Memb;Exc Dia 0.5 Cm Or Less (Pro Cah)",,11440,CPT,Professional,Both,,,,300,255,68.28,300,Sanford Health Plan,Sanford Health Plan,264,88,,percent of total billed charges,,
"Excision, Other Benign Lesion, Except Sktag,F,E,Eyelid,N,L,Muc Memb;Exc Dia 0.5 Cm Or Less (Pro Cah)",,11440,CPT,Professional,Both,,,,300,255,68.28,300,"UCare Health, Inc.",Individual & Family Plan,172.63872,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Excision, Other Benign Lesion, Except Sktag,F,E,Eyelid,N,L,Muc Memb;Exc Dia 0.5 Cm Or Less (Pro Cah)",,11440,CPT,Professional,Both,,,,300,255,68.28,300,"UCare Health, Inc.",Medical Assistance,86.714584,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Excision, Other Benign Lesion, Except Sktag,F,E,Eyelid,N,L,Muc Memb;Exc Dia 0.5 Cm Or Less (Pro Cah)",,11440,CPT,Professional,Both,,,,300,255,68.28,300,"UCare Health, Inc.",Medicare Advantage,122.13,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Excision, Other Benign Lesion, Except Sktag,F,E,Eyelid,N,L,Muc Memb;Exc Dia 0.5 Cm Or Less (Pro Cah)",,11440,CPT,Professional,Both,,,,300,255,68.28,300,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),97.704,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Excision, Other Benign Lesion, Except Sktag,F,E,Eyelid,N,L,Muc Memb;Exc Dia 0.5 Cm Or Less (Pro Cah)",,11440,CPT,Professional,Both,,,,300,255,68.28,300,UnitedHealthcare,Individual & Family,300,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Excision, Other Benign Lesion, Except Sktag,F,E,Eyelid,N,L,Muc Memb;Exc Dia 0.5 Cm Or Less (Pro Cah)",,11440,CPT,Professional,Both,,,,300,255,68.28,300,UnitedHealthcare,Medicare Advantage,122.13,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Other Benign Lesion, Except Sktag,F,E,Eyelid,N,L,Muc Memb;Exc Dia 0.5 Cm Or Less (Pro Cah)",,11440,CPT,Professional,Both,,,,300,255,68.28,300,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,78.83144,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"ERGOCALCIFEROL (VITAMIN D2) 1,250 MCG (50,000 UNIT) ORAL CAP",,16740,LOCAL,Facility,Both,1,Each,,10,8.5,2.866,10,Aetna,Commercial,9.2,92,,percent of total billed charges,,
"ERGOCALCIFEROL (VITAMIN D2) 1,250 MCG (50,000 UNIT) ORAL CAP",,16740,LOCAL,Facility,Outpatient,1,Each,,10,8.5,2.866,10,Aetna,Medicare Advantage,4.9,49,,percent of total billed charges,,
"ERGOCALCIFEROL (VITAMIN D2) 1,250 MCG (50,000 UNIT) ORAL CAP",,16740,LOCAL,Facility,Inpatient,1,Each,,10,8.5,2.866,10,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"ERGOCALCIFEROL (VITAMIN D2) 1,250 MCG (50,000 UNIT) ORAL CAP",,16740,LOCAL,Facility,Both,1,Each,,10,8.5,2.866,10,Aetna,PPO,9.3,93,,percent of total billed charges,,
"ERGOCALCIFEROL (VITAMIN D2) 1,250 MCG (50,000 UNIT) ORAL CAP",,16740,LOCAL,Facility,Both,1,Each,,10,8.5,2.866,10,America's PPO,America's PPO,9.603,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"ERGOCALCIFEROL (VITAMIN D2) 1,250 MCG (50,000 UNIT) ORAL CAP",,16740,LOCAL,Facility,Both,1,Each,,10,8.5,2.866,10,BlueCross BlueShield Minnesota, Federal Employee Program,9.84,98.4,,percent of total billed charges,,
"ERGOCALCIFEROL (VITAMIN D2) 1,250 MCG (50,000 UNIT) ORAL CAP",,16740,LOCAL,Facility,Both,1,Each,,10,8.5,2.866,10,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,10,100,,percent of total billed charges,,
"ERGOCALCIFEROL (VITAMIN D2) 1,250 MCG (50,000 UNIT) ORAL CAP",,16740,LOCAL,Facility,Both,1,Each,,10,8.5,2.866,10,BlueCross BlueShield Minnesota,High Value Network Plan,9,90,,percent of total billed charges,,
"ERGOCALCIFEROL (VITAMIN D2) 1,250 MCG (50,000 UNIT) ORAL CAP",,16740,LOCAL,Facility,Outpatient,1,Each,,10,8.5,2.866,10,BlueCross BlueShield Minnesota,Medicare Advantage,4.9,49,,percent of total billed charges,,
"ERGOCALCIFEROL (VITAMIN D2) 1,250 MCG (50,000 UNIT) ORAL CAP",,16740,LOCAL,Facility,Inpatient,1,Each,,10,8.5,2.866,10,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"ERGOCALCIFEROL (VITAMIN D2) 1,250 MCG (50,000 UNIT) ORAL CAP",,16740,LOCAL,Facility,Both,1,Each,,10,8.5,2.866,10,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,8.857,88.57,,percent of total billed charges,,
"ERGOCALCIFEROL (VITAMIN D2) 1,250 MCG (50,000 UNIT) ORAL CAP",,16740,LOCAL,Facility,Both,1,Each,,10,8.5,2.866,10,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,2.866,28.66,,percent of total billed charges,,
"ERGOCALCIFEROL (VITAMIN D2) 1,250 MCG (50,000 UNIT) ORAL CAP",,16740,LOCAL,Facility,Outpatient,1,Each,,10,8.5,2.866,10,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),4.9,49,,percent of total billed charges,,
"ERGOCALCIFEROL (VITAMIN D2) 1,250 MCG (50,000 UNIT) ORAL CAP",,16740,LOCAL,Facility,Inpatient,1,Each,,10,8.5,2.866,10,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"ERGOCALCIFEROL (VITAMIN D2) 1,250 MCG (50,000 UNIT) ORAL CAP",,16740,LOCAL,Facility,Both,1,Each,,10,8.5,2.866,10,CorVel,Worker's Compensation,10,100,,percent of total billed charges,,
"ERGOCALCIFEROL (VITAMIN D2) 1,250 MCG (50,000 UNIT) ORAL CAP",,16740,LOCAL,Facility,Both,1,Each,,10,8.5,2.866,10,First Health Group Corporation,First Health Network,9.7,97,,percent of total billed charges,,
"ERGOCALCIFEROL (VITAMIN D2) 1,250 MCG (50,000 UNIT) ORAL CAP",,16740,LOCAL,Facility,Both,1,Each,,10,8.5,2.866,10,"Health Partners, Inc.",Commercial,9.46,94.6,,percent of total billed charges,,
"ERGOCALCIFEROL (VITAMIN D2) 1,250 MCG (50,000 UNIT) ORAL CAP",,16740,LOCAL,Facility,Outpatient,1,Each,,10,8.5,2.866,10,"Health Partners, Inc.",Medicare Advantage,4.9,49,,percent of total billed charges,,
"ERGOCALCIFEROL (VITAMIN D2) 1,250 MCG (50,000 UNIT) ORAL CAP",,16740,LOCAL,Facility,Inpatient,1,Each,,10,8.5,2.866,10,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"ERGOCALCIFEROL (VITAMIN D2) 1,250 MCG (50,000 UNIT) ORAL CAP",,16740,LOCAL,Facility,Both,1,Each,,10,8.5,2.866,10,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),6,60,,percent of total billed charges,,
"ERGOCALCIFEROL (VITAMIN D2) 1,250 MCG (50,000 UNIT) ORAL CAP",,16740,LOCAL,Facility,Both,1,Each,,10,8.5,2.866,10,"Health Partners, Inc.",State of Minnesota Advantage Program,8.15,81.5,,percent of total billed charges,,
"ERGOCALCIFEROL (VITAMIN D2) 1,250 MCG (50,000 UNIT) ORAL CAP",,16740,LOCAL,Facility,Both,1,Each,,10,8.5,2.866,10,"Health Partners, Inc.",State Public Programs,5,50,,percent of total billed charges,,
"ERGOCALCIFEROL (VITAMIN D2) 1,250 MCG (50,000 UNIT) ORAL CAP",,16740,LOCAL,Facility,Both,1,Each,,10,8.5,2.866,10,Humana Insurance Company,Commercial PPO,9.5,95,,percent of total billed charges,,
"ERGOCALCIFEROL (VITAMIN D2) 1,250 MCG (50,000 UNIT) ORAL CAP",,16740,LOCAL,Facility,Outpatient,1,Each,,10,8.5,2.866,10,Humana Insurance Company,Medicare PPO,4.9,49,,percent of total billed charges,,
"ERGOCALCIFEROL (VITAMIN D2) 1,250 MCG (50,000 UNIT) ORAL CAP",,16740,LOCAL,Facility,Inpatient,1,Each,,10,8.5,2.866,10,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"ERGOCALCIFEROL (VITAMIN D2) 1,250 MCG (50,000 UNIT) ORAL CAP",,16740,LOCAL,Facility,Both,1,Each,,10,8.5,2.866,10,Medica,Individual & Family,9.91,99.1,,percent of total billed charges,,
"ERGOCALCIFEROL (VITAMIN D2) 1,250 MCG (50,000 UNIT) ORAL CAP",,16740,LOCAL,Facility,Outpatient,1,Each,,10,8.5,2.866,10,Medica,Medica Advantage Solution,4.98,49.8,,percent of total billed charges,,
"ERGOCALCIFEROL (VITAMIN D2) 1,250 MCG (50,000 UNIT) ORAL CAP",,16740,LOCAL,Facility,Inpatient,1,Each,,10,8.5,2.866,10,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"ERGOCALCIFEROL (VITAMIN D2) 1,250 MCG (50,000 UNIT) ORAL CAP",,16740,LOCAL,Facility,Outpatient,1,Each,,10,8.5,2.866,10,Medica,Medical Assistance,4.46,44.6,,percent of total billed charges,,
"ERGOCALCIFEROL (VITAMIN D2) 1,250 MCG (50,000 UNIT) ORAL CAP",,16740,LOCAL,Facility,Inpatient,1,Each,,10,8.5,2.866,10,Medica,Medical Assistance,,,,,Included in per diem rate,
"ERGOCALCIFEROL (VITAMIN D2) 1,250 MCG (50,000 UNIT) ORAL CAP",,16740,LOCAL,Facility,Outpatient,1,Each,,10,8.5,2.866,10,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,4.98,49.8,,percent of total billed charges,,
"ERGOCALCIFEROL (VITAMIN D2) 1,250 MCG (50,000 UNIT) ORAL CAP",,16740,LOCAL,Facility,Inpatient,1,Each,,10,8.5,2.866,10,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"ERGOCALCIFEROL (VITAMIN D2) 1,250 MCG (50,000 UNIT) ORAL CAP",,16740,LOCAL,Facility,Both,1,Each,,10,8.5,2.866,10,"Multiplan, Inc.","Multiplan, Inc.",9.4,94,,percent of total billed charges,,
"ERGOCALCIFEROL (VITAMIN D2) 1,250 MCG (50,000 UNIT) ORAL CAP",,16740,LOCAL,Facility,Outpatient,1,Each,,10,8.5,2.866,10,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,9.01,90.1,,percent of total billed charges,,
"ERGOCALCIFEROL (VITAMIN D2) 1,250 MCG (50,000 UNIT) ORAL CAP",,16740,LOCAL,Facility,Inpatient,1,Each,,10,8.5,2.866,10,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"ERGOCALCIFEROL (VITAMIN D2) 1,250 MCG (50,000 UNIT) ORAL CAP",,16740,LOCAL,Facility,Both,1,Each,,10,8.5,2.866,10,"Preferred One Administrative Services, INC.",PPO,9.86,98.6,,percent of total billed charges,,
"ERGOCALCIFEROL (VITAMIN D2) 1,250 MCG (50,000 UNIT) ORAL CAP",,16740,LOCAL,Facility,Outpatient,1,Each,,10,8.5,2.866,10,PrimeWest Health,Minnesota Senior Health Options (MSHO),5.145,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"ERGOCALCIFEROL (VITAMIN D2) 1,250 MCG (50,000 UNIT) ORAL CAP",,16740,LOCAL,Facility,Inpatient,1,Each,,10,8.5,2.866,10,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"ERGOCALCIFEROL (VITAMIN D2) 1,250 MCG (50,000 UNIT) ORAL CAP",,16740,LOCAL,Facility,Outpatient,1,Each,,10,8.5,2.866,10,PrimeWest Health,MinnesotaCare,5.136,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"ERGOCALCIFEROL (VITAMIN D2) 1,250 MCG (50,000 UNIT) ORAL CAP",,16740,LOCAL,Facility,Inpatient,1,Each,,10,8.5,2.866,10,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"ERGOCALCIFEROL (VITAMIN D2) 1,250 MCG (50,000 UNIT) ORAL CAP",,16740,LOCAL,Facility,Both,1,Each,,10,8.5,2.866,10,Sanford Health Plan,Sanford Health Plan,9.2,92,,percent of total billed charges,,
"ERGOCALCIFEROL (VITAMIN D2) 1,250 MCG (50,000 UNIT) ORAL CAP",,16740,LOCAL,Facility,Outpatient,1,Each,,10,8.5,2.866,10,"UCare Health, Inc.",Individual & Family Plan,5.635,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"ERGOCALCIFEROL (VITAMIN D2) 1,250 MCG (50,000 UNIT) ORAL CAP",,16740,LOCAL,Facility,Inpatient,1,Each,,10,8.5,2.866,10,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"ERGOCALCIFEROL (VITAMIN D2) 1,250 MCG (50,000 UNIT) ORAL CAP",,16740,LOCAL,Facility,Outpatient,1,Each,,10,8.5,2.866,10,"UCare Health, Inc.",Medical Assistance,5.047,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"ERGOCALCIFEROL (VITAMIN D2) 1,250 MCG (50,000 UNIT) ORAL CAP",,16740,LOCAL,Facility,Inpatient,1,Each,,10,8.5,2.866,10,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"ERGOCALCIFEROL (VITAMIN D2) 1,250 MCG (50,000 UNIT) ORAL CAP",,16740,LOCAL,Facility,Outpatient,1,Each,,10,8.5,2.866,10,"UCare Health, Inc.",Medicare Advantage,5.047,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"ERGOCALCIFEROL (VITAMIN D2) 1,250 MCG (50,000 UNIT) ORAL CAP",,16740,LOCAL,Facility,Inpatient,1,Each,,10,8.5,2.866,10,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"ERGOCALCIFEROL (VITAMIN D2) 1,250 MCG (50,000 UNIT) ORAL CAP",,16740,LOCAL,Facility,Outpatient,1,Each,,10,8.5,2.866,10,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),5.047,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"ERGOCALCIFEROL (VITAMIN D2) 1,250 MCG (50,000 UNIT) ORAL CAP",,16740,LOCAL,Facility,Inpatient,1,Each,,10,8.5,2.866,10,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"ERGOCALCIFEROL (VITAMIN D2) 1,250 MCG (50,000 UNIT) ORAL CAP",,16740,LOCAL,Facility,Both,1,Each,,10,8.5,2.866,10,UnitedHealthcare,Individual & Family,9.4,94,,percent of total billed charges,,
"ERGOCALCIFEROL (VITAMIN D2) 1,250 MCG (50,000 UNIT) ORAL CAP",,16740,LOCAL,Facility,Outpatient,1,Each,,10,8.5,2.866,10,UnitedHealthcare,Medicare Advantage,4.9,49,,percent of total billed charges,,
"ERGOCALCIFEROL (VITAMIN D2) 1,250 MCG (50,000 UNIT) ORAL CAP",,16740,LOCAL,Facility,Inpatient,1,Each,,10,8.5,2.866,10,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"ERGOCALCIFEROL (VITAMIN D2) 1,250 MCG (50,000 UNIT) ORAL CAP",,16740,LOCAL,Facility,Outpatient,1,Each,,10,8.5,2.866,10,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,4.8,48,,percent of total billed charges,,100% of DHS outpatient percentage
"ERGOCALCIFEROL (VITAMIN D2) 1,250 MCG (50,000 UNIT) ORAL CAP",,16740,LOCAL,Facility,Inpatient,1,Each,,10,8.5,2.866,10,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lip,Muc Mem;Exc Dia 0.6-1.0 Cm",,11441,CPT,Facility,Both,,,,215,182.75,61.619,449,Aetna,Commercial,197.8,92,,percent of total billed charges,,
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lip,Muc Mem;Exc Dia 0.6-1.0 Cm",,11441,CPT,Facility,Outpatient,,,,215,182.75,61.619,449,Aetna,Medicare Advantage,105.35,49,,percent of total billed charges,,
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lip,Muc Mem;Exc Dia 0.6-1.0 Cm",,11441,CPT,Facility,Inpatient,,,,215,182.75,61.619,449,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lip,Muc Mem;Exc Dia 0.6-1.0 Cm",,11441,CPT,Facility,Both,,,,215,182.75,61.619,449,Aetna,PPO,199.95,93,,percent of total billed charges,,
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lip,Muc Mem;Exc Dia 0.6-1.0 Cm",,11441,CPT,Facility,Both,,,,215,182.75,61.619,449,America's PPO,America's PPO,206.4645,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lip,Muc Mem;Exc Dia 0.6-1.0 Cm",,11441,CPT,Facility,Both,,,,215,182.75,61.619,449,BlueCross BlueShield Minnesota, Federal Employee Program,211.56,98.4,,percent of total billed charges,,
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lip,Muc Mem;Exc Dia 0.6-1.0 Cm",,11441,CPT,Facility,Both,,,,215,182.75,61.619,449,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,215,100,,percent of total billed charges,,
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lip,Muc Mem;Exc Dia 0.6-1.0 Cm",,11441,CPT,Facility,Both,,,,215,182.75,61.619,449,BlueCross BlueShield Minnesota,High Value Network Plan,193.5,90,,percent of total billed charges,,
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lip,Muc Mem;Exc Dia 0.6-1.0 Cm",,11441,CPT,Facility,Outpatient,,,,215,182.75,61.619,449,BlueCross BlueShield Minnesota,Medicare Advantage,105.35,49,,percent of total billed charges,,
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lip,Muc Mem;Exc Dia 0.6-1.0 Cm",,11441,CPT,Facility,Inpatient,,,,215,182.75,61.619,449,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lip,Muc Mem;Exc Dia 0.6-1.0 Cm",,11441,CPT,Facility,Both,,,,215,182.75,61.619,449,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,190.4255,88.57,,percent of total billed charges,,
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lip,Muc Mem;Exc Dia 0.6-1.0 Cm",,11441,CPT,Facility,Both,,,,215,182.75,61.619,449,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,61.619,28.66,,percent of total billed charges,,
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lip,Muc Mem;Exc Dia 0.6-1.0 Cm",,11441,CPT,Facility,Outpatient,,,,215,182.75,61.619,449,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),105.35,49,,percent of total billed charges,,
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lip,Muc Mem;Exc Dia 0.6-1.0 Cm",,11441,CPT,Facility,Inpatient,,,,215,182.75,61.619,449,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lip,Muc Mem;Exc Dia 0.6-1.0 Cm",,11441,CPT,Facility,Both,,,,215,182.75,61.619,449,CorVel,Worker's Compensation,215,100,,percent of total billed charges,,
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lip,Muc Mem;Exc Dia 0.6-1.0 Cm",,11441,CPT,Facility,Both,,,,215,182.75,61.619,449,First Health Group Corporation,First Health Network,208.55,97,,percent of total billed charges,,
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lip,Muc Mem;Exc Dia 0.6-1.0 Cm",,11441,CPT,Facility,Both,,,,215,182.75,61.619,449,"Health Partners, Inc.",Commercial,203.39,94.6,,percent of total billed charges,,
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lip,Muc Mem;Exc Dia 0.6-1.0 Cm",,11441,CPT,Facility,Outpatient,,,,215,182.75,61.619,449,"Health Partners, Inc.",Medicare Advantage,105.35,49,,percent of total billed charges,,
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lip,Muc Mem;Exc Dia 0.6-1.0 Cm",,11441,CPT,Facility,Inpatient,,,,215,182.75,61.619,449,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lip,Muc Mem;Exc Dia 0.6-1.0 Cm",,11441,CPT,Facility,Both,,,,215,182.75,61.619,449,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),129,60,,percent of total billed charges,,
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lip,Muc Mem;Exc Dia 0.6-1.0 Cm",,11441,CPT,Facility,Both,,,,215,182.75,61.619,449,"Health Partners, Inc.",State of Minnesota Advantage Program,175.225,81.5,,percent of total billed charges,,
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lip,Muc Mem;Exc Dia 0.6-1.0 Cm",,11441,CPT,Facility,Both,,,,215,182.75,61.619,449,"Health Partners, Inc.",State Public Programs,107.5,50,,percent of total billed charges,,
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lip,Muc Mem;Exc Dia 0.6-1.0 Cm",,11441,CPT,Facility,Both,,,,215,182.75,61.619,449,Humana Insurance Company,Commercial PPO,204.25,95,,percent of total billed charges,,
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lip,Muc Mem;Exc Dia 0.6-1.0 Cm",,11441,CPT,Facility,Outpatient,,,,215,182.75,61.619,449,Humana Insurance Company,Medicare PPO,105.35,49,,percent of total billed charges,,
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lip,Muc Mem;Exc Dia 0.6-1.0 Cm",,11441,CPT,Facility,Inpatient,,,,215,182.75,61.619,449,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lip,Muc Mem;Exc Dia 0.6-1.0 Cm",,11441,CPT,Facility,Both,,,,215,182.75,61.619,449,Medica,Individual & Family,213.065,99.1,,percent of total billed charges,,
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lip,Muc Mem;Exc Dia 0.6-1.0 Cm",,11441,CPT,Facility,Outpatient,,,,215,182.75,61.619,449,Medica,Medica Advantage Solution,107.07,49.8,,percent of total billed charges,,
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lip,Muc Mem;Exc Dia 0.6-1.0 Cm",,11441,CPT,Facility,Inpatient,,,,215,182.75,61.619,449,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lip,Muc Mem;Exc Dia 0.6-1.0 Cm",,11441,CPT,Facility,Outpatient,,,,215,182.75,61.619,449,Medica,Medical Assistance,449,,,Other,Grouper,All inclusive per visit
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lip,Muc Mem;Exc Dia 0.6-1.0 Cm",,11441,CPT,Facility,Inpatient,,,,215,182.75,61.619,449,Medica,Medical Assistance,,,,,Included in per diem rate,
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lip,Muc Mem;Exc Dia 0.6-1.0 Cm",,11441,CPT,Facility,Outpatient,,,,215,182.75,61.619,449,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,107.07,49.8,,percent of total billed charges,,
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lip,Muc Mem;Exc Dia 0.6-1.0 Cm",,11441,CPT,Facility,Inpatient,,,,215,182.75,61.619,449,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lip,Muc Mem;Exc Dia 0.6-1.0 Cm",,11441,CPT,Facility,Both,,,,215,182.75,61.619,449,"Multiplan, Inc.","Multiplan, Inc.",202.1,94,,percent of total billed charges,,
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lip,Muc Mem;Exc Dia 0.6-1.0 Cm",,11441,CPT,Facility,Outpatient,,,,215,182.75,61.619,449,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,193.715,90.1,,percent of total billed charges,,
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lip,Muc Mem;Exc Dia 0.6-1.0 Cm",,11441,CPT,Facility,Inpatient,,,,215,182.75,61.619,449,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lip,Muc Mem;Exc Dia 0.6-1.0 Cm",,11441,CPT,Facility,Both,,,,215,182.75,61.619,449,"Preferred One Administrative Services, INC.",PPO,211.99,98.6,,percent of total billed charges,,
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lip,Muc Mem;Exc Dia 0.6-1.0 Cm",,11441,CPT,Facility,Outpatient,,,,215,182.75,61.619,449,PrimeWest Health,Minnesota Senior Health Options (MSHO),110.6175,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lip,Muc Mem;Exc Dia 0.6-1.0 Cm",,11441,CPT,Facility,Inpatient,,,,215,182.75,61.619,449,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lip,Muc Mem;Exc Dia 0.6-1.0 Cm",,11441,CPT,Facility,Outpatient,,,,215,182.75,61.619,449,PrimeWest Health,MinnesotaCare,110.424,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lip,Muc Mem;Exc Dia 0.6-1.0 Cm",,11441,CPT,Facility,Inpatient,,,,215,182.75,61.619,449,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lip,Muc Mem;Exc Dia 0.6-1.0 Cm",,11441,CPT,Facility,Both,,,,215,182.75,61.619,449,Sanford Health Plan,Sanford Health Plan,197.8,92,,percent of total billed charges,,
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lip,Muc Mem;Exc Dia 0.6-1.0 Cm",,11441,CPT,Facility,Outpatient,,,,215,182.75,61.619,449,"UCare Health, Inc.",Individual & Family Plan,121.1525,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lip,Muc Mem;Exc Dia 0.6-1.0 Cm",,11441,CPT,Facility,Inpatient,,,,215,182.75,61.619,449,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lip,Muc Mem;Exc Dia 0.6-1.0 Cm",,11441,CPT,Facility,Outpatient,,,,215,182.75,61.619,449,"UCare Health, Inc.",Medical Assistance,108.5105,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lip,Muc Mem;Exc Dia 0.6-1.0 Cm",,11441,CPT,Facility,Inpatient,,,,215,182.75,61.619,449,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lip,Muc Mem;Exc Dia 0.6-1.0 Cm",,11441,CPT,Facility,Outpatient,,,,215,182.75,61.619,449,"UCare Health, Inc.",Medicare Advantage,108.5105,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lip,Muc Mem;Exc Dia 0.6-1.0 Cm",,11441,CPT,Facility,Inpatient,,,,215,182.75,61.619,449,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lip,Muc Mem;Exc Dia 0.6-1.0 Cm",,11441,CPT,Facility,Outpatient,,,,215,182.75,61.619,449,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),108.5105,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lip,Muc Mem;Exc Dia 0.6-1.0 Cm",,11441,CPT,Facility,Inpatient,,,,215,182.75,61.619,449,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lip,Muc Mem;Exc Dia 0.6-1.0 Cm",,11441,CPT,Facility,Both,,,,215,182.75,61.619,449,UnitedHealthcare,Individual & Family,202.1,94,,percent of total billed charges,,
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lip,Muc Mem;Exc Dia 0.6-1.0 Cm",,11441,CPT,Facility,Outpatient,,,,215,182.75,61.619,449,UnitedHealthcare,Medicare Advantage,105.35,49,,percent of total billed charges,,
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lip,Muc Mem;Exc Dia 0.6-1.0 Cm",,11441,CPT,Facility,Inpatient,,,,215,182.75,61.619,449,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lip,Muc Mem;Exc Dia 0.6-1.0 Cm",,11441,CPT,Facility,Outpatient,,,,215,182.75,61.619,449,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,103.2,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lip,Muc Mem;Exc Dia 0.6-1.0 Cm",,11441,CPT,Facility,Inpatient,,,,215,182.75,61.619,449,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lip,Muc Mem;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11441,CPT,Professional,Both,,,,740,629,84.64,740,Aetna,Commercial,629,85,,percent of total billed charges,,
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lip,Muc Mem;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11441,CPT,Professional,Both,,,,365,310.25,84.64,365,Aetna,Commercial,310.25,85,,percent of total billed charges,,
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lip,Muc Mem;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11441,CPT,Professional,Both,,,,740,629,84.64,740,Aetna,Medicare Advantage,129.95,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lip,Muc Mem;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11441,CPT,Professional,Both,,,,365,310.25,84.64,365,Aetna,Medicare Advantage,129.95,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lip,Muc Mem;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11441,CPT,Professional,Both,,,,740,629,84.64,740,Aetna,PPO,688.2,93,,percent of total billed charges,,
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lip,Muc Mem;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11441,CPT,Professional,Both,,,,365,310.25,84.64,365,Aetna,PPO,339.45,93,,percent of total billed charges,,
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lip,Muc Mem;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11441,CPT,Professional,Both,,,,740,629,84.64,740,America's PPO,America's PPO,632.256,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lip,Muc Mem;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11441,CPT,Professional,Both,,,,365,310.25,84.64,365,America's PPO,America's PPO,311.856,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lip,Muc Mem;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11441,CPT,Professional,Both,,,,740,629,84.64,740,BlueCross BlueShield Minnesota, Federal Employee Program,273.37,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lip,Muc Mem;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11441,CPT,Professional,Both,,,,365,310.25,84.64,365,BlueCross BlueShield Minnesota, Federal Employee Program,273.37,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lip,Muc Mem;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11441,CPT,Professional,Both,,,,740,629,84.64,740,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,277.74392,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lip,Muc Mem;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11441,CPT,Professional,Both,,,,365,310.25,84.64,365,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,277.74392,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lip,Muc Mem;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11441,CPT,Professional,Both,,,,740,629,84.64,740,BlueCross BlueShield Minnesota,High Value Network Plan,277.74392,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lip,Muc Mem;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11441,CPT,Professional,Both,,,,365,310.25,84.64,365,BlueCross BlueShield Minnesota,High Value Network Plan,277.74392,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lip,Muc Mem;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11441,CPT,Professional,Both,,,,740,629,84.64,740,BlueCross BlueShield Minnesota,Medicare Advantage,151.386,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lip,Muc Mem;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11441,CPT,Professional,Both,,,,365,310.25,84.64,365,BlueCross BlueShield Minnesota,Medicare Advantage,151.386,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lip,Muc Mem;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11441,CPT,Professional,Both,,,,740,629,84.64,740,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,277.74392,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lip,Muc Mem;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11441,CPT,Professional,Both,,,,365,310.25,84.64,365,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,277.74392,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lip,Muc Mem;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11441,CPT,Professional,Both,,,,740,629,84.64,740,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,97.71888,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lip,Muc Mem;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11441,CPT,Professional,Both,,,,365,310.25,84.64,365,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,97.71888,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lip,Muc Mem;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11441,CPT,Professional,Both,,,,740,629,84.64,740,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),151.386,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lip,Muc Mem;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11441,CPT,Professional,Both,,,,365,310.25,84.64,365,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),151.386,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lip,Muc Mem;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11441,CPT,Professional,Both,,,,740,629,84.64,740,CorVel,Worker's Compensation,254.4856356,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lip,Muc Mem;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11441,CPT,Professional,Both,,,,365,310.25,84.64,365,CorVel,Worker's Compensation,254.4856356,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lip,Muc Mem;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11441,CPT,Professional,Both,,,,740,629,84.64,740,First Health Group Corporation,First Health Network,717.8,97,,percent of total billed charges,,
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lip,Muc Mem;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11441,CPT,Professional,Both,,,,365,310.25,84.64,365,First Health Group Corporation,First Health Network,354.05,97,,percent of total billed charges,,
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lip,Muc Mem;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11441,CPT,Professional,Both,,,,740,629,84.64,740,"Health Partners, Inc.",Commercial,274.97,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lip,Muc Mem;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11441,CPT,Professional,Both,,,,365,310.25,84.64,365,"Health Partners, Inc.",Commercial,274.97,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lip,Muc Mem;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11441,CPT,Professional,Both,,,,740,629,84.64,740,"Health Partners, Inc.",Medicare Advantage,151.386,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lip,Muc Mem;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11441,CPT,Professional,Both,,,,365,310.25,84.64,365,"Health Partners, Inc.",Medicare Advantage,151.386,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lip,Muc Mem;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11441,CPT,Professional,Both,,,,740,629,84.64,740,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),131.48,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lip,Muc Mem;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11441,CPT,Professional,Both,,,,365,310.25,84.64,365,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),131.48,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lip,Muc Mem;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11441,CPT,Professional,Both,,,,740,629,84.64,740,"Health Partners, Inc.",State of Minnesota Advantage Program,236.886655,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lip,Muc Mem;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11441,CPT,Professional,Both,,,,365,310.25,84.64,365,"Health Partners, Inc.",State of Minnesota Advantage Program,236.886655,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lip,Muc Mem;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11441,CPT,Professional,Both,,,,740,629,84.64,740,"Health Partners, Inc.",State Public Programs,84.64,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lip,Muc Mem;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11441,CPT,Professional,Both,,,,365,310.25,84.64,365,"Health Partners, Inc.",State Public Programs,84.64,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lip,Muc Mem;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11441,CPT,Professional,Both,,,,740,629,84.64,740,Humana Insurance Company,Commercial PPO,131.64,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lip,Muc Mem;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11441,CPT,Professional,Both,,,,365,310.25,84.64,365,Humana Insurance Company,Commercial PPO,131.64,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lip,Muc Mem;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11441,CPT,Professional,Both,,,,740,629,84.64,740,Humana Insurance Company,Medicare PPO,740,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lip,Muc Mem;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11441,CPT,Professional,Both,,,,365,310.25,84.64,365,Humana Insurance Company,Medicare PPO,365,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lip,Muc Mem;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11441,CPT,Professional,Both,,,,740,629,84.64,740,Medica,Individual & Family,627.52,84.8,,percent of total billed charges,,
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lip,Muc Mem;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11441,CPT,Professional,Both,,,,365,310.25,84.64,365,Medica,Individual & Family,309.52,84.8,,percent of total billed charges,,
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lip,Muc Mem;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11441,CPT,Professional,Both,,,,740,629,84.64,740,Medica,Medica Advantage Solution,368.52,49.8,,percent of total billed charges,,
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lip,Muc Mem;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11441,CPT,Professional,Both,,,,365,310.25,84.64,365,Medica,Medica Advantage Solution,181.77,49.8,,percent of total billed charges,,
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lip,Muc Mem;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11441,CPT,Professional,Both,,,,740,629,84.64,740,Medica,Medical Assistance,97.72,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lip,Muc Mem;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11441,CPT,Professional,Both,,,,365,310.25,84.64,365,Medica,Medical Assistance,97.72,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lip,Muc Mem;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11441,CPT,Professional,Both,,,,740,629,84.64,740,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,131.64,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lip,Muc Mem;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11441,CPT,Professional,Both,,,,365,310.25,84.64,365,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,131.64,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lip,Muc Mem;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11441,CPT,Professional,Both,,,,740,629,84.64,740,"Multiplan, Inc.","Multiplan, Inc.",695.6,94,,percent of total billed charges,,
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lip,Muc Mem;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11441,CPT,Professional,Both,,,,365,310.25,84.64,365,"Multiplan, Inc.","Multiplan, Inc.",343.1,94,,percent of total billed charges,,
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lip,Muc Mem;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11441,CPT,Professional,Both,,,,740,629,84.64,740,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,666.74,90.1,,percent of total billed charges,,
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lip,Muc Mem;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11441,CPT,Professional,Both,,,,365,310.25,84.64,365,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,328.865,90.1,,percent of total billed charges,,
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lip,Muc Mem;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11441,CPT,Professional,Both,,,,740,629,84.64,740,"Preferred One Administrative Services, INC.",PPO,729.64,98.6,,percent of total billed charges,,
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lip,Muc Mem;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11441,CPT,Professional,Both,,,,365,310.25,84.64,365,"Preferred One Administrative Services, INC.",PPO,359.89,98.6,,percent of total billed charges,,
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lip,Muc Mem;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11441,CPT,Professional,Both,,,,740,629,84.64,740,PrimeWest Health,Minnesota Senior Health Options (MSHO),151.386,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lip,Muc Mem;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11441,CPT,Professional,Both,,,,365,310.25,84.64,365,PrimeWest Health,Minnesota Senior Health Options (MSHO),151.386,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lip,Muc Mem;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11441,CPT,Professional,Both,,,,740,629,84.64,740,PrimeWest Health,MinnesotaCare,104.5592016,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lip,Muc Mem;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11441,CPT,Professional,Both,,,,365,310.25,84.64,365,PrimeWest Health,MinnesotaCare,104.5592016,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lip,Muc Mem;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11441,CPT,Professional,Both,,,,740,629,84.64,740,Sanford Health Plan,Sanford Health Plan,651.2,88,,percent of total billed charges,,
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lip,Muc Mem;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11441,CPT,Professional,Both,,,,365,310.25,84.64,365,Sanford Health Plan,Sanford Health Plan,321.2,88,,percent of total billed charges,,
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lip,Muc Mem;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11441,CPT,Professional,Both,,,,740,629,84.64,740,"UCare Health, Inc.",Individual & Family Plan,213.993984,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lip,Muc Mem;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11441,CPT,Professional,Both,,,,365,310.25,84.64,365,"UCare Health, Inc.",Individual & Family Plan,213.993984,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lip,Muc Mem;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11441,CPT,Professional,Both,,,,740,629,84.64,740,"UCare Health, Inc.",Medical Assistance,107.490768,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lip,Muc Mem;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11441,CPT,Professional,Both,,,,365,310.25,84.64,365,"UCare Health, Inc.",Medical Assistance,107.490768,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lip,Muc Mem;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11441,CPT,Professional,Both,,,,740,629,84.64,740,"UCare Health, Inc.",Medicare Advantage,151.386,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lip,Muc Mem;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11441,CPT,Professional,Both,,,,365,310.25,84.64,365,"UCare Health, Inc.",Medicare Advantage,151.386,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lip,Muc Mem;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11441,CPT,Professional,Both,,,,740,629,84.64,740,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),121.1088,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lip,Muc Mem;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11441,CPT,Professional,Both,,,,365,310.25,84.64,365,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),121.1088,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lip,Muc Mem;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11441,CPT,Professional,Both,,,,740,629,84.64,740,UnitedHealthcare,Individual & Family,740,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lip,Muc Mem;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11441,CPT,Professional,Both,,,,365,310.25,84.64,365,UnitedHealthcare,Individual & Family,365,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lip,Muc Mem;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11441,CPT,Professional,Both,,,,740,629,84.64,740,UnitedHealthcare,Medicare Advantage,151.386,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lip,Muc Mem;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11441,CPT,Professional,Both,,,,365,310.25,84.64,365,UnitedHealthcare,Medicare Advantage,151.386,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lip,Muc Mem;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11441,CPT,Professional,Both,,,,740,629,84.64,740,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,97.71888,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lip,Muc Mem;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11441,CPT,Professional,Both,,,,365,310.25,84.64,365,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,97.71888,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision,Benign,Lesion Face/Ears/Eyelids; .6-1.0 Cm (Pbb)",,11441,CPT,Facility,Outpatient,,,,362,307.7,103.7492,362,Aetna,Commercial,333.04,92,,percent of total billed charges,,
"Excision,Benign,Lesion Face/Ears/Eyelids; .6-1.0 Cm (Pbb)",,11441,CPT,Professional,Outpatient,,,,378,321.3,84.64,378,Aetna,Commercial,321.3,85,,percent of total billed charges,,
"Excision,Benign,Lesion Face/Ears/Eyelids; .6-1.0 Cm (Pbb)",,11441,CPT,Facility,Outpatient,,,,362,307.7,103.7492,362,Aetna,Medicare Advantage,177.38,49,,percent of total billed charges,,
"Excision,Benign,Lesion Face/Ears/Eyelids; .6-1.0 Cm (Pbb)",,11441,CPT,Professional,Outpatient,,,,378,321.3,84.64,378,Aetna,Medicare Advantage,129.95,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision,Benign,Lesion Face/Ears/Eyelids; .6-1.0 Cm (Pbb)",,11441,CPT,Facility,Outpatient,,,,362,307.7,103.7492,362,Aetna,PPO,336.66,93,,percent of total billed charges,,
"Excision,Benign,Lesion Face/Ears/Eyelids; .6-1.0 Cm (Pbb)",,11441,CPT,Professional,Outpatient,,,,378,321.3,84.64,378,Aetna,PPO,351.54,93,,percent of total billed charges,,
"Excision,Benign,Lesion Face/Ears/Eyelids; .6-1.0 Cm (Pbb)",,11441,CPT,Facility,Outpatient,,,,362,307.7,103.7492,362,America's PPO,America's PPO,347.6286,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Excision,Benign,Lesion Face/Ears/Eyelids; .6-1.0 Cm (Pbb)",,11441,CPT,Professional,Outpatient,,,,378,321.3,84.64,378,America's PPO,America's PPO,322.9632,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Excision,Benign,Lesion Face/Ears/Eyelids; .6-1.0 Cm (Pbb)",,11441,CPT,Facility,Outpatient,,,,362,307.7,103.7492,362,BlueCross BlueShield Minnesota, Federal Employee Program,356.208,98.4,,percent of total billed charges,,
"Excision,Benign,Lesion Face/Ears/Eyelids; .6-1.0 Cm (Pbb)",,11441,CPT,Professional,Outpatient,,,,378,321.3,84.64,378,BlueCross BlueShield Minnesota, Federal Employee Program,273.37,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Excision,Benign,Lesion Face/Ears/Eyelids; .6-1.0 Cm (Pbb)",,11441,CPT,Facility,Outpatient,,,,362,307.7,103.7492,362,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,362,100,,percent of total billed charges,,
"Excision,Benign,Lesion Face/Ears/Eyelids; .6-1.0 Cm (Pbb)",,11441,CPT,Professional,Outpatient,,,,378,321.3,84.64,378,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,277.74392,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision,Benign,Lesion Face/Ears/Eyelids; .6-1.0 Cm (Pbb)",,11441,CPT,Facility,Outpatient,,,,362,307.7,103.7492,362,BlueCross BlueShield Minnesota,High Value Network Plan,325.8,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
"Excision,Benign,Lesion Face/Ears/Eyelids; .6-1.0 Cm (Pbb)",,11441,CPT,Professional,Outpatient,,,,378,321.3,84.64,378,BlueCross BlueShield Minnesota,High Value Network Plan,277.74392,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision,Benign,Lesion Face/Ears/Eyelids; .6-1.0 Cm (Pbb)",,11441,CPT,Facility,Outpatient,,,,362,307.7,103.7492,362,BlueCross BlueShield Minnesota,Medicare Advantage,177.38,49,,percent of total billed charges,,
"Excision,Benign,Lesion Face/Ears/Eyelids; .6-1.0 Cm (Pbb)",,11441,CPT,Professional,Outpatient,,,,378,321.3,84.64,378,BlueCross BlueShield Minnesota,Medicare Advantage,151.386,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision,Benign,Lesion Face/Ears/Eyelids; .6-1.0 Cm (Pbb)",,11441,CPT,Professional,Outpatient,,,,378,321.3,84.64,378,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,277.74392,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision,Benign,Lesion Face/Ears/Eyelids; .6-1.0 Cm (Pbb)",,11441,CPT,Facility,Outpatient,,,,362,307.7,103.7492,362,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,103.7492,28.66,,percent of total billed charges,,
"Excision,Benign,Lesion Face/Ears/Eyelids; .6-1.0 Cm (Pbb)",,11441,CPT,Professional,Outpatient,,,,378,321.3,84.64,378,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,97.71888,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision,Benign,Lesion Face/Ears/Eyelids; .6-1.0 Cm (Pbb)",,11441,CPT,Facility,Outpatient,,,,362,307.7,103.7492,362,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),177.38,49,,percent of total billed charges,,
"Excision,Benign,Lesion Face/Ears/Eyelids; .6-1.0 Cm (Pbb)",,11441,CPT,Professional,Outpatient,,,,378,321.3,84.64,378,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),151.386,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision,Benign,Lesion Face/Ears/Eyelids; .6-1.0 Cm (Pbb)",,11441,CPT,Facility,Outpatient,,,,362,307.7,103.7492,362,CorVel,Worker's Compensation,362,100,,percent of total billed charges,,
"Excision,Benign,Lesion Face/Ears/Eyelids; .6-1.0 Cm (Pbb)",,11441,CPT,Professional,Outpatient,,,,378,321.3,84.64,378,CorVel,Worker's Compensation,254.4856356,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Excision,Benign,Lesion Face/Ears/Eyelids; .6-1.0 Cm (Pbb)",,11441,CPT,Facility,Outpatient,,,,362,307.7,103.7492,362,First Health Group Corporation,First Health Network,351.14,97,,percent of total billed charges,,
"Excision,Benign,Lesion Face/Ears/Eyelids; .6-1.0 Cm (Pbb)",,11441,CPT,Professional,Outpatient,,,,378,321.3,84.64,378,First Health Group Corporation,First Health Network,366.66,97,,percent of total billed charges,,
"Excision,Benign,Lesion Face/Ears/Eyelids; .6-1.0 Cm (Pbb)",,11441,CPT,Facility,Outpatient,,,,362,307.7,103.7492,362,"Health Partners, Inc.",Commercial,342.452,94.6,,percent of total billed charges,,
"Excision,Benign,Lesion Face/Ears/Eyelids; .6-1.0 Cm (Pbb)",,11441,CPT,Professional,Outpatient,,,,378,321.3,84.64,378,"Health Partners, Inc.",Commercial,274.97,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision,Benign,Lesion Face/Ears/Eyelids; .6-1.0 Cm (Pbb)",,11441,CPT,Facility,Outpatient,,,,362,307.7,103.7492,362,"Health Partners, Inc.",Medicare Advantage,177.38,49,,percent of total billed charges,,
"Excision,Benign,Lesion Face/Ears/Eyelids; .6-1.0 Cm (Pbb)",,11441,CPT,Professional,Outpatient,,,,378,321.3,84.64,378,"Health Partners, Inc.",Medicare Advantage,151.386,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision,Benign,Lesion Face/Ears/Eyelids; .6-1.0 Cm (Pbb)",,11441,CPT,Facility,Outpatient,,,,362,307.7,103.7492,362,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),217.2,60,,percent of total billed charges,,
"Excision,Benign,Lesion Face/Ears/Eyelids; .6-1.0 Cm (Pbb)",,11441,CPT,Professional,Outpatient,,,,378,321.3,84.64,378,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),131.48,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Excision,Benign,Lesion Face/Ears/Eyelids; .6-1.0 Cm (Pbb)",,11441,CPT,Facility,Outpatient,,,,362,307.7,103.7492,362,"Health Partners, Inc.",State of Minnesota Advantage Program,295.03,81.5,,percent of total billed charges,,
"Excision,Benign,Lesion Face/Ears/Eyelids; .6-1.0 Cm (Pbb)",,11441,CPT,Professional,Outpatient,,,,378,321.3,84.64,378,"Health Partners, Inc.",State of Minnesota Advantage Program,236.886655,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision,Benign,Lesion Face/Ears/Eyelids; .6-1.0 Cm (Pbb)",,11441,CPT,Facility,Outpatient,,,,362,307.7,103.7492,362,"Health Partners, Inc.",State Public Programs,181,50,,percent of total billed charges,,
"Excision,Benign,Lesion Face/Ears/Eyelids; .6-1.0 Cm (Pbb)",,11441,CPT,Professional,Outpatient,,,,378,321.3,84.64,378,"Health Partners, Inc.",State Public Programs,84.64,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Excision,Benign,Lesion Face/Ears/Eyelids; .6-1.0 Cm (Pbb)",,11441,CPT,Facility,Outpatient,,,,362,307.7,103.7492,362,Humana Insurance Company,Commercial PPO,343.9,95,,percent of total billed charges,,
"Excision,Benign,Lesion Face/Ears/Eyelids; .6-1.0 Cm (Pbb)",,11441,CPT,Professional,Outpatient,,,,378,321.3,84.64,378,Humana Insurance Company,Commercial PPO,131.64,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Excision,Benign,Lesion Face/Ears/Eyelids; .6-1.0 Cm (Pbb)",,11441,CPT,Facility,Outpatient,,,,362,307.7,103.7492,362,Humana Insurance Company,Medicare PPO,177.38,49,,percent of total billed charges,,
"Excision,Benign,Lesion Face/Ears/Eyelids; .6-1.0 Cm (Pbb)",,11441,CPT,Professional,Outpatient,,,,378,321.3,84.64,378,Humana Insurance Company,Medicare PPO,378,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Excision,Benign,Lesion Face/Ears/Eyelids; .6-1.0 Cm (Pbb)",,11441,CPT,Facility,Outpatient,,,,362,307.7,103.7492,362,Medica,Individual & Family,358.742,99.1,,percent of total billed charges,,
"Excision,Benign,Lesion Face/Ears/Eyelids; .6-1.0 Cm (Pbb)",,11441,CPT,Professional,Outpatient,,,,378,321.3,84.64,378,Medica,Individual & Family,320.544,84.8,,percent of total billed charges,,
"Excision,Benign,Lesion Face/Ears/Eyelids; .6-1.0 Cm (Pbb)",,11441,CPT,Facility,Outpatient,,,,362,307.7,103.7492,362,Medica,Medica Advantage Solution,180.276,49.8,,percent of total billed charges,,
"Excision,Benign,Lesion Face/Ears/Eyelids; .6-1.0 Cm (Pbb)",,11441,CPT,Professional,Outpatient,,,,378,321.3,84.64,378,Medica,Medica Advantage Solution,188.244,49.8,,percent of total billed charges,,
"Excision,Benign,Lesion Face/Ears/Eyelids; .6-1.0 Cm (Pbb)",,11441,CPT,Facility,Outpatient,,,,362,307.7,103.7492,362,Medica,Medical Assistance,161.452,44.6,,percent of total billed charges,,
"Excision,Benign,Lesion Face/Ears/Eyelids; .6-1.0 Cm (Pbb)",,11441,CPT,Professional,Outpatient,,,,378,321.3,84.64,378,Medica,Medical Assistance,97.72,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Excision,Benign,Lesion Face/Ears/Eyelids; .6-1.0 Cm (Pbb)",,11441,CPT,Facility,Outpatient,,,,362,307.7,103.7492,362,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,180.276,49.8,,percent of total billed charges,,
"Excision,Benign,Lesion Face/Ears/Eyelids; .6-1.0 Cm (Pbb)",,11441,CPT,Professional,Outpatient,,,,378,321.3,84.64,378,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,131.64,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Excision,Benign,Lesion Face/Ears/Eyelids; .6-1.0 Cm (Pbb)",,11441,CPT,Facility,Outpatient,,,,362,307.7,103.7492,362,"Multiplan, Inc.","Multiplan, Inc.",340.28,94,,percent of total billed charges,,
"Excision,Benign,Lesion Face/Ears/Eyelids; .6-1.0 Cm (Pbb)",,11441,CPT,Professional,Outpatient,,,,378,321.3,84.64,378,"Multiplan, Inc.","Multiplan, Inc.",355.32,94,,percent of total billed charges,,
"Excision,Benign,Lesion Face/Ears/Eyelids; .6-1.0 Cm (Pbb)",,11441,CPT,Facility,Outpatient,,,,362,307.7,103.7492,362,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,326.162,90.1,,percent of total billed charges,,
"Excision,Benign,Lesion Face/Ears/Eyelids; .6-1.0 Cm (Pbb)",,11441,CPT,Professional,Outpatient,,,,378,321.3,84.64,378,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,340.578,90.1,,percent of total billed charges,,
"Excision,Benign,Lesion Face/Ears/Eyelids; .6-1.0 Cm (Pbb)",,11441,CPT,Facility,Outpatient,,,,362,307.7,103.7492,362,"Preferred One Administrative Services, INC.",PPO,356.932,98.6,,percent of total billed charges,,
"Excision,Benign,Lesion Face/Ears/Eyelids; .6-1.0 Cm (Pbb)",,11441,CPT,Professional,Outpatient,,,,378,321.3,84.64,378,"Preferred One Administrative Services, INC.",PPO,372.708,98.6,,percent of total billed charges,,
"Excision,Benign,Lesion Face/Ears/Eyelids; .6-1.0 Cm (Pbb)",,11441,CPT,Facility,Outpatient,,,,362,307.7,103.7492,362,PrimeWest Health,Minnesota Senior Health Options (MSHO),186.249,51.45,,percent of total billed charges,,
"Excision,Benign,Lesion Face/Ears/Eyelids; .6-1.0 Cm (Pbb)",,11441,CPT,Professional,Outpatient,,,,378,321.3,84.64,378,PrimeWest Health,Minnesota Senior Health Options (MSHO),151.386,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision,Benign,Lesion Face/Ears/Eyelids; .6-1.0 Cm (Pbb)",,11441,CPT,Facility,Outpatient,,,,362,307.7,103.7492,362,PrimeWest Health,MinnesotaCare,185.9232,51.36,,percent of total billed charges,,
"Excision,Benign,Lesion Face/Ears/Eyelids; .6-1.0 Cm (Pbb)",,11441,CPT,Professional,Outpatient,,,,378,321.3,84.64,378,PrimeWest Health,MinnesotaCare,104.5592016,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision,Benign,Lesion Face/Ears/Eyelids; .6-1.0 Cm (Pbb)",,11441,CPT,Facility,Outpatient,,,,362,307.7,103.7492,362,Sanford Health Plan,Sanford Health Plan,333.04,92,,percent of total billed charges,,
"Excision,Benign,Lesion Face/Ears/Eyelids; .6-1.0 Cm (Pbb)",,11441,CPT,Professional,Outpatient,,,,378,321.3,84.64,378,Sanford Health Plan,Sanford Health Plan,332.64,88,,percent of total billed charges,,
"Excision,Benign,Lesion Face/Ears/Eyelids; .6-1.0 Cm (Pbb)",,11441,CPT,Facility,Outpatient,,,,362,307.7,103.7492,362,"UCare Health, Inc.",Individual & Family Plan,203.987,56.35,,percent of total billed charges,,
"Excision,Benign,Lesion Face/Ears/Eyelids; .6-1.0 Cm (Pbb)",,11441,CPT,Professional,Outpatient,,,,378,321.3,84.64,378,"UCare Health, Inc.",Individual & Family Plan,213.993984,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Excision,Benign,Lesion Face/Ears/Eyelids; .6-1.0 Cm (Pbb)",,11441,CPT,Facility,Outpatient,,,,362,307.7,103.7492,362,"UCare Health, Inc.",Medical Assistance,182.7014,50.47,,percent of total billed charges,,
"Excision,Benign,Lesion Face/Ears/Eyelids; .6-1.0 Cm (Pbb)",,11441,CPT,Professional,Outpatient,,,,378,321.3,84.64,378,"UCare Health, Inc.",Medical Assistance,107.490768,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Excision,Benign,Lesion Face/Ears/Eyelids; .6-1.0 Cm (Pbb)",,11441,CPT,Facility,Outpatient,,,,362,307.7,103.7492,362,"UCare Health, Inc.",Medicare Advantage,182.7014,50.47,,percent of total billed charges,,
"Excision,Benign,Lesion Face/Ears/Eyelids; .6-1.0 Cm (Pbb)",,11441,CPT,Professional,Outpatient,,,,378,321.3,84.64,378,"UCare Health, Inc.",Medicare Advantage,151.386,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Excision,Benign,Lesion Face/Ears/Eyelids; .6-1.0 Cm (Pbb)",,11441,CPT,Facility,Outpatient,,,,362,307.7,103.7492,362,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),182.7014,50.47,,percent of total billed charges,,
"Excision,Benign,Lesion Face/Ears/Eyelids; .6-1.0 Cm (Pbb)",,11441,CPT,Professional,Outpatient,,,,378,321.3,84.64,378,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),121.1088,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Excision,Benign,Lesion Face/Ears/Eyelids; .6-1.0 Cm (Pbb)",,11441,CPT,Facility,Outpatient,,,,362,307.7,103.7492,362,UnitedHealthcare,Individual & Family,340.28,94,,percent of total billed charges,,
"Excision,Benign,Lesion Face/Ears/Eyelids; .6-1.0 Cm (Pbb)",,11441,CPT,Professional,Outpatient,,,,378,321.3,84.64,378,UnitedHealthcare,Individual & Family,378,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Excision,Benign,Lesion Face/Ears/Eyelids; .6-1.0 Cm (Pbb)",,11441,CPT,Facility,Outpatient,,,,362,307.7,103.7492,362,UnitedHealthcare,Medicare Advantage,177.38,49,,percent of total billed charges,,
"Excision,Benign,Lesion Face/Ears/Eyelids; .6-1.0 Cm (Pbb)",,11441,CPT,Professional,Outpatient,,,,378,321.3,84.64,378,UnitedHealthcare,Medicare Advantage,151.386,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision,Benign,Lesion Face/Ears/Eyelids; .6-1.0 Cm (Pbb)",,11441,CPT,Facility,Outpatient,,,,362,307.7,103.7492,362,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,173.76,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Excision,Benign,Lesion Face/Ears/Eyelids; .6-1.0 Cm (Pbb)",,11441,CPT,Professional,Outpatient,,,,378,321.3,84.64,378,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,97.71888,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Exc Benign Lesion Face/Ears/Eyes 1.1-2 Cm (Pbb),,11442,CPT,Facility,Outpatient,,,,165,140.25,47.289,165,Aetna,Commercial,151.8,92,,percent of total billed charges,,
Exc Benign Lesion Face/Ears/Eyes 1.1-2 Cm (Pbb),,11442,CPT,Professional,Outpatient,,,,270,229.5,93.15,270,Aetna,Commercial,229.5,85,,percent of total billed charges,,
Exc Benign Lesion Face/Ears/Eyes 1.1-2 Cm (Pbb),,11442,CPT,Facility,Outpatient,,,,165,140.25,47.289,165,Aetna,Medicare Advantage,80.85,49,,percent of total billed charges,,
Exc Benign Lesion Face/Ears/Eyes 1.1-2 Cm (Pbb),,11442,CPT,Professional,Outpatient,,,,270,229.5,93.15,270,Aetna,Medicare Advantage,143.06,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Exc Benign Lesion Face/Ears/Eyes 1.1-2 Cm (Pbb),,11442,CPT,Facility,Outpatient,,,,165,140.25,47.289,165,Aetna,PPO,153.45,93,,percent of total billed charges,,
Exc Benign Lesion Face/Ears/Eyes 1.1-2 Cm (Pbb),,11442,CPT,Professional,Outpatient,,,,270,229.5,93.15,270,Aetna,PPO,251.1,93,,percent of total billed charges,,
Exc Benign Lesion Face/Ears/Eyes 1.1-2 Cm (Pbb),,11442,CPT,Facility,Outpatient,,,,165,140.25,47.289,165,America's PPO,America's PPO,158.4495,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Exc Benign Lesion Face/Ears/Eyes 1.1-2 Cm (Pbb),,11442,CPT,Professional,Outpatient,,,,270,229.5,93.15,270,America's PPO,America's PPO,230.688,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Exc Benign Lesion Face/Ears/Eyes 1.1-2 Cm (Pbb),,11442,CPT,Facility,Outpatient,,,,165,140.25,47.289,165,BlueCross BlueShield Minnesota, Federal Employee Program,162.36,98.4,,percent of total billed charges,,
Exc Benign Lesion Face/Ears/Eyes 1.1-2 Cm (Pbb),,11442,CPT,Professional,Outpatient,,,,270,229.5,93.15,270,BlueCross BlueShield Minnesota, Federal Employee Program,270,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Exc Benign Lesion Face/Ears/Eyes 1.1-2 Cm (Pbb),,11442,CPT,Facility,Outpatient,,,,165,140.25,47.289,165,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,165,100,,percent of total billed charges,,
Exc Benign Lesion Face/Ears/Eyes 1.1-2 Cm (Pbb),,11442,CPT,Professional,Outpatient,,,,270,229.5,93.15,270,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,270,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Exc Benign Lesion Face/Ears/Eyes 1.1-2 Cm (Pbb),,11442,CPT,Facility,Outpatient,,,,165,140.25,47.289,165,BlueCross BlueShield Minnesota,High Value Network Plan,148.5,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
Exc Benign Lesion Face/Ears/Eyes 1.1-2 Cm (Pbb),,11442,CPT,Professional,Outpatient,,,,270,229.5,93.15,270,BlueCross BlueShield Minnesota,High Value Network Plan,270,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Exc Benign Lesion Face/Ears/Eyes 1.1-2 Cm (Pbb),,11442,CPT,Facility,Outpatient,,,,165,140.25,47.289,165,BlueCross BlueShield Minnesota,Medicare Advantage,80.85,49,,percent of total billed charges,,
Exc Benign Lesion Face/Ears/Eyes 1.1-2 Cm (Pbb),,11442,CPT,Professional,Outpatient,,,,270,229.5,93.15,270,BlueCross BlueShield Minnesota,Medicare Advantage,166.4165,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Exc Benign Lesion Face/Ears/Eyes 1.1-2 Cm (Pbb),,11442,CPT,Professional,Outpatient,,,,270,229.5,93.15,270,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,270,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Exc Benign Lesion Face/Ears/Eyes 1.1-2 Cm (Pbb),,11442,CPT,Facility,Outpatient,,,,165,140.25,47.289,165,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,47.289,28.66,,percent of total billed charges,,
Exc Benign Lesion Face/Ears/Eyes 1.1-2 Cm (Pbb),,11442,CPT,Professional,Outpatient,,,,270,229.5,93.15,270,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,107.5436,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Exc Benign Lesion Face/Ears/Eyes 1.1-2 Cm (Pbb),,11442,CPT,Facility,Outpatient,,,,165,140.25,47.289,165,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),80.85,49,,percent of total billed charges,,
Exc Benign Lesion Face/Ears/Eyes 1.1-2 Cm (Pbb),,11442,CPT,Professional,Outpatient,,,,270,229.5,93.15,270,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),166.4165,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Exc Benign Lesion Face/Ears/Eyes 1.1-2 Cm (Pbb),,11442,CPT,Facility,Outpatient,,,,165,140.25,47.289,165,CorVel,Worker's Compensation,165,100,,percent of total billed charges,,
Exc Benign Lesion Face/Ears/Eyes 1.1-2 Cm (Pbb),,11442,CPT,Professional,Outpatient,,,,270,229.5,93.15,270,CorVel,Worker's Compensation,270,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Exc Benign Lesion Face/Ears/Eyes 1.1-2 Cm (Pbb),,11442,CPT,Facility,Outpatient,,,,165,140.25,47.289,165,First Health Group Corporation,First Health Network,160.05,97,,percent of total billed charges,,
Exc Benign Lesion Face/Ears/Eyes 1.1-2 Cm (Pbb),,11442,CPT,Professional,Outpatient,,,,270,229.5,93.15,270,First Health Group Corporation,First Health Network,261.9,97,,percent of total billed charges,,
Exc Benign Lesion Face/Ears/Eyes 1.1-2 Cm (Pbb),,11442,CPT,Facility,Outpatient,,,,165,140.25,47.289,165,"Health Partners, Inc.",Commercial,156.09,94.6,,percent of total billed charges,,
Exc Benign Lesion Face/Ears/Eyes 1.1-2 Cm (Pbb),,11442,CPT,Professional,Outpatient,,,,270,229.5,93.15,270,"Health Partners, Inc.",Commercial,270,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Exc Benign Lesion Face/Ears/Eyes 1.1-2 Cm (Pbb),,11442,CPT,Facility,Outpatient,,,,165,140.25,47.289,165,"Health Partners, Inc.",Medicare Advantage,80.85,49,,percent of total billed charges,,
Exc Benign Lesion Face/Ears/Eyes 1.1-2 Cm (Pbb),,11442,CPT,Professional,Outpatient,,,,270,229.5,93.15,270,"Health Partners, Inc.",Medicare Advantage,166.4165,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Exc Benign Lesion Face/Ears/Eyes 1.1-2 Cm (Pbb),,11442,CPT,Facility,Outpatient,,,,165,140.25,47.289,165,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),99,60,,percent of total billed charges,,
Exc Benign Lesion Face/Ears/Eyes 1.1-2 Cm (Pbb),,11442,CPT,Professional,Outpatient,,,,270,229.5,93.15,270,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),144.7,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Exc Benign Lesion Face/Ears/Eyes 1.1-2 Cm (Pbb),,11442,CPT,Facility,Outpatient,,,,165,140.25,47.289,165,"Health Partners, Inc.",State of Minnesota Advantage Program,134.475,81.5,,percent of total billed charges,,
Exc Benign Lesion Face/Ears/Eyes 1.1-2 Cm (Pbb),,11442,CPT,Professional,Outpatient,,,,270,229.5,93.15,270,"Health Partners, Inc.",State of Minnesota Advantage Program,260.01793,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Exc Benign Lesion Face/Ears/Eyes 1.1-2 Cm (Pbb),,11442,CPT,Facility,Outpatient,,,,165,140.25,47.289,165,"Health Partners, Inc.",State Public Programs,82.5,50,,percent of total billed charges,,
Exc Benign Lesion Face/Ears/Eyes 1.1-2 Cm (Pbb),,11442,CPT,Professional,Outpatient,,,,270,229.5,93.15,270,"Health Partners, Inc.",State Public Programs,93.15,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Exc Benign Lesion Face/Ears/Eyes 1.1-2 Cm (Pbb),,11442,CPT,Facility,Outpatient,,,,165,140.25,47.289,165,Humana Insurance Company,Commercial PPO,156.75,95,,percent of total billed charges,,
Exc Benign Lesion Face/Ears/Eyes 1.1-2 Cm (Pbb),,11442,CPT,Professional,Outpatient,,,,270,229.5,93.15,270,Humana Insurance Company,Commercial PPO,144.71,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Exc Benign Lesion Face/Ears/Eyes 1.1-2 Cm (Pbb),,11442,CPT,Facility,Outpatient,,,,165,140.25,47.289,165,Humana Insurance Company,Medicare PPO,80.85,49,,percent of total billed charges,,
Exc Benign Lesion Face/Ears/Eyes 1.1-2 Cm (Pbb),,11442,CPT,Professional,Outpatient,,,,270,229.5,93.15,270,Humana Insurance Company,Medicare PPO,270,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Exc Benign Lesion Face/Ears/Eyes 1.1-2 Cm (Pbb),,11442,CPT,Facility,Outpatient,,,,165,140.25,47.289,165,Medica,Individual & Family,163.515,99.1,,percent of total billed charges,,
Exc Benign Lesion Face/Ears/Eyes 1.1-2 Cm (Pbb),,11442,CPT,Professional,Outpatient,,,,270,229.5,93.15,270,Medica,Individual & Family,228.96,84.8,,percent of total billed charges,,
Exc Benign Lesion Face/Ears/Eyes 1.1-2 Cm (Pbb),,11442,CPT,Facility,Outpatient,,,,165,140.25,47.289,165,Medica,Medica Advantage Solution,82.17,49.8,,percent of total billed charges,,
Exc Benign Lesion Face/Ears/Eyes 1.1-2 Cm (Pbb),,11442,CPT,Professional,Outpatient,,,,270,229.5,93.15,270,Medica,Medica Advantage Solution,134.46,49.8,,percent of total billed charges,,
Exc Benign Lesion Face/Ears/Eyes 1.1-2 Cm (Pbb),,11442,CPT,Facility,Outpatient,,,,165,140.25,47.289,165,Medica,Medical Assistance,73.59,44.6,,percent of total billed charges,,
Exc Benign Lesion Face/Ears/Eyes 1.1-2 Cm (Pbb),,11442,CPT,Professional,Outpatient,,,,270,229.5,93.15,270,Medica,Medical Assistance,107.54,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Exc Benign Lesion Face/Ears/Eyes 1.1-2 Cm (Pbb),,11442,CPT,Facility,Outpatient,,,,165,140.25,47.289,165,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,82.17,49.8,,percent of total billed charges,,
Exc Benign Lesion Face/Ears/Eyes 1.1-2 Cm (Pbb),,11442,CPT,Professional,Outpatient,,,,270,229.5,93.15,270,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,144.71,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Exc Benign Lesion Face/Ears/Eyes 1.1-2 Cm (Pbb),,11442,CPT,Facility,Outpatient,,,,165,140.25,47.289,165,"Multiplan, Inc.","Multiplan, Inc.",155.1,94,,percent of total billed charges,,
Exc Benign Lesion Face/Ears/Eyes 1.1-2 Cm (Pbb),,11442,CPT,Professional,Outpatient,,,,270,229.5,93.15,270,"Multiplan, Inc.","Multiplan, Inc.",253.8,94,,percent of total billed charges,,
Exc Benign Lesion Face/Ears/Eyes 1.1-2 Cm (Pbb),,11442,CPT,Facility,Outpatient,,,,165,140.25,47.289,165,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,148.665,90.1,,percent of total billed charges,,
Exc Benign Lesion Face/Ears/Eyes 1.1-2 Cm (Pbb),,11442,CPT,Professional,Outpatient,,,,270,229.5,93.15,270,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,243.27,90.1,,percent of total billed charges,,
Exc Benign Lesion Face/Ears/Eyes 1.1-2 Cm (Pbb),,11442,CPT,Facility,Outpatient,,,,165,140.25,47.289,165,"Preferred One Administrative Services, INC.",PPO,162.69,98.6,,percent of total billed charges,,
Exc Benign Lesion Face/Ears/Eyes 1.1-2 Cm (Pbb),,11442,CPT,Professional,Outpatient,,,,270,229.5,93.15,270,"Preferred One Administrative Services, INC.",PPO,266.22,98.6,,percent of total billed charges,,
Exc Benign Lesion Face/Ears/Eyes 1.1-2 Cm (Pbb),,11442,CPT,Facility,Outpatient,,,,165,140.25,47.289,165,PrimeWest Health,Minnesota Senior Health Options (MSHO),84.8925,51.45,,percent of total billed charges,,
Exc Benign Lesion Face/Ears/Eyes 1.1-2 Cm (Pbb),,11442,CPT,Professional,Outpatient,,,,270,229.5,93.15,270,PrimeWest Health,Minnesota Senior Health Options (MSHO),166.4165,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Exc Benign Lesion Face/Ears/Eyes 1.1-2 Cm (Pbb),,11442,CPT,Facility,Outpatient,,,,165,140.25,47.289,165,PrimeWest Health,MinnesotaCare,84.744,51.36,,percent of total billed charges,,
Exc Benign Lesion Face/Ears/Eyes 1.1-2 Cm (Pbb),,11442,CPT,Professional,Outpatient,,,,270,229.5,93.15,270,PrimeWest Health,MinnesotaCare,115.071652,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Exc Benign Lesion Face/Ears/Eyes 1.1-2 Cm (Pbb),,11442,CPT,Facility,Outpatient,,,,165,140.25,47.289,165,Sanford Health Plan,Sanford Health Plan,151.8,92,,percent of total billed charges,,
Exc Benign Lesion Face/Ears/Eyes 1.1-2 Cm (Pbb),,11442,CPT,Professional,Outpatient,,,,270,229.5,93.15,270,Sanford Health Plan,Sanford Health Plan,237.6,88,,percent of total billed charges,,
Exc Benign Lesion Face/Ears/Eyes 1.1-2 Cm (Pbb),,11442,CPT,Facility,Outpatient,,,,165,140.25,47.289,165,"UCare Health, Inc.",Individual & Family Plan,92.9775,56.35,,percent of total billed charges,,
Exc Benign Lesion Face/Ears/Eyes 1.1-2 Cm (Pbb),,11442,CPT,Professional,Outpatient,,,,270,229.5,93.15,270,"UCare Health, Inc.",Individual & Family Plan,235.240576,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Exc Benign Lesion Face/Ears/Eyes 1.1-2 Cm (Pbb),,11442,CPT,Facility,Outpatient,,,,165,140.25,47.289,165,"UCare Health, Inc.",Medical Assistance,83.2755,50.47,,percent of total billed charges,,
Exc Benign Lesion Face/Ears/Eyes 1.1-2 Cm (Pbb),,11442,CPT,Professional,Outpatient,,,,270,229.5,93.15,270,"UCare Health, Inc.",Medical Assistance,118.29796,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Exc Benign Lesion Face/Ears/Eyes 1.1-2 Cm (Pbb),,11442,CPT,Facility,Outpatient,,,,165,140.25,47.289,165,"UCare Health, Inc.",Medicare Advantage,83.2755,50.47,,percent of total billed charges,,
Exc Benign Lesion Face/Ears/Eyes 1.1-2 Cm (Pbb),,11442,CPT,Professional,Outpatient,,,,270,229.5,93.15,270,"UCare Health, Inc.",Medicare Advantage,166.4165,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Exc Benign Lesion Face/Ears/Eyes 1.1-2 Cm (Pbb),,11442,CPT,Facility,Outpatient,,,,165,140.25,47.289,165,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),83.2755,50.47,,percent of total billed charges,,
Exc Benign Lesion Face/Ears/Eyes 1.1-2 Cm (Pbb),,11442,CPT,Professional,Outpatient,,,,270,229.5,93.15,270,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),133.1332,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Exc Benign Lesion Face/Ears/Eyes 1.1-2 Cm (Pbb),,11442,CPT,Facility,Outpatient,,,,165,140.25,47.289,165,UnitedHealthcare,Individual & Family,155.1,94,,percent of total billed charges,,
Exc Benign Lesion Face/Ears/Eyes 1.1-2 Cm (Pbb),,11442,CPT,Professional,Outpatient,,,,270,229.5,93.15,270,UnitedHealthcare,Individual & Family,270,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Exc Benign Lesion Face/Ears/Eyes 1.1-2 Cm (Pbb),,11442,CPT,Facility,Outpatient,,,,165,140.25,47.289,165,UnitedHealthcare,Medicare Advantage,80.85,49,,percent of total billed charges,,
Exc Benign Lesion Face/Ears/Eyes 1.1-2 Cm (Pbb),,11442,CPT,Professional,Outpatient,,,,270,229.5,93.15,270,UnitedHealthcare,Medicare Advantage,166.4165,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Exc Benign Lesion Face/Ears/Eyes 1.1-2 Cm (Pbb),,11442,CPT,Facility,Outpatient,,,,165,140.25,47.289,165,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,79.2,48,,percent of total billed charges,,100% of DHS outpatient percentage
Exc Benign Lesion Face/Ears/Eyes 1.1-2 Cm (Pbb),,11442,CPT,Professional,Outpatient,,,,270,229.5,93.15,270,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,107.5436,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lp,Muc Memb;Exc Dia 1.1-2.0 Cm",,11442,CPT,Facility,Both,,,,255,216.75,73.083,449,Aetna,Commercial,234.6,92,,percent of total billed charges,,
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lp,Muc Memb;Exc Dia 1.1-2.0 Cm",,11442,CPT,Facility,Outpatient,,,,255,216.75,73.083,449,Aetna,Medicare Advantage,124.95,49,,percent of total billed charges,,
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lp,Muc Memb;Exc Dia 1.1-2.0 Cm",,11442,CPT,Facility,Inpatient,,,,255,216.75,73.083,449,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lp,Muc Memb;Exc Dia 1.1-2.0 Cm",,11442,CPT,Facility,Both,,,,255,216.75,73.083,449,Aetna,PPO,237.15,93,,percent of total billed charges,,
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lp,Muc Memb;Exc Dia 1.1-2.0 Cm",,11442,CPT,Facility,Both,,,,255,216.75,73.083,449,America's PPO,America's PPO,244.8765,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lp,Muc Memb;Exc Dia 1.1-2.0 Cm",,11442,CPT,Facility,Both,,,,255,216.75,73.083,449,BlueCross BlueShield Minnesota, Federal Employee Program,250.92,98.4,,percent of total billed charges,,
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lp,Muc Memb;Exc Dia 1.1-2.0 Cm",,11442,CPT,Facility,Both,,,,255,216.75,73.083,449,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,255,100,,percent of total billed charges,,
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lp,Muc Memb;Exc Dia 1.1-2.0 Cm",,11442,CPT,Facility,Both,,,,255,216.75,73.083,449,BlueCross BlueShield Minnesota,High Value Network Plan,229.5,90,,percent of total billed charges,,
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lp,Muc Memb;Exc Dia 1.1-2.0 Cm",,11442,CPT,Facility,Outpatient,,,,255,216.75,73.083,449,BlueCross BlueShield Minnesota,Medicare Advantage,124.95,49,,percent of total billed charges,,
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lp,Muc Memb;Exc Dia 1.1-2.0 Cm",,11442,CPT,Facility,Inpatient,,,,255,216.75,73.083,449,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lp,Muc Memb;Exc Dia 1.1-2.0 Cm",,11442,CPT,Facility,Both,,,,255,216.75,73.083,449,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,225.8535,88.57,,percent of total billed charges,,
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lp,Muc Memb;Exc Dia 1.1-2.0 Cm",,11442,CPT,Facility,Both,,,,255,216.75,73.083,449,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,73.083,28.66,,percent of total billed charges,,
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lp,Muc Memb;Exc Dia 1.1-2.0 Cm",,11442,CPT,Facility,Outpatient,,,,255,216.75,73.083,449,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),124.95,49,,percent of total billed charges,,
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lp,Muc Memb;Exc Dia 1.1-2.0 Cm",,11442,CPT,Facility,Inpatient,,,,255,216.75,73.083,449,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lp,Muc Memb;Exc Dia 1.1-2.0 Cm",,11442,CPT,Facility,Both,,,,255,216.75,73.083,449,CorVel,Worker's Compensation,255,100,,percent of total billed charges,,
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lp,Muc Memb;Exc Dia 1.1-2.0 Cm",,11442,CPT,Facility,Both,,,,255,216.75,73.083,449,First Health Group Corporation,First Health Network,247.35,97,,percent of total billed charges,,
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lp,Muc Memb;Exc Dia 1.1-2.0 Cm",,11442,CPT,Facility,Both,,,,255,216.75,73.083,449,"Health Partners, Inc.",Commercial,241.23,94.6,,percent of total billed charges,,
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lp,Muc Memb;Exc Dia 1.1-2.0 Cm",,11442,CPT,Facility,Outpatient,,,,255,216.75,73.083,449,"Health Partners, Inc.",Medicare Advantage,124.95,49,,percent of total billed charges,,
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lp,Muc Memb;Exc Dia 1.1-2.0 Cm",,11442,CPT,Facility,Inpatient,,,,255,216.75,73.083,449,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lp,Muc Memb;Exc Dia 1.1-2.0 Cm",,11442,CPT,Facility,Both,,,,255,216.75,73.083,449,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),153,60,,percent of total billed charges,,
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lp,Muc Memb;Exc Dia 1.1-2.0 Cm",,11442,CPT,Facility,Both,,,,255,216.75,73.083,449,"Health Partners, Inc.",State of Minnesota Advantage Program,207.825,81.5,,percent of total billed charges,,
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lp,Muc Memb;Exc Dia 1.1-2.0 Cm",,11442,CPT,Facility,Both,,,,255,216.75,73.083,449,"Health Partners, Inc.",State Public Programs,127.5,50,,percent of total billed charges,,
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lp,Muc Memb;Exc Dia 1.1-2.0 Cm",,11442,CPT,Facility,Both,,,,255,216.75,73.083,449,Humana Insurance Company,Commercial PPO,242.25,95,,percent of total billed charges,,
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lp,Muc Memb;Exc Dia 1.1-2.0 Cm",,11442,CPT,Facility,Outpatient,,,,255,216.75,73.083,449,Humana Insurance Company,Medicare PPO,124.95,49,,percent of total billed charges,,
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lp,Muc Memb;Exc Dia 1.1-2.0 Cm",,11442,CPT,Facility,Inpatient,,,,255,216.75,73.083,449,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lp,Muc Memb;Exc Dia 1.1-2.0 Cm",,11442,CPT,Facility,Both,,,,255,216.75,73.083,449,Medica,Individual & Family,252.705,99.1,,percent of total billed charges,,
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lp,Muc Memb;Exc Dia 1.1-2.0 Cm",,11442,CPT,Facility,Outpatient,,,,255,216.75,73.083,449,Medica,Medica Advantage Solution,126.99,49.8,,percent of total billed charges,,
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lp,Muc Memb;Exc Dia 1.1-2.0 Cm",,11442,CPT,Facility,Inpatient,,,,255,216.75,73.083,449,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lp,Muc Memb;Exc Dia 1.1-2.0 Cm",,11442,CPT,Facility,Outpatient,,,,255,216.75,73.083,449,Medica,Medical Assistance,449,,,Other,Grouper,All inclusive per visit
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lp,Muc Memb;Exc Dia 1.1-2.0 Cm",,11442,CPT,Facility,Inpatient,,,,255,216.75,73.083,449,Medica,Medical Assistance,,,,,Included in per diem rate,
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lp,Muc Memb;Exc Dia 1.1-2.0 Cm",,11442,CPT,Facility,Outpatient,,,,255,216.75,73.083,449,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,126.99,49.8,,percent of total billed charges,,
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lp,Muc Memb;Exc Dia 1.1-2.0 Cm",,11442,CPT,Facility,Inpatient,,,,255,216.75,73.083,449,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lp,Muc Memb;Exc Dia 1.1-2.0 Cm",,11442,CPT,Facility,Both,,,,255,216.75,73.083,449,"Multiplan, Inc.","Multiplan, Inc.",239.7,94,,percent of total billed charges,,
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lp,Muc Memb;Exc Dia 1.1-2.0 Cm",,11442,CPT,Facility,Outpatient,,,,255,216.75,73.083,449,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,229.755,90.1,,percent of total billed charges,,
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lp,Muc Memb;Exc Dia 1.1-2.0 Cm",,11442,CPT,Facility,Inpatient,,,,255,216.75,73.083,449,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lp,Muc Memb;Exc Dia 1.1-2.0 Cm",,11442,CPT,Facility,Both,,,,255,216.75,73.083,449,"Preferred One Administrative Services, INC.",PPO,251.43,98.6,,percent of total billed charges,,
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lp,Muc Memb;Exc Dia 1.1-2.0 Cm",,11442,CPT,Facility,Outpatient,,,,255,216.75,73.083,449,PrimeWest Health,Minnesota Senior Health Options (MSHO),131.1975,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lp,Muc Memb;Exc Dia 1.1-2.0 Cm",,11442,CPT,Facility,Inpatient,,,,255,216.75,73.083,449,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lp,Muc Memb;Exc Dia 1.1-2.0 Cm",,11442,CPT,Facility,Outpatient,,,,255,216.75,73.083,449,PrimeWest Health,MinnesotaCare,130.968,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lp,Muc Memb;Exc Dia 1.1-2.0 Cm",,11442,CPT,Facility,Inpatient,,,,255,216.75,73.083,449,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lp,Muc Memb;Exc Dia 1.1-2.0 Cm",,11442,CPT,Facility,Both,,,,255,216.75,73.083,449,Sanford Health Plan,Sanford Health Plan,234.6,92,,percent of total billed charges,,
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lp,Muc Memb;Exc Dia 1.1-2.0 Cm",,11442,CPT,Facility,Outpatient,,,,255,216.75,73.083,449,"UCare Health, Inc.",Individual & Family Plan,143.6925,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lp,Muc Memb;Exc Dia 1.1-2.0 Cm",,11442,CPT,Facility,Inpatient,,,,255,216.75,73.083,449,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lp,Muc Memb;Exc Dia 1.1-2.0 Cm",,11442,CPT,Facility,Outpatient,,,,255,216.75,73.083,449,"UCare Health, Inc.",Medical Assistance,128.6985,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lp,Muc Memb;Exc Dia 1.1-2.0 Cm",,11442,CPT,Facility,Inpatient,,,,255,216.75,73.083,449,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lp,Muc Memb;Exc Dia 1.1-2.0 Cm",,11442,CPT,Facility,Outpatient,,,,255,216.75,73.083,449,"UCare Health, Inc.",Medicare Advantage,128.6985,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lp,Muc Memb;Exc Dia 1.1-2.0 Cm",,11442,CPT,Facility,Inpatient,,,,255,216.75,73.083,449,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lp,Muc Memb;Exc Dia 1.1-2.0 Cm",,11442,CPT,Facility,Outpatient,,,,255,216.75,73.083,449,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),128.6985,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lp,Muc Memb;Exc Dia 1.1-2.0 Cm",,11442,CPT,Facility,Inpatient,,,,255,216.75,73.083,449,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lp,Muc Memb;Exc Dia 1.1-2.0 Cm",,11442,CPT,Facility,Both,,,,255,216.75,73.083,449,UnitedHealthcare,Individual & Family,239.7,94,,percent of total billed charges,,
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lp,Muc Memb;Exc Dia 1.1-2.0 Cm",,11442,CPT,Facility,Outpatient,,,,255,216.75,73.083,449,UnitedHealthcare,Medicare Advantage,124.95,49,,percent of total billed charges,,
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lp,Muc Memb;Exc Dia 1.1-2.0 Cm",,11442,CPT,Facility,Inpatient,,,,255,216.75,73.083,449,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lp,Muc Memb;Exc Dia 1.1-2.0 Cm",,11442,CPT,Facility,Outpatient,,,,255,216.75,73.083,449,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,122.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lp,Muc Memb;Exc Dia 1.1-2.0 Cm",,11442,CPT,Facility,Inpatient,,,,255,216.75,73.083,449,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lp,Muc Memb;Exc Dia 1.1-2.0 Cm (Pro Cah)",,11442,CPT,Professional,Both,,,,435,369.75,93.15,435,Aetna,Commercial,369.75,85,,percent of total billed charges,,
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lp,Muc Memb;Exc Dia 1.1-2.0 Cm (Pro Cah)",,11442,CPT,Professional,Both,,,,435,369.75,93.15,435,Aetna,Commercial,369.75,85,,percent of total billed charges,,
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lp,Muc Memb;Exc Dia 1.1-2.0 Cm (Pro Cah)",,11442,CPT,Professional,Both,,,,435,369.75,93.15,435,Aetna,Medicare Advantage,143.06,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lp,Muc Memb;Exc Dia 1.1-2.0 Cm (Pro Cah)",,11442,CPT,Professional,Both,,,,435,369.75,93.15,435,Aetna,Medicare Advantage,143.06,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lp,Muc Memb;Exc Dia 1.1-2.0 Cm (Pro Cah)",,11442,CPT,Professional,Both,,,,435,369.75,93.15,435,Aetna,PPO,404.55,93,,percent of total billed charges,,
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lp,Muc Memb;Exc Dia 1.1-2.0 Cm (Pro Cah)",,11442,CPT,Professional,Both,,,,435,369.75,93.15,435,Aetna,PPO,404.55,93,,percent of total billed charges,,
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lp,Muc Memb;Exc Dia 1.1-2.0 Cm (Pro Cah)",,11442,CPT,Professional,Both,,,,435,369.75,93.15,435,America's PPO,America's PPO,371.664,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lp,Muc Memb;Exc Dia 1.1-2.0 Cm (Pro Cah)",,11442,CPT,Professional,Both,,,,435,369.75,93.15,435,America's PPO,America's PPO,371.664,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lp,Muc Memb;Exc Dia 1.1-2.0 Cm (Pro Cah)",,11442,CPT,Professional,Both,,,,435,369.75,93.15,435,BlueCross BlueShield Minnesota, Federal Employee Program,301.61,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lp,Muc Memb;Exc Dia 1.1-2.0 Cm (Pro Cah)",,11442,CPT,Professional,Both,,,,435,369.75,93.15,435,BlueCross BlueShield Minnesota, Federal Employee Program,301.61,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lp,Muc Memb;Exc Dia 1.1-2.0 Cm (Pro Cah)",,11442,CPT,Professional,Both,,,,435,369.75,93.15,435,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,306.43576,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lp,Muc Memb;Exc Dia 1.1-2.0 Cm (Pro Cah)",,11442,CPT,Professional,Both,,,,435,369.75,93.15,435,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,306.43576,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lp,Muc Memb;Exc Dia 1.1-2.0 Cm (Pro Cah)",,11442,CPT,Professional,Both,,,,435,369.75,93.15,435,BlueCross BlueShield Minnesota,High Value Network Plan,306.43576,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lp,Muc Memb;Exc Dia 1.1-2.0 Cm (Pro Cah)",,11442,CPT,Professional,Both,,,,435,369.75,93.15,435,BlueCross BlueShield Minnesota,High Value Network Plan,306.43576,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lp,Muc Memb;Exc Dia 1.1-2.0 Cm (Pro Cah)",,11442,CPT,Professional,Both,,,,435,369.75,93.15,435,BlueCross BlueShield Minnesota,Medicare Advantage,166.4165,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lp,Muc Memb;Exc Dia 1.1-2.0 Cm (Pro Cah)",,11442,CPT,Professional,Both,,,,435,369.75,93.15,435,BlueCross BlueShield Minnesota,Medicare Advantage,166.4165,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lp,Muc Memb;Exc Dia 1.1-2.0 Cm (Pro Cah)",,11442,CPT,Professional,Both,,,,435,369.75,93.15,435,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,306.43576,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lp,Muc Memb;Exc Dia 1.1-2.0 Cm (Pro Cah)",,11442,CPT,Professional,Both,,,,435,369.75,93.15,435,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,306.43576,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lp,Muc Memb;Exc Dia 1.1-2.0 Cm (Pro Cah)",,11442,CPT,Professional,Both,,,,435,369.75,93.15,435,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,107.5436,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lp,Muc Memb;Exc Dia 1.1-2.0 Cm (Pro Cah)",,11442,CPT,Professional,Both,,,,435,369.75,93.15,435,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,107.5436,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lp,Muc Memb;Exc Dia 1.1-2.0 Cm (Pro Cah)",,11442,CPT,Professional,Both,,,,435,369.75,93.15,435,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),166.4165,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lp,Muc Memb;Exc Dia 1.1-2.0 Cm (Pro Cah)",,11442,CPT,Professional,Both,,,,435,369.75,93.15,435,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),166.4165,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lp,Muc Memb;Exc Dia 1.1-2.0 Cm (Pro Cah)",,11442,CPT,Professional,Both,,,,435,369.75,93.15,435,CorVel,Worker's Compensation,279.7200612,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lp,Muc Memb;Exc Dia 1.1-2.0 Cm (Pro Cah)",,11442,CPT,Professional,Both,,,,435,369.75,93.15,435,CorVel,Worker's Compensation,279.7200612,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lp,Muc Memb;Exc Dia 1.1-2.0 Cm (Pro Cah)",,11442,CPT,Professional,Both,,,,435,369.75,93.15,435,First Health Group Corporation,First Health Network,421.95,97,,percent of total billed charges,,
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lp,Muc Memb;Exc Dia 1.1-2.0 Cm (Pro Cah)",,11442,CPT,Professional,Both,,,,435,369.75,93.15,435,First Health Group Corporation,First Health Network,421.95,97,,percent of total billed charges,,
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lp,Muc Memb;Exc Dia 1.1-2.0 Cm (Pro Cah)",,11442,CPT,Professional,Both,,,,435,369.75,93.15,435,"Health Partners, Inc.",Commercial,301.82,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lp,Muc Memb;Exc Dia 1.1-2.0 Cm (Pro Cah)",,11442,CPT,Professional,Both,,,,435,369.75,93.15,435,"Health Partners, Inc.",Commercial,301.82,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lp,Muc Memb;Exc Dia 1.1-2.0 Cm (Pro Cah)",,11442,CPT,Professional,Both,,,,435,369.75,93.15,435,"Health Partners, Inc.",Medicare Advantage,166.4165,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lp,Muc Memb;Exc Dia 1.1-2.0 Cm (Pro Cah)",,11442,CPT,Professional,Both,,,,435,369.75,93.15,435,"Health Partners, Inc.",Medicare Advantage,166.4165,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lp,Muc Memb;Exc Dia 1.1-2.0 Cm (Pro Cah)",,11442,CPT,Professional,Both,,,,435,369.75,93.15,435,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),144.7,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lp,Muc Memb;Exc Dia 1.1-2.0 Cm (Pro Cah)",,11442,CPT,Professional,Both,,,,435,369.75,93.15,435,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),144.7,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lp,Muc Memb;Exc Dia 1.1-2.0 Cm (Pro Cah)",,11442,CPT,Professional,Both,,,,435,369.75,93.15,435,"Health Partners, Inc.",State of Minnesota Advantage Program,260.01793,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lp,Muc Memb;Exc Dia 1.1-2.0 Cm (Pro Cah)",,11442,CPT,Professional,Both,,,,435,369.75,93.15,435,"Health Partners, Inc.",State of Minnesota Advantage Program,260.01793,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lp,Muc Memb;Exc Dia 1.1-2.0 Cm (Pro Cah)",,11442,CPT,Professional,Both,,,,435,369.75,93.15,435,"Health Partners, Inc.",State Public Programs,93.15,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lp,Muc Memb;Exc Dia 1.1-2.0 Cm (Pro Cah)",,11442,CPT,Professional,Both,,,,435,369.75,93.15,435,"Health Partners, Inc.",State Public Programs,93.15,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lp,Muc Memb;Exc Dia 1.1-2.0 Cm (Pro Cah)",,11442,CPT,Professional,Both,,,,435,369.75,93.15,435,Humana Insurance Company,Commercial PPO,144.71,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lp,Muc Memb;Exc Dia 1.1-2.0 Cm (Pro Cah)",,11442,CPT,Professional,Both,,,,435,369.75,93.15,435,Humana Insurance Company,Commercial PPO,144.71,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lp,Muc Memb;Exc Dia 1.1-2.0 Cm (Pro Cah)",,11442,CPT,Professional,Both,,,,435,369.75,93.15,435,Humana Insurance Company,Medicare PPO,435,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lp,Muc Memb;Exc Dia 1.1-2.0 Cm (Pro Cah)",,11442,CPT,Professional,Both,,,,435,369.75,93.15,435,Humana Insurance Company,Medicare PPO,435,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lp,Muc Memb;Exc Dia 1.1-2.0 Cm (Pro Cah)",,11442,CPT,Professional,Both,,,,435,369.75,93.15,435,Medica,Individual & Family,368.88,84.8,,percent of total billed charges,,
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lp,Muc Memb;Exc Dia 1.1-2.0 Cm (Pro Cah)",,11442,CPT,Professional,Both,,,,435,369.75,93.15,435,Medica,Individual & Family,368.88,84.8,,percent of total billed charges,,
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lp,Muc Memb;Exc Dia 1.1-2.0 Cm (Pro Cah)",,11442,CPT,Professional,Both,,,,435,369.75,93.15,435,Medica,Medica Advantage Solution,216.63,49.8,,percent of total billed charges,,
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lp,Muc Memb;Exc Dia 1.1-2.0 Cm (Pro Cah)",,11442,CPT,Professional,Both,,,,435,369.75,93.15,435,Medica,Medica Advantage Solution,216.63,49.8,,percent of total billed charges,,
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lp,Muc Memb;Exc Dia 1.1-2.0 Cm (Pro Cah)",,11442,CPT,Professional,Both,,,,435,369.75,93.15,435,Medica,Medical Assistance,107.54,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lp,Muc Memb;Exc Dia 1.1-2.0 Cm (Pro Cah)",,11442,CPT,Professional,Both,,,,435,369.75,93.15,435,Medica,Medical Assistance,107.54,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lp,Muc Memb;Exc Dia 1.1-2.0 Cm (Pro Cah)",,11442,CPT,Professional,Both,,,,435,369.75,93.15,435,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,144.71,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lp,Muc Memb;Exc Dia 1.1-2.0 Cm (Pro Cah)",,11442,CPT,Professional,Both,,,,435,369.75,93.15,435,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,144.71,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lp,Muc Memb;Exc Dia 1.1-2.0 Cm (Pro Cah)",,11442,CPT,Professional,Both,,,,435,369.75,93.15,435,"Multiplan, Inc.","Multiplan, Inc.",408.9,94,,percent of total billed charges,,
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lp,Muc Memb;Exc Dia 1.1-2.0 Cm (Pro Cah)",,11442,CPT,Professional,Both,,,,435,369.75,93.15,435,"Multiplan, Inc.","Multiplan, Inc.",408.9,94,,percent of total billed charges,,
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lp,Muc Memb;Exc Dia 1.1-2.0 Cm (Pro Cah)",,11442,CPT,Professional,Both,,,,435,369.75,93.15,435,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,391.935,90.1,,percent of total billed charges,,
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lp,Muc Memb;Exc Dia 1.1-2.0 Cm (Pro Cah)",,11442,CPT,Professional,Both,,,,435,369.75,93.15,435,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,391.935,90.1,,percent of total billed charges,,
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lp,Muc Memb;Exc Dia 1.1-2.0 Cm (Pro Cah)",,11442,CPT,Professional,Both,,,,435,369.75,93.15,435,"Preferred One Administrative Services, INC.",PPO,428.91,98.6,,percent of total billed charges,,
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lp,Muc Memb;Exc Dia 1.1-2.0 Cm (Pro Cah)",,11442,CPT,Professional,Both,,,,435,369.75,93.15,435,"Preferred One Administrative Services, INC.",PPO,428.91,98.6,,percent of total billed charges,,
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lp,Muc Memb;Exc Dia 1.1-2.0 Cm (Pro Cah)",,11442,CPT,Professional,Both,,,,435,369.75,93.15,435,PrimeWest Health,Minnesota Senior Health Options (MSHO),166.4165,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lp,Muc Memb;Exc Dia 1.1-2.0 Cm (Pro Cah)",,11442,CPT,Professional,Both,,,,435,369.75,93.15,435,PrimeWest Health,Minnesota Senior Health Options (MSHO),166.4165,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lp,Muc Memb;Exc Dia 1.1-2.0 Cm (Pro Cah)",,11442,CPT,Professional,Both,,,,435,369.75,93.15,435,PrimeWest Health,MinnesotaCare,115.071652,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lp,Muc Memb;Exc Dia 1.1-2.0 Cm (Pro Cah)",,11442,CPT,Professional,Both,,,,435,369.75,93.15,435,PrimeWest Health,MinnesotaCare,115.071652,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lp,Muc Memb;Exc Dia 1.1-2.0 Cm (Pro Cah)",,11442,CPT,Professional,Both,,,,435,369.75,93.15,435,Sanford Health Plan,Sanford Health Plan,382.8,88,,percent of total billed charges,,
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lp,Muc Memb;Exc Dia 1.1-2.0 Cm (Pro Cah)",,11442,CPT,Professional,Both,,,,435,369.75,93.15,435,Sanford Health Plan,Sanford Health Plan,382.8,88,,percent of total billed charges,,
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lp,Muc Memb;Exc Dia 1.1-2.0 Cm (Pro Cah)",,11442,CPT,Professional,Both,,,,435,369.75,93.15,435,"UCare Health, Inc.",Individual & Family Plan,235.240576,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lp,Muc Memb;Exc Dia 1.1-2.0 Cm (Pro Cah)",,11442,CPT,Professional,Both,,,,435,369.75,93.15,435,"UCare Health, Inc.",Individual & Family Plan,235.240576,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lp,Muc Memb;Exc Dia 1.1-2.0 Cm (Pro Cah)",,11442,CPT,Professional,Both,,,,435,369.75,93.15,435,"UCare Health, Inc.",Medical Assistance,118.29796,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lp,Muc Memb;Exc Dia 1.1-2.0 Cm (Pro Cah)",,11442,CPT,Professional,Both,,,,435,369.75,93.15,435,"UCare Health, Inc.",Medical Assistance,118.29796,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lp,Muc Memb;Exc Dia 1.1-2.0 Cm (Pro Cah)",,11442,CPT,Professional,Both,,,,435,369.75,93.15,435,"UCare Health, Inc.",Medicare Advantage,166.4165,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lp,Muc Memb;Exc Dia 1.1-2.0 Cm (Pro Cah)",,11442,CPT,Professional,Both,,,,435,369.75,93.15,435,"UCare Health, Inc.",Medicare Advantage,166.4165,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lp,Muc Memb;Exc Dia 1.1-2.0 Cm (Pro Cah)",,11442,CPT,Professional,Both,,,,435,369.75,93.15,435,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),133.1332,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lp,Muc Memb;Exc Dia 1.1-2.0 Cm (Pro Cah)",,11442,CPT,Professional,Both,,,,435,369.75,93.15,435,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),133.1332,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lp,Muc Memb;Exc Dia 1.1-2.0 Cm (Pro Cah)",,11442,CPT,Professional,Both,,,,435,369.75,93.15,435,UnitedHealthcare,Individual & Family,435,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lp,Muc Memb;Exc Dia 1.1-2.0 Cm (Pro Cah)",,11442,CPT,Professional,Both,,,,435,369.75,93.15,435,UnitedHealthcare,Individual & Family,435,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lp,Muc Memb;Exc Dia 1.1-2.0 Cm (Pro Cah)",,11442,CPT,Professional,Both,,,,435,369.75,93.15,435,UnitedHealthcare,Medicare Advantage,166.4165,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lp,Muc Memb;Exc Dia 1.1-2.0 Cm (Pro Cah)",,11442,CPT,Professional,Both,,,,435,369.75,93.15,435,UnitedHealthcare,Medicare Advantage,166.4165,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lp,Muc Memb;Exc Dia 1.1-2.0 Cm (Pro Cah)",,11442,CPT,Professional,Both,,,,435,369.75,93.15,435,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,107.5436,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision,Benign Lesion Inc Margin,Except Sktg,Fc,Er,Elid,Ns,Lp,Muc Memb;Exc Dia 1.1-2.0 Cm (Pro Cah)",,11442,CPT,Professional,Both,,,,435,369.75,93.15,435,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,107.5436,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Excise Face-Mm B9 Marg 2.1-3 Cm (Pbb),,11443,CPT,Facility,Outpatient,,,,210,178.5,60.186,210,Aetna,Commercial,193.2,92,,percent of total billed charges,,
Excise Face-Mm B9 Marg 2.1-3 Cm (Pbb),,11443,CPT,Professional,Outpatient,,,,350,297.5,112.78,350,Aetna,Commercial,297.5,85,,percent of total billed charges,,
Excise Face-Mm B9 Marg 2.1-3 Cm (Pbb),,11443,CPT,Facility,Outpatient,,,,210,178.5,60.186,210,Aetna,Medicare Advantage,102.9,49,,percent of total billed charges,,
Excise Face-Mm B9 Marg 2.1-3 Cm (Pbb),,11443,CPT,Professional,Outpatient,,,,350,297.5,112.78,350,Aetna,Medicare Advantage,174.67,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Excise Face-Mm B9 Marg 2.1-3 Cm (Pbb),,11443,CPT,Facility,Outpatient,,,,210,178.5,60.186,210,Aetna,PPO,195.3,93,,percent of total billed charges,,
Excise Face-Mm B9 Marg 2.1-3 Cm (Pbb),,11443,CPT,Professional,Outpatient,,,,350,297.5,112.78,350,Aetna,PPO,325.5,93,,percent of total billed charges,,
Excise Face-Mm B9 Marg 2.1-3 Cm (Pbb),,11443,CPT,Facility,Outpatient,,,,210,178.5,60.186,210,America's PPO,America's PPO,201.663,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Excise Face-Mm B9 Marg 2.1-3 Cm (Pbb),,11443,CPT,Professional,Outpatient,,,,350,297.5,112.78,350,America's PPO,America's PPO,299.04,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Excise Face-Mm B9 Marg 2.1-3 Cm (Pbb),,11443,CPT,Facility,Outpatient,,,,210,178.5,60.186,210,BlueCross BlueShield Minnesota, Federal Employee Program,206.64,98.4,,percent of total billed charges,,
Excise Face-Mm B9 Marg 2.1-3 Cm (Pbb),,11443,CPT,Professional,Outpatient,,,,350,297.5,112.78,350,BlueCross BlueShield Minnesota, Federal Employee Program,350,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Excise Face-Mm B9 Marg 2.1-3 Cm (Pbb),,11443,CPT,Facility,Outpatient,,,,210,178.5,60.186,210,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,210,100,,percent of total billed charges,,
Excise Face-Mm B9 Marg 2.1-3 Cm (Pbb),,11443,CPT,Professional,Outpatient,,,,350,297.5,112.78,350,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,350,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Excise Face-Mm B9 Marg 2.1-3 Cm (Pbb),,11443,CPT,Facility,Outpatient,,,,210,178.5,60.186,210,BlueCross BlueShield Minnesota,High Value Network Plan,189,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
Excise Face-Mm B9 Marg 2.1-3 Cm (Pbb),,11443,CPT,Professional,Outpatient,,,,350,297.5,112.78,350,BlueCross BlueShield Minnesota,High Value Network Plan,350,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Excise Face-Mm B9 Marg 2.1-3 Cm (Pbb),,11443,CPT,Facility,Outpatient,,,,210,178.5,60.186,210,BlueCross BlueShield Minnesota,Medicare Advantage,102.9,49,,percent of total billed charges,,
Excise Face-Mm B9 Marg 2.1-3 Cm (Pbb),,11443,CPT,Professional,Outpatient,,,,350,297.5,112.78,350,BlueCross BlueShield Minnesota,Medicare Advantage,201.549,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Excise Face-Mm B9 Marg 2.1-3 Cm (Pbb),,11443,CPT,Professional,Outpatient,,,,350,297.5,112.78,350,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,350,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Excise Face-Mm B9 Marg 2.1-3 Cm (Pbb),,11443,CPT,Facility,Outpatient,,,,210,178.5,60.186,210,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,60.186,28.66,,percent of total billed charges,,
Excise Face-Mm B9 Marg 2.1-3 Cm (Pbb),,11443,CPT,Professional,Outpatient,,,,350,297.5,112.78,350,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,130.21056,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Excise Face-Mm B9 Marg 2.1-3 Cm (Pbb),,11443,CPT,Facility,Outpatient,,,,210,178.5,60.186,210,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),102.9,49,,percent of total billed charges,,
Excise Face-Mm B9 Marg 2.1-3 Cm (Pbb),,11443,CPT,Professional,Outpatient,,,,350,297.5,112.78,350,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),201.549,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Excise Face-Mm B9 Marg 2.1-3 Cm (Pbb),,11443,CPT,Facility,Outpatient,,,,210,178.5,60.186,210,CorVel,Worker's Compensation,210,100,,percent of total billed charges,,
Excise Face-Mm B9 Marg 2.1-3 Cm (Pbb),,11443,CPT,Professional,Outpatient,,,,350,297.5,112.78,350,CorVel,Worker's Compensation,340.316805,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Excise Face-Mm B9 Marg 2.1-3 Cm (Pbb),,11443,CPT,Facility,Outpatient,,,,210,178.5,60.186,210,First Health Group Corporation,First Health Network,203.7,97,,percent of total billed charges,,
Excise Face-Mm B9 Marg 2.1-3 Cm (Pbb),,11443,CPT,Professional,Outpatient,,,,350,297.5,112.78,350,First Health Group Corporation,First Health Network,339.5,97,,percent of total billed charges,,
Excise Face-Mm B9 Marg 2.1-3 Cm (Pbb),,11443,CPT,Facility,Outpatient,,,,210,178.5,60.186,210,"Health Partners, Inc.",Commercial,198.66,94.6,,percent of total billed charges,,
Excise Face-Mm B9 Marg 2.1-3 Cm (Pbb),,11443,CPT,Professional,Outpatient,,,,350,297.5,112.78,350,"Health Partners, Inc.",Commercial,350,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Excise Face-Mm B9 Marg 2.1-3 Cm (Pbb),,11443,CPT,Facility,Outpatient,,,,210,178.5,60.186,210,"Health Partners, Inc.",Medicare Advantage,102.9,49,,percent of total billed charges,,
Excise Face-Mm B9 Marg 2.1-3 Cm (Pbb),,11443,CPT,Professional,Outpatient,,,,350,297.5,112.78,350,"Health Partners, Inc.",Medicare Advantage,201.549,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Excise Face-Mm B9 Marg 2.1-3 Cm (Pbb),,11443,CPT,Facility,Outpatient,,,,210,178.5,60.186,210,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),126,60,,percent of total billed charges,,
Excise Face-Mm B9 Marg 2.1-3 Cm (Pbb),,11443,CPT,Professional,Outpatient,,,,350,297.5,112.78,350,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),175.2,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Excise Face-Mm B9 Marg 2.1-3 Cm (Pbb),,11443,CPT,Facility,Outpatient,,,,210,178.5,60.186,210,"Health Partners, Inc.",State of Minnesota Advantage Program,171.15,81.5,,percent of total billed charges,,
Excise Face-Mm B9 Marg 2.1-3 Cm (Pbb),,11443,CPT,Professional,Outpatient,,,,350,297.5,112.78,350,"Health Partners, Inc.",State of Minnesota Advantage Program,316.265265,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Excise Face-Mm B9 Marg 2.1-3 Cm (Pbb),,11443,CPT,Facility,Outpatient,,,,210,178.5,60.186,210,"Health Partners, Inc.",State Public Programs,105,50,,percent of total billed charges,,
Excise Face-Mm B9 Marg 2.1-3 Cm (Pbb),,11443,CPT,Professional,Outpatient,,,,350,297.5,112.78,350,"Health Partners, Inc.",State Public Programs,112.78,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Excise Face-Mm B9 Marg 2.1-3 Cm (Pbb),,11443,CPT,Facility,Outpatient,,,,210,178.5,60.186,210,Humana Insurance Company,Commercial PPO,199.5,95,,percent of total billed charges,,
Excise Face-Mm B9 Marg 2.1-3 Cm (Pbb),,11443,CPT,Professional,Outpatient,,,,350,297.5,112.78,350,Humana Insurance Company,Commercial PPO,175.26,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Excise Face-Mm B9 Marg 2.1-3 Cm (Pbb),,11443,CPT,Facility,Outpatient,,,,210,178.5,60.186,210,Humana Insurance Company,Medicare PPO,102.9,49,,percent of total billed charges,,
Excise Face-Mm B9 Marg 2.1-3 Cm (Pbb),,11443,CPT,Professional,Outpatient,,,,350,297.5,112.78,350,Humana Insurance Company,Medicare PPO,350,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Excise Face-Mm B9 Marg 2.1-3 Cm (Pbb),,11443,CPT,Facility,Outpatient,,,,210,178.5,60.186,210,Medica,Individual & Family,208.11,99.1,,percent of total billed charges,,
Excise Face-Mm B9 Marg 2.1-3 Cm (Pbb),,11443,CPT,Professional,Outpatient,,,,350,297.5,112.78,350,Medica,Individual & Family,296.8,84.8,,percent of total billed charges,,
Excise Face-Mm B9 Marg 2.1-3 Cm (Pbb),,11443,CPT,Facility,Outpatient,,,,210,178.5,60.186,210,Medica,Medica Advantage Solution,104.58,49.8,,percent of total billed charges,,
Excise Face-Mm B9 Marg 2.1-3 Cm (Pbb),,11443,CPT,Professional,Outpatient,,,,350,297.5,112.78,350,Medica,Medica Advantage Solution,174.3,49.8,,percent of total billed charges,,
Excise Face-Mm B9 Marg 2.1-3 Cm (Pbb),,11443,CPT,Facility,Outpatient,,,,210,178.5,60.186,210,Medica,Medical Assistance,93.66,44.6,,percent of total billed charges,,
Excise Face-Mm B9 Marg 2.1-3 Cm (Pbb),,11443,CPT,Professional,Outpatient,,,,350,297.5,112.78,350,Medica,Medical Assistance,130.21,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Excise Face-Mm B9 Marg 2.1-3 Cm (Pbb),,11443,CPT,Facility,Outpatient,,,,210,178.5,60.186,210,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,104.58,49.8,,percent of total billed charges,,
Excise Face-Mm B9 Marg 2.1-3 Cm (Pbb),,11443,CPT,Professional,Outpatient,,,,350,297.5,112.78,350,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,175.26,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Excise Face-Mm B9 Marg 2.1-3 Cm (Pbb),,11443,CPT,Facility,Outpatient,,,,210,178.5,60.186,210,"Multiplan, Inc.","Multiplan, Inc.",197.4,94,,percent of total billed charges,,
Excise Face-Mm B9 Marg 2.1-3 Cm (Pbb),,11443,CPT,Professional,Outpatient,,,,350,297.5,112.78,350,"Multiplan, Inc.","Multiplan, Inc.",329,94,,percent of total billed charges,,
Excise Face-Mm B9 Marg 2.1-3 Cm (Pbb),,11443,CPT,Facility,Outpatient,,,,210,178.5,60.186,210,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,189.21,90.1,,percent of total billed charges,,
Excise Face-Mm B9 Marg 2.1-3 Cm (Pbb),,11443,CPT,Professional,Outpatient,,,,350,297.5,112.78,350,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,315.35,90.1,,percent of total billed charges,,
Excise Face-Mm B9 Marg 2.1-3 Cm (Pbb),,11443,CPT,Facility,Outpatient,,,,210,178.5,60.186,210,"Preferred One Administrative Services, INC.",PPO,207.06,98.6,,percent of total billed charges,,
Excise Face-Mm B9 Marg 2.1-3 Cm (Pbb),,11443,CPT,Professional,Outpatient,,,,350,297.5,112.78,350,"Preferred One Administrative Services, INC.",PPO,345.1,98.6,,percent of total billed charges,,
Excise Face-Mm B9 Marg 2.1-3 Cm (Pbb),,11443,CPT,Facility,Outpatient,,,,210,178.5,60.186,210,PrimeWest Health,Minnesota Senior Health Options (MSHO),108.045,51.45,,percent of total billed charges,,
Excise Face-Mm B9 Marg 2.1-3 Cm (Pbb),,11443,CPT,Professional,Outpatient,,,,350,297.5,112.78,350,PrimeWest Health,Minnesota Senior Health Options (MSHO),201.549,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Excise Face-Mm B9 Marg 2.1-3 Cm (Pbb),,11443,CPT,Facility,Outpatient,,,,210,178.5,60.186,210,PrimeWest Health,MinnesotaCare,107.856,51.36,,percent of total billed charges,,
Excise Face-Mm B9 Marg 2.1-3 Cm (Pbb),,11443,CPT,Professional,Outpatient,,,,350,297.5,112.78,350,PrimeWest Health,MinnesotaCare,139.3252992,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Excise Face-Mm B9 Marg 2.1-3 Cm (Pbb),,11443,CPT,Facility,Outpatient,,,,210,178.5,60.186,210,Sanford Health Plan,Sanford Health Plan,193.2,92,,percent of total billed charges,,
Excise Face-Mm B9 Marg 2.1-3 Cm (Pbb),,11443,CPT,Professional,Outpatient,,,,350,297.5,112.78,350,Sanford Health Plan,Sanford Health Plan,308,88,,percent of total billed charges,,
Excise Face-Mm B9 Marg 2.1-3 Cm (Pbb),,11443,CPT,Facility,Outpatient,,,,210,178.5,60.186,210,"UCare Health, Inc.",Individual & Family Plan,118.335,56.35,,percent of total billed charges,,
Excise Face-Mm B9 Marg 2.1-3 Cm (Pbb),,11443,CPT,Professional,Outpatient,,,,350,297.5,112.78,350,"UCare Health, Inc.",Individual & Family Plan,284.902656,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Excise Face-Mm B9 Marg 2.1-3 Cm (Pbb),,11443,CPT,Facility,Outpatient,,,,210,178.5,60.186,210,"UCare Health, Inc.",Medical Assistance,105.987,50.47,,percent of total billed charges,,
Excise Face-Mm B9 Marg 2.1-3 Cm (Pbb),,11443,CPT,Professional,Outpatient,,,,350,297.5,112.78,350,"UCare Health, Inc.",Medical Assistance,143.231616,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Excise Face-Mm B9 Marg 2.1-3 Cm (Pbb),,11443,CPT,Facility,Outpatient,,,,210,178.5,60.186,210,"UCare Health, Inc.",Medicare Advantage,105.987,50.47,,percent of total billed charges,,
Excise Face-Mm B9 Marg 2.1-3 Cm (Pbb),,11443,CPT,Professional,Outpatient,,,,350,297.5,112.78,350,"UCare Health, Inc.",Medicare Advantage,201.549,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Excise Face-Mm B9 Marg 2.1-3 Cm (Pbb),,11443,CPT,Facility,Outpatient,,,,210,178.5,60.186,210,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),105.987,50.47,,percent of total billed charges,,
Excise Face-Mm B9 Marg 2.1-3 Cm (Pbb),,11443,CPT,Professional,Outpatient,,,,350,297.5,112.78,350,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),161.2392,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Excise Face-Mm B9 Marg 2.1-3 Cm (Pbb),,11443,CPT,Facility,Outpatient,,,,210,178.5,60.186,210,UnitedHealthcare,Individual & Family,197.4,94,,percent of total billed charges,,
Excise Face-Mm B9 Marg 2.1-3 Cm (Pbb),,11443,CPT,Professional,Outpatient,,,,350,297.5,112.78,350,UnitedHealthcare,Individual & Family,350,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Excise Face-Mm B9 Marg 2.1-3 Cm (Pbb),,11443,CPT,Facility,Outpatient,,,,210,178.5,60.186,210,UnitedHealthcare,Medicare Advantage,102.9,49,,percent of total billed charges,,
Excise Face-Mm B9 Marg 2.1-3 Cm (Pbb),,11443,CPT,Professional,Outpatient,,,,350,297.5,112.78,350,UnitedHealthcare,Medicare Advantage,201.549,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Excise Face-Mm B9 Marg 2.1-3 Cm (Pbb),,11443,CPT,Facility,Outpatient,,,,210,178.5,60.186,210,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,100.8,48,,percent of total billed charges,,100% of DHS outpatient percentage
Excise Face-Mm B9 Marg 2.1-3 Cm (Pbb),,11443,CPT,Professional,Outpatient,,,,350,297.5,112.78,350,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,130.21056,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision,Benign Lesion Face, Ears, Eyelids, Nose, Lips 2.1-3 Cm",,11443,CPT,Facility,Both,,,,330,280.5,94.578,449,Aetna,Commercial,303.6,92,,percent of total billed charges,,
"Excision,Benign Lesion Face, Ears, Eyelids, Nose, Lips 2.1-3 Cm",,11443,CPT,Facility,Outpatient,,,,330,280.5,94.578,449,Aetna,Medicare Advantage,161.7,49,,percent of total billed charges,,
"Excision,Benign Lesion Face, Ears, Eyelids, Nose, Lips 2.1-3 Cm",,11443,CPT,Facility,Inpatient,,,,330,280.5,94.578,449,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Excision,Benign Lesion Face, Ears, Eyelids, Nose, Lips 2.1-3 Cm",,11443,CPT,Facility,Both,,,,330,280.5,94.578,449,Aetna,PPO,306.9,93,,percent of total billed charges,,
"Excision,Benign Lesion Face, Ears, Eyelids, Nose, Lips 2.1-3 Cm",,11443,CPT,Facility,Both,,,,330,280.5,94.578,449,America's PPO,America's PPO,316.899,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Excision,Benign Lesion Face, Ears, Eyelids, Nose, Lips 2.1-3 Cm",,11443,CPT,Facility,Both,,,,330,280.5,94.578,449,BlueCross BlueShield Minnesota, Federal Employee Program,324.72,98.4,,percent of total billed charges,,
"Excision,Benign Lesion Face, Ears, Eyelids, Nose, Lips 2.1-3 Cm",,11443,CPT,Facility,Both,,,,330,280.5,94.578,449,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,330,100,,percent of total billed charges,,
"Excision,Benign Lesion Face, Ears, Eyelids, Nose, Lips 2.1-3 Cm",,11443,CPT,Facility,Both,,,,330,280.5,94.578,449,BlueCross BlueShield Minnesota,High Value Network Plan,297,90,,percent of total billed charges,,
"Excision,Benign Lesion Face, Ears, Eyelids, Nose, Lips 2.1-3 Cm",,11443,CPT,Facility,Outpatient,,,,330,280.5,94.578,449,BlueCross BlueShield Minnesota,Medicare Advantage,161.7,49,,percent of total billed charges,,
"Excision,Benign Lesion Face, Ears, Eyelids, Nose, Lips 2.1-3 Cm",,11443,CPT,Facility,Inpatient,,,,330,280.5,94.578,449,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Excision,Benign Lesion Face, Ears, Eyelids, Nose, Lips 2.1-3 Cm",,11443,CPT,Facility,Both,,,,330,280.5,94.578,449,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,292.281,88.57,,percent of total billed charges,,
"Excision,Benign Lesion Face, Ears, Eyelids, Nose, Lips 2.1-3 Cm",,11443,CPT,Facility,Both,,,,330,280.5,94.578,449,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,94.578,28.66,,percent of total billed charges,,
"Excision,Benign Lesion Face, Ears, Eyelids, Nose, Lips 2.1-3 Cm",,11443,CPT,Facility,Outpatient,,,,330,280.5,94.578,449,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),161.7,49,,percent of total billed charges,,
"Excision,Benign Lesion Face, Ears, Eyelids, Nose, Lips 2.1-3 Cm",,11443,CPT,Facility,Inpatient,,,,330,280.5,94.578,449,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Excision,Benign Lesion Face, Ears, Eyelids, Nose, Lips 2.1-3 Cm",,11443,CPT,Facility,Both,,,,330,280.5,94.578,449,CorVel,Worker's Compensation,330,100,,percent of total billed charges,,
"Excision,Benign Lesion Face, Ears, Eyelids, Nose, Lips 2.1-3 Cm",,11443,CPT,Facility,Both,,,,330,280.5,94.578,449,First Health Group Corporation,First Health Network,320.1,97,,percent of total billed charges,,
"Excision,Benign Lesion Face, Ears, Eyelids, Nose, Lips 2.1-3 Cm",,11443,CPT,Facility,Both,,,,330,280.5,94.578,449,"Health Partners, Inc.",Commercial,312.18,94.6,,percent of total billed charges,,
"Excision,Benign Lesion Face, Ears, Eyelids, Nose, Lips 2.1-3 Cm",,11443,CPT,Facility,Outpatient,,,,330,280.5,94.578,449,"Health Partners, Inc.",Medicare Advantage,161.7,49,,percent of total billed charges,,
"Excision,Benign Lesion Face, Ears, Eyelids, Nose, Lips 2.1-3 Cm",,11443,CPT,Facility,Inpatient,,,,330,280.5,94.578,449,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Excision,Benign Lesion Face, Ears, Eyelids, Nose, Lips 2.1-3 Cm",,11443,CPT,Facility,Both,,,,330,280.5,94.578,449,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),198,60,,percent of total billed charges,,
"Excision,Benign Lesion Face, Ears, Eyelids, Nose, Lips 2.1-3 Cm",,11443,CPT,Facility,Both,,,,330,280.5,94.578,449,"Health Partners, Inc.",State of Minnesota Advantage Program,268.95,81.5,,percent of total billed charges,,
"Excision,Benign Lesion Face, Ears, Eyelids, Nose, Lips 2.1-3 Cm",,11443,CPT,Facility,Both,,,,330,280.5,94.578,449,"Health Partners, Inc.",State Public Programs,165,50,,percent of total billed charges,,
"Excision,Benign Lesion Face, Ears, Eyelids, Nose, Lips 2.1-3 Cm",,11443,CPT,Facility,Both,,,,330,280.5,94.578,449,Humana Insurance Company,Commercial PPO,313.5,95,,percent of total billed charges,,
"Excision,Benign Lesion Face, Ears, Eyelids, Nose, Lips 2.1-3 Cm",,11443,CPT,Facility,Outpatient,,,,330,280.5,94.578,449,Humana Insurance Company,Medicare PPO,161.7,49,,percent of total billed charges,,
"Excision,Benign Lesion Face, Ears, Eyelids, Nose, Lips 2.1-3 Cm",,11443,CPT,Facility,Inpatient,,,,330,280.5,94.578,449,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Excision,Benign Lesion Face, Ears, Eyelids, Nose, Lips 2.1-3 Cm",,11443,CPT,Facility,Both,,,,330,280.5,94.578,449,Medica,Individual & Family,327.03,99.1,,percent of total billed charges,,
"Excision,Benign Lesion Face, Ears, Eyelids, Nose, Lips 2.1-3 Cm",,11443,CPT,Facility,Outpatient,,,,330,280.5,94.578,449,Medica,Medica Advantage Solution,164.34,49.8,,percent of total billed charges,,
"Excision,Benign Lesion Face, Ears, Eyelids, Nose, Lips 2.1-3 Cm",,11443,CPT,Facility,Inpatient,,,,330,280.5,94.578,449,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Excision,Benign Lesion Face, Ears, Eyelids, Nose, Lips 2.1-3 Cm",,11443,CPT,Facility,Outpatient,,,,330,280.5,94.578,449,Medica,Medical Assistance,449,,,Other,Grouper,All inclusive per visit
"Excision,Benign Lesion Face, Ears, Eyelids, Nose, Lips 2.1-3 Cm",,11443,CPT,Facility,Inpatient,,,,330,280.5,94.578,449,Medica,Medical Assistance,,,,,Included in per diem rate,
"Excision,Benign Lesion Face, Ears, Eyelids, Nose, Lips 2.1-3 Cm",,11443,CPT,Facility,Outpatient,,,,330,280.5,94.578,449,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,164.34,49.8,,percent of total billed charges,,
"Excision,Benign Lesion Face, Ears, Eyelids, Nose, Lips 2.1-3 Cm",,11443,CPT,Facility,Inpatient,,,,330,280.5,94.578,449,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Excision,Benign Lesion Face, Ears, Eyelids, Nose, Lips 2.1-3 Cm",,11443,CPT,Facility,Both,,,,330,280.5,94.578,449,"Multiplan, Inc.","Multiplan, Inc.",310.2,94,,percent of total billed charges,,
"Excision,Benign Lesion Face, Ears, Eyelids, Nose, Lips 2.1-3 Cm",,11443,CPT,Facility,Outpatient,,,,330,280.5,94.578,449,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,297.33,90.1,,percent of total billed charges,,
"Excision,Benign Lesion Face, Ears, Eyelids, Nose, Lips 2.1-3 Cm",,11443,CPT,Facility,Inpatient,,,,330,280.5,94.578,449,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Excision,Benign Lesion Face, Ears, Eyelids, Nose, Lips 2.1-3 Cm",,11443,CPT,Facility,Both,,,,330,280.5,94.578,449,"Preferred One Administrative Services, INC.",PPO,325.38,98.6,,percent of total billed charges,,
"Excision,Benign Lesion Face, Ears, Eyelids, Nose, Lips 2.1-3 Cm",,11443,CPT,Facility,Outpatient,,,,330,280.5,94.578,449,PrimeWest Health,Minnesota Senior Health Options (MSHO),169.785,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Excision,Benign Lesion Face, Ears, Eyelids, Nose, Lips 2.1-3 Cm",,11443,CPT,Facility,Inpatient,,,,330,280.5,94.578,449,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Excision,Benign Lesion Face, Ears, Eyelids, Nose, Lips 2.1-3 Cm",,11443,CPT,Facility,Outpatient,,,,330,280.5,94.578,449,PrimeWest Health,MinnesotaCare,169.488,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Excision,Benign Lesion Face, Ears, Eyelids, Nose, Lips 2.1-3 Cm",,11443,CPT,Facility,Inpatient,,,,330,280.5,94.578,449,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Excision,Benign Lesion Face, Ears, Eyelids, Nose, Lips 2.1-3 Cm",,11443,CPT,Facility,Both,,,,330,280.5,94.578,449,Sanford Health Plan,Sanford Health Plan,303.6,92,,percent of total billed charges,,
"Excision,Benign Lesion Face, Ears, Eyelids, Nose, Lips 2.1-3 Cm",,11443,CPT,Facility,Outpatient,,,,330,280.5,94.578,449,"UCare Health, Inc.",Individual & Family Plan,185.955,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Excision,Benign Lesion Face, Ears, Eyelids, Nose, Lips 2.1-3 Cm",,11443,CPT,Facility,Inpatient,,,,330,280.5,94.578,449,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Excision,Benign Lesion Face, Ears, Eyelids, Nose, Lips 2.1-3 Cm",,11443,CPT,Facility,Outpatient,,,,330,280.5,94.578,449,"UCare Health, Inc.",Medical Assistance,166.551,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Excision,Benign Lesion Face, Ears, Eyelids, Nose, Lips 2.1-3 Cm",,11443,CPT,Facility,Inpatient,,,,330,280.5,94.578,449,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Excision,Benign Lesion Face, Ears, Eyelids, Nose, Lips 2.1-3 Cm",,11443,CPT,Facility,Outpatient,,,,330,280.5,94.578,449,"UCare Health, Inc.",Medicare Advantage,166.551,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Excision,Benign Lesion Face, Ears, Eyelids, Nose, Lips 2.1-3 Cm",,11443,CPT,Facility,Inpatient,,,,330,280.5,94.578,449,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Excision,Benign Lesion Face, Ears, Eyelids, Nose, Lips 2.1-3 Cm",,11443,CPT,Facility,Outpatient,,,,330,280.5,94.578,449,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),166.551,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Excision,Benign Lesion Face, Ears, Eyelids, Nose, Lips 2.1-3 Cm",,11443,CPT,Facility,Inpatient,,,,330,280.5,94.578,449,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Excision,Benign Lesion Face, Ears, Eyelids, Nose, Lips 2.1-3 Cm",,11443,CPT,Facility,Both,,,,330,280.5,94.578,449,UnitedHealthcare,Individual & Family,310.2,94,,percent of total billed charges,,
"Excision,Benign Lesion Face, Ears, Eyelids, Nose, Lips 2.1-3 Cm",,11443,CPT,Facility,Outpatient,,,,330,280.5,94.578,449,UnitedHealthcare,Medicare Advantage,161.7,49,,percent of total billed charges,,
"Excision,Benign Lesion Face, Ears, Eyelids, Nose, Lips 2.1-3 Cm",,11443,CPT,Facility,Inpatient,,,,330,280.5,94.578,449,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Excision,Benign Lesion Face, Ears, Eyelids, Nose, Lips 2.1-3 Cm",,11443,CPT,Facility,Outpatient,,,,330,280.5,94.578,449,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,158.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Excision,Benign Lesion Face, Ears, Eyelids, Nose, Lips 2.1-3 Cm",,11443,CPT,Facility,Inpatient,,,,330,280.5,94.578,449,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Excision,Benign Lesion Face, Ears, Eyelids, Nose, Lips 2.1-3Cm (Pro Cah)",,11443,CPT,Professional,Both,,,,560,476,112.78,560,Aetna,Commercial,476,85,,percent of total billed charges,,
"Excision,Benign Lesion Face, Ears, Eyelids, Nose, Lips 2.1-3Cm (Pro Cah)",,11443,CPT,Professional,Both,,,,560,476,112.78,560,Aetna,Commercial,476,85,,percent of total billed charges,,
"Excision,Benign Lesion Face, Ears, Eyelids, Nose, Lips 2.1-3Cm (Pro Cah)",,11443,CPT,Professional,Both,,,,560,476,112.78,560,Aetna,Medicare Advantage,174.67,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision,Benign Lesion Face, Ears, Eyelids, Nose, Lips 2.1-3Cm (Pro Cah)",,11443,CPT,Professional,Both,,,,560,476,112.78,560,Aetna,Medicare Advantage,174.67,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision,Benign Lesion Face, Ears, Eyelids, Nose, Lips 2.1-3Cm (Pro Cah)",,11443,CPT,Professional,Both,,,,560,476,112.78,560,Aetna,PPO,520.8,93,,percent of total billed charges,,
"Excision,Benign Lesion Face, Ears, Eyelids, Nose, Lips 2.1-3Cm (Pro Cah)",,11443,CPT,Professional,Both,,,,560,476,112.78,560,Aetna,PPO,520.8,93,,percent of total billed charges,,
"Excision,Benign Lesion Face, Ears, Eyelids, Nose, Lips 2.1-3Cm (Pro Cah)",,11443,CPT,Professional,Both,,,,560,476,112.78,560,America's PPO,America's PPO,478.464,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Excision,Benign Lesion Face, Ears, Eyelids, Nose, Lips 2.1-3Cm (Pro Cah)",,11443,CPT,Professional,Both,,,,560,476,112.78,560,America's PPO,America's PPO,478.464,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Excision,Benign Lesion Face, Ears, Eyelids, Nose, Lips 2.1-3Cm (Pro Cah)",,11443,CPT,Professional,Both,,,,560,476,112.78,560,BlueCross BlueShield Minnesota, Federal Employee Program,367.02,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Excision,Benign Lesion Face, Ears, Eyelids, Nose, Lips 2.1-3Cm (Pro Cah)",,11443,CPT,Professional,Both,,,,560,476,112.78,560,BlueCross BlueShield Minnesota, Federal Employee Program,367.02,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Excision,Benign Lesion Face, Ears, Eyelids, Nose, Lips 2.1-3Cm (Pro Cah)",,11443,CPT,Professional,Both,,,,560,476,112.78,560,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,372.89232,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision,Benign Lesion Face, Ears, Eyelids, Nose, Lips 2.1-3Cm (Pro Cah)",,11443,CPT,Professional,Both,,,,560,476,112.78,560,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,372.89232,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision,Benign Lesion Face, Ears, Eyelids, Nose, Lips 2.1-3Cm (Pro Cah)",,11443,CPT,Professional,Both,,,,560,476,112.78,560,BlueCross BlueShield Minnesota,High Value Network Plan,372.89232,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision,Benign Lesion Face, Ears, Eyelids, Nose, Lips 2.1-3Cm (Pro Cah)",,11443,CPT,Professional,Both,,,,560,476,112.78,560,BlueCross BlueShield Minnesota,High Value Network Plan,372.89232,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision,Benign Lesion Face, Ears, Eyelids, Nose, Lips 2.1-3Cm (Pro Cah)",,11443,CPT,Professional,Both,,,,560,476,112.78,560,BlueCross BlueShield Minnesota,Medicare Advantage,201.549,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision,Benign Lesion Face, Ears, Eyelids, Nose, Lips 2.1-3Cm (Pro Cah)",,11443,CPT,Professional,Both,,,,560,476,112.78,560,BlueCross BlueShield Minnesota,Medicare Advantage,201.549,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision,Benign Lesion Face, Ears, Eyelids, Nose, Lips 2.1-3Cm (Pro Cah)",,11443,CPT,Professional,Both,,,,560,476,112.78,560,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,372.89232,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision,Benign Lesion Face, Ears, Eyelids, Nose, Lips 2.1-3Cm (Pro Cah)",,11443,CPT,Professional,Both,,,,560,476,112.78,560,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,372.89232,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision,Benign Lesion Face, Ears, Eyelids, Nose, Lips 2.1-3Cm (Pro Cah)",,11443,CPT,Professional,Both,,,,560,476,112.78,560,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,130.21056,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision,Benign Lesion Face, Ears, Eyelids, Nose, Lips 2.1-3Cm (Pro Cah)",,11443,CPT,Professional,Both,,,,560,476,112.78,560,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,130.21056,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision,Benign Lesion Face, Ears, Eyelids, Nose, Lips 2.1-3Cm (Pro Cah)",,11443,CPT,Professional,Both,,,,560,476,112.78,560,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),201.549,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision,Benign Lesion Face, Ears, Eyelids, Nose, Lips 2.1-3Cm (Pro Cah)",,11443,CPT,Professional,Both,,,,560,476,112.78,560,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),201.549,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision,Benign Lesion Face, Ears, Eyelids, Nose, Lips 2.1-3Cm (Pro Cah)",,11443,CPT,Professional,Both,,,,560,476,112.78,560,CorVel,Worker's Compensation,340.316805,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Excision,Benign Lesion Face, Ears, Eyelids, Nose, Lips 2.1-3Cm (Pro Cah)",,11443,CPT,Professional,Both,,,,560,476,112.78,560,CorVel,Worker's Compensation,340.316805,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Excision,Benign Lesion Face, Ears, Eyelids, Nose, Lips 2.1-3Cm (Pro Cah)",,11443,CPT,Professional,Both,,,,560,476,112.78,560,First Health Group Corporation,First Health Network,543.2,97,,percent of total billed charges,,
"Excision,Benign Lesion Face, Ears, Eyelids, Nose, Lips 2.1-3Cm (Pro Cah)",,11443,CPT,Professional,Both,,,,560,476,112.78,560,First Health Group Corporation,First Health Network,543.2,97,,percent of total billed charges,,
"Excision,Benign Lesion Face, Ears, Eyelids, Nose, Lips 2.1-3Cm (Pro Cah)",,11443,CPT,Professional,Both,,,,560,476,112.78,560,"Health Partners, Inc.",Commercial,367.11,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision,Benign Lesion Face, Ears, Eyelids, Nose, Lips 2.1-3Cm (Pro Cah)",,11443,CPT,Professional,Both,,,,560,476,112.78,560,"Health Partners, Inc.",Commercial,367.11,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision,Benign Lesion Face, Ears, Eyelids, Nose, Lips 2.1-3Cm (Pro Cah)",,11443,CPT,Professional,Both,,,,560,476,112.78,560,"Health Partners, Inc.",Medicare Advantage,201.549,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision,Benign Lesion Face, Ears, Eyelids, Nose, Lips 2.1-3Cm (Pro Cah)",,11443,CPT,Professional,Both,,,,560,476,112.78,560,"Health Partners, Inc.",Medicare Advantage,201.549,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision,Benign Lesion Face, Ears, Eyelids, Nose, Lips 2.1-3Cm (Pro Cah)",,11443,CPT,Professional,Both,,,,560,476,112.78,560,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),175.2,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Excision,Benign Lesion Face, Ears, Eyelids, Nose, Lips 2.1-3Cm (Pro Cah)",,11443,CPT,Professional,Both,,,,560,476,112.78,560,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),175.2,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Excision,Benign Lesion Face, Ears, Eyelids, Nose, Lips 2.1-3Cm (Pro Cah)",,11443,CPT,Professional,Both,,,,560,476,112.78,560,"Health Partners, Inc.",State of Minnesota Advantage Program,316.265265,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision,Benign Lesion Face, Ears, Eyelids, Nose, Lips 2.1-3Cm (Pro Cah)",,11443,CPT,Professional,Both,,,,560,476,112.78,560,"Health Partners, Inc.",State of Minnesota Advantage Program,316.265265,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision,Benign Lesion Face, Ears, Eyelids, Nose, Lips 2.1-3Cm (Pro Cah)",,11443,CPT,Professional,Both,,,,560,476,112.78,560,"Health Partners, Inc.",State Public Programs,112.78,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Excision,Benign Lesion Face, Ears, Eyelids, Nose, Lips 2.1-3Cm (Pro Cah)",,11443,CPT,Professional,Both,,,,560,476,112.78,560,"Health Partners, Inc.",State Public Programs,112.78,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Excision,Benign Lesion Face, Ears, Eyelids, Nose, Lips 2.1-3Cm (Pro Cah)",,11443,CPT,Professional,Both,,,,560,476,112.78,560,Humana Insurance Company,Commercial PPO,175.26,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Excision,Benign Lesion Face, Ears, Eyelids, Nose, Lips 2.1-3Cm (Pro Cah)",,11443,CPT,Professional,Both,,,,560,476,112.78,560,Humana Insurance Company,Commercial PPO,175.26,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Excision,Benign Lesion Face, Ears, Eyelids, Nose, Lips 2.1-3Cm (Pro Cah)",,11443,CPT,Professional,Both,,,,560,476,112.78,560,Humana Insurance Company,Medicare PPO,560,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Excision,Benign Lesion Face, Ears, Eyelids, Nose, Lips 2.1-3Cm (Pro Cah)",,11443,CPT,Professional,Both,,,,560,476,112.78,560,Humana Insurance Company,Medicare PPO,560,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Excision,Benign Lesion Face, Ears, Eyelids, Nose, Lips 2.1-3Cm (Pro Cah)",,11443,CPT,Professional,Both,,,,560,476,112.78,560,Medica,Individual & Family,474.88,84.8,,percent of total billed charges,,
"Excision,Benign Lesion Face, Ears, Eyelids, Nose, Lips 2.1-3Cm (Pro Cah)",,11443,CPT,Professional,Both,,,,560,476,112.78,560,Medica,Individual & Family,474.88,84.8,,percent of total billed charges,,
"Excision,Benign Lesion Face, Ears, Eyelids, Nose, Lips 2.1-3Cm (Pro Cah)",,11443,CPT,Professional,Both,,,,560,476,112.78,560,Medica,Medica Advantage Solution,278.88,49.8,,percent of total billed charges,,
"Excision,Benign Lesion Face, Ears, Eyelids, Nose, Lips 2.1-3Cm (Pro Cah)",,11443,CPT,Professional,Both,,,,560,476,112.78,560,Medica,Medica Advantage Solution,278.88,49.8,,percent of total billed charges,,
"Excision,Benign Lesion Face, Ears, Eyelids, Nose, Lips 2.1-3Cm (Pro Cah)",,11443,CPT,Professional,Both,,,,560,476,112.78,560,Medica,Medical Assistance,130.21,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Excision,Benign Lesion Face, Ears, Eyelids, Nose, Lips 2.1-3Cm (Pro Cah)",,11443,CPT,Professional,Both,,,,560,476,112.78,560,Medica,Medical Assistance,130.21,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Excision,Benign Lesion Face, Ears, Eyelids, Nose, Lips 2.1-3Cm (Pro Cah)",,11443,CPT,Professional,Both,,,,560,476,112.78,560,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,175.26,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Excision,Benign Lesion Face, Ears, Eyelids, Nose, Lips 2.1-3Cm (Pro Cah)",,11443,CPT,Professional,Both,,,,560,476,112.78,560,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,175.26,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Excision,Benign Lesion Face, Ears, Eyelids, Nose, Lips 2.1-3Cm (Pro Cah)",,11443,CPT,Professional,Both,,,,560,476,112.78,560,"Multiplan, Inc.","Multiplan, Inc.",526.4,94,,percent of total billed charges,,
"Excision,Benign Lesion Face, Ears, Eyelids, Nose, Lips 2.1-3Cm (Pro Cah)",,11443,CPT,Professional,Both,,,,560,476,112.78,560,"Multiplan, Inc.","Multiplan, Inc.",526.4,94,,percent of total billed charges,,
"Excision,Benign Lesion Face, Ears, Eyelids, Nose, Lips 2.1-3Cm (Pro Cah)",,11443,CPT,Professional,Both,,,,560,476,112.78,560,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,504.56,90.1,,percent of total billed charges,,
"Excision,Benign Lesion Face, Ears, Eyelids, Nose, Lips 2.1-3Cm (Pro Cah)",,11443,CPT,Professional,Both,,,,560,476,112.78,560,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,504.56,90.1,,percent of total billed charges,,
"Excision,Benign Lesion Face, Ears, Eyelids, Nose, Lips 2.1-3Cm (Pro Cah)",,11443,CPT,Professional,Both,,,,560,476,112.78,560,"Preferred One Administrative Services, INC.",PPO,552.16,98.6,,percent of total billed charges,,
"Excision,Benign Lesion Face, Ears, Eyelids, Nose, Lips 2.1-3Cm (Pro Cah)",,11443,CPT,Professional,Both,,,,560,476,112.78,560,"Preferred One Administrative Services, INC.",PPO,552.16,98.6,,percent of total billed charges,,
"Excision,Benign Lesion Face, Ears, Eyelids, Nose, Lips 2.1-3Cm (Pro Cah)",,11443,CPT,Professional,Both,,,,560,476,112.78,560,PrimeWest Health,Minnesota Senior Health Options (MSHO),201.549,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision,Benign Lesion Face, Ears, Eyelids, Nose, Lips 2.1-3Cm (Pro Cah)",,11443,CPT,Professional,Both,,,,560,476,112.78,560,PrimeWest Health,Minnesota Senior Health Options (MSHO),201.549,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision,Benign Lesion Face, Ears, Eyelids, Nose, Lips 2.1-3Cm (Pro Cah)",,11443,CPT,Professional,Both,,,,560,476,112.78,560,PrimeWest Health,MinnesotaCare,139.3252992,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision,Benign Lesion Face, Ears, Eyelids, Nose, Lips 2.1-3Cm (Pro Cah)",,11443,CPT,Professional,Both,,,,560,476,112.78,560,PrimeWest Health,MinnesotaCare,139.3252992,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision,Benign Lesion Face, Ears, Eyelids, Nose, Lips 2.1-3Cm (Pro Cah)",,11443,CPT,Professional,Both,,,,560,476,112.78,560,Sanford Health Plan,Sanford Health Plan,492.8,88,,percent of total billed charges,,
"Excision,Benign Lesion Face, Ears, Eyelids, Nose, Lips 2.1-3Cm (Pro Cah)",,11443,CPT,Professional,Both,,,,560,476,112.78,560,Sanford Health Plan,Sanford Health Plan,492.8,88,,percent of total billed charges,,
"Excision,Benign Lesion Face, Ears, Eyelids, Nose, Lips 2.1-3Cm (Pro Cah)",,11443,CPT,Professional,Both,,,,560,476,112.78,560,"UCare Health, Inc.",Individual & Family Plan,284.902656,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Excision,Benign Lesion Face, Ears, Eyelids, Nose, Lips 2.1-3Cm (Pro Cah)",,11443,CPT,Professional,Both,,,,560,476,112.78,560,"UCare Health, Inc.",Individual & Family Plan,284.902656,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Excision,Benign Lesion Face, Ears, Eyelids, Nose, Lips 2.1-3Cm (Pro Cah)",,11443,CPT,Professional,Both,,,,560,476,112.78,560,"UCare Health, Inc.",Medical Assistance,143.231616,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Excision,Benign Lesion Face, Ears, Eyelids, Nose, Lips 2.1-3Cm (Pro Cah)",,11443,CPT,Professional,Both,,,,560,476,112.78,560,"UCare Health, Inc.",Medical Assistance,143.231616,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Excision,Benign Lesion Face, Ears, Eyelids, Nose, Lips 2.1-3Cm (Pro Cah)",,11443,CPT,Professional,Both,,,,560,476,112.78,560,"UCare Health, Inc.",Medicare Advantage,201.549,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Excision,Benign Lesion Face, Ears, Eyelids, Nose, Lips 2.1-3Cm (Pro Cah)",,11443,CPT,Professional,Both,,,,560,476,112.78,560,"UCare Health, Inc.",Medicare Advantage,201.549,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Excision,Benign Lesion Face, Ears, Eyelids, Nose, Lips 2.1-3Cm (Pro Cah)",,11443,CPT,Professional,Both,,,,560,476,112.78,560,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),161.2392,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Excision,Benign Lesion Face, Ears, Eyelids, Nose, Lips 2.1-3Cm (Pro Cah)",,11443,CPT,Professional,Both,,,,560,476,112.78,560,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),161.2392,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Excision,Benign Lesion Face, Ears, Eyelids, Nose, Lips 2.1-3Cm (Pro Cah)",,11443,CPT,Professional,Both,,,,560,476,112.78,560,UnitedHealthcare,Individual & Family,560,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Excision,Benign Lesion Face, Ears, Eyelids, Nose, Lips 2.1-3Cm (Pro Cah)",,11443,CPT,Professional,Both,,,,560,476,112.78,560,UnitedHealthcare,Individual & Family,560,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Excision,Benign Lesion Face, Ears, Eyelids, Nose, Lips 2.1-3Cm (Pro Cah)",,11443,CPT,Professional,Both,,,,560,476,112.78,560,UnitedHealthcare,Medicare Advantage,201.549,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision,Benign Lesion Face, Ears, Eyelids, Nose, Lips 2.1-3Cm (Pro Cah)",,11443,CPT,Professional,Both,,,,560,476,112.78,560,UnitedHealthcare,Medicare Advantage,201.549,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision,Benign Lesion Face, Ears, Eyelids, Nose, Lips 2.1-3Cm (Pro Cah)",,11443,CPT,Professional,Both,,,,560,476,112.78,560,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,130.21056,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision,Benign Lesion Face, Ears, Eyelids, Nose, Lips 2.1-3Cm (Pro Cah)",,11443,CPT,Professional,Both,,,,560,476,112.78,560,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,130.21056,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision,Benign Lesion Inc Marg,Except Sktag/Face/Er/Eyld/Ns/Lip/Muc Memb;Ex Dia 3.1-4.0 Cm",,11444,CPT,Facility,Both,,,,480,408,137.568,480,Aetna,Commercial,441.6,92,,percent of total billed charges,,
"Excision,Benign Lesion Inc Marg,Except Sktag/Face/Er/Eyld/Ns/Lip/Muc Memb;Ex Dia 3.1-4.0 Cm",,11444,CPT,Facility,Outpatient,,,,480,408,137.568,480,Aetna,Medicare Advantage,235.2,49,,percent of total billed charges,,
"Excision,Benign Lesion Inc Marg,Except Sktag/Face/Er/Eyld/Ns/Lip/Muc Memb;Ex Dia 3.1-4.0 Cm",,11444,CPT,Facility,Inpatient,,,,480,408,137.568,480,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Excision,Benign Lesion Inc Marg,Except Sktag/Face/Er/Eyld/Ns/Lip/Muc Memb;Ex Dia 3.1-4.0 Cm",,11444,CPT,Facility,Both,,,,480,408,137.568,480,Aetna,PPO,446.4,93,,percent of total billed charges,,
"Excision,Benign Lesion Inc Marg,Except Sktag/Face/Er/Eyld/Ns/Lip/Muc Memb;Ex Dia 3.1-4.0 Cm",,11444,CPT,Facility,Both,,,,480,408,137.568,480,America's PPO,America's PPO,460.944,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Excision,Benign Lesion Inc Marg,Except Sktag/Face/Er/Eyld/Ns/Lip/Muc Memb;Ex Dia 3.1-4.0 Cm",,11444,CPT,Facility,Both,,,,480,408,137.568,480,BlueCross BlueShield Minnesota, Federal Employee Program,472.32,98.4,,percent of total billed charges,,
"Excision,Benign Lesion Inc Marg,Except Sktag/Face/Er/Eyld/Ns/Lip/Muc Memb;Ex Dia 3.1-4.0 Cm",,11444,CPT,Facility,Both,,,,480,408,137.568,480,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,480,100,,percent of total billed charges,,
"Excision,Benign Lesion Inc Marg,Except Sktag/Face/Er/Eyld/Ns/Lip/Muc Memb;Ex Dia 3.1-4.0 Cm",,11444,CPT,Facility,Both,,,,480,408,137.568,480,BlueCross BlueShield Minnesota,High Value Network Plan,432,90,,percent of total billed charges,,
"Excision,Benign Lesion Inc Marg,Except Sktag/Face/Er/Eyld/Ns/Lip/Muc Memb;Ex Dia 3.1-4.0 Cm",,11444,CPT,Facility,Outpatient,,,,480,408,137.568,480,BlueCross BlueShield Minnesota,Medicare Advantage,235.2,49,,percent of total billed charges,,
"Excision,Benign Lesion Inc Marg,Except Sktag/Face/Er/Eyld/Ns/Lip/Muc Memb;Ex Dia 3.1-4.0 Cm",,11444,CPT,Facility,Inpatient,,,,480,408,137.568,480,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Excision,Benign Lesion Inc Marg,Except Sktag/Face/Er/Eyld/Ns/Lip/Muc Memb;Ex Dia 3.1-4.0 Cm",,11444,CPT,Facility,Both,,,,480,408,137.568,480,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,425.136,88.57,,percent of total billed charges,,
"Excision,Benign Lesion Inc Marg,Except Sktag/Face/Er/Eyld/Ns/Lip/Muc Memb;Ex Dia 3.1-4.0 Cm",,11444,CPT,Facility,Both,,,,480,408,137.568,480,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,137.568,28.66,,percent of total billed charges,,
"Excision,Benign Lesion Inc Marg,Except Sktag/Face/Er/Eyld/Ns/Lip/Muc Memb;Ex Dia 3.1-4.0 Cm",,11444,CPT,Facility,Outpatient,,,,480,408,137.568,480,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),235.2,49,,percent of total billed charges,,
"Excision,Benign Lesion Inc Marg,Except Sktag/Face/Er/Eyld/Ns/Lip/Muc Memb;Ex Dia 3.1-4.0 Cm",,11444,CPT,Facility,Inpatient,,,,480,408,137.568,480,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Excision,Benign Lesion Inc Marg,Except Sktag/Face/Er/Eyld/Ns/Lip/Muc Memb;Ex Dia 3.1-4.0 Cm",,11444,CPT,Facility,Both,,,,480,408,137.568,480,CorVel,Worker's Compensation,480,100,,percent of total billed charges,,
"Excision,Benign Lesion Inc Marg,Except Sktag/Face/Er/Eyld/Ns/Lip/Muc Memb;Ex Dia 3.1-4.0 Cm",,11444,CPT,Facility,Both,,,,480,408,137.568,480,First Health Group Corporation,First Health Network,465.6,97,,percent of total billed charges,,
"Excision,Benign Lesion Inc Marg,Except Sktag/Face/Er/Eyld/Ns/Lip/Muc Memb;Ex Dia 3.1-4.0 Cm",,11444,CPT,Facility,Both,,,,480,408,137.568,480,"Health Partners, Inc.",Commercial,454.08,94.6,,percent of total billed charges,,
"Excision,Benign Lesion Inc Marg,Except Sktag/Face/Er/Eyld/Ns/Lip/Muc Memb;Ex Dia 3.1-4.0 Cm",,11444,CPT,Facility,Outpatient,,,,480,408,137.568,480,"Health Partners, Inc.",Medicare Advantage,235.2,49,,percent of total billed charges,,
"Excision,Benign Lesion Inc Marg,Except Sktag/Face/Er/Eyld/Ns/Lip/Muc Memb;Ex Dia 3.1-4.0 Cm",,11444,CPT,Facility,Inpatient,,,,480,408,137.568,480,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Excision,Benign Lesion Inc Marg,Except Sktag/Face/Er/Eyld/Ns/Lip/Muc Memb;Ex Dia 3.1-4.0 Cm",,11444,CPT,Facility,Both,,,,480,408,137.568,480,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),288,60,,percent of total billed charges,,
"Excision,Benign Lesion Inc Marg,Except Sktag/Face/Er/Eyld/Ns/Lip/Muc Memb;Ex Dia 3.1-4.0 Cm",,11444,CPT,Facility,Both,,,,480,408,137.568,480,"Health Partners, Inc.",State of Minnesota Advantage Program,391.2,81.5,,percent of total billed charges,,
"Excision,Benign Lesion Inc Marg,Except Sktag/Face/Er/Eyld/Ns/Lip/Muc Memb;Ex Dia 3.1-4.0 Cm",,11444,CPT,Facility,Both,,,,480,408,137.568,480,"Health Partners, Inc.",State Public Programs,240,50,,percent of total billed charges,,
"Excision,Benign Lesion Inc Marg,Except Sktag/Face/Er/Eyld/Ns/Lip/Muc Memb;Ex Dia 3.1-4.0 Cm",,11444,CPT,Facility,Both,,,,480,408,137.568,480,Humana Insurance Company,Commercial PPO,456,95,,percent of total billed charges,,
"Excision,Benign Lesion Inc Marg,Except Sktag/Face/Er/Eyld/Ns/Lip/Muc Memb;Ex Dia 3.1-4.0 Cm",,11444,CPT,Facility,Outpatient,,,,480,408,137.568,480,Humana Insurance Company,Medicare PPO,235.2,49,,percent of total billed charges,,
"Excision,Benign Lesion Inc Marg,Except Sktag/Face/Er/Eyld/Ns/Lip/Muc Memb;Ex Dia 3.1-4.0 Cm",,11444,CPT,Facility,Inpatient,,,,480,408,137.568,480,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Excision,Benign Lesion Inc Marg,Except Sktag/Face/Er/Eyld/Ns/Lip/Muc Memb;Ex Dia 3.1-4.0 Cm",,11444,CPT,Facility,Both,,,,480,408,137.568,480,Medica,Individual & Family,475.68,99.1,,percent of total billed charges,,
"Excision,Benign Lesion Inc Marg,Except Sktag/Face/Er/Eyld/Ns/Lip/Muc Memb;Ex Dia 3.1-4.0 Cm",,11444,CPT,Facility,Outpatient,,,,480,408,137.568,480,Medica,Medica Advantage Solution,239.04,49.8,,percent of total billed charges,,
"Excision,Benign Lesion Inc Marg,Except Sktag/Face/Er/Eyld/Ns/Lip/Muc Memb;Ex Dia 3.1-4.0 Cm",,11444,CPT,Facility,Inpatient,,,,480,408,137.568,480,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Excision,Benign Lesion Inc Marg,Except Sktag/Face/Er/Eyld/Ns/Lip/Muc Memb;Ex Dia 3.1-4.0 Cm",,11444,CPT,Facility,Outpatient,,,,480,408,137.568,480,Medica,Medical Assistance,449,,,Other,Grouper,All inclusive per visit
"Excision,Benign Lesion Inc Marg,Except Sktag/Face/Er/Eyld/Ns/Lip/Muc Memb;Ex Dia 3.1-4.0 Cm",,11444,CPT,Facility,Inpatient,,,,480,408,137.568,480,Medica,Medical Assistance,,,,,Included in per diem rate,
"Excision,Benign Lesion Inc Marg,Except Sktag/Face/Er/Eyld/Ns/Lip/Muc Memb;Ex Dia 3.1-4.0 Cm",,11444,CPT,Facility,Outpatient,,,,480,408,137.568,480,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,239.04,49.8,,percent of total billed charges,,
"Excision,Benign Lesion Inc Marg,Except Sktag/Face/Er/Eyld/Ns/Lip/Muc Memb;Ex Dia 3.1-4.0 Cm",,11444,CPT,Facility,Inpatient,,,,480,408,137.568,480,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Excision,Benign Lesion Inc Marg,Except Sktag/Face/Er/Eyld/Ns/Lip/Muc Memb;Ex Dia 3.1-4.0 Cm",,11444,CPT,Facility,Both,,,,480,408,137.568,480,"Multiplan, Inc.","Multiplan, Inc.",451.2,94,,percent of total billed charges,,
"Excision,Benign Lesion Inc Marg,Except Sktag/Face/Er/Eyld/Ns/Lip/Muc Memb;Ex Dia 3.1-4.0 Cm",,11444,CPT,Facility,Outpatient,,,,480,408,137.568,480,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,432.48,90.1,,percent of total billed charges,,
"Excision,Benign Lesion Inc Marg,Except Sktag/Face/Er/Eyld/Ns/Lip/Muc Memb;Ex Dia 3.1-4.0 Cm",,11444,CPT,Facility,Inpatient,,,,480,408,137.568,480,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Excision,Benign Lesion Inc Marg,Except Sktag/Face/Er/Eyld/Ns/Lip/Muc Memb;Ex Dia 3.1-4.0 Cm",,11444,CPT,Facility,Both,,,,480,408,137.568,480,"Preferred One Administrative Services, INC.",PPO,473.28,98.6,,percent of total billed charges,,
"Excision,Benign Lesion Inc Marg,Except Sktag/Face/Er/Eyld/Ns/Lip/Muc Memb;Ex Dia 3.1-4.0 Cm",,11444,CPT,Facility,Outpatient,,,,480,408,137.568,480,PrimeWest Health,Minnesota Senior Health Options (MSHO),246.96,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Excision,Benign Lesion Inc Marg,Except Sktag/Face/Er/Eyld/Ns/Lip/Muc Memb;Ex Dia 3.1-4.0 Cm",,11444,CPT,Facility,Inpatient,,,,480,408,137.568,480,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Excision,Benign Lesion Inc Marg,Except Sktag/Face/Er/Eyld/Ns/Lip/Muc Memb;Ex Dia 3.1-4.0 Cm",,11444,CPT,Facility,Outpatient,,,,480,408,137.568,480,PrimeWest Health,MinnesotaCare,246.528,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Excision,Benign Lesion Inc Marg,Except Sktag/Face/Er/Eyld/Ns/Lip/Muc Memb;Ex Dia 3.1-4.0 Cm",,11444,CPT,Facility,Inpatient,,,,480,408,137.568,480,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Excision,Benign Lesion Inc Marg,Except Sktag/Face/Er/Eyld/Ns/Lip/Muc Memb;Ex Dia 3.1-4.0 Cm",,11444,CPT,Facility,Both,,,,480,408,137.568,480,Sanford Health Plan,Sanford Health Plan,441.6,92,,percent of total billed charges,,
"Excision,Benign Lesion Inc Marg,Except Sktag/Face/Er/Eyld/Ns/Lip/Muc Memb;Ex Dia 3.1-4.0 Cm",,11444,CPT,Facility,Outpatient,,,,480,408,137.568,480,"UCare Health, Inc.",Individual & Family Plan,270.48,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Excision,Benign Lesion Inc Marg,Except Sktag/Face/Er/Eyld/Ns/Lip/Muc Memb;Ex Dia 3.1-4.0 Cm",,11444,CPT,Facility,Inpatient,,,,480,408,137.568,480,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Excision,Benign Lesion Inc Marg,Except Sktag/Face/Er/Eyld/Ns/Lip/Muc Memb;Ex Dia 3.1-4.0 Cm",,11444,CPT,Facility,Outpatient,,,,480,408,137.568,480,"UCare Health, Inc.",Medical Assistance,242.256,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Excision,Benign Lesion Inc Marg,Except Sktag/Face/Er/Eyld/Ns/Lip/Muc Memb;Ex Dia 3.1-4.0 Cm",,11444,CPT,Facility,Inpatient,,,,480,408,137.568,480,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Excision,Benign Lesion Inc Marg,Except Sktag/Face/Er/Eyld/Ns/Lip/Muc Memb;Ex Dia 3.1-4.0 Cm",,11444,CPT,Facility,Outpatient,,,,480,408,137.568,480,"UCare Health, Inc.",Medicare Advantage,242.256,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Excision,Benign Lesion Inc Marg,Except Sktag/Face/Er/Eyld/Ns/Lip/Muc Memb;Ex Dia 3.1-4.0 Cm",,11444,CPT,Facility,Inpatient,,,,480,408,137.568,480,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Excision,Benign Lesion Inc Marg,Except Sktag/Face/Er/Eyld/Ns/Lip/Muc Memb;Ex Dia 3.1-4.0 Cm",,11444,CPT,Facility,Outpatient,,,,480,408,137.568,480,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),242.256,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Excision,Benign Lesion Inc Marg,Except Sktag/Face/Er/Eyld/Ns/Lip/Muc Memb;Ex Dia 3.1-4.0 Cm",,11444,CPT,Facility,Inpatient,,,,480,408,137.568,480,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Excision,Benign Lesion Inc Marg,Except Sktag/Face/Er/Eyld/Ns/Lip/Muc Memb;Ex Dia 3.1-4.0 Cm",,11444,CPT,Facility,Both,,,,480,408,137.568,480,UnitedHealthcare,Individual & Family,451.2,94,,percent of total billed charges,,
"Excision,Benign Lesion Inc Marg,Except Sktag/Face/Er/Eyld/Ns/Lip/Muc Memb;Ex Dia 3.1-4.0 Cm",,11444,CPT,Facility,Outpatient,,,,480,408,137.568,480,UnitedHealthcare,Medicare Advantage,235.2,49,,percent of total billed charges,,
"Excision,Benign Lesion Inc Marg,Except Sktag/Face/Er/Eyld/Ns/Lip/Muc Memb;Ex Dia 3.1-4.0 Cm",,11444,CPT,Facility,Inpatient,,,,480,408,137.568,480,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Excision,Benign Lesion Inc Marg,Except Sktag/Face/Er/Eyld/Ns/Lip/Muc Memb;Ex Dia 3.1-4.0 Cm",,11444,CPT,Facility,Outpatient,,,,480,408,137.568,480,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,230.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Excision,Benign Lesion Inc Marg,Except Sktag/Face/Er/Eyld/Ns/Lip/Muc Memb;Ex Dia 3.1-4.0 Cm",,11444,CPT,Facility,Inpatient,,,,480,408,137.568,480,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Excision,Benign Lesion Inc Marg,Except Sktag/Face/Er/Eyld/Ns/Lip/Muc Memb;Ex Dia 3.1-4.0Cm (Pro Cah)",,11444,CPT,Professional,Both,,,,725,616.25,141.35,725,Aetna,Commercial,616.25,85,,percent of total billed charges,,
"Excision,Benign Lesion Inc Marg,Except Sktag/Face/Er/Eyld/Ns/Lip/Muc Memb;Ex Dia 3.1-4.0Cm (Pro Cah)",,11444,CPT,Professional,Both,,,,725,616.25,141.35,725,Aetna,Medicare Advantage,220.77,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision,Benign Lesion Inc Marg,Except Sktag/Face/Er/Eyld/Ns/Lip/Muc Memb;Ex Dia 3.1-4.0Cm (Pro Cah)",,11444,CPT,Professional,Both,,,,725,616.25,141.35,725,Aetna,PPO,674.25,93,,percent of total billed charges,,
"Excision,Benign Lesion Inc Marg,Except Sktag/Face/Er/Eyld/Ns/Lip/Muc Memb;Ex Dia 3.1-4.0Cm (Pro Cah)",,11444,CPT,Professional,Both,,,,725,616.25,141.35,725,America's PPO,America's PPO,619.44,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Excision,Benign Lesion Inc Marg,Except Sktag/Face/Er/Eyld/Ns/Lip/Muc Memb;Ex Dia 3.1-4.0Cm (Pro Cah)",,11444,CPT,Professional,Both,,,,725,616.25,141.35,725,BlueCross BlueShield Minnesota, Federal Employee Program,462.74,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Excision,Benign Lesion Inc Marg,Except Sktag/Face/Er/Eyld/Ns/Lip/Muc Memb;Ex Dia 3.1-4.0Cm (Pro Cah)",,11444,CPT,Professional,Both,,,,725,616.25,141.35,725,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,470.14384,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision,Benign Lesion Inc Marg,Except Sktag/Face/Er/Eyld/Ns/Lip/Muc Memb;Ex Dia 3.1-4.0Cm (Pro Cah)",,11444,CPT,Professional,Both,,,,725,616.25,141.35,725,BlueCross BlueShield Minnesota,High Value Network Plan,470.14384,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision,Benign Lesion Inc Marg,Except Sktag/Face/Er/Eyld/Ns/Lip/Muc Memb;Ex Dia 3.1-4.0Cm (Pro Cah)",,11444,CPT,Professional,Both,,,,725,616.25,141.35,725,BlueCross BlueShield Minnesota,Medicare Advantage,252.609,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision,Benign Lesion Inc Marg,Except Sktag/Face/Er/Eyld/Ns/Lip/Muc Memb;Ex Dia 3.1-4.0Cm (Pro Cah)",,11444,CPT,Professional,Both,,,,725,616.25,141.35,725,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,470.14384,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision,Benign Lesion Inc Marg,Except Sktag/Face/Er/Eyld/Ns/Lip/Muc Memb;Ex Dia 3.1-4.0Cm (Pro Cah)",,11444,CPT,Professional,Both,,,,725,616.25,141.35,725,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,163.20008,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision,Benign Lesion Inc Marg,Except Sktag/Face/Er/Eyld/Ns/Lip/Muc Memb;Ex Dia 3.1-4.0Cm (Pro Cah)",,11444,CPT,Professional,Both,,,,725,616.25,141.35,725,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),252.609,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision,Benign Lesion Inc Marg,Except Sktag/Face/Er/Eyld/Ns/Lip/Muc Memb;Ex Dia 3.1-4.0Cm (Pro Cah)",,11444,CPT,Professional,Both,,,,725,616.25,141.35,725,CorVel,Worker's Compensation,429.2780964,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Excision,Benign Lesion Inc Marg,Except Sktag/Face/Er/Eyld/Ns/Lip/Muc Memb;Ex Dia 3.1-4.0Cm (Pro Cah)",,11444,CPT,Professional,Both,,,,725,616.25,141.35,725,First Health Group Corporation,First Health Network,703.25,97,,percent of total billed charges,,
"Excision,Benign Lesion Inc Marg,Except Sktag/Face/Er/Eyld/Ns/Lip/Muc Memb;Ex Dia 3.1-4.0Cm (Pro Cah)",,11444,CPT,Professional,Both,,,,725,616.25,141.35,725,"Health Partners, Inc.",Commercial,463.61,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision,Benign Lesion Inc Marg,Except Sktag/Face/Er/Eyld/Ns/Lip/Muc Memb;Ex Dia 3.1-4.0Cm (Pro Cah)",,11444,CPT,Professional,Both,,,,725,616.25,141.35,725,"Health Partners, Inc.",Medicare Advantage,252.609,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision,Benign Lesion Inc Marg,Except Sktag/Face/Er/Eyld/Ns/Lip/Muc Memb;Ex Dia 3.1-4.0Cm (Pro Cah)",,11444,CPT,Professional,Both,,,,725,616.25,141.35,725,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),219.59,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Excision,Benign Lesion Inc Marg,Except Sktag/Face/Er/Eyld/Ns/Lip/Muc Memb;Ex Dia 3.1-4.0Cm (Pro Cah)",,11444,CPT,Professional,Both,,,,725,616.25,141.35,725,"Health Partners, Inc.",State of Minnesota Advantage Program,399.400015,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision,Benign Lesion Inc Marg,Except Sktag/Face/Er/Eyld/Ns/Lip/Muc Memb;Ex Dia 3.1-4.0Cm (Pro Cah)",,11444,CPT,Professional,Both,,,,725,616.25,141.35,725,"Health Partners, Inc.",State Public Programs,141.35,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Excision,Benign Lesion Inc Marg,Except Sktag/Face/Er/Eyld/Ns/Lip/Muc Memb;Ex Dia 3.1-4.0Cm (Pro Cah)",,11444,CPT,Professional,Both,,,,725,616.25,141.35,725,Humana Insurance Company,Commercial PPO,219.66,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Excision,Benign Lesion Inc Marg,Except Sktag/Face/Er/Eyld/Ns/Lip/Muc Memb;Ex Dia 3.1-4.0Cm (Pro Cah)",,11444,CPT,Professional,Both,,,,725,616.25,141.35,725,Humana Insurance Company,Medicare PPO,725,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Excision,Benign Lesion Inc Marg,Except Sktag/Face/Er/Eyld/Ns/Lip/Muc Memb;Ex Dia 3.1-4.0Cm (Pro Cah)",,11444,CPT,Professional,Both,,,,725,616.25,141.35,725,Medica,Individual & Family,614.8,84.8,,percent of total billed charges,,
"Excision,Benign Lesion Inc Marg,Except Sktag/Face/Er/Eyld/Ns/Lip/Muc Memb;Ex Dia 3.1-4.0Cm (Pro Cah)",,11444,CPT,Professional,Both,,,,725,616.25,141.35,725,Medica,Medica Advantage Solution,361.05,49.8,,percent of total billed charges,,
"Excision,Benign Lesion Inc Marg,Except Sktag/Face/Er/Eyld/Ns/Lip/Muc Memb;Ex Dia 3.1-4.0Cm (Pro Cah)",,11444,CPT,Professional,Both,,,,725,616.25,141.35,725,Medica,Medical Assistance,163.2,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Excision,Benign Lesion Inc Marg,Except Sktag/Face/Er/Eyld/Ns/Lip/Muc Memb;Ex Dia 3.1-4.0Cm (Pro Cah)",,11444,CPT,Professional,Both,,,,725,616.25,141.35,725,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,219.66,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Excision,Benign Lesion Inc Marg,Except Sktag/Face/Er/Eyld/Ns/Lip/Muc Memb;Ex Dia 3.1-4.0Cm (Pro Cah)",,11444,CPT,Professional,Both,,,,725,616.25,141.35,725,"Multiplan, Inc.","Multiplan, Inc.",681.5,94,,percent of total billed charges,,
"Excision,Benign Lesion Inc Marg,Except Sktag/Face/Er/Eyld/Ns/Lip/Muc Memb;Ex Dia 3.1-4.0Cm (Pro Cah)",,11444,CPT,Professional,Both,,,,725,616.25,141.35,725,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,653.225,90.1,,percent of total billed charges,,
"Excision,Benign Lesion Inc Marg,Except Sktag/Face/Er/Eyld/Ns/Lip/Muc Memb;Ex Dia 3.1-4.0Cm (Pro Cah)",,11444,CPT,Professional,Both,,,,725,616.25,141.35,725,"Preferred One Administrative Services, INC.",PPO,714.85,98.6,,percent of total billed charges,,
"Excision,Benign Lesion Inc Marg,Except Sktag/Face/Er/Eyld/Ns/Lip/Muc Memb;Ex Dia 3.1-4.0Cm (Pro Cah)",,11444,CPT,Professional,Both,,,,725,616.25,141.35,725,PrimeWest Health,Minnesota Senior Health Options (MSHO),252.609,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision,Benign Lesion Inc Marg,Except Sktag/Face/Er/Eyld/Ns/Lip/Muc Memb;Ex Dia 3.1-4.0Cm (Pro Cah)",,11444,CPT,Professional,Both,,,,725,616.25,141.35,725,PrimeWest Health,MinnesotaCare,174.6240856,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision,Benign Lesion Inc Marg,Except Sktag/Face/Er/Eyld/Ns/Lip/Muc Memb;Ex Dia 3.1-4.0Cm (Pro Cah)",,11444,CPT,Professional,Both,,,,725,616.25,141.35,725,Sanford Health Plan,Sanford Health Plan,638,88,,percent of total billed charges,,
"Excision,Benign Lesion Inc Marg,Except Sktag/Face/Er/Eyld/Ns/Lip/Muc Memb;Ex Dia 3.1-4.0Cm (Pro Cah)",,11444,CPT,Professional,Both,,,,725,616.25,141.35,725,"UCare Health, Inc.",Individual & Family Plan,357.079296,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Excision,Benign Lesion Inc Marg,Except Sktag/Face/Er/Eyld/Ns/Lip/Muc Memb;Ex Dia 3.1-4.0Cm (Pro Cah)",,11444,CPT,Professional,Both,,,,725,616.25,141.35,725,"UCare Health, Inc.",Medical Assistance,179.520088,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Excision,Benign Lesion Inc Marg,Except Sktag/Face/Er/Eyld/Ns/Lip/Muc Memb;Ex Dia 3.1-4.0Cm (Pro Cah)",,11444,CPT,Professional,Both,,,,725,616.25,141.35,725,"UCare Health, Inc.",Medicare Advantage,252.609,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Excision,Benign Lesion Inc Marg,Except Sktag/Face/Er/Eyld/Ns/Lip/Muc Memb;Ex Dia 3.1-4.0Cm (Pro Cah)",,11444,CPT,Professional,Both,,,,725,616.25,141.35,725,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),202.0872,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Excision,Benign Lesion Inc Marg,Except Sktag/Face/Er/Eyld/Ns/Lip/Muc Memb;Ex Dia 3.1-4.0Cm (Pro Cah)",,11444,CPT,Professional,Both,,,,725,616.25,141.35,725,UnitedHealthcare,Individual & Family,725,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Excision,Benign Lesion Inc Marg,Except Sktag/Face/Er/Eyld/Ns/Lip/Muc Memb;Ex Dia 3.1-4.0Cm (Pro Cah)",,11444,CPT,Professional,Both,,,,725,616.25,141.35,725,UnitedHealthcare,Medicare Advantage,252.609,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision,Benign Lesion Inc Marg,Except Sktag/Face/Er/Eyld/Ns/Lip/Muc Memb;Ex Dia 3.1-4.0Cm (Pro Cah)",,11444,CPT,Professional,Both,,,,725,616.25,141.35,725,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,163.20008,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision,  Benign Lesion Sktag,Face,Ear,Eyelid,Nose,Lip, Muc Memb; Exc Dia Over 4.0 Cm",,11446,CPT,Facility,Both,,,,635,539.75,181.991,1372,Aetna,Commercial,584.2,92,,percent of total billed charges,,
"Excision,  Benign Lesion Sktag,Face,Ear,Eyelid,Nose,Lip, Muc Memb; Exc Dia Over 4.0 Cm",,11446,CPT,Facility,Outpatient,,,,635,539.75,181.991,1372,Aetna,Medicare Advantage,311.15,49,,percent of total billed charges,,
"Excision,  Benign Lesion Sktag,Face,Ear,Eyelid,Nose,Lip, Muc Memb; Exc Dia Over 4.0 Cm",,11446,CPT,Facility,Inpatient,,,,635,539.75,181.991,1372,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Excision,  Benign Lesion Sktag,Face,Ear,Eyelid,Nose,Lip, Muc Memb; Exc Dia Over 4.0 Cm",,11446,CPT,Facility,Both,,,,635,539.75,181.991,1372,Aetna,PPO,590.55,93,,percent of total billed charges,,
"Excision,  Benign Lesion Sktag,Face,Ear,Eyelid,Nose,Lip, Muc Memb; Exc Dia Over 4.0 Cm",,11446,CPT,Facility,Both,,,,635,539.75,181.991,1372,America's PPO,America's PPO,609.7905,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Excision,  Benign Lesion Sktag,Face,Ear,Eyelid,Nose,Lip, Muc Memb; Exc Dia Over 4.0 Cm",,11446,CPT,Facility,Both,,,,635,539.75,181.991,1372,BlueCross BlueShield Minnesota, Federal Employee Program,624.84,98.4,,percent of total billed charges,,
"Excision,  Benign Lesion Sktag,Face,Ear,Eyelid,Nose,Lip, Muc Memb; Exc Dia Over 4.0 Cm",,11446,CPT,Facility,Both,,,,635,539.75,181.991,1372,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,635,100,,percent of total billed charges,,
"Excision,  Benign Lesion Sktag,Face,Ear,Eyelid,Nose,Lip, Muc Memb; Exc Dia Over 4.0 Cm",,11446,CPT,Facility,Both,,,,635,539.75,181.991,1372,BlueCross BlueShield Minnesota,High Value Network Plan,571.5,90,,percent of total billed charges,,
"Excision,  Benign Lesion Sktag,Face,Ear,Eyelid,Nose,Lip, Muc Memb; Exc Dia Over 4.0 Cm",,11446,CPT,Facility,Outpatient,,,,635,539.75,181.991,1372,BlueCross BlueShield Minnesota,Medicare Advantage,311.15,49,,percent of total billed charges,,
"Excision,  Benign Lesion Sktag,Face,Ear,Eyelid,Nose,Lip, Muc Memb; Exc Dia Over 4.0 Cm",,11446,CPT,Facility,Inpatient,,,,635,539.75,181.991,1372,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Excision,  Benign Lesion Sktag,Face,Ear,Eyelid,Nose,Lip, Muc Memb; Exc Dia Over 4.0 Cm",,11446,CPT,Facility,Both,,,,635,539.75,181.991,1372,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,562.4195,88.57,,percent of total billed charges,,
"Excision,  Benign Lesion Sktag,Face,Ear,Eyelid,Nose,Lip, Muc Memb; Exc Dia Over 4.0 Cm",,11446,CPT,Facility,Both,,,,635,539.75,181.991,1372,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,181.991,28.66,,percent of total billed charges,,
"Excision,  Benign Lesion Sktag,Face,Ear,Eyelid,Nose,Lip, Muc Memb; Exc Dia Over 4.0 Cm",,11446,CPT,Facility,Outpatient,,,,635,539.75,181.991,1372,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),311.15,49,,percent of total billed charges,,
"Excision,  Benign Lesion Sktag,Face,Ear,Eyelid,Nose,Lip, Muc Memb; Exc Dia Over 4.0 Cm",,11446,CPT,Facility,Inpatient,,,,635,539.75,181.991,1372,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Excision,  Benign Lesion Sktag,Face,Ear,Eyelid,Nose,Lip, Muc Memb; Exc Dia Over 4.0 Cm",,11446,CPT,Facility,Both,,,,635,539.75,181.991,1372,CorVel,Worker's Compensation,635,100,,percent of total billed charges,,
"Excision,  Benign Lesion Sktag,Face,Ear,Eyelid,Nose,Lip, Muc Memb; Exc Dia Over 4.0 Cm",,11446,CPT,Facility,Both,,,,635,539.75,181.991,1372,First Health Group Corporation,First Health Network,615.95,97,,percent of total billed charges,,
"Excision,  Benign Lesion Sktag,Face,Ear,Eyelid,Nose,Lip, Muc Memb; Exc Dia Over 4.0 Cm",,11446,CPT,Facility,Both,,,,635,539.75,181.991,1372,"Health Partners, Inc.",Commercial,600.71,94.6,,percent of total billed charges,,
"Excision,  Benign Lesion Sktag,Face,Ear,Eyelid,Nose,Lip, Muc Memb; Exc Dia Over 4.0 Cm",,11446,CPT,Facility,Outpatient,,,,635,539.75,181.991,1372,"Health Partners, Inc.",Medicare Advantage,311.15,49,,percent of total billed charges,,
"Excision,  Benign Lesion Sktag,Face,Ear,Eyelid,Nose,Lip, Muc Memb; Exc Dia Over 4.0 Cm",,11446,CPT,Facility,Inpatient,,,,635,539.75,181.991,1372,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Excision,  Benign Lesion Sktag,Face,Ear,Eyelid,Nose,Lip, Muc Memb; Exc Dia Over 4.0 Cm",,11446,CPT,Facility,Both,,,,635,539.75,181.991,1372,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),381,60,,percent of total billed charges,,
"Excision,  Benign Lesion Sktag,Face,Ear,Eyelid,Nose,Lip, Muc Memb; Exc Dia Over 4.0 Cm",,11446,CPT,Facility,Both,,,,635,539.75,181.991,1372,"Health Partners, Inc.",State of Minnesota Advantage Program,517.525,81.5,,percent of total billed charges,,
"Excision,  Benign Lesion Sktag,Face,Ear,Eyelid,Nose,Lip, Muc Memb; Exc Dia Over 4.0 Cm",,11446,CPT,Facility,Both,,,,635,539.75,181.991,1372,"Health Partners, Inc.",State Public Programs,317.5,50,,percent of total billed charges,,
"Excision,  Benign Lesion Sktag,Face,Ear,Eyelid,Nose,Lip, Muc Memb; Exc Dia Over 4.0 Cm",,11446,CPT,Facility,Both,,,,635,539.75,181.991,1372,Humana Insurance Company,Commercial PPO,603.25,95,,percent of total billed charges,,
"Excision,  Benign Lesion Sktag,Face,Ear,Eyelid,Nose,Lip, Muc Memb; Exc Dia Over 4.0 Cm",,11446,CPT,Facility,Outpatient,,,,635,539.75,181.991,1372,Humana Insurance Company,Medicare PPO,311.15,49,,percent of total billed charges,,
"Excision,  Benign Lesion Sktag,Face,Ear,Eyelid,Nose,Lip, Muc Memb; Exc Dia Over 4.0 Cm",,11446,CPT,Facility,Inpatient,,,,635,539.75,181.991,1372,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Excision,  Benign Lesion Sktag,Face,Ear,Eyelid,Nose,Lip, Muc Memb; Exc Dia Over 4.0 Cm",,11446,CPT,Facility,Both,,,,635,539.75,181.991,1372,Medica,Individual & Family,629.285,99.1,,percent of total billed charges,,
"Excision,  Benign Lesion Sktag,Face,Ear,Eyelid,Nose,Lip, Muc Memb; Exc Dia Over 4.0 Cm",,11446,CPT,Facility,Outpatient,,,,635,539.75,181.991,1372,Medica,Medica Advantage Solution,316.23,49.8,,percent of total billed charges,,
"Excision,  Benign Lesion Sktag,Face,Ear,Eyelid,Nose,Lip, Muc Memb; Exc Dia Over 4.0 Cm",,11446,CPT,Facility,Inpatient,,,,635,539.75,181.991,1372,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Excision,  Benign Lesion Sktag,Face,Ear,Eyelid,Nose,Lip, Muc Memb; Exc Dia Over 4.0 Cm",,11446,CPT,Facility,Outpatient,,,,635,539.75,181.991,1372,Medica,Medical Assistance,1372,,,Other,Grouper,All inclusive per visit
"Excision,  Benign Lesion Sktag,Face,Ear,Eyelid,Nose,Lip, Muc Memb; Exc Dia Over 4.0 Cm",,11446,CPT,Facility,Inpatient,,,,635,539.75,181.991,1372,Medica,Medical Assistance,,,,,Included in per diem rate,
"Excision,  Benign Lesion Sktag,Face,Ear,Eyelid,Nose,Lip, Muc Memb; Exc Dia Over 4.0 Cm",,11446,CPT,Facility,Outpatient,,,,635,539.75,181.991,1372,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,316.23,49.8,,percent of total billed charges,,
"Excision,  Benign Lesion Sktag,Face,Ear,Eyelid,Nose,Lip, Muc Memb; Exc Dia Over 4.0 Cm",,11446,CPT,Facility,Inpatient,,,,635,539.75,181.991,1372,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Excision,  Benign Lesion Sktag,Face,Ear,Eyelid,Nose,Lip, Muc Memb; Exc Dia Over 4.0 Cm",,11446,CPT,Facility,Both,,,,635,539.75,181.991,1372,"Multiplan, Inc.","Multiplan, Inc.",596.9,94,,percent of total billed charges,,
"Excision,  Benign Lesion Sktag,Face,Ear,Eyelid,Nose,Lip, Muc Memb; Exc Dia Over 4.0 Cm",,11446,CPT,Facility,Outpatient,,,,635,539.75,181.991,1372,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,572.135,90.1,,percent of total billed charges,,
"Excision,  Benign Lesion Sktag,Face,Ear,Eyelid,Nose,Lip, Muc Memb; Exc Dia Over 4.0 Cm",,11446,CPT,Facility,Inpatient,,,,635,539.75,181.991,1372,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Excision,  Benign Lesion Sktag,Face,Ear,Eyelid,Nose,Lip, Muc Memb; Exc Dia Over 4.0 Cm",,11446,CPT,Facility,Both,,,,635,539.75,181.991,1372,"Preferred One Administrative Services, INC.",PPO,626.11,98.6,,percent of total billed charges,,
"Excision,  Benign Lesion Sktag,Face,Ear,Eyelid,Nose,Lip, Muc Memb; Exc Dia Over 4.0 Cm",,11446,CPT,Facility,Outpatient,,,,635,539.75,181.991,1372,PrimeWest Health,Minnesota Senior Health Options (MSHO),326.7075,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Excision,  Benign Lesion Sktag,Face,Ear,Eyelid,Nose,Lip, Muc Memb; Exc Dia Over 4.0 Cm",,11446,CPT,Facility,Inpatient,,,,635,539.75,181.991,1372,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Excision,  Benign Lesion Sktag,Face,Ear,Eyelid,Nose,Lip, Muc Memb; Exc Dia Over 4.0 Cm",,11446,CPT,Facility,Outpatient,,,,635,539.75,181.991,1372,PrimeWest Health,MinnesotaCare,326.136,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Excision,  Benign Lesion Sktag,Face,Ear,Eyelid,Nose,Lip, Muc Memb; Exc Dia Over 4.0 Cm",,11446,CPT,Facility,Inpatient,,,,635,539.75,181.991,1372,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Excision,  Benign Lesion Sktag,Face,Ear,Eyelid,Nose,Lip, Muc Memb; Exc Dia Over 4.0 Cm",,11446,CPT,Facility,Both,,,,635,539.75,181.991,1372,Sanford Health Plan,Sanford Health Plan,584.2,92,,percent of total billed charges,,
"Excision,  Benign Lesion Sktag,Face,Ear,Eyelid,Nose,Lip, Muc Memb; Exc Dia Over 4.0 Cm",,11446,CPT,Facility,Outpatient,,,,635,539.75,181.991,1372,"UCare Health, Inc.",Individual & Family Plan,357.8225,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Excision,  Benign Lesion Sktag,Face,Ear,Eyelid,Nose,Lip, Muc Memb; Exc Dia Over 4.0 Cm",,11446,CPT,Facility,Inpatient,,,,635,539.75,181.991,1372,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Excision,  Benign Lesion Sktag,Face,Ear,Eyelid,Nose,Lip, Muc Memb; Exc Dia Over 4.0 Cm",,11446,CPT,Facility,Outpatient,,,,635,539.75,181.991,1372,"UCare Health, Inc.",Medical Assistance,320.4845,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Excision,  Benign Lesion Sktag,Face,Ear,Eyelid,Nose,Lip, Muc Memb; Exc Dia Over 4.0 Cm",,11446,CPT,Facility,Inpatient,,,,635,539.75,181.991,1372,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Excision,  Benign Lesion Sktag,Face,Ear,Eyelid,Nose,Lip, Muc Memb; Exc Dia Over 4.0 Cm",,11446,CPT,Facility,Outpatient,,,,635,539.75,181.991,1372,"UCare Health, Inc.",Medicare Advantage,320.4845,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Excision,  Benign Lesion Sktag,Face,Ear,Eyelid,Nose,Lip, Muc Memb; Exc Dia Over 4.0 Cm",,11446,CPT,Facility,Inpatient,,,,635,539.75,181.991,1372,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Excision,  Benign Lesion Sktag,Face,Ear,Eyelid,Nose,Lip, Muc Memb; Exc Dia Over 4.0 Cm",,11446,CPT,Facility,Outpatient,,,,635,539.75,181.991,1372,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),320.4845,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Excision,  Benign Lesion Sktag,Face,Ear,Eyelid,Nose,Lip, Muc Memb; Exc Dia Over 4.0 Cm",,11446,CPT,Facility,Inpatient,,,,635,539.75,181.991,1372,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Excision,  Benign Lesion Sktag,Face,Ear,Eyelid,Nose,Lip, Muc Memb; Exc Dia Over 4.0 Cm",,11446,CPT,Facility,Both,,,,635,539.75,181.991,1372,UnitedHealthcare,Individual & Family,596.9,94,,percent of total billed charges,,
"Excision,  Benign Lesion Sktag,Face,Ear,Eyelid,Nose,Lip, Muc Memb; Exc Dia Over 4.0 Cm",,11446,CPT,Facility,Outpatient,,,,635,539.75,181.991,1372,UnitedHealthcare,Medicare Advantage,311.15,49,,percent of total billed charges,,
"Excision,  Benign Lesion Sktag,Face,Ear,Eyelid,Nose,Lip, Muc Memb; Exc Dia Over 4.0 Cm",,11446,CPT,Facility,Inpatient,,,,635,539.75,181.991,1372,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Excision,  Benign Lesion Sktag,Face,Ear,Eyelid,Nose,Lip, Muc Memb; Exc Dia Over 4.0 Cm",,11446,CPT,Facility,Outpatient,,,,635,539.75,181.991,1372,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,304.8,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Excision,  Benign Lesion Sktag,Face,Ear,Eyelid,Nose,Lip, Muc Memb; Exc Dia Over 4.0 Cm",,11446,CPT,Facility,Inpatient,,,,635,539.75,181.991,1372,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Excision,  Benign Lesion Sktag,Face,Ear,Eyelid,Nose,Lip, Muc Memb; Exc Dia Over 4.0 Cm (Pro Cah)",,11446,CPT,Professional,Both,,,,990,841.5,197.21,990,Aetna,Commercial,841.5,85,,percent of total billed charges,,
"Excision,  Benign Lesion Sktag,Face,Ear,Eyelid,Nose,Lip, Muc Memb; Exc Dia Over 4.0 Cm (Pro Cah)",,11446,CPT,Professional,Both,,,,990,841.5,197.21,990,Aetna,Medicare Advantage,313.82,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision,  Benign Lesion Sktag,Face,Ear,Eyelid,Nose,Lip, Muc Memb; Exc Dia Over 4.0 Cm (Pro Cah)",,11446,CPT,Professional,Both,,,,990,841.5,197.21,990,Aetna,PPO,920.7,93,,percent of total billed charges,,
"Excision,  Benign Lesion Sktag,Face,Ear,Eyelid,Nose,Lip, Muc Memb; Exc Dia Over 4.0 Cm (Pro Cah)",,11446,CPT,Professional,Both,,,,990,841.5,197.21,990,America's PPO,America's PPO,845.856,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Excision,  Benign Lesion Sktag,Face,Ear,Eyelid,Nose,Lip, Muc Memb; Exc Dia Over 4.0 Cm (Pro Cah)",,11446,CPT,Professional,Both,,,,990,841.5,197.21,990,BlueCross BlueShield Minnesota, Federal Employee Program,647.97,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Excision,  Benign Lesion Sktag,Face,Ear,Eyelid,Nose,Lip, Muc Memb; Exc Dia Over 4.0 Cm (Pro Cah)",,11446,CPT,Professional,Both,,,,990,841.5,197.21,990,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,658.33752,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision,  Benign Lesion Sktag,Face,Ear,Eyelid,Nose,Lip, Muc Memb; Exc Dia Over 4.0 Cm (Pro Cah)",,11446,CPT,Professional,Both,,,,990,841.5,197.21,990,BlueCross BlueShield Minnesota,High Value Network Plan,658.33752,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision,  Benign Lesion Sktag,Face,Ear,Eyelid,Nose,Lip, Muc Memb; Exc Dia Over 4.0 Cm (Pro Cah)",,11446,CPT,Professional,Both,,,,990,841.5,197.21,990,BlueCross BlueShield Minnesota,Medicare Advantage,352.567,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision,  Benign Lesion Sktag,Face,Ear,Eyelid,Nose,Lip, Muc Memb; Exc Dia Over 4.0 Cm (Pro Cah)",,11446,CPT,Professional,Both,,,,990,841.5,197.21,990,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,658.33752,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision,  Benign Lesion Sktag,Face,Ear,Eyelid,Nose,Lip, Muc Memb; Exc Dia Over 4.0 Cm (Pro Cah)",,11446,CPT,Professional,Both,,,,990,841.5,197.21,990,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,227.6856,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision,  Benign Lesion Sktag,Face,Ear,Eyelid,Nose,Lip, Muc Memb; Exc Dia Over 4.0 Cm (Pro Cah)",,11446,CPT,Professional,Both,,,,990,841.5,197.21,990,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),352.567,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision,  Benign Lesion Sktag,Face,Ear,Eyelid,Nose,Lip, Muc Memb; Exc Dia Over 4.0 Cm (Pro Cah)",,11446,CPT,Professional,Both,,,,990,841.5,197.21,990,CorVel,Worker's Compensation,605.4750819,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Excision,  Benign Lesion Sktag,Face,Ear,Eyelid,Nose,Lip, Muc Memb; Exc Dia Over 4.0 Cm (Pro Cah)",,11446,CPT,Professional,Both,,,,990,841.5,197.21,990,First Health Group Corporation,First Health Network,960.3,97,,percent of total billed charges,,
"Excision,  Benign Lesion Sktag,Face,Ear,Eyelid,Nose,Lip, Muc Memb; Exc Dia Over 4.0 Cm (Pro Cah)",,11446,CPT,Professional,Both,,,,990,841.5,197.21,990,"Health Partners, Inc.",Commercial,653.69,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision,  Benign Lesion Sktag,Face,Ear,Eyelid,Nose,Lip, Muc Memb; Exc Dia Over 4.0 Cm (Pro Cah)",,11446,CPT,Professional,Both,,,,990,841.5,197.21,990,"Health Partners, Inc.",Medicare Advantage,352.567,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision,  Benign Lesion Sktag,Face,Ear,Eyelid,Nose,Lip, Muc Memb; Exc Dia Over 4.0 Cm (Pro Cah)",,11446,CPT,Professional,Both,,,,990,841.5,197.21,990,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),306.68,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Excision,  Benign Lesion Sktag,Face,Ear,Eyelid,Nose,Lip, Muc Memb; Exc Dia Over 4.0 Cm (Pro Cah)",,11446,CPT,Professional,Both,,,,990,841.5,197.21,990,"Health Partners, Inc.",State of Minnesota Advantage Program,563.153935,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision,  Benign Lesion Sktag,Face,Ear,Eyelid,Nose,Lip, Muc Memb; Exc Dia Over 4.0 Cm (Pro Cah)",,11446,CPT,Professional,Both,,,,990,841.5,197.21,990,"Health Partners, Inc.",State Public Programs,197.21,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Excision,  Benign Lesion Sktag,Face,Ear,Eyelid,Nose,Lip, Muc Memb; Exc Dia Over 4.0 Cm (Pro Cah)",,11446,CPT,Professional,Both,,,,990,841.5,197.21,990,Humana Insurance Company,Commercial PPO,306.58,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Excision,  Benign Lesion Sktag,Face,Ear,Eyelid,Nose,Lip, Muc Memb; Exc Dia Over 4.0 Cm (Pro Cah)",,11446,CPT,Professional,Both,,,,990,841.5,197.21,990,Humana Insurance Company,Medicare PPO,990,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Excision,  Benign Lesion Sktag,Face,Ear,Eyelid,Nose,Lip, Muc Memb; Exc Dia Over 4.0 Cm (Pro Cah)",,11446,CPT,Professional,Both,,,,990,841.5,197.21,990,Medica,Individual & Family,839.52,84.8,,percent of total billed charges,,
"Excision,  Benign Lesion Sktag,Face,Ear,Eyelid,Nose,Lip, Muc Memb; Exc Dia Over 4.0 Cm (Pro Cah)",,11446,CPT,Professional,Both,,,,990,841.5,197.21,990,Medica,Medica Advantage Solution,493.02,49.8,,percent of total billed charges,,
"Excision,  Benign Lesion Sktag,Face,Ear,Eyelid,Nose,Lip, Muc Memb; Exc Dia Over 4.0 Cm (Pro Cah)",,11446,CPT,Professional,Both,,,,990,841.5,197.21,990,Medica,Medical Assistance,227.69,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Excision,  Benign Lesion Sktag,Face,Ear,Eyelid,Nose,Lip, Muc Memb; Exc Dia Over 4.0 Cm (Pro Cah)",,11446,CPT,Professional,Both,,,,990,841.5,197.21,990,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,306.58,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Excision,  Benign Lesion Sktag,Face,Ear,Eyelid,Nose,Lip, Muc Memb; Exc Dia Over 4.0 Cm (Pro Cah)",,11446,CPT,Professional,Both,,,,990,841.5,197.21,990,"Multiplan, Inc.","Multiplan, Inc.",930.6,94,,percent of total billed charges,,
"Excision,  Benign Lesion Sktag,Face,Ear,Eyelid,Nose,Lip, Muc Memb; Exc Dia Over 4.0 Cm (Pro Cah)",,11446,CPT,Professional,Both,,,,990,841.5,197.21,990,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,891.99,90.1,,percent of total billed charges,,
"Excision,  Benign Lesion Sktag,Face,Ear,Eyelid,Nose,Lip, Muc Memb; Exc Dia Over 4.0 Cm (Pro Cah)",,11446,CPT,Professional,Both,,,,990,841.5,197.21,990,"Preferred One Administrative Services, INC.",PPO,976.14,98.6,,percent of total billed charges,,
"Excision,  Benign Lesion Sktag,Face,Ear,Eyelid,Nose,Lip, Muc Memb; Exc Dia Over 4.0 Cm (Pro Cah)",,11446,CPT,Professional,Both,,,,990,841.5,197.21,990,PrimeWest Health,Minnesota Senior Health Options (MSHO),352.567,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision,  Benign Lesion Sktag,Face,Ear,Eyelid,Nose,Lip, Muc Memb; Exc Dia Over 4.0 Cm (Pro Cah)",,11446,CPT,Professional,Both,,,,990,841.5,197.21,990,PrimeWest Health,MinnesotaCare,243.623592,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision,  Benign Lesion Sktag,Face,Ear,Eyelid,Nose,Lip, Muc Memb; Exc Dia Over 4.0 Cm (Pro Cah)",,11446,CPT,Professional,Both,,,,990,841.5,197.21,990,Sanford Health Plan,Sanford Health Plan,871.2,88,,percent of total billed charges,,
"Excision,  Benign Lesion Sktag,Face,Ear,Eyelid,Nose,Lip, Muc Memb; Exc Dia Over 4.0 Cm (Pro Cah)",,11446,CPT,Professional,Both,,,,990,841.5,197.21,990,"UCare Health, Inc.",Individual & Family Plan,498.376448,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Excision,  Benign Lesion Sktag,Face,Ear,Eyelid,Nose,Lip, Muc Memb; Exc Dia Over 4.0 Cm (Pro Cah)",,11446,CPT,Professional,Both,,,,990,841.5,197.21,990,"UCare Health, Inc.",Medical Assistance,250.45416,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Excision,  Benign Lesion Sktag,Face,Ear,Eyelid,Nose,Lip, Muc Memb; Exc Dia Over 4.0 Cm (Pro Cah)",,11446,CPT,Professional,Both,,,,990,841.5,197.21,990,"UCare Health, Inc.",Medicare Advantage,352.567,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Excision,  Benign Lesion Sktag,Face,Ear,Eyelid,Nose,Lip, Muc Memb; Exc Dia Over 4.0 Cm (Pro Cah)",,11446,CPT,Professional,Both,,,,990,841.5,197.21,990,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),282.0536,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Excision,  Benign Lesion Sktag,Face,Ear,Eyelid,Nose,Lip, Muc Memb; Exc Dia Over 4.0 Cm (Pro Cah)",,11446,CPT,Professional,Both,,,,990,841.5,197.21,990,UnitedHealthcare,Individual & Family,990,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Excision,  Benign Lesion Sktag,Face,Ear,Eyelid,Nose,Lip, Muc Memb; Exc Dia Over 4.0 Cm (Pro Cah)",,11446,CPT,Professional,Both,,,,990,841.5,197.21,990,UnitedHealthcare,Medicare Advantage,352.567,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision,  Benign Lesion Sktag,Face,Ear,Eyelid,Nose,Lip, Muc Memb; Exc Dia Over 4.0 Cm (Pro Cah)",,11446,CPT,Professional,Both,,,,990,841.5,197.21,990,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,227.6856,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
ACETAMINOPHEN 80 MG RECT SUPP,,16824,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
ACETAMINOPHEN 80 MG RECT SUPP,,16824,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
ACETAMINOPHEN 80 MG RECT SUPP,,16824,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
ACETAMINOPHEN 80 MG RECT SUPP,,16824,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
ACETAMINOPHEN 80 MG RECT SUPP,,16824,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
ACETAMINOPHEN 80 MG RECT SUPP,,16824,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
ACETAMINOPHEN 80 MG RECT SUPP,,16824,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
ACETAMINOPHEN 80 MG RECT SUPP,,16824,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
ACETAMINOPHEN 80 MG RECT SUPP,,16824,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
ACETAMINOPHEN 80 MG RECT SUPP,,16824,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
ACETAMINOPHEN 80 MG RECT SUPP,,16824,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
ACETAMINOPHEN 80 MG RECT SUPP,,16824,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
ACETAMINOPHEN 80 MG RECT SUPP,,16824,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
ACETAMINOPHEN 80 MG RECT SUPP,,16824,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
ACETAMINOPHEN 80 MG RECT SUPP,,16824,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
ACETAMINOPHEN 80 MG RECT SUPP,,16824,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
ACETAMINOPHEN 80 MG RECT SUPP,,16824,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
ACETAMINOPHEN 80 MG RECT SUPP,,16824,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
ACETAMINOPHEN 80 MG RECT SUPP,,16824,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ACETAMINOPHEN 80 MG RECT SUPP,,16824,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
ACETAMINOPHEN 80 MG RECT SUPP,,16824,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
ACETAMINOPHEN 80 MG RECT SUPP,,16824,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
ACETAMINOPHEN 80 MG RECT SUPP,,16824,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
ACETAMINOPHEN 80 MG RECT SUPP,,16824,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
ACETAMINOPHEN 80 MG RECT SUPP,,16824,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
ACETAMINOPHEN 80 MG RECT SUPP,,16824,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
ACETAMINOPHEN 80 MG RECT SUPP,,16824,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
ACETAMINOPHEN 80 MG RECT SUPP,,16824,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
ACETAMINOPHEN 80 MG RECT SUPP,,16824,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
ACETAMINOPHEN 80 MG RECT SUPP,,16824,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
ACETAMINOPHEN 80 MG RECT SUPP,,16824,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
ACETAMINOPHEN 80 MG RECT SUPP,,16824,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
ACETAMINOPHEN 80 MG RECT SUPP,,16824,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
ACETAMINOPHEN 80 MG RECT SUPP,,16824,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
ACETAMINOPHEN 80 MG RECT SUPP,,16824,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
ACETAMINOPHEN 80 MG RECT SUPP,,16824,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
ACETAMINOPHEN 80 MG RECT SUPP,,16824,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
ACETAMINOPHEN 80 MG RECT SUPP,,16824,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ACETAMINOPHEN 80 MG RECT SUPP,,16824,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
ACETAMINOPHEN 80 MG RECT SUPP,,16824,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
ACETAMINOPHEN 80 MG RECT SUPP,,16824,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
ACETAMINOPHEN 80 MG RECT SUPP,,16824,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
ACETAMINOPHEN 80 MG RECT SUPP,,16824,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
ACETAMINOPHEN 80 MG RECT SUPP,,16824,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ACETAMINOPHEN 80 MG RECT SUPP,,16824,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
ACETAMINOPHEN 80 MG RECT SUPP,,16824,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ACETAMINOPHEN 80 MG RECT SUPP,,16824,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ACETAMINOPHEN 80 MG RECT SUPP,,16824,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ACETAMINOPHEN 80 MG RECT SUPP,,16824,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ACETAMINOPHEN 80 MG RECT SUPP,,16824,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
ACETAMINOPHEN 80 MG RECT SUPP,,16824,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
ACETAMINOPHEN 80 MG RECT SUPP,,16824,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
ACETAMINOPHEN 80 MG RECT SUPP,,16824,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
ACETAMINOPHEN 80 MG RECT SUPP,,16824,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
ZALEPLON 5 MG ORAL CAP,,17046,LOCAL,Facility,Both,1,Each,,19,16.15,5.4454,19,Aetna,Commercial,17.48,92,,percent of total billed charges,,
ZALEPLON 5 MG ORAL CAP,,17046,LOCAL,Facility,Outpatient,1,Each,,19,16.15,5.4454,19,Aetna,Medicare Advantage,9.31,49,,percent of total billed charges,,
ZALEPLON 5 MG ORAL CAP,,17046,LOCAL,Facility,Inpatient,1,Each,,19,16.15,5.4454,19,Aetna,Medicare Advantage,,,,,Included in per diem rate,
ZALEPLON 5 MG ORAL CAP,,17046,LOCAL,Facility,Both,1,Each,,19,16.15,5.4454,19,Aetna,PPO,17.67,93,,percent of total billed charges,,
ZALEPLON 5 MG ORAL CAP,,17046,LOCAL,Facility,Both,1,Each,,19,16.15,5.4454,19,America's PPO,America's PPO,18.2457,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
ZALEPLON 5 MG ORAL CAP,,17046,LOCAL,Facility,Both,1,Each,,19,16.15,5.4454,19,BlueCross BlueShield Minnesota, Federal Employee Program,18.696,98.4,,percent of total billed charges,,
ZALEPLON 5 MG ORAL CAP,,17046,LOCAL,Facility,Both,1,Each,,19,16.15,5.4454,19,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,19,100,,percent of total billed charges,,
ZALEPLON 5 MG ORAL CAP,,17046,LOCAL,Facility,Both,1,Each,,19,16.15,5.4454,19,BlueCross BlueShield Minnesota,High Value Network Plan,17.1,90,,percent of total billed charges,,
ZALEPLON 5 MG ORAL CAP,,17046,LOCAL,Facility,Outpatient,1,Each,,19,16.15,5.4454,19,BlueCross BlueShield Minnesota,Medicare Advantage,9.31,49,,percent of total billed charges,,
ZALEPLON 5 MG ORAL CAP,,17046,LOCAL,Facility,Inpatient,1,Each,,19,16.15,5.4454,19,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
ZALEPLON 5 MG ORAL CAP,,17046,LOCAL,Facility,Both,1,Each,,19,16.15,5.4454,19,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,16.8283,88.57,,percent of total billed charges,,
ZALEPLON 5 MG ORAL CAP,,17046,LOCAL,Facility,Both,1,Each,,19,16.15,5.4454,19,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,5.4454,28.66,,percent of total billed charges,,
ZALEPLON 5 MG ORAL CAP,,17046,LOCAL,Facility,Outpatient,1,Each,,19,16.15,5.4454,19,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),9.31,49,,percent of total billed charges,,
ZALEPLON 5 MG ORAL CAP,,17046,LOCAL,Facility,Inpatient,1,Each,,19,16.15,5.4454,19,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
ZALEPLON 5 MG ORAL CAP,,17046,LOCAL,Facility,Both,1,Each,,19,16.15,5.4454,19,CorVel,Worker's Compensation,19,100,,percent of total billed charges,,
ZALEPLON 5 MG ORAL CAP,,17046,LOCAL,Facility,Both,1,Each,,19,16.15,5.4454,19,First Health Group Corporation,First Health Network,18.43,97,,percent of total billed charges,,
ZALEPLON 5 MG ORAL CAP,,17046,LOCAL,Facility,Both,1,Each,,19,16.15,5.4454,19,"Health Partners, Inc.",Commercial,17.974,94.6,,percent of total billed charges,,
ZALEPLON 5 MG ORAL CAP,,17046,LOCAL,Facility,Outpatient,1,Each,,19,16.15,5.4454,19,"Health Partners, Inc.",Medicare Advantage,9.31,49,,percent of total billed charges,,
ZALEPLON 5 MG ORAL CAP,,17046,LOCAL,Facility,Inpatient,1,Each,,19,16.15,5.4454,19,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ZALEPLON 5 MG ORAL CAP,,17046,LOCAL,Facility,Both,1,Each,,19,16.15,5.4454,19,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),11.4,60,,percent of total billed charges,,
ZALEPLON 5 MG ORAL CAP,,17046,LOCAL,Facility,Both,1,Each,,19,16.15,5.4454,19,"Health Partners, Inc.",State of Minnesota Advantage Program,15.485,81.5,,percent of total billed charges,,
ZALEPLON 5 MG ORAL CAP,,17046,LOCAL,Facility,Both,1,Each,,19,16.15,5.4454,19,"Health Partners, Inc.",State Public Programs,9.5,50,,percent of total billed charges,,
ZALEPLON 5 MG ORAL CAP,,17046,LOCAL,Facility,Both,1,Each,,19,16.15,5.4454,19,Humana Insurance Company,Commercial PPO,18.05,95,,percent of total billed charges,,
ZALEPLON 5 MG ORAL CAP,,17046,LOCAL,Facility,Outpatient,1,Each,,19,16.15,5.4454,19,Humana Insurance Company,Medicare PPO,9.31,49,,percent of total billed charges,,
ZALEPLON 5 MG ORAL CAP,,17046,LOCAL,Facility,Inpatient,1,Each,,19,16.15,5.4454,19,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
ZALEPLON 5 MG ORAL CAP,,17046,LOCAL,Facility,Both,1,Each,,19,16.15,5.4454,19,Medica,Individual & Family,18.829,99.1,,percent of total billed charges,,
ZALEPLON 5 MG ORAL CAP,,17046,LOCAL,Facility,Outpatient,1,Each,,19,16.15,5.4454,19,Medica,Medica Advantage Solution,9.462,49.8,,percent of total billed charges,,
ZALEPLON 5 MG ORAL CAP,,17046,LOCAL,Facility,Inpatient,1,Each,,19,16.15,5.4454,19,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
ZALEPLON 5 MG ORAL CAP,,17046,LOCAL,Facility,Outpatient,1,Each,,19,16.15,5.4454,19,Medica,Medical Assistance,8.474,44.6,,percent of total billed charges,,
ZALEPLON 5 MG ORAL CAP,,17046,LOCAL,Facility,Inpatient,1,Each,,19,16.15,5.4454,19,Medica,Medical Assistance,,,,,Included in per diem rate,
ZALEPLON 5 MG ORAL CAP,,17046,LOCAL,Facility,Outpatient,1,Each,,19,16.15,5.4454,19,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,9.462,49.8,,percent of total billed charges,,
ZALEPLON 5 MG ORAL CAP,,17046,LOCAL,Facility,Inpatient,1,Each,,19,16.15,5.4454,19,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
ZALEPLON 5 MG ORAL CAP,,17046,LOCAL,Facility,Both,1,Each,,19,16.15,5.4454,19,"Multiplan, Inc.","Multiplan, Inc.",17.86,94,,percent of total billed charges,,
ZALEPLON 5 MG ORAL CAP,,17046,LOCAL,Facility,Outpatient,1,Each,,19,16.15,5.4454,19,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,17.119,90.1,,percent of total billed charges,,
ZALEPLON 5 MG ORAL CAP,,17046,LOCAL,Facility,Inpatient,1,Each,,19,16.15,5.4454,19,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
ZALEPLON 5 MG ORAL CAP,,17046,LOCAL,Facility,Both,1,Each,,19,16.15,5.4454,19,"Preferred One Administrative Services, INC.",PPO,18.734,98.6,,percent of total billed charges,,
ZALEPLON 5 MG ORAL CAP,,17046,LOCAL,Facility,Outpatient,1,Each,,19,16.15,5.4454,19,PrimeWest Health,Minnesota Senior Health Options (MSHO),9.7755,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
ZALEPLON 5 MG ORAL CAP,,17046,LOCAL,Facility,Inpatient,1,Each,,19,16.15,5.4454,19,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ZALEPLON 5 MG ORAL CAP,,17046,LOCAL,Facility,Outpatient,1,Each,,19,16.15,5.4454,19,PrimeWest Health,MinnesotaCare,9.7584,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
ZALEPLON 5 MG ORAL CAP,,17046,LOCAL,Facility,Inpatient,1,Each,,19,16.15,5.4454,19,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
ZALEPLON 5 MG ORAL CAP,,17046,LOCAL,Facility,Both,1,Each,,19,16.15,5.4454,19,Sanford Health Plan,Sanford Health Plan,17.48,92,,percent of total billed charges,,
ZALEPLON 5 MG ORAL CAP,,17046,LOCAL,Facility,Outpatient,1,Each,,19,16.15,5.4454,19,"UCare Health, Inc.",Individual & Family Plan,10.7065,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
ZALEPLON 5 MG ORAL CAP,,17046,LOCAL,Facility,Inpatient,1,Each,,19,16.15,5.4454,19,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
ZALEPLON 5 MG ORAL CAP,,17046,LOCAL,Facility,Outpatient,1,Each,,19,16.15,5.4454,19,"UCare Health, Inc.",Medical Assistance,9.5893,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ZALEPLON 5 MG ORAL CAP,,17046,LOCAL,Facility,Inpatient,1,Each,,19,16.15,5.4454,19,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
ZALEPLON 5 MG ORAL CAP,,17046,LOCAL,Facility,Outpatient,1,Each,,19,16.15,5.4454,19,"UCare Health, Inc.",Medicare Advantage,9.5893,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ZALEPLON 5 MG ORAL CAP,,17046,LOCAL,Facility,Inpatient,1,Each,,19,16.15,5.4454,19,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ZALEPLON 5 MG ORAL CAP,,17046,LOCAL,Facility,Outpatient,1,Each,,19,16.15,5.4454,19,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),9.5893,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ZALEPLON 5 MG ORAL CAP,,17046,LOCAL,Facility,Inpatient,1,Each,,19,16.15,5.4454,19,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ZALEPLON 5 MG ORAL CAP,,17046,LOCAL,Facility,Both,1,Each,,19,16.15,5.4454,19,UnitedHealthcare,Individual & Family,17.86,94,,percent of total billed charges,,
ZALEPLON 5 MG ORAL CAP,,17046,LOCAL,Facility,Outpatient,1,Each,,19,16.15,5.4454,19,UnitedHealthcare,Medicare Advantage,9.31,49,,percent of total billed charges,,
ZALEPLON 5 MG ORAL CAP,,17046,LOCAL,Facility,Inpatient,1,Each,,19,16.15,5.4454,19,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
ZALEPLON 5 MG ORAL CAP,,17046,LOCAL,Facility,Outpatient,1,Each,,19,16.15,5.4454,19,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,9.12,48,,percent of total billed charges,,100% of DHS outpatient percentage
ZALEPLON 5 MG ORAL CAP,,17046,LOCAL,Facility,Inpatient,1,Each,,19,16.15,5.4454,19,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
WARFARIN 1 MG ORAL TABLET,,17110,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
WARFARIN 1 MG ORAL TABLET,,17110,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
WARFARIN 1 MG ORAL TABLET,,17110,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
WARFARIN 1 MG ORAL TABLET,,17110,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
WARFARIN 1 MG ORAL TABLET,,17110,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
WARFARIN 1 MG ORAL TABLET,,17110,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
WARFARIN 1 MG ORAL TABLET,,17110,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
WARFARIN 1 MG ORAL TABLET,,17110,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
WARFARIN 1 MG ORAL TABLET,,17110,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
WARFARIN 1 MG ORAL TABLET,,17110,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
WARFARIN 1 MG ORAL TABLET,,17110,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
WARFARIN 1 MG ORAL TABLET,,17110,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
WARFARIN 1 MG ORAL TABLET,,17110,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
WARFARIN 1 MG ORAL TABLET,,17110,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
WARFARIN 1 MG ORAL TABLET,,17110,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
WARFARIN 1 MG ORAL TABLET,,17110,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
WARFARIN 1 MG ORAL TABLET,,17110,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
WARFARIN 1 MG ORAL TABLET,,17110,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
WARFARIN 1 MG ORAL TABLET,,17110,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
WARFARIN 1 MG ORAL TABLET,,17110,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
WARFARIN 1 MG ORAL TABLET,,17110,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
WARFARIN 1 MG ORAL TABLET,,17110,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
WARFARIN 1 MG ORAL TABLET,,17110,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
WARFARIN 1 MG ORAL TABLET,,17110,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
WARFARIN 1 MG ORAL TABLET,,17110,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
WARFARIN 1 MG ORAL TABLET,,17110,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
WARFARIN 1 MG ORAL TABLET,,17110,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
WARFARIN 1 MG ORAL TABLET,,17110,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
WARFARIN 1 MG ORAL TABLET,,17110,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
WARFARIN 1 MG ORAL TABLET,,17110,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
WARFARIN 1 MG ORAL TABLET,,17110,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
WARFARIN 1 MG ORAL TABLET,,17110,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
WARFARIN 1 MG ORAL TABLET,,17110,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
WARFARIN 1 MG ORAL TABLET,,17110,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
WARFARIN 1 MG ORAL TABLET,,17110,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
WARFARIN 1 MG ORAL TABLET,,17110,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
WARFARIN 1 MG ORAL TABLET,,17110,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
WARFARIN 1 MG ORAL TABLET,,17110,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
WARFARIN 1 MG ORAL TABLET,,17110,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
WARFARIN 1 MG ORAL TABLET,,17110,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
WARFARIN 1 MG ORAL TABLET,,17110,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
WARFARIN 1 MG ORAL TABLET,,17110,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
WARFARIN 1 MG ORAL TABLET,,17110,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
WARFARIN 1 MG ORAL TABLET,,17110,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
WARFARIN 1 MG ORAL TABLET,,17110,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
WARFARIN 1 MG ORAL TABLET,,17110,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
WARFARIN 1 MG ORAL TABLET,,17110,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
WARFARIN 1 MG ORAL TABLET,,17110,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
WARFARIN 1 MG ORAL TABLET,,17110,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
WARFARIN 1 MG ORAL TABLET,,17110,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
WARFARIN 1 MG ORAL TABLET,,17110,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
WARFARIN 1 MG ORAL TABLET,,17110,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
WARFARIN 1 MG ORAL TABLET,,17110,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
WARFARIN 1 MG ORAL TABLET,,17110,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
BUDESONIDE 3 MG ORAL CECX,,17115,LOCAL,Facility,Both,1,Each,,112,95.2,32.0992,112,Aetna,Commercial,103.04,92,,percent of total billed charges,,
BUDESONIDE 3 MG ORAL CECX,,17115,LOCAL,Facility,Outpatient,1,Each,,112,95.2,32.0992,112,Aetna,Medicare Advantage,54.88,49,,percent of total billed charges,,
BUDESONIDE 3 MG ORAL CECX,,17115,LOCAL,Facility,Inpatient,1,Each,,112,95.2,32.0992,112,Aetna,Medicare Advantage,,,,,Included in per diem rate,
BUDESONIDE 3 MG ORAL CECX,,17115,LOCAL,Facility,Both,1,Each,,112,95.2,32.0992,112,Aetna,PPO,104.16,93,,percent of total billed charges,,
BUDESONIDE 3 MG ORAL CECX,,17115,LOCAL,Facility,Both,1,Each,,112,95.2,32.0992,112,America's PPO,America's PPO,107.5536,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
BUDESONIDE 3 MG ORAL CECX,,17115,LOCAL,Facility,Both,1,Each,,112,95.2,32.0992,112,BlueCross BlueShield Minnesota, Federal Employee Program,110.208,98.4,,percent of total billed charges,,
BUDESONIDE 3 MG ORAL CECX,,17115,LOCAL,Facility,Both,1,Each,,112,95.2,32.0992,112,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,112,100,,percent of total billed charges,,
BUDESONIDE 3 MG ORAL CECX,,17115,LOCAL,Facility,Both,1,Each,,112,95.2,32.0992,112,BlueCross BlueShield Minnesota,High Value Network Plan,100.8,90,,percent of total billed charges,,
BUDESONIDE 3 MG ORAL CECX,,17115,LOCAL,Facility,Outpatient,1,Each,,112,95.2,32.0992,112,BlueCross BlueShield Minnesota,Medicare Advantage,54.88,49,,percent of total billed charges,,
BUDESONIDE 3 MG ORAL CECX,,17115,LOCAL,Facility,Inpatient,1,Each,,112,95.2,32.0992,112,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
BUDESONIDE 3 MG ORAL CECX,,17115,LOCAL,Facility,Both,1,Each,,112,95.2,32.0992,112,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,99.1984,88.57,,percent of total billed charges,,
BUDESONIDE 3 MG ORAL CECX,,17115,LOCAL,Facility,Both,1,Each,,112,95.2,32.0992,112,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,32.0992,28.66,,percent of total billed charges,,
BUDESONIDE 3 MG ORAL CECX,,17115,LOCAL,Facility,Outpatient,1,Each,,112,95.2,32.0992,112,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),54.88,49,,percent of total billed charges,,
BUDESONIDE 3 MG ORAL CECX,,17115,LOCAL,Facility,Inpatient,1,Each,,112,95.2,32.0992,112,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
BUDESONIDE 3 MG ORAL CECX,,17115,LOCAL,Facility,Both,1,Each,,112,95.2,32.0992,112,CorVel,Worker's Compensation,112,100,,percent of total billed charges,,
BUDESONIDE 3 MG ORAL CECX,,17115,LOCAL,Facility,Both,1,Each,,112,95.2,32.0992,112,First Health Group Corporation,First Health Network,108.64,97,,percent of total billed charges,,
BUDESONIDE 3 MG ORAL CECX,,17115,LOCAL,Facility,Both,1,Each,,112,95.2,32.0992,112,"Health Partners, Inc.",Commercial,105.952,94.6,,percent of total billed charges,,
BUDESONIDE 3 MG ORAL CECX,,17115,LOCAL,Facility,Outpatient,1,Each,,112,95.2,32.0992,112,"Health Partners, Inc.",Medicare Advantage,54.88,49,,percent of total billed charges,,
BUDESONIDE 3 MG ORAL CECX,,17115,LOCAL,Facility,Inpatient,1,Each,,112,95.2,32.0992,112,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
BUDESONIDE 3 MG ORAL CECX,,17115,LOCAL,Facility,Both,1,Each,,112,95.2,32.0992,112,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),67.2,60,,percent of total billed charges,,
BUDESONIDE 3 MG ORAL CECX,,17115,LOCAL,Facility,Both,1,Each,,112,95.2,32.0992,112,"Health Partners, Inc.",State of Minnesota Advantage Program,91.28,81.5,,percent of total billed charges,,
BUDESONIDE 3 MG ORAL CECX,,17115,LOCAL,Facility,Both,1,Each,,112,95.2,32.0992,112,"Health Partners, Inc.",State Public Programs,56,50,,percent of total billed charges,,
BUDESONIDE 3 MG ORAL CECX,,17115,LOCAL,Facility,Both,1,Each,,112,95.2,32.0992,112,Humana Insurance Company,Commercial PPO,106.4,95,,percent of total billed charges,,
BUDESONIDE 3 MG ORAL CECX,,17115,LOCAL,Facility,Outpatient,1,Each,,112,95.2,32.0992,112,Humana Insurance Company,Medicare PPO,54.88,49,,percent of total billed charges,,
BUDESONIDE 3 MG ORAL CECX,,17115,LOCAL,Facility,Inpatient,1,Each,,112,95.2,32.0992,112,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
BUDESONIDE 3 MG ORAL CECX,,17115,LOCAL,Facility,Both,1,Each,,112,95.2,32.0992,112,Medica,Individual & Family,110.992,99.1,,percent of total billed charges,,
BUDESONIDE 3 MG ORAL CECX,,17115,LOCAL,Facility,Outpatient,1,Each,,112,95.2,32.0992,112,Medica,Medica Advantage Solution,55.776,49.8,,percent of total billed charges,,
BUDESONIDE 3 MG ORAL CECX,,17115,LOCAL,Facility,Inpatient,1,Each,,112,95.2,32.0992,112,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
BUDESONIDE 3 MG ORAL CECX,,17115,LOCAL,Facility,Outpatient,1,Each,,112,95.2,32.0992,112,Medica,Medical Assistance,49.952,44.6,,percent of total billed charges,,
BUDESONIDE 3 MG ORAL CECX,,17115,LOCAL,Facility,Inpatient,1,Each,,112,95.2,32.0992,112,Medica,Medical Assistance,,,,,Included in per diem rate,
BUDESONIDE 3 MG ORAL CECX,,17115,LOCAL,Facility,Outpatient,1,Each,,112,95.2,32.0992,112,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,55.776,49.8,,percent of total billed charges,,
BUDESONIDE 3 MG ORAL CECX,,17115,LOCAL,Facility,Inpatient,1,Each,,112,95.2,32.0992,112,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
BUDESONIDE 3 MG ORAL CECX,,17115,LOCAL,Facility,Both,1,Each,,112,95.2,32.0992,112,"Multiplan, Inc.","Multiplan, Inc.",105.28,94,,percent of total billed charges,,
BUDESONIDE 3 MG ORAL CECX,,17115,LOCAL,Facility,Outpatient,1,Each,,112,95.2,32.0992,112,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,100.912,90.1,,percent of total billed charges,,
BUDESONIDE 3 MG ORAL CECX,,17115,LOCAL,Facility,Inpatient,1,Each,,112,95.2,32.0992,112,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
BUDESONIDE 3 MG ORAL CECX,,17115,LOCAL,Facility,Both,1,Each,,112,95.2,32.0992,112,"Preferred One Administrative Services, INC.",PPO,110.432,98.6,,percent of total billed charges,,
BUDESONIDE 3 MG ORAL CECX,,17115,LOCAL,Facility,Outpatient,1,Each,,112,95.2,32.0992,112,PrimeWest Health,Minnesota Senior Health Options (MSHO),57.624,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
BUDESONIDE 3 MG ORAL CECX,,17115,LOCAL,Facility,Inpatient,1,Each,,112,95.2,32.0992,112,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
BUDESONIDE 3 MG ORAL CECX,,17115,LOCAL,Facility,Outpatient,1,Each,,112,95.2,32.0992,112,PrimeWest Health,MinnesotaCare,57.5232,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
BUDESONIDE 3 MG ORAL CECX,,17115,LOCAL,Facility,Inpatient,1,Each,,112,95.2,32.0992,112,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
BUDESONIDE 3 MG ORAL CECX,,17115,LOCAL,Facility,Both,1,Each,,112,95.2,32.0992,112,Sanford Health Plan,Sanford Health Plan,103.04,92,,percent of total billed charges,,
BUDESONIDE 3 MG ORAL CECX,,17115,LOCAL,Facility,Outpatient,1,Each,,112,95.2,32.0992,112,"UCare Health, Inc.",Individual & Family Plan,63.112,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
BUDESONIDE 3 MG ORAL CECX,,17115,LOCAL,Facility,Inpatient,1,Each,,112,95.2,32.0992,112,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
BUDESONIDE 3 MG ORAL CECX,,17115,LOCAL,Facility,Outpatient,1,Each,,112,95.2,32.0992,112,"UCare Health, Inc.",Medical Assistance,56.5264,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BUDESONIDE 3 MG ORAL CECX,,17115,LOCAL,Facility,Inpatient,1,Each,,112,95.2,32.0992,112,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
BUDESONIDE 3 MG ORAL CECX,,17115,LOCAL,Facility,Outpatient,1,Each,,112,95.2,32.0992,112,"UCare Health, Inc.",Medicare Advantage,56.5264,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BUDESONIDE 3 MG ORAL CECX,,17115,LOCAL,Facility,Inpatient,1,Each,,112,95.2,32.0992,112,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
BUDESONIDE 3 MG ORAL CECX,,17115,LOCAL,Facility,Outpatient,1,Each,,112,95.2,32.0992,112,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),56.5264,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BUDESONIDE 3 MG ORAL CECX,,17115,LOCAL,Facility,Inpatient,1,Each,,112,95.2,32.0992,112,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
BUDESONIDE 3 MG ORAL CECX,,17115,LOCAL,Facility,Both,1,Each,,112,95.2,32.0992,112,UnitedHealthcare,Individual & Family,105.28,94,,percent of total billed charges,,
BUDESONIDE 3 MG ORAL CECX,,17115,LOCAL,Facility,Outpatient,1,Each,,112,95.2,32.0992,112,UnitedHealthcare,Medicare Advantage,54.88,49,,percent of total billed charges,,
BUDESONIDE 3 MG ORAL CECX,,17115,LOCAL,Facility,Inpatient,1,Each,,112,95.2,32.0992,112,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
BUDESONIDE 3 MG ORAL CECX,,17115,LOCAL,Facility,Outpatient,1,Each,,112,95.2,32.0992,112,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,53.76,48,,percent of total billed charges,,100% of DHS outpatient percentage
BUDESONIDE 3 MG ORAL CECX,,17115,LOCAL,Facility,Inpatient,1,Each,,112,95.2,32.0992,112,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
FLUTICASONE PROPION-SALMETEROL 100-50 MCG/DOSE INHL DSDV,,17211,LOCAL,Facility,Both,1,Each,,711,604.35,203.7726,711,Aetna,Commercial,654.12,92,,percent of total billed charges,,
FLUTICASONE PROPION-SALMETEROL 100-50 MCG/DOSE INHL DSDV,,17211,LOCAL,Facility,Outpatient,1,Each,,711,604.35,203.7726,711,Aetna,Medicare Advantage,348.39,49,,percent of total billed charges,,
FLUTICASONE PROPION-SALMETEROL 100-50 MCG/DOSE INHL DSDV,,17211,LOCAL,Facility,Inpatient,1,Each,,711,604.35,203.7726,711,Aetna,Medicare Advantage,,,,,Included in per diem rate,
FLUTICASONE PROPION-SALMETEROL 100-50 MCG/DOSE INHL DSDV,,17211,LOCAL,Facility,Both,1,Each,,711,604.35,203.7726,711,Aetna,PPO,661.23,93,,percent of total billed charges,,
FLUTICASONE PROPION-SALMETEROL 100-50 MCG/DOSE INHL DSDV,,17211,LOCAL,Facility,Both,1,Each,,711,604.35,203.7726,711,America's PPO,America's PPO,682.7733,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
FLUTICASONE PROPION-SALMETEROL 100-50 MCG/DOSE INHL DSDV,,17211,LOCAL,Facility,Both,1,Each,,711,604.35,203.7726,711,BlueCross BlueShield Minnesota, Federal Employee Program,699.624,98.4,,percent of total billed charges,,
FLUTICASONE PROPION-SALMETEROL 100-50 MCG/DOSE INHL DSDV,,17211,LOCAL,Facility,Both,1,Each,,711,604.35,203.7726,711,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,711,100,,percent of total billed charges,,
FLUTICASONE PROPION-SALMETEROL 100-50 MCG/DOSE INHL DSDV,,17211,LOCAL,Facility,Both,1,Each,,711,604.35,203.7726,711,BlueCross BlueShield Minnesota,High Value Network Plan,639.9,90,,percent of total billed charges,,
FLUTICASONE PROPION-SALMETEROL 100-50 MCG/DOSE INHL DSDV,,17211,LOCAL,Facility,Outpatient,1,Each,,711,604.35,203.7726,711,BlueCross BlueShield Minnesota,Medicare Advantage,348.39,49,,percent of total billed charges,,
FLUTICASONE PROPION-SALMETEROL 100-50 MCG/DOSE INHL DSDV,,17211,LOCAL,Facility,Inpatient,1,Each,,711,604.35,203.7726,711,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
FLUTICASONE PROPION-SALMETEROL 100-50 MCG/DOSE INHL DSDV,,17211,LOCAL,Facility,Both,1,Each,,711,604.35,203.7726,711,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,629.7327,88.57,,percent of total billed charges,,
FLUTICASONE PROPION-SALMETEROL 100-50 MCG/DOSE INHL DSDV,,17211,LOCAL,Facility,Both,1,Each,,711,604.35,203.7726,711,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,203.7726,28.66,,percent of total billed charges,,
FLUTICASONE PROPION-SALMETEROL 100-50 MCG/DOSE INHL DSDV,,17211,LOCAL,Facility,Outpatient,1,Each,,711,604.35,203.7726,711,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),348.39,49,,percent of total billed charges,,
FLUTICASONE PROPION-SALMETEROL 100-50 MCG/DOSE INHL DSDV,,17211,LOCAL,Facility,Inpatient,1,Each,,711,604.35,203.7726,711,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
FLUTICASONE PROPION-SALMETEROL 100-50 MCG/DOSE INHL DSDV,,17211,LOCAL,Facility,Both,1,Each,,711,604.35,203.7726,711,CorVel,Worker's Compensation,711,100,,percent of total billed charges,,
FLUTICASONE PROPION-SALMETEROL 100-50 MCG/DOSE INHL DSDV,,17211,LOCAL,Facility,Both,1,Each,,711,604.35,203.7726,711,First Health Group Corporation,First Health Network,689.67,97,,percent of total billed charges,,
FLUTICASONE PROPION-SALMETEROL 100-50 MCG/DOSE INHL DSDV,,17211,LOCAL,Facility,Both,1,Each,,711,604.35,203.7726,711,"Health Partners, Inc.",Commercial,672.606,94.6,,percent of total billed charges,,
FLUTICASONE PROPION-SALMETEROL 100-50 MCG/DOSE INHL DSDV,,17211,LOCAL,Facility,Outpatient,1,Each,,711,604.35,203.7726,711,"Health Partners, Inc.",Medicare Advantage,348.39,49,,percent of total billed charges,,
FLUTICASONE PROPION-SALMETEROL 100-50 MCG/DOSE INHL DSDV,,17211,LOCAL,Facility,Inpatient,1,Each,,711,604.35,203.7726,711,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
FLUTICASONE PROPION-SALMETEROL 100-50 MCG/DOSE INHL DSDV,,17211,LOCAL,Facility,Both,1,Each,,711,604.35,203.7726,711,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),426.6,60,,percent of total billed charges,,
FLUTICASONE PROPION-SALMETEROL 100-50 MCG/DOSE INHL DSDV,,17211,LOCAL,Facility,Both,1,Each,,711,604.35,203.7726,711,"Health Partners, Inc.",State of Minnesota Advantage Program,579.465,81.5,,percent of total billed charges,,
FLUTICASONE PROPION-SALMETEROL 100-50 MCG/DOSE INHL DSDV,,17211,LOCAL,Facility,Both,1,Each,,711,604.35,203.7726,711,"Health Partners, Inc.",State Public Programs,355.5,50,,percent of total billed charges,,
FLUTICASONE PROPION-SALMETEROL 100-50 MCG/DOSE INHL DSDV,,17211,LOCAL,Facility,Both,1,Each,,711,604.35,203.7726,711,Humana Insurance Company,Commercial PPO,675.45,95,,percent of total billed charges,,
FLUTICASONE PROPION-SALMETEROL 100-50 MCG/DOSE INHL DSDV,,17211,LOCAL,Facility,Outpatient,1,Each,,711,604.35,203.7726,711,Humana Insurance Company,Medicare PPO,348.39,49,,percent of total billed charges,,
FLUTICASONE PROPION-SALMETEROL 100-50 MCG/DOSE INHL DSDV,,17211,LOCAL,Facility,Inpatient,1,Each,,711,604.35,203.7726,711,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
FLUTICASONE PROPION-SALMETEROL 100-50 MCG/DOSE INHL DSDV,,17211,LOCAL,Facility,Both,1,Each,,711,604.35,203.7726,711,Medica,Individual & Family,704.601,99.1,,percent of total billed charges,,
FLUTICASONE PROPION-SALMETEROL 100-50 MCG/DOSE INHL DSDV,,17211,LOCAL,Facility,Outpatient,1,Each,,711,604.35,203.7726,711,Medica,Medica Advantage Solution,354.078,49.8,,percent of total billed charges,,
FLUTICASONE PROPION-SALMETEROL 100-50 MCG/DOSE INHL DSDV,,17211,LOCAL,Facility,Inpatient,1,Each,,711,604.35,203.7726,711,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
FLUTICASONE PROPION-SALMETEROL 100-50 MCG/DOSE INHL DSDV,,17211,LOCAL,Facility,Outpatient,1,Each,,711,604.35,203.7726,711,Medica,Medical Assistance,317.106,44.6,,percent of total billed charges,,
FLUTICASONE PROPION-SALMETEROL 100-50 MCG/DOSE INHL DSDV,,17211,LOCAL,Facility,Inpatient,1,Each,,711,604.35,203.7726,711,Medica,Medical Assistance,,,,,Included in per diem rate,
FLUTICASONE PROPION-SALMETEROL 100-50 MCG/DOSE INHL DSDV,,17211,LOCAL,Facility,Outpatient,1,Each,,711,604.35,203.7726,711,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,354.078,49.8,,percent of total billed charges,,
FLUTICASONE PROPION-SALMETEROL 100-50 MCG/DOSE INHL DSDV,,17211,LOCAL,Facility,Inpatient,1,Each,,711,604.35,203.7726,711,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
FLUTICASONE PROPION-SALMETEROL 100-50 MCG/DOSE INHL DSDV,,17211,LOCAL,Facility,Both,1,Each,,711,604.35,203.7726,711,"Multiplan, Inc.","Multiplan, Inc.",668.34,94,,percent of total billed charges,,
FLUTICASONE PROPION-SALMETEROL 100-50 MCG/DOSE INHL DSDV,,17211,LOCAL,Facility,Outpatient,1,Each,,711,604.35,203.7726,711,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,640.611,90.1,,percent of total billed charges,,
FLUTICASONE PROPION-SALMETEROL 100-50 MCG/DOSE INHL DSDV,,17211,LOCAL,Facility,Inpatient,1,Each,,711,604.35,203.7726,711,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
FLUTICASONE PROPION-SALMETEROL 100-50 MCG/DOSE INHL DSDV,,17211,LOCAL,Facility,Both,1,Each,,711,604.35,203.7726,711,"Preferred One Administrative Services, INC.",PPO,701.046,98.6,,percent of total billed charges,,
FLUTICASONE PROPION-SALMETEROL 100-50 MCG/DOSE INHL DSDV,,17211,LOCAL,Facility,Outpatient,1,Each,,711,604.35,203.7726,711,PrimeWest Health,Minnesota Senior Health Options (MSHO),365.8095,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
FLUTICASONE PROPION-SALMETEROL 100-50 MCG/DOSE INHL DSDV,,17211,LOCAL,Facility,Inpatient,1,Each,,711,604.35,203.7726,711,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
FLUTICASONE PROPION-SALMETEROL 100-50 MCG/DOSE INHL DSDV,,17211,LOCAL,Facility,Outpatient,1,Each,,711,604.35,203.7726,711,PrimeWest Health,MinnesotaCare,365.1696,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
FLUTICASONE PROPION-SALMETEROL 100-50 MCG/DOSE INHL DSDV,,17211,LOCAL,Facility,Inpatient,1,Each,,711,604.35,203.7726,711,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
FLUTICASONE PROPION-SALMETEROL 100-50 MCG/DOSE INHL DSDV,,17211,LOCAL,Facility,Both,1,Each,,711,604.35,203.7726,711,Sanford Health Plan,Sanford Health Plan,654.12,92,,percent of total billed charges,,
FLUTICASONE PROPION-SALMETEROL 100-50 MCG/DOSE INHL DSDV,,17211,LOCAL,Facility,Outpatient,1,Each,,711,604.35,203.7726,711,"UCare Health, Inc.",Individual & Family Plan,400.6485,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
FLUTICASONE PROPION-SALMETEROL 100-50 MCG/DOSE INHL DSDV,,17211,LOCAL,Facility,Inpatient,1,Each,,711,604.35,203.7726,711,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
FLUTICASONE PROPION-SALMETEROL 100-50 MCG/DOSE INHL DSDV,,17211,LOCAL,Facility,Outpatient,1,Each,,711,604.35,203.7726,711,"UCare Health, Inc.",Medical Assistance,358.8417,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FLUTICASONE PROPION-SALMETEROL 100-50 MCG/DOSE INHL DSDV,,17211,LOCAL,Facility,Inpatient,1,Each,,711,604.35,203.7726,711,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
FLUTICASONE PROPION-SALMETEROL 100-50 MCG/DOSE INHL DSDV,,17211,LOCAL,Facility,Outpatient,1,Each,,711,604.35,203.7726,711,"UCare Health, Inc.",Medicare Advantage,358.8417,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FLUTICASONE PROPION-SALMETEROL 100-50 MCG/DOSE INHL DSDV,,17211,LOCAL,Facility,Inpatient,1,Each,,711,604.35,203.7726,711,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
FLUTICASONE PROPION-SALMETEROL 100-50 MCG/DOSE INHL DSDV,,17211,LOCAL,Facility,Outpatient,1,Each,,711,604.35,203.7726,711,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),358.8417,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FLUTICASONE PROPION-SALMETEROL 100-50 MCG/DOSE INHL DSDV,,17211,LOCAL,Facility,Inpatient,1,Each,,711,604.35,203.7726,711,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
FLUTICASONE PROPION-SALMETEROL 100-50 MCG/DOSE INHL DSDV,,17211,LOCAL,Facility,Both,1,Each,,711,604.35,203.7726,711,UnitedHealthcare,Individual & Family,668.34,94,,percent of total billed charges,,
FLUTICASONE PROPION-SALMETEROL 100-50 MCG/DOSE INHL DSDV,,17211,LOCAL,Facility,Outpatient,1,Each,,711,604.35,203.7726,711,UnitedHealthcare,Medicare Advantage,348.39,49,,percent of total billed charges,,
FLUTICASONE PROPION-SALMETEROL 100-50 MCG/DOSE INHL DSDV,,17211,LOCAL,Facility,Inpatient,1,Each,,711,604.35,203.7726,711,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
FLUTICASONE PROPION-SALMETEROL 100-50 MCG/DOSE INHL DSDV,,17211,LOCAL,Facility,Outpatient,1,Each,,711,604.35,203.7726,711,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,341.28,48,,percent of total billed charges,,100% of DHS outpatient percentage
FLUTICASONE PROPION-SALMETEROL 100-50 MCG/DOSE INHL DSDV,,17211,LOCAL,Facility,Inpatient,1,Each,,711,604.35,203.7726,711,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
IBUPROFEN 600 MG ORAL TABLET,,17257,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
IBUPROFEN 600 MG ORAL TABLET,,17257,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
IBUPROFEN 600 MG ORAL TABLET,,17257,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
IBUPROFEN 600 MG ORAL TABLET,,17257,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
IBUPROFEN 600 MG ORAL TABLET,,17257,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
IBUPROFEN 600 MG ORAL TABLET,,17257,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
IBUPROFEN 600 MG ORAL TABLET,,17257,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
IBUPROFEN 600 MG ORAL TABLET,,17257,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
IBUPROFEN 600 MG ORAL TABLET,,17257,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
IBUPROFEN 600 MG ORAL TABLET,,17257,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
IBUPROFEN 600 MG ORAL TABLET,,17257,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
IBUPROFEN 600 MG ORAL TABLET,,17257,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
IBUPROFEN 600 MG ORAL TABLET,,17257,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
IBUPROFEN 600 MG ORAL TABLET,,17257,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
IBUPROFEN 600 MG ORAL TABLET,,17257,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
IBUPROFEN 600 MG ORAL TABLET,,17257,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
IBUPROFEN 600 MG ORAL TABLET,,17257,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
IBUPROFEN 600 MG ORAL TABLET,,17257,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
IBUPROFEN 600 MG ORAL TABLET,,17257,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
IBUPROFEN 600 MG ORAL TABLET,,17257,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
IBUPROFEN 600 MG ORAL TABLET,,17257,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
IBUPROFEN 600 MG ORAL TABLET,,17257,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
IBUPROFEN 600 MG ORAL TABLET,,17257,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
IBUPROFEN 600 MG ORAL TABLET,,17257,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
IBUPROFEN 600 MG ORAL TABLET,,17257,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
IBUPROFEN 600 MG ORAL TABLET,,17257,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
IBUPROFEN 600 MG ORAL TABLET,,17257,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
IBUPROFEN 600 MG ORAL TABLET,,17257,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
IBUPROFEN 600 MG ORAL TABLET,,17257,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
IBUPROFEN 600 MG ORAL TABLET,,17257,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
IBUPROFEN 600 MG ORAL TABLET,,17257,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
IBUPROFEN 600 MG ORAL TABLET,,17257,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
IBUPROFEN 600 MG ORAL TABLET,,17257,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
IBUPROFEN 600 MG ORAL TABLET,,17257,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
IBUPROFEN 600 MG ORAL TABLET,,17257,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
IBUPROFEN 600 MG ORAL TABLET,,17257,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
IBUPROFEN 600 MG ORAL TABLET,,17257,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
IBUPROFEN 600 MG ORAL TABLET,,17257,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
IBUPROFEN 600 MG ORAL TABLET,,17257,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
IBUPROFEN 600 MG ORAL TABLET,,17257,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
IBUPROFEN 600 MG ORAL TABLET,,17257,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
IBUPROFEN 600 MG ORAL TABLET,,17257,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
IBUPROFEN 600 MG ORAL TABLET,,17257,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
IBUPROFEN 600 MG ORAL TABLET,,17257,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
IBUPROFEN 600 MG ORAL TABLET,,17257,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
IBUPROFEN 600 MG ORAL TABLET,,17257,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
IBUPROFEN 600 MG ORAL TABLET,,17257,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
IBUPROFEN 600 MG ORAL TABLET,,17257,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
IBUPROFEN 600 MG ORAL TABLET,,17257,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
IBUPROFEN 600 MG ORAL TABLET,,17257,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
IBUPROFEN 600 MG ORAL TABLET,,17257,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
IBUPROFEN 600 MG ORAL TABLET,,17257,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
IBUPROFEN 600 MG ORAL TABLET,,17257,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
IBUPROFEN 600 MG ORAL TABLET,,17257,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
BROMOCRIPTINE 2.5 MG ORAL TABLET,,17313,LOCAL,Facility,Both,1,Each,,20,17,5.732,20,Aetna,Commercial,18.4,92,,percent of total billed charges,,
BROMOCRIPTINE 2.5 MG ORAL TABLET,,17313,LOCAL,Facility,Outpatient,1,Each,,20,17,5.732,20,Aetna,Medicare Advantage,9.8,49,,percent of total billed charges,,
BROMOCRIPTINE 2.5 MG ORAL TABLET,,17313,LOCAL,Facility,Inpatient,1,Each,,20,17,5.732,20,Aetna,Medicare Advantage,,,,,Included in per diem rate,
BROMOCRIPTINE 2.5 MG ORAL TABLET,,17313,LOCAL,Facility,Both,1,Each,,20,17,5.732,20,Aetna,PPO,18.6,93,,percent of total billed charges,,
BROMOCRIPTINE 2.5 MG ORAL TABLET,,17313,LOCAL,Facility,Both,1,Each,,20,17,5.732,20,America's PPO,America's PPO,19.206,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
BROMOCRIPTINE 2.5 MG ORAL TABLET,,17313,LOCAL,Facility,Both,1,Each,,20,17,5.732,20,BlueCross BlueShield Minnesota, Federal Employee Program,19.68,98.4,,percent of total billed charges,,
BROMOCRIPTINE 2.5 MG ORAL TABLET,,17313,LOCAL,Facility,Both,1,Each,,20,17,5.732,20,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,20,100,,percent of total billed charges,,
BROMOCRIPTINE 2.5 MG ORAL TABLET,,17313,LOCAL,Facility,Both,1,Each,,20,17,5.732,20,BlueCross BlueShield Minnesota,High Value Network Plan,18,90,,percent of total billed charges,,
BROMOCRIPTINE 2.5 MG ORAL TABLET,,17313,LOCAL,Facility,Outpatient,1,Each,,20,17,5.732,20,BlueCross BlueShield Minnesota,Medicare Advantage,9.8,49,,percent of total billed charges,,
BROMOCRIPTINE 2.5 MG ORAL TABLET,,17313,LOCAL,Facility,Inpatient,1,Each,,20,17,5.732,20,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
BROMOCRIPTINE 2.5 MG ORAL TABLET,,17313,LOCAL,Facility,Both,1,Each,,20,17,5.732,20,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,17.714,88.57,,percent of total billed charges,,
BROMOCRIPTINE 2.5 MG ORAL TABLET,,17313,LOCAL,Facility,Both,1,Each,,20,17,5.732,20,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,5.732,28.66,,percent of total billed charges,,
BROMOCRIPTINE 2.5 MG ORAL TABLET,,17313,LOCAL,Facility,Outpatient,1,Each,,20,17,5.732,20,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),9.8,49,,percent of total billed charges,,
BROMOCRIPTINE 2.5 MG ORAL TABLET,,17313,LOCAL,Facility,Inpatient,1,Each,,20,17,5.732,20,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
BROMOCRIPTINE 2.5 MG ORAL TABLET,,17313,LOCAL,Facility,Both,1,Each,,20,17,5.732,20,CorVel,Worker's Compensation,20,100,,percent of total billed charges,,
BROMOCRIPTINE 2.5 MG ORAL TABLET,,17313,LOCAL,Facility,Both,1,Each,,20,17,5.732,20,First Health Group Corporation,First Health Network,19.4,97,,percent of total billed charges,,
BROMOCRIPTINE 2.5 MG ORAL TABLET,,17313,LOCAL,Facility,Both,1,Each,,20,17,5.732,20,"Health Partners, Inc.",Commercial,18.92,94.6,,percent of total billed charges,,
BROMOCRIPTINE 2.5 MG ORAL TABLET,,17313,LOCAL,Facility,Outpatient,1,Each,,20,17,5.732,20,"Health Partners, Inc.",Medicare Advantage,9.8,49,,percent of total billed charges,,
BROMOCRIPTINE 2.5 MG ORAL TABLET,,17313,LOCAL,Facility,Inpatient,1,Each,,20,17,5.732,20,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
BROMOCRIPTINE 2.5 MG ORAL TABLET,,17313,LOCAL,Facility,Both,1,Each,,20,17,5.732,20,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),12,60,,percent of total billed charges,,
BROMOCRIPTINE 2.5 MG ORAL TABLET,,17313,LOCAL,Facility,Both,1,Each,,20,17,5.732,20,"Health Partners, Inc.",State of Minnesota Advantage Program,16.3,81.5,,percent of total billed charges,,
BROMOCRIPTINE 2.5 MG ORAL TABLET,,17313,LOCAL,Facility,Both,1,Each,,20,17,5.732,20,"Health Partners, Inc.",State Public Programs,10,50,,percent of total billed charges,,
BROMOCRIPTINE 2.5 MG ORAL TABLET,,17313,LOCAL,Facility,Both,1,Each,,20,17,5.732,20,Humana Insurance Company,Commercial PPO,19,95,,percent of total billed charges,,
BROMOCRIPTINE 2.5 MG ORAL TABLET,,17313,LOCAL,Facility,Outpatient,1,Each,,20,17,5.732,20,Humana Insurance Company,Medicare PPO,9.8,49,,percent of total billed charges,,
BROMOCRIPTINE 2.5 MG ORAL TABLET,,17313,LOCAL,Facility,Inpatient,1,Each,,20,17,5.732,20,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
BROMOCRIPTINE 2.5 MG ORAL TABLET,,17313,LOCAL,Facility,Both,1,Each,,20,17,5.732,20,Medica,Individual & Family,19.82,99.1,,percent of total billed charges,,
BROMOCRIPTINE 2.5 MG ORAL TABLET,,17313,LOCAL,Facility,Outpatient,1,Each,,20,17,5.732,20,Medica,Medica Advantage Solution,9.96,49.8,,percent of total billed charges,,
BROMOCRIPTINE 2.5 MG ORAL TABLET,,17313,LOCAL,Facility,Inpatient,1,Each,,20,17,5.732,20,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
BROMOCRIPTINE 2.5 MG ORAL TABLET,,17313,LOCAL,Facility,Outpatient,1,Each,,20,17,5.732,20,Medica,Medical Assistance,8.92,44.6,,percent of total billed charges,,
BROMOCRIPTINE 2.5 MG ORAL TABLET,,17313,LOCAL,Facility,Inpatient,1,Each,,20,17,5.732,20,Medica,Medical Assistance,,,,,Included in per diem rate,
BROMOCRIPTINE 2.5 MG ORAL TABLET,,17313,LOCAL,Facility,Outpatient,1,Each,,20,17,5.732,20,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,9.96,49.8,,percent of total billed charges,,
BROMOCRIPTINE 2.5 MG ORAL TABLET,,17313,LOCAL,Facility,Inpatient,1,Each,,20,17,5.732,20,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
BROMOCRIPTINE 2.5 MG ORAL TABLET,,17313,LOCAL,Facility,Both,1,Each,,20,17,5.732,20,"Multiplan, Inc.","Multiplan, Inc.",18.8,94,,percent of total billed charges,,
BROMOCRIPTINE 2.5 MG ORAL TABLET,,17313,LOCAL,Facility,Outpatient,1,Each,,20,17,5.732,20,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,18.02,90.1,,percent of total billed charges,,
BROMOCRIPTINE 2.5 MG ORAL TABLET,,17313,LOCAL,Facility,Inpatient,1,Each,,20,17,5.732,20,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
BROMOCRIPTINE 2.5 MG ORAL TABLET,,17313,LOCAL,Facility,Both,1,Each,,20,17,5.732,20,"Preferred One Administrative Services, INC.",PPO,19.72,98.6,,percent of total billed charges,,
BROMOCRIPTINE 2.5 MG ORAL TABLET,,17313,LOCAL,Facility,Outpatient,1,Each,,20,17,5.732,20,PrimeWest Health,Minnesota Senior Health Options (MSHO),10.29,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
BROMOCRIPTINE 2.5 MG ORAL TABLET,,17313,LOCAL,Facility,Inpatient,1,Each,,20,17,5.732,20,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
BROMOCRIPTINE 2.5 MG ORAL TABLET,,17313,LOCAL,Facility,Outpatient,1,Each,,20,17,5.732,20,PrimeWest Health,MinnesotaCare,10.272,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
BROMOCRIPTINE 2.5 MG ORAL TABLET,,17313,LOCAL,Facility,Inpatient,1,Each,,20,17,5.732,20,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
BROMOCRIPTINE 2.5 MG ORAL TABLET,,17313,LOCAL,Facility,Both,1,Each,,20,17,5.732,20,Sanford Health Plan,Sanford Health Plan,18.4,92,,percent of total billed charges,,
BROMOCRIPTINE 2.5 MG ORAL TABLET,,17313,LOCAL,Facility,Outpatient,1,Each,,20,17,5.732,20,"UCare Health, Inc.",Individual & Family Plan,11.27,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
BROMOCRIPTINE 2.5 MG ORAL TABLET,,17313,LOCAL,Facility,Inpatient,1,Each,,20,17,5.732,20,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
BROMOCRIPTINE 2.5 MG ORAL TABLET,,17313,LOCAL,Facility,Outpatient,1,Each,,20,17,5.732,20,"UCare Health, Inc.",Medical Assistance,10.094,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BROMOCRIPTINE 2.5 MG ORAL TABLET,,17313,LOCAL,Facility,Inpatient,1,Each,,20,17,5.732,20,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
BROMOCRIPTINE 2.5 MG ORAL TABLET,,17313,LOCAL,Facility,Outpatient,1,Each,,20,17,5.732,20,"UCare Health, Inc.",Medicare Advantage,10.094,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BROMOCRIPTINE 2.5 MG ORAL TABLET,,17313,LOCAL,Facility,Inpatient,1,Each,,20,17,5.732,20,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
BROMOCRIPTINE 2.5 MG ORAL TABLET,,17313,LOCAL,Facility,Outpatient,1,Each,,20,17,5.732,20,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),10.094,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BROMOCRIPTINE 2.5 MG ORAL TABLET,,17313,LOCAL,Facility,Inpatient,1,Each,,20,17,5.732,20,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
BROMOCRIPTINE 2.5 MG ORAL TABLET,,17313,LOCAL,Facility,Both,1,Each,,20,17,5.732,20,UnitedHealthcare,Individual & Family,18.8,94,,percent of total billed charges,,
BROMOCRIPTINE 2.5 MG ORAL TABLET,,17313,LOCAL,Facility,Outpatient,1,Each,,20,17,5.732,20,UnitedHealthcare,Medicare Advantage,9.8,49,,percent of total billed charges,,
BROMOCRIPTINE 2.5 MG ORAL TABLET,,17313,LOCAL,Facility,Inpatient,1,Each,,20,17,5.732,20,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
BROMOCRIPTINE 2.5 MG ORAL TABLET,,17313,LOCAL,Facility,Outpatient,1,Each,,20,17,5.732,20,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,9.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
BROMOCRIPTINE 2.5 MG ORAL TABLET,,17313,LOCAL,Facility,Inpatient,1,Each,,20,17,5.732,20,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
CEFUROXIME AXETIL 500 MG ORAL TABLET,,17435,LOCAL,Facility,Both,1,Each,,41,34.85,11.7506,41,Aetna,Commercial,37.72,92,,percent of total billed charges,,
CEFUROXIME AXETIL 500 MG ORAL TABLET,,17435,LOCAL,Facility,Outpatient,1,Each,,41,34.85,11.7506,41,Aetna,Medicare Advantage,20.09,49,,percent of total billed charges,,
CEFUROXIME AXETIL 500 MG ORAL TABLET,,17435,LOCAL,Facility,Inpatient,1,Each,,41,34.85,11.7506,41,Aetna,Medicare Advantage,,,,,Included in per diem rate,
CEFUROXIME AXETIL 500 MG ORAL TABLET,,17435,LOCAL,Facility,Both,1,Each,,41,34.85,11.7506,41,Aetna,PPO,38.13,93,,percent of total billed charges,,
CEFUROXIME AXETIL 500 MG ORAL TABLET,,17435,LOCAL,Facility,Both,1,Each,,41,34.85,11.7506,41,America's PPO,America's PPO,39.3723,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
CEFUROXIME AXETIL 500 MG ORAL TABLET,,17435,LOCAL,Facility,Both,1,Each,,41,34.85,11.7506,41,BlueCross BlueShield Minnesota, Federal Employee Program,40.344,98.4,,percent of total billed charges,,
CEFUROXIME AXETIL 500 MG ORAL TABLET,,17435,LOCAL,Facility,Both,1,Each,,41,34.85,11.7506,41,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,41,100,,percent of total billed charges,,
CEFUROXIME AXETIL 500 MG ORAL TABLET,,17435,LOCAL,Facility,Both,1,Each,,41,34.85,11.7506,41,BlueCross BlueShield Minnesota,High Value Network Plan,36.9,90,,percent of total billed charges,,
CEFUROXIME AXETIL 500 MG ORAL TABLET,,17435,LOCAL,Facility,Outpatient,1,Each,,41,34.85,11.7506,41,BlueCross BlueShield Minnesota,Medicare Advantage,20.09,49,,percent of total billed charges,,
CEFUROXIME AXETIL 500 MG ORAL TABLET,,17435,LOCAL,Facility,Inpatient,1,Each,,41,34.85,11.7506,41,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
CEFUROXIME AXETIL 500 MG ORAL TABLET,,17435,LOCAL,Facility,Both,1,Each,,41,34.85,11.7506,41,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,36.3137,88.57,,percent of total billed charges,,
CEFUROXIME AXETIL 500 MG ORAL TABLET,,17435,LOCAL,Facility,Both,1,Each,,41,34.85,11.7506,41,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,11.7506,28.66,,percent of total billed charges,,
CEFUROXIME AXETIL 500 MG ORAL TABLET,,17435,LOCAL,Facility,Outpatient,1,Each,,41,34.85,11.7506,41,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),20.09,49,,percent of total billed charges,,
CEFUROXIME AXETIL 500 MG ORAL TABLET,,17435,LOCAL,Facility,Inpatient,1,Each,,41,34.85,11.7506,41,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
CEFUROXIME AXETIL 500 MG ORAL TABLET,,17435,LOCAL,Facility,Both,1,Each,,41,34.85,11.7506,41,CorVel,Worker's Compensation,41,100,,percent of total billed charges,,
CEFUROXIME AXETIL 500 MG ORAL TABLET,,17435,LOCAL,Facility,Both,1,Each,,41,34.85,11.7506,41,First Health Group Corporation,First Health Network,39.77,97,,percent of total billed charges,,
CEFUROXIME AXETIL 500 MG ORAL TABLET,,17435,LOCAL,Facility,Both,1,Each,,41,34.85,11.7506,41,"Health Partners, Inc.",Commercial,38.786,94.6,,percent of total billed charges,,
CEFUROXIME AXETIL 500 MG ORAL TABLET,,17435,LOCAL,Facility,Outpatient,1,Each,,41,34.85,11.7506,41,"Health Partners, Inc.",Medicare Advantage,20.09,49,,percent of total billed charges,,
CEFUROXIME AXETIL 500 MG ORAL TABLET,,17435,LOCAL,Facility,Inpatient,1,Each,,41,34.85,11.7506,41,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CEFUROXIME AXETIL 500 MG ORAL TABLET,,17435,LOCAL,Facility,Both,1,Each,,41,34.85,11.7506,41,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),24.6,60,,percent of total billed charges,,
CEFUROXIME AXETIL 500 MG ORAL TABLET,,17435,LOCAL,Facility,Both,1,Each,,41,34.85,11.7506,41,"Health Partners, Inc.",State of Minnesota Advantage Program,33.415,81.5,,percent of total billed charges,,
CEFUROXIME AXETIL 500 MG ORAL TABLET,,17435,LOCAL,Facility,Both,1,Each,,41,34.85,11.7506,41,"Health Partners, Inc.",State Public Programs,20.5,50,,percent of total billed charges,,
CEFUROXIME AXETIL 500 MG ORAL TABLET,,17435,LOCAL,Facility,Both,1,Each,,41,34.85,11.7506,41,Humana Insurance Company,Commercial PPO,38.95,95,,percent of total billed charges,,
CEFUROXIME AXETIL 500 MG ORAL TABLET,,17435,LOCAL,Facility,Outpatient,1,Each,,41,34.85,11.7506,41,Humana Insurance Company,Medicare PPO,20.09,49,,percent of total billed charges,,
CEFUROXIME AXETIL 500 MG ORAL TABLET,,17435,LOCAL,Facility,Inpatient,1,Each,,41,34.85,11.7506,41,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
CEFUROXIME AXETIL 500 MG ORAL TABLET,,17435,LOCAL,Facility,Both,1,Each,,41,34.85,11.7506,41,Medica,Individual & Family,40.631,99.1,,percent of total billed charges,,
CEFUROXIME AXETIL 500 MG ORAL TABLET,,17435,LOCAL,Facility,Outpatient,1,Each,,41,34.85,11.7506,41,Medica,Medica Advantage Solution,20.418,49.8,,percent of total billed charges,,
CEFUROXIME AXETIL 500 MG ORAL TABLET,,17435,LOCAL,Facility,Inpatient,1,Each,,41,34.85,11.7506,41,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
CEFUROXIME AXETIL 500 MG ORAL TABLET,,17435,LOCAL,Facility,Outpatient,1,Each,,41,34.85,11.7506,41,Medica,Medical Assistance,18.286,44.6,,percent of total billed charges,,
CEFUROXIME AXETIL 500 MG ORAL TABLET,,17435,LOCAL,Facility,Inpatient,1,Each,,41,34.85,11.7506,41,Medica,Medical Assistance,,,,,Included in per diem rate,
CEFUROXIME AXETIL 500 MG ORAL TABLET,,17435,LOCAL,Facility,Outpatient,1,Each,,41,34.85,11.7506,41,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,20.418,49.8,,percent of total billed charges,,
CEFUROXIME AXETIL 500 MG ORAL TABLET,,17435,LOCAL,Facility,Inpatient,1,Each,,41,34.85,11.7506,41,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
CEFUROXIME AXETIL 500 MG ORAL TABLET,,17435,LOCAL,Facility,Both,1,Each,,41,34.85,11.7506,41,"Multiplan, Inc.","Multiplan, Inc.",38.54,94,,percent of total billed charges,,
CEFUROXIME AXETIL 500 MG ORAL TABLET,,17435,LOCAL,Facility,Outpatient,1,Each,,41,34.85,11.7506,41,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,36.941,90.1,,percent of total billed charges,,
CEFUROXIME AXETIL 500 MG ORAL TABLET,,17435,LOCAL,Facility,Inpatient,1,Each,,41,34.85,11.7506,41,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
CEFUROXIME AXETIL 500 MG ORAL TABLET,,17435,LOCAL,Facility,Both,1,Each,,41,34.85,11.7506,41,"Preferred One Administrative Services, INC.",PPO,40.426,98.6,,percent of total billed charges,,
CEFUROXIME AXETIL 500 MG ORAL TABLET,,17435,LOCAL,Facility,Outpatient,1,Each,,41,34.85,11.7506,41,PrimeWest Health,Minnesota Senior Health Options (MSHO),21.0945,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
CEFUROXIME AXETIL 500 MG ORAL TABLET,,17435,LOCAL,Facility,Inpatient,1,Each,,41,34.85,11.7506,41,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CEFUROXIME AXETIL 500 MG ORAL TABLET,,17435,LOCAL,Facility,Outpatient,1,Each,,41,34.85,11.7506,41,PrimeWest Health,MinnesotaCare,21.0576,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
CEFUROXIME AXETIL 500 MG ORAL TABLET,,17435,LOCAL,Facility,Inpatient,1,Each,,41,34.85,11.7506,41,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
CEFUROXIME AXETIL 500 MG ORAL TABLET,,17435,LOCAL,Facility,Both,1,Each,,41,34.85,11.7506,41,Sanford Health Plan,Sanford Health Plan,37.72,92,,percent of total billed charges,,
CEFUROXIME AXETIL 500 MG ORAL TABLET,,17435,LOCAL,Facility,Outpatient,1,Each,,41,34.85,11.7506,41,"UCare Health, Inc.",Individual & Family Plan,23.1035,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
CEFUROXIME AXETIL 500 MG ORAL TABLET,,17435,LOCAL,Facility,Inpatient,1,Each,,41,34.85,11.7506,41,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
CEFUROXIME AXETIL 500 MG ORAL TABLET,,17435,LOCAL,Facility,Outpatient,1,Each,,41,34.85,11.7506,41,"UCare Health, Inc.",Medical Assistance,20.6927,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CEFUROXIME AXETIL 500 MG ORAL TABLET,,17435,LOCAL,Facility,Inpatient,1,Each,,41,34.85,11.7506,41,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
CEFUROXIME AXETIL 500 MG ORAL TABLET,,17435,LOCAL,Facility,Outpatient,1,Each,,41,34.85,11.7506,41,"UCare Health, Inc.",Medicare Advantage,20.6927,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CEFUROXIME AXETIL 500 MG ORAL TABLET,,17435,LOCAL,Facility,Inpatient,1,Each,,41,34.85,11.7506,41,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CEFUROXIME AXETIL 500 MG ORAL TABLET,,17435,LOCAL,Facility,Outpatient,1,Each,,41,34.85,11.7506,41,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),20.6927,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CEFUROXIME AXETIL 500 MG ORAL TABLET,,17435,LOCAL,Facility,Inpatient,1,Each,,41,34.85,11.7506,41,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CEFUROXIME AXETIL 500 MG ORAL TABLET,,17435,LOCAL,Facility,Both,1,Each,,41,34.85,11.7506,41,UnitedHealthcare,Individual & Family,38.54,94,,percent of total billed charges,,
CEFUROXIME AXETIL 500 MG ORAL TABLET,,17435,LOCAL,Facility,Outpatient,1,Each,,41,34.85,11.7506,41,UnitedHealthcare,Medicare Advantage,20.09,49,,percent of total billed charges,,
CEFUROXIME AXETIL 500 MG ORAL TABLET,,17435,LOCAL,Facility,Inpatient,1,Each,,41,34.85,11.7506,41,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
CEFUROXIME AXETIL 500 MG ORAL TABLET,,17435,LOCAL,Facility,Outpatient,1,Each,,41,34.85,11.7506,41,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,19.68,48,,percent of total billed charges,,100% of DHS outpatient percentage
CEFUROXIME AXETIL 500 MG ORAL TABLET,,17435,LOCAL,Facility,Inpatient,1,Each,,41,34.85,11.7506,41,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
FENTANYL 25 MCG/HR TD PT72,,17450,LOCAL,Facility,Both,1,Each,,96,81.6,27.5136,96,Aetna,Commercial,88.32,92,,percent of total billed charges,,
FENTANYL 25 MCG/HR TD PT72,,17450,LOCAL,Facility,Both,1,Each,,96,81.6,27.5136,96,Aetna,Commercial,88.32,92,,percent of total billed charges,,
FENTANYL 25 MCG/HR TD PT72,,17450,LOCAL,Facility,Outpatient,1,Each,,96,81.6,27.5136,96,Aetna,Medicare Advantage,47.04,49,,percent of total billed charges,,
FENTANYL 25 MCG/HR TD PT72,,17450,LOCAL,Facility,Outpatient,1,Each,,96,81.6,27.5136,96,Aetna,Medicare Advantage,47.04,49,,percent of total billed charges,,
FENTANYL 25 MCG/HR TD PT72,,17450,LOCAL,Facility,Inpatient,1,Each,,96,81.6,27.5136,96,Aetna,Medicare Advantage,,,,,Included in per diem rate,
FENTANYL 25 MCG/HR TD PT72,,17450,LOCAL,Facility,Inpatient,1,Each,,96,81.6,27.5136,96,Aetna,Medicare Advantage,,,,,Included in per diem rate,
FENTANYL 25 MCG/HR TD PT72,,17450,LOCAL,Facility,Both,1,Each,,96,81.6,27.5136,96,Aetna,PPO,89.28,93,,percent of total billed charges,,
FENTANYL 25 MCG/HR TD PT72,,17450,LOCAL,Facility,Both,1,Each,,96,81.6,27.5136,96,Aetna,PPO,89.28,93,,percent of total billed charges,,
FENTANYL 25 MCG/HR TD PT72,,17450,LOCAL,Facility,Both,1,Each,,96,81.6,27.5136,96,America's PPO,America's PPO,92.1888,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
FENTANYL 25 MCG/HR TD PT72,,17450,LOCAL,Facility,Both,1,Each,,96,81.6,27.5136,96,America's PPO,America's PPO,92.1888,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
FENTANYL 25 MCG/HR TD PT72,,17450,LOCAL,Facility,Both,1,Each,,96,81.6,27.5136,96,BlueCross BlueShield Minnesota, Federal Employee Program,94.464,98.4,,percent of total billed charges,,
FENTANYL 25 MCG/HR TD PT72,,17450,LOCAL,Facility,Both,1,Each,,96,81.6,27.5136,96,BlueCross BlueShield Minnesota, Federal Employee Program,94.464,98.4,,percent of total billed charges,,
FENTANYL 25 MCG/HR TD PT72,,17450,LOCAL,Facility,Both,1,Each,,96,81.6,27.5136,96,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,96,100,,percent of total billed charges,,
FENTANYL 25 MCG/HR TD PT72,,17450,LOCAL,Facility,Both,1,Each,,96,81.6,27.5136,96,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,96,100,,percent of total billed charges,,
FENTANYL 25 MCG/HR TD PT72,,17450,LOCAL,Facility,Both,1,Each,,96,81.6,27.5136,96,BlueCross BlueShield Minnesota,High Value Network Plan,86.4,90,,percent of total billed charges,,
FENTANYL 25 MCG/HR TD PT72,,17450,LOCAL,Facility,Both,1,Each,,96,81.6,27.5136,96,BlueCross BlueShield Minnesota,High Value Network Plan,86.4,90,,percent of total billed charges,,
FENTANYL 25 MCG/HR TD PT72,,17450,LOCAL,Facility,Outpatient,1,Each,,96,81.6,27.5136,96,BlueCross BlueShield Minnesota,Medicare Advantage,47.04,49,,percent of total billed charges,,
FENTANYL 25 MCG/HR TD PT72,,17450,LOCAL,Facility,Outpatient,1,Each,,96,81.6,27.5136,96,BlueCross BlueShield Minnesota,Medicare Advantage,47.04,49,,percent of total billed charges,,
FENTANYL 25 MCG/HR TD PT72,,17450,LOCAL,Facility,Inpatient,1,Each,,96,81.6,27.5136,96,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
FENTANYL 25 MCG/HR TD PT72,,17450,LOCAL,Facility,Inpatient,1,Each,,96,81.6,27.5136,96,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
FENTANYL 25 MCG/HR TD PT72,,17450,LOCAL,Facility,Both,1,Each,,96,81.6,27.5136,96,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,85.0272,88.57,,percent of total billed charges,,
FENTANYL 25 MCG/HR TD PT72,,17450,LOCAL,Facility,Both,1,Each,,96,81.6,27.5136,96,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,85.0272,88.57,,percent of total billed charges,,
FENTANYL 25 MCG/HR TD PT72,,17450,LOCAL,Facility,Both,1,Each,,96,81.6,27.5136,96,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,27.5136,28.66,,percent of total billed charges,,
FENTANYL 25 MCG/HR TD PT72,,17450,LOCAL,Facility,Both,1,Each,,96,81.6,27.5136,96,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,27.5136,28.66,,percent of total billed charges,,
FENTANYL 25 MCG/HR TD PT72,,17450,LOCAL,Facility,Outpatient,1,Each,,96,81.6,27.5136,96,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),47.04,49,,percent of total billed charges,,
FENTANYL 25 MCG/HR TD PT72,,17450,LOCAL,Facility,Outpatient,1,Each,,96,81.6,27.5136,96,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),47.04,49,,percent of total billed charges,,
FENTANYL 25 MCG/HR TD PT72,,17450,LOCAL,Facility,Inpatient,1,Each,,96,81.6,27.5136,96,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
FENTANYL 25 MCG/HR TD PT72,,17450,LOCAL,Facility,Inpatient,1,Each,,96,81.6,27.5136,96,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
FENTANYL 25 MCG/HR TD PT72,,17450,LOCAL,Facility,Both,1,Each,,96,81.6,27.5136,96,CorVel,Worker's Compensation,96,100,,percent of total billed charges,,
FENTANYL 25 MCG/HR TD PT72,,17450,LOCAL,Facility,Both,1,Each,,96,81.6,27.5136,96,CorVel,Worker's Compensation,96,100,,percent of total billed charges,,
FENTANYL 25 MCG/HR TD PT72,,17450,LOCAL,Facility,Both,1,Each,,96,81.6,27.5136,96,First Health Group Corporation,First Health Network,93.12,97,,percent of total billed charges,,
FENTANYL 25 MCG/HR TD PT72,,17450,LOCAL,Facility,Both,1,Each,,96,81.6,27.5136,96,First Health Group Corporation,First Health Network,93.12,97,,percent of total billed charges,,
FENTANYL 25 MCG/HR TD PT72,,17450,LOCAL,Facility,Both,1,Each,,96,81.6,27.5136,96,"Health Partners, Inc.",Commercial,90.816,94.6,,percent of total billed charges,,
FENTANYL 25 MCG/HR TD PT72,,17450,LOCAL,Facility,Both,1,Each,,96,81.6,27.5136,96,"Health Partners, Inc.",Commercial,90.816,94.6,,percent of total billed charges,,
FENTANYL 25 MCG/HR TD PT72,,17450,LOCAL,Facility,Outpatient,1,Each,,96,81.6,27.5136,96,"Health Partners, Inc.",Medicare Advantage,47.04,49,,percent of total billed charges,,
FENTANYL 25 MCG/HR TD PT72,,17450,LOCAL,Facility,Outpatient,1,Each,,96,81.6,27.5136,96,"Health Partners, Inc.",Medicare Advantage,47.04,49,,percent of total billed charges,,
FENTANYL 25 MCG/HR TD PT72,,17450,LOCAL,Facility,Inpatient,1,Each,,96,81.6,27.5136,96,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
FENTANYL 25 MCG/HR TD PT72,,17450,LOCAL,Facility,Inpatient,1,Each,,96,81.6,27.5136,96,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
FENTANYL 25 MCG/HR TD PT72,,17450,LOCAL,Facility,Both,1,Each,,96,81.6,27.5136,96,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),57.6,60,,percent of total billed charges,,
FENTANYL 25 MCG/HR TD PT72,,17450,LOCAL,Facility,Both,1,Each,,96,81.6,27.5136,96,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),57.6,60,,percent of total billed charges,,
FENTANYL 25 MCG/HR TD PT72,,17450,LOCAL,Facility,Both,1,Each,,96,81.6,27.5136,96,"Health Partners, Inc.",State of Minnesota Advantage Program,78.24,81.5,,percent of total billed charges,,
FENTANYL 25 MCG/HR TD PT72,,17450,LOCAL,Facility,Both,1,Each,,96,81.6,27.5136,96,"Health Partners, Inc.",State of Minnesota Advantage Program,78.24,81.5,,percent of total billed charges,,
FENTANYL 25 MCG/HR TD PT72,,17450,LOCAL,Facility,Both,1,Each,,96,81.6,27.5136,96,"Health Partners, Inc.",State Public Programs,48,50,,percent of total billed charges,,
FENTANYL 25 MCG/HR TD PT72,,17450,LOCAL,Facility,Both,1,Each,,96,81.6,27.5136,96,"Health Partners, Inc.",State Public Programs,48,50,,percent of total billed charges,,
FENTANYL 25 MCG/HR TD PT72,,17450,LOCAL,Facility,Both,1,Each,,96,81.6,27.5136,96,Humana Insurance Company,Commercial PPO,91.2,95,,percent of total billed charges,,
FENTANYL 25 MCG/HR TD PT72,,17450,LOCAL,Facility,Both,1,Each,,96,81.6,27.5136,96,Humana Insurance Company,Commercial PPO,91.2,95,,percent of total billed charges,,
FENTANYL 25 MCG/HR TD PT72,,17450,LOCAL,Facility,Outpatient,1,Each,,96,81.6,27.5136,96,Humana Insurance Company,Medicare PPO,47.04,49,,percent of total billed charges,,
FENTANYL 25 MCG/HR TD PT72,,17450,LOCAL,Facility,Outpatient,1,Each,,96,81.6,27.5136,96,Humana Insurance Company,Medicare PPO,47.04,49,,percent of total billed charges,,
FENTANYL 25 MCG/HR TD PT72,,17450,LOCAL,Facility,Inpatient,1,Each,,96,81.6,27.5136,96,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
FENTANYL 25 MCG/HR TD PT72,,17450,LOCAL,Facility,Inpatient,1,Each,,96,81.6,27.5136,96,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
FENTANYL 25 MCG/HR TD PT72,,17450,LOCAL,Facility,Both,1,Each,,96,81.6,27.5136,96,Medica,Individual & Family,95.136,99.1,,percent of total billed charges,,
FENTANYL 25 MCG/HR TD PT72,,17450,LOCAL,Facility,Both,1,Each,,96,81.6,27.5136,96,Medica,Individual & Family,95.136,99.1,,percent of total billed charges,,
FENTANYL 25 MCG/HR TD PT72,,17450,LOCAL,Facility,Outpatient,1,Each,,96,81.6,27.5136,96,Medica,Medica Advantage Solution,47.808,49.8,,percent of total billed charges,,
FENTANYL 25 MCG/HR TD PT72,,17450,LOCAL,Facility,Outpatient,1,Each,,96,81.6,27.5136,96,Medica,Medica Advantage Solution,47.808,49.8,,percent of total billed charges,,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 0.5 Cm Or Less",,11600,CPT,Facility,Both,,,,250,212.5,71.65,250,Aetna,Commercial,230,92,,percent of total billed charges,,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 0.5 Cm Or Less",,11600,CPT,Facility,Outpatient,,,,250,212.5,71.65,250,Aetna,Medicare Advantage,122.5,49,,percent of total billed charges,,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 0.5 Cm Or Less",,11600,CPT,Facility,Inpatient,,,,250,212.5,71.65,250,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 0.5 Cm Or Less",,11600,CPT,Facility,Both,,,,250,212.5,71.65,250,Aetna,PPO,232.5,93,,percent of total billed charges,,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 0.5 Cm Or Less",,11600,CPT,Facility,Both,,,,250,212.5,71.65,250,America's PPO,America's PPO,240.075,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 0.5 Cm Or Less",,11600,CPT,Facility,Both,,,,250,212.5,71.65,250,BlueCross BlueShield Minnesota, Federal Employee Program,246,98.4,,percent of total billed charges,,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 0.5 Cm Or Less",,11600,CPT,Facility,Both,,,,250,212.5,71.65,250,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,250,100,,percent of total billed charges,,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 0.5 Cm Or Less",,11600,CPT,Facility,Both,,,,250,212.5,71.65,250,BlueCross BlueShield Minnesota,High Value Network Plan,225,90,,percent of total billed charges,,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 0.5 Cm Or Less",,11600,CPT,Facility,Outpatient,,,,250,212.5,71.65,250,BlueCross BlueShield Minnesota,Medicare Advantage,122.5,49,,percent of total billed charges,,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 0.5 Cm Or Less",,11600,CPT,Facility,Inpatient,,,,250,212.5,71.65,250,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 0.5 Cm Or Less",,11600,CPT,Facility,Both,,,,250,212.5,71.65,250,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,221.425,88.57,,percent of total billed charges,,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 0.5 Cm Or Less",,11600,CPT,Facility,Both,,,,250,212.5,71.65,250,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,71.65,28.66,,percent of total billed charges,,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 0.5 Cm Or Less",,11600,CPT,Facility,Outpatient,,,,250,212.5,71.65,250,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),122.5,49,,percent of total billed charges,,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 0.5 Cm Or Less",,11600,CPT,Facility,Inpatient,,,,250,212.5,71.65,250,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 0.5 Cm Or Less",,11600,CPT,Facility,Both,,,,250,212.5,71.65,250,CorVel,Worker's Compensation,250,100,,percent of total billed charges,,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 0.5 Cm Or Less",,11600,CPT,Facility,Both,,,,250,212.5,71.65,250,First Health Group Corporation,First Health Network,242.5,97,,percent of total billed charges,,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 0.5 Cm Or Less",,11600,CPT,Facility,Both,,,,250,212.5,71.65,250,"Health Partners, Inc.",Commercial,236.5,94.6,,percent of total billed charges,,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 0.5 Cm Or Less",,11600,CPT,Facility,Outpatient,,,,250,212.5,71.65,250,"Health Partners, Inc.",Medicare Advantage,122.5,49,,percent of total billed charges,,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 0.5 Cm Or Less",,11600,CPT,Facility,Inpatient,,,,250,212.5,71.65,250,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 0.5 Cm Or Less",,11600,CPT,Facility,Both,,,,250,212.5,71.65,250,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),150,60,,percent of total billed charges,,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 0.5 Cm Or Less",,11600,CPT,Facility,Both,,,,250,212.5,71.65,250,"Health Partners, Inc.",State of Minnesota Advantage Program,203.75,81.5,,percent of total billed charges,,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 0.5 Cm Or Less",,11600,CPT,Facility,Both,,,,250,212.5,71.65,250,"Health Partners, Inc.",State Public Programs,125,50,,percent of total billed charges,,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 0.5 Cm Or Less",,11600,CPT,Facility,Both,,,,250,212.5,71.65,250,Humana Insurance Company,Commercial PPO,237.5,95,,percent of total billed charges,,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 0.5 Cm Or Less",,11600,CPT,Facility,Outpatient,,,,250,212.5,71.65,250,Humana Insurance Company,Medicare PPO,122.5,49,,percent of total billed charges,,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 0.5 Cm Or Less",,11600,CPT,Facility,Inpatient,,,,250,212.5,71.65,250,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 0.5 Cm Or Less",,11600,CPT,Facility,Both,,,,250,212.5,71.65,250,Medica,Individual & Family,247.75,99.1,,percent of total billed charges,,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 0.5 Cm Or Less",,11600,CPT,Facility,Outpatient,,,,250,212.5,71.65,250,Medica,Medica Advantage Solution,124.5,49.8,,percent of total billed charges,,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 0.5 Cm Or Less",,11600,CPT,Facility,Inpatient,,,,250,212.5,71.65,250,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 0.5 Cm Or Less",,11600,CPT,Facility,Outpatient,,,,250,212.5,71.65,250,Medica,Medical Assistance,111.5,44.6,,percent of total billed charges,,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 0.5 Cm Or Less",,11600,CPT,Facility,Inpatient,,,,250,212.5,71.65,250,Medica,Medical Assistance,,,,,Included in per diem rate,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 0.5 Cm Or Less",,11600,CPT,Facility,Outpatient,,,,250,212.5,71.65,250,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,124.5,49.8,,percent of total billed charges,,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 0.5 Cm Or Less",,11600,CPT,Facility,Inpatient,,,,250,212.5,71.65,250,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 0.5 Cm Or Less",,11600,CPT,Facility,Both,,,,250,212.5,71.65,250,"Multiplan, Inc.","Multiplan, Inc.",235,94,,percent of total billed charges,,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 0.5 Cm Or Less",,11600,CPT,Facility,Outpatient,,,,250,212.5,71.65,250,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,225.25,90.1,,percent of total billed charges,,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 0.5 Cm Or Less",,11600,CPT,Facility,Inpatient,,,,250,212.5,71.65,250,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 0.5 Cm Or Less",,11600,CPT,Facility,Both,,,,250,212.5,71.65,250,"Preferred One Administrative Services, INC.",PPO,246.5,98.6,,percent of total billed charges,,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 0.5 Cm Or Less",,11600,CPT,Facility,Outpatient,,,,250,212.5,71.65,250,PrimeWest Health,Minnesota Senior Health Options (MSHO),128.625,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 0.5 Cm Or Less",,11600,CPT,Facility,Inpatient,,,,250,212.5,71.65,250,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 0.5 Cm Or Less",,11600,CPT,Facility,Outpatient,,,,250,212.5,71.65,250,PrimeWest Health,MinnesotaCare,128.4,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 0.5 Cm Or Less",,11600,CPT,Facility,Inpatient,,,,250,212.5,71.65,250,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 0.5 Cm Or Less",,11600,CPT,Facility,Both,,,,250,212.5,71.65,250,Sanford Health Plan,Sanford Health Plan,230,92,,percent of total billed charges,,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 0.5 Cm Or Less",,11600,CPT,Facility,Outpatient,,,,250,212.5,71.65,250,"UCare Health, Inc.",Individual & Family Plan,140.875,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 0.5 Cm Or Less",,11600,CPT,Facility,Inpatient,,,,250,212.5,71.65,250,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 0.5 Cm Or Less",,11600,CPT,Facility,Outpatient,,,,250,212.5,71.65,250,"UCare Health, Inc.",Medical Assistance,126.175,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 0.5 Cm Or Less",,11600,CPT,Facility,Inpatient,,,,250,212.5,71.65,250,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 0.5 Cm Or Less",,11600,CPT,Facility,Outpatient,,,,250,212.5,71.65,250,"UCare Health, Inc.",Medicare Advantage,126.175,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 0.5 Cm Or Less",,11600,CPT,Facility,Inpatient,,,,250,212.5,71.65,250,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 0.5 Cm Or Less",,11600,CPT,Facility,Outpatient,,,,250,212.5,71.65,250,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),126.175,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 0.5 Cm Or Less",,11600,CPT,Facility,Inpatient,,,,250,212.5,71.65,250,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 0.5 Cm Or Less",,11600,CPT,Facility,Both,,,,250,212.5,71.65,250,UnitedHealthcare,Individual & Family,235,94,,percent of total billed charges,,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 0.5 Cm Or Less",,11600,CPT,Facility,Outpatient,,,,250,212.5,71.65,250,UnitedHealthcare,Medicare Advantage,122.5,49,,percent of total billed charges,,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 0.5 Cm Or Less",,11600,CPT,Facility,Inpatient,,,,250,212.5,71.65,250,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 0.5 Cm Or Less",,11600,CPT,Facility,Outpatient,,,,250,212.5,71.65,250,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,120,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 0.5 Cm Or Less",,11600,CPT,Facility,Inpatient,,,,250,212.5,71.65,250,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 0.5 Cm Or Less (Pro Cah)",,11600,CPT,Professional,Both,,,,375,318.75,76.79,375,Aetna,Commercial,318.75,85,,percent of total billed charges,,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 0.5 Cm Or Less (Pro Cah)",,11600,CPT,Professional,Both,,,,375,318.75,76.79,375,Aetna,Medicare Advantage,120.26,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 0.5 Cm Or Less (Pro Cah)",,11600,CPT,Professional,Both,,,,375,318.75,76.79,375,Aetna,PPO,348.75,93,,percent of total billed charges,,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 0.5 Cm Or Less (Pro Cah)",,11600,CPT,Professional,Both,,,,375,318.75,76.79,375,America's PPO,America's PPO,320.4,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 0.5 Cm Or Less (Pro Cah)",,11600,CPT,Professional,Both,,,,375,318.75,76.79,375,BlueCross BlueShield Minnesota, Federal Employee Program,250.65,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 0.5 Cm Or Less (Pro Cah)",,11600,CPT,Professional,Both,,,,375,318.75,76.79,375,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,254.6604,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 0.5 Cm Or Less (Pro Cah)",,11600,CPT,Professional,Both,,,,375,318.75,76.79,375,BlueCross BlueShield Minnesota,High Value Network Plan,254.6604,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 0.5 Cm Or Less (Pro Cah)",,11600,CPT,Professional,Both,,,,375,318.75,76.79,375,BlueCross BlueShield Minnesota,Medicare Advantage,137.402,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 0.5 Cm Or Less (Pro Cah)",,11600,CPT,Professional,Both,,,,375,318.75,76.79,375,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,254.6604,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 0.5 Cm Or Less (Pro Cah)",,11600,CPT,Professional,Both,,,,375,318.75,76.79,375,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,88.65616,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 0.5 Cm Or Less (Pro Cah)",,11600,CPT,Professional,Both,,,,375,318.75,76.79,375,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),137.402,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 0.5 Cm Or Less (Pro Cah)",,11600,CPT,Professional,Both,,,,375,318.75,76.79,375,CorVel,Worker's Compensation,232.8615975,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 0.5 Cm Or Less (Pro Cah)",,11600,CPT,Professional,Both,,,,375,318.75,76.79,375,First Health Group Corporation,First Health Network,363.75,97,,percent of total billed charges,,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 0.5 Cm Or Less (Pro Cah)",,11600,CPT,Professional,Both,,,,375,318.75,76.79,375,"Health Partners, Inc.",Commercial,251.03,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 0.5 Cm Or Less (Pro Cah)",,11600,CPT,Professional,Both,,,,375,318.75,76.79,375,"Health Partners, Inc.",Medicare Advantage,137.402,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 0.5 Cm Or Less (Pro Cah)",,11600,CPT,Professional,Both,,,,375,318.75,76.79,375,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),119.28,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 0.5 Cm Or Less (Pro Cah)",,11600,CPT,Professional,Both,,,,375,318.75,76.79,375,"Health Partners, Inc.",State of Minnesota Advantage Program,216.262345,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 0.5 Cm Or Less (Pro Cah)",,11600,CPT,Professional,Both,,,,375,318.75,76.79,375,"Health Partners, Inc.",State Public Programs,76.79,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 0.5 Cm Or Less (Pro Cah)",,11600,CPT,Professional,Both,,,,375,318.75,76.79,375,Humana Insurance Company,Commercial PPO,119.48,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 0.5 Cm Or Less (Pro Cah)",,11600,CPT,Professional,Both,,,,375,318.75,76.79,375,Humana Insurance Company,Medicare PPO,375,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 0.5 Cm Or Less (Pro Cah)",,11600,CPT,Professional,Both,,,,375,318.75,76.79,375,Medica,Individual & Family,318,84.8,,percent of total billed charges,,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 0.5 Cm Or Less (Pro Cah)",,11600,CPT,Professional,Both,,,,375,318.75,76.79,375,Medica,Medica Advantage Solution,186.75,49.8,,percent of total billed charges,,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 0.5 Cm Or Less (Pro Cah)",,11600,CPT,Professional,Both,,,,375,318.75,76.79,375,Medica,Medical Assistance,88.66,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 0.5 Cm Or Less (Pro Cah)",,11600,CPT,Professional,Both,,,,375,318.75,76.79,375,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,119.48,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 0.5 Cm Or Less (Pro Cah)",,11600,CPT,Professional,Both,,,,375,318.75,76.79,375,"Multiplan, Inc.","Multiplan, Inc.",352.5,94,,percent of total billed charges,,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 0.5 Cm Or Less (Pro Cah)",,11600,CPT,Professional,Both,,,,375,318.75,76.79,375,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,337.875,90.1,,percent of total billed charges,,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 0.5 Cm Or Less (Pro Cah)",,11600,CPT,Professional,Both,,,,375,318.75,76.79,375,"Preferred One Administrative Services, INC.",PPO,369.75,98.6,,percent of total billed charges,,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 0.5 Cm Or Less (Pro Cah)",,11600,CPT,Professional,Both,,,,375,318.75,76.79,375,PrimeWest Health,Minnesota Senior Health Options (MSHO),137.402,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 0.5 Cm Or Less (Pro Cah)",,11600,CPT,Professional,Both,,,,375,318.75,76.79,375,PrimeWest Health,MinnesotaCare,94.8620912,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 0.5 Cm Or Less (Pro Cah)",,11600,CPT,Professional,Both,,,,375,318.75,76.79,375,Sanford Health Plan,Sanford Health Plan,330,88,,percent of total billed charges,,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 0.5 Cm Or Less (Pro Cah)",,11600,CPT,Professional,Both,,,,375,318.75,76.79,375,"UCare Health, Inc.",Individual & Family Plan,194.226688,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 0.5 Cm Or Less (Pro Cah)",,11600,CPT,Professional,Both,,,,375,318.75,76.79,375,"UCare Health, Inc.",Medical Assistance,97.521776,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 0.5 Cm Or Less (Pro Cah)",,11600,CPT,Professional,Both,,,,375,318.75,76.79,375,"UCare Health, Inc.",Medicare Advantage,137.402,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 0.5 Cm Or Less (Pro Cah)",,11600,CPT,Professional,Both,,,,375,318.75,76.79,375,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),109.9216,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 0.5 Cm Or Less (Pro Cah)",,11600,CPT,Professional,Both,,,,375,318.75,76.79,375,UnitedHealthcare,Individual & Family,375,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 0.5 Cm Or Less (Pro Cah)",,11600,CPT,Professional,Both,,,,375,318.75,76.79,375,UnitedHealthcare,Medicare Advantage,137.402,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 0.5 Cm Or Less (Pro Cah)",,11600,CPT,Professional,Both,,,,375,318.75,76.79,375,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,88.65616,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision Malignant Lesion Including Margins, T/A/L, .6 To 1.0 Cm",,11601,CPT,Facility,Both,,,,275,233.75,78.815,275,Aetna,Commercial,253,92,,percent of total billed charges,,
"Excision Malignant Lesion Including Margins, T/A/L, .6 To 1.0 Cm",,11601,CPT,Facility,Outpatient,,,,275,233.75,78.815,275,Aetna,Medicare Advantage,134.75,49,,percent of total billed charges,,
"Excision Malignant Lesion Including Margins, T/A/L, .6 To 1.0 Cm",,11601,CPT,Facility,Inpatient,,,,275,233.75,78.815,275,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Excision Malignant Lesion Including Margins, T/A/L, .6 To 1.0 Cm",,11601,CPT,Facility,Both,,,,275,233.75,78.815,275,Aetna,PPO,255.75,93,,percent of total billed charges,,
"Excision Malignant Lesion Including Margins, T/A/L, .6 To 1.0 Cm",,11601,CPT,Facility,Both,,,,275,233.75,78.815,275,America's PPO,America's PPO,264.0825,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Excision Malignant Lesion Including Margins, T/A/L, .6 To 1.0 Cm",,11601,CPT,Facility,Both,,,,275,233.75,78.815,275,BlueCross BlueShield Minnesota, Federal Employee Program,270.6,98.4,,percent of total billed charges,,
"Excision Malignant Lesion Including Margins, T/A/L, .6 To 1.0 Cm",,11601,CPT,Facility,Both,,,,275,233.75,78.815,275,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,275,100,,percent of total billed charges,,
"Excision Malignant Lesion Including Margins, T/A/L, .6 To 1.0 Cm",,11601,CPT,Facility,Both,,,,275,233.75,78.815,275,BlueCross BlueShield Minnesota,High Value Network Plan,247.5,90,,percent of total billed charges,,
"Excision Malignant Lesion Including Margins, T/A/L, .6 To 1.0 Cm",,11601,CPT,Facility,Outpatient,,,,275,233.75,78.815,275,BlueCross BlueShield Minnesota,Medicare Advantage,134.75,49,,percent of total billed charges,,
"Excision Malignant Lesion Including Margins, T/A/L, .6 To 1.0 Cm",,11601,CPT,Facility,Inpatient,,,,275,233.75,78.815,275,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Excision Malignant Lesion Including Margins, T/A/L, .6 To 1.0 Cm",,11601,CPT,Facility,Both,,,,275,233.75,78.815,275,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,243.5675,88.57,,percent of total billed charges,,
"Excision Malignant Lesion Including Margins, T/A/L, .6 To 1.0 Cm",,11601,CPT,Facility,Both,,,,275,233.75,78.815,275,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,78.815,28.66,,percent of total billed charges,,
"Excision Malignant Lesion Including Margins, T/A/L, .6 To 1.0 Cm",,11601,CPT,Facility,Outpatient,,,,275,233.75,78.815,275,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),134.75,49,,percent of total billed charges,,
"Excision Malignant Lesion Including Margins, T/A/L, .6 To 1.0 Cm",,11601,CPT,Facility,Inpatient,,,,275,233.75,78.815,275,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Excision Malignant Lesion Including Margins, T/A/L, .6 To 1.0 Cm",,11601,CPT,Facility,Both,,,,275,233.75,78.815,275,CorVel,Worker's Compensation,275,100,,percent of total billed charges,,
"Excision Malignant Lesion Including Margins, T/A/L, .6 To 1.0 Cm",,11601,CPT,Facility,Both,,,,275,233.75,78.815,275,First Health Group Corporation,First Health Network,266.75,97,,percent of total billed charges,,
"Excision Malignant Lesion Including Margins, T/A/L, .6 To 1.0 Cm",,11601,CPT,Facility,Both,,,,275,233.75,78.815,275,"Health Partners, Inc.",Commercial,260.15,94.6,,percent of total billed charges,,
"Excision Malignant Lesion Including Margins, T/A/L, .6 To 1.0 Cm",,11601,CPT,Facility,Outpatient,,,,275,233.75,78.815,275,"Health Partners, Inc.",Medicare Advantage,134.75,49,,percent of total billed charges,,
"Excision Malignant Lesion Including Margins, T/A/L, .6 To 1.0 Cm",,11601,CPT,Facility,Inpatient,,,,275,233.75,78.815,275,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Excision Malignant Lesion Including Margins, T/A/L, .6 To 1.0 Cm",,11601,CPT,Facility,Both,,,,275,233.75,78.815,275,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),165,60,,percent of total billed charges,,
"Excision Malignant Lesion Including Margins, T/A/L, .6 To 1.0 Cm",,11601,CPT,Facility,Both,,,,275,233.75,78.815,275,"Health Partners, Inc.",State of Minnesota Advantage Program,224.125,81.5,,percent of total billed charges,,
"Excision Malignant Lesion Including Margins, T/A/L, .6 To 1.0 Cm",,11601,CPT,Facility,Both,,,,275,233.75,78.815,275,"Health Partners, Inc.",State Public Programs,137.5,50,,percent of total billed charges,,
"Excision Malignant Lesion Including Margins, T/A/L, .6 To 1.0 Cm",,11601,CPT,Facility,Both,,,,275,233.75,78.815,275,Humana Insurance Company,Commercial PPO,261.25,95,,percent of total billed charges,,
"Excision Malignant Lesion Including Margins, T/A/L, .6 To 1.0 Cm",,11601,CPT,Facility,Outpatient,,,,275,233.75,78.815,275,Humana Insurance Company,Medicare PPO,134.75,49,,percent of total billed charges,,
"Excision Malignant Lesion Including Margins, T/A/L, .6 To 1.0 Cm",,11601,CPT,Facility,Inpatient,,,,275,233.75,78.815,275,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Excision Malignant Lesion Including Margins, T/A/L, .6 To 1.0 Cm",,11601,CPT,Facility,Both,,,,275,233.75,78.815,275,Medica,Individual & Family,272.525,99.1,,percent of total billed charges,,
"Excision Malignant Lesion Including Margins, T/A/L, .6 To 1.0 Cm",,11601,CPT,Facility,Outpatient,,,,275,233.75,78.815,275,Medica,Medica Advantage Solution,136.95,49.8,,percent of total billed charges,,
"Excision Malignant Lesion Including Margins, T/A/L, .6 To 1.0 Cm",,11601,CPT,Facility,Inpatient,,,,275,233.75,78.815,275,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Excision Malignant Lesion Including Margins, T/A/L, .6 To 1.0 Cm",,11601,CPT,Facility,Outpatient,,,,275,233.75,78.815,275,Medica,Medical Assistance,122.65,44.6,,percent of total billed charges,,
"Excision Malignant Lesion Including Margins, T/A/L, .6 To 1.0 Cm",,11601,CPT,Facility,Inpatient,,,,275,233.75,78.815,275,Medica,Medical Assistance,,,,,Included in per diem rate,
"Excision Malignant Lesion Including Margins, T/A/L, .6 To 1.0 Cm",,11601,CPT,Facility,Outpatient,,,,275,233.75,78.815,275,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,136.95,49.8,,percent of total billed charges,,
"Excision Malignant Lesion Including Margins, T/A/L, .6 To 1.0 Cm",,11601,CPT,Facility,Inpatient,,,,275,233.75,78.815,275,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Excision Malignant Lesion Including Margins, T/A/L, .6 To 1.0 Cm",,11601,CPT,Facility,Both,,,,275,233.75,78.815,275,"Multiplan, Inc.","Multiplan, Inc.",258.5,94,,percent of total billed charges,,
"Excision Malignant Lesion Including Margins, T/A/L, .6 To 1.0 Cm",,11601,CPT,Facility,Outpatient,,,,275,233.75,78.815,275,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,247.775,90.1,,percent of total billed charges,,
"Excision Malignant Lesion Including Margins, T/A/L, .6 To 1.0 Cm",,11601,CPT,Facility,Inpatient,,,,275,233.75,78.815,275,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Excision Malignant Lesion Including Margins, T/A/L, .6 To 1.0 Cm",,11601,CPT,Facility,Both,,,,275,233.75,78.815,275,"Preferred One Administrative Services, INC.",PPO,271.15,98.6,,percent of total billed charges,,
"Excision Malignant Lesion Including Margins, T/A/L, .6 To 1.0 Cm",,11601,CPT,Facility,Outpatient,,,,275,233.75,78.815,275,PrimeWest Health,Minnesota Senior Health Options (MSHO),141.4875,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Excision Malignant Lesion Including Margins, T/A/L, .6 To 1.0 Cm",,11601,CPT,Facility,Inpatient,,,,275,233.75,78.815,275,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Excision Malignant Lesion Including Margins, T/A/L, .6 To 1.0 Cm",,11601,CPT,Facility,Outpatient,,,,275,233.75,78.815,275,PrimeWest Health,MinnesotaCare,141.24,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Excision Malignant Lesion Including Margins, T/A/L, .6 To 1.0 Cm",,11601,CPT,Facility,Inpatient,,,,275,233.75,78.815,275,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Excision Malignant Lesion Including Margins, T/A/L, .6 To 1.0 Cm",,11601,CPT,Facility,Both,,,,275,233.75,78.815,275,Sanford Health Plan,Sanford Health Plan,253,92,,percent of total billed charges,,
"Excision Malignant Lesion Including Margins, T/A/L, .6 To 1.0 Cm",,11601,CPT,Facility,Outpatient,,,,275,233.75,78.815,275,"UCare Health, Inc.",Individual & Family Plan,154.9625,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Excision Malignant Lesion Including Margins, T/A/L, .6 To 1.0 Cm",,11601,CPT,Facility,Inpatient,,,,275,233.75,78.815,275,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Excision Malignant Lesion Including Margins, T/A/L, .6 To 1.0 Cm",,11601,CPT,Facility,Outpatient,,,,275,233.75,78.815,275,"UCare Health, Inc.",Medical Assistance,138.7925,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Excision Malignant Lesion Including Margins, T/A/L, .6 To 1.0 Cm",,11601,CPT,Facility,Inpatient,,,,275,233.75,78.815,275,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Excision Malignant Lesion Including Margins, T/A/L, .6 To 1.0 Cm",,11601,CPT,Facility,Outpatient,,,,275,233.75,78.815,275,"UCare Health, Inc.",Medicare Advantage,138.7925,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Excision Malignant Lesion Including Margins, T/A/L, .6 To 1.0 Cm",,11601,CPT,Facility,Inpatient,,,,275,233.75,78.815,275,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Excision Malignant Lesion Including Margins, T/A/L, .6 To 1.0 Cm",,11601,CPT,Facility,Outpatient,,,,275,233.75,78.815,275,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),138.7925,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Excision Malignant Lesion Including Margins, T/A/L, .6 To 1.0 Cm",,11601,CPT,Facility,Inpatient,,,,275,233.75,78.815,275,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Excision Malignant Lesion Including Margins, T/A/L, .6 To 1.0 Cm",,11601,CPT,Facility,Both,,,,275,233.75,78.815,275,UnitedHealthcare,Individual & Family,258.5,94,,percent of total billed charges,,
"Excision Malignant Lesion Including Margins, T/A/L, .6 To 1.0 Cm",,11601,CPT,Facility,Outpatient,,,,275,233.75,78.815,275,UnitedHealthcare,Medicare Advantage,134.75,49,,percent of total billed charges,,
"Excision Malignant Lesion Including Margins, T/A/L, .6 To 1.0 Cm",,11601,CPT,Facility,Inpatient,,,,275,233.75,78.815,275,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Excision Malignant Lesion Including Margins, T/A/L, .6 To 1.0 Cm",,11601,CPT,Facility,Outpatient,,,,275,233.75,78.815,275,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,132,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Excision Malignant Lesion Including Margins, T/A/L, .6 To 1.0 Cm",,11601,CPT,Facility,Inpatient,,,,275,233.75,78.815,275,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 0.6 To 1.0 Cm (Pro Cah)",,11601,CPT,Professional,Both,,,,410,348.5,93.37,410,Aetna,Commercial,348.5,85,,percent of total billed charges,,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 0.6 To 1.0 Cm (Pro Cah)",,11601,CPT,Professional,Both,,,,410,348.5,93.37,410,Aetna,Medicare Advantage,145.65,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 0.6 To 1.0 Cm (Pro Cah)",,11601,CPT,Professional,Both,,,,410,348.5,93.37,410,Aetna,PPO,381.3,93,,percent of total billed charges,,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 0.6 To 1.0 Cm (Pro Cah)",,11601,CPT,Professional,Both,,,,410,348.5,93.37,410,America's PPO,America's PPO,350.304,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 0.6 To 1.0 Cm (Pro Cah)",,11601,CPT,Professional,Both,,,,410,348.5,93.37,410,BlueCross BlueShield Minnesota, Federal Employee Program,303.67,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 0.6 To 1.0 Cm (Pro Cah)",,11601,CPT,Professional,Both,,,,410,348.5,93.37,410,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,308.52872,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 0.6 To 1.0 Cm (Pro Cah)",,11601,CPT,Professional,Both,,,,410,348.5,93.37,410,BlueCross BlueShield Minnesota,High Value Network Plan,308.52872,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 0.6 To 1.0 Cm (Pro Cah)",,11601,CPT,Professional,Both,,,,410,348.5,93.37,410,BlueCross BlueShield Minnesota,Medicare Advantage,166.842,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 0.6 To 1.0 Cm (Pro Cah)",,11601,CPT,Professional,Both,,,,410,348.5,93.37,410,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,308.52872,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 0.6 To 1.0 Cm (Pro Cah)",,11601,CPT,Professional,Both,,,,410,348.5,93.37,410,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,107.7976,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 0.6 To 1.0 Cm (Pro Cah)",,11601,CPT,Professional,Both,,,,410,348.5,93.37,410,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),166.842,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 0.6 To 1.0 Cm (Pro Cah)",,11601,CPT,Professional,Both,,,,410,348.5,93.37,410,CorVel,Worker's Compensation,282.4169367,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 0.6 To 1.0 Cm (Pro Cah)",,11601,CPT,Professional,Both,,,,410,348.5,93.37,410,First Health Group Corporation,First Health Network,397.7,97,,percent of total billed charges,,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 0.6 To 1.0 Cm (Pro Cah)",,11601,CPT,Professional,Both,,,,410,348.5,93.37,410,"Health Partners, Inc.",Commercial,305.45,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 0.6 To 1.0 Cm (Pro Cah)",,11601,CPT,Professional,Both,,,,410,348.5,93.37,410,"Health Partners, Inc.",Medicare Advantage,166.842,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 0.6 To 1.0 Cm (Pro Cah)",,11601,CPT,Professional,Both,,,,410,348.5,93.37,410,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),145.04,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 0.6 To 1.0 Cm (Pro Cah)",,11601,CPT,Professional,Both,,,,410,348.5,93.37,410,"Health Partners, Inc.",State of Minnesota Advantage Program,263.145175,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 0.6 To 1.0 Cm (Pro Cah)",,11601,CPT,Professional,Both,,,,410,348.5,93.37,410,"Health Partners, Inc.",State Public Programs,93.37,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 0.6 To 1.0 Cm (Pro Cah)",,11601,CPT,Professional,Both,,,,410,348.5,93.37,410,Humana Insurance Company,Commercial PPO,145.08,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 0.6 To 1.0 Cm (Pro Cah)",,11601,CPT,Professional,Both,,,,410,348.5,93.37,410,Humana Insurance Company,Medicare PPO,410,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 0.6 To 1.0 Cm (Pro Cah)",,11601,CPT,Professional,Both,,,,410,348.5,93.37,410,Medica,Individual & Family,347.68,84.8,,percent of total billed charges,,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 0.6 To 1.0 Cm (Pro Cah)",,11601,CPT,Professional,Both,,,,410,348.5,93.37,410,Medica,Medica Advantage Solution,204.18,49.8,,percent of total billed charges,,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 0.6 To 1.0 Cm (Pro Cah)",,11601,CPT,Professional,Both,,,,410,348.5,93.37,410,Medica,Medical Assistance,107.8,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 0.6 To 1.0 Cm (Pro Cah)",,11601,CPT,Professional,Both,,,,410,348.5,93.37,410,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,145.08,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 0.6 To 1.0 Cm (Pro Cah)",,11601,CPT,Professional,Both,,,,410,348.5,93.37,410,"Multiplan, Inc.","Multiplan, Inc.",385.4,94,,percent of total billed charges,,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 0.6 To 1.0 Cm (Pro Cah)",,11601,CPT,Professional,Both,,,,410,348.5,93.37,410,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,369.41,90.1,,percent of total billed charges,,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 0.6 To 1.0 Cm (Pro Cah)",,11601,CPT,Professional,Both,,,,410,348.5,93.37,410,"Preferred One Administrative Services, INC.",PPO,404.26,98.6,,percent of total billed charges,,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 0.6 To 1.0 Cm (Pro Cah)",,11601,CPT,Professional,Both,,,,410,348.5,93.37,410,PrimeWest Health,Minnesota Senior Health Options (MSHO),166.842,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 0.6 To 1.0 Cm (Pro Cah)",,11601,CPT,Professional,Both,,,,410,348.5,93.37,410,PrimeWest Health,MinnesotaCare,115.343432,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 0.6 To 1.0 Cm (Pro Cah)",,11601,CPT,Professional,Both,,,,410,348.5,93.37,410,Sanford Health Plan,Sanford Health Plan,360.8,88,,percent of total billed charges,,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 0.6 To 1.0 Cm (Pro Cah)",,11601,CPT,Professional,Both,,,,410,348.5,93.37,410,"UCare Health, Inc.",Individual & Family Plan,235.842048,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 0.6 To 1.0 Cm (Pro Cah)",,11601,CPT,Professional,Both,,,,410,348.5,93.37,410,"UCare Health, Inc.",Medical Assistance,118.57736,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 0.6 To 1.0 Cm (Pro Cah)",,11601,CPT,Professional,Both,,,,410,348.5,93.37,410,"UCare Health, Inc.",Medicare Advantage,166.842,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 0.6 To 1.0 Cm (Pro Cah)",,11601,CPT,Professional,Both,,,,410,348.5,93.37,410,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),133.4736,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 0.6 To 1.0 Cm (Pro Cah)",,11601,CPT,Professional,Both,,,,410,348.5,93.37,410,UnitedHealthcare,Individual & Family,410,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 0.6 To 1.0 Cm (Pro Cah)",,11601,CPT,Professional,Both,,,,410,348.5,93.37,410,UnitedHealthcare,Medicare Advantage,166.842,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 0.6 To 1.0 Cm (Pro Cah)",,11601,CPT,Professional,Both,,,,410,348.5,93.37,410,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,107.7976,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision Malignant Lesion Including Margins, T/A/L, 1.1 To 2.0 Cm",,11602,CPT,Facility,Both,,,,260,221,74.516,260,Aetna,Commercial,239.2,92,,percent of total billed charges,,
"Excision Malignant Lesion Including Margins, T/A/L, 1.1 To 2.0 Cm",,11602,CPT,Facility,Outpatient,,,,260,221,74.516,260,Aetna,Medicare Advantage,127.4,49,,percent of total billed charges,,
"Excision Malignant Lesion Including Margins, T/A/L, 1.1 To 2.0 Cm",,11602,CPT,Facility,Inpatient,,,,260,221,74.516,260,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Excision Malignant Lesion Including Margins, T/A/L, 1.1 To 2.0 Cm",,11602,CPT,Facility,Both,,,,260,221,74.516,260,Aetna,PPO,241.8,93,,percent of total billed charges,,
"Excision Malignant Lesion Including Margins, T/A/L, 1.1 To 2.0 Cm",,11602,CPT,Facility,Both,,,,260,221,74.516,260,America's PPO,America's PPO,249.678,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Excision Malignant Lesion Including Margins, T/A/L, 1.1 To 2.0 Cm",,11602,CPT,Facility,Both,,,,260,221,74.516,260,BlueCross BlueShield Minnesota, Federal Employee Program,255.84,98.4,,percent of total billed charges,,
"Excision Malignant Lesion Including Margins, T/A/L, 1.1 To 2.0 Cm",,11602,CPT,Facility,Both,,,,260,221,74.516,260,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,260,100,,percent of total billed charges,,
"Excision Malignant Lesion Including Margins, T/A/L, 1.1 To 2.0 Cm",,11602,CPT,Facility,Both,,,,260,221,74.516,260,BlueCross BlueShield Minnesota,High Value Network Plan,234,90,,percent of total billed charges,,
"Excision Malignant Lesion Including Margins, T/A/L, 1.1 To 2.0 Cm",,11602,CPT,Facility,Outpatient,,,,260,221,74.516,260,BlueCross BlueShield Minnesota,Medicare Advantage,127.4,49,,percent of total billed charges,,
"Excision Malignant Lesion Including Margins, T/A/L, 1.1 To 2.0 Cm",,11602,CPT,Facility,Inpatient,,,,260,221,74.516,260,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Excision Malignant Lesion Including Margins, T/A/L, 1.1 To 2.0 Cm",,11602,CPT,Facility,Both,,,,260,221,74.516,260,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,230.282,88.57,,percent of total billed charges,,
"Excision Malignant Lesion Including Margins, T/A/L, 1.1 To 2.0 Cm",,11602,CPT,Facility,Both,,,,260,221,74.516,260,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,74.516,28.66,,percent of total billed charges,,
"Excision Malignant Lesion Including Margins, T/A/L, 1.1 To 2.0 Cm",,11602,CPT,Facility,Outpatient,,,,260,221,74.516,260,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),127.4,49,,percent of total billed charges,,
"Excision Malignant Lesion Including Margins, T/A/L, 1.1 To 2.0 Cm",,11602,CPT,Facility,Inpatient,,,,260,221,74.516,260,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Excision Malignant Lesion Including Margins, T/A/L, 1.1 To 2.0 Cm",,11602,CPT,Facility,Both,,,,260,221,74.516,260,CorVel,Worker's Compensation,260,100,,percent of total billed charges,,
"Excision Malignant Lesion Including Margins, T/A/L, 1.1 To 2.0 Cm",,11602,CPT,Facility,Both,,,,260,221,74.516,260,First Health Group Corporation,First Health Network,252.2,97,,percent of total billed charges,,
"Excision Malignant Lesion Including Margins, T/A/L, 1.1 To 2.0 Cm",,11602,CPT,Facility,Both,,,,260,221,74.516,260,"Health Partners, Inc.",Commercial,245.96,94.6,,percent of total billed charges,,
"Excision Malignant Lesion Including Margins, T/A/L, 1.1 To 2.0 Cm",,11602,CPT,Facility,Outpatient,,,,260,221,74.516,260,"Health Partners, Inc.",Medicare Advantage,127.4,49,,percent of total billed charges,,
"Excision Malignant Lesion Including Margins, T/A/L, 1.1 To 2.0 Cm",,11602,CPT,Facility,Inpatient,,,,260,221,74.516,260,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Excision Malignant Lesion Including Margins, T/A/L, 1.1 To 2.0 Cm",,11602,CPT,Facility,Both,,,,260,221,74.516,260,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),156,60,,percent of total billed charges,,
"Excision Malignant Lesion Including Margins, T/A/L, 1.1 To 2.0 Cm",,11602,CPT,Facility,Both,,,,260,221,74.516,260,"Health Partners, Inc.",State of Minnesota Advantage Program,211.9,81.5,,percent of total billed charges,,
"Excision Malignant Lesion Including Margins, T/A/L, 1.1 To 2.0 Cm",,11602,CPT,Facility,Both,,,,260,221,74.516,260,"Health Partners, Inc.",State Public Programs,130,50,,percent of total billed charges,,
"Excision Malignant Lesion Including Margins, T/A/L, 1.1 To 2.0 Cm",,11602,CPT,Facility,Both,,,,260,221,74.516,260,Humana Insurance Company,Commercial PPO,247,95,,percent of total billed charges,,
"Excision Malignant Lesion Including Margins, T/A/L, 1.1 To 2.0 Cm",,11602,CPT,Facility,Outpatient,,,,260,221,74.516,260,Humana Insurance Company,Medicare PPO,127.4,49,,percent of total billed charges,,
"Excision Malignant Lesion Including Margins, T/A/L, 1.1 To 2.0 Cm",,11602,CPT,Facility,Inpatient,,,,260,221,74.516,260,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Excision Malignant Lesion Including Margins, T/A/L, 1.1 To 2.0 Cm",,11602,CPT,Facility,Both,,,,260,221,74.516,260,Medica,Individual & Family,257.66,99.1,,percent of total billed charges,,
"Excision Malignant Lesion Including Margins, T/A/L, 1.1 To 2.0 Cm",,11602,CPT,Facility,Outpatient,,,,260,221,74.516,260,Medica,Medica Advantage Solution,129.48,49.8,,percent of total billed charges,,
"Excision Malignant Lesion Including Margins, T/A/L, 1.1 To 2.0 Cm",,11602,CPT,Facility,Inpatient,,,,260,221,74.516,260,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Excision Malignant Lesion Including Margins, T/A/L, 1.1 To 2.0 Cm",,11602,CPT,Facility,Outpatient,,,,260,221,74.516,260,Medica,Medical Assistance,115.96,44.6,,percent of total billed charges,,
"Excision Malignant Lesion Including Margins, T/A/L, 1.1 To 2.0 Cm",,11602,CPT,Facility,Inpatient,,,,260,221,74.516,260,Medica,Medical Assistance,,,,,Included in per diem rate,
"Excision Malignant Lesion Including Margins, T/A/L, 1.1 To 2.0 Cm",,11602,CPT,Facility,Outpatient,,,,260,221,74.516,260,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,129.48,49.8,,percent of total billed charges,,
"Excision Malignant Lesion Including Margins, T/A/L, 1.1 To 2.0 Cm",,11602,CPT,Facility,Inpatient,,,,260,221,74.516,260,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Excision Malignant Lesion Including Margins, T/A/L, 1.1 To 2.0 Cm",,11602,CPT,Facility,Both,,,,260,221,74.516,260,"Multiplan, Inc.","Multiplan, Inc.",244.4,94,,percent of total billed charges,,
"Excision Malignant Lesion Including Margins, T/A/L, 1.1 To 2.0 Cm",,11602,CPT,Facility,Outpatient,,,,260,221,74.516,260,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,234.26,90.1,,percent of total billed charges,,
"Excision Malignant Lesion Including Margins, T/A/L, 1.1 To 2.0 Cm",,11602,CPT,Facility,Inpatient,,,,260,221,74.516,260,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Excision Malignant Lesion Including Margins, T/A/L, 1.1 To 2.0 Cm",,11602,CPT,Facility,Both,,,,260,221,74.516,260,"Preferred One Administrative Services, INC.",PPO,256.36,98.6,,percent of total billed charges,,
"Excision Malignant Lesion Including Margins, T/A/L, 1.1 To 2.0 Cm",,11602,CPT,Facility,Outpatient,,,,260,221,74.516,260,PrimeWest Health,Minnesota Senior Health Options (MSHO),133.77,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Excision Malignant Lesion Including Margins, T/A/L, 1.1 To 2.0 Cm",,11602,CPT,Facility,Inpatient,,,,260,221,74.516,260,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Excision Malignant Lesion Including Margins, T/A/L, 1.1 To 2.0 Cm",,11602,CPT,Facility,Outpatient,,,,260,221,74.516,260,PrimeWest Health,MinnesotaCare,133.536,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Excision Malignant Lesion Including Margins, T/A/L, 1.1 To 2.0 Cm",,11602,CPT,Facility,Inpatient,,,,260,221,74.516,260,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Excision Malignant Lesion Including Margins, T/A/L, 1.1 To 2.0 Cm",,11602,CPT,Facility,Both,,,,260,221,74.516,260,Sanford Health Plan,Sanford Health Plan,239.2,92,,percent of total billed charges,,
"Excision Malignant Lesion Including Margins, T/A/L, 1.1 To 2.0 Cm",,11602,CPT,Facility,Outpatient,,,,260,221,74.516,260,"UCare Health, Inc.",Individual & Family Plan,146.51,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Excision Malignant Lesion Including Margins, T/A/L, 1.1 To 2.0 Cm",,11602,CPT,Facility,Inpatient,,,,260,221,74.516,260,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Excision Malignant Lesion Including Margins, T/A/L, 1.1 To 2.0 Cm",,11602,CPT,Facility,Outpatient,,,,260,221,74.516,260,"UCare Health, Inc.",Medical Assistance,131.222,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Excision Malignant Lesion Including Margins, T/A/L, 1.1 To 2.0 Cm",,11602,CPT,Facility,Inpatient,,,,260,221,74.516,260,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Excision Malignant Lesion Including Margins, T/A/L, 1.1 To 2.0 Cm",,11602,CPT,Facility,Outpatient,,,,260,221,74.516,260,"UCare Health, Inc.",Medicare Advantage,131.222,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Excision Malignant Lesion Including Margins, T/A/L, 1.1 To 2.0 Cm",,11602,CPT,Facility,Inpatient,,,,260,221,74.516,260,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Excision Malignant Lesion Including Margins, T/A/L, 1.1 To 2.0 Cm",,11602,CPT,Facility,Outpatient,,,,260,221,74.516,260,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),131.222,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Excision Malignant Lesion Including Margins, T/A/L, 1.1 To 2.0 Cm",,11602,CPT,Facility,Inpatient,,,,260,221,74.516,260,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Excision Malignant Lesion Including Margins, T/A/L, 1.1 To 2.0 Cm",,11602,CPT,Facility,Both,,,,260,221,74.516,260,UnitedHealthcare,Individual & Family,244.4,94,,percent of total billed charges,,
"Excision Malignant Lesion Including Margins, T/A/L, 1.1 To 2.0 Cm",,11602,CPT,Facility,Outpatient,,,,260,221,74.516,260,UnitedHealthcare,Medicare Advantage,127.4,49,,percent of total billed charges,,
"Excision Malignant Lesion Including Margins, T/A/L, 1.1 To 2.0 Cm",,11602,CPT,Facility,Inpatient,,,,260,221,74.516,260,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Excision Malignant Lesion Including Margins, T/A/L, 1.1 To 2.0 Cm",,11602,CPT,Facility,Outpatient,,,,260,221,74.516,260,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,124.8,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Excision Malignant Lesion Including Margins, T/A/L, 1.1 To 2.0 Cm",,11602,CPT,Facility,Inpatient,,,,260,221,74.516,260,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Excision,Malignant Lesion 1.1 To 2.0Cm (Pbb)",,11602,CPT,Facility,Outpatient,,,,459,390.15,131.5494,459,Aetna,Commercial,422.28,92,,percent of total billed charges,,
"Excision,Malignant Lesion 1.1 To 2.0Cm (Pbb)",,11602,CPT,Professional,Outpatient,,,,612,520.2,101.66,612,Aetna,Commercial,520.2,85,,percent of total billed charges,,
"Excision,Malignant Lesion 1.1 To 2.0Cm (Pbb)",,11602,CPT,Facility,Outpatient,,,,459,390.15,131.5494,459,Aetna,Medicare Advantage,224.91,49,,percent of total billed charges,,
"Excision,Malignant Lesion 1.1 To 2.0Cm (Pbb)",,11602,CPT,Professional,Outpatient,,,,612,520.2,101.66,612,Aetna,Medicare Advantage,158.64,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision,Malignant Lesion 1.1 To 2.0Cm (Pbb)",,11602,CPT,Facility,Outpatient,,,,459,390.15,131.5494,459,Aetna,PPO,426.87,93,,percent of total billed charges,,
"Excision,Malignant Lesion 1.1 To 2.0Cm (Pbb)",,11602,CPT,Professional,Outpatient,,,,612,520.2,101.66,612,Aetna,PPO,569.16,93,,percent of total billed charges,,
"Excision,Malignant Lesion 1.1 To 2.0Cm (Pbb)",,11602,CPT,Facility,Outpatient,,,,459,390.15,131.5494,459,America's PPO,America's PPO,440.7777,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Excision,Malignant Lesion 1.1 To 2.0Cm (Pbb)",,11602,CPT,Professional,Outpatient,,,,612,520.2,101.66,612,America's PPO,America's PPO,522.8928,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Excision,Malignant Lesion 1.1 To 2.0Cm (Pbb)",,11602,CPT,Facility,Outpatient,,,,459,390.15,131.5494,459,BlueCross BlueShield Minnesota, Federal Employee Program,451.656,98.4,,percent of total billed charges,,
"Excision,Malignant Lesion 1.1 To 2.0Cm (Pbb)",,11602,CPT,Professional,Outpatient,,,,612,520.2,101.66,612,BlueCross BlueShield Minnesota, Federal Employee Program,329.84,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Excision,Malignant Lesion 1.1 To 2.0Cm (Pbb)",,11602,CPT,Facility,Outpatient,,,,459,390.15,131.5494,459,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,459,100,,percent of total billed charges,,
"Excision,Malignant Lesion 1.1 To 2.0Cm (Pbb)",,11602,CPT,Professional,Outpatient,,,,612,520.2,101.66,612,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,335.11744,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision,Malignant Lesion 1.1 To 2.0Cm (Pbb)",,11602,CPT,Facility,Outpatient,,,,459,390.15,131.5494,459,BlueCross BlueShield Minnesota,High Value Network Plan,413.1,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
"Excision,Malignant Lesion 1.1 To 2.0Cm (Pbb)",,11602,CPT,Professional,Outpatient,,,,612,520.2,101.66,612,BlueCross BlueShield Minnesota,High Value Network Plan,335.11744,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision,Malignant Lesion 1.1 To 2.0Cm (Pbb)",,11602,CPT,Facility,Outpatient,,,,459,390.15,131.5494,459,BlueCross BlueShield Minnesota,Medicare Advantage,224.91,49,,percent of total billed charges,,
"Excision,Malignant Lesion 1.1 To 2.0Cm (Pbb)",,11602,CPT,Professional,Outpatient,,,,612,520.2,101.66,612,BlueCross BlueShield Minnesota,Medicare Advantage,181.7805,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision,Malignant Lesion 1.1 To 2.0Cm (Pbb)",,11602,CPT,Professional,Outpatient,,,,612,520.2,101.66,612,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,335.11744,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision,Malignant Lesion 1.1 To 2.0Cm (Pbb)",,11602,CPT,Facility,Outpatient,,,,459,390.15,131.5494,459,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,131.5494,28.66,,percent of total billed charges,,
"Excision,Malignant Lesion 1.1 To 2.0Cm (Pbb)",,11602,CPT,Professional,Outpatient,,,,612,520.2,101.66,612,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,117.36832,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision,Malignant Lesion 1.1 To 2.0Cm (Pbb)",,11602,CPT,Facility,Outpatient,,,,459,390.15,131.5494,459,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),224.91,49,,percent of total billed charges,,
"Excision,Malignant Lesion 1.1 To 2.0Cm (Pbb)",,11602,CPT,Professional,Outpatient,,,,612,520.2,101.66,612,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),181.7805,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision,Malignant Lesion 1.1 To 2.0Cm (Pbb)",,11602,CPT,Facility,Outpatient,,,,459,390.15,131.5494,459,CorVel,Worker's Compensation,459,100,,percent of total billed charges,,
"Excision,Malignant Lesion 1.1 To 2.0Cm (Pbb)",,11602,CPT,Professional,Outpatient,,,,612,520.2,101.66,612,CorVel,Worker's Compensation,307.4182824,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Excision,Malignant Lesion 1.1 To 2.0Cm (Pbb)",,11602,CPT,Facility,Outpatient,,,,459,390.15,131.5494,459,First Health Group Corporation,First Health Network,445.23,97,,percent of total billed charges,,
"Excision,Malignant Lesion 1.1 To 2.0Cm (Pbb)",,11602,CPT,Professional,Outpatient,,,,612,520.2,101.66,612,First Health Group Corporation,First Health Network,593.64,97,,percent of total billed charges,,
"Excision,Malignant Lesion 1.1 To 2.0Cm (Pbb)",,11602,CPT,Facility,Outpatient,,,,459,390.15,131.5494,459,"Health Partners, Inc.",Commercial,434.214,94.6,,percent of total billed charges,,
"Excision,Malignant Lesion 1.1 To 2.0Cm (Pbb)",,11602,CPT,Professional,Outpatient,,,,612,520.2,101.66,612,"Health Partners, Inc.",Commercial,332.29,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision,Malignant Lesion 1.1 To 2.0Cm (Pbb)",,11602,CPT,Facility,Outpatient,,,,459,390.15,131.5494,459,"Health Partners, Inc.",Medicare Advantage,224.91,49,,percent of total billed charges,,
"Excision,Malignant Lesion 1.1 To 2.0Cm (Pbb)",,11602,CPT,Professional,Outpatient,,,,612,520.2,101.66,612,"Health Partners, Inc.",Medicare Advantage,181.7805,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision,Malignant Lesion 1.1 To 2.0Cm (Pbb)",,11602,CPT,Facility,Outpatient,,,,459,390.15,131.5494,459,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),275.4,60,,percent of total billed charges,,
"Excision,Malignant Lesion 1.1 To 2.0Cm (Pbb)",,11602,CPT,Professional,Outpatient,,,,612,520.2,101.66,612,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),157.91,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Excision,Malignant Lesion 1.1 To 2.0Cm (Pbb)",,11602,CPT,Facility,Outpatient,,,,459,390.15,131.5494,459,"Health Partners, Inc.",State of Minnesota Advantage Program,374.085,81.5,,percent of total billed charges,,
"Excision,Malignant Lesion 1.1 To 2.0Cm (Pbb)",,11602,CPT,Professional,Outpatient,,,,612,520.2,101.66,612,"Health Partners, Inc.",State of Minnesota Advantage Program,286.267835,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision,Malignant Lesion 1.1 To 2.0Cm (Pbb)",,11602,CPT,Facility,Outpatient,,,,459,390.15,131.5494,459,"Health Partners, Inc.",State Public Programs,229.5,50,,percent of total billed charges,,
"Excision,Malignant Lesion 1.1 To 2.0Cm (Pbb)",,11602,CPT,Professional,Outpatient,,,,612,520.2,101.66,612,"Health Partners, Inc.",State Public Programs,101.66,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Excision,Malignant Lesion 1.1 To 2.0Cm (Pbb)",,11602,CPT,Facility,Outpatient,,,,459,390.15,131.5494,459,Humana Insurance Company,Commercial PPO,436.05,95,,percent of total billed charges,,
"Excision,Malignant Lesion 1.1 To 2.0Cm (Pbb)",,11602,CPT,Professional,Outpatient,,,,612,520.2,101.66,612,Humana Insurance Company,Commercial PPO,158.07,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Excision,Malignant Lesion 1.1 To 2.0Cm (Pbb)",,11602,CPT,Facility,Outpatient,,,,459,390.15,131.5494,459,Humana Insurance Company,Medicare PPO,224.91,49,,percent of total billed charges,,
"Excision,Malignant Lesion 1.1 To 2.0Cm (Pbb)",,11602,CPT,Professional,Outpatient,,,,612,520.2,101.66,612,Humana Insurance Company,Medicare PPO,612,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Excision,Malignant Lesion 1.1 To 2.0Cm (Pbb)",,11602,CPT,Facility,Outpatient,,,,459,390.15,131.5494,459,Medica,Individual & Family,454.869,99.1,,percent of total billed charges,,
"Excision,Malignant Lesion 1.1 To 2.0Cm (Pbb)",,11602,CPT,Professional,Outpatient,,,,612,520.2,101.66,612,Medica,Individual & Family,518.976,84.8,,percent of total billed charges,,
"Excision,Malignant Lesion 1.1 To 2.0Cm (Pbb)",,11602,CPT,Facility,Outpatient,,,,459,390.15,131.5494,459,Medica,Medica Advantage Solution,228.582,49.8,,percent of total billed charges,,
"Excision,Malignant Lesion 1.1 To 2.0Cm (Pbb)",,11602,CPT,Professional,Outpatient,,,,612,520.2,101.66,612,Medica,Medica Advantage Solution,304.776,49.8,,percent of total billed charges,,
"Excision,Malignant Lesion 1.1 To 2.0Cm (Pbb)",,11602,CPT,Facility,Outpatient,,,,459,390.15,131.5494,459,Medica,Medical Assistance,204.714,44.6,,percent of total billed charges,,
"Excision,Malignant Lesion 1.1 To 2.0Cm (Pbb)",,11602,CPT,Professional,Outpatient,,,,612,520.2,101.66,612,Medica,Medical Assistance,117.37,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Excision,Malignant Lesion 1.1 To 2.0Cm (Pbb)",,11602,CPT,Facility,Outpatient,,,,459,390.15,131.5494,459,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,228.582,49.8,,percent of total billed charges,,
"Excision,Malignant Lesion 1.1 To 2.0Cm (Pbb)",,11602,CPT,Professional,Outpatient,,,,612,520.2,101.66,612,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,158.07,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Excision,Malignant Lesion 1.1 To 2.0Cm (Pbb)",,11602,CPT,Facility,Outpatient,,,,459,390.15,131.5494,459,"Multiplan, Inc.","Multiplan, Inc.",431.46,94,,percent of total billed charges,,
"Excision,Malignant Lesion 1.1 To 2.0Cm (Pbb)",,11602,CPT,Professional,Outpatient,,,,612,520.2,101.66,612,"Multiplan, Inc.","Multiplan, Inc.",575.28,94,,percent of total billed charges,,
"Excision,Malignant Lesion 1.1 To 2.0Cm (Pbb)",,11602,CPT,Facility,Outpatient,,,,459,390.15,131.5494,459,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,413.559,90.1,,percent of total billed charges,,
"Excision,Malignant Lesion 1.1 To 2.0Cm (Pbb)",,11602,CPT,Professional,Outpatient,,,,612,520.2,101.66,612,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,551.412,90.1,,percent of total billed charges,,
"Excision,Malignant Lesion 1.1 To 2.0Cm (Pbb)",,11602,CPT,Facility,Outpatient,,,,459,390.15,131.5494,459,"Preferred One Administrative Services, INC.",PPO,452.574,98.6,,percent of total billed charges,,
"Excision,Malignant Lesion 1.1 To 2.0Cm (Pbb)",,11602,CPT,Professional,Outpatient,,,,612,520.2,101.66,612,"Preferred One Administrative Services, INC.",PPO,603.432,98.6,,percent of total billed charges,,
"Excision,Malignant Lesion 1.1 To 2.0Cm (Pbb)",,11602,CPT,Facility,Outpatient,,,,459,390.15,131.5494,459,PrimeWest Health,Minnesota Senior Health Options (MSHO),236.1555,51.45,,percent of total billed charges,,
"Excision,Malignant Lesion 1.1 To 2.0Cm (Pbb)",,11602,CPT,Professional,Outpatient,,,,612,520.2,101.66,612,PrimeWest Health,Minnesota Senior Health Options (MSHO),181.7805,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision,Malignant Lesion 1.1 To 2.0Cm (Pbb)",,11602,CPT,Facility,Outpatient,,,,459,390.15,131.5494,459,PrimeWest Health,MinnesotaCare,235.7424,51.36,,percent of total billed charges,,
"Excision,Malignant Lesion 1.1 To 2.0Cm (Pbb)",,11602,CPT,Professional,Outpatient,,,,612,520.2,101.66,612,PrimeWest Health,MinnesotaCare,125.5841024,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision,Malignant Lesion 1.1 To 2.0Cm (Pbb)",,11602,CPT,Facility,Outpatient,,,,459,390.15,131.5494,459,Sanford Health Plan,Sanford Health Plan,422.28,92,,percent of total billed charges,,
"Excision,Malignant Lesion 1.1 To 2.0Cm (Pbb)",,11602,CPT,Professional,Outpatient,,,,612,520.2,101.66,612,Sanford Health Plan,Sanford Health Plan,538.56,88,,percent of total billed charges,,
"Excision,Malignant Lesion 1.1 To 2.0Cm (Pbb)",,11602,CPT,Facility,Outpatient,,,,459,390.15,131.5494,459,"UCare Health, Inc.",Individual & Family Plan,258.6465,56.35,,percent of total billed charges,,
"Excision,Malignant Lesion 1.1 To 2.0Cm (Pbb)",,11602,CPT,Professional,Outpatient,,,,612,520.2,101.66,612,"UCare Health, Inc.",Individual & Family Plan,256.958592,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Excision,Malignant Lesion 1.1 To 2.0Cm (Pbb)",,11602,CPT,Facility,Outpatient,,,,459,390.15,131.5494,459,"UCare Health, Inc.",Medical Assistance,231.6573,50.47,,percent of total billed charges,,
"Excision,Malignant Lesion 1.1 To 2.0Cm (Pbb)",,11602,CPT,Professional,Outpatient,,,,612,520.2,101.66,612,"UCare Health, Inc.",Medical Assistance,129.105152,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Excision,Malignant Lesion 1.1 To 2.0Cm (Pbb)",,11602,CPT,Facility,Outpatient,,,,459,390.15,131.5494,459,"UCare Health, Inc.",Medicare Advantage,231.6573,50.47,,percent of total billed charges,,
"Excision,Malignant Lesion 1.1 To 2.0Cm (Pbb)",,11602,CPT,Professional,Outpatient,,,,612,520.2,101.66,612,"UCare Health, Inc.",Medicare Advantage,181.7805,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Excision,Malignant Lesion 1.1 To 2.0Cm (Pbb)",,11602,CPT,Facility,Outpatient,,,,459,390.15,131.5494,459,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),231.6573,50.47,,percent of total billed charges,,
"Excision,Malignant Lesion 1.1 To 2.0Cm (Pbb)",,11602,CPT,Professional,Outpatient,,,,612,520.2,101.66,612,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),145.4244,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Excision,Malignant Lesion 1.1 To 2.0Cm (Pbb)",,11602,CPT,Facility,Outpatient,,,,459,390.15,131.5494,459,UnitedHealthcare,Individual & Family,431.46,94,,percent of total billed charges,,
"Excision,Malignant Lesion 1.1 To 2.0Cm (Pbb)",,11602,CPT,Professional,Outpatient,,,,612,520.2,101.66,612,UnitedHealthcare,Individual & Family,612,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Excision,Malignant Lesion 1.1 To 2.0Cm (Pbb)",,11602,CPT,Facility,Outpatient,,,,459,390.15,131.5494,459,UnitedHealthcare,Medicare Advantage,224.91,49,,percent of total billed charges,,
"Excision,Malignant Lesion 1.1 To 2.0Cm (Pbb)",,11602,CPT,Professional,Outpatient,,,,612,520.2,101.66,612,UnitedHealthcare,Medicare Advantage,181.7805,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision,Malignant Lesion 1.1 To 2.0Cm (Pbb)",,11602,CPT,Facility,Outpatient,,,,459,390.15,131.5494,459,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,220.32,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Excision,Malignant Lesion 1.1 To 2.0Cm (Pbb)",,11602,CPT,Professional,Outpatient,,,,612,520.2,101.66,612,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,117.36832,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision,Malignant Lesion Inc Margins, Trunk, Arms, Or Legs; Excised Dia 1.1 To 2.0 Cm (Pro Cah)",,11602,CPT,Professional,Both,,,,1071,910.35,101.66,1071,Aetna,Commercial,910.35,85,,percent of total billed charges,,
"Excision,Malignant Lesion Inc Margins, Trunk, Arms, Or Legs; Excised Dia 1.1 To 2.0 Cm (Pro Cah)",,11602,CPT,Professional,Both,,,,445,378.25,101.66,445,Aetna,Commercial,378.25,85,,percent of total billed charges,,
"Excision,Malignant Lesion Inc Margins, Trunk, Arms, Or Legs; Excised Dia 1.1 To 2.0 Cm (Pro Cah)",,11602,CPT,Professional,Both,,,,1071,910.35,101.66,1071,Aetna,Medicare Advantage,158.64,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision,Malignant Lesion Inc Margins, Trunk, Arms, Or Legs; Excised Dia 1.1 To 2.0 Cm (Pro Cah)",,11602,CPT,Professional,Both,,,,445,378.25,101.66,445,Aetna,Medicare Advantage,158.64,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision,Malignant Lesion Inc Margins, Trunk, Arms, Or Legs; Excised Dia 1.1 To 2.0 Cm (Pro Cah)",,11602,CPT,Professional,Both,,,,1071,910.35,101.66,1071,Aetna,PPO,996.03,93,,percent of total billed charges,,
"Excision,Malignant Lesion Inc Margins, Trunk, Arms, Or Legs; Excised Dia 1.1 To 2.0 Cm (Pro Cah)",,11602,CPT,Professional,Both,,,,445,378.25,101.66,445,Aetna,PPO,413.85,93,,percent of total billed charges,,
"Excision,Malignant Lesion Inc Margins, Trunk, Arms, Or Legs; Excised Dia 1.1 To 2.0 Cm (Pro Cah)",,11602,CPT,Professional,Both,,,,1071,910.35,101.66,1071,America's PPO,America's PPO,915.0624,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Excision,Malignant Lesion Inc Margins, Trunk, Arms, Or Legs; Excised Dia 1.1 To 2.0 Cm (Pro Cah)",,11602,CPT,Professional,Both,,,,445,378.25,101.66,445,America's PPO,America's PPO,380.208,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Excision,Malignant Lesion Inc Margins, Trunk, Arms, Or Legs; Excised Dia 1.1 To 2.0 Cm (Pro Cah)",,11602,CPT,Professional,Both,,,,1071,910.35,101.66,1071,BlueCross BlueShield Minnesota, Federal Employee Program,329.84,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Excision,Malignant Lesion Inc Margins, Trunk, Arms, Or Legs; Excised Dia 1.1 To 2.0 Cm (Pro Cah)",,11602,CPT,Professional,Both,,,,445,378.25,101.66,445,BlueCross BlueShield Minnesota, Federal Employee Program,329.84,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Excision,Malignant Lesion Inc Margins, Trunk, Arms, Or Legs; Excised Dia 1.1 To 2.0 Cm (Pro Cah)",,11602,CPT,Professional,Both,,,,1071,910.35,101.66,1071,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,335.11744,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision,Malignant Lesion Inc Margins, Trunk, Arms, Or Legs; Excised Dia 1.1 To 2.0 Cm (Pro Cah)",,11602,CPT,Professional,Both,,,,445,378.25,101.66,445,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,335.11744,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision,Malignant Lesion Inc Margins, Trunk, Arms, Or Legs; Excised Dia 1.1 To 2.0 Cm (Pro Cah)",,11602,CPT,Professional,Both,,,,1071,910.35,101.66,1071,BlueCross BlueShield Minnesota,High Value Network Plan,335.11744,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision,Malignant Lesion Inc Margins, Trunk, Arms, Or Legs; Excised Dia 1.1 To 2.0 Cm (Pro Cah)",,11602,CPT,Professional,Both,,,,445,378.25,101.66,445,BlueCross BlueShield Minnesota,High Value Network Plan,335.11744,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision,Malignant Lesion Inc Margins, Trunk, Arms, Or Legs; Excised Dia 1.1 To 2.0 Cm (Pro Cah)",,11602,CPT,Professional,Both,,,,1071,910.35,101.66,1071,BlueCross BlueShield Minnesota,Medicare Advantage,181.7805,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision,Malignant Lesion Inc Margins, Trunk, Arms, Or Legs; Excised Dia 1.1 To 2.0 Cm (Pro Cah)",,11602,CPT,Professional,Both,,,,445,378.25,101.66,445,BlueCross BlueShield Minnesota,Medicare Advantage,181.7805,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision,Malignant Lesion Inc Margins, Trunk, Arms, Or Legs; Excised Dia 1.1 To 2.0 Cm (Pro Cah)",,11602,CPT,Professional,Both,,,,1071,910.35,101.66,1071,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,335.11744,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision,Malignant Lesion Inc Margins, Trunk, Arms, Or Legs; Excised Dia 1.1 To 2.0 Cm (Pro Cah)",,11602,CPT,Professional,Both,,,,445,378.25,101.66,445,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,335.11744,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision,Malignant Lesion Inc Margins, Trunk, Arms, Or Legs; Excised Dia 1.1 To 2.0 Cm (Pro Cah)",,11602,CPT,Professional,Both,,,,1071,910.35,101.66,1071,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,117.36832,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision,Malignant Lesion Inc Margins, Trunk, Arms, Or Legs; Excised Dia 1.1 To 2.0 Cm (Pro Cah)",,11602,CPT,Professional,Both,,,,445,378.25,101.66,445,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,117.36832,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision,Malignant Lesion Inc Margins, Trunk, Arms, Or Legs; Excised Dia 1.1 To 2.0 Cm (Pro Cah)",,11602,CPT,Professional,Both,,,,1071,910.35,101.66,1071,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),181.7805,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision,Malignant Lesion Inc Margins, Trunk, Arms, Or Legs; Excised Dia 1.1 To 2.0 Cm (Pro Cah)",,11602,CPT,Professional,Both,,,,445,378.25,101.66,445,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),181.7805,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision,Malignant Lesion Inc Margins, Trunk, Arms, Or Legs; Excised Dia 1.1 To 2.0 Cm (Pro Cah)",,11602,CPT,Professional,Both,,,,1071,910.35,101.66,1071,CorVel,Worker's Compensation,307.4182824,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Excision,Malignant Lesion Inc Margins, Trunk, Arms, Or Legs; Excised Dia 1.1 To 2.0 Cm (Pro Cah)",,11602,CPT,Professional,Both,,,,445,378.25,101.66,445,CorVel,Worker's Compensation,307.4182824,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Excision,Malignant Lesion Inc Margins, Trunk, Arms, Or Legs; Excised Dia 1.1 To 2.0 Cm (Pro Cah)",,11602,CPT,Professional,Both,,,,1071,910.35,101.66,1071,First Health Group Corporation,First Health Network,1038.87,97,,percent of total billed charges,,
"Excision,Malignant Lesion Inc Margins, Trunk, Arms, Or Legs; Excised Dia 1.1 To 2.0 Cm (Pro Cah)",,11602,CPT,Professional,Both,,,,445,378.25,101.66,445,First Health Group Corporation,First Health Network,431.65,97,,percent of total billed charges,,
"Excision,Malignant Lesion Inc Margins, Trunk, Arms, Or Legs; Excised Dia 1.1 To 2.0 Cm (Pro Cah)",,11602,CPT,Professional,Both,,,,1071,910.35,101.66,1071,"Health Partners, Inc.",Commercial,332.29,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision,Malignant Lesion Inc Margins, Trunk, Arms, Or Legs; Excised Dia 1.1 To 2.0 Cm (Pro Cah)",,11602,CPT,Professional,Both,,,,445,378.25,101.66,445,"Health Partners, Inc.",Commercial,332.29,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision,Malignant Lesion Inc Margins, Trunk, Arms, Or Legs; Excised Dia 1.1 To 2.0 Cm (Pro Cah)",,11602,CPT,Professional,Both,,,,1071,910.35,101.66,1071,"Health Partners, Inc.",Medicare Advantage,181.7805,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision,Malignant Lesion Inc Margins, Trunk, Arms, Or Legs; Excised Dia 1.1 To 2.0 Cm (Pro Cah)",,11602,CPT,Professional,Both,,,,445,378.25,101.66,445,"Health Partners, Inc.",Medicare Advantage,181.7805,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision,Malignant Lesion Inc Margins, Trunk, Arms, Or Legs; Excised Dia 1.1 To 2.0 Cm (Pro Cah)",,11602,CPT,Professional,Both,,,,1071,910.35,101.66,1071,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),157.91,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Excision,Malignant Lesion Inc Margins, Trunk, Arms, Or Legs; Excised Dia 1.1 To 2.0 Cm (Pro Cah)",,11602,CPT,Professional,Both,,,,445,378.25,101.66,445,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),157.91,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Excision,Malignant Lesion Inc Margins, Trunk, Arms, Or Legs; Excised Dia 1.1 To 2.0 Cm (Pro Cah)",,11602,CPT,Professional,Both,,,,1071,910.35,101.66,1071,"Health Partners, Inc.",State of Minnesota Advantage Program,286.267835,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision,Malignant Lesion Inc Margins, Trunk, Arms, Or Legs; Excised Dia 1.1 To 2.0 Cm (Pro Cah)",,11602,CPT,Professional,Both,,,,445,378.25,101.66,445,"Health Partners, Inc.",State of Minnesota Advantage Program,286.267835,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision,Malignant Lesion Inc Margins, Trunk, Arms, Or Legs; Excised Dia 1.1 To 2.0 Cm (Pro Cah)",,11602,CPT,Professional,Both,,,,1071,910.35,101.66,1071,"Health Partners, Inc.",State Public Programs,101.66,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Excision,Malignant Lesion Inc Margins, Trunk, Arms, Or Legs; Excised Dia 1.1 To 2.0 Cm (Pro Cah)",,11602,CPT,Professional,Both,,,,445,378.25,101.66,445,"Health Partners, Inc.",State Public Programs,101.66,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Excision,Malignant Lesion Inc Margins, Trunk, Arms, Or Legs; Excised Dia 1.1 To 2.0 Cm (Pro Cah)",,11602,CPT,Professional,Both,,,,1071,910.35,101.66,1071,Humana Insurance Company,Commercial PPO,158.07,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Excision,Malignant Lesion Inc Margins, Trunk, Arms, Or Legs; Excised Dia 1.1 To 2.0 Cm (Pro Cah)",,11602,CPT,Professional,Both,,,,445,378.25,101.66,445,Humana Insurance Company,Commercial PPO,158.07,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Excision,Malignant Lesion Inc Margins, Trunk, Arms, Or Legs; Excised Dia 1.1 To 2.0 Cm (Pro Cah)",,11602,CPT,Professional,Both,,,,1071,910.35,101.66,1071,Humana Insurance Company,Medicare PPO,1071,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Excision,Malignant Lesion Inc Margins, Trunk, Arms, Or Legs; Excised Dia 1.1 To 2.0 Cm (Pro Cah)",,11602,CPT,Professional,Both,,,,445,378.25,101.66,445,Humana Insurance Company,Medicare PPO,445,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Excision,Malignant Lesion Inc Margins, Trunk, Arms, Or Legs; Excised Dia 1.1 To 2.0 Cm (Pro Cah)",,11602,CPT,Professional,Both,,,,1071,910.35,101.66,1071,Medica,Individual & Family,908.208,84.8,,percent of total billed charges,,
"Excision,Malignant Lesion Inc Margins, Trunk, Arms, Or Legs; Excised Dia 1.1 To 2.0 Cm (Pro Cah)",,11602,CPT,Professional,Both,,,,445,378.25,101.66,445,Medica,Individual & Family,377.36,84.8,,percent of total billed charges,,
"Excision,Malignant Lesion Inc Margins, Trunk, Arms, Or Legs; Excised Dia 1.1 To 2.0 Cm (Pro Cah)",,11602,CPT,Professional,Both,,,,1071,910.35,101.66,1071,Medica,Medica Advantage Solution,533.358,49.8,,percent of total billed charges,,
"Excision,Malignant Lesion Inc Margins, Trunk, Arms, Or Legs; Excised Dia 1.1 To 2.0 Cm (Pro Cah)",,11602,CPT,Professional,Both,,,,445,378.25,101.66,445,Medica,Medica Advantage Solution,221.61,49.8,,percent of total billed charges,,
"Excision,Malignant Lesion Inc Margins, Trunk, Arms, Or Legs; Excised Dia 1.1 To 2.0 Cm (Pro Cah)",,11602,CPT,Professional,Both,,,,1071,910.35,101.66,1071,Medica,Medical Assistance,117.37,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Excision,Malignant Lesion Inc Margins, Trunk, Arms, Or Legs; Excised Dia 1.1 To 2.0 Cm (Pro Cah)",,11602,CPT,Professional,Both,,,,445,378.25,101.66,445,Medica,Medical Assistance,117.37,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Excision,Malignant Lesion Inc Margins, Trunk, Arms, Or Legs; Excised Dia 1.1 To 2.0 Cm (Pro Cah)",,11602,CPT,Professional,Both,,,,1071,910.35,101.66,1071,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,158.07,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Excision,Malignant Lesion Inc Margins, Trunk, Arms, Or Legs; Excised Dia 1.1 To 2.0 Cm (Pro Cah)",,11602,CPT,Professional,Both,,,,445,378.25,101.66,445,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,158.07,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Excision,Malignant Lesion Inc Margins, Trunk, Arms, Or Legs; Excised Dia 1.1 To 2.0 Cm (Pro Cah)",,11602,CPT,Professional,Both,,,,1071,910.35,101.66,1071,"Multiplan, Inc.","Multiplan, Inc.",1006.74,94,,percent of total billed charges,,
"Excision,Malignant Lesion Inc Margins, Trunk, Arms, Or Legs; Excised Dia 1.1 To 2.0 Cm (Pro Cah)",,11602,CPT,Professional,Both,,,,445,378.25,101.66,445,"Multiplan, Inc.","Multiplan, Inc.",418.3,94,,percent of total billed charges,,
"Excision,Malignant Lesion Inc Margins, Trunk, Arms, Or Legs; Excised Dia 1.1 To 2.0 Cm (Pro Cah)",,11602,CPT,Professional,Both,,,,1071,910.35,101.66,1071,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,964.971,90.1,,percent of total billed charges,,
"Excision,Malignant Lesion Inc Margins, Trunk, Arms, Or Legs; Excised Dia 1.1 To 2.0 Cm (Pro Cah)",,11602,CPT,Professional,Both,,,,445,378.25,101.66,445,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,400.945,90.1,,percent of total billed charges,,
"Excision,Malignant Lesion Inc Margins, Trunk, Arms, Or Legs; Excised Dia 1.1 To 2.0 Cm (Pro Cah)",,11602,CPT,Professional,Both,,,,1071,910.35,101.66,1071,"Preferred One Administrative Services, INC.",PPO,1056.006,98.6,,percent of total billed charges,,
"Excision,Malignant Lesion Inc Margins, Trunk, Arms, Or Legs; Excised Dia 1.1 To 2.0 Cm (Pro Cah)",,11602,CPT,Professional,Both,,,,445,378.25,101.66,445,"Preferred One Administrative Services, INC.",PPO,438.77,98.6,,percent of total billed charges,,
"Excision,Malignant Lesion Inc Margins, Trunk, Arms, Or Legs; Excised Dia 1.1 To 2.0 Cm (Pro Cah)",,11602,CPT,Professional,Both,,,,1071,910.35,101.66,1071,PrimeWest Health,Minnesota Senior Health Options (MSHO),181.7805,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision,Malignant Lesion Inc Margins, Trunk, Arms, Or Legs; Excised Dia 1.1 To 2.0 Cm (Pro Cah)",,11602,CPT,Professional,Both,,,,445,378.25,101.66,445,PrimeWest Health,Minnesota Senior Health Options (MSHO),181.7805,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision,Malignant Lesion Inc Margins, Trunk, Arms, Or Legs; Excised Dia 1.1 To 2.0 Cm (Pro Cah)",,11602,CPT,Professional,Both,,,,1071,910.35,101.66,1071,PrimeWest Health,MinnesotaCare,125.5841024,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision,Malignant Lesion Inc Margins, Trunk, Arms, Or Legs; Excised Dia 1.1 To 2.0 Cm (Pro Cah)",,11602,CPT,Professional,Both,,,,445,378.25,101.66,445,PrimeWest Health,MinnesotaCare,125.5841024,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision,Malignant Lesion Inc Margins, Trunk, Arms, Or Legs; Excised Dia 1.1 To 2.0 Cm (Pro Cah)",,11602,CPT,Professional,Both,,,,1071,910.35,101.66,1071,Sanford Health Plan,Sanford Health Plan,942.48,88,,percent of total billed charges,,
"Excision,Malignant Lesion Inc Margins, Trunk, Arms, Or Legs; Excised Dia 1.1 To 2.0 Cm (Pro Cah)",,11602,CPT,Professional,Both,,,,445,378.25,101.66,445,Sanford Health Plan,Sanford Health Plan,391.6,88,,percent of total billed charges,,
"Excision,Malignant Lesion Inc Margins, Trunk, Arms, Or Legs; Excised Dia 1.1 To 2.0 Cm (Pro Cah)",,11602,CPT,Professional,Both,,,,1071,910.35,101.66,1071,"UCare Health, Inc.",Individual & Family Plan,256.958592,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Excision,Malignant Lesion Inc Margins, Trunk, Arms, Or Legs; Excised Dia 1.1 To 2.0 Cm (Pro Cah)",,11602,CPT,Professional,Both,,,,445,378.25,101.66,445,"UCare Health, Inc.",Individual & Family Plan,256.958592,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Excision,Malignant Lesion Inc Margins, Trunk, Arms, Or Legs; Excised Dia 1.1 To 2.0 Cm (Pro Cah)",,11602,CPT,Professional,Both,,,,1071,910.35,101.66,1071,"UCare Health, Inc.",Medical Assistance,129.105152,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Excision,Malignant Lesion Inc Margins, Trunk, Arms, Or Legs; Excised Dia 1.1 To 2.0 Cm (Pro Cah)",,11602,CPT,Professional,Both,,,,445,378.25,101.66,445,"UCare Health, Inc.",Medical Assistance,129.105152,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Excision,Malignant Lesion Inc Margins, Trunk, Arms, Or Legs; Excised Dia 1.1 To 2.0 Cm (Pro Cah)",,11602,CPT,Professional,Both,,,,1071,910.35,101.66,1071,"UCare Health, Inc.",Medicare Advantage,181.7805,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Excision,Malignant Lesion Inc Margins, Trunk, Arms, Or Legs; Excised Dia 1.1 To 2.0 Cm (Pro Cah)",,11602,CPT,Professional,Both,,,,445,378.25,101.66,445,"UCare Health, Inc.",Medicare Advantage,181.7805,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Excision,Malignant Lesion Inc Margins, Trunk, Arms, Or Legs; Excised Dia 1.1 To 2.0 Cm (Pro Cah)",,11602,CPT,Professional,Both,,,,1071,910.35,101.66,1071,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),145.4244,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Excision,Malignant Lesion Inc Margins, Trunk, Arms, Or Legs; Excised Dia 1.1 To 2.0 Cm (Pro Cah)",,11602,CPT,Professional,Both,,,,445,378.25,101.66,445,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),145.4244,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Excision,Malignant Lesion Inc Margins, Trunk, Arms, Or Legs; Excised Dia 1.1 To 2.0 Cm (Pro Cah)",,11602,CPT,Professional,Both,,,,1071,910.35,101.66,1071,UnitedHealthcare,Individual & Family,1071,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Excision,Malignant Lesion Inc Margins, Trunk, Arms, Or Legs; Excised Dia 1.1 To 2.0 Cm (Pro Cah)",,11602,CPT,Professional,Both,,,,445,378.25,101.66,445,UnitedHealthcare,Individual & Family,445,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Excision,Malignant Lesion Inc Margins, Trunk, Arms, Or Legs; Excised Dia 1.1 To 2.0 Cm (Pro Cah)",,11602,CPT,Professional,Both,,,,1071,910.35,101.66,1071,UnitedHealthcare,Medicare Advantage,181.7805,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision,Malignant Lesion Inc Margins, Trunk, Arms, Or Legs; Excised Dia 1.1 To 2.0 Cm (Pro Cah)",,11602,CPT,Professional,Both,,,,445,378.25,101.66,445,UnitedHealthcare,Medicare Advantage,181.7805,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision,Malignant Lesion Inc Margins, Trunk, Arms, Or Legs; Excised Dia 1.1 To 2.0 Cm (Pro Cah)",,11602,CPT,Professional,Both,,,,1071,910.35,101.66,1071,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,117.36832,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision,Malignant Lesion Inc Margins, Trunk, Arms, Or Legs; Excised Dia 1.1 To 2.0 Cm (Pro Cah)",,11602,CPT,Professional,Both,,,,445,378.25,101.66,445,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,117.36832,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 2.1-3.0 Cm",,11603,CPT,Facility,Both,,,,310,263.5,88.846,310,Aetna,Commercial,285.2,92,,percent of total billed charges,,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 2.1-3.0 Cm",,11603,CPT,Facility,Outpatient,,,,310,263.5,88.846,310,Aetna,Medicare Advantage,151.9,49,,percent of total billed charges,,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 2.1-3.0 Cm",,11603,CPT,Facility,Inpatient,,,,310,263.5,88.846,310,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 2.1-3.0 Cm",,11603,CPT,Facility,Both,,,,310,263.5,88.846,310,Aetna,PPO,288.3,93,,percent of total billed charges,,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 2.1-3.0 Cm",,11603,CPT,Facility,Both,,,,310,263.5,88.846,310,America's PPO,America's PPO,297.693,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 2.1-3.0 Cm",,11603,CPT,Facility,Both,,,,310,263.5,88.846,310,BlueCross BlueShield Minnesota, Federal Employee Program,305.04,98.4,,percent of total billed charges,,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 2.1-3.0 Cm",,11603,CPT,Facility,Both,,,,310,263.5,88.846,310,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,310,100,,percent of total billed charges,,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 2.1-3.0 Cm",,11603,CPT,Facility,Both,,,,310,263.5,88.846,310,BlueCross BlueShield Minnesota,High Value Network Plan,279,90,,percent of total billed charges,,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 2.1-3.0 Cm",,11603,CPT,Facility,Outpatient,,,,310,263.5,88.846,310,BlueCross BlueShield Minnesota,Medicare Advantage,151.9,49,,percent of total billed charges,,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 2.1-3.0 Cm",,11603,CPT,Facility,Inpatient,,,,310,263.5,88.846,310,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 2.1-3.0 Cm",,11603,CPT,Facility,Both,,,,310,263.5,88.846,310,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,274.567,88.57,,percent of total billed charges,,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 2.1-3.0 Cm",,11603,CPT,Facility,Both,,,,310,263.5,88.846,310,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,88.846,28.66,,percent of total billed charges,,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 2.1-3.0 Cm",,11603,CPT,Facility,Outpatient,,,,310,263.5,88.846,310,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),151.9,49,,percent of total billed charges,,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 2.1-3.0 Cm",,11603,CPT,Facility,Inpatient,,,,310,263.5,88.846,310,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 2.1-3.0 Cm",,11603,CPT,Facility,Both,,,,310,263.5,88.846,310,CorVel,Worker's Compensation,310,100,,percent of total billed charges,,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 2.1-3.0 Cm",,11603,CPT,Facility,Both,,,,310,263.5,88.846,310,First Health Group Corporation,First Health Network,300.7,97,,percent of total billed charges,,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 2.1-3.0 Cm",,11603,CPT,Facility,Both,,,,310,263.5,88.846,310,"Health Partners, Inc.",Commercial,293.26,94.6,,percent of total billed charges,,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 2.1-3.0 Cm",,11603,CPT,Facility,Outpatient,,,,310,263.5,88.846,310,"Health Partners, Inc.",Medicare Advantage,151.9,49,,percent of total billed charges,,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 2.1-3.0 Cm",,11603,CPT,Facility,Inpatient,,,,310,263.5,88.846,310,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 2.1-3.0 Cm",,11603,CPT,Facility,Both,,,,310,263.5,88.846,310,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),186,60,,percent of total billed charges,,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 2.1-3.0 Cm",,11603,CPT,Facility,Both,,,,310,263.5,88.846,310,"Health Partners, Inc.",State of Minnesota Advantage Program,252.65,81.5,,percent of total billed charges,,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 2.1-3.0 Cm",,11603,CPT,Facility,Both,,,,310,263.5,88.846,310,"Health Partners, Inc.",State Public Programs,155,50,,percent of total billed charges,,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 2.1-3.0 Cm",,11603,CPT,Facility,Both,,,,310,263.5,88.846,310,Humana Insurance Company,Commercial PPO,294.5,95,,percent of total billed charges,,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 2.1-3.0 Cm",,11603,CPT,Facility,Outpatient,,,,310,263.5,88.846,310,Humana Insurance Company,Medicare PPO,151.9,49,,percent of total billed charges,,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 2.1-3.0 Cm",,11603,CPT,Facility,Inpatient,,,,310,263.5,88.846,310,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 2.1-3.0 Cm",,11603,CPT,Facility,Both,,,,310,263.5,88.846,310,Medica,Individual & Family,307.21,99.1,,percent of total billed charges,,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 2.1-3.0 Cm",,11603,CPT,Facility,Outpatient,,,,310,263.5,88.846,310,Medica,Medica Advantage Solution,154.38,49.8,,percent of total billed charges,,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 2.1-3.0 Cm",,11603,CPT,Facility,Inpatient,,,,310,263.5,88.846,310,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 2.1-3.0 Cm",,11603,CPT,Facility,Outpatient,,,,310,263.5,88.846,310,Medica,Medical Assistance,138.26,44.6,,percent of total billed charges,,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 2.1-3.0 Cm",,11603,CPT,Facility,Inpatient,,,,310,263.5,88.846,310,Medica,Medical Assistance,,,,,Included in per diem rate,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 2.1-3.0 Cm",,11603,CPT,Facility,Outpatient,,,,310,263.5,88.846,310,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,154.38,49.8,,percent of total billed charges,,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 2.1-3.0 Cm",,11603,CPT,Facility,Inpatient,,,,310,263.5,88.846,310,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 2.1-3.0 Cm",,11603,CPT,Facility,Both,,,,310,263.5,88.846,310,"Multiplan, Inc.","Multiplan, Inc.",291.4,94,,percent of total billed charges,,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 2.1-3.0 Cm",,11603,CPT,Facility,Outpatient,,,,310,263.5,88.846,310,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,279.31,90.1,,percent of total billed charges,,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 2.1-3.0 Cm",,11603,CPT,Facility,Inpatient,,,,310,263.5,88.846,310,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 2.1-3.0 Cm",,11603,CPT,Facility,Both,,,,310,263.5,88.846,310,"Preferred One Administrative Services, INC.",PPO,305.66,98.6,,percent of total billed charges,,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 2.1-3.0 Cm",,11603,CPT,Facility,Outpatient,,,,310,263.5,88.846,310,PrimeWest Health,Minnesota Senior Health Options (MSHO),159.495,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 2.1-3.0 Cm",,11603,CPT,Facility,Inpatient,,,,310,263.5,88.846,310,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 2.1-3.0 Cm",,11603,CPT,Facility,Outpatient,,,,310,263.5,88.846,310,PrimeWest Health,MinnesotaCare,159.216,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 2.1-3.0 Cm",,11603,CPT,Facility,Inpatient,,,,310,263.5,88.846,310,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 2.1-3.0 Cm",,11603,CPT,Facility,Both,,,,310,263.5,88.846,310,Sanford Health Plan,Sanford Health Plan,285.2,92,,percent of total billed charges,,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 2.1-3.0 Cm",,11603,CPT,Facility,Outpatient,,,,310,263.5,88.846,310,"UCare Health, Inc.",Individual & Family Plan,174.685,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 2.1-3.0 Cm",,11603,CPT,Facility,Inpatient,,,,310,263.5,88.846,310,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 2.1-3.0 Cm",,11603,CPT,Facility,Outpatient,,,,310,263.5,88.846,310,"UCare Health, Inc.",Medical Assistance,156.457,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 2.1-3.0 Cm",,11603,CPT,Facility,Inpatient,,,,310,263.5,88.846,310,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 2.1-3.0 Cm",,11603,CPT,Facility,Outpatient,,,,310,263.5,88.846,310,"UCare Health, Inc.",Medicare Advantage,156.457,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 2.1-3.0 Cm",,11603,CPT,Facility,Inpatient,,,,310,263.5,88.846,310,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 2.1-3.0 Cm",,11603,CPT,Facility,Outpatient,,,,310,263.5,88.846,310,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),156.457,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 2.1-3.0 Cm",,11603,CPT,Facility,Inpatient,,,,310,263.5,88.846,310,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 2.1-3.0 Cm",,11603,CPT,Facility,Both,,,,310,263.5,88.846,310,UnitedHealthcare,Individual & Family,291.4,94,,percent of total billed charges,,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 2.1-3.0 Cm",,11603,CPT,Facility,Outpatient,,,,310,263.5,88.846,310,UnitedHealthcare,Medicare Advantage,151.9,49,,percent of total billed charges,,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 2.1-3.0 Cm",,11603,CPT,Facility,Inpatient,,,,310,263.5,88.846,310,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 2.1-3.0 Cm",,11603,CPT,Facility,Outpatient,,,,310,263.5,88.846,310,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,148.8,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 2.1-3.0 Cm",,11603,CPT,Facility,Inpatient,,,,310,263.5,88.846,310,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 2.1-3.0 Cm (Pro Cah)",,11603,CPT,Professional,Both,,,,1186,1008.1,121.07,1186,Aetna,Commercial,1008.1,85,,percent of total billed charges,,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 2.1-3.0 Cm (Pro Cah)",,11603,CPT,Professional,Both,,,,530,450.5,121.07,530,Aetna,Commercial,450.5,85,,percent of total billed charges,,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 2.1-3.0 Cm (Pro Cah)",,11603,CPT,Professional,Both,,,,1186,1008.1,121.07,1186,Aetna,Medicare Advantage,188.94,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 2.1-3.0 Cm (Pro Cah)",,11603,CPT,Professional,Both,,,,530,450.5,121.07,530,Aetna,Medicare Advantage,188.94,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 2.1-3.0 Cm (Pro Cah)",,11603,CPT,Professional,Both,,,,1186,1008.1,121.07,1186,Aetna,PPO,1102.98,93,,percent of total billed charges,,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 2.1-3.0 Cm (Pro Cah)",,11603,CPT,Professional,Both,,,,530,450.5,121.07,530,Aetna,PPO,492.9,93,,percent of total billed charges,,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 2.1-3.0 Cm (Pro Cah)",,11603,CPT,Professional,Both,,,,1186,1008.1,121.07,1186,America's PPO,America's PPO,1013.3184,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 2.1-3.0 Cm (Pro Cah)",,11603,CPT,Professional,Both,,,,530,450.5,121.07,530,America's PPO,America's PPO,452.832,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 2.1-3.0 Cm (Pro Cah)",,11603,CPT,Professional,Both,,,,1186,1008.1,121.07,1186,BlueCross BlueShield Minnesota, Federal Employee Program,395.26,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 2.1-3.0 Cm (Pro Cah)",,11603,CPT,Professional,Both,,,,530,450.5,121.07,530,BlueCross BlueShield Minnesota, Federal Employee Program,395.26,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 2.1-3.0 Cm (Pro Cah)",,11603,CPT,Professional,Both,,,,1186,1008.1,121.07,1186,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,401.58416,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 2.1-3.0 Cm (Pro Cah)",,11603,CPT,Professional,Both,,,,530,450.5,121.07,530,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,401.58416,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 2.1-3.0 Cm (Pro Cah)",,11603,CPT,Professional,Both,,,,1186,1008.1,121.07,1186,BlueCross BlueShield Minnesota,High Value Network Plan,401.58416,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 2.1-3.0 Cm (Pro Cah)",,11603,CPT,Professional,Both,,,,530,450.5,121.07,530,BlueCross BlueShield Minnesota,High Value Network Plan,401.58416,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 2.1-3.0 Cm (Pro Cah)",,11603,CPT,Professional,Both,,,,1186,1008.1,121.07,1186,BlueCross BlueShield Minnesota,Medicare Advantage,216.3955,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 2.1-3.0 Cm (Pro Cah)",,11603,CPT,Professional,Both,,,,530,450.5,121.07,530,BlueCross BlueShield Minnesota,Medicare Advantage,216.3955,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 2.1-3.0 Cm (Pro Cah)",,11603,CPT,Professional,Both,,,,1186,1008.1,121.07,1186,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,401.58416,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 2.1-3.0 Cm (Pro Cah)",,11603,CPT,Professional,Both,,,,530,450.5,121.07,530,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,401.58416,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 2.1-3.0 Cm (Pro Cah)",,11603,CPT,Professional,Both,,,,1186,1008.1,121.07,1186,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,139.78128,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 2.1-3.0 Cm (Pro Cah)",,11603,CPT,Professional,Both,,,,530,450.5,121.07,530,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,139.78128,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 2.1-3.0 Cm (Pro Cah)",,11603,CPT,Professional,Both,,,,1186,1008.1,121.07,1186,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),216.3955,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 2.1-3.0 Cm (Pro Cah)",,11603,CPT,Professional,Both,,,,530,450.5,121.07,530,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),216.3955,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 2.1-3.0 Cm (Pro Cah)",,11603,CPT,Professional,Both,,,,1186,1008.1,121.07,1186,CorVel,Worker's Compensation,365.9911941,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 2.1-3.0 Cm (Pro Cah)",,11603,CPT,Professional,Both,,,,530,450.5,121.07,530,CorVel,Worker's Compensation,365.9911941,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 2.1-3.0 Cm (Pro Cah)",,11603,CPT,Professional,Both,,,,1186,1008.1,121.07,1186,First Health Group Corporation,First Health Network,1150.42,97,,percent of total billed charges,,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 2.1-3.0 Cm (Pro Cah)",,11603,CPT,Professional,Both,,,,530,450.5,121.07,530,First Health Group Corporation,First Health Network,514.1,97,,percent of total billed charges,,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 2.1-3.0 Cm (Pro Cah)",,11603,CPT,Professional,Both,,,,1186,1008.1,121.07,1186,"Health Partners, Inc.",Commercial,395.41,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 2.1-3.0 Cm (Pro Cah)",,11603,CPT,Professional,Both,,,,530,450.5,121.07,530,"Health Partners, Inc.",Commercial,395.41,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 2.1-3.0 Cm (Pro Cah)",,11603,CPT,Professional,Both,,,,1186,1008.1,121.07,1186,"Health Partners, Inc.",Medicare Advantage,216.3955,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 2.1-3.0 Cm (Pro Cah)",,11603,CPT,Professional,Both,,,,530,450.5,121.07,530,"Health Partners, Inc.",Medicare Advantage,216.3955,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 2.1-3.0 Cm (Pro Cah)",,11603,CPT,Professional,Both,,,,1186,1008.1,121.07,1186,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),188.07,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 2.1-3.0 Cm (Pro Cah)",,11603,CPT,Professional,Both,,,,530,450.5,121.07,530,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),188.07,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 2.1-3.0 Cm (Pro Cah)",,11603,CPT,Professional,Both,,,,1186,1008.1,121.07,1186,"Health Partners, Inc.",State of Minnesota Advantage Program,340.645715,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 2.1-3.0 Cm (Pro Cah)",,11603,CPT,Professional,Both,,,,530,450.5,121.07,530,"Health Partners, Inc.",State of Minnesota Advantage Program,340.645715,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 2.1-3.0 Cm (Pro Cah)",,11603,CPT,Professional,Both,,,,1186,1008.1,121.07,1186,"Health Partners, Inc.",State Public Programs,121.07,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 2.1-3.0 Cm (Pro Cah)",,11603,CPT,Professional,Both,,,,530,450.5,121.07,530,"Health Partners, Inc.",State Public Programs,121.07,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 2.1-3.0 Cm (Pro Cah)",,11603,CPT,Professional,Both,,,,1186,1008.1,121.07,1186,Humana Insurance Company,Commercial PPO,188.17,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 2.1-3.0 Cm (Pro Cah)",,11603,CPT,Professional,Both,,,,530,450.5,121.07,530,Humana Insurance Company,Commercial PPO,188.17,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 2.1-3.0 Cm (Pro Cah)",,11603,CPT,Professional,Both,,,,1186,1008.1,121.07,1186,Humana Insurance Company,Medicare PPO,1186,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 2.1-3.0 Cm (Pro Cah)",,11603,CPT,Professional,Both,,,,530,450.5,121.07,530,Humana Insurance Company,Medicare PPO,530,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 2.1-3.0 Cm (Pro Cah)",,11603,CPT,Professional,Both,,,,1186,1008.1,121.07,1186,Medica,Individual & Family,1005.728,84.8,,percent of total billed charges,,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 2.1-3.0 Cm (Pro Cah)",,11603,CPT,Professional,Both,,,,530,450.5,121.07,530,Medica,Individual & Family,449.44,84.8,,percent of total billed charges,,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 2.1-3.0 Cm (Pro Cah)",,11603,CPT,Professional,Both,,,,1186,1008.1,121.07,1186,Medica,Medica Advantage Solution,590.628,49.8,,percent of total billed charges,,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 2.1-3.0 Cm (Pro Cah)",,11603,CPT,Professional,Both,,,,530,450.5,121.07,530,Medica,Medica Advantage Solution,263.94,49.8,,percent of total billed charges,,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 2.1-3.0 Cm (Pro Cah)",,11603,CPT,Professional,Both,,,,1186,1008.1,121.07,1186,Medica,Medical Assistance,139.78,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 2.1-3.0 Cm (Pro Cah)",,11603,CPT,Professional,Both,,,,530,450.5,121.07,530,Medica,Medical Assistance,139.78,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 2.1-3.0 Cm (Pro Cah)",,11603,CPT,Professional,Both,,,,1186,1008.1,121.07,1186,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,188.17,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 2.1-3.0 Cm (Pro Cah)",,11603,CPT,Professional,Both,,,,530,450.5,121.07,530,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,188.17,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 2.1-3.0 Cm (Pro Cah)",,11603,CPT,Professional,Both,,,,1186,1008.1,121.07,1186,"Multiplan, Inc.","Multiplan, Inc.",1114.84,94,,percent of total billed charges,,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 2.1-3.0 Cm (Pro Cah)",,11603,CPT,Professional,Both,,,,530,450.5,121.07,530,"Multiplan, Inc.","Multiplan, Inc.",498.2,94,,percent of total billed charges,,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 2.1-3.0 Cm (Pro Cah)",,11603,CPT,Professional,Both,,,,1186,1008.1,121.07,1186,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1068.586,90.1,,percent of total billed charges,,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 2.1-3.0 Cm (Pro Cah)",,11603,CPT,Professional,Both,,,,530,450.5,121.07,530,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,477.53,90.1,,percent of total billed charges,,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 2.1-3.0 Cm (Pro Cah)",,11603,CPT,Professional,Both,,,,1186,1008.1,121.07,1186,"Preferred One Administrative Services, INC.",PPO,1169.396,98.6,,percent of total billed charges,,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 2.1-3.0 Cm (Pro Cah)",,11603,CPT,Professional,Both,,,,530,450.5,121.07,530,"Preferred One Administrative Services, INC.",PPO,522.58,98.6,,percent of total billed charges,,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 2.1-3.0 Cm (Pro Cah)",,11603,CPT,Professional,Both,,,,1186,1008.1,121.07,1186,PrimeWest Health,Minnesota Senior Health Options (MSHO),216.3955,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 2.1-3.0 Cm (Pro Cah)",,11603,CPT,Professional,Both,,,,530,450.5,121.07,530,PrimeWest Health,Minnesota Senior Health Options (MSHO),216.3955,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 2.1-3.0 Cm (Pro Cah)",,11603,CPT,Professional,Both,,,,1186,1008.1,121.07,1186,PrimeWest Health,MinnesotaCare,149.5659696,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 2.1-3.0 Cm (Pro Cah)",,11603,CPT,Professional,Both,,,,530,450.5,121.07,530,PrimeWest Health,MinnesotaCare,149.5659696,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 2.1-3.0 Cm (Pro Cah)",,11603,CPT,Professional,Both,,,,1186,1008.1,121.07,1186,Sanford Health Plan,Sanford Health Plan,1043.68,88,,percent of total billed charges,,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 2.1-3.0 Cm (Pro Cah)",,11603,CPT,Professional,Both,,,,530,450.5,121.07,530,Sanford Health Plan,Sanford Health Plan,466.4,88,,percent of total billed charges,,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 2.1-3.0 Cm (Pro Cah)",,11603,CPT,Professional,Both,,,,1186,1008.1,121.07,1186,"UCare Health, Inc.",Individual & Family Plan,305.889152,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 2.1-3.0 Cm (Pro Cah)",,11603,CPT,Professional,Both,,,,530,450.5,121.07,530,"UCare Health, Inc.",Individual & Family Plan,305.889152,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 2.1-3.0 Cm (Pro Cah)",,11603,CPT,Professional,Both,,,,1186,1008.1,121.07,1186,"UCare Health, Inc.",Medical Assistance,153.759408,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 2.1-3.0 Cm (Pro Cah)",,11603,CPT,Professional,Both,,,,530,450.5,121.07,530,"UCare Health, Inc.",Medical Assistance,153.759408,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 2.1-3.0 Cm (Pro Cah)",,11603,CPT,Professional,Both,,,,1186,1008.1,121.07,1186,"UCare Health, Inc.",Medicare Advantage,216.3955,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 2.1-3.0 Cm (Pro Cah)",,11603,CPT,Professional,Both,,,,530,450.5,121.07,530,"UCare Health, Inc.",Medicare Advantage,216.3955,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 2.1-3.0 Cm (Pro Cah)",,11603,CPT,Professional,Both,,,,1186,1008.1,121.07,1186,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),173.1164,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 2.1-3.0 Cm (Pro Cah)",,11603,CPT,Professional,Both,,,,530,450.5,121.07,530,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),173.1164,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 2.1-3.0 Cm (Pro Cah)",,11603,CPT,Professional,Both,,,,1186,1008.1,121.07,1186,UnitedHealthcare,Individual & Family,1186,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 2.1-3.0 Cm (Pro Cah)",,11603,CPT,Professional,Both,,,,530,450.5,121.07,530,UnitedHealthcare,Individual & Family,530,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 2.1-3.0 Cm (Pro Cah)",,11603,CPT,Professional,Both,,,,1186,1008.1,121.07,1186,UnitedHealthcare,Medicare Advantage,216.3955,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 2.1-3.0 Cm (Pro Cah)",,11603,CPT,Professional,Both,,,,530,450.5,121.07,530,UnitedHealthcare,Medicare Advantage,216.3955,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 2.1-3.0 Cm (Pro Cah)",,11603,CPT,Professional,Both,,,,1186,1008.1,121.07,1186,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,139.78128,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia 2.1-3.0 Cm (Pro Cah)",,11603,CPT,Professional,Both,,,,530,450.5,121.07,530,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,139.78128,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision,Malignant,Lesion Trunk/Arms/Legs; 2.1-3.0 Cm (Pbb)",,11603,CPT,Facility,Outpatient,,,,536,455.6,153.6176,536,Aetna,Commercial,493.12,92,,percent of total billed charges,,
"Excision,Malignant,Lesion Trunk/Arms/Legs; 2.1-3.0 Cm (Pbb)",,11603,CPT,Professional,Outpatient,,,,650,552.5,121.07,650,Aetna,Commercial,552.5,85,,percent of total billed charges,,
"Excision,Malignant,Lesion Trunk/Arms/Legs; 2.1-3.0 Cm (Pbb)",,11603,CPT,Facility,Outpatient,,,,536,455.6,153.6176,536,Aetna,Medicare Advantage,262.64,49,,percent of total billed charges,,
"Excision,Malignant,Lesion Trunk/Arms/Legs; 2.1-3.0 Cm (Pbb)",,11603,CPT,Professional,Outpatient,,,,650,552.5,121.07,650,Aetna,Medicare Advantage,188.94,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision,Malignant,Lesion Trunk/Arms/Legs; 2.1-3.0 Cm (Pbb)",,11603,CPT,Facility,Outpatient,,,,536,455.6,153.6176,536,Aetna,PPO,498.48,93,,percent of total billed charges,,
"Excision,Malignant,Lesion Trunk/Arms/Legs; 2.1-3.0 Cm (Pbb)",,11603,CPT,Professional,Outpatient,,,,650,552.5,121.07,650,Aetna,PPO,604.5,93,,percent of total billed charges,,
"Excision,Malignant,Lesion Trunk/Arms/Legs; 2.1-3.0 Cm (Pbb)",,11603,CPT,Facility,Outpatient,,,,536,455.6,153.6176,536,America's PPO,America's PPO,514.7208,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Excision,Malignant,Lesion Trunk/Arms/Legs; 2.1-3.0 Cm (Pbb)",,11603,CPT,Professional,Outpatient,,,,650,552.5,121.07,650,America's PPO,America's PPO,555.36,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Excision,Malignant,Lesion Trunk/Arms/Legs; 2.1-3.0 Cm (Pbb)",,11603,CPT,Facility,Outpatient,,,,536,455.6,153.6176,536,BlueCross BlueShield Minnesota, Federal Employee Program,527.424,98.4,,percent of total billed charges,,
"Excision,Malignant,Lesion Trunk/Arms/Legs; 2.1-3.0 Cm (Pbb)",,11603,CPT,Professional,Outpatient,,,,650,552.5,121.07,650,BlueCross BlueShield Minnesota, Federal Employee Program,395.26,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Excision,Malignant,Lesion Trunk/Arms/Legs; 2.1-3.0 Cm (Pbb)",,11603,CPT,Facility,Outpatient,,,,536,455.6,153.6176,536,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,536,100,,percent of total billed charges,,
"Excision,Malignant,Lesion Trunk/Arms/Legs; 2.1-3.0 Cm (Pbb)",,11603,CPT,Professional,Outpatient,,,,650,552.5,121.07,650,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,401.58416,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision,Malignant,Lesion Trunk/Arms/Legs; 2.1-3.0 Cm (Pbb)",,11603,CPT,Facility,Outpatient,,,,536,455.6,153.6176,536,BlueCross BlueShield Minnesota,High Value Network Plan,482.4,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
"Excision,Malignant,Lesion Trunk/Arms/Legs; 2.1-3.0 Cm (Pbb)",,11603,CPT,Professional,Outpatient,,,,650,552.5,121.07,650,BlueCross BlueShield Minnesota,High Value Network Plan,401.58416,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision,Malignant,Lesion Trunk/Arms/Legs; 2.1-3.0 Cm (Pbb)",,11603,CPT,Facility,Outpatient,,,,536,455.6,153.6176,536,BlueCross BlueShield Minnesota,Medicare Advantage,262.64,49,,percent of total billed charges,,
"Excision,Malignant,Lesion Trunk/Arms/Legs; 2.1-3.0 Cm (Pbb)",,11603,CPT,Professional,Outpatient,,,,650,552.5,121.07,650,BlueCross BlueShield Minnesota,Medicare Advantage,216.3955,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision,Malignant,Lesion Trunk/Arms/Legs; 2.1-3.0 Cm (Pbb)",,11603,CPT,Professional,Outpatient,,,,650,552.5,121.07,650,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,401.58416,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision,Malignant,Lesion Trunk/Arms/Legs; 2.1-3.0 Cm (Pbb)",,11603,CPT,Facility,Outpatient,,,,536,455.6,153.6176,536,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,153.6176,28.66,,percent of total billed charges,,
"Excision,Malignant,Lesion Trunk/Arms/Legs; 2.1-3.0 Cm (Pbb)",,11603,CPT,Professional,Outpatient,,,,650,552.5,121.07,650,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,139.78128,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision,Malignant,Lesion Trunk/Arms/Legs; 2.1-3.0 Cm (Pbb)",,11603,CPT,Facility,Outpatient,,,,536,455.6,153.6176,536,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),262.64,49,,percent of total billed charges,,
"Excision,Malignant,Lesion Trunk/Arms/Legs; 2.1-3.0 Cm (Pbb)",,11603,CPT,Professional,Outpatient,,,,650,552.5,121.07,650,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),216.3955,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision,Malignant,Lesion Trunk/Arms/Legs; 2.1-3.0 Cm (Pbb)",,11603,CPT,Facility,Outpatient,,,,536,455.6,153.6176,536,CorVel,Worker's Compensation,536,100,,percent of total billed charges,,
"Excision,Malignant,Lesion Trunk/Arms/Legs; 2.1-3.0 Cm (Pbb)",,11603,CPT,Professional,Outpatient,,,,650,552.5,121.07,650,CorVel,Worker's Compensation,365.9911941,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Excision,Malignant,Lesion Trunk/Arms/Legs; 2.1-3.0 Cm (Pbb)",,11603,CPT,Facility,Outpatient,,,,536,455.6,153.6176,536,First Health Group Corporation,First Health Network,519.92,97,,percent of total billed charges,,
"Excision,Malignant,Lesion Trunk/Arms/Legs; 2.1-3.0 Cm (Pbb)",,11603,CPT,Professional,Outpatient,,,,650,552.5,121.07,650,First Health Group Corporation,First Health Network,630.5,97,,percent of total billed charges,,
"Excision,Malignant,Lesion Trunk/Arms/Legs; 2.1-3.0 Cm (Pbb)",,11603,CPT,Facility,Outpatient,,,,536,455.6,153.6176,536,"Health Partners, Inc.",Commercial,507.056,94.6,,percent of total billed charges,,
"Excision,Malignant,Lesion Trunk/Arms/Legs; 2.1-3.0 Cm (Pbb)",,11603,CPT,Professional,Outpatient,,,,650,552.5,121.07,650,"Health Partners, Inc.",Commercial,395.41,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision,Malignant,Lesion Trunk/Arms/Legs; 2.1-3.0 Cm (Pbb)",,11603,CPT,Facility,Outpatient,,,,536,455.6,153.6176,536,"Health Partners, Inc.",Medicare Advantage,262.64,49,,percent of total billed charges,,
"Excision,Malignant,Lesion Trunk/Arms/Legs; 2.1-3.0 Cm (Pbb)",,11603,CPT,Professional,Outpatient,,,,650,552.5,121.07,650,"Health Partners, Inc.",Medicare Advantage,216.3955,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision,Malignant,Lesion Trunk/Arms/Legs; 2.1-3.0 Cm (Pbb)",,11603,CPT,Facility,Outpatient,,,,536,455.6,153.6176,536,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),321.6,60,,percent of total billed charges,,
"Excision,Malignant,Lesion Trunk/Arms/Legs; 2.1-3.0 Cm (Pbb)",,11603,CPT,Professional,Outpatient,,,,650,552.5,121.07,650,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),188.07,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Excision,Malignant,Lesion Trunk/Arms/Legs; 2.1-3.0 Cm (Pbb)",,11603,CPT,Facility,Outpatient,,,,536,455.6,153.6176,536,"Health Partners, Inc.",State of Minnesota Advantage Program,436.84,81.5,,percent of total billed charges,,
"Excision,Malignant,Lesion Trunk/Arms/Legs; 2.1-3.0 Cm (Pbb)",,11603,CPT,Professional,Outpatient,,,,650,552.5,121.07,650,"Health Partners, Inc.",State of Minnesota Advantage Program,340.645715,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision,Malignant,Lesion Trunk/Arms/Legs; 2.1-3.0 Cm (Pbb)",,11603,CPT,Facility,Outpatient,,,,536,455.6,153.6176,536,"Health Partners, Inc.",State Public Programs,268,50,,percent of total billed charges,,
"Excision,Malignant,Lesion Trunk/Arms/Legs; 2.1-3.0 Cm (Pbb)",,11603,CPT,Professional,Outpatient,,,,650,552.5,121.07,650,"Health Partners, Inc.",State Public Programs,121.07,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Excision,Malignant,Lesion Trunk/Arms/Legs; 2.1-3.0 Cm (Pbb)",,11603,CPT,Facility,Outpatient,,,,536,455.6,153.6176,536,Humana Insurance Company,Commercial PPO,509.2,95,,percent of total billed charges,,
"Excision,Malignant,Lesion Trunk/Arms/Legs; 2.1-3.0 Cm (Pbb)",,11603,CPT,Professional,Outpatient,,,,650,552.5,121.07,650,Humana Insurance Company,Commercial PPO,188.17,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Excision,Malignant,Lesion Trunk/Arms/Legs; 2.1-3.0 Cm (Pbb)",,11603,CPT,Facility,Outpatient,,,,536,455.6,153.6176,536,Humana Insurance Company,Medicare PPO,262.64,49,,percent of total billed charges,,
"Excision,Malignant,Lesion Trunk/Arms/Legs; 2.1-3.0 Cm (Pbb)",,11603,CPT,Professional,Outpatient,,,,650,552.5,121.07,650,Humana Insurance Company,Medicare PPO,650,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Excision,Malignant,Lesion Trunk/Arms/Legs; 2.1-3.0 Cm (Pbb)",,11603,CPT,Facility,Outpatient,,,,536,455.6,153.6176,536,Medica,Individual & Family,531.176,99.1,,percent of total billed charges,,
"Excision,Malignant,Lesion Trunk/Arms/Legs; 2.1-3.0 Cm (Pbb)",,11603,CPT,Professional,Outpatient,,,,650,552.5,121.07,650,Medica,Individual & Family,551.2,84.8,,percent of total billed charges,,
"Excision,Malignant,Lesion Trunk/Arms/Legs; 2.1-3.0 Cm (Pbb)",,11603,CPT,Facility,Outpatient,,,,536,455.6,153.6176,536,Medica,Medica Advantage Solution,266.928,49.8,,percent of total billed charges,,
"Excision,Malignant,Lesion Trunk/Arms/Legs; 2.1-3.0 Cm (Pbb)",,11603,CPT,Professional,Outpatient,,,,650,552.5,121.07,650,Medica,Medica Advantage Solution,323.7,49.8,,percent of total billed charges,,
"Excision,Malignant,Lesion Trunk/Arms/Legs; 2.1-3.0 Cm (Pbb)",,11603,CPT,Facility,Outpatient,,,,536,455.6,153.6176,536,Medica,Medical Assistance,239.056,44.6,,percent of total billed charges,,
"Excision,Malignant,Lesion Trunk/Arms/Legs; 2.1-3.0 Cm (Pbb)",,11603,CPT,Professional,Outpatient,,,,650,552.5,121.07,650,Medica,Medical Assistance,139.78,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Excision,Malignant,Lesion Trunk/Arms/Legs; 2.1-3.0 Cm (Pbb)",,11603,CPT,Facility,Outpatient,,,,536,455.6,153.6176,536,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,266.928,49.8,,percent of total billed charges,,
"Excision,Malignant,Lesion Trunk/Arms/Legs; 2.1-3.0 Cm (Pbb)",,11603,CPT,Professional,Outpatient,,,,650,552.5,121.07,650,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,188.17,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Excision,Malignant,Lesion Trunk/Arms/Legs; 2.1-3.0 Cm (Pbb)",,11603,CPT,Facility,Outpatient,,,,536,455.6,153.6176,536,"Multiplan, Inc.","Multiplan, Inc.",503.84,94,,percent of total billed charges,,
"Excision,Malignant,Lesion Trunk/Arms/Legs; 2.1-3.0 Cm (Pbb)",,11603,CPT,Professional,Outpatient,,,,650,552.5,121.07,650,"Multiplan, Inc.","Multiplan, Inc.",611,94,,percent of total billed charges,,
"Excision,Malignant,Lesion Trunk/Arms/Legs; 2.1-3.0 Cm (Pbb)",,11603,CPT,Facility,Outpatient,,,,536,455.6,153.6176,536,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,482.936,90.1,,percent of total billed charges,,
"Excision,Malignant,Lesion Trunk/Arms/Legs; 2.1-3.0 Cm (Pbb)",,11603,CPT,Professional,Outpatient,,,,650,552.5,121.07,650,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,585.65,90.1,,percent of total billed charges,,
"Excision,Malignant,Lesion Trunk/Arms/Legs; 2.1-3.0 Cm (Pbb)",,11603,CPT,Facility,Outpatient,,,,536,455.6,153.6176,536,"Preferred One Administrative Services, INC.",PPO,528.496,98.6,,percent of total billed charges,,
"Excision,Malignant,Lesion Trunk/Arms/Legs; 2.1-3.0 Cm (Pbb)",,11603,CPT,Professional,Outpatient,,,,650,552.5,121.07,650,"Preferred One Administrative Services, INC.",PPO,640.9,98.6,,percent of total billed charges,,
"Excision,Malignant,Lesion Trunk/Arms/Legs; 2.1-3.0 Cm (Pbb)",,11603,CPT,Facility,Outpatient,,,,536,455.6,153.6176,536,PrimeWest Health,Minnesota Senior Health Options (MSHO),275.772,51.45,,percent of total billed charges,,
"Excision,Malignant,Lesion Trunk/Arms/Legs; 2.1-3.0 Cm (Pbb)",,11603,CPT,Professional,Outpatient,,,,650,552.5,121.07,650,PrimeWest Health,Minnesota Senior Health Options (MSHO),216.3955,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision,Malignant,Lesion Trunk/Arms/Legs; 2.1-3.0 Cm (Pbb)",,11603,CPT,Facility,Outpatient,,,,536,455.6,153.6176,536,PrimeWest Health,MinnesotaCare,275.2896,51.36,,percent of total billed charges,,
"Excision,Malignant,Lesion Trunk/Arms/Legs; 2.1-3.0 Cm (Pbb)",,11603,CPT,Professional,Outpatient,,,,650,552.5,121.07,650,PrimeWest Health,MinnesotaCare,149.5659696,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision,Malignant,Lesion Trunk/Arms/Legs; 2.1-3.0 Cm (Pbb)",,11603,CPT,Facility,Outpatient,,,,536,455.6,153.6176,536,Sanford Health Plan,Sanford Health Plan,493.12,92,,percent of total billed charges,,
"Excision,Malignant,Lesion Trunk/Arms/Legs; 2.1-3.0 Cm (Pbb)",,11603,CPT,Professional,Outpatient,,,,650,552.5,121.07,650,Sanford Health Plan,Sanford Health Plan,572,88,,percent of total billed charges,,
"Excision,Malignant,Lesion Trunk/Arms/Legs; 2.1-3.0 Cm (Pbb)",,11603,CPT,Facility,Outpatient,,,,536,455.6,153.6176,536,"UCare Health, Inc.",Individual & Family Plan,302.036,56.35,,percent of total billed charges,,
"Excision,Malignant,Lesion Trunk/Arms/Legs; 2.1-3.0 Cm (Pbb)",,11603,CPT,Professional,Outpatient,,,,650,552.5,121.07,650,"UCare Health, Inc.",Individual & Family Plan,305.889152,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Excision,Malignant,Lesion Trunk/Arms/Legs; 2.1-3.0 Cm (Pbb)",,11603,CPT,Facility,Outpatient,,,,536,455.6,153.6176,536,"UCare Health, Inc.",Medical Assistance,270.5192,50.47,,percent of total billed charges,,
"Excision,Malignant,Lesion Trunk/Arms/Legs; 2.1-3.0 Cm (Pbb)",,11603,CPT,Professional,Outpatient,,,,650,552.5,121.07,650,"UCare Health, Inc.",Medical Assistance,153.759408,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Excision,Malignant,Lesion Trunk/Arms/Legs; 2.1-3.0 Cm (Pbb)",,11603,CPT,Facility,Outpatient,,,,536,455.6,153.6176,536,"UCare Health, Inc.",Medicare Advantage,270.5192,50.47,,percent of total billed charges,,
"Excision,Malignant,Lesion Trunk/Arms/Legs; 2.1-3.0 Cm (Pbb)",,11603,CPT,Professional,Outpatient,,,,650,552.5,121.07,650,"UCare Health, Inc.",Medicare Advantage,216.3955,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Excision,Malignant,Lesion Trunk/Arms/Legs; 2.1-3.0 Cm (Pbb)",,11603,CPT,Facility,Outpatient,,,,536,455.6,153.6176,536,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),270.5192,50.47,,percent of total billed charges,,
"Excision,Malignant,Lesion Trunk/Arms/Legs; 2.1-3.0 Cm (Pbb)",,11603,CPT,Professional,Outpatient,,,,650,552.5,121.07,650,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),173.1164,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Excision,Malignant,Lesion Trunk/Arms/Legs; 2.1-3.0 Cm (Pbb)",,11603,CPT,Facility,Outpatient,,,,536,455.6,153.6176,536,UnitedHealthcare,Individual & Family,503.84,94,,percent of total billed charges,,
"Excision,Malignant,Lesion Trunk/Arms/Legs; 2.1-3.0 Cm (Pbb)",,11603,CPT,Professional,Outpatient,,,,650,552.5,121.07,650,UnitedHealthcare,Individual & Family,650,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Excision,Malignant,Lesion Trunk/Arms/Legs; 2.1-3.0 Cm (Pbb)",,11603,CPT,Facility,Outpatient,,,,536,455.6,153.6176,536,UnitedHealthcare,Medicare Advantage,262.64,49,,percent of total billed charges,,
"Excision,Malignant,Lesion Trunk/Arms/Legs; 2.1-3.0 Cm (Pbb)",,11603,CPT,Professional,Outpatient,,,,650,552.5,121.07,650,UnitedHealthcare,Medicare Advantage,216.3955,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision,Malignant,Lesion Trunk/Arms/Legs; 2.1-3.0 Cm (Pbb)",,11603,CPT,Facility,Outpatient,,,,536,455.6,153.6176,536,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,257.28,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Excision,Malignant,Lesion Trunk/Arms/Legs; 2.1-3.0 Cm (Pbb)",,11603,CPT,Professional,Outpatient,,,,650,552.5,121.07,650,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,139.78128,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision, Malignant Lesion Inc Margins, Trunk, Arms, Or Legs; Exc Dia 3.1 To 4.0 Cm",,11604,CPT,Facility,Both,,,,412,350.2,118.0792,412,Aetna,Commercial,379.04,92,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins, Trunk, Arms, Or Legs; Exc Dia 3.1 To 4.0 Cm",,11604,CPT,Facility,Outpatient,,,,412,350.2,118.0792,412,Aetna,Medicare Advantage,201.88,49,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins, Trunk, Arms, Or Legs; Exc Dia 3.1 To 4.0 Cm",,11604,CPT,Facility,Inpatient,,,,412,350.2,118.0792,412,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Excision, Malignant Lesion Inc Margins, Trunk, Arms, Or Legs; Exc Dia 3.1 To 4.0 Cm",,11604,CPT,Facility,Both,,,,412,350.2,118.0792,412,Aetna,PPO,383.16,93,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins, Trunk, Arms, Or Legs; Exc Dia 3.1 To 4.0 Cm",,11604,CPT,Facility,Both,,,,412,350.2,118.0792,412,America's PPO,America's PPO,395.6436,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Excision, Malignant Lesion Inc Margins, Trunk, Arms, Or Legs; Exc Dia 3.1 To 4.0 Cm",,11604,CPT,Facility,Both,,,,412,350.2,118.0792,412,BlueCross BlueShield Minnesota, Federal Employee Program,405.408,98.4,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins, Trunk, Arms, Or Legs; Exc Dia 3.1 To 4.0 Cm",,11604,CPT,Facility,Both,,,,412,350.2,118.0792,412,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,412,100,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins, Trunk, Arms, Or Legs; Exc Dia 3.1 To 4.0 Cm",,11604,CPT,Facility,Both,,,,412,350.2,118.0792,412,BlueCross BlueShield Minnesota,High Value Network Plan,370.8,90,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins, Trunk, Arms, Or Legs; Exc Dia 3.1 To 4.0 Cm",,11604,CPT,Facility,Outpatient,,,,412,350.2,118.0792,412,BlueCross BlueShield Minnesota,Medicare Advantage,201.88,49,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins, Trunk, Arms, Or Legs; Exc Dia 3.1 To 4.0 Cm",,11604,CPT,Facility,Inpatient,,,,412,350.2,118.0792,412,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Excision, Malignant Lesion Inc Margins, Trunk, Arms, Or Legs; Exc Dia 3.1 To 4.0 Cm",,11604,CPT,Facility,Both,,,,412,350.2,118.0792,412,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,364.9084,88.57,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins, Trunk, Arms, Or Legs; Exc Dia 3.1 To 4.0 Cm",,11604,CPT,Facility,Both,,,,412,350.2,118.0792,412,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,118.0792,28.66,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins, Trunk, Arms, Or Legs; Exc Dia 3.1 To 4.0 Cm",,11604,CPT,Facility,Outpatient,,,,412,350.2,118.0792,412,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),201.88,49,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins, Trunk, Arms, Or Legs; Exc Dia 3.1 To 4.0 Cm",,11604,CPT,Facility,Inpatient,,,,412,350.2,118.0792,412,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Excision, Malignant Lesion Inc Margins, Trunk, Arms, Or Legs; Exc Dia 3.1 To 4.0 Cm",,11604,CPT,Facility,Both,,,,412,350.2,118.0792,412,CorVel,Worker's Compensation,412,100,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins, Trunk, Arms, Or Legs; Exc Dia 3.1 To 4.0 Cm",,11604,CPT,Facility,Both,,,,412,350.2,118.0792,412,First Health Group Corporation,First Health Network,399.64,97,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins, Trunk, Arms, Or Legs; Exc Dia 3.1 To 4.0 Cm",,11604,CPT,Facility,Both,,,,412,350.2,118.0792,412,"Health Partners, Inc.",Commercial,389.752,94.6,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins, Trunk, Arms, Or Legs; Exc Dia 3.1 To 4.0 Cm",,11604,CPT,Facility,Outpatient,,,,412,350.2,118.0792,412,"Health Partners, Inc.",Medicare Advantage,201.88,49,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins, Trunk, Arms, Or Legs; Exc Dia 3.1 To 4.0 Cm",,11604,CPT,Facility,Inpatient,,,,412,350.2,118.0792,412,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Excision, Malignant Lesion Inc Margins, Trunk, Arms, Or Legs; Exc Dia 3.1 To 4.0 Cm",,11604,CPT,Facility,Both,,,,412,350.2,118.0792,412,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),247.2,60,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins, Trunk, Arms, Or Legs; Exc Dia 3.1 To 4.0 Cm",,11604,CPT,Facility,Both,,,,412,350.2,118.0792,412,"Health Partners, Inc.",State of Minnesota Advantage Program,335.78,81.5,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins, Trunk, Arms, Or Legs; Exc Dia 3.1 To 4.0 Cm",,11604,CPT,Facility,Both,,,,412,350.2,118.0792,412,"Health Partners, Inc.",State Public Programs,206,50,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins, Trunk, Arms, Or Legs; Exc Dia 3.1 To 4.0 Cm",,11604,CPT,Facility,Both,,,,412,350.2,118.0792,412,Humana Insurance Company,Commercial PPO,391.4,95,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins, Trunk, Arms, Or Legs; Exc Dia 3.1 To 4.0 Cm",,11604,CPT,Facility,Outpatient,,,,412,350.2,118.0792,412,Humana Insurance Company,Medicare PPO,201.88,49,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins, Trunk, Arms, Or Legs; Exc Dia 3.1 To 4.0 Cm",,11604,CPT,Facility,Inpatient,,,,412,350.2,118.0792,412,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Excision, Malignant Lesion Inc Margins, Trunk, Arms, Or Legs; Exc Dia 3.1 To 4.0 Cm",,11604,CPT,Facility,Both,,,,412,350.2,118.0792,412,Medica,Individual & Family,408.292,99.1,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins, Trunk, Arms, Or Legs; Exc Dia 3.1 To 4.0 Cm",,11604,CPT,Facility,Outpatient,,,,412,350.2,118.0792,412,Medica,Medica Advantage Solution,205.176,49.8,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins, Trunk, Arms, Or Legs; Exc Dia 3.1 To 4.0 Cm",,11604,CPT,Facility,Inpatient,,,,412,350.2,118.0792,412,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Excision, Malignant Lesion Inc Margins, Trunk, Arms, Or Legs; Exc Dia 3.1 To 4.0 Cm",,11604,CPT,Facility,Outpatient,,,,412,350.2,118.0792,412,Medica,Medical Assistance,183.752,44.6,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins, Trunk, Arms, Or Legs; Exc Dia 3.1 To 4.0 Cm",,11604,CPT,Facility,Inpatient,,,,412,350.2,118.0792,412,Medica,Medical Assistance,,,,,Included in per diem rate,
"Excision, Malignant Lesion Inc Margins, Trunk, Arms, Or Legs; Exc Dia 3.1 To 4.0 Cm",,11604,CPT,Facility,Outpatient,,,,412,350.2,118.0792,412,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,205.176,49.8,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins, Trunk, Arms, Or Legs; Exc Dia 3.1 To 4.0 Cm",,11604,CPT,Facility,Inpatient,,,,412,350.2,118.0792,412,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Excision, Malignant Lesion Inc Margins, Trunk, Arms, Or Legs; Exc Dia 3.1 To 4.0 Cm",,11604,CPT,Facility,Both,,,,412,350.2,118.0792,412,"Multiplan, Inc.","Multiplan, Inc.",387.28,94,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins, Trunk, Arms, Or Legs; Exc Dia 3.1 To 4.0 Cm",,11604,CPT,Facility,Outpatient,,,,412,350.2,118.0792,412,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,371.212,90.1,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins, Trunk, Arms, Or Legs; Exc Dia 3.1 To 4.0 Cm",,11604,CPT,Facility,Inpatient,,,,412,350.2,118.0792,412,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Excision, Malignant Lesion Inc Margins, Trunk, Arms, Or Legs; Exc Dia 3.1 To 4.0 Cm",,11604,CPT,Facility,Both,,,,412,350.2,118.0792,412,"Preferred One Administrative Services, INC.",PPO,406.232,98.6,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins, Trunk, Arms, Or Legs; Exc Dia 3.1 To 4.0 Cm",,11604,CPT,Facility,Outpatient,,,,412,350.2,118.0792,412,PrimeWest Health,Minnesota Senior Health Options (MSHO),211.974,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Excision, Malignant Lesion Inc Margins, Trunk, Arms, Or Legs; Exc Dia 3.1 To 4.0 Cm",,11604,CPT,Facility,Inpatient,,,,412,350.2,118.0792,412,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Excision, Malignant Lesion Inc Margins, Trunk, Arms, Or Legs; Exc Dia 3.1 To 4.0 Cm",,11604,CPT,Facility,Outpatient,,,,412,350.2,118.0792,412,PrimeWest Health,MinnesotaCare,211.6032,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Excision, Malignant Lesion Inc Margins, Trunk, Arms, Or Legs; Exc Dia 3.1 To 4.0 Cm",,11604,CPT,Facility,Inpatient,,,,412,350.2,118.0792,412,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Excision, Malignant Lesion Inc Margins, Trunk, Arms, Or Legs; Exc Dia 3.1 To 4.0 Cm",,11604,CPT,Facility,Both,,,,412,350.2,118.0792,412,Sanford Health Plan,Sanford Health Plan,379.04,92,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins, Trunk, Arms, Or Legs; Exc Dia 3.1 To 4.0 Cm",,11604,CPT,Facility,Outpatient,,,,412,350.2,118.0792,412,"UCare Health, Inc.",Individual & Family Plan,232.162,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Excision, Malignant Lesion Inc Margins, Trunk, Arms, Or Legs; Exc Dia 3.1 To 4.0 Cm",,11604,CPT,Facility,Inpatient,,,,412,350.2,118.0792,412,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Excision, Malignant Lesion Inc Margins, Trunk, Arms, Or Legs; Exc Dia 3.1 To 4.0 Cm",,11604,CPT,Facility,Outpatient,,,,412,350.2,118.0792,412,"UCare Health, Inc.",Medical Assistance,207.9364,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Excision, Malignant Lesion Inc Margins, Trunk, Arms, Or Legs; Exc Dia 3.1 To 4.0 Cm",,11604,CPT,Facility,Inpatient,,,,412,350.2,118.0792,412,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Excision, Malignant Lesion Inc Margins, Trunk, Arms, Or Legs; Exc Dia 3.1 To 4.0 Cm",,11604,CPT,Facility,Outpatient,,,,412,350.2,118.0792,412,"UCare Health, Inc.",Medicare Advantage,207.9364,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Excision, Malignant Lesion Inc Margins, Trunk, Arms, Or Legs; Exc Dia 3.1 To 4.0 Cm",,11604,CPT,Facility,Inpatient,,,,412,350.2,118.0792,412,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Excision, Malignant Lesion Inc Margins, Trunk, Arms, Or Legs; Exc Dia 3.1 To 4.0 Cm",,11604,CPT,Facility,Outpatient,,,,412,350.2,118.0792,412,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),207.9364,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Excision, Malignant Lesion Inc Margins, Trunk, Arms, Or Legs; Exc Dia 3.1 To 4.0 Cm",,11604,CPT,Facility,Inpatient,,,,412,350.2,118.0792,412,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Excision, Malignant Lesion Inc Margins, Trunk, Arms, Or Legs; Exc Dia 3.1 To 4.0 Cm",,11604,CPT,Facility,Both,,,,412,350.2,118.0792,412,UnitedHealthcare,Individual & Family,387.28,94,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins, Trunk, Arms, Or Legs; Exc Dia 3.1 To 4.0 Cm",,11604,CPT,Facility,Outpatient,,,,412,350.2,118.0792,412,UnitedHealthcare,Medicare Advantage,201.88,49,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins, Trunk, Arms, Or Legs; Exc Dia 3.1 To 4.0 Cm",,11604,CPT,Facility,Inpatient,,,,412,350.2,118.0792,412,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Excision, Malignant Lesion Inc Margins, Trunk, Arms, Or Legs; Exc Dia 3.1 To 4.0 Cm",,11604,CPT,Facility,Outpatient,,,,412,350.2,118.0792,412,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,197.76,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Excision, Malignant Lesion Inc Margins, Trunk, Arms, Or Legs; Exc Dia 3.1 To 4.0 Cm",,11604,CPT,Facility,Inpatient,,,,412,350.2,118.0792,412,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Excision, Malignant Lesion Inc Margins, Trunk, Arms, Or Legs; Exc Dia 3.1 To 4.0 Cm (Pro Cah)",,11604,CPT,Professional,Both,,,,630,535.5,132.63,630,Aetna,Commercial,535.5,85,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins, Trunk, Arms, Or Legs; Exc Dia 3.1 To 4.0 Cm (Pro Cah)",,11604,CPT,Professional,Both,,,,630,535.5,132.63,630,Aetna,Medicare Advantage,207.69,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion Inc Margins, Trunk, Arms, Or Legs; Exc Dia 3.1 To 4.0 Cm (Pro Cah)",,11604,CPT,Professional,Both,,,,630,535.5,132.63,630,Aetna,PPO,585.9,93,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins, Trunk, Arms, Or Legs; Exc Dia 3.1 To 4.0 Cm (Pro Cah)",,11604,CPT,Professional,Both,,,,630,535.5,132.63,630,America's PPO,America's PPO,538.272,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Excision, Malignant Lesion Inc Margins, Trunk, Arms, Or Legs; Exc Dia 3.1 To 4.0 Cm (Pro Cah)",,11604,CPT,Professional,Both,,,,630,535.5,132.63,630,BlueCross BlueShield Minnesota, Federal Employee Program,435.2,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Excision, Malignant Lesion Inc Margins, Trunk, Arms, Or Legs; Exc Dia 3.1 To 4.0 Cm (Pro Cah)",,11604,CPT,Professional,Both,,,,630,535.5,132.63,630,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,442.1632,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Malignant Lesion Inc Margins, Trunk, Arms, Or Legs; Exc Dia 3.1 To 4.0 Cm (Pro Cah)",,11604,CPT,Professional,Both,,,,630,535.5,132.63,630,BlueCross BlueShield Minnesota,High Value Network Plan,442.1632,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Malignant Lesion Inc Margins, Trunk, Arms, Or Legs; Exc Dia 3.1 To 4.0 Cm (Pro Cah)",,11604,CPT,Professional,Both,,,,630,535.5,132.63,630,BlueCross BlueShield Minnesota,Medicare Advantage,237.2795,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion Inc Margins, Trunk, Arms, Or Legs; Exc Dia 3.1 To 4.0 Cm (Pro Cah)",,11604,CPT,Professional,Both,,,,630,535.5,132.63,630,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,442.1632,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Malignant Lesion Inc Margins, Trunk, Arms, Or Legs; Exc Dia 3.1 To 4.0 Cm (Pro Cah)",,11604,CPT,Professional,Both,,,,630,535.5,132.63,630,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,153.13152,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision, Malignant Lesion Inc Margins, Trunk, Arms, Or Legs; Exc Dia 3.1 To 4.0 Cm (Pro Cah)",,11604,CPT,Professional,Both,,,,630,535.5,132.63,630,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),237.2795,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion Inc Margins, Trunk, Arms, Or Legs; Exc Dia 3.1 To 4.0 Cm (Pro Cah)",,11604,CPT,Professional,Both,,,,630,535.5,132.63,630,CorVel,Worker's Compensation,402.0473784,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Excision, Malignant Lesion Inc Margins, Trunk, Arms, Or Legs; Exc Dia 3.1 To 4.0 Cm (Pro Cah)",,11604,CPT,Professional,Both,,,,630,535.5,132.63,630,First Health Group Corporation,First Health Network,611.1,97,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins, Trunk, Arms, Or Legs; Exc Dia 3.1 To 4.0 Cm (Pro Cah)",,11604,CPT,Professional,Both,,,,630,535.5,132.63,630,"Health Partners, Inc.",Commercial,433.86,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision, Malignant Lesion Inc Margins, Trunk, Arms, Or Legs; Exc Dia 3.1 To 4.0 Cm (Pro Cah)",,11604,CPT,Professional,Both,,,,630,535.5,132.63,630,"Health Partners, Inc.",Medicare Advantage,237.2795,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion Inc Margins, Trunk, Arms, Or Legs; Exc Dia 3.1 To 4.0 Cm (Pro Cah)",,11604,CPT,Professional,Both,,,,630,535.5,132.63,630,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),206.37,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Excision, Malignant Lesion Inc Margins, Trunk, Arms, Or Legs; Exc Dia 3.1 To 4.0 Cm (Pro Cah)",,11604,CPT,Professional,Both,,,,630,535.5,132.63,630,"Health Partners, Inc.",State of Minnesota Advantage Program,373.77039,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision, Malignant Lesion Inc Margins, Trunk, Arms, Or Legs; Exc Dia 3.1 To 4.0 Cm (Pro Cah)",,11604,CPT,Professional,Both,,,,630,535.5,132.63,630,"Health Partners, Inc.",State Public Programs,132.63,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Excision, Malignant Lesion Inc Margins, Trunk, Arms, Or Legs; Exc Dia 3.1 To 4.0 Cm (Pro Cah)",,11604,CPT,Professional,Both,,,,630,535.5,132.63,630,Humana Insurance Company,Commercial PPO,206.33,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Excision, Malignant Lesion Inc Margins, Trunk, Arms, Or Legs; Exc Dia 3.1 To 4.0 Cm (Pro Cah)",,11604,CPT,Professional,Both,,,,630,535.5,132.63,630,Humana Insurance Company,Medicare PPO,630,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion Inc Margins, Trunk, Arms, Or Legs; Exc Dia 3.1 To 4.0 Cm (Pro Cah)",,11604,CPT,Professional,Both,,,,630,535.5,132.63,630,Medica,Individual & Family,534.24,84.8,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins, Trunk, Arms, Or Legs; Exc Dia 3.1 To 4.0 Cm (Pro Cah)",,11604,CPT,Professional,Both,,,,630,535.5,132.63,630,Medica,Medica Advantage Solution,313.74,49.8,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins, Trunk, Arms, Or Legs; Exc Dia 3.1 To 4.0 Cm (Pro Cah)",,11604,CPT,Professional,Both,,,,630,535.5,132.63,630,Medica,Medical Assistance,153.13,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Excision, Malignant Lesion Inc Margins, Trunk, Arms, Or Legs; Exc Dia 3.1 To 4.0 Cm (Pro Cah)",,11604,CPT,Professional,Both,,,,630,535.5,132.63,630,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,206.33,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Excision, Malignant Lesion Inc Margins, Trunk, Arms, Or Legs; Exc Dia 3.1 To 4.0 Cm (Pro Cah)",,11604,CPT,Professional,Both,,,,630,535.5,132.63,630,"Multiplan, Inc.","Multiplan, Inc.",592.2,94,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins, Trunk, Arms, Or Legs; Exc Dia 3.1 To 4.0 Cm (Pro Cah)",,11604,CPT,Professional,Both,,,,630,535.5,132.63,630,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,567.63,90.1,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins, Trunk, Arms, Or Legs; Exc Dia 3.1 To 4.0 Cm (Pro Cah)",,11604,CPT,Professional,Both,,,,630,535.5,132.63,630,"Preferred One Administrative Services, INC.",PPO,621.18,98.6,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins, Trunk, Arms, Or Legs; Exc Dia 3.1 To 4.0 Cm (Pro Cah)",,11604,CPT,Professional,Both,,,,630,535.5,132.63,630,PrimeWest Health,Minnesota Senior Health Options (MSHO),237.2795,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion Inc Margins, Trunk, Arms, Or Legs; Exc Dia 3.1 To 4.0 Cm (Pro Cah)",,11604,CPT,Professional,Both,,,,630,535.5,132.63,630,PrimeWest Health,MinnesotaCare,163.8507264,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision, Malignant Lesion Inc Margins, Trunk, Arms, Or Legs; Exc Dia 3.1 To 4.0 Cm (Pro Cah)",,11604,CPT,Professional,Both,,,,630,535.5,132.63,630,Sanford Health Plan,Sanford Health Plan,554.4,88,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins, Trunk, Arms, Or Legs; Exc Dia 3.1 To 4.0 Cm (Pro Cah)",,11604,CPT,Professional,Both,,,,630,535.5,132.63,630,"UCare Health, Inc.",Individual & Family Plan,335.410048,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Excision, Malignant Lesion Inc Margins, Trunk, Arms, Or Legs; Exc Dia 3.1 To 4.0 Cm (Pro Cah)",,11604,CPT,Professional,Both,,,,630,535.5,132.63,630,"UCare Health, Inc.",Medical Assistance,168.444672,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Excision, Malignant Lesion Inc Margins, Trunk, Arms, Or Legs; Exc Dia 3.1 To 4.0 Cm (Pro Cah)",,11604,CPT,Professional,Both,,,,630,535.5,132.63,630,"UCare Health, Inc.",Medicare Advantage,237.2795,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Excision, Malignant Lesion Inc Margins, Trunk, Arms, Or Legs; Exc Dia 3.1 To 4.0 Cm (Pro Cah)",,11604,CPT,Professional,Both,,,,630,535.5,132.63,630,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),189.8236,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Excision, Malignant Lesion Inc Margins, Trunk, Arms, Or Legs; Exc Dia 3.1 To 4.0 Cm (Pro Cah)",,11604,CPT,Professional,Both,,,,630,535.5,132.63,630,UnitedHealthcare,Individual & Family,630,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Excision, Malignant Lesion Inc Margins, Trunk, Arms, Or Legs; Exc Dia 3.1 To 4.0 Cm (Pro Cah)",,11604,CPT,Professional,Both,,,,630,535.5,132.63,630,UnitedHealthcare,Medicare Advantage,237.2795,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion Inc Margins, Trunk, Arms, Or Legs; Exc Dia 3.1 To 4.0 Cm (Pro Cah)",,11604,CPT,Professional,Both,,,,630,535.5,132.63,630,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,153.13152,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia Over 4.0 Cm",,11606,CPT,Facility,Both,,,,530,450.5,151.898,530,Aetna,Commercial,487.6,92,,percent of total billed charges,,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia Over 4.0 Cm",,11606,CPT,Facility,Outpatient,,,,530,450.5,151.898,530,Aetna,Medicare Advantage,259.7,49,,percent of total billed charges,,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia Over 4.0 Cm",,11606,CPT,Facility,Inpatient,,,,530,450.5,151.898,530,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia Over 4.0 Cm",,11606,CPT,Facility,Both,,,,530,450.5,151.898,530,Aetna,PPO,492.9,93,,percent of total billed charges,,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia Over 4.0 Cm",,11606,CPT,Facility,Both,,,,530,450.5,151.898,530,America's PPO,America's PPO,508.959,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia Over 4.0 Cm",,11606,CPT,Facility,Both,,,,530,450.5,151.898,530,BlueCross BlueShield Minnesota, Federal Employee Program,521.52,98.4,,percent of total billed charges,,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia Over 4.0 Cm",,11606,CPT,Facility,Both,,,,530,450.5,151.898,530,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,530,100,,percent of total billed charges,,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia Over 4.0 Cm",,11606,CPT,Facility,Both,,,,530,450.5,151.898,530,BlueCross BlueShield Minnesota,High Value Network Plan,477,90,,percent of total billed charges,,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia Over 4.0 Cm",,11606,CPT,Facility,Outpatient,,,,530,450.5,151.898,530,BlueCross BlueShield Minnesota,Medicare Advantage,259.7,49,,percent of total billed charges,,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia Over 4.0 Cm",,11606,CPT,Facility,Inpatient,,,,530,450.5,151.898,530,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia Over 4.0 Cm",,11606,CPT,Facility,Both,,,,530,450.5,151.898,530,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,469.421,88.57,,percent of total billed charges,,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia Over 4.0 Cm",,11606,CPT,Facility,Both,,,,530,450.5,151.898,530,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,151.898,28.66,,percent of total billed charges,,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia Over 4.0 Cm",,11606,CPT,Facility,Outpatient,,,,530,450.5,151.898,530,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),259.7,49,,percent of total billed charges,,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia Over 4.0 Cm",,11606,CPT,Facility,Inpatient,,,,530,450.5,151.898,530,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia Over 4.0 Cm",,11606,CPT,Facility,Both,,,,530,450.5,151.898,530,CorVel,Worker's Compensation,530,100,,percent of total billed charges,,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia Over 4.0 Cm",,11606,CPT,Facility,Both,,,,530,450.5,151.898,530,First Health Group Corporation,First Health Network,514.1,97,,percent of total billed charges,,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia Over 4.0 Cm",,11606,CPT,Facility,Both,,,,530,450.5,151.898,530,"Health Partners, Inc.",Commercial,501.38,94.6,,percent of total billed charges,,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia Over 4.0 Cm",,11606,CPT,Facility,Outpatient,,,,530,450.5,151.898,530,"Health Partners, Inc.",Medicare Advantage,259.7,49,,percent of total billed charges,,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia Over 4.0 Cm",,11606,CPT,Facility,Inpatient,,,,530,450.5,151.898,530,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia Over 4.0 Cm",,11606,CPT,Facility,Both,,,,530,450.5,151.898,530,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),318,60,,percent of total billed charges,,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia Over 4.0 Cm",,11606,CPT,Facility,Both,,,,530,450.5,151.898,530,"Health Partners, Inc.",State of Minnesota Advantage Program,431.95,81.5,,percent of total billed charges,,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia Over 4.0 Cm",,11606,CPT,Facility,Both,,,,530,450.5,151.898,530,"Health Partners, Inc.",State Public Programs,265,50,,percent of total billed charges,,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia Over 4.0 Cm",,11606,CPT,Facility,Both,,,,530,450.5,151.898,530,Humana Insurance Company,Commercial PPO,503.5,95,,percent of total billed charges,,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia Over 4.0 Cm",,11606,CPT,Facility,Outpatient,,,,530,450.5,151.898,530,Humana Insurance Company,Medicare PPO,259.7,49,,percent of total billed charges,,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia Over 4.0 Cm",,11606,CPT,Facility,Inpatient,,,,530,450.5,151.898,530,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia Over 4.0 Cm",,11606,CPT,Facility,Both,,,,530,450.5,151.898,530,Medica,Individual & Family,525.23,99.1,,percent of total billed charges,,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia Over 4.0 Cm",,11606,CPT,Facility,Outpatient,,,,530,450.5,151.898,530,Medica,Medica Advantage Solution,263.94,49.8,,percent of total billed charges,,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia Over 4.0 Cm",,11606,CPT,Facility,Inpatient,,,,530,450.5,151.898,530,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia Over 4.0 Cm",,11606,CPT,Facility,Outpatient,,,,530,450.5,151.898,530,Medica,Medical Assistance,236.38,44.6,,percent of total billed charges,,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia Over 4.0 Cm",,11606,CPT,Facility,Inpatient,,,,530,450.5,151.898,530,Medica,Medical Assistance,,,,,Included in per diem rate,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia Over 4.0 Cm",,11606,CPT,Facility,Outpatient,,,,530,450.5,151.898,530,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,263.94,49.8,,percent of total billed charges,,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia Over 4.0 Cm",,11606,CPT,Facility,Inpatient,,,,530,450.5,151.898,530,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia Over 4.0 Cm",,11606,CPT,Facility,Both,,,,530,450.5,151.898,530,"Multiplan, Inc.","Multiplan, Inc.",498.2,94,,percent of total billed charges,,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia Over 4.0 Cm",,11606,CPT,Facility,Outpatient,,,,530,450.5,151.898,530,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,477.53,90.1,,percent of total billed charges,,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia Over 4.0 Cm",,11606,CPT,Facility,Inpatient,,,,530,450.5,151.898,530,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia Over 4.0 Cm",,11606,CPT,Facility,Both,,,,530,450.5,151.898,530,"Preferred One Administrative Services, INC.",PPO,522.58,98.6,,percent of total billed charges,,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia Over 4.0 Cm",,11606,CPT,Facility,Outpatient,,,,530,450.5,151.898,530,PrimeWest Health,Minnesota Senior Health Options (MSHO),272.685,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia Over 4.0 Cm",,11606,CPT,Facility,Inpatient,,,,530,450.5,151.898,530,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia Over 4.0 Cm",,11606,CPT,Facility,Outpatient,,,,530,450.5,151.898,530,PrimeWest Health,MinnesotaCare,272.208,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia Over 4.0 Cm",,11606,CPT,Facility,Inpatient,,,,530,450.5,151.898,530,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia Over 4.0 Cm",,11606,CPT,Facility,Both,,,,530,450.5,151.898,530,Sanford Health Plan,Sanford Health Plan,487.6,92,,percent of total billed charges,,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia Over 4.0 Cm",,11606,CPT,Facility,Outpatient,,,,530,450.5,151.898,530,"UCare Health, Inc.",Individual & Family Plan,298.655,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia Over 4.0 Cm",,11606,CPT,Facility,Inpatient,,,,530,450.5,151.898,530,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia Over 4.0 Cm",,11606,CPT,Facility,Outpatient,,,,530,450.5,151.898,530,"UCare Health, Inc.",Medical Assistance,267.491,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia Over 4.0 Cm",,11606,CPT,Facility,Inpatient,,,,530,450.5,151.898,530,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia Over 4.0 Cm",,11606,CPT,Facility,Outpatient,,,,530,450.5,151.898,530,"UCare Health, Inc.",Medicare Advantage,267.491,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia Over 4.0 Cm",,11606,CPT,Facility,Inpatient,,,,530,450.5,151.898,530,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia Over 4.0 Cm",,11606,CPT,Facility,Outpatient,,,,530,450.5,151.898,530,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),267.491,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia Over 4.0 Cm",,11606,CPT,Facility,Inpatient,,,,530,450.5,151.898,530,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia Over 4.0 Cm",,11606,CPT,Facility,Both,,,,530,450.5,151.898,530,UnitedHealthcare,Individual & Family,498.2,94,,percent of total billed charges,,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia Over 4.0 Cm",,11606,CPT,Facility,Outpatient,,,,530,450.5,151.898,530,UnitedHealthcare,Medicare Advantage,259.7,49,,percent of total billed charges,,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia Over 4.0 Cm",,11606,CPT,Facility,Inpatient,,,,530,450.5,151.898,530,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia Over 4.0 Cm",,11606,CPT,Facility,Outpatient,,,,530,450.5,151.898,530,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,254.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia Over 4.0 Cm",,11606,CPT,Facility,Inpatient,,,,530,450.5,151.898,530,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia Over 4.0 Cm (Pro Cah)",,11606,CPT,Professional,Both,,,,949,806.65,193.93,949,Aetna,Commercial,806.65,85,,percent of total billed charges,,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia Over 4.0 Cm (Pro Cah)",,11606,CPT,Professional,Both,,,,905,769.25,193.93,905,Aetna,Commercial,769.25,85,,percent of total billed charges,,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia Over 4.0 Cm (Pro Cah)",,11606,CPT,Professional,Both,,,,949,806.65,193.93,949,Aetna,Medicare Advantage,306.01,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia Over 4.0 Cm (Pro Cah)",,11606,CPT,Professional,Both,,,,905,769.25,193.93,905,Aetna,Medicare Advantage,306.01,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia Over 4.0 Cm (Pro Cah)",,11606,CPT,Professional,Both,,,,949,806.65,193.93,949,Aetna,PPO,882.57,93,,percent of total billed charges,,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia Over 4.0 Cm (Pro Cah)",,11606,CPT,Professional,Both,,,,905,769.25,193.93,905,Aetna,PPO,841.65,93,,percent of total billed charges,,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia Over 4.0 Cm (Pro Cah)",,11606,CPT,Professional,Both,,,,949,806.65,193.93,949,America's PPO,America's PPO,810.8256,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia Over 4.0 Cm (Pro Cah)",,11606,CPT,Professional,Both,,,,905,769.25,193.93,905,America's PPO,America's PPO,773.232,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia Over 4.0 Cm (Pro Cah)",,11606,CPT,Professional,Both,,,,949,806.65,193.93,949,BlueCross BlueShield Minnesota, Federal Employee Program,646.6,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia Over 4.0 Cm (Pro Cah)",,11606,CPT,Professional,Both,,,,905,769.25,193.93,905,BlueCross BlueShield Minnesota, Federal Employee Program,646.6,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia Over 4.0 Cm (Pro Cah)",,11606,CPT,Professional,Both,,,,949,806.65,193.93,949,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,656.9456,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia Over 4.0 Cm (Pro Cah)",,11606,CPT,Professional,Both,,,,905,769.25,193.93,905,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,656.9456,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia Over 4.0 Cm (Pro Cah)",,11606,CPT,Professional,Both,,,,949,806.65,193.93,949,BlueCross BlueShield Minnesota,High Value Network Plan,656.9456,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia Over 4.0 Cm (Pro Cah)",,11606,CPT,Professional,Both,,,,905,769.25,193.93,905,BlueCross BlueShield Minnesota,High Value Network Plan,656.9456,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia Over 4.0 Cm (Pro Cah)",,11606,CPT,Professional,Both,,,,949,806.65,193.93,949,BlueCross BlueShield Minnesota,Medicare Advantage,346.748,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia Over 4.0 Cm (Pro Cah)",,11606,CPT,Professional,Both,,,,905,769.25,193.93,905,BlueCross BlueShield Minnesota,Medicare Advantage,346.748,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia Over 4.0 Cm (Pro Cah)",,11606,CPT,Professional,Both,,,,949,806.65,193.93,949,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,656.9456,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia Over 4.0 Cm (Pro Cah)",,11606,CPT,Professional,Both,,,,905,769.25,193.93,905,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,656.9456,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia Over 4.0 Cm (Pro Cah)",,11606,CPT,Professional,Both,,,,949,806.65,193.93,949,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,223.90608,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia Over 4.0 Cm (Pro Cah)",,11606,CPT,Professional,Both,,,,905,769.25,193.93,905,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,223.90608,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia Over 4.0 Cm (Pro Cah)",,11606,CPT,Professional,Both,,,,949,806.65,193.93,949,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),346.748,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia Over 4.0 Cm (Pro Cah)",,11606,CPT,Professional,Both,,,,905,769.25,193.93,905,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),346.748,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia Over 4.0 Cm (Pro Cah)",,11606,CPT,Professional,Both,,,,949,806.65,193.93,949,CorVel,Worker's Compensation,592.540155,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia Over 4.0 Cm (Pro Cah)",,11606,CPT,Professional,Both,,,,905,769.25,193.93,905,CorVel,Worker's Compensation,592.540155,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia Over 4.0 Cm (Pro Cah)",,11606,CPT,Professional,Both,,,,949,806.65,193.93,949,First Health Group Corporation,First Health Network,920.53,97,,percent of total billed charges,,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia Over 4.0 Cm (Pro Cah)",,11606,CPT,Professional,Both,,,,905,769.25,193.93,905,First Health Group Corporation,First Health Network,877.85,97,,percent of total billed charges,,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia Over 4.0 Cm (Pro Cah)",,11606,CPT,Professional,Both,,,,949,806.65,193.93,949,"Health Partners, Inc.",Commercial,639.92,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia Over 4.0 Cm (Pro Cah)",,11606,CPT,Professional,Both,,,,905,769.25,193.93,905,"Health Partners, Inc.",Commercial,639.92,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia Over 4.0 Cm (Pro Cah)",,11606,CPT,Professional,Both,,,,949,806.65,193.93,949,"Health Partners, Inc.",Medicare Advantage,346.748,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia Over 4.0 Cm (Pro Cah)",,11606,CPT,Professional,Both,,,,905,769.25,193.93,905,"Health Partners, Inc.",Medicare Advantage,346.748,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia Over 4.0 Cm (Pro Cah)",,11606,CPT,Professional,Both,,,,949,806.65,193.93,949,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),301.6,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia Over 4.0 Cm (Pro Cah)",,11606,CPT,Professional,Both,,,,905,769.25,193.93,905,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),301.6,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia Over 4.0 Cm (Pro Cah)",,11606,CPT,Professional,Both,,,,949,806.65,193.93,949,"Health Partners, Inc.",State of Minnesota Advantage Program,551.29108,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia Over 4.0 Cm (Pro Cah)",,11606,CPT,Professional,Both,,,,905,769.25,193.93,905,"Health Partners, Inc.",State of Minnesota Advantage Program,551.29108,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia Over 4.0 Cm (Pro Cah)",,11606,CPT,Professional,Both,,,,949,806.65,193.93,949,"Health Partners, Inc.",State Public Programs,193.93,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia Over 4.0 Cm (Pro Cah)",,11606,CPT,Professional,Both,,,,905,769.25,193.93,905,"Health Partners, Inc.",State Public Programs,193.93,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia Over 4.0 Cm (Pro Cah)",,11606,CPT,Professional,Both,,,,949,806.65,193.93,949,Humana Insurance Company,Commercial PPO,301.52,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia Over 4.0 Cm (Pro Cah)",,11606,CPT,Professional,Both,,,,905,769.25,193.93,905,Humana Insurance Company,Commercial PPO,301.52,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia Over 4.0 Cm (Pro Cah)",,11606,CPT,Professional,Both,,,,949,806.65,193.93,949,Humana Insurance Company,Medicare PPO,949,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia Over 4.0 Cm (Pro Cah)",,11606,CPT,Professional,Both,,,,905,769.25,193.93,905,Humana Insurance Company,Medicare PPO,905,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia Over 4.0 Cm (Pro Cah)",,11606,CPT,Professional,Both,,,,949,806.65,193.93,949,Medica,Individual & Family,804.752,84.8,,percent of total billed charges,,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia Over 4.0 Cm (Pro Cah)",,11606,CPT,Professional,Both,,,,905,769.25,193.93,905,Medica,Individual & Family,767.44,84.8,,percent of total billed charges,,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia Over 4.0 Cm (Pro Cah)",,11606,CPT,Professional,Both,,,,949,806.65,193.93,949,Medica,Medica Advantage Solution,472.602,49.8,,percent of total billed charges,,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia Over 4.0 Cm (Pro Cah)",,11606,CPT,Professional,Both,,,,905,769.25,193.93,905,Medica,Medica Advantage Solution,450.69,49.8,,percent of total billed charges,,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia Over 4.0 Cm (Pro Cah)",,11606,CPT,Professional,Both,,,,949,806.65,193.93,949,Medica,Medical Assistance,223.91,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia Over 4.0 Cm (Pro Cah)",,11606,CPT,Professional,Both,,,,905,769.25,193.93,905,Medica,Medical Assistance,223.91,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia Over 4.0 Cm (Pro Cah)",,11606,CPT,Professional,Both,,,,949,806.65,193.93,949,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,301.52,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia Over 4.0 Cm (Pro Cah)",,11606,CPT,Professional,Both,,,,905,769.25,193.93,905,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,301.52,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia Over 4.0 Cm (Pro Cah)",,11606,CPT,Professional,Both,,,,949,806.65,193.93,949,"Multiplan, Inc.","Multiplan, Inc.",892.06,94,,percent of total billed charges,,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia Over 4.0 Cm (Pro Cah)",,11606,CPT,Professional,Both,,,,905,769.25,193.93,905,"Multiplan, Inc.","Multiplan, Inc.",850.7,94,,percent of total billed charges,,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia Over 4.0 Cm (Pro Cah)",,11606,CPT,Professional,Both,,,,949,806.65,193.93,949,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,855.049,90.1,,percent of total billed charges,,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia Over 4.0 Cm (Pro Cah)",,11606,CPT,Professional,Both,,,,905,769.25,193.93,905,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,815.405,90.1,,percent of total billed charges,,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia Over 4.0 Cm (Pro Cah)",,11606,CPT,Professional,Both,,,,949,806.65,193.93,949,"Preferred One Administrative Services, INC.",PPO,935.714,98.6,,percent of total billed charges,,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia Over 4.0 Cm (Pro Cah)",,11606,CPT,Professional,Both,,,,905,769.25,193.93,905,"Preferred One Administrative Services, INC.",PPO,892.33,98.6,,percent of total billed charges,,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia Over 4.0 Cm (Pro Cah)",,11606,CPT,Professional,Both,,,,949,806.65,193.93,949,PrimeWest Health,Minnesota Senior Health Options (MSHO),346.748,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia Over 4.0 Cm (Pro Cah)",,11606,CPT,Professional,Both,,,,905,769.25,193.93,905,PrimeWest Health,Minnesota Senior Health Options (MSHO),346.748,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia Over 4.0 Cm (Pro Cah)",,11606,CPT,Professional,Both,,,,949,806.65,193.93,949,PrimeWest Health,MinnesotaCare,239.5795056,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia Over 4.0 Cm (Pro Cah)",,11606,CPT,Professional,Both,,,,905,769.25,193.93,905,PrimeWest Health,MinnesotaCare,239.5795056,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia Over 4.0 Cm (Pro Cah)",,11606,CPT,Professional,Both,,,,949,806.65,193.93,949,Sanford Health Plan,Sanford Health Plan,835.12,88,,percent of total billed charges,,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia Over 4.0 Cm (Pro Cah)",,11606,CPT,Professional,Both,,,,905,769.25,193.93,905,Sanford Health Plan,Sanford Health Plan,796.4,88,,percent of total billed charges,,
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia Over 4.0 Cm (Pro Cah)",,11606,CPT,Professional,Both,,,,949,806.65,193.93,949,"UCare Health, Inc.",Individual & Family Plan,490.150912,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia Over 4.0 Cm (Pro Cah)",,11606,CPT,Professional,Both,,,,905,769.25,193.93,905,"UCare Health, Inc.",Individual & Family Plan,490.150912,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia Over 4.0 Cm (Pro Cah)",,11606,CPT,Professional,Both,,,,949,806.65,193.93,949,"UCare Health, Inc.",Medical Assistance,246.296688,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia Over 4.0 Cm (Pro Cah)",,11606,CPT,Professional,Both,,,,905,769.25,193.93,905,"UCare Health, Inc.",Medical Assistance,246.296688,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia Over 4.0 Cm (Pro Cah)",,11606,CPT,Professional,Both,,,,949,806.65,193.93,949,"UCare Health, Inc.",Medicare Advantage,346.748,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia Over 4.0 Cm (Pro Cah)",,11606,CPT,Professional,Both,,,,905,769.25,193.93,905,"UCare Health, Inc.",Medicare Advantage,346.748,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia Over 4.0 Cm (Pro Cah)",,11606,CPT,Professional,Both,,,,949,806.65,193.93,949,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),277.3984,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia Over 4.0 Cm (Pro Cah)",,11606,CPT,Professional,Both,,,,905,769.25,193.93,905,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),277.3984,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia Over 4.0 Cm (Pro Cah)",,11606,CPT,Professional,Both,,,,949,806.65,193.93,949,UnitedHealthcare,Individual & Family,949,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia Over 4.0 Cm (Pro Cah)",,11606,CPT,Professional,Both,,,,905,769.25,193.93,905,UnitedHealthcare,Individual & Family,905,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia Over 4.0 Cm (Pro Cah)",,11606,CPT,Professional,Both,,,,949,806.65,193.93,949,UnitedHealthcare,Medicare Advantage,346.748,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia Over 4.0 Cm (Pro Cah)",,11606,CPT,Professional,Both,,,,905,769.25,193.93,905,UnitedHealthcare,Medicare Advantage,346.748,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia Over 4.0 Cm (Pro Cah)",,11606,CPT,Professional,Both,,,,949,806.65,193.93,949,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,223.90608,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Exc Dia Over 4.0 Cm (Pro Cah)",,11606,CPT,Professional,Both,,,,905,769.25,193.93,905,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,223.90608,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision, Malignant Lesion Inc Margins,Scalp,Nk,Hds,Ft,Genitalia;Exc Dia 0.5 Cm Or <",,11620,CPT,Facility,Both,,,,230,195.5,65.918,230,Aetna,Commercial,211.6,92,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins,Scalp,Nk,Hds,Ft,Genitalia;Exc Dia 0.5 Cm Or <",,11620,CPT,Facility,Outpatient,,,,230,195.5,65.918,230,Aetna,Medicare Advantage,112.7,49,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins,Scalp,Nk,Hds,Ft,Genitalia;Exc Dia 0.5 Cm Or <",,11620,CPT,Facility,Inpatient,,,,230,195.5,65.918,230,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Excision, Malignant Lesion Inc Margins,Scalp,Nk,Hds,Ft,Genitalia;Exc Dia 0.5 Cm Or <",,11620,CPT,Facility,Both,,,,230,195.5,65.918,230,Aetna,PPO,213.9,93,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins,Scalp,Nk,Hds,Ft,Genitalia;Exc Dia 0.5 Cm Or <",,11620,CPT,Facility,Both,,,,230,195.5,65.918,230,America's PPO,America's PPO,220.869,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Excision, Malignant Lesion Inc Margins,Scalp,Nk,Hds,Ft,Genitalia;Exc Dia 0.5 Cm Or <",,11620,CPT,Facility,Both,,,,230,195.5,65.918,230,BlueCross BlueShield Minnesota, Federal Employee Program,226.32,98.4,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins,Scalp,Nk,Hds,Ft,Genitalia;Exc Dia 0.5 Cm Or <",,11620,CPT,Facility,Both,,,,230,195.5,65.918,230,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,230,100,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins,Scalp,Nk,Hds,Ft,Genitalia;Exc Dia 0.5 Cm Or <",,11620,CPT,Facility,Both,,,,230,195.5,65.918,230,BlueCross BlueShield Minnesota,High Value Network Plan,207,90,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins,Scalp,Nk,Hds,Ft,Genitalia;Exc Dia 0.5 Cm Or <",,11620,CPT,Facility,Outpatient,,,,230,195.5,65.918,230,BlueCross BlueShield Minnesota,Medicare Advantage,112.7,49,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins,Scalp,Nk,Hds,Ft,Genitalia;Exc Dia 0.5 Cm Or <",,11620,CPT,Facility,Inpatient,,,,230,195.5,65.918,230,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Excision, Malignant Lesion Inc Margins,Scalp,Nk,Hds,Ft,Genitalia;Exc Dia 0.5 Cm Or <",,11620,CPT,Facility,Both,,,,230,195.5,65.918,230,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,203.711,88.57,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins,Scalp,Nk,Hds,Ft,Genitalia;Exc Dia 0.5 Cm Or <",,11620,CPT,Facility,Both,,,,230,195.5,65.918,230,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,65.918,28.66,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins,Scalp,Nk,Hds,Ft,Genitalia;Exc Dia 0.5 Cm Or <",,11620,CPT,Facility,Outpatient,,,,230,195.5,65.918,230,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),112.7,49,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins,Scalp,Nk,Hds,Ft,Genitalia;Exc Dia 0.5 Cm Or <",,11620,CPT,Facility,Inpatient,,,,230,195.5,65.918,230,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Excision, Malignant Lesion Inc Margins,Scalp,Nk,Hds,Ft,Genitalia;Exc Dia 0.5 Cm Or <",,11620,CPT,Facility,Both,,,,230,195.5,65.918,230,CorVel,Worker's Compensation,230,100,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins,Scalp,Nk,Hds,Ft,Genitalia;Exc Dia 0.5 Cm Or <",,11620,CPT,Facility,Both,,,,230,195.5,65.918,230,First Health Group Corporation,First Health Network,223.1,97,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins,Scalp,Nk,Hds,Ft,Genitalia;Exc Dia 0.5 Cm Or <",,11620,CPT,Facility,Both,,,,230,195.5,65.918,230,"Health Partners, Inc.",Commercial,217.58,94.6,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins,Scalp,Nk,Hds,Ft,Genitalia;Exc Dia 0.5 Cm Or <",,11620,CPT,Facility,Outpatient,,,,230,195.5,65.918,230,"Health Partners, Inc.",Medicare Advantage,112.7,49,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins,Scalp,Nk,Hds,Ft,Genitalia;Exc Dia 0.5 Cm Or <",,11620,CPT,Facility,Inpatient,,,,230,195.5,65.918,230,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Excision, Malignant Lesion Inc Margins,Scalp,Nk,Hds,Ft,Genitalia;Exc Dia 0.5 Cm Or <",,11620,CPT,Facility,Both,,,,230,195.5,65.918,230,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),138,60,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins,Scalp,Nk,Hds,Ft,Genitalia;Exc Dia 0.5 Cm Or <",,11620,CPT,Facility,Both,,,,230,195.5,65.918,230,"Health Partners, Inc.",State of Minnesota Advantage Program,187.45,81.5,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins,Scalp,Nk,Hds,Ft,Genitalia;Exc Dia 0.5 Cm Or <",,11620,CPT,Facility,Both,,,,230,195.5,65.918,230,"Health Partners, Inc.",State Public Programs,115,50,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins,Scalp,Nk,Hds,Ft,Genitalia;Exc Dia 0.5 Cm Or <",,11620,CPT,Facility,Both,,,,230,195.5,65.918,230,Humana Insurance Company,Commercial PPO,218.5,95,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins,Scalp,Nk,Hds,Ft,Genitalia;Exc Dia 0.5 Cm Or <",,11620,CPT,Facility,Outpatient,,,,230,195.5,65.918,230,Humana Insurance Company,Medicare PPO,112.7,49,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins,Scalp,Nk,Hds,Ft,Genitalia;Exc Dia 0.5 Cm Or <",,11620,CPT,Facility,Inpatient,,,,230,195.5,65.918,230,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Excision, Malignant Lesion Inc Margins,Scalp,Nk,Hds,Ft,Genitalia;Exc Dia 0.5 Cm Or <",,11620,CPT,Facility,Both,,,,230,195.5,65.918,230,Medica,Individual & Family,227.93,99.1,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins,Scalp,Nk,Hds,Ft,Genitalia;Exc Dia 0.5 Cm Or <",,11620,CPT,Facility,Outpatient,,,,230,195.5,65.918,230,Medica,Medica Advantage Solution,114.54,49.8,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins,Scalp,Nk,Hds,Ft,Genitalia;Exc Dia 0.5 Cm Or <",,11620,CPT,Facility,Inpatient,,,,230,195.5,65.918,230,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Excision, Malignant Lesion Inc Margins,Scalp,Nk,Hds,Ft,Genitalia;Exc Dia 0.5 Cm Or <",,11620,CPT,Facility,Outpatient,,,,230,195.5,65.918,230,Medica,Medical Assistance,102.58,44.6,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins,Scalp,Nk,Hds,Ft,Genitalia;Exc Dia 0.5 Cm Or <",,11620,CPT,Facility,Inpatient,,,,230,195.5,65.918,230,Medica,Medical Assistance,,,,,Included in per diem rate,
"Excision, Malignant Lesion Inc Margins,Scalp,Nk,Hds,Ft,Genitalia;Exc Dia 0.5 Cm Or <",,11620,CPT,Facility,Outpatient,,,,230,195.5,65.918,230,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,114.54,49.8,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins,Scalp,Nk,Hds,Ft,Genitalia;Exc Dia 0.5 Cm Or <",,11620,CPT,Facility,Inpatient,,,,230,195.5,65.918,230,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Excision, Malignant Lesion Inc Margins,Scalp,Nk,Hds,Ft,Genitalia;Exc Dia 0.5 Cm Or <",,11620,CPT,Facility,Both,,,,230,195.5,65.918,230,"Multiplan, Inc.","Multiplan, Inc.",216.2,94,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins,Scalp,Nk,Hds,Ft,Genitalia;Exc Dia 0.5 Cm Or <",,11620,CPT,Facility,Outpatient,,,,230,195.5,65.918,230,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,207.23,90.1,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins,Scalp,Nk,Hds,Ft,Genitalia;Exc Dia 0.5 Cm Or <",,11620,CPT,Facility,Inpatient,,,,230,195.5,65.918,230,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Excision, Malignant Lesion Inc Margins,Scalp,Nk,Hds,Ft,Genitalia;Exc Dia 0.5 Cm Or <",,11620,CPT,Facility,Both,,,,230,195.5,65.918,230,"Preferred One Administrative Services, INC.",PPO,226.78,98.6,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins,Scalp,Nk,Hds,Ft,Genitalia;Exc Dia 0.5 Cm Or <",,11620,CPT,Facility,Outpatient,,,,230,195.5,65.918,230,PrimeWest Health,Minnesota Senior Health Options (MSHO),118.335,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Excision, Malignant Lesion Inc Margins,Scalp,Nk,Hds,Ft,Genitalia;Exc Dia 0.5 Cm Or <",,11620,CPT,Facility,Inpatient,,,,230,195.5,65.918,230,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Excision, Malignant Lesion Inc Margins,Scalp,Nk,Hds,Ft,Genitalia;Exc Dia 0.5 Cm Or <",,11620,CPT,Facility,Outpatient,,,,230,195.5,65.918,230,PrimeWest Health,MinnesotaCare,118.128,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Excision, Malignant Lesion Inc Margins,Scalp,Nk,Hds,Ft,Genitalia;Exc Dia 0.5 Cm Or <",,11620,CPT,Facility,Inpatient,,,,230,195.5,65.918,230,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Excision, Malignant Lesion Inc Margins,Scalp,Nk,Hds,Ft,Genitalia;Exc Dia 0.5 Cm Or <",,11620,CPT,Facility,Both,,,,230,195.5,65.918,230,Sanford Health Plan,Sanford Health Plan,211.6,92,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins,Scalp,Nk,Hds,Ft,Genitalia;Exc Dia 0.5 Cm Or <",,11620,CPT,Facility,Outpatient,,,,230,195.5,65.918,230,"UCare Health, Inc.",Individual & Family Plan,129.605,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Excision, Malignant Lesion Inc Margins,Scalp,Nk,Hds,Ft,Genitalia;Exc Dia 0.5 Cm Or <",,11620,CPT,Facility,Inpatient,,,,230,195.5,65.918,230,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Excision, Malignant Lesion Inc Margins,Scalp,Nk,Hds,Ft,Genitalia;Exc Dia 0.5 Cm Or <",,11620,CPT,Facility,Outpatient,,,,230,195.5,65.918,230,"UCare Health, Inc.",Medical Assistance,116.081,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Excision, Malignant Lesion Inc Margins,Scalp,Nk,Hds,Ft,Genitalia;Exc Dia 0.5 Cm Or <",,11620,CPT,Facility,Inpatient,,,,230,195.5,65.918,230,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Excision, Malignant Lesion Inc Margins,Scalp,Nk,Hds,Ft,Genitalia;Exc Dia 0.5 Cm Or <",,11620,CPT,Facility,Outpatient,,,,230,195.5,65.918,230,"UCare Health, Inc.",Medicare Advantage,116.081,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Excision, Malignant Lesion Inc Margins,Scalp,Nk,Hds,Ft,Genitalia;Exc Dia 0.5 Cm Or <",,11620,CPT,Facility,Inpatient,,,,230,195.5,65.918,230,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Excision, Malignant Lesion Inc Margins,Scalp,Nk,Hds,Ft,Genitalia;Exc Dia 0.5 Cm Or <",,11620,CPT,Facility,Outpatient,,,,230,195.5,65.918,230,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),116.081,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Excision, Malignant Lesion Inc Margins,Scalp,Nk,Hds,Ft,Genitalia;Exc Dia 0.5 Cm Or <",,11620,CPT,Facility,Inpatient,,,,230,195.5,65.918,230,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Excision, Malignant Lesion Inc Margins,Scalp,Nk,Hds,Ft,Genitalia;Exc Dia 0.5 Cm Or <",,11620,CPT,Facility,Both,,,,230,195.5,65.918,230,UnitedHealthcare,Individual & Family,216.2,94,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins,Scalp,Nk,Hds,Ft,Genitalia;Exc Dia 0.5 Cm Or <",,11620,CPT,Facility,Outpatient,,,,230,195.5,65.918,230,UnitedHealthcare,Medicare Advantage,112.7,49,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins,Scalp,Nk,Hds,Ft,Genitalia;Exc Dia 0.5 Cm Or <",,11620,CPT,Facility,Inpatient,,,,230,195.5,65.918,230,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Excision, Malignant Lesion Inc Margins,Scalp,Nk,Hds,Ft,Genitalia;Exc Dia 0.5 Cm Or <",,11620,CPT,Facility,Outpatient,,,,230,195.5,65.918,230,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,110.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Excision, Malignant Lesion Inc Margins,Scalp,Nk,Hds,Ft,Genitalia;Exc Dia 0.5 Cm Or <",,11620,CPT,Facility,Inpatient,,,,230,195.5,65.918,230,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Excision, Malignant Lesion Inc Margins,Scalp,Nk,Hds,Ft,Genitalia;Exc Dia 0.5 Cm Or < (Pro Cah)",,11620,CPT,Professional,Both,,,,443,376.55,77.22,443,Aetna,Commercial,376.55,85,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins,Scalp,Nk,Hds,Ft,Genitalia;Exc Dia 0.5 Cm Or < (Pro Cah)",,11620,CPT,Professional,Both,,,,390,331.5,77.22,390,Aetna,Commercial,331.5,85,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins,Scalp,Nk,Hds,Ft,Genitalia;Exc Dia 0.5 Cm Or < (Pro Cah)",,11620,CPT,Professional,Both,,,,443,376.55,77.22,443,Aetna,Medicare Advantage,120.96,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion Inc Margins,Scalp,Nk,Hds,Ft,Genitalia;Exc Dia 0.5 Cm Or < (Pro Cah)",,11620,CPT,Professional,Both,,,,390,331.5,77.22,390,Aetna,Medicare Advantage,120.96,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion Inc Margins,Scalp,Nk,Hds,Ft,Genitalia;Exc Dia 0.5 Cm Or < (Pro Cah)",,11620,CPT,Professional,Both,,,,443,376.55,77.22,443,Aetna,PPO,411.99,93,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins,Scalp,Nk,Hds,Ft,Genitalia;Exc Dia 0.5 Cm Or < (Pro Cah)",,11620,CPT,Professional,Both,,,,390,331.5,77.22,390,Aetna,PPO,362.7,93,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins,Scalp,Nk,Hds,Ft,Genitalia;Exc Dia 0.5 Cm Or < (Pro Cah)",,11620,CPT,Professional,Both,,,,443,376.55,77.22,443,America's PPO,America's PPO,378.4992,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Excision, Malignant Lesion Inc Margins,Scalp,Nk,Hds,Ft,Genitalia;Exc Dia 0.5 Cm Or < (Pro Cah)",,11620,CPT,Professional,Both,,,,390,331.5,77.22,390,America's PPO,America's PPO,333.216,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Excision, Malignant Lesion Inc Margins,Scalp,Nk,Hds,Ft,Genitalia;Exc Dia 0.5 Cm Or < (Pro Cah)",,11620,CPT,Professional,Both,,,,443,376.55,77.22,443,BlueCross BlueShield Minnesota, Federal Employee Program,252.03,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Excision, Malignant Lesion Inc Margins,Scalp,Nk,Hds,Ft,Genitalia;Exc Dia 0.5 Cm Or < (Pro Cah)",,11620,CPT,Professional,Both,,,,390,331.5,77.22,390,BlueCross BlueShield Minnesota, Federal Employee Program,252.03,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Excision, Malignant Lesion Inc Margins,Scalp,Nk,Hds,Ft,Genitalia;Exc Dia 0.5 Cm Or < (Pro Cah)",,11620,CPT,Professional,Both,,,,443,376.55,77.22,443,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,256.06248,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Malignant Lesion Inc Margins,Scalp,Nk,Hds,Ft,Genitalia;Exc Dia 0.5 Cm Or < (Pro Cah)",,11620,CPT,Professional,Both,,,,390,331.5,77.22,390,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,256.06248,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Malignant Lesion Inc Margins,Scalp,Nk,Hds,Ft,Genitalia;Exc Dia 0.5 Cm Or < (Pro Cah)",,11620,CPT,Professional,Both,,,,443,376.55,77.22,443,BlueCross BlueShield Minnesota,High Value Network Plan,256.06248,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Malignant Lesion Inc Margins,Scalp,Nk,Hds,Ft,Genitalia;Exc Dia 0.5 Cm Or < (Pro Cah)",,11620,CPT,Professional,Both,,,,390,331.5,77.22,390,BlueCross BlueShield Minnesota,High Value Network Plan,256.06248,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Malignant Lesion Inc Margins,Scalp,Nk,Hds,Ft,Genitalia;Exc Dia 0.5 Cm Or < (Pro Cah)",,11620,CPT,Professional,Both,,,,443,376.55,77.22,443,BlueCross BlueShield Minnesota,Medicare Advantage,138.184,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion Inc Margins,Scalp,Nk,Hds,Ft,Genitalia;Exc Dia 0.5 Cm Or < (Pro Cah)",,11620,CPT,Professional,Both,,,,390,331.5,77.22,390,BlueCross BlueShield Minnesota,Medicare Advantage,138.184,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion Inc Margins,Scalp,Nk,Hds,Ft,Genitalia;Exc Dia 0.5 Cm Or < (Pro Cah)",,11620,CPT,Professional,Both,,,,443,376.55,77.22,443,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,256.06248,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Malignant Lesion Inc Margins,Scalp,Nk,Hds,Ft,Genitalia;Exc Dia 0.5 Cm Or < (Pro Cah)",,11620,CPT,Professional,Both,,,,390,331.5,77.22,390,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,256.06248,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Malignant Lesion Inc Margins,Scalp,Nk,Hds,Ft,Genitalia;Exc Dia 0.5 Cm Or < (Pro Cah)",,11620,CPT,Professional,Both,,,,443,376.55,77.22,443,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,89.154,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision, Malignant Lesion Inc Margins,Scalp,Nk,Hds,Ft,Genitalia;Exc Dia 0.5 Cm Or < (Pro Cah)",,11620,CPT,Professional,Both,,,,390,331.5,77.22,390,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,89.154,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision, Malignant Lesion Inc Margins,Scalp,Nk,Hds,Ft,Genitalia;Exc Dia 0.5 Cm Or < (Pro Cah)",,11620,CPT,Professional,Both,,,,443,376.55,77.22,443,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),138.184,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion Inc Margins,Scalp,Nk,Hds,Ft,Genitalia;Exc Dia 0.5 Cm Or < (Pro Cah)",,11620,CPT,Professional,Both,,,,390,331.5,77.22,390,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),138.184,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion Inc Margins,Scalp,Nk,Hds,Ft,Genitalia;Exc Dia 0.5 Cm Or < (Pro Cah)",,11620,CPT,Professional,Both,,,,443,376.55,77.22,443,CorVel,Worker's Compensation,234.2137296,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Excision, Malignant Lesion Inc Margins,Scalp,Nk,Hds,Ft,Genitalia;Exc Dia 0.5 Cm Or < (Pro Cah)",,11620,CPT,Professional,Both,,,,390,331.5,77.22,390,CorVel,Worker's Compensation,234.2137296,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Excision, Malignant Lesion Inc Margins,Scalp,Nk,Hds,Ft,Genitalia;Exc Dia 0.5 Cm Or < (Pro Cah)",,11620,CPT,Professional,Both,,,,443,376.55,77.22,443,First Health Group Corporation,First Health Network,429.71,97,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins,Scalp,Nk,Hds,Ft,Genitalia;Exc Dia 0.5 Cm Or < (Pro Cah)",,11620,CPT,Professional,Both,,,,390,331.5,77.22,390,First Health Group Corporation,First Health Network,378.3,97,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins,Scalp,Nk,Hds,Ft,Genitalia;Exc Dia 0.5 Cm Or < (Pro Cah)",,11620,CPT,Professional,Both,,,,443,376.55,77.22,443,"Health Partners, Inc.",Commercial,252.49,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision, Malignant Lesion Inc Margins,Scalp,Nk,Hds,Ft,Genitalia;Exc Dia 0.5 Cm Or < (Pro Cah)",,11620,CPT,Professional,Both,,,,390,331.5,77.22,390,"Health Partners, Inc.",Commercial,252.49,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision, Malignant Lesion Inc Margins,Scalp,Nk,Hds,Ft,Genitalia;Exc Dia 0.5 Cm Or < (Pro Cah)",,11620,CPT,Professional,Both,,,,443,376.55,77.22,443,"Health Partners, Inc.",Medicare Advantage,138.184,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion Inc Margins,Scalp,Nk,Hds,Ft,Genitalia;Exc Dia 0.5 Cm Or < (Pro Cah)",,11620,CPT,Professional,Both,,,,390,331.5,77.22,390,"Health Partners, Inc.",Medicare Advantage,138.184,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion Inc Margins,Scalp,Nk,Hds,Ft,Genitalia;Exc Dia 0.5 Cm Or < (Pro Cah)",,11620,CPT,Professional,Both,,,,443,376.55,77.22,443,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),119.96,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Excision, Malignant Lesion Inc Margins,Scalp,Nk,Hds,Ft,Genitalia;Exc Dia 0.5 Cm Or < (Pro Cah)",,11620,CPT,Professional,Both,,,,390,331.5,77.22,390,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),119.96,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Excision, Malignant Lesion Inc Margins,Scalp,Nk,Hds,Ft,Genitalia;Exc Dia 0.5 Cm Or < (Pro Cah)",,11620,CPT,Professional,Both,,,,443,376.55,77.22,443,"Health Partners, Inc.",State of Minnesota Advantage Program,217.520135,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision, Malignant Lesion Inc Margins,Scalp,Nk,Hds,Ft,Genitalia;Exc Dia 0.5 Cm Or < (Pro Cah)",,11620,CPT,Professional,Both,,,,390,331.5,77.22,390,"Health Partners, Inc.",State of Minnesota Advantage Program,217.520135,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision, Malignant Lesion Inc Margins,Scalp,Nk,Hds,Ft,Genitalia;Exc Dia 0.5 Cm Or < (Pro Cah)",,11620,CPT,Professional,Both,,,,443,376.55,77.22,443,"Health Partners, Inc.",State Public Programs,77.22,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Excision, Malignant Lesion Inc Margins,Scalp,Nk,Hds,Ft,Genitalia;Exc Dia 0.5 Cm Or < (Pro Cah)",,11620,CPT,Professional,Both,,,,390,331.5,77.22,390,"Health Partners, Inc.",State Public Programs,77.22,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Excision, Malignant Lesion Inc Margins,Scalp,Nk,Hds,Ft,Genitalia;Exc Dia 0.5 Cm Or < (Pro Cah)",,11620,CPT,Professional,Both,,,,443,376.55,77.22,443,Humana Insurance Company,Commercial PPO,120.16,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Excision, Malignant Lesion Inc Margins,Scalp,Nk,Hds,Ft,Genitalia;Exc Dia 0.5 Cm Or < (Pro Cah)",,11620,CPT,Professional,Both,,,,390,331.5,77.22,390,Humana Insurance Company,Commercial PPO,120.16,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Excision, Malignant Lesion Inc Margins,Scalp,Nk,Hds,Ft,Genitalia;Exc Dia 0.5 Cm Or < (Pro Cah)",,11620,CPT,Professional,Both,,,,443,376.55,77.22,443,Humana Insurance Company,Medicare PPO,443,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion Inc Margins,Scalp,Nk,Hds,Ft,Genitalia;Exc Dia 0.5 Cm Or < (Pro Cah)",,11620,CPT,Professional,Both,,,,390,331.5,77.22,390,Humana Insurance Company,Medicare PPO,390,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion Inc Margins,Scalp,Nk,Hds,Ft,Genitalia;Exc Dia 0.5 Cm Or < (Pro Cah)",,11620,CPT,Professional,Both,,,,443,376.55,77.22,443,Medica,Individual & Family,375.664,84.8,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins,Scalp,Nk,Hds,Ft,Genitalia;Exc Dia 0.5 Cm Or < (Pro Cah)",,11620,CPT,Professional,Both,,,,390,331.5,77.22,390,Medica,Individual & Family,330.72,84.8,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins,Scalp,Nk,Hds,Ft,Genitalia;Exc Dia 0.5 Cm Or < (Pro Cah)",,11620,CPT,Professional,Both,,,,443,376.55,77.22,443,Medica,Medica Advantage Solution,220.614,49.8,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins,Scalp,Nk,Hds,Ft,Genitalia;Exc Dia 0.5 Cm Or < (Pro Cah)",,11620,CPT,Professional,Both,,,,390,331.5,77.22,390,Medica,Medica Advantage Solution,194.22,49.8,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins,Scalp,Nk,Hds,Ft,Genitalia;Exc Dia 0.5 Cm Or < (Pro Cah)",,11620,CPT,Professional,Both,,,,443,376.55,77.22,443,Medica,Medical Assistance,89.15,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Excision, Malignant Lesion Inc Margins,Scalp,Nk,Hds,Ft,Genitalia;Exc Dia 0.5 Cm Or < (Pro Cah)",,11620,CPT,Professional,Both,,,,390,331.5,77.22,390,Medica,Medical Assistance,89.15,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Excision, Malignant Lesion Inc Margins,Scalp,Nk,Hds,Ft,Genitalia;Exc Dia 0.5 Cm Or < (Pro Cah)",,11620,CPT,Professional,Both,,,,443,376.55,77.22,443,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,120.16,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Excision, Malignant Lesion Inc Margins,Scalp,Nk,Hds,Ft,Genitalia;Exc Dia 0.5 Cm Or < (Pro Cah)",,11620,CPT,Professional,Both,,,,390,331.5,77.22,390,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,120.16,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Excision, Malignant Lesion Inc Margins,Scalp,Nk,Hds,Ft,Genitalia;Exc Dia 0.5 Cm Or < (Pro Cah)",,11620,CPT,Professional,Both,,,,443,376.55,77.22,443,"Multiplan, Inc.","Multiplan, Inc.",416.42,94,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins,Scalp,Nk,Hds,Ft,Genitalia;Exc Dia 0.5 Cm Or < (Pro Cah)",,11620,CPT,Professional,Both,,,,390,331.5,77.22,390,"Multiplan, Inc.","Multiplan, Inc.",366.6,94,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins,Scalp,Nk,Hds,Ft,Genitalia;Exc Dia 0.5 Cm Or < (Pro Cah)",,11620,CPT,Professional,Both,,,,443,376.55,77.22,443,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,399.143,90.1,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins,Scalp,Nk,Hds,Ft,Genitalia;Exc Dia 0.5 Cm Or < (Pro Cah)",,11620,CPT,Professional,Both,,,,390,331.5,77.22,390,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,351.39,90.1,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins,Scalp,Nk,Hds,Ft,Genitalia;Exc Dia 0.5 Cm Or < (Pro Cah)",,11620,CPT,Professional,Both,,,,443,376.55,77.22,443,"Preferred One Administrative Services, INC.",PPO,436.798,98.6,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins,Scalp,Nk,Hds,Ft,Genitalia;Exc Dia 0.5 Cm Or < (Pro Cah)",,11620,CPT,Professional,Both,,,,390,331.5,77.22,390,"Preferred One Administrative Services, INC.",PPO,384.54,98.6,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins,Scalp,Nk,Hds,Ft,Genitalia;Exc Dia 0.5 Cm Or < (Pro Cah)",,11620,CPT,Professional,Both,,,,443,376.55,77.22,443,PrimeWest Health,Minnesota Senior Health Options (MSHO),138.184,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion Inc Margins,Scalp,Nk,Hds,Ft,Genitalia;Exc Dia 0.5 Cm Or < (Pro Cah)",,11620,CPT,Professional,Both,,,,390,331.5,77.22,390,PrimeWest Health,Minnesota Senior Health Options (MSHO),138.184,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion Inc Margins,Scalp,Nk,Hds,Ft,Genitalia;Exc Dia 0.5 Cm Or < (Pro Cah)",,11620,CPT,Professional,Both,,,,443,376.55,77.22,443,PrimeWest Health,MinnesotaCare,95.39478,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision, Malignant Lesion Inc Margins,Scalp,Nk,Hds,Ft,Genitalia;Exc Dia 0.5 Cm Or < (Pro Cah)",,11620,CPT,Professional,Both,,,,390,331.5,77.22,390,PrimeWest Health,MinnesotaCare,95.39478,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision, Malignant Lesion Inc Margins,Scalp,Nk,Hds,Ft,Genitalia;Exc Dia 0.5 Cm Or < (Pro Cah)",,11620,CPT,Professional,Both,,,,443,376.55,77.22,443,Sanford Health Plan,Sanford Health Plan,389.84,88,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins,Scalp,Nk,Hds,Ft,Genitalia;Exc Dia 0.5 Cm Or < (Pro Cah)",,11620,CPT,Professional,Both,,,,390,331.5,77.22,390,Sanford Health Plan,Sanford Health Plan,343.2,88,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins,Scalp,Nk,Hds,Ft,Genitalia;Exc Dia 0.5 Cm Or < (Pro Cah)",,11620,CPT,Professional,Both,,,,443,376.55,77.22,443,"UCare Health, Inc.",Individual & Family Plan,195.332096,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Excision, Malignant Lesion Inc Margins,Scalp,Nk,Hds,Ft,Genitalia;Exc Dia 0.5 Cm Or < (Pro Cah)",,11620,CPT,Professional,Both,,,,390,331.5,77.22,390,"UCare Health, Inc.",Individual & Family Plan,195.332096,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Excision, Malignant Lesion Inc Margins,Scalp,Nk,Hds,Ft,Genitalia;Exc Dia 0.5 Cm Or < (Pro Cah)",,11620,CPT,Professional,Both,,,,443,376.55,77.22,443,"UCare Health, Inc.",Medical Assistance,98.0694,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Excision, Malignant Lesion Inc Margins,Scalp,Nk,Hds,Ft,Genitalia;Exc Dia 0.5 Cm Or < (Pro Cah)",,11620,CPT,Professional,Both,,,,390,331.5,77.22,390,"UCare Health, Inc.",Medical Assistance,98.0694,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Excision, Malignant Lesion Inc Margins,Scalp,Nk,Hds,Ft,Genitalia;Exc Dia 0.5 Cm Or < (Pro Cah)",,11620,CPT,Professional,Both,,,,443,376.55,77.22,443,"UCare Health, Inc.",Medicare Advantage,138.184,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Excision, Malignant Lesion Inc Margins,Scalp,Nk,Hds,Ft,Genitalia;Exc Dia 0.5 Cm Or < (Pro Cah)",,11620,CPT,Professional,Both,,,,390,331.5,77.22,390,"UCare Health, Inc.",Medicare Advantage,138.184,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Excision, Malignant Lesion Inc Margins,Scalp,Nk,Hds,Ft,Genitalia;Exc Dia 0.5 Cm Or < (Pro Cah)",,11620,CPT,Professional,Both,,,,443,376.55,77.22,443,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),110.5472,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Excision, Malignant Lesion Inc Margins,Scalp,Nk,Hds,Ft,Genitalia;Exc Dia 0.5 Cm Or < (Pro Cah)",,11620,CPT,Professional,Both,,,,390,331.5,77.22,390,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),110.5472,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Excision, Malignant Lesion Inc Margins,Scalp,Nk,Hds,Ft,Genitalia;Exc Dia 0.5 Cm Or < (Pro Cah)",,11620,CPT,Professional,Both,,,,443,376.55,77.22,443,UnitedHealthcare,Individual & Family,443,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Excision, Malignant Lesion Inc Margins,Scalp,Nk,Hds,Ft,Genitalia;Exc Dia 0.5 Cm Or < (Pro Cah)",,11620,CPT,Professional,Both,,,,390,331.5,77.22,390,UnitedHealthcare,Individual & Family,390,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Excision, Malignant Lesion Inc Margins,Scalp,Nk,Hds,Ft,Genitalia;Exc Dia 0.5 Cm Or < (Pro Cah)",,11620,CPT,Professional,Both,,,,443,376.55,77.22,443,UnitedHealthcare,Medicare Advantage,138.184,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion Inc Margins,Scalp,Nk,Hds,Ft,Genitalia;Exc Dia 0.5 Cm Or < (Pro Cah)",,11620,CPT,Professional,Both,,,,390,331.5,77.22,390,UnitedHealthcare,Medicare Advantage,138.184,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion Inc Margins,Scalp,Nk,Hds,Ft,Genitalia;Exc Dia 0.5 Cm Or < (Pro Cah)",,11620,CPT,Professional,Both,,,,443,376.55,77.22,443,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,89.154,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision, Malignant Lesion Inc Margins,Scalp,Nk,Hds,Ft,Genitalia;Exc Dia 0.5 Cm Or < (Pro Cah)",,11620,CPT,Professional,Both,,,,390,331.5,77.22,390,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,89.154,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision, Malignant Lesion Scalp, Neck, Hands, Feet, Genitalia; Exc Dia 0.6-1.0 Cm",,11621,CPT,Facility,Both,,,,305,259.25,87.413,305,Aetna,Commercial,280.6,92,,percent of total billed charges,,
"Excision, Malignant Lesion Scalp, Neck, Hands, Feet, Genitalia; Exc Dia 0.6-1.0 Cm",,11621,CPT,Facility,Outpatient,,,,305,259.25,87.413,305,Aetna,Medicare Advantage,149.45,49,,percent of total billed charges,,
"Excision, Malignant Lesion Scalp, Neck, Hands, Feet, Genitalia; Exc Dia 0.6-1.0 Cm",,11621,CPT,Facility,Inpatient,,,,305,259.25,87.413,305,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Excision, Malignant Lesion Scalp, Neck, Hands, Feet, Genitalia; Exc Dia 0.6-1.0 Cm",,11621,CPT,Facility,Both,,,,305,259.25,87.413,305,Aetna,PPO,283.65,93,,percent of total billed charges,,
"Excision, Malignant Lesion Scalp, Neck, Hands, Feet, Genitalia; Exc Dia 0.6-1.0 Cm",,11621,CPT,Facility,Both,,,,305,259.25,87.413,305,America's PPO,America's PPO,292.8915,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Excision, Malignant Lesion Scalp, Neck, Hands, Feet, Genitalia; Exc Dia 0.6-1.0 Cm",,11621,CPT,Facility,Both,,,,305,259.25,87.413,305,BlueCross BlueShield Minnesota, Federal Employee Program,300.12,98.4,,percent of total billed charges,,
"Excision, Malignant Lesion Scalp, Neck, Hands, Feet, Genitalia; Exc Dia 0.6-1.0 Cm",,11621,CPT,Facility,Both,,,,305,259.25,87.413,305,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,305,100,,percent of total billed charges,,
"Excision, Malignant Lesion Scalp, Neck, Hands, Feet, Genitalia; Exc Dia 0.6-1.0 Cm",,11621,CPT,Facility,Both,,,,305,259.25,87.413,305,BlueCross BlueShield Minnesota,High Value Network Plan,274.5,90,,percent of total billed charges,,
"Excision, Malignant Lesion Scalp, Neck, Hands, Feet, Genitalia; Exc Dia 0.6-1.0 Cm",,11621,CPT,Facility,Outpatient,,,,305,259.25,87.413,305,BlueCross BlueShield Minnesota,Medicare Advantage,149.45,49,,percent of total billed charges,,
"Excision, Malignant Lesion Scalp, Neck, Hands, Feet, Genitalia; Exc Dia 0.6-1.0 Cm",,11621,CPT,Facility,Inpatient,,,,305,259.25,87.413,305,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Excision, Malignant Lesion Scalp, Neck, Hands, Feet, Genitalia; Exc Dia 0.6-1.0 Cm",,11621,CPT,Facility,Both,,,,305,259.25,87.413,305,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,270.1385,88.57,,percent of total billed charges,,
"Excision, Malignant Lesion Scalp, Neck, Hands, Feet, Genitalia; Exc Dia 0.6-1.0 Cm",,11621,CPT,Facility,Both,,,,305,259.25,87.413,305,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,87.413,28.66,,percent of total billed charges,,
"Excision, Malignant Lesion Scalp, Neck, Hands, Feet, Genitalia; Exc Dia 0.6-1.0 Cm",,11621,CPT,Facility,Outpatient,,,,305,259.25,87.413,305,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),149.45,49,,percent of total billed charges,,
"Excision, Malignant Lesion Scalp, Neck, Hands, Feet, Genitalia; Exc Dia 0.6-1.0 Cm",,11621,CPT,Facility,Inpatient,,,,305,259.25,87.413,305,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Excision, Malignant Lesion Scalp, Neck, Hands, Feet, Genitalia; Exc Dia 0.6-1.0 Cm",,11621,CPT,Facility,Both,,,,305,259.25,87.413,305,CorVel,Worker's Compensation,305,100,,percent of total billed charges,,
"Excision, Malignant Lesion Scalp, Neck, Hands, Feet, Genitalia; Exc Dia 0.6-1.0 Cm",,11621,CPT,Facility,Both,,,,305,259.25,87.413,305,First Health Group Corporation,First Health Network,295.85,97,,percent of total billed charges,,
"Excision, Malignant Lesion Scalp, Neck, Hands, Feet, Genitalia; Exc Dia 0.6-1.0 Cm",,11621,CPT,Facility,Both,,,,305,259.25,87.413,305,"Health Partners, Inc.",Commercial,288.53,94.6,,percent of total billed charges,,
"Excision, Malignant Lesion Scalp, Neck, Hands, Feet, Genitalia; Exc Dia 0.6-1.0 Cm",,11621,CPT,Facility,Outpatient,,,,305,259.25,87.413,305,"Health Partners, Inc.",Medicare Advantage,149.45,49,,percent of total billed charges,,
"Excision, Malignant Lesion Scalp, Neck, Hands, Feet, Genitalia; Exc Dia 0.6-1.0 Cm",,11621,CPT,Facility,Inpatient,,,,305,259.25,87.413,305,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Excision, Malignant Lesion Scalp, Neck, Hands, Feet, Genitalia; Exc Dia 0.6-1.0 Cm",,11621,CPT,Facility,Both,,,,305,259.25,87.413,305,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),183,60,,percent of total billed charges,,
"Excision, Malignant Lesion Scalp, Neck, Hands, Feet, Genitalia; Exc Dia 0.6-1.0 Cm",,11621,CPT,Facility,Both,,,,305,259.25,87.413,305,"Health Partners, Inc.",State of Minnesota Advantage Program,248.575,81.5,,percent of total billed charges,,
"Excision, Malignant Lesion Scalp, Neck, Hands, Feet, Genitalia; Exc Dia 0.6-1.0 Cm",,11621,CPT,Facility,Both,,,,305,259.25,87.413,305,"Health Partners, Inc.",State Public Programs,152.5,50,,percent of total billed charges,,
"Excision, Malignant Lesion Scalp, Neck, Hands, Feet, Genitalia; Exc Dia 0.6-1.0 Cm",,11621,CPT,Facility,Both,,,,305,259.25,87.413,305,Humana Insurance Company,Commercial PPO,289.75,95,,percent of total billed charges,,
"Excision, Malignant Lesion Scalp, Neck, Hands, Feet, Genitalia; Exc Dia 0.6-1.0 Cm",,11621,CPT,Facility,Outpatient,,,,305,259.25,87.413,305,Humana Insurance Company,Medicare PPO,149.45,49,,percent of total billed charges,,
"Excision, Malignant Lesion Scalp, Neck, Hands, Feet, Genitalia; Exc Dia 0.6-1.0 Cm",,11621,CPT,Facility,Inpatient,,,,305,259.25,87.413,305,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Excision, Malignant Lesion Scalp, Neck, Hands, Feet, Genitalia; Exc Dia 0.6-1.0 Cm",,11621,CPT,Facility,Both,,,,305,259.25,87.413,305,Medica,Individual & Family,302.255,99.1,,percent of total billed charges,,
"Excision, Malignant Lesion Scalp, Neck, Hands, Feet, Genitalia; Exc Dia 0.6-1.0 Cm",,11621,CPT,Facility,Outpatient,,,,305,259.25,87.413,305,Medica,Medica Advantage Solution,151.89,49.8,,percent of total billed charges,,
"Excision, Malignant Lesion Scalp, Neck, Hands, Feet, Genitalia; Exc Dia 0.6-1.0 Cm",,11621,CPT,Facility,Inpatient,,,,305,259.25,87.413,305,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Excision, Malignant Lesion Scalp, Neck, Hands, Feet, Genitalia; Exc Dia 0.6-1.0 Cm",,11621,CPT,Facility,Outpatient,,,,305,259.25,87.413,305,Medica,Medical Assistance,136.03,44.6,,percent of total billed charges,,
"Excision, Malignant Lesion Scalp, Neck, Hands, Feet, Genitalia; Exc Dia 0.6-1.0 Cm",,11621,CPT,Facility,Inpatient,,,,305,259.25,87.413,305,Medica,Medical Assistance,,,,,Included in per diem rate,
"Excision, Malignant Lesion Scalp, Neck, Hands, Feet, Genitalia; Exc Dia 0.6-1.0 Cm",,11621,CPT,Facility,Outpatient,,,,305,259.25,87.413,305,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,151.89,49.8,,percent of total billed charges,,
"Excision, Malignant Lesion Scalp, Neck, Hands, Feet, Genitalia; Exc Dia 0.6-1.0 Cm",,11621,CPT,Facility,Inpatient,,,,305,259.25,87.413,305,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Excision, Malignant Lesion Scalp, Neck, Hands, Feet, Genitalia; Exc Dia 0.6-1.0 Cm",,11621,CPT,Facility,Both,,,,305,259.25,87.413,305,"Multiplan, Inc.","Multiplan, Inc.",286.7,94,,percent of total billed charges,,
"Excision, Malignant Lesion Scalp, Neck, Hands, Feet, Genitalia; Exc Dia 0.6-1.0 Cm",,11621,CPT,Facility,Outpatient,,,,305,259.25,87.413,305,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,274.805,90.1,,percent of total billed charges,,
"Excision, Malignant Lesion Scalp, Neck, Hands, Feet, Genitalia; Exc Dia 0.6-1.0 Cm",,11621,CPT,Facility,Inpatient,,,,305,259.25,87.413,305,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Excision, Malignant Lesion Scalp, Neck, Hands, Feet, Genitalia; Exc Dia 0.6-1.0 Cm",,11621,CPT,Facility,Both,,,,305,259.25,87.413,305,"Preferred One Administrative Services, INC.",PPO,300.73,98.6,,percent of total billed charges,,
"Excision, Malignant Lesion Scalp, Neck, Hands, Feet, Genitalia; Exc Dia 0.6-1.0 Cm",,11621,CPT,Facility,Outpatient,,,,305,259.25,87.413,305,PrimeWest Health,Minnesota Senior Health Options (MSHO),156.9225,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Excision, Malignant Lesion Scalp, Neck, Hands, Feet, Genitalia; Exc Dia 0.6-1.0 Cm",,11621,CPT,Facility,Inpatient,,,,305,259.25,87.413,305,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Excision, Malignant Lesion Scalp, Neck, Hands, Feet, Genitalia; Exc Dia 0.6-1.0 Cm",,11621,CPT,Facility,Outpatient,,,,305,259.25,87.413,305,PrimeWest Health,MinnesotaCare,156.648,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Excision, Malignant Lesion Scalp, Neck, Hands, Feet, Genitalia; Exc Dia 0.6-1.0 Cm",,11621,CPT,Facility,Inpatient,,,,305,259.25,87.413,305,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Excision, Malignant Lesion Scalp, Neck, Hands, Feet, Genitalia; Exc Dia 0.6-1.0 Cm",,11621,CPT,Facility,Both,,,,305,259.25,87.413,305,Sanford Health Plan,Sanford Health Plan,280.6,92,,percent of total billed charges,,
"Excision, Malignant Lesion Scalp, Neck, Hands, Feet, Genitalia; Exc Dia 0.6-1.0 Cm",,11621,CPT,Facility,Outpatient,,,,305,259.25,87.413,305,"UCare Health, Inc.",Individual & Family Plan,171.8675,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Excision, Malignant Lesion Scalp, Neck, Hands, Feet, Genitalia; Exc Dia 0.6-1.0 Cm",,11621,CPT,Facility,Inpatient,,,,305,259.25,87.413,305,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Excision, Malignant Lesion Scalp, Neck, Hands, Feet, Genitalia; Exc Dia 0.6-1.0 Cm",,11621,CPT,Facility,Outpatient,,,,305,259.25,87.413,305,"UCare Health, Inc.",Medical Assistance,153.9335,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Excision, Malignant Lesion Scalp, Neck, Hands, Feet, Genitalia; Exc Dia 0.6-1.0 Cm",,11621,CPT,Facility,Inpatient,,,,305,259.25,87.413,305,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Excision, Malignant Lesion Scalp, Neck, Hands, Feet, Genitalia; Exc Dia 0.6-1.0 Cm",,11621,CPT,Facility,Outpatient,,,,305,259.25,87.413,305,"UCare Health, Inc.",Medicare Advantage,153.9335,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Excision, Malignant Lesion Scalp, Neck, Hands, Feet, Genitalia; Exc Dia 0.6-1.0 Cm",,11621,CPT,Facility,Inpatient,,,,305,259.25,87.413,305,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Excision, Malignant Lesion Scalp, Neck, Hands, Feet, Genitalia; Exc Dia 0.6-1.0 Cm",,11621,CPT,Facility,Outpatient,,,,305,259.25,87.413,305,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),153.9335,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Excision, Malignant Lesion Scalp, Neck, Hands, Feet, Genitalia; Exc Dia 0.6-1.0 Cm",,11621,CPT,Facility,Inpatient,,,,305,259.25,87.413,305,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Excision, Malignant Lesion Scalp, Neck, Hands, Feet, Genitalia; Exc Dia 0.6-1.0 Cm",,11621,CPT,Facility,Both,,,,305,259.25,87.413,305,UnitedHealthcare,Individual & Family,286.7,94,,percent of total billed charges,,
"Excision, Malignant Lesion Scalp, Neck, Hands, Feet, Genitalia; Exc Dia 0.6-1.0 Cm",,11621,CPT,Facility,Outpatient,,,,305,259.25,87.413,305,UnitedHealthcare,Medicare Advantage,149.45,49,,percent of total billed charges,,
"Excision, Malignant Lesion Scalp, Neck, Hands, Feet, Genitalia; Exc Dia 0.6-1.0 Cm",,11621,CPT,Facility,Inpatient,,,,305,259.25,87.413,305,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Excision, Malignant Lesion Scalp, Neck, Hands, Feet, Genitalia; Exc Dia 0.6-1.0 Cm",,11621,CPT,Facility,Outpatient,,,,305,259.25,87.413,305,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,146.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Excision, Malignant Lesion Scalp, Neck, Hands, Feet, Genitalia; Exc Dia 0.6-1.0 Cm",,11621,CPT,Facility,Inpatient,,,,305,259.25,87.413,305,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Excision, Malignant Lesion Scalp, Neck, Hands, Feet, Genitalia; Exc Dia 0.6-1.0 Cm (Pro Cah)",,11621,CPT,Professional,Both,,,,460,391,93.8,460,Aetna,Commercial,391,85,,percent of total billed charges,,
"Excision, Malignant Lesion Scalp, Neck, Hands, Feet, Genitalia; Exc Dia 0.6-1.0 Cm (Pro Cah)",,11621,CPT,Professional,Both,,,,460,391,93.8,460,Aetna,Medicare Advantage,146,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion Scalp, Neck, Hands, Feet, Genitalia; Exc Dia 0.6-1.0 Cm (Pro Cah)",,11621,CPT,Professional,Both,,,,460,391,93.8,460,Aetna,PPO,427.8,93,,percent of total billed charges,,
"Excision, Malignant Lesion Scalp, Neck, Hands, Feet, Genitalia; Exc Dia 0.6-1.0 Cm (Pro Cah)",,11621,CPT,Professional,Both,,,,460,391,93.8,460,America's PPO,America's PPO,393.024,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Excision, Malignant Lesion Scalp, Neck, Hands, Feet, Genitalia; Exc Dia 0.6-1.0 Cm (Pro Cah)",,11621,CPT,Professional,Both,,,,460,391,93.8,460,BlueCross BlueShield Minnesota, Federal Employee Program,305.74,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Excision, Malignant Lesion Scalp, Neck, Hands, Feet, Genitalia; Exc Dia 0.6-1.0 Cm (Pro Cah)",,11621,CPT,Professional,Both,,,,460,391,93.8,460,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,310.63184,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Malignant Lesion Scalp, Neck, Hands, Feet, Genitalia; Exc Dia 0.6-1.0 Cm (Pro Cah)",,11621,CPT,Professional,Both,,,,460,391,93.8,460,BlueCross BlueShield Minnesota,High Value Network Plan,310.63184,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Malignant Lesion Scalp, Neck, Hands, Feet, Genitalia; Exc Dia 0.6-1.0 Cm (Pro Cah)",,11621,CPT,Professional,Both,,,,460,391,93.8,460,BlueCross BlueShield Minnesota,Medicare Advantage,167.7505,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion Scalp, Neck, Hands, Feet, Genitalia; Exc Dia 0.6-1.0 Cm (Pro Cah)",,11621,CPT,Professional,Both,,,,460,391,93.8,460,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,310.63184,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Malignant Lesion Scalp, Neck, Hands, Feet, Genitalia; Exc Dia 0.6-1.0 Cm (Pro Cah)",,11621,CPT,Professional,Both,,,,460,391,93.8,460,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,108.29544,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision, Malignant Lesion Scalp, Neck, Hands, Feet, Genitalia; Exc Dia 0.6-1.0 Cm (Pro Cah)",,11621,CPT,Professional,Both,,,,460,391,93.8,460,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),167.7505,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion Scalp, Neck, Hands, Feet, Genitalia; Exc Dia 0.6-1.0 Cm (Pro Cah)",,11621,CPT,Professional,Both,,,,460,391,93.8,460,CorVel,Worker's Compensation,283.7690688,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Excision, Malignant Lesion Scalp, Neck, Hands, Feet, Genitalia; Exc Dia 0.6-1.0 Cm (Pro Cah)",,11621,CPT,Professional,Both,,,,460,391,93.8,460,First Health Group Corporation,First Health Network,446.2,97,,percent of total billed charges,,
"Excision, Malignant Lesion Scalp, Neck, Hands, Feet, Genitalia; Exc Dia 0.6-1.0 Cm (Pro Cah)",,11621,CPT,Professional,Both,,,,460,391,93.8,460,"Health Partners, Inc.",Commercial,306.89,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision, Malignant Lesion Scalp, Neck, Hands, Feet, Genitalia; Exc Dia 0.6-1.0 Cm (Pro Cah)",,11621,CPT,Professional,Both,,,,460,391,93.8,460,"Health Partners, Inc.",Medicare Advantage,167.7505,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion Scalp, Neck, Hands, Feet, Genitalia; Exc Dia 0.6-1.0 Cm (Pro Cah)",,11621,CPT,Professional,Both,,,,460,391,93.8,460,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),145.71,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Excision, Malignant Lesion Scalp, Neck, Hands, Feet, Genitalia; Exc Dia 0.6-1.0 Cm (Pro Cah)",,11621,CPT,Professional,Both,,,,460,391,93.8,460,"Health Partners, Inc.",State of Minnesota Advantage Program,264.385735,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision, Malignant Lesion Scalp, Neck, Hands, Feet, Genitalia; Exc Dia 0.6-1.0 Cm (Pro Cah)",,11621,CPT,Professional,Both,,,,460,391,93.8,460,"Health Partners, Inc.",State Public Programs,93.8,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Excision, Malignant Lesion Scalp, Neck, Hands, Feet, Genitalia; Exc Dia 0.6-1.0 Cm (Pro Cah)",,11621,CPT,Professional,Both,,,,460,391,93.8,460,Humana Insurance Company,Commercial PPO,145.87,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Excision, Malignant Lesion Scalp, Neck, Hands, Feet, Genitalia; Exc Dia 0.6-1.0 Cm (Pro Cah)",,11621,CPT,Professional,Both,,,,460,391,93.8,460,Humana Insurance Company,Medicare PPO,460,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion Scalp, Neck, Hands, Feet, Genitalia; Exc Dia 0.6-1.0 Cm (Pro Cah)",,11621,CPT,Professional,Both,,,,460,391,93.8,460,Medica,Individual & Family,390.08,84.8,,percent of total billed charges,,
"Excision, Malignant Lesion Scalp, Neck, Hands, Feet, Genitalia; Exc Dia 0.6-1.0 Cm (Pro Cah)",,11621,CPT,Professional,Both,,,,460,391,93.8,460,Medica,Medica Advantage Solution,229.08,49.8,,percent of total billed charges,,
"Excision, Malignant Lesion Scalp, Neck, Hands, Feet, Genitalia; Exc Dia 0.6-1.0 Cm (Pro Cah)",,11621,CPT,Professional,Both,,,,460,391,93.8,460,Medica,Medical Assistance,108.3,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Excision, Malignant Lesion Scalp, Neck, Hands, Feet, Genitalia; Exc Dia 0.6-1.0 Cm (Pro Cah)",,11621,CPT,Professional,Both,,,,460,391,93.8,460,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,145.87,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Excision, Malignant Lesion Scalp, Neck, Hands, Feet, Genitalia; Exc Dia 0.6-1.0 Cm (Pro Cah)",,11621,CPT,Professional,Both,,,,460,391,93.8,460,"Multiplan, Inc.","Multiplan, Inc.",432.4,94,,percent of total billed charges,,
"Excision, Malignant Lesion Scalp, Neck, Hands, Feet, Genitalia; Exc Dia 0.6-1.0 Cm (Pro Cah)",,11621,CPT,Professional,Both,,,,460,391,93.8,460,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,414.46,90.1,,percent of total billed charges,,
"Excision, Malignant Lesion Scalp, Neck, Hands, Feet, Genitalia; Exc Dia 0.6-1.0 Cm (Pro Cah)",,11621,CPT,Professional,Both,,,,460,391,93.8,460,"Preferred One Administrative Services, INC.",PPO,453.56,98.6,,percent of total billed charges,,
"Excision, Malignant Lesion Scalp, Neck, Hands, Feet, Genitalia; Exc Dia 0.6-1.0 Cm (Pro Cah)",,11621,CPT,Professional,Both,,,,460,391,93.8,460,PrimeWest Health,Minnesota Senior Health Options (MSHO),167.7505,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion Scalp, Neck, Hands, Feet, Genitalia; Exc Dia 0.6-1.0 Cm (Pro Cah)",,11621,CPT,Professional,Both,,,,460,391,93.8,460,PrimeWest Health,MinnesotaCare,115.8761208,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision, Malignant Lesion Scalp, Neck, Hands, Feet, Genitalia; Exc Dia 0.6-1.0 Cm (Pro Cah)",,11621,CPT,Professional,Both,,,,460,391,93.8,460,Sanford Health Plan,Sanford Health Plan,404.8,88,,percent of total billed charges,,
"Excision, Malignant Lesion Scalp, Neck, Hands, Feet, Genitalia; Exc Dia 0.6-1.0 Cm (Pro Cah)",,11621,CPT,Professional,Both,,,,460,391,93.8,460,"UCare Health, Inc.",Individual & Family Plan,237.126272,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Excision, Malignant Lesion Scalp, Neck, Hands, Feet, Genitalia; Exc Dia 0.6-1.0 Cm (Pro Cah)",,11621,CPT,Professional,Both,,,,460,391,93.8,460,"UCare Health, Inc.",Medical Assistance,119.124984,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Excision, Malignant Lesion Scalp, Neck, Hands, Feet, Genitalia; Exc Dia 0.6-1.0 Cm (Pro Cah)",,11621,CPT,Professional,Both,,,,460,391,93.8,460,"UCare Health, Inc.",Medicare Advantage,167.7505,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Excision, Malignant Lesion Scalp, Neck, Hands, Feet, Genitalia; Exc Dia 0.6-1.0 Cm (Pro Cah)",,11621,CPT,Professional,Both,,,,460,391,93.8,460,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),134.2004,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Excision, Malignant Lesion Scalp, Neck, Hands, Feet, Genitalia; Exc Dia 0.6-1.0 Cm (Pro Cah)",,11621,CPT,Professional,Both,,,,460,391,93.8,460,UnitedHealthcare,Individual & Family,460,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Excision, Malignant Lesion Scalp, Neck, Hands, Feet, Genitalia; Exc Dia 0.6-1.0 Cm (Pro Cah)",,11621,CPT,Professional,Both,,,,460,391,93.8,460,UnitedHealthcare,Medicare Advantage,167.7505,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion Scalp, Neck, Hands, Feet, Genitalia; Exc Dia 0.6-1.0 Cm (Pro Cah)",,11621,CPT,Professional,Both,,,,460,391,93.8,460,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,108.29544,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision,Malignant Lesion Inc Margin,Scalp,Nk,Hds,Ft,Genit; Exc Dia 1.1-2.0 Cm",,11622,CPT,Facility,Both,,,,332,282.2,95.1512,332,Aetna,Commercial,305.44,92,,percent of total billed charges,,
"Excision,Malignant Lesion Inc Margin,Scalp,Nk,Hds,Ft,Genit; Exc Dia 1.1-2.0 Cm",,11622,CPT,Facility,Outpatient,,,,332,282.2,95.1512,332,Aetna,Medicare Advantage,162.68,49,,percent of total billed charges,,
"Excision,Malignant Lesion Inc Margin,Scalp,Nk,Hds,Ft,Genit; Exc Dia 1.1-2.0 Cm",,11622,CPT,Facility,Inpatient,,,,332,282.2,95.1512,332,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Excision,Malignant Lesion Inc Margin,Scalp,Nk,Hds,Ft,Genit; Exc Dia 1.1-2.0 Cm",,11622,CPT,Facility,Both,,,,332,282.2,95.1512,332,Aetna,PPO,308.76,93,,percent of total billed charges,,
"Excision,Malignant Lesion Inc Margin,Scalp,Nk,Hds,Ft,Genit; Exc Dia 1.1-2.0 Cm",,11622,CPT,Facility,Both,,,,332,282.2,95.1512,332,America's PPO,America's PPO,318.8196,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Excision,Malignant Lesion Inc Margin,Scalp,Nk,Hds,Ft,Genit; Exc Dia 1.1-2.0 Cm",,11622,CPT,Facility,Both,,,,332,282.2,95.1512,332,BlueCross BlueShield Minnesota, Federal Employee Program,326.688,98.4,,percent of total billed charges,,
"Excision,Malignant Lesion Inc Margin,Scalp,Nk,Hds,Ft,Genit; Exc Dia 1.1-2.0 Cm",,11622,CPT,Facility,Both,,,,332,282.2,95.1512,332,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,332,100,,percent of total billed charges,,
"Excision,Malignant Lesion Inc Margin,Scalp,Nk,Hds,Ft,Genit; Exc Dia 1.1-2.0 Cm",,11622,CPT,Facility,Both,,,,332,282.2,95.1512,332,BlueCross BlueShield Minnesota,High Value Network Plan,298.8,90,,percent of total billed charges,,
"Excision,Malignant Lesion Inc Margin,Scalp,Nk,Hds,Ft,Genit; Exc Dia 1.1-2.0 Cm",,11622,CPT,Facility,Outpatient,,,,332,282.2,95.1512,332,BlueCross BlueShield Minnesota,Medicare Advantage,162.68,49,,percent of total billed charges,,
"Excision,Malignant Lesion Inc Margin,Scalp,Nk,Hds,Ft,Genit; Exc Dia 1.1-2.0 Cm",,11622,CPT,Facility,Inpatient,,,,332,282.2,95.1512,332,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Excision,Malignant Lesion Inc Margin,Scalp,Nk,Hds,Ft,Genit; Exc Dia 1.1-2.0 Cm",,11622,CPT,Facility,Both,,,,332,282.2,95.1512,332,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,294.0524,88.57,,percent of total billed charges,,
"Excision,Malignant Lesion Inc Margin,Scalp,Nk,Hds,Ft,Genit; Exc Dia 1.1-2.0 Cm",,11622,CPT,Facility,Both,,,,332,282.2,95.1512,332,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,95.1512,28.66,,percent of total billed charges,,
"Excision,Malignant Lesion Inc Margin,Scalp,Nk,Hds,Ft,Genit; Exc Dia 1.1-2.0 Cm",,11622,CPT,Facility,Outpatient,,,,332,282.2,95.1512,332,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),162.68,49,,percent of total billed charges,,
"Excision,Malignant Lesion Inc Margin,Scalp,Nk,Hds,Ft,Genit; Exc Dia 1.1-2.0 Cm",,11622,CPT,Facility,Inpatient,,,,332,282.2,95.1512,332,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Excision,Malignant Lesion Inc Margin,Scalp,Nk,Hds,Ft,Genit; Exc Dia 1.1-2.0 Cm",,11622,CPT,Facility,Both,,,,332,282.2,95.1512,332,CorVel,Worker's Compensation,332,100,,percent of total billed charges,,
"Excision,Malignant Lesion Inc Margin,Scalp,Nk,Hds,Ft,Genit; Exc Dia 1.1-2.0 Cm",,11622,CPT,Facility,Both,,,,332,282.2,95.1512,332,First Health Group Corporation,First Health Network,322.04,97,,percent of total billed charges,,
"Excision,Malignant Lesion Inc Margin,Scalp,Nk,Hds,Ft,Genit; Exc Dia 1.1-2.0 Cm",,11622,CPT,Facility,Both,,,,332,282.2,95.1512,332,"Health Partners, Inc.",Commercial,314.072,94.6,,percent of total billed charges,,
"Excision,Malignant Lesion Inc Margin,Scalp,Nk,Hds,Ft,Genit; Exc Dia 1.1-2.0 Cm",,11622,CPT,Facility,Outpatient,,,,332,282.2,95.1512,332,"Health Partners, Inc.",Medicare Advantage,162.68,49,,percent of total billed charges,,
"Excision,Malignant Lesion Inc Margin,Scalp,Nk,Hds,Ft,Genit; Exc Dia 1.1-2.0 Cm",,11622,CPT,Facility,Inpatient,,,,332,282.2,95.1512,332,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Excision,Malignant Lesion Inc Margin,Scalp,Nk,Hds,Ft,Genit; Exc Dia 1.1-2.0 Cm",,11622,CPT,Facility,Both,,,,332,282.2,95.1512,332,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),199.2,60,,percent of total billed charges,,
"Excision,Malignant Lesion Inc Margin,Scalp,Nk,Hds,Ft,Genit; Exc Dia 1.1-2.0 Cm",,11622,CPT,Facility,Both,,,,332,282.2,95.1512,332,"Health Partners, Inc.",State of Minnesota Advantage Program,270.58,81.5,,percent of total billed charges,,
"Excision,Malignant Lesion Inc Margin,Scalp,Nk,Hds,Ft,Genit; Exc Dia 1.1-2.0 Cm",,11622,CPT,Facility,Both,,,,332,282.2,95.1512,332,"Health Partners, Inc.",State Public Programs,166,50,,percent of total billed charges,,
"Excision,Malignant Lesion Inc Margin,Scalp,Nk,Hds,Ft,Genit; Exc Dia 1.1-2.0 Cm",,11622,CPT,Facility,Both,,,,332,282.2,95.1512,332,Humana Insurance Company,Commercial PPO,315.4,95,,percent of total billed charges,,
"Excision,Malignant Lesion Inc Margin,Scalp,Nk,Hds,Ft,Genit; Exc Dia 1.1-2.0 Cm",,11622,CPT,Facility,Outpatient,,,,332,282.2,95.1512,332,Humana Insurance Company,Medicare PPO,162.68,49,,percent of total billed charges,,
"Excision,Malignant Lesion Inc Margin,Scalp,Nk,Hds,Ft,Genit; Exc Dia 1.1-2.0 Cm",,11622,CPT,Facility,Inpatient,,,,332,282.2,95.1512,332,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Excision,Malignant Lesion Inc Margin,Scalp,Nk,Hds,Ft,Genit; Exc Dia 1.1-2.0 Cm",,11622,CPT,Facility,Both,,,,332,282.2,95.1512,332,Medica,Individual & Family,329.012,99.1,,percent of total billed charges,,
"Excision,Malignant Lesion Inc Margin,Scalp,Nk,Hds,Ft,Genit; Exc Dia 1.1-2.0 Cm",,11622,CPT,Facility,Outpatient,,,,332,282.2,95.1512,332,Medica,Medica Advantage Solution,165.336,49.8,,percent of total billed charges,,
"Excision,Malignant Lesion Inc Margin,Scalp,Nk,Hds,Ft,Genit; Exc Dia 1.1-2.0 Cm",,11622,CPT,Facility,Inpatient,,,,332,282.2,95.1512,332,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Excision,Malignant Lesion Inc Margin,Scalp,Nk,Hds,Ft,Genit; Exc Dia 1.1-2.0 Cm",,11622,CPT,Facility,Outpatient,,,,332,282.2,95.1512,332,Medica,Medical Assistance,148.072,44.6,,percent of total billed charges,,
"Excision,Malignant Lesion Inc Margin,Scalp,Nk,Hds,Ft,Genit; Exc Dia 1.1-2.0 Cm",,11622,CPT,Facility,Inpatient,,,,332,282.2,95.1512,332,Medica,Medical Assistance,,,,,Included in per diem rate,
"Excision,Malignant Lesion Inc Margin,Scalp,Nk,Hds,Ft,Genit; Exc Dia 1.1-2.0 Cm",,11622,CPT,Facility,Outpatient,,,,332,282.2,95.1512,332,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,165.336,49.8,,percent of total billed charges,,
"Excision,Malignant Lesion Inc Margin,Scalp,Nk,Hds,Ft,Genit; Exc Dia 1.1-2.0 Cm",,11622,CPT,Facility,Inpatient,,,,332,282.2,95.1512,332,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Excision,Malignant Lesion Inc Margin,Scalp,Nk,Hds,Ft,Genit; Exc Dia 1.1-2.0 Cm",,11622,CPT,Facility,Both,,,,332,282.2,95.1512,332,"Multiplan, Inc.","Multiplan, Inc.",312.08,94,,percent of total billed charges,,
"Excision,Malignant Lesion Inc Margin,Scalp,Nk,Hds,Ft,Genit; Exc Dia 1.1-2.0 Cm",,11622,CPT,Facility,Outpatient,,,,332,282.2,95.1512,332,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,299.132,90.1,,percent of total billed charges,,
"Excision,Malignant Lesion Inc Margin,Scalp,Nk,Hds,Ft,Genit; Exc Dia 1.1-2.0 Cm",,11622,CPT,Facility,Inpatient,,,,332,282.2,95.1512,332,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Excision,Malignant Lesion Inc Margin,Scalp,Nk,Hds,Ft,Genit; Exc Dia 1.1-2.0 Cm",,11622,CPT,Facility,Both,,,,332,282.2,95.1512,332,"Preferred One Administrative Services, INC.",PPO,327.352,98.6,,percent of total billed charges,,
"Excision,Malignant Lesion Inc Margin,Scalp,Nk,Hds,Ft,Genit; Exc Dia 1.1-2.0 Cm",,11622,CPT,Facility,Outpatient,,,,332,282.2,95.1512,332,PrimeWest Health,Minnesota Senior Health Options (MSHO),170.814,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Excision,Malignant Lesion Inc Margin,Scalp,Nk,Hds,Ft,Genit; Exc Dia 1.1-2.0 Cm",,11622,CPT,Facility,Inpatient,,,,332,282.2,95.1512,332,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Excision,Malignant Lesion Inc Margin,Scalp,Nk,Hds,Ft,Genit; Exc Dia 1.1-2.0 Cm",,11622,CPT,Facility,Outpatient,,,,332,282.2,95.1512,332,PrimeWest Health,MinnesotaCare,170.5152,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Excision,Malignant Lesion Inc Margin,Scalp,Nk,Hds,Ft,Genit; Exc Dia 1.1-2.0 Cm",,11622,CPT,Facility,Inpatient,,,,332,282.2,95.1512,332,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Excision,Malignant Lesion Inc Margin,Scalp,Nk,Hds,Ft,Genit; Exc Dia 1.1-2.0 Cm",,11622,CPT,Facility,Both,,,,332,282.2,95.1512,332,Sanford Health Plan,Sanford Health Plan,305.44,92,,percent of total billed charges,,
"Excision,Malignant Lesion Inc Margin,Scalp,Nk,Hds,Ft,Genit; Exc Dia 1.1-2.0 Cm",,11622,CPT,Facility,Outpatient,,,,332,282.2,95.1512,332,"UCare Health, Inc.",Individual & Family Plan,187.082,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Excision,Malignant Lesion Inc Margin,Scalp,Nk,Hds,Ft,Genit; Exc Dia 1.1-2.0 Cm",,11622,CPT,Facility,Inpatient,,,,332,282.2,95.1512,332,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Excision,Malignant Lesion Inc Margin,Scalp,Nk,Hds,Ft,Genit; Exc Dia 1.1-2.0 Cm",,11622,CPT,Facility,Outpatient,,,,332,282.2,95.1512,332,"UCare Health, Inc.",Medical Assistance,167.5604,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Excision,Malignant Lesion Inc Margin,Scalp,Nk,Hds,Ft,Genit; Exc Dia 1.1-2.0 Cm",,11622,CPT,Facility,Inpatient,,,,332,282.2,95.1512,332,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Excision,Malignant Lesion Inc Margin,Scalp,Nk,Hds,Ft,Genit; Exc Dia 1.1-2.0 Cm",,11622,CPT,Facility,Outpatient,,,,332,282.2,95.1512,332,"UCare Health, Inc.",Medicare Advantage,167.5604,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Excision,Malignant Lesion Inc Margin,Scalp,Nk,Hds,Ft,Genit; Exc Dia 1.1-2.0 Cm",,11622,CPT,Facility,Inpatient,,,,332,282.2,95.1512,332,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Excision,Malignant Lesion Inc Margin,Scalp,Nk,Hds,Ft,Genit; Exc Dia 1.1-2.0 Cm",,11622,CPT,Facility,Outpatient,,,,332,282.2,95.1512,332,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),167.5604,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Excision,Malignant Lesion Inc Margin,Scalp,Nk,Hds,Ft,Genit; Exc Dia 1.1-2.0 Cm",,11622,CPT,Facility,Inpatient,,,,332,282.2,95.1512,332,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Excision,Malignant Lesion Inc Margin,Scalp,Nk,Hds,Ft,Genit; Exc Dia 1.1-2.0 Cm",,11622,CPT,Facility,Both,,,,332,282.2,95.1512,332,UnitedHealthcare,Individual & Family,312.08,94,,percent of total billed charges,,
"Excision,Malignant Lesion Inc Margin,Scalp,Nk,Hds,Ft,Genit; Exc Dia 1.1-2.0 Cm",,11622,CPT,Facility,Outpatient,,,,332,282.2,95.1512,332,UnitedHealthcare,Medicare Advantage,162.68,49,,percent of total billed charges,,
"Excision,Malignant Lesion Inc Margin,Scalp,Nk,Hds,Ft,Genit; Exc Dia 1.1-2.0 Cm",,11622,CPT,Facility,Inpatient,,,,332,282.2,95.1512,332,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Excision,Malignant Lesion Inc Margin,Scalp,Nk,Hds,Ft,Genit; Exc Dia 1.1-2.0 Cm",,11622,CPT,Facility,Outpatient,,,,332,282.2,95.1512,332,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,159.36,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Excision,Malignant Lesion Inc Margin,Scalp,Nk,Hds,Ft,Genit; Exc Dia 1.1-2.0 Cm",,11622,CPT,Facility,Inpatient,,,,332,282.2,95.1512,332,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Excision,Malignant Lesion Inc Margin,Scalp,Nk,Hds,Ft,Genit; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11622,CPT,Professional,Both,,,,505,429.25,106.45,505,Aetna,Commercial,429.25,85,,percent of total billed charges,,
"Excision,Malignant Lesion Inc Margin,Scalp,Nk,Hds,Ft,Genit; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11622,CPT,Professional,Both,,,,505,429.25,106.45,505,Aetna,Medicare Advantage,165.76,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision,Malignant Lesion Inc Margin,Scalp,Nk,Hds,Ft,Genit; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11622,CPT,Professional,Both,,,,505,429.25,106.45,505,Aetna,PPO,469.65,93,,percent of total billed charges,,
"Excision,Malignant Lesion Inc Margin,Scalp,Nk,Hds,Ft,Genit; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11622,CPT,Professional,Both,,,,505,429.25,106.45,505,America's PPO,America's PPO,431.472,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Excision,Malignant Lesion Inc Margin,Scalp,Nk,Hds,Ft,Genit; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11622,CPT,Professional,Both,,,,505,429.25,106.45,505,BlueCross BlueShield Minnesota, Federal Employee Program,345.68,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Excision,Malignant Lesion Inc Margin,Scalp,Nk,Hds,Ft,Genit; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11622,CPT,Professional,Both,,,,505,429.25,106.45,505,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,351.21088,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision,Malignant Lesion Inc Margin,Scalp,Nk,Hds,Ft,Genit; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11622,CPT,Professional,Both,,,,505,429.25,106.45,505,BlueCross BlueShield Minnesota,High Value Network Plan,351.21088,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision,Malignant Lesion Inc Margin,Scalp,Nk,Hds,Ft,Genit; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11622,CPT,Professional,Both,,,,505,429.25,106.45,505,BlueCross BlueShield Minnesota,Medicare Advantage,190.2675,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision,Malignant Lesion Inc Margin,Scalp,Nk,Hds,Ft,Genit; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11622,CPT,Professional,Both,,,,505,429.25,106.45,505,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,351.21088,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision,Malignant Lesion Inc Margin,Scalp,Nk,Hds,Ft,Genit; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11622,CPT,Professional,Both,,,,505,429.25,106.45,505,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,122.90552,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision,Malignant Lesion Inc Margin,Scalp,Nk,Hds,Ft,Genit; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11622,CPT,Professional,Both,,,,505,429.25,106.45,505,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),190.2675,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision,Malignant Lesion Inc Margin,Scalp,Nk,Hds,Ft,Genit; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11622,CPT,Professional,Both,,,,505,429.25,106.45,505,CorVel,Worker's Compensation,321.3788952,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Excision,Malignant Lesion Inc Margin,Scalp,Nk,Hds,Ft,Genit; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11622,CPT,Professional,Both,,,,505,429.25,106.45,505,First Health Group Corporation,First Health Network,489.85,97,,percent of total billed charges,,
"Excision,Malignant Lesion Inc Margin,Scalp,Nk,Hds,Ft,Genit; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11622,CPT,Professional,Both,,,,505,429.25,106.45,505,"Health Partners, Inc.",Commercial,347.52,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision,Malignant Lesion Inc Margin,Scalp,Nk,Hds,Ft,Genit; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11622,CPT,Professional,Both,,,,505,429.25,106.45,505,"Health Partners, Inc.",Medicare Advantage,190.2675,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision,Malignant Lesion Inc Margin,Scalp,Nk,Hds,Ft,Genit; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11622,CPT,Professional,Both,,,,505,429.25,106.45,505,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),165.37,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Excision,Malignant Lesion Inc Margin,Scalp,Nk,Hds,Ft,Genit; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11622,CPT,Professional,Both,,,,505,429.25,106.45,505,"Health Partners, Inc.",State of Minnesota Advantage Program,299.38848,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision,Malignant Lesion Inc Margin,Scalp,Nk,Hds,Ft,Genit; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11622,CPT,Professional,Both,,,,505,429.25,106.45,505,"Health Partners, Inc.",State Public Programs,106.45,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Excision,Malignant Lesion Inc Margin,Scalp,Nk,Hds,Ft,Genit; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11622,CPT,Professional,Both,,,,505,429.25,106.45,505,Humana Insurance Company,Commercial PPO,165.45,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Excision,Malignant Lesion Inc Margin,Scalp,Nk,Hds,Ft,Genit; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11622,CPT,Professional,Both,,,,505,429.25,106.45,505,Humana Insurance Company,Medicare PPO,505,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Excision,Malignant Lesion Inc Margin,Scalp,Nk,Hds,Ft,Genit; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11622,CPT,Professional,Both,,,,505,429.25,106.45,505,Medica,Individual & Family,428.24,84.8,,percent of total billed charges,,
"Excision,Malignant Lesion Inc Margin,Scalp,Nk,Hds,Ft,Genit; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11622,CPT,Professional,Both,,,,505,429.25,106.45,505,Medica,Medica Advantage Solution,251.49,49.8,,percent of total billed charges,,
"Excision,Malignant Lesion Inc Margin,Scalp,Nk,Hds,Ft,Genit; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11622,CPT,Professional,Both,,,,505,429.25,106.45,505,Medica,Medical Assistance,122.91,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Excision,Malignant Lesion Inc Margin,Scalp,Nk,Hds,Ft,Genit; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11622,CPT,Professional,Both,,,,505,429.25,106.45,505,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,165.45,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Excision,Malignant Lesion Inc Margin,Scalp,Nk,Hds,Ft,Genit; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11622,CPT,Professional,Both,,,,505,429.25,106.45,505,"Multiplan, Inc.","Multiplan, Inc.",474.7,94,,percent of total billed charges,,
"Excision,Malignant Lesion Inc Margin,Scalp,Nk,Hds,Ft,Genit; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11622,CPT,Professional,Both,,,,505,429.25,106.45,505,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,455.005,90.1,,percent of total billed charges,,
"Excision,Malignant Lesion Inc Margin,Scalp,Nk,Hds,Ft,Genit; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11622,CPT,Professional,Both,,,,505,429.25,106.45,505,"Preferred One Administrative Services, INC.",PPO,497.93,98.6,,percent of total billed charges,,
"Excision,Malignant Lesion Inc Margin,Scalp,Nk,Hds,Ft,Genit; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11622,CPT,Professional,Both,,,,505,429.25,106.45,505,PrimeWest Health,Minnesota Senior Health Options (MSHO),190.2675,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision,Malignant Lesion Inc Margin,Scalp,Nk,Hds,Ft,Genit; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11622,CPT,Professional,Both,,,,505,429.25,106.45,505,PrimeWest Health,MinnesotaCare,131.5089064,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision,Malignant Lesion Inc Margin,Scalp,Nk,Hds,Ft,Genit; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11622,CPT,Professional,Both,,,,505,429.25,106.45,505,Sanford Health Plan,Sanford Health Plan,444.4,88,,percent of total billed charges,,
"Excision,Malignant Lesion Inc Margin,Scalp,Nk,Hds,Ft,Genit; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11622,CPT,Professional,Both,,,,505,429.25,106.45,505,"UCare Health, Inc.",Individual & Family Plan,268.95552,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Excision,Malignant Lesion Inc Margin,Scalp,Nk,Hds,Ft,Genit; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11622,CPT,Professional,Both,,,,505,429.25,106.45,505,"UCare Health, Inc.",Medical Assistance,135.196072,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Excision,Malignant Lesion Inc Margin,Scalp,Nk,Hds,Ft,Genit; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11622,CPT,Professional,Both,,,,505,429.25,106.45,505,"UCare Health, Inc.",Medicare Advantage,190.2675,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Excision,Malignant Lesion Inc Margin,Scalp,Nk,Hds,Ft,Genit; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11622,CPT,Professional,Both,,,,505,429.25,106.45,505,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),152.214,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Excision,Malignant Lesion Inc Margin,Scalp,Nk,Hds,Ft,Genit; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11622,CPT,Professional,Both,,,,505,429.25,106.45,505,UnitedHealthcare,Individual & Family,505,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Excision,Malignant Lesion Inc Margin,Scalp,Nk,Hds,Ft,Genit; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11622,CPT,Professional,Both,,,,505,429.25,106.45,505,UnitedHealthcare,Medicare Advantage,190.2675,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision,Malignant Lesion Inc Margin,Scalp,Nk,Hds,Ft,Genit; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11622,CPT,Professional,Both,,,,505,429.25,106.45,505,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,122.90552,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision, Malignant Lesion 2.1 To 3.0 Cm (Pbb)",,11623,CPT,Facility,Outpatient,,,,638,542.3,182.8508,638,Aetna,Commercial,586.96,92,,percent of total billed charges,,
"Excision, Malignant Lesion 2.1 To 3.0 Cm (Pbb)",,11623,CPT,Professional,Outpatient,,,,653,555.05,130.89,653,Aetna,Commercial,555.05,85,,percent of total billed charges,,
"Excision, Malignant Lesion 2.1 To 3.0 Cm (Pbb)",,11623,CPT,Facility,Outpatient,,,,638,542.3,182.8508,638,Aetna,Medicare Advantage,312.62,49,,percent of total billed charges,,
"Excision, Malignant Lesion 2.1 To 3.0 Cm (Pbb)",,11623,CPT,Professional,Outpatient,,,,653,555.05,130.89,653,Aetna,Medicare Advantage,204.75,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion 2.1 To 3.0 Cm (Pbb)",,11623,CPT,Facility,Outpatient,,,,638,542.3,182.8508,638,Aetna,PPO,593.34,93,,percent of total billed charges,,
"Excision, Malignant Lesion 2.1 To 3.0 Cm (Pbb)",,11623,CPT,Professional,Outpatient,,,,653,555.05,130.89,653,Aetna,PPO,607.29,93,,percent of total billed charges,,
"Excision, Malignant Lesion 2.1 To 3.0 Cm (Pbb)",,11623,CPT,Facility,Outpatient,,,,638,542.3,182.8508,638,America's PPO,America's PPO,612.6714,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Excision, Malignant Lesion 2.1 To 3.0 Cm (Pbb)",,11623,CPT,Professional,Outpatient,,,,653,555.05,130.89,653,America's PPO,America's PPO,557.9232,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Excision, Malignant Lesion 2.1 To 3.0 Cm (Pbb)",,11623,CPT,Facility,Outpatient,,,,638,542.3,182.8508,638,BlueCross BlueShield Minnesota, Federal Employee Program,627.792,98.4,,percent of total billed charges,,
"Excision, Malignant Lesion 2.1 To 3.0 Cm (Pbb)",,11623,CPT,Professional,Outpatient,,,,653,555.05,130.89,653,BlueCross BlueShield Minnesota, Federal Employee Program,428.31,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Excision, Malignant Lesion 2.1 To 3.0 Cm (Pbb)",,11623,CPT,Facility,Outpatient,,,,638,542.3,182.8508,638,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,638,100,,percent of total billed charges,,
"Excision, Malignant Lesion 2.1 To 3.0 Cm (Pbb)",,11623,CPT,Professional,Outpatient,,,,653,555.05,130.89,653,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,435.16296,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Malignant Lesion 2.1 To 3.0 Cm (Pbb)",,11623,CPT,Facility,Outpatient,,,,638,542.3,182.8508,638,BlueCross BlueShield Minnesota,High Value Network Plan,574.2,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
"Excision, Malignant Lesion 2.1 To 3.0 Cm (Pbb)",,11623,CPT,Professional,Outpatient,,,,653,555.05,130.89,653,BlueCross BlueShield Minnesota,High Value Network Plan,435.16296,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Malignant Lesion 2.1 To 3.0 Cm (Pbb)",,11623,CPT,Facility,Outpatient,,,,638,542.3,182.8508,638,BlueCross BlueShield Minnesota,Medicare Advantage,312.62,49,,percent of total billed charges,,
"Excision, Malignant Lesion 2.1 To 3.0 Cm (Pbb)",,11623,CPT,Professional,Outpatient,,,,653,555.05,130.89,653,BlueCross BlueShield Minnesota,Medicare Advantage,233.8985,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion 2.1 To 3.0 Cm (Pbb)",,11623,CPT,Professional,Outpatient,,,,653,555.05,130.89,653,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,435.16296,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Malignant Lesion 2.1 To 3.0 Cm (Pbb)",,11623,CPT,Facility,Outpatient,,,,638,542.3,182.8508,638,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,182.8508,28.66,,percent of total billed charges,,
"Excision, Malignant Lesion 2.1 To 3.0 Cm (Pbb)",,11623,CPT,Professional,Outpatient,,,,653,555.05,130.89,653,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,151.11984,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision, Malignant Lesion 2.1 To 3.0 Cm (Pbb)",,11623,CPT,Facility,Outpatient,,,,638,542.3,182.8508,638,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),312.62,49,,percent of total billed charges,,
"Excision, Malignant Lesion 2.1 To 3.0 Cm (Pbb)",,11623,CPT,Professional,Outpatient,,,,653,555.05,130.89,653,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),233.8985,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion 2.1 To 3.0 Cm (Pbb)",,11623,CPT,Facility,Outpatient,,,,638,542.3,182.8508,638,CorVel,Worker's Compensation,638,100,,percent of total billed charges,,
"Excision, Malignant Lesion 2.1 To 3.0 Cm (Pbb)",,11623,CPT,Professional,Outpatient,,,,653,555.05,130.89,653,CorVel,Worker's Compensation,395.738772,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Excision, Malignant Lesion 2.1 To 3.0 Cm (Pbb)",,11623,CPT,Facility,Outpatient,,,,638,542.3,182.8508,638,First Health Group Corporation,First Health Network,618.86,97,,percent of total billed charges,,
"Excision, Malignant Lesion 2.1 To 3.0 Cm (Pbb)",,11623,CPT,Professional,Outpatient,,,,653,555.05,130.89,653,First Health Group Corporation,First Health Network,633.41,97,,percent of total billed charges,,
"Excision, Malignant Lesion 2.1 To 3.0 Cm (Pbb)",,11623,CPT,Facility,Outpatient,,,,638,542.3,182.8508,638,"Health Partners, Inc.",Commercial,603.548,94.6,,percent of total billed charges,,
"Excision, Malignant Lesion 2.1 To 3.0 Cm (Pbb)",,11623,CPT,Professional,Outpatient,,,,653,555.05,130.89,653,"Health Partners, Inc.",Commercial,427.33,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision, Malignant Lesion 2.1 To 3.0 Cm (Pbb)",,11623,CPT,Facility,Outpatient,,,,638,542.3,182.8508,638,"Health Partners, Inc.",Medicare Advantage,312.62,49,,percent of total billed charges,,
"Excision, Malignant Lesion 2.1 To 3.0 Cm (Pbb)",,11623,CPT,Professional,Outpatient,,,,653,555.05,130.89,653,"Health Partners, Inc.",Medicare Advantage,233.8985,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion 2.1 To 3.0 Cm (Pbb)",,11623,CPT,Facility,Outpatient,,,,638,542.3,182.8508,638,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),382.8,60,,percent of total billed charges,,
"Excision, Malignant Lesion 2.1 To 3.0 Cm (Pbb)",,11623,CPT,Professional,Outpatient,,,,653,555.05,130.89,653,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),203.32,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Excision, Malignant Lesion 2.1 To 3.0 Cm (Pbb)",,11623,CPT,Facility,Outpatient,,,,638,542.3,182.8508,638,"Health Partners, Inc.",State of Minnesota Advantage Program,519.97,81.5,,percent of total billed charges,,
"Excision, Malignant Lesion 2.1 To 3.0 Cm (Pbb)",,11623,CPT,Professional,Outpatient,,,,653,555.05,130.89,653,"Health Partners, Inc.",State of Minnesota Advantage Program,368.144795,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision, Malignant Lesion 2.1 To 3.0 Cm (Pbb)",,11623,CPT,Facility,Outpatient,,,,638,542.3,182.8508,638,"Health Partners, Inc.",State Public Programs,319,50,,percent of total billed charges,,
"Excision, Malignant Lesion 2.1 To 3.0 Cm (Pbb)",,11623,CPT,Professional,Outpatient,,,,653,555.05,130.89,653,"Health Partners, Inc.",State Public Programs,130.89,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Excision, Malignant Lesion 2.1 To 3.0 Cm (Pbb)",,11623,CPT,Facility,Outpatient,,,,638,542.3,182.8508,638,Humana Insurance Company,Commercial PPO,606.1,95,,percent of total billed charges,,
"Excision, Malignant Lesion 2.1 To 3.0 Cm (Pbb)",,11623,CPT,Professional,Outpatient,,,,653,555.05,130.89,653,Humana Insurance Company,Commercial PPO,203.39,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Excision, Malignant Lesion 2.1 To 3.0 Cm (Pbb)",,11623,CPT,Facility,Outpatient,,,,638,542.3,182.8508,638,Humana Insurance Company,Medicare PPO,312.62,49,,percent of total billed charges,,
"Excision, Malignant Lesion 2.1 To 3.0 Cm (Pbb)",,11623,CPT,Professional,Outpatient,,,,653,555.05,130.89,653,Humana Insurance Company,Medicare PPO,653,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion 2.1 To 3.0 Cm (Pbb)",,11623,CPT,Facility,Outpatient,,,,638,542.3,182.8508,638,Medica,Individual & Family,632.258,99.1,,percent of total billed charges,,
"Excision, Malignant Lesion 2.1 To 3.0 Cm (Pbb)",,11623,CPT,Professional,Outpatient,,,,653,555.05,130.89,653,Medica,Individual & Family,553.744,84.8,,percent of total billed charges,,
"Excision, Malignant Lesion 2.1 To 3.0 Cm (Pbb)",,11623,CPT,Facility,Outpatient,,,,638,542.3,182.8508,638,Medica,Medica Advantage Solution,317.724,49.8,,percent of total billed charges,,
"Excision, Malignant Lesion 2.1 To 3.0 Cm (Pbb)",,11623,CPT,Professional,Outpatient,,,,653,555.05,130.89,653,Medica,Medica Advantage Solution,325.194,49.8,,percent of total billed charges,,
"Excision, Malignant Lesion 2.1 To 3.0 Cm (Pbb)",,11623,CPT,Facility,Outpatient,,,,638,542.3,182.8508,638,Medica,Medical Assistance,284.548,44.6,,percent of total billed charges,,
"Excision, Malignant Lesion 2.1 To 3.0 Cm (Pbb)",,11623,CPT,Professional,Outpatient,,,,653,555.05,130.89,653,Medica,Medical Assistance,151.12,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Excision, Malignant Lesion 2.1 To 3.0 Cm (Pbb)",,11623,CPT,Facility,Outpatient,,,,638,542.3,182.8508,638,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,317.724,49.8,,percent of total billed charges,,
"Excision, Malignant Lesion 2.1 To 3.0 Cm (Pbb)",,11623,CPT,Professional,Outpatient,,,,653,555.05,130.89,653,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,203.39,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Excision, Malignant Lesion 2.1 To 3.0 Cm (Pbb)",,11623,CPT,Facility,Outpatient,,,,638,542.3,182.8508,638,"Multiplan, Inc.","Multiplan, Inc.",599.72,94,,percent of total billed charges,,
"Excision, Malignant Lesion 2.1 To 3.0 Cm (Pbb)",,11623,CPT,Professional,Outpatient,,,,653,555.05,130.89,653,"Multiplan, Inc.","Multiplan, Inc.",613.82,94,,percent of total billed charges,,
"Excision, Malignant Lesion 2.1 To 3.0 Cm (Pbb)",,11623,CPT,Facility,Outpatient,,,,638,542.3,182.8508,638,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,574.838,90.1,,percent of total billed charges,,
"Excision, Malignant Lesion 2.1 To 3.0 Cm (Pbb)",,11623,CPT,Professional,Outpatient,,,,653,555.05,130.89,653,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,588.353,90.1,,percent of total billed charges,,
"Excision, Malignant Lesion 2.1 To 3.0 Cm (Pbb)",,11623,CPT,Facility,Outpatient,,,,638,542.3,182.8508,638,"Preferred One Administrative Services, INC.",PPO,629.068,98.6,,percent of total billed charges,,
"Excision, Malignant Lesion 2.1 To 3.0 Cm (Pbb)",,11623,CPT,Professional,Outpatient,,,,653,555.05,130.89,653,"Preferred One Administrative Services, INC.",PPO,643.858,98.6,,percent of total billed charges,,
"Excision, Malignant Lesion 2.1 To 3.0 Cm (Pbb)",,11623,CPT,Facility,Outpatient,,,,638,542.3,182.8508,638,PrimeWest Health,Minnesota Senior Health Options (MSHO),328.251,51.45,,percent of total billed charges,,
"Excision, Malignant Lesion 2.1 To 3.0 Cm (Pbb)",,11623,CPT,Professional,Outpatient,,,,653,555.05,130.89,653,PrimeWest Health,Minnesota Senior Health Options (MSHO),233.8985,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion 2.1 To 3.0 Cm (Pbb)",,11623,CPT,Facility,Outpatient,,,,638,542.3,182.8508,638,PrimeWest Health,MinnesotaCare,327.6768,51.36,,percent of total billed charges,,
"Excision, Malignant Lesion 2.1 To 3.0 Cm (Pbb)",,11623,CPT,Professional,Outpatient,,,,653,555.05,130.89,653,PrimeWest Health,MinnesotaCare,161.6982288,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision, Malignant Lesion 2.1 To 3.0 Cm (Pbb)",,11623,CPT,Facility,Outpatient,,,,638,542.3,182.8508,638,Sanford Health Plan,Sanford Health Plan,586.96,92,,percent of total billed charges,,
"Excision, Malignant Lesion 2.1 To 3.0 Cm (Pbb)",,11623,CPT,Professional,Outpatient,,,,653,555.05,130.89,653,Sanford Health Plan,Sanford Health Plan,574.64,88,,percent of total billed charges,,
"Excision, Malignant Lesion 2.1 To 3.0 Cm (Pbb)",,11623,CPT,Facility,Outpatient,,,,638,542.3,182.8508,638,"UCare Health, Inc.",Individual & Family Plan,359.513,56.35,,percent of total billed charges,,
"Excision, Malignant Lesion 2.1 To 3.0 Cm (Pbb)",,11623,CPT,Professional,Outpatient,,,,653,555.05,130.89,653,"UCare Health, Inc.",Individual & Family Plan,330.630784,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Excision, Malignant Lesion 2.1 To 3.0 Cm (Pbb)",,11623,CPT,Facility,Outpatient,,,,638,542.3,182.8508,638,"UCare Health, Inc.",Medical Assistance,321.9986,50.47,,percent of total billed charges,,
"Excision, Malignant Lesion 2.1 To 3.0 Cm (Pbb)",,11623,CPT,Professional,Outpatient,,,,653,555.05,130.89,653,"UCare Health, Inc.",Medical Assistance,166.231824,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Excision, Malignant Lesion 2.1 To 3.0 Cm (Pbb)",,11623,CPT,Facility,Outpatient,,,,638,542.3,182.8508,638,"UCare Health, Inc.",Medicare Advantage,321.9986,50.47,,percent of total billed charges,,
"Excision, Malignant Lesion 2.1 To 3.0 Cm (Pbb)",,11623,CPT,Professional,Outpatient,,,,653,555.05,130.89,653,"UCare Health, Inc.",Medicare Advantage,233.8985,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Excision, Malignant Lesion 2.1 To 3.0 Cm (Pbb)",,11623,CPT,Facility,Outpatient,,,,638,542.3,182.8508,638,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),321.9986,50.47,,percent of total billed charges,,
"Excision, Malignant Lesion 2.1 To 3.0 Cm (Pbb)",,11623,CPT,Professional,Outpatient,,,,653,555.05,130.89,653,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),187.1188,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Excision, Malignant Lesion 2.1 To 3.0 Cm (Pbb)",,11623,CPT,Facility,Outpatient,,,,638,542.3,182.8508,638,UnitedHealthcare,Individual & Family,599.72,94,,percent of total billed charges,,
"Excision, Malignant Lesion 2.1 To 3.0 Cm (Pbb)",,11623,CPT,Professional,Outpatient,,,,653,555.05,130.89,653,UnitedHealthcare,Individual & Family,653,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Excision, Malignant Lesion 2.1 To 3.0 Cm (Pbb)",,11623,CPT,Facility,Outpatient,,,,638,542.3,182.8508,638,UnitedHealthcare,Medicare Advantage,312.62,49,,percent of total billed charges,,
"Excision, Malignant Lesion 2.1 To 3.0 Cm (Pbb)",,11623,CPT,Professional,Outpatient,,,,653,555.05,130.89,653,UnitedHealthcare,Medicare Advantage,233.8985,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion 2.1 To 3.0 Cm (Pbb)",,11623,CPT,Facility,Outpatient,,,,638,542.3,182.8508,638,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,306.24,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Excision, Malignant Lesion 2.1 To 3.0 Cm (Pbb)",,11623,CPT,Professional,Outpatient,,,,653,555.05,130.89,653,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,151.11984,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision, Malignant Lesion Margins, Scalp, Neck, Hands, Ft, Genitalia; Excised Dia 2.1 To 3.0 Cm",,11623,CPT,Facility,Both,,,,370,314.5,106.042,449,Aetna,Commercial,340.4,92,,percent of total billed charges,,
"Excision, Malignant Lesion Margins, Scalp, Neck, Hands, Ft, Genitalia; Excised Dia 2.1 To 3.0 Cm",,11623,CPT,Facility,Outpatient,,,,370,314.5,106.042,449,Aetna,Medicare Advantage,181.3,49,,percent of total billed charges,,
"Excision, Malignant Lesion Margins, Scalp, Neck, Hands, Ft, Genitalia; Excised Dia 2.1 To 3.0 Cm",,11623,CPT,Facility,Inpatient,,,,370,314.5,106.042,449,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Excision, Malignant Lesion Margins, Scalp, Neck, Hands, Ft, Genitalia; Excised Dia 2.1 To 3.0 Cm",,11623,CPT,Facility,Both,,,,370,314.5,106.042,449,Aetna,PPO,344.1,93,,percent of total billed charges,,
"Excision, Malignant Lesion Margins, Scalp, Neck, Hands, Ft, Genitalia; Excised Dia 2.1 To 3.0 Cm",,11623,CPT,Facility,Both,,,,370,314.5,106.042,449,America's PPO,America's PPO,355.311,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Excision, Malignant Lesion Margins, Scalp, Neck, Hands, Ft, Genitalia; Excised Dia 2.1 To 3.0 Cm",,11623,CPT,Facility,Both,,,,370,314.5,106.042,449,BlueCross BlueShield Minnesota, Federal Employee Program,364.08,98.4,,percent of total billed charges,,
"Excision, Malignant Lesion Margins, Scalp, Neck, Hands, Ft, Genitalia; Excised Dia 2.1 To 3.0 Cm",,11623,CPT,Facility,Both,,,,370,314.5,106.042,449,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,370,100,,percent of total billed charges,,
"Excision, Malignant Lesion Margins, Scalp, Neck, Hands, Ft, Genitalia; Excised Dia 2.1 To 3.0 Cm",,11623,CPT,Facility,Both,,,,370,314.5,106.042,449,BlueCross BlueShield Minnesota,High Value Network Plan,333,90,,percent of total billed charges,,
"Excision, Malignant Lesion Margins, Scalp, Neck, Hands, Ft, Genitalia; Excised Dia 2.1 To 3.0 Cm",,11623,CPT,Facility,Outpatient,,,,370,314.5,106.042,449,BlueCross BlueShield Minnesota,Medicare Advantage,181.3,49,,percent of total billed charges,,
"Excision, Malignant Lesion Margins, Scalp, Neck, Hands, Ft, Genitalia; Excised Dia 2.1 To 3.0 Cm",,11623,CPT,Facility,Inpatient,,,,370,314.5,106.042,449,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Excision, Malignant Lesion Margins, Scalp, Neck, Hands, Ft, Genitalia; Excised Dia 2.1 To 3.0 Cm",,11623,CPT,Facility,Both,,,,370,314.5,106.042,449,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,327.709,88.57,,percent of total billed charges,,
"Excision, Malignant Lesion Margins, Scalp, Neck, Hands, Ft, Genitalia; Excised Dia 2.1 To 3.0 Cm",,11623,CPT,Facility,Both,,,,370,314.5,106.042,449,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,106.042,28.66,,percent of total billed charges,,
"Excision, Malignant Lesion Margins, Scalp, Neck, Hands, Ft, Genitalia; Excised Dia 2.1 To 3.0 Cm",,11623,CPT,Facility,Outpatient,,,,370,314.5,106.042,449,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),181.3,49,,percent of total billed charges,,
"Excision, Malignant Lesion Margins, Scalp, Neck, Hands, Ft, Genitalia; Excised Dia 2.1 To 3.0 Cm",,11623,CPT,Facility,Inpatient,,,,370,314.5,106.042,449,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Excision, Malignant Lesion Margins, Scalp, Neck, Hands, Ft, Genitalia; Excised Dia 2.1 To 3.0 Cm",,11623,CPT,Facility,Both,,,,370,314.5,106.042,449,CorVel,Worker's Compensation,370,100,,percent of total billed charges,,
"Excision, Malignant Lesion Margins, Scalp, Neck, Hands, Ft, Genitalia; Excised Dia 2.1 To 3.0 Cm",,11623,CPT,Facility,Both,,,,370,314.5,106.042,449,First Health Group Corporation,First Health Network,358.9,97,,percent of total billed charges,,
"Excision, Malignant Lesion Margins, Scalp, Neck, Hands, Ft, Genitalia; Excised Dia 2.1 To 3.0 Cm",,11623,CPT,Facility,Both,,,,370,314.5,106.042,449,"Health Partners, Inc.",Commercial,350.02,94.6,,percent of total billed charges,,
"Excision, Malignant Lesion Margins, Scalp, Neck, Hands, Ft, Genitalia; Excised Dia 2.1 To 3.0 Cm",,11623,CPT,Facility,Outpatient,,,,370,314.5,106.042,449,"Health Partners, Inc.",Medicare Advantage,181.3,49,,percent of total billed charges,,
"Excision, Malignant Lesion Margins, Scalp, Neck, Hands, Ft, Genitalia; Excised Dia 2.1 To 3.0 Cm",,11623,CPT,Facility,Inpatient,,,,370,314.5,106.042,449,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Excision, Malignant Lesion Margins, Scalp, Neck, Hands, Ft, Genitalia; Excised Dia 2.1 To 3.0 Cm",,11623,CPT,Facility,Both,,,,370,314.5,106.042,449,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),222,60,,percent of total billed charges,,
"Excision, Malignant Lesion Margins, Scalp, Neck, Hands, Ft, Genitalia; Excised Dia 2.1 To 3.0 Cm",,11623,CPT,Facility,Both,,,,370,314.5,106.042,449,"Health Partners, Inc.",State of Minnesota Advantage Program,301.55,81.5,,percent of total billed charges,,
"Excision, Malignant Lesion Margins, Scalp, Neck, Hands, Ft, Genitalia; Excised Dia 2.1 To 3.0 Cm",,11623,CPT,Facility,Both,,,,370,314.5,106.042,449,"Health Partners, Inc.",State Public Programs,185,50,,percent of total billed charges,,
"Excision, Malignant Lesion Margins, Scalp, Neck, Hands, Ft, Genitalia; Excised Dia 2.1 To 3.0 Cm",,11623,CPT,Facility,Both,,,,370,314.5,106.042,449,Humana Insurance Company,Commercial PPO,351.5,95,,percent of total billed charges,,
"Excision, Malignant Lesion Margins, Scalp, Neck, Hands, Ft, Genitalia; Excised Dia 2.1 To 3.0 Cm",,11623,CPT,Facility,Outpatient,,,,370,314.5,106.042,449,Humana Insurance Company,Medicare PPO,181.3,49,,percent of total billed charges,,
"Excision, Malignant Lesion Margins, Scalp, Neck, Hands, Ft, Genitalia; Excised Dia 2.1 To 3.0 Cm",,11623,CPT,Facility,Inpatient,,,,370,314.5,106.042,449,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Excision, Malignant Lesion Margins, Scalp, Neck, Hands, Ft, Genitalia; Excised Dia 2.1 To 3.0 Cm",,11623,CPT,Facility,Both,,,,370,314.5,106.042,449,Medica,Individual & Family,366.67,99.1,,percent of total billed charges,,
"Excision, Malignant Lesion Margins, Scalp, Neck, Hands, Ft, Genitalia; Excised Dia 2.1 To 3.0 Cm",,11623,CPT,Facility,Outpatient,,,,370,314.5,106.042,449,Medica,Medica Advantage Solution,184.26,49.8,,percent of total billed charges,,
"Excision, Malignant Lesion Margins, Scalp, Neck, Hands, Ft, Genitalia; Excised Dia 2.1 To 3.0 Cm",,11623,CPT,Facility,Inpatient,,,,370,314.5,106.042,449,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Excision, Malignant Lesion Margins, Scalp, Neck, Hands, Ft, Genitalia; Excised Dia 2.1 To 3.0 Cm",,11623,CPT,Facility,Outpatient,,,,370,314.5,106.042,449,Medica,Medical Assistance,449,,,Other,Grouper,All inclusive per visit
"Excision, Malignant Lesion Margins, Scalp, Neck, Hands, Ft, Genitalia; Excised Dia 2.1 To 3.0 Cm",,11623,CPT,Facility,Inpatient,,,,370,314.5,106.042,449,Medica,Medical Assistance,,,,,Included in per diem rate,
"Excision, Malignant Lesion Margins, Scalp, Neck, Hands, Ft, Genitalia; Excised Dia 2.1 To 3.0 Cm",,11623,CPT,Facility,Outpatient,,,,370,314.5,106.042,449,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,184.26,49.8,,percent of total billed charges,,
"Excision, Malignant Lesion Margins, Scalp, Neck, Hands, Ft, Genitalia; Excised Dia 2.1 To 3.0 Cm",,11623,CPT,Facility,Inpatient,,,,370,314.5,106.042,449,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Excision, Malignant Lesion Margins, Scalp, Neck, Hands, Ft, Genitalia; Excised Dia 2.1 To 3.0 Cm",,11623,CPT,Facility,Both,,,,370,314.5,106.042,449,"Multiplan, Inc.","Multiplan, Inc.",347.8,94,,percent of total billed charges,,
"Excision, Malignant Lesion Margins, Scalp, Neck, Hands, Ft, Genitalia; Excised Dia 2.1 To 3.0 Cm",,11623,CPT,Facility,Outpatient,,,,370,314.5,106.042,449,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,333.37,90.1,,percent of total billed charges,,
"Excision, Malignant Lesion Margins, Scalp, Neck, Hands, Ft, Genitalia; Excised Dia 2.1 To 3.0 Cm",,11623,CPT,Facility,Inpatient,,,,370,314.5,106.042,449,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Excision, Malignant Lesion Margins, Scalp, Neck, Hands, Ft, Genitalia; Excised Dia 2.1 To 3.0 Cm",,11623,CPT,Facility,Both,,,,370,314.5,106.042,449,"Preferred One Administrative Services, INC.",PPO,364.82,98.6,,percent of total billed charges,,
"Excision, Malignant Lesion Margins, Scalp, Neck, Hands, Ft, Genitalia; Excised Dia 2.1 To 3.0 Cm",,11623,CPT,Facility,Outpatient,,,,370,314.5,106.042,449,PrimeWest Health,Minnesota Senior Health Options (MSHO),190.365,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Excision, Malignant Lesion Margins, Scalp, Neck, Hands, Ft, Genitalia; Excised Dia 2.1 To 3.0 Cm",,11623,CPT,Facility,Inpatient,,,,370,314.5,106.042,449,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Excision, Malignant Lesion Margins, Scalp, Neck, Hands, Ft, Genitalia; Excised Dia 2.1 To 3.0 Cm",,11623,CPT,Facility,Outpatient,,,,370,314.5,106.042,449,PrimeWest Health,MinnesotaCare,190.032,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Excision, Malignant Lesion Margins, Scalp, Neck, Hands, Ft, Genitalia; Excised Dia 2.1 To 3.0 Cm",,11623,CPT,Facility,Inpatient,,,,370,314.5,106.042,449,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Excision, Malignant Lesion Margins, Scalp, Neck, Hands, Ft, Genitalia; Excised Dia 2.1 To 3.0 Cm",,11623,CPT,Facility,Both,,,,370,314.5,106.042,449,Sanford Health Plan,Sanford Health Plan,340.4,92,,percent of total billed charges,,
"Excision, Malignant Lesion Margins, Scalp, Neck, Hands, Ft, Genitalia; Excised Dia 2.1 To 3.0 Cm",,11623,CPT,Facility,Outpatient,,,,370,314.5,106.042,449,"UCare Health, Inc.",Individual & Family Plan,208.495,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Excision, Malignant Lesion Margins, Scalp, Neck, Hands, Ft, Genitalia; Excised Dia 2.1 To 3.0 Cm",,11623,CPT,Facility,Inpatient,,,,370,314.5,106.042,449,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Excision, Malignant Lesion Margins, Scalp, Neck, Hands, Ft, Genitalia; Excised Dia 2.1 To 3.0 Cm",,11623,CPT,Facility,Outpatient,,,,370,314.5,106.042,449,"UCare Health, Inc.",Medical Assistance,186.739,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Excision, Malignant Lesion Margins, Scalp, Neck, Hands, Ft, Genitalia; Excised Dia 2.1 To 3.0 Cm",,11623,CPT,Facility,Inpatient,,,,370,314.5,106.042,449,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Excision, Malignant Lesion Margins, Scalp, Neck, Hands, Ft, Genitalia; Excised Dia 2.1 To 3.0 Cm",,11623,CPT,Facility,Outpatient,,,,370,314.5,106.042,449,"UCare Health, Inc.",Medicare Advantage,186.739,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Excision, Malignant Lesion Margins, Scalp, Neck, Hands, Ft, Genitalia; Excised Dia 2.1 To 3.0 Cm",,11623,CPT,Facility,Inpatient,,,,370,314.5,106.042,449,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Excision, Malignant Lesion Margins, Scalp, Neck, Hands, Ft, Genitalia; Excised Dia 2.1 To 3.0 Cm",,11623,CPT,Facility,Outpatient,,,,370,314.5,106.042,449,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),186.739,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Excision, Malignant Lesion Margins, Scalp, Neck, Hands, Ft, Genitalia; Excised Dia 2.1 To 3.0 Cm",,11623,CPT,Facility,Inpatient,,,,370,314.5,106.042,449,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Excision, Malignant Lesion Margins, Scalp, Neck, Hands, Ft, Genitalia; Excised Dia 2.1 To 3.0 Cm",,11623,CPT,Facility,Both,,,,370,314.5,106.042,449,UnitedHealthcare,Individual & Family,347.8,94,,percent of total billed charges,,
"Excision, Malignant Lesion Margins, Scalp, Neck, Hands, Ft, Genitalia; Excised Dia 2.1 To 3.0 Cm",,11623,CPT,Facility,Outpatient,,,,370,314.5,106.042,449,UnitedHealthcare,Medicare Advantage,181.3,49,,percent of total billed charges,,
"Excision, Malignant Lesion Margins, Scalp, Neck, Hands, Ft, Genitalia; Excised Dia 2.1 To 3.0 Cm",,11623,CPT,Facility,Inpatient,,,,370,314.5,106.042,449,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Excision, Malignant Lesion Margins, Scalp, Neck, Hands, Ft, Genitalia; Excised Dia 2.1 To 3.0 Cm",,11623,CPT,Facility,Outpatient,,,,370,314.5,106.042,449,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,177.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Excision, Malignant Lesion Margins, Scalp, Neck, Hands, Ft, Genitalia; Excised Dia 2.1 To 3.0 Cm",,11623,CPT,Facility,Inpatient,,,,370,314.5,106.042,449,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Excision, Malignant Lesion Scalp, Neck,Hand,Feet,Genitalia;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11623,CPT,Professional,Both,,,,1291,1097.35,130.89,1291,Aetna,Commercial,1097.35,85,,percent of total billed charges,,
"Excision, Malignant Lesion Scalp, Neck,Hand,Feet,Genitalia;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11623,CPT,Professional,Both,,,,635,539.75,130.89,635,Aetna,Commercial,539.75,85,,percent of total billed charges,,
"Excision, Malignant Lesion Scalp, Neck,Hand,Feet,Genitalia;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11623,CPT,Professional,Both,,,,1291,1097.35,130.89,1291,Aetna,Medicare Advantage,204.75,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion Scalp, Neck,Hand,Feet,Genitalia;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11623,CPT,Professional,Both,,,,635,539.75,130.89,635,Aetna,Medicare Advantage,204.75,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion Scalp, Neck,Hand,Feet,Genitalia;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11623,CPT,Professional,Both,,,,1291,1097.35,130.89,1291,Aetna,PPO,1200.63,93,,percent of total billed charges,,
"Excision, Malignant Lesion Scalp, Neck,Hand,Feet,Genitalia;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11623,CPT,Professional,Both,,,,635,539.75,130.89,635,Aetna,PPO,590.55,93,,percent of total billed charges,,
"Excision, Malignant Lesion Scalp, Neck,Hand,Feet,Genitalia;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11623,CPT,Professional,Both,,,,1291,1097.35,130.89,1291,America's PPO,America's PPO,1103.0304,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Excision, Malignant Lesion Scalp, Neck,Hand,Feet,Genitalia;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11623,CPT,Professional,Both,,,,635,539.75,130.89,635,America's PPO,America's PPO,542.544,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Excision, Malignant Lesion Scalp, Neck,Hand,Feet,Genitalia;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11623,CPT,Professional,Both,,,,1291,1097.35,130.89,1291,BlueCross BlueShield Minnesota, Federal Employee Program,428.31,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Excision, Malignant Lesion Scalp, Neck,Hand,Feet,Genitalia;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11623,CPT,Professional,Both,,,,635,539.75,130.89,635,BlueCross BlueShield Minnesota, Federal Employee Program,428.31,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Excision, Malignant Lesion Scalp, Neck,Hand,Feet,Genitalia;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11623,CPT,Professional,Both,,,,1291,1097.35,130.89,1291,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,435.16296,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Malignant Lesion Scalp, Neck,Hand,Feet,Genitalia;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11623,CPT,Professional,Both,,,,635,539.75,130.89,635,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,435.16296,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Malignant Lesion Scalp, Neck,Hand,Feet,Genitalia;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11623,CPT,Professional,Both,,,,1291,1097.35,130.89,1291,BlueCross BlueShield Minnesota,High Value Network Plan,435.16296,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Malignant Lesion Scalp, Neck,Hand,Feet,Genitalia;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11623,CPT,Professional,Both,,,,635,539.75,130.89,635,BlueCross BlueShield Minnesota,High Value Network Plan,435.16296,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Malignant Lesion Scalp, Neck,Hand,Feet,Genitalia;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11623,CPT,Professional,Both,,,,1291,1097.35,130.89,1291,BlueCross BlueShield Minnesota,Medicare Advantage,233.8985,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion Scalp, Neck,Hand,Feet,Genitalia;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11623,CPT,Professional,Both,,,,635,539.75,130.89,635,BlueCross BlueShield Minnesota,Medicare Advantage,233.8985,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion Scalp, Neck,Hand,Feet,Genitalia;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11623,CPT,Professional,Both,,,,1291,1097.35,130.89,1291,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,435.16296,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Malignant Lesion Scalp, Neck,Hand,Feet,Genitalia;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11623,CPT,Professional,Both,,,,635,539.75,130.89,635,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,435.16296,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Malignant Lesion Scalp, Neck,Hand,Feet,Genitalia;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11623,CPT,Professional,Both,,,,1291,1097.35,130.89,1291,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,151.11984,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision, Malignant Lesion Scalp, Neck,Hand,Feet,Genitalia;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11623,CPT,Professional,Both,,,,635,539.75,130.89,635,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,151.11984,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision, Malignant Lesion Scalp, Neck,Hand,Feet,Genitalia;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11623,CPT,Professional,Both,,,,1291,1097.35,130.89,1291,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),233.8985,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion Scalp, Neck,Hand,Feet,Genitalia;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11623,CPT,Professional,Both,,,,635,539.75,130.89,635,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),233.8985,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion Scalp, Neck,Hand,Feet,Genitalia;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11623,CPT,Professional,Both,,,,1291,1097.35,130.89,1291,CorVel,Worker's Compensation,395.738772,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Excision, Malignant Lesion Scalp, Neck,Hand,Feet,Genitalia;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11623,CPT,Professional,Both,,,,635,539.75,130.89,635,CorVel,Worker's Compensation,395.738772,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Excision, Malignant Lesion Scalp, Neck,Hand,Feet,Genitalia;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11623,CPT,Professional,Both,,,,1291,1097.35,130.89,1291,First Health Group Corporation,First Health Network,1252.27,97,,percent of total billed charges,,
"Excision, Malignant Lesion Scalp, Neck,Hand,Feet,Genitalia;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11623,CPT,Professional,Both,,,,635,539.75,130.89,635,First Health Group Corporation,First Health Network,615.95,97,,percent of total billed charges,,
"Excision, Malignant Lesion Scalp, Neck,Hand,Feet,Genitalia;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11623,CPT,Professional,Both,,,,1291,1097.35,130.89,1291,"Health Partners, Inc.",Commercial,427.33,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision, Malignant Lesion Scalp, Neck,Hand,Feet,Genitalia;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11623,CPT,Professional,Both,,,,635,539.75,130.89,635,"Health Partners, Inc.",Commercial,427.33,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision, Malignant Lesion Scalp, Neck,Hand,Feet,Genitalia;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11623,CPT,Professional,Both,,,,1291,1097.35,130.89,1291,"Health Partners, Inc.",Medicare Advantage,233.8985,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion Scalp, Neck,Hand,Feet,Genitalia;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11623,CPT,Professional,Both,,,,635,539.75,130.89,635,"Health Partners, Inc.",Medicare Advantage,233.8985,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion Scalp, Neck,Hand,Feet,Genitalia;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11623,CPT,Professional,Both,,,,1291,1097.35,130.89,1291,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),203.32,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Excision, Malignant Lesion Scalp, Neck,Hand,Feet,Genitalia;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11623,CPT,Professional,Both,,,,635,539.75,130.89,635,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),203.32,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Excision, Malignant Lesion Scalp, Neck,Hand,Feet,Genitalia;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11623,CPT,Professional,Both,,,,1291,1097.35,130.89,1291,"Health Partners, Inc.",State of Minnesota Advantage Program,368.144795,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision, Malignant Lesion Scalp, Neck,Hand,Feet,Genitalia;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11623,CPT,Professional,Both,,,,635,539.75,130.89,635,"Health Partners, Inc.",State of Minnesota Advantage Program,368.144795,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision, Malignant Lesion Scalp, Neck,Hand,Feet,Genitalia;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11623,CPT,Professional,Both,,,,1291,1097.35,130.89,1291,"Health Partners, Inc.",State Public Programs,130.89,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Excision, Malignant Lesion Scalp, Neck,Hand,Feet,Genitalia;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11623,CPT,Professional,Both,,,,635,539.75,130.89,635,"Health Partners, Inc.",State Public Programs,130.89,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Excision, Malignant Lesion Scalp, Neck,Hand,Feet,Genitalia;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11623,CPT,Professional,Both,,,,1291,1097.35,130.89,1291,Humana Insurance Company,Commercial PPO,203.39,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Excision, Malignant Lesion Scalp, Neck,Hand,Feet,Genitalia;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11623,CPT,Professional,Both,,,,635,539.75,130.89,635,Humana Insurance Company,Commercial PPO,203.39,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Excision, Malignant Lesion Scalp, Neck,Hand,Feet,Genitalia;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11623,CPT,Professional,Both,,,,1291,1097.35,130.89,1291,Humana Insurance Company,Medicare PPO,1291,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion Scalp, Neck,Hand,Feet,Genitalia;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11623,CPT,Professional,Both,,,,635,539.75,130.89,635,Humana Insurance Company,Medicare PPO,635,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion Scalp, Neck,Hand,Feet,Genitalia;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11623,CPT,Professional,Both,,,,1291,1097.35,130.89,1291,Medica,Individual & Family,1094.768,84.8,,percent of total billed charges,,
"Excision, Malignant Lesion Scalp, Neck,Hand,Feet,Genitalia;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11623,CPT,Professional,Both,,,,635,539.75,130.89,635,Medica,Individual & Family,538.48,84.8,,percent of total billed charges,,
"Excision, Malignant Lesion Scalp, Neck,Hand,Feet,Genitalia;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11623,CPT,Professional,Both,,,,1291,1097.35,130.89,1291,Medica,Medica Advantage Solution,642.918,49.8,,percent of total billed charges,,
"Excision, Malignant Lesion Scalp, Neck,Hand,Feet,Genitalia;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11623,CPT,Professional,Both,,,,635,539.75,130.89,635,Medica,Medica Advantage Solution,316.23,49.8,,percent of total billed charges,,
"Excision, Malignant Lesion Scalp, Neck,Hand,Feet,Genitalia;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11623,CPT,Professional,Both,,,,1291,1097.35,130.89,1291,Medica,Medical Assistance,151.12,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Excision, Malignant Lesion Scalp, Neck,Hand,Feet,Genitalia;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11623,CPT,Professional,Both,,,,635,539.75,130.89,635,Medica,Medical Assistance,151.12,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Excision, Malignant Lesion Scalp, Neck,Hand,Feet,Genitalia;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11623,CPT,Professional,Both,,,,1291,1097.35,130.89,1291,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,203.39,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Excision, Malignant Lesion Scalp, Neck,Hand,Feet,Genitalia;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11623,CPT,Professional,Both,,,,635,539.75,130.89,635,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,203.39,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Excision, Malignant Lesion Scalp, Neck,Hand,Feet,Genitalia;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11623,CPT,Professional,Both,,,,1291,1097.35,130.89,1291,"Multiplan, Inc.","Multiplan, Inc.",1213.54,94,,percent of total billed charges,,
"Excision, Malignant Lesion Scalp, Neck,Hand,Feet,Genitalia;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11623,CPT,Professional,Both,,,,635,539.75,130.89,635,"Multiplan, Inc.","Multiplan, Inc.",596.9,94,,percent of total billed charges,,
"Excision, Malignant Lesion Scalp, Neck,Hand,Feet,Genitalia;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11623,CPT,Professional,Both,,,,1291,1097.35,130.89,1291,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1163.191,90.1,,percent of total billed charges,,
"Excision, Malignant Lesion Scalp, Neck,Hand,Feet,Genitalia;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11623,CPT,Professional,Both,,,,635,539.75,130.89,635,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,572.135,90.1,,percent of total billed charges,,
"Excision, Malignant Lesion Scalp, Neck,Hand,Feet,Genitalia;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11623,CPT,Professional,Both,,,,1291,1097.35,130.89,1291,"Preferred One Administrative Services, INC.",PPO,1272.926,98.6,,percent of total billed charges,,
"Excision, Malignant Lesion Scalp, Neck,Hand,Feet,Genitalia;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11623,CPT,Professional,Both,,,,635,539.75,130.89,635,"Preferred One Administrative Services, INC.",PPO,626.11,98.6,,percent of total billed charges,,
"Excision, Malignant Lesion Scalp, Neck,Hand,Feet,Genitalia;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11623,CPT,Professional,Both,,,,1291,1097.35,130.89,1291,PrimeWest Health,Minnesota Senior Health Options (MSHO),233.8985,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion Scalp, Neck,Hand,Feet,Genitalia;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11623,CPT,Professional,Both,,,,635,539.75,130.89,635,PrimeWest Health,Minnesota Senior Health Options (MSHO),233.8985,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion Scalp, Neck,Hand,Feet,Genitalia;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11623,CPT,Professional,Both,,,,1291,1097.35,130.89,1291,PrimeWest Health,MinnesotaCare,161.6982288,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision, Malignant Lesion Scalp, Neck,Hand,Feet,Genitalia;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11623,CPT,Professional,Both,,,,635,539.75,130.89,635,PrimeWest Health,MinnesotaCare,161.6982288,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision, Malignant Lesion Scalp, Neck,Hand,Feet,Genitalia;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11623,CPT,Professional,Both,,,,1291,1097.35,130.89,1291,Sanford Health Plan,Sanford Health Plan,1136.08,88,,percent of total billed charges,,
"Excision, Malignant Lesion Scalp, Neck,Hand,Feet,Genitalia;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11623,CPT,Professional,Both,,,,635,539.75,130.89,635,Sanford Health Plan,Sanford Health Plan,558.8,88,,percent of total billed charges,,
"Excision, Malignant Lesion Scalp, Neck,Hand,Feet,Genitalia;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11623,CPT,Professional,Both,,,,1291,1097.35,130.89,1291,"UCare Health, Inc.",Individual & Family Plan,330.630784,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Excision, Malignant Lesion Scalp, Neck,Hand,Feet,Genitalia;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11623,CPT,Professional,Both,,,,635,539.75,130.89,635,"UCare Health, Inc.",Individual & Family Plan,330.630784,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Excision, Malignant Lesion Scalp, Neck,Hand,Feet,Genitalia;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11623,CPT,Professional,Both,,,,1291,1097.35,130.89,1291,"UCare Health, Inc.",Medical Assistance,166.231824,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Excision, Malignant Lesion Scalp, Neck,Hand,Feet,Genitalia;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11623,CPT,Professional,Both,,,,635,539.75,130.89,635,"UCare Health, Inc.",Medical Assistance,166.231824,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Excision, Malignant Lesion Scalp, Neck,Hand,Feet,Genitalia;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11623,CPT,Professional,Both,,,,1291,1097.35,130.89,1291,"UCare Health, Inc.",Medicare Advantage,233.8985,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Excision, Malignant Lesion Scalp, Neck,Hand,Feet,Genitalia;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11623,CPT,Professional,Both,,,,635,539.75,130.89,635,"UCare Health, Inc.",Medicare Advantage,233.8985,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Excision, Malignant Lesion Scalp, Neck,Hand,Feet,Genitalia;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11623,CPT,Professional,Both,,,,1291,1097.35,130.89,1291,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),187.1188,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Excision, Malignant Lesion Scalp, Neck,Hand,Feet,Genitalia;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11623,CPT,Professional,Both,,,,635,539.75,130.89,635,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),187.1188,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Excision, Malignant Lesion Scalp, Neck,Hand,Feet,Genitalia;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11623,CPT,Professional,Both,,,,1291,1097.35,130.89,1291,UnitedHealthcare,Individual & Family,1291,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Excision, Malignant Lesion Scalp, Neck,Hand,Feet,Genitalia;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11623,CPT,Professional,Both,,,,635,539.75,130.89,635,UnitedHealthcare,Individual & Family,635,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Excision, Malignant Lesion Scalp, Neck,Hand,Feet,Genitalia;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11623,CPT,Professional,Both,,,,1291,1097.35,130.89,1291,UnitedHealthcare,Medicare Advantage,233.8985,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion Scalp, Neck,Hand,Feet,Genitalia;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11623,CPT,Professional,Both,,,,635,539.75,130.89,635,UnitedHealthcare,Medicare Advantage,233.8985,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion Scalp, Neck,Hand,Feet,Genitalia;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11623,CPT,Professional,Both,,,,1291,1097.35,130.89,1291,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,151.11984,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision, Malignant Lesion Scalp, Neck,Hand,Feet,Genitalia;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11623,CPT,Professional,Both,,,,635,539.75,130.89,635,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,151.11984,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision, Malignant Lesion 3.1 To 4.0 Cm (Pbb)",,11624,CPT,Facility,Outpatient,,,,862,732.7,247.0492,862,Aetna,Commercial,793.04,92,,percent of total billed charges,,
"Excision, Malignant Lesion 3.1 To 4.0 Cm (Pbb)",,11624,CPT,Professional,Outpatient,,,,834,708.9,147.68,834,Aetna,Commercial,708.9,85,,percent of total billed charges,,
"Excision, Malignant Lesion 3.1 To 4.0 Cm (Pbb)",,11624,CPT,Facility,Outpatient,,,,862,732.7,247.0492,862,Aetna,Medicare Advantage,422.38,49,,percent of total billed charges,,
"Excision, Malignant Lesion 3.1 To 4.0 Cm (Pbb)",,11624,CPT,Professional,Outpatient,,,,834,708.9,147.68,834,Aetna,Medicare Advantage,231.2,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion 3.1 To 4.0 Cm (Pbb)",,11624,CPT,Facility,Outpatient,,,,862,732.7,247.0492,862,Aetna,PPO,801.66,93,,percent of total billed charges,,
"Excision, Malignant Lesion 3.1 To 4.0 Cm (Pbb)",,11624,CPT,Professional,Outpatient,,,,834,708.9,147.68,834,Aetna,PPO,775.62,93,,percent of total billed charges,,
"Excision, Malignant Lesion 3.1 To 4.0 Cm (Pbb)",,11624,CPT,Facility,Outpatient,,,,862,732.7,247.0492,862,America's PPO,America's PPO,827.7786,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Excision, Malignant Lesion 3.1 To 4.0 Cm (Pbb)",,11624,CPT,Professional,Outpatient,,,,834,708.9,147.68,834,America's PPO,America's PPO,712.5696,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Excision, Malignant Lesion 3.1 To 4.0 Cm (Pbb)",,11624,CPT,Facility,Outpatient,,,,862,732.7,247.0492,862,BlueCross BlueShield Minnesota, Federal Employee Program,848.208,98.4,,percent of total billed charges,,
"Excision, Malignant Lesion 3.1 To 4.0 Cm (Pbb)",,11624,CPT,Professional,Outpatient,,,,834,708.9,147.68,834,BlueCross BlueShield Minnesota, Federal Employee Program,486.15,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Excision, Malignant Lesion 3.1 To 4.0 Cm (Pbb)",,11624,CPT,Facility,Outpatient,,,,862,732.7,247.0492,862,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,862,100,,percent of total billed charges,,
"Excision, Malignant Lesion 3.1 To 4.0 Cm (Pbb)",,11624,CPT,Professional,Outpatient,,,,834,708.9,147.68,834,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,493.9284,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Malignant Lesion 3.1 To 4.0 Cm (Pbb)",,11624,CPT,Facility,Outpatient,,,,862,732.7,247.0492,862,BlueCross BlueShield Minnesota,High Value Network Plan,775.8,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
"Excision, Malignant Lesion 3.1 To 4.0 Cm (Pbb)",,11624,CPT,Professional,Outpatient,,,,834,708.9,147.68,834,BlueCross BlueShield Minnesota,High Value Network Plan,493.9284,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Malignant Lesion 3.1 To 4.0 Cm (Pbb)",,11624,CPT,Facility,Outpatient,,,,862,732.7,247.0492,862,BlueCross BlueShield Minnesota,Medicare Advantage,422.38,49,,percent of total billed charges,,
"Excision, Malignant Lesion 3.1 To 4.0 Cm (Pbb)",,11624,CPT,Professional,Outpatient,,,,834,708.9,147.68,834,BlueCross BlueShield Minnesota,Medicare Advantage,263.902,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion 3.1 To 4.0 Cm (Pbb)",,11624,CPT,Professional,Outpatient,,,,834,708.9,147.68,834,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,493.9284,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Malignant Lesion 3.1 To 4.0 Cm (Pbb)",,11624,CPT,Facility,Outpatient,,,,862,732.7,247.0492,862,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,247.0492,28.66,,percent of total billed charges,,
"Excision, Malignant Lesion 3.1 To 4.0 Cm (Pbb)",,11624,CPT,Professional,Outpatient,,,,834,708.9,147.68,834,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,170.50512,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision, Malignant Lesion 3.1 To 4.0 Cm (Pbb)",,11624,CPT,Facility,Outpatient,,,,862,732.7,247.0492,862,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),422.38,49,,percent of total billed charges,,
"Excision, Malignant Lesion 3.1 To 4.0 Cm (Pbb)",,11624,CPT,Professional,Outpatient,,,,834,708.9,147.68,834,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),263.902,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion 3.1 To 4.0 Cm (Pbb)",,11624,CPT,Facility,Outpatient,,,,862,732.7,247.0492,862,CorVel,Worker's Compensation,862,100,,percent of total billed charges,,
"Excision, Malignant Lesion 3.1 To 4.0 Cm (Pbb)",,11624,CPT,Professional,Outpatient,,,,834,708.9,147.68,834,CorVel,Worker's Compensation,448.2536214,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Excision, Malignant Lesion 3.1 To 4.0 Cm (Pbb)",,11624,CPT,Facility,Outpatient,,,,862,732.7,247.0492,862,First Health Group Corporation,First Health Network,836.14,97,,percent of total billed charges,,
"Excision, Malignant Lesion 3.1 To 4.0 Cm (Pbb)",,11624,CPT,Professional,Outpatient,,,,834,708.9,147.68,834,First Health Group Corporation,First Health Network,808.98,97,,percent of total billed charges,,
"Excision, Malignant Lesion 3.1 To 4.0 Cm (Pbb)",,11624,CPT,Facility,Outpatient,,,,862,732.7,247.0492,862,"Health Partners, Inc.",Commercial,815.452,94.6,,percent of total billed charges,,
"Excision, Malignant Lesion 3.1 To 4.0 Cm (Pbb)",,11624,CPT,Professional,Outpatient,,,,834,708.9,147.68,834,"Health Partners, Inc.",Commercial,484.65,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision, Malignant Lesion 3.1 To 4.0 Cm (Pbb)",,11624,CPT,Facility,Outpatient,,,,862,732.7,247.0492,862,"Health Partners, Inc.",Medicare Advantage,422.38,49,,percent of total billed charges,,
"Excision, Malignant Lesion 3.1 To 4.0 Cm (Pbb)",,11624,CPT,Professional,Outpatient,,,,834,708.9,147.68,834,"Health Partners, Inc.",Medicare Advantage,263.902,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion 3.1 To 4.0 Cm (Pbb)",,11624,CPT,Facility,Outpatient,,,,862,732.7,247.0492,862,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),517.2,60,,percent of total billed charges,,
"Excision, Malignant Lesion 3.1 To 4.0 Cm (Pbb)",,11624,CPT,Professional,Outpatient,,,,834,708.9,147.68,834,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),229.76,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Excision, Malignant Lesion 3.1 To 4.0 Cm (Pbb)",,11624,CPT,Facility,Outpatient,,,,862,732.7,247.0492,862,"Health Partners, Inc.",State of Minnesota Advantage Program,702.53,81.5,,percent of total billed charges,,
"Excision, Malignant Lesion 3.1 To 4.0 Cm (Pbb)",,11624,CPT,Professional,Outpatient,,,,834,708.9,147.68,834,"Health Partners, Inc.",State of Minnesota Advantage Program,417.525975,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision, Malignant Lesion 3.1 To 4.0 Cm (Pbb)",,11624,CPT,Facility,Outpatient,,,,862,732.7,247.0492,862,"Health Partners, Inc.",State Public Programs,431,50,,percent of total billed charges,,
"Excision, Malignant Lesion 3.1 To 4.0 Cm (Pbb)",,11624,CPT,Professional,Outpatient,,,,834,708.9,147.68,834,"Health Partners, Inc.",State Public Programs,147.68,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Excision, Malignant Lesion 3.1 To 4.0 Cm (Pbb)",,11624,CPT,Facility,Outpatient,,,,862,732.7,247.0492,862,Humana Insurance Company,Commercial PPO,818.9,95,,percent of total billed charges,,
"Excision, Malignant Lesion 3.1 To 4.0 Cm (Pbb)",,11624,CPT,Professional,Outpatient,,,,834,708.9,147.68,834,Humana Insurance Company,Commercial PPO,229.48,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Excision, Malignant Lesion 3.1 To 4.0 Cm (Pbb)",,11624,CPT,Facility,Outpatient,,,,862,732.7,247.0492,862,Humana Insurance Company,Medicare PPO,422.38,49,,percent of total billed charges,,
"Excision, Malignant Lesion 3.1 To 4.0 Cm (Pbb)",,11624,CPT,Professional,Outpatient,,,,834,708.9,147.68,834,Humana Insurance Company,Medicare PPO,834,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion 3.1 To 4.0 Cm (Pbb)",,11624,CPT,Facility,Outpatient,,,,862,732.7,247.0492,862,Medica,Individual & Family,854.242,99.1,,percent of total billed charges,,
"Excision, Malignant Lesion 3.1 To 4.0 Cm (Pbb)",,11624,CPT,Professional,Outpatient,,,,834,708.9,147.68,834,Medica,Individual & Family,707.232,84.8,,percent of total billed charges,,
"Excision, Malignant Lesion 3.1 To 4.0 Cm (Pbb)",,11624,CPT,Facility,Outpatient,,,,862,732.7,247.0492,862,Medica,Medica Advantage Solution,429.276,49.8,,percent of total billed charges,,
"Excision, Malignant Lesion 3.1 To 4.0 Cm (Pbb)",,11624,CPT,Professional,Outpatient,,,,834,708.9,147.68,834,Medica,Medica Advantage Solution,415.332,49.8,,percent of total billed charges,,
"Excision, Malignant Lesion 3.1 To 4.0 Cm (Pbb)",,11624,CPT,Facility,Outpatient,,,,862,732.7,247.0492,862,Medica,Medical Assistance,384.452,44.6,,percent of total billed charges,,
"Excision, Malignant Lesion 3.1 To 4.0 Cm (Pbb)",,11624,CPT,Professional,Outpatient,,,,834,708.9,147.68,834,Medica,Medical Assistance,170.51,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Excision, Malignant Lesion 3.1 To 4.0 Cm (Pbb)",,11624,CPT,Facility,Outpatient,,,,862,732.7,247.0492,862,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,429.276,49.8,,percent of total billed charges,,
"Excision, Malignant Lesion 3.1 To 4.0 Cm (Pbb)",,11624,CPT,Professional,Outpatient,,,,834,708.9,147.68,834,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,229.48,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Excision, Malignant Lesion 3.1 To 4.0 Cm (Pbb)",,11624,CPT,Facility,Outpatient,,,,862,732.7,247.0492,862,"Multiplan, Inc.","Multiplan, Inc.",810.28,94,,percent of total billed charges,,
"Excision, Malignant Lesion 3.1 To 4.0 Cm (Pbb)",,11624,CPT,Professional,Outpatient,,,,834,708.9,147.68,834,"Multiplan, Inc.","Multiplan, Inc.",783.96,94,,percent of total billed charges,,
"Excision, Malignant Lesion 3.1 To 4.0 Cm (Pbb)",,11624,CPT,Facility,Outpatient,,,,862,732.7,247.0492,862,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,776.662,90.1,,percent of total billed charges,,
"Excision, Malignant Lesion 3.1 To 4.0 Cm (Pbb)",,11624,CPT,Professional,Outpatient,,,,834,708.9,147.68,834,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,751.434,90.1,,percent of total billed charges,,
"Excision, Malignant Lesion 3.1 To 4.0 Cm (Pbb)",,11624,CPT,Facility,Outpatient,,,,862,732.7,247.0492,862,"Preferred One Administrative Services, INC.",PPO,849.932,98.6,,percent of total billed charges,,
"Excision, Malignant Lesion 3.1 To 4.0 Cm (Pbb)",,11624,CPT,Professional,Outpatient,,,,834,708.9,147.68,834,"Preferred One Administrative Services, INC.",PPO,822.324,98.6,,percent of total billed charges,,
"Excision, Malignant Lesion 3.1 To 4.0 Cm (Pbb)",,11624,CPT,Facility,Outpatient,,,,862,732.7,247.0492,862,PrimeWest Health,Minnesota Senior Health Options (MSHO),443.499,51.45,,percent of total billed charges,,
"Excision, Malignant Lesion 3.1 To 4.0 Cm (Pbb)",,11624,CPT,Professional,Outpatient,,,,834,708.9,147.68,834,PrimeWest Health,Minnesota Senior Health Options (MSHO),263.902,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion 3.1 To 4.0 Cm (Pbb)",,11624,CPT,Facility,Outpatient,,,,862,732.7,247.0492,862,PrimeWest Health,MinnesotaCare,442.7232,51.36,,percent of total billed charges,,
"Excision, Malignant Lesion 3.1 To 4.0 Cm (Pbb)",,11624,CPT,Professional,Outpatient,,,,834,708.9,147.68,834,PrimeWest Health,MinnesotaCare,182.4404784,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision, Malignant Lesion 3.1 To 4.0 Cm (Pbb)",,11624,CPT,Facility,Outpatient,,,,862,732.7,247.0492,862,Sanford Health Plan,Sanford Health Plan,793.04,92,,percent of total billed charges,,
"Excision, Malignant Lesion 3.1 To 4.0 Cm (Pbb)",,11624,CPT,Professional,Outpatient,,,,834,708.9,147.68,834,Sanford Health Plan,Sanford Health Plan,733.92,88,,percent of total billed charges,,
"Excision, Malignant Lesion 3.1 To 4.0 Cm (Pbb)",,11624,CPT,Facility,Outpatient,,,,862,732.7,247.0492,862,"UCare Health, Inc.",Individual & Family Plan,485.737,56.35,,percent of total billed charges,,
"Excision, Malignant Lesion 3.1 To 4.0 Cm (Pbb)",,11624,CPT,Professional,Outpatient,,,,834,708.9,147.68,834,"UCare Health, Inc.",Individual & Family Plan,373.042688,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Excision, Malignant Lesion 3.1 To 4.0 Cm (Pbb)",,11624,CPT,Facility,Outpatient,,,,862,732.7,247.0492,862,"UCare Health, Inc.",Medical Assistance,435.0514,50.47,,percent of total billed charges,,
"Excision, Malignant Lesion 3.1 To 4.0 Cm (Pbb)",,11624,CPT,Professional,Outpatient,,,,834,708.9,147.68,834,"UCare Health, Inc.",Medical Assistance,187.555632,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Excision, Malignant Lesion 3.1 To 4.0 Cm (Pbb)",,11624,CPT,Facility,Outpatient,,,,862,732.7,247.0492,862,"UCare Health, Inc.",Medicare Advantage,435.0514,50.47,,percent of total billed charges,,
"Excision, Malignant Lesion 3.1 To 4.0 Cm (Pbb)",,11624,CPT,Professional,Outpatient,,,,834,708.9,147.68,834,"UCare Health, Inc.",Medicare Advantage,263.902,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Excision, Malignant Lesion 3.1 To 4.0 Cm (Pbb)",,11624,CPT,Facility,Outpatient,,,,862,732.7,247.0492,862,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),435.0514,50.47,,percent of total billed charges,,
"Excision, Malignant Lesion 3.1 To 4.0 Cm (Pbb)",,11624,CPT,Professional,Outpatient,,,,834,708.9,147.68,834,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),211.1216,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Excision, Malignant Lesion 3.1 To 4.0 Cm (Pbb)",,11624,CPT,Facility,Outpatient,,,,862,732.7,247.0492,862,UnitedHealthcare,Individual & Family,810.28,94,,percent of total billed charges,,
"Excision, Malignant Lesion 3.1 To 4.0 Cm (Pbb)",,11624,CPT,Professional,Outpatient,,,,834,708.9,147.68,834,UnitedHealthcare,Individual & Family,834,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Excision, Malignant Lesion 3.1 To 4.0 Cm (Pbb)",,11624,CPT,Facility,Outpatient,,,,862,732.7,247.0492,862,UnitedHealthcare,Medicare Advantage,422.38,49,,percent of total billed charges,,
"Excision, Malignant Lesion 3.1 To 4.0 Cm (Pbb)",,11624,CPT,Professional,Outpatient,,,,834,708.9,147.68,834,UnitedHealthcare,Medicare Advantage,263.902,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion 3.1 To 4.0 Cm (Pbb)",,11624,CPT,Facility,Outpatient,,,,862,732.7,247.0492,862,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,413.76,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Excision, Malignant Lesion 3.1 To 4.0 Cm (Pbb)",,11624,CPT,Professional,Outpatient,,,,834,708.9,147.68,834,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,170.50512,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision, Malignant Lesion W Margins,Scalp,Neck,Hands,Feet,Genitalia; Exc Dia 3.1 To 4.0 Cm",,11624,CPT,Facility,Both,,,,505,429.25,144.733,505,Aetna,Commercial,464.6,92,,percent of total billed charges,,
"Excision, Malignant Lesion W Margins,Scalp,Neck,Hands,Feet,Genitalia; Exc Dia 3.1 To 4.0 Cm",,11624,CPT,Facility,Outpatient,,,,505,429.25,144.733,505,Aetna,Medicare Advantage,247.45,49,,percent of total billed charges,,
"Excision, Malignant Lesion W Margins,Scalp,Neck,Hands,Feet,Genitalia; Exc Dia 3.1 To 4.0 Cm",,11624,CPT,Facility,Inpatient,,,,505,429.25,144.733,505,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Excision, Malignant Lesion W Margins,Scalp,Neck,Hands,Feet,Genitalia; Exc Dia 3.1 To 4.0 Cm",,11624,CPT,Facility,Both,,,,505,429.25,144.733,505,Aetna,PPO,469.65,93,,percent of total billed charges,,
"Excision, Malignant Lesion W Margins,Scalp,Neck,Hands,Feet,Genitalia; Exc Dia 3.1 To 4.0 Cm",,11624,CPT,Facility,Both,,,,505,429.25,144.733,505,America's PPO,America's PPO,484.9515,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Excision, Malignant Lesion W Margins,Scalp,Neck,Hands,Feet,Genitalia; Exc Dia 3.1 To 4.0 Cm",,11624,CPT,Facility,Both,,,,505,429.25,144.733,505,BlueCross BlueShield Minnesota, Federal Employee Program,496.92,98.4,,percent of total billed charges,,
"Excision, Malignant Lesion W Margins,Scalp,Neck,Hands,Feet,Genitalia; Exc Dia 3.1 To 4.0 Cm",,11624,CPT,Facility,Both,,,,505,429.25,144.733,505,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,505,100,,percent of total billed charges,,
"Excision, Malignant Lesion W Margins,Scalp,Neck,Hands,Feet,Genitalia; Exc Dia 3.1 To 4.0 Cm",,11624,CPT,Facility,Both,,,,505,429.25,144.733,505,BlueCross BlueShield Minnesota,High Value Network Plan,454.5,90,,percent of total billed charges,,
"Excision, Malignant Lesion W Margins,Scalp,Neck,Hands,Feet,Genitalia; Exc Dia 3.1 To 4.0 Cm",,11624,CPT,Facility,Outpatient,,,,505,429.25,144.733,505,BlueCross BlueShield Minnesota,Medicare Advantage,247.45,49,,percent of total billed charges,,
"Excision, Malignant Lesion W Margins,Scalp,Neck,Hands,Feet,Genitalia; Exc Dia 3.1 To 4.0 Cm",,11624,CPT,Facility,Inpatient,,,,505,429.25,144.733,505,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Excision, Malignant Lesion W Margins,Scalp,Neck,Hands,Feet,Genitalia; Exc Dia 3.1 To 4.0 Cm",,11624,CPT,Facility,Both,,,,505,429.25,144.733,505,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,447.2785,88.57,,percent of total billed charges,,
"Excision, Malignant Lesion W Margins,Scalp,Neck,Hands,Feet,Genitalia; Exc Dia 3.1 To 4.0 Cm",,11624,CPT,Facility,Both,,,,505,429.25,144.733,505,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,144.733,28.66,,percent of total billed charges,,
"Excision, Malignant Lesion W Margins,Scalp,Neck,Hands,Feet,Genitalia; Exc Dia 3.1 To 4.0 Cm",,11624,CPT,Facility,Outpatient,,,,505,429.25,144.733,505,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),247.45,49,,percent of total billed charges,,
"Excision, Malignant Lesion W Margins,Scalp,Neck,Hands,Feet,Genitalia; Exc Dia 3.1 To 4.0 Cm",,11624,CPT,Facility,Inpatient,,,,505,429.25,144.733,505,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Excision, Malignant Lesion W Margins,Scalp,Neck,Hands,Feet,Genitalia; Exc Dia 3.1 To 4.0 Cm",,11624,CPT,Facility,Both,,,,505,429.25,144.733,505,CorVel,Worker's Compensation,505,100,,percent of total billed charges,,
"Excision, Malignant Lesion W Margins,Scalp,Neck,Hands,Feet,Genitalia; Exc Dia 3.1 To 4.0 Cm",,11624,CPT,Facility,Both,,,,505,429.25,144.733,505,First Health Group Corporation,First Health Network,489.85,97,,percent of total billed charges,,
"Excision, Malignant Lesion W Margins,Scalp,Neck,Hands,Feet,Genitalia; Exc Dia 3.1 To 4.0 Cm",,11624,CPT,Facility,Both,,,,505,429.25,144.733,505,"Health Partners, Inc.",Commercial,477.73,94.6,,percent of total billed charges,,
"Excision, Malignant Lesion W Margins,Scalp,Neck,Hands,Feet,Genitalia; Exc Dia 3.1 To 4.0 Cm",,11624,CPT,Facility,Outpatient,,,,505,429.25,144.733,505,"Health Partners, Inc.",Medicare Advantage,247.45,49,,percent of total billed charges,,
"Excision, Malignant Lesion W Margins,Scalp,Neck,Hands,Feet,Genitalia; Exc Dia 3.1 To 4.0 Cm",,11624,CPT,Facility,Inpatient,,,,505,429.25,144.733,505,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Excision, Malignant Lesion W Margins,Scalp,Neck,Hands,Feet,Genitalia; Exc Dia 3.1 To 4.0 Cm",,11624,CPT,Facility,Both,,,,505,429.25,144.733,505,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),303,60,,percent of total billed charges,,
"Excision, Malignant Lesion W Margins,Scalp,Neck,Hands,Feet,Genitalia; Exc Dia 3.1 To 4.0 Cm",,11624,CPT,Facility,Both,,,,505,429.25,144.733,505,"Health Partners, Inc.",State of Minnesota Advantage Program,411.575,81.5,,percent of total billed charges,,
"Excision, Malignant Lesion W Margins,Scalp,Neck,Hands,Feet,Genitalia; Exc Dia 3.1 To 4.0 Cm",,11624,CPT,Facility,Both,,,,505,429.25,144.733,505,"Health Partners, Inc.",State Public Programs,252.5,50,,percent of total billed charges,,
"Excision, Malignant Lesion W Margins,Scalp,Neck,Hands,Feet,Genitalia; Exc Dia 3.1 To 4.0 Cm",,11624,CPT,Facility,Both,,,,505,429.25,144.733,505,Humana Insurance Company,Commercial PPO,479.75,95,,percent of total billed charges,,
"Excision, Malignant Lesion W Margins,Scalp,Neck,Hands,Feet,Genitalia; Exc Dia 3.1 To 4.0 Cm",,11624,CPT,Facility,Outpatient,,,,505,429.25,144.733,505,Humana Insurance Company,Medicare PPO,247.45,49,,percent of total billed charges,,
"Excision, Malignant Lesion W Margins,Scalp,Neck,Hands,Feet,Genitalia; Exc Dia 3.1 To 4.0 Cm",,11624,CPT,Facility,Inpatient,,,,505,429.25,144.733,505,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Excision, Malignant Lesion W Margins,Scalp,Neck,Hands,Feet,Genitalia; Exc Dia 3.1 To 4.0 Cm",,11624,CPT,Facility,Both,,,,505,429.25,144.733,505,Medica,Individual & Family,500.455,99.1,,percent of total billed charges,,
"Excision, Malignant Lesion W Margins,Scalp,Neck,Hands,Feet,Genitalia; Exc Dia 3.1 To 4.0 Cm",,11624,CPT,Facility,Outpatient,,,,505,429.25,144.733,505,Medica,Medica Advantage Solution,251.49,49.8,,percent of total billed charges,,
"Excision, Malignant Lesion W Margins,Scalp,Neck,Hands,Feet,Genitalia; Exc Dia 3.1 To 4.0 Cm",,11624,CPT,Facility,Inpatient,,,,505,429.25,144.733,505,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Excision, Malignant Lesion W Margins,Scalp,Neck,Hands,Feet,Genitalia; Exc Dia 3.1 To 4.0 Cm",,11624,CPT,Facility,Outpatient,,,,505,429.25,144.733,505,Medica,Medical Assistance,225.23,44.6,,percent of total billed charges,,
"Excision, Malignant Lesion W Margins,Scalp,Neck,Hands,Feet,Genitalia; Exc Dia 3.1 To 4.0 Cm",,11624,CPT,Facility,Inpatient,,,,505,429.25,144.733,505,Medica,Medical Assistance,,,,,Included in per diem rate,
"Excision, Malignant Lesion W Margins,Scalp,Neck,Hands,Feet,Genitalia; Exc Dia 3.1 To 4.0 Cm",,11624,CPT,Facility,Outpatient,,,,505,429.25,144.733,505,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,251.49,49.8,,percent of total billed charges,,
"Excision, Malignant Lesion W Margins,Scalp,Neck,Hands,Feet,Genitalia; Exc Dia 3.1 To 4.0 Cm",,11624,CPT,Facility,Inpatient,,,,505,429.25,144.733,505,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Excision, Malignant Lesion W Margins,Scalp,Neck,Hands,Feet,Genitalia; Exc Dia 3.1 To 4.0 Cm",,11624,CPT,Facility,Both,,,,505,429.25,144.733,505,"Multiplan, Inc.","Multiplan, Inc.",474.7,94,,percent of total billed charges,,
"Excision, Malignant Lesion W Margins,Scalp,Neck,Hands,Feet,Genitalia; Exc Dia 3.1 To 4.0 Cm",,11624,CPT,Facility,Outpatient,,,,505,429.25,144.733,505,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,455.005,90.1,,percent of total billed charges,,
"Excision, Malignant Lesion W Margins,Scalp,Neck,Hands,Feet,Genitalia; Exc Dia 3.1 To 4.0 Cm",,11624,CPT,Facility,Inpatient,,,,505,429.25,144.733,505,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Excision, Malignant Lesion W Margins,Scalp,Neck,Hands,Feet,Genitalia; Exc Dia 3.1 To 4.0 Cm",,11624,CPT,Facility,Both,,,,505,429.25,144.733,505,"Preferred One Administrative Services, INC.",PPO,497.93,98.6,,percent of total billed charges,,
"Excision, Malignant Lesion W Margins,Scalp,Neck,Hands,Feet,Genitalia; Exc Dia 3.1 To 4.0 Cm",,11624,CPT,Facility,Outpatient,,,,505,429.25,144.733,505,PrimeWest Health,Minnesota Senior Health Options (MSHO),259.8225,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Excision, Malignant Lesion W Margins,Scalp,Neck,Hands,Feet,Genitalia; Exc Dia 3.1 To 4.0 Cm",,11624,CPT,Facility,Inpatient,,,,505,429.25,144.733,505,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Excision, Malignant Lesion W Margins,Scalp,Neck,Hands,Feet,Genitalia; Exc Dia 3.1 To 4.0 Cm",,11624,CPT,Facility,Outpatient,,,,505,429.25,144.733,505,PrimeWest Health,MinnesotaCare,259.368,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Excision, Malignant Lesion W Margins,Scalp,Neck,Hands,Feet,Genitalia; Exc Dia 3.1 To 4.0 Cm",,11624,CPT,Facility,Inpatient,,,,505,429.25,144.733,505,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Excision, Malignant Lesion W Margins,Scalp,Neck,Hands,Feet,Genitalia; Exc Dia 3.1 To 4.0 Cm",,11624,CPT,Facility,Both,,,,505,429.25,144.733,505,Sanford Health Plan,Sanford Health Plan,464.6,92,,percent of total billed charges,,
"Excision, Malignant Lesion W Margins,Scalp,Neck,Hands,Feet,Genitalia; Exc Dia 3.1 To 4.0 Cm",,11624,CPT,Facility,Outpatient,,,,505,429.25,144.733,505,"UCare Health, Inc.",Individual & Family Plan,284.5675,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Excision, Malignant Lesion W Margins,Scalp,Neck,Hands,Feet,Genitalia; Exc Dia 3.1 To 4.0 Cm",,11624,CPT,Facility,Inpatient,,,,505,429.25,144.733,505,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Excision, Malignant Lesion W Margins,Scalp,Neck,Hands,Feet,Genitalia; Exc Dia 3.1 To 4.0 Cm",,11624,CPT,Facility,Outpatient,,,,505,429.25,144.733,505,"UCare Health, Inc.",Medical Assistance,254.8735,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Excision, Malignant Lesion W Margins,Scalp,Neck,Hands,Feet,Genitalia; Exc Dia 3.1 To 4.0 Cm",,11624,CPT,Facility,Inpatient,,,,505,429.25,144.733,505,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Excision, Malignant Lesion W Margins,Scalp,Neck,Hands,Feet,Genitalia; Exc Dia 3.1 To 4.0 Cm",,11624,CPT,Facility,Outpatient,,,,505,429.25,144.733,505,"UCare Health, Inc.",Medicare Advantage,254.8735,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Excision, Malignant Lesion W Margins,Scalp,Neck,Hands,Feet,Genitalia; Exc Dia 3.1 To 4.0 Cm",,11624,CPT,Facility,Inpatient,,,,505,429.25,144.733,505,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Excision, Malignant Lesion W Margins,Scalp,Neck,Hands,Feet,Genitalia; Exc Dia 3.1 To 4.0 Cm",,11624,CPT,Facility,Outpatient,,,,505,429.25,144.733,505,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),254.8735,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Excision, Malignant Lesion W Margins,Scalp,Neck,Hands,Feet,Genitalia; Exc Dia 3.1 To 4.0 Cm",,11624,CPT,Facility,Inpatient,,,,505,429.25,144.733,505,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Excision, Malignant Lesion W Margins,Scalp,Neck,Hands,Feet,Genitalia; Exc Dia 3.1 To 4.0 Cm",,11624,CPT,Facility,Both,,,,505,429.25,144.733,505,UnitedHealthcare,Individual & Family,474.7,94,,percent of total billed charges,,
"Excision, Malignant Lesion W Margins,Scalp,Neck,Hands,Feet,Genitalia; Exc Dia 3.1 To 4.0 Cm",,11624,CPT,Facility,Outpatient,,,,505,429.25,144.733,505,UnitedHealthcare,Medicare Advantage,247.45,49,,percent of total billed charges,,
"Excision, Malignant Lesion W Margins,Scalp,Neck,Hands,Feet,Genitalia; Exc Dia 3.1 To 4.0 Cm",,11624,CPT,Facility,Inpatient,,,,505,429.25,144.733,505,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Excision, Malignant Lesion W Margins,Scalp,Neck,Hands,Feet,Genitalia; Exc Dia 3.1 To 4.0 Cm",,11624,CPT,Facility,Outpatient,,,,505,429.25,144.733,505,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,242.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Excision, Malignant Lesion W Margins,Scalp,Neck,Hands,Feet,Genitalia; Exc Dia 3.1 To 4.0 Cm",,11624,CPT,Facility,Inpatient,,,,505,429.25,144.733,505,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Excision, Malignant Lesion W Margins,Scalp,Neck,Hands,Feet,Genitalia; Exc Dia 3.1 To 4.0 Cm (Pro Cah)",,11624,CPT,Professional,Both,,,,1696,1441.6,147.68,1696,Aetna,Commercial,1441.6,85,,percent of total billed charges,,
"Excision, Malignant Lesion W Margins,Scalp,Neck,Hands,Feet,Genitalia; Exc Dia 3.1 To 4.0 Cm (Pro Cah)",,11624,CPT,Professional,Both,,,,860,731,147.68,860,Aetna,Commercial,731,85,,percent of total billed charges,,
"Excision, Malignant Lesion W Margins,Scalp,Neck,Hands,Feet,Genitalia; Exc Dia 3.1 To 4.0 Cm (Pro Cah)",,11624,CPT,Professional,Both,,,,1696,1441.6,147.68,1696,Aetna,Medicare Advantage,231.2,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion W Margins,Scalp,Neck,Hands,Feet,Genitalia; Exc Dia 3.1 To 4.0 Cm (Pro Cah)",,11624,CPT,Professional,Both,,,,860,731,147.68,860,Aetna,Medicare Advantage,231.2,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion W Margins,Scalp,Neck,Hands,Feet,Genitalia; Exc Dia 3.1 To 4.0 Cm (Pro Cah)",,11624,CPT,Professional,Both,,,,1696,1441.6,147.68,1696,Aetna,PPO,1577.28,93,,percent of total billed charges,,
"Excision, Malignant Lesion W Margins,Scalp,Neck,Hands,Feet,Genitalia; Exc Dia 3.1 To 4.0 Cm (Pro Cah)",,11624,CPT,Professional,Both,,,,860,731,147.68,860,Aetna,PPO,799.8,93,,percent of total billed charges,,
"Excision, Malignant Lesion W Margins,Scalp,Neck,Hands,Feet,Genitalia; Exc Dia 3.1 To 4.0 Cm (Pro Cah)",,11624,CPT,Professional,Both,,,,1696,1441.6,147.68,1696,America's PPO,America's PPO,1449.0624,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Excision, Malignant Lesion W Margins,Scalp,Neck,Hands,Feet,Genitalia; Exc Dia 3.1 To 4.0 Cm (Pro Cah)",,11624,CPT,Professional,Both,,,,860,731,147.68,860,America's PPO,America's PPO,734.784,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Excision, Malignant Lesion W Margins,Scalp,Neck,Hands,Feet,Genitalia; Exc Dia 3.1 To 4.0 Cm (Pro Cah)",,11624,CPT,Professional,Both,,,,1696,1441.6,147.68,1696,BlueCross BlueShield Minnesota, Federal Employee Program,486.15,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Excision, Malignant Lesion W Margins,Scalp,Neck,Hands,Feet,Genitalia; Exc Dia 3.1 To 4.0 Cm (Pro Cah)",,11624,CPT,Professional,Both,,,,860,731,147.68,860,BlueCross BlueShield Minnesota, Federal Employee Program,486.15,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Excision, Malignant Lesion W Margins,Scalp,Neck,Hands,Feet,Genitalia; Exc Dia 3.1 To 4.0 Cm (Pro Cah)",,11624,CPT,Professional,Both,,,,1696,1441.6,147.68,1696,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,493.9284,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Malignant Lesion W Margins,Scalp,Neck,Hands,Feet,Genitalia; Exc Dia 3.1 To 4.0 Cm (Pro Cah)",,11624,CPT,Professional,Both,,,,860,731,147.68,860,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,493.9284,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Malignant Lesion W Margins,Scalp,Neck,Hands,Feet,Genitalia; Exc Dia 3.1 To 4.0 Cm (Pro Cah)",,11624,CPT,Professional,Both,,,,1696,1441.6,147.68,1696,BlueCross BlueShield Minnesota,High Value Network Plan,493.9284,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Malignant Lesion W Margins,Scalp,Neck,Hands,Feet,Genitalia; Exc Dia 3.1 To 4.0 Cm (Pro Cah)",,11624,CPT,Professional,Both,,,,860,731,147.68,860,BlueCross BlueShield Minnesota,High Value Network Plan,493.9284,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Malignant Lesion W Margins,Scalp,Neck,Hands,Feet,Genitalia; Exc Dia 3.1 To 4.0 Cm (Pro Cah)",,11624,CPT,Professional,Both,,,,1696,1441.6,147.68,1696,BlueCross BlueShield Minnesota,Medicare Advantage,263.902,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion W Margins,Scalp,Neck,Hands,Feet,Genitalia; Exc Dia 3.1 To 4.0 Cm (Pro Cah)",,11624,CPT,Professional,Both,,,,860,731,147.68,860,BlueCross BlueShield Minnesota,Medicare Advantage,263.902,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion W Margins,Scalp,Neck,Hands,Feet,Genitalia; Exc Dia 3.1 To 4.0 Cm (Pro Cah)",,11624,CPT,Professional,Both,,,,1696,1441.6,147.68,1696,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,493.9284,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Malignant Lesion W Margins,Scalp,Neck,Hands,Feet,Genitalia; Exc Dia 3.1 To 4.0 Cm (Pro Cah)",,11624,CPT,Professional,Both,,,,860,731,147.68,860,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,493.9284,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Malignant Lesion W Margins,Scalp,Neck,Hands,Feet,Genitalia; Exc Dia 3.1 To 4.0 Cm (Pro Cah)",,11624,CPT,Professional,Both,,,,1696,1441.6,147.68,1696,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,170.50512,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision, Malignant Lesion W Margins,Scalp,Neck,Hands,Feet,Genitalia; Exc Dia 3.1 To 4.0 Cm (Pro Cah)",,11624,CPT,Professional,Both,,,,860,731,147.68,860,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,170.50512,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision, Malignant Lesion W Margins,Scalp,Neck,Hands,Feet,Genitalia; Exc Dia 3.1 To 4.0 Cm (Pro Cah)",,11624,CPT,Professional,Both,,,,1696,1441.6,147.68,1696,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),263.902,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion W Margins,Scalp,Neck,Hands,Feet,Genitalia; Exc Dia 3.1 To 4.0 Cm (Pro Cah)",,11624,CPT,Professional,Both,,,,860,731,147.68,860,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),263.902,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion W Margins,Scalp,Neck,Hands,Feet,Genitalia; Exc Dia 3.1 To 4.0 Cm (Pro Cah)",,11624,CPT,Professional,Both,,,,1696,1441.6,147.68,1696,CorVel,Worker's Compensation,448.2536214,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Excision, Malignant Lesion W Margins,Scalp,Neck,Hands,Feet,Genitalia; Exc Dia 3.1 To 4.0 Cm (Pro Cah)",,11624,CPT,Professional,Both,,,,860,731,147.68,860,CorVel,Worker's Compensation,448.2536214,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Excision, Malignant Lesion W Margins,Scalp,Neck,Hands,Feet,Genitalia; Exc Dia 3.1 To 4.0 Cm (Pro Cah)",,11624,CPT,Professional,Both,,,,1696,1441.6,147.68,1696,First Health Group Corporation,First Health Network,1645.12,97,,percent of total billed charges,,
"Excision, Malignant Lesion W Margins,Scalp,Neck,Hands,Feet,Genitalia; Exc Dia 3.1 To 4.0 Cm (Pro Cah)",,11624,CPT,Professional,Both,,,,860,731,147.68,860,First Health Group Corporation,First Health Network,834.2,97,,percent of total billed charges,,
"Excision, Malignant Lesion W Margins,Scalp,Neck,Hands,Feet,Genitalia; Exc Dia 3.1 To 4.0 Cm (Pro Cah)",,11624,CPT,Professional,Both,,,,1696,1441.6,147.68,1696,"Health Partners, Inc.",Commercial,484.65,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision, Malignant Lesion W Margins,Scalp,Neck,Hands,Feet,Genitalia; Exc Dia 3.1 To 4.0 Cm (Pro Cah)",,11624,CPT,Professional,Both,,,,860,731,147.68,860,"Health Partners, Inc.",Commercial,484.65,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision, Malignant Lesion W Margins,Scalp,Neck,Hands,Feet,Genitalia; Exc Dia 3.1 To 4.0 Cm (Pro Cah)",,11624,CPT,Professional,Both,,,,1696,1441.6,147.68,1696,"Health Partners, Inc.",Medicare Advantage,263.902,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion W Margins,Scalp,Neck,Hands,Feet,Genitalia; Exc Dia 3.1 To 4.0 Cm (Pro Cah)",,11624,CPT,Professional,Both,,,,860,731,147.68,860,"Health Partners, Inc.",Medicare Advantage,263.902,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion W Margins,Scalp,Neck,Hands,Feet,Genitalia; Exc Dia 3.1 To 4.0 Cm (Pro Cah)",,11624,CPT,Professional,Both,,,,1696,1441.6,147.68,1696,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),229.76,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Excision, Malignant Lesion W Margins,Scalp,Neck,Hands,Feet,Genitalia; Exc Dia 3.1 To 4.0 Cm (Pro Cah)",,11624,CPT,Professional,Both,,,,860,731,147.68,860,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),229.76,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Excision, Malignant Lesion W Margins,Scalp,Neck,Hands,Feet,Genitalia; Exc Dia 3.1 To 4.0 Cm (Pro Cah)",,11624,CPT,Professional,Both,,,,1696,1441.6,147.68,1696,"Health Partners, Inc.",State of Minnesota Advantage Program,417.525975,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision, Malignant Lesion W Margins,Scalp,Neck,Hands,Feet,Genitalia; Exc Dia 3.1 To 4.0 Cm (Pro Cah)",,11624,CPT,Professional,Both,,,,860,731,147.68,860,"Health Partners, Inc.",State of Minnesota Advantage Program,417.525975,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision, Malignant Lesion W Margins,Scalp,Neck,Hands,Feet,Genitalia; Exc Dia 3.1 To 4.0 Cm (Pro Cah)",,11624,CPT,Professional,Both,,,,1696,1441.6,147.68,1696,"Health Partners, Inc.",State Public Programs,147.68,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Excision, Malignant Lesion W Margins,Scalp,Neck,Hands,Feet,Genitalia; Exc Dia 3.1 To 4.0 Cm (Pro Cah)",,11624,CPT,Professional,Both,,,,860,731,147.68,860,"Health Partners, Inc.",State Public Programs,147.68,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Excision, Malignant Lesion W Margins,Scalp,Neck,Hands,Feet,Genitalia; Exc Dia 3.1 To 4.0 Cm (Pro Cah)",,11624,CPT,Professional,Both,,,,1696,1441.6,147.68,1696,Humana Insurance Company,Commercial PPO,229.48,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Excision, Malignant Lesion W Margins,Scalp,Neck,Hands,Feet,Genitalia; Exc Dia 3.1 To 4.0 Cm (Pro Cah)",,11624,CPT,Professional,Both,,,,860,731,147.68,860,Humana Insurance Company,Commercial PPO,229.48,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Excision, Malignant Lesion W Margins,Scalp,Neck,Hands,Feet,Genitalia; Exc Dia 3.1 To 4.0 Cm (Pro Cah)",,11624,CPT,Professional,Both,,,,1696,1441.6,147.68,1696,Humana Insurance Company,Medicare PPO,1696,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion W Margins,Scalp,Neck,Hands,Feet,Genitalia; Exc Dia 3.1 To 4.0 Cm (Pro Cah)",,11624,CPT,Professional,Both,,,,860,731,147.68,860,Humana Insurance Company,Medicare PPO,860,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion W Margins,Scalp,Neck,Hands,Feet,Genitalia; Exc Dia 3.1 To 4.0 Cm (Pro Cah)",,11624,CPT,Professional,Both,,,,1696,1441.6,147.68,1696,Medica,Individual & Family,1438.208,84.8,,percent of total billed charges,,
"Excision, Malignant Lesion W Margins,Scalp,Neck,Hands,Feet,Genitalia; Exc Dia 3.1 To 4.0 Cm (Pro Cah)",,11624,CPT,Professional,Both,,,,860,731,147.68,860,Medica,Individual & Family,729.28,84.8,,percent of total billed charges,,
"Excision, Malignant Lesion W Margins,Scalp,Neck,Hands,Feet,Genitalia; Exc Dia 3.1 To 4.0 Cm (Pro Cah)",,11624,CPT,Professional,Both,,,,1696,1441.6,147.68,1696,Medica,Medica Advantage Solution,844.608,49.8,,percent of total billed charges,,
"Excision, Malignant Lesion W Margins,Scalp,Neck,Hands,Feet,Genitalia; Exc Dia 3.1 To 4.0 Cm (Pro Cah)",,11624,CPT,Professional,Both,,,,860,731,147.68,860,Medica,Medica Advantage Solution,428.28,49.8,,percent of total billed charges,,
"Excision, Malignant Lesion W Margins,Scalp,Neck,Hands,Feet,Genitalia; Exc Dia 3.1 To 4.0 Cm (Pro Cah)",,11624,CPT,Professional,Both,,,,1696,1441.6,147.68,1696,Medica,Medical Assistance,170.51,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Excision, Malignant Lesion W Margins,Scalp,Neck,Hands,Feet,Genitalia; Exc Dia 3.1 To 4.0 Cm (Pro Cah)",,11624,CPT,Professional,Both,,,,860,731,147.68,860,Medica,Medical Assistance,170.51,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Excision, Malignant Lesion W Margins,Scalp,Neck,Hands,Feet,Genitalia; Exc Dia 3.1 To 4.0 Cm (Pro Cah)",,11624,CPT,Professional,Both,,,,1696,1441.6,147.68,1696,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,229.48,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Excision, Malignant Lesion W Margins,Scalp,Neck,Hands,Feet,Genitalia; Exc Dia 3.1 To 4.0 Cm (Pro Cah)",,11624,CPT,Professional,Both,,,,860,731,147.68,860,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,229.48,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Excision, Malignant Lesion W Margins,Scalp,Neck,Hands,Feet,Genitalia; Exc Dia 3.1 To 4.0 Cm (Pro Cah)",,11624,CPT,Professional,Both,,,,1696,1441.6,147.68,1696,"Multiplan, Inc.","Multiplan, Inc.",1594.24,94,,percent of total billed charges,,
"Excision, Malignant Lesion W Margins,Scalp,Neck,Hands,Feet,Genitalia; Exc Dia 3.1 To 4.0 Cm (Pro Cah)",,11624,CPT,Professional,Both,,,,860,731,147.68,860,"Multiplan, Inc.","Multiplan, Inc.",808.4,94,,percent of total billed charges,,
"Excision, Malignant Lesion W Margins,Scalp,Neck,Hands,Feet,Genitalia; Exc Dia 3.1 To 4.0 Cm (Pro Cah)",,11624,CPT,Professional,Both,,,,1696,1441.6,147.68,1696,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1528.096,90.1,,percent of total billed charges,,
"Excision, Malignant Lesion W Margins,Scalp,Neck,Hands,Feet,Genitalia; Exc Dia 3.1 To 4.0 Cm (Pro Cah)",,11624,CPT,Professional,Both,,,,860,731,147.68,860,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,774.86,90.1,,percent of total billed charges,,
"Excision, Malignant Lesion W Margins,Scalp,Neck,Hands,Feet,Genitalia; Exc Dia 3.1 To 4.0 Cm (Pro Cah)",,11624,CPT,Professional,Both,,,,1696,1441.6,147.68,1696,"Preferred One Administrative Services, INC.",PPO,1672.256,98.6,,percent of total billed charges,,
"Excision, Malignant Lesion W Margins,Scalp,Neck,Hands,Feet,Genitalia; Exc Dia 3.1 To 4.0 Cm (Pro Cah)",,11624,CPT,Professional,Both,,,,860,731,147.68,860,"Preferred One Administrative Services, INC.",PPO,847.96,98.6,,percent of total billed charges,,
"Excision, Malignant Lesion W Margins,Scalp,Neck,Hands,Feet,Genitalia; Exc Dia 3.1 To 4.0 Cm (Pro Cah)",,11624,CPT,Professional,Both,,,,1696,1441.6,147.68,1696,PrimeWest Health,Minnesota Senior Health Options (MSHO),263.902,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion W Margins,Scalp,Neck,Hands,Feet,Genitalia; Exc Dia 3.1 To 4.0 Cm (Pro Cah)",,11624,CPT,Professional,Both,,,,860,731,147.68,860,PrimeWest Health,Minnesota Senior Health Options (MSHO),263.902,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion W Margins,Scalp,Neck,Hands,Feet,Genitalia; Exc Dia 3.1 To 4.0 Cm (Pro Cah)",,11624,CPT,Professional,Both,,,,1696,1441.6,147.68,1696,PrimeWest Health,MinnesotaCare,182.4404784,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision, Malignant Lesion W Margins,Scalp,Neck,Hands,Feet,Genitalia; Exc Dia 3.1 To 4.0 Cm (Pro Cah)",,11624,CPT,Professional,Both,,,,860,731,147.68,860,PrimeWest Health,MinnesotaCare,182.4404784,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision, Malignant Lesion W Margins,Scalp,Neck,Hands,Feet,Genitalia; Exc Dia 3.1 To 4.0 Cm (Pro Cah)",,11624,CPT,Professional,Both,,,,1696,1441.6,147.68,1696,Sanford Health Plan,Sanford Health Plan,1492.48,88,,percent of total billed charges,,
"Excision, Malignant Lesion W Margins,Scalp,Neck,Hands,Feet,Genitalia; Exc Dia 3.1 To 4.0 Cm (Pro Cah)",,11624,CPT,Professional,Both,,,,860,731,147.68,860,Sanford Health Plan,Sanford Health Plan,756.8,88,,percent of total billed charges,,
"Excision, Malignant Lesion W Margins,Scalp,Neck,Hands,Feet,Genitalia; Exc Dia 3.1 To 4.0 Cm (Pro Cah)",,11624,CPT,Professional,Both,,,,1696,1441.6,147.68,1696,"UCare Health, Inc.",Individual & Family Plan,373.042688,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Excision, Malignant Lesion W Margins,Scalp,Neck,Hands,Feet,Genitalia; Exc Dia 3.1 To 4.0 Cm (Pro Cah)",,11624,CPT,Professional,Both,,,,860,731,147.68,860,"UCare Health, Inc.",Individual & Family Plan,373.042688,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Excision, Malignant Lesion W Margins,Scalp,Neck,Hands,Feet,Genitalia; Exc Dia 3.1 To 4.0 Cm (Pro Cah)",,11624,CPT,Professional,Both,,,,1696,1441.6,147.68,1696,"UCare Health, Inc.",Medical Assistance,187.555632,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Excision, Malignant Lesion W Margins,Scalp,Neck,Hands,Feet,Genitalia; Exc Dia 3.1 To 4.0 Cm (Pro Cah)",,11624,CPT,Professional,Both,,,,860,731,147.68,860,"UCare Health, Inc.",Medical Assistance,187.555632,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Excision, Malignant Lesion W Margins,Scalp,Neck,Hands,Feet,Genitalia; Exc Dia 3.1 To 4.0 Cm (Pro Cah)",,11624,CPT,Professional,Both,,,,1696,1441.6,147.68,1696,"UCare Health, Inc.",Medicare Advantage,263.902,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Excision, Malignant Lesion W Margins,Scalp,Neck,Hands,Feet,Genitalia; Exc Dia 3.1 To 4.0 Cm (Pro Cah)",,11624,CPT,Professional,Both,,,,860,731,147.68,860,"UCare Health, Inc.",Medicare Advantage,263.902,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Excision, Malignant Lesion W Margins,Scalp,Neck,Hands,Feet,Genitalia; Exc Dia 3.1 To 4.0 Cm (Pro Cah)",,11624,CPT,Professional,Both,,,,1696,1441.6,147.68,1696,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),211.1216,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Excision, Malignant Lesion W Margins,Scalp,Neck,Hands,Feet,Genitalia; Exc Dia 3.1 To 4.0 Cm (Pro Cah)",,11624,CPT,Professional,Both,,,,860,731,147.68,860,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),211.1216,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Excision, Malignant Lesion W Margins,Scalp,Neck,Hands,Feet,Genitalia; Exc Dia 3.1 To 4.0 Cm (Pro Cah)",,11624,CPT,Professional,Both,,,,1696,1441.6,147.68,1696,UnitedHealthcare,Individual & Family,1696,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Excision, Malignant Lesion W Margins,Scalp,Neck,Hands,Feet,Genitalia; Exc Dia 3.1 To 4.0 Cm (Pro Cah)",,11624,CPT,Professional,Both,,,,860,731,147.68,860,UnitedHealthcare,Individual & Family,860,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Excision, Malignant Lesion W Margins,Scalp,Neck,Hands,Feet,Genitalia; Exc Dia 3.1 To 4.0 Cm (Pro Cah)",,11624,CPT,Professional,Both,,,,1696,1441.6,147.68,1696,UnitedHealthcare,Medicare Advantage,263.902,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion W Margins,Scalp,Neck,Hands,Feet,Genitalia; Exc Dia 3.1 To 4.0 Cm (Pro Cah)",,11624,CPT,Professional,Both,,,,860,731,147.68,860,UnitedHealthcare,Medicare Advantage,263.902,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion W Margins,Scalp,Neck,Hands,Feet,Genitalia; Exc Dia 3.1 To 4.0 Cm (Pro Cah)",,11624,CPT,Professional,Both,,,,1696,1441.6,147.68,1696,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,170.50512,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision, Malignant Lesion W Margins,Scalp,Neck,Hands,Feet,Genitalia; Exc Dia 3.1 To 4.0 Cm (Pro Cah)",,11624,CPT,Professional,Both,,,,860,731,147.68,860,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,170.50512,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision, Malignant Lesion Inc Margins,Sclp,Nk,Hds,Ft,Genital;Exc Dia Over 4.0 Cm",,11626,CPT,Facility,Both,,,,716,608.6,205.2056,716,Aetna,Commercial,658.72,92,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins,Sclp,Nk,Hds,Ft,Genital;Exc Dia Over 4.0 Cm",,11626,CPT,Facility,Outpatient,,,,716,608.6,205.2056,716,Aetna,Medicare Advantage,350.84,49,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins,Sclp,Nk,Hds,Ft,Genital;Exc Dia Over 4.0 Cm",,11626,CPT,Facility,Inpatient,,,,716,608.6,205.2056,716,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Excision, Malignant Lesion Inc Margins,Sclp,Nk,Hds,Ft,Genital;Exc Dia Over 4.0 Cm",,11626,CPT,Facility,Both,,,,716,608.6,205.2056,716,Aetna,PPO,665.88,93,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins,Sclp,Nk,Hds,Ft,Genital;Exc Dia Over 4.0 Cm",,11626,CPT,Facility,Both,,,,716,608.6,205.2056,716,America's PPO,America's PPO,687.5748,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Excision, Malignant Lesion Inc Margins,Sclp,Nk,Hds,Ft,Genital;Exc Dia Over 4.0 Cm",,11626,CPT,Facility,Both,,,,716,608.6,205.2056,716,BlueCross BlueShield Minnesota, Federal Employee Program,704.544,98.4,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins,Sclp,Nk,Hds,Ft,Genital;Exc Dia Over 4.0 Cm",,11626,CPT,Facility,Both,,,,716,608.6,205.2056,716,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,716,100,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins,Sclp,Nk,Hds,Ft,Genital;Exc Dia Over 4.0 Cm",,11626,CPT,Facility,Both,,,,716,608.6,205.2056,716,BlueCross BlueShield Minnesota,High Value Network Plan,644.4,90,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins,Sclp,Nk,Hds,Ft,Genital;Exc Dia Over 4.0 Cm",,11626,CPT,Facility,Outpatient,,,,716,608.6,205.2056,716,BlueCross BlueShield Minnesota,Medicare Advantage,350.84,49,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins,Sclp,Nk,Hds,Ft,Genital;Exc Dia Over 4.0 Cm",,11626,CPT,Facility,Inpatient,,,,716,608.6,205.2056,716,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Excision, Malignant Lesion Inc Margins,Sclp,Nk,Hds,Ft,Genital;Exc Dia Over 4.0 Cm",,11626,CPT,Facility,Both,,,,716,608.6,205.2056,716,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,634.1612,88.57,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins,Sclp,Nk,Hds,Ft,Genital;Exc Dia Over 4.0 Cm",,11626,CPT,Facility,Both,,,,716,608.6,205.2056,716,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,205.2056,28.66,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins,Sclp,Nk,Hds,Ft,Genital;Exc Dia Over 4.0 Cm",,11626,CPT,Facility,Outpatient,,,,716,608.6,205.2056,716,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),350.84,49,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins,Sclp,Nk,Hds,Ft,Genital;Exc Dia Over 4.0 Cm",,11626,CPT,Facility,Inpatient,,,,716,608.6,205.2056,716,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Excision, Malignant Lesion Inc Margins,Sclp,Nk,Hds,Ft,Genital;Exc Dia Over 4.0 Cm",,11626,CPT,Facility,Both,,,,716,608.6,205.2056,716,CorVel,Worker's Compensation,716,100,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins,Sclp,Nk,Hds,Ft,Genital;Exc Dia Over 4.0 Cm",,11626,CPT,Facility,Both,,,,716,608.6,205.2056,716,First Health Group Corporation,First Health Network,694.52,97,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins,Sclp,Nk,Hds,Ft,Genital;Exc Dia Over 4.0 Cm",,11626,CPT,Facility,Both,,,,716,608.6,205.2056,716,"Health Partners, Inc.",Commercial,677.336,94.6,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins,Sclp,Nk,Hds,Ft,Genital;Exc Dia Over 4.0 Cm",,11626,CPT,Facility,Outpatient,,,,716,608.6,205.2056,716,"Health Partners, Inc.",Medicare Advantage,350.84,49,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins,Sclp,Nk,Hds,Ft,Genital;Exc Dia Over 4.0 Cm",,11626,CPT,Facility,Inpatient,,,,716,608.6,205.2056,716,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Excision, Malignant Lesion Inc Margins,Sclp,Nk,Hds,Ft,Genital;Exc Dia Over 4.0 Cm",,11626,CPT,Facility,Both,,,,716,608.6,205.2056,716,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),429.6,60,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins,Sclp,Nk,Hds,Ft,Genital;Exc Dia Over 4.0 Cm",,11626,CPT,Facility,Both,,,,716,608.6,205.2056,716,"Health Partners, Inc.",State of Minnesota Advantage Program,583.54,81.5,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins,Sclp,Nk,Hds,Ft,Genital;Exc Dia Over 4.0 Cm",,11626,CPT,Facility,Both,,,,716,608.6,205.2056,716,"Health Partners, Inc.",State Public Programs,358,50,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins,Sclp,Nk,Hds,Ft,Genital;Exc Dia Over 4.0 Cm",,11626,CPT,Facility,Both,,,,716,608.6,205.2056,716,Humana Insurance Company,Commercial PPO,680.2,95,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins,Sclp,Nk,Hds,Ft,Genital;Exc Dia Over 4.0 Cm",,11626,CPT,Facility,Outpatient,,,,716,608.6,205.2056,716,Humana Insurance Company,Medicare PPO,350.84,49,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins,Sclp,Nk,Hds,Ft,Genital;Exc Dia Over 4.0 Cm",,11626,CPT,Facility,Inpatient,,,,716,608.6,205.2056,716,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Excision, Malignant Lesion Inc Margins,Sclp,Nk,Hds,Ft,Genital;Exc Dia Over 4.0 Cm",,11626,CPT,Facility,Both,,,,716,608.6,205.2056,716,Medica,Individual & Family,709.556,99.1,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins,Sclp,Nk,Hds,Ft,Genital;Exc Dia Over 4.0 Cm",,11626,CPT,Facility,Outpatient,,,,716,608.6,205.2056,716,Medica,Medica Advantage Solution,356.568,49.8,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins,Sclp,Nk,Hds,Ft,Genital;Exc Dia Over 4.0 Cm",,11626,CPT,Facility,Inpatient,,,,716,608.6,205.2056,716,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Excision, Malignant Lesion Inc Margins,Sclp,Nk,Hds,Ft,Genital;Exc Dia Over 4.0 Cm",,11626,CPT,Facility,Outpatient,,,,716,608.6,205.2056,716,Medica,Medical Assistance,319.336,44.6,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins,Sclp,Nk,Hds,Ft,Genital;Exc Dia Over 4.0 Cm",,11626,CPT,Facility,Inpatient,,,,716,608.6,205.2056,716,Medica,Medical Assistance,,,,,Included in per diem rate,
"Excision, Malignant Lesion Inc Margins,Sclp,Nk,Hds,Ft,Genital;Exc Dia Over 4.0 Cm",,11626,CPT,Facility,Outpatient,,,,716,608.6,205.2056,716,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,356.568,49.8,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins,Sclp,Nk,Hds,Ft,Genital;Exc Dia Over 4.0 Cm",,11626,CPT,Facility,Inpatient,,,,716,608.6,205.2056,716,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Excision, Malignant Lesion Inc Margins,Sclp,Nk,Hds,Ft,Genital;Exc Dia Over 4.0 Cm",,11626,CPT,Facility,Both,,,,716,608.6,205.2056,716,"Multiplan, Inc.","Multiplan, Inc.",673.04,94,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins,Sclp,Nk,Hds,Ft,Genital;Exc Dia Over 4.0 Cm",,11626,CPT,Facility,Outpatient,,,,716,608.6,205.2056,716,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,645.116,90.1,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins,Sclp,Nk,Hds,Ft,Genital;Exc Dia Over 4.0 Cm",,11626,CPT,Facility,Inpatient,,,,716,608.6,205.2056,716,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Excision, Malignant Lesion Inc Margins,Sclp,Nk,Hds,Ft,Genital;Exc Dia Over 4.0 Cm",,11626,CPT,Facility,Both,,,,716,608.6,205.2056,716,"Preferred One Administrative Services, INC.",PPO,705.976,98.6,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins,Sclp,Nk,Hds,Ft,Genital;Exc Dia Over 4.0 Cm",,11626,CPT,Facility,Outpatient,,,,716,608.6,205.2056,716,PrimeWest Health,Minnesota Senior Health Options (MSHO),368.382,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Excision, Malignant Lesion Inc Margins,Sclp,Nk,Hds,Ft,Genital;Exc Dia Over 4.0 Cm",,11626,CPT,Facility,Inpatient,,,,716,608.6,205.2056,716,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Excision, Malignant Lesion Inc Margins,Sclp,Nk,Hds,Ft,Genital;Exc Dia Over 4.0 Cm",,11626,CPT,Facility,Outpatient,,,,716,608.6,205.2056,716,PrimeWest Health,MinnesotaCare,367.7376,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Excision, Malignant Lesion Inc Margins,Sclp,Nk,Hds,Ft,Genital;Exc Dia Over 4.0 Cm",,11626,CPT,Facility,Inpatient,,,,716,608.6,205.2056,716,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Excision, Malignant Lesion Inc Margins,Sclp,Nk,Hds,Ft,Genital;Exc Dia Over 4.0 Cm",,11626,CPT,Facility,Both,,,,716,608.6,205.2056,716,Sanford Health Plan,Sanford Health Plan,658.72,92,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins,Sclp,Nk,Hds,Ft,Genital;Exc Dia Over 4.0 Cm",,11626,CPT,Facility,Outpatient,,,,716,608.6,205.2056,716,"UCare Health, Inc.",Individual & Family Plan,403.466,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Excision, Malignant Lesion Inc Margins,Sclp,Nk,Hds,Ft,Genital;Exc Dia Over 4.0 Cm",,11626,CPT,Facility,Inpatient,,,,716,608.6,205.2056,716,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Excision, Malignant Lesion Inc Margins,Sclp,Nk,Hds,Ft,Genital;Exc Dia Over 4.0 Cm",,11626,CPT,Facility,Outpatient,,,,716,608.6,205.2056,716,"UCare Health, Inc.",Medical Assistance,361.3652,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Excision, Malignant Lesion Inc Margins,Sclp,Nk,Hds,Ft,Genital;Exc Dia Over 4.0 Cm",,11626,CPT,Facility,Inpatient,,,,716,608.6,205.2056,716,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Excision, Malignant Lesion Inc Margins,Sclp,Nk,Hds,Ft,Genital;Exc Dia Over 4.0 Cm",,11626,CPT,Facility,Outpatient,,,,716,608.6,205.2056,716,"UCare Health, Inc.",Medicare Advantage,361.3652,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Excision, Malignant Lesion Inc Margins,Sclp,Nk,Hds,Ft,Genital;Exc Dia Over 4.0 Cm",,11626,CPT,Facility,Inpatient,,,,716,608.6,205.2056,716,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Excision, Malignant Lesion Inc Margins,Sclp,Nk,Hds,Ft,Genital;Exc Dia Over 4.0 Cm",,11626,CPT,Facility,Outpatient,,,,716,608.6,205.2056,716,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),361.3652,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Excision, Malignant Lesion Inc Margins,Sclp,Nk,Hds,Ft,Genital;Exc Dia Over 4.0 Cm",,11626,CPT,Facility,Inpatient,,,,716,608.6,205.2056,716,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Excision, Malignant Lesion Inc Margins,Sclp,Nk,Hds,Ft,Genital;Exc Dia Over 4.0 Cm",,11626,CPT,Facility,Both,,,,716,608.6,205.2056,716,UnitedHealthcare,Individual & Family,673.04,94,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins,Sclp,Nk,Hds,Ft,Genital;Exc Dia Over 4.0 Cm",,11626,CPT,Facility,Outpatient,,,,716,608.6,205.2056,716,UnitedHealthcare,Medicare Advantage,350.84,49,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins,Sclp,Nk,Hds,Ft,Genital;Exc Dia Over 4.0 Cm",,11626,CPT,Facility,Inpatient,,,,716,608.6,205.2056,716,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Excision, Malignant Lesion Inc Margins,Sclp,Nk,Hds,Ft,Genital;Exc Dia Over 4.0 Cm",,11626,CPT,Facility,Outpatient,,,,716,608.6,205.2056,716,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,343.68,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Excision, Malignant Lesion Inc Margins,Sclp,Nk,Hds,Ft,Genital;Exc Dia Over 4.0 Cm",,11626,CPT,Facility,Inpatient,,,,716,608.6,205.2056,716,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Excision, Malignant Lesion Inc Margins,Sclp,Nk,Hds,Ft,Genital;Exc Dia Over 4.0 Cm (Pro Cah)",,11626,CPT,Professional,Both,,,,1120,952,179.1,1120,Aetna,Commercial,952,85,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins,Sclp,Nk,Hds,Ft,Genital;Exc Dia Over 4.0 Cm (Pro Cah)",,11626,CPT,Professional,Both,,,,1120,952,179.1,1120,Aetna,Medicare Advantage,282.02,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion Inc Margins,Sclp,Nk,Hds,Ft,Genital;Exc Dia Over 4.0 Cm (Pro Cah)",,11626,CPT,Professional,Both,,,,1120,952,179.1,1120,Aetna,PPO,1041.6,93,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins,Sclp,Nk,Hds,Ft,Genital;Exc Dia Over 4.0 Cm (Pro Cah)",,11626,CPT,Professional,Both,,,,1120,952,179.1,1120,America's PPO,America's PPO,956.928,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Excision, Malignant Lesion Inc Margins,Sclp,Nk,Hds,Ft,Genital;Exc Dia Over 4.0 Cm (Pro Cah)",,11626,CPT,Professional,Both,,,,1120,952,179.1,1120,BlueCross BlueShield Minnesota, Federal Employee Program,596.33,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Excision, Malignant Lesion Inc Margins,Sclp,Nk,Hds,Ft,Genital;Exc Dia Over 4.0 Cm (Pro Cah)",,11626,CPT,Professional,Both,,,,1120,952,179.1,1120,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,605.87128,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Malignant Lesion Inc Margins,Sclp,Nk,Hds,Ft,Genital;Exc Dia Over 4.0 Cm (Pro Cah)",,11626,CPT,Professional,Both,,,,1120,952,179.1,1120,BlueCross BlueShield Minnesota,High Value Network Plan,605.87128,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Malignant Lesion Inc Margins,Sclp,Nk,Hds,Ft,Genital;Exc Dia Over 4.0 Cm (Pro Cah)",,11626,CPT,Professional,Both,,,,1120,952,179.1,1120,BlueCross BlueShield Minnesota,Medicare Advantage,320.229,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion Inc Margins,Sclp,Nk,Hds,Ft,Genital;Exc Dia Over 4.0 Cm (Pro Cah)",,11626,CPT,Professional,Both,,,,1120,952,179.1,1120,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,605.87128,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Malignant Lesion Inc Margins,Sclp,Nk,Hds,Ft,Genital;Exc Dia Over 4.0 Cm (Pro Cah)",,11626,CPT,Professional,Both,,,,1120,952,179.1,1120,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,206.77632,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision, Malignant Lesion Inc Margins,Sclp,Nk,Hds,Ft,Genital;Exc Dia Over 4.0 Cm (Pro Cah)",,11626,CPT,Professional,Both,,,,1120,952,179.1,1120,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),320.229,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion Inc Margins,Sclp,Nk,Hds,Ft,Genital;Exc Dia Over 4.0 Cm (Pro Cah)",,11626,CPT,Professional,Both,,,,1120,952,179.1,1120,CorVel,Worker's Compensation,546.7732038,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Excision, Malignant Lesion Inc Margins,Sclp,Nk,Hds,Ft,Genital;Exc Dia Over 4.0 Cm (Pro Cah)",,11626,CPT,Professional,Both,,,,1120,952,179.1,1120,First Health Group Corporation,First Health Network,1086.4,97,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins,Sclp,Nk,Hds,Ft,Genital;Exc Dia Over 4.0 Cm (Pro Cah)",,11626,CPT,Professional,Both,,,,1120,952,179.1,1120,"Health Partners, Inc.",Commercial,590.58,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision, Malignant Lesion Inc Margins,Sclp,Nk,Hds,Ft,Genital;Exc Dia Over 4.0 Cm (Pro Cah)",,11626,CPT,Professional,Both,,,,1120,952,179.1,1120,"Health Partners, Inc.",Medicare Advantage,320.229,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion Inc Margins,Sclp,Nk,Hds,Ft,Genital;Exc Dia Over 4.0 Cm (Pro Cah)",,11626,CPT,Professional,Both,,,,1120,952,179.1,1120,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),278.21,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Excision, Malignant Lesion Inc Margins,Sclp,Nk,Hds,Ft,Genital;Exc Dia Over 4.0 Cm (Pro Cah)",,11626,CPT,Professional,Both,,,,1120,952,179.1,1120,"Health Partners, Inc.",State of Minnesota Advantage Program,508.78467,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision, Malignant Lesion Inc Margins,Sclp,Nk,Hds,Ft,Genital;Exc Dia Over 4.0 Cm (Pro Cah)",,11626,CPT,Professional,Both,,,,1120,952,179.1,1120,"Health Partners, Inc.",State Public Programs,179.1,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Excision, Malignant Lesion Inc Margins,Sclp,Nk,Hds,Ft,Genital;Exc Dia Over 4.0 Cm (Pro Cah)",,11626,CPT,Professional,Both,,,,1120,952,179.1,1120,Humana Insurance Company,Commercial PPO,278.46,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Excision, Malignant Lesion Inc Margins,Sclp,Nk,Hds,Ft,Genital;Exc Dia Over 4.0 Cm (Pro Cah)",,11626,CPT,Professional,Both,,,,1120,952,179.1,1120,Humana Insurance Company,Medicare PPO,1120,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion Inc Margins,Sclp,Nk,Hds,Ft,Genital;Exc Dia Over 4.0 Cm (Pro Cah)",,11626,CPT,Professional,Both,,,,1120,952,179.1,1120,Medica,Individual & Family,949.76,84.8,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins,Sclp,Nk,Hds,Ft,Genital;Exc Dia Over 4.0 Cm (Pro Cah)",,11626,CPT,Professional,Both,,,,1120,952,179.1,1120,Medica,Medica Advantage Solution,557.76,49.8,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins,Sclp,Nk,Hds,Ft,Genital;Exc Dia Over 4.0 Cm (Pro Cah)",,11626,CPT,Professional,Both,,,,1120,952,179.1,1120,Medica,Medical Assistance,206.78,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Excision, Malignant Lesion Inc Margins,Sclp,Nk,Hds,Ft,Genital;Exc Dia Over 4.0 Cm (Pro Cah)",,11626,CPT,Professional,Both,,,,1120,952,179.1,1120,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,278.46,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Excision, Malignant Lesion Inc Margins,Sclp,Nk,Hds,Ft,Genital;Exc Dia Over 4.0 Cm (Pro Cah)",,11626,CPT,Professional,Both,,,,1120,952,179.1,1120,"Multiplan, Inc.","Multiplan, Inc.",1052.8,94,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins,Sclp,Nk,Hds,Ft,Genital;Exc Dia Over 4.0 Cm (Pro Cah)",,11626,CPT,Professional,Both,,,,1120,952,179.1,1120,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1009.12,90.1,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins,Sclp,Nk,Hds,Ft,Genital;Exc Dia Over 4.0 Cm (Pro Cah)",,11626,CPT,Professional,Both,,,,1120,952,179.1,1120,"Preferred One Administrative Services, INC.",PPO,1104.32,98.6,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins,Sclp,Nk,Hds,Ft,Genital;Exc Dia Over 4.0 Cm (Pro Cah)",,11626,CPT,Professional,Both,,,,1120,952,179.1,1120,PrimeWest Health,Minnesota Senior Health Options (MSHO),320.229,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion Inc Margins,Sclp,Nk,Hds,Ft,Genital;Exc Dia Over 4.0 Cm (Pro Cah)",,11626,CPT,Professional,Both,,,,1120,952,179.1,1120,PrimeWest Health,MinnesotaCare,221.2506624,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision, Malignant Lesion Inc Margins,Sclp,Nk,Hds,Ft,Genital;Exc Dia Over 4.0 Cm (Pro Cah)",,11626,CPT,Professional,Both,,,,1120,952,179.1,1120,Sanford Health Plan,Sanford Health Plan,985.6,88,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins,Sclp,Nk,Hds,Ft,Genital;Exc Dia Over 4.0 Cm (Pro Cah)",,11626,CPT,Professional,Both,,,,1120,952,179.1,1120,"UCare Health, Inc.",Individual & Family Plan,452.664576,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Excision, Malignant Lesion Inc Margins,Sclp,Nk,Hds,Ft,Genital;Exc Dia Over 4.0 Cm (Pro Cah)",,11626,CPT,Professional,Both,,,,1120,952,179.1,1120,"UCare Health, Inc.",Medical Assistance,227.453952,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Excision, Malignant Lesion Inc Margins,Sclp,Nk,Hds,Ft,Genital;Exc Dia Over 4.0 Cm (Pro Cah)",,11626,CPT,Professional,Both,,,,1120,952,179.1,1120,"UCare Health, Inc.",Medicare Advantage,320.229,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Excision, Malignant Lesion Inc Margins,Sclp,Nk,Hds,Ft,Genital;Exc Dia Over 4.0 Cm (Pro Cah)",,11626,CPT,Professional,Both,,,,1120,952,179.1,1120,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),256.1832,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Excision, Malignant Lesion Inc Margins,Sclp,Nk,Hds,Ft,Genital;Exc Dia Over 4.0 Cm (Pro Cah)",,11626,CPT,Professional,Both,,,,1120,952,179.1,1120,UnitedHealthcare,Individual & Family,1120,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Excision, Malignant Lesion Inc Margins,Sclp,Nk,Hds,Ft,Genital;Exc Dia Over 4.0 Cm (Pro Cah)",,11626,CPT,Professional,Both,,,,1120,952,179.1,1120,UnitedHealthcare,Medicare Advantage,320.229,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion Inc Margins,Sclp,Nk,Hds,Ft,Genital;Exc Dia Over 4.0 Cm (Pro Cah)",,11626,CPT,Professional,Both,,,,1120,952,179.1,1120,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,206.77632,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
FENTANYL 25 MCG/HR TD PT72,,17450,LOCAL,Facility,Inpatient,1,Each,,96,81.6,27.5136,96,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
FENTANYL 25 MCG/HR TD PT72,,17450,LOCAL,Facility,Inpatient,1,Each,,96,81.6,27.5136,96,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
FENTANYL 25 MCG/HR TD PT72,,17450,LOCAL,Facility,Outpatient,1,Each,,96,81.6,27.5136,96,Medica,Medical Assistance,42.816,44.6,,percent of total billed charges,,
FENTANYL 25 MCG/HR TD PT72,,17450,LOCAL,Facility,Outpatient,1,Each,,96,81.6,27.5136,96,Medica,Medical Assistance,42.816,44.6,,percent of total billed charges,,
FENTANYL 25 MCG/HR TD PT72,,17450,LOCAL,Facility,Inpatient,1,Each,,96,81.6,27.5136,96,Medica,Medical Assistance,,,,,Included in per diem rate,
FENTANYL 25 MCG/HR TD PT72,,17450,LOCAL,Facility,Inpatient,1,Each,,96,81.6,27.5136,96,Medica,Medical Assistance,,,,,Included in per diem rate,
FENTANYL 25 MCG/HR TD PT72,,17450,LOCAL,Facility,Outpatient,1,Each,,96,81.6,27.5136,96,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,47.808,49.8,,percent of total billed charges,,
FENTANYL 25 MCG/HR TD PT72,,17450,LOCAL,Facility,Outpatient,1,Each,,96,81.6,27.5136,96,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,47.808,49.8,,percent of total billed charges,,
FENTANYL 25 MCG/HR TD PT72,,17450,LOCAL,Facility,Inpatient,1,Each,,96,81.6,27.5136,96,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
FENTANYL 25 MCG/HR TD PT72,,17450,LOCAL,Facility,Inpatient,1,Each,,96,81.6,27.5136,96,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
FENTANYL 25 MCG/HR TD PT72,,17450,LOCAL,Facility,Both,1,Each,,96,81.6,27.5136,96,"Multiplan, Inc.","Multiplan, Inc.",90.24,94,,percent of total billed charges,,
FENTANYL 25 MCG/HR TD PT72,,17450,LOCAL,Facility,Both,1,Each,,96,81.6,27.5136,96,"Multiplan, Inc.","Multiplan, Inc.",90.24,94,,percent of total billed charges,,
FENTANYL 25 MCG/HR TD PT72,,17450,LOCAL,Facility,Outpatient,1,Each,,96,81.6,27.5136,96,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,86.496,90.1,,percent of total billed charges,,
FENTANYL 25 MCG/HR TD PT72,,17450,LOCAL,Facility,Outpatient,1,Each,,96,81.6,27.5136,96,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,86.496,90.1,,percent of total billed charges,,
FENTANYL 25 MCG/HR TD PT72,,17450,LOCAL,Facility,Inpatient,1,Each,,96,81.6,27.5136,96,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
FENTANYL 25 MCG/HR TD PT72,,17450,LOCAL,Facility,Inpatient,1,Each,,96,81.6,27.5136,96,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
FENTANYL 25 MCG/HR TD PT72,,17450,LOCAL,Facility,Both,1,Each,,96,81.6,27.5136,96,"Preferred One Administrative Services, INC.",PPO,94.656,98.6,,percent of total billed charges,,
FENTANYL 25 MCG/HR TD PT72,,17450,LOCAL,Facility,Both,1,Each,,96,81.6,27.5136,96,"Preferred One Administrative Services, INC.",PPO,94.656,98.6,,percent of total billed charges,,
FENTANYL 25 MCG/HR TD PT72,,17450,LOCAL,Facility,Outpatient,1,Each,,96,81.6,27.5136,96,PrimeWest Health,Minnesota Senior Health Options (MSHO),49.392,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
FENTANYL 25 MCG/HR TD PT72,,17450,LOCAL,Facility,Outpatient,1,Each,,96,81.6,27.5136,96,PrimeWest Health,Minnesota Senior Health Options (MSHO),49.392,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
FENTANYL 25 MCG/HR TD PT72,,17450,LOCAL,Facility,Inpatient,1,Each,,96,81.6,27.5136,96,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
FENTANYL 25 MCG/HR TD PT72,,17450,LOCAL,Facility,Inpatient,1,Each,,96,81.6,27.5136,96,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
FENTANYL 25 MCG/HR TD PT72,,17450,LOCAL,Facility,Outpatient,1,Each,,96,81.6,27.5136,96,PrimeWest Health,MinnesotaCare,49.3056,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
FENTANYL 25 MCG/HR TD PT72,,17450,LOCAL,Facility,Outpatient,1,Each,,96,81.6,27.5136,96,PrimeWest Health,MinnesotaCare,49.3056,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
FENTANYL 25 MCG/HR TD PT72,,17450,LOCAL,Facility,Inpatient,1,Each,,96,81.6,27.5136,96,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
FENTANYL 25 MCG/HR TD PT72,,17450,LOCAL,Facility,Inpatient,1,Each,,96,81.6,27.5136,96,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
FENTANYL 25 MCG/HR TD PT72,,17450,LOCAL,Facility,Both,1,Each,,96,81.6,27.5136,96,Sanford Health Plan,Sanford Health Plan,88.32,92,,percent of total billed charges,,
FENTANYL 25 MCG/HR TD PT72,,17450,LOCAL,Facility,Both,1,Each,,96,81.6,27.5136,96,Sanford Health Plan,Sanford Health Plan,88.32,92,,percent of total billed charges,,
FENTANYL 25 MCG/HR TD PT72,,17450,LOCAL,Facility,Outpatient,1,Each,,96,81.6,27.5136,96,"UCare Health, Inc.",Individual & Family Plan,54.096,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
FENTANYL 25 MCG/HR TD PT72,,17450,LOCAL,Facility,Outpatient,1,Each,,96,81.6,27.5136,96,"UCare Health, Inc.",Individual & Family Plan,54.096,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
FENTANYL 25 MCG/HR TD PT72,,17450,LOCAL,Facility,Inpatient,1,Each,,96,81.6,27.5136,96,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
FENTANYL 25 MCG/HR TD PT72,,17450,LOCAL,Facility,Inpatient,1,Each,,96,81.6,27.5136,96,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
FENTANYL 25 MCG/HR TD PT72,,17450,LOCAL,Facility,Outpatient,1,Each,,96,81.6,27.5136,96,"UCare Health, Inc.",Medical Assistance,48.4512,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FENTANYL 25 MCG/HR TD PT72,,17450,LOCAL,Facility,Outpatient,1,Each,,96,81.6,27.5136,96,"UCare Health, Inc.",Medical Assistance,48.4512,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FENTANYL 25 MCG/HR TD PT72,,17450,LOCAL,Facility,Inpatient,1,Each,,96,81.6,27.5136,96,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
FENTANYL 25 MCG/HR TD PT72,,17450,LOCAL,Facility,Inpatient,1,Each,,96,81.6,27.5136,96,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
FENTANYL 25 MCG/HR TD PT72,,17450,LOCAL,Facility,Outpatient,1,Each,,96,81.6,27.5136,96,"UCare Health, Inc.",Medicare Advantage,48.4512,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FENTANYL 25 MCG/HR TD PT72,,17450,LOCAL,Facility,Outpatient,1,Each,,96,81.6,27.5136,96,"UCare Health, Inc.",Medicare Advantage,48.4512,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FENTANYL 25 MCG/HR TD PT72,,17450,LOCAL,Facility,Inpatient,1,Each,,96,81.6,27.5136,96,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
FENTANYL 25 MCG/HR TD PT72,,17450,LOCAL,Facility,Inpatient,1,Each,,96,81.6,27.5136,96,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
FENTANYL 25 MCG/HR TD PT72,,17450,LOCAL,Facility,Outpatient,1,Each,,96,81.6,27.5136,96,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),48.4512,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FENTANYL 25 MCG/HR TD PT72,,17450,LOCAL,Facility,Outpatient,1,Each,,96,81.6,27.5136,96,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),48.4512,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FENTANYL 25 MCG/HR TD PT72,,17450,LOCAL,Facility,Inpatient,1,Each,,96,81.6,27.5136,96,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
FENTANYL 25 MCG/HR TD PT72,,17450,LOCAL,Facility,Inpatient,1,Each,,96,81.6,27.5136,96,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
FENTANYL 25 MCG/HR TD PT72,,17450,LOCAL,Facility,Both,1,Each,,96,81.6,27.5136,96,UnitedHealthcare,Individual & Family,90.24,94,,percent of total billed charges,,
FENTANYL 25 MCG/HR TD PT72,,17450,LOCAL,Facility,Both,1,Each,,96,81.6,27.5136,96,UnitedHealthcare,Individual & Family,90.24,94,,percent of total billed charges,,
FENTANYL 25 MCG/HR TD PT72,,17450,LOCAL,Facility,Outpatient,1,Each,,96,81.6,27.5136,96,UnitedHealthcare,Medicare Advantage,47.04,49,,percent of total billed charges,,
FENTANYL 25 MCG/HR TD PT72,,17450,LOCAL,Facility,Outpatient,1,Each,,96,81.6,27.5136,96,UnitedHealthcare,Medicare Advantage,47.04,49,,percent of total billed charges,,
FENTANYL 25 MCG/HR TD PT72,,17450,LOCAL,Facility,Inpatient,1,Each,,96,81.6,27.5136,96,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
FENTANYL 25 MCG/HR TD PT72,,17450,LOCAL,Facility,Inpatient,1,Each,,96,81.6,27.5136,96,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
FENTANYL 25 MCG/HR TD PT72,,17450,LOCAL,Facility,Outpatient,1,Each,,96,81.6,27.5136,96,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,46.08,48,,percent of total billed charges,,100% of DHS outpatient percentage
FENTANYL 25 MCG/HR TD PT72,,17450,LOCAL,Facility,Outpatient,1,Each,,96,81.6,27.5136,96,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,46.08,48,,percent of total billed charges,,100% of DHS outpatient percentage
FENTANYL 25 MCG/HR TD PT72,,17450,LOCAL,Facility,Inpatient,1,Each,,96,81.6,27.5136,96,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
FENTANYL 25 MCG/HR TD PT72,,17450,LOCAL,Facility,Inpatient,1,Each,,96,81.6,27.5136,96,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Excision, Malignant Lesion, Face, Ears, Eyelids, Nose, Lips; Exc Dia 0.5 Cm Or Less",,11640,CPT,Facility,Both,,,,372,316.2,106.6152,372,Aetna,Commercial,342.24,92,,percent of total billed charges,,
"Excision, Malignant Lesion, Face, Ears, Eyelids, Nose, Lips; Exc Dia 0.5 Cm Or Less",,11640,CPT,Facility,Outpatient,,,,372,316.2,106.6152,372,Aetna,Medicare Advantage,182.28,49,,percent of total billed charges,,
"Excision, Malignant Lesion, Face, Ears, Eyelids, Nose, Lips; Exc Dia 0.5 Cm Or Less",,11640,CPT,Facility,Inpatient,,,,372,316.2,106.6152,372,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Excision, Malignant Lesion, Face, Ears, Eyelids, Nose, Lips; Exc Dia 0.5 Cm Or Less",,11640,CPT,Facility,Both,,,,372,316.2,106.6152,372,Aetna,PPO,345.96,93,,percent of total billed charges,,
"Excision, Malignant Lesion, Face, Ears, Eyelids, Nose, Lips; Exc Dia 0.5 Cm Or Less",,11640,CPT,Facility,Both,,,,372,316.2,106.6152,372,America's PPO,America's PPO,357.2316,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Excision, Malignant Lesion, Face, Ears, Eyelids, Nose, Lips; Exc Dia 0.5 Cm Or Less",,11640,CPT,Facility,Both,,,,372,316.2,106.6152,372,BlueCross BlueShield Minnesota, Federal Employee Program,366.048,98.4,,percent of total billed charges,,
"Excision, Malignant Lesion, Face, Ears, Eyelids, Nose, Lips; Exc Dia 0.5 Cm Or Less",,11640,CPT,Facility,Both,,,,372,316.2,106.6152,372,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,372,100,,percent of total billed charges,,
"Excision, Malignant Lesion, Face, Ears, Eyelids, Nose, Lips; Exc Dia 0.5 Cm Or Less",,11640,CPT,Facility,Both,,,,372,316.2,106.6152,372,BlueCross BlueShield Minnesota,High Value Network Plan,334.8,90,,percent of total billed charges,,
"Excision, Malignant Lesion, Face, Ears, Eyelids, Nose, Lips; Exc Dia 0.5 Cm Or Less",,11640,CPT,Facility,Outpatient,,,,372,316.2,106.6152,372,BlueCross BlueShield Minnesota,Medicare Advantage,182.28,49,,percent of total billed charges,,
"Excision, Malignant Lesion, Face, Ears, Eyelids, Nose, Lips; Exc Dia 0.5 Cm Or Less",,11640,CPT,Facility,Inpatient,,,,372,316.2,106.6152,372,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Excision, Malignant Lesion, Face, Ears, Eyelids, Nose, Lips; Exc Dia 0.5 Cm Or Less",,11640,CPT,Facility,Both,,,,372,316.2,106.6152,372,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,329.4804,88.57,,percent of total billed charges,,
"Excision, Malignant Lesion, Face, Ears, Eyelids, Nose, Lips; Exc Dia 0.5 Cm Or Less",,11640,CPT,Facility,Both,,,,372,316.2,106.6152,372,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,106.6152,28.66,,percent of total billed charges,,
"Excision, Malignant Lesion, Face, Ears, Eyelids, Nose, Lips; Exc Dia 0.5 Cm Or Less",,11640,CPT,Facility,Outpatient,,,,372,316.2,106.6152,372,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),182.28,49,,percent of total billed charges,,
"Excision, Malignant Lesion, Face, Ears, Eyelids, Nose, Lips; Exc Dia 0.5 Cm Or Less",,11640,CPT,Facility,Inpatient,,,,372,316.2,106.6152,372,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Excision, Malignant Lesion, Face, Ears, Eyelids, Nose, Lips; Exc Dia 0.5 Cm Or Less",,11640,CPT,Facility,Both,,,,372,316.2,106.6152,372,CorVel,Worker's Compensation,372,100,,percent of total billed charges,,
"Excision, Malignant Lesion, Face, Ears, Eyelids, Nose, Lips; Exc Dia 0.5 Cm Or Less",,11640,CPT,Facility,Both,,,,372,316.2,106.6152,372,First Health Group Corporation,First Health Network,360.84,97,,percent of total billed charges,,
"Excision, Malignant Lesion, Face, Ears, Eyelids, Nose, Lips; Exc Dia 0.5 Cm Or Less",,11640,CPT,Facility,Both,,,,372,316.2,106.6152,372,"Health Partners, Inc.",Commercial,351.912,94.6,,percent of total billed charges,,
"Excision, Malignant Lesion, Face, Ears, Eyelids, Nose, Lips; Exc Dia 0.5 Cm Or Less",,11640,CPT,Facility,Outpatient,,,,372,316.2,106.6152,372,"Health Partners, Inc.",Medicare Advantage,182.28,49,,percent of total billed charges,,
"Excision, Malignant Lesion, Face, Ears, Eyelids, Nose, Lips; Exc Dia 0.5 Cm Or Less",,11640,CPT,Facility,Inpatient,,,,372,316.2,106.6152,372,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Excision, Malignant Lesion, Face, Ears, Eyelids, Nose, Lips; Exc Dia 0.5 Cm Or Less",,11640,CPT,Facility,Both,,,,372,316.2,106.6152,372,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),223.2,60,,percent of total billed charges,,
"Excision, Malignant Lesion, Face, Ears, Eyelids, Nose, Lips; Exc Dia 0.5 Cm Or Less",,11640,CPT,Facility,Both,,,,372,316.2,106.6152,372,"Health Partners, Inc.",State of Minnesota Advantage Program,303.18,81.5,,percent of total billed charges,,
"Excision, Malignant Lesion, Face, Ears, Eyelids, Nose, Lips; Exc Dia 0.5 Cm Or Less",,11640,CPT,Facility,Both,,,,372,316.2,106.6152,372,"Health Partners, Inc.",State Public Programs,186,50,,percent of total billed charges,,
"Excision, Malignant Lesion, Face, Ears, Eyelids, Nose, Lips; Exc Dia 0.5 Cm Or Less",,11640,CPT,Facility,Both,,,,372,316.2,106.6152,372,Humana Insurance Company,Commercial PPO,353.4,95,,percent of total billed charges,,
"Excision, Malignant Lesion, Face, Ears, Eyelids, Nose, Lips; Exc Dia 0.5 Cm Or Less",,11640,CPT,Facility,Outpatient,,,,372,316.2,106.6152,372,Humana Insurance Company,Medicare PPO,182.28,49,,percent of total billed charges,,
"Excision, Malignant Lesion, Face, Ears, Eyelids, Nose, Lips; Exc Dia 0.5 Cm Or Less",,11640,CPT,Facility,Inpatient,,,,372,316.2,106.6152,372,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Excision, Malignant Lesion, Face, Ears, Eyelids, Nose, Lips; Exc Dia 0.5 Cm Or Less",,11640,CPT,Facility,Both,,,,372,316.2,106.6152,372,Medica,Individual & Family,368.652,99.1,,percent of total billed charges,,
"Excision, Malignant Lesion, Face, Ears, Eyelids, Nose, Lips; Exc Dia 0.5 Cm Or Less",,11640,CPT,Facility,Outpatient,,,,372,316.2,106.6152,372,Medica,Medica Advantage Solution,185.256,49.8,,percent of total billed charges,,
"Excision, Malignant Lesion, Face, Ears, Eyelids, Nose, Lips; Exc Dia 0.5 Cm Or Less",,11640,CPT,Facility,Inpatient,,,,372,316.2,106.6152,372,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Excision, Malignant Lesion, Face, Ears, Eyelids, Nose, Lips; Exc Dia 0.5 Cm Or Less",,11640,CPT,Facility,Outpatient,,,,372,316.2,106.6152,372,Medica,Medical Assistance,165.912,44.6,,percent of total billed charges,,
"Excision, Malignant Lesion, Face, Ears, Eyelids, Nose, Lips; Exc Dia 0.5 Cm Or Less",,11640,CPT,Facility,Inpatient,,,,372,316.2,106.6152,372,Medica,Medical Assistance,,,,,Included in per diem rate,
"Excision, Malignant Lesion, Face, Ears, Eyelids, Nose, Lips; Exc Dia 0.5 Cm Or Less",,11640,CPT,Facility,Outpatient,,,,372,316.2,106.6152,372,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,185.256,49.8,,percent of total billed charges,,
"Excision, Malignant Lesion, Face, Ears, Eyelids, Nose, Lips; Exc Dia 0.5 Cm Or Less",,11640,CPT,Facility,Inpatient,,,,372,316.2,106.6152,372,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Excision, Malignant Lesion, Face, Ears, Eyelids, Nose, Lips; Exc Dia 0.5 Cm Or Less",,11640,CPT,Facility,Both,,,,372,316.2,106.6152,372,"Multiplan, Inc.","Multiplan, Inc.",349.68,94,,percent of total billed charges,,
"Excision, Malignant Lesion, Face, Ears, Eyelids, Nose, Lips; Exc Dia 0.5 Cm Or Less",,11640,CPT,Facility,Outpatient,,,,372,316.2,106.6152,372,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,335.172,90.1,,percent of total billed charges,,
"Excision, Malignant Lesion, Face, Ears, Eyelids, Nose, Lips; Exc Dia 0.5 Cm Or Less",,11640,CPT,Facility,Inpatient,,,,372,316.2,106.6152,372,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Excision, Malignant Lesion, Face, Ears, Eyelids, Nose, Lips; Exc Dia 0.5 Cm Or Less",,11640,CPT,Facility,Both,,,,372,316.2,106.6152,372,"Preferred One Administrative Services, INC.",PPO,366.792,98.6,,percent of total billed charges,,
"Excision, Malignant Lesion, Face, Ears, Eyelids, Nose, Lips; Exc Dia 0.5 Cm Or Less",,11640,CPT,Facility,Outpatient,,,,372,316.2,106.6152,372,PrimeWest Health,Minnesota Senior Health Options (MSHO),191.394,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Excision, Malignant Lesion, Face, Ears, Eyelids, Nose, Lips; Exc Dia 0.5 Cm Or Less",,11640,CPT,Facility,Inpatient,,,,372,316.2,106.6152,372,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Excision, Malignant Lesion, Face, Ears, Eyelids, Nose, Lips; Exc Dia 0.5 Cm Or Less",,11640,CPT,Facility,Outpatient,,,,372,316.2,106.6152,372,PrimeWest Health,MinnesotaCare,191.0592,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Excision, Malignant Lesion, Face, Ears, Eyelids, Nose, Lips; Exc Dia 0.5 Cm Or Less",,11640,CPT,Facility,Inpatient,,,,372,316.2,106.6152,372,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Excision, Malignant Lesion, Face, Ears, Eyelids, Nose, Lips; Exc Dia 0.5 Cm Or Less",,11640,CPT,Facility,Both,,,,372,316.2,106.6152,372,Sanford Health Plan,Sanford Health Plan,342.24,92,,percent of total billed charges,,
"Excision, Malignant Lesion, Face, Ears, Eyelids, Nose, Lips; Exc Dia 0.5 Cm Or Less",,11640,CPT,Facility,Outpatient,,,,372,316.2,106.6152,372,"UCare Health, Inc.",Individual & Family Plan,209.622,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Excision, Malignant Lesion, Face, Ears, Eyelids, Nose, Lips; Exc Dia 0.5 Cm Or Less",,11640,CPT,Facility,Inpatient,,,,372,316.2,106.6152,372,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Excision, Malignant Lesion, Face, Ears, Eyelids, Nose, Lips; Exc Dia 0.5 Cm Or Less",,11640,CPT,Facility,Outpatient,,,,372,316.2,106.6152,372,"UCare Health, Inc.",Medical Assistance,187.7484,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Excision, Malignant Lesion, Face, Ears, Eyelids, Nose, Lips; Exc Dia 0.5 Cm Or Less",,11640,CPT,Facility,Inpatient,,,,372,316.2,106.6152,372,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Excision, Malignant Lesion, Face, Ears, Eyelids, Nose, Lips; Exc Dia 0.5 Cm Or Less",,11640,CPT,Facility,Outpatient,,,,372,316.2,106.6152,372,"UCare Health, Inc.",Medicare Advantage,187.7484,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Excision, Malignant Lesion, Face, Ears, Eyelids, Nose, Lips; Exc Dia 0.5 Cm Or Less",,11640,CPT,Facility,Inpatient,,,,372,316.2,106.6152,372,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Excision, Malignant Lesion, Face, Ears, Eyelids, Nose, Lips; Exc Dia 0.5 Cm Or Less",,11640,CPT,Facility,Outpatient,,,,372,316.2,106.6152,372,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),187.7484,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Excision, Malignant Lesion, Face, Ears, Eyelids, Nose, Lips; Exc Dia 0.5 Cm Or Less",,11640,CPT,Facility,Inpatient,,,,372,316.2,106.6152,372,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Excision, Malignant Lesion, Face, Ears, Eyelids, Nose, Lips; Exc Dia 0.5 Cm Or Less",,11640,CPT,Facility,Both,,,,372,316.2,106.6152,372,UnitedHealthcare,Individual & Family,349.68,94,,percent of total billed charges,,
"Excision, Malignant Lesion, Face, Ears, Eyelids, Nose, Lips; Exc Dia 0.5 Cm Or Less",,11640,CPT,Facility,Outpatient,,,,372,316.2,106.6152,372,UnitedHealthcare,Medicare Advantage,182.28,49,,percent of total billed charges,,
"Excision, Malignant Lesion, Face, Ears, Eyelids, Nose, Lips; Exc Dia 0.5 Cm Or Less",,11640,CPT,Facility,Inpatient,,,,372,316.2,106.6152,372,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Excision, Malignant Lesion, Face, Ears, Eyelids, Nose, Lips; Exc Dia 0.5 Cm Or Less",,11640,CPT,Facility,Outpatient,,,,372,316.2,106.6152,372,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,178.56,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Excision, Malignant Lesion, Face, Ears, Eyelids, Nose, Lips; Exc Dia 0.5 Cm Or Less",,11640,CPT,Facility,Inpatient,,,,372,316.2,106.6152,372,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Excision, Malignant Lesion, Face, Ears, Eyelids, Nose, Lips; Exc Dia 0.5 Cm Or Less (Pro Cah)",,11640,CPT,Professional,Both,,,,455,386.75,79.84,455,Aetna,Commercial,386.75,85,,percent of total billed charges,,
"Excision, Malignant Lesion, Face, Ears, Eyelids, Nose, Lips; Exc Dia 0.5 Cm Or Less (Pro Cah)",,11640,CPT,Professional,Both,,,,455,386.75,79.84,455,Aetna,Medicare Advantage,124.13,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion, Face, Ears, Eyelids, Nose, Lips; Exc Dia 0.5 Cm Or Less (Pro Cah)",,11640,CPT,Professional,Both,,,,455,386.75,79.84,455,Aetna,PPO,423.15,93,,percent of total billed charges,,
"Excision, Malignant Lesion, Face, Ears, Eyelids, Nose, Lips; Exc Dia 0.5 Cm Or Less (Pro Cah)",,11640,CPT,Professional,Both,,,,455,386.75,79.84,455,America's PPO,America's PPO,388.752,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Excision, Malignant Lesion, Face, Ears, Eyelids, Nose, Lips; Exc Dia 0.5 Cm Or Less (Pro Cah)",,11640,CPT,Professional,Both,,,,455,386.75,79.84,455,BlueCross BlueShield Minnesota, Federal Employee Program,258.91,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Excision, Malignant Lesion, Face, Ears, Eyelids, Nose, Lips; Exc Dia 0.5 Cm Or Less (Pro Cah)",,11640,CPT,Professional,Both,,,,455,386.75,79.84,455,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,263.05256,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Malignant Lesion, Face, Ears, Eyelids, Nose, Lips; Exc Dia 0.5 Cm Or Less (Pro Cah)",,11640,CPT,Professional,Both,,,,455,386.75,79.84,455,BlueCross BlueShield Minnesota,High Value Network Plan,263.05256,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Malignant Lesion, Face, Ears, Eyelids, Nose, Lips; Exc Dia 0.5 Cm Or Less (Pro Cah)",,11640,CPT,Professional,Both,,,,455,386.75,79.84,455,BlueCross BlueShield Minnesota,Medicare Advantage,142.669,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion, Face, Ears, Eyelids, Nose, Lips; Exc Dia 0.5 Cm Or Less (Pro Cah)",,11640,CPT,Professional,Both,,,,455,386.75,79.84,455,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,263.05256,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Malignant Lesion, Face, Ears, Eyelids, Nose, Lips; Exc Dia 0.5 Cm Or Less (Pro Cah)",,11640,CPT,Professional,Both,,,,455,386.75,79.84,455,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,92.18168,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision, Malignant Lesion, Face, Ears, Eyelids, Nose, Lips; Exc Dia 0.5 Cm Or Less (Pro Cah)",,11640,CPT,Professional,Both,,,,455,386.75,79.84,455,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),142.669,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion, Face, Ears, Eyelids, Nose, Lips; Exc Dia 0.5 Cm Or Less (Pro Cah)",,11640,CPT,Professional,Both,,,,455,386.75,79.84,455,CorVel,Worker's Compensation,240.9918543,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Excision, Malignant Lesion, Face, Ears, Eyelids, Nose, Lips; Exc Dia 0.5 Cm Or Less (Pro Cah)",,11640,CPT,Professional,Both,,,,455,386.75,79.84,455,First Health Group Corporation,First Health Network,441.35,97,,percent of total billed charges,,
"Excision, Malignant Lesion, Face, Ears, Eyelids, Nose, Lips; Exc Dia 0.5 Cm Or Less (Pro Cah)",,11640,CPT,Professional,Both,,,,455,386.75,79.84,455,"Health Partners, Inc.",Commercial,259.74,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision, Malignant Lesion, Face, Ears, Eyelids, Nose, Lips; Exc Dia 0.5 Cm Or Less (Pro Cah)",,11640,CPT,Professional,Both,,,,455,386.75,79.84,455,"Health Partners, Inc.",Medicare Advantage,142.669,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion, Face, Ears, Eyelids, Nose, Lips; Exc Dia 0.5 Cm Or Less (Pro Cah)",,11640,CPT,Professional,Both,,,,455,386.75,79.84,455,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),124.37,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Excision, Malignant Lesion, Face, Ears, Eyelids, Nose, Lips; Exc Dia 0.5 Cm Or Less (Pro Cah)",,11640,CPT,Professional,Both,,,,455,386.75,79.84,455,"Health Partners, Inc.",State of Minnesota Advantage Program,223.76601,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision, Malignant Lesion, Face, Ears, Eyelids, Nose, Lips; Exc Dia 0.5 Cm Or Less (Pro Cah)",,11640,CPT,Professional,Both,,,,455,386.75,79.84,455,"Health Partners, Inc.",State Public Programs,79.84,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Excision, Malignant Lesion, Face, Ears, Eyelids, Nose, Lips; Exc Dia 0.5 Cm Or Less (Pro Cah)",,11640,CPT,Professional,Both,,,,455,386.75,79.84,455,Humana Insurance Company,Commercial PPO,124.06,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Excision, Malignant Lesion, Face, Ears, Eyelids, Nose, Lips; Exc Dia 0.5 Cm Or Less (Pro Cah)",,11640,CPT,Professional,Both,,,,455,386.75,79.84,455,Humana Insurance Company,Medicare PPO,455,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion, Face, Ears, Eyelids, Nose, Lips; Exc Dia 0.5 Cm Or Less (Pro Cah)",,11640,CPT,Professional,Both,,,,455,386.75,79.84,455,Medica,Individual & Family,385.84,84.8,,percent of total billed charges,,
"Excision, Malignant Lesion, Face, Ears, Eyelids, Nose, Lips; Exc Dia 0.5 Cm Or Less (Pro Cah)",,11640,CPT,Professional,Both,,,,455,386.75,79.84,455,Medica,Medica Advantage Solution,226.59,49.8,,percent of total billed charges,,
"Excision, Malignant Lesion, Face, Ears, Eyelids, Nose, Lips; Exc Dia 0.5 Cm Or Less (Pro Cah)",,11640,CPT,Professional,Both,,,,455,386.75,79.84,455,Medica,Medical Assistance,92.18,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Excision, Malignant Lesion, Face, Ears, Eyelids, Nose, Lips; Exc Dia 0.5 Cm Or Less (Pro Cah)",,11640,CPT,Professional,Both,,,,455,386.75,79.84,455,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,124.06,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Excision, Malignant Lesion, Face, Ears, Eyelids, Nose, Lips; Exc Dia 0.5 Cm Or Less (Pro Cah)",,11640,CPT,Professional,Both,,,,455,386.75,79.84,455,"Multiplan, Inc.","Multiplan, Inc.",427.7,94,,percent of total billed charges,,
"Excision, Malignant Lesion, Face, Ears, Eyelids, Nose, Lips; Exc Dia 0.5 Cm Or Less (Pro Cah)",,11640,CPT,Professional,Both,,,,455,386.75,79.84,455,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,409.955,90.1,,percent of total billed charges,,
"Excision, Malignant Lesion, Face, Ears, Eyelids, Nose, Lips; Exc Dia 0.5 Cm Or Less (Pro Cah)",,11640,CPT,Professional,Both,,,,455,386.75,79.84,455,"Preferred One Administrative Services, INC.",PPO,448.63,98.6,,percent of total billed charges,,
"Excision, Malignant Lesion, Face, Ears, Eyelids, Nose, Lips; Exc Dia 0.5 Cm Or Less (Pro Cah)",,11640,CPT,Professional,Both,,,,455,386.75,79.84,455,PrimeWest Health,Minnesota Senior Health Options (MSHO),142.669,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion, Face, Ears, Eyelids, Nose, Lips; Exc Dia 0.5 Cm Or Less (Pro Cah)",,11640,CPT,Professional,Both,,,,455,386.75,79.84,455,PrimeWest Health,MinnesotaCare,98.6343976,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision, Malignant Lesion, Face, Ears, Eyelids, Nose, Lips; Exc Dia 0.5 Cm Or Less (Pro Cah)",,11640,CPT,Professional,Both,,,,455,386.75,79.84,455,Sanford Health Plan,Sanford Health Plan,400.4,88,,percent of total billed charges,,
"Excision, Malignant Lesion, Face, Ears, Eyelids, Nose, Lips; Exc Dia 0.5 Cm Or Less (Pro Cah)",,11640,CPT,Professional,Both,,,,455,386.75,79.84,455,"UCare Health, Inc.",Individual & Family Plan,201.671936,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Excision, Malignant Lesion, Face, Ears, Eyelids, Nose, Lips; Exc Dia 0.5 Cm Or Less (Pro Cah)",,11640,CPT,Professional,Both,,,,455,386.75,79.84,455,"UCare Health, Inc.",Medical Assistance,101.399848,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Excision, Malignant Lesion, Face, Ears, Eyelids, Nose, Lips; Exc Dia 0.5 Cm Or Less (Pro Cah)",,11640,CPT,Professional,Both,,,,455,386.75,79.84,455,"UCare Health, Inc.",Medicare Advantage,142.669,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Excision, Malignant Lesion, Face, Ears, Eyelids, Nose, Lips; Exc Dia 0.5 Cm Or Less (Pro Cah)",,11640,CPT,Professional,Both,,,,455,386.75,79.84,455,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),114.1352,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Excision, Malignant Lesion, Face, Ears, Eyelids, Nose, Lips; Exc Dia 0.5 Cm Or Less (Pro Cah)",,11640,CPT,Professional,Both,,,,455,386.75,79.84,455,UnitedHealthcare,Individual & Family,455,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Excision, Malignant Lesion, Face, Ears, Eyelids, Nose, Lips; Exc Dia 0.5 Cm Or Less (Pro Cah)",,11640,CPT,Professional,Both,,,,455,386.75,79.84,455,UnitedHealthcare,Medicare Advantage,142.669,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion, Face, Ears, Eyelids, Nose, Lips; Exc Dia 0.5 Cm Or Less (Pro Cah)",,11640,CPT,Professional,Both,,,,455,386.75,79.84,455,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,92.18168,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision, Malignant Lesion Inc Margins,Face,Ears,Eyelids,Ns,Lips;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11641,CPT,Professional,Both,,,,545,463.25,97.51,545,Aetna,Commercial,463.25,85,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins,Face,Ears,Eyelids,Ns,Lips;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11641,CPT,Professional,Both,,,,545,463.25,97.51,545,Aetna,Commercial,463.25,85,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins,Face,Ears,Eyelids,Ns,Lips;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11641,CPT,Professional,Both,,,,545,463.25,97.51,545,Aetna,Medicare Advantage,152.09,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion Inc Margins,Face,Ears,Eyelids,Ns,Lips;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11641,CPT,Professional,Both,,,,545,463.25,97.51,545,Aetna,Medicare Advantage,152.09,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion Inc Margins,Face,Ears,Eyelids,Ns,Lips;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11641,CPT,Professional,Both,,,,545,463.25,97.51,545,Aetna,PPO,506.85,93,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins,Face,Ears,Eyelids,Ns,Lips;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11641,CPT,Professional,Both,,,,545,463.25,97.51,545,Aetna,PPO,506.85,93,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins,Face,Ears,Eyelids,Ns,Lips;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11641,CPT,Professional,Both,,,,545,463.25,97.51,545,America's PPO,America's PPO,465.648,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Excision, Malignant Lesion Inc Margins,Face,Ears,Eyelids,Ns,Lips;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11641,CPT,Professional,Both,,,,545,463.25,97.51,545,America's PPO,America's PPO,465.648,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Excision, Malignant Lesion Inc Margins,Face,Ears,Eyelids,Ns,Lips;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11641,CPT,Professional,Both,,,,545,463.25,97.51,545,BlueCross BlueShield Minnesota, Federal Employee Program,318.13,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Excision, Malignant Lesion Inc Margins,Face,Ears,Eyelids,Ns,Lips;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11641,CPT,Professional,Both,,,,545,463.25,97.51,545,BlueCross BlueShield Minnesota, Federal Employee Program,318.13,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Excision, Malignant Lesion Inc Margins,Face,Ears,Eyelids,Ns,Lips;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11641,CPT,Professional,Both,,,,545,463.25,97.51,545,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,323.22008,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Malignant Lesion Inc Margins,Face,Ears,Eyelids,Ns,Lips;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11641,CPT,Professional,Both,,,,545,463.25,97.51,545,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,323.22008,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Malignant Lesion Inc Margins,Face,Ears,Eyelids,Ns,Lips;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11641,CPT,Professional,Both,,,,545,463.25,97.51,545,BlueCross BlueShield Minnesota,High Value Network Plan,323.22008,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Malignant Lesion Inc Margins,Face,Ears,Eyelids,Ns,Lips;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11641,CPT,Professional,Both,,,,545,463.25,97.51,545,BlueCross BlueShield Minnesota,High Value Network Plan,323.22008,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Malignant Lesion Inc Margins,Face,Ears,Eyelids,Ns,Lips;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11641,CPT,Professional,Both,,,,545,463.25,97.51,545,BlueCross BlueShield Minnesota,Medicare Advantage,174.57,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion Inc Margins,Face,Ears,Eyelids,Ns,Lips;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11641,CPT,Professional,Both,,,,545,463.25,97.51,545,BlueCross BlueShield Minnesota,Medicare Advantage,174.57,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion Inc Margins,Face,Ears,Eyelids,Ns,Lips;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11641,CPT,Professional,Both,,,,545,463.25,97.51,545,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,323.22008,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Malignant Lesion Inc Margins,Face,Ears,Eyelids,Ns,Lips;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11641,CPT,Professional,Both,,,,545,463.25,97.51,545,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,323.22008,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Malignant Lesion Inc Margins,Face,Ears,Eyelids,Ns,Lips;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11641,CPT,Professional,Both,,,,545,463.25,97.51,545,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,112.58296,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision, Malignant Lesion Inc Margins,Face,Ears,Eyelids,Ns,Lips;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11641,CPT,Professional,Both,,,,545,463.25,97.51,545,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,112.58296,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision, Malignant Lesion Inc Margins,Face,Ears,Eyelids,Ns,Lips;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11641,CPT,Professional,Both,,,,545,463.25,97.51,545,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),174.57,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion Inc Margins,Face,Ears,Eyelids,Ns,Lips;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11641,CPT,Professional,Both,,,,545,463.25,97.51,545,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),174.57,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion Inc Margins,Face,Ears,Eyelids,Ns,Lips;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11641,CPT,Professional,Both,,,,545,463.25,97.51,545,CorVel,Worker's Compensation,295.2578256,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Excision, Malignant Lesion Inc Margins,Face,Ears,Eyelids,Ns,Lips;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11641,CPT,Professional,Both,,,,545,463.25,97.51,545,CorVel,Worker's Compensation,295.2578256,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Excision, Malignant Lesion Inc Margins,Face,Ears,Eyelids,Ns,Lips;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11641,CPT,Professional,Both,,,,545,463.25,97.51,545,First Health Group Corporation,First Health Network,528.65,97,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins,Face,Ears,Eyelids,Ns,Lips;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11641,CPT,Professional,Both,,,,545,463.25,97.51,545,First Health Group Corporation,First Health Network,528.65,97,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins,Face,Ears,Eyelids,Ns,Lips;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11641,CPT,Professional,Both,,,,545,463.25,97.51,545,"Health Partners, Inc.",Commercial,319.23,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision, Malignant Lesion Inc Margins,Face,Ears,Eyelids,Ns,Lips;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11641,CPT,Professional,Both,,,,545,463.25,97.51,545,"Health Partners, Inc.",Commercial,319.23,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision, Malignant Lesion Inc Margins,Face,Ears,Eyelids,Ns,Lips;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11641,CPT,Professional,Both,,,,545,463.25,97.51,545,"Health Partners, Inc.",Medicare Advantage,174.57,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion Inc Margins,Face,Ears,Eyelids,Ns,Lips;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11641,CPT,Professional,Both,,,,545,463.25,97.51,545,"Health Partners, Inc.",Medicare Advantage,174.57,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion Inc Margins,Face,Ears,Eyelids,Ns,Lips;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11641,CPT,Professional,Both,,,,545,463.25,97.51,545,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),151.81,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Excision, Malignant Lesion Inc Margins,Face,Ears,Eyelids,Ns,Lips;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11641,CPT,Professional,Both,,,,545,463.25,97.51,545,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),151.81,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Excision, Malignant Lesion Inc Margins,Face,Ears,Eyelids,Ns,Lips;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11641,CPT,Professional,Both,,,,545,463.25,97.51,545,"Health Partners, Inc.",State of Minnesota Advantage Program,275.016645,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision, Malignant Lesion Inc Margins,Face,Ears,Eyelids,Ns,Lips;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11641,CPT,Professional,Both,,,,545,463.25,97.51,545,"Health Partners, Inc.",State of Minnesota Advantage Program,275.016645,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision, Malignant Lesion Inc Margins,Face,Ears,Eyelids,Ns,Lips;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11641,CPT,Professional,Both,,,,545,463.25,97.51,545,"Health Partners, Inc.",State Public Programs,97.51,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Excision, Malignant Lesion Inc Margins,Face,Ears,Eyelids,Ns,Lips;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11641,CPT,Professional,Both,,,,545,463.25,97.51,545,"Health Partners, Inc.",State Public Programs,97.51,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Excision, Malignant Lesion Inc Margins,Face,Ears,Eyelids,Ns,Lips;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11641,CPT,Professional,Both,,,,545,463.25,97.51,545,Humana Insurance Company,Commercial PPO,151.8,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Excision, Malignant Lesion Inc Margins,Face,Ears,Eyelids,Ns,Lips;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11641,CPT,Professional,Both,,,,545,463.25,97.51,545,Humana Insurance Company,Commercial PPO,151.8,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Excision, Malignant Lesion Inc Margins,Face,Ears,Eyelids,Ns,Lips;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11641,CPT,Professional,Both,,,,545,463.25,97.51,545,Humana Insurance Company,Medicare PPO,545,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion Inc Margins,Face,Ears,Eyelids,Ns,Lips;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11641,CPT,Professional,Both,,,,545,463.25,97.51,545,Humana Insurance Company,Medicare PPO,545,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion Inc Margins,Face,Ears,Eyelids,Ns,Lips;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11641,CPT,Professional,Both,,,,545,463.25,97.51,545,Medica,Individual & Family,462.16,84.8,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins,Face,Ears,Eyelids,Ns,Lips;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11641,CPT,Professional,Both,,,,545,463.25,97.51,545,Medica,Individual & Family,462.16,84.8,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins,Face,Ears,Eyelids,Ns,Lips;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11641,CPT,Professional,Both,,,,545,463.25,97.51,545,Medica,Medica Advantage Solution,271.41,49.8,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins,Face,Ears,Eyelids,Ns,Lips;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11641,CPT,Professional,Both,,,,545,463.25,97.51,545,Medica,Medica Advantage Solution,271.41,49.8,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins,Face,Ears,Eyelids,Ns,Lips;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11641,CPT,Professional,Both,,,,545,463.25,97.51,545,Medica,Medical Assistance,112.58,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Excision, Malignant Lesion Inc Margins,Face,Ears,Eyelids,Ns,Lips;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11641,CPT,Professional,Both,,,,545,463.25,97.51,545,Medica,Medical Assistance,112.58,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Excision, Malignant Lesion Inc Margins,Face,Ears,Eyelids,Ns,Lips;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11641,CPT,Professional,Both,,,,545,463.25,97.51,545,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,151.8,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Excision, Malignant Lesion Inc Margins,Face,Ears,Eyelids,Ns,Lips;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11641,CPT,Professional,Both,,,,545,463.25,97.51,545,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,151.8,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Excision, Malignant Lesion Inc Margins,Face,Ears,Eyelids,Ns,Lips;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11641,CPT,Professional,Both,,,,545,463.25,97.51,545,"Multiplan, Inc.","Multiplan, Inc.",512.3,94,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins,Face,Ears,Eyelids,Ns,Lips;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11641,CPT,Professional,Both,,,,545,463.25,97.51,545,"Multiplan, Inc.","Multiplan, Inc.",512.3,94,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins,Face,Ears,Eyelids,Ns,Lips;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11641,CPT,Professional,Both,,,,545,463.25,97.51,545,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,491.045,90.1,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins,Face,Ears,Eyelids,Ns,Lips;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11641,CPT,Professional,Both,,,,545,463.25,97.51,545,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,491.045,90.1,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins,Face,Ears,Eyelids,Ns,Lips;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11641,CPT,Professional,Both,,,,545,463.25,97.51,545,"Preferred One Administrative Services, INC.",PPO,537.37,98.6,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins,Face,Ears,Eyelids,Ns,Lips;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11641,CPT,Professional,Both,,,,545,463.25,97.51,545,"Preferred One Administrative Services, INC.",PPO,537.37,98.6,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins,Face,Ears,Eyelids,Ns,Lips;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11641,CPT,Professional,Both,,,,545,463.25,97.51,545,PrimeWest Health,Minnesota Senior Health Options (MSHO),174.57,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion Inc Margins,Face,Ears,Eyelids,Ns,Lips;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11641,CPT,Professional,Both,,,,545,463.25,97.51,545,PrimeWest Health,Minnesota Senior Health Options (MSHO),174.57,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion Inc Margins,Face,Ears,Eyelids,Ns,Lips;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11641,CPT,Professional,Both,,,,545,463.25,97.51,545,PrimeWest Health,MinnesotaCare,120.4637672,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision, Malignant Lesion Inc Margins,Face,Ears,Eyelids,Ns,Lips;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11641,CPT,Professional,Both,,,,545,463.25,97.51,545,PrimeWest Health,MinnesotaCare,120.4637672,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision, Malignant Lesion Inc Margins,Face,Ears,Eyelids,Ns,Lips;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11641,CPT,Professional,Both,,,,545,463.25,97.51,545,Sanford Health Plan,Sanford Health Plan,479.6,88,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins,Face,Ears,Eyelids,Ns,Lips;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11641,CPT,Professional,Both,,,,545,463.25,97.51,545,Sanford Health Plan,Sanford Health Plan,479.6,88,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins,Face,Ears,Eyelids,Ns,Lips;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11641,CPT,Professional,Both,,,,545,463.25,97.51,545,"UCare Health, Inc.",Individual & Family Plan,246.76608,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Excision, Malignant Lesion Inc Margins,Face,Ears,Eyelids,Ns,Lips;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11641,CPT,Professional,Both,,,,545,463.25,97.51,545,"UCare Health, Inc.",Individual & Family Plan,246.76608,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Excision, Malignant Lesion Inc Margins,Face,Ears,Eyelids,Ns,Lips;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11641,CPT,Professional,Both,,,,545,463.25,97.51,545,"UCare Health, Inc.",Medical Assistance,123.841256,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Excision, Malignant Lesion Inc Margins,Face,Ears,Eyelids,Ns,Lips;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11641,CPT,Professional,Both,,,,545,463.25,97.51,545,"UCare Health, Inc.",Medical Assistance,123.841256,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Excision, Malignant Lesion Inc Margins,Face,Ears,Eyelids,Ns,Lips;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11641,CPT,Professional,Both,,,,545,463.25,97.51,545,"UCare Health, Inc.",Medicare Advantage,174.57,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Excision, Malignant Lesion Inc Margins,Face,Ears,Eyelids,Ns,Lips;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11641,CPT,Professional,Both,,,,545,463.25,97.51,545,"UCare Health, Inc.",Medicare Advantage,174.57,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Excision, Malignant Lesion Inc Margins,Face,Ears,Eyelids,Ns,Lips;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11641,CPT,Professional,Both,,,,545,463.25,97.51,545,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),139.656,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Excision, Malignant Lesion Inc Margins,Face,Ears,Eyelids,Ns,Lips;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11641,CPT,Professional,Both,,,,545,463.25,97.51,545,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),139.656,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Excision, Malignant Lesion Inc Margins,Face,Ears,Eyelids,Ns,Lips;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11641,CPT,Professional,Both,,,,545,463.25,97.51,545,UnitedHealthcare,Individual & Family,545,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Excision, Malignant Lesion Inc Margins,Face,Ears,Eyelids,Ns,Lips;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11641,CPT,Professional,Both,,,,545,463.25,97.51,545,UnitedHealthcare,Individual & Family,545,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Excision, Malignant Lesion Inc Margins,Face,Ears,Eyelids,Ns,Lips;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11641,CPT,Professional,Both,,,,545,463.25,97.51,545,UnitedHealthcare,Medicare Advantage,174.57,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion Inc Margins,Face,Ears,Eyelids,Ns,Lips;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11641,CPT,Professional,Both,,,,545,463.25,97.51,545,UnitedHealthcare,Medicare Advantage,174.57,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion Inc Margins,Face,Ears,Eyelids,Ns,Lips;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11641,CPT,Professional,Both,,,,545,463.25,97.51,545,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,112.58296,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision, Malignant Lesion Inc Margins,Face,Ears,Eyelids,Ns,Lips;Exc Dia 0.6-1.0 Cm (Pro Cah)",,11641,CPT,Professional,Both,,,,545,463.25,97.51,545,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,112.58296,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm",,11641,CPT,Facility,Both,,,,320,272,91.712,320,Aetna,Commercial,294.4,92,,percent of total billed charges,,
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm",,11641,CPT,Facility,Outpatient,,,,320,272,91.712,320,Aetna,Medicare Advantage,156.8,49,,percent of total billed charges,,
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm",,11641,CPT,Facility,Inpatient,,,,320,272,91.712,320,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm",,11641,CPT,Facility,Both,,,,320,272,91.712,320,Aetna,PPO,297.6,93,,percent of total billed charges,,
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm",,11641,CPT,Facility,Both,,,,320,272,91.712,320,America's PPO,America's PPO,307.296,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm",,11641,CPT,Facility,Both,,,,320,272,91.712,320,BlueCross BlueShield Minnesota, Federal Employee Program,314.88,98.4,,percent of total billed charges,,
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm",,11641,CPT,Facility,Both,,,,320,272,91.712,320,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,320,100,,percent of total billed charges,,
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm",,11641,CPT,Facility,Both,,,,320,272,91.712,320,BlueCross BlueShield Minnesota,High Value Network Plan,288,90,,percent of total billed charges,,
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm",,11641,CPT,Facility,Outpatient,,,,320,272,91.712,320,BlueCross BlueShield Minnesota,Medicare Advantage,156.8,49,,percent of total billed charges,,
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm",,11641,CPT,Facility,Inpatient,,,,320,272,91.712,320,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm",,11641,CPT,Facility,Both,,,,320,272,91.712,320,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,283.424,88.57,,percent of total billed charges,,
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm",,11641,CPT,Facility,Both,,,,320,272,91.712,320,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,91.712,28.66,,percent of total billed charges,,
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm",,11641,CPT,Facility,Outpatient,,,,320,272,91.712,320,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),156.8,49,,percent of total billed charges,,
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm",,11641,CPT,Facility,Inpatient,,,,320,272,91.712,320,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm",,11641,CPT,Facility,Both,,,,320,272,91.712,320,CorVel,Worker's Compensation,320,100,,percent of total billed charges,,
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm",,11641,CPT,Facility,Both,,,,320,272,91.712,320,First Health Group Corporation,First Health Network,310.4,97,,percent of total billed charges,,
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm",,11641,CPT,Facility,Both,,,,320,272,91.712,320,"Health Partners, Inc.",Commercial,302.72,94.6,,percent of total billed charges,,
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm",,11641,CPT,Facility,Outpatient,,,,320,272,91.712,320,"Health Partners, Inc.",Medicare Advantage,156.8,49,,percent of total billed charges,,
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm",,11641,CPT,Facility,Inpatient,,,,320,272,91.712,320,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm",,11641,CPT,Facility,Both,,,,320,272,91.712,320,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),192,60,,percent of total billed charges,,
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm",,11641,CPT,Facility,Both,,,,320,272,91.712,320,"Health Partners, Inc.",State of Minnesota Advantage Program,260.8,81.5,,percent of total billed charges,,
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm",,11641,CPT,Facility,Both,,,,320,272,91.712,320,"Health Partners, Inc.",State Public Programs,160,50,,percent of total billed charges,,
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm",,11641,CPT,Facility,Both,,,,320,272,91.712,320,Humana Insurance Company,Commercial PPO,304,95,,percent of total billed charges,,
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm",,11641,CPT,Facility,Outpatient,,,,320,272,91.712,320,Humana Insurance Company,Medicare PPO,156.8,49,,percent of total billed charges,,
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm",,11641,CPT,Facility,Inpatient,,,,320,272,91.712,320,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm",,11641,CPT,Facility,Both,,,,320,272,91.712,320,Medica,Individual & Family,317.12,99.1,,percent of total billed charges,,
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm",,11641,CPT,Facility,Outpatient,,,,320,272,91.712,320,Medica,Medica Advantage Solution,159.36,49.8,,percent of total billed charges,,
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm",,11641,CPT,Facility,Inpatient,,,,320,272,91.712,320,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm",,11641,CPT,Facility,Outpatient,,,,320,272,91.712,320,Medica,Medical Assistance,142.72,44.6,,percent of total billed charges,,
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm",,11641,CPT,Facility,Inpatient,,,,320,272,91.712,320,Medica,Medical Assistance,,,,,Included in per diem rate,
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm",,11641,CPT,Facility,Outpatient,,,,320,272,91.712,320,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,159.36,49.8,,percent of total billed charges,,
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm",,11641,CPT,Facility,Inpatient,,,,320,272,91.712,320,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm",,11641,CPT,Facility,Both,,,,320,272,91.712,320,"Multiplan, Inc.","Multiplan, Inc.",300.8,94,,percent of total billed charges,,
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm",,11641,CPT,Facility,Outpatient,,,,320,272,91.712,320,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,288.32,90.1,,percent of total billed charges,,
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm",,11641,CPT,Facility,Inpatient,,,,320,272,91.712,320,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm",,11641,CPT,Facility,Both,,,,320,272,91.712,320,"Preferred One Administrative Services, INC.",PPO,315.52,98.6,,percent of total billed charges,,
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm",,11641,CPT,Facility,Outpatient,,,,320,272,91.712,320,PrimeWest Health,Minnesota Senior Health Options (MSHO),164.64,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm",,11641,CPT,Facility,Inpatient,,,,320,272,91.712,320,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm",,11641,CPT,Facility,Outpatient,,,,320,272,91.712,320,PrimeWest Health,MinnesotaCare,164.352,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm",,11641,CPT,Facility,Inpatient,,,,320,272,91.712,320,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm",,11641,CPT,Facility,Both,,,,320,272,91.712,320,Sanford Health Plan,Sanford Health Plan,294.4,92,,percent of total billed charges,,
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm",,11641,CPT,Facility,Outpatient,,,,320,272,91.712,320,"UCare Health, Inc.",Individual & Family Plan,180.32,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm",,11641,CPT,Facility,Inpatient,,,,320,272,91.712,320,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm",,11641,CPT,Facility,Outpatient,,,,320,272,91.712,320,"UCare Health, Inc.",Medical Assistance,161.504,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm",,11641,CPT,Facility,Inpatient,,,,320,272,91.712,320,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm",,11641,CPT,Facility,Outpatient,,,,320,272,91.712,320,"UCare Health, Inc.",Medicare Advantage,161.504,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm",,11641,CPT,Facility,Inpatient,,,,320,272,91.712,320,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm",,11641,CPT,Facility,Outpatient,,,,320,272,91.712,320,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),161.504,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm",,11641,CPT,Facility,Inpatient,,,,320,272,91.712,320,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm",,11641,CPT,Facility,Both,,,,320,272,91.712,320,UnitedHealthcare,Individual & Family,300.8,94,,percent of total billed charges,,
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm",,11641,CPT,Facility,Outpatient,,,,320,272,91.712,320,UnitedHealthcare,Medicare Advantage,156.8,49,,percent of total billed charges,,
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm",,11641,CPT,Facility,Inpatient,,,,320,272,91.712,320,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm",,11641,CPT,Facility,Outpatient,,,,320,272,91.712,320,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,153.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm",,11641,CPT,Facility,Inpatient,,,,320,272,91.712,320,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm",,11642,CPT,Facility,Both,,,,365,310.25,104.609,365,Aetna,Commercial,335.8,92,,percent of total billed charges,,
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm",,11642,CPT,Facility,Outpatient,,,,365,310.25,104.609,365,Aetna,Medicare Advantage,178.85,49,,percent of total billed charges,,
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm",,11642,CPT,Facility,Inpatient,,,,365,310.25,104.609,365,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm",,11642,CPT,Facility,Both,,,,365,310.25,104.609,365,Aetna,PPO,339.45,93,,percent of total billed charges,,
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm",,11642,CPT,Facility,Both,,,,365,310.25,104.609,365,America's PPO,America's PPO,350.5095,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm",,11642,CPT,Facility,Both,,,,365,310.25,104.609,365,BlueCross BlueShield Minnesota, Federal Employee Program,359.16,98.4,,percent of total billed charges,,
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm",,11642,CPT,Facility,Both,,,,365,310.25,104.609,365,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,365,100,,percent of total billed charges,,
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm",,11642,CPT,Facility,Both,,,,365,310.25,104.609,365,BlueCross BlueShield Minnesota,High Value Network Plan,328.5,90,,percent of total billed charges,,
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm",,11642,CPT,Facility,Outpatient,,,,365,310.25,104.609,365,BlueCross BlueShield Minnesota,Medicare Advantage,178.85,49,,percent of total billed charges,,
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm",,11642,CPT,Facility,Inpatient,,,,365,310.25,104.609,365,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm",,11642,CPT,Facility,Both,,,,365,310.25,104.609,365,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,323.2805,88.57,,percent of total billed charges,,
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm",,11642,CPT,Facility,Both,,,,365,310.25,104.609,365,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,104.609,28.66,,percent of total billed charges,,
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm",,11642,CPT,Facility,Outpatient,,,,365,310.25,104.609,365,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),178.85,49,,percent of total billed charges,,
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm",,11642,CPT,Facility,Inpatient,,,,365,310.25,104.609,365,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm",,11642,CPT,Facility,Both,,,,365,310.25,104.609,365,CorVel,Worker's Compensation,365,100,,percent of total billed charges,,
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm",,11642,CPT,Facility,Both,,,,365,310.25,104.609,365,First Health Group Corporation,First Health Network,354.05,97,,percent of total billed charges,,
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm",,11642,CPT,Facility,Both,,,,365,310.25,104.609,365,"Health Partners, Inc.",Commercial,345.29,94.6,,percent of total billed charges,,
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm",,11642,CPT,Facility,Outpatient,,,,365,310.25,104.609,365,"Health Partners, Inc.",Medicare Advantage,178.85,49,,percent of total billed charges,,
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm",,11642,CPT,Facility,Inpatient,,,,365,310.25,104.609,365,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm",,11642,CPT,Facility,Both,,,,365,310.25,104.609,365,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),219,60,,percent of total billed charges,,
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm",,11642,CPT,Facility,Both,,,,365,310.25,104.609,365,"Health Partners, Inc.",State of Minnesota Advantage Program,297.475,81.5,,percent of total billed charges,,
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm",,11642,CPT,Facility,Both,,,,365,310.25,104.609,365,"Health Partners, Inc.",State Public Programs,182.5,50,,percent of total billed charges,,
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm",,11642,CPT,Facility,Both,,,,365,310.25,104.609,365,Humana Insurance Company,Commercial PPO,346.75,95,,percent of total billed charges,,
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm",,11642,CPT,Facility,Outpatient,,,,365,310.25,104.609,365,Humana Insurance Company,Medicare PPO,178.85,49,,percent of total billed charges,,
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm",,11642,CPT,Facility,Inpatient,,,,365,310.25,104.609,365,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm",,11642,CPT,Facility,Both,,,,365,310.25,104.609,365,Medica,Individual & Family,361.715,99.1,,percent of total billed charges,,
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm",,11642,CPT,Facility,Outpatient,,,,365,310.25,104.609,365,Medica,Medica Advantage Solution,181.77,49.8,,percent of total billed charges,,
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm",,11642,CPT,Facility,Inpatient,,,,365,310.25,104.609,365,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm",,11642,CPT,Facility,Outpatient,,,,365,310.25,104.609,365,Medica,Medical Assistance,162.79,44.6,,percent of total billed charges,,
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm",,11642,CPT,Facility,Inpatient,,,,365,310.25,104.609,365,Medica,Medical Assistance,,,,,Included in per diem rate,
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm",,11642,CPT,Facility,Outpatient,,,,365,310.25,104.609,365,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,181.77,49.8,,percent of total billed charges,,
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm",,11642,CPT,Facility,Inpatient,,,,365,310.25,104.609,365,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm",,11642,CPT,Facility,Both,,,,365,310.25,104.609,365,"Multiplan, Inc.","Multiplan, Inc.",343.1,94,,percent of total billed charges,,
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm",,11642,CPT,Facility,Outpatient,,,,365,310.25,104.609,365,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,328.865,90.1,,percent of total billed charges,,
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm",,11642,CPT,Facility,Inpatient,,,,365,310.25,104.609,365,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm",,11642,CPT,Facility,Both,,,,365,310.25,104.609,365,"Preferred One Administrative Services, INC.",PPO,359.89,98.6,,percent of total billed charges,,
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm",,11642,CPT,Facility,Outpatient,,,,365,310.25,104.609,365,PrimeWest Health,Minnesota Senior Health Options (MSHO),187.7925,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm",,11642,CPT,Facility,Inpatient,,,,365,310.25,104.609,365,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm",,11642,CPT,Facility,Outpatient,,,,365,310.25,104.609,365,PrimeWest Health,MinnesotaCare,187.464,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm",,11642,CPT,Facility,Inpatient,,,,365,310.25,104.609,365,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm",,11642,CPT,Facility,Both,,,,365,310.25,104.609,365,Sanford Health Plan,Sanford Health Plan,335.8,92,,percent of total billed charges,,
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm",,11642,CPT,Facility,Outpatient,,,,365,310.25,104.609,365,"UCare Health, Inc.",Individual & Family Plan,205.6775,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm",,11642,CPT,Facility,Inpatient,,,,365,310.25,104.609,365,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm",,11642,CPT,Facility,Outpatient,,,,365,310.25,104.609,365,"UCare Health, Inc.",Medical Assistance,184.2155,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm",,11642,CPT,Facility,Inpatient,,,,365,310.25,104.609,365,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm",,11642,CPT,Facility,Outpatient,,,,365,310.25,104.609,365,"UCare Health, Inc.",Medicare Advantage,184.2155,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm",,11642,CPT,Facility,Inpatient,,,,365,310.25,104.609,365,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm",,11642,CPT,Facility,Outpatient,,,,365,310.25,104.609,365,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),184.2155,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm",,11642,CPT,Facility,Inpatient,,,,365,310.25,104.609,365,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm",,11642,CPT,Facility,Both,,,,365,310.25,104.609,365,UnitedHealthcare,Individual & Family,343.1,94,,percent of total billed charges,,
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm",,11642,CPT,Facility,Outpatient,,,,365,310.25,104.609,365,UnitedHealthcare,Medicare Advantage,178.85,49,,percent of total billed charges,,
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm",,11642,CPT,Facility,Inpatient,,,,365,310.25,104.609,365,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm",,11642,CPT,Facility,Outpatient,,,,365,310.25,104.609,365,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,175.2,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm",,11642,CPT,Facility,Inpatient,,,,365,310.25,104.609,365,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11642,CPT,Professional,Both,,,,630,535.5,113.87,630,Aetna,Commercial,535.5,85,,percent of total billed charges,,
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11642,CPT,Professional,Both,,,,530,450.5,113.87,530,Aetna,Commercial,450.5,85,,percent of total billed charges,,
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11642,CPT,Professional,Both,,,,630,535.5,113.87,630,Aetna,Medicare Advantage,177.95,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11642,CPT,Professional,Both,,,,530,450.5,113.87,530,Aetna,Medicare Advantage,177.95,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11642,CPT,Professional,Both,,,,630,535.5,113.87,630,Aetna,PPO,585.9,93,,percent of total billed charges,,
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11642,CPT,Professional,Both,,,,530,450.5,113.87,530,Aetna,PPO,492.9,93,,percent of total billed charges,,
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11642,CPT,Professional,Both,,,,630,535.5,113.87,630,America's PPO,America's PPO,538.272,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11642,CPT,Professional,Both,,,,530,450.5,113.87,530,America's PPO,America's PPO,452.832,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11642,CPT,Professional,Both,,,,630,535.5,113.87,630,BlueCross BlueShield Minnesota, Federal Employee Program,371.16,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11642,CPT,Professional,Both,,,,530,450.5,113.87,530,BlueCross BlueShield Minnesota, Federal Employee Program,371.16,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11642,CPT,Professional,Both,,,,630,535.5,113.87,630,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,377.09856,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11642,CPT,Professional,Both,,,,530,450.5,113.87,530,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,377.09856,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11642,CPT,Professional,Both,,,,630,535.5,113.87,630,BlueCross BlueShield Minnesota,High Value Network Plan,377.09856,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11642,CPT,Professional,Both,,,,530,450.5,113.87,530,BlueCross BlueShield Minnesota,High Value Network Plan,377.09856,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11642,CPT,Professional,Both,,,,630,535.5,113.87,630,BlueCross BlueShield Minnesota,Medicare Advantage,203.734,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11642,CPT,Professional,Both,,,,530,450.5,113.87,530,BlueCross BlueShield Minnesota,Medicare Advantage,203.734,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11642,CPT,Professional,Both,,,,630,535.5,113.87,630,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,377.09856,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11642,CPT,Professional,Both,,,,530,450.5,113.87,530,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,377.09856,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11642,CPT,Professional,Both,,,,630,535.5,113.87,630,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,131.4704,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11642,CPT,Professional,Both,,,,530,450.5,113.87,530,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,131.4704,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11642,CPT,Professional,Both,,,,630,535.5,113.87,630,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),203.734,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11642,CPT,Professional,Both,,,,530,450.5,113.87,530,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),203.734,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11642,CPT,Professional,Both,,,,630,535.5,113.87,630,CorVel,Worker's Compensation,344.8353309,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11642,CPT,Professional,Both,,,,530,450.5,113.87,530,CorVel,Worker's Compensation,344.8353309,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11642,CPT,Professional,Both,,,,630,535.5,113.87,630,First Health Group Corporation,First Health Network,611.1,97,,percent of total billed charges,,
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11642,CPT,Professional,Both,,,,530,450.5,113.87,530,First Health Group Corporation,First Health Network,514.1,97,,percent of total billed charges,,
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11642,CPT,Professional,Both,,,,630,535.5,113.87,630,"Health Partners, Inc.",Commercial,372.19,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11642,CPT,Professional,Both,,,,530,450.5,113.87,530,"Health Partners, Inc.",Commercial,372.19,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11642,CPT,Professional,Both,,,,630,535.5,113.87,630,"Health Partners, Inc.",Medicare Advantage,203.734,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11642,CPT,Professional,Both,,,,530,450.5,113.87,530,"Health Partners, Inc.",Medicare Advantage,203.734,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11642,CPT,Professional,Both,,,,630,535.5,113.87,630,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),177.23,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11642,CPT,Professional,Both,,,,530,450.5,113.87,530,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),177.23,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11642,CPT,Professional,Both,,,,630,535.5,113.87,630,"Health Partners, Inc.",State of Minnesota Advantage Program,320.641685,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11642,CPT,Professional,Both,,,,530,450.5,113.87,530,"Health Partners, Inc.",State of Minnesota Advantage Program,320.641685,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11642,CPT,Professional,Both,,,,630,535.5,113.87,630,"Health Partners, Inc.",State Public Programs,113.87,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11642,CPT,Professional,Both,,,,530,450.5,113.87,530,"Health Partners, Inc.",State Public Programs,113.87,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11642,CPT,Professional,Both,,,,630,535.5,113.87,630,Humana Insurance Company,Commercial PPO,177.16,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11642,CPT,Professional,Both,,,,530,450.5,113.87,530,Humana Insurance Company,Commercial PPO,177.16,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11642,CPT,Professional,Both,,,,630,535.5,113.87,630,Humana Insurance Company,Medicare PPO,630,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11642,CPT,Professional,Both,,,,530,450.5,113.87,530,Humana Insurance Company,Medicare PPO,530,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11642,CPT,Professional,Both,,,,630,535.5,113.87,630,Medica,Individual & Family,534.24,84.8,,percent of total billed charges,,
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11642,CPT,Professional,Both,,,,530,450.5,113.87,530,Medica,Individual & Family,449.44,84.8,,percent of total billed charges,,
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11642,CPT,Professional,Both,,,,630,535.5,113.87,630,Medica,Medica Advantage Solution,313.74,49.8,,percent of total billed charges,,
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11642,CPT,Professional,Both,,,,530,450.5,113.87,530,Medica,Medica Advantage Solution,263.94,49.8,,percent of total billed charges,,
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11642,CPT,Professional,Both,,,,630,535.5,113.87,630,Medica,Medical Assistance,131.47,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11642,CPT,Professional,Both,,,,530,450.5,113.87,530,Medica,Medical Assistance,131.47,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11642,CPT,Professional,Both,,,,630,535.5,113.87,630,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,177.16,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11642,CPT,Professional,Both,,,,530,450.5,113.87,530,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,177.16,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11642,CPT,Professional,Both,,,,630,535.5,113.87,630,"Multiplan, Inc.","Multiplan, Inc.",592.2,94,,percent of total billed charges,,
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11642,CPT,Professional,Both,,,,530,450.5,113.87,530,"Multiplan, Inc.","Multiplan, Inc.",498.2,94,,percent of total billed charges,,
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11642,CPT,Professional,Both,,,,630,535.5,113.87,630,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,567.63,90.1,,percent of total billed charges,,
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11642,CPT,Professional,Both,,,,530,450.5,113.87,530,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,477.53,90.1,,percent of total billed charges,,
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11642,CPT,Professional,Both,,,,630,535.5,113.87,630,"Preferred One Administrative Services, INC.",PPO,621.18,98.6,,percent of total billed charges,,
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11642,CPT,Professional,Both,,,,530,450.5,113.87,530,"Preferred One Administrative Services, INC.",PPO,522.58,98.6,,percent of total billed charges,,
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11642,CPT,Professional,Both,,,,630,535.5,113.87,630,PrimeWest Health,Minnesota Senior Health Options (MSHO),203.734,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11642,CPT,Professional,Both,,,,530,450.5,113.87,530,PrimeWest Health,Minnesota Senior Health Options (MSHO),203.734,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11642,CPT,Professional,Both,,,,630,535.5,113.87,630,PrimeWest Health,MinnesotaCare,140.673328,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11642,CPT,Professional,Both,,,,530,450.5,113.87,530,PrimeWest Health,MinnesotaCare,140.673328,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11642,CPT,Professional,Both,,,,630,535.5,113.87,630,Sanford Health Plan,Sanford Health Plan,554.4,88,,percent of total billed charges,,
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11642,CPT,Professional,Both,,,,530,450.5,113.87,530,Sanford Health Plan,Sanford Health Plan,466.4,88,,percent of total billed charges,,
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11642,CPT,Professional,Both,,,,630,535.5,113.87,630,"UCare Health, Inc.",Individual & Family Plan,287.991296,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11642,CPT,Professional,Both,,,,530,450.5,113.87,530,"UCare Health, Inc.",Individual & Family Plan,287.991296,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11642,CPT,Professional,Both,,,,630,535.5,113.87,630,"UCare Health, Inc.",Medical Assistance,144.61744,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11642,CPT,Professional,Both,,,,530,450.5,113.87,530,"UCare Health, Inc.",Medical Assistance,144.61744,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11642,CPT,Professional,Both,,,,630,535.5,113.87,630,"UCare Health, Inc.",Medicare Advantage,203.734,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11642,CPT,Professional,Both,,,,530,450.5,113.87,530,"UCare Health, Inc.",Medicare Advantage,203.734,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11642,CPT,Professional,Both,,,,630,535.5,113.87,630,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),162.9872,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11642,CPT,Professional,Both,,,,530,450.5,113.87,530,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),162.9872,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11642,CPT,Professional,Both,,,,630,535.5,113.87,630,UnitedHealthcare,Individual & Family,630,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11642,CPT,Professional,Both,,,,530,450.5,113.87,530,UnitedHealthcare,Individual & Family,530,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11642,CPT,Professional,Both,,,,630,535.5,113.87,630,UnitedHealthcare,Medicare Advantage,203.734,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11642,CPT,Professional,Both,,,,530,450.5,113.87,530,UnitedHealthcare,Medicare Advantage,203.734,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11642,CPT,Professional,Both,,,,630,535.5,113.87,630,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,131.4704,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 1.1-2.0 Cm (Pro Cah)",,11642,CPT,Professional,Both,,,,530,450.5,113.87,530,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,131.4704,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision Malig 2.1 To 3.0 Face,Ears (Pbb)",,11643,CPT,Facility,Outpatient,,,,300,255,85.98,300,Aetna,Commercial,276,92,,percent of total billed charges,,
"Excision Malig 2.1 To 3.0 Face,Ears (Pbb)",,11643,CPT,Professional,Outpatient,,,,495,420.75,141.57,495,Aetna,Commercial,420.75,85,,percent of total billed charges,,
"Excision Malig 2.1 To 3.0 Face,Ears (Pbb)",,11643,CPT,Facility,Outpatient,,,,300,255,85.98,300,Aetna,Medicare Advantage,147,49,,percent of total billed charges,,
"Excision Malig 2.1 To 3.0 Face,Ears (Pbb)",,11643,CPT,Professional,Outpatient,,,,495,420.75,141.57,495,Aetna,Medicare Advantage,221.96,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision Malig 2.1 To 3.0 Face,Ears (Pbb)",,11643,CPT,Facility,Outpatient,,,,300,255,85.98,300,Aetna,PPO,279,93,,percent of total billed charges,,
"Excision Malig 2.1 To 3.0 Face,Ears (Pbb)",,11643,CPT,Professional,Outpatient,,,,495,420.75,141.57,495,Aetna,PPO,460.35,93,,percent of total billed charges,,
"Excision Malig 2.1 To 3.0 Face,Ears (Pbb)",,11643,CPT,Facility,Outpatient,,,,300,255,85.98,300,America's PPO,America's PPO,288.09,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Excision Malig 2.1 To 3.0 Face,Ears (Pbb)",,11643,CPT,Professional,Outpatient,,,,495,420.75,141.57,495,America's PPO,America's PPO,422.928,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Excision Malig 2.1 To 3.0 Face,Ears (Pbb)",,11643,CPT,Facility,Outpatient,,,,300,255,85.98,300,BlueCross BlueShield Minnesota, Federal Employee Program,295.2,98.4,,percent of total billed charges,,
"Excision Malig 2.1 To 3.0 Face,Ears (Pbb)",,11643,CPT,Professional,Outpatient,,,,495,420.75,141.57,495,BlueCross BlueShield Minnesota, Federal Employee Program,464.12,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Excision Malig 2.1 To 3.0 Face,Ears (Pbb)",,11643,CPT,Facility,Outpatient,,,,300,255,85.98,300,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,300,100,,percent of total billed charges,,
"Excision Malig 2.1 To 3.0 Face,Ears (Pbb)",,11643,CPT,Professional,Outpatient,,,,495,420.75,141.57,495,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,471.54592,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision Malig 2.1 To 3.0 Face,Ears (Pbb)",,11643,CPT,Facility,Outpatient,,,,300,255,85.98,300,BlueCross BlueShield Minnesota,High Value Network Plan,270,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
"Excision Malig 2.1 To 3.0 Face,Ears (Pbb)",,11643,CPT,Professional,Outpatient,,,,495,420.75,141.57,495,BlueCross BlueShield Minnesota,High Value Network Plan,471.54592,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision Malig 2.1 To 3.0 Face,Ears (Pbb)",,11643,CPT,Facility,Outpatient,,,,300,255,85.98,300,BlueCross BlueShield Minnesota,Medicare Advantage,147,49,,percent of total billed charges,,
"Excision Malig 2.1 To 3.0 Face,Ears (Pbb)",,11643,CPT,Professional,Outpatient,,,,495,420.75,141.57,495,BlueCross BlueShield Minnesota,Medicare Advantage,253.23,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision Malig 2.1 To 3.0 Face,Ears (Pbb)",,11643,CPT,Professional,Outpatient,,,,495,420.75,141.57,495,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,471.54592,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision Malig 2.1 To 3.0 Face,Ears (Pbb)",,11643,CPT,Facility,Outpatient,,,,300,255,85.98,300,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,85.98,28.66,,percent of total billed charges,,
"Excision Malig 2.1 To 3.0 Face,Ears (Pbb)",,11643,CPT,Professional,Outpatient,,,,495,420.75,141.57,495,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,163.45408,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision Malig 2.1 To 3.0 Face,Ears (Pbb)",,11643,CPT,Facility,Outpatient,,,,300,255,85.98,300,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),147,49,,percent of total billed charges,,
"Excision Malig 2.1 To 3.0 Face,Ears (Pbb)",,11643,CPT,Professional,Outpatient,,,,495,420.75,141.57,495,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),253.23,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision Malig 2.1 To 3.0 Face,Ears (Pbb)",,11643,CPT,Facility,Outpatient,,,,300,255,85.98,300,CorVel,Worker's Compensation,300,100,,percent of total billed charges,,
"Excision Malig 2.1 To 3.0 Face,Ears (Pbb)",,11643,CPT,Professional,Outpatient,,,,495,420.75,141.57,495,CorVel,Worker's Compensation,429.7576902,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Excision Malig 2.1 To 3.0 Face,Ears (Pbb)",,11643,CPT,Facility,Outpatient,,,,300,255,85.98,300,First Health Group Corporation,First Health Network,291,97,,percent of total billed charges,,
"Excision Malig 2.1 To 3.0 Face,Ears (Pbb)",,11643,CPT,Professional,Outpatient,,,,495,420.75,141.57,495,First Health Group Corporation,First Health Network,480.15,97,,percent of total billed charges,,
"Excision Malig 2.1 To 3.0 Face,Ears (Pbb)",,11643,CPT,Facility,Outpatient,,,,300,255,85.98,300,"Health Partners, Inc.",Commercial,283.8,94.6,,percent of total billed charges,,
"Excision Malig 2.1 To 3.0 Face,Ears (Pbb)",,11643,CPT,Professional,Outpatient,,,,495,420.75,141.57,495,"Health Partners, Inc.",Commercial,464.33,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision Malig 2.1 To 3.0 Face,Ears (Pbb)",,11643,CPT,Facility,Outpatient,,,,300,255,85.98,300,"Health Partners, Inc.",Medicare Advantage,147,49,,percent of total billed charges,,
"Excision Malig 2.1 To 3.0 Face,Ears (Pbb)",,11643,CPT,Professional,Outpatient,,,,495,420.75,141.57,495,"Health Partners, Inc.",Medicare Advantage,253.23,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision Malig 2.1 To 3.0 Face,Ears (Pbb)",,11643,CPT,Facility,Outpatient,,,,300,255,85.98,300,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),180,60,,percent of total billed charges,,
"Excision Malig 2.1 To 3.0 Face,Ears (Pbb)",,11643,CPT,Professional,Outpatient,,,,495,420.75,141.57,495,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),219.93,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Excision Malig 2.1 To 3.0 Face,Ears (Pbb)",,11643,CPT,Facility,Outpatient,,,,300,255,85.98,300,"Health Partners, Inc.",State of Minnesota Advantage Program,244.5,81.5,,percent of total billed charges,,
"Excision Malig 2.1 To 3.0 Face,Ears (Pbb)",,11643,CPT,Professional,Outpatient,,,,495,420.75,141.57,495,"Health Partners, Inc.",State of Minnesota Advantage Program,400.020295,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision Malig 2.1 To 3.0 Face,Ears (Pbb)",,11643,CPT,Facility,Outpatient,,,,300,255,85.98,300,"Health Partners, Inc.",State Public Programs,150,50,,percent of total billed charges,,
"Excision Malig 2.1 To 3.0 Face,Ears (Pbb)",,11643,CPT,Professional,Outpatient,,,,495,420.75,141.57,495,"Health Partners, Inc.",State Public Programs,141.57,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Excision Malig 2.1 To 3.0 Face,Ears (Pbb)",,11643,CPT,Facility,Outpatient,,,,300,255,85.98,300,Humana Insurance Company,Commercial PPO,285,95,,percent of total billed charges,,
"Excision Malig 2.1 To 3.0 Face,Ears (Pbb)",,11643,CPT,Professional,Outpatient,,,,495,420.75,141.57,495,Humana Insurance Company,Commercial PPO,220.2,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Excision Malig 2.1 To 3.0 Face,Ears (Pbb)",,11643,CPT,Facility,Outpatient,,,,300,255,85.98,300,Humana Insurance Company,Medicare PPO,147,49,,percent of total billed charges,,
"Excision Malig 2.1 To 3.0 Face,Ears (Pbb)",,11643,CPT,Professional,Outpatient,,,,495,420.75,141.57,495,Humana Insurance Company,Medicare PPO,495,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Excision Malig 2.1 To 3.0 Face,Ears (Pbb)",,11643,CPT,Facility,Outpatient,,,,300,255,85.98,300,Medica,Individual & Family,297.3,99.1,,percent of total billed charges,,
"Excision Malig 2.1 To 3.0 Face,Ears (Pbb)",,11643,CPT,Professional,Outpatient,,,,495,420.75,141.57,495,Medica,Individual & Family,419.76,84.8,,percent of total billed charges,,
"Excision Malig 2.1 To 3.0 Face,Ears (Pbb)",,11643,CPT,Facility,Outpatient,,,,300,255,85.98,300,Medica,Medica Advantage Solution,149.4,49.8,,percent of total billed charges,,
"Excision Malig 2.1 To 3.0 Face,Ears (Pbb)",,11643,CPT,Professional,Outpatient,,,,495,420.75,141.57,495,Medica,Medica Advantage Solution,246.51,49.8,,percent of total billed charges,,
"Excision Malig 2.1 To 3.0 Face,Ears (Pbb)",,11643,CPT,Facility,Outpatient,,,,300,255,85.98,300,Medica,Medical Assistance,133.8,44.6,,percent of total billed charges,,
"Excision Malig 2.1 To 3.0 Face,Ears (Pbb)",,11643,CPT,Professional,Outpatient,,,,495,420.75,141.57,495,Medica,Medical Assistance,163.45,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Excision Malig 2.1 To 3.0 Face,Ears (Pbb)",,11643,CPT,Facility,Outpatient,,,,300,255,85.98,300,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,149.4,49.8,,percent of total billed charges,,
"Excision Malig 2.1 To 3.0 Face,Ears (Pbb)",,11643,CPT,Professional,Outpatient,,,,495,420.75,141.57,495,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,220.2,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Excision Malig 2.1 To 3.0 Face,Ears (Pbb)",,11643,CPT,Facility,Outpatient,,,,300,255,85.98,300,"Multiplan, Inc.","Multiplan, Inc.",282,94,,percent of total billed charges,,
"Excision Malig 2.1 To 3.0 Face,Ears (Pbb)",,11643,CPT,Professional,Outpatient,,,,495,420.75,141.57,495,"Multiplan, Inc.","Multiplan, Inc.",465.3,94,,percent of total billed charges,,
"Excision Malig 2.1 To 3.0 Face,Ears (Pbb)",,11643,CPT,Facility,Outpatient,,,,300,255,85.98,300,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,270.3,90.1,,percent of total billed charges,,
"Excision Malig 2.1 To 3.0 Face,Ears (Pbb)",,11643,CPT,Professional,Outpatient,,,,495,420.75,141.57,495,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,445.995,90.1,,percent of total billed charges,,
"Excision Malig 2.1 To 3.0 Face,Ears (Pbb)",,11643,CPT,Facility,Outpatient,,,,300,255,85.98,300,"Preferred One Administrative Services, INC.",PPO,295.8,98.6,,percent of total billed charges,,
"Excision Malig 2.1 To 3.0 Face,Ears (Pbb)",,11643,CPT,Professional,Outpatient,,,,495,420.75,141.57,495,"Preferred One Administrative Services, INC.",PPO,488.07,98.6,,percent of total billed charges,,
"Excision Malig 2.1 To 3.0 Face,Ears (Pbb)",,11643,CPT,Facility,Outpatient,,,,300,255,85.98,300,PrimeWest Health,Minnesota Senior Health Options (MSHO),154.35,51.45,,percent of total billed charges,,
"Excision Malig 2.1 To 3.0 Face,Ears (Pbb)",,11643,CPT,Professional,Outpatient,,,,495,420.75,141.57,495,PrimeWest Health,Minnesota Senior Health Options (MSHO),253.23,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision Malig 2.1 To 3.0 Face,Ears (Pbb)",,11643,CPT,Facility,Outpatient,,,,300,255,85.98,300,PrimeWest Health,MinnesotaCare,154.08,51.36,,percent of total billed charges,,
"Excision Malig 2.1 To 3.0 Face,Ears (Pbb)",,11643,CPT,Professional,Outpatient,,,,495,420.75,141.57,495,PrimeWest Health,MinnesotaCare,174.8958656,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision Malig 2.1 To 3.0 Face,Ears (Pbb)",,11643,CPT,Facility,Outpatient,,,,300,255,85.98,300,Sanford Health Plan,Sanford Health Plan,276,92,,percent of total billed charges,,
"Excision Malig 2.1 To 3.0 Face,Ears (Pbb)",,11643,CPT,Professional,Outpatient,,,,495,420.75,141.57,495,Sanford Health Plan,Sanford Health Plan,435.6,88,,percent of total billed charges,,
"Excision Malig 2.1 To 3.0 Face,Ears (Pbb)",,11643,CPT,Facility,Outpatient,,,,300,255,85.98,300,"UCare Health, Inc.",Individual & Family Plan,169.05,56.35,,percent of total billed charges,,
"Excision Malig 2.1 To 3.0 Face,Ears (Pbb)",,11643,CPT,Professional,Outpatient,,,,495,420.75,141.57,495,"UCare Health, Inc.",Individual & Family Plan,357.95712,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Excision Malig 2.1 To 3.0 Face,Ears (Pbb)",,11643,CPT,Facility,Outpatient,,,,300,255,85.98,300,"UCare Health, Inc.",Medical Assistance,151.41,50.47,,percent of total billed charges,,
"Excision Malig 2.1 To 3.0 Face,Ears (Pbb)",,11643,CPT,Professional,Outpatient,,,,495,420.75,141.57,495,"UCare Health, Inc.",Medical Assistance,179.799488,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Excision Malig 2.1 To 3.0 Face,Ears (Pbb)",,11643,CPT,Facility,Outpatient,,,,300,255,85.98,300,"UCare Health, Inc.",Medicare Advantage,151.41,50.47,,percent of total billed charges,,
"Excision Malig 2.1 To 3.0 Face,Ears (Pbb)",,11643,CPT,Professional,Outpatient,,,,495,420.75,141.57,495,"UCare Health, Inc.",Medicare Advantage,253.23,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Excision Malig 2.1 To 3.0 Face,Ears (Pbb)",,11643,CPT,Facility,Outpatient,,,,300,255,85.98,300,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),151.41,50.47,,percent of total billed charges,,
"Excision Malig 2.1 To 3.0 Face,Ears (Pbb)",,11643,CPT,Professional,Outpatient,,,,495,420.75,141.57,495,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),202.584,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Excision Malig 2.1 To 3.0 Face,Ears (Pbb)",,11643,CPT,Facility,Outpatient,,,,300,255,85.98,300,UnitedHealthcare,Individual & Family,282,94,,percent of total billed charges,,
"Excision Malig 2.1 To 3.0 Face,Ears (Pbb)",,11643,CPT,Professional,Outpatient,,,,495,420.75,141.57,495,UnitedHealthcare,Individual & Family,495,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Excision Malig 2.1 To 3.0 Face,Ears (Pbb)",,11643,CPT,Facility,Outpatient,,,,300,255,85.98,300,UnitedHealthcare,Medicare Advantage,147,49,,percent of total billed charges,,
"Excision Malig 2.1 To 3.0 Face,Ears (Pbb)",,11643,CPT,Professional,Outpatient,,,,495,420.75,141.57,495,UnitedHealthcare,Medicare Advantage,253.23,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision Malig 2.1 To 3.0 Face,Ears (Pbb)",,11643,CPT,Facility,Outpatient,,,,300,255,85.98,300,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,144,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Excision Malig 2.1 To 3.0 Face,Ears (Pbb)",,11643,CPT,Professional,Outpatient,,,,495,420.75,141.57,495,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,163.45408,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision, Malignant Lesion Incl Margins,Face,Ears,Eyelids,Nose,Lips;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11643,CPT,Professional,Both,,,,795,675.75,141.57,795,Aetna,Commercial,675.75,85,,percent of total billed charges,,
"Excision, Malignant Lesion Incl Margins,Face,Ears,Eyelids,Nose,Lips;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11643,CPT,Professional,Both,,,,795,675.75,141.57,795,Aetna,Commercial,675.75,85,,percent of total billed charges,,
"Excision, Malignant Lesion Incl Margins,Face,Ears,Eyelids,Nose,Lips;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11643,CPT,Professional,Both,,,,795,675.75,141.57,795,Aetna,Medicare Advantage,221.96,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion Incl Margins,Face,Ears,Eyelids,Nose,Lips;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11643,CPT,Professional,Both,,,,795,675.75,141.57,795,Aetna,Medicare Advantage,221.96,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion Incl Margins,Face,Ears,Eyelids,Nose,Lips;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11643,CPT,Professional,Both,,,,795,675.75,141.57,795,Aetna,PPO,739.35,93,,percent of total billed charges,,
"Excision, Malignant Lesion Incl Margins,Face,Ears,Eyelids,Nose,Lips;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11643,CPT,Professional,Both,,,,795,675.75,141.57,795,Aetna,PPO,739.35,93,,percent of total billed charges,,
"Excision, Malignant Lesion Incl Margins,Face,Ears,Eyelids,Nose,Lips;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11643,CPT,Professional,Both,,,,795,675.75,141.57,795,America's PPO,America's PPO,679.248,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Excision, Malignant Lesion Incl Margins,Face,Ears,Eyelids,Nose,Lips;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11643,CPT,Professional,Both,,,,795,675.75,141.57,795,America's PPO,America's PPO,679.248,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Excision, Malignant Lesion Incl Margins,Face,Ears,Eyelids,Nose,Lips;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11643,CPT,Professional,Both,,,,795,675.75,141.57,795,BlueCross BlueShield Minnesota, Federal Employee Program,464.12,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Excision, Malignant Lesion Incl Margins,Face,Ears,Eyelids,Nose,Lips;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11643,CPT,Professional,Both,,,,795,675.75,141.57,795,BlueCross BlueShield Minnesota, Federal Employee Program,464.12,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Excision, Malignant Lesion Incl Margins,Face,Ears,Eyelids,Nose,Lips;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11643,CPT,Professional,Both,,,,795,675.75,141.57,795,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,471.54592,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Malignant Lesion Incl Margins,Face,Ears,Eyelids,Nose,Lips;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11643,CPT,Professional,Both,,,,795,675.75,141.57,795,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,471.54592,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Malignant Lesion Incl Margins,Face,Ears,Eyelids,Nose,Lips;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11643,CPT,Professional,Both,,,,795,675.75,141.57,795,BlueCross BlueShield Minnesota,High Value Network Plan,471.54592,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Malignant Lesion Incl Margins,Face,Ears,Eyelids,Nose,Lips;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11643,CPT,Professional,Both,,,,795,675.75,141.57,795,BlueCross BlueShield Minnesota,High Value Network Plan,471.54592,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Malignant Lesion Incl Margins,Face,Ears,Eyelids,Nose,Lips;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11643,CPT,Professional,Both,,,,795,675.75,141.57,795,BlueCross BlueShield Minnesota,Medicare Advantage,253.23,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion Incl Margins,Face,Ears,Eyelids,Nose,Lips;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11643,CPT,Professional,Both,,,,795,675.75,141.57,795,BlueCross BlueShield Minnesota,Medicare Advantage,253.23,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion Incl Margins,Face,Ears,Eyelids,Nose,Lips;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11643,CPT,Professional,Both,,,,795,675.75,141.57,795,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,471.54592,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Malignant Lesion Incl Margins,Face,Ears,Eyelids,Nose,Lips;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11643,CPT,Professional,Both,,,,795,675.75,141.57,795,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,471.54592,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Malignant Lesion Incl Margins,Face,Ears,Eyelids,Nose,Lips;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11643,CPT,Professional,Both,,,,795,675.75,141.57,795,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,163.45408,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision, Malignant Lesion Incl Margins,Face,Ears,Eyelids,Nose,Lips;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11643,CPT,Professional,Both,,,,795,675.75,141.57,795,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,163.45408,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision, Malignant Lesion Incl Margins,Face,Ears,Eyelids,Nose,Lips;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11643,CPT,Professional,Both,,,,795,675.75,141.57,795,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),253.23,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion Incl Margins,Face,Ears,Eyelids,Nose,Lips;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11643,CPT,Professional,Both,,,,795,675.75,141.57,795,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),253.23,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion Incl Margins,Face,Ears,Eyelids,Nose,Lips;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11643,CPT,Professional,Both,,,,795,675.75,141.57,795,CorVel,Worker's Compensation,429.7576902,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Excision, Malignant Lesion Incl Margins,Face,Ears,Eyelids,Nose,Lips;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11643,CPT,Professional,Both,,,,795,675.75,141.57,795,CorVel,Worker's Compensation,429.7576902,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Excision, Malignant Lesion Incl Margins,Face,Ears,Eyelids,Nose,Lips;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11643,CPT,Professional,Both,,,,795,675.75,141.57,795,First Health Group Corporation,First Health Network,771.15,97,,percent of total billed charges,,
"Excision, Malignant Lesion Incl Margins,Face,Ears,Eyelids,Nose,Lips;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11643,CPT,Professional,Both,,,,795,675.75,141.57,795,First Health Group Corporation,First Health Network,771.15,97,,percent of total billed charges,,
"Excision, Malignant Lesion Incl Margins,Face,Ears,Eyelids,Nose,Lips;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11643,CPT,Professional,Both,,,,795,675.75,141.57,795,"Health Partners, Inc.",Commercial,464.33,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision, Malignant Lesion Incl Margins,Face,Ears,Eyelids,Nose,Lips;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11643,CPT,Professional,Both,,,,795,675.75,141.57,795,"Health Partners, Inc.",Commercial,464.33,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision, Malignant Lesion Incl Margins,Face,Ears,Eyelids,Nose,Lips;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11643,CPT,Professional,Both,,,,795,675.75,141.57,795,"Health Partners, Inc.",Medicare Advantage,253.23,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion Incl Margins,Face,Ears,Eyelids,Nose,Lips;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11643,CPT,Professional,Both,,,,795,675.75,141.57,795,"Health Partners, Inc.",Medicare Advantage,253.23,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion Incl Margins,Face,Ears,Eyelids,Nose,Lips;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11643,CPT,Professional,Both,,,,795,675.75,141.57,795,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),219.93,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Excision, Malignant Lesion Incl Margins,Face,Ears,Eyelids,Nose,Lips;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11643,CPT,Professional,Both,,,,795,675.75,141.57,795,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),219.93,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Excision, Malignant Lesion Incl Margins,Face,Ears,Eyelids,Nose,Lips;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11643,CPT,Professional,Both,,,,795,675.75,141.57,795,"Health Partners, Inc.",State of Minnesota Advantage Program,400.020295,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision, Malignant Lesion Incl Margins,Face,Ears,Eyelids,Nose,Lips;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11643,CPT,Professional,Both,,,,795,675.75,141.57,795,"Health Partners, Inc.",State of Minnesota Advantage Program,400.020295,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision, Malignant Lesion Incl Margins,Face,Ears,Eyelids,Nose,Lips;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11643,CPT,Professional,Both,,,,795,675.75,141.57,795,"Health Partners, Inc.",State Public Programs,141.57,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Excision, Malignant Lesion Incl Margins,Face,Ears,Eyelids,Nose,Lips;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11643,CPT,Professional,Both,,,,795,675.75,141.57,795,"Health Partners, Inc.",State Public Programs,141.57,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Excision, Malignant Lesion Incl Margins,Face,Ears,Eyelids,Nose,Lips;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11643,CPT,Professional,Both,,,,795,675.75,141.57,795,Humana Insurance Company,Commercial PPO,220.2,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Excision, Malignant Lesion Incl Margins,Face,Ears,Eyelids,Nose,Lips;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11643,CPT,Professional,Both,,,,795,675.75,141.57,795,Humana Insurance Company,Commercial PPO,220.2,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Excision, Malignant Lesion Incl Margins,Face,Ears,Eyelids,Nose,Lips;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11643,CPT,Professional,Both,,,,795,675.75,141.57,795,Humana Insurance Company,Medicare PPO,795,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion Incl Margins,Face,Ears,Eyelids,Nose,Lips;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11643,CPT,Professional,Both,,,,795,675.75,141.57,795,Humana Insurance Company,Medicare PPO,795,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion Incl Margins,Face,Ears,Eyelids,Nose,Lips;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11643,CPT,Professional,Both,,,,795,675.75,141.57,795,Medica,Individual & Family,674.16,84.8,,percent of total billed charges,,
"Excision, Malignant Lesion Incl Margins,Face,Ears,Eyelids,Nose,Lips;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11643,CPT,Professional,Both,,,,795,675.75,141.57,795,Medica,Individual & Family,674.16,84.8,,percent of total billed charges,,
"Excision, Malignant Lesion Incl Margins,Face,Ears,Eyelids,Nose,Lips;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11643,CPT,Professional,Both,,,,795,675.75,141.57,795,Medica,Medica Advantage Solution,395.91,49.8,,percent of total billed charges,,
"Excision, Malignant Lesion Incl Margins,Face,Ears,Eyelids,Nose,Lips;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11643,CPT,Professional,Both,,,,795,675.75,141.57,795,Medica,Medica Advantage Solution,395.91,49.8,,percent of total billed charges,,
"Excision, Malignant Lesion Incl Margins,Face,Ears,Eyelids,Nose,Lips;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11643,CPT,Professional,Both,,,,795,675.75,141.57,795,Medica,Medical Assistance,163.45,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Excision, Malignant Lesion Incl Margins,Face,Ears,Eyelids,Nose,Lips;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11643,CPT,Professional,Both,,,,795,675.75,141.57,795,Medica,Medical Assistance,163.45,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Excision, Malignant Lesion Incl Margins,Face,Ears,Eyelids,Nose,Lips;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11643,CPT,Professional,Both,,,,795,675.75,141.57,795,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,220.2,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Excision, Malignant Lesion Incl Margins,Face,Ears,Eyelids,Nose,Lips;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11643,CPT,Professional,Both,,,,795,675.75,141.57,795,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,220.2,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Excision, Malignant Lesion Incl Margins,Face,Ears,Eyelids,Nose,Lips;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11643,CPT,Professional,Both,,,,795,675.75,141.57,795,"Multiplan, Inc.","Multiplan, Inc.",747.3,94,,percent of total billed charges,,
"Excision, Malignant Lesion Incl Margins,Face,Ears,Eyelids,Nose,Lips;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11643,CPT,Professional,Both,,,,795,675.75,141.57,795,"Multiplan, Inc.","Multiplan, Inc.",747.3,94,,percent of total billed charges,,
"Excision, Malignant Lesion Incl Margins,Face,Ears,Eyelids,Nose,Lips;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11643,CPT,Professional,Both,,,,795,675.75,141.57,795,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,716.295,90.1,,percent of total billed charges,,
"Excision, Malignant Lesion Incl Margins,Face,Ears,Eyelids,Nose,Lips;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11643,CPT,Professional,Both,,,,795,675.75,141.57,795,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,716.295,90.1,,percent of total billed charges,,
"Excision, Malignant Lesion Incl Margins,Face,Ears,Eyelids,Nose,Lips;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11643,CPT,Professional,Both,,,,795,675.75,141.57,795,"Preferred One Administrative Services, INC.",PPO,783.87,98.6,,percent of total billed charges,,
"Excision, Malignant Lesion Incl Margins,Face,Ears,Eyelids,Nose,Lips;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11643,CPT,Professional,Both,,,,795,675.75,141.57,795,"Preferred One Administrative Services, INC.",PPO,783.87,98.6,,percent of total billed charges,,
"Excision, Malignant Lesion Incl Margins,Face,Ears,Eyelids,Nose,Lips;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11643,CPT,Professional,Both,,,,795,675.75,141.57,795,PrimeWest Health,Minnesota Senior Health Options (MSHO),253.23,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion Incl Margins,Face,Ears,Eyelids,Nose,Lips;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11643,CPT,Professional,Both,,,,795,675.75,141.57,795,PrimeWest Health,Minnesota Senior Health Options (MSHO),253.23,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion Incl Margins,Face,Ears,Eyelids,Nose,Lips;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11643,CPT,Professional,Both,,,,795,675.75,141.57,795,PrimeWest Health,MinnesotaCare,174.8958656,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision, Malignant Lesion Incl Margins,Face,Ears,Eyelids,Nose,Lips;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11643,CPT,Professional,Both,,,,795,675.75,141.57,795,PrimeWest Health,MinnesotaCare,174.8958656,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision, Malignant Lesion Incl Margins,Face,Ears,Eyelids,Nose,Lips;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11643,CPT,Professional,Both,,,,795,675.75,141.57,795,Sanford Health Plan,Sanford Health Plan,699.6,88,,percent of total billed charges,,
"Excision, Malignant Lesion Incl Margins,Face,Ears,Eyelids,Nose,Lips;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11643,CPT,Professional,Both,,,,795,675.75,141.57,795,Sanford Health Plan,Sanford Health Plan,699.6,88,,percent of total billed charges,,
"Excision, Malignant Lesion Incl Margins,Face,Ears,Eyelids,Nose,Lips;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11643,CPT,Professional,Both,,,,795,675.75,141.57,795,"UCare Health, Inc.",Individual & Family Plan,357.95712,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Excision, Malignant Lesion Incl Margins,Face,Ears,Eyelids,Nose,Lips;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11643,CPT,Professional,Both,,,,795,675.75,141.57,795,"UCare Health, Inc.",Individual & Family Plan,357.95712,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Excision, Malignant Lesion Incl Margins,Face,Ears,Eyelids,Nose,Lips;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11643,CPT,Professional,Both,,,,795,675.75,141.57,795,"UCare Health, Inc.",Medical Assistance,179.799488,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Excision, Malignant Lesion Incl Margins,Face,Ears,Eyelids,Nose,Lips;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11643,CPT,Professional,Both,,,,795,675.75,141.57,795,"UCare Health, Inc.",Medical Assistance,179.799488,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Excision, Malignant Lesion Incl Margins,Face,Ears,Eyelids,Nose,Lips;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11643,CPT,Professional,Both,,,,795,675.75,141.57,795,"UCare Health, Inc.",Medicare Advantage,253.23,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Excision, Malignant Lesion Incl Margins,Face,Ears,Eyelids,Nose,Lips;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11643,CPT,Professional,Both,,,,795,675.75,141.57,795,"UCare Health, Inc.",Medicare Advantage,253.23,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Excision, Malignant Lesion Incl Margins,Face,Ears,Eyelids,Nose,Lips;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11643,CPT,Professional,Both,,,,795,675.75,141.57,795,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),202.584,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Excision, Malignant Lesion Incl Margins,Face,Ears,Eyelids,Nose,Lips;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11643,CPT,Professional,Both,,,,795,675.75,141.57,795,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),202.584,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Excision, Malignant Lesion Incl Margins,Face,Ears,Eyelids,Nose,Lips;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11643,CPT,Professional,Both,,,,795,675.75,141.57,795,UnitedHealthcare,Individual & Family,795,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Excision, Malignant Lesion Incl Margins,Face,Ears,Eyelids,Nose,Lips;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11643,CPT,Professional,Both,,,,795,675.75,141.57,795,UnitedHealthcare,Individual & Family,795,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Excision, Malignant Lesion Incl Margins,Face,Ears,Eyelids,Nose,Lips;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11643,CPT,Professional,Both,,,,795,675.75,141.57,795,UnitedHealthcare,Medicare Advantage,253.23,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion Incl Margins,Face,Ears,Eyelids,Nose,Lips;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11643,CPT,Professional,Both,,,,795,675.75,141.57,795,UnitedHealthcare,Medicare Advantage,253.23,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion Incl Margins,Face,Ears,Eyelids,Nose,Lips;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11643,CPT,Professional,Both,,,,795,675.75,141.57,795,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,163.45408,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision, Malignant Lesion Incl Margins,Face,Ears,Eyelids,Nose,Lips;Exc Dia 2.1-3.0 Cm (Pro Cah)",,11643,CPT,Professional,Both,,,,795,675.75,141.57,795,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,163.45408,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 2.1-3.0 Cm",,11643,CPT,Facility,Both,,,,530,450.5,151.898,530,Aetna,Commercial,487.6,92,,percent of total billed charges,,
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 2.1-3.0 Cm",,11643,CPT,Facility,Outpatient,,,,530,450.5,151.898,530,Aetna,Medicare Advantage,259.7,49,,percent of total billed charges,,
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 2.1-3.0 Cm",,11643,CPT,Facility,Inpatient,,,,530,450.5,151.898,530,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 2.1-3.0 Cm",,11643,CPT,Facility,Both,,,,530,450.5,151.898,530,Aetna,PPO,492.9,93,,percent of total billed charges,,
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 2.1-3.0 Cm",,11643,CPT,Facility,Both,,,,530,450.5,151.898,530,America's PPO,America's PPO,508.959,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 2.1-3.0 Cm",,11643,CPT,Facility,Both,,,,530,450.5,151.898,530,BlueCross BlueShield Minnesota, Federal Employee Program,521.52,98.4,,percent of total billed charges,,
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 2.1-3.0 Cm",,11643,CPT,Facility,Both,,,,530,450.5,151.898,530,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,530,100,,percent of total billed charges,,
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 2.1-3.0 Cm",,11643,CPT,Facility,Both,,,,530,450.5,151.898,530,BlueCross BlueShield Minnesota,High Value Network Plan,477,90,,percent of total billed charges,,
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 2.1-3.0 Cm",,11643,CPT,Facility,Outpatient,,,,530,450.5,151.898,530,BlueCross BlueShield Minnesota,Medicare Advantage,259.7,49,,percent of total billed charges,,
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 2.1-3.0 Cm",,11643,CPT,Facility,Inpatient,,,,530,450.5,151.898,530,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 2.1-3.0 Cm",,11643,CPT,Facility,Both,,,,530,450.5,151.898,530,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,469.421,88.57,,percent of total billed charges,,
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 2.1-3.0 Cm",,11643,CPT,Facility,Both,,,,530,450.5,151.898,530,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,151.898,28.66,,percent of total billed charges,,
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 2.1-3.0 Cm",,11643,CPT,Facility,Outpatient,,,,530,450.5,151.898,530,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),259.7,49,,percent of total billed charges,,
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 2.1-3.0 Cm",,11643,CPT,Facility,Inpatient,,,,530,450.5,151.898,530,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 2.1-3.0 Cm",,11643,CPT,Facility,Both,,,,530,450.5,151.898,530,CorVel,Worker's Compensation,530,100,,percent of total billed charges,,
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 2.1-3.0 Cm",,11643,CPT,Facility,Both,,,,530,450.5,151.898,530,First Health Group Corporation,First Health Network,514.1,97,,percent of total billed charges,,
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 2.1-3.0 Cm",,11643,CPT,Facility,Both,,,,530,450.5,151.898,530,"Health Partners, Inc.",Commercial,501.38,94.6,,percent of total billed charges,,
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 2.1-3.0 Cm",,11643,CPT,Facility,Outpatient,,,,530,450.5,151.898,530,"Health Partners, Inc.",Medicare Advantage,259.7,49,,percent of total billed charges,,
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 2.1-3.0 Cm",,11643,CPT,Facility,Inpatient,,,,530,450.5,151.898,530,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 2.1-3.0 Cm",,11643,CPT,Facility,Both,,,,530,450.5,151.898,530,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),318,60,,percent of total billed charges,,
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 2.1-3.0 Cm",,11643,CPT,Facility,Both,,,,530,450.5,151.898,530,"Health Partners, Inc.",State of Minnesota Advantage Program,431.95,81.5,,percent of total billed charges,,
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 2.1-3.0 Cm",,11643,CPT,Facility,Both,,,,530,450.5,151.898,530,"Health Partners, Inc.",State Public Programs,265,50,,percent of total billed charges,,
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 2.1-3.0 Cm",,11643,CPT,Facility,Both,,,,530,450.5,151.898,530,Humana Insurance Company,Commercial PPO,503.5,95,,percent of total billed charges,,
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 2.1-3.0 Cm",,11643,CPT,Facility,Outpatient,,,,530,450.5,151.898,530,Humana Insurance Company,Medicare PPO,259.7,49,,percent of total billed charges,,
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 2.1-3.0 Cm",,11643,CPT,Facility,Inpatient,,,,530,450.5,151.898,530,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 2.1-3.0 Cm",,11643,CPT,Facility,Both,,,,530,450.5,151.898,530,Medica,Individual & Family,525.23,99.1,,percent of total billed charges,,
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 2.1-3.0 Cm",,11643,CPT,Facility,Outpatient,,,,530,450.5,151.898,530,Medica,Medica Advantage Solution,263.94,49.8,,percent of total billed charges,,
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 2.1-3.0 Cm",,11643,CPT,Facility,Inpatient,,,,530,450.5,151.898,530,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 2.1-3.0 Cm",,11643,CPT,Facility,Outpatient,,,,530,450.5,151.898,530,Medica,Medical Assistance,236.38,44.6,,percent of total billed charges,,
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 2.1-3.0 Cm",,11643,CPT,Facility,Inpatient,,,,530,450.5,151.898,530,Medica,Medical Assistance,,,,,Included in per diem rate,
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 2.1-3.0 Cm",,11643,CPT,Facility,Outpatient,,,,530,450.5,151.898,530,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,263.94,49.8,,percent of total billed charges,,
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 2.1-3.0 Cm",,11643,CPT,Facility,Inpatient,,,,530,450.5,151.898,530,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 2.1-3.0 Cm",,11643,CPT,Facility,Both,,,,530,450.5,151.898,530,"Multiplan, Inc.","Multiplan, Inc.",498.2,94,,percent of total billed charges,,
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 2.1-3.0 Cm",,11643,CPT,Facility,Outpatient,,,,530,450.5,151.898,530,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,477.53,90.1,,percent of total billed charges,,
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 2.1-3.0 Cm",,11643,CPT,Facility,Inpatient,,,,530,450.5,151.898,530,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 2.1-3.0 Cm",,11643,CPT,Facility,Both,,,,530,450.5,151.898,530,"Preferred One Administrative Services, INC.",PPO,522.58,98.6,,percent of total billed charges,,
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 2.1-3.0 Cm",,11643,CPT,Facility,Outpatient,,,,530,450.5,151.898,530,PrimeWest Health,Minnesota Senior Health Options (MSHO),272.685,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 2.1-3.0 Cm",,11643,CPT,Facility,Inpatient,,,,530,450.5,151.898,530,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 2.1-3.0 Cm",,11643,CPT,Facility,Outpatient,,,,530,450.5,151.898,530,PrimeWest Health,MinnesotaCare,272.208,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 2.1-3.0 Cm",,11643,CPT,Facility,Inpatient,,,,530,450.5,151.898,530,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 2.1-3.0 Cm",,11643,CPT,Facility,Both,,,,530,450.5,151.898,530,Sanford Health Plan,Sanford Health Plan,487.6,92,,percent of total billed charges,,
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 2.1-3.0 Cm",,11643,CPT,Facility,Outpatient,,,,530,450.5,151.898,530,"UCare Health, Inc.",Individual & Family Plan,298.655,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 2.1-3.0 Cm",,11643,CPT,Facility,Inpatient,,,,530,450.5,151.898,530,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 2.1-3.0 Cm",,11643,CPT,Facility,Outpatient,,,,530,450.5,151.898,530,"UCare Health, Inc.",Medical Assistance,267.491,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 2.1-3.0 Cm",,11643,CPT,Facility,Inpatient,,,,530,450.5,151.898,530,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 2.1-3.0 Cm",,11643,CPT,Facility,Outpatient,,,,530,450.5,151.898,530,"UCare Health, Inc.",Medicare Advantage,267.491,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 2.1-3.0 Cm",,11643,CPT,Facility,Inpatient,,,,530,450.5,151.898,530,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 2.1-3.0 Cm",,11643,CPT,Facility,Outpatient,,,,530,450.5,151.898,530,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),267.491,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 2.1-3.0 Cm",,11643,CPT,Facility,Inpatient,,,,530,450.5,151.898,530,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 2.1-3.0 Cm",,11643,CPT,Facility,Both,,,,530,450.5,151.898,530,UnitedHealthcare,Individual & Family,498.2,94,,percent of total billed charges,,
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 2.1-3.0 Cm",,11643,CPT,Facility,Outpatient,,,,530,450.5,151.898,530,UnitedHealthcare,Medicare Advantage,259.7,49,,percent of total billed charges,,
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 2.1-3.0 Cm",,11643,CPT,Facility,Inpatient,,,,530,450.5,151.898,530,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 2.1-3.0 Cm",,11643,CPT,Facility,Outpatient,,,,530,450.5,151.898,530,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,254.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Excision,Malignant Lesion Inc Margin,Face,Ears,Eyelids, Nose, Lips; Exc Dia 2.1-3.0 Cm",,11643,CPT,Facility,Inpatient,,,,530,450.5,151.898,530,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Excision Malignant 3.1 To 4.0 Cm Face,Ears (Pbb)",,11644,CPT,Facility,Outpatient,,,,385,327.25,110.341,385,Aetna,Commercial,354.2,92,,percent of total billed charges,,
"Excision Malignant 3.1 To 4.0 Cm Face,Ears (Pbb)",,11644,CPT,Professional,Outpatient,,,,625,531.25,174.95,625,Aetna,Commercial,531.25,85,,percent of total billed charges,,
"Excision Malignant 3.1 To 4.0 Cm Face,Ears (Pbb)",,11644,CPT,Facility,Outpatient,,,,385,327.25,110.341,385,Aetna,Medicare Advantage,188.65,49,,percent of total billed charges,,
"Excision Malignant 3.1 To 4.0 Cm Face,Ears (Pbb)",,11644,CPT,Professional,Outpatient,,,,625,531.25,174.95,625,Aetna,Medicare Advantage,274.53,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision Malignant 3.1 To 4.0 Cm Face,Ears (Pbb)",,11644,CPT,Facility,Outpatient,,,,385,327.25,110.341,385,Aetna,PPO,358.05,93,,percent of total billed charges,,
"Excision Malignant 3.1 To 4.0 Cm Face,Ears (Pbb)",,11644,CPT,Professional,Outpatient,,,,625,531.25,174.95,625,Aetna,PPO,581.25,93,,percent of total billed charges,,
"Excision Malignant 3.1 To 4.0 Cm Face,Ears (Pbb)",,11644,CPT,Facility,Outpatient,,,,385,327.25,110.341,385,America's PPO,America's PPO,369.7155,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Excision Malignant 3.1 To 4.0 Cm Face,Ears (Pbb)",,11644,CPT,Professional,Outpatient,,,,625,531.25,174.95,625,America's PPO,America's PPO,534,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Excision Malignant 3.1 To 4.0 Cm Face,Ears (Pbb)",,11644,CPT,Facility,Outpatient,,,,385,327.25,110.341,385,BlueCross BlueShield Minnesota, Federal Employee Program,378.84,98.4,,percent of total billed charges,,
"Excision Malignant 3.1 To 4.0 Cm Face,Ears (Pbb)",,11644,CPT,Professional,Outpatient,,,,625,531.25,174.95,625,BlueCross BlueShield Minnesota, Federal Employee Program,575.67,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Excision Malignant 3.1 To 4.0 Cm Face,Ears (Pbb)",,11644,CPT,Facility,Outpatient,,,,385,327.25,110.341,385,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,385,100,,percent of total billed charges,,
"Excision Malignant 3.1 To 4.0 Cm Face,Ears (Pbb)",,11644,CPT,Professional,Outpatient,,,,625,531.25,174.95,625,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,584.88072,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision Malignant 3.1 To 4.0 Cm Face,Ears (Pbb)",,11644,CPT,Facility,Outpatient,,,,385,327.25,110.341,385,BlueCross BlueShield Minnesota,High Value Network Plan,346.5,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
"Excision Malignant 3.1 To 4.0 Cm Face,Ears (Pbb)",,11644,CPT,Professional,Outpatient,,,,625,531.25,174.95,625,BlueCross BlueShield Minnesota,High Value Network Plan,584.88072,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision Malignant 3.1 To 4.0 Cm Face,Ears (Pbb)",,11644,CPT,Facility,Outpatient,,,,385,327.25,110.341,385,BlueCross BlueShield Minnesota,Medicare Advantage,188.65,49,,percent of total billed charges,,
"Excision Malignant 3.1 To 4.0 Cm Face,Ears (Pbb)",,11644,CPT,Professional,Outpatient,,,,625,531.25,174.95,625,BlueCross BlueShield Minnesota,Medicare Advantage,312.5585,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision Malignant 3.1 To 4.0 Cm Face,Ears (Pbb)",,11644,CPT,Professional,Outpatient,,,,625,531.25,174.95,625,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,584.88072,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision Malignant 3.1 To 4.0 Cm Face,Ears (Pbb)",,11644,CPT,Facility,Outpatient,,,,385,327.25,110.341,385,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,110.341,28.66,,percent of total billed charges,,
"Excision Malignant 3.1 To 4.0 Cm Face,Ears (Pbb)",,11644,CPT,Professional,Outpatient,,,,625,531.25,174.95,625,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,201.99096,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision Malignant 3.1 To 4.0 Cm Face,Ears (Pbb)",,11644,CPT,Facility,Outpatient,,,,385,327.25,110.341,385,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),188.65,49,,percent of total billed charges,,
"Excision Malignant 3.1 To 4.0 Cm Face,Ears (Pbb)",,11644,CPT,Professional,Outpatient,,,,625,531.25,174.95,625,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),312.5585,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision Malignant 3.1 To 4.0 Cm Face,Ears (Pbb)",,11644,CPT,Facility,Outpatient,,,,385,327.25,110.341,385,CorVel,Worker's Compensation,385,100,,percent of total billed charges,,
"Excision Malignant 3.1 To 4.0 Cm Face,Ears (Pbb)",,11644,CPT,Professional,Outpatient,,,,625,531.25,174.95,625,CorVel,Worker's Compensation,531.6478632,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Excision Malignant 3.1 To 4.0 Cm Face,Ears (Pbb)",,11644,CPT,Facility,Outpatient,,,,385,327.25,110.341,385,First Health Group Corporation,First Health Network,373.45,97,,percent of total billed charges,,
"Excision Malignant 3.1 To 4.0 Cm Face,Ears (Pbb)",,11644,CPT,Professional,Outpatient,,,,625,531.25,174.95,625,First Health Group Corporation,First Health Network,606.25,97,,percent of total billed charges,,
"Excision Malignant 3.1 To 4.0 Cm Face,Ears (Pbb)",,11644,CPT,Facility,Outpatient,,,,385,327.25,110.341,385,"Health Partners, Inc.",Commercial,364.21,94.6,,percent of total billed charges,,
"Excision Malignant 3.1 To 4.0 Cm Face,Ears (Pbb)",,11644,CPT,Professional,Outpatient,,,,625,531.25,174.95,625,"Health Partners, Inc.",Commercial,573.89,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision Malignant 3.1 To 4.0 Cm Face,Ears (Pbb)",,11644,CPT,Facility,Outpatient,,,,385,327.25,110.341,385,"Health Partners, Inc.",Medicare Advantage,188.65,49,,percent of total billed charges,,
"Excision Malignant 3.1 To 4.0 Cm Face,Ears (Pbb)",,11644,CPT,Professional,Outpatient,,,,625,531.25,174.95,625,"Health Partners, Inc.",Medicare Advantage,312.5585,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision Malignant 3.1 To 4.0 Cm Face,Ears (Pbb)",,11644,CPT,Facility,Outpatient,,,,385,327.25,110.341,385,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),231,60,,percent of total billed charges,,
"Excision Malignant 3.1 To 4.0 Cm Face,Ears (Pbb)",,11644,CPT,Professional,Outpatient,,,,625,531.25,174.95,625,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),271.78,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Excision Malignant 3.1 To 4.0 Cm Face,Ears (Pbb)",,11644,CPT,Facility,Outpatient,,,,385,327.25,110.341,385,"Health Partners, Inc.",State of Minnesota Advantage Program,313.775,81.5,,percent of total billed charges,,
"Excision Malignant 3.1 To 4.0 Cm Face,Ears (Pbb)",,11644,CPT,Professional,Outpatient,,,,625,531.25,174.95,625,"Health Partners, Inc.",State of Minnesota Advantage Program,494.406235,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision Malignant 3.1 To 4.0 Cm Face,Ears (Pbb)",,11644,CPT,Facility,Outpatient,,,,385,327.25,110.341,385,"Health Partners, Inc.",State Public Programs,192.5,50,,percent of total billed charges,,
"Excision Malignant 3.1 To 4.0 Cm Face,Ears (Pbb)",,11644,CPT,Professional,Outpatient,,,,625,531.25,174.95,625,"Health Partners, Inc.",State Public Programs,174.95,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Excision Malignant 3.1 To 4.0 Cm Face,Ears (Pbb)",,11644,CPT,Facility,Outpatient,,,,385,327.25,110.341,385,Humana Insurance Company,Commercial PPO,365.75,95,,percent of total billed charges,,
"Excision Malignant 3.1 To 4.0 Cm Face,Ears (Pbb)",,11644,CPT,Professional,Outpatient,,,,625,531.25,174.95,625,Humana Insurance Company,Commercial PPO,271.79,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Excision Malignant 3.1 To 4.0 Cm Face,Ears (Pbb)",,11644,CPT,Facility,Outpatient,,,,385,327.25,110.341,385,Humana Insurance Company,Medicare PPO,188.65,49,,percent of total billed charges,,
"Excision Malignant 3.1 To 4.0 Cm Face,Ears (Pbb)",,11644,CPT,Professional,Outpatient,,,,625,531.25,174.95,625,Humana Insurance Company,Medicare PPO,625,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Excision Malignant 3.1 To 4.0 Cm Face,Ears (Pbb)",,11644,CPT,Facility,Outpatient,,,,385,327.25,110.341,385,Medica,Individual & Family,381.535,99.1,,percent of total billed charges,,
"Excision Malignant 3.1 To 4.0 Cm Face,Ears (Pbb)",,11644,CPT,Professional,Outpatient,,,,625,531.25,174.95,625,Medica,Individual & Family,530,84.8,,percent of total billed charges,,
"Excision Malignant 3.1 To 4.0 Cm Face,Ears (Pbb)",,11644,CPT,Facility,Outpatient,,,,385,327.25,110.341,385,Medica,Medica Advantage Solution,191.73,49.8,,percent of total billed charges,,
"Excision Malignant 3.1 To 4.0 Cm Face,Ears (Pbb)",,11644,CPT,Professional,Outpatient,,,,625,531.25,174.95,625,Medica,Medica Advantage Solution,311.25,49.8,,percent of total billed charges,,
"Excision Malignant 3.1 To 4.0 Cm Face,Ears (Pbb)",,11644,CPT,Facility,Outpatient,,,,385,327.25,110.341,385,Medica,Medical Assistance,171.71,44.6,,percent of total billed charges,,
"Excision Malignant 3.1 To 4.0 Cm Face,Ears (Pbb)",,11644,CPT,Professional,Outpatient,,,,625,531.25,174.95,625,Medica,Medical Assistance,201.99,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Excision Malignant 3.1 To 4.0 Cm Face,Ears (Pbb)",,11644,CPT,Facility,Outpatient,,,,385,327.25,110.341,385,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,191.73,49.8,,percent of total billed charges,,
"Excision Malignant 3.1 To 4.0 Cm Face,Ears (Pbb)",,11644,CPT,Professional,Outpatient,,,,625,531.25,174.95,625,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,271.79,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Excision Malignant 3.1 To 4.0 Cm Face,Ears (Pbb)",,11644,CPT,Facility,Outpatient,,,,385,327.25,110.341,385,"Multiplan, Inc.","Multiplan, Inc.",361.9,94,,percent of total billed charges,,
"Excision Malignant 3.1 To 4.0 Cm Face,Ears (Pbb)",,11644,CPT,Professional,Outpatient,,,,625,531.25,174.95,625,"Multiplan, Inc.","Multiplan, Inc.",587.5,94,,percent of total billed charges,,
"Excision Malignant 3.1 To 4.0 Cm Face,Ears (Pbb)",,11644,CPT,Facility,Outpatient,,,,385,327.25,110.341,385,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,346.885,90.1,,percent of total billed charges,,
"Excision Malignant 3.1 To 4.0 Cm Face,Ears (Pbb)",,11644,CPT,Professional,Outpatient,,,,625,531.25,174.95,625,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,563.125,90.1,,percent of total billed charges,,
"Excision Malignant 3.1 To 4.0 Cm Face,Ears (Pbb)",,11644,CPT,Facility,Outpatient,,,,385,327.25,110.341,385,"Preferred One Administrative Services, INC.",PPO,379.61,98.6,,percent of total billed charges,,
"Excision Malignant 3.1 To 4.0 Cm Face,Ears (Pbb)",,11644,CPT,Professional,Outpatient,,,,625,531.25,174.95,625,"Preferred One Administrative Services, INC.",PPO,616.25,98.6,,percent of total billed charges,,
"Excision Malignant 3.1 To 4.0 Cm Face,Ears (Pbb)",,11644,CPT,Facility,Outpatient,,,,385,327.25,110.341,385,PrimeWest Health,Minnesota Senior Health Options (MSHO),198.0825,51.45,,percent of total billed charges,,
"Excision Malignant 3.1 To 4.0 Cm Face,Ears (Pbb)",,11644,CPT,Professional,Outpatient,,,,625,531.25,174.95,625,PrimeWest Health,Minnesota Senior Health Options (MSHO),312.5585,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision Malignant 3.1 To 4.0 Cm Face,Ears (Pbb)",,11644,CPT,Facility,Outpatient,,,,385,327.25,110.341,385,PrimeWest Health,MinnesotaCare,197.736,51.36,,percent of total billed charges,,
"Excision Malignant 3.1 To 4.0 Cm Face,Ears (Pbb)",,11644,CPT,Professional,Outpatient,,,,625,531.25,174.95,625,PrimeWest Health,MinnesotaCare,216.1303272,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision Malignant 3.1 To 4.0 Cm Face,Ears (Pbb)",,11644,CPT,Facility,Outpatient,,,,385,327.25,110.341,385,Sanford Health Plan,Sanford Health Plan,354.2,92,,percent of total billed charges,,
"Excision Malignant 3.1 To 4.0 Cm Face,Ears (Pbb)",,11644,CPT,Professional,Outpatient,,,,625,531.25,174.95,625,Sanford Health Plan,Sanford Health Plan,550,88,,percent of total billed charges,,
"Excision Malignant 3.1 To 4.0 Cm Face,Ears (Pbb)",,11644,CPT,Facility,Outpatient,,,,385,327.25,110.341,385,"UCare Health, Inc.",Individual & Family Plan,216.9475,56.35,,percent of total billed charges,,
"Excision Malignant 3.1 To 4.0 Cm Face,Ears (Pbb)",,11644,CPT,Professional,Outpatient,,,,625,531.25,174.95,625,"UCare Health, Inc.",Individual & Family Plan,441.821824,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Excision Malignant 3.1 To 4.0 Cm Face,Ears (Pbb)",,11644,CPT,Facility,Outpatient,,,,385,327.25,110.341,385,"UCare Health, Inc.",Medical Assistance,194.3095,50.47,,percent of total billed charges,,
"Excision Malignant 3.1 To 4.0 Cm Face,Ears (Pbb)",,11644,CPT,Professional,Outpatient,,,,625,531.25,174.95,625,"UCare Health, Inc.",Medical Assistance,222.190056,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Excision Malignant 3.1 To 4.0 Cm Face,Ears (Pbb)",,11644,CPT,Facility,Outpatient,,,,385,327.25,110.341,385,"UCare Health, Inc.",Medicare Advantage,194.3095,50.47,,percent of total billed charges,,
"Excision Malignant 3.1 To 4.0 Cm Face,Ears (Pbb)",,11644,CPT,Professional,Outpatient,,,,625,531.25,174.95,625,"UCare Health, Inc.",Medicare Advantage,312.5585,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Excision Malignant 3.1 To 4.0 Cm Face,Ears (Pbb)",,11644,CPT,Facility,Outpatient,,,,385,327.25,110.341,385,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),194.3095,50.47,,percent of total billed charges,,
"Excision Malignant 3.1 To 4.0 Cm Face,Ears (Pbb)",,11644,CPT,Professional,Outpatient,,,,625,531.25,174.95,625,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),250.0468,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Excision Malignant 3.1 To 4.0 Cm Face,Ears (Pbb)",,11644,CPT,Facility,Outpatient,,,,385,327.25,110.341,385,UnitedHealthcare,Individual & Family,361.9,94,,percent of total billed charges,,
"Excision Malignant 3.1 To 4.0 Cm Face,Ears (Pbb)",,11644,CPT,Professional,Outpatient,,,,625,531.25,174.95,625,UnitedHealthcare,Individual & Family,625,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Excision Malignant 3.1 To 4.0 Cm Face,Ears (Pbb)",,11644,CPT,Facility,Outpatient,,,,385,327.25,110.341,385,UnitedHealthcare,Medicare Advantage,188.65,49,,percent of total billed charges,,
"Excision Malignant 3.1 To 4.0 Cm Face,Ears (Pbb)",,11644,CPT,Professional,Outpatient,,,,625,531.25,174.95,625,UnitedHealthcare,Medicare Advantage,312.5585,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision Malignant 3.1 To 4.0 Cm Face,Ears (Pbb)",,11644,CPT,Facility,Outpatient,,,,385,327.25,110.341,385,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,184.8,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Excision Malignant 3.1 To 4.0 Cm Face,Ears (Pbb)",,11644,CPT,Professional,Outpatient,,,,625,531.25,174.95,625,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,201.99096,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia 3.1-4.0 Cm",,11644,CPT,Facility,Both,,,,590,501.5,169.094,590,Aetna,Commercial,542.8,92,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia 3.1-4.0 Cm",,11644,CPT,Facility,Outpatient,,,,590,501.5,169.094,590,Aetna,Medicare Advantage,289.1,49,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia 3.1-4.0 Cm",,11644,CPT,Facility,Inpatient,,,,590,501.5,169.094,590,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia 3.1-4.0 Cm",,11644,CPT,Facility,Both,,,,590,501.5,169.094,590,Aetna,PPO,548.7,93,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia 3.1-4.0 Cm",,11644,CPT,Facility,Both,,,,590,501.5,169.094,590,America's PPO,America's PPO,566.577,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia 3.1-4.0 Cm",,11644,CPT,Facility,Both,,,,590,501.5,169.094,590,BlueCross BlueShield Minnesota, Federal Employee Program,580.56,98.4,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia 3.1-4.0 Cm",,11644,CPT,Facility,Both,,,,590,501.5,169.094,590,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,590,100,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia 3.1-4.0 Cm",,11644,CPT,Facility,Both,,,,590,501.5,169.094,590,BlueCross BlueShield Minnesota,High Value Network Plan,531,90,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia 3.1-4.0 Cm",,11644,CPT,Facility,Outpatient,,,,590,501.5,169.094,590,BlueCross BlueShield Minnesota,Medicare Advantage,289.1,49,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia 3.1-4.0 Cm",,11644,CPT,Facility,Inpatient,,,,590,501.5,169.094,590,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia 3.1-4.0 Cm",,11644,CPT,Facility,Both,,,,590,501.5,169.094,590,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,522.563,88.57,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia 3.1-4.0 Cm",,11644,CPT,Facility,Both,,,,590,501.5,169.094,590,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,169.094,28.66,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia 3.1-4.0 Cm",,11644,CPT,Facility,Outpatient,,,,590,501.5,169.094,590,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),289.1,49,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia 3.1-4.0 Cm",,11644,CPT,Facility,Inpatient,,,,590,501.5,169.094,590,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia 3.1-4.0 Cm",,11644,CPT,Facility,Both,,,,590,501.5,169.094,590,CorVel,Worker's Compensation,590,100,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia 3.1-4.0 Cm",,11644,CPT,Facility,Both,,,,590,501.5,169.094,590,First Health Group Corporation,First Health Network,572.3,97,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia 3.1-4.0 Cm",,11644,CPT,Facility,Both,,,,590,501.5,169.094,590,"Health Partners, Inc.",Commercial,558.14,94.6,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia 3.1-4.0 Cm",,11644,CPT,Facility,Outpatient,,,,590,501.5,169.094,590,"Health Partners, Inc.",Medicare Advantage,289.1,49,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia 3.1-4.0 Cm",,11644,CPT,Facility,Inpatient,,,,590,501.5,169.094,590,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia 3.1-4.0 Cm",,11644,CPT,Facility,Both,,,,590,501.5,169.094,590,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),354,60,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia 3.1-4.0 Cm",,11644,CPT,Facility,Both,,,,590,501.5,169.094,590,"Health Partners, Inc.",State of Minnesota Advantage Program,480.85,81.5,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia 3.1-4.0 Cm",,11644,CPT,Facility,Both,,,,590,501.5,169.094,590,"Health Partners, Inc.",State Public Programs,295,50,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia 3.1-4.0 Cm",,11644,CPT,Facility,Both,,,,590,501.5,169.094,590,Humana Insurance Company,Commercial PPO,560.5,95,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia 3.1-4.0 Cm",,11644,CPT,Facility,Outpatient,,,,590,501.5,169.094,590,Humana Insurance Company,Medicare PPO,289.1,49,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia 3.1-4.0 Cm",,11644,CPT,Facility,Inpatient,,,,590,501.5,169.094,590,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia 3.1-4.0 Cm",,11644,CPT,Facility,Both,,,,590,501.5,169.094,590,Medica,Individual & Family,584.69,99.1,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia 3.1-4.0 Cm",,11644,CPT,Facility,Outpatient,,,,590,501.5,169.094,590,Medica,Medica Advantage Solution,293.82,49.8,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia 3.1-4.0 Cm",,11644,CPT,Facility,Inpatient,,,,590,501.5,169.094,590,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia 3.1-4.0 Cm",,11644,CPT,Facility,Outpatient,,,,590,501.5,169.094,590,Medica,Medical Assistance,263.14,44.6,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia 3.1-4.0 Cm",,11644,CPT,Facility,Inpatient,,,,590,501.5,169.094,590,Medica,Medical Assistance,,,,,Included in per diem rate,
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia 3.1-4.0 Cm",,11644,CPT,Facility,Outpatient,,,,590,501.5,169.094,590,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,293.82,49.8,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia 3.1-4.0 Cm",,11644,CPT,Facility,Inpatient,,,,590,501.5,169.094,590,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia 3.1-4.0 Cm",,11644,CPT,Facility,Both,,,,590,501.5,169.094,590,"Multiplan, Inc.","Multiplan, Inc.",554.6,94,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia 3.1-4.0 Cm",,11644,CPT,Facility,Outpatient,,,,590,501.5,169.094,590,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,531.59,90.1,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia 3.1-4.0 Cm",,11644,CPT,Facility,Inpatient,,,,590,501.5,169.094,590,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia 3.1-4.0 Cm",,11644,CPT,Facility,Both,,,,590,501.5,169.094,590,"Preferred One Administrative Services, INC.",PPO,581.74,98.6,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia 3.1-4.0 Cm",,11644,CPT,Facility,Outpatient,,,,590,501.5,169.094,590,PrimeWest Health,Minnesota Senior Health Options (MSHO),303.555,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia 3.1-4.0 Cm",,11644,CPT,Facility,Inpatient,,,,590,501.5,169.094,590,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia 3.1-4.0 Cm",,11644,CPT,Facility,Outpatient,,,,590,501.5,169.094,590,PrimeWest Health,MinnesotaCare,303.024,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia 3.1-4.0 Cm",,11644,CPT,Facility,Inpatient,,,,590,501.5,169.094,590,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia 3.1-4.0 Cm",,11644,CPT,Facility,Both,,,,590,501.5,169.094,590,Sanford Health Plan,Sanford Health Plan,542.8,92,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia 3.1-4.0 Cm",,11644,CPT,Facility,Outpatient,,,,590,501.5,169.094,590,"UCare Health, Inc.",Individual & Family Plan,332.465,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia 3.1-4.0 Cm",,11644,CPT,Facility,Inpatient,,,,590,501.5,169.094,590,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia 3.1-4.0 Cm",,11644,CPT,Facility,Outpatient,,,,590,501.5,169.094,590,"UCare Health, Inc.",Medical Assistance,297.773,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia 3.1-4.0 Cm",,11644,CPT,Facility,Inpatient,,,,590,501.5,169.094,590,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia 3.1-4.0 Cm",,11644,CPT,Facility,Outpatient,,,,590,501.5,169.094,590,"UCare Health, Inc.",Medicare Advantage,297.773,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia 3.1-4.0 Cm",,11644,CPT,Facility,Inpatient,,,,590,501.5,169.094,590,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia 3.1-4.0 Cm",,11644,CPT,Facility,Outpatient,,,,590,501.5,169.094,590,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),297.773,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia 3.1-4.0 Cm",,11644,CPT,Facility,Inpatient,,,,590,501.5,169.094,590,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia 3.1-4.0 Cm",,11644,CPT,Facility,Both,,,,590,501.5,169.094,590,UnitedHealthcare,Individual & Family,554.6,94,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia 3.1-4.0 Cm",,11644,CPT,Facility,Outpatient,,,,590,501.5,169.094,590,UnitedHealthcare,Medicare Advantage,289.1,49,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia 3.1-4.0 Cm",,11644,CPT,Facility,Inpatient,,,,590,501.5,169.094,590,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia 3.1-4.0 Cm",,11644,CPT,Facility,Outpatient,,,,590,501.5,169.094,590,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,283.2,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia 3.1-4.0 Cm",,11644,CPT,Facility,Inpatient,,,,590,501.5,169.094,590,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia 3.1-4.0 Cm (Pro Cah)",,11644,CPT,Professional,Both,,,,1010,858.5,174.95,1010,Aetna,Commercial,858.5,85,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia 3.1-4.0 Cm (Pro Cah)",,11644,CPT,Professional,Both,,,,1010,858.5,174.95,1010,Aetna,Commercial,858.5,85,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia 3.1-4.0 Cm (Pro Cah)",,11644,CPT,Professional,Both,,,,1010,858.5,174.95,1010,Aetna,Medicare Advantage,274.53,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia 3.1-4.0 Cm (Pro Cah)",,11644,CPT,Professional,Both,,,,1010,858.5,174.95,1010,Aetna,Medicare Advantage,274.53,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia 3.1-4.0 Cm (Pro Cah)",,11644,CPT,Professional,Both,,,,1010,858.5,174.95,1010,Aetna,PPO,939.3,93,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia 3.1-4.0 Cm (Pro Cah)",,11644,CPT,Professional,Both,,,,1010,858.5,174.95,1010,Aetna,PPO,939.3,93,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia 3.1-4.0 Cm (Pro Cah)",,11644,CPT,Professional,Both,,,,1010,858.5,174.95,1010,America's PPO,America's PPO,862.944,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia 3.1-4.0 Cm (Pro Cah)",,11644,CPT,Professional,Both,,,,1010,858.5,174.95,1010,America's PPO,America's PPO,862.944,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia 3.1-4.0 Cm (Pro Cah)",,11644,CPT,Professional,Both,,,,1010,858.5,174.95,1010,BlueCross BlueShield Minnesota, Federal Employee Program,575.67,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia 3.1-4.0 Cm (Pro Cah)",,11644,CPT,Professional,Both,,,,1010,858.5,174.95,1010,BlueCross BlueShield Minnesota, Federal Employee Program,575.67,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia 3.1-4.0 Cm (Pro Cah)",,11644,CPT,Professional,Both,,,,1010,858.5,174.95,1010,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,584.88072,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia 3.1-4.0 Cm (Pro Cah)",,11644,CPT,Professional,Both,,,,1010,858.5,174.95,1010,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,584.88072,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia 3.1-4.0 Cm (Pro Cah)",,11644,CPT,Professional,Both,,,,1010,858.5,174.95,1010,BlueCross BlueShield Minnesota,High Value Network Plan,584.88072,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia 3.1-4.0 Cm (Pro Cah)",,11644,CPT,Professional,Both,,,,1010,858.5,174.95,1010,BlueCross BlueShield Minnesota,High Value Network Plan,584.88072,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia 3.1-4.0 Cm (Pro Cah)",,11644,CPT,Professional,Both,,,,1010,858.5,174.95,1010,BlueCross BlueShield Minnesota,Medicare Advantage,312.5585,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia 3.1-4.0 Cm (Pro Cah)",,11644,CPT,Professional,Both,,,,1010,858.5,174.95,1010,BlueCross BlueShield Minnesota,Medicare Advantage,312.5585,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia 3.1-4.0 Cm (Pro Cah)",,11644,CPT,Professional,Both,,,,1010,858.5,174.95,1010,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,584.88072,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia 3.1-4.0 Cm (Pro Cah)",,11644,CPT,Professional,Both,,,,1010,858.5,174.95,1010,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,584.88072,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia 3.1-4.0 Cm (Pro Cah)",,11644,CPT,Professional,Both,,,,1010,858.5,174.95,1010,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,201.99096,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia 3.1-4.0 Cm (Pro Cah)",,11644,CPT,Professional,Both,,,,1010,858.5,174.95,1010,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,201.99096,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia 3.1-4.0 Cm (Pro Cah)",,11644,CPT,Professional,Both,,,,1010,858.5,174.95,1010,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),312.5585,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia 3.1-4.0 Cm (Pro Cah)",,11644,CPT,Professional,Both,,,,1010,858.5,174.95,1010,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),312.5585,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia 3.1-4.0 Cm (Pro Cah)",,11644,CPT,Professional,Both,,,,1010,858.5,174.95,1010,CorVel,Worker's Compensation,531.6478632,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia 3.1-4.0 Cm (Pro Cah)",,11644,CPT,Professional,Both,,,,1010,858.5,174.95,1010,CorVel,Worker's Compensation,531.6478632,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia 3.1-4.0 Cm (Pro Cah)",,11644,CPT,Professional,Both,,,,1010,858.5,174.95,1010,First Health Group Corporation,First Health Network,979.7,97,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia 3.1-4.0 Cm (Pro Cah)",,11644,CPT,Professional,Both,,,,1010,858.5,174.95,1010,First Health Group Corporation,First Health Network,979.7,97,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia 3.1-4.0 Cm (Pro Cah)",,11644,CPT,Professional,Both,,,,1010,858.5,174.95,1010,"Health Partners, Inc.",Commercial,573.89,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia 3.1-4.0 Cm (Pro Cah)",,11644,CPT,Professional,Both,,,,1010,858.5,174.95,1010,"Health Partners, Inc.",Commercial,573.89,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia 3.1-4.0 Cm (Pro Cah)",,11644,CPT,Professional,Both,,,,1010,858.5,174.95,1010,"Health Partners, Inc.",Medicare Advantage,312.5585,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia 3.1-4.0 Cm (Pro Cah)",,11644,CPT,Professional,Both,,,,1010,858.5,174.95,1010,"Health Partners, Inc.",Medicare Advantage,312.5585,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia 3.1-4.0 Cm (Pro Cah)",,11644,CPT,Professional,Both,,,,1010,858.5,174.95,1010,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),271.78,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia 3.1-4.0 Cm (Pro Cah)",,11644,CPT,Professional,Both,,,,1010,858.5,174.95,1010,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),271.78,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia 3.1-4.0 Cm (Pro Cah)",,11644,CPT,Professional,Both,,,,1010,858.5,174.95,1010,"Health Partners, Inc.",State of Minnesota Advantage Program,494.406235,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia 3.1-4.0 Cm (Pro Cah)",,11644,CPT,Professional,Both,,,,1010,858.5,174.95,1010,"Health Partners, Inc.",State of Minnesota Advantage Program,494.406235,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia 3.1-4.0 Cm (Pro Cah)",,11644,CPT,Professional,Both,,,,1010,858.5,174.95,1010,"Health Partners, Inc.",State Public Programs,174.95,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia 3.1-4.0 Cm (Pro Cah)",,11644,CPT,Professional,Both,,,,1010,858.5,174.95,1010,"Health Partners, Inc.",State Public Programs,174.95,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia 3.1-4.0 Cm (Pro Cah)",,11644,CPT,Professional,Both,,,,1010,858.5,174.95,1010,Humana Insurance Company,Commercial PPO,271.79,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia 3.1-4.0 Cm (Pro Cah)",,11644,CPT,Professional,Both,,,,1010,858.5,174.95,1010,Humana Insurance Company,Commercial PPO,271.79,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia 3.1-4.0 Cm (Pro Cah)",,11644,CPT,Professional,Both,,,,1010,858.5,174.95,1010,Humana Insurance Company,Medicare PPO,1010,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia 3.1-4.0 Cm (Pro Cah)",,11644,CPT,Professional,Both,,,,1010,858.5,174.95,1010,Humana Insurance Company,Medicare PPO,1010,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia 3.1-4.0 Cm (Pro Cah)",,11644,CPT,Professional,Both,,,,1010,858.5,174.95,1010,Medica,Individual & Family,856.48,84.8,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia 3.1-4.0 Cm (Pro Cah)",,11644,CPT,Professional,Both,,,,1010,858.5,174.95,1010,Medica,Individual & Family,856.48,84.8,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia 3.1-4.0 Cm (Pro Cah)",,11644,CPT,Professional,Both,,,,1010,858.5,174.95,1010,Medica,Medica Advantage Solution,502.98,49.8,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia 3.1-4.0 Cm (Pro Cah)",,11644,CPT,Professional,Both,,,,1010,858.5,174.95,1010,Medica,Medica Advantage Solution,502.98,49.8,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia 3.1-4.0 Cm (Pro Cah)",,11644,CPT,Professional,Both,,,,1010,858.5,174.95,1010,Medica,Medical Assistance,201.99,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia 3.1-4.0 Cm (Pro Cah)",,11644,CPT,Professional,Both,,,,1010,858.5,174.95,1010,Medica,Medical Assistance,201.99,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia 3.1-4.0 Cm (Pro Cah)",,11644,CPT,Professional,Both,,,,1010,858.5,174.95,1010,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,271.79,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia 3.1-4.0 Cm (Pro Cah)",,11644,CPT,Professional,Both,,,,1010,858.5,174.95,1010,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,271.79,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia 3.1-4.0 Cm (Pro Cah)",,11644,CPT,Professional,Both,,,,1010,858.5,174.95,1010,"Multiplan, Inc.","Multiplan, Inc.",949.4,94,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia 3.1-4.0 Cm (Pro Cah)",,11644,CPT,Professional,Both,,,,1010,858.5,174.95,1010,"Multiplan, Inc.","Multiplan, Inc.",949.4,94,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia 3.1-4.0 Cm (Pro Cah)",,11644,CPT,Professional,Both,,,,1010,858.5,174.95,1010,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,910.01,90.1,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia 3.1-4.0 Cm (Pro Cah)",,11644,CPT,Professional,Both,,,,1010,858.5,174.95,1010,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,910.01,90.1,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia 3.1-4.0 Cm (Pro Cah)",,11644,CPT,Professional,Both,,,,1010,858.5,174.95,1010,"Preferred One Administrative Services, INC.",PPO,995.86,98.6,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia 3.1-4.0 Cm (Pro Cah)",,11644,CPT,Professional,Both,,,,1010,858.5,174.95,1010,"Preferred One Administrative Services, INC.",PPO,995.86,98.6,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia 3.1-4.0 Cm (Pro Cah)",,11644,CPT,Professional,Both,,,,1010,858.5,174.95,1010,PrimeWest Health,Minnesota Senior Health Options (MSHO),312.5585,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia 3.1-4.0 Cm (Pro Cah)",,11644,CPT,Professional,Both,,,,1010,858.5,174.95,1010,PrimeWest Health,Minnesota Senior Health Options (MSHO),312.5585,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia 3.1-4.0 Cm (Pro Cah)",,11644,CPT,Professional,Both,,,,1010,858.5,174.95,1010,PrimeWest Health,MinnesotaCare,216.1303272,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia 3.1-4.0 Cm (Pro Cah)",,11644,CPT,Professional,Both,,,,1010,858.5,174.95,1010,PrimeWest Health,MinnesotaCare,216.1303272,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia 3.1-4.0 Cm (Pro Cah)",,11644,CPT,Professional,Both,,,,1010,858.5,174.95,1010,Sanford Health Plan,Sanford Health Plan,888.8,88,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia 3.1-4.0 Cm (Pro Cah)",,11644,CPT,Professional,Both,,,,1010,858.5,174.95,1010,Sanford Health Plan,Sanford Health Plan,888.8,88,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia 3.1-4.0 Cm (Pro Cah)",,11644,CPT,Professional,Both,,,,1010,858.5,174.95,1010,"UCare Health, Inc.",Individual & Family Plan,441.821824,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia 3.1-4.0 Cm (Pro Cah)",,11644,CPT,Professional,Both,,,,1010,858.5,174.95,1010,"UCare Health, Inc.",Individual & Family Plan,441.821824,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia 3.1-4.0 Cm (Pro Cah)",,11644,CPT,Professional,Both,,,,1010,858.5,174.95,1010,"UCare Health, Inc.",Medical Assistance,222.190056,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia 3.1-4.0 Cm (Pro Cah)",,11644,CPT,Professional,Both,,,,1010,858.5,174.95,1010,"UCare Health, Inc.",Medical Assistance,222.190056,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia 3.1-4.0 Cm (Pro Cah)",,11644,CPT,Professional,Both,,,,1010,858.5,174.95,1010,"UCare Health, Inc.",Medicare Advantage,312.5585,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia 3.1-4.0 Cm (Pro Cah)",,11644,CPT,Professional,Both,,,,1010,858.5,174.95,1010,"UCare Health, Inc.",Medicare Advantage,312.5585,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia 3.1-4.0 Cm (Pro Cah)",,11644,CPT,Professional,Both,,,,1010,858.5,174.95,1010,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),250.0468,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia 3.1-4.0 Cm (Pro Cah)",,11644,CPT,Professional,Both,,,,1010,858.5,174.95,1010,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),250.0468,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia 3.1-4.0 Cm (Pro Cah)",,11644,CPT,Professional,Both,,,,1010,858.5,174.95,1010,UnitedHealthcare,Individual & Family,1010,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia 3.1-4.0 Cm (Pro Cah)",,11644,CPT,Professional,Both,,,,1010,858.5,174.95,1010,UnitedHealthcare,Individual & Family,1010,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia 3.1-4.0 Cm (Pro Cah)",,11644,CPT,Professional,Both,,,,1010,858.5,174.95,1010,UnitedHealthcare,Medicare Advantage,312.5585,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia 3.1-4.0 Cm (Pro Cah)",,11644,CPT,Professional,Both,,,,1010,858.5,174.95,1010,UnitedHealthcare,Medicare Advantage,312.5585,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia 3.1-4.0 Cm (Pro Cah)",,11644,CPT,Professional,Both,,,,1010,858.5,174.95,1010,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,201.99096,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia 3.1-4.0 Cm (Pro Cah)",,11644,CPT,Professional,Both,,,,1010,858.5,174.95,1010,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,201.99096,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia Over 4.0 Cm",,11646,CPT,Facility,Both,,,,889,755.65,254.7874,889,Aetna,Commercial,817.88,92,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia Over 4.0 Cm",,11646,CPT,Facility,Outpatient,,,,889,755.65,254.7874,889,Aetna,Medicare Advantage,435.61,49,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia Over 4.0 Cm",,11646,CPT,Facility,Inpatient,,,,889,755.65,254.7874,889,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia Over 4.0 Cm",,11646,CPT,Facility,Both,,,,889,755.65,254.7874,889,Aetna,PPO,826.77,93,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia Over 4.0 Cm",,11646,CPT,Facility,Both,,,,889,755.65,254.7874,889,America's PPO,America's PPO,853.7067,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia Over 4.0 Cm",,11646,CPT,Facility,Both,,,,889,755.65,254.7874,889,BlueCross BlueShield Minnesota, Federal Employee Program,874.776,98.4,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia Over 4.0 Cm",,11646,CPT,Facility,Both,,,,889,755.65,254.7874,889,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,889,100,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia Over 4.0 Cm",,11646,CPT,Facility,Both,,,,889,755.65,254.7874,889,BlueCross BlueShield Minnesota,High Value Network Plan,800.1,90,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia Over 4.0 Cm",,11646,CPT,Facility,Outpatient,,,,889,755.65,254.7874,889,BlueCross BlueShield Minnesota,Medicare Advantage,435.61,49,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia Over 4.0 Cm",,11646,CPT,Facility,Inpatient,,,,889,755.65,254.7874,889,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia Over 4.0 Cm",,11646,CPT,Facility,Both,,,,889,755.65,254.7874,889,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,787.3873,88.57,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia Over 4.0 Cm",,11646,CPT,Facility,Both,,,,889,755.65,254.7874,889,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,254.7874,28.66,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia Over 4.0 Cm",,11646,CPT,Facility,Outpatient,,,,889,755.65,254.7874,889,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),435.61,49,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia Over 4.0 Cm",,11646,CPT,Facility,Inpatient,,,,889,755.65,254.7874,889,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia Over 4.0 Cm",,11646,CPT,Facility,Both,,,,889,755.65,254.7874,889,CorVel,Worker's Compensation,889,100,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia Over 4.0 Cm",,11646,CPT,Facility,Both,,,,889,755.65,254.7874,889,First Health Group Corporation,First Health Network,862.33,97,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia Over 4.0 Cm",,11646,CPT,Facility,Both,,,,889,755.65,254.7874,889,"Health Partners, Inc.",Commercial,840.994,94.6,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia Over 4.0 Cm",,11646,CPT,Facility,Outpatient,,,,889,755.65,254.7874,889,"Health Partners, Inc.",Medicare Advantage,435.61,49,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia Over 4.0 Cm",,11646,CPT,Facility,Inpatient,,,,889,755.65,254.7874,889,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia Over 4.0 Cm",,11646,CPT,Facility,Both,,,,889,755.65,254.7874,889,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),533.4,60,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia Over 4.0 Cm",,11646,CPT,Facility,Both,,,,889,755.65,254.7874,889,"Health Partners, Inc.",State of Minnesota Advantage Program,724.535,81.5,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia Over 4.0 Cm",,11646,CPT,Facility,Both,,,,889,755.65,254.7874,889,"Health Partners, Inc.",State Public Programs,444.5,50,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia Over 4.0 Cm",,11646,CPT,Facility,Both,,,,889,755.65,254.7874,889,Humana Insurance Company,Commercial PPO,844.55,95,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia Over 4.0 Cm",,11646,CPT,Facility,Outpatient,,,,889,755.65,254.7874,889,Humana Insurance Company,Medicare PPO,435.61,49,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia Over 4.0 Cm",,11646,CPT,Facility,Inpatient,,,,889,755.65,254.7874,889,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia Over 4.0 Cm",,11646,CPT,Facility,Both,,,,889,755.65,254.7874,889,Medica,Individual & Family,880.999,99.1,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia Over 4.0 Cm",,11646,CPT,Facility,Outpatient,,,,889,755.65,254.7874,889,Medica,Medica Advantage Solution,442.722,49.8,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia Over 4.0 Cm",,11646,CPT,Facility,Inpatient,,,,889,755.65,254.7874,889,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia Over 4.0 Cm",,11646,CPT,Facility,Outpatient,,,,889,755.65,254.7874,889,Medica,Medical Assistance,396.494,44.6,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia Over 4.0 Cm",,11646,CPT,Facility,Inpatient,,,,889,755.65,254.7874,889,Medica,Medical Assistance,,,,,Included in per diem rate,
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia Over 4.0 Cm",,11646,CPT,Facility,Outpatient,,,,889,755.65,254.7874,889,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,442.722,49.8,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia Over 4.0 Cm",,11646,CPT,Facility,Inpatient,,,,889,755.65,254.7874,889,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia Over 4.0 Cm",,11646,CPT,Facility,Both,,,,889,755.65,254.7874,889,"Multiplan, Inc.","Multiplan, Inc.",835.66,94,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia Over 4.0 Cm",,11646,CPT,Facility,Outpatient,,,,889,755.65,254.7874,889,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,800.989,90.1,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia Over 4.0 Cm",,11646,CPT,Facility,Inpatient,,,,889,755.65,254.7874,889,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia Over 4.0 Cm",,11646,CPT,Facility,Both,,,,889,755.65,254.7874,889,"Preferred One Administrative Services, INC.",PPO,876.554,98.6,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia Over 4.0 Cm",,11646,CPT,Facility,Outpatient,,,,889,755.65,254.7874,889,PrimeWest Health,Minnesota Senior Health Options (MSHO),457.3905,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia Over 4.0 Cm",,11646,CPT,Facility,Inpatient,,,,889,755.65,254.7874,889,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia Over 4.0 Cm",,11646,CPT,Facility,Outpatient,,,,889,755.65,254.7874,889,PrimeWest Health,MinnesotaCare,456.5904,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia Over 4.0 Cm",,11646,CPT,Facility,Inpatient,,,,889,755.65,254.7874,889,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia Over 4.0 Cm",,11646,CPT,Facility,Both,,,,889,755.65,254.7874,889,Sanford Health Plan,Sanford Health Plan,817.88,92,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia Over 4.0 Cm",,11646,CPT,Facility,Outpatient,,,,889,755.65,254.7874,889,"UCare Health, Inc.",Individual & Family Plan,500.9515,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia Over 4.0 Cm",,11646,CPT,Facility,Inpatient,,,,889,755.65,254.7874,889,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia Over 4.0 Cm",,11646,CPT,Facility,Outpatient,,,,889,755.65,254.7874,889,"UCare Health, Inc.",Medical Assistance,448.6783,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia Over 4.0 Cm",,11646,CPT,Facility,Inpatient,,,,889,755.65,254.7874,889,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia Over 4.0 Cm",,11646,CPT,Facility,Outpatient,,,,889,755.65,254.7874,889,"UCare Health, Inc.",Medicare Advantage,448.6783,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia Over 4.0 Cm",,11646,CPT,Facility,Inpatient,,,,889,755.65,254.7874,889,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia Over 4.0 Cm",,11646,CPT,Facility,Outpatient,,,,889,755.65,254.7874,889,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),448.6783,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia Over 4.0 Cm",,11646,CPT,Facility,Inpatient,,,,889,755.65,254.7874,889,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia Over 4.0 Cm",,11646,CPT,Facility,Both,,,,889,755.65,254.7874,889,UnitedHealthcare,Individual & Family,835.66,94,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia Over 4.0 Cm",,11646,CPT,Facility,Outpatient,,,,889,755.65,254.7874,889,UnitedHealthcare,Medicare Advantage,435.61,49,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia Over 4.0 Cm",,11646,CPT,Facility,Inpatient,,,,889,755.65,254.7874,889,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia Over 4.0 Cm",,11646,CPT,Facility,Outpatient,,,,889,755.65,254.7874,889,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,426.72,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia Over 4.0 Cm",,11646,CPT,Facility,Inpatient,,,,889,755.65,254.7874,889,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia Over 4.0 Cm (Pro Cah)",,11646,CPT,Professional,Both,,,,1380,1173,239.97,1380,Aetna,Commercial,1173,85,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia Over 4.0 Cm (Pro Cah)",,11646,CPT,Professional,Both,,,,1380,1173,239.97,1380,Aetna,Medicare Advantage,378.7,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia Over 4.0 Cm (Pro Cah)",,11646,CPT,Professional,Both,,,,1380,1173,239.97,1380,Aetna,PPO,1283.4,93,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia Over 4.0 Cm (Pro Cah)",,11646,CPT,Professional,Both,,,,1380,1173,239.97,1380,America's PPO,America's PPO,1179.072,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia Over 4.0 Cm (Pro Cah)",,11646,CPT,Professional,Both,,,,1380,1173,239.97,1380,BlueCross BlueShield Minnesota, Federal Employee Program,796.71,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia Over 4.0 Cm (Pro Cah)",,11646,CPT,Professional,Both,,,,1380,1173,239.97,1380,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,809.45736,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia Over 4.0 Cm (Pro Cah)",,11646,CPT,Professional,Both,,,,1380,1173,239.97,1380,BlueCross BlueShield Minnesota,High Value Network Plan,809.45736,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia Over 4.0 Cm (Pro Cah)",,11646,CPT,Professional,Both,,,,1380,1173,239.97,1380,BlueCross BlueShield Minnesota,Medicare Advantage,428.8925,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia Over 4.0 Cm (Pro Cah)",,11646,CPT,Professional,Both,,,,1380,1173,239.97,1380,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,809.45736,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia Over 4.0 Cm (Pro Cah)",,11646,CPT,Professional,Both,,,,1380,1173,239.97,1380,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,277.05304,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia Over 4.0 Cm (Pro Cah)",,11646,CPT,Professional,Both,,,,1380,1173,239.97,1380,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),428.8925,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia Over 4.0 Cm (Pro Cah)",,11646,CPT,Professional,Both,,,,1380,1173,239.97,1380,CorVel,Worker's Compensation,732.193302,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia Over 4.0 Cm (Pro Cah)",,11646,CPT,Professional,Both,,,,1380,1173,239.97,1380,First Health Group Corporation,First Health Network,1338.6,97,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia Over 4.0 Cm (Pro Cah)",,11646,CPT,Professional,Both,,,,1380,1173,239.97,1380,"Health Partners, Inc.",Commercial,791.55,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia Over 4.0 Cm (Pro Cah)",,11646,CPT,Professional,Both,,,,1380,1173,239.97,1380,"Health Partners, Inc.",Medicare Advantage,428.8925,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia Over 4.0 Cm (Pro Cah)",,11646,CPT,Professional,Both,,,,1380,1173,239.97,1380,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),372.76,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia Over 4.0 Cm (Pro Cah)",,11646,CPT,Professional,Both,,,,1380,1173,239.97,1380,"Health Partners, Inc.",State of Minnesota Advantage Program,681.920325,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia Over 4.0 Cm (Pro Cah)",,11646,CPT,Professional,Both,,,,1380,1173,239.97,1380,"Health Partners, Inc.",State Public Programs,239.97,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia Over 4.0 Cm (Pro Cah)",,11646,CPT,Professional,Both,,,,1380,1173,239.97,1380,Humana Insurance Company,Commercial PPO,372.95,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia Over 4.0 Cm (Pro Cah)",,11646,CPT,Professional,Both,,,,1380,1173,239.97,1380,Humana Insurance Company,Medicare PPO,1380,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia Over 4.0 Cm (Pro Cah)",,11646,CPT,Professional,Both,,,,1380,1173,239.97,1380,Medica,Individual & Family,1170.24,84.8,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia Over 4.0 Cm (Pro Cah)",,11646,CPT,Professional,Both,,,,1380,1173,239.97,1380,Medica,Medica Advantage Solution,687.24,49.8,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia Over 4.0 Cm (Pro Cah)",,11646,CPT,Professional,Both,,,,1380,1173,239.97,1380,Medica,Medical Assistance,277.05,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia Over 4.0 Cm (Pro Cah)",,11646,CPT,Professional,Both,,,,1380,1173,239.97,1380,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,372.95,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia Over 4.0 Cm (Pro Cah)",,11646,CPT,Professional,Both,,,,1380,1173,239.97,1380,"Multiplan, Inc.","Multiplan, Inc.",1297.2,94,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia Over 4.0 Cm (Pro Cah)",,11646,CPT,Professional,Both,,,,1380,1173,239.97,1380,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1243.38,90.1,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia Over 4.0 Cm (Pro Cah)",,11646,CPT,Professional,Both,,,,1380,1173,239.97,1380,"Preferred One Administrative Services, INC.",PPO,1360.68,98.6,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia Over 4.0 Cm (Pro Cah)",,11646,CPT,Professional,Both,,,,1380,1173,239.97,1380,PrimeWest Health,Minnesota Senior Health Options (MSHO),428.8925,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia Over 4.0 Cm (Pro Cah)",,11646,CPT,Professional,Both,,,,1380,1173,239.97,1380,PrimeWest Health,MinnesotaCare,296.4467528,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia Over 4.0 Cm (Pro Cah)",,11646,CPT,Professional,Both,,,,1380,1173,239.97,1380,Sanford Health Plan,Sanford Health Plan,1214.4,88,,percent of total billed charges,,
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia Over 4.0 Cm (Pro Cah)",,11646,CPT,Professional,Both,,,,1380,1173,239.97,1380,"UCare Health, Inc.",Individual & Family Plan,606.26752,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia Over 4.0 Cm (Pro Cah)",,11646,CPT,Professional,Both,,,,1380,1173,239.97,1380,"UCare Health, Inc.",Medical Assistance,304.758344,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia Over 4.0 Cm (Pro Cah)",,11646,CPT,Professional,Both,,,,1380,1173,239.97,1380,"UCare Health, Inc.",Medicare Advantage,428.8925,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia Over 4.0 Cm (Pro Cah)",,11646,CPT,Professional,Both,,,,1380,1173,239.97,1380,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),343.114,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia Over 4.0 Cm (Pro Cah)",,11646,CPT,Professional,Both,,,,1380,1173,239.97,1380,UnitedHealthcare,Individual & Family,1380,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia Over 4.0 Cm (Pro Cah)",,11646,CPT,Professional,Both,,,,1380,1173,239.97,1380,UnitedHealthcare,Medicare Advantage,428.8925,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Malignant Lesion Inc Margins, Face, Ears, Eyelids,Nose,Lips; Exc Dia Over 4.0 Cm (Pro Cah)",,11646,CPT,Professional,Both,,,,1380,1173,239.97,1380,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,277.05304,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
LEVOFLOXACIN 500 MG ORAL TABLET,,17481,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
LEVOFLOXACIN 500 MG ORAL TABLET,,17481,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
LEVOFLOXACIN 500 MG ORAL TABLET,,17481,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
LEVOFLOXACIN 500 MG ORAL TABLET,,17481,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
LEVOFLOXACIN 500 MG ORAL TABLET,,17481,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
LEVOFLOXACIN 500 MG ORAL TABLET,,17481,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
LEVOFLOXACIN 500 MG ORAL TABLET,,17481,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
LEVOFLOXACIN 500 MG ORAL TABLET,,17481,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
LEVOFLOXACIN 500 MG ORAL TABLET,,17481,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
LEVOFLOXACIN 500 MG ORAL TABLET,,17481,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
LEVOFLOXACIN 500 MG ORAL TABLET,,17481,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
LEVOFLOXACIN 500 MG ORAL TABLET,,17481,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
LEVOFLOXACIN 500 MG ORAL TABLET,,17481,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
LEVOFLOXACIN 500 MG ORAL TABLET,,17481,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
LEVOFLOXACIN 500 MG ORAL TABLET,,17481,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
LEVOFLOXACIN 500 MG ORAL TABLET,,17481,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
LEVOFLOXACIN 500 MG ORAL TABLET,,17481,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
LEVOFLOXACIN 500 MG ORAL TABLET,,17481,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
LEVOFLOXACIN 500 MG ORAL TABLET,,17481,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LEVOFLOXACIN 500 MG ORAL TABLET,,17481,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
LEVOFLOXACIN 500 MG ORAL TABLET,,17481,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
LEVOFLOXACIN 500 MG ORAL TABLET,,17481,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
LEVOFLOXACIN 500 MG ORAL TABLET,,17481,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
LEVOFLOXACIN 500 MG ORAL TABLET,,17481,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
LEVOFLOXACIN 500 MG ORAL TABLET,,17481,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
LEVOFLOXACIN 500 MG ORAL TABLET,,17481,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
LEVOFLOXACIN 500 MG ORAL TABLET,,17481,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
LEVOFLOXACIN 500 MG ORAL TABLET,,17481,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
LEVOFLOXACIN 500 MG ORAL TABLET,,17481,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
LEVOFLOXACIN 500 MG ORAL TABLET,,17481,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
LEVOFLOXACIN 500 MG ORAL TABLET,,17481,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
LEVOFLOXACIN 500 MG ORAL TABLET,,17481,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
LEVOFLOXACIN 500 MG ORAL TABLET,,17481,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
LEVOFLOXACIN 500 MG ORAL TABLET,,17481,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
LEVOFLOXACIN 500 MG ORAL TABLET,,17481,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
LEVOFLOXACIN 500 MG ORAL TABLET,,17481,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
LEVOFLOXACIN 500 MG ORAL TABLET,,17481,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
LEVOFLOXACIN 500 MG ORAL TABLET,,17481,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LEVOFLOXACIN 500 MG ORAL TABLET,,17481,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
LEVOFLOXACIN 500 MG ORAL TABLET,,17481,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
LEVOFLOXACIN 500 MG ORAL TABLET,,17481,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
LEVOFLOXACIN 500 MG ORAL TABLET,,17481,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
LEVOFLOXACIN 500 MG ORAL TABLET,,17481,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
LEVOFLOXACIN 500 MG ORAL TABLET,,17481,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LEVOFLOXACIN 500 MG ORAL TABLET,,17481,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
LEVOFLOXACIN 500 MG ORAL TABLET,,17481,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LEVOFLOXACIN 500 MG ORAL TABLET,,17481,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LEVOFLOXACIN 500 MG ORAL TABLET,,17481,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LEVOFLOXACIN 500 MG ORAL TABLET,,17481,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LEVOFLOXACIN 500 MG ORAL TABLET,,17481,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
LEVOFLOXACIN 500 MG ORAL TABLET,,17481,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
LEVOFLOXACIN 500 MG ORAL TABLET,,17481,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
LEVOFLOXACIN 500 MG ORAL TABLET,,17481,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
LEVOFLOXACIN 500 MG ORAL TABLET,,17481,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"POLYMYXIN B SULFATE 500,000 UNIT INJ SOLR",,17564,LOCAL,Facility,Both,1,Each,,64,54.4,18.3424,64,Aetna,Commercial,58.88,92,,percent of total billed charges,,
"POLYMYXIN B SULFATE 500,000 UNIT INJ SOLR",,17564,LOCAL,Facility,Outpatient,1,Each,,64,54.4,18.3424,64,Aetna,Medicare Advantage,31.36,49,,percent of total billed charges,,
"POLYMYXIN B SULFATE 500,000 UNIT INJ SOLR",,17564,LOCAL,Facility,Inpatient,1,Each,,64,54.4,18.3424,64,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"POLYMYXIN B SULFATE 500,000 UNIT INJ SOLR",,17564,LOCAL,Facility,Both,1,Each,,64,54.4,18.3424,64,Aetna,PPO,59.52,93,,percent of total billed charges,,
"POLYMYXIN B SULFATE 500,000 UNIT INJ SOLR",,17564,LOCAL,Facility,Both,1,Each,,64,54.4,18.3424,64,America's PPO,America's PPO,61.4592,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"POLYMYXIN B SULFATE 500,000 UNIT INJ SOLR",,17564,LOCAL,Facility,Both,1,Each,,64,54.4,18.3424,64,BlueCross BlueShield Minnesota, Federal Employee Program,62.976,98.4,,percent of total billed charges,,
"POLYMYXIN B SULFATE 500,000 UNIT INJ SOLR",,17564,LOCAL,Facility,Both,1,Each,,64,54.4,18.3424,64,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,64,100,,percent of total billed charges,,
"POLYMYXIN B SULFATE 500,000 UNIT INJ SOLR",,17564,LOCAL,Facility,Both,1,Each,,64,54.4,18.3424,64,BlueCross BlueShield Minnesota,High Value Network Plan,57.6,90,,percent of total billed charges,,
"POLYMYXIN B SULFATE 500,000 UNIT INJ SOLR",,17564,LOCAL,Facility,Outpatient,1,Each,,64,54.4,18.3424,64,BlueCross BlueShield Minnesota,Medicare Advantage,31.36,49,,percent of total billed charges,,
"POLYMYXIN B SULFATE 500,000 UNIT INJ SOLR",,17564,LOCAL,Facility,Inpatient,1,Each,,64,54.4,18.3424,64,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"POLYMYXIN B SULFATE 500,000 UNIT INJ SOLR",,17564,LOCAL,Facility,Both,1,Each,,64,54.4,18.3424,64,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,56.6848,88.57,,percent of total billed charges,,
"POLYMYXIN B SULFATE 500,000 UNIT INJ SOLR",,17564,LOCAL,Facility,Both,1,Each,,64,54.4,18.3424,64,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,18.3424,28.66,,percent of total billed charges,,
"POLYMYXIN B SULFATE 500,000 UNIT INJ SOLR",,17564,LOCAL,Facility,Outpatient,1,Each,,64,54.4,18.3424,64,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),31.36,49,,percent of total billed charges,,
"POLYMYXIN B SULFATE 500,000 UNIT INJ SOLR",,17564,LOCAL,Facility,Inpatient,1,Each,,64,54.4,18.3424,64,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"POLYMYXIN B SULFATE 500,000 UNIT INJ SOLR",,17564,LOCAL,Facility,Both,1,Each,,64,54.4,18.3424,64,CorVel,Worker's Compensation,64,100,,percent of total billed charges,,
"POLYMYXIN B SULFATE 500,000 UNIT INJ SOLR",,17564,LOCAL,Facility,Both,1,Each,,64,54.4,18.3424,64,First Health Group Corporation,First Health Network,62.08,97,,percent of total billed charges,,
"POLYMYXIN B SULFATE 500,000 UNIT INJ SOLR",,17564,LOCAL,Facility,Both,1,Each,,64,54.4,18.3424,64,"Health Partners, Inc.",Commercial,60.544,94.6,,percent of total billed charges,,
"POLYMYXIN B SULFATE 500,000 UNIT INJ SOLR",,17564,LOCAL,Facility,Outpatient,1,Each,,64,54.4,18.3424,64,"Health Partners, Inc.",Medicare Advantage,31.36,49,,percent of total billed charges,,
"POLYMYXIN B SULFATE 500,000 UNIT INJ SOLR",,17564,LOCAL,Facility,Inpatient,1,Each,,64,54.4,18.3424,64,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"POLYMYXIN B SULFATE 500,000 UNIT INJ SOLR",,17564,LOCAL,Facility,Both,1,Each,,64,54.4,18.3424,64,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),38.4,60,,percent of total billed charges,,
"POLYMYXIN B SULFATE 500,000 UNIT INJ SOLR",,17564,LOCAL,Facility,Both,1,Each,,64,54.4,18.3424,64,"Health Partners, Inc.",State of Minnesota Advantage Program,52.16,81.5,,percent of total billed charges,,
"POLYMYXIN B SULFATE 500,000 UNIT INJ SOLR",,17564,LOCAL,Facility,Both,1,Each,,64,54.4,18.3424,64,"Health Partners, Inc.",State Public Programs,32,50,,percent of total billed charges,,
"POLYMYXIN B SULFATE 500,000 UNIT INJ SOLR",,17564,LOCAL,Facility,Both,1,Each,,64,54.4,18.3424,64,Humana Insurance Company,Commercial PPO,60.8,95,,percent of total billed charges,,
"POLYMYXIN B SULFATE 500,000 UNIT INJ SOLR",,17564,LOCAL,Facility,Outpatient,1,Each,,64,54.4,18.3424,64,Humana Insurance Company,Medicare PPO,31.36,49,,percent of total billed charges,,
"POLYMYXIN B SULFATE 500,000 UNIT INJ SOLR",,17564,LOCAL,Facility,Inpatient,1,Each,,64,54.4,18.3424,64,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"POLYMYXIN B SULFATE 500,000 UNIT INJ SOLR",,17564,LOCAL,Facility,Both,1,Each,,64,54.4,18.3424,64,Medica,Individual & Family,63.424,99.1,,percent of total billed charges,,
"POLYMYXIN B SULFATE 500,000 UNIT INJ SOLR",,17564,LOCAL,Facility,Outpatient,1,Each,,64,54.4,18.3424,64,Medica,Medica Advantage Solution,31.872,49.8,,percent of total billed charges,,
"POLYMYXIN B SULFATE 500,000 UNIT INJ SOLR",,17564,LOCAL,Facility,Inpatient,1,Each,,64,54.4,18.3424,64,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"POLYMYXIN B SULFATE 500,000 UNIT INJ SOLR",,17564,LOCAL,Facility,Outpatient,1,Each,,64,54.4,18.3424,64,Medica,Medical Assistance,28.544,44.6,,percent of total billed charges,,
"POLYMYXIN B SULFATE 500,000 UNIT INJ SOLR",,17564,LOCAL,Facility,Inpatient,1,Each,,64,54.4,18.3424,64,Medica,Medical Assistance,,,,,Included in per diem rate,
"POLYMYXIN B SULFATE 500,000 UNIT INJ SOLR",,17564,LOCAL,Facility,Outpatient,1,Each,,64,54.4,18.3424,64,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,31.872,49.8,,percent of total billed charges,,
"POLYMYXIN B SULFATE 500,000 UNIT INJ SOLR",,17564,LOCAL,Facility,Inpatient,1,Each,,64,54.4,18.3424,64,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"POLYMYXIN B SULFATE 500,000 UNIT INJ SOLR",,17564,LOCAL,Facility,Both,1,Each,,64,54.4,18.3424,64,"Multiplan, Inc.","Multiplan, Inc.",60.16,94,,percent of total billed charges,,
"POLYMYXIN B SULFATE 500,000 UNIT INJ SOLR",,17564,LOCAL,Facility,Outpatient,1,Each,,64,54.4,18.3424,64,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,57.664,90.1,,percent of total billed charges,,
"POLYMYXIN B SULFATE 500,000 UNIT INJ SOLR",,17564,LOCAL,Facility,Inpatient,1,Each,,64,54.4,18.3424,64,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"POLYMYXIN B SULFATE 500,000 UNIT INJ SOLR",,17564,LOCAL,Facility,Both,1,Each,,64,54.4,18.3424,64,"Preferred One Administrative Services, INC.",PPO,63.104,98.6,,percent of total billed charges,,
"POLYMYXIN B SULFATE 500,000 UNIT INJ SOLR",,17564,LOCAL,Facility,Outpatient,1,Each,,64,54.4,18.3424,64,PrimeWest Health,Minnesota Senior Health Options (MSHO),32.928,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"POLYMYXIN B SULFATE 500,000 UNIT INJ SOLR",,17564,LOCAL,Facility,Inpatient,1,Each,,64,54.4,18.3424,64,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"POLYMYXIN B SULFATE 500,000 UNIT INJ SOLR",,17564,LOCAL,Facility,Outpatient,1,Each,,64,54.4,18.3424,64,PrimeWest Health,MinnesotaCare,32.8704,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"POLYMYXIN B SULFATE 500,000 UNIT INJ SOLR",,17564,LOCAL,Facility,Inpatient,1,Each,,64,54.4,18.3424,64,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"POLYMYXIN B SULFATE 500,000 UNIT INJ SOLR",,17564,LOCAL,Facility,Both,1,Each,,64,54.4,18.3424,64,Sanford Health Plan,Sanford Health Plan,58.88,92,,percent of total billed charges,,
"POLYMYXIN B SULFATE 500,000 UNIT INJ SOLR",,17564,LOCAL,Facility,Outpatient,1,Each,,64,54.4,18.3424,64,"UCare Health, Inc.",Individual & Family Plan,36.064,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"POLYMYXIN B SULFATE 500,000 UNIT INJ SOLR",,17564,LOCAL,Facility,Inpatient,1,Each,,64,54.4,18.3424,64,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"POLYMYXIN B SULFATE 500,000 UNIT INJ SOLR",,17564,LOCAL,Facility,Outpatient,1,Each,,64,54.4,18.3424,64,"UCare Health, Inc.",Medical Assistance,32.3008,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"POLYMYXIN B SULFATE 500,000 UNIT INJ SOLR",,17564,LOCAL,Facility,Inpatient,1,Each,,64,54.4,18.3424,64,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"POLYMYXIN B SULFATE 500,000 UNIT INJ SOLR",,17564,LOCAL,Facility,Outpatient,1,Each,,64,54.4,18.3424,64,"UCare Health, Inc.",Medicare Advantage,32.3008,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"POLYMYXIN B SULFATE 500,000 UNIT INJ SOLR",,17564,LOCAL,Facility,Inpatient,1,Each,,64,54.4,18.3424,64,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"POLYMYXIN B SULFATE 500,000 UNIT INJ SOLR",,17564,LOCAL,Facility,Outpatient,1,Each,,64,54.4,18.3424,64,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),32.3008,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"POLYMYXIN B SULFATE 500,000 UNIT INJ SOLR",,17564,LOCAL,Facility,Inpatient,1,Each,,64,54.4,18.3424,64,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"POLYMYXIN B SULFATE 500,000 UNIT INJ SOLR",,17564,LOCAL,Facility,Both,1,Each,,64,54.4,18.3424,64,UnitedHealthcare,Individual & Family,60.16,94,,percent of total billed charges,,
"POLYMYXIN B SULFATE 500,000 UNIT INJ SOLR",,17564,LOCAL,Facility,Outpatient,1,Each,,64,54.4,18.3424,64,UnitedHealthcare,Medicare Advantage,31.36,49,,percent of total billed charges,,
"POLYMYXIN B SULFATE 500,000 UNIT INJ SOLR",,17564,LOCAL,Facility,Inpatient,1,Each,,64,54.4,18.3424,64,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"POLYMYXIN B SULFATE 500,000 UNIT INJ SOLR",,17564,LOCAL,Facility,Outpatient,1,Each,,64,54.4,18.3424,64,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,30.72,48,,percent of total billed charges,,100% of DHS outpatient percentage
"POLYMYXIN B SULFATE 500,000 UNIT INJ SOLR",,17564,LOCAL,Facility,Inpatient,1,Each,,64,54.4,18.3424,64,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Avulsion Nail Plate,,11730,CPT,Facility,Both,,,,107,90.95,30.6662,107,Aetna,Commercial,98.44,92,,percent of total billed charges,,
Avulsion Nail Plate,,11730,CPT,Facility,Outpatient,,,,107,90.95,30.6662,107,Aetna,Medicare Advantage,52.43,49,,percent of total billed charges,,
Avulsion Nail Plate,,11730,CPT,Facility,Inpatient,,,,107,90.95,30.6662,107,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Avulsion Nail Plate,,11730,CPT,Facility,Both,,,,107,90.95,30.6662,107,Aetna,PPO,99.51,93,,percent of total billed charges,,
Avulsion Nail Plate,,11730,CPT,Facility,Both,,,,107,90.95,30.6662,107,America's PPO,America's PPO,102.7521,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Avulsion Nail Plate,,11730,CPT,Facility,Both,,,,107,90.95,30.6662,107,BlueCross BlueShield Minnesota, Federal Employee Program,105.288,98.4,,percent of total billed charges,,
Avulsion Nail Plate,,11730,CPT,Facility,Both,,,,107,90.95,30.6662,107,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,107,100,,percent of total billed charges,,
Avulsion Nail Plate,,11730,CPT,Facility,Both,,,,107,90.95,30.6662,107,BlueCross BlueShield Minnesota,High Value Network Plan,96.3,90,,percent of total billed charges,,
Avulsion Nail Plate,,11730,CPT,Facility,Outpatient,,,,107,90.95,30.6662,107,BlueCross BlueShield Minnesota,Medicare Advantage,52.43,49,,percent of total billed charges,,
Avulsion Nail Plate,,11730,CPT,Facility,Inpatient,,,,107,90.95,30.6662,107,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Avulsion Nail Plate,,11730,CPT,Facility,Both,,,,107,90.95,30.6662,107,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,94.7699,88.57,,percent of total billed charges,,
Avulsion Nail Plate,,11730,CPT,Facility,Both,,,,107,90.95,30.6662,107,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,30.6662,28.66,,percent of total billed charges,,
Avulsion Nail Plate,,11730,CPT,Facility,Outpatient,,,,107,90.95,30.6662,107,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),52.43,49,,percent of total billed charges,,
Avulsion Nail Plate,,11730,CPT,Facility,Inpatient,,,,107,90.95,30.6662,107,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Avulsion Nail Plate,,11730,CPT,Facility,Both,,,,107,90.95,30.6662,107,CorVel,Worker's Compensation,107,100,,percent of total billed charges,,
Avulsion Nail Plate,,11730,CPT,Facility,Both,,,,107,90.95,30.6662,107,First Health Group Corporation,First Health Network,103.79,97,,percent of total billed charges,,
Avulsion Nail Plate,,11730,CPT,Facility,Both,,,,107,90.95,30.6662,107,"Health Partners, Inc.",Commercial,101.222,94.6,,percent of total billed charges,,
Avulsion Nail Plate,,11730,CPT,Facility,Outpatient,,,,107,90.95,30.6662,107,"Health Partners, Inc.",Medicare Advantage,52.43,49,,percent of total billed charges,,
Avulsion Nail Plate,,11730,CPT,Facility,Inpatient,,,,107,90.95,30.6662,107,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Avulsion Nail Plate,,11730,CPT,Facility,Both,,,,107,90.95,30.6662,107,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),64.2,60,,percent of total billed charges,,
Avulsion Nail Plate,,11730,CPT,Facility,Both,,,,107,90.95,30.6662,107,"Health Partners, Inc.",State of Minnesota Advantage Program,87.205,81.5,,percent of total billed charges,,
Avulsion Nail Plate,,11730,CPT,Facility,Both,,,,107,90.95,30.6662,107,"Health Partners, Inc.",State Public Programs,53.5,50,,percent of total billed charges,,
Avulsion Nail Plate,,11730,CPT,Facility,Both,,,,107,90.95,30.6662,107,Humana Insurance Company,Commercial PPO,101.65,95,,percent of total billed charges,,
Avulsion Nail Plate,,11730,CPT,Facility,Outpatient,,,,107,90.95,30.6662,107,Humana Insurance Company,Medicare PPO,52.43,49,,percent of total billed charges,,
Avulsion Nail Plate,,11730,CPT,Facility,Inpatient,,,,107,90.95,30.6662,107,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Avulsion Nail Plate,,11730,CPT,Facility,Both,,,,107,90.95,30.6662,107,Medica,Individual & Family,106.037,99.1,,percent of total billed charges,,
Avulsion Nail Plate,,11730,CPT,Facility,Outpatient,,,,107,90.95,30.6662,107,Medica,Medica Advantage Solution,53.286,49.8,,percent of total billed charges,,
Avulsion Nail Plate,,11730,CPT,Facility,Inpatient,,,,107,90.95,30.6662,107,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Avulsion Nail Plate,,11730,CPT,Facility,Outpatient,,,,107,90.95,30.6662,107,Medica,Medical Assistance,47.722,44.6,,percent of total billed charges,,
Avulsion Nail Plate,,11730,CPT,Facility,Inpatient,,,,107,90.95,30.6662,107,Medica,Medical Assistance,,,,,Included in per diem rate,
Avulsion Nail Plate,,11730,CPT,Facility,Outpatient,,,,107,90.95,30.6662,107,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,53.286,49.8,,percent of total billed charges,,
Avulsion Nail Plate,,11730,CPT,Facility,Inpatient,,,,107,90.95,30.6662,107,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Avulsion Nail Plate,,11730,CPT,Facility,Both,,,,107,90.95,30.6662,107,"Multiplan, Inc.","Multiplan, Inc.",100.58,94,,percent of total billed charges,,
Avulsion Nail Plate,,11730,CPT,Facility,Outpatient,,,,107,90.95,30.6662,107,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,96.407,90.1,,percent of total billed charges,,
Avulsion Nail Plate,,11730,CPT,Facility,Inpatient,,,,107,90.95,30.6662,107,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Avulsion Nail Plate,,11730,CPT,Facility,Both,,,,107,90.95,30.6662,107,"Preferred One Administrative Services, INC.",PPO,105.502,98.6,,percent of total billed charges,,
Avulsion Nail Plate,,11730,CPT,Facility,Outpatient,,,,107,90.95,30.6662,107,PrimeWest Health,Minnesota Senior Health Options (MSHO),55.0515,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Avulsion Nail Plate,,11730,CPT,Facility,Inpatient,,,,107,90.95,30.6662,107,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Avulsion Nail Plate,,11730,CPT,Facility,Outpatient,,,,107,90.95,30.6662,107,PrimeWest Health,MinnesotaCare,54.9552,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Avulsion Nail Plate,,11730,CPT,Facility,Inpatient,,,,107,90.95,30.6662,107,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Avulsion Nail Plate,,11730,CPT,Facility,Both,,,,107,90.95,30.6662,107,Sanford Health Plan,Sanford Health Plan,98.44,92,,percent of total billed charges,,
Avulsion Nail Plate,,11730,CPT,Facility,Outpatient,,,,107,90.95,30.6662,107,"UCare Health, Inc.",Individual & Family Plan,60.2945,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Avulsion Nail Plate,,11730,CPT,Facility,Inpatient,,,,107,90.95,30.6662,107,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Avulsion Nail Plate,,11730,CPT,Facility,Outpatient,,,,107,90.95,30.6662,107,"UCare Health, Inc.",Medical Assistance,54.0029,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Avulsion Nail Plate,,11730,CPT,Facility,Inpatient,,,,107,90.95,30.6662,107,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Avulsion Nail Plate,,11730,CPT,Facility,Outpatient,,,,107,90.95,30.6662,107,"UCare Health, Inc.",Medicare Advantage,54.0029,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Avulsion Nail Plate,,11730,CPT,Facility,Inpatient,,,,107,90.95,30.6662,107,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Avulsion Nail Plate,,11730,CPT,Facility,Outpatient,,,,107,90.95,30.6662,107,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),54.0029,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Avulsion Nail Plate,,11730,CPT,Facility,Inpatient,,,,107,90.95,30.6662,107,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Avulsion Nail Plate,,11730,CPT,Facility,Both,,,,107,90.95,30.6662,107,UnitedHealthcare,Individual & Family,100.58,94,,percent of total billed charges,,
Avulsion Nail Plate,,11730,CPT,Facility,Outpatient,,,,107,90.95,30.6662,107,UnitedHealthcare,Medicare Advantage,52.43,49,,percent of total billed charges,,
Avulsion Nail Plate,,11730,CPT,Facility,Inpatient,,,,107,90.95,30.6662,107,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Avulsion Nail Plate,,11730,CPT,Facility,Outpatient,,,,107,90.95,30.6662,107,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,51.36,48,,percent of total billed charges,,100% of DHS outpatient percentage
Avulsion Nail Plate,,11730,CPT,Facility,Inpatient,,,,107,90.95,30.6662,107,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Avulsion Of Nail Plate, Partial Or Complete, Simple; Single (Pro Cah)",,11730,CPT,Professional,Both,,,,179,152.15,33.37,179,Aetna,Commercial,152.15,85,,percent of total billed charges,,
"Avulsion Of Nail Plate, Partial Or Complete, Simple; Single (Pro Cah)",,11730,CPT,Professional,Both,,,,179,152.15,33.37,179,Aetna,Medicare Advantage,52.95,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Avulsion Of Nail Plate, Partial Or Complete, Simple; Single (Pro Cah)",,11730,CPT,Professional,Both,,,,179,152.15,33.37,179,Aetna,PPO,166.47,93,,percent of total billed charges,,
"Avulsion Of Nail Plate, Partial Or Complete, Simple; Single (Pro Cah)",,11730,CPT,Professional,Both,,,,179,152.15,33.37,179,America's PPO,America's PPO,152.9376,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Avulsion Of Nail Plate, Partial Or Complete, Simple; Single (Pro Cah)",,11730,CPT,Professional,Both,,,,179,152.15,33.37,179,BlueCross BlueShield Minnesota, Federal Employee Program,109.49,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Avulsion Of Nail Plate, Partial Or Complete, Simple; Single (Pro Cah)",,11730,CPT,Professional,Both,,,,179,152.15,33.37,179,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,111.24184,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Avulsion Of Nail Plate, Partial Or Complete, Simple; Single (Pro Cah)",,11730,CPT,Professional,Both,,,,179,152.15,33.37,179,BlueCross BlueShield Minnesota,High Value Network Plan,111.24184,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Avulsion Of Nail Plate, Partial Or Complete, Simple; Single (Pro Cah)",,11730,CPT,Professional,Both,,,,179,152.15,33.37,179,BlueCross BlueShield Minnesota,Medicare Advantage,59.662,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Avulsion Of Nail Plate, Partial Or Complete, Simple; Single (Pro Cah)",,11730,CPT,Professional,Both,,,,179,152.15,33.37,179,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,111.24184,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Avulsion Of Nail Plate, Partial Or Complete, Simple; Single (Pro Cah)",,11730,CPT,Professional,Both,,,,179,152.15,33.37,179,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,38.52672,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Avulsion Of Nail Plate, Partial Or Complete, Simple; Single (Pro Cah)",,11730,CPT,Professional,Both,,,,179,152.15,33.37,179,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),59.662,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Avulsion Of Nail Plate, Partial Or Complete, Simple; Single (Pro Cah)",,11730,CPT,Professional,Both,,,,179,152.15,33.37,179,CorVel,Worker's Compensation,101.9210712,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Avulsion Of Nail Plate, Partial Or Complete, Simple; Single (Pro Cah)",,11730,CPT,Professional,Both,,,,179,152.15,33.37,179,First Health Group Corporation,First Health Network,173.63,97,,percent of total billed charges,,
"Avulsion Of Nail Plate, Partial Or Complete, Simple; Single (Pro Cah)",,11730,CPT,Professional,Both,,,,179,152.15,33.37,179,"Health Partners, Inc.",Commercial,110.28,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Avulsion Of Nail Plate, Partial Or Complete, Simple; Single (Pro Cah)",,11730,CPT,Professional,Both,,,,179,152.15,33.37,179,"Health Partners, Inc.",Medicare Advantage,59.662,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Avulsion Of Nail Plate, Partial Or Complete, Simple; Single (Pro Cah)",,11730,CPT,Professional,Both,,,,179,152.15,33.37,179,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),51.85,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Avulsion Of Nail Plate, Partial Or Complete, Simple; Single (Pro Cah)",,11730,CPT,Professional,Both,,,,179,152.15,33.37,179,"Health Partners, Inc.",State of Minnesota Advantage Program,95.00622,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Avulsion Of Nail Plate, Partial Or Complete, Simple; Single (Pro Cah)",,11730,CPT,Professional,Both,,,,179,152.15,33.37,179,"Health Partners, Inc.",State Public Programs,33.37,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Avulsion Of Nail Plate, Partial Or Complete, Simple; Single (Pro Cah)",,11730,CPT,Professional,Both,,,,179,152.15,33.37,179,Humana Insurance Company,Commercial PPO,51.88,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Avulsion Of Nail Plate, Partial Or Complete, Simple; Single (Pro Cah)",,11730,CPT,Professional,Both,,,,179,152.15,33.37,179,Humana Insurance Company,Medicare PPO,179,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Avulsion Of Nail Plate, Partial Or Complete, Simple; Single (Pro Cah)",,11730,CPT,Professional,Both,,,,179,152.15,33.37,179,Medica,Individual & Family,151.792,84.8,,percent of total billed charges,,
"Avulsion Of Nail Plate, Partial Or Complete, Simple; Single (Pro Cah)",,11730,CPT,Professional,Both,,,,179,152.15,33.37,179,Medica,Medica Advantage Solution,89.142,49.8,,percent of total billed charges,,
"Avulsion Of Nail Plate, Partial Or Complete, Simple; Single (Pro Cah)",,11730,CPT,Professional,Both,,,,179,152.15,33.37,179,Medica,Medical Assistance,38.53,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Avulsion Of Nail Plate, Partial Or Complete, Simple; Single (Pro Cah)",,11730,CPT,Professional,Both,,,,179,152.15,33.37,179,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,51.88,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Avulsion Of Nail Plate, Partial Or Complete, Simple; Single (Pro Cah)",,11730,CPT,Professional,Both,,,,179,152.15,33.37,179,"Multiplan, Inc.","Multiplan, Inc.",168.26,94,,percent of total billed charges,,
"Avulsion Of Nail Plate, Partial Or Complete, Simple; Single (Pro Cah)",,11730,CPT,Professional,Both,,,,179,152.15,33.37,179,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,161.279,90.1,,percent of total billed charges,,
"Avulsion Of Nail Plate, Partial Or Complete, Simple; Single (Pro Cah)",,11730,CPT,Professional,Both,,,,179,152.15,33.37,179,"Preferred One Administrative Services, INC.",PPO,176.494,98.6,,percent of total billed charges,,
"Avulsion Of Nail Plate, Partial Or Complete, Simple; Single (Pro Cah)",,11730,CPT,Professional,Both,,,,179,152.15,33.37,179,PrimeWest Health,Minnesota Senior Health Options (MSHO),59.662,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Avulsion Of Nail Plate, Partial Or Complete, Simple; Single (Pro Cah)",,11730,CPT,Professional,Both,,,,179,152.15,33.37,179,PrimeWest Health,MinnesotaCare,41.2235904,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Avulsion Of Nail Plate, Partial Or Complete, Simple; Single (Pro Cah)",,11730,CPT,Professional,Both,,,,179,152.15,33.37,179,Sanford Health Plan,Sanford Health Plan,157.52,88,,percent of total billed charges,,
"Avulsion Of Nail Plate, Partial Or Complete, Simple; Single (Pro Cah)",,11730,CPT,Professional,Both,,,,179,152.15,33.37,179,"UCare Health, Inc.",Individual & Family Plan,84.336128,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Avulsion Of Nail Plate, Partial Or Complete, Simple; Single (Pro Cah)",,11730,CPT,Professional,Both,,,,179,152.15,33.37,179,"UCare Health, Inc.",Medical Assistance,42.379392,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Avulsion Of Nail Plate, Partial Or Complete, Simple; Single (Pro Cah)",,11730,CPT,Professional,Both,,,,179,152.15,33.37,179,"UCare Health, Inc.",Medicare Advantage,59.662,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Avulsion Of Nail Plate, Partial Or Complete, Simple; Single (Pro Cah)",,11730,CPT,Professional,Both,,,,179,152.15,33.37,179,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),47.7296,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Avulsion Of Nail Plate, Partial Or Complete, Simple; Single (Pro Cah)",,11730,CPT,Professional,Both,,,,179,152.15,33.37,179,UnitedHealthcare,Individual & Family,179,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Avulsion Of Nail Plate, Partial Or Complete, Simple; Single (Pro Cah)",,11730,CPT,Professional,Both,,,,179,152.15,33.37,179,UnitedHealthcare,Medicare Advantage,59.662,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Avulsion Of Nail Plate, Partial Or Complete, Simple; Single (Pro Cah)",,11730,CPT,Professional,Both,,,,179,152.15,33.37,179,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,38.52672,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Avulsion Nail Plate Ea Addl,,11732,CPT,Facility,Both,,,,95,80.75,27.227,95,Aetna,Commercial,87.4,92,,percent of total billed charges,,
Avulsion Nail Plate Ea Addl,,11732,CPT,Facility,Outpatient,,,,95,80.75,27.227,95,Aetna,Medicare Advantage,46.55,49,,percent of total billed charges,,
Avulsion Nail Plate Ea Addl,,11732,CPT,Facility,Inpatient,,,,95,80.75,27.227,95,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Avulsion Nail Plate Ea Addl,,11732,CPT,Facility,Both,,,,95,80.75,27.227,95,Aetna,PPO,88.35,93,,percent of total billed charges,,
Avulsion Nail Plate Ea Addl,,11732,CPT,Facility,Both,,,,95,80.75,27.227,95,America's PPO,America's PPO,91.2285,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Avulsion Nail Plate Ea Addl,,11732,CPT,Facility,Both,,,,95,80.75,27.227,95,BlueCross BlueShield Minnesota, Federal Employee Program,93.48,98.4,,percent of total billed charges,,
Avulsion Nail Plate Ea Addl,,11732,CPT,Facility,Both,,,,95,80.75,27.227,95,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,95,100,,percent of total billed charges,,
Avulsion Nail Plate Ea Addl,,11732,CPT,Facility,Both,,,,95,80.75,27.227,95,BlueCross BlueShield Minnesota,High Value Network Plan,85.5,90,,percent of total billed charges,,
Avulsion Nail Plate Ea Addl,,11732,CPT,Facility,Outpatient,,,,95,80.75,27.227,95,BlueCross BlueShield Minnesota,Medicare Advantage,46.55,49,,percent of total billed charges,,
Avulsion Nail Plate Ea Addl,,11732,CPT,Facility,Inpatient,,,,95,80.75,27.227,95,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Avulsion Nail Plate Ea Addl,,11732,CPT,Facility,Both,,,,95,80.75,27.227,95,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,84.1415,88.57,,percent of total billed charges,,
Avulsion Nail Plate Ea Addl,,11732,CPT,Facility,Both,,,,95,80.75,27.227,95,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,27.227,28.66,,percent of total billed charges,,
Avulsion Nail Plate Ea Addl,,11732,CPT,Facility,Outpatient,,,,95,80.75,27.227,95,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),46.55,49,,percent of total billed charges,,
Avulsion Nail Plate Ea Addl,,11732,CPT,Facility,Inpatient,,,,95,80.75,27.227,95,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Avulsion Nail Plate Ea Addl,,11732,CPT,Facility,Both,,,,95,80.75,27.227,95,CorVel,Worker's Compensation,95,100,,percent of total billed charges,,
Avulsion Nail Plate Ea Addl,,11732,CPT,Facility,Both,,,,95,80.75,27.227,95,First Health Group Corporation,First Health Network,92.15,97,,percent of total billed charges,,
Avulsion Nail Plate Ea Addl,,11732,CPT,Facility,Both,,,,95,80.75,27.227,95,"Health Partners, Inc.",Commercial,89.87,94.6,,percent of total billed charges,,
Avulsion Nail Plate Ea Addl,,11732,CPT,Facility,Outpatient,,,,95,80.75,27.227,95,"Health Partners, Inc.",Medicare Advantage,46.55,49,,percent of total billed charges,,
Avulsion Nail Plate Ea Addl,,11732,CPT,Facility,Inpatient,,,,95,80.75,27.227,95,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Avulsion Nail Plate Ea Addl,,11732,CPT,Facility,Both,,,,95,80.75,27.227,95,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),57,60,,percent of total billed charges,,
Avulsion Nail Plate Ea Addl,,11732,CPT,Facility,Both,,,,95,80.75,27.227,95,"Health Partners, Inc.",State of Minnesota Advantage Program,77.425,81.5,,percent of total billed charges,,
Avulsion Nail Plate Ea Addl,,11732,CPT,Facility,Both,,,,95,80.75,27.227,95,"Health Partners, Inc.",State Public Programs,47.5,50,,percent of total billed charges,,
Avulsion Nail Plate Ea Addl,,11732,CPT,Facility,Both,,,,95,80.75,27.227,95,Humana Insurance Company,Commercial PPO,90.25,95,,percent of total billed charges,,
Avulsion Nail Plate Ea Addl,,11732,CPT,Facility,Outpatient,,,,95,80.75,27.227,95,Humana Insurance Company,Medicare PPO,46.55,49,,percent of total billed charges,,
Avulsion Nail Plate Ea Addl,,11732,CPT,Facility,Inpatient,,,,95,80.75,27.227,95,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Avulsion Nail Plate Ea Addl,,11732,CPT,Facility,Both,,,,95,80.75,27.227,95,Medica,Individual & Family,94.145,99.1,,percent of total billed charges,,
Avulsion Nail Plate Ea Addl,,11732,CPT,Facility,Outpatient,,,,95,80.75,27.227,95,Medica,Medica Advantage Solution,47.31,49.8,,percent of total billed charges,,
Avulsion Nail Plate Ea Addl,,11732,CPT,Facility,Inpatient,,,,95,80.75,27.227,95,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Avulsion Nail Plate Ea Addl,,11732,CPT,Facility,Outpatient,,,,95,80.75,27.227,95,Medica,Medical Assistance,42.37,44.6,,percent of total billed charges,,
Avulsion Nail Plate Ea Addl,,11732,CPT,Facility,Inpatient,,,,95,80.75,27.227,95,Medica,Medical Assistance,,,,,Included in per diem rate,
Avulsion Nail Plate Ea Addl,,11732,CPT,Facility,Outpatient,,,,95,80.75,27.227,95,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,47.31,49.8,,percent of total billed charges,,
Avulsion Nail Plate Ea Addl,,11732,CPT,Facility,Inpatient,,,,95,80.75,27.227,95,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Avulsion Nail Plate Ea Addl,,11732,CPT,Facility,Both,,,,95,80.75,27.227,95,"Multiplan, Inc.","Multiplan, Inc.",89.3,94,,percent of total billed charges,,
Avulsion Nail Plate Ea Addl,,11732,CPT,Facility,Outpatient,,,,95,80.75,27.227,95,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,85.595,90.1,,percent of total billed charges,,
Avulsion Nail Plate Ea Addl,,11732,CPT,Facility,Inpatient,,,,95,80.75,27.227,95,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Avulsion Nail Plate Ea Addl,,11732,CPT,Facility,Both,,,,95,80.75,27.227,95,"Preferred One Administrative Services, INC.",PPO,93.67,98.6,,percent of total billed charges,,
Avulsion Nail Plate Ea Addl,,11732,CPT,Facility,Outpatient,,,,95,80.75,27.227,95,PrimeWest Health,Minnesota Senior Health Options (MSHO),48.8775,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Avulsion Nail Plate Ea Addl,,11732,CPT,Facility,Inpatient,,,,95,80.75,27.227,95,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Avulsion Nail Plate Ea Addl,,11732,CPT,Facility,Outpatient,,,,95,80.75,27.227,95,PrimeWest Health,MinnesotaCare,48.792,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Avulsion Nail Plate Ea Addl,,11732,CPT,Facility,Inpatient,,,,95,80.75,27.227,95,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Avulsion Nail Plate Ea Addl,,11732,CPT,Facility,Both,,,,95,80.75,27.227,95,Sanford Health Plan,Sanford Health Plan,87.4,92,,percent of total billed charges,,
Avulsion Nail Plate Ea Addl,,11732,CPT,Facility,Outpatient,,,,95,80.75,27.227,95,"UCare Health, Inc.",Individual & Family Plan,53.5325,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Avulsion Nail Plate Ea Addl,,11732,CPT,Facility,Inpatient,,,,95,80.75,27.227,95,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Avulsion Nail Plate Ea Addl,,11732,CPT,Facility,Outpatient,,,,95,80.75,27.227,95,"UCare Health, Inc.",Medical Assistance,47.9465,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Avulsion Nail Plate Ea Addl,,11732,CPT,Facility,Inpatient,,,,95,80.75,27.227,95,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Avulsion Nail Plate Ea Addl,,11732,CPT,Facility,Outpatient,,,,95,80.75,27.227,95,"UCare Health, Inc.",Medicare Advantage,47.9465,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Avulsion Nail Plate Ea Addl,,11732,CPT,Facility,Inpatient,,,,95,80.75,27.227,95,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Avulsion Nail Plate Ea Addl,,11732,CPT,Facility,Outpatient,,,,95,80.75,27.227,95,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),47.9465,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Avulsion Nail Plate Ea Addl,,11732,CPT,Facility,Inpatient,,,,95,80.75,27.227,95,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Avulsion Nail Plate Ea Addl,,11732,CPT,Facility,Both,,,,95,80.75,27.227,95,UnitedHealthcare,Individual & Family,89.3,94,,percent of total billed charges,,
Avulsion Nail Plate Ea Addl,,11732,CPT,Facility,Outpatient,,,,95,80.75,27.227,95,UnitedHealthcare,Medicare Advantage,46.55,49,,percent of total billed charges,,
Avulsion Nail Plate Ea Addl,,11732,CPT,Facility,Inpatient,,,,95,80.75,27.227,95,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Avulsion Nail Plate Ea Addl,,11732,CPT,Facility,Outpatient,,,,95,80.75,27.227,95,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,45.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
Avulsion Nail Plate Ea Addl,,11732,CPT,Facility,Inpatient,,,,95,80.75,27.227,95,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Excision Of Pilonidal Cyst Or Sinus; Complicated (Pro Cah),,11772,CPT,Professional,Both,,,,1654,1405.9,358.86,1654,Aetna,Commercial,1405.9,85,,percent of total billed charges,,
Excision Of Pilonidal Cyst Or Sinus; Complicated (Pro Cah),,11772,CPT,Professional,Both,,,,1654,1405.9,358.86,1654,Aetna,Medicare Advantage,570.5,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Excision Of Pilonidal Cyst Or Sinus; Complicated (Pro Cah),,11772,CPT,Professional,Both,,,,1654,1405.9,358.86,1654,Aetna,PPO,1538.22,93,,percent of total billed charges,,
Excision Of Pilonidal Cyst Or Sinus; Complicated (Pro Cah),,11772,CPT,Professional,Both,,,,1654,1405.9,358.86,1654,America's PPO,America's PPO,1413.1776,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Excision Of Pilonidal Cyst Or Sinus; Complicated (Pro Cah),,11772,CPT,Professional,Both,,,,1654,1405.9,358.86,1654,BlueCross BlueShield Minnesota, Federal Employee Program,1196.79,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Excision Of Pilonidal Cyst Or Sinus; Complicated (Pro Cah),,11772,CPT,Professional,Both,,,,1654,1405.9,358.86,1654,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1215.93864,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Excision Of Pilonidal Cyst Or Sinus; Complicated (Pro Cah),,11772,CPT,Professional,Both,,,,1654,1405.9,358.86,1654,BlueCross BlueShield Minnesota,High Value Network Plan,1215.93864,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Excision Of Pilonidal Cyst Or Sinus; Complicated (Pro Cah),,11772,CPT,Professional,Both,,,,1654,1405.9,358.86,1654,BlueCross BlueShield Minnesota,Medicare Advantage,641.2515,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Excision Of Pilonidal Cyst Or Sinus; Complicated (Pro Cah),,11772,CPT,Professional,Both,,,,1654,1405.9,358.86,1654,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1215.93864,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Excision Of Pilonidal Cyst Or Sinus; Complicated (Pro Cah),,11772,CPT,Professional,Both,,,,1654,1405.9,358.86,1654,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,414.31464,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Excision Of Pilonidal Cyst Or Sinus; Complicated (Pro Cah),,11772,CPT,Professional,Both,,,,1654,1405.9,358.86,1654,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),641.2515,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Excision Of Pilonidal Cyst Or Sinus; Complicated (Pro Cah),,11772,CPT,Professional,Both,,,,1654,1405.9,358.86,1654,CorVel,Worker's Compensation,1100.303038,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Excision Of Pilonidal Cyst Or Sinus; Complicated (Pro Cah),,11772,CPT,Professional,Both,,,,1654,1405.9,358.86,1654,First Health Group Corporation,First Health Network,1604.38,97,,percent of total billed charges,,
Excision Of Pilonidal Cyst Or Sinus; Complicated (Pro Cah),,11772,CPT,Professional,Both,,,,1654,1405.9,358.86,1654,"Health Partners, Inc.",Commercial,1188.42,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Excision Of Pilonidal Cyst Or Sinus; Complicated (Pro Cah),,11772,CPT,Professional,Both,,,,1654,1405.9,358.86,1654,"Health Partners, Inc.",Medicare Advantage,641.2515,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Excision Of Pilonidal Cyst Or Sinus; Complicated (Pro Cah),,11772,CPT,Professional,Both,,,,1654,1405.9,358.86,1654,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),557.44,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Excision Of Pilonidal Cyst Or Sinus; Complicated (Pro Cah),,11772,CPT,Professional,Both,,,,1654,1405.9,358.86,1654,"Health Partners, Inc.",State of Minnesota Advantage Program,1023.82383,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Excision Of Pilonidal Cyst Or Sinus; Complicated (Pro Cah),,11772,CPT,Professional,Both,,,,1654,1405.9,358.86,1654,"Health Partners, Inc.",State Public Programs,358.86,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Excision Of Pilonidal Cyst Or Sinus; Complicated (Pro Cah),,11772,CPT,Professional,Both,,,,1654,1405.9,358.86,1654,Humana Insurance Company,Commercial PPO,557.61,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Excision Of Pilonidal Cyst Or Sinus; Complicated (Pro Cah),,11772,CPT,Professional,Both,,,,1654,1405.9,358.86,1654,Humana Insurance Company,Medicare PPO,1654,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Excision Of Pilonidal Cyst Or Sinus; Complicated (Pro Cah),,11772,CPT,Professional,Both,,,,1654,1405.9,358.86,1654,Medica,Individual & Family,1402.592,84.8,,percent of total billed charges,,
Excision Of Pilonidal Cyst Or Sinus; Complicated (Pro Cah),,11772,CPT,Professional,Both,,,,1654,1405.9,358.86,1654,Medica,Medica Advantage Solution,823.692,49.8,,percent of total billed charges,,
Excision Of Pilonidal Cyst Or Sinus; Complicated (Pro Cah),,11772,CPT,Professional,Both,,,,1654,1405.9,358.86,1654,Medica,Medical Assistance,414.31,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Excision Of Pilonidal Cyst Or Sinus; Complicated (Pro Cah),,11772,CPT,Professional,Both,,,,1654,1405.9,358.86,1654,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,557.61,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Excision Of Pilonidal Cyst Or Sinus; Complicated (Pro Cah),,11772,CPT,Professional,Both,,,,1654,1405.9,358.86,1654,"Multiplan, Inc.","Multiplan, Inc.",1554.76,94,,percent of total billed charges,,
Excision Of Pilonidal Cyst Or Sinus; Complicated (Pro Cah),,11772,CPT,Professional,Both,,,,1654,1405.9,358.86,1654,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1490.254,90.1,,percent of total billed charges,,
Excision Of Pilonidal Cyst Or Sinus; Complicated (Pro Cah),,11772,CPT,Professional,Both,,,,1654,1405.9,358.86,1654,"Preferred One Administrative Services, INC.",PPO,1630.844,98.6,,percent of total billed charges,,
Excision Of Pilonidal Cyst Or Sinus; Complicated (Pro Cah),,11772,CPT,Professional,Both,,,,1654,1405.9,358.86,1654,PrimeWest Health,Minnesota Senior Health Options (MSHO),641.2515,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Excision Of Pilonidal Cyst Or Sinus; Complicated (Pro Cah),,11772,CPT,Professional,Both,,,,1654,1405.9,358.86,1654,PrimeWest Health,MinnesotaCare,443.3166648,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Excision Of Pilonidal Cyst Or Sinus; Complicated (Pro Cah),,11772,CPT,Professional,Both,,,,1654,1405.9,358.86,1654,Sanford Health Plan,Sanford Health Plan,1455.52,88,,percent of total billed charges,,
Excision Of Pilonidal Cyst Or Sinus; Complicated (Pro Cah),,11772,CPT,Professional,Both,,,,1654,1405.9,358.86,1654,"UCare Health, Inc.",Individual & Family Plan,906.450816,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Excision Of Pilonidal Cyst Or Sinus; Complicated (Pro Cah),,11772,CPT,Professional,Both,,,,1654,1405.9,358.86,1654,"UCare Health, Inc.",Medical Assistance,455.746104,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Excision Of Pilonidal Cyst Or Sinus; Complicated (Pro Cah),,11772,CPT,Professional,Both,,,,1654,1405.9,358.86,1654,"UCare Health, Inc.",Medicare Advantage,641.2515,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Excision Of Pilonidal Cyst Or Sinus; Complicated (Pro Cah),,11772,CPT,Professional,Both,,,,1654,1405.9,358.86,1654,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),513.0012,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Excision Of Pilonidal Cyst Or Sinus; Complicated (Pro Cah),,11772,CPT,Professional,Both,,,,1654,1405.9,358.86,1654,UnitedHealthcare,Individual & Family,1654,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Excision Of Pilonidal Cyst Or Sinus; Complicated (Pro Cah),,11772,CPT,Professional,Both,,,,1654,1405.9,358.86,1654,UnitedHealthcare,Medicare Advantage,641.2515,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Excision Of Pilonidal Cyst Or Sinus; Complicated (Pro Cah),,11772,CPT,Professional,Both,,,,1654,1405.9,358.86,1654,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,414.31464,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
VERAPAMIL 80 MG ORAL TABLET,,17581,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
VERAPAMIL 80 MG ORAL TABLET,,17581,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
VERAPAMIL 80 MG ORAL TABLET,,17581,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
VERAPAMIL 80 MG ORAL TABLET,,17581,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
VERAPAMIL 80 MG ORAL TABLET,,17581,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
VERAPAMIL 80 MG ORAL TABLET,,17581,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
VERAPAMIL 80 MG ORAL TABLET,,17581,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
VERAPAMIL 80 MG ORAL TABLET,,17581,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
VERAPAMIL 80 MG ORAL TABLET,,17581,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
VERAPAMIL 80 MG ORAL TABLET,,17581,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
VERAPAMIL 80 MG ORAL TABLET,,17581,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
VERAPAMIL 80 MG ORAL TABLET,,17581,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
VERAPAMIL 80 MG ORAL TABLET,,17581,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
VERAPAMIL 80 MG ORAL TABLET,,17581,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
VERAPAMIL 80 MG ORAL TABLET,,17581,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
VERAPAMIL 80 MG ORAL TABLET,,17581,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
VERAPAMIL 80 MG ORAL TABLET,,17581,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
VERAPAMIL 80 MG ORAL TABLET,,17581,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
VERAPAMIL 80 MG ORAL TABLET,,17581,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
VERAPAMIL 80 MG ORAL TABLET,,17581,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
VERAPAMIL 80 MG ORAL TABLET,,17581,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
VERAPAMIL 80 MG ORAL TABLET,,17581,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
VERAPAMIL 80 MG ORAL TABLET,,17581,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
VERAPAMIL 80 MG ORAL TABLET,,17581,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
VERAPAMIL 80 MG ORAL TABLET,,17581,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
VERAPAMIL 80 MG ORAL TABLET,,17581,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
VERAPAMIL 80 MG ORAL TABLET,,17581,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
VERAPAMIL 80 MG ORAL TABLET,,17581,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
VERAPAMIL 80 MG ORAL TABLET,,17581,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
VERAPAMIL 80 MG ORAL TABLET,,17581,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
VERAPAMIL 80 MG ORAL TABLET,,17581,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
VERAPAMIL 80 MG ORAL TABLET,,17581,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
VERAPAMIL 80 MG ORAL TABLET,,17581,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
VERAPAMIL 80 MG ORAL TABLET,,17581,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
VERAPAMIL 80 MG ORAL TABLET,,17581,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
VERAPAMIL 80 MG ORAL TABLET,,17581,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
VERAPAMIL 80 MG ORAL TABLET,,17581,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
VERAPAMIL 80 MG ORAL TABLET,,17581,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
VERAPAMIL 80 MG ORAL TABLET,,17581,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
VERAPAMIL 80 MG ORAL TABLET,,17581,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
VERAPAMIL 80 MG ORAL TABLET,,17581,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
VERAPAMIL 80 MG ORAL TABLET,,17581,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
VERAPAMIL 80 MG ORAL TABLET,,17581,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
VERAPAMIL 80 MG ORAL TABLET,,17581,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
VERAPAMIL 80 MG ORAL TABLET,,17581,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
VERAPAMIL 80 MG ORAL TABLET,,17581,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
VERAPAMIL 80 MG ORAL TABLET,,17581,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
VERAPAMIL 80 MG ORAL TABLET,,17581,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
VERAPAMIL 80 MG ORAL TABLET,,17581,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
VERAPAMIL 80 MG ORAL TABLET,,17581,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
VERAPAMIL 80 MG ORAL TABLET,,17581,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
VERAPAMIL 80 MG ORAL TABLET,,17581,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
VERAPAMIL 80 MG ORAL TABLET,,17581,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
VERAPAMIL 80 MG ORAL TABLET,,17581,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
SCOPOLAMINE BASE 1 MG OVER 3 DAYS TD PT3D,,17645,LOCAL,Facility,Both,1,Each,,91,77.35,26.0806,91,Aetna,Commercial,83.72,92,,percent of total billed charges,,
SCOPOLAMINE BASE 1 MG OVER 3 DAYS TD PT3D,,17645,LOCAL,Facility,Outpatient,1,Each,,91,77.35,26.0806,91,Aetna,Medicare Advantage,44.59,49,,percent of total billed charges,,
SCOPOLAMINE BASE 1 MG OVER 3 DAYS TD PT3D,,17645,LOCAL,Facility,Inpatient,1,Each,,91,77.35,26.0806,91,Aetna,Medicare Advantage,,,,,Included in per diem rate,
SCOPOLAMINE BASE 1 MG OVER 3 DAYS TD PT3D,,17645,LOCAL,Facility,Both,1,Each,,91,77.35,26.0806,91,Aetna,PPO,84.63,93,,percent of total billed charges,,
SCOPOLAMINE BASE 1 MG OVER 3 DAYS TD PT3D,,17645,LOCAL,Facility,Both,1,Each,,91,77.35,26.0806,91,America's PPO,America's PPO,87.3873,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SCOPOLAMINE BASE 1 MG OVER 3 DAYS TD PT3D,,17645,LOCAL,Facility,Both,1,Each,,91,77.35,26.0806,91,BlueCross BlueShield Minnesota, Federal Employee Program,89.544,98.4,,percent of total billed charges,,
SCOPOLAMINE BASE 1 MG OVER 3 DAYS TD PT3D,,17645,LOCAL,Facility,Both,1,Each,,91,77.35,26.0806,91,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,91,100,,percent of total billed charges,,
SCOPOLAMINE BASE 1 MG OVER 3 DAYS TD PT3D,,17645,LOCAL,Facility,Both,1,Each,,91,77.35,26.0806,91,BlueCross BlueShield Minnesota,High Value Network Plan,81.9,90,,percent of total billed charges,,
SCOPOLAMINE BASE 1 MG OVER 3 DAYS TD PT3D,,17645,LOCAL,Facility,Outpatient,1,Each,,91,77.35,26.0806,91,BlueCross BlueShield Minnesota,Medicare Advantage,44.59,49,,percent of total billed charges,,
SCOPOLAMINE BASE 1 MG OVER 3 DAYS TD PT3D,,17645,LOCAL,Facility,Inpatient,1,Each,,91,77.35,26.0806,91,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
SCOPOLAMINE BASE 1 MG OVER 3 DAYS TD PT3D,,17645,LOCAL,Facility,Both,1,Each,,91,77.35,26.0806,91,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,80.5987,88.57,,percent of total billed charges,,
SCOPOLAMINE BASE 1 MG OVER 3 DAYS TD PT3D,,17645,LOCAL,Facility,Both,1,Each,,91,77.35,26.0806,91,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,26.0806,28.66,,percent of total billed charges,,
SCOPOLAMINE BASE 1 MG OVER 3 DAYS TD PT3D,,17645,LOCAL,Facility,Outpatient,1,Each,,91,77.35,26.0806,91,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),44.59,49,,percent of total billed charges,,
SCOPOLAMINE BASE 1 MG OVER 3 DAYS TD PT3D,,17645,LOCAL,Facility,Inpatient,1,Each,,91,77.35,26.0806,91,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
SCOPOLAMINE BASE 1 MG OVER 3 DAYS TD PT3D,,17645,LOCAL,Facility,Both,1,Each,,91,77.35,26.0806,91,CorVel,Worker's Compensation,91,100,,percent of total billed charges,,
SCOPOLAMINE BASE 1 MG OVER 3 DAYS TD PT3D,,17645,LOCAL,Facility,Both,1,Each,,91,77.35,26.0806,91,First Health Group Corporation,First Health Network,88.27,97,,percent of total billed charges,,
SCOPOLAMINE BASE 1 MG OVER 3 DAYS TD PT3D,,17645,LOCAL,Facility,Both,1,Each,,91,77.35,26.0806,91,"Health Partners, Inc.",Commercial,86.086,94.6,,percent of total billed charges,,
SCOPOLAMINE BASE 1 MG OVER 3 DAYS TD PT3D,,17645,LOCAL,Facility,Outpatient,1,Each,,91,77.35,26.0806,91,"Health Partners, Inc.",Medicare Advantage,44.59,49,,percent of total billed charges,,
SCOPOLAMINE BASE 1 MG OVER 3 DAYS TD PT3D,,17645,LOCAL,Facility,Inpatient,1,Each,,91,77.35,26.0806,91,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SCOPOLAMINE BASE 1 MG OVER 3 DAYS TD PT3D,,17645,LOCAL,Facility,Both,1,Each,,91,77.35,26.0806,91,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),54.6,60,,percent of total billed charges,,
SCOPOLAMINE BASE 1 MG OVER 3 DAYS TD PT3D,,17645,LOCAL,Facility,Both,1,Each,,91,77.35,26.0806,91,"Health Partners, Inc.",State of Minnesota Advantage Program,74.165,81.5,,percent of total billed charges,,
SCOPOLAMINE BASE 1 MG OVER 3 DAYS TD PT3D,,17645,LOCAL,Facility,Both,1,Each,,91,77.35,26.0806,91,"Health Partners, Inc.",State Public Programs,45.5,50,,percent of total billed charges,,
SCOPOLAMINE BASE 1 MG OVER 3 DAYS TD PT3D,,17645,LOCAL,Facility,Both,1,Each,,91,77.35,26.0806,91,Humana Insurance Company,Commercial PPO,86.45,95,,percent of total billed charges,,
SCOPOLAMINE BASE 1 MG OVER 3 DAYS TD PT3D,,17645,LOCAL,Facility,Outpatient,1,Each,,91,77.35,26.0806,91,Humana Insurance Company,Medicare PPO,44.59,49,,percent of total billed charges,,
SCOPOLAMINE BASE 1 MG OVER 3 DAYS TD PT3D,,17645,LOCAL,Facility,Inpatient,1,Each,,91,77.35,26.0806,91,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
SCOPOLAMINE BASE 1 MG OVER 3 DAYS TD PT3D,,17645,LOCAL,Facility,Both,1,Each,,91,77.35,26.0806,91,Medica,Individual & Family,90.181,99.1,,percent of total billed charges,,
SCOPOLAMINE BASE 1 MG OVER 3 DAYS TD PT3D,,17645,LOCAL,Facility,Outpatient,1,Each,,91,77.35,26.0806,91,Medica,Medica Advantage Solution,45.318,49.8,,percent of total billed charges,,
SCOPOLAMINE BASE 1 MG OVER 3 DAYS TD PT3D,,17645,LOCAL,Facility,Inpatient,1,Each,,91,77.35,26.0806,91,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
SCOPOLAMINE BASE 1 MG OVER 3 DAYS TD PT3D,,17645,LOCAL,Facility,Outpatient,1,Each,,91,77.35,26.0806,91,Medica,Medical Assistance,40.586,44.6,,percent of total billed charges,,
SCOPOLAMINE BASE 1 MG OVER 3 DAYS TD PT3D,,17645,LOCAL,Facility,Inpatient,1,Each,,91,77.35,26.0806,91,Medica,Medical Assistance,,,,,Included in per diem rate,
SCOPOLAMINE BASE 1 MG OVER 3 DAYS TD PT3D,,17645,LOCAL,Facility,Outpatient,1,Each,,91,77.35,26.0806,91,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,45.318,49.8,,percent of total billed charges,,
SCOPOLAMINE BASE 1 MG OVER 3 DAYS TD PT3D,,17645,LOCAL,Facility,Inpatient,1,Each,,91,77.35,26.0806,91,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
SCOPOLAMINE BASE 1 MG OVER 3 DAYS TD PT3D,,17645,LOCAL,Facility,Both,1,Each,,91,77.35,26.0806,91,"Multiplan, Inc.","Multiplan, Inc.",85.54,94,,percent of total billed charges,,
SCOPOLAMINE BASE 1 MG OVER 3 DAYS TD PT3D,,17645,LOCAL,Facility,Outpatient,1,Each,,91,77.35,26.0806,91,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,81.991,90.1,,percent of total billed charges,,
SCOPOLAMINE BASE 1 MG OVER 3 DAYS TD PT3D,,17645,LOCAL,Facility,Inpatient,1,Each,,91,77.35,26.0806,91,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
SCOPOLAMINE BASE 1 MG OVER 3 DAYS TD PT3D,,17645,LOCAL,Facility,Both,1,Each,,91,77.35,26.0806,91,"Preferred One Administrative Services, INC.",PPO,89.726,98.6,,percent of total billed charges,,
SCOPOLAMINE BASE 1 MG OVER 3 DAYS TD PT3D,,17645,LOCAL,Facility,Outpatient,1,Each,,91,77.35,26.0806,91,PrimeWest Health,Minnesota Senior Health Options (MSHO),46.8195,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
SCOPOLAMINE BASE 1 MG OVER 3 DAYS TD PT3D,,17645,LOCAL,Facility,Inpatient,1,Each,,91,77.35,26.0806,91,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SCOPOLAMINE BASE 1 MG OVER 3 DAYS TD PT3D,,17645,LOCAL,Facility,Outpatient,1,Each,,91,77.35,26.0806,91,PrimeWest Health,MinnesotaCare,46.7376,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
SCOPOLAMINE BASE 1 MG OVER 3 DAYS TD PT3D,,17645,LOCAL,Facility,Inpatient,1,Each,,91,77.35,26.0806,91,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
SCOPOLAMINE BASE 1 MG OVER 3 DAYS TD PT3D,,17645,LOCAL,Facility,Both,1,Each,,91,77.35,26.0806,91,Sanford Health Plan,Sanford Health Plan,83.72,92,,percent of total billed charges,,
SCOPOLAMINE BASE 1 MG OVER 3 DAYS TD PT3D,,17645,LOCAL,Facility,Outpatient,1,Each,,91,77.35,26.0806,91,"UCare Health, Inc.",Individual & Family Plan,51.2785,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
SCOPOLAMINE BASE 1 MG OVER 3 DAYS TD PT3D,,17645,LOCAL,Facility,Inpatient,1,Each,,91,77.35,26.0806,91,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
SCOPOLAMINE BASE 1 MG OVER 3 DAYS TD PT3D,,17645,LOCAL,Facility,Outpatient,1,Each,,91,77.35,26.0806,91,"UCare Health, Inc.",Medical Assistance,45.9277,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SCOPOLAMINE BASE 1 MG OVER 3 DAYS TD PT3D,,17645,LOCAL,Facility,Inpatient,1,Each,,91,77.35,26.0806,91,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
SCOPOLAMINE BASE 1 MG OVER 3 DAYS TD PT3D,,17645,LOCAL,Facility,Outpatient,1,Each,,91,77.35,26.0806,91,"UCare Health, Inc.",Medicare Advantage,45.9277,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SCOPOLAMINE BASE 1 MG OVER 3 DAYS TD PT3D,,17645,LOCAL,Facility,Inpatient,1,Each,,91,77.35,26.0806,91,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SCOPOLAMINE BASE 1 MG OVER 3 DAYS TD PT3D,,17645,LOCAL,Facility,Outpatient,1,Each,,91,77.35,26.0806,91,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),45.9277,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SCOPOLAMINE BASE 1 MG OVER 3 DAYS TD PT3D,,17645,LOCAL,Facility,Inpatient,1,Each,,91,77.35,26.0806,91,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SCOPOLAMINE BASE 1 MG OVER 3 DAYS TD PT3D,,17645,LOCAL,Facility,Both,1,Each,,91,77.35,26.0806,91,UnitedHealthcare,Individual & Family,85.54,94,,percent of total billed charges,,
SCOPOLAMINE BASE 1 MG OVER 3 DAYS TD PT3D,,17645,LOCAL,Facility,Outpatient,1,Each,,91,77.35,26.0806,91,UnitedHealthcare,Medicare Advantage,44.59,49,,percent of total billed charges,,
SCOPOLAMINE BASE 1 MG OVER 3 DAYS TD PT3D,,17645,LOCAL,Facility,Inpatient,1,Each,,91,77.35,26.0806,91,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
SCOPOLAMINE BASE 1 MG OVER 3 DAYS TD PT3D,,17645,LOCAL,Facility,Outpatient,1,Each,,91,77.35,26.0806,91,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,43.68,48,,percent of total billed charges,,100% of DHS outpatient percentage
SCOPOLAMINE BASE 1 MG OVER 3 DAYS TD PT3D,,17645,LOCAL,Facility,Inpatient,1,Each,,91,77.35,26.0806,91,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
FLAVOXATE 100 MG ORAL TABLET,,17720,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,Aetna,Commercial,6.44,92,,percent of total billed charges,,
FLAVOXATE 100 MG ORAL TABLET,,17720,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,Aetna,Medicare Advantage,3.43,49,,percent of total billed charges,,
FLAVOXATE 100 MG ORAL TABLET,,17720,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,Aetna,Medicare Advantage,,,,,Included in per diem rate,
FLAVOXATE 100 MG ORAL TABLET,,17720,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,Aetna,PPO,6.51,93,,percent of total billed charges,,
FLAVOXATE 100 MG ORAL TABLET,,17720,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,America's PPO,America's PPO,6.7221,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
FLAVOXATE 100 MG ORAL TABLET,,17720,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,BlueCross BlueShield Minnesota, Federal Employee Program,6.888,98.4,,percent of total billed charges,,
FLAVOXATE 100 MG ORAL TABLET,,17720,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,7,100,,percent of total billed charges,,
FLAVOXATE 100 MG ORAL TABLET,,17720,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,BlueCross BlueShield Minnesota,High Value Network Plan,6.3,90,,percent of total billed charges,,
FLAVOXATE 100 MG ORAL TABLET,,17720,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,BlueCross BlueShield Minnesota,Medicare Advantage,3.43,49,,percent of total billed charges,,
FLAVOXATE 100 MG ORAL TABLET,,17720,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
FLAVOXATE 100 MG ORAL TABLET,,17720,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,6.1999,88.57,,percent of total billed charges,,
FLAVOXATE 100 MG ORAL TABLET,,17720,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,2.0062,28.66,,percent of total billed charges,,
FLAVOXATE 100 MG ORAL TABLET,,17720,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),3.43,49,,percent of total billed charges,,
FLAVOXATE 100 MG ORAL TABLET,,17720,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
FLAVOXATE 100 MG ORAL TABLET,,17720,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,CorVel,Worker's Compensation,7,100,,percent of total billed charges,,
FLAVOXATE 100 MG ORAL TABLET,,17720,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,First Health Group Corporation,First Health Network,6.79,97,,percent of total billed charges,,
FLAVOXATE 100 MG ORAL TABLET,,17720,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,"Health Partners, Inc.",Commercial,6.622,94.6,,percent of total billed charges,,
FLAVOXATE 100 MG ORAL TABLET,,17720,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,"Health Partners, Inc.",Medicare Advantage,3.43,49,,percent of total billed charges,,
FLAVOXATE 100 MG ORAL TABLET,,17720,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
FLAVOXATE 100 MG ORAL TABLET,,17720,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),4.2,60,,percent of total billed charges,,
FLAVOXATE 100 MG ORAL TABLET,,17720,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,"Health Partners, Inc.",State of Minnesota Advantage Program,5.705,81.5,,percent of total billed charges,,
FLAVOXATE 100 MG ORAL TABLET,,17720,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,"Health Partners, Inc.",State Public Programs,3.5,50,,percent of total billed charges,,
FLAVOXATE 100 MG ORAL TABLET,,17720,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,Humana Insurance Company,Commercial PPO,6.65,95,,percent of total billed charges,,
FLAVOXATE 100 MG ORAL TABLET,,17720,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,Humana Insurance Company,Medicare PPO,3.43,49,,percent of total billed charges,,
FLAVOXATE 100 MG ORAL TABLET,,17720,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
FLAVOXATE 100 MG ORAL TABLET,,17720,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,Medica,Individual & Family,6.937,99.1,,percent of total billed charges,,
FLAVOXATE 100 MG ORAL TABLET,,17720,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,Medica,Medica Advantage Solution,3.486,49.8,,percent of total billed charges,,
FLAVOXATE 100 MG ORAL TABLET,,17720,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
FLAVOXATE 100 MG ORAL TABLET,,17720,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,Medica,Medical Assistance,3.122,44.6,,percent of total billed charges,,
FLAVOXATE 100 MG ORAL TABLET,,17720,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,Medica,Medical Assistance,,,,,Included in per diem rate,
FLAVOXATE 100 MG ORAL TABLET,,17720,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,3.486,49.8,,percent of total billed charges,,
FLAVOXATE 100 MG ORAL TABLET,,17720,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
FLAVOXATE 100 MG ORAL TABLET,,17720,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,"Multiplan, Inc.","Multiplan, Inc.",6.58,94,,percent of total billed charges,,
FLAVOXATE 100 MG ORAL TABLET,,17720,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,6.307,90.1,,percent of total billed charges,,
FLAVOXATE 100 MG ORAL TABLET,,17720,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
FLAVOXATE 100 MG ORAL TABLET,,17720,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,"Preferred One Administrative Services, INC.",PPO,6.902,98.6,,percent of total billed charges,,
FLAVOXATE 100 MG ORAL TABLET,,17720,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,PrimeWest Health,Minnesota Senior Health Options (MSHO),3.6015,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
FLAVOXATE 100 MG ORAL TABLET,,17720,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
FLAVOXATE 100 MG ORAL TABLET,,17720,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,PrimeWest Health,MinnesotaCare,3.5952,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
FLAVOXATE 100 MG ORAL TABLET,,17720,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
FLAVOXATE 100 MG ORAL TABLET,,17720,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,Sanford Health Plan,Sanford Health Plan,6.44,92,,percent of total billed charges,,
FLAVOXATE 100 MG ORAL TABLET,,17720,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,"UCare Health, Inc.",Individual & Family Plan,3.9445,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
FLAVOXATE 100 MG ORAL TABLET,,17720,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
FLAVOXATE 100 MG ORAL TABLET,,17720,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,"UCare Health, Inc.",Medical Assistance,3.5329,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FLAVOXATE 100 MG ORAL TABLET,,17720,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
FLAVOXATE 100 MG ORAL TABLET,,17720,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,"UCare Health, Inc.",Medicare Advantage,3.5329,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FLAVOXATE 100 MG ORAL TABLET,,17720,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
FLAVOXATE 100 MG ORAL TABLET,,17720,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),3.5329,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FLAVOXATE 100 MG ORAL TABLET,,17720,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
FLAVOXATE 100 MG ORAL TABLET,,17720,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,UnitedHealthcare,Individual & Family,6.58,94,,percent of total billed charges,,
FLAVOXATE 100 MG ORAL TABLET,,17720,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,UnitedHealthcare,Medicare Advantage,3.43,49,,percent of total billed charges,,
FLAVOXATE 100 MG ORAL TABLET,,17720,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
FLAVOXATE 100 MG ORAL TABLET,,17720,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,3.36,48,,percent of total billed charges,,100% of DHS outpatient percentage
FLAVOXATE 100 MG ORAL TABLET,,17720,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Injection, Intralesion; 7 Lesions Or Less",,11900,CPT,Facility,Both,,,,70,59.5,20.062,299,Aetna,Commercial,64.4,92,,percent of total billed charges,,
"Injection, Intralesion; 7 Lesions Or Less",,11900,CPT,Facility,Outpatient,,,,70,59.5,20.062,299,Aetna,Medicare Advantage,34.3,49,,percent of total billed charges,,
"Injection, Intralesion; 7 Lesions Or Less",,11900,CPT,Facility,Inpatient,,,,70,59.5,20.062,299,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Injection, Intralesion; 7 Lesions Or Less",,11900,CPT,Facility,Both,,,,70,59.5,20.062,299,Aetna,PPO,65.1,93,,percent of total billed charges,,
"Injection, Intralesion; 7 Lesions Or Less",,11900,CPT,Facility,Both,,,,70,59.5,20.062,299,America's PPO,America's PPO,67.221,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Injection, Intralesion; 7 Lesions Or Less",,11900,CPT,Facility,Both,,,,70,59.5,20.062,299,BlueCross BlueShield Minnesota, Federal Employee Program,68.88,98.4,,percent of total billed charges,,
"Injection, Intralesion; 7 Lesions Or Less",,11900,CPT,Facility,Both,,,,70,59.5,20.062,299,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,70,100,,percent of total billed charges,,
"Injection, Intralesion; 7 Lesions Or Less",,11900,CPT,Facility,Both,,,,70,59.5,20.062,299,BlueCross BlueShield Minnesota,High Value Network Plan,63,90,,percent of total billed charges,,
"Injection, Intralesion; 7 Lesions Or Less",,11900,CPT,Facility,Outpatient,,,,70,59.5,20.062,299,BlueCross BlueShield Minnesota,Medicare Advantage,34.3,49,,percent of total billed charges,,
"Injection, Intralesion; 7 Lesions Or Less",,11900,CPT,Facility,Inpatient,,,,70,59.5,20.062,299,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Injection, Intralesion; 7 Lesions Or Less",,11900,CPT,Facility,Both,,,,70,59.5,20.062,299,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,61.999,88.57,,percent of total billed charges,,
"Injection, Intralesion; 7 Lesions Or Less",,11900,CPT,Facility,Both,,,,70,59.5,20.062,299,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,20.062,28.66,,percent of total billed charges,,
"Injection, Intralesion; 7 Lesions Or Less",,11900,CPT,Facility,Outpatient,,,,70,59.5,20.062,299,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),34.3,49,,percent of total billed charges,,
"Injection, Intralesion; 7 Lesions Or Less",,11900,CPT,Facility,Inpatient,,,,70,59.5,20.062,299,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Injection, Intralesion; 7 Lesions Or Less",,11900,CPT,Facility,Both,,,,70,59.5,20.062,299,CorVel,Worker's Compensation,70,100,,percent of total billed charges,,
"Injection, Intralesion; 7 Lesions Or Less",,11900,CPT,Facility,Both,,,,70,59.5,20.062,299,First Health Group Corporation,First Health Network,67.9,97,,percent of total billed charges,,
"Injection, Intralesion; 7 Lesions Or Less",,11900,CPT,Facility,Both,,,,70,59.5,20.062,299,"Health Partners, Inc.",Commercial,66.22,94.6,,percent of total billed charges,,
"Injection, Intralesion; 7 Lesions Or Less",,11900,CPT,Facility,Outpatient,,,,70,59.5,20.062,299,"Health Partners, Inc.",Medicare Advantage,34.3,49,,percent of total billed charges,,
"Injection, Intralesion; 7 Lesions Or Less",,11900,CPT,Facility,Inpatient,,,,70,59.5,20.062,299,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Injection, Intralesion; 7 Lesions Or Less",,11900,CPT,Facility,Both,,,,70,59.5,20.062,299,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),42,60,,percent of total billed charges,,
"Injection, Intralesion; 7 Lesions Or Less",,11900,CPT,Facility,Both,,,,70,59.5,20.062,299,"Health Partners, Inc.",State of Minnesota Advantage Program,57.05,81.5,,percent of total billed charges,,
"Injection, Intralesion; 7 Lesions Or Less",,11900,CPT,Facility,Both,,,,70,59.5,20.062,299,"Health Partners, Inc.",State Public Programs,35,50,,percent of total billed charges,,
"Injection, Intralesion; 7 Lesions Or Less",,11900,CPT,Facility,Both,,,,70,59.5,20.062,299,Humana Insurance Company,Commercial PPO,66.5,95,,percent of total billed charges,,
"Injection, Intralesion; 7 Lesions Or Less",,11900,CPT,Facility,Outpatient,,,,70,59.5,20.062,299,Humana Insurance Company,Medicare PPO,34.3,49,,percent of total billed charges,,
"Injection, Intralesion; 7 Lesions Or Less",,11900,CPT,Facility,Inpatient,,,,70,59.5,20.062,299,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Injection, Intralesion; 7 Lesions Or Less",,11900,CPT,Facility,Both,,,,70,59.5,20.062,299,Medica,Individual & Family,69.37,99.1,,percent of total billed charges,,
"Injection, Intralesion; 7 Lesions Or Less",,11900,CPT,Facility,Outpatient,,,,70,59.5,20.062,299,Medica,Medica Advantage Solution,34.86,49.8,,percent of total billed charges,,
"Injection, Intralesion; 7 Lesions Or Less",,11900,CPT,Facility,Inpatient,,,,70,59.5,20.062,299,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Injection, Intralesion; 7 Lesions Or Less",,11900,CPT,Facility,Outpatient,,,,70,59.5,20.062,299,Medica,Medical Assistance,299,,,Other,Grouper,All inclusive per visit
"Injection, Intralesion; 7 Lesions Or Less",,11900,CPT,Facility,Inpatient,,,,70,59.5,20.062,299,Medica,Medical Assistance,,,,,Included in per diem rate,
"Injection, Intralesion; 7 Lesions Or Less",,11900,CPT,Facility,Outpatient,,,,70,59.5,20.062,299,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,34.86,49.8,,percent of total billed charges,,
"Injection, Intralesion; 7 Lesions Or Less",,11900,CPT,Facility,Inpatient,,,,70,59.5,20.062,299,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Injection, Intralesion; 7 Lesions Or Less",,11900,CPT,Facility,Both,,,,70,59.5,20.062,299,"Multiplan, Inc.","Multiplan, Inc.",65.8,94,,percent of total billed charges,,
"Injection, Intralesion; 7 Lesions Or Less",,11900,CPT,Facility,Outpatient,,,,70,59.5,20.062,299,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,63.07,90.1,,percent of total billed charges,,
"Injection, Intralesion; 7 Lesions Or Less",,11900,CPT,Facility,Inpatient,,,,70,59.5,20.062,299,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Injection, Intralesion; 7 Lesions Or Less",,11900,CPT,Facility,Both,,,,70,59.5,20.062,299,"Preferred One Administrative Services, INC.",PPO,69.02,98.6,,percent of total billed charges,,
"Injection, Intralesion; 7 Lesions Or Less",,11900,CPT,Facility,Outpatient,,,,70,59.5,20.062,299,PrimeWest Health,Minnesota Senior Health Options (MSHO),36.015,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Injection, Intralesion; 7 Lesions Or Less",,11900,CPT,Facility,Inpatient,,,,70,59.5,20.062,299,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Injection, Intralesion; 7 Lesions Or Less",,11900,CPT,Facility,Outpatient,,,,70,59.5,20.062,299,PrimeWest Health,MinnesotaCare,35.952,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Injection, Intralesion; 7 Lesions Or Less",,11900,CPT,Facility,Inpatient,,,,70,59.5,20.062,299,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Injection, Intralesion; 7 Lesions Or Less",,11900,CPT,Facility,Both,,,,70,59.5,20.062,299,Sanford Health Plan,Sanford Health Plan,64.4,92,,percent of total billed charges,,
"Injection, Intralesion; 7 Lesions Or Less",,11900,CPT,Facility,Outpatient,,,,70,59.5,20.062,299,"UCare Health, Inc.",Individual & Family Plan,39.445,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Injection, Intralesion; 7 Lesions Or Less",,11900,CPT,Facility,Inpatient,,,,70,59.5,20.062,299,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Injection, Intralesion; 7 Lesions Or Less",,11900,CPT,Facility,Outpatient,,,,70,59.5,20.062,299,"UCare Health, Inc.",Medical Assistance,35.329,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Injection, Intralesion; 7 Lesions Or Less",,11900,CPT,Facility,Inpatient,,,,70,59.5,20.062,299,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Injection, Intralesion; 7 Lesions Or Less",,11900,CPT,Facility,Outpatient,,,,70,59.5,20.062,299,"UCare Health, Inc.",Medicare Advantage,35.329,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Injection, Intralesion; 7 Lesions Or Less",,11900,CPT,Facility,Inpatient,,,,70,59.5,20.062,299,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Injection, Intralesion; 7 Lesions Or Less",,11900,CPT,Facility,Outpatient,,,,70,59.5,20.062,299,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),35.329,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Injection, Intralesion; 7 Lesions Or Less",,11900,CPT,Facility,Inpatient,,,,70,59.5,20.062,299,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Injection, Intralesion; 7 Lesions Or Less",,11900,CPT,Facility,Both,,,,70,59.5,20.062,299,UnitedHealthcare,Individual & Family,65.8,94,,percent of total billed charges,,
"Injection, Intralesion; 7 Lesions Or Less",,11900,CPT,Facility,Outpatient,,,,70,59.5,20.062,299,UnitedHealthcare,Medicare Advantage,34.3,49,,percent of total billed charges,,
"Injection, Intralesion; 7 Lesions Or Less",,11900,CPT,Facility,Inpatient,,,,70,59.5,20.062,299,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Injection, Intralesion; 7 Lesions Or Less",,11900,CPT,Facility,Outpatient,,,,70,59.5,20.062,299,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,33.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Injection, Intralesion; 7 Lesions Or Less",,11900,CPT,Facility,Inpatient,,,,70,59.5,20.062,299,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Injection, Intralesional; Up To And Including 7 Lesions (Pro Cah)",,11900,CPT,Professional,Both,,,,125,106.25,18.54,125,Aetna,Commercial,106.25,85,,percent of total billed charges,,
"Injection, Intralesional; Up To And Including 7 Lesions (Pro Cah)",,11900,CPT,Professional,Both,,,,125,106.25,18.54,125,Aetna,Medicare Advantage,29.36,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Injection, Intralesional; Up To And Including 7 Lesions (Pro Cah)",,11900,CPT,Professional,Both,,,,125,106.25,18.54,125,Aetna,PPO,116.25,93,,percent of total billed charges,,
"Injection, Intralesional; Up To And Including 7 Lesions (Pro Cah)",,11900,CPT,Professional,Both,,,,125,106.25,18.54,125,America's PPO,America's PPO,106.8,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Injection, Intralesional; Up To And Including 7 Lesions (Pro Cah)",,11900,CPT,Professional,Both,,,,125,106.25,18.54,125,BlueCross BlueShield Minnesota, Federal Employee Program,61.29,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Injection, Intralesional; Up To And Including 7 Lesions (Pro Cah)",,11900,CPT,Professional,Both,,,,125,106.25,18.54,125,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,62.27064,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Injection, Intralesional; Up To And Including 7 Lesions (Pro Cah)",,11900,CPT,Professional,Both,,,,125,106.25,18.54,125,BlueCross BlueShield Minnesota,High Value Network Plan,62.27064,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Injection, Intralesional; Up To And Including 7 Lesions (Pro Cah)",,11900,CPT,Professional,Both,,,,125,106.25,18.54,125,BlueCross BlueShield Minnesota,Medicare Advantage,33.3385,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Injection, Intralesional; Up To And Including 7 Lesions (Pro Cah)",,11900,CPT,Professional,Both,,,,125,106.25,18.54,125,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,62.27064,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Injection, Intralesional; Up To And Including 7 Lesions (Pro Cah)",,11900,CPT,Professional,Both,,,,125,106.25,18.54,125,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,21.40712,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Injection, Intralesional; Up To And Including 7 Lesions (Pro Cah)",,11900,CPT,Professional,Both,,,,125,106.25,18.54,125,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),33.3385,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Injection, Intralesional; Up To And Including 7 Lesions (Pro Cah)",,11900,CPT,Professional,Both,,,,125,106.25,18.54,125,CorVel,Worker's Compensation,55.8464814,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Injection, Intralesional; Up To And Including 7 Lesions (Pro Cah)",,11900,CPT,Professional,Both,,,,125,106.25,18.54,125,First Health Group Corporation,First Health Network,121.25,97,,percent of total billed charges,,
"Injection, Intralesional; Up To And Including 7 Lesions (Pro Cah)",,11900,CPT,Professional,Both,,,,125,106.25,18.54,125,"Health Partners, Inc.",Commercial,60.22,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Injection, Intralesional; Up To And Including 7 Lesions (Pro Cah)",,11900,CPT,Professional,Both,,,,125,106.25,18.54,125,"Health Partners, Inc.",Medicare Advantage,33.3385,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Injection, Intralesional; Up To And Including 7 Lesions (Pro Cah)",,11900,CPT,Professional,Both,,,,125,106.25,18.54,125,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),29.14,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Injection, Intralesional; Up To And Including 7 Lesions (Pro Cah)",,11900,CPT,Professional,Both,,,,125,106.25,18.54,125,"Health Partners, Inc.",State of Minnesota Advantage Program,51.87953,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Injection, Intralesional; Up To And Including 7 Lesions (Pro Cah)",,11900,CPT,Professional,Both,,,,125,106.25,18.54,125,"Health Partners, Inc.",State Public Programs,18.54,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Injection, Intralesional; Up To And Including 7 Lesions (Pro Cah)",,11900,CPT,Professional,Both,,,,125,106.25,18.54,125,Humana Insurance Company,Commercial PPO,28.99,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Injection, Intralesional; Up To And Including 7 Lesions (Pro Cah)",,11900,CPT,Professional,Both,,,,125,106.25,18.54,125,Humana Insurance Company,Medicare PPO,125,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Injection, Intralesional; Up To And Including 7 Lesions (Pro Cah)",,11900,CPT,Professional,Both,,,,125,106.25,18.54,125,Medica,Individual & Family,106,84.8,,percent of total billed charges,,
"Injection, Intralesional; Up To And Including 7 Lesions (Pro Cah)",,11900,CPT,Professional,Both,,,,125,106.25,18.54,125,Medica,Medica Advantage Solution,62.25,49.8,,percent of total billed charges,,
"Injection, Intralesional; Up To And Including 7 Lesions (Pro Cah)",,11900,CPT,Professional,Both,,,,125,106.25,18.54,125,Medica,Medical Assistance,21.41,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Injection, Intralesional; Up To And Including 7 Lesions (Pro Cah)",,11900,CPT,Professional,Both,,,,125,106.25,18.54,125,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,28.99,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Injection, Intralesional; Up To And Including 7 Lesions (Pro Cah)",,11900,CPT,Professional,Both,,,,125,106.25,18.54,125,"Multiplan, Inc.","Multiplan, Inc.",117.5,94,,percent of total billed charges,,
"Injection, Intralesional; Up To And Including 7 Lesions (Pro Cah)",,11900,CPT,Professional,Both,,,,125,106.25,18.54,125,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,112.625,90.1,,percent of total billed charges,,
"Injection, Intralesional; Up To And Including 7 Lesions (Pro Cah)",,11900,CPT,Professional,Both,,,,125,106.25,18.54,125,"Preferred One Administrative Services, INC.",PPO,123.25,98.6,,percent of total billed charges,,
"Injection, Intralesional; Up To And Including 7 Lesions (Pro Cah)",,11900,CPT,Professional,Both,,,,125,106.25,18.54,125,PrimeWest Health,Minnesota Senior Health Options (MSHO),33.3385,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Injection, Intralesional; Up To And Including 7 Lesions (Pro Cah)",,11900,CPT,Professional,Both,,,,125,106.25,18.54,125,PrimeWest Health,MinnesotaCare,22.9056184,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Injection, Intralesional; Up To And Including 7 Lesions (Pro Cah)",,11900,CPT,Professional,Both,,,,125,106.25,18.54,125,Sanford Health Plan,Sanford Health Plan,110,88,,percent of total billed charges,,
"Injection, Intralesional; Up To And Including 7 Lesions (Pro Cah)",,11900,CPT,Professional,Both,,,,125,106.25,18.54,125,"UCare Health, Inc.",Individual & Family Plan,47.126144,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Injection, Intralesional; Up To And Including 7 Lesions (Pro Cah)",,11900,CPT,Professional,Both,,,,125,106.25,18.54,125,"UCare Health, Inc.",Medical Assistance,23.547832,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Injection, Intralesional; Up To And Including 7 Lesions (Pro Cah)",,11900,CPT,Professional,Both,,,,125,106.25,18.54,125,"UCare Health, Inc.",Medicare Advantage,33.3385,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Injection, Intralesional; Up To And Including 7 Lesions (Pro Cah)",,11900,CPT,Professional,Both,,,,125,106.25,18.54,125,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),26.6708,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Injection, Intralesional; Up To And Including 7 Lesions (Pro Cah)",,11900,CPT,Professional,Both,,,,125,106.25,18.54,125,UnitedHealthcare,Individual & Family,125,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Injection, Intralesional; Up To And Including 7 Lesions (Pro Cah)",,11900,CPT,Professional,Both,,,,125,106.25,18.54,125,UnitedHealthcare,Medicare Advantage,33.3385,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Injection, Intralesional; Up To And Including 7 Lesions (Pro Cah)",,11900,CPT,Professional,Both,,,,125,106.25,18.54,125,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,21.40712,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
LABETALOL 100 MG ORAL TABLET,,17723,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
LABETALOL 100 MG ORAL TABLET,,17723,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
LABETALOL 100 MG ORAL TABLET,,17723,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
LABETALOL 100 MG ORAL TABLET,,17723,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
LABETALOL 100 MG ORAL TABLET,,17723,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
LABETALOL 100 MG ORAL TABLET,,17723,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
LABETALOL 100 MG ORAL TABLET,,17723,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
LABETALOL 100 MG ORAL TABLET,,17723,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
LABETALOL 100 MG ORAL TABLET,,17723,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
LABETALOL 100 MG ORAL TABLET,,17723,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
LABETALOL 100 MG ORAL TABLET,,17723,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
LABETALOL 100 MG ORAL TABLET,,17723,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
LABETALOL 100 MG ORAL TABLET,,17723,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
LABETALOL 100 MG ORAL TABLET,,17723,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
LABETALOL 100 MG ORAL TABLET,,17723,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
LABETALOL 100 MG ORAL TABLET,,17723,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
LABETALOL 100 MG ORAL TABLET,,17723,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
LABETALOL 100 MG ORAL TABLET,,17723,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
LABETALOL 100 MG ORAL TABLET,,17723,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LABETALOL 100 MG ORAL TABLET,,17723,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
LABETALOL 100 MG ORAL TABLET,,17723,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
LABETALOL 100 MG ORAL TABLET,,17723,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
LABETALOL 100 MG ORAL TABLET,,17723,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
LABETALOL 100 MG ORAL TABLET,,17723,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
LABETALOL 100 MG ORAL TABLET,,17723,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
LABETALOL 100 MG ORAL TABLET,,17723,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
LABETALOL 100 MG ORAL TABLET,,17723,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
LABETALOL 100 MG ORAL TABLET,,17723,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
LABETALOL 100 MG ORAL TABLET,,17723,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
LABETALOL 100 MG ORAL TABLET,,17723,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
LABETALOL 100 MG ORAL TABLET,,17723,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
LABETALOL 100 MG ORAL TABLET,,17723,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
LABETALOL 100 MG ORAL TABLET,,17723,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
LABETALOL 100 MG ORAL TABLET,,17723,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
LABETALOL 100 MG ORAL TABLET,,17723,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
LABETALOL 100 MG ORAL TABLET,,17723,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
LABETALOL 100 MG ORAL TABLET,,17723,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
LABETALOL 100 MG ORAL TABLET,,17723,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LABETALOL 100 MG ORAL TABLET,,17723,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
LABETALOL 100 MG ORAL TABLET,,17723,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
LABETALOL 100 MG ORAL TABLET,,17723,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
LABETALOL 100 MG ORAL TABLET,,17723,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
LABETALOL 100 MG ORAL TABLET,,17723,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
LABETALOL 100 MG ORAL TABLET,,17723,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LABETALOL 100 MG ORAL TABLET,,17723,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
LABETALOL 100 MG ORAL TABLET,,17723,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LABETALOL 100 MG ORAL TABLET,,17723,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LABETALOL 100 MG ORAL TABLET,,17723,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LABETALOL 100 MG ORAL TABLET,,17723,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LABETALOL 100 MG ORAL TABLET,,17723,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
LABETALOL 100 MG ORAL TABLET,,17723,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
LABETALOL 100 MG ORAL TABLET,,17723,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
LABETALOL 100 MG ORAL TABLET,,17723,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
LABETALOL 100 MG ORAL TABLET,,17723,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
DILTIAZEM HCL 30 MG ORAL TABLET,,17809,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
DILTIAZEM HCL 30 MG ORAL TABLET,,17809,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
DILTIAZEM HCL 30 MG ORAL TABLET,,17809,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
DILTIAZEM HCL 30 MG ORAL TABLET,,17809,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
DILTIAZEM HCL 30 MG ORAL TABLET,,17809,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
DILTIAZEM HCL 30 MG ORAL TABLET,,17809,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
DILTIAZEM HCL 30 MG ORAL TABLET,,17809,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
DILTIAZEM HCL 30 MG ORAL TABLET,,17809,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
DILTIAZEM HCL 30 MG ORAL TABLET,,17809,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
DILTIAZEM HCL 30 MG ORAL TABLET,,17809,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
DILTIAZEM HCL 30 MG ORAL TABLET,,17809,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
DILTIAZEM HCL 30 MG ORAL TABLET,,17809,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
DILTIAZEM HCL 30 MG ORAL TABLET,,17809,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
DILTIAZEM HCL 30 MG ORAL TABLET,,17809,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
DILTIAZEM HCL 30 MG ORAL TABLET,,17809,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
DILTIAZEM HCL 30 MG ORAL TABLET,,17809,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
DILTIAZEM HCL 30 MG ORAL TABLET,,17809,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
DILTIAZEM HCL 30 MG ORAL TABLET,,17809,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
DILTIAZEM HCL 30 MG ORAL TABLET,,17809,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DILTIAZEM HCL 30 MG ORAL TABLET,,17809,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
DILTIAZEM HCL 30 MG ORAL TABLET,,17809,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
DILTIAZEM HCL 30 MG ORAL TABLET,,17809,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
DILTIAZEM HCL 30 MG ORAL TABLET,,17809,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
DILTIAZEM HCL 30 MG ORAL TABLET,,17809,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
DILTIAZEM HCL 30 MG ORAL TABLET,,17809,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
DILTIAZEM HCL 30 MG ORAL TABLET,,17809,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
DILTIAZEM HCL 30 MG ORAL TABLET,,17809,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
DILTIAZEM HCL 30 MG ORAL TABLET,,17809,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
DILTIAZEM HCL 30 MG ORAL TABLET,,17809,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
DILTIAZEM HCL 30 MG ORAL TABLET,,17809,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
DILTIAZEM HCL 30 MG ORAL TABLET,,17809,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
DILTIAZEM HCL 30 MG ORAL TABLET,,17809,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
DILTIAZEM HCL 30 MG ORAL TABLET,,17809,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
DILTIAZEM HCL 30 MG ORAL TABLET,,17809,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
DILTIAZEM HCL 30 MG ORAL TABLET,,17809,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
DILTIAZEM HCL 30 MG ORAL TABLET,,17809,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
DILTIAZEM HCL 30 MG ORAL TABLET,,17809,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
DILTIAZEM HCL 30 MG ORAL TABLET,,17809,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DILTIAZEM HCL 30 MG ORAL TABLET,,17809,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
DILTIAZEM HCL 30 MG ORAL TABLET,,17809,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
DILTIAZEM HCL 30 MG ORAL TABLET,,17809,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
DILTIAZEM HCL 30 MG ORAL TABLET,,17809,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
DILTIAZEM HCL 30 MG ORAL TABLET,,17809,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
DILTIAZEM HCL 30 MG ORAL TABLET,,17809,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DILTIAZEM HCL 30 MG ORAL TABLET,,17809,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
DILTIAZEM HCL 30 MG ORAL TABLET,,17809,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DILTIAZEM HCL 30 MG ORAL TABLET,,17809,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DILTIAZEM HCL 30 MG ORAL TABLET,,17809,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DILTIAZEM HCL 30 MG ORAL TABLET,,17809,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DILTIAZEM HCL 30 MG ORAL TABLET,,17809,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
DILTIAZEM HCL 30 MG ORAL TABLET,,17809,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
DILTIAZEM HCL 30 MG ORAL TABLET,,17809,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
DILTIAZEM HCL 30 MG ORAL TABLET,,17809,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
DILTIAZEM HCL 30 MG ORAL TABLET,,17809,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
FERROUS SULFATE 325 MG (65 MG IRON) ORAL TBEC,,17816,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
FERROUS SULFATE 325 MG (65 MG IRON) ORAL TBEC,,17816,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
FERROUS SULFATE 325 MG (65 MG IRON) ORAL TBEC,,17816,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
FERROUS SULFATE 325 MG (65 MG IRON) ORAL TBEC,,17816,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
FERROUS SULFATE 325 MG (65 MG IRON) ORAL TBEC,,17816,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
FERROUS SULFATE 325 MG (65 MG IRON) ORAL TBEC,,17816,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
FERROUS SULFATE 325 MG (65 MG IRON) ORAL TBEC,,17816,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
FERROUS SULFATE 325 MG (65 MG IRON) ORAL TBEC,,17816,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
FERROUS SULFATE 325 MG (65 MG IRON) ORAL TBEC,,17816,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
FERROUS SULFATE 325 MG (65 MG IRON) ORAL TBEC,,17816,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
FERROUS SULFATE 325 MG (65 MG IRON) ORAL TBEC,,17816,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
FERROUS SULFATE 325 MG (65 MG IRON) ORAL TBEC,,17816,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
FERROUS SULFATE 325 MG (65 MG IRON) ORAL TBEC,,17816,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
FERROUS SULFATE 325 MG (65 MG IRON) ORAL TBEC,,17816,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
FERROUS SULFATE 325 MG (65 MG IRON) ORAL TBEC,,17816,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
FERROUS SULFATE 325 MG (65 MG IRON) ORAL TBEC,,17816,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
FERROUS SULFATE 325 MG (65 MG IRON) ORAL TBEC,,17816,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
FERROUS SULFATE 325 MG (65 MG IRON) ORAL TBEC,,17816,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
FERROUS SULFATE 325 MG (65 MG IRON) ORAL TBEC,,17816,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
FERROUS SULFATE 325 MG (65 MG IRON) ORAL TBEC,,17816,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
FERROUS SULFATE 325 MG (65 MG IRON) ORAL TBEC,,17816,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
FERROUS SULFATE 325 MG (65 MG IRON) ORAL TBEC,,17816,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
FERROUS SULFATE 325 MG (65 MG IRON) ORAL TBEC,,17816,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
FERROUS SULFATE 325 MG (65 MG IRON) ORAL TBEC,,17816,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
FERROUS SULFATE 325 MG (65 MG IRON) ORAL TBEC,,17816,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
FERROUS SULFATE 325 MG (65 MG IRON) ORAL TBEC,,17816,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
FERROUS SULFATE 325 MG (65 MG IRON) ORAL TBEC,,17816,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
FERROUS SULFATE 325 MG (65 MG IRON) ORAL TBEC,,17816,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
FERROUS SULFATE 325 MG (65 MG IRON) ORAL TBEC,,17816,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
FERROUS SULFATE 325 MG (65 MG IRON) ORAL TBEC,,17816,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
FERROUS SULFATE 325 MG (65 MG IRON) ORAL TBEC,,17816,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
FERROUS SULFATE 325 MG (65 MG IRON) ORAL TBEC,,17816,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
FERROUS SULFATE 325 MG (65 MG IRON) ORAL TBEC,,17816,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
FERROUS SULFATE 325 MG (65 MG IRON) ORAL TBEC,,17816,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
FERROUS SULFATE 325 MG (65 MG IRON) ORAL TBEC,,17816,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
FERROUS SULFATE 325 MG (65 MG IRON) ORAL TBEC,,17816,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
FERROUS SULFATE 325 MG (65 MG IRON) ORAL TBEC,,17816,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
FERROUS SULFATE 325 MG (65 MG IRON) ORAL TBEC,,17816,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
FERROUS SULFATE 325 MG (65 MG IRON) ORAL TBEC,,17816,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
FERROUS SULFATE 325 MG (65 MG IRON) ORAL TBEC,,17816,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
FERROUS SULFATE 325 MG (65 MG IRON) ORAL TBEC,,17816,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
FERROUS SULFATE 325 MG (65 MG IRON) ORAL TBEC,,17816,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
FERROUS SULFATE 325 MG (65 MG IRON) ORAL TBEC,,17816,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
FERROUS SULFATE 325 MG (65 MG IRON) ORAL TBEC,,17816,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FERROUS SULFATE 325 MG (65 MG IRON) ORAL TBEC,,17816,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
FERROUS SULFATE 325 MG (65 MG IRON) ORAL TBEC,,17816,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FERROUS SULFATE 325 MG (65 MG IRON) ORAL TBEC,,17816,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
FERROUS SULFATE 325 MG (65 MG IRON) ORAL TBEC,,17816,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FERROUS SULFATE 325 MG (65 MG IRON) ORAL TBEC,,17816,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
FERROUS SULFATE 325 MG (65 MG IRON) ORAL TBEC,,17816,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
FERROUS SULFATE 325 MG (65 MG IRON) ORAL TBEC,,17816,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
FERROUS SULFATE 325 MG (65 MG IRON) ORAL TBEC,,17816,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
FERROUS SULFATE 325 MG (65 MG IRON) ORAL TBEC,,17816,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
FERROUS SULFATE 325 MG (65 MG IRON) ORAL TBEC,,17816,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
COLCHICINE (GOUT) 0.6 MG ORAL TABLET,,17853,LOCAL,Facility,Both,1,Each,,34,28.9,9.7444,34,Aetna,Commercial,31.28,92,,percent of total billed charges,,
COLCHICINE (GOUT) 0.6 MG ORAL TABLET,,17853,LOCAL,Facility,Outpatient,1,Each,,34,28.9,9.7444,34,Aetna,Medicare Advantage,16.66,49,,percent of total billed charges,,
COLCHICINE (GOUT) 0.6 MG ORAL TABLET,,17853,LOCAL,Facility,Inpatient,1,Each,,34,28.9,9.7444,34,Aetna,Medicare Advantage,,,,,Included in per diem rate,
COLCHICINE (GOUT) 0.6 MG ORAL TABLET,,17853,LOCAL,Facility,Both,1,Each,,34,28.9,9.7444,34,Aetna,PPO,31.62,93,,percent of total billed charges,,
COLCHICINE (GOUT) 0.6 MG ORAL TABLET,,17853,LOCAL,Facility,Both,1,Each,,34,28.9,9.7444,34,America's PPO,America's PPO,32.6502,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
COLCHICINE (GOUT) 0.6 MG ORAL TABLET,,17853,LOCAL,Facility,Both,1,Each,,34,28.9,9.7444,34,BlueCross BlueShield Minnesota, Federal Employee Program,33.456,98.4,,percent of total billed charges,,
COLCHICINE (GOUT) 0.6 MG ORAL TABLET,,17853,LOCAL,Facility,Both,1,Each,,34,28.9,9.7444,34,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,34,100,,percent of total billed charges,,
COLCHICINE (GOUT) 0.6 MG ORAL TABLET,,17853,LOCAL,Facility,Both,1,Each,,34,28.9,9.7444,34,BlueCross BlueShield Minnesota,High Value Network Plan,30.6,90,,percent of total billed charges,,
COLCHICINE (GOUT) 0.6 MG ORAL TABLET,,17853,LOCAL,Facility,Outpatient,1,Each,,34,28.9,9.7444,34,BlueCross BlueShield Minnesota,Medicare Advantage,16.66,49,,percent of total billed charges,,
COLCHICINE (GOUT) 0.6 MG ORAL TABLET,,17853,LOCAL,Facility,Inpatient,1,Each,,34,28.9,9.7444,34,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
COLCHICINE (GOUT) 0.6 MG ORAL TABLET,,17853,LOCAL,Facility,Both,1,Each,,34,28.9,9.7444,34,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,30.1138,88.57,,percent of total billed charges,,
COLCHICINE (GOUT) 0.6 MG ORAL TABLET,,17853,LOCAL,Facility,Both,1,Each,,34,28.9,9.7444,34,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,9.7444,28.66,,percent of total billed charges,,
COLCHICINE (GOUT) 0.6 MG ORAL TABLET,,17853,LOCAL,Facility,Outpatient,1,Each,,34,28.9,9.7444,34,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),16.66,49,,percent of total billed charges,,
COLCHICINE (GOUT) 0.6 MG ORAL TABLET,,17853,LOCAL,Facility,Inpatient,1,Each,,34,28.9,9.7444,34,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
COLCHICINE (GOUT) 0.6 MG ORAL TABLET,,17853,LOCAL,Facility,Both,1,Each,,34,28.9,9.7444,34,CorVel,Worker's Compensation,34,100,,percent of total billed charges,,
COLCHICINE (GOUT) 0.6 MG ORAL TABLET,,17853,LOCAL,Facility,Both,1,Each,,34,28.9,9.7444,34,First Health Group Corporation,First Health Network,32.98,97,,percent of total billed charges,,
COLCHICINE (GOUT) 0.6 MG ORAL TABLET,,17853,LOCAL,Facility,Both,1,Each,,34,28.9,9.7444,34,"Health Partners, Inc.",Commercial,32.164,94.6,,percent of total billed charges,,
COLCHICINE (GOUT) 0.6 MG ORAL TABLET,,17853,LOCAL,Facility,Outpatient,1,Each,,34,28.9,9.7444,34,"Health Partners, Inc.",Medicare Advantage,16.66,49,,percent of total billed charges,,
COLCHICINE (GOUT) 0.6 MG ORAL TABLET,,17853,LOCAL,Facility,Inpatient,1,Each,,34,28.9,9.7444,34,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
COLCHICINE (GOUT) 0.6 MG ORAL TABLET,,17853,LOCAL,Facility,Both,1,Each,,34,28.9,9.7444,34,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),20.4,60,,percent of total billed charges,,
COLCHICINE (GOUT) 0.6 MG ORAL TABLET,,17853,LOCAL,Facility,Both,1,Each,,34,28.9,9.7444,34,"Health Partners, Inc.",State of Minnesota Advantage Program,27.71,81.5,,percent of total billed charges,,
COLCHICINE (GOUT) 0.6 MG ORAL TABLET,,17853,LOCAL,Facility,Both,1,Each,,34,28.9,9.7444,34,"Health Partners, Inc.",State Public Programs,17,50,,percent of total billed charges,,
COLCHICINE (GOUT) 0.6 MG ORAL TABLET,,17853,LOCAL,Facility,Both,1,Each,,34,28.9,9.7444,34,Humana Insurance Company,Commercial PPO,32.3,95,,percent of total billed charges,,
COLCHICINE (GOUT) 0.6 MG ORAL TABLET,,17853,LOCAL,Facility,Outpatient,1,Each,,34,28.9,9.7444,34,Humana Insurance Company,Medicare PPO,16.66,49,,percent of total billed charges,,
COLCHICINE (GOUT) 0.6 MG ORAL TABLET,,17853,LOCAL,Facility,Inpatient,1,Each,,34,28.9,9.7444,34,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
COLCHICINE (GOUT) 0.6 MG ORAL TABLET,,17853,LOCAL,Facility,Both,1,Each,,34,28.9,9.7444,34,Medica,Individual & Family,33.694,99.1,,percent of total billed charges,,
COLCHICINE (GOUT) 0.6 MG ORAL TABLET,,17853,LOCAL,Facility,Outpatient,1,Each,,34,28.9,9.7444,34,Medica,Medica Advantage Solution,16.932,49.8,,percent of total billed charges,,
COLCHICINE (GOUT) 0.6 MG ORAL TABLET,,17853,LOCAL,Facility,Inpatient,1,Each,,34,28.9,9.7444,34,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
COLCHICINE (GOUT) 0.6 MG ORAL TABLET,,17853,LOCAL,Facility,Outpatient,1,Each,,34,28.9,9.7444,34,Medica,Medical Assistance,15.164,44.6,,percent of total billed charges,,
COLCHICINE (GOUT) 0.6 MG ORAL TABLET,,17853,LOCAL,Facility,Inpatient,1,Each,,34,28.9,9.7444,34,Medica,Medical Assistance,,,,,Included in per diem rate,
COLCHICINE (GOUT) 0.6 MG ORAL TABLET,,17853,LOCAL,Facility,Outpatient,1,Each,,34,28.9,9.7444,34,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,16.932,49.8,,percent of total billed charges,,
COLCHICINE (GOUT) 0.6 MG ORAL TABLET,,17853,LOCAL,Facility,Inpatient,1,Each,,34,28.9,9.7444,34,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
COLCHICINE (GOUT) 0.6 MG ORAL TABLET,,17853,LOCAL,Facility,Both,1,Each,,34,28.9,9.7444,34,"Multiplan, Inc.","Multiplan, Inc.",31.96,94,,percent of total billed charges,,
COLCHICINE (GOUT) 0.6 MG ORAL TABLET,,17853,LOCAL,Facility,Outpatient,1,Each,,34,28.9,9.7444,34,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,30.634,90.1,,percent of total billed charges,,
COLCHICINE (GOUT) 0.6 MG ORAL TABLET,,17853,LOCAL,Facility,Inpatient,1,Each,,34,28.9,9.7444,34,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
COLCHICINE (GOUT) 0.6 MG ORAL TABLET,,17853,LOCAL,Facility,Both,1,Each,,34,28.9,9.7444,34,"Preferred One Administrative Services, INC.",PPO,33.524,98.6,,percent of total billed charges,,
COLCHICINE (GOUT) 0.6 MG ORAL TABLET,,17853,LOCAL,Facility,Outpatient,1,Each,,34,28.9,9.7444,34,PrimeWest Health,Minnesota Senior Health Options (MSHO),17.493,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
COLCHICINE (GOUT) 0.6 MG ORAL TABLET,,17853,LOCAL,Facility,Inpatient,1,Each,,34,28.9,9.7444,34,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
COLCHICINE (GOUT) 0.6 MG ORAL TABLET,,17853,LOCAL,Facility,Outpatient,1,Each,,34,28.9,9.7444,34,PrimeWest Health,MinnesotaCare,17.4624,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
COLCHICINE (GOUT) 0.6 MG ORAL TABLET,,17853,LOCAL,Facility,Inpatient,1,Each,,34,28.9,9.7444,34,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
COLCHICINE (GOUT) 0.6 MG ORAL TABLET,,17853,LOCAL,Facility,Both,1,Each,,34,28.9,9.7444,34,Sanford Health Plan,Sanford Health Plan,31.28,92,,percent of total billed charges,,
COLCHICINE (GOUT) 0.6 MG ORAL TABLET,,17853,LOCAL,Facility,Outpatient,1,Each,,34,28.9,9.7444,34,"UCare Health, Inc.",Individual & Family Plan,19.159,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
COLCHICINE (GOUT) 0.6 MG ORAL TABLET,,17853,LOCAL,Facility,Inpatient,1,Each,,34,28.9,9.7444,34,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
COLCHICINE (GOUT) 0.6 MG ORAL TABLET,,17853,LOCAL,Facility,Outpatient,1,Each,,34,28.9,9.7444,34,"UCare Health, Inc.",Medical Assistance,17.1598,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
COLCHICINE (GOUT) 0.6 MG ORAL TABLET,,17853,LOCAL,Facility,Inpatient,1,Each,,34,28.9,9.7444,34,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
COLCHICINE (GOUT) 0.6 MG ORAL TABLET,,17853,LOCAL,Facility,Outpatient,1,Each,,34,28.9,9.7444,34,"UCare Health, Inc.",Medicare Advantage,17.1598,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
COLCHICINE (GOUT) 0.6 MG ORAL TABLET,,17853,LOCAL,Facility,Inpatient,1,Each,,34,28.9,9.7444,34,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
COLCHICINE (GOUT) 0.6 MG ORAL TABLET,,17853,LOCAL,Facility,Outpatient,1,Each,,34,28.9,9.7444,34,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),17.1598,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
COLCHICINE (GOUT) 0.6 MG ORAL TABLET,,17853,LOCAL,Facility,Inpatient,1,Each,,34,28.9,9.7444,34,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
COLCHICINE (GOUT) 0.6 MG ORAL TABLET,,17853,LOCAL,Facility,Both,1,Each,,34,28.9,9.7444,34,UnitedHealthcare,Individual & Family,31.96,94,,percent of total billed charges,,
COLCHICINE (GOUT) 0.6 MG ORAL TABLET,,17853,LOCAL,Facility,Outpatient,1,Each,,34,28.9,9.7444,34,UnitedHealthcare,Medicare Advantage,16.66,49,,percent of total billed charges,,
COLCHICINE (GOUT) 0.6 MG ORAL TABLET,,17853,LOCAL,Facility,Inpatient,1,Each,,34,28.9,9.7444,34,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
COLCHICINE (GOUT) 0.6 MG ORAL TABLET,,17853,LOCAL,Facility,Outpatient,1,Each,,34,28.9,9.7444,34,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,16.32,48,,percent of total billed charges,,100% of DHS outpatient percentage
COLCHICINE (GOUT) 0.6 MG ORAL TABLET,,17853,LOCAL,Facility,Inpatient,1,Each,,34,28.9,9.7444,34,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Removal, Non-Biodegradable Drug Delivery Implant (Pro Cah)",,11982,CPT,Professional,Both,,,,453,385.05,48.29,453,Aetna,Commercial,385.05,85,,percent of total billed charges,,
"Removal, Non-Biodegradable Drug Delivery Implant (Pro Cah)",,11982,CPT,Professional,Both,,,,453,385.05,48.29,453,Aetna,Medicare Advantage,71.4,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Removal, Non-Biodegradable Drug Delivery Implant (Pro Cah)",,11982,CPT,Professional,Both,,,,453,385.05,48.29,453,Aetna,PPO,421.29,93,,percent of total billed charges,,
"Removal, Non-Biodegradable Drug Delivery Implant (Pro Cah)",,11982,CPT,Professional,Both,,,,453,385.05,48.29,453,America's PPO,America's PPO,387.0432,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Removal, Non-Biodegradable Drug Delivery Implant (Pro Cah)",,11982,CPT,Professional,Both,,,,453,385.05,48.29,453,BlueCross BlueShield Minnesota, Federal Employee Program,151.49,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Removal, Non-Biodegradable Drug Delivery Implant (Pro Cah)",,11982,CPT,Professional,Both,,,,453,385.05,48.29,453,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,153.91384,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Removal, Non-Biodegradable Drug Delivery Implant (Pro Cah)",,11982,CPT,Professional,Both,,,,453,385.05,48.29,453,BlueCross BlueShield Minnesota,High Value Network Plan,153.91384,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Removal, Non-Biodegradable Drug Delivery Implant (Pro Cah)",,11982,CPT,Professional,Both,,,,453,385.05,48.29,453,BlueCross BlueShield Minnesota,Medicare Advantage,79.6145,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Removal, Non-Biodegradable Drug Delivery Implant (Pro Cah)",,11982,CPT,Professional,Both,,,,453,385.05,48.29,453,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,153.91384,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Removal, Non-Biodegradable Drug Delivery Implant (Pro Cah)",,11982,CPT,Professional,Both,,,,453,385.05,48.29,453,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,51.37912,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Removal, Non-Biodegradable Drug Delivery Implant (Pro Cah)",,11982,CPT,Professional,Both,,,,453,385.05,48.29,453,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),79.6145,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Removal, Non-Biodegradable Drug Delivery Implant (Pro Cah)",,11982,CPT,Professional,Both,,,,453,385.05,48.29,453,CorVel,Worker's Compensation,136.7614785,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Removal, Non-Biodegradable Drug Delivery Implant (Pro Cah)",,11982,CPT,Professional,Both,,,,453,385.05,48.29,453,First Health Group Corporation,First Health Network,439.41,97,,percent of total billed charges,,
"Removal, Non-Biodegradable Drug Delivery Implant (Pro Cah)",,11982,CPT,Professional,Both,,,,453,385.05,48.29,453,"Health Partners, Inc.",Commercial,148.01,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Removal, Non-Biodegradable Drug Delivery Implant (Pro Cah)",,11982,CPT,Professional,Both,,,,453,385.05,48.29,453,"Health Partners, Inc.",Medicare Advantage,79.6145,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Removal, Non-Biodegradable Drug Delivery Implant (Pro Cah)",,11982,CPT,Professional,Both,,,,453,385.05,48.29,453,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),69.13,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Removal, Non-Biodegradable Drug Delivery Implant (Pro Cah)",,11982,CPT,Professional,Both,,,,453,385.05,48.29,453,"Health Partners, Inc.",State of Minnesota Advantage Program,127.510615,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Removal, Non-Biodegradable Drug Delivery Implant (Pro Cah)",,11982,CPT,Professional,Both,,,,453,385.05,48.29,453,"Health Partners, Inc.",State Public Programs,48.29,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Removal, Non-Biodegradable Drug Delivery Implant (Pro Cah)",,11982,CPT,Professional,Both,,,,453,385.05,48.29,453,Humana Insurance Company,Commercial PPO,69.23,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Removal, Non-Biodegradable Drug Delivery Implant (Pro Cah)",,11982,CPT,Professional,Both,,,,453,385.05,48.29,453,Humana Insurance Company,Medicare PPO,453,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Removal, Non-Biodegradable Drug Delivery Implant (Pro Cah)",,11982,CPT,Professional,Both,,,,453,385.05,48.29,453,Medica,Individual & Family,384.144,84.8,,percent of total billed charges,,
"Removal, Non-Biodegradable Drug Delivery Implant (Pro Cah)",,11982,CPT,Professional,Both,,,,453,385.05,48.29,453,Medica,Medica Advantage Solution,225.594,49.8,,percent of total billed charges,,
"Removal, Non-Biodegradable Drug Delivery Implant (Pro Cah)",,11982,CPT,Professional,Both,,,,453,385.05,48.29,453,Medica,Medical Assistance,51.38,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Removal, Non-Biodegradable Drug Delivery Implant (Pro Cah)",,11982,CPT,Professional,Both,,,,453,385.05,48.29,453,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,69.23,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Removal, Non-Biodegradable Drug Delivery Implant (Pro Cah)",,11982,CPT,Professional,Both,,,,453,385.05,48.29,453,"Multiplan, Inc.","Multiplan, Inc.",425.82,94,,percent of total billed charges,,
"Removal, Non-Biodegradable Drug Delivery Implant (Pro Cah)",,11982,CPT,Professional,Both,,,,453,385.05,48.29,453,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,408.153,90.1,,percent of total billed charges,,
"Removal, Non-Biodegradable Drug Delivery Implant (Pro Cah)",,11982,CPT,Professional,Both,,,,453,385.05,48.29,453,"Preferred One Administrative Services, INC.",PPO,446.658,98.6,,percent of total billed charges,,
"Removal, Non-Biodegradable Drug Delivery Implant (Pro Cah)",,11982,CPT,Professional,Both,,,,453,385.05,48.29,453,PrimeWest Health,Minnesota Senior Health Options (MSHO),79.6145,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Removal, Non-Biodegradable Drug Delivery Implant (Pro Cah)",,11982,CPT,Professional,Both,,,,453,385.05,48.29,453,PrimeWest Health,MinnesotaCare,54.9756584,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Removal, Non-Biodegradable Drug Delivery Implant (Pro Cah)",,11982,CPT,Professional,Both,,,,453,385.05,48.29,453,Sanford Health Plan,Sanford Health Plan,398.64,88,,percent of total billed charges,,
"Removal, Non-Biodegradable Drug Delivery Implant (Pro Cah)",,11982,CPT,Professional,Both,,,,453,385.05,48.29,453,"UCare Health, Inc.",Individual & Family Plan,112.540288,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Removal, Non-Biodegradable Drug Delivery Implant (Pro Cah)",,11982,CPT,Professional,Both,,,,453,385.05,48.29,453,"UCare Health, Inc.",Medical Assistance,56.517032,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Removal, Non-Biodegradable Drug Delivery Implant (Pro Cah)",,11982,CPT,Professional,Both,,,,453,385.05,48.29,453,"UCare Health, Inc.",Medicare Advantage,79.6145,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Removal, Non-Biodegradable Drug Delivery Implant (Pro Cah)",,11982,CPT,Professional,Both,,,,453,385.05,48.29,453,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),63.6916,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Removal, Non-Biodegradable Drug Delivery Implant (Pro Cah)",,11982,CPT,Professional,Both,,,,453,385.05,48.29,453,UnitedHealthcare,Individual & Family,453,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Removal, Non-Biodegradable Drug Delivery Implant (Pro Cah)",,11982,CPT,Professional,Both,,,,453,385.05,48.29,453,UnitedHealthcare,Medicare Advantage,79.6145,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Removal, Non-Biodegradable Drug Delivery Implant (Pro Cah)",,11982,CPT,Professional,Both,,,,453,385.05,48.29,453,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,51.37912,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
PROPRANOLOL 20 MG ORAL TABLET,,18052,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
PROPRANOLOL 20 MG ORAL TABLET,,18052,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
PROPRANOLOL 20 MG ORAL TABLET,,18052,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
PROPRANOLOL 20 MG ORAL TABLET,,18052,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
PROPRANOLOL 20 MG ORAL TABLET,,18052,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
PROPRANOLOL 20 MG ORAL TABLET,,18052,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
PROPRANOLOL 20 MG ORAL TABLET,,18052,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
PROPRANOLOL 20 MG ORAL TABLET,,18052,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
PROPRANOLOL 20 MG ORAL TABLET,,18052,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
PROPRANOLOL 20 MG ORAL TABLET,,18052,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
PROPRANOLOL 20 MG ORAL TABLET,,18052,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
PROPRANOLOL 20 MG ORAL TABLET,,18052,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
PROPRANOLOL 20 MG ORAL TABLET,,18052,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
PROPRANOLOL 20 MG ORAL TABLET,,18052,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
PROPRANOLOL 20 MG ORAL TABLET,,18052,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
PROPRANOLOL 20 MG ORAL TABLET,,18052,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
PROPRANOLOL 20 MG ORAL TABLET,,18052,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
PROPRANOLOL 20 MG ORAL TABLET,,18052,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
PROPRANOLOL 20 MG ORAL TABLET,,18052,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PROPRANOLOL 20 MG ORAL TABLET,,18052,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
PROPRANOLOL 20 MG ORAL TABLET,,18052,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
PROPRANOLOL 20 MG ORAL TABLET,,18052,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
PROPRANOLOL 20 MG ORAL TABLET,,18052,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
PROPRANOLOL 20 MG ORAL TABLET,,18052,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
PROPRANOLOL 20 MG ORAL TABLET,,18052,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
PROPRANOLOL 20 MG ORAL TABLET,,18052,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
PROPRANOLOL 20 MG ORAL TABLET,,18052,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
PROPRANOLOL 20 MG ORAL TABLET,,18052,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
PROPRANOLOL 20 MG ORAL TABLET,,18052,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
PROPRANOLOL 20 MG ORAL TABLET,,18052,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
PROPRANOLOL 20 MG ORAL TABLET,,18052,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
PROPRANOLOL 20 MG ORAL TABLET,,18052,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
PROPRANOLOL 20 MG ORAL TABLET,,18052,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
PROPRANOLOL 20 MG ORAL TABLET,,18052,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
PROPRANOLOL 20 MG ORAL TABLET,,18052,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
PROPRANOLOL 20 MG ORAL TABLET,,18052,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
PROPRANOLOL 20 MG ORAL TABLET,,18052,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
PROPRANOLOL 20 MG ORAL TABLET,,18052,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PROPRANOLOL 20 MG ORAL TABLET,,18052,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
PROPRANOLOL 20 MG ORAL TABLET,,18052,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
PROPRANOLOL 20 MG ORAL TABLET,,18052,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
PROPRANOLOL 20 MG ORAL TABLET,,18052,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
PROPRANOLOL 20 MG ORAL TABLET,,18052,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
PROPRANOLOL 20 MG ORAL TABLET,,18052,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PROPRANOLOL 20 MG ORAL TABLET,,18052,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
PROPRANOLOL 20 MG ORAL TABLET,,18052,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PROPRANOLOL 20 MG ORAL TABLET,,18052,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PROPRANOLOL 20 MG ORAL TABLET,,18052,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PROPRANOLOL 20 MG ORAL TABLET,,18052,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PROPRANOLOL 20 MG ORAL TABLET,,18052,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
PROPRANOLOL 20 MG ORAL TABLET,,18052,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
PROPRANOLOL 20 MG ORAL TABLET,,18052,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
PROPRANOLOL 20 MG ORAL TABLET,,18052,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
PROPRANOLOL 20 MG ORAL TABLET,,18052,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
CELECOXIB 100 MG ORAL CAP,,18059,LOCAL,Facility,Both,1,Each,,8,6.8,2.2928,8,Aetna,Commercial,7.36,92,,percent of total billed charges,,
CELECOXIB 100 MG ORAL CAP,,18059,LOCAL,Facility,Outpatient,1,Each,,8,6.8,2.2928,8,Aetna,Medicare Advantage,3.92,49,,percent of total billed charges,,
CELECOXIB 100 MG ORAL CAP,,18059,LOCAL,Facility,Inpatient,1,Each,,8,6.8,2.2928,8,Aetna,Medicare Advantage,,,,,Included in per diem rate,
CELECOXIB 100 MG ORAL CAP,,18059,LOCAL,Facility,Both,1,Each,,8,6.8,2.2928,8,Aetna,PPO,7.44,93,,percent of total billed charges,,
CELECOXIB 100 MG ORAL CAP,,18059,LOCAL,Facility,Both,1,Each,,8,6.8,2.2928,8,America's PPO,America's PPO,7.6824,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
CELECOXIB 100 MG ORAL CAP,,18059,LOCAL,Facility,Both,1,Each,,8,6.8,2.2928,8,BlueCross BlueShield Minnesota, Federal Employee Program,7.872,98.4,,percent of total billed charges,,
CELECOXIB 100 MG ORAL CAP,,18059,LOCAL,Facility,Both,1,Each,,8,6.8,2.2928,8,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,8,100,,percent of total billed charges,,
CELECOXIB 100 MG ORAL CAP,,18059,LOCAL,Facility,Both,1,Each,,8,6.8,2.2928,8,BlueCross BlueShield Minnesota,High Value Network Plan,7.2,90,,percent of total billed charges,,
CELECOXIB 100 MG ORAL CAP,,18059,LOCAL,Facility,Outpatient,1,Each,,8,6.8,2.2928,8,BlueCross BlueShield Minnesota,Medicare Advantage,3.92,49,,percent of total billed charges,,
CELECOXIB 100 MG ORAL CAP,,18059,LOCAL,Facility,Inpatient,1,Each,,8,6.8,2.2928,8,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
CELECOXIB 100 MG ORAL CAP,,18059,LOCAL,Facility,Both,1,Each,,8,6.8,2.2928,8,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,7.0856,88.57,,percent of total billed charges,,
CELECOXIB 100 MG ORAL CAP,,18059,LOCAL,Facility,Both,1,Each,,8,6.8,2.2928,8,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,2.2928,28.66,,percent of total billed charges,,
CELECOXIB 100 MG ORAL CAP,,18059,LOCAL,Facility,Outpatient,1,Each,,8,6.8,2.2928,8,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),3.92,49,,percent of total billed charges,,
CELECOXIB 100 MG ORAL CAP,,18059,LOCAL,Facility,Inpatient,1,Each,,8,6.8,2.2928,8,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
CELECOXIB 100 MG ORAL CAP,,18059,LOCAL,Facility,Both,1,Each,,8,6.8,2.2928,8,CorVel,Worker's Compensation,8,100,,percent of total billed charges,,
CELECOXIB 100 MG ORAL CAP,,18059,LOCAL,Facility,Both,1,Each,,8,6.8,2.2928,8,First Health Group Corporation,First Health Network,7.76,97,,percent of total billed charges,,
CELECOXIB 100 MG ORAL CAP,,18059,LOCAL,Facility,Both,1,Each,,8,6.8,2.2928,8,"Health Partners, Inc.",Commercial,7.568,94.6,,percent of total billed charges,,
CELECOXIB 100 MG ORAL CAP,,18059,LOCAL,Facility,Outpatient,1,Each,,8,6.8,2.2928,8,"Health Partners, Inc.",Medicare Advantage,3.92,49,,percent of total billed charges,,
CELECOXIB 100 MG ORAL CAP,,18059,LOCAL,Facility,Inpatient,1,Each,,8,6.8,2.2928,8,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CELECOXIB 100 MG ORAL CAP,,18059,LOCAL,Facility,Both,1,Each,,8,6.8,2.2928,8,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),4.8,60,,percent of total billed charges,,
CELECOXIB 100 MG ORAL CAP,,18059,LOCAL,Facility,Both,1,Each,,8,6.8,2.2928,8,"Health Partners, Inc.",State of Minnesota Advantage Program,6.52,81.5,,percent of total billed charges,,
CELECOXIB 100 MG ORAL CAP,,18059,LOCAL,Facility,Both,1,Each,,8,6.8,2.2928,8,"Health Partners, Inc.",State Public Programs,4,50,,percent of total billed charges,,
CELECOXIB 100 MG ORAL CAP,,18059,LOCAL,Facility,Both,1,Each,,8,6.8,2.2928,8,Humana Insurance Company,Commercial PPO,7.6,95,,percent of total billed charges,,
CELECOXIB 100 MG ORAL CAP,,18059,LOCAL,Facility,Outpatient,1,Each,,8,6.8,2.2928,8,Humana Insurance Company,Medicare PPO,3.92,49,,percent of total billed charges,,
CELECOXIB 100 MG ORAL CAP,,18059,LOCAL,Facility,Inpatient,1,Each,,8,6.8,2.2928,8,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
CELECOXIB 100 MG ORAL CAP,,18059,LOCAL,Facility,Both,1,Each,,8,6.8,2.2928,8,Medica,Individual & Family,7.928,99.1,,percent of total billed charges,,
CELECOXIB 100 MG ORAL CAP,,18059,LOCAL,Facility,Outpatient,1,Each,,8,6.8,2.2928,8,Medica,Medica Advantage Solution,3.984,49.8,,percent of total billed charges,,
CELECOXIB 100 MG ORAL CAP,,18059,LOCAL,Facility,Inpatient,1,Each,,8,6.8,2.2928,8,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
CELECOXIB 100 MG ORAL CAP,,18059,LOCAL,Facility,Outpatient,1,Each,,8,6.8,2.2928,8,Medica,Medical Assistance,3.568,44.6,,percent of total billed charges,,
CELECOXIB 100 MG ORAL CAP,,18059,LOCAL,Facility,Inpatient,1,Each,,8,6.8,2.2928,8,Medica,Medical Assistance,,,,,Included in per diem rate,
CELECOXIB 100 MG ORAL CAP,,18059,LOCAL,Facility,Outpatient,1,Each,,8,6.8,2.2928,8,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,3.984,49.8,,percent of total billed charges,,
CELECOXIB 100 MG ORAL CAP,,18059,LOCAL,Facility,Inpatient,1,Each,,8,6.8,2.2928,8,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
CELECOXIB 100 MG ORAL CAP,,18059,LOCAL,Facility,Both,1,Each,,8,6.8,2.2928,8,"Multiplan, Inc.","Multiplan, Inc.",7.52,94,,percent of total billed charges,,
CELECOXIB 100 MG ORAL CAP,,18059,LOCAL,Facility,Outpatient,1,Each,,8,6.8,2.2928,8,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,7.208,90.1,,percent of total billed charges,,
CELECOXIB 100 MG ORAL CAP,,18059,LOCAL,Facility,Inpatient,1,Each,,8,6.8,2.2928,8,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
CELECOXIB 100 MG ORAL CAP,,18059,LOCAL,Facility,Both,1,Each,,8,6.8,2.2928,8,"Preferred One Administrative Services, INC.",PPO,7.888,98.6,,percent of total billed charges,,
CELECOXIB 100 MG ORAL CAP,,18059,LOCAL,Facility,Outpatient,1,Each,,8,6.8,2.2928,8,PrimeWest Health,Minnesota Senior Health Options (MSHO),4.116,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
CELECOXIB 100 MG ORAL CAP,,18059,LOCAL,Facility,Inpatient,1,Each,,8,6.8,2.2928,8,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CELECOXIB 100 MG ORAL CAP,,18059,LOCAL,Facility,Outpatient,1,Each,,8,6.8,2.2928,8,PrimeWest Health,MinnesotaCare,4.1088,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
CELECOXIB 100 MG ORAL CAP,,18059,LOCAL,Facility,Inpatient,1,Each,,8,6.8,2.2928,8,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
CELECOXIB 100 MG ORAL CAP,,18059,LOCAL,Facility,Both,1,Each,,8,6.8,2.2928,8,Sanford Health Plan,Sanford Health Plan,7.36,92,,percent of total billed charges,,
CELECOXIB 100 MG ORAL CAP,,18059,LOCAL,Facility,Outpatient,1,Each,,8,6.8,2.2928,8,"UCare Health, Inc.",Individual & Family Plan,4.508,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
CELECOXIB 100 MG ORAL CAP,,18059,LOCAL,Facility,Inpatient,1,Each,,8,6.8,2.2928,8,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
CELECOXIB 100 MG ORAL CAP,,18059,LOCAL,Facility,Outpatient,1,Each,,8,6.8,2.2928,8,"UCare Health, Inc.",Medical Assistance,4.0376,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CELECOXIB 100 MG ORAL CAP,,18059,LOCAL,Facility,Inpatient,1,Each,,8,6.8,2.2928,8,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
CELECOXIB 100 MG ORAL CAP,,18059,LOCAL,Facility,Outpatient,1,Each,,8,6.8,2.2928,8,"UCare Health, Inc.",Medicare Advantage,4.0376,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CELECOXIB 100 MG ORAL CAP,,18059,LOCAL,Facility,Inpatient,1,Each,,8,6.8,2.2928,8,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CELECOXIB 100 MG ORAL CAP,,18059,LOCAL,Facility,Outpatient,1,Each,,8,6.8,2.2928,8,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),4.0376,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CELECOXIB 100 MG ORAL CAP,,18059,LOCAL,Facility,Inpatient,1,Each,,8,6.8,2.2928,8,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CELECOXIB 100 MG ORAL CAP,,18059,LOCAL,Facility,Both,1,Each,,8,6.8,2.2928,8,UnitedHealthcare,Individual & Family,7.52,94,,percent of total billed charges,,
CELECOXIB 100 MG ORAL CAP,,18059,LOCAL,Facility,Outpatient,1,Each,,8,6.8,2.2928,8,UnitedHealthcare,Medicare Advantage,3.92,49,,percent of total billed charges,,
CELECOXIB 100 MG ORAL CAP,,18059,LOCAL,Facility,Inpatient,1,Each,,8,6.8,2.2928,8,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
CELECOXIB 100 MG ORAL CAP,,18059,LOCAL,Facility,Outpatient,1,Each,,8,6.8,2.2928,8,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,3.84,48,,percent of total billed charges,,100% of DHS outpatient percentage
CELECOXIB 100 MG ORAL CAP,,18059,LOCAL,Facility,Inpatient,1,Each,,8,6.8,2.2928,8,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Simple Repair Wounds Scalp, Nk, Axillae, Ext Genitalia, Trunk, Extremities; 2.5 Cm Or Less (Pro Cah)",,12001,CPT,Professional,Both,,,,458,389.3,26.83,458,Aetna,Commercial,389.3,85,,percent of total billed charges,,
"Simple Repair Wounds Scalp, Nk, Axillae, Ext Genitalia, Trunk, Extremities; 2.5 Cm Or Less (Pro Cah)",,12001,CPT,Professional,Both,,,,458,389.3,26.83,458,Aetna,Medicare Advantage,42.12,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Simple Repair Wounds Scalp, Nk, Axillae, Ext Genitalia, Trunk, Extremities; 2.5 Cm Or Less (Pro Cah)",,12001,CPT,Professional,Both,,,,458,389.3,26.83,458,Aetna,PPO,425.94,93,,percent of total billed charges,,
"Simple Repair Wounds Scalp, Nk, Axillae, Ext Genitalia, Trunk, Extremities; 2.5 Cm Or Less (Pro Cah)",,12001,CPT,Professional,Both,,,,458,389.3,26.83,458,America's PPO,America's PPO,391.3152,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Simple Repair Wounds Scalp, Nk, Axillae, Ext Genitalia, Trunk, Extremities; 2.5 Cm Or Less (Pro Cah)",,12001,CPT,Professional,Both,,,,458,389.3,26.83,458,BlueCross BlueShield Minnesota, Federal Employee Program,92.27,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Simple Repair Wounds Scalp, Nk, Axillae, Ext Genitalia, Trunk, Extremities; 2.5 Cm Or Less (Pro Cah)",,12001,CPT,Professional,Both,,,,458,389.3,26.83,458,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,93.74632,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Simple Repair Wounds Scalp, Nk, Axillae, Ext Genitalia, Trunk, Extremities; 2.5 Cm Or Less (Pro Cah)",,12001,CPT,Professional,Both,,,,458,389.3,26.83,458,BlueCross BlueShield Minnesota,High Value Network Plan,93.74632,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Simple Repair Wounds Scalp, Nk, Axillae, Ext Genitalia, Trunk, Extremities; 2.5 Cm Or Less (Pro Cah)",,12001,CPT,Professional,Both,,,,458,389.3,26.83,458,BlueCross BlueShield Minnesota,Medicare Advantage,48.001,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Simple Repair Wounds Scalp, Nk, Axillae, Ext Genitalia, Trunk, Extremities; 2.5 Cm Or Less (Pro Cah)",,12001,CPT,Professional,Both,,,,458,389.3,26.83,458,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,93.74632,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Simple Repair Wounds Scalp, Nk, Axillae, Ext Genitalia, Trunk, Extremities; 2.5 Cm Or Less (Pro Cah)",,12001,CPT,Professional,Both,,,,458,389.3,26.83,458,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,30.97784,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Simple Repair Wounds Scalp, Nk, Axillae, Ext Genitalia, Trunk, Extremities; 2.5 Cm Or Less (Pro Cah)",,12001,CPT,Professional,Both,,,,458,389.3,26.83,458,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),48.001,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Simple Repair Wounds Scalp, Nk, Axillae, Ext Genitalia, Trunk, Extremities; 2.5 Cm Or Less (Pro Cah)",,12001,CPT,Professional,Both,,,,458,389.3,26.83,458,CorVel,Worker's Compensation,82.2274989,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Simple Repair Wounds Scalp, Nk, Axillae, Ext Genitalia, Trunk, Extremities; 2.5 Cm Or Less (Pro Cah)",,12001,CPT,Professional,Both,,,,458,389.3,26.83,458,First Health Group Corporation,First Health Network,444.26,97,,percent of total billed charges,,
"Simple Repair Wounds Scalp, Nk, Axillae, Ext Genitalia, Trunk, Extremities; 2.5 Cm Or Less (Pro Cah)",,12001,CPT,Professional,Both,,,,458,389.3,26.83,458,"Health Partners, Inc.",Commercial,88.51,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Simple Repair Wounds Scalp, Nk, Axillae, Ext Genitalia, Trunk, Extremities; 2.5 Cm Or Less (Pro Cah)",,12001,CPT,Professional,Both,,,,458,389.3,26.83,458,"Health Partners, Inc.",Medicare Advantage,48.001,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Simple Repair Wounds Scalp, Nk, Axillae, Ext Genitalia, Trunk, Extremities; 2.5 Cm Or Less (Pro Cah)",,12001,CPT,Professional,Both,,,,458,389.3,26.83,458,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),42.02,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Simple Repair Wounds Scalp, Nk, Axillae, Ext Genitalia, Trunk, Extremities; 2.5 Cm Or Less (Pro Cah)",,12001,CPT,Professional,Both,,,,458,389.3,26.83,458,"Health Partners, Inc.",State of Minnesota Advantage Program,76.251365,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Simple Repair Wounds Scalp, Nk, Axillae, Ext Genitalia, Trunk, Extremities; 2.5 Cm Or Less (Pro Cah)",,12001,CPT,Professional,Both,,,,458,389.3,26.83,458,"Health Partners, Inc.",State Public Programs,26.83,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Simple Repair Wounds Scalp, Nk, Axillae, Ext Genitalia, Trunk, Extremities; 2.5 Cm Or Less (Pro Cah)",,12001,CPT,Professional,Both,,,,458,389.3,26.83,458,Humana Insurance Company,Commercial PPO,41.74,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Simple Repair Wounds Scalp, Nk, Axillae, Ext Genitalia, Trunk, Extremities; 2.5 Cm Or Less (Pro Cah)",,12001,CPT,Professional,Both,,,,458,389.3,26.83,458,Humana Insurance Company,Medicare PPO,458,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Simple Repair Wounds Scalp, Nk, Axillae, Ext Genitalia, Trunk, Extremities; 2.5 Cm Or Less (Pro Cah)",,12001,CPT,Professional,Both,,,,458,389.3,26.83,458,Medica,Individual & Family,388.384,84.8,,percent of total billed charges,,
"Simple Repair Wounds Scalp, Nk, Axillae, Ext Genitalia, Trunk, Extremities; 2.5 Cm Or Less (Pro Cah)",,12001,CPT,Professional,Both,,,,458,389.3,26.83,458,Medica,Medica Advantage Solution,228.084,49.8,,percent of total billed charges,,
"Simple Repair Wounds Scalp, Nk, Axillae, Ext Genitalia, Trunk, Extremities; 2.5 Cm Or Less (Pro Cah)",,12001,CPT,Professional,Both,,,,458,389.3,26.83,458,Medica,Medical Assistance,30.98,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Simple Repair Wounds Scalp, Nk, Axillae, Ext Genitalia, Trunk, Extremities; 2.5 Cm Or Less (Pro Cah)",,12001,CPT,Professional,Both,,,,458,389.3,26.83,458,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,41.74,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Simple Repair Wounds Scalp, Nk, Axillae, Ext Genitalia, Trunk, Extremities; 2.5 Cm Or Less (Pro Cah)",,12001,CPT,Professional,Both,,,,458,389.3,26.83,458,"Multiplan, Inc.","Multiplan, Inc.",430.52,94,,percent of total billed charges,,
"Simple Repair Wounds Scalp, Nk, Axillae, Ext Genitalia, Trunk, Extremities; 2.5 Cm Or Less (Pro Cah)",,12001,CPT,Professional,Both,,,,458,389.3,26.83,458,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,412.658,90.1,,percent of total billed charges,,
"Simple Repair Wounds Scalp, Nk, Axillae, Ext Genitalia, Trunk, Extremities; 2.5 Cm Or Less (Pro Cah)",,12001,CPT,Professional,Both,,,,458,389.3,26.83,458,"Preferred One Administrative Services, INC.",PPO,451.588,98.6,,percent of total billed charges,,
"Simple Repair Wounds Scalp, Nk, Axillae, Ext Genitalia, Trunk, Extremities; 2.5 Cm Or Less (Pro Cah)",,12001,CPT,Professional,Both,,,,458,389.3,26.83,458,PrimeWest Health,Minnesota Senior Health Options (MSHO),48.001,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Simple Repair Wounds Scalp, Nk, Axillae, Ext Genitalia, Trunk, Extremities; 2.5 Cm Or Less (Pro Cah)",,12001,CPT,Professional,Both,,,,458,389.3,26.83,458,PrimeWest Health,MinnesotaCare,33.1462888,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Simple Repair Wounds Scalp, Nk, Axillae, Ext Genitalia, Trunk, Extremities; 2.5 Cm Or Less (Pro Cah)",,12001,CPT,Professional,Both,,,,458,389.3,26.83,458,Sanford Health Plan,Sanford Health Plan,403.04,88,,percent of total billed charges,,
"Simple Repair Wounds Scalp, Nk, Axillae, Ext Genitalia, Trunk, Extremities; 2.5 Cm Or Less (Pro Cah)",,12001,CPT,Professional,Both,,,,458,389.3,26.83,458,"UCare Health, Inc.",Individual & Family Plan,67.852544,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Simple Repair Wounds Scalp, Nk, Axillae, Ext Genitalia, Trunk, Extremities; 2.5 Cm Or Less (Pro Cah)",,12001,CPT,Professional,Both,,,,458,389.3,26.83,458,"UCare Health, Inc.",Medical Assistance,34.075624,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Simple Repair Wounds Scalp, Nk, Axillae, Ext Genitalia, Trunk, Extremities; 2.5 Cm Or Less (Pro Cah)",,12001,CPT,Professional,Both,,,,458,389.3,26.83,458,"UCare Health, Inc.",Medicare Advantage,48.001,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Simple Repair Wounds Scalp, Nk, Axillae, Ext Genitalia, Trunk, Extremities; 2.5 Cm Or Less (Pro Cah)",,12001,CPT,Professional,Both,,,,458,389.3,26.83,458,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),38.4008,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Simple Repair Wounds Scalp, Nk, Axillae, Ext Genitalia, Trunk, Extremities; 2.5 Cm Or Less (Pro Cah)",,12001,CPT,Professional,Both,,,,458,389.3,26.83,458,UnitedHealthcare,Individual & Family,458,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Simple Repair Wounds Scalp, Nk, Axillae, Ext Genitalia, Trunk, Extremities; 2.5 Cm Or Less (Pro Cah)",,12001,CPT,Professional,Both,,,,458,389.3,26.83,458,UnitedHealthcare,Medicare Advantage,48.001,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Simple Repair Wounds Scalp, Nk, Axillae, Ext Genitalia, Trunk, Extremities; 2.5 Cm Or Less (Pro Cah)",,12001,CPT,Professional,Both,,,,458,389.3,26.83,458,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,30.97784,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Simple Repair Wounds Scalp, Nk, Axillae, Ext Genitalia, Trunk,Extremities; 2.6 Cm - 7.5 Cm (Pro Cah)",,12002,CPT,Professional,Both,,,,537,456.45,34.9,537,Aetna,Commercial,456.45,85,,percent of total billed charges,,
"Simple Repair Wounds Scalp, Nk, Axillae, Ext Genitalia, Trunk,Extremities; 2.6 Cm - 7.5 Cm (Pro Cah)",,12002,CPT,Professional,Both,,,,537,456.45,34.9,537,Aetna,Medicare Advantage,55.44,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Simple Repair Wounds Scalp, Nk, Axillae, Ext Genitalia, Trunk,Extremities; 2.6 Cm - 7.5 Cm (Pro Cah)",,12002,CPT,Professional,Both,,,,537,456.45,34.9,537,Aetna,PPO,499.41,93,,percent of total billed charges,,
"Simple Repair Wounds Scalp, Nk, Axillae, Ext Genitalia, Trunk,Extremities; 2.6 Cm - 7.5 Cm (Pro Cah)",,12002,CPT,Professional,Both,,,,537,456.45,34.9,537,America's PPO,America's PPO,458.8128,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Simple Repair Wounds Scalp, Nk, Axillae, Ext Genitalia, Trunk,Extremities; 2.6 Cm - 7.5 Cm (Pro Cah)",,12002,CPT,Professional,Both,,,,537,456.45,34.9,537,BlueCross BlueShield Minnesota, Federal Employee Program,120.51,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Simple Repair Wounds Scalp, Nk, Axillae, Ext Genitalia, Trunk,Extremities; 2.6 Cm - 7.5 Cm (Pro Cah)",,12002,CPT,Professional,Both,,,,537,456.45,34.9,537,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,122.43816,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Simple Repair Wounds Scalp, Nk, Axillae, Ext Genitalia, Trunk,Extremities; 2.6 Cm - 7.5 Cm (Pro Cah)",,12002,CPT,Professional,Both,,,,537,456.45,34.9,537,BlueCross BlueShield Minnesota,High Value Network Plan,122.43816,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Simple Repair Wounds Scalp, Nk, Axillae, Ext Genitalia, Trunk,Extremities; 2.6 Cm - 7.5 Cm (Pro Cah)",,12002,CPT,Professional,Both,,,,537,456.45,34.9,537,BlueCross BlueShield Minnesota,Medicare Advantage,62.7095,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Simple Repair Wounds Scalp, Nk, Axillae, Ext Genitalia, Trunk,Extremities; 2.6 Cm - 7.5 Cm (Pro Cah)",,12002,CPT,Professional,Both,,,,537,456.45,34.9,537,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,122.43816,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Simple Repair Wounds Scalp, Nk, Axillae, Ext Genitalia, Trunk,Extremities; 2.6 Cm - 7.5 Cm (Pro Cah)",,12002,CPT,Professional,Both,,,,537,456.45,34.9,537,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,40.29456,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Simple Repair Wounds Scalp, Nk, Axillae, Ext Genitalia, Trunk,Extremities; 2.6 Cm - 7.5 Cm (Pro Cah)",,12002,CPT,Professional,Both,,,,537,456.45,34.9,537,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),62.7095,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Simple Repair Wounds Scalp, Nk, Axillae, Ext Genitalia, Trunk,Extremities; 2.6 Cm - 7.5 Cm (Pro Cah)",,12002,CPT,Professional,Both,,,,537,456.45,34.9,537,CorVel,Worker's Compensation,107.646642,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Simple Repair Wounds Scalp, Nk, Axillae, Ext Genitalia, Trunk,Extremities; 2.6 Cm - 7.5 Cm (Pro Cah)",,12002,CPT,Professional,Both,,,,537,456.45,34.9,537,First Health Group Corporation,First Health Network,520.89,97,,percent of total billed charges,,
"Simple Repair Wounds Scalp, Nk, Axillae, Ext Genitalia, Trunk,Extremities; 2.6 Cm - 7.5 Cm (Pro Cah)",,12002,CPT,Professional,Both,,,,537,456.45,34.9,537,"Health Partners, Inc.",Commercial,116.09,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Simple Repair Wounds Scalp, Nk, Axillae, Ext Genitalia, Trunk,Extremities; 2.6 Cm - 7.5 Cm (Pro Cah)",,12002,CPT,Professional,Both,,,,537,456.45,34.9,537,"Health Partners, Inc.",Medicare Advantage,62.7095,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Simple Repair Wounds Scalp, Nk, Axillae, Ext Genitalia, Trunk,Extremities; 2.6 Cm - 7.5 Cm (Pro Cah)",,12002,CPT,Professional,Both,,,,537,456.45,34.9,537,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),54.56,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Simple Repair Wounds Scalp, Nk, Axillae, Ext Genitalia, Trunk,Extremities; 2.6 Cm - 7.5 Cm (Pro Cah)",,12002,CPT,Professional,Both,,,,537,456.45,34.9,537,"Health Partners, Inc.",State of Minnesota Advantage Program,100.011535,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Simple Repair Wounds Scalp, Nk, Axillae, Ext Genitalia, Trunk,Extremities; 2.6 Cm - 7.5 Cm (Pro Cah)",,12002,CPT,Professional,Both,,,,537,456.45,34.9,537,"Health Partners, Inc.",State Public Programs,34.9,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Simple Repair Wounds Scalp, Nk, Axillae, Ext Genitalia, Trunk,Extremities; 2.6 Cm - 7.5 Cm (Pro Cah)",,12002,CPT,Professional,Both,,,,537,456.45,34.9,537,Humana Insurance Company,Commercial PPO,54.53,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Simple Repair Wounds Scalp, Nk, Axillae, Ext Genitalia, Trunk,Extremities; 2.6 Cm - 7.5 Cm (Pro Cah)",,12002,CPT,Professional,Both,,,,537,456.45,34.9,537,Humana Insurance Company,Medicare PPO,537,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Simple Repair Wounds Scalp, Nk, Axillae, Ext Genitalia, Trunk,Extremities; 2.6 Cm - 7.5 Cm (Pro Cah)",,12002,CPT,Professional,Both,,,,537,456.45,34.9,537,Medica,Individual & Family,455.376,84.8,,percent of total billed charges,,
"Simple Repair Wounds Scalp, Nk, Axillae, Ext Genitalia, Trunk,Extremities; 2.6 Cm - 7.5 Cm (Pro Cah)",,12002,CPT,Professional,Both,,,,537,456.45,34.9,537,Medica,Medica Advantage Solution,267.426,49.8,,percent of total billed charges,,
"Simple Repair Wounds Scalp, Nk, Axillae, Ext Genitalia, Trunk,Extremities; 2.6 Cm - 7.5 Cm (Pro Cah)",,12002,CPT,Professional,Both,,,,537,456.45,34.9,537,Medica,Medical Assistance,40.29,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Simple Repair Wounds Scalp, Nk, Axillae, Ext Genitalia, Trunk,Extremities; 2.6 Cm - 7.5 Cm (Pro Cah)",,12002,CPT,Professional,Both,,,,537,456.45,34.9,537,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,54.53,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Simple Repair Wounds Scalp, Nk, Axillae, Ext Genitalia, Trunk,Extremities; 2.6 Cm - 7.5 Cm (Pro Cah)",,12002,CPT,Professional,Both,,,,537,456.45,34.9,537,"Multiplan, Inc.","Multiplan, Inc.",504.78,94,,percent of total billed charges,,
"Simple Repair Wounds Scalp, Nk, Axillae, Ext Genitalia, Trunk,Extremities; 2.6 Cm - 7.5 Cm (Pro Cah)",,12002,CPT,Professional,Both,,,,537,456.45,34.9,537,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,483.837,90.1,,percent of total billed charges,,
"Simple Repair Wounds Scalp, Nk, Axillae, Ext Genitalia, Trunk,Extremities; 2.6 Cm - 7.5 Cm (Pro Cah)",,12002,CPT,Professional,Both,,,,537,456.45,34.9,537,"Preferred One Administrative Services, INC.",PPO,529.482,98.6,,percent of total billed charges,,
"Simple Repair Wounds Scalp, Nk, Axillae, Ext Genitalia, Trunk,Extremities; 2.6 Cm - 7.5 Cm (Pro Cah)",,12002,CPT,Professional,Both,,,,537,456.45,34.9,537,PrimeWest Health,Minnesota Senior Health Options (MSHO),62.7095,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Simple Repair Wounds Scalp, Nk, Axillae, Ext Genitalia, Trunk,Extremities; 2.6 Cm - 7.5 Cm (Pro Cah)",,12002,CPT,Professional,Both,,,,537,456.45,34.9,537,PrimeWest Health,MinnesotaCare,43.1151792,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Simple Repair Wounds Scalp, Nk, Axillae, Ext Genitalia, Trunk,Extremities; 2.6 Cm - 7.5 Cm (Pro Cah)",,12002,CPT,Professional,Both,,,,537,456.45,34.9,537,Sanford Health Plan,Sanford Health Plan,472.56,88,,percent of total billed charges,,
"Simple Repair Wounds Scalp, Nk, Axillae, Ext Genitalia, Trunk,Extremities; 2.6 Cm - 7.5 Cm (Pro Cah)",,12002,CPT,Professional,Both,,,,537,456.45,34.9,537,"UCare Health, Inc.",Individual & Family Plan,88.643968,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Simple Repair Wounds Scalp, Nk, Axillae, Ext Genitalia, Trunk,Extremities; 2.6 Cm - 7.5 Cm (Pro Cah)",,12002,CPT,Professional,Both,,,,537,456.45,34.9,537,"UCare Health, Inc.",Medical Assistance,44.324016,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Simple Repair Wounds Scalp, Nk, Axillae, Ext Genitalia, Trunk,Extremities; 2.6 Cm - 7.5 Cm (Pro Cah)",,12002,CPT,Professional,Both,,,,537,456.45,34.9,537,"UCare Health, Inc.",Medicare Advantage,62.7095,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Simple Repair Wounds Scalp, Nk, Axillae, Ext Genitalia, Trunk,Extremities; 2.6 Cm - 7.5 Cm (Pro Cah)",,12002,CPT,Professional,Both,,,,537,456.45,34.9,537,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),50.1676,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Simple Repair Wounds Scalp, Nk, Axillae, Ext Genitalia, Trunk,Extremities; 2.6 Cm - 7.5 Cm (Pro Cah)",,12002,CPT,Professional,Both,,,,537,456.45,34.9,537,UnitedHealthcare,Individual & Family,537,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Simple Repair Wounds Scalp, Nk, Axillae, Ext Genitalia, Trunk,Extremities; 2.6 Cm - 7.5 Cm (Pro Cah)",,12002,CPT,Professional,Both,,,,537,456.45,34.9,537,UnitedHealthcare,Medicare Advantage,62.7095,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Simple Repair Wounds Scalp, Nk, Axillae, Ext Genitalia, Trunk,Extremities; 2.6 Cm - 7.5 Cm (Pro Cah)",,12002,CPT,Professional,Both,,,,537,456.45,34.9,537,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,40.29456,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Simple Repair Wounds Scalp, Nk, Axillae, Ext Genitalia,Trunk,Extremities; 7.6 Cm - 12.5 Cm (Pro Cah)",,12004,CPT,Professional,Both,,,,641,544.85,43.41,641,Aetna,Commercial,544.85,85,,percent of total billed charges,,
"Simple Repair Wounds Scalp, Nk, Axillae, Ext Genitalia,Trunk,Extremities; 7.6 Cm - 12.5 Cm (Pro Cah)",,12004,CPT,Professional,Both,,,,641,544.85,43.41,641,Aetna,Medicare Advantage,69,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Simple Repair Wounds Scalp, Nk, Axillae, Ext Genitalia,Trunk,Extremities; 7.6 Cm - 12.5 Cm (Pro Cah)",,12004,CPT,Professional,Both,,,,641,544.85,43.41,641,Aetna,PPO,596.13,93,,percent of total billed charges,,
"Simple Repair Wounds Scalp, Nk, Axillae, Ext Genitalia,Trunk,Extremities; 7.6 Cm - 12.5 Cm (Pro Cah)",,12004,CPT,Professional,Both,,,,641,544.85,43.41,641,America's PPO,America's PPO,547.6704,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Simple Repair Wounds Scalp, Nk, Axillae, Ext Genitalia,Trunk,Extremities; 7.6 Cm - 12.5 Cm (Pro Cah)",,12004,CPT,Professional,Both,,,,641,544.85,43.41,641,BlueCross BlueShield Minnesota, Federal Employee Program,149.43,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Simple Repair Wounds Scalp, Nk, Axillae, Ext Genitalia,Trunk,Extremities; 7.6 Cm - 12.5 Cm (Pro Cah)",,12004,CPT,Professional,Both,,,,641,544.85,43.41,641,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,151.82088,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Simple Repair Wounds Scalp, Nk, Axillae, Ext Genitalia,Trunk,Extremities; 7.6 Cm - 12.5 Cm (Pro Cah)",,12004,CPT,Professional,Both,,,,641,544.85,43.41,641,BlueCross BlueShield Minnesota,High Value Network Plan,151.82088,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Simple Repair Wounds Scalp, Nk, Axillae, Ext Genitalia,Trunk,Extremities; 7.6 Cm - 12.5 Cm (Pro Cah)",,12004,CPT,Professional,Both,,,,641,544.85,43.41,641,BlueCross BlueShield Minnesota,Medicare Advantage,77.809,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Simple Repair Wounds Scalp, Nk, Axillae, Ext Genitalia,Trunk,Extremities; 7.6 Cm - 12.5 Cm (Pro Cah)",,12004,CPT,Professional,Both,,,,641,544.85,43.41,641,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,151.82088,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Simple Repair Wounds Scalp, Nk, Axillae, Ext Genitalia,Trunk,Extremities; 7.6 Cm - 12.5 Cm (Pro Cah)",,12004,CPT,Professional,Both,,,,641,544.85,43.41,641,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,50.11928,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Simple Repair Wounds Scalp, Nk, Axillae, Ext Genitalia,Trunk,Extremities; 7.6 Cm - 12.5 Cm (Pro Cah)",,12004,CPT,Professional,Both,,,,641,544.85,43.41,641,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),77.809,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Simple Repair Wounds Scalp, Nk, Axillae, Ext Genitalia,Trunk,Extremities; 7.6 Cm - 12.5 Cm (Pro Cah)",,12004,CPT,Professional,Both,,,,641,544.85,43.41,641,CorVel,Worker's Compensation,133.0657851,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Simple Repair Wounds Scalp, Nk, Axillae, Ext Genitalia,Trunk,Extremities; 7.6 Cm - 12.5 Cm (Pro Cah)",,12004,CPT,Professional,Both,,,,641,544.85,43.41,641,First Health Group Corporation,First Health Network,621.77,97,,percent of total billed charges,,
"Simple Repair Wounds Scalp, Nk, Axillae, Ext Genitalia,Trunk,Extremities; 7.6 Cm - 12.5 Cm (Pro Cah)",,12004,CPT,Professional,Both,,,,641,544.85,43.41,641,"Health Partners, Inc.",Commercial,144.38,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Simple Repair Wounds Scalp, Nk, Axillae, Ext Genitalia,Trunk,Extremities; 7.6 Cm - 12.5 Cm (Pro Cah)",,12004,CPT,Professional,Both,,,,641,544.85,43.41,641,"Health Partners, Inc.",Medicare Advantage,77.809,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Simple Repair Wounds Scalp, Nk, Axillae, Ext Genitalia,Trunk,Extremities; 7.6 Cm - 12.5 Cm (Pro Cah)",,12004,CPT,Professional,Both,,,,641,544.85,43.41,641,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),67.77,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Simple Repair Wounds Scalp, Nk, Axillae, Ext Genitalia,Trunk,Extremities; 7.6 Cm - 12.5 Cm (Pro Cah)",,12004,CPT,Professional,Both,,,,641,544.85,43.41,641,"Health Partners, Inc.",State of Minnesota Advantage Program,124.38337,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Simple Repair Wounds Scalp, Nk, Axillae, Ext Genitalia,Trunk,Extremities; 7.6 Cm - 12.5 Cm (Pro Cah)",,12004,CPT,Professional,Both,,,,641,544.85,43.41,641,"Health Partners, Inc.",State Public Programs,43.41,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Simple Repair Wounds Scalp, Nk, Axillae, Ext Genitalia,Trunk,Extremities; 7.6 Cm - 12.5 Cm (Pro Cah)",,12004,CPT,Professional,Both,,,,641,544.85,43.41,641,Humana Insurance Company,Commercial PPO,67.66,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Simple Repair Wounds Scalp, Nk, Axillae, Ext Genitalia,Trunk,Extremities; 7.6 Cm - 12.5 Cm (Pro Cah)",,12004,CPT,Professional,Both,,,,641,544.85,43.41,641,Humana Insurance Company,Medicare PPO,641,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Simple Repair Wounds Scalp, Nk, Axillae, Ext Genitalia,Trunk,Extremities; 7.6 Cm - 12.5 Cm (Pro Cah)",,12004,CPT,Professional,Both,,,,641,544.85,43.41,641,Medica,Individual & Family,543.568,84.8,,percent of total billed charges,,
"Simple Repair Wounds Scalp, Nk, Axillae, Ext Genitalia,Trunk,Extremities; 7.6 Cm - 12.5 Cm (Pro Cah)",,12004,CPT,Professional,Both,,,,641,544.85,43.41,641,Medica,Medica Advantage Solution,319.218,49.8,,percent of total billed charges,,
"Simple Repair Wounds Scalp, Nk, Axillae, Ext Genitalia,Trunk,Extremities; 7.6 Cm - 12.5 Cm (Pro Cah)",,12004,CPT,Professional,Both,,,,641,544.85,43.41,641,Medica,Medical Assistance,50.12,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Simple Repair Wounds Scalp, Nk, Axillae, Ext Genitalia,Trunk,Extremities; 7.6 Cm - 12.5 Cm (Pro Cah)",,12004,CPT,Professional,Both,,,,641,544.85,43.41,641,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,67.66,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Simple Repair Wounds Scalp, Nk, Axillae, Ext Genitalia,Trunk,Extremities; 7.6 Cm - 12.5 Cm (Pro Cah)",,12004,CPT,Professional,Both,,,,641,544.85,43.41,641,"Multiplan, Inc.","Multiplan, Inc.",602.54,94,,percent of total billed charges,,
"Simple Repair Wounds Scalp, Nk, Axillae, Ext Genitalia,Trunk,Extremities; 7.6 Cm - 12.5 Cm (Pro Cah)",,12004,CPT,Professional,Both,,,,641,544.85,43.41,641,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,577.541,90.1,,percent of total billed charges,,
"Simple Repair Wounds Scalp, Nk, Axillae, Ext Genitalia,Trunk,Extremities; 7.6 Cm - 12.5 Cm (Pro Cah)",,12004,CPT,Professional,Both,,,,641,544.85,43.41,641,"Preferred One Administrative Services, INC.",PPO,632.026,98.6,,percent of total billed charges,,
"Simple Repair Wounds Scalp, Nk, Axillae, Ext Genitalia,Trunk,Extremities; 7.6 Cm - 12.5 Cm (Pro Cah)",,12004,CPT,Professional,Both,,,,641,544.85,43.41,641,PrimeWest Health,Minnesota Senior Health Options (MSHO),77.809,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Simple Repair Wounds Scalp, Nk, Axillae, Ext Genitalia,Trunk,Extremities; 7.6 Cm - 12.5 Cm (Pro Cah)",,12004,CPT,Professional,Both,,,,641,544.85,43.41,641,PrimeWest Health,MinnesotaCare,53.6276296,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Simple Repair Wounds Scalp, Nk, Axillae, Ext Genitalia,Trunk,Extremities; 7.6 Cm - 12.5 Cm (Pro Cah)",,12004,CPT,Professional,Both,,,,641,544.85,43.41,641,Sanford Health Plan,Sanford Health Plan,564.08,88,,percent of total billed charges,,
"Simple Repair Wounds Scalp, Nk, Axillae, Ext Genitalia,Trunk,Extremities; 7.6 Cm - 12.5 Cm (Pro Cah)",,12004,CPT,Professional,Both,,,,641,544.85,43.41,641,"UCare Health, Inc.",Individual & Family Plan,109.988096,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Simple Repair Wounds Scalp, Nk, Axillae, Ext Genitalia,Trunk,Extremities; 7.6 Cm - 12.5 Cm (Pro Cah)",,12004,CPT,Professional,Both,,,,641,544.85,43.41,641,"UCare Health, Inc.",Medical Assistance,55.131208,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Simple Repair Wounds Scalp, Nk, Axillae, Ext Genitalia,Trunk,Extremities; 7.6 Cm - 12.5 Cm (Pro Cah)",,12004,CPT,Professional,Both,,,,641,544.85,43.41,641,"UCare Health, Inc.",Medicare Advantage,77.809,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Simple Repair Wounds Scalp, Nk, Axillae, Ext Genitalia,Trunk,Extremities; 7.6 Cm - 12.5 Cm (Pro Cah)",,12004,CPT,Professional,Both,,,,641,544.85,43.41,641,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),62.2472,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Simple Repair Wounds Scalp, Nk, Axillae, Ext Genitalia,Trunk,Extremities; 7.6 Cm - 12.5 Cm (Pro Cah)",,12004,CPT,Professional,Both,,,,641,544.85,43.41,641,UnitedHealthcare,Individual & Family,641,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Simple Repair Wounds Scalp, Nk, Axillae, Ext Genitalia,Trunk,Extremities; 7.6 Cm - 12.5 Cm (Pro Cah)",,12004,CPT,Professional,Both,,,,641,544.85,43.41,641,UnitedHealthcare,Medicare Advantage,77.809,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Simple Repair Wounds Scalp, Nk, Axillae, Ext Genitalia,Trunk,Extremities; 7.6 Cm - 12.5 Cm (Pro Cah)",,12004,CPT,Professional,Both,,,,641,544.85,43.41,641,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,50.11928,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Simple Repair Wounds Face, Ears, Eyelids, Nose, Lips, Mucous Membranes; 2.5 Cm Or Less (Pro Cah)",,12011,CPT,Professional,Both,,,,532,452.2,32.94,532,Aetna,Commercial,452.2,85,,percent of total billed charges,,
"Simple Repair Wounds Face, Ears, Eyelids, Nose, Lips, Mucous Membranes; 2.5 Cm Or Less (Pro Cah)",,12011,CPT,Professional,Both,,,,532,452.2,32.94,532,Aetna,Medicare Advantage,52.29,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Simple Repair Wounds Face, Ears, Eyelids, Nose, Lips, Mucous Membranes; 2.5 Cm Or Less (Pro Cah)",,12011,CPT,Professional,Both,,,,532,452.2,32.94,532,Aetna,PPO,494.76,93,,percent of total billed charges,,
"Simple Repair Wounds Face, Ears, Eyelids, Nose, Lips, Mucous Membranes; 2.5 Cm Or Less (Pro Cah)",,12011,CPT,Professional,Both,,,,532,452.2,32.94,532,America's PPO,America's PPO,454.5408,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Simple Repair Wounds Face, Ears, Eyelids, Nose, Lips, Mucous Membranes; 2.5 Cm Or Less (Pro Cah)",,12011,CPT,Professional,Both,,,,532,452.2,32.94,532,BlueCross BlueShield Minnesota, Federal Employee Program,112.93,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Simple Repair Wounds Face, Ears, Eyelids, Nose, Lips, Mucous Membranes; 2.5 Cm Or Less (Pro Cah)",,12011,CPT,Professional,Both,,,,532,452.2,32.94,532,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,114.73688,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Simple Repair Wounds Face, Ears, Eyelids, Nose, Lips, Mucous Membranes; 2.5 Cm Or Less (Pro Cah)",,12011,CPT,Professional,Both,,,,532,452.2,32.94,532,BlueCross BlueShield Minnesota,High Value Network Plan,114.73688,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Simple Repair Wounds Face, Ears, Eyelids, Nose, Lips, Mucous Membranes; 2.5 Cm Or Less (Pro Cah)",,12011,CPT,Professional,Both,,,,532,452.2,32.94,532,BlueCross BlueShield Minnesota,Medicare Advantage,58.9375,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Simple Repair Wounds Face, Ears, Eyelids, Nose, Lips, Mucous Membranes; 2.5 Cm Or Less (Pro Cah)",,12011,CPT,Professional,Both,,,,532,452.2,32.94,532,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,114.73688,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Simple Repair Wounds Face, Ears, Eyelids, Nose, Lips, Mucous Membranes; 2.5 Cm Or Less (Pro Cah)",,12011,CPT,Professional,Both,,,,532,452.2,32.94,532,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,38.02888,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Simple Repair Wounds Face, Ears, Eyelids, Nose, Lips, Mucous Membranes; 2.5 Cm Or Less (Pro Cah)",,12011,CPT,Professional,Both,,,,532,452.2,32.94,532,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),58.9375,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Simple Repair Wounds Face, Ears, Eyelids, Nose, Lips, Mucous Membranes; 2.5 Cm Or Less (Pro Cah)",,12011,CPT,Professional,Both,,,,532,452.2,32.94,532,CorVel,Worker's Compensation,100.6663356,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Simple Repair Wounds Face, Ears, Eyelids, Nose, Lips, Mucous Membranes; 2.5 Cm Or Less (Pro Cah)",,12011,CPT,Professional,Both,,,,532,452.2,32.94,532,First Health Group Corporation,First Health Network,516.04,97,,percent of total billed charges,,
"Simple Repair Wounds Face, Ears, Eyelids, Nose, Lips, Mucous Membranes; 2.5 Cm Or Less (Pro Cah)",,12011,CPT,Professional,Both,,,,532,452.2,32.94,532,"Health Partners, Inc.",Commercial,108.1,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Simple Repair Wounds Face, Ears, Eyelids, Nose, Lips, Mucous Membranes; 2.5 Cm Or Less (Pro Cah)",,12011,CPT,Professional,Both,,,,532,452.2,32.94,532,"Health Partners, Inc.",Medicare Advantage,58.9375,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Simple Repair Wounds Face, Ears, Eyelids, Nose, Lips, Mucous Membranes; 2.5 Cm Or Less (Pro Cah)",,12011,CPT,Professional,Both,,,,532,452.2,32.94,532,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),51.51,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Simple Repair Wounds Face, Ears, Eyelids, Nose, Lips, Mucous Membranes; 2.5 Cm Or Less (Pro Cah)",,12011,CPT,Professional,Both,,,,532,452.2,32.94,532,"Health Partners, Inc.",State of Minnesota Advantage Program,93.12815,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Simple Repair Wounds Face, Ears, Eyelids, Nose, Lips, Mucous Membranes; 2.5 Cm Or Less (Pro Cah)",,12011,CPT,Professional,Both,,,,532,452.2,32.94,532,"Health Partners, Inc.",State Public Programs,32.94,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Simple Repair Wounds Face, Ears, Eyelids, Nose, Lips, Mucous Membranes; 2.5 Cm Or Less (Pro Cah)",,12011,CPT,Professional,Both,,,,532,452.2,32.94,532,Humana Insurance Company,Commercial PPO,51.25,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Simple Repair Wounds Face, Ears, Eyelids, Nose, Lips, Mucous Membranes; 2.5 Cm Or Less (Pro Cah)",,12011,CPT,Professional,Both,,,,532,452.2,32.94,532,Humana Insurance Company,Medicare PPO,532,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Simple Repair Wounds Face, Ears, Eyelids, Nose, Lips, Mucous Membranes; 2.5 Cm Or Less (Pro Cah)",,12011,CPT,Professional,Both,,,,532,452.2,32.94,532,Medica,Individual & Family,451.136,84.8,,percent of total billed charges,,
"Simple Repair Wounds Face, Ears, Eyelids, Nose, Lips, Mucous Membranes; 2.5 Cm Or Less (Pro Cah)",,12011,CPT,Professional,Both,,,,532,452.2,32.94,532,Medica,Medica Advantage Solution,264.936,49.8,,percent of total billed charges,,
"Simple Repair Wounds Face, Ears, Eyelids, Nose, Lips, Mucous Membranes; 2.5 Cm Or Less (Pro Cah)",,12011,CPT,Professional,Both,,,,532,452.2,32.94,532,Medica,Medical Assistance,38.03,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Simple Repair Wounds Face, Ears, Eyelids, Nose, Lips, Mucous Membranes; 2.5 Cm Or Less (Pro Cah)",,12011,CPT,Professional,Both,,,,532,452.2,32.94,532,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,51.25,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Simple Repair Wounds Face, Ears, Eyelids, Nose, Lips, Mucous Membranes; 2.5 Cm Or Less (Pro Cah)",,12011,CPT,Professional,Both,,,,532,452.2,32.94,532,"Multiplan, Inc.","Multiplan, Inc.",500.08,94,,percent of total billed charges,,
"Simple Repair Wounds Face, Ears, Eyelids, Nose, Lips, Mucous Membranes; 2.5 Cm Or Less (Pro Cah)",,12011,CPT,Professional,Both,,,,532,452.2,32.94,532,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,479.332,90.1,,percent of total billed charges,,
"Simple Repair Wounds Face, Ears, Eyelids, Nose, Lips, Mucous Membranes; 2.5 Cm Or Less (Pro Cah)",,12011,CPT,Professional,Both,,,,532,452.2,32.94,532,"Preferred One Administrative Services, INC.",PPO,524.552,98.6,,percent of total billed charges,,
"Simple Repair Wounds Face, Ears, Eyelids, Nose, Lips, Mucous Membranes; 2.5 Cm Or Less (Pro Cah)",,12011,CPT,Professional,Both,,,,532,452.2,32.94,532,PrimeWest Health,Minnesota Senior Health Options (MSHO),58.9375,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Simple Repair Wounds Face, Ears, Eyelids, Nose, Lips, Mucous Membranes; 2.5 Cm Or Less (Pro Cah)",,12011,CPT,Professional,Both,,,,532,452.2,32.94,532,PrimeWest Health,MinnesotaCare,40.6909016,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Simple Repair Wounds Face, Ears, Eyelids, Nose, Lips, Mucous Membranes; 2.5 Cm Or Less (Pro Cah)",,12011,CPT,Professional,Both,,,,532,452.2,32.94,532,Sanford Health Plan,Sanford Health Plan,468.16,88,,percent of total billed charges,,
"Simple Repair Wounds Face, Ears, Eyelids, Nose, Lips, Mucous Membranes; 2.5 Cm Or Less (Pro Cah)",,12011,CPT,Professional,Both,,,,532,452.2,32.94,532,"UCare Health, Inc.",Individual & Family Plan,83.312,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Simple Repair Wounds Face, Ears, Eyelids, Nose, Lips, Mucous Membranes; 2.5 Cm Or Less (Pro Cah)",,12011,CPT,Professional,Both,,,,532,452.2,32.94,532,"UCare Health, Inc.",Medical Assistance,41.831768,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Simple Repair Wounds Face, Ears, Eyelids, Nose, Lips, Mucous Membranes; 2.5 Cm Or Less (Pro Cah)",,12011,CPT,Professional,Both,,,,532,452.2,32.94,532,"UCare Health, Inc.",Medicare Advantage,58.9375,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Simple Repair Wounds Face, Ears, Eyelids, Nose, Lips, Mucous Membranes; 2.5 Cm Or Less (Pro Cah)",,12011,CPT,Professional,Both,,,,532,452.2,32.94,532,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),47.15,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Simple Repair Wounds Face, Ears, Eyelids, Nose, Lips, Mucous Membranes; 2.5 Cm Or Less (Pro Cah)",,12011,CPT,Professional,Both,,,,532,452.2,32.94,532,UnitedHealthcare,Individual & Family,532,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Simple Repair Wounds Face, Ears, Eyelids, Nose, Lips, Mucous Membranes; 2.5 Cm Or Less (Pro Cah)",,12011,CPT,Professional,Both,,,,532,452.2,32.94,532,UnitedHealthcare,Medicare Advantage,58.9375,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Simple Repair Wounds Face, Ears, Eyelids, Nose, Lips, Mucous Membranes; 2.5 Cm Or Less (Pro Cah)",,12011,CPT,Professional,Both,,,,532,452.2,32.94,532,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,38.02888,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Simple Repair Wounds Face, Ears, Eyelids, Nose, Lips, Mucous Membranes; 2.6 Cm-5.0 Cm (Pro Cah)",,12013,CPT,Professional,Both,,,,500,425,34.25,500,Aetna,Commercial,425,85,,percent of total billed charges,,
"Simple Repair Wounds Face, Ears, Eyelids, Nose, Lips, Mucous Membranes; 2.6 Cm-5.0 Cm (Pro Cah)",,12013,CPT,Professional,Both,,,,500,425,34.25,500,Aetna,Medicare Advantage,54.59,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Simple Repair Wounds Face, Ears, Eyelids, Nose, Lips, Mucous Membranes; 2.6 Cm-5.0 Cm (Pro Cah)",,12013,CPT,Professional,Both,,,,500,425,34.25,500,Aetna,PPO,465,93,,percent of total billed charges,,
"Simple Repair Wounds Face, Ears, Eyelids, Nose, Lips, Mucous Membranes; 2.6 Cm-5.0 Cm (Pro Cah)",,12013,CPT,Professional,Both,,,,500,425,34.25,500,America's PPO,America's PPO,427.2,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Simple Repair Wounds Face, Ears, Eyelids, Nose, Lips, Mucous Membranes; 2.6 Cm-5.0 Cm (Pro Cah)",,12013,CPT,Professional,Both,,,,500,425,34.25,500,BlueCross BlueShield Minnesota, Federal Employee Program,119.82,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Simple Repair Wounds Face, Ears, Eyelids, Nose, Lips, Mucous Membranes; 2.6 Cm-5.0 Cm (Pro Cah)",,12013,CPT,Professional,Both,,,,500,425,34.25,500,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,121.73712,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Simple Repair Wounds Face, Ears, Eyelids, Nose, Lips, Mucous Membranes; 2.6 Cm-5.0 Cm (Pro Cah)",,12013,CPT,Professional,Both,,,,500,425,34.25,500,BlueCross BlueShield Minnesota,High Value Network Plan,121.73712,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Simple Repair Wounds Face, Ears, Eyelids, Nose, Lips, Mucous Membranes; 2.6 Cm-5.0 Cm (Pro Cah)",,12013,CPT,Professional,Both,,,,500,425,34.25,500,BlueCross BlueShield Minnesota,Medicare Advantage,61.4445,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Simple Repair Wounds Face, Ears, Eyelids, Nose, Lips, Mucous Membranes; 2.6 Cm-5.0 Cm (Pro Cah)",,12013,CPT,Professional,Both,,,,500,425,34.25,500,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,121.73712,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Simple Repair Wounds Face, Ears, Eyelids, Nose, Lips, Mucous Membranes; 2.6 Cm-5.0 Cm (Pro Cah)",,12013,CPT,Professional,Both,,,,500,425,34.25,500,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,39.54272,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Simple Repair Wounds Face, Ears, Eyelids, Nose, Lips, Mucous Membranes; 2.6 Cm-5.0 Cm (Pro Cah)",,12013,CPT,Professional,Both,,,,500,425,34.25,500,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),61.4445,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Simple Repair Wounds Face, Ears, Eyelids, Nose, Lips, Mucous Membranes; 2.6 Cm-5.0 Cm (Pro Cah)",,12013,CPT,Professional,Both,,,,500,425,34.25,500,CorVel,Worker's Compensation,105.329277,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Simple Repair Wounds Face, Ears, Eyelids, Nose, Lips, Mucous Membranes; 2.6 Cm-5.0 Cm (Pro Cah)",,12013,CPT,Professional,Both,,,,500,425,34.25,500,First Health Group Corporation,First Health Network,485,97,,percent of total billed charges,,
"Simple Repair Wounds Face, Ears, Eyelids, Nose, Lips, Mucous Membranes; 2.6 Cm-5.0 Cm (Pro Cah)",,12013,CPT,Professional,Both,,,,500,425,34.25,500,"Health Partners, Inc.",Commercial,113.18,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Simple Repair Wounds Face, Ears, Eyelids, Nose, Lips, Mucous Membranes; 2.6 Cm-5.0 Cm (Pro Cah)",,12013,CPT,Professional,Both,,,,500,425,34.25,500,"Health Partners, Inc.",Medicare Advantage,61.4445,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Simple Repair Wounds Face, Ears, Eyelids, Nose, Lips, Mucous Membranes; 2.6 Cm-5.0 Cm (Pro Cah)",,12013,CPT,Professional,Both,,,,500,425,34.25,500,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),53.54,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Simple Repair Wounds Face, Ears, Eyelids, Nose, Lips, Mucous Membranes; 2.6 Cm-5.0 Cm (Pro Cah)",,12013,CPT,Professional,Both,,,,500,425,34.25,500,"Health Partners, Inc.",State of Minnesota Advantage Program,97.50457,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Simple Repair Wounds Face, Ears, Eyelids, Nose, Lips, Mucous Membranes; 2.6 Cm-5.0 Cm (Pro Cah)",,12013,CPT,Professional,Both,,,,500,425,34.25,500,"Health Partners, Inc.",State Public Programs,34.25,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Simple Repair Wounds Face, Ears, Eyelids, Nose, Lips, Mucous Membranes; 2.6 Cm-5.0 Cm (Pro Cah)",,12013,CPT,Professional,Both,,,,500,425,34.25,500,Humana Insurance Company,Commercial PPO,53.43,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Simple Repair Wounds Face, Ears, Eyelids, Nose, Lips, Mucous Membranes; 2.6 Cm-5.0 Cm (Pro Cah)",,12013,CPT,Professional,Both,,,,500,425,34.25,500,Humana Insurance Company,Medicare PPO,500,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Simple Repair Wounds Face, Ears, Eyelids, Nose, Lips, Mucous Membranes; 2.6 Cm-5.0 Cm (Pro Cah)",,12013,CPT,Professional,Both,,,,500,425,34.25,500,Medica,Individual & Family,424,84.8,,percent of total billed charges,,
"Simple Repair Wounds Face, Ears, Eyelids, Nose, Lips, Mucous Membranes; 2.6 Cm-5.0 Cm (Pro Cah)",,12013,CPT,Professional,Both,,,,500,425,34.25,500,Medica,Medica Advantage Solution,249,49.8,,percent of total billed charges,,
"Simple Repair Wounds Face, Ears, Eyelids, Nose, Lips, Mucous Membranes; 2.6 Cm-5.0 Cm (Pro Cah)",,12013,CPT,Professional,Both,,,,500,425,34.25,500,Medica,Medical Assistance,39.54,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Simple Repair Wounds Face, Ears, Eyelids, Nose, Lips, Mucous Membranes; 2.6 Cm-5.0 Cm (Pro Cah)",,12013,CPT,Professional,Both,,,,500,425,34.25,500,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,53.43,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Simple Repair Wounds Face, Ears, Eyelids, Nose, Lips, Mucous Membranes; 2.6 Cm-5.0 Cm (Pro Cah)",,12013,CPT,Professional,Both,,,,500,425,34.25,500,"Multiplan, Inc.","Multiplan, Inc.",470,94,,percent of total billed charges,,
"Simple Repair Wounds Face, Ears, Eyelids, Nose, Lips, Mucous Membranes; 2.6 Cm-5.0 Cm (Pro Cah)",,12013,CPT,Professional,Both,,,,500,425,34.25,500,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,450.5,90.1,,percent of total billed charges,,
"Simple Repair Wounds Face, Ears, Eyelids, Nose, Lips, Mucous Membranes; 2.6 Cm-5.0 Cm (Pro Cah)",,12013,CPT,Professional,Both,,,,500,425,34.25,500,"Preferred One Administrative Services, INC.",PPO,493,98.6,,percent of total billed charges,,
"Simple Repair Wounds Face, Ears, Eyelids, Nose, Lips, Mucous Membranes; 2.6 Cm-5.0 Cm (Pro Cah)",,12013,CPT,Professional,Both,,,,500,425,34.25,500,PrimeWest Health,Minnesota Senior Health Options (MSHO),61.4445,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Simple Repair Wounds Face, Ears, Eyelids, Nose, Lips, Mucous Membranes; 2.6 Cm-5.0 Cm (Pro Cah)",,12013,CPT,Professional,Both,,,,500,425,34.25,500,PrimeWest Health,MinnesotaCare,42.3107104,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Simple Repair Wounds Face, Ears, Eyelids, Nose, Lips, Mucous Membranes; 2.6 Cm-5.0 Cm (Pro Cah)",,12013,CPT,Professional,Both,,,,500,425,34.25,500,Sanford Health Plan,Sanford Health Plan,440,88,,percent of total billed charges,,
"Simple Repair Wounds Face, Ears, Eyelids, Nose, Lips, Mucous Membranes; 2.6 Cm-5.0 Cm (Pro Cah)",,12013,CPT,Professional,Both,,,,500,425,34.25,500,"UCare Health, Inc.",Individual & Family Plan,86.855808,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Simple Repair Wounds Face, Ears, Eyelids, Nose, Lips, Mucous Membranes; 2.6 Cm-5.0 Cm (Pro Cah)",,12013,CPT,Professional,Both,,,,500,425,34.25,500,"UCare Health, Inc.",Medical Assistance,43.496992,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Simple Repair Wounds Face, Ears, Eyelids, Nose, Lips, Mucous Membranes; 2.6 Cm-5.0 Cm (Pro Cah)",,12013,CPT,Professional,Both,,,,500,425,34.25,500,"UCare Health, Inc.",Medicare Advantage,61.4445,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Simple Repair Wounds Face, Ears, Eyelids, Nose, Lips, Mucous Membranes; 2.6 Cm-5.0 Cm (Pro Cah)",,12013,CPT,Professional,Both,,,,500,425,34.25,500,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),49.1556,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Simple Repair Wounds Face, Ears, Eyelids, Nose, Lips, Mucous Membranes; 2.6 Cm-5.0 Cm (Pro Cah)",,12013,CPT,Professional,Both,,,,500,425,34.25,500,UnitedHealthcare,Individual & Family,500,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Simple Repair Wounds Face, Ears, Eyelids, Nose, Lips, Mucous Membranes; 2.6 Cm-5.0 Cm (Pro Cah)",,12013,CPT,Professional,Both,,,,500,425,34.25,500,UnitedHealthcare,Medicare Advantage,61.4445,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Simple Repair Wounds Face, Ears, Eyelids, Nose, Lips, Mucous Membranes; 2.6 Cm-5.0 Cm (Pro Cah)",,12013,CPT,Professional,Both,,,,500,425,34.25,500,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,39.54272,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Simple Repair Wounds Of Face, Ears, Eyelids, Nose, Lips, Mucous Membranes; 5.1 Cm - 7.5 Cm (Pro Cah)",,12014,CPT,Professional,Both,,,,643,546.55,44.06,643,Aetna,Commercial,546.55,85,,percent of total billed charges,,
"Simple Repair Wounds Of Face, Ears, Eyelids, Nose, Lips, Mucous Membranes; 5.1 Cm - 7.5 Cm (Pro Cah)",,12014,CPT,Professional,Both,,,,643,546.55,44.06,643,Aetna,Medicare Advantage,70.14,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Simple Repair Wounds Of Face, Ears, Eyelids, Nose, Lips, Mucous Membranes; 5.1 Cm - 7.5 Cm (Pro Cah)",,12014,CPT,Professional,Both,,,,643,546.55,44.06,643,Aetna,PPO,597.99,93,,percent of total billed charges,,
"Simple Repair Wounds Of Face, Ears, Eyelids, Nose, Lips, Mucous Membranes; 5.1 Cm - 7.5 Cm (Pro Cah)",,12014,CPT,Professional,Both,,,,643,546.55,44.06,643,America's PPO,America's PPO,549.3792,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Simple Repair Wounds Of Face, Ears, Eyelids, Nose, Lips, Mucous Membranes; 5.1 Cm - 7.5 Cm (Pro Cah)",,12014,CPT,Professional,Both,,,,643,546.55,44.06,643,BlueCross BlueShield Minnesota, Federal Employee Program,152.87,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Simple Repair Wounds Of Face, Ears, Eyelids, Nose, Lips, Mucous Membranes; 5.1 Cm - 7.5 Cm (Pro Cah)",,12014,CPT,Professional,Both,,,,643,546.55,44.06,643,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,155.31592,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Simple Repair Wounds Of Face, Ears, Eyelids, Nose, Lips, Mucous Membranes; 5.1 Cm - 7.5 Cm (Pro Cah)",,12014,CPT,Professional,Both,,,,643,546.55,44.06,643,BlueCross BlueShield Minnesota,High Value Network Plan,155.31592,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Simple Repair Wounds Of Face, Ears, Eyelids, Nose, Lips, Mucous Membranes; 5.1 Cm - 7.5 Cm (Pro Cah)",,12014,CPT,Professional,Both,,,,643,546.55,44.06,643,BlueCross BlueShield Minnesota,Medicare Advantage,78.89,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Simple Repair Wounds Of Face, Ears, Eyelids, Nose, Lips, Mucous Membranes; 5.1 Cm - 7.5 Cm (Pro Cah)",,12014,CPT,Professional,Both,,,,643,546.55,44.06,643,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,155.31592,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Simple Repair Wounds Of Face, Ears, Eyelids, Nose, Lips, Mucous Membranes; 5.1 Cm - 7.5 Cm (Pro Cah)",,12014,CPT,Professional,Both,,,,643,546.55,44.06,643,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,50.87112,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Simple Repair Wounds Of Face, Ears, Eyelids, Nose, Lips, Mucous Membranes; 5.1 Cm - 7.5 Cm (Pro Cah)",,12014,CPT,Professional,Both,,,,643,546.55,44.06,643,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),78.89,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Simple Repair Wounds Of Face, Ears, Eyelids, Nose, Lips, Mucous Membranes; 5.1 Cm - 7.5 Cm (Pro Cah)",,12014,CPT,Professional,Both,,,,643,546.55,44.06,643,CorVel,Worker's Compensation,135.2615724,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Simple Repair Wounds Of Face, Ears, Eyelids, Nose, Lips, Mucous Membranes; 5.1 Cm - 7.5 Cm (Pro Cah)",,12014,CPT,Professional,Both,,,,643,546.55,44.06,643,First Health Group Corporation,First Health Network,623.71,97,,percent of total billed charges,,
"Simple Repair Wounds Of Face, Ears, Eyelids, Nose, Lips, Mucous Membranes; 5.1 Cm - 7.5 Cm (Pro Cah)",,12014,CPT,Professional,Both,,,,643,546.55,44.06,643,"Health Partners, Inc.",Commercial,145.83,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Simple Repair Wounds Of Face, Ears, Eyelids, Nose, Lips, Mucous Membranes; 5.1 Cm - 7.5 Cm (Pro Cah)",,12014,CPT,Professional,Both,,,,643,546.55,44.06,643,"Health Partners, Inc.",Medicare Advantage,78.89,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Simple Repair Wounds Of Face, Ears, Eyelids, Nose, Lips, Mucous Membranes; 5.1 Cm - 7.5 Cm (Pro Cah)",,12014,CPT,Professional,Both,,,,643,546.55,44.06,643,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),68.79,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Simple Repair Wounds Of Face, Ears, Eyelids, Nose, Lips, Mucous Membranes; 5.1 Cm - 7.5 Cm (Pro Cah)",,12014,CPT,Professional,Both,,,,643,546.55,44.06,643,"Health Partners, Inc.",State of Minnesota Advantage Program,125.632545,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Simple Repair Wounds Of Face, Ears, Eyelids, Nose, Lips, Mucous Membranes; 5.1 Cm - 7.5 Cm (Pro Cah)",,12014,CPT,Professional,Both,,,,643,546.55,44.06,643,"Health Partners, Inc.",State Public Programs,44.06,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Simple Repair Wounds Of Face, Ears, Eyelids, Nose, Lips, Mucous Membranes; 5.1 Cm - 7.5 Cm (Pro Cah)",,12014,CPT,Professional,Both,,,,643,546.55,44.06,643,Humana Insurance Company,Commercial PPO,68.6,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Simple Repair Wounds Of Face, Ears, Eyelids, Nose, Lips, Mucous Membranes; 5.1 Cm - 7.5 Cm (Pro Cah)",,12014,CPT,Professional,Both,,,,643,546.55,44.06,643,Humana Insurance Company,Medicare PPO,643,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Simple Repair Wounds Of Face, Ears, Eyelids, Nose, Lips, Mucous Membranes; 5.1 Cm - 7.5 Cm (Pro Cah)",,12014,CPT,Professional,Both,,,,643,546.55,44.06,643,Medica,Individual & Family,545.264,84.8,,percent of total billed charges,,
"Simple Repair Wounds Of Face, Ears, Eyelids, Nose, Lips, Mucous Membranes; 5.1 Cm - 7.5 Cm (Pro Cah)",,12014,CPT,Professional,Both,,,,643,546.55,44.06,643,Medica,Medica Advantage Solution,320.214,49.8,,percent of total billed charges,,
"Simple Repair Wounds Of Face, Ears, Eyelids, Nose, Lips, Mucous Membranes; 5.1 Cm - 7.5 Cm (Pro Cah)",,12014,CPT,Professional,Both,,,,643,546.55,44.06,643,Medica,Medical Assistance,50.87,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Simple Repair Wounds Of Face, Ears, Eyelids, Nose, Lips, Mucous Membranes; 5.1 Cm - 7.5 Cm (Pro Cah)",,12014,CPT,Professional,Both,,,,643,546.55,44.06,643,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,68.6,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Simple Repair Wounds Of Face, Ears, Eyelids, Nose, Lips, Mucous Membranes; 5.1 Cm - 7.5 Cm (Pro Cah)",,12014,CPT,Professional,Both,,,,643,546.55,44.06,643,"Multiplan, Inc.","Multiplan, Inc.",604.42,94,,percent of total billed charges,,
"Simple Repair Wounds Of Face, Ears, Eyelids, Nose, Lips, Mucous Membranes; 5.1 Cm - 7.5 Cm (Pro Cah)",,12014,CPT,Professional,Both,,,,643,546.55,44.06,643,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,579.343,90.1,,percent of total billed charges,,
"Simple Repair Wounds Of Face, Ears, Eyelids, Nose, Lips, Mucous Membranes; 5.1 Cm - 7.5 Cm (Pro Cah)",,12014,CPT,Professional,Both,,,,643,546.55,44.06,643,"Preferred One Administrative Services, INC.",PPO,633.998,98.6,,percent of total billed charges,,
"Simple Repair Wounds Of Face, Ears, Eyelids, Nose, Lips, Mucous Membranes; 5.1 Cm - 7.5 Cm (Pro Cah)",,12014,CPT,Professional,Both,,,,643,546.55,44.06,643,PrimeWest Health,Minnesota Senior Health Options (MSHO),78.89,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Simple Repair Wounds Of Face, Ears, Eyelids, Nose, Lips, Mucous Membranes; 5.1 Cm - 7.5 Cm (Pro Cah)",,12014,CPT,Professional,Both,,,,643,546.55,44.06,643,PrimeWest Health,MinnesotaCare,54.4320984,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Simple Repair Wounds Of Face, Ears, Eyelids, Nose, Lips, Mucous Membranes; 5.1 Cm - 7.5 Cm (Pro Cah)",,12014,CPT,Professional,Both,,,,643,546.55,44.06,643,Sanford Health Plan,Sanford Health Plan,565.84,88,,percent of total billed charges,,
"Simple Repair Wounds Of Face, Ears, Eyelids, Nose, Lips, Mucous Membranes; 5.1 Cm - 7.5 Cm (Pro Cah)",,12014,CPT,Professional,Both,,,,643,546.55,44.06,643,"UCare Health, Inc.",Individual & Family Plan,111.51616,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Simple Repair Wounds Of Face, Ears, Eyelids, Nose, Lips, Mucous Membranes; 5.1 Cm - 7.5 Cm (Pro Cah)",,12014,CPT,Professional,Both,,,,643,546.55,44.06,643,"UCare Health, Inc.",Medical Assistance,55.958232,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Simple Repair Wounds Of Face, Ears, Eyelids, Nose, Lips, Mucous Membranes; 5.1 Cm - 7.5 Cm (Pro Cah)",,12014,CPT,Professional,Both,,,,643,546.55,44.06,643,"UCare Health, Inc.",Medicare Advantage,78.89,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Simple Repair Wounds Of Face, Ears, Eyelids, Nose, Lips, Mucous Membranes; 5.1 Cm - 7.5 Cm (Pro Cah)",,12014,CPT,Professional,Both,,,,643,546.55,44.06,643,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),63.112,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Simple Repair Wounds Of Face, Ears, Eyelids, Nose, Lips, Mucous Membranes; 5.1 Cm - 7.5 Cm (Pro Cah)",,12014,CPT,Professional,Both,,,,643,546.55,44.06,643,UnitedHealthcare,Individual & Family,643,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Simple Repair Wounds Of Face, Ears, Eyelids, Nose, Lips, Mucous Membranes; 5.1 Cm - 7.5 Cm (Pro Cah)",,12014,CPT,Professional,Both,,,,643,546.55,44.06,643,UnitedHealthcare,Medicare Advantage,78.89,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Simple Repair Wounds Of Face, Ears, Eyelids, Nose, Lips, Mucous Membranes; 5.1 Cm - 7.5 Cm (Pro Cah)",,12014,CPT,Professional,Both,,,,643,546.55,44.06,643,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,50.87112,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Simple Repair Wounds Face, Ears, Eyelids, Nose, Lips, Mucous Membranes; 7.6 Cm - 12.5 Cm (Pro Cah)",,12015,CPT,Professional,Both,,,,561,476.85,55.62,561,Aetna,Commercial,476.85,85,,percent of total billed charges,,
"Simple Repair Wounds Face, Ears, Eyelids, Nose, Lips, Mucous Membranes; 7.6 Cm - 12.5 Cm (Pro Cah)",,12015,CPT,Professional,Both,,,,561,476.85,55.62,561,Aetna,Medicare Advantage,88.61,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Simple Repair Wounds Face, Ears, Eyelids, Nose, Lips, Mucous Membranes; 7.6 Cm - 12.5 Cm (Pro Cah)",,12015,CPT,Professional,Both,,,,561,476.85,55.62,561,Aetna,PPO,521.73,93,,percent of total billed charges,,
"Simple Repair Wounds Face, Ears, Eyelids, Nose, Lips, Mucous Membranes; 7.6 Cm - 12.5 Cm (Pro Cah)",,12015,CPT,Professional,Both,,,,561,476.85,55.62,561,America's PPO,America's PPO,479.3184,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Simple Repair Wounds Face, Ears, Eyelids, Nose, Lips, Mucous Membranes; 7.6 Cm - 12.5 Cm (Pro Cah)",,12015,CPT,Professional,Both,,,,561,476.85,55.62,561,BlueCross BlueShield Minnesota, Federal Employee Program,192.81,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Simple Repair Wounds Face, Ears, Eyelids, Nose, Lips, Mucous Membranes; 7.6 Cm - 12.5 Cm (Pro Cah)",,12015,CPT,Professional,Both,,,,561,476.85,55.62,561,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,195.89496,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Simple Repair Wounds Face, Ears, Eyelids, Nose, Lips, Mucous Membranes; 7.6 Cm - 12.5 Cm (Pro Cah)",,12015,CPT,Professional,Both,,,,561,476.85,55.62,561,BlueCross BlueShield Minnesota,High Value Network Plan,195.89496,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Simple Repair Wounds Face, Ears, Eyelids, Nose, Lips, Mucous Membranes; 7.6 Cm - 12.5 Cm (Pro Cah)",,12015,CPT,Professional,Both,,,,561,476.85,55.62,561,BlueCross BlueShield Minnesota,Medicare Advantage,99.4635,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Simple Repair Wounds Face, Ears, Eyelids, Nose, Lips, Mucous Membranes; 7.6 Cm - 12.5 Cm (Pro Cah)",,12015,CPT,Professional,Both,,,,561,476.85,55.62,561,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,195.89496,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Simple Repair Wounds Face, Ears, Eyelids, Nose, Lips, Mucous Membranes; 7.6 Cm - 12.5 Cm (Pro Cah)",,12015,CPT,Professional,Both,,,,561,476.85,55.62,561,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,64.22136,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Simple Repair Wounds Face, Ears, Eyelids, Nose, Lips, Mucous Membranes; 7.6 Cm - 12.5 Cm (Pro Cah)",,12015,CPT,Professional,Both,,,,561,476.85,55.62,561,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),99.4635,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Simple Repair Wounds Face, Ears, Eyelids, Nose, Lips, Mucous Membranes; 7.6 Cm - 12.5 Cm (Pro Cah)",,12015,CPT,Professional,Both,,,,561,476.85,55.62,561,CorVel,Worker's Compensation,170.8220421,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Simple Repair Wounds Face, Ears, Eyelids, Nose, Lips, Mucous Membranes; 7.6 Cm - 12.5 Cm (Pro Cah)",,12015,CPT,Professional,Both,,,,561,476.85,55.62,561,First Health Group Corporation,First Health Network,544.17,97,,percent of total billed charges,,
"Simple Repair Wounds Face, Ears, Eyelids, Nose, Lips, Mucous Membranes; 7.6 Cm - 12.5 Cm (Pro Cah)",,12015,CPT,Professional,Both,,,,561,476.85,55.62,561,"Health Partners, Inc.",Commercial,185.01,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Simple Repair Wounds Face, Ears, Eyelids, Nose, Lips, Mucous Membranes; 7.6 Cm - 12.5 Cm (Pro Cah)",,12015,CPT,Professional,Both,,,,561,476.85,55.62,561,"Health Partners, Inc.",Medicare Advantage,99.4635,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Simple Repair Wounds Face, Ears, Eyelids, Nose, Lips, Mucous Membranes; 7.6 Cm - 12.5 Cm (Pro Cah)",,12015,CPT,Professional,Both,,,,561,476.85,55.62,561,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),86.41,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Simple Repair Wounds Face, Ears, Eyelids, Nose, Lips, Mucous Membranes; 7.6 Cm - 12.5 Cm (Pro Cah)",,12015,CPT,Professional,Both,,,,561,476.85,55.62,561,"Health Partners, Inc.",State of Minnesota Advantage Program,159.386115,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Simple Repair Wounds Face, Ears, Eyelids, Nose, Lips, Mucous Membranes; 7.6 Cm - 12.5 Cm (Pro Cah)",,12015,CPT,Professional,Both,,,,561,476.85,55.62,561,"Health Partners, Inc.",State Public Programs,55.62,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Simple Repair Wounds Face, Ears, Eyelids, Nose, Lips, Mucous Membranes; 7.6 Cm - 12.5 Cm (Pro Cah)",,12015,CPT,Professional,Both,,,,561,476.85,55.62,561,Humana Insurance Company,Commercial PPO,86.49,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Simple Repair Wounds Face, Ears, Eyelids, Nose, Lips, Mucous Membranes; 7.6 Cm - 12.5 Cm (Pro Cah)",,12015,CPT,Professional,Both,,,,561,476.85,55.62,561,Humana Insurance Company,Medicare PPO,561,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Simple Repair Wounds Face, Ears, Eyelids, Nose, Lips, Mucous Membranes; 7.6 Cm - 12.5 Cm (Pro Cah)",,12015,CPT,Professional,Both,,,,561,476.85,55.62,561,Medica,Individual & Family,475.728,84.8,,percent of total billed charges,,
"Simple Repair Wounds Face, Ears, Eyelids, Nose, Lips, Mucous Membranes; 7.6 Cm - 12.5 Cm (Pro Cah)",,12015,CPT,Professional,Both,,,,561,476.85,55.62,561,Medica,Medica Advantage Solution,279.378,49.8,,percent of total billed charges,,
"Simple Repair Wounds Face, Ears, Eyelids, Nose, Lips, Mucous Membranes; 7.6 Cm - 12.5 Cm (Pro Cah)",,12015,CPT,Professional,Both,,,,561,476.85,55.62,561,Medica,Medical Assistance,64.22,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Simple Repair Wounds Face, Ears, Eyelids, Nose, Lips, Mucous Membranes; 7.6 Cm - 12.5 Cm (Pro Cah)",,12015,CPT,Professional,Both,,,,561,476.85,55.62,561,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,86.49,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Simple Repair Wounds Face, Ears, Eyelids, Nose, Lips, Mucous Membranes; 7.6 Cm - 12.5 Cm (Pro Cah)",,12015,CPT,Professional,Both,,,,561,476.85,55.62,561,"Multiplan, Inc.","Multiplan, Inc.",527.34,94,,percent of total billed charges,,
"Simple Repair Wounds Face, Ears, Eyelids, Nose, Lips, Mucous Membranes; 7.6 Cm - 12.5 Cm (Pro Cah)",,12015,CPT,Professional,Both,,,,561,476.85,55.62,561,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,505.461,90.1,,percent of total billed charges,,
"Simple Repair Wounds Face, Ears, Eyelids, Nose, Lips, Mucous Membranes; 7.6 Cm - 12.5 Cm (Pro Cah)",,12015,CPT,Professional,Both,,,,561,476.85,55.62,561,"Preferred One Administrative Services, INC.",PPO,553.146,98.6,,percent of total billed charges,,
"Simple Repair Wounds Face, Ears, Eyelids, Nose, Lips, Mucous Membranes; 7.6 Cm - 12.5 Cm (Pro Cah)",,12015,CPT,Professional,Both,,,,561,476.85,55.62,561,PrimeWest Health,Minnesota Senior Health Options (MSHO),99.4635,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Simple Repair Wounds Face, Ears, Eyelids, Nose, Lips, Mucous Membranes; 7.6 Cm - 12.5 Cm (Pro Cah)",,12015,CPT,Professional,Both,,,,561,476.85,55.62,561,PrimeWest Health,MinnesotaCare,68.7168552,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Simple Repair Wounds Face, Ears, Eyelids, Nose, Lips, Mucous Membranes; 7.6 Cm - 12.5 Cm (Pro Cah)",,12015,CPT,Professional,Both,,,,561,476.85,55.62,561,Sanford Health Plan,Sanford Health Plan,493.68,88,,percent of total billed charges,,
"Simple Repair Wounds Face, Ears, Eyelids, Nose, Lips, Mucous Membranes; 7.6 Cm - 12.5 Cm (Pro Cah)",,12015,CPT,Professional,Both,,,,561,476.85,55.62,561,"UCare Health, Inc.",Individual & Family Plan,140.598144,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Simple Repair Wounds Face, Ears, Eyelids, Nose, Lips, Mucous Membranes; 7.6 Cm - 12.5 Cm (Pro Cah)",,12015,CPT,Professional,Both,,,,561,476.85,55.62,561,"UCare Health, Inc.",Medical Assistance,70.643496,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Simple Repair Wounds Face, Ears, Eyelids, Nose, Lips, Mucous Membranes; 7.6 Cm - 12.5 Cm (Pro Cah)",,12015,CPT,Professional,Both,,,,561,476.85,55.62,561,"UCare Health, Inc.",Medicare Advantage,99.4635,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Simple Repair Wounds Face, Ears, Eyelids, Nose, Lips, Mucous Membranes; 7.6 Cm - 12.5 Cm (Pro Cah)",,12015,CPT,Professional,Both,,,,561,476.85,55.62,561,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),79.5708,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Simple Repair Wounds Face, Ears, Eyelids, Nose, Lips, Mucous Membranes; 7.6 Cm - 12.5 Cm (Pro Cah)",,12015,CPT,Professional,Both,,,,561,476.85,55.62,561,UnitedHealthcare,Individual & Family,561,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Simple Repair Wounds Face, Ears, Eyelids, Nose, Lips, Mucous Membranes; 7.6 Cm - 12.5 Cm (Pro Cah)",,12015,CPT,Professional,Both,,,,561,476.85,55.62,561,UnitedHealthcare,Medicare Advantage,99.4635,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Simple Repair Wounds Face, Ears, Eyelids, Nose, Lips, Mucous Membranes; 7.6 Cm - 12.5 Cm (Pro Cah)",,12015,CPT,Professional,Both,,,,561,476.85,55.62,561,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,64.22136,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Tx Of Superficial Wound Dehiscence; Simple Closure (Pro Cah),,12020,CPT,Professional,Both,,,,612,520.2,117.15,612,Aetna,Commercial,520.2,85,,percent of total billed charges,,
Tx Of Superficial Wound Dehiscence; Simple Closure (Pro Cah),,12020,CPT,Professional,Both,,,,612,520.2,117.15,612,Aetna,Medicare Advantage,184.35,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Tx Of Superficial Wound Dehiscence; Simple Closure (Pro Cah),,12020,CPT,Professional,Both,,,,612,520.2,117.15,612,Aetna,PPO,569.16,93,,percent of total billed charges,,
Tx Of Superficial Wound Dehiscence; Simple Closure (Pro Cah),,12020,CPT,Professional,Both,,,,612,520.2,117.15,612,America's PPO,America's PPO,522.8928,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Tx Of Superficial Wound Dehiscence; Simple Closure (Pro Cah),,12020,CPT,Professional,Both,,,,612,520.2,117.15,612,BlueCross BlueShield Minnesota, Federal Employee Program,386.99,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Tx Of Superficial Wound Dehiscence; Simple Closure (Pro Cah),,12020,CPT,Professional,Both,,,,612,520.2,117.15,612,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,393.18184,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Tx Of Superficial Wound Dehiscence; Simple Closure (Pro Cah),,12020,CPT,Professional,Both,,,,612,520.2,117.15,612,BlueCross BlueShield Minnesota,High Value Network Plan,393.18184,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Tx Of Superficial Wound Dehiscence; Simple Closure (Pro Cah),,12020,CPT,Professional,Both,,,,612,520.2,117.15,612,BlueCross BlueShield Minnesota,Medicare Advantage,209.5875,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Tx Of Superficial Wound Dehiscence; Simple Closure (Pro Cah),,12020,CPT,Professional,Both,,,,612,520.2,117.15,612,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,393.18184,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Tx Of Superficial Wound Dehiscence; Simple Closure (Pro Cah),,12020,CPT,Professional,Both,,,,612,520.2,117.15,612,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,135.24992,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Tx Of Superficial Wound Dehiscence; Simple Closure (Pro Cah),,12020,CPT,Professional,Both,,,,612,520.2,117.15,612,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),209.5875,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Tx Of Superficial Wound Dehiscence; Simple Closure (Pro Cah),,12020,CPT,Professional,Both,,,,612,520.2,117.15,612,CorVel,Worker's Compensation,355.0908465,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Tx Of Superficial Wound Dehiscence; Simple Closure (Pro Cah),,12020,CPT,Professional,Both,,,,612,520.2,117.15,612,First Health Group Corporation,First Health Network,593.64,97,,percent of total billed charges,,
Tx Of Superficial Wound Dehiscence; Simple Closure (Pro Cah),,12020,CPT,Professional,Both,,,,612,520.2,117.15,612,"Health Partners, Inc.",Commercial,383.07,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Tx Of Superficial Wound Dehiscence; Simple Closure (Pro Cah),,12020,CPT,Professional,Both,,,,612,520.2,117.15,612,"Health Partners, Inc.",Medicare Advantage,209.5875,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Tx Of Superficial Wound Dehiscence; Simple Closure (Pro Cah),,12020,CPT,Professional,Both,,,,612,520.2,117.15,612,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),182.31,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Tx Of Superficial Wound Dehiscence; Simple Closure (Pro Cah),,12020,CPT,Professional,Both,,,,612,520.2,117.15,612,"Health Partners, Inc.",State of Minnesota Advantage Program,330.014805,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Tx Of Superficial Wound Dehiscence; Simple Closure (Pro Cah),,12020,CPT,Professional,Both,,,,612,520.2,117.15,612,"Health Partners, Inc.",State Public Programs,117.15,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Tx Of Superficial Wound Dehiscence; Simple Closure (Pro Cah),,12020,CPT,Professional,Both,,,,612,520.2,117.15,612,Humana Insurance Company,Commercial PPO,182.25,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Tx Of Superficial Wound Dehiscence; Simple Closure (Pro Cah),,12020,CPT,Professional,Both,,,,612,520.2,117.15,612,Humana Insurance Company,Medicare PPO,612,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Tx Of Superficial Wound Dehiscence; Simple Closure (Pro Cah),,12020,CPT,Professional,Both,,,,612,520.2,117.15,612,Medica,Individual & Family,518.976,84.8,,percent of total billed charges,,
Tx Of Superficial Wound Dehiscence; Simple Closure (Pro Cah),,12020,CPT,Professional,Both,,,,612,520.2,117.15,612,Medica,Medica Advantage Solution,304.776,49.8,,percent of total billed charges,,
Tx Of Superficial Wound Dehiscence; Simple Closure (Pro Cah),,12020,CPT,Professional,Both,,,,612,520.2,117.15,612,Medica,Medical Assistance,135.25,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Tx Of Superficial Wound Dehiscence; Simple Closure (Pro Cah),,12020,CPT,Professional,Both,,,,612,520.2,117.15,612,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,182.25,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Tx Of Superficial Wound Dehiscence; Simple Closure (Pro Cah),,12020,CPT,Professional,Both,,,,612,520.2,117.15,612,"Multiplan, Inc.","Multiplan, Inc.",575.28,94,,percent of total billed charges,,
Tx Of Superficial Wound Dehiscence; Simple Closure (Pro Cah),,12020,CPT,Professional,Both,,,,612,520.2,117.15,612,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,551.412,90.1,,percent of total billed charges,,
Tx Of Superficial Wound Dehiscence; Simple Closure (Pro Cah),,12020,CPT,Professional,Both,,,,612,520.2,117.15,612,"Preferred One Administrative Services, INC.",PPO,603.432,98.6,,percent of total billed charges,,
Tx Of Superficial Wound Dehiscence; Simple Closure (Pro Cah),,12020,CPT,Professional,Both,,,,612,520.2,117.15,612,PrimeWest Health,Minnesota Senior Health Options (MSHO),209.5875,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Tx Of Superficial Wound Dehiscence; Simple Closure (Pro Cah),,12020,CPT,Professional,Both,,,,612,520.2,117.15,612,PrimeWest Health,MinnesotaCare,144.7174144,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Tx Of Superficial Wound Dehiscence; Simple Closure (Pro Cah),,12020,CPT,Professional,Both,,,,612,520.2,117.15,612,Sanford Health Plan,Sanford Health Plan,538.56,88,,percent of total billed charges,,
Tx Of Superficial Wound Dehiscence; Simple Closure (Pro Cah),,12020,CPT,Professional,Both,,,,612,520.2,117.15,612,"UCare Health, Inc.",Individual & Family Plan,296.2656,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Tx Of Superficial Wound Dehiscence; Simple Closure (Pro Cah),,12020,CPT,Professional,Both,,,,612,520.2,117.15,612,"UCare Health, Inc.",Medical Assistance,148.774912,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Tx Of Superficial Wound Dehiscence; Simple Closure (Pro Cah),,12020,CPT,Professional,Both,,,,612,520.2,117.15,612,"UCare Health, Inc.",Medicare Advantage,209.5875,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Tx Of Superficial Wound Dehiscence; Simple Closure (Pro Cah),,12020,CPT,Professional,Both,,,,612,520.2,117.15,612,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),167.67,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Tx Of Superficial Wound Dehiscence; Simple Closure (Pro Cah),,12020,CPT,Professional,Both,,,,612,520.2,117.15,612,UnitedHealthcare,Individual & Family,612,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Tx Of Superficial Wound Dehiscence; Simple Closure (Pro Cah),,12020,CPT,Professional,Both,,,,612,520.2,117.15,612,UnitedHealthcare,Medicare Advantage,209.5875,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Tx Of Superficial Wound Dehiscence; Simple Closure (Pro Cah),,12020,CPT,Professional,Both,,,,612,520.2,117.15,612,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,135.24992,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Treatment Of Superficial Wound Dehiscence; With Packing (Pro Cah),,12021,CPT,Professional,Both,,,,389,330.65,88.13,389,Aetna,Commercial,330.65,85,,percent of total billed charges,,
Treatment Of Superficial Wound Dehiscence; With Packing (Pro Cah),,12021,CPT,Professional,Both,,,,389,330.65,88.13,389,Aetna,Medicare Advantage,137.16,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Treatment Of Superficial Wound Dehiscence; With Packing (Pro Cah),,12021,CPT,Professional,Both,,,,389,330.65,88.13,389,Aetna,PPO,361.77,93,,percent of total billed charges,,
Treatment Of Superficial Wound Dehiscence; With Packing (Pro Cah),,12021,CPT,Professional,Both,,,,389,330.65,88.13,389,America's PPO,America's PPO,332.3616,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Treatment Of Superficial Wound Dehiscence; With Packing (Pro Cah),,12021,CPT,Professional,Both,,,,389,330.65,88.13,389,BlueCross BlueShield Minnesota, Federal Employee Program,289.9,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Treatment Of Superficial Wound Dehiscence; With Packing (Pro Cah),,12021,CPT,Professional,Both,,,,389,330.65,88.13,389,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,294.5384,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Treatment Of Superficial Wound Dehiscence; With Packing (Pro Cah),,12021,CPT,Professional,Both,,,,389,330.65,88.13,389,BlueCross BlueShield Minnesota,High Value Network Plan,294.5384,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Treatment Of Superficial Wound Dehiscence; With Packing (Pro Cah),,12021,CPT,Professional,Both,,,,389,330.65,88.13,389,BlueCross BlueShield Minnesota,Medicare Advantage,157.6765,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Treatment Of Superficial Wound Dehiscence; With Packing (Pro Cah),,12021,CPT,Professional,Both,,,,389,330.65,88.13,389,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,294.5384,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Treatment Of Superficial Wound Dehiscence; With Packing (Pro Cah),,12021,CPT,Professional,Both,,,,389,330.65,88.13,389,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,101.7524,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Treatment Of Superficial Wound Dehiscence; With Packing (Pro Cah),,12021,CPT,Professional,Both,,,,389,330.65,88.13,389,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),157.6765,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Treatment Of Superficial Wound Dehiscence; With Packing (Pro Cah),,12021,CPT,Professional,Both,,,,389,330.65,88.13,389,CorVel,Worker's Compensation,266.9859726,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Treatment Of Superficial Wound Dehiscence; With Packing (Pro Cah),,12021,CPT,Professional,Both,,,,389,330.65,88.13,389,First Health Group Corporation,First Health Network,377.33,97,,percent of total billed charges,,
Treatment Of Superficial Wound Dehiscence; With Packing (Pro Cah),,12021,CPT,Professional,Both,,,,389,330.65,88.13,389,"Health Partners, Inc.",Commercial,288.76,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Treatment Of Superficial Wound Dehiscence; With Packing (Pro Cah),,12021,CPT,Professional,Both,,,,389,330.65,88.13,389,"Health Partners, Inc.",Medicare Advantage,157.6765,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Treatment Of Superficial Wound Dehiscence; With Packing (Pro Cah),,12021,CPT,Professional,Both,,,,389,330.65,88.13,389,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),137.24,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Treatment Of Superficial Wound Dehiscence; With Packing (Pro Cah),,12021,CPT,Professional,Both,,,,389,330.65,88.13,389,"Health Partners, Inc.",State of Minnesota Advantage Program,248.76674,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Treatment Of Superficial Wound Dehiscence; With Packing (Pro Cah),,12021,CPT,Professional,Both,,,,389,330.65,88.13,389,"Health Partners, Inc.",State Public Programs,88.13,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Treatment Of Superficial Wound Dehiscence; With Packing (Pro Cah),,12021,CPT,Professional,Both,,,,389,330.65,88.13,389,Humana Insurance Company,Commercial PPO,137.11,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Treatment Of Superficial Wound Dehiscence; With Packing (Pro Cah),,12021,CPT,Professional,Both,,,,389,330.65,88.13,389,Humana Insurance Company,Medicare PPO,389,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Treatment Of Superficial Wound Dehiscence; With Packing (Pro Cah),,12021,CPT,Professional,Both,,,,389,330.65,88.13,389,Medica,Individual & Family,329.872,84.8,,percent of total billed charges,,
Treatment Of Superficial Wound Dehiscence; With Packing (Pro Cah),,12021,CPT,Professional,Both,,,,389,330.65,88.13,389,Medica,Medica Advantage Solution,193.722,49.8,,percent of total billed charges,,
Treatment Of Superficial Wound Dehiscence; With Packing (Pro Cah),,12021,CPT,Professional,Both,,,,389,330.65,88.13,389,Medica,Medical Assistance,101.75,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Treatment Of Superficial Wound Dehiscence; With Packing (Pro Cah),,12021,CPT,Professional,Both,,,,389,330.65,88.13,389,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,137.11,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Treatment Of Superficial Wound Dehiscence; With Packing (Pro Cah),,12021,CPT,Professional,Both,,,,389,330.65,88.13,389,"Multiplan, Inc.","Multiplan, Inc.",365.66,94,,percent of total billed charges,,
Treatment Of Superficial Wound Dehiscence; With Packing (Pro Cah),,12021,CPT,Professional,Both,,,,389,330.65,88.13,389,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,350.489,90.1,,percent of total billed charges,,
Treatment Of Superficial Wound Dehiscence; With Packing (Pro Cah),,12021,CPT,Professional,Both,,,,389,330.65,88.13,389,"Preferred One Administrative Services, INC.",PPO,383.554,98.6,,percent of total billed charges,,
Treatment Of Superficial Wound Dehiscence; With Packing (Pro Cah),,12021,CPT,Professional,Both,,,,389,330.65,88.13,389,PrimeWest Health,Minnesota Senior Health Options (MSHO),157.6765,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Treatment Of Superficial Wound Dehiscence; With Packing (Pro Cah),,12021,CPT,Professional,Both,,,,389,330.65,88.13,389,PrimeWest Health,MinnesotaCare,108.875068,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Treatment Of Superficial Wound Dehiscence; With Packing (Pro Cah),,12021,CPT,Professional,Both,,,,389,330.65,88.13,389,Sanford Health Plan,Sanford Health Plan,342.32,88,,percent of total billed charges,,
Treatment Of Superficial Wound Dehiscence; With Packing (Pro Cah),,12021,CPT,Professional,Both,,,,389,330.65,88.13,389,"UCare Health, Inc.",Individual & Family Plan,222.886016,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Treatment Of Superficial Wound Dehiscence; With Packing (Pro Cah),,12021,CPT,Professional,Both,,,,389,330.65,88.13,389,"UCare Health, Inc.",Medical Assistance,111.92764,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Treatment Of Superficial Wound Dehiscence; With Packing (Pro Cah),,12021,CPT,Professional,Both,,,,389,330.65,88.13,389,"UCare Health, Inc.",Medicare Advantage,157.6765,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Treatment Of Superficial Wound Dehiscence; With Packing (Pro Cah),,12021,CPT,Professional,Both,,,,389,330.65,88.13,389,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),126.1412,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Treatment Of Superficial Wound Dehiscence; With Packing (Pro Cah),,12021,CPT,Professional,Both,,,,389,330.65,88.13,389,UnitedHealthcare,Individual & Family,389,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Treatment Of Superficial Wound Dehiscence; With Packing (Pro Cah),,12021,CPT,Professional,Both,,,,389,330.65,88.13,389,UnitedHealthcare,Medicare Advantage,157.6765,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Treatment Of Superficial Wound Dehiscence; With Packing (Pro Cah),,12021,CPT,Professional,Both,,,,389,330.65,88.13,389,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,101.7524,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Repair Intermediate Wound Of Scalp, Axillae, Trunk Or Extremities, 2.5 Cm Or Less",,12031,CPT,Facility,Both,,,,281,238.85,80.5346,281,Aetna,Commercial,258.52,92,,percent of total billed charges,,
"Repair Intermediate Wound Of Scalp, Axillae, Trunk Or Extremities, 2.5 Cm Or Less",,12031,CPT,Facility,Outpatient,,,,281,238.85,80.5346,281,Aetna,Medicare Advantage,137.69,49,,percent of total billed charges,,
"Repair Intermediate Wound Of Scalp, Axillae, Trunk Or Extremities, 2.5 Cm Or Less",,12031,CPT,Facility,Inpatient,,,,281,238.85,80.5346,281,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Repair Intermediate Wound Of Scalp, Axillae, Trunk Or Extremities, 2.5 Cm Or Less",,12031,CPT,Facility,Both,,,,281,238.85,80.5346,281,Aetna,PPO,261.33,93,,percent of total billed charges,,
"Repair Intermediate Wound Of Scalp, Axillae, Trunk Or Extremities, 2.5 Cm Or Less",,12031,CPT,Facility,Both,,,,281,238.85,80.5346,281,America's PPO,America's PPO,269.8443,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Repair Intermediate Wound Of Scalp, Axillae, Trunk Or Extremities, 2.5 Cm Or Less",,12031,CPT,Facility,Both,,,,281,238.85,80.5346,281,BlueCross BlueShield Minnesota, Federal Employee Program,276.504,98.4,,percent of total billed charges,,
"Repair Intermediate Wound Of Scalp, Axillae, Trunk Or Extremities, 2.5 Cm Or Less",,12031,CPT,Facility,Both,,,,281,238.85,80.5346,281,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,281,100,,percent of total billed charges,,
"Repair Intermediate Wound Of Scalp, Axillae, Trunk Or Extremities, 2.5 Cm Or Less",,12031,CPT,Facility,Both,,,,281,238.85,80.5346,281,BlueCross BlueShield Minnesota,High Value Network Plan,252.9,90,,percent of total billed charges,,
"Repair Intermediate Wound Of Scalp, Axillae, Trunk Or Extremities, 2.5 Cm Or Less",,12031,CPT,Facility,Outpatient,,,,281,238.85,80.5346,281,BlueCross BlueShield Minnesota,Medicare Advantage,137.69,49,,percent of total billed charges,,
"Repair Intermediate Wound Of Scalp, Axillae, Trunk Or Extremities, 2.5 Cm Or Less",,12031,CPT,Facility,Inpatient,,,,281,238.85,80.5346,281,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Repair Intermediate Wound Of Scalp, Axillae, Trunk Or Extremities, 2.5 Cm Or Less",,12031,CPT,Facility,Both,,,,281,238.85,80.5346,281,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,248.8817,88.57,,percent of total billed charges,,
"Repair Intermediate Wound Of Scalp, Axillae, Trunk Or Extremities, 2.5 Cm Or Less",,12031,CPT,Facility,Both,,,,281,238.85,80.5346,281,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,80.5346,28.66,,percent of total billed charges,,
"Repair Intermediate Wound Of Scalp, Axillae, Trunk Or Extremities, 2.5 Cm Or Less",,12031,CPT,Facility,Outpatient,,,,281,238.85,80.5346,281,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),137.69,49,,percent of total billed charges,,
"Repair Intermediate Wound Of Scalp, Axillae, Trunk Or Extremities, 2.5 Cm Or Less",,12031,CPT,Facility,Inpatient,,,,281,238.85,80.5346,281,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Repair Intermediate Wound Of Scalp, Axillae, Trunk Or Extremities, 2.5 Cm Or Less",,12031,CPT,Facility,Both,,,,281,238.85,80.5346,281,CorVel,Worker's Compensation,281,100,,percent of total billed charges,,
"Repair Intermediate Wound Of Scalp, Axillae, Trunk Or Extremities, 2.5 Cm Or Less",,12031,CPT,Facility,Both,,,,281,238.85,80.5346,281,First Health Group Corporation,First Health Network,272.57,97,,percent of total billed charges,,
"Repair Intermediate Wound Of Scalp, Axillae, Trunk Or Extremities, 2.5 Cm Or Less",,12031,CPT,Facility,Both,,,,281,238.85,80.5346,281,"Health Partners, Inc.",Commercial,265.826,94.6,,percent of total billed charges,,
"Repair Intermediate Wound Of Scalp, Axillae, Trunk Or Extremities, 2.5 Cm Or Less",,12031,CPT,Facility,Outpatient,,,,281,238.85,80.5346,281,"Health Partners, Inc.",Medicare Advantage,137.69,49,,percent of total billed charges,,
"Repair Intermediate Wound Of Scalp, Axillae, Trunk Or Extremities, 2.5 Cm Or Less",,12031,CPT,Facility,Inpatient,,,,281,238.85,80.5346,281,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Repair Intermediate Wound Of Scalp, Axillae, Trunk Or Extremities, 2.5 Cm Or Less",,12031,CPT,Facility,Both,,,,281,238.85,80.5346,281,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),168.6,60,,percent of total billed charges,,
"Repair Intermediate Wound Of Scalp, Axillae, Trunk Or Extremities, 2.5 Cm Or Less",,12031,CPT,Facility,Both,,,,281,238.85,80.5346,281,"Health Partners, Inc.",State of Minnesota Advantage Program,229.015,81.5,,percent of total billed charges,,
"Repair Intermediate Wound Of Scalp, Axillae, Trunk Or Extremities, 2.5 Cm Or Less",,12031,CPT,Facility,Both,,,,281,238.85,80.5346,281,"Health Partners, Inc.",State Public Programs,140.5,50,,percent of total billed charges,,
"Repair Intermediate Wound Of Scalp, Axillae, Trunk Or Extremities, 2.5 Cm Or Less",,12031,CPT,Facility,Both,,,,281,238.85,80.5346,281,Humana Insurance Company,Commercial PPO,266.95,95,,percent of total billed charges,,
"Repair Intermediate Wound Of Scalp, Axillae, Trunk Or Extremities, 2.5 Cm Or Less",,12031,CPT,Facility,Outpatient,,,,281,238.85,80.5346,281,Humana Insurance Company,Medicare PPO,137.69,49,,percent of total billed charges,,
"Repair Intermediate Wound Of Scalp, Axillae, Trunk Or Extremities, 2.5 Cm Or Less",,12031,CPT,Facility,Inpatient,,,,281,238.85,80.5346,281,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Repair Intermediate Wound Of Scalp, Axillae, Trunk Or Extremities, 2.5 Cm Or Less",,12031,CPT,Facility,Both,,,,281,238.85,80.5346,281,Medica,Individual & Family,278.471,99.1,,percent of total billed charges,,
"Repair Intermediate Wound Of Scalp, Axillae, Trunk Or Extremities, 2.5 Cm Or Less",,12031,CPT,Facility,Outpatient,,,,281,238.85,80.5346,281,Medica,Medica Advantage Solution,139.938,49.8,,percent of total billed charges,,
"Repair Intermediate Wound Of Scalp, Axillae, Trunk Or Extremities, 2.5 Cm Or Less",,12031,CPT,Facility,Inpatient,,,,281,238.85,80.5346,281,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Repair Intermediate Wound Of Scalp, Axillae, Trunk Or Extremities, 2.5 Cm Or Less",,12031,CPT,Facility,Outpatient,,,,281,238.85,80.5346,281,Medica,Medical Assistance,125.326,44.6,,percent of total billed charges,,
"Repair Intermediate Wound Of Scalp, Axillae, Trunk Or Extremities, 2.5 Cm Or Less",,12031,CPT,Facility,Inpatient,,,,281,238.85,80.5346,281,Medica,Medical Assistance,,,,,Included in per diem rate,
"Repair Intermediate Wound Of Scalp, Axillae, Trunk Or Extremities, 2.5 Cm Or Less",,12031,CPT,Facility,Outpatient,,,,281,238.85,80.5346,281,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,139.938,49.8,,percent of total billed charges,,
"Repair Intermediate Wound Of Scalp, Axillae, Trunk Or Extremities, 2.5 Cm Or Less",,12031,CPT,Facility,Inpatient,,,,281,238.85,80.5346,281,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Repair Intermediate Wound Of Scalp, Axillae, Trunk Or Extremities, 2.5 Cm Or Less",,12031,CPT,Facility,Both,,,,281,238.85,80.5346,281,"Multiplan, Inc.","Multiplan, Inc.",264.14,94,,percent of total billed charges,,
"Repair Intermediate Wound Of Scalp, Axillae, Trunk Or Extremities, 2.5 Cm Or Less",,12031,CPT,Facility,Outpatient,,,,281,238.85,80.5346,281,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,253.181,90.1,,percent of total billed charges,,
"Repair Intermediate Wound Of Scalp, Axillae, Trunk Or Extremities, 2.5 Cm Or Less",,12031,CPT,Facility,Inpatient,,,,281,238.85,80.5346,281,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Repair Intermediate Wound Of Scalp, Axillae, Trunk Or Extremities, 2.5 Cm Or Less",,12031,CPT,Facility,Both,,,,281,238.85,80.5346,281,"Preferred One Administrative Services, INC.",PPO,277.066,98.6,,percent of total billed charges,,
"Repair Intermediate Wound Of Scalp, Axillae, Trunk Or Extremities, 2.5 Cm Or Less",,12031,CPT,Facility,Outpatient,,,,281,238.85,80.5346,281,PrimeWest Health,Minnesota Senior Health Options (MSHO),144.5745,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Repair Intermediate Wound Of Scalp, Axillae, Trunk Or Extremities, 2.5 Cm Or Less",,12031,CPT,Facility,Inpatient,,,,281,238.85,80.5346,281,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Repair Intermediate Wound Of Scalp, Axillae, Trunk Or Extremities, 2.5 Cm Or Less",,12031,CPT,Facility,Outpatient,,,,281,238.85,80.5346,281,PrimeWest Health,MinnesotaCare,144.3216,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Repair Intermediate Wound Of Scalp, Axillae, Trunk Or Extremities, 2.5 Cm Or Less",,12031,CPT,Facility,Inpatient,,,,281,238.85,80.5346,281,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Repair Intermediate Wound Of Scalp, Axillae, Trunk Or Extremities, 2.5 Cm Or Less",,12031,CPT,Facility,Both,,,,281,238.85,80.5346,281,Sanford Health Plan,Sanford Health Plan,258.52,92,,percent of total billed charges,,
"Repair Intermediate Wound Of Scalp, Axillae, Trunk Or Extremities, 2.5 Cm Or Less",,12031,CPT,Facility,Outpatient,,,,281,238.85,80.5346,281,"UCare Health, Inc.",Individual & Family Plan,158.3435,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Repair Intermediate Wound Of Scalp, Axillae, Trunk Or Extremities, 2.5 Cm Or Less",,12031,CPT,Facility,Inpatient,,,,281,238.85,80.5346,281,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Repair Intermediate Wound Of Scalp, Axillae, Trunk Or Extremities, 2.5 Cm Or Less",,12031,CPT,Facility,Outpatient,,,,281,238.85,80.5346,281,"UCare Health, Inc.",Medical Assistance,141.8207,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Repair Intermediate Wound Of Scalp, Axillae, Trunk Or Extremities, 2.5 Cm Or Less",,12031,CPT,Facility,Inpatient,,,,281,238.85,80.5346,281,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Repair Intermediate Wound Of Scalp, Axillae, Trunk Or Extremities, 2.5 Cm Or Less",,12031,CPT,Facility,Outpatient,,,,281,238.85,80.5346,281,"UCare Health, Inc.",Medicare Advantage,141.8207,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Repair Intermediate Wound Of Scalp, Axillae, Trunk Or Extremities, 2.5 Cm Or Less",,12031,CPT,Facility,Inpatient,,,,281,238.85,80.5346,281,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Repair Intermediate Wound Of Scalp, Axillae, Trunk Or Extremities, 2.5 Cm Or Less",,12031,CPT,Facility,Outpatient,,,,281,238.85,80.5346,281,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),141.8207,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Repair Intermediate Wound Of Scalp, Axillae, Trunk Or Extremities, 2.5 Cm Or Less",,12031,CPT,Facility,Inpatient,,,,281,238.85,80.5346,281,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Repair Intermediate Wound Of Scalp, Axillae, Trunk Or Extremities, 2.5 Cm Or Less",,12031,CPT,Facility,Both,,,,281,238.85,80.5346,281,UnitedHealthcare,Individual & Family,264.14,94,,percent of total billed charges,,
"Repair Intermediate Wound Of Scalp, Axillae, Trunk Or Extremities, 2.5 Cm Or Less",,12031,CPT,Facility,Outpatient,,,,281,238.85,80.5346,281,UnitedHealthcare,Medicare Advantage,137.69,49,,percent of total billed charges,,
"Repair Intermediate Wound Of Scalp, Axillae, Trunk Or Extremities, 2.5 Cm Or Less",,12031,CPT,Facility,Inpatient,,,,281,238.85,80.5346,281,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Repair Intermediate Wound Of Scalp, Axillae, Trunk Or Extremities, 2.5 Cm Or Less",,12031,CPT,Facility,Outpatient,,,,281,238.85,80.5346,281,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,134.88,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Repair Intermediate Wound Of Scalp, Axillae, Trunk Or Extremities, 2.5 Cm Or Less",,12031,CPT,Facility,Inpatient,,,,281,238.85,80.5346,281,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 2.5 Cm Or Less (Pro Cah)",,12031,CPT,Professional,Both,,,,434,368.9,95.55,434,Aetna,Commercial,368.9,85,,percent of total billed charges,,
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 2.5 Cm Or Less (Pro Cah)",,12031,CPT,Professional,Both,,,,434,368.9,95.55,434,Aetna,Medicare Advantage,148.86,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 2.5 Cm Or Less (Pro Cah)",,12031,CPT,Professional,Both,,,,434,368.9,95.55,434,Aetna,PPO,403.62,93,,percent of total billed charges,,
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 2.5 Cm Or Less (Pro Cah)",,12031,CPT,Professional,Both,,,,434,368.9,95.55,434,America's PPO,America's PPO,370.8096,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 2.5 Cm Or Less (Pro Cah)",,12031,CPT,Professional,Both,,,,434,368.9,95.55,434,BlueCross BlueShield Minnesota, Federal Employee Program,310.56,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 2.5 Cm Or Less (Pro Cah)",,12031,CPT,Professional,Both,,,,434,368.9,95.55,434,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,315.52896,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 2.5 Cm Or Less (Pro Cah)",,12031,CPT,Professional,Both,,,,434,368.9,95.55,434,BlueCross BlueShield Minnesota,High Value Network Plan,315.52896,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 2.5 Cm Or Less (Pro Cah)",,12031,CPT,Professional,Both,,,,434,368.9,95.55,434,BlueCross BlueShield Minnesota,Medicare Advantage,170.867,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 2.5 Cm Or Less (Pro Cah)",,12031,CPT,Professional,Both,,,,434,368.9,95.55,434,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,315.52896,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 2.5 Cm Or Less (Pro Cah)",,12031,CPT,Professional,Both,,,,434,368.9,95.55,434,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,110.31728,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 2.5 Cm Or Less (Pro Cah)",,12031,CPT,Professional,Both,,,,434,368.9,95.55,434,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),170.867,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 2.5 Cm Or Less (Pro Cah)",,12031,CPT,Professional,Both,,,,434,368.9,95.55,434,CorVel,Worker's Compensation,287.9215182,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 2.5 Cm Or Less (Pro Cah)",,12031,CPT,Professional,Both,,,,434,368.9,95.55,434,First Health Group Corporation,First Health Network,420.98,97,,percent of total billed charges,,
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 2.5 Cm Or Less (Pro Cah)",,12031,CPT,Professional,Both,,,,434,368.9,95.55,434,"Health Partners, Inc.",Commercial,311.25,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 2.5 Cm Or Less (Pro Cah)",,12031,CPT,Professional,Both,,,,434,368.9,95.55,434,"Health Partners, Inc.",Medicare Advantage,170.867,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 2.5 Cm Or Less (Pro Cah)",,12031,CPT,Professional,Both,,,,434,368.9,95.55,434,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),148.43,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 2.5 Cm Or Less (Pro Cah)",,12031,CPT,Professional,Both,,,,434,368.9,95.55,434,"Health Partners, Inc.",State of Minnesota Advantage Program,268.141875,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 2.5 Cm Or Less (Pro Cah)",,12031,CPT,Professional,Both,,,,434,368.9,95.55,434,"Health Partners, Inc.",State Public Programs,95.55,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 2.5 Cm Or Less (Pro Cah)",,12031,CPT,Professional,Both,,,,434,368.9,95.55,434,Humana Insurance Company,Commercial PPO,148.58,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 2.5 Cm Or Less (Pro Cah)",,12031,CPT,Professional,Both,,,,434,368.9,95.55,434,Humana Insurance Company,Medicare PPO,434,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 2.5 Cm Or Less (Pro Cah)",,12031,CPT,Professional,Both,,,,434,368.9,95.55,434,Medica,Individual & Family,368.032,84.8,,percent of total billed charges,,
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 2.5 Cm Or Less (Pro Cah)",,12031,CPT,Professional,Both,,,,434,368.9,95.55,434,Medica,Medica Advantage Solution,216.132,49.8,,percent of total billed charges,,
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 2.5 Cm Or Less (Pro Cah)",,12031,CPT,Professional,Both,,,,434,368.9,95.55,434,Medica,Medical Assistance,110.32,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 2.5 Cm Or Less (Pro Cah)",,12031,CPT,Professional,Both,,,,434,368.9,95.55,434,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,148.58,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 2.5 Cm Or Less (Pro Cah)",,12031,CPT,Professional,Both,,,,434,368.9,95.55,434,"Multiplan, Inc.","Multiplan, Inc.",407.96,94,,percent of total billed charges,,
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 2.5 Cm Or Less (Pro Cah)",,12031,CPT,Professional,Both,,,,434,368.9,95.55,434,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,391.034,90.1,,percent of total billed charges,,
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 2.5 Cm Or Less (Pro Cah)",,12031,CPT,Professional,Both,,,,434,368.9,95.55,434,"Preferred One Administrative Services, INC.",PPO,427.924,98.6,,percent of total billed charges,,
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 2.5 Cm Or Less (Pro Cah)",,12031,CPT,Professional,Both,,,,434,368.9,95.55,434,PrimeWest Health,Minnesota Senior Health Options (MSHO),170.867,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 2.5 Cm Or Less (Pro Cah)",,12031,CPT,Professional,Both,,,,434,368.9,95.55,434,PrimeWest Health,MinnesotaCare,118.0394896,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 2.5 Cm Or Less (Pro Cah)",,12031,CPT,Professional,Both,,,,434,368.9,95.55,434,Sanford Health Plan,Sanford Health Plan,381.92,88,,percent of total billed charges,,
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 2.5 Cm Or Less (Pro Cah)",,12031,CPT,Professional,Both,,,,434,368.9,95.55,434,"UCare Health, Inc.",Individual & Family Plan,241.531648,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 2.5 Cm Or Less (Pro Cah)",,12031,CPT,Professional,Both,,,,434,368.9,95.55,434,"UCare Health, Inc.",Medical Assistance,121.349008,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 2.5 Cm Or Less (Pro Cah)",,12031,CPT,Professional,Both,,,,434,368.9,95.55,434,"UCare Health, Inc.",Medicare Advantage,170.867,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 2.5 Cm Or Less (Pro Cah)",,12031,CPT,Professional,Both,,,,434,368.9,95.55,434,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),136.6936,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 2.5 Cm Or Less (Pro Cah)",,12031,CPT,Professional,Both,,,,434,368.9,95.55,434,UnitedHealthcare,Individual & Family,434,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 2.5 Cm Or Less (Pro Cah)",,12031,CPT,Professional,Both,,,,434,368.9,95.55,434,UnitedHealthcare,Medicare Advantage,170.867,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 2.5 Cm Or Less (Pro Cah)",,12031,CPT,Professional,Both,,,,434,368.9,95.55,434,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,110.31728,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Layer Closure Wound Scalp,Trunk,Extremities; 2.6-7.5 Cm (Pbb)",,12032,CPT,Facility,Outpatient,,,,541,459.85,155.0506,541,Aetna,Commercial,497.72,92,,percent of total billed charges,,
"Layer Closure Wound Scalp,Trunk,Extremities; 2.6-7.5 Cm (Pbb)",,12032,CPT,Professional,Outpatient,,,,790,671.5,119.76,790,Aetna,Commercial,671.5,85,,percent of total billed charges,,
"Layer Closure Wound Scalp,Trunk,Extremities; 2.6-7.5 Cm (Pbb)",,12032,CPT,Facility,Outpatient,,,,541,459.85,155.0506,541,Aetna,Medicare Advantage,265.09,49,,percent of total billed charges,,
"Layer Closure Wound Scalp,Trunk,Extremities; 2.6-7.5 Cm (Pbb)",,12032,CPT,Professional,Outpatient,,,,790,671.5,119.76,790,Aetna,Medicare Advantage,186.92,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Layer Closure Wound Scalp,Trunk,Extremities; 2.6-7.5 Cm (Pbb)",,12032,CPT,Facility,Outpatient,,,,541,459.85,155.0506,541,Aetna,PPO,503.13,93,,percent of total billed charges,,
"Layer Closure Wound Scalp,Trunk,Extremities; 2.6-7.5 Cm (Pbb)",,12032,CPT,Professional,Outpatient,,,,790,671.5,119.76,790,Aetna,PPO,734.7,93,,percent of total billed charges,,
"Layer Closure Wound Scalp,Trunk,Extremities; 2.6-7.5 Cm (Pbb)",,12032,CPT,Facility,Outpatient,,,,541,459.85,155.0506,541,America's PPO,America's PPO,519.5223,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Layer Closure Wound Scalp,Trunk,Extremities; 2.6-7.5 Cm (Pbb)",,12032,CPT,Professional,Outpatient,,,,790,671.5,119.76,790,America's PPO,America's PPO,674.976,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Layer Closure Wound Scalp,Trunk,Extremities; 2.6-7.5 Cm (Pbb)",,12032,CPT,Facility,Outpatient,,,,541,459.85,155.0506,541,BlueCross BlueShield Minnesota, Federal Employee Program,532.344,98.4,,percent of total billed charges,,
"Layer Closure Wound Scalp,Trunk,Extremities; 2.6-7.5 Cm (Pbb)",,12032,CPT,Professional,Outpatient,,,,790,671.5,119.76,790,BlueCross BlueShield Minnesota, Federal Employee Program,388.37,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Layer Closure Wound Scalp,Trunk,Extremities; 2.6-7.5 Cm (Pbb)",,12032,CPT,Facility,Outpatient,,,,541,459.85,155.0506,541,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,541,100,,percent of total billed charges,,
"Layer Closure Wound Scalp,Trunk,Extremities; 2.6-7.5 Cm (Pbb)",,12032,CPT,Professional,Outpatient,,,,790,671.5,119.76,790,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,394.58392,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Layer Closure Wound Scalp,Trunk,Extremities; 2.6-7.5 Cm (Pbb)",,12032,CPT,Facility,Outpatient,,,,541,459.85,155.0506,541,BlueCross BlueShield Minnesota,High Value Network Plan,486.9,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
"Layer Closure Wound Scalp,Trunk,Extremities; 2.6-7.5 Cm (Pbb)",,12032,CPT,Professional,Outpatient,,,,790,671.5,119.76,790,BlueCross BlueShield Minnesota,High Value Network Plan,394.58392,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Layer Closure Wound Scalp,Trunk,Extremities; 2.6-7.5 Cm (Pbb)",,12032,CPT,Facility,Outpatient,,,,541,459.85,155.0506,541,BlueCross BlueShield Minnesota,Medicare Advantage,265.09,49,,percent of total billed charges,,
"Layer Closure Wound Scalp,Trunk,Extremities; 2.6-7.5 Cm (Pbb)",,12032,CPT,Professional,Outpatient,,,,790,671.5,119.76,790,BlueCross BlueShield Minnesota,Medicare Advantage,214.268,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Layer Closure Wound Scalp,Trunk,Extremities; 2.6-7.5 Cm (Pbb)",,12032,CPT,Professional,Outpatient,,,,790,671.5,119.76,790,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,394.58392,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Layer Closure Wound Scalp,Trunk,Extremities; 2.6-7.5 Cm (Pbb)",,12032,CPT,Facility,Outpatient,,,,541,459.85,155.0506,541,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,155.0506,28.66,,percent of total billed charges,,
"Layer Closure Wound Scalp,Trunk,Extremities; 2.6-7.5 Cm (Pbb)",,12032,CPT,Professional,Outpatient,,,,790,671.5,119.76,790,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,138.26744,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Layer Closure Wound Scalp,Trunk,Extremities; 2.6-7.5 Cm (Pbb)",,12032,CPT,Facility,Outpatient,,,,541,459.85,155.0506,541,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),265.09,49,,percent of total billed charges,,
"Layer Closure Wound Scalp,Trunk,Extremities; 2.6-7.5 Cm (Pbb)",,12032,CPT,Professional,Outpatient,,,,790,671.5,119.76,790,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),214.268,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Layer Closure Wound Scalp,Trunk,Extremities; 2.6-7.5 Cm (Pbb)",,12032,CPT,Facility,Outpatient,,,,541,459.85,155.0506,541,CorVel,Worker's Compensation,541,100,,percent of total billed charges,,
"Layer Closure Wound Scalp,Trunk,Extremities; 2.6-7.5 Cm (Pbb)",,12032,CPT,Professional,Outpatient,,,,790,671.5,119.76,790,CorVel,Worker's Compensation,361.428336,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Layer Closure Wound Scalp,Trunk,Extremities; 2.6-7.5 Cm (Pbb)",,12032,CPT,Facility,Outpatient,,,,541,459.85,155.0506,541,First Health Group Corporation,First Health Network,524.77,97,,percent of total billed charges,,
"Layer Closure Wound Scalp,Trunk,Extremities; 2.6-7.5 Cm (Pbb)",,12032,CPT,Professional,Outpatient,,,,790,671.5,119.76,790,First Health Group Corporation,First Health Network,766.3,97,,percent of total billed charges,,
"Layer Closure Wound Scalp,Trunk,Extremities; 2.6-7.5 Cm (Pbb)",,12032,CPT,Facility,Outpatient,,,,541,459.85,155.0506,541,"Health Partners, Inc.",Commercial,511.786,94.6,,percent of total billed charges,,
"Layer Closure Wound Scalp,Trunk,Extremities; 2.6-7.5 Cm (Pbb)",,12032,CPT,Professional,Outpatient,,,,790,671.5,119.76,790,"Health Partners, Inc.",Commercial,391.06,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Layer Closure Wound Scalp,Trunk,Extremities; 2.6-7.5 Cm (Pbb)",,12032,CPT,Facility,Outpatient,,,,541,459.85,155.0506,541,"Health Partners, Inc.",Medicare Advantage,265.09,49,,percent of total billed charges,,
"Layer Closure Wound Scalp,Trunk,Extremities; 2.6-7.5 Cm (Pbb)",,12032,CPT,Professional,Outpatient,,,,790,671.5,119.76,790,"Health Partners, Inc.",Medicare Advantage,214.268,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Layer Closure Wound Scalp,Trunk,Extremities; 2.6-7.5 Cm (Pbb)",,12032,CPT,Facility,Outpatient,,,,541,459.85,155.0506,541,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),324.6,60,,percent of total billed charges,,
"Layer Closure Wound Scalp,Trunk,Extremities; 2.6-7.5 Cm (Pbb)",,12032,CPT,Professional,Outpatient,,,,790,671.5,119.76,790,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),186.04,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Layer Closure Wound Scalp,Trunk,Extremities; 2.6-7.5 Cm (Pbb)",,12032,CPT,Facility,Outpatient,,,,541,459.85,155.0506,541,"Health Partners, Inc.",State of Minnesota Advantage Program,440.915,81.5,,percent of total billed charges,,
"Layer Closure Wound Scalp,Trunk,Extremities; 2.6-7.5 Cm (Pbb)",,12032,CPT,Professional,Outpatient,,,,790,671.5,119.76,790,"Health Partners, Inc.",State of Minnesota Advantage Program,336.89819,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Layer Closure Wound Scalp,Trunk,Extremities; 2.6-7.5 Cm (Pbb)",,12032,CPT,Facility,Outpatient,,,,541,459.85,155.0506,541,"Health Partners, Inc.",State Public Programs,270.5,50,,percent of total billed charges,,
"Layer Closure Wound Scalp,Trunk,Extremities; 2.6-7.5 Cm (Pbb)",,12032,CPT,Professional,Outpatient,,,,790,671.5,119.76,790,"Health Partners, Inc.",State Public Programs,119.76,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Layer Closure Wound Scalp,Trunk,Extremities; 2.6-7.5 Cm (Pbb)",,12032,CPT,Facility,Outpatient,,,,541,459.85,155.0506,541,Humana Insurance Company,Commercial PPO,513.95,95,,percent of total billed charges,,
"Layer Closure Wound Scalp,Trunk,Extremities; 2.6-7.5 Cm (Pbb)",,12032,CPT,Professional,Outpatient,,,,790,671.5,119.76,790,Humana Insurance Company,Commercial PPO,186.32,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Layer Closure Wound Scalp,Trunk,Extremities; 2.6-7.5 Cm (Pbb)",,12032,CPT,Facility,Outpatient,,,,541,459.85,155.0506,541,Humana Insurance Company,Medicare PPO,265.09,49,,percent of total billed charges,,
"Layer Closure Wound Scalp,Trunk,Extremities; 2.6-7.5 Cm (Pbb)",,12032,CPT,Professional,Outpatient,,,,790,671.5,119.76,790,Humana Insurance Company,Medicare PPO,790,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Layer Closure Wound Scalp,Trunk,Extremities; 2.6-7.5 Cm (Pbb)",,12032,CPT,Facility,Outpatient,,,,541,459.85,155.0506,541,Medica,Individual & Family,536.131,99.1,,percent of total billed charges,,
"Layer Closure Wound Scalp,Trunk,Extremities; 2.6-7.5 Cm (Pbb)",,12032,CPT,Professional,Outpatient,,,,790,671.5,119.76,790,Medica,Individual & Family,669.92,84.8,,percent of total billed charges,,
"Layer Closure Wound Scalp,Trunk,Extremities; 2.6-7.5 Cm (Pbb)",,12032,CPT,Facility,Outpatient,,,,541,459.85,155.0506,541,Medica,Medica Advantage Solution,269.418,49.8,,percent of total billed charges,,
"Layer Closure Wound Scalp,Trunk,Extremities; 2.6-7.5 Cm (Pbb)",,12032,CPT,Professional,Outpatient,,,,790,671.5,119.76,790,Medica,Medica Advantage Solution,393.42,49.8,,percent of total billed charges,,
"Layer Closure Wound Scalp,Trunk,Extremities; 2.6-7.5 Cm (Pbb)",,12032,CPT,Facility,Outpatient,,,,541,459.85,155.0506,541,Medica,Medical Assistance,241.286,44.6,,percent of total billed charges,,
"Layer Closure Wound Scalp,Trunk,Extremities; 2.6-7.5 Cm (Pbb)",,12032,CPT,Professional,Outpatient,,,,790,671.5,119.76,790,Medica,Medical Assistance,138.27,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Layer Closure Wound Scalp,Trunk,Extremities; 2.6-7.5 Cm (Pbb)",,12032,CPT,Facility,Outpatient,,,,541,459.85,155.0506,541,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,269.418,49.8,,percent of total billed charges,,
"Layer Closure Wound Scalp,Trunk,Extremities; 2.6-7.5 Cm (Pbb)",,12032,CPT,Professional,Outpatient,,,,790,671.5,119.76,790,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,186.32,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Layer Closure Wound Scalp,Trunk,Extremities; 2.6-7.5 Cm (Pbb)",,12032,CPT,Facility,Outpatient,,,,541,459.85,155.0506,541,"Multiplan, Inc.","Multiplan, Inc.",508.54,94,,percent of total billed charges,,
"Layer Closure Wound Scalp,Trunk,Extremities; 2.6-7.5 Cm (Pbb)",,12032,CPT,Professional,Outpatient,,,,790,671.5,119.76,790,"Multiplan, Inc.","Multiplan, Inc.",742.6,94,,percent of total billed charges,,
"Layer Closure Wound Scalp,Trunk,Extremities; 2.6-7.5 Cm (Pbb)",,12032,CPT,Facility,Outpatient,,,,541,459.85,155.0506,541,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,487.441,90.1,,percent of total billed charges,,
"Layer Closure Wound Scalp,Trunk,Extremities; 2.6-7.5 Cm (Pbb)",,12032,CPT,Professional,Outpatient,,,,790,671.5,119.76,790,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,711.79,90.1,,percent of total billed charges,,
"Layer Closure Wound Scalp,Trunk,Extremities; 2.6-7.5 Cm (Pbb)",,12032,CPT,Facility,Outpatient,,,,541,459.85,155.0506,541,"Preferred One Administrative Services, INC.",PPO,533.426,98.6,,percent of total billed charges,,
"Layer Closure Wound Scalp,Trunk,Extremities; 2.6-7.5 Cm (Pbb)",,12032,CPT,Professional,Outpatient,,,,790,671.5,119.76,790,"Preferred One Administrative Services, INC.",PPO,778.94,98.6,,percent of total billed charges,,
"Layer Closure Wound Scalp,Trunk,Extremities; 2.6-7.5 Cm (Pbb)",,12032,CPT,Facility,Outpatient,,,,541,459.85,155.0506,541,PrimeWest Health,Minnesota Senior Health Options (MSHO),278.3445,51.45,,percent of total billed charges,,
"Layer Closure Wound Scalp,Trunk,Extremities; 2.6-7.5 Cm (Pbb)",,12032,CPT,Professional,Outpatient,,,,790,671.5,119.76,790,PrimeWest Health,Minnesota Senior Health Options (MSHO),214.268,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Layer Closure Wound Scalp,Trunk,Extremities; 2.6-7.5 Cm (Pbb)",,12032,CPT,Facility,Outpatient,,,,541,459.85,155.0506,541,PrimeWest Health,MinnesotaCare,277.8576,51.36,,percent of total billed charges,,
"Layer Closure Wound Scalp,Trunk,Extremities; 2.6-7.5 Cm (Pbb)",,12032,CPT,Professional,Outpatient,,,,790,671.5,119.76,790,PrimeWest Health,MinnesotaCare,147.9461608,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Layer Closure Wound Scalp,Trunk,Extremities; 2.6-7.5 Cm (Pbb)",,12032,CPT,Facility,Outpatient,,,,541,459.85,155.0506,541,Sanford Health Plan,Sanford Health Plan,497.72,92,,percent of total billed charges,,
"Layer Closure Wound Scalp,Trunk,Extremities; 2.6-7.5 Cm (Pbb)",,12032,CPT,Professional,Outpatient,,,,790,671.5,119.76,790,Sanford Health Plan,Sanford Health Plan,695.2,88,,percent of total billed charges,,
"Layer Closure Wound Scalp,Trunk,Extremities; 2.6-7.5 Cm (Pbb)",,12032,CPT,Facility,Outpatient,,,,541,459.85,155.0506,541,"UCare Health, Inc.",Individual & Family Plan,304.8535,56.35,,percent of total billed charges,,
"Layer Closure Wound Scalp,Trunk,Extremities; 2.6-7.5 Cm (Pbb)",,12032,CPT,Professional,Outpatient,,,,790,671.5,119.76,790,"UCare Health, Inc.",Individual & Family Plan,302.881792,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Layer Closure Wound Scalp,Trunk,Extremities; 2.6-7.5 Cm (Pbb)",,12032,CPT,Facility,Outpatient,,,,541,459.85,155.0506,541,"UCare Health, Inc.",Medical Assistance,273.0427,50.47,,percent of total billed charges,,
"Layer Closure Wound Scalp,Trunk,Extremities; 2.6-7.5 Cm (Pbb)",,12032,CPT,Professional,Outpatient,,,,790,671.5,119.76,790,"UCare Health, Inc.",Medical Assistance,152.094184,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Layer Closure Wound Scalp,Trunk,Extremities; 2.6-7.5 Cm (Pbb)",,12032,CPT,Facility,Outpatient,,,,541,459.85,155.0506,541,"UCare Health, Inc.",Medicare Advantage,273.0427,50.47,,percent of total billed charges,,
"Layer Closure Wound Scalp,Trunk,Extremities; 2.6-7.5 Cm (Pbb)",,12032,CPT,Professional,Outpatient,,,,790,671.5,119.76,790,"UCare Health, Inc.",Medicare Advantage,214.268,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Layer Closure Wound Scalp,Trunk,Extremities; 2.6-7.5 Cm (Pbb)",,12032,CPT,Facility,Outpatient,,,,541,459.85,155.0506,541,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),273.0427,50.47,,percent of total billed charges,,
"Layer Closure Wound Scalp,Trunk,Extremities; 2.6-7.5 Cm (Pbb)",,12032,CPT,Professional,Outpatient,,,,790,671.5,119.76,790,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),171.4144,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Layer Closure Wound Scalp,Trunk,Extremities; 2.6-7.5 Cm (Pbb)",,12032,CPT,Facility,Outpatient,,,,541,459.85,155.0506,541,UnitedHealthcare,Individual & Family,508.54,94,,percent of total billed charges,,
"Layer Closure Wound Scalp,Trunk,Extremities; 2.6-7.5 Cm (Pbb)",,12032,CPT,Professional,Outpatient,,,,790,671.5,119.76,790,UnitedHealthcare,Individual & Family,790,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Layer Closure Wound Scalp,Trunk,Extremities; 2.6-7.5 Cm (Pbb)",,12032,CPT,Facility,Outpatient,,,,541,459.85,155.0506,541,UnitedHealthcare,Medicare Advantage,265.09,49,,percent of total billed charges,,
"Layer Closure Wound Scalp,Trunk,Extremities; 2.6-7.5 Cm (Pbb)",,12032,CPT,Professional,Outpatient,,,,790,671.5,119.76,790,UnitedHealthcare,Medicare Advantage,214.268,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Layer Closure Wound Scalp,Trunk,Extremities; 2.6-7.5 Cm (Pbb)",,12032,CPT,Facility,Outpatient,,,,541,459.85,155.0506,541,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,259.68,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Layer Closure Wound Scalp,Trunk,Extremities; 2.6-7.5 Cm (Pbb)",,12032,CPT,Professional,Outpatient,,,,790,671.5,119.76,790,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,138.26744,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
CARBIDOPA-LEVODOPA 25-100 MG ORAL TABLET,,18101,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
CARBIDOPA-LEVODOPA 25-100 MG ORAL TABLET,,18101,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
CARBIDOPA-LEVODOPA 25-100 MG ORAL TABLET,,18101,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
CARBIDOPA-LEVODOPA 25-100 MG ORAL TABLET,,18101,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
CARBIDOPA-LEVODOPA 25-100 MG ORAL TABLET,,18101,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
CARBIDOPA-LEVODOPA 25-100 MG ORAL TABLET,,18101,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
CARBIDOPA-LEVODOPA 25-100 MG ORAL TABLET,,18101,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
CARBIDOPA-LEVODOPA 25-100 MG ORAL TABLET,,18101,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
CARBIDOPA-LEVODOPA 25-100 MG ORAL TABLET,,18101,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
CARBIDOPA-LEVODOPA 25-100 MG ORAL TABLET,,18101,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
CARBIDOPA-LEVODOPA 25-100 MG ORAL TABLET,,18101,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
CARBIDOPA-LEVODOPA 25-100 MG ORAL TABLET,,18101,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
CARBIDOPA-LEVODOPA 25-100 MG ORAL TABLET,,18101,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
CARBIDOPA-LEVODOPA 25-100 MG ORAL TABLET,,18101,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
CARBIDOPA-LEVODOPA 25-100 MG ORAL TABLET,,18101,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
CARBIDOPA-LEVODOPA 25-100 MG ORAL TABLET,,18101,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
CARBIDOPA-LEVODOPA 25-100 MG ORAL TABLET,,18101,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
CARBIDOPA-LEVODOPA 25-100 MG ORAL TABLET,,18101,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
CARBIDOPA-LEVODOPA 25-100 MG ORAL TABLET,,18101,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CARBIDOPA-LEVODOPA 25-100 MG ORAL TABLET,,18101,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
CARBIDOPA-LEVODOPA 25-100 MG ORAL TABLET,,18101,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
CARBIDOPA-LEVODOPA 25-100 MG ORAL TABLET,,18101,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
CARBIDOPA-LEVODOPA 25-100 MG ORAL TABLET,,18101,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
CARBIDOPA-LEVODOPA 25-100 MG ORAL TABLET,,18101,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
CARBIDOPA-LEVODOPA 25-100 MG ORAL TABLET,,18101,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
CARBIDOPA-LEVODOPA 25-100 MG ORAL TABLET,,18101,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
CARBIDOPA-LEVODOPA 25-100 MG ORAL TABLET,,18101,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
CARBIDOPA-LEVODOPA 25-100 MG ORAL TABLET,,18101,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
CARBIDOPA-LEVODOPA 25-100 MG ORAL TABLET,,18101,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
CARBIDOPA-LEVODOPA 25-100 MG ORAL TABLET,,18101,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
CARBIDOPA-LEVODOPA 25-100 MG ORAL TABLET,,18101,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
CARBIDOPA-LEVODOPA 25-100 MG ORAL TABLET,,18101,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
CARBIDOPA-LEVODOPA 25-100 MG ORAL TABLET,,18101,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
CARBIDOPA-LEVODOPA 25-100 MG ORAL TABLET,,18101,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
CARBIDOPA-LEVODOPA 25-100 MG ORAL TABLET,,18101,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
CARBIDOPA-LEVODOPA 25-100 MG ORAL TABLET,,18101,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
CARBIDOPA-LEVODOPA 25-100 MG ORAL TABLET,,18101,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
CARBIDOPA-LEVODOPA 25-100 MG ORAL TABLET,,18101,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CARBIDOPA-LEVODOPA 25-100 MG ORAL TABLET,,18101,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
CARBIDOPA-LEVODOPA 25-100 MG ORAL TABLET,,18101,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
CARBIDOPA-LEVODOPA 25-100 MG ORAL TABLET,,18101,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
CARBIDOPA-LEVODOPA 25-100 MG ORAL TABLET,,18101,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
CARBIDOPA-LEVODOPA 25-100 MG ORAL TABLET,,18101,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
CARBIDOPA-LEVODOPA 25-100 MG ORAL TABLET,,18101,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CARBIDOPA-LEVODOPA 25-100 MG ORAL TABLET,,18101,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
CARBIDOPA-LEVODOPA 25-100 MG ORAL TABLET,,18101,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CARBIDOPA-LEVODOPA 25-100 MG ORAL TABLET,,18101,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CARBIDOPA-LEVODOPA 25-100 MG ORAL TABLET,,18101,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CARBIDOPA-LEVODOPA 25-100 MG ORAL TABLET,,18101,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CARBIDOPA-LEVODOPA 25-100 MG ORAL TABLET,,18101,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
CARBIDOPA-LEVODOPA 25-100 MG ORAL TABLET,,18101,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
CARBIDOPA-LEVODOPA 25-100 MG ORAL TABLET,,18101,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
CARBIDOPA-LEVODOPA 25-100 MG ORAL TABLET,,18101,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
CARBIDOPA-LEVODOPA 25-100 MG ORAL TABLET,,18101,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 2.6 Cm - 7.5 Cm (Pro Cah)",,12032,CPT,Professional,Both,,,,1331,1131.35,119.76,1331,Aetna,Commercial,1131.35,85,,percent of total billed charges,,
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 2.6 Cm - 7.5 Cm (Pro Cah)",,12032,CPT,Professional,Both,,,,1331,1131.35,119.76,1331,Aetna,Medicare Advantage,186.92,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 2.6 Cm - 7.5 Cm (Pro Cah)",,12032,CPT,Professional,Both,,,,1331,1131.35,119.76,1331,Aetna,PPO,1237.83,93,,percent of total billed charges,,
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 2.6 Cm - 7.5 Cm (Pro Cah)",,12032,CPT,Professional,Both,,,,1331,1131.35,119.76,1331,America's PPO,America's PPO,1137.2064,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 2.6 Cm - 7.5 Cm (Pro Cah)",,12032,CPT,Professional,Both,,,,1331,1131.35,119.76,1331,BlueCross BlueShield Minnesota, Federal Employee Program,388.37,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 2.6 Cm - 7.5 Cm (Pro Cah)",,12032,CPT,Professional,Both,,,,1331,1131.35,119.76,1331,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,394.58392,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 2.6 Cm - 7.5 Cm (Pro Cah)",,12032,CPT,Professional,Both,,,,1331,1131.35,119.76,1331,BlueCross BlueShield Minnesota,High Value Network Plan,394.58392,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 2.6 Cm - 7.5 Cm (Pro Cah)",,12032,CPT,Professional,Both,,,,1331,1131.35,119.76,1331,BlueCross BlueShield Minnesota,Medicare Advantage,214.268,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 2.6 Cm - 7.5 Cm (Pro Cah)",,12032,CPT,Professional,Both,,,,1331,1131.35,119.76,1331,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,394.58392,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 2.6 Cm - 7.5 Cm (Pro Cah)",,12032,CPT,Professional,Both,,,,1331,1131.35,119.76,1331,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,138.26744,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 2.6 Cm - 7.5 Cm (Pro Cah)",,12032,CPT,Professional,Both,,,,1331,1131.35,119.76,1331,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),214.268,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 2.6 Cm - 7.5 Cm (Pro Cah)",,12032,CPT,Professional,Both,,,,1331,1131.35,119.76,1331,CorVel,Worker's Compensation,361.428336,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 2.6 Cm - 7.5 Cm (Pro Cah)",,12032,CPT,Professional,Both,,,,1331,1131.35,119.76,1331,First Health Group Corporation,First Health Network,1291.07,97,,percent of total billed charges,,
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 2.6 Cm - 7.5 Cm (Pro Cah)",,12032,CPT,Professional,Both,,,,1331,1131.35,119.76,1331,"Health Partners, Inc.",Commercial,391.06,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 2.6 Cm - 7.5 Cm (Pro Cah)",,12032,CPT,Professional,Both,,,,1331,1131.35,119.76,1331,"Health Partners, Inc.",Medicare Advantage,214.268,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 2.6 Cm - 7.5 Cm (Pro Cah)",,12032,CPT,Professional,Both,,,,1331,1131.35,119.76,1331,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),186.04,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 2.6 Cm - 7.5 Cm (Pro Cah)",,12032,CPT,Professional,Both,,,,1331,1131.35,119.76,1331,"Health Partners, Inc.",State of Minnesota Advantage Program,336.89819,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 2.6 Cm - 7.5 Cm (Pro Cah)",,12032,CPT,Professional,Both,,,,1331,1131.35,119.76,1331,"Health Partners, Inc.",State Public Programs,119.76,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 2.6 Cm - 7.5 Cm (Pro Cah)",,12032,CPT,Professional,Both,,,,1331,1131.35,119.76,1331,Humana Insurance Company,Commercial PPO,186.32,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 2.6 Cm - 7.5 Cm (Pro Cah)",,12032,CPT,Professional,Both,,,,1331,1131.35,119.76,1331,Humana Insurance Company,Medicare PPO,1331,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 2.6 Cm - 7.5 Cm (Pro Cah)",,12032,CPT,Professional,Both,,,,1331,1131.35,119.76,1331,Medica,Individual & Family,1128.688,84.8,,percent of total billed charges,,
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 2.6 Cm - 7.5 Cm (Pro Cah)",,12032,CPT,Professional,Both,,,,1331,1131.35,119.76,1331,Medica,Medica Advantage Solution,662.838,49.8,,percent of total billed charges,,
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 2.6 Cm - 7.5 Cm (Pro Cah)",,12032,CPT,Professional,Both,,,,1331,1131.35,119.76,1331,Medica,Medical Assistance,138.27,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 2.6 Cm - 7.5 Cm (Pro Cah)",,12032,CPT,Professional,Both,,,,1331,1131.35,119.76,1331,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,186.32,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 2.6 Cm - 7.5 Cm (Pro Cah)",,12032,CPT,Professional,Both,,,,1331,1131.35,119.76,1331,"Multiplan, Inc.","Multiplan, Inc.",1251.14,94,,percent of total billed charges,,
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 2.6 Cm - 7.5 Cm (Pro Cah)",,12032,CPT,Professional,Both,,,,1331,1131.35,119.76,1331,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1199.231,90.1,,percent of total billed charges,,
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 2.6 Cm - 7.5 Cm (Pro Cah)",,12032,CPT,Professional,Both,,,,1331,1131.35,119.76,1331,"Preferred One Administrative Services, INC.",PPO,1312.366,98.6,,percent of total billed charges,,
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 2.6 Cm - 7.5 Cm (Pro Cah)",,12032,CPT,Professional,Both,,,,1331,1131.35,119.76,1331,PrimeWest Health,Minnesota Senior Health Options (MSHO),214.268,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 2.6 Cm - 7.5 Cm (Pro Cah)",,12032,CPT,Professional,Both,,,,1331,1131.35,119.76,1331,PrimeWest Health,MinnesotaCare,147.9461608,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 2.6 Cm - 7.5 Cm (Pro Cah)",,12032,CPT,Professional,Both,,,,1331,1131.35,119.76,1331,Sanford Health Plan,Sanford Health Plan,1171.28,88,,percent of total billed charges,,
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 2.6 Cm - 7.5 Cm (Pro Cah)",,12032,CPT,Professional,Both,,,,1331,1131.35,119.76,1331,"UCare Health, Inc.",Individual & Family Plan,302.881792,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 2.6 Cm - 7.5 Cm (Pro Cah)",,12032,CPT,Professional,Both,,,,1331,1131.35,119.76,1331,"UCare Health, Inc.",Medical Assistance,152.094184,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 2.6 Cm - 7.5 Cm (Pro Cah)",,12032,CPT,Professional,Both,,,,1331,1131.35,119.76,1331,"UCare Health, Inc.",Medicare Advantage,214.268,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 2.6 Cm - 7.5 Cm (Pro Cah)",,12032,CPT,Professional,Both,,,,1331,1131.35,119.76,1331,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),171.4144,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 2.6 Cm - 7.5 Cm (Pro Cah)",,12032,CPT,Professional,Both,,,,1331,1131.35,119.76,1331,UnitedHealthcare,Individual & Family,1331,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 2.6 Cm - 7.5 Cm (Pro Cah)",,12032,CPT,Professional,Both,,,,1331,1131.35,119.76,1331,UnitedHealthcare,Medicare Advantage,214.268,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 2.6 Cm - 7.5 Cm (Pro Cah)",,12032,CPT,Professional,Both,,,,1331,1131.35,119.76,1331,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,138.26744,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 7.6 Cm - 12.5 Cm (Pro Cah)",,12034,CPT,Professional,Both,,,,1362,1157.7,128.27,1362,Aetna,Commercial,1157.7,85,,percent of total billed charges,,
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 7.6 Cm - 12.5 Cm (Pro Cah)",,12034,CPT,Professional,Both,,,,1362,1157.7,128.27,1362,Aetna,Medicare Advantage,200.58,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 7.6 Cm - 12.5 Cm (Pro Cah)",,12034,CPT,Professional,Both,,,,1362,1157.7,128.27,1362,Aetna,PPO,1266.66,93,,percent of total billed charges,,
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 7.6 Cm - 12.5 Cm (Pro Cah)",,12034,CPT,Professional,Both,,,,1362,1157.7,128.27,1362,America's PPO,America's PPO,1163.6928,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 7.6 Cm - 12.5 Cm (Pro Cah)",,12034,CPT,Professional,Both,,,,1362,1157.7,128.27,1362,BlueCross BlueShield Minnesota, Federal Employee Program,420.05,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 7.6 Cm - 12.5 Cm (Pro Cah)",,12034,CPT,Professional,Both,,,,1362,1157.7,128.27,1362,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,426.7708,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 7.6 Cm - 12.5 Cm (Pro Cah)",,12034,CPT,Professional,Both,,,,1362,1157.7,128.27,1362,BlueCross BlueShield Minnesota,High Value Network Plan,426.7708,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 7.6 Cm - 12.5 Cm (Pro Cah)",,12034,CPT,Professional,Both,,,,1362,1157.7,128.27,1362,BlueCross BlueShield Minnesota,Medicare Advantage,229.2295,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 7.6 Cm - 12.5 Cm (Pro Cah)",,12034,CPT,Professional,Both,,,,1362,1157.7,128.27,1362,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,426.7708,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 7.6 Cm - 12.5 Cm (Pro Cah)",,12034,CPT,Professional,Both,,,,1362,1157.7,128.27,1362,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,148.09216,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 7.6 Cm - 12.5 Cm (Pro Cah)",,12034,CPT,Professional,Both,,,,1362,1157.7,128.27,1362,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),229.2295,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 7.6 Cm - 12.5 Cm (Pro Cah)",,12034,CPT,Professional,Both,,,,1362,1157.7,128.27,1362,CorVel,Worker's Compensation,387.9329463,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 7.6 Cm - 12.5 Cm (Pro Cah)",,12034,CPT,Professional,Both,,,,1362,1157.7,128.27,1362,First Health Group Corporation,First Health Network,1321.14,97,,percent of total billed charges,,
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 7.6 Cm - 12.5 Cm (Pro Cah)",,12034,CPT,Professional,Both,,,,1362,1157.7,128.27,1362,"Health Partners, Inc.",Commercial,418.63,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 7.6 Cm - 12.5 Cm (Pro Cah)",,12034,CPT,Professional,Both,,,,1362,1157.7,128.27,1362,"Health Partners, Inc.",Medicare Advantage,229.2295,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 7.6 Cm - 12.5 Cm (Pro Cah)",,12034,CPT,Professional,Both,,,,1362,1157.7,128.27,1362,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),199.26,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 7.6 Cm - 12.5 Cm (Pro Cah)",,12034,CPT,Professional,Both,,,,1362,1157.7,128.27,1362,"Health Partners, Inc.",State of Minnesota Advantage Program,360.649745,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 7.6 Cm - 12.5 Cm (Pro Cah)",,12034,CPT,Professional,Both,,,,1362,1157.7,128.27,1362,"Health Partners, Inc.",State Public Programs,128.27,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 7.6 Cm - 12.5 Cm (Pro Cah)",,12034,CPT,Professional,Both,,,,1362,1157.7,128.27,1362,Humana Insurance Company,Commercial PPO,199.33,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 7.6 Cm - 12.5 Cm (Pro Cah)",,12034,CPT,Professional,Both,,,,1362,1157.7,128.27,1362,Humana Insurance Company,Medicare PPO,1362,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 7.6 Cm - 12.5 Cm (Pro Cah)",,12034,CPT,Professional,Both,,,,1362,1157.7,128.27,1362,Medica,Individual & Family,1154.976,84.8,,percent of total billed charges,,
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 7.6 Cm - 12.5 Cm (Pro Cah)",,12034,CPT,Professional,Both,,,,1362,1157.7,128.27,1362,Medica,Medica Advantage Solution,678.276,49.8,,percent of total billed charges,,
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 7.6 Cm - 12.5 Cm (Pro Cah)",,12034,CPT,Professional,Both,,,,1362,1157.7,128.27,1362,Medica,Medical Assistance,148.09,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 7.6 Cm - 12.5 Cm (Pro Cah)",,12034,CPT,Professional,Both,,,,1362,1157.7,128.27,1362,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,199.33,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 7.6 Cm - 12.5 Cm (Pro Cah)",,12034,CPT,Professional,Both,,,,1362,1157.7,128.27,1362,"Multiplan, Inc.","Multiplan, Inc.",1280.28,94,,percent of total billed charges,,
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 7.6 Cm - 12.5 Cm (Pro Cah)",,12034,CPT,Professional,Both,,,,1362,1157.7,128.27,1362,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1227.162,90.1,,percent of total billed charges,,
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 7.6 Cm - 12.5 Cm (Pro Cah)",,12034,CPT,Professional,Both,,,,1362,1157.7,128.27,1362,"Preferred One Administrative Services, INC.",PPO,1342.932,98.6,,percent of total billed charges,,
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 7.6 Cm - 12.5 Cm (Pro Cah)",,12034,CPT,Professional,Both,,,,1362,1157.7,128.27,1362,PrimeWest Health,Minnesota Senior Health Options (MSHO),229.2295,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 7.6 Cm - 12.5 Cm (Pro Cah)",,12034,CPT,Professional,Both,,,,1362,1157.7,128.27,1362,PrimeWest Health,MinnesotaCare,158.4586112,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 7.6 Cm - 12.5 Cm (Pro Cah)",,12034,CPT,Professional,Both,,,,1362,1157.7,128.27,1362,Sanford Health Plan,Sanford Health Plan,1198.56,88,,percent of total billed charges,,
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 7.6 Cm - 12.5 Cm (Pro Cah)",,12034,CPT,Professional,Both,,,,1362,1157.7,128.27,1362,"UCare Health, Inc.",Individual & Family Plan,324.030848,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 7.6 Cm - 12.5 Cm (Pro Cah)",,12034,CPT,Professional,Both,,,,1362,1157.7,128.27,1362,"UCare Health, Inc.",Medical Assistance,162.901376,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 7.6 Cm - 12.5 Cm (Pro Cah)",,12034,CPT,Professional,Both,,,,1362,1157.7,128.27,1362,"UCare Health, Inc.",Medicare Advantage,229.2295,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 7.6 Cm - 12.5 Cm (Pro Cah)",,12034,CPT,Professional,Both,,,,1362,1157.7,128.27,1362,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),183.3836,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 7.6 Cm - 12.5 Cm (Pro Cah)",,12034,CPT,Professional,Both,,,,1362,1157.7,128.27,1362,UnitedHealthcare,Individual & Family,1362,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 7.6 Cm - 12.5 Cm (Pro Cah)",,12034,CPT,Professional,Both,,,,1362,1157.7,128.27,1362,UnitedHealthcare,Medicare Advantage,229.2295,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 7.6 Cm - 12.5 Cm (Pro Cah)",,12034,CPT,Professional,Both,,,,1362,1157.7,128.27,1362,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,148.09216,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 7.6 Cm To 12.5 Cm (Pbb)",,12034,CPT,Facility,Outpatient,,,,622,528.7,178.2652,622,Aetna,Commercial,572.24,92,,percent of total billed charges,,
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 7.6 Cm To 12.5 Cm (Pbb)",,12034,CPT,Professional,Outpatient,,,,740,629,128.27,740,Aetna,Commercial,629,85,,percent of total billed charges,,
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 7.6 Cm To 12.5 Cm (Pbb)",,12034,CPT,Facility,Outpatient,,,,622,528.7,178.2652,622,Aetna,Medicare Advantage,304.78,49,,percent of total billed charges,,
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 7.6 Cm To 12.5 Cm (Pbb)",,12034,CPT,Professional,Outpatient,,,,740,629,128.27,740,Aetna,Medicare Advantage,200.58,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 7.6 Cm To 12.5 Cm (Pbb)",,12034,CPT,Facility,Outpatient,,,,622,528.7,178.2652,622,Aetna,PPO,578.46,93,,percent of total billed charges,,
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 7.6 Cm To 12.5 Cm (Pbb)",,12034,CPT,Professional,Outpatient,,,,740,629,128.27,740,Aetna,PPO,688.2,93,,percent of total billed charges,,
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 7.6 Cm To 12.5 Cm (Pbb)",,12034,CPT,Facility,Outpatient,,,,622,528.7,178.2652,622,America's PPO,America's PPO,597.3066,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 7.6 Cm To 12.5 Cm (Pbb)",,12034,CPT,Professional,Outpatient,,,,740,629,128.27,740,America's PPO,America's PPO,632.256,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 7.6 Cm To 12.5 Cm (Pbb)",,12034,CPT,Facility,Outpatient,,,,622,528.7,178.2652,622,BlueCross BlueShield Minnesota, Federal Employee Program,612.048,98.4,,percent of total billed charges,,
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 7.6 Cm To 12.5 Cm (Pbb)",,12034,CPT,Professional,Outpatient,,,,740,629,128.27,740,BlueCross BlueShield Minnesota, Federal Employee Program,420.05,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 7.6 Cm To 12.5 Cm (Pbb)",,12034,CPT,Facility,Outpatient,,,,622,528.7,178.2652,622,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,622,100,,percent of total billed charges,,
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 7.6 Cm To 12.5 Cm (Pbb)",,12034,CPT,Professional,Outpatient,,,,740,629,128.27,740,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,426.7708,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 7.6 Cm To 12.5 Cm (Pbb)",,12034,CPT,Facility,Outpatient,,,,622,528.7,178.2652,622,BlueCross BlueShield Minnesota,High Value Network Plan,559.8,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 7.6 Cm To 12.5 Cm (Pbb)",,12034,CPT,Professional,Outpatient,,,,740,629,128.27,740,BlueCross BlueShield Minnesota,High Value Network Plan,426.7708,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 7.6 Cm To 12.5 Cm (Pbb)",,12034,CPT,Facility,Outpatient,,,,622,528.7,178.2652,622,BlueCross BlueShield Minnesota,Medicare Advantage,304.78,49,,percent of total billed charges,,
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 7.6 Cm To 12.5 Cm (Pbb)",,12034,CPT,Professional,Outpatient,,,,740,629,128.27,740,BlueCross BlueShield Minnesota,Medicare Advantage,229.2295,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 7.6 Cm To 12.5 Cm (Pbb)",,12034,CPT,Professional,Outpatient,,,,740,629,128.27,740,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,426.7708,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 7.6 Cm To 12.5 Cm (Pbb)",,12034,CPT,Facility,Outpatient,,,,622,528.7,178.2652,622,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,178.2652,28.66,,percent of total billed charges,,
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 7.6 Cm To 12.5 Cm (Pbb)",,12034,CPT,Professional,Outpatient,,,,740,629,128.27,740,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,148.09216,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 7.6 Cm To 12.5 Cm (Pbb)",,12034,CPT,Facility,Outpatient,,,,622,528.7,178.2652,622,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),304.78,49,,percent of total billed charges,,
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 7.6 Cm To 12.5 Cm (Pbb)",,12034,CPT,Professional,Outpatient,,,,740,629,128.27,740,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),229.2295,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 7.6 Cm To 12.5 Cm (Pbb)",,12034,CPT,Facility,Outpatient,,,,622,528.7,178.2652,622,CorVel,Worker's Compensation,622,100,,percent of total billed charges,,
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 7.6 Cm To 12.5 Cm (Pbb)",,12034,CPT,Professional,Outpatient,,,,740,629,128.27,740,CorVel,Worker's Compensation,387.9329463,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 7.6 Cm To 12.5 Cm (Pbb)",,12034,CPT,Facility,Outpatient,,,,622,528.7,178.2652,622,First Health Group Corporation,First Health Network,603.34,97,,percent of total billed charges,,
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 7.6 Cm To 12.5 Cm (Pbb)",,12034,CPT,Professional,Outpatient,,,,740,629,128.27,740,First Health Group Corporation,First Health Network,717.8,97,,percent of total billed charges,,
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 7.6 Cm To 12.5 Cm (Pbb)",,12034,CPT,Facility,Outpatient,,,,622,528.7,178.2652,622,"Health Partners, Inc.",Commercial,588.412,94.6,,percent of total billed charges,,
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 7.6 Cm To 12.5 Cm (Pbb)",,12034,CPT,Professional,Outpatient,,,,740,629,128.27,740,"Health Partners, Inc.",Commercial,418.63,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 7.6 Cm To 12.5 Cm (Pbb)",,12034,CPT,Facility,Outpatient,,,,622,528.7,178.2652,622,"Health Partners, Inc.",Medicare Advantage,304.78,49,,percent of total billed charges,,
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 7.6 Cm To 12.5 Cm (Pbb)",,12034,CPT,Professional,Outpatient,,,,740,629,128.27,740,"Health Partners, Inc.",Medicare Advantage,229.2295,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 7.6 Cm To 12.5 Cm (Pbb)",,12034,CPT,Facility,Outpatient,,,,622,528.7,178.2652,622,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),373.2,60,,percent of total billed charges,,
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 7.6 Cm To 12.5 Cm (Pbb)",,12034,CPT,Professional,Outpatient,,,,740,629,128.27,740,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),199.26,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 7.6 Cm To 12.5 Cm (Pbb)",,12034,CPT,Facility,Outpatient,,,,622,528.7,178.2652,622,"Health Partners, Inc.",State of Minnesota Advantage Program,506.93,81.5,,percent of total billed charges,,
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 7.6 Cm To 12.5 Cm (Pbb)",,12034,CPT,Professional,Outpatient,,,,740,629,128.27,740,"Health Partners, Inc.",State of Minnesota Advantage Program,360.649745,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 7.6 Cm To 12.5 Cm (Pbb)",,12034,CPT,Facility,Outpatient,,,,622,528.7,178.2652,622,"Health Partners, Inc.",State Public Programs,311,50,,percent of total billed charges,,
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 7.6 Cm To 12.5 Cm (Pbb)",,12034,CPT,Professional,Outpatient,,,,740,629,128.27,740,"Health Partners, Inc.",State Public Programs,128.27,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 7.6 Cm To 12.5 Cm (Pbb)",,12034,CPT,Facility,Outpatient,,,,622,528.7,178.2652,622,Humana Insurance Company,Commercial PPO,590.9,95,,percent of total billed charges,,
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 7.6 Cm To 12.5 Cm (Pbb)",,12034,CPT,Professional,Outpatient,,,,740,629,128.27,740,Humana Insurance Company,Commercial PPO,199.33,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 7.6 Cm To 12.5 Cm (Pbb)",,12034,CPT,Facility,Outpatient,,,,622,528.7,178.2652,622,Humana Insurance Company,Medicare PPO,304.78,49,,percent of total billed charges,,
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 7.6 Cm To 12.5 Cm (Pbb)",,12034,CPT,Professional,Outpatient,,,,740,629,128.27,740,Humana Insurance Company,Medicare PPO,740,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 7.6 Cm To 12.5 Cm (Pbb)",,12034,CPT,Facility,Outpatient,,,,622,528.7,178.2652,622,Medica,Individual & Family,616.402,99.1,,percent of total billed charges,,
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 7.6 Cm To 12.5 Cm (Pbb)",,12034,CPT,Professional,Outpatient,,,,740,629,128.27,740,Medica,Individual & Family,627.52,84.8,,percent of total billed charges,,
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 7.6 Cm To 12.5 Cm (Pbb)",,12034,CPT,Facility,Outpatient,,,,622,528.7,178.2652,622,Medica,Medica Advantage Solution,309.756,49.8,,percent of total billed charges,,
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 7.6 Cm To 12.5 Cm (Pbb)",,12034,CPT,Professional,Outpatient,,,,740,629,128.27,740,Medica,Medica Advantage Solution,368.52,49.8,,percent of total billed charges,,
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 7.6 Cm To 12.5 Cm (Pbb)",,12034,CPT,Facility,Outpatient,,,,622,528.7,178.2652,622,Medica,Medical Assistance,277.412,44.6,,percent of total billed charges,,
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 7.6 Cm To 12.5 Cm (Pbb)",,12034,CPT,Professional,Outpatient,,,,740,629,128.27,740,Medica,Medical Assistance,148.09,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 7.6 Cm To 12.5 Cm (Pbb)",,12034,CPT,Facility,Outpatient,,,,622,528.7,178.2652,622,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,309.756,49.8,,percent of total billed charges,,
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 7.6 Cm To 12.5 Cm (Pbb)",,12034,CPT,Professional,Outpatient,,,,740,629,128.27,740,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,199.33,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 7.6 Cm To 12.5 Cm (Pbb)",,12034,CPT,Facility,Outpatient,,,,622,528.7,178.2652,622,"Multiplan, Inc.","Multiplan, Inc.",584.68,94,,percent of total billed charges,,
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 7.6 Cm To 12.5 Cm (Pbb)",,12034,CPT,Professional,Outpatient,,,,740,629,128.27,740,"Multiplan, Inc.","Multiplan, Inc.",695.6,94,,percent of total billed charges,,
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 7.6 Cm To 12.5 Cm (Pbb)",,12034,CPT,Facility,Outpatient,,,,622,528.7,178.2652,622,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,560.422,90.1,,percent of total billed charges,,
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 7.6 Cm To 12.5 Cm (Pbb)",,12034,CPT,Professional,Outpatient,,,,740,629,128.27,740,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,666.74,90.1,,percent of total billed charges,,
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 7.6 Cm To 12.5 Cm (Pbb)",,12034,CPT,Facility,Outpatient,,,,622,528.7,178.2652,622,"Preferred One Administrative Services, INC.",PPO,613.292,98.6,,percent of total billed charges,,
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 7.6 Cm To 12.5 Cm (Pbb)",,12034,CPT,Professional,Outpatient,,,,740,629,128.27,740,"Preferred One Administrative Services, INC.",PPO,729.64,98.6,,percent of total billed charges,,
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 7.6 Cm To 12.5 Cm (Pbb)",,12034,CPT,Facility,Outpatient,,,,622,528.7,178.2652,622,PrimeWest Health,Minnesota Senior Health Options (MSHO),320.019,51.45,,percent of total billed charges,,
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 7.6 Cm To 12.5 Cm (Pbb)",,12034,CPT,Professional,Outpatient,,,,740,629,128.27,740,PrimeWest Health,Minnesota Senior Health Options (MSHO),229.2295,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 7.6 Cm To 12.5 Cm (Pbb)",,12034,CPT,Facility,Outpatient,,,,622,528.7,178.2652,622,PrimeWest Health,MinnesotaCare,319.4592,51.36,,percent of total billed charges,,
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 7.6 Cm To 12.5 Cm (Pbb)",,12034,CPT,Professional,Outpatient,,,,740,629,128.27,740,PrimeWest Health,MinnesotaCare,158.4586112,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 7.6 Cm To 12.5 Cm (Pbb)",,12034,CPT,Facility,Outpatient,,,,622,528.7,178.2652,622,Sanford Health Plan,Sanford Health Plan,572.24,92,,percent of total billed charges,,
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 7.6 Cm To 12.5 Cm (Pbb)",,12034,CPT,Professional,Outpatient,,,,740,629,128.27,740,Sanford Health Plan,Sanford Health Plan,651.2,88,,percent of total billed charges,,
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 7.6 Cm To 12.5 Cm (Pbb)",,12034,CPT,Facility,Outpatient,,,,622,528.7,178.2652,622,"UCare Health, Inc.",Individual & Family Plan,350.497,56.35,,percent of total billed charges,,
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 7.6 Cm To 12.5 Cm (Pbb)",,12034,CPT,Professional,Outpatient,,,,740,629,128.27,740,"UCare Health, Inc.",Individual & Family Plan,324.030848,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 7.6 Cm To 12.5 Cm (Pbb)",,12034,CPT,Facility,Outpatient,,,,622,528.7,178.2652,622,"UCare Health, Inc.",Medical Assistance,313.9234,50.47,,percent of total billed charges,,
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 7.6 Cm To 12.5 Cm (Pbb)",,12034,CPT,Professional,Outpatient,,,,740,629,128.27,740,"UCare Health, Inc.",Medical Assistance,162.901376,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 7.6 Cm To 12.5 Cm (Pbb)",,12034,CPT,Facility,Outpatient,,,,622,528.7,178.2652,622,"UCare Health, Inc.",Medicare Advantage,313.9234,50.47,,percent of total billed charges,,
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 7.6 Cm To 12.5 Cm (Pbb)",,12034,CPT,Professional,Outpatient,,,,740,629,128.27,740,"UCare Health, Inc.",Medicare Advantage,229.2295,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 7.6 Cm To 12.5 Cm (Pbb)",,12034,CPT,Facility,Outpatient,,,,622,528.7,178.2652,622,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),313.9234,50.47,,percent of total billed charges,,
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 7.6 Cm To 12.5 Cm (Pbb)",,12034,CPT,Professional,Outpatient,,,,740,629,128.27,740,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),183.3836,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 7.6 Cm To 12.5 Cm (Pbb)",,12034,CPT,Facility,Outpatient,,,,622,528.7,178.2652,622,UnitedHealthcare,Individual & Family,584.68,94,,percent of total billed charges,,
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 7.6 Cm To 12.5 Cm (Pbb)",,12034,CPT,Professional,Outpatient,,,,740,629,128.27,740,UnitedHealthcare,Individual & Family,740,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 7.6 Cm To 12.5 Cm (Pbb)",,12034,CPT,Facility,Outpatient,,,,622,528.7,178.2652,622,UnitedHealthcare,Medicare Advantage,304.78,49,,percent of total billed charges,,
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 7.6 Cm To 12.5 Cm (Pbb)",,12034,CPT,Professional,Outpatient,,,,740,629,128.27,740,UnitedHealthcare,Medicare Advantage,229.2295,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 7.6 Cm To 12.5 Cm (Pbb)",,12034,CPT,Facility,Outpatient,,,,622,528.7,178.2652,622,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,298.56,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 7.6 Cm To 12.5 Cm (Pbb)",,12034,CPT,Professional,Outpatient,,,,740,629,128.27,740,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,148.09216,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Repair Intermed Wound; Scalp/Axillae/Trunk/Extrem 12.6-20.0 Cm (Pbb),,12035,CPT,Facility,Outpatient,,,,785,667.25,224.981,785,Aetna,Commercial,722.2,92,,percent of total billed charges,,
Repair Intermed Wound; Scalp/Axillae/Trunk/Extrem 12.6-20.0 Cm (Pbb),,12035,CPT,Professional,Outpatient,,,,1039,883.15,148.34,1039,Aetna,Commercial,883.15,85,,percent of total billed charges,,
Repair Intermed Wound; Scalp/Axillae/Trunk/Extrem 12.6-20.0 Cm (Pbb),,12035,CPT,Facility,Outpatient,,,,785,667.25,224.981,785,Aetna,Medicare Advantage,384.65,49,,percent of total billed charges,,
Repair Intermed Wound; Scalp/Axillae/Trunk/Extrem 12.6-20.0 Cm (Pbb),,12035,CPT,Professional,Outpatient,,,,1039,883.15,148.34,1039,Aetna,Medicare Advantage,233.22,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Repair Intermed Wound; Scalp/Axillae/Trunk/Extrem 12.6-20.0 Cm (Pbb),,12035,CPT,Facility,Outpatient,,,,785,667.25,224.981,785,Aetna,PPO,730.05,93,,percent of total billed charges,,
Repair Intermed Wound; Scalp/Axillae/Trunk/Extrem 12.6-20.0 Cm (Pbb),,12035,CPT,Professional,Outpatient,,,,1039,883.15,148.34,1039,Aetna,PPO,966.27,93,,percent of total billed charges,,
Repair Intermed Wound; Scalp/Axillae/Trunk/Extrem 12.6-20.0 Cm (Pbb),,12035,CPT,Facility,Outpatient,,,,785,667.25,224.981,785,America's PPO,America's PPO,753.8355,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Repair Intermed Wound; Scalp/Axillae/Trunk/Extrem 12.6-20.0 Cm (Pbb),,12035,CPT,Professional,Outpatient,,,,1039,883.15,148.34,1039,America's PPO,America's PPO,887.7216,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Repair Intermed Wound; Scalp/Axillae/Trunk/Extrem 12.6-20.0 Cm (Pbb),,12035,CPT,Facility,Outpatient,,,,785,667.25,224.981,785,BlueCross BlueShield Minnesota, Federal Employee Program,772.44,98.4,,percent of total billed charges,,
Repair Intermed Wound; Scalp/Axillae/Trunk/Extrem 12.6-20.0 Cm (Pbb),,12035,CPT,Professional,Outpatient,,,,1039,883.15,148.34,1039,BlueCross BlueShield Minnesota, Federal Employee Program,494.41,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Repair Intermed Wound; Scalp/Axillae/Trunk/Extrem 12.6-20.0 Cm (Pbb),,12035,CPT,Facility,Outpatient,,,,785,667.25,224.981,785,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,785,100,,percent of total billed charges,,
Repair Intermed Wound; Scalp/Axillae/Trunk/Extrem 12.6-20.0 Cm (Pbb),,12035,CPT,Professional,Outpatient,,,,1039,883.15,148.34,1039,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,502.32056,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Repair Intermed Wound; Scalp/Axillae/Trunk/Extrem 12.6-20.0 Cm (Pbb),,12035,CPT,Facility,Outpatient,,,,785,667.25,224.981,785,BlueCross BlueShield Minnesota,High Value Network Plan,706.5,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
Repair Intermed Wound; Scalp/Axillae/Trunk/Extrem 12.6-20.0 Cm (Pbb),,12035,CPT,Professional,Outpatient,,,,1039,883.15,148.34,1039,BlueCross BlueShield Minnesota,High Value Network Plan,502.32056,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Repair Intermed Wound; Scalp/Axillae/Trunk/Extrem 12.6-20.0 Cm (Pbb),,12035,CPT,Facility,Outpatient,,,,785,667.25,224.981,785,BlueCross BlueShield Minnesota,Medicare Advantage,384.65,49,,percent of total billed charges,,
Repair Intermed Wound; Scalp/Axillae/Trunk/Extrem 12.6-20.0 Cm (Pbb),,12035,CPT,Professional,Outpatient,,,,1039,883.15,148.34,1039,BlueCross BlueShield Minnesota,Medicare Advantage,265.2475,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Repair Intermed Wound; Scalp/Axillae/Trunk/Extrem 12.6-20.0 Cm (Pbb),,12035,CPT,Professional,Outpatient,,,,1039,883.15,148.34,1039,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,502.32056,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Repair Intermed Wound; Scalp/Axillae/Trunk/Extrem 12.6-20.0 Cm (Pbb),,12035,CPT,Facility,Outpatient,,,,785,667.25,224.981,785,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,224.981,28.66,,percent of total billed charges,,
Repair Intermed Wound; Scalp/Axillae/Trunk/Extrem 12.6-20.0 Cm (Pbb),,12035,CPT,Professional,Outpatient,,,,1039,883.15,148.34,1039,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,171.26712,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Repair Intermed Wound; Scalp/Axillae/Trunk/Extrem 12.6-20.0 Cm (Pbb),,12035,CPT,Facility,Outpatient,,,,785,667.25,224.981,785,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),384.65,49,,percent of total billed charges,,
Repair Intermed Wound; Scalp/Axillae/Trunk/Extrem 12.6-20.0 Cm (Pbb),,12035,CPT,Professional,Outpatient,,,,1039,883.15,148.34,1039,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),265.2475,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Repair Intermed Wound; Scalp/Axillae/Trunk/Extrem 12.6-20.0 Cm (Pbb),,12035,CPT,Facility,Outpatient,,,,785,667.25,224.981,785,CorVel,Worker's Compensation,785,100,,percent of total billed charges,,
Repair Intermed Wound; Scalp/Axillae/Trunk/Extrem 12.6-20.0 Cm (Pbb),,12035,CPT,Professional,Outpatient,,,,1039,883.15,148.34,1039,CorVel,Worker's Compensation,450.9975159,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Repair Intermed Wound; Scalp/Axillae/Trunk/Extrem 12.6-20.0 Cm (Pbb),,12035,CPT,Facility,Outpatient,,,,785,667.25,224.981,785,First Health Group Corporation,First Health Network,761.45,97,,percent of total billed charges,,
Repair Intermed Wound; Scalp/Axillae/Trunk/Extrem 12.6-20.0 Cm (Pbb),,12035,CPT,Professional,Outpatient,,,,1039,883.15,148.34,1039,First Health Group Corporation,First Health Network,1007.83,97,,percent of total billed charges,,
Repair Intermed Wound; Scalp/Axillae/Trunk/Extrem 12.6-20.0 Cm (Pbb),,12035,CPT,Facility,Outpatient,,,,785,667.25,224.981,785,"Health Partners, Inc.",Commercial,742.61,94.6,,percent of total billed charges,,
Repair Intermed Wound; Scalp/Axillae/Trunk/Extrem 12.6-20.0 Cm (Pbb),,12035,CPT,Professional,Outpatient,,,,1039,883.15,148.34,1039,"Health Partners, Inc.",Commercial,487.56,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Repair Intermed Wound; Scalp/Axillae/Trunk/Extrem 12.6-20.0 Cm (Pbb),,12035,CPT,Facility,Outpatient,,,,785,667.25,224.981,785,"Health Partners, Inc.",Medicare Advantage,384.65,49,,percent of total billed charges,,
Repair Intermed Wound; Scalp/Axillae/Trunk/Extrem 12.6-20.0 Cm (Pbb),,12035,CPT,Professional,Outpatient,,,,1039,883.15,148.34,1039,"Health Partners, Inc.",Medicare Advantage,265.2475,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Repair Intermed Wound; Scalp/Axillae/Trunk/Extrem 12.6-20.0 Cm (Pbb),,12035,CPT,Facility,Outpatient,,,,785,667.25,224.981,785,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),471,60,,percent of total billed charges,,
Repair Intermed Wound; Scalp/Axillae/Trunk/Extrem 12.6-20.0 Cm (Pbb),,12035,CPT,Professional,Outpatient,,,,1039,883.15,148.34,1039,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),230.77,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Repair Intermed Wound; Scalp/Axillae/Trunk/Extrem 12.6-20.0 Cm (Pbb),,12035,CPT,Facility,Outpatient,,,,785,667.25,224.981,785,"Health Partners, Inc.",State of Minnesota Advantage Program,639.775,81.5,,percent of total billed charges,,
Repair Intermed Wound; Scalp/Axillae/Trunk/Extrem 12.6-20.0 Cm (Pbb),,12035,CPT,Professional,Outpatient,,,,1039,883.15,148.34,1039,"Health Partners, Inc.",State of Minnesota Advantage Program,420.03294,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Repair Intermed Wound; Scalp/Axillae/Trunk/Extrem 12.6-20.0 Cm (Pbb),,12035,CPT,Facility,Outpatient,,,,785,667.25,224.981,785,"Health Partners, Inc.",State Public Programs,392.5,50,,percent of total billed charges,,
Repair Intermed Wound; Scalp/Axillae/Trunk/Extrem 12.6-20.0 Cm (Pbb),,12035,CPT,Professional,Outpatient,,,,1039,883.15,148.34,1039,"Health Partners, Inc.",State Public Programs,148.34,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Repair Intermed Wound; Scalp/Axillae/Trunk/Extrem 12.6-20.0 Cm (Pbb),,12035,CPT,Facility,Outpatient,,,,785,667.25,224.981,785,Humana Insurance Company,Commercial PPO,745.75,95,,percent of total billed charges,,
Repair Intermed Wound; Scalp/Axillae/Trunk/Extrem 12.6-20.0 Cm (Pbb),,12035,CPT,Professional,Outpatient,,,,1039,883.15,148.34,1039,Humana Insurance Company,Commercial PPO,230.65,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Repair Intermed Wound; Scalp/Axillae/Trunk/Extrem 12.6-20.0 Cm (Pbb),,12035,CPT,Facility,Outpatient,,,,785,667.25,224.981,785,Humana Insurance Company,Medicare PPO,384.65,49,,percent of total billed charges,,
Repair Intermed Wound; Scalp/Axillae/Trunk/Extrem 12.6-20.0 Cm (Pbb),,12035,CPT,Professional,Outpatient,,,,1039,883.15,148.34,1039,Humana Insurance Company,Medicare PPO,1039,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Repair Intermed Wound; Scalp/Axillae/Trunk/Extrem 12.6-20.0 Cm (Pbb),,12035,CPT,Facility,Outpatient,,,,785,667.25,224.981,785,Medica,Individual & Family,777.935,99.1,,percent of total billed charges,,
Repair Intermed Wound; Scalp/Axillae/Trunk/Extrem 12.6-20.0 Cm (Pbb),,12035,CPT,Professional,Outpatient,,,,1039,883.15,148.34,1039,Medica,Individual & Family,881.072,84.8,,percent of total billed charges,,
Repair Intermed Wound; Scalp/Axillae/Trunk/Extrem 12.6-20.0 Cm (Pbb),,12035,CPT,Facility,Outpatient,,,,785,667.25,224.981,785,Medica,Medica Advantage Solution,390.93,49.8,,percent of total billed charges,,
Repair Intermed Wound; Scalp/Axillae/Trunk/Extrem 12.6-20.0 Cm (Pbb),,12035,CPT,Professional,Outpatient,,,,1039,883.15,148.34,1039,Medica,Medica Advantage Solution,517.422,49.8,,percent of total billed charges,,
Repair Intermed Wound; Scalp/Axillae/Trunk/Extrem 12.6-20.0 Cm (Pbb),,12035,CPT,Facility,Outpatient,,,,785,667.25,224.981,785,Medica,Medical Assistance,350.11,44.6,,percent of total billed charges,,
Repair Intermed Wound; Scalp/Axillae/Trunk/Extrem 12.6-20.0 Cm (Pbb),,12035,CPT,Professional,Outpatient,,,,1039,883.15,148.34,1039,Medica,Medical Assistance,171.27,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Repair Intermed Wound; Scalp/Axillae/Trunk/Extrem 12.6-20.0 Cm (Pbb),,12035,CPT,Facility,Outpatient,,,,785,667.25,224.981,785,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,390.93,49.8,,percent of total billed charges,,
Repair Intermed Wound; Scalp/Axillae/Trunk/Extrem 12.6-20.0 Cm (Pbb),,12035,CPT,Professional,Outpatient,,,,1039,883.15,148.34,1039,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,230.65,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Repair Intermed Wound; Scalp/Axillae/Trunk/Extrem 12.6-20.0 Cm (Pbb),,12035,CPT,Facility,Outpatient,,,,785,667.25,224.981,785,"Multiplan, Inc.","Multiplan, Inc.",737.9,94,,percent of total billed charges,,
Repair Intermed Wound; Scalp/Axillae/Trunk/Extrem 12.6-20.0 Cm (Pbb),,12035,CPT,Professional,Outpatient,,,,1039,883.15,148.34,1039,"Multiplan, Inc.","Multiplan, Inc.",976.66,94,,percent of total billed charges,,
Repair Intermed Wound; Scalp/Axillae/Trunk/Extrem 12.6-20.0 Cm (Pbb),,12035,CPT,Facility,Outpatient,,,,785,667.25,224.981,785,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,707.285,90.1,,percent of total billed charges,,
Repair Intermed Wound; Scalp/Axillae/Trunk/Extrem 12.6-20.0 Cm (Pbb),,12035,CPT,Professional,Outpatient,,,,1039,883.15,148.34,1039,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,936.139,90.1,,percent of total billed charges,,
Repair Intermed Wound; Scalp/Axillae/Trunk/Extrem 12.6-20.0 Cm (Pbb),,12035,CPT,Facility,Outpatient,,,,785,667.25,224.981,785,"Preferred One Administrative Services, INC.",PPO,774.01,98.6,,percent of total billed charges,,
Repair Intermed Wound; Scalp/Axillae/Trunk/Extrem 12.6-20.0 Cm (Pbb),,12035,CPT,Professional,Outpatient,,,,1039,883.15,148.34,1039,"Preferred One Administrative Services, INC.",PPO,1024.454,98.6,,percent of total billed charges,,
Repair Intermed Wound; Scalp/Axillae/Trunk/Extrem 12.6-20.0 Cm (Pbb),,12035,CPT,Facility,Outpatient,,,,785,667.25,224.981,785,PrimeWest Health,Minnesota Senior Health Options (MSHO),403.8825,51.45,,percent of total billed charges,,
Repair Intermed Wound; Scalp/Axillae/Trunk/Extrem 12.6-20.0 Cm (Pbb),,12035,CPT,Professional,Outpatient,,,,1039,883.15,148.34,1039,PrimeWest Health,Minnesota Senior Health Options (MSHO),265.2475,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Repair Intermed Wound; Scalp/Axillae/Trunk/Extrem 12.6-20.0 Cm (Pbb),,12035,CPT,Facility,Outpatient,,,,785,667.25,224.981,785,PrimeWest Health,MinnesotaCare,403.176,51.36,,percent of total billed charges,,
Repair Intermed Wound; Scalp/Axillae/Trunk/Extrem 12.6-20.0 Cm (Pbb),,12035,CPT,Professional,Outpatient,,,,1039,883.15,148.34,1039,PrimeWest Health,MinnesotaCare,183.2558184,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Repair Intermed Wound; Scalp/Axillae/Trunk/Extrem 12.6-20.0 Cm (Pbb),,12035,CPT,Facility,Outpatient,,,,785,667.25,224.981,785,Sanford Health Plan,Sanford Health Plan,722.2,92,,percent of total billed charges,,
Repair Intermed Wound; Scalp/Axillae/Trunk/Extrem 12.6-20.0 Cm (Pbb),,12035,CPT,Professional,Outpatient,,,,1039,883.15,148.34,1039,Sanford Health Plan,Sanford Health Plan,914.32,88,,percent of total billed charges,,
Repair Intermed Wound; Scalp/Axillae/Trunk/Extrem 12.6-20.0 Cm (Pbb),,12035,CPT,Facility,Outpatient,,,,785,667.25,224.981,785,"UCare Health, Inc.",Individual & Family Plan,442.3475,56.35,,percent of total billed charges,,
Repair Intermed Wound; Scalp/Axillae/Trunk/Extrem 12.6-20.0 Cm (Pbb),,12035,CPT,Professional,Outpatient,,,,1039,883.15,148.34,1039,"UCare Health, Inc.",Individual & Family Plan,374.94464,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Repair Intermed Wound; Scalp/Axillae/Trunk/Extrem 12.6-20.0 Cm (Pbb),,12035,CPT,Facility,Outpatient,,,,785,667.25,224.981,785,"UCare Health, Inc.",Medical Assistance,396.1895,50.47,,percent of total billed charges,,
Repair Intermed Wound; Scalp/Axillae/Trunk/Extrem 12.6-20.0 Cm (Pbb),,12035,CPT,Professional,Outpatient,,,,1039,883.15,148.34,1039,"UCare Health, Inc.",Medical Assistance,188.393832,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Repair Intermed Wound; Scalp/Axillae/Trunk/Extrem 12.6-20.0 Cm (Pbb),,12035,CPT,Facility,Outpatient,,,,785,667.25,224.981,785,"UCare Health, Inc.",Medicare Advantage,396.1895,50.47,,percent of total billed charges,,
Repair Intermed Wound; Scalp/Axillae/Trunk/Extrem 12.6-20.0 Cm (Pbb),,12035,CPT,Professional,Outpatient,,,,1039,883.15,148.34,1039,"UCare Health, Inc.",Medicare Advantage,265.2475,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Repair Intermed Wound; Scalp/Axillae/Trunk/Extrem 12.6-20.0 Cm (Pbb),,12035,CPT,Facility,Outpatient,,,,785,667.25,224.981,785,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),396.1895,50.47,,percent of total billed charges,,
Repair Intermed Wound; Scalp/Axillae/Trunk/Extrem 12.6-20.0 Cm (Pbb),,12035,CPT,Professional,Outpatient,,,,1039,883.15,148.34,1039,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),212.198,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Repair Intermed Wound; Scalp/Axillae/Trunk/Extrem 12.6-20.0 Cm (Pbb),,12035,CPT,Facility,Outpatient,,,,785,667.25,224.981,785,UnitedHealthcare,Individual & Family,737.9,94,,percent of total billed charges,,
Repair Intermed Wound; Scalp/Axillae/Trunk/Extrem 12.6-20.0 Cm (Pbb),,12035,CPT,Professional,Outpatient,,,,1039,883.15,148.34,1039,UnitedHealthcare,Individual & Family,1039,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Repair Intermed Wound; Scalp/Axillae/Trunk/Extrem 12.6-20.0 Cm (Pbb),,12035,CPT,Facility,Outpatient,,,,785,667.25,224.981,785,UnitedHealthcare,Medicare Advantage,384.65,49,,percent of total billed charges,,
Repair Intermed Wound; Scalp/Axillae/Trunk/Extrem 12.6-20.0 Cm (Pbb),,12035,CPT,Professional,Outpatient,,,,1039,883.15,148.34,1039,UnitedHealthcare,Medicare Advantage,265.2475,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Repair Intermed Wound; Scalp/Axillae/Trunk/Extrem 12.6-20.0 Cm (Pbb),,12035,CPT,Facility,Outpatient,,,,785,667.25,224.981,785,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,376.8,48,,percent of total billed charges,,100% of DHS outpatient percentage
Repair Intermed Wound; Scalp/Axillae/Trunk/Extrem 12.6-20.0 Cm (Pbb),,12035,CPT,Professional,Outpatient,,,,1039,883.15,148.34,1039,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,171.26712,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 12.6 Cm-20.0 Cm (Pro Cah)",,12035,CPT,Professional,Both,,,,1824,1550.4,148.34,1824,Aetna,Commercial,1550.4,85,,percent of total billed charges,,
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 12.6 Cm-20.0 Cm (Pro Cah)",,12035,CPT,Professional,Both,,,,1824,1550.4,148.34,1824,Aetna,Medicare Advantage,233.22,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 12.6 Cm-20.0 Cm (Pro Cah)",,12035,CPT,Professional,Both,,,,1824,1550.4,148.34,1824,Aetna,PPO,1696.32,93,,percent of total billed charges,,
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 12.6 Cm-20.0 Cm (Pro Cah)",,12035,CPT,Professional,Both,,,,1824,1550.4,148.34,1824,America's PPO,America's PPO,1558.4256,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 12.6 Cm-20.0 Cm (Pro Cah)",,12035,CPT,Professional,Both,,,,1824,1550.4,148.34,1824,BlueCross BlueShield Minnesota, Federal Employee Program,494.41,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 12.6 Cm-20.0 Cm (Pro Cah)",,12035,CPT,Professional,Both,,,,1824,1550.4,148.34,1824,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,502.32056,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 12.6 Cm-20.0 Cm (Pro Cah)",,12035,CPT,Professional,Both,,,,1824,1550.4,148.34,1824,BlueCross BlueShield Minnesota,High Value Network Plan,502.32056,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 12.6 Cm-20.0 Cm (Pro Cah)",,12035,CPT,Professional,Both,,,,1824,1550.4,148.34,1824,BlueCross BlueShield Minnesota,Medicare Advantage,265.2475,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 12.6 Cm-20.0 Cm (Pro Cah)",,12035,CPT,Professional,Both,,,,1824,1550.4,148.34,1824,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,502.32056,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 12.6 Cm-20.0 Cm (Pro Cah)",,12035,CPT,Professional,Both,,,,1824,1550.4,148.34,1824,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,171.26712,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 12.6 Cm-20.0 Cm (Pro Cah)",,12035,CPT,Professional,Both,,,,1824,1550.4,148.34,1824,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),265.2475,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 12.6 Cm-20.0 Cm (Pro Cah)",,12035,CPT,Professional,Both,,,,1824,1550.4,148.34,1824,CorVel,Worker's Compensation,450.9975159,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 12.6 Cm-20.0 Cm (Pro Cah)",,12035,CPT,Professional,Both,,,,1824,1550.4,148.34,1824,First Health Group Corporation,First Health Network,1769.28,97,,percent of total billed charges,,
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 12.6 Cm-20.0 Cm (Pro Cah)",,12035,CPT,Professional,Both,,,,1824,1550.4,148.34,1824,"Health Partners, Inc.",Commercial,487.56,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 12.6 Cm-20.0 Cm (Pro Cah)",,12035,CPT,Professional,Both,,,,1824,1550.4,148.34,1824,"Health Partners, Inc.",Medicare Advantage,265.2475,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 12.6 Cm-20.0 Cm (Pro Cah)",,12035,CPT,Professional,Both,,,,1824,1550.4,148.34,1824,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),230.77,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 12.6 Cm-20.0 Cm (Pro Cah)",,12035,CPT,Professional,Both,,,,1824,1550.4,148.34,1824,"Health Partners, Inc.",State of Minnesota Advantage Program,420.03294,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 12.6 Cm-20.0 Cm (Pro Cah)",,12035,CPT,Professional,Both,,,,1824,1550.4,148.34,1824,"Health Partners, Inc.",State Public Programs,148.34,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 12.6 Cm-20.0 Cm (Pro Cah)",,12035,CPT,Professional,Both,,,,1824,1550.4,148.34,1824,Humana Insurance Company,Commercial PPO,230.65,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 12.6 Cm-20.0 Cm (Pro Cah)",,12035,CPT,Professional,Both,,,,1824,1550.4,148.34,1824,Humana Insurance Company,Medicare PPO,1824,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 12.6 Cm-20.0 Cm (Pro Cah)",,12035,CPT,Professional,Both,,,,1824,1550.4,148.34,1824,Medica,Individual & Family,1546.752,84.8,,percent of total billed charges,,
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 12.6 Cm-20.0 Cm (Pro Cah)",,12035,CPT,Professional,Both,,,,1824,1550.4,148.34,1824,Medica,Medica Advantage Solution,908.352,49.8,,percent of total billed charges,,
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 12.6 Cm-20.0 Cm (Pro Cah)",,12035,CPT,Professional,Both,,,,1824,1550.4,148.34,1824,Medica,Medical Assistance,171.27,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 12.6 Cm-20.0 Cm (Pro Cah)",,12035,CPT,Professional,Both,,,,1824,1550.4,148.34,1824,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,230.65,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 12.6 Cm-20.0 Cm (Pro Cah)",,12035,CPT,Professional,Both,,,,1824,1550.4,148.34,1824,"Multiplan, Inc.","Multiplan, Inc.",1714.56,94,,percent of total billed charges,,
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 12.6 Cm-20.0 Cm (Pro Cah)",,12035,CPT,Professional,Both,,,,1824,1550.4,148.34,1824,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1643.424,90.1,,percent of total billed charges,,
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 12.6 Cm-20.0 Cm (Pro Cah)",,12035,CPT,Professional,Both,,,,1824,1550.4,148.34,1824,"Preferred One Administrative Services, INC.",PPO,1798.464,98.6,,percent of total billed charges,,
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 12.6 Cm-20.0 Cm (Pro Cah)",,12035,CPT,Professional,Both,,,,1824,1550.4,148.34,1824,PrimeWest Health,Minnesota Senior Health Options (MSHO),265.2475,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 12.6 Cm-20.0 Cm (Pro Cah)",,12035,CPT,Professional,Both,,,,1824,1550.4,148.34,1824,PrimeWest Health,MinnesotaCare,183.2558184,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 12.6 Cm-20.0 Cm (Pro Cah)",,12035,CPT,Professional,Both,,,,1824,1550.4,148.34,1824,Sanford Health Plan,Sanford Health Plan,1605.12,88,,percent of total billed charges,,
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 12.6 Cm-20.0 Cm (Pro Cah)",,12035,CPT,Professional,Both,,,,1824,1550.4,148.34,1824,"UCare Health, Inc.",Individual & Family Plan,374.94464,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 12.6 Cm-20.0 Cm (Pro Cah)",,12035,CPT,Professional,Both,,,,1824,1550.4,148.34,1824,"UCare Health, Inc.",Medical Assistance,188.393832,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 12.6 Cm-20.0 Cm (Pro Cah)",,12035,CPT,Professional,Both,,,,1824,1550.4,148.34,1824,"UCare Health, Inc.",Medicare Advantage,265.2475,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 12.6 Cm-20.0 Cm (Pro Cah)",,12035,CPT,Professional,Both,,,,1824,1550.4,148.34,1824,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),212.198,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 12.6 Cm-20.0 Cm (Pro Cah)",,12035,CPT,Professional,Both,,,,1824,1550.4,148.34,1824,UnitedHealthcare,Individual & Family,1824,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 12.6 Cm-20.0 Cm (Pro Cah)",,12035,CPT,Professional,Both,,,,1824,1550.4,148.34,1824,UnitedHealthcare,Medicare Advantage,265.2475,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities; 12.6 Cm-20.0 Cm (Pro Cah)",,12035,CPT,Professional,Both,,,,1824,1550.4,148.34,1824,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,171.26712,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Layer Closure Wound Neck,Hand,Feet; 2.6-7.5 Cm (Pbb)",,12042,CPT,Facility,Outpatient,,,,510,433.5,146.166,510,Aetna,Commercial,469.2,92,,percent of total billed charges,,
"Layer Closure Wound Neck,Hand,Feet; 2.6-7.5 Cm (Pbb)",,12042,CPT,Professional,Outpatient,,,,678,576.3,123.03,678,Aetna,Commercial,576.3,85,,percent of total billed charges,,
"Layer Closure Wound Neck,Hand,Feet; 2.6-7.5 Cm (Pbb)",,12042,CPT,Facility,Outpatient,,,,510,433.5,146.166,510,Aetna,Medicare Advantage,249.9,49,,percent of total billed charges,,
"Layer Closure Wound Neck,Hand,Feet; 2.6-7.5 Cm (Pbb)",,12042,CPT,Professional,Outpatient,,,,678,576.3,123.03,678,Aetna,Medicare Advantage,192.36,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Layer Closure Wound Neck,Hand,Feet; 2.6-7.5 Cm (Pbb)",,12042,CPT,Facility,Outpatient,,,,510,433.5,146.166,510,Aetna,PPO,474.3,93,,percent of total billed charges,,
"Layer Closure Wound Neck,Hand,Feet; 2.6-7.5 Cm (Pbb)",,12042,CPT,Professional,Outpatient,,,,678,576.3,123.03,678,Aetna,PPO,630.54,93,,percent of total billed charges,,
"Layer Closure Wound Neck,Hand,Feet; 2.6-7.5 Cm (Pbb)",,12042,CPT,Facility,Outpatient,,,,510,433.5,146.166,510,America's PPO,America's PPO,489.753,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Layer Closure Wound Neck,Hand,Feet; 2.6-7.5 Cm (Pbb)",,12042,CPT,Professional,Outpatient,,,,678,576.3,123.03,678,America's PPO,America's PPO,579.2832,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Layer Closure Wound Neck,Hand,Feet; 2.6-7.5 Cm (Pbb)",,12042,CPT,Facility,Outpatient,,,,510,433.5,146.166,510,BlueCross BlueShield Minnesota, Federal Employee Program,501.84,98.4,,percent of total billed charges,,
"Layer Closure Wound Neck,Hand,Feet; 2.6-7.5 Cm (Pbb)",,12042,CPT,Professional,Outpatient,,,,678,576.3,123.03,678,BlueCross BlueShield Minnesota, Federal Employee Program,399.39,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Layer Closure Wound Neck,Hand,Feet; 2.6-7.5 Cm (Pbb)",,12042,CPT,Facility,Outpatient,,,,510,433.5,146.166,510,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,510,100,,percent of total billed charges,,
"Layer Closure Wound Neck,Hand,Feet; 2.6-7.5 Cm (Pbb)",,12042,CPT,Professional,Outpatient,,,,678,576.3,123.03,678,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,405.78024,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Layer Closure Wound Neck,Hand,Feet; 2.6-7.5 Cm (Pbb)",,12042,CPT,Facility,Outpatient,,,,510,433.5,146.166,510,BlueCross BlueShield Minnesota,High Value Network Plan,459,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
"Layer Closure Wound Neck,Hand,Feet; 2.6-7.5 Cm (Pbb)",,12042,CPT,Professional,Outpatient,,,,678,576.3,123.03,678,BlueCross BlueShield Minnesota,High Value Network Plan,405.78024,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Layer Closure Wound Neck,Hand,Feet; 2.6-7.5 Cm (Pbb)",,12042,CPT,Facility,Outpatient,,,,510,433.5,146.166,510,BlueCross BlueShield Minnesota,Medicare Advantage,249.9,49,,percent of total billed charges,,
"Layer Closure Wound Neck,Hand,Feet; 2.6-7.5 Cm (Pbb)",,12042,CPT,Professional,Outpatient,,,,678,576.3,123.03,678,BlueCross BlueShield Minnesota,Medicare Advantage,219.88,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Layer Closure Wound Neck,Hand,Feet; 2.6-7.5 Cm (Pbb)",,12042,CPT,Professional,Outpatient,,,,678,576.3,123.03,678,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,405.78024,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Layer Closure Wound Neck,Hand,Feet; 2.6-7.5 Cm (Pbb)",,12042,CPT,Facility,Outpatient,,,,510,433.5,146.166,510,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,146.166,28.66,,percent of total billed charges,,
"Layer Closure Wound Neck,Hand,Feet; 2.6-7.5 Cm (Pbb)",,12042,CPT,Professional,Outpatient,,,,678,576.3,123.03,678,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,142.04696,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Layer Closure Wound Neck,Hand,Feet; 2.6-7.5 Cm (Pbb)",,12042,CPT,Facility,Outpatient,,,,510,433.5,146.166,510,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),249.9,49,,percent of total billed charges,,
"Layer Closure Wound Neck,Hand,Feet; 2.6-7.5 Cm (Pbb)",,12042,CPT,Professional,Outpatient,,,,678,576.3,123.03,678,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),219.88,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Layer Closure Wound Neck,Hand,Feet; 2.6-7.5 Cm (Pbb)",,12042,CPT,Facility,Outpatient,,,,510,433.5,146.166,510,CorVel,Worker's Compensation,510,100,,percent of total billed charges,,
"Layer Closure Wound Neck,Hand,Feet; 2.6-7.5 Cm (Pbb)",,12042,CPT,Professional,Outpatient,,,,678,576.3,123.03,678,CorVel,Worker's Compensation,371.9041692,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Layer Closure Wound Neck,Hand,Feet; 2.6-7.5 Cm (Pbb)",,12042,CPT,Facility,Outpatient,,,,510,433.5,146.166,510,First Health Group Corporation,First Health Network,494.7,97,,percent of total billed charges,,
"Layer Closure Wound Neck,Hand,Feet; 2.6-7.5 Cm (Pbb)",,12042,CPT,Professional,Outpatient,,,,678,576.3,123.03,678,First Health Group Corporation,First Health Network,657.66,97,,percent of total billed charges,,
"Layer Closure Wound Neck,Hand,Feet; 2.6-7.5 Cm (Pbb)",,12042,CPT,Facility,Outpatient,,,,510,433.5,146.166,510,"Health Partners, Inc.",Commercial,482.46,94.6,,percent of total billed charges,,
"Layer Closure Wound Neck,Hand,Feet; 2.6-7.5 Cm (Pbb)",,12042,CPT,Professional,Outpatient,,,,678,576.3,123.03,678,"Health Partners, Inc.",Commercial,401.22,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Layer Closure Wound Neck,Hand,Feet; 2.6-7.5 Cm (Pbb)",,12042,CPT,Facility,Outpatient,,,,510,433.5,146.166,510,"Health Partners, Inc.",Medicare Advantage,249.9,49,,percent of total billed charges,,
"Layer Closure Wound Neck,Hand,Feet; 2.6-7.5 Cm (Pbb)",,12042,CPT,Professional,Outpatient,,,,678,576.3,123.03,678,"Health Partners, Inc.",Medicare Advantage,219.88,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Layer Closure Wound Neck,Hand,Feet; 2.6-7.5 Cm (Pbb)",,12042,CPT,Facility,Outpatient,,,,510,433.5,146.166,510,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),306,60,,percent of total billed charges,,
"Layer Closure Wound Neck,Hand,Feet; 2.6-7.5 Cm (Pbb)",,12042,CPT,Professional,Outpatient,,,,678,576.3,123.03,678,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),191.12,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Layer Closure Wound Neck,Hand,Feet; 2.6-7.5 Cm (Pbb)",,12042,CPT,Facility,Outpatient,,,,510,433.5,146.166,510,"Health Partners, Inc.",State of Minnesota Advantage Program,415.65,81.5,,percent of total billed charges,,
"Layer Closure Wound Neck,Hand,Feet; 2.6-7.5 Cm (Pbb)",,12042,CPT,Professional,Outpatient,,,,678,576.3,123.03,678,"Health Partners, Inc.",State of Minnesota Advantage Program,345.65103,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Layer Closure Wound Neck,Hand,Feet; 2.6-7.5 Cm (Pbb)",,12042,CPT,Facility,Outpatient,,,,510,433.5,146.166,510,"Health Partners, Inc.",State Public Programs,255,50,,percent of total billed charges,,
"Layer Closure Wound Neck,Hand,Feet; 2.6-7.5 Cm (Pbb)",,12042,CPT,Professional,Outpatient,,,,678,576.3,123.03,678,"Health Partners, Inc.",State Public Programs,123.03,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Layer Closure Wound Neck,Hand,Feet; 2.6-7.5 Cm (Pbb)",,12042,CPT,Facility,Outpatient,,,,510,433.5,146.166,510,Humana Insurance Company,Commercial PPO,484.5,95,,percent of total billed charges,,
"Layer Closure Wound Neck,Hand,Feet; 2.6-7.5 Cm (Pbb)",,12042,CPT,Professional,Outpatient,,,,678,576.3,123.03,678,Humana Insurance Company,Commercial PPO,191.2,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Layer Closure Wound Neck,Hand,Feet; 2.6-7.5 Cm (Pbb)",,12042,CPT,Facility,Outpatient,,,,510,433.5,146.166,510,Humana Insurance Company,Medicare PPO,249.9,49,,percent of total billed charges,,
"Layer Closure Wound Neck,Hand,Feet; 2.6-7.5 Cm (Pbb)",,12042,CPT,Professional,Outpatient,,,,678,576.3,123.03,678,Humana Insurance Company,Medicare PPO,678,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Layer Closure Wound Neck,Hand,Feet; 2.6-7.5 Cm (Pbb)",,12042,CPT,Facility,Outpatient,,,,510,433.5,146.166,510,Medica,Individual & Family,505.41,99.1,,percent of total billed charges,,
"Layer Closure Wound Neck,Hand,Feet; 2.6-7.5 Cm (Pbb)",,12042,CPT,Professional,Outpatient,,,,678,576.3,123.03,678,Medica,Individual & Family,574.944,84.8,,percent of total billed charges,,
"Layer Closure Wound Neck,Hand,Feet; 2.6-7.5 Cm (Pbb)",,12042,CPT,Facility,Outpatient,,,,510,433.5,146.166,510,Medica,Medica Advantage Solution,253.98,49.8,,percent of total billed charges,,
"Layer Closure Wound Neck,Hand,Feet; 2.6-7.5 Cm (Pbb)",,12042,CPT,Professional,Outpatient,,,,678,576.3,123.03,678,Medica,Medica Advantage Solution,337.644,49.8,,percent of total billed charges,,
"Layer Closure Wound Neck,Hand,Feet; 2.6-7.5 Cm (Pbb)",,12042,CPT,Facility,Outpatient,,,,510,433.5,146.166,510,Medica,Medical Assistance,227.46,44.6,,percent of total billed charges,,
"Layer Closure Wound Neck,Hand,Feet; 2.6-7.5 Cm (Pbb)",,12042,CPT,Professional,Outpatient,,,,678,576.3,123.03,678,Medica,Medical Assistance,142.05,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Layer Closure Wound Neck,Hand,Feet; 2.6-7.5 Cm (Pbb)",,12042,CPT,Facility,Outpatient,,,,510,433.5,146.166,510,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,253.98,49.8,,percent of total billed charges,,
"Layer Closure Wound Neck,Hand,Feet; 2.6-7.5 Cm (Pbb)",,12042,CPT,Professional,Outpatient,,,,678,576.3,123.03,678,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,191.2,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Layer Closure Wound Neck,Hand,Feet; 2.6-7.5 Cm (Pbb)",,12042,CPT,Facility,Outpatient,,,,510,433.5,146.166,510,"Multiplan, Inc.","Multiplan, Inc.",479.4,94,,percent of total billed charges,,
"Layer Closure Wound Neck,Hand,Feet; 2.6-7.5 Cm (Pbb)",,12042,CPT,Professional,Outpatient,,,,678,576.3,123.03,678,"Multiplan, Inc.","Multiplan, Inc.",637.32,94,,percent of total billed charges,,
"Layer Closure Wound Neck,Hand,Feet; 2.6-7.5 Cm (Pbb)",,12042,CPT,Facility,Outpatient,,,,510,433.5,146.166,510,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,459.51,90.1,,percent of total billed charges,,
"Layer Closure Wound Neck,Hand,Feet; 2.6-7.5 Cm (Pbb)",,12042,CPT,Professional,Outpatient,,,,678,576.3,123.03,678,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,610.878,90.1,,percent of total billed charges,,
"Layer Closure Wound Neck,Hand,Feet; 2.6-7.5 Cm (Pbb)",,12042,CPT,Facility,Outpatient,,,,510,433.5,146.166,510,"Preferred One Administrative Services, INC.",PPO,502.86,98.6,,percent of total billed charges,,
"Layer Closure Wound Neck,Hand,Feet; 2.6-7.5 Cm (Pbb)",,12042,CPT,Professional,Outpatient,,,,678,576.3,123.03,678,"Preferred One Administrative Services, INC.",PPO,668.508,98.6,,percent of total billed charges,,
"Layer Closure Wound Neck,Hand,Feet; 2.6-7.5 Cm (Pbb)",,12042,CPT,Facility,Outpatient,,,,510,433.5,146.166,510,PrimeWest Health,Minnesota Senior Health Options (MSHO),262.395,51.45,,percent of total billed charges,,
"Layer Closure Wound Neck,Hand,Feet; 2.6-7.5 Cm (Pbb)",,12042,CPT,Professional,Outpatient,,,,678,576.3,123.03,678,PrimeWest Health,Minnesota Senior Health Options (MSHO),219.88,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Layer Closure Wound Neck,Hand,Feet; 2.6-7.5 Cm (Pbb)",,12042,CPT,Facility,Outpatient,,,,510,433.5,146.166,510,PrimeWest Health,MinnesotaCare,261.936,51.36,,percent of total billed charges,,
"Layer Closure Wound Neck,Hand,Feet; 2.6-7.5 Cm (Pbb)",,12042,CPT,Professional,Outpatient,,,,678,576.3,123.03,678,PrimeWest Health,MinnesotaCare,151.9902472,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Layer Closure Wound Neck,Hand,Feet; 2.6-7.5 Cm (Pbb)",,12042,CPT,Facility,Outpatient,,,,510,433.5,146.166,510,Sanford Health Plan,Sanford Health Plan,469.2,92,,percent of total billed charges,,
"Layer Closure Wound Neck,Hand,Feet; 2.6-7.5 Cm (Pbb)",,12042,CPT,Professional,Outpatient,,,,678,576.3,123.03,678,Sanford Health Plan,Sanford Health Plan,596.64,88,,percent of total billed charges,,
"Layer Closure Wound Neck,Hand,Feet; 2.6-7.5 Cm (Pbb)",,12042,CPT,Facility,Outpatient,,,,510,433.5,146.166,510,"UCare Health, Inc.",Individual & Family Plan,287.385,56.35,,percent of total billed charges,,
"Layer Closure Wound Neck,Hand,Feet; 2.6-7.5 Cm (Pbb)",,12042,CPT,Professional,Outpatient,,,,678,576.3,123.03,678,"UCare Health, Inc.",Individual & Family Plan,310.81472,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Layer Closure Wound Neck,Hand,Feet; 2.6-7.5 Cm (Pbb)",,12042,CPT,Facility,Outpatient,,,,510,433.5,146.166,510,"UCare Health, Inc.",Medical Assistance,257.397,50.47,,percent of total billed charges,,
"Layer Closure Wound Neck,Hand,Feet; 2.6-7.5 Cm (Pbb)",,12042,CPT,Professional,Outpatient,,,,678,576.3,123.03,678,"UCare Health, Inc.",Medical Assistance,156.251656,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Layer Closure Wound Neck,Hand,Feet; 2.6-7.5 Cm (Pbb)",,12042,CPT,Facility,Outpatient,,,,510,433.5,146.166,510,"UCare Health, Inc.",Medicare Advantage,257.397,50.47,,percent of total billed charges,,
"Layer Closure Wound Neck,Hand,Feet; 2.6-7.5 Cm (Pbb)",,12042,CPT,Professional,Outpatient,,,,678,576.3,123.03,678,"UCare Health, Inc.",Medicare Advantage,219.88,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Layer Closure Wound Neck,Hand,Feet; 2.6-7.5 Cm (Pbb)",,12042,CPT,Facility,Outpatient,,,,510,433.5,146.166,510,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),257.397,50.47,,percent of total billed charges,,
"Layer Closure Wound Neck,Hand,Feet; 2.6-7.5 Cm (Pbb)",,12042,CPT,Professional,Outpatient,,,,678,576.3,123.03,678,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),175.904,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Layer Closure Wound Neck,Hand,Feet; 2.6-7.5 Cm (Pbb)",,12042,CPT,Facility,Outpatient,,,,510,433.5,146.166,510,UnitedHealthcare,Individual & Family,479.4,94,,percent of total billed charges,,
"Layer Closure Wound Neck,Hand,Feet; 2.6-7.5 Cm (Pbb)",,12042,CPT,Professional,Outpatient,,,,678,576.3,123.03,678,UnitedHealthcare,Individual & Family,678,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Layer Closure Wound Neck,Hand,Feet; 2.6-7.5 Cm (Pbb)",,12042,CPT,Facility,Outpatient,,,,510,433.5,146.166,510,UnitedHealthcare,Medicare Advantage,249.9,49,,percent of total billed charges,,
"Layer Closure Wound Neck,Hand,Feet; 2.6-7.5 Cm (Pbb)",,12042,CPT,Professional,Outpatient,,,,678,576.3,123.03,678,UnitedHealthcare,Medicare Advantage,219.88,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Layer Closure Wound Neck,Hand,Feet; 2.6-7.5 Cm (Pbb)",,12042,CPT,Facility,Outpatient,,,,510,433.5,146.166,510,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,244.8,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Layer Closure Wound Neck,Hand,Feet; 2.6-7.5 Cm (Pbb)",,12042,CPT,Professional,Outpatient,,,,678,576.3,123.03,678,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,142.04696,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Repair, Intermediate, Wounds Of Neck, Hands, Feet And/Or External Genitalia; 2.6 Cm-7.5 Cm (Pro Cah)",,12042,CPT,Professional,Both,,,,1188,1009.8,123.03,1188,Aetna,Commercial,1009.8,85,,percent of total billed charges,,
"Repair, Intermediate, Wounds Of Neck, Hands, Feet And/Or External Genitalia; 2.6 Cm-7.5 Cm (Pro Cah)",,12042,CPT,Professional,Both,,,,1188,1009.8,123.03,1188,Aetna,Medicare Advantage,192.36,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair, Intermediate, Wounds Of Neck, Hands, Feet And/Or External Genitalia; 2.6 Cm-7.5 Cm (Pro Cah)",,12042,CPT,Professional,Both,,,,1188,1009.8,123.03,1188,Aetna,PPO,1104.84,93,,percent of total billed charges,,
"Repair, Intermediate, Wounds Of Neck, Hands, Feet And/Or External Genitalia; 2.6 Cm-7.5 Cm (Pro Cah)",,12042,CPT,Professional,Both,,,,1188,1009.8,123.03,1188,America's PPO,America's PPO,1015.0272,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Repair, Intermediate, Wounds Of Neck, Hands, Feet And/Or External Genitalia; 2.6 Cm-7.5 Cm (Pro Cah)",,12042,CPT,Professional,Both,,,,1188,1009.8,123.03,1188,BlueCross BlueShield Minnesota, Federal Employee Program,399.39,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Repair, Intermediate, Wounds Of Neck, Hands, Feet And/Or External Genitalia; 2.6 Cm-7.5 Cm (Pro Cah)",,12042,CPT,Professional,Both,,,,1188,1009.8,123.03,1188,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,405.78024,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Repair, Intermediate, Wounds Of Neck, Hands, Feet And/Or External Genitalia; 2.6 Cm-7.5 Cm (Pro Cah)",,12042,CPT,Professional,Both,,,,1188,1009.8,123.03,1188,BlueCross BlueShield Minnesota,High Value Network Plan,405.78024,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Repair, Intermediate, Wounds Of Neck, Hands, Feet And/Or External Genitalia; 2.6 Cm-7.5 Cm (Pro Cah)",,12042,CPT,Professional,Both,,,,1188,1009.8,123.03,1188,BlueCross BlueShield Minnesota,Medicare Advantage,219.88,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair, Intermediate, Wounds Of Neck, Hands, Feet And/Or External Genitalia; 2.6 Cm-7.5 Cm (Pro Cah)",,12042,CPT,Professional,Both,,,,1188,1009.8,123.03,1188,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,405.78024,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Repair, Intermediate, Wounds Of Neck, Hands, Feet And/Or External Genitalia; 2.6 Cm-7.5 Cm (Pro Cah)",,12042,CPT,Professional,Both,,,,1188,1009.8,123.03,1188,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,142.04696,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Repair, Intermediate, Wounds Of Neck, Hands, Feet And/Or External Genitalia; 2.6 Cm-7.5 Cm (Pro Cah)",,12042,CPT,Professional,Both,,,,1188,1009.8,123.03,1188,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),219.88,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair, Intermediate, Wounds Of Neck, Hands, Feet And/Or External Genitalia; 2.6 Cm-7.5 Cm (Pro Cah)",,12042,CPT,Professional,Both,,,,1188,1009.8,123.03,1188,CorVel,Worker's Compensation,371.9041692,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Repair, Intermediate, Wounds Of Neck, Hands, Feet And/Or External Genitalia; 2.6 Cm-7.5 Cm (Pro Cah)",,12042,CPT,Professional,Both,,,,1188,1009.8,123.03,1188,First Health Group Corporation,First Health Network,1152.36,97,,percent of total billed charges,,
"Repair, Intermediate, Wounds Of Neck, Hands, Feet And/Or External Genitalia; 2.6 Cm-7.5 Cm (Pro Cah)",,12042,CPT,Professional,Both,,,,1188,1009.8,123.03,1188,"Health Partners, Inc.",Commercial,401.22,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Repair, Intermediate, Wounds Of Neck, Hands, Feet And/Or External Genitalia; 2.6 Cm-7.5 Cm (Pro Cah)",,12042,CPT,Professional,Both,,,,1188,1009.8,123.03,1188,"Health Partners, Inc.",Medicare Advantage,219.88,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair, Intermediate, Wounds Of Neck, Hands, Feet And/Or External Genitalia; 2.6 Cm-7.5 Cm (Pro Cah)",,12042,CPT,Professional,Both,,,,1188,1009.8,123.03,1188,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),191.12,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Repair, Intermediate, Wounds Of Neck, Hands, Feet And/Or External Genitalia; 2.6 Cm-7.5 Cm (Pro Cah)",,12042,CPT,Professional,Both,,,,1188,1009.8,123.03,1188,"Health Partners, Inc.",State of Minnesota Advantage Program,345.65103,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Repair, Intermediate, Wounds Of Neck, Hands, Feet And/Or External Genitalia; 2.6 Cm-7.5 Cm (Pro Cah)",,12042,CPT,Professional,Both,,,,1188,1009.8,123.03,1188,"Health Partners, Inc.",State Public Programs,123.03,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Repair, Intermediate, Wounds Of Neck, Hands, Feet And/Or External Genitalia; 2.6 Cm-7.5 Cm (Pro Cah)",,12042,CPT,Professional,Both,,,,1188,1009.8,123.03,1188,Humana Insurance Company,Commercial PPO,191.2,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Repair, Intermediate, Wounds Of Neck, Hands, Feet And/Or External Genitalia; 2.6 Cm-7.5 Cm (Pro Cah)",,12042,CPT,Professional,Both,,,,1188,1009.8,123.03,1188,Humana Insurance Company,Medicare PPO,1188,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Repair, Intermediate, Wounds Of Neck, Hands, Feet And/Or External Genitalia; 2.6 Cm-7.5 Cm (Pro Cah)",,12042,CPT,Professional,Both,,,,1188,1009.8,123.03,1188,Medica,Individual & Family,1007.424,84.8,,percent of total billed charges,,
"Repair, Intermediate, Wounds Of Neck, Hands, Feet And/Or External Genitalia; 2.6 Cm-7.5 Cm (Pro Cah)",,12042,CPT,Professional,Both,,,,1188,1009.8,123.03,1188,Medica,Medica Advantage Solution,591.624,49.8,,percent of total billed charges,,
"Repair, Intermediate, Wounds Of Neck, Hands, Feet And/Or External Genitalia; 2.6 Cm-7.5 Cm (Pro Cah)",,12042,CPT,Professional,Both,,,,1188,1009.8,123.03,1188,Medica,Medical Assistance,142.05,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Repair, Intermediate, Wounds Of Neck, Hands, Feet And/Or External Genitalia; 2.6 Cm-7.5 Cm (Pro Cah)",,12042,CPT,Professional,Both,,,,1188,1009.8,123.03,1188,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,191.2,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Repair, Intermediate, Wounds Of Neck, Hands, Feet And/Or External Genitalia; 2.6 Cm-7.5 Cm (Pro Cah)",,12042,CPT,Professional,Both,,,,1188,1009.8,123.03,1188,"Multiplan, Inc.","Multiplan, Inc.",1116.72,94,,percent of total billed charges,,
"Repair, Intermediate, Wounds Of Neck, Hands, Feet And/Or External Genitalia; 2.6 Cm-7.5 Cm (Pro Cah)",,12042,CPT,Professional,Both,,,,1188,1009.8,123.03,1188,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1070.388,90.1,,percent of total billed charges,,
"Repair, Intermediate, Wounds Of Neck, Hands, Feet And/Or External Genitalia; 2.6 Cm-7.5 Cm (Pro Cah)",,12042,CPT,Professional,Both,,,,1188,1009.8,123.03,1188,"Preferred One Administrative Services, INC.",PPO,1171.368,98.6,,percent of total billed charges,,
"Repair, Intermediate, Wounds Of Neck, Hands, Feet And/Or External Genitalia; 2.6 Cm-7.5 Cm (Pro Cah)",,12042,CPT,Professional,Both,,,,1188,1009.8,123.03,1188,PrimeWest Health,Minnesota Senior Health Options (MSHO),219.88,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair, Intermediate, Wounds Of Neck, Hands, Feet And/Or External Genitalia; 2.6 Cm-7.5 Cm (Pro Cah)",,12042,CPT,Professional,Both,,,,1188,1009.8,123.03,1188,PrimeWest Health,MinnesotaCare,151.9902472,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Repair, Intermediate, Wounds Of Neck, Hands, Feet And/Or External Genitalia; 2.6 Cm-7.5 Cm (Pro Cah)",,12042,CPT,Professional,Both,,,,1188,1009.8,123.03,1188,Sanford Health Plan,Sanford Health Plan,1045.44,88,,percent of total billed charges,,
"Repair, Intermediate, Wounds Of Neck, Hands, Feet And/Or External Genitalia; 2.6 Cm-7.5 Cm (Pro Cah)",,12042,CPT,Professional,Both,,,,1188,1009.8,123.03,1188,"UCare Health, Inc.",Individual & Family Plan,310.81472,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Repair, Intermediate, Wounds Of Neck, Hands, Feet And/Or External Genitalia; 2.6 Cm-7.5 Cm (Pro Cah)",,12042,CPT,Professional,Both,,,,1188,1009.8,123.03,1188,"UCare Health, Inc.",Medical Assistance,156.251656,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Repair, Intermediate, Wounds Of Neck, Hands, Feet And/Or External Genitalia; 2.6 Cm-7.5 Cm (Pro Cah)",,12042,CPT,Professional,Both,,,,1188,1009.8,123.03,1188,"UCare Health, Inc.",Medicare Advantage,219.88,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Repair, Intermediate, Wounds Of Neck, Hands, Feet And/Or External Genitalia; 2.6 Cm-7.5 Cm (Pro Cah)",,12042,CPT,Professional,Both,,,,1188,1009.8,123.03,1188,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),175.904,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Repair, Intermediate, Wounds Of Neck, Hands, Feet And/Or External Genitalia; 2.6 Cm-7.5 Cm (Pro Cah)",,12042,CPT,Professional,Both,,,,1188,1009.8,123.03,1188,UnitedHealthcare,Individual & Family,1188,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Repair, Intermediate, Wounds Of Neck, Hands, Feet And/Or External Genitalia; 2.6 Cm-7.5 Cm (Pro Cah)",,12042,CPT,Professional,Both,,,,1188,1009.8,123.03,1188,UnitedHealthcare,Medicare Advantage,219.88,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair, Intermediate, Wounds Of Neck, Hands, Feet And/Or External Genitalia; 2.6 Cm-7.5 Cm (Pro Cah)",,12042,CPT,Professional,Both,,,,1188,1009.8,123.03,1188,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,142.04696,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Layer Closure Wound Neck,Hand,Feet; 7.6-12.5 Cm (Pbb)",,12044,CPT,Facility,Outpatient,,,,643,546.55,184.2838,643,Aetna,Commercial,591.56,92,,percent of total billed charges,,
"Layer Closure Wound Neck,Hand,Feet; 7.6-12.5 Cm (Pbb)",,12044,CPT,Professional,Outpatient,,,,888,754.8,133.06,888,Aetna,Commercial,754.8,85,,percent of total billed charges,,
"Layer Closure Wound Neck,Hand,Feet; 7.6-12.5 Cm (Pbb)",,12044,CPT,Facility,Outpatient,,,,643,546.55,184.2838,643,Aetna,Medicare Advantage,315.07,49,,percent of total billed charges,,
"Layer Closure Wound Neck,Hand,Feet; 7.6-12.5 Cm (Pbb)",,12044,CPT,Professional,Outpatient,,,,888,754.8,133.06,888,Aetna,Medicare Advantage,207.69,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Layer Closure Wound Neck,Hand,Feet; 7.6-12.5 Cm (Pbb)",,12044,CPT,Facility,Outpatient,,,,643,546.55,184.2838,643,Aetna,PPO,597.99,93,,percent of total billed charges,,
"Layer Closure Wound Neck,Hand,Feet; 7.6-12.5 Cm (Pbb)",,12044,CPT,Professional,Outpatient,,,,888,754.8,133.06,888,Aetna,PPO,825.84,93,,percent of total billed charges,,
"Layer Closure Wound Neck,Hand,Feet; 7.6-12.5 Cm (Pbb)",,12044,CPT,Facility,Outpatient,,,,643,546.55,184.2838,643,America's PPO,America's PPO,617.4729,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Layer Closure Wound Neck,Hand,Feet; 7.6-12.5 Cm (Pbb)",,12044,CPT,Professional,Outpatient,,,,888,754.8,133.06,888,America's PPO,America's PPO,758.7072,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Layer Closure Wound Neck,Hand,Feet; 7.6-12.5 Cm (Pbb)",,12044,CPT,Facility,Outpatient,,,,643,546.55,184.2838,643,BlueCross BlueShield Minnesota, Federal Employee Program,632.712,98.4,,percent of total billed charges,,
"Layer Closure Wound Neck,Hand,Feet; 7.6-12.5 Cm (Pbb)",,12044,CPT,Professional,Outpatient,,,,888,754.8,133.06,888,BlueCross BlueShield Minnesota, Federal Employee Program,437.26,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Layer Closure Wound Neck,Hand,Feet; 7.6-12.5 Cm (Pbb)",,12044,CPT,Facility,Outpatient,,,,643,546.55,184.2838,643,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,643,100,,percent of total billed charges,,
"Layer Closure Wound Neck,Hand,Feet; 7.6-12.5 Cm (Pbb)",,12044,CPT,Professional,Outpatient,,,,888,754.8,133.06,888,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,444.25616,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Layer Closure Wound Neck,Hand,Feet; 7.6-12.5 Cm (Pbb)",,12044,CPT,Facility,Outpatient,,,,643,546.55,184.2838,643,BlueCross BlueShield Minnesota,High Value Network Plan,578.7,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
"Layer Closure Wound Neck,Hand,Feet; 7.6-12.5 Cm (Pbb)",,12044,CPT,Professional,Outpatient,,,,888,754.8,133.06,888,BlueCross BlueShield Minnesota,High Value Network Plan,444.25616,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Layer Closure Wound Neck,Hand,Feet; 7.6-12.5 Cm (Pbb)",,12044,CPT,Facility,Outpatient,,,,643,546.55,184.2838,643,BlueCross BlueShield Minnesota,Medicare Advantage,315.07,49,,percent of total billed charges,,
"Layer Closure Wound Neck,Hand,Feet; 7.6-12.5 Cm (Pbb)",,12044,CPT,Professional,Outpatient,,,,888,754.8,133.06,888,BlueCross BlueShield Minnesota,Medicare Advantage,237.9235,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Layer Closure Wound Neck,Hand,Feet; 7.6-12.5 Cm (Pbb)",,12044,CPT,Professional,Outpatient,,,,888,754.8,133.06,888,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,444.25616,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Layer Closure Wound Neck,Hand,Feet; 7.6-12.5 Cm (Pbb)",,12044,CPT,Facility,Outpatient,,,,643,546.55,184.2838,643,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,184.2838,28.66,,percent of total billed charges,,
"Layer Closure Wound Neck,Hand,Feet; 7.6-12.5 Cm (Pbb)",,12044,CPT,Professional,Outpatient,,,,888,754.8,133.06,888,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,153.62936,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Layer Closure Wound Neck,Hand,Feet; 7.6-12.5 Cm (Pbb)",,12044,CPT,Facility,Outpatient,,,,643,546.55,184.2838,643,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),315.07,49,,percent of total billed charges,,
"Layer Closure Wound Neck,Hand,Feet; 7.6-12.5 Cm (Pbb)",,12044,CPT,Professional,Outpatient,,,,888,754.8,133.06,888,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),237.9235,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Layer Closure Wound Neck,Hand,Feet; 7.6-12.5 Cm (Pbb)",,12044,CPT,Facility,Outpatient,,,,643,546.55,184.2838,643,CorVel,Worker's Compensation,643,100,,percent of total billed charges,,
"Layer Closure Wound Neck,Hand,Feet; 7.6-12.5 Cm (Pbb)",,12044,CPT,Professional,Outpatient,,,,888,754.8,133.06,888,CorVel,Worker's Compensation,402.7412445,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Layer Closure Wound Neck,Hand,Feet; 7.6-12.5 Cm (Pbb)",,12044,CPT,Facility,Outpatient,,,,643,546.55,184.2838,643,First Health Group Corporation,First Health Network,623.71,97,,percent of total billed charges,,
"Layer Closure Wound Neck,Hand,Feet; 7.6-12.5 Cm (Pbb)",,12044,CPT,Professional,Outpatient,,,,888,754.8,133.06,888,First Health Group Corporation,First Health Network,861.36,97,,percent of total billed charges,,
"Layer Closure Wound Neck,Hand,Feet; 7.6-12.5 Cm (Pbb)",,12044,CPT,Facility,Outpatient,,,,643,546.55,184.2838,643,"Health Partners, Inc.",Commercial,608.278,94.6,,percent of total billed charges,,
"Layer Closure Wound Neck,Hand,Feet; 7.6-12.5 Cm (Pbb)",,12044,CPT,Professional,Outpatient,,,,888,754.8,133.06,888,"Health Partners, Inc.",Commercial,434.59,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Layer Closure Wound Neck,Hand,Feet; 7.6-12.5 Cm (Pbb)",,12044,CPT,Facility,Outpatient,,,,643,546.55,184.2838,643,"Health Partners, Inc.",Medicare Advantage,315.07,49,,percent of total billed charges,,
"Layer Closure Wound Neck,Hand,Feet; 7.6-12.5 Cm (Pbb)",,12044,CPT,Professional,Outpatient,,,,888,754.8,133.06,888,"Health Partners, Inc.",Medicare Advantage,237.9235,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Layer Closure Wound Neck,Hand,Feet; 7.6-12.5 Cm (Pbb)",,12044,CPT,Facility,Outpatient,,,,643,546.55,184.2838,643,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),385.8,60,,percent of total billed charges,,
"Layer Closure Wound Neck,Hand,Feet; 7.6-12.5 Cm (Pbb)",,12044,CPT,Professional,Outpatient,,,,888,754.8,133.06,888,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),206.71,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Layer Closure Wound Neck,Hand,Feet; 7.6-12.5 Cm (Pbb)",,12044,CPT,Facility,Outpatient,,,,643,546.55,184.2838,643,"Health Partners, Inc.",State of Minnesota Advantage Program,524.045,81.5,,percent of total billed charges,,
"Layer Closure Wound Neck,Hand,Feet; 7.6-12.5 Cm (Pbb)",,12044,CPT,Professional,Outpatient,,,,888,754.8,133.06,888,"Health Partners, Inc.",State of Minnesota Advantage Program,374.399285,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Layer Closure Wound Neck,Hand,Feet; 7.6-12.5 Cm (Pbb)",,12044,CPT,Facility,Outpatient,,,,643,546.55,184.2838,643,"Health Partners, Inc.",State Public Programs,321.5,50,,percent of total billed charges,,
"Layer Closure Wound Neck,Hand,Feet; 7.6-12.5 Cm (Pbb)",,12044,CPT,Professional,Outpatient,,,,888,754.8,133.06,888,"Health Partners, Inc.",State Public Programs,133.06,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Layer Closure Wound Neck,Hand,Feet; 7.6-12.5 Cm (Pbb)",,12044,CPT,Facility,Outpatient,,,,643,546.55,184.2838,643,Humana Insurance Company,Commercial PPO,610.85,95,,percent of total billed charges,,
"Layer Closure Wound Neck,Hand,Feet; 7.6-12.5 Cm (Pbb)",,12044,CPT,Professional,Outpatient,,,,888,754.8,133.06,888,Humana Insurance Company,Commercial PPO,206.89,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Layer Closure Wound Neck,Hand,Feet; 7.6-12.5 Cm (Pbb)",,12044,CPT,Facility,Outpatient,,,,643,546.55,184.2838,643,Humana Insurance Company,Medicare PPO,315.07,49,,percent of total billed charges,,
"Layer Closure Wound Neck,Hand,Feet; 7.6-12.5 Cm (Pbb)",,12044,CPT,Professional,Outpatient,,,,888,754.8,133.06,888,Humana Insurance Company,Medicare PPO,888,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Layer Closure Wound Neck,Hand,Feet; 7.6-12.5 Cm (Pbb)",,12044,CPT,Facility,Outpatient,,,,643,546.55,184.2838,643,Medica,Individual & Family,637.213,99.1,,percent of total billed charges,,
"Layer Closure Wound Neck,Hand,Feet; 7.6-12.5 Cm (Pbb)",,12044,CPT,Professional,Outpatient,,,,888,754.8,133.06,888,Medica,Individual & Family,753.024,84.8,,percent of total billed charges,,
"Layer Closure Wound Neck,Hand,Feet; 7.6-12.5 Cm (Pbb)",,12044,CPT,Facility,Outpatient,,,,643,546.55,184.2838,643,Medica,Medica Advantage Solution,320.214,49.8,,percent of total billed charges,,
"Layer Closure Wound Neck,Hand,Feet; 7.6-12.5 Cm (Pbb)",,12044,CPT,Professional,Outpatient,,,,888,754.8,133.06,888,Medica,Medica Advantage Solution,442.224,49.8,,percent of total billed charges,,
"Layer Closure Wound Neck,Hand,Feet; 7.6-12.5 Cm (Pbb)",,12044,CPT,Facility,Outpatient,,,,643,546.55,184.2838,643,Medica,Medical Assistance,286.778,44.6,,percent of total billed charges,,
"Layer Closure Wound Neck,Hand,Feet; 7.6-12.5 Cm (Pbb)",,12044,CPT,Professional,Outpatient,,,,888,754.8,133.06,888,Medica,Medical Assistance,153.63,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Layer Closure Wound Neck,Hand,Feet; 7.6-12.5 Cm (Pbb)",,12044,CPT,Facility,Outpatient,,,,643,546.55,184.2838,643,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,320.214,49.8,,percent of total billed charges,,
"Layer Closure Wound Neck,Hand,Feet; 7.6-12.5 Cm (Pbb)",,12044,CPT,Professional,Outpatient,,,,888,754.8,133.06,888,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,206.89,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Layer Closure Wound Neck,Hand,Feet; 7.6-12.5 Cm (Pbb)",,12044,CPT,Facility,Outpatient,,,,643,546.55,184.2838,643,"Multiplan, Inc.","Multiplan, Inc.",604.42,94,,percent of total billed charges,,
"Layer Closure Wound Neck,Hand,Feet; 7.6-12.5 Cm (Pbb)",,12044,CPT,Professional,Outpatient,,,,888,754.8,133.06,888,"Multiplan, Inc.","Multiplan, Inc.",834.72,94,,percent of total billed charges,,
"Layer Closure Wound Neck,Hand,Feet; 7.6-12.5 Cm (Pbb)",,12044,CPT,Facility,Outpatient,,,,643,546.55,184.2838,643,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,579.343,90.1,,percent of total billed charges,,
"Layer Closure Wound Neck,Hand,Feet; 7.6-12.5 Cm (Pbb)",,12044,CPT,Professional,Outpatient,,,,888,754.8,133.06,888,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,800.088,90.1,,percent of total billed charges,,
"Layer Closure Wound Neck,Hand,Feet; 7.6-12.5 Cm (Pbb)",,12044,CPT,Facility,Outpatient,,,,643,546.55,184.2838,643,"Preferred One Administrative Services, INC.",PPO,633.998,98.6,,percent of total billed charges,,
"Layer Closure Wound Neck,Hand,Feet; 7.6-12.5 Cm (Pbb)",,12044,CPT,Professional,Outpatient,,,,888,754.8,133.06,888,"Preferred One Administrative Services, INC.",PPO,875.568,98.6,,percent of total billed charges,,
"Layer Closure Wound Neck,Hand,Feet; 7.6-12.5 Cm (Pbb)",,12044,CPT,Facility,Outpatient,,,,643,546.55,184.2838,643,PrimeWest Health,Minnesota Senior Health Options (MSHO),330.8235,51.45,,percent of total billed charges,,
"Layer Closure Wound Neck,Hand,Feet; 7.6-12.5 Cm (Pbb)",,12044,CPT,Professional,Outpatient,,,,888,754.8,133.06,888,PrimeWest Health,Minnesota Senior Health Options (MSHO),237.9235,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Layer Closure Wound Neck,Hand,Feet; 7.6-12.5 Cm (Pbb)",,12044,CPT,Facility,Outpatient,,,,643,546.55,184.2838,643,PrimeWest Health,MinnesotaCare,330.2448,51.36,,percent of total billed charges,,
"Layer Closure Wound Neck,Hand,Feet; 7.6-12.5 Cm (Pbb)",,12044,CPT,Professional,Outpatient,,,,888,754.8,133.06,888,PrimeWest Health,MinnesotaCare,164.3834152,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Layer Closure Wound Neck,Hand,Feet; 7.6-12.5 Cm (Pbb)",,12044,CPT,Facility,Outpatient,,,,643,546.55,184.2838,643,Sanford Health Plan,Sanford Health Plan,591.56,92,,percent of total billed charges,,
"Layer Closure Wound Neck,Hand,Feet; 7.6-12.5 Cm (Pbb)",,12044,CPT,Professional,Outpatient,,,,888,754.8,133.06,888,Sanford Health Plan,Sanford Health Plan,781.44,88,,percent of total billed charges,,
"Layer Closure Wound Neck,Hand,Feet; 7.6-12.5 Cm (Pbb)",,12044,CPT,Facility,Outpatient,,,,643,546.55,184.2838,643,"UCare Health, Inc.",Individual & Family Plan,362.3305,56.35,,percent of total billed charges,,
"Layer Closure Wound Neck,Hand,Feet; 7.6-12.5 Cm (Pbb)",,12044,CPT,Professional,Outpatient,,,,888,754.8,133.06,888,"UCare Health, Inc.",Individual & Family Plan,336.320384,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Layer Closure Wound Neck,Hand,Feet; 7.6-12.5 Cm (Pbb)",,12044,CPT,Facility,Outpatient,,,,643,546.55,184.2838,643,"UCare Health, Inc.",Medical Assistance,324.5221,50.47,,percent of total billed charges,,
"Layer Closure Wound Neck,Hand,Feet; 7.6-12.5 Cm (Pbb)",,12044,CPT,Professional,Outpatient,,,,888,754.8,133.06,888,"UCare Health, Inc.",Medical Assistance,168.992296,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Layer Closure Wound Neck,Hand,Feet; 7.6-12.5 Cm (Pbb)",,12044,CPT,Facility,Outpatient,,,,643,546.55,184.2838,643,"UCare Health, Inc.",Medicare Advantage,324.5221,50.47,,percent of total billed charges,,
"Layer Closure Wound Neck,Hand,Feet; 7.6-12.5 Cm (Pbb)",,12044,CPT,Professional,Outpatient,,,,888,754.8,133.06,888,"UCare Health, Inc.",Medicare Advantage,237.9235,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Layer Closure Wound Neck,Hand,Feet; 7.6-12.5 Cm (Pbb)",,12044,CPT,Facility,Outpatient,,,,643,546.55,184.2838,643,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),324.5221,50.47,,percent of total billed charges,,
"Layer Closure Wound Neck,Hand,Feet; 7.6-12.5 Cm (Pbb)",,12044,CPT,Professional,Outpatient,,,,888,754.8,133.06,888,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),190.3388,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Layer Closure Wound Neck,Hand,Feet; 7.6-12.5 Cm (Pbb)",,12044,CPT,Facility,Outpatient,,,,643,546.55,184.2838,643,UnitedHealthcare,Individual & Family,604.42,94,,percent of total billed charges,,
"Layer Closure Wound Neck,Hand,Feet; 7.6-12.5 Cm (Pbb)",,12044,CPT,Professional,Outpatient,,,,888,754.8,133.06,888,UnitedHealthcare,Individual & Family,888,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Layer Closure Wound Neck,Hand,Feet; 7.6-12.5 Cm (Pbb)",,12044,CPT,Facility,Outpatient,,,,643,546.55,184.2838,643,UnitedHealthcare,Medicare Advantage,315.07,49,,percent of total billed charges,,
"Layer Closure Wound Neck,Hand,Feet; 7.6-12.5 Cm (Pbb)",,12044,CPT,Professional,Outpatient,,,,888,754.8,133.06,888,UnitedHealthcare,Medicare Advantage,237.9235,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Layer Closure Wound Neck,Hand,Feet; 7.6-12.5 Cm (Pbb)",,12044,CPT,Facility,Outpatient,,,,643,546.55,184.2838,643,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,308.64,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Layer Closure Wound Neck,Hand,Feet; 7.6-12.5 Cm (Pbb)",,12044,CPT,Professional,Outpatient,,,,888,754.8,133.06,888,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,153.62936,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Repair, Intermediate, Wounds Neck, Hands, Feet And/Or External Genitalia; 7.6 Cm - 12.5 Cm (Pro Cah)",,12044,CPT,Professional,Both,,,,1531,1301.35,133.06,1531,Aetna,Commercial,1301.35,85,,percent of total billed charges,,
"Repair, Intermediate, Wounds Neck, Hands, Feet And/Or External Genitalia; 7.6 Cm - 12.5 Cm (Pro Cah)",,12044,CPT,Professional,Both,,,,1531,1301.35,133.06,1531,Aetna,Medicare Advantage,207.69,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair, Intermediate, Wounds Neck, Hands, Feet And/Or External Genitalia; 7.6 Cm - 12.5 Cm (Pro Cah)",,12044,CPT,Professional,Both,,,,1531,1301.35,133.06,1531,Aetna,PPO,1423.83,93,,percent of total billed charges,,
"Repair, Intermediate, Wounds Neck, Hands, Feet And/Or External Genitalia; 7.6 Cm - 12.5 Cm (Pro Cah)",,12044,CPT,Professional,Both,,,,1531,1301.35,133.06,1531,America's PPO,America's PPO,1308.0864,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Repair, Intermediate, Wounds Neck, Hands, Feet And/Or External Genitalia; 7.6 Cm - 12.5 Cm (Pro Cah)",,12044,CPT,Professional,Both,,,,1531,1301.35,133.06,1531,BlueCross BlueShield Minnesota, Federal Employee Program,437.26,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Repair, Intermediate, Wounds Neck, Hands, Feet And/Or External Genitalia; 7.6 Cm - 12.5 Cm (Pro Cah)",,12044,CPT,Professional,Both,,,,1531,1301.35,133.06,1531,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,444.25616,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Repair, Intermediate, Wounds Neck, Hands, Feet And/Or External Genitalia; 7.6 Cm - 12.5 Cm (Pro Cah)",,12044,CPT,Professional,Both,,,,1531,1301.35,133.06,1531,BlueCross BlueShield Minnesota,High Value Network Plan,444.25616,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Repair, Intermediate, Wounds Neck, Hands, Feet And/Or External Genitalia; 7.6 Cm - 12.5 Cm (Pro Cah)",,12044,CPT,Professional,Both,,,,1531,1301.35,133.06,1531,BlueCross BlueShield Minnesota,Medicare Advantage,237.9235,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair, Intermediate, Wounds Neck, Hands, Feet And/Or External Genitalia; 7.6 Cm - 12.5 Cm (Pro Cah)",,12044,CPT,Professional,Both,,,,1531,1301.35,133.06,1531,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,444.25616,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Repair, Intermediate, Wounds Neck, Hands, Feet And/Or External Genitalia; 7.6 Cm - 12.5 Cm (Pro Cah)",,12044,CPT,Professional,Both,,,,1531,1301.35,133.06,1531,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,153.62936,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Repair, Intermediate, Wounds Neck, Hands, Feet And/Or External Genitalia; 7.6 Cm - 12.5 Cm (Pro Cah)",,12044,CPT,Professional,Both,,,,1531,1301.35,133.06,1531,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),237.9235,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair, Intermediate, Wounds Neck, Hands, Feet And/Or External Genitalia; 7.6 Cm - 12.5 Cm (Pro Cah)",,12044,CPT,Professional,Both,,,,1531,1301.35,133.06,1531,CorVel,Worker's Compensation,402.7412445,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Repair, Intermediate, Wounds Neck, Hands, Feet And/Or External Genitalia; 7.6 Cm - 12.5 Cm (Pro Cah)",,12044,CPT,Professional,Both,,,,1531,1301.35,133.06,1531,First Health Group Corporation,First Health Network,1485.07,97,,percent of total billed charges,,
"Repair, Intermediate, Wounds Neck, Hands, Feet And/Or External Genitalia; 7.6 Cm - 12.5 Cm (Pro Cah)",,12044,CPT,Professional,Both,,,,1531,1301.35,133.06,1531,"Health Partners, Inc.",Commercial,434.59,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Repair, Intermediate, Wounds Neck, Hands, Feet And/Or External Genitalia; 7.6 Cm - 12.5 Cm (Pro Cah)",,12044,CPT,Professional,Both,,,,1531,1301.35,133.06,1531,"Health Partners, Inc.",Medicare Advantage,237.9235,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair, Intermediate, Wounds Neck, Hands, Feet And/Or External Genitalia; 7.6 Cm - 12.5 Cm (Pro Cah)",,12044,CPT,Professional,Both,,,,1531,1301.35,133.06,1531,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),206.71,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Repair, Intermediate, Wounds Neck, Hands, Feet And/Or External Genitalia; 7.6 Cm - 12.5 Cm (Pro Cah)",,12044,CPT,Professional,Both,,,,1531,1301.35,133.06,1531,"Health Partners, Inc.",State of Minnesota Advantage Program,374.399285,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Repair, Intermediate, Wounds Neck, Hands, Feet And/Or External Genitalia; 7.6 Cm - 12.5 Cm (Pro Cah)",,12044,CPT,Professional,Both,,,,1531,1301.35,133.06,1531,"Health Partners, Inc.",State Public Programs,133.06,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Repair, Intermediate, Wounds Neck, Hands, Feet And/Or External Genitalia; 7.6 Cm - 12.5 Cm (Pro Cah)",,12044,CPT,Professional,Both,,,,1531,1301.35,133.06,1531,Humana Insurance Company,Commercial PPO,206.89,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Repair, Intermediate, Wounds Neck, Hands, Feet And/Or External Genitalia; 7.6 Cm - 12.5 Cm (Pro Cah)",,12044,CPT,Professional,Both,,,,1531,1301.35,133.06,1531,Humana Insurance Company,Medicare PPO,1531,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Repair, Intermediate, Wounds Neck, Hands, Feet And/Or External Genitalia; 7.6 Cm - 12.5 Cm (Pro Cah)",,12044,CPT,Professional,Both,,,,1531,1301.35,133.06,1531,Medica,Individual & Family,1298.288,84.8,,percent of total billed charges,,
"Repair, Intermediate, Wounds Neck, Hands, Feet And/Or External Genitalia; 7.6 Cm - 12.5 Cm (Pro Cah)",,12044,CPT,Professional,Both,,,,1531,1301.35,133.06,1531,Medica,Medica Advantage Solution,762.438,49.8,,percent of total billed charges,,
"Repair, Intermediate, Wounds Neck, Hands, Feet And/Or External Genitalia; 7.6 Cm - 12.5 Cm (Pro Cah)",,12044,CPT,Professional,Both,,,,1531,1301.35,133.06,1531,Medica,Medical Assistance,153.63,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Repair, Intermediate, Wounds Neck, Hands, Feet And/Or External Genitalia; 7.6 Cm - 12.5 Cm (Pro Cah)",,12044,CPT,Professional,Both,,,,1531,1301.35,133.06,1531,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,206.89,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Repair, Intermediate, Wounds Neck, Hands, Feet And/Or External Genitalia; 7.6 Cm - 12.5 Cm (Pro Cah)",,12044,CPT,Professional,Both,,,,1531,1301.35,133.06,1531,"Multiplan, Inc.","Multiplan, Inc.",1439.14,94,,percent of total billed charges,,
"Repair, Intermediate, Wounds Neck, Hands, Feet And/Or External Genitalia; 7.6 Cm - 12.5 Cm (Pro Cah)",,12044,CPT,Professional,Both,,,,1531,1301.35,133.06,1531,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1379.431,90.1,,percent of total billed charges,,
"Repair, Intermediate, Wounds Neck, Hands, Feet And/Or External Genitalia; 7.6 Cm - 12.5 Cm (Pro Cah)",,12044,CPT,Professional,Both,,,,1531,1301.35,133.06,1531,"Preferred One Administrative Services, INC.",PPO,1509.566,98.6,,percent of total billed charges,,
"Repair, Intermediate, Wounds Neck, Hands, Feet And/Or External Genitalia; 7.6 Cm - 12.5 Cm (Pro Cah)",,12044,CPT,Professional,Both,,,,1531,1301.35,133.06,1531,PrimeWest Health,Minnesota Senior Health Options (MSHO),237.9235,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair, Intermediate, Wounds Neck, Hands, Feet And/Or External Genitalia; 7.6 Cm - 12.5 Cm (Pro Cah)",,12044,CPT,Professional,Both,,,,1531,1301.35,133.06,1531,PrimeWest Health,MinnesotaCare,164.3834152,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Repair, Intermediate, Wounds Neck, Hands, Feet And/Or External Genitalia; 7.6 Cm - 12.5 Cm (Pro Cah)",,12044,CPT,Professional,Both,,,,1531,1301.35,133.06,1531,Sanford Health Plan,Sanford Health Plan,1347.28,88,,percent of total billed charges,,
"Repair, Intermediate, Wounds Neck, Hands, Feet And/Or External Genitalia; 7.6 Cm - 12.5 Cm (Pro Cah)",,12044,CPT,Professional,Both,,,,1531,1301.35,133.06,1531,"UCare Health, Inc.",Individual & Family Plan,336.320384,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Repair, Intermediate, Wounds Neck, Hands, Feet And/Or External Genitalia; 7.6 Cm - 12.5 Cm (Pro Cah)",,12044,CPT,Professional,Both,,,,1531,1301.35,133.06,1531,"UCare Health, Inc.",Medical Assistance,168.992296,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Repair, Intermediate, Wounds Neck, Hands, Feet And/Or External Genitalia; 7.6 Cm - 12.5 Cm (Pro Cah)",,12044,CPT,Professional,Both,,,,1531,1301.35,133.06,1531,"UCare Health, Inc.",Medicare Advantage,237.9235,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Repair, Intermediate, Wounds Neck, Hands, Feet And/Or External Genitalia; 7.6 Cm - 12.5 Cm (Pro Cah)",,12044,CPT,Professional,Both,,,,1531,1301.35,133.06,1531,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),190.3388,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Repair, Intermediate, Wounds Neck, Hands, Feet And/Or External Genitalia; 7.6 Cm - 12.5 Cm (Pro Cah)",,12044,CPT,Professional,Both,,,,1531,1301.35,133.06,1531,UnitedHealthcare,Individual & Family,1531,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Repair, Intermediate, Wounds Neck, Hands, Feet And/Or External Genitalia; 7.6 Cm - 12.5 Cm (Pro Cah)",,12044,CPT,Professional,Both,,,,1531,1301.35,133.06,1531,UnitedHealthcare,Medicare Advantage,237.9235,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair, Intermediate, Wounds Neck, Hands, Feet And/Or External Genitalia; 7.6 Cm - 12.5 Cm (Pro Cah)",,12044,CPT,Professional,Both,,,,1531,1301.35,133.06,1531,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,153.62936,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Layer Closure Wound Face,Ear,Eyelid,Nose; 2.6-5.0 Cm (Pbb)",,12052,CPT,Facility,Outpatient,,,,469,398.65,134.4154,469,Aetna,Commercial,431.48,92,,percent of total billed charges,,
"Layer Closure Wound Face,Ear,Eyelid,Nose; 2.6-5.0 Cm (Pbb)",,12052,CPT,Professional,Outpatient,,,,593,504.05,125.22,593,Aetna,Commercial,504.05,85,,percent of total billed charges,,
"Layer Closure Wound Face,Ear,Eyelid,Nose; 2.6-5.0 Cm (Pbb)",,12052,CPT,Facility,Outpatient,,,,469,398.65,134.4154,469,Aetna,Medicare Advantage,229.81,49,,percent of total billed charges,,
"Layer Closure Wound Face,Ear,Eyelid,Nose; 2.6-5.0 Cm (Pbb)",,12052,CPT,Professional,Outpatient,,,,593,504.05,125.22,593,Aetna,Medicare Advantage,195.53,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Layer Closure Wound Face,Ear,Eyelid,Nose; 2.6-5.0 Cm (Pbb)",,12052,CPT,Facility,Outpatient,,,,469,398.65,134.4154,469,Aetna,PPO,436.17,93,,percent of total billed charges,,
"Layer Closure Wound Face,Ear,Eyelid,Nose; 2.6-5.0 Cm (Pbb)",,12052,CPT,Professional,Outpatient,,,,593,504.05,125.22,593,Aetna,PPO,551.49,93,,percent of total billed charges,,
"Layer Closure Wound Face,Ear,Eyelid,Nose; 2.6-5.0 Cm (Pbb)",,12052,CPT,Facility,Outpatient,,,,469,398.65,134.4154,469,America's PPO,America's PPO,450.3807,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Layer Closure Wound Face,Ear,Eyelid,Nose; 2.6-5.0 Cm (Pbb)",,12052,CPT,Professional,Outpatient,,,,593,504.05,125.22,593,America's PPO,America's PPO,506.6592,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Layer Closure Wound Face,Ear,Eyelid,Nose; 2.6-5.0 Cm (Pbb)",,12052,CPT,Facility,Outpatient,,,,469,398.65,134.4154,469,BlueCross BlueShield Minnesota, Federal Employee Program,461.496,98.4,,percent of total billed charges,,
"Layer Closure Wound Face,Ear,Eyelid,Nose; 2.6-5.0 Cm (Pbb)",,12052,CPT,Professional,Outpatient,,,,593,504.05,125.22,593,BlueCross BlueShield Minnesota, Federal Employee Program,408.34,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Layer Closure Wound Face,Ear,Eyelid,Nose; 2.6-5.0 Cm (Pbb)",,12052,CPT,Facility,Outpatient,,,,469,398.65,134.4154,469,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,469,100,,percent of total billed charges,,
"Layer Closure Wound Face,Ear,Eyelid,Nose; 2.6-5.0 Cm (Pbb)",,12052,CPT,Professional,Outpatient,,,,593,504.05,125.22,593,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,414.87344,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Layer Closure Wound Face,Ear,Eyelid,Nose; 2.6-5.0 Cm (Pbb)",,12052,CPT,Facility,Outpatient,,,,469,398.65,134.4154,469,BlueCross BlueShield Minnesota,High Value Network Plan,422.1,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
"Layer Closure Wound Face,Ear,Eyelid,Nose; 2.6-5.0 Cm (Pbb)",,12052,CPT,Professional,Outpatient,,,,593,504.05,125.22,593,BlueCross BlueShield Minnesota,High Value Network Plan,414.87344,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Layer Closure Wound Face,Ear,Eyelid,Nose; 2.6-5.0 Cm (Pbb)",,12052,CPT,Facility,Outpatient,,,,469,398.65,134.4154,469,BlueCross BlueShield Minnesota,Medicare Advantage,229.81,49,,percent of total billed charges,,
"Layer Closure Wound Face,Ear,Eyelid,Nose; 2.6-5.0 Cm (Pbb)",,12052,CPT,Professional,Outpatient,,,,593,504.05,125.22,593,BlueCross BlueShield Minnesota,Medicare Advantage,223.905,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Layer Closure Wound Face,Ear,Eyelid,Nose; 2.6-5.0 Cm (Pbb)",,12052,CPT,Professional,Outpatient,,,,593,504.05,125.22,593,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,414.87344,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Layer Closure Wound Face,Ear,Eyelid,Nose; 2.6-5.0 Cm (Pbb)",,12052,CPT,Facility,Outpatient,,,,469,398.65,134.4154,469,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,134.4154,28.66,,percent of total billed charges,,
"Layer Closure Wound Face,Ear,Eyelid,Nose; 2.6-5.0 Cm (Pbb)",,12052,CPT,Professional,Outpatient,,,,593,504.05,125.22,593,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,144.56664,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Layer Closure Wound Face,Ear,Eyelid,Nose; 2.6-5.0 Cm (Pbb)",,12052,CPT,Facility,Outpatient,,,,469,398.65,134.4154,469,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),229.81,49,,percent of total billed charges,,
"Layer Closure Wound Face,Ear,Eyelid,Nose; 2.6-5.0 Cm (Pbb)",,12052,CPT,Professional,Outpatient,,,,593,504.05,125.22,593,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),223.905,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Layer Closure Wound Face,Ear,Eyelid,Nose; 2.6-5.0 Cm (Pbb)",,12052,CPT,Facility,Outpatient,,,,469,398.65,134.4154,469,CorVel,Worker's Compensation,469,100,,percent of total billed charges,,
"Layer Closure Wound Face,Ear,Eyelid,Nose; 2.6-5.0 Cm (Pbb)",,12052,CPT,Professional,Outpatient,,,,593,504.05,125.22,593,CorVel,Worker's Compensation,377.7519894,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Layer Closure Wound Face,Ear,Eyelid,Nose; 2.6-5.0 Cm (Pbb)",,12052,CPT,Facility,Outpatient,,,,469,398.65,134.4154,469,First Health Group Corporation,First Health Network,454.93,97,,percent of total billed charges,,
"Layer Closure Wound Face,Ear,Eyelid,Nose; 2.6-5.0 Cm (Pbb)",,12052,CPT,Professional,Outpatient,,,,593,504.05,125.22,593,First Health Group Corporation,First Health Network,575.21,97,,percent of total billed charges,,
"Layer Closure Wound Face,Ear,Eyelid,Nose; 2.6-5.0 Cm (Pbb)",,12052,CPT,Facility,Outpatient,,,,469,398.65,134.4154,469,"Health Partners, Inc.",Commercial,443.674,94.6,,percent of total billed charges,,
"Layer Closure Wound Face,Ear,Eyelid,Nose; 2.6-5.0 Cm (Pbb)",,12052,CPT,Professional,Outpatient,,,,593,504.05,125.22,593,"Health Partners, Inc.",Commercial,407.74,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Layer Closure Wound Face,Ear,Eyelid,Nose; 2.6-5.0 Cm (Pbb)",,12052,CPT,Facility,Outpatient,,,,469,398.65,134.4154,469,"Health Partners, Inc.",Medicare Advantage,229.81,49,,percent of total billed charges,,
"Layer Closure Wound Face,Ear,Eyelid,Nose; 2.6-5.0 Cm (Pbb)",,12052,CPT,Professional,Outpatient,,,,593,504.05,125.22,593,"Health Partners, Inc.",Medicare Advantage,223.905,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Layer Closure Wound Face,Ear,Eyelid,Nose; 2.6-5.0 Cm (Pbb)",,12052,CPT,Facility,Outpatient,,,,469,398.65,134.4154,469,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),281.4,60,,percent of total billed charges,,
"Layer Closure Wound Face,Ear,Eyelid,Nose; 2.6-5.0 Cm (Pbb)",,12052,CPT,Professional,Outpatient,,,,593,504.05,125.22,593,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),194.51,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Layer Closure Wound Face,Ear,Eyelid,Nose; 2.6-5.0 Cm (Pbb)",,12052,CPT,Facility,Outpatient,,,,469,398.65,134.4154,469,"Health Partners, Inc.",State of Minnesota Advantage Program,382.235,81.5,,percent of total billed charges,,
"Layer Closure Wound Face,Ear,Eyelid,Nose; 2.6-5.0 Cm (Pbb)",,12052,CPT,Professional,Outpatient,,,,593,504.05,125.22,593,"Health Partners, Inc.",State of Minnesota Advantage Program,351.26801,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Layer Closure Wound Face,Ear,Eyelid,Nose; 2.6-5.0 Cm (Pbb)",,12052,CPT,Facility,Outpatient,,,,469,398.65,134.4154,469,"Health Partners, Inc.",State Public Programs,234.5,50,,percent of total billed charges,,
"Layer Closure Wound Face,Ear,Eyelid,Nose; 2.6-5.0 Cm (Pbb)",,12052,CPT,Professional,Outpatient,,,,593,504.05,125.22,593,"Health Partners, Inc.",State Public Programs,125.22,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Layer Closure Wound Face,Ear,Eyelid,Nose; 2.6-5.0 Cm (Pbb)",,12052,CPT,Facility,Outpatient,,,,469,398.65,134.4154,469,Humana Insurance Company,Commercial PPO,445.55,95,,percent of total billed charges,,
"Layer Closure Wound Face,Ear,Eyelid,Nose; 2.6-5.0 Cm (Pbb)",,12052,CPT,Professional,Outpatient,,,,593,504.05,125.22,593,Humana Insurance Company,Commercial PPO,194.7,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Layer Closure Wound Face,Ear,Eyelid,Nose; 2.6-5.0 Cm (Pbb)",,12052,CPT,Facility,Outpatient,,,,469,398.65,134.4154,469,Humana Insurance Company,Medicare PPO,229.81,49,,percent of total billed charges,,
"Layer Closure Wound Face,Ear,Eyelid,Nose; 2.6-5.0 Cm (Pbb)",,12052,CPT,Professional,Outpatient,,,,593,504.05,125.22,593,Humana Insurance Company,Medicare PPO,593,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Layer Closure Wound Face,Ear,Eyelid,Nose; 2.6-5.0 Cm (Pbb)",,12052,CPT,Facility,Outpatient,,,,469,398.65,134.4154,469,Medica,Individual & Family,464.779,99.1,,percent of total billed charges,,
"Layer Closure Wound Face,Ear,Eyelid,Nose; 2.6-5.0 Cm (Pbb)",,12052,CPT,Professional,Outpatient,,,,593,504.05,125.22,593,Medica,Individual & Family,502.864,84.8,,percent of total billed charges,,
"Layer Closure Wound Face,Ear,Eyelid,Nose; 2.6-5.0 Cm (Pbb)",,12052,CPT,Facility,Outpatient,,,,469,398.65,134.4154,469,Medica,Medica Advantage Solution,233.562,49.8,,percent of total billed charges,,
"Layer Closure Wound Face,Ear,Eyelid,Nose; 2.6-5.0 Cm (Pbb)",,12052,CPT,Professional,Outpatient,,,,593,504.05,125.22,593,Medica,Medica Advantage Solution,295.314,49.8,,percent of total billed charges,,
"Layer Closure Wound Face,Ear,Eyelid,Nose; 2.6-5.0 Cm (Pbb)",,12052,CPT,Facility,Outpatient,,,,469,398.65,134.4154,469,Medica,Medical Assistance,209.174,44.6,,percent of total billed charges,,
"Layer Closure Wound Face,Ear,Eyelid,Nose; 2.6-5.0 Cm (Pbb)",,12052,CPT,Professional,Outpatient,,,,593,504.05,125.22,593,Medica,Medical Assistance,144.57,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Layer Closure Wound Face,Ear,Eyelid,Nose; 2.6-5.0 Cm (Pbb)",,12052,CPT,Facility,Outpatient,,,,469,398.65,134.4154,469,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,233.562,49.8,,percent of total billed charges,,
"Layer Closure Wound Face,Ear,Eyelid,Nose; 2.6-5.0 Cm (Pbb)",,12052,CPT,Professional,Outpatient,,,,593,504.05,125.22,593,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,194.7,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Layer Closure Wound Face,Ear,Eyelid,Nose; 2.6-5.0 Cm (Pbb)",,12052,CPT,Facility,Outpatient,,,,469,398.65,134.4154,469,"Multiplan, Inc.","Multiplan, Inc.",440.86,94,,percent of total billed charges,,
"Layer Closure Wound Face,Ear,Eyelid,Nose; 2.6-5.0 Cm (Pbb)",,12052,CPT,Professional,Outpatient,,,,593,504.05,125.22,593,"Multiplan, Inc.","Multiplan, Inc.",557.42,94,,percent of total billed charges,,
"Layer Closure Wound Face,Ear,Eyelid,Nose; 2.6-5.0 Cm (Pbb)",,12052,CPT,Facility,Outpatient,,,,469,398.65,134.4154,469,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,422.569,90.1,,percent of total billed charges,,
"Layer Closure Wound Face,Ear,Eyelid,Nose; 2.6-5.0 Cm (Pbb)",,12052,CPT,Professional,Outpatient,,,,593,504.05,125.22,593,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,534.293,90.1,,percent of total billed charges,,
"Layer Closure Wound Face,Ear,Eyelid,Nose; 2.6-5.0 Cm (Pbb)",,12052,CPT,Facility,Outpatient,,,,469,398.65,134.4154,469,"Preferred One Administrative Services, INC.",PPO,462.434,98.6,,percent of total billed charges,,
"Layer Closure Wound Face,Ear,Eyelid,Nose; 2.6-5.0 Cm (Pbb)",,12052,CPT,Professional,Outpatient,,,,593,504.05,125.22,593,"Preferred One Administrative Services, INC.",PPO,584.698,98.6,,percent of total billed charges,,
"Layer Closure Wound Face,Ear,Eyelid,Nose; 2.6-5.0 Cm (Pbb)",,12052,CPT,Facility,Outpatient,,,,469,398.65,134.4154,469,PrimeWest Health,Minnesota Senior Health Options (MSHO),241.3005,51.45,,percent of total billed charges,,
"Layer Closure Wound Face,Ear,Eyelid,Nose; 2.6-5.0 Cm (Pbb)",,12052,CPT,Professional,Outpatient,,,,593,504.05,125.22,593,PrimeWest Health,Minnesota Senior Health Options (MSHO),223.905,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Layer Closure Wound Face,Ear,Eyelid,Nose; 2.6-5.0 Cm (Pbb)",,12052,CPT,Facility,Outpatient,,,,469,398.65,134.4154,469,PrimeWest Health,MinnesotaCare,240.8784,51.36,,percent of total billed charges,,
"Layer Closure Wound Face,Ear,Eyelid,Nose; 2.6-5.0 Cm (Pbb)",,12052,CPT,Professional,Outpatient,,,,593,504.05,125.22,593,PrimeWest Health,MinnesotaCare,154.6863048,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Layer Closure Wound Face,Ear,Eyelid,Nose; 2.6-5.0 Cm (Pbb)",,12052,CPT,Facility,Outpatient,,,,469,398.65,134.4154,469,Sanford Health Plan,Sanford Health Plan,431.48,92,,percent of total billed charges,,
"Layer Closure Wound Face,Ear,Eyelid,Nose; 2.6-5.0 Cm (Pbb)",,12052,CPT,Professional,Outpatient,,,,593,504.05,125.22,593,Sanford Health Plan,Sanford Health Plan,521.84,88,,percent of total billed charges,,
"Layer Closure Wound Face,Ear,Eyelid,Nose; 2.6-5.0 Cm (Pbb)",,12052,CPT,Facility,Outpatient,,,,469,398.65,134.4154,469,"UCare Health, Inc.",Individual & Family Plan,264.2815,56.35,,percent of total billed charges,,
"Layer Closure Wound Face,Ear,Eyelid,Nose; 2.6-5.0 Cm (Pbb)",,12052,CPT,Professional,Outpatient,,,,593,504.05,125.22,593,"UCare Health, Inc.",Individual & Family Plan,316.50432,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Layer Closure Wound Face,Ear,Eyelid,Nose; 2.6-5.0 Cm (Pbb)",,12052,CPT,Facility,Outpatient,,,,469,398.65,134.4154,469,"UCare Health, Inc.",Medical Assistance,236.7043,50.47,,percent of total billed charges,,
"Layer Closure Wound Face,Ear,Eyelid,Nose; 2.6-5.0 Cm (Pbb)",,12052,CPT,Professional,Outpatient,,,,593,504.05,125.22,593,"UCare Health, Inc.",Medical Assistance,159.023304,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Layer Closure Wound Face,Ear,Eyelid,Nose; 2.6-5.0 Cm (Pbb)",,12052,CPT,Facility,Outpatient,,,,469,398.65,134.4154,469,"UCare Health, Inc.",Medicare Advantage,236.7043,50.47,,percent of total billed charges,,
"Layer Closure Wound Face,Ear,Eyelid,Nose; 2.6-5.0 Cm (Pbb)",,12052,CPT,Professional,Outpatient,,,,593,504.05,125.22,593,"UCare Health, Inc.",Medicare Advantage,223.905,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Layer Closure Wound Face,Ear,Eyelid,Nose; 2.6-5.0 Cm (Pbb)",,12052,CPT,Facility,Outpatient,,,,469,398.65,134.4154,469,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),236.7043,50.47,,percent of total billed charges,,
"Layer Closure Wound Face,Ear,Eyelid,Nose; 2.6-5.0 Cm (Pbb)",,12052,CPT,Professional,Outpatient,,,,593,504.05,125.22,593,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),179.124,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Layer Closure Wound Face,Ear,Eyelid,Nose; 2.6-5.0 Cm (Pbb)",,12052,CPT,Facility,Outpatient,,,,469,398.65,134.4154,469,UnitedHealthcare,Individual & Family,440.86,94,,percent of total billed charges,,
"Layer Closure Wound Face,Ear,Eyelid,Nose; 2.6-5.0 Cm (Pbb)",,12052,CPT,Professional,Outpatient,,,,593,504.05,125.22,593,UnitedHealthcare,Individual & Family,593,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Layer Closure Wound Face,Ear,Eyelid,Nose; 2.6-5.0 Cm (Pbb)",,12052,CPT,Facility,Outpatient,,,,469,398.65,134.4154,469,UnitedHealthcare,Medicare Advantage,229.81,49,,percent of total billed charges,,
"Layer Closure Wound Face,Ear,Eyelid,Nose; 2.6-5.0 Cm (Pbb)",,12052,CPT,Professional,Outpatient,,,,593,504.05,125.22,593,UnitedHealthcare,Medicare Advantage,223.905,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Layer Closure Wound Face,Ear,Eyelid,Nose; 2.6-5.0 Cm (Pbb)",,12052,CPT,Facility,Outpatient,,,,469,398.65,134.4154,469,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,225.12,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Layer Closure Wound Face,Ear,Eyelid,Nose; 2.6-5.0 Cm (Pbb)",,12052,CPT,Professional,Outpatient,,,,593,504.05,125.22,593,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,144.56664,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Repair, Intermediate, Wounds Face,Ears,Eyelids,Nose,Lip,Mucous Membranes; 2.6  -  5.0 Cm (Pro Cah)",,12052,CPT,Professional,Both,,,,1062,902.7,125.22,1062,Aetna,Commercial,902.7,85,,percent of total billed charges,,
"Repair, Intermediate, Wounds Face,Ears,Eyelids,Nose,Lip,Mucous Membranes; 2.6  -  5.0 Cm (Pro Cah)",,12052,CPT,Professional,Both,,,,1062,902.7,125.22,1062,Aetna,Medicare Advantage,195.53,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair, Intermediate, Wounds Face,Ears,Eyelids,Nose,Lip,Mucous Membranes; 2.6  -  5.0 Cm (Pro Cah)",,12052,CPT,Professional,Both,,,,1062,902.7,125.22,1062,Aetna,PPO,987.66,93,,percent of total billed charges,,
"Repair, Intermediate, Wounds Face,Ears,Eyelids,Nose,Lip,Mucous Membranes; 2.6  -  5.0 Cm (Pro Cah)",,12052,CPT,Professional,Both,,,,1062,902.7,125.22,1062,America's PPO,America's PPO,907.3728,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Repair, Intermediate, Wounds Face,Ears,Eyelids,Nose,Lip,Mucous Membranes; 2.6  -  5.0 Cm (Pro Cah)",,12052,CPT,Professional,Both,,,,1062,902.7,125.22,1062,BlueCross BlueShield Minnesota, Federal Employee Program,408.34,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Repair, Intermediate, Wounds Face,Ears,Eyelids,Nose,Lip,Mucous Membranes; 2.6  -  5.0 Cm (Pro Cah)",,12052,CPT,Professional,Both,,,,1062,902.7,125.22,1062,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,414.87344,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Repair, Intermediate, Wounds Face,Ears,Eyelids,Nose,Lip,Mucous Membranes; 2.6  -  5.0 Cm (Pro Cah)",,12052,CPT,Professional,Both,,,,1062,902.7,125.22,1062,BlueCross BlueShield Minnesota,High Value Network Plan,414.87344,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Repair, Intermediate, Wounds Face,Ears,Eyelids,Nose,Lip,Mucous Membranes; 2.6  -  5.0 Cm (Pro Cah)",,12052,CPT,Professional,Both,,,,1062,902.7,125.22,1062,BlueCross BlueShield Minnesota,Medicare Advantage,223.905,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair, Intermediate, Wounds Face,Ears,Eyelids,Nose,Lip,Mucous Membranes; 2.6  -  5.0 Cm (Pro Cah)",,12052,CPT,Professional,Both,,,,1062,902.7,125.22,1062,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,414.87344,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Repair, Intermediate, Wounds Face,Ears,Eyelids,Nose,Lip,Mucous Membranes; 2.6  -  5.0 Cm (Pro Cah)",,12052,CPT,Professional,Both,,,,1062,902.7,125.22,1062,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,144.56664,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Repair, Intermediate, Wounds Face,Ears,Eyelids,Nose,Lip,Mucous Membranes; 2.6  -  5.0 Cm (Pro Cah)",,12052,CPT,Professional,Both,,,,1062,902.7,125.22,1062,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),223.905,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair, Intermediate, Wounds Face,Ears,Eyelids,Nose,Lip,Mucous Membranes; 2.6  -  5.0 Cm (Pro Cah)",,12052,CPT,Professional,Both,,,,1062,902.7,125.22,1062,CorVel,Worker's Compensation,377.7519894,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Repair, Intermediate, Wounds Face,Ears,Eyelids,Nose,Lip,Mucous Membranes; 2.6  -  5.0 Cm (Pro Cah)",,12052,CPT,Professional,Both,,,,1062,902.7,125.22,1062,First Health Group Corporation,First Health Network,1030.14,97,,percent of total billed charges,,
"Repair, Intermediate, Wounds Face,Ears,Eyelids,Nose,Lip,Mucous Membranes; 2.6  -  5.0 Cm (Pro Cah)",,12052,CPT,Professional,Both,,,,1062,902.7,125.22,1062,"Health Partners, Inc.",Commercial,407.74,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Repair, Intermediate, Wounds Face,Ears,Eyelids,Nose,Lip,Mucous Membranes; 2.6  -  5.0 Cm (Pro Cah)",,12052,CPT,Professional,Both,,,,1062,902.7,125.22,1062,"Health Partners, Inc.",Medicare Advantage,223.905,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair, Intermediate, Wounds Face,Ears,Eyelids,Nose,Lip,Mucous Membranes; 2.6  -  5.0 Cm (Pro Cah)",,12052,CPT,Professional,Both,,,,1062,902.7,125.22,1062,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),194.51,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Repair, Intermediate, Wounds Face,Ears,Eyelids,Nose,Lip,Mucous Membranes; 2.6  -  5.0 Cm (Pro Cah)",,12052,CPT,Professional,Both,,,,1062,902.7,125.22,1062,"Health Partners, Inc.",State of Minnesota Advantage Program,351.26801,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Repair, Intermediate, Wounds Face,Ears,Eyelids,Nose,Lip,Mucous Membranes; 2.6  -  5.0 Cm (Pro Cah)",,12052,CPT,Professional,Both,,,,1062,902.7,125.22,1062,"Health Partners, Inc.",State Public Programs,125.22,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Repair, Intermediate, Wounds Face,Ears,Eyelids,Nose,Lip,Mucous Membranes; 2.6  -  5.0 Cm (Pro Cah)",,12052,CPT,Professional,Both,,,,1062,902.7,125.22,1062,Humana Insurance Company,Commercial PPO,194.7,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Repair, Intermediate, Wounds Face,Ears,Eyelids,Nose,Lip,Mucous Membranes; 2.6  -  5.0 Cm (Pro Cah)",,12052,CPT,Professional,Both,,,,1062,902.7,125.22,1062,Humana Insurance Company,Medicare PPO,1062,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Repair, Intermediate, Wounds Face,Ears,Eyelids,Nose,Lip,Mucous Membranes; 2.6  -  5.0 Cm (Pro Cah)",,12052,CPT,Professional,Both,,,,1062,902.7,125.22,1062,Medica,Individual & Family,900.576,84.8,,percent of total billed charges,,
"Repair, Intermediate, Wounds Face,Ears,Eyelids,Nose,Lip,Mucous Membranes; 2.6  -  5.0 Cm (Pro Cah)",,12052,CPT,Professional,Both,,,,1062,902.7,125.22,1062,Medica,Medica Advantage Solution,528.876,49.8,,percent of total billed charges,,
"Repair, Intermediate, Wounds Face,Ears,Eyelids,Nose,Lip,Mucous Membranes; 2.6  -  5.0 Cm (Pro Cah)",,12052,CPT,Professional,Both,,,,1062,902.7,125.22,1062,Medica,Medical Assistance,144.57,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Repair, Intermediate, Wounds Face,Ears,Eyelids,Nose,Lip,Mucous Membranes; 2.6  -  5.0 Cm (Pro Cah)",,12052,CPT,Professional,Both,,,,1062,902.7,125.22,1062,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,194.7,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Repair, Intermediate, Wounds Face,Ears,Eyelids,Nose,Lip,Mucous Membranes; 2.6  -  5.0 Cm (Pro Cah)",,12052,CPT,Professional,Both,,,,1062,902.7,125.22,1062,"Multiplan, Inc.","Multiplan, Inc.",998.28,94,,percent of total billed charges,,
"Repair, Intermediate, Wounds Face,Ears,Eyelids,Nose,Lip,Mucous Membranes; 2.6  -  5.0 Cm (Pro Cah)",,12052,CPT,Professional,Both,,,,1062,902.7,125.22,1062,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,956.862,90.1,,percent of total billed charges,,
"Repair, Intermediate, Wounds Face,Ears,Eyelids,Nose,Lip,Mucous Membranes; 2.6  -  5.0 Cm (Pro Cah)",,12052,CPT,Professional,Both,,,,1062,902.7,125.22,1062,"Preferred One Administrative Services, INC.",PPO,1047.132,98.6,,percent of total billed charges,,
"Repair, Intermediate, Wounds Face,Ears,Eyelids,Nose,Lip,Mucous Membranes; 2.6  -  5.0 Cm (Pro Cah)",,12052,CPT,Professional,Both,,,,1062,902.7,125.22,1062,PrimeWest Health,Minnesota Senior Health Options (MSHO),223.905,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair, Intermediate, Wounds Face,Ears,Eyelids,Nose,Lip,Mucous Membranes; 2.6  -  5.0 Cm (Pro Cah)",,12052,CPT,Professional,Both,,,,1062,902.7,125.22,1062,PrimeWest Health,MinnesotaCare,154.6863048,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Repair, Intermediate, Wounds Face,Ears,Eyelids,Nose,Lip,Mucous Membranes; 2.6  -  5.0 Cm (Pro Cah)",,12052,CPT,Professional,Both,,,,1062,902.7,125.22,1062,Sanford Health Plan,Sanford Health Plan,934.56,88,,percent of total billed charges,,
"Repair, Intermediate, Wounds Face,Ears,Eyelids,Nose,Lip,Mucous Membranes; 2.6  -  5.0 Cm (Pro Cah)",,12052,CPT,Professional,Both,,,,1062,902.7,125.22,1062,"UCare Health, Inc.",Individual & Family Plan,316.50432,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Repair, Intermediate, Wounds Face,Ears,Eyelids,Nose,Lip,Mucous Membranes; 2.6  -  5.0 Cm (Pro Cah)",,12052,CPT,Professional,Both,,,,1062,902.7,125.22,1062,"UCare Health, Inc.",Medical Assistance,159.023304,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Repair, Intermediate, Wounds Face,Ears,Eyelids,Nose,Lip,Mucous Membranes; 2.6  -  5.0 Cm (Pro Cah)",,12052,CPT,Professional,Both,,,,1062,902.7,125.22,1062,"UCare Health, Inc.",Medicare Advantage,223.905,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Repair, Intermediate, Wounds Face,Ears,Eyelids,Nose,Lip,Mucous Membranes; 2.6  -  5.0 Cm (Pro Cah)",,12052,CPT,Professional,Both,,,,1062,902.7,125.22,1062,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),179.124,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Repair, Intermediate, Wounds Face,Ears,Eyelids,Nose,Lip,Mucous Membranes; 2.6  -  5.0 Cm (Pro Cah)",,12052,CPT,Professional,Both,,,,1062,902.7,125.22,1062,UnitedHealthcare,Individual & Family,1062,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Repair, Intermediate, Wounds Face,Ears,Eyelids,Nose,Lip,Mucous Membranes; 2.6  -  5.0 Cm (Pro Cah)",,12052,CPT,Professional,Both,,,,1062,902.7,125.22,1062,UnitedHealthcare,Medicare Advantage,223.905,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair, Intermediate, Wounds Face,Ears,Eyelids,Nose,Lip,Mucous Membranes; 2.6  -  5.0 Cm (Pro Cah)",,12052,CPT,Professional,Both,,,,1062,902.7,125.22,1062,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,144.56664,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Repair, Intermediate, Wounds Face,Ears,Eyelids,Nose,Lips,Mucous Membranes; 5.1 -7.5 Cm (Pro Cah)",,12053,CPT,Professional,Both,,,,1481,1258.85,134.6,1481,Aetna,Commercial,1258.85,85,,percent of total billed charges,,
"Repair, Intermediate, Wounds Face,Ears,Eyelids,Nose,Lips,Mucous Membranes; 5.1 -7.5 Cm (Pro Cah)",,12053,CPT,Professional,Both,,,,1481,1258.85,134.6,1481,Aetna,Medicare Advantage,209.93,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair, Intermediate, Wounds Face,Ears,Eyelids,Nose,Lips,Mucous Membranes; 5.1 -7.5 Cm (Pro Cah)",,12053,CPT,Professional,Both,,,,1481,1258.85,134.6,1481,Aetna,PPO,1377.33,93,,percent of total billed charges,,
"Repair, Intermediate, Wounds Face,Ears,Eyelids,Nose,Lips,Mucous Membranes; 5.1 -7.5 Cm (Pro Cah)",,12053,CPT,Professional,Both,,,,1481,1258.85,134.6,1481,America's PPO,America's PPO,1265.3664,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Repair, Intermediate, Wounds Face,Ears,Eyelids,Nose,Lips,Mucous Membranes; 5.1 -7.5 Cm (Pro Cah)",,12053,CPT,Professional,Both,,,,1481,1258.85,134.6,1481,BlueCross BlueShield Minnesota, Federal Employee Program,440.7,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Repair, Intermediate, Wounds Face,Ears,Eyelids,Nose,Lips,Mucous Membranes; 5.1 -7.5 Cm (Pro Cah)",,12053,CPT,Professional,Both,,,,1481,1258.85,134.6,1481,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,447.7512,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Repair, Intermediate, Wounds Face,Ears,Eyelids,Nose,Lips,Mucous Membranes; 5.1 -7.5 Cm (Pro Cah)",,12053,CPT,Professional,Both,,,,1481,1258.85,134.6,1481,BlueCross BlueShield Minnesota,High Value Network Plan,447.7512,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Repair, Intermediate, Wounds Face,Ears,Eyelids,Nose,Lips,Mucous Membranes; 5.1 -7.5 Cm (Pro Cah)",,12053,CPT,Professional,Both,,,,1481,1258.85,134.6,1481,BlueCross BlueShield Minnesota,Medicare Advantage,240.7295,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair, Intermediate, Wounds Face,Ears,Eyelids,Nose,Lips,Mucous Membranes; 5.1 -7.5 Cm (Pro Cah)",,12053,CPT,Professional,Both,,,,1481,1258.85,134.6,1481,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,447.7512,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Repair, Intermediate, Wounds Face,Ears,Eyelids,Nose,Lips,Mucous Membranes; 5.1 -7.5 Cm (Pro Cah)",,12053,CPT,Professional,Both,,,,1481,1258.85,134.6,1481,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,155.3972,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Repair, Intermediate, Wounds Face,Ears,Eyelids,Nose,Lips,Mucous Membranes; 5.1 -7.5 Cm (Pro Cah)",,12053,CPT,Professional,Both,,,,1481,1258.85,134.6,1481,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),240.7295,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair, Intermediate, Wounds Face,Ears,Eyelids,Nose,Lips,Mucous Membranes; 5.1 -7.5 Cm (Pro Cah)",,12053,CPT,Professional,Both,,,,1481,1258.85,134.6,1481,CorVel,Worker's Compensation,405.4495389,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Repair, Intermediate, Wounds Face,Ears,Eyelids,Nose,Lips,Mucous Membranes; 5.1 -7.5 Cm (Pro Cah)",,12053,CPT,Professional,Both,,,,1481,1258.85,134.6,1481,First Health Group Corporation,First Health Network,1436.57,97,,percent of total billed charges,,
"Repair, Intermediate, Wounds Face,Ears,Eyelids,Nose,Lips,Mucous Membranes; 5.1 -7.5 Cm (Pro Cah)",,12053,CPT,Professional,Both,,,,1481,1258.85,134.6,1481,"Health Partners, Inc.",Commercial,437.49,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Repair, Intermediate, Wounds Face,Ears,Eyelids,Nose,Lips,Mucous Membranes; 5.1 -7.5 Cm (Pro Cah)",,12053,CPT,Professional,Both,,,,1481,1258.85,134.6,1481,"Health Partners, Inc.",Medicare Advantage,240.7295,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair, Intermediate, Wounds Face,Ears,Eyelids,Nose,Lips,Mucous Membranes; 5.1 -7.5 Cm (Pro Cah)",,12053,CPT,Professional,Both,,,,1481,1258.85,134.6,1481,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),209.08,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Repair, Intermediate, Wounds Face,Ears,Eyelids,Nose,Lips,Mucous Membranes; 5.1 -7.5 Cm (Pro Cah)",,12053,CPT,Professional,Both,,,,1481,1258.85,134.6,1481,"Health Partners, Inc.",State of Minnesota Advantage Program,376.897635,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Repair, Intermediate, Wounds Face,Ears,Eyelids,Nose,Lips,Mucous Membranes; 5.1 -7.5 Cm (Pro Cah)",,12053,CPT,Professional,Both,,,,1481,1258.85,134.6,1481,"Health Partners, Inc.",State Public Programs,134.6,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Repair, Intermediate, Wounds Face,Ears,Eyelids,Nose,Lips,Mucous Membranes; 5.1 -7.5 Cm (Pro Cah)",,12053,CPT,Professional,Both,,,,1481,1258.85,134.6,1481,Humana Insurance Company,Commercial PPO,209.33,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Repair, Intermediate, Wounds Face,Ears,Eyelids,Nose,Lips,Mucous Membranes; 5.1 -7.5 Cm (Pro Cah)",,12053,CPT,Professional,Both,,,,1481,1258.85,134.6,1481,Humana Insurance Company,Medicare PPO,1481,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Repair, Intermediate, Wounds Face,Ears,Eyelids,Nose,Lips,Mucous Membranes; 5.1 -7.5 Cm (Pro Cah)",,12053,CPT,Professional,Both,,,,1481,1258.85,134.6,1481,Medica,Individual & Family,1255.888,84.8,,percent of total billed charges,,
"Repair, Intermediate, Wounds Face,Ears,Eyelids,Nose,Lips,Mucous Membranes; 5.1 -7.5 Cm (Pro Cah)",,12053,CPT,Professional,Both,,,,1481,1258.85,134.6,1481,Medica,Medica Advantage Solution,737.538,49.8,,percent of total billed charges,,
"Repair, Intermediate, Wounds Face,Ears,Eyelids,Nose,Lips,Mucous Membranes; 5.1 -7.5 Cm (Pro Cah)",,12053,CPT,Professional,Both,,,,1481,1258.85,134.6,1481,Medica,Medical Assistance,155.4,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Repair, Intermediate, Wounds Face,Ears,Eyelids,Nose,Lips,Mucous Membranes; 5.1 -7.5 Cm (Pro Cah)",,12053,CPT,Professional,Both,,,,1481,1258.85,134.6,1481,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,209.33,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Repair, Intermediate, Wounds Face,Ears,Eyelids,Nose,Lips,Mucous Membranes; 5.1 -7.5 Cm (Pro Cah)",,12053,CPT,Professional,Both,,,,1481,1258.85,134.6,1481,"Multiplan, Inc.","Multiplan, Inc.",1392.14,94,,percent of total billed charges,,
"Repair, Intermediate, Wounds Face,Ears,Eyelids,Nose,Lips,Mucous Membranes; 5.1 -7.5 Cm (Pro Cah)",,12053,CPT,Professional,Both,,,,1481,1258.85,134.6,1481,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1334.381,90.1,,percent of total billed charges,,
"Repair, Intermediate, Wounds Face,Ears,Eyelids,Nose,Lips,Mucous Membranes; 5.1 -7.5 Cm (Pro Cah)",,12053,CPT,Professional,Both,,,,1481,1258.85,134.6,1481,"Preferred One Administrative Services, INC.",PPO,1460.266,98.6,,percent of total billed charges,,
"Repair, Intermediate, Wounds Face,Ears,Eyelids,Nose,Lips,Mucous Membranes; 5.1 -7.5 Cm (Pro Cah)",,12053,CPT,Professional,Both,,,,1481,1258.85,134.6,1481,PrimeWest Health,Minnesota Senior Health Options (MSHO),240.7295,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair, Intermediate, Wounds Face,Ears,Eyelids,Nose,Lips,Mucous Membranes; 5.1 -7.5 Cm (Pro Cah)",,12053,CPT,Professional,Both,,,,1481,1258.85,134.6,1481,PrimeWest Health,MinnesotaCare,166.275004,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Repair, Intermediate, Wounds Face,Ears,Eyelids,Nose,Lips,Mucous Membranes; 5.1 -7.5 Cm (Pro Cah)",,12053,CPT,Professional,Both,,,,1481,1258.85,134.6,1481,Sanford Health Plan,Sanford Health Plan,1303.28,88,,percent of total billed charges,,
"Repair, Intermediate, Wounds Face,Ears,Eyelids,Nose,Lips,Mucous Membranes; 5.1 -7.5 Cm (Pro Cah)",,12053,CPT,Professional,Both,,,,1481,1258.85,134.6,1481,"UCare Health, Inc.",Individual & Family Plan,340.286848,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Repair, Intermediate, Wounds Face,Ears,Eyelids,Nose,Lips,Mucous Membranes; 5.1 -7.5 Cm (Pro Cah)",,12053,CPT,Professional,Both,,,,1481,1258.85,134.6,1481,"UCare Health, Inc.",Medical Assistance,170.93692,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Repair, Intermediate, Wounds Face,Ears,Eyelids,Nose,Lips,Mucous Membranes; 5.1 -7.5 Cm (Pro Cah)",,12053,CPT,Professional,Both,,,,1481,1258.85,134.6,1481,"UCare Health, Inc.",Medicare Advantage,240.7295,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Repair, Intermediate, Wounds Face,Ears,Eyelids,Nose,Lips,Mucous Membranes; 5.1 -7.5 Cm (Pro Cah)",,12053,CPT,Professional,Both,,,,1481,1258.85,134.6,1481,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),192.5836,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Repair, Intermediate, Wounds Face,Ears,Eyelids,Nose,Lips,Mucous Membranes; 5.1 -7.5 Cm (Pro Cah)",,12053,CPT,Professional,Both,,,,1481,1258.85,134.6,1481,UnitedHealthcare,Individual & Family,1481,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Repair, Intermediate, Wounds Face,Ears,Eyelids,Nose,Lips,Mucous Membranes; 5.1 -7.5 Cm (Pro Cah)",,12053,CPT,Professional,Both,,,,1481,1258.85,134.6,1481,UnitedHealthcare,Medicare Advantage,240.7295,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair, Intermediate, Wounds Face,Ears,Eyelids,Nose,Lips,Mucous Membranes; 5.1 -7.5 Cm (Pro Cah)",,12053,CPT,Professional,Both,,,,1481,1258.85,134.6,1481,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,155.3972,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Repair, Intermediate, Wounds Of Face, Ears, Eyelids, Nose, Lips; 5.1 To 7.5 Cm (Pbb)",,12053,CPT,Facility,Outpatient,,,,658,559.3,188.5828,658,Aetna,Commercial,605.36,92,,percent of total billed charges,,
"Repair, Intermediate, Wounds Of Face, Ears, Eyelids, Nose, Lips; 5.1 To 7.5 Cm (Pbb)",,12053,CPT,Professional,Outpatient,,,,823,699.55,134.6,823,Aetna,Commercial,699.55,85,,percent of total billed charges,,
"Repair, Intermediate, Wounds Of Face, Ears, Eyelids, Nose, Lips; 5.1 To 7.5 Cm (Pbb)",,12053,CPT,Facility,Outpatient,,,,658,559.3,188.5828,658,Aetna,Medicare Advantage,322.42,49,,percent of total billed charges,,
"Repair, Intermediate, Wounds Of Face, Ears, Eyelids, Nose, Lips; 5.1 To 7.5 Cm (Pbb)",,12053,CPT,Professional,Outpatient,,,,823,699.55,134.6,823,Aetna,Medicare Advantage,209.93,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair, Intermediate, Wounds Of Face, Ears, Eyelids, Nose, Lips; 5.1 To 7.5 Cm (Pbb)",,12053,CPT,Facility,Outpatient,,,,658,559.3,188.5828,658,Aetna,PPO,611.94,93,,percent of total billed charges,,
"Repair, Intermediate, Wounds Of Face, Ears, Eyelids, Nose, Lips; 5.1 To 7.5 Cm (Pbb)",,12053,CPT,Professional,Outpatient,,,,823,699.55,134.6,823,Aetna,PPO,765.39,93,,percent of total billed charges,,
"Repair, Intermediate, Wounds Of Face, Ears, Eyelids, Nose, Lips; 5.1 To 7.5 Cm (Pbb)",,12053,CPT,Facility,Outpatient,,,,658,559.3,188.5828,658,America's PPO,America's PPO,631.8774,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Repair, Intermediate, Wounds Of Face, Ears, Eyelids, Nose, Lips; 5.1 To 7.5 Cm (Pbb)",,12053,CPT,Professional,Outpatient,,,,823,699.55,134.6,823,America's PPO,America's PPO,703.1712,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Repair, Intermediate, Wounds Of Face, Ears, Eyelids, Nose, Lips; 5.1 To 7.5 Cm (Pbb)",,12053,CPT,Facility,Outpatient,,,,658,559.3,188.5828,658,BlueCross BlueShield Minnesota, Federal Employee Program,647.472,98.4,,percent of total billed charges,,
"Repair, Intermediate, Wounds Of Face, Ears, Eyelids, Nose, Lips; 5.1 To 7.5 Cm (Pbb)",,12053,CPT,Professional,Outpatient,,,,823,699.55,134.6,823,BlueCross BlueShield Minnesota, Federal Employee Program,440.7,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Repair, Intermediate, Wounds Of Face, Ears, Eyelids, Nose, Lips; 5.1 To 7.5 Cm (Pbb)",,12053,CPT,Facility,Outpatient,,,,658,559.3,188.5828,658,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,658,100,,percent of total billed charges,,
"Repair, Intermediate, Wounds Of Face, Ears, Eyelids, Nose, Lips; 5.1 To 7.5 Cm (Pbb)",,12053,CPT,Professional,Outpatient,,,,823,699.55,134.6,823,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,447.7512,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Repair, Intermediate, Wounds Of Face, Ears, Eyelids, Nose, Lips; 5.1 To 7.5 Cm (Pbb)",,12053,CPT,Facility,Outpatient,,,,658,559.3,188.5828,658,BlueCross BlueShield Minnesota,High Value Network Plan,592.2,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
"Repair, Intermediate, Wounds Of Face, Ears, Eyelids, Nose, Lips; 5.1 To 7.5 Cm (Pbb)",,12053,CPT,Professional,Outpatient,,,,823,699.55,134.6,823,BlueCross BlueShield Minnesota,High Value Network Plan,447.7512,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Repair, Intermediate, Wounds Of Face, Ears, Eyelids, Nose, Lips; 5.1 To 7.5 Cm (Pbb)",,12053,CPT,Facility,Outpatient,,,,658,559.3,188.5828,658,BlueCross BlueShield Minnesota,Medicare Advantage,322.42,49,,percent of total billed charges,,
"Repair, Intermediate, Wounds Of Face, Ears, Eyelids, Nose, Lips; 5.1 To 7.5 Cm (Pbb)",,12053,CPT,Professional,Outpatient,,,,823,699.55,134.6,823,BlueCross BlueShield Minnesota,Medicare Advantage,240.7295,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair, Intermediate, Wounds Of Face, Ears, Eyelids, Nose, Lips; 5.1 To 7.5 Cm (Pbb)",,12053,CPT,Professional,Outpatient,,,,823,699.55,134.6,823,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,447.7512,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Repair, Intermediate, Wounds Of Face, Ears, Eyelids, Nose, Lips; 5.1 To 7.5 Cm (Pbb)",,12053,CPT,Facility,Outpatient,,,,658,559.3,188.5828,658,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,188.5828,28.66,,percent of total billed charges,,
"Repair, Intermediate, Wounds Of Face, Ears, Eyelids, Nose, Lips; 5.1 To 7.5 Cm (Pbb)",,12053,CPT,Professional,Outpatient,,,,823,699.55,134.6,823,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,155.3972,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Repair, Intermediate, Wounds Of Face, Ears, Eyelids, Nose, Lips; 5.1 To 7.5 Cm (Pbb)",,12053,CPT,Facility,Outpatient,,,,658,559.3,188.5828,658,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),322.42,49,,percent of total billed charges,,
"Repair, Intermediate, Wounds Of Face, Ears, Eyelids, Nose, Lips; 5.1 To 7.5 Cm (Pbb)",,12053,CPT,Professional,Outpatient,,,,823,699.55,134.6,823,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),240.7295,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair, Intermediate, Wounds Of Face, Ears, Eyelids, Nose, Lips; 5.1 To 7.5 Cm (Pbb)",,12053,CPT,Facility,Outpatient,,,,658,559.3,188.5828,658,CorVel,Worker's Compensation,658,100,,percent of total billed charges,,
"Repair, Intermediate, Wounds Of Face, Ears, Eyelids, Nose, Lips; 5.1 To 7.5 Cm (Pbb)",,12053,CPT,Professional,Outpatient,,,,823,699.55,134.6,823,CorVel,Worker's Compensation,405.4495389,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Repair, Intermediate, Wounds Of Face, Ears, Eyelids, Nose, Lips; 5.1 To 7.5 Cm (Pbb)",,12053,CPT,Facility,Outpatient,,,,658,559.3,188.5828,658,First Health Group Corporation,First Health Network,638.26,97,,percent of total billed charges,,
"Repair, Intermediate, Wounds Of Face, Ears, Eyelids, Nose, Lips; 5.1 To 7.5 Cm (Pbb)",,12053,CPT,Professional,Outpatient,,,,823,699.55,134.6,823,First Health Group Corporation,First Health Network,798.31,97,,percent of total billed charges,,
"Repair, Intermediate, Wounds Of Face, Ears, Eyelids, Nose, Lips; 5.1 To 7.5 Cm (Pbb)",,12053,CPT,Facility,Outpatient,,,,658,559.3,188.5828,658,"Health Partners, Inc.",Commercial,622.468,94.6,,percent of total billed charges,,
"Repair, Intermediate, Wounds Of Face, Ears, Eyelids, Nose, Lips; 5.1 To 7.5 Cm (Pbb)",,12053,CPT,Professional,Outpatient,,,,823,699.55,134.6,823,"Health Partners, Inc.",Commercial,437.49,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Repair, Intermediate, Wounds Of Face, Ears, Eyelids, Nose, Lips; 5.1 To 7.5 Cm (Pbb)",,12053,CPT,Facility,Outpatient,,,,658,559.3,188.5828,658,"Health Partners, Inc.",Medicare Advantage,322.42,49,,percent of total billed charges,,
"Repair, Intermediate, Wounds Of Face, Ears, Eyelids, Nose, Lips; 5.1 To 7.5 Cm (Pbb)",,12053,CPT,Professional,Outpatient,,,,823,699.55,134.6,823,"Health Partners, Inc.",Medicare Advantage,240.7295,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair, Intermediate, Wounds Of Face, Ears, Eyelids, Nose, Lips; 5.1 To 7.5 Cm (Pbb)",,12053,CPT,Facility,Outpatient,,,,658,559.3,188.5828,658,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),394.8,60,,percent of total billed charges,,
"Repair, Intermediate, Wounds Of Face, Ears, Eyelids, Nose, Lips; 5.1 To 7.5 Cm (Pbb)",,12053,CPT,Professional,Outpatient,,,,823,699.55,134.6,823,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),209.08,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Repair, Intermediate, Wounds Of Face, Ears, Eyelids, Nose, Lips; 5.1 To 7.5 Cm (Pbb)",,12053,CPT,Facility,Outpatient,,,,658,559.3,188.5828,658,"Health Partners, Inc.",State of Minnesota Advantage Program,536.27,81.5,,percent of total billed charges,,
"Repair, Intermediate, Wounds Of Face, Ears, Eyelids, Nose, Lips; 5.1 To 7.5 Cm (Pbb)",,12053,CPT,Professional,Outpatient,,,,823,699.55,134.6,823,"Health Partners, Inc.",State of Minnesota Advantage Program,376.897635,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Repair, Intermediate, Wounds Of Face, Ears, Eyelids, Nose, Lips; 5.1 To 7.5 Cm (Pbb)",,12053,CPT,Facility,Outpatient,,,,658,559.3,188.5828,658,"Health Partners, Inc.",State Public Programs,329,50,,percent of total billed charges,,
"Repair, Intermediate, Wounds Of Face, Ears, Eyelids, Nose, Lips; 5.1 To 7.5 Cm (Pbb)",,12053,CPT,Professional,Outpatient,,,,823,699.55,134.6,823,"Health Partners, Inc.",State Public Programs,134.6,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Repair, Intermediate, Wounds Of Face, Ears, Eyelids, Nose, Lips; 5.1 To 7.5 Cm (Pbb)",,12053,CPT,Facility,Outpatient,,,,658,559.3,188.5828,658,Humana Insurance Company,Commercial PPO,625.1,95,,percent of total billed charges,,
"Repair, Intermediate, Wounds Of Face, Ears, Eyelids, Nose, Lips; 5.1 To 7.5 Cm (Pbb)",,12053,CPT,Professional,Outpatient,,,,823,699.55,134.6,823,Humana Insurance Company,Commercial PPO,209.33,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Repair, Intermediate, Wounds Of Face, Ears, Eyelids, Nose, Lips; 5.1 To 7.5 Cm (Pbb)",,12053,CPT,Facility,Outpatient,,,,658,559.3,188.5828,658,Humana Insurance Company,Medicare PPO,322.42,49,,percent of total billed charges,,
"Repair, Intermediate, Wounds Of Face, Ears, Eyelids, Nose, Lips; 5.1 To 7.5 Cm (Pbb)",,12053,CPT,Professional,Outpatient,,,,823,699.55,134.6,823,Humana Insurance Company,Medicare PPO,823,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Repair, Intermediate, Wounds Of Face, Ears, Eyelids, Nose, Lips; 5.1 To 7.5 Cm (Pbb)",,12053,CPT,Facility,Outpatient,,,,658,559.3,188.5828,658,Medica,Individual & Family,652.078,99.1,,percent of total billed charges,,
"Repair, Intermediate, Wounds Of Face, Ears, Eyelids, Nose, Lips; 5.1 To 7.5 Cm (Pbb)",,12053,CPT,Professional,Outpatient,,,,823,699.55,134.6,823,Medica,Individual & Family,697.904,84.8,,percent of total billed charges,,
"Repair, Intermediate, Wounds Of Face, Ears, Eyelids, Nose, Lips; 5.1 To 7.5 Cm (Pbb)",,12053,CPT,Facility,Outpatient,,,,658,559.3,188.5828,658,Medica,Medica Advantage Solution,327.684,49.8,,percent of total billed charges,,
"Repair, Intermediate, Wounds Of Face, Ears, Eyelids, Nose, Lips; 5.1 To 7.5 Cm (Pbb)",,12053,CPT,Professional,Outpatient,,,,823,699.55,134.6,823,Medica,Medica Advantage Solution,409.854,49.8,,percent of total billed charges,,
"Repair, Intermediate, Wounds Of Face, Ears, Eyelids, Nose, Lips; 5.1 To 7.5 Cm (Pbb)",,12053,CPT,Facility,Outpatient,,,,658,559.3,188.5828,658,Medica,Medical Assistance,293.468,44.6,,percent of total billed charges,,
"Repair, Intermediate, Wounds Of Face, Ears, Eyelids, Nose, Lips; 5.1 To 7.5 Cm (Pbb)",,12053,CPT,Professional,Outpatient,,,,823,699.55,134.6,823,Medica,Medical Assistance,155.4,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Repair, Intermediate, Wounds Of Face, Ears, Eyelids, Nose, Lips; 5.1 To 7.5 Cm (Pbb)",,12053,CPT,Facility,Outpatient,,,,658,559.3,188.5828,658,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,327.684,49.8,,percent of total billed charges,,
"Repair, Intermediate, Wounds Of Face, Ears, Eyelids, Nose, Lips; 5.1 To 7.5 Cm (Pbb)",,12053,CPT,Professional,Outpatient,,,,823,699.55,134.6,823,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,209.33,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Repair, Intermediate, Wounds Of Face, Ears, Eyelids, Nose, Lips; 5.1 To 7.5 Cm (Pbb)",,12053,CPT,Facility,Outpatient,,,,658,559.3,188.5828,658,"Multiplan, Inc.","Multiplan, Inc.",618.52,94,,percent of total billed charges,,
"Repair, Intermediate, Wounds Of Face, Ears, Eyelids, Nose, Lips; 5.1 To 7.5 Cm (Pbb)",,12053,CPT,Professional,Outpatient,,,,823,699.55,134.6,823,"Multiplan, Inc.","Multiplan, Inc.",773.62,94,,percent of total billed charges,,
"Repair, Intermediate, Wounds Of Face, Ears, Eyelids, Nose, Lips; 5.1 To 7.5 Cm (Pbb)",,12053,CPT,Facility,Outpatient,,,,658,559.3,188.5828,658,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,592.858,90.1,,percent of total billed charges,,
"Repair, Intermediate, Wounds Of Face, Ears, Eyelids, Nose, Lips; 5.1 To 7.5 Cm (Pbb)",,12053,CPT,Professional,Outpatient,,,,823,699.55,134.6,823,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,741.523,90.1,,percent of total billed charges,,
"Repair, Intermediate, Wounds Of Face, Ears, Eyelids, Nose, Lips; 5.1 To 7.5 Cm (Pbb)",,12053,CPT,Facility,Outpatient,,,,658,559.3,188.5828,658,"Preferred One Administrative Services, INC.",PPO,648.788,98.6,,percent of total billed charges,,
"Repair, Intermediate, Wounds Of Face, Ears, Eyelids, Nose, Lips; 5.1 To 7.5 Cm (Pbb)",,12053,CPT,Professional,Outpatient,,,,823,699.55,134.6,823,"Preferred One Administrative Services, INC.",PPO,811.478,98.6,,percent of total billed charges,,
"Repair, Intermediate, Wounds Of Face, Ears, Eyelids, Nose, Lips; 5.1 To 7.5 Cm (Pbb)",,12053,CPT,Facility,Outpatient,,,,658,559.3,188.5828,658,PrimeWest Health,Minnesota Senior Health Options (MSHO),338.541,51.45,,percent of total billed charges,,
"Repair, Intermediate, Wounds Of Face, Ears, Eyelids, Nose, Lips; 5.1 To 7.5 Cm (Pbb)",,12053,CPT,Professional,Outpatient,,,,823,699.55,134.6,823,PrimeWest Health,Minnesota Senior Health Options (MSHO),240.7295,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair, Intermediate, Wounds Of Face, Ears, Eyelids, Nose, Lips; 5.1 To 7.5 Cm (Pbb)",,12053,CPT,Facility,Outpatient,,,,658,559.3,188.5828,658,PrimeWest Health,MinnesotaCare,337.9488,51.36,,percent of total billed charges,,
"Repair, Intermediate, Wounds Of Face, Ears, Eyelids, Nose, Lips; 5.1 To 7.5 Cm (Pbb)",,12053,CPT,Professional,Outpatient,,,,823,699.55,134.6,823,PrimeWest Health,MinnesotaCare,166.275004,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Repair, Intermediate, Wounds Of Face, Ears, Eyelids, Nose, Lips; 5.1 To 7.5 Cm (Pbb)",,12053,CPT,Facility,Outpatient,,,,658,559.3,188.5828,658,Sanford Health Plan,Sanford Health Plan,605.36,92,,percent of total billed charges,,
"Repair, Intermediate, Wounds Of Face, Ears, Eyelids, Nose, Lips; 5.1 To 7.5 Cm (Pbb)",,12053,CPT,Professional,Outpatient,,,,823,699.55,134.6,823,Sanford Health Plan,Sanford Health Plan,724.24,88,,percent of total billed charges,,
"Repair, Intermediate, Wounds Of Face, Ears, Eyelids, Nose, Lips; 5.1 To 7.5 Cm (Pbb)",,12053,CPT,Facility,Outpatient,,,,658,559.3,188.5828,658,"UCare Health, Inc.",Individual & Family Plan,370.783,56.35,,percent of total billed charges,,
"Repair, Intermediate, Wounds Of Face, Ears, Eyelids, Nose, Lips; 5.1 To 7.5 Cm (Pbb)",,12053,CPT,Professional,Outpatient,,,,823,699.55,134.6,823,"UCare Health, Inc.",Individual & Family Plan,340.286848,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Repair, Intermediate, Wounds Of Face, Ears, Eyelids, Nose, Lips; 5.1 To 7.5 Cm (Pbb)",,12053,CPT,Facility,Outpatient,,,,658,559.3,188.5828,658,"UCare Health, Inc.",Medical Assistance,332.0926,50.47,,percent of total billed charges,,
"Repair, Intermediate, Wounds Of Face, Ears, Eyelids, Nose, Lips; 5.1 To 7.5 Cm (Pbb)",,12053,CPT,Professional,Outpatient,,,,823,699.55,134.6,823,"UCare Health, Inc.",Medical Assistance,170.93692,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Repair, Intermediate, Wounds Of Face, Ears, Eyelids, Nose, Lips; 5.1 To 7.5 Cm (Pbb)",,12053,CPT,Facility,Outpatient,,,,658,559.3,188.5828,658,"UCare Health, Inc.",Medicare Advantage,332.0926,50.47,,percent of total billed charges,,
"Repair, Intermediate, Wounds Of Face, Ears, Eyelids, Nose, Lips; 5.1 To 7.5 Cm (Pbb)",,12053,CPT,Professional,Outpatient,,,,823,699.55,134.6,823,"UCare Health, Inc.",Medicare Advantage,240.7295,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Repair, Intermediate, Wounds Of Face, Ears, Eyelids, Nose, Lips; 5.1 To 7.5 Cm (Pbb)",,12053,CPT,Facility,Outpatient,,,,658,559.3,188.5828,658,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),332.0926,50.47,,percent of total billed charges,,
"Repair, Intermediate, Wounds Of Face, Ears, Eyelids, Nose, Lips; 5.1 To 7.5 Cm (Pbb)",,12053,CPT,Professional,Outpatient,,,,823,699.55,134.6,823,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),192.5836,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Repair, Intermediate, Wounds Of Face, Ears, Eyelids, Nose, Lips; 5.1 To 7.5 Cm (Pbb)",,12053,CPT,Facility,Outpatient,,,,658,559.3,188.5828,658,UnitedHealthcare,Individual & Family,618.52,94,,percent of total billed charges,,
"Repair, Intermediate, Wounds Of Face, Ears, Eyelids, Nose, Lips; 5.1 To 7.5 Cm (Pbb)",,12053,CPT,Professional,Outpatient,,,,823,699.55,134.6,823,UnitedHealthcare,Individual & Family,823,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Repair, Intermediate, Wounds Of Face, Ears, Eyelids, Nose, Lips; 5.1 To 7.5 Cm (Pbb)",,12053,CPT,Facility,Outpatient,,,,658,559.3,188.5828,658,UnitedHealthcare,Medicare Advantage,322.42,49,,percent of total billed charges,,
"Repair, Intermediate, Wounds Of Face, Ears, Eyelids, Nose, Lips; 5.1 To 7.5 Cm (Pbb)",,12053,CPT,Professional,Outpatient,,,,823,699.55,134.6,823,UnitedHealthcare,Medicare Advantage,240.7295,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair, Intermediate, Wounds Of Face, Ears, Eyelids, Nose, Lips; 5.1 To 7.5 Cm (Pbb)",,12053,CPT,Facility,Outpatient,,,,658,559.3,188.5828,658,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,315.84,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Repair, Intermediate, Wounds Of Face, Ears, Eyelids, Nose, Lips; 5.1 To 7.5 Cm (Pbb)",,12053,CPT,Professional,Outpatient,,,,823,699.55,134.6,823,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,155.3972,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
BENAZEPRIL 10 MG ORAL TABLET,,18121,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
BENAZEPRIL 10 MG ORAL TABLET,,18121,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
BENAZEPRIL 10 MG ORAL TABLET,,18121,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
BENAZEPRIL 10 MG ORAL TABLET,,18121,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
BENAZEPRIL 10 MG ORAL TABLET,,18121,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
BENAZEPRIL 10 MG ORAL TABLET,,18121,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
BENAZEPRIL 10 MG ORAL TABLET,,18121,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
BENAZEPRIL 10 MG ORAL TABLET,,18121,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
BENAZEPRIL 10 MG ORAL TABLET,,18121,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
BENAZEPRIL 10 MG ORAL TABLET,,18121,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
BENAZEPRIL 10 MG ORAL TABLET,,18121,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
BENAZEPRIL 10 MG ORAL TABLET,,18121,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
BENAZEPRIL 10 MG ORAL TABLET,,18121,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
BENAZEPRIL 10 MG ORAL TABLET,,18121,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
BENAZEPRIL 10 MG ORAL TABLET,,18121,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
BENAZEPRIL 10 MG ORAL TABLET,,18121,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
BENAZEPRIL 10 MG ORAL TABLET,,18121,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
BENAZEPRIL 10 MG ORAL TABLET,,18121,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
BENAZEPRIL 10 MG ORAL TABLET,,18121,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
BENAZEPRIL 10 MG ORAL TABLET,,18121,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
BENAZEPRIL 10 MG ORAL TABLET,,18121,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
BENAZEPRIL 10 MG ORAL TABLET,,18121,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
BENAZEPRIL 10 MG ORAL TABLET,,18121,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
BENAZEPRIL 10 MG ORAL TABLET,,18121,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
BENAZEPRIL 10 MG ORAL TABLET,,18121,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
BENAZEPRIL 10 MG ORAL TABLET,,18121,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
BENAZEPRIL 10 MG ORAL TABLET,,18121,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
BENAZEPRIL 10 MG ORAL TABLET,,18121,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
BENAZEPRIL 10 MG ORAL TABLET,,18121,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
BENAZEPRIL 10 MG ORAL TABLET,,18121,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
BENAZEPRIL 10 MG ORAL TABLET,,18121,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
BENAZEPRIL 10 MG ORAL TABLET,,18121,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
BENAZEPRIL 10 MG ORAL TABLET,,18121,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
BENAZEPRIL 10 MG ORAL TABLET,,18121,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
BENAZEPRIL 10 MG ORAL TABLET,,18121,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
BENAZEPRIL 10 MG ORAL TABLET,,18121,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
BENAZEPRIL 10 MG ORAL TABLET,,18121,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
BENAZEPRIL 10 MG ORAL TABLET,,18121,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
BENAZEPRIL 10 MG ORAL TABLET,,18121,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
BENAZEPRIL 10 MG ORAL TABLET,,18121,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
BENAZEPRIL 10 MG ORAL TABLET,,18121,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
BENAZEPRIL 10 MG ORAL TABLET,,18121,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
BENAZEPRIL 10 MG ORAL TABLET,,18121,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
BENAZEPRIL 10 MG ORAL TABLET,,18121,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
BENAZEPRIL 10 MG ORAL TABLET,,18121,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
BENAZEPRIL 10 MG ORAL TABLET,,18121,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
BENAZEPRIL 10 MG ORAL TABLET,,18121,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
BENAZEPRIL 10 MG ORAL TABLET,,18121,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
BENAZEPRIL 10 MG ORAL TABLET,,18121,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
BENAZEPRIL 10 MG ORAL TABLET,,18121,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
BENAZEPRIL 10 MG ORAL TABLET,,18121,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
BENAZEPRIL 10 MG ORAL TABLET,,18121,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
BENAZEPRIL 10 MG ORAL TABLET,,18121,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
BENAZEPRIL 10 MG ORAL TABLET,,18121,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
BENAZEPRIL 10 MG ORAL TABLET,,18121,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
BENAZEPRIL 10 MG ORAL TABLET,,18121,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
BENAZEPRIL 10 MG ORAL TABLET,,18121,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
BENAZEPRIL 10 MG ORAL TABLET,,18121,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
BENAZEPRIL 10 MG ORAL TABLET,,18121,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
BENAZEPRIL 10 MG ORAL TABLET,,18121,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
BENAZEPRIL 10 MG ORAL TABLET,,18121,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
BENAZEPRIL 10 MG ORAL TABLET,,18121,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
BENAZEPRIL 10 MG ORAL TABLET,,18121,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
BENAZEPRIL 10 MG ORAL TABLET,,18121,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
BENAZEPRIL 10 MG ORAL TABLET,,18121,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
BENAZEPRIL 10 MG ORAL TABLET,,18121,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
BENAZEPRIL 10 MG ORAL TABLET,,18121,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
BENAZEPRIL 10 MG ORAL TABLET,,18121,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
BENAZEPRIL 10 MG ORAL TABLET,,18121,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
BENAZEPRIL 10 MG ORAL TABLET,,18121,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
BENAZEPRIL 10 MG ORAL TABLET,,18121,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
BENAZEPRIL 10 MG ORAL TABLET,,18121,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
BENAZEPRIL 10 MG ORAL TABLET,,18121,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
BENAZEPRIL 10 MG ORAL TABLET,,18121,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
BENAZEPRIL 10 MG ORAL TABLET,,18121,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
BENAZEPRIL 10 MG ORAL TABLET,,18121,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
BENAZEPRIL 10 MG ORAL TABLET,,18121,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
BENAZEPRIL 10 MG ORAL TABLET,,18121,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
BENAZEPRIL 10 MG ORAL TABLET,,18121,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
BENAZEPRIL 10 MG ORAL TABLET,,18121,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
BENAZEPRIL 10 MG ORAL TABLET,,18121,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
BENAZEPRIL 10 MG ORAL TABLET,,18121,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
BENAZEPRIL 10 MG ORAL TABLET,,18121,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
BENAZEPRIL 10 MG ORAL TABLET,,18121,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
BENAZEPRIL 10 MG ORAL TABLET,,18121,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
BENAZEPRIL 10 MG ORAL TABLET,,18121,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
BENAZEPRIL 10 MG ORAL TABLET,,18121,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BENAZEPRIL 10 MG ORAL TABLET,,18121,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BENAZEPRIL 10 MG ORAL TABLET,,18121,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
BENAZEPRIL 10 MG ORAL TABLET,,18121,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
BENAZEPRIL 10 MG ORAL TABLET,,18121,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BENAZEPRIL 10 MG ORAL TABLET,,18121,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BENAZEPRIL 10 MG ORAL TABLET,,18121,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
BENAZEPRIL 10 MG ORAL TABLET,,18121,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
BENAZEPRIL 10 MG ORAL TABLET,,18121,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BENAZEPRIL 10 MG ORAL TABLET,,18121,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BENAZEPRIL 10 MG ORAL TABLET,,18121,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
BENAZEPRIL 10 MG ORAL TABLET,,18121,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
BENAZEPRIL 10 MG ORAL TABLET,,18121,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
BENAZEPRIL 10 MG ORAL TABLET,,18121,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
BENAZEPRIL 10 MG ORAL TABLET,,18121,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
BENAZEPRIL 10 MG ORAL TABLET,,18121,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
BENAZEPRIL 10 MG ORAL TABLET,,18121,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
BENAZEPRIL 10 MG ORAL TABLET,,18121,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
BENAZEPRIL 10 MG ORAL TABLET,,18121,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
BENAZEPRIL 10 MG ORAL TABLET,,18121,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
BENAZEPRIL 10 MG ORAL TABLET,,18121,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
BENAZEPRIL 10 MG ORAL TABLET,,18121,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
MORPHINE 15 MG ORAL TABLET,,18216,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
MORPHINE 15 MG ORAL TABLET,,18216,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
MORPHINE 15 MG ORAL TABLET,,18216,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
MORPHINE 15 MG ORAL TABLET,,18216,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
MORPHINE 15 MG ORAL TABLET,,18216,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
MORPHINE 15 MG ORAL TABLET,,18216,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
MORPHINE 15 MG ORAL TABLET,,18216,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
MORPHINE 15 MG ORAL TABLET,,18216,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
MORPHINE 15 MG ORAL TABLET,,18216,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
MORPHINE 15 MG ORAL TABLET,,18216,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
MORPHINE 15 MG ORAL TABLET,,18216,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
MORPHINE 15 MG ORAL TABLET,,18216,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
MORPHINE 15 MG ORAL TABLET,,18216,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
MORPHINE 15 MG ORAL TABLET,,18216,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
MORPHINE 15 MG ORAL TABLET,,18216,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
MORPHINE 15 MG ORAL TABLET,,18216,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
MORPHINE 15 MG ORAL TABLET,,18216,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
MORPHINE 15 MG ORAL TABLET,,18216,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
MORPHINE 15 MG ORAL TABLET,,18216,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
MORPHINE 15 MG ORAL TABLET,,18216,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
MORPHINE 15 MG ORAL TABLET,,18216,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
MORPHINE 15 MG ORAL TABLET,,18216,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
MORPHINE 15 MG ORAL TABLET,,18216,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
MORPHINE 15 MG ORAL TABLET,,18216,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
MORPHINE 15 MG ORAL TABLET,,18216,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
MORPHINE 15 MG ORAL TABLET,,18216,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
MORPHINE 15 MG ORAL TABLET,,18216,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
MORPHINE 15 MG ORAL TABLET,,18216,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
MORPHINE 15 MG ORAL TABLET,,18216,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
MORPHINE 15 MG ORAL TABLET,,18216,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
MORPHINE 15 MG ORAL TABLET,,18216,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
MORPHINE 15 MG ORAL TABLET,,18216,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
MORPHINE 15 MG ORAL TABLET,,18216,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
MORPHINE 15 MG ORAL TABLET,,18216,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
MORPHINE 15 MG ORAL TABLET,,18216,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
MORPHINE 15 MG ORAL TABLET,,18216,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
MORPHINE 15 MG ORAL TABLET,,18216,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
MORPHINE 15 MG ORAL TABLET,,18216,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
MORPHINE 15 MG ORAL TABLET,,18216,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
MORPHINE 15 MG ORAL TABLET,,18216,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
MORPHINE 15 MG ORAL TABLET,,18216,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
MORPHINE 15 MG ORAL TABLET,,18216,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
MORPHINE 15 MG ORAL TABLET,,18216,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
MORPHINE 15 MG ORAL TABLET,,18216,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MORPHINE 15 MG ORAL TABLET,,18216,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
MORPHINE 15 MG ORAL TABLET,,18216,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MORPHINE 15 MG ORAL TABLET,,18216,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
MORPHINE 15 MG ORAL TABLET,,18216,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MORPHINE 15 MG ORAL TABLET,,18216,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
MORPHINE 15 MG ORAL TABLET,,18216,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
MORPHINE 15 MG ORAL TABLET,,18216,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
MORPHINE 15 MG ORAL TABLET,,18216,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
MORPHINE 15 MG ORAL TABLET,,18216,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
MORPHINE 15 MG ORAL TABLET,,18216,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
HYDROXYZINE HCL 10 MG ORAL TABLET,,18347,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
HYDROXYZINE HCL 10 MG ORAL TABLET,,18347,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
HYDROXYZINE HCL 10 MG ORAL TABLET,,18347,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
HYDROXYZINE HCL 10 MG ORAL TABLET,,18347,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
HYDROXYZINE HCL 10 MG ORAL TABLET,,18347,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
HYDROXYZINE HCL 10 MG ORAL TABLET,,18347,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
HYDROXYZINE HCL 10 MG ORAL TABLET,,18347,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
HYDROXYZINE HCL 10 MG ORAL TABLET,,18347,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
HYDROXYZINE HCL 10 MG ORAL TABLET,,18347,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
HYDROXYZINE HCL 10 MG ORAL TABLET,,18347,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
HYDROXYZINE HCL 10 MG ORAL TABLET,,18347,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
HYDROXYZINE HCL 10 MG ORAL TABLET,,18347,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
HYDROXYZINE HCL 10 MG ORAL TABLET,,18347,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
HYDROXYZINE HCL 10 MG ORAL TABLET,,18347,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
HYDROXYZINE HCL 10 MG ORAL TABLET,,18347,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
HYDROXYZINE HCL 10 MG ORAL TABLET,,18347,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
HYDROXYZINE HCL 10 MG ORAL TABLET,,18347,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
HYDROXYZINE HCL 10 MG ORAL TABLET,,18347,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
HYDROXYZINE HCL 10 MG ORAL TABLET,,18347,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
HYDROXYZINE HCL 10 MG ORAL TABLET,,18347,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
HYDROXYZINE HCL 10 MG ORAL TABLET,,18347,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
HYDROXYZINE HCL 10 MG ORAL TABLET,,18347,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
HYDROXYZINE HCL 10 MG ORAL TABLET,,18347,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
HYDROXYZINE HCL 10 MG ORAL TABLET,,18347,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
HYDROXYZINE HCL 10 MG ORAL TABLET,,18347,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
HYDROXYZINE HCL 10 MG ORAL TABLET,,18347,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
HYDROXYZINE HCL 10 MG ORAL TABLET,,18347,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
HYDROXYZINE HCL 10 MG ORAL TABLET,,18347,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
HYDROXYZINE HCL 10 MG ORAL TABLET,,18347,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
HYDROXYZINE HCL 10 MG ORAL TABLET,,18347,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
HYDROXYZINE HCL 10 MG ORAL TABLET,,18347,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
HYDROXYZINE HCL 10 MG ORAL TABLET,,18347,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
HYDROXYZINE HCL 10 MG ORAL TABLET,,18347,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
HYDROXYZINE HCL 10 MG ORAL TABLET,,18347,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
HYDROXYZINE HCL 10 MG ORAL TABLET,,18347,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
HYDROXYZINE HCL 10 MG ORAL TABLET,,18347,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
HYDROXYZINE HCL 10 MG ORAL TABLET,,18347,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
HYDROXYZINE HCL 10 MG ORAL TABLET,,18347,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
HYDROXYZINE HCL 10 MG ORAL TABLET,,18347,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
HYDROXYZINE HCL 10 MG ORAL TABLET,,18347,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
HYDROXYZINE HCL 10 MG ORAL TABLET,,18347,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
HYDROXYZINE HCL 10 MG ORAL TABLET,,18347,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
HYDROXYZINE HCL 10 MG ORAL TABLET,,18347,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
HYDROXYZINE HCL 10 MG ORAL TABLET,,18347,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
HYDROXYZINE HCL 10 MG ORAL TABLET,,18347,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
HYDROXYZINE HCL 10 MG ORAL TABLET,,18347,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
HYDROXYZINE HCL 10 MG ORAL TABLET,,18347,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
HYDROXYZINE HCL 10 MG ORAL TABLET,,18347,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
HYDROXYZINE HCL 10 MG ORAL TABLET,,18347,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
HYDROXYZINE HCL 10 MG ORAL TABLET,,18347,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
HYDROXYZINE HCL 10 MG ORAL TABLET,,18347,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
HYDROXYZINE HCL 10 MG ORAL TABLET,,18347,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
HYDROXYZINE HCL 10 MG ORAL TABLET,,18347,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
HYDROXYZINE HCL 10 MG ORAL TABLET,,18347,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
ONDANSETRON 4 MG ORAL TBDL,,18509,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
ONDANSETRON 4 MG ORAL TBDL,,18509,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
ONDANSETRON 4 MG ORAL TBDL,,18509,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
ONDANSETRON 4 MG ORAL TBDL,,18509,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
ONDANSETRON 4 MG ORAL TBDL,,18509,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
ONDANSETRON 4 MG ORAL TBDL,,18509,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
ONDANSETRON 4 MG ORAL TBDL,,18509,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
ONDANSETRON 4 MG ORAL TBDL,,18509,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
ONDANSETRON 4 MG ORAL TBDL,,18509,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
ONDANSETRON 4 MG ORAL TBDL,,18509,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
ONDANSETRON 4 MG ORAL TBDL,,18509,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
ONDANSETRON 4 MG ORAL TBDL,,18509,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
ONDANSETRON 4 MG ORAL TBDL,,18509,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
ONDANSETRON 4 MG ORAL TBDL,,18509,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
ONDANSETRON 4 MG ORAL TBDL,,18509,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
ONDANSETRON 4 MG ORAL TBDL,,18509,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
ONDANSETRON 4 MG ORAL TBDL,,18509,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
ONDANSETRON 4 MG ORAL TBDL,,18509,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
ONDANSETRON 4 MG ORAL TBDL,,18509,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ONDANSETRON 4 MG ORAL TBDL,,18509,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
ONDANSETRON 4 MG ORAL TBDL,,18509,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
ONDANSETRON 4 MG ORAL TBDL,,18509,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
ONDANSETRON 4 MG ORAL TBDL,,18509,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
ONDANSETRON 4 MG ORAL TBDL,,18509,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
ONDANSETRON 4 MG ORAL TBDL,,18509,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
ONDANSETRON 4 MG ORAL TBDL,,18509,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
ONDANSETRON 4 MG ORAL TBDL,,18509,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
ONDANSETRON 4 MG ORAL TBDL,,18509,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
ONDANSETRON 4 MG ORAL TBDL,,18509,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
ONDANSETRON 4 MG ORAL TBDL,,18509,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
ONDANSETRON 4 MG ORAL TBDL,,18509,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
ONDANSETRON 4 MG ORAL TBDL,,18509,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
ONDANSETRON 4 MG ORAL TBDL,,18509,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
ONDANSETRON 4 MG ORAL TBDL,,18509,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
ONDANSETRON 4 MG ORAL TBDL,,18509,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
ONDANSETRON 4 MG ORAL TBDL,,18509,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
ONDANSETRON 4 MG ORAL TBDL,,18509,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
ONDANSETRON 4 MG ORAL TBDL,,18509,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ONDANSETRON 4 MG ORAL TBDL,,18509,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
ONDANSETRON 4 MG ORAL TBDL,,18509,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
ONDANSETRON 4 MG ORAL TBDL,,18509,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
ONDANSETRON 4 MG ORAL TBDL,,18509,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
ONDANSETRON 4 MG ORAL TBDL,,18509,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
ONDANSETRON 4 MG ORAL TBDL,,18509,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ONDANSETRON 4 MG ORAL TBDL,,18509,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
ONDANSETRON 4 MG ORAL TBDL,,18509,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ONDANSETRON 4 MG ORAL TBDL,,18509,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ONDANSETRON 4 MG ORAL TBDL,,18509,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ONDANSETRON 4 MG ORAL TBDL,,18509,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ONDANSETRON 4 MG ORAL TBDL,,18509,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
ONDANSETRON 4 MG ORAL TBDL,,18509,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
ONDANSETRON 4 MG ORAL TBDL,,18509,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
ONDANSETRON 4 MG ORAL TBDL,,18509,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
ONDANSETRON 4 MG ORAL TBDL,,18509,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
CEFDINIR 300 MG ORAL CAP,,18535,LOCAL,Facility,Both,1,Each,,26,22.1,7.4516,26,Aetna,Commercial,23.92,92,,percent of total billed charges,,
CEFDINIR 300 MG ORAL CAP,,18535,LOCAL,Facility,Outpatient,1,Each,,26,22.1,7.4516,26,Aetna,Medicare Advantage,12.74,49,,percent of total billed charges,,
CEFDINIR 300 MG ORAL CAP,,18535,LOCAL,Facility,Inpatient,1,Each,,26,22.1,7.4516,26,Aetna,Medicare Advantage,,,,,Included in per diem rate,
CEFDINIR 300 MG ORAL CAP,,18535,LOCAL,Facility,Both,1,Each,,26,22.1,7.4516,26,Aetna,PPO,24.18,93,,percent of total billed charges,,
CEFDINIR 300 MG ORAL CAP,,18535,LOCAL,Facility,Both,1,Each,,26,22.1,7.4516,26,America's PPO,America's PPO,24.9678,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
CEFDINIR 300 MG ORAL CAP,,18535,LOCAL,Facility,Both,1,Each,,26,22.1,7.4516,26,BlueCross BlueShield Minnesota, Federal Employee Program,25.584,98.4,,percent of total billed charges,,
CEFDINIR 300 MG ORAL CAP,,18535,LOCAL,Facility,Both,1,Each,,26,22.1,7.4516,26,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,26,100,,percent of total billed charges,,
CEFDINIR 300 MG ORAL CAP,,18535,LOCAL,Facility,Both,1,Each,,26,22.1,7.4516,26,BlueCross BlueShield Minnesota,High Value Network Plan,23.4,90,,percent of total billed charges,,
CEFDINIR 300 MG ORAL CAP,,18535,LOCAL,Facility,Outpatient,1,Each,,26,22.1,7.4516,26,BlueCross BlueShield Minnesota,Medicare Advantage,12.74,49,,percent of total billed charges,,
CEFDINIR 300 MG ORAL CAP,,18535,LOCAL,Facility,Inpatient,1,Each,,26,22.1,7.4516,26,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
CEFDINIR 300 MG ORAL CAP,,18535,LOCAL,Facility,Both,1,Each,,26,22.1,7.4516,26,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,23.0282,88.57,,percent of total billed charges,,
CEFDINIR 300 MG ORAL CAP,,18535,LOCAL,Facility,Both,1,Each,,26,22.1,7.4516,26,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,7.4516,28.66,,percent of total billed charges,,
CEFDINIR 300 MG ORAL CAP,,18535,LOCAL,Facility,Outpatient,1,Each,,26,22.1,7.4516,26,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),12.74,49,,percent of total billed charges,,
CEFDINIR 300 MG ORAL CAP,,18535,LOCAL,Facility,Inpatient,1,Each,,26,22.1,7.4516,26,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
CEFDINIR 300 MG ORAL CAP,,18535,LOCAL,Facility,Both,1,Each,,26,22.1,7.4516,26,CorVel,Worker's Compensation,26,100,,percent of total billed charges,,
CEFDINIR 300 MG ORAL CAP,,18535,LOCAL,Facility,Both,1,Each,,26,22.1,7.4516,26,First Health Group Corporation,First Health Network,25.22,97,,percent of total billed charges,,
CEFDINIR 300 MG ORAL CAP,,18535,LOCAL,Facility,Both,1,Each,,26,22.1,7.4516,26,"Health Partners, Inc.",Commercial,24.596,94.6,,percent of total billed charges,,
CEFDINIR 300 MG ORAL CAP,,18535,LOCAL,Facility,Outpatient,1,Each,,26,22.1,7.4516,26,"Health Partners, Inc.",Medicare Advantage,12.74,49,,percent of total billed charges,,
CEFDINIR 300 MG ORAL CAP,,18535,LOCAL,Facility,Inpatient,1,Each,,26,22.1,7.4516,26,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CEFDINIR 300 MG ORAL CAP,,18535,LOCAL,Facility,Both,1,Each,,26,22.1,7.4516,26,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),15.6,60,,percent of total billed charges,,
CEFDINIR 300 MG ORAL CAP,,18535,LOCAL,Facility,Both,1,Each,,26,22.1,7.4516,26,"Health Partners, Inc.",State of Minnesota Advantage Program,21.19,81.5,,percent of total billed charges,,
CEFDINIR 300 MG ORAL CAP,,18535,LOCAL,Facility,Both,1,Each,,26,22.1,7.4516,26,"Health Partners, Inc.",State Public Programs,13,50,,percent of total billed charges,,
CEFDINIR 300 MG ORAL CAP,,18535,LOCAL,Facility,Both,1,Each,,26,22.1,7.4516,26,Humana Insurance Company,Commercial PPO,24.7,95,,percent of total billed charges,,
CEFDINIR 300 MG ORAL CAP,,18535,LOCAL,Facility,Outpatient,1,Each,,26,22.1,7.4516,26,Humana Insurance Company,Medicare PPO,12.74,49,,percent of total billed charges,,
CEFDINIR 300 MG ORAL CAP,,18535,LOCAL,Facility,Inpatient,1,Each,,26,22.1,7.4516,26,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
CEFDINIR 300 MG ORAL CAP,,18535,LOCAL,Facility,Both,1,Each,,26,22.1,7.4516,26,Medica,Individual & Family,25.766,99.1,,percent of total billed charges,,
CEFDINIR 300 MG ORAL CAP,,18535,LOCAL,Facility,Outpatient,1,Each,,26,22.1,7.4516,26,Medica,Medica Advantage Solution,12.948,49.8,,percent of total billed charges,,
CEFDINIR 300 MG ORAL CAP,,18535,LOCAL,Facility,Inpatient,1,Each,,26,22.1,7.4516,26,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
CEFDINIR 300 MG ORAL CAP,,18535,LOCAL,Facility,Outpatient,1,Each,,26,22.1,7.4516,26,Medica,Medical Assistance,11.596,44.6,,percent of total billed charges,,
CEFDINIR 300 MG ORAL CAP,,18535,LOCAL,Facility,Inpatient,1,Each,,26,22.1,7.4516,26,Medica,Medical Assistance,,,,,Included in per diem rate,
CEFDINIR 300 MG ORAL CAP,,18535,LOCAL,Facility,Outpatient,1,Each,,26,22.1,7.4516,26,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,12.948,49.8,,percent of total billed charges,,
CEFDINIR 300 MG ORAL CAP,,18535,LOCAL,Facility,Inpatient,1,Each,,26,22.1,7.4516,26,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
CEFDINIR 300 MG ORAL CAP,,18535,LOCAL,Facility,Both,1,Each,,26,22.1,7.4516,26,"Multiplan, Inc.","Multiplan, Inc.",24.44,94,,percent of total billed charges,,
CEFDINIR 300 MG ORAL CAP,,18535,LOCAL,Facility,Outpatient,1,Each,,26,22.1,7.4516,26,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,23.426,90.1,,percent of total billed charges,,
CEFDINIR 300 MG ORAL CAP,,18535,LOCAL,Facility,Inpatient,1,Each,,26,22.1,7.4516,26,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
CEFDINIR 300 MG ORAL CAP,,18535,LOCAL,Facility,Both,1,Each,,26,22.1,7.4516,26,"Preferred One Administrative Services, INC.",PPO,25.636,98.6,,percent of total billed charges,,
CEFDINIR 300 MG ORAL CAP,,18535,LOCAL,Facility,Outpatient,1,Each,,26,22.1,7.4516,26,PrimeWest Health,Minnesota Senior Health Options (MSHO),13.377,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
CEFDINIR 300 MG ORAL CAP,,18535,LOCAL,Facility,Inpatient,1,Each,,26,22.1,7.4516,26,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CEFDINIR 300 MG ORAL CAP,,18535,LOCAL,Facility,Outpatient,1,Each,,26,22.1,7.4516,26,PrimeWest Health,MinnesotaCare,13.3536,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
CEFDINIR 300 MG ORAL CAP,,18535,LOCAL,Facility,Inpatient,1,Each,,26,22.1,7.4516,26,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
CEFDINIR 300 MG ORAL CAP,,18535,LOCAL,Facility,Both,1,Each,,26,22.1,7.4516,26,Sanford Health Plan,Sanford Health Plan,23.92,92,,percent of total billed charges,,
CEFDINIR 300 MG ORAL CAP,,18535,LOCAL,Facility,Outpatient,1,Each,,26,22.1,7.4516,26,"UCare Health, Inc.",Individual & Family Plan,14.651,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
CEFDINIR 300 MG ORAL CAP,,18535,LOCAL,Facility,Inpatient,1,Each,,26,22.1,7.4516,26,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
CEFDINIR 300 MG ORAL CAP,,18535,LOCAL,Facility,Outpatient,1,Each,,26,22.1,7.4516,26,"UCare Health, Inc.",Medical Assistance,13.1222,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CEFDINIR 300 MG ORAL CAP,,18535,LOCAL,Facility,Inpatient,1,Each,,26,22.1,7.4516,26,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
CEFDINIR 300 MG ORAL CAP,,18535,LOCAL,Facility,Outpatient,1,Each,,26,22.1,7.4516,26,"UCare Health, Inc.",Medicare Advantage,13.1222,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CEFDINIR 300 MG ORAL CAP,,18535,LOCAL,Facility,Inpatient,1,Each,,26,22.1,7.4516,26,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CEFDINIR 300 MG ORAL CAP,,18535,LOCAL,Facility,Outpatient,1,Each,,26,22.1,7.4516,26,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),13.1222,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CEFDINIR 300 MG ORAL CAP,,18535,LOCAL,Facility,Inpatient,1,Each,,26,22.1,7.4516,26,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CEFDINIR 300 MG ORAL CAP,,18535,LOCAL,Facility,Both,1,Each,,26,22.1,7.4516,26,UnitedHealthcare,Individual & Family,24.44,94,,percent of total billed charges,,
CEFDINIR 300 MG ORAL CAP,,18535,LOCAL,Facility,Outpatient,1,Each,,26,22.1,7.4516,26,UnitedHealthcare,Medicare Advantage,12.74,49,,percent of total billed charges,,
CEFDINIR 300 MG ORAL CAP,,18535,LOCAL,Facility,Inpatient,1,Each,,26,22.1,7.4516,26,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
CEFDINIR 300 MG ORAL CAP,,18535,LOCAL,Facility,Outpatient,1,Each,,26,22.1,7.4516,26,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,12.48,48,,percent of total billed charges,,100% of DHS outpatient percentage
CEFDINIR 300 MG ORAL CAP,,18535,LOCAL,Facility,Inpatient,1,Each,,26,22.1,7.4516,26,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
LITHIUM CARBONATE 300 MG ORAL TABLET,,18661,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
LITHIUM CARBONATE 300 MG ORAL TABLET,,18661,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
LITHIUM CARBONATE 300 MG ORAL TABLET,,18661,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
LITHIUM CARBONATE 300 MG ORAL TABLET,,18661,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
LITHIUM CARBONATE 300 MG ORAL TABLET,,18661,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
LITHIUM CARBONATE 300 MG ORAL TABLET,,18661,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
LITHIUM CARBONATE 300 MG ORAL TABLET,,18661,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
LITHIUM CARBONATE 300 MG ORAL TABLET,,18661,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
LITHIUM CARBONATE 300 MG ORAL TABLET,,18661,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
LITHIUM CARBONATE 300 MG ORAL TABLET,,18661,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
LITHIUM CARBONATE 300 MG ORAL TABLET,,18661,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
LITHIUM CARBONATE 300 MG ORAL TABLET,,18661,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
LITHIUM CARBONATE 300 MG ORAL TABLET,,18661,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
LITHIUM CARBONATE 300 MG ORAL TABLET,,18661,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
LITHIUM CARBONATE 300 MG ORAL TABLET,,18661,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
LITHIUM CARBONATE 300 MG ORAL TABLET,,18661,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
LITHIUM CARBONATE 300 MG ORAL TABLET,,18661,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
LITHIUM CARBONATE 300 MG ORAL TABLET,,18661,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
LITHIUM CARBONATE 300 MG ORAL TABLET,,18661,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LITHIUM CARBONATE 300 MG ORAL TABLET,,18661,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
LITHIUM CARBONATE 300 MG ORAL TABLET,,18661,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
LITHIUM CARBONATE 300 MG ORAL TABLET,,18661,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
LITHIUM CARBONATE 300 MG ORAL TABLET,,18661,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
LITHIUM CARBONATE 300 MG ORAL TABLET,,18661,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
LITHIUM CARBONATE 300 MG ORAL TABLET,,18661,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
LITHIUM CARBONATE 300 MG ORAL TABLET,,18661,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
LITHIUM CARBONATE 300 MG ORAL TABLET,,18661,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
LITHIUM CARBONATE 300 MG ORAL TABLET,,18661,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
LITHIUM CARBONATE 300 MG ORAL TABLET,,18661,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
LITHIUM CARBONATE 300 MG ORAL TABLET,,18661,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
LITHIUM CARBONATE 300 MG ORAL TABLET,,18661,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
LITHIUM CARBONATE 300 MG ORAL TABLET,,18661,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
LITHIUM CARBONATE 300 MG ORAL TABLET,,18661,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
LITHIUM CARBONATE 300 MG ORAL TABLET,,18661,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
LITHIUM CARBONATE 300 MG ORAL TABLET,,18661,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
LITHIUM CARBONATE 300 MG ORAL TABLET,,18661,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
LITHIUM CARBONATE 300 MG ORAL TABLET,,18661,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
LITHIUM CARBONATE 300 MG ORAL TABLET,,18661,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LITHIUM CARBONATE 300 MG ORAL TABLET,,18661,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
LITHIUM CARBONATE 300 MG ORAL TABLET,,18661,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
LITHIUM CARBONATE 300 MG ORAL TABLET,,18661,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
LITHIUM CARBONATE 300 MG ORAL TABLET,,18661,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
LITHIUM CARBONATE 300 MG ORAL TABLET,,18661,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
LITHIUM CARBONATE 300 MG ORAL TABLET,,18661,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LITHIUM CARBONATE 300 MG ORAL TABLET,,18661,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
LITHIUM CARBONATE 300 MG ORAL TABLET,,18661,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LITHIUM CARBONATE 300 MG ORAL TABLET,,18661,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LITHIUM CARBONATE 300 MG ORAL TABLET,,18661,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LITHIUM CARBONATE 300 MG ORAL TABLET,,18661,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LITHIUM CARBONATE 300 MG ORAL TABLET,,18661,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
LITHIUM CARBONATE 300 MG ORAL TABLET,,18661,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
LITHIUM CARBONATE 300 MG ORAL TABLET,,18661,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
LITHIUM CARBONATE 300 MG ORAL TABLET,,18661,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
LITHIUM CARBONATE 300 MG ORAL TABLET,,18661,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
METFORMIN 500 MG ORAL TB24,,18834,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
METFORMIN 500 MG ORAL TB24,,18834,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
METFORMIN 500 MG ORAL TB24,,18834,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
METFORMIN 500 MG ORAL TB24,,18834,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
METFORMIN 500 MG ORAL TB24,,18834,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
METFORMIN 500 MG ORAL TB24,,18834,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
METFORMIN 500 MG ORAL TB24,,18834,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
METFORMIN 500 MG ORAL TB24,,18834,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
METFORMIN 500 MG ORAL TB24,,18834,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
METFORMIN 500 MG ORAL TB24,,18834,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
METFORMIN 500 MG ORAL TB24,,18834,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
METFORMIN 500 MG ORAL TB24,,18834,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
METFORMIN 500 MG ORAL TB24,,18834,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
METFORMIN 500 MG ORAL TB24,,18834,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
METFORMIN 500 MG ORAL TB24,,18834,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
METFORMIN 500 MG ORAL TB24,,18834,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
METFORMIN 500 MG ORAL TB24,,18834,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
METFORMIN 500 MG ORAL TB24,,18834,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
METFORMIN 500 MG ORAL TB24,,18834,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
METFORMIN 500 MG ORAL TB24,,18834,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
METFORMIN 500 MG ORAL TB24,,18834,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
METFORMIN 500 MG ORAL TB24,,18834,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
METFORMIN 500 MG ORAL TB24,,18834,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
METFORMIN 500 MG ORAL TB24,,18834,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
METFORMIN 500 MG ORAL TB24,,18834,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
METFORMIN 500 MG ORAL TB24,,18834,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
METFORMIN 500 MG ORAL TB24,,18834,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
METFORMIN 500 MG ORAL TB24,,18834,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
METFORMIN 500 MG ORAL TB24,,18834,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
METFORMIN 500 MG ORAL TB24,,18834,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
METFORMIN 500 MG ORAL TB24,,18834,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
METFORMIN 500 MG ORAL TB24,,18834,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
METFORMIN 500 MG ORAL TB24,,18834,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
METFORMIN 500 MG ORAL TB24,,18834,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
METFORMIN 500 MG ORAL TB24,,18834,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
METFORMIN 500 MG ORAL TB24,,18834,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
METFORMIN 500 MG ORAL TB24,,18834,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
METFORMIN 500 MG ORAL TB24,,18834,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
METFORMIN 500 MG ORAL TB24,,18834,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
METFORMIN 500 MG ORAL TB24,,18834,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
METFORMIN 500 MG ORAL TB24,,18834,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
METFORMIN 500 MG ORAL TB24,,18834,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
METFORMIN 500 MG ORAL TB24,,18834,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
METFORMIN 500 MG ORAL TB24,,18834,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
METFORMIN 500 MG ORAL TB24,,18834,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
METFORMIN 500 MG ORAL TB24,,18834,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
METFORMIN 500 MG ORAL TB24,,18834,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
METFORMIN 500 MG ORAL TB24,,18834,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
METFORMIN 500 MG ORAL TB24,,18834,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
METFORMIN 500 MG ORAL TB24,,18834,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
METFORMIN 500 MG ORAL TB24,,18834,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
METFORMIN 500 MG ORAL TB24,,18834,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
METFORMIN 500 MG ORAL TB24,,18834,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
METFORMIN 500 MG ORAL TB24,,18834,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
SERTRALINE 50 MG ORAL TABLET,,18856,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
SERTRALINE 50 MG ORAL TABLET,,18856,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
SERTRALINE 50 MG ORAL TABLET,,18856,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
SERTRALINE 50 MG ORAL TABLET,,18856,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
SERTRALINE 50 MG ORAL TABLET,,18856,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SERTRALINE 50 MG ORAL TABLET,,18856,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
SERTRALINE 50 MG ORAL TABLET,,18856,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
SERTRALINE 50 MG ORAL TABLET,,18856,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
SERTRALINE 50 MG ORAL TABLET,,18856,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
SERTRALINE 50 MG ORAL TABLET,,18856,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
SERTRALINE 50 MG ORAL TABLET,,18856,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
SERTRALINE 50 MG ORAL TABLET,,18856,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
SERTRALINE 50 MG ORAL TABLET,,18856,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
SERTRALINE 50 MG ORAL TABLET,,18856,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
SERTRALINE 50 MG ORAL TABLET,,18856,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
SERTRALINE 50 MG ORAL TABLET,,18856,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
SERTRALINE 50 MG ORAL TABLET,,18856,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
SERTRALINE 50 MG ORAL TABLET,,18856,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
SERTRALINE 50 MG ORAL TABLET,,18856,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SERTRALINE 50 MG ORAL TABLET,,18856,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
SERTRALINE 50 MG ORAL TABLET,,18856,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
SERTRALINE 50 MG ORAL TABLET,,18856,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
SERTRALINE 50 MG ORAL TABLET,,18856,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
SERTRALINE 50 MG ORAL TABLET,,18856,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
SERTRALINE 50 MG ORAL TABLET,,18856,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
SERTRALINE 50 MG ORAL TABLET,,18856,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
SERTRALINE 50 MG ORAL TABLET,,18856,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
SERTRALINE 50 MG ORAL TABLET,,18856,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
SERTRALINE 50 MG ORAL TABLET,,18856,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
SERTRALINE 50 MG ORAL TABLET,,18856,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
SERTRALINE 50 MG ORAL TABLET,,18856,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
SERTRALINE 50 MG ORAL TABLET,,18856,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
SERTRALINE 50 MG ORAL TABLET,,18856,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
SERTRALINE 50 MG ORAL TABLET,,18856,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
SERTRALINE 50 MG ORAL TABLET,,18856,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
SERTRALINE 50 MG ORAL TABLET,,18856,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
SERTRALINE 50 MG ORAL TABLET,,18856,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
SERTRALINE 50 MG ORAL TABLET,,18856,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SERTRALINE 50 MG ORAL TABLET,,18856,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
SERTRALINE 50 MG ORAL TABLET,,18856,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
SERTRALINE 50 MG ORAL TABLET,,18856,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
SERTRALINE 50 MG ORAL TABLET,,18856,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
SERTRALINE 50 MG ORAL TABLET,,18856,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
SERTRALINE 50 MG ORAL TABLET,,18856,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SERTRALINE 50 MG ORAL TABLET,,18856,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
SERTRALINE 50 MG ORAL TABLET,,18856,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SERTRALINE 50 MG ORAL TABLET,,18856,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SERTRALINE 50 MG ORAL TABLET,,18856,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SERTRALINE 50 MG ORAL TABLET,,18856,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SERTRALINE 50 MG ORAL TABLET,,18856,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
SERTRALINE 50 MG ORAL TABLET,,18856,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
SERTRALINE 50 MG ORAL TABLET,,18856,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
SERTRALINE 50 MG ORAL TABLET,,18856,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
SERTRALINE 50 MG ORAL TABLET,,18856,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
FLUDROCORTISONE 0.1 MG ORAL TABLET,,18894,LOCAL,Facility,Both,1,Each,,8,6.8,2.2928,8,Aetna,Commercial,7.36,92,,percent of total billed charges,,
FLUDROCORTISONE 0.1 MG ORAL TABLET,,18894,LOCAL,Facility,Outpatient,1,Each,,8,6.8,2.2928,8,Aetna,Medicare Advantage,3.92,49,,percent of total billed charges,,
FLUDROCORTISONE 0.1 MG ORAL TABLET,,18894,LOCAL,Facility,Inpatient,1,Each,,8,6.8,2.2928,8,Aetna,Medicare Advantage,,,,,Included in per diem rate,
FLUDROCORTISONE 0.1 MG ORAL TABLET,,18894,LOCAL,Facility,Both,1,Each,,8,6.8,2.2928,8,Aetna,PPO,7.44,93,,percent of total billed charges,,
FLUDROCORTISONE 0.1 MG ORAL TABLET,,18894,LOCAL,Facility,Both,1,Each,,8,6.8,2.2928,8,America's PPO,America's PPO,7.6824,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
FLUDROCORTISONE 0.1 MG ORAL TABLET,,18894,LOCAL,Facility,Both,1,Each,,8,6.8,2.2928,8,BlueCross BlueShield Minnesota, Federal Employee Program,7.872,98.4,,percent of total billed charges,,
FLUDROCORTISONE 0.1 MG ORAL TABLET,,18894,LOCAL,Facility,Both,1,Each,,8,6.8,2.2928,8,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,8,100,,percent of total billed charges,,
FLUDROCORTISONE 0.1 MG ORAL TABLET,,18894,LOCAL,Facility,Both,1,Each,,8,6.8,2.2928,8,BlueCross BlueShield Minnesota,High Value Network Plan,7.2,90,,percent of total billed charges,,
FLUDROCORTISONE 0.1 MG ORAL TABLET,,18894,LOCAL,Facility,Outpatient,1,Each,,8,6.8,2.2928,8,BlueCross BlueShield Minnesota,Medicare Advantage,3.92,49,,percent of total billed charges,,
FLUDROCORTISONE 0.1 MG ORAL TABLET,,18894,LOCAL,Facility,Inpatient,1,Each,,8,6.8,2.2928,8,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
FLUDROCORTISONE 0.1 MG ORAL TABLET,,18894,LOCAL,Facility,Both,1,Each,,8,6.8,2.2928,8,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,7.0856,88.57,,percent of total billed charges,,
FLUDROCORTISONE 0.1 MG ORAL TABLET,,18894,LOCAL,Facility,Both,1,Each,,8,6.8,2.2928,8,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,2.2928,28.66,,percent of total billed charges,,
FLUDROCORTISONE 0.1 MG ORAL TABLET,,18894,LOCAL,Facility,Outpatient,1,Each,,8,6.8,2.2928,8,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),3.92,49,,percent of total billed charges,,
FLUDROCORTISONE 0.1 MG ORAL TABLET,,18894,LOCAL,Facility,Inpatient,1,Each,,8,6.8,2.2928,8,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
FLUDROCORTISONE 0.1 MG ORAL TABLET,,18894,LOCAL,Facility,Both,1,Each,,8,6.8,2.2928,8,CorVel,Worker's Compensation,8,100,,percent of total billed charges,,
FLUDROCORTISONE 0.1 MG ORAL TABLET,,18894,LOCAL,Facility,Both,1,Each,,8,6.8,2.2928,8,First Health Group Corporation,First Health Network,7.76,97,,percent of total billed charges,,
FLUDROCORTISONE 0.1 MG ORAL TABLET,,18894,LOCAL,Facility,Both,1,Each,,8,6.8,2.2928,8,"Health Partners, Inc.",Commercial,7.568,94.6,,percent of total billed charges,,
FLUDROCORTISONE 0.1 MG ORAL TABLET,,18894,LOCAL,Facility,Outpatient,1,Each,,8,6.8,2.2928,8,"Health Partners, Inc.",Medicare Advantage,3.92,49,,percent of total billed charges,,
FLUDROCORTISONE 0.1 MG ORAL TABLET,,18894,LOCAL,Facility,Inpatient,1,Each,,8,6.8,2.2928,8,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
FLUDROCORTISONE 0.1 MG ORAL TABLET,,18894,LOCAL,Facility,Both,1,Each,,8,6.8,2.2928,8,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),4.8,60,,percent of total billed charges,,
FLUDROCORTISONE 0.1 MG ORAL TABLET,,18894,LOCAL,Facility,Both,1,Each,,8,6.8,2.2928,8,"Health Partners, Inc.",State of Minnesota Advantage Program,6.52,81.5,,percent of total billed charges,,
FLUDROCORTISONE 0.1 MG ORAL TABLET,,18894,LOCAL,Facility,Both,1,Each,,8,6.8,2.2928,8,"Health Partners, Inc.",State Public Programs,4,50,,percent of total billed charges,,
FLUDROCORTISONE 0.1 MG ORAL TABLET,,18894,LOCAL,Facility,Both,1,Each,,8,6.8,2.2928,8,Humana Insurance Company,Commercial PPO,7.6,95,,percent of total billed charges,,
FLUDROCORTISONE 0.1 MG ORAL TABLET,,18894,LOCAL,Facility,Outpatient,1,Each,,8,6.8,2.2928,8,Humana Insurance Company,Medicare PPO,3.92,49,,percent of total billed charges,,
FLUDROCORTISONE 0.1 MG ORAL TABLET,,18894,LOCAL,Facility,Inpatient,1,Each,,8,6.8,2.2928,8,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
FLUDROCORTISONE 0.1 MG ORAL TABLET,,18894,LOCAL,Facility,Both,1,Each,,8,6.8,2.2928,8,Medica,Individual & Family,7.928,99.1,,percent of total billed charges,,
FLUDROCORTISONE 0.1 MG ORAL TABLET,,18894,LOCAL,Facility,Outpatient,1,Each,,8,6.8,2.2928,8,Medica,Medica Advantage Solution,3.984,49.8,,percent of total billed charges,,
FLUDROCORTISONE 0.1 MG ORAL TABLET,,18894,LOCAL,Facility,Inpatient,1,Each,,8,6.8,2.2928,8,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
FLUDROCORTISONE 0.1 MG ORAL TABLET,,18894,LOCAL,Facility,Outpatient,1,Each,,8,6.8,2.2928,8,Medica,Medical Assistance,3.568,44.6,,percent of total billed charges,,
FLUDROCORTISONE 0.1 MG ORAL TABLET,,18894,LOCAL,Facility,Inpatient,1,Each,,8,6.8,2.2928,8,Medica,Medical Assistance,,,,,Included in per diem rate,
FLUDROCORTISONE 0.1 MG ORAL TABLET,,18894,LOCAL,Facility,Outpatient,1,Each,,8,6.8,2.2928,8,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,3.984,49.8,,percent of total billed charges,,
FLUDROCORTISONE 0.1 MG ORAL TABLET,,18894,LOCAL,Facility,Inpatient,1,Each,,8,6.8,2.2928,8,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
FLUDROCORTISONE 0.1 MG ORAL TABLET,,18894,LOCAL,Facility,Both,1,Each,,8,6.8,2.2928,8,"Multiplan, Inc.","Multiplan, Inc.",7.52,94,,percent of total billed charges,,
FLUDROCORTISONE 0.1 MG ORAL TABLET,,18894,LOCAL,Facility,Outpatient,1,Each,,8,6.8,2.2928,8,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,7.208,90.1,,percent of total billed charges,,
FLUDROCORTISONE 0.1 MG ORAL TABLET,,18894,LOCAL,Facility,Inpatient,1,Each,,8,6.8,2.2928,8,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
FLUDROCORTISONE 0.1 MG ORAL TABLET,,18894,LOCAL,Facility,Both,1,Each,,8,6.8,2.2928,8,"Preferred One Administrative Services, INC.",PPO,7.888,98.6,,percent of total billed charges,,
FLUDROCORTISONE 0.1 MG ORAL TABLET,,18894,LOCAL,Facility,Outpatient,1,Each,,8,6.8,2.2928,8,PrimeWest Health,Minnesota Senior Health Options (MSHO),4.116,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
FLUDROCORTISONE 0.1 MG ORAL TABLET,,18894,LOCAL,Facility,Inpatient,1,Each,,8,6.8,2.2928,8,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
FLUDROCORTISONE 0.1 MG ORAL TABLET,,18894,LOCAL,Facility,Outpatient,1,Each,,8,6.8,2.2928,8,PrimeWest Health,MinnesotaCare,4.1088,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
FLUDROCORTISONE 0.1 MG ORAL TABLET,,18894,LOCAL,Facility,Inpatient,1,Each,,8,6.8,2.2928,8,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
FLUDROCORTISONE 0.1 MG ORAL TABLET,,18894,LOCAL,Facility,Both,1,Each,,8,6.8,2.2928,8,Sanford Health Plan,Sanford Health Plan,7.36,92,,percent of total billed charges,,
FLUDROCORTISONE 0.1 MG ORAL TABLET,,18894,LOCAL,Facility,Outpatient,1,Each,,8,6.8,2.2928,8,"UCare Health, Inc.",Individual & Family Plan,4.508,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
FLUDROCORTISONE 0.1 MG ORAL TABLET,,18894,LOCAL,Facility,Inpatient,1,Each,,8,6.8,2.2928,8,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
FLUDROCORTISONE 0.1 MG ORAL TABLET,,18894,LOCAL,Facility,Outpatient,1,Each,,8,6.8,2.2928,8,"UCare Health, Inc.",Medical Assistance,4.0376,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FLUDROCORTISONE 0.1 MG ORAL TABLET,,18894,LOCAL,Facility,Inpatient,1,Each,,8,6.8,2.2928,8,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
FLUDROCORTISONE 0.1 MG ORAL TABLET,,18894,LOCAL,Facility,Outpatient,1,Each,,8,6.8,2.2928,8,"UCare Health, Inc.",Medicare Advantage,4.0376,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FLUDROCORTISONE 0.1 MG ORAL TABLET,,18894,LOCAL,Facility,Inpatient,1,Each,,8,6.8,2.2928,8,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
FLUDROCORTISONE 0.1 MG ORAL TABLET,,18894,LOCAL,Facility,Outpatient,1,Each,,8,6.8,2.2928,8,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),4.0376,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FLUDROCORTISONE 0.1 MG ORAL TABLET,,18894,LOCAL,Facility,Inpatient,1,Each,,8,6.8,2.2928,8,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
FLUDROCORTISONE 0.1 MG ORAL TABLET,,18894,LOCAL,Facility,Both,1,Each,,8,6.8,2.2928,8,UnitedHealthcare,Individual & Family,7.52,94,,percent of total billed charges,,
FLUDROCORTISONE 0.1 MG ORAL TABLET,,18894,LOCAL,Facility,Outpatient,1,Each,,8,6.8,2.2928,8,UnitedHealthcare,Medicare Advantage,3.92,49,,percent of total billed charges,,
FLUDROCORTISONE 0.1 MG ORAL TABLET,,18894,LOCAL,Facility,Inpatient,1,Each,,8,6.8,2.2928,8,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
FLUDROCORTISONE 0.1 MG ORAL TABLET,,18894,LOCAL,Facility,Outpatient,1,Each,,8,6.8,2.2928,8,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,3.84,48,,percent of total billed charges,,100% of DHS outpatient percentage
FLUDROCORTISONE 0.1 MG ORAL TABLET,,18894,LOCAL,Facility,Inpatient,1,Each,,8,6.8,2.2928,8,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
LISINOPRIL 2.5 MG ORAL TABLET,,18963,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
LISINOPRIL 2.5 MG ORAL TABLET,,18963,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
LISINOPRIL 2.5 MG ORAL TABLET,,18963,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
LISINOPRIL 2.5 MG ORAL TABLET,,18963,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
LISINOPRIL 2.5 MG ORAL TABLET,,18963,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
LISINOPRIL 2.5 MG ORAL TABLET,,18963,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
LISINOPRIL 2.5 MG ORAL TABLET,,18963,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
LISINOPRIL 2.5 MG ORAL TABLET,,18963,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
LISINOPRIL 2.5 MG ORAL TABLET,,18963,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
LISINOPRIL 2.5 MG ORAL TABLET,,18963,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
LISINOPRIL 2.5 MG ORAL TABLET,,18963,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
LISINOPRIL 2.5 MG ORAL TABLET,,18963,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
LISINOPRIL 2.5 MG ORAL TABLET,,18963,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
LISINOPRIL 2.5 MG ORAL TABLET,,18963,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
LISINOPRIL 2.5 MG ORAL TABLET,,18963,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
LISINOPRIL 2.5 MG ORAL TABLET,,18963,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
LISINOPRIL 2.5 MG ORAL TABLET,,18963,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
LISINOPRIL 2.5 MG ORAL TABLET,,18963,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
LISINOPRIL 2.5 MG ORAL TABLET,,18963,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LISINOPRIL 2.5 MG ORAL TABLET,,18963,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
LISINOPRIL 2.5 MG ORAL TABLET,,18963,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
LISINOPRIL 2.5 MG ORAL TABLET,,18963,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
LISINOPRIL 2.5 MG ORAL TABLET,,18963,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
LISINOPRIL 2.5 MG ORAL TABLET,,18963,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
LISINOPRIL 2.5 MG ORAL TABLET,,18963,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
LISINOPRIL 2.5 MG ORAL TABLET,,18963,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
LISINOPRIL 2.5 MG ORAL TABLET,,18963,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
LISINOPRIL 2.5 MG ORAL TABLET,,18963,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
LISINOPRIL 2.5 MG ORAL TABLET,,18963,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
LISINOPRIL 2.5 MG ORAL TABLET,,18963,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
LISINOPRIL 2.5 MG ORAL TABLET,,18963,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
LISINOPRIL 2.5 MG ORAL TABLET,,18963,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
LISINOPRIL 2.5 MG ORAL TABLET,,18963,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
LISINOPRIL 2.5 MG ORAL TABLET,,18963,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
LISINOPRIL 2.5 MG ORAL TABLET,,18963,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
LISINOPRIL 2.5 MG ORAL TABLET,,18963,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
LISINOPRIL 2.5 MG ORAL TABLET,,18963,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
LISINOPRIL 2.5 MG ORAL TABLET,,18963,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LISINOPRIL 2.5 MG ORAL TABLET,,18963,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
LISINOPRIL 2.5 MG ORAL TABLET,,18963,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
LISINOPRIL 2.5 MG ORAL TABLET,,18963,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
LISINOPRIL 2.5 MG ORAL TABLET,,18963,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
LISINOPRIL 2.5 MG ORAL TABLET,,18963,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
LISINOPRIL 2.5 MG ORAL TABLET,,18963,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LISINOPRIL 2.5 MG ORAL TABLET,,18963,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
LISINOPRIL 2.5 MG ORAL TABLET,,18963,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LISINOPRIL 2.5 MG ORAL TABLET,,18963,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LISINOPRIL 2.5 MG ORAL TABLET,,18963,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LISINOPRIL 2.5 MG ORAL TABLET,,18963,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LISINOPRIL 2.5 MG ORAL TABLET,,18963,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
LISINOPRIL 2.5 MG ORAL TABLET,,18963,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
LISINOPRIL 2.5 MG ORAL TABLET,,18963,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
LISINOPRIL 2.5 MG ORAL TABLET,,18963,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
LISINOPRIL 2.5 MG ORAL TABLET,,18963,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
CHOLECALCIFEROL (VITAMIN D3) 10 MCG (400 UNIT) ORAL TABLET,,19001,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
CHOLECALCIFEROL (VITAMIN D3) 10 MCG (400 UNIT) ORAL TABLET,,19001,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
CHOLECALCIFEROL (VITAMIN D3) 10 MCG (400 UNIT) ORAL TABLET,,19001,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
CHOLECALCIFEROL (VITAMIN D3) 10 MCG (400 UNIT) ORAL TABLET,,19001,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
CHOLECALCIFEROL (VITAMIN D3) 10 MCG (400 UNIT) ORAL TABLET,,19001,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
CHOLECALCIFEROL (VITAMIN D3) 10 MCG (400 UNIT) ORAL TABLET,,19001,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
CHOLECALCIFEROL (VITAMIN D3) 10 MCG (400 UNIT) ORAL TABLET,,19001,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
CHOLECALCIFEROL (VITAMIN D3) 10 MCG (400 UNIT) ORAL TABLET,,19001,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
CHOLECALCIFEROL (VITAMIN D3) 10 MCG (400 UNIT) ORAL TABLET,,19001,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
CHOLECALCIFEROL (VITAMIN D3) 10 MCG (400 UNIT) ORAL TABLET,,19001,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
CHOLECALCIFEROL (VITAMIN D3) 10 MCG (400 UNIT) ORAL TABLET,,19001,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
CHOLECALCIFEROL (VITAMIN D3) 10 MCG (400 UNIT) ORAL TABLET,,19001,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
CHOLECALCIFEROL (VITAMIN D3) 10 MCG (400 UNIT) ORAL TABLET,,19001,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
CHOLECALCIFEROL (VITAMIN D3) 10 MCG (400 UNIT) ORAL TABLET,,19001,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
CHOLECALCIFEROL (VITAMIN D3) 10 MCG (400 UNIT) ORAL TABLET,,19001,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
CHOLECALCIFEROL (VITAMIN D3) 10 MCG (400 UNIT) ORAL TABLET,,19001,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
CHOLECALCIFEROL (VITAMIN D3) 10 MCG (400 UNIT) ORAL TABLET,,19001,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
CHOLECALCIFEROL (VITAMIN D3) 10 MCG (400 UNIT) ORAL TABLET,,19001,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
CHOLECALCIFEROL (VITAMIN D3) 10 MCG (400 UNIT) ORAL TABLET,,19001,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
CHOLECALCIFEROL (VITAMIN D3) 10 MCG (400 UNIT) ORAL TABLET,,19001,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
CHOLECALCIFEROL (VITAMIN D3) 10 MCG (400 UNIT) ORAL TABLET,,19001,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
CHOLECALCIFEROL (VITAMIN D3) 10 MCG (400 UNIT) ORAL TABLET,,19001,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
CHOLECALCIFEROL (VITAMIN D3) 10 MCG (400 UNIT) ORAL TABLET,,19001,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
CHOLECALCIFEROL (VITAMIN D3) 10 MCG (400 UNIT) ORAL TABLET,,19001,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
CHOLECALCIFEROL (VITAMIN D3) 10 MCG (400 UNIT) ORAL TABLET,,19001,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
CHOLECALCIFEROL (VITAMIN D3) 10 MCG (400 UNIT) ORAL TABLET,,19001,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
CHOLECALCIFEROL (VITAMIN D3) 10 MCG (400 UNIT) ORAL TABLET,,19001,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
CHOLECALCIFEROL (VITAMIN D3) 10 MCG (400 UNIT) ORAL TABLET,,19001,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
CHOLECALCIFEROL (VITAMIN D3) 10 MCG (400 UNIT) ORAL TABLET,,19001,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
CHOLECALCIFEROL (VITAMIN D3) 10 MCG (400 UNIT) ORAL TABLET,,19001,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
CHOLECALCIFEROL (VITAMIN D3) 10 MCG (400 UNIT) ORAL TABLET,,19001,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
CHOLECALCIFEROL (VITAMIN D3) 10 MCG (400 UNIT) ORAL TABLET,,19001,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
CHOLECALCIFEROL (VITAMIN D3) 10 MCG (400 UNIT) ORAL TABLET,,19001,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
CHOLECALCIFEROL (VITAMIN D3) 10 MCG (400 UNIT) ORAL TABLET,,19001,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
CHOLECALCIFEROL (VITAMIN D3) 10 MCG (400 UNIT) ORAL TABLET,,19001,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
CHOLECALCIFEROL (VITAMIN D3) 10 MCG (400 UNIT) ORAL TABLET,,19001,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
CHOLECALCIFEROL (VITAMIN D3) 10 MCG (400 UNIT) ORAL TABLET,,19001,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CHOLECALCIFEROL (VITAMIN D3) 10 MCG (400 UNIT) ORAL TABLET,,19001,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CHOLECALCIFEROL (VITAMIN D3) 10 MCG (400 UNIT) ORAL TABLET,,19001,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
CHOLECALCIFEROL (VITAMIN D3) 10 MCG (400 UNIT) ORAL TABLET,,19001,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
CHOLECALCIFEROL (VITAMIN D3) 10 MCG (400 UNIT) ORAL TABLET,,19001,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
CHOLECALCIFEROL (VITAMIN D3) 10 MCG (400 UNIT) ORAL TABLET,,19001,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
CHOLECALCIFEROL (VITAMIN D3) 10 MCG (400 UNIT) ORAL TABLET,,19001,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
CHOLECALCIFEROL (VITAMIN D3) 10 MCG (400 UNIT) ORAL TABLET,,19001,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
CHOLECALCIFEROL (VITAMIN D3) 10 MCG (400 UNIT) ORAL TABLET,,19001,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
CHOLECALCIFEROL (VITAMIN D3) 10 MCG (400 UNIT) ORAL TABLET,,19001,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
CHOLECALCIFEROL (VITAMIN D3) 10 MCG (400 UNIT) ORAL TABLET,,19001,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
CHOLECALCIFEROL (VITAMIN D3) 10 MCG (400 UNIT) ORAL TABLET,,19001,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
CHOLECALCIFEROL (VITAMIN D3) 10 MCG (400 UNIT) ORAL TABLET,,19001,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
CHOLECALCIFEROL (VITAMIN D3) 10 MCG (400 UNIT) ORAL TABLET,,19001,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
CHOLECALCIFEROL (VITAMIN D3) 10 MCG (400 UNIT) ORAL TABLET,,19001,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
CHOLECALCIFEROL (VITAMIN D3) 10 MCG (400 UNIT) ORAL TABLET,,19001,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
CHOLECALCIFEROL (VITAMIN D3) 10 MCG (400 UNIT) ORAL TABLET,,19001,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
CHOLECALCIFEROL (VITAMIN D3) 10 MCG (400 UNIT) ORAL TABLET,,19001,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
CHOLECALCIFEROL (VITAMIN D3) 10 MCG (400 UNIT) ORAL TABLET,,19001,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
CHOLECALCIFEROL (VITAMIN D3) 10 MCG (400 UNIT) ORAL TABLET,,19001,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
CHOLECALCIFEROL (VITAMIN D3) 10 MCG (400 UNIT) ORAL TABLET,,19001,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
CHOLECALCIFEROL (VITAMIN D3) 10 MCG (400 UNIT) ORAL TABLET,,19001,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
CHOLECALCIFEROL (VITAMIN D3) 10 MCG (400 UNIT) ORAL TABLET,,19001,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
CHOLECALCIFEROL (VITAMIN D3) 10 MCG (400 UNIT) ORAL TABLET,,19001,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
CHOLECALCIFEROL (VITAMIN D3) 10 MCG (400 UNIT) ORAL TABLET,,19001,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
CHOLECALCIFEROL (VITAMIN D3) 10 MCG (400 UNIT) ORAL TABLET,,19001,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
CHOLECALCIFEROL (VITAMIN D3) 10 MCG (400 UNIT) ORAL TABLET,,19001,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
CHOLECALCIFEROL (VITAMIN D3) 10 MCG (400 UNIT) ORAL TABLET,,19001,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
CHOLECALCIFEROL (VITAMIN D3) 10 MCG (400 UNIT) ORAL TABLET,,19001,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
CHOLECALCIFEROL (VITAMIN D3) 10 MCG (400 UNIT) ORAL TABLET,,19001,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
CHOLECALCIFEROL (VITAMIN D3) 10 MCG (400 UNIT) ORAL TABLET,,19001,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
CHOLECALCIFEROL (VITAMIN D3) 10 MCG (400 UNIT) ORAL TABLET,,19001,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
CHOLECALCIFEROL (VITAMIN D3) 10 MCG (400 UNIT) ORAL TABLET,,19001,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
CHOLECALCIFEROL (VITAMIN D3) 10 MCG (400 UNIT) ORAL TABLET,,19001,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
CHOLECALCIFEROL (VITAMIN D3) 10 MCG (400 UNIT) ORAL TABLET,,19001,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
CHOLECALCIFEROL (VITAMIN D3) 10 MCG (400 UNIT) ORAL TABLET,,19001,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
CHOLECALCIFEROL (VITAMIN D3) 10 MCG (400 UNIT) ORAL TABLET,,19001,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
CHOLECALCIFEROL (VITAMIN D3) 10 MCG (400 UNIT) ORAL TABLET,,19001,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
CHOLECALCIFEROL (VITAMIN D3) 10 MCG (400 UNIT) ORAL TABLET,,19001,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CHOLECALCIFEROL (VITAMIN D3) 10 MCG (400 UNIT) ORAL TABLET,,19001,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CHOLECALCIFEROL (VITAMIN D3) 10 MCG (400 UNIT) ORAL TABLET,,19001,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
CHOLECALCIFEROL (VITAMIN D3) 10 MCG (400 UNIT) ORAL TABLET,,19001,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
CHOLECALCIFEROL (VITAMIN D3) 10 MCG (400 UNIT) ORAL TABLET,,19001,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
CHOLECALCIFEROL (VITAMIN D3) 10 MCG (400 UNIT) ORAL TABLET,,19001,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
CHOLECALCIFEROL (VITAMIN D3) 10 MCG (400 UNIT) ORAL TABLET,,19001,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
CHOLECALCIFEROL (VITAMIN D3) 10 MCG (400 UNIT) ORAL TABLET,,19001,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
CHOLECALCIFEROL (VITAMIN D3) 10 MCG (400 UNIT) ORAL TABLET,,19001,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
CHOLECALCIFEROL (VITAMIN D3) 10 MCG (400 UNIT) ORAL TABLET,,19001,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
CHOLECALCIFEROL (VITAMIN D3) 10 MCG (400 UNIT) ORAL TABLET,,19001,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
CHOLECALCIFEROL (VITAMIN D3) 10 MCG (400 UNIT) ORAL TABLET,,19001,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
CHOLECALCIFEROL (VITAMIN D3) 10 MCG (400 UNIT) ORAL TABLET,,19001,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CHOLECALCIFEROL (VITAMIN D3) 10 MCG (400 UNIT) ORAL TABLET,,19001,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CHOLECALCIFEROL (VITAMIN D3) 10 MCG (400 UNIT) ORAL TABLET,,19001,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
CHOLECALCIFEROL (VITAMIN D3) 10 MCG (400 UNIT) ORAL TABLET,,19001,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
CHOLECALCIFEROL (VITAMIN D3) 10 MCG (400 UNIT) ORAL TABLET,,19001,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CHOLECALCIFEROL (VITAMIN D3) 10 MCG (400 UNIT) ORAL TABLET,,19001,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CHOLECALCIFEROL (VITAMIN D3) 10 MCG (400 UNIT) ORAL TABLET,,19001,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CHOLECALCIFEROL (VITAMIN D3) 10 MCG (400 UNIT) ORAL TABLET,,19001,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CHOLECALCIFEROL (VITAMIN D3) 10 MCG (400 UNIT) ORAL TABLET,,19001,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CHOLECALCIFEROL (VITAMIN D3) 10 MCG (400 UNIT) ORAL TABLET,,19001,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CHOLECALCIFEROL (VITAMIN D3) 10 MCG (400 UNIT) ORAL TABLET,,19001,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CHOLECALCIFEROL (VITAMIN D3) 10 MCG (400 UNIT) ORAL TABLET,,19001,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CHOLECALCIFEROL (VITAMIN D3) 10 MCG (400 UNIT) ORAL TABLET,,19001,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
CHOLECALCIFEROL (VITAMIN D3) 10 MCG (400 UNIT) ORAL TABLET,,19001,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
CHOLECALCIFEROL (VITAMIN D3) 10 MCG (400 UNIT) ORAL TABLET,,19001,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
CHOLECALCIFEROL (VITAMIN D3) 10 MCG (400 UNIT) ORAL TABLET,,19001,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
CHOLECALCIFEROL (VITAMIN D3) 10 MCG (400 UNIT) ORAL TABLET,,19001,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
CHOLECALCIFEROL (VITAMIN D3) 10 MCG (400 UNIT) ORAL TABLET,,19001,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
CHOLECALCIFEROL (VITAMIN D3) 10 MCG (400 UNIT) ORAL TABLET,,19001,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
CHOLECALCIFEROL (VITAMIN D3) 10 MCG (400 UNIT) ORAL TABLET,,19001,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
CHOLECALCIFEROL (VITAMIN D3) 10 MCG (400 UNIT) ORAL TABLET,,19001,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
CHOLECALCIFEROL (VITAMIN D3) 10 MCG (400 UNIT) ORAL TABLET,,19001,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
ISOSORBIDE DINITRATE 5 MG ORAL TABLET,,19057,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,Aetna,Commercial,5.52,92,,percent of total billed charges,,
ISOSORBIDE DINITRATE 5 MG ORAL TABLET,,19057,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,Aetna,Commercial,5.52,92,,percent of total billed charges,,
ISOSORBIDE DINITRATE 5 MG ORAL TABLET,,19057,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,Aetna,Medicare Advantage,2.94,49,,percent of total billed charges,,
ISOSORBIDE DINITRATE 5 MG ORAL TABLET,,19057,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,Aetna,Medicare Advantage,2.94,49,,percent of total billed charges,,
ISOSORBIDE DINITRATE 5 MG ORAL TABLET,,19057,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,Aetna,Medicare Advantage,,,,,Included in per diem rate,
ISOSORBIDE DINITRATE 5 MG ORAL TABLET,,19057,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,Aetna,Medicare Advantage,,,,,Included in per diem rate,
ISOSORBIDE DINITRATE 5 MG ORAL TABLET,,19057,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,Aetna,PPO,5.58,93,,percent of total billed charges,,
ISOSORBIDE DINITRATE 5 MG ORAL TABLET,,19057,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,Aetna,PPO,5.58,93,,percent of total billed charges,,
ISOSORBIDE DINITRATE 5 MG ORAL TABLET,,19057,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,America's PPO,America's PPO,5.7618,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
ISOSORBIDE DINITRATE 5 MG ORAL TABLET,,19057,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,America's PPO,America's PPO,5.7618,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
ISOSORBIDE DINITRATE 5 MG ORAL TABLET,,19057,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota, Federal Employee Program,5.904,98.4,,percent of total billed charges,,
ISOSORBIDE DINITRATE 5 MG ORAL TABLET,,19057,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota, Federal Employee Program,5.904,98.4,,percent of total billed charges,,
ISOSORBIDE DINITRATE 5 MG ORAL TABLET,,19057,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,6,100,,percent of total billed charges,,
ISOSORBIDE DINITRATE 5 MG ORAL TABLET,,19057,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,6,100,,percent of total billed charges,,
ISOSORBIDE DINITRATE 5 MG ORAL TABLET,,19057,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota,High Value Network Plan,5.4,90,,percent of total billed charges,,
ISOSORBIDE DINITRATE 5 MG ORAL TABLET,,19057,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota,High Value Network Plan,5.4,90,,percent of total billed charges,,
ISOSORBIDE DINITRATE 5 MG ORAL TABLET,,19057,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota,Medicare Advantage,2.94,49,,percent of total billed charges,,
ISOSORBIDE DINITRATE 5 MG ORAL TABLET,,19057,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota,Medicare Advantage,2.94,49,,percent of total billed charges,,
ISOSORBIDE DINITRATE 5 MG ORAL TABLET,,19057,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
ISOSORBIDE DINITRATE 5 MG ORAL TABLET,,19057,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
ISOSORBIDE DINITRATE 5 MG ORAL TABLET,,19057,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,5.3142,88.57,,percent of total billed charges,,
ISOSORBIDE DINITRATE 5 MG ORAL TABLET,,19057,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,5.3142,88.57,,percent of total billed charges,,
ISOSORBIDE DINITRATE 5 MG ORAL TABLET,,19057,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.7196,28.66,,percent of total billed charges,,
ISOSORBIDE DINITRATE 5 MG ORAL TABLET,,19057,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.7196,28.66,,percent of total billed charges,,
ISOSORBIDE DINITRATE 5 MG ORAL TABLET,,19057,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.94,49,,percent of total billed charges,,
ISOSORBIDE DINITRATE 5 MG ORAL TABLET,,19057,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.94,49,,percent of total billed charges,,
ISOSORBIDE DINITRATE 5 MG ORAL TABLET,,19057,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
ISOSORBIDE DINITRATE 5 MG ORAL TABLET,,19057,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
ISOSORBIDE DINITRATE 5 MG ORAL TABLET,,19057,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,CorVel,Worker's Compensation,6,100,,percent of total billed charges,,
ISOSORBIDE DINITRATE 5 MG ORAL TABLET,,19057,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,CorVel,Worker's Compensation,6,100,,percent of total billed charges,,
ISOSORBIDE DINITRATE 5 MG ORAL TABLET,,19057,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,First Health Group Corporation,First Health Network,5.82,97,,percent of total billed charges,,
ISOSORBIDE DINITRATE 5 MG ORAL TABLET,,19057,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,First Health Group Corporation,First Health Network,5.82,97,,percent of total billed charges,,
ISOSORBIDE DINITRATE 5 MG ORAL TABLET,,19057,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,"Health Partners, Inc.",Commercial,5.676,94.6,,percent of total billed charges,,
ISOSORBIDE DINITRATE 5 MG ORAL TABLET,,19057,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,"Health Partners, Inc.",Commercial,5.676,94.6,,percent of total billed charges,,
ISOSORBIDE DINITRATE 5 MG ORAL TABLET,,19057,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,"Health Partners, Inc.",Medicare Advantage,2.94,49,,percent of total billed charges,,
ISOSORBIDE DINITRATE 5 MG ORAL TABLET,,19057,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,"Health Partners, Inc.",Medicare Advantage,2.94,49,,percent of total billed charges,,
ISOSORBIDE DINITRATE 5 MG ORAL TABLET,,19057,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ISOSORBIDE DINITRATE 5 MG ORAL TABLET,,19057,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ISOSORBIDE DINITRATE 5 MG ORAL TABLET,,19057,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3.6,60,,percent of total billed charges,,
ISOSORBIDE DINITRATE 5 MG ORAL TABLET,,19057,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3.6,60,,percent of total billed charges,,
ISOSORBIDE DINITRATE 5 MG ORAL TABLET,,19057,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,"Health Partners, Inc.",State of Minnesota Advantage Program,4.89,81.5,,percent of total billed charges,,
ISOSORBIDE DINITRATE 5 MG ORAL TABLET,,19057,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,"Health Partners, Inc.",State of Minnesota Advantage Program,4.89,81.5,,percent of total billed charges,,
ISOSORBIDE DINITRATE 5 MG ORAL TABLET,,19057,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,"Health Partners, Inc.",State Public Programs,3,50,,percent of total billed charges,,
ISOSORBIDE DINITRATE 5 MG ORAL TABLET,,19057,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,"Health Partners, Inc.",State Public Programs,3,50,,percent of total billed charges,,
ISOSORBIDE DINITRATE 5 MG ORAL TABLET,,19057,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,Humana Insurance Company,Commercial PPO,5.7,95,,percent of total billed charges,,
ISOSORBIDE DINITRATE 5 MG ORAL TABLET,,19057,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,Humana Insurance Company,Commercial PPO,5.7,95,,percent of total billed charges,,
ISOSORBIDE DINITRATE 5 MG ORAL TABLET,,19057,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,Humana Insurance Company,Medicare PPO,2.94,49,,percent of total billed charges,,
ISOSORBIDE DINITRATE 5 MG ORAL TABLET,,19057,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,Humana Insurance Company,Medicare PPO,2.94,49,,percent of total billed charges,,
ISOSORBIDE DINITRATE 5 MG ORAL TABLET,,19057,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
ISOSORBIDE DINITRATE 5 MG ORAL TABLET,,19057,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
ISOSORBIDE DINITRATE 5 MG ORAL TABLET,,19057,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,Medica,Individual & Family,5.946,99.1,,percent of total billed charges,,
ISOSORBIDE DINITRATE 5 MG ORAL TABLET,,19057,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,Medica,Individual & Family,5.946,99.1,,percent of total billed charges,,
ISOSORBIDE DINITRATE 5 MG ORAL TABLET,,19057,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,Medica,Medica Advantage Solution,2.988,49.8,,percent of total billed charges,,
ISOSORBIDE DINITRATE 5 MG ORAL TABLET,,19057,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,Medica,Medica Advantage Solution,2.988,49.8,,percent of total billed charges,,
ISOSORBIDE DINITRATE 5 MG ORAL TABLET,,19057,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
ISOSORBIDE DINITRATE 5 MG ORAL TABLET,,19057,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
ISOSORBIDE DINITRATE 5 MG ORAL TABLET,,19057,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,Medica,Medical Assistance,2.676,44.6,,percent of total billed charges,,
ISOSORBIDE DINITRATE 5 MG ORAL TABLET,,19057,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,Medica,Medical Assistance,2.676,44.6,,percent of total billed charges,,
ISOSORBIDE DINITRATE 5 MG ORAL TABLET,,19057,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,Medica,Medical Assistance,,,,,Included in per diem rate,
ISOSORBIDE DINITRATE 5 MG ORAL TABLET,,19057,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,Medica,Medical Assistance,,,,,Included in per diem rate,
ISOSORBIDE DINITRATE 5 MG ORAL TABLET,,19057,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.988,49.8,,percent of total billed charges,,
ISOSORBIDE DINITRATE 5 MG ORAL TABLET,,19057,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.988,49.8,,percent of total billed charges,,
ISOSORBIDE DINITRATE 5 MG ORAL TABLET,,19057,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
ISOSORBIDE DINITRATE 5 MG ORAL TABLET,,19057,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
ISOSORBIDE DINITRATE 5 MG ORAL TABLET,,19057,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,"Multiplan, Inc.","Multiplan, Inc.",5.64,94,,percent of total billed charges,,
ISOSORBIDE DINITRATE 5 MG ORAL TABLET,,19057,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,"Multiplan, Inc.","Multiplan, Inc.",5.64,94,,percent of total billed charges,,
ISOSORBIDE DINITRATE 5 MG ORAL TABLET,,19057,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,5.406,90.1,,percent of total billed charges,,
ISOSORBIDE DINITRATE 5 MG ORAL TABLET,,19057,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,5.406,90.1,,percent of total billed charges,,
ISOSORBIDE DINITRATE 5 MG ORAL TABLET,,19057,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
ISOSORBIDE DINITRATE 5 MG ORAL TABLET,,19057,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
ISOSORBIDE DINITRATE 5 MG ORAL TABLET,,19057,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,"Preferred One Administrative Services, INC.",PPO,5.916,98.6,,percent of total billed charges,,
ISOSORBIDE DINITRATE 5 MG ORAL TABLET,,19057,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,"Preferred One Administrative Services, INC.",PPO,5.916,98.6,,percent of total billed charges,,
ISOSORBIDE DINITRATE 5 MG ORAL TABLET,,19057,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,PrimeWest Health,Minnesota Senior Health Options (MSHO),3.087,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
ISOSORBIDE DINITRATE 5 MG ORAL TABLET,,19057,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,PrimeWest Health,Minnesota Senior Health Options (MSHO),3.087,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
ISOSORBIDE DINITRATE 5 MG ORAL TABLET,,19057,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ISOSORBIDE DINITRATE 5 MG ORAL TABLET,,19057,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ISOSORBIDE DINITRATE 5 MG ORAL TABLET,,19057,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,PrimeWest Health,MinnesotaCare,3.0816,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
ISOSORBIDE DINITRATE 5 MG ORAL TABLET,,19057,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,PrimeWest Health,MinnesotaCare,3.0816,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
ISOSORBIDE DINITRATE 5 MG ORAL TABLET,,19057,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
ISOSORBIDE DINITRATE 5 MG ORAL TABLET,,19057,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
ISOSORBIDE DINITRATE 5 MG ORAL TABLET,,19057,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,Sanford Health Plan,Sanford Health Plan,5.52,92,,percent of total billed charges,,
ISOSORBIDE DINITRATE 5 MG ORAL TABLET,,19057,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,Sanford Health Plan,Sanford Health Plan,5.52,92,,percent of total billed charges,,
ISOSORBIDE DINITRATE 5 MG ORAL TABLET,,19057,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,"UCare Health, Inc.",Individual & Family Plan,3.381,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
ISOSORBIDE DINITRATE 5 MG ORAL TABLET,,19057,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,"UCare Health, Inc.",Individual & Family Plan,3.381,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
ISOSORBIDE DINITRATE 5 MG ORAL TABLET,,19057,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
ISOSORBIDE DINITRATE 5 MG ORAL TABLET,,19057,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
ISOSORBIDE DINITRATE 5 MG ORAL TABLET,,19057,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,"UCare Health, Inc.",Medical Assistance,3.0282,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ISOSORBIDE DINITRATE 5 MG ORAL TABLET,,19057,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,"UCare Health, Inc.",Medical Assistance,3.0282,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ISOSORBIDE DINITRATE 5 MG ORAL TABLET,,19057,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
ISOSORBIDE DINITRATE 5 MG ORAL TABLET,,19057,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
ISOSORBIDE DINITRATE 5 MG ORAL TABLET,,19057,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,"UCare Health, Inc.",Medicare Advantage,3.0282,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ISOSORBIDE DINITRATE 5 MG ORAL TABLET,,19057,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,"UCare Health, Inc.",Medicare Advantage,3.0282,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ISOSORBIDE DINITRATE 5 MG ORAL TABLET,,19057,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ISOSORBIDE DINITRATE 5 MG ORAL TABLET,,19057,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ISOSORBIDE DINITRATE 5 MG ORAL TABLET,,19057,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),3.0282,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ISOSORBIDE DINITRATE 5 MG ORAL TABLET,,19057,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),3.0282,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ISOSORBIDE DINITRATE 5 MG ORAL TABLET,,19057,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ISOSORBIDE DINITRATE 5 MG ORAL TABLET,,19057,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ISOSORBIDE DINITRATE 5 MG ORAL TABLET,,19057,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,UnitedHealthcare,Individual & Family,5.64,94,,percent of total billed charges,,
ISOSORBIDE DINITRATE 5 MG ORAL TABLET,,19057,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,UnitedHealthcare,Individual & Family,5.64,94,,percent of total billed charges,,
ISOSORBIDE DINITRATE 5 MG ORAL TABLET,,19057,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,UnitedHealthcare,Medicare Advantage,2.94,49,,percent of total billed charges,,
ISOSORBIDE DINITRATE 5 MG ORAL TABLET,,19057,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,UnitedHealthcare,Medicare Advantage,2.94,49,,percent of total billed charges,,
ISOSORBIDE DINITRATE 5 MG ORAL TABLET,,19057,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
ISOSORBIDE DINITRATE 5 MG ORAL TABLET,,19057,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
ISOSORBIDE DINITRATE 5 MG ORAL TABLET,,19057,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.88,48,,percent of total billed charges,,100% of DHS outpatient percentage
ISOSORBIDE DINITRATE 5 MG ORAL TABLET,,19057,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.88,48,,percent of total billed charges,,100% of DHS outpatient percentage
ISOSORBIDE DINITRATE 5 MG ORAL TABLET,,19057,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
ISOSORBIDE DINITRATE 5 MG ORAL TABLET,,19057,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
ATENOLOL 50 MG ORAL TABLET,,19223,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
ATENOLOL 50 MG ORAL TABLET,,19223,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
ATENOLOL 50 MG ORAL TABLET,,19223,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
ATENOLOL 50 MG ORAL TABLET,,19223,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
ATENOLOL 50 MG ORAL TABLET,,19223,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
ATENOLOL 50 MG ORAL TABLET,,19223,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
ATENOLOL 50 MG ORAL TABLET,,19223,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
ATENOLOL 50 MG ORAL TABLET,,19223,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
ATENOLOL 50 MG ORAL TABLET,,19223,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
ATENOLOL 50 MG ORAL TABLET,,19223,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
ATENOLOL 50 MG ORAL TABLET,,19223,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
ATENOLOL 50 MG ORAL TABLET,,19223,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
ATENOLOL 50 MG ORAL TABLET,,19223,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
ATENOLOL 50 MG ORAL TABLET,,19223,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
ATENOLOL 50 MG ORAL TABLET,,19223,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
ATENOLOL 50 MG ORAL TABLET,,19223,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
ATENOLOL 50 MG ORAL TABLET,,19223,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
ATENOLOL 50 MG ORAL TABLET,,19223,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
ATENOLOL 50 MG ORAL TABLET,,19223,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
ATENOLOL 50 MG ORAL TABLET,,19223,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
ATENOLOL 50 MG ORAL TABLET,,19223,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
ATENOLOL 50 MG ORAL TABLET,,19223,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
ATENOLOL 50 MG ORAL TABLET,,19223,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
ATENOLOL 50 MG ORAL TABLET,,19223,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
ATENOLOL 50 MG ORAL TABLET,,19223,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
ATENOLOL 50 MG ORAL TABLET,,19223,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
ATENOLOL 50 MG ORAL TABLET,,19223,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
ATENOLOL 50 MG ORAL TABLET,,19223,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
ATENOLOL 50 MG ORAL TABLET,,19223,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
ATENOLOL 50 MG ORAL TABLET,,19223,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
ATENOLOL 50 MG ORAL TABLET,,19223,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
ATENOLOL 50 MG ORAL TABLET,,19223,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
ATENOLOL 50 MG ORAL TABLET,,19223,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
ATENOLOL 50 MG ORAL TABLET,,19223,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
ATENOLOL 50 MG ORAL TABLET,,19223,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
ATENOLOL 50 MG ORAL TABLET,,19223,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
ATENOLOL 50 MG ORAL TABLET,,19223,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ATENOLOL 50 MG ORAL TABLET,,19223,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ATENOLOL 50 MG ORAL TABLET,,19223,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
ATENOLOL 50 MG ORAL TABLET,,19223,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
ATENOLOL 50 MG ORAL TABLET,,19223,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
ATENOLOL 50 MG ORAL TABLET,,19223,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
ATENOLOL 50 MG ORAL TABLET,,19223,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
ATENOLOL 50 MG ORAL TABLET,,19223,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
ATENOLOL 50 MG ORAL TABLET,,19223,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
ATENOLOL 50 MG ORAL TABLET,,19223,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
ATENOLOL 50 MG ORAL TABLET,,19223,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
ATENOLOL 50 MG ORAL TABLET,,19223,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
ATENOLOL 50 MG ORAL TABLET,,19223,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
ATENOLOL 50 MG ORAL TABLET,,19223,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
ATENOLOL 50 MG ORAL TABLET,,19223,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
ATENOLOL 50 MG ORAL TABLET,,19223,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
ATENOLOL 50 MG ORAL TABLET,,19223,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
ATENOLOL 50 MG ORAL TABLET,,19223,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
ATENOLOL 50 MG ORAL TABLET,,19223,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
ATENOLOL 50 MG ORAL TABLET,,19223,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
ATENOLOL 50 MG ORAL TABLET,,19223,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
ATENOLOL 50 MG ORAL TABLET,,19223,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
ATENOLOL 50 MG ORAL TABLET,,19223,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
ATENOLOL 50 MG ORAL TABLET,,19223,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
ATENOLOL 50 MG ORAL TABLET,,19223,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
ATENOLOL 50 MG ORAL TABLET,,19223,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
ATENOLOL 50 MG ORAL TABLET,,19223,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
ATENOLOL 50 MG ORAL TABLET,,19223,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
ATENOLOL 50 MG ORAL TABLET,,19223,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
ATENOLOL 50 MG ORAL TABLET,,19223,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
ATENOLOL 50 MG ORAL TABLET,,19223,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
ATENOLOL 50 MG ORAL TABLET,,19223,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
ATENOLOL 50 MG ORAL TABLET,,19223,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
ATENOLOL 50 MG ORAL TABLET,,19223,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
ATENOLOL 50 MG ORAL TABLET,,19223,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
ATENOLOL 50 MG ORAL TABLET,,19223,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
ATENOLOL 50 MG ORAL TABLET,,19223,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
ATENOLOL 50 MG ORAL TABLET,,19223,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
ATENOLOL 50 MG ORAL TABLET,,19223,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ATENOLOL 50 MG ORAL TABLET,,19223,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ATENOLOL 50 MG ORAL TABLET,,19223,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
ATENOLOL 50 MG ORAL TABLET,,19223,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
ATENOLOL 50 MG ORAL TABLET,,19223,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
ATENOLOL 50 MG ORAL TABLET,,19223,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
ATENOLOL 50 MG ORAL TABLET,,19223,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
ATENOLOL 50 MG ORAL TABLET,,19223,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
ATENOLOL 50 MG ORAL TABLET,,19223,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
ATENOLOL 50 MG ORAL TABLET,,19223,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
ATENOLOL 50 MG ORAL TABLET,,19223,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
ATENOLOL 50 MG ORAL TABLET,,19223,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
ATENOLOL 50 MG ORAL TABLET,,19223,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ATENOLOL 50 MG ORAL TABLET,,19223,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ATENOLOL 50 MG ORAL TABLET,,19223,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
ATENOLOL 50 MG ORAL TABLET,,19223,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
ATENOLOL 50 MG ORAL TABLET,,19223,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ATENOLOL 50 MG ORAL TABLET,,19223,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ATENOLOL 50 MG ORAL TABLET,,19223,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ATENOLOL 50 MG ORAL TABLET,,19223,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ATENOLOL 50 MG ORAL TABLET,,19223,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ATENOLOL 50 MG ORAL TABLET,,19223,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ATENOLOL 50 MG ORAL TABLET,,19223,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ATENOLOL 50 MG ORAL TABLET,,19223,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ATENOLOL 50 MG ORAL TABLET,,19223,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
ATENOLOL 50 MG ORAL TABLET,,19223,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
ATENOLOL 50 MG ORAL TABLET,,19223,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
ATENOLOL 50 MG ORAL TABLET,,19223,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
ATENOLOL 50 MG ORAL TABLET,,19223,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
ATENOLOL 50 MG ORAL TABLET,,19223,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
ATENOLOL 50 MG ORAL TABLET,,19223,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
ATENOLOL 50 MG ORAL TABLET,,19223,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
ATENOLOL 50 MG ORAL TABLET,,19223,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
ATENOLOL 50 MG ORAL TABLET,,19223,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
BELLADONNA ALKALOIDS-OPIUM 16.2-60 MG RECT SUPP,,19267,LOCAL,Facility,Both,1,Each,,211,179.35,60.4726,211,Aetna,Commercial,194.12,92,,percent of total billed charges,,
BELLADONNA ALKALOIDS-OPIUM 16.2-60 MG RECT SUPP,,19267,LOCAL,Facility,Outpatient,1,Each,,211,179.35,60.4726,211,Aetna,Medicare Advantage,103.39,49,,percent of total billed charges,,
BELLADONNA ALKALOIDS-OPIUM 16.2-60 MG RECT SUPP,,19267,LOCAL,Facility,Inpatient,1,Each,,211,179.35,60.4726,211,Aetna,Medicare Advantage,,,,,Included in per diem rate,
BELLADONNA ALKALOIDS-OPIUM 16.2-60 MG RECT SUPP,,19267,LOCAL,Facility,Both,1,Each,,211,179.35,60.4726,211,Aetna,PPO,196.23,93,,percent of total billed charges,,
BELLADONNA ALKALOIDS-OPIUM 16.2-60 MG RECT SUPP,,19267,LOCAL,Facility,Both,1,Each,,211,179.35,60.4726,211,America's PPO,America's PPO,202.6233,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
BELLADONNA ALKALOIDS-OPIUM 16.2-60 MG RECT SUPP,,19267,LOCAL,Facility,Both,1,Each,,211,179.35,60.4726,211,BlueCross BlueShield Minnesota, Federal Employee Program,207.624,98.4,,percent of total billed charges,,
BELLADONNA ALKALOIDS-OPIUM 16.2-60 MG RECT SUPP,,19267,LOCAL,Facility,Both,1,Each,,211,179.35,60.4726,211,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,211,100,,percent of total billed charges,,
BELLADONNA ALKALOIDS-OPIUM 16.2-60 MG RECT SUPP,,19267,LOCAL,Facility,Both,1,Each,,211,179.35,60.4726,211,BlueCross BlueShield Minnesota,High Value Network Plan,189.9,90,,percent of total billed charges,,
BELLADONNA ALKALOIDS-OPIUM 16.2-60 MG RECT SUPP,,19267,LOCAL,Facility,Outpatient,1,Each,,211,179.35,60.4726,211,BlueCross BlueShield Minnesota,Medicare Advantage,103.39,49,,percent of total billed charges,,
BELLADONNA ALKALOIDS-OPIUM 16.2-60 MG RECT SUPP,,19267,LOCAL,Facility,Inpatient,1,Each,,211,179.35,60.4726,211,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
BELLADONNA ALKALOIDS-OPIUM 16.2-60 MG RECT SUPP,,19267,LOCAL,Facility,Both,1,Each,,211,179.35,60.4726,211,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,186.8827,88.57,,percent of total billed charges,,
BELLADONNA ALKALOIDS-OPIUM 16.2-60 MG RECT SUPP,,19267,LOCAL,Facility,Both,1,Each,,211,179.35,60.4726,211,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,60.4726,28.66,,percent of total billed charges,,
BELLADONNA ALKALOIDS-OPIUM 16.2-60 MG RECT SUPP,,19267,LOCAL,Facility,Outpatient,1,Each,,211,179.35,60.4726,211,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),103.39,49,,percent of total billed charges,,
BELLADONNA ALKALOIDS-OPIUM 16.2-60 MG RECT SUPP,,19267,LOCAL,Facility,Inpatient,1,Each,,211,179.35,60.4726,211,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
BELLADONNA ALKALOIDS-OPIUM 16.2-60 MG RECT SUPP,,19267,LOCAL,Facility,Both,1,Each,,211,179.35,60.4726,211,CorVel,Worker's Compensation,211,100,,percent of total billed charges,,
BELLADONNA ALKALOIDS-OPIUM 16.2-60 MG RECT SUPP,,19267,LOCAL,Facility,Both,1,Each,,211,179.35,60.4726,211,First Health Group Corporation,First Health Network,204.67,97,,percent of total billed charges,,
BELLADONNA ALKALOIDS-OPIUM 16.2-60 MG RECT SUPP,,19267,LOCAL,Facility,Both,1,Each,,211,179.35,60.4726,211,"Health Partners, Inc.",Commercial,199.606,94.6,,percent of total billed charges,,
BELLADONNA ALKALOIDS-OPIUM 16.2-60 MG RECT SUPP,,19267,LOCAL,Facility,Outpatient,1,Each,,211,179.35,60.4726,211,"Health Partners, Inc.",Medicare Advantage,103.39,49,,percent of total billed charges,,
BELLADONNA ALKALOIDS-OPIUM 16.2-60 MG RECT SUPP,,19267,LOCAL,Facility,Inpatient,1,Each,,211,179.35,60.4726,211,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
BELLADONNA ALKALOIDS-OPIUM 16.2-60 MG RECT SUPP,,19267,LOCAL,Facility,Both,1,Each,,211,179.35,60.4726,211,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),126.6,60,,percent of total billed charges,,
BELLADONNA ALKALOIDS-OPIUM 16.2-60 MG RECT SUPP,,19267,LOCAL,Facility,Both,1,Each,,211,179.35,60.4726,211,"Health Partners, Inc.",State of Minnesota Advantage Program,171.965,81.5,,percent of total billed charges,,
BELLADONNA ALKALOIDS-OPIUM 16.2-60 MG RECT SUPP,,19267,LOCAL,Facility,Both,1,Each,,211,179.35,60.4726,211,"Health Partners, Inc.",State Public Programs,105.5,50,,percent of total billed charges,,
BELLADONNA ALKALOIDS-OPIUM 16.2-60 MG RECT SUPP,,19267,LOCAL,Facility,Both,1,Each,,211,179.35,60.4726,211,Humana Insurance Company,Commercial PPO,200.45,95,,percent of total billed charges,,
BELLADONNA ALKALOIDS-OPIUM 16.2-60 MG RECT SUPP,,19267,LOCAL,Facility,Outpatient,1,Each,,211,179.35,60.4726,211,Humana Insurance Company,Medicare PPO,103.39,49,,percent of total billed charges,,
BELLADONNA ALKALOIDS-OPIUM 16.2-60 MG RECT SUPP,,19267,LOCAL,Facility,Inpatient,1,Each,,211,179.35,60.4726,211,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
BELLADONNA ALKALOIDS-OPIUM 16.2-60 MG RECT SUPP,,19267,LOCAL,Facility,Both,1,Each,,211,179.35,60.4726,211,Medica,Individual & Family,209.101,99.1,,percent of total billed charges,,
BELLADONNA ALKALOIDS-OPIUM 16.2-60 MG RECT SUPP,,19267,LOCAL,Facility,Outpatient,1,Each,,211,179.35,60.4726,211,Medica,Medica Advantage Solution,105.078,49.8,,percent of total billed charges,,
BELLADONNA ALKALOIDS-OPIUM 16.2-60 MG RECT SUPP,,19267,LOCAL,Facility,Inpatient,1,Each,,211,179.35,60.4726,211,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
BELLADONNA ALKALOIDS-OPIUM 16.2-60 MG RECT SUPP,,19267,LOCAL,Facility,Outpatient,1,Each,,211,179.35,60.4726,211,Medica,Medical Assistance,94.106,44.6,,percent of total billed charges,,
BELLADONNA ALKALOIDS-OPIUM 16.2-60 MG RECT SUPP,,19267,LOCAL,Facility,Inpatient,1,Each,,211,179.35,60.4726,211,Medica,Medical Assistance,,,,,Included in per diem rate,
BELLADONNA ALKALOIDS-OPIUM 16.2-60 MG RECT SUPP,,19267,LOCAL,Facility,Outpatient,1,Each,,211,179.35,60.4726,211,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,105.078,49.8,,percent of total billed charges,,
BELLADONNA ALKALOIDS-OPIUM 16.2-60 MG RECT SUPP,,19267,LOCAL,Facility,Inpatient,1,Each,,211,179.35,60.4726,211,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
BELLADONNA ALKALOIDS-OPIUM 16.2-60 MG RECT SUPP,,19267,LOCAL,Facility,Both,1,Each,,211,179.35,60.4726,211,"Multiplan, Inc.","Multiplan, Inc.",198.34,94,,percent of total billed charges,,
BELLADONNA ALKALOIDS-OPIUM 16.2-60 MG RECT SUPP,,19267,LOCAL,Facility,Outpatient,1,Each,,211,179.35,60.4726,211,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,190.111,90.1,,percent of total billed charges,,
BELLADONNA ALKALOIDS-OPIUM 16.2-60 MG RECT SUPP,,19267,LOCAL,Facility,Inpatient,1,Each,,211,179.35,60.4726,211,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
BELLADONNA ALKALOIDS-OPIUM 16.2-60 MG RECT SUPP,,19267,LOCAL,Facility,Both,1,Each,,211,179.35,60.4726,211,"Preferred One Administrative Services, INC.",PPO,208.046,98.6,,percent of total billed charges,,
BELLADONNA ALKALOIDS-OPIUM 16.2-60 MG RECT SUPP,,19267,LOCAL,Facility,Outpatient,1,Each,,211,179.35,60.4726,211,PrimeWest Health,Minnesota Senior Health Options (MSHO),108.5595,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
BELLADONNA ALKALOIDS-OPIUM 16.2-60 MG RECT SUPP,,19267,LOCAL,Facility,Inpatient,1,Each,,211,179.35,60.4726,211,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
BELLADONNA ALKALOIDS-OPIUM 16.2-60 MG RECT SUPP,,19267,LOCAL,Facility,Outpatient,1,Each,,211,179.35,60.4726,211,PrimeWest Health,MinnesotaCare,108.3696,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
BELLADONNA ALKALOIDS-OPIUM 16.2-60 MG RECT SUPP,,19267,LOCAL,Facility,Inpatient,1,Each,,211,179.35,60.4726,211,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
BELLADONNA ALKALOIDS-OPIUM 16.2-60 MG RECT SUPP,,19267,LOCAL,Facility,Both,1,Each,,211,179.35,60.4726,211,Sanford Health Plan,Sanford Health Plan,194.12,92,,percent of total billed charges,,
BELLADONNA ALKALOIDS-OPIUM 16.2-60 MG RECT SUPP,,19267,LOCAL,Facility,Outpatient,1,Each,,211,179.35,60.4726,211,"UCare Health, Inc.",Individual & Family Plan,118.8985,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
BELLADONNA ALKALOIDS-OPIUM 16.2-60 MG RECT SUPP,,19267,LOCAL,Facility,Inpatient,1,Each,,211,179.35,60.4726,211,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
BELLADONNA ALKALOIDS-OPIUM 16.2-60 MG RECT SUPP,,19267,LOCAL,Facility,Outpatient,1,Each,,211,179.35,60.4726,211,"UCare Health, Inc.",Medical Assistance,106.4917,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BELLADONNA ALKALOIDS-OPIUM 16.2-60 MG RECT SUPP,,19267,LOCAL,Facility,Inpatient,1,Each,,211,179.35,60.4726,211,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
BELLADONNA ALKALOIDS-OPIUM 16.2-60 MG RECT SUPP,,19267,LOCAL,Facility,Outpatient,1,Each,,211,179.35,60.4726,211,"UCare Health, Inc.",Medicare Advantage,106.4917,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BELLADONNA ALKALOIDS-OPIUM 16.2-60 MG RECT SUPP,,19267,LOCAL,Facility,Inpatient,1,Each,,211,179.35,60.4726,211,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
BELLADONNA ALKALOIDS-OPIUM 16.2-60 MG RECT SUPP,,19267,LOCAL,Facility,Outpatient,1,Each,,211,179.35,60.4726,211,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),106.4917,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BELLADONNA ALKALOIDS-OPIUM 16.2-60 MG RECT SUPP,,19267,LOCAL,Facility,Inpatient,1,Each,,211,179.35,60.4726,211,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
BELLADONNA ALKALOIDS-OPIUM 16.2-60 MG RECT SUPP,,19267,LOCAL,Facility,Both,1,Each,,211,179.35,60.4726,211,UnitedHealthcare,Individual & Family,198.34,94,,percent of total billed charges,,
BELLADONNA ALKALOIDS-OPIUM 16.2-60 MG RECT SUPP,,19267,LOCAL,Facility,Outpatient,1,Each,,211,179.35,60.4726,211,UnitedHealthcare,Medicare Advantage,103.39,49,,percent of total billed charges,,
BELLADONNA ALKALOIDS-OPIUM 16.2-60 MG RECT SUPP,,19267,LOCAL,Facility,Inpatient,1,Each,,211,179.35,60.4726,211,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
BELLADONNA ALKALOIDS-OPIUM 16.2-60 MG RECT SUPP,,19267,LOCAL,Facility,Outpatient,1,Each,,211,179.35,60.4726,211,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,101.28,48,,percent of total billed charges,,100% of DHS outpatient percentage
BELLADONNA ALKALOIDS-OPIUM 16.2-60 MG RECT SUPP,,19267,LOCAL,Facility,Inpatient,1,Each,,211,179.35,60.4726,211,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
CALCITRIOL 0.25 MCG ORAL CAP,,19277,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,Aetna,Commercial,6.44,92,,percent of total billed charges,,
CALCITRIOL 0.25 MCG ORAL CAP,,19277,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,Aetna,Medicare Advantage,3.43,49,,percent of total billed charges,,
CALCITRIOL 0.25 MCG ORAL CAP,,19277,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,Aetna,Medicare Advantage,,,,,Included in per diem rate,
CALCITRIOL 0.25 MCG ORAL CAP,,19277,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,Aetna,PPO,6.51,93,,percent of total billed charges,,
CALCITRIOL 0.25 MCG ORAL CAP,,19277,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,America's PPO,America's PPO,6.7221,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
CALCITRIOL 0.25 MCG ORAL CAP,,19277,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,BlueCross BlueShield Minnesota, Federal Employee Program,6.888,98.4,,percent of total billed charges,,
CALCITRIOL 0.25 MCG ORAL CAP,,19277,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,7,100,,percent of total billed charges,,
CALCITRIOL 0.25 MCG ORAL CAP,,19277,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,BlueCross BlueShield Minnesota,High Value Network Plan,6.3,90,,percent of total billed charges,,
CALCITRIOL 0.25 MCG ORAL CAP,,19277,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,BlueCross BlueShield Minnesota,Medicare Advantage,3.43,49,,percent of total billed charges,,
CALCITRIOL 0.25 MCG ORAL CAP,,19277,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
CALCITRIOL 0.25 MCG ORAL CAP,,19277,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,6.1999,88.57,,percent of total billed charges,,
CALCITRIOL 0.25 MCG ORAL CAP,,19277,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,2.0062,28.66,,percent of total billed charges,,
CALCITRIOL 0.25 MCG ORAL CAP,,19277,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),3.43,49,,percent of total billed charges,,
CALCITRIOL 0.25 MCG ORAL CAP,,19277,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
CALCITRIOL 0.25 MCG ORAL CAP,,19277,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,CorVel,Worker's Compensation,7,100,,percent of total billed charges,,
CALCITRIOL 0.25 MCG ORAL CAP,,19277,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,First Health Group Corporation,First Health Network,6.79,97,,percent of total billed charges,,
CALCITRIOL 0.25 MCG ORAL CAP,,19277,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,"Health Partners, Inc.",Commercial,6.622,94.6,,percent of total billed charges,,
CALCITRIOL 0.25 MCG ORAL CAP,,19277,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,"Health Partners, Inc.",Medicare Advantage,3.43,49,,percent of total billed charges,,
CALCITRIOL 0.25 MCG ORAL CAP,,19277,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CALCITRIOL 0.25 MCG ORAL CAP,,19277,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),4.2,60,,percent of total billed charges,,
CALCITRIOL 0.25 MCG ORAL CAP,,19277,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,"Health Partners, Inc.",State of Minnesota Advantage Program,5.705,81.5,,percent of total billed charges,,
CALCITRIOL 0.25 MCG ORAL CAP,,19277,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,"Health Partners, Inc.",State Public Programs,3.5,50,,percent of total billed charges,,
CALCITRIOL 0.25 MCG ORAL CAP,,19277,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,Humana Insurance Company,Commercial PPO,6.65,95,,percent of total billed charges,,
CALCITRIOL 0.25 MCG ORAL CAP,,19277,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,Humana Insurance Company,Medicare PPO,3.43,49,,percent of total billed charges,,
CALCITRIOL 0.25 MCG ORAL CAP,,19277,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
CALCITRIOL 0.25 MCG ORAL CAP,,19277,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,Medica,Individual & Family,6.937,99.1,,percent of total billed charges,,
CALCITRIOL 0.25 MCG ORAL CAP,,19277,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,Medica,Medica Advantage Solution,3.486,49.8,,percent of total billed charges,,
CALCITRIOL 0.25 MCG ORAL CAP,,19277,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
CALCITRIOL 0.25 MCG ORAL CAP,,19277,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,Medica,Medical Assistance,3.122,44.6,,percent of total billed charges,,
CALCITRIOL 0.25 MCG ORAL CAP,,19277,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,Medica,Medical Assistance,,,,,Included in per diem rate,
CALCITRIOL 0.25 MCG ORAL CAP,,19277,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,3.486,49.8,,percent of total billed charges,,
CALCITRIOL 0.25 MCG ORAL CAP,,19277,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
CALCITRIOL 0.25 MCG ORAL CAP,,19277,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,"Multiplan, Inc.","Multiplan, Inc.",6.58,94,,percent of total billed charges,,
CALCITRIOL 0.25 MCG ORAL CAP,,19277,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,6.307,90.1,,percent of total billed charges,,
CALCITRIOL 0.25 MCG ORAL CAP,,19277,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
CALCITRIOL 0.25 MCG ORAL CAP,,19277,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,"Preferred One Administrative Services, INC.",PPO,6.902,98.6,,percent of total billed charges,,
CALCITRIOL 0.25 MCG ORAL CAP,,19277,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,PrimeWest Health,Minnesota Senior Health Options (MSHO),3.6015,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
CALCITRIOL 0.25 MCG ORAL CAP,,19277,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CALCITRIOL 0.25 MCG ORAL CAP,,19277,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,PrimeWest Health,MinnesotaCare,3.5952,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
CALCITRIOL 0.25 MCG ORAL CAP,,19277,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
CALCITRIOL 0.25 MCG ORAL CAP,,19277,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,Sanford Health Plan,Sanford Health Plan,6.44,92,,percent of total billed charges,,
CALCITRIOL 0.25 MCG ORAL CAP,,19277,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,"UCare Health, Inc.",Individual & Family Plan,3.9445,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
CALCITRIOL 0.25 MCG ORAL CAP,,19277,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
CALCITRIOL 0.25 MCG ORAL CAP,,19277,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,"UCare Health, Inc.",Medical Assistance,3.5329,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CALCITRIOL 0.25 MCG ORAL CAP,,19277,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
CALCITRIOL 0.25 MCG ORAL CAP,,19277,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,"UCare Health, Inc.",Medicare Advantage,3.5329,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CALCITRIOL 0.25 MCG ORAL CAP,,19277,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CALCITRIOL 0.25 MCG ORAL CAP,,19277,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),3.5329,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CALCITRIOL 0.25 MCG ORAL CAP,,19277,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CALCITRIOL 0.25 MCG ORAL CAP,,19277,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,UnitedHealthcare,Individual & Family,6.58,94,,percent of total billed charges,,
CALCITRIOL 0.25 MCG ORAL CAP,,19277,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,UnitedHealthcare,Medicare Advantage,3.43,49,,percent of total billed charges,,
CALCITRIOL 0.25 MCG ORAL CAP,,19277,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
CALCITRIOL 0.25 MCG ORAL CAP,,19277,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,3.36,48,,percent of total billed charges,,100% of DHS outpatient percentage
CALCITRIOL 0.25 MCG ORAL CAP,,19277,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
LAMOTRIGINE 100 MG ORAL TABLET,,19318,LOCAL,Facility,Both,1,Each,,26,22.1,7.4516,26,Aetna,Commercial,23.92,92,,percent of total billed charges,,
LAMOTRIGINE 100 MG ORAL TABLET,,19318,LOCAL,Facility,Outpatient,1,Each,,26,22.1,7.4516,26,Aetna,Medicare Advantage,12.74,49,,percent of total billed charges,,
LAMOTRIGINE 100 MG ORAL TABLET,,19318,LOCAL,Facility,Inpatient,1,Each,,26,22.1,7.4516,26,Aetna,Medicare Advantage,,,,,Included in per diem rate,
LAMOTRIGINE 100 MG ORAL TABLET,,19318,LOCAL,Facility,Both,1,Each,,26,22.1,7.4516,26,Aetna,PPO,24.18,93,,percent of total billed charges,,
LAMOTRIGINE 100 MG ORAL TABLET,,19318,LOCAL,Facility,Both,1,Each,,26,22.1,7.4516,26,America's PPO,America's PPO,24.9678,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
LAMOTRIGINE 100 MG ORAL TABLET,,19318,LOCAL,Facility,Both,1,Each,,26,22.1,7.4516,26,BlueCross BlueShield Minnesota, Federal Employee Program,25.584,98.4,,percent of total billed charges,,
LAMOTRIGINE 100 MG ORAL TABLET,,19318,LOCAL,Facility,Both,1,Each,,26,22.1,7.4516,26,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,26,100,,percent of total billed charges,,
LAMOTRIGINE 100 MG ORAL TABLET,,19318,LOCAL,Facility,Both,1,Each,,26,22.1,7.4516,26,BlueCross BlueShield Minnesota,High Value Network Plan,23.4,90,,percent of total billed charges,,
LAMOTRIGINE 100 MG ORAL TABLET,,19318,LOCAL,Facility,Outpatient,1,Each,,26,22.1,7.4516,26,BlueCross BlueShield Minnesota,Medicare Advantage,12.74,49,,percent of total billed charges,,
LAMOTRIGINE 100 MG ORAL TABLET,,19318,LOCAL,Facility,Inpatient,1,Each,,26,22.1,7.4516,26,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
LAMOTRIGINE 100 MG ORAL TABLET,,19318,LOCAL,Facility,Both,1,Each,,26,22.1,7.4516,26,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,23.0282,88.57,,percent of total billed charges,,
LAMOTRIGINE 100 MG ORAL TABLET,,19318,LOCAL,Facility,Both,1,Each,,26,22.1,7.4516,26,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,7.4516,28.66,,percent of total billed charges,,
LAMOTRIGINE 100 MG ORAL TABLET,,19318,LOCAL,Facility,Outpatient,1,Each,,26,22.1,7.4516,26,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),12.74,49,,percent of total billed charges,,
LAMOTRIGINE 100 MG ORAL TABLET,,19318,LOCAL,Facility,Inpatient,1,Each,,26,22.1,7.4516,26,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
LAMOTRIGINE 100 MG ORAL TABLET,,19318,LOCAL,Facility,Both,1,Each,,26,22.1,7.4516,26,CorVel,Worker's Compensation,26,100,,percent of total billed charges,,
LAMOTRIGINE 100 MG ORAL TABLET,,19318,LOCAL,Facility,Both,1,Each,,26,22.1,7.4516,26,First Health Group Corporation,First Health Network,25.22,97,,percent of total billed charges,,
LAMOTRIGINE 100 MG ORAL TABLET,,19318,LOCAL,Facility,Both,1,Each,,26,22.1,7.4516,26,"Health Partners, Inc.",Commercial,24.596,94.6,,percent of total billed charges,,
LAMOTRIGINE 100 MG ORAL TABLET,,19318,LOCAL,Facility,Outpatient,1,Each,,26,22.1,7.4516,26,"Health Partners, Inc.",Medicare Advantage,12.74,49,,percent of total billed charges,,
LAMOTRIGINE 100 MG ORAL TABLET,,19318,LOCAL,Facility,Inpatient,1,Each,,26,22.1,7.4516,26,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LAMOTRIGINE 100 MG ORAL TABLET,,19318,LOCAL,Facility,Both,1,Each,,26,22.1,7.4516,26,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),15.6,60,,percent of total billed charges,,
LAMOTRIGINE 100 MG ORAL TABLET,,19318,LOCAL,Facility,Both,1,Each,,26,22.1,7.4516,26,"Health Partners, Inc.",State of Minnesota Advantage Program,21.19,81.5,,percent of total billed charges,,
LAMOTRIGINE 100 MG ORAL TABLET,,19318,LOCAL,Facility,Both,1,Each,,26,22.1,7.4516,26,"Health Partners, Inc.",State Public Programs,13,50,,percent of total billed charges,,
LAMOTRIGINE 100 MG ORAL TABLET,,19318,LOCAL,Facility,Both,1,Each,,26,22.1,7.4516,26,Humana Insurance Company,Commercial PPO,24.7,95,,percent of total billed charges,,
LAMOTRIGINE 100 MG ORAL TABLET,,19318,LOCAL,Facility,Outpatient,1,Each,,26,22.1,7.4516,26,Humana Insurance Company,Medicare PPO,12.74,49,,percent of total billed charges,,
LAMOTRIGINE 100 MG ORAL TABLET,,19318,LOCAL,Facility,Inpatient,1,Each,,26,22.1,7.4516,26,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
LAMOTRIGINE 100 MG ORAL TABLET,,19318,LOCAL,Facility,Both,1,Each,,26,22.1,7.4516,26,Medica,Individual & Family,25.766,99.1,,percent of total billed charges,,
LAMOTRIGINE 100 MG ORAL TABLET,,19318,LOCAL,Facility,Outpatient,1,Each,,26,22.1,7.4516,26,Medica,Medica Advantage Solution,12.948,49.8,,percent of total billed charges,,
LAMOTRIGINE 100 MG ORAL TABLET,,19318,LOCAL,Facility,Inpatient,1,Each,,26,22.1,7.4516,26,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
LAMOTRIGINE 100 MG ORAL TABLET,,19318,LOCAL,Facility,Outpatient,1,Each,,26,22.1,7.4516,26,Medica,Medical Assistance,11.596,44.6,,percent of total billed charges,,
LAMOTRIGINE 100 MG ORAL TABLET,,19318,LOCAL,Facility,Inpatient,1,Each,,26,22.1,7.4516,26,Medica,Medical Assistance,,,,,Included in per diem rate,
LAMOTRIGINE 100 MG ORAL TABLET,,19318,LOCAL,Facility,Outpatient,1,Each,,26,22.1,7.4516,26,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,12.948,49.8,,percent of total billed charges,,
LAMOTRIGINE 100 MG ORAL TABLET,,19318,LOCAL,Facility,Inpatient,1,Each,,26,22.1,7.4516,26,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
LAMOTRIGINE 100 MG ORAL TABLET,,19318,LOCAL,Facility,Both,1,Each,,26,22.1,7.4516,26,"Multiplan, Inc.","Multiplan, Inc.",24.44,94,,percent of total billed charges,,
LAMOTRIGINE 100 MG ORAL TABLET,,19318,LOCAL,Facility,Outpatient,1,Each,,26,22.1,7.4516,26,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,23.426,90.1,,percent of total billed charges,,
LAMOTRIGINE 100 MG ORAL TABLET,,19318,LOCAL,Facility,Inpatient,1,Each,,26,22.1,7.4516,26,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
LAMOTRIGINE 100 MG ORAL TABLET,,19318,LOCAL,Facility,Both,1,Each,,26,22.1,7.4516,26,"Preferred One Administrative Services, INC.",PPO,25.636,98.6,,percent of total billed charges,,
LAMOTRIGINE 100 MG ORAL TABLET,,19318,LOCAL,Facility,Outpatient,1,Each,,26,22.1,7.4516,26,PrimeWest Health,Minnesota Senior Health Options (MSHO),13.377,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
LAMOTRIGINE 100 MG ORAL TABLET,,19318,LOCAL,Facility,Inpatient,1,Each,,26,22.1,7.4516,26,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LAMOTRIGINE 100 MG ORAL TABLET,,19318,LOCAL,Facility,Outpatient,1,Each,,26,22.1,7.4516,26,PrimeWest Health,MinnesotaCare,13.3536,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
LAMOTRIGINE 100 MG ORAL TABLET,,19318,LOCAL,Facility,Inpatient,1,Each,,26,22.1,7.4516,26,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
LAMOTRIGINE 100 MG ORAL TABLET,,19318,LOCAL,Facility,Both,1,Each,,26,22.1,7.4516,26,Sanford Health Plan,Sanford Health Plan,23.92,92,,percent of total billed charges,,
LAMOTRIGINE 100 MG ORAL TABLET,,19318,LOCAL,Facility,Outpatient,1,Each,,26,22.1,7.4516,26,"UCare Health, Inc.",Individual & Family Plan,14.651,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
LAMOTRIGINE 100 MG ORAL TABLET,,19318,LOCAL,Facility,Inpatient,1,Each,,26,22.1,7.4516,26,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
LAMOTRIGINE 100 MG ORAL TABLET,,19318,LOCAL,Facility,Outpatient,1,Each,,26,22.1,7.4516,26,"UCare Health, Inc.",Medical Assistance,13.1222,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LAMOTRIGINE 100 MG ORAL TABLET,,19318,LOCAL,Facility,Inpatient,1,Each,,26,22.1,7.4516,26,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
LAMOTRIGINE 100 MG ORAL TABLET,,19318,LOCAL,Facility,Outpatient,1,Each,,26,22.1,7.4516,26,"UCare Health, Inc.",Medicare Advantage,13.1222,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LAMOTRIGINE 100 MG ORAL TABLET,,19318,LOCAL,Facility,Inpatient,1,Each,,26,22.1,7.4516,26,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LAMOTRIGINE 100 MG ORAL TABLET,,19318,LOCAL,Facility,Outpatient,1,Each,,26,22.1,7.4516,26,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),13.1222,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LAMOTRIGINE 100 MG ORAL TABLET,,19318,LOCAL,Facility,Inpatient,1,Each,,26,22.1,7.4516,26,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LAMOTRIGINE 100 MG ORAL TABLET,,19318,LOCAL,Facility,Both,1,Each,,26,22.1,7.4516,26,UnitedHealthcare,Individual & Family,24.44,94,,percent of total billed charges,,
LAMOTRIGINE 100 MG ORAL TABLET,,19318,LOCAL,Facility,Outpatient,1,Each,,26,22.1,7.4516,26,UnitedHealthcare,Medicare Advantage,12.74,49,,percent of total billed charges,,
LAMOTRIGINE 100 MG ORAL TABLET,,19318,LOCAL,Facility,Inpatient,1,Each,,26,22.1,7.4516,26,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
LAMOTRIGINE 100 MG ORAL TABLET,,19318,LOCAL,Facility,Outpatient,1,Each,,26,22.1,7.4516,26,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,12.48,48,,percent of total billed charges,,100% of DHS outpatient percentage
LAMOTRIGINE 100 MG ORAL TABLET,,19318,LOCAL,Facility,Inpatient,1,Each,,26,22.1,7.4516,26,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
FINASTERIDE 5 MG ORAL TABLET,,19375,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
FINASTERIDE 5 MG ORAL TABLET,,19375,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
FINASTERIDE 5 MG ORAL TABLET,,19375,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
FINASTERIDE 5 MG ORAL TABLET,,19375,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
FINASTERIDE 5 MG ORAL TABLET,,19375,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
FINASTERIDE 5 MG ORAL TABLET,,19375,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
FINASTERIDE 5 MG ORAL TABLET,,19375,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
FINASTERIDE 5 MG ORAL TABLET,,19375,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
FINASTERIDE 5 MG ORAL TABLET,,19375,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
FINASTERIDE 5 MG ORAL TABLET,,19375,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
FINASTERIDE 5 MG ORAL TABLET,,19375,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
FINASTERIDE 5 MG ORAL TABLET,,19375,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
FINASTERIDE 5 MG ORAL TABLET,,19375,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
FINASTERIDE 5 MG ORAL TABLET,,19375,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
FINASTERIDE 5 MG ORAL TABLET,,19375,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
FINASTERIDE 5 MG ORAL TABLET,,19375,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
FINASTERIDE 5 MG ORAL TABLET,,19375,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
FINASTERIDE 5 MG ORAL TABLET,,19375,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
FINASTERIDE 5 MG ORAL TABLET,,19375,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
FINASTERIDE 5 MG ORAL TABLET,,19375,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
FINASTERIDE 5 MG ORAL TABLET,,19375,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
FINASTERIDE 5 MG ORAL TABLET,,19375,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
FINASTERIDE 5 MG ORAL TABLET,,19375,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
FINASTERIDE 5 MG ORAL TABLET,,19375,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
FINASTERIDE 5 MG ORAL TABLET,,19375,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
FINASTERIDE 5 MG ORAL TABLET,,19375,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
FINASTERIDE 5 MG ORAL TABLET,,19375,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
FINASTERIDE 5 MG ORAL TABLET,,19375,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
FINASTERIDE 5 MG ORAL TABLET,,19375,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
FINASTERIDE 5 MG ORAL TABLET,,19375,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
FINASTERIDE 5 MG ORAL TABLET,,19375,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
FINASTERIDE 5 MG ORAL TABLET,,19375,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
FINASTERIDE 5 MG ORAL TABLET,,19375,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
FINASTERIDE 5 MG ORAL TABLET,,19375,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
FINASTERIDE 5 MG ORAL TABLET,,19375,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
FINASTERIDE 5 MG ORAL TABLET,,19375,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
FINASTERIDE 5 MG ORAL TABLET,,19375,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
FINASTERIDE 5 MG ORAL TABLET,,19375,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
FINASTERIDE 5 MG ORAL TABLET,,19375,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
FINASTERIDE 5 MG ORAL TABLET,,19375,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
FINASTERIDE 5 MG ORAL TABLET,,19375,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
FINASTERIDE 5 MG ORAL TABLET,,19375,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
FINASTERIDE 5 MG ORAL TABLET,,19375,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
FINASTERIDE 5 MG ORAL TABLET,,19375,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FINASTERIDE 5 MG ORAL TABLET,,19375,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
FINASTERIDE 5 MG ORAL TABLET,,19375,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FINASTERIDE 5 MG ORAL TABLET,,19375,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
FINASTERIDE 5 MG ORAL TABLET,,19375,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FINASTERIDE 5 MG ORAL TABLET,,19375,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
FINASTERIDE 5 MG ORAL TABLET,,19375,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
FINASTERIDE 5 MG ORAL TABLET,,19375,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
FINASTERIDE 5 MG ORAL TABLET,,19375,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
FINASTERIDE 5 MG ORAL TABLET,,19375,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
FINASTERIDE 5 MG ORAL TABLET,,19375,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
LORATADINE 10 MG ORAL TABLET,,19583,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
LORATADINE 10 MG ORAL TABLET,,19583,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
LORATADINE 10 MG ORAL TABLET,,19583,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
LORATADINE 10 MG ORAL TABLET,,19583,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
LORATADINE 10 MG ORAL TABLET,,19583,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
LORATADINE 10 MG ORAL TABLET,,19583,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
LORATADINE 10 MG ORAL TABLET,,19583,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
LORATADINE 10 MG ORAL TABLET,,19583,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
LORATADINE 10 MG ORAL TABLET,,19583,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
LORATADINE 10 MG ORAL TABLET,,19583,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
LORATADINE 10 MG ORAL TABLET,,19583,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
LORATADINE 10 MG ORAL TABLET,,19583,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
LORATADINE 10 MG ORAL TABLET,,19583,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
LORATADINE 10 MG ORAL TABLET,,19583,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
LORATADINE 10 MG ORAL TABLET,,19583,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
LORATADINE 10 MG ORAL TABLET,,19583,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
LORATADINE 10 MG ORAL TABLET,,19583,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
LORATADINE 10 MG ORAL TABLET,,19583,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
LORATADINE 10 MG ORAL TABLET,,19583,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LORATADINE 10 MG ORAL TABLET,,19583,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
LORATADINE 10 MG ORAL TABLET,,19583,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
LORATADINE 10 MG ORAL TABLET,,19583,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
LORATADINE 10 MG ORAL TABLET,,19583,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
LORATADINE 10 MG ORAL TABLET,,19583,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
LORATADINE 10 MG ORAL TABLET,,19583,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
LORATADINE 10 MG ORAL TABLET,,19583,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
LORATADINE 10 MG ORAL TABLET,,19583,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
LORATADINE 10 MG ORAL TABLET,,19583,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
LORATADINE 10 MG ORAL TABLET,,19583,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
LORATADINE 10 MG ORAL TABLET,,19583,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
LORATADINE 10 MG ORAL TABLET,,19583,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
LORATADINE 10 MG ORAL TABLET,,19583,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
LORATADINE 10 MG ORAL TABLET,,19583,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
LORATADINE 10 MG ORAL TABLET,,19583,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
LORATADINE 10 MG ORAL TABLET,,19583,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
LORATADINE 10 MG ORAL TABLET,,19583,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
LORATADINE 10 MG ORAL TABLET,,19583,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
LORATADINE 10 MG ORAL TABLET,,19583,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LORATADINE 10 MG ORAL TABLET,,19583,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
LORATADINE 10 MG ORAL TABLET,,19583,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
LORATADINE 10 MG ORAL TABLET,,19583,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
LORATADINE 10 MG ORAL TABLET,,19583,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
LORATADINE 10 MG ORAL TABLET,,19583,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
LORATADINE 10 MG ORAL TABLET,,19583,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LORATADINE 10 MG ORAL TABLET,,19583,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
LORATADINE 10 MG ORAL TABLET,,19583,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LORATADINE 10 MG ORAL TABLET,,19583,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LORATADINE 10 MG ORAL TABLET,,19583,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LORATADINE 10 MG ORAL TABLET,,19583,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LORATADINE 10 MG ORAL TABLET,,19583,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
LORATADINE 10 MG ORAL TABLET,,19583,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
LORATADINE 10 MG ORAL TABLET,,19583,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
LORATADINE 10 MG ORAL TABLET,,19583,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
LORATADINE 10 MG ORAL TABLET,,19583,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
GLIPIZIDE 5 MG ORAL TABLET,,19615,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
GLIPIZIDE 5 MG ORAL TABLET,,19615,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
GLIPIZIDE 5 MG ORAL TABLET,,19615,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
GLIPIZIDE 5 MG ORAL TABLET,,19615,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
GLIPIZIDE 5 MG ORAL TABLET,,19615,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
GLIPIZIDE 5 MG ORAL TABLET,,19615,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
GLIPIZIDE 5 MG ORAL TABLET,,19615,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
GLIPIZIDE 5 MG ORAL TABLET,,19615,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
GLIPIZIDE 5 MG ORAL TABLET,,19615,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
GLIPIZIDE 5 MG ORAL TABLET,,19615,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
GLIPIZIDE 5 MG ORAL TABLET,,19615,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
GLIPIZIDE 5 MG ORAL TABLET,,19615,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
GLIPIZIDE 5 MG ORAL TABLET,,19615,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
GLIPIZIDE 5 MG ORAL TABLET,,19615,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
GLIPIZIDE 5 MG ORAL TABLET,,19615,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
GLIPIZIDE 5 MG ORAL TABLET,,19615,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
GLIPIZIDE 5 MG ORAL TABLET,,19615,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
GLIPIZIDE 5 MG ORAL TABLET,,19615,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
GLIPIZIDE 5 MG ORAL TABLET,,19615,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
GLIPIZIDE 5 MG ORAL TABLET,,19615,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
GLIPIZIDE 5 MG ORAL TABLET,,19615,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
GLIPIZIDE 5 MG ORAL TABLET,,19615,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
GLIPIZIDE 5 MG ORAL TABLET,,19615,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
GLIPIZIDE 5 MG ORAL TABLET,,19615,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
GLIPIZIDE 5 MG ORAL TABLET,,19615,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
GLIPIZIDE 5 MG ORAL TABLET,,19615,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
GLIPIZIDE 5 MG ORAL TABLET,,19615,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
GLIPIZIDE 5 MG ORAL TABLET,,19615,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
GLIPIZIDE 5 MG ORAL TABLET,,19615,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
GLIPIZIDE 5 MG ORAL TABLET,,19615,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
GLIPIZIDE 5 MG ORAL TABLET,,19615,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
GLIPIZIDE 5 MG ORAL TABLET,,19615,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
GLIPIZIDE 5 MG ORAL TABLET,,19615,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
GLIPIZIDE 5 MG ORAL TABLET,,19615,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
GLIPIZIDE 5 MG ORAL TABLET,,19615,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
GLIPIZIDE 5 MG ORAL TABLET,,19615,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
GLIPIZIDE 5 MG ORAL TABLET,,19615,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
GLIPIZIDE 5 MG ORAL TABLET,,19615,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
GLIPIZIDE 5 MG ORAL TABLET,,19615,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
GLIPIZIDE 5 MG ORAL TABLET,,19615,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
GLIPIZIDE 5 MG ORAL TABLET,,19615,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
GLIPIZIDE 5 MG ORAL TABLET,,19615,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
GLIPIZIDE 5 MG ORAL TABLET,,19615,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
GLIPIZIDE 5 MG ORAL TABLET,,19615,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
GLIPIZIDE 5 MG ORAL TABLET,,19615,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
GLIPIZIDE 5 MG ORAL TABLET,,19615,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
GLIPIZIDE 5 MG ORAL TABLET,,19615,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
GLIPIZIDE 5 MG ORAL TABLET,,19615,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
GLIPIZIDE 5 MG ORAL TABLET,,19615,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
GLIPIZIDE 5 MG ORAL TABLET,,19615,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
GLIPIZIDE 5 MG ORAL TABLET,,19615,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
GLIPIZIDE 5 MG ORAL TABLET,,19615,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
GLIPIZIDE 5 MG ORAL TABLET,,19615,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
GLIPIZIDE 5 MG ORAL TABLET,,19615,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
RISPERIDONE 0.5 MG ORAL TABLET,,19630,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
RISPERIDONE 0.5 MG ORAL TABLET,,19630,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
RISPERIDONE 0.5 MG ORAL TABLET,,19630,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
RISPERIDONE 0.5 MG ORAL TABLET,,19630,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
RISPERIDONE 0.5 MG ORAL TABLET,,19630,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
RISPERIDONE 0.5 MG ORAL TABLET,,19630,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
RISPERIDONE 0.5 MG ORAL TABLET,,19630,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
RISPERIDONE 0.5 MG ORAL TABLET,,19630,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
RISPERIDONE 0.5 MG ORAL TABLET,,19630,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
RISPERIDONE 0.5 MG ORAL TABLET,,19630,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
RISPERIDONE 0.5 MG ORAL TABLET,,19630,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
RISPERIDONE 0.5 MG ORAL TABLET,,19630,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
RISPERIDONE 0.5 MG ORAL TABLET,,19630,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
RISPERIDONE 0.5 MG ORAL TABLET,,19630,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
RISPERIDONE 0.5 MG ORAL TABLET,,19630,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
RISPERIDONE 0.5 MG ORAL TABLET,,19630,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
RISPERIDONE 0.5 MG ORAL TABLET,,19630,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
RISPERIDONE 0.5 MG ORAL TABLET,,19630,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
RISPERIDONE 0.5 MG ORAL TABLET,,19630,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
RISPERIDONE 0.5 MG ORAL TABLET,,19630,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
RISPERIDONE 0.5 MG ORAL TABLET,,19630,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
RISPERIDONE 0.5 MG ORAL TABLET,,19630,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
RISPERIDONE 0.5 MG ORAL TABLET,,19630,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
RISPERIDONE 0.5 MG ORAL TABLET,,19630,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
RISPERIDONE 0.5 MG ORAL TABLET,,19630,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
RISPERIDONE 0.5 MG ORAL TABLET,,19630,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
RISPERIDONE 0.5 MG ORAL TABLET,,19630,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
RISPERIDONE 0.5 MG ORAL TABLET,,19630,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
RISPERIDONE 0.5 MG ORAL TABLET,,19630,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
RISPERIDONE 0.5 MG ORAL TABLET,,19630,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
RISPERIDONE 0.5 MG ORAL TABLET,,19630,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
RISPERIDONE 0.5 MG ORAL TABLET,,19630,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
RISPERIDONE 0.5 MG ORAL TABLET,,19630,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
RISPERIDONE 0.5 MG ORAL TABLET,,19630,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
RISPERIDONE 0.5 MG ORAL TABLET,,19630,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
RISPERIDONE 0.5 MG ORAL TABLET,,19630,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
RISPERIDONE 0.5 MG ORAL TABLET,,19630,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
RISPERIDONE 0.5 MG ORAL TABLET,,19630,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
RISPERIDONE 0.5 MG ORAL TABLET,,19630,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
RISPERIDONE 0.5 MG ORAL TABLET,,19630,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
RISPERIDONE 0.5 MG ORAL TABLET,,19630,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
RISPERIDONE 0.5 MG ORAL TABLET,,19630,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
RISPERIDONE 0.5 MG ORAL TABLET,,19630,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
RISPERIDONE 0.5 MG ORAL TABLET,,19630,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
RISPERIDONE 0.5 MG ORAL TABLET,,19630,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
RISPERIDONE 0.5 MG ORAL TABLET,,19630,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
RISPERIDONE 0.5 MG ORAL TABLET,,19630,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
RISPERIDONE 0.5 MG ORAL TABLET,,19630,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
RISPERIDONE 0.5 MG ORAL TABLET,,19630,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
RISPERIDONE 0.5 MG ORAL TABLET,,19630,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
RISPERIDONE 0.5 MG ORAL TABLET,,19630,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
RISPERIDONE 0.5 MG ORAL TABLET,,19630,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
RISPERIDONE 0.5 MG ORAL TABLET,,19630,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
RISPERIDONE 0.5 MG ORAL TABLET,,19630,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Repair Complex Wound,Face/Hand/Foot; 2.6 To 7.5 Cm (Pbb)",,13132,CPT,Facility,Outpatient,,,,1163,988.55,333.3158,1163,Aetna,Commercial,1069.96,92,,percent of total billed charges,,
"Repair Complex Wound,Face/Hand/Foot; 2.6 To 7.5 Cm (Pbb)",,13132,CPT,Professional,Outpatient,,,,1739,1478.15,188.92,1739,Aetna,Commercial,1478.15,85,,percent of total billed charges,,
"Repair Complex Wound,Face/Hand/Foot; 2.6 To 7.5 Cm (Pbb)",,13132,CPT,Facility,Outpatient,,,,1163,988.55,333.3158,1163,Aetna,Medicare Advantage,569.87,49,,percent of total billed charges,,
"Repair Complex Wound,Face/Hand/Foot; 2.6 To 7.5 Cm (Pbb)",,13132,CPT,Professional,Outpatient,,,,1739,1478.15,188.92,1739,Aetna,Medicare Advantage,297.24,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair Complex Wound,Face/Hand/Foot; 2.6 To 7.5 Cm (Pbb)",,13132,CPT,Facility,Outpatient,,,,1163,988.55,333.3158,1163,Aetna,PPO,1081.59,93,,percent of total billed charges,,
"Repair Complex Wound,Face/Hand/Foot; 2.6 To 7.5 Cm (Pbb)",,13132,CPT,Professional,Outpatient,,,,1739,1478.15,188.92,1739,Aetna,PPO,1617.27,93,,percent of total billed charges,,
"Repair Complex Wound,Face/Hand/Foot; 2.6 To 7.5 Cm (Pbb)",,13132,CPT,Facility,Outpatient,,,,1163,988.55,333.3158,1163,America's PPO,America's PPO,1116.8289,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Repair Complex Wound,Face/Hand/Foot; 2.6 To 7.5 Cm (Pbb)",,13132,CPT,Professional,Outpatient,,,,1739,1478.15,188.92,1739,America's PPO,America's PPO,1485.8016,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Repair Complex Wound,Face/Hand/Foot; 2.6 To 7.5 Cm (Pbb)",,13132,CPT,Facility,Outpatient,,,,1163,988.55,333.3158,1163,BlueCross BlueShield Minnesota, Federal Employee Program,1144.392,98.4,,percent of total billed charges,,
"Repair Complex Wound,Face/Hand/Foot; 2.6 To 7.5 Cm (Pbb)",,13132,CPT,Professional,Outpatient,,,,1739,1478.15,188.92,1739,BlueCross BlueShield Minnesota, Federal Employee Program,617.67,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Repair Complex Wound,Face/Hand/Foot; 2.6 To 7.5 Cm (Pbb)",,13132,CPT,Facility,Outpatient,,,,1163,988.55,333.3158,1163,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1163,100,,percent of total billed charges,,
"Repair Complex Wound,Face/Hand/Foot; 2.6 To 7.5 Cm (Pbb)",,13132,CPT,Professional,Outpatient,,,,1739,1478.15,188.92,1739,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,627.55272,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Repair Complex Wound,Face/Hand/Foot; 2.6 To 7.5 Cm (Pbb)",,13132,CPT,Facility,Outpatient,,,,1163,988.55,333.3158,1163,BlueCross BlueShield Minnesota,High Value Network Plan,1046.7,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
"Repair Complex Wound,Face/Hand/Foot; 2.6 To 7.5 Cm (Pbb)",,13132,CPT,Professional,Outpatient,,,,1739,1478.15,188.92,1739,BlueCross BlueShield Minnesota,High Value Network Plan,627.55272,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Repair Complex Wound,Face/Hand/Foot; 2.6 To 7.5 Cm (Pbb)",,13132,CPT,Facility,Outpatient,,,,1163,988.55,333.3158,1163,BlueCross BlueShield Minnesota,Medicare Advantage,569.87,49,,percent of total billed charges,,
"Repair Complex Wound,Face/Hand/Foot; 2.6 To 7.5 Cm (Pbb)",,13132,CPT,Professional,Outpatient,,,,1739,1478.15,188.92,1739,BlueCross BlueShield Minnesota,Medicare Advantage,337.8125,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair Complex Wound,Face/Hand/Foot; 2.6 To 7.5 Cm (Pbb)",,13132,CPT,Professional,Outpatient,,,,1739,1478.15,188.92,1739,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,627.55272,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Repair Complex Wound,Face/Hand/Foot; 2.6 To 7.5 Cm (Pbb)",,13132,CPT,Facility,Outpatient,,,,1163,988.55,333.3158,1163,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,333.3158,28.66,,percent of total billed charges,,
"Repair Complex Wound,Face/Hand/Foot; 2.6 To 7.5 Cm (Pbb)",,13132,CPT,Professional,Outpatient,,,,1739,1478.15,188.92,1739,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,218.11488,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Repair Complex Wound,Face/Hand/Foot; 2.6 To 7.5 Cm (Pbb)",,13132,CPT,Facility,Outpatient,,,,1163,988.55,333.3158,1163,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),569.87,49,,percent of total billed charges,,
"Repair Complex Wound,Face/Hand/Foot; 2.6 To 7.5 Cm (Pbb)",,13132,CPT,Professional,Outpatient,,,,1739,1478.15,188.92,1739,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),337.8125,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair Complex Wound,Face/Hand/Foot; 2.6 To 7.5 Cm (Pbb)",,13132,CPT,Facility,Outpatient,,,,1163,988.55,333.3158,1163,CorVel,Worker's Compensation,1163,100,,percent of total billed charges,,
"Repair Complex Wound,Face/Hand/Foot; 2.6 To 7.5 Cm (Pbb)",,13132,CPT,Professional,Outpatient,,,,1739,1478.15,188.92,1739,CorVel,Worker's Compensation,573.5948565,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Repair Complex Wound,Face/Hand/Foot; 2.6 To 7.5 Cm (Pbb)",,13132,CPT,Facility,Outpatient,,,,1163,988.55,333.3158,1163,First Health Group Corporation,First Health Network,1128.11,97,,percent of total billed charges,,
"Repair Complex Wound,Face/Hand/Foot; 2.6 To 7.5 Cm (Pbb)",,13132,CPT,Professional,Outpatient,,,,1739,1478.15,188.92,1739,First Health Group Corporation,First Health Network,1686.83,97,,percent of total billed charges,,
"Repair Complex Wound,Face/Hand/Foot; 2.6 To 7.5 Cm (Pbb)",,13132,CPT,Facility,Outpatient,,,,1163,988.55,333.3158,1163,"Health Partners, Inc.",Commercial,1100.198,94.6,,percent of total billed charges,,
"Repair Complex Wound,Face/Hand/Foot; 2.6 To 7.5 Cm (Pbb)",,13132,CPT,Professional,Outpatient,,,,1739,1478.15,188.92,1739,"Health Partners, Inc.",Commercial,619.6,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Repair Complex Wound,Face/Hand/Foot; 2.6 To 7.5 Cm (Pbb)",,13132,CPT,Facility,Outpatient,,,,1163,988.55,333.3158,1163,"Health Partners, Inc.",Medicare Advantage,569.87,49,,percent of total billed charges,,
"Repair Complex Wound,Face/Hand/Foot; 2.6 To 7.5 Cm (Pbb)",,13132,CPT,Professional,Outpatient,,,,1739,1478.15,188.92,1739,"Health Partners, Inc.",Medicare Advantage,337.8125,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair Complex Wound,Face/Hand/Foot; 2.6 To 7.5 Cm (Pbb)",,13132,CPT,Facility,Outpatient,,,,1163,988.55,333.3158,1163,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),697.8,60,,percent of total billed charges,,
"Repair Complex Wound,Face/Hand/Foot; 2.6 To 7.5 Cm (Pbb)",,13132,CPT,Professional,Outpatient,,,,1739,1478.15,188.92,1739,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),293.8,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Repair Complex Wound,Face/Hand/Foot; 2.6 To 7.5 Cm (Pbb)",,13132,CPT,Facility,Outpatient,,,,1163,988.55,333.3158,1163,"Health Partners, Inc.",State of Minnesota Advantage Program,947.845,81.5,,percent of total billed charges,,
"Repair Complex Wound,Face/Hand/Foot; 2.6 To 7.5 Cm (Pbb)",,13132,CPT,Professional,Outpatient,,,,1739,1478.15,188.92,1739,"Health Partners, Inc.",State of Minnesota Advantage Program,533.7854,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Repair Complex Wound,Face/Hand/Foot; 2.6 To 7.5 Cm (Pbb)",,13132,CPT,Facility,Outpatient,,,,1163,988.55,333.3158,1163,"Health Partners, Inc.",State Public Programs,581.5,50,,percent of total billed charges,,
"Repair Complex Wound,Face/Hand/Foot; 2.6 To 7.5 Cm (Pbb)",,13132,CPT,Professional,Outpatient,,,,1739,1478.15,188.92,1739,"Health Partners, Inc.",State Public Programs,188.92,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Repair Complex Wound,Face/Hand/Foot; 2.6 To 7.5 Cm (Pbb)",,13132,CPT,Facility,Outpatient,,,,1163,988.55,333.3158,1163,Humana Insurance Company,Commercial PPO,1104.85,95,,percent of total billed charges,,
"Repair Complex Wound,Face/Hand/Foot; 2.6 To 7.5 Cm (Pbb)",,13132,CPT,Professional,Outpatient,,,,1739,1478.15,188.92,1739,Humana Insurance Company,Commercial PPO,293.75,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Repair Complex Wound,Face/Hand/Foot; 2.6 To 7.5 Cm (Pbb)",,13132,CPT,Facility,Outpatient,,,,1163,988.55,333.3158,1163,Humana Insurance Company,Medicare PPO,569.87,49,,percent of total billed charges,,
"Repair Complex Wound,Face/Hand/Foot; 2.6 To 7.5 Cm (Pbb)",,13132,CPT,Professional,Outpatient,,,,1739,1478.15,188.92,1739,Humana Insurance Company,Medicare PPO,1739,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Repair Complex Wound,Face/Hand/Foot; 2.6 To 7.5 Cm (Pbb)",,13132,CPT,Facility,Outpatient,,,,1163,988.55,333.3158,1163,Medica,Individual & Family,1152.533,99.1,,percent of total billed charges,,
"Repair Complex Wound,Face/Hand/Foot; 2.6 To 7.5 Cm (Pbb)",,13132,CPT,Professional,Outpatient,,,,1739,1478.15,188.92,1739,Medica,Individual & Family,1474.672,84.8,,percent of total billed charges,,
"Repair Complex Wound,Face/Hand/Foot; 2.6 To 7.5 Cm (Pbb)",,13132,CPT,Facility,Outpatient,,,,1163,988.55,333.3158,1163,Medica,Medica Advantage Solution,579.174,49.8,,percent of total billed charges,,
"Repair Complex Wound,Face/Hand/Foot; 2.6 To 7.5 Cm (Pbb)",,13132,CPT,Professional,Outpatient,,,,1739,1478.15,188.92,1739,Medica,Medica Advantage Solution,866.022,49.8,,percent of total billed charges,,
"Repair Complex Wound,Face/Hand/Foot; 2.6 To 7.5 Cm (Pbb)",,13132,CPT,Facility,Outpatient,,,,1163,988.55,333.3158,1163,Medica,Medical Assistance,518.698,44.6,,percent of total billed charges,,
"Repair Complex Wound,Face/Hand/Foot; 2.6 To 7.5 Cm (Pbb)",,13132,CPT,Professional,Outpatient,,,,1739,1478.15,188.92,1739,Medica,Medical Assistance,218.11,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Repair Complex Wound,Face/Hand/Foot; 2.6 To 7.5 Cm (Pbb)",,13132,CPT,Facility,Outpatient,,,,1163,988.55,333.3158,1163,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,579.174,49.8,,percent of total billed charges,,
"Repair Complex Wound,Face/Hand/Foot; 2.6 To 7.5 Cm (Pbb)",,13132,CPT,Professional,Outpatient,,,,1739,1478.15,188.92,1739,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,293.75,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Repair Complex Wound,Face/Hand/Foot; 2.6 To 7.5 Cm (Pbb)",,13132,CPT,Facility,Outpatient,,,,1163,988.55,333.3158,1163,"Multiplan, Inc.","Multiplan, Inc.",1093.22,94,,percent of total billed charges,,
"Repair Complex Wound,Face/Hand/Foot; 2.6 To 7.5 Cm (Pbb)",,13132,CPT,Professional,Outpatient,,,,1739,1478.15,188.92,1739,"Multiplan, Inc.","Multiplan, Inc.",1634.66,94,,percent of total billed charges,,
"Repair Complex Wound,Face/Hand/Foot; 2.6 To 7.5 Cm (Pbb)",,13132,CPT,Facility,Outpatient,,,,1163,988.55,333.3158,1163,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1047.863,90.1,,percent of total billed charges,,
"Repair Complex Wound,Face/Hand/Foot; 2.6 To 7.5 Cm (Pbb)",,13132,CPT,Professional,Outpatient,,,,1739,1478.15,188.92,1739,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1566.839,90.1,,percent of total billed charges,,
"Repair Complex Wound,Face/Hand/Foot; 2.6 To 7.5 Cm (Pbb)",,13132,CPT,Facility,Outpatient,,,,1163,988.55,333.3158,1163,"Preferred One Administrative Services, INC.",PPO,1146.718,98.6,,percent of total billed charges,,
"Repair Complex Wound,Face/Hand/Foot; 2.6 To 7.5 Cm (Pbb)",,13132,CPT,Professional,Outpatient,,,,1739,1478.15,188.92,1739,"Preferred One Administrative Services, INC.",PPO,1714.654,98.6,,percent of total billed charges,,
"Repair Complex Wound,Face/Hand/Foot; 2.6 To 7.5 Cm (Pbb)",,13132,CPT,Facility,Outpatient,,,,1163,988.55,333.3158,1163,PrimeWest Health,Minnesota Senior Health Options (MSHO),598.3635,51.45,,percent of total billed charges,,
"Repair Complex Wound,Face/Hand/Foot; 2.6 To 7.5 Cm (Pbb)",,13132,CPT,Professional,Outpatient,,,,1739,1478.15,188.92,1739,PrimeWest Health,Minnesota Senior Health Options (MSHO),337.8125,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair Complex Wound,Face/Hand/Foot; 2.6 To 7.5 Cm (Pbb)",,13132,CPT,Facility,Outpatient,,,,1163,988.55,333.3158,1163,PrimeWest Health,MinnesotaCare,597.3168,51.36,,percent of total billed charges,,
"Repair Complex Wound,Face/Hand/Foot; 2.6 To 7.5 Cm (Pbb)",,13132,CPT,Professional,Outpatient,,,,1739,1478.15,188.92,1739,PrimeWest Health,MinnesotaCare,233.3829216,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Repair Complex Wound,Face/Hand/Foot; 2.6 To 7.5 Cm (Pbb)",,13132,CPT,Facility,Outpatient,,,,1163,988.55,333.3158,1163,Sanford Health Plan,Sanford Health Plan,1069.96,92,,percent of total billed charges,,
"Repair Complex Wound,Face/Hand/Foot; 2.6 To 7.5 Cm (Pbb)",,13132,CPT,Professional,Outpatient,,,,1739,1478.15,188.92,1739,Sanford Health Plan,Sanford Health Plan,1530.32,88,,percent of total billed charges,,
"Repair Complex Wound,Face/Hand/Foot; 2.6 To 7.5 Cm (Pbb)",,13132,CPT,Facility,Outpatient,,,,1163,988.55,333.3158,1163,"UCare Health, Inc.",Individual & Family Plan,655.3505,56.35,,percent of total billed charges,,
"Repair Complex Wound,Face/Hand/Foot; 2.6 To 7.5 Cm (Pbb)",,13132,CPT,Professional,Outpatient,,,,1739,1478.15,188.92,1739,"UCare Health, Inc.",Individual & Family Plan,477.52,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Repair Complex Wound,Face/Hand/Foot; 2.6 To 7.5 Cm (Pbb)",,13132,CPT,Facility,Outpatient,,,,1163,988.55,333.3158,1163,"UCare Health, Inc.",Medical Assistance,586.9661,50.47,,percent of total billed charges,,
"Repair Complex Wound,Face/Hand/Foot; 2.6 To 7.5 Cm (Pbb)",,13132,CPT,Professional,Outpatient,,,,1739,1478.15,188.92,1739,"UCare Health, Inc.",Medical Assistance,239.926368,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Repair Complex Wound,Face/Hand/Foot; 2.6 To 7.5 Cm (Pbb)",,13132,CPT,Facility,Outpatient,,,,1163,988.55,333.3158,1163,"UCare Health, Inc.",Medicare Advantage,586.9661,50.47,,percent of total billed charges,,
"Repair Complex Wound,Face/Hand/Foot; 2.6 To 7.5 Cm (Pbb)",,13132,CPT,Professional,Outpatient,,,,1739,1478.15,188.92,1739,"UCare Health, Inc.",Medicare Advantage,337.8125,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Repair Complex Wound,Face/Hand/Foot; 2.6 To 7.5 Cm (Pbb)",,13132,CPT,Facility,Outpatient,,,,1163,988.55,333.3158,1163,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),586.9661,50.47,,percent of total billed charges,,
"Repair Complex Wound,Face/Hand/Foot; 2.6 To 7.5 Cm (Pbb)",,13132,CPT,Professional,Outpatient,,,,1739,1478.15,188.92,1739,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),270.25,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Repair Complex Wound,Face/Hand/Foot; 2.6 To 7.5 Cm (Pbb)",,13132,CPT,Facility,Outpatient,,,,1163,988.55,333.3158,1163,UnitedHealthcare,Individual & Family,1093.22,94,,percent of total billed charges,,
"Repair Complex Wound,Face/Hand/Foot; 2.6 To 7.5 Cm (Pbb)",,13132,CPT,Professional,Outpatient,,,,1739,1478.15,188.92,1739,UnitedHealthcare,Individual & Family,1739,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Repair Complex Wound,Face/Hand/Foot; 2.6 To 7.5 Cm (Pbb)",,13132,CPT,Facility,Outpatient,,,,1163,988.55,333.3158,1163,UnitedHealthcare,Medicare Advantage,569.87,49,,percent of total billed charges,,
"Repair Complex Wound,Face/Hand/Foot; 2.6 To 7.5 Cm (Pbb)",,13132,CPT,Professional,Outpatient,,,,1739,1478.15,188.92,1739,UnitedHealthcare,Medicare Advantage,337.8125,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair Complex Wound,Face/Hand/Foot; 2.6 To 7.5 Cm (Pbb)",,13132,CPT,Facility,Outpatient,,,,1163,988.55,333.3158,1163,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,558.24,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Repair Complex Wound,Face/Hand/Foot; 2.6 To 7.5 Cm (Pbb)",,13132,CPT,Professional,Outpatient,,,,1739,1478.15,188.92,1739,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,218.11488,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Repair, Complex,Forehead,Cheeks,Chin,Mouth,Neck,Axillae,Genitalia,Hands,Feet; 2.6 - 7.5 Cm (Pro Cah)",,13132,CPT,Professional,Both,,,,2902,2466.7,188.92,2902,Aetna,Commercial,2466.7,85,,percent of total billed charges,,
"Repair, Complex,Forehead,Cheeks,Chin,Mouth,Neck,Axillae,Genitalia,Hands,Feet; 2.6 - 7.5 Cm (Pro Cah)",,13132,CPT,Professional,Both,,,,2902,2466.7,188.92,2902,Aetna,Medicare Advantage,297.24,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair, Complex,Forehead,Cheeks,Chin,Mouth,Neck,Axillae,Genitalia,Hands,Feet; 2.6 - 7.5 Cm (Pro Cah)",,13132,CPT,Professional,Both,,,,2902,2466.7,188.92,2902,Aetna,PPO,2698.86,93,,percent of total billed charges,,
"Repair, Complex,Forehead,Cheeks,Chin,Mouth,Neck,Axillae,Genitalia,Hands,Feet; 2.6 - 7.5 Cm (Pro Cah)",,13132,CPT,Professional,Both,,,,2902,2466.7,188.92,2902,America's PPO,America's PPO,2479.4688,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Repair, Complex,Forehead,Cheeks,Chin,Mouth,Neck,Axillae,Genitalia,Hands,Feet; 2.6 - 7.5 Cm (Pro Cah)",,13132,CPT,Professional,Both,,,,2902,2466.7,188.92,2902,BlueCross BlueShield Minnesota, Federal Employee Program,617.67,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Repair, Complex,Forehead,Cheeks,Chin,Mouth,Neck,Axillae,Genitalia,Hands,Feet; 2.6 - 7.5 Cm (Pro Cah)",,13132,CPT,Professional,Both,,,,2902,2466.7,188.92,2902,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,627.55272,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Repair, Complex,Forehead,Cheeks,Chin,Mouth,Neck,Axillae,Genitalia,Hands,Feet; 2.6 - 7.5 Cm (Pro Cah)",,13132,CPT,Professional,Both,,,,2902,2466.7,188.92,2902,BlueCross BlueShield Minnesota,High Value Network Plan,627.55272,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Repair, Complex,Forehead,Cheeks,Chin,Mouth,Neck,Axillae,Genitalia,Hands,Feet; 2.6 - 7.5 Cm (Pro Cah)",,13132,CPT,Professional,Both,,,,2902,2466.7,188.92,2902,BlueCross BlueShield Minnesota,Medicare Advantage,337.8125,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair, Complex,Forehead,Cheeks,Chin,Mouth,Neck,Axillae,Genitalia,Hands,Feet; 2.6 - 7.5 Cm (Pro Cah)",,13132,CPT,Professional,Both,,,,2902,2466.7,188.92,2902,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,627.55272,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Repair, Complex,Forehead,Cheeks,Chin,Mouth,Neck,Axillae,Genitalia,Hands,Feet; 2.6 - 7.5 Cm (Pro Cah)",,13132,CPT,Professional,Both,,,,2902,2466.7,188.92,2902,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,218.11488,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Repair, Complex,Forehead,Cheeks,Chin,Mouth,Neck,Axillae,Genitalia,Hands,Feet; 2.6 - 7.5 Cm (Pro Cah)",,13132,CPT,Professional,Both,,,,2902,2466.7,188.92,2902,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),337.8125,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair, Complex,Forehead,Cheeks,Chin,Mouth,Neck,Axillae,Genitalia,Hands,Feet; 2.6 - 7.5 Cm (Pro Cah)",,13132,CPT,Professional,Both,,,,2902,2466.7,188.92,2902,CorVel,Worker's Compensation,573.5948565,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Repair, Complex,Forehead,Cheeks,Chin,Mouth,Neck,Axillae,Genitalia,Hands,Feet; 2.6 - 7.5 Cm (Pro Cah)",,13132,CPT,Professional,Both,,,,2902,2466.7,188.92,2902,First Health Group Corporation,First Health Network,2814.94,97,,percent of total billed charges,,
"Repair, Complex,Forehead,Cheeks,Chin,Mouth,Neck,Axillae,Genitalia,Hands,Feet; 2.6 - 7.5 Cm (Pro Cah)",,13132,CPT,Professional,Both,,,,2902,2466.7,188.92,2902,"Health Partners, Inc.",Commercial,619.6,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Repair, Complex,Forehead,Cheeks,Chin,Mouth,Neck,Axillae,Genitalia,Hands,Feet; 2.6 - 7.5 Cm (Pro Cah)",,13132,CPT,Professional,Both,,,,2902,2466.7,188.92,2902,"Health Partners, Inc.",Medicare Advantage,337.8125,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair, Complex,Forehead,Cheeks,Chin,Mouth,Neck,Axillae,Genitalia,Hands,Feet; 2.6 - 7.5 Cm (Pro Cah)",,13132,CPT,Professional,Both,,,,2902,2466.7,188.92,2902,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),293.8,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Repair, Complex,Forehead,Cheeks,Chin,Mouth,Neck,Axillae,Genitalia,Hands,Feet; 2.6 - 7.5 Cm (Pro Cah)",,13132,CPT,Professional,Both,,,,2902,2466.7,188.92,2902,"Health Partners, Inc.",State of Minnesota Advantage Program,533.7854,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Repair, Complex,Forehead,Cheeks,Chin,Mouth,Neck,Axillae,Genitalia,Hands,Feet; 2.6 - 7.5 Cm (Pro Cah)",,13132,CPT,Professional,Both,,,,2902,2466.7,188.92,2902,"Health Partners, Inc.",State Public Programs,188.92,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Repair, Complex,Forehead,Cheeks,Chin,Mouth,Neck,Axillae,Genitalia,Hands,Feet; 2.6 - 7.5 Cm (Pro Cah)",,13132,CPT,Professional,Both,,,,2902,2466.7,188.92,2902,Humana Insurance Company,Commercial PPO,293.75,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Repair, Complex,Forehead,Cheeks,Chin,Mouth,Neck,Axillae,Genitalia,Hands,Feet; 2.6 - 7.5 Cm (Pro Cah)",,13132,CPT,Professional,Both,,,,2902,2466.7,188.92,2902,Humana Insurance Company,Medicare PPO,2902,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Repair, Complex,Forehead,Cheeks,Chin,Mouth,Neck,Axillae,Genitalia,Hands,Feet; 2.6 - 7.5 Cm (Pro Cah)",,13132,CPT,Professional,Both,,,,2902,2466.7,188.92,2902,Medica,Individual & Family,2460.896,84.8,,percent of total billed charges,,
"Repair, Complex,Forehead,Cheeks,Chin,Mouth,Neck,Axillae,Genitalia,Hands,Feet; 2.6 - 7.5 Cm (Pro Cah)",,13132,CPT,Professional,Both,,,,2902,2466.7,188.92,2902,Medica,Medica Advantage Solution,1445.196,49.8,,percent of total billed charges,,
"Repair, Complex,Forehead,Cheeks,Chin,Mouth,Neck,Axillae,Genitalia,Hands,Feet; 2.6 - 7.5 Cm (Pro Cah)",,13132,CPT,Professional,Both,,,,2902,2466.7,188.92,2902,Medica,Medical Assistance,218.11,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Repair, Complex,Forehead,Cheeks,Chin,Mouth,Neck,Axillae,Genitalia,Hands,Feet; 2.6 - 7.5 Cm (Pro Cah)",,13132,CPT,Professional,Both,,,,2902,2466.7,188.92,2902,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,293.75,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Repair, Complex,Forehead,Cheeks,Chin,Mouth,Neck,Axillae,Genitalia,Hands,Feet; 2.6 - 7.5 Cm (Pro Cah)",,13132,CPT,Professional,Both,,,,2902,2466.7,188.92,2902,"Multiplan, Inc.","Multiplan, Inc.",2727.88,94,,percent of total billed charges,,
"Repair, Complex,Forehead,Cheeks,Chin,Mouth,Neck,Axillae,Genitalia,Hands,Feet; 2.6 - 7.5 Cm (Pro Cah)",,13132,CPT,Professional,Both,,,,2902,2466.7,188.92,2902,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,2614.702,90.1,,percent of total billed charges,,
"Repair, Complex,Forehead,Cheeks,Chin,Mouth,Neck,Axillae,Genitalia,Hands,Feet; 2.6 - 7.5 Cm (Pro Cah)",,13132,CPT,Professional,Both,,,,2902,2466.7,188.92,2902,"Preferred One Administrative Services, INC.",PPO,2861.372,98.6,,percent of total billed charges,,
"Repair, Complex,Forehead,Cheeks,Chin,Mouth,Neck,Axillae,Genitalia,Hands,Feet; 2.6 - 7.5 Cm (Pro Cah)",,13132,CPT,Professional,Both,,,,2902,2466.7,188.92,2902,PrimeWest Health,Minnesota Senior Health Options (MSHO),337.8125,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair, Complex,Forehead,Cheeks,Chin,Mouth,Neck,Axillae,Genitalia,Hands,Feet; 2.6 - 7.5 Cm (Pro Cah)",,13132,CPT,Professional,Both,,,,2902,2466.7,188.92,2902,PrimeWest Health,MinnesotaCare,233.3829216,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Repair, Complex,Forehead,Cheeks,Chin,Mouth,Neck,Axillae,Genitalia,Hands,Feet; 2.6 - 7.5 Cm (Pro Cah)",,13132,CPT,Professional,Both,,,,2902,2466.7,188.92,2902,Sanford Health Plan,Sanford Health Plan,2553.76,88,,percent of total billed charges,,
"Repair, Complex,Forehead,Cheeks,Chin,Mouth,Neck,Axillae,Genitalia,Hands,Feet; 2.6 - 7.5 Cm (Pro Cah)",,13132,CPT,Professional,Both,,,,2902,2466.7,188.92,2902,"UCare Health, Inc.",Individual & Family Plan,477.52,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Repair, Complex,Forehead,Cheeks,Chin,Mouth,Neck,Axillae,Genitalia,Hands,Feet; 2.6 - 7.5 Cm (Pro Cah)",,13132,CPT,Professional,Both,,,,2902,2466.7,188.92,2902,"UCare Health, Inc.",Medical Assistance,239.926368,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Repair, Complex,Forehead,Cheeks,Chin,Mouth,Neck,Axillae,Genitalia,Hands,Feet; 2.6 - 7.5 Cm (Pro Cah)",,13132,CPT,Professional,Both,,,,2902,2466.7,188.92,2902,"UCare Health, Inc.",Medicare Advantage,337.8125,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Repair, Complex,Forehead,Cheeks,Chin,Mouth,Neck,Axillae,Genitalia,Hands,Feet; 2.6 - 7.5 Cm (Pro Cah)",,13132,CPT,Professional,Both,,,,2902,2466.7,188.92,2902,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),270.25,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Repair, Complex,Forehead,Cheeks,Chin,Mouth,Neck,Axillae,Genitalia,Hands,Feet; 2.6 - 7.5 Cm (Pro Cah)",,13132,CPT,Professional,Both,,,,2902,2466.7,188.92,2902,UnitedHealthcare,Individual & Family,2902,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Repair, Complex,Forehead,Cheeks,Chin,Mouth,Neck,Axillae,Genitalia,Hands,Feet; 2.6 - 7.5 Cm (Pro Cah)",,13132,CPT,Professional,Both,,,,2902,2466.7,188.92,2902,UnitedHealthcare,Medicare Advantage,337.8125,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair, Complex,Forehead,Cheeks,Chin,Mouth,Neck,Axillae,Genitalia,Hands,Feet; 2.6 - 7.5 Cm (Pro Cah)",,13132,CPT,Professional,Both,,,,2902,2466.7,188.92,2902,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,218.11488,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Repair, Complex, Eyelids, Nose, Ears And/Or Lips; 2.6 Cm To 7.5 Cm (Pro Cah)",,13152,CPT,Professional,Both,,,,1375,1168.75,208.77,1375,Aetna,Commercial,1168.75,85,,percent of total billed charges,,
"Repair, Complex, Eyelids, Nose, Ears And/Or Lips; 2.6 Cm To 7.5 Cm (Pro Cah)",,13152,CPT,Professional,Both,,,,1375,1168.75,208.77,1375,Aetna,Medicare Advantage,329.22,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair, Complex, Eyelids, Nose, Ears And/Or Lips; 2.6 Cm To 7.5 Cm (Pro Cah)",,13152,CPT,Professional,Both,,,,1375,1168.75,208.77,1375,Aetna,PPO,1278.75,93,,percent of total billed charges,,
"Repair, Complex, Eyelids, Nose, Ears And/Or Lips; 2.6 Cm To 7.5 Cm (Pro Cah)",,13152,CPT,Professional,Both,,,,1375,1168.75,208.77,1375,America's PPO,America's PPO,1174.8,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Repair, Complex, Eyelids, Nose, Ears And/Or Lips; 2.6 Cm To 7.5 Cm (Pro Cah)",,13152,CPT,Professional,Both,,,,1375,1168.75,208.77,1375,BlueCross BlueShield Minnesota, Federal Employee Program,684.47,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Repair, Complex, Eyelids, Nose, Ears And/Or Lips; 2.6 Cm To 7.5 Cm (Pro Cah)",,13152,CPT,Professional,Both,,,,1375,1168.75,208.77,1375,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,695.42152,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Repair, Complex, Eyelids, Nose, Ears And/Or Lips; 2.6 Cm To 7.5 Cm (Pro Cah)",,13152,CPT,Professional,Both,,,,1375,1168.75,208.77,1375,BlueCross BlueShield Minnesota,High Value Network Plan,695.42152,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Repair, Complex, Eyelids, Nose, Ears And/Or Lips; 2.6 Cm To 7.5 Cm (Pro Cah)",,13152,CPT,Professional,Both,,,,1375,1168.75,208.77,1375,BlueCross BlueShield Minnesota,Medicare Advantage,373.221,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair, Complex, Eyelids, Nose, Ears And/Or Lips; 2.6 Cm To 7.5 Cm (Pro Cah)",,13152,CPT,Professional,Both,,,,1375,1168.75,208.77,1375,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,695.42152,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Repair, Complex, Eyelids, Nose, Ears And/Or Lips; 2.6 Cm To 7.5 Cm (Pro Cah)",,13152,CPT,Professional,Both,,,,1375,1168.75,208.77,1375,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,241.03584,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Repair, Complex, Eyelids, Nose, Ears And/Or Lips; 2.6 Cm To 7.5 Cm (Pro Cah)",,13152,CPT,Professional,Both,,,,1375,1168.75,208.77,1375,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),373.221,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair, Complex, Eyelids, Nose, Ears And/Or Lips; 2.6 Cm To 7.5 Cm (Pro Cah)",,13152,CPT,Professional,Both,,,,1375,1168.75,208.77,1375,CorVel,Worker's Compensation,634.4374425,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Repair, Complex, Eyelids, Nose, Ears And/Or Lips; 2.6 Cm To 7.5 Cm (Pro Cah)",,13152,CPT,Professional,Both,,,,1375,1168.75,208.77,1375,First Health Group Corporation,First Health Network,1333.75,97,,percent of total billed charges,,
"Repair, Complex, Eyelids, Nose, Ears And/Or Lips; 2.6 Cm To 7.5 Cm (Pro Cah)",,13152,CPT,Professional,Both,,,,1375,1168.75,208.77,1375,"Health Partners, Inc.",Commercial,685.62,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Repair, Complex, Eyelids, Nose, Ears And/Or Lips; 2.6 Cm To 7.5 Cm (Pro Cah)",,13152,CPT,Professional,Both,,,,1375,1168.75,208.77,1375,"Health Partners, Inc.",Medicare Advantage,373.221,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair, Complex, Eyelids, Nose, Ears And/Or Lips; 2.6 Cm To 7.5 Cm (Pro Cah)",,13152,CPT,Professional,Both,,,,1375,1168.75,208.77,1375,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),324.64,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Repair, Complex, Eyelids, Nose, Ears And/Or Lips; 2.6 Cm To 7.5 Cm (Pro Cah)",,13152,CPT,Professional,Both,,,,1375,1168.75,208.77,1375,"Health Partners, Inc.",State of Minnesota Advantage Program,590.66163,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Repair, Complex, Eyelids, Nose, Ears And/Or Lips; 2.6 Cm To 7.5 Cm (Pro Cah)",,13152,CPT,Professional,Both,,,,1375,1168.75,208.77,1375,"Health Partners, Inc.",State Public Programs,208.77,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Repair, Complex, Eyelids, Nose, Ears And/Or Lips; 2.6 Cm To 7.5 Cm (Pro Cah)",,13152,CPT,Professional,Both,,,,1375,1168.75,208.77,1375,Humana Insurance Company,Commercial PPO,324.54,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Repair, Complex, Eyelids, Nose, Ears And/Or Lips; 2.6 Cm To 7.5 Cm (Pro Cah)",,13152,CPT,Professional,Both,,,,1375,1168.75,208.77,1375,Humana Insurance Company,Medicare PPO,1375,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Repair, Complex, Eyelids, Nose, Ears And/Or Lips; 2.6 Cm To 7.5 Cm (Pro Cah)",,13152,CPT,Professional,Both,,,,1375,1168.75,208.77,1375,Medica,Individual & Family,1166,84.8,,percent of total billed charges,,
"Repair, Complex, Eyelids, Nose, Ears And/Or Lips; 2.6 Cm To 7.5 Cm (Pro Cah)",,13152,CPT,Professional,Both,,,,1375,1168.75,208.77,1375,Medica,Medica Advantage Solution,684.75,49.8,,percent of total billed charges,,
"Repair, Complex, Eyelids, Nose, Ears And/Or Lips; 2.6 Cm To 7.5 Cm (Pro Cah)",,13152,CPT,Professional,Both,,,,1375,1168.75,208.77,1375,Medica,Medical Assistance,241.04,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Repair, Complex, Eyelids, Nose, Ears And/Or Lips; 2.6 Cm To 7.5 Cm (Pro Cah)",,13152,CPT,Professional,Both,,,,1375,1168.75,208.77,1375,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,324.54,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Repair, Complex, Eyelids, Nose, Ears And/Or Lips; 2.6 Cm To 7.5 Cm (Pro Cah)",,13152,CPT,Professional,Both,,,,1375,1168.75,208.77,1375,"Multiplan, Inc.","Multiplan, Inc.",1292.5,94,,percent of total billed charges,,
"Repair, Complex, Eyelids, Nose, Ears And/Or Lips; 2.6 Cm To 7.5 Cm (Pro Cah)",,13152,CPT,Professional,Both,,,,1375,1168.75,208.77,1375,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1238.875,90.1,,percent of total billed charges,,
"Repair, Complex, Eyelids, Nose, Ears And/Or Lips; 2.6 Cm To 7.5 Cm (Pro Cah)",,13152,CPT,Professional,Both,,,,1375,1168.75,208.77,1375,"Preferred One Administrative Services, INC.",PPO,1355.75,98.6,,percent of total billed charges,,
"Repair, Complex, Eyelids, Nose, Ears And/Or Lips; 2.6 Cm To 7.5 Cm (Pro Cah)",,13152,CPT,Professional,Both,,,,1375,1168.75,208.77,1375,PrimeWest Health,Minnesota Senior Health Options (MSHO),373.221,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair, Complex, Eyelids, Nose, Ears And/Or Lips; 2.6 Cm To 7.5 Cm (Pro Cah)",,13152,CPT,Professional,Both,,,,1375,1168.75,208.77,1375,PrimeWest Health,MinnesotaCare,257.9083488,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Repair, Complex, Eyelids, Nose, Ears And/Or Lips; 2.6 Cm To 7.5 Cm (Pro Cah)",,13152,CPT,Professional,Both,,,,1375,1168.75,208.77,1375,Sanford Health Plan,Sanford Health Plan,1210,88,,percent of total billed charges,,
"Repair, Complex, Eyelids, Nose, Ears And/Or Lips; 2.6 Cm To 7.5 Cm (Pro Cah)",,13152,CPT,Professional,Both,,,,1375,1168.75,208.77,1375,"UCare Health, Inc.",Individual & Family Plan,527.572224,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Repair, Complex, Eyelids, Nose, Ears And/Or Lips; 2.6 Cm To 7.5 Cm (Pro Cah)",,13152,CPT,Professional,Both,,,,1375,1168.75,208.77,1375,"UCare Health, Inc.",Medical Assistance,265.139424,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Repair, Complex, Eyelids, Nose, Ears And/Or Lips; 2.6 Cm To 7.5 Cm (Pro Cah)",,13152,CPT,Professional,Both,,,,1375,1168.75,208.77,1375,"UCare Health, Inc.",Medicare Advantage,373.221,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Repair, Complex, Eyelids, Nose, Ears And/Or Lips; 2.6 Cm To 7.5 Cm (Pro Cah)",,13152,CPT,Professional,Both,,,,1375,1168.75,208.77,1375,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),298.5768,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Repair, Complex, Eyelids, Nose, Ears And/Or Lips; 2.6 Cm To 7.5 Cm (Pro Cah)",,13152,CPT,Professional,Both,,,,1375,1168.75,208.77,1375,UnitedHealthcare,Individual & Family,1375,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Repair, Complex, Eyelids, Nose, Ears And/Or Lips; 2.6 Cm To 7.5 Cm (Pro Cah)",,13152,CPT,Professional,Both,,,,1375,1168.75,208.77,1375,UnitedHealthcare,Medicare Advantage,373.221,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair, Complex, Eyelids, Nose, Ears And/Or Lips; 2.6 Cm To 7.5 Cm (Pro Cah)",,13152,CPT,Professional,Both,,,,1375,1168.75,208.77,1375,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,241.03584,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Repair, Complex, Eyelids, Nose, Ears And/Or Lips; 2.6 To 7.5 Cm",,13152,CPT,Facility,Both,,,,805,684.25,230.713,805,Aetna,Commercial,740.6,92,,percent of total billed charges,,
"Repair, Complex, Eyelids, Nose, Ears And/Or Lips; 2.6 To 7.5 Cm",,13152,CPT,Facility,Outpatient,,,,805,684.25,230.713,805,Aetna,Medicare Advantage,394.45,49,,percent of total billed charges,,
"Repair, Complex, Eyelids, Nose, Ears And/Or Lips; 2.6 To 7.5 Cm",,13152,CPT,Facility,Inpatient,,,,805,684.25,230.713,805,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Repair, Complex, Eyelids, Nose, Ears And/Or Lips; 2.6 To 7.5 Cm",,13152,CPT,Facility,Both,,,,805,684.25,230.713,805,Aetna,PPO,748.65,93,,percent of total billed charges,,
"Repair, Complex, Eyelids, Nose, Ears And/Or Lips; 2.6 To 7.5 Cm",,13152,CPT,Facility,Both,,,,805,684.25,230.713,805,America's PPO,America's PPO,773.0415,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Repair, Complex, Eyelids, Nose, Ears And/Or Lips; 2.6 To 7.5 Cm",,13152,CPT,Facility,Both,,,,805,684.25,230.713,805,BlueCross BlueShield Minnesota, Federal Employee Program,792.12,98.4,,percent of total billed charges,,
"Repair, Complex, Eyelids, Nose, Ears And/Or Lips; 2.6 To 7.5 Cm",,13152,CPT,Facility,Both,,,,805,684.25,230.713,805,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,805,100,,percent of total billed charges,,
"Repair, Complex, Eyelids, Nose, Ears And/Or Lips; 2.6 To 7.5 Cm",,13152,CPT,Facility,Both,,,,805,684.25,230.713,805,BlueCross BlueShield Minnesota,High Value Network Plan,724.5,90,,percent of total billed charges,,
"Repair, Complex, Eyelids, Nose, Ears And/Or Lips; 2.6 To 7.5 Cm",,13152,CPT,Facility,Outpatient,,,,805,684.25,230.713,805,BlueCross BlueShield Minnesota,Medicare Advantage,394.45,49,,percent of total billed charges,,
"Repair, Complex, Eyelids, Nose, Ears And/Or Lips; 2.6 To 7.5 Cm",,13152,CPT,Facility,Inpatient,,,,805,684.25,230.713,805,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Repair, Complex, Eyelids, Nose, Ears And/Or Lips; 2.6 To 7.5 Cm",,13152,CPT,Facility,Both,,,,805,684.25,230.713,805,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,712.9885,88.57,,percent of total billed charges,,
"Repair, Complex, Eyelids, Nose, Ears And/Or Lips; 2.6 To 7.5 Cm",,13152,CPT,Facility,Both,,,,805,684.25,230.713,805,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,230.713,28.66,,percent of total billed charges,,
"Repair, Complex, Eyelids, Nose, Ears And/Or Lips; 2.6 To 7.5 Cm",,13152,CPT,Facility,Outpatient,,,,805,684.25,230.713,805,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),394.45,49,,percent of total billed charges,,
"Repair, Complex, Eyelids, Nose, Ears And/Or Lips; 2.6 To 7.5 Cm",,13152,CPT,Facility,Inpatient,,,,805,684.25,230.713,805,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Repair, Complex, Eyelids, Nose, Ears And/Or Lips; 2.6 To 7.5 Cm",,13152,CPT,Facility,Both,,,,805,684.25,230.713,805,CorVel,Worker's Compensation,805,100,,percent of total billed charges,,
"Repair, Complex, Eyelids, Nose, Ears And/Or Lips; 2.6 To 7.5 Cm",,13152,CPT,Facility,Both,,,,805,684.25,230.713,805,First Health Group Corporation,First Health Network,780.85,97,,percent of total billed charges,,
"Repair, Complex, Eyelids, Nose, Ears And/Or Lips; 2.6 To 7.5 Cm",,13152,CPT,Facility,Both,,,,805,684.25,230.713,805,"Health Partners, Inc.",Commercial,761.53,94.6,,percent of total billed charges,,
"Repair, Complex, Eyelids, Nose, Ears And/Or Lips; 2.6 To 7.5 Cm",,13152,CPT,Facility,Outpatient,,,,805,684.25,230.713,805,"Health Partners, Inc.",Medicare Advantage,394.45,49,,percent of total billed charges,,
"Repair, Complex, Eyelids, Nose, Ears And/Or Lips; 2.6 To 7.5 Cm",,13152,CPT,Facility,Inpatient,,,,805,684.25,230.713,805,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Repair, Complex, Eyelids, Nose, Ears And/Or Lips; 2.6 To 7.5 Cm",,13152,CPT,Facility,Both,,,,805,684.25,230.713,805,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),483,60,,percent of total billed charges,,
"Repair, Complex, Eyelids, Nose, Ears And/Or Lips; 2.6 To 7.5 Cm",,13152,CPT,Facility,Both,,,,805,684.25,230.713,805,"Health Partners, Inc.",State of Minnesota Advantage Program,656.075,81.5,,percent of total billed charges,,
"Repair, Complex, Eyelids, Nose, Ears And/Or Lips; 2.6 To 7.5 Cm",,13152,CPT,Facility,Both,,,,805,684.25,230.713,805,"Health Partners, Inc.",State Public Programs,402.5,50,,percent of total billed charges,,
"Repair, Complex, Eyelids, Nose, Ears And/Or Lips; 2.6 To 7.5 Cm",,13152,CPT,Facility,Both,,,,805,684.25,230.713,805,Humana Insurance Company,Commercial PPO,764.75,95,,percent of total billed charges,,
"Repair, Complex, Eyelids, Nose, Ears And/Or Lips; 2.6 To 7.5 Cm",,13152,CPT,Facility,Outpatient,,,,805,684.25,230.713,805,Humana Insurance Company,Medicare PPO,394.45,49,,percent of total billed charges,,
"Repair, Complex, Eyelids, Nose, Ears And/Or Lips; 2.6 To 7.5 Cm",,13152,CPT,Facility,Inpatient,,,,805,684.25,230.713,805,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Repair, Complex, Eyelids, Nose, Ears And/Or Lips; 2.6 To 7.5 Cm",,13152,CPT,Facility,Both,,,,805,684.25,230.713,805,Medica,Individual & Family,797.755,99.1,,percent of total billed charges,,
"Repair, Complex, Eyelids, Nose, Ears And/Or Lips; 2.6 To 7.5 Cm",,13152,CPT,Facility,Outpatient,,,,805,684.25,230.713,805,Medica,Medica Advantage Solution,400.89,49.8,,percent of total billed charges,,
"Repair, Complex, Eyelids, Nose, Ears And/Or Lips; 2.6 To 7.5 Cm",,13152,CPT,Facility,Inpatient,,,,805,684.25,230.713,805,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Repair, Complex, Eyelids, Nose, Ears And/Or Lips; 2.6 To 7.5 Cm",,13152,CPT,Facility,Outpatient,,,,805,684.25,230.713,805,Medica,Medical Assistance,299,,,Other,Grouper,All inclusive per visit
"Repair, Complex, Eyelids, Nose, Ears And/Or Lips; 2.6 To 7.5 Cm",,13152,CPT,Facility,Inpatient,,,,805,684.25,230.713,805,Medica,Medical Assistance,,,,,Included in per diem rate,
"Repair, Complex, Eyelids, Nose, Ears And/Or Lips; 2.6 To 7.5 Cm",,13152,CPT,Facility,Outpatient,,,,805,684.25,230.713,805,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,400.89,49.8,,percent of total billed charges,,
"Repair, Complex, Eyelids, Nose, Ears And/Or Lips; 2.6 To 7.5 Cm",,13152,CPT,Facility,Inpatient,,,,805,684.25,230.713,805,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Repair, Complex, Eyelids, Nose, Ears And/Or Lips; 2.6 To 7.5 Cm",,13152,CPT,Facility,Both,,,,805,684.25,230.713,805,"Multiplan, Inc.","Multiplan, Inc.",756.7,94,,percent of total billed charges,,
"Repair, Complex, Eyelids, Nose, Ears And/Or Lips; 2.6 To 7.5 Cm",,13152,CPT,Facility,Outpatient,,,,805,684.25,230.713,805,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,725.305,90.1,,percent of total billed charges,,
"Repair, Complex, Eyelids, Nose, Ears And/Or Lips; 2.6 To 7.5 Cm",,13152,CPT,Facility,Inpatient,,,,805,684.25,230.713,805,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Repair, Complex, Eyelids, Nose, Ears And/Or Lips; 2.6 To 7.5 Cm",,13152,CPT,Facility,Both,,,,805,684.25,230.713,805,"Preferred One Administrative Services, INC.",PPO,793.73,98.6,,percent of total billed charges,,
"Repair, Complex, Eyelids, Nose, Ears And/Or Lips; 2.6 To 7.5 Cm",,13152,CPT,Facility,Outpatient,,,,805,684.25,230.713,805,PrimeWest Health,Minnesota Senior Health Options (MSHO),414.1725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Repair, Complex, Eyelids, Nose, Ears And/Or Lips; 2.6 To 7.5 Cm",,13152,CPT,Facility,Inpatient,,,,805,684.25,230.713,805,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Repair, Complex, Eyelids, Nose, Ears And/Or Lips; 2.6 To 7.5 Cm",,13152,CPT,Facility,Outpatient,,,,805,684.25,230.713,805,PrimeWest Health,MinnesotaCare,413.448,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Repair, Complex, Eyelids, Nose, Ears And/Or Lips; 2.6 To 7.5 Cm",,13152,CPT,Facility,Inpatient,,,,805,684.25,230.713,805,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Repair, Complex, Eyelids, Nose, Ears And/Or Lips; 2.6 To 7.5 Cm",,13152,CPT,Facility,Both,,,,805,684.25,230.713,805,Sanford Health Plan,Sanford Health Plan,740.6,92,,percent of total billed charges,,
"Repair, Complex, Eyelids, Nose, Ears And/Or Lips; 2.6 To 7.5 Cm",,13152,CPT,Facility,Outpatient,,,,805,684.25,230.713,805,"UCare Health, Inc.",Individual & Family Plan,453.6175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Repair, Complex, Eyelids, Nose, Ears And/Or Lips; 2.6 To 7.5 Cm",,13152,CPT,Facility,Inpatient,,,,805,684.25,230.713,805,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Repair, Complex, Eyelids, Nose, Ears And/Or Lips; 2.6 To 7.5 Cm",,13152,CPT,Facility,Outpatient,,,,805,684.25,230.713,805,"UCare Health, Inc.",Medical Assistance,406.2835,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Repair, Complex, Eyelids, Nose, Ears And/Or Lips; 2.6 To 7.5 Cm",,13152,CPT,Facility,Inpatient,,,,805,684.25,230.713,805,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Repair, Complex, Eyelids, Nose, Ears And/Or Lips; 2.6 To 7.5 Cm",,13152,CPT,Facility,Outpatient,,,,805,684.25,230.713,805,"UCare Health, Inc.",Medicare Advantage,406.2835,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Repair, Complex, Eyelids, Nose, Ears And/Or Lips; 2.6 To 7.5 Cm",,13152,CPT,Facility,Inpatient,,,,805,684.25,230.713,805,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Repair, Complex, Eyelids, Nose, Ears And/Or Lips; 2.6 To 7.5 Cm",,13152,CPT,Facility,Outpatient,,,,805,684.25,230.713,805,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),406.2835,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Repair, Complex, Eyelids, Nose, Ears And/Or Lips; 2.6 To 7.5 Cm",,13152,CPT,Facility,Inpatient,,,,805,684.25,230.713,805,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Repair, Complex, Eyelids, Nose, Ears And/Or Lips; 2.6 To 7.5 Cm",,13152,CPT,Facility,Both,,,,805,684.25,230.713,805,UnitedHealthcare,Individual & Family,756.7,94,,percent of total billed charges,,
"Repair, Complex, Eyelids, Nose, Ears And/Or Lips; 2.6 To 7.5 Cm",,13152,CPT,Facility,Outpatient,,,,805,684.25,230.713,805,UnitedHealthcare,Medicare Advantage,394.45,49,,percent of total billed charges,,
"Repair, Complex, Eyelids, Nose, Ears And/Or Lips; 2.6 To 7.5 Cm",,13152,CPT,Facility,Inpatient,,,,805,684.25,230.713,805,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Repair, Complex, Eyelids, Nose, Ears And/Or Lips; 2.6 To 7.5 Cm",,13152,CPT,Facility,Outpatient,,,,805,684.25,230.713,805,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,386.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Repair, Complex, Eyelids, Nose, Ears And/Or Lips; 2.6 To 7.5 Cm",,13152,CPT,Facility,Inpatient,,,,805,684.25,230.713,805,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Secondary Closure Of Surgical Wound Or Dehiscence, Extensive Or Complicated (Pro Cah)",,13160,CPT,Professional,Both,,,,2550,2167.5,491.93,2550,Aetna,Commercial,2167.5,85,,percent of total billed charges,,
"Secondary Closure Of Surgical Wound Or Dehiscence, Extensive Or Complicated (Pro Cah)",,13160,CPT,Professional,Both,,,,2550,2167.5,491.93,2550,Aetna,Medicare Advantage,773.98,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Secondary Closure Of Surgical Wound Or Dehiscence, Extensive Or Complicated (Pro Cah)",,13160,CPT,Professional,Both,,,,2550,2167.5,491.93,2550,Aetna,PPO,2371.5,93,,percent of total billed charges,,
"Secondary Closure Of Surgical Wound Or Dehiscence, Extensive Or Complicated (Pro Cah)",,13160,CPT,Professional,Both,,,,2550,2167.5,491.93,2550,America's PPO,America's PPO,2178.72,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Secondary Closure Of Surgical Wound Or Dehiscence, Extensive Or Complicated (Pro Cah)",,13160,CPT,Professional,Both,,,,2550,2167.5,491.93,2550,BlueCross BlueShield Minnesota, Federal Employee Program,1635.43,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Secondary Closure Of Surgical Wound Or Dehiscence, Extensive Or Complicated (Pro Cah)",,13160,CPT,Professional,Both,,,,2550,2167.5,491.93,2550,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1661.59688,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Secondary Closure Of Surgical Wound Or Dehiscence, Extensive Or Complicated (Pro Cah)",,13160,CPT,Professional,Both,,,,2550,2167.5,491.93,2550,BlueCross BlueShield Minnesota,High Value Network Plan,1661.59688,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Secondary Closure Of Surgical Wound Or Dehiscence, Extensive Or Complicated (Pro Cah)",,13160,CPT,Professional,Both,,,,2550,2167.5,491.93,2550,BlueCross BlueShield Minnesota,Medicare Advantage,878.853,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Secondary Closure Of Surgical Wound Or Dehiscence, Extensive Or Complicated (Pro Cah)",,13160,CPT,Professional,Both,,,,2550,2167.5,491.93,2550,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1661.59688,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Secondary Closure Of Surgical Wound Or Dehiscence, Extensive Or Complicated (Pro Cah)",,13160,CPT,Professional,Both,,,,2550,2167.5,491.93,2550,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,567.95416,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Secondary Closure Of Surgical Wound Or Dehiscence, Extensive Or Complicated (Pro Cah)",,13160,CPT,Professional,Both,,,,2550,2167.5,491.93,2550,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),878.853,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Secondary Closure Of Surgical Wound Or Dehiscence, Extensive Or Complicated (Pro Cah)",,13160,CPT,Professional,Both,,,,2550,2167.5,491.93,2550,CorVel,Worker's Compensation,1499.930281,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Secondary Closure Of Surgical Wound Or Dehiscence, Extensive Or Complicated (Pro Cah)",,13160,CPT,Professional,Both,,,,2550,2167.5,491.93,2550,First Health Group Corporation,First Health Network,2473.5,97,,percent of total billed charges,,
"Secondary Closure Of Surgical Wound Or Dehiscence, Extensive Or Complicated (Pro Cah)",,13160,CPT,Professional,Both,,,,2550,2167.5,491.93,2550,"Health Partners, Inc.",Commercial,1620.1,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Secondary Closure Of Surgical Wound Or Dehiscence, Extensive Or Complicated (Pro Cah)",,13160,CPT,Professional,Both,,,,2550,2167.5,491.93,2550,"Health Partners, Inc.",Medicare Advantage,878.853,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Secondary Closure Of Surgical Wound Or Dehiscence, Extensive Or Complicated (Pro Cah)",,13160,CPT,Professional,Both,,,,2550,2167.5,491.93,2550,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),764.16,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Secondary Closure Of Surgical Wound Or Dehiscence, Extensive Or Complicated (Pro Cah)",,13160,CPT,Professional,Both,,,,2550,2167.5,491.93,2550,"Health Partners, Inc.",State of Minnesota Advantage Program,1395.71615,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Secondary Closure Of Surgical Wound Or Dehiscence, Extensive Or Complicated (Pro Cah)",,13160,CPT,Professional,Both,,,,2550,2167.5,491.93,2550,"Health Partners, Inc.",State Public Programs,491.93,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Secondary Closure Of Surgical Wound Or Dehiscence, Extensive Or Complicated (Pro Cah)",,13160,CPT,Professional,Both,,,,2550,2167.5,491.93,2550,Humana Insurance Company,Commercial PPO,764.22,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Secondary Closure Of Surgical Wound Or Dehiscence, Extensive Or Complicated (Pro Cah)",,13160,CPT,Professional,Both,,,,2550,2167.5,491.93,2550,Humana Insurance Company,Medicare PPO,2550,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Secondary Closure Of Surgical Wound Or Dehiscence, Extensive Or Complicated (Pro Cah)",,13160,CPT,Professional,Both,,,,2550,2167.5,491.93,2550,Medica,Individual & Family,2162.4,84.8,,percent of total billed charges,,
"Secondary Closure Of Surgical Wound Or Dehiscence, Extensive Or Complicated (Pro Cah)",,13160,CPT,Professional,Both,,,,2550,2167.5,491.93,2550,Medica,Medica Advantage Solution,1269.9,49.8,,percent of total billed charges,,
"Secondary Closure Of Surgical Wound Or Dehiscence, Extensive Or Complicated (Pro Cah)",,13160,CPT,Professional,Both,,,,2550,2167.5,491.93,2550,Medica,Medical Assistance,567.95,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Secondary Closure Of Surgical Wound Or Dehiscence, Extensive Or Complicated (Pro Cah)",,13160,CPT,Professional,Both,,,,2550,2167.5,491.93,2550,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,764.22,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Secondary Closure Of Surgical Wound Or Dehiscence, Extensive Or Complicated (Pro Cah)",,13160,CPT,Professional,Both,,,,2550,2167.5,491.93,2550,"Multiplan, Inc.","Multiplan, Inc.",2397,94,,percent of total billed charges,,
"Secondary Closure Of Surgical Wound Or Dehiscence, Extensive Or Complicated (Pro Cah)",,13160,CPT,Professional,Both,,,,2550,2167.5,491.93,2550,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,2297.55,90.1,,percent of total billed charges,,
"Secondary Closure Of Surgical Wound Or Dehiscence, Extensive Or Complicated (Pro Cah)",,13160,CPT,Professional,Both,,,,2550,2167.5,491.93,2550,"Preferred One Administrative Services, INC.",PPO,2514.3,98.6,,percent of total billed charges,,
"Secondary Closure Of Surgical Wound Or Dehiscence, Extensive Or Complicated (Pro Cah)",,13160,CPT,Professional,Both,,,,2550,2167.5,491.93,2550,PrimeWest Health,Minnesota Senior Health Options (MSHO),878.853,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Secondary Closure Of Surgical Wound Or Dehiscence, Extensive Or Complicated (Pro Cah)",,13160,CPT,Professional,Both,,,,2550,2167.5,491.93,2550,PrimeWest Health,MinnesotaCare,607.7109512,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Secondary Closure Of Surgical Wound Or Dehiscence, Extensive Or Complicated (Pro Cah)",,13160,CPT,Professional,Both,,,,2550,2167.5,491.93,2550,Sanford Health Plan,Sanford Health Plan,2244,88,,percent of total billed charges,,
"Secondary Closure Of Surgical Wound Or Dehiscence, Extensive Or Complicated (Pro Cah)",,13160,CPT,Professional,Both,,,,2550,2167.5,491.93,2550,"UCare Health, Inc.",Individual & Family Plan,1242.316032,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Secondary Closure Of Surgical Wound Or Dehiscence, Extensive Or Complicated (Pro Cah)",,13160,CPT,Professional,Both,,,,2550,2167.5,491.93,2550,"UCare Health, Inc.",Medical Assistance,624.749576,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Secondary Closure Of Surgical Wound Or Dehiscence, Extensive Or Complicated (Pro Cah)",,13160,CPT,Professional,Both,,,,2550,2167.5,491.93,2550,"UCare Health, Inc.",Medicare Advantage,878.853,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Secondary Closure Of Surgical Wound Or Dehiscence, Extensive Or Complicated (Pro Cah)",,13160,CPT,Professional,Both,,,,2550,2167.5,491.93,2550,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),703.0824,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Secondary Closure Of Surgical Wound Or Dehiscence, Extensive Or Complicated (Pro Cah)",,13160,CPT,Professional,Both,,,,2550,2167.5,491.93,2550,UnitedHealthcare,Individual & Family,2550,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Secondary Closure Of Surgical Wound Or Dehiscence, Extensive Or Complicated (Pro Cah)",,13160,CPT,Professional,Both,,,,2550,2167.5,491.93,2550,UnitedHealthcare,Medicare Advantage,878.853,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Secondary Closure Of Surgical Wound Or Dehiscence, Extensive Or Complicated (Pro Cah)",,13160,CPT,Professional,Both,,,,2550,2167.5,491.93,2550,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,567.95416,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
PRAZOSIN 2 MG ORAL CAP,,19666,LOCAL,Facility,Both,1,Each,,13,11.05,3.7258,13,Aetna,Commercial,11.96,92,,percent of total billed charges,,
PRAZOSIN 2 MG ORAL CAP,,19666,LOCAL,Facility,Outpatient,1,Each,,13,11.05,3.7258,13,Aetna,Medicare Advantage,6.37,49,,percent of total billed charges,,
PRAZOSIN 2 MG ORAL CAP,,19666,LOCAL,Facility,Inpatient,1,Each,,13,11.05,3.7258,13,Aetna,Medicare Advantage,,,,,Included in per diem rate,
PRAZOSIN 2 MG ORAL CAP,,19666,LOCAL,Facility,Both,1,Each,,13,11.05,3.7258,13,Aetna,PPO,12.09,93,,percent of total billed charges,,
PRAZOSIN 2 MG ORAL CAP,,19666,LOCAL,Facility,Both,1,Each,,13,11.05,3.7258,13,America's PPO,America's PPO,12.4839,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
PRAZOSIN 2 MG ORAL CAP,,19666,LOCAL,Facility,Both,1,Each,,13,11.05,3.7258,13,BlueCross BlueShield Minnesota, Federal Employee Program,12.792,98.4,,percent of total billed charges,,
PRAZOSIN 2 MG ORAL CAP,,19666,LOCAL,Facility,Both,1,Each,,13,11.05,3.7258,13,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,13,100,,percent of total billed charges,,
PRAZOSIN 2 MG ORAL CAP,,19666,LOCAL,Facility,Both,1,Each,,13,11.05,3.7258,13,BlueCross BlueShield Minnesota,High Value Network Plan,11.7,90,,percent of total billed charges,,
PRAZOSIN 2 MG ORAL CAP,,19666,LOCAL,Facility,Outpatient,1,Each,,13,11.05,3.7258,13,BlueCross BlueShield Minnesota,Medicare Advantage,6.37,49,,percent of total billed charges,,
PRAZOSIN 2 MG ORAL CAP,,19666,LOCAL,Facility,Inpatient,1,Each,,13,11.05,3.7258,13,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
PRAZOSIN 2 MG ORAL CAP,,19666,LOCAL,Facility,Both,1,Each,,13,11.05,3.7258,13,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,11.5141,88.57,,percent of total billed charges,,
PRAZOSIN 2 MG ORAL CAP,,19666,LOCAL,Facility,Both,1,Each,,13,11.05,3.7258,13,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,3.7258,28.66,,percent of total billed charges,,
PRAZOSIN 2 MG ORAL CAP,,19666,LOCAL,Facility,Outpatient,1,Each,,13,11.05,3.7258,13,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),6.37,49,,percent of total billed charges,,
PRAZOSIN 2 MG ORAL CAP,,19666,LOCAL,Facility,Inpatient,1,Each,,13,11.05,3.7258,13,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
PRAZOSIN 2 MG ORAL CAP,,19666,LOCAL,Facility,Both,1,Each,,13,11.05,3.7258,13,CorVel,Worker's Compensation,13,100,,percent of total billed charges,,
PRAZOSIN 2 MG ORAL CAP,,19666,LOCAL,Facility,Both,1,Each,,13,11.05,3.7258,13,First Health Group Corporation,First Health Network,12.61,97,,percent of total billed charges,,
PRAZOSIN 2 MG ORAL CAP,,19666,LOCAL,Facility,Both,1,Each,,13,11.05,3.7258,13,"Health Partners, Inc.",Commercial,12.298,94.6,,percent of total billed charges,,
PRAZOSIN 2 MG ORAL CAP,,19666,LOCAL,Facility,Outpatient,1,Each,,13,11.05,3.7258,13,"Health Partners, Inc.",Medicare Advantage,6.37,49,,percent of total billed charges,,
PRAZOSIN 2 MG ORAL CAP,,19666,LOCAL,Facility,Inpatient,1,Each,,13,11.05,3.7258,13,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PRAZOSIN 2 MG ORAL CAP,,19666,LOCAL,Facility,Both,1,Each,,13,11.05,3.7258,13,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),7.8,60,,percent of total billed charges,,
PRAZOSIN 2 MG ORAL CAP,,19666,LOCAL,Facility,Both,1,Each,,13,11.05,3.7258,13,"Health Partners, Inc.",State of Minnesota Advantage Program,10.595,81.5,,percent of total billed charges,,
PRAZOSIN 2 MG ORAL CAP,,19666,LOCAL,Facility,Both,1,Each,,13,11.05,3.7258,13,"Health Partners, Inc.",State Public Programs,6.5,50,,percent of total billed charges,,
PRAZOSIN 2 MG ORAL CAP,,19666,LOCAL,Facility,Both,1,Each,,13,11.05,3.7258,13,Humana Insurance Company,Commercial PPO,12.35,95,,percent of total billed charges,,
PRAZOSIN 2 MG ORAL CAP,,19666,LOCAL,Facility,Outpatient,1,Each,,13,11.05,3.7258,13,Humana Insurance Company,Medicare PPO,6.37,49,,percent of total billed charges,,
PRAZOSIN 2 MG ORAL CAP,,19666,LOCAL,Facility,Inpatient,1,Each,,13,11.05,3.7258,13,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
PRAZOSIN 2 MG ORAL CAP,,19666,LOCAL,Facility,Both,1,Each,,13,11.05,3.7258,13,Medica,Individual & Family,12.883,99.1,,percent of total billed charges,,
PRAZOSIN 2 MG ORAL CAP,,19666,LOCAL,Facility,Outpatient,1,Each,,13,11.05,3.7258,13,Medica,Medica Advantage Solution,6.474,49.8,,percent of total billed charges,,
PRAZOSIN 2 MG ORAL CAP,,19666,LOCAL,Facility,Inpatient,1,Each,,13,11.05,3.7258,13,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
PRAZOSIN 2 MG ORAL CAP,,19666,LOCAL,Facility,Outpatient,1,Each,,13,11.05,3.7258,13,Medica,Medical Assistance,5.798,44.6,,percent of total billed charges,,
PRAZOSIN 2 MG ORAL CAP,,19666,LOCAL,Facility,Inpatient,1,Each,,13,11.05,3.7258,13,Medica,Medical Assistance,,,,,Included in per diem rate,
PRAZOSIN 2 MG ORAL CAP,,19666,LOCAL,Facility,Outpatient,1,Each,,13,11.05,3.7258,13,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,6.474,49.8,,percent of total billed charges,,
PRAZOSIN 2 MG ORAL CAP,,19666,LOCAL,Facility,Inpatient,1,Each,,13,11.05,3.7258,13,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
PRAZOSIN 2 MG ORAL CAP,,19666,LOCAL,Facility,Both,1,Each,,13,11.05,3.7258,13,"Multiplan, Inc.","Multiplan, Inc.",12.22,94,,percent of total billed charges,,
PRAZOSIN 2 MG ORAL CAP,,19666,LOCAL,Facility,Outpatient,1,Each,,13,11.05,3.7258,13,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,11.713,90.1,,percent of total billed charges,,
PRAZOSIN 2 MG ORAL CAP,,19666,LOCAL,Facility,Inpatient,1,Each,,13,11.05,3.7258,13,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
PRAZOSIN 2 MG ORAL CAP,,19666,LOCAL,Facility,Both,1,Each,,13,11.05,3.7258,13,"Preferred One Administrative Services, INC.",PPO,12.818,98.6,,percent of total billed charges,,
PRAZOSIN 2 MG ORAL CAP,,19666,LOCAL,Facility,Outpatient,1,Each,,13,11.05,3.7258,13,PrimeWest Health,Minnesota Senior Health Options (MSHO),6.6885,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
PRAZOSIN 2 MG ORAL CAP,,19666,LOCAL,Facility,Inpatient,1,Each,,13,11.05,3.7258,13,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PRAZOSIN 2 MG ORAL CAP,,19666,LOCAL,Facility,Outpatient,1,Each,,13,11.05,3.7258,13,PrimeWest Health,MinnesotaCare,6.6768,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
PRAZOSIN 2 MG ORAL CAP,,19666,LOCAL,Facility,Inpatient,1,Each,,13,11.05,3.7258,13,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
PRAZOSIN 2 MG ORAL CAP,,19666,LOCAL,Facility,Both,1,Each,,13,11.05,3.7258,13,Sanford Health Plan,Sanford Health Plan,11.96,92,,percent of total billed charges,,
PRAZOSIN 2 MG ORAL CAP,,19666,LOCAL,Facility,Outpatient,1,Each,,13,11.05,3.7258,13,"UCare Health, Inc.",Individual & Family Plan,7.3255,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
PRAZOSIN 2 MG ORAL CAP,,19666,LOCAL,Facility,Inpatient,1,Each,,13,11.05,3.7258,13,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
PRAZOSIN 2 MG ORAL CAP,,19666,LOCAL,Facility,Outpatient,1,Each,,13,11.05,3.7258,13,"UCare Health, Inc.",Medical Assistance,6.5611,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PRAZOSIN 2 MG ORAL CAP,,19666,LOCAL,Facility,Inpatient,1,Each,,13,11.05,3.7258,13,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
PRAZOSIN 2 MG ORAL CAP,,19666,LOCAL,Facility,Outpatient,1,Each,,13,11.05,3.7258,13,"UCare Health, Inc.",Medicare Advantage,6.5611,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PRAZOSIN 2 MG ORAL CAP,,19666,LOCAL,Facility,Inpatient,1,Each,,13,11.05,3.7258,13,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PRAZOSIN 2 MG ORAL CAP,,19666,LOCAL,Facility,Outpatient,1,Each,,13,11.05,3.7258,13,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),6.5611,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PRAZOSIN 2 MG ORAL CAP,,19666,LOCAL,Facility,Inpatient,1,Each,,13,11.05,3.7258,13,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PRAZOSIN 2 MG ORAL CAP,,19666,LOCAL,Facility,Both,1,Each,,13,11.05,3.7258,13,UnitedHealthcare,Individual & Family,12.22,94,,percent of total billed charges,,
PRAZOSIN 2 MG ORAL CAP,,19666,LOCAL,Facility,Outpatient,1,Each,,13,11.05,3.7258,13,UnitedHealthcare,Medicare Advantage,6.37,49,,percent of total billed charges,,
PRAZOSIN 2 MG ORAL CAP,,19666,LOCAL,Facility,Inpatient,1,Each,,13,11.05,3.7258,13,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
PRAZOSIN 2 MG ORAL CAP,,19666,LOCAL,Facility,Outpatient,1,Each,,13,11.05,3.7258,13,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,6.24,48,,percent of total billed charges,,100% of DHS outpatient percentage
PRAZOSIN 2 MG ORAL CAP,,19666,LOCAL,Facility,Inpatient,1,Each,,13,11.05,3.7258,13,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
NAPROXEN 500 MG ORAL TABLET,,19738,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,Aetna,Commercial,6.44,92,,percent of total billed charges,,
NAPROXEN 500 MG ORAL TABLET,,19738,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,Aetna,Medicare Advantage,3.43,49,,percent of total billed charges,,
NAPROXEN 500 MG ORAL TABLET,,19738,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,Aetna,Medicare Advantage,,,,,Included in per diem rate,
NAPROXEN 500 MG ORAL TABLET,,19738,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,Aetna,PPO,6.51,93,,percent of total billed charges,,
NAPROXEN 500 MG ORAL TABLET,,19738,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,America's PPO,America's PPO,6.7221,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
NAPROXEN 500 MG ORAL TABLET,,19738,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,BlueCross BlueShield Minnesota, Federal Employee Program,6.888,98.4,,percent of total billed charges,,
NAPROXEN 500 MG ORAL TABLET,,19738,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,7,100,,percent of total billed charges,,
NAPROXEN 500 MG ORAL TABLET,,19738,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,BlueCross BlueShield Minnesota,High Value Network Plan,6.3,90,,percent of total billed charges,,
NAPROXEN 500 MG ORAL TABLET,,19738,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,BlueCross BlueShield Minnesota,Medicare Advantage,3.43,49,,percent of total billed charges,,
NAPROXEN 500 MG ORAL TABLET,,19738,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
NAPROXEN 500 MG ORAL TABLET,,19738,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,6.1999,88.57,,percent of total billed charges,,
NAPROXEN 500 MG ORAL TABLET,,19738,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,2.0062,28.66,,percent of total billed charges,,
NAPROXEN 500 MG ORAL TABLET,,19738,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),3.43,49,,percent of total billed charges,,
NAPROXEN 500 MG ORAL TABLET,,19738,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
NAPROXEN 500 MG ORAL TABLET,,19738,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,CorVel,Worker's Compensation,7,100,,percent of total billed charges,,
NAPROXEN 500 MG ORAL TABLET,,19738,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,First Health Group Corporation,First Health Network,6.79,97,,percent of total billed charges,,
NAPROXEN 500 MG ORAL TABLET,,19738,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,"Health Partners, Inc.",Commercial,6.622,94.6,,percent of total billed charges,,
NAPROXEN 500 MG ORAL TABLET,,19738,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,"Health Partners, Inc.",Medicare Advantage,3.43,49,,percent of total billed charges,,
NAPROXEN 500 MG ORAL TABLET,,19738,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
NAPROXEN 500 MG ORAL TABLET,,19738,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),4.2,60,,percent of total billed charges,,
NAPROXEN 500 MG ORAL TABLET,,19738,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,"Health Partners, Inc.",State of Minnesota Advantage Program,5.705,81.5,,percent of total billed charges,,
NAPROXEN 500 MG ORAL TABLET,,19738,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,"Health Partners, Inc.",State Public Programs,3.5,50,,percent of total billed charges,,
NAPROXEN 500 MG ORAL TABLET,,19738,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,Humana Insurance Company,Commercial PPO,6.65,95,,percent of total billed charges,,
NAPROXEN 500 MG ORAL TABLET,,19738,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,Humana Insurance Company,Medicare PPO,3.43,49,,percent of total billed charges,,
NAPROXEN 500 MG ORAL TABLET,,19738,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
NAPROXEN 500 MG ORAL TABLET,,19738,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,Medica,Individual & Family,6.937,99.1,,percent of total billed charges,,
NAPROXEN 500 MG ORAL TABLET,,19738,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,Medica,Medica Advantage Solution,3.486,49.8,,percent of total billed charges,,
NAPROXEN 500 MG ORAL TABLET,,19738,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
NAPROXEN 500 MG ORAL TABLET,,19738,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,Medica,Medical Assistance,3.122,44.6,,percent of total billed charges,,
NAPROXEN 500 MG ORAL TABLET,,19738,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,Medica,Medical Assistance,,,,,Included in per diem rate,
NAPROXEN 500 MG ORAL TABLET,,19738,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,3.486,49.8,,percent of total billed charges,,
NAPROXEN 500 MG ORAL TABLET,,19738,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
NAPROXEN 500 MG ORAL TABLET,,19738,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,"Multiplan, Inc.","Multiplan, Inc.",6.58,94,,percent of total billed charges,,
NAPROXEN 500 MG ORAL TABLET,,19738,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,6.307,90.1,,percent of total billed charges,,
NAPROXEN 500 MG ORAL TABLET,,19738,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
NAPROXEN 500 MG ORAL TABLET,,19738,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,"Preferred One Administrative Services, INC.",PPO,6.902,98.6,,percent of total billed charges,,
NAPROXEN 500 MG ORAL TABLET,,19738,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,PrimeWest Health,Minnesota Senior Health Options (MSHO),3.6015,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
NAPROXEN 500 MG ORAL TABLET,,19738,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
NAPROXEN 500 MG ORAL TABLET,,19738,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,PrimeWest Health,MinnesotaCare,3.5952,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
NAPROXEN 500 MG ORAL TABLET,,19738,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
NAPROXEN 500 MG ORAL TABLET,,19738,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,Sanford Health Plan,Sanford Health Plan,6.44,92,,percent of total billed charges,,
NAPROXEN 500 MG ORAL TABLET,,19738,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,"UCare Health, Inc.",Individual & Family Plan,3.9445,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
NAPROXEN 500 MG ORAL TABLET,,19738,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
NAPROXEN 500 MG ORAL TABLET,,19738,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,"UCare Health, Inc.",Medical Assistance,3.5329,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
NAPROXEN 500 MG ORAL TABLET,,19738,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
NAPROXEN 500 MG ORAL TABLET,,19738,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,"UCare Health, Inc.",Medicare Advantage,3.5329,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
NAPROXEN 500 MG ORAL TABLET,,19738,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
NAPROXEN 500 MG ORAL TABLET,,19738,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),3.5329,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
NAPROXEN 500 MG ORAL TABLET,,19738,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
NAPROXEN 500 MG ORAL TABLET,,19738,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,UnitedHealthcare,Individual & Family,6.58,94,,percent of total billed charges,,
NAPROXEN 500 MG ORAL TABLET,,19738,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,UnitedHealthcare,Medicare Advantage,3.43,49,,percent of total billed charges,,
NAPROXEN 500 MG ORAL TABLET,,19738,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
NAPROXEN 500 MG ORAL TABLET,,19738,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,3.36,48,,percent of total billed charges,,100% of DHS outpatient percentage
NAPROXEN 500 MG ORAL TABLET,,19738,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
VITAMIN B COMPLEX ORAL CAP,,19963,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
VITAMIN B COMPLEX ORAL CAP,,19963,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
VITAMIN B COMPLEX ORAL CAP,,19963,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
VITAMIN B COMPLEX ORAL CAP,,19963,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
VITAMIN B COMPLEX ORAL CAP,,19963,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
VITAMIN B COMPLEX ORAL CAP,,19963,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
VITAMIN B COMPLEX ORAL CAP,,19963,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
VITAMIN B COMPLEX ORAL CAP,,19963,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
VITAMIN B COMPLEX ORAL CAP,,19963,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
VITAMIN B COMPLEX ORAL CAP,,19963,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
VITAMIN B COMPLEX ORAL CAP,,19963,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
VITAMIN B COMPLEX ORAL CAP,,19963,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
VITAMIN B COMPLEX ORAL CAP,,19963,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
VITAMIN B COMPLEX ORAL CAP,,19963,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
VITAMIN B COMPLEX ORAL CAP,,19963,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
VITAMIN B COMPLEX ORAL CAP,,19963,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
VITAMIN B COMPLEX ORAL CAP,,19963,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
VITAMIN B COMPLEX ORAL CAP,,19963,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
VITAMIN B COMPLEX ORAL CAP,,19963,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
VITAMIN B COMPLEX ORAL CAP,,19963,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
VITAMIN B COMPLEX ORAL CAP,,19963,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
VITAMIN B COMPLEX ORAL CAP,,19963,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
VITAMIN B COMPLEX ORAL CAP,,19963,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
VITAMIN B COMPLEX ORAL CAP,,19963,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
VITAMIN B COMPLEX ORAL CAP,,19963,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
VITAMIN B COMPLEX ORAL CAP,,19963,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
VITAMIN B COMPLEX ORAL CAP,,19963,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
VITAMIN B COMPLEX ORAL CAP,,19963,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
VITAMIN B COMPLEX ORAL CAP,,19963,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
VITAMIN B COMPLEX ORAL CAP,,19963,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
VITAMIN B COMPLEX ORAL CAP,,19963,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
VITAMIN B COMPLEX ORAL CAP,,19963,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
VITAMIN B COMPLEX ORAL CAP,,19963,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
VITAMIN B COMPLEX ORAL CAP,,19963,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
VITAMIN B COMPLEX ORAL CAP,,19963,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
VITAMIN B COMPLEX ORAL CAP,,19963,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
VITAMIN B COMPLEX ORAL CAP,,19963,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
VITAMIN B COMPLEX ORAL CAP,,19963,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
VITAMIN B COMPLEX ORAL CAP,,19963,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
VITAMIN B COMPLEX ORAL CAP,,19963,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
VITAMIN B COMPLEX ORAL CAP,,19963,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
VITAMIN B COMPLEX ORAL CAP,,19963,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
VITAMIN B COMPLEX ORAL CAP,,19963,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
VITAMIN B COMPLEX ORAL CAP,,19963,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
VITAMIN B COMPLEX ORAL CAP,,19963,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
VITAMIN B COMPLEX ORAL CAP,,19963,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
VITAMIN B COMPLEX ORAL CAP,,19963,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
VITAMIN B COMPLEX ORAL CAP,,19963,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
VITAMIN B COMPLEX ORAL CAP,,19963,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
VITAMIN B COMPLEX ORAL CAP,,19963,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
VITAMIN B COMPLEX ORAL CAP,,19963,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
VITAMIN B COMPLEX ORAL CAP,,19963,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
VITAMIN B COMPLEX ORAL CAP,,19963,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
VITAMIN B COMPLEX ORAL CAP,,19963,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
DIAZEPAM 5 MG ORAL TABLET,,19982,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
DIAZEPAM 5 MG ORAL TABLET,,19982,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
DIAZEPAM 5 MG ORAL TABLET,,19982,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
DIAZEPAM 5 MG ORAL TABLET,,19982,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
DIAZEPAM 5 MG ORAL TABLET,,19982,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
DIAZEPAM 5 MG ORAL TABLET,,19982,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
DIAZEPAM 5 MG ORAL TABLET,,19982,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
DIAZEPAM 5 MG ORAL TABLET,,19982,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
DIAZEPAM 5 MG ORAL TABLET,,19982,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
DIAZEPAM 5 MG ORAL TABLET,,19982,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
DIAZEPAM 5 MG ORAL TABLET,,19982,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
DIAZEPAM 5 MG ORAL TABLET,,19982,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
DIAZEPAM 5 MG ORAL TABLET,,19982,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
DIAZEPAM 5 MG ORAL TABLET,,19982,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
DIAZEPAM 5 MG ORAL TABLET,,19982,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
DIAZEPAM 5 MG ORAL TABLET,,19982,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
DIAZEPAM 5 MG ORAL TABLET,,19982,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
DIAZEPAM 5 MG ORAL TABLET,,19982,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
DIAZEPAM 5 MG ORAL TABLET,,19982,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
DIAZEPAM 5 MG ORAL TABLET,,19982,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
DIAZEPAM 5 MG ORAL TABLET,,19982,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
DIAZEPAM 5 MG ORAL TABLET,,19982,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
DIAZEPAM 5 MG ORAL TABLET,,19982,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
DIAZEPAM 5 MG ORAL TABLET,,19982,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
DIAZEPAM 5 MG ORAL TABLET,,19982,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
DIAZEPAM 5 MG ORAL TABLET,,19982,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
DIAZEPAM 5 MG ORAL TABLET,,19982,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
DIAZEPAM 5 MG ORAL TABLET,,19982,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
DIAZEPAM 5 MG ORAL TABLET,,19982,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
DIAZEPAM 5 MG ORAL TABLET,,19982,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
DIAZEPAM 5 MG ORAL TABLET,,19982,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
DIAZEPAM 5 MG ORAL TABLET,,19982,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
DIAZEPAM 5 MG ORAL TABLET,,19982,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
DIAZEPAM 5 MG ORAL TABLET,,19982,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
DIAZEPAM 5 MG ORAL TABLET,,19982,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
DIAZEPAM 5 MG ORAL TABLET,,19982,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
DIAZEPAM 5 MG ORAL TABLET,,19982,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DIAZEPAM 5 MG ORAL TABLET,,19982,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DIAZEPAM 5 MG ORAL TABLET,,19982,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
DIAZEPAM 5 MG ORAL TABLET,,19982,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
DIAZEPAM 5 MG ORAL TABLET,,19982,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
DIAZEPAM 5 MG ORAL TABLET,,19982,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
DIAZEPAM 5 MG ORAL TABLET,,19982,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
DIAZEPAM 5 MG ORAL TABLET,,19982,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
DIAZEPAM 5 MG ORAL TABLET,,19982,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
DIAZEPAM 5 MG ORAL TABLET,,19982,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
DIAZEPAM 5 MG ORAL TABLET,,19982,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
DIAZEPAM 5 MG ORAL TABLET,,19982,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
DIAZEPAM 5 MG ORAL TABLET,,19982,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
DIAZEPAM 5 MG ORAL TABLET,,19982,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
DIAZEPAM 5 MG ORAL TABLET,,19982,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
DIAZEPAM 5 MG ORAL TABLET,,19982,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
DIAZEPAM 5 MG ORAL TABLET,,19982,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
DIAZEPAM 5 MG ORAL TABLET,,19982,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
DIAZEPAM 5 MG ORAL TABLET,,19982,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
DIAZEPAM 5 MG ORAL TABLET,,19982,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
DIAZEPAM 5 MG ORAL TABLET,,19982,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
DIAZEPAM 5 MG ORAL TABLET,,19982,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
DIAZEPAM 5 MG ORAL TABLET,,19982,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
DIAZEPAM 5 MG ORAL TABLET,,19982,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
DIAZEPAM 5 MG ORAL TABLET,,19982,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
DIAZEPAM 5 MG ORAL TABLET,,19982,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
DIAZEPAM 5 MG ORAL TABLET,,19982,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
DIAZEPAM 5 MG ORAL TABLET,,19982,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
DIAZEPAM 5 MG ORAL TABLET,,19982,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
DIAZEPAM 5 MG ORAL TABLET,,19982,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
DIAZEPAM 5 MG ORAL TABLET,,19982,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
DIAZEPAM 5 MG ORAL TABLET,,19982,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
DIAZEPAM 5 MG ORAL TABLET,,19982,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
DIAZEPAM 5 MG ORAL TABLET,,19982,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
DIAZEPAM 5 MG ORAL TABLET,,19982,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
DIAZEPAM 5 MG ORAL TABLET,,19982,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
DIAZEPAM 5 MG ORAL TABLET,,19982,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
DIAZEPAM 5 MG ORAL TABLET,,19982,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
DIAZEPAM 5 MG ORAL TABLET,,19982,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DIAZEPAM 5 MG ORAL TABLET,,19982,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DIAZEPAM 5 MG ORAL TABLET,,19982,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
DIAZEPAM 5 MG ORAL TABLET,,19982,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
DIAZEPAM 5 MG ORAL TABLET,,19982,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
DIAZEPAM 5 MG ORAL TABLET,,19982,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
DIAZEPAM 5 MG ORAL TABLET,,19982,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
DIAZEPAM 5 MG ORAL TABLET,,19982,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
DIAZEPAM 5 MG ORAL TABLET,,19982,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
DIAZEPAM 5 MG ORAL TABLET,,19982,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
DIAZEPAM 5 MG ORAL TABLET,,19982,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
DIAZEPAM 5 MG ORAL TABLET,,19982,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
DIAZEPAM 5 MG ORAL TABLET,,19982,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DIAZEPAM 5 MG ORAL TABLET,,19982,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DIAZEPAM 5 MG ORAL TABLET,,19982,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
DIAZEPAM 5 MG ORAL TABLET,,19982,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
DIAZEPAM 5 MG ORAL TABLET,,19982,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DIAZEPAM 5 MG ORAL TABLET,,19982,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DIAZEPAM 5 MG ORAL TABLET,,19982,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DIAZEPAM 5 MG ORAL TABLET,,19982,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DIAZEPAM 5 MG ORAL TABLET,,19982,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DIAZEPAM 5 MG ORAL TABLET,,19982,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DIAZEPAM 5 MG ORAL TABLET,,19982,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DIAZEPAM 5 MG ORAL TABLET,,19982,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DIAZEPAM 5 MG ORAL TABLET,,19982,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
DIAZEPAM 5 MG ORAL TABLET,,19982,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
DIAZEPAM 5 MG ORAL TABLET,,19982,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
DIAZEPAM 5 MG ORAL TABLET,,19982,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
DIAZEPAM 5 MG ORAL TABLET,,19982,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
DIAZEPAM 5 MG ORAL TABLET,,19982,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
DIAZEPAM 5 MG ORAL TABLET,,19982,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
DIAZEPAM 5 MG ORAL TABLET,,19982,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
DIAZEPAM 5 MG ORAL TABLET,,19982,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
DIAZEPAM 5 MG ORAL TABLET,,19982,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
METOCLOPRAMIDE HCL 10 MG ORAL TABLET,,19985,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
METOCLOPRAMIDE HCL 10 MG ORAL TABLET,,19985,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
METOCLOPRAMIDE HCL 10 MG ORAL TABLET,,19985,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
METOCLOPRAMIDE HCL 10 MG ORAL TABLET,,19985,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
METOCLOPRAMIDE HCL 10 MG ORAL TABLET,,19985,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
METOCLOPRAMIDE HCL 10 MG ORAL TABLET,,19985,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
METOCLOPRAMIDE HCL 10 MG ORAL TABLET,,19985,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
METOCLOPRAMIDE HCL 10 MG ORAL TABLET,,19985,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
METOCLOPRAMIDE HCL 10 MG ORAL TABLET,,19985,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
METOCLOPRAMIDE HCL 10 MG ORAL TABLET,,19985,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
METOCLOPRAMIDE HCL 10 MG ORAL TABLET,,19985,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
METOCLOPRAMIDE HCL 10 MG ORAL TABLET,,19985,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
METOCLOPRAMIDE HCL 10 MG ORAL TABLET,,19985,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
METOCLOPRAMIDE HCL 10 MG ORAL TABLET,,19985,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
METOCLOPRAMIDE HCL 10 MG ORAL TABLET,,19985,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
METOCLOPRAMIDE HCL 10 MG ORAL TABLET,,19985,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
METOCLOPRAMIDE HCL 10 MG ORAL TABLET,,19985,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
METOCLOPRAMIDE HCL 10 MG ORAL TABLET,,19985,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
METOCLOPRAMIDE HCL 10 MG ORAL TABLET,,19985,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
METOCLOPRAMIDE HCL 10 MG ORAL TABLET,,19985,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
METOCLOPRAMIDE HCL 10 MG ORAL TABLET,,19985,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
METOCLOPRAMIDE HCL 10 MG ORAL TABLET,,19985,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
METOCLOPRAMIDE HCL 10 MG ORAL TABLET,,19985,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
METOCLOPRAMIDE HCL 10 MG ORAL TABLET,,19985,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
METOCLOPRAMIDE HCL 10 MG ORAL TABLET,,19985,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
METOCLOPRAMIDE HCL 10 MG ORAL TABLET,,19985,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
METOCLOPRAMIDE HCL 10 MG ORAL TABLET,,19985,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
METOCLOPRAMIDE HCL 10 MG ORAL TABLET,,19985,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
METOCLOPRAMIDE HCL 10 MG ORAL TABLET,,19985,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
METOCLOPRAMIDE HCL 10 MG ORAL TABLET,,19985,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
METOCLOPRAMIDE HCL 10 MG ORAL TABLET,,19985,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
METOCLOPRAMIDE HCL 10 MG ORAL TABLET,,19985,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
METOCLOPRAMIDE HCL 10 MG ORAL TABLET,,19985,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
METOCLOPRAMIDE HCL 10 MG ORAL TABLET,,19985,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
METOCLOPRAMIDE HCL 10 MG ORAL TABLET,,19985,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
METOCLOPRAMIDE HCL 10 MG ORAL TABLET,,19985,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
METOCLOPRAMIDE HCL 10 MG ORAL TABLET,,19985,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
METOCLOPRAMIDE HCL 10 MG ORAL TABLET,,19985,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
METOCLOPRAMIDE HCL 10 MG ORAL TABLET,,19985,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
METOCLOPRAMIDE HCL 10 MG ORAL TABLET,,19985,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
METOCLOPRAMIDE HCL 10 MG ORAL TABLET,,19985,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
METOCLOPRAMIDE HCL 10 MG ORAL TABLET,,19985,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
METOCLOPRAMIDE HCL 10 MG ORAL TABLET,,19985,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
METOCLOPRAMIDE HCL 10 MG ORAL TABLET,,19985,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
METOCLOPRAMIDE HCL 10 MG ORAL TABLET,,19985,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
METOCLOPRAMIDE HCL 10 MG ORAL TABLET,,19985,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
METOCLOPRAMIDE HCL 10 MG ORAL TABLET,,19985,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
METOCLOPRAMIDE HCL 10 MG ORAL TABLET,,19985,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
METOCLOPRAMIDE HCL 10 MG ORAL TABLET,,19985,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
METOCLOPRAMIDE HCL 10 MG ORAL TABLET,,19985,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
METOCLOPRAMIDE HCL 10 MG ORAL TABLET,,19985,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
METOCLOPRAMIDE HCL 10 MG ORAL TABLET,,19985,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
METOCLOPRAMIDE HCL 10 MG ORAL TABLET,,19985,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
METOCLOPRAMIDE HCL 10 MG ORAL TABLET,,19985,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
DOXAZOSIN 2 MG ORAL TABLET,,20008,LOCAL,Facility,Both,1,Each,,19,16.15,5.4454,19,Aetna,Commercial,17.48,92,,percent of total billed charges,,
DOXAZOSIN 2 MG ORAL TABLET,,20008,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
DOXAZOSIN 2 MG ORAL TABLET,,20008,LOCAL,Facility,Outpatient,1,Each,,19,16.15,5.4454,19,Aetna,Medicare Advantage,9.31,49,,percent of total billed charges,,
DOXAZOSIN 2 MG ORAL TABLET,,20008,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
DOXAZOSIN 2 MG ORAL TABLET,,20008,LOCAL,Facility,Inpatient,1,Each,,19,16.15,5.4454,19,Aetna,Medicare Advantage,,,,,Included in per diem rate,
DOXAZOSIN 2 MG ORAL TABLET,,20008,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
DOXAZOSIN 2 MG ORAL TABLET,,20008,LOCAL,Facility,Both,1,Each,,19,16.15,5.4454,19,Aetna,PPO,17.67,93,,percent of total billed charges,,
DOXAZOSIN 2 MG ORAL TABLET,,20008,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
DOXAZOSIN 2 MG ORAL TABLET,,20008,LOCAL,Facility,Both,1,Each,,19,16.15,5.4454,19,America's PPO,America's PPO,18.2457,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
DOXAZOSIN 2 MG ORAL TABLET,,20008,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
DOXAZOSIN 2 MG ORAL TABLET,,20008,LOCAL,Facility,Both,1,Each,,19,16.15,5.4454,19,BlueCross BlueShield Minnesota, Federal Employee Program,18.696,98.4,,percent of total billed charges,,
DOXAZOSIN 2 MG ORAL TABLET,,20008,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
DOXAZOSIN 2 MG ORAL TABLET,,20008,LOCAL,Facility,Both,1,Each,,19,16.15,5.4454,19,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,19,100,,percent of total billed charges,,
DOXAZOSIN 2 MG ORAL TABLET,,20008,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
DOXAZOSIN 2 MG ORAL TABLET,,20008,LOCAL,Facility,Both,1,Each,,19,16.15,5.4454,19,BlueCross BlueShield Minnesota,High Value Network Plan,17.1,90,,percent of total billed charges,,
DOXAZOSIN 2 MG ORAL TABLET,,20008,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
DOXAZOSIN 2 MG ORAL TABLET,,20008,LOCAL,Facility,Outpatient,1,Each,,19,16.15,5.4454,19,BlueCross BlueShield Minnesota,Medicare Advantage,9.31,49,,percent of total billed charges,,
DOXAZOSIN 2 MG ORAL TABLET,,20008,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
DOXAZOSIN 2 MG ORAL TABLET,,20008,LOCAL,Facility,Inpatient,1,Each,,19,16.15,5.4454,19,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
DOXAZOSIN 2 MG ORAL TABLET,,20008,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
DOXAZOSIN 2 MG ORAL TABLET,,20008,LOCAL,Facility,Both,1,Each,,19,16.15,5.4454,19,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,16.8283,88.57,,percent of total billed charges,,
DOXAZOSIN 2 MG ORAL TABLET,,20008,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
DOXAZOSIN 2 MG ORAL TABLET,,20008,LOCAL,Facility,Both,1,Each,,19,16.15,5.4454,19,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,5.4454,28.66,,percent of total billed charges,,
DOXAZOSIN 2 MG ORAL TABLET,,20008,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
DOXAZOSIN 2 MG ORAL TABLET,,20008,LOCAL,Facility,Outpatient,1,Each,,19,16.15,5.4454,19,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),9.31,49,,percent of total billed charges,,
DOXAZOSIN 2 MG ORAL TABLET,,20008,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
DOXAZOSIN 2 MG ORAL TABLET,,20008,LOCAL,Facility,Inpatient,1,Each,,19,16.15,5.4454,19,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
DOXAZOSIN 2 MG ORAL TABLET,,20008,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
DOXAZOSIN 2 MG ORAL TABLET,,20008,LOCAL,Facility,Both,1,Each,,19,16.15,5.4454,19,CorVel,Worker's Compensation,19,100,,percent of total billed charges,,
DOXAZOSIN 2 MG ORAL TABLET,,20008,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
DOXAZOSIN 2 MG ORAL TABLET,,20008,LOCAL,Facility,Both,1,Each,,19,16.15,5.4454,19,First Health Group Corporation,First Health Network,18.43,97,,percent of total billed charges,,
DOXAZOSIN 2 MG ORAL TABLET,,20008,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
DOXAZOSIN 2 MG ORAL TABLET,,20008,LOCAL,Facility,Both,1,Each,,19,16.15,5.4454,19,"Health Partners, Inc.",Commercial,17.974,94.6,,percent of total billed charges,,
DOXAZOSIN 2 MG ORAL TABLET,,20008,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
DOXAZOSIN 2 MG ORAL TABLET,,20008,LOCAL,Facility,Outpatient,1,Each,,19,16.15,5.4454,19,"Health Partners, Inc.",Medicare Advantage,9.31,49,,percent of total billed charges,,
DOXAZOSIN 2 MG ORAL TABLET,,20008,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
DOXAZOSIN 2 MG ORAL TABLET,,20008,LOCAL,Facility,Inpatient,1,Each,,19,16.15,5.4454,19,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DOXAZOSIN 2 MG ORAL TABLET,,20008,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DOXAZOSIN 2 MG ORAL TABLET,,20008,LOCAL,Facility,Both,1,Each,,19,16.15,5.4454,19,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),11.4,60,,percent of total billed charges,,
DOXAZOSIN 2 MG ORAL TABLET,,20008,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
DOXAZOSIN 2 MG ORAL TABLET,,20008,LOCAL,Facility,Both,1,Each,,19,16.15,5.4454,19,"Health Partners, Inc.",State of Minnesota Advantage Program,15.485,81.5,,percent of total billed charges,,
DOXAZOSIN 2 MG ORAL TABLET,,20008,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
DOXAZOSIN 2 MG ORAL TABLET,,20008,LOCAL,Facility,Both,1,Each,,19,16.15,5.4454,19,"Health Partners, Inc.",State Public Programs,9.5,50,,percent of total billed charges,,
DOXAZOSIN 2 MG ORAL TABLET,,20008,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
DOXAZOSIN 2 MG ORAL TABLET,,20008,LOCAL,Facility,Both,1,Each,,19,16.15,5.4454,19,Humana Insurance Company,Commercial PPO,18.05,95,,percent of total billed charges,,
DOXAZOSIN 2 MG ORAL TABLET,,20008,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
DOXAZOSIN 2 MG ORAL TABLET,,20008,LOCAL,Facility,Outpatient,1,Each,,19,16.15,5.4454,19,Humana Insurance Company,Medicare PPO,9.31,49,,percent of total billed charges,,
DOXAZOSIN 2 MG ORAL TABLET,,20008,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
DOXAZOSIN 2 MG ORAL TABLET,,20008,LOCAL,Facility,Inpatient,1,Each,,19,16.15,5.4454,19,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
DOXAZOSIN 2 MG ORAL TABLET,,20008,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
DOXAZOSIN 2 MG ORAL TABLET,,20008,LOCAL,Facility,Both,1,Each,,19,16.15,5.4454,19,Medica,Individual & Family,18.829,99.1,,percent of total billed charges,,
DOXAZOSIN 2 MG ORAL TABLET,,20008,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
DOXAZOSIN 2 MG ORAL TABLET,,20008,LOCAL,Facility,Outpatient,1,Each,,19,16.15,5.4454,19,Medica,Medica Advantage Solution,9.462,49.8,,percent of total billed charges,,
DOXAZOSIN 2 MG ORAL TABLET,,20008,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
DOXAZOSIN 2 MG ORAL TABLET,,20008,LOCAL,Facility,Inpatient,1,Each,,19,16.15,5.4454,19,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
DOXAZOSIN 2 MG ORAL TABLET,,20008,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
DOXAZOSIN 2 MG ORAL TABLET,,20008,LOCAL,Facility,Outpatient,1,Each,,19,16.15,5.4454,19,Medica,Medical Assistance,8.474,44.6,,percent of total billed charges,,
DOXAZOSIN 2 MG ORAL TABLET,,20008,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
DOXAZOSIN 2 MG ORAL TABLET,,20008,LOCAL,Facility,Inpatient,1,Each,,19,16.15,5.4454,19,Medica,Medical Assistance,,,,,Included in per diem rate,
DOXAZOSIN 2 MG ORAL TABLET,,20008,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
DOXAZOSIN 2 MG ORAL TABLET,,20008,LOCAL,Facility,Outpatient,1,Each,,19,16.15,5.4454,19,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,9.462,49.8,,percent of total billed charges,,
DOXAZOSIN 2 MG ORAL TABLET,,20008,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
DOXAZOSIN 2 MG ORAL TABLET,,20008,LOCAL,Facility,Inpatient,1,Each,,19,16.15,5.4454,19,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
DOXAZOSIN 2 MG ORAL TABLET,,20008,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
DOXAZOSIN 2 MG ORAL TABLET,,20008,LOCAL,Facility,Both,1,Each,,19,16.15,5.4454,19,"Multiplan, Inc.","Multiplan, Inc.",17.86,94,,percent of total billed charges,,
DOXAZOSIN 2 MG ORAL TABLET,,20008,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
DOXAZOSIN 2 MG ORAL TABLET,,20008,LOCAL,Facility,Outpatient,1,Each,,19,16.15,5.4454,19,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,17.119,90.1,,percent of total billed charges,,
DOXAZOSIN 2 MG ORAL TABLET,,20008,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
DOXAZOSIN 2 MG ORAL TABLET,,20008,LOCAL,Facility,Inpatient,1,Each,,19,16.15,5.4454,19,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
DOXAZOSIN 2 MG ORAL TABLET,,20008,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
DOXAZOSIN 2 MG ORAL TABLET,,20008,LOCAL,Facility,Both,1,Each,,19,16.15,5.4454,19,"Preferred One Administrative Services, INC.",PPO,18.734,98.6,,percent of total billed charges,,
DOXAZOSIN 2 MG ORAL TABLET,,20008,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
DOXAZOSIN 2 MG ORAL TABLET,,20008,LOCAL,Facility,Outpatient,1,Each,,19,16.15,5.4454,19,PrimeWest Health,Minnesota Senior Health Options (MSHO),9.7755,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
DOXAZOSIN 2 MG ORAL TABLET,,20008,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
DOXAZOSIN 2 MG ORAL TABLET,,20008,LOCAL,Facility,Inpatient,1,Each,,19,16.15,5.4454,19,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DOXAZOSIN 2 MG ORAL TABLET,,20008,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DOXAZOSIN 2 MG ORAL TABLET,,20008,LOCAL,Facility,Outpatient,1,Each,,19,16.15,5.4454,19,PrimeWest Health,MinnesotaCare,9.7584,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
DOXAZOSIN 2 MG ORAL TABLET,,20008,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
DOXAZOSIN 2 MG ORAL TABLET,,20008,LOCAL,Facility,Inpatient,1,Each,,19,16.15,5.4454,19,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
DOXAZOSIN 2 MG ORAL TABLET,,20008,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
DOXAZOSIN 2 MG ORAL TABLET,,20008,LOCAL,Facility,Both,1,Each,,19,16.15,5.4454,19,Sanford Health Plan,Sanford Health Plan,17.48,92,,percent of total billed charges,,
DOXAZOSIN 2 MG ORAL TABLET,,20008,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
DOXAZOSIN 2 MG ORAL TABLET,,20008,LOCAL,Facility,Outpatient,1,Each,,19,16.15,5.4454,19,"UCare Health, Inc.",Individual & Family Plan,10.7065,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
DOXAZOSIN 2 MG ORAL TABLET,,20008,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
DOXAZOSIN 2 MG ORAL TABLET,,20008,LOCAL,Facility,Inpatient,1,Each,,19,16.15,5.4454,19,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
DOXAZOSIN 2 MG ORAL TABLET,,20008,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
DOXAZOSIN 2 MG ORAL TABLET,,20008,LOCAL,Facility,Outpatient,1,Each,,19,16.15,5.4454,19,"UCare Health, Inc.",Medical Assistance,9.5893,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DOXAZOSIN 2 MG ORAL TABLET,,20008,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DOXAZOSIN 2 MG ORAL TABLET,,20008,LOCAL,Facility,Inpatient,1,Each,,19,16.15,5.4454,19,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
DOXAZOSIN 2 MG ORAL TABLET,,20008,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
DOXAZOSIN 2 MG ORAL TABLET,,20008,LOCAL,Facility,Outpatient,1,Each,,19,16.15,5.4454,19,"UCare Health, Inc.",Medicare Advantage,9.5893,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DOXAZOSIN 2 MG ORAL TABLET,,20008,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DOXAZOSIN 2 MG ORAL TABLET,,20008,LOCAL,Facility,Inpatient,1,Each,,19,16.15,5.4454,19,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DOXAZOSIN 2 MG ORAL TABLET,,20008,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DOXAZOSIN 2 MG ORAL TABLET,,20008,LOCAL,Facility,Outpatient,1,Each,,19,16.15,5.4454,19,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),9.5893,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DOXAZOSIN 2 MG ORAL TABLET,,20008,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DOXAZOSIN 2 MG ORAL TABLET,,20008,LOCAL,Facility,Inpatient,1,Each,,19,16.15,5.4454,19,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DOXAZOSIN 2 MG ORAL TABLET,,20008,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DOXAZOSIN 2 MG ORAL TABLET,,20008,LOCAL,Facility,Both,1,Each,,19,16.15,5.4454,19,UnitedHealthcare,Individual & Family,17.86,94,,percent of total billed charges,,
DOXAZOSIN 2 MG ORAL TABLET,,20008,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
DOXAZOSIN 2 MG ORAL TABLET,,20008,LOCAL,Facility,Outpatient,1,Each,,19,16.15,5.4454,19,UnitedHealthcare,Medicare Advantage,9.31,49,,percent of total billed charges,,
DOXAZOSIN 2 MG ORAL TABLET,,20008,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
DOXAZOSIN 2 MG ORAL TABLET,,20008,LOCAL,Facility,Inpatient,1,Each,,19,16.15,5.4454,19,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
DOXAZOSIN 2 MG ORAL TABLET,,20008,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
DOXAZOSIN 2 MG ORAL TABLET,,20008,LOCAL,Facility,Outpatient,1,Each,,19,16.15,5.4454,19,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,9.12,48,,percent of total billed charges,,100% of DHS outpatient percentage
DOXAZOSIN 2 MG ORAL TABLET,,20008,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
DOXAZOSIN 2 MG ORAL TABLET,,20008,LOCAL,Facility,Inpatient,1,Each,,19,16.15,5.4454,19,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
DOXAZOSIN 2 MG ORAL TABLET,,20008,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
LEVOTHYROXINE 112 MCG ORAL TABLET,,20056,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
LEVOTHYROXINE 112 MCG ORAL TABLET,,20056,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
LEVOTHYROXINE 112 MCG ORAL TABLET,,20056,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
LEVOTHYROXINE 112 MCG ORAL TABLET,,20056,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
LEVOTHYROXINE 112 MCG ORAL TABLET,,20056,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
LEVOTHYROXINE 112 MCG ORAL TABLET,,20056,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
LEVOTHYROXINE 112 MCG ORAL TABLET,,20056,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
LEVOTHYROXINE 112 MCG ORAL TABLET,,20056,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
LEVOTHYROXINE 112 MCG ORAL TABLET,,20056,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
LEVOTHYROXINE 112 MCG ORAL TABLET,,20056,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
LEVOTHYROXINE 112 MCG ORAL TABLET,,20056,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
LEVOTHYROXINE 112 MCG ORAL TABLET,,20056,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
LEVOTHYROXINE 112 MCG ORAL TABLET,,20056,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
LEVOTHYROXINE 112 MCG ORAL TABLET,,20056,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
LEVOTHYROXINE 112 MCG ORAL TABLET,,20056,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
LEVOTHYROXINE 112 MCG ORAL TABLET,,20056,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
LEVOTHYROXINE 112 MCG ORAL TABLET,,20056,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
LEVOTHYROXINE 112 MCG ORAL TABLET,,20056,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
LEVOTHYROXINE 112 MCG ORAL TABLET,,20056,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LEVOTHYROXINE 112 MCG ORAL TABLET,,20056,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
LEVOTHYROXINE 112 MCG ORAL TABLET,,20056,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
LEVOTHYROXINE 112 MCG ORAL TABLET,,20056,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
LEVOTHYROXINE 112 MCG ORAL TABLET,,20056,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
LEVOTHYROXINE 112 MCG ORAL TABLET,,20056,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
LEVOTHYROXINE 112 MCG ORAL TABLET,,20056,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
LEVOTHYROXINE 112 MCG ORAL TABLET,,20056,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
LEVOTHYROXINE 112 MCG ORAL TABLET,,20056,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
LEVOTHYROXINE 112 MCG ORAL TABLET,,20056,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
LEVOTHYROXINE 112 MCG ORAL TABLET,,20056,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
LEVOTHYROXINE 112 MCG ORAL TABLET,,20056,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
LEVOTHYROXINE 112 MCG ORAL TABLET,,20056,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
LEVOTHYROXINE 112 MCG ORAL TABLET,,20056,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
LEVOTHYROXINE 112 MCG ORAL TABLET,,20056,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
LEVOTHYROXINE 112 MCG ORAL TABLET,,20056,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
LEVOTHYROXINE 112 MCG ORAL TABLET,,20056,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
LEVOTHYROXINE 112 MCG ORAL TABLET,,20056,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
LEVOTHYROXINE 112 MCG ORAL TABLET,,20056,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
LEVOTHYROXINE 112 MCG ORAL TABLET,,20056,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LEVOTHYROXINE 112 MCG ORAL TABLET,,20056,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
LEVOTHYROXINE 112 MCG ORAL TABLET,,20056,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
LEVOTHYROXINE 112 MCG ORAL TABLET,,20056,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
LEVOTHYROXINE 112 MCG ORAL TABLET,,20056,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
LEVOTHYROXINE 112 MCG ORAL TABLET,,20056,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
LEVOTHYROXINE 112 MCG ORAL TABLET,,20056,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LEVOTHYROXINE 112 MCG ORAL TABLET,,20056,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
LEVOTHYROXINE 112 MCG ORAL TABLET,,20056,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LEVOTHYROXINE 112 MCG ORAL TABLET,,20056,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LEVOTHYROXINE 112 MCG ORAL TABLET,,20056,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LEVOTHYROXINE 112 MCG ORAL TABLET,,20056,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LEVOTHYROXINE 112 MCG ORAL TABLET,,20056,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
LEVOTHYROXINE 112 MCG ORAL TABLET,,20056,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
LEVOTHYROXINE 112 MCG ORAL TABLET,,20056,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
LEVOTHYROXINE 112 MCG ORAL TABLET,,20056,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
LEVOTHYROXINE 112 MCG ORAL TABLET,,20056,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
AMOXICILLIN-POT CLAVULANATE 875-125 MG ORAL TABLET,,20079,LOCAL,Facility,Both,1,Each,,26,22.1,7.4516,26,Aetna,Commercial,23.92,92,,percent of total billed charges,,
AMOXICILLIN-POT CLAVULANATE 875-125 MG ORAL TABLET,,20079,LOCAL,Facility,Outpatient,1,Each,,26,22.1,7.4516,26,Aetna,Medicare Advantage,12.74,49,,percent of total billed charges,,
AMOXICILLIN-POT CLAVULANATE 875-125 MG ORAL TABLET,,20079,LOCAL,Facility,Inpatient,1,Each,,26,22.1,7.4516,26,Aetna,Medicare Advantage,,,,,Included in per diem rate,
AMOXICILLIN-POT CLAVULANATE 875-125 MG ORAL TABLET,,20079,LOCAL,Facility,Both,1,Each,,26,22.1,7.4516,26,Aetna,PPO,24.18,93,,percent of total billed charges,,
AMOXICILLIN-POT CLAVULANATE 875-125 MG ORAL TABLET,,20079,LOCAL,Facility,Both,1,Each,,26,22.1,7.4516,26,America's PPO,America's PPO,24.9678,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
AMOXICILLIN-POT CLAVULANATE 875-125 MG ORAL TABLET,,20079,LOCAL,Facility,Both,1,Each,,26,22.1,7.4516,26,BlueCross BlueShield Minnesota, Federal Employee Program,25.584,98.4,,percent of total billed charges,,
AMOXICILLIN-POT CLAVULANATE 875-125 MG ORAL TABLET,,20079,LOCAL,Facility,Both,1,Each,,26,22.1,7.4516,26,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,26,100,,percent of total billed charges,,
AMOXICILLIN-POT CLAVULANATE 875-125 MG ORAL TABLET,,20079,LOCAL,Facility,Both,1,Each,,26,22.1,7.4516,26,BlueCross BlueShield Minnesota,High Value Network Plan,23.4,90,,percent of total billed charges,,
AMOXICILLIN-POT CLAVULANATE 875-125 MG ORAL TABLET,,20079,LOCAL,Facility,Outpatient,1,Each,,26,22.1,7.4516,26,BlueCross BlueShield Minnesota,Medicare Advantage,12.74,49,,percent of total billed charges,,
AMOXICILLIN-POT CLAVULANATE 875-125 MG ORAL TABLET,,20079,LOCAL,Facility,Inpatient,1,Each,,26,22.1,7.4516,26,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
AMOXICILLIN-POT CLAVULANATE 875-125 MG ORAL TABLET,,20079,LOCAL,Facility,Both,1,Each,,26,22.1,7.4516,26,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,23.0282,88.57,,percent of total billed charges,,
AMOXICILLIN-POT CLAVULANATE 875-125 MG ORAL TABLET,,20079,LOCAL,Facility,Both,1,Each,,26,22.1,7.4516,26,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,7.4516,28.66,,percent of total billed charges,,
AMOXICILLIN-POT CLAVULANATE 875-125 MG ORAL TABLET,,20079,LOCAL,Facility,Outpatient,1,Each,,26,22.1,7.4516,26,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),12.74,49,,percent of total billed charges,,
AMOXICILLIN-POT CLAVULANATE 875-125 MG ORAL TABLET,,20079,LOCAL,Facility,Inpatient,1,Each,,26,22.1,7.4516,26,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
AMOXICILLIN-POT CLAVULANATE 875-125 MG ORAL TABLET,,20079,LOCAL,Facility,Both,1,Each,,26,22.1,7.4516,26,CorVel,Worker's Compensation,26,100,,percent of total billed charges,,
AMOXICILLIN-POT CLAVULANATE 875-125 MG ORAL TABLET,,20079,LOCAL,Facility,Both,1,Each,,26,22.1,7.4516,26,First Health Group Corporation,First Health Network,25.22,97,,percent of total billed charges,,
AMOXICILLIN-POT CLAVULANATE 875-125 MG ORAL TABLET,,20079,LOCAL,Facility,Both,1,Each,,26,22.1,7.4516,26,"Health Partners, Inc.",Commercial,24.596,94.6,,percent of total billed charges,,
AMOXICILLIN-POT CLAVULANATE 875-125 MG ORAL TABLET,,20079,LOCAL,Facility,Outpatient,1,Each,,26,22.1,7.4516,26,"Health Partners, Inc.",Medicare Advantage,12.74,49,,percent of total billed charges,,
AMOXICILLIN-POT CLAVULANATE 875-125 MG ORAL TABLET,,20079,LOCAL,Facility,Inpatient,1,Each,,26,22.1,7.4516,26,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
AMOXICILLIN-POT CLAVULANATE 875-125 MG ORAL TABLET,,20079,LOCAL,Facility,Both,1,Each,,26,22.1,7.4516,26,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),15.6,60,,percent of total billed charges,,
AMOXICILLIN-POT CLAVULANATE 875-125 MG ORAL TABLET,,20079,LOCAL,Facility,Both,1,Each,,26,22.1,7.4516,26,"Health Partners, Inc.",State of Minnesota Advantage Program,21.19,81.5,,percent of total billed charges,,
AMOXICILLIN-POT CLAVULANATE 875-125 MG ORAL TABLET,,20079,LOCAL,Facility,Both,1,Each,,26,22.1,7.4516,26,"Health Partners, Inc.",State Public Programs,13,50,,percent of total billed charges,,
AMOXICILLIN-POT CLAVULANATE 875-125 MG ORAL TABLET,,20079,LOCAL,Facility,Both,1,Each,,26,22.1,7.4516,26,Humana Insurance Company,Commercial PPO,24.7,95,,percent of total billed charges,,
AMOXICILLIN-POT CLAVULANATE 875-125 MG ORAL TABLET,,20079,LOCAL,Facility,Outpatient,1,Each,,26,22.1,7.4516,26,Humana Insurance Company,Medicare PPO,12.74,49,,percent of total billed charges,,
AMOXICILLIN-POT CLAVULANATE 875-125 MG ORAL TABLET,,20079,LOCAL,Facility,Inpatient,1,Each,,26,22.1,7.4516,26,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
AMOXICILLIN-POT CLAVULANATE 875-125 MG ORAL TABLET,,20079,LOCAL,Facility,Both,1,Each,,26,22.1,7.4516,26,Medica,Individual & Family,25.766,99.1,,percent of total billed charges,,
AMOXICILLIN-POT CLAVULANATE 875-125 MG ORAL TABLET,,20079,LOCAL,Facility,Outpatient,1,Each,,26,22.1,7.4516,26,Medica,Medica Advantage Solution,12.948,49.8,,percent of total billed charges,,
AMOXICILLIN-POT CLAVULANATE 875-125 MG ORAL TABLET,,20079,LOCAL,Facility,Inpatient,1,Each,,26,22.1,7.4516,26,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
AMOXICILLIN-POT CLAVULANATE 875-125 MG ORAL TABLET,,20079,LOCAL,Facility,Outpatient,1,Each,,26,22.1,7.4516,26,Medica,Medical Assistance,11.596,44.6,,percent of total billed charges,,
AMOXICILLIN-POT CLAVULANATE 875-125 MG ORAL TABLET,,20079,LOCAL,Facility,Inpatient,1,Each,,26,22.1,7.4516,26,Medica,Medical Assistance,,,,,Included in per diem rate,
AMOXICILLIN-POT CLAVULANATE 875-125 MG ORAL TABLET,,20079,LOCAL,Facility,Outpatient,1,Each,,26,22.1,7.4516,26,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,12.948,49.8,,percent of total billed charges,,
AMOXICILLIN-POT CLAVULANATE 875-125 MG ORAL TABLET,,20079,LOCAL,Facility,Inpatient,1,Each,,26,22.1,7.4516,26,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
AMOXICILLIN-POT CLAVULANATE 875-125 MG ORAL TABLET,,20079,LOCAL,Facility,Both,1,Each,,26,22.1,7.4516,26,"Multiplan, Inc.","Multiplan, Inc.",24.44,94,,percent of total billed charges,,
AMOXICILLIN-POT CLAVULANATE 875-125 MG ORAL TABLET,,20079,LOCAL,Facility,Outpatient,1,Each,,26,22.1,7.4516,26,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,23.426,90.1,,percent of total billed charges,,
AMOXICILLIN-POT CLAVULANATE 875-125 MG ORAL TABLET,,20079,LOCAL,Facility,Inpatient,1,Each,,26,22.1,7.4516,26,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
AMOXICILLIN-POT CLAVULANATE 875-125 MG ORAL TABLET,,20079,LOCAL,Facility,Both,1,Each,,26,22.1,7.4516,26,"Preferred One Administrative Services, INC.",PPO,25.636,98.6,,percent of total billed charges,,
AMOXICILLIN-POT CLAVULANATE 875-125 MG ORAL TABLET,,20079,LOCAL,Facility,Outpatient,1,Each,,26,22.1,7.4516,26,PrimeWest Health,Minnesota Senior Health Options (MSHO),13.377,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
AMOXICILLIN-POT CLAVULANATE 875-125 MG ORAL TABLET,,20079,LOCAL,Facility,Inpatient,1,Each,,26,22.1,7.4516,26,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
AMOXICILLIN-POT CLAVULANATE 875-125 MG ORAL TABLET,,20079,LOCAL,Facility,Outpatient,1,Each,,26,22.1,7.4516,26,PrimeWest Health,MinnesotaCare,13.3536,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
AMOXICILLIN-POT CLAVULANATE 875-125 MG ORAL TABLET,,20079,LOCAL,Facility,Inpatient,1,Each,,26,22.1,7.4516,26,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
AMOXICILLIN-POT CLAVULANATE 875-125 MG ORAL TABLET,,20079,LOCAL,Facility,Both,1,Each,,26,22.1,7.4516,26,Sanford Health Plan,Sanford Health Plan,23.92,92,,percent of total billed charges,,
AMOXICILLIN-POT CLAVULANATE 875-125 MG ORAL TABLET,,20079,LOCAL,Facility,Outpatient,1,Each,,26,22.1,7.4516,26,"UCare Health, Inc.",Individual & Family Plan,14.651,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
AMOXICILLIN-POT CLAVULANATE 875-125 MG ORAL TABLET,,20079,LOCAL,Facility,Inpatient,1,Each,,26,22.1,7.4516,26,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
AMOXICILLIN-POT CLAVULANATE 875-125 MG ORAL TABLET,,20079,LOCAL,Facility,Outpatient,1,Each,,26,22.1,7.4516,26,"UCare Health, Inc.",Medical Assistance,13.1222,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
AMOXICILLIN-POT CLAVULANATE 875-125 MG ORAL TABLET,,20079,LOCAL,Facility,Inpatient,1,Each,,26,22.1,7.4516,26,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
AMOXICILLIN-POT CLAVULANATE 875-125 MG ORAL TABLET,,20079,LOCAL,Facility,Outpatient,1,Each,,26,22.1,7.4516,26,"UCare Health, Inc.",Medicare Advantage,13.1222,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
AMOXICILLIN-POT CLAVULANATE 875-125 MG ORAL TABLET,,20079,LOCAL,Facility,Inpatient,1,Each,,26,22.1,7.4516,26,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
AMOXICILLIN-POT CLAVULANATE 875-125 MG ORAL TABLET,,20079,LOCAL,Facility,Outpatient,1,Each,,26,22.1,7.4516,26,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),13.1222,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
AMOXICILLIN-POT CLAVULANATE 875-125 MG ORAL TABLET,,20079,LOCAL,Facility,Inpatient,1,Each,,26,22.1,7.4516,26,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
AMOXICILLIN-POT CLAVULANATE 875-125 MG ORAL TABLET,,20079,LOCAL,Facility,Both,1,Each,,26,22.1,7.4516,26,UnitedHealthcare,Individual & Family,24.44,94,,percent of total billed charges,,
AMOXICILLIN-POT CLAVULANATE 875-125 MG ORAL TABLET,,20079,LOCAL,Facility,Outpatient,1,Each,,26,22.1,7.4516,26,UnitedHealthcare,Medicare Advantage,12.74,49,,percent of total billed charges,,
AMOXICILLIN-POT CLAVULANATE 875-125 MG ORAL TABLET,,20079,LOCAL,Facility,Inpatient,1,Each,,26,22.1,7.4516,26,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
AMOXICILLIN-POT CLAVULANATE 875-125 MG ORAL TABLET,,20079,LOCAL,Facility,Outpatient,1,Each,,26,22.1,7.4516,26,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,12.48,48,,percent of total billed charges,,100% of DHS outpatient percentage
AMOXICILLIN-POT CLAVULANATE 875-125 MG ORAL TABLET,,20079,LOCAL,Facility,Inpatient,1,Each,,26,22.1,7.4516,26,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
PHENOBARBITAL 32.4 MG ORAL TABLET,,20129,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
PHENOBARBITAL 32.4 MG ORAL TABLET,,20129,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
PHENOBARBITAL 32.4 MG ORAL TABLET,,20129,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
PHENOBARBITAL 32.4 MG ORAL TABLET,,20129,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
PHENOBARBITAL 32.4 MG ORAL TABLET,,20129,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
PHENOBARBITAL 32.4 MG ORAL TABLET,,20129,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
PHENOBARBITAL 32.4 MG ORAL TABLET,,20129,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
PHENOBARBITAL 32.4 MG ORAL TABLET,,20129,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
PHENOBARBITAL 32.4 MG ORAL TABLET,,20129,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
PHENOBARBITAL 32.4 MG ORAL TABLET,,20129,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
PHENOBARBITAL 32.4 MG ORAL TABLET,,20129,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
PHENOBARBITAL 32.4 MG ORAL TABLET,,20129,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
PHENOBARBITAL 32.4 MG ORAL TABLET,,20129,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
PHENOBARBITAL 32.4 MG ORAL TABLET,,20129,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
PHENOBARBITAL 32.4 MG ORAL TABLET,,20129,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
PHENOBARBITAL 32.4 MG ORAL TABLET,,20129,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
PHENOBARBITAL 32.4 MG ORAL TABLET,,20129,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
PHENOBARBITAL 32.4 MG ORAL TABLET,,20129,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
PHENOBARBITAL 32.4 MG ORAL TABLET,,20129,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PHENOBARBITAL 32.4 MG ORAL TABLET,,20129,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
PHENOBARBITAL 32.4 MG ORAL TABLET,,20129,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
PHENOBARBITAL 32.4 MG ORAL TABLET,,20129,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
PHENOBARBITAL 32.4 MG ORAL TABLET,,20129,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
PHENOBARBITAL 32.4 MG ORAL TABLET,,20129,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
PHENOBARBITAL 32.4 MG ORAL TABLET,,20129,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
PHENOBARBITAL 32.4 MG ORAL TABLET,,20129,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
PHENOBARBITAL 32.4 MG ORAL TABLET,,20129,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
PHENOBARBITAL 32.4 MG ORAL TABLET,,20129,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
PHENOBARBITAL 32.4 MG ORAL TABLET,,20129,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
PHENOBARBITAL 32.4 MG ORAL TABLET,,20129,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
PHENOBARBITAL 32.4 MG ORAL TABLET,,20129,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
PHENOBARBITAL 32.4 MG ORAL TABLET,,20129,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
PHENOBARBITAL 32.4 MG ORAL TABLET,,20129,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
PHENOBARBITAL 32.4 MG ORAL TABLET,,20129,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
PHENOBARBITAL 32.4 MG ORAL TABLET,,20129,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
PHENOBARBITAL 32.4 MG ORAL TABLET,,20129,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
PHENOBARBITAL 32.4 MG ORAL TABLET,,20129,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
PHENOBARBITAL 32.4 MG ORAL TABLET,,20129,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PHENOBARBITAL 32.4 MG ORAL TABLET,,20129,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
PHENOBARBITAL 32.4 MG ORAL TABLET,,20129,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
PHENOBARBITAL 32.4 MG ORAL TABLET,,20129,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
PHENOBARBITAL 32.4 MG ORAL TABLET,,20129,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
PHENOBARBITAL 32.4 MG ORAL TABLET,,20129,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
PHENOBARBITAL 32.4 MG ORAL TABLET,,20129,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PHENOBARBITAL 32.4 MG ORAL TABLET,,20129,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
PHENOBARBITAL 32.4 MG ORAL TABLET,,20129,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PHENOBARBITAL 32.4 MG ORAL TABLET,,20129,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PHENOBARBITAL 32.4 MG ORAL TABLET,,20129,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PHENOBARBITAL 32.4 MG ORAL TABLET,,20129,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PHENOBARBITAL 32.4 MG ORAL TABLET,,20129,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
PHENOBARBITAL 32.4 MG ORAL TABLET,,20129,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
PHENOBARBITAL 32.4 MG ORAL TABLET,,20129,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
PHENOBARBITAL 32.4 MG ORAL TABLET,,20129,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
PHENOBARBITAL 32.4 MG ORAL TABLET,,20129,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
AMOXICILLIN-POT CLAVULANATE 500-125 MG ORAL TABLET,,20227,LOCAL,Facility,Both,1,Each,,19,16.15,5.4454,19,Aetna,Commercial,17.48,92,,percent of total billed charges,,
AMOXICILLIN-POT CLAVULANATE 500-125 MG ORAL TABLET,,20227,LOCAL,Facility,Outpatient,1,Each,,19,16.15,5.4454,19,Aetna,Medicare Advantage,9.31,49,,percent of total billed charges,,
AMOXICILLIN-POT CLAVULANATE 500-125 MG ORAL TABLET,,20227,LOCAL,Facility,Inpatient,1,Each,,19,16.15,5.4454,19,Aetna,Medicare Advantage,,,,,Included in per diem rate,
AMOXICILLIN-POT CLAVULANATE 500-125 MG ORAL TABLET,,20227,LOCAL,Facility,Both,1,Each,,19,16.15,5.4454,19,Aetna,PPO,17.67,93,,percent of total billed charges,,
AMOXICILLIN-POT CLAVULANATE 500-125 MG ORAL TABLET,,20227,LOCAL,Facility,Both,1,Each,,19,16.15,5.4454,19,America's PPO,America's PPO,18.2457,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
AMOXICILLIN-POT CLAVULANATE 500-125 MG ORAL TABLET,,20227,LOCAL,Facility,Both,1,Each,,19,16.15,5.4454,19,BlueCross BlueShield Minnesota, Federal Employee Program,18.696,98.4,,percent of total billed charges,,
AMOXICILLIN-POT CLAVULANATE 500-125 MG ORAL TABLET,,20227,LOCAL,Facility,Both,1,Each,,19,16.15,5.4454,19,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,19,100,,percent of total billed charges,,
AMOXICILLIN-POT CLAVULANATE 500-125 MG ORAL TABLET,,20227,LOCAL,Facility,Both,1,Each,,19,16.15,5.4454,19,BlueCross BlueShield Minnesota,High Value Network Plan,17.1,90,,percent of total billed charges,,
AMOXICILLIN-POT CLAVULANATE 500-125 MG ORAL TABLET,,20227,LOCAL,Facility,Outpatient,1,Each,,19,16.15,5.4454,19,BlueCross BlueShield Minnesota,Medicare Advantage,9.31,49,,percent of total billed charges,,
AMOXICILLIN-POT CLAVULANATE 500-125 MG ORAL TABLET,,20227,LOCAL,Facility,Inpatient,1,Each,,19,16.15,5.4454,19,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
AMOXICILLIN-POT CLAVULANATE 500-125 MG ORAL TABLET,,20227,LOCAL,Facility,Both,1,Each,,19,16.15,5.4454,19,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,16.8283,88.57,,percent of total billed charges,,
AMOXICILLIN-POT CLAVULANATE 500-125 MG ORAL TABLET,,20227,LOCAL,Facility,Both,1,Each,,19,16.15,5.4454,19,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,5.4454,28.66,,percent of total billed charges,,
AMOXICILLIN-POT CLAVULANATE 500-125 MG ORAL TABLET,,20227,LOCAL,Facility,Outpatient,1,Each,,19,16.15,5.4454,19,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),9.31,49,,percent of total billed charges,,
AMOXICILLIN-POT CLAVULANATE 500-125 MG ORAL TABLET,,20227,LOCAL,Facility,Inpatient,1,Each,,19,16.15,5.4454,19,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
AMOXICILLIN-POT CLAVULANATE 500-125 MG ORAL TABLET,,20227,LOCAL,Facility,Both,1,Each,,19,16.15,5.4454,19,CorVel,Worker's Compensation,19,100,,percent of total billed charges,,
AMOXICILLIN-POT CLAVULANATE 500-125 MG ORAL TABLET,,20227,LOCAL,Facility,Both,1,Each,,19,16.15,5.4454,19,First Health Group Corporation,First Health Network,18.43,97,,percent of total billed charges,,
AMOXICILLIN-POT CLAVULANATE 500-125 MG ORAL TABLET,,20227,LOCAL,Facility,Both,1,Each,,19,16.15,5.4454,19,"Health Partners, Inc.",Commercial,17.974,94.6,,percent of total billed charges,,
AMOXICILLIN-POT CLAVULANATE 500-125 MG ORAL TABLET,,20227,LOCAL,Facility,Outpatient,1,Each,,19,16.15,5.4454,19,"Health Partners, Inc.",Medicare Advantage,9.31,49,,percent of total billed charges,,
AMOXICILLIN-POT CLAVULANATE 500-125 MG ORAL TABLET,,20227,LOCAL,Facility,Inpatient,1,Each,,19,16.15,5.4454,19,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
AMOXICILLIN-POT CLAVULANATE 500-125 MG ORAL TABLET,,20227,LOCAL,Facility,Both,1,Each,,19,16.15,5.4454,19,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),11.4,60,,percent of total billed charges,,
AMOXICILLIN-POT CLAVULANATE 500-125 MG ORAL TABLET,,20227,LOCAL,Facility,Both,1,Each,,19,16.15,5.4454,19,"Health Partners, Inc.",State of Minnesota Advantage Program,15.485,81.5,,percent of total billed charges,,
AMOXICILLIN-POT CLAVULANATE 500-125 MG ORAL TABLET,,20227,LOCAL,Facility,Both,1,Each,,19,16.15,5.4454,19,"Health Partners, Inc.",State Public Programs,9.5,50,,percent of total billed charges,,
AMOXICILLIN-POT CLAVULANATE 500-125 MG ORAL TABLET,,20227,LOCAL,Facility,Both,1,Each,,19,16.15,5.4454,19,Humana Insurance Company,Commercial PPO,18.05,95,,percent of total billed charges,,
AMOXICILLIN-POT CLAVULANATE 500-125 MG ORAL TABLET,,20227,LOCAL,Facility,Outpatient,1,Each,,19,16.15,5.4454,19,Humana Insurance Company,Medicare PPO,9.31,49,,percent of total billed charges,,
AMOXICILLIN-POT CLAVULANATE 500-125 MG ORAL TABLET,,20227,LOCAL,Facility,Inpatient,1,Each,,19,16.15,5.4454,19,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
AMOXICILLIN-POT CLAVULANATE 500-125 MG ORAL TABLET,,20227,LOCAL,Facility,Both,1,Each,,19,16.15,5.4454,19,Medica,Individual & Family,18.829,99.1,,percent of total billed charges,,
AMOXICILLIN-POT CLAVULANATE 500-125 MG ORAL TABLET,,20227,LOCAL,Facility,Outpatient,1,Each,,19,16.15,5.4454,19,Medica,Medica Advantage Solution,9.462,49.8,,percent of total billed charges,,
AMOXICILLIN-POT CLAVULANATE 500-125 MG ORAL TABLET,,20227,LOCAL,Facility,Inpatient,1,Each,,19,16.15,5.4454,19,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
AMOXICILLIN-POT CLAVULANATE 500-125 MG ORAL TABLET,,20227,LOCAL,Facility,Outpatient,1,Each,,19,16.15,5.4454,19,Medica,Medical Assistance,8.474,44.6,,percent of total billed charges,,
AMOXICILLIN-POT CLAVULANATE 500-125 MG ORAL TABLET,,20227,LOCAL,Facility,Inpatient,1,Each,,19,16.15,5.4454,19,Medica,Medical Assistance,,,,,Included in per diem rate,
AMOXICILLIN-POT CLAVULANATE 500-125 MG ORAL TABLET,,20227,LOCAL,Facility,Outpatient,1,Each,,19,16.15,5.4454,19,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,9.462,49.8,,percent of total billed charges,,
AMOXICILLIN-POT CLAVULANATE 500-125 MG ORAL TABLET,,20227,LOCAL,Facility,Inpatient,1,Each,,19,16.15,5.4454,19,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
AMOXICILLIN-POT CLAVULANATE 500-125 MG ORAL TABLET,,20227,LOCAL,Facility,Both,1,Each,,19,16.15,5.4454,19,"Multiplan, Inc.","Multiplan, Inc.",17.86,94,,percent of total billed charges,,
AMOXICILLIN-POT CLAVULANATE 500-125 MG ORAL TABLET,,20227,LOCAL,Facility,Outpatient,1,Each,,19,16.15,5.4454,19,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,17.119,90.1,,percent of total billed charges,,
AMOXICILLIN-POT CLAVULANATE 500-125 MG ORAL TABLET,,20227,LOCAL,Facility,Inpatient,1,Each,,19,16.15,5.4454,19,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
AMOXICILLIN-POT CLAVULANATE 500-125 MG ORAL TABLET,,20227,LOCAL,Facility,Both,1,Each,,19,16.15,5.4454,19,"Preferred One Administrative Services, INC.",PPO,18.734,98.6,,percent of total billed charges,,
AMOXICILLIN-POT CLAVULANATE 500-125 MG ORAL TABLET,,20227,LOCAL,Facility,Outpatient,1,Each,,19,16.15,5.4454,19,PrimeWest Health,Minnesota Senior Health Options (MSHO),9.7755,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
AMOXICILLIN-POT CLAVULANATE 500-125 MG ORAL TABLET,,20227,LOCAL,Facility,Inpatient,1,Each,,19,16.15,5.4454,19,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
AMOXICILLIN-POT CLAVULANATE 500-125 MG ORAL TABLET,,20227,LOCAL,Facility,Outpatient,1,Each,,19,16.15,5.4454,19,PrimeWest Health,MinnesotaCare,9.7584,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
AMOXICILLIN-POT CLAVULANATE 500-125 MG ORAL TABLET,,20227,LOCAL,Facility,Inpatient,1,Each,,19,16.15,5.4454,19,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
AMOXICILLIN-POT CLAVULANATE 500-125 MG ORAL TABLET,,20227,LOCAL,Facility,Both,1,Each,,19,16.15,5.4454,19,Sanford Health Plan,Sanford Health Plan,17.48,92,,percent of total billed charges,,
AMOXICILLIN-POT CLAVULANATE 500-125 MG ORAL TABLET,,20227,LOCAL,Facility,Outpatient,1,Each,,19,16.15,5.4454,19,"UCare Health, Inc.",Individual & Family Plan,10.7065,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
AMOXICILLIN-POT CLAVULANATE 500-125 MG ORAL TABLET,,20227,LOCAL,Facility,Inpatient,1,Each,,19,16.15,5.4454,19,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
AMOXICILLIN-POT CLAVULANATE 500-125 MG ORAL TABLET,,20227,LOCAL,Facility,Outpatient,1,Each,,19,16.15,5.4454,19,"UCare Health, Inc.",Medical Assistance,9.5893,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
AMOXICILLIN-POT CLAVULANATE 500-125 MG ORAL TABLET,,20227,LOCAL,Facility,Inpatient,1,Each,,19,16.15,5.4454,19,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
AMOXICILLIN-POT CLAVULANATE 500-125 MG ORAL TABLET,,20227,LOCAL,Facility,Outpatient,1,Each,,19,16.15,5.4454,19,"UCare Health, Inc.",Medicare Advantage,9.5893,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
AMOXICILLIN-POT CLAVULANATE 500-125 MG ORAL TABLET,,20227,LOCAL,Facility,Inpatient,1,Each,,19,16.15,5.4454,19,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
AMOXICILLIN-POT CLAVULANATE 500-125 MG ORAL TABLET,,20227,LOCAL,Facility,Outpatient,1,Each,,19,16.15,5.4454,19,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),9.5893,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
AMOXICILLIN-POT CLAVULANATE 500-125 MG ORAL TABLET,,20227,LOCAL,Facility,Inpatient,1,Each,,19,16.15,5.4454,19,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
AMOXICILLIN-POT CLAVULANATE 500-125 MG ORAL TABLET,,20227,LOCAL,Facility,Both,1,Each,,19,16.15,5.4454,19,UnitedHealthcare,Individual & Family,17.86,94,,percent of total billed charges,,
AMOXICILLIN-POT CLAVULANATE 500-125 MG ORAL TABLET,,20227,LOCAL,Facility,Outpatient,1,Each,,19,16.15,5.4454,19,UnitedHealthcare,Medicare Advantage,9.31,49,,percent of total billed charges,,
AMOXICILLIN-POT CLAVULANATE 500-125 MG ORAL TABLET,,20227,LOCAL,Facility,Inpatient,1,Each,,19,16.15,5.4454,19,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
AMOXICILLIN-POT CLAVULANATE 500-125 MG ORAL TABLET,,20227,LOCAL,Facility,Outpatient,1,Each,,19,16.15,5.4454,19,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,9.12,48,,percent of total billed charges,,100% of DHS outpatient percentage
AMOXICILLIN-POT CLAVULANATE 500-125 MG ORAL TABLET,,20227,LOCAL,Facility,Inpatient,1,Each,,19,16.15,5.4454,19,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
NICOTINE 7 MG/24 HR TD PT24,,20258,LOCAL,Facility,Both,1,Each,,13,11.05,3.7258,13,Aetna,Commercial,11.96,92,,percent of total billed charges,,
NICOTINE 7 MG/24 HR TD PT24,,20258,LOCAL,Facility,Outpatient,1,Each,,13,11.05,3.7258,13,Aetna,Medicare Advantage,6.37,49,,percent of total billed charges,,
NICOTINE 7 MG/24 HR TD PT24,,20258,LOCAL,Facility,Inpatient,1,Each,,13,11.05,3.7258,13,Aetna,Medicare Advantage,,,,,Included in per diem rate,
NICOTINE 7 MG/24 HR TD PT24,,20258,LOCAL,Facility,Both,1,Each,,13,11.05,3.7258,13,Aetna,PPO,12.09,93,,percent of total billed charges,,
NICOTINE 7 MG/24 HR TD PT24,,20258,LOCAL,Facility,Both,1,Each,,13,11.05,3.7258,13,America's PPO,America's PPO,12.4839,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
NICOTINE 7 MG/24 HR TD PT24,,20258,LOCAL,Facility,Both,1,Each,,13,11.05,3.7258,13,BlueCross BlueShield Minnesota, Federal Employee Program,12.792,98.4,,percent of total billed charges,,
NICOTINE 7 MG/24 HR TD PT24,,20258,LOCAL,Facility,Both,1,Each,,13,11.05,3.7258,13,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,13,100,,percent of total billed charges,,
NICOTINE 7 MG/24 HR TD PT24,,20258,LOCAL,Facility,Both,1,Each,,13,11.05,3.7258,13,BlueCross BlueShield Minnesota,High Value Network Plan,11.7,90,,percent of total billed charges,,
NICOTINE 7 MG/24 HR TD PT24,,20258,LOCAL,Facility,Outpatient,1,Each,,13,11.05,3.7258,13,BlueCross BlueShield Minnesota,Medicare Advantage,6.37,49,,percent of total billed charges,,
NICOTINE 7 MG/24 HR TD PT24,,20258,LOCAL,Facility,Inpatient,1,Each,,13,11.05,3.7258,13,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
NICOTINE 7 MG/24 HR TD PT24,,20258,LOCAL,Facility,Both,1,Each,,13,11.05,3.7258,13,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,11.5141,88.57,,percent of total billed charges,,
NICOTINE 7 MG/24 HR TD PT24,,20258,LOCAL,Facility,Both,1,Each,,13,11.05,3.7258,13,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,3.7258,28.66,,percent of total billed charges,,
NICOTINE 7 MG/24 HR TD PT24,,20258,LOCAL,Facility,Outpatient,1,Each,,13,11.05,3.7258,13,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),6.37,49,,percent of total billed charges,,
NICOTINE 7 MG/24 HR TD PT24,,20258,LOCAL,Facility,Inpatient,1,Each,,13,11.05,3.7258,13,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
NICOTINE 7 MG/24 HR TD PT24,,20258,LOCAL,Facility,Both,1,Each,,13,11.05,3.7258,13,CorVel,Worker's Compensation,13,100,,percent of total billed charges,,
NICOTINE 7 MG/24 HR TD PT24,,20258,LOCAL,Facility,Both,1,Each,,13,11.05,3.7258,13,First Health Group Corporation,First Health Network,12.61,97,,percent of total billed charges,,
NICOTINE 7 MG/24 HR TD PT24,,20258,LOCAL,Facility,Both,1,Each,,13,11.05,3.7258,13,"Health Partners, Inc.",Commercial,12.298,94.6,,percent of total billed charges,,
NICOTINE 7 MG/24 HR TD PT24,,20258,LOCAL,Facility,Outpatient,1,Each,,13,11.05,3.7258,13,"Health Partners, Inc.",Medicare Advantage,6.37,49,,percent of total billed charges,,
NICOTINE 7 MG/24 HR TD PT24,,20258,LOCAL,Facility,Inpatient,1,Each,,13,11.05,3.7258,13,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
NICOTINE 7 MG/24 HR TD PT24,,20258,LOCAL,Facility,Both,1,Each,,13,11.05,3.7258,13,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),7.8,60,,percent of total billed charges,,
NICOTINE 7 MG/24 HR TD PT24,,20258,LOCAL,Facility,Both,1,Each,,13,11.05,3.7258,13,"Health Partners, Inc.",State of Minnesota Advantage Program,10.595,81.5,,percent of total billed charges,,
NICOTINE 7 MG/24 HR TD PT24,,20258,LOCAL,Facility,Both,1,Each,,13,11.05,3.7258,13,"Health Partners, Inc.",State Public Programs,6.5,50,,percent of total billed charges,,
NICOTINE 7 MG/24 HR TD PT24,,20258,LOCAL,Facility,Both,1,Each,,13,11.05,3.7258,13,Humana Insurance Company,Commercial PPO,12.35,95,,percent of total billed charges,,
NICOTINE 7 MG/24 HR TD PT24,,20258,LOCAL,Facility,Outpatient,1,Each,,13,11.05,3.7258,13,Humana Insurance Company,Medicare PPO,6.37,49,,percent of total billed charges,,
NICOTINE 7 MG/24 HR TD PT24,,20258,LOCAL,Facility,Inpatient,1,Each,,13,11.05,3.7258,13,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
NICOTINE 7 MG/24 HR TD PT24,,20258,LOCAL,Facility,Both,1,Each,,13,11.05,3.7258,13,Medica,Individual & Family,12.883,99.1,,percent of total billed charges,,
NICOTINE 7 MG/24 HR TD PT24,,20258,LOCAL,Facility,Outpatient,1,Each,,13,11.05,3.7258,13,Medica,Medica Advantage Solution,6.474,49.8,,percent of total billed charges,,
NICOTINE 7 MG/24 HR TD PT24,,20258,LOCAL,Facility,Inpatient,1,Each,,13,11.05,3.7258,13,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
NICOTINE 7 MG/24 HR TD PT24,,20258,LOCAL,Facility,Outpatient,1,Each,,13,11.05,3.7258,13,Medica,Medical Assistance,5.798,44.6,,percent of total billed charges,,
NICOTINE 7 MG/24 HR TD PT24,,20258,LOCAL,Facility,Inpatient,1,Each,,13,11.05,3.7258,13,Medica,Medical Assistance,,,,,Included in per diem rate,
NICOTINE 7 MG/24 HR TD PT24,,20258,LOCAL,Facility,Outpatient,1,Each,,13,11.05,3.7258,13,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,6.474,49.8,,percent of total billed charges,,
NICOTINE 7 MG/24 HR TD PT24,,20258,LOCAL,Facility,Inpatient,1,Each,,13,11.05,3.7258,13,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
NICOTINE 7 MG/24 HR TD PT24,,20258,LOCAL,Facility,Both,1,Each,,13,11.05,3.7258,13,"Multiplan, Inc.","Multiplan, Inc.",12.22,94,,percent of total billed charges,,
NICOTINE 7 MG/24 HR TD PT24,,20258,LOCAL,Facility,Outpatient,1,Each,,13,11.05,3.7258,13,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,11.713,90.1,,percent of total billed charges,,
NICOTINE 7 MG/24 HR TD PT24,,20258,LOCAL,Facility,Inpatient,1,Each,,13,11.05,3.7258,13,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
NICOTINE 7 MG/24 HR TD PT24,,20258,LOCAL,Facility,Both,1,Each,,13,11.05,3.7258,13,"Preferred One Administrative Services, INC.",PPO,12.818,98.6,,percent of total billed charges,,
NICOTINE 7 MG/24 HR TD PT24,,20258,LOCAL,Facility,Outpatient,1,Each,,13,11.05,3.7258,13,PrimeWest Health,Minnesota Senior Health Options (MSHO),6.6885,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
NICOTINE 7 MG/24 HR TD PT24,,20258,LOCAL,Facility,Inpatient,1,Each,,13,11.05,3.7258,13,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
NICOTINE 7 MG/24 HR TD PT24,,20258,LOCAL,Facility,Outpatient,1,Each,,13,11.05,3.7258,13,PrimeWest Health,MinnesotaCare,6.6768,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
NICOTINE 7 MG/24 HR TD PT24,,20258,LOCAL,Facility,Inpatient,1,Each,,13,11.05,3.7258,13,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
NICOTINE 7 MG/24 HR TD PT24,,20258,LOCAL,Facility,Both,1,Each,,13,11.05,3.7258,13,Sanford Health Plan,Sanford Health Plan,11.96,92,,percent of total billed charges,,
NICOTINE 7 MG/24 HR TD PT24,,20258,LOCAL,Facility,Outpatient,1,Each,,13,11.05,3.7258,13,"UCare Health, Inc.",Individual & Family Plan,7.3255,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
NICOTINE 7 MG/24 HR TD PT24,,20258,LOCAL,Facility,Inpatient,1,Each,,13,11.05,3.7258,13,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
NICOTINE 7 MG/24 HR TD PT24,,20258,LOCAL,Facility,Outpatient,1,Each,,13,11.05,3.7258,13,"UCare Health, Inc.",Medical Assistance,6.5611,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
NICOTINE 7 MG/24 HR TD PT24,,20258,LOCAL,Facility,Inpatient,1,Each,,13,11.05,3.7258,13,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
NICOTINE 7 MG/24 HR TD PT24,,20258,LOCAL,Facility,Outpatient,1,Each,,13,11.05,3.7258,13,"UCare Health, Inc.",Medicare Advantage,6.5611,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
NICOTINE 7 MG/24 HR TD PT24,,20258,LOCAL,Facility,Inpatient,1,Each,,13,11.05,3.7258,13,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
NICOTINE 7 MG/24 HR TD PT24,,20258,LOCAL,Facility,Outpatient,1,Each,,13,11.05,3.7258,13,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),6.5611,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
NICOTINE 7 MG/24 HR TD PT24,,20258,LOCAL,Facility,Inpatient,1,Each,,13,11.05,3.7258,13,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
NICOTINE 7 MG/24 HR TD PT24,,20258,LOCAL,Facility,Both,1,Each,,13,11.05,3.7258,13,UnitedHealthcare,Individual & Family,12.22,94,,percent of total billed charges,,
NICOTINE 7 MG/24 HR TD PT24,,20258,LOCAL,Facility,Outpatient,1,Each,,13,11.05,3.7258,13,UnitedHealthcare,Medicare Advantage,6.37,49,,percent of total billed charges,,
NICOTINE 7 MG/24 HR TD PT24,,20258,LOCAL,Facility,Inpatient,1,Each,,13,11.05,3.7258,13,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
NICOTINE 7 MG/24 HR TD PT24,,20258,LOCAL,Facility,Outpatient,1,Each,,13,11.05,3.7258,13,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,6.24,48,,percent of total billed charges,,100% of DHS outpatient percentage
NICOTINE 7 MG/24 HR TD PT24,,20258,LOCAL,Facility,Inpatient,1,Each,,13,11.05,3.7258,13,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
SIMETHICONE 80 MG ORAL CHEW TAB,,20414,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
SIMETHICONE 80 MG ORAL CHEW TAB,,20414,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
SIMETHICONE 80 MG ORAL CHEW TAB,,20414,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
SIMETHICONE 80 MG ORAL CHEW TAB,,20414,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
SIMETHICONE 80 MG ORAL CHEW TAB,,20414,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SIMETHICONE 80 MG ORAL CHEW TAB,,20414,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
SIMETHICONE 80 MG ORAL CHEW TAB,,20414,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
SIMETHICONE 80 MG ORAL CHEW TAB,,20414,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
SIMETHICONE 80 MG ORAL CHEW TAB,,20414,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
SIMETHICONE 80 MG ORAL CHEW TAB,,20414,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
SIMETHICONE 80 MG ORAL CHEW TAB,,20414,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
SIMETHICONE 80 MG ORAL CHEW TAB,,20414,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
SIMETHICONE 80 MG ORAL CHEW TAB,,20414,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
SIMETHICONE 80 MG ORAL CHEW TAB,,20414,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
SIMETHICONE 80 MG ORAL CHEW TAB,,20414,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
SIMETHICONE 80 MG ORAL CHEW TAB,,20414,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
SIMETHICONE 80 MG ORAL CHEW TAB,,20414,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
SIMETHICONE 80 MG ORAL CHEW TAB,,20414,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
SIMETHICONE 80 MG ORAL CHEW TAB,,20414,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SIMETHICONE 80 MG ORAL CHEW TAB,,20414,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
SIMETHICONE 80 MG ORAL CHEW TAB,,20414,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
SIMETHICONE 80 MG ORAL CHEW TAB,,20414,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
SIMETHICONE 80 MG ORAL CHEW TAB,,20414,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
SIMETHICONE 80 MG ORAL CHEW TAB,,20414,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
SIMETHICONE 80 MG ORAL CHEW TAB,,20414,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
SIMETHICONE 80 MG ORAL CHEW TAB,,20414,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
SIMETHICONE 80 MG ORAL CHEW TAB,,20414,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
SIMETHICONE 80 MG ORAL CHEW TAB,,20414,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
SIMETHICONE 80 MG ORAL CHEW TAB,,20414,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
SIMETHICONE 80 MG ORAL CHEW TAB,,20414,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
SIMETHICONE 80 MG ORAL CHEW TAB,,20414,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
SIMETHICONE 80 MG ORAL CHEW TAB,,20414,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
SIMETHICONE 80 MG ORAL CHEW TAB,,20414,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
SIMETHICONE 80 MG ORAL CHEW TAB,,20414,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
SIMETHICONE 80 MG ORAL CHEW TAB,,20414,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
SIMETHICONE 80 MG ORAL CHEW TAB,,20414,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
SIMETHICONE 80 MG ORAL CHEW TAB,,20414,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
SIMETHICONE 80 MG ORAL CHEW TAB,,20414,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SIMETHICONE 80 MG ORAL CHEW TAB,,20414,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
SIMETHICONE 80 MG ORAL CHEW TAB,,20414,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
SIMETHICONE 80 MG ORAL CHEW TAB,,20414,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
SIMETHICONE 80 MG ORAL CHEW TAB,,20414,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
SIMETHICONE 80 MG ORAL CHEW TAB,,20414,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
SIMETHICONE 80 MG ORAL CHEW TAB,,20414,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SIMETHICONE 80 MG ORAL CHEW TAB,,20414,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
SIMETHICONE 80 MG ORAL CHEW TAB,,20414,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SIMETHICONE 80 MG ORAL CHEW TAB,,20414,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SIMETHICONE 80 MG ORAL CHEW TAB,,20414,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SIMETHICONE 80 MG ORAL CHEW TAB,,20414,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SIMETHICONE 80 MG ORAL CHEW TAB,,20414,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
SIMETHICONE 80 MG ORAL CHEW TAB,,20414,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
SIMETHICONE 80 MG ORAL CHEW TAB,,20414,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
SIMETHICONE 80 MG ORAL CHEW TAB,,20414,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
SIMETHICONE 80 MG ORAL CHEW TAB,,20414,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
BUSPIRONE 15 MG ORAL TABLET,,20430,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
BUSPIRONE 15 MG ORAL TABLET,,20430,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
BUSPIRONE 15 MG ORAL TABLET,,20430,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
BUSPIRONE 15 MG ORAL TABLET,,20430,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
BUSPIRONE 15 MG ORAL TABLET,,20430,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
BUSPIRONE 15 MG ORAL TABLET,,20430,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
BUSPIRONE 15 MG ORAL TABLET,,20430,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
BUSPIRONE 15 MG ORAL TABLET,,20430,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
BUSPIRONE 15 MG ORAL TABLET,,20430,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
BUSPIRONE 15 MG ORAL TABLET,,20430,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
BUSPIRONE 15 MG ORAL TABLET,,20430,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
BUSPIRONE 15 MG ORAL TABLET,,20430,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
BUSPIRONE 15 MG ORAL TABLET,,20430,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
BUSPIRONE 15 MG ORAL TABLET,,20430,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
BUSPIRONE 15 MG ORAL TABLET,,20430,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
BUSPIRONE 15 MG ORAL TABLET,,20430,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
BUSPIRONE 15 MG ORAL TABLET,,20430,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
BUSPIRONE 15 MG ORAL TABLET,,20430,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
BUSPIRONE 15 MG ORAL TABLET,,20430,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
BUSPIRONE 15 MG ORAL TABLET,,20430,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
BUSPIRONE 15 MG ORAL TABLET,,20430,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
BUSPIRONE 15 MG ORAL TABLET,,20430,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
BUSPIRONE 15 MG ORAL TABLET,,20430,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
BUSPIRONE 15 MG ORAL TABLET,,20430,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
BUSPIRONE 15 MG ORAL TABLET,,20430,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
BUSPIRONE 15 MG ORAL TABLET,,20430,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
BUSPIRONE 15 MG ORAL TABLET,,20430,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
BUSPIRONE 15 MG ORAL TABLET,,20430,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
BUSPIRONE 15 MG ORAL TABLET,,20430,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
BUSPIRONE 15 MG ORAL TABLET,,20430,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
BUSPIRONE 15 MG ORAL TABLET,,20430,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
BUSPIRONE 15 MG ORAL TABLET,,20430,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
BUSPIRONE 15 MG ORAL TABLET,,20430,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
BUSPIRONE 15 MG ORAL TABLET,,20430,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
BUSPIRONE 15 MG ORAL TABLET,,20430,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
BUSPIRONE 15 MG ORAL TABLET,,20430,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
BUSPIRONE 15 MG ORAL TABLET,,20430,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
BUSPIRONE 15 MG ORAL TABLET,,20430,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
BUSPIRONE 15 MG ORAL TABLET,,20430,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
BUSPIRONE 15 MG ORAL TABLET,,20430,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
BUSPIRONE 15 MG ORAL TABLET,,20430,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
BUSPIRONE 15 MG ORAL TABLET,,20430,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
BUSPIRONE 15 MG ORAL TABLET,,20430,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
BUSPIRONE 15 MG ORAL TABLET,,20430,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BUSPIRONE 15 MG ORAL TABLET,,20430,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
BUSPIRONE 15 MG ORAL TABLET,,20430,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BUSPIRONE 15 MG ORAL TABLET,,20430,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
BUSPIRONE 15 MG ORAL TABLET,,20430,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BUSPIRONE 15 MG ORAL TABLET,,20430,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
BUSPIRONE 15 MG ORAL TABLET,,20430,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
BUSPIRONE 15 MG ORAL TABLET,,20430,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
BUSPIRONE 15 MG ORAL TABLET,,20430,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
BUSPIRONE 15 MG ORAL TABLET,,20430,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
BUSPIRONE 15 MG ORAL TABLET,,20430,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
ESOMEPRAZOLE MAGNESIUM 20 MG ORAL CPDR,,20435,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,Aetna,Commercial,5.52,92,,percent of total billed charges,,
ESOMEPRAZOLE MAGNESIUM 20 MG ORAL CPDR,,20435,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,Aetna,Medicare Advantage,2.94,49,,percent of total billed charges,,
ESOMEPRAZOLE MAGNESIUM 20 MG ORAL CPDR,,20435,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,Aetna,Medicare Advantage,,,,,Included in per diem rate,
ESOMEPRAZOLE MAGNESIUM 20 MG ORAL CPDR,,20435,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,Aetna,PPO,5.58,93,,percent of total billed charges,,
ESOMEPRAZOLE MAGNESIUM 20 MG ORAL CPDR,,20435,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,America's PPO,America's PPO,5.7618,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
ESOMEPRAZOLE MAGNESIUM 20 MG ORAL CPDR,,20435,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota, Federal Employee Program,5.904,98.4,,percent of total billed charges,,
ESOMEPRAZOLE MAGNESIUM 20 MG ORAL CPDR,,20435,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,6,100,,percent of total billed charges,,
ESOMEPRAZOLE MAGNESIUM 20 MG ORAL CPDR,,20435,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota,High Value Network Plan,5.4,90,,percent of total billed charges,,
ESOMEPRAZOLE MAGNESIUM 20 MG ORAL CPDR,,20435,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota,Medicare Advantage,2.94,49,,percent of total billed charges,,
ESOMEPRAZOLE MAGNESIUM 20 MG ORAL CPDR,,20435,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
ESOMEPRAZOLE MAGNESIUM 20 MG ORAL CPDR,,20435,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,5.3142,88.57,,percent of total billed charges,,
ESOMEPRAZOLE MAGNESIUM 20 MG ORAL CPDR,,20435,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.7196,28.66,,percent of total billed charges,,
ESOMEPRAZOLE MAGNESIUM 20 MG ORAL CPDR,,20435,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.94,49,,percent of total billed charges,,
ESOMEPRAZOLE MAGNESIUM 20 MG ORAL CPDR,,20435,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
ESOMEPRAZOLE MAGNESIUM 20 MG ORAL CPDR,,20435,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,CorVel,Worker's Compensation,6,100,,percent of total billed charges,,
ESOMEPRAZOLE MAGNESIUM 20 MG ORAL CPDR,,20435,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,First Health Group Corporation,First Health Network,5.82,97,,percent of total billed charges,,
ESOMEPRAZOLE MAGNESIUM 20 MG ORAL CPDR,,20435,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,"Health Partners, Inc.",Commercial,5.676,94.6,,percent of total billed charges,,
ESOMEPRAZOLE MAGNESIUM 20 MG ORAL CPDR,,20435,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,"Health Partners, Inc.",Medicare Advantage,2.94,49,,percent of total billed charges,,
ESOMEPRAZOLE MAGNESIUM 20 MG ORAL CPDR,,20435,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ESOMEPRAZOLE MAGNESIUM 20 MG ORAL CPDR,,20435,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3.6,60,,percent of total billed charges,,
ESOMEPRAZOLE MAGNESIUM 20 MG ORAL CPDR,,20435,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,"Health Partners, Inc.",State of Minnesota Advantage Program,4.89,81.5,,percent of total billed charges,,
ESOMEPRAZOLE MAGNESIUM 20 MG ORAL CPDR,,20435,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,"Health Partners, Inc.",State Public Programs,3,50,,percent of total billed charges,,
ESOMEPRAZOLE MAGNESIUM 20 MG ORAL CPDR,,20435,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,Humana Insurance Company,Commercial PPO,5.7,95,,percent of total billed charges,,
ESOMEPRAZOLE MAGNESIUM 20 MG ORAL CPDR,,20435,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,Humana Insurance Company,Medicare PPO,2.94,49,,percent of total billed charges,,
ESOMEPRAZOLE MAGNESIUM 20 MG ORAL CPDR,,20435,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
ESOMEPRAZOLE MAGNESIUM 20 MG ORAL CPDR,,20435,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,Medica,Individual & Family,5.946,99.1,,percent of total billed charges,,
ESOMEPRAZOLE MAGNESIUM 20 MG ORAL CPDR,,20435,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,Medica,Medica Advantage Solution,2.988,49.8,,percent of total billed charges,,
ESOMEPRAZOLE MAGNESIUM 20 MG ORAL CPDR,,20435,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
ESOMEPRAZOLE MAGNESIUM 20 MG ORAL CPDR,,20435,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,Medica,Medical Assistance,2.676,44.6,,percent of total billed charges,,
ESOMEPRAZOLE MAGNESIUM 20 MG ORAL CPDR,,20435,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,Medica,Medical Assistance,,,,,Included in per diem rate,
ESOMEPRAZOLE MAGNESIUM 20 MG ORAL CPDR,,20435,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.988,49.8,,percent of total billed charges,,
ESOMEPRAZOLE MAGNESIUM 20 MG ORAL CPDR,,20435,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
ESOMEPRAZOLE MAGNESIUM 20 MG ORAL CPDR,,20435,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,"Multiplan, Inc.","Multiplan, Inc.",5.64,94,,percent of total billed charges,,
ESOMEPRAZOLE MAGNESIUM 20 MG ORAL CPDR,,20435,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,5.406,90.1,,percent of total billed charges,,
ESOMEPRAZOLE MAGNESIUM 20 MG ORAL CPDR,,20435,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
ESOMEPRAZOLE MAGNESIUM 20 MG ORAL CPDR,,20435,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,"Preferred One Administrative Services, INC.",PPO,5.916,98.6,,percent of total billed charges,,
ESOMEPRAZOLE MAGNESIUM 20 MG ORAL CPDR,,20435,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,PrimeWest Health,Minnesota Senior Health Options (MSHO),3.087,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
ESOMEPRAZOLE MAGNESIUM 20 MG ORAL CPDR,,20435,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ESOMEPRAZOLE MAGNESIUM 20 MG ORAL CPDR,,20435,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,PrimeWest Health,MinnesotaCare,3.0816,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
ESOMEPRAZOLE MAGNESIUM 20 MG ORAL CPDR,,20435,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
ESOMEPRAZOLE MAGNESIUM 20 MG ORAL CPDR,,20435,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,Sanford Health Plan,Sanford Health Plan,5.52,92,,percent of total billed charges,,
ESOMEPRAZOLE MAGNESIUM 20 MG ORAL CPDR,,20435,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,"UCare Health, Inc.",Individual & Family Plan,3.381,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
ESOMEPRAZOLE MAGNESIUM 20 MG ORAL CPDR,,20435,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
ESOMEPRAZOLE MAGNESIUM 20 MG ORAL CPDR,,20435,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,"UCare Health, Inc.",Medical Assistance,3.0282,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ESOMEPRAZOLE MAGNESIUM 20 MG ORAL CPDR,,20435,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
ESOMEPRAZOLE MAGNESIUM 20 MG ORAL CPDR,,20435,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,"UCare Health, Inc.",Medicare Advantage,3.0282,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ESOMEPRAZOLE MAGNESIUM 20 MG ORAL CPDR,,20435,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ESOMEPRAZOLE MAGNESIUM 20 MG ORAL CPDR,,20435,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),3.0282,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ESOMEPRAZOLE MAGNESIUM 20 MG ORAL CPDR,,20435,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ESOMEPRAZOLE MAGNESIUM 20 MG ORAL CPDR,,20435,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,UnitedHealthcare,Individual & Family,5.64,94,,percent of total billed charges,,
ESOMEPRAZOLE MAGNESIUM 20 MG ORAL CPDR,,20435,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,UnitedHealthcare,Medicare Advantage,2.94,49,,percent of total billed charges,,
ESOMEPRAZOLE MAGNESIUM 20 MG ORAL CPDR,,20435,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
ESOMEPRAZOLE MAGNESIUM 20 MG ORAL CPDR,,20435,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.88,48,,percent of total billed charges,,100% of DHS outpatient percentage
ESOMEPRAZOLE MAGNESIUM 20 MG ORAL CPDR,,20435,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
OXYCODONE 5 MG ORAL TABLET,,20439,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
OXYCODONE 5 MG ORAL TABLET,,20439,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
OXYCODONE 5 MG ORAL TABLET,,20439,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
OXYCODONE 5 MG ORAL TABLET,,20439,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
OXYCODONE 5 MG ORAL TABLET,,20439,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
OXYCODONE 5 MG ORAL TABLET,,20439,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
OXYCODONE 5 MG ORAL TABLET,,20439,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
OXYCODONE 5 MG ORAL TABLET,,20439,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
OXYCODONE 5 MG ORAL TABLET,,20439,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
OXYCODONE 5 MG ORAL TABLET,,20439,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
OXYCODONE 5 MG ORAL TABLET,,20439,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
OXYCODONE 5 MG ORAL TABLET,,20439,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
OXYCODONE 5 MG ORAL TABLET,,20439,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
OXYCODONE 5 MG ORAL TABLET,,20439,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
OXYCODONE 5 MG ORAL TABLET,,20439,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
OXYCODONE 5 MG ORAL TABLET,,20439,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
OXYCODONE 5 MG ORAL TABLET,,20439,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
OXYCODONE 5 MG ORAL TABLET,,20439,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
OXYCODONE 5 MG ORAL TABLET,,20439,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
OXYCODONE 5 MG ORAL TABLET,,20439,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
OXYCODONE 5 MG ORAL TABLET,,20439,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
OXYCODONE 5 MG ORAL TABLET,,20439,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
OXYCODONE 5 MG ORAL TABLET,,20439,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
OXYCODONE 5 MG ORAL TABLET,,20439,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
OXYCODONE 5 MG ORAL TABLET,,20439,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
OXYCODONE 5 MG ORAL TABLET,,20439,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
OXYCODONE 5 MG ORAL TABLET,,20439,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
OXYCODONE 5 MG ORAL TABLET,,20439,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
OXYCODONE 5 MG ORAL TABLET,,20439,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
OXYCODONE 5 MG ORAL TABLET,,20439,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
OXYCODONE 5 MG ORAL TABLET,,20439,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
OXYCODONE 5 MG ORAL TABLET,,20439,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
OXYCODONE 5 MG ORAL TABLET,,20439,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
OXYCODONE 5 MG ORAL TABLET,,20439,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
OXYCODONE 5 MG ORAL TABLET,,20439,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
OXYCODONE 5 MG ORAL TABLET,,20439,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
OXYCODONE 5 MG ORAL TABLET,,20439,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
OXYCODONE 5 MG ORAL TABLET,,20439,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
OXYCODONE 5 MG ORAL TABLET,,20439,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
OXYCODONE 5 MG ORAL TABLET,,20439,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
OXYCODONE 5 MG ORAL TABLET,,20439,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
OXYCODONE 5 MG ORAL TABLET,,20439,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
OXYCODONE 5 MG ORAL TABLET,,20439,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
OXYCODONE 5 MG ORAL TABLET,,20439,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
OXYCODONE 5 MG ORAL TABLET,,20439,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
OXYCODONE 5 MG ORAL TABLET,,20439,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
OXYCODONE 5 MG ORAL TABLET,,20439,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
OXYCODONE 5 MG ORAL TABLET,,20439,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
OXYCODONE 5 MG ORAL TABLET,,20439,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
OXYCODONE 5 MG ORAL TABLET,,20439,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
OXYCODONE 5 MG ORAL TABLET,,20439,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
OXYCODONE 5 MG ORAL TABLET,,20439,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
OXYCODONE 5 MG ORAL TABLET,,20439,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
OXYCODONE 5 MG ORAL TABLET,,20439,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
OLANZAPINE 5 MG ORAL TBDL,,20444,LOCAL,Facility,Both,1,Each,,68,57.8,19.4888,68,Aetna,Commercial,62.56,92,,percent of total billed charges,,
OLANZAPINE 5 MG ORAL TBDL,,20444,LOCAL,Facility,Both,1,Each,,68,57.8,19.4888,68,Aetna,Commercial,62.56,92,,percent of total billed charges,,
OLANZAPINE 5 MG ORAL TBDL,,20444,LOCAL,Facility,Outpatient,1,Each,,68,57.8,19.4888,68,Aetna,Medicare Advantage,33.32,49,,percent of total billed charges,,
OLANZAPINE 5 MG ORAL TBDL,,20444,LOCAL,Facility,Outpatient,1,Each,,68,57.8,19.4888,68,Aetna,Medicare Advantage,33.32,49,,percent of total billed charges,,
OLANZAPINE 5 MG ORAL TBDL,,20444,LOCAL,Facility,Inpatient,1,Each,,68,57.8,19.4888,68,Aetna,Medicare Advantage,,,,,Included in per diem rate,
OLANZAPINE 5 MG ORAL TBDL,,20444,LOCAL,Facility,Inpatient,1,Each,,68,57.8,19.4888,68,Aetna,Medicare Advantage,,,,,Included in per diem rate,
OLANZAPINE 5 MG ORAL TBDL,,20444,LOCAL,Facility,Both,1,Each,,68,57.8,19.4888,68,Aetna,PPO,63.24,93,,percent of total billed charges,,
OLANZAPINE 5 MG ORAL TBDL,,20444,LOCAL,Facility,Both,1,Each,,68,57.8,19.4888,68,Aetna,PPO,63.24,93,,percent of total billed charges,,
OLANZAPINE 5 MG ORAL TBDL,,20444,LOCAL,Facility,Both,1,Each,,68,57.8,19.4888,68,America's PPO,America's PPO,65.3004,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
OLANZAPINE 5 MG ORAL TBDL,,20444,LOCAL,Facility,Both,1,Each,,68,57.8,19.4888,68,America's PPO,America's PPO,65.3004,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
OLANZAPINE 5 MG ORAL TBDL,,20444,LOCAL,Facility,Both,1,Each,,68,57.8,19.4888,68,BlueCross BlueShield Minnesota, Federal Employee Program,66.912,98.4,,percent of total billed charges,,
OLANZAPINE 5 MG ORAL TBDL,,20444,LOCAL,Facility,Both,1,Each,,68,57.8,19.4888,68,BlueCross BlueShield Minnesota, Federal Employee Program,66.912,98.4,,percent of total billed charges,,
OLANZAPINE 5 MG ORAL TBDL,,20444,LOCAL,Facility,Both,1,Each,,68,57.8,19.4888,68,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,68,100,,percent of total billed charges,,
OLANZAPINE 5 MG ORAL TBDL,,20444,LOCAL,Facility,Both,1,Each,,68,57.8,19.4888,68,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,68,100,,percent of total billed charges,,
OLANZAPINE 5 MG ORAL TBDL,,20444,LOCAL,Facility,Both,1,Each,,68,57.8,19.4888,68,BlueCross BlueShield Minnesota,High Value Network Plan,61.2,90,,percent of total billed charges,,
OLANZAPINE 5 MG ORAL TBDL,,20444,LOCAL,Facility,Both,1,Each,,68,57.8,19.4888,68,BlueCross BlueShield Minnesota,High Value Network Plan,61.2,90,,percent of total billed charges,,
OLANZAPINE 5 MG ORAL TBDL,,20444,LOCAL,Facility,Outpatient,1,Each,,68,57.8,19.4888,68,BlueCross BlueShield Minnesota,Medicare Advantage,33.32,49,,percent of total billed charges,,
OLANZAPINE 5 MG ORAL TBDL,,20444,LOCAL,Facility,Outpatient,1,Each,,68,57.8,19.4888,68,BlueCross BlueShield Minnesota,Medicare Advantage,33.32,49,,percent of total billed charges,,
OLANZAPINE 5 MG ORAL TBDL,,20444,LOCAL,Facility,Inpatient,1,Each,,68,57.8,19.4888,68,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
OLANZAPINE 5 MG ORAL TBDL,,20444,LOCAL,Facility,Inpatient,1,Each,,68,57.8,19.4888,68,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
OLANZAPINE 5 MG ORAL TBDL,,20444,LOCAL,Facility,Both,1,Each,,68,57.8,19.4888,68,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,60.2276,88.57,,percent of total billed charges,,
OLANZAPINE 5 MG ORAL TBDL,,20444,LOCAL,Facility,Both,1,Each,,68,57.8,19.4888,68,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,60.2276,88.57,,percent of total billed charges,,
OLANZAPINE 5 MG ORAL TBDL,,20444,LOCAL,Facility,Both,1,Each,,68,57.8,19.4888,68,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,19.4888,28.66,,percent of total billed charges,,
OLANZAPINE 5 MG ORAL TBDL,,20444,LOCAL,Facility,Both,1,Each,,68,57.8,19.4888,68,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,19.4888,28.66,,percent of total billed charges,,
OLANZAPINE 5 MG ORAL TBDL,,20444,LOCAL,Facility,Outpatient,1,Each,,68,57.8,19.4888,68,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),33.32,49,,percent of total billed charges,,
OLANZAPINE 5 MG ORAL TBDL,,20444,LOCAL,Facility,Outpatient,1,Each,,68,57.8,19.4888,68,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),33.32,49,,percent of total billed charges,,
OLANZAPINE 5 MG ORAL TBDL,,20444,LOCAL,Facility,Inpatient,1,Each,,68,57.8,19.4888,68,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
OLANZAPINE 5 MG ORAL TBDL,,20444,LOCAL,Facility,Inpatient,1,Each,,68,57.8,19.4888,68,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
OLANZAPINE 5 MG ORAL TBDL,,20444,LOCAL,Facility,Both,1,Each,,68,57.8,19.4888,68,CorVel,Worker's Compensation,68,100,,percent of total billed charges,,
OLANZAPINE 5 MG ORAL TBDL,,20444,LOCAL,Facility,Both,1,Each,,68,57.8,19.4888,68,CorVel,Worker's Compensation,68,100,,percent of total billed charges,,
OLANZAPINE 5 MG ORAL TBDL,,20444,LOCAL,Facility,Both,1,Each,,68,57.8,19.4888,68,First Health Group Corporation,First Health Network,65.96,97,,percent of total billed charges,,
OLANZAPINE 5 MG ORAL TBDL,,20444,LOCAL,Facility,Both,1,Each,,68,57.8,19.4888,68,First Health Group Corporation,First Health Network,65.96,97,,percent of total billed charges,,
OLANZAPINE 5 MG ORAL TBDL,,20444,LOCAL,Facility,Both,1,Each,,68,57.8,19.4888,68,"Health Partners, Inc.",Commercial,64.328,94.6,,percent of total billed charges,,
OLANZAPINE 5 MG ORAL TBDL,,20444,LOCAL,Facility,Both,1,Each,,68,57.8,19.4888,68,"Health Partners, Inc.",Commercial,64.328,94.6,,percent of total billed charges,,
OLANZAPINE 5 MG ORAL TBDL,,20444,LOCAL,Facility,Outpatient,1,Each,,68,57.8,19.4888,68,"Health Partners, Inc.",Medicare Advantage,33.32,49,,percent of total billed charges,,
OLANZAPINE 5 MG ORAL TBDL,,20444,LOCAL,Facility,Outpatient,1,Each,,68,57.8,19.4888,68,"Health Partners, Inc.",Medicare Advantage,33.32,49,,percent of total billed charges,,
OLANZAPINE 5 MG ORAL TBDL,,20444,LOCAL,Facility,Inpatient,1,Each,,68,57.8,19.4888,68,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
OLANZAPINE 5 MG ORAL TBDL,,20444,LOCAL,Facility,Inpatient,1,Each,,68,57.8,19.4888,68,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
OLANZAPINE 5 MG ORAL TBDL,,20444,LOCAL,Facility,Both,1,Each,,68,57.8,19.4888,68,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),40.8,60,,percent of total billed charges,,
OLANZAPINE 5 MG ORAL TBDL,,20444,LOCAL,Facility,Both,1,Each,,68,57.8,19.4888,68,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),40.8,60,,percent of total billed charges,,
OLANZAPINE 5 MG ORAL TBDL,,20444,LOCAL,Facility,Both,1,Each,,68,57.8,19.4888,68,"Health Partners, Inc.",State of Minnesota Advantage Program,55.42,81.5,,percent of total billed charges,,
OLANZAPINE 5 MG ORAL TBDL,,20444,LOCAL,Facility,Both,1,Each,,68,57.8,19.4888,68,"Health Partners, Inc.",State of Minnesota Advantage Program,55.42,81.5,,percent of total billed charges,,
OLANZAPINE 5 MG ORAL TBDL,,20444,LOCAL,Facility,Both,1,Each,,68,57.8,19.4888,68,"Health Partners, Inc.",State Public Programs,34,50,,percent of total billed charges,,
OLANZAPINE 5 MG ORAL TBDL,,20444,LOCAL,Facility,Both,1,Each,,68,57.8,19.4888,68,"Health Partners, Inc.",State Public Programs,34,50,,percent of total billed charges,,
OLANZAPINE 5 MG ORAL TBDL,,20444,LOCAL,Facility,Both,1,Each,,68,57.8,19.4888,68,Humana Insurance Company,Commercial PPO,64.6,95,,percent of total billed charges,,
OLANZAPINE 5 MG ORAL TBDL,,20444,LOCAL,Facility,Both,1,Each,,68,57.8,19.4888,68,Humana Insurance Company,Commercial PPO,64.6,95,,percent of total billed charges,,
OLANZAPINE 5 MG ORAL TBDL,,20444,LOCAL,Facility,Outpatient,1,Each,,68,57.8,19.4888,68,Humana Insurance Company,Medicare PPO,33.32,49,,percent of total billed charges,,
OLANZAPINE 5 MG ORAL TBDL,,20444,LOCAL,Facility,Outpatient,1,Each,,68,57.8,19.4888,68,Humana Insurance Company,Medicare PPO,33.32,49,,percent of total billed charges,,
OLANZAPINE 5 MG ORAL TBDL,,20444,LOCAL,Facility,Inpatient,1,Each,,68,57.8,19.4888,68,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
OLANZAPINE 5 MG ORAL TBDL,,20444,LOCAL,Facility,Inpatient,1,Each,,68,57.8,19.4888,68,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
OLANZAPINE 5 MG ORAL TBDL,,20444,LOCAL,Facility,Both,1,Each,,68,57.8,19.4888,68,Medica,Individual & Family,67.388,99.1,,percent of total billed charges,,
OLANZAPINE 5 MG ORAL TBDL,,20444,LOCAL,Facility,Both,1,Each,,68,57.8,19.4888,68,Medica,Individual & Family,67.388,99.1,,percent of total billed charges,,
OLANZAPINE 5 MG ORAL TBDL,,20444,LOCAL,Facility,Outpatient,1,Each,,68,57.8,19.4888,68,Medica,Medica Advantage Solution,33.864,49.8,,percent of total billed charges,,
OLANZAPINE 5 MG ORAL TBDL,,20444,LOCAL,Facility,Outpatient,1,Each,,68,57.8,19.4888,68,Medica,Medica Advantage Solution,33.864,49.8,,percent of total billed charges,,
OLANZAPINE 5 MG ORAL TBDL,,20444,LOCAL,Facility,Inpatient,1,Each,,68,57.8,19.4888,68,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
OLANZAPINE 5 MG ORAL TBDL,,20444,LOCAL,Facility,Inpatient,1,Each,,68,57.8,19.4888,68,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
OLANZAPINE 5 MG ORAL TBDL,,20444,LOCAL,Facility,Outpatient,1,Each,,68,57.8,19.4888,68,Medica,Medical Assistance,30.328,44.6,,percent of total billed charges,,
OLANZAPINE 5 MG ORAL TBDL,,20444,LOCAL,Facility,Outpatient,1,Each,,68,57.8,19.4888,68,Medica,Medical Assistance,30.328,44.6,,percent of total billed charges,,
OLANZAPINE 5 MG ORAL TBDL,,20444,LOCAL,Facility,Inpatient,1,Each,,68,57.8,19.4888,68,Medica,Medical Assistance,,,,,Included in per diem rate,
OLANZAPINE 5 MG ORAL TBDL,,20444,LOCAL,Facility,Inpatient,1,Each,,68,57.8,19.4888,68,Medica,Medical Assistance,,,,,Included in per diem rate,
OLANZAPINE 5 MG ORAL TBDL,,20444,LOCAL,Facility,Outpatient,1,Each,,68,57.8,19.4888,68,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,33.864,49.8,,percent of total billed charges,,
OLANZAPINE 5 MG ORAL TBDL,,20444,LOCAL,Facility,Outpatient,1,Each,,68,57.8,19.4888,68,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,33.864,49.8,,percent of total billed charges,,
OLANZAPINE 5 MG ORAL TBDL,,20444,LOCAL,Facility,Inpatient,1,Each,,68,57.8,19.4888,68,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
OLANZAPINE 5 MG ORAL TBDL,,20444,LOCAL,Facility,Inpatient,1,Each,,68,57.8,19.4888,68,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
OLANZAPINE 5 MG ORAL TBDL,,20444,LOCAL,Facility,Both,1,Each,,68,57.8,19.4888,68,"Multiplan, Inc.","Multiplan, Inc.",63.92,94,,percent of total billed charges,,
OLANZAPINE 5 MG ORAL TBDL,,20444,LOCAL,Facility,Both,1,Each,,68,57.8,19.4888,68,"Multiplan, Inc.","Multiplan, Inc.",63.92,94,,percent of total billed charges,,
OLANZAPINE 5 MG ORAL TBDL,,20444,LOCAL,Facility,Outpatient,1,Each,,68,57.8,19.4888,68,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,61.268,90.1,,percent of total billed charges,,
OLANZAPINE 5 MG ORAL TBDL,,20444,LOCAL,Facility,Outpatient,1,Each,,68,57.8,19.4888,68,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,61.268,90.1,,percent of total billed charges,,
OLANZAPINE 5 MG ORAL TBDL,,20444,LOCAL,Facility,Inpatient,1,Each,,68,57.8,19.4888,68,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
OLANZAPINE 5 MG ORAL TBDL,,20444,LOCAL,Facility,Inpatient,1,Each,,68,57.8,19.4888,68,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
OLANZAPINE 5 MG ORAL TBDL,,20444,LOCAL,Facility,Both,1,Each,,68,57.8,19.4888,68,"Preferred One Administrative Services, INC.",PPO,67.048,98.6,,percent of total billed charges,,
OLANZAPINE 5 MG ORAL TBDL,,20444,LOCAL,Facility,Both,1,Each,,68,57.8,19.4888,68,"Preferred One Administrative Services, INC.",PPO,67.048,98.6,,percent of total billed charges,,
OLANZAPINE 5 MG ORAL TBDL,,20444,LOCAL,Facility,Outpatient,1,Each,,68,57.8,19.4888,68,PrimeWest Health,Minnesota Senior Health Options (MSHO),34.986,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
OLANZAPINE 5 MG ORAL TBDL,,20444,LOCAL,Facility,Outpatient,1,Each,,68,57.8,19.4888,68,PrimeWest Health,Minnesota Senior Health Options (MSHO),34.986,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
OLANZAPINE 5 MG ORAL TBDL,,20444,LOCAL,Facility,Inpatient,1,Each,,68,57.8,19.4888,68,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
OLANZAPINE 5 MG ORAL TBDL,,20444,LOCAL,Facility,Inpatient,1,Each,,68,57.8,19.4888,68,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
OLANZAPINE 5 MG ORAL TBDL,,20444,LOCAL,Facility,Outpatient,1,Each,,68,57.8,19.4888,68,PrimeWest Health,MinnesotaCare,34.9248,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
OLANZAPINE 5 MG ORAL TBDL,,20444,LOCAL,Facility,Outpatient,1,Each,,68,57.8,19.4888,68,PrimeWest Health,MinnesotaCare,34.9248,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
OLANZAPINE 5 MG ORAL TBDL,,20444,LOCAL,Facility,Inpatient,1,Each,,68,57.8,19.4888,68,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
OLANZAPINE 5 MG ORAL TBDL,,20444,LOCAL,Facility,Inpatient,1,Each,,68,57.8,19.4888,68,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
OLANZAPINE 5 MG ORAL TBDL,,20444,LOCAL,Facility,Both,1,Each,,68,57.8,19.4888,68,Sanford Health Plan,Sanford Health Plan,62.56,92,,percent of total billed charges,,
OLANZAPINE 5 MG ORAL TBDL,,20444,LOCAL,Facility,Both,1,Each,,68,57.8,19.4888,68,Sanford Health Plan,Sanford Health Plan,62.56,92,,percent of total billed charges,,
OLANZAPINE 5 MG ORAL TBDL,,20444,LOCAL,Facility,Outpatient,1,Each,,68,57.8,19.4888,68,"UCare Health, Inc.",Individual & Family Plan,38.318,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
OLANZAPINE 5 MG ORAL TBDL,,20444,LOCAL,Facility,Outpatient,1,Each,,68,57.8,19.4888,68,"UCare Health, Inc.",Individual & Family Plan,38.318,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
OLANZAPINE 5 MG ORAL TBDL,,20444,LOCAL,Facility,Inpatient,1,Each,,68,57.8,19.4888,68,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
OLANZAPINE 5 MG ORAL TBDL,,20444,LOCAL,Facility,Inpatient,1,Each,,68,57.8,19.4888,68,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
OLANZAPINE 5 MG ORAL TBDL,,20444,LOCAL,Facility,Outpatient,1,Each,,68,57.8,19.4888,68,"UCare Health, Inc.",Medical Assistance,34.3196,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
OLANZAPINE 5 MG ORAL TBDL,,20444,LOCAL,Facility,Outpatient,1,Each,,68,57.8,19.4888,68,"UCare Health, Inc.",Medical Assistance,34.3196,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
OLANZAPINE 5 MG ORAL TBDL,,20444,LOCAL,Facility,Inpatient,1,Each,,68,57.8,19.4888,68,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
OLANZAPINE 5 MG ORAL TBDL,,20444,LOCAL,Facility,Inpatient,1,Each,,68,57.8,19.4888,68,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
OLANZAPINE 5 MG ORAL TBDL,,20444,LOCAL,Facility,Outpatient,1,Each,,68,57.8,19.4888,68,"UCare Health, Inc.",Medicare Advantage,34.3196,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
OLANZAPINE 5 MG ORAL TBDL,,20444,LOCAL,Facility,Outpatient,1,Each,,68,57.8,19.4888,68,"UCare Health, Inc.",Medicare Advantage,34.3196,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
OLANZAPINE 5 MG ORAL TBDL,,20444,LOCAL,Facility,Inpatient,1,Each,,68,57.8,19.4888,68,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
OLANZAPINE 5 MG ORAL TBDL,,20444,LOCAL,Facility,Inpatient,1,Each,,68,57.8,19.4888,68,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
OLANZAPINE 5 MG ORAL TBDL,,20444,LOCAL,Facility,Outpatient,1,Each,,68,57.8,19.4888,68,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),34.3196,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
OLANZAPINE 5 MG ORAL TBDL,,20444,LOCAL,Facility,Outpatient,1,Each,,68,57.8,19.4888,68,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),34.3196,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
OLANZAPINE 5 MG ORAL TBDL,,20444,LOCAL,Facility,Inpatient,1,Each,,68,57.8,19.4888,68,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
OLANZAPINE 5 MG ORAL TBDL,,20444,LOCAL,Facility,Inpatient,1,Each,,68,57.8,19.4888,68,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
OLANZAPINE 5 MG ORAL TBDL,,20444,LOCAL,Facility,Both,1,Each,,68,57.8,19.4888,68,UnitedHealthcare,Individual & Family,63.92,94,,percent of total billed charges,,
OLANZAPINE 5 MG ORAL TBDL,,20444,LOCAL,Facility,Both,1,Each,,68,57.8,19.4888,68,UnitedHealthcare,Individual & Family,63.92,94,,percent of total billed charges,,
OLANZAPINE 5 MG ORAL TBDL,,20444,LOCAL,Facility,Outpatient,1,Each,,68,57.8,19.4888,68,UnitedHealthcare,Medicare Advantage,33.32,49,,percent of total billed charges,,
OLANZAPINE 5 MG ORAL TBDL,,20444,LOCAL,Facility,Outpatient,1,Each,,68,57.8,19.4888,68,UnitedHealthcare,Medicare Advantage,33.32,49,,percent of total billed charges,,
OLANZAPINE 5 MG ORAL TBDL,,20444,LOCAL,Facility,Inpatient,1,Each,,68,57.8,19.4888,68,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
OLANZAPINE 5 MG ORAL TBDL,,20444,LOCAL,Facility,Inpatient,1,Each,,68,57.8,19.4888,68,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
OLANZAPINE 5 MG ORAL TBDL,,20444,LOCAL,Facility,Outpatient,1,Each,,68,57.8,19.4888,68,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,32.64,48,,percent of total billed charges,,100% of DHS outpatient percentage
OLANZAPINE 5 MG ORAL TBDL,,20444,LOCAL,Facility,Outpatient,1,Each,,68,57.8,19.4888,68,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,32.64,48,,percent of total billed charges,,100% of DHS outpatient percentage
OLANZAPINE 5 MG ORAL TBDL,,20444,LOCAL,Facility,Inpatient,1,Each,,68,57.8,19.4888,68,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
OLANZAPINE 5 MG ORAL TBDL,,20444,LOCAL,Facility,Inpatient,1,Each,,68,57.8,19.4888,68,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
HYDROXYZINE PAMOATE 25 MG ORAL CAP,,20462,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
HYDROXYZINE PAMOATE 25 MG ORAL CAP,,20462,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
HYDROXYZINE PAMOATE 25 MG ORAL CAP,,20462,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
HYDROXYZINE PAMOATE 25 MG ORAL CAP,,20462,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
HYDROXYZINE PAMOATE 25 MG ORAL CAP,,20462,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
HYDROXYZINE PAMOATE 25 MG ORAL CAP,,20462,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
HYDROXYZINE PAMOATE 25 MG ORAL CAP,,20462,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
HYDROXYZINE PAMOATE 25 MG ORAL CAP,,20462,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
HYDROXYZINE PAMOATE 25 MG ORAL CAP,,20462,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
HYDROXYZINE PAMOATE 25 MG ORAL CAP,,20462,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
HYDROXYZINE PAMOATE 25 MG ORAL CAP,,20462,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
HYDROXYZINE PAMOATE 25 MG ORAL CAP,,20462,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
HYDROXYZINE PAMOATE 25 MG ORAL CAP,,20462,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
HYDROXYZINE PAMOATE 25 MG ORAL CAP,,20462,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
HYDROXYZINE PAMOATE 25 MG ORAL CAP,,20462,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
HYDROXYZINE PAMOATE 25 MG ORAL CAP,,20462,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
HYDROXYZINE PAMOATE 25 MG ORAL CAP,,20462,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
HYDROXYZINE PAMOATE 25 MG ORAL CAP,,20462,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
HYDROXYZINE PAMOATE 25 MG ORAL CAP,,20462,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
HYDROXYZINE PAMOATE 25 MG ORAL CAP,,20462,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
HYDROXYZINE PAMOATE 25 MG ORAL CAP,,20462,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
HYDROXYZINE PAMOATE 25 MG ORAL CAP,,20462,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
HYDROXYZINE PAMOATE 25 MG ORAL CAP,,20462,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
HYDROXYZINE PAMOATE 25 MG ORAL CAP,,20462,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
HYDROXYZINE PAMOATE 25 MG ORAL CAP,,20462,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
HYDROXYZINE PAMOATE 25 MG ORAL CAP,,20462,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
HYDROXYZINE PAMOATE 25 MG ORAL CAP,,20462,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
HYDROXYZINE PAMOATE 25 MG ORAL CAP,,20462,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
HYDROXYZINE PAMOATE 25 MG ORAL CAP,,20462,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
HYDROXYZINE PAMOATE 25 MG ORAL CAP,,20462,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
HYDROXYZINE PAMOATE 25 MG ORAL CAP,,20462,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
HYDROXYZINE PAMOATE 25 MG ORAL CAP,,20462,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
HYDROXYZINE PAMOATE 25 MG ORAL CAP,,20462,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
HYDROXYZINE PAMOATE 25 MG ORAL CAP,,20462,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
HYDROXYZINE PAMOATE 25 MG ORAL CAP,,20462,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
HYDROXYZINE PAMOATE 25 MG ORAL CAP,,20462,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
HYDROXYZINE PAMOATE 25 MG ORAL CAP,,20462,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
HYDROXYZINE PAMOATE 25 MG ORAL CAP,,20462,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
HYDROXYZINE PAMOATE 25 MG ORAL CAP,,20462,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
HYDROXYZINE PAMOATE 25 MG ORAL CAP,,20462,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
HYDROXYZINE PAMOATE 25 MG ORAL CAP,,20462,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
HYDROXYZINE PAMOATE 25 MG ORAL CAP,,20462,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
HYDROXYZINE PAMOATE 25 MG ORAL CAP,,20462,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
HYDROXYZINE PAMOATE 25 MG ORAL CAP,,20462,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
HYDROXYZINE PAMOATE 25 MG ORAL CAP,,20462,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
HYDROXYZINE PAMOATE 25 MG ORAL CAP,,20462,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
HYDROXYZINE PAMOATE 25 MG ORAL CAP,,20462,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
HYDROXYZINE PAMOATE 25 MG ORAL CAP,,20462,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
HYDROXYZINE PAMOATE 25 MG ORAL CAP,,20462,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
HYDROXYZINE PAMOATE 25 MG ORAL CAP,,20462,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
HYDROXYZINE PAMOATE 25 MG ORAL CAP,,20462,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
HYDROXYZINE PAMOATE 25 MG ORAL CAP,,20462,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
HYDROXYZINE PAMOATE 25 MG ORAL CAP,,20462,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
HYDROXYZINE PAMOATE 25 MG ORAL CAP,,20462,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
MAGNESIUM 200 MG ORAL TABLET,,22519,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
MAGNESIUM 200 MG ORAL TABLET,,22519,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
MAGNESIUM 200 MG ORAL TABLET,,22519,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
MAGNESIUM 200 MG ORAL TABLET,,22519,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
MAGNESIUM 200 MG ORAL TABLET,,22519,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
MAGNESIUM 200 MG ORAL TABLET,,22519,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
MAGNESIUM 200 MG ORAL TABLET,,22519,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
MAGNESIUM 200 MG ORAL TABLET,,22519,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
MAGNESIUM 200 MG ORAL TABLET,,22519,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
MAGNESIUM 200 MG ORAL TABLET,,22519,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
MAGNESIUM 200 MG ORAL TABLET,,22519,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
MAGNESIUM 200 MG ORAL TABLET,,22519,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
MAGNESIUM 200 MG ORAL TABLET,,22519,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
MAGNESIUM 200 MG ORAL TABLET,,22519,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
MAGNESIUM 200 MG ORAL TABLET,,22519,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
MAGNESIUM 200 MG ORAL TABLET,,22519,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
MAGNESIUM 200 MG ORAL TABLET,,22519,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
MAGNESIUM 200 MG ORAL TABLET,,22519,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
MAGNESIUM 200 MG ORAL TABLET,,22519,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
MAGNESIUM 200 MG ORAL TABLET,,22519,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
MAGNESIUM 200 MG ORAL TABLET,,22519,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
MAGNESIUM 200 MG ORAL TABLET,,22519,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
MAGNESIUM 200 MG ORAL TABLET,,22519,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
MAGNESIUM 200 MG ORAL TABLET,,22519,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
MAGNESIUM 200 MG ORAL TABLET,,22519,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
MAGNESIUM 200 MG ORAL TABLET,,22519,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
MAGNESIUM 200 MG ORAL TABLET,,22519,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
MAGNESIUM 200 MG ORAL TABLET,,22519,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
MAGNESIUM 200 MG ORAL TABLET,,22519,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
MAGNESIUM 200 MG ORAL TABLET,,22519,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
MAGNESIUM 200 MG ORAL TABLET,,22519,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
MAGNESIUM 200 MG ORAL TABLET,,22519,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
MAGNESIUM 200 MG ORAL TABLET,,22519,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
MAGNESIUM 200 MG ORAL TABLET,,22519,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
MAGNESIUM 200 MG ORAL TABLET,,22519,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
MAGNESIUM 200 MG ORAL TABLET,,22519,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
MAGNESIUM 200 MG ORAL TABLET,,22519,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
MAGNESIUM 200 MG ORAL TABLET,,22519,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
MAGNESIUM 200 MG ORAL TABLET,,22519,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
MAGNESIUM 200 MG ORAL TABLET,,22519,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
MAGNESIUM 200 MG ORAL TABLET,,22519,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
MAGNESIUM 200 MG ORAL TABLET,,22519,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
MAGNESIUM 200 MG ORAL TABLET,,22519,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
MAGNESIUM 200 MG ORAL TABLET,,22519,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MAGNESIUM 200 MG ORAL TABLET,,22519,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
MAGNESIUM 200 MG ORAL TABLET,,22519,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MAGNESIUM 200 MG ORAL TABLET,,22519,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
MAGNESIUM 200 MG ORAL TABLET,,22519,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MAGNESIUM 200 MG ORAL TABLET,,22519,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
MAGNESIUM 200 MG ORAL TABLET,,22519,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
MAGNESIUM 200 MG ORAL TABLET,,22519,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
MAGNESIUM 200 MG ORAL TABLET,,22519,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
MAGNESIUM 200 MG ORAL TABLET,,22519,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
MAGNESIUM 200 MG ORAL TABLET,,22519,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
OLMESARTAN 20 MG ORAL TABLET,,23570,LOCAL,Facility,Both,1,Each,,35,29.75,10.031,35,Aetna,Commercial,32.2,92,,percent of total billed charges,,
OLMESARTAN 20 MG ORAL TABLET,,23570,LOCAL,Facility,Outpatient,1,Each,,35,29.75,10.031,35,Aetna,Medicare Advantage,17.15,49,,percent of total billed charges,,
OLMESARTAN 20 MG ORAL TABLET,,23570,LOCAL,Facility,Inpatient,1,Each,,35,29.75,10.031,35,Aetna,Medicare Advantage,,,,,Included in per diem rate,
OLMESARTAN 20 MG ORAL TABLET,,23570,LOCAL,Facility,Both,1,Each,,35,29.75,10.031,35,Aetna,PPO,32.55,93,,percent of total billed charges,,
OLMESARTAN 20 MG ORAL TABLET,,23570,LOCAL,Facility,Both,1,Each,,35,29.75,10.031,35,America's PPO,America's PPO,33.6105,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
OLMESARTAN 20 MG ORAL TABLET,,23570,LOCAL,Facility,Both,1,Each,,35,29.75,10.031,35,BlueCross BlueShield Minnesota, Federal Employee Program,34.44,98.4,,percent of total billed charges,,
OLMESARTAN 20 MG ORAL TABLET,,23570,LOCAL,Facility,Both,1,Each,,35,29.75,10.031,35,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,35,100,,percent of total billed charges,,
OLMESARTAN 20 MG ORAL TABLET,,23570,LOCAL,Facility,Both,1,Each,,35,29.75,10.031,35,BlueCross BlueShield Minnesota,High Value Network Plan,31.5,90,,percent of total billed charges,,
OLMESARTAN 20 MG ORAL TABLET,,23570,LOCAL,Facility,Outpatient,1,Each,,35,29.75,10.031,35,BlueCross BlueShield Minnesota,Medicare Advantage,17.15,49,,percent of total billed charges,,
OLMESARTAN 20 MG ORAL TABLET,,23570,LOCAL,Facility,Inpatient,1,Each,,35,29.75,10.031,35,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
OLMESARTAN 20 MG ORAL TABLET,,23570,LOCAL,Facility,Both,1,Each,,35,29.75,10.031,35,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,30.9995,88.57,,percent of total billed charges,,
OLMESARTAN 20 MG ORAL TABLET,,23570,LOCAL,Facility,Both,1,Each,,35,29.75,10.031,35,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,10.031,28.66,,percent of total billed charges,,
OLMESARTAN 20 MG ORAL TABLET,,23570,LOCAL,Facility,Outpatient,1,Each,,35,29.75,10.031,35,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),17.15,49,,percent of total billed charges,,
OLMESARTAN 20 MG ORAL TABLET,,23570,LOCAL,Facility,Inpatient,1,Each,,35,29.75,10.031,35,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
OLMESARTAN 20 MG ORAL TABLET,,23570,LOCAL,Facility,Both,1,Each,,35,29.75,10.031,35,CorVel,Worker's Compensation,35,100,,percent of total billed charges,,
OLMESARTAN 20 MG ORAL TABLET,,23570,LOCAL,Facility,Both,1,Each,,35,29.75,10.031,35,First Health Group Corporation,First Health Network,33.95,97,,percent of total billed charges,,
OLMESARTAN 20 MG ORAL TABLET,,23570,LOCAL,Facility,Both,1,Each,,35,29.75,10.031,35,"Health Partners, Inc.",Commercial,33.11,94.6,,percent of total billed charges,,
OLMESARTAN 20 MG ORAL TABLET,,23570,LOCAL,Facility,Outpatient,1,Each,,35,29.75,10.031,35,"Health Partners, Inc.",Medicare Advantage,17.15,49,,percent of total billed charges,,
OLMESARTAN 20 MG ORAL TABLET,,23570,LOCAL,Facility,Inpatient,1,Each,,35,29.75,10.031,35,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
OLMESARTAN 20 MG ORAL TABLET,,23570,LOCAL,Facility,Both,1,Each,,35,29.75,10.031,35,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),21,60,,percent of total billed charges,,
OLMESARTAN 20 MG ORAL TABLET,,23570,LOCAL,Facility,Both,1,Each,,35,29.75,10.031,35,"Health Partners, Inc.",State of Minnesota Advantage Program,28.525,81.5,,percent of total billed charges,,
OLMESARTAN 20 MG ORAL TABLET,,23570,LOCAL,Facility,Both,1,Each,,35,29.75,10.031,35,"Health Partners, Inc.",State Public Programs,17.5,50,,percent of total billed charges,,
OLMESARTAN 20 MG ORAL TABLET,,23570,LOCAL,Facility,Both,1,Each,,35,29.75,10.031,35,Humana Insurance Company,Commercial PPO,33.25,95,,percent of total billed charges,,
OLMESARTAN 20 MG ORAL TABLET,,23570,LOCAL,Facility,Outpatient,1,Each,,35,29.75,10.031,35,Humana Insurance Company,Medicare PPO,17.15,49,,percent of total billed charges,,
OLMESARTAN 20 MG ORAL TABLET,,23570,LOCAL,Facility,Inpatient,1,Each,,35,29.75,10.031,35,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
OLMESARTAN 20 MG ORAL TABLET,,23570,LOCAL,Facility,Both,1,Each,,35,29.75,10.031,35,Medica,Individual & Family,34.685,99.1,,percent of total billed charges,,
OLMESARTAN 20 MG ORAL TABLET,,23570,LOCAL,Facility,Outpatient,1,Each,,35,29.75,10.031,35,Medica,Medica Advantage Solution,17.43,49.8,,percent of total billed charges,,
OLMESARTAN 20 MG ORAL TABLET,,23570,LOCAL,Facility,Inpatient,1,Each,,35,29.75,10.031,35,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
OLMESARTAN 20 MG ORAL TABLET,,23570,LOCAL,Facility,Outpatient,1,Each,,35,29.75,10.031,35,Medica,Medical Assistance,15.61,44.6,,percent of total billed charges,,
OLMESARTAN 20 MG ORAL TABLET,,23570,LOCAL,Facility,Inpatient,1,Each,,35,29.75,10.031,35,Medica,Medical Assistance,,,,,Included in per diem rate,
OLMESARTAN 20 MG ORAL TABLET,,23570,LOCAL,Facility,Outpatient,1,Each,,35,29.75,10.031,35,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,17.43,49.8,,percent of total billed charges,,
OLMESARTAN 20 MG ORAL TABLET,,23570,LOCAL,Facility,Inpatient,1,Each,,35,29.75,10.031,35,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
OLMESARTAN 20 MG ORAL TABLET,,23570,LOCAL,Facility,Both,1,Each,,35,29.75,10.031,35,"Multiplan, Inc.","Multiplan, Inc.",32.9,94,,percent of total billed charges,,
OLMESARTAN 20 MG ORAL TABLET,,23570,LOCAL,Facility,Outpatient,1,Each,,35,29.75,10.031,35,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,31.535,90.1,,percent of total billed charges,,
OLMESARTAN 20 MG ORAL TABLET,,23570,LOCAL,Facility,Inpatient,1,Each,,35,29.75,10.031,35,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
OLMESARTAN 20 MG ORAL TABLET,,23570,LOCAL,Facility,Both,1,Each,,35,29.75,10.031,35,"Preferred One Administrative Services, INC.",PPO,34.51,98.6,,percent of total billed charges,,
OLMESARTAN 20 MG ORAL TABLET,,23570,LOCAL,Facility,Outpatient,1,Each,,35,29.75,10.031,35,PrimeWest Health,Minnesota Senior Health Options (MSHO),18.0075,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
OLMESARTAN 20 MG ORAL TABLET,,23570,LOCAL,Facility,Inpatient,1,Each,,35,29.75,10.031,35,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
OLMESARTAN 20 MG ORAL TABLET,,23570,LOCAL,Facility,Outpatient,1,Each,,35,29.75,10.031,35,PrimeWest Health,MinnesotaCare,17.976,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
OLMESARTAN 20 MG ORAL TABLET,,23570,LOCAL,Facility,Inpatient,1,Each,,35,29.75,10.031,35,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
OLMESARTAN 20 MG ORAL TABLET,,23570,LOCAL,Facility,Both,1,Each,,35,29.75,10.031,35,Sanford Health Plan,Sanford Health Plan,32.2,92,,percent of total billed charges,,
OLMESARTAN 20 MG ORAL TABLET,,23570,LOCAL,Facility,Outpatient,1,Each,,35,29.75,10.031,35,"UCare Health, Inc.",Individual & Family Plan,19.7225,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
OLMESARTAN 20 MG ORAL TABLET,,23570,LOCAL,Facility,Inpatient,1,Each,,35,29.75,10.031,35,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
OLMESARTAN 20 MG ORAL TABLET,,23570,LOCAL,Facility,Outpatient,1,Each,,35,29.75,10.031,35,"UCare Health, Inc.",Medical Assistance,17.6645,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
OLMESARTAN 20 MG ORAL TABLET,,23570,LOCAL,Facility,Inpatient,1,Each,,35,29.75,10.031,35,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
OLMESARTAN 20 MG ORAL TABLET,,23570,LOCAL,Facility,Outpatient,1,Each,,35,29.75,10.031,35,"UCare Health, Inc.",Medicare Advantage,17.6645,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
OLMESARTAN 20 MG ORAL TABLET,,23570,LOCAL,Facility,Inpatient,1,Each,,35,29.75,10.031,35,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
OLMESARTAN 20 MG ORAL TABLET,,23570,LOCAL,Facility,Outpatient,1,Each,,35,29.75,10.031,35,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),17.6645,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
OLMESARTAN 20 MG ORAL TABLET,,23570,LOCAL,Facility,Inpatient,1,Each,,35,29.75,10.031,35,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
OLMESARTAN 20 MG ORAL TABLET,,23570,LOCAL,Facility,Both,1,Each,,35,29.75,10.031,35,UnitedHealthcare,Individual & Family,32.9,94,,percent of total billed charges,,
OLMESARTAN 20 MG ORAL TABLET,,23570,LOCAL,Facility,Outpatient,1,Each,,35,29.75,10.031,35,UnitedHealthcare,Medicare Advantage,17.15,49,,percent of total billed charges,,
OLMESARTAN 20 MG ORAL TABLET,,23570,LOCAL,Facility,Inpatient,1,Each,,35,29.75,10.031,35,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
OLMESARTAN 20 MG ORAL TABLET,,23570,LOCAL,Facility,Outpatient,1,Each,,35,29.75,10.031,35,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,16.8,48,,percent of total billed charges,,100% of DHS outpatient percentage
OLMESARTAN 20 MG ORAL TABLET,,23570,LOCAL,Facility,Inpatient,1,Each,,35,29.75,10.031,35,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
AZITHROMYCIN 500 MG ORAL TABLET,,25545,LOCAL,Facility,Both,1,Each,,75,63.75,21.495,75,Aetna,Commercial,69,92,,percent of total billed charges,,
AZITHROMYCIN 500 MG ORAL TABLET,,25545,LOCAL,Facility,Outpatient,1,Each,,75,63.75,21.495,75,Aetna,Medicare Advantage,36.75,49,,percent of total billed charges,,
AZITHROMYCIN 500 MG ORAL TABLET,,25545,LOCAL,Facility,Inpatient,1,Each,,75,63.75,21.495,75,Aetna,Medicare Advantage,,,,,Included in per diem rate,
AZITHROMYCIN 500 MG ORAL TABLET,,25545,LOCAL,Facility,Both,1,Each,,75,63.75,21.495,75,Aetna,PPO,69.75,93,,percent of total billed charges,,
AZITHROMYCIN 500 MG ORAL TABLET,,25545,LOCAL,Facility,Both,1,Each,,75,63.75,21.495,75,America's PPO,America's PPO,72.0225,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
AZITHROMYCIN 500 MG ORAL TABLET,,25545,LOCAL,Facility,Both,1,Each,,75,63.75,21.495,75,BlueCross BlueShield Minnesota, Federal Employee Program,73.8,98.4,,percent of total billed charges,,
AZITHROMYCIN 500 MG ORAL TABLET,,25545,LOCAL,Facility,Both,1,Each,,75,63.75,21.495,75,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,75,100,,percent of total billed charges,,
AZITHROMYCIN 500 MG ORAL TABLET,,25545,LOCAL,Facility,Both,1,Each,,75,63.75,21.495,75,BlueCross BlueShield Minnesota,High Value Network Plan,67.5,90,,percent of total billed charges,,
AZITHROMYCIN 500 MG ORAL TABLET,,25545,LOCAL,Facility,Outpatient,1,Each,,75,63.75,21.495,75,BlueCross BlueShield Minnesota,Medicare Advantage,36.75,49,,percent of total billed charges,,
AZITHROMYCIN 500 MG ORAL TABLET,,25545,LOCAL,Facility,Inpatient,1,Each,,75,63.75,21.495,75,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
AZITHROMYCIN 500 MG ORAL TABLET,,25545,LOCAL,Facility,Both,1,Each,,75,63.75,21.495,75,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,66.4275,88.57,,percent of total billed charges,,
AZITHROMYCIN 500 MG ORAL TABLET,,25545,LOCAL,Facility,Both,1,Each,,75,63.75,21.495,75,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,21.495,28.66,,percent of total billed charges,,
AZITHROMYCIN 500 MG ORAL TABLET,,25545,LOCAL,Facility,Outpatient,1,Each,,75,63.75,21.495,75,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),36.75,49,,percent of total billed charges,,
AZITHROMYCIN 500 MG ORAL TABLET,,25545,LOCAL,Facility,Inpatient,1,Each,,75,63.75,21.495,75,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
AZITHROMYCIN 500 MG ORAL TABLET,,25545,LOCAL,Facility,Both,1,Each,,75,63.75,21.495,75,CorVel,Worker's Compensation,75,100,,percent of total billed charges,,
AZITHROMYCIN 500 MG ORAL TABLET,,25545,LOCAL,Facility,Both,1,Each,,75,63.75,21.495,75,First Health Group Corporation,First Health Network,72.75,97,,percent of total billed charges,,
AZITHROMYCIN 500 MG ORAL TABLET,,25545,LOCAL,Facility,Both,1,Each,,75,63.75,21.495,75,"Health Partners, Inc.",Commercial,70.95,94.6,,percent of total billed charges,,
AZITHROMYCIN 500 MG ORAL TABLET,,25545,LOCAL,Facility,Outpatient,1,Each,,75,63.75,21.495,75,"Health Partners, Inc.",Medicare Advantage,36.75,49,,percent of total billed charges,,
AZITHROMYCIN 500 MG ORAL TABLET,,25545,LOCAL,Facility,Inpatient,1,Each,,75,63.75,21.495,75,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
AZITHROMYCIN 500 MG ORAL TABLET,,25545,LOCAL,Facility,Both,1,Each,,75,63.75,21.495,75,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),45,60,,percent of total billed charges,,
AZITHROMYCIN 500 MG ORAL TABLET,,25545,LOCAL,Facility,Both,1,Each,,75,63.75,21.495,75,"Health Partners, Inc.",State of Minnesota Advantage Program,61.125,81.5,,percent of total billed charges,,
AZITHROMYCIN 500 MG ORAL TABLET,,25545,LOCAL,Facility,Both,1,Each,,75,63.75,21.495,75,"Health Partners, Inc.",State Public Programs,37.5,50,,percent of total billed charges,,
AZITHROMYCIN 500 MG ORAL TABLET,,25545,LOCAL,Facility,Both,1,Each,,75,63.75,21.495,75,Humana Insurance Company,Commercial PPO,71.25,95,,percent of total billed charges,,
AZITHROMYCIN 500 MG ORAL TABLET,,25545,LOCAL,Facility,Outpatient,1,Each,,75,63.75,21.495,75,Humana Insurance Company,Medicare PPO,36.75,49,,percent of total billed charges,,
AZITHROMYCIN 500 MG ORAL TABLET,,25545,LOCAL,Facility,Inpatient,1,Each,,75,63.75,21.495,75,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
AZITHROMYCIN 500 MG ORAL TABLET,,25545,LOCAL,Facility,Both,1,Each,,75,63.75,21.495,75,Medica,Individual & Family,74.325,99.1,,percent of total billed charges,,
AZITHROMYCIN 500 MG ORAL TABLET,,25545,LOCAL,Facility,Outpatient,1,Each,,75,63.75,21.495,75,Medica,Medica Advantage Solution,37.35,49.8,,percent of total billed charges,,
AZITHROMYCIN 500 MG ORAL TABLET,,25545,LOCAL,Facility,Inpatient,1,Each,,75,63.75,21.495,75,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
AZITHROMYCIN 500 MG ORAL TABLET,,25545,LOCAL,Facility,Outpatient,1,Each,,75,63.75,21.495,75,Medica,Medical Assistance,33.45,44.6,,percent of total billed charges,,
AZITHROMYCIN 500 MG ORAL TABLET,,25545,LOCAL,Facility,Inpatient,1,Each,,75,63.75,21.495,75,Medica,Medical Assistance,,,,,Included in per diem rate,
AZITHROMYCIN 500 MG ORAL TABLET,,25545,LOCAL,Facility,Outpatient,1,Each,,75,63.75,21.495,75,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,37.35,49.8,,percent of total billed charges,,
AZITHROMYCIN 500 MG ORAL TABLET,,25545,LOCAL,Facility,Inpatient,1,Each,,75,63.75,21.495,75,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
AZITHROMYCIN 500 MG ORAL TABLET,,25545,LOCAL,Facility,Both,1,Each,,75,63.75,21.495,75,"Multiplan, Inc.","Multiplan, Inc.",70.5,94,,percent of total billed charges,,
AZITHROMYCIN 500 MG ORAL TABLET,,25545,LOCAL,Facility,Outpatient,1,Each,,75,63.75,21.495,75,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,67.575,90.1,,percent of total billed charges,,
AZITHROMYCIN 500 MG ORAL TABLET,,25545,LOCAL,Facility,Inpatient,1,Each,,75,63.75,21.495,75,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
AZITHROMYCIN 500 MG ORAL TABLET,,25545,LOCAL,Facility,Both,1,Each,,75,63.75,21.495,75,"Preferred One Administrative Services, INC.",PPO,73.95,98.6,,percent of total billed charges,,
AZITHROMYCIN 500 MG ORAL TABLET,,25545,LOCAL,Facility,Outpatient,1,Each,,75,63.75,21.495,75,PrimeWest Health,Minnesota Senior Health Options (MSHO),38.5875,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
AZITHROMYCIN 500 MG ORAL TABLET,,25545,LOCAL,Facility,Inpatient,1,Each,,75,63.75,21.495,75,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
AZITHROMYCIN 500 MG ORAL TABLET,,25545,LOCAL,Facility,Outpatient,1,Each,,75,63.75,21.495,75,PrimeWest Health,MinnesotaCare,38.52,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
AZITHROMYCIN 500 MG ORAL TABLET,,25545,LOCAL,Facility,Inpatient,1,Each,,75,63.75,21.495,75,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
AZITHROMYCIN 500 MG ORAL TABLET,,25545,LOCAL,Facility,Both,1,Each,,75,63.75,21.495,75,Sanford Health Plan,Sanford Health Plan,69,92,,percent of total billed charges,,
AZITHROMYCIN 500 MG ORAL TABLET,,25545,LOCAL,Facility,Outpatient,1,Each,,75,63.75,21.495,75,"UCare Health, Inc.",Individual & Family Plan,42.2625,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
AZITHROMYCIN 500 MG ORAL TABLET,,25545,LOCAL,Facility,Inpatient,1,Each,,75,63.75,21.495,75,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
AZITHROMYCIN 500 MG ORAL TABLET,,25545,LOCAL,Facility,Outpatient,1,Each,,75,63.75,21.495,75,"UCare Health, Inc.",Medical Assistance,37.8525,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
AZITHROMYCIN 500 MG ORAL TABLET,,25545,LOCAL,Facility,Inpatient,1,Each,,75,63.75,21.495,75,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
AZITHROMYCIN 500 MG ORAL TABLET,,25545,LOCAL,Facility,Outpatient,1,Each,,75,63.75,21.495,75,"UCare Health, Inc.",Medicare Advantage,37.8525,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
AZITHROMYCIN 500 MG ORAL TABLET,,25545,LOCAL,Facility,Inpatient,1,Each,,75,63.75,21.495,75,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
AZITHROMYCIN 500 MG ORAL TABLET,,25545,LOCAL,Facility,Outpatient,1,Each,,75,63.75,21.495,75,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),37.8525,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
AZITHROMYCIN 500 MG ORAL TABLET,,25545,LOCAL,Facility,Inpatient,1,Each,,75,63.75,21.495,75,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
AZITHROMYCIN 500 MG ORAL TABLET,,25545,LOCAL,Facility,Both,1,Each,,75,63.75,21.495,75,UnitedHealthcare,Individual & Family,70.5,94,,percent of total billed charges,,
AZITHROMYCIN 500 MG ORAL TABLET,,25545,LOCAL,Facility,Outpatient,1,Each,,75,63.75,21.495,75,UnitedHealthcare,Medicare Advantage,36.75,49,,percent of total billed charges,,
AZITHROMYCIN 500 MG ORAL TABLET,,25545,LOCAL,Facility,Inpatient,1,Each,,75,63.75,21.495,75,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
AZITHROMYCIN 500 MG ORAL TABLET,,25545,LOCAL,Facility,Outpatient,1,Each,,75,63.75,21.495,75,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,36,48,,percent of total billed charges,,100% of DHS outpatient percentage
AZITHROMYCIN 500 MG ORAL TABLET,,25545,LOCAL,Facility,Inpatient,1,Each,,75,63.75,21.495,75,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
ESCITALOPRAM OXALATE 10 MG ORAL TABLET,,25817,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
ESCITALOPRAM OXALATE 10 MG ORAL TABLET,,25817,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
ESCITALOPRAM OXALATE 10 MG ORAL TABLET,,25817,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
ESCITALOPRAM OXALATE 10 MG ORAL TABLET,,25817,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
ESCITALOPRAM OXALATE 10 MG ORAL TABLET,,25817,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
ESCITALOPRAM OXALATE 10 MG ORAL TABLET,,25817,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
ESCITALOPRAM OXALATE 10 MG ORAL TABLET,,25817,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
ESCITALOPRAM OXALATE 10 MG ORAL TABLET,,25817,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
ESCITALOPRAM OXALATE 10 MG ORAL TABLET,,25817,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
ESCITALOPRAM OXALATE 10 MG ORAL TABLET,,25817,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
ESCITALOPRAM OXALATE 10 MG ORAL TABLET,,25817,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
ESCITALOPRAM OXALATE 10 MG ORAL TABLET,,25817,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
ESCITALOPRAM OXALATE 10 MG ORAL TABLET,,25817,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
ESCITALOPRAM OXALATE 10 MG ORAL TABLET,,25817,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
ESCITALOPRAM OXALATE 10 MG ORAL TABLET,,25817,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
ESCITALOPRAM OXALATE 10 MG ORAL TABLET,,25817,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
ESCITALOPRAM OXALATE 10 MG ORAL TABLET,,25817,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
ESCITALOPRAM OXALATE 10 MG ORAL TABLET,,25817,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
ESCITALOPRAM OXALATE 10 MG ORAL TABLET,,25817,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ESCITALOPRAM OXALATE 10 MG ORAL TABLET,,25817,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
ESCITALOPRAM OXALATE 10 MG ORAL TABLET,,25817,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
ESCITALOPRAM OXALATE 10 MG ORAL TABLET,,25817,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
ESCITALOPRAM OXALATE 10 MG ORAL TABLET,,25817,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
ESCITALOPRAM OXALATE 10 MG ORAL TABLET,,25817,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
ESCITALOPRAM OXALATE 10 MG ORAL TABLET,,25817,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
ESCITALOPRAM OXALATE 10 MG ORAL TABLET,,25817,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
ESCITALOPRAM OXALATE 10 MG ORAL TABLET,,25817,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
ESCITALOPRAM OXALATE 10 MG ORAL TABLET,,25817,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
ESCITALOPRAM OXALATE 10 MG ORAL TABLET,,25817,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
ESCITALOPRAM OXALATE 10 MG ORAL TABLET,,25817,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
ESCITALOPRAM OXALATE 10 MG ORAL TABLET,,25817,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
ESCITALOPRAM OXALATE 10 MG ORAL TABLET,,25817,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
ESCITALOPRAM OXALATE 10 MG ORAL TABLET,,25817,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
ESCITALOPRAM OXALATE 10 MG ORAL TABLET,,25817,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
ESCITALOPRAM OXALATE 10 MG ORAL TABLET,,25817,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
ESCITALOPRAM OXALATE 10 MG ORAL TABLET,,25817,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
ESCITALOPRAM OXALATE 10 MG ORAL TABLET,,25817,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
ESCITALOPRAM OXALATE 10 MG ORAL TABLET,,25817,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ESCITALOPRAM OXALATE 10 MG ORAL TABLET,,25817,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
ESCITALOPRAM OXALATE 10 MG ORAL TABLET,,25817,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
ESCITALOPRAM OXALATE 10 MG ORAL TABLET,,25817,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
ESCITALOPRAM OXALATE 10 MG ORAL TABLET,,25817,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
ESCITALOPRAM OXALATE 10 MG ORAL TABLET,,25817,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
ESCITALOPRAM OXALATE 10 MG ORAL TABLET,,25817,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ESCITALOPRAM OXALATE 10 MG ORAL TABLET,,25817,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
ESCITALOPRAM OXALATE 10 MG ORAL TABLET,,25817,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ESCITALOPRAM OXALATE 10 MG ORAL TABLET,,25817,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ESCITALOPRAM OXALATE 10 MG ORAL TABLET,,25817,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ESCITALOPRAM OXALATE 10 MG ORAL TABLET,,25817,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ESCITALOPRAM OXALATE 10 MG ORAL TABLET,,25817,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
ESCITALOPRAM OXALATE 10 MG ORAL TABLET,,25817,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
ESCITALOPRAM OXALATE 10 MG ORAL TABLET,,25817,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
ESCITALOPRAM OXALATE 10 MG ORAL TABLET,,25817,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
ESCITALOPRAM OXALATE 10 MG ORAL TABLET,,25817,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
EPLERENONE 25 MG ORAL TABLET,,26115,LOCAL,Facility,Both,1,Each,,19,16.15,5.4454,19,Aetna,Commercial,17.48,92,,percent of total billed charges,,
EPLERENONE 25 MG ORAL TABLET,,26115,LOCAL,Facility,Outpatient,1,Each,,19,16.15,5.4454,19,Aetna,Medicare Advantage,9.31,49,,percent of total billed charges,,
EPLERENONE 25 MG ORAL TABLET,,26115,LOCAL,Facility,Inpatient,1,Each,,19,16.15,5.4454,19,Aetna,Medicare Advantage,,,,,Included in per diem rate,
EPLERENONE 25 MG ORAL TABLET,,26115,LOCAL,Facility,Both,1,Each,,19,16.15,5.4454,19,Aetna,PPO,17.67,93,,percent of total billed charges,,
EPLERENONE 25 MG ORAL TABLET,,26115,LOCAL,Facility,Both,1,Each,,19,16.15,5.4454,19,America's PPO,America's PPO,18.2457,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
EPLERENONE 25 MG ORAL TABLET,,26115,LOCAL,Facility,Both,1,Each,,19,16.15,5.4454,19,BlueCross BlueShield Minnesota, Federal Employee Program,18.696,98.4,,percent of total billed charges,,
EPLERENONE 25 MG ORAL TABLET,,26115,LOCAL,Facility,Both,1,Each,,19,16.15,5.4454,19,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,19,100,,percent of total billed charges,,
EPLERENONE 25 MG ORAL TABLET,,26115,LOCAL,Facility,Both,1,Each,,19,16.15,5.4454,19,BlueCross BlueShield Minnesota,High Value Network Plan,17.1,90,,percent of total billed charges,,
EPLERENONE 25 MG ORAL TABLET,,26115,LOCAL,Facility,Outpatient,1,Each,,19,16.15,5.4454,19,BlueCross BlueShield Minnesota,Medicare Advantage,9.31,49,,percent of total billed charges,,
EPLERENONE 25 MG ORAL TABLET,,26115,LOCAL,Facility,Inpatient,1,Each,,19,16.15,5.4454,19,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
EPLERENONE 25 MG ORAL TABLET,,26115,LOCAL,Facility,Both,1,Each,,19,16.15,5.4454,19,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,16.8283,88.57,,percent of total billed charges,,
EPLERENONE 25 MG ORAL TABLET,,26115,LOCAL,Facility,Both,1,Each,,19,16.15,5.4454,19,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,5.4454,28.66,,percent of total billed charges,,
EPLERENONE 25 MG ORAL TABLET,,26115,LOCAL,Facility,Outpatient,1,Each,,19,16.15,5.4454,19,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),9.31,49,,percent of total billed charges,,
EPLERENONE 25 MG ORAL TABLET,,26115,LOCAL,Facility,Inpatient,1,Each,,19,16.15,5.4454,19,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
EPLERENONE 25 MG ORAL TABLET,,26115,LOCAL,Facility,Both,1,Each,,19,16.15,5.4454,19,CorVel,Worker's Compensation,19,100,,percent of total billed charges,,
EPLERENONE 25 MG ORAL TABLET,,26115,LOCAL,Facility,Both,1,Each,,19,16.15,5.4454,19,First Health Group Corporation,First Health Network,18.43,97,,percent of total billed charges,,
EPLERENONE 25 MG ORAL TABLET,,26115,LOCAL,Facility,Both,1,Each,,19,16.15,5.4454,19,"Health Partners, Inc.",Commercial,17.974,94.6,,percent of total billed charges,,
EPLERENONE 25 MG ORAL TABLET,,26115,LOCAL,Facility,Outpatient,1,Each,,19,16.15,5.4454,19,"Health Partners, Inc.",Medicare Advantage,9.31,49,,percent of total billed charges,,
EPLERENONE 25 MG ORAL TABLET,,26115,LOCAL,Facility,Inpatient,1,Each,,19,16.15,5.4454,19,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
EPLERENONE 25 MG ORAL TABLET,,26115,LOCAL,Facility,Both,1,Each,,19,16.15,5.4454,19,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),11.4,60,,percent of total billed charges,,
EPLERENONE 25 MG ORAL TABLET,,26115,LOCAL,Facility,Both,1,Each,,19,16.15,5.4454,19,"Health Partners, Inc.",State of Minnesota Advantage Program,15.485,81.5,,percent of total billed charges,,
EPLERENONE 25 MG ORAL TABLET,,26115,LOCAL,Facility,Both,1,Each,,19,16.15,5.4454,19,"Health Partners, Inc.",State Public Programs,9.5,50,,percent of total billed charges,,
EPLERENONE 25 MG ORAL TABLET,,26115,LOCAL,Facility,Both,1,Each,,19,16.15,5.4454,19,Humana Insurance Company,Commercial PPO,18.05,95,,percent of total billed charges,,
EPLERENONE 25 MG ORAL TABLET,,26115,LOCAL,Facility,Outpatient,1,Each,,19,16.15,5.4454,19,Humana Insurance Company,Medicare PPO,9.31,49,,percent of total billed charges,,
EPLERENONE 25 MG ORAL TABLET,,26115,LOCAL,Facility,Inpatient,1,Each,,19,16.15,5.4454,19,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
EPLERENONE 25 MG ORAL TABLET,,26115,LOCAL,Facility,Both,1,Each,,19,16.15,5.4454,19,Medica,Individual & Family,18.829,99.1,,percent of total billed charges,,
EPLERENONE 25 MG ORAL TABLET,,26115,LOCAL,Facility,Outpatient,1,Each,,19,16.15,5.4454,19,Medica,Medica Advantage Solution,9.462,49.8,,percent of total billed charges,,
EPLERENONE 25 MG ORAL TABLET,,26115,LOCAL,Facility,Inpatient,1,Each,,19,16.15,5.4454,19,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
EPLERENONE 25 MG ORAL TABLET,,26115,LOCAL,Facility,Outpatient,1,Each,,19,16.15,5.4454,19,Medica,Medical Assistance,8.474,44.6,,percent of total billed charges,,
EPLERENONE 25 MG ORAL TABLET,,26115,LOCAL,Facility,Inpatient,1,Each,,19,16.15,5.4454,19,Medica,Medical Assistance,,,,,Included in per diem rate,
EPLERENONE 25 MG ORAL TABLET,,26115,LOCAL,Facility,Outpatient,1,Each,,19,16.15,5.4454,19,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,9.462,49.8,,percent of total billed charges,,
EPLERENONE 25 MG ORAL TABLET,,26115,LOCAL,Facility,Inpatient,1,Each,,19,16.15,5.4454,19,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
EPLERENONE 25 MG ORAL TABLET,,26115,LOCAL,Facility,Both,1,Each,,19,16.15,5.4454,19,"Multiplan, Inc.","Multiplan, Inc.",17.86,94,,percent of total billed charges,,
EPLERENONE 25 MG ORAL TABLET,,26115,LOCAL,Facility,Outpatient,1,Each,,19,16.15,5.4454,19,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,17.119,90.1,,percent of total billed charges,,
EPLERENONE 25 MG ORAL TABLET,,26115,LOCAL,Facility,Inpatient,1,Each,,19,16.15,5.4454,19,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
EPLERENONE 25 MG ORAL TABLET,,26115,LOCAL,Facility,Both,1,Each,,19,16.15,5.4454,19,"Preferred One Administrative Services, INC.",PPO,18.734,98.6,,percent of total billed charges,,
EPLERENONE 25 MG ORAL TABLET,,26115,LOCAL,Facility,Outpatient,1,Each,,19,16.15,5.4454,19,PrimeWest Health,Minnesota Senior Health Options (MSHO),9.7755,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
EPLERENONE 25 MG ORAL TABLET,,26115,LOCAL,Facility,Inpatient,1,Each,,19,16.15,5.4454,19,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
EPLERENONE 25 MG ORAL TABLET,,26115,LOCAL,Facility,Outpatient,1,Each,,19,16.15,5.4454,19,PrimeWest Health,MinnesotaCare,9.7584,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
EPLERENONE 25 MG ORAL TABLET,,26115,LOCAL,Facility,Inpatient,1,Each,,19,16.15,5.4454,19,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
EPLERENONE 25 MG ORAL TABLET,,26115,LOCAL,Facility,Both,1,Each,,19,16.15,5.4454,19,Sanford Health Plan,Sanford Health Plan,17.48,92,,percent of total billed charges,,
EPLERENONE 25 MG ORAL TABLET,,26115,LOCAL,Facility,Outpatient,1,Each,,19,16.15,5.4454,19,"UCare Health, Inc.",Individual & Family Plan,10.7065,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
EPLERENONE 25 MG ORAL TABLET,,26115,LOCAL,Facility,Inpatient,1,Each,,19,16.15,5.4454,19,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
EPLERENONE 25 MG ORAL TABLET,,26115,LOCAL,Facility,Outpatient,1,Each,,19,16.15,5.4454,19,"UCare Health, Inc.",Medical Assistance,9.5893,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
EPLERENONE 25 MG ORAL TABLET,,26115,LOCAL,Facility,Inpatient,1,Each,,19,16.15,5.4454,19,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
EPLERENONE 25 MG ORAL TABLET,,26115,LOCAL,Facility,Outpatient,1,Each,,19,16.15,5.4454,19,"UCare Health, Inc.",Medicare Advantage,9.5893,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
EPLERENONE 25 MG ORAL TABLET,,26115,LOCAL,Facility,Inpatient,1,Each,,19,16.15,5.4454,19,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
EPLERENONE 25 MG ORAL TABLET,,26115,LOCAL,Facility,Outpatient,1,Each,,19,16.15,5.4454,19,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),9.5893,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
EPLERENONE 25 MG ORAL TABLET,,26115,LOCAL,Facility,Inpatient,1,Each,,19,16.15,5.4454,19,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
EPLERENONE 25 MG ORAL TABLET,,26115,LOCAL,Facility,Both,1,Each,,19,16.15,5.4454,19,UnitedHealthcare,Individual & Family,17.86,94,,percent of total billed charges,,
EPLERENONE 25 MG ORAL TABLET,,26115,LOCAL,Facility,Outpatient,1,Each,,19,16.15,5.4454,19,UnitedHealthcare,Medicare Advantage,9.31,49,,percent of total billed charges,,
EPLERENONE 25 MG ORAL TABLET,,26115,LOCAL,Facility,Inpatient,1,Each,,19,16.15,5.4454,19,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
EPLERENONE 25 MG ORAL TABLET,,26115,LOCAL,Facility,Outpatient,1,Each,,19,16.15,5.4454,19,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,9.12,48,,percent of total billed charges,,100% of DHS outpatient percentage
EPLERENONE 25 MG ORAL TABLET,,26115,LOCAL,Facility,Inpatient,1,Each,,19,16.15,5.4454,19,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
EZETIMIBE 10 MG ORAL TABLET,,26311,LOCAL,Facility,Both,1,Each,,50,42.5,14.33,50,Aetna,Commercial,46,92,,percent of total billed charges,,
EZETIMIBE 10 MG ORAL TABLET,,26311,LOCAL,Facility,Outpatient,1,Each,,50,42.5,14.33,50,Aetna,Medicare Advantage,24.5,49,,percent of total billed charges,,
EZETIMIBE 10 MG ORAL TABLET,,26311,LOCAL,Facility,Inpatient,1,Each,,50,42.5,14.33,50,Aetna,Medicare Advantage,,,,,Included in per diem rate,
EZETIMIBE 10 MG ORAL TABLET,,26311,LOCAL,Facility,Both,1,Each,,50,42.5,14.33,50,Aetna,PPO,46.5,93,,percent of total billed charges,,
EZETIMIBE 10 MG ORAL TABLET,,26311,LOCAL,Facility,Both,1,Each,,50,42.5,14.33,50,America's PPO,America's PPO,48.015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
EZETIMIBE 10 MG ORAL TABLET,,26311,LOCAL,Facility,Both,1,Each,,50,42.5,14.33,50,BlueCross BlueShield Minnesota, Federal Employee Program,49.2,98.4,,percent of total billed charges,,
EZETIMIBE 10 MG ORAL TABLET,,26311,LOCAL,Facility,Both,1,Each,,50,42.5,14.33,50,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,50,100,,percent of total billed charges,,
EZETIMIBE 10 MG ORAL TABLET,,26311,LOCAL,Facility,Both,1,Each,,50,42.5,14.33,50,BlueCross BlueShield Minnesota,High Value Network Plan,45,90,,percent of total billed charges,,
EZETIMIBE 10 MG ORAL TABLET,,26311,LOCAL,Facility,Outpatient,1,Each,,50,42.5,14.33,50,BlueCross BlueShield Minnesota,Medicare Advantage,24.5,49,,percent of total billed charges,,
EZETIMIBE 10 MG ORAL TABLET,,26311,LOCAL,Facility,Inpatient,1,Each,,50,42.5,14.33,50,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
EZETIMIBE 10 MG ORAL TABLET,,26311,LOCAL,Facility,Both,1,Each,,50,42.5,14.33,50,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,44.285,88.57,,percent of total billed charges,,
EZETIMIBE 10 MG ORAL TABLET,,26311,LOCAL,Facility,Both,1,Each,,50,42.5,14.33,50,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,14.33,28.66,,percent of total billed charges,,
EZETIMIBE 10 MG ORAL TABLET,,26311,LOCAL,Facility,Outpatient,1,Each,,50,42.5,14.33,50,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),24.5,49,,percent of total billed charges,,
EZETIMIBE 10 MG ORAL TABLET,,26311,LOCAL,Facility,Inpatient,1,Each,,50,42.5,14.33,50,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
EZETIMIBE 10 MG ORAL TABLET,,26311,LOCAL,Facility,Both,1,Each,,50,42.5,14.33,50,CorVel,Worker's Compensation,50,100,,percent of total billed charges,,
EZETIMIBE 10 MG ORAL TABLET,,26311,LOCAL,Facility,Both,1,Each,,50,42.5,14.33,50,First Health Group Corporation,First Health Network,48.5,97,,percent of total billed charges,,
EZETIMIBE 10 MG ORAL TABLET,,26311,LOCAL,Facility,Both,1,Each,,50,42.5,14.33,50,"Health Partners, Inc.",Commercial,47.3,94.6,,percent of total billed charges,,
EZETIMIBE 10 MG ORAL TABLET,,26311,LOCAL,Facility,Outpatient,1,Each,,50,42.5,14.33,50,"Health Partners, Inc.",Medicare Advantage,24.5,49,,percent of total billed charges,,
EZETIMIBE 10 MG ORAL TABLET,,26311,LOCAL,Facility,Inpatient,1,Each,,50,42.5,14.33,50,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
EZETIMIBE 10 MG ORAL TABLET,,26311,LOCAL,Facility,Both,1,Each,,50,42.5,14.33,50,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),30,60,,percent of total billed charges,,
EZETIMIBE 10 MG ORAL TABLET,,26311,LOCAL,Facility,Both,1,Each,,50,42.5,14.33,50,"Health Partners, Inc.",State of Minnesota Advantage Program,40.75,81.5,,percent of total billed charges,,
EZETIMIBE 10 MG ORAL TABLET,,26311,LOCAL,Facility,Both,1,Each,,50,42.5,14.33,50,"Health Partners, Inc.",State Public Programs,25,50,,percent of total billed charges,,
EZETIMIBE 10 MG ORAL TABLET,,26311,LOCAL,Facility,Both,1,Each,,50,42.5,14.33,50,Humana Insurance Company,Commercial PPO,47.5,95,,percent of total billed charges,,
EZETIMIBE 10 MG ORAL TABLET,,26311,LOCAL,Facility,Outpatient,1,Each,,50,42.5,14.33,50,Humana Insurance Company,Medicare PPO,24.5,49,,percent of total billed charges,,
EZETIMIBE 10 MG ORAL TABLET,,26311,LOCAL,Facility,Inpatient,1,Each,,50,42.5,14.33,50,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
EZETIMIBE 10 MG ORAL TABLET,,26311,LOCAL,Facility,Both,1,Each,,50,42.5,14.33,50,Medica,Individual & Family,49.55,99.1,,percent of total billed charges,,
EZETIMIBE 10 MG ORAL TABLET,,26311,LOCAL,Facility,Outpatient,1,Each,,50,42.5,14.33,50,Medica,Medica Advantage Solution,24.9,49.8,,percent of total billed charges,,
EZETIMIBE 10 MG ORAL TABLET,,26311,LOCAL,Facility,Inpatient,1,Each,,50,42.5,14.33,50,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
EZETIMIBE 10 MG ORAL TABLET,,26311,LOCAL,Facility,Outpatient,1,Each,,50,42.5,14.33,50,Medica,Medical Assistance,22.3,44.6,,percent of total billed charges,,
EZETIMIBE 10 MG ORAL TABLET,,26311,LOCAL,Facility,Inpatient,1,Each,,50,42.5,14.33,50,Medica,Medical Assistance,,,,,Included in per diem rate,
EZETIMIBE 10 MG ORAL TABLET,,26311,LOCAL,Facility,Outpatient,1,Each,,50,42.5,14.33,50,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,24.9,49.8,,percent of total billed charges,,
EZETIMIBE 10 MG ORAL TABLET,,26311,LOCAL,Facility,Inpatient,1,Each,,50,42.5,14.33,50,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
EZETIMIBE 10 MG ORAL TABLET,,26311,LOCAL,Facility,Both,1,Each,,50,42.5,14.33,50,"Multiplan, Inc.","Multiplan, Inc.",47,94,,percent of total billed charges,,
EZETIMIBE 10 MG ORAL TABLET,,26311,LOCAL,Facility,Outpatient,1,Each,,50,42.5,14.33,50,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,45.05,90.1,,percent of total billed charges,,
EZETIMIBE 10 MG ORAL TABLET,,26311,LOCAL,Facility,Inpatient,1,Each,,50,42.5,14.33,50,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
EZETIMIBE 10 MG ORAL TABLET,,26311,LOCAL,Facility,Both,1,Each,,50,42.5,14.33,50,"Preferred One Administrative Services, INC.",PPO,49.3,98.6,,percent of total billed charges,,
EZETIMIBE 10 MG ORAL TABLET,,26311,LOCAL,Facility,Outpatient,1,Each,,50,42.5,14.33,50,PrimeWest Health,Minnesota Senior Health Options (MSHO),25.725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
EZETIMIBE 10 MG ORAL TABLET,,26311,LOCAL,Facility,Inpatient,1,Each,,50,42.5,14.33,50,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
EZETIMIBE 10 MG ORAL TABLET,,26311,LOCAL,Facility,Outpatient,1,Each,,50,42.5,14.33,50,PrimeWest Health,MinnesotaCare,25.68,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
EZETIMIBE 10 MG ORAL TABLET,,26311,LOCAL,Facility,Inpatient,1,Each,,50,42.5,14.33,50,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
EZETIMIBE 10 MG ORAL TABLET,,26311,LOCAL,Facility,Both,1,Each,,50,42.5,14.33,50,Sanford Health Plan,Sanford Health Plan,46,92,,percent of total billed charges,,
EZETIMIBE 10 MG ORAL TABLET,,26311,LOCAL,Facility,Outpatient,1,Each,,50,42.5,14.33,50,"UCare Health, Inc.",Individual & Family Plan,28.175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
EZETIMIBE 10 MG ORAL TABLET,,26311,LOCAL,Facility,Inpatient,1,Each,,50,42.5,14.33,50,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
EZETIMIBE 10 MG ORAL TABLET,,26311,LOCAL,Facility,Outpatient,1,Each,,50,42.5,14.33,50,"UCare Health, Inc.",Medical Assistance,25.235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
EZETIMIBE 10 MG ORAL TABLET,,26311,LOCAL,Facility,Inpatient,1,Each,,50,42.5,14.33,50,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
EZETIMIBE 10 MG ORAL TABLET,,26311,LOCAL,Facility,Outpatient,1,Each,,50,42.5,14.33,50,"UCare Health, Inc.",Medicare Advantage,25.235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
EZETIMIBE 10 MG ORAL TABLET,,26311,LOCAL,Facility,Inpatient,1,Each,,50,42.5,14.33,50,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
EZETIMIBE 10 MG ORAL TABLET,,26311,LOCAL,Facility,Outpatient,1,Each,,50,42.5,14.33,50,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),25.235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
EZETIMIBE 10 MG ORAL TABLET,,26311,LOCAL,Facility,Inpatient,1,Each,,50,42.5,14.33,50,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
EZETIMIBE 10 MG ORAL TABLET,,26311,LOCAL,Facility,Both,1,Each,,50,42.5,14.33,50,UnitedHealthcare,Individual & Family,47,94,,percent of total billed charges,,
EZETIMIBE 10 MG ORAL TABLET,,26311,LOCAL,Facility,Outpatient,1,Each,,50,42.5,14.33,50,UnitedHealthcare,Medicare Advantage,24.5,49,,percent of total billed charges,,
EZETIMIBE 10 MG ORAL TABLET,,26311,LOCAL,Facility,Inpatient,1,Each,,50,42.5,14.33,50,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
EZETIMIBE 10 MG ORAL TABLET,,26311,LOCAL,Facility,Outpatient,1,Each,,50,42.5,14.33,50,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,24,48,,percent of total billed charges,,100% of DHS outpatient percentage
EZETIMIBE 10 MG ORAL TABLET,,26311,LOCAL,Facility,Inpatient,1,Each,,50,42.5,14.33,50,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
DUTASTERIDE 0.5 MG ORAL CAP,,26344,LOCAL,Facility,Both,1,Each,,56,47.6,16.0496,56,Aetna,Commercial,51.52,92,,percent of total billed charges,,
DUTASTERIDE 0.5 MG ORAL CAP,,26344,LOCAL,Facility,Outpatient,1,Each,,56,47.6,16.0496,56,Aetna,Medicare Advantage,27.44,49,,percent of total billed charges,,
DUTASTERIDE 0.5 MG ORAL CAP,,26344,LOCAL,Facility,Inpatient,1,Each,,56,47.6,16.0496,56,Aetna,Medicare Advantage,,,,,Included in per diem rate,
DUTASTERIDE 0.5 MG ORAL CAP,,26344,LOCAL,Facility,Both,1,Each,,56,47.6,16.0496,56,Aetna,PPO,52.08,93,,percent of total billed charges,,
DUTASTERIDE 0.5 MG ORAL CAP,,26344,LOCAL,Facility,Both,1,Each,,56,47.6,16.0496,56,America's PPO,America's PPO,53.7768,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
DUTASTERIDE 0.5 MG ORAL CAP,,26344,LOCAL,Facility,Both,1,Each,,56,47.6,16.0496,56,BlueCross BlueShield Minnesota, Federal Employee Program,55.104,98.4,,percent of total billed charges,,
DUTASTERIDE 0.5 MG ORAL CAP,,26344,LOCAL,Facility,Both,1,Each,,56,47.6,16.0496,56,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,56,100,,percent of total billed charges,,
DUTASTERIDE 0.5 MG ORAL CAP,,26344,LOCAL,Facility,Both,1,Each,,56,47.6,16.0496,56,BlueCross BlueShield Minnesota,High Value Network Plan,50.4,90,,percent of total billed charges,,
DUTASTERIDE 0.5 MG ORAL CAP,,26344,LOCAL,Facility,Outpatient,1,Each,,56,47.6,16.0496,56,BlueCross BlueShield Minnesota,Medicare Advantage,27.44,49,,percent of total billed charges,,
DUTASTERIDE 0.5 MG ORAL CAP,,26344,LOCAL,Facility,Inpatient,1,Each,,56,47.6,16.0496,56,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
DUTASTERIDE 0.5 MG ORAL CAP,,26344,LOCAL,Facility,Both,1,Each,,56,47.6,16.0496,56,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,49.5992,88.57,,percent of total billed charges,,
DUTASTERIDE 0.5 MG ORAL CAP,,26344,LOCAL,Facility,Both,1,Each,,56,47.6,16.0496,56,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,16.0496,28.66,,percent of total billed charges,,
DUTASTERIDE 0.5 MG ORAL CAP,,26344,LOCAL,Facility,Outpatient,1,Each,,56,47.6,16.0496,56,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),27.44,49,,percent of total billed charges,,
DUTASTERIDE 0.5 MG ORAL CAP,,26344,LOCAL,Facility,Inpatient,1,Each,,56,47.6,16.0496,56,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
DUTASTERIDE 0.5 MG ORAL CAP,,26344,LOCAL,Facility,Both,1,Each,,56,47.6,16.0496,56,CorVel,Worker's Compensation,56,100,,percent of total billed charges,,
DUTASTERIDE 0.5 MG ORAL CAP,,26344,LOCAL,Facility,Both,1,Each,,56,47.6,16.0496,56,First Health Group Corporation,First Health Network,54.32,97,,percent of total billed charges,,
DUTASTERIDE 0.5 MG ORAL CAP,,26344,LOCAL,Facility,Both,1,Each,,56,47.6,16.0496,56,"Health Partners, Inc.",Commercial,52.976,94.6,,percent of total billed charges,,
DUTASTERIDE 0.5 MG ORAL CAP,,26344,LOCAL,Facility,Outpatient,1,Each,,56,47.6,16.0496,56,"Health Partners, Inc.",Medicare Advantage,27.44,49,,percent of total billed charges,,
DUTASTERIDE 0.5 MG ORAL CAP,,26344,LOCAL,Facility,Inpatient,1,Each,,56,47.6,16.0496,56,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DUTASTERIDE 0.5 MG ORAL CAP,,26344,LOCAL,Facility,Both,1,Each,,56,47.6,16.0496,56,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),33.6,60,,percent of total billed charges,,
DUTASTERIDE 0.5 MG ORAL CAP,,26344,LOCAL,Facility,Both,1,Each,,56,47.6,16.0496,56,"Health Partners, Inc.",State of Minnesota Advantage Program,45.64,81.5,,percent of total billed charges,,
DUTASTERIDE 0.5 MG ORAL CAP,,26344,LOCAL,Facility,Both,1,Each,,56,47.6,16.0496,56,"Health Partners, Inc.",State Public Programs,28,50,,percent of total billed charges,,
DUTASTERIDE 0.5 MG ORAL CAP,,26344,LOCAL,Facility,Both,1,Each,,56,47.6,16.0496,56,Humana Insurance Company,Commercial PPO,53.2,95,,percent of total billed charges,,
DUTASTERIDE 0.5 MG ORAL CAP,,26344,LOCAL,Facility,Outpatient,1,Each,,56,47.6,16.0496,56,Humana Insurance Company,Medicare PPO,27.44,49,,percent of total billed charges,,
DUTASTERIDE 0.5 MG ORAL CAP,,26344,LOCAL,Facility,Inpatient,1,Each,,56,47.6,16.0496,56,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
DUTASTERIDE 0.5 MG ORAL CAP,,26344,LOCAL,Facility,Both,1,Each,,56,47.6,16.0496,56,Medica,Individual & Family,55.496,99.1,,percent of total billed charges,,
DUTASTERIDE 0.5 MG ORAL CAP,,26344,LOCAL,Facility,Outpatient,1,Each,,56,47.6,16.0496,56,Medica,Medica Advantage Solution,27.888,49.8,,percent of total billed charges,,
DUTASTERIDE 0.5 MG ORAL CAP,,26344,LOCAL,Facility,Inpatient,1,Each,,56,47.6,16.0496,56,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
DUTASTERIDE 0.5 MG ORAL CAP,,26344,LOCAL,Facility,Outpatient,1,Each,,56,47.6,16.0496,56,Medica,Medical Assistance,24.976,44.6,,percent of total billed charges,,
DUTASTERIDE 0.5 MG ORAL CAP,,26344,LOCAL,Facility,Inpatient,1,Each,,56,47.6,16.0496,56,Medica,Medical Assistance,,,,,Included in per diem rate,
DUTASTERIDE 0.5 MG ORAL CAP,,26344,LOCAL,Facility,Outpatient,1,Each,,56,47.6,16.0496,56,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,27.888,49.8,,percent of total billed charges,,
DUTASTERIDE 0.5 MG ORAL CAP,,26344,LOCAL,Facility,Inpatient,1,Each,,56,47.6,16.0496,56,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
DUTASTERIDE 0.5 MG ORAL CAP,,26344,LOCAL,Facility,Both,1,Each,,56,47.6,16.0496,56,"Multiplan, Inc.","Multiplan, Inc.",52.64,94,,percent of total billed charges,,
DUTASTERIDE 0.5 MG ORAL CAP,,26344,LOCAL,Facility,Outpatient,1,Each,,56,47.6,16.0496,56,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,50.456,90.1,,percent of total billed charges,,
DUTASTERIDE 0.5 MG ORAL CAP,,26344,LOCAL,Facility,Inpatient,1,Each,,56,47.6,16.0496,56,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
DUTASTERIDE 0.5 MG ORAL CAP,,26344,LOCAL,Facility,Both,1,Each,,56,47.6,16.0496,56,"Preferred One Administrative Services, INC.",PPO,55.216,98.6,,percent of total billed charges,,
DUTASTERIDE 0.5 MG ORAL CAP,,26344,LOCAL,Facility,Outpatient,1,Each,,56,47.6,16.0496,56,PrimeWest Health,Minnesota Senior Health Options (MSHO),28.812,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
DUTASTERIDE 0.5 MG ORAL CAP,,26344,LOCAL,Facility,Inpatient,1,Each,,56,47.6,16.0496,56,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DUTASTERIDE 0.5 MG ORAL CAP,,26344,LOCAL,Facility,Outpatient,1,Each,,56,47.6,16.0496,56,PrimeWest Health,MinnesotaCare,28.7616,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
DUTASTERIDE 0.5 MG ORAL CAP,,26344,LOCAL,Facility,Inpatient,1,Each,,56,47.6,16.0496,56,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
DUTASTERIDE 0.5 MG ORAL CAP,,26344,LOCAL,Facility,Both,1,Each,,56,47.6,16.0496,56,Sanford Health Plan,Sanford Health Plan,51.52,92,,percent of total billed charges,,
DUTASTERIDE 0.5 MG ORAL CAP,,26344,LOCAL,Facility,Outpatient,1,Each,,56,47.6,16.0496,56,"UCare Health, Inc.",Individual & Family Plan,31.556,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
DUTASTERIDE 0.5 MG ORAL CAP,,26344,LOCAL,Facility,Inpatient,1,Each,,56,47.6,16.0496,56,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
DUTASTERIDE 0.5 MG ORAL CAP,,26344,LOCAL,Facility,Outpatient,1,Each,,56,47.6,16.0496,56,"UCare Health, Inc.",Medical Assistance,28.2632,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DUTASTERIDE 0.5 MG ORAL CAP,,26344,LOCAL,Facility,Inpatient,1,Each,,56,47.6,16.0496,56,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
DUTASTERIDE 0.5 MG ORAL CAP,,26344,LOCAL,Facility,Outpatient,1,Each,,56,47.6,16.0496,56,"UCare Health, Inc.",Medicare Advantage,28.2632,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DUTASTERIDE 0.5 MG ORAL CAP,,26344,LOCAL,Facility,Inpatient,1,Each,,56,47.6,16.0496,56,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DUTASTERIDE 0.5 MG ORAL CAP,,26344,LOCAL,Facility,Outpatient,1,Each,,56,47.6,16.0496,56,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),28.2632,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DUTASTERIDE 0.5 MG ORAL CAP,,26344,LOCAL,Facility,Inpatient,1,Each,,56,47.6,16.0496,56,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DUTASTERIDE 0.5 MG ORAL CAP,,26344,LOCAL,Facility,Both,1,Each,,56,47.6,16.0496,56,UnitedHealthcare,Individual & Family,52.64,94,,percent of total billed charges,,
DUTASTERIDE 0.5 MG ORAL CAP,,26344,LOCAL,Facility,Outpatient,1,Each,,56,47.6,16.0496,56,UnitedHealthcare,Medicare Advantage,27.44,49,,percent of total billed charges,,
DUTASTERIDE 0.5 MG ORAL CAP,,26344,LOCAL,Facility,Inpatient,1,Each,,56,47.6,16.0496,56,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
DUTASTERIDE 0.5 MG ORAL CAP,,26344,LOCAL,Facility,Outpatient,1,Each,,56,47.6,16.0496,56,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,26.88,48,,percent of total billed charges,,100% of DHS outpatient percentage
DUTASTERIDE 0.5 MG ORAL CAP,,26344,LOCAL,Facility,Inpatient,1,Each,,56,47.6,16.0496,56,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Adjacent Tissue Transfer Or Rearrangement F/C/C/M/N/A/G/H/F 10Sqcm Or Less(Pro Cah),,14040,CPT,Professional,Both,,,,1785,1517.25,391.79,1785,Aetna,Commercial,1517.25,85,,percent of total billed charges,,
Adjacent Tissue Transfer Or Rearrangement F/C/C/M/N/A/G/H/F 10Sqcm Or Less(Pro Cah),,14040,CPT,Professional,Both,,,,1785,1517.25,391.79,1785,Aetna,Medicare Advantage,610.39,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Adjacent Tissue Transfer Or Rearrangement F/C/C/M/N/A/G/H/F 10Sqcm Or Less(Pro Cah),,14040,CPT,Professional,Both,,,,1785,1517.25,391.79,1785,Aetna,PPO,1660.05,93,,percent of total billed charges,,
Adjacent Tissue Transfer Or Rearrangement F/C/C/M/N/A/G/H/F 10Sqcm Or Less(Pro Cah),,14040,CPT,Professional,Both,,,,1785,1517.25,391.79,1785,America's PPO,America's PPO,1525.104,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Adjacent Tissue Transfer Or Rearrangement F/C/C/M/N/A/G/H/F 10Sqcm Or Less(Pro Cah),,14040,CPT,Professional,Both,,,,1785,1517.25,391.79,1785,BlueCross BlueShield Minnesota, Federal Employee Program,1276.66,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Adjacent Tissue Transfer Or Rearrangement F/C/C/M/N/A/G/H/F 10Sqcm Or Less(Pro Cah),,14040,CPT,Professional,Both,,,,1785,1517.25,391.79,1785,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1297.08656,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Adjacent Tissue Transfer Or Rearrangement F/C/C/M/N/A/G/H/F 10Sqcm Or Less(Pro Cah),,14040,CPT,Professional,Both,,,,1785,1517.25,391.79,1785,BlueCross BlueShield Minnesota,High Value Network Plan,1297.08656,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Adjacent Tissue Transfer Or Rearrangement F/C/C/M/N/A/G/H/F 10Sqcm Or Less(Pro Cah),,14040,CPT,Professional,Both,,,,1785,1517.25,391.79,1785,BlueCross BlueShield Minnesota,Medicare Advantage,700.166,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Adjacent Tissue Transfer Or Rearrangement F/C/C/M/N/A/G/H/F 10Sqcm Or Less(Pro Cah),,14040,CPT,Professional,Both,,,,1785,1517.25,391.79,1785,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1297.08656,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Adjacent Tissue Transfer Or Rearrangement F/C/C/M/N/A/G/H/F 10Sqcm Or Less(Pro Cah),,14040,CPT,Professional,Both,,,,1785,1517.25,391.79,1785,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,452.34352,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Adjacent Tissue Transfer Or Rearrangement F/C/C/M/N/A/G/H/F 10Sqcm Or Less(Pro Cah),,14040,CPT,Professional,Both,,,,1785,1517.25,391.79,1785,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),700.166,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Adjacent Tissue Transfer Or Rearrangement F/C/C/M/N/A/G/H/F 10Sqcm Or Less(Pro Cah),,14040,CPT,Professional,Both,,,,1785,1517.25,391.79,1785,CorVel,Worker's Compensation,1183.204252,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Adjacent Tissue Transfer Or Rearrangement F/C/C/M/N/A/G/H/F 10Sqcm Or Less(Pro Cah),,14040,CPT,Professional,Both,,,,1785,1517.25,391.79,1785,First Health Group Corporation,First Health Network,1731.45,97,,percent of total billed charges,,
Adjacent Tissue Transfer Or Rearrangement F/C/C/M/N/A/G/H/F 10Sqcm Or Less(Pro Cah),,14040,CPT,Professional,Both,,,,1785,1517.25,391.79,1785,"Health Partners, Inc.",Commercial,1277.65,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Adjacent Tissue Transfer Or Rearrangement F/C/C/M/N/A/G/H/F 10Sqcm Or Less(Pro Cah),,14040,CPT,Professional,Both,,,,1785,1517.25,391.79,1785,"Health Partners, Inc.",Medicare Advantage,700.166,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Adjacent Tissue Transfer Or Rearrangement F/C/C/M/N/A/G/H/F 10Sqcm Or Less(Pro Cah),,14040,CPT,Professional,Both,,,,1785,1517.25,391.79,1785,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),608.95,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Adjacent Tissue Transfer Or Rearrangement F/C/C/M/N/A/G/H/F 10Sqcm Or Less(Pro Cah),,14040,CPT,Professional,Both,,,,1785,1517.25,391.79,1785,"Health Partners, Inc.",State of Minnesota Advantage Program,1100.695475,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Adjacent Tissue Transfer Or Rearrangement F/C/C/M/N/A/G/H/F 10Sqcm Or Less(Pro Cah),,14040,CPT,Professional,Both,,,,1785,1517.25,391.79,1785,"Health Partners, Inc.",State Public Programs,391.79,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Adjacent Tissue Transfer Or Rearrangement F/C/C/M/N/A/G/H/F 10Sqcm Or Less(Pro Cah),,14040,CPT,Professional,Both,,,,1785,1517.25,391.79,1785,Humana Insurance Company,Commercial PPO,608.84,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Adjacent Tissue Transfer Or Rearrangement F/C/C/M/N/A/G/H/F 10Sqcm Or Less(Pro Cah),,14040,CPT,Professional,Both,,,,1785,1517.25,391.79,1785,Humana Insurance Company,Medicare PPO,1785,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Adjacent Tissue Transfer Or Rearrangement F/C/C/M/N/A/G/H/F 10Sqcm Or Less(Pro Cah),,14040,CPT,Professional,Both,,,,1785,1517.25,391.79,1785,Medica,Individual & Family,1513.68,84.8,,percent of total billed charges,,
Adjacent Tissue Transfer Or Rearrangement F/C/C/M/N/A/G/H/F 10Sqcm Or Less(Pro Cah),,14040,CPT,Professional,Both,,,,1785,1517.25,391.79,1785,Medica,Medica Advantage Solution,888.93,49.8,,percent of total billed charges,,
Adjacent Tissue Transfer Or Rearrangement F/C/C/M/N/A/G/H/F 10Sqcm Or Less(Pro Cah),,14040,CPT,Professional,Both,,,,1785,1517.25,391.79,1785,Medica,Medical Assistance,452.34,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Adjacent Tissue Transfer Or Rearrangement F/C/C/M/N/A/G/H/F 10Sqcm Or Less(Pro Cah),,14040,CPT,Professional,Both,,,,1785,1517.25,391.79,1785,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,608.84,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Adjacent Tissue Transfer Or Rearrangement F/C/C/M/N/A/G/H/F 10Sqcm Or Less(Pro Cah),,14040,CPT,Professional,Both,,,,1785,1517.25,391.79,1785,"Multiplan, Inc.","Multiplan, Inc.",1677.9,94,,percent of total billed charges,,
Adjacent Tissue Transfer Or Rearrangement F/C/C/M/N/A/G/H/F 10Sqcm Or Less(Pro Cah),,14040,CPT,Professional,Both,,,,1785,1517.25,391.79,1785,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1608.285,90.1,,percent of total billed charges,,
Adjacent Tissue Transfer Or Rearrangement F/C/C/M/N/A/G/H/F 10Sqcm Or Less(Pro Cah),,14040,CPT,Professional,Both,,,,1785,1517.25,391.79,1785,"Preferred One Administrative Services, INC.",PPO,1760.01,98.6,,percent of total billed charges,,
Adjacent Tissue Transfer Or Rearrangement F/C/C/M/N/A/G/H/F 10Sqcm Or Less(Pro Cah),,14040,CPT,Professional,Both,,,,1785,1517.25,391.79,1785,PrimeWest Health,Minnesota Senior Health Options (MSHO),700.166,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Adjacent Tissue Transfer Or Rearrangement F/C/C/M/N/A/G/H/F 10Sqcm Or Less(Pro Cah),,14040,CPT,Professional,Both,,,,1785,1517.25,391.79,1785,PrimeWest Health,MinnesotaCare,484.0075664,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Adjacent Tissue Transfer Or Rearrangement F/C/C/M/N/A/G/H/F 10Sqcm Or Less(Pro Cah),,14040,CPT,Professional,Both,,,,1785,1517.25,391.79,1785,Sanford Health Plan,Sanford Health Plan,1570.8,88,,percent of total billed charges,,
Adjacent Tissue Transfer Or Rearrangement F/C/C/M/N/A/G/H/F 10Sqcm Or Less(Pro Cah),,14040,CPT,Professional,Both,,,,1785,1517.25,391.79,1785,"UCare Health, Inc.",Individual & Family Plan,989.730304,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Adjacent Tissue Transfer Or Rearrangement F/C/C/M/N/A/G/H/F 10Sqcm Or Less(Pro Cah),,14040,CPT,Professional,Both,,,,1785,1517.25,391.79,1785,"UCare Health, Inc.",Medical Assistance,497.577872,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Adjacent Tissue Transfer Or Rearrangement F/C/C/M/N/A/G/H/F 10Sqcm Or Less(Pro Cah),,14040,CPT,Professional,Both,,,,1785,1517.25,391.79,1785,"UCare Health, Inc.",Medicare Advantage,700.166,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Adjacent Tissue Transfer Or Rearrangement F/C/C/M/N/A/G/H/F 10Sqcm Or Less(Pro Cah),,14040,CPT,Professional,Both,,,,1785,1517.25,391.79,1785,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),560.1328,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Adjacent Tissue Transfer Or Rearrangement F/C/C/M/N/A/G/H/F 10Sqcm Or Less(Pro Cah),,14040,CPT,Professional,Both,,,,1785,1517.25,391.79,1785,UnitedHealthcare,Individual & Family,1785,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Adjacent Tissue Transfer Or Rearrangement F/C/C/M/N/A/G/H/F 10Sqcm Or Less(Pro Cah),,14040,CPT,Professional,Both,,,,1785,1517.25,391.79,1785,UnitedHealthcare,Medicare Advantage,700.166,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Adjacent Tissue Transfer Or Rearrangement F/C/C/M/N/A/G/H/F 10Sqcm Or Less(Pro Cah),,14040,CPT,Professional,Both,,,,1785,1517.25,391.79,1785,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,452.34352,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
POLYVINYL ALCOHOL-POVIDON(PF) 1.4-0.6 % OPHT DPET,,26362,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
POLYVINYL ALCOHOL-POVIDON(PF) 1.4-0.6 % OPHT DPET,,26362,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
POLYVINYL ALCOHOL-POVIDON(PF) 1.4-0.6 % OPHT DPET,,26362,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
POLYVINYL ALCOHOL-POVIDON(PF) 1.4-0.6 % OPHT DPET,,26362,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
POLYVINYL ALCOHOL-POVIDON(PF) 1.4-0.6 % OPHT DPET,,26362,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
POLYVINYL ALCOHOL-POVIDON(PF) 1.4-0.6 % OPHT DPET,,26362,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
POLYVINYL ALCOHOL-POVIDON(PF) 1.4-0.6 % OPHT DPET,,26362,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
POLYVINYL ALCOHOL-POVIDON(PF) 1.4-0.6 % OPHT DPET,,26362,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
POLYVINYL ALCOHOL-POVIDON(PF) 1.4-0.6 % OPHT DPET,,26362,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
POLYVINYL ALCOHOL-POVIDON(PF) 1.4-0.6 % OPHT DPET,,26362,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
POLYVINYL ALCOHOL-POVIDON(PF) 1.4-0.6 % OPHT DPET,,26362,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
POLYVINYL ALCOHOL-POVIDON(PF) 1.4-0.6 % OPHT DPET,,26362,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
POLYVINYL ALCOHOL-POVIDON(PF) 1.4-0.6 % OPHT DPET,,26362,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
POLYVINYL ALCOHOL-POVIDON(PF) 1.4-0.6 % OPHT DPET,,26362,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
POLYVINYL ALCOHOL-POVIDON(PF) 1.4-0.6 % OPHT DPET,,26362,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
POLYVINYL ALCOHOL-POVIDON(PF) 1.4-0.6 % OPHT DPET,,26362,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
POLYVINYL ALCOHOL-POVIDON(PF) 1.4-0.6 % OPHT DPET,,26362,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
POLYVINYL ALCOHOL-POVIDON(PF) 1.4-0.6 % OPHT DPET,,26362,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
POLYVINYL ALCOHOL-POVIDON(PF) 1.4-0.6 % OPHT DPET,,26362,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
POLYVINYL ALCOHOL-POVIDON(PF) 1.4-0.6 % OPHT DPET,,26362,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
POLYVINYL ALCOHOL-POVIDON(PF) 1.4-0.6 % OPHT DPET,,26362,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
POLYVINYL ALCOHOL-POVIDON(PF) 1.4-0.6 % OPHT DPET,,26362,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
POLYVINYL ALCOHOL-POVIDON(PF) 1.4-0.6 % OPHT DPET,,26362,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
POLYVINYL ALCOHOL-POVIDON(PF) 1.4-0.6 % OPHT DPET,,26362,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
POLYVINYL ALCOHOL-POVIDON(PF) 1.4-0.6 % OPHT DPET,,26362,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
POLYVINYL ALCOHOL-POVIDON(PF) 1.4-0.6 % OPHT DPET,,26362,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
POLYVINYL ALCOHOL-POVIDON(PF) 1.4-0.6 % OPHT DPET,,26362,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
POLYVINYL ALCOHOL-POVIDON(PF) 1.4-0.6 % OPHT DPET,,26362,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
POLYVINYL ALCOHOL-POVIDON(PF) 1.4-0.6 % OPHT DPET,,26362,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
POLYVINYL ALCOHOL-POVIDON(PF) 1.4-0.6 % OPHT DPET,,26362,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
POLYVINYL ALCOHOL-POVIDON(PF) 1.4-0.6 % OPHT DPET,,26362,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
POLYVINYL ALCOHOL-POVIDON(PF) 1.4-0.6 % OPHT DPET,,26362,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
POLYVINYL ALCOHOL-POVIDON(PF) 1.4-0.6 % OPHT DPET,,26362,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
POLYVINYL ALCOHOL-POVIDON(PF) 1.4-0.6 % OPHT DPET,,26362,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
POLYVINYL ALCOHOL-POVIDON(PF) 1.4-0.6 % OPHT DPET,,26362,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
POLYVINYL ALCOHOL-POVIDON(PF) 1.4-0.6 % OPHT DPET,,26362,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
POLYVINYL ALCOHOL-POVIDON(PF) 1.4-0.6 % OPHT DPET,,26362,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
POLYVINYL ALCOHOL-POVIDON(PF) 1.4-0.6 % OPHT DPET,,26362,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
POLYVINYL ALCOHOL-POVIDON(PF) 1.4-0.6 % OPHT DPET,,26362,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
POLYVINYL ALCOHOL-POVIDON(PF) 1.4-0.6 % OPHT DPET,,26362,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
POLYVINYL ALCOHOL-POVIDON(PF) 1.4-0.6 % OPHT DPET,,26362,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
POLYVINYL ALCOHOL-POVIDON(PF) 1.4-0.6 % OPHT DPET,,26362,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
POLYVINYL ALCOHOL-POVIDON(PF) 1.4-0.6 % OPHT DPET,,26362,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
POLYVINYL ALCOHOL-POVIDON(PF) 1.4-0.6 % OPHT DPET,,26362,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
POLYVINYL ALCOHOL-POVIDON(PF) 1.4-0.6 % OPHT DPET,,26362,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
POLYVINYL ALCOHOL-POVIDON(PF) 1.4-0.6 % OPHT DPET,,26362,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
POLYVINYL ALCOHOL-POVIDON(PF) 1.4-0.6 % OPHT DPET,,26362,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
POLYVINYL ALCOHOL-POVIDON(PF) 1.4-0.6 % OPHT DPET,,26362,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
POLYVINYL ALCOHOL-POVIDON(PF) 1.4-0.6 % OPHT DPET,,26362,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
POLYVINYL ALCOHOL-POVIDON(PF) 1.4-0.6 % OPHT DPET,,26362,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
POLYVINYL ALCOHOL-POVIDON(PF) 1.4-0.6 % OPHT DPET,,26362,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
POLYVINYL ALCOHOL-POVIDON(PF) 1.4-0.6 % OPHT DPET,,26362,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
POLYVINYL ALCOHOL-POVIDON(PF) 1.4-0.6 % OPHT DPET,,26362,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
POLYVINYL ALCOHOL-POVIDON(PF) 1.4-0.6 % OPHT DPET,,26362,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
CYCLOBENZAPRINE 5 MG ORAL TABLET,,27495,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,Aetna,Commercial,6.44,92,,percent of total billed charges,,
CYCLOBENZAPRINE 5 MG ORAL TABLET,,27495,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,Aetna,Medicare Advantage,3.43,49,,percent of total billed charges,,
CYCLOBENZAPRINE 5 MG ORAL TABLET,,27495,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,Aetna,Medicare Advantage,,,,,Included in per diem rate,
CYCLOBENZAPRINE 5 MG ORAL TABLET,,27495,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,Aetna,PPO,6.51,93,,percent of total billed charges,,
CYCLOBENZAPRINE 5 MG ORAL TABLET,,27495,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,America's PPO,America's PPO,6.7221,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
CYCLOBENZAPRINE 5 MG ORAL TABLET,,27495,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,BlueCross BlueShield Minnesota, Federal Employee Program,6.888,98.4,,percent of total billed charges,,
CYCLOBENZAPRINE 5 MG ORAL TABLET,,27495,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,7,100,,percent of total billed charges,,
CYCLOBENZAPRINE 5 MG ORAL TABLET,,27495,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,BlueCross BlueShield Minnesota,High Value Network Plan,6.3,90,,percent of total billed charges,,
CYCLOBENZAPRINE 5 MG ORAL TABLET,,27495,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,BlueCross BlueShield Minnesota,Medicare Advantage,3.43,49,,percent of total billed charges,,
CYCLOBENZAPRINE 5 MG ORAL TABLET,,27495,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
CYCLOBENZAPRINE 5 MG ORAL TABLET,,27495,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,6.1999,88.57,,percent of total billed charges,,
CYCLOBENZAPRINE 5 MG ORAL TABLET,,27495,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,2.0062,28.66,,percent of total billed charges,,
CYCLOBENZAPRINE 5 MG ORAL TABLET,,27495,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),3.43,49,,percent of total billed charges,,
CYCLOBENZAPRINE 5 MG ORAL TABLET,,27495,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
CYCLOBENZAPRINE 5 MG ORAL TABLET,,27495,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,CorVel,Worker's Compensation,7,100,,percent of total billed charges,,
CYCLOBENZAPRINE 5 MG ORAL TABLET,,27495,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,First Health Group Corporation,First Health Network,6.79,97,,percent of total billed charges,,
CYCLOBENZAPRINE 5 MG ORAL TABLET,,27495,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,"Health Partners, Inc.",Commercial,6.622,94.6,,percent of total billed charges,,
CYCLOBENZAPRINE 5 MG ORAL TABLET,,27495,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,"Health Partners, Inc.",Medicare Advantage,3.43,49,,percent of total billed charges,,
CYCLOBENZAPRINE 5 MG ORAL TABLET,,27495,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CYCLOBENZAPRINE 5 MG ORAL TABLET,,27495,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),4.2,60,,percent of total billed charges,,
CYCLOBENZAPRINE 5 MG ORAL TABLET,,27495,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,"Health Partners, Inc.",State of Minnesota Advantage Program,5.705,81.5,,percent of total billed charges,,
CYCLOBENZAPRINE 5 MG ORAL TABLET,,27495,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,"Health Partners, Inc.",State Public Programs,3.5,50,,percent of total billed charges,,
CYCLOBENZAPRINE 5 MG ORAL TABLET,,27495,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,Humana Insurance Company,Commercial PPO,6.65,95,,percent of total billed charges,,
CYCLOBENZAPRINE 5 MG ORAL TABLET,,27495,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,Humana Insurance Company,Medicare PPO,3.43,49,,percent of total billed charges,,
CYCLOBENZAPRINE 5 MG ORAL TABLET,,27495,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
CYCLOBENZAPRINE 5 MG ORAL TABLET,,27495,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,Medica,Individual & Family,6.937,99.1,,percent of total billed charges,,
CYCLOBENZAPRINE 5 MG ORAL TABLET,,27495,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,Medica,Medica Advantage Solution,3.486,49.8,,percent of total billed charges,,
CYCLOBENZAPRINE 5 MG ORAL TABLET,,27495,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
CYCLOBENZAPRINE 5 MG ORAL TABLET,,27495,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,Medica,Medical Assistance,3.122,44.6,,percent of total billed charges,,
CYCLOBENZAPRINE 5 MG ORAL TABLET,,27495,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,Medica,Medical Assistance,,,,,Included in per diem rate,
CYCLOBENZAPRINE 5 MG ORAL TABLET,,27495,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,3.486,49.8,,percent of total billed charges,,
CYCLOBENZAPRINE 5 MG ORAL TABLET,,27495,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
CYCLOBENZAPRINE 5 MG ORAL TABLET,,27495,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,"Multiplan, Inc.","Multiplan, Inc.",6.58,94,,percent of total billed charges,,
CYCLOBENZAPRINE 5 MG ORAL TABLET,,27495,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,6.307,90.1,,percent of total billed charges,,
CYCLOBENZAPRINE 5 MG ORAL TABLET,,27495,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
CYCLOBENZAPRINE 5 MG ORAL TABLET,,27495,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,"Preferred One Administrative Services, INC.",PPO,6.902,98.6,,percent of total billed charges,,
CYCLOBENZAPRINE 5 MG ORAL TABLET,,27495,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,PrimeWest Health,Minnesota Senior Health Options (MSHO),3.6015,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
CYCLOBENZAPRINE 5 MG ORAL TABLET,,27495,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CYCLOBENZAPRINE 5 MG ORAL TABLET,,27495,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,PrimeWest Health,MinnesotaCare,3.5952,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
CYCLOBENZAPRINE 5 MG ORAL TABLET,,27495,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
CYCLOBENZAPRINE 5 MG ORAL TABLET,,27495,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,Sanford Health Plan,Sanford Health Plan,6.44,92,,percent of total billed charges,,
CYCLOBENZAPRINE 5 MG ORAL TABLET,,27495,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,"UCare Health, Inc.",Individual & Family Plan,3.9445,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
CYCLOBENZAPRINE 5 MG ORAL TABLET,,27495,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
CYCLOBENZAPRINE 5 MG ORAL TABLET,,27495,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,"UCare Health, Inc.",Medical Assistance,3.5329,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CYCLOBENZAPRINE 5 MG ORAL TABLET,,27495,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
CYCLOBENZAPRINE 5 MG ORAL TABLET,,27495,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,"UCare Health, Inc.",Medicare Advantage,3.5329,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CYCLOBENZAPRINE 5 MG ORAL TABLET,,27495,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CYCLOBENZAPRINE 5 MG ORAL TABLET,,27495,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),3.5329,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CYCLOBENZAPRINE 5 MG ORAL TABLET,,27495,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CYCLOBENZAPRINE 5 MG ORAL TABLET,,27495,LOCAL,Facility,Both,1,Each,,7,5.95,2.0062,7,UnitedHealthcare,Individual & Family,6.58,94,,percent of total billed charges,,
CYCLOBENZAPRINE 5 MG ORAL TABLET,,27495,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,UnitedHealthcare,Medicare Advantage,3.43,49,,percent of total billed charges,,
CYCLOBENZAPRINE 5 MG ORAL TABLET,,27495,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
CYCLOBENZAPRINE 5 MG ORAL TABLET,,27495,LOCAL,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,3.36,48,,percent of total billed charges,,100% of DHS outpatient percentage
CYCLOBENZAPRINE 5 MG ORAL TABLET,,27495,LOCAL,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
ARIPIPRAZOLE 5 MG ORAL TABLET,,29042,LOCAL,Facility,Both,1,Each,,145,123.25,41.557,145,Aetna,Commercial,133.4,92,,percent of total billed charges,,
ARIPIPRAZOLE 5 MG ORAL TABLET,,29042,LOCAL,Facility,Outpatient,1,Each,,145,123.25,41.557,145,Aetna,Medicare Advantage,71.05,49,,percent of total billed charges,,
ARIPIPRAZOLE 5 MG ORAL TABLET,,29042,LOCAL,Facility,Inpatient,1,Each,,145,123.25,41.557,145,Aetna,Medicare Advantage,,,,,Included in per diem rate,
ARIPIPRAZOLE 5 MG ORAL TABLET,,29042,LOCAL,Facility,Both,1,Each,,145,123.25,41.557,145,Aetna,PPO,134.85,93,,percent of total billed charges,,
ARIPIPRAZOLE 5 MG ORAL TABLET,,29042,LOCAL,Facility,Both,1,Each,,145,123.25,41.557,145,America's PPO,America's PPO,139.2435,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
ARIPIPRAZOLE 5 MG ORAL TABLET,,29042,LOCAL,Facility,Both,1,Each,,145,123.25,41.557,145,BlueCross BlueShield Minnesota, Federal Employee Program,142.68,98.4,,percent of total billed charges,,
ARIPIPRAZOLE 5 MG ORAL TABLET,,29042,LOCAL,Facility,Both,1,Each,,145,123.25,41.557,145,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,145,100,,percent of total billed charges,,
ARIPIPRAZOLE 5 MG ORAL TABLET,,29042,LOCAL,Facility,Both,1,Each,,145,123.25,41.557,145,BlueCross BlueShield Minnesota,High Value Network Plan,130.5,90,,percent of total billed charges,,
ARIPIPRAZOLE 5 MG ORAL TABLET,,29042,LOCAL,Facility,Outpatient,1,Each,,145,123.25,41.557,145,BlueCross BlueShield Minnesota,Medicare Advantage,71.05,49,,percent of total billed charges,,
ARIPIPRAZOLE 5 MG ORAL TABLET,,29042,LOCAL,Facility,Inpatient,1,Each,,145,123.25,41.557,145,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
ARIPIPRAZOLE 5 MG ORAL TABLET,,29042,LOCAL,Facility,Both,1,Each,,145,123.25,41.557,145,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,128.4265,88.57,,percent of total billed charges,,
ARIPIPRAZOLE 5 MG ORAL TABLET,,29042,LOCAL,Facility,Both,1,Each,,145,123.25,41.557,145,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,41.557,28.66,,percent of total billed charges,,
ARIPIPRAZOLE 5 MG ORAL TABLET,,29042,LOCAL,Facility,Outpatient,1,Each,,145,123.25,41.557,145,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),71.05,49,,percent of total billed charges,,
ARIPIPRAZOLE 5 MG ORAL TABLET,,29042,LOCAL,Facility,Inpatient,1,Each,,145,123.25,41.557,145,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
ARIPIPRAZOLE 5 MG ORAL TABLET,,29042,LOCAL,Facility,Both,1,Each,,145,123.25,41.557,145,CorVel,Worker's Compensation,145,100,,percent of total billed charges,,
ARIPIPRAZOLE 5 MG ORAL TABLET,,29042,LOCAL,Facility,Both,1,Each,,145,123.25,41.557,145,First Health Group Corporation,First Health Network,140.65,97,,percent of total billed charges,,
ARIPIPRAZOLE 5 MG ORAL TABLET,,29042,LOCAL,Facility,Both,1,Each,,145,123.25,41.557,145,"Health Partners, Inc.",Commercial,137.17,94.6,,percent of total billed charges,,
ARIPIPRAZOLE 5 MG ORAL TABLET,,29042,LOCAL,Facility,Outpatient,1,Each,,145,123.25,41.557,145,"Health Partners, Inc.",Medicare Advantage,71.05,49,,percent of total billed charges,,
ARIPIPRAZOLE 5 MG ORAL TABLET,,29042,LOCAL,Facility,Inpatient,1,Each,,145,123.25,41.557,145,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ARIPIPRAZOLE 5 MG ORAL TABLET,,29042,LOCAL,Facility,Both,1,Each,,145,123.25,41.557,145,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),87,60,,percent of total billed charges,,
ARIPIPRAZOLE 5 MG ORAL TABLET,,29042,LOCAL,Facility,Both,1,Each,,145,123.25,41.557,145,"Health Partners, Inc.",State of Minnesota Advantage Program,118.175,81.5,,percent of total billed charges,,
ARIPIPRAZOLE 5 MG ORAL TABLET,,29042,LOCAL,Facility,Both,1,Each,,145,123.25,41.557,145,"Health Partners, Inc.",State Public Programs,72.5,50,,percent of total billed charges,,
ARIPIPRAZOLE 5 MG ORAL TABLET,,29042,LOCAL,Facility,Both,1,Each,,145,123.25,41.557,145,Humana Insurance Company,Commercial PPO,137.75,95,,percent of total billed charges,,
ARIPIPRAZOLE 5 MG ORAL TABLET,,29042,LOCAL,Facility,Outpatient,1,Each,,145,123.25,41.557,145,Humana Insurance Company,Medicare PPO,71.05,49,,percent of total billed charges,,
ARIPIPRAZOLE 5 MG ORAL TABLET,,29042,LOCAL,Facility,Inpatient,1,Each,,145,123.25,41.557,145,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
ARIPIPRAZOLE 5 MG ORAL TABLET,,29042,LOCAL,Facility,Both,1,Each,,145,123.25,41.557,145,Medica,Individual & Family,143.695,99.1,,percent of total billed charges,,
ARIPIPRAZOLE 5 MG ORAL TABLET,,29042,LOCAL,Facility,Outpatient,1,Each,,145,123.25,41.557,145,Medica,Medica Advantage Solution,72.21,49.8,,percent of total billed charges,,
ARIPIPRAZOLE 5 MG ORAL TABLET,,29042,LOCAL,Facility,Inpatient,1,Each,,145,123.25,41.557,145,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
ARIPIPRAZOLE 5 MG ORAL TABLET,,29042,LOCAL,Facility,Outpatient,1,Each,,145,123.25,41.557,145,Medica,Medical Assistance,64.67,44.6,,percent of total billed charges,,
ARIPIPRAZOLE 5 MG ORAL TABLET,,29042,LOCAL,Facility,Inpatient,1,Each,,145,123.25,41.557,145,Medica,Medical Assistance,,,,,Included in per diem rate,
ARIPIPRAZOLE 5 MG ORAL TABLET,,29042,LOCAL,Facility,Outpatient,1,Each,,145,123.25,41.557,145,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,72.21,49.8,,percent of total billed charges,,
ARIPIPRAZOLE 5 MG ORAL TABLET,,29042,LOCAL,Facility,Inpatient,1,Each,,145,123.25,41.557,145,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
ARIPIPRAZOLE 5 MG ORAL TABLET,,29042,LOCAL,Facility,Both,1,Each,,145,123.25,41.557,145,"Multiplan, Inc.","Multiplan, Inc.",136.3,94,,percent of total billed charges,,
ARIPIPRAZOLE 5 MG ORAL TABLET,,29042,LOCAL,Facility,Outpatient,1,Each,,145,123.25,41.557,145,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,130.645,90.1,,percent of total billed charges,,
ARIPIPRAZOLE 5 MG ORAL TABLET,,29042,LOCAL,Facility,Inpatient,1,Each,,145,123.25,41.557,145,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
ARIPIPRAZOLE 5 MG ORAL TABLET,,29042,LOCAL,Facility,Both,1,Each,,145,123.25,41.557,145,"Preferred One Administrative Services, INC.",PPO,142.97,98.6,,percent of total billed charges,,
ARIPIPRAZOLE 5 MG ORAL TABLET,,29042,LOCAL,Facility,Outpatient,1,Each,,145,123.25,41.557,145,PrimeWest Health,Minnesota Senior Health Options (MSHO),74.6025,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
ARIPIPRAZOLE 5 MG ORAL TABLET,,29042,LOCAL,Facility,Inpatient,1,Each,,145,123.25,41.557,145,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ARIPIPRAZOLE 5 MG ORAL TABLET,,29042,LOCAL,Facility,Outpatient,1,Each,,145,123.25,41.557,145,PrimeWest Health,MinnesotaCare,74.472,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
ARIPIPRAZOLE 5 MG ORAL TABLET,,29042,LOCAL,Facility,Inpatient,1,Each,,145,123.25,41.557,145,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
ARIPIPRAZOLE 5 MG ORAL TABLET,,29042,LOCAL,Facility,Both,1,Each,,145,123.25,41.557,145,Sanford Health Plan,Sanford Health Plan,133.4,92,,percent of total billed charges,,
ARIPIPRAZOLE 5 MG ORAL TABLET,,29042,LOCAL,Facility,Outpatient,1,Each,,145,123.25,41.557,145,"UCare Health, Inc.",Individual & Family Plan,81.7075,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
ARIPIPRAZOLE 5 MG ORAL TABLET,,29042,LOCAL,Facility,Inpatient,1,Each,,145,123.25,41.557,145,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
ARIPIPRAZOLE 5 MG ORAL TABLET,,29042,LOCAL,Facility,Outpatient,1,Each,,145,123.25,41.557,145,"UCare Health, Inc.",Medical Assistance,73.1815,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ARIPIPRAZOLE 5 MG ORAL TABLET,,29042,LOCAL,Facility,Inpatient,1,Each,,145,123.25,41.557,145,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
ARIPIPRAZOLE 5 MG ORAL TABLET,,29042,LOCAL,Facility,Outpatient,1,Each,,145,123.25,41.557,145,"UCare Health, Inc.",Medicare Advantage,73.1815,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ARIPIPRAZOLE 5 MG ORAL TABLET,,29042,LOCAL,Facility,Inpatient,1,Each,,145,123.25,41.557,145,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ARIPIPRAZOLE 5 MG ORAL TABLET,,29042,LOCAL,Facility,Outpatient,1,Each,,145,123.25,41.557,145,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),73.1815,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ARIPIPRAZOLE 5 MG ORAL TABLET,,29042,LOCAL,Facility,Inpatient,1,Each,,145,123.25,41.557,145,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ARIPIPRAZOLE 5 MG ORAL TABLET,,29042,LOCAL,Facility,Both,1,Each,,145,123.25,41.557,145,UnitedHealthcare,Individual & Family,136.3,94,,percent of total billed charges,,
ARIPIPRAZOLE 5 MG ORAL TABLET,,29042,LOCAL,Facility,Outpatient,1,Each,,145,123.25,41.557,145,UnitedHealthcare,Medicare Advantage,71.05,49,,percent of total billed charges,,
ARIPIPRAZOLE 5 MG ORAL TABLET,,29042,LOCAL,Facility,Inpatient,1,Each,,145,123.25,41.557,145,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
ARIPIPRAZOLE 5 MG ORAL TABLET,,29042,LOCAL,Facility,Outpatient,1,Each,,145,123.25,41.557,145,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,69.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
ARIPIPRAZOLE 5 MG ORAL TABLET,,29042,LOCAL,Facility,Inpatient,1,Each,,145,123.25,41.557,145,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
ROSUVASTATIN 10 MG ORAL TABLET,,29264,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
ROSUVASTATIN 10 MG ORAL TABLET,,29264,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
ROSUVASTATIN 10 MG ORAL TABLET,,29264,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
ROSUVASTATIN 10 MG ORAL TABLET,,29264,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
ROSUVASTATIN 10 MG ORAL TABLET,,29264,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
ROSUVASTATIN 10 MG ORAL TABLET,,29264,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
ROSUVASTATIN 10 MG ORAL TABLET,,29264,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
ROSUVASTATIN 10 MG ORAL TABLET,,29264,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
ROSUVASTATIN 10 MG ORAL TABLET,,29264,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
ROSUVASTATIN 10 MG ORAL TABLET,,29264,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
ROSUVASTATIN 10 MG ORAL TABLET,,29264,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
ROSUVASTATIN 10 MG ORAL TABLET,,29264,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
ROSUVASTATIN 10 MG ORAL TABLET,,29264,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
ROSUVASTATIN 10 MG ORAL TABLET,,29264,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
ROSUVASTATIN 10 MG ORAL TABLET,,29264,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
ROSUVASTATIN 10 MG ORAL TABLET,,29264,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
ROSUVASTATIN 10 MG ORAL TABLET,,29264,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
ROSUVASTATIN 10 MG ORAL TABLET,,29264,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
ROSUVASTATIN 10 MG ORAL TABLET,,29264,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ROSUVASTATIN 10 MG ORAL TABLET,,29264,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
ROSUVASTATIN 10 MG ORAL TABLET,,29264,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
ROSUVASTATIN 10 MG ORAL TABLET,,29264,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
ROSUVASTATIN 10 MG ORAL TABLET,,29264,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
ROSUVASTATIN 10 MG ORAL TABLET,,29264,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
ROSUVASTATIN 10 MG ORAL TABLET,,29264,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
ROSUVASTATIN 10 MG ORAL TABLET,,29264,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
ROSUVASTATIN 10 MG ORAL TABLET,,29264,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
ROSUVASTATIN 10 MG ORAL TABLET,,29264,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
ROSUVASTATIN 10 MG ORAL TABLET,,29264,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
ROSUVASTATIN 10 MG ORAL TABLET,,29264,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
ROSUVASTATIN 10 MG ORAL TABLET,,29264,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
ROSUVASTATIN 10 MG ORAL TABLET,,29264,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
ROSUVASTATIN 10 MG ORAL TABLET,,29264,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
ROSUVASTATIN 10 MG ORAL TABLET,,29264,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
ROSUVASTATIN 10 MG ORAL TABLET,,29264,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
ROSUVASTATIN 10 MG ORAL TABLET,,29264,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
ROSUVASTATIN 10 MG ORAL TABLET,,29264,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
ROSUVASTATIN 10 MG ORAL TABLET,,29264,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ROSUVASTATIN 10 MG ORAL TABLET,,29264,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
ROSUVASTATIN 10 MG ORAL TABLET,,29264,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
ROSUVASTATIN 10 MG ORAL TABLET,,29264,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
ROSUVASTATIN 10 MG ORAL TABLET,,29264,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
ROSUVASTATIN 10 MG ORAL TABLET,,29264,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
ROSUVASTATIN 10 MG ORAL TABLET,,29264,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ROSUVASTATIN 10 MG ORAL TABLET,,29264,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
ROSUVASTATIN 10 MG ORAL TABLET,,29264,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ROSUVASTATIN 10 MG ORAL TABLET,,29264,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ROSUVASTATIN 10 MG ORAL TABLET,,29264,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ROSUVASTATIN 10 MG ORAL TABLET,,29264,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ROSUVASTATIN 10 MG ORAL TABLET,,29264,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
ROSUVASTATIN 10 MG ORAL TABLET,,29264,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
ROSUVASTATIN 10 MG ORAL TABLET,,29264,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
ROSUVASTATIN 10 MG ORAL TABLET,,29264,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
ROSUVASTATIN 10 MG ORAL TABLET,,29264,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
MICONAZOLE NITRATE 200 MG- 2 % (9 GRAM) VAGL KIT,,29408,LOCAL,Facility,Both,1,Each,,47,39.95,13.4702,47,Aetna,Commercial,43.24,92,,percent of total billed charges,,
MICONAZOLE NITRATE 200 MG- 2 % (9 GRAM) VAGL KIT,,29408,LOCAL,Facility,Outpatient,1,Each,,47,39.95,13.4702,47,Aetna,Medicare Advantage,23.03,49,,percent of total billed charges,,
MICONAZOLE NITRATE 200 MG- 2 % (9 GRAM) VAGL KIT,,29408,LOCAL,Facility,Inpatient,1,Each,,47,39.95,13.4702,47,Aetna,Medicare Advantage,,,,,Included in per diem rate,
MICONAZOLE NITRATE 200 MG- 2 % (9 GRAM) VAGL KIT,,29408,LOCAL,Facility,Both,1,Each,,47,39.95,13.4702,47,Aetna,PPO,43.71,93,,percent of total billed charges,,
MICONAZOLE NITRATE 200 MG- 2 % (9 GRAM) VAGL KIT,,29408,LOCAL,Facility,Both,1,Each,,47,39.95,13.4702,47,America's PPO,America's PPO,45.1341,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
MICONAZOLE NITRATE 200 MG- 2 % (9 GRAM) VAGL KIT,,29408,LOCAL,Facility,Both,1,Each,,47,39.95,13.4702,47,BlueCross BlueShield Minnesota, Federal Employee Program,46.248,98.4,,percent of total billed charges,,
MICONAZOLE NITRATE 200 MG- 2 % (9 GRAM) VAGL KIT,,29408,LOCAL,Facility,Both,1,Each,,47,39.95,13.4702,47,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,47,100,,percent of total billed charges,,
MICONAZOLE NITRATE 200 MG- 2 % (9 GRAM) VAGL KIT,,29408,LOCAL,Facility,Both,1,Each,,47,39.95,13.4702,47,BlueCross BlueShield Minnesota,High Value Network Plan,42.3,90,,percent of total billed charges,,
MICONAZOLE NITRATE 200 MG- 2 % (9 GRAM) VAGL KIT,,29408,LOCAL,Facility,Outpatient,1,Each,,47,39.95,13.4702,47,BlueCross BlueShield Minnesota,Medicare Advantage,23.03,49,,percent of total billed charges,,
MICONAZOLE NITRATE 200 MG- 2 % (9 GRAM) VAGL KIT,,29408,LOCAL,Facility,Inpatient,1,Each,,47,39.95,13.4702,47,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
MICONAZOLE NITRATE 200 MG- 2 % (9 GRAM) VAGL KIT,,29408,LOCAL,Facility,Both,1,Each,,47,39.95,13.4702,47,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,41.6279,88.57,,percent of total billed charges,,
MICONAZOLE NITRATE 200 MG- 2 % (9 GRAM) VAGL KIT,,29408,LOCAL,Facility,Both,1,Each,,47,39.95,13.4702,47,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,13.4702,28.66,,percent of total billed charges,,
MICONAZOLE NITRATE 200 MG- 2 % (9 GRAM) VAGL KIT,,29408,LOCAL,Facility,Outpatient,1,Each,,47,39.95,13.4702,47,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),23.03,49,,percent of total billed charges,,
MICONAZOLE NITRATE 200 MG- 2 % (9 GRAM) VAGL KIT,,29408,LOCAL,Facility,Inpatient,1,Each,,47,39.95,13.4702,47,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
MICONAZOLE NITRATE 200 MG- 2 % (9 GRAM) VAGL KIT,,29408,LOCAL,Facility,Both,1,Each,,47,39.95,13.4702,47,CorVel,Worker's Compensation,47,100,,percent of total billed charges,,
MICONAZOLE NITRATE 200 MG- 2 % (9 GRAM) VAGL KIT,,29408,LOCAL,Facility,Both,1,Each,,47,39.95,13.4702,47,First Health Group Corporation,First Health Network,45.59,97,,percent of total billed charges,,
MICONAZOLE NITRATE 200 MG- 2 % (9 GRAM) VAGL KIT,,29408,LOCAL,Facility,Both,1,Each,,47,39.95,13.4702,47,"Health Partners, Inc.",Commercial,44.462,94.6,,percent of total billed charges,,
MICONAZOLE NITRATE 200 MG- 2 % (9 GRAM) VAGL KIT,,29408,LOCAL,Facility,Outpatient,1,Each,,47,39.95,13.4702,47,"Health Partners, Inc.",Medicare Advantage,23.03,49,,percent of total billed charges,,
MICONAZOLE NITRATE 200 MG- 2 % (9 GRAM) VAGL KIT,,29408,LOCAL,Facility,Inpatient,1,Each,,47,39.95,13.4702,47,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
MICONAZOLE NITRATE 200 MG- 2 % (9 GRAM) VAGL KIT,,29408,LOCAL,Facility,Both,1,Each,,47,39.95,13.4702,47,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),28.2,60,,percent of total billed charges,,
MICONAZOLE NITRATE 200 MG- 2 % (9 GRAM) VAGL KIT,,29408,LOCAL,Facility,Both,1,Each,,47,39.95,13.4702,47,"Health Partners, Inc.",State of Minnesota Advantage Program,38.305,81.5,,percent of total billed charges,,
MICONAZOLE NITRATE 200 MG- 2 % (9 GRAM) VAGL KIT,,29408,LOCAL,Facility,Both,1,Each,,47,39.95,13.4702,47,"Health Partners, Inc.",State Public Programs,23.5,50,,percent of total billed charges,,
MICONAZOLE NITRATE 200 MG- 2 % (9 GRAM) VAGL KIT,,29408,LOCAL,Facility,Both,1,Each,,47,39.95,13.4702,47,Humana Insurance Company,Commercial PPO,44.65,95,,percent of total billed charges,,
MICONAZOLE NITRATE 200 MG- 2 % (9 GRAM) VAGL KIT,,29408,LOCAL,Facility,Outpatient,1,Each,,47,39.95,13.4702,47,Humana Insurance Company,Medicare PPO,23.03,49,,percent of total billed charges,,
MICONAZOLE NITRATE 200 MG- 2 % (9 GRAM) VAGL KIT,,29408,LOCAL,Facility,Inpatient,1,Each,,47,39.95,13.4702,47,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
MICONAZOLE NITRATE 200 MG- 2 % (9 GRAM) VAGL KIT,,29408,LOCAL,Facility,Both,1,Each,,47,39.95,13.4702,47,Medica,Individual & Family,46.577,99.1,,percent of total billed charges,,
MICONAZOLE NITRATE 200 MG- 2 % (9 GRAM) VAGL KIT,,29408,LOCAL,Facility,Outpatient,1,Each,,47,39.95,13.4702,47,Medica,Medica Advantage Solution,23.406,49.8,,percent of total billed charges,,
MICONAZOLE NITRATE 200 MG- 2 % (9 GRAM) VAGL KIT,,29408,LOCAL,Facility,Inpatient,1,Each,,47,39.95,13.4702,47,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
MICONAZOLE NITRATE 200 MG- 2 % (9 GRAM) VAGL KIT,,29408,LOCAL,Facility,Outpatient,1,Each,,47,39.95,13.4702,47,Medica,Medical Assistance,20.962,44.6,,percent of total billed charges,,
MICONAZOLE NITRATE 200 MG- 2 % (9 GRAM) VAGL KIT,,29408,LOCAL,Facility,Inpatient,1,Each,,47,39.95,13.4702,47,Medica,Medical Assistance,,,,,Included in per diem rate,
MICONAZOLE NITRATE 200 MG- 2 % (9 GRAM) VAGL KIT,,29408,LOCAL,Facility,Outpatient,1,Each,,47,39.95,13.4702,47,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,23.406,49.8,,percent of total billed charges,,
MICONAZOLE NITRATE 200 MG- 2 % (9 GRAM) VAGL KIT,,29408,LOCAL,Facility,Inpatient,1,Each,,47,39.95,13.4702,47,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
MICONAZOLE NITRATE 200 MG- 2 % (9 GRAM) VAGL KIT,,29408,LOCAL,Facility,Both,1,Each,,47,39.95,13.4702,47,"Multiplan, Inc.","Multiplan, Inc.",44.18,94,,percent of total billed charges,,
MICONAZOLE NITRATE 200 MG- 2 % (9 GRAM) VAGL KIT,,29408,LOCAL,Facility,Outpatient,1,Each,,47,39.95,13.4702,47,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,42.347,90.1,,percent of total billed charges,,
MICONAZOLE NITRATE 200 MG- 2 % (9 GRAM) VAGL KIT,,29408,LOCAL,Facility,Inpatient,1,Each,,47,39.95,13.4702,47,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
MICONAZOLE NITRATE 200 MG- 2 % (9 GRAM) VAGL KIT,,29408,LOCAL,Facility,Both,1,Each,,47,39.95,13.4702,47,"Preferred One Administrative Services, INC.",PPO,46.342,98.6,,percent of total billed charges,,
MICONAZOLE NITRATE 200 MG- 2 % (9 GRAM) VAGL KIT,,29408,LOCAL,Facility,Outpatient,1,Each,,47,39.95,13.4702,47,PrimeWest Health,Minnesota Senior Health Options (MSHO),24.1815,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
MICONAZOLE NITRATE 200 MG- 2 % (9 GRAM) VAGL KIT,,29408,LOCAL,Facility,Inpatient,1,Each,,47,39.95,13.4702,47,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
MICONAZOLE NITRATE 200 MG- 2 % (9 GRAM) VAGL KIT,,29408,LOCAL,Facility,Outpatient,1,Each,,47,39.95,13.4702,47,PrimeWest Health,MinnesotaCare,24.1392,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
MICONAZOLE NITRATE 200 MG- 2 % (9 GRAM) VAGL KIT,,29408,LOCAL,Facility,Inpatient,1,Each,,47,39.95,13.4702,47,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
MICONAZOLE NITRATE 200 MG- 2 % (9 GRAM) VAGL KIT,,29408,LOCAL,Facility,Both,1,Each,,47,39.95,13.4702,47,Sanford Health Plan,Sanford Health Plan,43.24,92,,percent of total billed charges,,
MICONAZOLE NITRATE 200 MG- 2 % (9 GRAM) VAGL KIT,,29408,LOCAL,Facility,Outpatient,1,Each,,47,39.95,13.4702,47,"UCare Health, Inc.",Individual & Family Plan,26.4845,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
MICONAZOLE NITRATE 200 MG- 2 % (9 GRAM) VAGL KIT,,29408,LOCAL,Facility,Inpatient,1,Each,,47,39.95,13.4702,47,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
MICONAZOLE NITRATE 200 MG- 2 % (9 GRAM) VAGL KIT,,29408,LOCAL,Facility,Outpatient,1,Each,,47,39.95,13.4702,47,"UCare Health, Inc.",Medical Assistance,23.7209,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MICONAZOLE NITRATE 200 MG- 2 % (9 GRAM) VAGL KIT,,29408,LOCAL,Facility,Inpatient,1,Each,,47,39.95,13.4702,47,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
MICONAZOLE NITRATE 200 MG- 2 % (9 GRAM) VAGL KIT,,29408,LOCAL,Facility,Outpatient,1,Each,,47,39.95,13.4702,47,"UCare Health, Inc.",Medicare Advantage,23.7209,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MICONAZOLE NITRATE 200 MG- 2 % (9 GRAM) VAGL KIT,,29408,LOCAL,Facility,Inpatient,1,Each,,47,39.95,13.4702,47,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
MICONAZOLE NITRATE 200 MG- 2 % (9 GRAM) VAGL KIT,,29408,LOCAL,Facility,Outpatient,1,Each,,47,39.95,13.4702,47,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),23.7209,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MICONAZOLE NITRATE 200 MG- 2 % (9 GRAM) VAGL KIT,,29408,LOCAL,Facility,Inpatient,1,Each,,47,39.95,13.4702,47,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
MICONAZOLE NITRATE 200 MG- 2 % (9 GRAM) VAGL KIT,,29408,LOCAL,Facility,Both,1,Each,,47,39.95,13.4702,47,UnitedHealthcare,Individual & Family,44.18,94,,percent of total billed charges,,
MICONAZOLE NITRATE 200 MG- 2 % (9 GRAM) VAGL KIT,,29408,LOCAL,Facility,Outpatient,1,Each,,47,39.95,13.4702,47,UnitedHealthcare,Medicare Advantage,23.03,49,,percent of total billed charges,,
MICONAZOLE NITRATE 200 MG- 2 % (9 GRAM) VAGL KIT,,29408,LOCAL,Facility,Inpatient,1,Each,,47,39.95,13.4702,47,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
MICONAZOLE NITRATE 200 MG- 2 % (9 GRAM) VAGL KIT,,29408,LOCAL,Facility,Outpatient,1,Each,,47,39.95,13.4702,47,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,22.56,48,,percent of total billed charges,,100% of DHS outpatient percentage
MICONAZOLE NITRATE 200 MG- 2 % (9 GRAM) VAGL KIT,,29408,LOCAL,Facility,Inpatient,1,Each,,47,39.95,13.4702,47,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
POTASSIUM CHLORIDE 10 MEQ ORAL TBTQ,,29436,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
POTASSIUM CHLORIDE 10 MEQ ORAL TBTQ,,29436,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
POTASSIUM CHLORIDE 10 MEQ ORAL TBTQ,,29436,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
POTASSIUM CHLORIDE 10 MEQ ORAL TBTQ,,29436,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
POTASSIUM CHLORIDE 10 MEQ ORAL TBTQ,,29436,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
POTASSIUM CHLORIDE 10 MEQ ORAL TBTQ,,29436,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
POTASSIUM CHLORIDE 10 MEQ ORAL TBTQ,,29436,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
POTASSIUM CHLORIDE 10 MEQ ORAL TBTQ,,29436,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
POTASSIUM CHLORIDE 10 MEQ ORAL TBTQ,,29436,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
POTASSIUM CHLORIDE 10 MEQ ORAL TBTQ,,29436,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
POTASSIUM CHLORIDE 10 MEQ ORAL TBTQ,,29436,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
POTASSIUM CHLORIDE 10 MEQ ORAL TBTQ,,29436,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
POTASSIUM CHLORIDE 10 MEQ ORAL TBTQ,,29436,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
POTASSIUM CHLORIDE 10 MEQ ORAL TBTQ,,29436,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
POTASSIUM CHLORIDE 10 MEQ ORAL TBTQ,,29436,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
POTASSIUM CHLORIDE 10 MEQ ORAL TBTQ,,29436,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
POTASSIUM CHLORIDE 10 MEQ ORAL TBTQ,,29436,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
POTASSIUM CHLORIDE 10 MEQ ORAL TBTQ,,29436,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
POTASSIUM CHLORIDE 10 MEQ ORAL TBTQ,,29436,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
POTASSIUM CHLORIDE 10 MEQ ORAL TBTQ,,29436,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
POTASSIUM CHLORIDE 10 MEQ ORAL TBTQ,,29436,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
POTASSIUM CHLORIDE 10 MEQ ORAL TBTQ,,29436,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
POTASSIUM CHLORIDE 10 MEQ ORAL TBTQ,,29436,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
POTASSIUM CHLORIDE 10 MEQ ORAL TBTQ,,29436,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
POTASSIUM CHLORIDE 10 MEQ ORAL TBTQ,,29436,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
POTASSIUM CHLORIDE 10 MEQ ORAL TBTQ,,29436,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
POTASSIUM CHLORIDE 10 MEQ ORAL TBTQ,,29436,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
POTASSIUM CHLORIDE 10 MEQ ORAL TBTQ,,29436,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
POTASSIUM CHLORIDE 10 MEQ ORAL TBTQ,,29436,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
POTASSIUM CHLORIDE 10 MEQ ORAL TBTQ,,29436,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
POTASSIUM CHLORIDE 10 MEQ ORAL TBTQ,,29436,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
POTASSIUM CHLORIDE 10 MEQ ORAL TBTQ,,29436,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
POTASSIUM CHLORIDE 10 MEQ ORAL TBTQ,,29436,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
POTASSIUM CHLORIDE 10 MEQ ORAL TBTQ,,29436,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
POTASSIUM CHLORIDE 10 MEQ ORAL TBTQ,,29436,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
POTASSIUM CHLORIDE 10 MEQ ORAL TBTQ,,29436,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
POTASSIUM CHLORIDE 10 MEQ ORAL TBTQ,,29436,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
POTASSIUM CHLORIDE 10 MEQ ORAL TBTQ,,29436,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
POTASSIUM CHLORIDE 10 MEQ ORAL TBTQ,,29436,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
POTASSIUM CHLORIDE 10 MEQ ORAL TBTQ,,29436,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
POTASSIUM CHLORIDE 10 MEQ ORAL TBTQ,,29436,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
POTASSIUM CHLORIDE 10 MEQ ORAL TBTQ,,29436,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
POTASSIUM CHLORIDE 10 MEQ ORAL TBTQ,,29436,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
POTASSIUM CHLORIDE 10 MEQ ORAL TBTQ,,29436,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
POTASSIUM CHLORIDE 10 MEQ ORAL TBTQ,,29436,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
POTASSIUM CHLORIDE 10 MEQ ORAL TBTQ,,29436,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
POTASSIUM CHLORIDE 10 MEQ ORAL TBTQ,,29436,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
POTASSIUM CHLORIDE 10 MEQ ORAL TBTQ,,29436,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
POTASSIUM CHLORIDE 10 MEQ ORAL TBTQ,,29436,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
POTASSIUM CHLORIDE 10 MEQ ORAL TBTQ,,29436,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
POTASSIUM CHLORIDE 10 MEQ ORAL TBTQ,,29436,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
POTASSIUM CHLORIDE 10 MEQ ORAL TBTQ,,29436,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
POTASSIUM CHLORIDE 10 MEQ ORAL TBTQ,,29436,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
POTASSIUM CHLORIDE 10 MEQ ORAL TBTQ,,29436,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
BUPROPION HCL 150 MG ORAL TB24,,29496,LOCAL,Facility,Both,1,Each,,12,10.2,3.4392,12,Aetna,Commercial,11.04,92,,percent of total billed charges,,
BUPROPION HCL 150 MG ORAL TB24,,29496,LOCAL,Facility,Outpatient,1,Each,,12,10.2,3.4392,12,Aetna,Medicare Advantage,5.88,49,,percent of total billed charges,,
BUPROPION HCL 150 MG ORAL TB24,,29496,LOCAL,Facility,Inpatient,1,Each,,12,10.2,3.4392,12,Aetna,Medicare Advantage,,,,,Included in per diem rate,
BUPROPION HCL 150 MG ORAL TB24,,29496,LOCAL,Facility,Both,1,Each,,12,10.2,3.4392,12,Aetna,PPO,11.16,93,,percent of total billed charges,,
BUPROPION HCL 150 MG ORAL TB24,,29496,LOCAL,Facility,Both,1,Each,,12,10.2,3.4392,12,America's PPO,America's PPO,11.5236,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
BUPROPION HCL 150 MG ORAL TB24,,29496,LOCAL,Facility,Both,1,Each,,12,10.2,3.4392,12,BlueCross BlueShield Minnesota, Federal Employee Program,11.808,98.4,,percent of total billed charges,,
BUPROPION HCL 150 MG ORAL TB24,,29496,LOCAL,Facility,Both,1,Each,,12,10.2,3.4392,12,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,12,100,,percent of total billed charges,,
BUPROPION HCL 150 MG ORAL TB24,,29496,LOCAL,Facility,Both,1,Each,,12,10.2,3.4392,12,BlueCross BlueShield Minnesota,High Value Network Plan,10.8,90,,percent of total billed charges,,
BUPROPION HCL 150 MG ORAL TB24,,29496,LOCAL,Facility,Outpatient,1,Each,,12,10.2,3.4392,12,BlueCross BlueShield Minnesota,Medicare Advantage,5.88,49,,percent of total billed charges,,
BUPROPION HCL 150 MG ORAL TB24,,29496,LOCAL,Facility,Inpatient,1,Each,,12,10.2,3.4392,12,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
BUPROPION HCL 150 MG ORAL TB24,,29496,LOCAL,Facility,Both,1,Each,,12,10.2,3.4392,12,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,10.6284,88.57,,percent of total billed charges,,
BUPROPION HCL 150 MG ORAL TB24,,29496,LOCAL,Facility,Both,1,Each,,12,10.2,3.4392,12,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,3.4392,28.66,,percent of total billed charges,,
BUPROPION HCL 150 MG ORAL TB24,,29496,LOCAL,Facility,Outpatient,1,Each,,12,10.2,3.4392,12,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),5.88,49,,percent of total billed charges,,
BUPROPION HCL 150 MG ORAL TB24,,29496,LOCAL,Facility,Inpatient,1,Each,,12,10.2,3.4392,12,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
BUPROPION HCL 150 MG ORAL TB24,,29496,LOCAL,Facility,Both,1,Each,,12,10.2,3.4392,12,CorVel,Worker's Compensation,12,100,,percent of total billed charges,,
BUPROPION HCL 150 MG ORAL TB24,,29496,LOCAL,Facility,Both,1,Each,,12,10.2,3.4392,12,First Health Group Corporation,First Health Network,11.64,97,,percent of total billed charges,,
BUPROPION HCL 150 MG ORAL TB24,,29496,LOCAL,Facility,Both,1,Each,,12,10.2,3.4392,12,"Health Partners, Inc.",Commercial,11.352,94.6,,percent of total billed charges,,
BUPROPION HCL 150 MG ORAL TB24,,29496,LOCAL,Facility,Outpatient,1,Each,,12,10.2,3.4392,12,"Health Partners, Inc.",Medicare Advantage,5.88,49,,percent of total billed charges,,
BUPROPION HCL 150 MG ORAL TB24,,29496,LOCAL,Facility,Inpatient,1,Each,,12,10.2,3.4392,12,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
BUPROPION HCL 150 MG ORAL TB24,,29496,LOCAL,Facility,Both,1,Each,,12,10.2,3.4392,12,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),7.2,60,,percent of total billed charges,,
BUPROPION HCL 150 MG ORAL TB24,,29496,LOCAL,Facility,Both,1,Each,,12,10.2,3.4392,12,"Health Partners, Inc.",State of Minnesota Advantage Program,9.78,81.5,,percent of total billed charges,,
BUPROPION HCL 150 MG ORAL TB24,,29496,LOCAL,Facility,Both,1,Each,,12,10.2,3.4392,12,"Health Partners, Inc.",State Public Programs,6,50,,percent of total billed charges,,
BUPROPION HCL 150 MG ORAL TB24,,29496,LOCAL,Facility,Both,1,Each,,12,10.2,3.4392,12,Humana Insurance Company,Commercial PPO,11.4,95,,percent of total billed charges,,
BUPROPION HCL 150 MG ORAL TB24,,29496,LOCAL,Facility,Outpatient,1,Each,,12,10.2,3.4392,12,Humana Insurance Company,Medicare PPO,5.88,49,,percent of total billed charges,,
BUPROPION HCL 150 MG ORAL TB24,,29496,LOCAL,Facility,Inpatient,1,Each,,12,10.2,3.4392,12,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
BUPROPION HCL 150 MG ORAL TB24,,29496,LOCAL,Facility,Both,1,Each,,12,10.2,3.4392,12,Medica,Individual & Family,11.892,99.1,,percent of total billed charges,,
BUPROPION HCL 150 MG ORAL TB24,,29496,LOCAL,Facility,Outpatient,1,Each,,12,10.2,3.4392,12,Medica,Medica Advantage Solution,5.976,49.8,,percent of total billed charges,,
BUPROPION HCL 150 MG ORAL TB24,,29496,LOCAL,Facility,Inpatient,1,Each,,12,10.2,3.4392,12,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
BUPROPION HCL 150 MG ORAL TB24,,29496,LOCAL,Facility,Outpatient,1,Each,,12,10.2,3.4392,12,Medica,Medical Assistance,5.352,44.6,,percent of total billed charges,,
BUPROPION HCL 150 MG ORAL TB24,,29496,LOCAL,Facility,Inpatient,1,Each,,12,10.2,3.4392,12,Medica,Medical Assistance,,,,,Included in per diem rate,
BUPROPION HCL 150 MG ORAL TB24,,29496,LOCAL,Facility,Outpatient,1,Each,,12,10.2,3.4392,12,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,5.976,49.8,,percent of total billed charges,,
BUPROPION HCL 150 MG ORAL TB24,,29496,LOCAL,Facility,Inpatient,1,Each,,12,10.2,3.4392,12,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
BUPROPION HCL 150 MG ORAL TB24,,29496,LOCAL,Facility,Both,1,Each,,12,10.2,3.4392,12,"Multiplan, Inc.","Multiplan, Inc.",11.28,94,,percent of total billed charges,,
BUPROPION HCL 150 MG ORAL TB24,,29496,LOCAL,Facility,Outpatient,1,Each,,12,10.2,3.4392,12,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,10.812,90.1,,percent of total billed charges,,
BUPROPION HCL 150 MG ORAL TB24,,29496,LOCAL,Facility,Inpatient,1,Each,,12,10.2,3.4392,12,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
BUPROPION HCL 150 MG ORAL TB24,,29496,LOCAL,Facility,Both,1,Each,,12,10.2,3.4392,12,"Preferred One Administrative Services, INC.",PPO,11.832,98.6,,percent of total billed charges,,
BUPROPION HCL 150 MG ORAL TB24,,29496,LOCAL,Facility,Outpatient,1,Each,,12,10.2,3.4392,12,PrimeWest Health,Minnesota Senior Health Options (MSHO),6.174,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
BUPROPION HCL 150 MG ORAL TB24,,29496,LOCAL,Facility,Inpatient,1,Each,,12,10.2,3.4392,12,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
BUPROPION HCL 150 MG ORAL TB24,,29496,LOCAL,Facility,Outpatient,1,Each,,12,10.2,3.4392,12,PrimeWest Health,MinnesotaCare,6.1632,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
BUPROPION HCL 150 MG ORAL TB24,,29496,LOCAL,Facility,Inpatient,1,Each,,12,10.2,3.4392,12,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
BUPROPION HCL 150 MG ORAL TB24,,29496,LOCAL,Facility,Both,1,Each,,12,10.2,3.4392,12,Sanford Health Plan,Sanford Health Plan,11.04,92,,percent of total billed charges,,
BUPROPION HCL 150 MG ORAL TB24,,29496,LOCAL,Facility,Outpatient,1,Each,,12,10.2,3.4392,12,"UCare Health, Inc.",Individual & Family Plan,6.762,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
BUPROPION HCL 150 MG ORAL TB24,,29496,LOCAL,Facility,Inpatient,1,Each,,12,10.2,3.4392,12,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
BUPROPION HCL 150 MG ORAL TB24,,29496,LOCAL,Facility,Outpatient,1,Each,,12,10.2,3.4392,12,"UCare Health, Inc.",Medical Assistance,6.0564,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BUPROPION HCL 150 MG ORAL TB24,,29496,LOCAL,Facility,Inpatient,1,Each,,12,10.2,3.4392,12,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
BUPROPION HCL 150 MG ORAL TB24,,29496,LOCAL,Facility,Outpatient,1,Each,,12,10.2,3.4392,12,"UCare Health, Inc.",Medicare Advantage,6.0564,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BUPROPION HCL 150 MG ORAL TB24,,29496,LOCAL,Facility,Inpatient,1,Each,,12,10.2,3.4392,12,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
BUPROPION HCL 150 MG ORAL TB24,,29496,LOCAL,Facility,Outpatient,1,Each,,12,10.2,3.4392,12,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),6.0564,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BUPROPION HCL 150 MG ORAL TB24,,29496,LOCAL,Facility,Inpatient,1,Each,,12,10.2,3.4392,12,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
BUPROPION HCL 150 MG ORAL TB24,,29496,LOCAL,Facility,Both,1,Each,,12,10.2,3.4392,12,UnitedHealthcare,Individual & Family,11.28,94,,percent of total billed charges,,
BUPROPION HCL 150 MG ORAL TB24,,29496,LOCAL,Facility,Outpatient,1,Each,,12,10.2,3.4392,12,UnitedHealthcare,Medicare Advantage,5.88,49,,percent of total billed charges,,
BUPROPION HCL 150 MG ORAL TB24,,29496,LOCAL,Facility,Inpatient,1,Each,,12,10.2,3.4392,12,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
BUPROPION HCL 150 MG ORAL TB24,,29496,LOCAL,Facility,Outpatient,1,Each,,12,10.2,3.4392,12,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,5.76,48,,percent of total billed charges,,100% of DHS outpatient percentage
BUPROPION HCL 150 MG ORAL TB24,,29496,LOCAL,Facility,Inpatient,1,Each,,12,10.2,3.4392,12,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
MEMANTINE 10 MG ORAL TABLET,,30967,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
MEMANTINE 10 MG ORAL TABLET,,30967,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
MEMANTINE 10 MG ORAL TABLET,,30967,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
MEMANTINE 10 MG ORAL TABLET,,30967,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
MEMANTINE 10 MG ORAL TABLET,,30967,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
MEMANTINE 10 MG ORAL TABLET,,30967,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
MEMANTINE 10 MG ORAL TABLET,,30967,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
MEMANTINE 10 MG ORAL TABLET,,30967,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
MEMANTINE 10 MG ORAL TABLET,,30967,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
MEMANTINE 10 MG ORAL TABLET,,30967,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
MEMANTINE 10 MG ORAL TABLET,,30967,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
MEMANTINE 10 MG ORAL TABLET,,30967,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
MEMANTINE 10 MG ORAL TABLET,,30967,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
MEMANTINE 10 MG ORAL TABLET,,30967,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
MEMANTINE 10 MG ORAL TABLET,,30967,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
MEMANTINE 10 MG ORAL TABLET,,30967,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
MEMANTINE 10 MG ORAL TABLET,,30967,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
MEMANTINE 10 MG ORAL TABLET,,30967,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
MEMANTINE 10 MG ORAL TABLET,,30967,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
MEMANTINE 10 MG ORAL TABLET,,30967,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
MEMANTINE 10 MG ORAL TABLET,,30967,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
MEMANTINE 10 MG ORAL TABLET,,30967,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
MEMANTINE 10 MG ORAL TABLET,,30967,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
MEMANTINE 10 MG ORAL TABLET,,30967,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
MEMANTINE 10 MG ORAL TABLET,,30967,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
MEMANTINE 10 MG ORAL TABLET,,30967,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
MEMANTINE 10 MG ORAL TABLET,,30967,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
MEMANTINE 10 MG ORAL TABLET,,30967,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
MEMANTINE 10 MG ORAL TABLET,,30967,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
MEMANTINE 10 MG ORAL TABLET,,30967,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
MEMANTINE 10 MG ORAL TABLET,,30967,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
MEMANTINE 10 MG ORAL TABLET,,30967,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
MEMANTINE 10 MG ORAL TABLET,,30967,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
MEMANTINE 10 MG ORAL TABLET,,30967,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
MEMANTINE 10 MG ORAL TABLET,,30967,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
MEMANTINE 10 MG ORAL TABLET,,30967,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
MEMANTINE 10 MG ORAL TABLET,,30967,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
MEMANTINE 10 MG ORAL TABLET,,30967,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
MEMANTINE 10 MG ORAL TABLET,,30967,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
MEMANTINE 10 MG ORAL TABLET,,30967,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
MEMANTINE 10 MG ORAL TABLET,,30967,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
MEMANTINE 10 MG ORAL TABLET,,30967,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
MEMANTINE 10 MG ORAL TABLET,,30967,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
MEMANTINE 10 MG ORAL TABLET,,30967,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MEMANTINE 10 MG ORAL TABLET,,30967,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
MEMANTINE 10 MG ORAL TABLET,,30967,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MEMANTINE 10 MG ORAL TABLET,,30967,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
MEMANTINE 10 MG ORAL TABLET,,30967,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MEMANTINE 10 MG ORAL TABLET,,30967,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
MEMANTINE 10 MG ORAL TABLET,,30967,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
MEMANTINE 10 MG ORAL TABLET,,30967,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
MEMANTINE 10 MG ORAL TABLET,,30967,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
MEMANTINE 10 MG ORAL TABLET,,30967,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
MEMANTINE 10 MG ORAL TABLET,,30967,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
METOPROLOL TARTRATE 25 MG ORAL TABLET,,31247,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
METOPROLOL TARTRATE 25 MG ORAL TABLET,,31247,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
METOPROLOL TARTRATE 25 MG ORAL TABLET,,31247,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
METOPROLOL TARTRATE 25 MG ORAL TABLET,,31247,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
METOPROLOL TARTRATE 25 MG ORAL TABLET,,31247,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
METOPROLOL TARTRATE 25 MG ORAL TABLET,,31247,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
METOPROLOL TARTRATE 25 MG ORAL TABLET,,31247,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
METOPROLOL TARTRATE 25 MG ORAL TABLET,,31247,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
METOPROLOL TARTRATE 25 MG ORAL TABLET,,31247,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
METOPROLOL TARTRATE 25 MG ORAL TABLET,,31247,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
METOPROLOL TARTRATE 25 MG ORAL TABLET,,31247,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
METOPROLOL TARTRATE 25 MG ORAL TABLET,,31247,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
METOPROLOL TARTRATE 25 MG ORAL TABLET,,31247,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
METOPROLOL TARTRATE 25 MG ORAL TABLET,,31247,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
METOPROLOL TARTRATE 25 MG ORAL TABLET,,31247,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
METOPROLOL TARTRATE 25 MG ORAL TABLET,,31247,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
METOPROLOL TARTRATE 25 MG ORAL TABLET,,31247,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
METOPROLOL TARTRATE 25 MG ORAL TABLET,,31247,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
METOPROLOL TARTRATE 25 MG ORAL TABLET,,31247,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
METOPROLOL TARTRATE 25 MG ORAL TABLET,,31247,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
METOPROLOL TARTRATE 25 MG ORAL TABLET,,31247,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
METOPROLOL TARTRATE 25 MG ORAL TABLET,,31247,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
METOPROLOL TARTRATE 25 MG ORAL TABLET,,31247,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
METOPROLOL TARTRATE 25 MG ORAL TABLET,,31247,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
METOPROLOL TARTRATE 25 MG ORAL TABLET,,31247,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
METOPROLOL TARTRATE 25 MG ORAL TABLET,,31247,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
METOPROLOL TARTRATE 25 MG ORAL TABLET,,31247,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
METOPROLOL TARTRATE 25 MG ORAL TABLET,,31247,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
METOPROLOL TARTRATE 25 MG ORAL TABLET,,31247,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
METOPROLOL TARTRATE 25 MG ORAL TABLET,,31247,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
METOPROLOL TARTRATE 25 MG ORAL TABLET,,31247,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
METOPROLOL TARTRATE 25 MG ORAL TABLET,,31247,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
METOPROLOL TARTRATE 25 MG ORAL TABLET,,31247,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
METOPROLOL TARTRATE 25 MG ORAL TABLET,,31247,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
METOPROLOL TARTRATE 25 MG ORAL TABLET,,31247,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
METOPROLOL TARTRATE 25 MG ORAL TABLET,,31247,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
METOPROLOL TARTRATE 25 MG ORAL TABLET,,31247,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
METOPROLOL TARTRATE 25 MG ORAL TABLET,,31247,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
METOPROLOL TARTRATE 25 MG ORAL TABLET,,31247,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
METOPROLOL TARTRATE 25 MG ORAL TABLET,,31247,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
METOPROLOL TARTRATE 25 MG ORAL TABLET,,31247,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
METOPROLOL TARTRATE 25 MG ORAL TABLET,,31247,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
METOPROLOL TARTRATE 25 MG ORAL TABLET,,31247,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
METOPROLOL TARTRATE 25 MG ORAL TABLET,,31247,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
METOPROLOL TARTRATE 25 MG ORAL TABLET,,31247,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
METOPROLOL TARTRATE 25 MG ORAL TABLET,,31247,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
METOPROLOL TARTRATE 25 MG ORAL TABLET,,31247,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
METOPROLOL TARTRATE 25 MG ORAL TABLET,,31247,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
METOPROLOL TARTRATE 25 MG ORAL TABLET,,31247,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
METOPROLOL TARTRATE 25 MG ORAL TABLET,,31247,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
METOPROLOL TARTRATE 25 MG ORAL TABLET,,31247,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
METOPROLOL TARTRATE 25 MG ORAL TABLET,,31247,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
METOPROLOL TARTRATE 25 MG ORAL TABLET,,31247,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
METOPROLOL TARTRATE 25 MG ORAL TABLET,,31247,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
METOPROLOL TARTRATE 25 MG ORAL TABLET,,31247,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
METOPROLOL TARTRATE 25 MG ORAL TABLET,,31247,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
METOPROLOL TARTRATE 25 MG ORAL TABLET,,31247,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
METOPROLOL TARTRATE 25 MG ORAL TABLET,,31247,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
METOPROLOL TARTRATE 25 MG ORAL TABLET,,31247,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
METOPROLOL TARTRATE 25 MG ORAL TABLET,,31247,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
METOPROLOL TARTRATE 25 MG ORAL TABLET,,31247,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
METOPROLOL TARTRATE 25 MG ORAL TABLET,,31247,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
METOPROLOL TARTRATE 25 MG ORAL TABLET,,31247,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
METOPROLOL TARTRATE 25 MG ORAL TABLET,,31247,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
METOPROLOL TARTRATE 25 MG ORAL TABLET,,31247,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
METOPROLOL TARTRATE 25 MG ORAL TABLET,,31247,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
METOPROLOL TARTRATE 25 MG ORAL TABLET,,31247,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
METOPROLOL TARTRATE 25 MG ORAL TABLET,,31247,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
METOPROLOL TARTRATE 25 MG ORAL TABLET,,31247,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
METOPROLOL TARTRATE 25 MG ORAL TABLET,,31247,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
METOPROLOL TARTRATE 25 MG ORAL TABLET,,31247,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
METOPROLOL TARTRATE 25 MG ORAL TABLET,,31247,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
METOPROLOL TARTRATE 25 MG ORAL TABLET,,31247,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
METOPROLOL TARTRATE 25 MG ORAL TABLET,,31247,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
METOPROLOL TARTRATE 25 MG ORAL TABLET,,31247,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
METOPROLOL TARTRATE 25 MG ORAL TABLET,,31247,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
METOPROLOL TARTRATE 25 MG ORAL TABLET,,31247,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
METOPROLOL TARTRATE 25 MG ORAL TABLET,,31247,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
METOPROLOL TARTRATE 25 MG ORAL TABLET,,31247,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
METOPROLOL TARTRATE 25 MG ORAL TABLET,,31247,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
METOPROLOL TARTRATE 25 MG ORAL TABLET,,31247,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
METOPROLOL TARTRATE 25 MG ORAL TABLET,,31247,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
METOPROLOL TARTRATE 25 MG ORAL TABLET,,31247,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
METOPROLOL TARTRATE 25 MG ORAL TABLET,,31247,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
METOPROLOL TARTRATE 25 MG ORAL TABLET,,31247,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
METOPROLOL TARTRATE 25 MG ORAL TABLET,,31247,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
METOPROLOL TARTRATE 25 MG ORAL TABLET,,31247,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
METOPROLOL TARTRATE 25 MG ORAL TABLET,,31247,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
METOPROLOL TARTRATE 25 MG ORAL TABLET,,31247,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
METOPROLOL TARTRATE 25 MG ORAL TABLET,,31247,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
METOPROLOL TARTRATE 25 MG ORAL TABLET,,31247,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
METOPROLOL TARTRATE 25 MG ORAL TABLET,,31247,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
METOPROLOL TARTRATE 25 MG ORAL TABLET,,31247,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
METOPROLOL TARTRATE 25 MG ORAL TABLET,,31247,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
METOPROLOL TARTRATE 25 MG ORAL TABLET,,31247,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
METOPROLOL TARTRATE 25 MG ORAL TABLET,,31247,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
METOPROLOL TARTRATE 25 MG ORAL TABLET,,31247,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
METOPROLOL TARTRATE 25 MG ORAL TABLET,,31247,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
METOPROLOL TARTRATE 25 MG ORAL TABLET,,31247,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
METOPROLOL TARTRATE 25 MG ORAL TABLET,,31247,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
METOPROLOL TARTRATE 25 MG ORAL TABLET,,31247,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
METOPROLOL TARTRATE 25 MG ORAL TABLET,,31247,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
METOPROLOL TARTRATE 25 MG ORAL TABLET,,31247,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
METOPROLOL TARTRATE 25 MG ORAL TABLET,,31247,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
METOPROLOL TARTRATE 25 MG ORAL TABLET,,31247,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
METOPROLOL TARTRATE 25 MG ORAL TABLET,,31247,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
METOPROLOL TARTRATE 25 MG ORAL TABLET,,31247,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
METOPROLOL TARTRATE 25 MG ORAL TABLET,,31247,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
TIOTROPIUM BROMIDE 18 MCG INHL CPDV,,34527,LOCAL,Facility,Both,1,Each,,213,181.05,61.0458,213,Aetna,Commercial,195.96,92,,percent of total billed charges,,
TIOTROPIUM BROMIDE 18 MCG INHL CPDV,,34527,LOCAL,Facility,Outpatient,1,Each,,213,181.05,61.0458,213,Aetna,Medicare Advantage,104.37,49,,percent of total billed charges,,
TIOTROPIUM BROMIDE 18 MCG INHL CPDV,,34527,LOCAL,Facility,Inpatient,1,Each,,213,181.05,61.0458,213,Aetna,Medicare Advantage,,,,,Included in per diem rate,
TIOTROPIUM BROMIDE 18 MCG INHL CPDV,,34527,LOCAL,Facility,Both,1,Each,,213,181.05,61.0458,213,Aetna,PPO,198.09,93,,percent of total billed charges,,
TIOTROPIUM BROMIDE 18 MCG INHL CPDV,,34527,LOCAL,Facility,Both,1,Each,,213,181.05,61.0458,213,America's PPO,America's PPO,204.5439,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
TIOTROPIUM BROMIDE 18 MCG INHL CPDV,,34527,LOCAL,Facility,Both,1,Each,,213,181.05,61.0458,213,BlueCross BlueShield Minnesota, Federal Employee Program,209.592,98.4,,percent of total billed charges,,
TIOTROPIUM BROMIDE 18 MCG INHL CPDV,,34527,LOCAL,Facility,Both,1,Each,,213,181.05,61.0458,213,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,213,100,,percent of total billed charges,,
TIOTROPIUM BROMIDE 18 MCG INHL CPDV,,34527,LOCAL,Facility,Both,1,Each,,213,181.05,61.0458,213,BlueCross BlueShield Minnesota,High Value Network Plan,191.7,90,,percent of total billed charges,,
TIOTROPIUM BROMIDE 18 MCG INHL CPDV,,34527,LOCAL,Facility,Outpatient,1,Each,,213,181.05,61.0458,213,BlueCross BlueShield Minnesota,Medicare Advantage,104.37,49,,percent of total billed charges,,
TIOTROPIUM BROMIDE 18 MCG INHL CPDV,,34527,LOCAL,Facility,Inpatient,1,Each,,213,181.05,61.0458,213,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
TIOTROPIUM BROMIDE 18 MCG INHL CPDV,,34527,LOCAL,Facility,Both,1,Each,,213,181.05,61.0458,213,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,188.6541,88.57,,percent of total billed charges,,
TIOTROPIUM BROMIDE 18 MCG INHL CPDV,,34527,LOCAL,Facility,Both,1,Each,,213,181.05,61.0458,213,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,61.0458,28.66,,percent of total billed charges,,
TIOTROPIUM BROMIDE 18 MCG INHL CPDV,,34527,LOCAL,Facility,Outpatient,1,Each,,213,181.05,61.0458,213,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),104.37,49,,percent of total billed charges,,
TIOTROPIUM BROMIDE 18 MCG INHL CPDV,,34527,LOCAL,Facility,Inpatient,1,Each,,213,181.05,61.0458,213,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
TIOTROPIUM BROMIDE 18 MCG INHL CPDV,,34527,LOCAL,Facility,Both,1,Each,,213,181.05,61.0458,213,CorVel,Worker's Compensation,213,100,,percent of total billed charges,,
TIOTROPIUM BROMIDE 18 MCG INHL CPDV,,34527,LOCAL,Facility,Both,1,Each,,213,181.05,61.0458,213,First Health Group Corporation,First Health Network,206.61,97,,percent of total billed charges,,
TIOTROPIUM BROMIDE 18 MCG INHL CPDV,,34527,LOCAL,Facility,Both,1,Each,,213,181.05,61.0458,213,"Health Partners, Inc.",Commercial,201.498,94.6,,percent of total billed charges,,
TIOTROPIUM BROMIDE 18 MCG INHL CPDV,,34527,LOCAL,Facility,Outpatient,1,Each,,213,181.05,61.0458,213,"Health Partners, Inc.",Medicare Advantage,104.37,49,,percent of total billed charges,,
TIOTROPIUM BROMIDE 18 MCG INHL CPDV,,34527,LOCAL,Facility,Inpatient,1,Each,,213,181.05,61.0458,213,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
TIOTROPIUM BROMIDE 18 MCG INHL CPDV,,34527,LOCAL,Facility,Both,1,Each,,213,181.05,61.0458,213,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),127.8,60,,percent of total billed charges,,
TIOTROPIUM BROMIDE 18 MCG INHL CPDV,,34527,LOCAL,Facility,Both,1,Each,,213,181.05,61.0458,213,"Health Partners, Inc.",State of Minnesota Advantage Program,173.595,81.5,,percent of total billed charges,,
TIOTROPIUM BROMIDE 18 MCG INHL CPDV,,34527,LOCAL,Facility,Both,1,Each,,213,181.05,61.0458,213,"Health Partners, Inc.",State Public Programs,106.5,50,,percent of total billed charges,,
TIOTROPIUM BROMIDE 18 MCG INHL CPDV,,34527,LOCAL,Facility,Both,1,Each,,213,181.05,61.0458,213,Humana Insurance Company,Commercial PPO,202.35,95,,percent of total billed charges,,
TIOTROPIUM BROMIDE 18 MCG INHL CPDV,,34527,LOCAL,Facility,Outpatient,1,Each,,213,181.05,61.0458,213,Humana Insurance Company,Medicare PPO,104.37,49,,percent of total billed charges,,
TIOTROPIUM BROMIDE 18 MCG INHL CPDV,,34527,LOCAL,Facility,Inpatient,1,Each,,213,181.05,61.0458,213,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
TIOTROPIUM BROMIDE 18 MCG INHL CPDV,,34527,LOCAL,Facility,Both,1,Each,,213,181.05,61.0458,213,Medica,Individual & Family,211.083,99.1,,percent of total billed charges,,
TIOTROPIUM BROMIDE 18 MCG INHL CPDV,,34527,LOCAL,Facility,Outpatient,1,Each,,213,181.05,61.0458,213,Medica,Medica Advantage Solution,106.074,49.8,,percent of total billed charges,,
TIOTROPIUM BROMIDE 18 MCG INHL CPDV,,34527,LOCAL,Facility,Inpatient,1,Each,,213,181.05,61.0458,213,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
TIOTROPIUM BROMIDE 18 MCG INHL CPDV,,34527,LOCAL,Facility,Outpatient,1,Each,,213,181.05,61.0458,213,Medica,Medical Assistance,94.998,44.6,,percent of total billed charges,,
TIOTROPIUM BROMIDE 18 MCG INHL CPDV,,34527,LOCAL,Facility,Inpatient,1,Each,,213,181.05,61.0458,213,Medica,Medical Assistance,,,,,Included in per diem rate,
TIOTROPIUM BROMIDE 18 MCG INHL CPDV,,34527,LOCAL,Facility,Outpatient,1,Each,,213,181.05,61.0458,213,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,106.074,49.8,,percent of total billed charges,,
TIOTROPIUM BROMIDE 18 MCG INHL CPDV,,34527,LOCAL,Facility,Inpatient,1,Each,,213,181.05,61.0458,213,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
TIOTROPIUM BROMIDE 18 MCG INHL CPDV,,34527,LOCAL,Facility,Both,1,Each,,213,181.05,61.0458,213,"Multiplan, Inc.","Multiplan, Inc.",200.22,94,,percent of total billed charges,,
TIOTROPIUM BROMIDE 18 MCG INHL CPDV,,34527,LOCAL,Facility,Outpatient,1,Each,,213,181.05,61.0458,213,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,191.913,90.1,,percent of total billed charges,,
TIOTROPIUM BROMIDE 18 MCG INHL CPDV,,34527,LOCAL,Facility,Inpatient,1,Each,,213,181.05,61.0458,213,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
TIOTROPIUM BROMIDE 18 MCG INHL CPDV,,34527,LOCAL,Facility,Both,1,Each,,213,181.05,61.0458,213,"Preferred One Administrative Services, INC.",PPO,210.018,98.6,,percent of total billed charges,,
TIOTROPIUM BROMIDE 18 MCG INHL CPDV,,34527,LOCAL,Facility,Outpatient,1,Each,,213,181.05,61.0458,213,PrimeWest Health,Minnesota Senior Health Options (MSHO),109.5885,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
TIOTROPIUM BROMIDE 18 MCG INHL CPDV,,34527,LOCAL,Facility,Inpatient,1,Each,,213,181.05,61.0458,213,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
TIOTROPIUM BROMIDE 18 MCG INHL CPDV,,34527,LOCAL,Facility,Outpatient,1,Each,,213,181.05,61.0458,213,PrimeWest Health,MinnesotaCare,109.3968,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
TIOTROPIUM BROMIDE 18 MCG INHL CPDV,,34527,LOCAL,Facility,Inpatient,1,Each,,213,181.05,61.0458,213,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
TIOTROPIUM BROMIDE 18 MCG INHL CPDV,,34527,LOCAL,Facility,Both,1,Each,,213,181.05,61.0458,213,Sanford Health Plan,Sanford Health Plan,195.96,92,,percent of total billed charges,,
TIOTROPIUM BROMIDE 18 MCG INHL CPDV,,34527,LOCAL,Facility,Outpatient,1,Each,,213,181.05,61.0458,213,"UCare Health, Inc.",Individual & Family Plan,120.0255,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
TIOTROPIUM BROMIDE 18 MCG INHL CPDV,,34527,LOCAL,Facility,Inpatient,1,Each,,213,181.05,61.0458,213,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
TIOTROPIUM BROMIDE 18 MCG INHL CPDV,,34527,LOCAL,Facility,Outpatient,1,Each,,213,181.05,61.0458,213,"UCare Health, Inc.",Medical Assistance,107.5011,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TIOTROPIUM BROMIDE 18 MCG INHL CPDV,,34527,LOCAL,Facility,Inpatient,1,Each,,213,181.05,61.0458,213,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
TIOTROPIUM BROMIDE 18 MCG INHL CPDV,,34527,LOCAL,Facility,Outpatient,1,Each,,213,181.05,61.0458,213,"UCare Health, Inc.",Medicare Advantage,107.5011,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TIOTROPIUM BROMIDE 18 MCG INHL CPDV,,34527,LOCAL,Facility,Inpatient,1,Each,,213,181.05,61.0458,213,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
TIOTROPIUM BROMIDE 18 MCG INHL CPDV,,34527,LOCAL,Facility,Outpatient,1,Each,,213,181.05,61.0458,213,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),107.5011,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TIOTROPIUM BROMIDE 18 MCG INHL CPDV,,34527,LOCAL,Facility,Inpatient,1,Each,,213,181.05,61.0458,213,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
TIOTROPIUM BROMIDE 18 MCG INHL CPDV,,34527,LOCAL,Facility,Both,1,Each,,213,181.05,61.0458,213,UnitedHealthcare,Individual & Family,200.22,94,,percent of total billed charges,,
TIOTROPIUM BROMIDE 18 MCG INHL CPDV,,34527,LOCAL,Facility,Outpatient,1,Each,,213,181.05,61.0458,213,UnitedHealthcare,Medicare Advantage,104.37,49,,percent of total billed charges,,
TIOTROPIUM BROMIDE 18 MCG INHL CPDV,,34527,LOCAL,Facility,Inpatient,1,Each,,213,181.05,61.0458,213,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
TIOTROPIUM BROMIDE 18 MCG INHL CPDV,,34527,LOCAL,Facility,Outpatient,1,Each,,213,181.05,61.0458,213,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,102.24,48,,percent of total billed charges,,100% of DHS outpatient percentage
TIOTROPIUM BROMIDE 18 MCG INHL CPDV,,34527,LOCAL,Facility,Inpatient,1,Each,,213,181.05,61.0458,213,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
GLYCERIN (ADULT) RECT SUPP,,34697,LOCAL,Facility,Both,1,Each,,10,8.5,2.866,10,Aetna,Commercial,9.2,92,,percent of total billed charges,,
GLYCERIN (ADULT) RECT SUPP,,34697,LOCAL,Facility,Outpatient,1,Each,,10,8.5,2.866,10,Aetna,Medicare Advantage,4.9,49,,percent of total billed charges,,
GLYCERIN (ADULT) RECT SUPP,,34697,LOCAL,Facility,Inpatient,1,Each,,10,8.5,2.866,10,Aetna,Medicare Advantage,,,,,Included in per diem rate,
GLYCERIN (ADULT) RECT SUPP,,34697,LOCAL,Facility,Both,1,Each,,10,8.5,2.866,10,Aetna,PPO,9.3,93,,percent of total billed charges,,
GLYCERIN (ADULT) RECT SUPP,,34697,LOCAL,Facility,Both,1,Each,,10,8.5,2.866,10,America's PPO,America's PPO,9.603,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
GLYCERIN (ADULT) RECT SUPP,,34697,LOCAL,Facility,Both,1,Each,,10,8.5,2.866,10,BlueCross BlueShield Minnesota, Federal Employee Program,9.84,98.4,,percent of total billed charges,,
GLYCERIN (ADULT) RECT SUPP,,34697,LOCAL,Facility,Both,1,Each,,10,8.5,2.866,10,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,10,100,,percent of total billed charges,,
GLYCERIN (ADULT) RECT SUPP,,34697,LOCAL,Facility,Both,1,Each,,10,8.5,2.866,10,BlueCross BlueShield Minnesota,High Value Network Plan,9,90,,percent of total billed charges,,
GLYCERIN (ADULT) RECT SUPP,,34697,LOCAL,Facility,Outpatient,1,Each,,10,8.5,2.866,10,BlueCross BlueShield Minnesota,Medicare Advantage,4.9,49,,percent of total billed charges,,
GLYCERIN (ADULT) RECT SUPP,,34697,LOCAL,Facility,Inpatient,1,Each,,10,8.5,2.866,10,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
GLYCERIN (ADULT) RECT SUPP,,34697,LOCAL,Facility,Both,1,Each,,10,8.5,2.866,10,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,8.857,88.57,,percent of total billed charges,,
GLYCERIN (ADULT) RECT SUPP,,34697,LOCAL,Facility,Both,1,Each,,10,8.5,2.866,10,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,2.866,28.66,,percent of total billed charges,,
GLYCERIN (ADULT) RECT SUPP,,34697,LOCAL,Facility,Outpatient,1,Each,,10,8.5,2.866,10,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),4.9,49,,percent of total billed charges,,
GLYCERIN (ADULT) RECT SUPP,,34697,LOCAL,Facility,Inpatient,1,Each,,10,8.5,2.866,10,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
GLYCERIN (ADULT) RECT SUPP,,34697,LOCAL,Facility,Both,1,Each,,10,8.5,2.866,10,CorVel,Worker's Compensation,10,100,,percent of total billed charges,,
GLYCERIN (ADULT) RECT SUPP,,34697,LOCAL,Facility,Both,1,Each,,10,8.5,2.866,10,First Health Group Corporation,First Health Network,9.7,97,,percent of total billed charges,,
GLYCERIN (ADULT) RECT SUPP,,34697,LOCAL,Facility,Both,1,Each,,10,8.5,2.866,10,"Health Partners, Inc.",Commercial,9.46,94.6,,percent of total billed charges,,
GLYCERIN (ADULT) RECT SUPP,,34697,LOCAL,Facility,Outpatient,1,Each,,10,8.5,2.866,10,"Health Partners, Inc.",Medicare Advantage,4.9,49,,percent of total billed charges,,
GLYCERIN (ADULT) RECT SUPP,,34697,LOCAL,Facility,Inpatient,1,Each,,10,8.5,2.866,10,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
GLYCERIN (ADULT) RECT SUPP,,34697,LOCAL,Facility,Both,1,Each,,10,8.5,2.866,10,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),6,60,,percent of total billed charges,,
GLYCERIN (ADULT) RECT SUPP,,34697,LOCAL,Facility,Both,1,Each,,10,8.5,2.866,10,"Health Partners, Inc.",State of Minnesota Advantage Program,8.15,81.5,,percent of total billed charges,,
GLYCERIN (ADULT) RECT SUPP,,34697,LOCAL,Facility,Both,1,Each,,10,8.5,2.866,10,"Health Partners, Inc.",State Public Programs,5,50,,percent of total billed charges,,
GLYCERIN (ADULT) RECT SUPP,,34697,LOCAL,Facility,Both,1,Each,,10,8.5,2.866,10,Humana Insurance Company,Commercial PPO,9.5,95,,percent of total billed charges,,
GLYCERIN (ADULT) RECT SUPP,,34697,LOCAL,Facility,Outpatient,1,Each,,10,8.5,2.866,10,Humana Insurance Company,Medicare PPO,4.9,49,,percent of total billed charges,,
GLYCERIN (ADULT) RECT SUPP,,34697,LOCAL,Facility,Inpatient,1,Each,,10,8.5,2.866,10,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
GLYCERIN (ADULT) RECT SUPP,,34697,LOCAL,Facility,Both,1,Each,,10,8.5,2.866,10,Medica,Individual & Family,9.91,99.1,,percent of total billed charges,,
GLYCERIN (ADULT) RECT SUPP,,34697,LOCAL,Facility,Outpatient,1,Each,,10,8.5,2.866,10,Medica,Medica Advantage Solution,4.98,49.8,,percent of total billed charges,,
GLYCERIN (ADULT) RECT SUPP,,34697,LOCAL,Facility,Inpatient,1,Each,,10,8.5,2.866,10,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
GLYCERIN (ADULT) RECT SUPP,,34697,LOCAL,Facility,Outpatient,1,Each,,10,8.5,2.866,10,Medica,Medical Assistance,4.46,44.6,,percent of total billed charges,,
GLYCERIN (ADULT) RECT SUPP,,34697,LOCAL,Facility,Inpatient,1,Each,,10,8.5,2.866,10,Medica,Medical Assistance,,,,,Included in per diem rate,
GLYCERIN (ADULT) RECT SUPP,,34697,LOCAL,Facility,Outpatient,1,Each,,10,8.5,2.866,10,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,4.98,49.8,,percent of total billed charges,,
GLYCERIN (ADULT) RECT SUPP,,34697,LOCAL,Facility,Inpatient,1,Each,,10,8.5,2.866,10,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
GLYCERIN (ADULT) RECT SUPP,,34697,LOCAL,Facility,Both,1,Each,,10,8.5,2.866,10,"Multiplan, Inc.","Multiplan, Inc.",9.4,94,,percent of total billed charges,,
GLYCERIN (ADULT) RECT SUPP,,34697,LOCAL,Facility,Outpatient,1,Each,,10,8.5,2.866,10,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,9.01,90.1,,percent of total billed charges,,
GLYCERIN (ADULT) RECT SUPP,,34697,LOCAL,Facility,Inpatient,1,Each,,10,8.5,2.866,10,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
GLYCERIN (ADULT) RECT SUPP,,34697,LOCAL,Facility,Both,1,Each,,10,8.5,2.866,10,"Preferred One Administrative Services, INC.",PPO,9.86,98.6,,percent of total billed charges,,
GLYCERIN (ADULT) RECT SUPP,,34697,LOCAL,Facility,Outpatient,1,Each,,10,8.5,2.866,10,PrimeWest Health,Minnesota Senior Health Options (MSHO),5.145,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
GLYCERIN (ADULT) RECT SUPP,,34697,LOCAL,Facility,Inpatient,1,Each,,10,8.5,2.866,10,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
GLYCERIN (ADULT) RECT SUPP,,34697,LOCAL,Facility,Outpatient,1,Each,,10,8.5,2.866,10,PrimeWest Health,MinnesotaCare,5.136,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
GLYCERIN (ADULT) RECT SUPP,,34697,LOCAL,Facility,Inpatient,1,Each,,10,8.5,2.866,10,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
GLYCERIN (ADULT) RECT SUPP,,34697,LOCAL,Facility,Both,1,Each,,10,8.5,2.866,10,Sanford Health Plan,Sanford Health Plan,9.2,92,,percent of total billed charges,,
GLYCERIN (ADULT) RECT SUPP,,34697,LOCAL,Facility,Outpatient,1,Each,,10,8.5,2.866,10,"UCare Health, Inc.",Individual & Family Plan,5.635,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
GLYCERIN (ADULT) RECT SUPP,,34697,LOCAL,Facility,Inpatient,1,Each,,10,8.5,2.866,10,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
GLYCERIN (ADULT) RECT SUPP,,34697,LOCAL,Facility,Outpatient,1,Each,,10,8.5,2.866,10,"UCare Health, Inc.",Medical Assistance,5.047,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
GLYCERIN (ADULT) RECT SUPP,,34697,LOCAL,Facility,Inpatient,1,Each,,10,8.5,2.866,10,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
GLYCERIN (ADULT) RECT SUPP,,34697,LOCAL,Facility,Outpatient,1,Each,,10,8.5,2.866,10,"UCare Health, Inc.",Medicare Advantage,5.047,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
GLYCERIN (ADULT) RECT SUPP,,34697,LOCAL,Facility,Inpatient,1,Each,,10,8.5,2.866,10,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
GLYCERIN (ADULT) RECT SUPP,,34697,LOCAL,Facility,Outpatient,1,Each,,10,8.5,2.866,10,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),5.047,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
GLYCERIN (ADULT) RECT SUPP,,34697,LOCAL,Facility,Inpatient,1,Each,,10,8.5,2.866,10,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
GLYCERIN (ADULT) RECT SUPP,,34697,LOCAL,Facility,Both,1,Each,,10,8.5,2.866,10,UnitedHealthcare,Individual & Family,9.4,94,,percent of total billed charges,,
GLYCERIN (ADULT) RECT SUPP,,34697,LOCAL,Facility,Outpatient,1,Each,,10,8.5,2.866,10,UnitedHealthcare,Medicare Advantage,4.9,49,,percent of total billed charges,,
GLYCERIN (ADULT) RECT SUPP,,34697,LOCAL,Facility,Inpatient,1,Each,,10,8.5,2.866,10,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
GLYCERIN (ADULT) RECT SUPP,,34697,LOCAL,Facility,Outpatient,1,Each,,10,8.5,2.866,10,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,4.8,48,,percent of total billed charges,,100% of DHS outpatient percentage
GLYCERIN (ADULT) RECT SUPP,,34697,LOCAL,Facility,Inpatient,1,Each,,10,8.5,2.866,10,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
RACEPINEPHRINE 2.25 % INHL NEBU,,35716,LOCAL,Facility,Both,1,Each,,9,7.65,2.5794,9,Aetna,Commercial,8.28,92,,percent of total billed charges,,
RACEPINEPHRINE 2.25 % INHL NEBU,,35716,LOCAL,Facility,Outpatient,1,Each,,9,7.65,2.5794,9,Aetna,Medicare Advantage,4.41,49,,percent of total billed charges,,
RACEPINEPHRINE 2.25 % INHL NEBU,,35716,LOCAL,Facility,Inpatient,1,Each,,9,7.65,2.5794,9,Aetna,Medicare Advantage,,,,,Included in per diem rate,
RACEPINEPHRINE 2.25 % INHL NEBU,,35716,LOCAL,Facility,Both,1,Each,,9,7.65,2.5794,9,Aetna,PPO,8.37,93,,percent of total billed charges,,
RACEPINEPHRINE 2.25 % INHL NEBU,,35716,LOCAL,Facility,Both,1,Each,,9,7.65,2.5794,9,America's PPO,America's PPO,8.6427,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
RACEPINEPHRINE 2.25 % INHL NEBU,,35716,LOCAL,Facility,Both,1,Each,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota, Federal Employee Program,8.856,98.4,,percent of total billed charges,,
RACEPINEPHRINE 2.25 % INHL NEBU,,35716,LOCAL,Facility,Both,1,Each,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,9,100,,percent of total billed charges,,
RACEPINEPHRINE 2.25 % INHL NEBU,,35716,LOCAL,Facility,Both,1,Each,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota,High Value Network Plan,8.1,90,,percent of total billed charges,,
RACEPINEPHRINE 2.25 % INHL NEBU,,35716,LOCAL,Facility,Outpatient,1,Each,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota,Medicare Advantage,4.41,49,,percent of total billed charges,,
RACEPINEPHRINE 2.25 % INHL NEBU,,35716,LOCAL,Facility,Inpatient,1,Each,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
RACEPINEPHRINE 2.25 % INHL NEBU,,35716,LOCAL,Facility,Both,1,Each,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,7.9713,88.57,,percent of total billed charges,,
RACEPINEPHRINE 2.25 % INHL NEBU,,35716,LOCAL,Facility,Both,1,Each,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,2.5794,28.66,,percent of total billed charges,,
RACEPINEPHRINE 2.25 % INHL NEBU,,35716,LOCAL,Facility,Outpatient,1,Each,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),4.41,49,,percent of total billed charges,,
RACEPINEPHRINE 2.25 % INHL NEBU,,35716,LOCAL,Facility,Inpatient,1,Each,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
RACEPINEPHRINE 2.25 % INHL NEBU,,35716,LOCAL,Facility,Both,1,Each,,9,7.65,2.5794,9,CorVel,Worker's Compensation,9,100,,percent of total billed charges,,
RACEPINEPHRINE 2.25 % INHL NEBU,,35716,LOCAL,Facility,Both,1,Each,,9,7.65,2.5794,9,First Health Group Corporation,First Health Network,8.73,97,,percent of total billed charges,,
RACEPINEPHRINE 2.25 % INHL NEBU,,35716,LOCAL,Facility,Both,1,Each,,9,7.65,2.5794,9,"Health Partners, Inc.",Commercial,8.514,94.6,,percent of total billed charges,,
RACEPINEPHRINE 2.25 % INHL NEBU,,35716,LOCAL,Facility,Outpatient,1,Each,,9,7.65,2.5794,9,"Health Partners, Inc.",Medicare Advantage,4.41,49,,percent of total billed charges,,
RACEPINEPHRINE 2.25 % INHL NEBU,,35716,LOCAL,Facility,Inpatient,1,Each,,9,7.65,2.5794,9,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
RACEPINEPHRINE 2.25 % INHL NEBU,,35716,LOCAL,Facility,Both,1,Each,,9,7.65,2.5794,9,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),5.4,60,,percent of total billed charges,,
RACEPINEPHRINE 2.25 % INHL NEBU,,35716,LOCAL,Facility,Both,1,Each,,9,7.65,2.5794,9,"Health Partners, Inc.",State of Minnesota Advantage Program,7.335,81.5,,percent of total billed charges,,
RACEPINEPHRINE 2.25 % INHL NEBU,,35716,LOCAL,Facility,Both,1,Each,,9,7.65,2.5794,9,"Health Partners, Inc.",State Public Programs,4.5,50,,percent of total billed charges,,
RACEPINEPHRINE 2.25 % INHL NEBU,,35716,LOCAL,Facility,Both,1,Each,,9,7.65,2.5794,9,Humana Insurance Company,Commercial PPO,8.55,95,,percent of total billed charges,,
RACEPINEPHRINE 2.25 % INHL NEBU,,35716,LOCAL,Facility,Outpatient,1,Each,,9,7.65,2.5794,9,Humana Insurance Company,Medicare PPO,4.41,49,,percent of total billed charges,,
RACEPINEPHRINE 2.25 % INHL NEBU,,35716,LOCAL,Facility,Inpatient,1,Each,,9,7.65,2.5794,9,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
RACEPINEPHRINE 2.25 % INHL NEBU,,35716,LOCAL,Facility,Both,1,Each,,9,7.65,2.5794,9,Medica,Individual & Family,8.919,99.1,,percent of total billed charges,,
RACEPINEPHRINE 2.25 % INHL NEBU,,35716,LOCAL,Facility,Outpatient,1,Each,,9,7.65,2.5794,9,Medica,Medica Advantage Solution,4.482,49.8,,percent of total billed charges,,
RACEPINEPHRINE 2.25 % INHL NEBU,,35716,LOCAL,Facility,Inpatient,1,Each,,9,7.65,2.5794,9,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
RACEPINEPHRINE 2.25 % INHL NEBU,,35716,LOCAL,Facility,Outpatient,1,Each,,9,7.65,2.5794,9,Medica,Medical Assistance,4.014,44.6,,percent of total billed charges,,
RACEPINEPHRINE 2.25 % INHL NEBU,,35716,LOCAL,Facility,Inpatient,1,Each,,9,7.65,2.5794,9,Medica,Medical Assistance,,,,,Included in per diem rate,
RACEPINEPHRINE 2.25 % INHL NEBU,,35716,LOCAL,Facility,Outpatient,1,Each,,9,7.65,2.5794,9,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,4.482,49.8,,percent of total billed charges,,
RACEPINEPHRINE 2.25 % INHL NEBU,,35716,LOCAL,Facility,Inpatient,1,Each,,9,7.65,2.5794,9,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
RACEPINEPHRINE 2.25 % INHL NEBU,,35716,LOCAL,Facility,Both,1,Each,,9,7.65,2.5794,9,"Multiplan, Inc.","Multiplan, Inc.",8.46,94,,percent of total billed charges,,
RACEPINEPHRINE 2.25 % INHL NEBU,,35716,LOCAL,Facility,Outpatient,1,Each,,9,7.65,2.5794,9,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,8.109,90.1,,percent of total billed charges,,
RACEPINEPHRINE 2.25 % INHL NEBU,,35716,LOCAL,Facility,Inpatient,1,Each,,9,7.65,2.5794,9,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
RACEPINEPHRINE 2.25 % INHL NEBU,,35716,LOCAL,Facility,Both,1,Each,,9,7.65,2.5794,9,"Preferred One Administrative Services, INC.",PPO,8.874,98.6,,percent of total billed charges,,
RACEPINEPHRINE 2.25 % INHL NEBU,,35716,LOCAL,Facility,Outpatient,1,Each,,9,7.65,2.5794,9,PrimeWest Health,Minnesota Senior Health Options (MSHO),4.6305,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
RACEPINEPHRINE 2.25 % INHL NEBU,,35716,LOCAL,Facility,Inpatient,1,Each,,9,7.65,2.5794,9,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
RACEPINEPHRINE 2.25 % INHL NEBU,,35716,LOCAL,Facility,Outpatient,1,Each,,9,7.65,2.5794,9,PrimeWest Health,MinnesotaCare,4.6224,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
RACEPINEPHRINE 2.25 % INHL NEBU,,35716,LOCAL,Facility,Inpatient,1,Each,,9,7.65,2.5794,9,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
RACEPINEPHRINE 2.25 % INHL NEBU,,35716,LOCAL,Facility,Both,1,Each,,9,7.65,2.5794,9,Sanford Health Plan,Sanford Health Plan,8.28,92,,percent of total billed charges,,
RACEPINEPHRINE 2.25 % INHL NEBU,,35716,LOCAL,Facility,Outpatient,1,Each,,9,7.65,2.5794,9,"UCare Health, Inc.",Individual & Family Plan,5.0715,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
RACEPINEPHRINE 2.25 % INHL NEBU,,35716,LOCAL,Facility,Inpatient,1,Each,,9,7.65,2.5794,9,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
RACEPINEPHRINE 2.25 % INHL NEBU,,35716,LOCAL,Facility,Outpatient,1,Each,,9,7.65,2.5794,9,"UCare Health, Inc.",Medical Assistance,4.5423,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
RACEPINEPHRINE 2.25 % INHL NEBU,,35716,LOCAL,Facility,Inpatient,1,Each,,9,7.65,2.5794,9,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
RACEPINEPHRINE 2.25 % INHL NEBU,,35716,LOCAL,Facility,Outpatient,1,Each,,9,7.65,2.5794,9,"UCare Health, Inc.",Medicare Advantage,4.5423,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
RACEPINEPHRINE 2.25 % INHL NEBU,,35716,LOCAL,Facility,Inpatient,1,Each,,9,7.65,2.5794,9,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
RACEPINEPHRINE 2.25 % INHL NEBU,,35716,LOCAL,Facility,Outpatient,1,Each,,9,7.65,2.5794,9,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),4.5423,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
RACEPINEPHRINE 2.25 % INHL NEBU,,35716,LOCAL,Facility,Inpatient,1,Each,,9,7.65,2.5794,9,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
RACEPINEPHRINE 2.25 % INHL NEBU,,35716,LOCAL,Facility,Both,1,Each,,9,7.65,2.5794,9,UnitedHealthcare,Individual & Family,8.46,94,,percent of total billed charges,,
RACEPINEPHRINE 2.25 % INHL NEBU,,35716,LOCAL,Facility,Outpatient,1,Each,,9,7.65,2.5794,9,UnitedHealthcare,Medicare Advantage,4.41,49,,percent of total billed charges,,
RACEPINEPHRINE 2.25 % INHL NEBU,,35716,LOCAL,Facility,Inpatient,1,Each,,9,7.65,2.5794,9,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
RACEPINEPHRINE 2.25 % INHL NEBU,,35716,LOCAL,Facility,Outpatient,1,Each,,9,7.65,2.5794,9,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,4.32,48,,percent of total billed charges,,100% of DHS outpatient percentage
RACEPINEPHRINE 2.25 % INHL NEBU,,35716,LOCAL,Facility,Inpatient,1,Each,,9,7.65,2.5794,9,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
NITROFURANTOIN MONOHYD/M-CRYST 100 MG ORAL CAP,,36081,LOCAL,Facility,Both,1,Each,,20,17,5.732,20,Aetna,Commercial,18.4,92,,percent of total billed charges,,
NITROFURANTOIN MONOHYD/M-CRYST 100 MG ORAL CAP,,36081,LOCAL,Facility,Outpatient,1,Each,,20,17,5.732,20,Aetna,Medicare Advantage,9.8,49,,percent of total billed charges,,
NITROFURANTOIN MONOHYD/M-CRYST 100 MG ORAL CAP,,36081,LOCAL,Facility,Inpatient,1,Each,,20,17,5.732,20,Aetna,Medicare Advantage,,,,,Included in per diem rate,
NITROFURANTOIN MONOHYD/M-CRYST 100 MG ORAL CAP,,36081,LOCAL,Facility,Both,1,Each,,20,17,5.732,20,Aetna,PPO,18.6,93,,percent of total billed charges,,
NITROFURANTOIN MONOHYD/M-CRYST 100 MG ORAL CAP,,36081,LOCAL,Facility,Both,1,Each,,20,17,5.732,20,America's PPO,America's PPO,19.206,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
NITROFURANTOIN MONOHYD/M-CRYST 100 MG ORAL CAP,,36081,LOCAL,Facility,Both,1,Each,,20,17,5.732,20,BlueCross BlueShield Minnesota, Federal Employee Program,19.68,98.4,,percent of total billed charges,,
NITROFURANTOIN MONOHYD/M-CRYST 100 MG ORAL CAP,,36081,LOCAL,Facility,Both,1,Each,,20,17,5.732,20,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,20,100,,percent of total billed charges,,
NITROFURANTOIN MONOHYD/M-CRYST 100 MG ORAL CAP,,36081,LOCAL,Facility,Both,1,Each,,20,17,5.732,20,BlueCross BlueShield Minnesota,High Value Network Plan,18,90,,percent of total billed charges,,
NITROFURANTOIN MONOHYD/M-CRYST 100 MG ORAL CAP,,36081,LOCAL,Facility,Outpatient,1,Each,,20,17,5.732,20,BlueCross BlueShield Minnesota,Medicare Advantage,9.8,49,,percent of total billed charges,,
NITROFURANTOIN MONOHYD/M-CRYST 100 MG ORAL CAP,,36081,LOCAL,Facility,Inpatient,1,Each,,20,17,5.732,20,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
NITROFURANTOIN MONOHYD/M-CRYST 100 MG ORAL CAP,,36081,LOCAL,Facility,Both,1,Each,,20,17,5.732,20,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,17.714,88.57,,percent of total billed charges,,
NITROFURANTOIN MONOHYD/M-CRYST 100 MG ORAL CAP,,36081,LOCAL,Facility,Both,1,Each,,20,17,5.732,20,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,5.732,28.66,,percent of total billed charges,,
NITROFURANTOIN MONOHYD/M-CRYST 100 MG ORAL CAP,,36081,LOCAL,Facility,Outpatient,1,Each,,20,17,5.732,20,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),9.8,49,,percent of total billed charges,,
NITROFURANTOIN MONOHYD/M-CRYST 100 MG ORAL CAP,,36081,LOCAL,Facility,Inpatient,1,Each,,20,17,5.732,20,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
NITROFURANTOIN MONOHYD/M-CRYST 100 MG ORAL CAP,,36081,LOCAL,Facility,Both,1,Each,,20,17,5.732,20,CorVel,Worker's Compensation,20,100,,percent of total billed charges,,
NITROFURANTOIN MONOHYD/M-CRYST 100 MG ORAL CAP,,36081,LOCAL,Facility,Both,1,Each,,20,17,5.732,20,First Health Group Corporation,First Health Network,19.4,97,,percent of total billed charges,,
NITROFURANTOIN MONOHYD/M-CRYST 100 MG ORAL CAP,,36081,LOCAL,Facility,Both,1,Each,,20,17,5.732,20,"Health Partners, Inc.",Commercial,18.92,94.6,,percent of total billed charges,,
NITROFURANTOIN MONOHYD/M-CRYST 100 MG ORAL CAP,,36081,LOCAL,Facility,Outpatient,1,Each,,20,17,5.732,20,"Health Partners, Inc.",Medicare Advantage,9.8,49,,percent of total billed charges,,
NITROFURANTOIN MONOHYD/M-CRYST 100 MG ORAL CAP,,36081,LOCAL,Facility,Inpatient,1,Each,,20,17,5.732,20,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
NITROFURANTOIN MONOHYD/M-CRYST 100 MG ORAL CAP,,36081,LOCAL,Facility,Both,1,Each,,20,17,5.732,20,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),12,60,,percent of total billed charges,,
NITROFURANTOIN MONOHYD/M-CRYST 100 MG ORAL CAP,,36081,LOCAL,Facility,Both,1,Each,,20,17,5.732,20,"Health Partners, Inc.",State of Minnesota Advantage Program,16.3,81.5,,percent of total billed charges,,
NITROFURANTOIN MONOHYD/M-CRYST 100 MG ORAL CAP,,36081,LOCAL,Facility,Both,1,Each,,20,17,5.732,20,"Health Partners, Inc.",State Public Programs,10,50,,percent of total billed charges,,
NITROFURANTOIN MONOHYD/M-CRYST 100 MG ORAL CAP,,36081,LOCAL,Facility,Both,1,Each,,20,17,5.732,20,Humana Insurance Company,Commercial PPO,19,95,,percent of total billed charges,,
NITROFURANTOIN MONOHYD/M-CRYST 100 MG ORAL CAP,,36081,LOCAL,Facility,Outpatient,1,Each,,20,17,5.732,20,Humana Insurance Company,Medicare PPO,9.8,49,,percent of total billed charges,,
NITROFURANTOIN MONOHYD/M-CRYST 100 MG ORAL CAP,,36081,LOCAL,Facility,Inpatient,1,Each,,20,17,5.732,20,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
NITROFURANTOIN MONOHYD/M-CRYST 100 MG ORAL CAP,,36081,LOCAL,Facility,Both,1,Each,,20,17,5.732,20,Medica,Individual & Family,19.82,99.1,,percent of total billed charges,,
NITROFURANTOIN MONOHYD/M-CRYST 100 MG ORAL CAP,,36081,LOCAL,Facility,Outpatient,1,Each,,20,17,5.732,20,Medica,Medica Advantage Solution,9.96,49.8,,percent of total billed charges,,
NITROFURANTOIN MONOHYD/M-CRYST 100 MG ORAL CAP,,36081,LOCAL,Facility,Inpatient,1,Each,,20,17,5.732,20,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
NITROFURANTOIN MONOHYD/M-CRYST 100 MG ORAL CAP,,36081,LOCAL,Facility,Outpatient,1,Each,,20,17,5.732,20,Medica,Medical Assistance,8.92,44.6,,percent of total billed charges,,
NITROFURANTOIN MONOHYD/M-CRYST 100 MG ORAL CAP,,36081,LOCAL,Facility,Inpatient,1,Each,,20,17,5.732,20,Medica,Medical Assistance,,,,,Included in per diem rate,
NITROFURANTOIN MONOHYD/M-CRYST 100 MG ORAL CAP,,36081,LOCAL,Facility,Outpatient,1,Each,,20,17,5.732,20,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,9.96,49.8,,percent of total billed charges,,
NITROFURANTOIN MONOHYD/M-CRYST 100 MG ORAL CAP,,36081,LOCAL,Facility,Inpatient,1,Each,,20,17,5.732,20,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
NITROFURANTOIN MONOHYD/M-CRYST 100 MG ORAL CAP,,36081,LOCAL,Facility,Both,1,Each,,20,17,5.732,20,"Multiplan, Inc.","Multiplan, Inc.",18.8,94,,percent of total billed charges,,
NITROFURANTOIN MONOHYD/M-CRYST 100 MG ORAL CAP,,36081,LOCAL,Facility,Outpatient,1,Each,,20,17,5.732,20,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,18.02,90.1,,percent of total billed charges,,
NITROFURANTOIN MONOHYD/M-CRYST 100 MG ORAL CAP,,36081,LOCAL,Facility,Inpatient,1,Each,,20,17,5.732,20,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
NITROFURANTOIN MONOHYD/M-CRYST 100 MG ORAL CAP,,36081,LOCAL,Facility,Both,1,Each,,20,17,5.732,20,"Preferred One Administrative Services, INC.",PPO,19.72,98.6,,percent of total billed charges,,
NITROFURANTOIN MONOHYD/M-CRYST 100 MG ORAL CAP,,36081,LOCAL,Facility,Outpatient,1,Each,,20,17,5.732,20,PrimeWest Health,Minnesota Senior Health Options (MSHO),10.29,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
NITROFURANTOIN MONOHYD/M-CRYST 100 MG ORAL CAP,,36081,LOCAL,Facility,Inpatient,1,Each,,20,17,5.732,20,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
NITROFURANTOIN MONOHYD/M-CRYST 100 MG ORAL CAP,,36081,LOCAL,Facility,Outpatient,1,Each,,20,17,5.732,20,PrimeWest Health,MinnesotaCare,10.272,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
NITROFURANTOIN MONOHYD/M-CRYST 100 MG ORAL CAP,,36081,LOCAL,Facility,Inpatient,1,Each,,20,17,5.732,20,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
NITROFURANTOIN MONOHYD/M-CRYST 100 MG ORAL CAP,,36081,LOCAL,Facility,Both,1,Each,,20,17,5.732,20,Sanford Health Plan,Sanford Health Plan,18.4,92,,percent of total billed charges,,
NITROFURANTOIN MONOHYD/M-CRYST 100 MG ORAL CAP,,36081,LOCAL,Facility,Outpatient,1,Each,,20,17,5.732,20,"UCare Health, Inc.",Individual & Family Plan,11.27,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
NITROFURANTOIN MONOHYD/M-CRYST 100 MG ORAL CAP,,36081,LOCAL,Facility,Inpatient,1,Each,,20,17,5.732,20,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
NITROFURANTOIN MONOHYD/M-CRYST 100 MG ORAL CAP,,36081,LOCAL,Facility,Outpatient,1,Each,,20,17,5.732,20,"UCare Health, Inc.",Medical Assistance,10.094,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
NITROFURANTOIN MONOHYD/M-CRYST 100 MG ORAL CAP,,36081,LOCAL,Facility,Inpatient,1,Each,,20,17,5.732,20,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
NITROFURANTOIN MONOHYD/M-CRYST 100 MG ORAL CAP,,36081,LOCAL,Facility,Outpatient,1,Each,,20,17,5.732,20,"UCare Health, Inc.",Medicare Advantage,10.094,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
NITROFURANTOIN MONOHYD/M-CRYST 100 MG ORAL CAP,,36081,LOCAL,Facility,Inpatient,1,Each,,20,17,5.732,20,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
NITROFURANTOIN MONOHYD/M-CRYST 100 MG ORAL CAP,,36081,LOCAL,Facility,Outpatient,1,Each,,20,17,5.732,20,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),10.094,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
NITROFURANTOIN MONOHYD/M-CRYST 100 MG ORAL CAP,,36081,LOCAL,Facility,Inpatient,1,Each,,20,17,5.732,20,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
NITROFURANTOIN MONOHYD/M-CRYST 100 MG ORAL CAP,,36081,LOCAL,Facility,Both,1,Each,,20,17,5.732,20,UnitedHealthcare,Individual & Family,18.8,94,,percent of total billed charges,,
NITROFURANTOIN MONOHYD/M-CRYST 100 MG ORAL CAP,,36081,LOCAL,Facility,Outpatient,1,Each,,20,17,5.732,20,UnitedHealthcare,Medicare Advantage,9.8,49,,percent of total billed charges,,
NITROFURANTOIN MONOHYD/M-CRYST 100 MG ORAL CAP,,36081,LOCAL,Facility,Inpatient,1,Each,,20,17,5.732,20,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
NITROFURANTOIN MONOHYD/M-CRYST 100 MG ORAL CAP,,36081,LOCAL,Facility,Outpatient,1,Each,,20,17,5.732,20,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,9.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
NITROFURANTOIN MONOHYD/M-CRYST 100 MG ORAL CAP,,36081,LOCAL,Facility,Inpatient,1,Each,,20,17,5.732,20,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
CALCIUM ACETATE(PHOSPHAT BIND) 667 MG ORAL CAP,,36119,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,Aetna,Commercial,5.52,92,,percent of total billed charges,,
CALCIUM ACETATE(PHOSPHAT BIND) 667 MG ORAL CAP,,36119,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,Aetna,Medicare Advantage,2.94,49,,percent of total billed charges,,
CALCIUM ACETATE(PHOSPHAT BIND) 667 MG ORAL CAP,,36119,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,Aetna,Medicare Advantage,,,,,Included in per diem rate,
CALCIUM ACETATE(PHOSPHAT BIND) 667 MG ORAL CAP,,36119,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,Aetna,PPO,5.58,93,,percent of total billed charges,,
CALCIUM ACETATE(PHOSPHAT BIND) 667 MG ORAL CAP,,36119,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,America's PPO,America's PPO,5.7618,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
CALCIUM ACETATE(PHOSPHAT BIND) 667 MG ORAL CAP,,36119,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota, Federal Employee Program,5.904,98.4,,percent of total billed charges,,
CALCIUM ACETATE(PHOSPHAT BIND) 667 MG ORAL CAP,,36119,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,6,100,,percent of total billed charges,,
CALCIUM ACETATE(PHOSPHAT BIND) 667 MG ORAL CAP,,36119,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota,High Value Network Plan,5.4,90,,percent of total billed charges,,
CALCIUM ACETATE(PHOSPHAT BIND) 667 MG ORAL CAP,,36119,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota,Medicare Advantage,2.94,49,,percent of total billed charges,,
CALCIUM ACETATE(PHOSPHAT BIND) 667 MG ORAL CAP,,36119,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
CALCIUM ACETATE(PHOSPHAT BIND) 667 MG ORAL CAP,,36119,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,5.3142,88.57,,percent of total billed charges,,
CALCIUM ACETATE(PHOSPHAT BIND) 667 MG ORAL CAP,,36119,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.7196,28.66,,percent of total billed charges,,
CALCIUM ACETATE(PHOSPHAT BIND) 667 MG ORAL CAP,,36119,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.94,49,,percent of total billed charges,,
CALCIUM ACETATE(PHOSPHAT BIND) 667 MG ORAL CAP,,36119,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
CALCIUM ACETATE(PHOSPHAT BIND) 667 MG ORAL CAP,,36119,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,CorVel,Worker's Compensation,6,100,,percent of total billed charges,,
CALCIUM ACETATE(PHOSPHAT BIND) 667 MG ORAL CAP,,36119,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,First Health Group Corporation,First Health Network,5.82,97,,percent of total billed charges,,
CALCIUM ACETATE(PHOSPHAT BIND) 667 MG ORAL CAP,,36119,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,"Health Partners, Inc.",Commercial,5.676,94.6,,percent of total billed charges,,
CALCIUM ACETATE(PHOSPHAT BIND) 667 MG ORAL CAP,,36119,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,"Health Partners, Inc.",Medicare Advantage,2.94,49,,percent of total billed charges,,
CALCIUM ACETATE(PHOSPHAT BIND) 667 MG ORAL CAP,,36119,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CALCIUM ACETATE(PHOSPHAT BIND) 667 MG ORAL CAP,,36119,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3.6,60,,percent of total billed charges,,
CALCIUM ACETATE(PHOSPHAT BIND) 667 MG ORAL CAP,,36119,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,"Health Partners, Inc.",State of Minnesota Advantage Program,4.89,81.5,,percent of total billed charges,,
CALCIUM ACETATE(PHOSPHAT BIND) 667 MG ORAL CAP,,36119,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,"Health Partners, Inc.",State Public Programs,3,50,,percent of total billed charges,,
CALCIUM ACETATE(PHOSPHAT BIND) 667 MG ORAL CAP,,36119,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,Humana Insurance Company,Commercial PPO,5.7,95,,percent of total billed charges,,
CALCIUM ACETATE(PHOSPHAT BIND) 667 MG ORAL CAP,,36119,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,Humana Insurance Company,Medicare PPO,2.94,49,,percent of total billed charges,,
CALCIUM ACETATE(PHOSPHAT BIND) 667 MG ORAL CAP,,36119,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
CALCIUM ACETATE(PHOSPHAT BIND) 667 MG ORAL CAP,,36119,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,Medica,Individual & Family,5.946,99.1,,percent of total billed charges,,
CALCIUM ACETATE(PHOSPHAT BIND) 667 MG ORAL CAP,,36119,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,Medica,Medica Advantage Solution,2.988,49.8,,percent of total billed charges,,
CALCIUM ACETATE(PHOSPHAT BIND) 667 MG ORAL CAP,,36119,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
CALCIUM ACETATE(PHOSPHAT BIND) 667 MG ORAL CAP,,36119,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,Medica,Medical Assistance,2.676,44.6,,percent of total billed charges,,
CALCIUM ACETATE(PHOSPHAT BIND) 667 MG ORAL CAP,,36119,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,Medica,Medical Assistance,,,,,Included in per diem rate,
CALCIUM ACETATE(PHOSPHAT BIND) 667 MG ORAL CAP,,36119,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.988,49.8,,percent of total billed charges,,
CALCIUM ACETATE(PHOSPHAT BIND) 667 MG ORAL CAP,,36119,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
CALCIUM ACETATE(PHOSPHAT BIND) 667 MG ORAL CAP,,36119,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,"Multiplan, Inc.","Multiplan, Inc.",5.64,94,,percent of total billed charges,,
CALCIUM ACETATE(PHOSPHAT BIND) 667 MG ORAL CAP,,36119,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,5.406,90.1,,percent of total billed charges,,
CALCIUM ACETATE(PHOSPHAT BIND) 667 MG ORAL CAP,,36119,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
CALCIUM ACETATE(PHOSPHAT BIND) 667 MG ORAL CAP,,36119,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,"Preferred One Administrative Services, INC.",PPO,5.916,98.6,,percent of total billed charges,,
CALCIUM ACETATE(PHOSPHAT BIND) 667 MG ORAL CAP,,36119,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,PrimeWest Health,Minnesota Senior Health Options (MSHO),3.087,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
CALCIUM ACETATE(PHOSPHAT BIND) 667 MG ORAL CAP,,36119,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CALCIUM ACETATE(PHOSPHAT BIND) 667 MG ORAL CAP,,36119,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,PrimeWest Health,MinnesotaCare,3.0816,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
CALCIUM ACETATE(PHOSPHAT BIND) 667 MG ORAL CAP,,36119,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
CALCIUM ACETATE(PHOSPHAT BIND) 667 MG ORAL CAP,,36119,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,Sanford Health Plan,Sanford Health Plan,5.52,92,,percent of total billed charges,,
CALCIUM ACETATE(PHOSPHAT BIND) 667 MG ORAL CAP,,36119,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,"UCare Health, Inc.",Individual & Family Plan,3.381,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
CALCIUM ACETATE(PHOSPHAT BIND) 667 MG ORAL CAP,,36119,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
CALCIUM ACETATE(PHOSPHAT BIND) 667 MG ORAL CAP,,36119,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,"UCare Health, Inc.",Medical Assistance,3.0282,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CALCIUM ACETATE(PHOSPHAT BIND) 667 MG ORAL CAP,,36119,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
CALCIUM ACETATE(PHOSPHAT BIND) 667 MG ORAL CAP,,36119,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,"UCare Health, Inc.",Medicare Advantage,3.0282,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CALCIUM ACETATE(PHOSPHAT BIND) 667 MG ORAL CAP,,36119,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CALCIUM ACETATE(PHOSPHAT BIND) 667 MG ORAL CAP,,36119,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),3.0282,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CALCIUM ACETATE(PHOSPHAT BIND) 667 MG ORAL CAP,,36119,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CALCIUM ACETATE(PHOSPHAT BIND) 667 MG ORAL CAP,,36119,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,UnitedHealthcare,Individual & Family,5.64,94,,percent of total billed charges,,
CALCIUM ACETATE(PHOSPHAT BIND) 667 MG ORAL CAP,,36119,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,UnitedHealthcare,Medicare Advantage,2.94,49,,percent of total billed charges,,
CALCIUM ACETATE(PHOSPHAT BIND) 667 MG ORAL CAP,,36119,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
CALCIUM ACETATE(PHOSPHAT BIND) 667 MG ORAL CAP,,36119,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.88,48,,percent of total billed charges,,100% of DHS outpatient percentage
CALCIUM ACETATE(PHOSPHAT BIND) 667 MG ORAL CAP,,36119,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
DULOXETINE 30 MG ORAL CPDR,,36269,LOCAL,Facility,Both,1,Each,,20,17,5.732,20,Aetna,Commercial,18.4,92,,percent of total billed charges,,
DULOXETINE 30 MG ORAL CPDR,,36269,LOCAL,Facility,Outpatient,1,Each,,20,17,5.732,20,Aetna,Medicare Advantage,9.8,49,,percent of total billed charges,,
DULOXETINE 30 MG ORAL CPDR,,36269,LOCAL,Facility,Inpatient,1,Each,,20,17,5.732,20,Aetna,Medicare Advantage,,,,,Included in per diem rate,
DULOXETINE 30 MG ORAL CPDR,,36269,LOCAL,Facility,Both,1,Each,,20,17,5.732,20,Aetna,PPO,18.6,93,,percent of total billed charges,,
DULOXETINE 30 MG ORAL CPDR,,36269,LOCAL,Facility,Both,1,Each,,20,17,5.732,20,America's PPO,America's PPO,19.206,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
DULOXETINE 30 MG ORAL CPDR,,36269,LOCAL,Facility,Both,1,Each,,20,17,5.732,20,BlueCross BlueShield Minnesota, Federal Employee Program,19.68,98.4,,percent of total billed charges,,
DULOXETINE 30 MG ORAL CPDR,,36269,LOCAL,Facility,Both,1,Each,,20,17,5.732,20,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,20,100,,percent of total billed charges,,
DULOXETINE 30 MG ORAL CPDR,,36269,LOCAL,Facility,Both,1,Each,,20,17,5.732,20,BlueCross BlueShield Minnesota,High Value Network Plan,18,90,,percent of total billed charges,,
DULOXETINE 30 MG ORAL CPDR,,36269,LOCAL,Facility,Outpatient,1,Each,,20,17,5.732,20,BlueCross BlueShield Minnesota,Medicare Advantage,9.8,49,,percent of total billed charges,,
DULOXETINE 30 MG ORAL CPDR,,36269,LOCAL,Facility,Inpatient,1,Each,,20,17,5.732,20,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
DULOXETINE 30 MG ORAL CPDR,,36269,LOCAL,Facility,Both,1,Each,,20,17,5.732,20,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,17.714,88.57,,percent of total billed charges,,
DULOXETINE 30 MG ORAL CPDR,,36269,LOCAL,Facility,Both,1,Each,,20,17,5.732,20,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,5.732,28.66,,percent of total billed charges,,
DULOXETINE 30 MG ORAL CPDR,,36269,LOCAL,Facility,Outpatient,1,Each,,20,17,5.732,20,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),9.8,49,,percent of total billed charges,,
DULOXETINE 30 MG ORAL CPDR,,36269,LOCAL,Facility,Inpatient,1,Each,,20,17,5.732,20,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
DULOXETINE 30 MG ORAL CPDR,,36269,LOCAL,Facility,Both,1,Each,,20,17,5.732,20,CorVel,Worker's Compensation,20,100,,percent of total billed charges,,
DULOXETINE 30 MG ORAL CPDR,,36269,LOCAL,Facility,Both,1,Each,,20,17,5.732,20,First Health Group Corporation,First Health Network,19.4,97,,percent of total billed charges,,
DULOXETINE 30 MG ORAL CPDR,,36269,LOCAL,Facility,Both,1,Each,,20,17,5.732,20,"Health Partners, Inc.",Commercial,18.92,94.6,,percent of total billed charges,,
DULOXETINE 30 MG ORAL CPDR,,36269,LOCAL,Facility,Outpatient,1,Each,,20,17,5.732,20,"Health Partners, Inc.",Medicare Advantage,9.8,49,,percent of total billed charges,,
DULOXETINE 30 MG ORAL CPDR,,36269,LOCAL,Facility,Inpatient,1,Each,,20,17,5.732,20,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DULOXETINE 30 MG ORAL CPDR,,36269,LOCAL,Facility,Both,1,Each,,20,17,5.732,20,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),12,60,,percent of total billed charges,,
DULOXETINE 30 MG ORAL CPDR,,36269,LOCAL,Facility,Both,1,Each,,20,17,5.732,20,"Health Partners, Inc.",State of Minnesota Advantage Program,16.3,81.5,,percent of total billed charges,,
DULOXETINE 30 MG ORAL CPDR,,36269,LOCAL,Facility,Both,1,Each,,20,17,5.732,20,"Health Partners, Inc.",State Public Programs,10,50,,percent of total billed charges,,
DULOXETINE 30 MG ORAL CPDR,,36269,LOCAL,Facility,Both,1,Each,,20,17,5.732,20,Humana Insurance Company,Commercial PPO,19,95,,percent of total billed charges,,
DULOXETINE 30 MG ORAL CPDR,,36269,LOCAL,Facility,Outpatient,1,Each,,20,17,5.732,20,Humana Insurance Company,Medicare PPO,9.8,49,,percent of total billed charges,,
DULOXETINE 30 MG ORAL CPDR,,36269,LOCAL,Facility,Inpatient,1,Each,,20,17,5.732,20,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
DULOXETINE 30 MG ORAL CPDR,,36269,LOCAL,Facility,Both,1,Each,,20,17,5.732,20,Medica,Individual & Family,19.82,99.1,,percent of total billed charges,,
DULOXETINE 30 MG ORAL CPDR,,36269,LOCAL,Facility,Outpatient,1,Each,,20,17,5.732,20,Medica,Medica Advantage Solution,9.96,49.8,,percent of total billed charges,,
DULOXETINE 30 MG ORAL CPDR,,36269,LOCAL,Facility,Inpatient,1,Each,,20,17,5.732,20,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
DULOXETINE 30 MG ORAL CPDR,,36269,LOCAL,Facility,Outpatient,1,Each,,20,17,5.732,20,Medica,Medical Assistance,8.92,44.6,,percent of total billed charges,,
DULOXETINE 30 MG ORAL CPDR,,36269,LOCAL,Facility,Inpatient,1,Each,,20,17,5.732,20,Medica,Medical Assistance,,,,,Included in per diem rate,
DULOXETINE 30 MG ORAL CPDR,,36269,LOCAL,Facility,Outpatient,1,Each,,20,17,5.732,20,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,9.96,49.8,,percent of total billed charges,,
DULOXETINE 30 MG ORAL CPDR,,36269,LOCAL,Facility,Inpatient,1,Each,,20,17,5.732,20,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
DULOXETINE 30 MG ORAL CPDR,,36269,LOCAL,Facility,Both,1,Each,,20,17,5.732,20,"Multiplan, Inc.","Multiplan, Inc.",18.8,94,,percent of total billed charges,,
DULOXETINE 30 MG ORAL CPDR,,36269,LOCAL,Facility,Outpatient,1,Each,,20,17,5.732,20,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,18.02,90.1,,percent of total billed charges,,
DULOXETINE 30 MG ORAL CPDR,,36269,LOCAL,Facility,Inpatient,1,Each,,20,17,5.732,20,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
DULOXETINE 30 MG ORAL CPDR,,36269,LOCAL,Facility,Both,1,Each,,20,17,5.732,20,"Preferred One Administrative Services, INC.",PPO,19.72,98.6,,percent of total billed charges,,
DULOXETINE 30 MG ORAL CPDR,,36269,LOCAL,Facility,Outpatient,1,Each,,20,17,5.732,20,PrimeWest Health,Minnesota Senior Health Options (MSHO),10.29,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
DULOXETINE 30 MG ORAL CPDR,,36269,LOCAL,Facility,Inpatient,1,Each,,20,17,5.732,20,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DULOXETINE 30 MG ORAL CPDR,,36269,LOCAL,Facility,Outpatient,1,Each,,20,17,5.732,20,PrimeWest Health,MinnesotaCare,10.272,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
DULOXETINE 30 MG ORAL CPDR,,36269,LOCAL,Facility,Inpatient,1,Each,,20,17,5.732,20,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
DULOXETINE 30 MG ORAL CPDR,,36269,LOCAL,Facility,Both,1,Each,,20,17,5.732,20,Sanford Health Plan,Sanford Health Plan,18.4,92,,percent of total billed charges,,
DULOXETINE 30 MG ORAL CPDR,,36269,LOCAL,Facility,Outpatient,1,Each,,20,17,5.732,20,"UCare Health, Inc.",Individual & Family Plan,11.27,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
DULOXETINE 30 MG ORAL CPDR,,36269,LOCAL,Facility,Inpatient,1,Each,,20,17,5.732,20,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
DULOXETINE 30 MG ORAL CPDR,,36269,LOCAL,Facility,Outpatient,1,Each,,20,17,5.732,20,"UCare Health, Inc.",Medical Assistance,10.094,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DULOXETINE 30 MG ORAL CPDR,,36269,LOCAL,Facility,Inpatient,1,Each,,20,17,5.732,20,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
DULOXETINE 30 MG ORAL CPDR,,36269,LOCAL,Facility,Outpatient,1,Each,,20,17,5.732,20,"UCare Health, Inc.",Medicare Advantage,10.094,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DULOXETINE 30 MG ORAL CPDR,,36269,LOCAL,Facility,Inpatient,1,Each,,20,17,5.732,20,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DULOXETINE 30 MG ORAL CPDR,,36269,LOCAL,Facility,Outpatient,1,Each,,20,17,5.732,20,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),10.094,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DULOXETINE 30 MG ORAL CPDR,,36269,LOCAL,Facility,Inpatient,1,Each,,20,17,5.732,20,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DULOXETINE 30 MG ORAL CPDR,,36269,LOCAL,Facility,Both,1,Each,,20,17,5.732,20,UnitedHealthcare,Individual & Family,18.8,94,,percent of total billed charges,,
DULOXETINE 30 MG ORAL CPDR,,36269,LOCAL,Facility,Outpatient,1,Each,,20,17,5.732,20,UnitedHealthcare,Medicare Advantage,9.8,49,,percent of total billed charges,,
DULOXETINE 30 MG ORAL CPDR,,36269,LOCAL,Facility,Inpatient,1,Each,,20,17,5.732,20,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
DULOXETINE 30 MG ORAL CPDR,,36269,LOCAL,Facility,Outpatient,1,Each,,20,17,5.732,20,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,9.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
DULOXETINE 30 MG ORAL CPDR,,36269,LOCAL,Facility,Inpatient,1,Each,,20,17,5.732,20,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
SOLIFENACIN 5 MG ORAL TABLET,,37190,LOCAL,Facility,Both,1,Each,,71,60.35,20.3486,71,Aetna,Commercial,65.32,92,,percent of total billed charges,,
SOLIFENACIN 5 MG ORAL TABLET,,37190,LOCAL,Facility,Outpatient,1,Each,,71,60.35,20.3486,71,Aetna,Medicare Advantage,34.79,49,,percent of total billed charges,,
SOLIFENACIN 5 MG ORAL TABLET,,37190,LOCAL,Facility,Inpatient,1,Each,,71,60.35,20.3486,71,Aetna,Medicare Advantage,,,,,Included in per diem rate,
SOLIFENACIN 5 MG ORAL TABLET,,37190,LOCAL,Facility,Both,1,Each,,71,60.35,20.3486,71,Aetna,PPO,66.03,93,,percent of total billed charges,,
SOLIFENACIN 5 MG ORAL TABLET,,37190,LOCAL,Facility,Both,1,Each,,71,60.35,20.3486,71,America's PPO,America's PPO,68.1813,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SOLIFENACIN 5 MG ORAL TABLET,,37190,LOCAL,Facility,Both,1,Each,,71,60.35,20.3486,71,BlueCross BlueShield Minnesota, Federal Employee Program,69.864,98.4,,percent of total billed charges,,
SOLIFENACIN 5 MG ORAL TABLET,,37190,LOCAL,Facility,Both,1,Each,,71,60.35,20.3486,71,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,71,100,,percent of total billed charges,,
SOLIFENACIN 5 MG ORAL TABLET,,37190,LOCAL,Facility,Both,1,Each,,71,60.35,20.3486,71,BlueCross BlueShield Minnesota,High Value Network Plan,63.9,90,,percent of total billed charges,,
SOLIFENACIN 5 MG ORAL TABLET,,37190,LOCAL,Facility,Outpatient,1,Each,,71,60.35,20.3486,71,BlueCross BlueShield Minnesota,Medicare Advantage,34.79,49,,percent of total billed charges,,
SOLIFENACIN 5 MG ORAL TABLET,,37190,LOCAL,Facility,Inpatient,1,Each,,71,60.35,20.3486,71,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
SOLIFENACIN 5 MG ORAL TABLET,,37190,LOCAL,Facility,Both,1,Each,,71,60.35,20.3486,71,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,62.8847,88.57,,percent of total billed charges,,
SOLIFENACIN 5 MG ORAL TABLET,,37190,LOCAL,Facility,Both,1,Each,,71,60.35,20.3486,71,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,20.3486,28.66,,percent of total billed charges,,
SOLIFENACIN 5 MG ORAL TABLET,,37190,LOCAL,Facility,Outpatient,1,Each,,71,60.35,20.3486,71,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),34.79,49,,percent of total billed charges,,
SOLIFENACIN 5 MG ORAL TABLET,,37190,LOCAL,Facility,Inpatient,1,Each,,71,60.35,20.3486,71,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
SOLIFENACIN 5 MG ORAL TABLET,,37190,LOCAL,Facility,Both,1,Each,,71,60.35,20.3486,71,CorVel,Worker's Compensation,71,100,,percent of total billed charges,,
SOLIFENACIN 5 MG ORAL TABLET,,37190,LOCAL,Facility,Both,1,Each,,71,60.35,20.3486,71,First Health Group Corporation,First Health Network,68.87,97,,percent of total billed charges,,
SOLIFENACIN 5 MG ORAL TABLET,,37190,LOCAL,Facility,Both,1,Each,,71,60.35,20.3486,71,"Health Partners, Inc.",Commercial,67.166,94.6,,percent of total billed charges,,
SOLIFENACIN 5 MG ORAL TABLET,,37190,LOCAL,Facility,Outpatient,1,Each,,71,60.35,20.3486,71,"Health Partners, Inc.",Medicare Advantage,34.79,49,,percent of total billed charges,,
SOLIFENACIN 5 MG ORAL TABLET,,37190,LOCAL,Facility,Inpatient,1,Each,,71,60.35,20.3486,71,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SOLIFENACIN 5 MG ORAL TABLET,,37190,LOCAL,Facility,Both,1,Each,,71,60.35,20.3486,71,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),42.6,60,,percent of total billed charges,,
SOLIFENACIN 5 MG ORAL TABLET,,37190,LOCAL,Facility,Both,1,Each,,71,60.35,20.3486,71,"Health Partners, Inc.",State of Minnesota Advantage Program,57.865,81.5,,percent of total billed charges,,
SOLIFENACIN 5 MG ORAL TABLET,,37190,LOCAL,Facility,Both,1,Each,,71,60.35,20.3486,71,"Health Partners, Inc.",State Public Programs,35.5,50,,percent of total billed charges,,
SOLIFENACIN 5 MG ORAL TABLET,,37190,LOCAL,Facility,Both,1,Each,,71,60.35,20.3486,71,Humana Insurance Company,Commercial PPO,67.45,95,,percent of total billed charges,,
SOLIFENACIN 5 MG ORAL TABLET,,37190,LOCAL,Facility,Outpatient,1,Each,,71,60.35,20.3486,71,Humana Insurance Company,Medicare PPO,34.79,49,,percent of total billed charges,,
SOLIFENACIN 5 MG ORAL TABLET,,37190,LOCAL,Facility,Inpatient,1,Each,,71,60.35,20.3486,71,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
SOLIFENACIN 5 MG ORAL TABLET,,37190,LOCAL,Facility,Both,1,Each,,71,60.35,20.3486,71,Medica,Individual & Family,70.361,99.1,,percent of total billed charges,,
SOLIFENACIN 5 MG ORAL TABLET,,37190,LOCAL,Facility,Outpatient,1,Each,,71,60.35,20.3486,71,Medica,Medica Advantage Solution,35.358,49.8,,percent of total billed charges,,
SOLIFENACIN 5 MG ORAL TABLET,,37190,LOCAL,Facility,Inpatient,1,Each,,71,60.35,20.3486,71,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
SOLIFENACIN 5 MG ORAL TABLET,,37190,LOCAL,Facility,Outpatient,1,Each,,71,60.35,20.3486,71,Medica,Medical Assistance,31.666,44.6,,percent of total billed charges,,
SOLIFENACIN 5 MG ORAL TABLET,,37190,LOCAL,Facility,Inpatient,1,Each,,71,60.35,20.3486,71,Medica,Medical Assistance,,,,,Included in per diem rate,
SOLIFENACIN 5 MG ORAL TABLET,,37190,LOCAL,Facility,Outpatient,1,Each,,71,60.35,20.3486,71,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,35.358,49.8,,percent of total billed charges,,
SOLIFENACIN 5 MG ORAL TABLET,,37190,LOCAL,Facility,Inpatient,1,Each,,71,60.35,20.3486,71,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
SOLIFENACIN 5 MG ORAL TABLET,,37190,LOCAL,Facility,Both,1,Each,,71,60.35,20.3486,71,"Multiplan, Inc.","Multiplan, Inc.",66.74,94,,percent of total billed charges,,
SOLIFENACIN 5 MG ORAL TABLET,,37190,LOCAL,Facility,Outpatient,1,Each,,71,60.35,20.3486,71,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,63.971,90.1,,percent of total billed charges,,
SOLIFENACIN 5 MG ORAL TABLET,,37190,LOCAL,Facility,Inpatient,1,Each,,71,60.35,20.3486,71,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
SOLIFENACIN 5 MG ORAL TABLET,,37190,LOCAL,Facility,Both,1,Each,,71,60.35,20.3486,71,"Preferred One Administrative Services, INC.",PPO,70.006,98.6,,percent of total billed charges,,
SOLIFENACIN 5 MG ORAL TABLET,,37190,LOCAL,Facility,Outpatient,1,Each,,71,60.35,20.3486,71,PrimeWest Health,Minnesota Senior Health Options (MSHO),36.5295,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
SOLIFENACIN 5 MG ORAL TABLET,,37190,LOCAL,Facility,Inpatient,1,Each,,71,60.35,20.3486,71,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SOLIFENACIN 5 MG ORAL TABLET,,37190,LOCAL,Facility,Outpatient,1,Each,,71,60.35,20.3486,71,PrimeWest Health,MinnesotaCare,36.4656,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
SOLIFENACIN 5 MG ORAL TABLET,,37190,LOCAL,Facility,Inpatient,1,Each,,71,60.35,20.3486,71,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
SOLIFENACIN 5 MG ORAL TABLET,,37190,LOCAL,Facility,Both,1,Each,,71,60.35,20.3486,71,Sanford Health Plan,Sanford Health Plan,65.32,92,,percent of total billed charges,,
SOLIFENACIN 5 MG ORAL TABLET,,37190,LOCAL,Facility,Outpatient,1,Each,,71,60.35,20.3486,71,"UCare Health, Inc.",Individual & Family Plan,40.0085,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
SOLIFENACIN 5 MG ORAL TABLET,,37190,LOCAL,Facility,Inpatient,1,Each,,71,60.35,20.3486,71,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
SOLIFENACIN 5 MG ORAL TABLET,,37190,LOCAL,Facility,Outpatient,1,Each,,71,60.35,20.3486,71,"UCare Health, Inc.",Medical Assistance,35.8337,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SOLIFENACIN 5 MG ORAL TABLET,,37190,LOCAL,Facility,Inpatient,1,Each,,71,60.35,20.3486,71,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
SOLIFENACIN 5 MG ORAL TABLET,,37190,LOCAL,Facility,Outpatient,1,Each,,71,60.35,20.3486,71,"UCare Health, Inc.",Medicare Advantage,35.8337,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SOLIFENACIN 5 MG ORAL TABLET,,37190,LOCAL,Facility,Inpatient,1,Each,,71,60.35,20.3486,71,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SOLIFENACIN 5 MG ORAL TABLET,,37190,LOCAL,Facility,Outpatient,1,Each,,71,60.35,20.3486,71,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),35.8337,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SOLIFENACIN 5 MG ORAL TABLET,,37190,LOCAL,Facility,Inpatient,1,Each,,71,60.35,20.3486,71,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SOLIFENACIN 5 MG ORAL TABLET,,37190,LOCAL,Facility,Both,1,Each,,71,60.35,20.3486,71,UnitedHealthcare,Individual & Family,66.74,94,,percent of total billed charges,,
SOLIFENACIN 5 MG ORAL TABLET,,37190,LOCAL,Facility,Outpatient,1,Each,,71,60.35,20.3486,71,UnitedHealthcare,Medicare Advantage,34.79,49,,percent of total billed charges,,
SOLIFENACIN 5 MG ORAL TABLET,,37190,LOCAL,Facility,Inpatient,1,Each,,71,60.35,20.3486,71,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
SOLIFENACIN 5 MG ORAL TABLET,,37190,LOCAL,Facility,Outpatient,1,Each,,71,60.35,20.3486,71,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,34.08,48,,percent of total billed charges,,100% of DHS outpatient percentage
SOLIFENACIN 5 MG ORAL TABLET,,37190,LOCAL,Facility,Inpatient,1,Each,,71,60.35,20.3486,71,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
ESZOPICLONE 1 MG ORAL TABLET,,37285,LOCAL,Facility,Both,1,Each,,57,48.45,16.3362,57,Aetna,Commercial,52.44,92,,percent of total billed charges,,
ESZOPICLONE 1 MG ORAL TABLET,,37285,LOCAL,Facility,Outpatient,1,Each,,57,48.45,16.3362,57,Aetna,Medicare Advantage,27.93,49,,percent of total billed charges,,
ESZOPICLONE 1 MG ORAL TABLET,,37285,LOCAL,Facility,Inpatient,1,Each,,57,48.45,16.3362,57,Aetna,Medicare Advantage,,,,,Included in per diem rate,
ESZOPICLONE 1 MG ORAL TABLET,,37285,LOCAL,Facility,Both,1,Each,,57,48.45,16.3362,57,Aetna,PPO,53.01,93,,percent of total billed charges,,
ESZOPICLONE 1 MG ORAL TABLET,,37285,LOCAL,Facility,Both,1,Each,,57,48.45,16.3362,57,America's PPO,America's PPO,54.7371,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
ESZOPICLONE 1 MG ORAL TABLET,,37285,LOCAL,Facility,Both,1,Each,,57,48.45,16.3362,57,BlueCross BlueShield Minnesota, Federal Employee Program,56.088,98.4,,percent of total billed charges,,
ESZOPICLONE 1 MG ORAL TABLET,,37285,LOCAL,Facility,Both,1,Each,,57,48.45,16.3362,57,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,57,100,,percent of total billed charges,,
ESZOPICLONE 1 MG ORAL TABLET,,37285,LOCAL,Facility,Both,1,Each,,57,48.45,16.3362,57,BlueCross BlueShield Minnesota,High Value Network Plan,51.3,90,,percent of total billed charges,,
ESZOPICLONE 1 MG ORAL TABLET,,37285,LOCAL,Facility,Outpatient,1,Each,,57,48.45,16.3362,57,BlueCross BlueShield Minnesota,Medicare Advantage,27.93,49,,percent of total billed charges,,
ESZOPICLONE 1 MG ORAL TABLET,,37285,LOCAL,Facility,Inpatient,1,Each,,57,48.45,16.3362,57,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
ESZOPICLONE 1 MG ORAL TABLET,,37285,LOCAL,Facility,Both,1,Each,,57,48.45,16.3362,57,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,50.4849,88.57,,percent of total billed charges,,
ESZOPICLONE 1 MG ORAL TABLET,,37285,LOCAL,Facility,Both,1,Each,,57,48.45,16.3362,57,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,16.3362,28.66,,percent of total billed charges,,
ESZOPICLONE 1 MG ORAL TABLET,,37285,LOCAL,Facility,Outpatient,1,Each,,57,48.45,16.3362,57,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),27.93,49,,percent of total billed charges,,
ESZOPICLONE 1 MG ORAL TABLET,,37285,LOCAL,Facility,Inpatient,1,Each,,57,48.45,16.3362,57,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
ESZOPICLONE 1 MG ORAL TABLET,,37285,LOCAL,Facility,Both,1,Each,,57,48.45,16.3362,57,CorVel,Worker's Compensation,57,100,,percent of total billed charges,,
ESZOPICLONE 1 MG ORAL TABLET,,37285,LOCAL,Facility,Both,1,Each,,57,48.45,16.3362,57,First Health Group Corporation,First Health Network,55.29,97,,percent of total billed charges,,
ESZOPICLONE 1 MG ORAL TABLET,,37285,LOCAL,Facility,Both,1,Each,,57,48.45,16.3362,57,"Health Partners, Inc.",Commercial,53.922,94.6,,percent of total billed charges,,
ESZOPICLONE 1 MG ORAL TABLET,,37285,LOCAL,Facility,Outpatient,1,Each,,57,48.45,16.3362,57,"Health Partners, Inc.",Medicare Advantage,27.93,49,,percent of total billed charges,,
ESZOPICLONE 1 MG ORAL TABLET,,37285,LOCAL,Facility,Inpatient,1,Each,,57,48.45,16.3362,57,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ESZOPICLONE 1 MG ORAL TABLET,,37285,LOCAL,Facility,Both,1,Each,,57,48.45,16.3362,57,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),34.2,60,,percent of total billed charges,,
ESZOPICLONE 1 MG ORAL TABLET,,37285,LOCAL,Facility,Both,1,Each,,57,48.45,16.3362,57,"Health Partners, Inc.",State of Minnesota Advantage Program,46.455,81.5,,percent of total billed charges,,
ESZOPICLONE 1 MG ORAL TABLET,,37285,LOCAL,Facility,Both,1,Each,,57,48.45,16.3362,57,"Health Partners, Inc.",State Public Programs,28.5,50,,percent of total billed charges,,
ESZOPICLONE 1 MG ORAL TABLET,,37285,LOCAL,Facility,Both,1,Each,,57,48.45,16.3362,57,Humana Insurance Company,Commercial PPO,54.15,95,,percent of total billed charges,,
ESZOPICLONE 1 MG ORAL TABLET,,37285,LOCAL,Facility,Outpatient,1,Each,,57,48.45,16.3362,57,Humana Insurance Company,Medicare PPO,27.93,49,,percent of total billed charges,,
ESZOPICLONE 1 MG ORAL TABLET,,37285,LOCAL,Facility,Inpatient,1,Each,,57,48.45,16.3362,57,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
ESZOPICLONE 1 MG ORAL TABLET,,37285,LOCAL,Facility,Both,1,Each,,57,48.45,16.3362,57,Medica,Individual & Family,56.487,99.1,,percent of total billed charges,,
ESZOPICLONE 1 MG ORAL TABLET,,37285,LOCAL,Facility,Outpatient,1,Each,,57,48.45,16.3362,57,Medica,Medica Advantage Solution,28.386,49.8,,percent of total billed charges,,
ESZOPICLONE 1 MG ORAL TABLET,,37285,LOCAL,Facility,Inpatient,1,Each,,57,48.45,16.3362,57,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
ESZOPICLONE 1 MG ORAL TABLET,,37285,LOCAL,Facility,Outpatient,1,Each,,57,48.45,16.3362,57,Medica,Medical Assistance,25.422,44.6,,percent of total billed charges,,
ESZOPICLONE 1 MG ORAL TABLET,,37285,LOCAL,Facility,Inpatient,1,Each,,57,48.45,16.3362,57,Medica,Medical Assistance,,,,,Included in per diem rate,
ESZOPICLONE 1 MG ORAL TABLET,,37285,LOCAL,Facility,Outpatient,1,Each,,57,48.45,16.3362,57,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,28.386,49.8,,percent of total billed charges,,
ESZOPICLONE 1 MG ORAL TABLET,,37285,LOCAL,Facility,Inpatient,1,Each,,57,48.45,16.3362,57,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
ESZOPICLONE 1 MG ORAL TABLET,,37285,LOCAL,Facility,Both,1,Each,,57,48.45,16.3362,57,"Multiplan, Inc.","Multiplan, Inc.",53.58,94,,percent of total billed charges,,
ESZOPICLONE 1 MG ORAL TABLET,,37285,LOCAL,Facility,Outpatient,1,Each,,57,48.45,16.3362,57,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,51.357,90.1,,percent of total billed charges,,
ESZOPICLONE 1 MG ORAL TABLET,,37285,LOCAL,Facility,Inpatient,1,Each,,57,48.45,16.3362,57,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
ESZOPICLONE 1 MG ORAL TABLET,,37285,LOCAL,Facility,Both,1,Each,,57,48.45,16.3362,57,"Preferred One Administrative Services, INC.",PPO,56.202,98.6,,percent of total billed charges,,
ESZOPICLONE 1 MG ORAL TABLET,,37285,LOCAL,Facility,Outpatient,1,Each,,57,48.45,16.3362,57,PrimeWest Health,Minnesota Senior Health Options (MSHO),29.3265,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
ESZOPICLONE 1 MG ORAL TABLET,,37285,LOCAL,Facility,Inpatient,1,Each,,57,48.45,16.3362,57,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ESZOPICLONE 1 MG ORAL TABLET,,37285,LOCAL,Facility,Outpatient,1,Each,,57,48.45,16.3362,57,PrimeWest Health,MinnesotaCare,29.2752,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
ESZOPICLONE 1 MG ORAL TABLET,,37285,LOCAL,Facility,Inpatient,1,Each,,57,48.45,16.3362,57,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
ESZOPICLONE 1 MG ORAL TABLET,,37285,LOCAL,Facility,Both,1,Each,,57,48.45,16.3362,57,Sanford Health Plan,Sanford Health Plan,52.44,92,,percent of total billed charges,,
ESZOPICLONE 1 MG ORAL TABLET,,37285,LOCAL,Facility,Outpatient,1,Each,,57,48.45,16.3362,57,"UCare Health, Inc.",Individual & Family Plan,32.1195,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
ESZOPICLONE 1 MG ORAL TABLET,,37285,LOCAL,Facility,Inpatient,1,Each,,57,48.45,16.3362,57,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
ESZOPICLONE 1 MG ORAL TABLET,,37285,LOCAL,Facility,Outpatient,1,Each,,57,48.45,16.3362,57,"UCare Health, Inc.",Medical Assistance,28.7679,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ESZOPICLONE 1 MG ORAL TABLET,,37285,LOCAL,Facility,Inpatient,1,Each,,57,48.45,16.3362,57,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
ESZOPICLONE 1 MG ORAL TABLET,,37285,LOCAL,Facility,Outpatient,1,Each,,57,48.45,16.3362,57,"UCare Health, Inc.",Medicare Advantage,28.7679,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ESZOPICLONE 1 MG ORAL TABLET,,37285,LOCAL,Facility,Inpatient,1,Each,,57,48.45,16.3362,57,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ESZOPICLONE 1 MG ORAL TABLET,,37285,LOCAL,Facility,Outpatient,1,Each,,57,48.45,16.3362,57,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),28.7679,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ESZOPICLONE 1 MG ORAL TABLET,,37285,LOCAL,Facility,Inpatient,1,Each,,57,48.45,16.3362,57,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ESZOPICLONE 1 MG ORAL TABLET,,37285,LOCAL,Facility,Both,1,Each,,57,48.45,16.3362,57,UnitedHealthcare,Individual & Family,53.58,94,,percent of total billed charges,,
ESZOPICLONE 1 MG ORAL TABLET,,37285,LOCAL,Facility,Outpatient,1,Each,,57,48.45,16.3362,57,UnitedHealthcare,Medicare Advantage,27.93,49,,percent of total billed charges,,
ESZOPICLONE 1 MG ORAL TABLET,,37285,LOCAL,Facility,Inpatient,1,Each,,57,48.45,16.3362,57,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
ESZOPICLONE 1 MG ORAL TABLET,,37285,LOCAL,Facility,Outpatient,1,Each,,57,48.45,16.3362,57,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,27.36,48,,percent of total billed charges,,100% of DHS outpatient percentage
ESZOPICLONE 1 MG ORAL TABLET,,37285,LOCAL,Facility,Inpatient,1,Each,,57,48.45,16.3362,57,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
LUTEIN 20 MG ORAL CAP,,37680,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
LUTEIN 20 MG ORAL CAP,,37680,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
LUTEIN 20 MG ORAL CAP,,37680,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
LUTEIN 20 MG ORAL CAP,,37680,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
LUTEIN 20 MG ORAL CAP,,37680,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
LUTEIN 20 MG ORAL CAP,,37680,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
LUTEIN 20 MG ORAL CAP,,37680,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
LUTEIN 20 MG ORAL CAP,,37680,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
LUTEIN 20 MG ORAL CAP,,37680,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
LUTEIN 20 MG ORAL CAP,,37680,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
LUTEIN 20 MG ORAL CAP,,37680,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
LUTEIN 20 MG ORAL CAP,,37680,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
LUTEIN 20 MG ORAL CAP,,37680,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
LUTEIN 20 MG ORAL CAP,,37680,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
LUTEIN 20 MG ORAL CAP,,37680,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
LUTEIN 20 MG ORAL CAP,,37680,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
LUTEIN 20 MG ORAL CAP,,37680,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
LUTEIN 20 MG ORAL CAP,,37680,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
LUTEIN 20 MG ORAL CAP,,37680,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LUTEIN 20 MG ORAL CAP,,37680,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
LUTEIN 20 MG ORAL CAP,,37680,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
LUTEIN 20 MG ORAL CAP,,37680,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
LUTEIN 20 MG ORAL CAP,,37680,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
LUTEIN 20 MG ORAL CAP,,37680,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
LUTEIN 20 MG ORAL CAP,,37680,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
LUTEIN 20 MG ORAL CAP,,37680,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
LUTEIN 20 MG ORAL CAP,,37680,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
LUTEIN 20 MG ORAL CAP,,37680,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
LUTEIN 20 MG ORAL CAP,,37680,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
LUTEIN 20 MG ORAL CAP,,37680,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
LUTEIN 20 MG ORAL CAP,,37680,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
LUTEIN 20 MG ORAL CAP,,37680,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
LUTEIN 20 MG ORAL CAP,,37680,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
LUTEIN 20 MG ORAL CAP,,37680,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
LUTEIN 20 MG ORAL CAP,,37680,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
LUTEIN 20 MG ORAL CAP,,37680,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
LUTEIN 20 MG ORAL CAP,,37680,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
LUTEIN 20 MG ORAL CAP,,37680,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LUTEIN 20 MG ORAL CAP,,37680,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
LUTEIN 20 MG ORAL CAP,,37680,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
LUTEIN 20 MG ORAL CAP,,37680,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
LUTEIN 20 MG ORAL CAP,,37680,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
LUTEIN 20 MG ORAL CAP,,37680,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
LUTEIN 20 MG ORAL CAP,,37680,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LUTEIN 20 MG ORAL CAP,,37680,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
LUTEIN 20 MG ORAL CAP,,37680,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LUTEIN 20 MG ORAL CAP,,37680,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LUTEIN 20 MG ORAL CAP,,37680,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LUTEIN 20 MG ORAL CAP,,37680,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LUTEIN 20 MG ORAL CAP,,37680,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
LUTEIN 20 MG ORAL CAP,,37680,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
LUTEIN 20 MG ORAL CAP,,37680,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
LUTEIN 20 MG ORAL CAP,,37680,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
LUTEIN 20 MG ORAL CAP,,37680,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Split-Thick Autograft, Trunk, Arm, Leg; 1St 100 Sq Cm Or Less, Or 1% Of Body Area Infant/Child (Pbb)",,15100,CPT,Facility,Outpatient,,,,2472,2101.2,708.4752,2472,Aetna,Commercial,2274.24,92,,percent of total billed charges,,
"Split-Thick Autograft, Trunk, Arm, Leg; 1St 100 Sq Cm Or Less, Or 1% Of Body Area Infant/Child (Pbb)",,15100,CPT,Professional,Outpatient,,,,2489,2115.65,442.41,2489,Aetna,Commercial,2115.65,85,,percent of total billed charges,,
"Split-Thick Autograft, Trunk, Arm, Leg; 1St 100 Sq Cm Or Less, Or 1% Of Body Area Infant/Child (Pbb)",,15100,CPT,Facility,Outpatient,,,,2472,2101.2,708.4752,2472,Aetna,Medicare Advantage,1211.28,49,,percent of total billed charges,,
"Split-Thick Autograft, Trunk, Arm, Leg; 1St 100 Sq Cm Or Less, Or 1% Of Body Area Infant/Child (Pbb)",,15100,CPT,Professional,Outpatient,,,,2489,2115.65,442.41,2489,Aetna,Medicare Advantage,692.37,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Split-Thick Autograft, Trunk, Arm, Leg; 1St 100 Sq Cm Or Less, Or 1% Of Body Area Infant/Child (Pbb)",,15100,CPT,Facility,Outpatient,,,,2472,2101.2,708.4752,2472,Aetna,PPO,2298.96,93,,percent of total billed charges,,
"Split-Thick Autograft, Trunk, Arm, Leg; 1St 100 Sq Cm Or Less, Or 1% Of Body Area Infant/Child (Pbb)",,15100,CPT,Professional,Outpatient,,,,2489,2115.65,442.41,2489,Aetna,PPO,2314.77,93,,percent of total billed charges,,
"Split-Thick Autograft, Trunk, Arm, Leg; 1St 100 Sq Cm Or Less, Or 1% Of Body Area Infant/Child (Pbb)",,15100,CPT,Facility,Outpatient,,,,2472,2101.2,708.4752,2472,America's PPO,America's PPO,2373.8616,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Split-Thick Autograft, Trunk, Arm, Leg; 1St 100 Sq Cm Or Less, Or 1% Of Body Area Infant/Child (Pbb)",,15100,CPT,Professional,Outpatient,,,,2489,2115.65,442.41,2489,America's PPO,America's PPO,2126.6016,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Split-Thick Autograft, Trunk, Arm, Leg; 1St 100 Sq Cm Or Less, Or 1% Of Body Area Infant/Child (Pbb)",,15100,CPT,Facility,Outpatient,,,,2472,2101.2,708.4752,2472,BlueCross BlueShield Minnesota, Federal Employee Program,2432.448,98.4,,percent of total billed charges,,
"Split-Thick Autograft, Trunk, Arm, Leg; 1St 100 Sq Cm Or Less, Or 1% Of Body Area Infant/Child (Pbb)",,15100,CPT,Professional,Outpatient,,,,2489,2115.65,442.41,2489,BlueCross BlueShield Minnesota, Federal Employee Program,1472.23,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Split-Thick Autograft, Trunk, Arm, Leg; 1St 100 Sq Cm Or Less, Or 1% Of Body Area Infant/Child (Pbb)",,15100,CPT,Facility,Outpatient,,,,2472,2101.2,708.4752,2472,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,2472,100,,percent of total billed charges,,
"Split-Thick Autograft, Trunk, Arm, Leg; 1St 100 Sq Cm Or Less, Or 1% Of Body Area Infant/Child (Pbb)",,15100,CPT,Professional,Outpatient,,,,2489,2115.65,442.41,2489,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1495.78568,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Split-Thick Autograft, Trunk, Arm, Leg; 1St 100 Sq Cm Or Less, Or 1% Of Body Area Infant/Child (Pbb)",,15100,CPT,Facility,Outpatient,,,,2472,2101.2,708.4752,2472,BlueCross BlueShield Minnesota,High Value Network Plan,2224.8,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
"Split-Thick Autograft, Trunk, Arm, Leg; 1St 100 Sq Cm Or Less, Or 1% Of Body Area Infant/Child (Pbb)",,15100,CPT,Professional,Outpatient,,,,2489,2115.65,442.41,2489,BlueCross BlueShield Minnesota,High Value Network Plan,1495.78568,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Split-Thick Autograft, Trunk, Arm, Leg; 1St 100 Sq Cm Or Less, Or 1% Of Body Area Infant/Child (Pbb)",,15100,CPT,Facility,Outpatient,,,,2472,2101.2,708.4752,2472,BlueCross BlueShield Minnesota,Medicare Advantage,1211.28,49,,percent of total billed charges,,
"Split-Thick Autograft, Trunk, Arm, Leg; 1St 100 Sq Cm Or Less, Or 1% Of Body Area Infant/Child (Pbb)",,15100,CPT,Professional,Outpatient,,,,2489,2115.65,442.41,2489,BlueCross BlueShield Minnesota,Medicare Advantage,790.372,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Split-Thick Autograft, Trunk, Arm, Leg; 1St 100 Sq Cm Or Less, Or 1% Of Body Area Infant/Child (Pbb)",,15100,CPT,Professional,Outpatient,,,,2489,2115.65,442.41,2489,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1495.78568,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Split-Thick Autograft, Trunk, Arm, Leg; 1St 100 Sq Cm Or Less, Or 1% Of Body Area Infant/Child (Pbb)",,15100,CPT,Facility,Outpatient,,,,2472,2101.2,708.4752,2472,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,708.4752,28.66,,percent of total billed charges,,
"Split-Thick Autograft, Trunk, Arm, Leg; 1St 100 Sq Cm Or Less, Or 1% Of Body Area Infant/Child (Pbb)",,15100,CPT,Professional,Outpatient,,,,2489,2115.65,442.41,2489,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,510.78384,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Split-Thick Autograft, Trunk, Arm, Leg; 1St 100 Sq Cm Or Less, Or 1% Of Body Area Infant/Child (Pbb)",,15100,CPT,Facility,Outpatient,,,,2472,2101.2,708.4752,2472,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1211.28,49,,percent of total billed charges,,
"Split-Thick Autograft, Trunk, Arm, Leg; 1St 100 Sq Cm Or Less, Or 1% Of Body Area Infant/Child (Pbb)",,15100,CPT,Professional,Outpatient,,,,2489,2115.65,442.41,2489,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),790.372,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Split-Thick Autograft, Trunk, Arm, Leg; 1St 100 Sq Cm Or Less, Or 1% Of Body Area Infant/Child (Pbb)",,15100,CPT,Facility,Outpatient,,,,2472,2101.2,708.4752,2472,CorVel,Worker's Compensation,2472,100,,percent of total billed charges,,
"Split-Thick Autograft, Trunk, Arm, Leg; 1St 100 Sq Cm Or Less, Or 1% Of Body Area Infant/Child (Pbb)",,15100,CPT,Professional,Outpatient,,,,2489,2115.65,442.41,2489,CorVel,Worker's Compensation,1344.907967,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Split-Thick Autograft, Trunk, Arm, Leg; 1St 100 Sq Cm Or Less, Or 1% Of Body Area Infant/Child (Pbb)",,15100,CPT,Facility,Outpatient,,,,2472,2101.2,708.4752,2472,First Health Group Corporation,First Health Network,2397.84,97,,percent of total billed charges,,
"Split-Thick Autograft, Trunk, Arm, Leg; 1St 100 Sq Cm Or Less, Or 1% Of Body Area Infant/Child (Pbb)",,15100,CPT,Professional,Outpatient,,,,2489,2115.65,442.41,2489,First Health Group Corporation,First Health Network,2414.33,97,,percent of total billed charges,,
"Split-Thick Autograft, Trunk, Arm, Leg; 1St 100 Sq Cm Or Less, Or 1% Of Body Area Infant/Child (Pbb)",,15100,CPT,Facility,Outpatient,,,,2472,2101.2,708.4752,2472,"Health Partners, Inc.",Commercial,2338.512,94.6,,percent of total billed charges,,
"Split-Thick Autograft, Trunk, Arm, Leg; 1St 100 Sq Cm Or Less, Or 1% Of Body Area Infant/Child (Pbb)",,15100,CPT,Professional,Outpatient,,,,2489,2115.65,442.41,2489,"Health Partners, Inc.",Commercial,1452.5,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Split-Thick Autograft, Trunk, Arm, Leg; 1St 100 Sq Cm Or Less, Or 1% Of Body Area Infant/Child (Pbb)",,15100,CPT,Facility,Outpatient,,,,2472,2101.2,708.4752,2472,"Health Partners, Inc.",Medicare Advantage,1211.28,49,,percent of total billed charges,,
"Split-Thick Autograft, Trunk, Arm, Leg; 1St 100 Sq Cm Or Less, Or 1% Of Body Area Infant/Child (Pbb)",,15100,CPT,Professional,Outpatient,,,,2489,2115.65,442.41,2489,"Health Partners, Inc.",Medicare Advantage,790.372,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Split-Thick Autograft, Trunk, Arm, Leg; 1St 100 Sq Cm Or Less, Or 1% Of Body Area Infant/Child (Pbb)",,15100,CPT,Facility,Outpatient,,,,2472,2101.2,708.4752,2472,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1483.2,60,,percent of total billed charges,,
"Split-Thick Autograft, Trunk, Arm, Leg; 1St 100 Sq Cm Or Less, Or 1% Of Body Area Infant/Child (Pbb)",,15100,CPT,Professional,Outpatient,,,,2489,2115.65,442.41,2489,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),687.23,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Split-Thick Autograft, Trunk, Arm, Leg; 1St 100 Sq Cm Or Less, Or 1% Of Body Area Infant/Child (Pbb)",,15100,CPT,Facility,Outpatient,,,,2472,2101.2,708.4752,2472,"Health Partners, Inc.",State of Minnesota Advantage Program,2014.68,81.5,,percent of total billed charges,,
"Split-Thick Autograft, Trunk, Arm, Leg; 1St 100 Sq Cm Or Less, Or 1% Of Body Area Infant/Child (Pbb)",,15100,CPT,Professional,Outpatient,,,,2489,2115.65,442.41,2489,"Health Partners, Inc.",State of Minnesota Advantage Program,1251.32875,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Split-Thick Autograft, Trunk, Arm, Leg; 1St 100 Sq Cm Or Less, Or 1% Of Body Area Infant/Child (Pbb)",,15100,CPT,Facility,Outpatient,,,,2472,2101.2,708.4752,2472,"Health Partners, Inc.",State Public Programs,1236,50,,percent of total billed charges,,
"Split-Thick Autograft, Trunk, Arm, Leg; 1St 100 Sq Cm Or Less, Or 1% Of Body Area Infant/Child (Pbb)",,15100,CPT,Professional,Outpatient,,,,2489,2115.65,442.41,2489,"Health Partners, Inc.",State Public Programs,442.41,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Split-Thick Autograft, Trunk, Arm, Leg; 1St 100 Sq Cm Or Less, Or 1% Of Body Area Infant/Child (Pbb)",,15100,CPT,Facility,Outpatient,,,,2472,2101.2,708.4752,2472,Humana Insurance Company,Commercial PPO,2348.4,95,,percent of total billed charges,,
"Split-Thick Autograft, Trunk, Arm, Leg; 1St 100 Sq Cm Or Less, Or 1% Of Body Area Infant/Child (Pbb)",,15100,CPT,Professional,Outpatient,,,,2489,2115.65,442.41,2489,Humana Insurance Company,Commercial PPO,687.28,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Split-Thick Autograft, Trunk, Arm, Leg; 1St 100 Sq Cm Or Less, Or 1% Of Body Area Infant/Child (Pbb)",,15100,CPT,Facility,Outpatient,,,,2472,2101.2,708.4752,2472,Humana Insurance Company,Medicare PPO,1211.28,49,,percent of total billed charges,,
"Split-Thick Autograft, Trunk, Arm, Leg; 1St 100 Sq Cm Or Less, Or 1% Of Body Area Infant/Child (Pbb)",,15100,CPT,Professional,Outpatient,,,,2489,2115.65,442.41,2489,Humana Insurance Company,Medicare PPO,2489,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Split-Thick Autograft, Trunk, Arm, Leg; 1St 100 Sq Cm Or Less, Or 1% Of Body Area Infant/Child (Pbb)",,15100,CPT,Facility,Outpatient,,,,2472,2101.2,708.4752,2472,Medica,Individual & Family,2449.752,99.1,,percent of total billed charges,,
"Split-Thick Autograft, Trunk, Arm, Leg; 1St 100 Sq Cm Or Less, Or 1% Of Body Area Infant/Child (Pbb)",,15100,CPT,Professional,Outpatient,,,,2489,2115.65,442.41,2489,Medica,Individual & Family,2110.672,84.8,,percent of total billed charges,,
"Split-Thick Autograft, Trunk, Arm, Leg; 1St 100 Sq Cm Or Less, Or 1% Of Body Area Infant/Child (Pbb)",,15100,CPT,Facility,Outpatient,,,,2472,2101.2,708.4752,2472,Medica,Medica Advantage Solution,1231.056,49.8,,percent of total billed charges,,
"Split-Thick Autograft, Trunk, Arm, Leg; 1St 100 Sq Cm Or Less, Or 1% Of Body Area Infant/Child (Pbb)",,15100,CPT,Professional,Outpatient,,,,2489,2115.65,442.41,2489,Medica,Medica Advantage Solution,1239.522,49.8,,percent of total billed charges,,
"Split-Thick Autograft, Trunk, Arm, Leg; 1St 100 Sq Cm Or Less, Or 1% Of Body Area Infant/Child (Pbb)",,15100,CPT,Facility,Outpatient,,,,2472,2101.2,708.4752,2472,Medica,Medical Assistance,1102.512,44.6,,percent of total billed charges,,
"Split-Thick Autograft, Trunk, Arm, Leg; 1St 100 Sq Cm Or Less, Or 1% Of Body Area Infant/Child (Pbb)",,15100,CPT,Professional,Outpatient,,,,2489,2115.65,442.41,2489,Medica,Medical Assistance,510.78,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Split-Thick Autograft, Trunk, Arm, Leg; 1St 100 Sq Cm Or Less, Or 1% Of Body Area Infant/Child (Pbb)",,15100,CPT,Facility,Outpatient,,,,2472,2101.2,708.4752,2472,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1231.056,49.8,,percent of total billed charges,,
"Split-Thick Autograft, Trunk, Arm, Leg; 1St 100 Sq Cm Or Less, Or 1% Of Body Area Infant/Child (Pbb)",,15100,CPT,Professional,Outpatient,,,,2489,2115.65,442.41,2489,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,687.28,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Split-Thick Autograft, Trunk, Arm, Leg; 1St 100 Sq Cm Or Less, Or 1% Of Body Area Infant/Child (Pbb)",,15100,CPT,Facility,Outpatient,,,,2472,2101.2,708.4752,2472,"Multiplan, Inc.","Multiplan, Inc.",2323.68,94,,percent of total billed charges,,
"Split-Thick Autograft, Trunk, Arm, Leg; 1St 100 Sq Cm Or Less, Or 1% Of Body Area Infant/Child (Pbb)",,15100,CPT,Professional,Outpatient,,,,2489,2115.65,442.41,2489,"Multiplan, Inc.","Multiplan, Inc.",2339.66,94,,percent of total billed charges,,
"Split-Thick Autograft, Trunk, Arm, Leg; 1St 100 Sq Cm Or Less, Or 1% Of Body Area Infant/Child (Pbb)",,15100,CPT,Facility,Outpatient,,,,2472,2101.2,708.4752,2472,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,2227.272,90.1,,percent of total billed charges,,
"Split-Thick Autograft, Trunk, Arm, Leg; 1St 100 Sq Cm Or Less, Or 1% Of Body Area Infant/Child (Pbb)",,15100,CPT,Professional,Outpatient,,,,2489,2115.65,442.41,2489,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,2242.589,90.1,,percent of total billed charges,,
"Split-Thick Autograft, Trunk, Arm, Leg; 1St 100 Sq Cm Or Less, Or 1% Of Body Area Infant/Child (Pbb)",,15100,CPT,Facility,Outpatient,,,,2472,2101.2,708.4752,2472,"Preferred One Administrative Services, INC.",PPO,2437.392,98.6,,percent of total billed charges,,
"Split-Thick Autograft, Trunk, Arm, Leg; 1St 100 Sq Cm Or Less, Or 1% Of Body Area Infant/Child (Pbb)",,15100,CPT,Professional,Outpatient,,,,2489,2115.65,442.41,2489,"Preferred One Administrative Services, INC.",PPO,2454.154,98.6,,percent of total billed charges,,
"Split-Thick Autograft, Trunk, Arm, Leg; 1St 100 Sq Cm Or Less, Or 1% Of Body Area Infant/Child (Pbb)",,15100,CPT,Facility,Outpatient,,,,2472,2101.2,708.4752,2472,PrimeWest Health,Minnesota Senior Health Options (MSHO),1271.844,51.45,,percent of total billed charges,,
"Split-Thick Autograft, Trunk, Arm, Leg; 1St 100 Sq Cm Or Less, Or 1% Of Body Area Infant/Child (Pbb)",,15100,CPT,Professional,Outpatient,,,,2489,2115.65,442.41,2489,PrimeWest Health,Minnesota Senior Health Options (MSHO),790.372,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Split-Thick Autograft, Trunk, Arm, Leg; 1St 100 Sq Cm Or Less, Or 1% Of Body Area Infant/Child (Pbb)",,15100,CPT,Facility,Outpatient,,,,2472,2101.2,708.4752,2472,PrimeWest Health,MinnesotaCare,1269.6192,51.36,,percent of total billed charges,,
"Split-Thick Autograft, Trunk, Arm, Leg; 1St 100 Sq Cm Or Less, Or 1% Of Body Area Infant/Child (Pbb)",,15100,CPT,Professional,Outpatient,,,,2489,2115.65,442.41,2489,PrimeWest Health,MinnesotaCare,546.5387088,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Split-Thick Autograft, Trunk, Arm, Leg; 1St 100 Sq Cm Or Less, Or 1% Of Body Area Infant/Child (Pbb)",,15100,CPT,Facility,Outpatient,,,,2472,2101.2,708.4752,2472,Sanford Health Plan,Sanford Health Plan,2274.24,92,,percent of total billed charges,,
"Split-Thick Autograft, Trunk, Arm, Leg; 1St 100 Sq Cm Or Less, Or 1% Of Body Area Infant/Child (Pbb)",,15100,CPT,Professional,Outpatient,,,,2489,2115.65,442.41,2489,Sanford Health Plan,Sanford Health Plan,2190.32,88,,percent of total billed charges,,
"Split-Thick Autograft, Trunk, Arm, Leg; 1St 100 Sq Cm Or Less, Or 1% Of Body Area Infant/Child (Pbb)",,15100,CPT,Facility,Outpatient,,,,2472,2101.2,708.4752,2472,"UCare Health, Inc.",Individual & Family Plan,1392.972,56.35,,percent of total billed charges,,
"Split-Thick Autograft, Trunk, Arm, Leg; 1St 100 Sq Cm Or Less, Or 1% Of Body Area Infant/Child (Pbb)",,15100,CPT,Professional,Outpatient,,,,2489,2115.65,442.41,2489,"UCare Health, Inc.",Individual & Family Plan,1117.242368,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Split-Thick Autograft, Trunk, Arm, Leg; 1St 100 Sq Cm Or Less, Or 1% Of Body Area Infant/Child (Pbb)",,15100,CPT,Facility,Outpatient,,,,2472,2101.2,708.4752,2472,"UCare Health, Inc.",Medical Assistance,1247.6184,50.47,,percent of total billed charges,,
"Split-Thick Autograft, Trunk, Arm, Leg; 1St 100 Sq Cm Or Less, Or 1% Of Body Area Infant/Child (Pbb)",,15100,CPT,Professional,Outpatient,,,,2489,2115.65,442.41,2489,"UCare Health, Inc.",Medical Assistance,561.862224,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Split-Thick Autograft, Trunk, Arm, Leg; 1St 100 Sq Cm Or Less, Or 1% Of Body Area Infant/Child (Pbb)",,15100,CPT,Facility,Outpatient,,,,2472,2101.2,708.4752,2472,"UCare Health, Inc.",Medicare Advantage,1247.6184,50.47,,percent of total billed charges,,
"Split-Thick Autograft, Trunk, Arm, Leg; 1St 100 Sq Cm Or Less, Or 1% Of Body Area Infant/Child (Pbb)",,15100,CPT,Professional,Outpatient,,,,2489,2115.65,442.41,2489,"UCare Health, Inc.",Medicare Advantage,790.372,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Split-Thick Autograft, Trunk, Arm, Leg; 1St 100 Sq Cm Or Less, Or 1% Of Body Area Infant/Child (Pbb)",,15100,CPT,Facility,Outpatient,,,,2472,2101.2,708.4752,2472,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1247.6184,50.47,,percent of total billed charges,,
"Split-Thick Autograft, Trunk, Arm, Leg; 1St 100 Sq Cm Or Less, Or 1% Of Body Area Infant/Child (Pbb)",,15100,CPT,Professional,Outpatient,,,,2489,2115.65,442.41,2489,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),632.2976,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Split-Thick Autograft, Trunk, Arm, Leg; 1St 100 Sq Cm Or Less, Or 1% Of Body Area Infant/Child (Pbb)",,15100,CPT,Facility,Outpatient,,,,2472,2101.2,708.4752,2472,UnitedHealthcare,Individual & Family,2323.68,94,,percent of total billed charges,,
"Split-Thick Autograft, Trunk, Arm, Leg; 1St 100 Sq Cm Or Less, Or 1% Of Body Area Infant/Child (Pbb)",,15100,CPT,Professional,Outpatient,,,,2489,2115.65,442.41,2489,UnitedHealthcare,Individual & Family,2489,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Split-Thick Autograft, Trunk, Arm, Leg; 1St 100 Sq Cm Or Less, Or 1% Of Body Area Infant/Child (Pbb)",,15100,CPT,Facility,Outpatient,,,,2472,2101.2,708.4752,2472,UnitedHealthcare,Medicare Advantage,1211.28,49,,percent of total billed charges,,
"Split-Thick Autograft, Trunk, Arm, Leg; 1St 100 Sq Cm Or Less, Or 1% Of Body Area Infant/Child (Pbb)",,15100,CPT,Professional,Outpatient,,,,2489,2115.65,442.41,2489,UnitedHealthcare,Medicare Advantage,790.372,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Split-Thick Autograft, Trunk, Arm, Leg; 1St 100 Sq Cm Or Less, Or 1% Of Body Area Infant/Child (Pbb)",,15100,CPT,Facility,Outpatient,,,,2472,2101.2,708.4752,2472,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1186.56,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Split-Thick Autograft, Trunk, Arm, Leg; 1St 100 Sq Cm Or Less, Or 1% Of Body Area Infant/Child (Pbb)",,15100,CPT,Professional,Outpatient,,,,2489,2115.65,442.41,2489,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,510.78384,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Split-Thickness Autograft, Trunk,Arms,Legs;First 100 Sq Cm Or Less, Infant/Child (Pro Cah)",,15100,CPT,Professional,Both,,,,4961,4216.85,442.41,4961,Aetna,Commercial,4216.85,85,,percent of total billed charges,,
"Split-Thickness Autograft, Trunk,Arms,Legs;First 100 Sq Cm Or Less, Infant/Child (Pro Cah)",,15100,CPT,Professional,Both,,,,4961,4216.85,442.41,4961,Aetna,Medicare Advantage,692.37,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Split-Thickness Autograft, Trunk,Arms,Legs;First 100 Sq Cm Or Less, Infant/Child (Pro Cah)",,15100,CPT,Professional,Both,,,,4961,4216.85,442.41,4961,Aetna,PPO,4613.73,93,,percent of total billed charges,,
"Split-Thickness Autograft, Trunk,Arms,Legs;First 100 Sq Cm Or Less, Infant/Child (Pro Cah)",,15100,CPT,Professional,Both,,,,4961,4216.85,442.41,4961,America's PPO,America's PPO,4238.6784,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Split-Thickness Autograft, Trunk,Arms,Legs;First 100 Sq Cm Or Less, Infant/Child (Pro Cah)",,15100,CPT,Professional,Both,,,,4961,4216.85,442.41,4961,BlueCross BlueShield Minnesota, Federal Employee Program,1472.23,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Split-Thickness Autograft, Trunk,Arms,Legs;First 100 Sq Cm Or Less, Infant/Child (Pro Cah)",,15100,CPT,Professional,Both,,,,4961,4216.85,442.41,4961,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1495.78568,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Split-Thickness Autograft, Trunk,Arms,Legs;First 100 Sq Cm Or Less, Infant/Child (Pro Cah)",,15100,CPT,Professional,Both,,,,4961,4216.85,442.41,4961,BlueCross BlueShield Minnesota,High Value Network Plan,1495.78568,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Split-Thickness Autograft, Trunk,Arms,Legs;First 100 Sq Cm Or Less, Infant/Child (Pro Cah)",,15100,CPT,Professional,Both,,,,4961,4216.85,442.41,4961,BlueCross BlueShield Minnesota,Medicare Advantage,790.372,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Split-Thickness Autograft, Trunk,Arms,Legs;First 100 Sq Cm Or Less, Infant/Child (Pro Cah)",,15100,CPT,Professional,Both,,,,4961,4216.85,442.41,4961,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1495.78568,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Split-Thickness Autograft, Trunk,Arms,Legs;First 100 Sq Cm Or Less, Infant/Child (Pro Cah)",,15100,CPT,Professional,Both,,,,4961,4216.85,442.41,4961,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,510.78384,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Split-Thickness Autograft, Trunk,Arms,Legs;First 100 Sq Cm Or Less, Infant/Child (Pro Cah)",,15100,CPT,Professional,Both,,,,4961,4216.85,442.41,4961,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),790.372,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Split-Thickness Autograft, Trunk,Arms,Legs;First 100 Sq Cm Or Less, Infant/Child (Pro Cah)",,15100,CPT,Professional,Both,,,,4961,4216.85,442.41,4961,CorVel,Worker's Compensation,1344.907967,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Split-Thickness Autograft, Trunk,Arms,Legs;First 100 Sq Cm Or Less, Infant/Child (Pro Cah)",,15100,CPT,Professional,Both,,,,4961,4216.85,442.41,4961,First Health Group Corporation,First Health Network,4812.17,97,,percent of total billed charges,,
"Split-Thickness Autograft, Trunk,Arms,Legs;First 100 Sq Cm Or Less, Infant/Child (Pro Cah)",,15100,CPT,Professional,Both,,,,4961,4216.85,442.41,4961,"Health Partners, Inc.",Commercial,1452.5,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Split-Thickness Autograft, Trunk,Arms,Legs;First 100 Sq Cm Or Less, Infant/Child (Pro Cah)",,15100,CPT,Professional,Both,,,,4961,4216.85,442.41,4961,"Health Partners, Inc.",Medicare Advantage,790.372,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Split-Thickness Autograft, Trunk,Arms,Legs;First 100 Sq Cm Or Less, Infant/Child (Pro Cah)",,15100,CPT,Professional,Both,,,,4961,4216.85,442.41,4961,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),687.23,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Split-Thickness Autograft, Trunk,Arms,Legs;First 100 Sq Cm Or Less, Infant/Child (Pro Cah)",,15100,CPT,Professional,Both,,,,4961,4216.85,442.41,4961,"Health Partners, Inc.",State of Minnesota Advantage Program,1251.32875,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Split-Thickness Autograft, Trunk,Arms,Legs;First 100 Sq Cm Or Less, Infant/Child (Pro Cah)",,15100,CPT,Professional,Both,,,,4961,4216.85,442.41,4961,"Health Partners, Inc.",State Public Programs,442.41,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Split-Thickness Autograft, Trunk,Arms,Legs;First 100 Sq Cm Or Less, Infant/Child (Pro Cah)",,15100,CPT,Professional,Both,,,,4961,4216.85,442.41,4961,Humana Insurance Company,Commercial PPO,687.28,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Split-Thickness Autograft, Trunk,Arms,Legs;First 100 Sq Cm Or Less, Infant/Child (Pro Cah)",,15100,CPT,Professional,Both,,,,4961,4216.85,442.41,4961,Humana Insurance Company,Medicare PPO,4961,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Split-Thickness Autograft, Trunk,Arms,Legs;First 100 Sq Cm Or Less, Infant/Child (Pro Cah)",,15100,CPT,Professional,Both,,,,4961,4216.85,442.41,4961,Medica,Individual & Family,4206.928,84.8,,percent of total billed charges,,
"Split-Thickness Autograft, Trunk,Arms,Legs;First 100 Sq Cm Or Less, Infant/Child (Pro Cah)",,15100,CPT,Professional,Both,,,,4961,4216.85,442.41,4961,Medica,Medica Advantage Solution,2470.578,49.8,,percent of total billed charges,,
"Split-Thickness Autograft, Trunk,Arms,Legs;First 100 Sq Cm Or Less, Infant/Child (Pro Cah)",,15100,CPT,Professional,Both,,,,4961,4216.85,442.41,4961,Medica,Medical Assistance,510.78,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Split-Thickness Autograft, Trunk,Arms,Legs;First 100 Sq Cm Or Less, Infant/Child (Pro Cah)",,15100,CPT,Professional,Both,,,,4961,4216.85,442.41,4961,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,687.28,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Split-Thickness Autograft, Trunk,Arms,Legs;First 100 Sq Cm Or Less, Infant/Child (Pro Cah)",,15100,CPT,Professional,Both,,,,4961,4216.85,442.41,4961,"Multiplan, Inc.","Multiplan, Inc.",4663.34,94,,percent of total billed charges,,
"Split-Thickness Autograft, Trunk,Arms,Legs;First 100 Sq Cm Or Less, Infant/Child (Pro Cah)",,15100,CPT,Professional,Both,,,,4961,4216.85,442.41,4961,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4469.861,90.1,,percent of total billed charges,,
"Split-Thickness Autograft, Trunk,Arms,Legs;First 100 Sq Cm Or Less, Infant/Child (Pro Cah)",,15100,CPT,Professional,Both,,,,4961,4216.85,442.41,4961,"Preferred One Administrative Services, INC.",PPO,4891.546,98.6,,percent of total billed charges,,
"Split-Thickness Autograft, Trunk,Arms,Legs;First 100 Sq Cm Or Less, Infant/Child (Pro Cah)",,15100,CPT,Professional,Both,,,,4961,4216.85,442.41,4961,PrimeWest Health,Minnesota Senior Health Options (MSHO),790.372,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Split-Thickness Autograft, Trunk,Arms,Legs;First 100 Sq Cm Or Less, Infant/Child (Pro Cah)",,15100,CPT,Professional,Both,,,,4961,4216.85,442.41,4961,PrimeWest Health,MinnesotaCare,546.5387088,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Split-Thickness Autograft, Trunk,Arms,Legs;First 100 Sq Cm Or Less, Infant/Child (Pro Cah)",,15100,CPT,Professional,Both,,,,4961,4216.85,442.41,4961,Sanford Health Plan,Sanford Health Plan,4365.68,88,,percent of total billed charges,,
"Split-Thickness Autograft, Trunk,Arms,Legs;First 100 Sq Cm Or Less, Infant/Child (Pro Cah)",,15100,CPT,Professional,Both,,,,4961,4216.85,442.41,4961,"UCare Health, Inc.",Individual & Family Plan,1117.242368,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Split-Thickness Autograft, Trunk,Arms,Legs;First 100 Sq Cm Or Less, Infant/Child (Pro Cah)",,15100,CPT,Professional,Both,,,,4961,4216.85,442.41,4961,"UCare Health, Inc.",Medical Assistance,561.862224,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Split-Thickness Autograft, Trunk,Arms,Legs;First 100 Sq Cm Or Less, Infant/Child (Pro Cah)",,15100,CPT,Professional,Both,,,,4961,4216.85,442.41,4961,"UCare Health, Inc.",Medicare Advantage,790.372,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Split-Thickness Autograft, Trunk,Arms,Legs;First 100 Sq Cm Or Less, Infant/Child (Pro Cah)",,15100,CPT,Professional,Both,,,,4961,4216.85,442.41,4961,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),632.2976,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Split-Thickness Autograft, Trunk,Arms,Legs;First 100 Sq Cm Or Less, Infant/Child (Pro Cah)",,15100,CPT,Professional,Both,,,,4961,4216.85,442.41,4961,UnitedHealthcare,Individual & Family,4961,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Split-Thickness Autograft, Trunk,Arms,Legs;First 100 Sq Cm Or Less, Infant/Child (Pro Cah)",,15100,CPT,Professional,Both,,,,4961,4216.85,442.41,4961,UnitedHealthcare,Medicare Advantage,790.372,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Split-Thickness Autograft, Trunk,Arms,Legs;First 100 Sq Cm Or Less, Infant/Child (Pro Cah)",,15100,CPT,Professional,Both,,,,4961,4216.85,442.41,4961,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,510.78384,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
ESOMEPRAZOLE SODIUM 40 MG IV SOLR,,38078,LOCAL,Facility,Both,1,Each,,189,160.65,54.1674,189,Aetna,Commercial,173.88,92,,percent of total billed charges,,
ESOMEPRAZOLE SODIUM 40 MG IV SOLR,,38078,LOCAL,Facility,Both,1,Each,,189,160.65,54.1674,189,Aetna,Commercial,173.88,92,,percent of total billed charges,,
ESOMEPRAZOLE SODIUM 40 MG IV SOLR,,38078,LOCAL,Facility,Outpatient,1,Each,,189,160.65,54.1674,189,Aetna,Medicare Advantage,92.61,49,,percent of total billed charges,,
ESOMEPRAZOLE SODIUM 40 MG IV SOLR,,38078,LOCAL,Facility,Outpatient,1,Each,,189,160.65,54.1674,189,Aetna,Medicare Advantage,92.61,49,,percent of total billed charges,,
ESOMEPRAZOLE SODIUM 40 MG IV SOLR,,38078,LOCAL,Facility,Inpatient,1,Each,,189,160.65,54.1674,189,Aetna,Medicare Advantage,,,,,Included in per diem rate,
ESOMEPRAZOLE SODIUM 40 MG IV SOLR,,38078,LOCAL,Facility,Inpatient,1,Each,,189,160.65,54.1674,189,Aetna,Medicare Advantage,,,,,Included in per diem rate,
ESOMEPRAZOLE SODIUM 40 MG IV SOLR,,38078,LOCAL,Facility,Both,1,Each,,189,160.65,54.1674,189,Aetna,PPO,175.77,93,,percent of total billed charges,,
ESOMEPRAZOLE SODIUM 40 MG IV SOLR,,38078,LOCAL,Facility,Both,1,Each,,189,160.65,54.1674,189,Aetna,PPO,175.77,93,,percent of total billed charges,,
ESOMEPRAZOLE SODIUM 40 MG IV SOLR,,38078,LOCAL,Facility,Both,1,Each,,189,160.65,54.1674,189,America's PPO,America's PPO,181.4967,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
ESOMEPRAZOLE SODIUM 40 MG IV SOLR,,38078,LOCAL,Facility,Both,1,Each,,189,160.65,54.1674,189,America's PPO,America's PPO,181.4967,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
ESOMEPRAZOLE SODIUM 40 MG IV SOLR,,38078,LOCAL,Facility,Both,1,Each,,189,160.65,54.1674,189,BlueCross BlueShield Minnesota, Federal Employee Program,185.976,98.4,,percent of total billed charges,,
ESOMEPRAZOLE SODIUM 40 MG IV SOLR,,38078,LOCAL,Facility,Both,1,Each,,189,160.65,54.1674,189,BlueCross BlueShield Minnesota, Federal Employee Program,185.976,98.4,,percent of total billed charges,,
ESOMEPRAZOLE SODIUM 40 MG IV SOLR,,38078,LOCAL,Facility,Both,1,Each,,189,160.65,54.1674,189,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,189,100,,percent of total billed charges,,
ESOMEPRAZOLE SODIUM 40 MG IV SOLR,,38078,LOCAL,Facility,Both,1,Each,,189,160.65,54.1674,189,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,189,100,,percent of total billed charges,,
ESOMEPRAZOLE SODIUM 40 MG IV SOLR,,38078,LOCAL,Facility,Both,1,Each,,189,160.65,54.1674,189,BlueCross BlueShield Minnesota,High Value Network Plan,170.1,90,,percent of total billed charges,,
ESOMEPRAZOLE SODIUM 40 MG IV SOLR,,38078,LOCAL,Facility,Both,1,Each,,189,160.65,54.1674,189,BlueCross BlueShield Minnesota,High Value Network Plan,170.1,90,,percent of total billed charges,,
ESOMEPRAZOLE SODIUM 40 MG IV SOLR,,38078,LOCAL,Facility,Outpatient,1,Each,,189,160.65,54.1674,189,BlueCross BlueShield Minnesota,Medicare Advantage,92.61,49,,percent of total billed charges,,
ESOMEPRAZOLE SODIUM 40 MG IV SOLR,,38078,LOCAL,Facility,Outpatient,1,Each,,189,160.65,54.1674,189,BlueCross BlueShield Minnesota,Medicare Advantage,92.61,49,,percent of total billed charges,,
ESOMEPRAZOLE SODIUM 40 MG IV SOLR,,38078,LOCAL,Facility,Inpatient,1,Each,,189,160.65,54.1674,189,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
ESOMEPRAZOLE SODIUM 40 MG IV SOLR,,38078,LOCAL,Facility,Inpatient,1,Each,,189,160.65,54.1674,189,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
ESOMEPRAZOLE SODIUM 40 MG IV SOLR,,38078,LOCAL,Facility,Both,1,Each,,189,160.65,54.1674,189,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,167.3973,88.57,,percent of total billed charges,,
ESOMEPRAZOLE SODIUM 40 MG IV SOLR,,38078,LOCAL,Facility,Both,1,Each,,189,160.65,54.1674,189,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,167.3973,88.57,,percent of total billed charges,,
ESOMEPRAZOLE SODIUM 40 MG IV SOLR,,38078,LOCAL,Facility,Both,1,Each,,189,160.65,54.1674,189,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,54.1674,28.66,,percent of total billed charges,,
ESOMEPRAZOLE SODIUM 40 MG IV SOLR,,38078,LOCAL,Facility,Both,1,Each,,189,160.65,54.1674,189,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,54.1674,28.66,,percent of total billed charges,,
ESOMEPRAZOLE SODIUM 40 MG IV SOLR,,38078,LOCAL,Facility,Outpatient,1,Each,,189,160.65,54.1674,189,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),92.61,49,,percent of total billed charges,,
ESOMEPRAZOLE SODIUM 40 MG IV SOLR,,38078,LOCAL,Facility,Outpatient,1,Each,,189,160.65,54.1674,189,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),92.61,49,,percent of total billed charges,,
ESOMEPRAZOLE SODIUM 40 MG IV SOLR,,38078,LOCAL,Facility,Inpatient,1,Each,,189,160.65,54.1674,189,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
ESOMEPRAZOLE SODIUM 40 MG IV SOLR,,38078,LOCAL,Facility,Inpatient,1,Each,,189,160.65,54.1674,189,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
ESOMEPRAZOLE SODIUM 40 MG IV SOLR,,38078,LOCAL,Facility,Both,1,Each,,189,160.65,54.1674,189,CorVel,Worker's Compensation,189,100,,percent of total billed charges,,
ESOMEPRAZOLE SODIUM 40 MG IV SOLR,,38078,LOCAL,Facility,Both,1,Each,,189,160.65,54.1674,189,CorVel,Worker's Compensation,189,100,,percent of total billed charges,,
ESOMEPRAZOLE SODIUM 40 MG IV SOLR,,38078,LOCAL,Facility,Both,1,Each,,189,160.65,54.1674,189,First Health Group Corporation,First Health Network,183.33,97,,percent of total billed charges,,
ESOMEPRAZOLE SODIUM 40 MG IV SOLR,,38078,LOCAL,Facility,Both,1,Each,,189,160.65,54.1674,189,First Health Group Corporation,First Health Network,183.33,97,,percent of total billed charges,,
ESOMEPRAZOLE SODIUM 40 MG IV SOLR,,38078,LOCAL,Facility,Both,1,Each,,189,160.65,54.1674,189,"Health Partners, Inc.",Commercial,178.794,94.6,,percent of total billed charges,,
ESOMEPRAZOLE SODIUM 40 MG IV SOLR,,38078,LOCAL,Facility,Both,1,Each,,189,160.65,54.1674,189,"Health Partners, Inc.",Commercial,178.794,94.6,,percent of total billed charges,,
ESOMEPRAZOLE SODIUM 40 MG IV SOLR,,38078,LOCAL,Facility,Outpatient,1,Each,,189,160.65,54.1674,189,"Health Partners, Inc.",Medicare Advantage,92.61,49,,percent of total billed charges,,
ESOMEPRAZOLE SODIUM 40 MG IV SOLR,,38078,LOCAL,Facility,Outpatient,1,Each,,189,160.65,54.1674,189,"Health Partners, Inc.",Medicare Advantage,92.61,49,,percent of total billed charges,,
ESOMEPRAZOLE SODIUM 40 MG IV SOLR,,38078,LOCAL,Facility,Inpatient,1,Each,,189,160.65,54.1674,189,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ESOMEPRAZOLE SODIUM 40 MG IV SOLR,,38078,LOCAL,Facility,Inpatient,1,Each,,189,160.65,54.1674,189,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ESOMEPRAZOLE SODIUM 40 MG IV SOLR,,38078,LOCAL,Facility,Both,1,Each,,189,160.65,54.1674,189,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),113.4,60,,percent of total billed charges,,
ESOMEPRAZOLE SODIUM 40 MG IV SOLR,,38078,LOCAL,Facility,Both,1,Each,,189,160.65,54.1674,189,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),113.4,60,,percent of total billed charges,,
ESOMEPRAZOLE SODIUM 40 MG IV SOLR,,38078,LOCAL,Facility,Both,1,Each,,189,160.65,54.1674,189,"Health Partners, Inc.",State of Minnesota Advantage Program,154.035,81.5,,percent of total billed charges,,
ESOMEPRAZOLE SODIUM 40 MG IV SOLR,,38078,LOCAL,Facility,Both,1,Each,,189,160.65,54.1674,189,"Health Partners, Inc.",State of Minnesota Advantage Program,154.035,81.5,,percent of total billed charges,,
ESOMEPRAZOLE SODIUM 40 MG IV SOLR,,38078,LOCAL,Facility,Both,1,Each,,189,160.65,54.1674,189,"Health Partners, Inc.",State Public Programs,94.5,50,,percent of total billed charges,,
ESOMEPRAZOLE SODIUM 40 MG IV SOLR,,38078,LOCAL,Facility,Both,1,Each,,189,160.65,54.1674,189,"Health Partners, Inc.",State Public Programs,94.5,50,,percent of total billed charges,,
ESOMEPRAZOLE SODIUM 40 MG IV SOLR,,38078,LOCAL,Facility,Both,1,Each,,189,160.65,54.1674,189,Humana Insurance Company,Commercial PPO,179.55,95,,percent of total billed charges,,
ESOMEPRAZOLE SODIUM 40 MG IV SOLR,,38078,LOCAL,Facility,Both,1,Each,,189,160.65,54.1674,189,Humana Insurance Company,Commercial PPO,179.55,95,,percent of total billed charges,,
ESOMEPRAZOLE SODIUM 40 MG IV SOLR,,38078,LOCAL,Facility,Outpatient,1,Each,,189,160.65,54.1674,189,Humana Insurance Company,Medicare PPO,92.61,49,,percent of total billed charges,,
ESOMEPRAZOLE SODIUM 40 MG IV SOLR,,38078,LOCAL,Facility,Outpatient,1,Each,,189,160.65,54.1674,189,Humana Insurance Company,Medicare PPO,92.61,49,,percent of total billed charges,,
ESOMEPRAZOLE SODIUM 40 MG IV SOLR,,38078,LOCAL,Facility,Inpatient,1,Each,,189,160.65,54.1674,189,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
ESOMEPRAZOLE SODIUM 40 MG IV SOLR,,38078,LOCAL,Facility,Inpatient,1,Each,,189,160.65,54.1674,189,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
ESOMEPRAZOLE SODIUM 40 MG IV SOLR,,38078,LOCAL,Facility,Both,1,Each,,189,160.65,54.1674,189,Medica,Individual & Family,187.299,99.1,,percent of total billed charges,,
ESOMEPRAZOLE SODIUM 40 MG IV SOLR,,38078,LOCAL,Facility,Both,1,Each,,189,160.65,54.1674,189,Medica,Individual & Family,187.299,99.1,,percent of total billed charges,,
ESOMEPRAZOLE SODIUM 40 MG IV SOLR,,38078,LOCAL,Facility,Outpatient,1,Each,,189,160.65,54.1674,189,Medica,Medica Advantage Solution,94.122,49.8,,percent of total billed charges,,
ESOMEPRAZOLE SODIUM 40 MG IV SOLR,,38078,LOCAL,Facility,Outpatient,1,Each,,189,160.65,54.1674,189,Medica,Medica Advantage Solution,94.122,49.8,,percent of total billed charges,,
ESOMEPRAZOLE SODIUM 40 MG IV SOLR,,38078,LOCAL,Facility,Inpatient,1,Each,,189,160.65,54.1674,189,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
ESOMEPRAZOLE SODIUM 40 MG IV SOLR,,38078,LOCAL,Facility,Inpatient,1,Each,,189,160.65,54.1674,189,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
ESOMEPRAZOLE SODIUM 40 MG IV SOLR,,38078,LOCAL,Facility,Outpatient,1,Each,,189,160.65,54.1674,189,Medica,Medical Assistance,84.294,44.6,,percent of total billed charges,,
ESOMEPRAZOLE SODIUM 40 MG IV SOLR,,38078,LOCAL,Facility,Outpatient,1,Each,,189,160.65,54.1674,189,Medica,Medical Assistance,84.294,44.6,,percent of total billed charges,,
ESOMEPRAZOLE SODIUM 40 MG IV SOLR,,38078,LOCAL,Facility,Inpatient,1,Each,,189,160.65,54.1674,189,Medica,Medical Assistance,,,,,Included in per diem rate,
ESOMEPRAZOLE SODIUM 40 MG IV SOLR,,38078,LOCAL,Facility,Inpatient,1,Each,,189,160.65,54.1674,189,Medica,Medical Assistance,,,,,Included in per diem rate,
ESOMEPRAZOLE SODIUM 40 MG IV SOLR,,38078,LOCAL,Facility,Outpatient,1,Each,,189,160.65,54.1674,189,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,94.122,49.8,,percent of total billed charges,,
ESOMEPRAZOLE SODIUM 40 MG IV SOLR,,38078,LOCAL,Facility,Outpatient,1,Each,,189,160.65,54.1674,189,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,94.122,49.8,,percent of total billed charges,,
ESOMEPRAZOLE SODIUM 40 MG IV SOLR,,38078,LOCAL,Facility,Inpatient,1,Each,,189,160.65,54.1674,189,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
ESOMEPRAZOLE SODIUM 40 MG IV SOLR,,38078,LOCAL,Facility,Inpatient,1,Each,,189,160.65,54.1674,189,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
ESOMEPRAZOLE SODIUM 40 MG IV SOLR,,38078,LOCAL,Facility,Both,1,Each,,189,160.65,54.1674,189,"Multiplan, Inc.","Multiplan, Inc.",177.66,94,,percent of total billed charges,,
ESOMEPRAZOLE SODIUM 40 MG IV SOLR,,38078,LOCAL,Facility,Both,1,Each,,189,160.65,54.1674,189,"Multiplan, Inc.","Multiplan, Inc.",177.66,94,,percent of total billed charges,,
ESOMEPRAZOLE SODIUM 40 MG IV SOLR,,38078,LOCAL,Facility,Outpatient,1,Each,,189,160.65,54.1674,189,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,170.289,90.1,,percent of total billed charges,,
ESOMEPRAZOLE SODIUM 40 MG IV SOLR,,38078,LOCAL,Facility,Outpatient,1,Each,,189,160.65,54.1674,189,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,170.289,90.1,,percent of total billed charges,,
ESOMEPRAZOLE SODIUM 40 MG IV SOLR,,38078,LOCAL,Facility,Inpatient,1,Each,,189,160.65,54.1674,189,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
ESOMEPRAZOLE SODIUM 40 MG IV SOLR,,38078,LOCAL,Facility,Inpatient,1,Each,,189,160.65,54.1674,189,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
ESOMEPRAZOLE SODIUM 40 MG IV SOLR,,38078,LOCAL,Facility,Both,1,Each,,189,160.65,54.1674,189,"Preferred One Administrative Services, INC.",PPO,186.354,98.6,,percent of total billed charges,,
ESOMEPRAZOLE SODIUM 40 MG IV SOLR,,38078,LOCAL,Facility,Both,1,Each,,189,160.65,54.1674,189,"Preferred One Administrative Services, INC.",PPO,186.354,98.6,,percent of total billed charges,,
ESOMEPRAZOLE SODIUM 40 MG IV SOLR,,38078,LOCAL,Facility,Outpatient,1,Each,,189,160.65,54.1674,189,PrimeWest Health,Minnesota Senior Health Options (MSHO),97.2405,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
ESOMEPRAZOLE SODIUM 40 MG IV SOLR,,38078,LOCAL,Facility,Outpatient,1,Each,,189,160.65,54.1674,189,PrimeWest Health,Minnesota Senior Health Options (MSHO),97.2405,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
ESOMEPRAZOLE SODIUM 40 MG IV SOLR,,38078,LOCAL,Facility,Inpatient,1,Each,,189,160.65,54.1674,189,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ESOMEPRAZOLE SODIUM 40 MG IV SOLR,,38078,LOCAL,Facility,Inpatient,1,Each,,189,160.65,54.1674,189,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ESOMEPRAZOLE SODIUM 40 MG IV SOLR,,38078,LOCAL,Facility,Outpatient,1,Each,,189,160.65,54.1674,189,PrimeWest Health,MinnesotaCare,97.0704,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
ESOMEPRAZOLE SODIUM 40 MG IV SOLR,,38078,LOCAL,Facility,Outpatient,1,Each,,189,160.65,54.1674,189,PrimeWest Health,MinnesotaCare,97.0704,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
ESOMEPRAZOLE SODIUM 40 MG IV SOLR,,38078,LOCAL,Facility,Inpatient,1,Each,,189,160.65,54.1674,189,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
ESOMEPRAZOLE SODIUM 40 MG IV SOLR,,38078,LOCAL,Facility,Inpatient,1,Each,,189,160.65,54.1674,189,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
ESOMEPRAZOLE SODIUM 40 MG IV SOLR,,38078,LOCAL,Facility,Both,1,Each,,189,160.65,54.1674,189,Sanford Health Plan,Sanford Health Plan,173.88,92,,percent of total billed charges,,
ESOMEPRAZOLE SODIUM 40 MG IV SOLR,,38078,LOCAL,Facility,Both,1,Each,,189,160.65,54.1674,189,Sanford Health Plan,Sanford Health Plan,173.88,92,,percent of total billed charges,,
ESOMEPRAZOLE SODIUM 40 MG IV SOLR,,38078,LOCAL,Facility,Outpatient,1,Each,,189,160.65,54.1674,189,"UCare Health, Inc.",Individual & Family Plan,106.5015,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
ESOMEPRAZOLE SODIUM 40 MG IV SOLR,,38078,LOCAL,Facility,Outpatient,1,Each,,189,160.65,54.1674,189,"UCare Health, Inc.",Individual & Family Plan,106.5015,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
ESOMEPRAZOLE SODIUM 40 MG IV SOLR,,38078,LOCAL,Facility,Inpatient,1,Each,,189,160.65,54.1674,189,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
ESOMEPRAZOLE SODIUM 40 MG IV SOLR,,38078,LOCAL,Facility,Inpatient,1,Each,,189,160.65,54.1674,189,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
ESOMEPRAZOLE SODIUM 40 MG IV SOLR,,38078,LOCAL,Facility,Outpatient,1,Each,,189,160.65,54.1674,189,"UCare Health, Inc.",Medical Assistance,95.3883,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ESOMEPRAZOLE SODIUM 40 MG IV SOLR,,38078,LOCAL,Facility,Outpatient,1,Each,,189,160.65,54.1674,189,"UCare Health, Inc.",Medical Assistance,95.3883,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ESOMEPRAZOLE SODIUM 40 MG IV SOLR,,38078,LOCAL,Facility,Inpatient,1,Each,,189,160.65,54.1674,189,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
ESOMEPRAZOLE SODIUM 40 MG IV SOLR,,38078,LOCAL,Facility,Inpatient,1,Each,,189,160.65,54.1674,189,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
ESOMEPRAZOLE SODIUM 40 MG IV SOLR,,38078,LOCAL,Facility,Outpatient,1,Each,,189,160.65,54.1674,189,"UCare Health, Inc.",Medicare Advantage,95.3883,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ESOMEPRAZOLE SODIUM 40 MG IV SOLR,,38078,LOCAL,Facility,Outpatient,1,Each,,189,160.65,54.1674,189,"UCare Health, Inc.",Medicare Advantage,95.3883,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ESOMEPRAZOLE SODIUM 40 MG IV SOLR,,38078,LOCAL,Facility,Inpatient,1,Each,,189,160.65,54.1674,189,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ESOMEPRAZOLE SODIUM 40 MG IV SOLR,,38078,LOCAL,Facility,Inpatient,1,Each,,189,160.65,54.1674,189,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ESOMEPRAZOLE SODIUM 40 MG IV SOLR,,38078,LOCAL,Facility,Outpatient,1,Each,,189,160.65,54.1674,189,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),95.3883,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ESOMEPRAZOLE SODIUM 40 MG IV SOLR,,38078,LOCAL,Facility,Outpatient,1,Each,,189,160.65,54.1674,189,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),95.3883,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ESOMEPRAZOLE SODIUM 40 MG IV SOLR,,38078,LOCAL,Facility,Inpatient,1,Each,,189,160.65,54.1674,189,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ESOMEPRAZOLE SODIUM 40 MG IV SOLR,,38078,LOCAL,Facility,Inpatient,1,Each,,189,160.65,54.1674,189,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ESOMEPRAZOLE SODIUM 40 MG IV SOLR,,38078,LOCAL,Facility,Both,1,Each,,189,160.65,54.1674,189,UnitedHealthcare,Individual & Family,177.66,94,,percent of total billed charges,,
ESOMEPRAZOLE SODIUM 40 MG IV SOLR,,38078,LOCAL,Facility,Both,1,Each,,189,160.65,54.1674,189,UnitedHealthcare,Individual & Family,177.66,94,,percent of total billed charges,,
ESOMEPRAZOLE SODIUM 40 MG IV SOLR,,38078,LOCAL,Facility,Outpatient,1,Each,,189,160.65,54.1674,189,UnitedHealthcare,Medicare Advantage,92.61,49,,percent of total billed charges,,
ESOMEPRAZOLE SODIUM 40 MG IV SOLR,,38078,LOCAL,Facility,Outpatient,1,Each,,189,160.65,54.1674,189,UnitedHealthcare,Medicare Advantage,92.61,49,,percent of total billed charges,,
ESOMEPRAZOLE SODIUM 40 MG IV SOLR,,38078,LOCAL,Facility,Inpatient,1,Each,,189,160.65,54.1674,189,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
ESOMEPRAZOLE SODIUM 40 MG IV SOLR,,38078,LOCAL,Facility,Inpatient,1,Each,,189,160.65,54.1674,189,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
ESOMEPRAZOLE SODIUM 40 MG IV SOLR,,38078,LOCAL,Facility,Outpatient,1,Each,,189,160.65,54.1674,189,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,90.72,48,,percent of total billed charges,,100% of DHS outpatient percentage
ESOMEPRAZOLE SODIUM 40 MG IV SOLR,,38078,LOCAL,Facility,Outpatient,1,Each,,189,160.65,54.1674,189,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,90.72,48,,percent of total billed charges,,100% of DHS outpatient percentage
ESOMEPRAZOLE SODIUM 40 MG IV SOLR,,38078,LOCAL,Facility,Inpatient,1,Each,,189,160.65,54.1674,189,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
ESOMEPRAZOLE SODIUM 40 MG IV SOLR,,38078,LOCAL,Facility,Inpatient,1,Each,,189,160.65,54.1674,189,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
FENTANYL 12 MCG/HR TD PT72,,38326,LOCAL,Facility,Both,1,Each,,20,17,5.732,20,Aetna,Commercial,18.4,92,,percent of total billed charges,,
FENTANYL 12 MCG/HR TD PT72,,38326,LOCAL,Facility,Outpatient,1,Each,,20,17,5.732,20,Aetna,Medicare Advantage,9.8,49,,percent of total billed charges,,
FENTANYL 12 MCG/HR TD PT72,,38326,LOCAL,Facility,Inpatient,1,Each,,20,17,5.732,20,Aetna,Medicare Advantage,,,,,Included in per diem rate,
FENTANYL 12 MCG/HR TD PT72,,38326,LOCAL,Facility,Both,1,Each,,20,17,5.732,20,Aetna,PPO,18.6,93,,percent of total billed charges,,
FENTANYL 12 MCG/HR TD PT72,,38326,LOCAL,Facility,Both,1,Each,,20,17,5.732,20,America's PPO,America's PPO,19.206,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
FENTANYL 12 MCG/HR TD PT72,,38326,LOCAL,Facility,Both,1,Each,,20,17,5.732,20,BlueCross BlueShield Minnesota, Federal Employee Program,19.68,98.4,,percent of total billed charges,,
FENTANYL 12 MCG/HR TD PT72,,38326,LOCAL,Facility,Both,1,Each,,20,17,5.732,20,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,20,100,,percent of total billed charges,,
FENTANYL 12 MCG/HR TD PT72,,38326,LOCAL,Facility,Both,1,Each,,20,17,5.732,20,BlueCross BlueShield Minnesota,High Value Network Plan,18,90,,percent of total billed charges,,
FENTANYL 12 MCG/HR TD PT72,,38326,LOCAL,Facility,Outpatient,1,Each,,20,17,5.732,20,BlueCross BlueShield Minnesota,Medicare Advantage,9.8,49,,percent of total billed charges,,
FENTANYL 12 MCG/HR TD PT72,,38326,LOCAL,Facility,Inpatient,1,Each,,20,17,5.732,20,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
FENTANYL 12 MCG/HR TD PT72,,38326,LOCAL,Facility,Both,1,Each,,20,17,5.732,20,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,17.714,88.57,,percent of total billed charges,,
FENTANYL 12 MCG/HR TD PT72,,38326,LOCAL,Facility,Both,1,Each,,20,17,5.732,20,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,5.732,28.66,,percent of total billed charges,,
FENTANYL 12 MCG/HR TD PT72,,38326,LOCAL,Facility,Outpatient,1,Each,,20,17,5.732,20,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),9.8,49,,percent of total billed charges,,
FENTANYL 12 MCG/HR TD PT72,,38326,LOCAL,Facility,Inpatient,1,Each,,20,17,5.732,20,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
FENTANYL 12 MCG/HR TD PT72,,38326,LOCAL,Facility,Both,1,Each,,20,17,5.732,20,CorVel,Worker's Compensation,20,100,,percent of total billed charges,,
FENTANYL 12 MCG/HR TD PT72,,38326,LOCAL,Facility,Both,1,Each,,20,17,5.732,20,First Health Group Corporation,First Health Network,19.4,97,,percent of total billed charges,,
FENTANYL 12 MCG/HR TD PT72,,38326,LOCAL,Facility,Both,1,Each,,20,17,5.732,20,"Health Partners, Inc.",Commercial,18.92,94.6,,percent of total billed charges,,
FENTANYL 12 MCG/HR TD PT72,,38326,LOCAL,Facility,Outpatient,1,Each,,20,17,5.732,20,"Health Partners, Inc.",Medicare Advantage,9.8,49,,percent of total billed charges,,
FENTANYL 12 MCG/HR TD PT72,,38326,LOCAL,Facility,Inpatient,1,Each,,20,17,5.732,20,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
FENTANYL 12 MCG/HR TD PT72,,38326,LOCAL,Facility,Both,1,Each,,20,17,5.732,20,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),12,60,,percent of total billed charges,,
FENTANYL 12 MCG/HR TD PT72,,38326,LOCAL,Facility,Both,1,Each,,20,17,5.732,20,"Health Partners, Inc.",State of Minnesota Advantage Program,16.3,81.5,,percent of total billed charges,,
FENTANYL 12 MCG/HR TD PT72,,38326,LOCAL,Facility,Both,1,Each,,20,17,5.732,20,"Health Partners, Inc.",State Public Programs,10,50,,percent of total billed charges,,
FENTANYL 12 MCG/HR TD PT72,,38326,LOCAL,Facility,Both,1,Each,,20,17,5.732,20,Humana Insurance Company,Commercial PPO,19,95,,percent of total billed charges,,
FENTANYL 12 MCG/HR TD PT72,,38326,LOCAL,Facility,Outpatient,1,Each,,20,17,5.732,20,Humana Insurance Company,Medicare PPO,9.8,49,,percent of total billed charges,,
FENTANYL 12 MCG/HR TD PT72,,38326,LOCAL,Facility,Inpatient,1,Each,,20,17,5.732,20,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
FENTANYL 12 MCG/HR TD PT72,,38326,LOCAL,Facility,Both,1,Each,,20,17,5.732,20,Medica,Individual & Family,19.82,99.1,,percent of total billed charges,,
FENTANYL 12 MCG/HR TD PT72,,38326,LOCAL,Facility,Outpatient,1,Each,,20,17,5.732,20,Medica,Medica Advantage Solution,9.96,49.8,,percent of total billed charges,,
FENTANYL 12 MCG/HR TD PT72,,38326,LOCAL,Facility,Inpatient,1,Each,,20,17,5.732,20,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
FENTANYL 12 MCG/HR TD PT72,,38326,LOCAL,Facility,Outpatient,1,Each,,20,17,5.732,20,Medica,Medical Assistance,8.92,44.6,,percent of total billed charges,,
FENTANYL 12 MCG/HR TD PT72,,38326,LOCAL,Facility,Inpatient,1,Each,,20,17,5.732,20,Medica,Medical Assistance,,,,,Included in per diem rate,
FENTANYL 12 MCG/HR TD PT72,,38326,LOCAL,Facility,Outpatient,1,Each,,20,17,5.732,20,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,9.96,49.8,,percent of total billed charges,,
FENTANYL 12 MCG/HR TD PT72,,38326,LOCAL,Facility,Inpatient,1,Each,,20,17,5.732,20,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
FENTANYL 12 MCG/HR TD PT72,,38326,LOCAL,Facility,Both,1,Each,,20,17,5.732,20,"Multiplan, Inc.","Multiplan, Inc.",18.8,94,,percent of total billed charges,,
FENTANYL 12 MCG/HR TD PT72,,38326,LOCAL,Facility,Outpatient,1,Each,,20,17,5.732,20,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,18.02,90.1,,percent of total billed charges,,
FENTANYL 12 MCG/HR TD PT72,,38326,LOCAL,Facility,Inpatient,1,Each,,20,17,5.732,20,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
FENTANYL 12 MCG/HR TD PT72,,38326,LOCAL,Facility,Both,1,Each,,20,17,5.732,20,"Preferred One Administrative Services, INC.",PPO,19.72,98.6,,percent of total billed charges,,
FENTANYL 12 MCG/HR TD PT72,,38326,LOCAL,Facility,Outpatient,1,Each,,20,17,5.732,20,PrimeWest Health,Minnesota Senior Health Options (MSHO),10.29,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
FENTANYL 12 MCG/HR TD PT72,,38326,LOCAL,Facility,Inpatient,1,Each,,20,17,5.732,20,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
FENTANYL 12 MCG/HR TD PT72,,38326,LOCAL,Facility,Outpatient,1,Each,,20,17,5.732,20,PrimeWest Health,MinnesotaCare,10.272,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
FENTANYL 12 MCG/HR TD PT72,,38326,LOCAL,Facility,Inpatient,1,Each,,20,17,5.732,20,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
FENTANYL 12 MCG/HR TD PT72,,38326,LOCAL,Facility,Both,1,Each,,20,17,5.732,20,Sanford Health Plan,Sanford Health Plan,18.4,92,,percent of total billed charges,,
FENTANYL 12 MCG/HR TD PT72,,38326,LOCAL,Facility,Outpatient,1,Each,,20,17,5.732,20,"UCare Health, Inc.",Individual & Family Plan,11.27,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
FENTANYL 12 MCG/HR TD PT72,,38326,LOCAL,Facility,Inpatient,1,Each,,20,17,5.732,20,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
FENTANYL 12 MCG/HR TD PT72,,38326,LOCAL,Facility,Outpatient,1,Each,,20,17,5.732,20,"UCare Health, Inc.",Medical Assistance,10.094,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FENTANYL 12 MCG/HR TD PT72,,38326,LOCAL,Facility,Inpatient,1,Each,,20,17,5.732,20,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
FENTANYL 12 MCG/HR TD PT72,,38326,LOCAL,Facility,Outpatient,1,Each,,20,17,5.732,20,"UCare Health, Inc.",Medicare Advantage,10.094,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FENTANYL 12 MCG/HR TD PT72,,38326,LOCAL,Facility,Inpatient,1,Each,,20,17,5.732,20,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
FENTANYL 12 MCG/HR TD PT72,,38326,LOCAL,Facility,Outpatient,1,Each,,20,17,5.732,20,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),10.094,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FENTANYL 12 MCG/HR TD PT72,,38326,LOCAL,Facility,Inpatient,1,Each,,20,17,5.732,20,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
FENTANYL 12 MCG/HR TD PT72,,38326,LOCAL,Facility,Both,1,Each,,20,17,5.732,20,UnitedHealthcare,Individual & Family,18.8,94,,percent of total billed charges,,
FENTANYL 12 MCG/HR TD PT72,,38326,LOCAL,Facility,Outpatient,1,Each,,20,17,5.732,20,UnitedHealthcare,Medicare Advantage,9.8,49,,percent of total billed charges,,
FENTANYL 12 MCG/HR TD PT72,,38326,LOCAL,Facility,Inpatient,1,Each,,20,17,5.732,20,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
FENTANYL 12 MCG/HR TD PT72,,38326,LOCAL,Facility,Outpatient,1,Each,,20,17,5.732,20,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,9.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
FENTANYL 12 MCG/HR TD PT72,,38326,LOCAL,Facility,Inpatient,1,Each,,20,17,5.732,20,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
App Skin Sub Graft F/N/O/H/G Total Area Up To 100 Sq Cm; First 25 Sq Cm Or Less (Pro Cah),,15275,CPT,Professional,Both,,,,428,363.8,57.37,428,Aetna,Commercial,363.8,85,,percent of total billed charges,,
App Skin Sub Graft F/N/O/H/G Total Area Up To 100 Sq Cm; First 25 Sq Cm Or Less (Pro Cah),,15275,CPT,Professional,Both,,,,428,363.8,57.37,428,Aetna,Medicare Advantage,91.64,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
App Skin Sub Graft F/N/O/H/G Total Area Up To 100 Sq Cm; First 25 Sq Cm Or Less (Pro Cah),,15275,CPT,Professional,Both,,,,428,363.8,57.37,428,Aetna,PPO,398.04,93,,percent of total billed charges,,
App Skin Sub Graft F/N/O/H/G Total Area Up To 100 Sq Cm; First 25 Sq Cm Or Less (Pro Cah),,15275,CPT,Professional,Both,,,,428,363.8,57.37,428,America's PPO,America's PPO,365.6832,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
App Skin Sub Graft F/N/O/H/G Total Area Up To 100 Sq Cm; First 25 Sq Cm Or Less (Pro Cah),,15275,CPT,Professional,Both,,,,428,363.8,57.37,428,BlueCross BlueShield Minnesota, Federal Employee Program,189.37,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
App Skin Sub Graft F/N/O/H/G Total Area Up To 100 Sq Cm; First 25 Sq Cm Or Less (Pro Cah),,15275,CPT,Professional,Both,,,,428,363.8,57.37,428,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,192.39992,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
App Skin Sub Graft F/N/O/H/G Total Area Up To 100 Sq Cm; First 25 Sq Cm Or Less (Pro Cah),,15275,CPT,Professional,Both,,,,428,363.8,57.37,428,BlueCross BlueShield Minnesota,High Value Network Plan,192.39992,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
App Skin Sub Graft F/N/O/H/G Total Area Up To 100 Sq Cm; First 25 Sq Cm Or Less (Pro Cah),,15275,CPT,Professional,Both,,,,428,363.8,57.37,428,BlueCross BlueShield Minnesota,Medicare Advantage,102.718,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
App Skin Sub Graft F/N/O/H/G Total Area Up To 100 Sq Cm; First 25 Sq Cm Or Less (Pro Cah),,15275,CPT,Professional,Both,,,,428,363.8,57.37,428,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,192.39992,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
App Skin Sub Graft F/N/O/H/G Total Area Up To 100 Sq Cm; First 25 Sq Cm Or Less (Pro Cah),,15275,CPT,Professional,Both,,,,428,363.8,57.37,428,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,66.23304,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
App Skin Sub Graft F/N/O/H/G Total Area Up To 100 Sq Cm; First 25 Sq Cm Or Less (Pro Cah),,15275,CPT,Professional,Both,,,,428,363.8,57.37,428,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),102.718,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
App Skin Sub Graft F/N/O/H/G Total Area Up To 100 Sq Cm; First 25 Sq Cm Or Less (Pro Cah),,15275,CPT,Professional,Both,,,,428,363.8,57.37,428,CorVel,Worker's Compensation,175.9739811,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
App Skin Sub Graft F/N/O/H/G Total Area Up To 100 Sq Cm; First 25 Sq Cm Or Less (Pro Cah),,15275,CPT,Professional,Both,,,,428,363.8,57.37,428,First Health Group Corporation,First Health Network,415.16,97,,percent of total billed charges,,
App Skin Sub Graft F/N/O/H/G Total Area Up To 100 Sq Cm; First 25 Sq Cm Or Less (Pro Cah),,15275,CPT,Professional,Both,,,,428,363.8,57.37,428,"Health Partners, Inc.",Commercial,190.08,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
App Skin Sub Graft F/N/O/H/G Total Area Up To 100 Sq Cm; First 25 Sq Cm Or Less (Pro Cah),,15275,CPT,Professional,Both,,,,428,363.8,57.37,428,"Health Partners, Inc.",Medicare Advantage,102.718,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
App Skin Sub Graft F/N/O/H/G Total Area Up To 100 Sq Cm; First 25 Sq Cm Or Less (Pro Cah),,15275,CPT,Professional,Both,,,,428,363.8,57.37,428,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),89.12,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
App Skin Sub Graft F/N/O/H/G Total Area Up To 100 Sq Cm; First 25 Sq Cm Or Less (Pro Cah),,15275,CPT,Professional,Both,,,,428,363.8,57.37,428,"Health Partners, Inc.",State of Minnesota Advantage Program,163.75392,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
App Skin Sub Graft F/N/O/H/G Total Area Up To 100 Sq Cm; First 25 Sq Cm Or Less (Pro Cah),,15275,CPT,Professional,Both,,,,428,363.8,57.37,428,"Health Partners, Inc.",State Public Programs,57.37,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
App Skin Sub Graft F/N/O/H/G Total Area Up To 100 Sq Cm; First 25 Sq Cm Or Less (Pro Cah),,15275,CPT,Professional,Both,,,,428,363.8,57.37,428,Humana Insurance Company,Commercial PPO,89.32,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
App Skin Sub Graft F/N/O/H/G Total Area Up To 100 Sq Cm; First 25 Sq Cm Or Less (Pro Cah),,15275,CPT,Professional,Both,,,,428,363.8,57.37,428,Humana Insurance Company,Medicare PPO,428,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
App Skin Sub Graft F/N/O/H/G Total Area Up To 100 Sq Cm; First 25 Sq Cm Or Less (Pro Cah),,15275,CPT,Professional,Both,,,,428,363.8,57.37,428,Medica,Individual & Family,362.944,84.8,,percent of total billed charges,,
App Skin Sub Graft F/N/O/H/G Total Area Up To 100 Sq Cm; First 25 Sq Cm Or Less (Pro Cah),,15275,CPT,Professional,Both,,,,428,363.8,57.37,428,Medica,Medica Advantage Solution,213.144,49.8,,percent of total billed charges,,
App Skin Sub Graft F/N/O/H/G Total Area Up To 100 Sq Cm; First 25 Sq Cm Or Less (Pro Cah),,15275,CPT,Professional,Both,,,,428,363.8,57.37,428,Medica,Medical Assistance,66.23,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
App Skin Sub Graft F/N/O/H/G Total Area Up To 100 Sq Cm; First 25 Sq Cm Or Less (Pro Cah),,15275,CPT,Professional,Both,,,,428,363.8,57.37,428,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,89.32,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
App Skin Sub Graft F/N/O/H/G Total Area Up To 100 Sq Cm; First 25 Sq Cm Or Less (Pro Cah),,15275,CPT,Professional,Both,,,,428,363.8,57.37,428,"Multiplan, Inc.","Multiplan, Inc.",402.32,94,,percent of total billed charges,,
App Skin Sub Graft F/N/O/H/G Total Area Up To 100 Sq Cm; First 25 Sq Cm Or Less (Pro Cah),,15275,CPT,Professional,Both,,,,428,363.8,57.37,428,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,385.628,90.1,,percent of total billed charges,,
App Skin Sub Graft F/N/O/H/G Total Area Up To 100 Sq Cm; First 25 Sq Cm Or Less (Pro Cah),,15275,CPT,Professional,Both,,,,428,363.8,57.37,428,"Preferred One Administrative Services, INC.",PPO,422.008,98.6,,percent of total billed charges,,
App Skin Sub Graft F/N/O/H/G Total Area Up To 100 Sq Cm; First 25 Sq Cm Or Less (Pro Cah),,15275,CPT,Professional,Both,,,,428,363.8,57.37,428,PrimeWest Health,Minnesota Senior Health Options (MSHO),102.718,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
App Skin Sub Graft F/N/O/H/G Total Area Up To 100 Sq Cm; First 25 Sq Cm Or Less (Pro Cah),,15275,CPT,Professional,Both,,,,428,363.8,57.37,428,PrimeWest Health,MinnesotaCare,70.8693528,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
App Skin Sub Graft F/N/O/H/G Total Area Up To 100 Sq Cm; First 25 Sq Cm Or Less (Pro Cah),,15275,CPT,Professional,Both,,,,428,363.8,57.37,428,Sanford Health Plan,Sanford Health Plan,376.64,88,,percent of total billed charges,,
App Skin Sub Graft F/N/O/H/G Total Area Up To 100 Sq Cm; First 25 Sq Cm Or Less (Pro Cah),,15275,CPT,Professional,Both,,,,428,363.8,57.37,428,"UCare Health, Inc.",Individual & Family Plan,145.198592,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
App Skin Sub Graft F/N/O/H/G Total Area Up To 100 Sq Cm; First 25 Sq Cm Or Less (Pro Cah),,15275,CPT,Professional,Both,,,,428,363.8,57.37,428,"UCare Health, Inc.",Medical Assistance,72.856344,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
App Skin Sub Graft F/N/O/H/G Total Area Up To 100 Sq Cm; First 25 Sq Cm Or Less (Pro Cah),,15275,CPT,Professional,Both,,,,428,363.8,57.37,428,"UCare Health, Inc.",Medicare Advantage,102.718,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
App Skin Sub Graft F/N/O/H/G Total Area Up To 100 Sq Cm; First 25 Sq Cm Or Less (Pro Cah),,15275,CPT,Professional,Both,,,,428,363.8,57.37,428,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),82.1744,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
App Skin Sub Graft F/N/O/H/G Total Area Up To 100 Sq Cm; First 25 Sq Cm Or Less (Pro Cah),,15275,CPT,Professional,Both,,,,428,363.8,57.37,428,UnitedHealthcare,Individual & Family,428,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
App Skin Sub Graft F/N/O/H/G Total Area Up To 100 Sq Cm; First 25 Sq Cm Or Less (Pro Cah),,15275,CPT,Professional,Both,,,,428,363.8,57.37,428,UnitedHealthcare,Medicare Advantage,102.718,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
App Skin Sub Graft F/N/O/H/G Total Area Up To 100 Sq Cm; First 25 Sq Cm Or Less (Pro Cah),,15275,CPT,Professional,Both,,,,428,363.8,57.37,428,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,66.23304,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Apply Skin Sub Graft F/N/O/H/G Total Wound Up To 100 Sq Cm,1St 25 Sq Cm Or Less",,15275,CPT,Facility,Both,,,,102,86.7,29.2332,102,Aetna,Commercial,93.84,92,,percent of total billed charges,,
"Apply Skin Sub Graft F/N/O/H/G Total Wound Up To 100 Sq Cm,1St 25 Sq Cm Or Less",,15275,CPT,Facility,Outpatient,,,,102,86.7,29.2332,102,Aetna,Medicare Advantage,49.98,49,,percent of total billed charges,,
"Apply Skin Sub Graft F/N/O/H/G Total Wound Up To 100 Sq Cm,1St 25 Sq Cm Or Less",,15275,CPT,Facility,Inpatient,,,,102,86.7,29.2332,102,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Apply Skin Sub Graft F/N/O/H/G Total Wound Up To 100 Sq Cm,1St 25 Sq Cm Or Less",,15275,CPT,Facility,Both,,,,102,86.7,29.2332,102,Aetna,PPO,94.86,93,,percent of total billed charges,,
"Apply Skin Sub Graft F/N/O/H/G Total Wound Up To 100 Sq Cm,1St 25 Sq Cm Or Less",,15275,CPT,Facility,Both,,,,102,86.7,29.2332,102,America's PPO,America's PPO,97.9506,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Apply Skin Sub Graft F/N/O/H/G Total Wound Up To 100 Sq Cm,1St 25 Sq Cm Or Less",,15275,CPT,Facility,Both,,,,102,86.7,29.2332,102,BlueCross BlueShield Minnesota, Federal Employee Program,100.368,98.4,,percent of total billed charges,,
"Apply Skin Sub Graft F/N/O/H/G Total Wound Up To 100 Sq Cm,1St 25 Sq Cm Or Less",,15275,CPT,Facility,Both,,,,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,102,100,,percent of total billed charges,,
"Apply Skin Sub Graft F/N/O/H/G Total Wound Up To 100 Sq Cm,1St 25 Sq Cm Or Less",,15275,CPT,Facility,Both,,,,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,High Value Network Plan,91.8,90,,percent of total billed charges,,
"Apply Skin Sub Graft F/N/O/H/G Total Wound Up To 100 Sq Cm,1St 25 Sq Cm Or Less",,15275,CPT,Facility,Outpatient,,,,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,Medicare Advantage,49.98,49,,percent of total billed charges,,
"Apply Skin Sub Graft F/N/O/H/G Total Wound Up To 100 Sq Cm,1St 25 Sq Cm Or Less",,15275,CPT,Facility,Inpatient,,,,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Apply Skin Sub Graft F/N/O/H/G Total Wound Up To 100 Sq Cm,1St 25 Sq Cm Or Less",,15275,CPT,Facility,Both,,,,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,90.3414,88.57,,percent of total billed charges,,
"Apply Skin Sub Graft F/N/O/H/G Total Wound Up To 100 Sq Cm,1St 25 Sq Cm Or Less",,15275,CPT,Facility,Both,,,,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,29.2332,28.66,,percent of total billed charges,,
"Apply Skin Sub Graft F/N/O/H/G Total Wound Up To 100 Sq Cm,1St 25 Sq Cm Or Less",,15275,CPT,Facility,Outpatient,,,,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),49.98,49,,percent of total billed charges,,
"Apply Skin Sub Graft F/N/O/H/G Total Wound Up To 100 Sq Cm,1St 25 Sq Cm Or Less",,15275,CPT,Facility,Inpatient,,,,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Apply Skin Sub Graft F/N/O/H/G Total Wound Up To 100 Sq Cm,1St 25 Sq Cm Or Less",,15275,CPT,Facility,Both,,,,102,86.7,29.2332,102,CorVel,Worker's Compensation,102,100,,percent of total billed charges,,
"Apply Skin Sub Graft F/N/O/H/G Total Wound Up To 100 Sq Cm,1St 25 Sq Cm Or Less",,15275,CPT,Facility,Both,,,,102,86.7,29.2332,102,First Health Group Corporation,First Health Network,98.94,97,,percent of total billed charges,,
"Apply Skin Sub Graft F/N/O/H/G Total Wound Up To 100 Sq Cm,1St 25 Sq Cm Or Less",,15275,CPT,Facility,Both,,,,102,86.7,29.2332,102,"Health Partners, Inc.",Commercial,96.492,94.6,,percent of total billed charges,,
"Apply Skin Sub Graft F/N/O/H/G Total Wound Up To 100 Sq Cm,1St 25 Sq Cm Or Less",,15275,CPT,Facility,Outpatient,,,,102,86.7,29.2332,102,"Health Partners, Inc.",Medicare Advantage,49.98,49,,percent of total billed charges,,
"Apply Skin Sub Graft F/N/O/H/G Total Wound Up To 100 Sq Cm,1St 25 Sq Cm Or Less",,15275,CPT,Facility,Inpatient,,,,102,86.7,29.2332,102,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Apply Skin Sub Graft F/N/O/H/G Total Wound Up To 100 Sq Cm,1St 25 Sq Cm Or Less",,15275,CPT,Facility,Both,,,,102,86.7,29.2332,102,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),61.2,60,,percent of total billed charges,,
"Apply Skin Sub Graft F/N/O/H/G Total Wound Up To 100 Sq Cm,1St 25 Sq Cm Or Less",,15275,CPT,Facility,Both,,,,102,86.7,29.2332,102,"Health Partners, Inc.",State of Minnesota Advantage Program,83.13,81.5,,percent of total billed charges,,
"Apply Skin Sub Graft F/N/O/H/G Total Wound Up To 100 Sq Cm,1St 25 Sq Cm Or Less",,15275,CPT,Facility,Both,,,,102,86.7,29.2332,102,"Health Partners, Inc.",State Public Programs,51,50,,percent of total billed charges,,
"Apply Skin Sub Graft F/N/O/H/G Total Wound Up To 100 Sq Cm,1St 25 Sq Cm Or Less",,15275,CPT,Facility,Both,,,,102,86.7,29.2332,102,Humana Insurance Company,Commercial PPO,96.9,95,,percent of total billed charges,,
"Apply Skin Sub Graft F/N/O/H/G Total Wound Up To 100 Sq Cm,1St 25 Sq Cm Or Less",,15275,CPT,Facility,Outpatient,,,,102,86.7,29.2332,102,Humana Insurance Company,Medicare PPO,49.98,49,,percent of total billed charges,,
"Apply Skin Sub Graft F/N/O/H/G Total Wound Up To 100 Sq Cm,1St 25 Sq Cm Or Less",,15275,CPT,Facility,Inpatient,,,,102,86.7,29.2332,102,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Apply Skin Sub Graft F/N/O/H/G Total Wound Up To 100 Sq Cm,1St 25 Sq Cm Or Less",,15275,CPT,Facility,Both,,,,102,86.7,29.2332,102,Medica,Individual & Family,101.082,99.1,,percent of total billed charges,,
"Apply Skin Sub Graft F/N/O/H/G Total Wound Up To 100 Sq Cm,1St 25 Sq Cm Or Less",,15275,CPT,Facility,Outpatient,,,,102,86.7,29.2332,102,Medica,Medica Advantage Solution,50.796,49.8,,percent of total billed charges,,
"Apply Skin Sub Graft F/N/O/H/G Total Wound Up To 100 Sq Cm,1St 25 Sq Cm Or Less",,15275,CPT,Facility,Inpatient,,,,102,86.7,29.2332,102,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Apply Skin Sub Graft F/N/O/H/G Total Wound Up To 100 Sq Cm,1St 25 Sq Cm Or Less",,15275,CPT,Facility,Outpatient,,,,102,86.7,29.2332,102,Medica,Medical Assistance,45.492,44.6,,percent of total billed charges,,
"Apply Skin Sub Graft F/N/O/H/G Total Wound Up To 100 Sq Cm,1St 25 Sq Cm Or Less",,15275,CPT,Facility,Inpatient,,,,102,86.7,29.2332,102,Medica,Medical Assistance,,,,,Included in per diem rate,
"Apply Skin Sub Graft F/N/O/H/G Total Wound Up To 100 Sq Cm,1St 25 Sq Cm Or Less",,15275,CPT,Facility,Outpatient,,,,102,86.7,29.2332,102,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,50.796,49.8,,percent of total billed charges,,
"Apply Skin Sub Graft F/N/O/H/G Total Wound Up To 100 Sq Cm,1St 25 Sq Cm Or Less",,15275,CPT,Facility,Inpatient,,,,102,86.7,29.2332,102,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Apply Skin Sub Graft F/N/O/H/G Total Wound Up To 100 Sq Cm,1St 25 Sq Cm Or Less",,15275,CPT,Facility,Both,,,,102,86.7,29.2332,102,"Multiplan, Inc.","Multiplan, Inc.",95.88,94,,percent of total billed charges,,
"Apply Skin Sub Graft F/N/O/H/G Total Wound Up To 100 Sq Cm,1St 25 Sq Cm Or Less",,15275,CPT,Facility,Outpatient,,,,102,86.7,29.2332,102,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,91.902,90.1,,percent of total billed charges,,
"Apply Skin Sub Graft F/N/O/H/G Total Wound Up To 100 Sq Cm,1St 25 Sq Cm Or Less",,15275,CPT,Facility,Inpatient,,,,102,86.7,29.2332,102,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Apply Skin Sub Graft F/N/O/H/G Total Wound Up To 100 Sq Cm,1St 25 Sq Cm Or Less",,15275,CPT,Facility,Both,,,,102,86.7,29.2332,102,"Preferred One Administrative Services, INC.",PPO,100.572,98.6,,percent of total billed charges,,
"Apply Skin Sub Graft F/N/O/H/G Total Wound Up To 100 Sq Cm,1St 25 Sq Cm Or Less",,15275,CPT,Facility,Outpatient,,,,102,86.7,29.2332,102,PrimeWest Health,Minnesota Senior Health Options (MSHO),52.479,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Apply Skin Sub Graft F/N/O/H/G Total Wound Up To 100 Sq Cm,1St 25 Sq Cm Or Less",,15275,CPT,Facility,Inpatient,,,,102,86.7,29.2332,102,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Apply Skin Sub Graft F/N/O/H/G Total Wound Up To 100 Sq Cm,1St 25 Sq Cm Or Less",,15275,CPT,Facility,Outpatient,,,,102,86.7,29.2332,102,PrimeWest Health,MinnesotaCare,52.3872,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Apply Skin Sub Graft F/N/O/H/G Total Wound Up To 100 Sq Cm,1St 25 Sq Cm Or Less",,15275,CPT,Facility,Inpatient,,,,102,86.7,29.2332,102,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Apply Skin Sub Graft F/N/O/H/G Total Wound Up To 100 Sq Cm,1St 25 Sq Cm Or Less",,15275,CPT,Facility,Both,,,,102,86.7,29.2332,102,Sanford Health Plan,Sanford Health Plan,93.84,92,,percent of total billed charges,,
"Apply Skin Sub Graft F/N/O/H/G Total Wound Up To 100 Sq Cm,1St 25 Sq Cm Or Less",,15275,CPT,Facility,Outpatient,,,,102,86.7,29.2332,102,"UCare Health, Inc.",Individual & Family Plan,57.477,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Apply Skin Sub Graft F/N/O/H/G Total Wound Up To 100 Sq Cm,1St 25 Sq Cm Or Less",,15275,CPT,Facility,Inpatient,,,,102,86.7,29.2332,102,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Apply Skin Sub Graft F/N/O/H/G Total Wound Up To 100 Sq Cm,1St 25 Sq Cm Or Less",,15275,CPT,Facility,Outpatient,,,,102,86.7,29.2332,102,"UCare Health, Inc.",Medical Assistance,51.4794,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Apply Skin Sub Graft F/N/O/H/G Total Wound Up To 100 Sq Cm,1St 25 Sq Cm Or Less",,15275,CPT,Facility,Inpatient,,,,102,86.7,29.2332,102,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Apply Skin Sub Graft F/N/O/H/G Total Wound Up To 100 Sq Cm,1St 25 Sq Cm Or Less",,15275,CPT,Facility,Outpatient,,,,102,86.7,29.2332,102,"UCare Health, Inc.",Medicare Advantage,51.4794,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Apply Skin Sub Graft F/N/O/H/G Total Wound Up To 100 Sq Cm,1St 25 Sq Cm Or Less",,15275,CPT,Facility,Inpatient,,,,102,86.7,29.2332,102,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Apply Skin Sub Graft F/N/O/H/G Total Wound Up To 100 Sq Cm,1St 25 Sq Cm Or Less",,15275,CPT,Facility,Outpatient,,,,102,86.7,29.2332,102,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),51.4794,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Apply Skin Sub Graft F/N/O/H/G Total Wound Up To 100 Sq Cm,1St 25 Sq Cm Or Less",,15275,CPT,Facility,Inpatient,,,,102,86.7,29.2332,102,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Apply Skin Sub Graft F/N/O/H/G Total Wound Up To 100 Sq Cm,1St 25 Sq Cm Or Less",,15275,CPT,Facility,Both,,,,102,86.7,29.2332,102,UnitedHealthcare,Individual & Family,95.88,94,,percent of total billed charges,,
"Apply Skin Sub Graft F/N/O/H/G Total Wound Up To 100 Sq Cm,1St 25 Sq Cm Or Less",,15275,CPT,Facility,Outpatient,,,,102,86.7,29.2332,102,UnitedHealthcare,Medicare Advantage,49.98,49,,percent of total billed charges,,
"Apply Skin Sub Graft F/N/O/H/G Total Wound Up To 100 Sq Cm,1St 25 Sq Cm Or Less",,15275,CPT,Facility,Inpatient,,,,102,86.7,29.2332,102,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Apply Skin Sub Graft F/N/O/H/G Total Wound Up To 100 Sq Cm,1St 25 Sq Cm Or Less",,15275,CPT,Facility,Outpatient,,,,102,86.7,29.2332,102,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,48.96,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Apply Skin Sub Graft F/N/O/H/G Total Wound Up To 100 Sq Cm,1St 25 Sq Cm Or Less",,15275,CPT,Facility,Inpatient,,,,102,86.7,29.2332,102,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
CALCIUM CARBONATE-VITAMIN D3 500 MG-5 MCG (200 UNIT) ORAL TABLET,,38433,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
CALCIUM CARBONATE-VITAMIN D3 500 MG-5 MCG (200 UNIT) ORAL TABLET,,38433,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
CALCIUM CARBONATE-VITAMIN D3 500 MG-5 MCG (200 UNIT) ORAL TABLET,,38433,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
CALCIUM CARBONATE-VITAMIN D3 500 MG-5 MCG (200 UNIT) ORAL TABLET,,38433,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
CALCIUM CARBONATE-VITAMIN D3 500 MG-5 MCG (200 UNIT) ORAL TABLET,,38433,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
CALCIUM CARBONATE-VITAMIN D3 500 MG-5 MCG (200 UNIT) ORAL TABLET,,38433,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
CALCIUM CARBONATE-VITAMIN D3 500 MG-5 MCG (200 UNIT) ORAL TABLET,,38433,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
CALCIUM CARBONATE-VITAMIN D3 500 MG-5 MCG (200 UNIT) ORAL TABLET,,38433,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
CALCIUM CARBONATE-VITAMIN D3 500 MG-5 MCG (200 UNIT) ORAL TABLET,,38433,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
CALCIUM CARBONATE-VITAMIN D3 500 MG-5 MCG (200 UNIT) ORAL TABLET,,38433,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
CALCIUM CARBONATE-VITAMIN D3 500 MG-5 MCG (200 UNIT) ORAL TABLET,,38433,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
CALCIUM CARBONATE-VITAMIN D3 500 MG-5 MCG (200 UNIT) ORAL TABLET,,38433,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
CALCIUM CARBONATE-VITAMIN D3 500 MG-5 MCG (200 UNIT) ORAL TABLET,,38433,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
CALCIUM CARBONATE-VITAMIN D3 500 MG-5 MCG (200 UNIT) ORAL TABLET,,38433,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
CALCIUM CARBONATE-VITAMIN D3 500 MG-5 MCG (200 UNIT) ORAL TABLET,,38433,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
CALCIUM CARBONATE-VITAMIN D3 500 MG-5 MCG (200 UNIT) ORAL TABLET,,38433,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
CALCIUM CARBONATE-VITAMIN D3 500 MG-5 MCG (200 UNIT) ORAL TABLET,,38433,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
CALCIUM CARBONATE-VITAMIN D3 500 MG-5 MCG (200 UNIT) ORAL TABLET,,38433,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
CALCIUM CARBONATE-VITAMIN D3 500 MG-5 MCG (200 UNIT) ORAL TABLET,,38433,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CALCIUM CARBONATE-VITAMIN D3 500 MG-5 MCG (200 UNIT) ORAL TABLET,,38433,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
CALCIUM CARBONATE-VITAMIN D3 500 MG-5 MCG (200 UNIT) ORAL TABLET,,38433,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
CALCIUM CARBONATE-VITAMIN D3 500 MG-5 MCG (200 UNIT) ORAL TABLET,,38433,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
CALCIUM CARBONATE-VITAMIN D3 500 MG-5 MCG (200 UNIT) ORAL TABLET,,38433,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
CALCIUM CARBONATE-VITAMIN D3 500 MG-5 MCG (200 UNIT) ORAL TABLET,,38433,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
CALCIUM CARBONATE-VITAMIN D3 500 MG-5 MCG (200 UNIT) ORAL TABLET,,38433,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
CALCIUM CARBONATE-VITAMIN D3 500 MG-5 MCG (200 UNIT) ORAL TABLET,,38433,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
CALCIUM CARBONATE-VITAMIN D3 500 MG-5 MCG (200 UNIT) ORAL TABLET,,38433,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
CALCIUM CARBONATE-VITAMIN D3 500 MG-5 MCG (200 UNIT) ORAL TABLET,,38433,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
CALCIUM CARBONATE-VITAMIN D3 500 MG-5 MCG (200 UNIT) ORAL TABLET,,38433,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
CALCIUM CARBONATE-VITAMIN D3 500 MG-5 MCG (200 UNIT) ORAL TABLET,,38433,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
CALCIUM CARBONATE-VITAMIN D3 500 MG-5 MCG (200 UNIT) ORAL TABLET,,38433,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
CALCIUM CARBONATE-VITAMIN D3 500 MG-5 MCG (200 UNIT) ORAL TABLET,,38433,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
CALCIUM CARBONATE-VITAMIN D3 500 MG-5 MCG (200 UNIT) ORAL TABLET,,38433,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
CALCIUM CARBONATE-VITAMIN D3 500 MG-5 MCG (200 UNIT) ORAL TABLET,,38433,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
CALCIUM CARBONATE-VITAMIN D3 500 MG-5 MCG (200 UNIT) ORAL TABLET,,38433,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
CALCIUM CARBONATE-VITAMIN D3 500 MG-5 MCG (200 UNIT) ORAL TABLET,,38433,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
CALCIUM CARBONATE-VITAMIN D3 500 MG-5 MCG (200 UNIT) ORAL TABLET,,38433,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
CALCIUM CARBONATE-VITAMIN D3 500 MG-5 MCG (200 UNIT) ORAL TABLET,,38433,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CALCIUM CARBONATE-VITAMIN D3 500 MG-5 MCG (200 UNIT) ORAL TABLET,,38433,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
CALCIUM CARBONATE-VITAMIN D3 500 MG-5 MCG (200 UNIT) ORAL TABLET,,38433,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
CALCIUM CARBONATE-VITAMIN D3 500 MG-5 MCG (200 UNIT) ORAL TABLET,,38433,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
CALCIUM CARBONATE-VITAMIN D3 500 MG-5 MCG (200 UNIT) ORAL TABLET,,38433,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
CALCIUM CARBONATE-VITAMIN D3 500 MG-5 MCG (200 UNIT) ORAL TABLET,,38433,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
CALCIUM CARBONATE-VITAMIN D3 500 MG-5 MCG (200 UNIT) ORAL TABLET,,38433,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CALCIUM CARBONATE-VITAMIN D3 500 MG-5 MCG (200 UNIT) ORAL TABLET,,38433,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
CALCIUM CARBONATE-VITAMIN D3 500 MG-5 MCG (200 UNIT) ORAL TABLET,,38433,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CALCIUM CARBONATE-VITAMIN D3 500 MG-5 MCG (200 UNIT) ORAL TABLET,,38433,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CALCIUM CARBONATE-VITAMIN D3 500 MG-5 MCG (200 UNIT) ORAL TABLET,,38433,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CALCIUM CARBONATE-VITAMIN D3 500 MG-5 MCG (200 UNIT) ORAL TABLET,,38433,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CALCIUM CARBONATE-VITAMIN D3 500 MG-5 MCG (200 UNIT) ORAL TABLET,,38433,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
CALCIUM CARBONATE-VITAMIN D3 500 MG-5 MCG (200 UNIT) ORAL TABLET,,38433,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
CALCIUM CARBONATE-VITAMIN D3 500 MG-5 MCG (200 UNIT) ORAL TABLET,,38433,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
CALCIUM CARBONATE-VITAMIN D3 500 MG-5 MCG (200 UNIT) ORAL TABLET,,38433,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
CALCIUM CARBONATE-VITAMIN D3 500 MG-5 MCG (200 UNIT) ORAL TABLET,,38433,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
PREGABALIN 25 MG ORAL CAP,,38893,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
PREGABALIN 25 MG ORAL CAP,,38893,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
PREGABALIN 25 MG ORAL CAP,,38893,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
PREGABALIN 25 MG ORAL CAP,,38893,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
PREGABALIN 25 MG ORAL CAP,,38893,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
PREGABALIN 25 MG ORAL CAP,,38893,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
PREGABALIN 25 MG ORAL CAP,,38893,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
PREGABALIN 25 MG ORAL CAP,,38893,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
PREGABALIN 25 MG ORAL CAP,,38893,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
PREGABALIN 25 MG ORAL CAP,,38893,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
PREGABALIN 25 MG ORAL CAP,,38893,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
PREGABALIN 25 MG ORAL CAP,,38893,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
PREGABALIN 25 MG ORAL CAP,,38893,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
PREGABALIN 25 MG ORAL CAP,,38893,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
PREGABALIN 25 MG ORAL CAP,,38893,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
PREGABALIN 25 MG ORAL CAP,,38893,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
PREGABALIN 25 MG ORAL CAP,,38893,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
PREGABALIN 25 MG ORAL CAP,,38893,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
PREGABALIN 25 MG ORAL CAP,,38893,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PREGABALIN 25 MG ORAL CAP,,38893,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
PREGABALIN 25 MG ORAL CAP,,38893,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
PREGABALIN 25 MG ORAL CAP,,38893,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
PREGABALIN 25 MG ORAL CAP,,38893,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
PREGABALIN 25 MG ORAL CAP,,38893,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
PREGABALIN 25 MG ORAL CAP,,38893,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
PREGABALIN 25 MG ORAL CAP,,38893,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
PREGABALIN 25 MG ORAL CAP,,38893,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
PREGABALIN 25 MG ORAL CAP,,38893,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
PREGABALIN 25 MG ORAL CAP,,38893,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
PREGABALIN 25 MG ORAL CAP,,38893,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
PREGABALIN 25 MG ORAL CAP,,38893,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
PREGABALIN 25 MG ORAL CAP,,38893,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
PREGABALIN 25 MG ORAL CAP,,38893,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
PREGABALIN 25 MG ORAL CAP,,38893,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
PREGABALIN 25 MG ORAL CAP,,38893,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
PREGABALIN 25 MG ORAL CAP,,38893,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
PREGABALIN 25 MG ORAL CAP,,38893,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
PREGABALIN 25 MG ORAL CAP,,38893,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PREGABALIN 25 MG ORAL CAP,,38893,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
PREGABALIN 25 MG ORAL CAP,,38893,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
PREGABALIN 25 MG ORAL CAP,,38893,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
PREGABALIN 25 MG ORAL CAP,,38893,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
PREGABALIN 25 MG ORAL CAP,,38893,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
PREGABALIN 25 MG ORAL CAP,,38893,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PREGABALIN 25 MG ORAL CAP,,38893,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
PREGABALIN 25 MG ORAL CAP,,38893,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PREGABALIN 25 MG ORAL CAP,,38893,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PREGABALIN 25 MG ORAL CAP,,38893,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PREGABALIN 25 MG ORAL CAP,,38893,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PREGABALIN 25 MG ORAL CAP,,38893,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
PREGABALIN 25 MG ORAL CAP,,38893,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
PREGABALIN 25 MG ORAL CAP,,38893,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
PREGABALIN 25 MG ORAL CAP,,38893,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
PREGABALIN 25 MG ORAL CAP,,38893,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
PREGABALIN 100 MG ORAL CAP,,38896,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,Aetna,Commercial,5.52,92,,percent of total billed charges,,
PREGABALIN 100 MG ORAL CAP,,38896,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,Aetna,Medicare Advantage,2.94,49,,percent of total billed charges,,
PREGABALIN 100 MG ORAL CAP,,38896,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,Aetna,Medicare Advantage,,,,,Included in per diem rate,
PREGABALIN 100 MG ORAL CAP,,38896,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,Aetna,PPO,5.58,93,,percent of total billed charges,,
PREGABALIN 100 MG ORAL CAP,,38896,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,America's PPO,America's PPO,5.7618,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
PREGABALIN 100 MG ORAL CAP,,38896,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota, Federal Employee Program,5.904,98.4,,percent of total billed charges,,
PREGABALIN 100 MG ORAL CAP,,38896,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,6,100,,percent of total billed charges,,
PREGABALIN 100 MG ORAL CAP,,38896,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota,High Value Network Plan,5.4,90,,percent of total billed charges,,
PREGABALIN 100 MG ORAL CAP,,38896,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota,Medicare Advantage,2.94,49,,percent of total billed charges,,
PREGABALIN 100 MG ORAL CAP,,38896,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
PREGABALIN 100 MG ORAL CAP,,38896,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,5.3142,88.57,,percent of total billed charges,,
PREGABALIN 100 MG ORAL CAP,,38896,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.7196,28.66,,percent of total billed charges,,
PREGABALIN 100 MG ORAL CAP,,38896,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.94,49,,percent of total billed charges,,
PREGABALIN 100 MG ORAL CAP,,38896,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
PREGABALIN 100 MG ORAL CAP,,38896,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,CorVel,Worker's Compensation,6,100,,percent of total billed charges,,
PREGABALIN 100 MG ORAL CAP,,38896,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,First Health Group Corporation,First Health Network,5.82,97,,percent of total billed charges,,
PREGABALIN 100 MG ORAL CAP,,38896,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,"Health Partners, Inc.",Commercial,5.676,94.6,,percent of total billed charges,,
PREGABALIN 100 MG ORAL CAP,,38896,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,"Health Partners, Inc.",Medicare Advantage,2.94,49,,percent of total billed charges,,
PREGABALIN 100 MG ORAL CAP,,38896,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PREGABALIN 100 MG ORAL CAP,,38896,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3.6,60,,percent of total billed charges,,
PREGABALIN 100 MG ORAL CAP,,38896,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,"Health Partners, Inc.",State of Minnesota Advantage Program,4.89,81.5,,percent of total billed charges,,
PREGABALIN 100 MG ORAL CAP,,38896,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,"Health Partners, Inc.",State Public Programs,3,50,,percent of total billed charges,,
PREGABALIN 100 MG ORAL CAP,,38896,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,Humana Insurance Company,Commercial PPO,5.7,95,,percent of total billed charges,,
PREGABALIN 100 MG ORAL CAP,,38896,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,Humana Insurance Company,Medicare PPO,2.94,49,,percent of total billed charges,,
PREGABALIN 100 MG ORAL CAP,,38896,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
PREGABALIN 100 MG ORAL CAP,,38896,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,Medica,Individual & Family,5.946,99.1,,percent of total billed charges,,
PREGABALIN 100 MG ORAL CAP,,38896,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,Medica,Medica Advantage Solution,2.988,49.8,,percent of total billed charges,,
PREGABALIN 100 MG ORAL CAP,,38896,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
PREGABALIN 100 MG ORAL CAP,,38896,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,Medica,Medical Assistance,2.676,44.6,,percent of total billed charges,,
PREGABALIN 100 MG ORAL CAP,,38896,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,Medica,Medical Assistance,,,,,Included in per diem rate,
PREGABALIN 100 MG ORAL CAP,,38896,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.988,49.8,,percent of total billed charges,,
PREGABALIN 100 MG ORAL CAP,,38896,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
PREGABALIN 100 MG ORAL CAP,,38896,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,"Multiplan, Inc.","Multiplan, Inc.",5.64,94,,percent of total billed charges,,
PREGABALIN 100 MG ORAL CAP,,38896,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,5.406,90.1,,percent of total billed charges,,
PREGABALIN 100 MG ORAL CAP,,38896,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
PREGABALIN 100 MG ORAL CAP,,38896,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,"Preferred One Administrative Services, INC.",PPO,5.916,98.6,,percent of total billed charges,,
PREGABALIN 100 MG ORAL CAP,,38896,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,PrimeWest Health,Minnesota Senior Health Options (MSHO),3.087,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
PREGABALIN 100 MG ORAL CAP,,38896,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PREGABALIN 100 MG ORAL CAP,,38896,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,PrimeWest Health,MinnesotaCare,3.0816,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
PREGABALIN 100 MG ORAL CAP,,38896,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
PREGABALIN 100 MG ORAL CAP,,38896,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,Sanford Health Plan,Sanford Health Plan,5.52,92,,percent of total billed charges,,
PREGABALIN 100 MG ORAL CAP,,38896,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,"UCare Health, Inc.",Individual & Family Plan,3.381,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
PREGABALIN 100 MG ORAL CAP,,38896,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
PREGABALIN 100 MG ORAL CAP,,38896,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,"UCare Health, Inc.",Medical Assistance,3.0282,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PREGABALIN 100 MG ORAL CAP,,38896,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
PREGABALIN 100 MG ORAL CAP,,38896,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,"UCare Health, Inc.",Medicare Advantage,3.0282,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PREGABALIN 100 MG ORAL CAP,,38896,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PREGABALIN 100 MG ORAL CAP,,38896,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),3.0282,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PREGABALIN 100 MG ORAL CAP,,38896,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PREGABALIN 100 MG ORAL CAP,,38896,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,UnitedHealthcare,Individual & Family,5.64,94,,percent of total billed charges,,
PREGABALIN 100 MG ORAL CAP,,38896,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,UnitedHealthcare,Medicare Advantage,2.94,49,,percent of total billed charges,,
PREGABALIN 100 MG ORAL CAP,,38896,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
PREGABALIN 100 MG ORAL CAP,,38896,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.88,48,,percent of total billed charges,,100% of DHS outpatient percentage
PREGABALIN 100 MG ORAL CAP,,38896,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
DIAZEPAM 5-7.5-10 MG RECT KIT,,39244,LOCAL,Facility,Both,1,Each,,1516,1288.6,434.4856,1516,Aetna,Commercial,1394.72,92,,percent of total billed charges,,
DIAZEPAM 5-7.5-10 MG RECT KIT,,39244,LOCAL,Facility,Outpatient,1,Each,,1516,1288.6,434.4856,1516,Aetna,Medicare Advantage,742.84,49,,percent of total billed charges,,
DIAZEPAM 5-7.5-10 MG RECT KIT,,39244,LOCAL,Facility,Inpatient,1,Each,,1516,1288.6,434.4856,1516,Aetna,Medicare Advantage,,,,,Included in per diem rate,
DIAZEPAM 5-7.5-10 MG RECT KIT,,39244,LOCAL,Facility,Both,1,Each,,1516,1288.6,434.4856,1516,Aetna,PPO,1409.88,93,,percent of total billed charges,,
DIAZEPAM 5-7.5-10 MG RECT KIT,,39244,LOCAL,Facility,Both,1,Each,,1516,1288.6,434.4856,1516,America's PPO,America's PPO,1455.8148,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
DIAZEPAM 5-7.5-10 MG RECT KIT,,39244,LOCAL,Facility,Both,1,Each,,1516,1288.6,434.4856,1516,BlueCross BlueShield Minnesota, Federal Employee Program,1491.744,98.4,,percent of total billed charges,,
DIAZEPAM 5-7.5-10 MG RECT KIT,,39244,LOCAL,Facility,Both,1,Each,,1516,1288.6,434.4856,1516,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1516,100,,percent of total billed charges,,
DIAZEPAM 5-7.5-10 MG RECT KIT,,39244,LOCAL,Facility,Both,1,Each,,1516,1288.6,434.4856,1516,BlueCross BlueShield Minnesota,High Value Network Plan,1364.4,90,,percent of total billed charges,,
DIAZEPAM 5-7.5-10 MG RECT KIT,,39244,LOCAL,Facility,Outpatient,1,Each,,1516,1288.6,434.4856,1516,BlueCross BlueShield Minnesota,Medicare Advantage,742.84,49,,percent of total billed charges,,
DIAZEPAM 5-7.5-10 MG RECT KIT,,39244,LOCAL,Facility,Inpatient,1,Each,,1516,1288.6,434.4856,1516,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
DIAZEPAM 5-7.5-10 MG RECT KIT,,39244,LOCAL,Facility,Both,1,Each,,1516,1288.6,434.4856,1516,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1342.7212,88.57,,percent of total billed charges,,
DIAZEPAM 5-7.5-10 MG RECT KIT,,39244,LOCAL,Facility,Both,1,Each,,1516,1288.6,434.4856,1516,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,434.4856,28.66,,percent of total billed charges,,
DIAZEPAM 5-7.5-10 MG RECT KIT,,39244,LOCAL,Facility,Outpatient,1,Each,,1516,1288.6,434.4856,1516,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),742.84,49,,percent of total billed charges,,
DIAZEPAM 5-7.5-10 MG RECT KIT,,39244,LOCAL,Facility,Inpatient,1,Each,,1516,1288.6,434.4856,1516,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
DIAZEPAM 5-7.5-10 MG RECT KIT,,39244,LOCAL,Facility,Both,1,Each,,1516,1288.6,434.4856,1516,CorVel,Worker's Compensation,1516,100,,percent of total billed charges,,
DIAZEPAM 5-7.5-10 MG RECT KIT,,39244,LOCAL,Facility,Both,1,Each,,1516,1288.6,434.4856,1516,First Health Group Corporation,First Health Network,1470.52,97,,percent of total billed charges,,
DIAZEPAM 5-7.5-10 MG RECT KIT,,39244,LOCAL,Facility,Both,1,Each,,1516,1288.6,434.4856,1516,"Health Partners, Inc.",Commercial,1434.136,94.6,,percent of total billed charges,,
DIAZEPAM 5-7.5-10 MG RECT KIT,,39244,LOCAL,Facility,Outpatient,1,Each,,1516,1288.6,434.4856,1516,"Health Partners, Inc.",Medicare Advantage,742.84,49,,percent of total billed charges,,
DIAZEPAM 5-7.5-10 MG RECT KIT,,39244,LOCAL,Facility,Inpatient,1,Each,,1516,1288.6,434.4856,1516,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DIAZEPAM 5-7.5-10 MG RECT KIT,,39244,LOCAL,Facility,Both,1,Each,,1516,1288.6,434.4856,1516,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),909.6,60,,percent of total billed charges,,
DIAZEPAM 5-7.5-10 MG RECT KIT,,39244,LOCAL,Facility,Both,1,Each,,1516,1288.6,434.4856,1516,"Health Partners, Inc.",State of Minnesota Advantage Program,1235.54,81.5,,percent of total billed charges,,
DIAZEPAM 5-7.5-10 MG RECT KIT,,39244,LOCAL,Facility,Both,1,Each,,1516,1288.6,434.4856,1516,"Health Partners, Inc.",State Public Programs,758,50,,percent of total billed charges,,
DIAZEPAM 5-7.5-10 MG RECT KIT,,39244,LOCAL,Facility,Both,1,Each,,1516,1288.6,434.4856,1516,Humana Insurance Company,Commercial PPO,1440.2,95,,percent of total billed charges,,
DIAZEPAM 5-7.5-10 MG RECT KIT,,39244,LOCAL,Facility,Outpatient,1,Each,,1516,1288.6,434.4856,1516,Humana Insurance Company,Medicare PPO,742.84,49,,percent of total billed charges,,
DIAZEPAM 5-7.5-10 MG RECT KIT,,39244,LOCAL,Facility,Inpatient,1,Each,,1516,1288.6,434.4856,1516,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
DIAZEPAM 5-7.5-10 MG RECT KIT,,39244,LOCAL,Facility,Both,1,Each,,1516,1288.6,434.4856,1516,Medica,Individual & Family,1502.356,99.1,,percent of total billed charges,,
DIAZEPAM 5-7.5-10 MG RECT KIT,,39244,LOCAL,Facility,Outpatient,1,Each,,1516,1288.6,434.4856,1516,Medica,Medica Advantage Solution,754.968,49.8,,percent of total billed charges,,
DIAZEPAM 5-7.5-10 MG RECT KIT,,39244,LOCAL,Facility,Inpatient,1,Each,,1516,1288.6,434.4856,1516,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
DIAZEPAM 5-7.5-10 MG RECT KIT,,39244,LOCAL,Facility,Outpatient,1,Each,,1516,1288.6,434.4856,1516,Medica,Medical Assistance,676.136,44.6,,percent of total billed charges,,
DIAZEPAM 5-7.5-10 MG RECT KIT,,39244,LOCAL,Facility,Inpatient,1,Each,,1516,1288.6,434.4856,1516,Medica,Medical Assistance,,,,,Included in per diem rate,
DIAZEPAM 5-7.5-10 MG RECT KIT,,39244,LOCAL,Facility,Outpatient,1,Each,,1516,1288.6,434.4856,1516,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,754.968,49.8,,percent of total billed charges,,
DIAZEPAM 5-7.5-10 MG RECT KIT,,39244,LOCAL,Facility,Inpatient,1,Each,,1516,1288.6,434.4856,1516,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
DIAZEPAM 5-7.5-10 MG RECT KIT,,39244,LOCAL,Facility,Both,1,Each,,1516,1288.6,434.4856,1516,"Multiplan, Inc.","Multiplan, Inc.",1425.04,94,,percent of total billed charges,,
DIAZEPAM 5-7.5-10 MG RECT KIT,,39244,LOCAL,Facility,Outpatient,1,Each,,1516,1288.6,434.4856,1516,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1365.916,90.1,,percent of total billed charges,,
DIAZEPAM 5-7.5-10 MG RECT KIT,,39244,LOCAL,Facility,Inpatient,1,Each,,1516,1288.6,434.4856,1516,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
DIAZEPAM 5-7.5-10 MG RECT KIT,,39244,LOCAL,Facility,Both,1,Each,,1516,1288.6,434.4856,1516,"Preferred One Administrative Services, INC.",PPO,1494.776,98.6,,percent of total billed charges,,
DIAZEPAM 5-7.5-10 MG RECT KIT,,39244,LOCAL,Facility,Outpatient,1,Each,,1516,1288.6,434.4856,1516,PrimeWest Health,Minnesota Senior Health Options (MSHO),779.982,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
DIAZEPAM 5-7.5-10 MG RECT KIT,,39244,LOCAL,Facility,Inpatient,1,Each,,1516,1288.6,434.4856,1516,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DIAZEPAM 5-7.5-10 MG RECT KIT,,39244,LOCAL,Facility,Outpatient,1,Each,,1516,1288.6,434.4856,1516,PrimeWest Health,MinnesotaCare,778.6176,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
DIAZEPAM 5-7.5-10 MG RECT KIT,,39244,LOCAL,Facility,Inpatient,1,Each,,1516,1288.6,434.4856,1516,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
DIAZEPAM 5-7.5-10 MG RECT KIT,,39244,LOCAL,Facility,Both,1,Each,,1516,1288.6,434.4856,1516,Sanford Health Plan,Sanford Health Plan,1394.72,92,,percent of total billed charges,,
DIAZEPAM 5-7.5-10 MG RECT KIT,,39244,LOCAL,Facility,Outpatient,1,Each,,1516,1288.6,434.4856,1516,"UCare Health, Inc.",Individual & Family Plan,854.266,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
DIAZEPAM 5-7.5-10 MG RECT KIT,,39244,LOCAL,Facility,Inpatient,1,Each,,1516,1288.6,434.4856,1516,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
DIAZEPAM 5-7.5-10 MG RECT KIT,,39244,LOCAL,Facility,Outpatient,1,Each,,1516,1288.6,434.4856,1516,"UCare Health, Inc.",Medical Assistance,765.1252,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DIAZEPAM 5-7.5-10 MG RECT KIT,,39244,LOCAL,Facility,Inpatient,1,Each,,1516,1288.6,434.4856,1516,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
DIAZEPAM 5-7.5-10 MG RECT KIT,,39244,LOCAL,Facility,Outpatient,1,Each,,1516,1288.6,434.4856,1516,"UCare Health, Inc.",Medicare Advantage,765.1252,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DIAZEPAM 5-7.5-10 MG RECT KIT,,39244,LOCAL,Facility,Inpatient,1,Each,,1516,1288.6,434.4856,1516,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DIAZEPAM 5-7.5-10 MG RECT KIT,,39244,LOCAL,Facility,Outpatient,1,Each,,1516,1288.6,434.4856,1516,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),765.1252,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DIAZEPAM 5-7.5-10 MG RECT KIT,,39244,LOCAL,Facility,Inpatient,1,Each,,1516,1288.6,434.4856,1516,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DIAZEPAM 5-7.5-10 MG RECT KIT,,39244,LOCAL,Facility,Both,1,Each,,1516,1288.6,434.4856,1516,UnitedHealthcare,Individual & Family,1425.04,94,,percent of total billed charges,,
DIAZEPAM 5-7.5-10 MG RECT KIT,,39244,LOCAL,Facility,Outpatient,1,Each,,1516,1288.6,434.4856,1516,UnitedHealthcare,Medicare Advantage,742.84,49,,percent of total billed charges,,
DIAZEPAM 5-7.5-10 MG RECT KIT,,39244,LOCAL,Facility,Inpatient,1,Each,,1516,1288.6,434.4856,1516,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
DIAZEPAM 5-7.5-10 MG RECT KIT,,39244,LOCAL,Facility,Outpatient,1,Each,,1516,1288.6,434.4856,1516,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,727.68,48,,percent of total billed charges,,100% of DHS outpatient percentage
DIAZEPAM 5-7.5-10 MG RECT KIT,,39244,LOCAL,Facility,Inpatient,1,Each,,1516,1288.6,434.4856,1516,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"SODIUM CHLORIDE 1,000 MG MISC TBSO",,65820,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
"SODIUM CHLORIDE 1,000 MG MISC TBSO",,65820,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
"SODIUM CHLORIDE 1,000 MG MISC TBSO",,65820,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"SODIUM CHLORIDE 1,000 MG MISC TBSO",,65820,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
"SODIUM CHLORIDE 1,000 MG MISC TBSO",,65820,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"SODIUM CHLORIDE 1,000 MG MISC TBSO",,65820,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
"SODIUM CHLORIDE 1,000 MG MISC TBSO",,65820,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
"SODIUM CHLORIDE 1,000 MG MISC TBSO",,65820,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
"SODIUM CHLORIDE 1,000 MG MISC TBSO",,65820,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
"SODIUM CHLORIDE 1,000 MG MISC TBSO",,65820,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"SODIUM CHLORIDE 1,000 MG MISC TBSO",,65820,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
"SODIUM CHLORIDE 1,000 MG MISC TBSO",,65820,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
"SODIUM CHLORIDE 1,000 MG MISC TBSO",,65820,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
"SODIUM CHLORIDE 1,000 MG MISC TBSO",,65820,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"SODIUM CHLORIDE 1,000 MG MISC TBSO",,65820,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
"SODIUM CHLORIDE 1,000 MG MISC TBSO",,65820,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
"SODIUM CHLORIDE 1,000 MG MISC TBSO",,65820,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
"SODIUM CHLORIDE 1,000 MG MISC TBSO",,65820,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
"SODIUM CHLORIDE 1,000 MG MISC TBSO",,65820,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"SODIUM CHLORIDE 1,000 MG MISC TBSO",,65820,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
"SODIUM CHLORIDE 1,000 MG MISC TBSO",,65820,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
"SODIUM CHLORIDE 1,000 MG MISC TBSO",,65820,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
"SODIUM CHLORIDE 1,000 MG MISC TBSO",,65820,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
"SODIUM CHLORIDE 1,000 MG MISC TBSO",,65820,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
"SODIUM CHLORIDE 1,000 MG MISC TBSO",,65820,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"SODIUM CHLORIDE 1,000 MG MISC TBSO",,65820,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
"SODIUM CHLORIDE 1,000 MG MISC TBSO",,65820,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
"SODIUM CHLORIDE 1,000 MG MISC TBSO",,65820,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"SODIUM CHLORIDE 1,000 MG MISC TBSO",,65820,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
"SODIUM CHLORIDE 1,000 MG MISC TBSO",,65820,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
"SODIUM CHLORIDE 1,000 MG MISC TBSO",,65820,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
"SODIUM CHLORIDE 1,000 MG MISC TBSO",,65820,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"SODIUM CHLORIDE 1,000 MG MISC TBSO",,65820,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
"SODIUM CHLORIDE 1,000 MG MISC TBSO",,65820,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
"SODIUM CHLORIDE 1,000 MG MISC TBSO",,65820,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"SODIUM CHLORIDE 1,000 MG MISC TBSO",,65820,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
"SODIUM CHLORIDE 1,000 MG MISC TBSO",,65820,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"SODIUM CHLORIDE 1,000 MG MISC TBSO",,65820,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"SODIUM CHLORIDE 1,000 MG MISC TBSO",,65820,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"SODIUM CHLORIDE 1,000 MG MISC TBSO",,65820,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"SODIUM CHLORIDE 1,000 MG MISC TBSO",,65820,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
"SODIUM CHLORIDE 1,000 MG MISC TBSO",,65820,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"SODIUM CHLORIDE 1,000 MG MISC TBSO",,65820,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"SODIUM CHLORIDE 1,000 MG MISC TBSO",,65820,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"SODIUM CHLORIDE 1,000 MG MISC TBSO",,65820,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"SODIUM CHLORIDE 1,000 MG MISC TBSO",,65820,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"SODIUM CHLORIDE 1,000 MG MISC TBSO",,65820,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"SODIUM CHLORIDE 1,000 MG MISC TBSO",,65820,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"SODIUM CHLORIDE 1,000 MG MISC TBSO",,65820,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"SODIUM CHLORIDE 1,000 MG MISC TBSO",,65820,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
"SODIUM CHLORIDE 1,000 MG MISC TBSO",,65820,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
"SODIUM CHLORIDE 1,000 MG MISC TBSO",,65820,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"SODIUM CHLORIDE 1,000 MG MISC TBSO",,65820,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
"SODIUM CHLORIDE 1,000 MG MISC TBSO",,65820,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"VIT A,C AND E-LUTEIN-MINERALS 300 MCG-200 MG-27 MG-2 MG ORAL TABLET",,66593,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
"VIT A,C AND E-LUTEIN-MINERALS 300 MCG-200 MG-27 MG-2 MG ORAL TABLET",,66593,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
"VIT A,C AND E-LUTEIN-MINERALS 300 MCG-200 MG-27 MG-2 MG ORAL TABLET",,66593,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"VIT A,C AND E-LUTEIN-MINERALS 300 MCG-200 MG-27 MG-2 MG ORAL TABLET",,66593,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
"VIT A,C AND E-LUTEIN-MINERALS 300 MCG-200 MG-27 MG-2 MG ORAL TABLET",,66593,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"VIT A,C AND E-LUTEIN-MINERALS 300 MCG-200 MG-27 MG-2 MG ORAL TABLET",,66593,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
"VIT A,C AND E-LUTEIN-MINERALS 300 MCG-200 MG-27 MG-2 MG ORAL TABLET",,66593,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
"VIT A,C AND E-LUTEIN-MINERALS 300 MCG-200 MG-27 MG-2 MG ORAL TABLET",,66593,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
"VIT A,C AND E-LUTEIN-MINERALS 300 MCG-200 MG-27 MG-2 MG ORAL TABLET",,66593,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
"VIT A,C AND E-LUTEIN-MINERALS 300 MCG-200 MG-27 MG-2 MG ORAL TABLET",,66593,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"VIT A,C AND E-LUTEIN-MINERALS 300 MCG-200 MG-27 MG-2 MG ORAL TABLET",,66593,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
"VIT A,C AND E-LUTEIN-MINERALS 300 MCG-200 MG-27 MG-2 MG ORAL TABLET",,66593,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
"VIT A,C AND E-LUTEIN-MINERALS 300 MCG-200 MG-27 MG-2 MG ORAL TABLET",,66593,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
"VIT A,C AND E-LUTEIN-MINERALS 300 MCG-200 MG-27 MG-2 MG ORAL TABLET",,66593,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"VIT A,C AND E-LUTEIN-MINERALS 300 MCG-200 MG-27 MG-2 MG ORAL TABLET",,66593,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
"VIT A,C AND E-LUTEIN-MINERALS 300 MCG-200 MG-27 MG-2 MG ORAL TABLET",,66593,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
"VIT A,C AND E-LUTEIN-MINERALS 300 MCG-200 MG-27 MG-2 MG ORAL TABLET",,66593,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
"VIT A,C AND E-LUTEIN-MINERALS 300 MCG-200 MG-27 MG-2 MG ORAL TABLET",,66593,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
"VIT A,C AND E-LUTEIN-MINERALS 300 MCG-200 MG-27 MG-2 MG ORAL TABLET",,66593,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"VIT A,C AND E-LUTEIN-MINERALS 300 MCG-200 MG-27 MG-2 MG ORAL TABLET",,66593,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
"VIT A,C AND E-LUTEIN-MINERALS 300 MCG-200 MG-27 MG-2 MG ORAL TABLET",,66593,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
"VIT A,C AND E-LUTEIN-MINERALS 300 MCG-200 MG-27 MG-2 MG ORAL TABLET",,66593,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
"VIT A,C AND E-LUTEIN-MINERALS 300 MCG-200 MG-27 MG-2 MG ORAL TABLET",,66593,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
"VIT A,C AND E-LUTEIN-MINERALS 300 MCG-200 MG-27 MG-2 MG ORAL TABLET",,66593,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
"VIT A,C AND E-LUTEIN-MINERALS 300 MCG-200 MG-27 MG-2 MG ORAL TABLET",,66593,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"VIT A,C AND E-LUTEIN-MINERALS 300 MCG-200 MG-27 MG-2 MG ORAL TABLET",,66593,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
"VIT A,C AND E-LUTEIN-MINERALS 300 MCG-200 MG-27 MG-2 MG ORAL TABLET",,66593,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
"VIT A,C AND E-LUTEIN-MINERALS 300 MCG-200 MG-27 MG-2 MG ORAL TABLET",,66593,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"VIT A,C AND E-LUTEIN-MINERALS 300 MCG-200 MG-27 MG-2 MG ORAL TABLET",,66593,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
"VIT A,C AND E-LUTEIN-MINERALS 300 MCG-200 MG-27 MG-2 MG ORAL TABLET",,66593,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
"VIT A,C AND E-LUTEIN-MINERALS 300 MCG-200 MG-27 MG-2 MG ORAL TABLET",,66593,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
"VIT A,C AND E-LUTEIN-MINERALS 300 MCG-200 MG-27 MG-2 MG ORAL TABLET",,66593,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"VIT A,C AND E-LUTEIN-MINERALS 300 MCG-200 MG-27 MG-2 MG ORAL TABLET",,66593,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
"VIT A,C AND E-LUTEIN-MINERALS 300 MCG-200 MG-27 MG-2 MG ORAL TABLET",,66593,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
"VIT A,C AND E-LUTEIN-MINERALS 300 MCG-200 MG-27 MG-2 MG ORAL TABLET",,66593,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"VIT A,C AND E-LUTEIN-MINERALS 300 MCG-200 MG-27 MG-2 MG ORAL TABLET",,66593,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
"VIT A,C AND E-LUTEIN-MINERALS 300 MCG-200 MG-27 MG-2 MG ORAL TABLET",,66593,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"VIT A,C AND E-LUTEIN-MINERALS 300 MCG-200 MG-27 MG-2 MG ORAL TABLET",,66593,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"VIT A,C AND E-LUTEIN-MINERALS 300 MCG-200 MG-27 MG-2 MG ORAL TABLET",,66593,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"VIT A,C AND E-LUTEIN-MINERALS 300 MCG-200 MG-27 MG-2 MG ORAL TABLET",,66593,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"VIT A,C AND E-LUTEIN-MINERALS 300 MCG-200 MG-27 MG-2 MG ORAL TABLET",,66593,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
"VIT A,C AND E-LUTEIN-MINERALS 300 MCG-200 MG-27 MG-2 MG ORAL TABLET",,66593,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"VIT A,C AND E-LUTEIN-MINERALS 300 MCG-200 MG-27 MG-2 MG ORAL TABLET",,66593,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"VIT A,C AND E-LUTEIN-MINERALS 300 MCG-200 MG-27 MG-2 MG ORAL TABLET",,66593,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"VIT A,C AND E-LUTEIN-MINERALS 300 MCG-200 MG-27 MG-2 MG ORAL TABLET",,66593,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"VIT A,C AND E-LUTEIN-MINERALS 300 MCG-200 MG-27 MG-2 MG ORAL TABLET",,66593,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"VIT A,C AND E-LUTEIN-MINERALS 300 MCG-200 MG-27 MG-2 MG ORAL TABLET",,66593,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"VIT A,C AND E-LUTEIN-MINERALS 300 MCG-200 MG-27 MG-2 MG ORAL TABLET",,66593,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"VIT A,C AND E-LUTEIN-MINERALS 300 MCG-200 MG-27 MG-2 MG ORAL TABLET",,66593,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"VIT A,C AND E-LUTEIN-MINERALS 300 MCG-200 MG-27 MG-2 MG ORAL TABLET",,66593,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
"VIT A,C AND E-LUTEIN-MINERALS 300 MCG-200 MG-27 MG-2 MG ORAL TABLET",,66593,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
"VIT A,C AND E-LUTEIN-MINERALS 300 MCG-200 MG-27 MG-2 MG ORAL TABLET",,66593,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"VIT A,C AND E-LUTEIN-MINERALS 300 MCG-200 MG-27 MG-2 MG ORAL TABLET",,66593,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
"VIT A,C AND E-LUTEIN-MINERALS 300 MCG-200 MG-27 MG-2 MG ORAL TABLET",,66593,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
SACCHAROMYCES BOULARDII 250 MG ORAL PWPK,,66862,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,Aetna,Commercial,5.52,92,,percent of total billed charges,,
SACCHAROMYCES BOULARDII 250 MG ORAL PWPK,,66862,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,Aetna,Medicare Advantage,2.94,49,,percent of total billed charges,,
SACCHAROMYCES BOULARDII 250 MG ORAL PWPK,,66862,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,Aetna,Medicare Advantage,,,,,Included in per diem rate,
SACCHAROMYCES BOULARDII 250 MG ORAL PWPK,,66862,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,Aetna,PPO,5.58,93,,percent of total billed charges,,
SACCHAROMYCES BOULARDII 250 MG ORAL PWPK,,66862,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,America's PPO,America's PPO,5.7618,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SACCHAROMYCES BOULARDII 250 MG ORAL PWPK,,66862,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota, Federal Employee Program,5.904,98.4,,percent of total billed charges,,
SACCHAROMYCES BOULARDII 250 MG ORAL PWPK,,66862,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,6,100,,percent of total billed charges,,
SACCHAROMYCES BOULARDII 250 MG ORAL PWPK,,66862,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota,High Value Network Plan,5.4,90,,percent of total billed charges,,
SACCHAROMYCES BOULARDII 250 MG ORAL PWPK,,66862,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota,Medicare Advantage,2.94,49,,percent of total billed charges,,
SACCHAROMYCES BOULARDII 250 MG ORAL PWPK,,66862,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
SACCHAROMYCES BOULARDII 250 MG ORAL PWPK,,66862,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,5.3142,88.57,,percent of total billed charges,,
SACCHAROMYCES BOULARDII 250 MG ORAL PWPK,,66862,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.7196,28.66,,percent of total billed charges,,
SACCHAROMYCES BOULARDII 250 MG ORAL PWPK,,66862,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.94,49,,percent of total billed charges,,
SACCHAROMYCES BOULARDII 250 MG ORAL PWPK,,66862,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
SACCHAROMYCES BOULARDII 250 MG ORAL PWPK,,66862,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,CorVel,Worker's Compensation,6,100,,percent of total billed charges,,
SACCHAROMYCES BOULARDII 250 MG ORAL PWPK,,66862,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,First Health Group Corporation,First Health Network,5.82,97,,percent of total billed charges,,
SACCHAROMYCES BOULARDII 250 MG ORAL PWPK,,66862,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,"Health Partners, Inc.",Commercial,5.676,94.6,,percent of total billed charges,,
SACCHAROMYCES BOULARDII 250 MG ORAL PWPK,,66862,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,"Health Partners, Inc.",Medicare Advantage,2.94,49,,percent of total billed charges,,
SACCHAROMYCES BOULARDII 250 MG ORAL PWPK,,66862,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SACCHAROMYCES BOULARDII 250 MG ORAL PWPK,,66862,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3.6,60,,percent of total billed charges,,
SACCHAROMYCES BOULARDII 250 MG ORAL PWPK,,66862,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,"Health Partners, Inc.",State of Minnesota Advantage Program,4.89,81.5,,percent of total billed charges,,
SACCHAROMYCES BOULARDII 250 MG ORAL PWPK,,66862,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,"Health Partners, Inc.",State Public Programs,3,50,,percent of total billed charges,,
SACCHAROMYCES BOULARDII 250 MG ORAL PWPK,,66862,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,Humana Insurance Company,Commercial PPO,5.7,95,,percent of total billed charges,,
SACCHAROMYCES BOULARDII 250 MG ORAL PWPK,,66862,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,Humana Insurance Company,Medicare PPO,2.94,49,,percent of total billed charges,,
SACCHAROMYCES BOULARDII 250 MG ORAL PWPK,,66862,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
SACCHAROMYCES BOULARDII 250 MG ORAL PWPK,,66862,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,Medica,Individual & Family,5.946,99.1,,percent of total billed charges,,
SACCHAROMYCES BOULARDII 250 MG ORAL PWPK,,66862,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,Medica,Medica Advantage Solution,2.988,49.8,,percent of total billed charges,,
SACCHAROMYCES BOULARDII 250 MG ORAL PWPK,,66862,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
SACCHAROMYCES BOULARDII 250 MG ORAL PWPK,,66862,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,Medica,Medical Assistance,2.676,44.6,,percent of total billed charges,,
SACCHAROMYCES BOULARDII 250 MG ORAL PWPK,,66862,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,Medica,Medical Assistance,,,,,Included in per diem rate,
SACCHAROMYCES BOULARDII 250 MG ORAL PWPK,,66862,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.988,49.8,,percent of total billed charges,,
SACCHAROMYCES BOULARDII 250 MG ORAL PWPK,,66862,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
SACCHAROMYCES BOULARDII 250 MG ORAL PWPK,,66862,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,"Multiplan, Inc.","Multiplan, Inc.",5.64,94,,percent of total billed charges,,
SACCHAROMYCES BOULARDII 250 MG ORAL PWPK,,66862,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,5.406,90.1,,percent of total billed charges,,
SACCHAROMYCES BOULARDII 250 MG ORAL PWPK,,66862,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
SACCHAROMYCES BOULARDII 250 MG ORAL PWPK,,66862,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,"Preferred One Administrative Services, INC.",PPO,5.916,98.6,,percent of total billed charges,,
SACCHAROMYCES BOULARDII 250 MG ORAL PWPK,,66862,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,PrimeWest Health,Minnesota Senior Health Options (MSHO),3.087,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
SACCHAROMYCES BOULARDII 250 MG ORAL PWPK,,66862,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SACCHAROMYCES BOULARDII 250 MG ORAL PWPK,,66862,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,PrimeWest Health,MinnesotaCare,3.0816,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
SACCHAROMYCES BOULARDII 250 MG ORAL PWPK,,66862,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
SACCHAROMYCES BOULARDII 250 MG ORAL PWPK,,66862,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,Sanford Health Plan,Sanford Health Plan,5.52,92,,percent of total billed charges,,
SACCHAROMYCES BOULARDII 250 MG ORAL PWPK,,66862,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,"UCare Health, Inc.",Individual & Family Plan,3.381,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
SACCHAROMYCES BOULARDII 250 MG ORAL PWPK,,66862,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
SACCHAROMYCES BOULARDII 250 MG ORAL PWPK,,66862,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,"UCare Health, Inc.",Medical Assistance,3.0282,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SACCHAROMYCES BOULARDII 250 MG ORAL PWPK,,66862,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
SACCHAROMYCES BOULARDII 250 MG ORAL PWPK,,66862,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,"UCare Health, Inc.",Medicare Advantage,3.0282,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SACCHAROMYCES BOULARDII 250 MG ORAL PWPK,,66862,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SACCHAROMYCES BOULARDII 250 MG ORAL PWPK,,66862,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),3.0282,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SACCHAROMYCES BOULARDII 250 MG ORAL PWPK,,66862,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SACCHAROMYCES BOULARDII 250 MG ORAL PWPK,,66862,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,UnitedHealthcare,Individual & Family,5.64,94,,percent of total billed charges,,
SACCHAROMYCES BOULARDII 250 MG ORAL PWPK,,66862,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,UnitedHealthcare,Medicare Advantage,2.94,49,,percent of total billed charges,,
SACCHAROMYCES BOULARDII 250 MG ORAL PWPK,,66862,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
SACCHAROMYCES BOULARDII 250 MG ORAL PWPK,,66862,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.88,48,,percent of total billed charges,,100% of DHS outpatient percentage
SACCHAROMYCES BOULARDII 250 MG ORAL PWPK,,66862,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5-400-5,000 MG-UNIT-UNIT TOP OIPK",,68026,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5-400-5,000 MG-UNIT-UNIT TOP OIPK",,68026,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5-400-5,000 MG-UNIT-UNIT TOP OIPK",,68026,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5-400-5,000 MG-UNIT-UNIT TOP OIPK",,68026,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5-400-5,000 MG-UNIT-UNIT TOP OIPK",,68026,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5-400-5,000 MG-UNIT-UNIT TOP OIPK",,68026,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5-400-5,000 MG-UNIT-UNIT TOP OIPK",,68026,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5-400-5,000 MG-UNIT-UNIT TOP OIPK",,68026,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5-400-5,000 MG-UNIT-UNIT TOP OIPK",,68026,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5-400-5,000 MG-UNIT-UNIT TOP OIPK",,68026,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5-400-5,000 MG-UNIT-UNIT TOP OIPK",,68026,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5-400-5,000 MG-UNIT-UNIT TOP OIPK",,68026,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5-400-5,000 MG-UNIT-UNIT TOP OIPK",,68026,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5-400-5,000 MG-UNIT-UNIT TOP OIPK",,68026,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5-400-5,000 MG-UNIT-UNIT TOP OIPK",,68026,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5-400-5,000 MG-UNIT-UNIT TOP OIPK",,68026,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5-400-5,000 MG-UNIT-UNIT TOP OIPK",,68026,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5-400-5,000 MG-UNIT-UNIT TOP OIPK",,68026,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5-400-5,000 MG-UNIT-UNIT TOP OIPK",,68026,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5-400-5,000 MG-UNIT-UNIT TOP OIPK",,68026,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5-400-5,000 MG-UNIT-UNIT TOP OIPK",,68026,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5-400-5,000 MG-UNIT-UNIT TOP OIPK",,68026,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5-400-5,000 MG-UNIT-UNIT TOP OIPK",,68026,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5-400-5,000 MG-UNIT-UNIT TOP OIPK",,68026,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5-400-5,000 MG-UNIT-UNIT TOP OIPK",,68026,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5-400-5,000 MG-UNIT-UNIT TOP OIPK",,68026,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5-400-5,000 MG-UNIT-UNIT TOP OIPK",,68026,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5-400-5,000 MG-UNIT-UNIT TOP OIPK",,68026,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5-400-5,000 MG-UNIT-UNIT TOP OIPK",,68026,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5-400-5,000 MG-UNIT-UNIT TOP OIPK",,68026,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5-400-5,000 MG-UNIT-UNIT TOP OIPK",,68026,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5-400-5,000 MG-UNIT-UNIT TOP OIPK",,68026,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5-400-5,000 MG-UNIT-UNIT TOP OIPK",,68026,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5-400-5,000 MG-UNIT-UNIT TOP OIPK",,68026,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5-400-5,000 MG-UNIT-UNIT TOP OIPK",,68026,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5-400-5,000 MG-UNIT-UNIT TOP OIPK",,68026,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5-400-5,000 MG-UNIT-UNIT TOP OIPK",,68026,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5-400-5,000 MG-UNIT-UNIT TOP OIPK",,68026,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5-400-5,000 MG-UNIT-UNIT TOP OIPK",,68026,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5-400-5,000 MG-UNIT-UNIT TOP OIPK",,68026,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5-400-5,000 MG-UNIT-UNIT TOP OIPK",,68026,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5-400-5,000 MG-UNIT-UNIT TOP OIPK",,68026,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5-400-5,000 MG-UNIT-UNIT TOP OIPK",,68026,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5-400-5,000 MG-UNIT-UNIT TOP OIPK",,68026,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5-400-5,000 MG-UNIT-UNIT TOP OIPK",,68026,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5-400-5,000 MG-UNIT-UNIT TOP OIPK",,68026,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5-400-5,000 MG-UNIT-UNIT TOP OIPK",,68026,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5-400-5,000 MG-UNIT-UNIT TOP OIPK",,68026,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5-400-5,000 MG-UNIT-UNIT TOP OIPK",,68026,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5-400-5,000 MG-UNIT-UNIT TOP OIPK",,68026,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5-400-5,000 MG-UNIT-UNIT TOP OIPK",,68026,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5-400-5,000 MG-UNIT-UNIT TOP OIPK",,68026,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5-400-5,000 MG-UNIT-UNIT TOP OIPK",,68026,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5-400-5,000 MG-UNIT-UNIT TOP OIPK",,68026,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) ORAL TABLET",,68109,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
"CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) ORAL TABLET",,68109,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
"CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) ORAL TABLET",,68109,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) ORAL TABLET",,68109,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
"CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) ORAL TABLET",,68109,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) ORAL TABLET",,68109,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
"CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) ORAL TABLET",,68109,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
"CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) ORAL TABLET",,68109,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
"CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) ORAL TABLET",,68109,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
"CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) ORAL TABLET",,68109,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) ORAL TABLET",,68109,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
"CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) ORAL TABLET",,68109,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
"CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) ORAL TABLET",,68109,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
"CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) ORAL TABLET",,68109,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) ORAL TABLET",,68109,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
"CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) ORAL TABLET",,68109,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
"CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) ORAL TABLET",,68109,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
"CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) ORAL TABLET",,68109,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
"CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) ORAL TABLET",,68109,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) ORAL TABLET",,68109,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
"CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) ORAL TABLET",,68109,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
"CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) ORAL TABLET",,68109,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
"CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) ORAL TABLET",,68109,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
"CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) ORAL TABLET",,68109,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
"CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) ORAL TABLET",,68109,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) ORAL TABLET",,68109,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
"CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) ORAL TABLET",,68109,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
"CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) ORAL TABLET",,68109,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) ORAL TABLET",,68109,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
"CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) ORAL TABLET",,68109,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
"CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) ORAL TABLET",,68109,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
"CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) ORAL TABLET",,68109,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) ORAL TABLET",,68109,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
"CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) ORAL TABLET",,68109,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
"CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) ORAL TABLET",,68109,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) ORAL TABLET",,68109,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
"CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) ORAL TABLET",,68109,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) ORAL TABLET",,68109,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) ORAL TABLET",,68109,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) ORAL TABLET",,68109,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) ORAL TABLET",,68109,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
"CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) ORAL TABLET",,68109,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) ORAL TABLET",,68109,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) ORAL TABLET",,68109,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) ORAL TABLET",,68109,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) ORAL TABLET",,68109,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) ORAL TABLET",,68109,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) ORAL TABLET",,68109,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) ORAL TABLET",,68109,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) ORAL TABLET",,68109,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
"CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) ORAL TABLET",,68109,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
"CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) ORAL TABLET",,68109,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) ORAL TABLET",,68109,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
"CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) ORAL TABLET",,68109,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
SITAGLIPTIN PHOSPHATE 25 MG ORAL TABLET,,68209,LOCAL,Facility,Both,1,Each,,99,84.15,28.3734,99,Aetna,Commercial,91.08,92,,percent of total billed charges,,
SITAGLIPTIN PHOSPHATE 25 MG ORAL TABLET,,68209,LOCAL,Facility,Outpatient,1,Each,,99,84.15,28.3734,99,Aetna,Medicare Advantage,48.51,49,,percent of total billed charges,,
SITAGLIPTIN PHOSPHATE 25 MG ORAL TABLET,,68209,LOCAL,Facility,Inpatient,1,Each,,99,84.15,28.3734,99,Aetna,Medicare Advantage,,,,,Included in per diem rate,
SITAGLIPTIN PHOSPHATE 25 MG ORAL TABLET,,68209,LOCAL,Facility,Both,1,Each,,99,84.15,28.3734,99,Aetna,PPO,92.07,93,,percent of total billed charges,,
SITAGLIPTIN PHOSPHATE 25 MG ORAL TABLET,,68209,LOCAL,Facility,Both,1,Each,,99,84.15,28.3734,99,America's PPO,America's PPO,95.0697,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SITAGLIPTIN PHOSPHATE 25 MG ORAL TABLET,,68209,LOCAL,Facility,Both,1,Each,,99,84.15,28.3734,99,BlueCross BlueShield Minnesota, Federal Employee Program,97.416,98.4,,percent of total billed charges,,
SITAGLIPTIN PHOSPHATE 25 MG ORAL TABLET,,68209,LOCAL,Facility,Both,1,Each,,99,84.15,28.3734,99,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,99,100,,percent of total billed charges,,
SITAGLIPTIN PHOSPHATE 25 MG ORAL TABLET,,68209,LOCAL,Facility,Both,1,Each,,99,84.15,28.3734,99,BlueCross BlueShield Minnesota,High Value Network Plan,89.1,90,,percent of total billed charges,,
SITAGLIPTIN PHOSPHATE 25 MG ORAL TABLET,,68209,LOCAL,Facility,Outpatient,1,Each,,99,84.15,28.3734,99,BlueCross BlueShield Minnesota,Medicare Advantage,48.51,49,,percent of total billed charges,,
SITAGLIPTIN PHOSPHATE 25 MG ORAL TABLET,,68209,LOCAL,Facility,Inpatient,1,Each,,99,84.15,28.3734,99,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
SITAGLIPTIN PHOSPHATE 25 MG ORAL TABLET,,68209,LOCAL,Facility,Both,1,Each,,99,84.15,28.3734,99,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,87.6843,88.57,,percent of total billed charges,,
SITAGLIPTIN PHOSPHATE 25 MG ORAL TABLET,,68209,LOCAL,Facility,Both,1,Each,,99,84.15,28.3734,99,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,28.3734,28.66,,percent of total billed charges,,
SITAGLIPTIN PHOSPHATE 25 MG ORAL TABLET,,68209,LOCAL,Facility,Outpatient,1,Each,,99,84.15,28.3734,99,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),48.51,49,,percent of total billed charges,,
SITAGLIPTIN PHOSPHATE 25 MG ORAL TABLET,,68209,LOCAL,Facility,Inpatient,1,Each,,99,84.15,28.3734,99,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
SITAGLIPTIN PHOSPHATE 25 MG ORAL TABLET,,68209,LOCAL,Facility,Both,1,Each,,99,84.15,28.3734,99,CorVel,Worker's Compensation,99,100,,percent of total billed charges,,
SITAGLIPTIN PHOSPHATE 25 MG ORAL TABLET,,68209,LOCAL,Facility,Both,1,Each,,99,84.15,28.3734,99,First Health Group Corporation,First Health Network,96.03,97,,percent of total billed charges,,
SITAGLIPTIN PHOSPHATE 25 MG ORAL TABLET,,68209,LOCAL,Facility,Both,1,Each,,99,84.15,28.3734,99,"Health Partners, Inc.",Commercial,93.654,94.6,,percent of total billed charges,,
SITAGLIPTIN PHOSPHATE 25 MG ORAL TABLET,,68209,LOCAL,Facility,Outpatient,1,Each,,99,84.15,28.3734,99,"Health Partners, Inc.",Medicare Advantage,48.51,49,,percent of total billed charges,,
SITAGLIPTIN PHOSPHATE 25 MG ORAL TABLET,,68209,LOCAL,Facility,Inpatient,1,Each,,99,84.15,28.3734,99,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SITAGLIPTIN PHOSPHATE 25 MG ORAL TABLET,,68209,LOCAL,Facility,Both,1,Each,,99,84.15,28.3734,99,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),59.4,60,,percent of total billed charges,,
SITAGLIPTIN PHOSPHATE 25 MG ORAL TABLET,,68209,LOCAL,Facility,Both,1,Each,,99,84.15,28.3734,99,"Health Partners, Inc.",State of Minnesota Advantage Program,80.685,81.5,,percent of total billed charges,,
SITAGLIPTIN PHOSPHATE 25 MG ORAL TABLET,,68209,LOCAL,Facility,Both,1,Each,,99,84.15,28.3734,99,"Health Partners, Inc.",State Public Programs,49.5,50,,percent of total billed charges,,
SITAGLIPTIN PHOSPHATE 25 MG ORAL TABLET,,68209,LOCAL,Facility,Both,1,Each,,99,84.15,28.3734,99,Humana Insurance Company,Commercial PPO,94.05,95,,percent of total billed charges,,
SITAGLIPTIN PHOSPHATE 25 MG ORAL TABLET,,68209,LOCAL,Facility,Outpatient,1,Each,,99,84.15,28.3734,99,Humana Insurance Company,Medicare PPO,48.51,49,,percent of total billed charges,,
SITAGLIPTIN PHOSPHATE 25 MG ORAL TABLET,,68209,LOCAL,Facility,Inpatient,1,Each,,99,84.15,28.3734,99,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
SITAGLIPTIN PHOSPHATE 25 MG ORAL TABLET,,68209,LOCAL,Facility,Both,1,Each,,99,84.15,28.3734,99,Medica,Individual & Family,98.109,99.1,,percent of total billed charges,,
SITAGLIPTIN PHOSPHATE 25 MG ORAL TABLET,,68209,LOCAL,Facility,Outpatient,1,Each,,99,84.15,28.3734,99,Medica,Medica Advantage Solution,49.302,49.8,,percent of total billed charges,,
SITAGLIPTIN PHOSPHATE 25 MG ORAL TABLET,,68209,LOCAL,Facility,Inpatient,1,Each,,99,84.15,28.3734,99,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
SITAGLIPTIN PHOSPHATE 25 MG ORAL TABLET,,68209,LOCAL,Facility,Outpatient,1,Each,,99,84.15,28.3734,99,Medica,Medical Assistance,44.154,44.6,,percent of total billed charges,,
SITAGLIPTIN PHOSPHATE 25 MG ORAL TABLET,,68209,LOCAL,Facility,Inpatient,1,Each,,99,84.15,28.3734,99,Medica,Medical Assistance,,,,,Included in per diem rate,
SITAGLIPTIN PHOSPHATE 25 MG ORAL TABLET,,68209,LOCAL,Facility,Outpatient,1,Each,,99,84.15,28.3734,99,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,49.302,49.8,,percent of total billed charges,,
SITAGLIPTIN PHOSPHATE 25 MG ORAL TABLET,,68209,LOCAL,Facility,Inpatient,1,Each,,99,84.15,28.3734,99,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
SITAGLIPTIN PHOSPHATE 25 MG ORAL TABLET,,68209,LOCAL,Facility,Both,1,Each,,99,84.15,28.3734,99,"Multiplan, Inc.","Multiplan, Inc.",93.06,94,,percent of total billed charges,,
SITAGLIPTIN PHOSPHATE 25 MG ORAL TABLET,,68209,LOCAL,Facility,Outpatient,1,Each,,99,84.15,28.3734,99,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,89.199,90.1,,percent of total billed charges,,
SITAGLIPTIN PHOSPHATE 25 MG ORAL TABLET,,68209,LOCAL,Facility,Inpatient,1,Each,,99,84.15,28.3734,99,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
SITAGLIPTIN PHOSPHATE 25 MG ORAL TABLET,,68209,LOCAL,Facility,Both,1,Each,,99,84.15,28.3734,99,"Preferred One Administrative Services, INC.",PPO,97.614,98.6,,percent of total billed charges,,
SITAGLIPTIN PHOSPHATE 25 MG ORAL TABLET,,68209,LOCAL,Facility,Outpatient,1,Each,,99,84.15,28.3734,99,PrimeWest Health,Minnesota Senior Health Options (MSHO),50.9355,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
SITAGLIPTIN PHOSPHATE 25 MG ORAL TABLET,,68209,LOCAL,Facility,Inpatient,1,Each,,99,84.15,28.3734,99,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SITAGLIPTIN PHOSPHATE 25 MG ORAL TABLET,,68209,LOCAL,Facility,Outpatient,1,Each,,99,84.15,28.3734,99,PrimeWest Health,MinnesotaCare,50.8464,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
SITAGLIPTIN PHOSPHATE 25 MG ORAL TABLET,,68209,LOCAL,Facility,Inpatient,1,Each,,99,84.15,28.3734,99,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
SITAGLIPTIN PHOSPHATE 25 MG ORAL TABLET,,68209,LOCAL,Facility,Both,1,Each,,99,84.15,28.3734,99,Sanford Health Plan,Sanford Health Plan,91.08,92,,percent of total billed charges,,
SITAGLIPTIN PHOSPHATE 25 MG ORAL TABLET,,68209,LOCAL,Facility,Outpatient,1,Each,,99,84.15,28.3734,99,"UCare Health, Inc.",Individual & Family Plan,55.7865,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
SITAGLIPTIN PHOSPHATE 25 MG ORAL TABLET,,68209,LOCAL,Facility,Inpatient,1,Each,,99,84.15,28.3734,99,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
SITAGLIPTIN PHOSPHATE 25 MG ORAL TABLET,,68209,LOCAL,Facility,Outpatient,1,Each,,99,84.15,28.3734,99,"UCare Health, Inc.",Medical Assistance,49.9653,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SITAGLIPTIN PHOSPHATE 25 MG ORAL TABLET,,68209,LOCAL,Facility,Inpatient,1,Each,,99,84.15,28.3734,99,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
SITAGLIPTIN PHOSPHATE 25 MG ORAL TABLET,,68209,LOCAL,Facility,Outpatient,1,Each,,99,84.15,28.3734,99,"UCare Health, Inc.",Medicare Advantage,49.9653,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SITAGLIPTIN PHOSPHATE 25 MG ORAL TABLET,,68209,LOCAL,Facility,Inpatient,1,Each,,99,84.15,28.3734,99,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SITAGLIPTIN PHOSPHATE 25 MG ORAL TABLET,,68209,LOCAL,Facility,Outpatient,1,Each,,99,84.15,28.3734,99,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),49.9653,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SITAGLIPTIN PHOSPHATE 25 MG ORAL TABLET,,68209,LOCAL,Facility,Inpatient,1,Each,,99,84.15,28.3734,99,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SITAGLIPTIN PHOSPHATE 25 MG ORAL TABLET,,68209,LOCAL,Facility,Both,1,Each,,99,84.15,28.3734,99,UnitedHealthcare,Individual & Family,93.06,94,,percent of total billed charges,,
SITAGLIPTIN PHOSPHATE 25 MG ORAL TABLET,,68209,LOCAL,Facility,Outpatient,1,Each,,99,84.15,28.3734,99,UnitedHealthcare,Medicare Advantage,48.51,49,,percent of total billed charges,,
SITAGLIPTIN PHOSPHATE 25 MG ORAL TABLET,,68209,LOCAL,Facility,Inpatient,1,Each,,99,84.15,28.3734,99,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
SITAGLIPTIN PHOSPHATE 25 MG ORAL TABLET,,68209,LOCAL,Facility,Outpatient,1,Each,,99,84.15,28.3734,99,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,47.52,48,,percent of total billed charges,,100% of DHS outpatient percentage
SITAGLIPTIN PHOSPHATE 25 MG ORAL TABLET,,68209,LOCAL,Facility,Inpatient,1,Each,,99,84.15,28.3734,99,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
FERROUS GLUCONATE 324 MG (38 MG IRON) ORAL TABLET,,68309,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
FERROUS GLUCONATE 324 MG (38 MG IRON) ORAL TABLET,,68309,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
FERROUS GLUCONATE 324 MG (38 MG IRON) ORAL TABLET,,68309,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
FERROUS GLUCONATE 324 MG (38 MG IRON) ORAL TABLET,,68309,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
FERROUS GLUCONATE 324 MG (38 MG IRON) ORAL TABLET,,68309,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
FERROUS GLUCONATE 324 MG (38 MG IRON) ORAL TABLET,,68309,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
FERROUS GLUCONATE 324 MG (38 MG IRON) ORAL TABLET,,68309,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
FERROUS GLUCONATE 324 MG (38 MG IRON) ORAL TABLET,,68309,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
FERROUS GLUCONATE 324 MG (38 MG IRON) ORAL TABLET,,68309,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
FERROUS GLUCONATE 324 MG (38 MG IRON) ORAL TABLET,,68309,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
FERROUS GLUCONATE 324 MG (38 MG IRON) ORAL TABLET,,68309,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
FERROUS GLUCONATE 324 MG (38 MG IRON) ORAL TABLET,,68309,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
FERROUS GLUCONATE 324 MG (38 MG IRON) ORAL TABLET,,68309,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
FERROUS GLUCONATE 324 MG (38 MG IRON) ORAL TABLET,,68309,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
FERROUS GLUCONATE 324 MG (38 MG IRON) ORAL TABLET,,68309,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
FERROUS GLUCONATE 324 MG (38 MG IRON) ORAL TABLET,,68309,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
FERROUS GLUCONATE 324 MG (38 MG IRON) ORAL TABLET,,68309,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
FERROUS GLUCONATE 324 MG (38 MG IRON) ORAL TABLET,,68309,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
FERROUS GLUCONATE 324 MG (38 MG IRON) ORAL TABLET,,68309,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
FERROUS GLUCONATE 324 MG (38 MG IRON) ORAL TABLET,,68309,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
FERROUS GLUCONATE 324 MG (38 MG IRON) ORAL TABLET,,68309,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
FERROUS GLUCONATE 324 MG (38 MG IRON) ORAL TABLET,,68309,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
FERROUS GLUCONATE 324 MG (38 MG IRON) ORAL TABLET,,68309,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
FERROUS GLUCONATE 324 MG (38 MG IRON) ORAL TABLET,,68309,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
FERROUS GLUCONATE 324 MG (38 MG IRON) ORAL TABLET,,68309,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
FERROUS GLUCONATE 324 MG (38 MG IRON) ORAL TABLET,,68309,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
FERROUS GLUCONATE 324 MG (38 MG IRON) ORAL TABLET,,68309,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
FERROUS GLUCONATE 324 MG (38 MG IRON) ORAL TABLET,,68309,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
FERROUS GLUCONATE 324 MG (38 MG IRON) ORAL TABLET,,68309,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
FERROUS GLUCONATE 324 MG (38 MG IRON) ORAL TABLET,,68309,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
FERROUS GLUCONATE 324 MG (38 MG IRON) ORAL TABLET,,68309,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
FERROUS GLUCONATE 324 MG (38 MG IRON) ORAL TABLET,,68309,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
FERROUS GLUCONATE 324 MG (38 MG IRON) ORAL TABLET,,68309,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
FERROUS GLUCONATE 324 MG (38 MG IRON) ORAL TABLET,,68309,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
FERROUS GLUCONATE 324 MG (38 MG IRON) ORAL TABLET,,68309,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
FERROUS GLUCONATE 324 MG (38 MG IRON) ORAL TABLET,,68309,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
FERROUS GLUCONATE 324 MG (38 MG IRON) ORAL TABLET,,68309,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
FERROUS GLUCONATE 324 MG (38 MG IRON) ORAL TABLET,,68309,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
FERROUS GLUCONATE 324 MG (38 MG IRON) ORAL TABLET,,68309,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
FERROUS GLUCONATE 324 MG (38 MG IRON) ORAL TABLET,,68309,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
FERROUS GLUCONATE 324 MG (38 MG IRON) ORAL TABLET,,68309,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
FERROUS GLUCONATE 324 MG (38 MG IRON) ORAL TABLET,,68309,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
FERROUS GLUCONATE 324 MG (38 MG IRON) ORAL TABLET,,68309,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
FERROUS GLUCONATE 324 MG (38 MG IRON) ORAL TABLET,,68309,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FERROUS GLUCONATE 324 MG (38 MG IRON) ORAL TABLET,,68309,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
FERROUS GLUCONATE 324 MG (38 MG IRON) ORAL TABLET,,68309,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FERROUS GLUCONATE 324 MG (38 MG IRON) ORAL TABLET,,68309,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
FERROUS GLUCONATE 324 MG (38 MG IRON) ORAL TABLET,,68309,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FERROUS GLUCONATE 324 MG (38 MG IRON) ORAL TABLET,,68309,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
FERROUS GLUCONATE 324 MG (38 MG IRON) ORAL TABLET,,68309,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
FERROUS GLUCONATE 324 MG (38 MG IRON) ORAL TABLET,,68309,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
FERROUS GLUCONATE 324 MG (38 MG IRON) ORAL TABLET,,68309,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
FERROUS GLUCONATE 324 MG (38 MG IRON) ORAL TABLET,,68309,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
FERROUS GLUCONATE 324 MG (38 MG IRON) ORAL TABLET,,68309,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
CALCIUM CARBONATE-VITAMIN D3 600 MG-10 MCG (400 UNIT) ORAL TABLET,,68385,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
CALCIUM CARBONATE-VITAMIN D3 600 MG-10 MCG (400 UNIT) ORAL TABLET,,68385,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
CALCIUM CARBONATE-VITAMIN D3 600 MG-10 MCG (400 UNIT) ORAL TABLET,,68385,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
CALCIUM CARBONATE-VITAMIN D3 600 MG-10 MCG (400 UNIT) ORAL TABLET,,68385,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
CALCIUM CARBONATE-VITAMIN D3 600 MG-10 MCG (400 UNIT) ORAL TABLET,,68385,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
CALCIUM CARBONATE-VITAMIN D3 600 MG-10 MCG (400 UNIT) ORAL TABLET,,68385,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
CALCIUM CARBONATE-VITAMIN D3 600 MG-10 MCG (400 UNIT) ORAL TABLET,,68385,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
CALCIUM CARBONATE-VITAMIN D3 600 MG-10 MCG (400 UNIT) ORAL TABLET,,68385,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
CALCIUM CARBONATE-VITAMIN D3 600 MG-10 MCG (400 UNIT) ORAL TABLET,,68385,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
CALCIUM CARBONATE-VITAMIN D3 600 MG-10 MCG (400 UNIT) ORAL TABLET,,68385,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
CALCIUM CARBONATE-VITAMIN D3 600 MG-10 MCG (400 UNIT) ORAL TABLET,,68385,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
CALCIUM CARBONATE-VITAMIN D3 600 MG-10 MCG (400 UNIT) ORAL TABLET,,68385,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
CALCIUM CARBONATE-VITAMIN D3 600 MG-10 MCG (400 UNIT) ORAL TABLET,,68385,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
CALCIUM CARBONATE-VITAMIN D3 600 MG-10 MCG (400 UNIT) ORAL TABLET,,68385,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
CALCIUM CARBONATE-VITAMIN D3 600 MG-10 MCG (400 UNIT) ORAL TABLET,,68385,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
CALCIUM CARBONATE-VITAMIN D3 600 MG-10 MCG (400 UNIT) ORAL TABLET,,68385,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
CALCIUM CARBONATE-VITAMIN D3 600 MG-10 MCG (400 UNIT) ORAL TABLET,,68385,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
CALCIUM CARBONATE-VITAMIN D3 600 MG-10 MCG (400 UNIT) ORAL TABLET,,68385,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
CALCIUM CARBONATE-VITAMIN D3 600 MG-10 MCG (400 UNIT) ORAL TABLET,,68385,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CALCIUM CARBONATE-VITAMIN D3 600 MG-10 MCG (400 UNIT) ORAL TABLET,,68385,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
CALCIUM CARBONATE-VITAMIN D3 600 MG-10 MCG (400 UNIT) ORAL TABLET,,68385,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
CALCIUM CARBONATE-VITAMIN D3 600 MG-10 MCG (400 UNIT) ORAL TABLET,,68385,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
CALCIUM CARBONATE-VITAMIN D3 600 MG-10 MCG (400 UNIT) ORAL TABLET,,68385,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
CALCIUM CARBONATE-VITAMIN D3 600 MG-10 MCG (400 UNIT) ORAL TABLET,,68385,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
CALCIUM CARBONATE-VITAMIN D3 600 MG-10 MCG (400 UNIT) ORAL TABLET,,68385,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
CALCIUM CARBONATE-VITAMIN D3 600 MG-10 MCG (400 UNIT) ORAL TABLET,,68385,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
CALCIUM CARBONATE-VITAMIN D3 600 MG-10 MCG (400 UNIT) ORAL TABLET,,68385,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
CALCIUM CARBONATE-VITAMIN D3 600 MG-10 MCG (400 UNIT) ORAL TABLET,,68385,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
CALCIUM CARBONATE-VITAMIN D3 600 MG-10 MCG (400 UNIT) ORAL TABLET,,68385,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
CALCIUM CARBONATE-VITAMIN D3 600 MG-10 MCG (400 UNIT) ORAL TABLET,,68385,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
CALCIUM CARBONATE-VITAMIN D3 600 MG-10 MCG (400 UNIT) ORAL TABLET,,68385,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
CALCIUM CARBONATE-VITAMIN D3 600 MG-10 MCG (400 UNIT) ORAL TABLET,,68385,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
CALCIUM CARBONATE-VITAMIN D3 600 MG-10 MCG (400 UNIT) ORAL TABLET,,68385,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
CALCIUM CARBONATE-VITAMIN D3 600 MG-10 MCG (400 UNIT) ORAL TABLET,,68385,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
CALCIUM CARBONATE-VITAMIN D3 600 MG-10 MCG (400 UNIT) ORAL TABLET,,68385,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
CALCIUM CARBONATE-VITAMIN D3 600 MG-10 MCG (400 UNIT) ORAL TABLET,,68385,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
CALCIUM CARBONATE-VITAMIN D3 600 MG-10 MCG (400 UNIT) ORAL TABLET,,68385,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
CALCIUM CARBONATE-VITAMIN D3 600 MG-10 MCG (400 UNIT) ORAL TABLET,,68385,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CALCIUM CARBONATE-VITAMIN D3 600 MG-10 MCG (400 UNIT) ORAL TABLET,,68385,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
CALCIUM CARBONATE-VITAMIN D3 600 MG-10 MCG (400 UNIT) ORAL TABLET,,68385,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
CALCIUM CARBONATE-VITAMIN D3 600 MG-10 MCG (400 UNIT) ORAL TABLET,,68385,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
CALCIUM CARBONATE-VITAMIN D3 600 MG-10 MCG (400 UNIT) ORAL TABLET,,68385,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
CALCIUM CARBONATE-VITAMIN D3 600 MG-10 MCG (400 UNIT) ORAL TABLET,,68385,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
CALCIUM CARBONATE-VITAMIN D3 600 MG-10 MCG (400 UNIT) ORAL TABLET,,68385,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CALCIUM CARBONATE-VITAMIN D3 600 MG-10 MCG (400 UNIT) ORAL TABLET,,68385,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
CALCIUM CARBONATE-VITAMIN D3 600 MG-10 MCG (400 UNIT) ORAL TABLET,,68385,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CALCIUM CARBONATE-VITAMIN D3 600 MG-10 MCG (400 UNIT) ORAL TABLET,,68385,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CALCIUM CARBONATE-VITAMIN D3 600 MG-10 MCG (400 UNIT) ORAL TABLET,,68385,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CALCIUM CARBONATE-VITAMIN D3 600 MG-10 MCG (400 UNIT) ORAL TABLET,,68385,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CALCIUM CARBONATE-VITAMIN D3 600 MG-10 MCG (400 UNIT) ORAL TABLET,,68385,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
CALCIUM CARBONATE-VITAMIN D3 600 MG-10 MCG (400 UNIT) ORAL TABLET,,68385,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
CALCIUM CARBONATE-VITAMIN D3 600 MG-10 MCG (400 UNIT) ORAL TABLET,,68385,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
CALCIUM CARBONATE-VITAMIN D3 600 MG-10 MCG (400 UNIT) ORAL TABLET,,68385,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
CALCIUM CARBONATE-VITAMIN D3 600 MG-10 MCG (400 UNIT) ORAL TABLET,,68385,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
SILVER NITRATE APPLICATORS 75-25 % TOP STCK,,69016,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
SILVER NITRATE APPLICATORS 75-25 % TOP STCK,,69016,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
SILVER NITRATE APPLICATORS 75-25 % TOP STCK,,69016,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
SILVER NITRATE APPLICATORS 75-25 % TOP STCK,,69016,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
SILVER NITRATE APPLICATORS 75-25 % TOP STCK,,69016,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SILVER NITRATE APPLICATORS 75-25 % TOP STCK,,69016,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
SILVER NITRATE APPLICATORS 75-25 % TOP STCK,,69016,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
SILVER NITRATE APPLICATORS 75-25 % TOP STCK,,69016,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
SILVER NITRATE APPLICATORS 75-25 % TOP STCK,,69016,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
SILVER NITRATE APPLICATORS 75-25 % TOP STCK,,69016,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
SILVER NITRATE APPLICATORS 75-25 % TOP STCK,,69016,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
SILVER NITRATE APPLICATORS 75-25 % TOP STCK,,69016,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
SILVER NITRATE APPLICATORS 75-25 % TOP STCK,,69016,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
SILVER NITRATE APPLICATORS 75-25 % TOP STCK,,69016,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
SILVER NITRATE APPLICATORS 75-25 % TOP STCK,,69016,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
SILVER NITRATE APPLICATORS 75-25 % TOP STCK,,69016,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
SILVER NITRATE APPLICATORS 75-25 % TOP STCK,,69016,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
SILVER NITRATE APPLICATORS 75-25 % TOP STCK,,69016,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
SILVER NITRATE APPLICATORS 75-25 % TOP STCK,,69016,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SILVER NITRATE APPLICATORS 75-25 % TOP STCK,,69016,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
SILVER NITRATE APPLICATORS 75-25 % TOP STCK,,69016,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
SILVER NITRATE APPLICATORS 75-25 % TOP STCK,,69016,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
SILVER NITRATE APPLICATORS 75-25 % TOP STCK,,69016,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
SILVER NITRATE APPLICATORS 75-25 % TOP STCK,,69016,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
SILVER NITRATE APPLICATORS 75-25 % TOP STCK,,69016,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
SILVER NITRATE APPLICATORS 75-25 % TOP STCK,,69016,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
SILVER NITRATE APPLICATORS 75-25 % TOP STCK,,69016,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
SILVER NITRATE APPLICATORS 75-25 % TOP STCK,,69016,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
SILVER NITRATE APPLICATORS 75-25 % TOP STCK,,69016,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
SILVER NITRATE APPLICATORS 75-25 % TOP STCK,,69016,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
SILVER NITRATE APPLICATORS 75-25 % TOP STCK,,69016,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
SILVER NITRATE APPLICATORS 75-25 % TOP STCK,,69016,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
SILVER NITRATE APPLICATORS 75-25 % TOP STCK,,69016,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
SILVER NITRATE APPLICATORS 75-25 % TOP STCK,,69016,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
SILVER NITRATE APPLICATORS 75-25 % TOP STCK,,69016,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
SILVER NITRATE APPLICATORS 75-25 % TOP STCK,,69016,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
SILVER NITRATE APPLICATORS 75-25 % TOP STCK,,69016,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
SILVER NITRATE APPLICATORS 75-25 % TOP STCK,,69016,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SILVER NITRATE APPLICATORS 75-25 % TOP STCK,,69016,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
SILVER NITRATE APPLICATORS 75-25 % TOP STCK,,69016,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
SILVER NITRATE APPLICATORS 75-25 % TOP STCK,,69016,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
SILVER NITRATE APPLICATORS 75-25 % TOP STCK,,69016,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
SILVER NITRATE APPLICATORS 75-25 % TOP STCK,,69016,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
SILVER NITRATE APPLICATORS 75-25 % TOP STCK,,69016,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SILVER NITRATE APPLICATORS 75-25 % TOP STCK,,69016,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
SILVER NITRATE APPLICATORS 75-25 % TOP STCK,,69016,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SILVER NITRATE APPLICATORS 75-25 % TOP STCK,,69016,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SILVER NITRATE APPLICATORS 75-25 % TOP STCK,,69016,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SILVER NITRATE APPLICATORS 75-25 % TOP STCK,,69016,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SILVER NITRATE APPLICATORS 75-25 % TOP STCK,,69016,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
SILVER NITRATE APPLICATORS 75-25 % TOP STCK,,69016,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
SILVER NITRATE APPLICATORS 75-25 % TOP STCK,,69016,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
SILVER NITRATE APPLICATORS 75-25 % TOP STCK,,69016,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
SILVER NITRATE APPLICATORS 75-25 % TOP STCK,,69016,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Blepharoplasty Lower Eyelid (Pro Cah),,15820,CPT,Professional,Both,,,,612,520.2,304.776,612,Aetna,Commercial,520.2,85,,percent of total billed charges,,
Blepharoplasty Lower Eyelid (Pro Cah),,15820,CPT,Professional,Both,,,,612,520.2,304.776,612,Aetna,Medicare Advantage,514.64,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Blepharoplasty Lower Eyelid (Pro Cah),,15820,CPT,Professional,Both,,,,612,520.2,304.776,612,Aetna,PPO,569.16,93,,percent of total billed charges,,
Blepharoplasty Lower Eyelid (Pro Cah),,15820,CPT,Professional,Both,,,,612,520.2,304.776,612,America's PPO,America's PPO,522.8928,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Blepharoplasty Lower Eyelid (Pro Cah),,15820,CPT,Professional,Both,,,,612,520.2,304.776,612,BlueCross BlueShield Minnesota, Federal Employee Program,612,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Blepharoplasty Lower Eyelid (Pro Cah),,15820,CPT,Professional,Both,,,,612,520.2,304.776,612,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,612,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Blepharoplasty Lower Eyelid (Pro Cah),,15820,CPT,Professional,Both,,,,612,520.2,304.776,612,BlueCross BlueShield Minnesota,High Value Network Plan,612,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Blepharoplasty Lower Eyelid (Pro Cah),,15820,CPT,Professional,Both,,,,612,520.2,304.776,612,BlueCross BlueShield Minnesota,Medicare Advantage,589.8465,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Blepharoplasty Lower Eyelid (Pro Cah),,15820,CPT,Professional,Both,,,,612,520.2,304.776,612,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,612,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Blepharoplasty Lower Eyelid (Pro Cah),,15820,CPT,Professional,Both,,,,612,520.2,304.776,612,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,381.07112,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Blepharoplasty Lower Eyelid (Pro Cah),,15820,CPT,Professional,Both,,,,612,520.2,304.776,612,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),589.8465,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Blepharoplasty Lower Eyelid (Pro Cah),,15820,CPT,Professional,Both,,,,612,520.2,304.776,612,CorVel,Worker's Compensation,612,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Blepharoplasty Lower Eyelid (Pro Cah),,15820,CPT,Professional,Both,,,,612,520.2,304.776,612,First Health Group Corporation,First Health Network,593.64,97,,percent of total billed charges,,
Blepharoplasty Lower Eyelid (Pro Cah),,15820,CPT,Professional,Both,,,,612,520.2,304.776,612,"Health Partners, Inc.",Commercial,612,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Blepharoplasty Lower Eyelid (Pro Cah),,15820,CPT,Professional,Both,,,,612,520.2,304.776,612,"Health Partners, Inc.",Medicare Advantage,589.8465,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Blepharoplasty Lower Eyelid (Pro Cah),,15820,CPT,Professional,Both,,,,612,520.2,304.776,612,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),512.71,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Blepharoplasty Lower Eyelid (Pro Cah),,15820,CPT,Professional,Both,,,,612,520.2,304.776,612,"Health Partners, Inc.",State of Minnesota Advantage Program,612,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Blepharoplasty Lower Eyelid (Pro Cah),,15820,CPT,Professional,Both,,,,612,520.2,304.776,612,"Health Partners, Inc.",State Public Programs,330.06,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Blepharoplasty Lower Eyelid (Pro Cah),,15820,CPT,Professional,Both,,,,612,520.2,304.776,612,Humana Insurance Company,Commercial PPO,512.91,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Blepharoplasty Lower Eyelid (Pro Cah),,15820,CPT,Professional,Both,,,,612,520.2,304.776,612,Humana Insurance Company,Medicare PPO,612,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Blepharoplasty Lower Eyelid (Pro Cah),,15820,CPT,Professional,Both,,,,612,520.2,304.776,612,Medica,Individual & Family,518.976,84.8,,percent of total billed charges,,
Blepharoplasty Lower Eyelid (Pro Cah),,15820,CPT,Professional,Both,,,,612,520.2,304.776,612,Medica,Medica Advantage Solution,304.776,49.8,,percent of total billed charges,,
Blepharoplasty Lower Eyelid (Pro Cah),,15820,CPT,Professional,Both,,,,612,520.2,304.776,612,Medica,Medical Assistance,381.07,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Blepharoplasty Lower Eyelid (Pro Cah),,15820,CPT,Professional,Both,,,,612,520.2,304.776,612,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,512.91,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Blepharoplasty Lower Eyelid (Pro Cah),,15820,CPT,Professional,Both,,,,612,520.2,304.776,612,"Multiplan, Inc.","Multiplan, Inc.",575.28,94,,percent of total billed charges,,
Blepharoplasty Lower Eyelid (Pro Cah),,15820,CPT,Professional,Both,,,,612,520.2,304.776,612,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,551.412,90.1,,percent of total billed charges,,
Blepharoplasty Lower Eyelid (Pro Cah),,15820,CPT,Professional,Both,,,,612,520.2,304.776,612,"Preferred One Administrative Services, INC.",PPO,603.432,98.6,,percent of total billed charges,,
Blepharoplasty Lower Eyelid (Pro Cah),,15820,CPT,Professional,Both,,,,612,520.2,304.776,612,PrimeWest Health,Minnesota Senior Health Options (MSHO),589.8465,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Blepharoplasty Lower Eyelid (Pro Cah),,15820,CPT,Professional,Both,,,,612,520.2,304.776,612,PrimeWest Health,MinnesotaCare,407.7460984,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Blepharoplasty Lower Eyelid (Pro Cah),,15820,CPT,Professional,Both,,,,612,520.2,304.776,612,Sanford Health Plan,Sanford Health Plan,538.56,88,,percent of total billed charges,,
Blepharoplasty Lower Eyelid (Pro Cah),,15820,CPT,Professional,Both,,,,612,520.2,304.776,612,"UCare Health, Inc.",Individual & Family Plan,612,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Blepharoplasty Lower Eyelid (Pro Cah),,15820,CPT,Professional,Both,,,,612,520.2,304.776,612,"UCare Health, Inc.",Medical Assistance,419.178232,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Blepharoplasty Lower Eyelid (Pro Cah),,15820,CPT,Professional,Both,,,,612,520.2,304.776,612,"UCare Health, Inc.",Medicare Advantage,589.8465,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Blepharoplasty Lower Eyelid (Pro Cah),,15820,CPT,Professional,Both,,,,612,520.2,304.776,612,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),471.8772,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Blepharoplasty Lower Eyelid (Pro Cah),,15820,CPT,Professional,Both,,,,612,520.2,304.776,612,UnitedHealthcare,Individual & Family,612,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Blepharoplasty Lower Eyelid (Pro Cah),,15820,CPT,Professional,Both,,,,612,520.2,304.776,612,UnitedHealthcare,Medicare Advantage,589.8465,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Blepharoplasty Lower Eyelid (Pro Cah),,15820,CPT,Professional,Both,,,,612,520.2,304.776,612,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,381.07112,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Blepharoplasty Lower Eyelid Herniated Fat Pad (Pro Cah),,15821,CPT,Professional,Both,,,,612,520.2,304.776,612,Aetna,Commercial,520.2,85,,percent of total billed charges,,
Blepharoplasty Lower Eyelid Herniated Fat Pad (Pro Cah),,15821,CPT,Professional,Both,,,,612,520.2,304.776,612,Aetna,Medicare Advantage,545.35,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Blepharoplasty Lower Eyelid Herniated Fat Pad (Pro Cah),,15821,CPT,Professional,Both,,,,612,520.2,304.776,612,Aetna,PPO,569.16,93,,percent of total billed charges,,
Blepharoplasty Lower Eyelid Herniated Fat Pad (Pro Cah),,15821,CPT,Professional,Both,,,,612,520.2,304.776,612,America's PPO,America's PPO,522.8928,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Blepharoplasty Lower Eyelid Herniated Fat Pad (Pro Cah),,15821,CPT,Professional,Both,,,,612,520.2,304.776,612,BlueCross BlueShield Minnesota, Federal Employee Program,612,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Blepharoplasty Lower Eyelid Herniated Fat Pad (Pro Cah),,15821,CPT,Professional,Both,,,,612,520.2,304.776,612,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,612,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Blepharoplasty Lower Eyelid Herniated Fat Pad (Pro Cah),,15821,CPT,Professional,Both,,,,612,520.2,304.776,612,BlueCross BlueShield Minnesota,High Value Network Plan,612,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Blepharoplasty Lower Eyelid Herniated Fat Pad (Pro Cah),,15821,CPT,Professional,Both,,,,612,520.2,304.776,612,BlueCross BlueShield Minnesota,Medicare Advantage,612,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Blepharoplasty Lower Eyelid Herniated Fat Pad (Pro Cah),,15821,CPT,Professional,Both,,,,612,520.2,304.776,612,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,612,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Blepharoplasty Lower Eyelid Herniated Fat Pad (Pro Cah),,15821,CPT,Professional,Both,,,,612,520.2,304.776,612,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,404.48992,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Blepharoplasty Lower Eyelid Herniated Fat Pad (Pro Cah),,15821,CPT,Professional,Both,,,,612,520.2,304.776,612,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),612,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Blepharoplasty Lower Eyelid Herniated Fat Pad (Pro Cah),,15821,CPT,Professional,Both,,,,612,520.2,304.776,612,CorVel,Worker's Compensation,612,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Blepharoplasty Lower Eyelid Herniated Fat Pad (Pro Cah),,15821,CPT,Professional,Both,,,,612,520.2,304.776,612,First Health Group Corporation,First Health Network,593.64,97,,percent of total billed charges,,
Blepharoplasty Lower Eyelid Herniated Fat Pad (Pro Cah),,15821,CPT,Professional,Both,,,,612,520.2,304.776,612,"Health Partners, Inc.",Commercial,612,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Blepharoplasty Lower Eyelid Herniated Fat Pad (Pro Cah),,15821,CPT,Professional,Both,,,,612,520.2,304.776,612,"Health Partners, Inc.",Medicare Advantage,612,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Blepharoplasty Lower Eyelid Herniated Fat Pad (Pro Cah),,15821,CPT,Professional,Both,,,,612,520.2,304.776,612,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),544.57,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Blepharoplasty Lower Eyelid Herniated Fat Pad (Pro Cah),,15821,CPT,Professional,Both,,,,612,520.2,304.776,612,"Health Partners, Inc.",State of Minnesota Advantage Program,612,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Blepharoplasty Lower Eyelid Herniated Fat Pad (Pro Cah),,15821,CPT,Professional,Both,,,,612,520.2,304.776,612,"Health Partners, Inc.",State Public Programs,350.35,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Blepharoplasty Lower Eyelid Herniated Fat Pad (Pro Cah),,15821,CPT,Professional,Both,,,,612,520.2,304.776,612,Humana Insurance Company,Commercial PPO,544.33,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Blepharoplasty Lower Eyelid Herniated Fat Pad (Pro Cah),,15821,CPT,Professional,Both,,,,612,520.2,304.776,612,Humana Insurance Company,Medicare PPO,612,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Blepharoplasty Lower Eyelid Herniated Fat Pad (Pro Cah),,15821,CPT,Professional,Both,,,,612,520.2,304.776,612,Medica,Individual & Family,518.976,84.8,,percent of total billed charges,,
Blepharoplasty Lower Eyelid Herniated Fat Pad (Pro Cah),,15821,CPT,Professional,Both,,,,612,520.2,304.776,612,Medica,Medica Advantage Solution,304.776,49.8,,percent of total billed charges,,
Blepharoplasty Lower Eyelid Herniated Fat Pad (Pro Cah),,15821,CPT,Professional,Both,,,,612,520.2,304.776,612,Medica,Medical Assistance,404.49,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Blepharoplasty Lower Eyelid Herniated Fat Pad (Pro Cah),,15821,CPT,Professional,Both,,,,612,520.2,304.776,612,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,544.33,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Blepharoplasty Lower Eyelid Herniated Fat Pad (Pro Cah),,15821,CPT,Professional,Both,,,,612,520.2,304.776,612,"Multiplan, Inc.","Multiplan, Inc.",575.28,94,,percent of total billed charges,,
Blepharoplasty Lower Eyelid Herniated Fat Pad (Pro Cah),,15821,CPT,Professional,Both,,,,612,520.2,304.776,612,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,551.412,90.1,,percent of total billed charges,,
Blepharoplasty Lower Eyelid Herniated Fat Pad (Pro Cah),,15821,CPT,Professional,Both,,,,612,520.2,304.776,612,"Preferred One Administrative Services, INC.",PPO,603.432,98.6,,percent of total billed charges,,
Blepharoplasty Lower Eyelid Herniated Fat Pad (Pro Cah),,15821,CPT,Professional,Both,,,,612,520.2,304.776,612,PrimeWest Health,Minnesota Senior Health Options (MSHO),612,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Blepharoplasty Lower Eyelid Herniated Fat Pad (Pro Cah),,15821,CPT,Professional,Both,,,,612,520.2,304.776,612,PrimeWest Health,MinnesotaCare,432.8042144,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Blepharoplasty Lower Eyelid Herniated Fat Pad (Pro Cah),,15821,CPT,Professional,Both,,,,612,520.2,304.776,612,Sanford Health Plan,Sanford Health Plan,538.56,88,,percent of total billed charges,,
Blepharoplasty Lower Eyelid Herniated Fat Pad (Pro Cah),,15821,CPT,Professional,Both,,,,612,520.2,304.776,612,"UCare Health, Inc.",Individual & Family Plan,612,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Blepharoplasty Lower Eyelid Herniated Fat Pad (Pro Cah),,15821,CPT,Professional,Both,,,,612,520.2,304.776,612,"UCare Health, Inc.",Medical Assistance,444.938912,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Blepharoplasty Lower Eyelid Herniated Fat Pad (Pro Cah),,15821,CPT,Professional,Both,,,,612,520.2,304.776,612,"UCare Health, Inc.",Medicare Advantage,612,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Blepharoplasty Lower Eyelid Herniated Fat Pad (Pro Cah),,15821,CPT,Professional,Both,,,,612,520.2,304.776,612,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),500.7836,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Blepharoplasty Lower Eyelid Herniated Fat Pad (Pro Cah),,15821,CPT,Professional,Both,,,,612,520.2,304.776,612,UnitedHealthcare,Individual & Family,612,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Blepharoplasty Lower Eyelid Herniated Fat Pad (Pro Cah),,15821,CPT,Professional,Both,,,,612,520.2,304.776,612,UnitedHealthcare,Medicare Advantage,612,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Blepharoplasty Lower Eyelid Herniated Fat Pad (Pro Cah),,15821,CPT,Professional,Both,,,,612,520.2,304.776,612,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,404.48992,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Blepharoplasty Upper Eyelid (Pro Cah),,15822,CPT,Professional,Both,,,,612,520.2,254.58,612,Aetna,Commercial,520.2,85,,percent of total billed charges,,
Blepharoplasty Upper Eyelid (Pro Cah),,15822,CPT,Professional,Both,,,,612,520.2,254.58,612,Aetna,Medicare Advantage,395.83,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Blepharoplasty Upper Eyelid (Pro Cah),,15822,CPT,Professional,Both,,,,612,520.2,254.58,612,Aetna,PPO,569.16,93,,percent of total billed charges,,
Blepharoplasty Upper Eyelid (Pro Cah),,15822,CPT,Professional,Both,,,,612,520.2,254.58,612,America's PPO,America's PPO,522.8928,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Blepharoplasty Upper Eyelid (Pro Cah),,15822,CPT,Professional,Both,,,,612,520.2,254.58,612,BlueCross BlueShield Minnesota, Federal Employee Program,612,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Blepharoplasty Upper Eyelid (Pro Cah),,15822,CPT,Professional,Both,,,,612,520.2,254.58,612,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,612,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Blepharoplasty Upper Eyelid (Pro Cah),,15822,CPT,Professional,Both,,,,612,520.2,254.58,612,BlueCross BlueShield Minnesota,High Value Network Plan,612,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Blepharoplasty Upper Eyelid (Pro Cah),,15822,CPT,Professional,Both,,,,612,520.2,254.58,612,BlueCross BlueShield Minnesota,Medicare Advantage,454.963,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Blepharoplasty Upper Eyelid (Pro Cah),,15822,CPT,Professional,Both,,,,612,520.2,254.58,612,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,612,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Blepharoplasty Upper Eyelid (Pro Cah),,15822,CPT,Professional,Both,,,,612,520.2,254.58,612,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,293.91864,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Blepharoplasty Upper Eyelid (Pro Cah),,15822,CPT,Professional,Both,,,,612,520.2,254.58,612,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),454.963,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Blepharoplasty Upper Eyelid (Pro Cah),,15822,CPT,Professional,Both,,,,612,520.2,254.58,612,CorVel,Worker's Compensation,612,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Blepharoplasty Upper Eyelid (Pro Cah),,15822,CPT,Professional,Both,,,,612,520.2,254.58,612,First Health Group Corporation,First Health Network,593.64,97,,percent of total billed charges,,
Blepharoplasty Upper Eyelid (Pro Cah),,15822,CPT,Professional,Both,,,,612,520.2,254.58,612,"Health Partners, Inc.",Commercial,612,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Blepharoplasty Upper Eyelid (Pro Cah),,15822,CPT,Professional,Both,,,,612,520.2,254.58,612,"Health Partners, Inc.",Medicare Advantage,454.963,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Blepharoplasty Upper Eyelid (Pro Cah),,15822,CPT,Professional,Both,,,,612,520.2,254.58,612,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),395.8,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Blepharoplasty Upper Eyelid (Pro Cah),,15822,CPT,Professional,Both,,,,612,520.2,254.58,612,"Health Partners, Inc.",State of Minnesota Advantage Program,612,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Blepharoplasty Upper Eyelid (Pro Cah),,15822,CPT,Professional,Both,,,,612,520.2,254.58,612,"Health Partners, Inc.",State Public Programs,254.58,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Blepharoplasty Upper Eyelid (Pro Cah),,15822,CPT,Professional,Both,,,,612,520.2,254.58,612,Humana Insurance Company,Commercial PPO,395.62,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Blepharoplasty Upper Eyelid (Pro Cah),,15822,CPT,Professional,Both,,,,612,520.2,254.58,612,Humana Insurance Company,Medicare PPO,612,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Blepharoplasty Upper Eyelid (Pro Cah),,15822,CPT,Professional,Both,,,,612,520.2,254.58,612,Medica,Individual & Family,518.976,84.8,,percent of total billed charges,,
Blepharoplasty Upper Eyelid (Pro Cah),,15822,CPT,Professional,Both,,,,612,520.2,254.58,612,Medica,Medica Advantage Solution,304.776,49.8,,percent of total billed charges,,
Blepharoplasty Upper Eyelid (Pro Cah),,15822,CPT,Professional,Both,,,,612,520.2,254.58,612,Medica,Medical Assistance,293.92,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Blepharoplasty Upper Eyelid (Pro Cah),,15822,CPT,Professional,Both,,,,612,520.2,254.58,612,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,395.62,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Blepharoplasty Upper Eyelid (Pro Cah),,15822,CPT,Professional,Both,,,,612,520.2,254.58,612,"Multiplan, Inc.","Multiplan, Inc.",575.28,94,,percent of total billed charges,,
Blepharoplasty Upper Eyelid (Pro Cah),,15822,CPT,Professional,Both,,,,612,520.2,254.58,612,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,551.412,90.1,,percent of total billed charges,,
Blepharoplasty Upper Eyelid (Pro Cah),,15822,CPT,Professional,Both,,,,612,520.2,254.58,612,"Preferred One Administrative Services, INC.",PPO,603.432,98.6,,percent of total billed charges,,
Blepharoplasty Upper Eyelid (Pro Cah),,15822,CPT,Professional,Both,,,,612,520.2,254.58,612,PrimeWest Health,Minnesota Senior Health Options (MSHO),454.963,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Blepharoplasty Upper Eyelid (Pro Cah),,15822,CPT,Professional,Both,,,,612,520.2,254.58,612,PrimeWest Health,MinnesotaCare,314.4929448,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Blepharoplasty Upper Eyelid (Pro Cah),,15822,CPT,Professional,Both,,,,612,520.2,254.58,612,Sanford Health Plan,Sanford Health Plan,538.56,88,,percent of total billed charges,,
Blepharoplasty Upper Eyelid (Pro Cah),,15822,CPT,Professional,Both,,,,612,520.2,254.58,612,"UCare Health, Inc.",Individual & Family Plan,612,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Blepharoplasty Upper Eyelid (Pro Cah),,15822,CPT,Professional,Both,,,,612,520.2,254.58,612,"UCare Health, Inc.",Medical Assistance,323.310504,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Blepharoplasty Upper Eyelid (Pro Cah),,15822,CPT,Professional,Both,,,,612,520.2,254.58,612,"UCare Health, Inc.",Medicare Advantage,454.963,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Blepharoplasty Upper Eyelid (Pro Cah),,15822,CPT,Professional,Both,,,,612,520.2,254.58,612,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),363.9704,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Blepharoplasty Upper Eyelid (Pro Cah),,15822,CPT,Professional,Both,,,,612,520.2,254.58,612,UnitedHealthcare,Individual & Family,612,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Blepharoplasty Upper Eyelid (Pro Cah),,15822,CPT,Professional,Both,,,,612,520.2,254.58,612,UnitedHealthcare,Medicare Advantage,454.963,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Blepharoplasty Upper Eyelid (Pro Cah),,15822,CPT,Professional,Both,,,,612,520.2,254.58,612,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,293.91864,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Blepharoplasty, Upper Eyelid; With Excessive Skin Weighting Down Lid (Pro Cah)",,15823,CPT,Professional,Both,,,,612,520.2,304.776,612,Aetna,Commercial,520.2,85,,percent of total billed charges,,
"Blepharoplasty, Upper Eyelid; With Excessive Skin Weighting Down Lid (Pro Cah)",,15823,CPT,Professional,Both,,,,612,520.2,304.776,612,Aetna,Medicare Advantage,548.87,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Blepharoplasty, Upper Eyelid; With Excessive Skin Weighting Down Lid (Pro Cah)",,15823,CPT,Professional,Both,,,,612,520.2,304.776,612,Aetna,PPO,569.16,93,,percent of total billed charges,,
"Blepharoplasty, Upper Eyelid; With Excessive Skin Weighting Down Lid (Pro Cah)",,15823,CPT,Professional,Both,,,,612,520.2,304.776,612,America's PPO,America's PPO,522.8928,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Blepharoplasty, Upper Eyelid; With Excessive Skin Weighting Down Lid (Pro Cah)",,15823,CPT,Professional,Both,,,,612,520.2,304.776,612,BlueCross BlueShield Minnesota, Federal Employee Program,612,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Blepharoplasty, Upper Eyelid; With Excessive Skin Weighting Down Lid (Pro Cah)",,15823,CPT,Professional,Both,,,,612,520.2,304.776,612,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,612,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Blepharoplasty, Upper Eyelid; With Excessive Skin Weighting Down Lid (Pro Cah)",,15823,CPT,Professional,Both,,,,612,520.2,304.776,612,BlueCross BlueShield Minnesota,High Value Network Plan,612,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Blepharoplasty, Upper Eyelid; With Excessive Skin Weighting Down Lid (Pro Cah)",,15823,CPT,Professional,Both,,,,612,520.2,304.776,612,BlueCross BlueShield Minnesota,Medicare Advantage,612,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Blepharoplasty, Upper Eyelid; With Excessive Skin Weighting Down Lid (Pro Cah)",,15823,CPT,Professional,Both,,,,612,520.2,304.776,612,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,612,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Blepharoplasty, Upper Eyelid; With Excessive Skin Weighting Down Lid (Pro Cah)",,15823,CPT,Professional,Both,,,,612,520.2,304.776,612,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,406.25776,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Blepharoplasty, Upper Eyelid; With Excessive Skin Weighting Down Lid (Pro Cah)",,15823,CPT,Professional,Both,,,,612,520.2,304.776,612,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),612,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Blepharoplasty, Upper Eyelid; With Excessive Skin Weighting Down Lid (Pro Cah)",,15823,CPT,Professional,Both,,,,612,520.2,304.776,612,CorVel,Worker's Compensation,612,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Blepharoplasty, Upper Eyelid; With Excessive Skin Weighting Down Lid (Pro Cah)",,15823,CPT,Professional,Both,,,,612,520.2,304.776,612,First Health Group Corporation,First Health Network,593.64,97,,percent of total billed charges,,
"Blepharoplasty, Upper Eyelid; With Excessive Skin Weighting Down Lid (Pro Cah)",,15823,CPT,Professional,Both,,,,612,520.2,304.776,612,"Health Partners, Inc.",Commercial,612,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Blepharoplasty, Upper Eyelid; With Excessive Skin Weighting Down Lid (Pro Cah)",,15823,CPT,Professional,Both,,,,612,520.2,304.776,612,"Health Partners, Inc.",Medicare Advantage,612,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Blepharoplasty, Upper Eyelid; With Excessive Skin Weighting Down Lid (Pro Cah)",,15823,CPT,Professional,Both,,,,612,520.2,304.776,612,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),546.94,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Blepharoplasty, Upper Eyelid; With Excessive Skin Weighting Down Lid (Pro Cah)",,15823,CPT,Professional,Both,,,,612,520.2,304.776,612,"Health Partners, Inc.",State of Minnesota Advantage Program,612,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Blepharoplasty, Upper Eyelid; With Excessive Skin Weighting Down Lid (Pro Cah)",,15823,CPT,Professional,Both,,,,612,520.2,304.776,612,"Health Partners, Inc.",State Public Programs,351.88,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Blepharoplasty, Upper Eyelid; With Excessive Skin Weighting Down Lid (Pro Cah)",,15823,CPT,Professional,Both,,,,612,520.2,304.776,612,Humana Insurance Company,Commercial PPO,546.92,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Blepharoplasty, Upper Eyelid; With Excessive Skin Weighting Down Lid (Pro Cah)",,15823,CPT,Professional,Both,,,,612,520.2,304.776,612,Humana Insurance Company,Medicare PPO,612,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Blepharoplasty, Upper Eyelid; With Excessive Skin Weighting Down Lid (Pro Cah)",,15823,CPT,Professional,Both,,,,612,520.2,304.776,612,Medica,Individual & Family,518.976,84.8,,percent of total billed charges,,
"Blepharoplasty, Upper Eyelid; With Excessive Skin Weighting Down Lid (Pro Cah)",,15823,CPT,Professional,Both,,,,612,520.2,304.776,612,Medica,Medica Advantage Solution,304.776,49.8,,percent of total billed charges,,
"Blepharoplasty, Upper Eyelid; With Excessive Skin Weighting Down Lid (Pro Cah)",,15823,CPT,Professional,Both,,,,612,520.2,304.776,612,Medica,Medical Assistance,406.26,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Blepharoplasty, Upper Eyelid; With Excessive Skin Weighting Down Lid (Pro Cah)",,15823,CPT,Professional,Both,,,,612,520.2,304.776,612,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,546.92,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Blepharoplasty, Upper Eyelid; With Excessive Skin Weighting Down Lid (Pro Cah)",,15823,CPT,Professional,Both,,,,612,520.2,304.776,612,"Multiplan, Inc.","Multiplan, Inc.",575.28,94,,percent of total billed charges,,
"Blepharoplasty, Upper Eyelid; With Excessive Skin Weighting Down Lid (Pro Cah)",,15823,CPT,Professional,Both,,,,612,520.2,304.776,612,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,551.412,90.1,,percent of total billed charges,,
"Blepharoplasty, Upper Eyelid; With Excessive Skin Weighting Down Lid (Pro Cah)",,15823,CPT,Professional,Both,,,,612,520.2,304.776,612,"Preferred One Administrative Services, INC.",PPO,603.432,98.6,,percent of total billed charges,,
"Blepharoplasty, Upper Eyelid; With Excessive Skin Weighting Down Lid (Pro Cah)",,15823,CPT,Professional,Both,,,,612,520.2,304.776,612,PrimeWest Health,Minnesota Senior Health Options (MSHO),612,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Blepharoplasty, Upper Eyelid; With Excessive Skin Weighting Down Lid (Pro Cah)",,15823,CPT,Professional,Both,,,,612,520.2,304.776,612,PrimeWest Health,MinnesotaCare,434.6958032,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Blepharoplasty, Upper Eyelid; With Excessive Skin Weighting Down Lid (Pro Cah)",,15823,CPT,Professional,Both,,,,612,520.2,304.776,612,Sanford Health Plan,Sanford Health Plan,538.56,88,,percent of total billed charges,,
"Blepharoplasty, Upper Eyelid; With Excessive Skin Weighting Down Lid (Pro Cah)",,15823,CPT,Professional,Both,,,,612,520.2,304.776,612,"UCare Health, Inc.",Individual & Family Plan,612,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Blepharoplasty, Upper Eyelid; With Excessive Skin Weighting Down Lid (Pro Cah)",,15823,CPT,Professional,Both,,,,612,520.2,304.776,612,"UCare Health, Inc.",Medical Assistance,446.883536,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Blepharoplasty, Upper Eyelid; With Excessive Skin Weighting Down Lid (Pro Cah)",,15823,CPT,Professional,Both,,,,612,520.2,304.776,612,"UCare Health, Inc.",Medicare Advantage,612,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Blepharoplasty, Upper Eyelid; With Excessive Skin Weighting Down Lid (Pro Cah)",,15823,CPT,Professional,Both,,,,612,520.2,304.776,612,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),503.1664,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Blepharoplasty, Upper Eyelid; With Excessive Skin Weighting Down Lid (Pro Cah)",,15823,CPT,Professional,Both,,,,612,520.2,304.776,612,UnitedHealthcare,Individual & Family,612,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Blepharoplasty, Upper Eyelid; With Excessive Skin Weighting Down Lid (Pro Cah)",,15823,CPT,Professional,Both,,,,612,520.2,304.776,612,UnitedHealthcare,Medicare Advantage,612,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Blepharoplasty, Upper Eyelid; With Excessive Skin Weighting Down Lid (Pro Cah)",,15823,CPT,Professional,Both,,,,612,520.2,304.776,612,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,406.25776,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
RIVASTIGMINE 4.6 MG/24 HOUR TD PT24,,76843,LOCAL,Facility,Both,1,Each,,124,105.4,35.5384,124,Aetna,Commercial,114.08,92,,percent of total billed charges,,
RIVASTIGMINE 4.6 MG/24 HOUR TD PT24,,76843,LOCAL,Facility,Outpatient,1,Each,,124,105.4,35.5384,124,Aetna,Medicare Advantage,60.76,49,,percent of total billed charges,,
RIVASTIGMINE 4.6 MG/24 HOUR TD PT24,,76843,LOCAL,Facility,Inpatient,1,Each,,124,105.4,35.5384,124,Aetna,Medicare Advantage,,,,,Included in per diem rate,
RIVASTIGMINE 4.6 MG/24 HOUR TD PT24,,76843,LOCAL,Facility,Both,1,Each,,124,105.4,35.5384,124,Aetna,PPO,115.32,93,,percent of total billed charges,,
RIVASTIGMINE 4.6 MG/24 HOUR TD PT24,,76843,LOCAL,Facility,Both,1,Each,,124,105.4,35.5384,124,America's PPO,America's PPO,119.0772,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
RIVASTIGMINE 4.6 MG/24 HOUR TD PT24,,76843,LOCAL,Facility,Both,1,Each,,124,105.4,35.5384,124,BlueCross BlueShield Minnesota, Federal Employee Program,122.016,98.4,,percent of total billed charges,,
RIVASTIGMINE 4.6 MG/24 HOUR TD PT24,,76843,LOCAL,Facility,Both,1,Each,,124,105.4,35.5384,124,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,124,100,,percent of total billed charges,,
RIVASTIGMINE 4.6 MG/24 HOUR TD PT24,,76843,LOCAL,Facility,Both,1,Each,,124,105.4,35.5384,124,BlueCross BlueShield Minnesota,High Value Network Plan,111.6,90,,percent of total billed charges,,
RIVASTIGMINE 4.6 MG/24 HOUR TD PT24,,76843,LOCAL,Facility,Outpatient,1,Each,,124,105.4,35.5384,124,BlueCross BlueShield Minnesota,Medicare Advantage,60.76,49,,percent of total billed charges,,
RIVASTIGMINE 4.6 MG/24 HOUR TD PT24,,76843,LOCAL,Facility,Inpatient,1,Each,,124,105.4,35.5384,124,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
RIVASTIGMINE 4.6 MG/24 HOUR TD PT24,,76843,LOCAL,Facility,Both,1,Each,,124,105.4,35.5384,124,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,109.8268,88.57,,percent of total billed charges,,
RIVASTIGMINE 4.6 MG/24 HOUR TD PT24,,76843,LOCAL,Facility,Both,1,Each,,124,105.4,35.5384,124,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,35.5384,28.66,,percent of total billed charges,,
RIVASTIGMINE 4.6 MG/24 HOUR TD PT24,,76843,LOCAL,Facility,Outpatient,1,Each,,124,105.4,35.5384,124,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),60.76,49,,percent of total billed charges,,
RIVASTIGMINE 4.6 MG/24 HOUR TD PT24,,76843,LOCAL,Facility,Inpatient,1,Each,,124,105.4,35.5384,124,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
RIVASTIGMINE 4.6 MG/24 HOUR TD PT24,,76843,LOCAL,Facility,Both,1,Each,,124,105.4,35.5384,124,CorVel,Worker's Compensation,124,100,,percent of total billed charges,,
RIVASTIGMINE 4.6 MG/24 HOUR TD PT24,,76843,LOCAL,Facility,Both,1,Each,,124,105.4,35.5384,124,First Health Group Corporation,First Health Network,120.28,97,,percent of total billed charges,,
RIVASTIGMINE 4.6 MG/24 HOUR TD PT24,,76843,LOCAL,Facility,Both,1,Each,,124,105.4,35.5384,124,"Health Partners, Inc.",Commercial,117.304,94.6,,percent of total billed charges,,
RIVASTIGMINE 4.6 MG/24 HOUR TD PT24,,76843,LOCAL,Facility,Outpatient,1,Each,,124,105.4,35.5384,124,"Health Partners, Inc.",Medicare Advantage,60.76,49,,percent of total billed charges,,
RIVASTIGMINE 4.6 MG/24 HOUR TD PT24,,76843,LOCAL,Facility,Inpatient,1,Each,,124,105.4,35.5384,124,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
RIVASTIGMINE 4.6 MG/24 HOUR TD PT24,,76843,LOCAL,Facility,Both,1,Each,,124,105.4,35.5384,124,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),74.4,60,,percent of total billed charges,,
RIVASTIGMINE 4.6 MG/24 HOUR TD PT24,,76843,LOCAL,Facility,Both,1,Each,,124,105.4,35.5384,124,"Health Partners, Inc.",State of Minnesota Advantage Program,101.06,81.5,,percent of total billed charges,,
RIVASTIGMINE 4.6 MG/24 HOUR TD PT24,,76843,LOCAL,Facility,Both,1,Each,,124,105.4,35.5384,124,"Health Partners, Inc.",State Public Programs,62,50,,percent of total billed charges,,
RIVASTIGMINE 4.6 MG/24 HOUR TD PT24,,76843,LOCAL,Facility,Both,1,Each,,124,105.4,35.5384,124,Humana Insurance Company,Commercial PPO,117.8,95,,percent of total billed charges,,
RIVASTIGMINE 4.6 MG/24 HOUR TD PT24,,76843,LOCAL,Facility,Outpatient,1,Each,,124,105.4,35.5384,124,Humana Insurance Company,Medicare PPO,60.76,49,,percent of total billed charges,,
RIVASTIGMINE 4.6 MG/24 HOUR TD PT24,,76843,LOCAL,Facility,Inpatient,1,Each,,124,105.4,35.5384,124,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
RIVASTIGMINE 4.6 MG/24 HOUR TD PT24,,76843,LOCAL,Facility,Both,1,Each,,124,105.4,35.5384,124,Medica,Individual & Family,122.884,99.1,,percent of total billed charges,,
RIVASTIGMINE 4.6 MG/24 HOUR TD PT24,,76843,LOCAL,Facility,Outpatient,1,Each,,124,105.4,35.5384,124,Medica,Medica Advantage Solution,61.752,49.8,,percent of total billed charges,,
RIVASTIGMINE 4.6 MG/24 HOUR TD PT24,,76843,LOCAL,Facility,Inpatient,1,Each,,124,105.4,35.5384,124,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
RIVASTIGMINE 4.6 MG/24 HOUR TD PT24,,76843,LOCAL,Facility,Outpatient,1,Each,,124,105.4,35.5384,124,Medica,Medical Assistance,55.304,44.6,,percent of total billed charges,,
RIVASTIGMINE 4.6 MG/24 HOUR TD PT24,,76843,LOCAL,Facility,Inpatient,1,Each,,124,105.4,35.5384,124,Medica,Medical Assistance,,,,,Included in per diem rate,
RIVASTIGMINE 4.6 MG/24 HOUR TD PT24,,76843,LOCAL,Facility,Outpatient,1,Each,,124,105.4,35.5384,124,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,61.752,49.8,,percent of total billed charges,,
RIVASTIGMINE 4.6 MG/24 HOUR TD PT24,,76843,LOCAL,Facility,Inpatient,1,Each,,124,105.4,35.5384,124,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
RIVASTIGMINE 4.6 MG/24 HOUR TD PT24,,76843,LOCAL,Facility,Both,1,Each,,124,105.4,35.5384,124,"Multiplan, Inc.","Multiplan, Inc.",116.56,94,,percent of total billed charges,,
RIVASTIGMINE 4.6 MG/24 HOUR TD PT24,,76843,LOCAL,Facility,Outpatient,1,Each,,124,105.4,35.5384,124,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,111.724,90.1,,percent of total billed charges,,
RIVASTIGMINE 4.6 MG/24 HOUR TD PT24,,76843,LOCAL,Facility,Inpatient,1,Each,,124,105.4,35.5384,124,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
RIVASTIGMINE 4.6 MG/24 HOUR TD PT24,,76843,LOCAL,Facility,Both,1,Each,,124,105.4,35.5384,124,"Preferred One Administrative Services, INC.",PPO,122.264,98.6,,percent of total billed charges,,
RIVASTIGMINE 4.6 MG/24 HOUR TD PT24,,76843,LOCAL,Facility,Outpatient,1,Each,,124,105.4,35.5384,124,PrimeWest Health,Minnesota Senior Health Options (MSHO),63.798,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
RIVASTIGMINE 4.6 MG/24 HOUR TD PT24,,76843,LOCAL,Facility,Inpatient,1,Each,,124,105.4,35.5384,124,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
RIVASTIGMINE 4.6 MG/24 HOUR TD PT24,,76843,LOCAL,Facility,Outpatient,1,Each,,124,105.4,35.5384,124,PrimeWest Health,MinnesotaCare,63.6864,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
RIVASTIGMINE 4.6 MG/24 HOUR TD PT24,,76843,LOCAL,Facility,Inpatient,1,Each,,124,105.4,35.5384,124,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
RIVASTIGMINE 4.6 MG/24 HOUR TD PT24,,76843,LOCAL,Facility,Both,1,Each,,124,105.4,35.5384,124,Sanford Health Plan,Sanford Health Plan,114.08,92,,percent of total billed charges,,
RIVASTIGMINE 4.6 MG/24 HOUR TD PT24,,76843,LOCAL,Facility,Outpatient,1,Each,,124,105.4,35.5384,124,"UCare Health, Inc.",Individual & Family Plan,69.874,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
RIVASTIGMINE 4.6 MG/24 HOUR TD PT24,,76843,LOCAL,Facility,Inpatient,1,Each,,124,105.4,35.5384,124,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
RIVASTIGMINE 4.6 MG/24 HOUR TD PT24,,76843,LOCAL,Facility,Outpatient,1,Each,,124,105.4,35.5384,124,"UCare Health, Inc.",Medical Assistance,62.5828,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
RIVASTIGMINE 4.6 MG/24 HOUR TD PT24,,76843,LOCAL,Facility,Inpatient,1,Each,,124,105.4,35.5384,124,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
RIVASTIGMINE 4.6 MG/24 HOUR TD PT24,,76843,LOCAL,Facility,Outpatient,1,Each,,124,105.4,35.5384,124,"UCare Health, Inc.",Medicare Advantage,62.5828,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
RIVASTIGMINE 4.6 MG/24 HOUR TD PT24,,76843,LOCAL,Facility,Inpatient,1,Each,,124,105.4,35.5384,124,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
RIVASTIGMINE 4.6 MG/24 HOUR TD PT24,,76843,LOCAL,Facility,Outpatient,1,Each,,124,105.4,35.5384,124,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),62.5828,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
RIVASTIGMINE 4.6 MG/24 HOUR TD PT24,,76843,LOCAL,Facility,Inpatient,1,Each,,124,105.4,35.5384,124,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
RIVASTIGMINE 4.6 MG/24 HOUR TD PT24,,76843,LOCAL,Facility,Both,1,Each,,124,105.4,35.5384,124,UnitedHealthcare,Individual & Family,116.56,94,,percent of total billed charges,,
RIVASTIGMINE 4.6 MG/24 HOUR TD PT24,,76843,LOCAL,Facility,Outpatient,1,Each,,124,105.4,35.5384,124,UnitedHealthcare,Medicare Advantage,60.76,49,,percent of total billed charges,,
RIVASTIGMINE 4.6 MG/24 HOUR TD PT24,,76843,LOCAL,Facility,Inpatient,1,Each,,124,105.4,35.5384,124,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
RIVASTIGMINE 4.6 MG/24 HOUR TD PT24,,76843,LOCAL,Facility,Outpatient,1,Each,,124,105.4,35.5384,124,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,59.52,48,,percent of total billed charges,,100% of DHS outpatient percentage
RIVASTIGMINE 4.6 MG/24 HOUR TD PT24,,76843,LOCAL,Facility,Inpatient,1,Each,,124,105.4,35.5384,124,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
RIVASTIGMINE 9.5 MG/24 HOUR TD PT24,,76844,LOCAL,Facility,Both,1,Each,,124,105.4,35.5384,124,Aetna,Commercial,114.08,92,,percent of total billed charges,,
RIVASTIGMINE 9.5 MG/24 HOUR TD PT24,,76844,LOCAL,Facility,Both,1,Each,,124,105.4,35.5384,124,Aetna,Commercial,114.08,92,,percent of total billed charges,,
RIVASTIGMINE 9.5 MG/24 HOUR TD PT24,,76844,LOCAL,Facility,Outpatient,1,Each,,124,105.4,35.5384,124,Aetna,Medicare Advantage,60.76,49,,percent of total billed charges,,
RIVASTIGMINE 9.5 MG/24 HOUR TD PT24,,76844,LOCAL,Facility,Outpatient,1,Each,,124,105.4,35.5384,124,Aetna,Medicare Advantage,60.76,49,,percent of total billed charges,,
RIVASTIGMINE 9.5 MG/24 HOUR TD PT24,,76844,LOCAL,Facility,Inpatient,1,Each,,124,105.4,35.5384,124,Aetna,Medicare Advantage,,,,,Included in per diem rate,
RIVASTIGMINE 9.5 MG/24 HOUR TD PT24,,76844,LOCAL,Facility,Inpatient,1,Each,,124,105.4,35.5384,124,Aetna,Medicare Advantage,,,,,Included in per diem rate,
RIVASTIGMINE 9.5 MG/24 HOUR TD PT24,,76844,LOCAL,Facility,Both,1,Each,,124,105.4,35.5384,124,Aetna,PPO,115.32,93,,percent of total billed charges,,
RIVASTIGMINE 9.5 MG/24 HOUR TD PT24,,76844,LOCAL,Facility,Both,1,Each,,124,105.4,35.5384,124,Aetna,PPO,115.32,93,,percent of total billed charges,,
RIVASTIGMINE 9.5 MG/24 HOUR TD PT24,,76844,LOCAL,Facility,Both,1,Each,,124,105.4,35.5384,124,America's PPO,America's PPO,119.0772,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
RIVASTIGMINE 9.5 MG/24 HOUR TD PT24,,76844,LOCAL,Facility,Both,1,Each,,124,105.4,35.5384,124,America's PPO,America's PPO,119.0772,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
RIVASTIGMINE 9.5 MG/24 HOUR TD PT24,,76844,LOCAL,Facility,Both,1,Each,,124,105.4,35.5384,124,BlueCross BlueShield Minnesota, Federal Employee Program,122.016,98.4,,percent of total billed charges,,
RIVASTIGMINE 9.5 MG/24 HOUR TD PT24,,76844,LOCAL,Facility,Both,1,Each,,124,105.4,35.5384,124,BlueCross BlueShield Minnesota, Federal Employee Program,122.016,98.4,,percent of total billed charges,,
RIVASTIGMINE 9.5 MG/24 HOUR TD PT24,,76844,LOCAL,Facility,Both,1,Each,,124,105.4,35.5384,124,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,124,100,,percent of total billed charges,,
RIVASTIGMINE 9.5 MG/24 HOUR TD PT24,,76844,LOCAL,Facility,Both,1,Each,,124,105.4,35.5384,124,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,124,100,,percent of total billed charges,,
RIVASTIGMINE 9.5 MG/24 HOUR TD PT24,,76844,LOCAL,Facility,Both,1,Each,,124,105.4,35.5384,124,BlueCross BlueShield Minnesota,High Value Network Plan,111.6,90,,percent of total billed charges,,
RIVASTIGMINE 9.5 MG/24 HOUR TD PT24,,76844,LOCAL,Facility,Both,1,Each,,124,105.4,35.5384,124,BlueCross BlueShield Minnesota,High Value Network Plan,111.6,90,,percent of total billed charges,,
RIVASTIGMINE 9.5 MG/24 HOUR TD PT24,,76844,LOCAL,Facility,Outpatient,1,Each,,124,105.4,35.5384,124,BlueCross BlueShield Minnesota,Medicare Advantage,60.76,49,,percent of total billed charges,,
RIVASTIGMINE 9.5 MG/24 HOUR TD PT24,,76844,LOCAL,Facility,Outpatient,1,Each,,124,105.4,35.5384,124,BlueCross BlueShield Minnesota,Medicare Advantage,60.76,49,,percent of total billed charges,,
RIVASTIGMINE 9.5 MG/24 HOUR TD PT24,,76844,LOCAL,Facility,Inpatient,1,Each,,124,105.4,35.5384,124,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
RIVASTIGMINE 9.5 MG/24 HOUR TD PT24,,76844,LOCAL,Facility,Inpatient,1,Each,,124,105.4,35.5384,124,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
RIVASTIGMINE 9.5 MG/24 HOUR TD PT24,,76844,LOCAL,Facility,Both,1,Each,,124,105.4,35.5384,124,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,109.8268,88.57,,percent of total billed charges,,
RIVASTIGMINE 9.5 MG/24 HOUR TD PT24,,76844,LOCAL,Facility,Both,1,Each,,124,105.4,35.5384,124,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,109.8268,88.57,,percent of total billed charges,,
RIVASTIGMINE 9.5 MG/24 HOUR TD PT24,,76844,LOCAL,Facility,Both,1,Each,,124,105.4,35.5384,124,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,35.5384,28.66,,percent of total billed charges,,
RIVASTIGMINE 9.5 MG/24 HOUR TD PT24,,76844,LOCAL,Facility,Both,1,Each,,124,105.4,35.5384,124,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,35.5384,28.66,,percent of total billed charges,,
RIVASTIGMINE 9.5 MG/24 HOUR TD PT24,,76844,LOCAL,Facility,Outpatient,1,Each,,124,105.4,35.5384,124,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),60.76,49,,percent of total billed charges,,
RIVASTIGMINE 9.5 MG/24 HOUR TD PT24,,76844,LOCAL,Facility,Outpatient,1,Each,,124,105.4,35.5384,124,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),60.76,49,,percent of total billed charges,,
RIVASTIGMINE 9.5 MG/24 HOUR TD PT24,,76844,LOCAL,Facility,Inpatient,1,Each,,124,105.4,35.5384,124,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
RIVASTIGMINE 9.5 MG/24 HOUR TD PT24,,76844,LOCAL,Facility,Inpatient,1,Each,,124,105.4,35.5384,124,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
RIVASTIGMINE 9.5 MG/24 HOUR TD PT24,,76844,LOCAL,Facility,Both,1,Each,,124,105.4,35.5384,124,CorVel,Worker's Compensation,124,100,,percent of total billed charges,,
RIVASTIGMINE 9.5 MG/24 HOUR TD PT24,,76844,LOCAL,Facility,Both,1,Each,,124,105.4,35.5384,124,CorVel,Worker's Compensation,124,100,,percent of total billed charges,,
RIVASTIGMINE 9.5 MG/24 HOUR TD PT24,,76844,LOCAL,Facility,Both,1,Each,,124,105.4,35.5384,124,First Health Group Corporation,First Health Network,120.28,97,,percent of total billed charges,,
RIVASTIGMINE 9.5 MG/24 HOUR TD PT24,,76844,LOCAL,Facility,Both,1,Each,,124,105.4,35.5384,124,First Health Group Corporation,First Health Network,120.28,97,,percent of total billed charges,,
RIVASTIGMINE 9.5 MG/24 HOUR TD PT24,,76844,LOCAL,Facility,Both,1,Each,,124,105.4,35.5384,124,"Health Partners, Inc.",Commercial,117.304,94.6,,percent of total billed charges,,
RIVASTIGMINE 9.5 MG/24 HOUR TD PT24,,76844,LOCAL,Facility,Both,1,Each,,124,105.4,35.5384,124,"Health Partners, Inc.",Commercial,117.304,94.6,,percent of total billed charges,,
RIVASTIGMINE 9.5 MG/24 HOUR TD PT24,,76844,LOCAL,Facility,Outpatient,1,Each,,124,105.4,35.5384,124,"Health Partners, Inc.",Medicare Advantage,60.76,49,,percent of total billed charges,,
RIVASTIGMINE 9.5 MG/24 HOUR TD PT24,,76844,LOCAL,Facility,Outpatient,1,Each,,124,105.4,35.5384,124,"Health Partners, Inc.",Medicare Advantage,60.76,49,,percent of total billed charges,,
RIVASTIGMINE 9.5 MG/24 HOUR TD PT24,,76844,LOCAL,Facility,Inpatient,1,Each,,124,105.4,35.5384,124,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
RIVASTIGMINE 9.5 MG/24 HOUR TD PT24,,76844,LOCAL,Facility,Inpatient,1,Each,,124,105.4,35.5384,124,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
RIVASTIGMINE 9.5 MG/24 HOUR TD PT24,,76844,LOCAL,Facility,Both,1,Each,,124,105.4,35.5384,124,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),74.4,60,,percent of total billed charges,,
RIVASTIGMINE 9.5 MG/24 HOUR TD PT24,,76844,LOCAL,Facility,Both,1,Each,,124,105.4,35.5384,124,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),74.4,60,,percent of total billed charges,,
RIVASTIGMINE 9.5 MG/24 HOUR TD PT24,,76844,LOCAL,Facility,Both,1,Each,,124,105.4,35.5384,124,"Health Partners, Inc.",State of Minnesota Advantage Program,101.06,81.5,,percent of total billed charges,,
RIVASTIGMINE 9.5 MG/24 HOUR TD PT24,,76844,LOCAL,Facility,Both,1,Each,,124,105.4,35.5384,124,"Health Partners, Inc.",State of Minnesota Advantage Program,101.06,81.5,,percent of total billed charges,,
RIVASTIGMINE 9.5 MG/24 HOUR TD PT24,,76844,LOCAL,Facility,Both,1,Each,,124,105.4,35.5384,124,"Health Partners, Inc.",State Public Programs,62,50,,percent of total billed charges,,
RIVASTIGMINE 9.5 MG/24 HOUR TD PT24,,76844,LOCAL,Facility,Both,1,Each,,124,105.4,35.5384,124,"Health Partners, Inc.",State Public Programs,62,50,,percent of total billed charges,,
RIVASTIGMINE 9.5 MG/24 HOUR TD PT24,,76844,LOCAL,Facility,Both,1,Each,,124,105.4,35.5384,124,Humana Insurance Company,Commercial PPO,117.8,95,,percent of total billed charges,,
RIVASTIGMINE 9.5 MG/24 HOUR TD PT24,,76844,LOCAL,Facility,Both,1,Each,,124,105.4,35.5384,124,Humana Insurance Company,Commercial PPO,117.8,95,,percent of total billed charges,,
RIVASTIGMINE 9.5 MG/24 HOUR TD PT24,,76844,LOCAL,Facility,Outpatient,1,Each,,124,105.4,35.5384,124,Humana Insurance Company,Medicare PPO,60.76,49,,percent of total billed charges,,
RIVASTIGMINE 9.5 MG/24 HOUR TD PT24,,76844,LOCAL,Facility,Outpatient,1,Each,,124,105.4,35.5384,124,Humana Insurance Company,Medicare PPO,60.76,49,,percent of total billed charges,,
RIVASTIGMINE 9.5 MG/24 HOUR TD PT24,,76844,LOCAL,Facility,Inpatient,1,Each,,124,105.4,35.5384,124,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
RIVASTIGMINE 9.5 MG/24 HOUR TD PT24,,76844,LOCAL,Facility,Inpatient,1,Each,,124,105.4,35.5384,124,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
RIVASTIGMINE 9.5 MG/24 HOUR TD PT24,,76844,LOCAL,Facility,Both,1,Each,,124,105.4,35.5384,124,Medica,Individual & Family,122.884,99.1,,percent of total billed charges,,
RIVASTIGMINE 9.5 MG/24 HOUR TD PT24,,76844,LOCAL,Facility,Both,1,Each,,124,105.4,35.5384,124,Medica,Individual & Family,122.884,99.1,,percent of total billed charges,,
RIVASTIGMINE 9.5 MG/24 HOUR TD PT24,,76844,LOCAL,Facility,Outpatient,1,Each,,124,105.4,35.5384,124,Medica,Medica Advantage Solution,61.752,49.8,,percent of total billed charges,,
RIVASTIGMINE 9.5 MG/24 HOUR TD PT24,,76844,LOCAL,Facility,Outpatient,1,Each,,124,105.4,35.5384,124,Medica,Medica Advantage Solution,61.752,49.8,,percent of total billed charges,,
RIVASTIGMINE 9.5 MG/24 HOUR TD PT24,,76844,LOCAL,Facility,Inpatient,1,Each,,124,105.4,35.5384,124,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
RIVASTIGMINE 9.5 MG/24 HOUR TD PT24,,76844,LOCAL,Facility,Inpatient,1,Each,,124,105.4,35.5384,124,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
RIVASTIGMINE 9.5 MG/24 HOUR TD PT24,,76844,LOCAL,Facility,Outpatient,1,Each,,124,105.4,35.5384,124,Medica,Medical Assistance,55.304,44.6,,percent of total billed charges,,
RIVASTIGMINE 9.5 MG/24 HOUR TD PT24,,76844,LOCAL,Facility,Outpatient,1,Each,,124,105.4,35.5384,124,Medica,Medical Assistance,55.304,44.6,,percent of total billed charges,,
RIVASTIGMINE 9.5 MG/24 HOUR TD PT24,,76844,LOCAL,Facility,Inpatient,1,Each,,124,105.4,35.5384,124,Medica,Medical Assistance,,,,,Included in per diem rate,
RIVASTIGMINE 9.5 MG/24 HOUR TD PT24,,76844,LOCAL,Facility,Inpatient,1,Each,,124,105.4,35.5384,124,Medica,Medical Assistance,,,,,Included in per diem rate,
RIVASTIGMINE 9.5 MG/24 HOUR TD PT24,,76844,LOCAL,Facility,Outpatient,1,Each,,124,105.4,35.5384,124,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,61.752,49.8,,percent of total billed charges,,
RIVASTIGMINE 9.5 MG/24 HOUR TD PT24,,76844,LOCAL,Facility,Outpatient,1,Each,,124,105.4,35.5384,124,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,61.752,49.8,,percent of total billed charges,,
RIVASTIGMINE 9.5 MG/24 HOUR TD PT24,,76844,LOCAL,Facility,Inpatient,1,Each,,124,105.4,35.5384,124,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
RIVASTIGMINE 9.5 MG/24 HOUR TD PT24,,76844,LOCAL,Facility,Inpatient,1,Each,,124,105.4,35.5384,124,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
RIVASTIGMINE 9.5 MG/24 HOUR TD PT24,,76844,LOCAL,Facility,Both,1,Each,,124,105.4,35.5384,124,"Multiplan, Inc.","Multiplan, Inc.",116.56,94,,percent of total billed charges,,
RIVASTIGMINE 9.5 MG/24 HOUR TD PT24,,76844,LOCAL,Facility,Both,1,Each,,124,105.4,35.5384,124,"Multiplan, Inc.","Multiplan, Inc.",116.56,94,,percent of total billed charges,,
RIVASTIGMINE 9.5 MG/24 HOUR TD PT24,,76844,LOCAL,Facility,Outpatient,1,Each,,124,105.4,35.5384,124,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,111.724,90.1,,percent of total billed charges,,
RIVASTIGMINE 9.5 MG/24 HOUR TD PT24,,76844,LOCAL,Facility,Outpatient,1,Each,,124,105.4,35.5384,124,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,111.724,90.1,,percent of total billed charges,,
RIVASTIGMINE 9.5 MG/24 HOUR TD PT24,,76844,LOCAL,Facility,Inpatient,1,Each,,124,105.4,35.5384,124,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
RIVASTIGMINE 9.5 MG/24 HOUR TD PT24,,76844,LOCAL,Facility,Inpatient,1,Each,,124,105.4,35.5384,124,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
RIVASTIGMINE 9.5 MG/24 HOUR TD PT24,,76844,LOCAL,Facility,Both,1,Each,,124,105.4,35.5384,124,"Preferred One Administrative Services, INC.",PPO,122.264,98.6,,percent of total billed charges,,
RIVASTIGMINE 9.5 MG/24 HOUR TD PT24,,76844,LOCAL,Facility,Both,1,Each,,124,105.4,35.5384,124,"Preferred One Administrative Services, INC.",PPO,122.264,98.6,,percent of total billed charges,,
RIVASTIGMINE 9.5 MG/24 HOUR TD PT24,,76844,LOCAL,Facility,Outpatient,1,Each,,124,105.4,35.5384,124,PrimeWest Health,Minnesota Senior Health Options (MSHO),63.798,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
RIVASTIGMINE 9.5 MG/24 HOUR TD PT24,,76844,LOCAL,Facility,Outpatient,1,Each,,124,105.4,35.5384,124,PrimeWest Health,Minnesota Senior Health Options (MSHO),63.798,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
RIVASTIGMINE 9.5 MG/24 HOUR TD PT24,,76844,LOCAL,Facility,Inpatient,1,Each,,124,105.4,35.5384,124,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
RIVASTIGMINE 9.5 MG/24 HOUR TD PT24,,76844,LOCAL,Facility,Inpatient,1,Each,,124,105.4,35.5384,124,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
RIVASTIGMINE 9.5 MG/24 HOUR TD PT24,,76844,LOCAL,Facility,Outpatient,1,Each,,124,105.4,35.5384,124,PrimeWest Health,MinnesotaCare,63.6864,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
RIVASTIGMINE 9.5 MG/24 HOUR TD PT24,,76844,LOCAL,Facility,Outpatient,1,Each,,124,105.4,35.5384,124,PrimeWest Health,MinnesotaCare,63.6864,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
RIVASTIGMINE 9.5 MG/24 HOUR TD PT24,,76844,LOCAL,Facility,Inpatient,1,Each,,124,105.4,35.5384,124,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
RIVASTIGMINE 9.5 MG/24 HOUR TD PT24,,76844,LOCAL,Facility,Inpatient,1,Each,,124,105.4,35.5384,124,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
RIVASTIGMINE 9.5 MG/24 HOUR TD PT24,,76844,LOCAL,Facility,Both,1,Each,,124,105.4,35.5384,124,Sanford Health Plan,Sanford Health Plan,114.08,92,,percent of total billed charges,,
RIVASTIGMINE 9.5 MG/24 HOUR TD PT24,,76844,LOCAL,Facility,Both,1,Each,,124,105.4,35.5384,124,Sanford Health Plan,Sanford Health Plan,114.08,92,,percent of total billed charges,,
RIVASTIGMINE 9.5 MG/24 HOUR TD PT24,,76844,LOCAL,Facility,Outpatient,1,Each,,124,105.4,35.5384,124,"UCare Health, Inc.",Individual & Family Plan,69.874,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
RIVASTIGMINE 9.5 MG/24 HOUR TD PT24,,76844,LOCAL,Facility,Outpatient,1,Each,,124,105.4,35.5384,124,"UCare Health, Inc.",Individual & Family Plan,69.874,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
RIVASTIGMINE 9.5 MG/24 HOUR TD PT24,,76844,LOCAL,Facility,Inpatient,1,Each,,124,105.4,35.5384,124,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
RIVASTIGMINE 9.5 MG/24 HOUR TD PT24,,76844,LOCAL,Facility,Inpatient,1,Each,,124,105.4,35.5384,124,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
RIVASTIGMINE 9.5 MG/24 HOUR TD PT24,,76844,LOCAL,Facility,Outpatient,1,Each,,124,105.4,35.5384,124,"UCare Health, Inc.",Medical Assistance,62.5828,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
RIVASTIGMINE 9.5 MG/24 HOUR TD PT24,,76844,LOCAL,Facility,Outpatient,1,Each,,124,105.4,35.5384,124,"UCare Health, Inc.",Medical Assistance,62.5828,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
RIVASTIGMINE 9.5 MG/24 HOUR TD PT24,,76844,LOCAL,Facility,Inpatient,1,Each,,124,105.4,35.5384,124,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
RIVASTIGMINE 9.5 MG/24 HOUR TD PT24,,76844,LOCAL,Facility,Inpatient,1,Each,,124,105.4,35.5384,124,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
RIVASTIGMINE 9.5 MG/24 HOUR TD PT24,,76844,LOCAL,Facility,Outpatient,1,Each,,124,105.4,35.5384,124,"UCare Health, Inc.",Medicare Advantage,62.5828,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
RIVASTIGMINE 9.5 MG/24 HOUR TD PT24,,76844,LOCAL,Facility,Outpatient,1,Each,,124,105.4,35.5384,124,"UCare Health, Inc.",Medicare Advantage,62.5828,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
RIVASTIGMINE 9.5 MG/24 HOUR TD PT24,,76844,LOCAL,Facility,Inpatient,1,Each,,124,105.4,35.5384,124,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
RIVASTIGMINE 9.5 MG/24 HOUR TD PT24,,76844,LOCAL,Facility,Inpatient,1,Each,,124,105.4,35.5384,124,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
RIVASTIGMINE 9.5 MG/24 HOUR TD PT24,,76844,LOCAL,Facility,Outpatient,1,Each,,124,105.4,35.5384,124,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),62.5828,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
RIVASTIGMINE 9.5 MG/24 HOUR TD PT24,,76844,LOCAL,Facility,Outpatient,1,Each,,124,105.4,35.5384,124,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),62.5828,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
RIVASTIGMINE 9.5 MG/24 HOUR TD PT24,,76844,LOCAL,Facility,Inpatient,1,Each,,124,105.4,35.5384,124,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
RIVASTIGMINE 9.5 MG/24 HOUR TD PT24,,76844,LOCAL,Facility,Inpatient,1,Each,,124,105.4,35.5384,124,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
RIVASTIGMINE 9.5 MG/24 HOUR TD PT24,,76844,LOCAL,Facility,Both,1,Each,,124,105.4,35.5384,124,UnitedHealthcare,Individual & Family,116.56,94,,percent of total billed charges,,
RIVASTIGMINE 9.5 MG/24 HOUR TD PT24,,76844,LOCAL,Facility,Both,1,Each,,124,105.4,35.5384,124,UnitedHealthcare,Individual & Family,116.56,94,,percent of total billed charges,,
RIVASTIGMINE 9.5 MG/24 HOUR TD PT24,,76844,LOCAL,Facility,Outpatient,1,Each,,124,105.4,35.5384,124,UnitedHealthcare,Medicare Advantage,60.76,49,,percent of total billed charges,,
RIVASTIGMINE 9.5 MG/24 HOUR TD PT24,,76844,LOCAL,Facility,Outpatient,1,Each,,124,105.4,35.5384,124,UnitedHealthcare,Medicare Advantage,60.76,49,,percent of total billed charges,,
RIVASTIGMINE 9.5 MG/24 HOUR TD PT24,,76844,LOCAL,Facility,Inpatient,1,Each,,124,105.4,35.5384,124,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
RIVASTIGMINE 9.5 MG/24 HOUR TD PT24,,76844,LOCAL,Facility,Inpatient,1,Each,,124,105.4,35.5384,124,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
RIVASTIGMINE 9.5 MG/24 HOUR TD PT24,,76844,LOCAL,Facility,Outpatient,1,Each,,124,105.4,35.5384,124,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,59.52,48,,percent of total billed charges,,100% of DHS outpatient percentage
RIVASTIGMINE 9.5 MG/24 HOUR TD PT24,,76844,LOCAL,Facility,Outpatient,1,Each,,124,105.4,35.5384,124,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,59.52,48,,percent of total billed charges,,100% of DHS outpatient percentage
RIVASTIGMINE 9.5 MG/24 HOUR TD PT24,,76844,LOCAL,Facility,Inpatient,1,Each,,124,105.4,35.5384,124,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
RIVASTIGMINE 9.5 MG/24 HOUR TD PT24,,76844,LOCAL,Facility,Inpatient,1,Each,,124,105.4,35.5384,124,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
OSELTAMIVIR 30 MG ORAL CAP,,79159,LOCAL,Facility,Both,1,Each,,81,68.85,23.2146,81,Aetna,Commercial,74.52,92,,percent of total billed charges,,
OSELTAMIVIR 30 MG ORAL CAP,,79159,LOCAL,Facility,Outpatient,1,Each,,81,68.85,23.2146,81,Aetna,Medicare Advantage,39.69,49,,percent of total billed charges,,
OSELTAMIVIR 30 MG ORAL CAP,,79159,LOCAL,Facility,Inpatient,1,Each,,81,68.85,23.2146,81,Aetna,Medicare Advantage,,,,,Included in per diem rate,
OSELTAMIVIR 30 MG ORAL CAP,,79159,LOCAL,Facility,Both,1,Each,,81,68.85,23.2146,81,Aetna,PPO,75.33,93,,percent of total billed charges,,
OSELTAMIVIR 30 MG ORAL CAP,,79159,LOCAL,Facility,Both,1,Each,,81,68.85,23.2146,81,America's PPO,America's PPO,77.7843,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
OSELTAMIVIR 30 MG ORAL CAP,,79159,LOCAL,Facility,Both,1,Each,,81,68.85,23.2146,81,BlueCross BlueShield Minnesota, Federal Employee Program,79.704,98.4,,percent of total billed charges,,
OSELTAMIVIR 30 MG ORAL CAP,,79159,LOCAL,Facility,Both,1,Each,,81,68.85,23.2146,81,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,81,100,,percent of total billed charges,,
OSELTAMIVIR 30 MG ORAL CAP,,79159,LOCAL,Facility,Both,1,Each,,81,68.85,23.2146,81,BlueCross BlueShield Minnesota,High Value Network Plan,72.9,90,,percent of total billed charges,,
OSELTAMIVIR 30 MG ORAL CAP,,79159,LOCAL,Facility,Outpatient,1,Each,,81,68.85,23.2146,81,BlueCross BlueShield Minnesota,Medicare Advantage,39.69,49,,percent of total billed charges,,
OSELTAMIVIR 30 MG ORAL CAP,,79159,LOCAL,Facility,Inpatient,1,Each,,81,68.85,23.2146,81,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
OSELTAMIVIR 30 MG ORAL CAP,,79159,LOCAL,Facility,Both,1,Each,,81,68.85,23.2146,81,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,71.7417,88.57,,percent of total billed charges,,
OSELTAMIVIR 30 MG ORAL CAP,,79159,LOCAL,Facility,Both,1,Each,,81,68.85,23.2146,81,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,23.2146,28.66,,percent of total billed charges,,
OSELTAMIVIR 30 MG ORAL CAP,,79159,LOCAL,Facility,Outpatient,1,Each,,81,68.85,23.2146,81,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),39.69,49,,percent of total billed charges,,
OSELTAMIVIR 30 MG ORAL CAP,,79159,LOCAL,Facility,Inpatient,1,Each,,81,68.85,23.2146,81,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
OSELTAMIVIR 30 MG ORAL CAP,,79159,LOCAL,Facility,Both,1,Each,,81,68.85,23.2146,81,CorVel,Worker's Compensation,81,100,,percent of total billed charges,,
OSELTAMIVIR 30 MG ORAL CAP,,79159,LOCAL,Facility,Both,1,Each,,81,68.85,23.2146,81,First Health Group Corporation,First Health Network,78.57,97,,percent of total billed charges,,
OSELTAMIVIR 30 MG ORAL CAP,,79159,LOCAL,Facility,Both,1,Each,,81,68.85,23.2146,81,"Health Partners, Inc.",Commercial,76.626,94.6,,percent of total billed charges,,
OSELTAMIVIR 30 MG ORAL CAP,,79159,LOCAL,Facility,Outpatient,1,Each,,81,68.85,23.2146,81,"Health Partners, Inc.",Medicare Advantage,39.69,49,,percent of total billed charges,,
OSELTAMIVIR 30 MG ORAL CAP,,79159,LOCAL,Facility,Inpatient,1,Each,,81,68.85,23.2146,81,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
OSELTAMIVIR 30 MG ORAL CAP,,79159,LOCAL,Facility,Both,1,Each,,81,68.85,23.2146,81,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),48.6,60,,percent of total billed charges,,
OSELTAMIVIR 30 MG ORAL CAP,,79159,LOCAL,Facility,Both,1,Each,,81,68.85,23.2146,81,"Health Partners, Inc.",State of Minnesota Advantage Program,66.015,81.5,,percent of total billed charges,,
OSELTAMIVIR 30 MG ORAL CAP,,79159,LOCAL,Facility,Both,1,Each,,81,68.85,23.2146,81,"Health Partners, Inc.",State Public Programs,40.5,50,,percent of total billed charges,,
OSELTAMIVIR 30 MG ORAL CAP,,79159,LOCAL,Facility,Both,1,Each,,81,68.85,23.2146,81,Humana Insurance Company,Commercial PPO,76.95,95,,percent of total billed charges,,
OSELTAMIVIR 30 MG ORAL CAP,,79159,LOCAL,Facility,Outpatient,1,Each,,81,68.85,23.2146,81,Humana Insurance Company,Medicare PPO,39.69,49,,percent of total billed charges,,
OSELTAMIVIR 30 MG ORAL CAP,,79159,LOCAL,Facility,Inpatient,1,Each,,81,68.85,23.2146,81,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
OSELTAMIVIR 30 MG ORAL CAP,,79159,LOCAL,Facility,Both,1,Each,,81,68.85,23.2146,81,Medica,Individual & Family,80.271,99.1,,percent of total billed charges,,
OSELTAMIVIR 30 MG ORAL CAP,,79159,LOCAL,Facility,Outpatient,1,Each,,81,68.85,23.2146,81,Medica,Medica Advantage Solution,40.338,49.8,,percent of total billed charges,,
OSELTAMIVIR 30 MG ORAL CAP,,79159,LOCAL,Facility,Inpatient,1,Each,,81,68.85,23.2146,81,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
OSELTAMIVIR 30 MG ORAL CAP,,79159,LOCAL,Facility,Outpatient,1,Each,,81,68.85,23.2146,81,Medica,Medical Assistance,36.126,44.6,,percent of total billed charges,,
OSELTAMIVIR 30 MG ORAL CAP,,79159,LOCAL,Facility,Inpatient,1,Each,,81,68.85,23.2146,81,Medica,Medical Assistance,,,,,Included in per diem rate,
OSELTAMIVIR 30 MG ORAL CAP,,79159,LOCAL,Facility,Outpatient,1,Each,,81,68.85,23.2146,81,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,40.338,49.8,,percent of total billed charges,,
OSELTAMIVIR 30 MG ORAL CAP,,79159,LOCAL,Facility,Inpatient,1,Each,,81,68.85,23.2146,81,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
OSELTAMIVIR 30 MG ORAL CAP,,79159,LOCAL,Facility,Both,1,Each,,81,68.85,23.2146,81,"Multiplan, Inc.","Multiplan, Inc.",76.14,94,,percent of total billed charges,,
OSELTAMIVIR 30 MG ORAL CAP,,79159,LOCAL,Facility,Outpatient,1,Each,,81,68.85,23.2146,81,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,72.981,90.1,,percent of total billed charges,,
OSELTAMIVIR 30 MG ORAL CAP,,79159,LOCAL,Facility,Inpatient,1,Each,,81,68.85,23.2146,81,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
OSELTAMIVIR 30 MG ORAL CAP,,79159,LOCAL,Facility,Both,1,Each,,81,68.85,23.2146,81,"Preferred One Administrative Services, INC.",PPO,79.866,98.6,,percent of total billed charges,,
OSELTAMIVIR 30 MG ORAL CAP,,79159,LOCAL,Facility,Outpatient,1,Each,,81,68.85,23.2146,81,PrimeWest Health,Minnesota Senior Health Options (MSHO),41.6745,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
OSELTAMIVIR 30 MG ORAL CAP,,79159,LOCAL,Facility,Inpatient,1,Each,,81,68.85,23.2146,81,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
OSELTAMIVIR 30 MG ORAL CAP,,79159,LOCAL,Facility,Outpatient,1,Each,,81,68.85,23.2146,81,PrimeWest Health,MinnesotaCare,41.6016,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
OSELTAMIVIR 30 MG ORAL CAP,,79159,LOCAL,Facility,Inpatient,1,Each,,81,68.85,23.2146,81,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
OSELTAMIVIR 30 MG ORAL CAP,,79159,LOCAL,Facility,Both,1,Each,,81,68.85,23.2146,81,Sanford Health Plan,Sanford Health Plan,74.52,92,,percent of total billed charges,,
OSELTAMIVIR 30 MG ORAL CAP,,79159,LOCAL,Facility,Outpatient,1,Each,,81,68.85,23.2146,81,"UCare Health, Inc.",Individual & Family Plan,45.6435,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
OSELTAMIVIR 30 MG ORAL CAP,,79159,LOCAL,Facility,Inpatient,1,Each,,81,68.85,23.2146,81,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
OSELTAMIVIR 30 MG ORAL CAP,,79159,LOCAL,Facility,Outpatient,1,Each,,81,68.85,23.2146,81,"UCare Health, Inc.",Medical Assistance,40.8807,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
OSELTAMIVIR 30 MG ORAL CAP,,79159,LOCAL,Facility,Inpatient,1,Each,,81,68.85,23.2146,81,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
OSELTAMIVIR 30 MG ORAL CAP,,79159,LOCAL,Facility,Outpatient,1,Each,,81,68.85,23.2146,81,"UCare Health, Inc.",Medicare Advantage,40.8807,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
OSELTAMIVIR 30 MG ORAL CAP,,79159,LOCAL,Facility,Inpatient,1,Each,,81,68.85,23.2146,81,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
OSELTAMIVIR 30 MG ORAL CAP,,79159,LOCAL,Facility,Outpatient,1,Each,,81,68.85,23.2146,81,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),40.8807,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
OSELTAMIVIR 30 MG ORAL CAP,,79159,LOCAL,Facility,Inpatient,1,Each,,81,68.85,23.2146,81,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
OSELTAMIVIR 30 MG ORAL CAP,,79159,LOCAL,Facility,Both,1,Each,,81,68.85,23.2146,81,UnitedHealthcare,Individual & Family,76.14,94,,percent of total billed charges,,
OSELTAMIVIR 30 MG ORAL CAP,,79159,LOCAL,Facility,Outpatient,1,Each,,81,68.85,23.2146,81,UnitedHealthcare,Medicare Advantage,39.69,49,,percent of total billed charges,,
OSELTAMIVIR 30 MG ORAL CAP,,79159,LOCAL,Facility,Inpatient,1,Each,,81,68.85,23.2146,81,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
OSELTAMIVIR 30 MG ORAL CAP,,79159,LOCAL,Facility,Outpatient,1,Each,,81,68.85,23.2146,81,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,38.88,48,,percent of total billed charges,,100% of DHS outpatient percentage
OSELTAMIVIR 30 MG ORAL CAP,,79159,LOCAL,Facility,Inpatient,1,Each,,81,68.85,23.2146,81,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Excision, Coccygeal Pressure Ulcer, With Coccygectomy; With Primary Suture (Pro Cah)",,15920,CPT,Professional,Both,,,,1683,1430.55,396.82,1683,Aetna,Commercial,1430.55,85,,percent of total billed charges,,
"Excision, Coccygeal Pressure Ulcer, With Coccygectomy; With Primary Suture (Pro Cah)",,15920,CPT,Professional,Both,,,,1683,1430.55,396.82,1683,Aetna,Medicare Advantage,608.95,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Coccygeal Pressure Ulcer, With Coccygectomy; With Primary Suture (Pro Cah)",,15920,CPT,Professional,Both,,,,1683,1430.55,396.82,1683,Aetna,PPO,1565.19,93,,percent of total billed charges,,
"Excision, Coccygeal Pressure Ulcer, With Coccygectomy; With Primary Suture (Pro Cah)",,15920,CPT,Professional,Both,,,,1683,1430.55,396.82,1683,America's PPO,America's PPO,1437.9552,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Excision, Coccygeal Pressure Ulcer, With Coccygectomy; With Primary Suture (Pro Cah)",,15920,CPT,Professional,Both,,,,1683,1430.55,396.82,1683,BlueCross BlueShield Minnesota, Federal Employee Program,1324.87,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Excision, Coccygeal Pressure Ulcer, With Coccygectomy; With Primary Suture (Pro Cah)",,15920,CPT,Professional,Both,,,,1683,1430.55,396.82,1683,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1346.06792,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Coccygeal Pressure Ulcer, With Coccygectomy; With Primary Suture (Pro Cah)",,15920,CPT,Professional,Both,,,,1683,1430.55,396.82,1683,BlueCross BlueShield Minnesota,High Value Network Plan,1346.06792,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Coccygeal Pressure Ulcer, With Coccygectomy; With Primary Suture (Pro Cah)",,15920,CPT,Professional,Both,,,,1683,1430.55,396.82,1683,BlueCross BlueShield Minnesota,Medicare Advantage,709.0095,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Coccygeal Pressure Ulcer, With Coccygectomy; With Primary Suture (Pro Cah)",,15920,CPT,Professional,Both,,,,1683,1430.55,396.82,1683,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1346.06792,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Coccygeal Pressure Ulcer, With Coccygectomy; With Primary Suture (Pro Cah)",,15920,CPT,Professional,Both,,,,1683,1430.55,396.82,1683,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,458.14488,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision, Coccygeal Pressure Ulcer, With Coccygectomy; With Primary Suture (Pro Cah)",,15920,CPT,Professional,Both,,,,1683,1430.55,396.82,1683,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),709.0095,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Coccygeal Pressure Ulcer, With Coccygectomy; With Primary Suture (Pro Cah)",,15920,CPT,Professional,Both,,,,1683,1430.55,396.82,1683,CorVel,Worker's Compensation,1207.20678,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Excision, Coccygeal Pressure Ulcer, With Coccygectomy; With Primary Suture (Pro Cah)",,15920,CPT,Professional,Both,,,,1683,1430.55,396.82,1683,First Health Group Corporation,First Health Network,1632.51,97,,percent of total billed charges,,
"Excision, Coccygeal Pressure Ulcer, With Coccygectomy; With Primary Suture (Pro Cah)",,15920,CPT,Professional,Both,,,,1683,1430.55,396.82,1683,"Health Partners, Inc.",Commercial,1304.49,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision, Coccygeal Pressure Ulcer, With Coccygectomy; With Primary Suture (Pro Cah)",,15920,CPT,Professional,Both,,,,1683,1430.55,396.82,1683,"Health Partners, Inc.",Medicare Advantage,709.0095,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Coccygeal Pressure Ulcer, With Coccygectomy; With Primary Suture (Pro Cah)",,15920,CPT,Professional,Both,,,,1683,1430.55,396.82,1683,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),616.41,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Excision, Coccygeal Pressure Ulcer, With Coccygectomy; With Primary Suture (Pro Cah)",,15920,CPT,Professional,Both,,,,1683,1430.55,396.82,1683,"Health Partners, Inc.",State of Minnesota Advantage Program,1123.818135,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision, Coccygeal Pressure Ulcer, With Coccygectomy; With Primary Suture (Pro Cah)",,15920,CPT,Professional,Both,,,,1683,1430.55,396.82,1683,"Health Partners, Inc.",State Public Programs,396.82,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Excision, Coccygeal Pressure Ulcer, With Coccygectomy; With Primary Suture (Pro Cah)",,15920,CPT,Professional,Both,,,,1683,1430.55,396.82,1683,Humana Insurance Company,Commercial PPO,616.53,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Excision, Coccygeal Pressure Ulcer, With Coccygectomy; With Primary Suture (Pro Cah)",,15920,CPT,Professional,Both,,,,1683,1430.55,396.82,1683,Humana Insurance Company,Medicare PPO,1683,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Excision, Coccygeal Pressure Ulcer, With Coccygectomy; With Primary Suture (Pro Cah)",,15920,CPT,Professional,Both,,,,1683,1430.55,396.82,1683,Medica,Individual & Family,1427.184,84.8,,percent of total billed charges,,
"Excision, Coccygeal Pressure Ulcer, With Coccygectomy; With Primary Suture (Pro Cah)",,15920,CPT,Professional,Both,,,,1683,1430.55,396.82,1683,Medica,Medica Advantage Solution,838.134,49.8,,percent of total billed charges,,
"Excision, Coccygeal Pressure Ulcer, With Coccygectomy; With Primary Suture (Pro Cah)",,15920,CPT,Professional,Both,,,,1683,1430.55,396.82,1683,Medica,Medical Assistance,458.14,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Excision, Coccygeal Pressure Ulcer, With Coccygectomy; With Primary Suture (Pro Cah)",,15920,CPT,Professional,Both,,,,1683,1430.55,396.82,1683,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,616.53,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Excision, Coccygeal Pressure Ulcer, With Coccygectomy; With Primary Suture (Pro Cah)",,15920,CPT,Professional,Both,,,,1683,1430.55,396.82,1683,"Multiplan, Inc.","Multiplan, Inc.",1582.02,94,,percent of total billed charges,,
"Excision, Coccygeal Pressure Ulcer, With Coccygectomy; With Primary Suture (Pro Cah)",,15920,CPT,Professional,Both,,,,1683,1430.55,396.82,1683,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1516.383,90.1,,percent of total billed charges,,
"Excision, Coccygeal Pressure Ulcer, With Coccygectomy; With Primary Suture (Pro Cah)",,15920,CPT,Professional,Both,,,,1683,1430.55,396.82,1683,"Preferred One Administrative Services, INC.",PPO,1659.438,98.6,,percent of total billed charges,,
"Excision, Coccygeal Pressure Ulcer, With Coccygectomy; With Primary Suture (Pro Cah)",,15920,CPT,Professional,Both,,,,1683,1430.55,396.82,1683,PrimeWest Health,Minnesota Senior Health Options (MSHO),709.0095,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Coccygeal Pressure Ulcer, With Coccygectomy; With Primary Suture (Pro Cah)",,15920,CPT,Professional,Both,,,,1683,1430.55,396.82,1683,PrimeWest Health,MinnesotaCare,490.2150216,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision, Coccygeal Pressure Ulcer, With Coccygectomy; With Primary Suture (Pro Cah)",,15920,CPT,Professional,Both,,,,1683,1430.55,396.82,1683,Sanford Health Plan,Sanford Health Plan,1481.04,88,,percent of total billed charges,,
"Excision, Coccygeal Pressure Ulcer, With Coccygectomy; With Primary Suture (Pro Cah)",,15920,CPT,Professional,Both,,,,1683,1430.55,396.82,1683,"UCare Health, Inc.",Individual & Family Plan,1002.231168,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Excision, Coccygeal Pressure Ulcer, With Coccygectomy; With Primary Suture (Pro Cah)",,15920,CPT,Professional,Both,,,,1683,1430.55,396.82,1683,"UCare Health, Inc.",Medical Assistance,503.959368,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Excision, Coccygeal Pressure Ulcer, With Coccygectomy; With Primary Suture (Pro Cah)",,15920,CPT,Professional,Both,,,,1683,1430.55,396.82,1683,"UCare Health, Inc.",Medicare Advantage,709.0095,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Excision, Coccygeal Pressure Ulcer, With Coccygectomy; With Primary Suture (Pro Cah)",,15920,CPT,Professional,Both,,,,1683,1430.55,396.82,1683,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),567.2076,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Excision, Coccygeal Pressure Ulcer, With Coccygectomy; With Primary Suture (Pro Cah)",,15920,CPT,Professional,Both,,,,1683,1430.55,396.82,1683,UnitedHealthcare,Individual & Family,1683,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Excision, Coccygeal Pressure Ulcer, With Coccygectomy; With Primary Suture (Pro Cah)",,15920,CPT,Professional,Both,,,,1683,1430.55,396.82,1683,UnitedHealthcare,Medicare Advantage,709.0095,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Coccygeal Pressure Ulcer, With Coccygectomy; With Primary Suture (Pro Cah)",,15920,CPT,Professional,Both,,,,1683,1430.55,396.82,1683,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,458.14488,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"POTASSIUM, SODIUM PHOSPHATES 280-160-250 MG ORAL PWPK",,79379,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
"POTASSIUM, SODIUM PHOSPHATES 280-160-250 MG ORAL PWPK",,79379,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
"POTASSIUM, SODIUM PHOSPHATES 280-160-250 MG ORAL PWPK",,79379,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"POTASSIUM, SODIUM PHOSPHATES 280-160-250 MG ORAL PWPK",,79379,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
"POTASSIUM, SODIUM PHOSPHATES 280-160-250 MG ORAL PWPK",,79379,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"POTASSIUM, SODIUM PHOSPHATES 280-160-250 MG ORAL PWPK",,79379,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
"POTASSIUM, SODIUM PHOSPHATES 280-160-250 MG ORAL PWPK",,79379,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
"POTASSIUM, SODIUM PHOSPHATES 280-160-250 MG ORAL PWPK",,79379,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
"POTASSIUM, SODIUM PHOSPHATES 280-160-250 MG ORAL PWPK",,79379,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
"POTASSIUM, SODIUM PHOSPHATES 280-160-250 MG ORAL PWPK",,79379,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"POTASSIUM, SODIUM PHOSPHATES 280-160-250 MG ORAL PWPK",,79379,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
"POTASSIUM, SODIUM PHOSPHATES 280-160-250 MG ORAL PWPK",,79379,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
"POTASSIUM, SODIUM PHOSPHATES 280-160-250 MG ORAL PWPK",,79379,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
"POTASSIUM, SODIUM PHOSPHATES 280-160-250 MG ORAL PWPK",,79379,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"POTASSIUM, SODIUM PHOSPHATES 280-160-250 MG ORAL PWPK",,79379,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
"POTASSIUM, SODIUM PHOSPHATES 280-160-250 MG ORAL PWPK",,79379,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
"POTASSIUM, SODIUM PHOSPHATES 280-160-250 MG ORAL PWPK",,79379,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
"POTASSIUM, SODIUM PHOSPHATES 280-160-250 MG ORAL PWPK",,79379,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
"POTASSIUM, SODIUM PHOSPHATES 280-160-250 MG ORAL PWPK",,79379,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"POTASSIUM, SODIUM PHOSPHATES 280-160-250 MG ORAL PWPK",,79379,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
"POTASSIUM, SODIUM PHOSPHATES 280-160-250 MG ORAL PWPK",,79379,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
"POTASSIUM, SODIUM PHOSPHATES 280-160-250 MG ORAL PWPK",,79379,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
"POTASSIUM, SODIUM PHOSPHATES 280-160-250 MG ORAL PWPK",,79379,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
"POTASSIUM, SODIUM PHOSPHATES 280-160-250 MG ORAL PWPK",,79379,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
"POTASSIUM, SODIUM PHOSPHATES 280-160-250 MG ORAL PWPK",,79379,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"POTASSIUM, SODIUM PHOSPHATES 280-160-250 MG ORAL PWPK",,79379,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
"POTASSIUM, SODIUM PHOSPHATES 280-160-250 MG ORAL PWPK",,79379,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
"POTASSIUM, SODIUM PHOSPHATES 280-160-250 MG ORAL PWPK",,79379,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"POTASSIUM, SODIUM PHOSPHATES 280-160-250 MG ORAL PWPK",,79379,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
"POTASSIUM, SODIUM PHOSPHATES 280-160-250 MG ORAL PWPK",,79379,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
"POTASSIUM, SODIUM PHOSPHATES 280-160-250 MG ORAL PWPK",,79379,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
"POTASSIUM, SODIUM PHOSPHATES 280-160-250 MG ORAL PWPK",,79379,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"POTASSIUM, SODIUM PHOSPHATES 280-160-250 MG ORAL PWPK",,79379,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
"POTASSIUM, SODIUM PHOSPHATES 280-160-250 MG ORAL PWPK",,79379,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
"POTASSIUM, SODIUM PHOSPHATES 280-160-250 MG ORAL PWPK",,79379,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"POTASSIUM, SODIUM PHOSPHATES 280-160-250 MG ORAL PWPK",,79379,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
"POTASSIUM, SODIUM PHOSPHATES 280-160-250 MG ORAL PWPK",,79379,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"POTASSIUM, SODIUM PHOSPHATES 280-160-250 MG ORAL PWPK",,79379,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"POTASSIUM, SODIUM PHOSPHATES 280-160-250 MG ORAL PWPK",,79379,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"POTASSIUM, SODIUM PHOSPHATES 280-160-250 MG ORAL PWPK",,79379,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"POTASSIUM, SODIUM PHOSPHATES 280-160-250 MG ORAL PWPK",,79379,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
"POTASSIUM, SODIUM PHOSPHATES 280-160-250 MG ORAL PWPK",,79379,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"POTASSIUM, SODIUM PHOSPHATES 280-160-250 MG ORAL PWPK",,79379,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"POTASSIUM, SODIUM PHOSPHATES 280-160-250 MG ORAL PWPK",,79379,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"POTASSIUM, SODIUM PHOSPHATES 280-160-250 MG ORAL PWPK",,79379,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"POTASSIUM, SODIUM PHOSPHATES 280-160-250 MG ORAL PWPK",,79379,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"POTASSIUM, SODIUM PHOSPHATES 280-160-250 MG ORAL PWPK",,79379,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"POTASSIUM, SODIUM PHOSPHATES 280-160-250 MG ORAL PWPK",,79379,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"POTASSIUM, SODIUM PHOSPHATES 280-160-250 MG ORAL PWPK",,79379,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"POTASSIUM, SODIUM PHOSPHATES 280-160-250 MG ORAL PWPK",,79379,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
"POTASSIUM, SODIUM PHOSPHATES 280-160-250 MG ORAL PWPK",,79379,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
"POTASSIUM, SODIUM PHOSPHATES 280-160-250 MG ORAL PWPK",,79379,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"POTASSIUM, SODIUM PHOSPHATES 280-160-250 MG ORAL PWPK",,79379,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
"POTASSIUM, SODIUM PHOSPHATES 280-160-250 MG ORAL PWPK",,79379,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Initial Treatment, First Degree Burn, When No More Than Local Treatment Is Required (Pro Cah)",,16000,CPT,Professional,Both,,,,209,177.65,27.7,209,Aetna,Commercial,177.65,85,,percent of total billed charges,,
"Initial Treatment, First Degree Burn, When No More Than Local Treatment Is Required (Pro Cah)",,16000,CPT,Professional,Both,,,,209,177.65,27.7,209,Aetna,Medicare Advantage,43.26,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Initial Treatment, First Degree Burn, When No More Than Local Treatment Is Required (Pro Cah)",,16000,CPT,Professional,Both,,,,209,177.65,27.7,209,Aetna,PPO,194.37,93,,percent of total billed charges,,
"Initial Treatment, First Degree Burn, When No More Than Local Treatment Is Required (Pro Cah)",,16000,CPT,Professional,Both,,,,209,177.65,27.7,209,America's PPO,America's PPO,178.5696,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Initial Treatment, First Degree Burn, When No More Than Local Treatment Is Required (Pro Cah)",,16000,CPT,Professional,Both,,,,209,177.65,27.7,209,BlueCross BlueShield Minnesota, Federal Employee Program,93.65,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Initial Treatment, First Degree Burn, When No More Than Local Treatment Is Required (Pro Cah)",,16000,CPT,Professional,Both,,,,209,177.65,27.7,209,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,95.1484,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Initial Treatment, First Degree Burn, When No More Than Local Treatment Is Required (Pro Cah)",,16000,CPT,Professional,Both,,,,209,177.65,27.7,209,BlueCross BlueShield Minnesota,High Value Network Plan,95.1484,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Initial Treatment, First Degree Burn, When No More Than Local Treatment Is Required (Pro Cah)",,16000,CPT,Professional,Both,,,,209,177.65,27.7,209,BlueCross BlueShield Minnesota,Medicare Advantage,49.565,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Initial Treatment, First Degree Burn, When No More Than Local Treatment Is Required (Pro Cah)",,16000,CPT,Professional,Both,,,,209,177.65,27.7,209,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,95.1484,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Initial Treatment, First Degree Burn, When No More Than Local Treatment Is Required (Pro Cah)",,16000,CPT,Professional,Both,,,,209,177.65,27.7,209,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,31.98368,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Initial Treatment, First Degree Burn, When No More Than Local Treatment Is Required (Pro Cah)",,16000,CPT,Professional,Both,,,,209,177.65,27.7,209,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),49.565,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Initial Treatment, First Degree Burn, When No More Than Local Treatment Is Required (Pro Cah)",,16000,CPT,Professional,Both,,,,209,177.65,27.7,209,CorVel,Worker's Compensation,83.7200163,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Initial Treatment, First Degree Burn, When No More Than Local Treatment Is Required (Pro Cah)",,16000,CPT,Professional,Both,,,,209,177.65,27.7,209,First Health Group Corporation,First Health Network,202.73,97,,percent of total billed charges,,
"Initial Treatment, First Degree Burn, When No More Than Local Treatment Is Required (Pro Cah)",,16000,CPT,Professional,Both,,,,209,177.65,27.7,209,"Health Partners, Inc.",Commercial,89.97,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Initial Treatment, First Degree Burn, When No More Than Local Treatment Is Required (Pro Cah)",,16000,CPT,Professional,Both,,,,209,177.65,27.7,209,"Health Partners, Inc.",Medicare Advantage,49.565,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Initial Treatment, First Degree Burn, When No More Than Local Treatment Is Required (Pro Cah)",,16000,CPT,Professional,Both,,,,209,177.65,27.7,209,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),43.38,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Initial Treatment, First Degree Burn, When No More Than Local Treatment Is Required (Pro Cah)",,16000,CPT,Professional,Both,,,,209,177.65,27.7,209,"Health Partners, Inc.",State of Minnesota Advantage Program,77.509155,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Initial Treatment, First Degree Burn, When No More Than Local Treatment Is Required (Pro Cah)",,16000,CPT,Professional,Both,,,,209,177.65,27.7,209,"Health Partners, Inc.",State Public Programs,27.7,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Initial Treatment, First Degree Burn, When No More Than Local Treatment Is Required (Pro Cah)",,16000,CPT,Professional,Both,,,,209,177.65,27.7,209,Humana Insurance Company,Commercial PPO,43.1,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Initial Treatment, First Degree Burn, When No More Than Local Treatment Is Required (Pro Cah)",,16000,CPT,Professional,Both,,,,209,177.65,27.7,209,Humana Insurance Company,Medicare PPO,209,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Initial Treatment, First Degree Burn, When No More Than Local Treatment Is Required (Pro Cah)",,16000,CPT,Professional,Both,,,,209,177.65,27.7,209,Medica,Individual & Family,177.232,84.8,,percent of total billed charges,,
"Initial Treatment, First Degree Burn, When No More Than Local Treatment Is Required (Pro Cah)",,16000,CPT,Professional,Both,,,,209,177.65,27.7,209,Medica,Medica Advantage Solution,104.082,49.8,,percent of total billed charges,,
"Initial Treatment, First Degree Burn, When No More Than Local Treatment Is Required (Pro Cah)",,16000,CPT,Professional,Both,,,,209,177.65,27.7,209,Medica,Medical Assistance,31.98,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Initial Treatment, First Degree Burn, When No More Than Local Treatment Is Required (Pro Cah)",,16000,CPT,Professional,Both,,,,209,177.65,27.7,209,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,43.1,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Initial Treatment, First Degree Burn, When No More Than Local Treatment Is Required (Pro Cah)",,16000,CPT,Professional,Both,,,,209,177.65,27.7,209,"Multiplan, Inc.","Multiplan, Inc.",196.46,94,,percent of total billed charges,,
"Initial Treatment, First Degree Burn, When No More Than Local Treatment Is Required (Pro Cah)",,16000,CPT,Professional,Both,,,,209,177.65,27.7,209,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,188.309,90.1,,percent of total billed charges,,
"Initial Treatment, First Degree Burn, When No More Than Local Treatment Is Required (Pro Cah)",,16000,CPT,Professional,Both,,,,209,177.65,27.7,209,"Preferred One Administrative Services, INC.",PPO,206.074,98.6,,percent of total billed charges,,
"Initial Treatment, First Degree Burn, When No More Than Local Treatment Is Required (Pro Cah)",,16000,CPT,Professional,Both,,,,209,177.65,27.7,209,PrimeWest Health,Minnesota Senior Health Options (MSHO),49.565,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Initial Treatment, First Degree Burn, When No More Than Local Treatment Is Required (Pro Cah)",,16000,CPT,Professional,Both,,,,209,177.65,27.7,209,PrimeWest Health,MinnesotaCare,34.2225376,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Initial Treatment, First Degree Burn, When No More Than Local Treatment Is Required (Pro Cah)",,16000,CPT,Professional,Both,,,,209,177.65,27.7,209,Sanford Health Plan,Sanford Health Plan,183.92,88,,percent of total billed charges,,
"Initial Treatment, First Degree Burn, When No More Than Local Treatment Is Required (Pro Cah)",,16000,CPT,Professional,Both,,,,209,177.65,27.7,209,"UCare Health, Inc.",Individual & Family Plan,70.06336,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Initial Treatment, First Degree Burn, When No More Than Local Treatment Is Required (Pro Cah)",,16000,CPT,Professional,Both,,,,209,177.65,27.7,209,"UCare Health, Inc.",Medical Assistance,35.182048,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Initial Treatment, First Degree Burn, When No More Than Local Treatment Is Required (Pro Cah)",,16000,CPT,Professional,Both,,,,209,177.65,27.7,209,"UCare Health, Inc.",Medicare Advantage,49.565,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Initial Treatment, First Degree Burn, When No More Than Local Treatment Is Required (Pro Cah)",,16000,CPT,Professional,Both,,,,209,177.65,27.7,209,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),39.652,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Initial Treatment, First Degree Burn, When No More Than Local Treatment Is Required (Pro Cah)",,16000,CPT,Professional,Both,,,,209,177.65,27.7,209,UnitedHealthcare,Individual & Family,209,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Initial Treatment, First Degree Burn, When No More Than Local Treatment Is Required (Pro Cah)",,16000,CPT,Professional,Both,,,,209,177.65,27.7,209,UnitedHealthcare,Medicare Advantage,49.565,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Initial Treatment, First Degree Burn, When No More Than Local Treatment Is Required (Pro Cah)",,16000,CPT,Professional,Both,,,,209,177.65,27.7,209,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,31.98368,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
DYCLONINE 2 MG MM LOZG,,79488,LOCAL,Facility,Both,1,Each,,18,15.3,5.1588,18,Aetna,Commercial,16.56,92,,percent of total billed charges,,
DYCLONINE 2 MG MM LOZG,,79488,LOCAL,Facility,Outpatient,1,Each,,18,15.3,5.1588,18,Aetna,Medicare Advantage,8.82,49,,percent of total billed charges,,
DYCLONINE 2 MG MM LOZG,,79488,LOCAL,Facility,Inpatient,1,Each,,18,15.3,5.1588,18,Aetna,Medicare Advantage,,,,,Included in per diem rate,
DYCLONINE 2 MG MM LOZG,,79488,LOCAL,Facility,Both,1,Each,,18,15.3,5.1588,18,Aetna,PPO,16.74,93,,percent of total billed charges,,
DYCLONINE 2 MG MM LOZG,,79488,LOCAL,Facility,Both,1,Each,,18,15.3,5.1588,18,America's PPO,America's PPO,17.2854,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
DYCLONINE 2 MG MM LOZG,,79488,LOCAL,Facility,Both,1,Each,,18,15.3,5.1588,18,BlueCross BlueShield Minnesota, Federal Employee Program,17.712,98.4,,percent of total billed charges,,
DYCLONINE 2 MG MM LOZG,,79488,LOCAL,Facility,Both,1,Each,,18,15.3,5.1588,18,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,18,100,,percent of total billed charges,,
DYCLONINE 2 MG MM LOZG,,79488,LOCAL,Facility,Both,1,Each,,18,15.3,5.1588,18,BlueCross BlueShield Minnesota,High Value Network Plan,16.2,90,,percent of total billed charges,,
DYCLONINE 2 MG MM LOZG,,79488,LOCAL,Facility,Outpatient,1,Each,,18,15.3,5.1588,18,BlueCross BlueShield Minnesota,Medicare Advantage,8.82,49,,percent of total billed charges,,
DYCLONINE 2 MG MM LOZG,,79488,LOCAL,Facility,Inpatient,1,Each,,18,15.3,5.1588,18,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
DYCLONINE 2 MG MM LOZG,,79488,LOCAL,Facility,Both,1,Each,,18,15.3,5.1588,18,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,15.9426,88.57,,percent of total billed charges,,
DYCLONINE 2 MG MM LOZG,,79488,LOCAL,Facility,Both,1,Each,,18,15.3,5.1588,18,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,5.1588,28.66,,percent of total billed charges,,
DYCLONINE 2 MG MM LOZG,,79488,LOCAL,Facility,Outpatient,1,Each,,18,15.3,5.1588,18,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),8.82,49,,percent of total billed charges,,
DYCLONINE 2 MG MM LOZG,,79488,LOCAL,Facility,Inpatient,1,Each,,18,15.3,5.1588,18,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
DYCLONINE 2 MG MM LOZG,,79488,LOCAL,Facility,Both,1,Each,,18,15.3,5.1588,18,CorVel,Worker's Compensation,18,100,,percent of total billed charges,,
DYCLONINE 2 MG MM LOZG,,79488,LOCAL,Facility,Both,1,Each,,18,15.3,5.1588,18,First Health Group Corporation,First Health Network,17.46,97,,percent of total billed charges,,
DYCLONINE 2 MG MM LOZG,,79488,LOCAL,Facility,Both,1,Each,,18,15.3,5.1588,18,"Health Partners, Inc.",Commercial,17.028,94.6,,percent of total billed charges,,
DYCLONINE 2 MG MM LOZG,,79488,LOCAL,Facility,Outpatient,1,Each,,18,15.3,5.1588,18,"Health Partners, Inc.",Medicare Advantage,8.82,49,,percent of total billed charges,,
DYCLONINE 2 MG MM LOZG,,79488,LOCAL,Facility,Inpatient,1,Each,,18,15.3,5.1588,18,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DYCLONINE 2 MG MM LOZG,,79488,LOCAL,Facility,Both,1,Each,,18,15.3,5.1588,18,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),10.8,60,,percent of total billed charges,,
DYCLONINE 2 MG MM LOZG,,79488,LOCAL,Facility,Both,1,Each,,18,15.3,5.1588,18,"Health Partners, Inc.",State of Minnesota Advantage Program,14.67,81.5,,percent of total billed charges,,
DYCLONINE 2 MG MM LOZG,,79488,LOCAL,Facility,Both,1,Each,,18,15.3,5.1588,18,"Health Partners, Inc.",State Public Programs,9,50,,percent of total billed charges,,
DYCLONINE 2 MG MM LOZG,,79488,LOCAL,Facility,Both,1,Each,,18,15.3,5.1588,18,Humana Insurance Company,Commercial PPO,17.1,95,,percent of total billed charges,,
DYCLONINE 2 MG MM LOZG,,79488,LOCAL,Facility,Outpatient,1,Each,,18,15.3,5.1588,18,Humana Insurance Company,Medicare PPO,8.82,49,,percent of total billed charges,,
DYCLONINE 2 MG MM LOZG,,79488,LOCAL,Facility,Inpatient,1,Each,,18,15.3,5.1588,18,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
DYCLONINE 2 MG MM LOZG,,79488,LOCAL,Facility,Both,1,Each,,18,15.3,5.1588,18,Medica,Individual & Family,17.838,99.1,,percent of total billed charges,,
DYCLONINE 2 MG MM LOZG,,79488,LOCAL,Facility,Outpatient,1,Each,,18,15.3,5.1588,18,Medica,Medica Advantage Solution,8.964,49.8,,percent of total billed charges,,
DYCLONINE 2 MG MM LOZG,,79488,LOCAL,Facility,Inpatient,1,Each,,18,15.3,5.1588,18,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
DYCLONINE 2 MG MM LOZG,,79488,LOCAL,Facility,Outpatient,1,Each,,18,15.3,5.1588,18,Medica,Medical Assistance,8.028,44.6,,percent of total billed charges,,
DYCLONINE 2 MG MM LOZG,,79488,LOCAL,Facility,Inpatient,1,Each,,18,15.3,5.1588,18,Medica,Medical Assistance,,,,,Included in per diem rate,
DYCLONINE 2 MG MM LOZG,,79488,LOCAL,Facility,Outpatient,1,Each,,18,15.3,5.1588,18,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,8.964,49.8,,percent of total billed charges,,
DYCLONINE 2 MG MM LOZG,,79488,LOCAL,Facility,Inpatient,1,Each,,18,15.3,5.1588,18,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
DYCLONINE 2 MG MM LOZG,,79488,LOCAL,Facility,Both,1,Each,,18,15.3,5.1588,18,"Multiplan, Inc.","Multiplan, Inc.",16.92,94,,percent of total billed charges,,
DYCLONINE 2 MG MM LOZG,,79488,LOCAL,Facility,Outpatient,1,Each,,18,15.3,5.1588,18,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,16.218,90.1,,percent of total billed charges,,
DYCLONINE 2 MG MM LOZG,,79488,LOCAL,Facility,Inpatient,1,Each,,18,15.3,5.1588,18,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
DYCLONINE 2 MG MM LOZG,,79488,LOCAL,Facility,Both,1,Each,,18,15.3,5.1588,18,"Preferred One Administrative Services, INC.",PPO,17.748,98.6,,percent of total billed charges,,
DYCLONINE 2 MG MM LOZG,,79488,LOCAL,Facility,Outpatient,1,Each,,18,15.3,5.1588,18,PrimeWest Health,Minnesota Senior Health Options (MSHO),9.261,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
DYCLONINE 2 MG MM LOZG,,79488,LOCAL,Facility,Inpatient,1,Each,,18,15.3,5.1588,18,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DYCLONINE 2 MG MM LOZG,,79488,LOCAL,Facility,Outpatient,1,Each,,18,15.3,5.1588,18,PrimeWest Health,MinnesotaCare,9.2448,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
DYCLONINE 2 MG MM LOZG,,79488,LOCAL,Facility,Inpatient,1,Each,,18,15.3,5.1588,18,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
DYCLONINE 2 MG MM LOZG,,79488,LOCAL,Facility,Both,1,Each,,18,15.3,5.1588,18,Sanford Health Plan,Sanford Health Plan,16.56,92,,percent of total billed charges,,
DYCLONINE 2 MG MM LOZG,,79488,LOCAL,Facility,Outpatient,1,Each,,18,15.3,5.1588,18,"UCare Health, Inc.",Individual & Family Plan,10.143,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
DYCLONINE 2 MG MM LOZG,,79488,LOCAL,Facility,Inpatient,1,Each,,18,15.3,5.1588,18,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
DYCLONINE 2 MG MM LOZG,,79488,LOCAL,Facility,Outpatient,1,Each,,18,15.3,5.1588,18,"UCare Health, Inc.",Medical Assistance,9.0846,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DYCLONINE 2 MG MM LOZG,,79488,LOCAL,Facility,Inpatient,1,Each,,18,15.3,5.1588,18,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
DYCLONINE 2 MG MM LOZG,,79488,LOCAL,Facility,Outpatient,1,Each,,18,15.3,5.1588,18,"UCare Health, Inc.",Medicare Advantage,9.0846,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DYCLONINE 2 MG MM LOZG,,79488,LOCAL,Facility,Inpatient,1,Each,,18,15.3,5.1588,18,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DYCLONINE 2 MG MM LOZG,,79488,LOCAL,Facility,Outpatient,1,Each,,18,15.3,5.1588,18,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),9.0846,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DYCLONINE 2 MG MM LOZG,,79488,LOCAL,Facility,Inpatient,1,Each,,18,15.3,5.1588,18,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DYCLONINE 2 MG MM LOZG,,79488,LOCAL,Facility,Both,1,Each,,18,15.3,5.1588,18,UnitedHealthcare,Individual & Family,16.92,94,,percent of total billed charges,,
DYCLONINE 2 MG MM LOZG,,79488,LOCAL,Facility,Outpatient,1,Each,,18,15.3,5.1588,18,UnitedHealthcare,Medicare Advantage,8.82,49,,percent of total billed charges,,
DYCLONINE 2 MG MM LOZG,,79488,LOCAL,Facility,Inpatient,1,Each,,18,15.3,5.1588,18,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
DYCLONINE 2 MG MM LOZG,,79488,LOCAL,Facility,Outpatient,1,Each,,18,15.3,5.1588,18,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,8.64,48,,percent of total billed charges,,100% of DHS outpatient percentage
DYCLONINE 2 MG MM LOZG,,79488,LOCAL,Facility,Inpatient,1,Each,,18,15.3,5.1588,18,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
NEBIVOLOL 10 MG ORAL TABLET,,80533,LOCAL,Facility,Both,1,Each,,29,24.65,8.3114,29,Aetna,Commercial,26.68,92,,percent of total billed charges,,
NEBIVOLOL 10 MG ORAL TABLET,,80533,LOCAL,Facility,Outpatient,1,Each,,29,24.65,8.3114,29,Aetna,Medicare Advantage,14.21,49,,percent of total billed charges,,
NEBIVOLOL 10 MG ORAL TABLET,,80533,LOCAL,Facility,Inpatient,1,Each,,29,24.65,8.3114,29,Aetna,Medicare Advantage,,,,,Included in per diem rate,
NEBIVOLOL 10 MG ORAL TABLET,,80533,LOCAL,Facility,Both,1,Each,,29,24.65,8.3114,29,Aetna,PPO,26.97,93,,percent of total billed charges,,
NEBIVOLOL 10 MG ORAL TABLET,,80533,LOCAL,Facility,Both,1,Each,,29,24.65,8.3114,29,America's PPO,America's PPO,27.8487,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
NEBIVOLOL 10 MG ORAL TABLET,,80533,LOCAL,Facility,Both,1,Each,,29,24.65,8.3114,29,BlueCross BlueShield Minnesota, Federal Employee Program,28.536,98.4,,percent of total billed charges,,
NEBIVOLOL 10 MG ORAL TABLET,,80533,LOCAL,Facility,Both,1,Each,,29,24.65,8.3114,29,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,29,100,,percent of total billed charges,,
NEBIVOLOL 10 MG ORAL TABLET,,80533,LOCAL,Facility,Both,1,Each,,29,24.65,8.3114,29,BlueCross BlueShield Minnesota,High Value Network Plan,26.1,90,,percent of total billed charges,,
NEBIVOLOL 10 MG ORAL TABLET,,80533,LOCAL,Facility,Outpatient,1,Each,,29,24.65,8.3114,29,BlueCross BlueShield Minnesota,Medicare Advantage,14.21,49,,percent of total billed charges,,
NEBIVOLOL 10 MG ORAL TABLET,,80533,LOCAL,Facility,Inpatient,1,Each,,29,24.65,8.3114,29,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
NEBIVOLOL 10 MG ORAL TABLET,,80533,LOCAL,Facility,Both,1,Each,,29,24.65,8.3114,29,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,25.6853,88.57,,percent of total billed charges,,
NEBIVOLOL 10 MG ORAL TABLET,,80533,LOCAL,Facility,Both,1,Each,,29,24.65,8.3114,29,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,8.3114,28.66,,percent of total billed charges,,
NEBIVOLOL 10 MG ORAL TABLET,,80533,LOCAL,Facility,Outpatient,1,Each,,29,24.65,8.3114,29,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),14.21,49,,percent of total billed charges,,
NEBIVOLOL 10 MG ORAL TABLET,,80533,LOCAL,Facility,Inpatient,1,Each,,29,24.65,8.3114,29,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
NEBIVOLOL 10 MG ORAL TABLET,,80533,LOCAL,Facility,Both,1,Each,,29,24.65,8.3114,29,CorVel,Worker's Compensation,29,100,,percent of total billed charges,,
NEBIVOLOL 10 MG ORAL TABLET,,80533,LOCAL,Facility,Both,1,Each,,29,24.65,8.3114,29,First Health Group Corporation,First Health Network,28.13,97,,percent of total billed charges,,
NEBIVOLOL 10 MG ORAL TABLET,,80533,LOCAL,Facility,Both,1,Each,,29,24.65,8.3114,29,"Health Partners, Inc.",Commercial,27.434,94.6,,percent of total billed charges,,
NEBIVOLOL 10 MG ORAL TABLET,,80533,LOCAL,Facility,Outpatient,1,Each,,29,24.65,8.3114,29,"Health Partners, Inc.",Medicare Advantage,14.21,49,,percent of total billed charges,,
NEBIVOLOL 10 MG ORAL TABLET,,80533,LOCAL,Facility,Inpatient,1,Each,,29,24.65,8.3114,29,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
NEBIVOLOL 10 MG ORAL TABLET,,80533,LOCAL,Facility,Both,1,Each,,29,24.65,8.3114,29,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),17.4,60,,percent of total billed charges,,
NEBIVOLOL 10 MG ORAL TABLET,,80533,LOCAL,Facility,Both,1,Each,,29,24.65,8.3114,29,"Health Partners, Inc.",State of Minnesota Advantage Program,23.635,81.5,,percent of total billed charges,,
NEBIVOLOL 10 MG ORAL TABLET,,80533,LOCAL,Facility,Both,1,Each,,29,24.65,8.3114,29,"Health Partners, Inc.",State Public Programs,14.5,50,,percent of total billed charges,,
NEBIVOLOL 10 MG ORAL TABLET,,80533,LOCAL,Facility,Both,1,Each,,29,24.65,8.3114,29,Humana Insurance Company,Commercial PPO,27.55,95,,percent of total billed charges,,
NEBIVOLOL 10 MG ORAL TABLET,,80533,LOCAL,Facility,Outpatient,1,Each,,29,24.65,8.3114,29,Humana Insurance Company,Medicare PPO,14.21,49,,percent of total billed charges,,
NEBIVOLOL 10 MG ORAL TABLET,,80533,LOCAL,Facility,Inpatient,1,Each,,29,24.65,8.3114,29,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
NEBIVOLOL 10 MG ORAL TABLET,,80533,LOCAL,Facility,Both,1,Each,,29,24.65,8.3114,29,Medica,Individual & Family,28.739,99.1,,percent of total billed charges,,
NEBIVOLOL 10 MG ORAL TABLET,,80533,LOCAL,Facility,Outpatient,1,Each,,29,24.65,8.3114,29,Medica,Medica Advantage Solution,14.442,49.8,,percent of total billed charges,,
NEBIVOLOL 10 MG ORAL TABLET,,80533,LOCAL,Facility,Inpatient,1,Each,,29,24.65,8.3114,29,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
NEBIVOLOL 10 MG ORAL TABLET,,80533,LOCAL,Facility,Outpatient,1,Each,,29,24.65,8.3114,29,Medica,Medical Assistance,12.934,44.6,,percent of total billed charges,,
NEBIVOLOL 10 MG ORAL TABLET,,80533,LOCAL,Facility,Inpatient,1,Each,,29,24.65,8.3114,29,Medica,Medical Assistance,,,,,Included in per diem rate,
NEBIVOLOL 10 MG ORAL TABLET,,80533,LOCAL,Facility,Outpatient,1,Each,,29,24.65,8.3114,29,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,14.442,49.8,,percent of total billed charges,,
NEBIVOLOL 10 MG ORAL TABLET,,80533,LOCAL,Facility,Inpatient,1,Each,,29,24.65,8.3114,29,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
NEBIVOLOL 10 MG ORAL TABLET,,80533,LOCAL,Facility,Both,1,Each,,29,24.65,8.3114,29,"Multiplan, Inc.","Multiplan, Inc.",27.26,94,,percent of total billed charges,,
NEBIVOLOL 10 MG ORAL TABLET,,80533,LOCAL,Facility,Outpatient,1,Each,,29,24.65,8.3114,29,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,26.129,90.1,,percent of total billed charges,,
NEBIVOLOL 10 MG ORAL TABLET,,80533,LOCAL,Facility,Inpatient,1,Each,,29,24.65,8.3114,29,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
NEBIVOLOL 10 MG ORAL TABLET,,80533,LOCAL,Facility,Both,1,Each,,29,24.65,8.3114,29,"Preferred One Administrative Services, INC.",PPO,28.594,98.6,,percent of total billed charges,,
NEBIVOLOL 10 MG ORAL TABLET,,80533,LOCAL,Facility,Outpatient,1,Each,,29,24.65,8.3114,29,PrimeWest Health,Minnesota Senior Health Options (MSHO),14.9205,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
NEBIVOLOL 10 MG ORAL TABLET,,80533,LOCAL,Facility,Inpatient,1,Each,,29,24.65,8.3114,29,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
NEBIVOLOL 10 MG ORAL TABLET,,80533,LOCAL,Facility,Outpatient,1,Each,,29,24.65,8.3114,29,PrimeWest Health,MinnesotaCare,14.8944,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
NEBIVOLOL 10 MG ORAL TABLET,,80533,LOCAL,Facility,Inpatient,1,Each,,29,24.65,8.3114,29,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
NEBIVOLOL 10 MG ORAL TABLET,,80533,LOCAL,Facility,Both,1,Each,,29,24.65,8.3114,29,Sanford Health Plan,Sanford Health Plan,26.68,92,,percent of total billed charges,,
NEBIVOLOL 10 MG ORAL TABLET,,80533,LOCAL,Facility,Outpatient,1,Each,,29,24.65,8.3114,29,"UCare Health, Inc.",Individual & Family Plan,16.3415,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
NEBIVOLOL 10 MG ORAL TABLET,,80533,LOCAL,Facility,Inpatient,1,Each,,29,24.65,8.3114,29,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
NEBIVOLOL 10 MG ORAL TABLET,,80533,LOCAL,Facility,Outpatient,1,Each,,29,24.65,8.3114,29,"UCare Health, Inc.",Medical Assistance,14.6363,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
NEBIVOLOL 10 MG ORAL TABLET,,80533,LOCAL,Facility,Inpatient,1,Each,,29,24.65,8.3114,29,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
NEBIVOLOL 10 MG ORAL TABLET,,80533,LOCAL,Facility,Outpatient,1,Each,,29,24.65,8.3114,29,"UCare Health, Inc.",Medicare Advantage,14.6363,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
NEBIVOLOL 10 MG ORAL TABLET,,80533,LOCAL,Facility,Inpatient,1,Each,,29,24.65,8.3114,29,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
NEBIVOLOL 10 MG ORAL TABLET,,80533,LOCAL,Facility,Outpatient,1,Each,,29,24.65,8.3114,29,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),14.6363,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
NEBIVOLOL 10 MG ORAL TABLET,,80533,LOCAL,Facility,Inpatient,1,Each,,29,24.65,8.3114,29,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
NEBIVOLOL 10 MG ORAL TABLET,,80533,LOCAL,Facility,Both,1,Each,,29,24.65,8.3114,29,UnitedHealthcare,Individual & Family,27.26,94,,percent of total billed charges,,
NEBIVOLOL 10 MG ORAL TABLET,,80533,LOCAL,Facility,Outpatient,1,Each,,29,24.65,8.3114,29,UnitedHealthcare,Medicare Advantage,14.21,49,,percent of total billed charges,,
NEBIVOLOL 10 MG ORAL TABLET,,80533,LOCAL,Facility,Inpatient,1,Each,,29,24.65,8.3114,29,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
NEBIVOLOL 10 MG ORAL TABLET,,80533,LOCAL,Facility,Outpatient,1,Each,,29,24.65,8.3114,29,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,13.92,48,,percent of total billed charges,,100% of DHS outpatient percentage
NEBIVOLOL 10 MG ORAL TABLET,,80533,LOCAL,Facility,Inpatient,1,Each,,29,24.65,8.3114,29,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
DESVENLAFAXINE SUCCINATE 50 MG ORAL TB24,,81905,LOCAL,Facility,Both,1,Each,,56,47.6,16.0496,56,Aetna,Commercial,51.52,92,,percent of total billed charges,,
DESVENLAFAXINE SUCCINATE 50 MG ORAL TB24,,81905,LOCAL,Facility,Outpatient,1,Each,,56,47.6,16.0496,56,Aetna,Medicare Advantage,27.44,49,,percent of total billed charges,,
DESVENLAFAXINE SUCCINATE 50 MG ORAL TB24,,81905,LOCAL,Facility,Inpatient,1,Each,,56,47.6,16.0496,56,Aetna,Medicare Advantage,,,,,Included in per diem rate,
DESVENLAFAXINE SUCCINATE 50 MG ORAL TB24,,81905,LOCAL,Facility,Both,1,Each,,56,47.6,16.0496,56,Aetna,PPO,52.08,93,,percent of total billed charges,,
DESVENLAFAXINE SUCCINATE 50 MG ORAL TB24,,81905,LOCAL,Facility,Both,1,Each,,56,47.6,16.0496,56,America's PPO,America's PPO,53.7768,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
DESVENLAFAXINE SUCCINATE 50 MG ORAL TB24,,81905,LOCAL,Facility,Both,1,Each,,56,47.6,16.0496,56,BlueCross BlueShield Minnesota, Federal Employee Program,55.104,98.4,,percent of total billed charges,,
DESVENLAFAXINE SUCCINATE 50 MG ORAL TB24,,81905,LOCAL,Facility,Both,1,Each,,56,47.6,16.0496,56,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,56,100,,percent of total billed charges,,
DESVENLAFAXINE SUCCINATE 50 MG ORAL TB24,,81905,LOCAL,Facility,Both,1,Each,,56,47.6,16.0496,56,BlueCross BlueShield Minnesota,High Value Network Plan,50.4,90,,percent of total billed charges,,
DESVENLAFAXINE SUCCINATE 50 MG ORAL TB24,,81905,LOCAL,Facility,Outpatient,1,Each,,56,47.6,16.0496,56,BlueCross BlueShield Minnesota,Medicare Advantage,27.44,49,,percent of total billed charges,,
DESVENLAFAXINE SUCCINATE 50 MG ORAL TB24,,81905,LOCAL,Facility,Inpatient,1,Each,,56,47.6,16.0496,56,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
DESVENLAFAXINE SUCCINATE 50 MG ORAL TB24,,81905,LOCAL,Facility,Both,1,Each,,56,47.6,16.0496,56,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,49.5992,88.57,,percent of total billed charges,,
DESVENLAFAXINE SUCCINATE 50 MG ORAL TB24,,81905,LOCAL,Facility,Both,1,Each,,56,47.6,16.0496,56,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,16.0496,28.66,,percent of total billed charges,,
DESVENLAFAXINE SUCCINATE 50 MG ORAL TB24,,81905,LOCAL,Facility,Outpatient,1,Each,,56,47.6,16.0496,56,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),27.44,49,,percent of total billed charges,,
DESVENLAFAXINE SUCCINATE 50 MG ORAL TB24,,81905,LOCAL,Facility,Inpatient,1,Each,,56,47.6,16.0496,56,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
DESVENLAFAXINE SUCCINATE 50 MG ORAL TB24,,81905,LOCAL,Facility,Both,1,Each,,56,47.6,16.0496,56,CorVel,Worker's Compensation,56,100,,percent of total billed charges,,
DESVENLAFAXINE SUCCINATE 50 MG ORAL TB24,,81905,LOCAL,Facility,Both,1,Each,,56,47.6,16.0496,56,First Health Group Corporation,First Health Network,54.32,97,,percent of total billed charges,,
DESVENLAFAXINE SUCCINATE 50 MG ORAL TB24,,81905,LOCAL,Facility,Both,1,Each,,56,47.6,16.0496,56,"Health Partners, Inc.",Commercial,52.976,94.6,,percent of total billed charges,,
DESVENLAFAXINE SUCCINATE 50 MG ORAL TB24,,81905,LOCAL,Facility,Outpatient,1,Each,,56,47.6,16.0496,56,"Health Partners, Inc.",Medicare Advantage,27.44,49,,percent of total billed charges,,
DESVENLAFAXINE SUCCINATE 50 MG ORAL TB24,,81905,LOCAL,Facility,Inpatient,1,Each,,56,47.6,16.0496,56,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DESVENLAFAXINE SUCCINATE 50 MG ORAL TB24,,81905,LOCAL,Facility,Both,1,Each,,56,47.6,16.0496,56,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),33.6,60,,percent of total billed charges,,
DESVENLAFAXINE SUCCINATE 50 MG ORAL TB24,,81905,LOCAL,Facility,Both,1,Each,,56,47.6,16.0496,56,"Health Partners, Inc.",State of Minnesota Advantage Program,45.64,81.5,,percent of total billed charges,,
DESVENLAFAXINE SUCCINATE 50 MG ORAL TB24,,81905,LOCAL,Facility,Both,1,Each,,56,47.6,16.0496,56,"Health Partners, Inc.",State Public Programs,28,50,,percent of total billed charges,,
DESVENLAFAXINE SUCCINATE 50 MG ORAL TB24,,81905,LOCAL,Facility,Both,1,Each,,56,47.6,16.0496,56,Humana Insurance Company,Commercial PPO,53.2,95,,percent of total billed charges,,
DESVENLAFAXINE SUCCINATE 50 MG ORAL TB24,,81905,LOCAL,Facility,Outpatient,1,Each,,56,47.6,16.0496,56,Humana Insurance Company,Medicare PPO,27.44,49,,percent of total billed charges,,
DESVENLAFAXINE SUCCINATE 50 MG ORAL TB24,,81905,LOCAL,Facility,Inpatient,1,Each,,56,47.6,16.0496,56,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
DESVENLAFAXINE SUCCINATE 50 MG ORAL TB24,,81905,LOCAL,Facility,Both,1,Each,,56,47.6,16.0496,56,Medica,Individual & Family,55.496,99.1,,percent of total billed charges,,
DESVENLAFAXINE SUCCINATE 50 MG ORAL TB24,,81905,LOCAL,Facility,Outpatient,1,Each,,56,47.6,16.0496,56,Medica,Medica Advantage Solution,27.888,49.8,,percent of total billed charges,,
DESVENLAFAXINE SUCCINATE 50 MG ORAL TB24,,81905,LOCAL,Facility,Inpatient,1,Each,,56,47.6,16.0496,56,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
DESVENLAFAXINE SUCCINATE 50 MG ORAL TB24,,81905,LOCAL,Facility,Outpatient,1,Each,,56,47.6,16.0496,56,Medica,Medical Assistance,24.976,44.6,,percent of total billed charges,,
DESVENLAFAXINE SUCCINATE 50 MG ORAL TB24,,81905,LOCAL,Facility,Inpatient,1,Each,,56,47.6,16.0496,56,Medica,Medical Assistance,,,,,Included in per diem rate,
DESVENLAFAXINE SUCCINATE 50 MG ORAL TB24,,81905,LOCAL,Facility,Outpatient,1,Each,,56,47.6,16.0496,56,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,27.888,49.8,,percent of total billed charges,,
DESVENLAFAXINE SUCCINATE 50 MG ORAL TB24,,81905,LOCAL,Facility,Inpatient,1,Each,,56,47.6,16.0496,56,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
DESVENLAFAXINE SUCCINATE 50 MG ORAL TB24,,81905,LOCAL,Facility,Both,1,Each,,56,47.6,16.0496,56,"Multiplan, Inc.","Multiplan, Inc.",52.64,94,,percent of total billed charges,,
DESVENLAFAXINE SUCCINATE 50 MG ORAL TB24,,81905,LOCAL,Facility,Outpatient,1,Each,,56,47.6,16.0496,56,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,50.456,90.1,,percent of total billed charges,,
DESVENLAFAXINE SUCCINATE 50 MG ORAL TB24,,81905,LOCAL,Facility,Inpatient,1,Each,,56,47.6,16.0496,56,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
DESVENLAFAXINE SUCCINATE 50 MG ORAL TB24,,81905,LOCAL,Facility,Both,1,Each,,56,47.6,16.0496,56,"Preferred One Administrative Services, INC.",PPO,55.216,98.6,,percent of total billed charges,,
DESVENLAFAXINE SUCCINATE 50 MG ORAL TB24,,81905,LOCAL,Facility,Outpatient,1,Each,,56,47.6,16.0496,56,PrimeWest Health,Minnesota Senior Health Options (MSHO),28.812,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
DESVENLAFAXINE SUCCINATE 50 MG ORAL TB24,,81905,LOCAL,Facility,Inpatient,1,Each,,56,47.6,16.0496,56,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DESVENLAFAXINE SUCCINATE 50 MG ORAL TB24,,81905,LOCAL,Facility,Outpatient,1,Each,,56,47.6,16.0496,56,PrimeWest Health,MinnesotaCare,28.7616,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
DESVENLAFAXINE SUCCINATE 50 MG ORAL TB24,,81905,LOCAL,Facility,Inpatient,1,Each,,56,47.6,16.0496,56,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
DESVENLAFAXINE SUCCINATE 50 MG ORAL TB24,,81905,LOCAL,Facility,Both,1,Each,,56,47.6,16.0496,56,Sanford Health Plan,Sanford Health Plan,51.52,92,,percent of total billed charges,,
DESVENLAFAXINE SUCCINATE 50 MG ORAL TB24,,81905,LOCAL,Facility,Outpatient,1,Each,,56,47.6,16.0496,56,"UCare Health, Inc.",Individual & Family Plan,31.556,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
DESVENLAFAXINE SUCCINATE 50 MG ORAL TB24,,81905,LOCAL,Facility,Inpatient,1,Each,,56,47.6,16.0496,56,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
DESVENLAFAXINE SUCCINATE 50 MG ORAL TB24,,81905,LOCAL,Facility,Outpatient,1,Each,,56,47.6,16.0496,56,"UCare Health, Inc.",Medical Assistance,28.2632,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DESVENLAFAXINE SUCCINATE 50 MG ORAL TB24,,81905,LOCAL,Facility,Inpatient,1,Each,,56,47.6,16.0496,56,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
DESVENLAFAXINE SUCCINATE 50 MG ORAL TB24,,81905,LOCAL,Facility,Outpatient,1,Each,,56,47.6,16.0496,56,"UCare Health, Inc.",Medicare Advantage,28.2632,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DESVENLAFAXINE SUCCINATE 50 MG ORAL TB24,,81905,LOCAL,Facility,Inpatient,1,Each,,56,47.6,16.0496,56,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DESVENLAFAXINE SUCCINATE 50 MG ORAL TB24,,81905,LOCAL,Facility,Outpatient,1,Each,,56,47.6,16.0496,56,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),28.2632,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DESVENLAFAXINE SUCCINATE 50 MG ORAL TB24,,81905,LOCAL,Facility,Inpatient,1,Each,,56,47.6,16.0496,56,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DESVENLAFAXINE SUCCINATE 50 MG ORAL TB24,,81905,LOCAL,Facility,Both,1,Each,,56,47.6,16.0496,56,UnitedHealthcare,Individual & Family,52.64,94,,percent of total billed charges,,
DESVENLAFAXINE SUCCINATE 50 MG ORAL TB24,,81905,LOCAL,Facility,Outpatient,1,Each,,56,47.6,16.0496,56,UnitedHealthcare,Medicare Advantage,27.44,49,,percent of total billed charges,,
DESVENLAFAXINE SUCCINATE 50 MG ORAL TB24,,81905,LOCAL,Facility,Inpatient,1,Each,,56,47.6,16.0496,56,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
DESVENLAFAXINE SUCCINATE 50 MG ORAL TB24,,81905,LOCAL,Facility,Outpatient,1,Each,,56,47.6,16.0496,56,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,26.88,48,,percent of total billed charges,,100% of DHS outpatient percentage
DESVENLAFAXINE SUCCINATE 50 MG ORAL TB24,,81905,LOCAL,Facility,Inpatient,1,Each,,56,47.6,16.0496,56,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
BIFIDOBACTERIUM INFANTIS 4 MG ORAL CAP,,82524,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
BIFIDOBACTERIUM INFANTIS 4 MG ORAL CAP,,82524,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
BIFIDOBACTERIUM INFANTIS 4 MG ORAL CAP,,82524,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
BIFIDOBACTERIUM INFANTIS 4 MG ORAL CAP,,82524,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
BIFIDOBACTERIUM INFANTIS 4 MG ORAL CAP,,82524,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
BIFIDOBACTERIUM INFANTIS 4 MG ORAL CAP,,82524,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
BIFIDOBACTERIUM INFANTIS 4 MG ORAL CAP,,82524,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
BIFIDOBACTERIUM INFANTIS 4 MG ORAL CAP,,82524,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
BIFIDOBACTERIUM INFANTIS 4 MG ORAL CAP,,82524,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
BIFIDOBACTERIUM INFANTIS 4 MG ORAL CAP,,82524,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
BIFIDOBACTERIUM INFANTIS 4 MG ORAL CAP,,82524,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
BIFIDOBACTERIUM INFANTIS 4 MG ORAL CAP,,82524,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
BIFIDOBACTERIUM INFANTIS 4 MG ORAL CAP,,82524,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
BIFIDOBACTERIUM INFANTIS 4 MG ORAL CAP,,82524,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
BIFIDOBACTERIUM INFANTIS 4 MG ORAL CAP,,82524,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
BIFIDOBACTERIUM INFANTIS 4 MG ORAL CAP,,82524,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
BIFIDOBACTERIUM INFANTIS 4 MG ORAL CAP,,82524,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
BIFIDOBACTERIUM INFANTIS 4 MG ORAL CAP,,82524,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
BIFIDOBACTERIUM INFANTIS 4 MG ORAL CAP,,82524,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
BIFIDOBACTERIUM INFANTIS 4 MG ORAL CAP,,82524,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
BIFIDOBACTERIUM INFANTIS 4 MG ORAL CAP,,82524,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
BIFIDOBACTERIUM INFANTIS 4 MG ORAL CAP,,82524,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
BIFIDOBACTERIUM INFANTIS 4 MG ORAL CAP,,82524,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
BIFIDOBACTERIUM INFANTIS 4 MG ORAL CAP,,82524,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
BIFIDOBACTERIUM INFANTIS 4 MG ORAL CAP,,82524,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
BIFIDOBACTERIUM INFANTIS 4 MG ORAL CAP,,82524,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
BIFIDOBACTERIUM INFANTIS 4 MG ORAL CAP,,82524,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
BIFIDOBACTERIUM INFANTIS 4 MG ORAL CAP,,82524,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
BIFIDOBACTERIUM INFANTIS 4 MG ORAL CAP,,82524,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
BIFIDOBACTERIUM INFANTIS 4 MG ORAL CAP,,82524,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
BIFIDOBACTERIUM INFANTIS 4 MG ORAL CAP,,82524,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
BIFIDOBACTERIUM INFANTIS 4 MG ORAL CAP,,82524,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
BIFIDOBACTERIUM INFANTIS 4 MG ORAL CAP,,82524,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
BIFIDOBACTERIUM INFANTIS 4 MG ORAL CAP,,82524,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
BIFIDOBACTERIUM INFANTIS 4 MG ORAL CAP,,82524,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
BIFIDOBACTERIUM INFANTIS 4 MG ORAL CAP,,82524,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
BIFIDOBACTERIUM INFANTIS 4 MG ORAL CAP,,82524,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
BIFIDOBACTERIUM INFANTIS 4 MG ORAL CAP,,82524,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
BIFIDOBACTERIUM INFANTIS 4 MG ORAL CAP,,82524,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
BIFIDOBACTERIUM INFANTIS 4 MG ORAL CAP,,82524,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
BIFIDOBACTERIUM INFANTIS 4 MG ORAL CAP,,82524,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
BIFIDOBACTERIUM INFANTIS 4 MG ORAL CAP,,82524,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
BIFIDOBACTERIUM INFANTIS 4 MG ORAL CAP,,82524,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
BIFIDOBACTERIUM INFANTIS 4 MG ORAL CAP,,82524,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BIFIDOBACTERIUM INFANTIS 4 MG ORAL CAP,,82524,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
BIFIDOBACTERIUM INFANTIS 4 MG ORAL CAP,,82524,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BIFIDOBACTERIUM INFANTIS 4 MG ORAL CAP,,82524,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
BIFIDOBACTERIUM INFANTIS 4 MG ORAL CAP,,82524,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BIFIDOBACTERIUM INFANTIS 4 MG ORAL CAP,,82524,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
BIFIDOBACTERIUM INFANTIS 4 MG ORAL CAP,,82524,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
BIFIDOBACTERIUM INFANTIS 4 MG ORAL CAP,,82524,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
BIFIDOBACTERIUM INFANTIS 4 MG ORAL CAP,,82524,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
BIFIDOBACTERIUM INFANTIS 4 MG ORAL CAP,,82524,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
BIFIDOBACTERIUM INFANTIS 4 MG ORAL CAP,,82524,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"PRENATAL VIT27,CALCIUM-IRON-FA 60 MG IRON-1 MG ORAL TABLET",,82851,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
"PRENATAL VIT27,CALCIUM-IRON-FA 60 MG IRON-1 MG ORAL TABLET",,82851,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
"PRENATAL VIT27,CALCIUM-IRON-FA 60 MG IRON-1 MG ORAL TABLET",,82851,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"PRENATAL VIT27,CALCIUM-IRON-FA 60 MG IRON-1 MG ORAL TABLET",,82851,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
"PRENATAL VIT27,CALCIUM-IRON-FA 60 MG IRON-1 MG ORAL TABLET",,82851,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"PRENATAL VIT27,CALCIUM-IRON-FA 60 MG IRON-1 MG ORAL TABLET",,82851,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
"PRENATAL VIT27,CALCIUM-IRON-FA 60 MG IRON-1 MG ORAL TABLET",,82851,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
"PRENATAL VIT27,CALCIUM-IRON-FA 60 MG IRON-1 MG ORAL TABLET",,82851,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
"PRENATAL VIT27,CALCIUM-IRON-FA 60 MG IRON-1 MG ORAL TABLET",,82851,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
"PRENATAL VIT27,CALCIUM-IRON-FA 60 MG IRON-1 MG ORAL TABLET",,82851,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"PRENATAL VIT27,CALCIUM-IRON-FA 60 MG IRON-1 MG ORAL TABLET",,82851,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
"PRENATAL VIT27,CALCIUM-IRON-FA 60 MG IRON-1 MG ORAL TABLET",,82851,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
"PRENATAL VIT27,CALCIUM-IRON-FA 60 MG IRON-1 MG ORAL TABLET",,82851,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
"PRENATAL VIT27,CALCIUM-IRON-FA 60 MG IRON-1 MG ORAL TABLET",,82851,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"PRENATAL VIT27,CALCIUM-IRON-FA 60 MG IRON-1 MG ORAL TABLET",,82851,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
"PRENATAL VIT27,CALCIUM-IRON-FA 60 MG IRON-1 MG ORAL TABLET",,82851,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
"PRENATAL VIT27,CALCIUM-IRON-FA 60 MG IRON-1 MG ORAL TABLET",,82851,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
"PRENATAL VIT27,CALCIUM-IRON-FA 60 MG IRON-1 MG ORAL TABLET",,82851,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
"PRENATAL VIT27,CALCIUM-IRON-FA 60 MG IRON-1 MG ORAL TABLET",,82851,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"PRENATAL VIT27,CALCIUM-IRON-FA 60 MG IRON-1 MG ORAL TABLET",,82851,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
"PRENATAL VIT27,CALCIUM-IRON-FA 60 MG IRON-1 MG ORAL TABLET",,82851,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
"PRENATAL VIT27,CALCIUM-IRON-FA 60 MG IRON-1 MG ORAL TABLET",,82851,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
"PRENATAL VIT27,CALCIUM-IRON-FA 60 MG IRON-1 MG ORAL TABLET",,82851,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
"PRENATAL VIT27,CALCIUM-IRON-FA 60 MG IRON-1 MG ORAL TABLET",,82851,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
"PRENATAL VIT27,CALCIUM-IRON-FA 60 MG IRON-1 MG ORAL TABLET",,82851,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"PRENATAL VIT27,CALCIUM-IRON-FA 60 MG IRON-1 MG ORAL TABLET",,82851,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
"PRENATAL VIT27,CALCIUM-IRON-FA 60 MG IRON-1 MG ORAL TABLET",,82851,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
"PRENATAL VIT27,CALCIUM-IRON-FA 60 MG IRON-1 MG ORAL TABLET",,82851,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"PRENATAL VIT27,CALCIUM-IRON-FA 60 MG IRON-1 MG ORAL TABLET",,82851,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
"PRENATAL VIT27,CALCIUM-IRON-FA 60 MG IRON-1 MG ORAL TABLET",,82851,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
"PRENATAL VIT27,CALCIUM-IRON-FA 60 MG IRON-1 MG ORAL TABLET",,82851,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
"PRENATAL VIT27,CALCIUM-IRON-FA 60 MG IRON-1 MG ORAL TABLET",,82851,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"PRENATAL VIT27,CALCIUM-IRON-FA 60 MG IRON-1 MG ORAL TABLET",,82851,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
"PRENATAL VIT27,CALCIUM-IRON-FA 60 MG IRON-1 MG ORAL TABLET",,82851,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
"PRENATAL VIT27,CALCIUM-IRON-FA 60 MG IRON-1 MG ORAL TABLET",,82851,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"PRENATAL VIT27,CALCIUM-IRON-FA 60 MG IRON-1 MG ORAL TABLET",,82851,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
"PRENATAL VIT27,CALCIUM-IRON-FA 60 MG IRON-1 MG ORAL TABLET",,82851,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"PRENATAL VIT27,CALCIUM-IRON-FA 60 MG IRON-1 MG ORAL TABLET",,82851,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"PRENATAL VIT27,CALCIUM-IRON-FA 60 MG IRON-1 MG ORAL TABLET",,82851,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"PRENATAL VIT27,CALCIUM-IRON-FA 60 MG IRON-1 MG ORAL TABLET",,82851,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"PRENATAL VIT27,CALCIUM-IRON-FA 60 MG IRON-1 MG ORAL TABLET",,82851,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
"PRENATAL VIT27,CALCIUM-IRON-FA 60 MG IRON-1 MG ORAL TABLET",,82851,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"PRENATAL VIT27,CALCIUM-IRON-FA 60 MG IRON-1 MG ORAL TABLET",,82851,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"PRENATAL VIT27,CALCIUM-IRON-FA 60 MG IRON-1 MG ORAL TABLET",,82851,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"PRENATAL VIT27,CALCIUM-IRON-FA 60 MG IRON-1 MG ORAL TABLET",,82851,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"PRENATAL VIT27,CALCIUM-IRON-FA 60 MG IRON-1 MG ORAL TABLET",,82851,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"PRENATAL VIT27,CALCIUM-IRON-FA 60 MG IRON-1 MG ORAL TABLET",,82851,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"PRENATAL VIT27,CALCIUM-IRON-FA 60 MG IRON-1 MG ORAL TABLET",,82851,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"PRENATAL VIT27,CALCIUM-IRON-FA 60 MG IRON-1 MG ORAL TABLET",,82851,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"PRENATAL VIT27,CALCIUM-IRON-FA 60 MG IRON-1 MG ORAL TABLET",,82851,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
"PRENATAL VIT27,CALCIUM-IRON-FA 60 MG IRON-1 MG ORAL TABLET",,82851,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
"PRENATAL VIT27,CALCIUM-IRON-FA 60 MG IRON-1 MG ORAL TABLET",,82851,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"PRENATAL VIT27,CALCIUM-IRON-FA 60 MG IRON-1 MG ORAL TABLET",,82851,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
"PRENATAL VIT27,CALCIUM-IRON-FA 60 MG IRON-1 MG ORAL TABLET",,82851,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
CARBOXYMETHYLCELL-GLYCERIN(PF) 0.5-0.9 % OPHT DPET,,84510,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
CARBOXYMETHYLCELL-GLYCERIN(PF) 0.5-0.9 % OPHT DPET,,84510,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
CARBOXYMETHYLCELL-GLYCERIN(PF) 0.5-0.9 % OPHT DPET,,84510,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
CARBOXYMETHYLCELL-GLYCERIN(PF) 0.5-0.9 % OPHT DPET,,84510,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
CARBOXYMETHYLCELL-GLYCERIN(PF) 0.5-0.9 % OPHT DPET,,84510,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
CARBOXYMETHYLCELL-GLYCERIN(PF) 0.5-0.9 % OPHT DPET,,84510,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
CARBOXYMETHYLCELL-GLYCERIN(PF) 0.5-0.9 % OPHT DPET,,84510,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
CARBOXYMETHYLCELL-GLYCERIN(PF) 0.5-0.9 % OPHT DPET,,84510,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
CARBOXYMETHYLCELL-GLYCERIN(PF) 0.5-0.9 % OPHT DPET,,84510,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
CARBOXYMETHYLCELL-GLYCERIN(PF) 0.5-0.9 % OPHT DPET,,84510,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
CARBOXYMETHYLCELL-GLYCERIN(PF) 0.5-0.9 % OPHT DPET,,84510,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
CARBOXYMETHYLCELL-GLYCERIN(PF) 0.5-0.9 % OPHT DPET,,84510,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
CARBOXYMETHYLCELL-GLYCERIN(PF) 0.5-0.9 % OPHT DPET,,84510,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
CARBOXYMETHYLCELL-GLYCERIN(PF) 0.5-0.9 % OPHT DPET,,84510,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
CARBOXYMETHYLCELL-GLYCERIN(PF) 0.5-0.9 % OPHT DPET,,84510,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
CARBOXYMETHYLCELL-GLYCERIN(PF) 0.5-0.9 % OPHT DPET,,84510,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
CARBOXYMETHYLCELL-GLYCERIN(PF) 0.5-0.9 % OPHT DPET,,84510,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
CARBOXYMETHYLCELL-GLYCERIN(PF) 0.5-0.9 % OPHT DPET,,84510,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
CARBOXYMETHYLCELL-GLYCERIN(PF) 0.5-0.9 % OPHT DPET,,84510,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CARBOXYMETHYLCELL-GLYCERIN(PF) 0.5-0.9 % OPHT DPET,,84510,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
CARBOXYMETHYLCELL-GLYCERIN(PF) 0.5-0.9 % OPHT DPET,,84510,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
CARBOXYMETHYLCELL-GLYCERIN(PF) 0.5-0.9 % OPHT DPET,,84510,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
CARBOXYMETHYLCELL-GLYCERIN(PF) 0.5-0.9 % OPHT DPET,,84510,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
CARBOXYMETHYLCELL-GLYCERIN(PF) 0.5-0.9 % OPHT DPET,,84510,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
CARBOXYMETHYLCELL-GLYCERIN(PF) 0.5-0.9 % OPHT DPET,,84510,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
CARBOXYMETHYLCELL-GLYCERIN(PF) 0.5-0.9 % OPHT DPET,,84510,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
CARBOXYMETHYLCELL-GLYCERIN(PF) 0.5-0.9 % OPHT DPET,,84510,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
CARBOXYMETHYLCELL-GLYCERIN(PF) 0.5-0.9 % OPHT DPET,,84510,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
CARBOXYMETHYLCELL-GLYCERIN(PF) 0.5-0.9 % OPHT DPET,,84510,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
CARBOXYMETHYLCELL-GLYCERIN(PF) 0.5-0.9 % OPHT DPET,,84510,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
CARBOXYMETHYLCELL-GLYCERIN(PF) 0.5-0.9 % OPHT DPET,,84510,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
CARBOXYMETHYLCELL-GLYCERIN(PF) 0.5-0.9 % OPHT DPET,,84510,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
CARBOXYMETHYLCELL-GLYCERIN(PF) 0.5-0.9 % OPHT DPET,,84510,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
CARBOXYMETHYLCELL-GLYCERIN(PF) 0.5-0.9 % OPHT DPET,,84510,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
CARBOXYMETHYLCELL-GLYCERIN(PF) 0.5-0.9 % OPHT DPET,,84510,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
CARBOXYMETHYLCELL-GLYCERIN(PF) 0.5-0.9 % OPHT DPET,,84510,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
CARBOXYMETHYLCELL-GLYCERIN(PF) 0.5-0.9 % OPHT DPET,,84510,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
CARBOXYMETHYLCELL-GLYCERIN(PF) 0.5-0.9 % OPHT DPET,,84510,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CARBOXYMETHYLCELL-GLYCERIN(PF) 0.5-0.9 % OPHT DPET,,84510,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
CARBOXYMETHYLCELL-GLYCERIN(PF) 0.5-0.9 % OPHT DPET,,84510,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
CARBOXYMETHYLCELL-GLYCERIN(PF) 0.5-0.9 % OPHT DPET,,84510,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
CARBOXYMETHYLCELL-GLYCERIN(PF) 0.5-0.9 % OPHT DPET,,84510,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
CARBOXYMETHYLCELL-GLYCERIN(PF) 0.5-0.9 % OPHT DPET,,84510,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
CARBOXYMETHYLCELL-GLYCERIN(PF) 0.5-0.9 % OPHT DPET,,84510,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CARBOXYMETHYLCELL-GLYCERIN(PF) 0.5-0.9 % OPHT DPET,,84510,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
CARBOXYMETHYLCELL-GLYCERIN(PF) 0.5-0.9 % OPHT DPET,,84510,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CARBOXYMETHYLCELL-GLYCERIN(PF) 0.5-0.9 % OPHT DPET,,84510,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CARBOXYMETHYLCELL-GLYCERIN(PF) 0.5-0.9 % OPHT DPET,,84510,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CARBOXYMETHYLCELL-GLYCERIN(PF) 0.5-0.9 % OPHT DPET,,84510,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CARBOXYMETHYLCELL-GLYCERIN(PF) 0.5-0.9 % OPHT DPET,,84510,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
CARBOXYMETHYLCELL-GLYCERIN(PF) 0.5-0.9 % OPHT DPET,,84510,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
CARBOXYMETHYLCELL-GLYCERIN(PF) 0.5-0.9 % OPHT DPET,,84510,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
CARBOXYMETHYLCELL-GLYCERIN(PF) 0.5-0.9 % OPHT DPET,,84510,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
CARBOXYMETHYLCELL-GLYCERIN(PF) 0.5-0.9 % OPHT DPET,,84510,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"VITAMIN E (DL, ACETATE) 180 MG (400 UNIT) ORAL CAP",,85375,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
"VITAMIN E (DL, ACETATE) 180 MG (400 UNIT) ORAL CAP",,85375,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
"VITAMIN E (DL, ACETATE) 180 MG (400 UNIT) ORAL CAP",,85375,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"VITAMIN E (DL, ACETATE) 180 MG (400 UNIT) ORAL CAP",,85375,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
"VITAMIN E (DL, ACETATE) 180 MG (400 UNIT) ORAL CAP",,85375,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"VITAMIN E (DL, ACETATE) 180 MG (400 UNIT) ORAL CAP",,85375,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
"VITAMIN E (DL, ACETATE) 180 MG (400 UNIT) ORAL CAP",,85375,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
"VITAMIN E (DL, ACETATE) 180 MG (400 UNIT) ORAL CAP",,85375,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
"VITAMIN E (DL, ACETATE) 180 MG (400 UNIT) ORAL CAP",,85375,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
"VITAMIN E (DL, ACETATE) 180 MG (400 UNIT) ORAL CAP",,85375,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"VITAMIN E (DL, ACETATE) 180 MG (400 UNIT) ORAL CAP",,85375,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
"VITAMIN E (DL, ACETATE) 180 MG (400 UNIT) ORAL CAP",,85375,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
"VITAMIN E (DL, ACETATE) 180 MG (400 UNIT) ORAL CAP",,85375,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
"VITAMIN E (DL, ACETATE) 180 MG (400 UNIT) ORAL CAP",,85375,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"VITAMIN E (DL, ACETATE) 180 MG (400 UNIT) ORAL CAP",,85375,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
"VITAMIN E (DL, ACETATE) 180 MG (400 UNIT) ORAL CAP",,85375,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
"VITAMIN E (DL, ACETATE) 180 MG (400 UNIT) ORAL CAP",,85375,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
"VITAMIN E (DL, ACETATE) 180 MG (400 UNIT) ORAL CAP",,85375,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
"VITAMIN E (DL, ACETATE) 180 MG (400 UNIT) ORAL CAP",,85375,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"VITAMIN E (DL, ACETATE) 180 MG (400 UNIT) ORAL CAP",,85375,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
"VITAMIN E (DL, ACETATE) 180 MG (400 UNIT) ORAL CAP",,85375,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
"VITAMIN E (DL, ACETATE) 180 MG (400 UNIT) ORAL CAP",,85375,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
"VITAMIN E (DL, ACETATE) 180 MG (400 UNIT) ORAL CAP",,85375,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
"VITAMIN E (DL, ACETATE) 180 MG (400 UNIT) ORAL CAP",,85375,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
"VITAMIN E (DL, ACETATE) 180 MG (400 UNIT) ORAL CAP",,85375,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"VITAMIN E (DL, ACETATE) 180 MG (400 UNIT) ORAL CAP",,85375,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
"VITAMIN E (DL, ACETATE) 180 MG (400 UNIT) ORAL CAP",,85375,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
"VITAMIN E (DL, ACETATE) 180 MG (400 UNIT) ORAL CAP",,85375,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"VITAMIN E (DL, ACETATE) 180 MG (400 UNIT) ORAL CAP",,85375,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
"VITAMIN E (DL, ACETATE) 180 MG (400 UNIT) ORAL CAP",,85375,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
"VITAMIN E (DL, ACETATE) 180 MG (400 UNIT) ORAL CAP",,85375,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
"VITAMIN E (DL, ACETATE) 180 MG (400 UNIT) ORAL CAP",,85375,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"VITAMIN E (DL, ACETATE) 180 MG (400 UNIT) ORAL CAP",,85375,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
"VITAMIN E (DL, ACETATE) 180 MG (400 UNIT) ORAL CAP",,85375,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
"VITAMIN E (DL, ACETATE) 180 MG (400 UNIT) ORAL CAP",,85375,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"VITAMIN E (DL, ACETATE) 180 MG (400 UNIT) ORAL CAP",,85375,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
"VITAMIN E (DL, ACETATE) 180 MG (400 UNIT) ORAL CAP",,85375,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"VITAMIN E (DL, ACETATE) 180 MG (400 UNIT) ORAL CAP",,85375,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"VITAMIN E (DL, ACETATE) 180 MG (400 UNIT) ORAL CAP",,85375,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"VITAMIN E (DL, ACETATE) 180 MG (400 UNIT) ORAL CAP",,85375,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"VITAMIN E (DL, ACETATE) 180 MG (400 UNIT) ORAL CAP",,85375,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
"VITAMIN E (DL, ACETATE) 180 MG (400 UNIT) ORAL CAP",,85375,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"VITAMIN E (DL, ACETATE) 180 MG (400 UNIT) ORAL CAP",,85375,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"VITAMIN E (DL, ACETATE) 180 MG (400 UNIT) ORAL CAP",,85375,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"VITAMIN E (DL, ACETATE) 180 MG (400 UNIT) ORAL CAP",,85375,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"VITAMIN E (DL, ACETATE) 180 MG (400 UNIT) ORAL CAP",,85375,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"VITAMIN E (DL, ACETATE) 180 MG (400 UNIT) ORAL CAP",,85375,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"VITAMIN E (DL, ACETATE) 180 MG (400 UNIT) ORAL CAP",,85375,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"VITAMIN E (DL, ACETATE) 180 MG (400 UNIT) ORAL CAP",,85375,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"VITAMIN E (DL, ACETATE) 180 MG (400 UNIT) ORAL CAP",,85375,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
"VITAMIN E (DL, ACETATE) 180 MG (400 UNIT) ORAL CAP",,85375,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
"VITAMIN E (DL, ACETATE) 180 MG (400 UNIT) ORAL CAP",,85375,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"VITAMIN E (DL, ACETATE) 180 MG (400 UNIT) ORAL CAP",,85375,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
"VITAMIN E (DL, ACETATE) 180 MG (400 UNIT) ORAL CAP",,85375,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
FEBUXOSTAT 40 MG ORAL TABLET,,85881,LOCAL,Facility,Both,1,Each,,49,41.65,14.0434,49,Aetna,Commercial,45.08,92,,percent of total billed charges,,
FEBUXOSTAT 40 MG ORAL TABLET,,85881,LOCAL,Facility,Outpatient,1,Each,,49,41.65,14.0434,49,Aetna,Medicare Advantage,24.01,49,,percent of total billed charges,,
FEBUXOSTAT 40 MG ORAL TABLET,,85881,LOCAL,Facility,Inpatient,1,Each,,49,41.65,14.0434,49,Aetna,Medicare Advantage,,,,,Included in per diem rate,
FEBUXOSTAT 40 MG ORAL TABLET,,85881,LOCAL,Facility,Both,1,Each,,49,41.65,14.0434,49,Aetna,PPO,45.57,93,,percent of total billed charges,,
FEBUXOSTAT 40 MG ORAL TABLET,,85881,LOCAL,Facility,Both,1,Each,,49,41.65,14.0434,49,America's PPO,America's PPO,47.0547,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
FEBUXOSTAT 40 MG ORAL TABLET,,85881,LOCAL,Facility,Both,1,Each,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota, Federal Employee Program,48.216,98.4,,percent of total billed charges,,
FEBUXOSTAT 40 MG ORAL TABLET,,85881,LOCAL,Facility,Both,1,Each,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,49,100,,percent of total billed charges,,
FEBUXOSTAT 40 MG ORAL TABLET,,85881,LOCAL,Facility,Both,1,Each,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,High Value Network Plan,44.1,90,,percent of total billed charges,,
FEBUXOSTAT 40 MG ORAL TABLET,,85881,LOCAL,Facility,Outpatient,1,Each,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Medicare Advantage,24.01,49,,percent of total billed charges,,
FEBUXOSTAT 40 MG ORAL TABLET,,85881,LOCAL,Facility,Inpatient,1,Each,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
FEBUXOSTAT 40 MG ORAL TABLET,,85881,LOCAL,Facility,Both,1,Each,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,43.3993,88.57,,percent of total billed charges,,
FEBUXOSTAT 40 MG ORAL TABLET,,85881,LOCAL,Facility,Both,1,Each,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,14.0434,28.66,,percent of total billed charges,,
FEBUXOSTAT 40 MG ORAL TABLET,,85881,LOCAL,Facility,Outpatient,1,Each,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),24.01,49,,percent of total billed charges,,
FEBUXOSTAT 40 MG ORAL TABLET,,85881,LOCAL,Facility,Inpatient,1,Each,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
FEBUXOSTAT 40 MG ORAL TABLET,,85881,LOCAL,Facility,Both,1,Each,,49,41.65,14.0434,49,CorVel,Worker's Compensation,49,100,,percent of total billed charges,,
FEBUXOSTAT 40 MG ORAL TABLET,,85881,LOCAL,Facility,Both,1,Each,,49,41.65,14.0434,49,First Health Group Corporation,First Health Network,47.53,97,,percent of total billed charges,,
FEBUXOSTAT 40 MG ORAL TABLET,,85881,LOCAL,Facility,Both,1,Each,,49,41.65,14.0434,49,"Health Partners, Inc.",Commercial,46.354,94.6,,percent of total billed charges,,
FEBUXOSTAT 40 MG ORAL TABLET,,85881,LOCAL,Facility,Outpatient,1,Each,,49,41.65,14.0434,49,"Health Partners, Inc.",Medicare Advantage,24.01,49,,percent of total billed charges,,
FEBUXOSTAT 40 MG ORAL TABLET,,85881,LOCAL,Facility,Inpatient,1,Each,,49,41.65,14.0434,49,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
FEBUXOSTAT 40 MG ORAL TABLET,,85881,LOCAL,Facility,Both,1,Each,,49,41.65,14.0434,49,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),29.4,60,,percent of total billed charges,,
FEBUXOSTAT 40 MG ORAL TABLET,,85881,LOCAL,Facility,Both,1,Each,,49,41.65,14.0434,49,"Health Partners, Inc.",State of Minnesota Advantage Program,39.935,81.5,,percent of total billed charges,,
FEBUXOSTAT 40 MG ORAL TABLET,,85881,LOCAL,Facility,Both,1,Each,,49,41.65,14.0434,49,"Health Partners, Inc.",State Public Programs,24.5,50,,percent of total billed charges,,
FEBUXOSTAT 40 MG ORAL TABLET,,85881,LOCAL,Facility,Both,1,Each,,49,41.65,14.0434,49,Humana Insurance Company,Commercial PPO,46.55,95,,percent of total billed charges,,
FEBUXOSTAT 40 MG ORAL TABLET,,85881,LOCAL,Facility,Outpatient,1,Each,,49,41.65,14.0434,49,Humana Insurance Company,Medicare PPO,24.01,49,,percent of total billed charges,,
FEBUXOSTAT 40 MG ORAL TABLET,,85881,LOCAL,Facility,Inpatient,1,Each,,49,41.65,14.0434,49,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
FEBUXOSTAT 40 MG ORAL TABLET,,85881,LOCAL,Facility,Both,1,Each,,49,41.65,14.0434,49,Medica,Individual & Family,48.559,99.1,,percent of total billed charges,,
FEBUXOSTAT 40 MG ORAL TABLET,,85881,LOCAL,Facility,Outpatient,1,Each,,49,41.65,14.0434,49,Medica,Medica Advantage Solution,24.402,49.8,,percent of total billed charges,,
FEBUXOSTAT 40 MG ORAL TABLET,,85881,LOCAL,Facility,Inpatient,1,Each,,49,41.65,14.0434,49,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
FEBUXOSTAT 40 MG ORAL TABLET,,85881,LOCAL,Facility,Outpatient,1,Each,,49,41.65,14.0434,49,Medica,Medical Assistance,21.854,44.6,,percent of total billed charges,,
FEBUXOSTAT 40 MG ORAL TABLET,,85881,LOCAL,Facility,Inpatient,1,Each,,49,41.65,14.0434,49,Medica,Medical Assistance,,,,,Included in per diem rate,
FEBUXOSTAT 40 MG ORAL TABLET,,85881,LOCAL,Facility,Outpatient,1,Each,,49,41.65,14.0434,49,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,24.402,49.8,,percent of total billed charges,,
FEBUXOSTAT 40 MG ORAL TABLET,,85881,LOCAL,Facility,Inpatient,1,Each,,49,41.65,14.0434,49,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
FEBUXOSTAT 40 MG ORAL TABLET,,85881,LOCAL,Facility,Both,1,Each,,49,41.65,14.0434,49,"Multiplan, Inc.","Multiplan, Inc.",46.06,94,,percent of total billed charges,,
FEBUXOSTAT 40 MG ORAL TABLET,,85881,LOCAL,Facility,Outpatient,1,Each,,49,41.65,14.0434,49,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,44.149,90.1,,percent of total billed charges,,
FEBUXOSTAT 40 MG ORAL TABLET,,85881,LOCAL,Facility,Inpatient,1,Each,,49,41.65,14.0434,49,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
FEBUXOSTAT 40 MG ORAL TABLET,,85881,LOCAL,Facility,Both,1,Each,,49,41.65,14.0434,49,"Preferred One Administrative Services, INC.",PPO,48.314,98.6,,percent of total billed charges,,
FEBUXOSTAT 40 MG ORAL TABLET,,85881,LOCAL,Facility,Outpatient,1,Each,,49,41.65,14.0434,49,PrimeWest Health,Minnesota Senior Health Options (MSHO),25.2105,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
FEBUXOSTAT 40 MG ORAL TABLET,,85881,LOCAL,Facility,Inpatient,1,Each,,49,41.65,14.0434,49,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
FEBUXOSTAT 40 MG ORAL TABLET,,85881,LOCAL,Facility,Outpatient,1,Each,,49,41.65,14.0434,49,PrimeWest Health,MinnesotaCare,25.1664,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
FEBUXOSTAT 40 MG ORAL TABLET,,85881,LOCAL,Facility,Inpatient,1,Each,,49,41.65,14.0434,49,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
FEBUXOSTAT 40 MG ORAL TABLET,,85881,LOCAL,Facility,Both,1,Each,,49,41.65,14.0434,49,Sanford Health Plan,Sanford Health Plan,45.08,92,,percent of total billed charges,,
FEBUXOSTAT 40 MG ORAL TABLET,,85881,LOCAL,Facility,Outpatient,1,Each,,49,41.65,14.0434,49,"UCare Health, Inc.",Individual & Family Plan,27.6115,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
FEBUXOSTAT 40 MG ORAL TABLET,,85881,LOCAL,Facility,Inpatient,1,Each,,49,41.65,14.0434,49,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
FEBUXOSTAT 40 MG ORAL TABLET,,85881,LOCAL,Facility,Outpatient,1,Each,,49,41.65,14.0434,49,"UCare Health, Inc.",Medical Assistance,24.7303,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FEBUXOSTAT 40 MG ORAL TABLET,,85881,LOCAL,Facility,Inpatient,1,Each,,49,41.65,14.0434,49,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
FEBUXOSTAT 40 MG ORAL TABLET,,85881,LOCAL,Facility,Outpatient,1,Each,,49,41.65,14.0434,49,"UCare Health, Inc.",Medicare Advantage,24.7303,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FEBUXOSTAT 40 MG ORAL TABLET,,85881,LOCAL,Facility,Inpatient,1,Each,,49,41.65,14.0434,49,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
FEBUXOSTAT 40 MG ORAL TABLET,,85881,LOCAL,Facility,Outpatient,1,Each,,49,41.65,14.0434,49,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),24.7303,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FEBUXOSTAT 40 MG ORAL TABLET,,85881,LOCAL,Facility,Inpatient,1,Each,,49,41.65,14.0434,49,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
FEBUXOSTAT 40 MG ORAL TABLET,,85881,LOCAL,Facility,Both,1,Each,,49,41.65,14.0434,49,UnitedHealthcare,Individual & Family,46.06,94,,percent of total billed charges,,
FEBUXOSTAT 40 MG ORAL TABLET,,85881,LOCAL,Facility,Outpatient,1,Each,,49,41.65,14.0434,49,UnitedHealthcare,Medicare Advantage,24.01,49,,percent of total billed charges,,
FEBUXOSTAT 40 MG ORAL TABLET,,85881,LOCAL,Facility,Inpatient,1,Each,,49,41.65,14.0434,49,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
FEBUXOSTAT 40 MG ORAL TABLET,,85881,LOCAL,Facility,Outpatient,1,Each,,49,41.65,14.0434,49,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,23.52,48,,percent of total billed charges,,100% of DHS outpatient percentage
FEBUXOSTAT 40 MG ORAL TABLET,,85881,LOCAL,Facility,Inpatient,1,Each,,49,41.65,14.0434,49,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
LEVONORGESTREL 1.5 MG ORAL TABLET,,88055,LOCAL,Facility,Both,1,Each,,165,140.25,47.289,165,Aetna,Commercial,151.8,92,,percent of total billed charges,,
LEVONORGESTREL 1.5 MG ORAL TABLET,,88055,LOCAL,Facility,Outpatient,1,Each,,165,140.25,47.289,165,Aetna,Medicare Advantage,80.85,49,,percent of total billed charges,,
LEVONORGESTREL 1.5 MG ORAL TABLET,,88055,LOCAL,Facility,Inpatient,1,Each,,165,140.25,47.289,165,Aetna,Medicare Advantage,,,,,Included in per diem rate,
LEVONORGESTREL 1.5 MG ORAL TABLET,,88055,LOCAL,Facility,Both,1,Each,,165,140.25,47.289,165,Aetna,PPO,153.45,93,,percent of total billed charges,,
LEVONORGESTREL 1.5 MG ORAL TABLET,,88055,LOCAL,Facility,Both,1,Each,,165,140.25,47.289,165,America's PPO,America's PPO,158.4495,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
LEVONORGESTREL 1.5 MG ORAL TABLET,,88055,LOCAL,Facility,Both,1,Each,,165,140.25,47.289,165,BlueCross BlueShield Minnesota, Federal Employee Program,162.36,98.4,,percent of total billed charges,,
LEVONORGESTREL 1.5 MG ORAL TABLET,,88055,LOCAL,Facility,Both,1,Each,,165,140.25,47.289,165,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,165,100,,percent of total billed charges,,
LEVONORGESTREL 1.5 MG ORAL TABLET,,88055,LOCAL,Facility,Both,1,Each,,165,140.25,47.289,165,BlueCross BlueShield Minnesota,High Value Network Plan,148.5,90,,percent of total billed charges,,
LEVONORGESTREL 1.5 MG ORAL TABLET,,88055,LOCAL,Facility,Outpatient,1,Each,,165,140.25,47.289,165,BlueCross BlueShield Minnesota,Medicare Advantage,80.85,49,,percent of total billed charges,,
LEVONORGESTREL 1.5 MG ORAL TABLET,,88055,LOCAL,Facility,Inpatient,1,Each,,165,140.25,47.289,165,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
LEVONORGESTREL 1.5 MG ORAL TABLET,,88055,LOCAL,Facility,Both,1,Each,,165,140.25,47.289,165,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,146.1405,88.57,,percent of total billed charges,,
LEVONORGESTREL 1.5 MG ORAL TABLET,,88055,LOCAL,Facility,Both,1,Each,,165,140.25,47.289,165,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,47.289,28.66,,percent of total billed charges,,
LEVONORGESTREL 1.5 MG ORAL TABLET,,88055,LOCAL,Facility,Outpatient,1,Each,,165,140.25,47.289,165,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),80.85,49,,percent of total billed charges,,
LEVONORGESTREL 1.5 MG ORAL TABLET,,88055,LOCAL,Facility,Inpatient,1,Each,,165,140.25,47.289,165,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
LEVONORGESTREL 1.5 MG ORAL TABLET,,88055,LOCAL,Facility,Both,1,Each,,165,140.25,47.289,165,CorVel,Worker's Compensation,165,100,,percent of total billed charges,,
LEVONORGESTREL 1.5 MG ORAL TABLET,,88055,LOCAL,Facility,Both,1,Each,,165,140.25,47.289,165,First Health Group Corporation,First Health Network,160.05,97,,percent of total billed charges,,
LEVONORGESTREL 1.5 MG ORAL TABLET,,88055,LOCAL,Facility,Both,1,Each,,165,140.25,47.289,165,"Health Partners, Inc.",Commercial,156.09,94.6,,percent of total billed charges,,
LEVONORGESTREL 1.5 MG ORAL TABLET,,88055,LOCAL,Facility,Outpatient,1,Each,,165,140.25,47.289,165,"Health Partners, Inc.",Medicare Advantage,80.85,49,,percent of total billed charges,,
LEVONORGESTREL 1.5 MG ORAL TABLET,,88055,LOCAL,Facility,Inpatient,1,Each,,165,140.25,47.289,165,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LEVONORGESTREL 1.5 MG ORAL TABLET,,88055,LOCAL,Facility,Both,1,Each,,165,140.25,47.289,165,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),99,60,,percent of total billed charges,,
LEVONORGESTREL 1.5 MG ORAL TABLET,,88055,LOCAL,Facility,Both,1,Each,,165,140.25,47.289,165,"Health Partners, Inc.",State of Minnesota Advantage Program,134.475,81.5,,percent of total billed charges,,
LEVONORGESTREL 1.5 MG ORAL TABLET,,88055,LOCAL,Facility,Both,1,Each,,165,140.25,47.289,165,"Health Partners, Inc.",State Public Programs,82.5,50,,percent of total billed charges,,
LEVONORGESTREL 1.5 MG ORAL TABLET,,88055,LOCAL,Facility,Both,1,Each,,165,140.25,47.289,165,Humana Insurance Company,Commercial PPO,156.75,95,,percent of total billed charges,,
LEVONORGESTREL 1.5 MG ORAL TABLET,,88055,LOCAL,Facility,Outpatient,1,Each,,165,140.25,47.289,165,Humana Insurance Company,Medicare PPO,80.85,49,,percent of total billed charges,,
LEVONORGESTREL 1.5 MG ORAL TABLET,,88055,LOCAL,Facility,Inpatient,1,Each,,165,140.25,47.289,165,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
LEVONORGESTREL 1.5 MG ORAL TABLET,,88055,LOCAL,Facility,Both,1,Each,,165,140.25,47.289,165,Medica,Individual & Family,163.515,99.1,,percent of total billed charges,,
LEVONORGESTREL 1.5 MG ORAL TABLET,,88055,LOCAL,Facility,Outpatient,1,Each,,165,140.25,47.289,165,Medica,Medica Advantage Solution,82.17,49.8,,percent of total billed charges,,
LEVONORGESTREL 1.5 MG ORAL TABLET,,88055,LOCAL,Facility,Inpatient,1,Each,,165,140.25,47.289,165,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
LEVONORGESTREL 1.5 MG ORAL TABLET,,88055,LOCAL,Facility,Outpatient,1,Each,,165,140.25,47.289,165,Medica,Medical Assistance,73.59,44.6,,percent of total billed charges,,
LEVONORGESTREL 1.5 MG ORAL TABLET,,88055,LOCAL,Facility,Inpatient,1,Each,,165,140.25,47.289,165,Medica,Medical Assistance,,,,,Included in per diem rate,
LEVONORGESTREL 1.5 MG ORAL TABLET,,88055,LOCAL,Facility,Outpatient,1,Each,,165,140.25,47.289,165,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,82.17,49.8,,percent of total billed charges,,
LEVONORGESTREL 1.5 MG ORAL TABLET,,88055,LOCAL,Facility,Inpatient,1,Each,,165,140.25,47.289,165,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
LEVONORGESTREL 1.5 MG ORAL TABLET,,88055,LOCAL,Facility,Both,1,Each,,165,140.25,47.289,165,"Multiplan, Inc.","Multiplan, Inc.",155.1,94,,percent of total billed charges,,
LEVONORGESTREL 1.5 MG ORAL TABLET,,88055,LOCAL,Facility,Outpatient,1,Each,,165,140.25,47.289,165,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,148.665,90.1,,percent of total billed charges,,
LEVONORGESTREL 1.5 MG ORAL TABLET,,88055,LOCAL,Facility,Inpatient,1,Each,,165,140.25,47.289,165,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
LEVONORGESTREL 1.5 MG ORAL TABLET,,88055,LOCAL,Facility,Both,1,Each,,165,140.25,47.289,165,"Preferred One Administrative Services, INC.",PPO,162.69,98.6,,percent of total billed charges,,
LEVONORGESTREL 1.5 MG ORAL TABLET,,88055,LOCAL,Facility,Outpatient,1,Each,,165,140.25,47.289,165,PrimeWest Health,Minnesota Senior Health Options (MSHO),84.8925,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
LEVONORGESTREL 1.5 MG ORAL TABLET,,88055,LOCAL,Facility,Inpatient,1,Each,,165,140.25,47.289,165,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LEVONORGESTREL 1.5 MG ORAL TABLET,,88055,LOCAL,Facility,Outpatient,1,Each,,165,140.25,47.289,165,PrimeWest Health,MinnesotaCare,84.744,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
LEVONORGESTREL 1.5 MG ORAL TABLET,,88055,LOCAL,Facility,Inpatient,1,Each,,165,140.25,47.289,165,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
LEVONORGESTREL 1.5 MG ORAL TABLET,,88055,LOCAL,Facility,Both,1,Each,,165,140.25,47.289,165,Sanford Health Plan,Sanford Health Plan,151.8,92,,percent of total billed charges,,
LEVONORGESTREL 1.5 MG ORAL TABLET,,88055,LOCAL,Facility,Outpatient,1,Each,,165,140.25,47.289,165,"UCare Health, Inc.",Individual & Family Plan,92.9775,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
LEVONORGESTREL 1.5 MG ORAL TABLET,,88055,LOCAL,Facility,Inpatient,1,Each,,165,140.25,47.289,165,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
LEVONORGESTREL 1.5 MG ORAL TABLET,,88055,LOCAL,Facility,Outpatient,1,Each,,165,140.25,47.289,165,"UCare Health, Inc.",Medical Assistance,83.2755,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LEVONORGESTREL 1.5 MG ORAL TABLET,,88055,LOCAL,Facility,Inpatient,1,Each,,165,140.25,47.289,165,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
LEVONORGESTREL 1.5 MG ORAL TABLET,,88055,LOCAL,Facility,Outpatient,1,Each,,165,140.25,47.289,165,"UCare Health, Inc.",Medicare Advantage,83.2755,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LEVONORGESTREL 1.5 MG ORAL TABLET,,88055,LOCAL,Facility,Inpatient,1,Each,,165,140.25,47.289,165,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LEVONORGESTREL 1.5 MG ORAL TABLET,,88055,LOCAL,Facility,Outpatient,1,Each,,165,140.25,47.289,165,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),83.2755,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LEVONORGESTREL 1.5 MG ORAL TABLET,,88055,LOCAL,Facility,Inpatient,1,Each,,165,140.25,47.289,165,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LEVONORGESTREL 1.5 MG ORAL TABLET,,88055,LOCAL,Facility,Both,1,Each,,165,140.25,47.289,165,UnitedHealthcare,Individual & Family,155.1,94,,percent of total billed charges,,
LEVONORGESTREL 1.5 MG ORAL TABLET,,88055,LOCAL,Facility,Outpatient,1,Each,,165,140.25,47.289,165,UnitedHealthcare,Medicare Advantage,80.85,49,,percent of total billed charges,,
LEVONORGESTREL 1.5 MG ORAL TABLET,,88055,LOCAL,Facility,Inpatient,1,Each,,165,140.25,47.289,165,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
LEVONORGESTREL 1.5 MG ORAL TABLET,,88055,LOCAL,Facility,Outpatient,1,Each,,165,140.25,47.289,165,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,79.2,48,,percent of total billed charges,,100% of DHS outpatient percentage
LEVONORGESTREL 1.5 MG ORAL TABLET,,88055,LOCAL,Facility,Inpatient,1,Each,,165,140.25,47.289,165,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
KETOROLAC (PF) 0.45 % OPHT DPET,,88056,LOCAL,Facility,Both,1,Each,,1444,1227.4,413.8504,1444,Aetna,Commercial,1328.48,92,,percent of total billed charges,,
KETOROLAC (PF) 0.45 % OPHT DPET,,88056,LOCAL,Facility,Outpatient,1,Each,,1444,1227.4,413.8504,1444,Aetna,Medicare Advantage,707.56,49,,percent of total billed charges,,
KETOROLAC (PF) 0.45 % OPHT DPET,,88056,LOCAL,Facility,Inpatient,1,Each,,1444,1227.4,413.8504,1444,Aetna,Medicare Advantage,,,,,Included in per diem rate,
KETOROLAC (PF) 0.45 % OPHT DPET,,88056,LOCAL,Facility,Both,1,Each,,1444,1227.4,413.8504,1444,Aetna,PPO,1342.92,93,,percent of total billed charges,,
KETOROLAC (PF) 0.45 % OPHT DPET,,88056,LOCAL,Facility,Both,1,Each,,1444,1227.4,413.8504,1444,America's PPO,America's PPO,1386.6732,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
KETOROLAC (PF) 0.45 % OPHT DPET,,88056,LOCAL,Facility,Both,1,Each,,1444,1227.4,413.8504,1444,BlueCross BlueShield Minnesota, Federal Employee Program,1420.896,98.4,,percent of total billed charges,,
KETOROLAC (PF) 0.45 % OPHT DPET,,88056,LOCAL,Facility,Both,1,Each,,1444,1227.4,413.8504,1444,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1444,100,,percent of total billed charges,,
KETOROLAC (PF) 0.45 % OPHT DPET,,88056,LOCAL,Facility,Both,1,Each,,1444,1227.4,413.8504,1444,BlueCross BlueShield Minnesota,High Value Network Plan,1299.6,90,,percent of total billed charges,,
KETOROLAC (PF) 0.45 % OPHT DPET,,88056,LOCAL,Facility,Outpatient,1,Each,,1444,1227.4,413.8504,1444,BlueCross BlueShield Minnesota,Medicare Advantage,707.56,49,,percent of total billed charges,,
KETOROLAC (PF) 0.45 % OPHT DPET,,88056,LOCAL,Facility,Inpatient,1,Each,,1444,1227.4,413.8504,1444,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
KETOROLAC (PF) 0.45 % OPHT DPET,,88056,LOCAL,Facility,Both,1,Each,,1444,1227.4,413.8504,1444,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1278.9508,88.57,,percent of total billed charges,,
KETOROLAC (PF) 0.45 % OPHT DPET,,88056,LOCAL,Facility,Both,1,Each,,1444,1227.4,413.8504,1444,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,413.8504,28.66,,percent of total billed charges,,
KETOROLAC (PF) 0.45 % OPHT DPET,,88056,LOCAL,Facility,Outpatient,1,Each,,1444,1227.4,413.8504,1444,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),707.56,49,,percent of total billed charges,,
KETOROLAC (PF) 0.45 % OPHT DPET,,88056,LOCAL,Facility,Inpatient,1,Each,,1444,1227.4,413.8504,1444,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
KETOROLAC (PF) 0.45 % OPHT DPET,,88056,LOCAL,Facility,Both,1,Each,,1444,1227.4,413.8504,1444,CorVel,Worker's Compensation,1444,100,,percent of total billed charges,,
KETOROLAC (PF) 0.45 % OPHT DPET,,88056,LOCAL,Facility,Both,1,Each,,1444,1227.4,413.8504,1444,First Health Group Corporation,First Health Network,1400.68,97,,percent of total billed charges,,
KETOROLAC (PF) 0.45 % OPHT DPET,,88056,LOCAL,Facility,Both,1,Each,,1444,1227.4,413.8504,1444,"Health Partners, Inc.",Commercial,1366.024,94.6,,percent of total billed charges,,
KETOROLAC (PF) 0.45 % OPHT DPET,,88056,LOCAL,Facility,Outpatient,1,Each,,1444,1227.4,413.8504,1444,"Health Partners, Inc.",Medicare Advantage,707.56,49,,percent of total billed charges,,
KETOROLAC (PF) 0.45 % OPHT DPET,,88056,LOCAL,Facility,Inpatient,1,Each,,1444,1227.4,413.8504,1444,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
KETOROLAC (PF) 0.45 % OPHT DPET,,88056,LOCAL,Facility,Both,1,Each,,1444,1227.4,413.8504,1444,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),866.4,60,,percent of total billed charges,,
KETOROLAC (PF) 0.45 % OPHT DPET,,88056,LOCAL,Facility,Both,1,Each,,1444,1227.4,413.8504,1444,"Health Partners, Inc.",State of Minnesota Advantage Program,1176.86,81.5,,percent of total billed charges,,
KETOROLAC (PF) 0.45 % OPHT DPET,,88056,LOCAL,Facility,Both,1,Each,,1444,1227.4,413.8504,1444,"Health Partners, Inc.",State Public Programs,722,50,,percent of total billed charges,,
KETOROLAC (PF) 0.45 % OPHT DPET,,88056,LOCAL,Facility,Both,1,Each,,1444,1227.4,413.8504,1444,Humana Insurance Company,Commercial PPO,1371.8,95,,percent of total billed charges,,
KETOROLAC (PF) 0.45 % OPHT DPET,,88056,LOCAL,Facility,Outpatient,1,Each,,1444,1227.4,413.8504,1444,Humana Insurance Company,Medicare PPO,707.56,49,,percent of total billed charges,,
KETOROLAC (PF) 0.45 % OPHT DPET,,88056,LOCAL,Facility,Inpatient,1,Each,,1444,1227.4,413.8504,1444,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
KETOROLAC (PF) 0.45 % OPHT DPET,,88056,LOCAL,Facility,Both,1,Each,,1444,1227.4,413.8504,1444,Medica,Individual & Family,1431.004,99.1,,percent of total billed charges,,
KETOROLAC (PF) 0.45 % OPHT DPET,,88056,LOCAL,Facility,Outpatient,1,Each,,1444,1227.4,413.8504,1444,Medica,Medica Advantage Solution,719.112,49.8,,percent of total billed charges,,
KETOROLAC (PF) 0.45 % OPHT DPET,,88056,LOCAL,Facility,Inpatient,1,Each,,1444,1227.4,413.8504,1444,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
KETOROLAC (PF) 0.45 % OPHT DPET,,88056,LOCAL,Facility,Outpatient,1,Each,,1444,1227.4,413.8504,1444,Medica,Medical Assistance,644.024,44.6,,percent of total billed charges,,
KETOROLAC (PF) 0.45 % OPHT DPET,,88056,LOCAL,Facility,Inpatient,1,Each,,1444,1227.4,413.8504,1444,Medica,Medical Assistance,,,,,Included in per diem rate,
KETOROLAC (PF) 0.45 % OPHT DPET,,88056,LOCAL,Facility,Outpatient,1,Each,,1444,1227.4,413.8504,1444,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,719.112,49.8,,percent of total billed charges,,
KETOROLAC (PF) 0.45 % OPHT DPET,,88056,LOCAL,Facility,Inpatient,1,Each,,1444,1227.4,413.8504,1444,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
KETOROLAC (PF) 0.45 % OPHT DPET,,88056,LOCAL,Facility,Both,1,Each,,1444,1227.4,413.8504,1444,"Multiplan, Inc.","Multiplan, Inc.",1357.36,94,,percent of total billed charges,,
KETOROLAC (PF) 0.45 % OPHT DPET,,88056,LOCAL,Facility,Outpatient,1,Each,,1444,1227.4,413.8504,1444,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1301.044,90.1,,percent of total billed charges,,
KETOROLAC (PF) 0.45 % OPHT DPET,,88056,LOCAL,Facility,Inpatient,1,Each,,1444,1227.4,413.8504,1444,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
KETOROLAC (PF) 0.45 % OPHT DPET,,88056,LOCAL,Facility,Both,1,Each,,1444,1227.4,413.8504,1444,"Preferred One Administrative Services, INC.",PPO,1423.784,98.6,,percent of total billed charges,,
KETOROLAC (PF) 0.45 % OPHT DPET,,88056,LOCAL,Facility,Outpatient,1,Each,,1444,1227.4,413.8504,1444,PrimeWest Health,Minnesota Senior Health Options (MSHO),742.938,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
KETOROLAC (PF) 0.45 % OPHT DPET,,88056,LOCAL,Facility,Inpatient,1,Each,,1444,1227.4,413.8504,1444,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
KETOROLAC (PF) 0.45 % OPHT DPET,,88056,LOCAL,Facility,Outpatient,1,Each,,1444,1227.4,413.8504,1444,PrimeWest Health,MinnesotaCare,741.6384,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
KETOROLAC (PF) 0.45 % OPHT DPET,,88056,LOCAL,Facility,Inpatient,1,Each,,1444,1227.4,413.8504,1444,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
KETOROLAC (PF) 0.45 % OPHT DPET,,88056,LOCAL,Facility,Both,1,Each,,1444,1227.4,413.8504,1444,Sanford Health Plan,Sanford Health Plan,1328.48,92,,percent of total billed charges,,
KETOROLAC (PF) 0.45 % OPHT DPET,,88056,LOCAL,Facility,Outpatient,1,Each,,1444,1227.4,413.8504,1444,"UCare Health, Inc.",Individual & Family Plan,813.694,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
KETOROLAC (PF) 0.45 % OPHT DPET,,88056,LOCAL,Facility,Inpatient,1,Each,,1444,1227.4,413.8504,1444,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
KETOROLAC (PF) 0.45 % OPHT DPET,,88056,LOCAL,Facility,Outpatient,1,Each,,1444,1227.4,413.8504,1444,"UCare Health, Inc.",Medical Assistance,728.7868,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
KETOROLAC (PF) 0.45 % OPHT DPET,,88056,LOCAL,Facility,Inpatient,1,Each,,1444,1227.4,413.8504,1444,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
KETOROLAC (PF) 0.45 % OPHT DPET,,88056,LOCAL,Facility,Outpatient,1,Each,,1444,1227.4,413.8504,1444,"UCare Health, Inc.",Medicare Advantage,728.7868,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
KETOROLAC (PF) 0.45 % OPHT DPET,,88056,LOCAL,Facility,Inpatient,1,Each,,1444,1227.4,413.8504,1444,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
KETOROLAC (PF) 0.45 % OPHT DPET,,88056,LOCAL,Facility,Outpatient,1,Each,,1444,1227.4,413.8504,1444,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),728.7868,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
KETOROLAC (PF) 0.45 % OPHT DPET,,88056,LOCAL,Facility,Inpatient,1,Each,,1444,1227.4,413.8504,1444,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
KETOROLAC (PF) 0.45 % OPHT DPET,,88056,LOCAL,Facility,Both,1,Each,,1444,1227.4,413.8504,1444,UnitedHealthcare,Individual & Family,1357.36,94,,percent of total billed charges,,
KETOROLAC (PF) 0.45 % OPHT DPET,,88056,LOCAL,Facility,Outpatient,1,Each,,1444,1227.4,413.8504,1444,UnitedHealthcare,Medicare Advantage,707.56,49,,percent of total billed charges,,
KETOROLAC (PF) 0.45 % OPHT DPET,,88056,LOCAL,Facility,Inpatient,1,Each,,1444,1227.4,413.8504,1444,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
KETOROLAC (PF) 0.45 % OPHT DPET,,88056,LOCAL,Facility,Outpatient,1,Each,,1444,1227.4,413.8504,1444,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,693.12,48,,percent of total billed charges,,100% of DHS outpatient percentage
KETOROLAC (PF) 0.45 % OPHT DPET,,88056,LOCAL,Facility,Inpatient,1,Each,,1444,1227.4,413.8504,1444,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"OMEGA 3-DHA-EPA-FISH OIL 1,000 MG (120 MG-180 MG) ORAL CAP",,89793,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
"OMEGA 3-DHA-EPA-FISH OIL 1,000 MG (120 MG-180 MG) ORAL CAP",,89793,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
"OMEGA 3-DHA-EPA-FISH OIL 1,000 MG (120 MG-180 MG) ORAL CAP",,89793,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"OMEGA 3-DHA-EPA-FISH OIL 1,000 MG (120 MG-180 MG) ORAL CAP",,89793,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
"OMEGA 3-DHA-EPA-FISH OIL 1,000 MG (120 MG-180 MG) ORAL CAP",,89793,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"OMEGA 3-DHA-EPA-FISH OIL 1,000 MG (120 MG-180 MG) ORAL CAP",,89793,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
"OMEGA 3-DHA-EPA-FISH OIL 1,000 MG (120 MG-180 MG) ORAL CAP",,89793,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
"OMEGA 3-DHA-EPA-FISH OIL 1,000 MG (120 MG-180 MG) ORAL CAP",,89793,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
"OMEGA 3-DHA-EPA-FISH OIL 1,000 MG (120 MG-180 MG) ORAL CAP",,89793,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
"OMEGA 3-DHA-EPA-FISH OIL 1,000 MG (120 MG-180 MG) ORAL CAP",,89793,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"OMEGA 3-DHA-EPA-FISH OIL 1,000 MG (120 MG-180 MG) ORAL CAP",,89793,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
"OMEGA 3-DHA-EPA-FISH OIL 1,000 MG (120 MG-180 MG) ORAL CAP",,89793,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
"OMEGA 3-DHA-EPA-FISH OIL 1,000 MG (120 MG-180 MG) ORAL CAP",,89793,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
"OMEGA 3-DHA-EPA-FISH OIL 1,000 MG (120 MG-180 MG) ORAL CAP",,89793,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"OMEGA 3-DHA-EPA-FISH OIL 1,000 MG (120 MG-180 MG) ORAL CAP",,89793,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
"OMEGA 3-DHA-EPA-FISH OIL 1,000 MG (120 MG-180 MG) ORAL CAP",,89793,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
"OMEGA 3-DHA-EPA-FISH OIL 1,000 MG (120 MG-180 MG) ORAL CAP",,89793,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
"OMEGA 3-DHA-EPA-FISH OIL 1,000 MG (120 MG-180 MG) ORAL CAP",,89793,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
"OMEGA 3-DHA-EPA-FISH OIL 1,000 MG (120 MG-180 MG) ORAL CAP",,89793,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"OMEGA 3-DHA-EPA-FISH OIL 1,000 MG (120 MG-180 MG) ORAL CAP",,89793,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
"OMEGA 3-DHA-EPA-FISH OIL 1,000 MG (120 MG-180 MG) ORAL CAP",,89793,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
"OMEGA 3-DHA-EPA-FISH OIL 1,000 MG (120 MG-180 MG) ORAL CAP",,89793,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
"OMEGA 3-DHA-EPA-FISH OIL 1,000 MG (120 MG-180 MG) ORAL CAP",,89793,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
"OMEGA 3-DHA-EPA-FISH OIL 1,000 MG (120 MG-180 MG) ORAL CAP",,89793,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
"OMEGA 3-DHA-EPA-FISH OIL 1,000 MG (120 MG-180 MG) ORAL CAP",,89793,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"OMEGA 3-DHA-EPA-FISH OIL 1,000 MG (120 MG-180 MG) ORAL CAP",,89793,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
"OMEGA 3-DHA-EPA-FISH OIL 1,000 MG (120 MG-180 MG) ORAL CAP",,89793,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
"OMEGA 3-DHA-EPA-FISH OIL 1,000 MG (120 MG-180 MG) ORAL CAP",,89793,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"OMEGA 3-DHA-EPA-FISH OIL 1,000 MG (120 MG-180 MG) ORAL CAP",,89793,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
"OMEGA 3-DHA-EPA-FISH OIL 1,000 MG (120 MG-180 MG) ORAL CAP",,89793,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
"OMEGA 3-DHA-EPA-FISH OIL 1,000 MG (120 MG-180 MG) ORAL CAP",,89793,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
"OMEGA 3-DHA-EPA-FISH OIL 1,000 MG (120 MG-180 MG) ORAL CAP",,89793,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"OMEGA 3-DHA-EPA-FISH OIL 1,000 MG (120 MG-180 MG) ORAL CAP",,89793,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
"OMEGA 3-DHA-EPA-FISH OIL 1,000 MG (120 MG-180 MG) ORAL CAP",,89793,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
"OMEGA 3-DHA-EPA-FISH OIL 1,000 MG (120 MG-180 MG) ORAL CAP",,89793,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"OMEGA 3-DHA-EPA-FISH OIL 1,000 MG (120 MG-180 MG) ORAL CAP",,89793,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
"OMEGA 3-DHA-EPA-FISH OIL 1,000 MG (120 MG-180 MG) ORAL CAP",,89793,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"OMEGA 3-DHA-EPA-FISH OIL 1,000 MG (120 MG-180 MG) ORAL CAP",,89793,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"OMEGA 3-DHA-EPA-FISH OIL 1,000 MG (120 MG-180 MG) ORAL CAP",,89793,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"OMEGA 3-DHA-EPA-FISH OIL 1,000 MG (120 MG-180 MG) ORAL CAP",,89793,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"OMEGA 3-DHA-EPA-FISH OIL 1,000 MG (120 MG-180 MG) ORAL CAP",,89793,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
"OMEGA 3-DHA-EPA-FISH OIL 1,000 MG (120 MG-180 MG) ORAL CAP",,89793,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"OMEGA 3-DHA-EPA-FISH OIL 1,000 MG (120 MG-180 MG) ORAL CAP",,89793,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"OMEGA 3-DHA-EPA-FISH OIL 1,000 MG (120 MG-180 MG) ORAL CAP",,89793,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"OMEGA 3-DHA-EPA-FISH OIL 1,000 MG (120 MG-180 MG) ORAL CAP",,89793,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"OMEGA 3-DHA-EPA-FISH OIL 1,000 MG (120 MG-180 MG) ORAL CAP",,89793,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"OMEGA 3-DHA-EPA-FISH OIL 1,000 MG (120 MG-180 MG) ORAL CAP",,89793,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"OMEGA 3-DHA-EPA-FISH OIL 1,000 MG (120 MG-180 MG) ORAL CAP",,89793,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"OMEGA 3-DHA-EPA-FISH OIL 1,000 MG (120 MG-180 MG) ORAL CAP",,89793,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"OMEGA 3-DHA-EPA-FISH OIL 1,000 MG (120 MG-180 MG) ORAL CAP",,89793,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
"OMEGA 3-DHA-EPA-FISH OIL 1,000 MG (120 MG-180 MG) ORAL CAP",,89793,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
"OMEGA 3-DHA-EPA-FISH OIL 1,000 MG (120 MG-180 MG) ORAL CAP",,89793,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"OMEGA 3-DHA-EPA-FISH OIL 1,000 MG (120 MG-180 MG) ORAL CAP",,89793,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
"OMEGA 3-DHA-EPA-FISH OIL 1,000 MG (120 MG-180 MG) ORAL CAP",,89793,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"RABIES VACCINE, PCEC (PF) 2.5 UNIT IM SUSR",,90675,CPT,Facility,Both,1,Each,,1719,1461.15,492.6654,1719,Aetna,Commercial,1581.48,92,,percent of total billed charges,,
"RABIES VACCINE, PCEC (PF) 2.5 UNIT IM SUSR",,90675,CPT,Facility,Outpatient,1,Each,,1719,1461.15,492.6654,1719,Aetna,Medicare Advantage,842.31,49,,percent of total billed charges,,
"RABIES VACCINE, PCEC (PF) 2.5 UNIT IM SUSR",,90675,CPT,Facility,Inpatient,1,Each,,1719,1461.15,492.6654,1719,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"RABIES VACCINE, PCEC (PF) 2.5 UNIT IM SUSR",,90675,CPT,Facility,Both,1,Each,,1719,1461.15,492.6654,1719,Aetna,PPO,1598.67,93,,percent of total billed charges,,
"RABIES VACCINE, PCEC (PF) 2.5 UNIT IM SUSR",,90675,CPT,Facility,Both,1,Each,,1719,1461.15,492.6654,1719,America's PPO,America's PPO,1650.7557,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"RABIES VACCINE, PCEC (PF) 2.5 UNIT IM SUSR",,90675,CPT,Facility,Both,1,Each,,1719,1461.15,492.6654,1719,BlueCross BlueShield Minnesota, Federal Employee Program,1691.496,98.4,,percent of total billed charges,,
"RABIES VACCINE, PCEC (PF) 2.5 UNIT IM SUSR",,90675,CPT,Facility,Both,1,Each,,1719,1461.15,492.6654,1719,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1719,100,,percent of total billed charges,,
"RABIES VACCINE, PCEC (PF) 2.5 UNIT IM SUSR",,90675,CPT,Facility,Both,1,Each,,1719,1461.15,492.6654,1719,BlueCross BlueShield Minnesota,High Value Network Plan,1547.1,90,,percent of total billed charges,,
"RABIES VACCINE, PCEC (PF) 2.5 UNIT IM SUSR",,90675,CPT,Facility,Outpatient,1,Each,,1719,1461.15,492.6654,1719,BlueCross BlueShield Minnesota,Medicare Advantage,842.31,49,,percent of total billed charges,,
"RABIES VACCINE, PCEC (PF) 2.5 UNIT IM SUSR",,90675,CPT,Facility,Inpatient,1,Each,,1719,1461.15,492.6654,1719,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"RABIES VACCINE, PCEC (PF) 2.5 UNIT IM SUSR",,90675,CPT,Facility,Both,1,Each,,1719,1461.15,492.6654,1719,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1522.5183,88.57,,percent of total billed charges,,
"RABIES VACCINE, PCEC (PF) 2.5 UNIT IM SUSR",,90675,CPT,Facility,Both,1,Each,,1719,1461.15,492.6654,1719,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,492.6654,28.66,,percent of total billed charges,,
"RABIES VACCINE, PCEC (PF) 2.5 UNIT IM SUSR",,90675,CPT,Facility,Outpatient,1,Each,,1719,1461.15,492.6654,1719,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),842.31,49,,percent of total billed charges,,
"RABIES VACCINE, PCEC (PF) 2.5 UNIT IM SUSR",,90675,CPT,Facility,Inpatient,1,Each,,1719,1461.15,492.6654,1719,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"RABIES VACCINE, PCEC (PF) 2.5 UNIT IM SUSR",,90675,CPT,Facility,Both,1,Each,,1719,1461.15,492.6654,1719,CorVel,Worker's Compensation,1719,100,,percent of total billed charges,,
"RABIES VACCINE, PCEC (PF) 2.5 UNIT IM SUSR",,90675,CPT,Facility,Both,1,Each,,1719,1461.15,492.6654,1719,First Health Group Corporation,First Health Network,1667.43,97,,percent of total billed charges,,
"RABIES VACCINE, PCEC (PF) 2.5 UNIT IM SUSR",,90675,CPT,Facility,Both,1,Each,,1719,1461.15,492.6654,1719,"Health Partners, Inc.",Commercial,1626.174,94.6,,percent of total billed charges,,
"RABIES VACCINE, PCEC (PF) 2.5 UNIT IM SUSR",,90675,CPT,Facility,Outpatient,1,Each,,1719,1461.15,492.6654,1719,"Health Partners, Inc.",Medicare Advantage,842.31,49,,percent of total billed charges,,
"RABIES VACCINE, PCEC (PF) 2.5 UNIT IM SUSR",,90675,CPT,Facility,Inpatient,1,Each,,1719,1461.15,492.6654,1719,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"RABIES VACCINE, PCEC (PF) 2.5 UNIT IM SUSR",,90675,CPT,Facility,Both,1,Each,,1719,1461.15,492.6654,1719,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1031.4,60,,percent of total billed charges,,
"RABIES VACCINE, PCEC (PF) 2.5 UNIT IM SUSR",,90675,CPT,Facility,Both,1,Each,,1719,1461.15,492.6654,1719,"Health Partners, Inc.",State of Minnesota Advantage Program,1400.985,81.5,,percent of total billed charges,,
"RABIES VACCINE, PCEC (PF) 2.5 UNIT IM SUSR",,90675,CPT,Facility,Both,1,Each,,1719,1461.15,492.6654,1719,"Health Partners, Inc.",State Public Programs,859.5,50,,percent of total billed charges,,
"RABIES VACCINE, PCEC (PF) 2.5 UNIT IM SUSR",,90675,CPT,Facility,Both,1,Each,,1719,1461.15,492.6654,1719,Humana Insurance Company,Commercial PPO,1633.05,95,,percent of total billed charges,,
"RABIES VACCINE, PCEC (PF) 2.5 UNIT IM SUSR",,90675,CPT,Facility,Outpatient,1,Each,,1719,1461.15,492.6654,1719,Humana Insurance Company,Medicare PPO,842.31,49,,percent of total billed charges,,
"RABIES VACCINE, PCEC (PF) 2.5 UNIT IM SUSR",,90675,CPT,Facility,Inpatient,1,Each,,1719,1461.15,492.6654,1719,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"RABIES VACCINE, PCEC (PF) 2.5 UNIT IM SUSR",,90675,CPT,Facility,Both,1,Each,,1719,1461.15,492.6654,1719,Medica,Individual & Family,1703.529,99.1,,percent of total billed charges,,
"RABIES VACCINE, PCEC (PF) 2.5 UNIT IM SUSR",,90675,CPT,Facility,Outpatient,1,Each,,1719,1461.15,492.6654,1719,Medica,Medica Advantage Solution,856.062,49.8,,percent of total billed charges,,
"RABIES VACCINE, PCEC (PF) 2.5 UNIT IM SUSR",,90675,CPT,Facility,Inpatient,1,Each,,1719,1461.15,492.6654,1719,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"RABIES VACCINE, PCEC (PF) 2.5 UNIT IM SUSR",,90675,CPT,Facility,Outpatient,1,Each,,1719,1461.15,492.6654,1719,Medica,Medical Assistance,766.674,44.6,,percent of total billed charges,,
"RABIES VACCINE, PCEC (PF) 2.5 UNIT IM SUSR",,90675,CPT,Facility,Inpatient,1,Each,,1719,1461.15,492.6654,1719,Medica,Medical Assistance,,,,,Included in per diem rate,
"RABIES VACCINE, PCEC (PF) 2.5 UNIT IM SUSR",,90675,CPT,Facility,Outpatient,1,Each,,1719,1461.15,492.6654,1719,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,856.062,49.8,,percent of total billed charges,,
"RABIES VACCINE, PCEC (PF) 2.5 UNIT IM SUSR",,90675,CPT,Facility,Inpatient,1,Each,,1719,1461.15,492.6654,1719,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"RABIES VACCINE, PCEC (PF) 2.5 UNIT IM SUSR",,90675,CPT,Facility,Both,1,Each,,1719,1461.15,492.6654,1719,"Multiplan, Inc.","Multiplan, Inc.",1615.86,94,,percent of total billed charges,,
"RABIES VACCINE, PCEC (PF) 2.5 UNIT IM SUSR",,90675,CPT,Facility,Outpatient,1,Each,,1719,1461.15,492.6654,1719,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1548.819,90.1,,percent of total billed charges,,
"RABIES VACCINE, PCEC (PF) 2.5 UNIT IM SUSR",,90675,CPT,Facility,Inpatient,1,Each,,1719,1461.15,492.6654,1719,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"RABIES VACCINE, PCEC (PF) 2.5 UNIT IM SUSR",,90675,CPT,Facility,Both,1,Each,,1719,1461.15,492.6654,1719,"Preferred One Administrative Services, INC.",PPO,1694.934,98.6,,percent of total billed charges,,
"RABIES VACCINE, PCEC (PF) 2.5 UNIT IM SUSR",,90675,CPT,Facility,Outpatient,1,Each,,1719,1461.15,492.6654,1719,PrimeWest Health,Minnesota Senior Health Options (MSHO),884.4255,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"RABIES VACCINE, PCEC (PF) 2.5 UNIT IM SUSR",,90675,CPT,Facility,Inpatient,1,Each,,1719,1461.15,492.6654,1719,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"RABIES VACCINE, PCEC (PF) 2.5 UNIT IM SUSR",,90675,CPT,Facility,Outpatient,1,Each,,1719,1461.15,492.6654,1719,PrimeWest Health,MinnesotaCare,882.8784,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"RABIES VACCINE, PCEC (PF) 2.5 UNIT IM SUSR",,90675,CPT,Facility,Inpatient,1,Each,,1719,1461.15,492.6654,1719,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"RABIES VACCINE, PCEC (PF) 2.5 UNIT IM SUSR",,90675,CPT,Facility,Both,1,Each,,1719,1461.15,492.6654,1719,Sanford Health Plan,Sanford Health Plan,1581.48,92,,percent of total billed charges,,
"RABIES VACCINE, PCEC (PF) 2.5 UNIT IM SUSR",,90675,CPT,Facility,Outpatient,1,Each,,1719,1461.15,492.6654,1719,"UCare Health, Inc.",Individual & Family Plan,968.6565,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"RABIES VACCINE, PCEC (PF) 2.5 UNIT IM SUSR",,90675,CPT,Facility,Inpatient,1,Each,,1719,1461.15,492.6654,1719,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"RABIES VACCINE, PCEC (PF) 2.5 UNIT IM SUSR",,90675,CPT,Facility,Outpatient,1,Each,,1719,1461.15,492.6654,1719,"UCare Health, Inc.",Medical Assistance,867.5793,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"RABIES VACCINE, PCEC (PF) 2.5 UNIT IM SUSR",,90675,CPT,Facility,Inpatient,1,Each,,1719,1461.15,492.6654,1719,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"RABIES VACCINE, PCEC (PF) 2.5 UNIT IM SUSR",,90675,CPT,Facility,Outpatient,1,Each,,1719,1461.15,492.6654,1719,"UCare Health, Inc.",Medicare Advantage,867.5793,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"RABIES VACCINE, PCEC (PF) 2.5 UNIT IM SUSR",,90675,CPT,Facility,Inpatient,1,Each,,1719,1461.15,492.6654,1719,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"RABIES VACCINE, PCEC (PF) 2.5 UNIT IM SUSR",,90675,CPT,Facility,Outpatient,1,Each,,1719,1461.15,492.6654,1719,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),867.5793,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"RABIES VACCINE, PCEC (PF) 2.5 UNIT IM SUSR",,90675,CPT,Facility,Inpatient,1,Each,,1719,1461.15,492.6654,1719,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"RABIES VACCINE, PCEC (PF) 2.5 UNIT IM SUSR",,90675,CPT,Facility,Both,1,Each,,1719,1461.15,492.6654,1719,UnitedHealthcare,Individual & Family,1615.86,94,,percent of total billed charges,,
"RABIES VACCINE, PCEC (PF) 2.5 UNIT IM SUSR",,90675,CPT,Facility,Outpatient,1,Each,,1719,1461.15,492.6654,1719,UnitedHealthcare,Medicare Advantage,842.31,49,,percent of total billed charges,,
"RABIES VACCINE, PCEC (PF) 2.5 UNIT IM SUSR",,90675,CPT,Facility,Inpatient,1,Each,,1719,1461.15,492.6654,1719,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"RABIES VACCINE, PCEC (PF) 2.5 UNIT IM SUSR",,90675,CPT,Facility,Outpatient,1,Each,,1719,1461.15,492.6654,1719,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,825.12,48,,percent of total billed charges,,100% of DHS outpatient percentage
"RABIES VACCINE, PCEC (PF) 2.5 UNIT IM SUSR",,90675,CPT,Facility,Inpatient,1,Each,,1719,1461.15,492.6654,1719,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
WITCH HAZEL 50 % TOP PADM,,90681,LOCAL,Facility,Both,1,Each,,33,28.05,9.4578,33,Aetna,Commercial,30.36,92,,percent of total billed charges,,
WITCH HAZEL 50 % TOP PADM,,90681,LOCAL,Facility,Outpatient,1,Each,,33,28.05,9.4578,33,Aetna,Medicare Advantage,16.17,49,,percent of total billed charges,,
WITCH HAZEL 50 % TOP PADM,,90681,LOCAL,Facility,Inpatient,1,Each,,33,28.05,9.4578,33,Aetna,Medicare Advantage,,,,,Included in per diem rate,
WITCH HAZEL 50 % TOP PADM,,90681,LOCAL,Facility,Both,1,Each,,33,28.05,9.4578,33,Aetna,PPO,30.69,93,,percent of total billed charges,,
WITCH HAZEL 50 % TOP PADM,,90681,LOCAL,Facility,Both,1,Each,,33,28.05,9.4578,33,America's PPO,America's PPO,31.6899,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
WITCH HAZEL 50 % TOP PADM,,90681,LOCAL,Facility,Both,1,Each,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota, Federal Employee Program,32.472,98.4,,percent of total billed charges,,
WITCH HAZEL 50 % TOP PADM,,90681,LOCAL,Facility,Both,1,Each,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,33,100,,percent of total billed charges,,
WITCH HAZEL 50 % TOP PADM,,90681,LOCAL,Facility,Both,1,Each,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota,High Value Network Plan,29.7,90,,percent of total billed charges,,
WITCH HAZEL 50 % TOP PADM,,90681,LOCAL,Facility,Outpatient,1,Each,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota,Medicare Advantage,16.17,49,,percent of total billed charges,,
WITCH HAZEL 50 % TOP PADM,,90681,LOCAL,Facility,Inpatient,1,Each,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
WITCH HAZEL 50 % TOP PADM,,90681,LOCAL,Facility,Both,1,Each,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,29.2281,88.57,,percent of total billed charges,,
WITCH HAZEL 50 % TOP PADM,,90681,LOCAL,Facility,Both,1,Each,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,9.4578,28.66,,percent of total billed charges,,
WITCH HAZEL 50 % TOP PADM,,90681,LOCAL,Facility,Outpatient,1,Each,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),16.17,49,,percent of total billed charges,,
WITCH HAZEL 50 % TOP PADM,,90681,LOCAL,Facility,Inpatient,1,Each,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
WITCH HAZEL 50 % TOP PADM,,90681,LOCAL,Facility,Both,1,Each,,33,28.05,9.4578,33,CorVel,Worker's Compensation,33,100,,percent of total billed charges,,
WITCH HAZEL 50 % TOP PADM,,90681,LOCAL,Facility,Both,1,Each,,33,28.05,9.4578,33,First Health Group Corporation,First Health Network,32.01,97,,percent of total billed charges,,
WITCH HAZEL 50 % TOP PADM,,90681,LOCAL,Facility,Both,1,Each,,33,28.05,9.4578,33,"Health Partners, Inc.",Commercial,31.218,94.6,,percent of total billed charges,,
WITCH HAZEL 50 % TOP PADM,,90681,LOCAL,Facility,Outpatient,1,Each,,33,28.05,9.4578,33,"Health Partners, Inc.",Medicare Advantage,16.17,49,,percent of total billed charges,,
WITCH HAZEL 50 % TOP PADM,,90681,LOCAL,Facility,Inpatient,1,Each,,33,28.05,9.4578,33,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
WITCH HAZEL 50 % TOP PADM,,90681,LOCAL,Facility,Both,1,Each,,33,28.05,9.4578,33,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),19.8,60,,percent of total billed charges,,
WITCH HAZEL 50 % TOP PADM,,90681,LOCAL,Facility,Both,1,Each,,33,28.05,9.4578,33,"Health Partners, Inc.",State of Minnesota Advantage Program,26.895,81.5,,percent of total billed charges,,
WITCH HAZEL 50 % TOP PADM,,90681,LOCAL,Facility,Both,1,Each,,33,28.05,9.4578,33,"Health Partners, Inc.",State Public Programs,16.5,50,,percent of total billed charges,,
WITCH HAZEL 50 % TOP PADM,,90681,LOCAL,Facility,Both,1,Each,,33,28.05,9.4578,33,Humana Insurance Company,Commercial PPO,31.35,95,,percent of total billed charges,,
WITCH HAZEL 50 % TOP PADM,,90681,LOCAL,Facility,Outpatient,1,Each,,33,28.05,9.4578,33,Humana Insurance Company,Medicare PPO,16.17,49,,percent of total billed charges,,
WITCH HAZEL 50 % TOP PADM,,90681,LOCAL,Facility,Inpatient,1,Each,,33,28.05,9.4578,33,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
WITCH HAZEL 50 % TOP PADM,,90681,LOCAL,Facility,Both,1,Each,,33,28.05,9.4578,33,Medica,Individual & Family,32.703,99.1,,percent of total billed charges,,
WITCH HAZEL 50 % TOP PADM,,90681,LOCAL,Facility,Outpatient,1,Each,,33,28.05,9.4578,33,Medica,Medica Advantage Solution,16.434,49.8,,percent of total billed charges,,
WITCH HAZEL 50 % TOP PADM,,90681,LOCAL,Facility,Inpatient,1,Each,,33,28.05,9.4578,33,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
WITCH HAZEL 50 % TOP PADM,,90681,LOCAL,Facility,Outpatient,1,Each,,33,28.05,9.4578,33,Medica,Medical Assistance,14.718,44.6,,percent of total billed charges,,
WITCH HAZEL 50 % TOP PADM,,90681,LOCAL,Facility,Inpatient,1,Each,,33,28.05,9.4578,33,Medica,Medical Assistance,,,,,Included in per diem rate,
WITCH HAZEL 50 % TOP PADM,,90681,LOCAL,Facility,Outpatient,1,Each,,33,28.05,9.4578,33,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,16.434,49.8,,percent of total billed charges,,
WITCH HAZEL 50 % TOP PADM,,90681,LOCAL,Facility,Inpatient,1,Each,,33,28.05,9.4578,33,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
WITCH HAZEL 50 % TOP PADM,,90681,LOCAL,Facility,Both,1,Each,,33,28.05,9.4578,33,"Multiplan, Inc.","Multiplan, Inc.",31.02,94,,percent of total billed charges,,
WITCH HAZEL 50 % TOP PADM,,90681,LOCAL,Facility,Outpatient,1,Each,,33,28.05,9.4578,33,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,29.733,90.1,,percent of total billed charges,,
WITCH HAZEL 50 % TOP PADM,,90681,LOCAL,Facility,Inpatient,1,Each,,33,28.05,9.4578,33,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
WITCH HAZEL 50 % TOP PADM,,90681,LOCAL,Facility,Both,1,Each,,33,28.05,9.4578,33,"Preferred One Administrative Services, INC.",PPO,32.538,98.6,,percent of total billed charges,,
WITCH HAZEL 50 % TOP PADM,,90681,LOCAL,Facility,Outpatient,1,Each,,33,28.05,9.4578,33,PrimeWest Health,Minnesota Senior Health Options (MSHO),16.9785,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
WITCH HAZEL 50 % TOP PADM,,90681,LOCAL,Facility,Inpatient,1,Each,,33,28.05,9.4578,33,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
WITCH HAZEL 50 % TOP PADM,,90681,LOCAL,Facility,Outpatient,1,Each,,33,28.05,9.4578,33,PrimeWest Health,MinnesotaCare,16.9488,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
WITCH HAZEL 50 % TOP PADM,,90681,LOCAL,Facility,Inpatient,1,Each,,33,28.05,9.4578,33,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
WITCH HAZEL 50 % TOP PADM,,90681,LOCAL,Facility,Both,1,Each,,33,28.05,9.4578,33,Sanford Health Plan,Sanford Health Plan,30.36,92,,percent of total billed charges,,
WITCH HAZEL 50 % TOP PADM,,90681,LOCAL,Facility,Outpatient,1,Each,,33,28.05,9.4578,33,"UCare Health, Inc.",Individual & Family Plan,18.5955,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
WITCH HAZEL 50 % TOP PADM,,90681,LOCAL,Facility,Inpatient,1,Each,,33,28.05,9.4578,33,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
WITCH HAZEL 50 % TOP PADM,,90681,LOCAL,Facility,Outpatient,1,Each,,33,28.05,9.4578,33,"UCare Health, Inc.",Medical Assistance,16.6551,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
WITCH HAZEL 50 % TOP PADM,,90681,LOCAL,Facility,Inpatient,1,Each,,33,28.05,9.4578,33,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
WITCH HAZEL 50 % TOP PADM,,90681,LOCAL,Facility,Outpatient,1,Each,,33,28.05,9.4578,33,"UCare Health, Inc.",Medicare Advantage,16.6551,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
WITCH HAZEL 50 % TOP PADM,,90681,LOCAL,Facility,Inpatient,1,Each,,33,28.05,9.4578,33,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
WITCH HAZEL 50 % TOP PADM,,90681,LOCAL,Facility,Outpatient,1,Each,,33,28.05,9.4578,33,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),16.6551,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
WITCH HAZEL 50 % TOP PADM,,90681,LOCAL,Facility,Inpatient,1,Each,,33,28.05,9.4578,33,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
WITCH HAZEL 50 % TOP PADM,,90681,LOCAL,Facility,Both,1,Each,,33,28.05,9.4578,33,UnitedHealthcare,Individual & Family,31.02,94,,percent of total billed charges,,
WITCH HAZEL 50 % TOP PADM,,90681,LOCAL,Facility,Outpatient,1,Each,,33,28.05,9.4578,33,UnitedHealthcare,Medicare Advantage,16.17,49,,percent of total billed charges,,
WITCH HAZEL 50 % TOP PADM,,90681,LOCAL,Facility,Inpatient,1,Each,,33,28.05,9.4578,33,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
WITCH HAZEL 50 % TOP PADM,,90681,LOCAL,Facility,Outpatient,1,Each,,33,28.05,9.4578,33,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,15.84,48,,percent of total billed charges,,100% of DHS outpatient percentage
WITCH HAZEL 50 % TOP PADM,,90681,LOCAL,Facility,Inpatient,1,Each,,33,28.05,9.4578,33,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"MEASLES,MUMPS,RUBELLA VACC(PF) 1,000-12,500 TCID50/0.5 ML SUBQ SOLR",,90707,CPT,Facility,Both,1,Each,,411,349.35,117.7926,411,Aetna,Commercial,378.12,92,,percent of total billed charges,,
"MEASLES,MUMPS,RUBELLA VACC(PF) 1,000-12,500 TCID50/0.5 ML SUBQ SOLR",,90707,CPT,Facility,Outpatient,1,Each,,411,349.35,117.7926,411,Aetna,Medicare Advantage,201.39,49,,percent of total billed charges,,
"MEASLES,MUMPS,RUBELLA VACC(PF) 1,000-12,500 TCID50/0.5 ML SUBQ SOLR",,90707,CPT,Facility,Inpatient,1,Each,,411,349.35,117.7926,411,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"MEASLES,MUMPS,RUBELLA VACC(PF) 1,000-12,500 TCID50/0.5 ML SUBQ SOLR",,90707,CPT,Facility,Both,1,Each,,411,349.35,117.7926,411,Aetna,PPO,382.23,93,,percent of total billed charges,,
"MEASLES,MUMPS,RUBELLA VACC(PF) 1,000-12,500 TCID50/0.5 ML SUBQ SOLR",,90707,CPT,Facility,Both,1,Each,,411,349.35,117.7926,411,America's PPO,America's PPO,394.6833,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"MEASLES,MUMPS,RUBELLA VACC(PF) 1,000-12,500 TCID50/0.5 ML SUBQ SOLR",,90707,CPT,Facility,Both,1,Each,,411,349.35,117.7926,411,BlueCross BlueShield Minnesota, Federal Employee Program,404.424,98.4,,percent of total billed charges,,
"MEASLES,MUMPS,RUBELLA VACC(PF) 1,000-12,500 TCID50/0.5 ML SUBQ SOLR",,90707,CPT,Facility,Both,1,Each,,411,349.35,117.7926,411,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,411,100,,percent of total billed charges,,
"MEASLES,MUMPS,RUBELLA VACC(PF) 1,000-12,500 TCID50/0.5 ML SUBQ SOLR",,90707,CPT,Facility,Both,1,Each,,411,349.35,117.7926,411,BlueCross BlueShield Minnesota,High Value Network Plan,369.9,90,,percent of total billed charges,,
"MEASLES,MUMPS,RUBELLA VACC(PF) 1,000-12,500 TCID50/0.5 ML SUBQ SOLR",,90707,CPT,Facility,Outpatient,1,Each,,411,349.35,117.7926,411,BlueCross BlueShield Minnesota,Medicare Advantage,201.39,49,,percent of total billed charges,,
"MEASLES,MUMPS,RUBELLA VACC(PF) 1,000-12,500 TCID50/0.5 ML SUBQ SOLR",,90707,CPT,Facility,Inpatient,1,Each,,411,349.35,117.7926,411,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"MEASLES,MUMPS,RUBELLA VACC(PF) 1,000-12,500 TCID50/0.5 ML SUBQ SOLR",,90707,CPT,Facility,Both,1,Each,,411,349.35,117.7926,411,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,364.0227,88.57,,percent of total billed charges,,
"MEASLES,MUMPS,RUBELLA VACC(PF) 1,000-12,500 TCID50/0.5 ML SUBQ SOLR",,90707,CPT,Facility,Both,1,Each,,411,349.35,117.7926,411,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,117.7926,28.66,,percent of total billed charges,,
"MEASLES,MUMPS,RUBELLA VACC(PF) 1,000-12,500 TCID50/0.5 ML SUBQ SOLR",,90707,CPT,Facility,Outpatient,1,Each,,411,349.35,117.7926,411,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),201.39,49,,percent of total billed charges,,
"MEASLES,MUMPS,RUBELLA VACC(PF) 1,000-12,500 TCID50/0.5 ML SUBQ SOLR",,90707,CPT,Facility,Inpatient,1,Each,,411,349.35,117.7926,411,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"MEASLES,MUMPS,RUBELLA VACC(PF) 1,000-12,500 TCID50/0.5 ML SUBQ SOLR",,90707,CPT,Facility,Both,1,Each,,411,349.35,117.7926,411,CorVel,Worker's Compensation,411,100,,percent of total billed charges,,
"MEASLES,MUMPS,RUBELLA VACC(PF) 1,000-12,500 TCID50/0.5 ML SUBQ SOLR",,90707,CPT,Facility,Both,1,Each,,411,349.35,117.7926,411,First Health Group Corporation,First Health Network,398.67,97,,percent of total billed charges,,
"MEASLES,MUMPS,RUBELLA VACC(PF) 1,000-12,500 TCID50/0.5 ML SUBQ SOLR",,90707,CPT,Facility,Both,1,Each,,411,349.35,117.7926,411,"Health Partners, Inc.",Commercial,388.806,94.6,,percent of total billed charges,,
"MEASLES,MUMPS,RUBELLA VACC(PF) 1,000-12,500 TCID50/0.5 ML SUBQ SOLR",,90707,CPT,Facility,Outpatient,1,Each,,411,349.35,117.7926,411,"Health Partners, Inc.",Medicare Advantage,201.39,49,,percent of total billed charges,,
"MEASLES,MUMPS,RUBELLA VACC(PF) 1,000-12,500 TCID50/0.5 ML SUBQ SOLR",,90707,CPT,Facility,Inpatient,1,Each,,411,349.35,117.7926,411,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"MEASLES,MUMPS,RUBELLA VACC(PF) 1,000-12,500 TCID50/0.5 ML SUBQ SOLR",,90707,CPT,Facility,Both,1,Each,,411,349.35,117.7926,411,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),246.6,60,,percent of total billed charges,,
"MEASLES,MUMPS,RUBELLA VACC(PF) 1,000-12,500 TCID50/0.5 ML SUBQ SOLR",,90707,CPT,Facility,Both,1,Each,,411,349.35,117.7926,411,"Health Partners, Inc.",State of Minnesota Advantage Program,334.965,81.5,,percent of total billed charges,,
"MEASLES,MUMPS,RUBELLA VACC(PF) 1,000-12,500 TCID50/0.5 ML SUBQ SOLR",,90707,CPT,Facility,Both,1,Each,,411,349.35,117.7926,411,"Health Partners, Inc.",State Public Programs,205.5,50,,percent of total billed charges,,
"MEASLES,MUMPS,RUBELLA VACC(PF) 1,000-12,500 TCID50/0.5 ML SUBQ SOLR",,90707,CPT,Facility,Both,1,Each,,411,349.35,117.7926,411,Humana Insurance Company,Commercial PPO,390.45,95,,percent of total billed charges,,
"MEASLES,MUMPS,RUBELLA VACC(PF) 1,000-12,500 TCID50/0.5 ML SUBQ SOLR",,90707,CPT,Facility,Outpatient,1,Each,,411,349.35,117.7926,411,Humana Insurance Company,Medicare PPO,201.39,49,,percent of total billed charges,,
"MEASLES,MUMPS,RUBELLA VACC(PF) 1,000-12,500 TCID50/0.5 ML SUBQ SOLR",,90707,CPT,Facility,Inpatient,1,Each,,411,349.35,117.7926,411,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"MEASLES,MUMPS,RUBELLA VACC(PF) 1,000-12,500 TCID50/0.5 ML SUBQ SOLR",,90707,CPT,Facility,Both,1,Each,,411,349.35,117.7926,411,Medica,Individual & Family,407.301,99.1,,percent of total billed charges,,
"MEASLES,MUMPS,RUBELLA VACC(PF) 1,000-12,500 TCID50/0.5 ML SUBQ SOLR",,90707,CPT,Facility,Outpatient,1,Each,,411,349.35,117.7926,411,Medica,Medica Advantage Solution,204.678,49.8,,percent of total billed charges,,
"MEASLES,MUMPS,RUBELLA VACC(PF) 1,000-12,500 TCID50/0.5 ML SUBQ SOLR",,90707,CPT,Facility,Inpatient,1,Each,,411,349.35,117.7926,411,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"MEASLES,MUMPS,RUBELLA VACC(PF) 1,000-12,500 TCID50/0.5 ML SUBQ SOLR",,90707,CPT,Facility,Outpatient,1,Each,,411,349.35,117.7926,411,Medica,Medical Assistance,183.306,44.6,,percent of total billed charges,,
"MEASLES,MUMPS,RUBELLA VACC(PF) 1,000-12,500 TCID50/0.5 ML SUBQ SOLR",,90707,CPT,Facility,Inpatient,1,Each,,411,349.35,117.7926,411,Medica,Medical Assistance,,,,,Included in per diem rate,
"MEASLES,MUMPS,RUBELLA VACC(PF) 1,000-12,500 TCID50/0.5 ML SUBQ SOLR",,90707,CPT,Facility,Outpatient,1,Each,,411,349.35,117.7926,411,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,204.678,49.8,,percent of total billed charges,,
"MEASLES,MUMPS,RUBELLA VACC(PF) 1,000-12,500 TCID50/0.5 ML SUBQ SOLR",,90707,CPT,Facility,Inpatient,1,Each,,411,349.35,117.7926,411,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"MEASLES,MUMPS,RUBELLA VACC(PF) 1,000-12,500 TCID50/0.5 ML SUBQ SOLR",,90707,CPT,Facility,Both,1,Each,,411,349.35,117.7926,411,"Multiplan, Inc.","Multiplan, Inc.",386.34,94,,percent of total billed charges,,
"MEASLES,MUMPS,RUBELLA VACC(PF) 1,000-12,500 TCID50/0.5 ML SUBQ SOLR",,90707,CPT,Facility,Outpatient,1,Each,,411,349.35,117.7926,411,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,370.311,90.1,,percent of total billed charges,,
"MEASLES,MUMPS,RUBELLA VACC(PF) 1,000-12,500 TCID50/0.5 ML SUBQ SOLR",,90707,CPT,Facility,Inpatient,1,Each,,411,349.35,117.7926,411,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"MEASLES,MUMPS,RUBELLA VACC(PF) 1,000-12,500 TCID50/0.5 ML SUBQ SOLR",,90707,CPT,Facility,Both,1,Each,,411,349.35,117.7926,411,"Preferred One Administrative Services, INC.",PPO,405.246,98.6,,percent of total billed charges,,
"MEASLES,MUMPS,RUBELLA VACC(PF) 1,000-12,500 TCID50/0.5 ML SUBQ SOLR",,90707,CPT,Facility,Outpatient,1,Each,,411,349.35,117.7926,411,PrimeWest Health,Minnesota Senior Health Options (MSHO),211.4595,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"MEASLES,MUMPS,RUBELLA VACC(PF) 1,000-12,500 TCID50/0.5 ML SUBQ SOLR",,90707,CPT,Facility,Inpatient,1,Each,,411,349.35,117.7926,411,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"MEASLES,MUMPS,RUBELLA VACC(PF) 1,000-12,500 TCID50/0.5 ML SUBQ SOLR",,90707,CPT,Facility,Outpatient,1,Each,,411,349.35,117.7926,411,PrimeWest Health,MinnesotaCare,211.0896,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"MEASLES,MUMPS,RUBELLA VACC(PF) 1,000-12,500 TCID50/0.5 ML SUBQ SOLR",,90707,CPT,Facility,Inpatient,1,Each,,411,349.35,117.7926,411,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"MEASLES,MUMPS,RUBELLA VACC(PF) 1,000-12,500 TCID50/0.5 ML SUBQ SOLR",,90707,CPT,Facility,Both,1,Each,,411,349.35,117.7926,411,Sanford Health Plan,Sanford Health Plan,378.12,92,,percent of total billed charges,,
"MEASLES,MUMPS,RUBELLA VACC(PF) 1,000-12,500 TCID50/0.5 ML SUBQ SOLR",,90707,CPT,Facility,Outpatient,1,Each,,411,349.35,117.7926,411,"UCare Health, Inc.",Individual & Family Plan,231.5985,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"MEASLES,MUMPS,RUBELLA VACC(PF) 1,000-12,500 TCID50/0.5 ML SUBQ SOLR",,90707,CPT,Facility,Inpatient,1,Each,,411,349.35,117.7926,411,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"MEASLES,MUMPS,RUBELLA VACC(PF) 1,000-12,500 TCID50/0.5 ML SUBQ SOLR",,90707,CPT,Facility,Outpatient,1,Each,,411,349.35,117.7926,411,"UCare Health, Inc.",Medical Assistance,207.4317,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"MEASLES,MUMPS,RUBELLA VACC(PF) 1,000-12,500 TCID50/0.5 ML SUBQ SOLR",,90707,CPT,Facility,Inpatient,1,Each,,411,349.35,117.7926,411,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"MEASLES,MUMPS,RUBELLA VACC(PF) 1,000-12,500 TCID50/0.5 ML SUBQ SOLR",,90707,CPT,Facility,Outpatient,1,Each,,411,349.35,117.7926,411,"UCare Health, Inc.",Medicare Advantage,207.4317,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"MEASLES,MUMPS,RUBELLA VACC(PF) 1,000-12,500 TCID50/0.5 ML SUBQ SOLR",,90707,CPT,Facility,Inpatient,1,Each,,411,349.35,117.7926,411,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"MEASLES,MUMPS,RUBELLA VACC(PF) 1,000-12,500 TCID50/0.5 ML SUBQ SOLR",,90707,CPT,Facility,Outpatient,1,Each,,411,349.35,117.7926,411,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),207.4317,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"MEASLES,MUMPS,RUBELLA VACC(PF) 1,000-12,500 TCID50/0.5 ML SUBQ SOLR",,90707,CPT,Facility,Inpatient,1,Each,,411,349.35,117.7926,411,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"MEASLES,MUMPS,RUBELLA VACC(PF) 1,000-12,500 TCID50/0.5 ML SUBQ SOLR",,90707,CPT,Facility,Both,1,Each,,411,349.35,117.7926,411,UnitedHealthcare,Individual & Family,386.34,94,,percent of total billed charges,,
"MEASLES,MUMPS,RUBELLA VACC(PF) 1,000-12,500 TCID50/0.5 ML SUBQ SOLR",,90707,CPT,Facility,Outpatient,1,Each,,411,349.35,117.7926,411,UnitedHealthcare,Medicare Advantage,201.39,49,,percent of total billed charges,,
"MEASLES,MUMPS,RUBELLA VACC(PF) 1,000-12,500 TCID50/0.5 ML SUBQ SOLR",,90707,CPT,Facility,Inpatient,1,Each,,411,349.35,117.7926,411,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"MEASLES,MUMPS,RUBELLA VACC(PF) 1,000-12,500 TCID50/0.5 ML SUBQ SOLR",,90707,CPT,Facility,Outpatient,1,Each,,411,349.35,117.7926,411,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,197.28,48,,percent of total billed charges,,100% of DHS outpatient percentage
"MEASLES,MUMPS,RUBELLA VACC(PF) 1,000-12,500 TCID50/0.5 ML SUBQ SOLR",,90707,CPT,Facility,Inpatient,1,Each,,411,349.35,117.7926,411,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
RIFAXIMIN 550 MG ORAL TABLET,,91389,LOCAL,Facility,Both,1,Each,,266,226.1,76.2356,266,Aetna,Commercial,244.72,92,,percent of total billed charges,,
RIFAXIMIN 550 MG ORAL TABLET,,91389,LOCAL,Facility,Outpatient,1,Each,,266,226.1,76.2356,266,Aetna,Medicare Advantage,130.34,49,,percent of total billed charges,,
RIFAXIMIN 550 MG ORAL TABLET,,91389,LOCAL,Facility,Inpatient,1,Each,,266,226.1,76.2356,266,Aetna,Medicare Advantage,,,,,Included in per diem rate,
RIFAXIMIN 550 MG ORAL TABLET,,91389,LOCAL,Facility,Both,1,Each,,266,226.1,76.2356,266,Aetna,PPO,247.38,93,,percent of total billed charges,,
RIFAXIMIN 550 MG ORAL TABLET,,91389,LOCAL,Facility,Both,1,Each,,266,226.1,76.2356,266,America's PPO,America's PPO,255.4398,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
RIFAXIMIN 550 MG ORAL TABLET,,91389,LOCAL,Facility,Both,1,Each,,266,226.1,76.2356,266,BlueCross BlueShield Minnesota, Federal Employee Program,261.744,98.4,,percent of total billed charges,,
RIFAXIMIN 550 MG ORAL TABLET,,91389,LOCAL,Facility,Both,1,Each,,266,226.1,76.2356,266,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,266,100,,percent of total billed charges,,
RIFAXIMIN 550 MG ORAL TABLET,,91389,LOCAL,Facility,Both,1,Each,,266,226.1,76.2356,266,BlueCross BlueShield Minnesota,High Value Network Plan,239.4,90,,percent of total billed charges,,
RIFAXIMIN 550 MG ORAL TABLET,,91389,LOCAL,Facility,Outpatient,1,Each,,266,226.1,76.2356,266,BlueCross BlueShield Minnesota,Medicare Advantage,130.34,49,,percent of total billed charges,,
RIFAXIMIN 550 MG ORAL TABLET,,91389,LOCAL,Facility,Inpatient,1,Each,,266,226.1,76.2356,266,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
RIFAXIMIN 550 MG ORAL TABLET,,91389,LOCAL,Facility,Both,1,Each,,266,226.1,76.2356,266,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,235.5962,88.57,,percent of total billed charges,,
RIFAXIMIN 550 MG ORAL TABLET,,91389,LOCAL,Facility,Both,1,Each,,266,226.1,76.2356,266,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,76.2356,28.66,,percent of total billed charges,,
RIFAXIMIN 550 MG ORAL TABLET,,91389,LOCAL,Facility,Outpatient,1,Each,,266,226.1,76.2356,266,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),130.34,49,,percent of total billed charges,,
RIFAXIMIN 550 MG ORAL TABLET,,91389,LOCAL,Facility,Inpatient,1,Each,,266,226.1,76.2356,266,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
RIFAXIMIN 550 MG ORAL TABLET,,91389,LOCAL,Facility,Both,1,Each,,266,226.1,76.2356,266,CorVel,Worker's Compensation,266,100,,percent of total billed charges,,
RIFAXIMIN 550 MG ORAL TABLET,,91389,LOCAL,Facility,Both,1,Each,,266,226.1,76.2356,266,First Health Group Corporation,First Health Network,258.02,97,,percent of total billed charges,,
RIFAXIMIN 550 MG ORAL TABLET,,91389,LOCAL,Facility,Both,1,Each,,266,226.1,76.2356,266,"Health Partners, Inc.",Commercial,251.636,94.6,,percent of total billed charges,,
RIFAXIMIN 550 MG ORAL TABLET,,91389,LOCAL,Facility,Outpatient,1,Each,,266,226.1,76.2356,266,"Health Partners, Inc.",Medicare Advantage,130.34,49,,percent of total billed charges,,
RIFAXIMIN 550 MG ORAL TABLET,,91389,LOCAL,Facility,Inpatient,1,Each,,266,226.1,76.2356,266,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
RIFAXIMIN 550 MG ORAL TABLET,,91389,LOCAL,Facility,Both,1,Each,,266,226.1,76.2356,266,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),159.6,60,,percent of total billed charges,,
RIFAXIMIN 550 MG ORAL TABLET,,91389,LOCAL,Facility,Both,1,Each,,266,226.1,76.2356,266,"Health Partners, Inc.",State of Minnesota Advantage Program,216.79,81.5,,percent of total billed charges,,
RIFAXIMIN 550 MG ORAL TABLET,,91389,LOCAL,Facility,Both,1,Each,,266,226.1,76.2356,266,"Health Partners, Inc.",State Public Programs,133,50,,percent of total billed charges,,
RIFAXIMIN 550 MG ORAL TABLET,,91389,LOCAL,Facility,Both,1,Each,,266,226.1,76.2356,266,Humana Insurance Company,Commercial PPO,252.7,95,,percent of total billed charges,,
RIFAXIMIN 550 MG ORAL TABLET,,91389,LOCAL,Facility,Outpatient,1,Each,,266,226.1,76.2356,266,Humana Insurance Company,Medicare PPO,130.34,49,,percent of total billed charges,,
RIFAXIMIN 550 MG ORAL TABLET,,91389,LOCAL,Facility,Inpatient,1,Each,,266,226.1,76.2356,266,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
RIFAXIMIN 550 MG ORAL TABLET,,91389,LOCAL,Facility,Both,1,Each,,266,226.1,76.2356,266,Medica,Individual & Family,263.606,99.1,,percent of total billed charges,,
RIFAXIMIN 550 MG ORAL TABLET,,91389,LOCAL,Facility,Outpatient,1,Each,,266,226.1,76.2356,266,Medica,Medica Advantage Solution,132.468,49.8,,percent of total billed charges,,
RIFAXIMIN 550 MG ORAL TABLET,,91389,LOCAL,Facility,Inpatient,1,Each,,266,226.1,76.2356,266,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
RIFAXIMIN 550 MG ORAL TABLET,,91389,LOCAL,Facility,Outpatient,1,Each,,266,226.1,76.2356,266,Medica,Medical Assistance,118.636,44.6,,percent of total billed charges,,
RIFAXIMIN 550 MG ORAL TABLET,,91389,LOCAL,Facility,Inpatient,1,Each,,266,226.1,76.2356,266,Medica,Medical Assistance,,,,,Included in per diem rate,
RIFAXIMIN 550 MG ORAL TABLET,,91389,LOCAL,Facility,Outpatient,1,Each,,266,226.1,76.2356,266,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,132.468,49.8,,percent of total billed charges,,
RIFAXIMIN 550 MG ORAL TABLET,,91389,LOCAL,Facility,Inpatient,1,Each,,266,226.1,76.2356,266,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
RIFAXIMIN 550 MG ORAL TABLET,,91389,LOCAL,Facility,Both,1,Each,,266,226.1,76.2356,266,"Multiplan, Inc.","Multiplan, Inc.",250.04,94,,percent of total billed charges,,
RIFAXIMIN 550 MG ORAL TABLET,,91389,LOCAL,Facility,Outpatient,1,Each,,266,226.1,76.2356,266,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,239.666,90.1,,percent of total billed charges,,
RIFAXIMIN 550 MG ORAL TABLET,,91389,LOCAL,Facility,Inpatient,1,Each,,266,226.1,76.2356,266,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
RIFAXIMIN 550 MG ORAL TABLET,,91389,LOCAL,Facility,Both,1,Each,,266,226.1,76.2356,266,"Preferred One Administrative Services, INC.",PPO,262.276,98.6,,percent of total billed charges,,
RIFAXIMIN 550 MG ORAL TABLET,,91389,LOCAL,Facility,Outpatient,1,Each,,266,226.1,76.2356,266,PrimeWest Health,Minnesota Senior Health Options (MSHO),136.857,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
RIFAXIMIN 550 MG ORAL TABLET,,91389,LOCAL,Facility,Inpatient,1,Each,,266,226.1,76.2356,266,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
RIFAXIMIN 550 MG ORAL TABLET,,91389,LOCAL,Facility,Outpatient,1,Each,,266,226.1,76.2356,266,PrimeWest Health,MinnesotaCare,136.6176,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
RIFAXIMIN 550 MG ORAL TABLET,,91389,LOCAL,Facility,Inpatient,1,Each,,266,226.1,76.2356,266,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
RIFAXIMIN 550 MG ORAL TABLET,,91389,LOCAL,Facility,Both,1,Each,,266,226.1,76.2356,266,Sanford Health Plan,Sanford Health Plan,244.72,92,,percent of total billed charges,,
RIFAXIMIN 550 MG ORAL TABLET,,91389,LOCAL,Facility,Outpatient,1,Each,,266,226.1,76.2356,266,"UCare Health, Inc.",Individual & Family Plan,149.891,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
RIFAXIMIN 550 MG ORAL TABLET,,91389,LOCAL,Facility,Inpatient,1,Each,,266,226.1,76.2356,266,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
RIFAXIMIN 550 MG ORAL TABLET,,91389,LOCAL,Facility,Outpatient,1,Each,,266,226.1,76.2356,266,"UCare Health, Inc.",Medical Assistance,134.2502,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
RIFAXIMIN 550 MG ORAL TABLET,,91389,LOCAL,Facility,Inpatient,1,Each,,266,226.1,76.2356,266,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
RIFAXIMIN 550 MG ORAL TABLET,,91389,LOCAL,Facility,Outpatient,1,Each,,266,226.1,76.2356,266,"UCare Health, Inc.",Medicare Advantage,134.2502,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
RIFAXIMIN 550 MG ORAL TABLET,,91389,LOCAL,Facility,Inpatient,1,Each,,266,226.1,76.2356,266,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
RIFAXIMIN 550 MG ORAL TABLET,,91389,LOCAL,Facility,Outpatient,1,Each,,266,226.1,76.2356,266,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),134.2502,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
RIFAXIMIN 550 MG ORAL TABLET,,91389,LOCAL,Facility,Inpatient,1,Each,,266,226.1,76.2356,266,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
RIFAXIMIN 550 MG ORAL TABLET,,91389,LOCAL,Facility,Both,1,Each,,266,226.1,76.2356,266,UnitedHealthcare,Individual & Family,250.04,94,,percent of total billed charges,,
RIFAXIMIN 550 MG ORAL TABLET,,91389,LOCAL,Facility,Outpatient,1,Each,,266,226.1,76.2356,266,UnitedHealthcare,Medicare Advantage,130.34,49,,percent of total billed charges,,
RIFAXIMIN 550 MG ORAL TABLET,,91389,LOCAL,Facility,Inpatient,1,Each,,266,226.1,76.2356,266,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
RIFAXIMIN 550 MG ORAL TABLET,,91389,LOCAL,Facility,Outpatient,1,Each,,266,226.1,76.2356,266,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,127.68,48,,percent of total billed charges,,100% of DHS outpatient percentage
RIFAXIMIN 550 MG ORAL TABLET,,91389,LOCAL,Facility,Inpatient,1,Each,,266,226.1,76.2356,266,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
THIAMINE MONONITRATE (VIT B1) 100 MG ORAL TABLET,,92790,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
THIAMINE MONONITRATE (VIT B1) 100 MG ORAL TABLET,,92790,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
THIAMINE MONONITRATE (VIT B1) 100 MG ORAL TABLET,,92790,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
THIAMINE MONONITRATE (VIT B1) 100 MG ORAL TABLET,,92790,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
THIAMINE MONONITRATE (VIT B1) 100 MG ORAL TABLET,,92790,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
THIAMINE MONONITRATE (VIT B1) 100 MG ORAL TABLET,,92790,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
THIAMINE MONONITRATE (VIT B1) 100 MG ORAL TABLET,,92790,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
THIAMINE MONONITRATE (VIT B1) 100 MG ORAL TABLET,,92790,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
THIAMINE MONONITRATE (VIT B1) 100 MG ORAL TABLET,,92790,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
THIAMINE MONONITRATE (VIT B1) 100 MG ORAL TABLET,,92790,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
THIAMINE MONONITRATE (VIT B1) 100 MG ORAL TABLET,,92790,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
THIAMINE MONONITRATE (VIT B1) 100 MG ORAL TABLET,,92790,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
THIAMINE MONONITRATE (VIT B1) 100 MG ORAL TABLET,,92790,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
THIAMINE MONONITRATE (VIT B1) 100 MG ORAL TABLET,,92790,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
THIAMINE MONONITRATE (VIT B1) 100 MG ORAL TABLET,,92790,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
THIAMINE MONONITRATE (VIT B1) 100 MG ORAL TABLET,,92790,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
THIAMINE MONONITRATE (VIT B1) 100 MG ORAL TABLET,,92790,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
THIAMINE MONONITRATE (VIT B1) 100 MG ORAL TABLET,,92790,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
THIAMINE MONONITRATE (VIT B1) 100 MG ORAL TABLET,,92790,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
THIAMINE MONONITRATE (VIT B1) 100 MG ORAL TABLET,,92790,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
THIAMINE MONONITRATE (VIT B1) 100 MG ORAL TABLET,,92790,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
THIAMINE MONONITRATE (VIT B1) 100 MG ORAL TABLET,,92790,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
THIAMINE MONONITRATE (VIT B1) 100 MG ORAL TABLET,,92790,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
THIAMINE MONONITRATE (VIT B1) 100 MG ORAL TABLET,,92790,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
THIAMINE MONONITRATE (VIT B1) 100 MG ORAL TABLET,,92790,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
THIAMINE MONONITRATE (VIT B1) 100 MG ORAL TABLET,,92790,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
THIAMINE MONONITRATE (VIT B1) 100 MG ORAL TABLET,,92790,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
THIAMINE MONONITRATE (VIT B1) 100 MG ORAL TABLET,,92790,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
THIAMINE MONONITRATE (VIT B1) 100 MG ORAL TABLET,,92790,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
THIAMINE MONONITRATE (VIT B1) 100 MG ORAL TABLET,,92790,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
THIAMINE MONONITRATE (VIT B1) 100 MG ORAL TABLET,,92790,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
THIAMINE MONONITRATE (VIT B1) 100 MG ORAL TABLET,,92790,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
THIAMINE MONONITRATE (VIT B1) 100 MG ORAL TABLET,,92790,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
THIAMINE MONONITRATE (VIT B1) 100 MG ORAL TABLET,,92790,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
THIAMINE MONONITRATE (VIT B1) 100 MG ORAL TABLET,,92790,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
THIAMINE MONONITRATE (VIT B1) 100 MG ORAL TABLET,,92790,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
THIAMINE MONONITRATE (VIT B1) 100 MG ORAL TABLET,,92790,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
THIAMINE MONONITRATE (VIT B1) 100 MG ORAL TABLET,,92790,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
THIAMINE MONONITRATE (VIT B1) 100 MG ORAL TABLET,,92790,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
THIAMINE MONONITRATE (VIT B1) 100 MG ORAL TABLET,,92790,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
THIAMINE MONONITRATE (VIT B1) 100 MG ORAL TABLET,,92790,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
THIAMINE MONONITRATE (VIT B1) 100 MG ORAL TABLET,,92790,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
THIAMINE MONONITRATE (VIT B1) 100 MG ORAL TABLET,,92790,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
THIAMINE MONONITRATE (VIT B1) 100 MG ORAL TABLET,,92790,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
THIAMINE MONONITRATE (VIT B1) 100 MG ORAL TABLET,,92790,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
THIAMINE MONONITRATE (VIT B1) 100 MG ORAL TABLET,,92790,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
THIAMINE MONONITRATE (VIT B1) 100 MG ORAL TABLET,,92790,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
THIAMINE MONONITRATE (VIT B1) 100 MG ORAL TABLET,,92790,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
THIAMINE MONONITRATE (VIT B1) 100 MG ORAL TABLET,,92790,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
THIAMINE MONONITRATE (VIT B1) 100 MG ORAL TABLET,,92790,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
THIAMINE MONONITRATE (VIT B1) 100 MG ORAL TABLET,,92790,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
THIAMINE MONONITRATE (VIT B1) 100 MG ORAL TABLET,,92790,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
THIAMINE MONONITRATE (VIT B1) 100 MG ORAL TABLET,,92790,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
THIAMINE MONONITRATE (VIT B1) 100 MG ORAL TABLET,,92790,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
RIVAROXABAN 10 MG ORAL TABLET,,97000,LOCAL,Facility,Both,1,Each,,98,83.3,28.0868,98,Aetna,Commercial,90.16,92,,percent of total billed charges,,
RIVAROXABAN 10 MG ORAL TABLET,,97000,LOCAL,Facility,Outpatient,1,Each,,98,83.3,28.0868,98,Aetna,Medicare Advantage,48.02,49,,percent of total billed charges,,
RIVAROXABAN 10 MG ORAL TABLET,,97000,LOCAL,Facility,Inpatient,1,Each,,98,83.3,28.0868,98,Aetna,Medicare Advantage,,,,,Included in per diem rate,
RIVAROXABAN 10 MG ORAL TABLET,,97000,LOCAL,Facility,Both,1,Each,,98,83.3,28.0868,98,Aetna,PPO,91.14,93,,percent of total billed charges,,
RIVAROXABAN 10 MG ORAL TABLET,,97000,LOCAL,Facility,Both,1,Each,,98,83.3,28.0868,98,America's PPO,America's PPO,94.1094,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
RIVAROXABAN 10 MG ORAL TABLET,,97000,LOCAL,Facility,Both,1,Each,,98,83.3,28.0868,98,BlueCross BlueShield Minnesota, Federal Employee Program,96.432,98.4,,percent of total billed charges,,
RIVAROXABAN 10 MG ORAL TABLET,,97000,LOCAL,Facility,Both,1,Each,,98,83.3,28.0868,98,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,98,100,,percent of total billed charges,,
RIVAROXABAN 10 MG ORAL TABLET,,97000,LOCAL,Facility,Both,1,Each,,98,83.3,28.0868,98,BlueCross BlueShield Minnesota,High Value Network Plan,88.2,90,,percent of total billed charges,,
RIVAROXABAN 10 MG ORAL TABLET,,97000,LOCAL,Facility,Outpatient,1,Each,,98,83.3,28.0868,98,BlueCross BlueShield Minnesota,Medicare Advantage,48.02,49,,percent of total billed charges,,
RIVAROXABAN 10 MG ORAL TABLET,,97000,LOCAL,Facility,Inpatient,1,Each,,98,83.3,28.0868,98,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
RIVAROXABAN 10 MG ORAL TABLET,,97000,LOCAL,Facility,Both,1,Each,,98,83.3,28.0868,98,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,86.7986,88.57,,percent of total billed charges,,
RIVAROXABAN 10 MG ORAL TABLET,,97000,LOCAL,Facility,Both,1,Each,,98,83.3,28.0868,98,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,28.0868,28.66,,percent of total billed charges,,
RIVAROXABAN 10 MG ORAL TABLET,,97000,LOCAL,Facility,Outpatient,1,Each,,98,83.3,28.0868,98,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),48.02,49,,percent of total billed charges,,
RIVAROXABAN 10 MG ORAL TABLET,,97000,LOCAL,Facility,Inpatient,1,Each,,98,83.3,28.0868,98,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
RIVAROXABAN 10 MG ORAL TABLET,,97000,LOCAL,Facility,Both,1,Each,,98,83.3,28.0868,98,CorVel,Worker's Compensation,98,100,,percent of total billed charges,,
RIVAROXABAN 10 MG ORAL TABLET,,97000,LOCAL,Facility,Both,1,Each,,98,83.3,28.0868,98,First Health Group Corporation,First Health Network,95.06,97,,percent of total billed charges,,
RIVAROXABAN 10 MG ORAL TABLET,,97000,LOCAL,Facility,Both,1,Each,,98,83.3,28.0868,98,"Health Partners, Inc.",Commercial,92.708,94.6,,percent of total billed charges,,
RIVAROXABAN 10 MG ORAL TABLET,,97000,LOCAL,Facility,Outpatient,1,Each,,98,83.3,28.0868,98,"Health Partners, Inc.",Medicare Advantage,48.02,49,,percent of total billed charges,,
RIVAROXABAN 10 MG ORAL TABLET,,97000,LOCAL,Facility,Inpatient,1,Each,,98,83.3,28.0868,98,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
RIVAROXABAN 10 MG ORAL TABLET,,97000,LOCAL,Facility,Both,1,Each,,98,83.3,28.0868,98,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),58.8,60,,percent of total billed charges,,
RIVAROXABAN 10 MG ORAL TABLET,,97000,LOCAL,Facility,Both,1,Each,,98,83.3,28.0868,98,"Health Partners, Inc.",State of Minnesota Advantage Program,79.87,81.5,,percent of total billed charges,,
RIVAROXABAN 10 MG ORAL TABLET,,97000,LOCAL,Facility,Both,1,Each,,98,83.3,28.0868,98,"Health Partners, Inc.",State Public Programs,49,50,,percent of total billed charges,,
RIVAROXABAN 10 MG ORAL TABLET,,97000,LOCAL,Facility,Both,1,Each,,98,83.3,28.0868,98,Humana Insurance Company,Commercial PPO,93.1,95,,percent of total billed charges,,
RIVAROXABAN 10 MG ORAL TABLET,,97000,LOCAL,Facility,Outpatient,1,Each,,98,83.3,28.0868,98,Humana Insurance Company,Medicare PPO,48.02,49,,percent of total billed charges,,
RIVAROXABAN 10 MG ORAL TABLET,,97000,LOCAL,Facility,Inpatient,1,Each,,98,83.3,28.0868,98,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
RIVAROXABAN 10 MG ORAL TABLET,,97000,LOCAL,Facility,Both,1,Each,,98,83.3,28.0868,98,Medica,Individual & Family,97.118,99.1,,percent of total billed charges,,
RIVAROXABAN 10 MG ORAL TABLET,,97000,LOCAL,Facility,Outpatient,1,Each,,98,83.3,28.0868,98,Medica,Medica Advantage Solution,48.804,49.8,,percent of total billed charges,,
RIVAROXABAN 10 MG ORAL TABLET,,97000,LOCAL,Facility,Inpatient,1,Each,,98,83.3,28.0868,98,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
RIVAROXABAN 10 MG ORAL TABLET,,97000,LOCAL,Facility,Outpatient,1,Each,,98,83.3,28.0868,98,Medica,Medical Assistance,43.708,44.6,,percent of total billed charges,,
RIVAROXABAN 10 MG ORAL TABLET,,97000,LOCAL,Facility,Inpatient,1,Each,,98,83.3,28.0868,98,Medica,Medical Assistance,,,,,Included in per diem rate,
RIVAROXABAN 10 MG ORAL TABLET,,97000,LOCAL,Facility,Outpatient,1,Each,,98,83.3,28.0868,98,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,48.804,49.8,,percent of total billed charges,,
RIVAROXABAN 10 MG ORAL TABLET,,97000,LOCAL,Facility,Inpatient,1,Each,,98,83.3,28.0868,98,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
RIVAROXABAN 10 MG ORAL TABLET,,97000,LOCAL,Facility,Both,1,Each,,98,83.3,28.0868,98,"Multiplan, Inc.","Multiplan, Inc.",92.12,94,,percent of total billed charges,,
RIVAROXABAN 10 MG ORAL TABLET,,97000,LOCAL,Facility,Outpatient,1,Each,,98,83.3,28.0868,98,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,88.298,90.1,,percent of total billed charges,,
RIVAROXABAN 10 MG ORAL TABLET,,97000,LOCAL,Facility,Inpatient,1,Each,,98,83.3,28.0868,98,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
RIVAROXABAN 10 MG ORAL TABLET,,97000,LOCAL,Facility,Both,1,Each,,98,83.3,28.0868,98,"Preferred One Administrative Services, INC.",PPO,96.628,98.6,,percent of total billed charges,,
RIVAROXABAN 10 MG ORAL TABLET,,97000,LOCAL,Facility,Outpatient,1,Each,,98,83.3,28.0868,98,PrimeWest Health,Minnesota Senior Health Options (MSHO),50.421,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
RIVAROXABAN 10 MG ORAL TABLET,,97000,LOCAL,Facility,Inpatient,1,Each,,98,83.3,28.0868,98,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
RIVAROXABAN 10 MG ORAL TABLET,,97000,LOCAL,Facility,Outpatient,1,Each,,98,83.3,28.0868,98,PrimeWest Health,MinnesotaCare,50.3328,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
RIVAROXABAN 10 MG ORAL TABLET,,97000,LOCAL,Facility,Inpatient,1,Each,,98,83.3,28.0868,98,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
RIVAROXABAN 10 MG ORAL TABLET,,97000,LOCAL,Facility,Both,1,Each,,98,83.3,28.0868,98,Sanford Health Plan,Sanford Health Plan,90.16,92,,percent of total billed charges,,
RIVAROXABAN 10 MG ORAL TABLET,,97000,LOCAL,Facility,Outpatient,1,Each,,98,83.3,28.0868,98,"UCare Health, Inc.",Individual & Family Plan,55.223,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
RIVAROXABAN 10 MG ORAL TABLET,,97000,LOCAL,Facility,Inpatient,1,Each,,98,83.3,28.0868,98,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
RIVAROXABAN 10 MG ORAL TABLET,,97000,LOCAL,Facility,Outpatient,1,Each,,98,83.3,28.0868,98,"UCare Health, Inc.",Medical Assistance,49.4606,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
RIVAROXABAN 10 MG ORAL TABLET,,97000,LOCAL,Facility,Inpatient,1,Each,,98,83.3,28.0868,98,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
RIVAROXABAN 10 MG ORAL TABLET,,97000,LOCAL,Facility,Outpatient,1,Each,,98,83.3,28.0868,98,"UCare Health, Inc.",Medicare Advantage,49.4606,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
RIVAROXABAN 10 MG ORAL TABLET,,97000,LOCAL,Facility,Inpatient,1,Each,,98,83.3,28.0868,98,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
RIVAROXABAN 10 MG ORAL TABLET,,97000,LOCAL,Facility,Outpatient,1,Each,,98,83.3,28.0868,98,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),49.4606,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
RIVAROXABAN 10 MG ORAL TABLET,,97000,LOCAL,Facility,Inpatient,1,Each,,98,83.3,28.0868,98,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
RIVAROXABAN 10 MG ORAL TABLET,,97000,LOCAL,Facility,Both,1,Each,,98,83.3,28.0868,98,UnitedHealthcare,Individual & Family,92.12,94,,percent of total billed charges,,
RIVAROXABAN 10 MG ORAL TABLET,,97000,LOCAL,Facility,Outpatient,1,Each,,98,83.3,28.0868,98,UnitedHealthcare,Medicare Advantage,48.02,49,,percent of total billed charges,,
RIVAROXABAN 10 MG ORAL TABLET,,97000,LOCAL,Facility,Inpatient,1,Each,,98,83.3,28.0868,98,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
RIVAROXABAN 10 MG ORAL TABLET,,97000,LOCAL,Facility,Outpatient,1,Each,,98,83.3,28.0868,98,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,47.04,48,,percent of total billed charges,,100% of DHS outpatient percentage
RIVAROXABAN 10 MG ORAL TABLET,,97000,LOCAL,Facility,Inpatient,1,Each,,98,83.3,28.0868,98,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
TICAGRELOR 90 MG ORAL TABLET,,97141,LOCAL,Facility,Both,1,Each,,44,37.4,12.6104,44,Aetna,Commercial,40.48,92,,percent of total billed charges,,
TICAGRELOR 90 MG ORAL TABLET,,97141,LOCAL,Facility,Outpatient,1,Each,,44,37.4,12.6104,44,Aetna,Medicare Advantage,21.56,49,,percent of total billed charges,,
TICAGRELOR 90 MG ORAL TABLET,,97141,LOCAL,Facility,Inpatient,1,Each,,44,37.4,12.6104,44,Aetna,Medicare Advantage,,,,,Included in per diem rate,
TICAGRELOR 90 MG ORAL TABLET,,97141,LOCAL,Facility,Both,1,Each,,44,37.4,12.6104,44,Aetna,PPO,40.92,93,,percent of total billed charges,,
TICAGRELOR 90 MG ORAL TABLET,,97141,LOCAL,Facility,Both,1,Each,,44,37.4,12.6104,44,America's PPO,America's PPO,42.2532,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
TICAGRELOR 90 MG ORAL TABLET,,97141,LOCAL,Facility,Both,1,Each,,44,37.4,12.6104,44,BlueCross BlueShield Minnesota, Federal Employee Program,43.296,98.4,,percent of total billed charges,,
TICAGRELOR 90 MG ORAL TABLET,,97141,LOCAL,Facility,Both,1,Each,,44,37.4,12.6104,44,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,44,100,,percent of total billed charges,,
TICAGRELOR 90 MG ORAL TABLET,,97141,LOCAL,Facility,Both,1,Each,,44,37.4,12.6104,44,BlueCross BlueShield Minnesota,High Value Network Plan,39.6,90,,percent of total billed charges,,
TICAGRELOR 90 MG ORAL TABLET,,97141,LOCAL,Facility,Outpatient,1,Each,,44,37.4,12.6104,44,BlueCross BlueShield Minnesota,Medicare Advantage,21.56,49,,percent of total billed charges,,
TICAGRELOR 90 MG ORAL TABLET,,97141,LOCAL,Facility,Inpatient,1,Each,,44,37.4,12.6104,44,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
TICAGRELOR 90 MG ORAL TABLET,,97141,LOCAL,Facility,Both,1,Each,,44,37.4,12.6104,44,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,38.9708,88.57,,percent of total billed charges,,
TICAGRELOR 90 MG ORAL TABLET,,97141,LOCAL,Facility,Both,1,Each,,44,37.4,12.6104,44,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,12.6104,28.66,,percent of total billed charges,,
TICAGRELOR 90 MG ORAL TABLET,,97141,LOCAL,Facility,Outpatient,1,Each,,44,37.4,12.6104,44,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),21.56,49,,percent of total billed charges,,
TICAGRELOR 90 MG ORAL TABLET,,97141,LOCAL,Facility,Inpatient,1,Each,,44,37.4,12.6104,44,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
TICAGRELOR 90 MG ORAL TABLET,,97141,LOCAL,Facility,Both,1,Each,,44,37.4,12.6104,44,CorVel,Worker's Compensation,44,100,,percent of total billed charges,,
TICAGRELOR 90 MG ORAL TABLET,,97141,LOCAL,Facility,Both,1,Each,,44,37.4,12.6104,44,First Health Group Corporation,First Health Network,42.68,97,,percent of total billed charges,,
TICAGRELOR 90 MG ORAL TABLET,,97141,LOCAL,Facility,Both,1,Each,,44,37.4,12.6104,44,"Health Partners, Inc.",Commercial,41.624,94.6,,percent of total billed charges,,
TICAGRELOR 90 MG ORAL TABLET,,97141,LOCAL,Facility,Outpatient,1,Each,,44,37.4,12.6104,44,"Health Partners, Inc.",Medicare Advantage,21.56,49,,percent of total billed charges,,
TICAGRELOR 90 MG ORAL TABLET,,97141,LOCAL,Facility,Inpatient,1,Each,,44,37.4,12.6104,44,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
TICAGRELOR 90 MG ORAL TABLET,,97141,LOCAL,Facility,Both,1,Each,,44,37.4,12.6104,44,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),26.4,60,,percent of total billed charges,,
TICAGRELOR 90 MG ORAL TABLET,,97141,LOCAL,Facility,Both,1,Each,,44,37.4,12.6104,44,"Health Partners, Inc.",State of Minnesota Advantage Program,35.86,81.5,,percent of total billed charges,,
TICAGRELOR 90 MG ORAL TABLET,,97141,LOCAL,Facility,Both,1,Each,,44,37.4,12.6104,44,"Health Partners, Inc.",State Public Programs,22,50,,percent of total billed charges,,
TICAGRELOR 90 MG ORAL TABLET,,97141,LOCAL,Facility,Both,1,Each,,44,37.4,12.6104,44,Humana Insurance Company,Commercial PPO,41.8,95,,percent of total billed charges,,
TICAGRELOR 90 MG ORAL TABLET,,97141,LOCAL,Facility,Outpatient,1,Each,,44,37.4,12.6104,44,Humana Insurance Company,Medicare PPO,21.56,49,,percent of total billed charges,,
TICAGRELOR 90 MG ORAL TABLET,,97141,LOCAL,Facility,Inpatient,1,Each,,44,37.4,12.6104,44,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
TICAGRELOR 90 MG ORAL TABLET,,97141,LOCAL,Facility,Both,1,Each,,44,37.4,12.6104,44,Medica,Individual & Family,43.604,99.1,,percent of total billed charges,,
TICAGRELOR 90 MG ORAL TABLET,,97141,LOCAL,Facility,Outpatient,1,Each,,44,37.4,12.6104,44,Medica,Medica Advantage Solution,21.912,49.8,,percent of total billed charges,,
TICAGRELOR 90 MG ORAL TABLET,,97141,LOCAL,Facility,Inpatient,1,Each,,44,37.4,12.6104,44,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
TICAGRELOR 90 MG ORAL TABLET,,97141,LOCAL,Facility,Outpatient,1,Each,,44,37.4,12.6104,44,Medica,Medical Assistance,19.624,44.6,,percent of total billed charges,,
TICAGRELOR 90 MG ORAL TABLET,,97141,LOCAL,Facility,Inpatient,1,Each,,44,37.4,12.6104,44,Medica,Medical Assistance,,,,,Included in per diem rate,
TICAGRELOR 90 MG ORAL TABLET,,97141,LOCAL,Facility,Outpatient,1,Each,,44,37.4,12.6104,44,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,21.912,49.8,,percent of total billed charges,,
TICAGRELOR 90 MG ORAL TABLET,,97141,LOCAL,Facility,Inpatient,1,Each,,44,37.4,12.6104,44,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
TICAGRELOR 90 MG ORAL TABLET,,97141,LOCAL,Facility,Both,1,Each,,44,37.4,12.6104,44,"Multiplan, Inc.","Multiplan, Inc.",41.36,94,,percent of total billed charges,,
TICAGRELOR 90 MG ORAL TABLET,,97141,LOCAL,Facility,Outpatient,1,Each,,44,37.4,12.6104,44,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,39.644,90.1,,percent of total billed charges,,
TICAGRELOR 90 MG ORAL TABLET,,97141,LOCAL,Facility,Inpatient,1,Each,,44,37.4,12.6104,44,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
TICAGRELOR 90 MG ORAL TABLET,,97141,LOCAL,Facility,Both,1,Each,,44,37.4,12.6104,44,"Preferred One Administrative Services, INC.",PPO,43.384,98.6,,percent of total billed charges,,
TICAGRELOR 90 MG ORAL TABLET,,97141,LOCAL,Facility,Outpatient,1,Each,,44,37.4,12.6104,44,PrimeWest Health,Minnesota Senior Health Options (MSHO),22.638,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
TICAGRELOR 90 MG ORAL TABLET,,97141,LOCAL,Facility,Inpatient,1,Each,,44,37.4,12.6104,44,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
TICAGRELOR 90 MG ORAL TABLET,,97141,LOCAL,Facility,Outpatient,1,Each,,44,37.4,12.6104,44,PrimeWest Health,MinnesotaCare,22.5984,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
TICAGRELOR 90 MG ORAL TABLET,,97141,LOCAL,Facility,Inpatient,1,Each,,44,37.4,12.6104,44,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
TICAGRELOR 90 MG ORAL TABLET,,97141,LOCAL,Facility,Both,1,Each,,44,37.4,12.6104,44,Sanford Health Plan,Sanford Health Plan,40.48,92,,percent of total billed charges,,
TICAGRELOR 90 MG ORAL TABLET,,97141,LOCAL,Facility,Outpatient,1,Each,,44,37.4,12.6104,44,"UCare Health, Inc.",Individual & Family Plan,24.794,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
TICAGRELOR 90 MG ORAL TABLET,,97141,LOCAL,Facility,Inpatient,1,Each,,44,37.4,12.6104,44,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
TICAGRELOR 90 MG ORAL TABLET,,97141,LOCAL,Facility,Outpatient,1,Each,,44,37.4,12.6104,44,"UCare Health, Inc.",Medical Assistance,22.2068,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TICAGRELOR 90 MG ORAL TABLET,,97141,LOCAL,Facility,Inpatient,1,Each,,44,37.4,12.6104,44,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
TICAGRELOR 90 MG ORAL TABLET,,97141,LOCAL,Facility,Outpatient,1,Each,,44,37.4,12.6104,44,"UCare Health, Inc.",Medicare Advantage,22.2068,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TICAGRELOR 90 MG ORAL TABLET,,97141,LOCAL,Facility,Inpatient,1,Each,,44,37.4,12.6104,44,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
TICAGRELOR 90 MG ORAL TABLET,,97141,LOCAL,Facility,Outpatient,1,Each,,44,37.4,12.6104,44,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),22.2068,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TICAGRELOR 90 MG ORAL TABLET,,97141,LOCAL,Facility,Inpatient,1,Each,,44,37.4,12.6104,44,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
TICAGRELOR 90 MG ORAL TABLET,,97141,LOCAL,Facility,Both,1,Each,,44,37.4,12.6104,44,UnitedHealthcare,Individual & Family,41.36,94,,percent of total billed charges,,
TICAGRELOR 90 MG ORAL TABLET,,97141,LOCAL,Facility,Outpatient,1,Each,,44,37.4,12.6104,44,UnitedHealthcare,Medicare Advantage,21.56,49,,percent of total billed charges,,
TICAGRELOR 90 MG ORAL TABLET,,97141,LOCAL,Facility,Inpatient,1,Each,,44,37.4,12.6104,44,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
TICAGRELOR 90 MG ORAL TABLET,,97141,LOCAL,Facility,Outpatient,1,Each,,44,37.4,12.6104,44,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,21.12,48,,percent of total billed charges,,100% of DHS outpatient percentage
TICAGRELOR 90 MG ORAL TABLET,,97141,LOCAL,Facility,Inpatient,1,Each,,44,37.4,12.6104,44,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
BENZOCAINE-MENTHOL 15-3.6 MG MM LOZG,,97552,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
BENZOCAINE-MENTHOL 15-3.6 MG MM LOZG,,97552,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
BENZOCAINE-MENTHOL 15-3.6 MG MM LOZG,,97552,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
BENZOCAINE-MENTHOL 15-3.6 MG MM LOZG,,97552,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
BENZOCAINE-MENTHOL 15-3.6 MG MM LOZG,,97552,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
BENZOCAINE-MENTHOL 15-3.6 MG MM LOZG,,97552,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
BENZOCAINE-MENTHOL 15-3.6 MG MM LOZG,,97552,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
BENZOCAINE-MENTHOL 15-3.6 MG MM LOZG,,97552,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
BENZOCAINE-MENTHOL 15-3.6 MG MM LOZG,,97552,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
BENZOCAINE-MENTHOL 15-3.6 MG MM LOZG,,97552,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
BENZOCAINE-MENTHOL 15-3.6 MG MM LOZG,,97552,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
BENZOCAINE-MENTHOL 15-3.6 MG MM LOZG,,97552,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
BENZOCAINE-MENTHOL 15-3.6 MG MM LOZG,,97552,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
BENZOCAINE-MENTHOL 15-3.6 MG MM LOZG,,97552,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
BENZOCAINE-MENTHOL 15-3.6 MG MM LOZG,,97552,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
BENZOCAINE-MENTHOL 15-3.6 MG MM LOZG,,97552,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
BENZOCAINE-MENTHOL 15-3.6 MG MM LOZG,,97552,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
BENZOCAINE-MENTHOL 15-3.6 MG MM LOZG,,97552,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
BENZOCAINE-MENTHOL 15-3.6 MG MM LOZG,,97552,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
BENZOCAINE-MENTHOL 15-3.6 MG MM LOZG,,97552,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
BENZOCAINE-MENTHOL 15-3.6 MG MM LOZG,,97552,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
BENZOCAINE-MENTHOL 15-3.6 MG MM LOZG,,97552,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
BENZOCAINE-MENTHOL 15-3.6 MG MM LOZG,,97552,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
BENZOCAINE-MENTHOL 15-3.6 MG MM LOZG,,97552,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
BENZOCAINE-MENTHOL 15-3.6 MG MM LOZG,,97552,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
BENZOCAINE-MENTHOL 15-3.6 MG MM LOZG,,97552,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
BENZOCAINE-MENTHOL 15-3.6 MG MM LOZG,,97552,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
BENZOCAINE-MENTHOL 15-3.6 MG MM LOZG,,97552,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
BENZOCAINE-MENTHOL 15-3.6 MG MM LOZG,,97552,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
BENZOCAINE-MENTHOL 15-3.6 MG MM LOZG,,97552,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
BENZOCAINE-MENTHOL 15-3.6 MG MM LOZG,,97552,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
BENZOCAINE-MENTHOL 15-3.6 MG MM LOZG,,97552,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
BENZOCAINE-MENTHOL 15-3.6 MG MM LOZG,,97552,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
BENZOCAINE-MENTHOL 15-3.6 MG MM LOZG,,97552,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
BENZOCAINE-MENTHOL 15-3.6 MG MM LOZG,,97552,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
BENZOCAINE-MENTHOL 15-3.6 MG MM LOZG,,97552,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
BENZOCAINE-MENTHOL 15-3.6 MG MM LOZG,,97552,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
BENZOCAINE-MENTHOL 15-3.6 MG MM LOZG,,97552,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
BENZOCAINE-MENTHOL 15-3.6 MG MM LOZG,,97552,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
BENZOCAINE-MENTHOL 15-3.6 MG MM LOZG,,97552,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
BENZOCAINE-MENTHOL 15-3.6 MG MM LOZG,,97552,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
BENZOCAINE-MENTHOL 15-3.6 MG MM LOZG,,97552,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
BENZOCAINE-MENTHOL 15-3.6 MG MM LOZG,,97552,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
BENZOCAINE-MENTHOL 15-3.6 MG MM LOZG,,97552,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BENZOCAINE-MENTHOL 15-3.6 MG MM LOZG,,97552,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
BENZOCAINE-MENTHOL 15-3.6 MG MM LOZG,,97552,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BENZOCAINE-MENTHOL 15-3.6 MG MM LOZG,,97552,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
BENZOCAINE-MENTHOL 15-3.6 MG MM LOZG,,97552,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BENZOCAINE-MENTHOL 15-3.6 MG MM LOZG,,97552,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
BENZOCAINE-MENTHOL 15-3.6 MG MM LOZG,,97552,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
BENZOCAINE-MENTHOL 15-3.6 MG MM LOZG,,97552,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
BENZOCAINE-MENTHOL 15-3.6 MG MM LOZG,,97552,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
BENZOCAINE-MENTHOL 15-3.6 MG MM LOZG,,97552,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
BENZOCAINE-MENTHOL 15-3.6 MG MM LOZG,,97552,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
HYDROXOCOBALAMIN 5 GRAM IV SOLR,,97959,LOCAL,Facility,Both,1,Each,,2711,2304.35,776.9726,2711,Aetna,Commercial,2494.12,92,,percent of total billed charges,,
HYDROXOCOBALAMIN 5 GRAM IV SOLR,,97959,LOCAL,Facility,Outpatient,1,Each,,2711,2304.35,776.9726,2711,Aetna,Medicare Advantage,1328.39,49,,percent of total billed charges,,
HYDROXOCOBALAMIN 5 GRAM IV SOLR,,97959,LOCAL,Facility,Inpatient,1,Each,,2711,2304.35,776.9726,2711,Aetna,Medicare Advantage,,,,,Included in per diem rate,
HYDROXOCOBALAMIN 5 GRAM IV SOLR,,97959,LOCAL,Facility,Both,1,Each,,2711,2304.35,776.9726,2711,Aetna,PPO,2521.23,93,,percent of total billed charges,,
HYDROXOCOBALAMIN 5 GRAM IV SOLR,,97959,LOCAL,Facility,Both,1,Each,,2711,2304.35,776.9726,2711,America's PPO,America's PPO,2603.3733,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
HYDROXOCOBALAMIN 5 GRAM IV SOLR,,97959,LOCAL,Facility,Both,1,Each,,2711,2304.35,776.9726,2711,BlueCross BlueShield Minnesota, Federal Employee Program,2667.624,98.4,,percent of total billed charges,,
HYDROXOCOBALAMIN 5 GRAM IV SOLR,,97959,LOCAL,Facility,Both,1,Each,,2711,2304.35,776.9726,2711,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,2711,100,,percent of total billed charges,,
HYDROXOCOBALAMIN 5 GRAM IV SOLR,,97959,LOCAL,Facility,Both,1,Each,,2711,2304.35,776.9726,2711,BlueCross BlueShield Minnesota,High Value Network Plan,2439.9,90,,percent of total billed charges,,
HYDROXOCOBALAMIN 5 GRAM IV SOLR,,97959,LOCAL,Facility,Outpatient,1,Each,,2711,2304.35,776.9726,2711,BlueCross BlueShield Minnesota,Medicare Advantage,1328.39,49,,percent of total billed charges,,
HYDROXOCOBALAMIN 5 GRAM IV SOLR,,97959,LOCAL,Facility,Inpatient,1,Each,,2711,2304.35,776.9726,2711,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
HYDROXOCOBALAMIN 5 GRAM IV SOLR,,97959,LOCAL,Facility,Both,1,Each,,2711,2304.35,776.9726,2711,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,2401.1327,88.57,,percent of total billed charges,,
HYDROXOCOBALAMIN 5 GRAM IV SOLR,,97959,LOCAL,Facility,Both,1,Each,,2711,2304.35,776.9726,2711,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,776.9726,28.66,,percent of total billed charges,,
HYDROXOCOBALAMIN 5 GRAM IV SOLR,,97959,LOCAL,Facility,Outpatient,1,Each,,2711,2304.35,776.9726,2711,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1328.39,49,,percent of total billed charges,,
HYDROXOCOBALAMIN 5 GRAM IV SOLR,,97959,LOCAL,Facility,Inpatient,1,Each,,2711,2304.35,776.9726,2711,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
HYDROXOCOBALAMIN 5 GRAM IV SOLR,,97959,LOCAL,Facility,Both,1,Each,,2711,2304.35,776.9726,2711,CorVel,Worker's Compensation,2711,100,,percent of total billed charges,,
HYDROXOCOBALAMIN 5 GRAM IV SOLR,,97959,LOCAL,Facility,Both,1,Each,,2711,2304.35,776.9726,2711,First Health Group Corporation,First Health Network,2629.67,97,,percent of total billed charges,,
HYDROXOCOBALAMIN 5 GRAM IV SOLR,,97959,LOCAL,Facility,Both,1,Each,,2711,2304.35,776.9726,2711,"Health Partners, Inc.",Commercial,2564.606,94.6,,percent of total billed charges,,
HYDROXOCOBALAMIN 5 GRAM IV SOLR,,97959,LOCAL,Facility,Outpatient,1,Each,,2711,2304.35,776.9726,2711,"Health Partners, Inc.",Medicare Advantage,1328.39,49,,percent of total billed charges,,
HYDROXOCOBALAMIN 5 GRAM IV SOLR,,97959,LOCAL,Facility,Inpatient,1,Each,,2711,2304.35,776.9726,2711,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
HYDROXOCOBALAMIN 5 GRAM IV SOLR,,97959,LOCAL,Facility,Both,1,Each,,2711,2304.35,776.9726,2711,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1626.6,60,,percent of total billed charges,,
HYDROXOCOBALAMIN 5 GRAM IV SOLR,,97959,LOCAL,Facility,Both,1,Each,,2711,2304.35,776.9726,2711,"Health Partners, Inc.",State of Minnesota Advantage Program,2209.465,81.5,,percent of total billed charges,,
HYDROXOCOBALAMIN 5 GRAM IV SOLR,,97959,LOCAL,Facility,Both,1,Each,,2711,2304.35,776.9726,2711,"Health Partners, Inc.",State Public Programs,1355.5,50,,percent of total billed charges,,
HYDROXOCOBALAMIN 5 GRAM IV SOLR,,97959,LOCAL,Facility,Both,1,Each,,2711,2304.35,776.9726,2711,Humana Insurance Company,Commercial PPO,2575.45,95,,percent of total billed charges,,
HYDROXOCOBALAMIN 5 GRAM IV SOLR,,97959,LOCAL,Facility,Outpatient,1,Each,,2711,2304.35,776.9726,2711,Humana Insurance Company,Medicare PPO,1328.39,49,,percent of total billed charges,,
HYDROXOCOBALAMIN 5 GRAM IV SOLR,,97959,LOCAL,Facility,Inpatient,1,Each,,2711,2304.35,776.9726,2711,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
HYDROXOCOBALAMIN 5 GRAM IV SOLR,,97959,LOCAL,Facility,Both,1,Each,,2711,2304.35,776.9726,2711,Medica,Individual & Family,2686.601,99.1,,percent of total billed charges,,
HYDROXOCOBALAMIN 5 GRAM IV SOLR,,97959,LOCAL,Facility,Outpatient,1,Each,,2711,2304.35,776.9726,2711,Medica,Medica Advantage Solution,1350.078,49.8,,percent of total billed charges,,
HYDROXOCOBALAMIN 5 GRAM IV SOLR,,97959,LOCAL,Facility,Inpatient,1,Each,,2711,2304.35,776.9726,2711,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
HYDROXOCOBALAMIN 5 GRAM IV SOLR,,97959,LOCAL,Facility,Outpatient,1,Each,,2711,2304.35,776.9726,2711,Medica,Medical Assistance,1209.106,44.6,,percent of total billed charges,,
HYDROXOCOBALAMIN 5 GRAM IV SOLR,,97959,LOCAL,Facility,Inpatient,1,Each,,2711,2304.35,776.9726,2711,Medica,Medical Assistance,,,,,Included in per diem rate,
HYDROXOCOBALAMIN 5 GRAM IV SOLR,,97959,LOCAL,Facility,Outpatient,1,Each,,2711,2304.35,776.9726,2711,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1350.078,49.8,,percent of total billed charges,,
HYDROXOCOBALAMIN 5 GRAM IV SOLR,,97959,LOCAL,Facility,Inpatient,1,Each,,2711,2304.35,776.9726,2711,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
HYDROXOCOBALAMIN 5 GRAM IV SOLR,,97959,LOCAL,Facility,Both,1,Each,,2711,2304.35,776.9726,2711,"Multiplan, Inc.","Multiplan, Inc.",2548.34,94,,percent of total billed charges,,
HYDROXOCOBALAMIN 5 GRAM IV SOLR,,97959,LOCAL,Facility,Outpatient,1,Each,,2711,2304.35,776.9726,2711,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,2442.611,90.1,,percent of total billed charges,,
HYDROXOCOBALAMIN 5 GRAM IV SOLR,,97959,LOCAL,Facility,Inpatient,1,Each,,2711,2304.35,776.9726,2711,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
HYDROXOCOBALAMIN 5 GRAM IV SOLR,,97959,LOCAL,Facility,Both,1,Each,,2711,2304.35,776.9726,2711,"Preferred One Administrative Services, INC.",PPO,2673.046,98.6,,percent of total billed charges,,
HYDROXOCOBALAMIN 5 GRAM IV SOLR,,97959,LOCAL,Facility,Outpatient,1,Each,,2711,2304.35,776.9726,2711,PrimeWest Health,Minnesota Senior Health Options (MSHO),1394.8095,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
HYDROXOCOBALAMIN 5 GRAM IV SOLR,,97959,LOCAL,Facility,Inpatient,1,Each,,2711,2304.35,776.9726,2711,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
HYDROXOCOBALAMIN 5 GRAM IV SOLR,,97959,LOCAL,Facility,Outpatient,1,Each,,2711,2304.35,776.9726,2711,PrimeWest Health,MinnesotaCare,1392.3696,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
HYDROXOCOBALAMIN 5 GRAM IV SOLR,,97959,LOCAL,Facility,Inpatient,1,Each,,2711,2304.35,776.9726,2711,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
HYDROXOCOBALAMIN 5 GRAM IV SOLR,,97959,LOCAL,Facility,Both,1,Each,,2711,2304.35,776.9726,2711,Sanford Health Plan,Sanford Health Plan,2494.12,92,,percent of total billed charges,,
HYDROXOCOBALAMIN 5 GRAM IV SOLR,,97959,LOCAL,Facility,Outpatient,1,Each,,2711,2304.35,776.9726,2711,"UCare Health, Inc.",Individual & Family Plan,1527.6485,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
HYDROXOCOBALAMIN 5 GRAM IV SOLR,,97959,LOCAL,Facility,Inpatient,1,Each,,2711,2304.35,776.9726,2711,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
HYDROXOCOBALAMIN 5 GRAM IV SOLR,,97959,LOCAL,Facility,Outpatient,1,Each,,2711,2304.35,776.9726,2711,"UCare Health, Inc.",Medical Assistance,1368.2417,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
HYDROXOCOBALAMIN 5 GRAM IV SOLR,,97959,LOCAL,Facility,Inpatient,1,Each,,2711,2304.35,776.9726,2711,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
HYDROXOCOBALAMIN 5 GRAM IV SOLR,,97959,LOCAL,Facility,Outpatient,1,Each,,2711,2304.35,776.9726,2711,"UCare Health, Inc.",Medicare Advantage,1368.2417,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
HYDROXOCOBALAMIN 5 GRAM IV SOLR,,97959,LOCAL,Facility,Inpatient,1,Each,,2711,2304.35,776.9726,2711,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
HYDROXOCOBALAMIN 5 GRAM IV SOLR,,97959,LOCAL,Facility,Outpatient,1,Each,,2711,2304.35,776.9726,2711,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1368.2417,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
HYDROXOCOBALAMIN 5 GRAM IV SOLR,,97959,LOCAL,Facility,Inpatient,1,Each,,2711,2304.35,776.9726,2711,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
HYDROXOCOBALAMIN 5 GRAM IV SOLR,,97959,LOCAL,Facility,Both,1,Each,,2711,2304.35,776.9726,2711,UnitedHealthcare,Individual & Family,2548.34,94,,percent of total billed charges,,
HYDROXOCOBALAMIN 5 GRAM IV SOLR,,97959,LOCAL,Facility,Outpatient,1,Each,,2711,2304.35,776.9726,2711,UnitedHealthcare,Medicare Advantage,1328.39,49,,percent of total billed charges,,
HYDROXOCOBALAMIN 5 GRAM IV SOLR,,97959,LOCAL,Facility,Inpatient,1,Each,,2711,2304.35,776.9726,2711,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
HYDROXOCOBALAMIN 5 GRAM IV SOLR,,97959,LOCAL,Facility,Outpatient,1,Each,,2711,2304.35,776.9726,2711,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1301.28,48,,percent of total billed charges,,100% of DHS outpatient percentage
HYDROXOCOBALAMIN 5 GRAM IV SOLR,,97959,LOCAL,Facility,Inpatient,1,Each,,2711,2304.35,776.9726,2711,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
DORZOLAMIDE-TIMOLOL (PF) 2-0.5 % OPHT DPET,,100219,LOCAL,Facility,Both,1,Each,,18,15.3,5.1588,18,Aetna,Commercial,16.56,92,,percent of total billed charges,,
DORZOLAMIDE-TIMOLOL (PF) 2-0.5 % OPHT DPET,,100219,LOCAL,Facility,Outpatient,1,Each,,18,15.3,5.1588,18,Aetna,Medicare Advantage,8.82,49,,percent of total billed charges,,
DORZOLAMIDE-TIMOLOL (PF) 2-0.5 % OPHT DPET,,100219,LOCAL,Facility,Inpatient,1,Each,,18,15.3,5.1588,18,Aetna,Medicare Advantage,,,,,Included in per diem rate,
DORZOLAMIDE-TIMOLOL (PF) 2-0.5 % OPHT DPET,,100219,LOCAL,Facility,Both,1,Each,,18,15.3,5.1588,18,Aetna,PPO,16.74,93,,percent of total billed charges,,
DORZOLAMIDE-TIMOLOL (PF) 2-0.5 % OPHT DPET,,100219,LOCAL,Facility,Both,1,Each,,18,15.3,5.1588,18,America's PPO,America's PPO,17.2854,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
DORZOLAMIDE-TIMOLOL (PF) 2-0.5 % OPHT DPET,,100219,LOCAL,Facility,Both,1,Each,,18,15.3,5.1588,18,BlueCross BlueShield Minnesota, Federal Employee Program,17.712,98.4,,percent of total billed charges,,
DORZOLAMIDE-TIMOLOL (PF) 2-0.5 % OPHT DPET,,100219,LOCAL,Facility,Both,1,Each,,18,15.3,5.1588,18,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,18,100,,percent of total billed charges,,
DORZOLAMIDE-TIMOLOL (PF) 2-0.5 % OPHT DPET,,100219,LOCAL,Facility,Both,1,Each,,18,15.3,5.1588,18,BlueCross BlueShield Minnesota,High Value Network Plan,16.2,90,,percent of total billed charges,,
DORZOLAMIDE-TIMOLOL (PF) 2-0.5 % OPHT DPET,,100219,LOCAL,Facility,Outpatient,1,Each,,18,15.3,5.1588,18,BlueCross BlueShield Minnesota,Medicare Advantage,8.82,49,,percent of total billed charges,,
DORZOLAMIDE-TIMOLOL (PF) 2-0.5 % OPHT DPET,,100219,LOCAL,Facility,Inpatient,1,Each,,18,15.3,5.1588,18,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
DORZOLAMIDE-TIMOLOL (PF) 2-0.5 % OPHT DPET,,100219,LOCAL,Facility,Both,1,Each,,18,15.3,5.1588,18,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,15.9426,88.57,,percent of total billed charges,,
DORZOLAMIDE-TIMOLOL (PF) 2-0.5 % OPHT DPET,,100219,LOCAL,Facility,Both,1,Each,,18,15.3,5.1588,18,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,5.1588,28.66,,percent of total billed charges,,
DORZOLAMIDE-TIMOLOL (PF) 2-0.5 % OPHT DPET,,100219,LOCAL,Facility,Outpatient,1,Each,,18,15.3,5.1588,18,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),8.82,49,,percent of total billed charges,,
DORZOLAMIDE-TIMOLOL (PF) 2-0.5 % OPHT DPET,,100219,LOCAL,Facility,Inpatient,1,Each,,18,15.3,5.1588,18,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
DORZOLAMIDE-TIMOLOL (PF) 2-0.5 % OPHT DPET,,100219,LOCAL,Facility,Both,1,Each,,18,15.3,5.1588,18,CorVel,Worker's Compensation,18,100,,percent of total billed charges,,
DORZOLAMIDE-TIMOLOL (PF) 2-0.5 % OPHT DPET,,100219,LOCAL,Facility,Both,1,Each,,18,15.3,5.1588,18,First Health Group Corporation,First Health Network,17.46,97,,percent of total billed charges,,
DORZOLAMIDE-TIMOLOL (PF) 2-0.5 % OPHT DPET,,100219,LOCAL,Facility,Both,1,Each,,18,15.3,5.1588,18,"Health Partners, Inc.",Commercial,17.028,94.6,,percent of total billed charges,,
DORZOLAMIDE-TIMOLOL (PF) 2-0.5 % OPHT DPET,,100219,LOCAL,Facility,Outpatient,1,Each,,18,15.3,5.1588,18,"Health Partners, Inc.",Medicare Advantage,8.82,49,,percent of total billed charges,,
DORZOLAMIDE-TIMOLOL (PF) 2-0.5 % OPHT DPET,,100219,LOCAL,Facility,Inpatient,1,Each,,18,15.3,5.1588,18,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DORZOLAMIDE-TIMOLOL (PF) 2-0.5 % OPHT DPET,,100219,LOCAL,Facility,Both,1,Each,,18,15.3,5.1588,18,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),10.8,60,,percent of total billed charges,,
DORZOLAMIDE-TIMOLOL (PF) 2-0.5 % OPHT DPET,,100219,LOCAL,Facility,Both,1,Each,,18,15.3,5.1588,18,"Health Partners, Inc.",State of Minnesota Advantage Program,14.67,81.5,,percent of total billed charges,,
DORZOLAMIDE-TIMOLOL (PF) 2-0.5 % OPHT DPET,,100219,LOCAL,Facility,Both,1,Each,,18,15.3,5.1588,18,"Health Partners, Inc.",State Public Programs,9,50,,percent of total billed charges,,
DORZOLAMIDE-TIMOLOL (PF) 2-0.5 % OPHT DPET,,100219,LOCAL,Facility,Both,1,Each,,18,15.3,5.1588,18,Humana Insurance Company,Commercial PPO,17.1,95,,percent of total billed charges,,
DORZOLAMIDE-TIMOLOL (PF) 2-0.5 % OPHT DPET,,100219,LOCAL,Facility,Outpatient,1,Each,,18,15.3,5.1588,18,Humana Insurance Company,Medicare PPO,8.82,49,,percent of total billed charges,,
DORZOLAMIDE-TIMOLOL (PF) 2-0.5 % OPHT DPET,,100219,LOCAL,Facility,Inpatient,1,Each,,18,15.3,5.1588,18,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
DORZOLAMIDE-TIMOLOL (PF) 2-0.5 % OPHT DPET,,100219,LOCAL,Facility,Both,1,Each,,18,15.3,5.1588,18,Medica,Individual & Family,17.838,99.1,,percent of total billed charges,,
DORZOLAMIDE-TIMOLOL (PF) 2-0.5 % OPHT DPET,,100219,LOCAL,Facility,Outpatient,1,Each,,18,15.3,5.1588,18,Medica,Medica Advantage Solution,8.964,49.8,,percent of total billed charges,,
DORZOLAMIDE-TIMOLOL (PF) 2-0.5 % OPHT DPET,,100219,LOCAL,Facility,Inpatient,1,Each,,18,15.3,5.1588,18,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
DORZOLAMIDE-TIMOLOL (PF) 2-0.5 % OPHT DPET,,100219,LOCAL,Facility,Outpatient,1,Each,,18,15.3,5.1588,18,Medica,Medical Assistance,8.028,44.6,,percent of total billed charges,,
DORZOLAMIDE-TIMOLOL (PF) 2-0.5 % OPHT DPET,,100219,LOCAL,Facility,Inpatient,1,Each,,18,15.3,5.1588,18,Medica,Medical Assistance,,,,,Included in per diem rate,
DORZOLAMIDE-TIMOLOL (PF) 2-0.5 % OPHT DPET,,100219,LOCAL,Facility,Outpatient,1,Each,,18,15.3,5.1588,18,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,8.964,49.8,,percent of total billed charges,,
DORZOLAMIDE-TIMOLOL (PF) 2-0.5 % OPHT DPET,,100219,LOCAL,Facility,Inpatient,1,Each,,18,15.3,5.1588,18,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
DORZOLAMIDE-TIMOLOL (PF) 2-0.5 % OPHT DPET,,100219,LOCAL,Facility,Both,1,Each,,18,15.3,5.1588,18,"Multiplan, Inc.","Multiplan, Inc.",16.92,94,,percent of total billed charges,,
DORZOLAMIDE-TIMOLOL (PF) 2-0.5 % OPHT DPET,,100219,LOCAL,Facility,Outpatient,1,Each,,18,15.3,5.1588,18,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,16.218,90.1,,percent of total billed charges,,
DORZOLAMIDE-TIMOLOL (PF) 2-0.5 % OPHT DPET,,100219,LOCAL,Facility,Inpatient,1,Each,,18,15.3,5.1588,18,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
DORZOLAMIDE-TIMOLOL (PF) 2-0.5 % OPHT DPET,,100219,LOCAL,Facility,Both,1,Each,,18,15.3,5.1588,18,"Preferred One Administrative Services, INC.",PPO,17.748,98.6,,percent of total billed charges,,
DORZOLAMIDE-TIMOLOL (PF) 2-0.5 % OPHT DPET,,100219,LOCAL,Facility,Outpatient,1,Each,,18,15.3,5.1588,18,PrimeWest Health,Minnesota Senior Health Options (MSHO),9.261,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
DORZOLAMIDE-TIMOLOL (PF) 2-0.5 % OPHT DPET,,100219,LOCAL,Facility,Inpatient,1,Each,,18,15.3,5.1588,18,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DORZOLAMIDE-TIMOLOL (PF) 2-0.5 % OPHT DPET,,100219,LOCAL,Facility,Outpatient,1,Each,,18,15.3,5.1588,18,PrimeWest Health,MinnesotaCare,9.2448,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
DORZOLAMIDE-TIMOLOL (PF) 2-0.5 % OPHT DPET,,100219,LOCAL,Facility,Inpatient,1,Each,,18,15.3,5.1588,18,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
DORZOLAMIDE-TIMOLOL (PF) 2-0.5 % OPHT DPET,,100219,LOCAL,Facility,Both,1,Each,,18,15.3,5.1588,18,Sanford Health Plan,Sanford Health Plan,16.56,92,,percent of total billed charges,,
DORZOLAMIDE-TIMOLOL (PF) 2-0.5 % OPHT DPET,,100219,LOCAL,Facility,Outpatient,1,Each,,18,15.3,5.1588,18,"UCare Health, Inc.",Individual & Family Plan,10.143,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
DORZOLAMIDE-TIMOLOL (PF) 2-0.5 % OPHT DPET,,100219,LOCAL,Facility,Inpatient,1,Each,,18,15.3,5.1588,18,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
DORZOLAMIDE-TIMOLOL (PF) 2-0.5 % OPHT DPET,,100219,LOCAL,Facility,Outpatient,1,Each,,18,15.3,5.1588,18,"UCare Health, Inc.",Medical Assistance,9.0846,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DORZOLAMIDE-TIMOLOL (PF) 2-0.5 % OPHT DPET,,100219,LOCAL,Facility,Inpatient,1,Each,,18,15.3,5.1588,18,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
DORZOLAMIDE-TIMOLOL (PF) 2-0.5 % OPHT DPET,,100219,LOCAL,Facility,Outpatient,1,Each,,18,15.3,5.1588,18,"UCare Health, Inc.",Medicare Advantage,9.0846,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DORZOLAMIDE-TIMOLOL (PF) 2-0.5 % OPHT DPET,,100219,LOCAL,Facility,Inpatient,1,Each,,18,15.3,5.1588,18,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DORZOLAMIDE-TIMOLOL (PF) 2-0.5 % OPHT DPET,,100219,LOCAL,Facility,Outpatient,1,Each,,18,15.3,5.1588,18,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),9.0846,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DORZOLAMIDE-TIMOLOL (PF) 2-0.5 % OPHT DPET,,100219,LOCAL,Facility,Inpatient,1,Each,,18,15.3,5.1588,18,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DORZOLAMIDE-TIMOLOL (PF) 2-0.5 % OPHT DPET,,100219,LOCAL,Facility,Both,1,Each,,18,15.3,5.1588,18,UnitedHealthcare,Individual & Family,16.92,94,,percent of total billed charges,,
DORZOLAMIDE-TIMOLOL (PF) 2-0.5 % OPHT DPET,,100219,LOCAL,Facility,Outpatient,1,Each,,18,15.3,5.1588,18,UnitedHealthcare,Medicare Advantage,8.82,49,,percent of total billed charges,,
DORZOLAMIDE-TIMOLOL (PF) 2-0.5 % OPHT DPET,,100219,LOCAL,Facility,Inpatient,1,Each,,18,15.3,5.1588,18,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
DORZOLAMIDE-TIMOLOL (PF) 2-0.5 % OPHT DPET,,100219,LOCAL,Facility,Outpatient,1,Each,,18,15.3,5.1588,18,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,8.64,48,,percent of total billed charges,,100% of DHS outpatient percentage
DORZOLAMIDE-TIMOLOL (PF) 2-0.5 % OPHT DPET,,100219,LOCAL,Facility,Inpatient,1,Each,,18,15.3,5.1588,18,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
TAFLUPROST (PF) 0.0015 % OPHT DPET,,100251,LOCAL,Facility,Both,1,Each,,387,328.95,110.9142,387,Aetna,Commercial,356.04,92,,percent of total billed charges,,
TAFLUPROST (PF) 0.0015 % OPHT DPET,,100251,LOCAL,Facility,Both,1,Each,,1077,915.45,308.6682,1077,Aetna,Commercial,990.84,92,,percent of total billed charges,,
TAFLUPROST (PF) 0.0015 % OPHT DPET,,100251,LOCAL,Facility,Outpatient,1,Each,,387,328.95,110.9142,387,Aetna,Medicare Advantage,189.63,49,,percent of total billed charges,,
TAFLUPROST (PF) 0.0015 % OPHT DPET,,100251,LOCAL,Facility,Outpatient,1,Each,,1077,915.45,308.6682,1077,Aetna,Medicare Advantage,527.73,49,,percent of total billed charges,,
TAFLUPROST (PF) 0.0015 % OPHT DPET,,100251,LOCAL,Facility,Inpatient,1,Each,,387,328.95,110.9142,387,Aetna,Medicare Advantage,,,,,Included in per diem rate,
TAFLUPROST (PF) 0.0015 % OPHT DPET,,100251,LOCAL,Facility,Inpatient,1,Each,,1077,915.45,308.6682,1077,Aetna,Medicare Advantage,,,,,Included in per diem rate,
TAFLUPROST (PF) 0.0015 % OPHT DPET,,100251,LOCAL,Facility,Both,1,Each,,387,328.95,110.9142,387,Aetna,PPO,359.91,93,,percent of total billed charges,,
TAFLUPROST (PF) 0.0015 % OPHT DPET,,100251,LOCAL,Facility,Both,1,Each,,1077,915.45,308.6682,1077,Aetna,PPO,1001.61,93,,percent of total billed charges,,
TAFLUPROST (PF) 0.0015 % OPHT DPET,,100251,LOCAL,Facility,Both,1,Each,,387,328.95,110.9142,387,America's PPO,America's PPO,371.6361,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
TAFLUPROST (PF) 0.0015 % OPHT DPET,,100251,LOCAL,Facility,Both,1,Each,,1077,915.45,308.6682,1077,America's PPO,America's PPO,1034.2431,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
TAFLUPROST (PF) 0.0015 % OPHT DPET,,100251,LOCAL,Facility,Both,1,Each,,387,328.95,110.9142,387,BlueCross BlueShield Minnesota, Federal Employee Program,380.808,98.4,,percent of total billed charges,,
TAFLUPROST (PF) 0.0015 % OPHT DPET,,100251,LOCAL,Facility,Both,1,Each,,1077,915.45,308.6682,1077,BlueCross BlueShield Minnesota, Federal Employee Program,1059.768,98.4,,percent of total billed charges,,
TAFLUPROST (PF) 0.0015 % OPHT DPET,,100251,LOCAL,Facility,Both,1,Each,,387,328.95,110.9142,387,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,387,100,,percent of total billed charges,,
TAFLUPROST (PF) 0.0015 % OPHT DPET,,100251,LOCAL,Facility,Both,1,Each,,1077,915.45,308.6682,1077,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1077,100,,percent of total billed charges,,
TAFLUPROST (PF) 0.0015 % OPHT DPET,,100251,LOCAL,Facility,Both,1,Each,,387,328.95,110.9142,387,BlueCross BlueShield Minnesota,High Value Network Plan,348.3,90,,percent of total billed charges,,
TAFLUPROST (PF) 0.0015 % OPHT DPET,,100251,LOCAL,Facility,Both,1,Each,,1077,915.45,308.6682,1077,BlueCross BlueShield Minnesota,High Value Network Plan,969.3,90,,percent of total billed charges,,
TAFLUPROST (PF) 0.0015 % OPHT DPET,,100251,LOCAL,Facility,Outpatient,1,Each,,387,328.95,110.9142,387,BlueCross BlueShield Minnesota,Medicare Advantage,189.63,49,,percent of total billed charges,,
TAFLUPROST (PF) 0.0015 % OPHT DPET,,100251,LOCAL,Facility,Outpatient,1,Each,,1077,915.45,308.6682,1077,BlueCross BlueShield Minnesota,Medicare Advantage,527.73,49,,percent of total billed charges,,
TAFLUPROST (PF) 0.0015 % OPHT DPET,,100251,LOCAL,Facility,Inpatient,1,Each,,387,328.95,110.9142,387,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
TAFLUPROST (PF) 0.0015 % OPHT DPET,,100251,LOCAL,Facility,Inpatient,1,Each,,1077,915.45,308.6682,1077,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
TAFLUPROST (PF) 0.0015 % OPHT DPET,,100251,LOCAL,Facility,Both,1,Each,,387,328.95,110.9142,387,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,342.7659,88.57,,percent of total billed charges,,
TAFLUPROST (PF) 0.0015 % OPHT DPET,,100251,LOCAL,Facility,Both,1,Each,,1077,915.45,308.6682,1077,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,953.8989,88.57,,percent of total billed charges,,
TAFLUPROST (PF) 0.0015 % OPHT DPET,,100251,LOCAL,Facility,Both,1,Each,,387,328.95,110.9142,387,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,110.9142,28.66,,percent of total billed charges,,
TAFLUPROST (PF) 0.0015 % OPHT DPET,,100251,LOCAL,Facility,Both,1,Each,,1077,915.45,308.6682,1077,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,308.6682,28.66,,percent of total billed charges,,
TAFLUPROST (PF) 0.0015 % OPHT DPET,,100251,LOCAL,Facility,Outpatient,1,Each,,387,328.95,110.9142,387,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),189.63,49,,percent of total billed charges,,
TAFLUPROST (PF) 0.0015 % OPHT DPET,,100251,LOCAL,Facility,Outpatient,1,Each,,1077,915.45,308.6682,1077,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),527.73,49,,percent of total billed charges,,
TAFLUPROST (PF) 0.0015 % OPHT DPET,,100251,LOCAL,Facility,Inpatient,1,Each,,387,328.95,110.9142,387,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
TAFLUPROST (PF) 0.0015 % OPHT DPET,,100251,LOCAL,Facility,Inpatient,1,Each,,1077,915.45,308.6682,1077,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
TAFLUPROST (PF) 0.0015 % OPHT DPET,,100251,LOCAL,Facility,Both,1,Each,,387,328.95,110.9142,387,CorVel,Worker's Compensation,387,100,,percent of total billed charges,,
TAFLUPROST (PF) 0.0015 % OPHT DPET,,100251,LOCAL,Facility,Both,1,Each,,1077,915.45,308.6682,1077,CorVel,Worker's Compensation,1077,100,,percent of total billed charges,,
TAFLUPROST (PF) 0.0015 % OPHT DPET,,100251,LOCAL,Facility,Both,1,Each,,387,328.95,110.9142,387,First Health Group Corporation,First Health Network,375.39,97,,percent of total billed charges,,
TAFLUPROST (PF) 0.0015 % OPHT DPET,,100251,LOCAL,Facility,Both,1,Each,,1077,915.45,308.6682,1077,First Health Group Corporation,First Health Network,1044.69,97,,percent of total billed charges,,
TAFLUPROST (PF) 0.0015 % OPHT DPET,,100251,LOCAL,Facility,Both,1,Each,,387,328.95,110.9142,387,"Health Partners, Inc.",Commercial,366.102,94.6,,percent of total billed charges,,
TAFLUPROST (PF) 0.0015 % OPHT DPET,,100251,LOCAL,Facility,Both,1,Each,,1077,915.45,308.6682,1077,"Health Partners, Inc.",Commercial,1018.842,94.6,,percent of total billed charges,,
TAFLUPROST (PF) 0.0015 % OPHT DPET,,100251,LOCAL,Facility,Outpatient,1,Each,,387,328.95,110.9142,387,"Health Partners, Inc.",Medicare Advantage,189.63,49,,percent of total billed charges,,
TAFLUPROST (PF) 0.0015 % OPHT DPET,,100251,LOCAL,Facility,Outpatient,1,Each,,1077,915.45,308.6682,1077,"Health Partners, Inc.",Medicare Advantage,527.73,49,,percent of total billed charges,,
TAFLUPROST (PF) 0.0015 % OPHT DPET,,100251,LOCAL,Facility,Inpatient,1,Each,,387,328.95,110.9142,387,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
TAFLUPROST (PF) 0.0015 % OPHT DPET,,100251,LOCAL,Facility,Inpatient,1,Each,,1077,915.45,308.6682,1077,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
TAFLUPROST (PF) 0.0015 % OPHT DPET,,100251,LOCAL,Facility,Both,1,Each,,387,328.95,110.9142,387,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),232.2,60,,percent of total billed charges,,
TAFLUPROST (PF) 0.0015 % OPHT DPET,,100251,LOCAL,Facility,Both,1,Each,,1077,915.45,308.6682,1077,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),646.2,60,,percent of total billed charges,,
TAFLUPROST (PF) 0.0015 % OPHT DPET,,100251,LOCAL,Facility,Both,1,Each,,387,328.95,110.9142,387,"Health Partners, Inc.",State of Minnesota Advantage Program,315.405,81.5,,percent of total billed charges,,
TAFLUPROST (PF) 0.0015 % OPHT DPET,,100251,LOCAL,Facility,Both,1,Each,,1077,915.45,308.6682,1077,"Health Partners, Inc.",State of Minnesota Advantage Program,877.755,81.5,,percent of total billed charges,,
TAFLUPROST (PF) 0.0015 % OPHT DPET,,100251,LOCAL,Facility,Both,1,Each,,387,328.95,110.9142,387,"Health Partners, Inc.",State Public Programs,193.5,50,,percent of total billed charges,,
TAFLUPROST (PF) 0.0015 % OPHT DPET,,100251,LOCAL,Facility,Both,1,Each,,1077,915.45,308.6682,1077,"Health Partners, Inc.",State Public Programs,538.5,50,,percent of total billed charges,,
TAFLUPROST (PF) 0.0015 % OPHT DPET,,100251,LOCAL,Facility,Both,1,Each,,387,328.95,110.9142,387,Humana Insurance Company,Commercial PPO,367.65,95,,percent of total billed charges,,
TAFLUPROST (PF) 0.0015 % OPHT DPET,,100251,LOCAL,Facility,Both,1,Each,,1077,915.45,308.6682,1077,Humana Insurance Company,Commercial PPO,1023.15,95,,percent of total billed charges,,
TAFLUPROST (PF) 0.0015 % OPHT DPET,,100251,LOCAL,Facility,Outpatient,1,Each,,387,328.95,110.9142,387,Humana Insurance Company,Medicare PPO,189.63,49,,percent of total billed charges,,
TAFLUPROST (PF) 0.0015 % OPHT DPET,,100251,LOCAL,Facility,Outpatient,1,Each,,1077,915.45,308.6682,1077,Humana Insurance Company,Medicare PPO,527.73,49,,percent of total billed charges,,
TAFLUPROST (PF) 0.0015 % OPHT DPET,,100251,LOCAL,Facility,Inpatient,1,Each,,387,328.95,110.9142,387,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
TAFLUPROST (PF) 0.0015 % OPHT DPET,,100251,LOCAL,Facility,Inpatient,1,Each,,1077,915.45,308.6682,1077,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
TAFLUPROST (PF) 0.0015 % OPHT DPET,,100251,LOCAL,Facility,Both,1,Each,,387,328.95,110.9142,387,Medica,Individual & Family,383.517,99.1,,percent of total billed charges,,
TAFLUPROST (PF) 0.0015 % OPHT DPET,,100251,LOCAL,Facility,Both,1,Each,,1077,915.45,308.6682,1077,Medica,Individual & Family,1067.307,99.1,,percent of total billed charges,,
TAFLUPROST (PF) 0.0015 % OPHT DPET,,100251,LOCAL,Facility,Outpatient,1,Each,,387,328.95,110.9142,387,Medica,Medica Advantage Solution,192.726,49.8,,percent of total billed charges,,
TAFLUPROST (PF) 0.0015 % OPHT DPET,,100251,LOCAL,Facility,Outpatient,1,Each,,1077,915.45,308.6682,1077,Medica,Medica Advantage Solution,536.346,49.8,,percent of total billed charges,,
TAFLUPROST (PF) 0.0015 % OPHT DPET,,100251,LOCAL,Facility,Inpatient,1,Each,,387,328.95,110.9142,387,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
TAFLUPROST (PF) 0.0015 % OPHT DPET,,100251,LOCAL,Facility,Inpatient,1,Each,,1077,915.45,308.6682,1077,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
TAFLUPROST (PF) 0.0015 % OPHT DPET,,100251,LOCAL,Facility,Outpatient,1,Each,,387,328.95,110.9142,387,Medica,Medical Assistance,172.602,44.6,,percent of total billed charges,,
TAFLUPROST (PF) 0.0015 % OPHT DPET,,100251,LOCAL,Facility,Outpatient,1,Each,,1077,915.45,308.6682,1077,Medica,Medical Assistance,480.342,44.6,,percent of total billed charges,,
TAFLUPROST (PF) 0.0015 % OPHT DPET,,100251,LOCAL,Facility,Inpatient,1,Each,,387,328.95,110.9142,387,Medica,Medical Assistance,,,,,Included in per diem rate,
TAFLUPROST (PF) 0.0015 % OPHT DPET,,100251,LOCAL,Facility,Inpatient,1,Each,,1077,915.45,308.6682,1077,Medica,Medical Assistance,,,,,Included in per diem rate,
TAFLUPROST (PF) 0.0015 % OPHT DPET,,100251,LOCAL,Facility,Outpatient,1,Each,,387,328.95,110.9142,387,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,192.726,49.8,,percent of total billed charges,,
TAFLUPROST (PF) 0.0015 % OPHT DPET,,100251,LOCAL,Facility,Outpatient,1,Each,,1077,915.45,308.6682,1077,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,536.346,49.8,,percent of total billed charges,,
TAFLUPROST (PF) 0.0015 % OPHT DPET,,100251,LOCAL,Facility,Inpatient,1,Each,,387,328.95,110.9142,387,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
TAFLUPROST (PF) 0.0015 % OPHT DPET,,100251,LOCAL,Facility,Inpatient,1,Each,,1077,915.45,308.6682,1077,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
TAFLUPROST (PF) 0.0015 % OPHT DPET,,100251,LOCAL,Facility,Both,1,Each,,387,328.95,110.9142,387,"Multiplan, Inc.","Multiplan, Inc.",363.78,94,,percent of total billed charges,,
TAFLUPROST (PF) 0.0015 % OPHT DPET,,100251,LOCAL,Facility,Both,1,Each,,1077,915.45,308.6682,1077,"Multiplan, Inc.","Multiplan, Inc.",1012.38,94,,percent of total billed charges,,
TAFLUPROST (PF) 0.0015 % OPHT DPET,,100251,LOCAL,Facility,Outpatient,1,Each,,387,328.95,110.9142,387,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,348.687,90.1,,percent of total billed charges,,
TAFLUPROST (PF) 0.0015 % OPHT DPET,,100251,LOCAL,Facility,Outpatient,1,Each,,1077,915.45,308.6682,1077,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,970.377,90.1,,percent of total billed charges,,
TAFLUPROST (PF) 0.0015 % OPHT DPET,,100251,LOCAL,Facility,Inpatient,1,Each,,387,328.95,110.9142,387,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
TAFLUPROST (PF) 0.0015 % OPHT DPET,,100251,LOCAL,Facility,Inpatient,1,Each,,1077,915.45,308.6682,1077,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
TAFLUPROST (PF) 0.0015 % OPHT DPET,,100251,LOCAL,Facility,Both,1,Each,,387,328.95,110.9142,387,"Preferred One Administrative Services, INC.",PPO,381.582,98.6,,percent of total billed charges,,
TAFLUPROST (PF) 0.0015 % OPHT DPET,,100251,LOCAL,Facility,Both,1,Each,,1077,915.45,308.6682,1077,"Preferred One Administrative Services, INC.",PPO,1061.922,98.6,,percent of total billed charges,,
TAFLUPROST (PF) 0.0015 % OPHT DPET,,100251,LOCAL,Facility,Outpatient,1,Each,,387,328.95,110.9142,387,PrimeWest Health,Minnesota Senior Health Options (MSHO),199.1115,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
TAFLUPROST (PF) 0.0015 % OPHT DPET,,100251,LOCAL,Facility,Outpatient,1,Each,,1077,915.45,308.6682,1077,PrimeWest Health,Minnesota Senior Health Options (MSHO),554.1165,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
TAFLUPROST (PF) 0.0015 % OPHT DPET,,100251,LOCAL,Facility,Inpatient,1,Each,,387,328.95,110.9142,387,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
TAFLUPROST (PF) 0.0015 % OPHT DPET,,100251,LOCAL,Facility,Inpatient,1,Each,,1077,915.45,308.6682,1077,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
TAFLUPROST (PF) 0.0015 % OPHT DPET,,100251,LOCAL,Facility,Outpatient,1,Each,,387,328.95,110.9142,387,PrimeWest Health,MinnesotaCare,198.7632,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
TAFLUPROST (PF) 0.0015 % OPHT DPET,,100251,LOCAL,Facility,Outpatient,1,Each,,1077,915.45,308.6682,1077,PrimeWest Health,MinnesotaCare,553.1472,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
TAFLUPROST (PF) 0.0015 % OPHT DPET,,100251,LOCAL,Facility,Inpatient,1,Each,,387,328.95,110.9142,387,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
TAFLUPROST (PF) 0.0015 % OPHT DPET,,100251,LOCAL,Facility,Inpatient,1,Each,,1077,915.45,308.6682,1077,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
TAFLUPROST (PF) 0.0015 % OPHT DPET,,100251,LOCAL,Facility,Both,1,Each,,387,328.95,110.9142,387,Sanford Health Plan,Sanford Health Plan,356.04,92,,percent of total billed charges,,
TAFLUPROST (PF) 0.0015 % OPHT DPET,,100251,LOCAL,Facility,Both,1,Each,,1077,915.45,308.6682,1077,Sanford Health Plan,Sanford Health Plan,990.84,92,,percent of total billed charges,,
TAFLUPROST (PF) 0.0015 % OPHT DPET,,100251,LOCAL,Facility,Outpatient,1,Each,,387,328.95,110.9142,387,"UCare Health, Inc.",Individual & Family Plan,218.0745,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
TAFLUPROST (PF) 0.0015 % OPHT DPET,,100251,LOCAL,Facility,Outpatient,1,Each,,1077,915.45,308.6682,1077,"UCare Health, Inc.",Individual & Family Plan,606.8895,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
TAFLUPROST (PF) 0.0015 % OPHT DPET,,100251,LOCAL,Facility,Inpatient,1,Each,,387,328.95,110.9142,387,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
TAFLUPROST (PF) 0.0015 % OPHT DPET,,100251,LOCAL,Facility,Inpatient,1,Each,,1077,915.45,308.6682,1077,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
TAFLUPROST (PF) 0.0015 % OPHT DPET,,100251,LOCAL,Facility,Outpatient,1,Each,,387,328.95,110.9142,387,"UCare Health, Inc.",Medical Assistance,195.3189,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TAFLUPROST (PF) 0.0015 % OPHT DPET,,100251,LOCAL,Facility,Outpatient,1,Each,,1077,915.45,308.6682,1077,"UCare Health, Inc.",Medical Assistance,543.5619,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TAFLUPROST (PF) 0.0015 % OPHT DPET,,100251,LOCAL,Facility,Inpatient,1,Each,,387,328.95,110.9142,387,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
TAFLUPROST (PF) 0.0015 % OPHT DPET,,100251,LOCAL,Facility,Inpatient,1,Each,,1077,915.45,308.6682,1077,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
TAFLUPROST (PF) 0.0015 % OPHT DPET,,100251,LOCAL,Facility,Outpatient,1,Each,,387,328.95,110.9142,387,"UCare Health, Inc.",Medicare Advantage,195.3189,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TAFLUPROST (PF) 0.0015 % OPHT DPET,,100251,LOCAL,Facility,Outpatient,1,Each,,1077,915.45,308.6682,1077,"UCare Health, Inc.",Medicare Advantage,543.5619,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TAFLUPROST (PF) 0.0015 % OPHT DPET,,100251,LOCAL,Facility,Inpatient,1,Each,,387,328.95,110.9142,387,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
TAFLUPROST (PF) 0.0015 % OPHT DPET,,100251,LOCAL,Facility,Inpatient,1,Each,,1077,915.45,308.6682,1077,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
TAFLUPROST (PF) 0.0015 % OPHT DPET,,100251,LOCAL,Facility,Outpatient,1,Each,,387,328.95,110.9142,387,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),195.3189,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TAFLUPROST (PF) 0.0015 % OPHT DPET,,100251,LOCAL,Facility,Outpatient,1,Each,,1077,915.45,308.6682,1077,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),543.5619,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TAFLUPROST (PF) 0.0015 % OPHT DPET,,100251,LOCAL,Facility,Inpatient,1,Each,,387,328.95,110.9142,387,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
TAFLUPROST (PF) 0.0015 % OPHT DPET,,100251,LOCAL,Facility,Inpatient,1,Each,,1077,915.45,308.6682,1077,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
TAFLUPROST (PF) 0.0015 % OPHT DPET,,100251,LOCAL,Facility,Both,1,Each,,387,328.95,110.9142,387,UnitedHealthcare,Individual & Family,363.78,94,,percent of total billed charges,,
TAFLUPROST (PF) 0.0015 % OPHT DPET,,100251,LOCAL,Facility,Both,1,Each,,1077,915.45,308.6682,1077,UnitedHealthcare,Individual & Family,1012.38,94,,percent of total billed charges,,
TAFLUPROST (PF) 0.0015 % OPHT DPET,,100251,LOCAL,Facility,Outpatient,1,Each,,387,328.95,110.9142,387,UnitedHealthcare,Medicare Advantage,189.63,49,,percent of total billed charges,,
TAFLUPROST (PF) 0.0015 % OPHT DPET,,100251,LOCAL,Facility,Outpatient,1,Each,,1077,915.45,308.6682,1077,UnitedHealthcare,Medicare Advantage,527.73,49,,percent of total billed charges,,
TAFLUPROST (PF) 0.0015 % OPHT DPET,,100251,LOCAL,Facility,Inpatient,1,Each,,387,328.95,110.9142,387,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
TAFLUPROST (PF) 0.0015 % OPHT DPET,,100251,LOCAL,Facility,Inpatient,1,Each,,1077,915.45,308.6682,1077,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
TAFLUPROST (PF) 0.0015 % OPHT DPET,,100251,LOCAL,Facility,Outpatient,1,Each,,387,328.95,110.9142,387,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,185.76,48,,percent of total billed charges,,100% of DHS outpatient percentage
TAFLUPROST (PF) 0.0015 % OPHT DPET,,100251,LOCAL,Facility,Outpatient,1,Each,,1077,915.45,308.6682,1077,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,516.96,48,,percent of total billed charges,,100% of DHS outpatient percentage
TAFLUPROST (PF) 0.0015 % OPHT DPET,,100251,LOCAL,Facility,Inpatient,1,Each,,387,328.95,110.9142,387,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
TAFLUPROST (PF) 0.0015 % OPHT DPET,,100251,LOCAL,Facility,Inpatient,1,Each,,1077,915.45,308.6682,1077,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Destruction, Premalignant Lesion; First Lesion",,17000,CPT,Facility,Both,,,,90,76.5,25.794,90,Aetna,Commercial,82.8,92,,percent of total billed charges,,
"Destruction, Premalignant Lesion; First Lesion",,17000,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,Aetna,Medicare Advantage,44.1,49,,percent of total billed charges,,
"Destruction, Premalignant Lesion; First Lesion",,17000,CPT,Facility,Inpatient,,,,90,76.5,25.794,90,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Destruction, Premalignant Lesion; First Lesion",,17000,CPT,Facility,Both,,,,90,76.5,25.794,90,Aetna,PPO,83.7,93,,percent of total billed charges,,
"Destruction, Premalignant Lesion; First Lesion",,17000,CPT,Facility,Both,,,,90,76.5,25.794,90,America's PPO,America's PPO,86.427,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Destruction, Premalignant Lesion; First Lesion",,17000,CPT,Facility,Both,,,,90,76.5,25.794,90,BlueCross BlueShield Minnesota, Federal Employee Program,88.56,98.4,,percent of total billed charges,,
"Destruction, Premalignant Lesion; First Lesion",,17000,CPT,Facility,Both,,,,90,76.5,25.794,90,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,90,100,,percent of total billed charges,,
"Destruction, Premalignant Lesion; First Lesion",,17000,CPT,Facility,Both,,,,90,76.5,25.794,90,BlueCross BlueShield Minnesota,High Value Network Plan,81,90,,percent of total billed charges,,
"Destruction, Premalignant Lesion; First Lesion",,17000,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,BlueCross BlueShield Minnesota,Medicare Advantage,44.1,49,,percent of total billed charges,,
"Destruction, Premalignant Lesion; First Lesion",,17000,CPT,Facility,Inpatient,,,,90,76.5,25.794,90,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Destruction, Premalignant Lesion; First Lesion",,17000,CPT,Facility,Both,,,,90,76.5,25.794,90,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,79.713,88.57,,percent of total billed charges,,
"Destruction, Premalignant Lesion; First Lesion",,17000,CPT,Facility,Both,,,,90,76.5,25.794,90,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,25.794,28.66,,percent of total billed charges,,
"Destruction, Premalignant Lesion; First Lesion",,17000,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),44.1,49,,percent of total billed charges,,
"Destruction, Premalignant Lesion; First Lesion",,17000,CPT,Facility,Inpatient,,,,90,76.5,25.794,90,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Destruction, Premalignant Lesion; First Lesion",,17000,CPT,Facility,Both,,,,90,76.5,25.794,90,CorVel,Worker's Compensation,90,100,,percent of total billed charges,,
"Destruction, Premalignant Lesion; First Lesion",,17000,CPT,Facility,Both,,,,90,76.5,25.794,90,First Health Group Corporation,First Health Network,87.3,97,,percent of total billed charges,,
"Destruction, Premalignant Lesion; First Lesion",,17000,CPT,Facility,Both,,,,90,76.5,25.794,90,"Health Partners, Inc.",Commercial,85.14,94.6,,percent of total billed charges,,
"Destruction, Premalignant Lesion; First Lesion",,17000,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,"Health Partners, Inc.",Medicare Advantage,44.1,49,,percent of total billed charges,,
"Destruction, Premalignant Lesion; First Lesion",,17000,CPT,Facility,Inpatient,,,,90,76.5,25.794,90,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Destruction, Premalignant Lesion; First Lesion",,17000,CPT,Facility,Both,,,,90,76.5,25.794,90,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),54,60,,percent of total billed charges,,
"Destruction, Premalignant Lesion; First Lesion",,17000,CPT,Facility,Both,,,,90,76.5,25.794,90,"Health Partners, Inc.",State of Minnesota Advantage Program,73.35,81.5,,percent of total billed charges,,
"Destruction, Premalignant Lesion; First Lesion",,17000,CPT,Facility,Both,,,,90,76.5,25.794,90,"Health Partners, Inc.",State Public Programs,45,50,,percent of total billed charges,,
"Destruction, Premalignant Lesion; First Lesion",,17000,CPT,Facility,Both,,,,90,76.5,25.794,90,Humana Insurance Company,Commercial PPO,85.5,95,,percent of total billed charges,,
"Destruction, Premalignant Lesion; First Lesion",,17000,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,Humana Insurance Company,Medicare PPO,44.1,49,,percent of total billed charges,,
"Destruction, Premalignant Lesion; First Lesion",,17000,CPT,Facility,Inpatient,,,,90,76.5,25.794,90,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Destruction, Premalignant Lesion; First Lesion",,17000,CPT,Facility,Both,,,,90,76.5,25.794,90,Medica,Individual & Family,89.19,99.1,,percent of total billed charges,,
"Destruction, Premalignant Lesion; First Lesion",,17000,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,Medica,Medica Advantage Solution,44.82,49.8,,percent of total billed charges,,
"Destruction, Premalignant Lesion; First Lesion",,17000,CPT,Facility,Inpatient,,,,90,76.5,25.794,90,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Destruction, Premalignant Lesion; First Lesion",,17000,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,Medica,Medical Assistance,40.14,44.6,,percent of total billed charges,,
"Destruction, Premalignant Lesion; First Lesion",,17000,CPT,Facility,Inpatient,,,,90,76.5,25.794,90,Medica,Medical Assistance,,,,,Included in per diem rate,
"Destruction, Premalignant Lesion; First Lesion",,17000,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,44.82,49.8,,percent of total billed charges,,
"Destruction, Premalignant Lesion; First Lesion",,17000,CPT,Facility,Inpatient,,,,90,76.5,25.794,90,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Destruction, Premalignant Lesion; First Lesion",,17000,CPT,Facility,Both,,,,90,76.5,25.794,90,"Multiplan, Inc.","Multiplan, Inc.",84.6,94,,percent of total billed charges,,
"Destruction, Premalignant Lesion; First Lesion",,17000,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,81.09,90.1,,percent of total billed charges,,
"Destruction, Premalignant Lesion; First Lesion",,17000,CPT,Facility,Inpatient,,,,90,76.5,25.794,90,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Destruction, Premalignant Lesion; First Lesion",,17000,CPT,Facility,Both,,,,90,76.5,25.794,90,"Preferred One Administrative Services, INC.",PPO,88.74,98.6,,percent of total billed charges,,
"Destruction, Premalignant Lesion; First Lesion",,17000,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,PrimeWest Health,Minnesota Senior Health Options (MSHO),46.305,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Destruction, Premalignant Lesion; First Lesion",,17000,CPT,Facility,Inpatient,,,,90,76.5,25.794,90,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Destruction, Premalignant Lesion; First Lesion",,17000,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,PrimeWest Health,MinnesotaCare,46.224,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Destruction, Premalignant Lesion; First Lesion",,17000,CPT,Facility,Inpatient,,,,90,76.5,25.794,90,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Destruction, Premalignant Lesion; First Lesion",,17000,CPT,Facility,Both,,,,90,76.5,25.794,90,Sanford Health Plan,Sanford Health Plan,82.8,92,,percent of total billed charges,,
"Destruction, Premalignant Lesion; First Lesion",,17000,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,"UCare Health, Inc.",Individual & Family Plan,50.715,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Destruction, Premalignant Lesion; First Lesion",,17000,CPT,Facility,Inpatient,,,,90,76.5,25.794,90,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Destruction, Premalignant Lesion; First Lesion",,17000,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,"UCare Health, Inc.",Medical Assistance,45.423,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Destruction, Premalignant Lesion; First Lesion",,17000,CPT,Facility,Inpatient,,,,90,76.5,25.794,90,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Destruction, Premalignant Lesion; First Lesion",,17000,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,"UCare Health, Inc.",Medicare Advantage,45.423,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Destruction, Premalignant Lesion; First Lesion",,17000,CPT,Facility,Inpatient,,,,90,76.5,25.794,90,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Destruction, Premalignant Lesion; First Lesion",,17000,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),45.423,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Destruction, Premalignant Lesion; First Lesion",,17000,CPT,Facility,Inpatient,,,,90,76.5,25.794,90,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Destruction, Premalignant Lesion; First Lesion",,17000,CPT,Facility,Both,,,,90,76.5,25.794,90,UnitedHealthcare,Individual & Family,84.6,94,,percent of total billed charges,,
"Destruction, Premalignant Lesion; First Lesion",,17000,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,UnitedHealthcare,Medicare Advantage,44.1,49,,percent of total billed charges,,
"Destruction, Premalignant Lesion; First Lesion",,17000,CPT,Facility,Inpatient,,,,90,76.5,25.794,90,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Destruction, Premalignant Lesion; First Lesion",,17000,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,43.2,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Destruction, Premalignant Lesion; First Lesion",,17000,CPT,Facility,Inpatient,,,,90,76.5,25.794,90,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Destruction, Premalignant Lesions (Eg, Actinic Keratoses); First Lesion (Pro Cah)",,17000,CPT,Professional,Both,,,,125,106.25,34.9,125,Aetna,Commercial,106.25,85,,percent of total billed charges,,
"Destruction, Premalignant Lesions (Eg, Actinic Keratoses); First Lesion (Pro Cah)",,17000,CPT,Professional,Both,,,,125,106.25,34.9,125,Aetna,Medicare Advantage,53.71,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Destruction, Premalignant Lesions (Eg, Actinic Keratoses); First Lesion (Pro Cah)",,17000,CPT,Professional,Both,,,,125,106.25,34.9,125,Aetna,PPO,116.25,93,,percent of total billed charges,,
"Destruction, Premalignant Lesions (Eg, Actinic Keratoses); First Lesion (Pro Cah)",,17000,CPT,Professional,Both,,,,125,106.25,34.9,125,America's PPO,America's PPO,106.8,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Destruction, Premalignant Lesions (Eg, Actinic Keratoses); First Lesion (Pro Cah)",,17000,CPT,Professional,Both,,,,125,106.25,34.9,125,BlueCross BlueShield Minnesota, Federal Employee Program,112.24,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Destruction, Premalignant Lesions (Eg, Actinic Keratoses); First Lesion (Pro Cah)",,17000,CPT,Professional,Both,,,,125,106.25,34.9,125,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,114.03584,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Destruction, Premalignant Lesions (Eg, Actinic Keratoses); First Lesion (Pro Cah)",,17000,CPT,Professional,Both,,,,125,106.25,34.9,125,BlueCross BlueShield Minnesota,High Value Network Plan,114.03584,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Destruction, Premalignant Lesions (Eg, Actinic Keratoses); First Lesion (Pro Cah)",,17000,CPT,Professional,Both,,,,125,106.25,34.9,125,BlueCross BlueShield Minnesota,Medicare Advantage,62.652,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Destruction, Premalignant Lesions (Eg, Actinic Keratoses); First Lesion (Pro Cah)",,17000,CPT,Professional,Both,,,,125,106.25,34.9,125,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,114.03584,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Destruction, Premalignant Lesions (Eg, Actinic Keratoses); First Lesion (Pro Cah)",,17000,CPT,Professional,Both,,,,125,106.25,34.9,125,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,40.29456,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Destruction, Premalignant Lesions (Eg, Actinic Keratoses); First Lesion (Pro Cah)",,17000,CPT,Professional,Both,,,,125,106.25,34.9,125,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),62.652,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Destruction, Premalignant Lesions (Eg, Actinic Keratoses); First Lesion (Pro Cah)",,17000,CPT,Professional,Both,,,,125,106.25,34.9,125,CorVel,Worker's Compensation,105.913656,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Destruction, Premalignant Lesions (Eg, Actinic Keratoses); First Lesion (Pro Cah)",,17000,CPT,Professional,Both,,,,125,106.25,34.9,125,First Health Group Corporation,First Health Network,121.25,97,,percent of total billed charges,,
"Destruction, Premalignant Lesions (Eg, Actinic Keratoses); First Lesion (Pro Cah)",,17000,CPT,Professional,Both,,,,125,106.25,34.9,125,"Health Partners, Inc.",Commercial,113.9,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Destruction, Premalignant Lesions (Eg, Actinic Keratoses); First Lesion (Pro Cah)",,17000,CPT,Professional,Both,,,,125,106.25,34.9,125,"Health Partners, Inc.",Medicare Advantage,62.652,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Destruction, Premalignant Lesions (Eg, Actinic Keratoses); First Lesion (Pro Cah)",,17000,CPT,Professional,Both,,,,125,106.25,34.9,125,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),54.56,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Destruction, Premalignant Lesions (Eg, Actinic Keratoses); First Lesion (Pro Cah)",,17000,CPT,Professional,Both,,,,125,106.25,34.9,125,"Health Partners, Inc.",State of Minnesota Advantage Program,98.12485,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Destruction, Premalignant Lesions (Eg, Actinic Keratoses); First Lesion (Pro Cah)",,17000,CPT,Professional,Both,,,,125,106.25,34.9,125,"Health Partners, Inc.",State Public Programs,34.9,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Destruction, Premalignant Lesions (Eg, Actinic Keratoses); First Lesion (Pro Cah)",,17000,CPT,Professional,Both,,,,125,106.25,34.9,125,Humana Insurance Company,Commercial PPO,54.48,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Destruction, Premalignant Lesions (Eg, Actinic Keratoses); First Lesion (Pro Cah)",,17000,CPT,Professional,Both,,,,125,106.25,34.9,125,Humana Insurance Company,Medicare PPO,125,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Destruction, Premalignant Lesions (Eg, Actinic Keratoses); First Lesion (Pro Cah)",,17000,CPT,Professional,Both,,,,125,106.25,34.9,125,Medica,Individual & Family,106,84.8,,percent of total billed charges,,
"Destruction, Premalignant Lesions (Eg, Actinic Keratoses); First Lesion (Pro Cah)",,17000,CPT,Professional,Both,,,,125,106.25,34.9,125,Medica,Medica Advantage Solution,62.25,49.8,,percent of total billed charges,,
"Destruction, Premalignant Lesions (Eg, Actinic Keratoses); First Lesion (Pro Cah)",,17000,CPT,Professional,Both,,,,125,106.25,34.9,125,Medica,Medical Assistance,40.29,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Destruction, Premalignant Lesions (Eg, Actinic Keratoses); First Lesion (Pro Cah)",,17000,CPT,Professional,Both,,,,125,106.25,34.9,125,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,54.48,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Destruction, Premalignant Lesions (Eg, Actinic Keratoses); First Lesion (Pro Cah)",,17000,CPT,Professional,Both,,,,125,106.25,34.9,125,"Multiplan, Inc.","Multiplan, Inc.",117.5,94,,percent of total billed charges,,
"Destruction, Premalignant Lesions (Eg, Actinic Keratoses); First Lesion (Pro Cah)",,17000,CPT,Professional,Both,,,,125,106.25,34.9,125,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,112.625,90.1,,percent of total billed charges,,
"Destruction, Premalignant Lesions (Eg, Actinic Keratoses); First Lesion (Pro Cah)",,17000,CPT,Professional,Both,,,,125,106.25,34.9,125,"Preferred One Administrative Services, INC.",PPO,123.25,98.6,,percent of total billed charges,,
"Destruction, Premalignant Lesions (Eg, Actinic Keratoses); First Lesion (Pro Cah)",,17000,CPT,Professional,Both,,,,125,106.25,34.9,125,PrimeWest Health,Minnesota Senior Health Options (MSHO),62.652,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Destruction, Premalignant Lesions (Eg, Actinic Keratoses); First Lesion (Pro Cah)",,17000,CPT,Professional,Both,,,,125,106.25,34.9,125,PrimeWest Health,MinnesotaCare,43.1151792,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Destruction, Premalignant Lesions (Eg, Actinic Keratoses); First Lesion (Pro Cah)",,17000,CPT,Professional,Both,,,,125,106.25,34.9,125,Sanford Health Plan,Sanford Health Plan,110,88,,percent of total billed charges,,
"Destruction, Premalignant Lesions (Eg, Actinic Keratoses); First Lesion (Pro Cah)",,17000,CPT,Professional,Both,,,,125,106.25,34.9,125,"UCare Health, Inc.",Individual & Family Plan,88.562688,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Destruction, Premalignant Lesions (Eg, Actinic Keratoses); First Lesion (Pro Cah)",,17000,CPT,Professional,Both,,,,125,106.25,34.9,125,"UCare Health, Inc.",Medical Assistance,44.324016,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Destruction, Premalignant Lesions (Eg, Actinic Keratoses); First Lesion (Pro Cah)",,17000,CPT,Professional,Both,,,,125,106.25,34.9,125,"UCare Health, Inc.",Medicare Advantage,62.652,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Destruction, Premalignant Lesions (Eg, Actinic Keratoses); First Lesion (Pro Cah)",,17000,CPT,Professional,Both,,,,125,106.25,34.9,125,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),50.1216,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Destruction, Premalignant Lesions (Eg, Actinic Keratoses); First Lesion (Pro Cah)",,17000,CPT,Professional,Both,,,,125,106.25,34.9,125,UnitedHealthcare,Individual & Family,125,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Destruction, Premalignant Lesions (Eg, Actinic Keratoses); First Lesion (Pro Cah)",,17000,CPT,Professional,Both,,,,125,106.25,34.9,125,UnitedHealthcare,Medicare Advantage,62.652,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Destruction, Premalignant Lesions (Eg, Actinic Keratoses); First Lesion (Pro Cah)",,17000,CPT,Professional,Both,,,,125,106.25,34.9,125,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,40.29456,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Destruction, Premalignant Lesions, 2-14 Lesions, Each",,17003,CPT,Facility,Both,,,,24,20.4,6.8784,24,Aetna,Commercial,22.08,92,,percent of total billed charges,,
"Destruction, Premalignant Lesions, 2-14 Lesions, Each",,17003,CPT,Facility,Outpatient,,,,24,20.4,6.8784,24,Aetna,Medicare Advantage,11.76,49,,percent of total billed charges,,
"Destruction, Premalignant Lesions, 2-14 Lesions, Each",,17003,CPT,Facility,Inpatient,,,,24,20.4,6.8784,24,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Destruction, Premalignant Lesions, 2-14 Lesions, Each",,17003,CPT,Facility,Both,,,,24,20.4,6.8784,24,Aetna,PPO,22.32,93,,percent of total billed charges,,
"Destruction, Premalignant Lesions, 2-14 Lesions, Each",,17003,CPT,Facility,Both,,,,24,20.4,6.8784,24,America's PPO,America's PPO,23.0472,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Destruction, Premalignant Lesions, 2-14 Lesions, Each",,17003,CPT,Facility,Both,,,,24,20.4,6.8784,24,BlueCross BlueShield Minnesota, Federal Employee Program,23.616,98.4,,percent of total billed charges,,
"Destruction, Premalignant Lesions, 2-14 Lesions, Each",,17003,CPT,Facility,Both,,,,24,20.4,6.8784,24,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,24,100,,percent of total billed charges,,
"Destruction, Premalignant Lesions, 2-14 Lesions, Each",,17003,CPT,Facility,Both,,,,24,20.4,6.8784,24,BlueCross BlueShield Minnesota,High Value Network Plan,21.6,90,,percent of total billed charges,,
"Destruction, Premalignant Lesions, 2-14 Lesions, Each",,17003,CPT,Facility,Outpatient,,,,24,20.4,6.8784,24,BlueCross BlueShield Minnesota,Medicare Advantage,11.76,49,,percent of total billed charges,,
"Destruction, Premalignant Lesions, 2-14 Lesions, Each",,17003,CPT,Facility,Inpatient,,,,24,20.4,6.8784,24,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Destruction, Premalignant Lesions, 2-14 Lesions, Each",,17003,CPT,Facility,Both,,,,24,20.4,6.8784,24,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,21.2568,88.57,,percent of total billed charges,,
"Destruction, Premalignant Lesions, 2-14 Lesions, Each",,17003,CPT,Facility,Both,,,,24,20.4,6.8784,24,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,6.8784,28.66,,percent of total billed charges,,
"Destruction, Premalignant Lesions, 2-14 Lesions, Each",,17003,CPT,Facility,Outpatient,,,,24,20.4,6.8784,24,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),11.76,49,,percent of total billed charges,,
"Destruction, Premalignant Lesions, 2-14 Lesions, Each",,17003,CPT,Facility,Inpatient,,,,24,20.4,6.8784,24,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Destruction, Premalignant Lesions, 2-14 Lesions, Each",,17003,CPT,Facility,Both,,,,24,20.4,6.8784,24,CorVel,Worker's Compensation,24,100,,percent of total billed charges,,
"Destruction, Premalignant Lesions, 2-14 Lesions, Each",,17003,CPT,Facility,Both,,,,24,20.4,6.8784,24,First Health Group Corporation,First Health Network,23.28,97,,percent of total billed charges,,
"Destruction, Premalignant Lesions, 2-14 Lesions, Each",,17003,CPT,Facility,Both,,,,24,20.4,6.8784,24,"Health Partners, Inc.",Commercial,22.704,94.6,,percent of total billed charges,,
"Destruction, Premalignant Lesions, 2-14 Lesions, Each",,17003,CPT,Facility,Outpatient,,,,24,20.4,6.8784,24,"Health Partners, Inc.",Medicare Advantage,11.76,49,,percent of total billed charges,,
"Destruction, Premalignant Lesions, 2-14 Lesions, Each",,17003,CPT,Facility,Inpatient,,,,24,20.4,6.8784,24,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Destruction, Premalignant Lesions, 2-14 Lesions, Each",,17003,CPT,Facility,Both,,,,24,20.4,6.8784,24,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),14.4,60,,percent of total billed charges,,
"Destruction, Premalignant Lesions, 2-14 Lesions, Each",,17003,CPT,Facility,Both,,,,24,20.4,6.8784,24,"Health Partners, Inc.",State of Minnesota Advantage Program,19.56,81.5,,percent of total billed charges,,
"Destruction, Premalignant Lesions, 2-14 Lesions, Each",,17003,CPT,Facility,Both,,,,24,20.4,6.8784,24,"Health Partners, Inc.",State Public Programs,12,50,,percent of total billed charges,,
"Destruction, Premalignant Lesions, 2-14 Lesions, Each",,17003,CPT,Facility,Both,,,,24,20.4,6.8784,24,Humana Insurance Company,Commercial PPO,22.8,95,,percent of total billed charges,,
"Destruction, Premalignant Lesions, 2-14 Lesions, Each",,17003,CPT,Facility,Outpatient,,,,24,20.4,6.8784,24,Humana Insurance Company,Medicare PPO,11.76,49,,percent of total billed charges,,
"Destruction, Premalignant Lesions, 2-14 Lesions, Each",,17003,CPT,Facility,Inpatient,,,,24,20.4,6.8784,24,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Destruction, Premalignant Lesions, 2-14 Lesions, Each",,17003,CPT,Facility,Both,,,,24,20.4,6.8784,24,Medica,Individual & Family,23.784,99.1,,percent of total billed charges,,
"Destruction, Premalignant Lesions, 2-14 Lesions, Each",,17003,CPT,Facility,Outpatient,,,,24,20.4,6.8784,24,Medica,Medica Advantage Solution,11.952,49.8,,percent of total billed charges,,
"Destruction, Premalignant Lesions, 2-14 Lesions, Each",,17003,CPT,Facility,Inpatient,,,,24,20.4,6.8784,24,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Destruction, Premalignant Lesions, 2-14 Lesions, Each",,17003,CPT,Facility,Outpatient,,,,24,20.4,6.8784,24,Medica,Medical Assistance,10.704,44.6,,percent of total billed charges,,
"Destruction, Premalignant Lesions, 2-14 Lesions, Each",,17003,CPT,Facility,Inpatient,,,,24,20.4,6.8784,24,Medica,Medical Assistance,,,,,Included in per diem rate,
"Destruction, Premalignant Lesions, 2-14 Lesions, Each",,17003,CPT,Facility,Outpatient,,,,24,20.4,6.8784,24,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,11.952,49.8,,percent of total billed charges,,
"Destruction, Premalignant Lesions, 2-14 Lesions, Each",,17003,CPT,Facility,Inpatient,,,,24,20.4,6.8784,24,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Destruction, Premalignant Lesions, 2-14 Lesions, Each",,17003,CPT,Facility,Both,,,,24,20.4,6.8784,24,"Multiplan, Inc.","Multiplan, Inc.",22.56,94,,percent of total billed charges,,
"Destruction, Premalignant Lesions, 2-14 Lesions, Each",,17003,CPT,Facility,Outpatient,,,,24,20.4,6.8784,24,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,21.624,90.1,,percent of total billed charges,,
"Destruction, Premalignant Lesions, 2-14 Lesions, Each",,17003,CPT,Facility,Inpatient,,,,24,20.4,6.8784,24,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Destruction, Premalignant Lesions, 2-14 Lesions, Each",,17003,CPT,Facility,Both,,,,24,20.4,6.8784,24,"Preferred One Administrative Services, INC.",PPO,23.664,98.6,,percent of total billed charges,,
"Destruction, Premalignant Lesions, 2-14 Lesions, Each",,17003,CPT,Facility,Outpatient,,,,24,20.4,6.8784,24,PrimeWest Health,Minnesota Senior Health Options (MSHO),12.348,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Destruction, Premalignant Lesions, 2-14 Lesions, Each",,17003,CPT,Facility,Inpatient,,,,24,20.4,6.8784,24,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Destruction, Premalignant Lesions, 2-14 Lesions, Each",,17003,CPT,Facility,Outpatient,,,,24,20.4,6.8784,24,PrimeWest Health,MinnesotaCare,12.3264,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Destruction, Premalignant Lesions, 2-14 Lesions, Each",,17003,CPT,Facility,Inpatient,,,,24,20.4,6.8784,24,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Destruction, Premalignant Lesions, 2-14 Lesions, Each",,17003,CPT,Facility,Both,,,,24,20.4,6.8784,24,Sanford Health Plan,Sanford Health Plan,22.08,92,,percent of total billed charges,,
"Destruction, Premalignant Lesions, 2-14 Lesions, Each",,17003,CPT,Facility,Outpatient,,,,24,20.4,6.8784,24,"UCare Health, Inc.",Individual & Family Plan,13.524,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Destruction, Premalignant Lesions, 2-14 Lesions, Each",,17003,CPT,Facility,Inpatient,,,,24,20.4,6.8784,24,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Destruction, Premalignant Lesions, 2-14 Lesions, Each",,17003,CPT,Facility,Outpatient,,,,24,20.4,6.8784,24,"UCare Health, Inc.",Medical Assistance,12.1128,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Destruction, Premalignant Lesions, 2-14 Lesions, Each",,17003,CPT,Facility,Inpatient,,,,24,20.4,6.8784,24,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Destruction, Premalignant Lesions, 2-14 Lesions, Each",,17003,CPT,Facility,Outpatient,,,,24,20.4,6.8784,24,"UCare Health, Inc.",Medicare Advantage,12.1128,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Destruction, Premalignant Lesions, 2-14 Lesions, Each",,17003,CPT,Facility,Inpatient,,,,24,20.4,6.8784,24,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Destruction, Premalignant Lesions, 2-14 Lesions, Each",,17003,CPT,Facility,Outpatient,,,,24,20.4,6.8784,24,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),12.1128,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Destruction, Premalignant Lesions, 2-14 Lesions, Each",,17003,CPT,Facility,Inpatient,,,,24,20.4,6.8784,24,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Destruction, Premalignant Lesions, 2-14 Lesions, Each",,17003,CPT,Facility,Both,,,,24,20.4,6.8784,24,UnitedHealthcare,Individual & Family,22.56,94,,percent of total billed charges,,
"Destruction, Premalignant Lesions, 2-14 Lesions, Each",,17003,CPT,Facility,Outpatient,,,,24,20.4,6.8784,24,UnitedHealthcare,Medicare Advantage,11.76,49,,percent of total billed charges,,
"Destruction, Premalignant Lesions, 2-14 Lesions, Each",,17003,CPT,Facility,Inpatient,,,,24,20.4,6.8784,24,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Destruction, Premalignant Lesions, 2-14 Lesions, Each",,17003,CPT,Facility,Outpatient,,,,24,20.4,6.8784,24,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,11.52,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Destruction, Premalignant Lesions, 2-14 Lesions, Each",,17003,CPT,Facility,Inpatient,,,,24,20.4,6.8784,24,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Destruction, Premalignant Lesions; Second Through 14 Lesions, Each (Pro Cah)",,17003,CPT,Professional,Both,,,,24,20.4,1.3,24,Aetna,Commercial,20.4,85,,percent of total billed charges,,
"Destruction, Premalignant Lesions; Second Through 14 Lesions, Each (Pro Cah)",,17003,CPT,Professional,Both,,,,24,20.4,1.3,24,Aetna,Medicare Advantage,2.1,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Destruction, Premalignant Lesions; Second Through 14 Lesions, Each (Pro Cah)",,17003,CPT,Professional,Both,,,,24,20.4,1.3,24,Aetna,PPO,22.32,93,,percent of total billed charges,,
"Destruction, Premalignant Lesions; Second Through 14 Lesions, Each (Pro Cah)",,17003,CPT,Professional,Both,,,,24,20.4,1.3,24,America's PPO,America's PPO,20.5056,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Destruction, Premalignant Lesions; Second Through 14 Lesions, Each (Pro Cah)",,17003,CPT,Professional,Both,,,,24,20.4,1.3,24,BlueCross BlueShield Minnesota, Federal Employee Program,4.13,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Destruction, Premalignant Lesions; Second Through 14 Lesions, Each (Pro Cah)",,17003,CPT,Professional,Both,,,,24,20.4,1.3,24,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,4.19608,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Destruction, Premalignant Lesions; Second Through 14 Lesions, Each (Pro Cah)",,17003,CPT,Professional,Both,,,,24,20.4,1.3,24,BlueCross BlueShield Minnesota,High Value Network Plan,4.19608,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Destruction, Premalignant Lesions; Second Through 14 Lesions, Each (Pro Cah)",,17003,CPT,Professional,Both,,,,24,20.4,1.3,24,BlueCross BlueShield Minnesota,Medicare Advantage,2.3575,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Destruction, Premalignant Lesions; Second Through 14 Lesions, Each (Pro Cah)",,17003,CPT,Professional,Both,,,,24,20.4,1.3,24,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.19608,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Destruction, Premalignant Lesions; Second Through 14 Lesions, Each (Pro Cah)",,17003,CPT,Professional,Both,,,,24,20.4,1.3,24,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.50368,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Destruction, Premalignant Lesions; Second Through 14 Lesions, Each (Pro Cah)",,17003,CPT,Professional,Both,,,,24,20.4,1.3,24,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.3575,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Destruction, Premalignant Lesions; Second Through 14 Lesions, Each (Pro Cah)",,17003,CPT,Professional,Both,,,,24,20.4,1.3,24,CorVel,Worker's Compensation,4.0476642,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Destruction, Premalignant Lesions; Second Through 14 Lesions, Each (Pro Cah)",,17003,CPT,Professional,Both,,,,24,20.4,1.3,24,First Health Group Corporation,First Health Network,23.28,97,,percent of total billed charges,,
"Destruction, Premalignant Lesions; Second Through 14 Lesions, Each (Pro Cah)",,17003,CPT,Professional,Both,,,,24,20.4,1.3,24,"Health Partners, Inc.",Commercial,4.35,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Destruction, Premalignant Lesions; Second Through 14 Lesions, Each (Pro Cah)",,17003,CPT,Professional,Both,,,,24,20.4,1.3,24,"Health Partners, Inc.",Medicare Advantage,2.3575,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Destruction, Premalignant Lesions; Second Through 14 Lesions, Each (Pro Cah)",,17003,CPT,Professional,Both,,,,24,20.4,1.3,24,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),2.03,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Destruction, Premalignant Lesions; Second Through 14 Lesions, Each (Pro Cah)",,17003,CPT,Professional,Both,,,,24,20.4,1.3,24,"Health Partners, Inc.",State of Minnesota Advantage Program,3.747525,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Destruction, Premalignant Lesions; Second Through 14 Lesions, Each (Pro Cah)",,17003,CPT,Professional,Both,,,,24,20.4,1.3,24,"Health Partners, Inc.",State Public Programs,1.3,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Destruction, Premalignant Lesions; Second Through 14 Lesions, Each (Pro Cah)",,17003,CPT,Professional,Both,,,,24,20.4,1.3,24,Humana Insurance Company,Commercial PPO,2.05,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Destruction, Premalignant Lesions; Second Through 14 Lesions, Each (Pro Cah)",,17003,CPT,Professional,Both,,,,24,20.4,1.3,24,Humana Insurance Company,Medicare PPO,24,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Destruction, Premalignant Lesions; Second Through 14 Lesions, Each (Pro Cah)",,17003,CPT,Professional,Both,,,,24,20.4,1.3,24,Medica,Individual & Family,20.352,84.8,,percent of total billed charges,,
"Destruction, Premalignant Lesions; Second Through 14 Lesions, Each (Pro Cah)",,17003,CPT,Professional,Both,,,,24,20.4,1.3,24,Medica,Medica Advantage Solution,11.952,49.8,,percent of total billed charges,,
"Destruction, Premalignant Lesions; Second Through 14 Lesions, Each (Pro Cah)",,17003,CPT,Professional,Both,,,,24,20.4,1.3,24,Medica,Medical Assistance,1.5,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Destruction, Premalignant Lesions; Second Through 14 Lesions, Each (Pro Cah)",,17003,CPT,Professional,Both,,,,24,20.4,1.3,24,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.05,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Destruction, Premalignant Lesions; Second Through 14 Lesions, Each (Pro Cah)",,17003,CPT,Professional,Both,,,,24,20.4,1.3,24,"Multiplan, Inc.","Multiplan, Inc.",22.56,94,,percent of total billed charges,,
"Destruction, Premalignant Lesions; Second Through 14 Lesions, Each (Pro Cah)",,17003,CPT,Professional,Both,,,,24,20.4,1.3,24,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,21.624,90.1,,percent of total billed charges,,
"Destruction, Premalignant Lesions; Second Through 14 Lesions, Each (Pro Cah)",,17003,CPT,Professional,Both,,,,24,20.4,1.3,24,"Preferred One Administrative Services, INC.",PPO,23.664,98.6,,percent of total billed charges,,
"Destruction, Premalignant Lesions; Second Through 14 Lesions, Each (Pro Cah)",,17003,CPT,Professional,Both,,,,24,20.4,1.3,24,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.3575,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Destruction, Premalignant Lesions; Second Through 14 Lesions, Each (Pro Cah)",,17003,CPT,Professional,Both,,,,24,20.4,1.3,24,PrimeWest Health,MinnesotaCare,1.6089376,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Destruction, Premalignant Lesions; Second Through 14 Lesions, Each (Pro Cah)",,17003,CPT,Professional,Both,,,,24,20.4,1.3,24,Sanford Health Plan,Sanford Health Plan,21.12,88,,percent of total billed charges,,
"Destruction, Premalignant Lesions; Second Through 14 Lesions, Each (Pro Cah)",,17003,CPT,Professional,Both,,,,24,20.4,1.3,24,"UCare Health, Inc.",Individual & Family Plan,3.33248,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Destruction, Premalignant Lesions; Second Through 14 Lesions, Each (Pro Cah)",,17003,CPT,Professional,Both,,,,24,20.4,1.3,24,"UCare Health, Inc.",Medical Assistance,1.654048,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Destruction, Premalignant Lesions; Second Through 14 Lesions, Each (Pro Cah)",,17003,CPT,Professional,Both,,,,24,20.4,1.3,24,"UCare Health, Inc.",Medicare Advantage,2.3575,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Destruction, Premalignant Lesions; Second Through 14 Lesions, Each (Pro Cah)",,17003,CPT,Professional,Both,,,,24,20.4,1.3,24,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1.886,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Destruction, Premalignant Lesions; Second Through 14 Lesions, Each (Pro Cah)",,17003,CPT,Professional,Both,,,,24,20.4,1.3,24,UnitedHealthcare,Individual & Family,24,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Destruction, Premalignant Lesions; Second Through 14 Lesions, Each (Pro Cah)",,17003,CPT,Professional,Both,,,,24,20.4,1.3,24,UnitedHealthcare,Medicare Advantage,2.3575,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Destruction, Premalignant Lesions; Second Through 14 Lesions, Each (Pro Cah)",,17003,CPT,Professional,Both,,,,24,20.4,1.3,24,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1.50368,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Destruction Premalignant Lesion; 15 Or More Lesions (Pro Cah),,17004,CPT,Professional,Both,,,,420,357,62.38,420,Aetna,Commercial,357,85,,percent of total billed charges,,
Destruction Premalignant Lesion; 15 Or More Lesions (Pro Cah),,17004,CPT,Professional,Both,,,,420,357,62.38,420,Aetna,Medicare Advantage,96.77,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Destruction Premalignant Lesion; 15 Or More Lesions (Pro Cah),,17004,CPT,Professional,Both,,,,420,357,62.38,420,Aetna,PPO,390.6,93,,percent of total billed charges,,
Destruction Premalignant Lesion; 15 Or More Lesions (Pro Cah),,17004,CPT,Professional,Both,,,,420,357,62.38,420,America's PPO,America's PPO,358.848,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Destruction Premalignant Lesion; 15 Or More Lesions (Pro Cah),,17004,CPT,Professional,Both,,,,420,357,62.38,420,BlueCross BlueShield Minnesota, Federal Employee Program,203.14,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Destruction Premalignant Lesion; 15 Or More Lesions (Pro Cah),,17004,CPT,Professional,Both,,,,420,357,62.38,420,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,206.39024,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Destruction Premalignant Lesion; 15 Or More Lesions (Pro Cah),,17004,CPT,Professional,Both,,,,420,357,62.38,420,BlueCross BlueShield Minnesota,High Value Network Plan,206.39024,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Destruction Premalignant Lesion; 15 Or More Lesions (Pro Cah),,17004,CPT,Professional,Both,,,,420,357,62.38,420,BlueCross BlueShield Minnesota,Medicare Advantage,111.5385,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Destruction Premalignant Lesion; 15 Or More Lesions (Pro Cah),,17004,CPT,Professional,Both,,,,420,357,62.38,420,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,206.39024,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Destruction Premalignant Lesion; 15 Or More Lesions (Pro Cah),,17004,CPT,Professional,Both,,,,420,357,62.38,420,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,72.02424,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Destruction Premalignant Lesion; 15 Or More Lesions (Pro Cah),,17004,CPT,Professional,Both,,,,420,357,62.38,420,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),111.5385,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Destruction Premalignant Lesion; 15 Or More Lesions (Pro Cah),,17004,CPT,Professional,Both,,,,420,357,62.38,420,CorVel,Worker's Compensation,186.7265547,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Destruction Premalignant Lesion; 15 Or More Lesions (Pro Cah),,17004,CPT,Professional,Both,,,,420,357,62.38,420,First Health Group Corporation,First Health Network,407.4,97,,percent of total billed charges,,
Destruction Premalignant Lesion; 15 Or More Lesions (Pro Cah),,17004,CPT,Professional,Both,,,,420,357,62.38,420,"Health Partners, Inc.",Commercial,201.7,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Destruction Premalignant Lesion; 15 Or More Lesions (Pro Cah),,17004,CPT,Professional,Both,,,,420,357,62.38,420,"Health Partners, Inc.",Medicare Advantage,111.5385,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Destruction Premalignant Lesion; 15 Or More Lesions (Pro Cah),,17004,CPT,Professional,Both,,,,420,357,62.38,420,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),97.26,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Destruction Premalignant Lesion; 15 Or More Lesions (Pro Cah),,17004,CPT,Professional,Both,,,,420,357,62.38,420,"Health Partners, Inc.",State of Minnesota Advantage Program,173.76455,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Destruction Premalignant Lesion; 15 Or More Lesions (Pro Cah),,17004,CPT,Professional,Both,,,,420,357,62.38,420,"Health Partners, Inc.",State Public Programs,62.38,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Destruction Premalignant Lesion; 15 Or More Lesions (Pro Cah),,17004,CPT,Professional,Both,,,,420,357,62.38,420,Humana Insurance Company,Commercial PPO,96.99,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Destruction Premalignant Lesion; 15 Or More Lesions (Pro Cah),,17004,CPT,Professional,Both,,,,420,357,62.38,420,Humana Insurance Company,Medicare PPO,420,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Destruction Premalignant Lesion; 15 Or More Lesions (Pro Cah),,17004,CPT,Professional,Both,,,,420,357,62.38,420,Medica,Individual & Family,356.16,84.8,,percent of total billed charges,,
Destruction Premalignant Lesion; 15 Or More Lesions (Pro Cah),,17004,CPT,Professional,Both,,,,420,357,62.38,420,Medica,Medica Advantage Solution,209.16,49.8,,percent of total billed charges,,
Destruction Premalignant Lesion; 15 Or More Lesions (Pro Cah),,17004,CPT,Professional,Both,,,,420,357,62.38,420,Medica,Medical Assistance,72.02,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Destruction Premalignant Lesion; 15 Or More Lesions (Pro Cah),,17004,CPT,Professional,Both,,,,420,357,62.38,420,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,96.99,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Destruction Premalignant Lesion; 15 Or More Lesions (Pro Cah),,17004,CPT,Professional,Both,,,,420,357,62.38,420,"Multiplan, Inc.","Multiplan, Inc.",394.8,94,,percent of total billed charges,,
Destruction Premalignant Lesion; 15 Or More Lesions (Pro Cah),,17004,CPT,Professional,Both,,,,420,357,62.38,420,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,378.42,90.1,,percent of total billed charges,,
Destruction Premalignant Lesion; 15 Or More Lesions (Pro Cah),,17004,CPT,Professional,Both,,,,420,357,62.38,420,"Preferred One Administrative Services, INC.",PPO,414.12,98.6,,percent of total billed charges,,
Destruction Premalignant Lesion; 15 Or More Lesions (Pro Cah),,17004,CPT,Professional,Both,,,,420,357,62.38,420,PrimeWest Health,Minnesota Senior Health Options (MSHO),111.5385,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Destruction Premalignant Lesion; 15 Or More Lesions (Pro Cah),,17004,CPT,Professional,Both,,,,420,357,62.38,420,PrimeWest Health,MinnesotaCare,77.0659368,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Destruction Premalignant Lesion; 15 Or More Lesions (Pro Cah),,17004,CPT,Professional,Both,,,,420,357,62.38,420,Sanford Health Plan,Sanford Health Plan,369.6,88,,percent of total billed charges,,
Destruction Premalignant Lesion; 15 Or More Lesions (Pro Cah),,17004,CPT,Professional,Both,,,,420,357,62.38,420,"UCare Health, Inc.",Individual & Family Plan,157.666944,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Destruction Premalignant Lesion; 15 Or More Lesions (Pro Cah),,17004,CPT,Professional,Both,,,,420,357,62.38,420,"UCare Health, Inc.",Medical Assistance,79.226664,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Destruction Premalignant Lesion; 15 Or More Lesions (Pro Cah),,17004,CPT,Professional,Both,,,,420,357,62.38,420,"UCare Health, Inc.",Medicare Advantage,111.5385,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Destruction Premalignant Lesion; 15 Or More Lesions (Pro Cah),,17004,CPT,Professional,Both,,,,420,357,62.38,420,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),89.2308,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Destruction Premalignant Lesion; 15 Or More Lesions (Pro Cah),,17004,CPT,Professional,Both,,,,420,357,62.38,420,UnitedHealthcare,Individual & Family,420,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Destruction Premalignant Lesion; 15 Or More Lesions (Pro Cah),,17004,CPT,Professional,Both,,,,420,357,62.38,420,UnitedHealthcare,Medicare Advantage,111.5385,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Destruction Premalignant Lesion; 15 Or More Lesions (Pro Cah),,17004,CPT,Professional,Both,,,,420,357,62.38,420,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,72.02424,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Destruction, Premalignant Lesions, 15 Or More Lesions",,17004,CPT,Facility,Both,,,,220,187,63.052,220,Aetna,Commercial,202.4,92,,percent of total billed charges,,
"Destruction, Premalignant Lesions, 15 Or More Lesions",,17004,CPT,Facility,Outpatient,,,,220,187,63.052,220,Aetna,Medicare Advantage,107.8,49,,percent of total billed charges,,
"Destruction, Premalignant Lesions, 15 Or More Lesions",,17004,CPT,Facility,Inpatient,,,,220,187,63.052,220,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Destruction, Premalignant Lesions, 15 Or More Lesions",,17004,CPT,Facility,Both,,,,220,187,63.052,220,Aetna,PPO,204.6,93,,percent of total billed charges,,
"Destruction, Premalignant Lesions, 15 Or More Lesions",,17004,CPT,Facility,Both,,,,220,187,63.052,220,America's PPO,America's PPO,211.266,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Destruction, Premalignant Lesions, 15 Or More Lesions",,17004,CPT,Facility,Both,,,,220,187,63.052,220,BlueCross BlueShield Minnesota, Federal Employee Program,216.48,98.4,,percent of total billed charges,,
"Destruction, Premalignant Lesions, 15 Or More Lesions",,17004,CPT,Facility,Both,,,,220,187,63.052,220,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,220,100,,percent of total billed charges,,
"Destruction, Premalignant Lesions, 15 Or More Lesions",,17004,CPT,Facility,Both,,,,220,187,63.052,220,BlueCross BlueShield Minnesota,High Value Network Plan,198,90,,percent of total billed charges,,
"Destruction, Premalignant Lesions, 15 Or More Lesions",,17004,CPT,Facility,Outpatient,,,,220,187,63.052,220,BlueCross BlueShield Minnesota,Medicare Advantage,107.8,49,,percent of total billed charges,,
"Destruction, Premalignant Lesions, 15 Or More Lesions",,17004,CPT,Facility,Inpatient,,,,220,187,63.052,220,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Destruction, Premalignant Lesions, 15 Or More Lesions",,17004,CPT,Facility,Both,,,,220,187,63.052,220,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,194.854,88.57,,percent of total billed charges,,
"Destruction, Premalignant Lesions, 15 Or More Lesions",,17004,CPT,Facility,Both,,,,220,187,63.052,220,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,63.052,28.66,,percent of total billed charges,,
"Destruction, Premalignant Lesions, 15 Or More Lesions",,17004,CPT,Facility,Outpatient,,,,220,187,63.052,220,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),107.8,49,,percent of total billed charges,,
"Destruction, Premalignant Lesions, 15 Or More Lesions",,17004,CPT,Facility,Inpatient,,,,220,187,63.052,220,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Destruction, Premalignant Lesions, 15 Or More Lesions",,17004,CPT,Facility,Both,,,,220,187,63.052,220,CorVel,Worker's Compensation,220,100,,percent of total billed charges,,
"Destruction, Premalignant Lesions, 15 Or More Lesions",,17004,CPT,Facility,Both,,,,220,187,63.052,220,First Health Group Corporation,First Health Network,213.4,97,,percent of total billed charges,,
"Destruction, Premalignant Lesions, 15 Or More Lesions",,17004,CPT,Facility,Both,,,,220,187,63.052,220,"Health Partners, Inc.",Commercial,208.12,94.6,,percent of total billed charges,,
"Destruction, Premalignant Lesions, 15 Or More Lesions",,17004,CPT,Facility,Outpatient,,,,220,187,63.052,220,"Health Partners, Inc.",Medicare Advantage,107.8,49,,percent of total billed charges,,
"Destruction, Premalignant Lesions, 15 Or More Lesions",,17004,CPT,Facility,Inpatient,,,,220,187,63.052,220,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Destruction, Premalignant Lesions, 15 Or More Lesions",,17004,CPT,Facility,Both,,,,220,187,63.052,220,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),132,60,,percent of total billed charges,,
"Destruction, Premalignant Lesions, 15 Or More Lesions",,17004,CPT,Facility,Both,,,,220,187,63.052,220,"Health Partners, Inc.",State of Minnesota Advantage Program,179.3,81.5,,percent of total billed charges,,
"Destruction, Premalignant Lesions, 15 Or More Lesions",,17004,CPT,Facility,Both,,,,220,187,63.052,220,"Health Partners, Inc.",State Public Programs,110,50,,percent of total billed charges,,
"Destruction, Premalignant Lesions, 15 Or More Lesions",,17004,CPT,Facility,Both,,,,220,187,63.052,220,Humana Insurance Company,Commercial PPO,209,95,,percent of total billed charges,,
"Destruction, Premalignant Lesions, 15 Or More Lesions",,17004,CPT,Facility,Outpatient,,,,220,187,63.052,220,Humana Insurance Company,Medicare PPO,107.8,49,,percent of total billed charges,,
"Destruction, Premalignant Lesions, 15 Or More Lesions",,17004,CPT,Facility,Inpatient,,,,220,187,63.052,220,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Destruction, Premalignant Lesions, 15 Or More Lesions",,17004,CPT,Facility,Both,,,,220,187,63.052,220,Medica,Individual & Family,218.02,99.1,,percent of total billed charges,,
"Destruction, Premalignant Lesions, 15 Or More Lesions",,17004,CPT,Facility,Outpatient,,,,220,187,63.052,220,Medica,Medica Advantage Solution,109.56,49.8,,percent of total billed charges,,
"Destruction, Premalignant Lesions, 15 Or More Lesions",,17004,CPT,Facility,Inpatient,,,,220,187,63.052,220,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Destruction, Premalignant Lesions, 15 Or More Lesions",,17004,CPT,Facility,Outpatient,,,,220,187,63.052,220,Medica,Medical Assistance,98.12,44.6,,percent of total billed charges,,
"Destruction, Premalignant Lesions, 15 Or More Lesions",,17004,CPT,Facility,Inpatient,,,,220,187,63.052,220,Medica,Medical Assistance,,,,,Included in per diem rate,
"Destruction, Premalignant Lesions, 15 Or More Lesions",,17004,CPT,Facility,Outpatient,,,,220,187,63.052,220,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,109.56,49.8,,percent of total billed charges,,
"Destruction, Premalignant Lesions, 15 Or More Lesions",,17004,CPT,Facility,Inpatient,,,,220,187,63.052,220,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Destruction, Premalignant Lesions, 15 Or More Lesions",,17004,CPT,Facility,Both,,,,220,187,63.052,220,"Multiplan, Inc.","Multiplan, Inc.",206.8,94,,percent of total billed charges,,
"Destruction, Premalignant Lesions, 15 Or More Lesions",,17004,CPT,Facility,Outpatient,,,,220,187,63.052,220,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,198.22,90.1,,percent of total billed charges,,
"Destruction, Premalignant Lesions, 15 Or More Lesions",,17004,CPT,Facility,Inpatient,,,,220,187,63.052,220,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Destruction, Premalignant Lesions, 15 Or More Lesions",,17004,CPT,Facility,Both,,,,220,187,63.052,220,"Preferred One Administrative Services, INC.",PPO,216.92,98.6,,percent of total billed charges,,
"Destruction, Premalignant Lesions, 15 Or More Lesions",,17004,CPT,Facility,Outpatient,,,,220,187,63.052,220,PrimeWest Health,Minnesota Senior Health Options (MSHO),113.19,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Destruction, Premalignant Lesions, 15 Or More Lesions",,17004,CPT,Facility,Inpatient,,,,220,187,63.052,220,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Destruction, Premalignant Lesions, 15 Or More Lesions",,17004,CPT,Facility,Outpatient,,,,220,187,63.052,220,PrimeWest Health,MinnesotaCare,112.992,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Destruction, Premalignant Lesions, 15 Or More Lesions",,17004,CPT,Facility,Inpatient,,,,220,187,63.052,220,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Destruction, Premalignant Lesions, 15 Or More Lesions",,17004,CPT,Facility,Both,,,,220,187,63.052,220,Sanford Health Plan,Sanford Health Plan,202.4,92,,percent of total billed charges,,
"Destruction, Premalignant Lesions, 15 Or More Lesions",,17004,CPT,Facility,Outpatient,,,,220,187,63.052,220,"UCare Health, Inc.",Individual & Family Plan,123.97,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Destruction, Premalignant Lesions, 15 Or More Lesions",,17004,CPT,Facility,Inpatient,,,,220,187,63.052,220,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Destruction, Premalignant Lesions, 15 Or More Lesions",,17004,CPT,Facility,Outpatient,,,,220,187,63.052,220,"UCare Health, Inc.",Medical Assistance,111.034,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Destruction, Premalignant Lesions, 15 Or More Lesions",,17004,CPT,Facility,Inpatient,,,,220,187,63.052,220,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Destruction, Premalignant Lesions, 15 Or More Lesions",,17004,CPT,Facility,Outpatient,,,,220,187,63.052,220,"UCare Health, Inc.",Medicare Advantage,111.034,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Destruction, Premalignant Lesions, 15 Or More Lesions",,17004,CPT,Facility,Inpatient,,,,220,187,63.052,220,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Destruction, Premalignant Lesions, 15 Or More Lesions",,17004,CPT,Facility,Outpatient,,,,220,187,63.052,220,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),111.034,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Destruction, Premalignant Lesions, 15 Or More Lesions",,17004,CPT,Facility,Inpatient,,,,220,187,63.052,220,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Destruction, Premalignant Lesions, 15 Or More Lesions",,17004,CPT,Facility,Both,,,,220,187,63.052,220,UnitedHealthcare,Individual & Family,206.8,94,,percent of total billed charges,,
"Destruction, Premalignant Lesions, 15 Or More Lesions",,17004,CPT,Facility,Outpatient,,,,220,187,63.052,220,UnitedHealthcare,Medicare Advantage,107.8,49,,percent of total billed charges,,
"Destruction, Premalignant Lesions, 15 Or More Lesions",,17004,CPT,Facility,Inpatient,,,,220,187,63.052,220,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Destruction, Premalignant Lesions, 15 Or More Lesions",,17004,CPT,Facility,Outpatient,,,,220,187,63.052,220,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,105.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Destruction, Premalignant Lesions, 15 Or More Lesions",,17004,CPT,Facility,Inpatient,,,,220,187,63.052,220,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"CALCIUM ACETATE-ALUMINUM SULF 952-1,347 MG TOP PWPK",,101424,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,Aetna,Commercial,5.52,92,,percent of total billed charges,,
"CALCIUM ACETATE-ALUMINUM SULF 952-1,347 MG TOP PWPK",,101424,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,Aetna,Medicare Advantage,2.94,49,,percent of total billed charges,,
"CALCIUM ACETATE-ALUMINUM SULF 952-1,347 MG TOP PWPK",,101424,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"CALCIUM ACETATE-ALUMINUM SULF 952-1,347 MG TOP PWPK",,101424,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,Aetna,PPO,5.58,93,,percent of total billed charges,,
"CALCIUM ACETATE-ALUMINUM SULF 952-1,347 MG TOP PWPK",,101424,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,America's PPO,America's PPO,5.7618,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"CALCIUM ACETATE-ALUMINUM SULF 952-1,347 MG TOP PWPK",,101424,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota, Federal Employee Program,5.904,98.4,,percent of total billed charges,,
"CALCIUM ACETATE-ALUMINUM SULF 952-1,347 MG TOP PWPK",,101424,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,6,100,,percent of total billed charges,,
"CALCIUM ACETATE-ALUMINUM SULF 952-1,347 MG TOP PWPK",,101424,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota,High Value Network Plan,5.4,90,,percent of total billed charges,,
"CALCIUM ACETATE-ALUMINUM SULF 952-1,347 MG TOP PWPK",,101424,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota,Medicare Advantage,2.94,49,,percent of total billed charges,,
"CALCIUM ACETATE-ALUMINUM SULF 952-1,347 MG TOP PWPK",,101424,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"CALCIUM ACETATE-ALUMINUM SULF 952-1,347 MG TOP PWPK",,101424,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,5.3142,88.57,,percent of total billed charges,,
"CALCIUM ACETATE-ALUMINUM SULF 952-1,347 MG TOP PWPK",,101424,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.7196,28.66,,percent of total billed charges,,
"CALCIUM ACETATE-ALUMINUM SULF 952-1,347 MG TOP PWPK",,101424,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.94,49,,percent of total billed charges,,
"CALCIUM ACETATE-ALUMINUM SULF 952-1,347 MG TOP PWPK",,101424,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"CALCIUM ACETATE-ALUMINUM SULF 952-1,347 MG TOP PWPK",,101424,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,CorVel,Worker's Compensation,6,100,,percent of total billed charges,,
"CALCIUM ACETATE-ALUMINUM SULF 952-1,347 MG TOP PWPK",,101424,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,First Health Group Corporation,First Health Network,5.82,97,,percent of total billed charges,,
"CALCIUM ACETATE-ALUMINUM SULF 952-1,347 MG TOP PWPK",,101424,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,"Health Partners, Inc.",Commercial,5.676,94.6,,percent of total billed charges,,
"CALCIUM ACETATE-ALUMINUM SULF 952-1,347 MG TOP PWPK",,101424,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,"Health Partners, Inc.",Medicare Advantage,2.94,49,,percent of total billed charges,,
"CALCIUM ACETATE-ALUMINUM SULF 952-1,347 MG TOP PWPK",,101424,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"CALCIUM ACETATE-ALUMINUM SULF 952-1,347 MG TOP PWPK",,101424,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3.6,60,,percent of total billed charges,,
"CALCIUM ACETATE-ALUMINUM SULF 952-1,347 MG TOP PWPK",,101424,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,"Health Partners, Inc.",State of Minnesota Advantage Program,4.89,81.5,,percent of total billed charges,,
"CALCIUM ACETATE-ALUMINUM SULF 952-1,347 MG TOP PWPK",,101424,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,"Health Partners, Inc.",State Public Programs,3,50,,percent of total billed charges,,
"CALCIUM ACETATE-ALUMINUM SULF 952-1,347 MG TOP PWPK",,101424,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,Humana Insurance Company,Commercial PPO,5.7,95,,percent of total billed charges,,
"CALCIUM ACETATE-ALUMINUM SULF 952-1,347 MG TOP PWPK",,101424,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,Humana Insurance Company,Medicare PPO,2.94,49,,percent of total billed charges,,
"CALCIUM ACETATE-ALUMINUM SULF 952-1,347 MG TOP PWPK",,101424,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"CALCIUM ACETATE-ALUMINUM SULF 952-1,347 MG TOP PWPK",,101424,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,Medica,Individual & Family,5.946,99.1,,percent of total billed charges,,
"CALCIUM ACETATE-ALUMINUM SULF 952-1,347 MG TOP PWPK",,101424,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,Medica,Medica Advantage Solution,2.988,49.8,,percent of total billed charges,,
"CALCIUM ACETATE-ALUMINUM SULF 952-1,347 MG TOP PWPK",,101424,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"CALCIUM ACETATE-ALUMINUM SULF 952-1,347 MG TOP PWPK",,101424,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,Medica,Medical Assistance,2.676,44.6,,percent of total billed charges,,
"CALCIUM ACETATE-ALUMINUM SULF 952-1,347 MG TOP PWPK",,101424,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,Medica,Medical Assistance,,,,,Included in per diem rate,
"CALCIUM ACETATE-ALUMINUM SULF 952-1,347 MG TOP PWPK",,101424,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.988,49.8,,percent of total billed charges,,
"CALCIUM ACETATE-ALUMINUM SULF 952-1,347 MG TOP PWPK",,101424,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"CALCIUM ACETATE-ALUMINUM SULF 952-1,347 MG TOP PWPK",,101424,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,"Multiplan, Inc.","Multiplan, Inc.",5.64,94,,percent of total billed charges,,
"CALCIUM ACETATE-ALUMINUM SULF 952-1,347 MG TOP PWPK",,101424,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,5.406,90.1,,percent of total billed charges,,
"CALCIUM ACETATE-ALUMINUM SULF 952-1,347 MG TOP PWPK",,101424,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"CALCIUM ACETATE-ALUMINUM SULF 952-1,347 MG TOP PWPK",,101424,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,"Preferred One Administrative Services, INC.",PPO,5.916,98.6,,percent of total billed charges,,
"CALCIUM ACETATE-ALUMINUM SULF 952-1,347 MG TOP PWPK",,101424,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,PrimeWest Health,Minnesota Senior Health Options (MSHO),3.087,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"CALCIUM ACETATE-ALUMINUM SULF 952-1,347 MG TOP PWPK",,101424,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"CALCIUM ACETATE-ALUMINUM SULF 952-1,347 MG TOP PWPK",,101424,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,PrimeWest Health,MinnesotaCare,3.0816,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"CALCIUM ACETATE-ALUMINUM SULF 952-1,347 MG TOP PWPK",,101424,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"CALCIUM ACETATE-ALUMINUM SULF 952-1,347 MG TOP PWPK",,101424,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,Sanford Health Plan,Sanford Health Plan,5.52,92,,percent of total billed charges,,
"CALCIUM ACETATE-ALUMINUM SULF 952-1,347 MG TOP PWPK",,101424,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,"UCare Health, Inc.",Individual & Family Plan,3.381,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"CALCIUM ACETATE-ALUMINUM SULF 952-1,347 MG TOP PWPK",,101424,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"CALCIUM ACETATE-ALUMINUM SULF 952-1,347 MG TOP PWPK",,101424,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,"UCare Health, Inc.",Medical Assistance,3.0282,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"CALCIUM ACETATE-ALUMINUM SULF 952-1,347 MG TOP PWPK",,101424,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"CALCIUM ACETATE-ALUMINUM SULF 952-1,347 MG TOP PWPK",,101424,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,"UCare Health, Inc.",Medicare Advantage,3.0282,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"CALCIUM ACETATE-ALUMINUM SULF 952-1,347 MG TOP PWPK",,101424,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"CALCIUM ACETATE-ALUMINUM SULF 952-1,347 MG TOP PWPK",,101424,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),3.0282,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"CALCIUM ACETATE-ALUMINUM SULF 952-1,347 MG TOP PWPK",,101424,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"CALCIUM ACETATE-ALUMINUM SULF 952-1,347 MG TOP PWPK",,101424,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,UnitedHealthcare,Individual & Family,5.64,94,,percent of total billed charges,,
"CALCIUM ACETATE-ALUMINUM SULF 952-1,347 MG TOP PWPK",,101424,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,UnitedHealthcare,Medicare Advantage,2.94,49,,percent of total billed charges,,
"CALCIUM ACETATE-ALUMINUM SULF 952-1,347 MG TOP PWPK",,101424,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"CALCIUM ACETATE-ALUMINUM SULF 952-1,347 MG TOP PWPK",,101424,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.88,48,,percent of total billed charges,,100% of DHS outpatient percentage
"CALCIUM ACETATE-ALUMINUM SULF 952-1,347 MG TOP PWPK",,101424,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
MULTIVITAMIN WITH FOLIC ACID 400 MCG ORAL TABLET,,102144,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
MULTIVITAMIN WITH FOLIC ACID 400 MCG ORAL TABLET,,102144,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
MULTIVITAMIN WITH FOLIC ACID 400 MCG ORAL TABLET,,102144,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
MULTIVITAMIN WITH FOLIC ACID 400 MCG ORAL TABLET,,102144,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
MULTIVITAMIN WITH FOLIC ACID 400 MCG ORAL TABLET,,102144,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
MULTIVITAMIN WITH FOLIC ACID 400 MCG ORAL TABLET,,102144,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
MULTIVITAMIN WITH FOLIC ACID 400 MCG ORAL TABLET,,102144,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
MULTIVITAMIN WITH FOLIC ACID 400 MCG ORAL TABLET,,102144,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
MULTIVITAMIN WITH FOLIC ACID 400 MCG ORAL TABLET,,102144,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
MULTIVITAMIN WITH FOLIC ACID 400 MCG ORAL TABLET,,102144,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
MULTIVITAMIN WITH FOLIC ACID 400 MCG ORAL TABLET,,102144,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
MULTIVITAMIN WITH FOLIC ACID 400 MCG ORAL TABLET,,102144,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
MULTIVITAMIN WITH FOLIC ACID 400 MCG ORAL TABLET,,102144,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
MULTIVITAMIN WITH FOLIC ACID 400 MCG ORAL TABLET,,102144,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
MULTIVITAMIN WITH FOLIC ACID 400 MCG ORAL TABLET,,102144,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
MULTIVITAMIN WITH FOLIC ACID 400 MCG ORAL TABLET,,102144,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
MULTIVITAMIN WITH FOLIC ACID 400 MCG ORAL TABLET,,102144,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
MULTIVITAMIN WITH FOLIC ACID 400 MCG ORAL TABLET,,102144,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
MULTIVITAMIN WITH FOLIC ACID 400 MCG ORAL TABLET,,102144,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
MULTIVITAMIN WITH FOLIC ACID 400 MCG ORAL TABLET,,102144,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
MULTIVITAMIN WITH FOLIC ACID 400 MCG ORAL TABLET,,102144,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
MULTIVITAMIN WITH FOLIC ACID 400 MCG ORAL TABLET,,102144,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
MULTIVITAMIN WITH FOLIC ACID 400 MCG ORAL TABLET,,102144,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
MULTIVITAMIN WITH FOLIC ACID 400 MCG ORAL TABLET,,102144,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
MULTIVITAMIN WITH FOLIC ACID 400 MCG ORAL TABLET,,102144,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
MULTIVITAMIN WITH FOLIC ACID 400 MCG ORAL TABLET,,102144,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
MULTIVITAMIN WITH FOLIC ACID 400 MCG ORAL TABLET,,102144,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
MULTIVITAMIN WITH FOLIC ACID 400 MCG ORAL TABLET,,102144,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
MULTIVITAMIN WITH FOLIC ACID 400 MCG ORAL TABLET,,102144,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
MULTIVITAMIN WITH FOLIC ACID 400 MCG ORAL TABLET,,102144,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
MULTIVITAMIN WITH FOLIC ACID 400 MCG ORAL TABLET,,102144,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
MULTIVITAMIN WITH FOLIC ACID 400 MCG ORAL TABLET,,102144,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
MULTIVITAMIN WITH FOLIC ACID 400 MCG ORAL TABLET,,102144,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
MULTIVITAMIN WITH FOLIC ACID 400 MCG ORAL TABLET,,102144,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
MULTIVITAMIN WITH FOLIC ACID 400 MCG ORAL TABLET,,102144,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
MULTIVITAMIN WITH FOLIC ACID 400 MCG ORAL TABLET,,102144,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
MULTIVITAMIN WITH FOLIC ACID 400 MCG ORAL TABLET,,102144,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
MULTIVITAMIN WITH FOLIC ACID 400 MCG ORAL TABLET,,102144,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
MULTIVITAMIN WITH FOLIC ACID 400 MCG ORAL TABLET,,102144,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
MULTIVITAMIN WITH FOLIC ACID 400 MCG ORAL TABLET,,102144,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
MULTIVITAMIN WITH FOLIC ACID 400 MCG ORAL TABLET,,102144,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
MULTIVITAMIN WITH FOLIC ACID 400 MCG ORAL TABLET,,102144,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
MULTIVITAMIN WITH FOLIC ACID 400 MCG ORAL TABLET,,102144,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
MULTIVITAMIN WITH FOLIC ACID 400 MCG ORAL TABLET,,102144,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MULTIVITAMIN WITH FOLIC ACID 400 MCG ORAL TABLET,,102144,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
MULTIVITAMIN WITH FOLIC ACID 400 MCG ORAL TABLET,,102144,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MULTIVITAMIN WITH FOLIC ACID 400 MCG ORAL TABLET,,102144,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
MULTIVITAMIN WITH FOLIC ACID 400 MCG ORAL TABLET,,102144,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MULTIVITAMIN WITH FOLIC ACID 400 MCG ORAL TABLET,,102144,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
MULTIVITAMIN WITH FOLIC ACID 400 MCG ORAL TABLET,,102144,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
MULTIVITAMIN WITH FOLIC ACID 400 MCG ORAL TABLET,,102144,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
MULTIVITAMIN WITH FOLIC ACID 400 MCG ORAL TABLET,,102144,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
MULTIVITAMIN WITH FOLIC ACID 400 MCG ORAL TABLET,,102144,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
MULTIVITAMIN WITH FOLIC ACID 400 MCG ORAL TABLET,,102144,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Destruction Benign Lesions Other Than Skin Tags Or Cutaneous Vasc Prolif Lesions; Up To 14 (Pro Cah),,17110,CPT,Professional,Both,,,,175,148.75,46.63,175,Aetna,Commercial,148.75,85,,percent of total billed charges,,
Destruction Benign Lesions Other Than Skin Tags Or Cutaneous Vasc Prolif Lesions; Up To 14 (Pro Cah),,17110,CPT,Professional,Both,,,,175,148.75,46.63,175,Aetna,Commercial,148.75,85,,percent of total billed charges,,
Destruction Benign Lesions Other Than Skin Tags Or Cutaneous Vasc Prolif Lesions; Up To 14 (Pro Cah),,17110,CPT,Professional,Both,,,,175,148.75,46.63,175,Aetna,Medicare Advantage,65.81,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Destruction Benign Lesions Other Than Skin Tags Or Cutaneous Vasc Prolif Lesions; Up To 14 (Pro Cah),,17110,CPT,Professional,Both,,,,175,148.75,46.63,175,Aetna,Medicare Advantage,65.81,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Destruction Benign Lesions Other Than Skin Tags Or Cutaneous Vasc Prolif Lesions; Up To 14 (Pro Cah),,17110,CPT,Professional,Both,,,,175,148.75,46.63,175,Aetna,PPO,162.75,93,,percent of total billed charges,,
Destruction Benign Lesions Other Than Skin Tags Or Cutaneous Vasc Prolif Lesions; Up To 14 (Pro Cah),,17110,CPT,Professional,Both,,,,175,148.75,46.63,175,Aetna,PPO,162.75,93,,percent of total billed charges,,
Destruction Benign Lesions Other Than Skin Tags Or Cutaneous Vasc Prolif Lesions; Up To 14 (Pro Cah),,17110,CPT,Professional,Both,,,,175,148.75,46.63,175,America's PPO,America's PPO,149.52,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Destruction Benign Lesions Other Than Skin Tags Or Cutaneous Vasc Prolif Lesions; Up To 14 (Pro Cah),,17110,CPT,Professional,Both,,,,175,148.75,46.63,175,America's PPO,America's PPO,149.52,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Destruction Benign Lesions Other Than Skin Tags Or Cutaneous Vasc Prolif Lesions; Up To 14 (Pro Cah),,17110,CPT,Professional,Both,,,,175,148.75,46.63,175,BlueCross BlueShield Minnesota, Federal Employee Program,137.72,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Destruction Benign Lesions Other Than Skin Tags Or Cutaneous Vasc Prolif Lesions; Up To 14 (Pro Cah),,17110,CPT,Professional,Both,,,,175,148.75,46.63,175,BlueCross BlueShield Minnesota, Federal Employee Program,137.72,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Destruction Benign Lesions Other Than Skin Tags Or Cutaneous Vasc Prolif Lesions; Up To 14 (Pro Cah),,17110,CPT,Professional,Both,,,,175,148.75,46.63,175,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,139.92352,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Destruction Benign Lesions Other Than Skin Tags Or Cutaneous Vasc Prolif Lesions; Up To 14 (Pro Cah),,17110,CPT,Professional,Both,,,,175,148.75,46.63,175,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,139.92352,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Destruction Benign Lesions Other Than Skin Tags Or Cutaneous Vasc Prolif Lesions; Up To 14 (Pro Cah),,17110,CPT,Professional,Both,,,,175,148.75,46.63,175,BlueCross BlueShield Minnesota,High Value Network Plan,139.92352,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Destruction Benign Lesions Other Than Skin Tags Or Cutaneous Vasc Prolif Lesions; Up To 14 (Pro Cah),,17110,CPT,Professional,Both,,,,175,148.75,46.63,175,BlueCross BlueShield Minnesota,High Value Network Plan,139.92352,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Destruction Benign Lesions Other Than Skin Tags Or Cutaneous Vasc Prolif Lesions; Up To 14 (Pro Cah),,17110,CPT,Professional,Both,,,,175,148.75,46.63,175,BlueCross BlueShield Minnesota,Medicare Advantage,77.0155,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Destruction Benign Lesions Other Than Skin Tags Or Cutaneous Vasc Prolif Lesions; Up To 14 (Pro Cah),,17110,CPT,Professional,Both,,,,175,148.75,46.63,175,BlueCross BlueShield Minnesota,Medicare Advantage,77.0155,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Destruction Benign Lesions Other Than Skin Tags Or Cutaneous Vasc Prolif Lesions; Up To 14 (Pro Cah),,17110,CPT,Professional,Both,,,,175,148.75,46.63,175,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,139.92352,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Destruction Benign Lesions Other Than Skin Tags Or Cutaneous Vasc Prolif Lesions; Up To 14 (Pro Cah),,17110,CPT,Professional,Both,,,,175,148.75,46.63,175,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,139.92352,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Destruction Benign Lesions Other Than Skin Tags Or Cutaneous Vasc Prolif Lesions; Up To 14 (Pro Cah),,17110,CPT,Professional,Both,,,,175,148.75,46.63,175,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,49.61128,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Destruction Benign Lesions Other Than Skin Tags Or Cutaneous Vasc Prolif Lesions; Up To 14 (Pro Cah),,17110,CPT,Professional,Both,,,,175,148.75,46.63,175,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,49.61128,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Destruction Benign Lesions Other Than Skin Tags Or Cutaneous Vasc Prolif Lesions; Up To 14 (Pro Cah),,17110,CPT,Professional,Both,,,,175,148.75,46.63,175,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),77.0155,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Destruction Benign Lesions Other Than Skin Tags Or Cutaneous Vasc Prolif Lesions; Up To 14 (Pro Cah),,17110,CPT,Professional,Both,,,,175,148.75,46.63,175,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),77.0155,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Destruction Benign Lesions Other Than Skin Tags Or Cutaneous Vasc Prolif Lesions; Up To 14 (Pro Cah),,17110,CPT,Professional,Both,,,,175,148.75,46.63,175,CorVel,Worker's Compensation,128.5264365,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Destruction Benign Lesions Other Than Skin Tags Or Cutaneous Vasc Prolif Lesions; Up To 14 (Pro Cah),,17110,CPT,Professional,Both,,,,175,148.75,46.63,175,CorVel,Worker's Compensation,128.5264365,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Destruction Benign Lesions Other Than Skin Tags Or Cutaneous Vasc Prolif Lesions; Up To 14 (Pro Cah),,17110,CPT,Professional,Both,,,,175,148.75,46.63,175,First Health Group Corporation,First Health Network,169.75,97,,percent of total billed charges,,
Destruction Benign Lesions Other Than Skin Tags Or Cutaneous Vasc Prolif Lesions; Up To 14 (Pro Cah),,17110,CPT,Professional,Both,,,,175,148.75,46.63,175,First Health Group Corporation,First Health Network,169.75,97,,percent of total billed charges,,
Destruction Benign Lesions Other Than Skin Tags Or Cutaneous Vasc Prolif Lesions; Up To 14 (Pro Cah),,17110,CPT,Professional,Both,,,,175,148.75,46.63,175,"Health Partners, Inc.",Commercial,139.3,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Destruction Benign Lesions Other Than Skin Tags Or Cutaneous Vasc Prolif Lesions; Up To 14 (Pro Cah),,17110,CPT,Professional,Both,,,,175,148.75,46.63,175,"Health Partners, Inc.",Commercial,139.3,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Destruction Benign Lesions Other Than Skin Tags Or Cutaneous Vasc Prolif Lesions; Up To 14 (Pro Cah),,17110,CPT,Professional,Both,,,,175,148.75,46.63,175,"Health Partners, Inc.",Medicare Advantage,77.0155,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Destruction Benign Lesions Other Than Skin Tags Or Cutaneous Vasc Prolif Lesions; Up To 14 (Pro Cah),,17110,CPT,Professional,Both,,,,175,148.75,46.63,175,"Health Partners, Inc.",Medicare Advantage,77.0155,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Destruction Benign Lesions Other Than Skin Tags Or Cutaneous Vasc Prolif Lesions; Up To 14 (Pro Cah),,17110,CPT,Professional,Both,,,,175,148.75,46.63,175,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),66.76,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Destruction Benign Lesions Other Than Skin Tags Or Cutaneous Vasc Prolif Lesions; Up To 14 (Pro Cah),,17110,CPT,Professional,Both,,,,175,148.75,46.63,175,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),66.76,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Destruction Benign Lesions Other Than Skin Tags Or Cutaneous Vasc Prolif Lesions; Up To 14 (Pro Cah),,17110,CPT,Professional,Both,,,,175,148.75,46.63,175,"Health Partners, Inc.",State of Minnesota Advantage Program,120.00695,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Destruction Benign Lesions Other Than Skin Tags Or Cutaneous Vasc Prolif Lesions; Up To 14 (Pro Cah),,17110,CPT,Professional,Both,,,,175,148.75,46.63,175,"Health Partners, Inc.",State of Minnesota Advantage Program,120.00695,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Destruction Benign Lesions Other Than Skin Tags Or Cutaneous Vasc Prolif Lesions; Up To 14 (Pro Cah),,17110,CPT,Professional,Both,,,,175,148.75,46.63,175,"Health Partners, Inc.",State Public Programs,46.63,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Destruction Benign Lesions Other Than Skin Tags Or Cutaneous Vasc Prolif Lesions; Up To 14 (Pro Cah),,17110,CPT,Professional,Both,,,,175,148.75,46.63,175,"Health Partners, Inc.",State Public Programs,46.63,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Destruction Benign Lesions Other Than Skin Tags Or Cutaneous Vasc Prolif Lesions; Up To 14 (Pro Cah),,17110,CPT,Professional,Both,,,,175,148.75,46.63,175,Humana Insurance Company,Commercial PPO,66.97,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Destruction Benign Lesions Other Than Skin Tags Or Cutaneous Vasc Prolif Lesions; Up To 14 (Pro Cah),,17110,CPT,Professional,Both,,,,175,148.75,46.63,175,Humana Insurance Company,Commercial PPO,66.97,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Destruction Benign Lesions Other Than Skin Tags Or Cutaneous Vasc Prolif Lesions; Up To 14 (Pro Cah),,17110,CPT,Professional,Both,,,,175,148.75,46.63,175,Humana Insurance Company,Medicare PPO,175,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Destruction Benign Lesions Other Than Skin Tags Or Cutaneous Vasc Prolif Lesions; Up To 14 (Pro Cah),,17110,CPT,Professional,Both,,,,175,148.75,46.63,175,Humana Insurance Company,Medicare PPO,175,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Destruction Benign Lesions Other Than Skin Tags Or Cutaneous Vasc Prolif Lesions; Up To 14 (Pro Cah),,17110,CPT,Professional,Both,,,,175,148.75,46.63,175,Medica,Individual & Family,148.4,84.8,,percent of total billed charges,,
Destruction Benign Lesions Other Than Skin Tags Or Cutaneous Vasc Prolif Lesions; Up To 14 (Pro Cah),,17110,CPT,Professional,Both,,,,175,148.75,46.63,175,Medica,Individual & Family,148.4,84.8,,percent of total billed charges,,
Destruction Benign Lesions Other Than Skin Tags Or Cutaneous Vasc Prolif Lesions; Up To 14 (Pro Cah),,17110,CPT,Professional,Both,,,,175,148.75,46.63,175,Medica,Medica Advantage Solution,87.15,49.8,,percent of total billed charges,,
Destruction Benign Lesions Other Than Skin Tags Or Cutaneous Vasc Prolif Lesions; Up To 14 (Pro Cah),,17110,CPT,Professional,Both,,,,175,148.75,46.63,175,Medica,Medica Advantage Solution,87.15,49.8,,percent of total billed charges,,
Destruction Benign Lesions Other Than Skin Tags Or Cutaneous Vasc Prolif Lesions; Up To 14 (Pro Cah),,17110,CPT,Professional,Both,,,,175,148.75,46.63,175,Medica,Medical Assistance,49.61,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Destruction Benign Lesions Other Than Skin Tags Or Cutaneous Vasc Prolif Lesions; Up To 14 (Pro Cah),,17110,CPT,Professional,Both,,,,175,148.75,46.63,175,Medica,Medical Assistance,49.61,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Destruction Benign Lesions Other Than Skin Tags Or Cutaneous Vasc Prolif Lesions; Up To 14 (Pro Cah),,17110,CPT,Professional,Both,,,,175,148.75,46.63,175,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,66.97,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Destruction Benign Lesions Other Than Skin Tags Or Cutaneous Vasc Prolif Lesions; Up To 14 (Pro Cah),,17110,CPT,Professional,Both,,,,175,148.75,46.63,175,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,66.97,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Destruction Benign Lesions Other Than Skin Tags Or Cutaneous Vasc Prolif Lesions; Up To 14 (Pro Cah),,17110,CPT,Professional,Both,,,,175,148.75,46.63,175,"Multiplan, Inc.","Multiplan, Inc.",164.5,94,,percent of total billed charges,,
Destruction Benign Lesions Other Than Skin Tags Or Cutaneous Vasc Prolif Lesions; Up To 14 (Pro Cah),,17110,CPT,Professional,Both,,,,175,148.75,46.63,175,"Multiplan, Inc.","Multiplan, Inc.",164.5,94,,percent of total billed charges,,
Destruction Benign Lesions Other Than Skin Tags Or Cutaneous Vasc Prolif Lesions; Up To 14 (Pro Cah),,17110,CPT,Professional,Both,,,,175,148.75,46.63,175,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,157.675,90.1,,percent of total billed charges,,
Destruction Benign Lesions Other Than Skin Tags Or Cutaneous Vasc Prolif Lesions; Up To 14 (Pro Cah),,17110,CPT,Professional,Both,,,,175,148.75,46.63,175,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,157.675,90.1,,percent of total billed charges,,
Destruction Benign Lesions Other Than Skin Tags Or Cutaneous Vasc Prolif Lesions; Up To 14 (Pro Cah),,17110,CPT,Professional,Both,,,,175,148.75,46.63,175,"Preferred One Administrative Services, INC.",PPO,172.55,98.6,,percent of total billed charges,,
Destruction Benign Lesions Other Than Skin Tags Or Cutaneous Vasc Prolif Lesions; Up To 14 (Pro Cah),,17110,CPT,Professional,Both,,,,175,148.75,46.63,175,"Preferred One Administrative Services, INC.",PPO,172.55,98.6,,percent of total billed charges,,
Destruction Benign Lesions Other Than Skin Tags Or Cutaneous Vasc Prolif Lesions; Up To 14 (Pro Cah),,17110,CPT,Professional,Both,,,,175,148.75,46.63,175,PrimeWest Health,Minnesota Senior Health Options (MSHO),77.0155,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Destruction Benign Lesions Other Than Skin Tags Or Cutaneous Vasc Prolif Lesions; Up To 14 (Pro Cah),,17110,CPT,Professional,Both,,,,175,148.75,46.63,175,PrimeWest Health,Minnesota Senior Health Options (MSHO),77.0155,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Destruction Benign Lesions Other Than Skin Tags Or Cutaneous Vasc Prolif Lesions; Up To 14 (Pro Cah),,17110,CPT,Professional,Both,,,,175,148.75,46.63,175,PrimeWest Health,MinnesotaCare,53.0840696,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Destruction Benign Lesions Other Than Skin Tags Or Cutaneous Vasc Prolif Lesions; Up To 14 (Pro Cah),,17110,CPT,Professional,Both,,,,175,148.75,46.63,175,PrimeWest Health,MinnesotaCare,53.0840696,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Destruction Benign Lesions Other Than Skin Tags Or Cutaneous Vasc Prolif Lesions; Up To 14 (Pro Cah),,17110,CPT,Professional,Both,,,,175,148.75,46.63,175,Sanford Health Plan,Sanford Health Plan,154,88,,percent of total billed charges,,
Destruction Benign Lesions Other Than Skin Tags Or Cutaneous Vasc Prolif Lesions; Up To 14 (Pro Cah),,17110,CPT,Professional,Both,,,,175,148.75,46.63,175,Sanford Health Plan,Sanford Health Plan,154,88,,percent of total billed charges,,
Destruction Benign Lesions Other Than Skin Tags Or Cutaneous Vasc Prolif Lesions; Up To 14 (Pro Cah),,17110,CPT,Professional,Both,,,,175,148.75,46.63,175,"UCare Health, Inc.",Individual & Family Plan,108.866432,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Destruction Benign Lesions Other Than Skin Tags Or Cutaneous Vasc Prolif Lesions; Up To 14 (Pro Cah),,17110,CPT,Professional,Both,,,,175,148.75,46.63,175,"UCare Health, Inc.",Individual & Family Plan,108.866432,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Destruction Benign Lesions Other Than Skin Tags Or Cutaneous Vasc Prolif Lesions; Up To 14 (Pro Cah),,17110,CPT,Professional,Both,,,,175,148.75,46.63,175,"UCare Health, Inc.",Medical Assistance,54.572408,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Destruction Benign Lesions Other Than Skin Tags Or Cutaneous Vasc Prolif Lesions; Up To 14 (Pro Cah),,17110,CPT,Professional,Both,,,,175,148.75,46.63,175,"UCare Health, Inc.",Medical Assistance,54.572408,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Destruction Benign Lesions Other Than Skin Tags Or Cutaneous Vasc Prolif Lesions; Up To 14 (Pro Cah),,17110,CPT,Professional,Both,,,,175,148.75,46.63,175,"UCare Health, Inc.",Medicare Advantage,77.0155,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Destruction Benign Lesions Other Than Skin Tags Or Cutaneous Vasc Prolif Lesions; Up To 14 (Pro Cah),,17110,CPT,Professional,Both,,,,175,148.75,46.63,175,"UCare Health, Inc.",Medicare Advantage,77.0155,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Destruction Benign Lesions Other Than Skin Tags Or Cutaneous Vasc Prolif Lesions; Up To 14 (Pro Cah),,17110,CPT,Professional,Both,,,,175,148.75,46.63,175,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),61.6124,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Destruction Benign Lesions Other Than Skin Tags Or Cutaneous Vasc Prolif Lesions; Up To 14 (Pro Cah),,17110,CPT,Professional,Both,,,,175,148.75,46.63,175,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),61.6124,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Destruction Benign Lesions Other Than Skin Tags Or Cutaneous Vasc Prolif Lesions; Up To 14 (Pro Cah),,17110,CPT,Professional,Both,,,,175,148.75,46.63,175,UnitedHealthcare,Individual & Family,175,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Destruction Benign Lesions Other Than Skin Tags Or Cutaneous Vasc Prolif Lesions; Up To 14 (Pro Cah),,17110,CPT,Professional,Both,,,,175,148.75,46.63,175,UnitedHealthcare,Individual & Family,175,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Destruction Benign Lesions Other Than Skin Tags Or Cutaneous Vasc Prolif Lesions; Up To 14 (Pro Cah),,17110,CPT,Professional,Both,,,,175,148.75,46.63,175,UnitedHealthcare,Medicare Advantage,77.0155,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Destruction Benign Lesions Other Than Skin Tags Or Cutaneous Vasc Prolif Lesions; Up To 14 (Pro Cah),,17110,CPT,Professional,Both,,,,175,148.75,46.63,175,UnitedHealthcare,Medicare Advantage,77.0155,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Destruction Benign Lesions Other Than Skin Tags Or Cutaneous Vasc Prolif Lesions; Up To 14 (Pro Cah),,17110,CPT,Professional,Both,,,,175,148.75,46.63,175,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,49.61128,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Destruction Benign Lesions Other Than Skin Tags Or Cutaneous Vasc Prolif Lesions; Up To 14 (Pro Cah),,17110,CPT,Professional,Both,,,,175,148.75,46.63,175,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,49.61128,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Destruction Of Benign Skin Lesions, Up To 14 Lesions",,17110,CPT,Facility,Both,,,,110,93.5,31.526,299,Aetna,Commercial,101.2,92,,percent of total billed charges,,
"Destruction Of Benign Skin Lesions, Up To 14 Lesions",,17110,CPT,Facility,Outpatient,,,,110,93.5,31.526,299,Aetna,Medicare Advantage,53.9,49,,percent of total billed charges,,
"Destruction Of Benign Skin Lesions, Up To 14 Lesions",,17110,CPT,Facility,Inpatient,,,,110,93.5,31.526,299,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Destruction Of Benign Skin Lesions, Up To 14 Lesions",,17110,CPT,Facility,Both,,,,110,93.5,31.526,299,Aetna,PPO,102.3,93,,percent of total billed charges,,
"Destruction Of Benign Skin Lesions, Up To 14 Lesions",,17110,CPT,Facility,Both,,,,110,93.5,31.526,299,America's PPO,America's PPO,105.633,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Destruction Of Benign Skin Lesions, Up To 14 Lesions",,17110,CPT,Facility,Both,,,,110,93.5,31.526,299,BlueCross BlueShield Minnesota, Federal Employee Program,108.24,98.4,,percent of total billed charges,,
"Destruction Of Benign Skin Lesions, Up To 14 Lesions",,17110,CPT,Facility,Both,,,,110,93.5,31.526,299,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,110,100,,percent of total billed charges,,
"Destruction Of Benign Skin Lesions, Up To 14 Lesions",,17110,CPT,Facility,Both,,,,110,93.5,31.526,299,BlueCross BlueShield Minnesota,High Value Network Plan,99,90,,percent of total billed charges,,
"Destruction Of Benign Skin Lesions, Up To 14 Lesions",,17110,CPT,Facility,Outpatient,,,,110,93.5,31.526,299,BlueCross BlueShield Minnesota,Medicare Advantage,53.9,49,,percent of total billed charges,,
"Destruction Of Benign Skin Lesions, Up To 14 Lesions",,17110,CPT,Facility,Inpatient,,,,110,93.5,31.526,299,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Destruction Of Benign Skin Lesions, Up To 14 Lesions",,17110,CPT,Facility,Both,,,,110,93.5,31.526,299,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,97.427,88.57,,percent of total billed charges,,
"Destruction Of Benign Skin Lesions, Up To 14 Lesions",,17110,CPT,Facility,Both,,,,110,93.5,31.526,299,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,31.526,28.66,,percent of total billed charges,,
"Destruction Of Benign Skin Lesions, Up To 14 Lesions",,17110,CPT,Facility,Outpatient,,,,110,93.5,31.526,299,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),53.9,49,,percent of total billed charges,,
"Destruction Of Benign Skin Lesions, Up To 14 Lesions",,17110,CPT,Facility,Inpatient,,,,110,93.5,31.526,299,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Destruction Of Benign Skin Lesions, Up To 14 Lesions",,17110,CPT,Facility,Both,,,,110,93.5,31.526,299,CorVel,Worker's Compensation,110,100,,percent of total billed charges,,
"Destruction Of Benign Skin Lesions, Up To 14 Lesions",,17110,CPT,Facility,Both,,,,110,93.5,31.526,299,First Health Group Corporation,First Health Network,106.7,97,,percent of total billed charges,,
"Destruction Of Benign Skin Lesions, Up To 14 Lesions",,17110,CPT,Facility,Both,,,,110,93.5,31.526,299,"Health Partners, Inc.",Commercial,104.06,94.6,,percent of total billed charges,,
"Destruction Of Benign Skin Lesions, Up To 14 Lesions",,17110,CPT,Facility,Outpatient,,,,110,93.5,31.526,299,"Health Partners, Inc.",Medicare Advantage,53.9,49,,percent of total billed charges,,
"Destruction Of Benign Skin Lesions, Up To 14 Lesions",,17110,CPT,Facility,Inpatient,,,,110,93.5,31.526,299,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Destruction Of Benign Skin Lesions, Up To 14 Lesions",,17110,CPT,Facility,Both,,,,110,93.5,31.526,299,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),66,60,,percent of total billed charges,,
"Destruction Of Benign Skin Lesions, Up To 14 Lesions",,17110,CPT,Facility,Both,,,,110,93.5,31.526,299,"Health Partners, Inc.",State of Minnesota Advantage Program,89.65,81.5,,percent of total billed charges,,
"Destruction Of Benign Skin Lesions, Up To 14 Lesions",,17110,CPT,Facility,Both,,,,110,93.5,31.526,299,"Health Partners, Inc.",State Public Programs,55,50,,percent of total billed charges,,
"Destruction Of Benign Skin Lesions, Up To 14 Lesions",,17110,CPT,Facility,Both,,,,110,93.5,31.526,299,Humana Insurance Company,Commercial PPO,104.5,95,,percent of total billed charges,,
"Destruction Of Benign Skin Lesions, Up To 14 Lesions",,17110,CPT,Facility,Outpatient,,,,110,93.5,31.526,299,Humana Insurance Company,Medicare PPO,53.9,49,,percent of total billed charges,,
"Destruction Of Benign Skin Lesions, Up To 14 Lesions",,17110,CPT,Facility,Inpatient,,,,110,93.5,31.526,299,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Destruction Of Benign Skin Lesions, Up To 14 Lesions",,17110,CPT,Facility,Both,,,,110,93.5,31.526,299,Medica,Individual & Family,109.01,99.1,,percent of total billed charges,,
"Destruction Of Benign Skin Lesions, Up To 14 Lesions",,17110,CPT,Facility,Outpatient,,,,110,93.5,31.526,299,Medica,Medica Advantage Solution,54.78,49.8,,percent of total billed charges,,
"Destruction Of Benign Skin Lesions, Up To 14 Lesions",,17110,CPT,Facility,Inpatient,,,,110,93.5,31.526,299,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Destruction Of Benign Skin Lesions, Up To 14 Lesions",,17110,CPT,Facility,Outpatient,,,,110,93.5,31.526,299,Medica,Medical Assistance,299,,,Other,Grouper,All inclusive per visit
"Destruction Of Benign Skin Lesions, Up To 14 Lesions",,17110,CPT,Facility,Inpatient,,,,110,93.5,31.526,299,Medica,Medical Assistance,,,,,Included in per diem rate,
"Destruction Of Benign Skin Lesions, Up To 14 Lesions",,17110,CPT,Facility,Outpatient,,,,110,93.5,31.526,299,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,54.78,49.8,,percent of total billed charges,,
"Destruction Of Benign Skin Lesions, Up To 14 Lesions",,17110,CPT,Facility,Inpatient,,,,110,93.5,31.526,299,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Destruction Of Benign Skin Lesions, Up To 14 Lesions",,17110,CPT,Facility,Both,,,,110,93.5,31.526,299,"Multiplan, Inc.","Multiplan, Inc.",103.4,94,,percent of total billed charges,,
"Destruction Of Benign Skin Lesions, Up To 14 Lesions",,17110,CPT,Facility,Outpatient,,,,110,93.5,31.526,299,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,99.11,90.1,,percent of total billed charges,,
"Destruction Of Benign Skin Lesions, Up To 14 Lesions",,17110,CPT,Facility,Inpatient,,,,110,93.5,31.526,299,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Destruction Of Benign Skin Lesions, Up To 14 Lesions",,17110,CPT,Facility,Both,,,,110,93.5,31.526,299,"Preferred One Administrative Services, INC.",PPO,108.46,98.6,,percent of total billed charges,,
"Destruction Of Benign Skin Lesions, Up To 14 Lesions",,17110,CPT,Facility,Outpatient,,,,110,93.5,31.526,299,PrimeWest Health,Minnesota Senior Health Options (MSHO),56.595,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Destruction Of Benign Skin Lesions, Up To 14 Lesions",,17110,CPT,Facility,Inpatient,,,,110,93.5,31.526,299,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Destruction Of Benign Skin Lesions, Up To 14 Lesions",,17110,CPT,Facility,Outpatient,,,,110,93.5,31.526,299,PrimeWest Health,MinnesotaCare,56.496,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Destruction Of Benign Skin Lesions, Up To 14 Lesions",,17110,CPT,Facility,Inpatient,,,,110,93.5,31.526,299,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Destruction Of Benign Skin Lesions, Up To 14 Lesions",,17110,CPT,Facility,Both,,,,110,93.5,31.526,299,Sanford Health Plan,Sanford Health Plan,101.2,92,,percent of total billed charges,,
"Destruction Of Benign Skin Lesions, Up To 14 Lesions",,17110,CPT,Facility,Outpatient,,,,110,93.5,31.526,299,"UCare Health, Inc.",Individual & Family Plan,61.985,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Destruction Of Benign Skin Lesions, Up To 14 Lesions",,17110,CPT,Facility,Inpatient,,,,110,93.5,31.526,299,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Destruction Of Benign Skin Lesions, Up To 14 Lesions",,17110,CPT,Facility,Outpatient,,,,110,93.5,31.526,299,"UCare Health, Inc.",Medical Assistance,55.517,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Destruction Of Benign Skin Lesions, Up To 14 Lesions",,17110,CPT,Facility,Inpatient,,,,110,93.5,31.526,299,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Destruction Of Benign Skin Lesions, Up To 14 Lesions",,17110,CPT,Facility,Outpatient,,,,110,93.5,31.526,299,"UCare Health, Inc.",Medicare Advantage,55.517,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Destruction Of Benign Skin Lesions, Up To 14 Lesions",,17110,CPT,Facility,Inpatient,,,,110,93.5,31.526,299,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Destruction Of Benign Skin Lesions, Up To 14 Lesions",,17110,CPT,Facility,Outpatient,,,,110,93.5,31.526,299,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),55.517,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Destruction Of Benign Skin Lesions, Up To 14 Lesions",,17110,CPT,Facility,Inpatient,,,,110,93.5,31.526,299,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Destruction Of Benign Skin Lesions, Up To 14 Lesions",,17110,CPT,Facility,Both,,,,110,93.5,31.526,299,UnitedHealthcare,Individual & Family,103.4,94,,percent of total billed charges,,
"Destruction Of Benign Skin Lesions, Up To 14 Lesions",,17110,CPT,Facility,Outpatient,,,,110,93.5,31.526,299,UnitedHealthcare,Medicare Advantage,53.9,49,,percent of total billed charges,,
"Destruction Of Benign Skin Lesions, Up To 14 Lesions",,17110,CPT,Facility,Inpatient,,,,110,93.5,31.526,299,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Destruction Of Benign Skin Lesions, Up To 14 Lesions",,17110,CPT,Facility,Outpatient,,,,110,93.5,31.526,299,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,52.8,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Destruction Of Benign Skin Lesions, Up To 14 Lesions",,17110,CPT,Facility,Inpatient,,,,110,93.5,31.526,299,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
APIXABAN 2.5 MG ORAL TABLET,,105310,LOCAL,Facility,Both,1,Each,,54,45.9,15.4764,54,Aetna,Commercial,49.68,92,,percent of total billed charges,,
APIXABAN 2.5 MG ORAL TABLET,,105310,LOCAL,Facility,Outpatient,1,Each,,54,45.9,15.4764,54,Aetna,Medicare Advantage,26.46,49,,percent of total billed charges,,
APIXABAN 2.5 MG ORAL TABLET,,105310,LOCAL,Facility,Inpatient,1,Each,,54,45.9,15.4764,54,Aetna,Medicare Advantage,,,,,Included in per diem rate,
APIXABAN 2.5 MG ORAL TABLET,,105310,LOCAL,Facility,Both,1,Each,,54,45.9,15.4764,54,Aetna,PPO,50.22,93,,percent of total billed charges,,
APIXABAN 2.5 MG ORAL TABLET,,105310,LOCAL,Facility,Both,1,Each,,54,45.9,15.4764,54,America's PPO,America's PPO,51.8562,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
APIXABAN 2.5 MG ORAL TABLET,,105310,LOCAL,Facility,Both,1,Each,,54,45.9,15.4764,54,BlueCross BlueShield Minnesota, Federal Employee Program,53.136,98.4,,percent of total billed charges,,
APIXABAN 2.5 MG ORAL TABLET,,105310,LOCAL,Facility,Both,1,Each,,54,45.9,15.4764,54,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,54,100,,percent of total billed charges,,
APIXABAN 2.5 MG ORAL TABLET,,105310,LOCAL,Facility,Both,1,Each,,54,45.9,15.4764,54,BlueCross BlueShield Minnesota,High Value Network Plan,48.6,90,,percent of total billed charges,,
APIXABAN 2.5 MG ORAL TABLET,,105310,LOCAL,Facility,Outpatient,1,Each,,54,45.9,15.4764,54,BlueCross BlueShield Minnesota,Medicare Advantage,26.46,49,,percent of total billed charges,,
APIXABAN 2.5 MG ORAL TABLET,,105310,LOCAL,Facility,Inpatient,1,Each,,54,45.9,15.4764,54,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
APIXABAN 2.5 MG ORAL TABLET,,105310,LOCAL,Facility,Both,1,Each,,54,45.9,15.4764,54,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,47.8278,88.57,,percent of total billed charges,,
APIXABAN 2.5 MG ORAL TABLET,,105310,LOCAL,Facility,Both,1,Each,,54,45.9,15.4764,54,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,15.4764,28.66,,percent of total billed charges,,
APIXABAN 2.5 MG ORAL TABLET,,105310,LOCAL,Facility,Outpatient,1,Each,,54,45.9,15.4764,54,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),26.46,49,,percent of total billed charges,,
APIXABAN 2.5 MG ORAL TABLET,,105310,LOCAL,Facility,Inpatient,1,Each,,54,45.9,15.4764,54,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
APIXABAN 2.5 MG ORAL TABLET,,105310,LOCAL,Facility,Both,1,Each,,54,45.9,15.4764,54,CorVel,Worker's Compensation,54,100,,percent of total billed charges,,
APIXABAN 2.5 MG ORAL TABLET,,105310,LOCAL,Facility,Both,1,Each,,54,45.9,15.4764,54,First Health Group Corporation,First Health Network,52.38,97,,percent of total billed charges,,
APIXABAN 2.5 MG ORAL TABLET,,105310,LOCAL,Facility,Both,1,Each,,54,45.9,15.4764,54,"Health Partners, Inc.",Commercial,51.084,94.6,,percent of total billed charges,,
APIXABAN 2.5 MG ORAL TABLET,,105310,LOCAL,Facility,Outpatient,1,Each,,54,45.9,15.4764,54,"Health Partners, Inc.",Medicare Advantage,26.46,49,,percent of total billed charges,,
APIXABAN 2.5 MG ORAL TABLET,,105310,LOCAL,Facility,Inpatient,1,Each,,54,45.9,15.4764,54,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
APIXABAN 2.5 MG ORAL TABLET,,105310,LOCAL,Facility,Both,1,Each,,54,45.9,15.4764,54,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),32.4,60,,percent of total billed charges,,
APIXABAN 2.5 MG ORAL TABLET,,105310,LOCAL,Facility,Both,1,Each,,54,45.9,15.4764,54,"Health Partners, Inc.",State of Minnesota Advantage Program,44.01,81.5,,percent of total billed charges,,
APIXABAN 2.5 MG ORAL TABLET,,105310,LOCAL,Facility,Both,1,Each,,54,45.9,15.4764,54,"Health Partners, Inc.",State Public Programs,27,50,,percent of total billed charges,,
APIXABAN 2.5 MG ORAL TABLET,,105310,LOCAL,Facility,Both,1,Each,,54,45.9,15.4764,54,Humana Insurance Company,Commercial PPO,51.3,95,,percent of total billed charges,,
APIXABAN 2.5 MG ORAL TABLET,,105310,LOCAL,Facility,Outpatient,1,Each,,54,45.9,15.4764,54,Humana Insurance Company,Medicare PPO,26.46,49,,percent of total billed charges,,
APIXABAN 2.5 MG ORAL TABLET,,105310,LOCAL,Facility,Inpatient,1,Each,,54,45.9,15.4764,54,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
APIXABAN 2.5 MG ORAL TABLET,,105310,LOCAL,Facility,Both,1,Each,,54,45.9,15.4764,54,Medica,Individual & Family,53.514,99.1,,percent of total billed charges,,
APIXABAN 2.5 MG ORAL TABLET,,105310,LOCAL,Facility,Outpatient,1,Each,,54,45.9,15.4764,54,Medica,Medica Advantage Solution,26.892,49.8,,percent of total billed charges,,
APIXABAN 2.5 MG ORAL TABLET,,105310,LOCAL,Facility,Inpatient,1,Each,,54,45.9,15.4764,54,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
APIXABAN 2.5 MG ORAL TABLET,,105310,LOCAL,Facility,Outpatient,1,Each,,54,45.9,15.4764,54,Medica,Medical Assistance,24.084,44.6,,percent of total billed charges,,
APIXABAN 2.5 MG ORAL TABLET,,105310,LOCAL,Facility,Inpatient,1,Each,,54,45.9,15.4764,54,Medica,Medical Assistance,,,,,Included in per diem rate,
APIXABAN 2.5 MG ORAL TABLET,,105310,LOCAL,Facility,Outpatient,1,Each,,54,45.9,15.4764,54,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,26.892,49.8,,percent of total billed charges,,
APIXABAN 2.5 MG ORAL TABLET,,105310,LOCAL,Facility,Inpatient,1,Each,,54,45.9,15.4764,54,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
APIXABAN 2.5 MG ORAL TABLET,,105310,LOCAL,Facility,Both,1,Each,,54,45.9,15.4764,54,"Multiplan, Inc.","Multiplan, Inc.",50.76,94,,percent of total billed charges,,
APIXABAN 2.5 MG ORAL TABLET,,105310,LOCAL,Facility,Outpatient,1,Each,,54,45.9,15.4764,54,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,48.654,90.1,,percent of total billed charges,,
APIXABAN 2.5 MG ORAL TABLET,,105310,LOCAL,Facility,Inpatient,1,Each,,54,45.9,15.4764,54,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
APIXABAN 2.5 MG ORAL TABLET,,105310,LOCAL,Facility,Both,1,Each,,54,45.9,15.4764,54,"Preferred One Administrative Services, INC.",PPO,53.244,98.6,,percent of total billed charges,,
APIXABAN 2.5 MG ORAL TABLET,,105310,LOCAL,Facility,Outpatient,1,Each,,54,45.9,15.4764,54,PrimeWest Health,Minnesota Senior Health Options (MSHO),27.783,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
APIXABAN 2.5 MG ORAL TABLET,,105310,LOCAL,Facility,Inpatient,1,Each,,54,45.9,15.4764,54,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
APIXABAN 2.5 MG ORAL TABLET,,105310,LOCAL,Facility,Outpatient,1,Each,,54,45.9,15.4764,54,PrimeWest Health,MinnesotaCare,27.7344,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
APIXABAN 2.5 MG ORAL TABLET,,105310,LOCAL,Facility,Inpatient,1,Each,,54,45.9,15.4764,54,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
APIXABAN 2.5 MG ORAL TABLET,,105310,LOCAL,Facility,Both,1,Each,,54,45.9,15.4764,54,Sanford Health Plan,Sanford Health Plan,49.68,92,,percent of total billed charges,,
APIXABAN 2.5 MG ORAL TABLET,,105310,LOCAL,Facility,Outpatient,1,Each,,54,45.9,15.4764,54,"UCare Health, Inc.",Individual & Family Plan,30.429,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
APIXABAN 2.5 MG ORAL TABLET,,105310,LOCAL,Facility,Inpatient,1,Each,,54,45.9,15.4764,54,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
APIXABAN 2.5 MG ORAL TABLET,,105310,LOCAL,Facility,Outpatient,1,Each,,54,45.9,15.4764,54,"UCare Health, Inc.",Medical Assistance,27.2538,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
APIXABAN 2.5 MG ORAL TABLET,,105310,LOCAL,Facility,Inpatient,1,Each,,54,45.9,15.4764,54,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
APIXABAN 2.5 MG ORAL TABLET,,105310,LOCAL,Facility,Outpatient,1,Each,,54,45.9,15.4764,54,"UCare Health, Inc.",Medicare Advantage,27.2538,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
APIXABAN 2.5 MG ORAL TABLET,,105310,LOCAL,Facility,Inpatient,1,Each,,54,45.9,15.4764,54,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
APIXABAN 2.5 MG ORAL TABLET,,105310,LOCAL,Facility,Outpatient,1,Each,,54,45.9,15.4764,54,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),27.2538,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
APIXABAN 2.5 MG ORAL TABLET,,105310,LOCAL,Facility,Inpatient,1,Each,,54,45.9,15.4764,54,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
APIXABAN 2.5 MG ORAL TABLET,,105310,LOCAL,Facility,Both,1,Each,,54,45.9,15.4764,54,UnitedHealthcare,Individual & Family,50.76,94,,percent of total billed charges,,
APIXABAN 2.5 MG ORAL TABLET,,105310,LOCAL,Facility,Outpatient,1,Each,,54,45.9,15.4764,54,UnitedHealthcare,Medicare Advantage,26.46,49,,percent of total billed charges,,
APIXABAN 2.5 MG ORAL TABLET,,105310,LOCAL,Facility,Inpatient,1,Each,,54,45.9,15.4764,54,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
APIXABAN 2.5 MG ORAL TABLET,,105310,LOCAL,Facility,Outpatient,1,Each,,54,45.9,15.4764,54,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,25.92,48,,percent of total billed charges,,100% of DHS outpatient percentage
APIXABAN 2.5 MG ORAL TABLET,,105310,LOCAL,Facility,Inpatient,1,Each,,54,45.9,15.4764,54,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
MEMANTINE 28 MG ORAL CSPX,,106177,LOCAL,Facility,Both,1,Each,,74,62.9,21.2084,74,Aetna,Commercial,68.08,92,,percent of total billed charges,,
MEMANTINE 28 MG ORAL CSPX,,106177,LOCAL,Facility,Outpatient,1,Each,,74,62.9,21.2084,74,Aetna,Medicare Advantage,36.26,49,,percent of total billed charges,,
MEMANTINE 28 MG ORAL CSPX,,106177,LOCAL,Facility,Inpatient,1,Each,,74,62.9,21.2084,74,Aetna,Medicare Advantage,,,,,Included in per diem rate,
MEMANTINE 28 MG ORAL CSPX,,106177,LOCAL,Facility,Both,1,Each,,74,62.9,21.2084,74,Aetna,PPO,68.82,93,,percent of total billed charges,,
MEMANTINE 28 MG ORAL CSPX,,106177,LOCAL,Facility,Both,1,Each,,74,62.9,21.2084,74,America's PPO,America's PPO,71.0622,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
MEMANTINE 28 MG ORAL CSPX,,106177,LOCAL,Facility,Both,1,Each,,74,62.9,21.2084,74,BlueCross BlueShield Minnesota, Federal Employee Program,72.816,98.4,,percent of total billed charges,,
MEMANTINE 28 MG ORAL CSPX,,106177,LOCAL,Facility,Both,1,Each,,74,62.9,21.2084,74,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,74,100,,percent of total billed charges,,
MEMANTINE 28 MG ORAL CSPX,,106177,LOCAL,Facility,Both,1,Each,,74,62.9,21.2084,74,BlueCross BlueShield Minnesota,High Value Network Plan,66.6,90,,percent of total billed charges,,
MEMANTINE 28 MG ORAL CSPX,,106177,LOCAL,Facility,Outpatient,1,Each,,74,62.9,21.2084,74,BlueCross BlueShield Minnesota,Medicare Advantage,36.26,49,,percent of total billed charges,,
MEMANTINE 28 MG ORAL CSPX,,106177,LOCAL,Facility,Inpatient,1,Each,,74,62.9,21.2084,74,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
MEMANTINE 28 MG ORAL CSPX,,106177,LOCAL,Facility,Both,1,Each,,74,62.9,21.2084,74,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,65.5418,88.57,,percent of total billed charges,,
MEMANTINE 28 MG ORAL CSPX,,106177,LOCAL,Facility,Both,1,Each,,74,62.9,21.2084,74,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,21.2084,28.66,,percent of total billed charges,,
MEMANTINE 28 MG ORAL CSPX,,106177,LOCAL,Facility,Outpatient,1,Each,,74,62.9,21.2084,74,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),36.26,49,,percent of total billed charges,,
MEMANTINE 28 MG ORAL CSPX,,106177,LOCAL,Facility,Inpatient,1,Each,,74,62.9,21.2084,74,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
MEMANTINE 28 MG ORAL CSPX,,106177,LOCAL,Facility,Both,1,Each,,74,62.9,21.2084,74,CorVel,Worker's Compensation,74,100,,percent of total billed charges,,
MEMANTINE 28 MG ORAL CSPX,,106177,LOCAL,Facility,Both,1,Each,,74,62.9,21.2084,74,First Health Group Corporation,First Health Network,71.78,97,,percent of total billed charges,,
MEMANTINE 28 MG ORAL CSPX,,106177,LOCAL,Facility,Both,1,Each,,74,62.9,21.2084,74,"Health Partners, Inc.",Commercial,70.004,94.6,,percent of total billed charges,,
MEMANTINE 28 MG ORAL CSPX,,106177,LOCAL,Facility,Outpatient,1,Each,,74,62.9,21.2084,74,"Health Partners, Inc.",Medicare Advantage,36.26,49,,percent of total billed charges,,
MEMANTINE 28 MG ORAL CSPX,,106177,LOCAL,Facility,Inpatient,1,Each,,74,62.9,21.2084,74,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
MEMANTINE 28 MG ORAL CSPX,,106177,LOCAL,Facility,Both,1,Each,,74,62.9,21.2084,74,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),44.4,60,,percent of total billed charges,,
MEMANTINE 28 MG ORAL CSPX,,106177,LOCAL,Facility,Both,1,Each,,74,62.9,21.2084,74,"Health Partners, Inc.",State of Minnesota Advantage Program,60.31,81.5,,percent of total billed charges,,
MEMANTINE 28 MG ORAL CSPX,,106177,LOCAL,Facility,Both,1,Each,,74,62.9,21.2084,74,"Health Partners, Inc.",State Public Programs,37,50,,percent of total billed charges,,
MEMANTINE 28 MG ORAL CSPX,,106177,LOCAL,Facility,Both,1,Each,,74,62.9,21.2084,74,Humana Insurance Company,Commercial PPO,70.3,95,,percent of total billed charges,,
MEMANTINE 28 MG ORAL CSPX,,106177,LOCAL,Facility,Outpatient,1,Each,,74,62.9,21.2084,74,Humana Insurance Company,Medicare PPO,36.26,49,,percent of total billed charges,,
MEMANTINE 28 MG ORAL CSPX,,106177,LOCAL,Facility,Inpatient,1,Each,,74,62.9,21.2084,74,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
MEMANTINE 28 MG ORAL CSPX,,106177,LOCAL,Facility,Both,1,Each,,74,62.9,21.2084,74,Medica,Individual & Family,73.334,99.1,,percent of total billed charges,,
MEMANTINE 28 MG ORAL CSPX,,106177,LOCAL,Facility,Outpatient,1,Each,,74,62.9,21.2084,74,Medica,Medica Advantage Solution,36.852,49.8,,percent of total billed charges,,
MEMANTINE 28 MG ORAL CSPX,,106177,LOCAL,Facility,Inpatient,1,Each,,74,62.9,21.2084,74,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
MEMANTINE 28 MG ORAL CSPX,,106177,LOCAL,Facility,Outpatient,1,Each,,74,62.9,21.2084,74,Medica,Medical Assistance,33.004,44.6,,percent of total billed charges,,
MEMANTINE 28 MG ORAL CSPX,,106177,LOCAL,Facility,Inpatient,1,Each,,74,62.9,21.2084,74,Medica,Medical Assistance,,,,,Included in per diem rate,
MEMANTINE 28 MG ORAL CSPX,,106177,LOCAL,Facility,Outpatient,1,Each,,74,62.9,21.2084,74,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,36.852,49.8,,percent of total billed charges,,
MEMANTINE 28 MG ORAL CSPX,,106177,LOCAL,Facility,Inpatient,1,Each,,74,62.9,21.2084,74,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
MEMANTINE 28 MG ORAL CSPX,,106177,LOCAL,Facility,Both,1,Each,,74,62.9,21.2084,74,"Multiplan, Inc.","Multiplan, Inc.",69.56,94,,percent of total billed charges,,
MEMANTINE 28 MG ORAL CSPX,,106177,LOCAL,Facility,Outpatient,1,Each,,74,62.9,21.2084,74,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,66.674,90.1,,percent of total billed charges,,
MEMANTINE 28 MG ORAL CSPX,,106177,LOCAL,Facility,Inpatient,1,Each,,74,62.9,21.2084,74,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
MEMANTINE 28 MG ORAL CSPX,,106177,LOCAL,Facility,Both,1,Each,,74,62.9,21.2084,74,"Preferred One Administrative Services, INC.",PPO,72.964,98.6,,percent of total billed charges,,
MEMANTINE 28 MG ORAL CSPX,,106177,LOCAL,Facility,Outpatient,1,Each,,74,62.9,21.2084,74,PrimeWest Health,Minnesota Senior Health Options (MSHO),38.073,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
MEMANTINE 28 MG ORAL CSPX,,106177,LOCAL,Facility,Inpatient,1,Each,,74,62.9,21.2084,74,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
MEMANTINE 28 MG ORAL CSPX,,106177,LOCAL,Facility,Outpatient,1,Each,,74,62.9,21.2084,74,PrimeWest Health,MinnesotaCare,38.0064,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
MEMANTINE 28 MG ORAL CSPX,,106177,LOCAL,Facility,Inpatient,1,Each,,74,62.9,21.2084,74,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
MEMANTINE 28 MG ORAL CSPX,,106177,LOCAL,Facility,Both,1,Each,,74,62.9,21.2084,74,Sanford Health Plan,Sanford Health Plan,68.08,92,,percent of total billed charges,,
MEMANTINE 28 MG ORAL CSPX,,106177,LOCAL,Facility,Outpatient,1,Each,,74,62.9,21.2084,74,"UCare Health, Inc.",Individual & Family Plan,41.699,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
MEMANTINE 28 MG ORAL CSPX,,106177,LOCAL,Facility,Inpatient,1,Each,,74,62.9,21.2084,74,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
MEMANTINE 28 MG ORAL CSPX,,106177,LOCAL,Facility,Outpatient,1,Each,,74,62.9,21.2084,74,"UCare Health, Inc.",Medical Assistance,37.3478,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MEMANTINE 28 MG ORAL CSPX,,106177,LOCAL,Facility,Inpatient,1,Each,,74,62.9,21.2084,74,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
MEMANTINE 28 MG ORAL CSPX,,106177,LOCAL,Facility,Outpatient,1,Each,,74,62.9,21.2084,74,"UCare Health, Inc.",Medicare Advantage,37.3478,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MEMANTINE 28 MG ORAL CSPX,,106177,LOCAL,Facility,Inpatient,1,Each,,74,62.9,21.2084,74,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
MEMANTINE 28 MG ORAL CSPX,,106177,LOCAL,Facility,Outpatient,1,Each,,74,62.9,21.2084,74,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),37.3478,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MEMANTINE 28 MG ORAL CSPX,,106177,LOCAL,Facility,Inpatient,1,Each,,74,62.9,21.2084,74,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
MEMANTINE 28 MG ORAL CSPX,,106177,LOCAL,Facility,Both,1,Each,,74,62.9,21.2084,74,UnitedHealthcare,Individual & Family,69.56,94,,percent of total billed charges,,
MEMANTINE 28 MG ORAL CSPX,,106177,LOCAL,Facility,Outpatient,1,Each,,74,62.9,21.2084,74,UnitedHealthcare,Medicare Advantage,36.26,49,,percent of total billed charges,,
MEMANTINE 28 MG ORAL CSPX,,106177,LOCAL,Facility,Inpatient,1,Each,,74,62.9,21.2084,74,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
MEMANTINE 28 MG ORAL CSPX,,106177,LOCAL,Facility,Outpatient,1,Each,,74,62.9,21.2084,74,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,35.52,48,,percent of total billed charges,,100% of DHS outpatient percentage
MEMANTINE 28 MG ORAL CSPX,,106177,LOCAL,Facility,Inpatient,1,Each,,74,62.9,21.2084,74,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"VIT C,E-ZN-COPPR-LUTEIN-ZEAXAN 250-90-40-1 MG ORAL CAP",,109047,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
"VIT C,E-ZN-COPPR-LUTEIN-ZEAXAN 250-90-40-1 MG ORAL CAP",,109047,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
"VIT C,E-ZN-COPPR-LUTEIN-ZEAXAN 250-90-40-1 MG ORAL CAP",,109047,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"VIT C,E-ZN-COPPR-LUTEIN-ZEAXAN 250-90-40-1 MG ORAL CAP",,109047,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
"VIT C,E-ZN-COPPR-LUTEIN-ZEAXAN 250-90-40-1 MG ORAL CAP",,109047,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"VIT C,E-ZN-COPPR-LUTEIN-ZEAXAN 250-90-40-1 MG ORAL CAP",,109047,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
"VIT C,E-ZN-COPPR-LUTEIN-ZEAXAN 250-90-40-1 MG ORAL CAP",,109047,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
"VIT C,E-ZN-COPPR-LUTEIN-ZEAXAN 250-90-40-1 MG ORAL CAP",,109047,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
"VIT C,E-ZN-COPPR-LUTEIN-ZEAXAN 250-90-40-1 MG ORAL CAP",,109047,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
"VIT C,E-ZN-COPPR-LUTEIN-ZEAXAN 250-90-40-1 MG ORAL CAP",,109047,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"VIT C,E-ZN-COPPR-LUTEIN-ZEAXAN 250-90-40-1 MG ORAL CAP",,109047,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
"VIT C,E-ZN-COPPR-LUTEIN-ZEAXAN 250-90-40-1 MG ORAL CAP",,109047,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
"VIT C,E-ZN-COPPR-LUTEIN-ZEAXAN 250-90-40-1 MG ORAL CAP",,109047,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
"VIT C,E-ZN-COPPR-LUTEIN-ZEAXAN 250-90-40-1 MG ORAL CAP",,109047,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"VIT C,E-ZN-COPPR-LUTEIN-ZEAXAN 250-90-40-1 MG ORAL CAP",,109047,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
"VIT C,E-ZN-COPPR-LUTEIN-ZEAXAN 250-90-40-1 MG ORAL CAP",,109047,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
"VIT C,E-ZN-COPPR-LUTEIN-ZEAXAN 250-90-40-1 MG ORAL CAP",,109047,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
"VIT C,E-ZN-COPPR-LUTEIN-ZEAXAN 250-90-40-1 MG ORAL CAP",,109047,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
"VIT C,E-ZN-COPPR-LUTEIN-ZEAXAN 250-90-40-1 MG ORAL CAP",,109047,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"VIT C,E-ZN-COPPR-LUTEIN-ZEAXAN 250-90-40-1 MG ORAL CAP",,109047,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
"VIT C,E-ZN-COPPR-LUTEIN-ZEAXAN 250-90-40-1 MG ORAL CAP",,109047,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
"VIT C,E-ZN-COPPR-LUTEIN-ZEAXAN 250-90-40-1 MG ORAL CAP",,109047,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
"VIT C,E-ZN-COPPR-LUTEIN-ZEAXAN 250-90-40-1 MG ORAL CAP",,109047,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
"VIT C,E-ZN-COPPR-LUTEIN-ZEAXAN 250-90-40-1 MG ORAL CAP",,109047,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
"VIT C,E-ZN-COPPR-LUTEIN-ZEAXAN 250-90-40-1 MG ORAL CAP",,109047,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"VIT C,E-ZN-COPPR-LUTEIN-ZEAXAN 250-90-40-1 MG ORAL CAP",,109047,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
"VIT C,E-ZN-COPPR-LUTEIN-ZEAXAN 250-90-40-1 MG ORAL CAP",,109047,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
"VIT C,E-ZN-COPPR-LUTEIN-ZEAXAN 250-90-40-1 MG ORAL CAP",,109047,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"VIT C,E-ZN-COPPR-LUTEIN-ZEAXAN 250-90-40-1 MG ORAL CAP",,109047,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
"VIT C,E-ZN-COPPR-LUTEIN-ZEAXAN 250-90-40-1 MG ORAL CAP",,109047,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
"VIT C,E-ZN-COPPR-LUTEIN-ZEAXAN 250-90-40-1 MG ORAL CAP",,109047,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
"VIT C,E-ZN-COPPR-LUTEIN-ZEAXAN 250-90-40-1 MG ORAL CAP",,109047,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"VIT C,E-ZN-COPPR-LUTEIN-ZEAXAN 250-90-40-1 MG ORAL CAP",,109047,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
"VIT C,E-ZN-COPPR-LUTEIN-ZEAXAN 250-90-40-1 MG ORAL CAP",,109047,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
"VIT C,E-ZN-COPPR-LUTEIN-ZEAXAN 250-90-40-1 MG ORAL CAP",,109047,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"VIT C,E-ZN-COPPR-LUTEIN-ZEAXAN 250-90-40-1 MG ORAL CAP",,109047,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
"VIT C,E-ZN-COPPR-LUTEIN-ZEAXAN 250-90-40-1 MG ORAL CAP",,109047,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"VIT C,E-ZN-COPPR-LUTEIN-ZEAXAN 250-90-40-1 MG ORAL CAP",,109047,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"VIT C,E-ZN-COPPR-LUTEIN-ZEAXAN 250-90-40-1 MG ORAL CAP",,109047,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"VIT C,E-ZN-COPPR-LUTEIN-ZEAXAN 250-90-40-1 MG ORAL CAP",,109047,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"VIT C,E-ZN-COPPR-LUTEIN-ZEAXAN 250-90-40-1 MG ORAL CAP",,109047,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
"VIT C,E-ZN-COPPR-LUTEIN-ZEAXAN 250-90-40-1 MG ORAL CAP",,109047,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"VIT C,E-ZN-COPPR-LUTEIN-ZEAXAN 250-90-40-1 MG ORAL CAP",,109047,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"VIT C,E-ZN-COPPR-LUTEIN-ZEAXAN 250-90-40-1 MG ORAL CAP",,109047,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"VIT C,E-ZN-COPPR-LUTEIN-ZEAXAN 250-90-40-1 MG ORAL CAP",,109047,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"VIT C,E-ZN-COPPR-LUTEIN-ZEAXAN 250-90-40-1 MG ORAL CAP",,109047,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"VIT C,E-ZN-COPPR-LUTEIN-ZEAXAN 250-90-40-1 MG ORAL CAP",,109047,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"VIT C,E-ZN-COPPR-LUTEIN-ZEAXAN 250-90-40-1 MG ORAL CAP",,109047,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"VIT C,E-ZN-COPPR-LUTEIN-ZEAXAN 250-90-40-1 MG ORAL CAP",,109047,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"VIT C,E-ZN-COPPR-LUTEIN-ZEAXAN 250-90-40-1 MG ORAL CAP",,109047,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
"VIT C,E-ZN-COPPR-LUTEIN-ZEAXAN 250-90-40-1 MG ORAL CAP",,109047,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
"VIT C,E-ZN-COPPR-LUTEIN-ZEAXAN 250-90-40-1 MG ORAL CAP",,109047,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"VIT C,E-ZN-COPPR-LUTEIN-ZEAXAN 250-90-40-1 MG ORAL CAP",,109047,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
"VIT C,E-ZN-COPPR-LUTEIN-ZEAXAN 250-90-40-1 MG ORAL CAP",,109047,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
GUAIFENESIN 600 MG ORAL TA12,,111425,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,Aetna,Commercial,5.52,92,,percent of total billed charges,,
GUAIFENESIN 600 MG ORAL TA12,,111425,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,Aetna,Medicare Advantage,2.94,49,,percent of total billed charges,,
GUAIFENESIN 600 MG ORAL TA12,,111425,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,Aetna,Medicare Advantage,,,,,Included in per diem rate,
GUAIFENESIN 600 MG ORAL TA12,,111425,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,Aetna,PPO,5.58,93,,percent of total billed charges,,
GUAIFENESIN 600 MG ORAL TA12,,111425,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,America's PPO,America's PPO,5.7618,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
GUAIFENESIN 600 MG ORAL TA12,,111425,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota, Federal Employee Program,5.904,98.4,,percent of total billed charges,,
GUAIFENESIN 600 MG ORAL TA12,,111425,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,6,100,,percent of total billed charges,,
GUAIFENESIN 600 MG ORAL TA12,,111425,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota,High Value Network Plan,5.4,90,,percent of total billed charges,,
GUAIFENESIN 600 MG ORAL TA12,,111425,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota,Medicare Advantage,2.94,49,,percent of total billed charges,,
GUAIFENESIN 600 MG ORAL TA12,,111425,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
GUAIFENESIN 600 MG ORAL TA12,,111425,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,5.3142,88.57,,percent of total billed charges,,
GUAIFENESIN 600 MG ORAL TA12,,111425,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.7196,28.66,,percent of total billed charges,,
GUAIFENESIN 600 MG ORAL TA12,,111425,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.94,49,,percent of total billed charges,,
GUAIFENESIN 600 MG ORAL TA12,,111425,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
GUAIFENESIN 600 MG ORAL TA12,,111425,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,CorVel,Worker's Compensation,6,100,,percent of total billed charges,,
GUAIFENESIN 600 MG ORAL TA12,,111425,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,First Health Group Corporation,First Health Network,5.82,97,,percent of total billed charges,,
GUAIFENESIN 600 MG ORAL TA12,,111425,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,"Health Partners, Inc.",Commercial,5.676,94.6,,percent of total billed charges,,
GUAIFENESIN 600 MG ORAL TA12,,111425,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,"Health Partners, Inc.",Medicare Advantage,2.94,49,,percent of total billed charges,,
GUAIFENESIN 600 MG ORAL TA12,,111425,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
GUAIFENESIN 600 MG ORAL TA12,,111425,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3.6,60,,percent of total billed charges,,
GUAIFENESIN 600 MG ORAL TA12,,111425,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,"Health Partners, Inc.",State of Minnesota Advantage Program,4.89,81.5,,percent of total billed charges,,
GUAIFENESIN 600 MG ORAL TA12,,111425,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,"Health Partners, Inc.",State Public Programs,3,50,,percent of total billed charges,,
GUAIFENESIN 600 MG ORAL TA12,,111425,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,Humana Insurance Company,Commercial PPO,5.7,95,,percent of total billed charges,,
GUAIFENESIN 600 MG ORAL TA12,,111425,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,Humana Insurance Company,Medicare PPO,2.94,49,,percent of total billed charges,,
GUAIFENESIN 600 MG ORAL TA12,,111425,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
GUAIFENESIN 600 MG ORAL TA12,,111425,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,Medica,Individual & Family,5.946,99.1,,percent of total billed charges,,
GUAIFENESIN 600 MG ORAL TA12,,111425,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,Medica,Medica Advantage Solution,2.988,49.8,,percent of total billed charges,,
GUAIFENESIN 600 MG ORAL TA12,,111425,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
GUAIFENESIN 600 MG ORAL TA12,,111425,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,Medica,Medical Assistance,2.676,44.6,,percent of total billed charges,,
GUAIFENESIN 600 MG ORAL TA12,,111425,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,Medica,Medical Assistance,,,,,Included in per diem rate,
GUAIFENESIN 600 MG ORAL TA12,,111425,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.988,49.8,,percent of total billed charges,,
GUAIFENESIN 600 MG ORAL TA12,,111425,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
GUAIFENESIN 600 MG ORAL TA12,,111425,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,"Multiplan, Inc.","Multiplan, Inc.",5.64,94,,percent of total billed charges,,
GUAIFENESIN 600 MG ORAL TA12,,111425,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,5.406,90.1,,percent of total billed charges,,
GUAIFENESIN 600 MG ORAL TA12,,111425,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
GUAIFENESIN 600 MG ORAL TA12,,111425,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,"Preferred One Administrative Services, INC.",PPO,5.916,98.6,,percent of total billed charges,,
GUAIFENESIN 600 MG ORAL TA12,,111425,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,PrimeWest Health,Minnesota Senior Health Options (MSHO),3.087,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
GUAIFENESIN 600 MG ORAL TA12,,111425,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
GUAIFENESIN 600 MG ORAL TA12,,111425,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,PrimeWest Health,MinnesotaCare,3.0816,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
GUAIFENESIN 600 MG ORAL TA12,,111425,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
GUAIFENESIN 600 MG ORAL TA12,,111425,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,Sanford Health Plan,Sanford Health Plan,5.52,92,,percent of total billed charges,,
GUAIFENESIN 600 MG ORAL TA12,,111425,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,"UCare Health, Inc.",Individual & Family Plan,3.381,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
GUAIFENESIN 600 MG ORAL TA12,,111425,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
GUAIFENESIN 600 MG ORAL TA12,,111425,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,"UCare Health, Inc.",Medical Assistance,3.0282,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
GUAIFENESIN 600 MG ORAL TA12,,111425,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
GUAIFENESIN 600 MG ORAL TA12,,111425,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,"UCare Health, Inc.",Medicare Advantage,3.0282,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
GUAIFENESIN 600 MG ORAL TA12,,111425,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
GUAIFENESIN 600 MG ORAL TA12,,111425,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),3.0282,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
GUAIFENESIN 600 MG ORAL TA12,,111425,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
GUAIFENESIN 600 MG ORAL TA12,,111425,LOCAL,Facility,Both,1,Each,,6,5.1,1.7196,6,UnitedHealthcare,Individual & Family,5.64,94,,percent of total billed charges,,
GUAIFENESIN 600 MG ORAL TA12,,111425,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,UnitedHealthcare,Medicare Advantage,2.94,49,,percent of total billed charges,,
GUAIFENESIN 600 MG ORAL TA12,,111425,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
GUAIFENESIN 600 MG ORAL TA12,,111425,LOCAL,Facility,Outpatient,1,Each,,6,5.1,1.7196,6,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.88,48,,percent of total billed charges,,100% of DHS outpatient percentage
GUAIFENESIN 600 MG ORAL TA12,,111425,LOCAL,Facility,Inpatient,1,Each,,6,5.1,1.7196,6,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
VITAMINS B1-B2-B3-B12-PROTEASE 2.5 MG-2.5 MG- 5 MG-100 MCG ORAL TABLET,,112383,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
VITAMINS B1-B2-B3-B12-PROTEASE 2.5 MG-2.5 MG- 5 MG-100 MCG ORAL TABLET,,112383,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
VITAMINS B1-B2-B3-B12-PROTEASE 2.5 MG-2.5 MG- 5 MG-100 MCG ORAL TABLET,,112383,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
VITAMINS B1-B2-B3-B12-PROTEASE 2.5 MG-2.5 MG- 5 MG-100 MCG ORAL TABLET,,112383,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
VITAMINS B1-B2-B3-B12-PROTEASE 2.5 MG-2.5 MG- 5 MG-100 MCG ORAL TABLET,,112383,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
VITAMINS B1-B2-B3-B12-PROTEASE 2.5 MG-2.5 MG- 5 MG-100 MCG ORAL TABLET,,112383,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
VITAMINS B1-B2-B3-B12-PROTEASE 2.5 MG-2.5 MG- 5 MG-100 MCG ORAL TABLET,,112383,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
VITAMINS B1-B2-B3-B12-PROTEASE 2.5 MG-2.5 MG- 5 MG-100 MCG ORAL TABLET,,112383,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
VITAMINS B1-B2-B3-B12-PROTEASE 2.5 MG-2.5 MG- 5 MG-100 MCG ORAL TABLET,,112383,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
VITAMINS B1-B2-B3-B12-PROTEASE 2.5 MG-2.5 MG- 5 MG-100 MCG ORAL TABLET,,112383,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
VITAMINS B1-B2-B3-B12-PROTEASE 2.5 MG-2.5 MG- 5 MG-100 MCG ORAL TABLET,,112383,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
VITAMINS B1-B2-B3-B12-PROTEASE 2.5 MG-2.5 MG- 5 MG-100 MCG ORAL TABLET,,112383,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
VITAMINS B1-B2-B3-B12-PROTEASE 2.5 MG-2.5 MG- 5 MG-100 MCG ORAL TABLET,,112383,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
VITAMINS B1-B2-B3-B12-PROTEASE 2.5 MG-2.5 MG- 5 MG-100 MCG ORAL TABLET,,112383,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
VITAMINS B1-B2-B3-B12-PROTEASE 2.5 MG-2.5 MG- 5 MG-100 MCG ORAL TABLET,,112383,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
VITAMINS B1-B2-B3-B12-PROTEASE 2.5 MG-2.5 MG- 5 MG-100 MCG ORAL TABLET,,112383,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
VITAMINS B1-B2-B3-B12-PROTEASE 2.5 MG-2.5 MG- 5 MG-100 MCG ORAL TABLET,,112383,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
VITAMINS B1-B2-B3-B12-PROTEASE 2.5 MG-2.5 MG- 5 MG-100 MCG ORAL TABLET,,112383,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
VITAMINS B1-B2-B3-B12-PROTEASE 2.5 MG-2.5 MG- 5 MG-100 MCG ORAL TABLET,,112383,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
VITAMINS B1-B2-B3-B12-PROTEASE 2.5 MG-2.5 MG- 5 MG-100 MCG ORAL TABLET,,112383,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
VITAMINS B1-B2-B3-B12-PROTEASE 2.5 MG-2.5 MG- 5 MG-100 MCG ORAL TABLET,,112383,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
VITAMINS B1-B2-B3-B12-PROTEASE 2.5 MG-2.5 MG- 5 MG-100 MCG ORAL TABLET,,112383,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
VITAMINS B1-B2-B3-B12-PROTEASE 2.5 MG-2.5 MG- 5 MG-100 MCG ORAL TABLET,,112383,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
VITAMINS B1-B2-B3-B12-PROTEASE 2.5 MG-2.5 MG- 5 MG-100 MCG ORAL TABLET,,112383,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
VITAMINS B1-B2-B3-B12-PROTEASE 2.5 MG-2.5 MG- 5 MG-100 MCG ORAL TABLET,,112383,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
VITAMINS B1-B2-B3-B12-PROTEASE 2.5 MG-2.5 MG- 5 MG-100 MCG ORAL TABLET,,112383,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
VITAMINS B1-B2-B3-B12-PROTEASE 2.5 MG-2.5 MG- 5 MG-100 MCG ORAL TABLET,,112383,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
VITAMINS B1-B2-B3-B12-PROTEASE 2.5 MG-2.5 MG- 5 MG-100 MCG ORAL TABLET,,112383,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
VITAMINS B1-B2-B3-B12-PROTEASE 2.5 MG-2.5 MG- 5 MG-100 MCG ORAL TABLET,,112383,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
VITAMINS B1-B2-B3-B12-PROTEASE 2.5 MG-2.5 MG- 5 MG-100 MCG ORAL TABLET,,112383,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
VITAMINS B1-B2-B3-B12-PROTEASE 2.5 MG-2.5 MG- 5 MG-100 MCG ORAL TABLET,,112383,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
VITAMINS B1-B2-B3-B12-PROTEASE 2.5 MG-2.5 MG- 5 MG-100 MCG ORAL TABLET,,112383,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
VITAMINS B1-B2-B3-B12-PROTEASE 2.5 MG-2.5 MG- 5 MG-100 MCG ORAL TABLET,,112383,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
VITAMINS B1-B2-B3-B12-PROTEASE 2.5 MG-2.5 MG- 5 MG-100 MCG ORAL TABLET,,112383,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
VITAMINS B1-B2-B3-B12-PROTEASE 2.5 MG-2.5 MG- 5 MG-100 MCG ORAL TABLET,,112383,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
VITAMINS B1-B2-B3-B12-PROTEASE 2.5 MG-2.5 MG- 5 MG-100 MCG ORAL TABLET,,112383,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
VITAMINS B1-B2-B3-B12-PROTEASE 2.5 MG-2.5 MG- 5 MG-100 MCG ORAL TABLET,,112383,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
VITAMINS B1-B2-B3-B12-PROTEASE 2.5 MG-2.5 MG- 5 MG-100 MCG ORAL TABLET,,112383,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
VITAMINS B1-B2-B3-B12-PROTEASE 2.5 MG-2.5 MG- 5 MG-100 MCG ORAL TABLET,,112383,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
VITAMINS B1-B2-B3-B12-PROTEASE 2.5 MG-2.5 MG- 5 MG-100 MCG ORAL TABLET,,112383,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
VITAMINS B1-B2-B3-B12-PROTEASE 2.5 MG-2.5 MG- 5 MG-100 MCG ORAL TABLET,,112383,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
VITAMINS B1-B2-B3-B12-PROTEASE 2.5 MG-2.5 MG- 5 MG-100 MCG ORAL TABLET,,112383,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
VITAMINS B1-B2-B3-B12-PROTEASE 2.5 MG-2.5 MG- 5 MG-100 MCG ORAL TABLET,,112383,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
VITAMINS B1-B2-B3-B12-PROTEASE 2.5 MG-2.5 MG- 5 MG-100 MCG ORAL TABLET,,112383,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
VITAMINS B1-B2-B3-B12-PROTEASE 2.5 MG-2.5 MG- 5 MG-100 MCG ORAL TABLET,,112383,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
VITAMINS B1-B2-B3-B12-PROTEASE 2.5 MG-2.5 MG- 5 MG-100 MCG ORAL TABLET,,112383,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
VITAMINS B1-B2-B3-B12-PROTEASE 2.5 MG-2.5 MG- 5 MG-100 MCG ORAL TABLET,,112383,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
VITAMINS B1-B2-B3-B12-PROTEASE 2.5 MG-2.5 MG- 5 MG-100 MCG ORAL TABLET,,112383,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
VITAMINS B1-B2-B3-B12-PROTEASE 2.5 MG-2.5 MG- 5 MG-100 MCG ORAL TABLET,,112383,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
VITAMINS B1-B2-B3-B12-PROTEASE 2.5 MG-2.5 MG- 5 MG-100 MCG ORAL TABLET,,112383,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
VITAMINS B1-B2-B3-B12-PROTEASE 2.5 MG-2.5 MG- 5 MG-100 MCG ORAL TABLET,,112383,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
VITAMINS B1-B2-B3-B12-PROTEASE 2.5 MG-2.5 MG- 5 MG-100 MCG ORAL TABLET,,112383,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
VITAMINS B1-B2-B3-B12-PROTEASE 2.5 MG-2.5 MG- 5 MG-100 MCG ORAL TABLET,,112383,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
VITAMINS B1-B2-B3-B12-PROTEASE 2.5 MG-2.5 MG- 5 MG-100 MCG ORAL TABLET,,112383,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Chemical Cauterization Of Granulation Tissue,,17250,CPT,Facility,Both,,,,85,72.25,24.361,85,Aetna,Commercial,78.2,92,,percent of total billed charges,,
Chemical Cauterization Of Granulation Tissue,,17250,CPT,Facility,Outpatient,,,,85,72.25,24.361,85,Aetna,Medicare Advantage,41.65,49,,percent of total billed charges,,
Chemical Cauterization Of Granulation Tissue,,17250,CPT,Facility,Inpatient,,,,85,72.25,24.361,85,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Chemical Cauterization Of Granulation Tissue,,17250,CPT,Facility,Both,,,,85,72.25,24.361,85,Aetna,PPO,79.05,93,,percent of total billed charges,,
Chemical Cauterization Of Granulation Tissue,,17250,CPT,Facility,Both,,,,85,72.25,24.361,85,America's PPO,America's PPO,81.6255,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Chemical Cauterization Of Granulation Tissue,,17250,CPT,Facility,Both,,,,85,72.25,24.361,85,BlueCross BlueShield Minnesota, Federal Employee Program,83.64,98.4,,percent of total billed charges,,
Chemical Cauterization Of Granulation Tissue,,17250,CPT,Facility,Both,,,,85,72.25,24.361,85,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,85,100,,percent of total billed charges,,
Chemical Cauterization Of Granulation Tissue,,17250,CPT,Facility,Both,,,,85,72.25,24.361,85,BlueCross BlueShield Minnesota,High Value Network Plan,76.5,90,,percent of total billed charges,,
Chemical Cauterization Of Granulation Tissue,,17250,CPT,Facility,Outpatient,,,,85,72.25,24.361,85,BlueCross BlueShield Minnesota,Medicare Advantage,41.65,49,,percent of total billed charges,,
Chemical Cauterization Of Granulation Tissue,,17250,CPT,Facility,Inpatient,,,,85,72.25,24.361,85,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Chemical Cauterization Of Granulation Tissue,,17250,CPT,Facility,Both,,,,85,72.25,24.361,85,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,75.2845,88.57,,percent of total billed charges,,
Chemical Cauterization Of Granulation Tissue,,17250,CPT,Facility,Both,,,,85,72.25,24.361,85,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,24.361,28.66,,percent of total billed charges,,
Chemical Cauterization Of Granulation Tissue,,17250,CPT,Facility,Outpatient,,,,85,72.25,24.361,85,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),41.65,49,,percent of total billed charges,,
Chemical Cauterization Of Granulation Tissue,,17250,CPT,Facility,Inpatient,,,,85,72.25,24.361,85,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Chemical Cauterization Of Granulation Tissue,,17250,CPT,Facility,Both,,,,85,72.25,24.361,85,CorVel,Worker's Compensation,85,100,,percent of total billed charges,,
Chemical Cauterization Of Granulation Tissue,,17250,CPT,Facility,Both,,,,85,72.25,24.361,85,First Health Group Corporation,First Health Network,82.45,97,,percent of total billed charges,,
Chemical Cauterization Of Granulation Tissue,,17250,CPT,Facility,Both,,,,85,72.25,24.361,85,"Health Partners, Inc.",Commercial,80.41,94.6,,percent of total billed charges,,
Chemical Cauterization Of Granulation Tissue,,17250,CPT,Facility,Outpatient,,,,85,72.25,24.361,85,"Health Partners, Inc.",Medicare Advantage,41.65,49,,percent of total billed charges,,
Chemical Cauterization Of Granulation Tissue,,17250,CPT,Facility,Inpatient,,,,85,72.25,24.361,85,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Chemical Cauterization Of Granulation Tissue,,17250,CPT,Facility,Both,,,,85,72.25,24.361,85,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),51,60,,percent of total billed charges,,
Chemical Cauterization Of Granulation Tissue,,17250,CPT,Facility,Both,,,,85,72.25,24.361,85,"Health Partners, Inc.",State of Minnesota Advantage Program,69.275,81.5,,percent of total billed charges,,
Chemical Cauterization Of Granulation Tissue,,17250,CPT,Facility,Both,,,,85,72.25,24.361,85,"Health Partners, Inc.",State Public Programs,42.5,50,,percent of total billed charges,,
Chemical Cauterization Of Granulation Tissue,,17250,CPT,Facility,Both,,,,85,72.25,24.361,85,Humana Insurance Company,Commercial PPO,80.75,95,,percent of total billed charges,,
Chemical Cauterization Of Granulation Tissue,,17250,CPT,Facility,Outpatient,,,,85,72.25,24.361,85,Humana Insurance Company,Medicare PPO,41.65,49,,percent of total billed charges,,
Chemical Cauterization Of Granulation Tissue,,17250,CPT,Facility,Inpatient,,,,85,72.25,24.361,85,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Chemical Cauterization Of Granulation Tissue,,17250,CPT,Facility,Both,,,,85,72.25,24.361,85,Medica,Individual & Family,84.235,99.1,,percent of total billed charges,,
Chemical Cauterization Of Granulation Tissue,,17250,CPT,Facility,Outpatient,,,,85,72.25,24.361,85,Medica,Medica Advantage Solution,42.33,49.8,,percent of total billed charges,,
Chemical Cauterization Of Granulation Tissue,,17250,CPT,Facility,Inpatient,,,,85,72.25,24.361,85,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Chemical Cauterization Of Granulation Tissue,,17250,CPT,Facility,Outpatient,,,,85,72.25,24.361,85,Medica,Medical Assistance,37.91,44.6,,percent of total billed charges,,
Chemical Cauterization Of Granulation Tissue,,17250,CPT,Facility,Inpatient,,,,85,72.25,24.361,85,Medica,Medical Assistance,,,,,Included in per diem rate,
Chemical Cauterization Of Granulation Tissue,,17250,CPT,Facility,Outpatient,,,,85,72.25,24.361,85,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,42.33,49.8,,percent of total billed charges,,
Chemical Cauterization Of Granulation Tissue,,17250,CPT,Facility,Inpatient,,,,85,72.25,24.361,85,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Chemical Cauterization Of Granulation Tissue,,17250,CPT,Facility,Both,,,,85,72.25,24.361,85,"Multiplan, Inc.","Multiplan, Inc.",79.9,94,,percent of total billed charges,,
Chemical Cauterization Of Granulation Tissue,,17250,CPT,Facility,Outpatient,,,,85,72.25,24.361,85,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,76.585,90.1,,percent of total billed charges,,
Chemical Cauterization Of Granulation Tissue,,17250,CPT,Facility,Inpatient,,,,85,72.25,24.361,85,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Chemical Cauterization Of Granulation Tissue,,17250,CPT,Facility,Both,,,,85,72.25,24.361,85,"Preferred One Administrative Services, INC.",PPO,83.81,98.6,,percent of total billed charges,,
Chemical Cauterization Of Granulation Tissue,,17250,CPT,Facility,Outpatient,,,,85,72.25,24.361,85,PrimeWest Health,Minnesota Senior Health Options (MSHO),43.7325,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Chemical Cauterization Of Granulation Tissue,,17250,CPT,Facility,Inpatient,,,,85,72.25,24.361,85,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Chemical Cauterization Of Granulation Tissue,,17250,CPT,Facility,Outpatient,,,,85,72.25,24.361,85,PrimeWest Health,MinnesotaCare,43.656,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Chemical Cauterization Of Granulation Tissue,,17250,CPT,Facility,Inpatient,,,,85,72.25,24.361,85,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Chemical Cauterization Of Granulation Tissue,,17250,CPT,Facility,Both,,,,85,72.25,24.361,85,Sanford Health Plan,Sanford Health Plan,78.2,92,,percent of total billed charges,,
Chemical Cauterization Of Granulation Tissue,,17250,CPT,Facility,Outpatient,,,,85,72.25,24.361,85,"UCare Health, Inc.",Individual & Family Plan,47.8975,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Chemical Cauterization Of Granulation Tissue,,17250,CPT,Facility,Inpatient,,,,85,72.25,24.361,85,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Chemical Cauterization Of Granulation Tissue,,17250,CPT,Facility,Outpatient,,,,85,72.25,24.361,85,"UCare Health, Inc.",Medical Assistance,42.8995,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Chemical Cauterization Of Granulation Tissue,,17250,CPT,Facility,Inpatient,,,,85,72.25,24.361,85,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Chemical Cauterization Of Granulation Tissue,,17250,CPT,Facility,Outpatient,,,,85,72.25,24.361,85,"UCare Health, Inc.",Medicare Advantage,42.8995,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Chemical Cauterization Of Granulation Tissue,,17250,CPT,Facility,Inpatient,,,,85,72.25,24.361,85,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Chemical Cauterization Of Granulation Tissue,,17250,CPT,Facility,Outpatient,,,,85,72.25,24.361,85,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),42.8995,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Chemical Cauterization Of Granulation Tissue,,17250,CPT,Facility,Inpatient,,,,85,72.25,24.361,85,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Chemical Cauterization Of Granulation Tissue,,17250,CPT,Facility,Both,,,,85,72.25,24.361,85,UnitedHealthcare,Individual & Family,79.9,94,,percent of total billed charges,,
Chemical Cauterization Of Granulation Tissue,,17250,CPT,Facility,Outpatient,,,,85,72.25,24.361,85,UnitedHealthcare,Medicare Advantage,41.65,49,,percent of total billed charges,,
Chemical Cauterization Of Granulation Tissue,,17250,CPT,Facility,Inpatient,,,,85,72.25,24.361,85,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Chemical Cauterization Of Granulation Tissue,,17250,CPT,Facility,Outpatient,,,,85,72.25,24.361,85,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,40.8,48,,percent of total billed charges,,100% of DHS outpatient percentage
Chemical Cauterization Of Granulation Tissue,,17250,CPT,Facility,Inpatient,,,,85,72.25,24.361,85,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Chemical Cauterization Of Granulation Tissue (Ie, Proud Flesh) (Pro Cah)",,17250,CPT,Professional,Both,,,,150,127.5,23.12,150,Aetna,Commercial,127.5,85,,percent of total billed charges,,
"Chemical Cauterization Of Granulation Tissue (Ie, Proud Flesh) (Pro Cah)",,17250,CPT,Professional,Both,,,,150,127.5,23.12,150,Aetna,Commercial,127.5,85,,percent of total billed charges,,
"Chemical Cauterization Of Granulation Tissue (Ie, Proud Flesh) (Pro Cah)",,17250,CPT,Professional,Both,,,,150,127.5,23.12,150,Aetna,Medicare Advantage,35.86,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Chemical Cauterization Of Granulation Tissue (Ie, Proud Flesh) (Pro Cah)",,17250,CPT,Professional,Both,,,,150,127.5,23.12,150,Aetna,Medicare Advantage,35.86,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Chemical Cauterization Of Granulation Tissue (Ie, Proud Flesh) (Pro Cah)",,17250,CPT,Professional,Both,,,,150,127.5,23.12,150,Aetna,PPO,139.5,93,,percent of total billed charges,,
"Chemical Cauterization Of Granulation Tissue (Ie, Proud Flesh) (Pro Cah)",,17250,CPT,Professional,Both,,,,150,127.5,23.12,150,Aetna,PPO,139.5,93,,percent of total billed charges,,
"Chemical Cauterization Of Granulation Tissue (Ie, Proud Flesh) (Pro Cah)",,17250,CPT,Professional,Both,,,,150,127.5,23.12,150,America's PPO,America's PPO,128.16,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Chemical Cauterization Of Granulation Tissue (Ie, Proud Flesh) (Pro Cah)",,17250,CPT,Professional,Both,,,,150,127.5,23.12,150,America's PPO,America's PPO,128.16,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Chemical Cauterization Of Granulation Tissue (Ie, Proud Flesh) (Pro Cah)",,17250,CPT,Professional,Both,,,,150,127.5,23.12,150,BlueCross BlueShield Minnesota, Federal Employee Program,76.43,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Chemical Cauterization Of Granulation Tissue (Ie, Proud Flesh) (Pro Cah)",,17250,CPT,Professional,Both,,,,150,127.5,23.12,150,BlueCross BlueShield Minnesota, Federal Employee Program,76.43,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Chemical Cauterization Of Granulation Tissue (Ie, Proud Flesh) (Pro Cah)",,17250,CPT,Professional,Both,,,,150,127.5,23.12,150,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,77.65288,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Chemical Cauterization Of Granulation Tissue (Ie, Proud Flesh) (Pro Cah)",,17250,CPT,Professional,Both,,,,150,127.5,23.12,150,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,77.65288,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Chemical Cauterization Of Granulation Tissue (Ie, Proud Flesh) (Pro Cah)",,17250,CPT,Professional,Both,,,,150,127.5,23.12,150,BlueCross BlueShield Minnesota,High Value Network Plan,77.65288,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Chemical Cauterization Of Granulation Tissue (Ie, Proud Flesh) (Pro Cah)",,17250,CPT,Professional,Both,,,,150,127.5,23.12,150,BlueCross BlueShield Minnesota,High Value Network Plan,77.65288,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Chemical Cauterization Of Granulation Tissue (Ie, Proud Flesh) (Pro Cah)",,17250,CPT,Professional,Both,,,,150,127.5,23.12,150,BlueCross BlueShield Minnesota,Medicare Advantage,41.5495,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Chemical Cauterization Of Granulation Tissue (Ie, Proud Flesh) (Pro Cah)",,17250,CPT,Professional,Both,,,,150,127.5,23.12,150,BlueCross BlueShield Minnesota,Medicare Advantage,41.5495,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Chemical Cauterization Of Granulation Tissue (Ie, Proud Flesh) (Pro Cah)",,17250,CPT,Professional,Both,,,,150,127.5,23.12,150,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,77.65288,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Chemical Cauterization Of Granulation Tissue (Ie, Proud Flesh) (Pro Cah)",,17250,CPT,Professional,Both,,,,150,127.5,23.12,150,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,77.65288,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Chemical Cauterization Of Granulation Tissue (Ie, Proud Flesh) (Pro Cah)",,17250,CPT,Professional,Both,,,,150,127.5,23.12,150,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,26.69032,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Chemical Cauterization Of Granulation Tissue (Ie, Proud Flesh) (Pro Cah)",,17250,CPT,Professional,Both,,,,150,127.5,23.12,150,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,26.69032,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Chemical Cauterization Of Granulation Tissue (Ie, Proud Flesh) (Pro Cah)",,17250,CPT,Professional,Both,,,,150,127.5,23.12,150,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),41.5495,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Chemical Cauterization Of Granulation Tissue (Ie, Proud Flesh) (Pro Cah)",,17250,CPT,Professional,Both,,,,150,127.5,23.12,150,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),41.5495,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Chemical Cauterization Of Granulation Tissue (Ie, Proud Flesh) (Pro Cah)",,17250,CPT,Professional,Both,,,,150,127.5,23.12,150,CorVel,Worker's Compensation,70.421028,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Chemical Cauterization Of Granulation Tissue (Ie, Proud Flesh) (Pro Cah)",,17250,CPT,Professional,Both,,,,150,127.5,23.12,150,CorVel,Worker's Compensation,70.421028,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Chemical Cauterization Of Granulation Tissue (Ie, Proud Flesh) (Pro Cah)",,17250,CPT,Professional,Both,,,,150,127.5,23.12,150,First Health Group Corporation,First Health Network,145.5,97,,percent of total billed charges,,
"Chemical Cauterization Of Granulation Tissue (Ie, Proud Flesh) (Pro Cah)",,17250,CPT,Professional,Both,,,,150,127.5,23.12,150,First Health Group Corporation,First Health Network,145.5,97,,percent of total billed charges,,
"Chemical Cauterization Of Granulation Tissue (Ie, Proud Flesh) (Pro Cah)",,17250,CPT,Professional,Both,,,,150,127.5,23.12,150,"Health Partners, Inc.",Commercial,76.18,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Chemical Cauterization Of Granulation Tissue (Ie, Proud Flesh) (Pro Cah)",,17250,CPT,Professional,Both,,,,150,127.5,23.12,150,"Health Partners, Inc.",Commercial,76.18,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Chemical Cauterization Of Granulation Tissue (Ie, Proud Flesh) (Pro Cah)",,17250,CPT,Professional,Both,,,,150,127.5,23.12,150,"Health Partners, Inc.",Medicare Advantage,41.5495,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Chemical Cauterization Of Granulation Tissue (Ie, Proud Flesh) (Pro Cah)",,17250,CPT,Professional,Both,,,,150,127.5,23.12,150,"Health Partners, Inc.",Medicare Advantage,41.5495,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Chemical Cauterization Of Granulation Tissue (Ie, Proud Flesh) (Pro Cah)",,17250,CPT,Professional,Both,,,,150,127.5,23.12,150,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),36.26,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Chemical Cauterization Of Granulation Tissue (Ie, Proud Flesh) (Pro Cah)",,17250,CPT,Professional,Both,,,,150,127.5,23.12,150,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),36.26,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Chemical Cauterization Of Granulation Tissue (Ie, Proud Flesh) (Pro Cah)",,17250,CPT,Professional,Both,,,,150,127.5,23.12,150,"Health Partners, Inc.",State of Minnesota Advantage Program,65.62907,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Chemical Cauterization Of Granulation Tissue (Ie, Proud Flesh) (Pro Cah)",,17250,CPT,Professional,Both,,,,150,127.5,23.12,150,"Health Partners, Inc.",State of Minnesota Advantage Program,65.62907,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Chemical Cauterization Of Granulation Tissue (Ie, Proud Flesh) (Pro Cah)",,17250,CPT,Professional,Both,,,,150,127.5,23.12,150,"Health Partners, Inc.",State Public Programs,23.12,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Chemical Cauterization Of Granulation Tissue (Ie, Proud Flesh) (Pro Cah)",,17250,CPT,Professional,Both,,,,150,127.5,23.12,150,"Health Partners, Inc.",State Public Programs,23.12,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Chemical Cauterization Of Granulation Tissue (Ie, Proud Flesh) (Pro Cah)",,17250,CPT,Professional,Both,,,,150,127.5,23.12,150,Humana Insurance Company,Commercial PPO,36.13,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Chemical Cauterization Of Granulation Tissue (Ie, Proud Flesh) (Pro Cah)",,17250,CPT,Professional,Both,,,,150,127.5,23.12,150,Humana Insurance Company,Commercial PPO,36.13,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Chemical Cauterization Of Granulation Tissue (Ie, Proud Flesh) (Pro Cah)",,17250,CPT,Professional,Both,,,,150,127.5,23.12,150,Humana Insurance Company,Medicare PPO,150,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Chemical Cauterization Of Granulation Tissue (Ie, Proud Flesh) (Pro Cah)",,17250,CPT,Professional,Both,,,,150,127.5,23.12,150,Humana Insurance Company,Medicare PPO,150,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Chemical Cauterization Of Granulation Tissue (Ie, Proud Flesh) (Pro Cah)",,17250,CPT,Professional,Both,,,,150,127.5,23.12,150,Medica,Individual & Family,127.2,84.8,,percent of total billed charges,,
"Chemical Cauterization Of Granulation Tissue (Ie, Proud Flesh) (Pro Cah)",,17250,CPT,Professional,Both,,,,150,127.5,23.12,150,Medica,Individual & Family,127.2,84.8,,percent of total billed charges,,
"Chemical Cauterization Of Granulation Tissue (Ie, Proud Flesh) (Pro Cah)",,17250,CPT,Professional,Both,,,,150,127.5,23.12,150,Medica,Medica Advantage Solution,74.7,49.8,,percent of total billed charges,,
"Chemical Cauterization Of Granulation Tissue (Ie, Proud Flesh) (Pro Cah)",,17250,CPT,Professional,Both,,,,150,127.5,23.12,150,Medica,Medica Advantage Solution,74.7,49.8,,percent of total billed charges,,
"Chemical Cauterization Of Granulation Tissue (Ie, Proud Flesh) (Pro Cah)",,17250,CPT,Professional,Both,,,,150,127.5,23.12,150,Medica,Medical Assistance,26.69,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Chemical Cauterization Of Granulation Tissue (Ie, Proud Flesh) (Pro Cah)",,17250,CPT,Professional,Both,,,,150,127.5,23.12,150,Medica,Medical Assistance,26.69,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Chemical Cauterization Of Granulation Tissue (Ie, Proud Flesh) (Pro Cah)",,17250,CPT,Professional,Both,,,,150,127.5,23.12,150,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,36.13,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Chemical Cauterization Of Granulation Tissue (Ie, Proud Flesh) (Pro Cah)",,17250,CPT,Professional,Both,,,,150,127.5,23.12,150,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,36.13,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Chemical Cauterization Of Granulation Tissue (Ie, Proud Flesh) (Pro Cah)",,17250,CPT,Professional,Both,,,,150,127.5,23.12,150,"Multiplan, Inc.","Multiplan, Inc.",141,94,,percent of total billed charges,,
"Chemical Cauterization Of Granulation Tissue (Ie, Proud Flesh) (Pro Cah)",,17250,CPT,Professional,Both,,,,150,127.5,23.12,150,"Multiplan, Inc.","Multiplan, Inc.",141,94,,percent of total billed charges,,
"Chemical Cauterization Of Granulation Tissue (Ie, Proud Flesh) (Pro Cah)",,17250,CPT,Professional,Both,,,,150,127.5,23.12,150,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,135.15,90.1,,percent of total billed charges,,
"Chemical Cauterization Of Granulation Tissue (Ie, Proud Flesh) (Pro Cah)",,17250,CPT,Professional,Both,,,,150,127.5,23.12,150,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,135.15,90.1,,percent of total billed charges,,
"Chemical Cauterization Of Granulation Tissue (Ie, Proud Flesh) (Pro Cah)",,17250,CPT,Professional,Both,,,,150,127.5,23.12,150,"Preferred One Administrative Services, INC.",PPO,147.9,98.6,,percent of total billed charges,,
"Chemical Cauterization Of Granulation Tissue (Ie, Proud Flesh) (Pro Cah)",,17250,CPT,Professional,Both,,,,150,127.5,23.12,150,"Preferred One Administrative Services, INC.",PPO,147.9,98.6,,percent of total billed charges,,
"Chemical Cauterization Of Granulation Tissue (Ie, Proud Flesh) (Pro Cah)",,17250,CPT,Professional,Both,,,,150,127.5,23.12,150,PrimeWest Health,Minnesota Senior Health Options (MSHO),41.5495,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Chemical Cauterization Of Granulation Tissue (Ie, Proud Flesh) (Pro Cah)",,17250,CPT,Professional,Both,,,,150,127.5,23.12,150,PrimeWest Health,Minnesota Senior Health Options (MSHO),41.5495,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Chemical Cauterization Of Granulation Tissue (Ie, Proud Flesh) (Pro Cah)",,17250,CPT,Professional,Both,,,,150,127.5,23.12,150,PrimeWest Health,MinnesotaCare,28.5586424,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Chemical Cauterization Of Granulation Tissue (Ie, Proud Flesh) (Pro Cah)",,17250,CPT,Professional,Both,,,,150,127.5,23.12,150,PrimeWest Health,MinnesotaCare,28.5586424,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Chemical Cauterization Of Granulation Tissue (Ie, Proud Flesh) (Pro Cah)",,17250,CPT,Professional,Both,,,,150,127.5,23.12,150,Sanford Health Plan,Sanford Health Plan,132,88,,percent of total billed charges,,
"Chemical Cauterization Of Granulation Tissue (Ie, Proud Flesh) (Pro Cah)",,17250,CPT,Professional,Both,,,,150,127.5,23.12,150,Sanford Health Plan,Sanford Health Plan,132,88,,percent of total billed charges,,
"Chemical Cauterization Of Granulation Tissue (Ie, Proud Flesh) (Pro Cah)",,17250,CPT,Professional,Both,,,,150,127.5,23.12,150,"UCare Health, Inc.",Individual & Family Plan,58.732928,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Chemical Cauterization Of Granulation Tissue (Ie, Proud Flesh) (Pro Cah)",,17250,CPT,Professional,Both,,,,150,127.5,23.12,150,"UCare Health, Inc.",Individual & Family Plan,58.732928,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Chemical Cauterization Of Granulation Tissue (Ie, Proud Flesh) (Pro Cah)",,17250,CPT,Professional,Both,,,,150,127.5,23.12,150,"UCare Health, Inc.",Medical Assistance,29.359352,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Chemical Cauterization Of Granulation Tissue (Ie, Proud Flesh) (Pro Cah)",,17250,CPT,Professional,Both,,,,150,127.5,23.12,150,"UCare Health, Inc.",Medical Assistance,29.359352,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Chemical Cauterization Of Granulation Tissue (Ie, Proud Flesh) (Pro Cah)",,17250,CPT,Professional,Both,,,,150,127.5,23.12,150,"UCare Health, Inc.",Medicare Advantage,41.5495,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Chemical Cauterization Of Granulation Tissue (Ie, Proud Flesh) (Pro Cah)",,17250,CPT,Professional,Both,,,,150,127.5,23.12,150,"UCare Health, Inc.",Medicare Advantage,41.5495,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Chemical Cauterization Of Granulation Tissue (Ie, Proud Flesh) (Pro Cah)",,17250,CPT,Professional,Both,,,,150,127.5,23.12,150,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),33.2396,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Chemical Cauterization Of Granulation Tissue (Ie, Proud Flesh) (Pro Cah)",,17250,CPT,Professional,Both,,,,150,127.5,23.12,150,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),33.2396,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Chemical Cauterization Of Granulation Tissue (Ie, Proud Flesh) (Pro Cah)",,17250,CPT,Professional,Both,,,,150,127.5,23.12,150,UnitedHealthcare,Individual & Family,150,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Chemical Cauterization Of Granulation Tissue (Ie, Proud Flesh) (Pro Cah)",,17250,CPT,Professional,Both,,,,150,127.5,23.12,150,UnitedHealthcare,Individual & Family,150,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Chemical Cauterization Of Granulation Tissue (Ie, Proud Flesh) (Pro Cah)",,17250,CPT,Professional,Both,,,,150,127.5,23.12,150,UnitedHealthcare,Medicare Advantage,41.5495,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Chemical Cauterization Of Granulation Tissue (Ie, Proud Flesh) (Pro Cah)",,17250,CPT,Professional,Both,,,,150,127.5,23.12,150,UnitedHealthcare,Medicare Advantage,41.5495,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Chemical Cauterization Of Granulation Tissue (Ie, Proud Flesh) (Pro Cah)",,17250,CPT,Professional,Both,,,,150,127.5,23.12,150,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,26.69032,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Chemical Cauterization Of Granulation Tissue (Ie, Proud Flesh) (Pro Cah)",,17250,CPT,Professional,Both,,,,150,127.5,23.12,150,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,26.69032,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Chemical Cauterization Of Granulation Tissue (Pbb),,17250,CPT,Facility,Outpatient,,,,55,46.75,15.763,55,Aetna,Commercial,50.6,92,,percent of total billed charges,,
Chemical Cauterization Of Granulation Tissue (Pbb),,17250,CPT,Professional,Outpatient,,,,95,80.75,23.12,95,Aetna,Commercial,80.75,85,,percent of total billed charges,,
Chemical Cauterization Of Granulation Tissue (Pbb),,17250,CPT,Facility,Outpatient,,,,55,46.75,15.763,55,Aetna,Medicare Advantage,26.95,49,,percent of total billed charges,,
Chemical Cauterization Of Granulation Tissue (Pbb),,17250,CPT,Professional,Outpatient,,,,95,80.75,23.12,95,Aetna,Medicare Advantage,35.86,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Chemical Cauterization Of Granulation Tissue (Pbb),,17250,CPT,Facility,Outpatient,,,,55,46.75,15.763,55,Aetna,PPO,51.15,93,,percent of total billed charges,,
Chemical Cauterization Of Granulation Tissue (Pbb),,17250,CPT,Professional,Outpatient,,,,95,80.75,23.12,95,Aetna,PPO,88.35,93,,percent of total billed charges,,
Chemical Cauterization Of Granulation Tissue (Pbb),,17250,CPT,Facility,Outpatient,,,,55,46.75,15.763,55,America's PPO,America's PPO,52.8165,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Chemical Cauterization Of Granulation Tissue (Pbb),,17250,CPT,Professional,Outpatient,,,,95,80.75,23.12,95,America's PPO,America's PPO,81.168,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Chemical Cauterization Of Granulation Tissue (Pbb),,17250,CPT,Facility,Outpatient,,,,55,46.75,15.763,55,BlueCross BlueShield Minnesota, Federal Employee Program,54.12,98.4,,percent of total billed charges,,
Chemical Cauterization Of Granulation Tissue (Pbb),,17250,CPT,Professional,Outpatient,,,,95,80.75,23.12,95,BlueCross BlueShield Minnesota, Federal Employee Program,76.43,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Chemical Cauterization Of Granulation Tissue (Pbb),,17250,CPT,Facility,Outpatient,,,,55,46.75,15.763,55,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,55,100,,percent of total billed charges,,
Chemical Cauterization Of Granulation Tissue (Pbb),,17250,CPT,Professional,Outpatient,,,,95,80.75,23.12,95,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,77.65288,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Chemical Cauterization Of Granulation Tissue (Pbb),,17250,CPT,Facility,Outpatient,,,,55,46.75,15.763,55,BlueCross BlueShield Minnesota,High Value Network Plan,49.5,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
Chemical Cauterization Of Granulation Tissue (Pbb),,17250,CPT,Professional,Outpatient,,,,95,80.75,23.12,95,BlueCross BlueShield Minnesota,High Value Network Plan,77.65288,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Chemical Cauterization Of Granulation Tissue (Pbb),,17250,CPT,Facility,Outpatient,,,,55,46.75,15.763,55,BlueCross BlueShield Minnesota,Medicare Advantage,26.95,49,,percent of total billed charges,,
Chemical Cauterization Of Granulation Tissue (Pbb),,17250,CPT,Professional,Outpatient,,,,95,80.75,23.12,95,BlueCross BlueShield Minnesota,Medicare Advantage,41.5495,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Chemical Cauterization Of Granulation Tissue (Pbb),,17250,CPT,Professional,Outpatient,,,,95,80.75,23.12,95,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,77.65288,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Chemical Cauterization Of Granulation Tissue (Pbb),,17250,CPT,Facility,Outpatient,,,,55,46.75,15.763,55,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,15.763,28.66,,percent of total billed charges,,
Chemical Cauterization Of Granulation Tissue (Pbb),,17250,CPT,Professional,Outpatient,,,,95,80.75,23.12,95,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,26.69032,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Chemical Cauterization Of Granulation Tissue (Pbb),,17250,CPT,Facility,Outpatient,,,,55,46.75,15.763,55,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),26.95,49,,percent of total billed charges,,
Chemical Cauterization Of Granulation Tissue (Pbb),,17250,CPT,Professional,Outpatient,,,,95,80.75,23.12,95,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),41.5495,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Chemical Cauterization Of Granulation Tissue (Pbb),,17250,CPT,Facility,Outpatient,,,,55,46.75,15.763,55,CorVel,Worker's Compensation,55,100,,percent of total billed charges,,
Chemical Cauterization Of Granulation Tissue (Pbb),,17250,CPT,Professional,Outpatient,,,,95,80.75,23.12,95,CorVel,Worker's Compensation,70.421028,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Chemical Cauterization Of Granulation Tissue (Pbb),,17250,CPT,Facility,Outpatient,,,,55,46.75,15.763,55,First Health Group Corporation,First Health Network,53.35,97,,percent of total billed charges,,
Chemical Cauterization Of Granulation Tissue (Pbb),,17250,CPT,Professional,Outpatient,,,,95,80.75,23.12,95,First Health Group Corporation,First Health Network,92.15,97,,percent of total billed charges,,
Chemical Cauterization Of Granulation Tissue (Pbb),,17250,CPT,Facility,Outpatient,,,,55,46.75,15.763,55,"Health Partners, Inc.",Commercial,52.03,94.6,,percent of total billed charges,,
Chemical Cauterization Of Granulation Tissue (Pbb),,17250,CPT,Professional,Outpatient,,,,95,80.75,23.12,95,"Health Partners, Inc.",Commercial,76.18,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Chemical Cauterization Of Granulation Tissue (Pbb),,17250,CPT,Facility,Outpatient,,,,55,46.75,15.763,55,"Health Partners, Inc.",Medicare Advantage,26.95,49,,percent of total billed charges,,
Chemical Cauterization Of Granulation Tissue (Pbb),,17250,CPT,Professional,Outpatient,,,,95,80.75,23.12,95,"Health Partners, Inc.",Medicare Advantage,41.5495,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Chemical Cauterization Of Granulation Tissue (Pbb),,17250,CPT,Facility,Outpatient,,,,55,46.75,15.763,55,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),33,60,,percent of total billed charges,,
Chemical Cauterization Of Granulation Tissue (Pbb),,17250,CPT,Professional,Outpatient,,,,95,80.75,23.12,95,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),36.26,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Chemical Cauterization Of Granulation Tissue (Pbb),,17250,CPT,Facility,Outpatient,,,,55,46.75,15.763,55,"Health Partners, Inc.",State of Minnesota Advantage Program,44.825,81.5,,percent of total billed charges,,
Chemical Cauterization Of Granulation Tissue (Pbb),,17250,CPT,Professional,Outpatient,,,,95,80.75,23.12,95,"Health Partners, Inc.",State of Minnesota Advantage Program,65.62907,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Chemical Cauterization Of Granulation Tissue (Pbb),,17250,CPT,Facility,Outpatient,,,,55,46.75,15.763,55,"Health Partners, Inc.",State Public Programs,27.5,50,,percent of total billed charges,,
Chemical Cauterization Of Granulation Tissue (Pbb),,17250,CPT,Professional,Outpatient,,,,95,80.75,23.12,95,"Health Partners, Inc.",State Public Programs,23.12,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Chemical Cauterization Of Granulation Tissue (Pbb),,17250,CPT,Facility,Outpatient,,,,55,46.75,15.763,55,Humana Insurance Company,Commercial PPO,52.25,95,,percent of total billed charges,,
Chemical Cauterization Of Granulation Tissue (Pbb),,17250,CPT,Professional,Outpatient,,,,95,80.75,23.12,95,Humana Insurance Company,Commercial PPO,36.13,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Chemical Cauterization Of Granulation Tissue (Pbb),,17250,CPT,Facility,Outpatient,,,,55,46.75,15.763,55,Humana Insurance Company,Medicare PPO,26.95,49,,percent of total billed charges,,
Chemical Cauterization Of Granulation Tissue (Pbb),,17250,CPT,Professional,Outpatient,,,,95,80.75,23.12,95,Humana Insurance Company,Medicare PPO,95,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Chemical Cauterization Of Granulation Tissue (Pbb),,17250,CPT,Facility,Outpatient,,,,55,46.75,15.763,55,Medica,Individual & Family,54.505,99.1,,percent of total billed charges,,
Chemical Cauterization Of Granulation Tissue (Pbb),,17250,CPT,Professional,Outpatient,,,,95,80.75,23.12,95,Medica,Individual & Family,80.56,84.8,,percent of total billed charges,,
Chemical Cauterization Of Granulation Tissue (Pbb),,17250,CPT,Facility,Outpatient,,,,55,46.75,15.763,55,Medica,Medica Advantage Solution,27.39,49.8,,percent of total billed charges,,
Chemical Cauterization Of Granulation Tissue (Pbb),,17250,CPT,Professional,Outpatient,,,,95,80.75,23.12,95,Medica,Medica Advantage Solution,47.31,49.8,,percent of total billed charges,,
Chemical Cauterization Of Granulation Tissue (Pbb),,17250,CPT,Facility,Outpatient,,,,55,46.75,15.763,55,Medica,Medical Assistance,24.53,44.6,,percent of total billed charges,,
Chemical Cauterization Of Granulation Tissue (Pbb),,17250,CPT,Professional,Outpatient,,,,95,80.75,23.12,95,Medica,Medical Assistance,26.69,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Chemical Cauterization Of Granulation Tissue (Pbb),,17250,CPT,Facility,Outpatient,,,,55,46.75,15.763,55,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,27.39,49.8,,percent of total billed charges,,
Chemical Cauterization Of Granulation Tissue (Pbb),,17250,CPT,Professional,Outpatient,,,,95,80.75,23.12,95,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,36.13,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Chemical Cauterization Of Granulation Tissue (Pbb),,17250,CPT,Facility,Outpatient,,,,55,46.75,15.763,55,"Multiplan, Inc.","Multiplan, Inc.",51.7,94,,percent of total billed charges,,
Chemical Cauterization Of Granulation Tissue (Pbb),,17250,CPT,Professional,Outpatient,,,,95,80.75,23.12,95,"Multiplan, Inc.","Multiplan, Inc.",89.3,94,,percent of total billed charges,,
Chemical Cauterization Of Granulation Tissue (Pbb),,17250,CPT,Facility,Outpatient,,,,55,46.75,15.763,55,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,49.555,90.1,,percent of total billed charges,,
Chemical Cauterization Of Granulation Tissue (Pbb),,17250,CPT,Professional,Outpatient,,,,95,80.75,23.12,95,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,85.595,90.1,,percent of total billed charges,,
Chemical Cauterization Of Granulation Tissue (Pbb),,17250,CPT,Facility,Outpatient,,,,55,46.75,15.763,55,"Preferred One Administrative Services, INC.",PPO,54.23,98.6,,percent of total billed charges,,
Chemical Cauterization Of Granulation Tissue (Pbb),,17250,CPT,Professional,Outpatient,,,,95,80.75,23.12,95,"Preferred One Administrative Services, INC.",PPO,93.67,98.6,,percent of total billed charges,,
Chemical Cauterization Of Granulation Tissue (Pbb),,17250,CPT,Facility,Outpatient,,,,55,46.75,15.763,55,PrimeWest Health,Minnesota Senior Health Options (MSHO),28.2975,51.45,,percent of total billed charges,,
Chemical Cauterization Of Granulation Tissue (Pbb),,17250,CPT,Professional,Outpatient,,,,95,80.75,23.12,95,PrimeWest Health,Minnesota Senior Health Options (MSHO),41.5495,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Chemical Cauterization Of Granulation Tissue (Pbb),,17250,CPT,Facility,Outpatient,,,,55,46.75,15.763,55,PrimeWest Health,MinnesotaCare,28.248,51.36,,percent of total billed charges,,
Chemical Cauterization Of Granulation Tissue (Pbb),,17250,CPT,Professional,Outpatient,,,,95,80.75,23.12,95,PrimeWest Health,MinnesotaCare,28.5586424,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Chemical Cauterization Of Granulation Tissue (Pbb),,17250,CPT,Facility,Outpatient,,,,55,46.75,15.763,55,Sanford Health Plan,Sanford Health Plan,50.6,92,,percent of total billed charges,,
Chemical Cauterization Of Granulation Tissue (Pbb),,17250,CPT,Professional,Outpatient,,,,95,80.75,23.12,95,Sanford Health Plan,Sanford Health Plan,83.6,88,,percent of total billed charges,,
Chemical Cauterization Of Granulation Tissue (Pbb),,17250,CPT,Facility,Outpatient,,,,55,46.75,15.763,55,"UCare Health, Inc.",Individual & Family Plan,30.9925,56.35,,percent of total billed charges,,
Chemical Cauterization Of Granulation Tissue (Pbb),,17250,CPT,Professional,Outpatient,,,,95,80.75,23.12,95,"UCare Health, Inc.",Individual & Family Plan,58.732928,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Chemical Cauterization Of Granulation Tissue (Pbb),,17250,CPT,Facility,Outpatient,,,,55,46.75,15.763,55,"UCare Health, Inc.",Medical Assistance,27.7585,50.47,,percent of total billed charges,,
Chemical Cauterization Of Granulation Tissue (Pbb),,17250,CPT,Professional,Outpatient,,,,95,80.75,23.12,95,"UCare Health, Inc.",Medical Assistance,29.359352,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Chemical Cauterization Of Granulation Tissue (Pbb),,17250,CPT,Facility,Outpatient,,,,55,46.75,15.763,55,"UCare Health, Inc.",Medicare Advantage,27.7585,50.47,,percent of total billed charges,,
Chemical Cauterization Of Granulation Tissue (Pbb),,17250,CPT,Professional,Outpatient,,,,95,80.75,23.12,95,"UCare Health, Inc.",Medicare Advantage,41.5495,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Chemical Cauterization Of Granulation Tissue (Pbb),,17250,CPT,Facility,Outpatient,,,,55,46.75,15.763,55,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),27.7585,50.47,,percent of total billed charges,,
Chemical Cauterization Of Granulation Tissue (Pbb),,17250,CPT,Professional,Outpatient,,,,95,80.75,23.12,95,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),33.2396,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Chemical Cauterization Of Granulation Tissue (Pbb),,17250,CPT,Facility,Outpatient,,,,55,46.75,15.763,55,UnitedHealthcare,Individual & Family,51.7,94,,percent of total billed charges,,
Chemical Cauterization Of Granulation Tissue (Pbb),,17250,CPT,Professional,Outpatient,,,,95,80.75,23.12,95,UnitedHealthcare,Individual & Family,95,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Chemical Cauterization Of Granulation Tissue (Pbb),,17250,CPT,Facility,Outpatient,,,,55,46.75,15.763,55,UnitedHealthcare,Medicare Advantage,26.95,49,,percent of total billed charges,,
Chemical Cauterization Of Granulation Tissue (Pbb),,17250,CPT,Professional,Outpatient,,,,95,80.75,23.12,95,UnitedHealthcare,Medicare Advantage,41.5495,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Chemical Cauterization Of Granulation Tissue (Pbb),,17250,CPT,Facility,Outpatient,,,,55,46.75,15.763,55,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,26.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
Chemical Cauterization Of Granulation Tissue (Pbb),,17250,CPT,Professional,Outpatient,,,,95,80.75,23.12,95,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,26.69032,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
DANTROLENE 250 MG IV SUSR,,112496,LOCAL,Facility,Both,1,Each,,10531,8951.35,3018.1846,10531,Aetna,Commercial,9688.52,92,,percent of total billed charges,,
DANTROLENE 250 MG IV SUSR,,112496,LOCAL,Facility,Outpatient,1,Each,,10531,8951.35,3018.1846,10531,Aetna,Medicare Advantage,5160.19,49,,percent of total billed charges,,
DANTROLENE 250 MG IV SUSR,,112496,LOCAL,Facility,Inpatient,1,Each,,10531,8951.35,3018.1846,10531,Aetna,Medicare Advantage,,,,,Included in per diem rate,
DANTROLENE 250 MG IV SUSR,,112496,LOCAL,Facility,Both,1,Each,,10531,8951.35,3018.1846,10531,Aetna,PPO,9793.83,93,,percent of total billed charges,,
DANTROLENE 250 MG IV SUSR,,112496,LOCAL,Facility,Both,1,Each,,10531,8951.35,3018.1846,10531,America's PPO,America's PPO,10112.9193,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
DANTROLENE 250 MG IV SUSR,,112496,LOCAL,Facility,Both,1,Each,,10531,8951.35,3018.1846,10531,BlueCross BlueShield Minnesota, Federal Employee Program,10362.504,98.4,,percent of total billed charges,,
DANTROLENE 250 MG IV SUSR,,112496,LOCAL,Facility,Both,1,Each,,10531,8951.35,3018.1846,10531,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,10531,100,,percent of total billed charges,,
DANTROLENE 250 MG IV SUSR,,112496,LOCAL,Facility,Both,1,Each,,10531,8951.35,3018.1846,10531,BlueCross BlueShield Minnesota,High Value Network Plan,9477.9,90,,percent of total billed charges,,
DANTROLENE 250 MG IV SUSR,,112496,LOCAL,Facility,Outpatient,1,Each,,10531,8951.35,3018.1846,10531,BlueCross BlueShield Minnesota,Medicare Advantage,5160.19,49,,percent of total billed charges,,
DANTROLENE 250 MG IV SUSR,,112496,LOCAL,Facility,Inpatient,1,Each,,10531,8951.35,3018.1846,10531,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
DANTROLENE 250 MG IV SUSR,,112496,LOCAL,Facility,Both,1,Each,,10531,8951.35,3018.1846,10531,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,9327.3067,88.57,,percent of total billed charges,,
DANTROLENE 250 MG IV SUSR,,112496,LOCAL,Facility,Both,1,Each,,10531,8951.35,3018.1846,10531,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,3018.1846,28.66,,percent of total billed charges,,
DANTROLENE 250 MG IV SUSR,,112496,LOCAL,Facility,Outpatient,1,Each,,10531,8951.35,3018.1846,10531,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),5160.19,49,,percent of total billed charges,,
DANTROLENE 250 MG IV SUSR,,112496,LOCAL,Facility,Inpatient,1,Each,,10531,8951.35,3018.1846,10531,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
DANTROLENE 250 MG IV SUSR,,112496,LOCAL,Facility,Both,1,Each,,10531,8951.35,3018.1846,10531,CorVel,Worker's Compensation,10531,100,,percent of total billed charges,,
DANTROLENE 250 MG IV SUSR,,112496,LOCAL,Facility,Both,1,Each,,10531,8951.35,3018.1846,10531,First Health Group Corporation,First Health Network,10215.07,97,,percent of total billed charges,,
DANTROLENE 250 MG IV SUSR,,112496,LOCAL,Facility,Both,1,Each,,10531,8951.35,3018.1846,10531,"Health Partners, Inc.",Commercial,9962.326,94.6,,percent of total billed charges,,
DANTROLENE 250 MG IV SUSR,,112496,LOCAL,Facility,Outpatient,1,Each,,10531,8951.35,3018.1846,10531,"Health Partners, Inc.",Medicare Advantage,5160.19,49,,percent of total billed charges,,
DANTROLENE 250 MG IV SUSR,,112496,LOCAL,Facility,Inpatient,1,Each,,10531,8951.35,3018.1846,10531,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DANTROLENE 250 MG IV SUSR,,112496,LOCAL,Facility,Both,1,Each,,10531,8951.35,3018.1846,10531,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),6318.6,60,,percent of total billed charges,,
DANTROLENE 250 MG IV SUSR,,112496,LOCAL,Facility,Both,1,Each,,10531,8951.35,3018.1846,10531,"Health Partners, Inc.",State of Minnesota Advantage Program,8582.765,81.5,,percent of total billed charges,,
DANTROLENE 250 MG IV SUSR,,112496,LOCAL,Facility,Both,1,Each,,10531,8951.35,3018.1846,10531,"Health Partners, Inc.",State Public Programs,5265.5,50,,percent of total billed charges,,
DANTROLENE 250 MG IV SUSR,,112496,LOCAL,Facility,Both,1,Each,,10531,8951.35,3018.1846,10531,Humana Insurance Company,Commercial PPO,10004.45,95,,percent of total billed charges,,
DANTROLENE 250 MG IV SUSR,,112496,LOCAL,Facility,Outpatient,1,Each,,10531,8951.35,3018.1846,10531,Humana Insurance Company,Medicare PPO,5160.19,49,,percent of total billed charges,,
DANTROLENE 250 MG IV SUSR,,112496,LOCAL,Facility,Inpatient,1,Each,,10531,8951.35,3018.1846,10531,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
DANTROLENE 250 MG IV SUSR,,112496,LOCAL,Facility,Both,1,Each,,10531,8951.35,3018.1846,10531,Medica,Individual & Family,10436.221,99.1,,percent of total billed charges,,
DANTROLENE 250 MG IV SUSR,,112496,LOCAL,Facility,Outpatient,1,Each,,10531,8951.35,3018.1846,10531,Medica,Medica Advantage Solution,5244.438,49.8,,percent of total billed charges,,
DANTROLENE 250 MG IV SUSR,,112496,LOCAL,Facility,Inpatient,1,Each,,10531,8951.35,3018.1846,10531,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
DANTROLENE 250 MG IV SUSR,,112496,LOCAL,Facility,Outpatient,1,Each,,10531,8951.35,3018.1846,10531,Medica,Medical Assistance,4696.826,44.6,,percent of total billed charges,,
DANTROLENE 250 MG IV SUSR,,112496,LOCAL,Facility,Inpatient,1,Each,,10531,8951.35,3018.1846,10531,Medica,Medical Assistance,,,,,Included in per diem rate,
DANTROLENE 250 MG IV SUSR,,112496,LOCAL,Facility,Outpatient,1,Each,,10531,8951.35,3018.1846,10531,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,5244.438,49.8,,percent of total billed charges,,
DANTROLENE 250 MG IV SUSR,,112496,LOCAL,Facility,Inpatient,1,Each,,10531,8951.35,3018.1846,10531,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
DANTROLENE 250 MG IV SUSR,,112496,LOCAL,Facility,Both,1,Each,,10531,8951.35,3018.1846,10531,"Multiplan, Inc.","Multiplan, Inc.",9899.14,94,,percent of total billed charges,,
DANTROLENE 250 MG IV SUSR,,112496,LOCAL,Facility,Outpatient,1,Each,,10531,8951.35,3018.1846,10531,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,9488.431,90.1,,percent of total billed charges,,
DANTROLENE 250 MG IV SUSR,,112496,LOCAL,Facility,Inpatient,1,Each,,10531,8951.35,3018.1846,10531,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
DANTROLENE 250 MG IV SUSR,,112496,LOCAL,Facility,Both,1,Each,,10531,8951.35,3018.1846,10531,"Preferred One Administrative Services, INC.",PPO,10383.566,98.6,,percent of total billed charges,,
DANTROLENE 250 MG IV SUSR,,112496,LOCAL,Facility,Outpatient,1,Each,,10531,8951.35,3018.1846,10531,PrimeWest Health,Minnesota Senior Health Options (MSHO),5418.1995,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
DANTROLENE 250 MG IV SUSR,,112496,LOCAL,Facility,Inpatient,1,Each,,10531,8951.35,3018.1846,10531,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DANTROLENE 250 MG IV SUSR,,112496,LOCAL,Facility,Outpatient,1,Each,,10531,8951.35,3018.1846,10531,PrimeWest Health,MinnesotaCare,5408.7216,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
DANTROLENE 250 MG IV SUSR,,112496,LOCAL,Facility,Inpatient,1,Each,,10531,8951.35,3018.1846,10531,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
DANTROLENE 250 MG IV SUSR,,112496,LOCAL,Facility,Both,1,Each,,10531,8951.35,3018.1846,10531,Sanford Health Plan,Sanford Health Plan,9688.52,92,,percent of total billed charges,,
DANTROLENE 250 MG IV SUSR,,112496,LOCAL,Facility,Outpatient,1,Each,,10531,8951.35,3018.1846,10531,"UCare Health, Inc.",Individual & Family Plan,5934.2185,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
DANTROLENE 250 MG IV SUSR,,112496,LOCAL,Facility,Inpatient,1,Each,,10531,8951.35,3018.1846,10531,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
DANTROLENE 250 MG IV SUSR,,112496,LOCAL,Facility,Outpatient,1,Each,,10531,8951.35,3018.1846,10531,"UCare Health, Inc.",Medical Assistance,5314.9957,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DANTROLENE 250 MG IV SUSR,,112496,LOCAL,Facility,Inpatient,1,Each,,10531,8951.35,3018.1846,10531,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
DANTROLENE 250 MG IV SUSR,,112496,LOCAL,Facility,Outpatient,1,Each,,10531,8951.35,3018.1846,10531,"UCare Health, Inc.",Medicare Advantage,5314.9957,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DANTROLENE 250 MG IV SUSR,,112496,LOCAL,Facility,Inpatient,1,Each,,10531,8951.35,3018.1846,10531,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DANTROLENE 250 MG IV SUSR,,112496,LOCAL,Facility,Outpatient,1,Each,,10531,8951.35,3018.1846,10531,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),5314.9957,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DANTROLENE 250 MG IV SUSR,,112496,LOCAL,Facility,Inpatient,1,Each,,10531,8951.35,3018.1846,10531,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DANTROLENE 250 MG IV SUSR,,112496,LOCAL,Facility,Both,1,Each,,10531,8951.35,3018.1846,10531,UnitedHealthcare,Individual & Family,9899.14,94,,percent of total billed charges,,
DANTROLENE 250 MG IV SUSR,,112496,LOCAL,Facility,Outpatient,1,Each,,10531,8951.35,3018.1846,10531,UnitedHealthcare,Medicare Advantage,5160.19,49,,percent of total billed charges,,
DANTROLENE 250 MG IV SUSR,,112496,LOCAL,Facility,Inpatient,1,Each,,10531,8951.35,3018.1846,10531,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
DANTROLENE 250 MG IV SUSR,,112496,LOCAL,Facility,Outpatient,1,Each,,10531,8951.35,3018.1846,10531,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,5054.88,48,,percent of total billed charges,,100% of DHS outpatient percentage
DANTROLENE 250 MG IV SUSR,,112496,LOCAL,Facility,Inpatient,1,Each,,10531,8951.35,3018.1846,10531,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
OXYCODONE 10 MG ORAL TR12,,113360,LOCAL,Facility,Both,1,Each,,31,26.35,8.8846,31,Aetna,Commercial,28.52,92,,percent of total billed charges,,
OXYCODONE 10 MG ORAL TR12,,113360,LOCAL,Facility,Outpatient,1,Each,,31,26.35,8.8846,31,Aetna,Medicare Advantage,15.19,49,,percent of total billed charges,,
OXYCODONE 10 MG ORAL TR12,,113360,LOCAL,Facility,Inpatient,1,Each,,31,26.35,8.8846,31,Aetna,Medicare Advantage,,,,,Included in per diem rate,
OXYCODONE 10 MG ORAL TR12,,113360,LOCAL,Facility,Both,1,Each,,31,26.35,8.8846,31,Aetna,PPO,28.83,93,,percent of total billed charges,,
OXYCODONE 10 MG ORAL TR12,,113360,LOCAL,Facility,Both,1,Each,,31,26.35,8.8846,31,America's PPO,America's PPO,29.7693,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
OXYCODONE 10 MG ORAL TR12,,113360,LOCAL,Facility,Both,1,Each,,31,26.35,8.8846,31,BlueCross BlueShield Minnesota, Federal Employee Program,30.504,98.4,,percent of total billed charges,,
OXYCODONE 10 MG ORAL TR12,,113360,LOCAL,Facility,Both,1,Each,,31,26.35,8.8846,31,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,31,100,,percent of total billed charges,,
OXYCODONE 10 MG ORAL TR12,,113360,LOCAL,Facility,Both,1,Each,,31,26.35,8.8846,31,BlueCross BlueShield Minnesota,High Value Network Plan,27.9,90,,percent of total billed charges,,
OXYCODONE 10 MG ORAL TR12,,113360,LOCAL,Facility,Outpatient,1,Each,,31,26.35,8.8846,31,BlueCross BlueShield Minnesota,Medicare Advantage,15.19,49,,percent of total billed charges,,
OXYCODONE 10 MG ORAL TR12,,113360,LOCAL,Facility,Inpatient,1,Each,,31,26.35,8.8846,31,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
OXYCODONE 10 MG ORAL TR12,,113360,LOCAL,Facility,Both,1,Each,,31,26.35,8.8846,31,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,27.4567,88.57,,percent of total billed charges,,
OXYCODONE 10 MG ORAL TR12,,113360,LOCAL,Facility,Both,1,Each,,31,26.35,8.8846,31,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,8.8846,28.66,,percent of total billed charges,,
OXYCODONE 10 MG ORAL TR12,,113360,LOCAL,Facility,Outpatient,1,Each,,31,26.35,8.8846,31,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),15.19,49,,percent of total billed charges,,
OXYCODONE 10 MG ORAL TR12,,113360,LOCAL,Facility,Inpatient,1,Each,,31,26.35,8.8846,31,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
OXYCODONE 10 MG ORAL TR12,,113360,LOCAL,Facility,Both,1,Each,,31,26.35,8.8846,31,CorVel,Worker's Compensation,31,100,,percent of total billed charges,,
OXYCODONE 10 MG ORAL TR12,,113360,LOCAL,Facility,Both,1,Each,,31,26.35,8.8846,31,First Health Group Corporation,First Health Network,30.07,97,,percent of total billed charges,,
OXYCODONE 10 MG ORAL TR12,,113360,LOCAL,Facility,Both,1,Each,,31,26.35,8.8846,31,"Health Partners, Inc.",Commercial,29.326,94.6,,percent of total billed charges,,
OXYCODONE 10 MG ORAL TR12,,113360,LOCAL,Facility,Outpatient,1,Each,,31,26.35,8.8846,31,"Health Partners, Inc.",Medicare Advantage,15.19,49,,percent of total billed charges,,
OXYCODONE 10 MG ORAL TR12,,113360,LOCAL,Facility,Inpatient,1,Each,,31,26.35,8.8846,31,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
OXYCODONE 10 MG ORAL TR12,,113360,LOCAL,Facility,Both,1,Each,,31,26.35,8.8846,31,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),18.6,60,,percent of total billed charges,,
OXYCODONE 10 MG ORAL TR12,,113360,LOCAL,Facility,Both,1,Each,,31,26.35,8.8846,31,"Health Partners, Inc.",State of Minnesota Advantage Program,25.265,81.5,,percent of total billed charges,,
OXYCODONE 10 MG ORAL TR12,,113360,LOCAL,Facility,Both,1,Each,,31,26.35,8.8846,31,"Health Partners, Inc.",State Public Programs,15.5,50,,percent of total billed charges,,
OXYCODONE 10 MG ORAL TR12,,113360,LOCAL,Facility,Both,1,Each,,31,26.35,8.8846,31,Humana Insurance Company,Commercial PPO,29.45,95,,percent of total billed charges,,
OXYCODONE 10 MG ORAL TR12,,113360,LOCAL,Facility,Outpatient,1,Each,,31,26.35,8.8846,31,Humana Insurance Company,Medicare PPO,15.19,49,,percent of total billed charges,,
OXYCODONE 10 MG ORAL TR12,,113360,LOCAL,Facility,Inpatient,1,Each,,31,26.35,8.8846,31,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
OXYCODONE 10 MG ORAL TR12,,113360,LOCAL,Facility,Both,1,Each,,31,26.35,8.8846,31,Medica,Individual & Family,30.721,99.1,,percent of total billed charges,,
OXYCODONE 10 MG ORAL TR12,,113360,LOCAL,Facility,Outpatient,1,Each,,31,26.35,8.8846,31,Medica,Medica Advantage Solution,15.438,49.8,,percent of total billed charges,,
OXYCODONE 10 MG ORAL TR12,,113360,LOCAL,Facility,Inpatient,1,Each,,31,26.35,8.8846,31,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
OXYCODONE 10 MG ORAL TR12,,113360,LOCAL,Facility,Outpatient,1,Each,,31,26.35,8.8846,31,Medica,Medical Assistance,13.826,44.6,,percent of total billed charges,,
OXYCODONE 10 MG ORAL TR12,,113360,LOCAL,Facility,Inpatient,1,Each,,31,26.35,8.8846,31,Medica,Medical Assistance,,,,,Included in per diem rate,
OXYCODONE 10 MG ORAL TR12,,113360,LOCAL,Facility,Outpatient,1,Each,,31,26.35,8.8846,31,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,15.438,49.8,,percent of total billed charges,,
OXYCODONE 10 MG ORAL TR12,,113360,LOCAL,Facility,Inpatient,1,Each,,31,26.35,8.8846,31,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
OXYCODONE 10 MG ORAL TR12,,113360,LOCAL,Facility,Both,1,Each,,31,26.35,8.8846,31,"Multiplan, Inc.","Multiplan, Inc.",29.14,94,,percent of total billed charges,,
OXYCODONE 10 MG ORAL TR12,,113360,LOCAL,Facility,Outpatient,1,Each,,31,26.35,8.8846,31,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,27.931,90.1,,percent of total billed charges,,
OXYCODONE 10 MG ORAL TR12,,113360,LOCAL,Facility,Inpatient,1,Each,,31,26.35,8.8846,31,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
OXYCODONE 10 MG ORAL TR12,,113360,LOCAL,Facility,Both,1,Each,,31,26.35,8.8846,31,"Preferred One Administrative Services, INC.",PPO,30.566,98.6,,percent of total billed charges,,
OXYCODONE 10 MG ORAL TR12,,113360,LOCAL,Facility,Outpatient,1,Each,,31,26.35,8.8846,31,PrimeWest Health,Minnesota Senior Health Options (MSHO),15.9495,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
OXYCODONE 10 MG ORAL TR12,,113360,LOCAL,Facility,Inpatient,1,Each,,31,26.35,8.8846,31,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
OXYCODONE 10 MG ORAL TR12,,113360,LOCAL,Facility,Outpatient,1,Each,,31,26.35,8.8846,31,PrimeWest Health,MinnesotaCare,15.9216,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
OXYCODONE 10 MG ORAL TR12,,113360,LOCAL,Facility,Inpatient,1,Each,,31,26.35,8.8846,31,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
OXYCODONE 10 MG ORAL TR12,,113360,LOCAL,Facility,Both,1,Each,,31,26.35,8.8846,31,Sanford Health Plan,Sanford Health Plan,28.52,92,,percent of total billed charges,,
OXYCODONE 10 MG ORAL TR12,,113360,LOCAL,Facility,Outpatient,1,Each,,31,26.35,8.8846,31,"UCare Health, Inc.",Individual & Family Plan,17.4685,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
OXYCODONE 10 MG ORAL TR12,,113360,LOCAL,Facility,Inpatient,1,Each,,31,26.35,8.8846,31,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
OXYCODONE 10 MG ORAL TR12,,113360,LOCAL,Facility,Outpatient,1,Each,,31,26.35,8.8846,31,"UCare Health, Inc.",Medical Assistance,15.6457,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
OXYCODONE 10 MG ORAL TR12,,113360,LOCAL,Facility,Inpatient,1,Each,,31,26.35,8.8846,31,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
OXYCODONE 10 MG ORAL TR12,,113360,LOCAL,Facility,Outpatient,1,Each,,31,26.35,8.8846,31,"UCare Health, Inc.",Medicare Advantage,15.6457,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
OXYCODONE 10 MG ORAL TR12,,113360,LOCAL,Facility,Inpatient,1,Each,,31,26.35,8.8846,31,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
OXYCODONE 10 MG ORAL TR12,,113360,LOCAL,Facility,Outpatient,1,Each,,31,26.35,8.8846,31,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),15.6457,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
OXYCODONE 10 MG ORAL TR12,,113360,LOCAL,Facility,Inpatient,1,Each,,31,26.35,8.8846,31,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
OXYCODONE 10 MG ORAL TR12,,113360,LOCAL,Facility,Both,1,Each,,31,26.35,8.8846,31,UnitedHealthcare,Individual & Family,29.14,94,,percent of total billed charges,,
OXYCODONE 10 MG ORAL TR12,,113360,LOCAL,Facility,Outpatient,1,Each,,31,26.35,8.8846,31,UnitedHealthcare,Medicare Advantage,15.19,49,,percent of total billed charges,,
OXYCODONE 10 MG ORAL TR12,,113360,LOCAL,Facility,Inpatient,1,Each,,31,26.35,8.8846,31,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
OXYCODONE 10 MG ORAL TR12,,113360,LOCAL,Facility,Outpatient,1,Each,,31,26.35,8.8846,31,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,14.88,48,,percent of total billed charges,,100% of DHS outpatient percentage
OXYCODONE 10 MG ORAL TR12,,113360,LOCAL,Facility,Inpatient,1,Each,,31,26.35,8.8846,31,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 0.5 Cm Or Less",,17260,CPT,Facility,Both,,,,156,132.6,44.7096,156,Aetna,Commercial,143.52,92,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 0.5 Cm Or Less",,17260,CPT,Facility,Outpatient,,,,156,132.6,44.7096,156,Aetna,Medicare Advantage,76.44,49,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 0.5 Cm Or Less",,17260,CPT,Facility,Inpatient,,,,156,132.6,44.7096,156,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 0.5 Cm Or Less",,17260,CPT,Facility,Both,,,,156,132.6,44.7096,156,Aetna,PPO,145.08,93,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 0.5 Cm Or Less",,17260,CPT,Facility,Both,,,,156,132.6,44.7096,156,America's PPO,America's PPO,149.8068,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 0.5 Cm Or Less",,17260,CPT,Facility,Both,,,,156,132.6,44.7096,156,BlueCross BlueShield Minnesota, Federal Employee Program,153.504,98.4,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 0.5 Cm Or Less",,17260,CPT,Facility,Both,,,,156,132.6,44.7096,156,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,156,100,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 0.5 Cm Or Less",,17260,CPT,Facility,Both,,,,156,132.6,44.7096,156,BlueCross BlueShield Minnesota,High Value Network Plan,140.4,90,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 0.5 Cm Or Less",,17260,CPT,Facility,Outpatient,,,,156,132.6,44.7096,156,BlueCross BlueShield Minnesota,Medicare Advantage,76.44,49,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 0.5 Cm Or Less",,17260,CPT,Facility,Inpatient,,,,156,132.6,44.7096,156,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 0.5 Cm Or Less",,17260,CPT,Facility,Both,,,,156,132.6,44.7096,156,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,138.1692,88.57,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 0.5 Cm Or Less",,17260,CPT,Facility,Both,,,,156,132.6,44.7096,156,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,44.7096,28.66,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 0.5 Cm Or Less",,17260,CPT,Facility,Outpatient,,,,156,132.6,44.7096,156,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),76.44,49,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 0.5 Cm Or Less",,17260,CPT,Facility,Inpatient,,,,156,132.6,44.7096,156,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 0.5 Cm Or Less",,17260,CPT,Facility,Both,,,,156,132.6,44.7096,156,CorVel,Worker's Compensation,156,100,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 0.5 Cm Or Less",,17260,CPT,Facility,Both,,,,156,132.6,44.7096,156,First Health Group Corporation,First Health Network,151.32,97,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 0.5 Cm Or Less",,17260,CPT,Facility,Both,,,,156,132.6,44.7096,156,"Health Partners, Inc.",Commercial,147.576,94.6,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 0.5 Cm Or Less",,17260,CPT,Facility,Outpatient,,,,156,132.6,44.7096,156,"Health Partners, Inc.",Medicare Advantage,76.44,49,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 0.5 Cm Or Less",,17260,CPT,Facility,Inpatient,,,,156,132.6,44.7096,156,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 0.5 Cm Or Less",,17260,CPT,Facility,Both,,,,156,132.6,44.7096,156,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),93.6,60,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 0.5 Cm Or Less",,17260,CPT,Facility,Both,,,,156,132.6,44.7096,156,"Health Partners, Inc.",State of Minnesota Advantage Program,127.14,81.5,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 0.5 Cm Or Less",,17260,CPT,Facility,Both,,,,156,132.6,44.7096,156,"Health Partners, Inc.",State Public Programs,78,50,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 0.5 Cm Or Less",,17260,CPT,Facility,Both,,,,156,132.6,44.7096,156,Humana Insurance Company,Commercial PPO,148.2,95,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 0.5 Cm Or Less",,17260,CPT,Facility,Outpatient,,,,156,132.6,44.7096,156,Humana Insurance Company,Medicare PPO,76.44,49,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 0.5 Cm Or Less",,17260,CPT,Facility,Inpatient,,,,156,132.6,44.7096,156,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 0.5 Cm Or Less",,17260,CPT,Facility,Both,,,,156,132.6,44.7096,156,Medica,Individual & Family,154.596,99.1,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 0.5 Cm Or Less",,17260,CPT,Facility,Outpatient,,,,156,132.6,44.7096,156,Medica,Medica Advantage Solution,77.688,49.8,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 0.5 Cm Or Less",,17260,CPT,Facility,Inpatient,,,,156,132.6,44.7096,156,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 0.5 Cm Or Less",,17260,CPT,Facility,Outpatient,,,,156,132.6,44.7096,156,Medica,Medical Assistance,69.576,44.6,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 0.5 Cm Or Less",,17260,CPT,Facility,Inpatient,,,,156,132.6,44.7096,156,Medica,Medical Assistance,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 0.5 Cm Or Less",,17260,CPT,Facility,Outpatient,,,,156,132.6,44.7096,156,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,77.688,49.8,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 0.5 Cm Or Less",,17260,CPT,Facility,Inpatient,,,,156,132.6,44.7096,156,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 0.5 Cm Or Less",,17260,CPT,Facility,Both,,,,156,132.6,44.7096,156,"Multiplan, Inc.","Multiplan, Inc.",146.64,94,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 0.5 Cm Or Less",,17260,CPT,Facility,Outpatient,,,,156,132.6,44.7096,156,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,140.556,90.1,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 0.5 Cm Or Less",,17260,CPT,Facility,Inpatient,,,,156,132.6,44.7096,156,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 0.5 Cm Or Less",,17260,CPT,Facility,Both,,,,156,132.6,44.7096,156,"Preferred One Administrative Services, INC.",PPO,153.816,98.6,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 0.5 Cm Or Less",,17260,CPT,Facility,Outpatient,,,,156,132.6,44.7096,156,PrimeWest Health,Minnesota Senior Health Options (MSHO),80.262,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 0.5 Cm Or Less",,17260,CPT,Facility,Inpatient,,,,156,132.6,44.7096,156,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 0.5 Cm Or Less",,17260,CPT,Facility,Outpatient,,,,156,132.6,44.7096,156,PrimeWest Health,MinnesotaCare,80.1216,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 0.5 Cm Or Less",,17260,CPT,Facility,Inpatient,,,,156,132.6,44.7096,156,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 0.5 Cm Or Less",,17260,CPT,Facility,Both,,,,156,132.6,44.7096,156,Sanford Health Plan,Sanford Health Plan,143.52,92,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 0.5 Cm Or Less",,17260,CPT,Facility,Outpatient,,,,156,132.6,44.7096,156,"UCare Health, Inc.",Individual & Family Plan,87.906,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 0.5 Cm Or Less",,17260,CPT,Facility,Inpatient,,,,156,132.6,44.7096,156,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 0.5 Cm Or Less",,17260,CPT,Facility,Outpatient,,,,156,132.6,44.7096,156,"UCare Health, Inc.",Medical Assistance,78.7332,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 0.5 Cm Or Less",,17260,CPT,Facility,Inpatient,,,,156,132.6,44.7096,156,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 0.5 Cm Or Less",,17260,CPT,Facility,Outpatient,,,,156,132.6,44.7096,156,"UCare Health, Inc.",Medicare Advantage,78.7332,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 0.5 Cm Or Less",,17260,CPT,Facility,Inpatient,,,,156,132.6,44.7096,156,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 0.5 Cm Or Less",,17260,CPT,Facility,Outpatient,,,,156,132.6,44.7096,156,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),78.7332,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 0.5 Cm Or Less",,17260,CPT,Facility,Inpatient,,,,156,132.6,44.7096,156,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 0.5 Cm Or Less",,17260,CPT,Facility,Both,,,,156,132.6,44.7096,156,UnitedHealthcare,Individual & Family,146.64,94,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 0.5 Cm Or Less",,17260,CPT,Facility,Outpatient,,,,156,132.6,44.7096,156,UnitedHealthcare,Medicare Advantage,76.44,49,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 0.5 Cm Or Less",,17260,CPT,Facility,Inpatient,,,,156,132.6,44.7096,156,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 0.5 Cm Or Less",,17260,CPT,Facility,Outpatient,,,,156,132.6,44.7096,156,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,74.88,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 0.5 Cm Or Less",,17260,CPT,Facility,Inpatient,,,,156,132.6,44.7096,156,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 0.5 Cm Or Less (Pro Cah)",,17260,CPT,Professional,Both,,,,225,191.25,44.71,225,Aetna,Commercial,191.25,85,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 0.5 Cm Or Less (Pro Cah)",,17260,CPT,Professional,Both,,,,225,191.25,44.71,225,Aetna,Medicare Advantage,69.6,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 0.5 Cm Or Less (Pro Cah)",,17260,CPT,Professional,Both,,,,225,191.25,44.71,225,Aetna,PPO,209.25,93,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 0.5 Cm Or Less (Pro Cah)",,17260,CPT,Professional,Both,,,,225,191.25,44.71,225,America's PPO,America's PPO,192.24,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 0.5 Cm Or Less (Pro Cah)",,17260,CPT,Professional,Both,,,,225,191.25,44.71,225,BlueCross BlueShield Minnesota, Federal Employee Program,144.61,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 0.5 Cm Or Less (Pro Cah)",,17260,CPT,Professional,Both,,,,225,191.25,44.71,225,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,146.92376,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 0.5 Cm Or Less (Pro Cah)",,17260,CPT,Professional,Both,,,,225,191.25,44.71,225,BlueCross BlueShield Minnesota,High Value Network Plan,146.92376,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 0.5 Cm Or Less (Pro Cah)",,17260,CPT,Professional,Both,,,,225,191.25,44.71,225,BlueCross BlueShield Minnesota,Medicare Advantage,79.9825,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 0.5 Cm Or Less (Pro Cah)",,17260,CPT,Professional,Both,,,,225,191.25,44.71,225,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,146.92376,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 0.5 Cm Or Less (Pro Cah)",,17260,CPT,Professional,Both,,,,225,191.25,44.71,225,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,51.62296,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 0.5 Cm Or Less (Pro Cah)",,17260,CPT,Professional,Both,,,,225,191.25,44.71,225,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),79.9825,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 0.5 Cm Or Less (Pro Cah)",,17260,CPT,Professional,Both,,,,225,191.25,44.71,225,CorVel,Worker's Compensation,135.340833,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 0.5 Cm Or Less (Pro Cah)",,17260,CPT,Professional,Both,,,,225,191.25,44.71,225,First Health Group Corporation,First Health Network,218.25,97,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 0.5 Cm Or Less (Pro Cah)",,17260,CPT,Professional,Both,,,,225,191.25,44.71,225,"Health Partners, Inc.",Commercial,145.83,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 0.5 Cm Or Less (Pro Cah)",,17260,CPT,Professional,Both,,,,225,191.25,44.71,225,"Health Partners, Inc.",Medicare Advantage,79.9825,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 0.5 Cm Or Less (Pro Cah)",,17260,CPT,Professional,Both,,,,225,191.25,44.71,225,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),69.47,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 0.5 Cm Or Less (Pro Cah)",,17260,CPT,Professional,Both,,,,225,191.25,44.71,225,"Health Partners, Inc.",State of Minnesota Advantage Program,125.632545,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 0.5 Cm Or Less (Pro Cah)",,17260,CPT,Professional,Both,,,,225,191.25,44.71,225,"Health Partners, Inc.",State Public Programs,44.71,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 0.5 Cm Or Less (Pro Cah)",,17260,CPT,Professional,Both,,,,225,191.25,44.71,225,Humana Insurance Company,Commercial PPO,69.55,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 0.5 Cm Or Less (Pro Cah)",,17260,CPT,Professional,Both,,,,225,191.25,44.71,225,Humana Insurance Company,Medicare PPO,225,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 0.5 Cm Or Less (Pro Cah)",,17260,CPT,Professional,Both,,,,225,191.25,44.71,225,Medica,Individual & Family,190.8,84.8,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 0.5 Cm Or Less (Pro Cah)",,17260,CPT,Professional,Both,,,,225,191.25,44.71,225,Medica,Medica Advantage Solution,112.05,49.8,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 0.5 Cm Or Less (Pro Cah)",,17260,CPT,Professional,Both,,,,225,191.25,44.71,225,Medica,Medical Assistance,51.62,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 0.5 Cm Or Less (Pro Cah)",,17260,CPT,Professional,Both,,,,225,191.25,44.71,225,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,69.55,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 0.5 Cm Or Less (Pro Cah)",,17260,CPT,Professional,Both,,,,225,191.25,44.71,225,"Multiplan, Inc.","Multiplan, Inc.",211.5,94,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 0.5 Cm Or Less (Pro Cah)",,17260,CPT,Professional,Both,,,,225,191.25,44.71,225,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,202.725,90.1,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 0.5 Cm Or Less (Pro Cah)",,17260,CPT,Professional,Both,,,,225,191.25,44.71,225,"Preferred One Administrative Services, INC.",PPO,221.85,98.6,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 0.5 Cm Or Less (Pro Cah)",,17260,CPT,Professional,Both,,,,225,191.25,44.71,225,PrimeWest Health,Minnesota Senior Health Options (MSHO),79.9825,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 0.5 Cm Or Less (Pro Cah)",,17260,CPT,Professional,Both,,,,225,191.25,44.71,225,PrimeWest Health,MinnesotaCare,55.2365672,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 0.5 Cm Or Less (Pro Cah)",,17260,CPT,Professional,Both,,,,225,191.25,44.71,225,Sanford Health Plan,Sanford Health Plan,198,88,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 0.5 Cm Or Less (Pro Cah)",,17260,CPT,Professional,Both,,,,225,191.25,44.71,225,"UCare Health, Inc.",Individual & Family Plan,113.06048,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 0.5 Cm Or Less (Pro Cah)",,17260,CPT,Professional,Both,,,,225,191.25,44.71,225,"UCare Health, Inc.",Medical Assistance,56.785256,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 0.5 Cm Or Less (Pro Cah)",,17260,CPT,Professional,Both,,,,225,191.25,44.71,225,"UCare Health, Inc.",Medicare Advantage,79.9825,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 0.5 Cm Or Less (Pro Cah)",,17260,CPT,Professional,Both,,,,225,191.25,44.71,225,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),63.986,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 0.5 Cm Or Less (Pro Cah)",,17260,CPT,Professional,Both,,,,225,191.25,44.71,225,UnitedHealthcare,Individual & Family,225,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 0.5 Cm Or Less (Pro Cah)",,17260,CPT,Professional,Both,,,,225,191.25,44.71,225,UnitedHealthcare,Medicare Advantage,79.9825,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 0.5 Cm Or Less (Pro Cah)",,17260,CPT,Professional,Both,,,,225,191.25,44.71,225,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,51.62296,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; 0.6 To 1.0 Cm",,17261,CPT,Facility,Both,,,,235,199.75,67.351,235,Aetna,Commercial,216.2,92,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; 0.6 To 1.0 Cm",,17261,CPT,Facility,Outpatient,,,,235,199.75,67.351,235,Aetna,Medicare Advantage,115.15,49,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; 0.6 To 1.0 Cm",,17261,CPT,Facility,Inpatient,,,,235,199.75,67.351,235,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; 0.6 To 1.0 Cm",,17261,CPT,Facility,Both,,,,235,199.75,67.351,235,Aetna,PPO,218.55,93,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; 0.6 To 1.0 Cm",,17261,CPT,Facility,Both,,,,235,199.75,67.351,235,America's PPO,America's PPO,225.6705,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; 0.6 To 1.0 Cm",,17261,CPT,Facility,Both,,,,235,199.75,67.351,235,BlueCross BlueShield Minnesota, Federal Employee Program,231.24,98.4,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; 0.6 To 1.0 Cm",,17261,CPT,Facility,Both,,,,235,199.75,67.351,235,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,235,100,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; 0.6 To 1.0 Cm",,17261,CPT,Facility,Both,,,,235,199.75,67.351,235,BlueCross BlueShield Minnesota,High Value Network Plan,211.5,90,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; 0.6 To 1.0 Cm",,17261,CPT,Facility,Outpatient,,,,235,199.75,67.351,235,BlueCross BlueShield Minnesota,Medicare Advantage,115.15,49,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; 0.6 To 1.0 Cm",,17261,CPT,Facility,Inpatient,,,,235,199.75,67.351,235,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; 0.6 To 1.0 Cm",,17261,CPT,Facility,Both,,,,235,199.75,67.351,235,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,208.1395,88.57,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; 0.6 To 1.0 Cm",,17261,CPT,Facility,Both,,,,235,199.75,67.351,235,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,67.351,28.66,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; 0.6 To 1.0 Cm",,17261,CPT,Facility,Outpatient,,,,235,199.75,67.351,235,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),115.15,49,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; 0.6 To 1.0 Cm",,17261,CPT,Facility,Inpatient,,,,235,199.75,67.351,235,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; 0.6 To 1.0 Cm",,17261,CPT,Facility,Both,,,,235,199.75,67.351,235,CorVel,Worker's Compensation,235,100,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; 0.6 To 1.0 Cm",,17261,CPT,Facility,Both,,,,235,199.75,67.351,235,First Health Group Corporation,First Health Network,227.95,97,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; 0.6 To 1.0 Cm",,17261,CPT,Facility,Both,,,,235,199.75,67.351,235,"Health Partners, Inc.",Commercial,222.31,94.6,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; 0.6 To 1.0 Cm",,17261,CPT,Facility,Outpatient,,,,235,199.75,67.351,235,"Health Partners, Inc.",Medicare Advantage,115.15,49,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; 0.6 To 1.0 Cm",,17261,CPT,Facility,Inpatient,,,,235,199.75,67.351,235,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; 0.6 To 1.0 Cm",,17261,CPT,Facility,Both,,,,235,199.75,67.351,235,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),141,60,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; 0.6 To 1.0 Cm",,17261,CPT,Facility,Both,,,,235,199.75,67.351,235,"Health Partners, Inc.",State of Minnesota Advantage Program,191.525,81.5,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; 0.6 To 1.0 Cm",,17261,CPT,Facility,Both,,,,235,199.75,67.351,235,"Health Partners, Inc.",State Public Programs,117.5,50,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; 0.6 To 1.0 Cm",,17261,CPT,Facility,Both,,,,235,199.75,67.351,235,Humana Insurance Company,Commercial PPO,223.25,95,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; 0.6 To 1.0 Cm",,17261,CPT,Facility,Outpatient,,,,235,199.75,67.351,235,Humana Insurance Company,Medicare PPO,115.15,49,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; 0.6 To 1.0 Cm",,17261,CPT,Facility,Inpatient,,,,235,199.75,67.351,235,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; 0.6 To 1.0 Cm",,17261,CPT,Facility,Both,,,,235,199.75,67.351,235,Medica,Individual & Family,232.885,99.1,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; 0.6 To 1.0 Cm",,17261,CPT,Facility,Outpatient,,,,235,199.75,67.351,235,Medica,Medica Advantage Solution,117.03,49.8,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; 0.6 To 1.0 Cm",,17261,CPT,Facility,Inpatient,,,,235,199.75,67.351,235,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; 0.6 To 1.0 Cm",,17261,CPT,Facility,Outpatient,,,,235,199.75,67.351,235,Medica,Medical Assistance,104.81,44.6,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; 0.6 To 1.0 Cm",,17261,CPT,Facility,Inpatient,,,,235,199.75,67.351,235,Medica,Medical Assistance,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; 0.6 To 1.0 Cm",,17261,CPT,Facility,Outpatient,,,,235,199.75,67.351,235,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,117.03,49.8,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; 0.6 To 1.0 Cm",,17261,CPT,Facility,Inpatient,,,,235,199.75,67.351,235,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; 0.6 To 1.0 Cm",,17261,CPT,Facility,Both,,,,235,199.75,67.351,235,"Multiplan, Inc.","Multiplan, Inc.",220.9,94,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; 0.6 To 1.0 Cm",,17261,CPT,Facility,Outpatient,,,,235,199.75,67.351,235,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,211.735,90.1,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; 0.6 To 1.0 Cm",,17261,CPT,Facility,Inpatient,,,,235,199.75,67.351,235,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; 0.6 To 1.0 Cm",,17261,CPT,Facility,Both,,,,235,199.75,67.351,235,"Preferred One Administrative Services, INC.",PPO,231.71,98.6,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; 0.6 To 1.0 Cm",,17261,CPT,Facility,Outpatient,,,,235,199.75,67.351,235,PrimeWest Health,Minnesota Senior Health Options (MSHO),120.9075,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; 0.6 To 1.0 Cm",,17261,CPT,Facility,Inpatient,,,,235,199.75,67.351,235,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; 0.6 To 1.0 Cm",,17261,CPT,Facility,Outpatient,,,,235,199.75,67.351,235,PrimeWest Health,MinnesotaCare,120.696,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; 0.6 To 1.0 Cm",,17261,CPT,Facility,Inpatient,,,,235,199.75,67.351,235,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; 0.6 To 1.0 Cm",,17261,CPT,Facility,Both,,,,235,199.75,67.351,235,Sanford Health Plan,Sanford Health Plan,216.2,92,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; 0.6 To 1.0 Cm",,17261,CPT,Facility,Outpatient,,,,235,199.75,67.351,235,"UCare Health, Inc.",Individual & Family Plan,132.4225,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; 0.6 To 1.0 Cm",,17261,CPT,Facility,Inpatient,,,,235,199.75,67.351,235,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; 0.6 To 1.0 Cm",,17261,CPT,Facility,Outpatient,,,,235,199.75,67.351,235,"UCare Health, Inc.",Medical Assistance,118.6045,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; 0.6 To 1.0 Cm",,17261,CPT,Facility,Inpatient,,,,235,199.75,67.351,235,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; 0.6 To 1.0 Cm",,17261,CPT,Facility,Outpatient,,,,235,199.75,67.351,235,"UCare Health, Inc.",Medicare Advantage,118.6045,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; 0.6 To 1.0 Cm",,17261,CPT,Facility,Inpatient,,,,235,199.75,67.351,235,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; 0.6 To 1.0 Cm",,17261,CPT,Facility,Outpatient,,,,235,199.75,67.351,235,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),118.6045,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; 0.6 To 1.0 Cm",,17261,CPT,Facility,Inpatient,,,,235,199.75,67.351,235,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; 0.6 To 1.0 Cm",,17261,CPT,Facility,Both,,,,235,199.75,67.351,235,UnitedHealthcare,Individual & Family,220.9,94,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; 0.6 To 1.0 Cm",,17261,CPT,Facility,Outpatient,,,,235,199.75,67.351,235,UnitedHealthcare,Medicare Advantage,115.15,49,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; 0.6 To 1.0 Cm",,17261,CPT,Facility,Inpatient,,,,235,199.75,67.351,235,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; 0.6 To 1.0 Cm",,17261,CPT,Facility,Outpatient,,,,235,199.75,67.351,235,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,112.8,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; 0.6 To 1.0 Cm",,17261,CPT,Facility,Inpatient,,,,235,199.75,67.351,235,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; 0.6 To 1.0 Cm (Procah)",,17261,CPT,Professional,Both,,,,305,259.25,54.75,305,Aetna,Commercial,259.25,85,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; 0.6 To 1.0 Cm (Procah)",,17261,CPT,Professional,Both,,,,305,259.25,54.75,305,Aetna,Medicare Advantage,85.53,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; 0.6 To 1.0 Cm (Procah)",,17261,CPT,Professional,Both,,,,305,259.25,54.75,305,Aetna,PPO,283.65,93,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; 0.6 To 1.0 Cm (Procah)",,17261,CPT,Professional,Both,,,,305,259.25,54.75,305,America's PPO,America's PPO,260.592,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; 0.6 To 1.0 Cm (Procah)",,17261,CPT,Professional,Both,,,,305,259.25,54.75,305,BlueCross BlueShield Minnesota, Federal Employee Program,176.97,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; 0.6 To 1.0 Cm (Procah)",,17261,CPT,Professional,Both,,,,305,259.25,54.75,305,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,179.80152,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; 0.6 To 1.0 Cm (Procah)",,17261,CPT,Professional,Both,,,,305,259.25,54.75,305,BlueCross BlueShield Minnesota,High Value Network Plan,179.80152,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; 0.6 To 1.0 Cm (Procah)",,17261,CPT,Professional,Both,,,,305,259.25,54.75,305,BlueCross BlueShield Minnesota,Medicare Advantage,97.911,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; 0.6 To 1.0 Cm (Procah)",,17261,CPT,Professional,Both,,,,305,259.25,54.75,305,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,179.80152,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; 0.6 To 1.0 Cm (Procah)",,17261,CPT,Professional,Both,,,,305,259.25,54.75,305,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,63.21552,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; 0.6 To 1.0 Cm (Procah)",,17261,CPT,Professional,Both,,,,305,259.25,54.75,305,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),97.911,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; 0.6 To 1.0 Cm (Procah)",,17261,CPT,Professional,Both,,,,305,259.25,54.75,305,CorVel,Worker's Compensation,164.8465989,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; 0.6 To 1.0 Cm (Procah)",,17261,CPT,Professional,Both,,,,305,259.25,54.75,305,First Health Group Corporation,First Health Network,295.85,97,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; 0.6 To 1.0 Cm (Procah)",,17261,CPT,Professional,Both,,,,305,259.25,54.75,305,"Health Partners, Inc.",Commercial,178.48,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; 0.6 To 1.0 Cm (Procah)",,17261,CPT,Professional,Both,,,,305,259.25,54.75,305,"Health Partners, Inc.",Medicare Advantage,97.911,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; 0.6 To 1.0 Cm (Procah)",,17261,CPT,Professional,Both,,,,305,259.25,54.75,305,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),85.06,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; 0.6 To 1.0 Cm (Procah)",,17261,CPT,Professional,Both,,,,305,259.25,54.75,305,"Health Partners, Inc.",State of Minnesota Advantage Program,153.76052,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; 0.6 To 1.0 Cm (Procah)",,17261,CPT,Professional,Both,,,,305,259.25,54.75,305,"Health Partners, Inc.",State Public Programs,54.75,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; 0.6 To 1.0 Cm (Procah)",,17261,CPT,Professional,Both,,,,305,259.25,54.75,305,Humana Insurance Company,Commercial PPO,85.14,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; 0.6 To 1.0 Cm (Procah)",,17261,CPT,Professional,Both,,,,305,259.25,54.75,305,Humana Insurance Company,Medicare PPO,305,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; 0.6 To 1.0 Cm (Procah)",,17261,CPT,Professional,Both,,,,305,259.25,54.75,305,Medica,Individual & Family,258.64,84.8,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; 0.6 To 1.0 Cm (Procah)",,17261,CPT,Professional,Both,,,,305,259.25,54.75,305,Medica,Medica Advantage Solution,151.89,49.8,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; 0.6 To 1.0 Cm (Procah)",,17261,CPT,Professional,Both,,,,305,259.25,54.75,305,Medica,Medical Assistance,63.22,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; 0.6 To 1.0 Cm (Procah)",,17261,CPT,Professional,Both,,,,305,259.25,54.75,305,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,85.14,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; 0.6 To 1.0 Cm (Procah)",,17261,CPT,Professional,Both,,,,305,259.25,54.75,305,"Multiplan, Inc.","Multiplan, Inc.",286.7,94,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; 0.6 To 1.0 Cm (Procah)",,17261,CPT,Professional,Both,,,,305,259.25,54.75,305,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,274.805,90.1,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; 0.6 To 1.0 Cm (Procah)",,17261,CPT,Professional,Both,,,,305,259.25,54.75,305,"Preferred One Administrative Services, INC.",PPO,300.73,98.6,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; 0.6 To 1.0 Cm (Procah)",,17261,CPT,Professional,Both,,,,305,259.25,54.75,305,PrimeWest Health,Minnesota Senior Health Options (MSHO),97.911,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; 0.6 To 1.0 Cm (Procah)",,17261,CPT,Professional,Both,,,,305,259.25,54.75,305,PrimeWest Health,MinnesotaCare,67.6406064,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; 0.6 To 1.0 Cm (Procah)",,17261,CPT,Professional,Both,,,,305,259.25,54.75,305,Sanford Health Plan,Sanford Health Plan,268.4,88,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; 0.6 To 1.0 Cm (Procah)",,17261,CPT,Professional,Both,,,,305,259.25,54.75,305,"UCare Health, Inc.",Individual & Family Plan,138.403584,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; 0.6 To 1.0 Cm (Procah)",,17261,CPT,Professional,Both,,,,305,259.25,54.75,305,"UCare Health, Inc.",Medical Assistance,69.537072,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; 0.6 To 1.0 Cm (Procah)",,17261,CPT,Professional,Both,,,,305,259.25,54.75,305,"UCare Health, Inc.",Medicare Advantage,97.911,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; 0.6 To 1.0 Cm (Procah)",,17261,CPT,Professional,Both,,,,305,259.25,54.75,305,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),78.3288,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; 0.6 To 1.0 Cm (Procah)",,17261,CPT,Professional,Both,,,,305,259.25,54.75,305,UnitedHealthcare,Individual & Family,305,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; 0.6 To 1.0 Cm (Procah)",,17261,CPT,Professional,Both,,,,305,259.25,54.75,305,UnitedHealthcare,Medicare Advantage,97.911,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; 0.6 To 1.0 Cm (Procah)",,17261,CPT,Professional,Both,,,,305,259.25,54.75,305,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,63.21552,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 1.1 To 2.0 Cm",,17262,CPT,Facility,Both,,,,281,238.85,80.5346,281,Aetna,Commercial,258.52,92,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 1.1 To 2.0 Cm",,17262,CPT,Facility,Outpatient,,,,281,238.85,80.5346,281,Aetna,Medicare Advantage,137.69,49,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 1.1 To 2.0 Cm",,17262,CPT,Facility,Inpatient,,,,281,238.85,80.5346,281,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 1.1 To 2.0 Cm",,17262,CPT,Facility,Both,,,,281,238.85,80.5346,281,Aetna,PPO,261.33,93,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 1.1 To 2.0 Cm",,17262,CPT,Facility,Both,,,,281,238.85,80.5346,281,America's PPO,America's PPO,269.8443,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 1.1 To 2.0 Cm",,17262,CPT,Facility,Both,,,,281,238.85,80.5346,281,BlueCross BlueShield Minnesota, Federal Employee Program,276.504,98.4,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 1.1 To 2.0 Cm",,17262,CPT,Facility,Both,,,,281,238.85,80.5346,281,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,281,100,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 1.1 To 2.0 Cm",,17262,CPT,Facility,Both,,,,281,238.85,80.5346,281,BlueCross BlueShield Minnesota,High Value Network Plan,252.9,90,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 1.1 To 2.0 Cm",,17262,CPT,Facility,Outpatient,,,,281,238.85,80.5346,281,BlueCross BlueShield Minnesota,Medicare Advantage,137.69,49,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 1.1 To 2.0 Cm",,17262,CPT,Facility,Inpatient,,,,281,238.85,80.5346,281,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 1.1 To 2.0 Cm",,17262,CPT,Facility,Both,,,,281,238.85,80.5346,281,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,248.8817,88.57,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 1.1 To 2.0 Cm",,17262,CPT,Facility,Both,,,,281,238.85,80.5346,281,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,80.5346,28.66,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 1.1 To 2.0 Cm",,17262,CPT,Facility,Outpatient,,,,281,238.85,80.5346,281,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),137.69,49,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 1.1 To 2.0 Cm",,17262,CPT,Facility,Inpatient,,,,281,238.85,80.5346,281,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 1.1 To 2.0 Cm",,17262,CPT,Facility,Both,,,,281,238.85,80.5346,281,CorVel,Worker's Compensation,281,100,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 1.1 To 2.0 Cm",,17262,CPT,Facility,Both,,,,281,238.85,80.5346,281,First Health Group Corporation,First Health Network,272.57,97,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 1.1 To 2.0 Cm",,17262,CPT,Facility,Both,,,,281,238.85,80.5346,281,"Health Partners, Inc.",Commercial,265.826,94.6,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 1.1 To 2.0 Cm",,17262,CPT,Facility,Outpatient,,,,281,238.85,80.5346,281,"Health Partners, Inc.",Medicare Advantage,137.69,49,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 1.1 To 2.0 Cm",,17262,CPT,Facility,Inpatient,,,,281,238.85,80.5346,281,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 1.1 To 2.0 Cm",,17262,CPT,Facility,Both,,,,281,238.85,80.5346,281,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),168.6,60,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 1.1 To 2.0 Cm",,17262,CPT,Facility,Both,,,,281,238.85,80.5346,281,"Health Partners, Inc.",State of Minnesota Advantage Program,229.015,81.5,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 1.1 To 2.0 Cm",,17262,CPT,Facility,Both,,,,281,238.85,80.5346,281,"Health Partners, Inc.",State Public Programs,140.5,50,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 1.1 To 2.0 Cm",,17262,CPT,Facility,Both,,,,281,238.85,80.5346,281,Humana Insurance Company,Commercial PPO,266.95,95,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 1.1 To 2.0 Cm",,17262,CPT,Facility,Outpatient,,,,281,238.85,80.5346,281,Humana Insurance Company,Medicare PPO,137.69,49,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 1.1 To 2.0 Cm",,17262,CPT,Facility,Inpatient,,,,281,238.85,80.5346,281,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 1.1 To 2.0 Cm",,17262,CPT,Facility,Both,,,,281,238.85,80.5346,281,Medica,Individual & Family,278.471,99.1,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 1.1 To 2.0 Cm",,17262,CPT,Facility,Outpatient,,,,281,238.85,80.5346,281,Medica,Medica Advantage Solution,139.938,49.8,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 1.1 To 2.0 Cm",,17262,CPT,Facility,Inpatient,,,,281,238.85,80.5346,281,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 1.1 To 2.0 Cm",,17262,CPT,Facility,Outpatient,,,,281,238.85,80.5346,281,Medica,Medical Assistance,125.326,44.6,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 1.1 To 2.0 Cm",,17262,CPT,Facility,Inpatient,,,,281,238.85,80.5346,281,Medica,Medical Assistance,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 1.1 To 2.0 Cm",,17262,CPT,Facility,Outpatient,,,,281,238.85,80.5346,281,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,139.938,49.8,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 1.1 To 2.0 Cm",,17262,CPT,Facility,Inpatient,,,,281,238.85,80.5346,281,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 1.1 To 2.0 Cm",,17262,CPT,Facility,Both,,,,281,238.85,80.5346,281,"Multiplan, Inc.","Multiplan, Inc.",264.14,94,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 1.1 To 2.0 Cm",,17262,CPT,Facility,Outpatient,,,,281,238.85,80.5346,281,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,253.181,90.1,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 1.1 To 2.0 Cm",,17262,CPT,Facility,Inpatient,,,,281,238.85,80.5346,281,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 1.1 To 2.0 Cm",,17262,CPT,Facility,Both,,,,281,238.85,80.5346,281,"Preferred One Administrative Services, INC.",PPO,277.066,98.6,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 1.1 To 2.0 Cm",,17262,CPT,Facility,Outpatient,,,,281,238.85,80.5346,281,PrimeWest Health,Minnesota Senior Health Options (MSHO),144.5745,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 1.1 To 2.0 Cm",,17262,CPT,Facility,Inpatient,,,,281,238.85,80.5346,281,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 1.1 To 2.0 Cm",,17262,CPT,Facility,Outpatient,,,,281,238.85,80.5346,281,PrimeWest Health,MinnesotaCare,144.3216,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 1.1 To 2.0 Cm",,17262,CPT,Facility,Inpatient,,,,281,238.85,80.5346,281,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 1.1 To 2.0 Cm",,17262,CPT,Facility,Both,,,,281,238.85,80.5346,281,Sanford Health Plan,Sanford Health Plan,258.52,92,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 1.1 To 2.0 Cm",,17262,CPT,Facility,Outpatient,,,,281,238.85,80.5346,281,"UCare Health, Inc.",Individual & Family Plan,158.3435,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 1.1 To 2.0 Cm",,17262,CPT,Facility,Inpatient,,,,281,238.85,80.5346,281,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 1.1 To 2.0 Cm",,17262,CPT,Facility,Outpatient,,,,281,238.85,80.5346,281,"UCare Health, Inc.",Medical Assistance,141.8207,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 1.1 To 2.0 Cm",,17262,CPT,Facility,Inpatient,,,,281,238.85,80.5346,281,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 1.1 To 2.0 Cm",,17262,CPT,Facility,Outpatient,,,,281,238.85,80.5346,281,"UCare Health, Inc.",Medicare Advantage,141.8207,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 1.1 To 2.0 Cm",,17262,CPT,Facility,Inpatient,,,,281,238.85,80.5346,281,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 1.1 To 2.0 Cm",,17262,CPT,Facility,Outpatient,,,,281,238.85,80.5346,281,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),141.8207,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 1.1 To 2.0 Cm",,17262,CPT,Facility,Inpatient,,,,281,238.85,80.5346,281,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 1.1 To 2.0 Cm",,17262,CPT,Facility,Both,,,,281,238.85,80.5346,281,UnitedHealthcare,Individual & Family,264.14,94,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 1.1 To 2.0 Cm",,17262,CPT,Facility,Outpatient,,,,281,238.85,80.5346,281,UnitedHealthcare,Medicare Advantage,137.69,49,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 1.1 To 2.0 Cm",,17262,CPT,Facility,Inpatient,,,,281,238.85,80.5346,281,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 1.1 To 2.0 Cm",,17262,CPT,Facility,Outpatient,,,,281,238.85,80.5346,281,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,134.88,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 1.1 To 2.0 Cm",,17262,CPT,Facility,Inpatient,,,,281,238.85,80.5346,281,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 1.1 To 2.0 Cm (Pro Cah)",,17262,CPT,Professional,Both,,,,355,301.75,69.37,355,Aetna,Commercial,301.75,85,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 1.1 To 2.0 Cm (Pro Cah)",,17262,CPT,Professional,Both,,,,355,301.75,69.37,355,Aetna,Medicare Advantage,108.21,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 1.1 To 2.0 Cm (Pro Cah)",,17262,CPT,Professional,Both,,,,355,301.75,69.37,355,Aetna,PPO,330.15,93,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 1.1 To 2.0 Cm (Pro Cah)",,17262,CPT,Professional,Both,,,,355,301.75,69.37,355,America's PPO,America's PPO,303.312,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 1.1 To 2.0 Cm (Pro Cah)",,17262,CPT,Professional,Both,,,,355,301.75,69.37,355,BlueCross BlueShield Minnesota, Federal Employee Program,225.86,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 1.1 To 2.0 Cm (Pro Cah)",,17262,CPT,Professional,Both,,,,355,301.75,69.37,355,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,229.47376,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 1.1 To 2.0 Cm (Pro Cah)",,17262,CPT,Professional,Both,,,,355,301.75,69.37,355,BlueCross BlueShield Minnesota,High Value Network Plan,229.47376,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 1.1 To 2.0 Cm (Pro Cah)",,17262,CPT,Professional,Both,,,,355,301.75,69.37,355,BlueCross BlueShield Minnesota,Medicare Advantage,124.1885,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 1.1 To 2.0 Cm (Pro Cah)",,17262,CPT,Professional,Both,,,,355,301.75,69.37,355,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,229.47376,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 1.1 To 2.0 Cm (Pro Cah)",,17262,CPT,Professional,Both,,,,355,301.75,69.37,355,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,80.09128,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 1.1 To 2.0 Cm (Pro Cah)",,17262,CPT,Professional,Both,,,,355,301.75,69.37,355,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),124.1885,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 1.1 To 2.0 Cm (Pro Cah)",,17262,CPT,Professional,Both,,,,355,301.75,69.37,355,CorVel,Worker's Compensation,208.7784657,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 1.1 To 2.0 Cm (Pro Cah)",,17262,CPT,Professional,Both,,,,355,301.75,69.37,355,First Health Group Corporation,First Health Network,344.35,97,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 1.1 To 2.0 Cm (Pro Cah)",,17262,CPT,Professional,Both,,,,355,301.75,69.37,355,"Health Partners, Inc.",Commercial,225.64,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 1.1 To 2.0 Cm (Pro Cah)",,17262,CPT,Professional,Both,,,,355,301.75,69.37,355,"Health Partners, Inc.",Medicare Advantage,124.1885,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 1.1 To 2.0 Cm (Pro Cah)",,17262,CPT,Professional,Both,,,,355,301.75,69.37,355,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),108.1,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 1.1 To 2.0 Cm (Pro Cah)",,17262,CPT,Professional,Both,,,,355,301.75,69.37,355,"Health Partners, Inc.",State of Minnesota Advantage Program,194.38886,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 1.1 To 2.0 Cm (Pro Cah)",,17262,CPT,Professional,Both,,,,355,301.75,69.37,355,"Health Partners, Inc.",State Public Programs,69.37,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 1.1 To 2.0 Cm (Pro Cah)",,17262,CPT,Professional,Both,,,,355,301.75,69.37,355,Humana Insurance Company,Commercial PPO,107.99,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 1.1 To 2.0 Cm (Pro Cah)",,17262,CPT,Professional,Both,,,,355,301.75,69.37,355,Humana Insurance Company,Medicare PPO,355,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 1.1 To 2.0 Cm (Pro Cah)",,17262,CPT,Professional,Both,,,,355,301.75,69.37,355,Medica,Individual & Family,301.04,84.8,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 1.1 To 2.0 Cm (Pro Cah)",,17262,CPT,Professional,Both,,,,355,301.75,69.37,355,Medica,Medica Advantage Solution,176.79,49.8,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 1.1 To 2.0 Cm (Pro Cah)",,17262,CPT,Professional,Both,,,,355,301.75,69.37,355,Medica,Medical Assistance,80.09,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 1.1 To 2.0 Cm (Pro Cah)",,17262,CPT,Professional,Both,,,,355,301.75,69.37,355,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,107.99,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 1.1 To 2.0 Cm (Pro Cah)",,17262,CPT,Professional,Both,,,,355,301.75,69.37,355,"Multiplan, Inc.","Multiplan, Inc.",333.7,94,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 1.1 To 2.0 Cm (Pro Cah)",,17262,CPT,Professional,Both,,,,355,301.75,69.37,355,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,319.855,90.1,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 1.1 To 2.0 Cm (Pro Cah)",,17262,CPT,Professional,Both,,,,355,301.75,69.37,355,"Preferred One Administrative Services, INC.",PPO,350.03,98.6,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 1.1 To 2.0 Cm (Pro Cah)",,17262,CPT,Professional,Both,,,,355,301.75,69.37,355,PrimeWest Health,Minnesota Senior Health Options (MSHO),124.1885,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 1.1 To 2.0 Cm (Pro Cah)",,17262,CPT,Professional,Both,,,,355,301.75,69.37,355,PrimeWest Health,MinnesotaCare,85.6976696,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 1.1 To 2.0 Cm (Pro Cah)",,17262,CPT,Professional,Both,,,,355,301.75,69.37,355,Sanford Health Plan,Sanford Health Plan,312.4,88,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 1.1 To 2.0 Cm (Pro Cah)",,17262,CPT,Professional,Both,,,,355,301.75,69.37,355,"UCare Health, Inc.",Individual & Family Plan,175.548544,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 1.1 To 2.0 Cm (Pro Cah)",,17262,CPT,Professional,Both,,,,355,301.75,69.37,355,"UCare Health, Inc.",Medical Assistance,88.100408,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 1.1 To 2.0 Cm (Pro Cah)",,17262,CPT,Professional,Both,,,,355,301.75,69.37,355,"UCare Health, Inc.",Medicare Advantage,124.1885,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 1.1 To 2.0 Cm (Pro Cah)",,17262,CPT,Professional,Both,,,,355,301.75,69.37,355,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),99.3508,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 1.1 To 2.0 Cm (Pro Cah)",,17262,CPT,Professional,Both,,,,355,301.75,69.37,355,UnitedHealthcare,Individual & Family,355,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 1.1 To 2.0 Cm (Pro Cah)",,17262,CPT,Professional,Both,,,,355,301.75,69.37,355,UnitedHealthcare,Medicare Advantage,124.1885,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 1.1 To 2.0 Cm (Pro Cah)",,17262,CPT,Professional,Both,,,,355,301.75,69.37,355,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,80.09128,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 2.1 To 3.0 Cm",,17263,CPT,Facility,Both,,,,321,272.85,91.9986,321,Aetna,Commercial,295.32,92,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 2.1 To 3.0 Cm",,17263,CPT,Facility,Outpatient,,,,321,272.85,91.9986,321,Aetna,Medicare Advantage,157.29,49,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 2.1 To 3.0 Cm",,17263,CPT,Facility,Inpatient,,,,321,272.85,91.9986,321,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 2.1 To 3.0 Cm",,17263,CPT,Facility,Both,,,,321,272.85,91.9986,321,Aetna,PPO,298.53,93,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 2.1 To 3.0 Cm",,17263,CPT,Facility,Both,,,,321,272.85,91.9986,321,America's PPO,America's PPO,308.2563,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 2.1 To 3.0 Cm",,17263,CPT,Facility,Both,,,,321,272.85,91.9986,321,BlueCross BlueShield Minnesota, Federal Employee Program,315.864,98.4,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 2.1 To 3.0 Cm",,17263,CPT,Facility,Both,,,,321,272.85,91.9986,321,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,321,100,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 2.1 To 3.0 Cm",,17263,CPT,Facility,Both,,,,321,272.85,91.9986,321,BlueCross BlueShield Minnesota,High Value Network Plan,288.9,90,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 2.1 To 3.0 Cm",,17263,CPT,Facility,Outpatient,,,,321,272.85,91.9986,321,BlueCross BlueShield Minnesota,Medicare Advantage,157.29,49,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 2.1 To 3.0 Cm",,17263,CPT,Facility,Inpatient,,,,321,272.85,91.9986,321,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 2.1 To 3.0 Cm",,17263,CPT,Facility,Both,,,,321,272.85,91.9986,321,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,284.3097,88.57,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 2.1 To 3.0 Cm",,17263,CPT,Facility,Both,,,,321,272.85,91.9986,321,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,91.9986,28.66,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 2.1 To 3.0 Cm",,17263,CPT,Facility,Outpatient,,,,321,272.85,91.9986,321,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),157.29,49,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 2.1 To 3.0 Cm",,17263,CPT,Facility,Inpatient,,,,321,272.85,91.9986,321,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 2.1 To 3.0 Cm",,17263,CPT,Facility,Both,,,,321,272.85,91.9986,321,CorVel,Worker's Compensation,321,100,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 2.1 To 3.0 Cm",,17263,CPT,Facility,Both,,,,321,272.85,91.9986,321,First Health Group Corporation,First Health Network,311.37,97,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 2.1 To 3.0 Cm",,17263,CPT,Facility,Both,,,,321,272.85,91.9986,321,"Health Partners, Inc.",Commercial,303.666,94.6,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 2.1 To 3.0 Cm",,17263,CPT,Facility,Outpatient,,,,321,272.85,91.9986,321,"Health Partners, Inc.",Medicare Advantage,157.29,49,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 2.1 To 3.0 Cm",,17263,CPT,Facility,Inpatient,,,,321,272.85,91.9986,321,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 2.1 To 3.0 Cm",,17263,CPT,Facility,Both,,,,321,272.85,91.9986,321,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),192.6,60,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 2.1 To 3.0 Cm",,17263,CPT,Facility,Both,,,,321,272.85,91.9986,321,"Health Partners, Inc.",State of Minnesota Advantage Program,261.615,81.5,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 2.1 To 3.0 Cm",,17263,CPT,Facility,Both,,,,321,272.85,91.9986,321,"Health Partners, Inc.",State Public Programs,160.5,50,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 2.1 To 3.0 Cm",,17263,CPT,Facility,Both,,,,321,272.85,91.9986,321,Humana Insurance Company,Commercial PPO,304.95,95,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 2.1 To 3.0 Cm",,17263,CPT,Facility,Outpatient,,,,321,272.85,91.9986,321,Humana Insurance Company,Medicare PPO,157.29,49,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 2.1 To 3.0 Cm",,17263,CPT,Facility,Inpatient,,,,321,272.85,91.9986,321,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 2.1 To 3.0 Cm",,17263,CPT,Facility,Both,,,,321,272.85,91.9986,321,Medica,Individual & Family,318.111,99.1,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 2.1 To 3.0 Cm",,17263,CPT,Facility,Outpatient,,,,321,272.85,91.9986,321,Medica,Medica Advantage Solution,159.858,49.8,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 2.1 To 3.0 Cm",,17263,CPT,Facility,Inpatient,,,,321,272.85,91.9986,321,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 2.1 To 3.0 Cm",,17263,CPT,Facility,Outpatient,,,,321,272.85,91.9986,321,Medica,Medical Assistance,143.166,44.6,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 2.1 To 3.0 Cm",,17263,CPT,Facility,Inpatient,,,,321,272.85,91.9986,321,Medica,Medical Assistance,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 2.1 To 3.0 Cm",,17263,CPT,Facility,Outpatient,,,,321,272.85,91.9986,321,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,159.858,49.8,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 2.1 To 3.0 Cm",,17263,CPT,Facility,Inpatient,,,,321,272.85,91.9986,321,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 2.1 To 3.0 Cm",,17263,CPT,Facility,Both,,,,321,272.85,91.9986,321,"Multiplan, Inc.","Multiplan, Inc.",301.74,94,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 2.1 To 3.0 Cm",,17263,CPT,Facility,Outpatient,,,,321,272.85,91.9986,321,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,289.221,90.1,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 2.1 To 3.0 Cm",,17263,CPT,Facility,Inpatient,,,,321,272.85,91.9986,321,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 2.1 To 3.0 Cm",,17263,CPT,Facility,Both,,,,321,272.85,91.9986,321,"Preferred One Administrative Services, INC.",PPO,316.506,98.6,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 2.1 To 3.0 Cm",,17263,CPT,Facility,Outpatient,,,,321,272.85,91.9986,321,PrimeWest Health,Minnesota Senior Health Options (MSHO),165.1545,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 2.1 To 3.0 Cm",,17263,CPT,Facility,Inpatient,,,,321,272.85,91.9986,321,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 2.1 To 3.0 Cm",,17263,CPT,Facility,Outpatient,,,,321,272.85,91.9986,321,PrimeWest Health,MinnesotaCare,164.8656,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 2.1 To 3.0 Cm",,17263,CPT,Facility,Inpatient,,,,321,272.85,91.9986,321,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 2.1 To 3.0 Cm",,17263,CPT,Facility,Both,,,,321,272.85,91.9986,321,Sanford Health Plan,Sanford Health Plan,295.32,92,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 2.1 To 3.0 Cm",,17263,CPT,Facility,Outpatient,,,,321,272.85,91.9986,321,"UCare Health, Inc.",Individual & Family Plan,180.8835,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 2.1 To 3.0 Cm",,17263,CPT,Facility,Inpatient,,,,321,272.85,91.9986,321,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 2.1 To 3.0 Cm",,17263,CPT,Facility,Outpatient,,,,321,272.85,91.9986,321,"UCare Health, Inc.",Medical Assistance,162.0087,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 2.1 To 3.0 Cm",,17263,CPT,Facility,Inpatient,,,,321,272.85,91.9986,321,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 2.1 To 3.0 Cm",,17263,CPT,Facility,Outpatient,,,,321,272.85,91.9986,321,"UCare Health, Inc.",Medicare Advantage,162.0087,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 2.1 To 3.0 Cm",,17263,CPT,Facility,Inpatient,,,,321,272.85,91.9986,321,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 2.1 To 3.0 Cm",,17263,CPT,Facility,Outpatient,,,,321,272.85,91.9986,321,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),162.0087,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 2.1 To 3.0 Cm",,17263,CPT,Facility,Inpatient,,,,321,272.85,91.9986,321,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 2.1 To 3.0 Cm",,17263,CPT,Facility,Both,,,,321,272.85,91.9986,321,UnitedHealthcare,Individual & Family,301.74,94,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 2.1 To 3.0 Cm",,17263,CPT,Facility,Outpatient,,,,321,272.85,91.9986,321,UnitedHealthcare,Medicare Advantage,157.29,49,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 2.1 To 3.0 Cm",,17263,CPT,Facility,Inpatient,,,,321,272.85,91.9986,321,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 2.1 To 3.0 Cm",,17263,CPT,Facility,Outpatient,,,,321,272.85,91.9986,321,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,154.08,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 2.1 To 3.0 Cm",,17263,CPT,Facility,Inpatient,,,,321,272.85,91.9986,321,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 2.1 To 3.0 Cm (Pro Cah)",,17263,CPT,Professional,Both,,,,390,331.5,76.79,390,Aetna,Commercial,331.5,85,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 2.1 To 3.0 Cm (Pro Cah)",,17263,CPT,Professional,Both,,,,390,331.5,76.79,390,Aetna,Medicare Advantage,120.02,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 2.1 To 3.0 Cm (Pro Cah)",,17263,CPT,Professional,Both,,,,390,331.5,76.79,390,Aetna,PPO,362.7,93,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 2.1 To 3.0 Cm (Pro Cah)",,17263,CPT,Professional,Both,,,,390,331.5,76.79,390,America's PPO,America's PPO,333.216,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 2.1 To 3.0 Cm (Pro Cah)",,17263,CPT,Professional,Both,,,,390,331.5,76.79,390,BlueCross BlueShield Minnesota, Federal Employee Program,249.27,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 2.1 To 3.0 Cm (Pro Cah)",,17263,CPT,Professional,Both,,,,390,331.5,76.79,390,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,253.25832,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 2.1 To 3.0 Cm (Pro Cah)",,17263,CPT,Professional,Both,,,,390,331.5,76.79,390,BlueCross BlueShield Minnesota,High Value Network Plan,253.25832,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 2.1 To 3.0 Cm (Pro Cah)",,17263,CPT,Professional,Both,,,,390,331.5,76.79,390,BlueCross BlueShield Minnesota,Medicare Advantage,137.264,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 2.1 To 3.0 Cm (Pro Cah)",,17263,CPT,Professional,Both,,,,390,331.5,76.79,390,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,253.25832,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 2.1 To 3.0 Cm (Pro Cah)",,17263,CPT,Professional,Both,,,,390,331.5,76.79,390,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,88.65616,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 2.1 To 3.0 Cm (Pro Cah)",,17263,CPT,Professional,Both,,,,390,331.5,76.79,390,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),137.264,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 2.1 To 3.0 Cm (Pro Cah)",,17263,CPT,Professional,Both,,,,390,331.5,76.79,390,CorVel,Worker's Compensation,231.5235711,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 2.1 To 3.0 Cm (Pro Cah)",,17263,CPT,Professional,Both,,,,390,331.5,76.79,390,First Health Group Corporation,First Health Network,378.3,97,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 2.1 To 3.0 Cm (Pro Cah)",,17263,CPT,Professional,Both,,,,390,331.5,76.79,390,"Health Partners, Inc.",Commercial,250.3,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 2.1 To 3.0 Cm (Pro Cah)",,17263,CPT,Professional,Both,,,,390,331.5,76.79,390,"Health Partners, Inc.",Medicare Advantage,137.264,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 2.1 To 3.0 Cm (Pro Cah)",,17263,CPT,Professional,Both,,,,390,331.5,76.79,390,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),119.28,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 2.1 To 3.0 Cm (Pro Cah)",,17263,CPT,Professional,Both,,,,390,331.5,76.79,390,"Health Partners, Inc.",State of Minnesota Advantage Program,215.63345,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 2.1 To 3.0 Cm (Pro Cah)",,17263,CPT,Professional,Both,,,,390,331.5,76.79,390,"Health Partners, Inc.",State Public Programs,76.79,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 2.1 To 3.0 Cm (Pro Cah)",,17263,CPT,Professional,Both,,,,390,331.5,76.79,390,Humana Insurance Company,Commercial PPO,119.36,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 2.1 To 3.0 Cm (Pro Cah)",,17263,CPT,Professional,Both,,,,390,331.5,76.79,390,Humana Insurance Company,Medicare PPO,390,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 2.1 To 3.0 Cm (Pro Cah)",,17263,CPT,Professional,Both,,,,390,331.5,76.79,390,Medica,Individual & Family,330.72,84.8,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 2.1 To 3.0 Cm (Pro Cah)",,17263,CPT,Professional,Both,,,,390,331.5,76.79,390,Medica,Medica Advantage Solution,194.22,49.8,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 2.1 To 3.0 Cm (Pro Cah)",,17263,CPT,Professional,Both,,,,390,331.5,76.79,390,Medica,Medical Assistance,88.66,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 2.1 To 3.0 Cm (Pro Cah)",,17263,CPT,Professional,Both,,,,390,331.5,76.79,390,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,119.36,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 2.1 To 3.0 Cm (Pro Cah)",,17263,CPT,Professional,Both,,,,390,331.5,76.79,390,"Multiplan, Inc.","Multiplan, Inc.",366.6,94,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 2.1 To 3.0 Cm (Pro Cah)",,17263,CPT,Professional,Both,,,,390,331.5,76.79,390,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,351.39,90.1,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 2.1 To 3.0 Cm (Pro Cah)",,17263,CPT,Professional,Both,,,,390,331.5,76.79,390,"Preferred One Administrative Services, INC.",PPO,384.54,98.6,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 2.1 To 3.0 Cm (Pro Cah)",,17263,CPT,Professional,Both,,,,390,331.5,76.79,390,PrimeWest Health,Minnesota Senior Health Options (MSHO),137.264,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 2.1 To 3.0 Cm (Pro Cah)",,17263,CPT,Professional,Both,,,,390,331.5,76.79,390,PrimeWest Health,MinnesotaCare,94.8620912,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 2.1 To 3.0 Cm (Pro Cah)",,17263,CPT,Professional,Both,,,,390,331.5,76.79,390,Sanford Health Plan,Sanford Health Plan,343.2,88,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 2.1 To 3.0 Cm (Pro Cah)",,17263,CPT,Professional,Both,,,,390,331.5,76.79,390,"UCare Health, Inc.",Individual & Family Plan,194.031616,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 2.1 To 3.0 Cm (Pro Cah)",,17263,CPT,Professional,Both,,,,390,331.5,76.79,390,"UCare Health, Inc.",Medical Assistance,97.521776,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 2.1 To 3.0 Cm (Pro Cah)",,17263,CPT,Professional,Both,,,,390,331.5,76.79,390,"UCare Health, Inc.",Medicare Advantage,137.264,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 2.1 To 3.0 Cm (Pro Cah)",,17263,CPT,Professional,Both,,,,390,331.5,76.79,390,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),109.8112,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 2.1 To 3.0 Cm (Pro Cah)",,17263,CPT,Professional,Both,,,,390,331.5,76.79,390,UnitedHealthcare,Individual & Family,390,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 2.1 To 3.0 Cm (Pro Cah)",,17263,CPT,Professional,Both,,,,390,331.5,76.79,390,UnitedHealthcare,Medicare Advantage,137.264,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 2.1 To 3.0 Cm (Pro Cah)",,17263,CPT,Professional,Both,,,,390,331.5,76.79,390,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,88.65616,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 3.1 To 4.0 Cm",,17264,CPT,Facility,Both,,,,367,311.95,105.1822,367,Aetna,Commercial,337.64,92,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 3.1 To 4.0 Cm",,17264,CPT,Facility,Outpatient,,,,367,311.95,105.1822,367,Aetna,Medicare Advantage,179.83,49,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 3.1 To 4.0 Cm",,17264,CPT,Facility,Inpatient,,,,367,311.95,105.1822,367,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 3.1 To 4.0 Cm",,17264,CPT,Facility,Both,,,,367,311.95,105.1822,367,Aetna,PPO,341.31,93,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 3.1 To 4.0 Cm",,17264,CPT,Facility,Both,,,,367,311.95,105.1822,367,America's PPO,America's PPO,352.4301,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 3.1 To 4.0 Cm",,17264,CPT,Facility,Both,,,,367,311.95,105.1822,367,BlueCross BlueShield Minnesota, Federal Employee Program,361.128,98.4,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 3.1 To 4.0 Cm",,17264,CPT,Facility,Both,,,,367,311.95,105.1822,367,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,367,100,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 3.1 To 4.0 Cm",,17264,CPT,Facility,Both,,,,367,311.95,105.1822,367,BlueCross BlueShield Minnesota,High Value Network Plan,330.3,90,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 3.1 To 4.0 Cm",,17264,CPT,Facility,Outpatient,,,,367,311.95,105.1822,367,BlueCross BlueShield Minnesota,Medicare Advantage,179.83,49,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 3.1 To 4.0 Cm",,17264,CPT,Facility,Inpatient,,,,367,311.95,105.1822,367,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 3.1 To 4.0 Cm",,17264,CPT,Facility,Both,,,,367,311.95,105.1822,367,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,325.0519,88.57,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 3.1 To 4.0 Cm",,17264,CPT,Facility,Both,,,,367,311.95,105.1822,367,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,105.1822,28.66,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 3.1 To 4.0 Cm",,17264,CPT,Facility,Outpatient,,,,367,311.95,105.1822,367,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),179.83,49,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 3.1 To 4.0 Cm",,17264,CPT,Facility,Inpatient,,,,367,311.95,105.1822,367,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 3.1 To 4.0 Cm",,17264,CPT,Facility,Both,,,,367,311.95,105.1822,367,CorVel,Worker's Compensation,367,100,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 3.1 To 4.0 Cm",,17264,CPT,Facility,Both,,,,367,311.95,105.1822,367,First Health Group Corporation,First Health Network,355.99,97,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 3.1 To 4.0 Cm",,17264,CPT,Facility,Both,,,,367,311.95,105.1822,367,"Health Partners, Inc.",Commercial,347.182,94.6,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 3.1 To 4.0 Cm",,17264,CPT,Facility,Outpatient,,,,367,311.95,105.1822,367,"Health Partners, Inc.",Medicare Advantage,179.83,49,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 3.1 To 4.0 Cm",,17264,CPT,Facility,Inpatient,,,,367,311.95,105.1822,367,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 3.1 To 4.0 Cm",,17264,CPT,Facility,Both,,,,367,311.95,105.1822,367,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),220.2,60,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 3.1 To 4.0 Cm",,17264,CPT,Facility,Both,,,,367,311.95,105.1822,367,"Health Partners, Inc.",State of Minnesota Advantage Program,299.105,81.5,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 3.1 To 4.0 Cm",,17264,CPT,Facility,Both,,,,367,311.95,105.1822,367,"Health Partners, Inc.",State Public Programs,183.5,50,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 3.1 To 4.0 Cm",,17264,CPT,Facility,Both,,,,367,311.95,105.1822,367,Humana Insurance Company,Commercial PPO,348.65,95,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 3.1 To 4.0 Cm",,17264,CPT,Facility,Outpatient,,,,367,311.95,105.1822,367,Humana Insurance Company,Medicare PPO,179.83,49,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 3.1 To 4.0 Cm",,17264,CPT,Facility,Inpatient,,,,367,311.95,105.1822,367,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 3.1 To 4.0 Cm",,17264,CPT,Facility,Both,,,,367,311.95,105.1822,367,Medica,Individual & Family,363.697,99.1,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 3.1 To 4.0 Cm",,17264,CPT,Facility,Outpatient,,,,367,311.95,105.1822,367,Medica,Medica Advantage Solution,182.766,49.8,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 3.1 To 4.0 Cm",,17264,CPT,Facility,Inpatient,,,,367,311.95,105.1822,367,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 3.1 To 4.0 Cm",,17264,CPT,Facility,Outpatient,,,,367,311.95,105.1822,367,Medica,Medical Assistance,163.682,44.6,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 3.1 To 4.0 Cm",,17264,CPT,Facility,Inpatient,,,,367,311.95,105.1822,367,Medica,Medical Assistance,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 3.1 To 4.0 Cm",,17264,CPT,Facility,Outpatient,,,,367,311.95,105.1822,367,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,182.766,49.8,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 3.1 To 4.0 Cm",,17264,CPT,Facility,Inpatient,,,,367,311.95,105.1822,367,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 3.1 To 4.0 Cm",,17264,CPT,Facility,Both,,,,367,311.95,105.1822,367,"Multiplan, Inc.","Multiplan, Inc.",344.98,94,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 3.1 To 4.0 Cm",,17264,CPT,Facility,Outpatient,,,,367,311.95,105.1822,367,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,330.667,90.1,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 3.1 To 4.0 Cm",,17264,CPT,Facility,Inpatient,,,,367,311.95,105.1822,367,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 3.1 To 4.0 Cm",,17264,CPT,Facility,Both,,,,367,311.95,105.1822,367,"Preferred One Administrative Services, INC.",PPO,361.862,98.6,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 3.1 To 4.0 Cm",,17264,CPT,Facility,Outpatient,,,,367,311.95,105.1822,367,PrimeWest Health,Minnesota Senior Health Options (MSHO),188.8215,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 3.1 To 4.0 Cm",,17264,CPT,Facility,Inpatient,,,,367,311.95,105.1822,367,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 3.1 To 4.0 Cm",,17264,CPT,Facility,Outpatient,,,,367,311.95,105.1822,367,PrimeWest Health,MinnesotaCare,188.4912,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 3.1 To 4.0 Cm",,17264,CPT,Facility,Inpatient,,,,367,311.95,105.1822,367,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 3.1 To 4.0 Cm",,17264,CPT,Facility,Both,,,,367,311.95,105.1822,367,Sanford Health Plan,Sanford Health Plan,337.64,92,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 3.1 To 4.0 Cm",,17264,CPT,Facility,Outpatient,,,,367,311.95,105.1822,367,"UCare Health, Inc.",Individual & Family Plan,206.8045,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 3.1 To 4.0 Cm",,17264,CPT,Facility,Inpatient,,,,367,311.95,105.1822,367,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 3.1 To 4.0 Cm",,17264,CPT,Facility,Outpatient,,,,367,311.95,105.1822,367,"UCare Health, Inc.",Medical Assistance,185.2249,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 3.1 To 4.0 Cm",,17264,CPT,Facility,Inpatient,,,,367,311.95,105.1822,367,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 3.1 To 4.0 Cm",,17264,CPT,Facility,Outpatient,,,,367,311.95,105.1822,367,"UCare Health, Inc.",Medicare Advantage,185.2249,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 3.1 To 4.0 Cm",,17264,CPT,Facility,Inpatient,,,,367,311.95,105.1822,367,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 3.1 To 4.0 Cm",,17264,CPT,Facility,Outpatient,,,,367,311.95,105.1822,367,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),185.2249,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 3.1 To 4.0 Cm",,17264,CPT,Facility,Inpatient,,,,367,311.95,105.1822,367,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 3.1 To 4.0 Cm",,17264,CPT,Facility,Both,,,,367,311.95,105.1822,367,UnitedHealthcare,Individual & Family,344.98,94,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 3.1 To 4.0 Cm",,17264,CPT,Facility,Outpatient,,,,367,311.95,105.1822,367,UnitedHealthcare,Medicare Advantage,179.83,49,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 3.1 To 4.0 Cm",,17264,CPT,Facility,Inpatient,,,,367,311.95,105.1822,367,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 3.1 To 4.0 Cm",,17264,CPT,Facility,Outpatient,,,,367,311.95,105.1822,367,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,176.16,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 3.1 To 4.0 Cm",,17264,CPT,Facility,Inpatient,,,,367,311.95,105.1822,367,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 3.1 To 4.0 Cm (Pro Cah)",,17264,CPT,Professional,Both,,,,420,357,81.8,420,Aetna,Commercial,357,85,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 3.1 To 4.0 Cm (Pro Cah)",,17264,CPT,Professional,Both,,,,420,357,81.8,420,Aetna,Medicare Advantage,128.33,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 3.1 To 4.0 Cm (Pro Cah)",,17264,CPT,Professional,Both,,,,420,357,81.8,420,Aetna,PPO,390.6,93,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 3.1 To 4.0 Cm (Pro Cah)",,17264,CPT,Professional,Both,,,,420,357,81.8,420,America's PPO,America's PPO,358.848,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 3.1 To 4.0 Cm (Pro Cah)",,17264,CPT,Professional,Both,,,,420,357,81.8,420,BlueCross BlueShield Minnesota, Federal Employee Program,265.8,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 3.1 To 4.0 Cm (Pro Cah)",,17264,CPT,Professional,Both,,,,420,357,81.8,420,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,270.0528,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 3.1 To 4.0 Cm (Pro Cah)",,17264,CPT,Professional,Both,,,,420,357,81.8,420,BlueCross BlueShield Minnesota,High Value Network Plan,270.0528,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 3.1 To 4.0 Cm (Pro Cah)",,17264,CPT,Professional,Both,,,,420,357,81.8,420,BlueCross BlueShield Minnesota,Medicare Advantage,146.4065,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 3.1 To 4.0 Cm (Pro Cah)",,17264,CPT,Professional,Both,,,,420,357,81.8,420,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,270.0528,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 3.1 To 4.0 Cm (Pro Cah)",,17264,CPT,Professional,Both,,,,420,357,81.8,420,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,94.44736,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 3.1 To 4.0 Cm (Pro Cah)",,17264,CPT,Professional,Both,,,,420,357,81.8,420,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),146.4065,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 3.1 To 4.0 Cm (Pro Cah)",,17264,CPT,Professional,Both,,,,420,357,81.8,420,CorVel,Worker's Compensation,247.279638,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 3.1 To 4.0 Cm (Pro Cah)",,17264,CPT,Professional,Both,,,,420,357,81.8,420,First Health Group Corporation,First Health Network,407.4,97,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 3.1 To 4.0 Cm (Pro Cah)",,17264,CPT,Professional,Both,,,,420,357,81.8,420,"Health Partners, Inc.",Commercial,266.99,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 3.1 To 4.0 Cm (Pro Cah)",,17264,CPT,Professional,Both,,,,420,357,81.8,420,"Health Partners, Inc.",Medicare Advantage,146.4065,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 3.1 To 4.0 Cm (Pro Cah)",,17264,CPT,Professional,Both,,,,420,357,81.8,420,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),127.42,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 3.1 To 4.0 Cm (Pro Cah)",,17264,CPT,Professional,Both,,,,420,357,81.8,420,"Health Partners, Inc.",State of Minnesota Advantage Program,230.011885,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 3.1 To 4.0 Cm (Pro Cah)",,17264,CPT,Professional,Both,,,,420,357,81.8,420,"Health Partners, Inc.",State Public Programs,81.8,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 3.1 To 4.0 Cm (Pro Cah)",,17264,CPT,Professional,Both,,,,420,357,81.8,420,Humana Insurance Company,Commercial PPO,127.31,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 3.1 To 4.0 Cm (Pro Cah)",,17264,CPT,Professional,Both,,,,420,357,81.8,420,Humana Insurance Company,Medicare PPO,420,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 3.1 To 4.0 Cm (Pro Cah)",,17264,CPT,Professional,Both,,,,420,357,81.8,420,Medica,Individual & Family,356.16,84.8,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 3.1 To 4.0 Cm (Pro Cah)",,17264,CPT,Professional,Both,,,,420,357,81.8,420,Medica,Medica Advantage Solution,209.16,49.8,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 3.1 To 4.0 Cm (Pro Cah)",,17264,CPT,Professional,Both,,,,420,357,81.8,420,Medica,Medical Assistance,94.45,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 3.1 To 4.0 Cm (Pro Cah)",,17264,CPT,Professional,Both,,,,420,357,81.8,420,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,127.31,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 3.1 To 4.0 Cm (Pro Cah)",,17264,CPT,Professional,Both,,,,420,357,81.8,420,"Multiplan, Inc.","Multiplan, Inc.",394.8,94,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 3.1 To 4.0 Cm (Pro Cah)",,17264,CPT,Professional,Both,,,,420,357,81.8,420,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,378.42,90.1,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 3.1 To 4.0 Cm (Pro Cah)",,17264,CPT,Professional,Both,,,,420,357,81.8,420,"Preferred One Administrative Services, INC.",PPO,414.12,98.6,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 3.1 To 4.0 Cm (Pro Cah)",,17264,CPT,Professional,Both,,,,420,357,81.8,420,PrimeWest Health,Minnesota Senior Health Options (MSHO),146.4065,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 3.1 To 4.0 Cm (Pro Cah)",,17264,CPT,Professional,Both,,,,420,357,81.8,420,PrimeWest Health,MinnesotaCare,101.0586752,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 3.1 To 4.0 Cm (Pro Cah)",,17264,CPT,Professional,Both,,,,420,357,81.8,420,Sanford Health Plan,Sanford Health Plan,369.6,88,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 3.1 To 4.0 Cm (Pro Cah)",,17264,CPT,Professional,Both,,,,420,357,81.8,420,"UCare Health, Inc.",Individual & Family Plan,206.955136,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 3.1 To 4.0 Cm (Pro Cah)",,17264,CPT,Professional,Both,,,,420,357,81.8,420,"UCare Health, Inc.",Medical Assistance,103.892096,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 3.1 To 4.0 Cm (Pro Cah)",,17264,CPT,Professional,Both,,,,420,357,81.8,420,"UCare Health, Inc.",Medicare Advantage,146.4065,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 3.1 To 4.0 Cm (Pro Cah)",,17264,CPT,Professional,Both,,,,420,357,81.8,420,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),117.1252,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 3.1 To 4.0 Cm (Pro Cah)",,17264,CPT,Professional,Both,,,,420,357,81.8,420,UnitedHealthcare,Individual & Family,420,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 3.1 To 4.0 Cm (Pro Cah)",,17264,CPT,Professional,Both,,,,420,357,81.8,420,UnitedHealthcare,Medicare Advantage,146.4065,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter 3.1 To 4.0 Cm (Pro Cah)",,17264,CPT,Professional,Both,,,,420,357,81.8,420,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,94.44736,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter Over 4.0 Cm",,17266,CPT,Facility,Both,,,,398,338.3,114.0668,398,Aetna,Commercial,366.16,92,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter Over 4.0 Cm",,17266,CPT,Facility,Outpatient,,,,398,338.3,114.0668,398,Aetna,Medicare Advantage,195.02,49,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter Over 4.0 Cm",,17266,CPT,Facility,Inpatient,,,,398,338.3,114.0668,398,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter Over 4.0 Cm",,17266,CPT,Facility,Both,,,,398,338.3,114.0668,398,Aetna,PPO,370.14,93,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter Over 4.0 Cm",,17266,CPT,Facility,Both,,,,398,338.3,114.0668,398,America's PPO,America's PPO,382.1994,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter Over 4.0 Cm",,17266,CPT,Facility,Both,,,,398,338.3,114.0668,398,BlueCross BlueShield Minnesota, Federal Employee Program,391.632,98.4,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter Over 4.0 Cm",,17266,CPT,Facility,Both,,,,398,338.3,114.0668,398,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,398,100,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter Over 4.0 Cm",,17266,CPT,Facility,Both,,,,398,338.3,114.0668,398,BlueCross BlueShield Minnesota,High Value Network Plan,358.2,90,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter Over 4.0 Cm",,17266,CPT,Facility,Outpatient,,,,398,338.3,114.0668,398,BlueCross BlueShield Minnesota,Medicare Advantage,195.02,49,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter Over 4.0 Cm",,17266,CPT,Facility,Inpatient,,,,398,338.3,114.0668,398,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter Over 4.0 Cm",,17266,CPT,Facility,Both,,,,398,338.3,114.0668,398,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,352.5086,88.57,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter Over 4.0 Cm",,17266,CPT,Facility,Both,,,,398,338.3,114.0668,398,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,114.0668,28.66,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter Over 4.0 Cm",,17266,CPT,Facility,Outpatient,,,,398,338.3,114.0668,398,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),195.02,49,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter Over 4.0 Cm",,17266,CPT,Facility,Inpatient,,,,398,338.3,114.0668,398,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter Over 4.0 Cm",,17266,CPT,Facility,Both,,,,398,338.3,114.0668,398,CorVel,Worker's Compensation,398,100,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter Over 4.0 Cm",,17266,CPT,Facility,Both,,,,398,338.3,114.0668,398,First Health Group Corporation,First Health Network,386.06,97,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter Over 4.0 Cm",,17266,CPT,Facility,Both,,,,398,338.3,114.0668,398,"Health Partners, Inc.",Commercial,376.508,94.6,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter Over 4.0 Cm",,17266,CPT,Facility,Outpatient,,,,398,338.3,114.0668,398,"Health Partners, Inc.",Medicare Advantage,195.02,49,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter Over 4.0 Cm",,17266,CPT,Facility,Inpatient,,,,398,338.3,114.0668,398,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter Over 4.0 Cm",,17266,CPT,Facility,Both,,,,398,338.3,114.0668,398,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),238.8,60,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter Over 4.0 Cm",,17266,CPT,Facility,Both,,,,398,338.3,114.0668,398,"Health Partners, Inc.",State of Minnesota Advantage Program,324.37,81.5,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter Over 4.0 Cm",,17266,CPT,Facility,Both,,,,398,338.3,114.0668,398,"Health Partners, Inc.",State Public Programs,199,50,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter Over 4.0 Cm",,17266,CPT,Facility,Both,,,,398,338.3,114.0668,398,Humana Insurance Company,Commercial PPO,378.1,95,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter Over 4.0 Cm",,17266,CPT,Facility,Outpatient,,,,398,338.3,114.0668,398,Humana Insurance Company,Medicare PPO,195.02,49,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter Over 4.0 Cm",,17266,CPT,Facility,Inpatient,,,,398,338.3,114.0668,398,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter Over 4.0 Cm",,17266,CPT,Facility,Both,,,,398,338.3,114.0668,398,Medica,Individual & Family,394.418,99.1,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter Over 4.0 Cm",,17266,CPT,Facility,Outpatient,,,,398,338.3,114.0668,398,Medica,Medica Advantage Solution,198.204,49.8,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter Over 4.0 Cm",,17266,CPT,Facility,Inpatient,,,,398,338.3,114.0668,398,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter Over 4.0 Cm",,17266,CPT,Facility,Outpatient,,,,398,338.3,114.0668,398,Medica,Medical Assistance,177.508,44.6,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter Over 4.0 Cm",,17266,CPT,Facility,Inpatient,,,,398,338.3,114.0668,398,Medica,Medical Assistance,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter Over 4.0 Cm",,17266,CPT,Facility,Outpatient,,,,398,338.3,114.0668,398,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,198.204,49.8,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter Over 4.0 Cm",,17266,CPT,Facility,Inpatient,,,,398,338.3,114.0668,398,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter Over 4.0 Cm",,17266,CPT,Facility,Both,,,,398,338.3,114.0668,398,"Multiplan, Inc.","Multiplan, Inc.",374.12,94,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter Over 4.0 Cm",,17266,CPT,Facility,Outpatient,,,,398,338.3,114.0668,398,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,358.598,90.1,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter Over 4.0 Cm",,17266,CPT,Facility,Inpatient,,,,398,338.3,114.0668,398,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter Over 4.0 Cm",,17266,CPT,Facility,Both,,,,398,338.3,114.0668,398,"Preferred One Administrative Services, INC.",PPO,392.428,98.6,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter Over 4.0 Cm",,17266,CPT,Facility,Outpatient,,,,398,338.3,114.0668,398,PrimeWest Health,Minnesota Senior Health Options (MSHO),204.771,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter Over 4.0 Cm",,17266,CPT,Facility,Inpatient,,,,398,338.3,114.0668,398,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter Over 4.0 Cm",,17266,CPT,Facility,Outpatient,,,,398,338.3,114.0668,398,PrimeWest Health,MinnesotaCare,204.4128,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter Over 4.0 Cm",,17266,CPT,Facility,Inpatient,,,,398,338.3,114.0668,398,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter Over 4.0 Cm",,17266,CPT,Facility,Both,,,,398,338.3,114.0668,398,Sanford Health Plan,Sanford Health Plan,366.16,92,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter Over 4.0 Cm",,17266,CPT,Facility,Outpatient,,,,398,338.3,114.0668,398,"UCare Health, Inc.",Individual & Family Plan,224.273,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter Over 4.0 Cm",,17266,CPT,Facility,Inpatient,,,,398,338.3,114.0668,398,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter Over 4.0 Cm",,17266,CPT,Facility,Outpatient,,,,398,338.3,114.0668,398,"UCare Health, Inc.",Medical Assistance,200.8706,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter Over 4.0 Cm",,17266,CPT,Facility,Inpatient,,,,398,338.3,114.0668,398,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter Over 4.0 Cm",,17266,CPT,Facility,Outpatient,,,,398,338.3,114.0668,398,"UCare Health, Inc.",Medicare Advantage,200.8706,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter Over 4.0 Cm",,17266,CPT,Facility,Inpatient,,,,398,338.3,114.0668,398,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter Over 4.0 Cm",,17266,CPT,Facility,Outpatient,,,,398,338.3,114.0668,398,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),200.8706,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter Over 4.0 Cm",,17266,CPT,Facility,Inpatient,,,,398,338.3,114.0668,398,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter Over 4.0 Cm",,17266,CPT,Facility,Both,,,,398,338.3,114.0668,398,UnitedHealthcare,Individual & Family,374.12,94,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter Over 4.0 Cm",,17266,CPT,Facility,Outpatient,,,,398,338.3,114.0668,398,UnitedHealthcare,Medicare Advantage,195.02,49,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter Over 4.0 Cm",,17266,CPT,Facility,Inpatient,,,,398,338.3,114.0668,398,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter Over 4.0 Cm",,17266,CPT,Facility,Outpatient,,,,398,338.3,114.0668,398,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,191.04,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter Over 4.0 Cm",,17266,CPT,Facility,Inpatient,,,,398,338.3,114.0668,398,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter Over 4.0 Cm (Pro Cah)",,17266,CPT,Professional,Both,,,,485,412.25,96.2,485,Aetna,Commercial,412.25,85,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter Over 4.0 Cm (Pro Cah)",,17266,CPT,Professional,Both,,,,485,412.25,96.2,485,Aetna,Medicare Advantage,150.56,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter Over 4.0 Cm (Pro Cah)",,17266,CPT,Professional,Both,,,,485,412.25,96.2,485,Aetna,PPO,451.05,93,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter Over 4.0 Cm (Pro Cah)",,17266,CPT,Professional,Both,,,,485,412.25,96.2,485,America's PPO,America's PPO,414.384,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter Over 4.0 Cm (Pro Cah)",,17266,CPT,Professional,Both,,,,485,412.25,96.2,485,BlueCross BlueShield Minnesota, Federal Employee Program,313.31,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter Over 4.0 Cm (Pro Cah)",,17266,CPT,Professional,Both,,,,485,412.25,96.2,485,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,318.32296,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter Over 4.0 Cm (Pro Cah)",,17266,CPT,Professional,Both,,,,485,412.25,96.2,485,BlueCross BlueShield Minnesota,High Value Network Plan,318.32296,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter Over 4.0 Cm (Pro Cah)",,17266,CPT,Professional,Both,,,,485,412.25,96.2,485,BlueCross BlueShield Minnesota,Medicare Advantage,172.1665,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter Over 4.0 Cm (Pro Cah)",,17266,CPT,Professional,Both,,,,485,412.25,96.2,485,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,318.32296,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter Over 4.0 Cm (Pro Cah)",,17266,CPT,Professional,Both,,,,485,412.25,96.2,485,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,111.06912,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter Over 4.0 Cm (Pro Cah)",,17266,CPT,Professional,Both,,,,485,412.25,96.2,485,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),172.1665,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter Over 4.0 Cm (Pro Cah)",,17266,CPT,Professional,Both,,,,485,412.25,96.2,485,CorVel,Worker's Compensation,290.0655846,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter Over 4.0 Cm (Pro Cah)",,17266,CPT,Professional,Both,,,,485,412.25,96.2,485,First Health Group Corporation,First Health Network,470.45,97,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter Over 4.0 Cm (Pro Cah)",,17266,CPT,Professional,Both,,,,485,412.25,96.2,485,"Health Partners, Inc.",Commercial,312.7,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter Over 4.0 Cm (Pro Cah)",,17266,CPT,Professional,Both,,,,485,412.25,96.2,485,"Health Partners, Inc.",Medicare Advantage,172.1665,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter Over 4.0 Cm (Pro Cah)",,17266,CPT,Professional,Both,,,,485,412.25,96.2,485,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),149.78,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter Over 4.0 Cm (Pro Cah)",,17266,CPT,Professional,Both,,,,485,412.25,96.2,485,"Health Partners, Inc.",State of Minnesota Advantage Program,269.39105,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter Over 4.0 Cm (Pro Cah)",,17266,CPT,Professional,Both,,,,485,412.25,96.2,485,"Health Partners, Inc.",State Public Programs,96.2,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter Over 4.0 Cm (Pro Cah)",,17266,CPT,Professional,Both,,,,485,412.25,96.2,485,Humana Insurance Company,Commercial PPO,149.71,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter Over 4.0 Cm (Pro Cah)",,17266,CPT,Professional,Both,,,,485,412.25,96.2,485,Humana Insurance Company,Medicare PPO,485,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter Over 4.0 Cm (Pro Cah)",,17266,CPT,Professional,Both,,,,485,412.25,96.2,485,Medica,Individual & Family,411.28,84.8,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter Over 4.0 Cm (Pro Cah)",,17266,CPT,Professional,Both,,,,485,412.25,96.2,485,Medica,Medica Advantage Solution,241.53,49.8,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter Over 4.0 Cm (Pro Cah)",,17266,CPT,Professional,Both,,,,485,412.25,96.2,485,Medica,Medical Assistance,111.07,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter Over 4.0 Cm (Pro Cah)",,17266,CPT,Professional,Both,,,,485,412.25,96.2,485,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,149.71,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter Over 4.0 Cm (Pro Cah)",,17266,CPT,Professional,Both,,,,485,412.25,96.2,485,"Multiplan, Inc.","Multiplan, Inc.",455.9,94,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter Over 4.0 Cm (Pro Cah)",,17266,CPT,Professional,Both,,,,485,412.25,96.2,485,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,436.985,90.1,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter Over 4.0 Cm (Pro Cah)",,17266,CPT,Professional,Both,,,,485,412.25,96.2,485,"Preferred One Administrative Services, INC.",PPO,478.21,98.6,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter Over 4.0 Cm (Pro Cah)",,17266,CPT,Professional,Both,,,,485,412.25,96.2,485,PrimeWest Health,Minnesota Senior Health Options (MSHO),172.1665,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter Over 4.0 Cm (Pro Cah)",,17266,CPT,Professional,Both,,,,485,412.25,96.2,485,PrimeWest Health,MinnesotaCare,118.8439584,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter Over 4.0 Cm (Pro Cah)",,17266,CPT,Professional,Both,,,,485,412.25,96.2,485,Sanford Health Plan,Sanford Health Plan,426.8,88,,percent of total billed charges,,
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter Over 4.0 Cm (Pro Cah)",,17266,CPT,Professional,Both,,,,485,412.25,96.2,485,"UCare Health, Inc.",Individual & Family Plan,243.368576,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter Over 4.0 Cm (Pro Cah)",,17266,CPT,Professional,Both,,,,485,412.25,96.2,485,"UCare Health, Inc.",Medical Assistance,122.176032,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter Over 4.0 Cm (Pro Cah)",,17266,CPT,Professional,Both,,,,485,412.25,96.2,485,"UCare Health, Inc.",Medicare Advantage,172.1665,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter Over 4.0 Cm (Pro Cah)",,17266,CPT,Professional,Both,,,,485,412.25,96.2,485,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),137.7332,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter Over 4.0 Cm (Pro Cah)",,17266,CPT,Professional,Both,,,,485,412.25,96.2,485,UnitedHealthcare,Individual & Family,485,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter Over 4.0 Cm (Pro Cah)",,17266,CPT,Professional,Both,,,,485,412.25,96.2,485,UnitedHealthcare,Medicare Advantage,172.1665,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Destruction, Malignant Lesion, Trunk, Arms Or Legs; Lesion Diameter Over 4.0 Cm (Pro Cah)",,17266,CPT,Professional,Both,,,,485,412.25,96.2,485,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,111.06912,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Dia 0.5 Cm Or Less",,17270,CPT,Facility,Both,,,,255,216.75,73.083,255,Aetna,Commercial,234.6,92,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Dia 0.5 Cm Or Less",,17270,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,Aetna,Medicare Advantage,124.95,49,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Dia 0.5 Cm Or Less",,17270,CPT,Facility,Inpatient,,,,255,216.75,73.083,255,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Dia 0.5 Cm Or Less",,17270,CPT,Facility,Both,,,,255,216.75,73.083,255,Aetna,PPO,237.15,93,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Dia 0.5 Cm Or Less",,17270,CPT,Facility,Both,,,,255,216.75,73.083,255,America's PPO,America's PPO,244.8765,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Dia 0.5 Cm Or Less",,17270,CPT,Facility,Both,,,,255,216.75,73.083,255,BlueCross BlueShield Minnesota, Federal Employee Program,250.92,98.4,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Dia 0.5 Cm Or Less",,17270,CPT,Facility,Both,,,,255,216.75,73.083,255,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,255,100,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Dia 0.5 Cm Or Less",,17270,CPT,Facility,Both,,,,255,216.75,73.083,255,BlueCross BlueShield Minnesota,High Value Network Plan,229.5,90,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Dia 0.5 Cm Or Less",,17270,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,BlueCross BlueShield Minnesota,Medicare Advantage,124.95,49,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Dia 0.5 Cm Or Less",,17270,CPT,Facility,Inpatient,,,,255,216.75,73.083,255,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Dia 0.5 Cm Or Less",,17270,CPT,Facility,Both,,,,255,216.75,73.083,255,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,225.8535,88.57,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Dia 0.5 Cm Or Less",,17270,CPT,Facility,Both,,,,255,216.75,73.083,255,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,73.083,28.66,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Dia 0.5 Cm Or Less",,17270,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),124.95,49,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Dia 0.5 Cm Or Less",,17270,CPT,Facility,Inpatient,,,,255,216.75,73.083,255,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Dia 0.5 Cm Or Less",,17270,CPT,Facility,Both,,,,255,216.75,73.083,255,CorVel,Worker's Compensation,255,100,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Dia 0.5 Cm Or Less",,17270,CPT,Facility,Both,,,,255,216.75,73.083,255,First Health Group Corporation,First Health Network,247.35,97,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Dia 0.5 Cm Or Less",,17270,CPT,Facility,Both,,,,255,216.75,73.083,255,"Health Partners, Inc.",Commercial,241.23,94.6,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Dia 0.5 Cm Or Less",,17270,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,"Health Partners, Inc.",Medicare Advantage,124.95,49,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Dia 0.5 Cm Or Less",,17270,CPT,Facility,Inpatient,,,,255,216.75,73.083,255,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Dia 0.5 Cm Or Less",,17270,CPT,Facility,Both,,,,255,216.75,73.083,255,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),153,60,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Dia 0.5 Cm Or Less",,17270,CPT,Facility,Both,,,,255,216.75,73.083,255,"Health Partners, Inc.",State of Minnesota Advantage Program,207.825,81.5,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Dia 0.5 Cm Or Less",,17270,CPT,Facility,Both,,,,255,216.75,73.083,255,"Health Partners, Inc.",State Public Programs,127.5,50,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Dia 0.5 Cm Or Less",,17270,CPT,Facility,Both,,,,255,216.75,73.083,255,Humana Insurance Company,Commercial PPO,242.25,95,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Dia 0.5 Cm Or Less",,17270,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,Humana Insurance Company,Medicare PPO,124.95,49,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Dia 0.5 Cm Or Less",,17270,CPT,Facility,Inpatient,,,,255,216.75,73.083,255,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Dia 0.5 Cm Or Less",,17270,CPT,Facility,Both,,,,255,216.75,73.083,255,Medica,Individual & Family,252.705,99.1,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Dia 0.5 Cm Or Less",,17270,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,Medica,Medica Advantage Solution,126.99,49.8,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Dia 0.5 Cm Or Less",,17270,CPT,Facility,Inpatient,,,,255,216.75,73.083,255,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Dia 0.5 Cm Or Less",,17270,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,Medica,Medical Assistance,113.73,44.6,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Dia 0.5 Cm Or Less",,17270,CPT,Facility,Inpatient,,,,255,216.75,73.083,255,Medica,Medical Assistance,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Dia 0.5 Cm Or Less",,17270,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,126.99,49.8,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Dia 0.5 Cm Or Less",,17270,CPT,Facility,Inpatient,,,,255,216.75,73.083,255,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Dia 0.5 Cm Or Less",,17270,CPT,Facility,Both,,,,255,216.75,73.083,255,"Multiplan, Inc.","Multiplan, Inc.",239.7,94,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Dia 0.5 Cm Or Less",,17270,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,229.755,90.1,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Dia 0.5 Cm Or Less",,17270,CPT,Facility,Inpatient,,,,255,216.75,73.083,255,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Dia 0.5 Cm Or Less",,17270,CPT,Facility,Both,,,,255,216.75,73.083,255,"Preferred One Administrative Services, INC.",PPO,251.43,98.6,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Dia 0.5 Cm Or Less",,17270,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,PrimeWest Health,Minnesota Senior Health Options (MSHO),131.1975,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Dia 0.5 Cm Or Less",,17270,CPT,Facility,Inpatient,,,,255,216.75,73.083,255,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Dia 0.5 Cm Or Less",,17270,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,PrimeWest Health,MinnesotaCare,130.968,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Dia 0.5 Cm Or Less",,17270,CPT,Facility,Inpatient,,,,255,216.75,73.083,255,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Dia 0.5 Cm Or Less",,17270,CPT,Facility,Both,,,,255,216.75,73.083,255,Sanford Health Plan,Sanford Health Plan,234.6,92,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Dia 0.5 Cm Or Less",,17270,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,"UCare Health, Inc.",Individual & Family Plan,143.6925,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Dia 0.5 Cm Or Less",,17270,CPT,Facility,Inpatient,,,,255,216.75,73.083,255,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Dia 0.5 Cm Or Less",,17270,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,"UCare Health, Inc.",Medical Assistance,128.6985,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Dia 0.5 Cm Or Less",,17270,CPT,Facility,Inpatient,,,,255,216.75,73.083,255,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Dia 0.5 Cm Or Less",,17270,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,"UCare Health, Inc.",Medicare Advantage,128.6985,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Dia 0.5 Cm Or Less",,17270,CPT,Facility,Inpatient,,,,255,216.75,73.083,255,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Dia 0.5 Cm Or Less",,17270,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),128.6985,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Dia 0.5 Cm Or Less",,17270,CPT,Facility,Inpatient,,,,255,216.75,73.083,255,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Dia 0.5 Cm Or Less",,17270,CPT,Facility,Both,,,,255,216.75,73.083,255,UnitedHealthcare,Individual & Family,239.7,94,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Dia 0.5 Cm Or Less",,17270,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,UnitedHealthcare,Medicare Advantage,124.95,49,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Dia 0.5 Cm Or Less",,17270,CPT,Facility,Inpatient,,,,255,216.75,73.083,255,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Dia 0.5 Cm Or Less",,17270,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,122.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Dia 0.5 Cm Or Less",,17270,CPT,Facility,Inpatient,,,,255,216.75,73.083,255,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Dia 0.5 Cm Or Less (Pro Cah)",,17270,CPT,Professional,Both,,,,300,255,59.99,300,Aetna,Commercial,255,85,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Dia 0.5 Cm Or Less (Pro Cah)",,17270,CPT,Professional,Both,,,,300,255,59.99,300,Aetna,Medicare Advantage,93.36,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Dia 0.5 Cm Or Less (Pro Cah)",,17270,CPT,Professional,Both,,,,300,255,59.99,300,Aetna,PPO,279,93,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Dia 0.5 Cm Or Less (Pro Cah)",,17270,CPT,Professional,Both,,,,300,255,59.99,300,America's PPO,America's PPO,256.32,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Dia 0.5 Cm Or Less (Pro Cah)",,17270,CPT,Professional,Both,,,,300,255,59.99,300,BlueCross BlueShield Minnesota, Federal Employee Program,195.56,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Dia 0.5 Cm Or Less (Pro Cah)",,17270,CPT,Professional,Both,,,,300,255,59.99,300,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,198.68896,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Dia 0.5 Cm Or Less (Pro Cah)",,17270,CPT,Professional,Both,,,,300,255,59.99,300,BlueCross BlueShield Minnesota,High Value Network Plan,198.68896,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Dia 0.5 Cm Or Less (Pro Cah)",,17270,CPT,Professional,Both,,,,300,255,59.99,300,BlueCross BlueShield Minnesota,Medicare Advantage,107.1685,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Dia 0.5 Cm Or Less (Pro Cah)",,17270,CPT,Professional,Both,,,,300,255,59.99,300,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,198.68896,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Dia 0.5 Cm Or Less (Pro Cah)",,17270,CPT,Professional,Both,,,,300,255,59.99,300,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,69.26072,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Dia 0.5 Cm Or Less (Pro Cah)",,17270,CPT,Professional,Both,,,,300,255,59.99,300,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),107.1685,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Dia 0.5 Cm Or Less (Pro Cah)",,17270,CPT,Professional,Both,,,,300,255,59.99,300,CorVel,Worker's Compensation,179.9222337,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Dia 0.5 Cm Or Less (Pro Cah)",,17270,CPT,Professional,Both,,,,300,255,59.99,300,First Health Group Corporation,First Health Network,291,97,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Dia 0.5 Cm Or Less (Pro Cah)",,17270,CPT,Professional,Both,,,,300,255,59.99,300,"Health Partners, Inc.",Commercial,194.44,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Dia 0.5 Cm Or Less (Pro Cah)",,17270,CPT,Professional,Both,,,,300,255,59.99,300,"Health Partners, Inc.",Medicare Advantage,107.1685,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Dia 0.5 Cm Or Less (Pro Cah)",,17270,CPT,Professional,Both,,,,300,255,59.99,300,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),93.19,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Dia 0.5 Cm Or Less (Pro Cah)",,17270,CPT,Professional,Both,,,,300,255,59.99,300,"Health Partners, Inc.",State of Minnesota Advantage Program,167.51006,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Dia 0.5 Cm Or Less (Pro Cah)",,17270,CPT,Professional,Both,,,,300,255,59.99,300,"Health Partners, Inc.",State Public Programs,59.99,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Dia 0.5 Cm Or Less (Pro Cah)",,17270,CPT,Professional,Both,,,,300,255,59.99,300,Humana Insurance Company,Commercial PPO,93.19,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Dia 0.5 Cm Or Less (Pro Cah)",,17270,CPT,Professional,Both,,,,300,255,59.99,300,Humana Insurance Company,Medicare PPO,300,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Dia 0.5 Cm Or Less (Pro Cah)",,17270,CPT,Professional,Both,,,,300,255,59.99,300,Medica,Individual & Family,254.4,84.8,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Dia 0.5 Cm Or Less (Pro Cah)",,17270,CPT,Professional,Both,,,,300,255,59.99,300,Medica,Medica Advantage Solution,149.4,49.8,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Dia 0.5 Cm Or Less (Pro Cah)",,17270,CPT,Professional,Both,,,,300,255,59.99,300,Medica,Medical Assistance,69.26,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Dia 0.5 Cm Or Less (Pro Cah)",,17270,CPT,Professional,Both,,,,300,255,59.99,300,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,93.19,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Dia 0.5 Cm Or Less (Pro Cah)",,17270,CPT,Professional,Both,,,,300,255,59.99,300,"Multiplan, Inc.","Multiplan, Inc.",282,94,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Dia 0.5 Cm Or Less (Pro Cah)",,17270,CPT,Professional,Both,,,,300,255,59.99,300,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,270.3,90.1,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Dia 0.5 Cm Or Less (Pro Cah)",,17270,CPT,Professional,Both,,,,300,255,59.99,300,"Preferred One Administrative Services, INC.",PPO,295.8,98.6,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Dia 0.5 Cm Or Less (Pro Cah)",,17270,CPT,Professional,Both,,,,300,255,59.99,300,PrimeWest Health,Minnesota Senior Health Options (MSHO),107.1685,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Dia 0.5 Cm Or Less (Pro Cah)",,17270,CPT,Professional,Both,,,,300,255,59.99,300,PrimeWest Health,MinnesotaCare,74.1089704,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Dia 0.5 Cm Or Less (Pro Cah)",,17270,CPT,Professional,Both,,,,300,255,59.99,300,Sanford Health Plan,Sanford Health Plan,264,88,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Dia 0.5 Cm Or Less (Pro Cah)",,17270,CPT,Professional,Both,,,,300,255,59.99,300,"UCare Health, Inc.",Individual & Family Plan,151.489664,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Dia 0.5 Cm Or Less (Pro Cah)",,17270,CPT,Professional,Both,,,,300,255,59.99,300,"UCare Health, Inc.",Medical Assistance,76.186792,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Dia 0.5 Cm Or Less (Pro Cah)",,17270,CPT,Professional,Both,,,,300,255,59.99,300,"UCare Health, Inc.",Medicare Advantage,107.1685,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Dia 0.5 Cm Or Less (Pro Cah)",,17270,CPT,Professional,Both,,,,300,255,59.99,300,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),85.7348,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Dia 0.5 Cm Or Less (Pro Cah)",,17270,CPT,Professional,Both,,,,300,255,59.99,300,UnitedHealthcare,Individual & Family,300,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Dia 0.5 Cm Or Less (Pro Cah)",,17270,CPT,Professional,Both,,,,300,255,59.99,300,UnitedHealthcare,Medicare Advantage,107.1685,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Dia 0.5 Cm Or Less (Pro Cah)",,17270,CPT,Professional,Both,,,,300,255,59.99,300,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,69.26072,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 0.6 To 1.0 Cm",,17271,CPT,Facility,Both,,,,255,216.75,73.083,255,Aetna,Commercial,234.6,92,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 0.6 To 1.0 Cm",,17271,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,Aetna,Medicare Advantage,124.95,49,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 0.6 To 1.0 Cm",,17271,CPT,Facility,Inpatient,,,,255,216.75,73.083,255,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 0.6 To 1.0 Cm",,17271,CPT,Facility,Both,,,,255,216.75,73.083,255,Aetna,PPO,237.15,93,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 0.6 To 1.0 Cm",,17271,CPT,Facility,Both,,,,255,216.75,73.083,255,America's PPO,America's PPO,244.8765,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 0.6 To 1.0 Cm",,17271,CPT,Facility,Both,,,,255,216.75,73.083,255,BlueCross BlueShield Minnesota, Federal Employee Program,250.92,98.4,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 0.6 To 1.0 Cm",,17271,CPT,Facility,Both,,,,255,216.75,73.083,255,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,255,100,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 0.6 To 1.0 Cm",,17271,CPT,Facility,Both,,,,255,216.75,73.083,255,BlueCross BlueShield Minnesota,High Value Network Plan,229.5,90,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 0.6 To 1.0 Cm",,17271,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,BlueCross BlueShield Minnesota,Medicare Advantage,124.95,49,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 0.6 To 1.0 Cm",,17271,CPT,Facility,Inpatient,,,,255,216.75,73.083,255,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 0.6 To 1.0 Cm",,17271,CPT,Facility,Both,,,,255,216.75,73.083,255,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,225.8535,88.57,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 0.6 To 1.0 Cm",,17271,CPT,Facility,Both,,,,255,216.75,73.083,255,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,73.083,28.66,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 0.6 To 1.0 Cm",,17271,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),124.95,49,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 0.6 To 1.0 Cm",,17271,CPT,Facility,Inpatient,,,,255,216.75,73.083,255,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 0.6 To 1.0 Cm",,17271,CPT,Facility,Both,,,,255,216.75,73.083,255,CorVel,Worker's Compensation,255,100,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 0.6 To 1.0 Cm",,17271,CPT,Facility,Both,,,,255,216.75,73.083,255,First Health Group Corporation,First Health Network,247.35,97,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 0.6 To 1.0 Cm",,17271,CPT,Facility,Both,,,,255,216.75,73.083,255,"Health Partners, Inc.",Commercial,241.23,94.6,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 0.6 To 1.0 Cm",,17271,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,"Health Partners, Inc.",Medicare Advantage,124.95,49,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 0.6 To 1.0 Cm",,17271,CPT,Facility,Inpatient,,,,255,216.75,73.083,255,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 0.6 To 1.0 Cm",,17271,CPT,Facility,Both,,,,255,216.75,73.083,255,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),153,60,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 0.6 To 1.0 Cm",,17271,CPT,Facility,Both,,,,255,216.75,73.083,255,"Health Partners, Inc.",State of Minnesota Advantage Program,207.825,81.5,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 0.6 To 1.0 Cm",,17271,CPT,Facility,Both,,,,255,216.75,73.083,255,"Health Partners, Inc.",State Public Programs,127.5,50,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 0.6 To 1.0 Cm",,17271,CPT,Facility,Both,,,,255,216.75,73.083,255,Humana Insurance Company,Commercial PPO,242.25,95,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 0.6 To 1.0 Cm",,17271,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,Humana Insurance Company,Medicare PPO,124.95,49,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 0.6 To 1.0 Cm",,17271,CPT,Facility,Inpatient,,,,255,216.75,73.083,255,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 0.6 To 1.0 Cm",,17271,CPT,Facility,Both,,,,255,216.75,73.083,255,Medica,Individual & Family,252.705,99.1,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 0.6 To 1.0 Cm",,17271,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,Medica,Medica Advantage Solution,126.99,49.8,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 0.6 To 1.0 Cm",,17271,CPT,Facility,Inpatient,,,,255,216.75,73.083,255,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 0.6 To 1.0 Cm",,17271,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,Medica,Medical Assistance,113.73,44.6,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 0.6 To 1.0 Cm",,17271,CPT,Facility,Inpatient,,,,255,216.75,73.083,255,Medica,Medical Assistance,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 0.6 To 1.0 Cm",,17271,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,126.99,49.8,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 0.6 To 1.0 Cm",,17271,CPT,Facility,Inpatient,,,,255,216.75,73.083,255,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 0.6 To 1.0 Cm",,17271,CPT,Facility,Both,,,,255,216.75,73.083,255,"Multiplan, Inc.","Multiplan, Inc.",239.7,94,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 0.6 To 1.0 Cm",,17271,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,229.755,90.1,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 0.6 To 1.0 Cm",,17271,CPT,Facility,Inpatient,,,,255,216.75,73.083,255,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 0.6 To 1.0 Cm",,17271,CPT,Facility,Both,,,,255,216.75,73.083,255,"Preferred One Administrative Services, INC.",PPO,251.43,98.6,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 0.6 To 1.0 Cm",,17271,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,PrimeWest Health,Minnesota Senior Health Options (MSHO),131.1975,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 0.6 To 1.0 Cm",,17271,CPT,Facility,Inpatient,,,,255,216.75,73.083,255,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 0.6 To 1.0 Cm",,17271,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,PrimeWest Health,MinnesotaCare,130.968,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 0.6 To 1.0 Cm",,17271,CPT,Facility,Inpatient,,,,255,216.75,73.083,255,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 0.6 To 1.0 Cm",,17271,CPT,Facility,Both,,,,255,216.75,73.083,255,Sanford Health Plan,Sanford Health Plan,234.6,92,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 0.6 To 1.0 Cm",,17271,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,"UCare Health, Inc.",Individual & Family Plan,143.6925,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 0.6 To 1.0 Cm",,17271,CPT,Facility,Inpatient,,,,255,216.75,73.083,255,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 0.6 To 1.0 Cm",,17271,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,"UCare Health, Inc.",Medical Assistance,128.6985,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 0.6 To 1.0 Cm",,17271,CPT,Facility,Inpatient,,,,255,216.75,73.083,255,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 0.6 To 1.0 Cm",,17271,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,"UCare Health, Inc.",Medicare Advantage,128.6985,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 0.6 To 1.0 Cm",,17271,CPT,Facility,Inpatient,,,,255,216.75,73.083,255,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 0.6 To 1.0 Cm",,17271,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),128.6985,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 0.6 To 1.0 Cm",,17271,CPT,Facility,Inpatient,,,,255,216.75,73.083,255,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 0.6 To 1.0 Cm",,17271,CPT,Facility,Both,,,,255,216.75,73.083,255,UnitedHealthcare,Individual & Family,239.7,94,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 0.6 To 1.0 Cm",,17271,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,UnitedHealthcare,Medicare Advantage,124.95,49,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 0.6 To 1.0 Cm",,17271,CPT,Facility,Inpatient,,,,255,216.75,73.083,255,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 0.6 To 1.0 Cm",,17271,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,122.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 0.6 To 1.0 Cm",,17271,CPT,Facility,Inpatient,,,,255,216.75,73.083,255,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 0.6 To 1.0 Cm (Procah)",,17271,CPT,Professional,Both,,,,345,293.25,66.32,345,Aetna,Commercial,293.25,85,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 0.6 To 1.0 Cm (Procah)",,17271,CPT,Professional,Both,,,,345,293.25,66.32,345,Aetna,Medicare Advantage,103.3,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 0.6 To 1.0 Cm (Procah)",,17271,CPT,Professional,Both,,,,345,293.25,66.32,345,Aetna,PPO,320.85,93,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 0.6 To 1.0 Cm (Procah)",,17271,CPT,Professional,Both,,,,345,293.25,66.32,345,America's PPO,America's PPO,294.768,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 0.6 To 1.0 Cm (Procah)",,17271,CPT,Professional,Both,,,,345,293.25,66.32,345,BlueCross BlueShield Minnesota, Federal Employee Program,215.53,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 0.6 To 1.0 Cm (Procah)",,17271,CPT,Professional,Both,,,,345,293.25,66.32,345,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,218.97848,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 0.6 To 1.0 Cm (Procah)",,17271,CPT,Professional,Both,,,,345,293.25,66.32,345,BlueCross BlueShield Minnesota,High Value Network Plan,218.97848,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 0.6 To 1.0 Cm (Procah)",,17271,CPT,Professional,Both,,,,345,293.25,66.32,345,BlueCross BlueShield Minnesota,Medicare Advantage,118.565,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 0.6 To 1.0 Cm (Procah)",,17271,CPT,Professional,Both,,,,345,293.25,66.32,345,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,218.97848,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 0.6 To 1.0 Cm (Procah)",,17271,CPT,Professional,Both,,,,345,293.25,66.32,345,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,76.56576,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 0.6 To 1.0 Cm (Procah)",,17271,CPT,Professional,Both,,,,345,293.25,66.32,345,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),118.565,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 0.6 To 1.0 Cm (Procah)",,17271,CPT,Professional,Both,,,,345,293.25,66.32,345,CorVel,Worker's Compensation,198.6196749,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 0.6 To 1.0 Cm (Procah)",,17271,CPT,Professional,Both,,,,345,293.25,66.32,345,First Health Group Corporation,First Health Network,334.65,97,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 0.6 To 1.0 Cm (Procah)",,17271,CPT,Professional,Both,,,,345,293.25,66.32,345,"Health Partners, Inc.",Commercial,214.75,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 0.6 To 1.0 Cm (Procah)",,17271,CPT,Professional,Both,,,,345,293.25,66.32,345,"Health Partners, Inc.",Medicare Advantage,118.565,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 0.6 To 1.0 Cm (Procah)",,17271,CPT,Professional,Both,,,,345,293.25,66.32,345,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),103.36,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 0.6 To 1.0 Cm (Procah)",,17271,CPT,Professional,Both,,,,345,293.25,66.32,345,"Health Partners, Inc.",State of Minnesota Advantage Program,185.007125,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 0.6 To 1.0 Cm (Procah)",,17271,CPT,Professional,Both,,,,345,293.25,66.32,345,"Health Partners, Inc.",State Public Programs,66.32,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 0.6 To 1.0 Cm (Procah)",,17271,CPT,Professional,Both,,,,345,293.25,66.32,345,Humana Insurance Company,Commercial PPO,103.1,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 0.6 To 1.0 Cm (Procah)",,17271,CPT,Professional,Both,,,,345,293.25,66.32,345,Humana Insurance Company,Medicare PPO,345,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 0.6 To 1.0 Cm (Procah)",,17271,CPT,Professional,Both,,,,345,293.25,66.32,345,Medica,Individual & Family,292.56,84.8,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 0.6 To 1.0 Cm (Procah)",,17271,CPT,Professional,Both,,,,345,293.25,66.32,345,Medica,Medica Advantage Solution,171.81,49.8,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 0.6 To 1.0 Cm (Procah)",,17271,CPT,Professional,Both,,,,345,293.25,66.32,345,Medica,Medical Assistance,76.57,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 0.6 To 1.0 Cm (Procah)",,17271,CPT,Professional,Both,,,,345,293.25,66.32,345,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,103.1,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 0.6 To 1.0 Cm (Procah)",,17271,CPT,Professional,Both,,,,345,293.25,66.32,345,"Multiplan, Inc.","Multiplan, Inc.",324.3,94,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 0.6 To 1.0 Cm (Procah)",,17271,CPT,Professional,Both,,,,345,293.25,66.32,345,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,310.845,90.1,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 0.6 To 1.0 Cm (Procah)",,17271,CPT,Professional,Both,,,,345,293.25,66.32,345,"Preferred One Administrative Services, INC.",PPO,340.17,98.6,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 0.6 To 1.0 Cm (Procah)",,17271,CPT,Professional,Both,,,,345,293.25,66.32,345,PrimeWest Health,Minnesota Senior Health Options (MSHO),118.565,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 0.6 To 1.0 Cm (Procah)",,17271,CPT,Professional,Both,,,,345,293.25,66.32,345,PrimeWest Health,MinnesotaCare,81.9253632,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 0.6 To 1.0 Cm (Procah)",,17271,CPT,Professional,Both,,,,345,293.25,66.32,345,Sanford Health Plan,Sanford Health Plan,303.6,88,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 0.6 To 1.0 Cm (Procah)",,17271,CPT,Professional,Both,,,,345,293.25,66.32,345,"UCare Health, Inc.",Individual & Family Plan,167.59936,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 0.6 To 1.0 Cm (Procah)",,17271,CPT,Professional,Both,,,,345,293.25,66.32,345,"UCare Health, Inc.",Medical Assistance,84.222336,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 0.6 To 1.0 Cm (Procah)",,17271,CPT,Professional,Both,,,,345,293.25,66.32,345,"UCare Health, Inc.",Medicare Advantage,118.565,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 0.6 To 1.0 Cm (Procah)",,17271,CPT,Professional,Both,,,,345,293.25,66.32,345,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),94.852,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 0.6 To 1.0 Cm (Procah)",,17271,CPT,Professional,Both,,,,345,293.25,66.32,345,UnitedHealthcare,Individual & Family,345,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 0.6 To 1.0 Cm (Procah)",,17271,CPT,Professional,Both,,,,345,293.25,66.32,345,UnitedHealthcare,Medicare Advantage,118.565,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 0.6 To 1.0 Cm (Procah)",,17271,CPT,Professional,Both,,,,345,293.25,66.32,345,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,76.56576,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 1.1 To 2.0 Cm",,17272,CPT,Facility,Both,,,,281,238.85,80.5346,281,Aetna,Commercial,258.52,92,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 1.1 To 2.0 Cm",,17272,CPT,Facility,Outpatient,,,,281,238.85,80.5346,281,Aetna,Medicare Advantage,137.69,49,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 1.1 To 2.0 Cm",,17272,CPT,Facility,Inpatient,,,,281,238.85,80.5346,281,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 1.1 To 2.0 Cm",,17272,CPT,Facility,Both,,,,281,238.85,80.5346,281,Aetna,PPO,261.33,93,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 1.1 To 2.0 Cm",,17272,CPT,Facility,Both,,,,281,238.85,80.5346,281,America's PPO,America's PPO,269.8443,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 1.1 To 2.0 Cm",,17272,CPT,Facility,Both,,,,281,238.85,80.5346,281,BlueCross BlueShield Minnesota, Federal Employee Program,276.504,98.4,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 1.1 To 2.0 Cm",,17272,CPT,Facility,Both,,,,281,238.85,80.5346,281,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,281,100,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 1.1 To 2.0 Cm",,17272,CPT,Facility,Both,,,,281,238.85,80.5346,281,BlueCross BlueShield Minnesota,High Value Network Plan,252.9,90,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 1.1 To 2.0 Cm",,17272,CPT,Facility,Outpatient,,,,281,238.85,80.5346,281,BlueCross BlueShield Minnesota,Medicare Advantage,137.69,49,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 1.1 To 2.0 Cm",,17272,CPT,Facility,Inpatient,,,,281,238.85,80.5346,281,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 1.1 To 2.0 Cm",,17272,CPT,Facility,Both,,,,281,238.85,80.5346,281,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,248.8817,88.57,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 1.1 To 2.0 Cm",,17272,CPT,Facility,Both,,,,281,238.85,80.5346,281,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,80.5346,28.66,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 1.1 To 2.0 Cm",,17272,CPT,Facility,Outpatient,,,,281,238.85,80.5346,281,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),137.69,49,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 1.1 To 2.0 Cm",,17272,CPT,Facility,Inpatient,,,,281,238.85,80.5346,281,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 1.1 To 2.0 Cm",,17272,CPT,Facility,Both,,,,281,238.85,80.5346,281,CorVel,Worker's Compensation,281,100,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 1.1 To 2.0 Cm",,17272,CPT,Facility,Both,,,,281,238.85,80.5346,281,First Health Group Corporation,First Health Network,272.57,97,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 1.1 To 2.0 Cm",,17272,CPT,Facility,Both,,,,281,238.85,80.5346,281,"Health Partners, Inc.",Commercial,265.826,94.6,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 1.1 To 2.0 Cm",,17272,CPT,Facility,Outpatient,,,,281,238.85,80.5346,281,"Health Partners, Inc.",Medicare Advantage,137.69,49,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 1.1 To 2.0 Cm",,17272,CPT,Facility,Inpatient,,,,281,238.85,80.5346,281,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 1.1 To 2.0 Cm",,17272,CPT,Facility,Both,,,,281,238.85,80.5346,281,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),168.6,60,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 1.1 To 2.0 Cm",,17272,CPT,Facility,Both,,,,281,238.85,80.5346,281,"Health Partners, Inc.",State of Minnesota Advantage Program,229.015,81.5,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 1.1 To 2.0 Cm",,17272,CPT,Facility,Both,,,,281,238.85,80.5346,281,"Health Partners, Inc.",State Public Programs,140.5,50,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 1.1 To 2.0 Cm",,17272,CPT,Facility,Both,,,,281,238.85,80.5346,281,Humana Insurance Company,Commercial PPO,266.95,95,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 1.1 To 2.0 Cm",,17272,CPT,Facility,Outpatient,,,,281,238.85,80.5346,281,Humana Insurance Company,Medicare PPO,137.69,49,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 1.1 To 2.0 Cm",,17272,CPT,Facility,Inpatient,,,,281,238.85,80.5346,281,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 1.1 To 2.0 Cm",,17272,CPT,Facility,Both,,,,281,238.85,80.5346,281,Medica,Individual & Family,278.471,99.1,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 1.1 To 2.0 Cm",,17272,CPT,Facility,Outpatient,,,,281,238.85,80.5346,281,Medica,Medica Advantage Solution,139.938,49.8,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 1.1 To 2.0 Cm",,17272,CPT,Facility,Inpatient,,,,281,238.85,80.5346,281,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 1.1 To 2.0 Cm",,17272,CPT,Facility,Outpatient,,,,281,238.85,80.5346,281,Medica,Medical Assistance,125.326,44.6,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 1.1 To 2.0 Cm",,17272,CPT,Facility,Inpatient,,,,281,238.85,80.5346,281,Medica,Medical Assistance,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 1.1 To 2.0 Cm",,17272,CPT,Facility,Outpatient,,,,281,238.85,80.5346,281,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,139.938,49.8,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 1.1 To 2.0 Cm",,17272,CPT,Facility,Inpatient,,,,281,238.85,80.5346,281,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 1.1 To 2.0 Cm",,17272,CPT,Facility,Both,,,,281,238.85,80.5346,281,"Multiplan, Inc.","Multiplan, Inc.",264.14,94,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 1.1 To 2.0 Cm",,17272,CPT,Facility,Outpatient,,,,281,238.85,80.5346,281,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,253.181,90.1,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 1.1 To 2.0 Cm",,17272,CPT,Facility,Inpatient,,,,281,238.85,80.5346,281,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 1.1 To 2.0 Cm",,17272,CPT,Facility,Both,,,,281,238.85,80.5346,281,"Preferred One Administrative Services, INC.",PPO,277.066,98.6,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 1.1 To 2.0 Cm",,17272,CPT,Facility,Outpatient,,,,281,238.85,80.5346,281,PrimeWest Health,Minnesota Senior Health Options (MSHO),144.5745,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 1.1 To 2.0 Cm",,17272,CPT,Facility,Inpatient,,,,281,238.85,80.5346,281,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 1.1 To 2.0 Cm",,17272,CPT,Facility,Outpatient,,,,281,238.85,80.5346,281,PrimeWest Health,MinnesotaCare,144.3216,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 1.1 To 2.0 Cm",,17272,CPT,Facility,Inpatient,,,,281,238.85,80.5346,281,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 1.1 To 2.0 Cm",,17272,CPT,Facility,Both,,,,281,238.85,80.5346,281,Sanford Health Plan,Sanford Health Plan,258.52,92,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 1.1 To 2.0 Cm",,17272,CPT,Facility,Outpatient,,,,281,238.85,80.5346,281,"UCare Health, Inc.",Individual & Family Plan,158.3435,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 1.1 To 2.0 Cm",,17272,CPT,Facility,Inpatient,,,,281,238.85,80.5346,281,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 1.1 To 2.0 Cm",,17272,CPT,Facility,Outpatient,,,,281,238.85,80.5346,281,"UCare Health, Inc.",Medical Assistance,141.8207,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 1.1 To 2.0 Cm",,17272,CPT,Facility,Inpatient,,,,281,238.85,80.5346,281,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 1.1 To 2.0 Cm",,17272,CPT,Facility,Outpatient,,,,281,238.85,80.5346,281,"UCare Health, Inc.",Medicare Advantage,141.8207,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 1.1 To 2.0 Cm",,17272,CPT,Facility,Inpatient,,,,281,238.85,80.5346,281,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 1.1 To 2.0 Cm",,17272,CPT,Facility,Outpatient,,,,281,238.85,80.5346,281,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),141.8207,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 1.1 To 2.0 Cm",,17272,CPT,Facility,Inpatient,,,,281,238.85,80.5346,281,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 1.1 To 2.0 Cm",,17272,CPT,Facility,Both,,,,281,238.85,80.5346,281,UnitedHealthcare,Individual & Family,264.14,94,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 1.1 To 2.0 Cm",,17272,CPT,Facility,Outpatient,,,,281,238.85,80.5346,281,UnitedHealthcare,Medicare Advantage,137.69,49,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 1.1 To 2.0 Cm",,17272,CPT,Facility,Inpatient,,,,281,238.85,80.5346,281,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 1.1 To 2.0 Cm",,17272,CPT,Facility,Outpatient,,,,281,238.85,80.5346,281,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,134.88,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 1.1 To 2.0 Cm",,17272,CPT,Facility,Inpatient,,,,281,238.85,80.5346,281,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 1.1 To 2.0 Cm (Procah)",,17272,CPT,Professional,Both,,,,390,331.5,76.13,390,Aetna,Commercial,331.5,85,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 1.1 To 2.0 Cm (Procah)",,17272,CPT,Professional,Both,,,,390,331.5,76.13,390,Aetna,Medicare Advantage,118.97,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 1.1 To 2.0 Cm (Procah)",,17272,CPT,Professional,Both,,,,390,331.5,76.13,390,Aetna,PPO,362.7,93,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 1.1 To 2.0 Cm (Procah)",,17272,CPT,Professional,Both,,,,390,331.5,76.13,390,America's PPO,America's PPO,333.216,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 1.1 To 2.0 Cm (Procah)",,17272,CPT,Professional,Both,,,,390,331.5,76.13,390,BlueCross BlueShield Minnesota, Federal Employee Program,247.21,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 1.1 To 2.0 Cm (Procah)",,17272,CPT,Professional,Both,,,,390,331.5,76.13,390,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,251.16536,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 1.1 To 2.0 Cm (Procah)",,17272,CPT,Professional,Both,,,,390,331.5,76.13,390,BlueCross BlueShield Minnesota,High Value Network Plan,251.16536,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 1.1 To 2.0 Cm (Procah)",,17272,CPT,Professional,Both,,,,390,331.5,76.13,390,BlueCross BlueShield Minnesota,Medicare Advantage,136.0795,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 1.1 To 2.0 Cm (Procah)",,17272,CPT,Professional,Both,,,,390,331.5,76.13,390,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,251.16536,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 1.1 To 2.0 Cm (Procah)",,17272,CPT,Professional,Both,,,,390,331.5,76.13,390,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,87.89416,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 1.1 To 2.0 Cm (Procah)",,17272,CPT,Professional,Both,,,,390,331.5,76.13,390,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),136.0795,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 1.1 To 2.0 Cm (Procah)",,17272,CPT,Professional,Both,,,,390,331.5,76.13,390,CorVel,Worker's Compensation,229.499739,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 1.1 To 2.0 Cm (Procah)",,17272,CPT,Professional,Both,,,,390,331.5,76.13,390,First Health Group Corporation,First Health Network,378.3,97,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 1.1 To 2.0 Cm (Procah)",,17272,CPT,Professional,Both,,,,390,331.5,76.13,390,"Health Partners, Inc.",Commercial,248.13,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 1.1 To 2.0 Cm (Procah)",,17272,CPT,Professional,Both,,,,390,331.5,76.13,390,"Health Partners, Inc.",Medicare Advantage,136.0795,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 1.1 To 2.0 Cm (Procah)",,17272,CPT,Professional,Both,,,,390,331.5,76.13,390,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),118.27,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 1.1 To 2.0 Cm (Procah)",,17272,CPT,Professional,Both,,,,390,331.5,76.13,390,"Health Partners, Inc.",State of Minnesota Advantage Program,213.763995,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 1.1 To 2.0 Cm (Procah)",,17272,CPT,Professional,Both,,,,390,331.5,76.13,390,"Health Partners, Inc.",State Public Programs,76.13,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 1.1 To 2.0 Cm (Procah)",,17272,CPT,Professional,Both,,,,390,331.5,76.13,390,Humana Insurance Company,Commercial PPO,118.33,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 1.1 To 2.0 Cm (Procah)",,17272,CPT,Professional,Both,,,,390,331.5,76.13,390,Humana Insurance Company,Medicare PPO,390,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 1.1 To 2.0 Cm (Procah)",,17272,CPT,Professional,Both,,,,390,331.5,76.13,390,Medica,Individual & Family,330.72,84.8,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 1.1 To 2.0 Cm (Procah)",,17272,CPT,Professional,Both,,,,390,331.5,76.13,390,Medica,Medica Advantage Solution,194.22,49.8,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 1.1 To 2.0 Cm (Procah)",,17272,CPT,Professional,Both,,,,390,331.5,76.13,390,Medica,Medical Assistance,87.89,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 1.1 To 2.0 Cm (Procah)",,17272,CPT,Professional,Both,,,,390,331.5,76.13,390,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,118.33,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 1.1 To 2.0 Cm (Procah)",,17272,CPT,Professional,Both,,,,390,331.5,76.13,390,"Multiplan, Inc.","Multiplan, Inc.",366.6,94,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 1.1 To 2.0 Cm (Procah)",,17272,CPT,Professional,Both,,,,390,331.5,76.13,390,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,351.39,90.1,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 1.1 To 2.0 Cm (Procah)",,17272,CPT,Professional,Both,,,,390,331.5,76.13,390,"Preferred One Administrative Services, INC.",PPO,384.54,98.6,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 1.1 To 2.0 Cm (Procah)",,17272,CPT,Professional,Both,,,,390,331.5,76.13,390,PrimeWest Health,Minnesota Senior Health Options (MSHO),136.0795,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 1.1 To 2.0 Cm (Procah)",,17272,CPT,Professional,Both,,,,390,331.5,76.13,390,PrimeWest Health,MinnesotaCare,94.0467512,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 1.1 To 2.0 Cm (Procah)",,17272,CPT,Professional,Both,,,,390,331.5,76.13,390,Sanford Health Plan,Sanford Health Plan,343.2,88,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 1.1 To 2.0 Cm (Procah)",,17272,CPT,Professional,Both,,,,390,331.5,76.13,390,"UCare Health, Inc.",Individual & Family Plan,192.357248,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 1.1 To 2.0 Cm (Procah)",,17272,CPT,Professional,Both,,,,390,331.5,76.13,390,"UCare Health, Inc.",Medical Assistance,96.683576,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 1.1 To 2.0 Cm (Procah)",,17272,CPT,Professional,Both,,,,390,331.5,76.13,390,"UCare Health, Inc.",Medicare Advantage,136.0795,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 1.1 To 2.0 Cm (Procah)",,17272,CPT,Professional,Both,,,,390,331.5,76.13,390,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),108.8636,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 1.1 To 2.0 Cm (Procah)",,17272,CPT,Professional,Both,,,,390,331.5,76.13,390,UnitedHealthcare,Individual & Family,390,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 1.1 To 2.0 Cm (Procah)",,17272,CPT,Professional,Both,,,,390,331.5,76.13,390,UnitedHealthcare,Medicare Advantage,136.0795,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 1.1 To 2.0 Cm (Procah)",,17272,CPT,Professional,Both,,,,390,331.5,76.13,390,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,87.89416,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia;2.1 To 3.0 C",,17273,CPT,Facility,Both,,,,326,277.1,93.4316,326,Aetna,Commercial,299.92,92,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia;2.1 To 3.0 C",,17273,CPT,Facility,Outpatient,,,,326,277.1,93.4316,326,Aetna,Medicare Advantage,159.74,49,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia;2.1 To 3.0 C",,17273,CPT,Facility,Inpatient,,,,326,277.1,93.4316,326,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia;2.1 To 3.0 C",,17273,CPT,Facility,Both,,,,326,277.1,93.4316,326,Aetna,PPO,303.18,93,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia;2.1 To 3.0 C",,17273,CPT,Facility,Both,,,,326,277.1,93.4316,326,America's PPO,America's PPO,313.0578,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia;2.1 To 3.0 C",,17273,CPT,Facility,Both,,,,326,277.1,93.4316,326,BlueCross BlueShield Minnesota, Federal Employee Program,320.784,98.4,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia;2.1 To 3.0 C",,17273,CPT,Facility,Both,,,,326,277.1,93.4316,326,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,326,100,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia;2.1 To 3.0 C",,17273,CPT,Facility,Both,,,,326,277.1,93.4316,326,BlueCross BlueShield Minnesota,High Value Network Plan,293.4,90,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia;2.1 To 3.0 C",,17273,CPT,Facility,Outpatient,,,,326,277.1,93.4316,326,BlueCross BlueShield Minnesota,Medicare Advantage,159.74,49,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia;2.1 To 3.0 C",,17273,CPT,Facility,Inpatient,,,,326,277.1,93.4316,326,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia;2.1 To 3.0 C",,17273,CPT,Facility,Both,,,,326,277.1,93.4316,326,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,288.7382,88.57,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia;2.1 To 3.0 C",,17273,CPT,Facility,Both,,,,326,277.1,93.4316,326,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,93.4316,28.66,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia;2.1 To 3.0 C",,17273,CPT,Facility,Outpatient,,,,326,277.1,93.4316,326,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),159.74,49,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia;2.1 To 3.0 C",,17273,CPT,Facility,Inpatient,,,,326,277.1,93.4316,326,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia;2.1 To 3.0 C",,17273,CPT,Facility,Both,,,,326,277.1,93.4316,326,CorVel,Worker's Compensation,326,100,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia;2.1 To 3.0 C",,17273,CPT,Facility,Both,,,,326,277.1,93.4316,326,First Health Group Corporation,First Health Network,316.22,97,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia;2.1 To 3.0 C",,17273,CPT,Facility,Both,,,,326,277.1,93.4316,326,"Health Partners, Inc.",Commercial,308.396,94.6,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia;2.1 To 3.0 C",,17273,CPT,Facility,Outpatient,,,,326,277.1,93.4316,326,"Health Partners, Inc.",Medicare Advantage,159.74,49,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia;2.1 To 3.0 C",,17273,CPT,Facility,Inpatient,,,,326,277.1,93.4316,326,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia;2.1 To 3.0 C",,17273,CPT,Facility,Both,,,,326,277.1,93.4316,326,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),195.6,60,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia;2.1 To 3.0 C",,17273,CPT,Facility,Both,,,,326,277.1,93.4316,326,"Health Partners, Inc.",State of Minnesota Advantage Program,265.69,81.5,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia;2.1 To 3.0 C",,17273,CPT,Facility,Both,,,,326,277.1,93.4316,326,"Health Partners, Inc.",State Public Programs,163,50,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia;2.1 To 3.0 C",,17273,CPT,Facility,Both,,,,326,277.1,93.4316,326,Humana Insurance Company,Commercial PPO,309.7,95,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia;2.1 To 3.0 C",,17273,CPT,Facility,Outpatient,,,,326,277.1,93.4316,326,Humana Insurance Company,Medicare PPO,159.74,49,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia;2.1 To 3.0 C",,17273,CPT,Facility,Inpatient,,,,326,277.1,93.4316,326,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia;2.1 To 3.0 C",,17273,CPT,Facility,Both,,,,326,277.1,93.4316,326,Medica,Individual & Family,323.066,99.1,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia;2.1 To 3.0 C",,17273,CPT,Facility,Outpatient,,,,326,277.1,93.4316,326,Medica,Medica Advantage Solution,162.348,49.8,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia;2.1 To 3.0 C",,17273,CPT,Facility,Inpatient,,,,326,277.1,93.4316,326,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia;2.1 To 3.0 C",,17273,CPT,Facility,Outpatient,,,,326,277.1,93.4316,326,Medica,Medical Assistance,145.396,44.6,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia;2.1 To 3.0 C",,17273,CPT,Facility,Inpatient,,,,326,277.1,93.4316,326,Medica,Medical Assistance,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia;2.1 To 3.0 C",,17273,CPT,Facility,Outpatient,,,,326,277.1,93.4316,326,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,162.348,49.8,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia;2.1 To 3.0 C",,17273,CPT,Facility,Inpatient,,,,326,277.1,93.4316,326,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia;2.1 To 3.0 C",,17273,CPT,Facility,Both,,,,326,277.1,93.4316,326,"Multiplan, Inc.","Multiplan, Inc.",306.44,94,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia;2.1 To 3.0 C",,17273,CPT,Facility,Outpatient,,,,326,277.1,93.4316,326,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,293.726,90.1,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia;2.1 To 3.0 C",,17273,CPT,Facility,Inpatient,,,,326,277.1,93.4316,326,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia;2.1 To 3.0 C",,17273,CPT,Facility,Both,,,,326,277.1,93.4316,326,"Preferred One Administrative Services, INC.",PPO,321.436,98.6,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia;2.1 To 3.0 C",,17273,CPT,Facility,Outpatient,,,,326,277.1,93.4316,326,PrimeWest Health,Minnesota Senior Health Options (MSHO),167.727,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia;2.1 To 3.0 C",,17273,CPT,Facility,Inpatient,,,,326,277.1,93.4316,326,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia;2.1 To 3.0 C",,17273,CPT,Facility,Outpatient,,,,326,277.1,93.4316,326,PrimeWest Health,MinnesotaCare,167.4336,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia;2.1 To 3.0 C",,17273,CPT,Facility,Inpatient,,,,326,277.1,93.4316,326,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia;2.1 To 3.0 C",,17273,CPT,Facility,Both,,,,326,277.1,93.4316,326,Sanford Health Plan,Sanford Health Plan,299.92,92,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia;2.1 To 3.0 C",,17273,CPT,Facility,Outpatient,,,,326,277.1,93.4316,326,"UCare Health, Inc.",Individual & Family Plan,183.701,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia;2.1 To 3.0 C",,17273,CPT,Facility,Inpatient,,,,326,277.1,93.4316,326,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia;2.1 To 3.0 C",,17273,CPT,Facility,Outpatient,,,,326,277.1,93.4316,326,"UCare Health, Inc.",Medical Assistance,164.5322,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia;2.1 To 3.0 C",,17273,CPT,Facility,Inpatient,,,,326,277.1,93.4316,326,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia;2.1 To 3.0 C",,17273,CPT,Facility,Outpatient,,,,326,277.1,93.4316,326,"UCare Health, Inc.",Medicare Advantage,164.5322,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia;2.1 To 3.0 C",,17273,CPT,Facility,Inpatient,,,,326,277.1,93.4316,326,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia;2.1 To 3.0 C",,17273,CPT,Facility,Outpatient,,,,326,277.1,93.4316,326,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),164.5322,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia;2.1 To 3.0 C",,17273,CPT,Facility,Inpatient,,,,326,277.1,93.4316,326,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia;2.1 To 3.0 C",,17273,CPT,Facility,Both,,,,326,277.1,93.4316,326,UnitedHealthcare,Individual & Family,306.44,94,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia;2.1 To 3.0 C",,17273,CPT,Facility,Outpatient,,,,326,277.1,93.4316,326,UnitedHealthcare,Medicare Advantage,159.74,49,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia;2.1 To 3.0 C",,17273,CPT,Facility,Inpatient,,,,326,277.1,93.4316,326,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia;2.1 To 3.0 C",,17273,CPT,Facility,Outpatient,,,,326,277.1,93.4316,326,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,156.48,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia;2.1 To 3.0 C",,17273,CPT,Facility,Inpatient,,,,326,277.1,93.4316,326,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia;2.1 To 3.0 Cm (Pro Cah)",,17273,CPT,Professional,Both,,,,435,369.75,85.95,435,Aetna,Commercial,369.75,85,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia;2.1 To 3.0 Cm (Pro Cah)",,17273,CPT,Professional,Both,,,,435,369.75,85.95,435,Aetna,Medicare Advantage,134.89,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia;2.1 To 3.0 Cm (Pro Cah)",,17273,CPT,Professional,Both,,,,435,369.75,85.95,435,Aetna,PPO,404.55,93,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia;2.1 To 3.0 Cm (Pro Cah)",,17273,CPT,Professional,Both,,,,435,369.75,85.95,435,America's PPO,America's PPO,371.664,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia;2.1 To 3.0 Cm (Pro Cah)",,17273,CPT,Professional,Both,,,,435,369.75,85.95,435,BlueCross BlueShield Minnesota, Federal Employee Program,279.57,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia;2.1 To 3.0 Cm (Pro Cah)",,17273,CPT,Professional,Both,,,,435,369.75,85.95,435,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,284.04312,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia;2.1 To 3.0 Cm (Pro Cah)",,17273,CPT,Professional,Both,,,,435,369.75,85.95,435,BlueCross BlueShield Minnesota,High Value Network Plan,284.04312,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia;2.1 To 3.0 Cm (Pro Cah)",,17273,CPT,Professional,Both,,,,435,369.75,85.95,435,BlueCross BlueShield Minnesota,Medicare Advantage,153.732,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia;2.1 To 3.0 Cm (Pro Cah)",,17273,CPT,Professional,Both,,,,435,369.75,85.95,435,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,284.04312,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia;2.1 To 3.0 Cm (Pro Cah)",,17273,CPT,Professional,Both,,,,435,369.75,85.95,435,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,99.23272,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia;2.1 To 3.0 Cm (Pro Cah)",,17273,CPT,Professional,Both,,,,435,369.75,85.95,435,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),153.732,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia;2.1 To 3.0 Cm (Pro Cah)",,17273,CPT,Professional,Both,,,,435,369.75,85.95,435,CorVel,Worker's Compensation,259.6684728,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia;2.1 To 3.0 Cm (Pro Cah)",,17273,CPT,Professional,Both,,,,435,369.75,85.95,435,First Health Group Corporation,First Health Network,421.95,97,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia;2.1 To 3.0 Cm (Pro Cah)",,17273,CPT,Professional,Both,,,,435,369.75,85.95,435,"Health Partners, Inc.",Commercial,280.05,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia;2.1 To 3.0 Cm (Pro Cah)",,17273,CPT,Professional,Both,,,,435,369.75,85.95,435,"Health Partners, Inc.",Medicare Advantage,153.732,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia;2.1 To 3.0 Cm (Pro Cah)",,17273,CPT,Professional,Both,,,,435,369.75,85.95,435,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),133.52,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia;2.1 To 3.0 Cm (Pro Cah)",,17273,CPT,Professional,Both,,,,435,369.75,85.95,435,"Health Partners, Inc.",State of Minnesota Advantage Program,241.263075,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia;2.1 To 3.0 Cm (Pro Cah)",,17273,CPT,Professional,Both,,,,435,369.75,85.95,435,"Health Partners, Inc.",State Public Programs,85.95,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia;2.1 To 3.0 Cm (Pro Cah)",,17273,CPT,Professional,Both,,,,435,369.75,85.95,435,Humana Insurance Company,Commercial PPO,133.68,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia;2.1 To 3.0 Cm (Pro Cah)",,17273,CPT,Professional,Both,,,,435,369.75,85.95,435,Humana Insurance Company,Medicare PPO,435,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia;2.1 To 3.0 Cm (Pro Cah)",,17273,CPT,Professional,Both,,,,435,369.75,85.95,435,Medica,Individual & Family,368.88,84.8,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia;2.1 To 3.0 Cm (Pro Cah)",,17273,CPT,Professional,Both,,,,435,369.75,85.95,435,Medica,Medica Advantage Solution,216.63,49.8,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia;2.1 To 3.0 Cm (Pro Cah)",,17273,CPT,Professional,Both,,,,435,369.75,85.95,435,Medica,Medical Assistance,99.23,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia;2.1 To 3.0 Cm (Pro Cah)",,17273,CPT,Professional,Both,,,,435,369.75,85.95,435,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,133.68,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia;2.1 To 3.0 Cm (Pro Cah)",,17273,CPT,Professional,Both,,,,435,369.75,85.95,435,"Multiplan, Inc.","Multiplan, Inc.",408.9,94,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia;2.1 To 3.0 Cm (Pro Cah)",,17273,CPT,Professional,Both,,,,435,369.75,85.95,435,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,391.935,90.1,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia;2.1 To 3.0 Cm (Pro Cah)",,17273,CPT,Professional,Both,,,,435,369.75,85.95,435,"Preferred One Administrative Services, INC.",PPO,428.91,98.6,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia;2.1 To 3.0 Cm (Pro Cah)",,17273,CPT,Professional,Both,,,,435,369.75,85.95,435,PrimeWest Health,Minnesota Senior Health Options (MSHO),153.732,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia;2.1 To 3.0 Cm (Pro Cah)",,17273,CPT,Professional,Both,,,,435,369.75,85.95,435,PrimeWest Health,MinnesotaCare,106.1790104,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia;2.1 To 3.0 Cm (Pro Cah)",,17273,CPT,Professional,Both,,,,435,369.75,85.95,435,Sanford Health Plan,Sanford Health Plan,382.8,88,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia;2.1 To 3.0 Cm (Pro Cah)",,17273,CPT,Professional,Both,,,,435,369.75,85.95,435,"UCare Health, Inc.",Individual & Family Plan,217.310208,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia;2.1 To 3.0 Cm (Pro Cah)",,17273,CPT,Professional,Both,,,,435,369.75,85.95,435,"UCare Health, Inc.",Medical Assistance,109.155992,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia;2.1 To 3.0 Cm (Pro Cah)",,17273,CPT,Professional,Both,,,,435,369.75,85.95,435,"UCare Health, Inc.",Medicare Advantage,153.732,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia;2.1 To 3.0 Cm (Pro Cah)",,17273,CPT,Professional,Both,,,,435,369.75,85.95,435,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),122.9856,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia;2.1 To 3.0 Cm (Pro Cah)",,17273,CPT,Professional,Both,,,,435,369.75,85.95,435,UnitedHealthcare,Individual & Family,435,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia;2.1 To 3.0 Cm (Pro Cah)",,17273,CPT,Professional,Both,,,,435,369.75,85.95,435,UnitedHealthcare,Medicare Advantage,153.732,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia;2.1 To 3.0 Cm (Pro Cah)",,17273,CPT,Professional,Both,,,,435,369.75,85.95,435,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,99.23272,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 3.1 To 4.0 Cm",,17274,CPT,Facility,Both,,,,408,346.8,116.9328,408,Aetna,Commercial,375.36,92,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 3.1 To 4.0 Cm",,17274,CPT,Facility,Outpatient,,,,408,346.8,116.9328,408,Aetna,Medicare Advantage,199.92,49,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 3.1 To 4.0 Cm",,17274,CPT,Facility,Inpatient,,,,408,346.8,116.9328,408,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 3.1 To 4.0 Cm",,17274,CPT,Facility,Both,,,,408,346.8,116.9328,408,Aetna,PPO,379.44,93,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 3.1 To 4.0 Cm",,17274,CPT,Facility,Both,,,,408,346.8,116.9328,408,America's PPO,America's PPO,391.8024,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 3.1 To 4.0 Cm",,17274,CPT,Facility,Both,,,,408,346.8,116.9328,408,BlueCross BlueShield Minnesota, Federal Employee Program,401.472,98.4,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 3.1 To 4.0 Cm",,17274,CPT,Facility,Both,,,,408,346.8,116.9328,408,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,408,100,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 3.1 To 4.0 Cm",,17274,CPT,Facility,Both,,,,408,346.8,116.9328,408,BlueCross BlueShield Minnesota,High Value Network Plan,367.2,90,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 3.1 To 4.0 Cm",,17274,CPT,Facility,Outpatient,,,,408,346.8,116.9328,408,BlueCross BlueShield Minnesota,Medicare Advantage,199.92,49,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 3.1 To 4.0 Cm",,17274,CPT,Facility,Inpatient,,,,408,346.8,116.9328,408,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 3.1 To 4.0 Cm",,17274,CPT,Facility,Both,,,,408,346.8,116.9328,408,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,361.3656,88.57,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 3.1 To 4.0 Cm",,17274,CPT,Facility,Both,,,,408,346.8,116.9328,408,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,116.9328,28.66,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 3.1 To 4.0 Cm",,17274,CPT,Facility,Outpatient,,,,408,346.8,116.9328,408,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),199.92,49,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 3.1 To 4.0 Cm",,17274,CPT,Facility,Inpatient,,,,408,346.8,116.9328,408,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 3.1 To 4.0 Cm",,17274,CPT,Facility,Both,,,,408,346.8,116.9328,408,CorVel,Worker's Compensation,408,100,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 3.1 To 4.0 Cm",,17274,CPT,Facility,Both,,,,408,346.8,116.9328,408,First Health Group Corporation,First Health Network,395.76,97,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 3.1 To 4.0 Cm",,17274,CPT,Facility,Both,,,,408,346.8,116.9328,408,"Health Partners, Inc.",Commercial,385.968,94.6,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 3.1 To 4.0 Cm",,17274,CPT,Facility,Outpatient,,,,408,346.8,116.9328,408,"Health Partners, Inc.",Medicare Advantage,199.92,49,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 3.1 To 4.0 Cm",,17274,CPT,Facility,Inpatient,,,,408,346.8,116.9328,408,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 3.1 To 4.0 Cm",,17274,CPT,Facility,Both,,,,408,346.8,116.9328,408,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),244.8,60,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 3.1 To 4.0 Cm",,17274,CPT,Facility,Both,,,,408,346.8,116.9328,408,"Health Partners, Inc.",State of Minnesota Advantage Program,332.52,81.5,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 3.1 To 4.0 Cm",,17274,CPT,Facility,Both,,,,408,346.8,116.9328,408,"Health Partners, Inc.",State Public Programs,204,50,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 3.1 To 4.0 Cm",,17274,CPT,Facility,Both,,,,408,346.8,116.9328,408,Humana Insurance Company,Commercial PPO,387.6,95,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 3.1 To 4.0 Cm",,17274,CPT,Facility,Outpatient,,,,408,346.8,116.9328,408,Humana Insurance Company,Medicare PPO,199.92,49,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 3.1 To 4.0 Cm",,17274,CPT,Facility,Inpatient,,,,408,346.8,116.9328,408,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 3.1 To 4.0 Cm",,17274,CPT,Facility,Both,,,,408,346.8,116.9328,408,Medica,Individual & Family,404.328,99.1,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 3.1 To 4.0 Cm",,17274,CPT,Facility,Outpatient,,,,408,346.8,116.9328,408,Medica,Medica Advantage Solution,203.184,49.8,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 3.1 To 4.0 Cm",,17274,CPT,Facility,Inpatient,,,,408,346.8,116.9328,408,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 3.1 To 4.0 Cm",,17274,CPT,Facility,Outpatient,,,,408,346.8,116.9328,408,Medica,Medical Assistance,181.968,44.6,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 3.1 To 4.0 Cm",,17274,CPT,Facility,Inpatient,,,,408,346.8,116.9328,408,Medica,Medical Assistance,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 3.1 To 4.0 Cm",,17274,CPT,Facility,Outpatient,,,,408,346.8,116.9328,408,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,203.184,49.8,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 3.1 To 4.0 Cm",,17274,CPT,Facility,Inpatient,,,,408,346.8,116.9328,408,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 3.1 To 4.0 Cm",,17274,CPT,Facility,Both,,,,408,346.8,116.9328,408,"Multiplan, Inc.","Multiplan, Inc.",383.52,94,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 3.1 To 4.0 Cm",,17274,CPT,Facility,Outpatient,,,,408,346.8,116.9328,408,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,367.608,90.1,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 3.1 To 4.0 Cm",,17274,CPT,Facility,Inpatient,,,,408,346.8,116.9328,408,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 3.1 To 4.0 Cm",,17274,CPT,Facility,Both,,,,408,346.8,116.9328,408,"Preferred One Administrative Services, INC.",PPO,402.288,98.6,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 3.1 To 4.0 Cm",,17274,CPT,Facility,Outpatient,,,,408,346.8,116.9328,408,PrimeWest Health,Minnesota Senior Health Options (MSHO),209.916,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 3.1 To 4.0 Cm",,17274,CPT,Facility,Inpatient,,,,408,346.8,116.9328,408,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 3.1 To 4.0 Cm",,17274,CPT,Facility,Outpatient,,,,408,346.8,116.9328,408,PrimeWest Health,MinnesotaCare,209.5488,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 3.1 To 4.0 Cm",,17274,CPT,Facility,Inpatient,,,,408,346.8,116.9328,408,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 3.1 To 4.0 Cm",,17274,CPT,Facility,Both,,,,408,346.8,116.9328,408,Sanford Health Plan,Sanford Health Plan,375.36,92,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 3.1 To 4.0 Cm",,17274,CPT,Facility,Outpatient,,,,408,346.8,116.9328,408,"UCare Health, Inc.",Individual & Family Plan,229.908,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 3.1 To 4.0 Cm",,17274,CPT,Facility,Inpatient,,,,408,346.8,116.9328,408,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 3.1 To 4.0 Cm",,17274,CPT,Facility,Outpatient,,,,408,346.8,116.9328,408,"UCare Health, Inc.",Medical Assistance,205.9176,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 3.1 To 4.0 Cm",,17274,CPT,Facility,Inpatient,,,,408,346.8,116.9328,408,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 3.1 To 4.0 Cm",,17274,CPT,Facility,Outpatient,,,,408,346.8,116.9328,408,"UCare Health, Inc.",Medicare Advantage,205.9176,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 3.1 To 4.0 Cm",,17274,CPT,Facility,Inpatient,,,,408,346.8,116.9328,408,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 3.1 To 4.0 Cm",,17274,CPT,Facility,Outpatient,,,,408,346.8,116.9328,408,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),205.9176,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 3.1 To 4.0 Cm",,17274,CPT,Facility,Inpatient,,,,408,346.8,116.9328,408,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 3.1 To 4.0 Cm",,17274,CPT,Facility,Both,,,,408,346.8,116.9328,408,UnitedHealthcare,Individual & Family,383.52,94,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 3.1 To 4.0 Cm",,17274,CPT,Facility,Outpatient,,,,408,346.8,116.9328,408,UnitedHealthcare,Medicare Advantage,199.92,49,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 3.1 To 4.0 Cm",,17274,CPT,Facility,Inpatient,,,,408,346.8,116.9328,408,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 3.1 To 4.0 Cm",,17274,CPT,Facility,Outpatient,,,,408,346.8,116.9328,408,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,195.84,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 3.1 To 4.0 Cm",,17274,CPT,Facility,Inpatient,,,,408,346.8,116.9328,408,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 3.1 To 4.0 Cm (Procah)",,17274,CPT,Professional,Both,,,,535,454.75,105.14,535,Aetna,Commercial,454.75,85,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 3.1 To 4.0 Cm (Procah)",,17274,CPT,Professional,Both,,,,535,454.75,105.14,535,Aetna,Medicare Advantage,164.48,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 3.1 To 4.0 Cm (Procah)",,17274,CPT,Professional,Both,,,,535,454.75,105.14,535,Aetna,PPO,497.55,93,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 3.1 To 4.0 Cm (Procah)",,17274,CPT,Professional,Both,,,,535,454.75,105.14,535,America's PPO,America's PPO,457.104,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 3.1 To 4.0 Cm (Procah)",,17274,CPT,Professional,Both,,,,535,454.75,105.14,535,BlueCross BlueShield Minnesota, Federal Employee Program,342.23,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 3.1 To 4.0 Cm (Procah)",,17274,CPT,Professional,Both,,,,535,454.75,105.14,535,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,347.70568,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 3.1 To 4.0 Cm (Procah)",,17274,CPT,Professional,Both,,,,535,454.75,105.14,535,BlueCross BlueShield Minnesota,High Value Network Plan,347.70568,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 3.1 To 4.0 Cm (Procah)",,17274,CPT,Professional,Both,,,,535,454.75,105.14,535,BlueCross BlueShield Minnesota,Medicare Advantage,188.117,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 3.1 To 4.0 Cm (Procah)",,17274,CPT,Professional,Both,,,,535,454.75,105.14,535,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,347.70568,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 3.1 To 4.0 Cm (Procah)",,17274,CPT,Professional,Both,,,,535,454.75,105.14,535,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,121.39168,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 3.1 To 4.0 Cm (Procah)",,17274,CPT,Professional,Both,,,,535,454.75,105.14,535,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),188.117,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 3.1 To 4.0 Cm (Procah)",,17274,CPT,Professional,Both,,,,535,454.75,105.14,535,CorVel,Worker's Compensation,317.3016762,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 3.1 To 4.0 Cm (Procah)",,17274,CPT,Professional,Both,,,,535,454.75,105.14,535,First Health Group Corporation,First Health Network,518.95,97,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 3.1 To 4.0 Cm (Procah)",,17274,CPT,Professional,Both,,,,535,454.75,105.14,535,"Health Partners, Inc.",Commercial,343.17,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 3.1 To 4.0 Cm (Procah)",,17274,CPT,Professional,Both,,,,535,454.75,105.14,535,"Health Partners, Inc.",Medicare Advantage,188.117,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 3.1 To 4.0 Cm (Procah)",,17274,CPT,Professional,Both,,,,535,454.75,105.14,535,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),163.68,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 3.1 To 4.0 Cm (Procah)",,17274,CPT,Professional,Both,,,,535,454.75,105.14,535,"Health Partners, Inc.",State of Minnesota Advantage Program,295.640955,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 3.1 To 4.0 Cm (Procah)",,17274,CPT,Professional,Both,,,,535,454.75,105.14,535,"Health Partners, Inc.",State Public Programs,105.14,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 3.1 To 4.0 Cm (Procah)",,17274,CPT,Professional,Both,,,,535,454.75,105.14,535,Humana Insurance Company,Commercial PPO,163.58,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 3.1 To 4.0 Cm (Procah)",,17274,CPT,Professional,Both,,,,535,454.75,105.14,535,Humana Insurance Company,Medicare PPO,535,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 3.1 To 4.0 Cm (Procah)",,17274,CPT,Professional,Both,,,,535,454.75,105.14,535,Medica,Individual & Family,453.68,84.8,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 3.1 To 4.0 Cm (Procah)",,17274,CPT,Professional,Both,,,,535,454.75,105.14,535,Medica,Medica Advantage Solution,266.43,49.8,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 3.1 To 4.0 Cm (Procah)",,17274,CPT,Professional,Both,,,,535,454.75,105.14,535,Medica,Medical Assistance,121.39,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 3.1 To 4.0 Cm (Procah)",,17274,CPT,Professional,Both,,,,535,454.75,105.14,535,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,163.58,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 3.1 To 4.0 Cm (Procah)",,17274,CPT,Professional,Both,,,,535,454.75,105.14,535,"Multiplan, Inc.","Multiplan, Inc.",502.9,94,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 3.1 To 4.0 Cm (Procah)",,17274,CPT,Professional,Both,,,,535,454.75,105.14,535,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,482.035,90.1,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 3.1 To 4.0 Cm (Procah)",,17274,CPT,Professional,Both,,,,535,454.75,105.14,535,"Preferred One Administrative Services, INC.",PPO,527.51,98.6,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 3.1 To 4.0 Cm (Procah)",,17274,CPT,Professional,Both,,,,535,454.75,105.14,535,PrimeWest Health,Minnesota Senior Health Options (MSHO),188.117,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 3.1 To 4.0 Cm (Procah)",,17274,CPT,Professional,Both,,,,535,454.75,105.14,535,PrimeWest Health,MinnesotaCare,129.8890976,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 3.1 To 4.0 Cm (Procah)",,17274,CPT,Professional,Both,,,,535,454.75,105.14,535,Sanford Health Plan,Sanford Health Plan,470.8,88,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 3.1 To 4.0 Cm (Procah)",,17274,CPT,Professional,Both,,,,535,454.75,105.14,535,"UCare Health, Inc.",Individual & Family Plan,265.915648,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 3.1 To 4.0 Cm (Procah)",,17274,CPT,Professional,Both,,,,535,454.75,105.14,535,"UCare Health, Inc.",Medical Assistance,133.530848,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 3.1 To 4.0 Cm (Procah)",,17274,CPT,Professional,Both,,,,535,454.75,105.14,535,"UCare Health, Inc.",Medicare Advantage,188.117,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 3.1 To 4.0 Cm (Procah)",,17274,CPT,Professional,Both,,,,535,454.75,105.14,535,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),150.4936,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 3.1 To 4.0 Cm (Procah)",,17274,CPT,Professional,Both,,,,535,454.75,105.14,535,UnitedHealthcare,Individual & Family,535,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 3.1 To 4.0 Cm (Procah)",,17274,CPT,Professional,Both,,,,535,454.75,105.14,535,UnitedHealthcare,Medicare Advantage,188.117,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; 3.1 To 4.0 Cm (Procah)",,17274,CPT,Professional,Both,,,,535,454.75,105.14,535,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,121.39168,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Over 4.0 Cm",,17276,CPT,Facility,Both,,,,411,349.35,117.7926,411,Aetna,Commercial,378.12,92,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Over 4.0 Cm",,17276,CPT,Facility,Outpatient,,,,411,349.35,117.7926,411,Aetna,Medicare Advantage,201.39,49,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Over 4.0 Cm",,17276,CPT,Facility,Inpatient,,,,411,349.35,117.7926,411,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Over 4.0 Cm",,17276,CPT,Facility,Both,,,,411,349.35,117.7926,411,Aetna,PPO,382.23,93,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Over 4.0 Cm",,17276,CPT,Facility,Both,,,,411,349.35,117.7926,411,America's PPO,America's PPO,394.6833,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Over 4.0 Cm",,17276,CPT,Facility,Both,,,,411,349.35,117.7926,411,BlueCross BlueShield Minnesota, Federal Employee Program,404.424,98.4,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Over 4.0 Cm",,17276,CPT,Facility,Both,,,,411,349.35,117.7926,411,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,411,100,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Over 4.0 Cm",,17276,CPT,Facility,Both,,,,411,349.35,117.7926,411,BlueCross BlueShield Minnesota,High Value Network Plan,369.9,90,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Over 4.0 Cm",,17276,CPT,Facility,Outpatient,,,,411,349.35,117.7926,411,BlueCross BlueShield Minnesota,Medicare Advantage,201.39,49,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Over 4.0 Cm",,17276,CPT,Facility,Inpatient,,,,411,349.35,117.7926,411,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Over 4.0 Cm",,17276,CPT,Facility,Both,,,,411,349.35,117.7926,411,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,364.0227,88.57,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Over 4.0 Cm",,17276,CPT,Facility,Both,,,,411,349.35,117.7926,411,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,117.7926,28.66,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Over 4.0 Cm",,17276,CPT,Facility,Outpatient,,,,411,349.35,117.7926,411,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),201.39,49,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Over 4.0 Cm",,17276,CPT,Facility,Inpatient,,,,411,349.35,117.7926,411,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Over 4.0 Cm",,17276,CPT,Facility,Both,,,,411,349.35,117.7926,411,CorVel,Worker's Compensation,411,100,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Over 4.0 Cm",,17276,CPT,Facility,Both,,,,411,349.35,117.7926,411,First Health Group Corporation,First Health Network,398.67,97,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Over 4.0 Cm",,17276,CPT,Facility,Both,,,,411,349.35,117.7926,411,"Health Partners, Inc.",Commercial,388.806,94.6,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Over 4.0 Cm",,17276,CPT,Facility,Outpatient,,,,411,349.35,117.7926,411,"Health Partners, Inc.",Medicare Advantage,201.39,49,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Over 4.0 Cm",,17276,CPT,Facility,Inpatient,,,,411,349.35,117.7926,411,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Over 4.0 Cm",,17276,CPT,Facility,Both,,,,411,349.35,117.7926,411,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),246.6,60,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Over 4.0 Cm",,17276,CPT,Facility,Both,,,,411,349.35,117.7926,411,"Health Partners, Inc.",State of Minnesota Advantage Program,334.965,81.5,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Over 4.0 Cm",,17276,CPT,Facility,Both,,,,411,349.35,117.7926,411,"Health Partners, Inc.",State Public Programs,205.5,50,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Over 4.0 Cm",,17276,CPT,Facility,Both,,,,411,349.35,117.7926,411,Humana Insurance Company,Commercial PPO,390.45,95,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Over 4.0 Cm",,17276,CPT,Facility,Outpatient,,,,411,349.35,117.7926,411,Humana Insurance Company,Medicare PPO,201.39,49,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Over 4.0 Cm",,17276,CPT,Facility,Inpatient,,,,411,349.35,117.7926,411,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Over 4.0 Cm",,17276,CPT,Facility,Both,,,,411,349.35,117.7926,411,Medica,Individual & Family,407.301,99.1,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Over 4.0 Cm",,17276,CPT,Facility,Outpatient,,,,411,349.35,117.7926,411,Medica,Medica Advantage Solution,204.678,49.8,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Over 4.0 Cm",,17276,CPT,Facility,Inpatient,,,,411,349.35,117.7926,411,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Over 4.0 Cm",,17276,CPT,Facility,Outpatient,,,,411,349.35,117.7926,411,Medica,Medical Assistance,183.306,44.6,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Over 4.0 Cm",,17276,CPT,Facility,Inpatient,,,,411,349.35,117.7926,411,Medica,Medical Assistance,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Over 4.0 Cm",,17276,CPT,Facility,Outpatient,,,,411,349.35,117.7926,411,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,204.678,49.8,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Over 4.0 Cm",,17276,CPT,Facility,Inpatient,,,,411,349.35,117.7926,411,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Over 4.0 Cm",,17276,CPT,Facility,Both,,,,411,349.35,117.7926,411,"Multiplan, Inc.","Multiplan, Inc.",386.34,94,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Over 4.0 Cm",,17276,CPT,Facility,Outpatient,,,,411,349.35,117.7926,411,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,370.311,90.1,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Over 4.0 Cm",,17276,CPT,Facility,Inpatient,,,,411,349.35,117.7926,411,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Over 4.0 Cm",,17276,CPT,Facility,Both,,,,411,349.35,117.7926,411,"Preferred One Administrative Services, INC.",PPO,405.246,98.6,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Over 4.0 Cm",,17276,CPT,Facility,Outpatient,,,,411,349.35,117.7926,411,PrimeWest Health,Minnesota Senior Health Options (MSHO),211.4595,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Over 4.0 Cm",,17276,CPT,Facility,Inpatient,,,,411,349.35,117.7926,411,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Over 4.0 Cm",,17276,CPT,Facility,Outpatient,,,,411,349.35,117.7926,411,PrimeWest Health,MinnesotaCare,211.0896,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Over 4.0 Cm",,17276,CPT,Facility,Inpatient,,,,411,349.35,117.7926,411,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Over 4.0 Cm",,17276,CPT,Facility,Both,,,,411,349.35,117.7926,411,Sanford Health Plan,Sanford Health Plan,378.12,92,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Over 4.0 Cm",,17276,CPT,Facility,Outpatient,,,,411,349.35,117.7926,411,"UCare Health, Inc.",Individual & Family Plan,231.5985,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Over 4.0 Cm",,17276,CPT,Facility,Inpatient,,,,411,349.35,117.7926,411,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Over 4.0 Cm",,17276,CPT,Facility,Outpatient,,,,411,349.35,117.7926,411,"UCare Health, Inc.",Medical Assistance,207.4317,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Over 4.0 Cm",,17276,CPT,Facility,Inpatient,,,,411,349.35,117.7926,411,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Over 4.0 Cm",,17276,CPT,Facility,Outpatient,,,,411,349.35,117.7926,411,"UCare Health, Inc.",Medicare Advantage,207.4317,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Over 4.0 Cm",,17276,CPT,Facility,Inpatient,,,,411,349.35,117.7926,411,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Over 4.0 Cm",,17276,CPT,Facility,Outpatient,,,,411,349.35,117.7926,411,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),207.4317,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Over 4.0 Cm",,17276,CPT,Facility,Inpatient,,,,411,349.35,117.7926,411,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Over 4.0 Cm",,17276,CPT,Facility,Both,,,,411,349.35,117.7926,411,UnitedHealthcare,Individual & Family,386.34,94,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Over 4.0 Cm",,17276,CPT,Facility,Outpatient,,,,411,349.35,117.7926,411,UnitedHealthcare,Medicare Advantage,201.39,49,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Over 4.0 Cm",,17276,CPT,Facility,Inpatient,,,,411,349.35,117.7926,411,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Over 4.0 Cm",,17276,CPT,Facility,Outpatient,,,,411,349.35,117.7926,411,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,197.28,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Over 4.0 Cm",,17276,CPT,Facility,Inpatient,,,,411,349.35,117.7926,411,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Over 4.0 Cm (Procah)",,17276,CPT,Professional,Both,,,,610,518.5,126.31,610,Aetna,Commercial,518.5,85,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Over 4.0 Cm (Procah)",,17276,CPT,Professional,Both,,,,610,518.5,126.31,610,Aetna,Medicare Advantage,197.81,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Over 4.0 Cm (Procah)",,17276,CPT,Professional,Both,,,,610,518.5,126.31,610,Aetna,PPO,567.3,93,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Over 4.0 Cm (Procah)",,17276,CPT,Professional,Both,,,,610,518.5,126.31,610,America's PPO,America's PPO,521.184,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Over 4.0 Cm (Procah)",,17276,CPT,Professional,Both,,,,610,518.5,126.31,610,BlueCross BlueShield Minnesota, Federal Employee Program,412.47,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Over 4.0 Cm (Procah)",,17276,CPT,Professional,Both,,,,610,518.5,126.31,610,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,419.06952,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Over 4.0 Cm (Procah)",,17276,CPT,Professional,Both,,,,610,518.5,126.31,610,BlueCross BlueShield Minnesota,High Value Network Plan,419.06952,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Over 4.0 Cm (Procah)",,17276,CPT,Professional,Both,,,,610,518.5,126.31,610,BlueCross BlueShield Minnesota,Medicare Advantage,226.0095,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Over 4.0 Cm (Procah)",,17276,CPT,Professional,Both,,,,610,518.5,126.31,610,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,419.06952,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Over 4.0 Cm (Procah)",,17276,CPT,Professional,Both,,,,610,518.5,126.31,610,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,145.82648,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Over 4.0 Cm (Procah)",,17276,CPT,Professional,Both,,,,610,518.5,126.31,610,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),226.0095,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Over 4.0 Cm (Procah)",,17276,CPT,Professional,Both,,,,610,518.5,126.31,610,CorVel,Worker's Compensation,381.2656521,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Over 4.0 Cm (Procah)",,17276,CPT,Professional,Both,,,,610,518.5,126.31,610,First Health Group Corporation,First Health Network,591.7,97,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Over 4.0 Cm (Procah)",,17276,CPT,Professional,Both,,,,610,518.5,126.31,610,"Health Partners, Inc.",Commercial,412.1,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Over 4.0 Cm (Procah)",,17276,CPT,Professional,Both,,,,610,518.5,126.31,610,"Health Partners, Inc.",Medicare Advantage,226.0095,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Over 4.0 Cm (Procah)",,17276,CPT,Professional,Both,,,,610,518.5,126.31,610,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),196.55,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Over 4.0 Cm (Procah)",,17276,CPT,Professional,Both,,,,610,518.5,126.31,610,"Health Partners, Inc.",State of Minnesota Advantage Program,355.02415,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Over 4.0 Cm (Procah)",,17276,CPT,Professional,Both,,,,610,518.5,126.31,610,"Health Partners, Inc.",State Public Programs,126.31,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Over 4.0 Cm (Procah)",,17276,CPT,Professional,Both,,,,610,518.5,126.31,610,Humana Insurance Company,Commercial PPO,196.53,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Over 4.0 Cm (Procah)",,17276,CPT,Professional,Both,,,,610,518.5,126.31,610,Humana Insurance Company,Medicare PPO,610,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Over 4.0 Cm (Procah)",,17276,CPT,Professional,Both,,,,610,518.5,126.31,610,Medica,Individual & Family,517.28,84.8,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Over 4.0 Cm (Procah)",,17276,CPT,Professional,Both,,,,610,518.5,126.31,610,Medica,Medica Advantage Solution,303.78,49.8,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Over 4.0 Cm (Procah)",,17276,CPT,Professional,Both,,,,610,518.5,126.31,610,Medica,Medical Assistance,145.83,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Over 4.0 Cm (Procah)",,17276,CPT,Professional,Both,,,,610,518.5,126.31,610,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,196.53,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Over 4.0 Cm (Procah)",,17276,CPT,Professional,Both,,,,610,518.5,126.31,610,"Multiplan, Inc.","Multiplan, Inc.",573.4,94,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Over 4.0 Cm (Procah)",,17276,CPT,Professional,Both,,,,610,518.5,126.31,610,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,549.61,90.1,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Over 4.0 Cm (Procah)",,17276,CPT,Professional,Both,,,,610,518.5,126.31,610,"Preferred One Administrative Services, INC.",PPO,601.46,98.6,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Over 4.0 Cm (Procah)",,17276,CPT,Professional,Both,,,,610,518.5,126.31,610,PrimeWest Health,Minnesota Senior Health Options (MSHO),226.0095,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Over 4.0 Cm (Procah)",,17276,CPT,Professional,Both,,,,610,518.5,126.31,610,PrimeWest Health,MinnesotaCare,156.0343336,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Over 4.0 Cm (Procah)",,17276,CPT,Professional,Both,,,,610,518.5,126.31,610,Sanford Health Plan,Sanford Health Plan,536.8,88,,percent of total billed charges,,
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Over 4.0 Cm (Procah)",,17276,CPT,Professional,Both,,,,610,518.5,126.31,610,"UCare Health, Inc.",Individual & Family Plan,319.479168,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Over 4.0 Cm (Procah)",,17276,CPT,Professional,Both,,,,610,518.5,126.31,610,"UCare Health, Inc.",Medical Assistance,160.409128,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Over 4.0 Cm (Procah)",,17276,CPT,Professional,Both,,,,610,518.5,126.31,610,"UCare Health, Inc.",Medicare Advantage,226.0095,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Over 4.0 Cm (Procah)",,17276,CPT,Professional,Both,,,,610,518.5,126.31,610,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),180.8076,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Over 4.0 Cm (Procah)",,17276,CPT,Professional,Both,,,,610,518.5,126.31,610,UnitedHealthcare,Individual & Family,610,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Over 4.0 Cm (Procah)",,17276,CPT,Professional,Both,,,,610,518.5,126.31,610,UnitedHealthcare,Medicare Advantage,226.0095,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Destruction, Malignant Lesion, Scalp, Neck, Hands, Feet, Genitalia; Over 4.0 Cm (Procah)",,17276,CPT,Professional,Both,,,,610,518.5,126.31,610,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,145.82648,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Destruction, Malignant Lesion, Face, Ears, Eyelid, Nose, Lips; 0.5Cm Or Less",,17280,CPT,Facility,Both,,,,230,195.5,65.918,230,Aetna,Commercial,211.6,92,,percent of total billed charges,,
"Destruction, Malignant Lesion, Face, Ears, Eyelid, Nose, Lips; 0.5Cm Or Less",,17280,CPT,Facility,Outpatient,,,,230,195.5,65.918,230,Aetna,Medicare Advantage,112.7,49,,percent of total billed charges,,
"Destruction, Malignant Lesion, Face, Ears, Eyelid, Nose, Lips; 0.5Cm Or Less",,17280,CPT,Facility,Inpatient,,,,230,195.5,65.918,230,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Face, Ears, Eyelid, Nose, Lips; 0.5Cm Or Less",,17280,CPT,Facility,Both,,,,230,195.5,65.918,230,Aetna,PPO,213.9,93,,percent of total billed charges,,
"Destruction, Malignant Lesion, Face, Ears, Eyelid, Nose, Lips; 0.5Cm Or Less",,17280,CPT,Facility,Both,,,,230,195.5,65.918,230,America's PPO,America's PPO,220.869,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Destruction, Malignant Lesion, Face, Ears, Eyelid, Nose, Lips; 0.5Cm Or Less",,17280,CPT,Facility,Both,,,,230,195.5,65.918,230,BlueCross BlueShield Minnesota, Federal Employee Program,226.32,98.4,,percent of total billed charges,,
"Destruction, Malignant Lesion, Face, Ears, Eyelid, Nose, Lips; 0.5Cm Or Less",,17280,CPT,Facility,Both,,,,230,195.5,65.918,230,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,230,100,,percent of total billed charges,,
"Destruction, Malignant Lesion, Face, Ears, Eyelid, Nose, Lips; 0.5Cm Or Less",,17280,CPT,Facility,Both,,,,230,195.5,65.918,230,BlueCross BlueShield Minnesota,High Value Network Plan,207,90,,percent of total billed charges,,
"Destruction, Malignant Lesion, Face, Ears, Eyelid, Nose, Lips; 0.5Cm Or Less",,17280,CPT,Facility,Outpatient,,,,230,195.5,65.918,230,BlueCross BlueShield Minnesota,Medicare Advantage,112.7,49,,percent of total billed charges,,
"Destruction, Malignant Lesion, Face, Ears, Eyelid, Nose, Lips; 0.5Cm Or Less",,17280,CPT,Facility,Inpatient,,,,230,195.5,65.918,230,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Face, Ears, Eyelid, Nose, Lips; 0.5Cm Or Less",,17280,CPT,Facility,Both,,,,230,195.5,65.918,230,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,203.711,88.57,,percent of total billed charges,,
"Destruction, Malignant Lesion, Face, Ears, Eyelid, Nose, Lips; 0.5Cm Or Less",,17280,CPT,Facility,Both,,,,230,195.5,65.918,230,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,65.918,28.66,,percent of total billed charges,,
"Destruction, Malignant Lesion, Face, Ears, Eyelid, Nose, Lips; 0.5Cm Or Less",,17280,CPT,Facility,Outpatient,,,,230,195.5,65.918,230,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),112.7,49,,percent of total billed charges,,
"Destruction, Malignant Lesion, Face, Ears, Eyelid, Nose, Lips; 0.5Cm Or Less",,17280,CPT,Facility,Inpatient,,,,230,195.5,65.918,230,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Face, Ears, Eyelid, Nose, Lips; 0.5Cm Or Less",,17280,CPT,Facility,Both,,,,230,195.5,65.918,230,CorVel,Worker's Compensation,230,100,,percent of total billed charges,,
"Destruction, Malignant Lesion, Face, Ears, Eyelid, Nose, Lips; 0.5Cm Or Less",,17280,CPT,Facility,Both,,,,230,195.5,65.918,230,First Health Group Corporation,First Health Network,223.1,97,,percent of total billed charges,,
"Destruction, Malignant Lesion, Face, Ears, Eyelid, Nose, Lips; 0.5Cm Or Less",,17280,CPT,Facility,Both,,,,230,195.5,65.918,230,"Health Partners, Inc.",Commercial,217.58,94.6,,percent of total billed charges,,
"Destruction, Malignant Lesion, Face, Ears, Eyelid, Nose, Lips; 0.5Cm Or Less",,17280,CPT,Facility,Outpatient,,,,230,195.5,65.918,230,"Health Partners, Inc.",Medicare Advantage,112.7,49,,percent of total billed charges,,
"Destruction, Malignant Lesion, Face, Ears, Eyelid, Nose, Lips; 0.5Cm Or Less",,17280,CPT,Facility,Inpatient,,,,230,195.5,65.918,230,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Face, Ears, Eyelid, Nose, Lips; 0.5Cm Or Less",,17280,CPT,Facility,Both,,,,230,195.5,65.918,230,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),138,60,,percent of total billed charges,,
"Destruction, Malignant Lesion, Face, Ears, Eyelid, Nose, Lips; 0.5Cm Or Less",,17280,CPT,Facility,Both,,,,230,195.5,65.918,230,"Health Partners, Inc.",State of Minnesota Advantage Program,187.45,81.5,,percent of total billed charges,,
"Destruction, Malignant Lesion, Face, Ears, Eyelid, Nose, Lips; 0.5Cm Or Less",,17280,CPT,Facility,Both,,,,230,195.5,65.918,230,"Health Partners, Inc.",State Public Programs,115,50,,percent of total billed charges,,
"Destruction, Malignant Lesion, Face, Ears, Eyelid, Nose, Lips; 0.5Cm Or Less",,17280,CPT,Facility,Both,,,,230,195.5,65.918,230,Humana Insurance Company,Commercial PPO,218.5,95,,percent of total billed charges,,
"Destruction, Malignant Lesion, Face, Ears, Eyelid, Nose, Lips; 0.5Cm Or Less",,17280,CPT,Facility,Outpatient,,,,230,195.5,65.918,230,Humana Insurance Company,Medicare PPO,112.7,49,,percent of total billed charges,,
"Destruction, Malignant Lesion, Face, Ears, Eyelid, Nose, Lips; 0.5Cm Or Less",,17280,CPT,Facility,Inpatient,,,,230,195.5,65.918,230,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Face, Ears, Eyelid, Nose, Lips; 0.5Cm Or Less",,17280,CPT,Facility,Both,,,,230,195.5,65.918,230,Medica,Individual & Family,227.93,99.1,,percent of total billed charges,,
"Destruction, Malignant Lesion, Face, Ears, Eyelid, Nose, Lips; 0.5Cm Or Less",,17280,CPT,Facility,Outpatient,,,,230,195.5,65.918,230,Medica,Medica Advantage Solution,114.54,49.8,,percent of total billed charges,,
"Destruction, Malignant Lesion, Face, Ears, Eyelid, Nose, Lips; 0.5Cm Or Less",,17280,CPT,Facility,Inpatient,,,,230,195.5,65.918,230,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Face, Ears, Eyelid, Nose, Lips; 0.5Cm Or Less",,17280,CPT,Facility,Outpatient,,,,230,195.5,65.918,230,Medica,Medical Assistance,102.58,44.6,,percent of total billed charges,,
"Destruction, Malignant Lesion, Face, Ears, Eyelid, Nose, Lips; 0.5Cm Or Less",,17280,CPT,Facility,Inpatient,,,,230,195.5,65.918,230,Medica,Medical Assistance,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Face, Ears, Eyelid, Nose, Lips; 0.5Cm Or Less",,17280,CPT,Facility,Outpatient,,,,230,195.5,65.918,230,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,114.54,49.8,,percent of total billed charges,,
"Destruction, Malignant Lesion, Face, Ears, Eyelid, Nose, Lips; 0.5Cm Or Less",,17280,CPT,Facility,Inpatient,,,,230,195.5,65.918,230,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Face, Ears, Eyelid, Nose, Lips; 0.5Cm Or Less",,17280,CPT,Facility,Both,,,,230,195.5,65.918,230,"Multiplan, Inc.","Multiplan, Inc.",216.2,94,,percent of total billed charges,,
"Destruction, Malignant Lesion, Face, Ears, Eyelid, Nose, Lips; 0.5Cm Or Less",,17280,CPT,Facility,Outpatient,,,,230,195.5,65.918,230,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,207.23,90.1,,percent of total billed charges,,
"Destruction, Malignant Lesion, Face, Ears, Eyelid, Nose, Lips; 0.5Cm Or Less",,17280,CPT,Facility,Inpatient,,,,230,195.5,65.918,230,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Destruction, Malignant Lesion, Face, Ears, Eyelid, Nose, Lips; 0.5Cm Or Less",,17280,CPT,Facility,Both,,,,230,195.5,65.918,230,"Preferred One Administrative Services, INC.",PPO,226.78,98.6,,percent of total billed charges,,
"Destruction, Malignant Lesion, Face, Ears, Eyelid, Nose, Lips; 0.5Cm Or Less",,17280,CPT,Facility,Outpatient,,,,230,195.5,65.918,230,PrimeWest Health,Minnesota Senior Health Options (MSHO),118.335,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Destruction, Malignant Lesion, Face, Ears, Eyelid, Nose, Lips; 0.5Cm Or Less",,17280,CPT,Facility,Inpatient,,,,230,195.5,65.918,230,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Face, Ears, Eyelid, Nose, Lips; 0.5Cm Or Less",,17280,CPT,Facility,Outpatient,,,,230,195.5,65.918,230,PrimeWest Health,MinnesotaCare,118.128,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Destruction, Malignant Lesion, Face, Ears, Eyelid, Nose, Lips; 0.5Cm Or Less",,17280,CPT,Facility,Inpatient,,,,230,195.5,65.918,230,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Face, Ears, Eyelid, Nose, Lips; 0.5Cm Or Less",,17280,CPT,Facility,Both,,,,230,195.5,65.918,230,Sanford Health Plan,Sanford Health Plan,211.6,92,,percent of total billed charges,,
"Destruction, Malignant Lesion, Face, Ears, Eyelid, Nose, Lips; 0.5Cm Or Less",,17280,CPT,Facility,Outpatient,,,,230,195.5,65.918,230,"UCare Health, Inc.",Individual & Family Plan,129.605,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Destruction, Malignant Lesion, Face, Ears, Eyelid, Nose, Lips; 0.5Cm Or Less",,17280,CPT,Facility,Inpatient,,,,230,195.5,65.918,230,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Face, Ears, Eyelid, Nose, Lips; 0.5Cm Or Less",,17280,CPT,Facility,Outpatient,,,,230,195.5,65.918,230,"UCare Health, Inc.",Medical Assistance,116.081,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Destruction, Malignant Lesion, Face, Ears, Eyelid, Nose, Lips; 0.5Cm Or Less",,17280,CPT,Facility,Inpatient,,,,230,195.5,65.918,230,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Face, Ears, Eyelid, Nose, Lips; 0.5Cm Or Less",,17280,CPT,Facility,Outpatient,,,,230,195.5,65.918,230,"UCare Health, Inc.",Medicare Advantage,116.081,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Destruction, Malignant Lesion, Face, Ears, Eyelid, Nose, Lips; 0.5Cm Or Less",,17280,CPT,Facility,Inpatient,,,,230,195.5,65.918,230,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Face, Ears, Eyelid, Nose, Lips; 0.5Cm Or Less",,17280,CPT,Facility,Outpatient,,,,230,195.5,65.918,230,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),116.081,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Destruction, Malignant Lesion, Face, Ears, Eyelid, Nose, Lips; 0.5Cm Or Less",,17280,CPT,Facility,Inpatient,,,,230,195.5,65.918,230,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Face, Ears, Eyelid, Nose, Lips; 0.5Cm Or Less",,17280,CPT,Facility,Both,,,,230,195.5,65.918,230,UnitedHealthcare,Individual & Family,216.2,94,,percent of total billed charges,,
"Destruction, Malignant Lesion, Face, Ears, Eyelid, Nose, Lips; 0.5Cm Or Less",,17280,CPT,Facility,Outpatient,,,,230,195.5,65.918,230,UnitedHealthcare,Medicare Advantage,112.7,49,,percent of total billed charges,,
"Destruction, Malignant Lesion, Face, Ears, Eyelid, Nose, Lips; 0.5Cm Or Less",,17280,CPT,Facility,Inpatient,,,,230,195.5,65.918,230,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Face, Ears, Eyelid, Nose, Lips; 0.5Cm Or Less",,17280,CPT,Facility,Outpatient,,,,230,195.5,65.918,230,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,110.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Destruction, Malignant Lesion, Face, Ears, Eyelid, Nose, Lips; 0.5Cm Or Less",,17280,CPT,Facility,Inpatient,,,,230,195.5,65.918,230,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Face, Ears, Eyelide, Nose, Lips; 0.5Cm Or Less (Pro Cah)",,17280,CPT,Professional,Both,,,,310,263.5,54.53,310,Aetna,Commercial,263.5,85,,percent of total billed charges,,
"Destruction, Malignant Lesion, Face, Ears, Eyelide, Nose, Lips; 0.5Cm Or Less (Pro Cah)",,17280,CPT,Professional,Both,,,,310,263.5,54.53,310,Aetna,Medicare Advantage,85.17,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Destruction, Malignant Lesion, Face, Ears, Eyelide, Nose, Lips; 0.5Cm Or Less (Pro Cah)",,17280,CPT,Professional,Both,,,,310,263.5,54.53,310,Aetna,PPO,288.3,93,,percent of total billed charges,,
"Destruction, Malignant Lesion, Face, Ears, Eyelide, Nose, Lips; 0.5Cm Or Less (Pro Cah)",,17280,CPT,Professional,Both,,,,310,263.5,54.53,310,America's PPO,America's PPO,264.864,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Destruction, Malignant Lesion, Face, Ears, Eyelide, Nose, Lips; 0.5Cm Or Less (Pro Cah)",,17280,CPT,Professional,Both,,,,310,263.5,54.53,310,BlueCross BlueShield Minnesota, Federal Employee Program,176.28,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Destruction, Malignant Lesion, Face, Ears, Eyelide, Nose, Lips; 0.5Cm Or Less (Pro Cah)",,17280,CPT,Professional,Both,,,,310,263.5,54.53,310,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,179.10048,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Destruction, Malignant Lesion, Face, Ears, Eyelide, Nose, Lips; 0.5Cm Or Less (Pro Cah)",,17280,CPT,Professional,Both,,,,310,263.5,54.53,310,BlueCross BlueShield Minnesota,High Value Network Plan,179.10048,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Destruction, Malignant Lesion, Face, Ears, Eyelide, Nose, Lips; 0.5Cm Or Less (Pro Cah)",,17280,CPT,Professional,Both,,,,310,263.5,54.53,310,BlueCross BlueShield Minnesota,Medicare Advantage,97.52,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Destruction, Malignant Lesion, Face, Ears, Eyelide, Nose, Lips; 0.5Cm Or Less (Pro Cah)",,17280,CPT,Professional,Both,,,,310,263.5,54.53,310,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,179.10048,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Destruction, Malignant Lesion, Face, Ears, Eyelide, Nose, Lips; 0.5Cm Or Less (Pro Cah)",,17280,CPT,Professional,Both,,,,310,263.5,54.53,310,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,62.96152,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Destruction, Malignant Lesion, Face, Ears, Eyelide, Nose, Lips; 0.5Cm Or Less (Pro Cah)",,17280,CPT,Professional,Both,,,,310,263.5,54.53,310,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),97.52,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Destruction, Malignant Lesion, Face, Ears, Eyelide, Nose, Lips; 0.5Cm Or Less (Pro Cah)",,17280,CPT,Professional,Both,,,,310,263.5,54.53,310,CorVel,Worker's Compensation,164.1661668,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Destruction, Malignant Lesion, Face, Ears, Eyelide, Nose, Lips; 0.5Cm Or Less (Pro Cah)",,17280,CPT,Professional,Both,,,,310,263.5,54.53,310,First Health Group Corporation,First Health Network,300.7,97,,percent of total billed charges,,
"Destruction, Malignant Lesion, Face, Ears, Eyelide, Nose, Lips; 0.5Cm Or Less (Pro Cah)",,17280,CPT,Professional,Both,,,,310,263.5,54.53,310,"Health Partners, Inc.",Commercial,177.75,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Destruction, Malignant Lesion, Face, Ears, Eyelide, Nose, Lips; 0.5Cm Or Less (Pro Cah)",,17280,CPT,Professional,Both,,,,310,263.5,54.53,310,"Health Partners, Inc.",Medicare Advantage,97.52,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Destruction, Malignant Lesion, Face, Ears, Eyelide, Nose, Lips; 0.5Cm Or Less (Pro Cah)",,17280,CPT,Professional,Both,,,,310,263.5,54.53,310,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),84.72,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Destruction, Malignant Lesion, Face, Ears, Eyelide, Nose, Lips; 0.5Cm Or Less (Pro Cah)",,17280,CPT,Professional,Both,,,,310,263.5,54.53,310,"Health Partners, Inc.",State of Minnesota Advantage Program,153.131625,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Destruction, Malignant Lesion, Face, Ears, Eyelide, Nose, Lips; 0.5Cm Or Less (Pro Cah)",,17280,CPT,Professional,Both,,,,310,263.5,54.53,310,"Health Partners, Inc.",State Public Programs,54.53,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Destruction, Malignant Lesion, Face, Ears, Eyelide, Nose, Lips; 0.5Cm Or Less (Pro Cah)",,17280,CPT,Professional,Both,,,,310,263.5,54.53,310,Humana Insurance Company,Commercial PPO,84.8,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Destruction, Malignant Lesion, Face, Ears, Eyelide, Nose, Lips; 0.5Cm Or Less (Pro Cah)",,17280,CPT,Professional,Both,,,,310,263.5,54.53,310,Humana Insurance Company,Medicare PPO,310,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Destruction, Malignant Lesion, Face, Ears, Eyelide, Nose, Lips; 0.5Cm Or Less (Pro Cah)",,17280,CPT,Professional,Both,,,,310,263.5,54.53,310,Medica,Individual & Family,262.88,84.8,,percent of total billed charges,,
"Destruction, Malignant Lesion, Face, Ears, Eyelide, Nose, Lips; 0.5Cm Or Less (Pro Cah)",,17280,CPT,Professional,Both,,,,310,263.5,54.53,310,Medica,Medica Advantage Solution,154.38,49.8,,percent of total billed charges,,
"Destruction, Malignant Lesion, Face, Ears, Eyelide, Nose, Lips; 0.5Cm Or Less (Pro Cah)",,17280,CPT,Professional,Both,,,,310,263.5,54.53,310,Medica,Medical Assistance,62.96,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Destruction, Malignant Lesion, Face, Ears, Eyelide, Nose, Lips; 0.5Cm Or Less (Pro Cah)",,17280,CPT,Professional,Both,,,,310,263.5,54.53,310,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,84.8,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Destruction, Malignant Lesion, Face, Ears, Eyelide, Nose, Lips; 0.5Cm Or Less (Pro Cah)",,17280,CPT,Professional,Both,,,,310,263.5,54.53,310,"Multiplan, Inc.","Multiplan, Inc.",291.4,94,,percent of total billed charges,,
"Destruction, Malignant Lesion, Face, Ears, Eyelide, Nose, Lips; 0.5Cm Or Less (Pro Cah)",,17280,CPT,Professional,Both,,,,310,263.5,54.53,310,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,279.31,90.1,,percent of total billed charges,,
"Destruction, Malignant Lesion, Face, Ears, Eyelide, Nose, Lips; 0.5Cm Or Less (Pro Cah)",,17280,CPT,Professional,Both,,,,310,263.5,54.53,310,"Preferred One Administrative Services, INC.",PPO,305.66,98.6,,percent of total billed charges,,
"Destruction, Malignant Lesion, Face, Ears, Eyelide, Nose, Lips; 0.5Cm Or Less (Pro Cah)",,17280,CPT,Professional,Both,,,,310,263.5,54.53,310,PrimeWest Health,Minnesota Senior Health Options (MSHO),97.52,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Destruction, Malignant Lesion, Face, Ears, Eyelide, Nose, Lips; 0.5Cm Or Less (Pro Cah)",,17280,CPT,Professional,Both,,,,310,263.5,54.53,310,PrimeWest Health,MinnesotaCare,67.3688264,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Destruction, Malignant Lesion, Face, Ears, Eyelide, Nose, Lips; 0.5Cm Or Less (Pro Cah)",,17280,CPT,Professional,Both,,,,310,263.5,54.53,310,Sanford Health Plan,Sanford Health Plan,272.8,88,,percent of total billed charges,,
"Destruction, Malignant Lesion, Face, Ears, Eyelide, Nose, Lips; 0.5Cm Or Less (Pro Cah)",,17280,CPT,Professional,Both,,,,310,263.5,54.53,310,"UCare Health, Inc.",Individual & Family Plan,137.85088,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Destruction, Malignant Lesion, Face, Ears, Eyelide, Nose, Lips; 0.5Cm Or Less (Pro Cah)",,17280,CPT,Professional,Both,,,,310,263.5,54.53,310,"UCare Health, Inc.",Medical Assistance,69.257672,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Destruction, Malignant Lesion, Face, Ears, Eyelide, Nose, Lips; 0.5Cm Or Less (Pro Cah)",,17280,CPT,Professional,Both,,,,310,263.5,54.53,310,"UCare Health, Inc.",Medicare Advantage,97.52,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Destruction, Malignant Lesion, Face, Ears, Eyelide, Nose, Lips; 0.5Cm Or Less (Pro Cah)",,17280,CPT,Professional,Both,,,,310,263.5,54.53,310,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),78.016,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Destruction, Malignant Lesion, Face, Ears, Eyelide, Nose, Lips; 0.5Cm Or Less (Pro Cah)",,17280,CPT,Professional,Both,,,,310,263.5,54.53,310,UnitedHealthcare,Individual & Family,310,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Destruction, Malignant Lesion, Face, Ears, Eyelide, Nose, Lips; 0.5Cm Or Less (Pro Cah)",,17280,CPT,Professional,Both,,,,310,263.5,54.53,310,UnitedHealthcare,Medicare Advantage,97.52,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Destruction, Malignant Lesion, Face, Ears, Eyelide, Nose, Lips; 0.5Cm Or Less (Pro Cah)",,17280,CPT,Professional,Both,,,,310,263.5,54.53,310,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,62.96152,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Destruction, Malignant Lesion, Face, Ears, Eyelid, Nose, Lips; 0.6 To 1.0 Cm",,17281,CPT,Facility,Both,,,,265,225.25,75.949,265,Aetna,Commercial,243.8,92,,percent of total billed charges,,
"Destruction, Malignant Lesion, Face, Ears, Eyelid, Nose, Lips; 0.6 To 1.0 Cm",,17281,CPT,Facility,Outpatient,,,,265,225.25,75.949,265,Aetna,Medicare Advantage,129.85,49,,percent of total billed charges,,
"Destruction, Malignant Lesion, Face, Ears, Eyelid, Nose, Lips; 0.6 To 1.0 Cm",,17281,CPT,Facility,Inpatient,,,,265,225.25,75.949,265,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Face, Ears, Eyelid, Nose, Lips; 0.6 To 1.0 Cm",,17281,CPT,Facility,Both,,,,265,225.25,75.949,265,Aetna,PPO,246.45,93,,percent of total billed charges,,
"Destruction, Malignant Lesion, Face, Ears, Eyelid, Nose, Lips; 0.6 To 1.0 Cm",,17281,CPT,Facility,Both,,,,265,225.25,75.949,265,America's PPO,America's PPO,254.4795,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Destruction, Malignant Lesion, Face, Ears, Eyelid, Nose, Lips; 0.6 To 1.0 Cm",,17281,CPT,Facility,Both,,,,265,225.25,75.949,265,BlueCross BlueShield Minnesota, Federal Employee Program,260.76,98.4,,percent of total billed charges,,
"Destruction, Malignant Lesion, Face, Ears, Eyelid, Nose, Lips; 0.6 To 1.0 Cm",,17281,CPT,Facility,Both,,,,265,225.25,75.949,265,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,265,100,,percent of total billed charges,,
"Destruction, Malignant Lesion, Face, Ears, Eyelid, Nose, Lips; 0.6 To 1.0 Cm",,17281,CPT,Facility,Both,,,,265,225.25,75.949,265,BlueCross BlueShield Minnesota,High Value Network Plan,238.5,90,,percent of total billed charges,,
"Destruction, Malignant Lesion, Face, Ears, Eyelid, Nose, Lips; 0.6 To 1.0 Cm",,17281,CPT,Facility,Outpatient,,,,265,225.25,75.949,265,BlueCross BlueShield Minnesota,Medicare Advantage,129.85,49,,percent of total billed charges,,
"Destruction, Malignant Lesion, Face, Ears, Eyelid, Nose, Lips; 0.6 To 1.0 Cm",,17281,CPT,Facility,Inpatient,,,,265,225.25,75.949,265,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Face, Ears, Eyelid, Nose, Lips; 0.6 To 1.0 Cm",,17281,CPT,Facility,Both,,,,265,225.25,75.949,265,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,234.7105,88.57,,percent of total billed charges,,
"Destruction, Malignant Lesion, Face, Ears, Eyelid, Nose, Lips; 0.6 To 1.0 Cm",,17281,CPT,Facility,Both,,,,265,225.25,75.949,265,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,75.949,28.66,,percent of total billed charges,,
"Destruction, Malignant Lesion, Face, Ears, Eyelid, Nose, Lips; 0.6 To 1.0 Cm",,17281,CPT,Facility,Outpatient,,,,265,225.25,75.949,265,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),129.85,49,,percent of total billed charges,,
"Destruction, Malignant Lesion, Face, Ears, Eyelid, Nose, Lips; 0.6 To 1.0 Cm",,17281,CPT,Facility,Inpatient,,,,265,225.25,75.949,265,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Face, Ears, Eyelid, Nose, Lips; 0.6 To 1.0 Cm",,17281,CPT,Facility,Both,,,,265,225.25,75.949,265,CorVel,Worker's Compensation,265,100,,percent of total billed charges,,
"Destruction, Malignant Lesion, Face, Ears, Eyelid, Nose, Lips; 0.6 To 1.0 Cm",,17281,CPT,Facility,Both,,,,265,225.25,75.949,265,First Health Group Corporation,First Health Network,257.05,97,,percent of total billed charges,,
"Destruction, Malignant Lesion, Face, Ears, Eyelid, Nose, Lips; 0.6 To 1.0 Cm",,17281,CPT,Facility,Both,,,,265,225.25,75.949,265,"Health Partners, Inc.",Commercial,250.69,94.6,,percent of total billed charges,,
"Destruction, Malignant Lesion, Face, Ears, Eyelid, Nose, Lips; 0.6 To 1.0 Cm",,17281,CPT,Facility,Outpatient,,,,265,225.25,75.949,265,"Health Partners, Inc.",Medicare Advantage,129.85,49,,percent of total billed charges,,
"Destruction, Malignant Lesion, Face, Ears, Eyelid, Nose, Lips; 0.6 To 1.0 Cm",,17281,CPT,Facility,Inpatient,,,,265,225.25,75.949,265,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Face, Ears, Eyelid, Nose, Lips; 0.6 To 1.0 Cm",,17281,CPT,Facility,Both,,,,265,225.25,75.949,265,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),159,60,,percent of total billed charges,,
"Destruction, Malignant Lesion, Face, Ears, Eyelid, Nose, Lips; 0.6 To 1.0 Cm",,17281,CPT,Facility,Both,,,,265,225.25,75.949,265,"Health Partners, Inc.",State of Minnesota Advantage Program,215.975,81.5,,percent of total billed charges,,
"Destruction, Malignant Lesion, Face, Ears, Eyelid, Nose, Lips; 0.6 To 1.0 Cm",,17281,CPT,Facility,Both,,,,265,225.25,75.949,265,"Health Partners, Inc.",State Public Programs,132.5,50,,percent of total billed charges,,
"Destruction, Malignant Lesion, Face, Ears, Eyelid, Nose, Lips; 0.6 To 1.0 Cm",,17281,CPT,Facility,Both,,,,265,225.25,75.949,265,Humana Insurance Company,Commercial PPO,251.75,95,,percent of total billed charges,,
"Destruction, Malignant Lesion, Face, Ears, Eyelid, Nose, Lips; 0.6 To 1.0 Cm",,17281,CPT,Facility,Outpatient,,,,265,225.25,75.949,265,Humana Insurance Company,Medicare PPO,129.85,49,,percent of total billed charges,,
"Destruction, Malignant Lesion, Face, Ears, Eyelid, Nose, Lips; 0.6 To 1.0 Cm",,17281,CPT,Facility,Inpatient,,,,265,225.25,75.949,265,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Face, Ears, Eyelid, Nose, Lips; 0.6 To 1.0 Cm",,17281,CPT,Facility,Both,,,,265,225.25,75.949,265,Medica,Individual & Family,262.615,99.1,,percent of total billed charges,,
"Destruction, Malignant Lesion, Face, Ears, Eyelid, Nose, Lips; 0.6 To 1.0 Cm",,17281,CPT,Facility,Outpatient,,,,265,225.25,75.949,265,Medica,Medica Advantage Solution,131.97,49.8,,percent of total billed charges,,
"Destruction, Malignant Lesion, Face, Ears, Eyelid, Nose, Lips; 0.6 To 1.0 Cm",,17281,CPT,Facility,Inpatient,,,,265,225.25,75.949,265,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Face, Ears, Eyelid, Nose, Lips; 0.6 To 1.0 Cm",,17281,CPT,Facility,Outpatient,,,,265,225.25,75.949,265,Medica,Medical Assistance,118.19,44.6,,percent of total billed charges,,
"Destruction, Malignant Lesion, Face, Ears, Eyelid, Nose, Lips; 0.6 To 1.0 Cm",,17281,CPT,Facility,Inpatient,,,,265,225.25,75.949,265,Medica,Medical Assistance,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Face, Ears, Eyelid, Nose, Lips; 0.6 To 1.0 Cm",,17281,CPT,Facility,Outpatient,,,,265,225.25,75.949,265,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,131.97,49.8,,percent of total billed charges,,
"Destruction, Malignant Lesion, Face, Ears, Eyelid, Nose, Lips; 0.6 To 1.0 Cm",,17281,CPT,Facility,Inpatient,,,,265,225.25,75.949,265,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Face, Ears, Eyelid, Nose, Lips; 0.6 To 1.0 Cm",,17281,CPT,Facility,Both,,,,265,225.25,75.949,265,"Multiplan, Inc.","Multiplan, Inc.",249.1,94,,percent of total billed charges,,
"Destruction, Malignant Lesion, Face, Ears, Eyelid, Nose, Lips; 0.6 To 1.0 Cm",,17281,CPT,Facility,Outpatient,,,,265,225.25,75.949,265,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,238.765,90.1,,percent of total billed charges,,
"Destruction, Malignant Lesion, Face, Ears, Eyelid, Nose, Lips; 0.6 To 1.0 Cm",,17281,CPT,Facility,Inpatient,,,,265,225.25,75.949,265,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Destruction, Malignant Lesion, Face, Ears, Eyelid, Nose, Lips; 0.6 To 1.0 Cm",,17281,CPT,Facility,Both,,,,265,225.25,75.949,265,"Preferred One Administrative Services, INC.",PPO,261.29,98.6,,percent of total billed charges,,
"Destruction, Malignant Lesion, Face, Ears, Eyelid, Nose, Lips; 0.6 To 1.0 Cm",,17281,CPT,Facility,Outpatient,,,,265,225.25,75.949,265,PrimeWest Health,Minnesota Senior Health Options (MSHO),136.3425,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Destruction, Malignant Lesion, Face, Ears, Eyelid, Nose, Lips; 0.6 To 1.0 Cm",,17281,CPT,Facility,Inpatient,,,,265,225.25,75.949,265,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Face, Ears, Eyelid, Nose, Lips; 0.6 To 1.0 Cm",,17281,CPT,Facility,Outpatient,,,,265,225.25,75.949,265,PrimeWest Health,MinnesotaCare,136.104,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Destruction, Malignant Lesion, Face, Ears, Eyelid, Nose, Lips; 0.6 To 1.0 Cm",,17281,CPT,Facility,Inpatient,,,,265,225.25,75.949,265,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Face, Ears, Eyelid, Nose, Lips; 0.6 To 1.0 Cm",,17281,CPT,Facility,Both,,,,265,225.25,75.949,265,Sanford Health Plan,Sanford Health Plan,243.8,92,,percent of total billed charges,,
"Destruction, Malignant Lesion, Face, Ears, Eyelid, Nose, Lips; 0.6 To 1.0 Cm",,17281,CPT,Facility,Outpatient,,,,265,225.25,75.949,265,"UCare Health, Inc.",Individual & Family Plan,149.3275,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Destruction, Malignant Lesion, Face, Ears, Eyelid, Nose, Lips; 0.6 To 1.0 Cm",,17281,CPT,Facility,Inpatient,,,,265,225.25,75.949,265,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Face, Ears, Eyelid, Nose, Lips; 0.6 To 1.0 Cm",,17281,CPT,Facility,Outpatient,,,,265,225.25,75.949,265,"UCare Health, Inc.",Medical Assistance,133.7455,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Destruction, Malignant Lesion, Face, Ears, Eyelid, Nose, Lips; 0.6 To 1.0 Cm",,17281,CPT,Facility,Inpatient,,,,265,225.25,75.949,265,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Face, Ears, Eyelid, Nose, Lips; 0.6 To 1.0 Cm",,17281,CPT,Facility,Outpatient,,,,265,225.25,75.949,265,"UCare Health, Inc.",Medicare Advantage,133.7455,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Destruction, Malignant Lesion, Face, Ears, Eyelid, Nose, Lips; 0.6 To 1.0 Cm",,17281,CPT,Facility,Inpatient,,,,265,225.25,75.949,265,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Face, Ears, Eyelid, Nose, Lips; 0.6 To 1.0 Cm",,17281,CPT,Facility,Outpatient,,,,265,225.25,75.949,265,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),133.7455,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Destruction, Malignant Lesion, Face, Ears, Eyelid, Nose, Lips; 0.6 To 1.0 Cm",,17281,CPT,Facility,Inpatient,,,,265,225.25,75.949,265,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Face, Ears, Eyelid, Nose, Lips; 0.6 To 1.0 Cm",,17281,CPT,Facility,Both,,,,265,225.25,75.949,265,UnitedHealthcare,Individual & Family,249.1,94,,percent of total billed charges,,
"Destruction, Malignant Lesion, Face, Ears, Eyelid, Nose, Lips; 0.6 To 1.0 Cm",,17281,CPT,Facility,Outpatient,,,,265,225.25,75.949,265,UnitedHealthcare,Medicare Advantage,129.85,49,,percent of total billed charges,,
"Destruction, Malignant Lesion, Face, Ears, Eyelid, Nose, Lips; 0.6 To 1.0 Cm",,17281,CPT,Facility,Inpatient,,,,265,225.25,75.949,265,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Face, Ears, Eyelid, Nose, Lips; 0.6 To 1.0 Cm",,17281,CPT,Facility,Outpatient,,,,265,225.25,75.949,265,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,127.2,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Destruction, Malignant Lesion, Face, Ears, Eyelid, Nose, Lips; 0.6 To 1.0 Cm",,17281,CPT,Facility,Inpatient,,,,265,225.25,75.949,265,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Face, Ears, Eyelide, Nose, Lips; 0.6 To 1.0 Cm (Pro Cah)",,17281,CPT,Professional,Both,,,,395,335.75,74.39,395,Aetna,Commercial,335.75,85,,percent of total billed charges,,
"Destruction, Malignant Lesion, Face, Ears, Eyelide, Nose, Lips; 0.6 To 1.0 Cm (Pro Cah)",,17281,CPT,Professional,Both,,,,395,335.75,74.39,395,Aetna,Medicare Advantage,116.04,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Destruction, Malignant Lesion, Face, Ears, Eyelide, Nose, Lips; 0.6 To 1.0 Cm (Pro Cah)",,17281,CPT,Professional,Both,,,,395,335.75,74.39,395,Aetna,PPO,367.35,93,,percent of total billed charges,,
"Destruction, Malignant Lesion, Face, Ears, Eyelide, Nose, Lips; 0.6 To 1.0 Cm (Pro Cah)",,17281,CPT,Professional,Both,,,,395,335.75,74.39,395,America's PPO,America's PPO,337.488,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Destruction, Malignant Lesion, Face, Ears, Eyelide, Nose, Lips; 0.6 To 1.0 Cm (Pro Cah)",,17281,CPT,Professional,Both,,,,395,335.75,74.39,395,BlueCross BlueShield Minnesota, Federal Employee Program,241.7,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Destruction, Malignant Lesion, Face, Ears, Eyelide, Nose, Lips; 0.6 To 1.0 Cm (Pro Cah)",,17281,CPT,Professional,Both,,,,395,335.75,74.39,395,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,245.5672,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Destruction, Malignant Lesion, Face, Ears, Eyelide, Nose, Lips; 0.6 To 1.0 Cm (Pro Cah)",,17281,CPT,Professional,Both,,,,395,335.75,74.39,395,BlueCross BlueShield Minnesota,High Value Network Plan,245.5672,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Destruction, Malignant Lesion, Face, Ears, Eyelide, Nose, Lips; 0.6 To 1.0 Cm (Pro Cah)",,17281,CPT,Professional,Both,,,,395,335.75,74.39,395,BlueCross BlueShield Minnesota,Medicare Advantage,132.94,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Destruction, Malignant Lesion, Face, Ears, Eyelide, Nose, Lips; 0.6 To 1.0 Cm (Pro Cah)",,17281,CPT,Professional,Both,,,,395,335.75,74.39,395,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,245.5672,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Destruction, Malignant Lesion, Face, Ears, Eyelide, Nose, Lips; 0.6 To 1.0 Cm (Pro Cah)",,17281,CPT,Professional,Both,,,,395,335.75,74.39,395,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,85.88248,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Destruction, Malignant Lesion, Face, Ears, Eyelide, Nose, Lips; 0.6 To 1.0 Cm (Pro Cah)",,17281,CPT,Professional,Both,,,,395,335.75,74.39,395,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),132.94,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Destruction, Malignant Lesion, Face, Ears, Eyelide, Nose, Lips; 0.6 To 1.0 Cm (Pro Cah)",,17281,CPT,Professional,Both,,,,395,335.75,74.39,395,CorVel,Worker's Compensation,223.8628326,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Destruction, Malignant Lesion, Face, Ears, Eyelide, Nose, Lips; 0.6 To 1.0 Cm (Pro Cah)",,17281,CPT,Professional,Both,,,,395,335.75,74.39,395,First Health Group Corporation,First Health Network,383.15,97,,percent of total billed charges,,
"Destruction, Malignant Lesion, Face, Ears, Eyelide, Nose, Lips; 0.6 To 1.0 Cm (Pro Cah)",,17281,CPT,Professional,Both,,,,395,335.75,74.39,395,"Health Partners, Inc.",Commercial,241.6,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Destruction, Malignant Lesion, Face, Ears, Eyelide, Nose, Lips; 0.6 To 1.0 Cm (Pro Cah)",,17281,CPT,Professional,Both,,,,395,335.75,74.39,395,"Health Partners, Inc.",Medicare Advantage,132.94,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Destruction, Malignant Lesion, Face, Ears, Eyelide, Nose, Lips; 0.6 To 1.0 Cm (Pro Cah)",,17281,CPT,Professional,Both,,,,395,335.75,74.39,395,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),115.56,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Destruction, Malignant Lesion, Face, Ears, Eyelide, Nose, Lips; 0.6 To 1.0 Cm (Pro Cah)",,17281,CPT,Professional,Both,,,,395,335.75,74.39,395,"Health Partners, Inc.",State of Minnesota Advantage Program,208.1384,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Destruction, Malignant Lesion, Face, Ears, Eyelide, Nose, Lips; 0.6 To 1.0 Cm (Pro Cah)",,17281,CPT,Professional,Both,,,,395,335.75,74.39,395,"Health Partners, Inc.",State Public Programs,74.39,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Destruction, Malignant Lesion, Face, Ears, Eyelide, Nose, Lips; 0.6 To 1.0 Cm (Pro Cah)",,17281,CPT,Professional,Both,,,,395,335.75,74.39,395,Humana Insurance Company,Commercial PPO,115.6,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Destruction, Malignant Lesion, Face, Ears, Eyelide, Nose, Lips; 0.6 To 1.0 Cm (Pro Cah)",,17281,CPT,Professional,Both,,,,395,335.75,74.39,395,Humana Insurance Company,Medicare PPO,395,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Destruction, Malignant Lesion, Face, Ears, Eyelide, Nose, Lips; 0.6 To 1.0 Cm (Pro Cah)",,17281,CPT,Professional,Both,,,,395,335.75,74.39,395,Medica,Individual & Family,334.96,84.8,,percent of total billed charges,,
"Destruction, Malignant Lesion, Face, Ears, Eyelide, Nose, Lips; 0.6 To 1.0 Cm (Pro Cah)",,17281,CPT,Professional,Both,,,,395,335.75,74.39,395,Medica,Medica Advantage Solution,196.71,49.8,,percent of total billed charges,,
"Destruction, Malignant Lesion, Face, Ears, Eyelide, Nose, Lips; 0.6 To 1.0 Cm (Pro Cah)",,17281,CPT,Professional,Both,,,,395,335.75,74.39,395,Medica,Medical Assistance,85.88,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Destruction, Malignant Lesion, Face, Ears, Eyelide, Nose, Lips; 0.6 To 1.0 Cm (Pro Cah)",,17281,CPT,Professional,Both,,,,395,335.75,74.39,395,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,115.6,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Destruction, Malignant Lesion, Face, Ears, Eyelide, Nose, Lips; 0.6 To 1.0 Cm (Pro Cah)",,17281,CPT,Professional,Both,,,,395,335.75,74.39,395,"Multiplan, Inc.","Multiplan, Inc.",371.3,94,,percent of total billed charges,,
"Destruction, Malignant Lesion, Face, Ears, Eyelide, Nose, Lips; 0.6 To 1.0 Cm (Pro Cah)",,17281,CPT,Professional,Both,,,,395,335.75,74.39,395,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,355.895,90.1,,percent of total billed charges,,
"Destruction, Malignant Lesion, Face, Ears, Eyelide, Nose, Lips; 0.6 To 1.0 Cm (Pro Cah)",,17281,CPT,Professional,Both,,,,395,335.75,74.39,395,"Preferred One Administrative Services, INC.",PPO,389.47,98.6,,percent of total billed charges,,
"Destruction, Malignant Lesion, Face, Ears, Eyelide, Nose, Lips; 0.6 To 1.0 Cm (Pro Cah)",,17281,CPT,Professional,Both,,,,395,335.75,74.39,395,PrimeWest Health,Minnesota Senior Health Options (MSHO),132.94,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Destruction, Malignant Lesion, Face, Ears, Eyelide, Nose, Lips; 0.6 To 1.0 Cm (Pro Cah)",,17281,CPT,Professional,Both,,,,395,335.75,74.39,395,PrimeWest Health,MinnesotaCare,91.8942536,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Destruction, Malignant Lesion, Face, Ears, Eyelide, Nose, Lips; 0.6 To 1.0 Cm (Pro Cah)",,17281,CPT,Professional,Both,,,,395,335.75,74.39,395,Sanford Health Plan,Sanford Health Plan,347.6,88,,percent of total billed charges,,
"Destruction, Malignant Lesion, Face, Ears, Eyelide, Nose, Lips; 0.6 To 1.0 Cm (Pro Cah)",,17281,CPT,Professional,Both,,,,395,335.75,74.39,395,"UCare Health, Inc.",Individual & Family Plan,187.91936,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Destruction, Malignant Lesion, Face, Ears, Eyelide, Nose, Lips; 0.6 To 1.0 Cm (Pro Cah)",,17281,CPT,Professional,Both,,,,395,335.75,74.39,395,"UCare Health, Inc.",Medical Assistance,94.470728,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Destruction, Malignant Lesion, Face, Ears, Eyelide, Nose, Lips; 0.6 To 1.0 Cm (Pro Cah)",,17281,CPT,Professional,Both,,,,395,335.75,74.39,395,"UCare Health, Inc.",Medicare Advantage,132.94,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Destruction, Malignant Lesion, Face, Ears, Eyelide, Nose, Lips; 0.6 To 1.0 Cm (Pro Cah)",,17281,CPT,Professional,Both,,,,395,335.75,74.39,395,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),106.352,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Destruction, Malignant Lesion, Face, Ears, Eyelide, Nose, Lips; 0.6 To 1.0 Cm (Pro Cah)",,17281,CPT,Professional,Both,,,,395,335.75,74.39,395,UnitedHealthcare,Individual & Family,395,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Destruction, Malignant Lesion, Face, Ears, Eyelide, Nose, Lips; 0.6 To 1.0 Cm (Pro Cah)",,17281,CPT,Professional,Both,,,,395,335.75,74.39,395,UnitedHealthcare,Medicare Advantage,132.94,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Destruction, Malignant Lesion, Face, Ears, Eyelide, Nose, Lips; 0.6 To 1.0 Cm (Pro Cah)",,17281,CPT,Professional,Both,,,,395,335.75,74.39,395,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,85.88248,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Destruction, Malignant Lesion, Face, Ears, Eyelid, Nose, Lips; 1.1 To 2.0 Cm",,17282,CPT,Facility,Both,,,,311,264.35,89.1326,311,Aetna,Commercial,286.12,92,,percent of total billed charges,,
"Destruction, Malignant Lesion, Face, Ears, Eyelid, Nose, Lips; 1.1 To 2.0 Cm",,17282,CPT,Facility,Outpatient,,,,311,264.35,89.1326,311,Aetna,Medicare Advantage,152.39,49,,percent of total billed charges,,
"Destruction, Malignant Lesion, Face, Ears, Eyelid, Nose, Lips; 1.1 To 2.0 Cm",,17282,CPT,Facility,Inpatient,,,,311,264.35,89.1326,311,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Face, Ears, Eyelid, Nose, Lips; 1.1 To 2.0 Cm",,17282,CPT,Facility,Both,,,,311,264.35,89.1326,311,Aetna,PPO,289.23,93,,percent of total billed charges,,
"Destruction, Malignant Lesion, Face, Ears, Eyelid, Nose, Lips; 1.1 To 2.0 Cm",,17282,CPT,Facility,Both,,,,311,264.35,89.1326,311,America's PPO,America's PPO,298.6533,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Destruction, Malignant Lesion, Face, Ears, Eyelid, Nose, Lips; 1.1 To 2.0 Cm",,17282,CPT,Facility,Both,,,,311,264.35,89.1326,311,BlueCross BlueShield Minnesota, Federal Employee Program,306.024,98.4,,percent of total billed charges,,
"Destruction, Malignant Lesion, Face, Ears, Eyelid, Nose, Lips; 1.1 To 2.0 Cm",,17282,CPT,Facility,Both,,,,311,264.35,89.1326,311,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,311,100,,percent of total billed charges,,
"Destruction, Malignant Lesion, Face, Ears, Eyelid, Nose, Lips; 1.1 To 2.0 Cm",,17282,CPT,Facility,Both,,,,311,264.35,89.1326,311,BlueCross BlueShield Minnesota,High Value Network Plan,279.9,90,,percent of total billed charges,,
"Destruction, Malignant Lesion, Face, Ears, Eyelid, Nose, Lips; 1.1 To 2.0 Cm",,17282,CPT,Facility,Outpatient,,,,311,264.35,89.1326,311,BlueCross BlueShield Minnesota,Medicare Advantage,152.39,49,,percent of total billed charges,,
"Destruction, Malignant Lesion, Face, Ears, Eyelid, Nose, Lips; 1.1 To 2.0 Cm",,17282,CPT,Facility,Inpatient,,,,311,264.35,89.1326,311,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Face, Ears, Eyelid, Nose, Lips; 1.1 To 2.0 Cm",,17282,CPT,Facility,Both,,,,311,264.35,89.1326,311,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,275.4527,88.57,,percent of total billed charges,,
"Destruction, Malignant Lesion, Face, Ears, Eyelid, Nose, Lips; 1.1 To 2.0 Cm",,17282,CPT,Facility,Both,,,,311,264.35,89.1326,311,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,89.1326,28.66,,percent of total billed charges,,
"Destruction, Malignant Lesion, Face, Ears, Eyelid, Nose, Lips; 1.1 To 2.0 Cm",,17282,CPT,Facility,Outpatient,,,,311,264.35,89.1326,311,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),152.39,49,,percent of total billed charges,,
"Destruction, Malignant Lesion, Face, Ears, Eyelid, Nose, Lips; 1.1 To 2.0 Cm",,17282,CPT,Facility,Inpatient,,,,311,264.35,89.1326,311,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Face, Ears, Eyelid, Nose, Lips; 1.1 To 2.0 Cm",,17282,CPT,Facility,Both,,,,311,264.35,89.1326,311,CorVel,Worker's Compensation,311,100,,percent of total billed charges,,
"Destruction, Malignant Lesion, Face, Ears, Eyelid, Nose, Lips; 1.1 To 2.0 Cm",,17282,CPT,Facility,Both,,,,311,264.35,89.1326,311,First Health Group Corporation,First Health Network,301.67,97,,percent of total billed charges,,
"Destruction, Malignant Lesion, Face, Ears, Eyelid, Nose, Lips; 1.1 To 2.0 Cm",,17282,CPT,Facility,Both,,,,311,264.35,89.1326,311,"Health Partners, Inc.",Commercial,294.206,94.6,,percent of total billed charges,,
"Destruction, Malignant Lesion, Face, Ears, Eyelid, Nose, Lips; 1.1 To 2.0 Cm",,17282,CPT,Facility,Outpatient,,,,311,264.35,89.1326,311,"Health Partners, Inc.",Medicare Advantage,152.39,49,,percent of total billed charges,,
"Destruction, Malignant Lesion, Face, Ears, Eyelid, Nose, Lips; 1.1 To 2.0 Cm",,17282,CPT,Facility,Inpatient,,,,311,264.35,89.1326,311,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Face, Ears, Eyelid, Nose, Lips; 1.1 To 2.0 Cm",,17282,CPT,Facility,Both,,,,311,264.35,89.1326,311,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),186.6,60,,percent of total billed charges,,
"Destruction, Malignant Lesion, Face, Ears, Eyelid, Nose, Lips; 1.1 To 2.0 Cm",,17282,CPT,Facility,Both,,,,311,264.35,89.1326,311,"Health Partners, Inc.",State of Minnesota Advantage Program,253.465,81.5,,percent of total billed charges,,
"Destruction, Malignant Lesion, Face, Ears, Eyelid, Nose, Lips; 1.1 To 2.0 Cm",,17282,CPT,Facility,Both,,,,311,264.35,89.1326,311,"Health Partners, Inc.",State Public Programs,155.5,50,,percent of total billed charges,,
"Destruction, Malignant Lesion, Face, Ears, Eyelid, Nose, Lips; 1.1 To 2.0 Cm",,17282,CPT,Facility,Both,,,,311,264.35,89.1326,311,Humana Insurance Company,Commercial PPO,295.45,95,,percent of total billed charges,,
"Destruction, Malignant Lesion, Face, Ears, Eyelid, Nose, Lips; 1.1 To 2.0 Cm",,17282,CPT,Facility,Outpatient,,,,311,264.35,89.1326,311,Humana Insurance Company,Medicare PPO,152.39,49,,percent of total billed charges,,
"Destruction, Malignant Lesion, Face, Ears, Eyelid, Nose, Lips; 1.1 To 2.0 Cm",,17282,CPT,Facility,Inpatient,,,,311,264.35,89.1326,311,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Face, Ears, Eyelid, Nose, Lips; 1.1 To 2.0 Cm",,17282,CPT,Facility,Both,,,,311,264.35,89.1326,311,Medica,Individual & Family,308.201,99.1,,percent of total billed charges,,
"Destruction, Malignant Lesion, Face, Ears, Eyelid, Nose, Lips; 1.1 To 2.0 Cm",,17282,CPT,Facility,Outpatient,,,,311,264.35,89.1326,311,Medica,Medica Advantage Solution,154.878,49.8,,percent of total billed charges,,
"Destruction, Malignant Lesion, Face, Ears, Eyelid, Nose, Lips; 1.1 To 2.0 Cm",,17282,CPT,Facility,Inpatient,,,,311,264.35,89.1326,311,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Face, Ears, Eyelid, Nose, Lips; 1.1 To 2.0 Cm",,17282,CPT,Facility,Outpatient,,,,311,264.35,89.1326,311,Medica,Medical Assistance,138.706,44.6,,percent of total billed charges,,
"Destruction, Malignant Lesion, Face, Ears, Eyelid, Nose, Lips; 1.1 To 2.0 Cm",,17282,CPT,Facility,Inpatient,,,,311,264.35,89.1326,311,Medica,Medical Assistance,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Face, Ears, Eyelid, Nose, Lips; 1.1 To 2.0 Cm",,17282,CPT,Facility,Outpatient,,,,311,264.35,89.1326,311,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,154.878,49.8,,percent of total billed charges,,
"Destruction, Malignant Lesion, Face, Ears, Eyelid, Nose, Lips; 1.1 To 2.0 Cm",,17282,CPT,Facility,Inpatient,,,,311,264.35,89.1326,311,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Face, Ears, Eyelid, Nose, Lips; 1.1 To 2.0 Cm",,17282,CPT,Facility,Both,,,,311,264.35,89.1326,311,"Multiplan, Inc.","Multiplan, Inc.",292.34,94,,percent of total billed charges,,
"Destruction, Malignant Lesion, Face, Ears, Eyelid, Nose, Lips; 1.1 To 2.0 Cm",,17282,CPT,Facility,Outpatient,,,,311,264.35,89.1326,311,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,280.211,90.1,,percent of total billed charges,,
"Destruction, Malignant Lesion, Face, Ears, Eyelid, Nose, Lips; 1.1 To 2.0 Cm",,17282,CPT,Facility,Inpatient,,,,311,264.35,89.1326,311,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Destruction, Malignant Lesion, Face, Ears, Eyelid, Nose, Lips; 1.1 To 2.0 Cm",,17282,CPT,Facility,Both,,,,311,264.35,89.1326,311,"Preferred One Administrative Services, INC.",PPO,306.646,98.6,,percent of total billed charges,,
"Destruction, Malignant Lesion, Face, Ears, Eyelid, Nose, Lips; 1.1 To 2.0 Cm",,17282,CPT,Facility,Outpatient,,,,311,264.35,89.1326,311,PrimeWest Health,Minnesota Senior Health Options (MSHO),160.0095,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Destruction, Malignant Lesion, Face, Ears, Eyelid, Nose, Lips; 1.1 To 2.0 Cm",,17282,CPT,Facility,Inpatient,,,,311,264.35,89.1326,311,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Face, Ears, Eyelid, Nose, Lips; 1.1 To 2.0 Cm",,17282,CPT,Facility,Outpatient,,,,311,264.35,89.1326,311,PrimeWest Health,MinnesotaCare,159.7296,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Destruction, Malignant Lesion, Face, Ears, Eyelid, Nose, Lips; 1.1 To 2.0 Cm",,17282,CPT,Facility,Inpatient,,,,311,264.35,89.1326,311,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Face, Ears, Eyelid, Nose, Lips; 1.1 To 2.0 Cm",,17282,CPT,Facility,Both,,,,311,264.35,89.1326,311,Sanford Health Plan,Sanford Health Plan,286.12,92,,percent of total billed charges,,
"Destruction, Malignant Lesion, Face, Ears, Eyelid, Nose, Lips; 1.1 To 2.0 Cm",,17282,CPT,Facility,Outpatient,,,,311,264.35,89.1326,311,"UCare Health, Inc.",Individual & Family Plan,175.2485,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Destruction, Malignant Lesion, Face, Ears, Eyelid, Nose, Lips; 1.1 To 2.0 Cm",,17282,CPT,Facility,Inpatient,,,,311,264.35,89.1326,311,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Face, Ears, Eyelid, Nose, Lips; 1.1 To 2.0 Cm",,17282,CPT,Facility,Outpatient,,,,311,264.35,89.1326,311,"UCare Health, Inc.",Medical Assistance,156.9617,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Destruction, Malignant Lesion, Face, Ears, Eyelid, Nose, Lips; 1.1 To 2.0 Cm",,17282,CPT,Facility,Inpatient,,,,311,264.35,89.1326,311,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Face, Ears, Eyelid, Nose, Lips; 1.1 To 2.0 Cm",,17282,CPT,Facility,Outpatient,,,,311,264.35,89.1326,311,"UCare Health, Inc.",Medicare Advantage,156.9617,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Destruction, Malignant Lesion, Face, Ears, Eyelid, Nose, Lips; 1.1 To 2.0 Cm",,17282,CPT,Facility,Inpatient,,,,311,264.35,89.1326,311,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Face, Ears, Eyelid, Nose, Lips; 1.1 To 2.0 Cm",,17282,CPT,Facility,Outpatient,,,,311,264.35,89.1326,311,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),156.9617,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Destruction, Malignant Lesion, Face, Ears, Eyelid, Nose, Lips; 1.1 To 2.0 Cm",,17282,CPT,Facility,Inpatient,,,,311,264.35,89.1326,311,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Face, Ears, Eyelid, Nose, Lips; 1.1 To 2.0 Cm",,17282,CPT,Facility,Both,,,,311,264.35,89.1326,311,UnitedHealthcare,Individual & Family,292.34,94,,percent of total billed charges,,
"Destruction, Malignant Lesion, Face, Ears, Eyelid, Nose, Lips; 1.1 To 2.0 Cm",,17282,CPT,Facility,Outpatient,,,,311,264.35,89.1326,311,UnitedHealthcare,Medicare Advantage,152.39,49,,percent of total billed charges,,
"Destruction, Malignant Lesion, Face, Ears, Eyelid, Nose, Lips; 1.1 To 2.0 Cm",,17282,CPT,Facility,Inpatient,,,,311,264.35,89.1326,311,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Face, Ears, Eyelid, Nose, Lips; 1.1 To 2.0 Cm",,17282,CPT,Facility,Outpatient,,,,311,264.35,89.1326,311,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,149.28,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Destruction, Malignant Lesion, Face, Ears, Eyelid, Nose, Lips; 1.1 To 2.0 Cm",,17282,CPT,Facility,Inpatient,,,,311,264.35,89.1326,311,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Destruction, Malignant Lesion, Face, Ears, Eyelide, Nose, Lips; 1.1 To 2.0 Cm (Pro Cah)",,17282,CPT,Professional,Both,,,,465,395.25,85.73,465,Aetna,Commercial,395.25,85,,percent of total billed charges,,
"Destruction, Malignant Lesion, Face, Ears, Eyelide, Nose, Lips; 1.1 To 2.0 Cm (Pro Cah)",,17282,CPT,Professional,Both,,,,465,395.25,85.73,465,Aetna,Medicare Advantage,134.19,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Destruction, Malignant Lesion, Face, Ears, Eyelide, Nose, Lips; 1.1 To 2.0 Cm (Pro Cah)",,17282,CPT,Professional,Both,,,,465,395.25,85.73,465,Aetna,PPO,432.45,93,,percent of total billed charges,,
"Destruction, Malignant Lesion, Face, Ears, Eyelide, Nose, Lips; 1.1 To 2.0 Cm (Pro Cah)",,17282,CPT,Professional,Both,,,,465,395.25,85.73,465,America's PPO,America's PPO,397.296,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Destruction, Malignant Lesion, Face, Ears, Eyelide, Nose, Lips; 1.1 To 2.0 Cm (Pro Cah)",,17282,CPT,Professional,Both,,,,465,395.25,85.73,465,BlueCross BlueShield Minnesota, Federal Employee Program,278.88,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Destruction, Malignant Lesion, Face, Ears, Eyelide, Nose, Lips; 1.1 To 2.0 Cm (Pro Cah)",,17282,CPT,Professional,Both,,,,465,395.25,85.73,465,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,283.34208,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Destruction, Malignant Lesion, Face, Ears, Eyelide, Nose, Lips; 1.1 To 2.0 Cm (Pro Cah)",,17282,CPT,Professional,Both,,,,465,395.25,85.73,465,BlueCross BlueShield Minnesota,High Value Network Plan,283.34208,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Destruction, Malignant Lesion, Face, Ears, Eyelide, Nose, Lips; 1.1 To 2.0 Cm (Pro Cah)",,17282,CPT,Professional,Both,,,,465,395.25,85.73,465,BlueCross BlueShield Minnesota,Medicare Advantage,153.341,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Destruction, Malignant Lesion, Face, Ears, Eyelide, Nose, Lips; 1.1 To 2.0 Cm (Pro Cah)",,17282,CPT,Professional,Both,,,,465,395.25,85.73,465,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,283.34208,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Destruction, Malignant Lesion, Face, Ears, Eyelide, Nose, Lips; 1.1 To 2.0 Cm (Pro Cah)",,17282,CPT,Professional,Both,,,,465,395.25,85.73,465,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,98.97872,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Destruction, Malignant Lesion, Face, Ears, Eyelide, Nose, Lips; 1.1 To 2.0 Cm (Pro Cah)",,17282,CPT,Professional,Both,,,,465,395.25,85.73,465,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),153.341,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Destruction, Malignant Lesion, Face, Ears, Eyelide, Nose, Lips; 1.1 To 2.0 Cm (Pro Cah)",,17282,CPT,Professional,Both,,,,465,395.25,85.73,465,CorVel,Worker's Compensation,258.3163407,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Destruction, Malignant Lesion, Face, Ears, Eyelide, Nose, Lips; 1.1 To 2.0 Cm (Pro Cah)",,17282,CPT,Professional,Both,,,,465,395.25,85.73,465,First Health Group Corporation,First Health Network,451.05,97,,percent of total billed charges,,
"Destruction, Malignant Lesion, Face, Ears, Eyelide, Nose, Lips; 1.1 To 2.0 Cm (Pro Cah)",,17282,CPT,Professional,Both,,,,465,395.25,85.73,465,"Health Partners, Inc.",Commercial,278.6,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Destruction, Malignant Lesion, Face, Ears, Eyelide, Nose, Lips; 1.1 To 2.0 Cm (Pro Cah)",,17282,CPT,Professional,Both,,,,465,395.25,85.73,465,"Health Partners, Inc.",Medicare Advantage,153.341,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Destruction, Malignant Lesion, Face, Ears, Eyelide, Nose, Lips; 1.1 To 2.0 Cm (Pro Cah)",,17282,CPT,Professional,Both,,,,465,395.25,85.73,465,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),133.18,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Destruction, Malignant Lesion, Face, Ears, Eyelide, Nose, Lips; 1.1 To 2.0 Cm (Pro Cah)",,17282,CPT,Professional,Both,,,,465,395.25,85.73,465,"Health Partners, Inc.",State of Minnesota Advantage Program,240.0139,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Destruction, Malignant Lesion, Face, Ears, Eyelide, Nose, Lips; 1.1 To 2.0 Cm (Pro Cah)",,17282,CPT,Professional,Both,,,,465,395.25,85.73,465,"Health Partners, Inc.",State Public Programs,85.73,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Destruction, Malignant Lesion, Face, Ears, Eyelide, Nose, Lips; 1.1 To 2.0 Cm (Pro Cah)",,17282,CPT,Professional,Both,,,,465,395.25,85.73,465,Humana Insurance Company,Commercial PPO,133.34,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Destruction, Malignant Lesion, Face, Ears, Eyelide, Nose, Lips; 1.1 To 2.0 Cm (Pro Cah)",,17282,CPT,Professional,Both,,,,465,395.25,85.73,465,Humana Insurance Company,Medicare PPO,465,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Destruction, Malignant Lesion, Face, Ears, Eyelide, Nose, Lips; 1.1 To 2.0 Cm (Pro Cah)",,17282,CPT,Professional,Both,,,,465,395.25,85.73,465,Medica,Individual & Family,394.32,84.8,,percent of total billed charges,,
"Destruction, Malignant Lesion, Face, Ears, Eyelide, Nose, Lips; 1.1 To 2.0 Cm (Pro Cah)",,17282,CPT,Professional,Both,,,,465,395.25,85.73,465,Medica,Medica Advantage Solution,231.57,49.8,,percent of total billed charges,,
"Destruction, Malignant Lesion, Face, Ears, Eyelide, Nose, Lips; 1.1 To 2.0 Cm (Pro Cah)",,17282,CPT,Professional,Both,,,,465,395.25,85.73,465,Medica,Medical Assistance,98.98,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Destruction, Malignant Lesion, Face, Ears, Eyelide, Nose, Lips; 1.1 To 2.0 Cm (Pro Cah)",,17282,CPT,Professional,Both,,,,465,395.25,85.73,465,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,133.34,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Destruction, Malignant Lesion, Face, Ears, Eyelide, Nose, Lips; 1.1 To 2.0 Cm (Pro Cah)",,17282,CPT,Professional,Both,,,,465,395.25,85.73,465,"Multiplan, Inc.","Multiplan, Inc.",437.1,94,,percent of total billed charges,,
"Destruction, Malignant Lesion, Face, Ears, Eyelide, Nose, Lips; 1.1 To 2.0 Cm (Pro Cah)",,17282,CPT,Professional,Both,,,,465,395.25,85.73,465,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,418.965,90.1,,percent of total billed charges,,
"Destruction, Malignant Lesion, Face, Ears, Eyelide, Nose, Lips; 1.1 To 2.0 Cm (Pro Cah)",,17282,CPT,Professional,Both,,,,465,395.25,85.73,465,"Preferred One Administrative Services, INC.",PPO,458.49,98.6,,percent of total billed charges,,
"Destruction, Malignant Lesion, Face, Ears, Eyelide, Nose, Lips; 1.1 To 2.0 Cm (Pro Cah)",,17282,CPT,Professional,Both,,,,465,395.25,85.73,465,PrimeWest Health,Minnesota Senior Health Options (MSHO),153.341,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Destruction, Malignant Lesion, Face, Ears, Eyelide, Nose, Lips; 1.1 To 2.0 Cm (Pro Cah)",,17282,CPT,Professional,Both,,,,465,395.25,85.73,465,PrimeWest Health,MinnesotaCare,105.9072304,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Destruction, Malignant Lesion, Face, Ears, Eyelide, Nose, Lips; 1.1 To 2.0 Cm (Pro Cah)",,17282,CPT,Professional,Both,,,,465,395.25,85.73,465,Sanford Health Plan,Sanford Health Plan,409.2,88,,percent of total billed charges,,
"Destruction, Malignant Lesion, Face, Ears, Eyelide, Nose, Lips; 1.1 To 2.0 Cm (Pro Cah)",,17282,CPT,Professional,Both,,,,465,395.25,85.73,465,"UCare Health, Inc.",Individual & Family Plan,216.757504,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Destruction, Malignant Lesion, Face, Ears, Eyelide, Nose, Lips; 1.1 To 2.0 Cm (Pro Cah)",,17282,CPT,Professional,Both,,,,465,395.25,85.73,465,"UCare Health, Inc.",Medical Assistance,108.876592,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Destruction, Malignant Lesion, Face, Ears, Eyelide, Nose, Lips; 1.1 To 2.0 Cm (Pro Cah)",,17282,CPT,Professional,Both,,,,465,395.25,85.73,465,"UCare Health, Inc.",Medicare Advantage,153.341,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Destruction, Malignant Lesion, Face, Ears, Eyelide, Nose, Lips; 1.1 To 2.0 Cm (Pro Cah)",,17282,CPT,Professional,Both,,,,465,395.25,85.73,465,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),122.6728,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Destruction, Malignant Lesion, Face, Ears, Eyelide, Nose, Lips; 1.1 To 2.0 Cm (Pro Cah)",,17282,CPT,Professional,Both,,,,465,395.25,85.73,465,UnitedHealthcare,Individual & Family,465,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Destruction, Malignant Lesion, Face, Ears, Eyelide, Nose, Lips; 1.1 To 2.0 Cm (Pro Cah)",,17282,CPT,Professional,Both,,,,465,395.25,85.73,465,UnitedHealthcare,Medicare Advantage,153.341,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Destruction, Malignant Lesion, Face, Ears, Eyelide, Nose, Lips; 1.1 To 2.0 Cm (Pro Cah)",,17282,CPT,Professional,Both,,,,465,395.25,85.73,465,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,98.97872,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;2.1 To 3.0 Cm",,17283,CPT,Facility,Both,,,,383,325.55,109.7678,383,Aetna,Commercial,352.36,92,,percent of total billed charges,,
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;2.1 To 3.0 Cm",,17283,CPT,Facility,Outpatient,,,,383,325.55,109.7678,383,Aetna,Medicare Advantage,187.67,49,,percent of total billed charges,,
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;2.1 To 3.0 Cm",,17283,CPT,Facility,Inpatient,,,,383,325.55,109.7678,383,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;2.1 To 3.0 Cm",,17283,CPT,Facility,Both,,,,383,325.55,109.7678,383,Aetna,PPO,356.19,93,,percent of total billed charges,,
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;2.1 To 3.0 Cm",,17283,CPT,Facility,Both,,,,383,325.55,109.7678,383,America's PPO,America's PPO,367.7949,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;2.1 To 3.0 Cm",,17283,CPT,Facility,Both,,,,383,325.55,109.7678,383,BlueCross BlueShield Minnesota, Federal Employee Program,376.872,98.4,,percent of total billed charges,,
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;2.1 To 3.0 Cm",,17283,CPT,Facility,Both,,,,383,325.55,109.7678,383,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,383,100,,percent of total billed charges,,
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;2.1 To 3.0 Cm",,17283,CPT,Facility,Both,,,,383,325.55,109.7678,383,BlueCross BlueShield Minnesota,High Value Network Plan,344.7,90,,percent of total billed charges,,
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;2.1 To 3.0 Cm",,17283,CPT,Facility,Outpatient,,,,383,325.55,109.7678,383,BlueCross BlueShield Minnesota,Medicare Advantage,187.67,49,,percent of total billed charges,,
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;2.1 To 3.0 Cm",,17283,CPT,Facility,Inpatient,,,,383,325.55,109.7678,383,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;2.1 To 3.0 Cm",,17283,CPT,Facility,Both,,,,383,325.55,109.7678,383,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,339.2231,88.57,,percent of total billed charges,,
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;2.1 To 3.0 Cm",,17283,CPT,Facility,Both,,,,383,325.55,109.7678,383,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,109.7678,28.66,,percent of total billed charges,,
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;2.1 To 3.0 Cm",,17283,CPT,Facility,Outpatient,,,,383,325.55,109.7678,383,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),187.67,49,,percent of total billed charges,,
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;2.1 To 3.0 Cm",,17283,CPT,Facility,Inpatient,,,,383,325.55,109.7678,383,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;2.1 To 3.0 Cm",,17283,CPT,Facility,Both,,,,383,325.55,109.7678,383,CorVel,Worker's Compensation,383,100,,percent of total billed charges,,
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;2.1 To 3.0 Cm",,17283,CPT,Facility,Both,,,,383,325.55,109.7678,383,First Health Group Corporation,First Health Network,371.51,97,,percent of total billed charges,,
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;2.1 To 3.0 Cm",,17283,CPT,Facility,Both,,,,383,325.55,109.7678,383,"Health Partners, Inc.",Commercial,362.318,94.6,,percent of total billed charges,,
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;2.1 To 3.0 Cm",,17283,CPT,Facility,Outpatient,,,,383,325.55,109.7678,383,"Health Partners, Inc.",Medicare Advantage,187.67,49,,percent of total billed charges,,
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;2.1 To 3.0 Cm",,17283,CPT,Facility,Inpatient,,,,383,325.55,109.7678,383,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;2.1 To 3.0 Cm",,17283,CPT,Facility,Both,,,,383,325.55,109.7678,383,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),229.8,60,,percent of total billed charges,,
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;2.1 To 3.0 Cm",,17283,CPT,Facility,Both,,,,383,325.55,109.7678,383,"Health Partners, Inc.",State of Minnesota Advantage Program,312.145,81.5,,percent of total billed charges,,
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;2.1 To 3.0 Cm",,17283,CPT,Facility,Both,,,,383,325.55,109.7678,383,"Health Partners, Inc.",State Public Programs,191.5,50,,percent of total billed charges,,
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;2.1 To 3.0 Cm",,17283,CPT,Facility,Both,,,,383,325.55,109.7678,383,Humana Insurance Company,Commercial PPO,363.85,95,,percent of total billed charges,,
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;2.1 To 3.0 Cm",,17283,CPT,Facility,Outpatient,,,,383,325.55,109.7678,383,Humana Insurance Company,Medicare PPO,187.67,49,,percent of total billed charges,,
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;2.1 To 3.0 Cm",,17283,CPT,Facility,Inpatient,,,,383,325.55,109.7678,383,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;2.1 To 3.0 Cm",,17283,CPT,Facility,Both,,,,383,325.55,109.7678,383,Medica,Individual & Family,379.553,99.1,,percent of total billed charges,,
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;2.1 To 3.0 Cm",,17283,CPT,Facility,Outpatient,,,,383,325.55,109.7678,383,Medica,Medica Advantage Solution,190.734,49.8,,percent of total billed charges,,
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;2.1 To 3.0 Cm",,17283,CPT,Facility,Inpatient,,,,383,325.55,109.7678,383,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;2.1 To 3.0 Cm",,17283,CPT,Facility,Outpatient,,,,383,325.55,109.7678,383,Medica,Medical Assistance,170.818,44.6,,percent of total billed charges,,
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;2.1 To 3.0 Cm",,17283,CPT,Facility,Inpatient,,,,383,325.55,109.7678,383,Medica,Medical Assistance,,,,,Included in per diem rate,
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;2.1 To 3.0 Cm",,17283,CPT,Facility,Outpatient,,,,383,325.55,109.7678,383,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,190.734,49.8,,percent of total billed charges,,
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;2.1 To 3.0 Cm",,17283,CPT,Facility,Inpatient,,,,383,325.55,109.7678,383,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;2.1 To 3.0 Cm",,17283,CPT,Facility,Both,,,,383,325.55,109.7678,383,"Multiplan, Inc.","Multiplan, Inc.",360.02,94,,percent of total billed charges,,
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;2.1 To 3.0 Cm",,17283,CPT,Facility,Outpatient,,,,383,325.55,109.7678,383,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,345.083,90.1,,percent of total billed charges,,
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;2.1 To 3.0 Cm",,17283,CPT,Facility,Inpatient,,,,383,325.55,109.7678,383,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;2.1 To 3.0 Cm",,17283,CPT,Facility,Both,,,,383,325.55,109.7678,383,"Preferred One Administrative Services, INC.",PPO,377.638,98.6,,percent of total billed charges,,
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;2.1 To 3.0 Cm",,17283,CPT,Facility,Outpatient,,,,383,325.55,109.7678,383,PrimeWest Health,Minnesota Senior Health Options (MSHO),197.0535,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;2.1 To 3.0 Cm",,17283,CPT,Facility,Inpatient,,,,383,325.55,109.7678,383,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;2.1 To 3.0 Cm",,17283,CPT,Facility,Outpatient,,,,383,325.55,109.7678,383,PrimeWest Health,MinnesotaCare,196.7088,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;2.1 To 3.0 Cm",,17283,CPT,Facility,Inpatient,,,,383,325.55,109.7678,383,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;2.1 To 3.0 Cm",,17283,CPT,Facility,Both,,,,383,325.55,109.7678,383,Sanford Health Plan,Sanford Health Plan,352.36,92,,percent of total billed charges,,
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;2.1 To 3.0 Cm",,17283,CPT,Facility,Outpatient,,,,383,325.55,109.7678,383,"UCare Health, Inc.",Individual & Family Plan,215.8205,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;2.1 To 3.0 Cm",,17283,CPT,Facility,Inpatient,,,,383,325.55,109.7678,383,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;2.1 To 3.0 Cm",,17283,CPT,Facility,Outpatient,,,,383,325.55,109.7678,383,"UCare Health, Inc.",Medical Assistance,193.3001,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;2.1 To 3.0 Cm",,17283,CPT,Facility,Inpatient,,,,383,325.55,109.7678,383,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;2.1 To 3.0 Cm",,17283,CPT,Facility,Outpatient,,,,383,325.55,109.7678,383,"UCare Health, Inc.",Medicare Advantage,193.3001,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;2.1 To 3.0 Cm",,17283,CPT,Facility,Inpatient,,,,383,325.55,109.7678,383,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;2.1 To 3.0 Cm",,17283,CPT,Facility,Outpatient,,,,383,325.55,109.7678,383,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),193.3001,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;2.1 To 3.0 Cm",,17283,CPT,Facility,Inpatient,,,,383,325.55,109.7678,383,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;2.1 To 3.0 Cm",,17283,CPT,Facility,Both,,,,383,325.55,109.7678,383,UnitedHealthcare,Individual & Family,360.02,94,,percent of total billed charges,,
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;2.1 To 3.0 Cm",,17283,CPT,Facility,Outpatient,,,,383,325.55,109.7678,383,UnitedHealthcare,Medicare Advantage,187.67,49,,percent of total billed charges,,
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;2.1 To 3.0 Cm",,17283,CPT,Facility,Inpatient,,,,383,325.55,109.7678,383,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;2.1 To 3.0 Cm",,17283,CPT,Facility,Outpatient,,,,383,325.55,109.7678,383,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,183.84,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;2.1 To 3.0 Cm",,17283,CPT,Facility,Inpatient,,,,383,325.55,109.7678,383,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;2.1 To 3.0 Cm (Pro Cah)",,17283,CPT,Professional,Both,,,,550,467.5,106.67,550,Aetna,Commercial,467.5,85,,percent of total billed charges,,
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;2.1 To 3.0 Cm (Pro Cah)",,17283,CPT,Professional,Both,,,,550,467.5,106.67,550,Aetna,Medicare Advantage,167.4,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;2.1 To 3.0 Cm (Pro Cah)",,17283,CPT,Professional,Both,,,,550,467.5,106.67,550,Aetna,PPO,511.5,93,,percent of total billed charges,,
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;2.1 To 3.0 Cm (Pro Cah)",,17283,CPT,Professional,Both,,,,550,467.5,106.67,550,America's PPO,America's PPO,469.92,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;2.1 To 3.0 Cm (Pro Cah)",,17283,CPT,Professional,Both,,,,550,467.5,106.67,550,BlueCross BlueShield Minnesota, Federal Employee Program,347.05,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;2.1 To 3.0 Cm (Pro Cah)",,17283,CPT,Professional,Both,,,,550,467.5,106.67,550,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,352.6028,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;2.1 To 3.0 Cm (Pro Cah)",,17283,CPT,Professional,Both,,,,550,467.5,106.67,550,BlueCross BlueShield Minnesota,High Value Network Plan,352.6028,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;2.1 To 3.0 Cm (Pro Cah)",,17283,CPT,Professional,Both,,,,550,467.5,106.67,550,BlueCross BlueShield Minnesota,Medicare Advantage,190.854,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;2.1 To 3.0 Cm (Pro Cah)",,17283,CPT,Professional,Both,,,,550,467.5,106.67,550,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,352.6028,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;2.1 To 3.0 Cm (Pro Cah)",,17283,CPT,Professional,Both,,,,550,467.5,106.67,550,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,123.15952,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;2.1 To 3.0 Cm (Pro Cah)",,17283,CPT,Professional,Both,,,,550,467.5,106.67,550,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),190.854,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;2.1 To 3.0 Cm (Pro Cah)",,17283,CPT,Professional,Both,,,,550,467.5,106.67,550,CorVel,Worker's Compensation,322.0210404,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;2.1 To 3.0 Cm (Pro Cah)",,17283,CPT,Professional,Both,,,,550,467.5,106.67,550,First Health Group Corporation,First Health Network,533.5,97,,percent of total billed charges,,
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;2.1 To 3.0 Cm (Pro Cah)",,17283,CPT,Professional,Both,,,,550,467.5,106.67,550,"Health Partners, Inc.",Commercial,348.25,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;2.1 To 3.0 Cm (Pro Cah)",,17283,CPT,Professional,Both,,,,550,467.5,106.67,550,"Health Partners, Inc.",Medicare Advantage,190.854,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;2.1 To 3.0 Cm (Pro Cah)",,17283,CPT,Professional,Both,,,,550,467.5,106.67,550,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),166.05,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;2.1 To 3.0 Cm (Pro Cah)",,17283,CPT,Professional,Both,,,,550,467.5,106.67,550,"Health Partners, Inc.",State of Minnesota Advantage Program,300.017375,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;2.1 To 3.0 Cm (Pro Cah)",,17283,CPT,Professional,Both,,,,550,467.5,106.67,550,"Health Partners, Inc.",State Public Programs,106.67,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;2.1 To 3.0 Cm (Pro Cah)",,17283,CPT,Professional,Both,,,,550,467.5,106.67,550,Humana Insurance Company,Commercial PPO,165.96,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;2.1 To 3.0 Cm (Pro Cah)",,17283,CPT,Professional,Both,,,,550,467.5,106.67,550,Humana Insurance Company,Medicare PPO,550,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;2.1 To 3.0 Cm (Pro Cah)",,17283,CPT,Professional,Both,,,,550,467.5,106.67,550,Medica,Individual & Family,466.4,84.8,,percent of total billed charges,,
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;2.1 To 3.0 Cm (Pro Cah)",,17283,CPT,Professional,Both,,,,550,467.5,106.67,550,Medica,Medica Advantage Solution,273.9,49.8,,percent of total billed charges,,
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;2.1 To 3.0 Cm (Pro Cah)",,17283,CPT,Professional,Both,,,,550,467.5,106.67,550,Medica,Medical Assistance,123.16,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;2.1 To 3.0 Cm (Pro Cah)",,17283,CPT,Professional,Both,,,,550,467.5,106.67,550,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,165.96,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;2.1 To 3.0 Cm (Pro Cah)",,17283,CPT,Professional,Both,,,,550,467.5,106.67,550,"Multiplan, Inc.","Multiplan, Inc.",517,94,,percent of total billed charges,,
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;2.1 To 3.0 Cm (Pro Cah)",,17283,CPT,Professional,Both,,,,550,467.5,106.67,550,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,495.55,90.1,,percent of total billed charges,,
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;2.1 To 3.0 Cm (Pro Cah)",,17283,CPT,Professional,Both,,,,550,467.5,106.67,550,"Preferred One Administrative Services, INC.",PPO,542.3,98.6,,percent of total billed charges,,
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;2.1 To 3.0 Cm (Pro Cah)",,17283,CPT,Professional,Both,,,,550,467.5,106.67,550,PrimeWest Health,Minnesota Senior Health Options (MSHO),190.854,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;2.1 To 3.0 Cm (Pro Cah)",,17283,CPT,Professional,Both,,,,550,467.5,106.67,550,PrimeWest Health,MinnesotaCare,131.7806864,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;2.1 To 3.0 Cm (Pro Cah)",,17283,CPT,Professional,Both,,,,550,467.5,106.67,550,Sanford Health Plan,Sanford Health Plan,484,88,,percent of total billed charges,,
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;2.1 To 3.0 Cm (Pro Cah)",,17283,CPT,Professional,Both,,,,550,467.5,106.67,550,"UCare Health, Inc.",Individual & Family Plan,269.784576,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;2.1 To 3.0 Cm (Pro Cah)",,17283,CPT,Professional,Both,,,,550,467.5,106.67,550,"UCare Health, Inc.",Medical Assistance,135.475472,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;2.1 To 3.0 Cm (Pro Cah)",,17283,CPT,Professional,Both,,,,550,467.5,106.67,550,"UCare Health, Inc.",Medicare Advantage,190.854,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;2.1 To 3.0 Cm (Pro Cah)",,17283,CPT,Professional,Both,,,,550,467.5,106.67,550,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),152.6832,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;2.1 To 3.0 Cm (Pro Cah)",,17283,CPT,Professional,Both,,,,550,467.5,106.67,550,UnitedHealthcare,Individual & Family,550,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;2.1 To 3.0 Cm (Pro Cah)",,17283,CPT,Professional,Both,,,,550,467.5,106.67,550,UnitedHealthcare,Medicare Advantage,190.854,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;2.1 To 3.0 Cm (Pro Cah)",,17283,CPT,Professional,Both,,,,550,467.5,106.67,550,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,123.15952,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;3.1 To 4.0 Cm",,17284,CPT,Facility,Both,,,,368,312.8,105.4688,368,Aetna,Commercial,338.56,92,,percent of total billed charges,,
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;3.1 To 4.0 Cm",,17284,CPT,Facility,Outpatient,,,,368,312.8,105.4688,368,Aetna,Medicare Advantage,180.32,49,,percent of total billed charges,,
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;3.1 To 4.0 Cm",,17284,CPT,Facility,Inpatient,,,,368,312.8,105.4688,368,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;3.1 To 4.0 Cm",,17284,CPT,Facility,Both,,,,368,312.8,105.4688,368,Aetna,PPO,342.24,93,,percent of total billed charges,,
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;3.1 To 4.0 Cm",,17284,CPT,Facility,Both,,,,368,312.8,105.4688,368,America's PPO,America's PPO,353.3904,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;3.1 To 4.0 Cm",,17284,CPT,Facility,Both,,,,368,312.8,105.4688,368,BlueCross BlueShield Minnesota, Federal Employee Program,362.112,98.4,,percent of total billed charges,,
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;3.1 To 4.0 Cm",,17284,CPT,Facility,Both,,,,368,312.8,105.4688,368,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,368,100,,percent of total billed charges,,
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;3.1 To 4.0 Cm",,17284,CPT,Facility,Both,,,,368,312.8,105.4688,368,BlueCross BlueShield Minnesota,High Value Network Plan,331.2,90,,percent of total billed charges,,
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;3.1 To 4.0 Cm",,17284,CPT,Facility,Outpatient,,,,368,312.8,105.4688,368,BlueCross BlueShield Minnesota,Medicare Advantage,180.32,49,,percent of total billed charges,,
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;3.1 To 4.0 Cm",,17284,CPT,Facility,Inpatient,,,,368,312.8,105.4688,368,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;3.1 To 4.0 Cm",,17284,CPT,Facility,Both,,,,368,312.8,105.4688,368,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,325.9376,88.57,,percent of total billed charges,,
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;3.1 To 4.0 Cm",,17284,CPT,Facility,Both,,,,368,312.8,105.4688,368,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,105.4688,28.66,,percent of total billed charges,,
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;3.1 To 4.0 Cm",,17284,CPT,Facility,Outpatient,,,,368,312.8,105.4688,368,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),180.32,49,,percent of total billed charges,,
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;3.1 To 4.0 Cm",,17284,CPT,Facility,Inpatient,,,,368,312.8,105.4688,368,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;3.1 To 4.0 Cm",,17284,CPT,Facility,Both,,,,368,312.8,105.4688,368,CorVel,Worker's Compensation,368,100,,percent of total billed charges,,
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;3.1 To 4.0 Cm",,17284,CPT,Facility,Both,,,,368,312.8,105.4688,368,First Health Group Corporation,First Health Network,356.96,97,,percent of total billed charges,,
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;3.1 To 4.0 Cm",,17284,CPT,Facility,Both,,,,368,312.8,105.4688,368,"Health Partners, Inc.",Commercial,348.128,94.6,,percent of total billed charges,,
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;3.1 To 4.0 Cm",,17284,CPT,Facility,Outpatient,,,,368,312.8,105.4688,368,"Health Partners, Inc.",Medicare Advantage,180.32,49,,percent of total billed charges,,
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;3.1 To 4.0 Cm",,17284,CPT,Facility,Inpatient,,,,368,312.8,105.4688,368,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;3.1 To 4.0 Cm",,17284,CPT,Facility,Both,,,,368,312.8,105.4688,368,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),220.8,60,,percent of total billed charges,,
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;3.1 To 4.0 Cm",,17284,CPT,Facility,Both,,,,368,312.8,105.4688,368,"Health Partners, Inc.",State of Minnesota Advantage Program,299.92,81.5,,percent of total billed charges,,
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;3.1 To 4.0 Cm",,17284,CPT,Facility,Both,,,,368,312.8,105.4688,368,"Health Partners, Inc.",State Public Programs,184,50,,percent of total billed charges,,
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;3.1 To 4.0 Cm",,17284,CPT,Facility,Both,,,,368,312.8,105.4688,368,Humana Insurance Company,Commercial PPO,349.6,95,,percent of total billed charges,,
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;3.1 To 4.0 Cm",,17284,CPT,Facility,Outpatient,,,,368,312.8,105.4688,368,Humana Insurance Company,Medicare PPO,180.32,49,,percent of total billed charges,,
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;3.1 To 4.0 Cm",,17284,CPT,Facility,Inpatient,,,,368,312.8,105.4688,368,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;3.1 To 4.0 Cm",,17284,CPT,Facility,Both,,,,368,312.8,105.4688,368,Medica,Individual & Family,364.688,99.1,,percent of total billed charges,,
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;3.1 To 4.0 Cm",,17284,CPT,Facility,Outpatient,,,,368,312.8,105.4688,368,Medica,Medica Advantage Solution,183.264,49.8,,percent of total billed charges,,
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;3.1 To 4.0 Cm",,17284,CPT,Facility,Inpatient,,,,368,312.8,105.4688,368,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;3.1 To 4.0 Cm",,17284,CPT,Facility,Outpatient,,,,368,312.8,105.4688,368,Medica,Medical Assistance,164.128,44.6,,percent of total billed charges,,
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;3.1 To 4.0 Cm",,17284,CPT,Facility,Inpatient,,,,368,312.8,105.4688,368,Medica,Medical Assistance,,,,,Included in per diem rate,
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;3.1 To 4.0 Cm",,17284,CPT,Facility,Outpatient,,,,368,312.8,105.4688,368,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,183.264,49.8,,percent of total billed charges,,
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;3.1 To 4.0 Cm",,17284,CPT,Facility,Inpatient,,,,368,312.8,105.4688,368,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;3.1 To 4.0 Cm",,17284,CPT,Facility,Both,,,,368,312.8,105.4688,368,"Multiplan, Inc.","Multiplan, Inc.",345.92,94,,percent of total billed charges,,
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;3.1 To 4.0 Cm",,17284,CPT,Facility,Outpatient,,,,368,312.8,105.4688,368,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,331.568,90.1,,percent of total billed charges,,
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;3.1 To 4.0 Cm",,17284,CPT,Facility,Inpatient,,,,368,312.8,105.4688,368,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;3.1 To 4.0 Cm",,17284,CPT,Facility,Both,,,,368,312.8,105.4688,368,"Preferred One Administrative Services, INC.",PPO,362.848,98.6,,percent of total billed charges,,
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;3.1 To 4.0 Cm",,17284,CPT,Facility,Outpatient,,,,368,312.8,105.4688,368,PrimeWest Health,Minnesota Senior Health Options (MSHO),189.336,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;3.1 To 4.0 Cm",,17284,CPT,Facility,Inpatient,,,,368,312.8,105.4688,368,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;3.1 To 4.0 Cm",,17284,CPT,Facility,Outpatient,,,,368,312.8,105.4688,368,PrimeWest Health,MinnesotaCare,189.0048,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;3.1 To 4.0 Cm",,17284,CPT,Facility,Inpatient,,,,368,312.8,105.4688,368,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;3.1 To 4.0 Cm",,17284,CPT,Facility,Both,,,,368,312.8,105.4688,368,Sanford Health Plan,Sanford Health Plan,338.56,92,,percent of total billed charges,,
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;3.1 To 4.0 Cm",,17284,CPT,Facility,Outpatient,,,,368,312.8,105.4688,368,"UCare Health, Inc.",Individual & Family Plan,207.368,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;3.1 To 4.0 Cm",,17284,CPT,Facility,Inpatient,,,,368,312.8,105.4688,368,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;3.1 To 4.0 Cm",,17284,CPT,Facility,Outpatient,,,,368,312.8,105.4688,368,"UCare Health, Inc.",Medical Assistance,185.7296,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;3.1 To 4.0 Cm",,17284,CPT,Facility,Inpatient,,,,368,312.8,105.4688,368,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;3.1 To 4.0 Cm",,17284,CPT,Facility,Outpatient,,,,368,312.8,105.4688,368,"UCare Health, Inc.",Medicare Advantage,185.7296,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;3.1 To 4.0 Cm",,17284,CPT,Facility,Inpatient,,,,368,312.8,105.4688,368,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;3.1 To 4.0 Cm",,17284,CPT,Facility,Outpatient,,,,368,312.8,105.4688,368,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),185.7296,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;3.1 To 4.0 Cm",,17284,CPT,Facility,Inpatient,,,,368,312.8,105.4688,368,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;3.1 To 4.0 Cm",,17284,CPT,Facility,Both,,,,368,312.8,105.4688,368,UnitedHealthcare,Individual & Family,345.92,94,,percent of total billed charges,,
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;3.1 To 4.0 Cm",,17284,CPT,Facility,Outpatient,,,,368,312.8,105.4688,368,UnitedHealthcare,Medicare Advantage,180.32,49,,percent of total billed charges,,
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;3.1 To 4.0 Cm",,17284,CPT,Facility,Inpatient,,,,368,312.8,105.4688,368,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;3.1 To 4.0 Cm",,17284,CPT,Facility,Outpatient,,,,368,312.8,105.4688,368,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,176.64,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;3.1 To 4.0 Cm",,17284,CPT,Facility,Inpatient,,,,368,312.8,105.4688,368,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;3.1 To 4.0 Cm (Pro Cah)",,17284,CPT,Professional,Both,,,,530,450.5,124.34,530,Aetna,Commercial,450.5,85,,percent of total billed charges,,
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;3.1 To 4.0 Cm (Pro Cah)",,17284,CPT,Professional,Both,,,,530,450.5,124.34,530,Aetna,Medicare Advantage,195.36,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;3.1 To 4.0 Cm (Pro Cah)",,17284,CPT,Professional,Both,,,,530,450.5,124.34,530,Aetna,PPO,492.9,93,,percent of total billed charges,,
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;3.1 To 4.0 Cm (Pro Cah)",,17284,CPT,Professional,Both,,,,530,450.5,124.34,530,America's PPO,America's PPO,452.832,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;3.1 To 4.0 Cm (Pro Cah)",,17284,CPT,Professional,Both,,,,530,450.5,124.34,530,BlueCross BlueShield Minnesota, Federal Employee Program,405.59,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;3.1 To 4.0 Cm (Pro Cah)",,17284,CPT,Professional,Both,,,,530,450.5,124.34,530,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,412.07944,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;3.1 To 4.0 Cm (Pro Cah)",,17284,CPT,Professional,Both,,,,530,450.5,124.34,530,BlueCross BlueShield Minnesota,High Value Network Plan,412.07944,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;3.1 To 4.0 Cm (Pro Cah)",,17284,CPT,Professional,Both,,,,530,450.5,124.34,530,BlueCross BlueShield Minnesota,Medicare Advantage,222.341,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;3.1 To 4.0 Cm (Pro Cah)",,17284,CPT,Professional,Both,,,,530,450.5,124.34,530,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,412.07944,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;3.1 To 4.0 Cm (Pro Cah)",,17284,CPT,Professional,Both,,,,530,450.5,124.34,530,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,143.5608,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;3.1 To 4.0 Cm (Pro Cah)",,17284,CPT,Professional,Both,,,,530,450.5,124.34,530,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),222.341,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;3.1 To 4.0 Cm (Pro Cah)",,17284,CPT,Professional,Both,,,,530,450.5,124.34,530,CorVel,Worker's Compensation,376.3091778,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;3.1 To 4.0 Cm (Pro Cah)",,17284,CPT,Professional,Both,,,,530,450.5,124.34,530,First Health Group Corporation,First Health Network,514.1,97,,percent of total billed charges,,
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;3.1 To 4.0 Cm (Pro Cah)",,17284,CPT,Professional,Both,,,,530,450.5,124.34,530,"Health Partners, Inc.",Commercial,406.3,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;3.1 To 4.0 Cm (Pro Cah)",,17284,CPT,Professional,Both,,,,530,450.5,124.34,530,"Health Partners, Inc.",Medicare Advantage,222.341,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;3.1 To 4.0 Cm (Pro Cah)",,17284,CPT,Professional,Both,,,,530,450.5,124.34,530,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),193.16,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;3.1 To 4.0 Cm (Pro Cah)",,17284,CPT,Professional,Both,,,,530,450.5,124.34,530,"Health Partners, Inc.",State of Minnesota Advantage Program,350.02745,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;3.1 To 4.0 Cm (Pro Cah)",,17284,CPT,Professional,Both,,,,530,450.5,124.34,530,"Health Partners, Inc.",State Public Programs,124.34,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;3.1 To 4.0 Cm (Pro Cah)",,17284,CPT,Professional,Both,,,,530,450.5,124.34,530,Humana Insurance Company,Commercial PPO,193.34,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;3.1 To 4.0 Cm (Pro Cah)",,17284,CPT,Professional,Both,,,,530,450.5,124.34,530,Humana Insurance Company,Medicare PPO,530,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;3.1 To 4.0 Cm (Pro Cah)",,17284,CPT,Professional,Both,,,,530,450.5,124.34,530,Medica,Individual & Family,449.44,84.8,,percent of total billed charges,,
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;3.1 To 4.0 Cm (Pro Cah)",,17284,CPT,Professional,Both,,,,530,450.5,124.34,530,Medica,Medica Advantage Solution,263.94,49.8,,percent of total billed charges,,
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;3.1 To 4.0 Cm (Pro Cah)",,17284,CPT,Professional,Both,,,,530,450.5,124.34,530,Medica,Medical Assistance,143.56,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;3.1 To 4.0 Cm (Pro Cah)",,17284,CPT,Professional,Both,,,,530,450.5,124.34,530,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,193.34,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;3.1 To 4.0 Cm (Pro Cah)",,17284,CPT,Professional,Both,,,,530,450.5,124.34,530,"Multiplan, Inc.","Multiplan, Inc.",498.2,94,,percent of total billed charges,,
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;3.1 To 4.0 Cm (Pro Cah)",,17284,CPT,Professional,Both,,,,530,450.5,124.34,530,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,477.53,90.1,,percent of total billed charges,,
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;3.1 To 4.0 Cm (Pro Cah)",,17284,CPT,Professional,Both,,,,530,450.5,124.34,530,"Preferred One Administrative Services, INC.",PPO,522.58,98.6,,percent of total billed charges,,
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;3.1 To 4.0 Cm (Pro Cah)",,17284,CPT,Professional,Both,,,,530,450.5,124.34,530,PrimeWest Health,Minnesota Senior Health Options (MSHO),222.341,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;3.1 To 4.0 Cm (Pro Cah)",,17284,CPT,Professional,Both,,,,530,450.5,124.34,530,PrimeWest Health,MinnesotaCare,153.610056,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;3.1 To 4.0 Cm (Pro Cah)",,17284,CPT,Professional,Both,,,,530,450.5,124.34,530,Sanford Health Plan,Sanford Health Plan,466.4,88,,percent of total billed charges,,
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;3.1 To 4.0 Cm (Pro Cah)",,17284,CPT,Professional,Both,,,,530,450.5,124.34,530,"UCare Health, Inc.",Individual & Family Plan,314.293504,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;3.1 To 4.0 Cm (Pro Cah)",,17284,CPT,Professional,Both,,,,530,450.5,124.34,530,"UCare Health, Inc.",Medical Assistance,157.91688,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;3.1 To 4.0 Cm (Pro Cah)",,17284,CPT,Professional,Both,,,,530,450.5,124.34,530,"UCare Health, Inc.",Medicare Advantage,222.341,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;3.1 To 4.0 Cm (Pro Cah)",,17284,CPT,Professional,Both,,,,530,450.5,124.34,530,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),177.8728,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;3.1 To 4.0 Cm (Pro Cah)",,17284,CPT,Professional,Both,,,,530,450.5,124.34,530,UnitedHealthcare,Individual & Family,530,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;3.1 To 4.0 Cm (Pro Cah)",,17284,CPT,Professional,Both,,,,530,450.5,124.34,530,UnitedHealthcare,Medicare Advantage,222.341,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Destruction Malignant Lesion,Face, Ears, Eyelids, Nose, Lips, Mucous Membrane;3.1 To 4.0 Cm (Pro Cah)",,17284,CPT,Professional,Both,,,,530,450.5,124.34,530,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,143.5608,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Destruction,Malignant Lesion,Face,Ears,Eyelids,Nose,Lips,Muc Memb; Lesion Dia Over 4.0 Cm",,17286,CPT,Facility,Both,,,,612,520.2,175.3992,612,Aetna,Commercial,563.04,92,,percent of total billed charges,,
"Destruction,Malignant Lesion,Face,Ears,Eyelids,Nose,Lips,Muc Memb; Lesion Dia Over 4.0 Cm",,17286,CPT,Facility,Outpatient,,,,612,520.2,175.3992,612,Aetna,Medicare Advantage,299.88,49,,percent of total billed charges,,
"Destruction,Malignant Lesion,Face,Ears,Eyelids,Nose,Lips,Muc Memb; Lesion Dia Over 4.0 Cm",,17286,CPT,Facility,Inpatient,,,,612,520.2,175.3992,612,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Destruction,Malignant Lesion,Face,Ears,Eyelids,Nose,Lips,Muc Memb; Lesion Dia Over 4.0 Cm",,17286,CPT,Facility,Both,,,,612,520.2,175.3992,612,Aetna,PPO,569.16,93,,percent of total billed charges,,
"Destruction,Malignant Lesion,Face,Ears,Eyelids,Nose,Lips,Muc Memb; Lesion Dia Over 4.0 Cm",,17286,CPT,Facility,Both,,,,612,520.2,175.3992,612,America's PPO,America's PPO,587.7036,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Destruction,Malignant Lesion,Face,Ears,Eyelids,Nose,Lips,Muc Memb; Lesion Dia Over 4.0 Cm",,17286,CPT,Facility,Both,,,,612,520.2,175.3992,612,BlueCross BlueShield Minnesota, Federal Employee Program,602.208,98.4,,percent of total billed charges,,
"Destruction,Malignant Lesion,Face,Ears,Eyelids,Nose,Lips,Muc Memb; Lesion Dia Over 4.0 Cm",,17286,CPT,Facility,Both,,,,612,520.2,175.3992,612,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,612,100,,percent of total billed charges,,
"Destruction,Malignant Lesion,Face,Ears,Eyelids,Nose,Lips,Muc Memb; Lesion Dia Over 4.0 Cm",,17286,CPT,Facility,Both,,,,612,520.2,175.3992,612,BlueCross BlueShield Minnesota,High Value Network Plan,550.8,90,,percent of total billed charges,,
"Destruction,Malignant Lesion,Face,Ears,Eyelids,Nose,Lips,Muc Memb; Lesion Dia Over 4.0 Cm",,17286,CPT,Facility,Outpatient,,,,612,520.2,175.3992,612,BlueCross BlueShield Minnesota,Medicare Advantage,299.88,49,,percent of total billed charges,,
"Destruction,Malignant Lesion,Face,Ears,Eyelids,Nose,Lips,Muc Memb; Lesion Dia Over 4.0 Cm",,17286,CPT,Facility,Inpatient,,,,612,520.2,175.3992,612,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Destruction,Malignant Lesion,Face,Ears,Eyelids,Nose,Lips,Muc Memb; Lesion Dia Over 4.0 Cm",,17286,CPT,Facility,Both,,,,612,520.2,175.3992,612,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,542.0484,88.57,,percent of total billed charges,,
"Destruction,Malignant Lesion,Face,Ears,Eyelids,Nose,Lips,Muc Memb; Lesion Dia Over 4.0 Cm",,17286,CPT,Facility,Both,,,,612,520.2,175.3992,612,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,175.3992,28.66,,percent of total billed charges,,
"Destruction,Malignant Lesion,Face,Ears,Eyelids,Nose,Lips,Muc Memb; Lesion Dia Over 4.0 Cm",,17286,CPT,Facility,Outpatient,,,,612,520.2,175.3992,612,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),299.88,49,,percent of total billed charges,,
"Destruction,Malignant Lesion,Face,Ears,Eyelids,Nose,Lips,Muc Memb; Lesion Dia Over 4.0 Cm",,17286,CPT,Facility,Inpatient,,,,612,520.2,175.3992,612,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Destruction,Malignant Lesion,Face,Ears,Eyelids,Nose,Lips,Muc Memb; Lesion Dia Over 4.0 Cm",,17286,CPT,Facility,Both,,,,612,520.2,175.3992,612,CorVel,Worker's Compensation,612,100,,percent of total billed charges,,
"Destruction,Malignant Lesion,Face,Ears,Eyelids,Nose,Lips,Muc Memb; Lesion Dia Over 4.0 Cm",,17286,CPT,Facility,Both,,,,612,520.2,175.3992,612,First Health Group Corporation,First Health Network,593.64,97,,percent of total billed charges,,
"Destruction,Malignant Lesion,Face,Ears,Eyelids,Nose,Lips,Muc Memb; Lesion Dia Over 4.0 Cm",,17286,CPT,Facility,Both,,,,612,520.2,175.3992,612,"Health Partners, Inc.",Commercial,578.952,94.6,,percent of total billed charges,,
"Destruction,Malignant Lesion,Face,Ears,Eyelids,Nose,Lips,Muc Memb; Lesion Dia Over 4.0 Cm",,17286,CPT,Facility,Outpatient,,,,612,520.2,175.3992,612,"Health Partners, Inc.",Medicare Advantage,299.88,49,,percent of total billed charges,,
"Destruction,Malignant Lesion,Face,Ears,Eyelids,Nose,Lips,Muc Memb; Lesion Dia Over 4.0 Cm",,17286,CPT,Facility,Inpatient,,,,612,520.2,175.3992,612,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Destruction,Malignant Lesion,Face,Ears,Eyelids,Nose,Lips,Muc Memb; Lesion Dia Over 4.0 Cm",,17286,CPT,Facility,Both,,,,612,520.2,175.3992,612,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),367.2,60,,percent of total billed charges,,
"Destruction,Malignant Lesion,Face,Ears,Eyelids,Nose,Lips,Muc Memb; Lesion Dia Over 4.0 Cm",,17286,CPT,Facility,Both,,,,612,520.2,175.3992,612,"Health Partners, Inc.",State of Minnesota Advantage Program,498.78,81.5,,percent of total billed charges,,
"Destruction,Malignant Lesion,Face,Ears,Eyelids,Nose,Lips,Muc Memb; Lesion Dia Over 4.0 Cm",,17286,CPT,Facility,Both,,,,612,520.2,175.3992,612,"Health Partners, Inc.",State Public Programs,306,50,,percent of total billed charges,,
"Destruction,Malignant Lesion,Face,Ears,Eyelids,Nose,Lips,Muc Memb; Lesion Dia Over 4.0 Cm",,17286,CPT,Facility,Both,,,,612,520.2,175.3992,612,Humana Insurance Company,Commercial PPO,581.4,95,,percent of total billed charges,,
"Destruction,Malignant Lesion,Face,Ears,Eyelids,Nose,Lips,Muc Memb; Lesion Dia Over 4.0 Cm",,17286,CPT,Facility,Outpatient,,,,612,520.2,175.3992,612,Humana Insurance Company,Medicare PPO,299.88,49,,percent of total billed charges,,
"Destruction,Malignant Lesion,Face,Ears,Eyelids,Nose,Lips,Muc Memb; Lesion Dia Over 4.0 Cm",,17286,CPT,Facility,Inpatient,,,,612,520.2,175.3992,612,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Destruction,Malignant Lesion,Face,Ears,Eyelids,Nose,Lips,Muc Memb; Lesion Dia Over 4.0 Cm",,17286,CPT,Facility,Both,,,,612,520.2,175.3992,612,Medica,Individual & Family,606.492,99.1,,percent of total billed charges,,
"Destruction,Malignant Lesion,Face,Ears,Eyelids,Nose,Lips,Muc Memb; Lesion Dia Over 4.0 Cm",,17286,CPT,Facility,Outpatient,,,,612,520.2,175.3992,612,Medica,Medica Advantage Solution,304.776,49.8,,percent of total billed charges,,
"Destruction,Malignant Lesion,Face,Ears,Eyelids,Nose,Lips,Muc Memb; Lesion Dia Over 4.0 Cm",,17286,CPT,Facility,Inpatient,,,,612,520.2,175.3992,612,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Destruction,Malignant Lesion,Face,Ears,Eyelids,Nose,Lips,Muc Memb; Lesion Dia Over 4.0 Cm",,17286,CPT,Facility,Outpatient,,,,612,520.2,175.3992,612,Medica,Medical Assistance,272.952,44.6,,percent of total billed charges,,
"Destruction,Malignant Lesion,Face,Ears,Eyelids,Nose,Lips,Muc Memb; Lesion Dia Over 4.0 Cm",,17286,CPT,Facility,Inpatient,,,,612,520.2,175.3992,612,Medica,Medical Assistance,,,,,Included in per diem rate,
"Destruction,Malignant Lesion,Face,Ears,Eyelids,Nose,Lips,Muc Memb; Lesion Dia Over 4.0 Cm",,17286,CPT,Facility,Outpatient,,,,612,520.2,175.3992,612,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,304.776,49.8,,percent of total billed charges,,
"Destruction,Malignant Lesion,Face,Ears,Eyelids,Nose,Lips,Muc Memb; Lesion Dia Over 4.0 Cm",,17286,CPT,Facility,Inpatient,,,,612,520.2,175.3992,612,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Destruction,Malignant Lesion,Face,Ears,Eyelids,Nose,Lips,Muc Memb; Lesion Dia Over 4.0 Cm",,17286,CPT,Facility,Both,,,,612,520.2,175.3992,612,"Multiplan, Inc.","Multiplan, Inc.",575.28,94,,percent of total billed charges,,
"Destruction,Malignant Lesion,Face,Ears,Eyelids,Nose,Lips,Muc Memb; Lesion Dia Over 4.0 Cm",,17286,CPT,Facility,Outpatient,,,,612,520.2,175.3992,612,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,551.412,90.1,,percent of total billed charges,,
"Destruction,Malignant Lesion,Face,Ears,Eyelids,Nose,Lips,Muc Memb; Lesion Dia Over 4.0 Cm",,17286,CPT,Facility,Inpatient,,,,612,520.2,175.3992,612,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Destruction,Malignant Lesion,Face,Ears,Eyelids,Nose,Lips,Muc Memb; Lesion Dia Over 4.0 Cm",,17286,CPT,Facility,Both,,,,612,520.2,175.3992,612,"Preferred One Administrative Services, INC.",PPO,603.432,98.6,,percent of total billed charges,,
"Destruction,Malignant Lesion,Face,Ears,Eyelids,Nose,Lips,Muc Memb; Lesion Dia Over 4.0 Cm",,17286,CPT,Facility,Outpatient,,,,612,520.2,175.3992,612,PrimeWest Health,Minnesota Senior Health Options (MSHO),314.874,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Destruction,Malignant Lesion,Face,Ears,Eyelids,Nose,Lips,Muc Memb; Lesion Dia Over 4.0 Cm",,17286,CPT,Facility,Inpatient,,,,612,520.2,175.3992,612,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Destruction,Malignant Lesion,Face,Ears,Eyelids,Nose,Lips,Muc Memb; Lesion Dia Over 4.0 Cm",,17286,CPT,Facility,Outpatient,,,,612,520.2,175.3992,612,PrimeWest Health,MinnesotaCare,314.3232,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Destruction,Malignant Lesion,Face,Ears,Eyelids,Nose,Lips,Muc Memb; Lesion Dia Over 4.0 Cm",,17286,CPT,Facility,Inpatient,,,,612,520.2,175.3992,612,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Destruction,Malignant Lesion,Face,Ears,Eyelids,Nose,Lips,Muc Memb; Lesion Dia Over 4.0 Cm",,17286,CPT,Facility,Both,,,,612,520.2,175.3992,612,Sanford Health Plan,Sanford Health Plan,563.04,92,,percent of total billed charges,,
"Destruction,Malignant Lesion,Face,Ears,Eyelids,Nose,Lips,Muc Memb; Lesion Dia Over 4.0 Cm",,17286,CPT,Facility,Outpatient,,,,612,520.2,175.3992,612,"UCare Health, Inc.",Individual & Family Plan,344.862,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Destruction,Malignant Lesion,Face,Ears,Eyelids,Nose,Lips,Muc Memb; Lesion Dia Over 4.0 Cm",,17286,CPT,Facility,Inpatient,,,,612,520.2,175.3992,612,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Destruction,Malignant Lesion,Face,Ears,Eyelids,Nose,Lips,Muc Memb; Lesion Dia Over 4.0 Cm",,17286,CPT,Facility,Outpatient,,,,612,520.2,175.3992,612,"UCare Health, Inc.",Medical Assistance,308.8764,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Destruction,Malignant Lesion,Face,Ears,Eyelids,Nose,Lips,Muc Memb; Lesion Dia Over 4.0 Cm",,17286,CPT,Facility,Inpatient,,,,612,520.2,175.3992,612,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Destruction,Malignant Lesion,Face,Ears,Eyelids,Nose,Lips,Muc Memb; Lesion Dia Over 4.0 Cm",,17286,CPT,Facility,Outpatient,,,,612,520.2,175.3992,612,"UCare Health, Inc.",Medicare Advantage,308.8764,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Destruction,Malignant Lesion,Face,Ears,Eyelids,Nose,Lips,Muc Memb; Lesion Dia Over 4.0 Cm",,17286,CPT,Facility,Inpatient,,,,612,520.2,175.3992,612,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Destruction,Malignant Lesion,Face,Ears,Eyelids,Nose,Lips,Muc Memb; Lesion Dia Over 4.0 Cm",,17286,CPT,Facility,Outpatient,,,,612,520.2,175.3992,612,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),308.8764,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Destruction,Malignant Lesion,Face,Ears,Eyelids,Nose,Lips,Muc Memb; Lesion Dia Over 4.0 Cm",,17286,CPT,Facility,Inpatient,,,,612,520.2,175.3992,612,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Destruction,Malignant Lesion,Face,Ears,Eyelids,Nose,Lips,Muc Memb; Lesion Dia Over 4.0 Cm",,17286,CPT,Facility,Both,,,,612,520.2,175.3992,612,UnitedHealthcare,Individual & Family,575.28,94,,percent of total billed charges,,
"Destruction,Malignant Lesion,Face,Ears,Eyelids,Nose,Lips,Muc Memb; Lesion Dia Over 4.0 Cm",,17286,CPT,Facility,Outpatient,,,,612,520.2,175.3992,612,UnitedHealthcare,Medicare Advantage,299.88,49,,percent of total billed charges,,
"Destruction,Malignant Lesion,Face,Ears,Eyelids,Nose,Lips,Muc Memb; Lesion Dia Over 4.0 Cm",,17286,CPT,Facility,Inpatient,,,,612,520.2,175.3992,612,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Destruction,Malignant Lesion,Face,Ears,Eyelids,Nose,Lips,Muc Memb; Lesion Dia Over 4.0 Cm",,17286,CPT,Facility,Outpatient,,,,612,520.2,175.3992,612,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,293.76,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Destruction,Malignant Lesion,Face,Ears,Eyelids,Nose,Lips,Muc Memb; Lesion Dia Over 4.0 Cm",,17286,CPT,Facility,Inpatient,,,,612,520.2,175.3992,612,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Destruction,Malignant Lesion,Face,Ears,Eyelids,Nose,Lips,Muc Memb; Lesion Dia Over 4.0 Cm (Pro Cah)",,17286,CPT,Professional,Both,,,,815,692.75,167.75,815,Aetna,Commercial,692.75,85,,percent of total billed charges,,
"Destruction,Malignant Lesion,Face,Ears,Eyelids,Nose,Lips,Muc Memb; Lesion Dia Over 4.0 Cm (Pro Cah)",,17286,CPT,Professional,Both,,,,815,692.75,167.75,815,Aetna,Medicare Advantage,264.95,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Destruction,Malignant Lesion,Face,Ears,Eyelids,Nose,Lips,Muc Memb; Lesion Dia Over 4.0 Cm (Pro Cah)",,17286,CPT,Professional,Both,,,,815,692.75,167.75,815,Aetna,PPO,757.95,93,,percent of total billed charges,,
"Destruction,Malignant Lesion,Face,Ears,Eyelids,Nose,Lips,Muc Memb; Lesion Dia Over 4.0 Cm (Pro Cah)",,17286,CPT,Professional,Both,,,,815,692.75,167.75,815,America's PPO,America's PPO,696.336,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Destruction,Malignant Lesion,Face,Ears,Eyelids,Nose,Lips,Muc Memb; Lesion Dia Over 4.0 Cm (Pro Cah)",,17286,CPT,Professional,Both,,,,815,692.75,167.75,815,BlueCross BlueShield Minnesota, Federal Employee Program,547.44,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Destruction,Malignant Lesion,Face,Ears,Eyelids,Nose,Lips,Muc Memb; Lesion Dia Over 4.0 Cm (Pro Cah)",,17286,CPT,Professional,Both,,,,815,692.75,167.75,815,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,556.19904,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Destruction,Malignant Lesion,Face,Ears,Eyelids,Nose,Lips,Muc Memb; Lesion Dia Over 4.0 Cm (Pro Cah)",,17286,CPT,Professional,Both,,,,815,692.75,167.75,815,BlueCross BlueShield Minnesota,High Value Network Plan,556.19904,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Destruction,Malignant Lesion,Face,Ears,Eyelids,Nose,Lips,Muc Memb; Lesion Dia Over 4.0 Cm (Pro Cah)",,17286,CPT,Professional,Both,,,,815,692.75,167.75,815,BlueCross BlueShield Minnesota,Medicare Advantage,299.9545,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Destruction,Malignant Lesion,Face,Ears,Eyelids,Nose,Lips,Muc Memb; Lesion Dia Over 4.0 Cm (Pro Cah)",,17286,CPT,Professional,Both,,,,815,692.75,167.75,815,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,556.19904,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Destruction,Malignant Lesion,Face,Ears,Eyelids,Nose,Lips,Muc Memb; Lesion Dia Over 4.0 Cm (Pro Cah)",,17286,CPT,Professional,Both,,,,815,692.75,167.75,815,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,193.68008,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Destruction,Malignant Lesion,Face,Ears,Eyelids,Nose,Lips,Muc Memb; Lesion Dia Over 4.0 Cm (Pro Cah)",,17286,CPT,Professional,Both,,,,815,692.75,167.75,815,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),299.9545,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Destruction,Malignant Lesion,Face,Ears,Eyelids,Nose,Lips,Muc Memb; Lesion Dia Over 4.0 Cm (Pro Cah)",,17286,CPT,Professional,Both,,,,815,692.75,167.75,815,CorVel,Worker's Compensation,508.4426433,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Destruction,Malignant Lesion,Face,Ears,Eyelids,Nose,Lips,Muc Memb; Lesion Dia Over 4.0 Cm (Pro Cah)",,17286,CPT,Professional,Both,,,,815,692.75,167.75,815,First Health Group Corporation,First Health Network,790.55,97,,percent of total billed charges,,
"Destruction,Malignant Lesion,Face,Ears,Eyelids,Nose,Lips,Muc Memb; Lesion Dia Over 4.0 Cm (Pro Cah)",,17286,CPT,Professional,Both,,,,815,692.75,167.75,815,"Health Partners, Inc.",Commercial,549.22,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Destruction,Malignant Lesion,Face,Ears,Eyelids,Nose,Lips,Muc Memb; Lesion Dia Over 4.0 Cm (Pro Cah)",,17286,CPT,Professional,Both,,,,815,692.75,167.75,815,"Health Partners, Inc.",Medicare Advantage,299.9545,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Destruction,Malignant Lesion,Face,Ears,Eyelids,Nose,Lips,Muc Memb; Lesion Dia Over 4.0 Cm (Pro Cah)",,17286,CPT,Professional,Both,,,,815,692.75,167.75,815,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),260.93,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Destruction,Malignant Lesion,Face,Ears,Eyelids,Nose,Lips,Muc Memb; Lesion Dia Over 4.0 Cm (Pro Cah)",,17286,CPT,Professional,Both,,,,815,692.75,167.75,815,"Health Partners, Inc.",State of Minnesota Advantage Program,473.15303,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Destruction,Malignant Lesion,Face,Ears,Eyelids,Nose,Lips,Muc Memb; Lesion Dia Over 4.0 Cm (Pro Cah)",,17286,CPT,Professional,Both,,,,815,692.75,167.75,815,"Health Partners, Inc.",State Public Programs,167.75,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Destruction,Malignant Lesion,Face,Ears,Eyelids,Nose,Lips,Muc Memb; Lesion Dia Over 4.0 Cm (Pro Cah)",,17286,CPT,Professional,Both,,,,815,692.75,167.75,815,Humana Insurance Company,Commercial PPO,260.83,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Destruction,Malignant Lesion,Face,Ears,Eyelids,Nose,Lips,Muc Memb; Lesion Dia Over 4.0 Cm (Pro Cah)",,17286,CPT,Professional,Both,,,,815,692.75,167.75,815,Humana Insurance Company,Medicare PPO,815,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Destruction,Malignant Lesion,Face,Ears,Eyelids,Nose,Lips,Muc Memb; Lesion Dia Over 4.0 Cm (Pro Cah)",,17286,CPT,Professional,Both,,,,815,692.75,167.75,815,Medica,Individual & Family,691.12,84.8,,percent of total billed charges,,
"Destruction,Malignant Lesion,Face,Ears,Eyelids,Nose,Lips,Muc Memb; Lesion Dia Over 4.0 Cm (Pro Cah)",,17286,CPT,Professional,Both,,,,815,692.75,167.75,815,Medica,Medica Advantage Solution,405.87,49.8,,percent of total billed charges,,
"Destruction,Malignant Lesion,Face,Ears,Eyelids,Nose,Lips,Muc Memb; Lesion Dia Over 4.0 Cm (Pro Cah)",,17286,CPT,Professional,Both,,,,815,692.75,167.75,815,Medica,Medical Assistance,193.68,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Destruction,Malignant Lesion,Face,Ears,Eyelids,Nose,Lips,Muc Memb; Lesion Dia Over 4.0 Cm (Pro Cah)",,17286,CPT,Professional,Both,,,,815,692.75,167.75,815,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,260.83,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Destruction,Malignant Lesion,Face,Ears,Eyelids,Nose,Lips,Muc Memb; Lesion Dia Over 4.0 Cm (Pro Cah)",,17286,CPT,Professional,Both,,,,815,692.75,167.75,815,"Multiplan, Inc.","Multiplan, Inc.",766.1,94,,percent of total billed charges,,
"Destruction,Malignant Lesion,Face,Ears,Eyelids,Nose,Lips,Muc Memb; Lesion Dia Over 4.0 Cm (Pro Cah)",,17286,CPT,Professional,Both,,,,815,692.75,167.75,815,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,734.315,90.1,,percent of total billed charges,,
"Destruction,Malignant Lesion,Face,Ears,Eyelids,Nose,Lips,Muc Memb; Lesion Dia Over 4.0 Cm (Pro Cah)",,17286,CPT,Professional,Both,,,,815,692.75,167.75,815,"Preferred One Administrative Services, INC.",PPO,803.59,98.6,,percent of total billed charges,,
"Destruction,Malignant Lesion,Face,Ears,Eyelids,Nose,Lips,Muc Memb; Lesion Dia Over 4.0 Cm (Pro Cah)",,17286,CPT,Professional,Both,,,,815,692.75,167.75,815,PrimeWest Health,Minnesota Senior Health Options (MSHO),299.9545,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Destruction,Malignant Lesion,Face,Ears,Eyelids,Nose,Lips,Muc Memb; Lesion Dia Over 4.0 Cm (Pro Cah)",,17286,CPT,Professional,Both,,,,815,692.75,167.75,815,PrimeWest Health,MinnesotaCare,207.2376856,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Destruction,Malignant Lesion,Face,Ears,Eyelids,Nose,Lips,Muc Memb; Lesion Dia Over 4.0 Cm (Pro Cah)",,17286,CPT,Professional,Both,,,,815,692.75,167.75,815,Sanford Health Plan,Sanford Health Plan,717.2,88,,percent of total billed charges,,
"Destruction,Malignant Lesion,Face,Ears,Eyelids,Nose,Lips,Muc Memb; Lesion Dia Over 4.0 Cm (Pro Cah)",,17286,CPT,Professional,Both,,,,815,692.75,167.75,815,"UCare Health, Inc.",Individual & Family Plan,424.005248,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Destruction,Malignant Lesion,Face,Ears,Eyelids,Nose,Lips,Muc Memb; Lesion Dia Over 4.0 Cm (Pro Cah)",,17286,CPT,Professional,Both,,,,815,692.75,167.75,815,"UCare Health, Inc.",Medical Assistance,213.048088,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Destruction,Malignant Lesion,Face,Ears,Eyelids,Nose,Lips,Muc Memb; Lesion Dia Over 4.0 Cm (Pro Cah)",,17286,CPT,Professional,Both,,,,815,692.75,167.75,815,"UCare Health, Inc.",Medicare Advantage,299.9545,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Destruction,Malignant Lesion,Face,Ears,Eyelids,Nose,Lips,Muc Memb; Lesion Dia Over 4.0 Cm (Pro Cah)",,17286,CPT,Professional,Both,,,,815,692.75,167.75,815,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),239.9636,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Destruction,Malignant Lesion,Face,Ears,Eyelids,Nose,Lips,Muc Memb; Lesion Dia Over 4.0 Cm (Pro Cah)",,17286,CPT,Professional,Both,,,,815,692.75,167.75,815,UnitedHealthcare,Individual & Family,815,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Destruction,Malignant Lesion,Face,Ears,Eyelids,Nose,Lips,Muc Memb; Lesion Dia Over 4.0 Cm (Pro Cah)",,17286,CPT,Professional,Both,,,,815,692.75,167.75,815,UnitedHealthcare,Medicare Advantage,299.9545,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Destruction,Malignant Lesion,Face,Ears,Eyelids,Nose,Lips,Muc Memb; Lesion Dia Over 4.0 Cm (Pro Cah)",,17286,CPT,Professional,Both,,,,815,692.75,167.75,815,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,193.68008,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"LYTES-GLUT-ZINC-GINGER-LACTO16 6,000-10-275 MG ORAL PWPK",,116510,LOCAL,Facility,Both,1,Each,,15,12.75,4.299,15,Aetna,Commercial,13.8,92,,percent of total billed charges,,
"LYTES-GLUT-ZINC-GINGER-LACTO16 6,000-10-275 MG ORAL PWPK",,116510,LOCAL,Facility,Outpatient,1,Each,,15,12.75,4.299,15,Aetna,Medicare Advantage,7.35,49,,percent of total billed charges,,
"LYTES-GLUT-ZINC-GINGER-LACTO16 6,000-10-275 MG ORAL PWPK",,116510,LOCAL,Facility,Inpatient,1,Each,,15,12.75,4.299,15,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"LYTES-GLUT-ZINC-GINGER-LACTO16 6,000-10-275 MG ORAL PWPK",,116510,LOCAL,Facility,Both,1,Each,,15,12.75,4.299,15,Aetna,PPO,13.95,93,,percent of total billed charges,,
"LYTES-GLUT-ZINC-GINGER-LACTO16 6,000-10-275 MG ORAL PWPK",,116510,LOCAL,Facility,Both,1,Each,,15,12.75,4.299,15,America's PPO,America's PPO,14.4045,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"LYTES-GLUT-ZINC-GINGER-LACTO16 6,000-10-275 MG ORAL PWPK",,116510,LOCAL,Facility,Both,1,Each,,15,12.75,4.299,15,BlueCross BlueShield Minnesota, Federal Employee Program,14.76,98.4,,percent of total billed charges,,
"LYTES-GLUT-ZINC-GINGER-LACTO16 6,000-10-275 MG ORAL PWPK",,116510,LOCAL,Facility,Both,1,Each,,15,12.75,4.299,15,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,15,100,,percent of total billed charges,,
"LYTES-GLUT-ZINC-GINGER-LACTO16 6,000-10-275 MG ORAL PWPK",,116510,LOCAL,Facility,Both,1,Each,,15,12.75,4.299,15,BlueCross BlueShield Minnesota,High Value Network Plan,13.5,90,,percent of total billed charges,,
"LYTES-GLUT-ZINC-GINGER-LACTO16 6,000-10-275 MG ORAL PWPK",,116510,LOCAL,Facility,Outpatient,1,Each,,15,12.75,4.299,15,BlueCross BlueShield Minnesota,Medicare Advantage,7.35,49,,percent of total billed charges,,
"LYTES-GLUT-ZINC-GINGER-LACTO16 6,000-10-275 MG ORAL PWPK",,116510,LOCAL,Facility,Inpatient,1,Each,,15,12.75,4.299,15,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"LYTES-GLUT-ZINC-GINGER-LACTO16 6,000-10-275 MG ORAL PWPK",,116510,LOCAL,Facility,Both,1,Each,,15,12.75,4.299,15,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,13.2855,88.57,,percent of total billed charges,,
"LYTES-GLUT-ZINC-GINGER-LACTO16 6,000-10-275 MG ORAL PWPK",,116510,LOCAL,Facility,Both,1,Each,,15,12.75,4.299,15,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,4.299,28.66,,percent of total billed charges,,
"LYTES-GLUT-ZINC-GINGER-LACTO16 6,000-10-275 MG ORAL PWPK",,116510,LOCAL,Facility,Outpatient,1,Each,,15,12.75,4.299,15,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),7.35,49,,percent of total billed charges,,
"LYTES-GLUT-ZINC-GINGER-LACTO16 6,000-10-275 MG ORAL PWPK",,116510,LOCAL,Facility,Inpatient,1,Each,,15,12.75,4.299,15,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"LYTES-GLUT-ZINC-GINGER-LACTO16 6,000-10-275 MG ORAL PWPK",,116510,LOCAL,Facility,Both,1,Each,,15,12.75,4.299,15,CorVel,Worker's Compensation,15,100,,percent of total billed charges,,
"LYTES-GLUT-ZINC-GINGER-LACTO16 6,000-10-275 MG ORAL PWPK",,116510,LOCAL,Facility,Both,1,Each,,15,12.75,4.299,15,First Health Group Corporation,First Health Network,14.55,97,,percent of total billed charges,,
"LYTES-GLUT-ZINC-GINGER-LACTO16 6,000-10-275 MG ORAL PWPK",,116510,LOCAL,Facility,Both,1,Each,,15,12.75,4.299,15,"Health Partners, Inc.",Commercial,14.19,94.6,,percent of total billed charges,,
"LYTES-GLUT-ZINC-GINGER-LACTO16 6,000-10-275 MG ORAL PWPK",,116510,LOCAL,Facility,Outpatient,1,Each,,15,12.75,4.299,15,"Health Partners, Inc.",Medicare Advantage,7.35,49,,percent of total billed charges,,
"LYTES-GLUT-ZINC-GINGER-LACTO16 6,000-10-275 MG ORAL PWPK",,116510,LOCAL,Facility,Inpatient,1,Each,,15,12.75,4.299,15,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"LYTES-GLUT-ZINC-GINGER-LACTO16 6,000-10-275 MG ORAL PWPK",,116510,LOCAL,Facility,Both,1,Each,,15,12.75,4.299,15,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),9,60,,percent of total billed charges,,
"LYTES-GLUT-ZINC-GINGER-LACTO16 6,000-10-275 MG ORAL PWPK",,116510,LOCAL,Facility,Both,1,Each,,15,12.75,4.299,15,"Health Partners, Inc.",State of Minnesota Advantage Program,12.225,81.5,,percent of total billed charges,,
"LYTES-GLUT-ZINC-GINGER-LACTO16 6,000-10-275 MG ORAL PWPK",,116510,LOCAL,Facility,Both,1,Each,,15,12.75,4.299,15,"Health Partners, Inc.",State Public Programs,7.5,50,,percent of total billed charges,,
"LYTES-GLUT-ZINC-GINGER-LACTO16 6,000-10-275 MG ORAL PWPK",,116510,LOCAL,Facility,Both,1,Each,,15,12.75,4.299,15,Humana Insurance Company,Commercial PPO,14.25,95,,percent of total billed charges,,
"LYTES-GLUT-ZINC-GINGER-LACTO16 6,000-10-275 MG ORAL PWPK",,116510,LOCAL,Facility,Outpatient,1,Each,,15,12.75,4.299,15,Humana Insurance Company,Medicare PPO,7.35,49,,percent of total billed charges,,
"LYTES-GLUT-ZINC-GINGER-LACTO16 6,000-10-275 MG ORAL PWPK",,116510,LOCAL,Facility,Inpatient,1,Each,,15,12.75,4.299,15,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"LYTES-GLUT-ZINC-GINGER-LACTO16 6,000-10-275 MG ORAL PWPK",,116510,LOCAL,Facility,Both,1,Each,,15,12.75,4.299,15,Medica,Individual & Family,14.865,99.1,,percent of total billed charges,,
"LYTES-GLUT-ZINC-GINGER-LACTO16 6,000-10-275 MG ORAL PWPK",,116510,LOCAL,Facility,Outpatient,1,Each,,15,12.75,4.299,15,Medica,Medica Advantage Solution,7.47,49.8,,percent of total billed charges,,
"LYTES-GLUT-ZINC-GINGER-LACTO16 6,000-10-275 MG ORAL PWPK",,116510,LOCAL,Facility,Inpatient,1,Each,,15,12.75,4.299,15,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"LYTES-GLUT-ZINC-GINGER-LACTO16 6,000-10-275 MG ORAL PWPK",,116510,LOCAL,Facility,Outpatient,1,Each,,15,12.75,4.299,15,Medica,Medical Assistance,6.69,44.6,,percent of total billed charges,,
"LYTES-GLUT-ZINC-GINGER-LACTO16 6,000-10-275 MG ORAL PWPK",,116510,LOCAL,Facility,Inpatient,1,Each,,15,12.75,4.299,15,Medica,Medical Assistance,,,,,Included in per diem rate,
"LYTES-GLUT-ZINC-GINGER-LACTO16 6,000-10-275 MG ORAL PWPK",,116510,LOCAL,Facility,Outpatient,1,Each,,15,12.75,4.299,15,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,7.47,49.8,,percent of total billed charges,,
"LYTES-GLUT-ZINC-GINGER-LACTO16 6,000-10-275 MG ORAL PWPK",,116510,LOCAL,Facility,Inpatient,1,Each,,15,12.75,4.299,15,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"LYTES-GLUT-ZINC-GINGER-LACTO16 6,000-10-275 MG ORAL PWPK",,116510,LOCAL,Facility,Both,1,Each,,15,12.75,4.299,15,"Multiplan, Inc.","Multiplan, Inc.",14.1,94,,percent of total billed charges,,
"LYTES-GLUT-ZINC-GINGER-LACTO16 6,000-10-275 MG ORAL PWPK",,116510,LOCAL,Facility,Outpatient,1,Each,,15,12.75,4.299,15,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,13.515,90.1,,percent of total billed charges,,
"LYTES-GLUT-ZINC-GINGER-LACTO16 6,000-10-275 MG ORAL PWPK",,116510,LOCAL,Facility,Inpatient,1,Each,,15,12.75,4.299,15,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"LYTES-GLUT-ZINC-GINGER-LACTO16 6,000-10-275 MG ORAL PWPK",,116510,LOCAL,Facility,Both,1,Each,,15,12.75,4.299,15,"Preferred One Administrative Services, INC.",PPO,14.79,98.6,,percent of total billed charges,,
"LYTES-GLUT-ZINC-GINGER-LACTO16 6,000-10-275 MG ORAL PWPK",,116510,LOCAL,Facility,Outpatient,1,Each,,15,12.75,4.299,15,PrimeWest Health,Minnesota Senior Health Options (MSHO),7.7175,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"LYTES-GLUT-ZINC-GINGER-LACTO16 6,000-10-275 MG ORAL PWPK",,116510,LOCAL,Facility,Inpatient,1,Each,,15,12.75,4.299,15,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"LYTES-GLUT-ZINC-GINGER-LACTO16 6,000-10-275 MG ORAL PWPK",,116510,LOCAL,Facility,Outpatient,1,Each,,15,12.75,4.299,15,PrimeWest Health,MinnesotaCare,7.704,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"LYTES-GLUT-ZINC-GINGER-LACTO16 6,000-10-275 MG ORAL PWPK",,116510,LOCAL,Facility,Inpatient,1,Each,,15,12.75,4.299,15,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"LYTES-GLUT-ZINC-GINGER-LACTO16 6,000-10-275 MG ORAL PWPK",,116510,LOCAL,Facility,Both,1,Each,,15,12.75,4.299,15,Sanford Health Plan,Sanford Health Plan,13.8,92,,percent of total billed charges,,
"LYTES-GLUT-ZINC-GINGER-LACTO16 6,000-10-275 MG ORAL PWPK",,116510,LOCAL,Facility,Outpatient,1,Each,,15,12.75,4.299,15,"UCare Health, Inc.",Individual & Family Plan,8.4525,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"LYTES-GLUT-ZINC-GINGER-LACTO16 6,000-10-275 MG ORAL PWPK",,116510,LOCAL,Facility,Inpatient,1,Each,,15,12.75,4.299,15,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"LYTES-GLUT-ZINC-GINGER-LACTO16 6,000-10-275 MG ORAL PWPK",,116510,LOCAL,Facility,Outpatient,1,Each,,15,12.75,4.299,15,"UCare Health, Inc.",Medical Assistance,7.5705,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"LYTES-GLUT-ZINC-GINGER-LACTO16 6,000-10-275 MG ORAL PWPK",,116510,LOCAL,Facility,Inpatient,1,Each,,15,12.75,4.299,15,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"LYTES-GLUT-ZINC-GINGER-LACTO16 6,000-10-275 MG ORAL PWPK",,116510,LOCAL,Facility,Outpatient,1,Each,,15,12.75,4.299,15,"UCare Health, Inc.",Medicare Advantage,7.5705,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"LYTES-GLUT-ZINC-GINGER-LACTO16 6,000-10-275 MG ORAL PWPK",,116510,LOCAL,Facility,Inpatient,1,Each,,15,12.75,4.299,15,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"LYTES-GLUT-ZINC-GINGER-LACTO16 6,000-10-275 MG ORAL PWPK",,116510,LOCAL,Facility,Outpatient,1,Each,,15,12.75,4.299,15,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),7.5705,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"LYTES-GLUT-ZINC-GINGER-LACTO16 6,000-10-275 MG ORAL PWPK",,116510,LOCAL,Facility,Inpatient,1,Each,,15,12.75,4.299,15,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"LYTES-GLUT-ZINC-GINGER-LACTO16 6,000-10-275 MG ORAL PWPK",,116510,LOCAL,Facility,Both,1,Each,,15,12.75,4.299,15,UnitedHealthcare,Individual & Family,14.1,94,,percent of total billed charges,,
"LYTES-GLUT-ZINC-GINGER-LACTO16 6,000-10-275 MG ORAL PWPK",,116510,LOCAL,Facility,Outpatient,1,Each,,15,12.75,4.299,15,UnitedHealthcare,Medicare Advantage,7.35,49,,percent of total billed charges,,
"LYTES-GLUT-ZINC-GINGER-LACTO16 6,000-10-275 MG ORAL PWPK",,116510,LOCAL,Facility,Inpatient,1,Each,,15,12.75,4.299,15,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"LYTES-GLUT-ZINC-GINGER-LACTO16 6,000-10-275 MG ORAL PWPK",,116510,LOCAL,Facility,Outpatient,1,Each,,15,12.75,4.299,15,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,7.2,48,,percent of total billed charges,,100% of DHS outpatient percentage
"LYTES-GLUT-ZINC-GINGER-LACTO16 6,000-10-275 MG ORAL PWPK",,116510,LOCAL,Facility,Inpatient,1,Each,,15,12.75,4.299,15,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
WHEAT DEXTRIN 3 GRAM/4 GRAM ORAL PWPK,,119420,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
WHEAT DEXTRIN 3 GRAM/4 GRAM ORAL PWPK,,119420,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
WHEAT DEXTRIN 3 GRAM/4 GRAM ORAL PWPK,,119420,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
WHEAT DEXTRIN 3 GRAM/4 GRAM ORAL PWPK,,119420,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
WHEAT DEXTRIN 3 GRAM/4 GRAM ORAL PWPK,,119420,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
WHEAT DEXTRIN 3 GRAM/4 GRAM ORAL PWPK,,119420,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
WHEAT DEXTRIN 3 GRAM/4 GRAM ORAL PWPK,,119420,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
WHEAT DEXTRIN 3 GRAM/4 GRAM ORAL PWPK,,119420,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
WHEAT DEXTRIN 3 GRAM/4 GRAM ORAL PWPK,,119420,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
WHEAT DEXTRIN 3 GRAM/4 GRAM ORAL PWPK,,119420,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
WHEAT DEXTRIN 3 GRAM/4 GRAM ORAL PWPK,,119420,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
WHEAT DEXTRIN 3 GRAM/4 GRAM ORAL PWPK,,119420,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
WHEAT DEXTRIN 3 GRAM/4 GRAM ORAL PWPK,,119420,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
WHEAT DEXTRIN 3 GRAM/4 GRAM ORAL PWPK,,119420,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
WHEAT DEXTRIN 3 GRAM/4 GRAM ORAL PWPK,,119420,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
WHEAT DEXTRIN 3 GRAM/4 GRAM ORAL PWPK,,119420,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
WHEAT DEXTRIN 3 GRAM/4 GRAM ORAL PWPK,,119420,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
WHEAT DEXTRIN 3 GRAM/4 GRAM ORAL PWPK,,119420,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
WHEAT DEXTRIN 3 GRAM/4 GRAM ORAL PWPK,,119420,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
WHEAT DEXTRIN 3 GRAM/4 GRAM ORAL PWPK,,119420,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
WHEAT DEXTRIN 3 GRAM/4 GRAM ORAL PWPK,,119420,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
WHEAT DEXTRIN 3 GRAM/4 GRAM ORAL PWPK,,119420,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
WHEAT DEXTRIN 3 GRAM/4 GRAM ORAL PWPK,,119420,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
WHEAT DEXTRIN 3 GRAM/4 GRAM ORAL PWPK,,119420,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
WHEAT DEXTRIN 3 GRAM/4 GRAM ORAL PWPK,,119420,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
WHEAT DEXTRIN 3 GRAM/4 GRAM ORAL PWPK,,119420,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
WHEAT DEXTRIN 3 GRAM/4 GRAM ORAL PWPK,,119420,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
WHEAT DEXTRIN 3 GRAM/4 GRAM ORAL PWPK,,119420,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
WHEAT DEXTRIN 3 GRAM/4 GRAM ORAL PWPK,,119420,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
WHEAT DEXTRIN 3 GRAM/4 GRAM ORAL PWPK,,119420,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
WHEAT DEXTRIN 3 GRAM/4 GRAM ORAL PWPK,,119420,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
WHEAT DEXTRIN 3 GRAM/4 GRAM ORAL PWPK,,119420,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
WHEAT DEXTRIN 3 GRAM/4 GRAM ORAL PWPK,,119420,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
WHEAT DEXTRIN 3 GRAM/4 GRAM ORAL PWPK,,119420,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
WHEAT DEXTRIN 3 GRAM/4 GRAM ORAL PWPK,,119420,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
WHEAT DEXTRIN 3 GRAM/4 GRAM ORAL PWPK,,119420,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
WHEAT DEXTRIN 3 GRAM/4 GRAM ORAL PWPK,,119420,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
WHEAT DEXTRIN 3 GRAM/4 GRAM ORAL PWPK,,119420,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
WHEAT DEXTRIN 3 GRAM/4 GRAM ORAL PWPK,,119420,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
WHEAT DEXTRIN 3 GRAM/4 GRAM ORAL PWPK,,119420,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
WHEAT DEXTRIN 3 GRAM/4 GRAM ORAL PWPK,,119420,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
WHEAT DEXTRIN 3 GRAM/4 GRAM ORAL PWPK,,119420,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
WHEAT DEXTRIN 3 GRAM/4 GRAM ORAL PWPK,,119420,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
WHEAT DEXTRIN 3 GRAM/4 GRAM ORAL PWPK,,119420,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
WHEAT DEXTRIN 3 GRAM/4 GRAM ORAL PWPK,,119420,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
WHEAT DEXTRIN 3 GRAM/4 GRAM ORAL PWPK,,119420,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
WHEAT DEXTRIN 3 GRAM/4 GRAM ORAL PWPK,,119420,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
WHEAT DEXTRIN 3 GRAM/4 GRAM ORAL PWPK,,119420,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
WHEAT DEXTRIN 3 GRAM/4 GRAM ORAL PWPK,,119420,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
WHEAT DEXTRIN 3 GRAM/4 GRAM ORAL PWPK,,119420,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
WHEAT DEXTRIN 3 GRAM/4 GRAM ORAL PWPK,,119420,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
WHEAT DEXTRIN 3 GRAM/4 GRAM ORAL PWPK,,119420,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
WHEAT DEXTRIN 3 GRAM/4 GRAM ORAL PWPK,,119420,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
WHEAT DEXTRIN 3 GRAM/4 GRAM ORAL PWPK,,119420,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
PATIROMER CALCIUM SORBITEX 8.4 GRAM ORAL PWPK,,119445,LOCAL,Facility,Both,1,Each,,223,189.55,63.9118,223,Aetna,Commercial,205.16,92,,percent of total billed charges,,
PATIROMER CALCIUM SORBITEX 8.4 GRAM ORAL PWPK,,119445,LOCAL,Facility,Outpatient,1,Each,,223,189.55,63.9118,223,Aetna,Medicare Advantage,109.27,49,,percent of total billed charges,,
PATIROMER CALCIUM SORBITEX 8.4 GRAM ORAL PWPK,,119445,LOCAL,Facility,Inpatient,1,Each,,223,189.55,63.9118,223,Aetna,Medicare Advantage,,,,,Included in per diem rate,
PATIROMER CALCIUM SORBITEX 8.4 GRAM ORAL PWPK,,119445,LOCAL,Facility,Both,1,Each,,223,189.55,63.9118,223,Aetna,PPO,207.39,93,,percent of total billed charges,,
PATIROMER CALCIUM SORBITEX 8.4 GRAM ORAL PWPK,,119445,LOCAL,Facility,Both,1,Each,,223,189.55,63.9118,223,America's PPO,America's PPO,214.1469,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
PATIROMER CALCIUM SORBITEX 8.4 GRAM ORAL PWPK,,119445,LOCAL,Facility,Both,1,Each,,223,189.55,63.9118,223,BlueCross BlueShield Minnesota, Federal Employee Program,219.432,98.4,,percent of total billed charges,,
PATIROMER CALCIUM SORBITEX 8.4 GRAM ORAL PWPK,,119445,LOCAL,Facility,Both,1,Each,,223,189.55,63.9118,223,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,223,100,,percent of total billed charges,,
PATIROMER CALCIUM SORBITEX 8.4 GRAM ORAL PWPK,,119445,LOCAL,Facility,Both,1,Each,,223,189.55,63.9118,223,BlueCross BlueShield Minnesota,High Value Network Plan,200.7,90,,percent of total billed charges,,
PATIROMER CALCIUM SORBITEX 8.4 GRAM ORAL PWPK,,119445,LOCAL,Facility,Outpatient,1,Each,,223,189.55,63.9118,223,BlueCross BlueShield Minnesota,Medicare Advantage,109.27,49,,percent of total billed charges,,
PATIROMER CALCIUM SORBITEX 8.4 GRAM ORAL PWPK,,119445,LOCAL,Facility,Inpatient,1,Each,,223,189.55,63.9118,223,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
PATIROMER CALCIUM SORBITEX 8.4 GRAM ORAL PWPK,,119445,LOCAL,Facility,Both,1,Each,,223,189.55,63.9118,223,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,197.5111,88.57,,percent of total billed charges,,
PATIROMER CALCIUM SORBITEX 8.4 GRAM ORAL PWPK,,119445,LOCAL,Facility,Both,1,Each,,223,189.55,63.9118,223,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,63.9118,28.66,,percent of total billed charges,,
PATIROMER CALCIUM SORBITEX 8.4 GRAM ORAL PWPK,,119445,LOCAL,Facility,Outpatient,1,Each,,223,189.55,63.9118,223,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),109.27,49,,percent of total billed charges,,
PATIROMER CALCIUM SORBITEX 8.4 GRAM ORAL PWPK,,119445,LOCAL,Facility,Inpatient,1,Each,,223,189.55,63.9118,223,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
PATIROMER CALCIUM SORBITEX 8.4 GRAM ORAL PWPK,,119445,LOCAL,Facility,Both,1,Each,,223,189.55,63.9118,223,CorVel,Worker's Compensation,223,100,,percent of total billed charges,,
PATIROMER CALCIUM SORBITEX 8.4 GRAM ORAL PWPK,,119445,LOCAL,Facility,Both,1,Each,,223,189.55,63.9118,223,First Health Group Corporation,First Health Network,216.31,97,,percent of total billed charges,,
PATIROMER CALCIUM SORBITEX 8.4 GRAM ORAL PWPK,,119445,LOCAL,Facility,Both,1,Each,,223,189.55,63.9118,223,"Health Partners, Inc.",Commercial,210.958,94.6,,percent of total billed charges,,
PATIROMER CALCIUM SORBITEX 8.4 GRAM ORAL PWPK,,119445,LOCAL,Facility,Outpatient,1,Each,,223,189.55,63.9118,223,"Health Partners, Inc.",Medicare Advantage,109.27,49,,percent of total billed charges,,
PATIROMER CALCIUM SORBITEX 8.4 GRAM ORAL PWPK,,119445,LOCAL,Facility,Inpatient,1,Each,,223,189.55,63.9118,223,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PATIROMER CALCIUM SORBITEX 8.4 GRAM ORAL PWPK,,119445,LOCAL,Facility,Both,1,Each,,223,189.55,63.9118,223,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),133.8,60,,percent of total billed charges,,
PATIROMER CALCIUM SORBITEX 8.4 GRAM ORAL PWPK,,119445,LOCAL,Facility,Both,1,Each,,223,189.55,63.9118,223,"Health Partners, Inc.",State of Minnesota Advantage Program,181.745,81.5,,percent of total billed charges,,
PATIROMER CALCIUM SORBITEX 8.4 GRAM ORAL PWPK,,119445,LOCAL,Facility,Both,1,Each,,223,189.55,63.9118,223,"Health Partners, Inc.",State Public Programs,111.5,50,,percent of total billed charges,,
PATIROMER CALCIUM SORBITEX 8.4 GRAM ORAL PWPK,,119445,LOCAL,Facility,Both,1,Each,,223,189.55,63.9118,223,Humana Insurance Company,Commercial PPO,211.85,95,,percent of total billed charges,,
PATIROMER CALCIUM SORBITEX 8.4 GRAM ORAL PWPK,,119445,LOCAL,Facility,Outpatient,1,Each,,223,189.55,63.9118,223,Humana Insurance Company,Medicare PPO,109.27,49,,percent of total billed charges,,
PATIROMER CALCIUM SORBITEX 8.4 GRAM ORAL PWPK,,119445,LOCAL,Facility,Inpatient,1,Each,,223,189.55,63.9118,223,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
PATIROMER CALCIUM SORBITEX 8.4 GRAM ORAL PWPK,,119445,LOCAL,Facility,Both,1,Each,,223,189.55,63.9118,223,Medica,Individual & Family,220.993,99.1,,percent of total billed charges,,
PATIROMER CALCIUM SORBITEX 8.4 GRAM ORAL PWPK,,119445,LOCAL,Facility,Outpatient,1,Each,,223,189.55,63.9118,223,Medica,Medica Advantage Solution,111.054,49.8,,percent of total billed charges,,
PATIROMER CALCIUM SORBITEX 8.4 GRAM ORAL PWPK,,119445,LOCAL,Facility,Inpatient,1,Each,,223,189.55,63.9118,223,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
PATIROMER CALCIUM SORBITEX 8.4 GRAM ORAL PWPK,,119445,LOCAL,Facility,Outpatient,1,Each,,223,189.55,63.9118,223,Medica,Medical Assistance,99.458,44.6,,percent of total billed charges,,
PATIROMER CALCIUM SORBITEX 8.4 GRAM ORAL PWPK,,119445,LOCAL,Facility,Inpatient,1,Each,,223,189.55,63.9118,223,Medica,Medical Assistance,,,,,Included in per diem rate,
PATIROMER CALCIUM SORBITEX 8.4 GRAM ORAL PWPK,,119445,LOCAL,Facility,Outpatient,1,Each,,223,189.55,63.9118,223,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,111.054,49.8,,percent of total billed charges,,
PATIROMER CALCIUM SORBITEX 8.4 GRAM ORAL PWPK,,119445,LOCAL,Facility,Inpatient,1,Each,,223,189.55,63.9118,223,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
PATIROMER CALCIUM SORBITEX 8.4 GRAM ORAL PWPK,,119445,LOCAL,Facility,Both,1,Each,,223,189.55,63.9118,223,"Multiplan, Inc.","Multiplan, Inc.",209.62,94,,percent of total billed charges,,
PATIROMER CALCIUM SORBITEX 8.4 GRAM ORAL PWPK,,119445,LOCAL,Facility,Outpatient,1,Each,,223,189.55,63.9118,223,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,200.923,90.1,,percent of total billed charges,,
PATIROMER CALCIUM SORBITEX 8.4 GRAM ORAL PWPK,,119445,LOCAL,Facility,Inpatient,1,Each,,223,189.55,63.9118,223,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
PATIROMER CALCIUM SORBITEX 8.4 GRAM ORAL PWPK,,119445,LOCAL,Facility,Both,1,Each,,223,189.55,63.9118,223,"Preferred One Administrative Services, INC.",PPO,219.878,98.6,,percent of total billed charges,,
PATIROMER CALCIUM SORBITEX 8.4 GRAM ORAL PWPK,,119445,LOCAL,Facility,Outpatient,1,Each,,223,189.55,63.9118,223,PrimeWest Health,Minnesota Senior Health Options (MSHO),114.7335,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
PATIROMER CALCIUM SORBITEX 8.4 GRAM ORAL PWPK,,119445,LOCAL,Facility,Inpatient,1,Each,,223,189.55,63.9118,223,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PATIROMER CALCIUM SORBITEX 8.4 GRAM ORAL PWPK,,119445,LOCAL,Facility,Outpatient,1,Each,,223,189.55,63.9118,223,PrimeWest Health,MinnesotaCare,114.5328,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
PATIROMER CALCIUM SORBITEX 8.4 GRAM ORAL PWPK,,119445,LOCAL,Facility,Inpatient,1,Each,,223,189.55,63.9118,223,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
PATIROMER CALCIUM SORBITEX 8.4 GRAM ORAL PWPK,,119445,LOCAL,Facility,Both,1,Each,,223,189.55,63.9118,223,Sanford Health Plan,Sanford Health Plan,205.16,92,,percent of total billed charges,,
PATIROMER CALCIUM SORBITEX 8.4 GRAM ORAL PWPK,,119445,LOCAL,Facility,Outpatient,1,Each,,223,189.55,63.9118,223,"UCare Health, Inc.",Individual & Family Plan,125.6605,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
PATIROMER CALCIUM SORBITEX 8.4 GRAM ORAL PWPK,,119445,LOCAL,Facility,Inpatient,1,Each,,223,189.55,63.9118,223,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
PATIROMER CALCIUM SORBITEX 8.4 GRAM ORAL PWPK,,119445,LOCAL,Facility,Outpatient,1,Each,,223,189.55,63.9118,223,"UCare Health, Inc.",Medical Assistance,112.5481,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PATIROMER CALCIUM SORBITEX 8.4 GRAM ORAL PWPK,,119445,LOCAL,Facility,Inpatient,1,Each,,223,189.55,63.9118,223,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
PATIROMER CALCIUM SORBITEX 8.4 GRAM ORAL PWPK,,119445,LOCAL,Facility,Outpatient,1,Each,,223,189.55,63.9118,223,"UCare Health, Inc.",Medicare Advantage,112.5481,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PATIROMER CALCIUM SORBITEX 8.4 GRAM ORAL PWPK,,119445,LOCAL,Facility,Inpatient,1,Each,,223,189.55,63.9118,223,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PATIROMER CALCIUM SORBITEX 8.4 GRAM ORAL PWPK,,119445,LOCAL,Facility,Outpatient,1,Each,,223,189.55,63.9118,223,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),112.5481,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PATIROMER CALCIUM SORBITEX 8.4 GRAM ORAL PWPK,,119445,LOCAL,Facility,Inpatient,1,Each,,223,189.55,63.9118,223,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PATIROMER CALCIUM SORBITEX 8.4 GRAM ORAL PWPK,,119445,LOCAL,Facility,Both,1,Each,,223,189.55,63.9118,223,UnitedHealthcare,Individual & Family,209.62,94,,percent of total billed charges,,
PATIROMER CALCIUM SORBITEX 8.4 GRAM ORAL PWPK,,119445,LOCAL,Facility,Outpatient,1,Each,,223,189.55,63.9118,223,UnitedHealthcare,Medicare Advantage,109.27,49,,percent of total billed charges,,
PATIROMER CALCIUM SORBITEX 8.4 GRAM ORAL PWPK,,119445,LOCAL,Facility,Inpatient,1,Each,,223,189.55,63.9118,223,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
PATIROMER CALCIUM SORBITEX 8.4 GRAM ORAL PWPK,,119445,LOCAL,Facility,Outpatient,1,Each,,223,189.55,63.9118,223,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,107.04,48,,percent of total billed charges,,100% of DHS outpatient percentage
PATIROMER CALCIUM SORBITEX 8.4 GRAM ORAL PWPK,,119445,LOCAL,Facility,Inpatient,1,Each,,223,189.55,63.9118,223,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
ROFLUMILAST 250 MCG ORAL TABLET,,130826,LOCAL,Facility,Both,1,Each,,55,46.75,15.763,55,Aetna,Commercial,50.6,92,,percent of total billed charges,,
ROFLUMILAST 250 MCG ORAL TABLET,,130826,LOCAL,Facility,Outpatient,1,Each,,55,46.75,15.763,55,Aetna,Medicare Advantage,26.95,49,,percent of total billed charges,,
ROFLUMILAST 250 MCG ORAL TABLET,,130826,LOCAL,Facility,Inpatient,1,Each,,55,46.75,15.763,55,Aetna,Medicare Advantage,,,,,Included in per diem rate,
ROFLUMILAST 250 MCG ORAL TABLET,,130826,LOCAL,Facility,Both,1,Each,,55,46.75,15.763,55,Aetna,PPO,51.15,93,,percent of total billed charges,,
ROFLUMILAST 250 MCG ORAL TABLET,,130826,LOCAL,Facility,Both,1,Each,,55,46.75,15.763,55,America's PPO,America's PPO,52.8165,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
ROFLUMILAST 250 MCG ORAL TABLET,,130826,LOCAL,Facility,Both,1,Each,,55,46.75,15.763,55,BlueCross BlueShield Minnesota, Federal Employee Program,54.12,98.4,,percent of total billed charges,,
ROFLUMILAST 250 MCG ORAL TABLET,,130826,LOCAL,Facility,Both,1,Each,,55,46.75,15.763,55,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,55,100,,percent of total billed charges,,
ROFLUMILAST 250 MCG ORAL TABLET,,130826,LOCAL,Facility,Both,1,Each,,55,46.75,15.763,55,BlueCross BlueShield Minnesota,High Value Network Plan,49.5,90,,percent of total billed charges,,
ROFLUMILAST 250 MCG ORAL TABLET,,130826,LOCAL,Facility,Outpatient,1,Each,,55,46.75,15.763,55,BlueCross BlueShield Minnesota,Medicare Advantage,26.95,49,,percent of total billed charges,,
ROFLUMILAST 250 MCG ORAL TABLET,,130826,LOCAL,Facility,Inpatient,1,Each,,55,46.75,15.763,55,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
ROFLUMILAST 250 MCG ORAL TABLET,,130826,LOCAL,Facility,Both,1,Each,,55,46.75,15.763,55,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,48.7135,88.57,,percent of total billed charges,,
ROFLUMILAST 250 MCG ORAL TABLET,,130826,LOCAL,Facility,Both,1,Each,,55,46.75,15.763,55,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,15.763,28.66,,percent of total billed charges,,
ROFLUMILAST 250 MCG ORAL TABLET,,130826,LOCAL,Facility,Outpatient,1,Each,,55,46.75,15.763,55,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),26.95,49,,percent of total billed charges,,
ROFLUMILAST 250 MCG ORAL TABLET,,130826,LOCAL,Facility,Inpatient,1,Each,,55,46.75,15.763,55,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
ROFLUMILAST 250 MCG ORAL TABLET,,130826,LOCAL,Facility,Both,1,Each,,55,46.75,15.763,55,CorVel,Worker's Compensation,55,100,,percent of total billed charges,,
ROFLUMILAST 250 MCG ORAL TABLET,,130826,LOCAL,Facility,Both,1,Each,,55,46.75,15.763,55,First Health Group Corporation,First Health Network,53.35,97,,percent of total billed charges,,
ROFLUMILAST 250 MCG ORAL TABLET,,130826,LOCAL,Facility,Both,1,Each,,55,46.75,15.763,55,"Health Partners, Inc.",Commercial,52.03,94.6,,percent of total billed charges,,
ROFLUMILAST 250 MCG ORAL TABLET,,130826,LOCAL,Facility,Outpatient,1,Each,,55,46.75,15.763,55,"Health Partners, Inc.",Medicare Advantage,26.95,49,,percent of total billed charges,,
ROFLUMILAST 250 MCG ORAL TABLET,,130826,LOCAL,Facility,Inpatient,1,Each,,55,46.75,15.763,55,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ROFLUMILAST 250 MCG ORAL TABLET,,130826,LOCAL,Facility,Both,1,Each,,55,46.75,15.763,55,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),33,60,,percent of total billed charges,,
ROFLUMILAST 250 MCG ORAL TABLET,,130826,LOCAL,Facility,Both,1,Each,,55,46.75,15.763,55,"Health Partners, Inc.",State of Minnesota Advantage Program,44.825,81.5,,percent of total billed charges,,
ROFLUMILAST 250 MCG ORAL TABLET,,130826,LOCAL,Facility,Both,1,Each,,55,46.75,15.763,55,"Health Partners, Inc.",State Public Programs,27.5,50,,percent of total billed charges,,
ROFLUMILAST 250 MCG ORAL TABLET,,130826,LOCAL,Facility,Both,1,Each,,55,46.75,15.763,55,Humana Insurance Company,Commercial PPO,52.25,95,,percent of total billed charges,,
ROFLUMILAST 250 MCG ORAL TABLET,,130826,LOCAL,Facility,Outpatient,1,Each,,55,46.75,15.763,55,Humana Insurance Company,Medicare PPO,26.95,49,,percent of total billed charges,,
ROFLUMILAST 250 MCG ORAL TABLET,,130826,LOCAL,Facility,Inpatient,1,Each,,55,46.75,15.763,55,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
ROFLUMILAST 250 MCG ORAL TABLET,,130826,LOCAL,Facility,Both,1,Each,,55,46.75,15.763,55,Medica,Individual & Family,54.505,99.1,,percent of total billed charges,,
ROFLUMILAST 250 MCG ORAL TABLET,,130826,LOCAL,Facility,Outpatient,1,Each,,55,46.75,15.763,55,Medica,Medica Advantage Solution,27.39,49.8,,percent of total billed charges,,
ROFLUMILAST 250 MCG ORAL TABLET,,130826,LOCAL,Facility,Inpatient,1,Each,,55,46.75,15.763,55,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
ROFLUMILAST 250 MCG ORAL TABLET,,130826,LOCAL,Facility,Outpatient,1,Each,,55,46.75,15.763,55,Medica,Medical Assistance,24.53,44.6,,percent of total billed charges,,
ROFLUMILAST 250 MCG ORAL TABLET,,130826,LOCAL,Facility,Inpatient,1,Each,,55,46.75,15.763,55,Medica,Medical Assistance,,,,,Included in per diem rate,
ROFLUMILAST 250 MCG ORAL TABLET,,130826,LOCAL,Facility,Outpatient,1,Each,,55,46.75,15.763,55,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,27.39,49.8,,percent of total billed charges,,
ROFLUMILAST 250 MCG ORAL TABLET,,130826,LOCAL,Facility,Inpatient,1,Each,,55,46.75,15.763,55,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
ROFLUMILAST 250 MCG ORAL TABLET,,130826,LOCAL,Facility,Both,1,Each,,55,46.75,15.763,55,"Multiplan, Inc.","Multiplan, Inc.",51.7,94,,percent of total billed charges,,
ROFLUMILAST 250 MCG ORAL TABLET,,130826,LOCAL,Facility,Outpatient,1,Each,,55,46.75,15.763,55,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,49.555,90.1,,percent of total billed charges,,
ROFLUMILAST 250 MCG ORAL TABLET,,130826,LOCAL,Facility,Inpatient,1,Each,,55,46.75,15.763,55,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
ROFLUMILAST 250 MCG ORAL TABLET,,130826,LOCAL,Facility,Both,1,Each,,55,46.75,15.763,55,"Preferred One Administrative Services, INC.",PPO,54.23,98.6,,percent of total billed charges,,
ROFLUMILAST 250 MCG ORAL TABLET,,130826,LOCAL,Facility,Outpatient,1,Each,,55,46.75,15.763,55,PrimeWest Health,Minnesota Senior Health Options (MSHO),28.2975,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
ROFLUMILAST 250 MCG ORAL TABLET,,130826,LOCAL,Facility,Inpatient,1,Each,,55,46.75,15.763,55,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ROFLUMILAST 250 MCG ORAL TABLET,,130826,LOCAL,Facility,Outpatient,1,Each,,55,46.75,15.763,55,PrimeWest Health,MinnesotaCare,28.248,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
ROFLUMILAST 250 MCG ORAL TABLET,,130826,LOCAL,Facility,Inpatient,1,Each,,55,46.75,15.763,55,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
ROFLUMILAST 250 MCG ORAL TABLET,,130826,LOCAL,Facility,Both,1,Each,,55,46.75,15.763,55,Sanford Health Plan,Sanford Health Plan,50.6,92,,percent of total billed charges,,
ROFLUMILAST 250 MCG ORAL TABLET,,130826,LOCAL,Facility,Outpatient,1,Each,,55,46.75,15.763,55,"UCare Health, Inc.",Individual & Family Plan,30.9925,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
ROFLUMILAST 250 MCG ORAL TABLET,,130826,LOCAL,Facility,Inpatient,1,Each,,55,46.75,15.763,55,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
ROFLUMILAST 250 MCG ORAL TABLET,,130826,LOCAL,Facility,Outpatient,1,Each,,55,46.75,15.763,55,"UCare Health, Inc.",Medical Assistance,27.7585,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ROFLUMILAST 250 MCG ORAL TABLET,,130826,LOCAL,Facility,Inpatient,1,Each,,55,46.75,15.763,55,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
ROFLUMILAST 250 MCG ORAL TABLET,,130826,LOCAL,Facility,Outpatient,1,Each,,55,46.75,15.763,55,"UCare Health, Inc.",Medicare Advantage,27.7585,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ROFLUMILAST 250 MCG ORAL TABLET,,130826,LOCAL,Facility,Inpatient,1,Each,,55,46.75,15.763,55,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ROFLUMILAST 250 MCG ORAL TABLET,,130826,LOCAL,Facility,Outpatient,1,Each,,55,46.75,15.763,55,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),27.7585,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ROFLUMILAST 250 MCG ORAL TABLET,,130826,LOCAL,Facility,Inpatient,1,Each,,55,46.75,15.763,55,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ROFLUMILAST 250 MCG ORAL TABLET,,130826,LOCAL,Facility,Both,1,Each,,55,46.75,15.763,55,UnitedHealthcare,Individual & Family,51.7,94,,percent of total billed charges,,
ROFLUMILAST 250 MCG ORAL TABLET,,130826,LOCAL,Facility,Outpatient,1,Each,,55,46.75,15.763,55,UnitedHealthcare,Medicare Advantage,26.95,49,,percent of total billed charges,,
ROFLUMILAST 250 MCG ORAL TABLET,,130826,LOCAL,Facility,Inpatient,1,Each,,55,46.75,15.763,55,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
ROFLUMILAST 250 MCG ORAL TABLET,,130826,LOCAL,Facility,Outpatient,1,Each,,55,46.75,15.763,55,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,26.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
ROFLUMILAST 250 MCG ORAL TABLET,,130826,LOCAL,Facility,Inpatient,1,Each,,55,46.75,15.763,55,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
PHENAZOPYRIDINE 99.5 MG ORAL TABLET,,134014,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
PHENAZOPYRIDINE 99.5 MG ORAL TABLET,,134014,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
PHENAZOPYRIDINE 99.5 MG ORAL TABLET,,134014,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
PHENAZOPYRIDINE 99.5 MG ORAL TABLET,,134014,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
PHENAZOPYRIDINE 99.5 MG ORAL TABLET,,134014,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
PHENAZOPYRIDINE 99.5 MG ORAL TABLET,,134014,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
PHENAZOPYRIDINE 99.5 MG ORAL TABLET,,134014,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
PHENAZOPYRIDINE 99.5 MG ORAL TABLET,,134014,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
PHENAZOPYRIDINE 99.5 MG ORAL TABLET,,134014,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
PHENAZOPYRIDINE 99.5 MG ORAL TABLET,,134014,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
PHENAZOPYRIDINE 99.5 MG ORAL TABLET,,134014,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
PHENAZOPYRIDINE 99.5 MG ORAL TABLET,,134014,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
PHENAZOPYRIDINE 99.5 MG ORAL TABLET,,134014,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
PHENAZOPYRIDINE 99.5 MG ORAL TABLET,,134014,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
PHENAZOPYRIDINE 99.5 MG ORAL TABLET,,134014,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
PHENAZOPYRIDINE 99.5 MG ORAL TABLET,,134014,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
PHENAZOPYRIDINE 99.5 MG ORAL TABLET,,134014,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
PHENAZOPYRIDINE 99.5 MG ORAL TABLET,,134014,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
PHENAZOPYRIDINE 99.5 MG ORAL TABLET,,134014,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PHENAZOPYRIDINE 99.5 MG ORAL TABLET,,134014,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
PHENAZOPYRIDINE 99.5 MG ORAL TABLET,,134014,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
PHENAZOPYRIDINE 99.5 MG ORAL TABLET,,134014,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
PHENAZOPYRIDINE 99.5 MG ORAL TABLET,,134014,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
PHENAZOPYRIDINE 99.5 MG ORAL TABLET,,134014,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
PHENAZOPYRIDINE 99.5 MG ORAL TABLET,,134014,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
PHENAZOPYRIDINE 99.5 MG ORAL TABLET,,134014,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
PHENAZOPYRIDINE 99.5 MG ORAL TABLET,,134014,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
PHENAZOPYRIDINE 99.5 MG ORAL TABLET,,134014,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
PHENAZOPYRIDINE 99.5 MG ORAL TABLET,,134014,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
PHENAZOPYRIDINE 99.5 MG ORAL TABLET,,134014,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
PHENAZOPYRIDINE 99.5 MG ORAL TABLET,,134014,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
PHENAZOPYRIDINE 99.5 MG ORAL TABLET,,134014,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
PHENAZOPYRIDINE 99.5 MG ORAL TABLET,,134014,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
PHENAZOPYRIDINE 99.5 MG ORAL TABLET,,134014,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
PHENAZOPYRIDINE 99.5 MG ORAL TABLET,,134014,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
PHENAZOPYRIDINE 99.5 MG ORAL TABLET,,134014,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
PHENAZOPYRIDINE 99.5 MG ORAL TABLET,,134014,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
PHENAZOPYRIDINE 99.5 MG ORAL TABLET,,134014,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PHENAZOPYRIDINE 99.5 MG ORAL TABLET,,134014,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
PHENAZOPYRIDINE 99.5 MG ORAL TABLET,,134014,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
PHENAZOPYRIDINE 99.5 MG ORAL TABLET,,134014,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
PHENAZOPYRIDINE 99.5 MG ORAL TABLET,,134014,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
PHENAZOPYRIDINE 99.5 MG ORAL TABLET,,134014,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
PHENAZOPYRIDINE 99.5 MG ORAL TABLET,,134014,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PHENAZOPYRIDINE 99.5 MG ORAL TABLET,,134014,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
PHENAZOPYRIDINE 99.5 MG ORAL TABLET,,134014,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PHENAZOPYRIDINE 99.5 MG ORAL TABLET,,134014,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PHENAZOPYRIDINE 99.5 MG ORAL TABLET,,134014,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PHENAZOPYRIDINE 99.5 MG ORAL TABLET,,134014,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PHENAZOPYRIDINE 99.5 MG ORAL TABLET,,134014,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
PHENAZOPYRIDINE 99.5 MG ORAL TABLET,,134014,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
PHENAZOPYRIDINE 99.5 MG ORAL TABLET,,134014,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
PHENAZOPYRIDINE 99.5 MG ORAL TABLET,,134014,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
PHENAZOPYRIDINE 99.5 MG ORAL TABLET,,134014,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
CYCLOPENT-TROPIC-PHEN-KETR-WAT 1 %-1 %-10 %- 0.5 % OPHT DROP,,139351,LOCAL,Facility,Both,1,Each,,50,42.5,14.33,50,Aetna,Commercial,46,92,,percent of total billed charges,,
CYCLOPENT-TROPIC-PHEN-KETR-WAT 1 %-1 %-10 %- 0.5 % OPHT DROP,,139351,LOCAL,Facility,Outpatient,1,Each,,50,42.5,14.33,50,Aetna,Medicare Advantage,24.5,49,,percent of total billed charges,,
CYCLOPENT-TROPIC-PHEN-KETR-WAT 1 %-1 %-10 %- 0.5 % OPHT DROP,,139351,LOCAL,Facility,Inpatient,1,Each,,50,42.5,14.33,50,Aetna,Medicare Advantage,,,,,Included in per diem rate,
CYCLOPENT-TROPIC-PHEN-KETR-WAT 1 %-1 %-10 %- 0.5 % OPHT DROP,,139351,LOCAL,Facility,Both,1,Each,,50,42.5,14.33,50,Aetna,PPO,46.5,93,,percent of total billed charges,,
CYCLOPENT-TROPIC-PHEN-KETR-WAT 1 %-1 %-10 %- 0.5 % OPHT DROP,,139351,LOCAL,Facility,Both,1,Each,,50,42.5,14.33,50,America's PPO,America's PPO,48.015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
CYCLOPENT-TROPIC-PHEN-KETR-WAT 1 %-1 %-10 %- 0.5 % OPHT DROP,,139351,LOCAL,Facility,Both,1,Each,,50,42.5,14.33,50,BlueCross BlueShield Minnesota, Federal Employee Program,49.2,98.4,,percent of total billed charges,,
CYCLOPENT-TROPIC-PHEN-KETR-WAT 1 %-1 %-10 %- 0.5 % OPHT DROP,,139351,LOCAL,Facility,Both,1,Each,,50,42.5,14.33,50,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,50,100,,percent of total billed charges,,
CYCLOPENT-TROPIC-PHEN-KETR-WAT 1 %-1 %-10 %- 0.5 % OPHT DROP,,139351,LOCAL,Facility,Both,1,Each,,50,42.5,14.33,50,BlueCross BlueShield Minnesota,High Value Network Plan,45,90,,percent of total billed charges,,
CYCLOPENT-TROPIC-PHEN-KETR-WAT 1 %-1 %-10 %- 0.5 % OPHT DROP,,139351,LOCAL,Facility,Outpatient,1,Each,,50,42.5,14.33,50,BlueCross BlueShield Minnesota,Medicare Advantage,24.5,49,,percent of total billed charges,,
CYCLOPENT-TROPIC-PHEN-KETR-WAT 1 %-1 %-10 %- 0.5 % OPHT DROP,,139351,LOCAL,Facility,Inpatient,1,Each,,50,42.5,14.33,50,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
CYCLOPENT-TROPIC-PHEN-KETR-WAT 1 %-1 %-10 %- 0.5 % OPHT DROP,,139351,LOCAL,Facility,Both,1,Each,,50,42.5,14.33,50,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,44.285,88.57,,percent of total billed charges,,
CYCLOPENT-TROPIC-PHEN-KETR-WAT 1 %-1 %-10 %- 0.5 % OPHT DROP,,139351,LOCAL,Facility,Both,1,Each,,50,42.5,14.33,50,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,14.33,28.66,,percent of total billed charges,,
CYCLOPENT-TROPIC-PHEN-KETR-WAT 1 %-1 %-10 %- 0.5 % OPHT DROP,,139351,LOCAL,Facility,Outpatient,1,Each,,50,42.5,14.33,50,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),24.5,49,,percent of total billed charges,,
CYCLOPENT-TROPIC-PHEN-KETR-WAT 1 %-1 %-10 %- 0.5 % OPHT DROP,,139351,LOCAL,Facility,Inpatient,1,Each,,50,42.5,14.33,50,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
CYCLOPENT-TROPIC-PHEN-KETR-WAT 1 %-1 %-10 %- 0.5 % OPHT DROP,,139351,LOCAL,Facility,Both,1,Each,,50,42.5,14.33,50,CorVel,Worker's Compensation,50,100,,percent of total billed charges,,
CYCLOPENT-TROPIC-PHEN-KETR-WAT 1 %-1 %-10 %- 0.5 % OPHT DROP,,139351,LOCAL,Facility,Both,1,Each,,50,42.5,14.33,50,First Health Group Corporation,First Health Network,48.5,97,,percent of total billed charges,,
CYCLOPENT-TROPIC-PHEN-KETR-WAT 1 %-1 %-10 %- 0.5 % OPHT DROP,,139351,LOCAL,Facility,Both,1,Each,,50,42.5,14.33,50,"Health Partners, Inc.",Commercial,47.3,94.6,,percent of total billed charges,,
CYCLOPENT-TROPIC-PHEN-KETR-WAT 1 %-1 %-10 %- 0.5 % OPHT DROP,,139351,LOCAL,Facility,Outpatient,1,Each,,50,42.5,14.33,50,"Health Partners, Inc.",Medicare Advantage,24.5,49,,percent of total billed charges,,
CYCLOPENT-TROPIC-PHEN-KETR-WAT 1 %-1 %-10 %- 0.5 % OPHT DROP,,139351,LOCAL,Facility,Inpatient,1,Each,,50,42.5,14.33,50,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CYCLOPENT-TROPIC-PHEN-KETR-WAT 1 %-1 %-10 %- 0.5 % OPHT DROP,,139351,LOCAL,Facility,Both,1,Each,,50,42.5,14.33,50,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),30,60,,percent of total billed charges,,
CYCLOPENT-TROPIC-PHEN-KETR-WAT 1 %-1 %-10 %- 0.5 % OPHT DROP,,139351,LOCAL,Facility,Both,1,Each,,50,42.5,14.33,50,"Health Partners, Inc.",State of Minnesota Advantage Program,40.75,81.5,,percent of total billed charges,,
CYCLOPENT-TROPIC-PHEN-KETR-WAT 1 %-1 %-10 %- 0.5 % OPHT DROP,,139351,LOCAL,Facility,Both,1,Each,,50,42.5,14.33,50,"Health Partners, Inc.",State Public Programs,25,50,,percent of total billed charges,,
CYCLOPENT-TROPIC-PHEN-KETR-WAT 1 %-1 %-10 %- 0.5 % OPHT DROP,,139351,LOCAL,Facility,Both,1,Each,,50,42.5,14.33,50,Humana Insurance Company,Commercial PPO,47.5,95,,percent of total billed charges,,
CYCLOPENT-TROPIC-PHEN-KETR-WAT 1 %-1 %-10 %- 0.5 % OPHT DROP,,139351,LOCAL,Facility,Outpatient,1,Each,,50,42.5,14.33,50,Humana Insurance Company,Medicare PPO,24.5,49,,percent of total billed charges,,
CYCLOPENT-TROPIC-PHEN-KETR-WAT 1 %-1 %-10 %- 0.5 % OPHT DROP,,139351,LOCAL,Facility,Inpatient,1,Each,,50,42.5,14.33,50,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
CYCLOPENT-TROPIC-PHEN-KETR-WAT 1 %-1 %-10 %- 0.5 % OPHT DROP,,139351,LOCAL,Facility,Both,1,Each,,50,42.5,14.33,50,Medica,Individual & Family,49.55,99.1,,percent of total billed charges,,
CYCLOPENT-TROPIC-PHEN-KETR-WAT 1 %-1 %-10 %- 0.5 % OPHT DROP,,139351,LOCAL,Facility,Outpatient,1,Each,,50,42.5,14.33,50,Medica,Medica Advantage Solution,24.9,49.8,,percent of total billed charges,,
CYCLOPENT-TROPIC-PHEN-KETR-WAT 1 %-1 %-10 %- 0.5 % OPHT DROP,,139351,LOCAL,Facility,Inpatient,1,Each,,50,42.5,14.33,50,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
CYCLOPENT-TROPIC-PHEN-KETR-WAT 1 %-1 %-10 %- 0.5 % OPHT DROP,,139351,LOCAL,Facility,Outpatient,1,Each,,50,42.5,14.33,50,Medica,Medical Assistance,22.3,44.6,,percent of total billed charges,,
CYCLOPENT-TROPIC-PHEN-KETR-WAT 1 %-1 %-10 %- 0.5 % OPHT DROP,,139351,LOCAL,Facility,Inpatient,1,Each,,50,42.5,14.33,50,Medica,Medical Assistance,,,,,Included in per diem rate,
CYCLOPENT-TROPIC-PHEN-KETR-WAT 1 %-1 %-10 %- 0.5 % OPHT DROP,,139351,LOCAL,Facility,Outpatient,1,Each,,50,42.5,14.33,50,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,24.9,49.8,,percent of total billed charges,,
CYCLOPENT-TROPIC-PHEN-KETR-WAT 1 %-1 %-10 %- 0.5 % OPHT DROP,,139351,LOCAL,Facility,Inpatient,1,Each,,50,42.5,14.33,50,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
CYCLOPENT-TROPIC-PHEN-KETR-WAT 1 %-1 %-10 %- 0.5 % OPHT DROP,,139351,LOCAL,Facility,Both,1,Each,,50,42.5,14.33,50,"Multiplan, Inc.","Multiplan, Inc.",47,94,,percent of total billed charges,,
CYCLOPENT-TROPIC-PHEN-KETR-WAT 1 %-1 %-10 %- 0.5 % OPHT DROP,,139351,LOCAL,Facility,Outpatient,1,Each,,50,42.5,14.33,50,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,45.05,90.1,,percent of total billed charges,,
CYCLOPENT-TROPIC-PHEN-KETR-WAT 1 %-1 %-10 %- 0.5 % OPHT DROP,,139351,LOCAL,Facility,Inpatient,1,Each,,50,42.5,14.33,50,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
CYCLOPENT-TROPIC-PHEN-KETR-WAT 1 %-1 %-10 %- 0.5 % OPHT DROP,,139351,LOCAL,Facility,Both,1,Each,,50,42.5,14.33,50,"Preferred One Administrative Services, INC.",PPO,49.3,98.6,,percent of total billed charges,,
CYCLOPENT-TROPIC-PHEN-KETR-WAT 1 %-1 %-10 %- 0.5 % OPHT DROP,,139351,LOCAL,Facility,Outpatient,1,Each,,50,42.5,14.33,50,PrimeWest Health,Minnesota Senior Health Options (MSHO),25.725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
CYCLOPENT-TROPIC-PHEN-KETR-WAT 1 %-1 %-10 %- 0.5 % OPHT DROP,,139351,LOCAL,Facility,Inpatient,1,Each,,50,42.5,14.33,50,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CYCLOPENT-TROPIC-PHEN-KETR-WAT 1 %-1 %-10 %- 0.5 % OPHT DROP,,139351,LOCAL,Facility,Outpatient,1,Each,,50,42.5,14.33,50,PrimeWest Health,MinnesotaCare,25.68,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
CYCLOPENT-TROPIC-PHEN-KETR-WAT 1 %-1 %-10 %- 0.5 % OPHT DROP,,139351,LOCAL,Facility,Inpatient,1,Each,,50,42.5,14.33,50,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
CYCLOPENT-TROPIC-PHEN-KETR-WAT 1 %-1 %-10 %- 0.5 % OPHT DROP,,139351,LOCAL,Facility,Both,1,Each,,50,42.5,14.33,50,Sanford Health Plan,Sanford Health Plan,46,92,,percent of total billed charges,,
CYCLOPENT-TROPIC-PHEN-KETR-WAT 1 %-1 %-10 %- 0.5 % OPHT DROP,,139351,LOCAL,Facility,Outpatient,1,Each,,50,42.5,14.33,50,"UCare Health, Inc.",Individual & Family Plan,28.175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
CYCLOPENT-TROPIC-PHEN-KETR-WAT 1 %-1 %-10 %- 0.5 % OPHT DROP,,139351,LOCAL,Facility,Inpatient,1,Each,,50,42.5,14.33,50,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
CYCLOPENT-TROPIC-PHEN-KETR-WAT 1 %-1 %-10 %- 0.5 % OPHT DROP,,139351,LOCAL,Facility,Outpatient,1,Each,,50,42.5,14.33,50,"UCare Health, Inc.",Medical Assistance,25.235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CYCLOPENT-TROPIC-PHEN-KETR-WAT 1 %-1 %-10 %- 0.5 % OPHT DROP,,139351,LOCAL,Facility,Inpatient,1,Each,,50,42.5,14.33,50,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
CYCLOPENT-TROPIC-PHEN-KETR-WAT 1 %-1 %-10 %- 0.5 % OPHT DROP,,139351,LOCAL,Facility,Outpatient,1,Each,,50,42.5,14.33,50,"UCare Health, Inc.",Medicare Advantage,25.235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CYCLOPENT-TROPIC-PHEN-KETR-WAT 1 %-1 %-10 %- 0.5 % OPHT DROP,,139351,LOCAL,Facility,Inpatient,1,Each,,50,42.5,14.33,50,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CYCLOPENT-TROPIC-PHEN-KETR-WAT 1 %-1 %-10 %- 0.5 % OPHT DROP,,139351,LOCAL,Facility,Outpatient,1,Each,,50,42.5,14.33,50,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),25.235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CYCLOPENT-TROPIC-PHEN-KETR-WAT 1 %-1 %-10 %- 0.5 % OPHT DROP,,139351,LOCAL,Facility,Inpatient,1,Each,,50,42.5,14.33,50,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CYCLOPENT-TROPIC-PHEN-KETR-WAT 1 %-1 %-10 %- 0.5 % OPHT DROP,,139351,LOCAL,Facility,Both,1,Each,,50,42.5,14.33,50,UnitedHealthcare,Individual & Family,47,94,,percent of total billed charges,,
CYCLOPENT-TROPIC-PHEN-KETR-WAT 1 %-1 %-10 %- 0.5 % OPHT DROP,,139351,LOCAL,Facility,Outpatient,1,Each,,50,42.5,14.33,50,UnitedHealthcare,Medicare Advantage,24.5,49,,percent of total billed charges,,
CYCLOPENT-TROPIC-PHEN-KETR-WAT 1 %-1 %-10 %- 0.5 % OPHT DROP,,139351,LOCAL,Facility,Inpatient,1,Each,,50,42.5,14.33,50,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
CYCLOPENT-TROPIC-PHEN-KETR-WAT 1 %-1 %-10 %- 0.5 % OPHT DROP,,139351,LOCAL,Facility,Outpatient,1,Each,,50,42.5,14.33,50,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,24,48,,percent of total billed charges,,100% of DHS outpatient percentage
CYCLOPENT-TROPIC-PHEN-KETR-WAT 1 %-1 %-10 %- 0.5 % OPHT DROP,,139351,LOCAL,Facility,Inpatient,1,Each,,50,42.5,14.33,50,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
ALTEPLASE 0.09 MG/KG BOLUS - MHS,,480104,LOCAL,Facility,Both,1,Each,,31682,26929.7,9080.0612,31682,Aetna,Commercial,29147.44,92,,percent of total billed charges,,
ALTEPLASE 0.09 MG/KG BOLUS - MHS,,480104,LOCAL,Facility,Outpatient,1,Each,,31682,26929.7,9080.0612,31682,Aetna,Medicare Advantage,15524.18,49,,percent of total billed charges,,
ALTEPLASE 0.09 MG/KG BOLUS - MHS,,480104,LOCAL,Facility,Inpatient,1,Each,,31682,26929.7,9080.0612,31682,Aetna,Medicare Advantage,,,,,Included in per diem rate,
ALTEPLASE 0.09 MG/KG BOLUS - MHS,,480104,LOCAL,Facility,Both,1,Each,,31682,26929.7,9080.0612,31682,Aetna,PPO,29464.26,93,,percent of total billed charges,,
ALTEPLASE 0.09 MG/KG BOLUS - MHS,,480104,LOCAL,Facility,Both,1,Each,,31682,26929.7,9080.0612,31682,America's PPO,America's PPO,30424.2246,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
ALTEPLASE 0.09 MG/KG BOLUS - MHS,,480104,LOCAL,Facility,Both,1,Each,,31682,26929.7,9080.0612,31682,BlueCross BlueShield Minnesota, Federal Employee Program,31175.088,98.4,,percent of total billed charges,,
ALTEPLASE 0.09 MG/KG BOLUS - MHS,,480104,LOCAL,Facility,Both,1,Each,,31682,26929.7,9080.0612,31682,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,31682,100,,percent of total billed charges,,
ALTEPLASE 0.09 MG/KG BOLUS - MHS,,480104,LOCAL,Facility,Both,1,Each,,31682,26929.7,9080.0612,31682,BlueCross BlueShield Minnesota,High Value Network Plan,28513.8,90,,percent of total billed charges,,
ALTEPLASE 0.09 MG/KG BOLUS - MHS,,480104,LOCAL,Facility,Outpatient,1,Each,,31682,26929.7,9080.0612,31682,BlueCross BlueShield Minnesota,Medicare Advantage,15524.18,49,,percent of total billed charges,,
ALTEPLASE 0.09 MG/KG BOLUS - MHS,,480104,LOCAL,Facility,Inpatient,1,Each,,31682,26929.7,9080.0612,31682,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
ALTEPLASE 0.09 MG/KG BOLUS - MHS,,480104,LOCAL,Facility,Both,1,Each,,31682,26929.7,9080.0612,31682,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,28060.7474,88.57,,percent of total billed charges,,
ALTEPLASE 0.09 MG/KG BOLUS - MHS,,480104,LOCAL,Facility,Both,1,Each,,31682,26929.7,9080.0612,31682,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,9080.0612,28.66,,percent of total billed charges,,
ALTEPLASE 0.09 MG/KG BOLUS - MHS,,480104,LOCAL,Facility,Outpatient,1,Each,,31682,26929.7,9080.0612,31682,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),15524.18,49,,percent of total billed charges,,
ALTEPLASE 0.09 MG/KG BOLUS - MHS,,480104,LOCAL,Facility,Inpatient,1,Each,,31682,26929.7,9080.0612,31682,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
ALTEPLASE 0.09 MG/KG BOLUS - MHS,,480104,LOCAL,Facility,Both,1,Each,,31682,26929.7,9080.0612,31682,CorVel,Worker's Compensation,31682,100,,percent of total billed charges,,
ALTEPLASE 0.09 MG/KG BOLUS - MHS,,480104,LOCAL,Facility,Both,1,Each,,31682,26929.7,9080.0612,31682,First Health Group Corporation,First Health Network,30731.54,97,,percent of total billed charges,,
ALTEPLASE 0.09 MG/KG BOLUS - MHS,,480104,LOCAL,Facility,Both,1,Each,,31682,26929.7,9080.0612,31682,"Health Partners, Inc.",Commercial,29971.172,94.6,,percent of total billed charges,,
ALTEPLASE 0.09 MG/KG BOLUS - MHS,,480104,LOCAL,Facility,Outpatient,1,Each,,31682,26929.7,9080.0612,31682,"Health Partners, Inc.",Medicare Advantage,15524.18,49,,percent of total billed charges,,
ALTEPLASE 0.09 MG/KG BOLUS - MHS,,480104,LOCAL,Facility,Inpatient,1,Each,,31682,26929.7,9080.0612,31682,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ALTEPLASE 0.09 MG/KG BOLUS - MHS,,480104,LOCAL,Facility,Both,1,Each,,31682,26929.7,9080.0612,31682,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),19009.2,60,,percent of total billed charges,,
ALTEPLASE 0.09 MG/KG BOLUS - MHS,,480104,LOCAL,Facility,Both,1,Each,,31682,26929.7,9080.0612,31682,"Health Partners, Inc.",State of Minnesota Advantage Program,25820.83,81.5,,percent of total billed charges,,
ALTEPLASE 0.09 MG/KG BOLUS - MHS,,480104,LOCAL,Facility,Both,1,Each,,31682,26929.7,9080.0612,31682,"Health Partners, Inc.",State Public Programs,15841,50,,percent of total billed charges,,
ALTEPLASE 0.09 MG/KG BOLUS - MHS,,480104,LOCAL,Facility,Both,1,Each,,31682,26929.7,9080.0612,31682,Humana Insurance Company,Commercial PPO,30097.9,95,,percent of total billed charges,,
ALTEPLASE 0.09 MG/KG BOLUS - MHS,,480104,LOCAL,Facility,Outpatient,1,Each,,31682,26929.7,9080.0612,31682,Humana Insurance Company,Medicare PPO,15524.18,49,,percent of total billed charges,,
ALTEPLASE 0.09 MG/KG BOLUS - MHS,,480104,LOCAL,Facility,Inpatient,1,Each,,31682,26929.7,9080.0612,31682,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
ALTEPLASE 0.09 MG/KG BOLUS - MHS,,480104,LOCAL,Facility,Both,1,Each,,31682,26929.7,9080.0612,31682,Medica,Individual & Family,31396.862,99.1,,percent of total billed charges,,
ALTEPLASE 0.09 MG/KG BOLUS - MHS,,480104,LOCAL,Facility,Outpatient,1,Each,,31682,26929.7,9080.0612,31682,Medica,Medica Advantage Solution,15777.636,49.8,,percent of total billed charges,,
ALTEPLASE 0.09 MG/KG BOLUS - MHS,,480104,LOCAL,Facility,Inpatient,1,Each,,31682,26929.7,9080.0612,31682,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
ALTEPLASE 0.09 MG/KG BOLUS - MHS,,480104,LOCAL,Facility,Outpatient,1,Each,,31682,26929.7,9080.0612,31682,Medica,Medical Assistance,14130.172,44.6,,percent of total billed charges,,
ALTEPLASE 0.09 MG/KG BOLUS - MHS,,480104,LOCAL,Facility,Inpatient,1,Each,,31682,26929.7,9080.0612,31682,Medica,Medical Assistance,,,,,Included in per diem rate,
ALTEPLASE 0.09 MG/KG BOLUS - MHS,,480104,LOCAL,Facility,Outpatient,1,Each,,31682,26929.7,9080.0612,31682,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,15777.636,49.8,,percent of total billed charges,,
ALTEPLASE 0.09 MG/KG BOLUS - MHS,,480104,LOCAL,Facility,Inpatient,1,Each,,31682,26929.7,9080.0612,31682,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
ALTEPLASE 0.09 MG/KG BOLUS - MHS,,480104,LOCAL,Facility,Both,1,Each,,31682,26929.7,9080.0612,31682,"Multiplan, Inc.","Multiplan, Inc.",29781.08,94,,percent of total billed charges,,
ALTEPLASE 0.09 MG/KG BOLUS - MHS,,480104,LOCAL,Facility,Outpatient,1,Each,,31682,26929.7,9080.0612,31682,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,28545.482,90.1,,percent of total billed charges,,
ALTEPLASE 0.09 MG/KG BOLUS - MHS,,480104,LOCAL,Facility,Inpatient,1,Each,,31682,26929.7,9080.0612,31682,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
ALTEPLASE 0.09 MG/KG BOLUS - MHS,,480104,LOCAL,Facility,Both,1,Each,,31682,26929.7,9080.0612,31682,"Preferred One Administrative Services, INC.",PPO,31238.452,98.6,,percent of total billed charges,,
ALTEPLASE 0.09 MG/KG BOLUS - MHS,,480104,LOCAL,Facility,Outpatient,1,Each,,31682,26929.7,9080.0612,31682,PrimeWest Health,Minnesota Senior Health Options (MSHO),16300.389,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
ALTEPLASE 0.09 MG/KG BOLUS - MHS,,480104,LOCAL,Facility,Inpatient,1,Each,,31682,26929.7,9080.0612,31682,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ALTEPLASE 0.09 MG/KG BOLUS - MHS,,480104,LOCAL,Facility,Outpatient,1,Each,,31682,26929.7,9080.0612,31682,PrimeWest Health,MinnesotaCare,16271.8752,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
ALTEPLASE 0.09 MG/KG BOLUS - MHS,,480104,LOCAL,Facility,Inpatient,1,Each,,31682,26929.7,9080.0612,31682,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
ALTEPLASE 0.09 MG/KG BOLUS - MHS,,480104,LOCAL,Facility,Both,1,Each,,31682,26929.7,9080.0612,31682,Sanford Health Plan,Sanford Health Plan,29147.44,92,,percent of total billed charges,,
ALTEPLASE 0.09 MG/KG BOLUS - MHS,,480104,LOCAL,Facility,Outpatient,1,Each,,31682,26929.7,9080.0612,31682,"UCare Health, Inc.",Individual & Family Plan,17852.807,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
ALTEPLASE 0.09 MG/KG BOLUS - MHS,,480104,LOCAL,Facility,Inpatient,1,Each,,31682,26929.7,9080.0612,31682,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
ALTEPLASE 0.09 MG/KG BOLUS - MHS,,480104,LOCAL,Facility,Outpatient,1,Each,,31682,26929.7,9080.0612,31682,"UCare Health, Inc.",Medical Assistance,15989.9054,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ALTEPLASE 0.09 MG/KG BOLUS - MHS,,480104,LOCAL,Facility,Inpatient,1,Each,,31682,26929.7,9080.0612,31682,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
ALTEPLASE 0.09 MG/KG BOLUS - MHS,,480104,LOCAL,Facility,Outpatient,1,Each,,31682,26929.7,9080.0612,31682,"UCare Health, Inc.",Medicare Advantage,15989.9054,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ALTEPLASE 0.09 MG/KG BOLUS - MHS,,480104,LOCAL,Facility,Inpatient,1,Each,,31682,26929.7,9080.0612,31682,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ALTEPLASE 0.09 MG/KG BOLUS - MHS,,480104,LOCAL,Facility,Outpatient,1,Each,,31682,26929.7,9080.0612,31682,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),15989.9054,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ALTEPLASE 0.09 MG/KG BOLUS - MHS,,480104,LOCAL,Facility,Inpatient,1,Each,,31682,26929.7,9080.0612,31682,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ALTEPLASE 0.09 MG/KG BOLUS - MHS,,480104,LOCAL,Facility,Both,1,Each,,31682,26929.7,9080.0612,31682,UnitedHealthcare,Individual & Family,29781.08,94,,percent of total billed charges,,
ALTEPLASE 0.09 MG/KG BOLUS - MHS,,480104,LOCAL,Facility,Outpatient,1,Each,,31682,26929.7,9080.0612,31682,UnitedHealthcare,Medicare Advantage,15524.18,49,,percent of total billed charges,,
ALTEPLASE 0.09 MG/KG BOLUS - MHS,,480104,LOCAL,Facility,Inpatient,1,Each,,31682,26929.7,9080.0612,31682,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
ALTEPLASE 0.09 MG/KG BOLUS - MHS,,480104,LOCAL,Facility,Outpatient,1,Each,,31682,26929.7,9080.0612,31682,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,15207.36,48,,percent of total billed charges,,100% of DHS outpatient percentage
ALTEPLASE 0.09 MG/KG BOLUS - MHS,,480104,LOCAL,Facility,Inpatient,1,Each,,31682,26929.7,9080.0612,31682,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
NONFORMULARY MEDICATION - MHS,,480116,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
NONFORMULARY MEDICATION - MHS,,480116,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
NONFORMULARY MEDICATION - MHS,,480116,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
NONFORMULARY MEDICATION - MHS,,480116,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
NONFORMULARY MEDICATION - MHS,,480116,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
NONFORMULARY MEDICATION - MHS,,480116,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
NONFORMULARY MEDICATION - MHS,,480116,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
NONFORMULARY MEDICATION - MHS,,480116,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
NONFORMULARY MEDICATION - MHS,,480116,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
NONFORMULARY MEDICATION - MHS,,480116,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
NONFORMULARY MEDICATION - MHS,,480116,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
NONFORMULARY MEDICATION - MHS,,480116,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
NONFORMULARY MEDICATION - MHS,,480116,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
NONFORMULARY MEDICATION - MHS,,480116,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
NONFORMULARY MEDICATION - MHS,,480116,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
NONFORMULARY MEDICATION - MHS,,480116,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
NONFORMULARY MEDICATION - MHS,,480116,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
NONFORMULARY MEDICATION - MHS,,480116,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
NONFORMULARY MEDICATION - MHS,,480116,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
NONFORMULARY MEDICATION - MHS,,480116,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
NONFORMULARY MEDICATION - MHS,,480116,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
NONFORMULARY MEDICATION - MHS,,480116,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
NONFORMULARY MEDICATION - MHS,,480116,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
NONFORMULARY MEDICATION - MHS,,480116,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
NONFORMULARY MEDICATION - MHS,,480116,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
NONFORMULARY MEDICATION - MHS,,480116,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
NONFORMULARY MEDICATION - MHS,,480116,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
NONFORMULARY MEDICATION - MHS,,480116,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
NONFORMULARY MEDICATION - MHS,,480116,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
NONFORMULARY MEDICATION - MHS,,480116,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
NONFORMULARY MEDICATION - MHS,,480116,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
NONFORMULARY MEDICATION - MHS,,480116,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
NONFORMULARY MEDICATION - MHS,,480116,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
NONFORMULARY MEDICATION - MHS,,480116,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
NONFORMULARY MEDICATION - MHS,,480116,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
NONFORMULARY MEDICATION - MHS,,480116,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
NONFORMULARY MEDICATION - MHS,,480116,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
NONFORMULARY MEDICATION - MHS,,480116,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
NONFORMULARY MEDICATION - MHS,,480116,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
NONFORMULARY MEDICATION - MHS,,480116,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
NONFORMULARY MEDICATION - MHS,,480116,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
NONFORMULARY MEDICATION - MHS,,480116,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
NONFORMULARY MEDICATION - MHS,,480116,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
NONFORMULARY MEDICATION - MHS,,480116,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
NONFORMULARY MEDICATION - MHS,,480116,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
NONFORMULARY MEDICATION - MHS,,480116,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
NONFORMULARY MEDICATION - MHS,,480116,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
NONFORMULARY MEDICATION - MHS,,480116,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
NONFORMULARY MEDICATION - MHS,,480116,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
NONFORMULARY MEDICATION - MHS,,480116,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
NONFORMULARY MEDICATION - MHS,,480116,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
NONFORMULARY MEDICATION - MHS,,480116,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
NONFORMULARY MEDICATION - MHS,,480116,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
NONFORMULARY MEDICATION - MHS,,480116,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
BENZOCAINE-MENTHOL LOZENGE WRAPPER,,900717,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
BENZOCAINE-MENTHOL LOZENGE WRAPPER,,900717,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
BENZOCAINE-MENTHOL LOZENGE WRAPPER,,900717,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
BENZOCAINE-MENTHOL LOZENGE WRAPPER,,900717,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
BENZOCAINE-MENTHOL LOZENGE WRAPPER,,900717,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
BENZOCAINE-MENTHOL LOZENGE WRAPPER,,900717,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
BENZOCAINE-MENTHOL LOZENGE WRAPPER,,900717,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
BENZOCAINE-MENTHOL LOZENGE WRAPPER,,900717,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
BENZOCAINE-MENTHOL LOZENGE WRAPPER,,900717,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
BENZOCAINE-MENTHOL LOZENGE WRAPPER,,900717,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
BENZOCAINE-MENTHOL LOZENGE WRAPPER,,900717,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
BENZOCAINE-MENTHOL LOZENGE WRAPPER,,900717,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
BENZOCAINE-MENTHOL LOZENGE WRAPPER,,900717,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
BENZOCAINE-MENTHOL LOZENGE WRAPPER,,900717,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
BENZOCAINE-MENTHOL LOZENGE WRAPPER,,900717,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
BENZOCAINE-MENTHOL LOZENGE WRAPPER,,900717,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
BENZOCAINE-MENTHOL LOZENGE WRAPPER,,900717,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
BENZOCAINE-MENTHOL LOZENGE WRAPPER,,900717,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
BENZOCAINE-MENTHOL LOZENGE WRAPPER,,900717,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
BENZOCAINE-MENTHOL LOZENGE WRAPPER,,900717,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
BENZOCAINE-MENTHOL LOZENGE WRAPPER,,900717,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
BENZOCAINE-MENTHOL LOZENGE WRAPPER,,900717,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
BENZOCAINE-MENTHOL LOZENGE WRAPPER,,900717,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
BENZOCAINE-MENTHOL LOZENGE WRAPPER,,900717,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
BENZOCAINE-MENTHOL LOZENGE WRAPPER,,900717,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
BENZOCAINE-MENTHOL LOZENGE WRAPPER,,900717,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
BENZOCAINE-MENTHOL LOZENGE WRAPPER,,900717,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
BENZOCAINE-MENTHOL LOZENGE WRAPPER,,900717,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
BENZOCAINE-MENTHOL LOZENGE WRAPPER,,900717,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
BENZOCAINE-MENTHOL LOZENGE WRAPPER,,900717,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
BENZOCAINE-MENTHOL LOZENGE WRAPPER,,900717,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
BENZOCAINE-MENTHOL LOZENGE WRAPPER,,900717,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
BENZOCAINE-MENTHOL LOZENGE WRAPPER,,900717,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
BENZOCAINE-MENTHOL LOZENGE WRAPPER,,900717,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
BENZOCAINE-MENTHOL LOZENGE WRAPPER,,900717,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
BENZOCAINE-MENTHOL LOZENGE WRAPPER,,900717,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
BENZOCAINE-MENTHOL LOZENGE WRAPPER,,900717,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
BENZOCAINE-MENTHOL LOZENGE WRAPPER,,900717,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
BENZOCAINE-MENTHOL LOZENGE WRAPPER,,900717,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
BENZOCAINE-MENTHOL LOZENGE WRAPPER,,900717,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
BENZOCAINE-MENTHOL LOZENGE WRAPPER,,900717,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
BENZOCAINE-MENTHOL LOZENGE WRAPPER,,900717,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
BENZOCAINE-MENTHOL LOZENGE WRAPPER,,900717,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
BENZOCAINE-MENTHOL LOZENGE WRAPPER,,900717,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BENZOCAINE-MENTHOL LOZENGE WRAPPER,,900717,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
BENZOCAINE-MENTHOL LOZENGE WRAPPER,,900717,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BENZOCAINE-MENTHOL LOZENGE WRAPPER,,900717,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
BENZOCAINE-MENTHOL LOZENGE WRAPPER,,900717,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BENZOCAINE-MENTHOL LOZENGE WRAPPER,,900717,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
BENZOCAINE-MENTHOL LOZENGE WRAPPER,,900717,LOCAL,Facility,Both,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
BENZOCAINE-MENTHOL LOZENGE WRAPPER,,900717,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
BENZOCAINE-MENTHOL LOZENGE WRAPPER,,900717,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
BENZOCAINE-MENTHOL LOZENGE WRAPPER,,900717,LOCAL,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
BENZOCAINE-MENTHOL LOZENGE WRAPPER,,900717,LOCAL,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
ABATACEPT (WITH MALTOSE) 250 MG IV SOLR,,J0129,HCPCS,Facility,Both,1,Each,,4968,4222.8,1423.8288,4968,Aetna,Commercial,4570.56,92,,percent of total billed charges,,
ABATACEPT (WITH MALTOSE) 250 MG IV SOLR,,J0129,HCPCS,Facility,Outpatient,1,Each,,4968,4222.8,1423.8288,4968,Aetna,Medicare Advantage,2434.32,49,,percent of total billed charges,,
ABATACEPT (WITH MALTOSE) 250 MG IV SOLR,,J0129,HCPCS,Facility,Inpatient,1,Each,,4968,4222.8,1423.8288,4968,Aetna,Medicare Advantage,,,,,Included in per diem rate,
ABATACEPT (WITH MALTOSE) 250 MG IV SOLR,,J0129,HCPCS,Facility,Both,1,Each,,4968,4222.8,1423.8288,4968,Aetna,PPO,4620.24,93,,percent of total billed charges,,
ABATACEPT (WITH MALTOSE) 250 MG IV SOLR,,J0129,HCPCS,Facility,Both,1,Each,,4968,4222.8,1423.8288,4968,America's PPO,America's PPO,4770.7704,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
ABATACEPT (WITH MALTOSE) 250 MG IV SOLR,,J0129,HCPCS,Facility,Both,1,Each,,4968,4222.8,1423.8288,4968,BlueCross BlueShield Minnesota, Federal Employee Program,4888.512,98.4,,percent of total billed charges,,
ABATACEPT (WITH MALTOSE) 250 MG IV SOLR,,J0129,HCPCS,Facility,Both,1,Each,,4968,4222.8,1423.8288,4968,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,4968,100,,percent of total billed charges,,
ABATACEPT (WITH MALTOSE) 250 MG IV SOLR,,J0129,HCPCS,Facility,Both,1,Each,,4968,4222.8,1423.8288,4968,BlueCross BlueShield Minnesota,High Value Network Plan,4471.2,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
ABATACEPT (WITH MALTOSE) 250 MG IV SOLR,,J0129,HCPCS,Facility,Outpatient,1,Each,,4968,4222.8,1423.8288,4968,BlueCross BlueShield Minnesota,Medicare Advantage,2434.32,49,,percent of total billed charges,,
ABATACEPT (WITH MALTOSE) 250 MG IV SOLR,,J0129,HCPCS,Facility,Inpatient,1,Each,,4968,4222.8,1423.8288,4968,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
ABATACEPT (WITH MALTOSE) 250 MG IV SOLR,,J0129,HCPCS,Facility,Both,1,Each,,4968,4222.8,1423.8288,4968,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4400.1576,88.57,,percent of total billed charges,,
ABATACEPT (WITH MALTOSE) 250 MG IV SOLR,,J0129,HCPCS,Facility,Both,1,Each,,4968,4222.8,1423.8288,4968,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1423.8288,28.66,,percent of total billed charges,,
ABATACEPT (WITH MALTOSE) 250 MG IV SOLR,,J0129,HCPCS,Facility,Outpatient,1,Each,,4968,4222.8,1423.8288,4968,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2434.32,49,,percent of total billed charges,,
ABATACEPT (WITH MALTOSE) 250 MG IV SOLR,,J0129,HCPCS,Facility,Inpatient,1,Each,,4968,4222.8,1423.8288,4968,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
ABATACEPT (WITH MALTOSE) 250 MG IV SOLR,,J0129,HCPCS,Facility,Both,1,Each,,4968,4222.8,1423.8288,4968,CorVel,Worker's Compensation,4968,100,,percent of total billed charges,,
ABATACEPT (WITH MALTOSE) 250 MG IV SOLR,,J0129,HCPCS,Facility,Both,1,Each,,4968,4222.8,1423.8288,4968,First Health Group Corporation,First Health Network,4818.96,97,,percent of total billed charges,,
ABATACEPT (WITH MALTOSE) 250 MG IV SOLR,,J0129,HCPCS,Facility,Both,1,Each,,4968,4222.8,1423.8288,4968,"Health Partners, Inc.",Commercial,4699.728,94.6,,percent of total billed charges,,
ABATACEPT (WITH MALTOSE) 250 MG IV SOLR,,J0129,HCPCS,Facility,Outpatient,1,Each,,4968,4222.8,1423.8288,4968,"Health Partners, Inc.",Medicare Advantage,2434.32,49,,percent of total billed charges,,
ABATACEPT (WITH MALTOSE) 250 MG IV SOLR,,J0129,HCPCS,Facility,Inpatient,1,Each,,4968,4222.8,1423.8288,4968,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ABATACEPT (WITH MALTOSE) 250 MG IV SOLR,,J0129,HCPCS,Facility,Both,1,Each,,4968,4222.8,1423.8288,4968,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),2980.8,60,,percent of total billed charges,,
ABATACEPT (WITH MALTOSE) 250 MG IV SOLR,,J0129,HCPCS,Facility,Both,1,Each,,4968,4222.8,1423.8288,4968,"Health Partners, Inc.",State of Minnesota Advantage Program,4048.92,81.5,,percent of total billed charges,,
ABATACEPT (WITH MALTOSE) 250 MG IV SOLR,,J0129,HCPCS,Facility,Both,1,Each,,4968,4222.8,1423.8288,4968,"Health Partners, Inc.",State Public Programs,2484,50,,percent of total billed charges,,
ABATACEPT (WITH MALTOSE) 250 MG IV SOLR,,J0129,HCPCS,Facility,Both,1,Each,,4968,4222.8,1423.8288,4968,Humana Insurance Company,Commercial PPO,4719.6,95,,percent of total billed charges,,
ABATACEPT (WITH MALTOSE) 250 MG IV SOLR,,J0129,HCPCS,Facility,Outpatient,1,Each,,4968,4222.8,1423.8288,4968,Humana Insurance Company,Medicare PPO,2434.32,49,,percent of total billed charges,,
ABATACEPT (WITH MALTOSE) 250 MG IV SOLR,,J0129,HCPCS,Facility,Inpatient,1,Each,,4968,4222.8,1423.8288,4968,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
ABATACEPT (WITH MALTOSE) 250 MG IV SOLR,,J0129,HCPCS,Facility,Both,1,Each,,4968,4222.8,1423.8288,4968,Medica,Individual & Family,4923.288,99.1,,percent of total billed charges,,
ABATACEPT (WITH MALTOSE) 250 MG IV SOLR,,J0129,HCPCS,Facility,Outpatient,1,Each,,4968,4222.8,1423.8288,4968,Medica,Medica Advantage Solution,2474.064,49.8,,percent of total billed charges,,
ABATACEPT (WITH MALTOSE) 250 MG IV SOLR,,J0129,HCPCS,Facility,Inpatient,1,Each,,4968,4222.8,1423.8288,4968,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
ABATACEPT (WITH MALTOSE) 250 MG IV SOLR,,J0129,HCPCS,Facility,Outpatient,1,Each,,4968,4222.8,1423.8288,4968,Medica,Medical Assistance,2215.728,44.6,,percent of total billed charges,,
ABATACEPT (WITH MALTOSE) 250 MG IV SOLR,,J0129,HCPCS,Facility,Inpatient,1,Each,,4968,4222.8,1423.8288,4968,Medica,Medical Assistance,,,,,Included in per diem rate,
ABATACEPT (WITH MALTOSE) 250 MG IV SOLR,,J0129,HCPCS,Facility,Outpatient,1,Each,,4968,4222.8,1423.8288,4968,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2474.064,49.8,,percent of total billed charges,,
ABATACEPT (WITH MALTOSE) 250 MG IV SOLR,,J0129,HCPCS,Facility,Inpatient,1,Each,,4968,4222.8,1423.8288,4968,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
ABATACEPT (WITH MALTOSE) 250 MG IV SOLR,,J0129,HCPCS,Facility,Both,1,Each,,4968,4222.8,1423.8288,4968,"Multiplan, Inc.","Multiplan, Inc.",4669.92,94,,percent of total billed charges,,
ABATACEPT (WITH MALTOSE) 250 MG IV SOLR,,J0129,HCPCS,Facility,Outpatient,1,Each,,4968,4222.8,1423.8288,4968,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4476.168,90.1,,percent of total billed charges,,
ABATACEPT (WITH MALTOSE) 250 MG IV SOLR,,J0129,HCPCS,Facility,Inpatient,1,Each,,4968,4222.8,1423.8288,4968,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
ABATACEPT (WITH MALTOSE) 250 MG IV SOLR,,J0129,HCPCS,Facility,Both,1,Each,,4968,4222.8,1423.8288,4968,"Preferred One Administrative Services, INC.",PPO,4898.448,98.6,,percent of total billed charges,,
ABATACEPT (WITH MALTOSE) 250 MG IV SOLR,,J0129,HCPCS,Facility,Outpatient,1,Each,,4968,4222.8,1423.8288,4968,PrimeWest Health,Minnesota Senior Health Options (MSHO),2556.036,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
ABATACEPT (WITH MALTOSE) 250 MG IV SOLR,,J0129,HCPCS,Facility,Inpatient,1,Each,,4968,4222.8,1423.8288,4968,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ABATACEPT (WITH MALTOSE) 250 MG IV SOLR,,J0129,HCPCS,Facility,Outpatient,1,Each,,4968,4222.8,1423.8288,4968,PrimeWest Health,MinnesotaCare,2551.5648,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
ABATACEPT (WITH MALTOSE) 250 MG IV SOLR,,J0129,HCPCS,Facility,Inpatient,1,Each,,4968,4222.8,1423.8288,4968,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
ABATACEPT (WITH MALTOSE) 250 MG IV SOLR,,J0129,HCPCS,Facility,Both,1,Each,,4968,4222.8,1423.8288,4968,Sanford Health Plan,Sanford Health Plan,4570.56,92,,percent of total billed charges,,
ABATACEPT (WITH MALTOSE) 250 MG IV SOLR,,J0129,HCPCS,Facility,Outpatient,1,Each,,4968,4222.8,1423.8288,4968,"UCare Health, Inc.",Individual & Family Plan,2799.468,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
ABATACEPT (WITH MALTOSE) 250 MG IV SOLR,,J0129,HCPCS,Facility,Inpatient,1,Each,,4968,4222.8,1423.8288,4968,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
ABATACEPT (WITH MALTOSE) 250 MG IV SOLR,,J0129,HCPCS,Facility,Outpatient,1,Each,,4968,4222.8,1423.8288,4968,"UCare Health, Inc.",Medical Assistance,2507.3496,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ABATACEPT (WITH MALTOSE) 250 MG IV SOLR,,J0129,HCPCS,Facility,Inpatient,1,Each,,4968,4222.8,1423.8288,4968,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
ABATACEPT (WITH MALTOSE) 250 MG IV SOLR,,J0129,HCPCS,Facility,Outpatient,1,Each,,4968,4222.8,1423.8288,4968,"UCare Health, Inc.",Medicare Advantage,2507.3496,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ABATACEPT (WITH MALTOSE) 250 MG IV SOLR,,J0129,HCPCS,Facility,Inpatient,1,Each,,4968,4222.8,1423.8288,4968,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ABATACEPT (WITH MALTOSE) 250 MG IV SOLR,,J0129,HCPCS,Facility,Outpatient,1,Each,,4968,4222.8,1423.8288,4968,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2507.3496,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ABATACEPT (WITH MALTOSE) 250 MG IV SOLR,,J0129,HCPCS,Facility,Inpatient,1,Each,,4968,4222.8,1423.8288,4968,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ABATACEPT (WITH MALTOSE) 250 MG IV SOLR,,J0129,HCPCS,Facility,Both,1,Each,,4968,4222.8,1423.8288,4968,UnitedHealthcare,Individual & Family,4669.92,94,,percent of total billed charges,,
ABATACEPT (WITH MALTOSE) 250 MG IV SOLR,,J0129,HCPCS,Facility,Outpatient,1,Each,,4968,4222.8,1423.8288,4968,UnitedHealthcare,Medicare Advantage,2434.32,49,,percent of total billed charges,,
ABATACEPT (WITH MALTOSE) 250 MG IV SOLR,,J0129,HCPCS,Facility,Inpatient,1,Each,,4968,4222.8,1423.8288,4968,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
ABATACEPT (WITH MALTOSE) 250 MG IV SOLR,,J0129,HCPCS,Facility,Outpatient,1,Each,,4968,4222.8,1423.8288,4968,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2384.64,48,,percent of total billed charges,,100% of DHS outpatient percentage
ABATACEPT (WITH MALTOSE) 250 MG IV SOLR,,J0129,HCPCS,Facility,Inpatient,1,Each,,4968,4222.8,1423.8288,4968,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
EPINEPHRINE 0.15 MG/0.15 ML INJ ATIN,,J0171,HCPCS,Facility,Both,1,Each,,964,819.4,276.2824,964,Aetna,Commercial,886.88,92,,percent of total billed charges,,
EPINEPHRINE 0.15 MG/0.15 ML INJ ATIN,,J0171,HCPCS,Facility,Outpatient,1,Each,,964,819.4,276.2824,964,Aetna,Medicare Advantage,472.36,49,,percent of total billed charges,,
EPINEPHRINE 0.15 MG/0.15 ML INJ ATIN,,J0171,HCPCS,Facility,Inpatient,1,Each,,964,819.4,276.2824,964,Aetna,Medicare Advantage,,,,,Included in per diem rate,
EPINEPHRINE 0.15 MG/0.15 ML INJ ATIN,,J0171,HCPCS,Facility,Both,1,Each,,964,819.4,276.2824,964,Aetna,PPO,896.52,93,,percent of total billed charges,,
EPINEPHRINE 0.15 MG/0.15 ML INJ ATIN,,J0171,HCPCS,Facility,Both,1,Each,,964,819.4,276.2824,964,America's PPO,America's PPO,925.7292,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
EPINEPHRINE 0.15 MG/0.15 ML INJ ATIN,,J0171,HCPCS,Facility,Both,1,Each,,964,819.4,276.2824,964,BlueCross BlueShield Minnesota, Federal Employee Program,948.576,98.4,,percent of total billed charges,,
EPINEPHRINE 0.15 MG/0.15 ML INJ ATIN,,J0171,HCPCS,Facility,Both,1,Each,,964,819.4,276.2824,964,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,964,100,,percent of total billed charges,,
EPINEPHRINE 0.15 MG/0.15 ML INJ ATIN,,J0171,HCPCS,Facility,Both,1,Each,,964,819.4,276.2824,964,BlueCross BlueShield Minnesota,High Value Network Plan,867.6,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
EPINEPHRINE 0.15 MG/0.15 ML INJ ATIN,,J0171,HCPCS,Facility,Outpatient,1,Each,,964,819.4,276.2824,964,BlueCross BlueShield Minnesota,Medicare Advantage,472.36,49,,percent of total billed charges,,
EPINEPHRINE 0.15 MG/0.15 ML INJ ATIN,,J0171,HCPCS,Facility,Inpatient,1,Each,,964,819.4,276.2824,964,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
EPINEPHRINE 0.15 MG/0.15 ML INJ ATIN,,J0171,HCPCS,Facility,Both,1,Each,,964,819.4,276.2824,964,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,853.8148,88.57,,percent of total billed charges,,
EPINEPHRINE 0.15 MG/0.15 ML INJ ATIN,,J0171,HCPCS,Facility,Both,1,Each,,964,819.4,276.2824,964,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,276.2824,28.66,,percent of total billed charges,,
EPINEPHRINE 0.15 MG/0.15 ML INJ ATIN,,J0171,HCPCS,Facility,Outpatient,1,Each,,964,819.4,276.2824,964,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),472.36,49,,percent of total billed charges,,
EPINEPHRINE 0.15 MG/0.15 ML INJ ATIN,,J0171,HCPCS,Facility,Inpatient,1,Each,,964,819.4,276.2824,964,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
EPINEPHRINE 0.15 MG/0.15 ML INJ ATIN,,J0171,HCPCS,Facility,Both,1,Each,,964,819.4,276.2824,964,CorVel,Worker's Compensation,964,100,,percent of total billed charges,,
EPINEPHRINE 0.15 MG/0.15 ML INJ ATIN,,J0171,HCPCS,Facility,Both,1,Each,,964,819.4,276.2824,964,First Health Group Corporation,First Health Network,935.08,97,,percent of total billed charges,,
EPINEPHRINE 0.15 MG/0.15 ML INJ ATIN,,J0171,HCPCS,Facility,Both,1,Each,,964,819.4,276.2824,964,"Health Partners, Inc.",Commercial,911.944,94.6,,percent of total billed charges,,
EPINEPHRINE 0.15 MG/0.15 ML INJ ATIN,,J0171,HCPCS,Facility,Outpatient,1,Each,,964,819.4,276.2824,964,"Health Partners, Inc.",Medicare Advantage,472.36,49,,percent of total billed charges,,
EPINEPHRINE 0.15 MG/0.15 ML INJ ATIN,,J0171,HCPCS,Facility,Inpatient,1,Each,,964,819.4,276.2824,964,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
EPINEPHRINE 0.15 MG/0.15 ML INJ ATIN,,J0171,HCPCS,Facility,Both,1,Each,,964,819.4,276.2824,964,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),578.4,60,,percent of total billed charges,,
EPINEPHRINE 0.15 MG/0.15 ML INJ ATIN,,J0171,HCPCS,Facility,Both,1,Each,,964,819.4,276.2824,964,"Health Partners, Inc.",State of Minnesota Advantage Program,785.66,81.5,,percent of total billed charges,,
EPINEPHRINE 0.15 MG/0.15 ML INJ ATIN,,J0171,HCPCS,Facility,Both,1,Each,,964,819.4,276.2824,964,"Health Partners, Inc.",State Public Programs,482,50,,percent of total billed charges,,
EPINEPHRINE 0.15 MG/0.15 ML INJ ATIN,,J0171,HCPCS,Facility,Both,1,Each,,964,819.4,276.2824,964,Humana Insurance Company,Commercial PPO,915.8,95,,percent of total billed charges,,
EPINEPHRINE 0.15 MG/0.15 ML INJ ATIN,,J0171,HCPCS,Facility,Outpatient,1,Each,,964,819.4,276.2824,964,Humana Insurance Company,Medicare PPO,472.36,49,,percent of total billed charges,,
EPINEPHRINE 0.15 MG/0.15 ML INJ ATIN,,J0171,HCPCS,Facility,Inpatient,1,Each,,964,819.4,276.2824,964,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
EPINEPHRINE 0.15 MG/0.15 ML INJ ATIN,,J0171,HCPCS,Facility,Both,1,Each,,964,819.4,276.2824,964,Medica,Individual & Family,955.324,99.1,,percent of total billed charges,,
EPINEPHRINE 0.15 MG/0.15 ML INJ ATIN,,J0171,HCPCS,Facility,Outpatient,1,Each,,964,819.4,276.2824,964,Medica,Medica Advantage Solution,480.072,49.8,,percent of total billed charges,,
EPINEPHRINE 0.15 MG/0.15 ML INJ ATIN,,J0171,HCPCS,Facility,Inpatient,1,Each,,964,819.4,276.2824,964,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
EPINEPHRINE 0.15 MG/0.15 ML INJ ATIN,,J0171,HCPCS,Facility,Outpatient,1,Each,,964,819.4,276.2824,964,Medica,Medical Assistance,429.944,44.6,,percent of total billed charges,,
EPINEPHRINE 0.15 MG/0.15 ML INJ ATIN,,J0171,HCPCS,Facility,Inpatient,1,Each,,964,819.4,276.2824,964,Medica,Medical Assistance,,,,,Included in per diem rate,
EPINEPHRINE 0.15 MG/0.15 ML INJ ATIN,,J0171,HCPCS,Facility,Outpatient,1,Each,,964,819.4,276.2824,964,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,480.072,49.8,,percent of total billed charges,,
EPINEPHRINE 0.15 MG/0.15 ML INJ ATIN,,J0171,HCPCS,Facility,Inpatient,1,Each,,964,819.4,276.2824,964,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
EPINEPHRINE 0.15 MG/0.15 ML INJ ATIN,,J0171,HCPCS,Facility,Both,1,Each,,964,819.4,276.2824,964,"Multiplan, Inc.","Multiplan, Inc.",906.16,94,,percent of total billed charges,,
EPINEPHRINE 0.15 MG/0.15 ML INJ ATIN,,J0171,HCPCS,Facility,Outpatient,1,Each,,964,819.4,276.2824,964,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,868.564,90.1,,percent of total billed charges,,
EPINEPHRINE 0.15 MG/0.15 ML INJ ATIN,,J0171,HCPCS,Facility,Inpatient,1,Each,,964,819.4,276.2824,964,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
EPINEPHRINE 0.15 MG/0.15 ML INJ ATIN,,J0171,HCPCS,Facility,Both,1,Each,,964,819.4,276.2824,964,"Preferred One Administrative Services, INC.",PPO,950.504,98.6,,percent of total billed charges,,
EPINEPHRINE 0.15 MG/0.15 ML INJ ATIN,,J0171,HCPCS,Facility,Outpatient,1,Each,,964,819.4,276.2824,964,PrimeWest Health,Minnesota Senior Health Options (MSHO),495.978,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
EPINEPHRINE 0.15 MG/0.15 ML INJ ATIN,,J0171,HCPCS,Facility,Inpatient,1,Each,,964,819.4,276.2824,964,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
EPINEPHRINE 0.15 MG/0.15 ML INJ ATIN,,J0171,HCPCS,Facility,Outpatient,1,Each,,964,819.4,276.2824,964,PrimeWest Health,MinnesotaCare,495.1104,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
EPINEPHRINE 0.15 MG/0.15 ML INJ ATIN,,J0171,HCPCS,Facility,Inpatient,1,Each,,964,819.4,276.2824,964,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
EPINEPHRINE 0.15 MG/0.15 ML INJ ATIN,,J0171,HCPCS,Facility,Both,1,Each,,964,819.4,276.2824,964,Sanford Health Plan,Sanford Health Plan,886.88,92,,percent of total billed charges,,
EPINEPHRINE 0.15 MG/0.15 ML INJ ATIN,,J0171,HCPCS,Facility,Outpatient,1,Each,,964,819.4,276.2824,964,"UCare Health, Inc.",Individual & Family Plan,543.214,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
EPINEPHRINE 0.15 MG/0.15 ML INJ ATIN,,J0171,HCPCS,Facility,Inpatient,1,Each,,964,819.4,276.2824,964,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
EPINEPHRINE 0.15 MG/0.15 ML INJ ATIN,,J0171,HCPCS,Facility,Outpatient,1,Each,,964,819.4,276.2824,964,"UCare Health, Inc.",Medical Assistance,486.5308,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
EPINEPHRINE 0.15 MG/0.15 ML INJ ATIN,,J0171,HCPCS,Facility,Inpatient,1,Each,,964,819.4,276.2824,964,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
EPINEPHRINE 0.15 MG/0.15 ML INJ ATIN,,J0171,HCPCS,Facility,Outpatient,1,Each,,964,819.4,276.2824,964,"UCare Health, Inc.",Medicare Advantage,486.5308,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
EPINEPHRINE 0.15 MG/0.15 ML INJ ATIN,,J0171,HCPCS,Facility,Inpatient,1,Each,,964,819.4,276.2824,964,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
EPINEPHRINE 0.15 MG/0.15 ML INJ ATIN,,J0171,HCPCS,Facility,Outpatient,1,Each,,964,819.4,276.2824,964,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),486.5308,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
EPINEPHRINE 0.15 MG/0.15 ML INJ ATIN,,J0171,HCPCS,Facility,Inpatient,1,Each,,964,819.4,276.2824,964,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
EPINEPHRINE 0.15 MG/0.15 ML INJ ATIN,,J0171,HCPCS,Facility,Both,1,Each,,964,819.4,276.2824,964,UnitedHealthcare,Individual & Family,906.16,94,,percent of total billed charges,,
EPINEPHRINE 0.15 MG/0.15 ML INJ ATIN,,J0171,HCPCS,Facility,Outpatient,1,Each,,964,819.4,276.2824,964,UnitedHealthcare,Medicare Advantage,472.36,49,,percent of total billed charges,,
EPINEPHRINE 0.15 MG/0.15 ML INJ ATIN,,J0171,HCPCS,Facility,Inpatient,1,Each,,964,819.4,276.2824,964,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
EPINEPHRINE 0.15 MG/0.15 ML INJ ATIN,,J0171,HCPCS,Facility,Outpatient,1,Each,,964,819.4,276.2824,964,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,462.72,48,,percent of total billed charges,,100% of DHS outpatient percentage
EPINEPHRINE 0.15 MG/0.15 ML INJ ATIN,,J0171,HCPCS,Facility,Inpatient,1,Each,,964,819.4,276.2824,964,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
EPINEPHRINE 0.15 MG/0.3 ML INJ ATIN,,J0171,HCPCS,Facility,Both,1,Each,,1249,1061.65,357.9634,1249,Aetna,Commercial,1149.08,92,,percent of total billed charges,,
EPINEPHRINE 0.15 MG/0.3 ML INJ ATIN,,J0171,HCPCS,Facility,Outpatient,1,Each,,1249,1061.65,357.9634,1249,Aetna,Medicare Advantage,612.01,49,,percent of total billed charges,,
EPINEPHRINE 0.15 MG/0.3 ML INJ ATIN,,J0171,HCPCS,Facility,Inpatient,1,Each,,1249,1061.65,357.9634,1249,Aetna,Medicare Advantage,,,,,Included in per diem rate,
EPINEPHRINE 0.15 MG/0.3 ML INJ ATIN,,J0171,HCPCS,Facility,Both,1,Each,,1249,1061.65,357.9634,1249,Aetna,PPO,1161.57,93,,percent of total billed charges,,
EPINEPHRINE 0.15 MG/0.3 ML INJ ATIN,,J0171,HCPCS,Facility,Both,1,Each,,1249,1061.65,357.9634,1249,America's PPO,America's PPO,1199.4147,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
EPINEPHRINE 0.15 MG/0.3 ML INJ ATIN,,J0171,HCPCS,Facility,Both,1,Each,,1249,1061.65,357.9634,1249,BlueCross BlueShield Minnesota, Federal Employee Program,1229.016,98.4,,percent of total billed charges,,
EPINEPHRINE 0.15 MG/0.3 ML INJ ATIN,,J0171,HCPCS,Facility,Both,1,Each,,1249,1061.65,357.9634,1249,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1249,100,,percent of total billed charges,,
EPINEPHRINE 0.15 MG/0.3 ML INJ ATIN,,J0171,HCPCS,Facility,Both,1,Each,,1249,1061.65,357.9634,1249,BlueCross BlueShield Minnesota,High Value Network Plan,1124.1,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
EPINEPHRINE 0.15 MG/0.3 ML INJ ATIN,,J0171,HCPCS,Facility,Outpatient,1,Each,,1249,1061.65,357.9634,1249,BlueCross BlueShield Minnesota,Medicare Advantage,612.01,49,,percent of total billed charges,,
EPINEPHRINE 0.15 MG/0.3 ML INJ ATIN,,J0171,HCPCS,Facility,Inpatient,1,Each,,1249,1061.65,357.9634,1249,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
EPINEPHRINE 0.15 MG/0.3 ML INJ ATIN,,J0171,HCPCS,Facility,Both,1,Each,,1249,1061.65,357.9634,1249,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1106.2393,88.57,,percent of total billed charges,,
EPINEPHRINE 0.15 MG/0.3 ML INJ ATIN,,J0171,HCPCS,Facility,Both,1,Each,,1249,1061.65,357.9634,1249,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,357.9634,28.66,,percent of total billed charges,,
EPINEPHRINE 0.15 MG/0.3 ML INJ ATIN,,J0171,HCPCS,Facility,Outpatient,1,Each,,1249,1061.65,357.9634,1249,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),612.01,49,,percent of total billed charges,,
EPINEPHRINE 0.15 MG/0.3 ML INJ ATIN,,J0171,HCPCS,Facility,Inpatient,1,Each,,1249,1061.65,357.9634,1249,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
EPINEPHRINE 0.15 MG/0.3 ML INJ ATIN,,J0171,HCPCS,Facility,Both,1,Each,,1249,1061.65,357.9634,1249,CorVel,Worker's Compensation,1249,100,,percent of total billed charges,,
EPINEPHRINE 0.15 MG/0.3 ML INJ ATIN,,J0171,HCPCS,Facility,Both,1,Each,,1249,1061.65,357.9634,1249,First Health Group Corporation,First Health Network,1211.53,97,,percent of total billed charges,,
EPINEPHRINE 0.15 MG/0.3 ML INJ ATIN,,J0171,HCPCS,Facility,Both,1,Each,,1249,1061.65,357.9634,1249,"Health Partners, Inc.",Commercial,1181.554,94.6,,percent of total billed charges,,
EPINEPHRINE 0.15 MG/0.3 ML INJ ATIN,,J0171,HCPCS,Facility,Outpatient,1,Each,,1249,1061.65,357.9634,1249,"Health Partners, Inc.",Medicare Advantage,612.01,49,,percent of total billed charges,,
EPINEPHRINE 0.15 MG/0.3 ML INJ ATIN,,J0171,HCPCS,Facility,Inpatient,1,Each,,1249,1061.65,357.9634,1249,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
EPINEPHRINE 0.15 MG/0.3 ML INJ ATIN,,J0171,HCPCS,Facility,Both,1,Each,,1249,1061.65,357.9634,1249,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),749.4,60,,percent of total billed charges,,
EPINEPHRINE 0.15 MG/0.3 ML INJ ATIN,,J0171,HCPCS,Facility,Both,1,Each,,1249,1061.65,357.9634,1249,"Health Partners, Inc.",State of Minnesota Advantage Program,1017.935,81.5,,percent of total billed charges,,
EPINEPHRINE 0.15 MG/0.3 ML INJ ATIN,,J0171,HCPCS,Facility,Both,1,Each,,1249,1061.65,357.9634,1249,"Health Partners, Inc.",State Public Programs,624.5,50,,percent of total billed charges,,
EPINEPHRINE 0.15 MG/0.3 ML INJ ATIN,,J0171,HCPCS,Facility,Both,1,Each,,1249,1061.65,357.9634,1249,Humana Insurance Company,Commercial PPO,1186.55,95,,percent of total billed charges,,
EPINEPHRINE 0.15 MG/0.3 ML INJ ATIN,,J0171,HCPCS,Facility,Outpatient,1,Each,,1249,1061.65,357.9634,1249,Humana Insurance Company,Medicare PPO,612.01,49,,percent of total billed charges,,
EPINEPHRINE 0.15 MG/0.3 ML INJ ATIN,,J0171,HCPCS,Facility,Inpatient,1,Each,,1249,1061.65,357.9634,1249,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
EPINEPHRINE 0.15 MG/0.3 ML INJ ATIN,,J0171,HCPCS,Facility,Both,1,Each,,1249,1061.65,357.9634,1249,Medica,Individual & Family,1237.759,99.1,,percent of total billed charges,,
EPINEPHRINE 0.15 MG/0.3 ML INJ ATIN,,J0171,HCPCS,Facility,Outpatient,1,Each,,1249,1061.65,357.9634,1249,Medica,Medica Advantage Solution,622.002,49.8,,percent of total billed charges,,
EPINEPHRINE 0.15 MG/0.3 ML INJ ATIN,,J0171,HCPCS,Facility,Inpatient,1,Each,,1249,1061.65,357.9634,1249,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
EPINEPHRINE 0.15 MG/0.3 ML INJ ATIN,,J0171,HCPCS,Facility,Outpatient,1,Each,,1249,1061.65,357.9634,1249,Medica,Medical Assistance,557.054,44.6,,percent of total billed charges,,
EPINEPHRINE 0.15 MG/0.3 ML INJ ATIN,,J0171,HCPCS,Facility,Inpatient,1,Each,,1249,1061.65,357.9634,1249,Medica,Medical Assistance,,,,,Included in per diem rate,
EPINEPHRINE 0.15 MG/0.3 ML INJ ATIN,,J0171,HCPCS,Facility,Outpatient,1,Each,,1249,1061.65,357.9634,1249,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,622.002,49.8,,percent of total billed charges,,
EPINEPHRINE 0.15 MG/0.3 ML INJ ATIN,,J0171,HCPCS,Facility,Inpatient,1,Each,,1249,1061.65,357.9634,1249,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
EPINEPHRINE 0.15 MG/0.3 ML INJ ATIN,,J0171,HCPCS,Facility,Both,1,Each,,1249,1061.65,357.9634,1249,"Multiplan, Inc.","Multiplan, Inc.",1174.06,94,,percent of total billed charges,,
EPINEPHRINE 0.15 MG/0.3 ML INJ ATIN,,J0171,HCPCS,Facility,Outpatient,1,Each,,1249,1061.65,357.9634,1249,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1125.349,90.1,,percent of total billed charges,,
EPINEPHRINE 0.15 MG/0.3 ML INJ ATIN,,J0171,HCPCS,Facility,Inpatient,1,Each,,1249,1061.65,357.9634,1249,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
EPINEPHRINE 0.15 MG/0.3 ML INJ ATIN,,J0171,HCPCS,Facility,Both,1,Each,,1249,1061.65,357.9634,1249,"Preferred One Administrative Services, INC.",PPO,1231.514,98.6,,percent of total billed charges,,
EPINEPHRINE 0.15 MG/0.3 ML INJ ATIN,,J0171,HCPCS,Facility,Outpatient,1,Each,,1249,1061.65,357.9634,1249,PrimeWest Health,Minnesota Senior Health Options (MSHO),642.6105,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
EPINEPHRINE 0.15 MG/0.3 ML INJ ATIN,,J0171,HCPCS,Facility,Inpatient,1,Each,,1249,1061.65,357.9634,1249,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
EPINEPHRINE 0.15 MG/0.3 ML INJ ATIN,,J0171,HCPCS,Facility,Outpatient,1,Each,,1249,1061.65,357.9634,1249,PrimeWest Health,MinnesotaCare,641.4864,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
EPINEPHRINE 0.15 MG/0.3 ML INJ ATIN,,J0171,HCPCS,Facility,Inpatient,1,Each,,1249,1061.65,357.9634,1249,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
EPINEPHRINE 0.15 MG/0.3 ML INJ ATIN,,J0171,HCPCS,Facility,Both,1,Each,,1249,1061.65,357.9634,1249,Sanford Health Plan,Sanford Health Plan,1149.08,92,,percent of total billed charges,,
EPINEPHRINE 0.15 MG/0.3 ML INJ ATIN,,J0171,HCPCS,Facility,Outpatient,1,Each,,1249,1061.65,357.9634,1249,"UCare Health, Inc.",Individual & Family Plan,703.8115,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
EPINEPHRINE 0.15 MG/0.3 ML INJ ATIN,,J0171,HCPCS,Facility,Inpatient,1,Each,,1249,1061.65,357.9634,1249,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
EPINEPHRINE 0.15 MG/0.3 ML INJ ATIN,,J0171,HCPCS,Facility,Outpatient,1,Each,,1249,1061.65,357.9634,1249,"UCare Health, Inc.",Medical Assistance,630.3703,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
EPINEPHRINE 0.15 MG/0.3 ML INJ ATIN,,J0171,HCPCS,Facility,Inpatient,1,Each,,1249,1061.65,357.9634,1249,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
EPINEPHRINE 0.15 MG/0.3 ML INJ ATIN,,J0171,HCPCS,Facility,Outpatient,1,Each,,1249,1061.65,357.9634,1249,"UCare Health, Inc.",Medicare Advantage,630.3703,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
EPINEPHRINE 0.15 MG/0.3 ML INJ ATIN,,J0171,HCPCS,Facility,Inpatient,1,Each,,1249,1061.65,357.9634,1249,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
EPINEPHRINE 0.15 MG/0.3 ML INJ ATIN,,J0171,HCPCS,Facility,Outpatient,1,Each,,1249,1061.65,357.9634,1249,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),630.3703,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
EPINEPHRINE 0.15 MG/0.3 ML INJ ATIN,,J0171,HCPCS,Facility,Inpatient,1,Each,,1249,1061.65,357.9634,1249,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
EPINEPHRINE 0.15 MG/0.3 ML INJ ATIN,,J0171,HCPCS,Facility,Both,1,Each,,1249,1061.65,357.9634,1249,UnitedHealthcare,Individual & Family,1174.06,94,,percent of total billed charges,,
EPINEPHRINE 0.15 MG/0.3 ML INJ ATIN,,J0171,HCPCS,Facility,Outpatient,1,Each,,1249,1061.65,357.9634,1249,UnitedHealthcare,Medicare Advantage,612.01,49,,percent of total billed charges,,
EPINEPHRINE 0.15 MG/0.3 ML INJ ATIN,,J0171,HCPCS,Facility,Inpatient,1,Each,,1249,1061.65,357.9634,1249,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
EPINEPHRINE 0.15 MG/0.3 ML INJ ATIN,,J0171,HCPCS,Facility,Outpatient,1,Each,,1249,1061.65,357.9634,1249,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,599.52,48,,percent of total billed charges,,100% of DHS outpatient percentage
EPINEPHRINE 0.15 MG/0.3 ML INJ ATIN,,J0171,HCPCS,Facility,Inpatient,1,Each,,1249,1061.65,357.9634,1249,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
EPINEPHRINE 0.3 MG/0.3 ML INJ ATIN,,J0171,HCPCS,Facility,Both,1,Each,,964,819.4,276.2824,964,Aetna,Commercial,886.88,92,,percent of total billed charges,,
EPINEPHRINE 0.3 MG/0.3 ML INJ ATIN,,J0171,HCPCS,Facility,Outpatient,1,Each,,964,819.4,276.2824,964,Aetna,Medicare Advantage,472.36,49,,percent of total billed charges,,
EPINEPHRINE 0.3 MG/0.3 ML INJ ATIN,,J0171,HCPCS,Facility,Inpatient,1,Each,,964,819.4,276.2824,964,Aetna,Medicare Advantage,,,,,Included in per diem rate,
EPINEPHRINE 0.3 MG/0.3 ML INJ ATIN,,J0171,HCPCS,Facility,Both,1,Each,,964,819.4,276.2824,964,Aetna,PPO,896.52,93,,percent of total billed charges,,
EPINEPHRINE 0.3 MG/0.3 ML INJ ATIN,,J0171,HCPCS,Facility,Both,1,Each,,964,819.4,276.2824,964,America's PPO,America's PPO,925.7292,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
EPINEPHRINE 0.3 MG/0.3 ML INJ ATIN,,J0171,HCPCS,Facility,Both,1,Each,,964,819.4,276.2824,964,BlueCross BlueShield Minnesota, Federal Employee Program,948.576,98.4,,percent of total billed charges,,
EPINEPHRINE 0.3 MG/0.3 ML INJ ATIN,,J0171,HCPCS,Facility,Both,1,Each,,964,819.4,276.2824,964,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,964,100,,percent of total billed charges,,
EPINEPHRINE 0.3 MG/0.3 ML INJ ATIN,,J0171,HCPCS,Facility,Both,1,Each,,964,819.4,276.2824,964,BlueCross BlueShield Minnesota,High Value Network Plan,867.6,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
EPINEPHRINE 0.3 MG/0.3 ML INJ ATIN,,J0171,HCPCS,Facility,Outpatient,1,Each,,964,819.4,276.2824,964,BlueCross BlueShield Minnesota,Medicare Advantage,472.36,49,,percent of total billed charges,,
EPINEPHRINE 0.3 MG/0.3 ML INJ ATIN,,J0171,HCPCS,Facility,Inpatient,1,Each,,964,819.4,276.2824,964,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
EPINEPHRINE 0.3 MG/0.3 ML INJ ATIN,,J0171,HCPCS,Facility,Both,1,Each,,964,819.4,276.2824,964,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,853.8148,88.57,,percent of total billed charges,,
EPINEPHRINE 0.3 MG/0.3 ML INJ ATIN,,J0171,HCPCS,Facility,Both,1,Each,,964,819.4,276.2824,964,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,276.2824,28.66,,percent of total billed charges,,
EPINEPHRINE 0.3 MG/0.3 ML INJ ATIN,,J0171,HCPCS,Facility,Outpatient,1,Each,,964,819.4,276.2824,964,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),472.36,49,,percent of total billed charges,,
EPINEPHRINE 0.3 MG/0.3 ML INJ ATIN,,J0171,HCPCS,Facility,Inpatient,1,Each,,964,819.4,276.2824,964,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
EPINEPHRINE 0.3 MG/0.3 ML INJ ATIN,,J0171,HCPCS,Facility,Both,1,Each,,964,819.4,276.2824,964,CorVel,Worker's Compensation,964,100,,percent of total billed charges,,
EPINEPHRINE 0.3 MG/0.3 ML INJ ATIN,,J0171,HCPCS,Facility,Both,1,Each,,964,819.4,276.2824,964,First Health Group Corporation,First Health Network,935.08,97,,percent of total billed charges,,
EPINEPHRINE 0.3 MG/0.3 ML INJ ATIN,,J0171,HCPCS,Facility,Both,1,Each,,964,819.4,276.2824,964,"Health Partners, Inc.",Commercial,911.944,94.6,,percent of total billed charges,,
EPINEPHRINE 0.3 MG/0.3 ML INJ ATIN,,J0171,HCPCS,Facility,Outpatient,1,Each,,964,819.4,276.2824,964,"Health Partners, Inc.",Medicare Advantage,472.36,49,,percent of total billed charges,,
EPINEPHRINE 0.3 MG/0.3 ML INJ ATIN,,J0171,HCPCS,Facility,Inpatient,1,Each,,964,819.4,276.2824,964,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
EPINEPHRINE 0.3 MG/0.3 ML INJ ATIN,,J0171,HCPCS,Facility,Both,1,Each,,964,819.4,276.2824,964,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),578.4,60,,percent of total billed charges,,
EPINEPHRINE 0.3 MG/0.3 ML INJ ATIN,,J0171,HCPCS,Facility,Both,1,Each,,964,819.4,276.2824,964,"Health Partners, Inc.",State of Minnesota Advantage Program,785.66,81.5,,percent of total billed charges,,
EPINEPHRINE 0.3 MG/0.3 ML INJ ATIN,,J0171,HCPCS,Facility,Both,1,Each,,964,819.4,276.2824,964,"Health Partners, Inc.",State Public Programs,482,50,,percent of total billed charges,,
EPINEPHRINE 0.3 MG/0.3 ML INJ ATIN,,J0171,HCPCS,Facility,Both,1,Each,,964,819.4,276.2824,964,Humana Insurance Company,Commercial PPO,915.8,95,,percent of total billed charges,,
EPINEPHRINE 0.3 MG/0.3 ML INJ ATIN,,J0171,HCPCS,Facility,Outpatient,1,Each,,964,819.4,276.2824,964,Humana Insurance Company,Medicare PPO,472.36,49,,percent of total billed charges,,
EPINEPHRINE 0.3 MG/0.3 ML INJ ATIN,,J0171,HCPCS,Facility,Inpatient,1,Each,,964,819.4,276.2824,964,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
EPINEPHRINE 0.3 MG/0.3 ML INJ ATIN,,J0171,HCPCS,Facility,Both,1,Each,,964,819.4,276.2824,964,Medica,Individual & Family,955.324,99.1,,percent of total billed charges,,
EPINEPHRINE 0.3 MG/0.3 ML INJ ATIN,,J0171,HCPCS,Facility,Outpatient,1,Each,,964,819.4,276.2824,964,Medica,Medica Advantage Solution,480.072,49.8,,percent of total billed charges,,
EPINEPHRINE 0.3 MG/0.3 ML INJ ATIN,,J0171,HCPCS,Facility,Inpatient,1,Each,,964,819.4,276.2824,964,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
EPINEPHRINE 0.3 MG/0.3 ML INJ ATIN,,J0171,HCPCS,Facility,Outpatient,1,Each,,964,819.4,276.2824,964,Medica,Medical Assistance,429.944,44.6,,percent of total billed charges,,
EPINEPHRINE 0.3 MG/0.3 ML INJ ATIN,,J0171,HCPCS,Facility,Inpatient,1,Each,,964,819.4,276.2824,964,Medica,Medical Assistance,,,,,Included in per diem rate,
EPINEPHRINE 0.3 MG/0.3 ML INJ ATIN,,J0171,HCPCS,Facility,Outpatient,1,Each,,964,819.4,276.2824,964,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,480.072,49.8,,percent of total billed charges,,
EPINEPHRINE 0.3 MG/0.3 ML INJ ATIN,,J0171,HCPCS,Facility,Inpatient,1,Each,,964,819.4,276.2824,964,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
EPINEPHRINE 0.3 MG/0.3 ML INJ ATIN,,J0171,HCPCS,Facility,Both,1,Each,,964,819.4,276.2824,964,"Multiplan, Inc.","Multiplan, Inc.",906.16,94,,percent of total billed charges,,
EPINEPHRINE 0.3 MG/0.3 ML INJ ATIN,,J0171,HCPCS,Facility,Outpatient,1,Each,,964,819.4,276.2824,964,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,868.564,90.1,,percent of total billed charges,,
EPINEPHRINE 0.3 MG/0.3 ML INJ ATIN,,J0171,HCPCS,Facility,Inpatient,1,Each,,964,819.4,276.2824,964,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
EPINEPHRINE 0.3 MG/0.3 ML INJ ATIN,,J0171,HCPCS,Facility,Both,1,Each,,964,819.4,276.2824,964,"Preferred One Administrative Services, INC.",PPO,950.504,98.6,,percent of total billed charges,,
EPINEPHRINE 0.3 MG/0.3 ML INJ ATIN,,J0171,HCPCS,Facility,Outpatient,1,Each,,964,819.4,276.2824,964,PrimeWest Health,Minnesota Senior Health Options (MSHO),495.978,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
EPINEPHRINE 0.3 MG/0.3 ML INJ ATIN,,J0171,HCPCS,Facility,Inpatient,1,Each,,964,819.4,276.2824,964,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
EPINEPHRINE 0.3 MG/0.3 ML INJ ATIN,,J0171,HCPCS,Facility,Outpatient,1,Each,,964,819.4,276.2824,964,PrimeWest Health,MinnesotaCare,495.1104,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
EPINEPHRINE 0.3 MG/0.3 ML INJ ATIN,,J0171,HCPCS,Facility,Inpatient,1,Each,,964,819.4,276.2824,964,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
EPINEPHRINE 0.3 MG/0.3 ML INJ ATIN,,J0171,HCPCS,Facility,Both,1,Each,,964,819.4,276.2824,964,Sanford Health Plan,Sanford Health Plan,886.88,92,,percent of total billed charges,,
EPINEPHRINE 0.3 MG/0.3 ML INJ ATIN,,J0171,HCPCS,Facility,Outpatient,1,Each,,964,819.4,276.2824,964,"UCare Health, Inc.",Individual & Family Plan,543.214,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
EPINEPHRINE 0.3 MG/0.3 ML INJ ATIN,,J0171,HCPCS,Facility,Inpatient,1,Each,,964,819.4,276.2824,964,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
EPINEPHRINE 0.3 MG/0.3 ML INJ ATIN,,J0171,HCPCS,Facility,Outpatient,1,Each,,964,819.4,276.2824,964,"UCare Health, Inc.",Medical Assistance,486.5308,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
EPINEPHRINE 0.3 MG/0.3 ML INJ ATIN,,J0171,HCPCS,Facility,Inpatient,1,Each,,964,819.4,276.2824,964,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
EPINEPHRINE 0.3 MG/0.3 ML INJ ATIN,,J0171,HCPCS,Facility,Outpatient,1,Each,,964,819.4,276.2824,964,"UCare Health, Inc.",Medicare Advantage,486.5308,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
EPINEPHRINE 0.3 MG/0.3 ML INJ ATIN,,J0171,HCPCS,Facility,Inpatient,1,Each,,964,819.4,276.2824,964,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
EPINEPHRINE 0.3 MG/0.3 ML INJ ATIN,,J0171,HCPCS,Facility,Outpatient,1,Each,,964,819.4,276.2824,964,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),486.5308,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
EPINEPHRINE 0.3 MG/0.3 ML INJ ATIN,,J0171,HCPCS,Facility,Inpatient,1,Each,,964,819.4,276.2824,964,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
EPINEPHRINE 0.3 MG/0.3 ML INJ ATIN,,J0171,HCPCS,Facility,Both,1,Each,,964,819.4,276.2824,964,UnitedHealthcare,Individual & Family,906.16,94,,percent of total billed charges,,
EPINEPHRINE 0.3 MG/0.3 ML INJ ATIN,,J0171,HCPCS,Facility,Outpatient,1,Each,,964,819.4,276.2824,964,UnitedHealthcare,Medicare Advantage,472.36,49,,percent of total billed charges,,
EPINEPHRINE 0.3 MG/0.3 ML INJ ATIN,,J0171,HCPCS,Facility,Inpatient,1,Each,,964,819.4,276.2824,964,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
EPINEPHRINE 0.3 MG/0.3 ML INJ ATIN,,J0171,HCPCS,Facility,Outpatient,1,Each,,964,819.4,276.2824,964,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,462.72,48,,percent of total billed charges,,100% of DHS outpatient percentage
EPINEPHRINE 0.3 MG/0.3 ML INJ ATIN,,J0171,HCPCS,Facility,Inpatient,1,Each,,964,819.4,276.2824,964,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
REMDESIVIR 100 MG IV SOLR,,J0248,HCPCS,Facility,Both,1,Each,,2264,1924.4,648.8624,2264,Aetna,Commercial,2082.88,92,,percent of total billed charges,,
REMDESIVIR 100 MG IV SOLR,,J0248,HCPCS,Facility,Outpatient,1,Each,,2264,1924.4,648.8624,2264,Aetna,Medicare Advantage,1109.36,49,,percent of total billed charges,,
REMDESIVIR 100 MG IV SOLR,,J0248,HCPCS,Facility,Inpatient,1,Each,,2264,1924.4,648.8624,2264,Aetna,Medicare Advantage,,,,,Included in per diem rate,
REMDESIVIR 100 MG IV SOLR,,J0248,HCPCS,Facility,Both,1,Each,,2264,1924.4,648.8624,2264,Aetna,PPO,2105.52,93,,percent of total billed charges,,
REMDESIVIR 100 MG IV SOLR,,J0248,HCPCS,Facility,Both,1,Each,,2264,1924.4,648.8624,2264,America's PPO,America's PPO,2174.1192,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
REMDESIVIR 100 MG IV SOLR,,J0248,HCPCS,Facility,Both,1,Each,,2264,1924.4,648.8624,2264,BlueCross BlueShield Minnesota, Federal Employee Program,2227.776,98.4,,percent of total billed charges,,
REMDESIVIR 100 MG IV SOLR,,J0248,HCPCS,Facility,Both,1,Each,,2264,1924.4,648.8624,2264,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,2264,100,,percent of total billed charges,,
REMDESIVIR 100 MG IV SOLR,,J0248,HCPCS,Facility,Both,1,Each,,2264,1924.4,648.8624,2264,BlueCross BlueShield Minnesota,High Value Network Plan,2037.6,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
REMDESIVIR 100 MG IV SOLR,,J0248,HCPCS,Facility,Outpatient,1,Each,,2264,1924.4,648.8624,2264,BlueCross BlueShield Minnesota,Medicare Advantage,1109.36,49,,percent of total billed charges,,
REMDESIVIR 100 MG IV SOLR,,J0248,HCPCS,Facility,Inpatient,1,Each,,2264,1924.4,648.8624,2264,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
REMDESIVIR 100 MG IV SOLR,,J0248,HCPCS,Facility,Both,1,Each,,2264,1924.4,648.8624,2264,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,2005.2248,88.57,,percent of total billed charges,,
REMDESIVIR 100 MG IV SOLR,,J0248,HCPCS,Facility,Both,1,Each,,2264,1924.4,648.8624,2264,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,648.8624,28.66,,percent of total billed charges,,
REMDESIVIR 100 MG IV SOLR,,J0248,HCPCS,Facility,Outpatient,1,Each,,2264,1924.4,648.8624,2264,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1109.36,49,,percent of total billed charges,,
REMDESIVIR 100 MG IV SOLR,,J0248,HCPCS,Facility,Inpatient,1,Each,,2264,1924.4,648.8624,2264,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
REMDESIVIR 100 MG IV SOLR,,J0248,HCPCS,Facility,Both,1,Each,,2264,1924.4,648.8624,2264,CorVel,Worker's Compensation,2264,100,,percent of total billed charges,,
REMDESIVIR 100 MG IV SOLR,,J0248,HCPCS,Facility,Both,1,Each,,2264,1924.4,648.8624,2264,First Health Group Corporation,First Health Network,2196.08,97,,percent of total billed charges,,
REMDESIVIR 100 MG IV SOLR,,J0248,HCPCS,Facility,Both,1,Each,,2264,1924.4,648.8624,2264,"Health Partners, Inc.",Commercial,2141.744,94.6,,percent of total billed charges,,
REMDESIVIR 100 MG IV SOLR,,J0248,HCPCS,Facility,Outpatient,1,Each,,2264,1924.4,648.8624,2264,"Health Partners, Inc.",Medicare Advantage,1109.36,49,,percent of total billed charges,,
REMDESIVIR 100 MG IV SOLR,,J0248,HCPCS,Facility,Inpatient,1,Each,,2264,1924.4,648.8624,2264,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
REMDESIVIR 100 MG IV SOLR,,J0248,HCPCS,Facility,Both,1,Each,,2264,1924.4,648.8624,2264,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1358.4,60,,percent of total billed charges,,
REMDESIVIR 100 MG IV SOLR,,J0248,HCPCS,Facility,Both,1,Each,,2264,1924.4,648.8624,2264,"Health Partners, Inc.",State of Minnesota Advantage Program,1845.16,81.5,,percent of total billed charges,,
REMDESIVIR 100 MG IV SOLR,,J0248,HCPCS,Facility,Both,1,Each,,2264,1924.4,648.8624,2264,"Health Partners, Inc.",State Public Programs,1132,50,,percent of total billed charges,,
REMDESIVIR 100 MG IV SOLR,,J0248,HCPCS,Facility,Both,1,Each,,2264,1924.4,648.8624,2264,Humana Insurance Company,Commercial PPO,2150.8,95,,percent of total billed charges,,
REMDESIVIR 100 MG IV SOLR,,J0248,HCPCS,Facility,Outpatient,1,Each,,2264,1924.4,648.8624,2264,Humana Insurance Company,Medicare PPO,1109.36,49,,percent of total billed charges,,
REMDESIVIR 100 MG IV SOLR,,J0248,HCPCS,Facility,Inpatient,1,Each,,2264,1924.4,648.8624,2264,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
REMDESIVIR 100 MG IV SOLR,,J0248,HCPCS,Facility,Both,1,Each,,2264,1924.4,648.8624,2264,Medica,Individual & Family,2243.624,99.1,,percent of total billed charges,,
REMDESIVIR 100 MG IV SOLR,,J0248,HCPCS,Facility,Outpatient,1,Each,,2264,1924.4,648.8624,2264,Medica,Medica Advantage Solution,1127.472,49.8,,percent of total billed charges,,
REMDESIVIR 100 MG IV SOLR,,J0248,HCPCS,Facility,Inpatient,1,Each,,2264,1924.4,648.8624,2264,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
REMDESIVIR 100 MG IV SOLR,,J0248,HCPCS,Facility,Outpatient,1,Each,,2264,1924.4,648.8624,2264,Medica,Medical Assistance,1009.744,44.6,,percent of total billed charges,,
REMDESIVIR 100 MG IV SOLR,,J0248,HCPCS,Facility,Inpatient,1,Each,,2264,1924.4,648.8624,2264,Medica,Medical Assistance,,,,,Included in per diem rate,
REMDESIVIR 100 MG IV SOLR,,J0248,HCPCS,Facility,Outpatient,1,Each,,2264,1924.4,648.8624,2264,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1127.472,49.8,,percent of total billed charges,,
REMDESIVIR 100 MG IV SOLR,,J0248,HCPCS,Facility,Inpatient,1,Each,,2264,1924.4,648.8624,2264,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
REMDESIVIR 100 MG IV SOLR,,J0248,HCPCS,Facility,Both,1,Each,,2264,1924.4,648.8624,2264,"Multiplan, Inc.","Multiplan, Inc.",2128.16,94,,percent of total billed charges,,
REMDESIVIR 100 MG IV SOLR,,J0248,HCPCS,Facility,Outpatient,1,Each,,2264,1924.4,648.8624,2264,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,2039.864,90.1,,percent of total billed charges,,
REMDESIVIR 100 MG IV SOLR,,J0248,HCPCS,Facility,Inpatient,1,Each,,2264,1924.4,648.8624,2264,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
REMDESIVIR 100 MG IV SOLR,,J0248,HCPCS,Facility,Both,1,Each,,2264,1924.4,648.8624,2264,"Preferred One Administrative Services, INC.",PPO,2232.304,98.6,,percent of total billed charges,,
REMDESIVIR 100 MG IV SOLR,,J0248,HCPCS,Facility,Outpatient,1,Each,,2264,1924.4,648.8624,2264,PrimeWest Health,Minnesota Senior Health Options (MSHO),1164.828,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
REMDESIVIR 100 MG IV SOLR,,J0248,HCPCS,Facility,Inpatient,1,Each,,2264,1924.4,648.8624,2264,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
REMDESIVIR 100 MG IV SOLR,,J0248,HCPCS,Facility,Outpatient,1,Each,,2264,1924.4,648.8624,2264,PrimeWest Health,MinnesotaCare,1162.7904,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
REMDESIVIR 100 MG IV SOLR,,J0248,HCPCS,Facility,Inpatient,1,Each,,2264,1924.4,648.8624,2264,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
REMDESIVIR 100 MG IV SOLR,,J0248,HCPCS,Facility,Both,1,Each,,2264,1924.4,648.8624,2264,Sanford Health Plan,Sanford Health Plan,2082.88,92,,percent of total billed charges,,
REMDESIVIR 100 MG IV SOLR,,J0248,HCPCS,Facility,Outpatient,1,Each,,2264,1924.4,648.8624,2264,"UCare Health, Inc.",Individual & Family Plan,1275.764,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
REMDESIVIR 100 MG IV SOLR,,J0248,HCPCS,Facility,Inpatient,1,Each,,2264,1924.4,648.8624,2264,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
REMDESIVIR 100 MG IV SOLR,,J0248,HCPCS,Facility,Outpatient,1,Each,,2264,1924.4,648.8624,2264,"UCare Health, Inc.",Medical Assistance,1142.6408,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
REMDESIVIR 100 MG IV SOLR,,J0248,HCPCS,Facility,Inpatient,1,Each,,2264,1924.4,648.8624,2264,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
REMDESIVIR 100 MG IV SOLR,,J0248,HCPCS,Facility,Outpatient,1,Each,,2264,1924.4,648.8624,2264,"UCare Health, Inc.",Medicare Advantage,1142.6408,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
REMDESIVIR 100 MG IV SOLR,,J0248,HCPCS,Facility,Inpatient,1,Each,,2264,1924.4,648.8624,2264,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
REMDESIVIR 100 MG IV SOLR,,J0248,HCPCS,Facility,Outpatient,1,Each,,2264,1924.4,648.8624,2264,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1142.6408,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
REMDESIVIR 100 MG IV SOLR,,J0248,HCPCS,Facility,Inpatient,1,Each,,2264,1924.4,648.8624,2264,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
REMDESIVIR 100 MG IV SOLR,,J0248,HCPCS,Facility,Both,1,Each,,2264,1924.4,648.8624,2264,UnitedHealthcare,Individual & Family,2128.16,94,,percent of total billed charges,,
REMDESIVIR 100 MG IV SOLR,,J0248,HCPCS,Facility,Outpatient,1,Each,,2264,1924.4,648.8624,2264,UnitedHealthcare,Medicare Advantage,1109.36,49,,percent of total billed charges,,
REMDESIVIR 100 MG IV SOLR,,J0248,HCPCS,Facility,Inpatient,1,Each,,2264,1924.4,648.8624,2264,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
REMDESIVIR 100 MG IV SOLR,,J0248,HCPCS,Facility,Outpatient,1,Each,,2264,1924.4,648.8624,2264,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1086.72,48,,percent of total billed charges,,100% of DHS outpatient percentage
REMDESIVIR 100 MG IV SOLR,,J0248,HCPCS,Facility,Inpatient,1,Each,,2264,1924.4,648.8624,2264,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
AMPICILLIN SODIUM 1 GRAM INJ SOLR,,J0290,HCPCS,Facility,Both,1,Each,,42,35.7,12.0372,42,Aetna,Commercial,38.64,92,,percent of total billed charges,,
AMPICILLIN SODIUM 1 GRAM INJ SOLR,,J0290,HCPCS,Facility,Outpatient,1,Each,,42,35.7,12.0372,42,Aetna,Medicare Advantage,20.58,49,,percent of total billed charges,,
AMPICILLIN SODIUM 1 GRAM INJ SOLR,,J0290,HCPCS,Facility,Inpatient,1,Each,,42,35.7,12.0372,42,Aetna,Medicare Advantage,,,,,Included in per diem rate,
AMPICILLIN SODIUM 1 GRAM INJ SOLR,,J0290,HCPCS,Facility,Both,1,Each,,42,35.7,12.0372,42,Aetna,PPO,39.06,93,,percent of total billed charges,,
AMPICILLIN SODIUM 1 GRAM INJ SOLR,,J0290,HCPCS,Facility,Both,1,Each,,42,35.7,12.0372,42,America's PPO,America's PPO,40.3326,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
AMPICILLIN SODIUM 1 GRAM INJ SOLR,,J0290,HCPCS,Facility,Both,1,Each,,42,35.7,12.0372,42,BlueCross BlueShield Minnesota, Federal Employee Program,41.328,98.4,,percent of total billed charges,,
AMPICILLIN SODIUM 1 GRAM INJ SOLR,,J0290,HCPCS,Facility,Both,1,Each,,42,35.7,12.0372,42,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,42,100,,percent of total billed charges,,
AMPICILLIN SODIUM 1 GRAM INJ SOLR,,J0290,HCPCS,Facility,Both,1,Each,,42,35.7,12.0372,42,BlueCross BlueShield Minnesota,High Value Network Plan,37.8,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
AMPICILLIN SODIUM 1 GRAM INJ SOLR,,J0290,HCPCS,Facility,Outpatient,1,Each,,42,35.7,12.0372,42,BlueCross BlueShield Minnesota,Medicare Advantage,20.58,49,,percent of total billed charges,,
AMPICILLIN SODIUM 1 GRAM INJ SOLR,,J0290,HCPCS,Facility,Inpatient,1,Each,,42,35.7,12.0372,42,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
AMPICILLIN SODIUM 1 GRAM INJ SOLR,,J0290,HCPCS,Facility,Both,1,Each,,42,35.7,12.0372,42,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,37.1994,88.57,,percent of total billed charges,,
AMPICILLIN SODIUM 1 GRAM INJ SOLR,,J0290,HCPCS,Facility,Both,1,Each,,42,35.7,12.0372,42,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,12.0372,28.66,,percent of total billed charges,,
AMPICILLIN SODIUM 1 GRAM INJ SOLR,,J0290,HCPCS,Facility,Outpatient,1,Each,,42,35.7,12.0372,42,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),20.58,49,,percent of total billed charges,,
AMPICILLIN SODIUM 1 GRAM INJ SOLR,,J0290,HCPCS,Facility,Inpatient,1,Each,,42,35.7,12.0372,42,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
AMPICILLIN SODIUM 1 GRAM INJ SOLR,,J0290,HCPCS,Facility,Both,1,Each,,42,35.7,12.0372,42,CorVel,Worker's Compensation,42,100,,percent of total billed charges,,
AMPICILLIN SODIUM 1 GRAM INJ SOLR,,J0290,HCPCS,Facility,Both,1,Each,,42,35.7,12.0372,42,First Health Group Corporation,First Health Network,40.74,97,,percent of total billed charges,,
AMPICILLIN SODIUM 1 GRAM INJ SOLR,,J0290,HCPCS,Facility,Both,1,Each,,42,35.7,12.0372,42,"Health Partners, Inc.",Commercial,39.732,94.6,,percent of total billed charges,,
AMPICILLIN SODIUM 1 GRAM INJ SOLR,,J0290,HCPCS,Facility,Outpatient,1,Each,,42,35.7,12.0372,42,"Health Partners, Inc.",Medicare Advantage,20.58,49,,percent of total billed charges,,
AMPICILLIN SODIUM 1 GRAM INJ SOLR,,J0290,HCPCS,Facility,Inpatient,1,Each,,42,35.7,12.0372,42,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
AMPICILLIN SODIUM 1 GRAM INJ SOLR,,J0290,HCPCS,Facility,Both,1,Each,,42,35.7,12.0372,42,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),25.2,60,,percent of total billed charges,,
AMPICILLIN SODIUM 1 GRAM INJ SOLR,,J0290,HCPCS,Facility,Both,1,Each,,42,35.7,12.0372,42,"Health Partners, Inc.",State of Minnesota Advantage Program,34.23,81.5,,percent of total billed charges,,
AMPICILLIN SODIUM 1 GRAM INJ SOLR,,J0290,HCPCS,Facility,Both,1,Each,,42,35.7,12.0372,42,"Health Partners, Inc.",State Public Programs,21,50,,percent of total billed charges,,
AMPICILLIN SODIUM 1 GRAM INJ SOLR,,J0290,HCPCS,Facility,Both,1,Each,,42,35.7,12.0372,42,Humana Insurance Company,Commercial PPO,39.9,95,,percent of total billed charges,,
AMPICILLIN SODIUM 1 GRAM INJ SOLR,,J0290,HCPCS,Facility,Outpatient,1,Each,,42,35.7,12.0372,42,Humana Insurance Company,Medicare PPO,20.58,49,,percent of total billed charges,,
AMPICILLIN SODIUM 1 GRAM INJ SOLR,,J0290,HCPCS,Facility,Inpatient,1,Each,,42,35.7,12.0372,42,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
AMPICILLIN SODIUM 1 GRAM INJ SOLR,,J0290,HCPCS,Facility,Both,1,Each,,42,35.7,12.0372,42,Medica,Individual & Family,41.622,99.1,,percent of total billed charges,,
AMPICILLIN SODIUM 1 GRAM INJ SOLR,,J0290,HCPCS,Facility,Outpatient,1,Each,,42,35.7,12.0372,42,Medica,Medica Advantage Solution,20.916,49.8,,percent of total billed charges,,
AMPICILLIN SODIUM 1 GRAM INJ SOLR,,J0290,HCPCS,Facility,Inpatient,1,Each,,42,35.7,12.0372,42,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
AMPICILLIN SODIUM 1 GRAM INJ SOLR,,J0290,HCPCS,Facility,Outpatient,1,Each,,42,35.7,12.0372,42,Medica,Medical Assistance,18.732,44.6,,percent of total billed charges,,
AMPICILLIN SODIUM 1 GRAM INJ SOLR,,J0290,HCPCS,Facility,Inpatient,1,Each,,42,35.7,12.0372,42,Medica,Medical Assistance,,,,,Included in per diem rate,
AMPICILLIN SODIUM 1 GRAM INJ SOLR,,J0290,HCPCS,Facility,Outpatient,1,Each,,42,35.7,12.0372,42,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,20.916,49.8,,percent of total billed charges,,
AMPICILLIN SODIUM 1 GRAM INJ SOLR,,J0290,HCPCS,Facility,Inpatient,1,Each,,42,35.7,12.0372,42,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
AMPICILLIN SODIUM 1 GRAM INJ SOLR,,J0290,HCPCS,Facility,Both,1,Each,,42,35.7,12.0372,42,"Multiplan, Inc.","Multiplan, Inc.",39.48,94,,percent of total billed charges,,
AMPICILLIN SODIUM 1 GRAM INJ SOLR,,J0290,HCPCS,Facility,Outpatient,1,Each,,42,35.7,12.0372,42,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,37.842,90.1,,percent of total billed charges,,
AMPICILLIN SODIUM 1 GRAM INJ SOLR,,J0290,HCPCS,Facility,Inpatient,1,Each,,42,35.7,12.0372,42,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
AMPICILLIN SODIUM 1 GRAM INJ SOLR,,J0290,HCPCS,Facility,Both,1,Each,,42,35.7,12.0372,42,"Preferred One Administrative Services, INC.",PPO,41.412,98.6,,percent of total billed charges,,
AMPICILLIN SODIUM 1 GRAM INJ SOLR,,J0290,HCPCS,Facility,Outpatient,1,Each,,42,35.7,12.0372,42,PrimeWest Health,Minnesota Senior Health Options (MSHO),21.609,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
AMPICILLIN SODIUM 1 GRAM INJ SOLR,,J0290,HCPCS,Facility,Inpatient,1,Each,,42,35.7,12.0372,42,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
AMPICILLIN SODIUM 1 GRAM INJ SOLR,,J0290,HCPCS,Facility,Outpatient,1,Each,,42,35.7,12.0372,42,PrimeWest Health,MinnesotaCare,21.5712,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
AMPICILLIN SODIUM 1 GRAM INJ SOLR,,J0290,HCPCS,Facility,Inpatient,1,Each,,42,35.7,12.0372,42,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
AMPICILLIN SODIUM 1 GRAM INJ SOLR,,J0290,HCPCS,Facility,Both,1,Each,,42,35.7,12.0372,42,Sanford Health Plan,Sanford Health Plan,38.64,92,,percent of total billed charges,,
AMPICILLIN SODIUM 1 GRAM INJ SOLR,,J0290,HCPCS,Facility,Outpatient,1,Each,,42,35.7,12.0372,42,"UCare Health, Inc.",Individual & Family Plan,23.667,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
AMPICILLIN SODIUM 1 GRAM INJ SOLR,,J0290,HCPCS,Facility,Inpatient,1,Each,,42,35.7,12.0372,42,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
AMPICILLIN SODIUM 1 GRAM INJ SOLR,,J0290,HCPCS,Facility,Outpatient,1,Each,,42,35.7,12.0372,42,"UCare Health, Inc.",Medical Assistance,21.1974,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
AMPICILLIN SODIUM 1 GRAM INJ SOLR,,J0290,HCPCS,Facility,Inpatient,1,Each,,42,35.7,12.0372,42,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
AMPICILLIN SODIUM 1 GRAM INJ SOLR,,J0290,HCPCS,Facility,Outpatient,1,Each,,42,35.7,12.0372,42,"UCare Health, Inc.",Medicare Advantage,21.1974,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
AMPICILLIN SODIUM 1 GRAM INJ SOLR,,J0290,HCPCS,Facility,Inpatient,1,Each,,42,35.7,12.0372,42,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
AMPICILLIN SODIUM 1 GRAM INJ SOLR,,J0290,HCPCS,Facility,Outpatient,1,Each,,42,35.7,12.0372,42,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),21.1974,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
AMPICILLIN SODIUM 1 GRAM INJ SOLR,,J0290,HCPCS,Facility,Inpatient,1,Each,,42,35.7,12.0372,42,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
AMPICILLIN SODIUM 1 GRAM INJ SOLR,,J0290,HCPCS,Facility,Both,1,Each,,42,35.7,12.0372,42,UnitedHealthcare,Individual & Family,39.48,94,,percent of total billed charges,,
AMPICILLIN SODIUM 1 GRAM INJ SOLR,,J0290,HCPCS,Facility,Outpatient,1,Each,,42,35.7,12.0372,42,UnitedHealthcare,Medicare Advantage,20.58,49,,percent of total billed charges,,
AMPICILLIN SODIUM 1 GRAM INJ SOLR,,J0290,HCPCS,Facility,Inpatient,1,Each,,42,35.7,12.0372,42,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
AMPICILLIN SODIUM 1 GRAM INJ SOLR,,J0290,HCPCS,Facility,Outpatient,1,Each,,42,35.7,12.0372,42,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,20.16,48,,percent of total billed charges,,100% of DHS outpatient percentage
AMPICILLIN SODIUM 1 GRAM INJ SOLR,,J0290,HCPCS,Facility,Inpatient,1,Each,,42,35.7,12.0372,42,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
AMPICILLIN SODIUM 1 GRAM IV SOLR,,J0290,HCPCS,Facility,Both,1,Each,,86,73.1,24.6476,86,Aetna,Commercial,79.12,92,,percent of total billed charges,,
AMPICILLIN SODIUM 1 GRAM IV SOLR,,J0290,HCPCS,Facility,Outpatient,1,Each,,86,73.1,24.6476,86,Aetna,Medicare Advantage,42.14,49,,percent of total billed charges,,
AMPICILLIN SODIUM 1 GRAM IV SOLR,,J0290,HCPCS,Facility,Inpatient,1,Each,,86,73.1,24.6476,86,Aetna,Medicare Advantage,,,,,Included in per diem rate,
AMPICILLIN SODIUM 1 GRAM IV SOLR,,J0290,HCPCS,Facility,Both,1,Each,,86,73.1,24.6476,86,Aetna,PPO,79.98,93,,percent of total billed charges,,
AMPICILLIN SODIUM 1 GRAM IV SOLR,,J0290,HCPCS,Facility,Both,1,Each,,86,73.1,24.6476,86,America's PPO,America's PPO,82.5858,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
AMPICILLIN SODIUM 1 GRAM IV SOLR,,J0290,HCPCS,Facility,Both,1,Each,,86,73.1,24.6476,86,BlueCross BlueShield Minnesota, Federal Employee Program,84.624,98.4,,percent of total billed charges,,
AMPICILLIN SODIUM 1 GRAM IV SOLR,,J0290,HCPCS,Facility,Both,1,Each,,86,73.1,24.6476,86,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,86,100,,percent of total billed charges,,
AMPICILLIN SODIUM 1 GRAM IV SOLR,,J0290,HCPCS,Facility,Both,1,Each,,86,73.1,24.6476,86,BlueCross BlueShield Minnesota,High Value Network Plan,77.4,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
AMPICILLIN SODIUM 1 GRAM IV SOLR,,J0290,HCPCS,Facility,Outpatient,1,Each,,86,73.1,24.6476,86,BlueCross BlueShield Minnesota,Medicare Advantage,42.14,49,,percent of total billed charges,,
AMPICILLIN SODIUM 1 GRAM IV SOLR,,J0290,HCPCS,Facility,Inpatient,1,Each,,86,73.1,24.6476,86,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
AMPICILLIN SODIUM 1 GRAM IV SOLR,,J0290,HCPCS,Facility,Both,1,Each,,86,73.1,24.6476,86,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,76.1702,88.57,,percent of total billed charges,,
AMPICILLIN SODIUM 1 GRAM IV SOLR,,J0290,HCPCS,Facility,Both,1,Each,,86,73.1,24.6476,86,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,24.6476,28.66,,percent of total billed charges,,
AMPICILLIN SODIUM 1 GRAM IV SOLR,,J0290,HCPCS,Facility,Outpatient,1,Each,,86,73.1,24.6476,86,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),42.14,49,,percent of total billed charges,,
AMPICILLIN SODIUM 1 GRAM IV SOLR,,J0290,HCPCS,Facility,Inpatient,1,Each,,86,73.1,24.6476,86,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
AMPICILLIN SODIUM 1 GRAM IV SOLR,,J0290,HCPCS,Facility,Both,1,Each,,86,73.1,24.6476,86,CorVel,Worker's Compensation,86,100,,percent of total billed charges,,
AMPICILLIN SODIUM 1 GRAM IV SOLR,,J0290,HCPCS,Facility,Both,1,Each,,86,73.1,24.6476,86,First Health Group Corporation,First Health Network,83.42,97,,percent of total billed charges,,
AMPICILLIN SODIUM 1 GRAM IV SOLR,,J0290,HCPCS,Facility,Both,1,Each,,86,73.1,24.6476,86,"Health Partners, Inc.",Commercial,81.356,94.6,,percent of total billed charges,,
AMPICILLIN SODIUM 1 GRAM IV SOLR,,J0290,HCPCS,Facility,Outpatient,1,Each,,86,73.1,24.6476,86,"Health Partners, Inc.",Medicare Advantage,42.14,49,,percent of total billed charges,,
AMPICILLIN SODIUM 1 GRAM IV SOLR,,J0290,HCPCS,Facility,Inpatient,1,Each,,86,73.1,24.6476,86,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
AMPICILLIN SODIUM 1 GRAM IV SOLR,,J0290,HCPCS,Facility,Both,1,Each,,86,73.1,24.6476,86,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),51.6,60,,percent of total billed charges,,
AMPICILLIN SODIUM 1 GRAM IV SOLR,,J0290,HCPCS,Facility,Both,1,Each,,86,73.1,24.6476,86,"Health Partners, Inc.",State of Minnesota Advantage Program,70.09,81.5,,percent of total billed charges,,
AMPICILLIN SODIUM 1 GRAM IV SOLR,,J0290,HCPCS,Facility,Both,1,Each,,86,73.1,24.6476,86,"Health Partners, Inc.",State Public Programs,43,50,,percent of total billed charges,,
AMPICILLIN SODIUM 1 GRAM IV SOLR,,J0290,HCPCS,Facility,Both,1,Each,,86,73.1,24.6476,86,Humana Insurance Company,Commercial PPO,81.7,95,,percent of total billed charges,,
AMPICILLIN SODIUM 1 GRAM IV SOLR,,J0290,HCPCS,Facility,Outpatient,1,Each,,86,73.1,24.6476,86,Humana Insurance Company,Medicare PPO,42.14,49,,percent of total billed charges,,
AMPICILLIN SODIUM 1 GRAM IV SOLR,,J0290,HCPCS,Facility,Inpatient,1,Each,,86,73.1,24.6476,86,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
AMPICILLIN SODIUM 1 GRAM IV SOLR,,J0290,HCPCS,Facility,Both,1,Each,,86,73.1,24.6476,86,Medica,Individual & Family,85.226,99.1,,percent of total billed charges,,
AMPICILLIN SODIUM 1 GRAM IV SOLR,,J0290,HCPCS,Facility,Outpatient,1,Each,,86,73.1,24.6476,86,Medica,Medica Advantage Solution,42.828,49.8,,percent of total billed charges,,
AMPICILLIN SODIUM 1 GRAM IV SOLR,,J0290,HCPCS,Facility,Inpatient,1,Each,,86,73.1,24.6476,86,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
AMPICILLIN SODIUM 1 GRAM IV SOLR,,J0290,HCPCS,Facility,Outpatient,1,Each,,86,73.1,24.6476,86,Medica,Medical Assistance,38.356,44.6,,percent of total billed charges,,
AMPICILLIN SODIUM 1 GRAM IV SOLR,,J0290,HCPCS,Facility,Inpatient,1,Each,,86,73.1,24.6476,86,Medica,Medical Assistance,,,,,Included in per diem rate,
AMPICILLIN SODIUM 1 GRAM IV SOLR,,J0290,HCPCS,Facility,Outpatient,1,Each,,86,73.1,24.6476,86,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,42.828,49.8,,percent of total billed charges,,
AMPICILLIN SODIUM 1 GRAM IV SOLR,,J0290,HCPCS,Facility,Inpatient,1,Each,,86,73.1,24.6476,86,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
AMPICILLIN SODIUM 1 GRAM IV SOLR,,J0290,HCPCS,Facility,Both,1,Each,,86,73.1,24.6476,86,"Multiplan, Inc.","Multiplan, Inc.",80.84,94,,percent of total billed charges,,
AMPICILLIN SODIUM 1 GRAM IV SOLR,,J0290,HCPCS,Facility,Outpatient,1,Each,,86,73.1,24.6476,86,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,77.486,90.1,,percent of total billed charges,,
AMPICILLIN SODIUM 1 GRAM IV SOLR,,J0290,HCPCS,Facility,Inpatient,1,Each,,86,73.1,24.6476,86,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
AMPICILLIN SODIUM 1 GRAM IV SOLR,,J0290,HCPCS,Facility,Both,1,Each,,86,73.1,24.6476,86,"Preferred One Administrative Services, INC.",PPO,84.796,98.6,,percent of total billed charges,,
AMPICILLIN SODIUM 1 GRAM IV SOLR,,J0290,HCPCS,Facility,Outpatient,1,Each,,86,73.1,24.6476,86,PrimeWest Health,Minnesota Senior Health Options (MSHO),44.247,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
AMPICILLIN SODIUM 1 GRAM IV SOLR,,J0290,HCPCS,Facility,Inpatient,1,Each,,86,73.1,24.6476,86,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
AMPICILLIN SODIUM 1 GRAM IV SOLR,,J0290,HCPCS,Facility,Outpatient,1,Each,,86,73.1,24.6476,86,PrimeWest Health,MinnesotaCare,44.1696,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
AMPICILLIN SODIUM 1 GRAM IV SOLR,,J0290,HCPCS,Facility,Inpatient,1,Each,,86,73.1,24.6476,86,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
AMPICILLIN SODIUM 1 GRAM IV SOLR,,J0290,HCPCS,Facility,Both,1,Each,,86,73.1,24.6476,86,Sanford Health Plan,Sanford Health Plan,79.12,92,,percent of total billed charges,,
AMPICILLIN SODIUM 1 GRAM IV SOLR,,J0290,HCPCS,Facility,Outpatient,1,Each,,86,73.1,24.6476,86,"UCare Health, Inc.",Individual & Family Plan,48.461,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
AMPICILLIN SODIUM 1 GRAM IV SOLR,,J0290,HCPCS,Facility,Inpatient,1,Each,,86,73.1,24.6476,86,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
AMPICILLIN SODIUM 1 GRAM IV SOLR,,J0290,HCPCS,Facility,Outpatient,1,Each,,86,73.1,24.6476,86,"UCare Health, Inc.",Medical Assistance,43.4042,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
AMPICILLIN SODIUM 1 GRAM IV SOLR,,J0290,HCPCS,Facility,Inpatient,1,Each,,86,73.1,24.6476,86,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
AMPICILLIN SODIUM 1 GRAM IV SOLR,,J0290,HCPCS,Facility,Outpatient,1,Each,,86,73.1,24.6476,86,"UCare Health, Inc.",Medicare Advantage,43.4042,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
AMPICILLIN SODIUM 1 GRAM IV SOLR,,J0290,HCPCS,Facility,Inpatient,1,Each,,86,73.1,24.6476,86,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
AMPICILLIN SODIUM 1 GRAM IV SOLR,,J0290,HCPCS,Facility,Outpatient,1,Each,,86,73.1,24.6476,86,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),43.4042,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
AMPICILLIN SODIUM 1 GRAM IV SOLR,,J0290,HCPCS,Facility,Inpatient,1,Each,,86,73.1,24.6476,86,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
AMPICILLIN SODIUM 1 GRAM IV SOLR,,J0290,HCPCS,Facility,Both,1,Each,,86,73.1,24.6476,86,UnitedHealthcare,Individual & Family,80.84,94,,percent of total billed charges,,
AMPICILLIN SODIUM 1 GRAM IV SOLR,,J0290,HCPCS,Facility,Outpatient,1,Each,,86,73.1,24.6476,86,UnitedHealthcare,Medicare Advantage,42.14,49,,percent of total billed charges,,
AMPICILLIN SODIUM 1 GRAM IV SOLR,,J0290,HCPCS,Facility,Inpatient,1,Each,,86,73.1,24.6476,86,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
AMPICILLIN SODIUM 1 GRAM IV SOLR,,J0290,HCPCS,Facility,Outpatient,1,Each,,86,73.1,24.6476,86,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,41.28,48,,percent of total billed charges,,100% of DHS outpatient percentage
AMPICILLIN SODIUM 1 GRAM IV SOLR,,J0290,HCPCS,Facility,Inpatient,1,Each,,86,73.1,24.6476,86,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
AMPICILLIN SODIUM 2 GRAM INJ SOLR,,J0290,HCPCS,Facility,Both,1,Each,,77,65.45,22.0682,77,Aetna,Commercial,70.84,92,,percent of total billed charges,,
AMPICILLIN SODIUM 2 GRAM INJ SOLR,,J0290,HCPCS,Facility,Outpatient,1,Each,,77,65.45,22.0682,77,Aetna,Medicare Advantage,37.73,49,,percent of total billed charges,,
AMPICILLIN SODIUM 2 GRAM INJ SOLR,,J0290,HCPCS,Facility,Inpatient,1,Each,,77,65.45,22.0682,77,Aetna,Medicare Advantage,,,,,Included in per diem rate,
AMPICILLIN SODIUM 2 GRAM INJ SOLR,,J0290,HCPCS,Facility,Both,1,Each,,77,65.45,22.0682,77,Aetna,PPO,71.61,93,,percent of total billed charges,,
AMPICILLIN SODIUM 2 GRAM INJ SOLR,,J0290,HCPCS,Facility,Both,1,Each,,77,65.45,22.0682,77,America's PPO,America's PPO,73.9431,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
AMPICILLIN SODIUM 2 GRAM INJ SOLR,,J0290,HCPCS,Facility,Both,1,Each,,77,65.45,22.0682,77,BlueCross BlueShield Minnesota, Federal Employee Program,75.768,98.4,,percent of total billed charges,,
AMPICILLIN SODIUM 2 GRAM INJ SOLR,,J0290,HCPCS,Facility,Both,1,Each,,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,77,100,,percent of total billed charges,,
AMPICILLIN SODIUM 2 GRAM INJ SOLR,,J0290,HCPCS,Facility,Both,1,Each,,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,High Value Network Plan,69.3,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
AMPICILLIN SODIUM 2 GRAM INJ SOLR,,J0290,HCPCS,Facility,Outpatient,1,Each,,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,Medicare Advantage,37.73,49,,percent of total billed charges,,
AMPICILLIN SODIUM 2 GRAM INJ SOLR,,J0290,HCPCS,Facility,Inpatient,1,Each,,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
AMPICILLIN SODIUM 2 GRAM INJ SOLR,,J0290,HCPCS,Facility,Both,1,Each,,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,68.1989,88.57,,percent of total billed charges,,
AMPICILLIN SODIUM 2 GRAM INJ SOLR,,J0290,HCPCS,Facility,Both,1,Each,,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,22.0682,28.66,,percent of total billed charges,,
AMPICILLIN SODIUM 2 GRAM INJ SOLR,,J0290,HCPCS,Facility,Outpatient,1,Each,,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),37.73,49,,percent of total billed charges,,
AMPICILLIN SODIUM 2 GRAM INJ SOLR,,J0290,HCPCS,Facility,Inpatient,1,Each,,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
AMPICILLIN SODIUM 2 GRAM INJ SOLR,,J0290,HCPCS,Facility,Both,1,Each,,77,65.45,22.0682,77,CorVel,Worker's Compensation,77,100,,percent of total billed charges,,
AMPICILLIN SODIUM 2 GRAM INJ SOLR,,J0290,HCPCS,Facility,Both,1,Each,,77,65.45,22.0682,77,First Health Group Corporation,First Health Network,74.69,97,,percent of total billed charges,,
AMPICILLIN SODIUM 2 GRAM INJ SOLR,,J0290,HCPCS,Facility,Both,1,Each,,77,65.45,22.0682,77,"Health Partners, Inc.",Commercial,72.842,94.6,,percent of total billed charges,,
AMPICILLIN SODIUM 2 GRAM INJ SOLR,,J0290,HCPCS,Facility,Outpatient,1,Each,,77,65.45,22.0682,77,"Health Partners, Inc.",Medicare Advantage,37.73,49,,percent of total billed charges,,
AMPICILLIN SODIUM 2 GRAM INJ SOLR,,J0290,HCPCS,Facility,Inpatient,1,Each,,77,65.45,22.0682,77,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
AMPICILLIN SODIUM 2 GRAM INJ SOLR,,J0290,HCPCS,Facility,Both,1,Each,,77,65.45,22.0682,77,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),46.2,60,,percent of total billed charges,,
AMPICILLIN SODIUM 2 GRAM INJ SOLR,,J0290,HCPCS,Facility,Both,1,Each,,77,65.45,22.0682,77,"Health Partners, Inc.",State of Minnesota Advantage Program,62.755,81.5,,percent of total billed charges,,
AMPICILLIN SODIUM 2 GRAM INJ SOLR,,J0290,HCPCS,Facility,Both,1,Each,,77,65.45,22.0682,77,"Health Partners, Inc.",State Public Programs,38.5,50,,percent of total billed charges,,
AMPICILLIN SODIUM 2 GRAM INJ SOLR,,J0290,HCPCS,Facility,Both,1,Each,,77,65.45,22.0682,77,Humana Insurance Company,Commercial PPO,73.15,95,,percent of total billed charges,,
AMPICILLIN SODIUM 2 GRAM INJ SOLR,,J0290,HCPCS,Facility,Outpatient,1,Each,,77,65.45,22.0682,77,Humana Insurance Company,Medicare PPO,37.73,49,,percent of total billed charges,,
AMPICILLIN SODIUM 2 GRAM INJ SOLR,,J0290,HCPCS,Facility,Inpatient,1,Each,,77,65.45,22.0682,77,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
AMPICILLIN SODIUM 2 GRAM INJ SOLR,,J0290,HCPCS,Facility,Both,1,Each,,77,65.45,22.0682,77,Medica,Individual & Family,76.307,99.1,,percent of total billed charges,,
AMPICILLIN SODIUM 2 GRAM INJ SOLR,,J0290,HCPCS,Facility,Outpatient,1,Each,,77,65.45,22.0682,77,Medica,Medica Advantage Solution,38.346,49.8,,percent of total billed charges,,
AMPICILLIN SODIUM 2 GRAM INJ SOLR,,J0290,HCPCS,Facility,Inpatient,1,Each,,77,65.45,22.0682,77,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
AMPICILLIN SODIUM 2 GRAM INJ SOLR,,J0290,HCPCS,Facility,Outpatient,1,Each,,77,65.45,22.0682,77,Medica,Medical Assistance,34.342,44.6,,percent of total billed charges,,
AMPICILLIN SODIUM 2 GRAM INJ SOLR,,J0290,HCPCS,Facility,Inpatient,1,Each,,77,65.45,22.0682,77,Medica,Medical Assistance,,,,,Included in per diem rate,
AMPICILLIN SODIUM 2 GRAM INJ SOLR,,J0290,HCPCS,Facility,Outpatient,1,Each,,77,65.45,22.0682,77,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,38.346,49.8,,percent of total billed charges,,
AMPICILLIN SODIUM 2 GRAM INJ SOLR,,J0290,HCPCS,Facility,Inpatient,1,Each,,77,65.45,22.0682,77,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
AMPICILLIN SODIUM 2 GRAM INJ SOLR,,J0290,HCPCS,Facility,Both,1,Each,,77,65.45,22.0682,77,"Multiplan, Inc.","Multiplan, Inc.",72.38,94,,percent of total billed charges,,
AMPICILLIN SODIUM 2 GRAM INJ SOLR,,J0290,HCPCS,Facility,Outpatient,1,Each,,77,65.45,22.0682,77,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,69.377,90.1,,percent of total billed charges,,
AMPICILLIN SODIUM 2 GRAM INJ SOLR,,J0290,HCPCS,Facility,Inpatient,1,Each,,77,65.45,22.0682,77,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
AMPICILLIN SODIUM 2 GRAM INJ SOLR,,J0290,HCPCS,Facility,Both,1,Each,,77,65.45,22.0682,77,"Preferred One Administrative Services, INC.",PPO,75.922,98.6,,percent of total billed charges,,
AMPICILLIN SODIUM 2 GRAM INJ SOLR,,J0290,HCPCS,Facility,Outpatient,1,Each,,77,65.45,22.0682,77,PrimeWest Health,Minnesota Senior Health Options (MSHO),39.6165,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
AMPICILLIN SODIUM 2 GRAM INJ SOLR,,J0290,HCPCS,Facility,Inpatient,1,Each,,77,65.45,22.0682,77,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
AMPICILLIN SODIUM 2 GRAM INJ SOLR,,J0290,HCPCS,Facility,Outpatient,1,Each,,77,65.45,22.0682,77,PrimeWest Health,MinnesotaCare,39.5472,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
AMPICILLIN SODIUM 2 GRAM INJ SOLR,,J0290,HCPCS,Facility,Inpatient,1,Each,,77,65.45,22.0682,77,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
AMPICILLIN SODIUM 2 GRAM INJ SOLR,,J0290,HCPCS,Facility,Both,1,Each,,77,65.45,22.0682,77,Sanford Health Plan,Sanford Health Plan,70.84,92,,percent of total billed charges,,
AMPICILLIN SODIUM 2 GRAM INJ SOLR,,J0290,HCPCS,Facility,Outpatient,1,Each,,77,65.45,22.0682,77,"UCare Health, Inc.",Individual & Family Plan,43.3895,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
AMPICILLIN SODIUM 2 GRAM INJ SOLR,,J0290,HCPCS,Facility,Inpatient,1,Each,,77,65.45,22.0682,77,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
AMPICILLIN SODIUM 2 GRAM INJ SOLR,,J0290,HCPCS,Facility,Outpatient,1,Each,,77,65.45,22.0682,77,"UCare Health, Inc.",Medical Assistance,38.8619,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
AMPICILLIN SODIUM 2 GRAM INJ SOLR,,J0290,HCPCS,Facility,Inpatient,1,Each,,77,65.45,22.0682,77,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
AMPICILLIN SODIUM 2 GRAM INJ SOLR,,J0290,HCPCS,Facility,Outpatient,1,Each,,77,65.45,22.0682,77,"UCare Health, Inc.",Medicare Advantage,38.8619,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
AMPICILLIN SODIUM 2 GRAM INJ SOLR,,J0290,HCPCS,Facility,Inpatient,1,Each,,77,65.45,22.0682,77,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
AMPICILLIN SODIUM 2 GRAM INJ SOLR,,J0290,HCPCS,Facility,Outpatient,1,Each,,77,65.45,22.0682,77,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),38.8619,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
AMPICILLIN SODIUM 2 GRAM INJ SOLR,,J0290,HCPCS,Facility,Inpatient,1,Each,,77,65.45,22.0682,77,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
AMPICILLIN SODIUM 2 GRAM INJ SOLR,,J0290,HCPCS,Facility,Both,1,Each,,77,65.45,22.0682,77,UnitedHealthcare,Individual & Family,72.38,94,,percent of total billed charges,,
AMPICILLIN SODIUM 2 GRAM INJ SOLR,,J0290,HCPCS,Facility,Outpatient,1,Each,,77,65.45,22.0682,77,UnitedHealthcare,Medicare Advantage,37.73,49,,percent of total billed charges,,
AMPICILLIN SODIUM 2 GRAM INJ SOLR,,J0290,HCPCS,Facility,Inpatient,1,Each,,77,65.45,22.0682,77,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
AMPICILLIN SODIUM 2 GRAM INJ SOLR,,J0290,HCPCS,Facility,Outpatient,1,Each,,77,65.45,22.0682,77,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,36.96,48,,percent of total billed charges,,100% of DHS outpatient percentage
AMPICILLIN SODIUM 2 GRAM INJ SOLR,,J0290,HCPCS,Facility,Inpatient,1,Each,,77,65.45,22.0682,77,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
AMPICILLIN SODIUM 500 MG INJ SOLR,,J0290,HCPCS,Facility,Both,1,Each,,21,17.85,6.0186,21,Aetna,Commercial,19.32,92,,percent of total billed charges,,
AMPICILLIN SODIUM 500 MG INJ SOLR,,J0290,HCPCS,Facility,Outpatient,1,Each,,21,17.85,6.0186,21,Aetna,Medicare Advantage,10.29,49,,percent of total billed charges,,
AMPICILLIN SODIUM 500 MG INJ SOLR,,J0290,HCPCS,Facility,Inpatient,1,Each,,21,17.85,6.0186,21,Aetna,Medicare Advantage,,,,,Included in per diem rate,
AMPICILLIN SODIUM 500 MG INJ SOLR,,J0290,HCPCS,Facility,Both,1,Each,,21,17.85,6.0186,21,Aetna,PPO,19.53,93,,percent of total billed charges,,
AMPICILLIN SODIUM 500 MG INJ SOLR,,J0290,HCPCS,Facility,Both,1,Each,,21,17.85,6.0186,21,America's PPO,America's PPO,20.1663,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
AMPICILLIN SODIUM 500 MG INJ SOLR,,J0290,HCPCS,Facility,Both,1,Each,,21,17.85,6.0186,21,BlueCross BlueShield Minnesota, Federal Employee Program,20.664,98.4,,percent of total billed charges,,
AMPICILLIN SODIUM 500 MG INJ SOLR,,J0290,HCPCS,Facility,Both,1,Each,,21,17.85,6.0186,21,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,21,100,,percent of total billed charges,,
AMPICILLIN SODIUM 500 MG INJ SOLR,,J0290,HCPCS,Facility,Both,1,Each,,21,17.85,6.0186,21,BlueCross BlueShield Minnesota,High Value Network Plan,18.9,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
AMPICILLIN SODIUM 500 MG INJ SOLR,,J0290,HCPCS,Facility,Outpatient,1,Each,,21,17.85,6.0186,21,BlueCross BlueShield Minnesota,Medicare Advantage,10.29,49,,percent of total billed charges,,
AMPICILLIN SODIUM 500 MG INJ SOLR,,J0290,HCPCS,Facility,Inpatient,1,Each,,21,17.85,6.0186,21,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
AMPICILLIN SODIUM 500 MG INJ SOLR,,J0290,HCPCS,Facility,Both,1,Each,,21,17.85,6.0186,21,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,18.5997,88.57,,percent of total billed charges,,
AMPICILLIN SODIUM 500 MG INJ SOLR,,J0290,HCPCS,Facility,Both,1,Each,,21,17.85,6.0186,21,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,6.0186,28.66,,percent of total billed charges,,
AMPICILLIN SODIUM 500 MG INJ SOLR,,J0290,HCPCS,Facility,Outpatient,1,Each,,21,17.85,6.0186,21,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),10.29,49,,percent of total billed charges,,
AMPICILLIN SODIUM 500 MG INJ SOLR,,J0290,HCPCS,Facility,Inpatient,1,Each,,21,17.85,6.0186,21,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
AMPICILLIN SODIUM 500 MG INJ SOLR,,J0290,HCPCS,Facility,Both,1,Each,,21,17.85,6.0186,21,CorVel,Worker's Compensation,21,100,,percent of total billed charges,,
AMPICILLIN SODIUM 500 MG INJ SOLR,,J0290,HCPCS,Facility,Both,1,Each,,21,17.85,6.0186,21,First Health Group Corporation,First Health Network,20.37,97,,percent of total billed charges,,
AMPICILLIN SODIUM 500 MG INJ SOLR,,J0290,HCPCS,Facility,Both,1,Each,,21,17.85,6.0186,21,"Health Partners, Inc.",Commercial,19.866,94.6,,percent of total billed charges,,
AMPICILLIN SODIUM 500 MG INJ SOLR,,J0290,HCPCS,Facility,Outpatient,1,Each,,21,17.85,6.0186,21,"Health Partners, Inc.",Medicare Advantage,10.29,49,,percent of total billed charges,,
AMPICILLIN SODIUM 500 MG INJ SOLR,,J0290,HCPCS,Facility,Inpatient,1,Each,,21,17.85,6.0186,21,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
AMPICILLIN SODIUM 500 MG INJ SOLR,,J0290,HCPCS,Facility,Both,1,Each,,21,17.85,6.0186,21,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),12.6,60,,percent of total billed charges,,
AMPICILLIN SODIUM 500 MG INJ SOLR,,J0290,HCPCS,Facility,Both,1,Each,,21,17.85,6.0186,21,"Health Partners, Inc.",State of Minnesota Advantage Program,17.115,81.5,,percent of total billed charges,,
AMPICILLIN SODIUM 500 MG INJ SOLR,,J0290,HCPCS,Facility,Both,1,Each,,21,17.85,6.0186,21,"Health Partners, Inc.",State Public Programs,10.5,50,,percent of total billed charges,,
AMPICILLIN SODIUM 500 MG INJ SOLR,,J0290,HCPCS,Facility,Both,1,Each,,21,17.85,6.0186,21,Humana Insurance Company,Commercial PPO,19.95,95,,percent of total billed charges,,
AMPICILLIN SODIUM 500 MG INJ SOLR,,J0290,HCPCS,Facility,Outpatient,1,Each,,21,17.85,6.0186,21,Humana Insurance Company,Medicare PPO,10.29,49,,percent of total billed charges,,
AMPICILLIN SODIUM 500 MG INJ SOLR,,J0290,HCPCS,Facility,Inpatient,1,Each,,21,17.85,6.0186,21,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
AMPICILLIN SODIUM 500 MG INJ SOLR,,J0290,HCPCS,Facility,Both,1,Each,,21,17.85,6.0186,21,Medica,Individual & Family,20.811,99.1,,percent of total billed charges,,
AMPICILLIN SODIUM 500 MG INJ SOLR,,J0290,HCPCS,Facility,Outpatient,1,Each,,21,17.85,6.0186,21,Medica,Medica Advantage Solution,10.458,49.8,,percent of total billed charges,,
AMPICILLIN SODIUM 500 MG INJ SOLR,,J0290,HCPCS,Facility,Inpatient,1,Each,,21,17.85,6.0186,21,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
AMPICILLIN SODIUM 500 MG INJ SOLR,,J0290,HCPCS,Facility,Outpatient,1,Each,,21,17.85,6.0186,21,Medica,Medical Assistance,9.366,44.6,,percent of total billed charges,,
AMPICILLIN SODIUM 500 MG INJ SOLR,,J0290,HCPCS,Facility,Inpatient,1,Each,,21,17.85,6.0186,21,Medica,Medical Assistance,,,,,Included in per diem rate,
AMPICILLIN SODIUM 500 MG INJ SOLR,,J0290,HCPCS,Facility,Outpatient,1,Each,,21,17.85,6.0186,21,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,10.458,49.8,,percent of total billed charges,,
AMPICILLIN SODIUM 500 MG INJ SOLR,,J0290,HCPCS,Facility,Inpatient,1,Each,,21,17.85,6.0186,21,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
AMPICILLIN SODIUM 500 MG INJ SOLR,,J0290,HCPCS,Facility,Both,1,Each,,21,17.85,6.0186,21,"Multiplan, Inc.","Multiplan, Inc.",19.74,94,,percent of total billed charges,,
AMPICILLIN SODIUM 500 MG INJ SOLR,,J0290,HCPCS,Facility,Outpatient,1,Each,,21,17.85,6.0186,21,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,18.921,90.1,,percent of total billed charges,,
AMPICILLIN SODIUM 500 MG INJ SOLR,,J0290,HCPCS,Facility,Inpatient,1,Each,,21,17.85,6.0186,21,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
AMPICILLIN SODIUM 500 MG INJ SOLR,,J0290,HCPCS,Facility,Both,1,Each,,21,17.85,6.0186,21,"Preferred One Administrative Services, INC.",PPO,20.706,98.6,,percent of total billed charges,,
AMPICILLIN SODIUM 500 MG INJ SOLR,,J0290,HCPCS,Facility,Outpatient,1,Each,,21,17.85,6.0186,21,PrimeWest Health,Minnesota Senior Health Options (MSHO),10.8045,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
AMPICILLIN SODIUM 500 MG INJ SOLR,,J0290,HCPCS,Facility,Inpatient,1,Each,,21,17.85,6.0186,21,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
AMPICILLIN SODIUM 500 MG INJ SOLR,,J0290,HCPCS,Facility,Outpatient,1,Each,,21,17.85,6.0186,21,PrimeWest Health,MinnesotaCare,10.7856,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
AMPICILLIN SODIUM 500 MG INJ SOLR,,J0290,HCPCS,Facility,Inpatient,1,Each,,21,17.85,6.0186,21,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
AMPICILLIN SODIUM 500 MG INJ SOLR,,J0290,HCPCS,Facility,Both,1,Each,,21,17.85,6.0186,21,Sanford Health Plan,Sanford Health Plan,19.32,92,,percent of total billed charges,,
AMPICILLIN SODIUM 500 MG INJ SOLR,,J0290,HCPCS,Facility,Outpatient,1,Each,,21,17.85,6.0186,21,"UCare Health, Inc.",Individual & Family Plan,11.8335,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
AMPICILLIN SODIUM 500 MG INJ SOLR,,J0290,HCPCS,Facility,Inpatient,1,Each,,21,17.85,6.0186,21,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
AMPICILLIN SODIUM 500 MG INJ SOLR,,J0290,HCPCS,Facility,Outpatient,1,Each,,21,17.85,6.0186,21,"UCare Health, Inc.",Medical Assistance,10.5987,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
AMPICILLIN SODIUM 500 MG INJ SOLR,,J0290,HCPCS,Facility,Inpatient,1,Each,,21,17.85,6.0186,21,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
AMPICILLIN SODIUM 500 MG INJ SOLR,,J0290,HCPCS,Facility,Outpatient,1,Each,,21,17.85,6.0186,21,"UCare Health, Inc.",Medicare Advantage,10.5987,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
AMPICILLIN SODIUM 500 MG INJ SOLR,,J0290,HCPCS,Facility,Inpatient,1,Each,,21,17.85,6.0186,21,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
AMPICILLIN SODIUM 500 MG INJ SOLR,,J0290,HCPCS,Facility,Outpatient,1,Each,,21,17.85,6.0186,21,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),10.5987,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
AMPICILLIN SODIUM 500 MG INJ SOLR,,J0290,HCPCS,Facility,Inpatient,1,Each,,21,17.85,6.0186,21,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
AMPICILLIN SODIUM 500 MG INJ SOLR,,J0290,HCPCS,Facility,Both,1,Each,,21,17.85,6.0186,21,UnitedHealthcare,Individual & Family,19.74,94,,percent of total billed charges,,
AMPICILLIN SODIUM 500 MG INJ SOLR,,J0290,HCPCS,Facility,Outpatient,1,Each,,21,17.85,6.0186,21,UnitedHealthcare,Medicare Advantage,10.29,49,,percent of total billed charges,,
AMPICILLIN SODIUM 500 MG INJ SOLR,,J0290,HCPCS,Facility,Inpatient,1,Each,,21,17.85,6.0186,21,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
AMPICILLIN SODIUM 500 MG INJ SOLR,,J0290,HCPCS,Facility,Outpatient,1,Each,,21,17.85,6.0186,21,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,10.08,48,,percent of total billed charges,,100% of DHS outpatient percentage
AMPICILLIN SODIUM 500 MG INJ SOLR,,J0290,HCPCS,Facility,Inpatient,1,Each,,21,17.85,6.0186,21,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
AMPICILLIN-SULBACTAM 1.5 GRAM INJ SOLR,,J0295,HCPCS,Facility,Both,1,Each,,26,22.1,7.4516,26,Aetna,Commercial,23.92,92,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 1.5 GRAM INJ SOLR,,J0295,HCPCS,Facility,Outpatient,1,Each,,26,22.1,7.4516,26,Aetna,Medicare Advantage,12.74,49,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 1.5 GRAM INJ SOLR,,J0295,HCPCS,Facility,Inpatient,1,Each,,26,22.1,7.4516,26,Aetna,Medicare Advantage,,,,,Included in per diem rate,
AMPICILLIN-SULBACTAM 1.5 GRAM INJ SOLR,,J0295,HCPCS,Facility,Both,1,Each,,26,22.1,7.4516,26,Aetna,PPO,24.18,93,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 1.5 GRAM INJ SOLR,,J0295,HCPCS,Facility,Both,1,Each,,26,22.1,7.4516,26,America's PPO,America's PPO,24.9678,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
AMPICILLIN-SULBACTAM 1.5 GRAM INJ SOLR,,J0295,HCPCS,Facility,Both,1,Each,,26,22.1,7.4516,26,BlueCross BlueShield Minnesota, Federal Employee Program,25.584,98.4,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 1.5 GRAM INJ SOLR,,J0295,HCPCS,Facility,Both,1,Each,,26,22.1,7.4516,26,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,26,100,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 1.5 GRAM INJ SOLR,,J0295,HCPCS,Facility,Both,1,Each,,26,22.1,7.4516,26,BlueCross BlueShield Minnesota,High Value Network Plan,23.4,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
AMPICILLIN-SULBACTAM 1.5 GRAM INJ SOLR,,J0295,HCPCS,Facility,Outpatient,1,Each,,26,22.1,7.4516,26,BlueCross BlueShield Minnesota,Medicare Advantage,12.74,49,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 1.5 GRAM INJ SOLR,,J0295,HCPCS,Facility,Inpatient,1,Each,,26,22.1,7.4516,26,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
AMPICILLIN-SULBACTAM 1.5 GRAM INJ SOLR,,J0295,HCPCS,Facility,Both,1,Each,,26,22.1,7.4516,26,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,23.0282,88.57,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 1.5 GRAM INJ SOLR,,J0295,HCPCS,Facility,Both,1,Each,,26,22.1,7.4516,26,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,7.4516,28.66,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 1.5 GRAM INJ SOLR,,J0295,HCPCS,Facility,Outpatient,1,Each,,26,22.1,7.4516,26,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),12.74,49,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 1.5 GRAM INJ SOLR,,J0295,HCPCS,Facility,Inpatient,1,Each,,26,22.1,7.4516,26,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
AMPICILLIN-SULBACTAM 1.5 GRAM INJ SOLR,,J0295,HCPCS,Facility,Both,1,Each,,26,22.1,7.4516,26,CorVel,Worker's Compensation,26,100,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 1.5 GRAM INJ SOLR,,J0295,HCPCS,Facility,Both,1,Each,,26,22.1,7.4516,26,First Health Group Corporation,First Health Network,25.22,97,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 1.5 GRAM INJ SOLR,,J0295,HCPCS,Facility,Both,1,Each,,26,22.1,7.4516,26,"Health Partners, Inc.",Commercial,24.596,94.6,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 1.5 GRAM INJ SOLR,,J0295,HCPCS,Facility,Outpatient,1,Each,,26,22.1,7.4516,26,"Health Partners, Inc.",Medicare Advantage,12.74,49,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 1.5 GRAM INJ SOLR,,J0295,HCPCS,Facility,Inpatient,1,Each,,26,22.1,7.4516,26,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
AMPICILLIN-SULBACTAM 1.5 GRAM INJ SOLR,,J0295,HCPCS,Facility,Both,1,Each,,26,22.1,7.4516,26,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),15.6,60,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 1.5 GRAM INJ SOLR,,J0295,HCPCS,Facility,Both,1,Each,,26,22.1,7.4516,26,"Health Partners, Inc.",State of Minnesota Advantage Program,21.19,81.5,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 1.5 GRAM INJ SOLR,,J0295,HCPCS,Facility,Both,1,Each,,26,22.1,7.4516,26,"Health Partners, Inc.",State Public Programs,13,50,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 1.5 GRAM INJ SOLR,,J0295,HCPCS,Facility,Both,1,Each,,26,22.1,7.4516,26,Humana Insurance Company,Commercial PPO,24.7,95,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 1.5 GRAM INJ SOLR,,J0295,HCPCS,Facility,Outpatient,1,Each,,26,22.1,7.4516,26,Humana Insurance Company,Medicare PPO,12.74,49,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 1.5 GRAM INJ SOLR,,J0295,HCPCS,Facility,Inpatient,1,Each,,26,22.1,7.4516,26,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
AMPICILLIN-SULBACTAM 1.5 GRAM INJ SOLR,,J0295,HCPCS,Facility,Both,1,Each,,26,22.1,7.4516,26,Medica,Individual & Family,25.766,99.1,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 1.5 GRAM INJ SOLR,,J0295,HCPCS,Facility,Outpatient,1,Each,,26,22.1,7.4516,26,Medica,Medica Advantage Solution,12.948,49.8,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 1.5 GRAM INJ SOLR,,J0295,HCPCS,Facility,Inpatient,1,Each,,26,22.1,7.4516,26,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
AMPICILLIN-SULBACTAM 1.5 GRAM INJ SOLR,,J0295,HCPCS,Facility,Outpatient,1,Each,,26,22.1,7.4516,26,Medica,Medical Assistance,11.596,44.6,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 1.5 GRAM INJ SOLR,,J0295,HCPCS,Facility,Inpatient,1,Each,,26,22.1,7.4516,26,Medica,Medical Assistance,,,,,Included in per diem rate,
AMPICILLIN-SULBACTAM 1.5 GRAM INJ SOLR,,J0295,HCPCS,Facility,Outpatient,1,Each,,26,22.1,7.4516,26,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,12.948,49.8,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 1.5 GRAM INJ SOLR,,J0295,HCPCS,Facility,Inpatient,1,Each,,26,22.1,7.4516,26,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
AMPICILLIN-SULBACTAM 1.5 GRAM INJ SOLR,,J0295,HCPCS,Facility,Both,1,Each,,26,22.1,7.4516,26,"Multiplan, Inc.","Multiplan, Inc.",24.44,94,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 1.5 GRAM INJ SOLR,,J0295,HCPCS,Facility,Outpatient,1,Each,,26,22.1,7.4516,26,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,23.426,90.1,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 1.5 GRAM INJ SOLR,,J0295,HCPCS,Facility,Inpatient,1,Each,,26,22.1,7.4516,26,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
AMPICILLIN-SULBACTAM 1.5 GRAM INJ SOLR,,J0295,HCPCS,Facility,Both,1,Each,,26,22.1,7.4516,26,"Preferred One Administrative Services, INC.",PPO,25.636,98.6,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 1.5 GRAM INJ SOLR,,J0295,HCPCS,Facility,Outpatient,1,Each,,26,22.1,7.4516,26,PrimeWest Health,Minnesota Senior Health Options (MSHO),13.377,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
AMPICILLIN-SULBACTAM 1.5 GRAM INJ SOLR,,J0295,HCPCS,Facility,Inpatient,1,Each,,26,22.1,7.4516,26,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
AMPICILLIN-SULBACTAM 1.5 GRAM INJ SOLR,,J0295,HCPCS,Facility,Outpatient,1,Each,,26,22.1,7.4516,26,PrimeWest Health,MinnesotaCare,13.3536,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
AMPICILLIN-SULBACTAM 1.5 GRAM INJ SOLR,,J0295,HCPCS,Facility,Inpatient,1,Each,,26,22.1,7.4516,26,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
AMPICILLIN-SULBACTAM 1.5 GRAM INJ SOLR,,J0295,HCPCS,Facility,Both,1,Each,,26,22.1,7.4516,26,Sanford Health Plan,Sanford Health Plan,23.92,92,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 1.5 GRAM INJ SOLR,,J0295,HCPCS,Facility,Outpatient,1,Each,,26,22.1,7.4516,26,"UCare Health, Inc.",Individual & Family Plan,14.651,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
AMPICILLIN-SULBACTAM 1.5 GRAM INJ SOLR,,J0295,HCPCS,Facility,Inpatient,1,Each,,26,22.1,7.4516,26,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
AMPICILLIN-SULBACTAM 1.5 GRAM INJ SOLR,,J0295,HCPCS,Facility,Outpatient,1,Each,,26,22.1,7.4516,26,"UCare Health, Inc.",Medical Assistance,13.1222,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
AMPICILLIN-SULBACTAM 1.5 GRAM INJ SOLR,,J0295,HCPCS,Facility,Inpatient,1,Each,,26,22.1,7.4516,26,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
AMPICILLIN-SULBACTAM 1.5 GRAM INJ SOLR,,J0295,HCPCS,Facility,Outpatient,1,Each,,26,22.1,7.4516,26,"UCare Health, Inc.",Medicare Advantage,13.1222,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
AMPICILLIN-SULBACTAM 1.5 GRAM INJ SOLR,,J0295,HCPCS,Facility,Inpatient,1,Each,,26,22.1,7.4516,26,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
AMPICILLIN-SULBACTAM 1.5 GRAM INJ SOLR,,J0295,HCPCS,Facility,Outpatient,1,Each,,26,22.1,7.4516,26,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),13.1222,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
AMPICILLIN-SULBACTAM 1.5 GRAM INJ SOLR,,J0295,HCPCS,Facility,Inpatient,1,Each,,26,22.1,7.4516,26,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
AMPICILLIN-SULBACTAM 1.5 GRAM INJ SOLR,,J0295,HCPCS,Facility,Both,1,Each,,26,22.1,7.4516,26,UnitedHealthcare,Individual & Family,24.44,94,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 1.5 GRAM INJ SOLR,,J0295,HCPCS,Facility,Outpatient,1,Each,,26,22.1,7.4516,26,UnitedHealthcare,Medicare Advantage,12.74,49,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 1.5 GRAM INJ SOLR,,J0295,HCPCS,Facility,Inpatient,1,Each,,26,22.1,7.4516,26,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
AMPICILLIN-SULBACTAM 1.5 GRAM INJ SOLR,,J0295,HCPCS,Facility,Outpatient,1,Each,,26,22.1,7.4516,26,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,12.48,48,,percent of total billed charges,,100% of DHS outpatient percentage
AMPICILLIN-SULBACTAM 1.5 GRAM INJ SOLR,,J0295,HCPCS,Facility,Inpatient,1,Each,,26,22.1,7.4516,26,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
AMPICILLIN-SULBACTAM 1.5 GRAM IV SOLR,,J0295,HCPCS,Facility,Both,1,Each,,33,28.05,9.4578,33,Aetna,Commercial,30.36,92,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 1.5 GRAM IV SOLR,,J0295,HCPCS,Facility,Both,1,Each,,33,28.05,9.4578,33,Aetna,Commercial,30.36,92,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 1.5 GRAM IV SOLR,,J0295,HCPCS,Facility,Outpatient,1,Each,,33,28.05,9.4578,33,Aetna,Medicare Advantage,16.17,49,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 1.5 GRAM IV SOLR,,J0295,HCPCS,Facility,Outpatient,1,Each,,33,28.05,9.4578,33,Aetna,Medicare Advantage,16.17,49,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 1.5 GRAM IV SOLR,,J0295,HCPCS,Facility,Inpatient,1,Each,,33,28.05,9.4578,33,Aetna,Medicare Advantage,,,,,Included in per diem rate,
AMPICILLIN-SULBACTAM 1.5 GRAM IV SOLR,,J0295,HCPCS,Facility,Inpatient,1,Each,,33,28.05,9.4578,33,Aetna,Medicare Advantage,,,,,Included in per diem rate,
AMPICILLIN-SULBACTAM 1.5 GRAM IV SOLR,,J0295,HCPCS,Facility,Both,1,Each,,33,28.05,9.4578,33,Aetna,PPO,30.69,93,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 1.5 GRAM IV SOLR,,J0295,HCPCS,Facility,Both,1,Each,,33,28.05,9.4578,33,Aetna,PPO,30.69,93,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 1.5 GRAM IV SOLR,,J0295,HCPCS,Facility,Both,1,Each,,33,28.05,9.4578,33,America's PPO,America's PPO,31.6899,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
AMPICILLIN-SULBACTAM 1.5 GRAM IV SOLR,,J0295,HCPCS,Facility,Both,1,Each,,33,28.05,9.4578,33,America's PPO,America's PPO,31.6899,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
AMPICILLIN-SULBACTAM 1.5 GRAM IV SOLR,,J0295,HCPCS,Facility,Both,1,Each,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota, Federal Employee Program,32.472,98.4,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 1.5 GRAM IV SOLR,,J0295,HCPCS,Facility,Both,1,Each,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota, Federal Employee Program,32.472,98.4,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 1.5 GRAM IV SOLR,,J0295,HCPCS,Facility,Both,1,Each,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,33,100,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 1.5 GRAM IV SOLR,,J0295,HCPCS,Facility,Both,1,Each,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,33,100,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 1.5 GRAM IV SOLR,,J0295,HCPCS,Facility,Both,1,Each,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota,High Value Network Plan,29.7,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
AMPICILLIN-SULBACTAM 1.5 GRAM IV SOLR,,J0295,HCPCS,Facility,Both,1,Each,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota,High Value Network Plan,29.7,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
AMPICILLIN-SULBACTAM 1.5 GRAM IV SOLR,,J0295,HCPCS,Facility,Outpatient,1,Each,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota,Medicare Advantage,16.17,49,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 1.5 GRAM IV SOLR,,J0295,HCPCS,Facility,Outpatient,1,Each,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota,Medicare Advantage,16.17,49,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 1.5 GRAM IV SOLR,,J0295,HCPCS,Facility,Inpatient,1,Each,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
AMPICILLIN-SULBACTAM 1.5 GRAM IV SOLR,,J0295,HCPCS,Facility,Inpatient,1,Each,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
AMPICILLIN-SULBACTAM 1.5 GRAM IV SOLR,,J0295,HCPCS,Facility,Both,1,Each,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,29.2281,88.57,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 1.5 GRAM IV SOLR,,J0295,HCPCS,Facility,Both,1,Each,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,29.2281,88.57,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 1.5 GRAM IV SOLR,,J0295,HCPCS,Facility,Both,1,Each,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,9.4578,28.66,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 1.5 GRAM IV SOLR,,J0295,HCPCS,Facility,Both,1,Each,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,9.4578,28.66,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 1.5 GRAM IV SOLR,,J0295,HCPCS,Facility,Outpatient,1,Each,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),16.17,49,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 1.5 GRAM IV SOLR,,J0295,HCPCS,Facility,Outpatient,1,Each,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),16.17,49,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 1.5 GRAM IV SOLR,,J0295,HCPCS,Facility,Inpatient,1,Each,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
AMPICILLIN-SULBACTAM 1.5 GRAM IV SOLR,,J0295,HCPCS,Facility,Inpatient,1,Each,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
AMPICILLIN-SULBACTAM 1.5 GRAM IV SOLR,,J0295,HCPCS,Facility,Both,1,Each,,33,28.05,9.4578,33,CorVel,Worker's Compensation,33,100,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 1.5 GRAM IV SOLR,,J0295,HCPCS,Facility,Both,1,Each,,33,28.05,9.4578,33,CorVel,Worker's Compensation,33,100,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 1.5 GRAM IV SOLR,,J0295,HCPCS,Facility,Both,1,Each,,33,28.05,9.4578,33,First Health Group Corporation,First Health Network,32.01,97,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 1.5 GRAM IV SOLR,,J0295,HCPCS,Facility,Both,1,Each,,33,28.05,9.4578,33,First Health Group Corporation,First Health Network,32.01,97,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 1.5 GRAM IV SOLR,,J0295,HCPCS,Facility,Both,1,Each,,33,28.05,9.4578,33,"Health Partners, Inc.",Commercial,31.218,94.6,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 1.5 GRAM IV SOLR,,J0295,HCPCS,Facility,Both,1,Each,,33,28.05,9.4578,33,"Health Partners, Inc.",Commercial,31.218,94.6,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 1.5 GRAM IV SOLR,,J0295,HCPCS,Facility,Outpatient,1,Each,,33,28.05,9.4578,33,"Health Partners, Inc.",Medicare Advantage,16.17,49,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 1.5 GRAM IV SOLR,,J0295,HCPCS,Facility,Outpatient,1,Each,,33,28.05,9.4578,33,"Health Partners, Inc.",Medicare Advantage,16.17,49,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 1.5 GRAM IV SOLR,,J0295,HCPCS,Facility,Inpatient,1,Each,,33,28.05,9.4578,33,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
AMPICILLIN-SULBACTAM 1.5 GRAM IV SOLR,,J0295,HCPCS,Facility,Inpatient,1,Each,,33,28.05,9.4578,33,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
AMPICILLIN-SULBACTAM 1.5 GRAM IV SOLR,,J0295,HCPCS,Facility,Both,1,Each,,33,28.05,9.4578,33,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),19.8,60,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 1.5 GRAM IV SOLR,,J0295,HCPCS,Facility,Both,1,Each,,33,28.05,9.4578,33,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),19.8,60,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 1.5 GRAM IV SOLR,,J0295,HCPCS,Facility,Both,1,Each,,33,28.05,9.4578,33,"Health Partners, Inc.",State of Minnesota Advantage Program,26.895,81.5,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 1.5 GRAM IV SOLR,,J0295,HCPCS,Facility,Both,1,Each,,33,28.05,9.4578,33,"Health Partners, Inc.",State of Minnesota Advantage Program,26.895,81.5,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 1.5 GRAM IV SOLR,,J0295,HCPCS,Facility,Both,1,Each,,33,28.05,9.4578,33,"Health Partners, Inc.",State Public Programs,16.5,50,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 1.5 GRAM IV SOLR,,J0295,HCPCS,Facility,Both,1,Each,,33,28.05,9.4578,33,"Health Partners, Inc.",State Public Programs,16.5,50,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 1.5 GRAM IV SOLR,,J0295,HCPCS,Facility,Both,1,Each,,33,28.05,9.4578,33,Humana Insurance Company,Commercial PPO,31.35,95,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 1.5 GRAM IV SOLR,,J0295,HCPCS,Facility,Both,1,Each,,33,28.05,9.4578,33,Humana Insurance Company,Commercial PPO,31.35,95,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 1.5 GRAM IV SOLR,,J0295,HCPCS,Facility,Outpatient,1,Each,,33,28.05,9.4578,33,Humana Insurance Company,Medicare PPO,16.17,49,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 1.5 GRAM IV SOLR,,J0295,HCPCS,Facility,Outpatient,1,Each,,33,28.05,9.4578,33,Humana Insurance Company,Medicare PPO,16.17,49,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 1.5 GRAM IV SOLR,,J0295,HCPCS,Facility,Inpatient,1,Each,,33,28.05,9.4578,33,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
AMPICILLIN-SULBACTAM 1.5 GRAM IV SOLR,,J0295,HCPCS,Facility,Inpatient,1,Each,,33,28.05,9.4578,33,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
AMPICILLIN-SULBACTAM 1.5 GRAM IV SOLR,,J0295,HCPCS,Facility,Both,1,Each,,33,28.05,9.4578,33,Medica,Individual & Family,32.703,99.1,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 1.5 GRAM IV SOLR,,J0295,HCPCS,Facility,Both,1,Each,,33,28.05,9.4578,33,Medica,Individual & Family,32.703,99.1,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 1.5 GRAM IV SOLR,,J0295,HCPCS,Facility,Outpatient,1,Each,,33,28.05,9.4578,33,Medica,Medica Advantage Solution,16.434,49.8,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 1.5 GRAM IV SOLR,,J0295,HCPCS,Facility,Outpatient,1,Each,,33,28.05,9.4578,33,Medica,Medica Advantage Solution,16.434,49.8,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 1.5 GRAM IV SOLR,,J0295,HCPCS,Facility,Inpatient,1,Each,,33,28.05,9.4578,33,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
AMPICILLIN-SULBACTAM 1.5 GRAM IV SOLR,,J0295,HCPCS,Facility,Inpatient,1,Each,,33,28.05,9.4578,33,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
AMPICILLIN-SULBACTAM 1.5 GRAM IV SOLR,,J0295,HCPCS,Facility,Outpatient,1,Each,,33,28.05,9.4578,33,Medica,Medical Assistance,14.718,44.6,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 1.5 GRAM IV SOLR,,J0295,HCPCS,Facility,Outpatient,1,Each,,33,28.05,9.4578,33,Medica,Medical Assistance,14.718,44.6,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 1.5 GRAM IV SOLR,,J0295,HCPCS,Facility,Inpatient,1,Each,,33,28.05,9.4578,33,Medica,Medical Assistance,,,,,Included in per diem rate,
AMPICILLIN-SULBACTAM 1.5 GRAM IV SOLR,,J0295,HCPCS,Facility,Inpatient,1,Each,,33,28.05,9.4578,33,Medica,Medical Assistance,,,,,Included in per diem rate,
AMPICILLIN-SULBACTAM 1.5 GRAM IV SOLR,,J0295,HCPCS,Facility,Outpatient,1,Each,,33,28.05,9.4578,33,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,16.434,49.8,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 1.5 GRAM IV SOLR,,J0295,HCPCS,Facility,Outpatient,1,Each,,33,28.05,9.4578,33,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,16.434,49.8,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 1.5 GRAM IV SOLR,,J0295,HCPCS,Facility,Inpatient,1,Each,,33,28.05,9.4578,33,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
AMPICILLIN-SULBACTAM 1.5 GRAM IV SOLR,,J0295,HCPCS,Facility,Inpatient,1,Each,,33,28.05,9.4578,33,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
AMPICILLIN-SULBACTAM 1.5 GRAM IV SOLR,,J0295,HCPCS,Facility,Both,1,Each,,33,28.05,9.4578,33,"Multiplan, Inc.","Multiplan, Inc.",31.02,94,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 1.5 GRAM IV SOLR,,J0295,HCPCS,Facility,Both,1,Each,,33,28.05,9.4578,33,"Multiplan, Inc.","Multiplan, Inc.",31.02,94,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 1.5 GRAM IV SOLR,,J0295,HCPCS,Facility,Outpatient,1,Each,,33,28.05,9.4578,33,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,29.733,90.1,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 1.5 GRAM IV SOLR,,J0295,HCPCS,Facility,Outpatient,1,Each,,33,28.05,9.4578,33,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,29.733,90.1,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 1.5 GRAM IV SOLR,,J0295,HCPCS,Facility,Inpatient,1,Each,,33,28.05,9.4578,33,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
AMPICILLIN-SULBACTAM 1.5 GRAM IV SOLR,,J0295,HCPCS,Facility,Inpatient,1,Each,,33,28.05,9.4578,33,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
AMPICILLIN-SULBACTAM 1.5 GRAM IV SOLR,,J0295,HCPCS,Facility,Both,1,Each,,33,28.05,9.4578,33,"Preferred One Administrative Services, INC.",PPO,32.538,98.6,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 1.5 GRAM IV SOLR,,J0295,HCPCS,Facility,Both,1,Each,,33,28.05,9.4578,33,"Preferred One Administrative Services, INC.",PPO,32.538,98.6,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 1.5 GRAM IV SOLR,,J0295,HCPCS,Facility,Outpatient,1,Each,,33,28.05,9.4578,33,PrimeWest Health,Minnesota Senior Health Options (MSHO),16.9785,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
AMPICILLIN-SULBACTAM 1.5 GRAM IV SOLR,,J0295,HCPCS,Facility,Outpatient,1,Each,,33,28.05,9.4578,33,PrimeWest Health,Minnesota Senior Health Options (MSHO),16.9785,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
AMPICILLIN-SULBACTAM 1.5 GRAM IV SOLR,,J0295,HCPCS,Facility,Inpatient,1,Each,,33,28.05,9.4578,33,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
AMPICILLIN-SULBACTAM 1.5 GRAM IV SOLR,,J0295,HCPCS,Facility,Inpatient,1,Each,,33,28.05,9.4578,33,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
AMPICILLIN-SULBACTAM 1.5 GRAM IV SOLR,,J0295,HCPCS,Facility,Outpatient,1,Each,,33,28.05,9.4578,33,PrimeWest Health,MinnesotaCare,16.9488,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
AMPICILLIN-SULBACTAM 1.5 GRAM IV SOLR,,J0295,HCPCS,Facility,Outpatient,1,Each,,33,28.05,9.4578,33,PrimeWest Health,MinnesotaCare,16.9488,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
AMPICILLIN-SULBACTAM 1.5 GRAM IV SOLR,,J0295,HCPCS,Facility,Inpatient,1,Each,,33,28.05,9.4578,33,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
AMPICILLIN-SULBACTAM 1.5 GRAM IV SOLR,,J0295,HCPCS,Facility,Inpatient,1,Each,,33,28.05,9.4578,33,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
AMPICILLIN-SULBACTAM 1.5 GRAM IV SOLR,,J0295,HCPCS,Facility,Both,1,Each,,33,28.05,9.4578,33,Sanford Health Plan,Sanford Health Plan,30.36,92,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 1.5 GRAM IV SOLR,,J0295,HCPCS,Facility,Both,1,Each,,33,28.05,9.4578,33,Sanford Health Plan,Sanford Health Plan,30.36,92,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 1.5 GRAM IV SOLR,,J0295,HCPCS,Facility,Outpatient,1,Each,,33,28.05,9.4578,33,"UCare Health, Inc.",Individual & Family Plan,18.5955,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
AMPICILLIN-SULBACTAM 1.5 GRAM IV SOLR,,J0295,HCPCS,Facility,Outpatient,1,Each,,33,28.05,9.4578,33,"UCare Health, Inc.",Individual & Family Plan,18.5955,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
AMPICILLIN-SULBACTAM 1.5 GRAM IV SOLR,,J0295,HCPCS,Facility,Inpatient,1,Each,,33,28.05,9.4578,33,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
AMPICILLIN-SULBACTAM 1.5 GRAM IV SOLR,,J0295,HCPCS,Facility,Inpatient,1,Each,,33,28.05,9.4578,33,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
AMPICILLIN-SULBACTAM 1.5 GRAM IV SOLR,,J0295,HCPCS,Facility,Outpatient,1,Each,,33,28.05,9.4578,33,"UCare Health, Inc.",Medical Assistance,16.6551,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
AMPICILLIN-SULBACTAM 1.5 GRAM IV SOLR,,J0295,HCPCS,Facility,Outpatient,1,Each,,33,28.05,9.4578,33,"UCare Health, Inc.",Medical Assistance,16.6551,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
AMPICILLIN-SULBACTAM 1.5 GRAM IV SOLR,,J0295,HCPCS,Facility,Inpatient,1,Each,,33,28.05,9.4578,33,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
AMPICILLIN-SULBACTAM 1.5 GRAM IV SOLR,,J0295,HCPCS,Facility,Inpatient,1,Each,,33,28.05,9.4578,33,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
AMPICILLIN-SULBACTAM 1.5 GRAM IV SOLR,,J0295,HCPCS,Facility,Outpatient,1,Each,,33,28.05,9.4578,33,"UCare Health, Inc.",Medicare Advantage,16.6551,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
AMPICILLIN-SULBACTAM 1.5 GRAM IV SOLR,,J0295,HCPCS,Facility,Outpatient,1,Each,,33,28.05,9.4578,33,"UCare Health, Inc.",Medicare Advantage,16.6551,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
AMPICILLIN-SULBACTAM 1.5 GRAM IV SOLR,,J0295,HCPCS,Facility,Inpatient,1,Each,,33,28.05,9.4578,33,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
AMPICILLIN-SULBACTAM 1.5 GRAM IV SOLR,,J0295,HCPCS,Facility,Inpatient,1,Each,,33,28.05,9.4578,33,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
AMPICILLIN-SULBACTAM 1.5 GRAM IV SOLR,,J0295,HCPCS,Facility,Outpatient,1,Each,,33,28.05,9.4578,33,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),16.6551,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
AMPICILLIN-SULBACTAM 1.5 GRAM IV SOLR,,J0295,HCPCS,Facility,Outpatient,1,Each,,33,28.05,9.4578,33,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),16.6551,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
AMPICILLIN-SULBACTAM 1.5 GRAM IV SOLR,,J0295,HCPCS,Facility,Inpatient,1,Each,,33,28.05,9.4578,33,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
AMPICILLIN-SULBACTAM 1.5 GRAM IV SOLR,,J0295,HCPCS,Facility,Inpatient,1,Each,,33,28.05,9.4578,33,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
AMPICILLIN-SULBACTAM 1.5 GRAM IV SOLR,,J0295,HCPCS,Facility,Both,1,Each,,33,28.05,9.4578,33,UnitedHealthcare,Individual & Family,31.02,94,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 1.5 GRAM IV SOLR,,J0295,HCPCS,Facility,Both,1,Each,,33,28.05,9.4578,33,UnitedHealthcare,Individual & Family,31.02,94,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 1.5 GRAM IV SOLR,,J0295,HCPCS,Facility,Outpatient,1,Each,,33,28.05,9.4578,33,UnitedHealthcare,Medicare Advantage,16.17,49,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 1.5 GRAM IV SOLR,,J0295,HCPCS,Facility,Outpatient,1,Each,,33,28.05,9.4578,33,UnitedHealthcare,Medicare Advantage,16.17,49,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 1.5 GRAM IV SOLR,,J0295,HCPCS,Facility,Inpatient,1,Each,,33,28.05,9.4578,33,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
AMPICILLIN-SULBACTAM 1.5 GRAM IV SOLR,,J0295,HCPCS,Facility,Inpatient,1,Each,,33,28.05,9.4578,33,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
AMPICILLIN-SULBACTAM 1.5 GRAM IV SOLR,,J0295,HCPCS,Facility,Outpatient,1,Each,,33,28.05,9.4578,33,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,15.84,48,,percent of total billed charges,,100% of DHS outpatient percentage
AMPICILLIN-SULBACTAM 1.5 GRAM IV SOLR,,J0295,HCPCS,Facility,Outpatient,1,Each,,33,28.05,9.4578,33,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,15.84,48,,percent of total billed charges,,100% of DHS outpatient percentage
AMPICILLIN-SULBACTAM 1.5 GRAM IV SOLR,,J0295,HCPCS,Facility,Inpatient,1,Each,,33,28.05,9.4578,33,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
AMPICILLIN-SULBACTAM 1.5 GRAM IV SOLR,,J0295,HCPCS,Facility,Inpatient,1,Each,,33,28.05,9.4578,33,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
AMPICILLIN-SULBACTAM 3 GRAM INJ SOLR,,J0295,HCPCS,Facility,Both,1,Each,,71,60.35,20.3486,71,Aetna,Commercial,65.32,92,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 3 GRAM INJ SOLR,,J0295,HCPCS,Facility,Both,1,Each,,52,44.2,14.9032,52,Aetna,Commercial,47.84,92,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 3 GRAM INJ SOLR,,J0295,HCPCS,Facility,Outpatient,1,Each,,71,60.35,20.3486,71,Aetna,Medicare Advantage,34.79,49,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 3 GRAM INJ SOLR,,J0295,HCPCS,Facility,Outpatient,1,Each,,52,44.2,14.9032,52,Aetna,Medicare Advantage,25.48,49,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 3 GRAM INJ SOLR,,J0295,HCPCS,Facility,Inpatient,1,Each,,71,60.35,20.3486,71,Aetna,Medicare Advantage,,,,,Included in per diem rate,
AMPICILLIN-SULBACTAM 3 GRAM INJ SOLR,,J0295,HCPCS,Facility,Inpatient,1,Each,,52,44.2,14.9032,52,Aetna,Medicare Advantage,,,,,Included in per diem rate,
AMPICILLIN-SULBACTAM 3 GRAM INJ SOLR,,J0295,HCPCS,Facility,Both,1,Each,,71,60.35,20.3486,71,Aetna,PPO,66.03,93,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 3 GRAM INJ SOLR,,J0295,HCPCS,Facility,Both,1,Each,,52,44.2,14.9032,52,Aetna,PPO,48.36,93,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 3 GRAM INJ SOLR,,J0295,HCPCS,Facility,Both,1,Each,,71,60.35,20.3486,71,America's PPO,America's PPO,68.1813,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
AMPICILLIN-SULBACTAM 3 GRAM INJ SOLR,,J0295,HCPCS,Facility,Both,1,Each,,52,44.2,14.9032,52,America's PPO,America's PPO,49.9356,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
AMPICILLIN-SULBACTAM 3 GRAM INJ SOLR,,J0295,HCPCS,Facility,Both,1,Each,,71,60.35,20.3486,71,BlueCross BlueShield Minnesota, Federal Employee Program,69.864,98.4,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 3 GRAM INJ SOLR,,J0295,HCPCS,Facility,Both,1,Each,,52,44.2,14.9032,52,BlueCross BlueShield Minnesota, Federal Employee Program,51.168,98.4,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 3 GRAM INJ SOLR,,J0295,HCPCS,Facility,Both,1,Each,,71,60.35,20.3486,71,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,71,100,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 3 GRAM INJ SOLR,,J0295,HCPCS,Facility,Both,1,Each,,52,44.2,14.9032,52,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,52,100,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 3 GRAM INJ SOLR,,J0295,HCPCS,Facility,Both,1,Each,,71,60.35,20.3486,71,BlueCross BlueShield Minnesota,High Value Network Plan,63.9,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
AMPICILLIN-SULBACTAM 3 GRAM INJ SOLR,,J0295,HCPCS,Facility,Both,1,Each,,52,44.2,14.9032,52,BlueCross BlueShield Minnesota,High Value Network Plan,46.8,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
AMPICILLIN-SULBACTAM 3 GRAM INJ SOLR,,J0295,HCPCS,Facility,Outpatient,1,Each,,71,60.35,20.3486,71,BlueCross BlueShield Minnesota,Medicare Advantage,34.79,49,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 3 GRAM INJ SOLR,,J0295,HCPCS,Facility,Outpatient,1,Each,,52,44.2,14.9032,52,BlueCross BlueShield Minnesota,Medicare Advantage,25.48,49,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 3 GRAM INJ SOLR,,J0295,HCPCS,Facility,Inpatient,1,Each,,71,60.35,20.3486,71,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
AMPICILLIN-SULBACTAM 3 GRAM INJ SOLR,,J0295,HCPCS,Facility,Inpatient,1,Each,,52,44.2,14.9032,52,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
AMPICILLIN-SULBACTAM 3 GRAM INJ SOLR,,J0295,HCPCS,Facility,Both,1,Each,,71,60.35,20.3486,71,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,62.8847,88.57,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 3 GRAM INJ SOLR,,J0295,HCPCS,Facility,Both,1,Each,,52,44.2,14.9032,52,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,46.0564,88.57,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 3 GRAM INJ SOLR,,J0295,HCPCS,Facility,Both,1,Each,,71,60.35,20.3486,71,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,20.3486,28.66,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 3 GRAM INJ SOLR,,J0295,HCPCS,Facility,Both,1,Each,,52,44.2,14.9032,52,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,14.9032,28.66,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 3 GRAM INJ SOLR,,J0295,HCPCS,Facility,Outpatient,1,Each,,71,60.35,20.3486,71,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),34.79,49,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 3 GRAM INJ SOLR,,J0295,HCPCS,Facility,Outpatient,1,Each,,52,44.2,14.9032,52,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),25.48,49,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 3 GRAM INJ SOLR,,J0295,HCPCS,Facility,Inpatient,1,Each,,71,60.35,20.3486,71,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
AMPICILLIN-SULBACTAM 3 GRAM INJ SOLR,,J0295,HCPCS,Facility,Inpatient,1,Each,,52,44.2,14.9032,52,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
AMPICILLIN-SULBACTAM 3 GRAM INJ SOLR,,J0295,HCPCS,Facility,Both,1,Each,,71,60.35,20.3486,71,CorVel,Worker's Compensation,71,100,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 3 GRAM INJ SOLR,,J0295,HCPCS,Facility,Both,1,Each,,52,44.2,14.9032,52,CorVel,Worker's Compensation,52,100,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 3 GRAM INJ SOLR,,J0295,HCPCS,Facility,Both,1,Each,,71,60.35,20.3486,71,First Health Group Corporation,First Health Network,68.87,97,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 3 GRAM INJ SOLR,,J0295,HCPCS,Facility,Both,1,Each,,52,44.2,14.9032,52,First Health Group Corporation,First Health Network,50.44,97,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 3 GRAM INJ SOLR,,J0295,HCPCS,Facility,Both,1,Each,,71,60.35,20.3486,71,"Health Partners, Inc.",Commercial,67.166,94.6,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 3 GRAM INJ SOLR,,J0295,HCPCS,Facility,Both,1,Each,,52,44.2,14.9032,52,"Health Partners, Inc.",Commercial,49.192,94.6,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 3 GRAM INJ SOLR,,J0295,HCPCS,Facility,Outpatient,1,Each,,71,60.35,20.3486,71,"Health Partners, Inc.",Medicare Advantage,34.79,49,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 3 GRAM INJ SOLR,,J0295,HCPCS,Facility,Outpatient,1,Each,,52,44.2,14.9032,52,"Health Partners, Inc.",Medicare Advantage,25.48,49,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 3 GRAM INJ SOLR,,J0295,HCPCS,Facility,Inpatient,1,Each,,71,60.35,20.3486,71,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
AMPICILLIN-SULBACTAM 3 GRAM INJ SOLR,,J0295,HCPCS,Facility,Inpatient,1,Each,,52,44.2,14.9032,52,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
AMPICILLIN-SULBACTAM 3 GRAM INJ SOLR,,J0295,HCPCS,Facility,Both,1,Each,,71,60.35,20.3486,71,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),42.6,60,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 3 GRAM INJ SOLR,,J0295,HCPCS,Facility,Both,1,Each,,52,44.2,14.9032,52,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),31.2,60,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 3 GRAM INJ SOLR,,J0295,HCPCS,Facility,Both,1,Each,,71,60.35,20.3486,71,"Health Partners, Inc.",State of Minnesota Advantage Program,57.865,81.5,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 3 GRAM INJ SOLR,,J0295,HCPCS,Facility,Both,1,Each,,52,44.2,14.9032,52,"Health Partners, Inc.",State of Minnesota Advantage Program,42.38,81.5,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 3 GRAM INJ SOLR,,J0295,HCPCS,Facility,Both,1,Each,,71,60.35,20.3486,71,"Health Partners, Inc.",State Public Programs,35.5,50,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 3 GRAM INJ SOLR,,J0295,HCPCS,Facility,Both,1,Each,,52,44.2,14.9032,52,"Health Partners, Inc.",State Public Programs,26,50,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 3 GRAM INJ SOLR,,J0295,HCPCS,Facility,Both,1,Each,,71,60.35,20.3486,71,Humana Insurance Company,Commercial PPO,67.45,95,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 3 GRAM INJ SOLR,,J0295,HCPCS,Facility,Both,1,Each,,52,44.2,14.9032,52,Humana Insurance Company,Commercial PPO,49.4,95,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 3 GRAM INJ SOLR,,J0295,HCPCS,Facility,Outpatient,1,Each,,71,60.35,20.3486,71,Humana Insurance Company,Medicare PPO,34.79,49,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 3 GRAM INJ SOLR,,J0295,HCPCS,Facility,Outpatient,1,Each,,52,44.2,14.9032,52,Humana Insurance Company,Medicare PPO,25.48,49,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 3 GRAM INJ SOLR,,J0295,HCPCS,Facility,Inpatient,1,Each,,71,60.35,20.3486,71,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
AMPICILLIN-SULBACTAM 3 GRAM INJ SOLR,,J0295,HCPCS,Facility,Inpatient,1,Each,,52,44.2,14.9032,52,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
AMPICILLIN-SULBACTAM 3 GRAM INJ SOLR,,J0295,HCPCS,Facility,Both,1,Each,,71,60.35,20.3486,71,Medica,Individual & Family,70.361,99.1,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 3 GRAM INJ SOLR,,J0295,HCPCS,Facility,Both,1,Each,,52,44.2,14.9032,52,Medica,Individual & Family,51.532,99.1,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 3 GRAM INJ SOLR,,J0295,HCPCS,Facility,Outpatient,1,Each,,71,60.35,20.3486,71,Medica,Medica Advantage Solution,35.358,49.8,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 3 GRAM INJ SOLR,,J0295,HCPCS,Facility,Outpatient,1,Each,,52,44.2,14.9032,52,Medica,Medica Advantage Solution,25.896,49.8,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 3 GRAM INJ SOLR,,J0295,HCPCS,Facility,Inpatient,1,Each,,71,60.35,20.3486,71,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
AMPICILLIN-SULBACTAM 3 GRAM INJ SOLR,,J0295,HCPCS,Facility,Inpatient,1,Each,,52,44.2,14.9032,52,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
AMPICILLIN-SULBACTAM 3 GRAM INJ SOLR,,J0295,HCPCS,Facility,Outpatient,1,Each,,71,60.35,20.3486,71,Medica,Medical Assistance,31.666,44.6,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 3 GRAM INJ SOLR,,J0295,HCPCS,Facility,Outpatient,1,Each,,52,44.2,14.9032,52,Medica,Medical Assistance,23.192,44.6,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 3 GRAM INJ SOLR,,J0295,HCPCS,Facility,Inpatient,1,Each,,71,60.35,20.3486,71,Medica,Medical Assistance,,,,,Included in per diem rate,
AMPICILLIN-SULBACTAM 3 GRAM INJ SOLR,,J0295,HCPCS,Facility,Inpatient,1,Each,,52,44.2,14.9032,52,Medica,Medical Assistance,,,,,Included in per diem rate,
AMPICILLIN-SULBACTAM 3 GRAM INJ SOLR,,J0295,HCPCS,Facility,Outpatient,1,Each,,71,60.35,20.3486,71,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,35.358,49.8,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 3 GRAM INJ SOLR,,J0295,HCPCS,Facility,Outpatient,1,Each,,52,44.2,14.9032,52,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,25.896,49.8,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 3 GRAM INJ SOLR,,J0295,HCPCS,Facility,Inpatient,1,Each,,71,60.35,20.3486,71,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
AMPICILLIN-SULBACTAM 3 GRAM INJ SOLR,,J0295,HCPCS,Facility,Inpatient,1,Each,,52,44.2,14.9032,52,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
AMPICILLIN-SULBACTAM 3 GRAM INJ SOLR,,J0295,HCPCS,Facility,Both,1,Each,,71,60.35,20.3486,71,"Multiplan, Inc.","Multiplan, Inc.",66.74,94,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 3 GRAM INJ SOLR,,J0295,HCPCS,Facility,Both,1,Each,,52,44.2,14.9032,52,"Multiplan, Inc.","Multiplan, Inc.",48.88,94,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 3 GRAM INJ SOLR,,J0295,HCPCS,Facility,Outpatient,1,Each,,71,60.35,20.3486,71,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,63.971,90.1,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 3 GRAM INJ SOLR,,J0295,HCPCS,Facility,Outpatient,1,Each,,52,44.2,14.9032,52,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,46.852,90.1,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 3 GRAM INJ SOLR,,J0295,HCPCS,Facility,Inpatient,1,Each,,71,60.35,20.3486,71,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
AMPICILLIN-SULBACTAM 3 GRAM INJ SOLR,,J0295,HCPCS,Facility,Inpatient,1,Each,,52,44.2,14.9032,52,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
AMPICILLIN-SULBACTAM 3 GRAM INJ SOLR,,J0295,HCPCS,Facility,Both,1,Each,,71,60.35,20.3486,71,"Preferred One Administrative Services, INC.",PPO,70.006,98.6,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 3 GRAM INJ SOLR,,J0295,HCPCS,Facility,Both,1,Each,,52,44.2,14.9032,52,"Preferred One Administrative Services, INC.",PPO,51.272,98.6,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 3 GRAM INJ SOLR,,J0295,HCPCS,Facility,Outpatient,1,Each,,71,60.35,20.3486,71,PrimeWest Health,Minnesota Senior Health Options (MSHO),36.5295,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
AMPICILLIN-SULBACTAM 3 GRAM INJ SOLR,,J0295,HCPCS,Facility,Outpatient,1,Each,,52,44.2,14.9032,52,PrimeWest Health,Minnesota Senior Health Options (MSHO),26.754,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
AMPICILLIN-SULBACTAM 3 GRAM INJ SOLR,,J0295,HCPCS,Facility,Inpatient,1,Each,,71,60.35,20.3486,71,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
AMPICILLIN-SULBACTAM 3 GRAM INJ SOLR,,J0295,HCPCS,Facility,Inpatient,1,Each,,52,44.2,14.9032,52,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
AMPICILLIN-SULBACTAM 3 GRAM INJ SOLR,,J0295,HCPCS,Facility,Outpatient,1,Each,,71,60.35,20.3486,71,PrimeWest Health,MinnesotaCare,36.4656,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
AMPICILLIN-SULBACTAM 3 GRAM INJ SOLR,,J0295,HCPCS,Facility,Outpatient,1,Each,,52,44.2,14.9032,52,PrimeWest Health,MinnesotaCare,26.7072,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
AMPICILLIN-SULBACTAM 3 GRAM INJ SOLR,,J0295,HCPCS,Facility,Inpatient,1,Each,,71,60.35,20.3486,71,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
AMPICILLIN-SULBACTAM 3 GRAM INJ SOLR,,J0295,HCPCS,Facility,Inpatient,1,Each,,52,44.2,14.9032,52,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
AMPICILLIN-SULBACTAM 3 GRAM INJ SOLR,,J0295,HCPCS,Facility,Both,1,Each,,71,60.35,20.3486,71,Sanford Health Plan,Sanford Health Plan,65.32,92,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 3 GRAM INJ SOLR,,J0295,HCPCS,Facility,Both,1,Each,,52,44.2,14.9032,52,Sanford Health Plan,Sanford Health Plan,47.84,92,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 3 GRAM INJ SOLR,,J0295,HCPCS,Facility,Outpatient,1,Each,,71,60.35,20.3486,71,"UCare Health, Inc.",Individual & Family Plan,40.0085,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
AMPICILLIN-SULBACTAM 3 GRAM INJ SOLR,,J0295,HCPCS,Facility,Outpatient,1,Each,,52,44.2,14.9032,52,"UCare Health, Inc.",Individual & Family Plan,29.302,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
AMPICILLIN-SULBACTAM 3 GRAM INJ SOLR,,J0295,HCPCS,Facility,Inpatient,1,Each,,71,60.35,20.3486,71,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
AMPICILLIN-SULBACTAM 3 GRAM INJ SOLR,,J0295,HCPCS,Facility,Inpatient,1,Each,,52,44.2,14.9032,52,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
AMPICILLIN-SULBACTAM 3 GRAM INJ SOLR,,J0295,HCPCS,Facility,Outpatient,1,Each,,71,60.35,20.3486,71,"UCare Health, Inc.",Medical Assistance,35.8337,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
AMPICILLIN-SULBACTAM 3 GRAM INJ SOLR,,J0295,HCPCS,Facility,Outpatient,1,Each,,52,44.2,14.9032,52,"UCare Health, Inc.",Medical Assistance,26.2444,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
AMPICILLIN-SULBACTAM 3 GRAM INJ SOLR,,J0295,HCPCS,Facility,Inpatient,1,Each,,71,60.35,20.3486,71,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
AMPICILLIN-SULBACTAM 3 GRAM INJ SOLR,,J0295,HCPCS,Facility,Inpatient,1,Each,,52,44.2,14.9032,52,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
AMPICILLIN-SULBACTAM 3 GRAM INJ SOLR,,J0295,HCPCS,Facility,Outpatient,1,Each,,71,60.35,20.3486,71,"UCare Health, Inc.",Medicare Advantage,35.8337,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
AMPICILLIN-SULBACTAM 3 GRAM INJ SOLR,,J0295,HCPCS,Facility,Outpatient,1,Each,,52,44.2,14.9032,52,"UCare Health, Inc.",Medicare Advantage,26.2444,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
AMPICILLIN-SULBACTAM 3 GRAM INJ SOLR,,J0295,HCPCS,Facility,Inpatient,1,Each,,71,60.35,20.3486,71,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
AMPICILLIN-SULBACTAM 3 GRAM INJ SOLR,,J0295,HCPCS,Facility,Inpatient,1,Each,,52,44.2,14.9032,52,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
AMPICILLIN-SULBACTAM 3 GRAM INJ SOLR,,J0295,HCPCS,Facility,Outpatient,1,Each,,71,60.35,20.3486,71,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),35.8337,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
AMPICILLIN-SULBACTAM 3 GRAM INJ SOLR,,J0295,HCPCS,Facility,Outpatient,1,Each,,52,44.2,14.9032,52,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),26.2444,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
AMPICILLIN-SULBACTAM 3 GRAM INJ SOLR,,J0295,HCPCS,Facility,Inpatient,1,Each,,71,60.35,20.3486,71,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
AMPICILLIN-SULBACTAM 3 GRAM INJ SOLR,,J0295,HCPCS,Facility,Inpatient,1,Each,,52,44.2,14.9032,52,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
AMPICILLIN-SULBACTAM 3 GRAM INJ SOLR,,J0295,HCPCS,Facility,Both,1,Each,,71,60.35,20.3486,71,UnitedHealthcare,Individual & Family,66.74,94,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 3 GRAM INJ SOLR,,J0295,HCPCS,Facility,Both,1,Each,,52,44.2,14.9032,52,UnitedHealthcare,Individual & Family,48.88,94,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 3 GRAM INJ SOLR,,J0295,HCPCS,Facility,Outpatient,1,Each,,71,60.35,20.3486,71,UnitedHealthcare,Medicare Advantage,34.79,49,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 3 GRAM INJ SOLR,,J0295,HCPCS,Facility,Outpatient,1,Each,,52,44.2,14.9032,52,UnitedHealthcare,Medicare Advantage,25.48,49,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 3 GRAM INJ SOLR,,J0295,HCPCS,Facility,Inpatient,1,Each,,71,60.35,20.3486,71,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
AMPICILLIN-SULBACTAM 3 GRAM INJ SOLR,,J0295,HCPCS,Facility,Inpatient,1,Each,,52,44.2,14.9032,52,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
AMPICILLIN-SULBACTAM 3 GRAM INJ SOLR,,J0295,HCPCS,Facility,Outpatient,1,Each,,71,60.35,20.3486,71,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,34.08,48,,percent of total billed charges,,100% of DHS outpatient percentage
AMPICILLIN-SULBACTAM 3 GRAM INJ SOLR,,J0295,HCPCS,Facility,Outpatient,1,Each,,52,44.2,14.9032,52,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,24.96,48,,percent of total billed charges,,100% of DHS outpatient percentage
AMPICILLIN-SULBACTAM 3 GRAM INJ SOLR,,J0295,HCPCS,Facility,Inpatient,1,Each,,71,60.35,20.3486,71,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
AMPICILLIN-SULBACTAM 3 GRAM INJ SOLR,,J0295,HCPCS,Facility,Inpatient,1,Each,,52,44.2,14.9032,52,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
AMPICILLIN-SULBACTAM 3 GRAM IV SOLR,,J0295,HCPCS,Facility,Both,1,Each,,54,45.9,15.4764,54,Aetna,Commercial,49.68,92,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 3 GRAM IV SOLR,,J0295,HCPCS,Facility,Both,1,Each,,54,45.9,15.4764,54,Aetna,Commercial,49.68,92,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 3 GRAM IV SOLR,,J0295,HCPCS,Facility,Outpatient,1,Each,,54,45.9,15.4764,54,Aetna,Medicare Advantage,26.46,49,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 3 GRAM IV SOLR,,J0295,HCPCS,Facility,Outpatient,1,Each,,54,45.9,15.4764,54,Aetna,Medicare Advantage,26.46,49,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 3 GRAM IV SOLR,,J0295,HCPCS,Facility,Inpatient,1,Each,,54,45.9,15.4764,54,Aetna,Medicare Advantage,,,,,Included in per diem rate,
AMPICILLIN-SULBACTAM 3 GRAM IV SOLR,,J0295,HCPCS,Facility,Inpatient,1,Each,,54,45.9,15.4764,54,Aetna,Medicare Advantage,,,,,Included in per diem rate,
AMPICILLIN-SULBACTAM 3 GRAM IV SOLR,,J0295,HCPCS,Facility,Both,1,Each,,54,45.9,15.4764,54,Aetna,PPO,50.22,93,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 3 GRAM IV SOLR,,J0295,HCPCS,Facility,Both,1,Each,,54,45.9,15.4764,54,Aetna,PPO,50.22,93,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 3 GRAM IV SOLR,,J0295,HCPCS,Facility,Both,1,Each,,54,45.9,15.4764,54,America's PPO,America's PPO,51.8562,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
AMPICILLIN-SULBACTAM 3 GRAM IV SOLR,,J0295,HCPCS,Facility,Both,1,Each,,54,45.9,15.4764,54,America's PPO,America's PPO,51.8562,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
AMPICILLIN-SULBACTAM 3 GRAM IV SOLR,,J0295,HCPCS,Facility,Both,1,Each,,54,45.9,15.4764,54,BlueCross BlueShield Minnesota, Federal Employee Program,53.136,98.4,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 3 GRAM IV SOLR,,J0295,HCPCS,Facility,Both,1,Each,,54,45.9,15.4764,54,BlueCross BlueShield Minnesota, Federal Employee Program,53.136,98.4,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 3 GRAM IV SOLR,,J0295,HCPCS,Facility,Both,1,Each,,54,45.9,15.4764,54,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,54,100,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 3 GRAM IV SOLR,,J0295,HCPCS,Facility,Both,1,Each,,54,45.9,15.4764,54,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,54,100,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 3 GRAM IV SOLR,,J0295,HCPCS,Facility,Both,1,Each,,54,45.9,15.4764,54,BlueCross BlueShield Minnesota,High Value Network Plan,48.6,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
AMPICILLIN-SULBACTAM 3 GRAM IV SOLR,,J0295,HCPCS,Facility,Both,1,Each,,54,45.9,15.4764,54,BlueCross BlueShield Minnesota,High Value Network Plan,48.6,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
AMPICILLIN-SULBACTAM 3 GRAM IV SOLR,,J0295,HCPCS,Facility,Outpatient,1,Each,,54,45.9,15.4764,54,BlueCross BlueShield Minnesota,Medicare Advantage,26.46,49,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 3 GRAM IV SOLR,,J0295,HCPCS,Facility,Outpatient,1,Each,,54,45.9,15.4764,54,BlueCross BlueShield Minnesota,Medicare Advantage,26.46,49,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 3 GRAM IV SOLR,,J0295,HCPCS,Facility,Inpatient,1,Each,,54,45.9,15.4764,54,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
AMPICILLIN-SULBACTAM 3 GRAM IV SOLR,,J0295,HCPCS,Facility,Inpatient,1,Each,,54,45.9,15.4764,54,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
AMPICILLIN-SULBACTAM 3 GRAM IV SOLR,,J0295,HCPCS,Facility,Both,1,Each,,54,45.9,15.4764,54,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,47.8278,88.57,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 3 GRAM IV SOLR,,J0295,HCPCS,Facility,Both,1,Each,,54,45.9,15.4764,54,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,47.8278,88.57,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 3 GRAM IV SOLR,,J0295,HCPCS,Facility,Both,1,Each,,54,45.9,15.4764,54,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,15.4764,28.66,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 3 GRAM IV SOLR,,J0295,HCPCS,Facility,Both,1,Each,,54,45.9,15.4764,54,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,15.4764,28.66,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 3 GRAM IV SOLR,,J0295,HCPCS,Facility,Outpatient,1,Each,,54,45.9,15.4764,54,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),26.46,49,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 3 GRAM IV SOLR,,J0295,HCPCS,Facility,Outpatient,1,Each,,54,45.9,15.4764,54,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),26.46,49,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 3 GRAM IV SOLR,,J0295,HCPCS,Facility,Inpatient,1,Each,,54,45.9,15.4764,54,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
AMPICILLIN-SULBACTAM 3 GRAM IV SOLR,,J0295,HCPCS,Facility,Inpatient,1,Each,,54,45.9,15.4764,54,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
AMPICILLIN-SULBACTAM 3 GRAM IV SOLR,,J0295,HCPCS,Facility,Both,1,Each,,54,45.9,15.4764,54,CorVel,Worker's Compensation,54,100,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 3 GRAM IV SOLR,,J0295,HCPCS,Facility,Both,1,Each,,54,45.9,15.4764,54,CorVel,Worker's Compensation,54,100,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 3 GRAM IV SOLR,,J0295,HCPCS,Facility,Both,1,Each,,54,45.9,15.4764,54,First Health Group Corporation,First Health Network,52.38,97,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 3 GRAM IV SOLR,,J0295,HCPCS,Facility,Both,1,Each,,54,45.9,15.4764,54,First Health Group Corporation,First Health Network,52.38,97,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 3 GRAM IV SOLR,,J0295,HCPCS,Facility,Both,1,Each,,54,45.9,15.4764,54,"Health Partners, Inc.",Commercial,51.084,94.6,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 3 GRAM IV SOLR,,J0295,HCPCS,Facility,Both,1,Each,,54,45.9,15.4764,54,"Health Partners, Inc.",Commercial,51.084,94.6,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 3 GRAM IV SOLR,,J0295,HCPCS,Facility,Outpatient,1,Each,,54,45.9,15.4764,54,"Health Partners, Inc.",Medicare Advantage,26.46,49,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 3 GRAM IV SOLR,,J0295,HCPCS,Facility,Outpatient,1,Each,,54,45.9,15.4764,54,"Health Partners, Inc.",Medicare Advantage,26.46,49,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 3 GRAM IV SOLR,,J0295,HCPCS,Facility,Inpatient,1,Each,,54,45.9,15.4764,54,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
AMPICILLIN-SULBACTAM 3 GRAM IV SOLR,,J0295,HCPCS,Facility,Inpatient,1,Each,,54,45.9,15.4764,54,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
AMPICILLIN-SULBACTAM 3 GRAM IV SOLR,,J0295,HCPCS,Facility,Both,1,Each,,54,45.9,15.4764,54,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),32.4,60,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 3 GRAM IV SOLR,,J0295,HCPCS,Facility,Both,1,Each,,54,45.9,15.4764,54,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),32.4,60,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 3 GRAM IV SOLR,,J0295,HCPCS,Facility,Both,1,Each,,54,45.9,15.4764,54,"Health Partners, Inc.",State of Minnesota Advantage Program,44.01,81.5,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 3 GRAM IV SOLR,,J0295,HCPCS,Facility,Both,1,Each,,54,45.9,15.4764,54,"Health Partners, Inc.",State of Minnesota Advantage Program,44.01,81.5,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 3 GRAM IV SOLR,,J0295,HCPCS,Facility,Both,1,Each,,54,45.9,15.4764,54,"Health Partners, Inc.",State Public Programs,27,50,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 3 GRAM IV SOLR,,J0295,HCPCS,Facility,Both,1,Each,,54,45.9,15.4764,54,"Health Partners, Inc.",State Public Programs,27,50,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 3 GRAM IV SOLR,,J0295,HCPCS,Facility,Both,1,Each,,54,45.9,15.4764,54,Humana Insurance Company,Commercial PPO,51.3,95,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 3 GRAM IV SOLR,,J0295,HCPCS,Facility,Both,1,Each,,54,45.9,15.4764,54,Humana Insurance Company,Commercial PPO,51.3,95,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 3 GRAM IV SOLR,,J0295,HCPCS,Facility,Outpatient,1,Each,,54,45.9,15.4764,54,Humana Insurance Company,Medicare PPO,26.46,49,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 3 GRAM IV SOLR,,J0295,HCPCS,Facility,Outpatient,1,Each,,54,45.9,15.4764,54,Humana Insurance Company,Medicare PPO,26.46,49,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 3 GRAM IV SOLR,,J0295,HCPCS,Facility,Inpatient,1,Each,,54,45.9,15.4764,54,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
AMPICILLIN-SULBACTAM 3 GRAM IV SOLR,,J0295,HCPCS,Facility,Inpatient,1,Each,,54,45.9,15.4764,54,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
AMPICILLIN-SULBACTAM 3 GRAM IV SOLR,,J0295,HCPCS,Facility,Both,1,Each,,54,45.9,15.4764,54,Medica,Individual & Family,53.514,99.1,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 3 GRAM IV SOLR,,J0295,HCPCS,Facility,Both,1,Each,,54,45.9,15.4764,54,Medica,Individual & Family,53.514,99.1,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 3 GRAM IV SOLR,,J0295,HCPCS,Facility,Outpatient,1,Each,,54,45.9,15.4764,54,Medica,Medica Advantage Solution,26.892,49.8,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 3 GRAM IV SOLR,,J0295,HCPCS,Facility,Outpatient,1,Each,,54,45.9,15.4764,54,Medica,Medica Advantage Solution,26.892,49.8,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 3 GRAM IV SOLR,,J0295,HCPCS,Facility,Inpatient,1,Each,,54,45.9,15.4764,54,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
AMPICILLIN-SULBACTAM 3 GRAM IV SOLR,,J0295,HCPCS,Facility,Inpatient,1,Each,,54,45.9,15.4764,54,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
AMPICILLIN-SULBACTAM 3 GRAM IV SOLR,,J0295,HCPCS,Facility,Outpatient,1,Each,,54,45.9,15.4764,54,Medica,Medical Assistance,24.084,44.6,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 3 GRAM IV SOLR,,J0295,HCPCS,Facility,Outpatient,1,Each,,54,45.9,15.4764,54,Medica,Medical Assistance,24.084,44.6,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 3 GRAM IV SOLR,,J0295,HCPCS,Facility,Inpatient,1,Each,,54,45.9,15.4764,54,Medica,Medical Assistance,,,,,Included in per diem rate,
AMPICILLIN-SULBACTAM 3 GRAM IV SOLR,,J0295,HCPCS,Facility,Inpatient,1,Each,,54,45.9,15.4764,54,Medica,Medical Assistance,,,,,Included in per diem rate,
AMPICILLIN-SULBACTAM 3 GRAM IV SOLR,,J0295,HCPCS,Facility,Outpatient,1,Each,,54,45.9,15.4764,54,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,26.892,49.8,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 3 GRAM IV SOLR,,J0295,HCPCS,Facility,Outpatient,1,Each,,54,45.9,15.4764,54,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,26.892,49.8,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 3 GRAM IV SOLR,,J0295,HCPCS,Facility,Inpatient,1,Each,,54,45.9,15.4764,54,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
AMPICILLIN-SULBACTAM 3 GRAM IV SOLR,,J0295,HCPCS,Facility,Inpatient,1,Each,,54,45.9,15.4764,54,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
AMPICILLIN-SULBACTAM 3 GRAM IV SOLR,,J0295,HCPCS,Facility,Both,1,Each,,54,45.9,15.4764,54,"Multiplan, Inc.","Multiplan, Inc.",50.76,94,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 3 GRAM IV SOLR,,J0295,HCPCS,Facility,Both,1,Each,,54,45.9,15.4764,54,"Multiplan, Inc.","Multiplan, Inc.",50.76,94,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 3 GRAM IV SOLR,,J0295,HCPCS,Facility,Outpatient,1,Each,,54,45.9,15.4764,54,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,48.654,90.1,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 3 GRAM IV SOLR,,J0295,HCPCS,Facility,Outpatient,1,Each,,54,45.9,15.4764,54,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,48.654,90.1,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 3 GRAM IV SOLR,,J0295,HCPCS,Facility,Inpatient,1,Each,,54,45.9,15.4764,54,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
AMPICILLIN-SULBACTAM 3 GRAM IV SOLR,,J0295,HCPCS,Facility,Inpatient,1,Each,,54,45.9,15.4764,54,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
AMPICILLIN-SULBACTAM 3 GRAM IV SOLR,,J0295,HCPCS,Facility,Both,1,Each,,54,45.9,15.4764,54,"Preferred One Administrative Services, INC.",PPO,53.244,98.6,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 3 GRAM IV SOLR,,J0295,HCPCS,Facility,Both,1,Each,,54,45.9,15.4764,54,"Preferred One Administrative Services, INC.",PPO,53.244,98.6,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 3 GRAM IV SOLR,,J0295,HCPCS,Facility,Outpatient,1,Each,,54,45.9,15.4764,54,PrimeWest Health,Minnesota Senior Health Options (MSHO),27.783,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
AMPICILLIN-SULBACTAM 3 GRAM IV SOLR,,J0295,HCPCS,Facility,Outpatient,1,Each,,54,45.9,15.4764,54,PrimeWest Health,Minnesota Senior Health Options (MSHO),27.783,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
AMPICILLIN-SULBACTAM 3 GRAM IV SOLR,,J0295,HCPCS,Facility,Inpatient,1,Each,,54,45.9,15.4764,54,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
AMPICILLIN-SULBACTAM 3 GRAM IV SOLR,,J0295,HCPCS,Facility,Inpatient,1,Each,,54,45.9,15.4764,54,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
AMPICILLIN-SULBACTAM 3 GRAM IV SOLR,,J0295,HCPCS,Facility,Outpatient,1,Each,,54,45.9,15.4764,54,PrimeWest Health,MinnesotaCare,27.7344,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
AMPICILLIN-SULBACTAM 3 GRAM IV SOLR,,J0295,HCPCS,Facility,Outpatient,1,Each,,54,45.9,15.4764,54,PrimeWest Health,MinnesotaCare,27.7344,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
AMPICILLIN-SULBACTAM 3 GRAM IV SOLR,,J0295,HCPCS,Facility,Inpatient,1,Each,,54,45.9,15.4764,54,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
AMPICILLIN-SULBACTAM 3 GRAM IV SOLR,,J0295,HCPCS,Facility,Inpatient,1,Each,,54,45.9,15.4764,54,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
AMPICILLIN-SULBACTAM 3 GRAM IV SOLR,,J0295,HCPCS,Facility,Both,1,Each,,54,45.9,15.4764,54,Sanford Health Plan,Sanford Health Plan,49.68,92,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 3 GRAM IV SOLR,,J0295,HCPCS,Facility,Both,1,Each,,54,45.9,15.4764,54,Sanford Health Plan,Sanford Health Plan,49.68,92,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 3 GRAM IV SOLR,,J0295,HCPCS,Facility,Outpatient,1,Each,,54,45.9,15.4764,54,"UCare Health, Inc.",Individual & Family Plan,30.429,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
AMPICILLIN-SULBACTAM 3 GRAM IV SOLR,,J0295,HCPCS,Facility,Outpatient,1,Each,,54,45.9,15.4764,54,"UCare Health, Inc.",Individual & Family Plan,30.429,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
AMPICILLIN-SULBACTAM 3 GRAM IV SOLR,,J0295,HCPCS,Facility,Inpatient,1,Each,,54,45.9,15.4764,54,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
AMPICILLIN-SULBACTAM 3 GRAM IV SOLR,,J0295,HCPCS,Facility,Inpatient,1,Each,,54,45.9,15.4764,54,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
AMPICILLIN-SULBACTAM 3 GRAM IV SOLR,,J0295,HCPCS,Facility,Outpatient,1,Each,,54,45.9,15.4764,54,"UCare Health, Inc.",Medical Assistance,27.2538,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
AMPICILLIN-SULBACTAM 3 GRAM IV SOLR,,J0295,HCPCS,Facility,Outpatient,1,Each,,54,45.9,15.4764,54,"UCare Health, Inc.",Medical Assistance,27.2538,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
AMPICILLIN-SULBACTAM 3 GRAM IV SOLR,,J0295,HCPCS,Facility,Inpatient,1,Each,,54,45.9,15.4764,54,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
AMPICILLIN-SULBACTAM 3 GRAM IV SOLR,,J0295,HCPCS,Facility,Inpatient,1,Each,,54,45.9,15.4764,54,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
AMPICILLIN-SULBACTAM 3 GRAM IV SOLR,,J0295,HCPCS,Facility,Outpatient,1,Each,,54,45.9,15.4764,54,"UCare Health, Inc.",Medicare Advantage,27.2538,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
AMPICILLIN-SULBACTAM 3 GRAM IV SOLR,,J0295,HCPCS,Facility,Outpatient,1,Each,,54,45.9,15.4764,54,"UCare Health, Inc.",Medicare Advantage,27.2538,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
AMPICILLIN-SULBACTAM 3 GRAM IV SOLR,,J0295,HCPCS,Facility,Inpatient,1,Each,,54,45.9,15.4764,54,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
AMPICILLIN-SULBACTAM 3 GRAM IV SOLR,,J0295,HCPCS,Facility,Inpatient,1,Each,,54,45.9,15.4764,54,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
AMPICILLIN-SULBACTAM 3 GRAM IV SOLR,,J0295,HCPCS,Facility,Outpatient,1,Each,,54,45.9,15.4764,54,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),27.2538,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
AMPICILLIN-SULBACTAM 3 GRAM IV SOLR,,J0295,HCPCS,Facility,Outpatient,1,Each,,54,45.9,15.4764,54,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),27.2538,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
AMPICILLIN-SULBACTAM 3 GRAM IV SOLR,,J0295,HCPCS,Facility,Inpatient,1,Each,,54,45.9,15.4764,54,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
AMPICILLIN-SULBACTAM 3 GRAM IV SOLR,,J0295,HCPCS,Facility,Inpatient,1,Each,,54,45.9,15.4764,54,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
AMPICILLIN-SULBACTAM 3 GRAM IV SOLR,,J0295,HCPCS,Facility,Both,1,Each,,54,45.9,15.4764,54,UnitedHealthcare,Individual & Family,50.76,94,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 3 GRAM IV SOLR,,J0295,HCPCS,Facility,Both,1,Each,,54,45.9,15.4764,54,UnitedHealthcare,Individual & Family,50.76,94,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 3 GRAM IV SOLR,,J0295,HCPCS,Facility,Outpatient,1,Each,,54,45.9,15.4764,54,UnitedHealthcare,Medicare Advantage,26.46,49,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 3 GRAM IV SOLR,,J0295,HCPCS,Facility,Outpatient,1,Each,,54,45.9,15.4764,54,UnitedHealthcare,Medicare Advantage,26.46,49,,percent of total billed charges,,
AMPICILLIN-SULBACTAM 3 GRAM IV SOLR,,J0295,HCPCS,Facility,Inpatient,1,Each,,54,45.9,15.4764,54,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
AMPICILLIN-SULBACTAM 3 GRAM IV SOLR,,J0295,HCPCS,Facility,Inpatient,1,Each,,54,45.9,15.4764,54,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
AMPICILLIN-SULBACTAM 3 GRAM IV SOLR,,J0295,HCPCS,Facility,Outpatient,1,Each,,54,45.9,15.4764,54,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,25.92,48,,percent of total billed charges,,100% of DHS outpatient percentage
AMPICILLIN-SULBACTAM 3 GRAM IV SOLR,,J0295,HCPCS,Facility,Outpatient,1,Each,,54,45.9,15.4764,54,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,25.92,48,,percent of total billed charges,,100% of DHS outpatient percentage
AMPICILLIN-SULBACTAM 3 GRAM IV SOLR,,J0295,HCPCS,Facility,Inpatient,1,Each,,54,45.9,15.4764,54,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
AMPICILLIN-SULBACTAM 3 GRAM IV SOLR,,J0295,HCPCS,Facility,Inpatient,1,Each,,54,45.9,15.4764,54,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
AZITHROMYCIN 500 MG IV SOLR,,J0456,HCPCS,Facility,Both,1,Each,,53,45.05,15.1898,53,Aetna,Commercial,48.76,92,,percent of total billed charges,,
AZITHROMYCIN 500 MG IV SOLR,,J0456,HCPCS,Facility,Outpatient,1,Each,,53,45.05,15.1898,53,Aetna,Medicare Advantage,25.97,49,,percent of total billed charges,,
AZITHROMYCIN 500 MG IV SOLR,,J0456,HCPCS,Facility,Inpatient,1,Each,,53,45.05,15.1898,53,Aetna,Medicare Advantage,,,,,Included in per diem rate,
AZITHROMYCIN 500 MG IV SOLR,,J0456,HCPCS,Facility,Both,1,Each,,53,45.05,15.1898,53,Aetna,PPO,49.29,93,,percent of total billed charges,,
AZITHROMYCIN 500 MG IV SOLR,,J0456,HCPCS,Facility,Both,1,Each,,53,45.05,15.1898,53,America's PPO,America's PPO,50.8959,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
AZITHROMYCIN 500 MG IV SOLR,,J0456,HCPCS,Facility,Both,1,Each,,53,45.05,15.1898,53,BlueCross BlueShield Minnesota, Federal Employee Program,52.152,98.4,,percent of total billed charges,,
AZITHROMYCIN 500 MG IV SOLR,,J0456,HCPCS,Facility,Both,1,Each,,53,45.05,15.1898,53,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,53,100,,percent of total billed charges,,
AZITHROMYCIN 500 MG IV SOLR,,J0456,HCPCS,Facility,Both,1,Each,,53,45.05,15.1898,53,BlueCross BlueShield Minnesota,High Value Network Plan,47.7,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
AZITHROMYCIN 500 MG IV SOLR,,J0456,HCPCS,Facility,Outpatient,1,Each,,53,45.05,15.1898,53,BlueCross BlueShield Minnesota,Medicare Advantage,25.97,49,,percent of total billed charges,,
AZITHROMYCIN 500 MG IV SOLR,,J0456,HCPCS,Facility,Inpatient,1,Each,,53,45.05,15.1898,53,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
AZITHROMYCIN 500 MG IV SOLR,,J0456,HCPCS,Facility,Both,1,Each,,53,45.05,15.1898,53,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,46.9421,88.57,,percent of total billed charges,,
AZITHROMYCIN 500 MG IV SOLR,,J0456,HCPCS,Facility,Both,1,Each,,53,45.05,15.1898,53,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,15.1898,28.66,,percent of total billed charges,,
AZITHROMYCIN 500 MG IV SOLR,,J0456,HCPCS,Facility,Outpatient,1,Each,,53,45.05,15.1898,53,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),25.97,49,,percent of total billed charges,,
AZITHROMYCIN 500 MG IV SOLR,,J0456,HCPCS,Facility,Inpatient,1,Each,,53,45.05,15.1898,53,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
AZITHROMYCIN 500 MG IV SOLR,,J0456,HCPCS,Facility,Both,1,Each,,53,45.05,15.1898,53,CorVel,Worker's Compensation,53,100,,percent of total billed charges,,
AZITHROMYCIN 500 MG IV SOLR,,J0456,HCPCS,Facility,Both,1,Each,,53,45.05,15.1898,53,First Health Group Corporation,First Health Network,51.41,97,,percent of total billed charges,,
AZITHROMYCIN 500 MG IV SOLR,,J0456,HCPCS,Facility,Both,1,Each,,53,45.05,15.1898,53,"Health Partners, Inc.",Commercial,50.138,94.6,,percent of total billed charges,,
AZITHROMYCIN 500 MG IV SOLR,,J0456,HCPCS,Facility,Outpatient,1,Each,,53,45.05,15.1898,53,"Health Partners, Inc.",Medicare Advantage,25.97,49,,percent of total billed charges,,
AZITHROMYCIN 500 MG IV SOLR,,J0456,HCPCS,Facility,Inpatient,1,Each,,53,45.05,15.1898,53,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
AZITHROMYCIN 500 MG IV SOLR,,J0456,HCPCS,Facility,Both,1,Each,,53,45.05,15.1898,53,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),31.8,60,,percent of total billed charges,,
AZITHROMYCIN 500 MG IV SOLR,,J0456,HCPCS,Facility,Both,1,Each,,53,45.05,15.1898,53,"Health Partners, Inc.",State of Minnesota Advantage Program,43.195,81.5,,percent of total billed charges,,
AZITHROMYCIN 500 MG IV SOLR,,J0456,HCPCS,Facility,Both,1,Each,,53,45.05,15.1898,53,"Health Partners, Inc.",State Public Programs,26.5,50,,percent of total billed charges,,
AZITHROMYCIN 500 MG IV SOLR,,J0456,HCPCS,Facility,Both,1,Each,,53,45.05,15.1898,53,Humana Insurance Company,Commercial PPO,50.35,95,,percent of total billed charges,,
AZITHROMYCIN 500 MG IV SOLR,,J0456,HCPCS,Facility,Outpatient,1,Each,,53,45.05,15.1898,53,Humana Insurance Company,Medicare PPO,25.97,49,,percent of total billed charges,,
AZITHROMYCIN 500 MG IV SOLR,,J0456,HCPCS,Facility,Inpatient,1,Each,,53,45.05,15.1898,53,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
AZITHROMYCIN 500 MG IV SOLR,,J0456,HCPCS,Facility,Both,1,Each,,53,45.05,15.1898,53,Medica,Individual & Family,52.523,99.1,,percent of total billed charges,,
AZITHROMYCIN 500 MG IV SOLR,,J0456,HCPCS,Facility,Outpatient,1,Each,,53,45.05,15.1898,53,Medica,Medica Advantage Solution,26.394,49.8,,percent of total billed charges,,
AZITHROMYCIN 500 MG IV SOLR,,J0456,HCPCS,Facility,Inpatient,1,Each,,53,45.05,15.1898,53,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
AZITHROMYCIN 500 MG IV SOLR,,J0456,HCPCS,Facility,Outpatient,1,Each,,53,45.05,15.1898,53,Medica,Medical Assistance,23.638,44.6,,percent of total billed charges,,
AZITHROMYCIN 500 MG IV SOLR,,J0456,HCPCS,Facility,Inpatient,1,Each,,53,45.05,15.1898,53,Medica,Medical Assistance,,,,,Included in per diem rate,
AZITHROMYCIN 500 MG IV SOLR,,J0456,HCPCS,Facility,Outpatient,1,Each,,53,45.05,15.1898,53,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,26.394,49.8,,percent of total billed charges,,
AZITHROMYCIN 500 MG IV SOLR,,J0456,HCPCS,Facility,Inpatient,1,Each,,53,45.05,15.1898,53,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
AZITHROMYCIN 500 MG IV SOLR,,J0456,HCPCS,Facility,Both,1,Each,,53,45.05,15.1898,53,"Multiplan, Inc.","Multiplan, Inc.",49.82,94,,percent of total billed charges,,
AZITHROMYCIN 500 MG IV SOLR,,J0456,HCPCS,Facility,Outpatient,1,Each,,53,45.05,15.1898,53,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,47.753,90.1,,percent of total billed charges,,
AZITHROMYCIN 500 MG IV SOLR,,J0456,HCPCS,Facility,Inpatient,1,Each,,53,45.05,15.1898,53,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
AZITHROMYCIN 500 MG IV SOLR,,J0456,HCPCS,Facility,Both,1,Each,,53,45.05,15.1898,53,"Preferred One Administrative Services, INC.",PPO,52.258,98.6,,percent of total billed charges,,
AZITHROMYCIN 500 MG IV SOLR,,J0456,HCPCS,Facility,Outpatient,1,Each,,53,45.05,15.1898,53,PrimeWest Health,Minnesota Senior Health Options (MSHO),27.2685,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
AZITHROMYCIN 500 MG IV SOLR,,J0456,HCPCS,Facility,Inpatient,1,Each,,53,45.05,15.1898,53,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
AZITHROMYCIN 500 MG IV SOLR,,J0456,HCPCS,Facility,Outpatient,1,Each,,53,45.05,15.1898,53,PrimeWest Health,MinnesotaCare,27.2208,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
AZITHROMYCIN 500 MG IV SOLR,,J0456,HCPCS,Facility,Inpatient,1,Each,,53,45.05,15.1898,53,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
AZITHROMYCIN 500 MG IV SOLR,,J0456,HCPCS,Facility,Both,1,Each,,53,45.05,15.1898,53,Sanford Health Plan,Sanford Health Plan,48.76,92,,percent of total billed charges,,
AZITHROMYCIN 500 MG IV SOLR,,J0456,HCPCS,Facility,Outpatient,1,Each,,53,45.05,15.1898,53,"UCare Health, Inc.",Individual & Family Plan,29.8655,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
AZITHROMYCIN 500 MG IV SOLR,,J0456,HCPCS,Facility,Inpatient,1,Each,,53,45.05,15.1898,53,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
AZITHROMYCIN 500 MG IV SOLR,,J0456,HCPCS,Facility,Outpatient,1,Each,,53,45.05,15.1898,53,"UCare Health, Inc.",Medical Assistance,26.7491,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
AZITHROMYCIN 500 MG IV SOLR,,J0456,HCPCS,Facility,Inpatient,1,Each,,53,45.05,15.1898,53,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
AZITHROMYCIN 500 MG IV SOLR,,J0456,HCPCS,Facility,Outpatient,1,Each,,53,45.05,15.1898,53,"UCare Health, Inc.",Medicare Advantage,26.7491,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
AZITHROMYCIN 500 MG IV SOLR,,J0456,HCPCS,Facility,Inpatient,1,Each,,53,45.05,15.1898,53,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
AZITHROMYCIN 500 MG IV SOLR,,J0456,HCPCS,Facility,Outpatient,1,Each,,53,45.05,15.1898,53,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),26.7491,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
AZITHROMYCIN 500 MG IV SOLR,,J0456,HCPCS,Facility,Inpatient,1,Each,,53,45.05,15.1898,53,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
AZITHROMYCIN 500 MG IV SOLR,,J0456,HCPCS,Facility,Both,1,Each,,53,45.05,15.1898,53,UnitedHealthcare,Individual & Family,49.82,94,,percent of total billed charges,,
AZITHROMYCIN 500 MG IV SOLR,,J0456,HCPCS,Facility,Outpatient,1,Each,,53,45.05,15.1898,53,UnitedHealthcare,Medicare Advantage,25.97,49,,percent of total billed charges,,
AZITHROMYCIN 500 MG IV SOLR,,J0456,HCPCS,Facility,Inpatient,1,Each,,53,45.05,15.1898,53,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
AZITHROMYCIN 500 MG IV SOLR,,J0456,HCPCS,Facility,Outpatient,1,Each,,53,45.05,15.1898,53,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,25.44,48,,percent of total billed charges,,100% of DHS outpatient percentage
AZITHROMYCIN 500 MG IV SOLR,,J0456,HCPCS,Facility,Inpatient,1,Each,,53,45.05,15.1898,53,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
AZTREONAM 1 GRAM INJ SOLR,,J0457,HCPCS,Facility,Both,1,Each,,161,136.85,46.1426,161,Aetna,Commercial,148.12,92,,percent of total billed charges,,
AZTREONAM 1 GRAM INJ SOLR,,J0457,HCPCS,Facility,Outpatient,1,Each,,161,136.85,46.1426,161,Aetna,Medicare Advantage,78.89,49,,percent of total billed charges,,
AZTREONAM 1 GRAM INJ SOLR,,J0457,HCPCS,Facility,Inpatient,1,Each,,161,136.85,46.1426,161,Aetna,Medicare Advantage,,,,,Included in per diem rate,
AZTREONAM 1 GRAM INJ SOLR,,J0457,HCPCS,Facility,Both,1,Each,,161,136.85,46.1426,161,Aetna,PPO,149.73,93,,percent of total billed charges,,
AZTREONAM 1 GRAM INJ SOLR,,J0457,HCPCS,Facility,Both,1,Each,,161,136.85,46.1426,161,America's PPO,America's PPO,154.6083,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
AZTREONAM 1 GRAM INJ SOLR,,J0457,HCPCS,Facility,Both,1,Each,,161,136.85,46.1426,161,BlueCross BlueShield Minnesota, Federal Employee Program,158.424,98.4,,percent of total billed charges,,
AZTREONAM 1 GRAM INJ SOLR,,J0457,HCPCS,Facility,Both,1,Each,,161,136.85,46.1426,161,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,161,100,,percent of total billed charges,,
AZTREONAM 1 GRAM INJ SOLR,,J0457,HCPCS,Facility,Both,1,Each,,161,136.85,46.1426,161,BlueCross BlueShield Minnesota,High Value Network Plan,144.9,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
AZTREONAM 1 GRAM INJ SOLR,,J0457,HCPCS,Facility,Outpatient,1,Each,,161,136.85,46.1426,161,BlueCross BlueShield Minnesota,Medicare Advantage,78.89,49,,percent of total billed charges,,
AZTREONAM 1 GRAM INJ SOLR,,J0457,HCPCS,Facility,Inpatient,1,Each,,161,136.85,46.1426,161,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
AZTREONAM 1 GRAM INJ SOLR,,J0457,HCPCS,Facility,Both,1,Each,,161,136.85,46.1426,161,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,142.5977,88.57,,percent of total billed charges,,
AZTREONAM 1 GRAM INJ SOLR,,J0457,HCPCS,Facility,Both,1,Each,,161,136.85,46.1426,161,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,46.1426,28.66,,percent of total billed charges,,
AZTREONAM 1 GRAM INJ SOLR,,J0457,HCPCS,Facility,Outpatient,1,Each,,161,136.85,46.1426,161,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),78.89,49,,percent of total billed charges,,
AZTREONAM 1 GRAM INJ SOLR,,J0457,HCPCS,Facility,Inpatient,1,Each,,161,136.85,46.1426,161,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
AZTREONAM 1 GRAM INJ SOLR,,J0457,HCPCS,Facility,Both,1,Each,,161,136.85,46.1426,161,CorVel,Worker's Compensation,161,100,,percent of total billed charges,,
AZTREONAM 1 GRAM INJ SOLR,,J0457,HCPCS,Facility,Both,1,Each,,161,136.85,46.1426,161,First Health Group Corporation,First Health Network,156.17,97,,percent of total billed charges,,
AZTREONAM 1 GRAM INJ SOLR,,J0457,HCPCS,Facility,Both,1,Each,,161,136.85,46.1426,161,"Health Partners, Inc.",Commercial,152.306,94.6,,percent of total billed charges,,
AZTREONAM 1 GRAM INJ SOLR,,J0457,HCPCS,Facility,Outpatient,1,Each,,161,136.85,46.1426,161,"Health Partners, Inc.",Medicare Advantage,78.89,49,,percent of total billed charges,,
AZTREONAM 1 GRAM INJ SOLR,,J0457,HCPCS,Facility,Inpatient,1,Each,,161,136.85,46.1426,161,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
AZTREONAM 1 GRAM INJ SOLR,,J0457,HCPCS,Facility,Both,1,Each,,161,136.85,46.1426,161,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),96.6,60,,percent of total billed charges,,
AZTREONAM 1 GRAM INJ SOLR,,J0457,HCPCS,Facility,Both,1,Each,,161,136.85,46.1426,161,"Health Partners, Inc.",State of Minnesota Advantage Program,131.215,81.5,,percent of total billed charges,,
AZTREONAM 1 GRAM INJ SOLR,,J0457,HCPCS,Facility,Both,1,Each,,161,136.85,46.1426,161,"Health Partners, Inc.",State Public Programs,80.5,50,,percent of total billed charges,,
AZTREONAM 1 GRAM INJ SOLR,,J0457,HCPCS,Facility,Both,1,Each,,161,136.85,46.1426,161,Humana Insurance Company,Commercial PPO,152.95,95,,percent of total billed charges,,
AZTREONAM 1 GRAM INJ SOLR,,J0457,HCPCS,Facility,Outpatient,1,Each,,161,136.85,46.1426,161,Humana Insurance Company,Medicare PPO,78.89,49,,percent of total billed charges,,
AZTREONAM 1 GRAM INJ SOLR,,J0457,HCPCS,Facility,Inpatient,1,Each,,161,136.85,46.1426,161,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
AZTREONAM 1 GRAM INJ SOLR,,J0457,HCPCS,Facility,Both,1,Each,,161,136.85,46.1426,161,Medica,Individual & Family,159.551,99.1,,percent of total billed charges,,
AZTREONAM 1 GRAM INJ SOLR,,J0457,HCPCS,Facility,Outpatient,1,Each,,161,136.85,46.1426,161,Medica,Medica Advantage Solution,80.178,49.8,,percent of total billed charges,,
AZTREONAM 1 GRAM INJ SOLR,,J0457,HCPCS,Facility,Inpatient,1,Each,,161,136.85,46.1426,161,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
AZTREONAM 1 GRAM INJ SOLR,,J0457,HCPCS,Facility,Outpatient,1,Each,,161,136.85,46.1426,161,Medica,Medical Assistance,71.806,44.6,,percent of total billed charges,,
AZTREONAM 1 GRAM INJ SOLR,,J0457,HCPCS,Facility,Inpatient,1,Each,,161,136.85,46.1426,161,Medica,Medical Assistance,,,,,Included in per diem rate,
AZTREONAM 1 GRAM INJ SOLR,,J0457,HCPCS,Facility,Outpatient,1,Each,,161,136.85,46.1426,161,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,80.178,49.8,,percent of total billed charges,,
AZTREONAM 1 GRAM INJ SOLR,,J0457,HCPCS,Facility,Inpatient,1,Each,,161,136.85,46.1426,161,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
AZTREONAM 1 GRAM INJ SOLR,,J0457,HCPCS,Facility,Both,1,Each,,161,136.85,46.1426,161,"Multiplan, Inc.","Multiplan, Inc.",151.34,94,,percent of total billed charges,,
AZTREONAM 1 GRAM INJ SOLR,,J0457,HCPCS,Facility,Outpatient,1,Each,,161,136.85,46.1426,161,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,145.061,90.1,,percent of total billed charges,,
AZTREONAM 1 GRAM INJ SOLR,,J0457,HCPCS,Facility,Inpatient,1,Each,,161,136.85,46.1426,161,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
AZTREONAM 1 GRAM INJ SOLR,,J0457,HCPCS,Facility,Both,1,Each,,161,136.85,46.1426,161,"Preferred One Administrative Services, INC.",PPO,158.746,98.6,,percent of total billed charges,,
AZTREONAM 1 GRAM INJ SOLR,,J0457,HCPCS,Facility,Outpatient,1,Each,,161,136.85,46.1426,161,PrimeWest Health,Minnesota Senior Health Options (MSHO),82.8345,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
AZTREONAM 1 GRAM INJ SOLR,,J0457,HCPCS,Facility,Inpatient,1,Each,,161,136.85,46.1426,161,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
AZTREONAM 1 GRAM INJ SOLR,,J0457,HCPCS,Facility,Outpatient,1,Each,,161,136.85,46.1426,161,PrimeWest Health,MinnesotaCare,82.6896,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
AZTREONAM 1 GRAM INJ SOLR,,J0457,HCPCS,Facility,Inpatient,1,Each,,161,136.85,46.1426,161,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
AZTREONAM 1 GRAM INJ SOLR,,J0457,HCPCS,Facility,Both,1,Each,,161,136.85,46.1426,161,Sanford Health Plan,Sanford Health Plan,148.12,92,,percent of total billed charges,,
AZTREONAM 1 GRAM INJ SOLR,,J0457,HCPCS,Facility,Outpatient,1,Each,,161,136.85,46.1426,161,"UCare Health, Inc.",Individual & Family Plan,90.7235,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
AZTREONAM 1 GRAM INJ SOLR,,J0457,HCPCS,Facility,Inpatient,1,Each,,161,136.85,46.1426,161,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
AZTREONAM 1 GRAM INJ SOLR,,J0457,HCPCS,Facility,Outpatient,1,Each,,161,136.85,46.1426,161,"UCare Health, Inc.",Medical Assistance,81.2567,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
AZTREONAM 1 GRAM INJ SOLR,,J0457,HCPCS,Facility,Inpatient,1,Each,,161,136.85,46.1426,161,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
AZTREONAM 1 GRAM INJ SOLR,,J0457,HCPCS,Facility,Outpatient,1,Each,,161,136.85,46.1426,161,"UCare Health, Inc.",Medicare Advantage,81.2567,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
AZTREONAM 1 GRAM INJ SOLR,,J0457,HCPCS,Facility,Inpatient,1,Each,,161,136.85,46.1426,161,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
AZTREONAM 1 GRAM INJ SOLR,,J0457,HCPCS,Facility,Outpatient,1,Each,,161,136.85,46.1426,161,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),81.2567,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
AZTREONAM 1 GRAM INJ SOLR,,J0457,HCPCS,Facility,Inpatient,1,Each,,161,136.85,46.1426,161,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
AZTREONAM 1 GRAM INJ SOLR,,J0457,HCPCS,Facility,Both,1,Each,,161,136.85,46.1426,161,UnitedHealthcare,Individual & Family,151.34,94,,percent of total billed charges,,
AZTREONAM 1 GRAM INJ SOLR,,J0457,HCPCS,Facility,Outpatient,1,Each,,161,136.85,46.1426,161,UnitedHealthcare,Medicare Advantage,78.89,49,,percent of total billed charges,,
AZTREONAM 1 GRAM INJ SOLR,,J0457,HCPCS,Facility,Inpatient,1,Each,,161,136.85,46.1426,161,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
AZTREONAM 1 GRAM INJ SOLR,,J0457,HCPCS,Facility,Outpatient,1,Each,,161,136.85,46.1426,161,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,77.28,48,,percent of total billed charges,,100% of DHS outpatient percentage
AZTREONAM 1 GRAM INJ SOLR,,J0457,HCPCS,Facility,Inpatient,1,Each,,161,136.85,46.1426,161,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
ONABOTULINUMTOXINA 100 UNIT INJ SOLR,,J0585,HCPCS,Facility,Both,1,Each,,2511,2134.35,719.6526,2511,Aetna,Commercial,2310.12,92,,percent of total billed charges,,
ONABOTULINUMTOXINA 100 UNIT INJ SOLR,,J0585,HCPCS,Facility,Outpatient,1,Each,,2511,2134.35,719.6526,2511,Aetna,Medicare Advantage,1230.39,49,,percent of total billed charges,,
ONABOTULINUMTOXINA 100 UNIT INJ SOLR,,J0585,HCPCS,Facility,Inpatient,1,Each,,2511,2134.35,719.6526,2511,Aetna,Medicare Advantage,,,,,Included in per diem rate,
ONABOTULINUMTOXINA 100 UNIT INJ SOLR,,J0585,HCPCS,Facility,Both,1,Each,,2511,2134.35,719.6526,2511,Aetna,PPO,2335.23,93,,percent of total billed charges,,
ONABOTULINUMTOXINA 100 UNIT INJ SOLR,,J0585,HCPCS,Facility,Both,1,Each,,2511,2134.35,719.6526,2511,America's PPO,America's PPO,2411.3133,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
ONABOTULINUMTOXINA 100 UNIT INJ SOLR,,J0585,HCPCS,Facility,Both,1,Each,,2511,2134.35,719.6526,2511,BlueCross BlueShield Minnesota, Federal Employee Program,2470.824,98.4,,percent of total billed charges,,
ONABOTULINUMTOXINA 100 UNIT INJ SOLR,,J0585,HCPCS,Facility,Both,1,Each,,2511,2134.35,719.6526,2511,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,2511,100,,percent of total billed charges,,
ONABOTULINUMTOXINA 100 UNIT INJ SOLR,,J0585,HCPCS,Facility,Both,1,Each,,2511,2134.35,719.6526,2511,BlueCross BlueShield Minnesota,High Value Network Plan,2259.9,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
ONABOTULINUMTOXINA 100 UNIT INJ SOLR,,J0585,HCPCS,Facility,Outpatient,1,Each,,2511,2134.35,719.6526,2511,BlueCross BlueShield Minnesota,Medicare Advantage,1230.39,49,,percent of total billed charges,,
ONABOTULINUMTOXINA 100 UNIT INJ SOLR,,J0585,HCPCS,Facility,Inpatient,1,Each,,2511,2134.35,719.6526,2511,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
ONABOTULINUMTOXINA 100 UNIT INJ SOLR,,J0585,HCPCS,Facility,Both,1,Each,,2511,2134.35,719.6526,2511,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,2223.9927,88.57,,percent of total billed charges,,
ONABOTULINUMTOXINA 100 UNIT INJ SOLR,,J0585,HCPCS,Facility,Both,1,Each,,2511,2134.35,719.6526,2511,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,719.6526,28.66,,percent of total billed charges,,
ONABOTULINUMTOXINA 100 UNIT INJ SOLR,,J0585,HCPCS,Facility,Outpatient,1,Each,,2511,2134.35,719.6526,2511,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1230.39,49,,percent of total billed charges,,
ONABOTULINUMTOXINA 100 UNIT INJ SOLR,,J0585,HCPCS,Facility,Inpatient,1,Each,,2511,2134.35,719.6526,2511,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
ONABOTULINUMTOXINA 100 UNIT INJ SOLR,,J0585,HCPCS,Facility,Both,1,Each,,2511,2134.35,719.6526,2511,CorVel,Worker's Compensation,2511,100,,percent of total billed charges,,
ONABOTULINUMTOXINA 100 UNIT INJ SOLR,,J0585,HCPCS,Facility,Both,1,Each,,2511,2134.35,719.6526,2511,First Health Group Corporation,First Health Network,2435.67,97,,percent of total billed charges,,
ONABOTULINUMTOXINA 100 UNIT INJ SOLR,,J0585,HCPCS,Facility,Both,1,Each,,2511,2134.35,719.6526,2511,"Health Partners, Inc.",Commercial,2375.406,94.6,,percent of total billed charges,,
ONABOTULINUMTOXINA 100 UNIT INJ SOLR,,J0585,HCPCS,Facility,Outpatient,1,Each,,2511,2134.35,719.6526,2511,"Health Partners, Inc.",Medicare Advantage,1230.39,49,,percent of total billed charges,,
ONABOTULINUMTOXINA 100 UNIT INJ SOLR,,J0585,HCPCS,Facility,Inpatient,1,Each,,2511,2134.35,719.6526,2511,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ONABOTULINUMTOXINA 100 UNIT INJ SOLR,,J0585,HCPCS,Facility,Both,1,Each,,2511,2134.35,719.6526,2511,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1506.6,60,,percent of total billed charges,,
ONABOTULINUMTOXINA 100 UNIT INJ SOLR,,J0585,HCPCS,Facility,Both,1,Each,,2511,2134.35,719.6526,2511,"Health Partners, Inc.",State of Minnesota Advantage Program,2046.465,81.5,,percent of total billed charges,,
ONABOTULINUMTOXINA 100 UNIT INJ SOLR,,J0585,HCPCS,Facility,Both,1,Each,,2511,2134.35,719.6526,2511,"Health Partners, Inc.",State Public Programs,1255.5,50,,percent of total billed charges,,
ONABOTULINUMTOXINA 100 UNIT INJ SOLR,,J0585,HCPCS,Facility,Both,1,Each,,2511,2134.35,719.6526,2511,Humana Insurance Company,Commercial PPO,2385.45,95,,percent of total billed charges,,
ONABOTULINUMTOXINA 100 UNIT INJ SOLR,,J0585,HCPCS,Facility,Outpatient,1,Each,,2511,2134.35,719.6526,2511,Humana Insurance Company,Medicare PPO,1230.39,49,,percent of total billed charges,,
ONABOTULINUMTOXINA 100 UNIT INJ SOLR,,J0585,HCPCS,Facility,Inpatient,1,Each,,2511,2134.35,719.6526,2511,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
ONABOTULINUMTOXINA 100 UNIT INJ SOLR,,J0585,HCPCS,Facility,Both,1,Each,,2511,2134.35,719.6526,2511,Medica,Individual & Family,2488.401,99.1,,percent of total billed charges,,
ONABOTULINUMTOXINA 100 UNIT INJ SOLR,,J0585,HCPCS,Facility,Outpatient,1,Each,,2511,2134.35,719.6526,2511,Medica,Medica Advantage Solution,1250.478,49.8,,percent of total billed charges,,
ONABOTULINUMTOXINA 100 UNIT INJ SOLR,,J0585,HCPCS,Facility,Inpatient,1,Each,,2511,2134.35,719.6526,2511,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
ONABOTULINUMTOXINA 100 UNIT INJ SOLR,,J0585,HCPCS,Facility,Outpatient,1,Each,,2511,2134.35,719.6526,2511,Medica,Medical Assistance,1119.906,44.6,,percent of total billed charges,,
ONABOTULINUMTOXINA 100 UNIT INJ SOLR,,J0585,HCPCS,Facility,Inpatient,1,Each,,2511,2134.35,719.6526,2511,Medica,Medical Assistance,,,,,Included in per diem rate,
ONABOTULINUMTOXINA 100 UNIT INJ SOLR,,J0585,HCPCS,Facility,Outpatient,1,Each,,2511,2134.35,719.6526,2511,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1250.478,49.8,,percent of total billed charges,,
ONABOTULINUMTOXINA 100 UNIT INJ SOLR,,J0585,HCPCS,Facility,Inpatient,1,Each,,2511,2134.35,719.6526,2511,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
ONABOTULINUMTOXINA 100 UNIT INJ SOLR,,J0585,HCPCS,Facility,Both,1,Each,,2511,2134.35,719.6526,2511,"Multiplan, Inc.","Multiplan, Inc.",2360.34,94,,percent of total billed charges,,
ONABOTULINUMTOXINA 100 UNIT INJ SOLR,,J0585,HCPCS,Facility,Outpatient,1,Each,,2511,2134.35,719.6526,2511,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,2262.411,90.1,,percent of total billed charges,,
ONABOTULINUMTOXINA 100 UNIT INJ SOLR,,J0585,HCPCS,Facility,Inpatient,1,Each,,2511,2134.35,719.6526,2511,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
ONABOTULINUMTOXINA 100 UNIT INJ SOLR,,J0585,HCPCS,Facility,Both,1,Each,,2511,2134.35,719.6526,2511,"Preferred One Administrative Services, INC.",PPO,2475.846,98.6,,percent of total billed charges,,
ONABOTULINUMTOXINA 100 UNIT INJ SOLR,,J0585,HCPCS,Facility,Outpatient,1,Each,,2511,2134.35,719.6526,2511,PrimeWest Health,Minnesota Senior Health Options (MSHO),1291.9095,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
ONABOTULINUMTOXINA 100 UNIT INJ SOLR,,J0585,HCPCS,Facility,Inpatient,1,Each,,2511,2134.35,719.6526,2511,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ONABOTULINUMTOXINA 100 UNIT INJ SOLR,,J0585,HCPCS,Facility,Outpatient,1,Each,,2511,2134.35,719.6526,2511,PrimeWest Health,MinnesotaCare,1289.6496,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
ONABOTULINUMTOXINA 100 UNIT INJ SOLR,,J0585,HCPCS,Facility,Inpatient,1,Each,,2511,2134.35,719.6526,2511,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
ONABOTULINUMTOXINA 100 UNIT INJ SOLR,,J0585,HCPCS,Facility,Both,1,Each,,2511,2134.35,719.6526,2511,Sanford Health Plan,Sanford Health Plan,2310.12,92,,percent of total billed charges,,
ONABOTULINUMTOXINA 100 UNIT INJ SOLR,,J0585,HCPCS,Facility,Outpatient,1,Each,,2511,2134.35,719.6526,2511,"UCare Health, Inc.",Individual & Family Plan,1414.9485,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
ONABOTULINUMTOXINA 100 UNIT INJ SOLR,,J0585,HCPCS,Facility,Inpatient,1,Each,,2511,2134.35,719.6526,2511,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
ONABOTULINUMTOXINA 100 UNIT INJ SOLR,,J0585,HCPCS,Facility,Outpatient,1,Each,,2511,2134.35,719.6526,2511,"UCare Health, Inc.",Medical Assistance,1267.3017,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ONABOTULINUMTOXINA 100 UNIT INJ SOLR,,J0585,HCPCS,Facility,Inpatient,1,Each,,2511,2134.35,719.6526,2511,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
ONABOTULINUMTOXINA 100 UNIT INJ SOLR,,J0585,HCPCS,Facility,Outpatient,1,Each,,2511,2134.35,719.6526,2511,"UCare Health, Inc.",Medicare Advantage,1267.3017,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ONABOTULINUMTOXINA 100 UNIT INJ SOLR,,J0585,HCPCS,Facility,Inpatient,1,Each,,2511,2134.35,719.6526,2511,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ONABOTULINUMTOXINA 100 UNIT INJ SOLR,,J0585,HCPCS,Facility,Outpatient,1,Each,,2511,2134.35,719.6526,2511,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1267.3017,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ONABOTULINUMTOXINA 100 UNIT INJ SOLR,,J0585,HCPCS,Facility,Inpatient,1,Each,,2511,2134.35,719.6526,2511,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ONABOTULINUMTOXINA 100 UNIT INJ SOLR,,J0585,HCPCS,Facility,Both,1,Each,,2511,2134.35,719.6526,2511,UnitedHealthcare,Individual & Family,2360.34,94,,percent of total billed charges,,
ONABOTULINUMTOXINA 100 UNIT INJ SOLR,,J0585,HCPCS,Facility,Outpatient,1,Each,,2511,2134.35,719.6526,2511,UnitedHealthcare,Medicare Advantage,1230.39,49,,percent of total billed charges,,
ONABOTULINUMTOXINA 100 UNIT INJ SOLR,,J0585,HCPCS,Facility,Inpatient,1,Each,,2511,2134.35,719.6526,2511,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
ONABOTULINUMTOXINA 100 UNIT INJ SOLR,,J0585,HCPCS,Facility,Outpatient,1,Each,,2511,2134.35,719.6526,2511,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1205.28,48,,percent of total billed charges,,100% of DHS outpatient percentage
ONABOTULINUMTOXINA 100 UNIT INJ SOLR,,J0585,HCPCS,Facility,Inpatient,1,Each,,2511,2134.35,719.6526,2511,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
CEFAZOLIN 1 GRAM INJ SOLR,,J0690,HCPCS,Facility,Both,1,Each,,14,11.9,4.0124,14,Aetna,Commercial,12.88,92,,percent of total billed charges,,
CEFAZOLIN 1 GRAM INJ SOLR,,J0690,HCPCS,Facility,Outpatient,1,Each,,14,11.9,4.0124,14,Aetna,Medicare Advantage,6.86,49,,percent of total billed charges,,
CEFAZOLIN 1 GRAM INJ SOLR,,J0690,HCPCS,Facility,Inpatient,1,Each,,14,11.9,4.0124,14,Aetna,Medicare Advantage,,,,,Included in per diem rate,
CEFAZOLIN 1 GRAM INJ SOLR,,J0690,HCPCS,Facility,Both,1,Each,,14,11.9,4.0124,14,Aetna,PPO,13.02,93,,percent of total billed charges,,
CEFAZOLIN 1 GRAM INJ SOLR,,J0690,HCPCS,Facility,Both,1,Each,,14,11.9,4.0124,14,America's PPO,America's PPO,13.4442,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
CEFAZOLIN 1 GRAM INJ SOLR,,J0690,HCPCS,Facility,Both,1,Each,,14,11.9,4.0124,14,BlueCross BlueShield Minnesota, Federal Employee Program,13.776,98.4,,percent of total billed charges,,
CEFAZOLIN 1 GRAM INJ SOLR,,J0690,HCPCS,Facility,Both,1,Each,,14,11.9,4.0124,14,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,14,100,,percent of total billed charges,,
CEFAZOLIN 1 GRAM INJ SOLR,,J0690,HCPCS,Facility,Both,1,Each,,14,11.9,4.0124,14,BlueCross BlueShield Minnesota,High Value Network Plan,12.6,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
CEFAZOLIN 1 GRAM INJ SOLR,,J0690,HCPCS,Facility,Outpatient,1,Each,,14,11.9,4.0124,14,BlueCross BlueShield Minnesota,Medicare Advantage,6.86,49,,percent of total billed charges,,
CEFAZOLIN 1 GRAM INJ SOLR,,J0690,HCPCS,Facility,Inpatient,1,Each,,14,11.9,4.0124,14,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
CEFAZOLIN 1 GRAM INJ SOLR,,J0690,HCPCS,Facility,Both,1,Each,,14,11.9,4.0124,14,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,12.3998,88.57,,percent of total billed charges,,
CEFAZOLIN 1 GRAM INJ SOLR,,J0690,HCPCS,Facility,Both,1,Each,,14,11.9,4.0124,14,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,4.0124,28.66,,percent of total billed charges,,
CEFAZOLIN 1 GRAM INJ SOLR,,J0690,HCPCS,Facility,Outpatient,1,Each,,14,11.9,4.0124,14,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),6.86,49,,percent of total billed charges,,
CEFAZOLIN 1 GRAM INJ SOLR,,J0690,HCPCS,Facility,Inpatient,1,Each,,14,11.9,4.0124,14,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
CEFAZOLIN 1 GRAM INJ SOLR,,J0690,HCPCS,Facility,Both,1,Each,,14,11.9,4.0124,14,CorVel,Worker's Compensation,14,100,,percent of total billed charges,,
CEFAZOLIN 1 GRAM INJ SOLR,,J0690,HCPCS,Facility,Both,1,Each,,14,11.9,4.0124,14,First Health Group Corporation,First Health Network,13.58,97,,percent of total billed charges,,
CEFAZOLIN 1 GRAM INJ SOLR,,J0690,HCPCS,Facility,Both,1,Each,,14,11.9,4.0124,14,"Health Partners, Inc.",Commercial,13.244,94.6,,percent of total billed charges,,
CEFAZOLIN 1 GRAM INJ SOLR,,J0690,HCPCS,Facility,Outpatient,1,Each,,14,11.9,4.0124,14,"Health Partners, Inc.",Medicare Advantage,6.86,49,,percent of total billed charges,,
CEFAZOLIN 1 GRAM INJ SOLR,,J0690,HCPCS,Facility,Inpatient,1,Each,,14,11.9,4.0124,14,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CEFAZOLIN 1 GRAM INJ SOLR,,J0690,HCPCS,Facility,Both,1,Each,,14,11.9,4.0124,14,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),8.4,60,,percent of total billed charges,,
CEFAZOLIN 1 GRAM INJ SOLR,,J0690,HCPCS,Facility,Both,1,Each,,14,11.9,4.0124,14,"Health Partners, Inc.",State of Minnesota Advantage Program,11.41,81.5,,percent of total billed charges,,
CEFAZOLIN 1 GRAM INJ SOLR,,J0690,HCPCS,Facility,Both,1,Each,,14,11.9,4.0124,14,"Health Partners, Inc.",State Public Programs,7,50,,percent of total billed charges,,
CEFAZOLIN 1 GRAM INJ SOLR,,J0690,HCPCS,Facility,Both,1,Each,,14,11.9,4.0124,14,Humana Insurance Company,Commercial PPO,13.3,95,,percent of total billed charges,,
CEFAZOLIN 1 GRAM INJ SOLR,,J0690,HCPCS,Facility,Outpatient,1,Each,,14,11.9,4.0124,14,Humana Insurance Company,Medicare PPO,6.86,49,,percent of total billed charges,,
CEFAZOLIN 1 GRAM INJ SOLR,,J0690,HCPCS,Facility,Inpatient,1,Each,,14,11.9,4.0124,14,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
CEFAZOLIN 1 GRAM INJ SOLR,,J0690,HCPCS,Facility,Both,1,Each,,14,11.9,4.0124,14,Medica,Individual & Family,13.874,99.1,,percent of total billed charges,,
CEFAZOLIN 1 GRAM INJ SOLR,,J0690,HCPCS,Facility,Outpatient,1,Each,,14,11.9,4.0124,14,Medica,Medica Advantage Solution,6.972,49.8,,percent of total billed charges,,
CEFAZOLIN 1 GRAM INJ SOLR,,J0690,HCPCS,Facility,Inpatient,1,Each,,14,11.9,4.0124,14,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
CEFAZOLIN 1 GRAM INJ SOLR,,J0690,HCPCS,Facility,Outpatient,1,Each,,14,11.9,4.0124,14,Medica,Medical Assistance,6.244,44.6,,percent of total billed charges,,
CEFAZOLIN 1 GRAM INJ SOLR,,J0690,HCPCS,Facility,Inpatient,1,Each,,14,11.9,4.0124,14,Medica,Medical Assistance,,,,,Included in per diem rate,
CEFAZOLIN 1 GRAM INJ SOLR,,J0690,HCPCS,Facility,Outpatient,1,Each,,14,11.9,4.0124,14,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,6.972,49.8,,percent of total billed charges,,
CEFAZOLIN 1 GRAM INJ SOLR,,J0690,HCPCS,Facility,Inpatient,1,Each,,14,11.9,4.0124,14,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
CEFAZOLIN 1 GRAM INJ SOLR,,J0690,HCPCS,Facility,Both,1,Each,,14,11.9,4.0124,14,"Multiplan, Inc.","Multiplan, Inc.",13.16,94,,percent of total billed charges,,
CEFAZOLIN 1 GRAM INJ SOLR,,J0690,HCPCS,Facility,Outpatient,1,Each,,14,11.9,4.0124,14,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,12.614,90.1,,percent of total billed charges,,
CEFAZOLIN 1 GRAM INJ SOLR,,J0690,HCPCS,Facility,Inpatient,1,Each,,14,11.9,4.0124,14,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
CEFAZOLIN 1 GRAM INJ SOLR,,J0690,HCPCS,Facility,Both,1,Each,,14,11.9,4.0124,14,"Preferred One Administrative Services, INC.",PPO,13.804,98.6,,percent of total billed charges,,
CEFAZOLIN 1 GRAM INJ SOLR,,J0690,HCPCS,Facility,Outpatient,1,Each,,14,11.9,4.0124,14,PrimeWest Health,Minnesota Senior Health Options (MSHO),7.203,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
CEFAZOLIN 1 GRAM INJ SOLR,,J0690,HCPCS,Facility,Inpatient,1,Each,,14,11.9,4.0124,14,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CEFAZOLIN 1 GRAM INJ SOLR,,J0690,HCPCS,Facility,Outpatient,1,Each,,14,11.9,4.0124,14,PrimeWest Health,MinnesotaCare,7.1904,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
CEFAZOLIN 1 GRAM INJ SOLR,,J0690,HCPCS,Facility,Inpatient,1,Each,,14,11.9,4.0124,14,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
CEFAZOLIN 1 GRAM INJ SOLR,,J0690,HCPCS,Facility,Both,1,Each,,14,11.9,4.0124,14,Sanford Health Plan,Sanford Health Plan,12.88,92,,percent of total billed charges,,
CEFAZOLIN 1 GRAM INJ SOLR,,J0690,HCPCS,Facility,Outpatient,1,Each,,14,11.9,4.0124,14,"UCare Health, Inc.",Individual & Family Plan,7.889,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
CEFAZOLIN 1 GRAM INJ SOLR,,J0690,HCPCS,Facility,Inpatient,1,Each,,14,11.9,4.0124,14,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
CEFAZOLIN 1 GRAM INJ SOLR,,J0690,HCPCS,Facility,Outpatient,1,Each,,14,11.9,4.0124,14,"UCare Health, Inc.",Medical Assistance,7.0658,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CEFAZOLIN 1 GRAM INJ SOLR,,J0690,HCPCS,Facility,Inpatient,1,Each,,14,11.9,4.0124,14,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
CEFAZOLIN 1 GRAM INJ SOLR,,J0690,HCPCS,Facility,Outpatient,1,Each,,14,11.9,4.0124,14,"UCare Health, Inc.",Medicare Advantage,7.0658,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CEFAZOLIN 1 GRAM INJ SOLR,,J0690,HCPCS,Facility,Inpatient,1,Each,,14,11.9,4.0124,14,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CEFAZOLIN 1 GRAM INJ SOLR,,J0690,HCPCS,Facility,Outpatient,1,Each,,14,11.9,4.0124,14,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),7.0658,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CEFAZOLIN 1 GRAM INJ SOLR,,J0690,HCPCS,Facility,Inpatient,1,Each,,14,11.9,4.0124,14,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CEFAZOLIN 1 GRAM INJ SOLR,,J0690,HCPCS,Facility,Both,1,Each,,14,11.9,4.0124,14,UnitedHealthcare,Individual & Family,13.16,94,,percent of total billed charges,,
CEFAZOLIN 1 GRAM INJ SOLR,,J0690,HCPCS,Facility,Outpatient,1,Each,,14,11.9,4.0124,14,UnitedHealthcare,Medicare Advantage,6.86,49,,percent of total billed charges,,
CEFAZOLIN 1 GRAM INJ SOLR,,J0690,HCPCS,Facility,Inpatient,1,Each,,14,11.9,4.0124,14,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
CEFAZOLIN 1 GRAM INJ SOLR,,J0690,HCPCS,Facility,Outpatient,1,Each,,14,11.9,4.0124,14,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,6.72,48,,percent of total billed charges,,100% of DHS outpatient percentage
CEFAZOLIN 1 GRAM INJ SOLR,,J0690,HCPCS,Facility,Inpatient,1,Each,,14,11.9,4.0124,14,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
CEFAZOLIN 1 GRAM IV SOLR,,J0690,HCPCS,Facility,Both,1,Each,,17,14.45,4.8722,17,Aetna,Commercial,15.64,92,,percent of total billed charges,,
CEFAZOLIN 1 GRAM IV SOLR,,J0690,HCPCS,Facility,Outpatient,1,Each,,17,14.45,4.8722,17,Aetna,Medicare Advantage,8.33,49,,percent of total billed charges,,
CEFAZOLIN 1 GRAM IV SOLR,,J0690,HCPCS,Facility,Inpatient,1,Each,,17,14.45,4.8722,17,Aetna,Medicare Advantage,,,,,Included in per diem rate,
CEFAZOLIN 1 GRAM IV SOLR,,J0690,HCPCS,Facility,Both,1,Each,,17,14.45,4.8722,17,Aetna,PPO,15.81,93,,percent of total billed charges,,
CEFAZOLIN 1 GRAM IV SOLR,,J0690,HCPCS,Facility,Both,1,Each,,17,14.45,4.8722,17,America's PPO,America's PPO,16.3251,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
CEFAZOLIN 1 GRAM IV SOLR,,J0690,HCPCS,Facility,Both,1,Each,,17,14.45,4.8722,17,BlueCross BlueShield Minnesota, Federal Employee Program,16.728,98.4,,percent of total billed charges,,
CEFAZOLIN 1 GRAM IV SOLR,,J0690,HCPCS,Facility,Both,1,Each,,17,14.45,4.8722,17,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,17,100,,percent of total billed charges,,
CEFAZOLIN 1 GRAM IV SOLR,,J0690,HCPCS,Facility,Both,1,Each,,17,14.45,4.8722,17,BlueCross BlueShield Minnesota,High Value Network Plan,15.3,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
CEFAZOLIN 1 GRAM IV SOLR,,J0690,HCPCS,Facility,Outpatient,1,Each,,17,14.45,4.8722,17,BlueCross BlueShield Minnesota,Medicare Advantage,8.33,49,,percent of total billed charges,,
CEFAZOLIN 1 GRAM IV SOLR,,J0690,HCPCS,Facility,Inpatient,1,Each,,17,14.45,4.8722,17,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
CEFAZOLIN 1 GRAM IV SOLR,,J0690,HCPCS,Facility,Both,1,Each,,17,14.45,4.8722,17,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,15.0569,88.57,,percent of total billed charges,,
CEFAZOLIN 1 GRAM IV SOLR,,J0690,HCPCS,Facility,Both,1,Each,,17,14.45,4.8722,17,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,4.8722,28.66,,percent of total billed charges,,
CEFAZOLIN 1 GRAM IV SOLR,,J0690,HCPCS,Facility,Outpatient,1,Each,,17,14.45,4.8722,17,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),8.33,49,,percent of total billed charges,,
CEFAZOLIN 1 GRAM IV SOLR,,J0690,HCPCS,Facility,Inpatient,1,Each,,17,14.45,4.8722,17,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
CEFAZOLIN 1 GRAM IV SOLR,,J0690,HCPCS,Facility,Both,1,Each,,17,14.45,4.8722,17,CorVel,Worker's Compensation,17,100,,percent of total billed charges,,
CEFAZOLIN 1 GRAM IV SOLR,,J0690,HCPCS,Facility,Both,1,Each,,17,14.45,4.8722,17,First Health Group Corporation,First Health Network,16.49,97,,percent of total billed charges,,
CEFAZOLIN 1 GRAM IV SOLR,,J0690,HCPCS,Facility,Both,1,Each,,17,14.45,4.8722,17,"Health Partners, Inc.",Commercial,16.082,94.6,,percent of total billed charges,,
CEFAZOLIN 1 GRAM IV SOLR,,J0690,HCPCS,Facility,Outpatient,1,Each,,17,14.45,4.8722,17,"Health Partners, Inc.",Medicare Advantage,8.33,49,,percent of total billed charges,,
CEFAZOLIN 1 GRAM IV SOLR,,J0690,HCPCS,Facility,Inpatient,1,Each,,17,14.45,4.8722,17,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CEFAZOLIN 1 GRAM IV SOLR,,J0690,HCPCS,Facility,Both,1,Each,,17,14.45,4.8722,17,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),10.2,60,,percent of total billed charges,,
CEFAZOLIN 1 GRAM IV SOLR,,J0690,HCPCS,Facility,Both,1,Each,,17,14.45,4.8722,17,"Health Partners, Inc.",State of Minnesota Advantage Program,13.855,81.5,,percent of total billed charges,,
CEFAZOLIN 1 GRAM IV SOLR,,J0690,HCPCS,Facility,Both,1,Each,,17,14.45,4.8722,17,"Health Partners, Inc.",State Public Programs,8.5,50,,percent of total billed charges,,
CEFAZOLIN 1 GRAM IV SOLR,,J0690,HCPCS,Facility,Both,1,Each,,17,14.45,4.8722,17,Humana Insurance Company,Commercial PPO,16.15,95,,percent of total billed charges,,
CEFAZOLIN 1 GRAM IV SOLR,,J0690,HCPCS,Facility,Outpatient,1,Each,,17,14.45,4.8722,17,Humana Insurance Company,Medicare PPO,8.33,49,,percent of total billed charges,,
CEFAZOLIN 1 GRAM IV SOLR,,J0690,HCPCS,Facility,Inpatient,1,Each,,17,14.45,4.8722,17,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
CEFAZOLIN 1 GRAM IV SOLR,,J0690,HCPCS,Facility,Both,1,Each,,17,14.45,4.8722,17,Medica,Individual & Family,16.847,99.1,,percent of total billed charges,,
CEFAZOLIN 1 GRAM IV SOLR,,J0690,HCPCS,Facility,Outpatient,1,Each,,17,14.45,4.8722,17,Medica,Medica Advantage Solution,8.466,49.8,,percent of total billed charges,,
CEFAZOLIN 1 GRAM IV SOLR,,J0690,HCPCS,Facility,Inpatient,1,Each,,17,14.45,4.8722,17,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
CEFAZOLIN 1 GRAM IV SOLR,,J0690,HCPCS,Facility,Outpatient,1,Each,,17,14.45,4.8722,17,Medica,Medical Assistance,7.582,44.6,,percent of total billed charges,,
CEFAZOLIN 1 GRAM IV SOLR,,J0690,HCPCS,Facility,Inpatient,1,Each,,17,14.45,4.8722,17,Medica,Medical Assistance,,,,,Included in per diem rate,
CEFAZOLIN 1 GRAM IV SOLR,,J0690,HCPCS,Facility,Outpatient,1,Each,,17,14.45,4.8722,17,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,8.466,49.8,,percent of total billed charges,,
CEFAZOLIN 1 GRAM IV SOLR,,J0690,HCPCS,Facility,Inpatient,1,Each,,17,14.45,4.8722,17,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
CEFAZOLIN 1 GRAM IV SOLR,,J0690,HCPCS,Facility,Both,1,Each,,17,14.45,4.8722,17,"Multiplan, Inc.","Multiplan, Inc.",15.98,94,,percent of total billed charges,,
CEFAZOLIN 1 GRAM IV SOLR,,J0690,HCPCS,Facility,Outpatient,1,Each,,17,14.45,4.8722,17,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,15.317,90.1,,percent of total billed charges,,
CEFAZOLIN 1 GRAM IV SOLR,,J0690,HCPCS,Facility,Inpatient,1,Each,,17,14.45,4.8722,17,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
CEFAZOLIN 1 GRAM IV SOLR,,J0690,HCPCS,Facility,Both,1,Each,,17,14.45,4.8722,17,"Preferred One Administrative Services, INC.",PPO,16.762,98.6,,percent of total billed charges,,
CEFAZOLIN 1 GRAM IV SOLR,,J0690,HCPCS,Facility,Outpatient,1,Each,,17,14.45,4.8722,17,PrimeWest Health,Minnesota Senior Health Options (MSHO),8.7465,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
CEFAZOLIN 1 GRAM IV SOLR,,J0690,HCPCS,Facility,Inpatient,1,Each,,17,14.45,4.8722,17,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CEFAZOLIN 1 GRAM IV SOLR,,J0690,HCPCS,Facility,Outpatient,1,Each,,17,14.45,4.8722,17,PrimeWest Health,MinnesotaCare,8.7312,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
CEFAZOLIN 1 GRAM IV SOLR,,J0690,HCPCS,Facility,Inpatient,1,Each,,17,14.45,4.8722,17,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
CEFAZOLIN 1 GRAM IV SOLR,,J0690,HCPCS,Facility,Both,1,Each,,17,14.45,4.8722,17,Sanford Health Plan,Sanford Health Plan,15.64,92,,percent of total billed charges,,
CEFAZOLIN 1 GRAM IV SOLR,,J0690,HCPCS,Facility,Outpatient,1,Each,,17,14.45,4.8722,17,"UCare Health, Inc.",Individual & Family Plan,9.5795,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
CEFAZOLIN 1 GRAM IV SOLR,,J0690,HCPCS,Facility,Inpatient,1,Each,,17,14.45,4.8722,17,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
CEFAZOLIN 1 GRAM IV SOLR,,J0690,HCPCS,Facility,Outpatient,1,Each,,17,14.45,4.8722,17,"UCare Health, Inc.",Medical Assistance,8.5799,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CEFAZOLIN 1 GRAM IV SOLR,,J0690,HCPCS,Facility,Inpatient,1,Each,,17,14.45,4.8722,17,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
CEFAZOLIN 1 GRAM IV SOLR,,J0690,HCPCS,Facility,Outpatient,1,Each,,17,14.45,4.8722,17,"UCare Health, Inc.",Medicare Advantage,8.5799,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CEFAZOLIN 1 GRAM IV SOLR,,J0690,HCPCS,Facility,Inpatient,1,Each,,17,14.45,4.8722,17,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CEFAZOLIN 1 GRAM IV SOLR,,J0690,HCPCS,Facility,Outpatient,1,Each,,17,14.45,4.8722,17,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),8.5799,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CEFAZOLIN 1 GRAM IV SOLR,,J0690,HCPCS,Facility,Inpatient,1,Each,,17,14.45,4.8722,17,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CEFAZOLIN 1 GRAM IV SOLR,,J0690,HCPCS,Facility,Both,1,Each,,17,14.45,4.8722,17,UnitedHealthcare,Individual & Family,15.98,94,,percent of total billed charges,,
CEFAZOLIN 1 GRAM IV SOLR,,J0690,HCPCS,Facility,Outpatient,1,Each,,17,14.45,4.8722,17,UnitedHealthcare,Medicare Advantage,8.33,49,,percent of total billed charges,,
CEFAZOLIN 1 GRAM IV SOLR,,J0690,HCPCS,Facility,Inpatient,1,Each,,17,14.45,4.8722,17,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
CEFAZOLIN 1 GRAM IV SOLR,,J0690,HCPCS,Facility,Outpatient,1,Each,,17,14.45,4.8722,17,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,8.16,48,,percent of total billed charges,,100% of DHS outpatient percentage
CEFAZOLIN 1 GRAM IV SOLR,,J0690,HCPCS,Facility,Inpatient,1,Each,,17,14.45,4.8722,17,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
CEFAZOLIN 2 GRAM INJ SOLR,,J0690,HCPCS,Facility,Both,1,Each,,37,31.45,10.6042,37,Aetna,Commercial,34.04,92,,percent of total billed charges,,
CEFAZOLIN 2 GRAM INJ SOLR,,J0690,HCPCS,Facility,Outpatient,1,Each,,37,31.45,10.6042,37,Aetna,Medicare Advantage,18.13,49,,percent of total billed charges,,
CEFAZOLIN 2 GRAM INJ SOLR,,J0690,HCPCS,Facility,Inpatient,1,Each,,37,31.45,10.6042,37,Aetna,Medicare Advantage,,,,,Included in per diem rate,
CEFAZOLIN 2 GRAM INJ SOLR,,J0690,HCPCS,Facility,Both,1,Each,,37,31.45,10.6042,37,Aetna,PPO,34.41,93,,percent of total billed charges,,
CEFAZOLIN 2 GRAM INJ SOLR,,J0690,HCPCS,Facility,Both,1,Each,,37,31.45,10.6042,37,America's PPO,America's PPO,35.5311,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
CEFAZOLIN 2 GRAM INJ SOLR,,J0690,HCPCS,Facility,Both,1,Each,,37,31.45,10.6042,37,BlueCross BlueShield Minnesota, Federal Employee Program,36.408,98.4,,percent of total billed charges,,
CEFAZOLIN 2 GRAM INJ SOLR,,J0690,HCPCS,Facility,Both,1,Each,,37,31.45,10.6042,37,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,37,100,,percent of total billed charges,,
CEFAZOLIN 2 GRAM INJ SOLR,,J0690,HCPCS,Facility,Both,1,Each,,37,31.45,10.6042,37,BlueCross BlueShield Minnesota,High Value Network Plan,33.3,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
CEFAZOLIN 2 GRAM INJ SOLR,,J0690,HCPCS,Facility,Outpatient,1,Each,,37,31.45,10.6042,37,BlueCross BlueShield Minnesota,Medicare Advantage,18.13,49,,percent of total billed charges,,
CEFAZOLIN 2 GRAM INJ SOLR,,J0690,HCPCS,Facility,Inpatient,1,Each,,37,31.45,10.6042,37,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
CEFAZOLIN 2 GRAM INJ SOLR,,J0690,HCPCS,Facility,Both,1,Each,,37,31.45,10.6042,37,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,32.7709,88.57,,percent of total billed charges,,
CEFAZOLIN 2 GRAM INJ SOLR,,J0690,HCPCS,Facility,Both,1,Each,,37,31.45,10.6042,37,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,10.6042,28.66,,percent of total billed charges,,
CEFAZOLIN 2 GRAM INJ SOLR,,J0690,HCPCS,Facility,Outpatient,1,Each,,37,31.45,10.6042,37,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),18.13,49,,percent of total billed charges,,
CEFAZOLIN 2 GRAM INJ SOLR,,J0690,HCPCS,Facility,Inpatient,1,Each,,37,31.45,10.6042,37,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
CEFAZOLIN 2 GRAM INJ SOLR,,J0690,HCPCS,Facility,Both,1,Each,,37,31.45,10.6042,37,CorVel,Worker's Compensation,37,100,,percent of total billed charges,,
CEFAZOLIN 2 GRAM INJ SOLR,,J0690,HCPCS,Facility,Both,1,Each,,37,31.45,10.6042,37,First Health Group Corporation,First Health Network,35.89,97,,percent of total billed charges,,
CEFAZOLIN 2 GRAM INJ SOLR,,J0690,HCPCS,Facility,Both,1,Each,,37,31.45,10.6042,37,"Health Partners, Inc.",Commercial,35.002,94.6,,percent of total billed charges,,
CEFAZOLIN 2 GRAM INJ SOLR,,J0690,HCPCS,Facility,Outpatient,1,Each,,37,31.45,10.6042,37,"Health Partners, Inc.",Medicare Advantage,18.13,49,,percent of total billed charges,,
CEFAZOLIN 2 GRAM INJ SOLR,,J0690,HCPCS,Facility,Inpatient,1,Each,,37,31.45,10.6042,37,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CEFAZOLIN 2 GRAM INJ SOLR,,J0690,HCPCS,Facility,Both,1,Each,,37,31.45,10.6042,37,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),22.2,60,,percent of total billed charges,,
CEFAZOLIN 2 GRAM INJ SOLR,,J0690,HCPCS,Facility,Both,1,Each,,37,31.45,10.6042,37,"Health Partners, Inc.",State of Minnesota Advantage Program,30.155,81.5,,percent of total billed charges,,
CEFAZOLIN 2 GRAM INJ SOLR,,J0690,HCPCS,Facility,Both,1,Each,,37,31.45,10.6042,37,"Health Partners, Inc.",State Public Programs,18.5,50,,percent of total billed charges,,
CEFAZOLIN 2 GRAM INJ SOLR,,J0690,HCPCS,Facility,Both,1,Each,,37,31.45,10.6042,37,Humana Insurance Company,Commercial PPO,35.15,95,,percent of total billed charges,,
CEFAZOLIN 2 GRAM INJ SOLR,,J0690,HCPCS,Facility,Outpatient,1,Each,,37,31.45,10.6042,37,Humana Insurance Company,Medicare PPO,18.13,49,,percent of total billed charges,,
CEFAZOLIN 2 GRAM INJ SOLR,,J0690,HCPCS,Facility,Inpatient,1,Each,,37,31.45,10.6042,37,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
CEFAZOLIN 2 GRAM INJ SOLR,,J0690,HCPCS,Facility,Both,1,Each,,37,31.45,10.6042,37,Medica,Individual & Family,36.667,99.1,,percent of total billed charges,,
CEFAZOLIN 2 GRAM INJ SOLR,,J0690,HCPCS,Facility,Outpatient,1,Each,,37,31.45,10.6042,37,Medica,Medica Advantage Solution,18.426,49.8,,percent of total billed charges,,
CEFAZOLIN 2 GRAM INJ SOLR,,J0690,HCPCS,Facility,Inpatient,1,Each,,37,31.45,10.6042,37,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
CEFAZOLIN 2 GRAM INJ SOLR,,J0690,HCPCS,Facility,Outpatient,1,Each,,37,31.45,10.6042,37,Medica,Medical Assistance,16.502,44.6,,percent of total billed charges,,
CEFAZOLIN 2 GRAM INJ SOLR,,J0690,HCPCS,Facility,Inpatient,1,Each,,37,31.45,10.6042,37,Medica,Medical Assistance,,,,,Included in per diem rate,
CEFAZOLIN 2 GRAM INJ SOLR,,J0690,HCPCS,Facility,Outpatient,1,Each,,37,31.45,10.6042,37,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,18.426,49.8,,percent of total billed charges,,
CEFAZOLIN 2 GRAM INJ SOLR,,J0690,HCPCS,Facility,Inpatient,1,Each,,37,31.45,10.6042,37,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
CEFAZOLIN 2 GRAM INJ SOLR,,J0690,HCPCS,Facility,Both,1,Each,,37,31.45,10.6042,37,"Multiplan, Inc.","Multiplan, Inc.",34.78,94,,percent of total billed charges,,
CEFAZOLIN 2 GRAM INJ SOLR,,J0690,HCPCS,Facility,Outpatient,1,Each,,37,31.45,10.6042,37,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,33.337,90.1,,percent of total billed charges,,
CEFAZOLIN 2 GRAM INJ SOLR,,J0690,HCPCS,Facility,Inpatient,1,Each,,37,31.45,10.6042,37,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
CEFAZOLIN 2 GRAM INJ SOLR,,J0690,HCPCS,Facility,Both,1,Each,,37,31.45,10.6042,37,"Preferred One Administrative Services, INC.",PPO,36.482,98.6,,percent of total billed charges,,
CEFAZOLIN 2 GRAM INJ SOLR,,J0690,HCPCS,Facility,Outpatient,1,Each,,37,31.45,10.6042,37,PrimeWest Health,Minnesota Senior Health Options (MSHO),19.0365,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
CEFAZOLIN 2 GRAM INJ SOLR,,J0690,HCPCS,Facility,Inpatient,1,Each,,37,31.45,10.6042,37,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CEFAZOLIN 2 GRAM INJ SOLR,,J0690,HCPCS,Facility,Outpatient,1,Each,,37,31.45,10.6042,37,PrimeWest Health,MinnesotaCare,19.0032,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
CEFAZOLIN 2 GRAM INJ SOLR,,J0690,HCPCS,Facility,Inpatient,1,Each,,37,31.45,10.6042,37,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
CEFAZOLIN 2 GRAM INJ SOLR,,J0690,HCPCS,Facility,Both,1,Each,,37,31.45,10.6042,37,Sanford Health Plan,Sanford Health Plan,34.04,92,,percent of total billed charges,,
CEFAZOLIN 2 GRAM INJ SOLR,,J0690,HCPCS,Facility,Outpatient,1,Each,,37,31.45,10.6042,37,"UCare Health, Inc.",Individual & Family Plan,20.8495,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
CEFAZOLIN 2 GRAM INJ SOLR,,J0690,HCPCS,Facility,Inpatient,1,Each,,37,31.45,10.6042,37,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
CEFAZOLIN 2 GRAM INJ SOLR,,J0690,HCPCS,Facility,Outpatient,1,Each,,37,31.45,10.6042,37,"UCare Health, Inc.",Medical Assistance,18.6739,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CEFAZOLIN 2 GRAM INJ SOLR,,J0690,HCPCS,Facility,Inpatient,1,Each,,37,31.45,10.6042,37,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
CEFAZOLIN 2 GRAM INJ SOLR,,J0690,HCPCS,Facility,Outpatient,1,Each,,37,31.45,10.6042,37,"UCare Health, Inc.",Medicare Advantage,18.6739,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CEFAZOLIN 2 GRAM INJ SOLR,,J0690,HCPCS,Facility,Inpatient,1,Each,,37,31.45,10.6042,37,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CEFAZOLIN 2 GRAM INJ SOLR,,J0690,HCPCS,Facility,Outpatient,1,Each,,37,31.45,10.6042,37,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),18.6739,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CEFAZOLIN 2 GRAM INJ SOLR,,J0690,HCPCS,Facility,Inpatient,1,Each,,37,31.45,10.6042,37,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CEFAZOLIN 2 GRAM INJ SOLR,,J0690,HCPCS,Facility,Both,1,Each,,37,31.45,10.6042,37,UnitedHealthcare,Individual & Family,34.78,94,,percent of total billed charges,,
CEFAZOLIN 2 GRAM INJ SOLR,,J0690,HCPCS,Facility,Outpatient,1,Each,,37,31.45,10.6042,37,UnitedHealthcare,Medicare Advantage,18.13,49,,percent of total billed charges,,
CEFAZOLIN 2 GRAM INJ SOLR,,J0690,HCPCS,Facility,Inpatient,1,Each,,37,31.45,10.6042,37,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
CEFAZOLIN 2 GRAM INJ SOLR,,J0690,HCPCS,Facility,Outpatient,1,Each,,37,31.45,10.6042,37,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,17.76,48,,percent of total billed charges,,100% of DHS outpatient percentage
CEFAZOLIN 2 GRAM INJ SOLR,,J0690,HCPCS,Facility,Inpatient,1,Each,,37,31.45,10.6042,37,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
CEFAZOLIN IN DEXTROSE (ISO-OS) 2 GRAM/50 ML IV PGBK,,J0690,HCPCS,Facility,Both,1,Each,,86,73.1,24.6476,86,Aetna,Commercial,79.12,92,,percent of total billed charges,,
CEFAZOLIN IN DEXTROSE (ISO-OS) 2 GRAM/50 ML IV PGBK,,J0690,HCPCS,Facility,Outpatient,1,Each,,86,73.1,24.6476,86,Aetna,Medicare Advantage,42.14,49,,percent of total billed charges,,
CEFAZOLIN IN DEXTROSE (ISO-OS) 2 GRAM/50 ML IV PGBK,,J0690,HCPCS,Facility,Inpatient,1,Each,,86,73.1,24.6476,86,Aetna,Medicare Advantage,,,,,Included in per diem rate,
CEFAZOLIN IN DEXTROSE (ISO-OS) 2 GRAM/50 ML IV PGBK,,J0690,HCPCS,Facility,Both,1,Each,,86,73.1,24.6476,86,Aetna,PPO,79.98,93,,percent of total billed charges,,
CEFAZOLIN IN DEXTROSE (ISO-OS) 2 GRAM/50 ML IV PGBK,,J0690,HCPCS,Facility,Both,1,Each,,86,73.1,24.6476,86,America's PPO,America's PPO,82.5858,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
CEFAZOLIN IN DEXTROSE (ISO-OS) 2 GRAM/50 ML IV PGBK,,J0690,HCPCS,Facility,Both,1,Each,,86,73.1,24.6476,86,BlueCross BlueShield Minnesota, Federal Employee Program,84.624,98.4,,percent of total billed charges,,
CEFAZOLIN IN DEXTROSE (ISO-OS) 2 GRAM/50 ML IV PGBK,,J0690,HCPCS,Facility,Both,1,Each,,86,73.1,24.6476,86,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,86,100,,percent of total billed charges,,
CEFAZOLIN IN DEXTROSE (ISO-OS) 2 GRAM/50 ML IV PGBK,,J0690,HCPCS,Facility,Both,1,Each,,86,73.1,24.6476,86,BlueCross BlueShield Minnesota,High Value Network Plan,77.4,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
CEFAZOLIN IN DEXTROSE (ISO-OS) 2 GRAM/50 ML IV PGBK,,J0690,HCPCS,Facility,Outpatient,1,Each,,86,73.1,24.6476,86,BlueCross BlueShield Minnesota,Medicare Advantage,42.14,49,,percent of total billed charges,,
CEFAZOLIN IN DEXTROSE (ISO-OS) 2 GRAM/50 ML IV PGBK,,J0690,HCPCS,Facility,Inpatient,1,Each,,86,73.1,24.6476,86,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
CEFAZOLIN IN DEXTROSE (ISO-OS) 2 GRAM/50 ML IV PGBK,,J0690,HCPCS,Facility,Both,1,Each,,86,73.1,24.6476,86,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,76.1702,88.57,,percent of total billed charges,,
CEFAZOLIN IN DEXTROSE (ISO-OS) 2 GRAM/50 ML IV PGBK,,J0690,HCPCS,Facility,Both,1,Each,,86,73.1,24.6476,86,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,24.6476,28.66,,percent of total billed charges,,
CEFAZOLIN IN DEXTROSE (ISO-OS) 2 GRAM/50 ML IV PGBK,,J0690,HCPCS,Facility,Outpatient,1,Each,,86,73.1,24.6476,86,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),42.14,49,,percent of total billed charges,,
CEFAZOLIN IN DEXTROSE (ISO-OS) 2 GRAM/50 ML IV PGBK,,J0690,HCPCS,Facility,Inpatient,1,Each,,86,73.1,24.6476,86,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
CEFAZOLIN IN DEXTROSE (ISO-OS) 2 GRAM/50 ML IV PGBK,,J0690,HCPCS,Facility,Both,1,Each,,86,73.1,24.6476,86,CorVel,Worker's Compensation,86,100,,percent of total billed charges,,
CEFAZOLIN IN DEXTROSE (ISO-OS) 2 GRAM/50 ML IV PGBK,,J0690,HCPCS,Facility,Both,1,Each,,86,73.1,24.6476,86,First Health Group Corporation,First Health Network,83.42,97,,percent of total billed charges,,
CEFAZOLIN IN DEXTROSE (ISO-OS) 2 GRAM/50 ML IV PGBK,,J0690,HCPCS,Facility,Both,1,Each,,86,73.1,24.6476,86,"Health Partners, Inc.",Commercial,81.356,94.6,,percent of total billed charges,,
CEFAZOLIN IN DEXTROSE (ISO-OS) 2 GRAM/50 ML IV PGBK,,J0690,HCPCS,Facility,Outpatient,1,Each,,86,73.1,24.6476,86,"Health Partners, Inc.",Medicare Advantage,42.14,49,,percent of total billed charges,,
CEFAZOLIN IN DEXTROSE (ISO-OS) 2 GRAM/50 ML IV PGBK,,J0690,HCPCS,Facility,Inpatient,1,Each,,86,73.1,24.6476,86,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CEFAZOLIN IN DEXTROSE (ISO-OS) 2 GRAM/50 ML IV PGBK,,J0690,HCPCS,Facility,Both,1,Each,,86,73.1,24.6476,86,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),51.6,60,,percent of total billed charges,,
CEFAZOLIN IN DEXTROSE (ISO-OS) 2 GRAM/50 ML IV PGBK,,J0690,HCPCS,Facility,Both,1,Each,,86,73.1,24.6476,86,"Health Partners, Inc.",State of Minnesota Advantage Program,70.09,81.5,,percent of total billed charges,,
CEFAZOLIN IN DEXTROSE (ISO-OS) 2 GRAM/50 ML IV PGBK,,J0690,HCPCS,Facility,Both,1,Each,,86,73.1,24.6476,86,"Health Partners, Inc.",State Public Programs,43,50,,percent of total billed charges,,
CEFAZOLIN IN DEXTROSE (ISO-OS) 2 GRAM/50 ML IV PGBK,,J0690,HCPCS,Facility,Both,1,Each,,86,73.1,24.6476,86,Humana Insurance Company,Commercial PPO,81.7,95,,percent of total billed charges,,
CEFAZOLIN IN DEXTROSE (ISO-OS) 2 GRAM/50 ML IV PGBK,,J0690,HCPCS,Facility,Outpatient,1,Each,,86,73.1,24.6476,86,Humana Insurance Company,Medicare PPO,42.14,49,,percent of total billed charges,,
CEFAZOLIN IN DEXTROSE (ISO-OS) 2 GRAM/50 ML IV PGBK,,J0690,HCPCS,Facility,Inpatient,1,Each,,86,73.1,24.6476,86,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
CEFAZOLIN IN DEXTROSE (ISO-OS) 2 GRAM/50 ML IV PGBK,,J0690,HCPCS,Facility,Both,1,Each,,86,73.1,24.6476,86,Medica,Individual & Family,85.226,99.1,,percent of total billed charges,,
CEFAZOLIN IN DEXTROSE (ISO-OS) 2 GRAM/50 ML IV PGBK,,J0690,HCPCS,Facility,Outpatient,1,Each,,86,73.1,24.6476,86,Medica,Medica Advantage Solution,42.828,49.8,,percent of total billed charges,,
CEFAZOLIN IN DEXTROSE (ISO-OS) 2 GRAM/50 ML IV PGBK,,J0690,HCPCS,Facility,Inpatient,1,Each,,86,73.1,24.6476,86,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
CEFAZOLIN IN DEXTROSE (ISO-OS) 2 GRAM/50 ML IV PGBK,,J0690,HCPCS,Facility,Outpatient,1,Each,,86,73.1,24.6476,86,Medica,Medical Assistance,38.356,44.6,,percent of total billed charges,,
CEFAZOLIN IN DEXTROSE (ISO-OS) 2 GRAM/50 ML IV PGBK,,J0690,HCPCS,Facility,Inpatient,1,Each,,86,73.1,24.6476,86,Medica,Medical Assistance,,,,,Included in per diem rate,
CEFAZOLIN IN DEXTROSE (ISO-OS) 2 GRAM/50 ML IV PGBK,,J0690,HCPCS,Facility,Outpatient,1,Each,,86,73.1,24.6476,86,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,42.828,49.8,,percent of total billed charges,,
CEFAZOLIN IN DEXTROSE (ISO-OS) 2 GRAM/50 ML IV PGBK,,J0690,HCPCS,Facility,Inpatient,1,Each,,86,73.1,24.6476,86,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
CEFAZOLIN IN DEXTROSE (ISO-OS) 2 GRAM/50 ML IV PGBK,,J0690,HCPCS,Facility,Both,1,Each,,86,73.1,24.6476,86,"Multiplan, Inc.","Multiplan, Inc.",80.84,94,,percent of total billed charges,,
CEFAZOLIN IN DEXTROSE (ISO-OS) 2 GRAM/50 ML IV PGBK,,J0690,HCPCS,Facility,Outpatient,1,Each,,86,73.1,24.6476,86,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,77.486,90.1,,percent of total billed charges,,
CEFAZOLIN IN DEXTROSE (ISO-OS) 2 GRAM/50 ML IV PGBK,,J0690,HCPCS,Facility,Inpatient,1,Each,,86,73.1,24.6476,86,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
CEFAZOLIN IN DEXTROSE (ISO-OS) 2 GRAM/50 ML IV PGBK,,J0690,HCPCS,Facility,Both,1,Each,,86,73.1,24.6476,86,"Preferred One Administrative Services, INC.",PPO,84.796,98.6,,percent of total billed charges,,
CEFAZOLIN IN DEXTROSE (ISO-OS) 2 GRAM/50 ML IV PGBK,,J0690,HCPCS,Facility,Outpatient,1,Each,,86,73.1,24.6476,86,PrimeWest Health,Minnesota Senior Health Options (MSHO),44.247,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
CEFAZOLIN IN DEXTROSE (ISO-OS) 2 GRAM/50 ML IV PGBK,,J0690,HCPCS,Facility,Inpatient,1,Each,,86,73.1,24.6476,86,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CEFAZOLIN IN DEXTROSE (ISO-OS) 2 GRAM/50 ML IV PGBK,,J0690,HCPCS,Facility,Outpatient,1,Each,,86,73.1,24.6476,86,PrimeWest Health,MinnesotaCare,44.1696,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
CEFAZOLIN IN DEXTROSE (ISO-OS) 2 GRAM/50 ML IV PGBK,,J0690,HCPCS,Facility,Inpatient,1,Each,,86,73.1,24.6476,86,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
CEFAZOLIN IN DEXTROSE (ISO-OS) 2 GRAM/50 ML IV PGBK,,J0690,HCPCS,Facility,Both,1,Each,,86,73.1,24.6476,86,Sanford Health Plan,Sanford Health Plan,79.12,92,,percent of total billed charges,,
CEFAZOLIN IN DEXTROSE (ISO-OS) 2 GRAM/50 ML IV PGBK,,J0690,HCPCS,Facility,Outpatient,1,Each,,86,73.1,24.6476,86,"UCare Health, Inc.",Individual & Family Plan,48.461,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
CEFAZOLIN IN DEXTROSE (ISO-OS) 2 GRAM/50 ML IV PGBK,,J0690,HCPCS,Facility,Inpatient,1,Each,,86,73.1,24.6476,86,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
CEFAZOLIN IN DEXTROSE (ISO-OS) 2 GRAM/50 ML IV PGBK,,J0690,HCPCS,Facility,Outpatient,1,Each,,86,73.1,24.6476,86,"UCare Health, Inc.",Medical Assistance,43.4042,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CEFAZOLIN IN DEXTROSE (ISO-OS) 2 GRAM/50 ML IV PGBK,,J0690,HCPCS,Facility,Inpatient,1,Each,,86,73.1,24.6476,86,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
CEFAZOLIN IN DEXTROSE (ISO-OS) 2 GRAM/50 ML IV PGBK,,J0690,HCPCS,Facility,Outpatient,1,Each,,86,73.1,24.6476,86,"UCare Health, Inc.",Medicare Advantage,43.4042,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CEFAZOLIN IN DEXTROSE (ISO-OS) 2 GRAM/50 ML IV PGBK,,J0690,HCPCS,Facility,Inpatient,1,Each,,86,73.1,24.6476,86,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CEFAZOLIN IN DEXTROSE (ISO-OS) 2 GRAM/50 ML IV PGBK,,J0690,HCPCS,Facility,Outpatient,1,Each,,86,73.1,24.6476,86,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),43.4042,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CEFAZOLIN IN DEXTROSE (ISO-OS) 2 GRAM/50 ML IV PGBK,,J0690,HCPCS,Facility,Inpatient,1,Each,,86,73.1,24.6476,86,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CEFAZOLIN IN DEXTROSE (ISO-OS) 2 GRAM/50 ML IV PGBK,,J0690,HCPCS,Facility,Both,1,Each,,86,73.1,24.6476,86,UnitedHealthcare,Individual & Family,80.84,94,,percent of total billed charges,,
CEFAZOLIN IN DEXTROSE (ISO-OS) 2 GRAM/50 ML IV PGBK,,J0690,HCPCS,Facility,Outpatient,1,Each,,86,73.1,24.6476,86,UnitedHealthcare,Medicare Advantage,42.14,49,,percent of total billed charges,,
CEFAZOLIN IN DEXTROSE (ISO-OS) 2 GRAM/50 ML IV PGBK,,J0690,HCPCS,Facility,Inpatient,1,Each,,86,73.1,24.6476,86,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
CEFAZOLIN IN DEXTROSE (ISO-OS) 2 GRAM/50 ML IV PGBK,,J0690,HCPCS,Facility,Outpatient,1,Each,,86,73.1,24.6476,86,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,41.28,48,,percent of total billed charges,,100% of DHS outpatient percentage
CEFAZOLIN IN DEXTROSE (ISO-OS) 2 GRAM/50 ML IV PGBK,,J0690,HCPCS,Facility,Inpatient,1,Each,,86,73.1,24.6476,86,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
CEFEPIME 1 GRAM INJ SOLR,,J0692,HCPCS,Facility,Both,1,Each,,35,29.75,10.031,35,Aetna,Commercial,32.2,92,,percent of total billed charges,,
CEFEPIME 1 GRAM INJ SOLR,,J0692,HCPCS,Facility,Outpatient,1,Each,,35,29.75,10.031,35,Aetna,Medicare Advantage,17.15,49,,percent of total billed charges,,
CEFEPIME 1 GRAM INJ SOLR,,J0692,HCPCS,Facility,Inpatient,1,Each,,35,29.75,10.031,35,Aetna,Medicare Advantage,,,,,Included in per diem rate,
CEFEPIME 1 GRAM INJ SOLR,,J0692,HCPCS,Facility,Both,1,Each,,35,29.75,10.031,35,Aetna,PPO,32.55,93,,percent of total billed charges,,
CEFEPIME 1 GRAM INJ SOLR,,J0692,HCPCS,Facility,Both,1,Each,,35,29.75,10.031,35,America's PPO,America's PPO,33.6105,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
CEFEPIME 1 GRAM INJ SOLR,,J0692,HCPCS,Facility,Both,1,Each,,35,29.75,10.031,35,BlueCross BlueShield Minnesota, Federal Employee Program,34.44,98.4,,percent of total billed charges,,
CEFEPIME 1 GRAM INJ SOLR,,J0692,HCPCS,Facility,Both,1,Each,,35,29.75,10.031,35,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,35,100,,percent of total billed charges,,
CEFEPIME 1 GRAM INJ SOLR,,J0692,HCPCS,Facility,Both,1,Each,,35,29.75,10.031,35,BlueCross BlueShield Minnesota,High Value Network Plan,31.5,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
CEFEPIME 1 GRAM INJ SOLR,,J0692,HCPCS,Facility,Outpatient,1,Each,,35,29.75,10.031,35,BlueCross BlueShield Minnesota,Medicare Advantage,17.15,49,,percent of total billed charges,,
CEFEPIME 1 GRAM INJ SOLR,,J0692,HCPCS,Facility,Inpatient,1,Each,,35,29.75,10.031,35,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
CEFEPIME 1 GRAM INJ SOLR,,J0692,HCPCS,Facility,Both,1,Each,,35,29.75,10.031,35,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,30.9995,88.57,,percent of total billed charges,,
CEFEPIME 1 GRAM INJ SOLR,,J0692,HCPCS,Facility,Both,1,Each,,35,29.75,10.031,35,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,10.031,28.66,,percent of total billed charges,,
CEFEPIME 1 GRAM INJ SOLR,,J0692,HCPCS,Facility,Outpatient,1,Each,,35,29.75,10.031,35,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),17.15,49,,percent of total billed charges,,
CEFEPIME 1 GRAM INJ SOLR,,J0692,HCPCS,Facility,Inpatient,1,Each,,35,29.75,10.031,35,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
CEFEPIME 1 GRAM INJ SOLR,,J0692,HCPCS,Facility,Both,1,Each,,35,29.75,10.031,35,CorVel,Worker's Compensation,35,100,,percent of total billed charges,,
CEFEPIME 1 GRAM INJ SOLR,,J0692,HCPCS,Facility,Both,1,Each,,35,29.75,10.031,35,First Health Group Corporation,First Health Network,33.95,97,,percent of total billed charges,,
CEFEPIME 1 GRAM INJ SOLR,,J0692,HCPCS,Facility,Both,1,Each,,35,29.75,10.031,35,"Health Partners, Inc.",Commercial,33.11,94.6,,percent of total billed charges,,
CEFEPIME 1 GRAM INJ SOLR,,J0692,HCPCS,Facility,Outpatient,1,Each,,35,29.75,10.031,35,"Health Partners, Inc.",Medicare Advantage,17.15,49,,percent of total billed charges,,
CEFEPIME 1 GRAM INJ SOLR,,J0692,HCPCS,Facility,Inpatient,1,Each,,35,29.75,10.031,35,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CEFEPIME 1 GRAM INJ SOLR,,J0692,HCPCS,Facility,Both,1,Each,,35,29.75,10.031,35,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),21,60,,percent of total billed charges,,
CEFEPIME 1 GRAM INJ SOLR,,J0692,HCPCS,Facility,Both,1,Each,,35,29.75,10.031,35,"Health Partners, Inc.",State of Minnesota Advantage Program,28.525,81.5,,percent of total billed charges,,
CEFEPIME 1 GRAM INJ SOLR,,J0692,HCPCS,Facility,Both,1,Each,,35,29.75,10.031,35,"Health Partners, Inc.",State Public Programs,17.5,50,,percent of total billed charges,,
CEFEPIME 1 GRAM INJ SOLR,,J0692,HCPCS,Facility,Both,1,Each,,35,29.75,10.031,35,Humana Insurance Company,Commercial PPO,33.25,95,,percent of total billed charges,,
CEFEPIME 1 GRAM INJ SOLR,,J0692,HCPCS,Facility,Outpatient,1,Each,,35,29.75,10.031,35,Humana Insurance Company,Medicare PPO,17.15,49,,percent of total billed charges,,
CEFEPIME 1 GRAM INJ SOLR,,J0692,HCPCS,Facility,Inpatient,1,Each,,35,29.75,10.031,35,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
CEFEPIME 1 GRAM INJ SOLR,,J0692,HCPCS,Facility,Both,1,Each,,35,29.75,10.031,35,Medica,Individual & Family,34.685,99.1,,percent of total billed charges,,
CEFEPIME 1 GRAM INJ SOLR,,J0692,HCPCS,Facility,Outpatient,1,Each,,35,29.75,10.031,35,Medica,Medica Advantage Solution,17.43,49.8,,percent of total billed charges,,
CEFEPIME 1 GRAM INJ SOLR,,J0692,HCPCS,Facility,Inpatient,1,Each,,35,29.75,10.031,35,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
CEFEPIME 1 GRAM INJ SOLR,,J0692,HCPCS,Facility,Outpatient,1,Each,,35,29.75,10.031,35,Medica,Medical Assistance,15.61,44.6,,percent of total billed charges,,
CEFEPIME 1 GRAM INJ SOLR,,J0692,HCPCS,Facility,Inpatient,1,Each,,35,29.75,10.031,35,Medica,Medical Assistance,,,,,Included in per diem rate,
CEFEPIME 1 GRAM INJ SOLR,,J0692,HCPCS,Facility,Outpatient,1,Each,,35,29.75,10.031,35,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,17.43,49.8,,percent of total billed charges,,
CEFEPIME 1 GRAM INJ SOLR,,J0692,HCPCS,Facility,Inpatient,1,Each,,35,29.75,10.031,35,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
CEFEPIME 1 GRAM INJ SOLR,,J0692,HCPCS,Facility,Both,1,Each,,35,29.75,10.031,35,"Multiplan, Inc.","Multiplan, Inc.",32.9,94,,percent of total billed charges,,
CEFEPIME 1 GRAM INJ SOLR,,J0692,HCPCS,Facility,Outpatient,1,Each,,35,29.75,10.031,35,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,31.535,90.1,,percent of total billed charges,,
CEFEPIME 1 GRAM INJ SOLR,,J0692,HCPCS,Facility,Inpatient,1,Each,,35,29.75,10.031,35,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
CEFEPIME 1 GRAM INJ SOLR,,J0692,HCPCS,Facility,Both,1,Each,,35,29.75,10.031,35,"Preferred One Administrative Services, INC.",PPO,34.51,98.6,,percent of total billed charges,,
CEFEPIME 1 GRAM INJ SOLR,,J0692,HCPCS,Facility,Outpatient,1,Each,,35,29.75,10.031,35,PrimeWest Health,Minnesota Senior Health Options (MSHO),18.0075,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
CEFEPIME 1 GRAM INJ SOLR,,J0692,HCPCS,Facility,Inpatient,1,Each,,35,29.75,10.031,35,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CEFEPIME 1 GRAM INJ SOLR,,J0692,HCPCS,Facility,Outpatient,1,Each,,35,29.75,10.031,35,PrimeWest Health,MinnesotaCare,17.976,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
CEFEPIME 1 GRAM INJ SOLR,,J0692,HCPCS,Facility,Inpatient,1,Each,,35,29.75,10.031,35,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
CEFEPIME 1 GRAM INJ SOLR,,J0692,HCPCS,Facility,Both,1,Each,,35,29.75,10.031,35,Sanford Health Plan,Sanford Health Plan,32.2,92,,percent of total billed charges,,
CEFEPIME 1 GRAM INJ SOLR,,J0692,HCPCS,Facility,Outpatient,1,Each,,35,29.75,10.031,35,"UCare Health, Inc.",Individual & Family Plan,19.7225,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
CEFEPIME 1 GRAM INJ SOLR,,J0692,HCPCS,Facility,Inpatient,1,Each,,35,29.75,10.031,35,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
CEFEPIME 1 GRAM INJ SOLR,,J0692,HCPCS,Facility,Outpatient,1,Each,,35,29.75,10.031,35,"UCare Health, Inc.",Medical Assistance,17.6645,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CEFEPIME 1 GRAM INJ SOLR,,J0692,HCPCS,Facility,Inpatient,1,Each,,35,29.75,10.031,35,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
CEFEPIME 1 GRAM INJ SOLR,,J0692,HCPCS,Facility,Outpatient,1,Each,,35,29.75,10.031,35,"UCare Health, Inc.",Medicare Advantage,17.6645,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CEFEPIME 1 GRAM INJ SOLR,,J0692,HCPCS,Facility,Inpatient,1,Each,,35,29.75,10.031,35,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CEFEPIME 1 GRAM INJ SOLR,,J0692,HCPCS,Facility,Outpatient,1,Each,,35,29.75,10.031,35,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),17.6645,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CEFEPIME 1 GRAM INJ SOLR,,J0692,HCPCS,Facility,Inpatient,1,Each,,35,29.75,10.031,35,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CEFEPIME 1 GRAM INJ SOLR,,J0692,HCPCS,Facility,Both,1,Each,,35,29.75,10.031,35,UnitedHealthcare,Individual & Family,32.9,94,,percent of total billed charges,,
CEFEPIME 1 GRAM INJ SOLR,,J0692,HCPCS,Facility,Outpatient,1,Each,,35,29.75,10.031,35,UnitedHealthcare,Medicare Advantage,17.15,49,,percent of total billed charges,,
CEFEPIME 1 GRAM INJ SOLR,,J0692,HCPCS,Facility,Inpatient,1,Each,,35,29.75,10.031,35,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
CEFEPIME 1 GRAM INJ SOLR,,J0692,HCPCS,Facility,Outpatient,1,Each,,35,29.75,10.031,35,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,16.8,48,,percent of total billed charges,,100% of DHS outpatient percentage
CEFEPIME 1 GRAM INJ SOLR,,J0692,HCPCS,Facility,Inpatient,1,Each,,35,29.75,10.031,35,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
CEFEPIME 2 GRAM INJ SOLR,,J0692,HCPCS,Facility,Both,1,Each,,182,154.7,52.1612,182,Aetna,Commercial,167.44,92,,percent of total billed charges,,
CEFEPIME 2 GRAM INJ SOLR,,J0692,HCPCS,Facility,Outpatient,1,Each,,182,154.7,52.1612,182,Aetna,Medicare Advantage,89.18,49,,percent of total billed charges,,
CEFEPIME 2 GRAM INJ SOLR,,J0692,HCPCS,Facility,Inpatient,1,Each,,182,154.7,52.1612,182,Aetna,Medicare Advantage,,,,,Included in per diem rate,
CEFEPIME 2 GRAM INJ SOLR,,J0692,HCPCS,Facility,Both,1,Each,,182,154.7,52.1612,182,Aetna,PPO,169.26,93,,percent of total billed charges,,
CEFEPIME 2 GRAM INJ SOLR,,J0692,HCPCS,Facility,Both,1,Each,,182,154.7,52.1612,182,America's PPO,America's PPO,174.7746,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
CEFEPIME 2 GRAM INJ SOLR,,J0692,HCPCS,Facility,Both,1,Each,,182,154.7,52.1612,182,BlueCross BlueShield Minnesota, Federal Employee Program,179.088,98.4,,percent of total billed charges,,
CEFEPIME 2 GRAM INJ SOLR,,J0692,HCPCS,Facility,Both,1,Each,,182,154.7,52.1612,182,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,182,100,,percent of total billed charges,,
CEFEPIME 2 GRAM INJ SOLR,,J0692,HCPCS,Facility,Both,1,Each,,182,154.7,52.1612,182,BlueCross BlueShield Minnesota,High Value Network Plan,163.8,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
CEFEPIME 2 GRAM INJ SOLR,,J0692,HCPCS,Facility,Outpatient,1,Each,,182,154.7,52.1612,182,BlueCross BlueShield Minnesota,Medicare Advantage,89.18,49,,percent of total billed charges,,
CEFEPIME 2 GRAM INJ SOLR,,J0692,HCPCS,Facility,Inpatient,1,Each,,182,154.7,52.1612,182,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
CEFEPIME 2 GRAM INJ SOLR,,J0692,HCPCS,Facility,Both,1,Each,,182,154.7,52.1612,182,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,161.1974,88.57,,percent of total billed charges,,
CEFEPIME 2 GRAM INJ SOLR,,J0692,HCPCS,Facility,Both,1,Each,,182,154.7,52.1612,182,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,52.1612,28.66,,percent of total billed charges,,
CEFEPIME 2 GRAM INJ SOLR,,J0692,HCPCS,Facility,Outpatient,1,Each,,182,154.7,52.1612,182,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),89.18,49,,percent of total billed charges,,
CEFEPIME 2 GRAM INJ SOLR,,J0692,HCPCS,Facility,Inpatient,1,Each,,182,154.7,52.1612,182,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
CEFEPIME 2 GRAM INJ SOLR,,J0692,HCPCS,Facility,Both,1,Each,,182,154.7,52.1612,182,CorVel,Worker's Compensation,182,100,,percent of total billed charges,,
CEFEPIME 2 GRAM INJ SOLR,,J0692,HCPCS,Facility,Both,1,Each,,182,154.7,52.1612,182,First Health Group Corporation,First Health Network,176.54,97,,percent of total billed charges,,
CEFEPIME 2 GRAM INJ SOLR,,J0692,HCPCS,Facility,Both,1,Each,,182,154.7,52.1612,182,"Health Partners, Inc.",Commercial,172.172,94.6,,percent of total billed charges,,
CEFEPIME 2 GRAM INJ SOLR,,J0692,HCPCS,Facility,Outpatient,1,Each,,182,154.7,52.1612,182,"Health Partners, Inc.",Medicare Advantage,89.18,49,,percent of total billed charges,,
CEFEPIME 2 GRAM INJ SOLR,,J0692,HCPCS,Facility,Inpatient,1,Each,,182,154.7,52.1612,182,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CEFEPIME 2 GRAM INJ SOLR,,J0692,HCPCS,Facility,Both,1,Each,,182,154.7,52.1612,182,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),109.2,60,,percent of total billed charges,,
CEFEPIME 2 GRAM INJ SOLR,,J0692,HCPCS,Facility,Both,1,Each,,182,154.7,52.1612,182,"Health Partners, Inc.",State of Minnesota Advantage Program,148.33,81.5,,percent of total billed charges,,
CEFEPIME 2 GRAM INJ SOLR,,J0692,HCPCS,Facility,Both,1,Each,,182,154.7,52.1612,182,"Health Partners, Inc.",State Public Programs,91,50,,percent of total billed charges,,
CEFEPIME 2 GRAM INJ SOLR,,J0692,HCPCS,Facility,Both,1,Each,,182,154.7,52.1612,182,Humana Insurance Company,Commercial PPO,172.9,95,,percent of total billed charges,,
CEFEPIME 2 GRAM INJ SOLR,,J0692,HCPCS,Facility,Outpatient,1,Each,,182,154.7,52.1612,182,Humana Insurance Company,Medicare PPO,89.18,49,,percent of total billed charges,,
CEFEPIME 2 GRAM INJ SOLR,,J0692,HCPCS,Facility,Inpatient,1,Each,,182,154.7,52.1612,182,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
CEFEPIME 2 GRAM INJ SOLR,,J0692,HCPCS,Facility,Both,1,Each,,182,154.7,52.1612,182,Medica,Individual & Family,180.362,99.1,,percent of total billed charges,,
CEFEPIME 2 GRAM INJ SOLR,,J0692,HCPCS,Facility,Outpatient,1,Each,,182,154.7,52.1612,182,Medica,Medica Advantage Solution,90.636,49.8,,percent of total billed charges,,
CEFEPIME 2 GRAM INJ SOLR,,J0692,HCPCS,Facility,Inpatient,1,Each,,182,154.7,52.1612,182,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
CEFEPIME 2 GRAM INJ SOLR,,J0692,HCPCS,Facility,Outpatient,1,Each,,182,154.7,52.1612,182,Medica,Medical Assistance,81.172,44.6,,percent of total billed charges,,
CEFEPIME 2 GRAM INJ SOLR,,J0692,HCPCS,Facility,Inpatient,1,Each,,182,154.7,52.1612,182,Medica,Medical Assistance,,,,,Included in per diem rate,
CEFEPIME 2 GRAM INJ SOLR,,J0692,HCPCS,Facility,Outpatient,1,Each,,182,154.7,52.1612,182,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,90.636,49.8,,percent of total billed charges,,
CEFEPIME 2 GRAM INJ SOLR,,J0692,HCPCS,Facility,Inpatient,1,Each,,182,154.7,52.1612,182,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
CEFEPIME 2 GRAM INJ SOLR,,J0692,HCPCS,Facility,Both,1,Each,,182,154.7,52.1612,182,"Multiplan, Inc.","Multiplan, Inc.",171.08,94,,percent of total billed charges,,
CEFEPIME 2 GRAM INJ SOLR,,J0692,HCPCS,Facility,Outpatient,1,Each,,182,154.7,52.1612,182,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,163.982,90.1,,percent of total billed charges,,
CEFEPIME 2 GRAM INJ SOLR,,J0692,HCPCS,Facility,Inpatient,1,Each,,182,154.7,52.1612,182,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
CEFEPIME 2 GRAM INJ SOLR,,J0692,HCPCS,Facility,Both,1,Each,,182,154.7,52.1612,182,"Preferred One Administrative Services, INC.",PPO,179.452,98.6,,percent of total billed charges,,
CEFEPIME 2 GRAM INJ SOLR,,J0692,HCPCS,Facility,Outpatient,1,Each,,182,154.7,52.1612,182,PrimeWest Health,Minnesota Senior Health Options (MSHO),93.639,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
CEFEPIME 2 GRAM INJ SOLR,,J0692,HCPCS,Facility,Inpatient,1,Each,,182,154.7,52.1612,182,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CEFEPIME 2 GRAM INJ SOLR,,J0692,HCPCS,Facility,Outpatient,1,Each,,182,154.7,52.1612,182,PrimeWest Health,MinnesotaCare,93.4752,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
CEFEPIME 2 GRAM INJ SOLR,,J0692,HCPCS,Facility,Inpatient,1,Each,,182,154.7,52.1612,182,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
CEFEPIME 2 GRAM INJ SOLR,,J0692,HCPCS,Facility,Both,1,Each,,182,154.7,52.1612,182,Sanford Health Plan,Sanford Health Plan,167.44,92,,percent of total billed charges,,
CEFEPIME 2 GRAM INJ SOLR,,J0692,HCPCS,Facility,Outpatient,1,Each,,182,154.7,52.1612,182,"UCare Health, Inc.",Individual & Family Plan,102.557,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
CEFEPIME 2 GRAM INJ SOLR,,J0692,HCPCS,Facility,Inpatient,1,Each,,182,154.7,52.1612,182,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
CEFEPIME 2 GRAM INJ SOLR,,J0692,HCPCS,Facility,Outpatient,1,Each,,182,154.7,52.1612,182,"UCare Health, Inc.",Medical Assistance,91.8554,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CEFEPIME 2 GRAM INJ SOLR,,J0692,HCPCS,Facility,Inpatient,1,Each,,182,154.7,52.1612,182,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
CEFEPIME 2 GRAM INJ SOLR,,J0692,HCPCS,Facility,Outpatient,1,Each,,182,154.7,52.1612,182,"UCare Health, Inc.",Medicare Advantage,91.8554,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CEFEPIME 2 GRAM INJ SOLR,,J0692,HCPCS,Facility,Inpatient,1,Each,,182,154.7,52.1612,182,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CEFEPIME 2 GRAM INJ SOLR,,J0692,HCPCS,Facility,Outpatient,1,Each,,182,154.7,52.1612,182,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),91.8554,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CEFEPIME 2 GRAM INJ SOLR,,J0692,HCPCS,Facility,Inpatient,1,Each,,182,154.7,52.1612,182,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CEFEPIME 2 GRAM INJ SOLR,,J0692,HCPCS,Facility,Both,1,Each,,182,154.7,52.1612,182,UnitedHealthcare,Individual & Family,171.08,94,,percent of total billed charges,,
CEFEPIME 2 GRAM INJ SOLR,,J0692,HCPCS,Facility,Outpatient,1,Each,,182,154.7,52.1612,182,UnitedHealthcare,Medicare Advantage,89.18,49,,percent of total billed charges,,
CEFEPIME 2 GRAM INJ SOLR,,J0692,HCPCS,Facility,Inpatient,1,Each,,182,154.7,52.1612,182,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
CEFEPIME 2 GRAM INJ SOLR,,J0692,HCPCS,Facility,Outpatient,1,Each,,182,154.7,52.1612,182,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,87.36,48,,percent of total billed charges,,100% of DHS outpatient percentage
CEFEPIME 2 GRAM INJ SOLR,,J0692,HCPCS,Facility,Inpatient,1,Each,,182,154.7,52.1612,182,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
CEFOXITIN 1 GRAM IV SOLR,,J0694,HCPCS,Facility,Both,1,Each,,58,49.3,16.6228,58,Aetna,Commercial,53.36,92,,percent of total billed charges,,
CEFOXITIN 1 GRAM IV SOLR,,J0694,HCPCS,Facility,Outpatient,1,Each,,58,49.3,16.6228,58,Aetna,Medicare Advantage,28.42,49,,percent of total billed charges,,
CEFOXITIN 1 GRAM IV SOLR,,J0694,HCPCS,Facility,Inpatient,1,Each,,58,49.3,16.6228,58,Aetna,Medicare Advantage,,,,,Included in per diem rate,
CEFOXITIN 1 GRAM IV SOLR,,J0694,HCPCS,Facility,Both,1,Each,,58,49.3,16.6228,58,Aetna,PPO,53.94,93,,percent of total billed charges,,
CEFOXITIN 1 GRAM IV SOLR,,J0694,HCPCS,Facility,Both,1,Each,,58,49.3,16.6228,58,America's PPO,America's PPO,55.6974,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
CEFOXITIN 1 GRAM IV SOLR,,J0694,HCPCS,Facility,Both,1,Each,,58,49.3,16.6228,58,BlueCross BlueShield Minnesota, Federal Employee Program,57.072,98.4,,percent of total billed charges,,
CEFOXITIN 1 GRAM IV SOLR,,J0694,HCPCS,Facility,Both,1,Each,,58,49.3,16.6228,58,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,58,100,,percent of total billed charges,,
CEFOXITIN 1 GRAM IV SOLR,,J0694,HCPCS,Facility,Both,1,Each,,58,49.3,16.6228,58,BlueCross BlueShield Minnesota,High Value Network Plan,52.2,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
CEFOXITIN 1 GRAM IV SOLR,,J0694,HCPCS,Facility,Outpatient,1,Each,,58,49.3,16.6228,58,BlueCross BlueShield Minnesota,Medicare Advantage,28.42,49,,percent of total billed charges,,
CEFOXITIN 1 GRAM IV SOLR,,J0694,HCPCS,Facility,Inpatient,1,Each,,58,49.3,16.6228,58,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
CEFOXITIN 1 GRAM IV SOLR,,J0694,HCPCS,Facility,Both,1,Each,,58,49.3,16.6228,58,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,51.3706,88.57,,percent of total billed charges,,
CEFOXITIN 1 GRAM IV SOLR,,J0694,HCPCS,Facility,Both,1,Each,,58,49.3,16.6228,58,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,16.6228,28.66,,percent of total billed charges,,
CEFOXITIN 1 GRAM IV SOLR,,J0694,HCPCS,Facility,Outpatient,1,Each,,58,49.3,16.6228,58,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),28.42,49,,percent of total billed charges,,
CEFOXITIN 1 GRAM IV SOLR,,J0694,HCPCS,Facility,Inpatient,1,Each,,58,49.3,16.6228,58,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
CEFOXITIN 1 GRAM IV SOLR,,J0694,HCPCS,Facility,Both,1,Each,,58,49.3,16.6228,58,CorVel,Worker's Compensation,58,100,,percent of total billed charges,,
CEFOXITIN 1 GRAM IV SOLR,,J0694,HCPCS,Facility,Both,1,Each,,58,49.3,16.6228,58,First Health Group Corporation,First Health Network,56.26,97,,percent of total billed charges,,
CEFOXITIN 1 GRAM IV SOLR,,J0694,HCPCS,Facility,Both,1,Each,,58,49.3,16.6228,58,"Health Partners, Inc.",Commercial,54.868,94.6,,percent of total billed charges,,
CEFOXITIN 1 GRAM IV SOLR,,J0694,HCPCS,Facility,Outpatient,1,Each,,58,49.3,16.6228,58,"Health Partners, Inc.",Medicare Advantage,28.42,49,,percent of total billed charges,,
CEFOXITIN 1 GRAM IV SOLR,,J0694,HCPCS,Facility,Inpatient,1,Each,,58,49.3,16.6228,58,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CEFOXITIN 1 GRAM IV SOLR,,J0694,HCPCS,Facility,Both,1,Each,,58,49.3,16.6228,58,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),34.8,60,,percent of total billed charges,,
CEFOXITIN 1 GRAM IV SOLR,,J0694,HCPCS,Facility,Both,1,Each,,58,49.3,16.6228,58,"Health Partners, Inc.",State of Minnesota Advantage Program,47.27,81.5,,percent of total billed charges,,
CEFOXITIN 1 GRAM IV SOLR,,J0694,HCPCS,Facility,Both,1,Each,,58,49.3,16.6228,58,"Health Partners, Inc.",State Public Programs,29,50,,percent of total billed charges,,
CEFOXITIN 1 GRAM IV SOLR,,J0694,HCPCS,Facility,Both,1,Each,,58,49.3,16.6228,58,Humana Insurance Company,Commercial PPO,55.1,95,,percent of total billed charges,,
CEFOXITIN 1 GRAM IV SOLR,,J0694,HCPCS,Facility,Outpatient,1,Each,,58,49.3,16.6228,58,Humana Insurance Company,Medicare PPO,28.42,49,,percent of total billed charges,,
CEFOXITIN 1 GRAM IV SOLR,,J0694,HCPCS,Facility,Inpatient,1,Each,,58,49.3,16.6228,58,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
CEFOXITIN 1 GRAM IV SOLR,,J0694,HCPCS,Facility,Both,1,Each,,58,49.3,16.6228,58,Medica,Individual & Family,57.478,99.1,,percent of total billed charges,,
CEFOXITIN 1 GRAM IV SOLR,,J0694,HCPCS,Facility,Outpatient,1,Each,,58,49.3,16.6228,58,Medica,Medica Advantage Solution,28.884,49.8,,percent of total billed charges,,
CEFOXITIN 1 GRAM IV SOLR,,J0694,HCPCS,Facility,Inpatient,1,Each,,58,49.3,16.6228,58,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
CEFOXITIN 1 GRAM IV SOLR,,J0694,HCPCS,Facility,Outpatient,1,Each,,58,49.3,16.6228,58,Medica,Medical Assistance,25.868,44.6,,percent of total billed charges,,
CEFOXITIN 1 GRAM IV SOLR,,J0694,HCPCS,Facility,Inpatient,1,Each,,58,49.3,16.6228,58,Medica,Medical Assistance,,,,,Included in per diem rate,
CEFOXITIN 1 GRAM IV SOLR,,J0694,HCPCS,Facility,Outpatient,1,Each,,58,49.3,16.6228,58,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,28.884,49.8,,percent of total billed charges,,
CEFOXITIN 1 GRAM IV SOLR,,J0694,HCPCS,Facility,Inpatient,1,Each,,58,49.3,16.6228,58,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
CEFOXITIN 1 GRAM IV SOLR,,J0694,HCPCS,Facility,Both,1,Each,,58,49.3,16.6228,58,"Multiplan, Inc.","Multiplan, Inc.",54.52,94,,percent of total billed charges,,
CEFOXITIN 1 GRAM IV SOLR,,J0694,HCPCS,Facility,Outpatient,1,Each,,58,49.3,16.6228,58,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,52.258,90.1,,percent of total billed charges,,
CEFOXITIN 1 GRAM IV SOLR,,J0694,HCPCS,Facility,Inpatient,1,Each,,58,49.3,16.6228,58,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
CEFOXITIN 1 GRAM IV SOLR,,J0694,HCPCS,Facility,Both,1,Each,,58,49.3,16.6228,58,"Preferred One Administrative Services, INC.",PPO,57.188,98.6,,percent of total billed charges,,
CEFOXITIN 1 GRAM IV SOLR,,J0694,HCPCS,Facility,Outpatient,1,Each,,58,49.3,16.6228,58,PrimeWest Health,Minnesota Senior Health Options (MSHO),29.841,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
CEFOXITIN 1 GRAM IV SOLR,,J0694,HCPCS,Facility,Inpatient,1,Each,,58,49.3,16.6228,58,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CEFOXITIN 1 GRAM IV SOLR,,J0694,HCPCS,Facility,Outpatient,1,Each,,58,49.3,16.6228,58,PrimeWest Health,MinnesotaCare,29.7888,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
CEFOXITIN 1 GRAM IV SOLR,,J0694,HCPCS,Facility,Inpatient,1,Each,,58,49.3,16.6228,58,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
CEFOXITIN 1 GRAM IV SOLR,,J0694,HCPCS,Facility,Both,1,Each,,58,49.3,16.6228,58,Sanford Health Plan,Sanford Health Plan,53.36,92,,percent of total billed charges,,
CEFOXITIN 1 GRAM IV SOLR,,J0694,HCPCS,Facility,Outpatient,1,Each,,58,49.3,16.6228,58,"UCare Health, Inc.",Individual & Family Plan,32.683,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
CEFOXITIN 1 GRAM IV SOLR,,J0694,HCPCS,Facility,Inpatient,1,Each,,58,49.3,16.6228,58,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
CEFOXITIN 1 GRAM IV SOLR,,J0694,HCPCS,Facility,Outpatient,1,Each,,58,49.3,16.6228,58,"UCare Health, Inc.",Medical Assistance,29.2726,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CEFOXITIN 1 GRAM IV SOLR,,J0694,HCPCS,Facility,Inpatient,1,Each,,58,49.3,16.6228,58,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
CEFOXITIN 1 GRAM IV SOLR,,J0694,HCPCS,Facility,Outpatient,1,Each,,58,49.3,16.6228,58,"UCare Health, Inc.",Medicare Advantage,29.2726,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CEFOXITIN 1 GRAM IV SOLR,,J0694,HCPCS,Facility,Inpatient,1,Each,,58,49.3,16.6228,58,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CEFOXITIN 1 GRAM IV SOLR,,J0694,HCPCS,Facility,Outpatient,1,Each,,58,49.3,16.6228,58,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),29.2726,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CEFOXITIN 1 GRAM IV SOLR,,J0694,HCPCS,Facility,Inpatient,1,Each,,58,49.3,16.6228,58,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CEFOXITIN 1 GRAM IV SOLR,,J0694,HCPCS,Facility,Both,1,Each,,58,49.3,16.6228,58,UnitedHealthcare,Individual & Family,54.52,94,,percent of total billed charges,,
CEFOXITIN 1 GRAM IV SOLR,,J0694,HCPCS,Facility,Outpatient,1,Each,,58,49.3,16.6228,58,UnitedHealthcare,Medicare Advantage,28.42,49,,percent of total billed charges,,
CEFOXITIN 1 GRAM IV SOLR,,J0694,HCPCS,Facility,Inpatient,1,Each,,58,49.3,16.6228,58,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
CEFOXITIN 1 GRAM IV SOLR,,J0694,HCPCS,Facility,Outpatient,1,Each,,58,49.3,16.6228,58,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,27.84,48,,percent of total billed charges,,100% of DHS outpatient percentage
CEFOXITIN 1 GRAM IV SOLR,,J0694,HCPCS,Facility,Inpatient,1,Each,,58,49.3,16.6228,58,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
CEFOXITIN 2 GRAM IV SOLR,,J0694,HCPCS,Facility,Both,1,Each,,58,49.3,16.6228,58,Aetna,Commercial,53.36,92,,percent of total billed charges,,
CEFOXITIN 2 GRAM IV SOLR,,J0694,HCPCS,Facility,Outpatient,1,Each,,58,49.3,16.6228,58,Aetna,Medicare Advantage,28.42,49,,percent of total billed charges,,
CEFOXITIN 2 GRAM IV SOLR,,J0694,HCPCS,Facility,Inpatient,1,Each,,58,49.3,16.6228,58,Aetna,Medicare Advantage,,,,,Included in per diem rate,
CEFOXITIN 2 GRAM IV SOLR,,J0694,HCPCS,Facility,Both,1,Each,,58,49.3,16.6228,58,Aetna,PPO,53.94,93,,percent of total billed charges,,
CEFOXITIN 2 GRAM IV SOLR,,J0694,HCPCS,Facility,Both,1,Each,,58,49.3,16.6228,58,America's PPO,America's PPO,55.6974,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
CEFOXITIN 2 GRAM IV SOLR,,J0694,HCPCS,Facility,Both,1,Each,,58,49.3,16.6228,58,BlueCross BlueShield Minnesota, Federal Employee Program,57.072,98.4,,percent of total billed charges,,
CEFOXITIN 2 GRAM IV SOLR,,J0694,HCPCS,Facility,Both,1,Each,,58,49.3,16.6228,58,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,58,100,,percent of total billed charges,,
CEFOXITIN 2 GRAM IV SOLR,,J0694,HCPCS,Facility,Both,1,Each,,58,49.3,16.6228,58,BlueCross BlueShield Minnesota,High Value Network Plan,52.2,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
CEFOXITIN 2 GRAM IV SOLR,,J0694,HCPCS,Facility,Outpatient,1,Each,,58,49.3,16.6228,58,BlueCross BlueShield Minnesota,Medicare Advantage,28.42,49,,percent of total billed charges,,
CEFOXITIN 2 GRAM IV SOLR,,J0694,HCPCS,Facility,Inpatient,1,Each,,58,49.3,16.6228,58,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
CEFOXITIN 2 GRAM IV SOLR,,J0694,HCPCS,Facility,Both,1,Each,,58,49.3,16.6228,58,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,51.3706,88.57,,percent of total billed charges,,
CEFOXITIN 2 GRAM IV SOLR,,J0694,HCPCS,Facility,Both,1,Each,,58,49.3,16.6228,58,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,16.6228,28.66,,percent of total billed charges,,
CEFOXITIN 2 GRAM IV SOLR,,J0694,HCPCS,Facility,Outpatient,1,Each,,58,49.3,16.6228,58,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),28.42,49,,percent of total billed charges,,
CEFOXITIN 2 GRAM IV SOLR,,J0694,HCPCS,Facility,Inpatient,1,Each,,58,49.3,16.6228,58,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
CEFOXITIN 2 GRAM IV SOLR,,J0694,HCPCS,Facility,Both,1,Each,,58,49.3,16.6228,58,CorVel,Worker's Compensation,58,100,,percent of total billed charges,,
CEFOXITIN 2 GRAM IV SOLR,,J0694,HCPCS,Facility,Both,1,Each,,58,49.3,16.6228,58,First Health Group Corporation,First Health Network,56.26,97,,percent of total billed charges,,
CEFOXITIN 2 GRAM IV SOLR,,J0694,HCPCS,Facility,Both,1,Each,,58,49.3,16.6228,58,"Health Partners, Inc.",Commercial,54.868,94.6,,percent of total billed charges,,
CEFOXITIN 2 GRAM IV SOLR,,J0694,HCPCS,Facility,Outpatient,1,Each,,58,49.3,16.6228,58,"Health Partners, Inc.",Medicare Advantage,28.42,49,,percent of total billed charges,,
CEFOXITIN 2 GRAM IV SOLR,,J0694,HCPCS,Facility,Inpatient,1,Each,,58,49.3,16.6228,58,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CEFOXITIN 2 GRAM IV SOLR,,J0694,HCPCS,Facility,Both,1,Each,,58,49.3,16.6228,58,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),34.8,60,,percent of total billed charges,,
CEFOXITIN 2 GRAM IV SOLR,,J0694,HCPCS,Facility,Both,1,Each,,58,49.3,16.6228,58,"Health Partners, Inc.",State of Minnesota Advantage Program,47.27,81.5,,percent of total billed charges,,
CEFOXITIN 2 GRAM IV SOLR,,J0694,HCPCS,Facility,Both,1,Each,,58,49.3,16.6228,58,"Health Partners, Inc.",State Public Programs,29,50,,percent of total billed charges,,
CEFOXITIN 2 GRAM IV SOLR,,J0694,HCPCS,Facility,Both,1,Each,,58,49.3,16.6228,58,Humana Insurance Company,Commercial PPO,55.1,95,,percent of total billed charges,,
CEFOXITIN 2 GRAM IV SOLR,,J0694,HCPCS,Facility,Outpatient,1,Each,,58,49.3,16.6228,58,Humana Insurance Company,Medicare PPO,28.42,49,,percent of total billed charges,,
CEFOXITIN 2 GRAM IV SOLR,,J0694,HCPCS,Facility,Inpatient,1,Each,,58,49.3,16.6228,58,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
CEFOXITIN 2 GRAM IV SOLR,,J0694,HCPCS,Facility,Both,1,Each,,58,49.3,16.6228,58,Medica,Individual & Family,57.478,99.1,,percent of total billed charges,,
CEFOXITIN 2 GRAM IV SOLR,,J0694,HCPCS,Facility,Outpatient,1,Each,,58,49.3,16.6228,58,Medica,Medica Advantage Solution,28.884,49.8,,percent of total billed charges,,
CEFOXITIN 2 GRAM IV SOLR,,J0694,HCPCS,Facility,Inpatient,1,Each,,58,49.3,16.6228,58,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
CEFOXITIN 2 GRAM IV SOLR,,J0694,HCPCS,Facility,Outpatient,1,Each,,58,49.3,16.6228,58,Medica,Medical Assistance,25.868,44.6,,percent of total billed charges,,
CEFOXITIN 2 GRAM IV SOLR,,J0694,HCPCS,Facility,Inpatient,1,Each,,58,49.3,16.6228,58,Medica,Medical Assistance,,,,,Included in per diem rate,
CEFOXITIN 2 GRAM IV SOLR,,J0694,HCPCS,Facility,Outpatient,1,Each,,58,49.3,16.6228,58,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,28.884,49.8,,percent of total billed charges,,
CEFOXITIN 2 GRAM IV SOLR,,J0694,HCPCS,Facility,Inpatient,1,Each,,58,49.3,16.6228,58,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
CEFOXITIN 2 GRAM IV SOLR,,J0694,HCPCS,Facility,Both,1,Each,,58,49.3,16.6228,58,"Multiplan, Inc.","Multiplan, Inc.",54.52,94,,percent of total billed charges,,
CEFOXITIN 2 GRAM IV SOLR,,J0694,HCPCS,Facility,Outpatient,1,Each,,58,49.3,16.6228,58,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,52.258,90.1,,percent of total billed charges,,
CEFOXITIN 2 GRAM IV SOLR,,J0694,HCPCS,Facility,Inpatient,1,Each,,58,49.3,16.6228,58,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
CEFOXITIN 2 GRAM IV SOLR,,J0694,HCPCS,Facility,Both,1,Each,,58,49.3,16.6228,58,"Preferred One Administrative Services, INC.",PPO,57.188,98.6,,percent of total billed charges,,
CEFOXITIN 2 GRAM IV SOLR,,J0694,HCPCS,Facility,Outpatient,1,Each,,58,49.3,16.6228,58,PrimeWest Health,Minnesota Senior Health Options (MSHO),29.841,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
CEFOXITIN 2 GRAM IV SOLR,,J0694,HCPCS,Facility,Inpatient,1,Each,,58,49.3,16.6228,58,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CEFOXITIN 2 GRAM IV SOLR,,J0694,HCPCS,Facility,Outpatient,1,Each,,58,49.3,16.6228,58,PrimeWest Health,MinnesotaCare,29.7888,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
CEFOXITIN 2 GRAM IV SOLR,,J0694,HCPCS,Facility,Inpatient,1,Each,,58,49.3,16.6228,58,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
CEFOXITIN 2 GRAM IV SOLR,,J0694,HCPCS,Facility,Both,1,Each,,58,49.3,16.6228,58,Sanford Health Plan,Sanford Health Plan,53.36,92,,percent of total billed charges,,
CEFOXITIN 2 GRAM IV SOLR,,J0694,HCPCS,Facility,Outpatient,1,Each,,58,49.3,16.6228,58,"UCare Health, Inc.",Individual & Family Plan,32.683,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
CEFOXITIN 2 GRAM IV SOLR,,J0694,HCPCS,Facility,Inpatient,1,Each,,58,49.3,16.6228,58,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
CEFOXITIN 2 GRAM IV SOLR,,J0694,HCPCS,Facility,Outpatient,1,Each,,58,49.3,16.6228,58,"UCare Health, Inc.",Medical Assistance,29.2726,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CEFOXITIN 2 GRAM IV SOLR,,J0694,HCPCS,Facility,Inpatient,1,Each,,58,49.3,16.6228,58,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
CEFOXITIN 2 GRAM IV SOLR,,J0694,HCPCS,Facility,Outpatient,1,Each,,58,49.3,16.6228,58,"UCare Health, Inc.",Medicare Advantage,29.2726,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CEFOXITIN 2 GRAM IV SOLR,,J0694,HCPCS,Facility,Inpatient,1,Each,,58,49.3,16.6228,58,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CEFOXITIN 2 GRAM IV SOLR,,J0694,HCPCS,Facility,Outpatient,1,Each,,58,49.3,16.6228,58,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),29.2726,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CEFOXITIN 2 GRAM IV SOLR,,J0694,HCPCS,Facility,Inpatient,1,Each,,58,49.3,16.6228,58,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CEFOXITIN 2 GRAM IV SOLR,,J0694,HCPCS,Facility,Both,1,Each,,58,49.3,16.6228,58,UnitedHealthcare,Individual & Family,54.52,94,,percent of total billed charges,,
CEFOXITIN 2 GRAM IV SOLR,,J0694,HCPCS,Facility,Outpatient,1,Each,,58,49.3,16.6228,58,UnitedHealthcare,Medicare Advantage,28.42,49,,percent of total billed charges,,
CEFOXITIN 2 GRAM IV SOLR,,J0694,HCPCS,Facility,Inpatient,1,Each,,58,49.3,16.6228,58,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
CEFOXITIN 2 GRAM IV SOLR,,J0694,HCPCS,Facility,Outpatient,1,Each,,58,49.3,16.6228,58,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,27.84,48,,percent of total billed charges,,100% of DHS outpatient percentage
CEFOXITIN 2 GRAM IV SOLR,,J0694,HCPCS,Facility,Inpatient,1,Each,,58,49.3,16.6228,58,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
CEFTRIAXONE 1 GRAM INJ SOLR,,J0696,HCPCS,Facility,Both,1,Each,,207,175.95,59.3262,207,Aetna,Commercial,190.44,92,,percent of total billed charges,,
CEFTRIAXONE 1 GRAM INJ SOLR,,J0696,HCPCS,Facility,Both,1,Each,,10,8.5,2.866,10,Aetna,Commercial,9.2,92,,percent of total billed charges,,
CEFTRIAXONE 1 GRAM INJ SOLR,,J0696,HCPCS,Facility,Outpatient,1,Each,,207,175.95,59.3262,207,Aetna,Medicare Advantage,101.43,49,,percent of total billed charges,,
CEFTRIAXONE 1 GRAM INJ SOLR,,J0696,HCPCS,Facility,Outpatient,1,Each,,10,8.5,2.866,10,Aetna,Medicare Advantage,4.9,49,,percent of total billed charges,,
CEFTRIAXONE 1 GRAM INJ SOLR,,J0696,HCPCS,Facility,Inpatient,1,Each,,207,175.95,59.3262,207,Aetna,Medicare Advantage,,,,,Included in per diem rate,
CEFTRIAXONE 1 GRAM INJ SOLR,,J0696,HCPCS,Facility,Inpatient,1,Each,,10,8.5,2.866,10,Aetna,Medicare Advantage,,,,,Included in per diem rate,
CEFTRIAXONE 1 GRAM INJ SOLR,,J0696,HCPCS,Facility,Both,1,Each,,207,175.95,59.3262,207,Aetna,PPO,192.51,93,,percent of total billed charges,,
CEFTRIAXONE 1 GRAM INJ SOLR,,J0696,HCPCS,Facility,Both,1,Each,,10,8.5,2.866,10,Aetna,PPO,9.3,93,,percent of total billed charges,,
CEFTRIAXONE 1 GRAM INJ SOLR,,J0696,HCPCS,Facility,Both,1,Each,,207,175.95,59.3262,207,America's PPO,America's PPO,198.7821,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
CEFTRIAXONE 1 GRAM INJ SOLR,,J0696,HCPCS,Facility,Both,1,Each,,10,8.5,2.866,10,America's PPO,America's PPO,9.603,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
CEFTRIAXONE 1 GRAM INJ SOLR,,J0696,HCPCS,Facility,Both,1,Each,,207,175.95,59.3262,207,BlueCross BlueShield Minnesota, Federal Employee Program,203.688,98.4,,percent of total billed charges,,
CEFTRIAXONE 1 GRAM INJ SOLR,,J0696,HCPCS,Facility,Both,1,Each,,10,8.5,2.866,10,BlueCross BlueShield Minnesota, Federal Employee Program,9.84,98.4,,percent of total billed charges,,
CEFTRIAXONE 1 GRAM INJ SOLR,,J0696,HCPCS,Facility,Both,1,Each,,207,175.95,59.3262,207,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,207,100,,percent of total billed charges,,
CEFTRIAXONE 1 GRAM INJ SOLR,,J0696,HCPCS,Facility,Both,1,Each,,10,8.5,2.866,10,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,10,100,,percent of total billed charges,,
CEFTRIAXONE 1 GRAM INJ SOLR,,J0696,HCPCS,Facility,Both,1,Each,,207,175.95,59.3262,207,BlueCross BlueShield Minnesota,High Value Network Plan,186.3,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
CEFTRIAXONE 1 GRAM INJ SOLR,,J0696,HCPCS,Facility,Both,1,Each,,10,8.5,2.866,10,BlueCross BlueShield Minnesota,High Value Network Plan,9,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
CEFTRIAXONE 1 GRAM INJ SOLR,,J0696,HCPCS,Facility,Outpatient,1,Each,,207,175.95,59.3262,207,BlueCross BlueShield Minnesota,Medicare Advantage,101.43,49,,percent of total billed charges,,
CEFTRIAXONE 1 GRAM INJ SOLR,,J0696,HCPCS,Facility,Outpatient,1,Each,,10,8.5,2.866,10,BlueCross BlueShield Minnesota,Medicare Advantage,4.9,49,,percent of total billed charges,,
CEFTRIAXONE 1 GRAM INJ SOLR,,J0696,HCPCS,Facility,Inpatient,1,Each,,207,175.95,59.3262,207,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
CEFTRIAXONE 1 GRAM INJ SOLR,,J0696,HCPCS,Facility,Inpatient,1,Each,,10,8.5,2.866,10,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
CEFTRIAXONE 1 GRAM INJ SOLR,,J0696,HCPCS,Facility,Both,1,Each,,207,175.95,59.3262,207,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,183.3399,88.57,,percent of total billed charges,,
CEFTRIAXONE 1 GRAM INJ SOLR,,J0696,HCPCS,Facility,Both,1,Each,,10,8.5,2.866,10,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,8.857,88.57,,percent of total billed charges,,
CEFTRIAXONE 1 GRAM INJ SOLR,,J0696,HCPCS,Facility,Both,1,Each,,207,175.95,59.3262,207,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,59.3262,28.66,,percent of total billed charges,,
CEFTRIAXONE 1 GRAM INJ SOLR,,J0696,HCPCS,Facility,Both,1,Each,,10,8.5,2.866,10,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,2.866,28.66,,percent of total billed charges,,
CEFTRIAXONE 1 GRAM INJ SOLR,,J0696,HCPCS,Facility,Outpatient,1,Each,,207,175.95,59.3262,207,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),101.43,49,,percent of total billed charges,,
CEFTRIAXONE 1 GRAM INJ SOLR,,J0696,HCPCS,Facility,Outpatient,1,Each,,10,8.5,2.866,10,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),4.9,49,,percent of total billed charges,,
CEFTRIAXONE 1 GRAM INJ SOLR,,J0696,HCPCS,Facility,Inpatient,1,Each,,207,175.95,59.3262,207,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
CEFTRIAXONE 1 GRAM INJ SOLR,,J0696,HCPCS,Facility,Inpatient,1,Each,,10,8.5,2.866,10,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
CEFTRIAXONE 1 GRAM INJ SOLR,,J0696,HCPCS,Facility,Both,1,Each,,207,175.95,59.3262,207,CorVel,Worker's Compensation,207,100,,percent of total billed charges,,
CEFTRIAXONE 1 GRAM INJ SOLR,,J0696,HCPCS,Facility,Both,1,Each,,10,8.5,2.866,10,CorVel,Worker's Compensation,10,100,,percent of total billed charges,,
CEFTRIAXONE 1 GRAM INJ SOLR,,J0696,HCPCS,Facility,Both,1,Each,,207,175.95,59.3262,207,First Health Group Corporation,First Health Network,200.79,97,,percent of total billed charges,,
CEFTRIAXONE 1 GRAM INJ SOLR,,J0696,HCPCS,Facility,Both,1,Each,,10,8.5,2.866,10,First Health Group Corporation,First Health Network,9.7,97,,percent of total billed charges,,
CEFTRIAXONE 1 GRAM INJ SOLR,,J0696,HCPCS,Facility,Both,1,Each,,207,175.95,59.3262,207,"Health Partners, Inc.",Commercial,195.822,94.6,,percent of total billed charges,,
CEFTRIAXONE 1 GRAM INJ SOLR,,J0696,HCPCS,Facility,Both,1,Each,,10,8.5,2.866,10,"Health Partners, Inc.",Commercial,9.46,94.6,,percent of total billed charges,,
CEFTRIAXONE 1 GRAM INJ SOLR,,J0696,HCPCS,Facility,Outpatient,1,Each,,207,175.95,59.3262,207,"Health Partners, Inc.",Medicare Advantage,101.43,49,,percent of total billed charges,,
CEFTRIAXONE 1 GRAM INJ SOLR,,J0696,HCPCS,Facility,Outpatient,1,Each,,10,8.5,2.866,10,"Health Partners, Inc.",Medicare Advantage,4.9,49,,percent of total billed charges,,
CEFTRIAXONE 1 GRAM INJ SOLR,,J0696,HCPCS,Facility,Inpatient,1,Each,,207,175.95,59.3262,207,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CEFTRIAXONE 1 GRAM INJ SOLR,,J0696,HCPCS,Facility,Inpatient,1,Each,,10,8.5,2.866,10,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CEFTRIAXONE 1 GRAM INJ SOLR,,J0696,HCPCS,Facility,Both,1,Each,,207,175.95,59.3262,207,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),124.2,60,,percent of total billed charges,,
CEFTRIAXONE 1 GRAM INJ SOLR,,J0696,HCPCS,Facility,Both,1,Each,,10,8.5,2.866,10,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),6,60,,percent of total billed charges,,
CEFTRIAXONE 1 GRAM INJ SOLR,,J0696,HCPCS,Facility,Both,1,Each,,207,175.95,59.3262,207,"Health Partners, Inc.",State of Minnesota Advantage Program,168.705,81.5,,percent of total billed charges,,
CEFTRIAXONE 1 GRAM INJ SOLR,,J0696,HCPCS,Facility,Both,1,Each,,10,8.5,2.866,10,"Health Partners, Inc.",State of Minnesota Advantage Program,8.15,81.5,,percent of total billed charges,,
CEFTRIAXONE 1 GRAM INJ SOLR,,J0696,HCPCS,Facility,Both,1,Each,,207,175.95,59.3262,207,"Health Partners, Inc.",State Public Programs,103.5,50,,percent of total billed charges,,
CEFTRIAXONE 1 GRAM INJ SOLR,,J0696,HCPCS,Facility,Both,1,Each,,10,8.5,2.866,10,"Health Partners, Inc.",State Public Programs,5,50,,percent of total billed charges,,
CEFTRIAXONE 1 GRAM INJ SOLR,,J0696,HCPCS,Facility,Both,1,Each,,207,175.95,59.3262,207,Humana Insurance Company,Commercial PPO,196.65,95,,percent of total billed charges,,
CEFTRIAXONE 1 GRAM INJ SOLR,,J0696,HCPCS,Facility,Both,1,Each,,10,8.5,2.866,10,Humana Insurance Company,Commercial PPO,9.5,95,,percent of total billed charges,,
CEFTRIAXONE 1 GRAM INJ SOLR,,J0696,HCPCS,Facility,Outpatient,1,Each,,207,175.95,59.3262,207,Humana Insurance Company,Medicare PPO,101.43,49,,percent of total billed charges,,
CEFTRIAXONE 1 GRAM INJ SOLR,,J0696,HCPCS,Facility,Outpatient,1,Each,,10,8.5,2.866,10,Humana Insurance Company,Medicare PPO,4.9,49,,percent of total billed charges,,
CEFTRIAXONE 1 GRAM INJ SOLR,,J0696,HCPCS,Facility,Inpatient,1,Each,,207,175.95,59.3262,207,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
CEFTRIAXONE 1 GRAM INJ SOLR,,J0696,HCPCS,Facility,Inpatient,1,Each,,10,8.5,2.866,10,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
CEFTRIAXONE 1 GRAM INJ SOLR,,J0696,HCPCS,Facility,Both,1,Each,,207,175.95,59.3262,207,Medica,Individual & Family,205.137,99.1,,percent of total billed charges,,
CEFTRIAXONE 1 GRAM INJ SOLR,,J0696,HCPCS,Facility,Both,1,Each,,10,8.5,2.866,10,Medica,Individual & Family,9.91,99.1,,percent of total billed charges,,
CEFTRIAXONE 1 GRAM INJ SOLR,,J0696,HCPCS,Facility,Outpatient,1,Each,,207,175.95,59.3262,207,Medica,Medica Advantage Solution,103.086,49.8,,percent of total billed charges,,
CEFTRIAXONE 1 GRAM INJ SOLR,,J0696,HCPCS,Facility,Outpatient,1,Each,,10,8.5,2.866,10,Medica,Medica Advantage Solution,4.98,49.8,,percent of total billed charges,,
CEFTRIAXONE 1 GRAM INJ SOLR,,J0696,HCPCS,Facility,Inpatient,1,Each,,207,175.95,59.3262,207,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
CEFTRIAXONE 1 GRAM INJ SOLR,,J0696,HCPCS,Facility,Inpatient,1,Each,,10,8.5,2.866,10,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
CEFTRIAXONE 1 GRAM INJ SOLR,,J0696,HCPCS,Facility,Outpatient,1,Each,,207,175.95,59.3262,207,Medica,Medical Assistance,92.322,44.6,,percent of total billed charges,,
CEFTRIAXONE 1 GRAM INJ SOLR,,J0696,HCPCS,Facility,Outpatient,1,Each,,10,8.5,2.866,10,Medica,Medical Assistance,4.46,44.6,,percent of total billed charges,,
CEFTRIAXONE 1 GRAM INJ SOLR,,J0696,HCPCS,Facility,Inpatient,1,Each,,207,175.95,59.3262,207,Medica,Medical Assistance,,,,,Included in per diem rate,
CEFTRIAXONE 1 GRAM INJ SOLR,,J0696,HCPCS,Facility,Inpatient,1,Each,,10,8.5,2.866,10,Medica,Medical Assistance,,,,,Included in per diem rate,
CEFTRIAXONE 1 GRAM INJ SOLR,,J0696,HCPCS,Facility,Outpatient,1,Each,,207,175.95,59.3262,207,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,103.086,49.8,,percent of total billed charges,,
CEFTRIAXONE 1 GRAM INJ SOLR,,J0696,HCPCS,Facility,Outpatient,1,Each,,10,8.5,2.866,10,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,4.98,49.8,,percent of total billed charges,,
CEFTRIAXONE 1 GRAM INJ SOLR,,J0696,HCPCS,Facility,Inpatient,1,Each,,207,175.95,59.3262,207,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
CEFTRIAXONE 1 GRAM INJ SOLR,,J0696,HCPCS,Facility,Inpatient,1,Each,,10,8.5,2.866,10,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
CEFTRIAXONE 1 GRAM INJ SOLR,,J0696,HCPCS,Facility,Both,1,Each,,207,175.95,59.3262,207,"Multiplan, Inc.","Multiplan, Inc.",194.58,94,,percent of total billed charges,,
CEFTRIAXONE 1 GRAM INJ SOLR,,J0696,HCPCS,Facility,Both,1,Each,,10,8.5,2.866,10,"Multiplan, Inc.","Multiplan, Inc.",9.4,94,,percent of total billed charges,,
CEFTRIAXONE 1 GRAM INJ SOLR,,J0696,HCPCS,Facility,Outpatient,1,Each,,207,175.95,59.3262,207,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,186.507,90.1,,percent of total billed charges,,
CEFTRIAXONE 1 GRAM INJ SOLR,,J0696,HCPCS,Facility,Outpatient,1,Each,,10,8.5,2.866,10,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,9.01,90.1,,percent of total billed charges,,
CEFTRIAXONE 1 GRAM INJ SOLR,,J0696,HCPCS,Facility,Inpatient,1,Each,,207,175.95,59.3262,207,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
CEFTRIAXONE 1 GRAM INJ SOLR,,J0696,HCPCS,Facility,Inpatient,1,Each,,10,8.5,2.866,10,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
CEFTRIAXONE 1 GRAM INJ SOLR,,J0696,HCPCS,Facility,Both,1,Each,,207,175.95,59.3262,207,"Preferred One Administrative Services, INC.",PPO,204.102,98.6,,percent of total billed charges,,
CEFTRIAXONE 1 GRAM INJ SOLR,,J0696,HCPCS,Facility,Both,1,Each,,10,8.5,2.866,10,"Preferred One Administrative Services, INC.",PPO,9.86,98.6,,percent of total billed charges,,
CEFTRIAXONE 1 GRAM INJ SOLR,,J0696,HCPCS,Facility,Outpatient,1,Each,,207,175.95,59.3262,207,PrimeWest Health,Minnesota Senior Health Options (MSHO),106.5015,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
CEFTRIAXONE 1 GRAM INJ SOLR,,J0696,HCPCS,Facility,Outpatient,1,Each,,10,8.5,2.866,10,PrimeWest Health,Minnesota Senior Health Options (MSHO),5.145,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
CEFTRIAXONE 1 GRAM INJ SOLR,,J0696,HCPCS,Facility,Inpatient,1,Each,,207,175.95,59.3262,207,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CEFTRIAXONE 1 GRAM INJ SOLR,,J0696,HCPCS,Facility,Inpatient,1,Each,,10,8.5,2.866,10,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CEFTRIAXONE 1 GRAM INJ SOLR,,J0696,HCPCS,Facility,Outpatient,1,Each,,207,175.95,59.3262,207,PrimeWest Health,MinnesotaCare,106.3152,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
CEFTRIAXONE 1 GRAM INJ SOLR,,J0696,HCPCS,Facility,Outpatient,1,Each,,10,8.5,2.866,10,PrimeWest Health,MinnesotaCare,5.136,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
CEFTRIAXONE 1 GRAM INJ SOLR,,J0696,HCPCS,Facility,Inpatient,1,Each,,207,175.95,59.3262,207,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
CEFTRIAXONE 1 GRAM INJ SOLR,,J0696,HCPCS,Facility,Inpatient,1,Each,,10,8.5,2.866,10,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
CEFTRIAXONE 1 GRAM INJ SOLR,,J0696,HCPCS,Facility,Both,1,Each,,207,175.95,59.3262,207,Sanford Health Plan,Sanford Health Plan,190.44,92,,percent of total billed charges,,
CEFTRIAXONE 1 GRAM INJ SOLR,,J0696,HCPCS,Facility,Both,1,Each,,10,8.5,2.866,10,Sanford Health Plan,Sanford Health Plan,9.2,92,,percent of total billed charges,,
CEFTRIAXONE 1 GRAM INJ SOLR,,J0696,HCPCS,Facility,Outpatient,1,Each,,207,175.95,59.3262,207,"UCare Health, Inc.",Individual & Family Plan,116.6445,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
CEFTRIAXONE 1 GRAM INJ SOLR,,J0696,HCPCS,Facility,Outpatient,1,Each,,10,8.5,2.866,10,"UCare Health, Inc.",Individual & Family Plan,5.635,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
CEFTRIAXONE 1 GRAM INJ SOLR,,J0696,HCPCS,Facility,Inpatient,1,Each,,207,175.95,59.3262,207,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
CEFTRIAXONE 1 GRAM INJ SOLR,,J0696,HCPCS,Facility,Inpatient,1,Each,,10,8.5,2.866,10,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
CEFTRIAXONE 1 GRAM INJ SOLR,,J0696,HCPCS,Facility,Outpatient,1,Each,,207,175.95,59.3262,207,"UCare Health, Inc.",Medical Assistance,104.4729,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CEFTRIAXONE 1 GRAM INJ SOLR,,J0696,HCPCS,Facility,Outpatient,1,Each,,10,8.5,2.866,10,"UCare Health, Inc.",Medical Assistance,5.047,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CEFTRIAXONE 1 GRAM INJ SOLR,,J0696,HCPCS,Facility,Inpatient,1,Each,,207,175.95,59.3262,207,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
CEFTRIAXONE 1 GRAM INJ SOLR,,J0696,HCPCS,Facility,Inpatient,1,Each,,10,8.5,2.866,10,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
CEFTRIAXONE 1 GRAM INJ SOLR,,J0696,HCPCS,Facility,Outpatient,1,Each,,207,175.95,59.3262,207,"UCare Health, Inc.",Medicare Advantage,104.4729,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CEFTRIAXONE 1 GRAM INJ SOLR,,J0696,HCPCS,Facility,Outpatient,1,Each,,10,8.5,2.866,10,"UCare Health, Inc.",Medicare Advantage,5.047,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CEFTRIAXONE 1 GRAM INJ SOLR,,J0696,HCPCS,Facility,Inpatient,1,Each,,207,175.95,59.3262,207,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CEFTRIAXONE 1 GRAM INJ SOLR,,J0696,HCPCS,Facility,Inpatient,1,Each,,10,8.5,2.866,10,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CEFTRIAXONE 1 GRAM INJ SOLR,,J0696,HCPCS,Facility,Outpatient,1,Each,,207,175.95,59.3262,207,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),104.4729,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CEFTRIAXONE 1 GRAM INJ SOLR,,J0696,HCPCS,Facility,Outpatient,1,Each,,10,8.5,2.866,10,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),5.047,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CEFTRIAXONE 1 GRAM INJ SOLR,,J0696,HCPCS,Facility,Inpatient,1,Each,,207,175.95,59.3262,207,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CEFTRIAXONE 1 GRAM INJ SOLR,,J0696,HCPCS,Facility,Inpatient,1,Each,,10,8.5,2.866,10,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CEFTRIAXONE 1 GRAM INJ SOLR,,J0696,HCPCS,Facility,Both,1,Each,,207,175.95,59.3262,207,UnitedHealthcare,Individual & Family,194.58,94,,percent of total billed charges,,
CEFTRIAXONE 1 GRAM INJ SOLR,,J0696,HCPCS,Facility,Both,1,Each,,10,8.5,2.866,10,UnitedHealthcare,Individual & Family,9.4,94,,percent of total billed charges,,
CEFTRIAXONE 1 GRAM INJ SOLR,,J0696,HCPCS,Facility,Outpatient,1,Each,,207,175.95,59.3262,207,UnitedHealthcare,Medicare Advantage,101.43,49,,percent of total billed charges,,
CEFTRIAXONE 1 GRAM INJ SOLR,,J0696,HCPCS,Facility,Outpatient,1,Each,,10,8.5,2.866,10,UnitedHealthcare,Medicare Advantage,4.9,49,,percent of total billed charges,,
CEFTRIAXONE 1 GRAM INJ SOLR,,J0696,HCPCS,Facility,Inpatient,1,Each,,207,175.95,59.3262,207,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
CEFTRIAXONE 1 GRAM INJ SOLR,,J0696,HCPCS,Facility,Inpatient,1,Each,,10,8.5,2.866,10,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
CEFTRIAXONE 1 GRAM INJ SOLR,,J0696,HCPCS,Facility,Outpatient,1,Each,,207,175.95,59.3262,207,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,99.36,48,,percent of total billed charges,,100% of DHS outpatient percentage
CEFTRIAXONE 1 GRAM INJ SOLR,,J0696,HCPCS,Facility,Outpatient,1,Each,,10,8.5,2.866,10,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,4.8,48,,percent of total billed charges,,100% of DHS outpatient percentage
CEFTRIAXONE 1 GRAM INJ SOLR,,J0696,HCPCS,Facility,Inpatient,1,Each,,207,175.95,59.3262,207,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
CEFTRIAXONE 1 GRAM INJ SOLR,,J0696,HCPCS,Facility,Inpatient,1,Each,,10,8.5,2.866,10,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
CEFTRIAXONE 1 GRAM IV SOLR,,J0696,HCPCS,Facility,Both,1,Each,,26,22.1,7.4516,26,Aetna,Commercial,23.92,92,,percent of total billed charges,,
CEFTRIAXONE 1 GRAM IV SOLR,,J0696,HCPCS,Facility,Both,1,Each,,26,22.1,7.4516,26,Aetna,Commercial,23.92,92,,percent of total billed charges,,
CEFTRIAXONE 1 GRAM IV SOLR,,J0696,HCPCS,Facility,Outpatient,1,Each,,26,22.1,7.4516,26,Aetna,Medicare Advantage,12.74,49,,percent of total billed charges,,
CEFTRIAXONE 1 GRAM IV SOLR,,J0696,HCPCS,Facility,Outpatient,1,Each,,26,22.1,7.4516,26,Aetna,Medicare Advantage,12.74,49,,percent of total billed charges,,
CEFTRIAXONE 1 GRAM IV SOLR,,J0696,HCPCS,Facility,Inpatient,1,Each,,26,22.1,7.4516,26,Aetna,Medicare Advantage,,,,,Included in per diem rate,
CEFTRIAXONE 1 GRAM IV SOLR,,J0696,HCPCS,Facility,Inpatient,1,Each,,26,22.1,7.4516,26,Aetna,Medicare Advantage,,,,,Included in per diem rate,
CEFTRIAXONE 1 GRAM IV SOLR,,J0696,HCPCS,Facility,Both,1,Each,,26,22.1,7.4516,26,Aetna,PPO,24.18,93,,percent of total billed charges,,
CEFTRIAXONE 1 GRAM IV SOLR,,J0696,HCPCS,Facility,Both,1,Each,,26,22.1,7.4516,26,Aetna,PPO,24.18,93,,percent of total billed charges,,
CEFTRIAXONE 1 GRAM IV SOLR,,J0696,HCPCS,Facility,Both,1,Each,,26,22.1,7.4516,26,America's PPO,America's PPO,24.9678,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
CEFTRIAXONE 1 GRAM IV SOLR,,J0696,HCPCS,Facility,Both,1,Each,,26,22.1,7.4516,26,America's PPO,America's PPO,24.9678,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
CEFTRIAXONE 1 GRAM IV SOLR,,J0696,HCPCS,Facility,Both,1,Each,,26,22.1,7.4516,26,BlueCross BlueShield Minnesota, Federal Employee Program,25.584,98.4,,percent of total billed charges,,
CEFTRIAXONE 1 GRAM IV SOLR,,J0696,HCPCS,Facility,Both,1,Each,,26,22.1,7.4516,26,BlueCross BlueShield Minnesota, Federal Employee Program,25.584,98.4,,percent of total billed charges,,
CEFTRIAXONE 1 GRAM IV SOLR,,J0696,HCPCS,Facility,Both,1,Each,,26,22.1,7.4516,26,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,26,100,,percent of total billed charges,,
CEFTRIAXONE 1 GRAM IV SOLR,,J0696,HCPCS,Facility,Both,1,Each,,26,22.1,7.4516,26,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,26,100,,percent of total billed charges,,
CEFTRIAXONE 1 GRAM IV SOLR,,J0696,HCPCS,Facility,Both,1,Each,,26,22.1,7.4516,26,BlueCross BlueShield Minnesota,High Value Network Plan,23.4,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
CEFTRIAXONE 1 GRAM IV SOLR,,J0696,HCPCS,Facility,Both,1,Each,,26,22.1,7.4516,26,BlueCross BlueShield Minnesota,High Value Network Plan,23.4,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
CEFTRIAXONE 1 GRAM IV SOLR,,J0696,HCPCS,Facility,Outpatient,1,Each,,26,22.1,7.4516,26,BlueCross BlueShield Minnesota,Medicare Advantage,12.74,49,,percent of total billed charges,,
CEFTRIAXONE 1 GRAM IV SOLR,,J0696,HCPCS,Facility,Outpatient,1,Each,,26,22.1,7.4516,26,BlueCross BlueShield Minnesota,Medicare Advantage,12.74,49,,percent of total billed charges,,
CEFTRIAXONE 1 GRAM IV SOLR,,J0696,HCPCS,Facility,Inpatient,1,Each,,26,22.1,7.4516,26,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
CEFTRIAXONE 1 GRAM IV SOLR,,J0696,HCPCS,Facility,Inpatient,1,Each,,26,22.1,7.4516,26,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
CEFTRIAXONE 1 GRAM IV SOLR,,J0696,HCPCS,Facility,Both,1,Each,,26,22.1,7.4516,26,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,23.0282,88.57,,percent of total billed charges,,
CEFTRIAXONE 1 GRAM IV SOLR,,J0696,HCPCS,Facility,Both,1,Each,,26,22.1,7.4516,26,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,23.0282,88.57,,percent of total billed charges,,
CEFTRIAXONE 1 GRAM IV SOLR,,J0696,HCPCS,Facility,Both,1,Each,,26,22.1,7.4516,26,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,7.4516,28.66,,percent of total billed charges,,
CEFTRIAXONE 1 GRAM IV SOLR,,J0696,HCPCS,Facility,Both,1,Each,,26,22.1,7.4516,26,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,7.4516,28.66,,percent of total billed charges,,
CEFTRIAXONE 1 GRAM IV SOLR,,J0696,HCPCS,Facility,Outpatient,1,Each,,26,22.1,7.4516,26,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),12.74,49,,percent of total billed charges,,
CEFTRIAXONE 1 GRAM IV SOLR,,J0696,HCPCS,Facility,Outpatient,1,Each,,26,22.1,7.4516,26,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),12.74,49,,percent of total billed charges,,
CEFTRIAXONE 1 GRAM IV SOLR,,J0696,HCPCS,Facility,Inpatient,1,Each,,26,22.1,7.4516,26,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
CEFTRIAXONE 1 GRAM IV SOLR,,J0696,HCPCS,Facility,Inpatient,1,Each,,26,22.1,7.4516,26,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
CEFTRIAXONE 1 GRAM IV SOLR,,J0696,HCPCS,Facility,Both,1,Each,,26,22.1,7.4516,26,CorVel,Worker's Compensation,26,100,,percent of total billed charges,,
CEFTRIAXONE 1 GRAM IV SOLR,,J0696,HCPCS,Facility,Both,1,Each,,26,22.1,7.4516,26,CorVel,Worker's Compensation,26,100,,percent of total billed charges,,
CEFTRIAXONE 1 GRAM IV SOLR,,J0696,HCPCS,Facility,Both,1,Each,,26,22.1,7.4516,26,First Health Group Corporation,First Health Network,25.22,97,,percent of total billed charges,,
CEFTRIAXONE 1 GRAM IV SOLR,,J0696,HCPCS,Facility,Both,1,Each,,26,22.1,7.4516,26,First Health Group Corporation,First Health Network,25.22,97,,percent of total billed charges,,
CEFTRIAXONE 1 GRAM IV SOLR,,J0696,HCPCS,Facility,Both,1,Each,,26,22.1,7.4516,26,"Health Partners, Inc.",Commercial,24.596,94.6,,percent of total billed charges,,
CEFTRIAXONE 1 GRAM IV SOLR,,J0696,HCPCS,Facility,Both,1,Each,,26,22.1,7.4516,26,"Health Partners, Inc.",Commercial,24.596,94.6,,percent of total billed charges,,
CEFTRIAXONE 1 GRAM IV SOLR,,J0696,HCPCS,Facility,Outpatient,1,Each,,26,22.1,7.4516,26,"Health Partners, Inc.",Medicare Advantage,12.74,49,,percent of total billed charges,,
CEFTRIAXONE 1 GRAM IV SOLR,,J0696,HCPCS,Facility,Outpatient,1,Each,,26,22.1,7.4516,26,"Health Partners, Inc.",Medicare Advantage,12.74,49,,percent of total billed charges,,
CEFTRIAXONE 1 GRAM IV SOLR,,J0696,HCPCS,Facility,Inpatient,1,Each,,26,22.1,7.4516,26,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CEFTRIAXONE 1 GRAM IV SOLR,,J0696,HCPCS,Facility,Inpatient,1,Each,,26,22.1,7.4516,26,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CEFTRIAXONE 1 GRAM IV SOLR,,J0696,HCPCS,Facility,Both,1,Each,,26,22.1,7.4516,26,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),15.6,60,,percent of total billed charges,,
CEFTRIAXONE 1 GRAM IV SOLR,,J0696,HCPCS,Facility,Both,1,Each,,26,22.1,7.4516,26,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),15.6,60,,percent of total billed charges,,
CEFTRIAXONE 1 GRAM IV SOLR,,J0696,HCPCS,Facility,Both,1,Each,,26,22.1,7.4516,26,"Health Partners, Inc.",State of Minnesota Advantage Program,21.19,81.5,,percent of total billed charges,,
CEFTRIAXONE 1 GRAM IV SOLR,,J0696,HCPCS,Facility,Both,1,Each,,26,22.1,7.4516,26,"Health Partners, Inc.",State of Minnesota Advantage Program,21.19,81.5,,percent of total billed charges,,
CEFTRIAXONE 1 GRAM IV SOLR,,J0696,HCPCS,Facility,Both,1,Each,,26,22.1,7.4516,26,"Health Partners, Inc.",State Public Programs,13,50,,percent of total billed charges,,
CEFTRIAXONE 1 GRAM IV SOLR,,J0696,HCPCS,Facility,Both,1,Each,,26,22.1,7.4516,26,"Health Partners, Inc.",State Public Programs,13,50,,percent of total billed charges,,
CEFTRIAXONE 1 GRAM IV SOLR,,J0696,HCPCS,Facility,Both,1,Each,,26,22.1,7.4516,26,Humana Insurance Company,Commercial PPO,24.7,95,,percent of total billed charges,,
CEFTRIAXONE 1 GRAM IV SOLR,,J0696,HCPCS,Facility,Both,1,Each,,26,22.1,7.4516,26,Humana Insurance Company,Commercial PPO,24.7,95,,percent of total billed charges,,
CEFTRIAXONE 1 GRAM IV SOLR,,J0696,HCPCS,Facility,Outpatient,1,Each,,26,22.1,7.4516,26,Humana Insurance Company,Medicare PPO,12.74,49,,percent of total billed charges,,
CEFTRIAXONE 1 GRAM IV SOLR,,J0696,HCPCS,Facility,Outpatient,1,Each,,26,22.1,7.4516,26,Humana Insurance Company,Medicare PPO,12.74,49,,percent of total billed charges,,
CEFTRIAXONE 1 GRAM IV SOLR,,J0696,HCPCS,Facility,Inpatient,1,Each,,26,22.1,7.4516,26,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
CEFTRIAXONE 1 GRAM IV SOLR,,J0696,HCPCS,Facility,Inpatient,1,Each,,26,22.1,7.4516,26,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
CEFTRIAXONE 1 GRAM IV SOLR,,J0696,HCPCS,Facility,Both,1,Each,,26,22.1,7.4516,26,Medica,Individual & Family,25.766,99.1,,percent of total billed charges,,
CEFTRIAXONE 1 GRAM IV SOLR,,J0696,HCPCS,Facility,Both,1,Each,,26,22.1,7.4516,26,Medica,Individual & Family,25.766,99.1,,percent of total billed charges,,
CEFTRIAXONE 1 GRAM IV SOLR,,J0696,HCPCS,Facility,Outpatient,1,Each,,26,22.1,7.4516,26,Medica,Medica Advantage Solution,12.948,49.8,,percent of total billed charges,,
CEFTRIAXONE 1 GRAM IV SOLR,,J0696,HCPCS,Facility,Outpatient,1,Each,,26,22.1,7.4516,26,Medica,Medica Advantage Solution,12.948,49.8,,percent of total billed charges,,
CEFTRIAXONE 1 GRAM IV SOLR,,J0696,HCPCS,Facility,Inpatient,1,Each,,26,22.1,7.4516,26,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
CEFTRIAXONE 1 GRAM IV SOLR,,J0696,HCPCS,Facility,Inpatient,1,Each,,26,22.1,7.4516,26,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
CEFTRIAXONE 1 GRAM IV SOLR,,J0696,HCPCS,Facility,Outpatient,1,Each,,26,22.1,7.4516,26,Medica,Medical Assistance,11.596,44.6,,percent of total billed charges,,
CEFTRIAXONE 1 GRAM IV SOLR,,J0696,HCPCS,Facility,Outpatient,1,Each,,26,22.1,7.4516,26,Medica,Medical Assistance,11.596,44.6,,percent of total billed charges,,
CEFTRIAXONE 1 GRAM IV SOLR,,J0696,HCPCS,Facility,Inpatient,1,Each,,26,22.1,7.4516,26,Medica,Medical Assistance,,,,,Included in per diem rate,
CEFTRIAXONE 1 GRAM IV SOLR,,J0696,HCPCS,Facility,Inpatient,1,Each,,26,22.1,7.4516,26,Medica,Medical Assistance,,,,,Included in per diem rate,
CEFTRIAXONE 1 GRAM IV SOLR,,J0696,HCPCS,Facility,Outpatient,1,Each,,26,22.1,7.4516,26,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,12.948,49.8,,percent of total billed charges,,
CEFTRIAXONE 1 GRAM IV SOLR,,J0696,HCPCS,Facility,Outpatient,1,Each,,26,22.1,7.4516,26,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,12.948,49.8,,percent of total billed charges,,
CEFTRIAXONE 1 GRAM IV SOLR,,J0696,HCPCS,Facility,Inpatient,1,Each,,26,22.1,7.4516,26,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
CEFTRIAXONE 1 GRAM IV SOLR,,J0696,HCPCS,Facility,Inpatient,1,Each,,26,22.1,7.4516,26,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
CEFTRIAXONE 1 GRAM IV SOLR,,J0696,HCPCS,Facility,Both,1,Each,,26,22.1,7.4516,26,"Multiplan, Inc.","Multiplan, Inc.",24.44,94,,percent of total billed charges,,
CEFTRIAXONE 1 GRAM IV SOLR,,J0696,HCPCS,Facility,Both,1,Each,,26,22.1,7.4516,26,"Multiplan, Inc.","Multiplan, Inc.",24.44,94,,percent of total billed charges,,
CEFTRIAXONE 1 GRAM IV SOLR,,J0696,HCPCS,Facility,Outpatient,1,Each,,26,22.1,7.4516,26,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,23.426,90.1,,percent of total billed charges,,
CEFTRIAXONE 1 GRAM IV SOLR,,J0696,HCPCS,Facility,Outpatient,1,Each,,26,22.1,7.4516,26,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,23.426,90.1,,percent of total billed charges,,
CEFTRIAXONE 1 GRAM IV SOLR,,J0696,HCPCS,Facility,Inpatient,1,Each,,26,22.1,7.4516,26,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
CEFTRIAXONE 1 GRAM IV SOLR,,J0696,HCPCS,Facility,Inpatient,1,Each,,26,22.1,7.4516,26,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
CEFTRIAXONE 1 GRAM IV SOLR,,J0696,HCPCS,Facility,Both,1,Each,,26,22.1,7.4516,26,"Preferred One Administrative Services, INC.",PPO,25.636,98.6,,percent of total billed charges,,
CEFTRIAXONE 1 GRAM IV SOLR,,J0696,HCPCS,Facility,Both,1,Each,,26,22.1,7.4516,26,"Preferred One Administrative Services, INC.",PPO,25.636,98.6,,percent of total billed charges,,
CEFTRIAXONE 1 GRAM IV SOLR,,J0696,HCPCS,Facility,Outpatient,1,Each,,26,22.1,7.4516,26,PrimeWest Health,Minnesota Senior Health Options (MSHO),13.377,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
CEFTRIAXONE 1 GRAM IV SOLR,,J0696,HCPCS,Facility,Outpatient,1,Each,,26,22.1,7.4516,26,PrimeWest Health,Minnesota Senior Health Options (MSHO),13.377,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
CEFTRIAXONE 1 GRAM IV SOLR,,J0696,HCPCS,Facility,Inpatient,1,Each,,26,22.1,7.4516,26,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CEFTRIAXONE 1 GRAM IV SOLR,,J0696,HCPCS,Facility,Inpatient,1,Each,,26,22.1,7.4516,26,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CEFTRIAXONE 1 GRAM IV SOLR,,J0696,HCPCS,Facility,Outpatient,1,Each,,26,22.1,7.4516,26,PrimeWest Health,MinnesotaCare,13.3536,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
CEFTRIAXONE 1 GRAM IV SOLR,,J0696,HCPCS,Facility,Outpatient,1,Each,,26,22.1,7.4516,26,PrimeWest Health,MinnesotaCare,13.3536,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
CEFTRIAXONE 1 GRAM IV SOLR,,J0696,HCPCS,Facility,Inpatient,1,Each,,26,22.1,7.4516,26,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
CEFTRIAXONE 1 GRAM IV SOLR,,J0696,HCPCS,Facility,Inpatient,1,Each,,26,22.1,7.4516,26,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
CEFTRIAXONE 1 GRAM IV SOLR,,J0696,HCPCS,Facility,Both,1,Each,,26,22.1,7.4516,26,Sanford Health Plan,Sanford Health Plan,23.92,92,,percent of total billed charges,,
CEFTRIAXONE 1 GRAM IV SOLR,,J0696,HCPCS,Facility,Both,1,Each,,26,22.1,7.4516,26,Sanford Health Plan,Sanford Health Plan,23.92,92,,percent of total billed charges,,
CEFTRIAXONE 1 GRAM IV SOLR,,J0696,HCPCS,Facility,Outpatient,1,Each,,26,22.1,7.4516,26,"UCare Health, Inc.",Individual & Family Plan,14.651,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
CEFTRIAXONE 1 GRAM IV SOLR,,J0696,HCPCS,Facility,Outpatient,1,Each,,26,22.1,7.4516,26,"UCare Health, Inc.",Individual & Family Plan,14.651,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
CEFTRIAXONE 1 GRAM IV SOLR,,J0696,HCPCS,Facility,Inpatient,1,Each,,26,22.1,7.4516,26,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
CEFTRIAXONE 1 GRAM IV SOLR,,J0696,HCPCS,Facility,Inpatient,1,Each,,26,22.1,7.4516,26,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
CEFTRIAXONE 1 GRAM IV SOLR,,J0696,HCPCS,Facility,Outpatient,1,Each,,26,22.1,7.4516,26,"UCare Health, Inc.",Medical Assistance,13.1222,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CEFTRIAXONE 1 GRAM IV SOLR,,J0696,HCPCS,Facility,Outpatient,1,Each,,26,22.1,7.4516,26,"UCare Health, Inc.",Medical Assistance,13.1222,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CEFTRIAXONE 1 GRAM IV SOLR,,J0696,HCPCS,Facility,Inpatient,1,Each,,26,22.1,7.4516,26,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
CEFTRIAXONE 1 GRAM IV SOLR,,J0696,HCPCS,Facility,Inpatient,1,Each,,26,22.1,7.4516,26,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
CEFTRIAXONE 1 GRAM IV SOLR,,J0696,HCPCS,Facility,Outpatient,1,Each,,26,22.1,7.4516,26,"UCare Health, Inc.",Medicare Advantage,13.1222,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CEFTRIAXONE 1 GRAM IV SOLR,,J0696,HCPCS,Facility,Outpatient,1,Each,,26,22.1,7.4516,26,"UCare Health, Inc.",Medicare Advantage,13.1222,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CEFTRIAXONE 1 GRAM IV SOLR,,J0696,HCPCS,Facility,Inpatient,1,Each,,26,22.1,7.4516,26,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CEFTRIAXONE 1 GRAM IV SOLR,,J0696,HCPCS,Facility,Inpatient,1,Each,,26,22.1,7.4516,26,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CEFTRIAXONE 1 GRAM IV SOLR,,J0696,HCPCS,Facility,Outpatient,1,Each,,26,22.1,7.4516,26,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),13.1222,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CEFTRIAXONE 1 GRAM IV SOLR,,J0696,HCPCS,Facility,Outpatient,1,Each,,26,22.1,7.4516,26,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),13.1222,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CEFTRIAXONE 1 GRAM IV SOLR,,J0696,HCPCS,Facility,Inpatient,1,Each,,26,22.1,7.4516,26,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CEFTRIAXONE 1 GRAM IV SOLR,,J0696,HCPCS,Facility,Inpatient,1,Each,,26,22.1,7.4516,26,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CEFTRIAXONE 1 GRAM IV SOLR,,J0696,HCPCS,Facility,Both,1,Each,,26,22.1,7.4516,26,UnitedHealthcare,Individual & Family,24.44,94,,percent of total billed charges,,
CEFTRIAXONE 1 GRAM IV SOLR,,J0696,HCPCS,Facility,Both,1,Each,,26,22.1,7.4516,26,UnitedHealthcare,Individual & Family,24.44,94,,percent of total billed charges,,
CEFTRIAXONE 1 GRAM IV SOLR,,J0696,HCPCS,Facility,Outpatient,1,Each,,26,22.1,7.4516,26,UnitedHealthcare,Medicare Advantage,12.74,49,,percent of total billed charges,,
CEFTRIAXONE 1 GRAM IV SOLR,,J0696,HCPCS,Facility,Outpatient,1,Each,,26,22.1,7.4516,26,UnitedHealthcare,Medicare Advantage,12.74,49,,percent of total billed charges,,
CEFTRIAXONE 1 GRAM IV SOLR,,J0696,HCPCS,Facility,Inpatient,1,Each,,26,22.1,7.4516,26,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
CEFTRIAXONE 1 GRAM IV SOLR,,J0696,HCPCS,Facility,Inpatient,1,Each,,26,22.1,7.4516,26,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
CEFTRIAXONE 1 GRAM IV SOLR,,J0696,HCPCS,Facility,Outpatient,1,Each,,26,22.1,7.4516,26,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,12.48,48,,percent of total billed charges,,100% of DHS outpatient percentage
CEFTRIAXONE 1 GRAM IV SOLR,,J0696,HCPCS,Facility,Outpatient,1,Each,,26,22.1,7.4516,26,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,12.48,48,,percent of total billed charges,,100% of DHS outpatient percentage
CEFTRIAXONE 1 GRAM IV SOLR,,J0696,HCPCS,Facility,Inpatient,1,Each,,26,22.1,7.4516,26,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
CEFTRIAXONE 1 GRAM IV SOLR,,J0696,HCPCS,Facility,Inpatient,1,Each,,26,22.1,7.4516,26,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
CEFTRIAXONE 2 GRAM INJ SOLR,,J0696,HCPCS,Facility,Both,1,Each,,18,15.3,5.1588,18,Aetna,Commercial,16.56,92,,percent of total billed charges,,
CEFTRIAXONE 2 GRAM INJ SOLR,,J0696,HCPCS,Facility,Outpatient,1,Each,,18,15.3,5.1588,18,Aetna,Medicare Advantage,8.82,49,,percent of total billed charges,,
CEFTRIAXONE 2 GRAM INJ SOLR,,J0696,HCPCS,Facility,Inpatient,1,Each,,18,15.3,5.1588,18,Aetna,Medicare Advantage,,,,,Included in per diem rate,
CEFTRIAXONE 2 GRAM INJ SOLR,,J0696,HCPCS,Facility,Both,1,Each,,18,15.3,5.1588,18,Aetna,PPO,16.74,93,,percent of total billed charges,,
CEFTRIAXONE 2 GRAM INJ SOLR,,J0696,HCPCS,Facility,Both,1,Each,,18,15.3,5.1588,18,America's PPO,America's PPO,17.2854,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
CEFTRIAXONE 2 GRAM INJ SOLR,,J0696,HCPCS,Facility,Both,1,Each,,18,15.3,5.1588,18,BlueCross BlueShield Minnesota, Federal Employee Program,17.712,98.4,,percent of total billed charges,,
CEFTRIAXONE 2 GRAM INJ SOLR,,J0696,HCPCS,Facility,Both,1,Each,,18,15.3,5.1588,18,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,18,100,,percent of total billed charges,,
CEFTRIAXONE 2 GRAM INJ SOLR,,J0696,HCPCS,Facility,Both,1,Each,,18,15.3,5.1588,18,BlueCross BlueShield Minnesota,High Value Network Plan,16.2,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
CEFTRIAXONE 2 GRAM INJ SOLR,,J0696,HCPCS,Facility,Outpatient,1,Each,,18,15.3,5.1588,18,BlueCross BlueShield Minnesota,Medicare Advantage,8.82,49,,percent of total billed charges,,
CEFTRIAXONE 2 GRAM INJ SOLR,,J0696,HCPCS,Facility,Inpatient,1,Each,,18,15.3,5.1588,18,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
CEFTRIAXONE 2 GRAM INJ SOLR,,J0696,HCPCS,Facility,Both,1,Each,,18,15.3,5.1588,18,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,15.9426,88.57,,percent of total billed charges,,
CEFTRIAXONE 2 GRAM INJ SOLR,,J0696,HCPCS,Facility,Both,1,Each,,18,15.3,5.1588,18,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,5.1588,28.66,,percent of total billed charges,,
CEFTRIAXONE 2 GRAM INJ SOLR,,J0696,HCPCS,Facility,Outpatient,1,Each,,18,15.3,5.1588,18,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),8.82,49,,percent of total billed charges,,
CEFTRIAXONE 2 GRAM INJ SOLR,,J0696,HCPCS,Facility,Inpatient,1,Each,,18,15.3,5.1588,18,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
CEFTRIAXONE 2 GRAM INJ SOLR,,J0696,HCPCS,Facility,Both,1,Each,,18,15.3,5.1588,18,CorVel,Worker's Compensation,18,100,,percent of total billed charges,,
CEFTRIAXONE 2 GRAM INJ SOLR,,J0696,HCPCS,Facility,Both,1,Each,,18,15.3,5.1588,18,First Health Group Corporation,First Health Network,17.46,97,,percent of total billed charges,,
CEFTRIAXONE 2 GRAM INJ SOLR,,J0696,HCPCS,Facility,Both,1,Each,,18,15.3,5.1588,18,"Health Partners, Inc.",Commercial,17.028,94.6,,percent of total billed charges,,
CEFTRIAXONE 2 GRAM INJ SOLR,,J0696,HCPCS,Facility,Outpatient,1,Each,,18,15.3,5.1588,18,"Health Partners, Inc.",Medicare Advantage,8.82,49,,percent of total billed charges,,
CEFTRIAXONE 2 GRAM INJ SOLR,,J0696,HCPCS,Facility,Inpatient,1,Each,,18,15.3,5.1588,18,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CEFTRIAXONE 2 GRAM INJ SOLR,,J0696,HCPCS,Facility,Both,1,Each,,18,15.3,5.1588,18,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),10.8,60,,percent of total billed charges,,
CEFTRIAXONE 2 GRAM INJ SOLR,,J0696,HCPCS,Facility,Both,1,Each,,18,15.3,5.1588,18,"Health Partners, Inc.",State of Minnesota Advantage Program,14.67,81.5,,percent of total billed charges,,
CEFTRIAXONE 2 GRAM INJ SOLR,,J0696,HCPCS,Facility,Both,1,Each,,18,15.3,5.1588,18,"Health Partners, Inc.",State Public Programs,9,50,,percent of total billed charges,,
CEFTRIAXONE 2 GRAM INJ SOLR,,J0696,HCPCS,Facility,Both,1,Each,,18,15.3,5.1588,18,Humana Insurance Company,Commercial PPO,17.1,95,,percent of total billed charges,,
CEFTRIAXONE 2 GRAM INJ SOLR,,J0696,HCPCS,Facility,Outpatient,1,Each,,18,15.3,5.1588,18,Humana Insurance Company,Medicare PPO,8.82,49,,percent of total billed charges,,
CEFTRIAXONE 2 GRAM INJ SOLR,,J0696,HCPCS,Facility,Inpatient,1,Each,,18,15.3,5.1588,18,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
CEFTRIAXONE 2 GRAM INJ SOLR,,J0696,HCPCS,Facility,Both,1,Each,,18,15.3,5.1588,18,Medica,Individual & Family,17.838,99.1,,percent of total billed charges,,
CEFTRIAXONE 2 GRAM INJ SOLR,,J0696,HCPCS,Facility,Outpatient,1,Each,,18,15.3,5.1588,18,Medica,Medica Advantage Solution,8.964,49.8,,percent of total billed charges,,
CEFTRIAXONE 2 GRAM INJ SOLR,,J0696,HCPCS,Facility,Inpatient,1,Each,,18,15.3,5.1588,18,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
CEFTRIAXONE 2 GRAM INJ SOLR,,J0696,HCPCS,Facility,Outpatient,1,Each,,18,15.3,5.1588,18,Medica,Medical Assistance,8.028,44.6,,percent of total billed charges,,
CEFTRIAXONE 2 GRAM INJ SOLR,,J0696,HCPCS,Facility,Inpatient,1,Each,,18,15.3,5.1588,18,Medica,Medical Assistance,,,,,Included in per diem rate,
CEFTRIAXONE 2 GRAM INJ SOLR,,J0696,HCPCS,Facility,Outpatient,1,Each,,18,15.3,5.1588,18,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,8.964,49.8,,percent of total billed charges,,
CEFTRIAXONE 2 GRAM INJ SOLR,,J0696,HCPCS,Facility,Inpatient,1,Each,,18,15.3,5.1588,18,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
CEFTRIAXONE 2 GRAM INJ SOLR,,J0696,HCPCS,Facility,Both,1,Each,,18,15.3,5.1588,18,"Multiplan, Inc.","Multiplan, Inc.",16.92,94,,percent of total billed charges,,
CEFTRIAXONE 2 GRAM INJ SOLR,,J0696,HCPCS,Facility,Outpatient,1,Each,,18,15.3,5.1588,18,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,16.218,90.1,,percent of total billed charges,,
CEFTRIAXONE 2 GRAM INJ SOLR,,J0696,HCPCS,Facility,Inpatient,1,Each,,18,15.3,5.1588,18,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
CEFTRIAXONE 2 GRAM INJ SOLR,,J0696,HCPCS,Facility,Both,1,Each,,18,15.3,5.1588,18,"Preferred One Administrative Services, INC.",PPO,17.748,98.6,,percent of total billed charges,,
CEFTRIAXONE 2 GRAM INJ SOLR,,J0696,HCPCS,Facility,Outpatient,1,Each,,18,15.3,5.1588,18,PrimeWest Health,Minnesota Senior Health Options (MSHO),9.261,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
CEFTRIAXONE 2 GRAM INJ SOLR,,J0696,HCPCS,Facility,Inpatient,1,Each,,18,15.3,5.1588,18,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CEFTRIAXONE 2 GRAM INJ SOLR,,J0696,HCPCS,Facility,Outpatient,1,Each,,18,15.3,5.1588,18,PrimeWest Health,MinnesotaCare,9.2448,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
CEFTRIAXONE 2 GRAM INJ SOLR,,J0696,HCPCS,Facility,Inpatient,1,Each,,18,15.3,5.1588,18,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
CEFTRIAXONE 2 GRAM INJ SOLR,,J0696,HCPCS,Facility,Both,1,Each,,18,15.3,5.1588,18,Sanford Health Plan,Sanford Health Plan,16.56,92,,percent of total billed charges,,
CEFTRIAXONE 2 GRAM INJ SOLR,,J0696,HCPCS,Facility,Outpatient,1,Each,,18,15.3,5.1588,18,"UCare Health, Inc.",Individual & Family Plan,10.143,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
CEFTRIAXONE 2 GRAM INJ SOLR,,J0696,HCPCS,Facility,Inpatient,1,Each,,18,15.3,5.1588,18,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
CEFTRIAXONE 2 GRAM INJ SOLR,,J0696,HCPCS,Facility,Outpatient,1,Each,,18,15.3,5.1588,18,"UCare Health, Inc.",Medical Assistance,9.0846,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CEFTRIAXONE 2 GRAM INJ SOLR,,J0696,HCPCS,Facility,Inpatient,1,Each,,18,15.3,5.1588,18,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
CEFTRIAXONE 2 GRAM INJ SOLR,,J0696,HCPCS,Facility,Outpatient,1,Each,,18,15.3,5.1588,18,"UCare Health, Inc.",Medicare Advantage,9.0846,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CEFTRIAXONE 2 GRAM INJ SOLR,,J0696,HCPCS,Facility,Inpatient,1,Each,,18,15.3,5.1588,18,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CEFTRIAXONE 2 GRAM INJ SOLR,,J0696,HCPCS,Facility,Outpatient,1,Each,,18,15.3,5.1588,18,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),9.0846,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CEFTRIAXONE 2 GRAM INJ SOLR,,J0696,HCPCS,Facility,Inpatient,1,Each,,18,15.3,5.1588,18,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CEFTRIAXONE 2 GRAM INJ SOLR,,J0696,HCPCS,Facility,Both,1,Each,,18,15.3,5.1588,18,UnitedHealthcare,Individual & Family,16.92,94,,percent of total billed charges,,
CEFTRIAXONE 2 GRAM INJ SOLR,,J0696,HCPCS,Facility,Outpatient,1,Each,,18,15.3,5.1588,18,UnitedHealthcare,Medicare Advantage,8.82,49,,percent of total billed charges,,
CEFTRIAXONE 2 GRAM INJ SOLR,,J0696,HCPCS,Facility,Inpatient,1,Each,,18,15.3,5.1588,18,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
CEFTRIAXONE 2 GRAM INJ SOLR,,J0696,HCPCS,Facility,Outpatient,1,Each,,18,15.3,5.1588,18,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,8.64,48,,percent of total billed charges,,100% of DHS outpatient percentage
CEFTRIAXONE 2 GRAM INJ SOLR,,J0696,HCPCS,Facility,Inpatient,1,Each,,18,15.3,5.1588,18,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
CEFTRIAXONE 2 GRAM IV SOLR,,J0696,HCPCS,Facility,Both,1,Each,,48,40.8,13.7568,48,Aetna,Commercial,44.16,92,,percent of total billed charges,,
CEFTRIAXONE 2 GRAM IV SOLR,,J0696,HCPCS,Facility,Outpatient,1,Each,,48,40.8,13.7568,48,Aetna,Medicare Advantage,23.52,49,,percent of total billed charges,,
CEFTRIAXONE 2 GRAM IV SOLR,,J0696,HCPCS,Facility,Inpatient,1,Each,,48,40.8,13.7568,48,Aetna,Medicare Advantage,,,,,Included in per diem rate,
CEFTRIAXONE 2 GRAM IV SOLR,,J0696,HCPCS,Facility,Both,1,Each,,48,40.8,13.7568,48,Aetna,PPO,44.64,93,,percent of total billed charges,,
CEFTRIAXONE 2 GRAM IV SOLR,,J0696,HCPCS,Facility,Both,1,Each,,48,40.8,13.7568,48,America's PPO,America's PPO,46.0944,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
CEFTRIAXONE 2 GRAM IV SOLR,,J0696,HCPCS,Facility,Both,1,Each,,48,40.8,13.7568,48,BlueCross BlueShield Minnesota, Federal Employee Program,47.232,98.4,,percent of total billed charges,,
CEFTRIAXONE 2 GRAM IV SOLR,,J0696,HCPCS,Facility,Both,1,Each,,48,40.8,13.7568,48,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,48,100,,percent of total billed charges,,
CEFTRIAXONE 2 GRAM IV SOLR,,J0696,HCPCS,Facility,Both,1,Each,,48,40.8,13.7568,48,BlueCross BlueShield Minnesota,High Value Network Plan,43.2,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
CEFTRIAXONE 2 GRAM IV SOLR,,J0696,HCPCS,Facility,Outpatient,1,Each,,48,40.8,13.7568,48,BlueCross BlueShield Minnesota,Medicare Advantage,23.52,49,,percent of total billed charges,,
CEFTRIAXONE 2 GRAM IV SOLR,,J0696,HCPCS,Facility,Inpatient,1,Each,,48,40.8,13.7568,48,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
CEFTRIAXONE 2 GRAM IV SOLR,,J0696,HCPCS,Facility,Both,1,Each,,48,40.8,13.7568,48,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,42.5136,88.57,,percent of total billed charges,,
CEFTRIAXONE 2 GRAM IV SOLR,,J0696,HCPCS,Facility,Both,1,Each,,48,40.8,13.7568,48,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,13.7568,28.66,,percent of total billed charges,,
CEFTRIAXONE 2 GRAM IV SOLR,,J0696,HCPCS,Facility,Outpatient,1,Each,,48,40.8,13.7568,48,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),23.52,49,,percent of total billed charges,,
CEFTRIAXONE 2 GRAM IV SOLR,,J0696,HCPCS,Facility,Inpatient,1,Each,,48,40.8,13.7568,48,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
CEFTRIAXONE 2 GRAM IV SOLR,,J0696,HCPCS,Facility,Both,1,Each,,48,40.8,13.7568,48,CorVel,Worker's Compensation,48,100,,percent of total billed charges,,
CEFTRIAXONE 2 GRAM IV SOLR,,J0696,HCPCS,Facility,Both,1,Each,,48,40.8,13.7568,48,First Health Group Corporation,First Health Network,46.56,97,,percent of total billed charges,,
CEFTRIAXONE 2 GRAM IV SOLR,,J0696,HCPCS,Facility,Both,1,Each,,48,40.8,13.7568,48,"Health Partners, Inc.",Commercial,45.408,94.6,,percent of total billed charges,,
CEFTRIAXONE 2 GRAM IV SOLR,,J0696,HCPCS,Facility,Outpatient,1,Each,,48,40.8,13.7568,48,"Health Partners, Inc.",Medicare Advantage,23.52,49,,percent of total billed charges,,
CEFTRIAXONE 2 GRAM IV SOLR,,J0696,HCPCS,Facility,Inpatient,1,Each,,48,40.8,13.7568,48,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CEFTRIAXONE 2 GRAM IV SOLR,,J0696,HCPCS,Facility,Both,1,Each,,48,40.8,13.7568,48,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),28.8,60,,percent of total billed charges,,
CEFTRIAXONE 2 GRAM IV SOLR,,J0696,HCPCS,Facility,Both,1,Each,,48,40.8,13.7568,48,"Health Partners, Inc.",State of Minnesota Advantage Program,39.12,81.5,,percent of total billed charges,,
CEFTRIAXONE 2 GRAM IV SOLR,,J0696,HCPCS,Facility,Both,1,Each,,48,40.8,13.7568,48,"Health Partners, Inc.",State Public Programs,24,50,,percent of total billed charges,,
CEFTRIAXONE 2 GRAM IV SOLR,,J0696,HCPCS,Facility,Both,1,Each,,48,40.8,13.7568,48,Humana Insurance Company,Commercial PPO,45.6,95,,percent of total billed charges,,
CEFTRIAXONE 2 GRAM IV SOLR,,J0696,HCPCS,Facility,Outpatient,1,Each,,48,40.8,13.7568,48,Humana Insurance Company,Medicare PPO,23.52,49,,percent of total billed charges,,
CEFTRIAXONE 2 GRAM IV SOLR,,J0696,HCPCS,Facility,Inpatient,1,Each,,48,40.8,13.7568,48,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
CEFTRIAXONE 2 GRAM IV SOLR,,J0696,HCPCS,Facility,Both,1,Each,,48,40.8,13.7568,48,Medica,Individual & Family,47.568,99.1,,percent of total billed charges,,
CEFTRIAXONE 2 GRAM IV SOLR,,J0696,HCPCS,Facility,Outpatient,1,Each,,48,40.8,13.7568,48,Medica,Medica Advantage Solution,23.904,49.8,,percent of total billed charges,,
CEFTRIAXONE 2 GRAM IV SOLR,,J0696,HCPCS,Facility,Inpatient,1,Each,,48,40.8,13.7568,48,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
CEFTRIAXONE 2 GRAM IV SOLR,,J0696,HCPCS,Facility,Outpatient,1,Each,,48,40.8,13.7568,48,Medica,Medical Assistance,21.408,44.6,,percent of total billed charges,,
CEFTRIAXONE 2 GRAM IV SOLR,,J0696,HCPCS,Facility,Inpatient,1,Each,,48,40.8,13.7568,48,Medica,Medical Assistance,,,,,Included in per diem rate,
CEFTRIAXONE 2 GRAM IV SOLR,,J0696,HCPCS,Facility,Outpatient,1,Each,,48,40.8,13.7568,48,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,23.904,49.8,,percent of total billed charges,,
CEFTRIAXONE 2 GRAM IV SOLR,,J0696,HCPCS,Facility,Inpatient,1,Each,,48,40.8,13.7568,48,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
CEFTRIAXONE 2 GRAM IV SOLR,,J0696,HCPCS,Facility,Both,1,Each,,48,40.8,13.7568,48,"Multiplan, Inc.","Multiplan, Inc.",45.12,94,,percent of total billed charges,,
CEFTRIAXONE 2 GRAM IV SOLR,,J0696,HCPCS,Facility,Outpatient,1,Each,,48,40.8,13.7568,48,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,43.248,90.1,,percent of total billed charges,,
CEFTRIAXONE 2 GRAM IV SOLR,,J0696,HCPCS,Facility,Inpatient,1,Each,,48,40.8,13.7568,48,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
CEFTRIAXONE 2 GRAM IV SOLR,,J0696,HCPCS,Facility,Both,1,Each,,48,40.8,13.7568,48,"Preferred One Administrative Services, INC.",PPO,47.328,98.6,,percent of total billed charges,,
CEFTRIAXONE 2 GRAM IV SOLR,,J0696,HCPCS,Facility,Outpatient,1,Each,,48,40.8,13.7568,48,PrimeWest Health,Minnesota Senior Health Options (MSHO),24.696,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
CEFTRIAXONE 2 GRAM IV SOLR,,J0696,HCPCS,Facility,Inpatient,1,Each,,48,40.8,13.7568,48,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CEFTRIAXONE 2 GRAM IV SOLR,,J0696,HCPCS,Facility,Outpatient,1,Each,,48,40.8,13.7568,48,PrimeWest Health,MinnesotaCare,24.6528,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
CEFTRIAXONE 2 GRAM IV SOLR,,J0696,HCPCS,Facility,Inpatient,1,Each,,48,40.8,13.7568,48,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
CEFTRIAXONE 2 GRAM IV SOLR,,J0696,HCPCS,Facility,Both,1,Each,,48,40.8,13.7568,48,Sanford Health Plan,Sanford Health Plan,44.16,92,,percent of total billed charges,,
CEFTRIAXONE 2 GRAM IV SOLR,,J0696,HCPCS,Facility,Outpatient,1,Each,,48,40.8,13.7568,48,"UCare Health, Inc.",Individual & Family Plan,27.048,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
CEFTRIAXONE 2 GRAM IV SOLR,,J0696,HCPCS,Facility,Inpatient,1,Each,,48,40.8,13.7568,48,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
CEFTRIAXONE 2 GRAM IV SOLR,,J0696,HCPCS,Facility,Outpatient,1,Each,,48,40.8,13.7568,48,"UCare Health, Inc.",Medical Assistance,24.2256,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CEFTRIAXONE 2 GRAM IV SOLR,,J0696,HCPCS,Facility,Inpatient,1,Each,,48,40.8,13.7568,48,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
CEFTRIAXONE 2 GRAM IV SOLR,,J0696,HCPCS,Facility,Outpatient,1,Each,,48,40.8,13.7568,48,"UCare Health, Inc.",Medicare Advantage,24.2256,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CEFTRIAXONE 2 GRAM IV SOLR,,J0696,HCPCS,Facility,Inpatient,1,Each,,48,40.8,13.7568,48,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CEFTRIAXONE 2 GRAM IV SOLR,,J0696,HCPCS,Facility,Outpatient,1,Each,,48,40.8,13.7568,48,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),24.2256,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CEFTRIAXONE 2 GRAM IV SOLR,,J0696,HCPCS,Facility,Inpatient,1,Each,,48,40.8,13.7568,48,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CEFTRIAXONE 2 GRAM IV SOLR,,J0696,HCPCS,Facility,Both,1,Each,,48,40.8,13.7568,48,UnitedHealthcare,Individual & Family,45.12,94,,percent of total billed charges,,
CEFTRIAXONE 2 GRAM IV SOLR,,J0696,HCPCS,Facility,Outpatient,1,Each,,48,40.8,13.7568,48,UnitedHealthcare,Medicare Advantage,23.52,49,,percent of total billed charges,,
CEFTRIAXONE 2 GRAM IV SOLR,,J0696,HCPCS,Facility,Inpatient,1,Each,,48,40.8,13.7568,48,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
CEFTRIAXONE 2 GRAM IV SOLR,,J0696,HCPCS,Facility,Outpatient,1,Each,,48,40.8,13.7568,48,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,23.04,48,,percent of total billed charges,,100% of DHS outpatient percentage
CEFTRIAXONE 2 GRAM IV SOLR,,J0696,HCPCS,Facility,Inpatient,1,Each,,48,40.8,13.7568,48,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
CEFTRIAXONE 500 MG INJ SOLR,,J0696,HCPCS,Facility,Both,1,Each,,121,102.85,34.6786,121,Aetna,Commercial,111.32,92,,percent of total billed charges,,
CEFTRIAXONE 500 MG INJ SOLR,,J0696,HCPCS,Facility,Outpatient,1,Each,,121,102.85,34.6786,121,Aetna,Medicare Advantage,59.29,49,,percent of total billed charges,,
CEFTRIAXONE 500 MG INJ SOLR,,J0696,HCPCS,Facility,Inpatient,1,Each,,121,102.85,34.6786,121,Aetna,Medicare Advantage,,,,,Included in per diem rate,
CEFTRIAXONE 500 MG INJ SOLR,,J0696,HCPCS,Facility,Both,1,Each,,121,102.85,34.6786,121,Aetna,PPO,112.53,93,,percent of total billed charges,,
CEFTRIAXONE 500 MG INJ SOLR,,J0696,HCPCS,Facility,Both,1,Each,,121,102.85,34.6786,121,America's PPO,America's PPO,116.1963,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
CEFTRIAXONE 500 MG INJ SOLR,,J0696,HCPCS,Facility,Both,1,Each,,121,102.85,34.6786,121,BlueCross BlueShield Minnesota, Federal Employee Program,119.064,98.4,,percent of total billed charges,,
CEFTRIAXONE 500 MG INJ SOLR,,J0696,HCPCS,Facility,Both,1,Each,,121,102.85,34.6786,121,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,121,100,,percent of total billed charges,,
CEFTRIAXONE 500 MG INJ SOLR,,J0696,HCPCS,Facility,Both,1,Each,,121,102.85,34.6786,121,BlueCross BlueShield Minnesota,High Value Network Plan,108.9,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
CEFTRIAXONE 500 MG INJ SOLR,,J0696,HCPCS,Facility,Outpatient,1,Each,,121,102.85,34.6786,121,BlueCross BlueShield Minnesota,Medicare Advantage,59.29,49,,percent of total billed charges,,
CEFTRIAXONE 500 MG INJ SOLR,,J0696,HCPCS,Facility,Inpatient,1,Each,,121,102.85,34.6786,121,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
CEFTRIAXONE 500 MG INJ SOLR,,J0696,HCPCS,Facility,Both,1,Each,,121,102.85,34.6786,121,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,107.1697,88.57,,percent of total billed charges,,
CEFTRIAXONE 500 MG INJ SOLR,,J0696,HCPCS,Facility,Both,1,Each,,121,102.85,34.6786,121,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,34.6786,28.66,,percent of total billed charges,,
CEFTRIAXONE 500 MG INJ SOLR,,J0696,HCPCS,Facility,Outpatient,1,Each,,121,102.85,34.6786,121,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),59.29,49,,percent of total billed charges,,
CEFTRIAXONE 500 MG INJ SOLR,,J0696,HCPCS,Facility,Inpatient,1,Each,,121,102.85,34.6786,121,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
CEFTRIAXONE 500 MG INJ SOLR,,J0696,HCPCS,Facility,Both,1,Each,,121,102.85,34.6786,121,CorVel,Worker's Compensation,121,100,,percent of total billed charges,,
CEFTRIAXONE 500 MG INJ SOLR,,J0696,HCPCS,Facility,Both,1,Each,,121,102.85,34.6786,121,First Health Group Corporation,First Health Network,117.37,97,,percent of total billed charges,,
CEFTRIAXONE 500 MG INJ SOLR,,J0696,HCPCS,Facility,Both,1,Each,,121,102.85,34.6786,121,"Health Partners, Inc.",Commercial,114.466,94.6,,percent of total billed charges,,
CEFTRIAXONE 500 MG INJ SOLR,,J0696,HCPCS,Facility,Outpatient,1,Each,,121,102.85,34.6786,121,"Health Partners, Inc.",Medicare Advantage,59.29,49,,percent of total billed charges,,
CEFTRIAXONE 500 MG INJ SOLR,,J0696,HCPCS,Facility,Inpatient,1,Each,,121,102.85,34.6786,121,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CEFTRIAXONE 500 MG INJ SOLR,,J0696,HCPCS,Facility,Both,1,Each,,121,102.85,34.6786,121,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),72.6,60,,percent of total billed charges,,
CEFTRIAXONE 500 MG INJ SOLR,,J0696,HCPCS,Facility,Both,1,Each,,121,102.85,34.6786,121,"Health Partners, Inc.",State of Minnesota Advantage Program,98.615,81.5,,percent of total billed charges,,
CEFTRIAXONE 500 MG INJ SOLR,,J0696,HCPCS,Facility,Both,1,Each,,121,102.85,34.6786,121,"Health Partners, Inc.",State Public Programs,60.5,50,,percent of total billed charges,,
CEFTRIAXONE 500 MG INJ SOLR,,J0696,HCPCS,Facility,Both,1,Each,,121,102.85,34.6786,121,Humana Insurance Company,Commercial PPO,114.95,95,,percent of total billed charges,,
CEFTRIAXONE 500 MG INJ SOLR,,J0696,HCPCS,Facility,Outpatient,1,Each,,121,102.85,34.6786,121,Humana Insurance Company,Medicare PPO,59.29,49,,percent of total billed charges,,
CEFTRIAXONE 500 MG INJ SOLR,,J0696,HCPCS,Facility,Inpatient,1,Each,,121,102.85,34.6786,121,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
CEFTRIAXONE 500 MG INJ SOLR,,J0696,HCPCS,Facility,Both,1,Each,,121,102.85,34.6786,121,Medica,Individual & Family,119.911,99.1,,percent of total billed charges,,
CEFTRIAXONE 500 MG INJ SOLR,,J0696,HCPCS,Facility,Outpatient,1,Each,,121,102.85,34.6786,121,Medica,Medica Advantage Solution,60.258,49.8,,percent of total billed charges,,
CEFTRIAXONE 500 MG INJ SOLR,,J0696,HCPCS,Facility,Inpatient,1,Each,,121,102.85,34.6786,121,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
CEFTRIAXONE 500 MG INJ SOLR,,J0696,HCPCS,Facility,Outpatient,1,Each,,121,102.85,34.6786,121,Medica,Medical Assistance,53.966,44.6,,percent of total billed charges,,
CEFTRIAXONE 500 MG INJ SOLR,,J0696,HCPCS,Facility,Inpatient,1,Each,,121,102.85,34.6786,121,Medica,Medical Assistance,,,,,Included in per diem rate,
CEFTRIAXONE 500 MG INJ SOLR,,J0696,HCPCS,Facility,Outpatient,1,Each,,121,102.85,34.6786,121,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,60.258,49.8,,percent of total billed charges,,
CEFTRIAXONE 500 MG INJ SOLR,,J0696,HCPCS,Facility,Inpatient,1,Each,,121,102.85,34.6786,121,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
CEFTRIAXONE 500 MG INJ SOLR,,J0696,HCPCS,Facility,Both,1,Each,,121,102.85,34.6786,121,"Multiplan, Inc.","Multiplan, Inc.",113.74,94,,percent of total billed charges,,
CEFTRIAXONE 500 MG INJ SOLR,,J0696,HCPCS,Facility,Outpatient,1,Each,,121,102.85,34.6786,121,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,109.021,90.1,,percent of total billed charges,,
CEFTRIAXONE 500 MG INJ SOLR,,J0696,HCPCS,Facility,Inpatient,1,Each,,121,102.85,34.6786,121,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
CEFTRIAXONE 500 MG INJ SOLR,,J0696,HCPCS,Facility,Both,1,Each,,121,102.85,34.6786,121,"Preferred One Administrative Services, INC.",PPO,119.306,98.6,,percent of total billed charges,,
CEFTRIAXONE 500 MG INJ SOLR,,J0696,HCPCS,Facility,Outpatient,1,Each,,121,102.85,34.6786,121,PrimeWest Health,Minnesota Senior Health Options (MSHO),62.2545,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
CEFTRIAXONE 500 MG INJ SOLR,,J0696,HCPCS,Facility,Inpatient,1,Each,,121,102.85,34.6786,121,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CEFTRIAXONE 500 MG INJ SOLR,,J0696,HCPCS,Facility,Outpatient,1,Each,,121,102.85,34.6786,121,PrimeWest Health,MinnesotaCare,62.1456,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
CEFTRIAXONE 500 MG INJ SOLR,,J0696,HCPCS,Facility,Inpatient,1,Each,,121,102.85,34.6786,121,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
CEFTRIAXONE 500 MG INJ SOLR,,J0696,HCPCS,Facility,Both,1,Each,,121,102.85,34.6786,121,Sanford Health Plan,Sanford Health Plan,111.32,92,,percent of total billed charges,,
CEFTRIAXONE 500 MG INJ SOLR,,J0696,HCPCS,Facility,Outpatient,1,Each,,121,102.85,34.6786,121,"UCare Health, Inc.",Individual & Family Plan,68.1835,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
CEFTRIAXONE 500 MG INJ SOLR,,J0696,HCPCS,Facility,Inpatient,1,Each,,121,102.85,34.6786,121,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
CEFTRIAXONE 500 MG INJ SOLR,,J0696,HCPCS,Facility,Outpatient,1,Each,,121,102.85,34.6786,121,"UCare Health, Inc.",Medical Assistance,61.0687,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CEFTRIAXONE 500 MG INJ SOLR,,J0696,HCPCS,Facility,Inpatient,1,Each,,121,102.85,34.6786,121,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
CEFTRIAXONE 500 MG INJ SOLR,,J0696,HCPCS,Facility,Outpatient,1,Each,,121,102.85,34.6786,121,"UCare Health, Inc.",Medicare Advantage,61.0687,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CEFTRIAXONE 500 MG INJ SOLR,,J0696,HCPCS,Facility,Inpatient,1,Each,,121,102.85,34.6786,121,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CEFTRIAXONE 500 MG INJ SOLR,,J0696,HCPCS,Facility,Outpatient,1,Each,,121,102.85,34.6786,121,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),61.0687,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CEFTRIAXONE 500 MG INJ SOLR,,J0696,HCPCS,Facility,Inpatient,1,Each,,121,102.85,34.6786,121,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CEFTRIAXONE 500 MG INJ SOLR,,J0696,HCPCS,Facility,Both,1,Each,,121,102.85,34.6786,121,UnitedHealthcare,Individual & Family,113.74,94,,percent of total billed charges,,
CEFTRIAXONE 500 MG INJ SOLR,,J0696,HCPCS,Facility,Outpatient,1,Each,,121,102.85,34.6786,121,UnitedHealthcare,Medicare Advantage,59.29,49,,percent of total billed charges,,
CEFTRIAXONE 500 MG INJ SOLR,,J0696,HCPCS,Facility,Inpatient,1,Each,,121,102.85,34.6786,121,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
CEFTRIAXONE 500 MG INJ SOLR,,J0696,HCPCS,Facility,Outpatient,1,Each,,121,102.85,34.6786,121,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,58.08,48,,percent of total billed charges,,100% of DHS outpatient percentage
CEFTRIAXONE 500 MG INJ SOLR,,J0696,HCPCS,Facility,Inpatient,1,Each,,121,102.85,34.6786,121,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
CEFUROXIME SODIUM 1.5 GRAM IV SOLR,,J0697,HCPCS,Facility,Both,1,Each,,36,30.6,10.3176,36,Aetna,Commercial,33.12,92,,percent of total billed charges,,
CEFUROXIME SODIUM 1.5 GRAM IV SOLR,,J0697,HCPCS,Facility,Outpatient,1,Each,,36,30.6,10.3176,36,Aetna,Medicare Advantage,17.64,49,,percent of total billed charges,,
CEFUROXIME SODIUM 1.5 GRAM IV SOLR,,J0697,HCPCS,Facility,Inpatient,1,Each,,36,30.6,10.3176,36,Aetna,Medicare Advantage,,,,,Included in per diem rate,
CEFUROXIME SODIUM 1.5 GRAM IV SOLR,,J0697,HCPCS,Facility,Both,1,Each,,36,30.6,10.3176,36,Aetna,PPO,33.48,93,,percent of total billed charges,,
CEFUROXIME SODIUM 1.5 GRAM IV SOLR,,J0697,HCPCS,Facility,Both,1,Each,,36,30.6,10.3176,36,America's PPO,America's PPO,34.5708,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
CEFUROXIME SODIUM 1.5 GRAM IV SOLR,,J0697,HCPCS,Facility,Both,1,Each,,36,30.6,10.3176,36,BlueCross BlueShield Minnesota, Federal Employee Program,35.424,98.4,,percent of total billed charges,,
CEFUROXIME SODIUM 1.5 GRAM IV SOLR,,J0697,HCPCS,Facility,Both,1,Each,,36,30.6,10.3176,36,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,36,100,,percent of total billed charges,,
CEFUROXIME SODIUM 1.5 GRAM IV SOLR,,J0697,HCPCS,Facility,Both,1,Each,,36,30.6,10.3176,36,BlueCross BlueShield Minnesota,High Value Network Plan,32.4,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
CEFUROXIME SODIUM 1.5 GRAM IV SOLR,,J0697,HCPCS,Facility,Outpatient,1,Each,,36,30.6,10.3176,36,BlueCross BlueShield Minnesota,Medicare Advantage,17.64,49,,percent of total billed charges,,
CEFUROXIME SODIUM 1.5 GRAM IV SOLR,,J0697,HCPCS,Facility,Inpatient,1,Each,,36,30.6,10.3176,36,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
CEFUROXIME SODIUM 1.5 GRAM IV SOLR,,J0697,HCPCS,Facility,Both,1,Each,,36,30.6,10.3176,36,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,31.8852,88.57,,percent of total billed charges,,
CEFUROXIME SODIUM 1.5 GRAM IV SOLR,,J0697,HCPCS,Facility,Both,1,Each,,36,30.6,10.3176,36,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,10.3176,28.66,,percent of total billed charges,,
CEFUROXIME SODIUM 1.5 GRAM IV SOLR,,J0697,HCPCS,Facility,Outpatient,1,Each,,36,30.6,10.3176,36,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),17.64,49,,percent of total billed charges,,
CEFUROXIME SODIUM 1.5 GRAM IV SOLR,,J0697,HCPCS,Facility,Inpatient,1,Each,,36,30.6,10.3176,36,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
CEFUROXIME SODIUM 1.5 GRAM IV SOLR,,J0697,HCPCS,Facility,Both,1,Each,,36,30.6,10.3176,36,CorVel,Worker's Compensation,36,100,,percent of total billed charges,,
CEFUROXIME SODIUM 1.5 GRAM IV SOLR,,J0697,HCPCS,Facility,Both,1,Each,,36,30.6,10.3176,36,First Health Group Corporation,First Health Network,34.92,97,,percent of total billed charges,,
CEFUROXIME SODIUM 1.5 GRAM IV SOLR,,J0697,HCPCS,Facility,Both,1,Each,,36,30.6,10.3176,36,"Health Partners, Inc.",Commercial,34.056,94.6,,percent of total billed charges,,
CEFUROXIME SODIUM 1.5 GRAM IV SOLR,,J0697,HCPCS,Facility,Outpatient,1,Each,,36,30.6,10.3176,36,"Health Partners, Inc.",Medicare Advantage,17.64,49,,percent of total billed charges,,
CEFUROXIME SODIUM 1.5 GRAM IV SOLR,,J0697,HCPCS,Facility,Inpatient,1,Each,,36,30.6,10.3176,36,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CEFUROXIME SODIUM 1.5 GRAM IV SOLR,,J0697,HCPCS,Facility,Both,1,Each,,36,30.6,10.3176,36,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),21.6,60,,percent of total billed charges,,
CEFUROXIME SODIUM 1.5 GRAM IV SOLR,,J0697,HCPCS,Facility,Both,1,Each,,36,30.6,10.3176,36,"Health Partners, Inc.",State of Minnesota Advantage Program,29.34,81.5,,percent of total billed charges,,
CEFUROXIME SODIUM 1.5 GRAM IV SOLR,,J0697,HCPCS,Facility,Both,1,Each,,36,30.6,10.3176,36,"Health Partners, Inc.",State Public Programs,18,50,,percent of total billed charges,,
CEFUROXIME SODIUM 1.5 GRAM IV SOLR,,J0697,HCPCS,Facility,Both,1,Each,,36,30.6,10.3176,36,Humana Insurance Company,Commercial PPO,34.2,95,,percent of total billed charges,,
CEFUROXIME SODIUM 1.5 GRAM IV SOLR,,J0697,HCPCS,Facility,Outpatient,1,Each,,36,30.6,10.3176,36,Humana Insurance Company,Medicare PPO,17.64,49,,percent of total billed charges,,
CEFUROXIME SODIUM 1.5 GRAM IV SOLR,,J0697,HCPCS,Facility,Inpatient,1,Each,,36,30.6,10.3176,36,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
CEFUROXIME SODIUM 1.5 GRAM IV SOLR,,J0697,HCPCS,Facility,Both,1,Each,,36,30.6,10.3176,36,Medica,Individual & Family,35.676,99.1,,percent of total billed charges,,
CEFUROXIME SODIUM 1.5 GRAM IV SOLR,,J0697,HCPCS,Facility,Outpatient,1,Each,,36,30.6,10.3176,36,Medica,Medica Advantage Solution,17.928,49.8,,percent of total billed charges,,
CEFUROXIME SODIUM 1.5 GRAM IV SOLR,,J0697,HCPCS,Facility,Inpatient,1,Each,,36,30.6,10.3176,36,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
CEFUROXIME SODIUM 1.5 GRAM IV SOLR,,J0697,HCPCS,Facility,Outpatient,1,Each,,36,30.6,10.3176,36,Medica,Medical Assistance,16.056,44.6,,percent of total billed charges,,
CEFUROXIME SODIUM 1.5 GRAM IV SOLR,,J0697,HCPCS,Facility,Inpatient,1,Each,,36,30.6,10.3176,36,Medica,Medical Assistance,,,,,Included in per diem rate,
CEFUROXIME SODIUM 1.5 GRAM IV SOLR,,J0697,HCPCS,Facility,Outpatient,1,Each,,36,30.6,10.3176,36,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,17.928,49.8,,percent of total billed charges,,
CEFUROXIME SODIUM 1.5 GRAM IV SOLR,,J0697,HCPCS,Facility,Inpatient,1,Each,,36,30.6,10.3176,36,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
CEFUROXIME SODIUM 1.5 GRAM IV SOLR,,J0697,HCPCS,Facility,Both,1,Each,,36,30.6,10.3176,36,"Multiplan, Inc.","Multiplan, Inc.",33.84,94,,percent of total billed charges,,
CEFUROXIME SODIUM 1.5 GRAM IV SOLR,,J0697,HCPCS,Facility,Outpatient,1,Each,,36,30.6,10.3176,36,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,32.436,90.1,,percent of total billed charges,,
CEFUROXIME SODIUM 1.5 GRAM IV SOLR,,J0697,HCPCS,Facility,Inpatient,1,Each,,36,30.6,10.3176,36,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
CEFUROXIME SODIUM 1.5 GRAM IV SOLR,,J0697,HCPCS,Facility,Both,1,Each,,36,30.6,10.3176,36,"Preferred One Administrative Services, INC.",PPO,35.496,98.6,,percent of total billed charges,,
CEFUROXIME SODIUM 1.5 GRAM IV SOLR,,J0697,HCPCS,Facility,Outpatient,1,Each,,36,30.6,10.3176,36,PrimeWest Health,Minnesota Senior Health Options (MSHO),18.522,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
CEFUROXIME SODIUM 1.5 GRAM IV SOLR,,J0697,HCPCS,Facility,Inpatient,1,Each,,36,30.6,10.3176,36,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CEFUROXIME SODIUM 1.5 GRAM IV SOLR,,J0697,HCPCS,Facility,Outpatient,1,Each,,36,30.6,10.3176,36,PrimeWest Health,MinnesotaCare,18.4896,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
CEFUROXIME SODIUM 1.5 GRAM IV SOLR,,J0697,HCPCS,Facility,Inpatient,1,Each,,36,30.6,10.3176,36,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
CEFUROXIME SODIUM 1.5 GRAM IV SOLR,,J0697,HCPCS,Facility,Both,1,Each,,36,30.6,10.3176,36,Sanford Health Plan,Sanford Health Plan,33.12,92,,percent of total billed charges,,
CEFUROXIME SODIUM 1.5 GRAM IV SOLR,,J0697,HCPCS,Facility,Outpatient,1,Each,,36,30.6,10.3176,36,"UCare Health, Inc.",Individual & Family Plan,20.286,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
CEFUROXIME SODIUM 1.5 GRAM IV SOLR,,J0697,HCPCS,Facility,Inpatient,1,Each,,36,30.6,10.3176,36,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
CEFUROXIME SODIUM 1.5 GRAM IV SOLR,,J0697,HCPCS,Facility,Outpatient,1,Each,,36,30.6,10.3176,36,"UCare Health, Inc.",Medical Assistance,18.1692,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CEFUROXIME SODIUM 1.5 GRAM IV SOLR,,J0697,HCPCS,Facility,Inpatient,1,Each,,36,30.6,10.3176,36,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
CEFUROXIME SODIUM 1.5 GRAM IV SOLR,,J0697,HCPCS,Facility,Outpatient,1,Each,,36,30.6,10.3176,36,"UCare Health, Inc.",Medicare Advantage,18.1692,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CEFUROXIME SODIUM 1.5 GRAM IV SOLR,,J0697,HCPCS,Facility,Inpatient,1,Each,,36,30.6,10.3176,36,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CEFUROXIME SODIUM 1.5 GRAM IV SOLR,,J0697,HCPCS,Facility,Outpatient,1,Each,,36,30.6,10.3176,36,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),18.1692,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CEFUROXIME SODIUM 1.5 GRAM IV SOLR,,J0697,HCPCS,Facility,Inpatient,1,Each,,36,30.6,10.3176,36,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CEFUROXIME SODIUM 1.5 GRAM IV SOLR,,J0697,HCPCS,Facility,Both,1,Each,,36,30.6,10.3176,36,UnitedHealthcare,Individual & Family,33.84,94,,percent of total billed charges,,
CEFUROXIME SODIUM 1.5 GRAM IV SOLR,,J0697,HCPCS,Facility,Outpatient,1,Each,,36,30.6,10.3176,36,UnitedHealthcare,Medicare Advantage,17.64,49,,percent of total billed charges,,
CEFUROXIME SODIUM 1.5 GRAM IV SOLR,,J0697,HCPCS,Facility,Inpatient,1,Each,,36,30.6,10.3176,36,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
CEFUROXIME SODIUM 1.5 GRAM IV SOLR,,J0697,HCPCS,Facility,Outpatient,1,Each,,36,30.6,10.3176,36,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,17.28,48,,percent of total billed charges,,100% of DHS outpatient percentage
CEFUROXIME SODIUM 1.5 GRAM IV SOLR,,J0697,HCPCS,Facility,Inpatient,1,Each,,36,30.6,10.3176,36,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
CEFTAZIDIME 1 GRAM INJ SOLR,,J0713,HCPCS,Facility,Both,1,Each,,27,22.95,7.7382,27,Aetna,Commercial,24.84,92,,percent of total billed charges,,
CEFTAZIDIME 1 GRAM INJ SOLR,,J0713,HCPCS,Facility,Outpatient,1,Each,,27,22.95,7.7382,27,Aetna,Medicare Advantage,13.23,49,,percent of total billed charges,,
CEFTAZIDIME 1 GRAM INJ SOLR,,J0713,HCPCS,Facility,Inpatient,1,Each,,27,22.95,7.7382,27,Aetna,Medicare Advantage,,,,,Included in per diem rate,
CEFTAZIDIME 1 GRAM INJ SOLR,,J0713,HCPCS,Facility,Both,1,Each,,27,22.95,7.7382,27,Aetna,PPO,25.11,93,,percent of total billed charges,,
CEFTAZIDIME 1 GRAM INJ SOLR,,J0713,HCPCS,Facility,Both,1,Each,,27,22.95,7.7382,27,America's PPO,America's PPO,25.9281,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
CEFTAZIDIME 1 GRAM INJ SOLR,,J0713,HCPCS,Facility,Both,1,Each,,27,22.95,7.7382,27,BlueCross BlueShield Minnesota, Federal Employee Program,26.568,98.4,,percent of total billed charges,,
CEFTAZIDIME 1 GRAM INJ SOLR,,J0713,HCPCS,Facility,Both,1,Each,,27,22.95,7.7382,27,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,27,100,,percent of total billed charges,,
CEFTAZIDIME 1 GRAM INJ SOLR,,J0713,HCPCS,Facility,Both,1,Each,,27,22.95,7.7382,27,BlueCross BlueShield Minnesota,High Value Network Plan,24.3,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
CEFTAZIDIME 1 GRAM INJ SOLR,,J0713,HCPCS,Facility,Outpatient,1,Each,,27,22.95,7.7382,27,BlueCross BlueShield Minnesota,Medicare Advantage,13.23,49,,percent of total billed charges,,
CEFTAZIDIME 1 GRAM INJ SOLR,,J0713,HCPCS,Facility,Inpatient,1,Each,,27,22.95,7.7382,27,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
CEFTAZIDIME 1 GRAM INJ SOLR,,J0713,HCPCS,Facility,Both,1,Each,,27,22.95,7.7382,27,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,23.9139,88.57,,percent of total billed charges,,
CEFTAZIDIME 1 GRAM INJ SOLR,,J0713,HCPCS,Facility,Both,1,Each,,27,22.95,7.7382,27,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,7.7382,28.66,,percent of total billed charges,,
CEFTAZIDIME 1 GRAM INJ SOLR,,J0713,HCPCS,Facility,Outpatient,1,Each,,27,22.95,7.7382,27,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),13.23,49,,percent of total billed charges,,
CEFTAZIDIME 1 GRAM INJ SOLR,,J0713,HCPCS,Facility,Inpatient,1,Each,,27,22.95,7.7382,27,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
CEFTAZIDIME 1 GRAM INJ SOLR,,J0713,HCPCS,Facility,Both,1,Each,,27,22.95,7.7382,27,CorVel,Worker's Compensation,27,100,,percent of total billed charges,,
CEFTAZIDIME 1 GRAM INJ SOLR,,J0713,HCPCS,Facility,Both,1,Each,,27,22.95,7.7382,27,First Health Group Corporation,First Health Network,26.19,97,,percent of total billed charges,,
CEFTAZIDIME 1 GRAM INJ SOLR,,J0713,HCPCS,Facility,Both,1,Each,,27,22.95,7.7382,27,"Health Partners, Inc.",Commercial,25.542,94.6,,percent of total billed charges,,
CEFTAZIDIME 1 GRAM INJ SOLR,,J0713,HCPCS,Facility,Outpatient,1,Each,,27,22.95,7.7382,27,"Health Partners, Inc.",Medicare Advantage,13.23,49,,percent of total billed charges,,
CEFTAZIDIME 1 GRAM INJ SOLR,,J0713,HCPCS,Facility,Inpatient,1,Each,,27,22.95,7.7382,27,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CEFTAZIDIME 1 GRAM INJ SOLR,,J0713,HCPCS,Facility,Both,1,Each,,27,22.95,7.7382,27,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),16.2,60,,percent of total billed charges,,
CEFTAZIDIME 1 GRAM INJ SOLR,,J0713,HCPCS,Facility,Both,1,Each,,27,22.95,7.7382,27,"Health Partners, Inc.",State of Minnesota Advantage Program,22.005,81.5,,percent of total billed charges,,
CEFTAZIDIME 1 GRAM INJ SOLR,,J0713,HCPCS,Facility,Both,1,Each,,27,22.95,7.7382,27,"Health Partners, Inc.",State Public Programs,13.5,50,,percent of total billed charges,,
CEFTAZIDIME 1 GRAM INJ SOLR,,J0713,HCPCS,Facility,Both,1,Each,,27,22.95,7.7382,27,Humana Insurance Company,Commercial PPO,25.65,95,,percent of total billed charges,,
CEFTAZIDIME 1 GRAM INJ SOLR,,J0713,HCPCS,Facility,Outpatient,1,Each,,27,22.95,7.7382,27,Humana Insurance Company,Medicare PPO,13.23,49,,percent of total billed charges,,
CEFTAZIDIME 1 GRAM INJ SOLR,,J0713,HCPCS,Facility,Inpatient,1,Each,,27,22.95,7.7382,27,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
CEFTAZIDIME 1 GRAM INJ SOLR,,J0713,HCPCS,Facility,Both,1,Each,,27,22.95,7.7382,27,Medica,Individual & Family,26.757,99.1,,percent of total billed charges,,
CEFTAZIDIME 1 GRAM INJ SOLR,,J0713,HCPCS,Facility,Outpatient,1,Each,,27,22.95,7.7382,27,Medica,Medica Advantage Solution,13.446,49.8,,percent of total billed charges,,
CEFTAZIDIME 1 GRAM INJ SOLR,,J0713,HCPCS,Facility,Inpatient,1,Each,,27,22.95,7.7382,27,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
CEFTAZIDIME 1 GRAM INJ SOLR,,J0713,HCPCS,Facility,Outpatient,1,Each,,27,22.95,7.7382,27,Medica,Medical Assistance,12.042,44.6,,percent of total billed charges,,
CEFTAZIDIME 1 GRAM INJ SOLR,,J0713,HCPCS,Facility,Inpatient,1,Each,,27,22.95,7.7382,27,Medica,Medical Assistance,,,,,Included in per diem rate,
CEFTAZIDIME 1 GRAM INJ SOLR,,J0713,HCPCS,Facility,Outpatient,1,Each,,27,22.95,7.7382,27,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,13.446,49.8,,percent of total billed charges,,
CEFTAZIDIME 1 GRAM INJ SOLR,,J0713,HCPCS,Facility,Inpatient,1,Each,,27,22.95,7.7382,27,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
CEFTAZIDIME 1 GRAM INJ SOLR,,J0713,HCPCS,Facility,Both,1,Each,,27,22.95,7.7382,27,"Multiplan, Inc.","Multiplan, Inc.",25.38,94,,percent of total billed charges,,
CEFTAZIDIME 1 GRAM INJ SOLR,,J0713,HCPCS,Facility,Outpatient,1,Each,,27,22.95,7.7382,27,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,24.327,90.1,,percent of total billed charges,,
CEFTAZIDIME 1 GRAM INJ SOLR,,J0713,HCPCS,Facility,Inpatient,1,Each,,27,22.95,7.7382,27,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
CEFTAZIDIME 1 GRAM INJ SOLR,,J0713,HCPCS,Facility,Both,1,Each,,27,22.95,7.7382,27,"Preferred One Administrative Services, INC.",PPO,26.622,98.6,,percent of total billed charges,,
CEFTAZIDIME 1 GRAM INJ SOLR,,J0713,HCPCS,Facility,Outpatient,1,Each,,27,22.95,7.7382,27,PrimeWest Health,Minnesota Senior Health Options (MSHO),13.8915,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
CEFTAZIDIME 1 GRAM INJ SOLR,,J0713,HCPCS,Facility,Inpatient,1,Each,,27,22.95,7.7382,27,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CEFTAZIDIME 1 GRAM INJ SOLR,,J0713,HCPCS,Facility,Outpatient,1,Each,,27,22.95,7.7382,27,PrimeWest Health,MinnesotaCare,13.8672,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
CEFTAZIDIME 1 GRAM INJ SOLR,,J0713,HCPCS,Facility,Inpatient,1,Each,,27,22.95,7.7382,27,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
CEFTAZIDIME 1 GRAM INJ SOLR,,J0713,HCPCS,Facility,Both,1,Each,,27,22.95,7.7382,27,Sanford Health Plan,Sanford Health Plan,24.84,92,,percent of total billed charges,,
CEFTAZIDIME 1 GRAM INJ SOLR,,J0713,HCPCS,Facility,Outpatient,1,Each,,27,22.95,7.7382,27,"UCare Health, Inc.",Individual & Family Plan,15.2145,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
CEFTAZIDIME 1 GRAM INJ SOLR,,J0713,HCPCS,Facility,Inpatient,1,Each,,27,22.95,7.7382,27,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
CEFTAZIDIME 1 GRAM INJ SOLR,,J0713,HCPCS,Facility,Outpatient,1,Each,,27,22.95,7.7382,27,"UCare Health, Inc.",Medical Assistance,13.6269,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CEFTAZIDIME 1 GRAM INJ SOLR,,J0713,HCPCS,Facility,Inpatient,1,Each,,27,22.95,7.7382,27,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
CEFTAZIDIME 1 GRAM INJ SOLR,,J0713,HCPCS,Facility,Outpatient,1,Each,,27,22.95,7.7382,27,"UCare Health, Inc.",Medicare Advantage,13.6269,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CEFTAZIDIME 1 GRAM INJ SOLR,,J0713,HCPCS,Facility,Inpatient,1,Each,,27,22.95,7.7382,27,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CEFTAZIDIME 1 GRAM INJ SOLR,,J0713,HCPCS,Facility,Outpatient,1,Each,,27,22.95,7.7382,27,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),13.6269,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CEFTAZIDIME 1 GRAM INJ SOLR,,J0713,HCPCS,Facility,Inpatient,1,Each,,27,22.95,7.7382,27,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CEFTAZIDIME 1 GRAM INJ SOLR,,J0713,HCPCS,Facility,Both,1,Each,,27,22.95,7.7382,27,UnitedHealthcare,Individual & Family,25.38,94,,percent of total billed charges,,
CEFTAZIDIME 1 GRAM INJ SOLR,,J0713,HCPCS,Facility,Outpatient,1,Each,,27,22.95,7.7382,27,UnitedHealthcare,Medicare Advantage,13.23,49,,percent of total billed charges,,
CEFTAZIDIME 1 GRAM INJ SOLR,,J0713,HCPCS,Facility,Inpatient,1,Each,,27,22.95,7.7382,27,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
CEFTAZIDIME 1 GRAM INJ SOLR,,J0713,HCPCS,Facility,Outpatient,1,Each,,27,22.95,7.7382,27,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,12.96,48,,percent of total billed charges,,100% of DHS outpatient percentage
CEFTAZIDIME 1 GRAM INJ SOLR,,J0713,HCPCS,Facility,Inpatient,1,Each,,27,22.95,7.7382,27,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
CERTOLIZUMAB PEGOL 400 MG/2 ML (200 MG/ML X 2) SUBQ SYKT,,J0717,HCPCS,Facility,Both,1,Each,,19443,16526.55,5572.3638,19443,Aetna,Commercial,17887.56,92,,percent of total billed charges,,
CERTOLIZUMAB PEGOL 400 MG/2 ML (200 MG/ML X 2) SUBQ SYKT,,J0717,HCPCS,Facility,Outpatient,1,Each,,19443,16526.55,5572.3638,19443,Aetna,Medicare Advantage,9527.07,49,,percent of total billed charges,,
CERTOLIZUMAB PEGOL 400 MG/2 ML (200 MG/ML X 2) SUBQ SYKT,,J0717,HCPCS,Facility,Inpatient,1,Each,,19443,16526.55,5572.3638,19443,Aetna,Medicare Advantage,,,,,Included in per diem rate,
CERTOLIZUMAB PEGOL 400 MG/2 ML (200 MG/ML X 2) SUBQ SYKT,,J0717,HCPCS,Facility,Both,1,Each,,19443,16526.55,5572.3638,19443,Aetna,PPO,18081.99,93,,percent of total billed charges,,
CERTOLIZUMAB PEGOL 400 MG/2 ML (200 MG/ML X 2) SUBQ SYKT,,J0717,HCPCS,Facility,Both,1,Each,,19443,16526.55,5572.3638,19443,America's PPO,America's PPO,18671.1129,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
CERTOLIZUMAB PEGOL 400 MG/2 ML (200 MG/ML X 2) SUBQ SYKT,,J0717,HCPCS,Facility,Both,1,Each,,19443,16526.55,5572.3638,19443,BlueCross BlueShield Minnesota, Federal Employee Program,19131.912,98.4,,percent of total billed charges,,
CERTOLIZUMAB PEGOL 400 MG/2 ML (200 MG/ML X 2) SUBQ SYKT,,J0717,HCPCS,Facility,Both,1,Each,,19443,16526.55,5572.3638,19443,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,19443,100,,percent of total billed charges,,
CERTOLIZUMAB PEGOL 400 MG/2 ML (200 MG/ML X 2) SUBQ SYKT,,J0717,HCPCS,Facility,Both,1,Each,,19443,16526.55,5572.3638,19443,BlueCross BlueShield Minnesota,High Value Network Plan,17498.7,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
CERTOLIZUMAB PEGOL 400 MG/2 ML (200 MG/ML X 2) SUBQ SYKT,,J0717,HCPCS,Facility,Outpatient,1,Each,,19443,16526.55,5572.3638,19443,BlueCross BlueShield Minnesota,Medicare Advantage,9527.07,49,,percent of total billed charges,,
CERTOLIZUMAB PEGOL 400 MG/2 ML (200 MG/ML X 2) SUBQ SYKT,,J0717,HCPCS,Facility,Inpatient,1,Each,,19443,16526.55,5572.3638,19443,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
CERTOLIZUMAB PEGOL 400 MG/2 ML (200 MG/ML X 2) SUBQ SYKT,,J0717,HCPCS,Facility,Both,1,Each,,19443,16526.55,5572.3638,19443,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,17220.6651,88.57,,percent of total billed charges,,
CERTOLIZUMAB PEGOL 400 MG/2 ML (200 MG/ML X 2) SUBQ SYKT,,J0717,HCPCS,Facility,Both,1,Each,,19443,16526.55,5572.3638,19443,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,5572.3638,28.66,,percent of total billed charges,,
CERTOLIZUMAB PEGOL 400 MG/2 ML (200 MG/ML X 2) SUBQ SYKT,,J0717,HCPCS,Facility,Outpatient,1,Each,,19443,16526.55,5572.3638,19443,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),9527.07,49,,percent of total billed charges,,
CERTOLIZUMAB PEGOL 400 MG/2 ML (200 MG/ML X 2) SUBQ SYKT,,J0717,HCPCS,Facility,Inpatient,1,Each,,19443,16526.55,5572.3638,19443,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
CERTOLIZUMAB PEGOL 400 MG/2 ML (200 MG/ML X 2) SUBQ SYKT,,J0717,HCPCS,Facility,Both,1,Each,,19443,16526.55,5572.3638,19443,CorVel,Worker's Compensation,19443,100,,percent of total billed charges,,
CERTOLIZUMAB PEGOL 400 MG/2 ML (200 MG/ML X 2) SUBQ SYKT,,J0717,HCPCS,Facility,Both,1,Each,,19443,16526.55,5572.3638,19443,First Health Group Corporation,First Health Network,18859.71,97,,percent of total billed charges,,
CERTOLIZUMAB PEGOL 400 MG/2 ML (200 MG/ML X 2) SUBQ SYKT,,J0717,HCPCS,Facility,Both,1,Each,,19443,16526.55,5572.3638,19443,"Health Partners, Inc.",Commercial,18393.078,94.6,,percent of total billed charges,,
CERTOLIZUMAB PEGOL 400 MG/2 ML (200 MG/ML X 2) SUBQ SYKT,,J0717,HCPCS,Facility,Outpatient,1,Each,,19443,16526.55,5572.3638,19443,"Health Partners, Inc.",Medicare Advantage,9527.07,49,,percent of total billed charges,,
CERTOLIZUMAB PEGOL 400 MG/2 ML (200 MG/ML X 2) SUBQ SYKT,,J0717,HCPCS,Facility,Inpatient,1,Each,,19443,16526.55,5572.3638,19443,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CERTOLIZUMAB PEGOL 400 MG/2 ML (200 MG/ML X 2) SUBQ SYKT,,J0717,HCPCS,Facility,Both,1,Each,,19443,16526.55,5572.3638,19443,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),11665.8,60,,percent of total billed charges,,
CERTOLIZUMAB PEGOL 400 MG/2 ML (200 MG/ML X 2) SUBQ SYKT,,J0717,HCPCS,Facility,Both,1,Each,,19443,16526.55,5572.3638,19443,"Health Partners, Inc.",State of Minnesota Advantage Program,15846.045,81.5,,percent of total billed charges,,
CERTOLIZUMAB PEGOL 400 MG/2 ML (200 MG/ML X 2) SUBQ SYKT,,J0717,HCPCS,Facility,Both,1,Each,,19443,16526.55,5572.3638,19443,"Health Partners, Inc.",State Public Programs,9721.5,50,,percent of total billed charges,,
CERTOLIZUMAB PEGOL 400 MG/2 ML (200 MG/ML X 2) SUBQ SYKT,,J0717,HCPCS,Facility,Both,1,Each,,19443,16526.55,5572.3638,19443,Humana Insurance Company,Commercial PPO,18470.85,95,,percent of total billed charges,,
CERTOLIZUMAB PEGOL 400 MG/2 ML (200 MG/ML X 2) SUBQ SYKT,,J0717,HCPCS,Facility,Outpatient,1,Each,,19443,16526.55,5572.3638,19443,Humana Insurance Company,Medicare PPO,9527.07,49,,percent of total billed charges,,
CERTOLIZUMAB PEGOL 400 MG/2 ML (200 MG/ML X 2) SUBQ SYKT,,J0717,HCPCS,Facility,Inpatient,1,Each,,19443,16526.55,5572.3638,19443,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
CERTOLIZUMAB PEGOL 400 MG/2 ML (200 MG/ML X 2) SUBQ SYKT,,J0717,HCPCS,Facility,Both,1,Each,,19443,16526.55,5572.3638,19443,Medica,Individual & Family,19268.013,99.1,,percent of total billed charges,,
CERTOLIZUMAB PEGOL 400 MG/2 ML (200 MG/ML X 2) SUBQ SYKT,,J0717,HCPCS,Facility,Outpatient,1,Each,,19443,16526.55,5572.3638,19443,Medica,Medica Advantage Solution,9682.614,49.8,,percent of total billed charges,,
CERTOLIZUMAB PEGOL 400 MG/2 ML (200 MG/ML X 2) SUBQ SYKT,,J0717,HCPCS,Facility,Inpatient,1,Each,,19443,16526.55,5572.3638,19443,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
CERTOLIZUMAB PEGOL 400 MG/2 ML (200 MG/ML X 2) SUBQ SYKT,,J0717,HCPCS,Facility,Outpatient,1,Each,,19443,16526.55,5572.3638,19443,Medica,Medical Assistance,8671.578,44.6,,percent of total billed charges,,
CERTOLIZUMAB PEGOL 400 MG/2 ML (200 MG/ML X 2) SUBQ SYKT,,J0717,HCPCS,Facility,Inpatient,1,Each,,19443,16526.55,5572.3638,19443,Medica,Medical Assistance,,,,,Included in per diem rate,
CERTOLIZUMAB PEGOL 400 MG/2 ML (200 MG/ML X 2) SUBQ SYKT,,J0717,HCPCS,Facility,Outpatient,1,Each,,19443,16526.55,5572.3638,19443,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,9682.614,49.8,,percent of total billed charges,,
CERTOLIZUMAB PEGOL 400 MG/2 ML (200 MG/ML X 2) SUBQ SYKT,,J0717,HCPCS,Facility,Inpatient,1,Each,,19443,16526.55,5572.3638,19443,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
CERTOLIZUMAB PEGOL 400 MG/2 ML (200 MG/ML X 2) SUBQ SYKT,,J0717,HCPCS,Facility,Both,1,Each,,19443,16526.55,5572.3638,19443,"Multiplan, Inc.","Multiplan, Inc.",18276.42,94,,percent of total billed charges,,
CERTOLIZUMAB PEGOL 400 MG/2 ML (200 MG/ML X 2) SUBQ SYKT,,J0717,HCPCS,Facility,Outpatient,1,Each,,19443,16526.55,5572.3638,19443,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,17518.143,90.1,,percent of total billed charges,,
CERTOLIZUMAB PEGOL 400 MG/2 ML (200 MG/ML X 2) SUBQ SYKT,,J0717,HCPCS,Facility,Inpatient,1,Each,,19443,16526.55,5572.3638,19443,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
CERTOLIZUMAB PEGOL 400 MG/2 ML (200 MG/ML X 2) SUBQ SYKT,,J0717,HCPCS,Facility,Both,1,Each,,19443,16526.55,5572.3638,19443,"Preferred One Administrative Services, INC.",PPO,19170.798,98.6,,percent of total billed charges,,
CERTOLIZUMAB PEGOL 400 MG/2 ML (200 MG/ML X 2) SUBQ SYKT,,J0717,HCPCS,Facility,Outpatient,1,Each,,19443,16526.55,5572.3638,19443,PrimeWest Health,Minnesota Senior Health Options (MSHO),10003.4235,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
CERTOLIZUMAB PEGOL 400 MG/2 ML (200 MG/ML X 2) SUBQ SYKT,,J0717,HCPCS,Facility,Inpatient,1,Each,,19443,16526.55,5572.3638,19443,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CERTOLIZUMAB PEGOL 400 MG/2 ML (200 MG/ML X 2) SUBQ SYKT,,J0717,HCPCS,Facility,Outpatient,1,Each,,19443,16526.55,5572.3638,19443,PrimeWest Health,MinnesotaCare,9985.9248,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
CERTOLIZUMAB PEGOL 400 MG/2 ML (200 MG/ML X 2) SUBQ SYKT,,J0717,HCPCS,Facility,Inpatient,1,Each,,19443,16526.55,5572.3638,19443,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
CERTOLIZUMAB PEGOL 400 MG/2 ML (200 MG/ML X 2) SUBQ SYKT,,J0717,HCPCS,Facility,Both,1,Each,,19443,16526.55,5572.3638,19443,Sanford Health Plan,Sanford Health Plan,17887.56,92,,percent of total billed charges,,
CERTOLIZUMAB PEGOL 400 MG/2 ML (200 MG/ML X 2) SUBQ SYKT,,J0717,HCPCS,Facility,Outpatient,1,Each,,19443,16526.55,5572.3638,19443,"UCare Health, Inc.",Individual & Family Plan,10956.1305,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
CERTOLIZUMAB PEGOL 400 MG/2 ML (200 MG/ML X 2) SUBQ SYKT,,J0717,HCPCS,Facility,Inpatient,1,Each,,19443,16526.55,5572.3638,19443,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
CERTOLIZUMAB PEGOL 400 MG/2 ML (200 MG/ML X 2) SUBQ SYKT,,J0717,HCPCS,Facility,Outpatient,1,Each,,19443,16526.55,5572.3638,19443,"UCare Health, Inc.",Medical Assistance,9812.8821,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CERTOLIZUMAB PEGOL 400 MG/2 ML (200 MG/ML X 2) SUBQ SYKT,,J0717,HCPCS,Facility,Inpatient,1,Each,,19443,16526.55,5572.3638,19443,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
CERTOLIZUMAB PEGOL 400 MG/2 ML (200 MG/ML X 2) SUBQ SYKT,,J0717,HCPCS,Facility,Outpatient,1,Each,,19443,16526.55,5572.3638,19443,"UCare Health, Inc.",Medicare Advantage,9812.8821,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CERTOLIZUMAB PEGOL 400 MG/2 ML (200 MG/ML X 2) SUBQ SYKT,,J0717,HCPCS,Facility,Inpatient,1,Each,,19443,16526.55,5572.3638,19443,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CERTOLIZUMAB PEGOL 400 MG/2 ML (200 MG/ML X 2) SUBQ SYKT,,J0717,HCPCS,Facility,Outpatient,1,Each,,19443,16526.55,5572.3638,19443,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),9812.8821,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CERTOLIZUMAB PEGOL 400 MG/2 ML (200 MG/ML X 2) SUBQ SYKT,,J0717,HCPCS,Facility,Inpatient,1,Each,,19443,16526.55,5572.3638,19443,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CERTOLIZUMAB PEGOL 400 MG/2 ML (200 MG/ML X 2) SUBQ SYKT,,J0717,HCPCS,Facility,Both,1,Each,,19443,16526.55,5572.3638,19443,UnitedHealthcare,Individual & Family,18276.42,94,,percent of total billed charges,,
CERTOLIZUMAB PEGOL 400 MG/2 ML (200 MG/ML X 2) SUBQ SYKT,,J0717,HCPCS,Facility,Outpatient,1,Each,,19443,16526.55,5572.3638,19443,UnitedHealthcare,Medicare Advantage,9527.07,49,,percent of total billed charges,,
CERTOLIZUMAB PEGOL 400 MG/2 ML (200 MG/ML X 2) SUBQ SYKT,,J0717,HCPCS,Facility,Inpatient,1,Each,,19443,16526.55,5572.3638,19443,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
CERTOLIZUMAB PEGOL 400 MG/2 ML (200 MG/ML X 2) SUBQ SYKT,,J0717,HCPCS,Facility,Outpatient,1,Each,,19443,16526.55,5572.3638,19443,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,9332.64,48,,percent of total billed charges,,100% of DHS outpatient percentage
CERTOLIZUMAB PEGOL 400 MG/2 ML (200 MG/ML X 2) SUBQ SYKT,,J0717,HCPCS,Facility,Inpatient,1,Each,,19443,16526.55,5572.3638,19443,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
DAPTOMYCIN 500 MG IV SOLR,,J0878,HCPCS,Facility,Both,1,Each,,101,85.85,28.9466,101,Aetna,Commercial,92.92,92,,percent of total billed charges,,
DAPTOMYCIN 500 MG IV SOLR,,J0878,HCPCS,Facility,Outpatient,1,Each,,101,85.85,28.9466,101,Aetna,Medicare Advantage,49.49,49,,percent of total billed charges,,
DAPTOMYCIN 500 MG IV SOLR,,J0878,HCPCS,Facility,Inpatient,1,Each,,101,85.85,28.9466,101,Aetna,Medicare Advantage,,,,,Included in per diem rate,
DAPTOMYCIN 500 MG IV SOLR,,J0878,HCPCS,Facility,Both,1,Each,,101,85.85,28.9466,101,Aetna,PPO,93.93,93,,percent of total billed charges,,
DAPTOMYCIN 500 MG IV SOLR,,J0878,HCPCS,Facility,Both,1,Each,,101,85.85,28.9466,101,America's PPO,America's PPO,96.9903,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
DAPTOMYCIN 500 MG IV SOLR,,J0878,HCPCS,Facility,Both,1,Each,,101,85.85,28.9466,101,BlueCross BlueShield Minnesota, Federal Employee Program,99.384,98.4,,percent of total billed charges,,
DAPTOMYCIN 500 MG IV SOLR,,J0878,HCPCS,Facility,Both,1,Each,,101,85.85,28.9466,101,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,101,100,,percent of total billed charges,,
DAPTOMYCIN 500 MG IV SOLR,,J0878,HCPCS,Facility,Both,1,Each,,101,85.85,28.9466,101,BlueCross BlueShield Minnesota,High Value Network Plan,90.9,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
DAPTOMYCIN 500 MG IV SOLR,,J0878,HCPCS,Facility,Outpatient,1,Each,,101,85.85,28.9466,101,BlueCross BlueShield Minnesota,Medicare Advantage,49.49,49,,percent of total billed charges,,
DAPTOMYCIN 500 MG IV SOLR,,J0878,HCPCS,Facility,Inpatient,1,Each,,101,85.85,28.9466,101,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
DAPTOMYCIN 500 MG IV SOLR,,J0878,HCPCS,Facility,Both,1,Each,,101,85.85,28.9466,101,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,89.4557,88.57,,percent of total billed charges,,
DAPTOMYCIN 500 MG IV SOLR,,J0878,HCPCS,Facility,Both,1,Each,,101,85.85,28.9466,101,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,28.9466,28.66,,percent of total billed charges,,
DAPTOMYCIN 500 MG IV SOLR,,J0878,HCPCS,Facility,Outpatient,1,Each,,101,85.85,28.9466,101,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),49.49,49,,percent of total billed charges,,
DAPTOMYCIN 500 MG IV SOLR,,J0878,HCPCS,Facility,Inpatient,1,Each,,101,85.85,28.9466,101,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
DAPTOMYCIN 500 MG IV SOLR,,J0878,HCPCS,Facility,Both,1,Each,,101,85.85,28.9466,101,CorVel,Worker's Compensation,101,100,,percent of total billed charges,,
DAPTOMYCIN 500 MG IV SOLR,,J0878,HCPCS,Facility,Both,1,Each,,101,85.85,28.9466,101,First Health Group Corporation,First Health Network,97.97,97,,percent of total billed charges,,
DAPTOMYCIN 500 MG IV SOLR,,J0878,HCPCS,Facility,Both,1,Each,,101,85.85,28.9466,101,"Health Partners, Inc.",Commercial,95.546,94.6,,percent of total billed charges,,
DAPTOMYCIN 500 MG IV SOLR,,J0878,HCPCS,Facility,Outpatient,1,Each,,101,85.85,28.9466,101,"Health Partners, Inc.",Medicare Advantage,49.49,49,,percent of total billed charges,,
DAPTOMYCIN 500 MG IV SOLR,,J0878,HCPCS,Facility,Inpatient,1,Each,,101,85.85,28.9466,101,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DAPTOMYCIN 500 MG IV SOLR,,J0878,HCPCS,Facility,Both,1,Each,,101,85.85,28.9466,101,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),60.6,60,,percent of total billed charges,,
DAPTOMYCIN 500 MG IV SOLR,,J0878,HCPCS,Facility,Both,1,Each,,101,85.85,28.9466,101,"Health Partners, Inc.",State of Minnesota Advantage Program,82.315,81.5,,percent of total billed charges,,
DAPTOMYCIN 500 MG IV SOLR,,J0878,HCPCS,Facility,Both,1,Each,,101,85.85,28.9466,101,"Health Partners, Inc.",State Public Programs,50.5,50,,percent of total billed charges,,
DAPTOMYCIN 500 MG IV SOLR,,J0878,HCPCS,Facility,Both,1,Each,,101,85.85,28.9466,101,Humana Insurance Company,Commercial PPO,95.95,95,,percent of total billed charges,,
DAPTOMYCIN 500 MG IV SOLR,,J0878,HCPCS,Facility,Outpatient,1,Each,,101,85.85,28.9466,101,Humana Insurance Company,Medicare PPO,49.49,49,,percent of total billed charges,,
DAPTOMYCIN 500 MG IV SOLR,,J0878,HCPCS,Facility,Inpatient,1,Each,,101,85.85,28.9466,101,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
DAPTOMYCIN 500 MG IV SOLR,,J0878,HCPCS,Facility,Both,1,Each,,101,85.85,28.9466,101,Medica,Individual & Family,100.091,99.1,,percent of total billed charges,,
DAPTOMYCIN 500 MG IV SOLR,,J0878,HCPCS,Facility,Outpatient,1,Each,,101,85.85,28.9466,101,Medica,Medica Advantage Solution,50.298,49.8,,percent of total billed charges,,
DAPTOMYCIN 500 MG IV SOLR,,J0878,HCPCS,Facility,Inpatient,1,Each,,101,85.85,28.9466,101,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
DAPTOMYCIN 500 MG IV SOLR,,J0878,HCPCS,Facility,Outpatient,1,Each,,101,85.85,28.9466,101,Medica,Medical Assistance,45.046,44.6,,percent of total billed charges,,
DAPTOMYCIN 500 MG IV SOLR,,J0878,HCPCS,Facility,Inpatient,1,Each,,101,85.85,28.9466,101,Medica,Medical Assistance,,,,,Included in per diem rate,
DAPTOMYCIN 500 MG IV SOLR,,J0878,HCPCS,Facility,Outpatient,1,Each,,101,85.85,28.9466,101,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,50.298,49.8,,percent of total billed charges,,
DAPTOMYCIN 500 MG IV SOLR,,J0878,HCPCS,Facility,Inpatient,1,Each,,101,85.85,28.9466,101,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
DAPTOMYCIN 500 MG IV SOLR,,J0878,HCPCS,Facility,Both,1,Each,,101,85.85,28.9466,101,"Multiplan, Inc.","Multiplan, Inc.",94.94,94,,percent of total billed charges,,
DAPTOMYCIN 500 MG IV SOLR,,J0878,HCPCS,Facility,Outpatient,1,Each,,101,85.85,28.9466,101,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,91.001,90.1,,percent of total billed charges,,
DAPTOMYCIN 500 MG IV SOLR,,J0878,HCPCS,Facility,Inpatient,1,Each,,101,85.85,28.9466,101,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
DAPTOMYCIN 500 MG IV SOLR,,J0878,HCPCS,Facility,Both,1,Each,,101,85.85,28.9466,101,"Preferred One Administrative Services, INC.",PPO,99.586,98.6,,percent of total billed charges,,
DAPTOMYCIN 500 MG IV SOLR,,J0878,HCPCS,Facility,Outpatient,1,Each,,101,85.85,28.9466,101,PrimeWest Health,Minnesota Senior Health Options (MSHO),51.9645,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
DAPTOMYCIN 500 MG IV SOLR,,J0878,HCPCS,Facility,Inpatient,1,Each,,101,85.85,28.9466,101,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DAPTOMYCIN 500 MG IV SOLR,,J0878,HCPCS,Facility,Outpatient,1,Each,,101,85.85,28.9466,101,PrimeWest Health,MinnesotaCare,51.8736,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
DAPTOMYCIN 500 MG IV SOLR,,J0878,HCPCS,Facility,Inpatient,1,Each,,101,85.85,28.9466,101,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
DAPTOMYCIN 500 MG IV SOLR,,J0878,HCPCS,Facility,Both,1,Each,,101,85.85,28.9466,101,Sanford Health Plan,Sanford Health Plan,92.92,92,,percent of total billed charges,,
DAPTOMYCIN 500 MG IV SOLR,,J0878,HCPCS,Facility,Outpatient,1,Each,,101,85.85,28.9466,101,"UCare Health, Inc.",Individual & Family Plan,56.9135,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
DAPTOMYCIN 500 MG IV SOLR,,J0878,HCPCS,Facility,Inpatient,1,Each,,101,85.85,28.9466,101,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
DAPTOMYCIN 500 MG IV SOLR,,J0878,HCPCS,Facility,Outpatient,1,Each,,101,85.85,28.9466,101,"UCare Health, Inc.",Medical Assistance,50.9747,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DAPTOMYCIN 500 MG IV SOLR,,J0878,HCPCS,Facility,Inpatient,1,Each,,101,85.85,28.9466,101,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
DAPTOMYCIN 500 MG IV SOLR,,J0878,HCPCS,Facility,Outpatient,1,Each,,101,85.85,28.9466,101,"UCare Health, Inc.",Medicare Advantage,50.9747,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DAPTOMYCIN 500 MG IV SOLR,,J0878,HCPCS,Facility,Inpatient,1,Each,,101,85.85,28.9466,101,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DAPTOMYCIN 500 MG IV SOLR,,J0878,HCPCS,Facility,Outpatient,1,Each,,101,85.85,28.9466,101,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),50.9747,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DAPTOMYCIN 500 MG IV SOLR,,J0878,HCPCS,Facility,Inpatient,1,Each,,101,85.85,28.9466,101,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DAPTOMYCIN 500 MG IV SOLR,,J0878,HCPCS,Facility,Both,1,Each,,101,85.85,28.9466,101,UnitedHealthcare,Individual & Family,94.94,94,,percent of total billed charges,,
DAPTOMYCIN 500 MG IV SOLR,,J0878,HCPCS,Facility,Outpatient,1,Each,,101,85.85,28.9466,101,UnitedHealthcare,Medicare Advantage,49.49,49,,percent of total billed charges,,
DAPTOMYCIN 500 MG IV SOLR,,J0878,HCPCS,Facility,Inpatient,1,Each,,101,85.85,28.9466,101,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
DAPTOMYCIN 500 MG IV SOLR,,J0878,HCPCS,Facility,Outpatient,1,Each,,101,85.85,28.9466,101,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,48.48,48,,percent of total billed charges,,100% of DHS outpatient percentage
DAPTOMYCIN 500 MG IV SOLR,,J0878,HCPCS,Facility,Inpatient,1,Each,,101,85.85,28.9466,101,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Puncture Aspiration Of Cyst Of Breast (Pro Cah),,19000,CPT,Professional,Both,,,,255,216.75,25.96,255,Aetna,Commercial,216.75,85,,percent of total billed charges,,
Puncture Aspiration Of Cyst Of Breast (Pro Cah),,19000,CPT,Professional,Both,,,,255,216.75,25.96,255,Aetna,Medicare Advantage,41.62,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Puncture Aspiration Of Cyst Of Breast (Pro Cah),,19000,CPT,Professional,Both,,,,255,216.75,25.96,255,Aetna,PPO,237.15,93,,percent of total billed charges,,
Puncture Aspiration Of Cyst Of Breast (Pro Cah),,19000,CPT,Professional,Both,,,,255,216.75,25.96,255,America's PPO,America's PPO,217.872,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Puncture Aspiration Of Cyst Of Breast (Pro Cah),,19000,CPT,Professional,Both,,,,255,216.75,25.96,255,BlueCross BlueShield Minnesota, Federal Employee Program,86.76,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Puncture Aspiration Of Cyst Of Breast (Pro Cah),,19000,CPT,Professional,Both,,,,255,216.75,25.96,255,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,88.14816,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Puncture Aspiration Of Cyst Of Breast (Pro Cah),,19000,CPT,Professional,Both,,,,255,216.75,25.96,255,BlueCross BlueShield Minnesota,High Value Network Plan,88.14816,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Puncture Aspiration Of Cyst Of Breast (Pro Cah),,19000,CPT,Professional,Both,,,,255,216.75,25.96,255,BlueCross BlueShield Minnesota,Medicare Advantage,46.4485,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Puncture Aspiration Of Cyst Of Breast (Pro Cah),,19000,CPT,Professional,Both,,,,255,216.75,25.96,255,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,88.14816,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Puncture Aspiration Of Cyst Of Breast (Pro Cah),,19000,CPT,Professional,Both,,,,255,216.75,25.96,255,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,29.972,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Puncture Aspiration Of Cyst Of Breast (Pro Cah),,19000,CPT,Professional,Both,,,,255,216.75,25.96,255,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),46.4485,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Puncture Aspiration Of Cyst Of Breast (Pro Cah),,19000,CPT,Professional,Both,,,,255,216.75,25.96,255,CorVel,Worker's Compensation,79.8872961,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Puncture Aspiration Of Cyst Of Breast (Pro Cah),,19000,CPT,Professional,Both,,,,255,216.75,25.96,255,First Health Group Corporation,First Health Network,247.35,97,,percent of total billed charges,,
Puncture Aspiration Of Cyst Of Breast (Pro Cah),,19000,CPT,Professional,Both,,,,255,216.75,25.96,255,"Health Partners, Inc.",Commercial,86.34,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Puncture Aspiration Of Cyst Of Breast (Pro Cah),,19000,CPT,Professional,Both,,,,255,216.75,25.96,255,"Health Partners, Inc.",Medicare Advantage,46.4485,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Puncture Aspiration Of Cyst Of Breast (Pro Cah),,19000,CPT,Professional,Both,,,,255,216.75,25.96,255,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),40.66,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Puncture Aspiration Of Cyst Of Breast (Pro Cah),,19000,CPT,Professional,Both,,,,255,216.75,25.96,255,"Health Partners, Inc.",State of Minnesota Advantage Program,74.38191,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Puncture Aspiration Of Cyst Of Breast (Pro Cah),,19000,CPT,Professional,Both,,,,255,216.75,25.96,255,"Health Partners, Inc.",State Public Programs,25.96,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Puncture Aspiration Of Cyst Of Breast (Pro Cah),,19000,CPT,Professional,Both,,,,255,216.75,25.96,255,Humana Insurance Company,Commercial PPO,40.39,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Puncture Aspiration Of Cyst Of Breast (Pro Cah),,19000,CPT,Professional,Both,,,,255,216.75,25.96,255,Humana Insurance Company,Medicare PPO,255,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Puncture Aspiration Of Cyst Of Breast (Pro Cah),,19000,CPT,Professional,Both,,,,255,216.75,25.96,255,Medica,Individual & Family,216.24,84.8,,percent of total billed charges,,
Puncture Aspiration Of Cyst Of Breast (Pro Cah),,19000,CPT,Professional,Both,,,,255,216.75,25.96,255,Medica,Medica Advantage Solution,126.99,49.8,,percent of total billed charges,,
Puncture Aspiration Of Cyst Of Breast (Pro Cah),,19000,CPT,Professional,Both,,,,255,216.75,25.96,255,Medica,Medical Assistance,29.97,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Puncture Aspiration Of Cyst Of Breast (Pro Cah),,19000,CPT,Professional,Both,,,,255,216.75,25.96,255,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,40.39,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Puncture Aspiration Of Cyst Of Breast (Pro Cah),,19000,CPT,Professional,Both,,,,255,216.75,25.96,255,"Multiplan, Inc.","Multiplan, Inc.",239.7,94,,percent of total billed charges,,
Puncture Aspiration Of Cyst Of Breast (Pro Cah),,19000,CPT,Professional,Both,,,,255,216.75,25.96,255,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,229.755,90.1,,percent of total billed charges,,
Puncture Aspiration Of Cyst Of Breast (Pro Cah),,19000,CPT,Professional,Both,,,,255,216.75,25.96,255,"Preferred One Administrative Services, INC.",PPO,251.43,98.6,,percent of total billed charges,,
Puncture Aspiration Of Cyst Of Breast (Pro Cah),,19000,CPT,Professional,Both,,,,255,216.75,25.96,255,PrimeWest Health,Minnesota Senior Health Options (MSHO),46.4485,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Puncture Aspiration Of Cyst Of Breast (Pro Cah),,19000,CPT,Professional,Both,,,,255,216.75,25.96,255,PrimeWest Health,MinnesotaCare,32.07004,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Puncture Aspiration Of Cyst Of Breast (Pro Cah),,19000,CPT,Professional,Both,,,,255,216.75,25.96,255,Sanford Health Plan,Sanford Health Plan,224.4,88,,percent of total billed charges,,
Puncture Aspiration Of Cyst Of Breast (Pro Cah),,19000,CPT,Professional,Both,,,,255,216.75,25.96,255,"UCare Health, Inc.",Individual & Family Plan,65.657984,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Puncture Aspiration Of Cyst Of Breast (Pro Cah),,19000,CPT,Professional,Both,,,,255,216.75,25.96,255,"UCare Health, Inc.",Medical Assistance,32.9692,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Puncture Aspiration Of Cyst Of Breast (Pro Cah),,19000,CPT,Professional,Both,,,,255,216.75,25.96,255,"UCare Health, Inc.",Medicare Advantage,46.4485,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Puncture Aspiration Of Cyst Of Breast (Pro Cah),,19000,CPT,Professional,Both,,,,255,216.75,25.96,255,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),37.1588,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Puncture Aspiration Of Cyst Of Breast (Pro Cah),,19000,CPT,Professional,Both,,,,255,216.75,25.96,255,UnitedHealthcare,Individual & Family,255,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Puncture Aspiration Of Cyst Of Breast (Pro Cah),,19000,CPT,Professional,Both,,,,255,216.75,25.96,255,UnitedHealthcare,Medicare Advantage,46.4485,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Puncture Aspiration Of Cyst Of Breast (Pro Cah),,19000,CPT,Professional,Both,,,,255,216.75,25.96,255,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,29.972,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
DEFEROXAMINE 500 MG INJ SOLR,,J0895,HCPCS,Facility,Both,1,Each,,75,63.75,21.495,75,Aetna,Commercial,69,92,,percent of total billed charges,,
DEFEROXAMINE 500 MG INJ SOLR,,J0895,HCPCS,Facility,Outpatient,1,Each,,75,63.75,21.495,75,Aetna,Medicare Advantage,36.75,49,,percent of total billed charges,,
DEFEROXAMINE 500 MG INJ SOLR,,J0895,HCPCS,Facility,Inpatient,1,Each,,75,63.75,21.495,75,Aetna,Medicare Advantage,,,,,Included in per diem rate,
DEFEROXAMINE 500 MG INJ SOLR,,J0895,HCPCS,Facility,Both,1,Each,,75,63.75,21.495,75,Aetna,PPO,69.75,93,,percent of total billed charges,,
DEFEROXAMINE 500 MG INJ SOLR,,J0895,HCPCS,Facility,Both,1,Each,,75,63.75,21.495,75,America's PPO,America's PPO,72.0225,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
DEFEROXAMINE 500 MG INJ SOLR,,J0895,HCPCS,Facility,Both,1,Each,,75,63.75,21.495,75,BlueCross BlueShield Minnesota, Federal Employee Program,73.8,98.4,,percent of total billed charges,,
DEFEROXAMINE 500 MG INJ SOLR,,J0895,HCPCS,Facility,Both,1,Each,,75,63.75,21.495,75,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,75,100,,percent of total billed charges,,
DEFEROXAMINE 500 MG INJ SOLR,,J0895,HCPCS,Facility,Both,1,Each,,75,63.75,21.495,75,BlueCross BlueShield Minnesota,High Value Network Plan,67.5,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
DEFEROXAMINE 500 MG INJ SOLR,,J0895,HCPCS,Facility,Outpatient,1,Each,,75,63.75,21.495,75,BlueCross BlueShield Minnesota,Medicare Advantage,36.75,49,,percent of total billed charges,,
DEFEROXAMINE 500 MG INJ SOLR,,J0895,HCPCS,Facility,Inpatient,1,Each,,75,63.75,21.495,75,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
DEFEROXAMINE 500 MG INJ SOLR,,J0895,HCPCS,Facility,Both,1,Each,,75,63.75,21.495,75,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,66.4275,88.57,,percent of total billed charges,,
DEFEROXAMINE 500 MG INJ SOLR,,J0895,HCPCS,Facility,Both,1,Each,,75,63.75,21.495,75,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,21.495,28.66,,percent of total billed charges,,
DEFEROXAMINE 500 MG INJ SOLR,,J0895,HCPCS,Facility,Outpatient,1,Each,,75,63.75,21.495,75,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),36.75,49,,percent of total billed charges,,
DEFEROXAMINE 500 MG INJ SOLR,,J0895,HCPCS,Facility,Inpatient,1,Each,,75,63.75,21.495,75,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
DEFEROXAMINE 500 MG INJ SOLR,,J0895,HCPCS,Facility,Both,1,Each,,75,63.75,21.495,75,CorVel,Worker's Compensation,75,100,,percent of total billed charges,,
DEFEROXAMINE 500 MG INJ SOLR,,J0895,HCPCS,Facility,Both,1,Each,,75,63.75,21.495,75,First Health Group Corporation,First Health Network,72.75,97,,percent of total billed charges,,
DEFEROXAMINE 500 MG INJ SOLR,,J0895,HCPCS,Facility,Both,1,Each,,75,63.75,21.495,75,"Health Partners, Inc.",Commercial,70.95,94.6,,percent of total billed charges,,
DEFEROXAMINE 500 MG INJ SOLR,,J0895,HCPCS,Facility,Outpatient,1,Each,,75,63.75,21.495,75,"Health Partners, Inc.",Medicare Advantage,36.75,49,,percent of total billed charges,,
DEFEROXAMINE 500 MG INJ SOLR,,J0895,HCPCS,Facility,Inpatient,1,Each,,75,63.75,21.495,75,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DEFEROXAMINE 500 MG INJ SOLR,,J0895,HCPCS,Facility,Both,1,Each,,75,63.75,21.495,75,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),45,60,,percent of total billed charges,,
DEFEROXAMINE 500 MG INJ SOLR,,J0895,HCPCS,Facility,Both,1,Each,,75,63.75,21.495,75,"Health Partners, Inc.",State of Minnesota Advantage Program,61.125,81.5,,percent of total billed charges,,
DEFEROXAMINE 500 MG INJ SOLR,,J0895,HCPCS,Facility,Both,1,Each,,75,63.75,21.495,75,"Health Partners, Inc.",State Public Programs,37.5,50,,percent of total billed charges,,
DEFEROXAMINE 500 MG INJ SOLR,,J0895,HCPCS,Facility,Both,1,Each,,75,63.75,21.495,75,Humana Insurance Company,Commercial PPO,71.25,95,,percent of total billed charges,,
DEFEROXAMINE 500 MG INJ SOLR,,J0895,HCPCS,Facility,Outpatient,1,Each,,75,63.75,21.495,75,Humana Insurance Company,Medicare PPO,36.75,49,,percent of total billed charges,,
DEFEROXAMINE 500 MG INJ SOLR,,J0895,HCPCS,Facility,Inpatient,1,Each,,75,63.75,21.495,75,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
DEFEROXAMINE 500 MG INJ SOLR,,J0895,HCPCS,Facility,Both,1,Each,,75,63.75,21.495,75,Medica,Individual & Family,74.325,99.1,,percent of total billed charges,,
DEFEROXAMINE 500 MG INJ SOLR,,J0895,HCPCS,Facility,Outpatient,1,Each,,75,63.75,21.495,75,Medica,Medica Advantage Solution,37.35,49.8,,percent of total billed charges,,
DEFEROXAMINE 500 MG INJ SOLR,,J0895,HCPCS,Facility,Inpatient,1,Each,,75,63.75,21.495,75,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
DEFEROXAMINE 500 MG INJ SOLR,,J0895,HCPCS,Facility,Outpatient,1,Each,,75,63.75,21.495,75,Medica,Medical Assistance,33.45,44.6,,percent of total billed charges,,
DEFEROXAMINE 500 MG INJ SOLR,,J0895,HCPCS,Facility,Inpatient,1,Each,,75,63.75,21.495,75,Medica,Medical Assistance,,,,,Included in per diem rate,
DEFEROXAMINE 500 MG INJ SOLR,,J0895,HCPCS,Facility,Outpatient,1,Each,,75,63.75,21.495,75,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,37.35,49.8,,percent of total billed charges,,
DEFEROXAMINE 500 MG INJ SOLR,,J0895,HCPCS,Facility,Inpatient,1,Each,,75,63.75,21.495,75,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
DEFEROXAMINE 500 MG INJ SOLR,,J0895,HCPCS,Facility,Both,1,Each,,75,63.75,21.495,75,"Multiplan, Inc.","Multiplan, Inc.",70.5,94,,percent of total billed charges,,
DEFEROXAMINE 500 MG INJ SOLR,,J0895,HCPCS,Facility,Outpatient,1,Each,,75,63.75,21.495,75,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,67.575,90.1,,percent of total billed charges,,
DEFEROXAMINE 500 MG INJ SOLR,,J0895,HCPCS,Facility,Inpatient,1,Each,,75,63.75,21.495,75,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
DEFEROXAMINE 500 MG INJ SOLR,,J0895,HCPCS,Facility,Both,1,Each,,75,63.75,21.495,75,"Preferred One Administrative Services, INC.",PPO,73.95,98.6,,percent of total billed charges,,
DEFEROXAMINE 500 MG INJ SOLR,,J0895,HCPCS,Facility,Outpatient,1,Each,,75,63.75,21.495,75,PrimeWest Health,Minnesota Senior Health Options (MSHO),38.5875,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
DEFEROXAMINE 500 MG INJ SOLR,,J0895,HCPCS,Facility,Inpatient,1,Each,,75,63.75,21.495,75,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DEFEROXAMINE 500 MG INJ SOLR,,J0895,HCPCS,Facility,Outpatient,1,Each,,75,63.75,21.495,75,PrimeWest Health,MinnesotaCare,38.52,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
DEFEROXAMINE 500 MG INJ SOLR,,J0895,HCPCS,Facility,Inpatient,1,Each,,75,63.75,21.495,75,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
DEFEROXAMINE 500 MG INJ SOLR,,J0895,HCPCS,Facility,Both,1,Each,,75,63.75,21.495,75,Sanford Health Plan,Sanford Health Plan,69,92,,percent of total billed charges,,
DEFEROXAMINE 500 MG INJ SOLR,,J0895,HCPCS,Facility,Outpatient,1,Each,,75,63.75,21.495,75,"UCare Health, Inc.",Individual & Family Plan,42.2625,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
DEFEROXAMINE 500 MG INJ SOLR,,J0895,HCPCS,Facility,Inpatient,1,Each,,75,63.75,21.495,75,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
DEFEROXAMINE 500 MG INJ SOLR,,J0895,HCPCS,Facility,Outpatient,1,Each,,75,63.75,21.495,75,"UCare Health, Inc.",Medical Assistance,37.8525,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DEFEROXAMINE 500 MG INJ SOLR,,J0895,HCPCS,Facility,Inpatient,1,Each,,75,63.75,21.495,75,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
DEFEROXAMINE 500 MG INJ SOLR,,J0895,HCPCS,Facility,Outpatient,1,Each,,75,63.75,21.495,75,"UCare Health, Inc.",Medicare Advantage,37.8525,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DEFEROXAMINE 500 MG INJ SOLR,,J0895,HCPCS,Facility,Inpatient,1,Each,,75,63.75,21.495,75,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DEFEROXAMINE 500 MG INJ SOLR,,J0895,HCPCS,Facility,Outpatient,1,Each,,75,63.75,21.495,75,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),37.8525,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DEFEROXAMINE 500 MG INJ SOLR,,J0895,HCPCS,Facility,Inpatient,1,Each,,75,63.75,21.495,75,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DEFEROXAMINE 500 MG INJ SOLR,,J0895,HCPCS,Facility,Both,1,Each,,75,63.75,21.495,75,UnitedHealthcare,Individual & Family,70.5,94,,percent of total billed charges,,
DEFEROXAMINE 500 MG INJ SOLR,,J0895,HCPCS,Facility,Outpatient,1,Each,,75,63.75,21.495,75,UnitedHealthcare,Medicare Advantage,36.75,49,,percent of total billed charges,,
DEFEROXAMINE 500 MG INJ SOLR,,J0895,HCPCS,Facility,Inpatient,1,Each,,75,63.75,21.495,75,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
DEFEROXAMINE 500 MG INJ SOLR,,J0895,HCPCS,Facility,Outpatient,1,Each,,75,63.75,21.495,75,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,36,48,,percent of total billed charges,,100% of DHS outpatient percentage
DEFEROXAMINE 500 MG INJ SOLR,,J0895,HCPCS,Facility,Inpatient,1,Each,,75,63.75,21.495,75,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
ACETAZOLAMIDE SODIUM 500 MG INJ SOLR,,J1120,HCPCS,Facility,Both,1,Each,,215,182.75,61.619,215,Aetna,Commercial,197.8,92,,percent of total billed charges,,
ACETAZOLAMIDE SODIUM 500 MG INJ SOLR,,J1120,HCPCS,Facility,Outpatient,1,Each,,215,182.75,61.619,215,Aetna,Medicare Advantage,105.35,49,,percent of total billed charges,,
ACETAZOLAMIDE SODIUM 500 MG INJ SOLR,,J1120,HCPCS,Facility,Inpatient,1,Each,,215,182.75,61.619,215,Aetna,Medicare Advantage,,,,,Included in per diem rate,
ACETAZOLAMIDE SODIUM 500 MG INJ SOLR,,J1120,HCPCS,Facility,Both,1,Each,,215,182.75,61.619,215,Aetna,PPO,199.95,93,,percent of total billed charges,,
ACETAZOLAMIDE SODIUM 500 MG INJ SOLR,,J1120,HCPCS,Facility,Both,1,Each,,215,182.75,61.619,215,America's PPO,America's PPO,206.4645,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
ACETAZOLAMIDE SODIUM 500 MG INJ SOLR,,J1120,HCPCS,Facility,Both,1,Each,,215,182.75,61.619,215,BlueCross BlueShield Minnesota, Federal Employee Program,211.56,98.4,,percent of total billed charges,,
ACETAZOLAMIDE SODIUM 500 MG INJ SOLR,,J1120,HCPCS,Facility,Both,1,Each,,215,182.75,61.619,215,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,215,100,,percent of total billed charges,,
ACETAZOLAMIDE SODIUM 500 MG INJ SOLR,,J1120,HCPCS,Facility,Both,1,Each,,215,182.75,61.619,215,BlueCross BlueShield Minnesota,High Value Network Plan,193.5,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
ACETAZOLAMIDE SODIUM 500 MG INJ SOLR,,J1120,HCPCS,Facility,Outpatient,1,Each,,215,182.75,61.619,215,BlueCross BlueShield Minnesota,Medicare Advantage,105.35,49,,percent of total billed charges,,
ACETAZOLAMIDE SODIUM 500 MG INJ SOLR,,J1120,HCPCS,Facility,Inpatient,1,Each,,215,182.75,61.619,215,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
ACETAZOLAMIDE SODIUM 500 MG INJ SOLR,,J1120,HCPCS,Facility,Both,1,Each,,215,182.75,61.619,215,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,190.4255,88.57,,percent of total billed charges,,
ACETAZOLAMIDE SODIUM 500 MG INJ SOLR,,J1120,HCPCS,Facility,Both,1,Each,,215,182.75,61.619,215,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,61.619,28.66,,percent of total billed charges,,
ACETAZOLAMIDE SODIUM 500 MG INJ SOLR,,J1120,HCPCS,Facility,Outpatient,1,Each,,215,182.75,61.619,215,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),105.35,49,,percent of total billed charges,,
ACETAZOLAMIDE SODIUM 500 MG INJ SOLR,,J1120,HCPCS,Facility,Inpatient,1,Each,,215,182.75,61.619,215,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
ACETAZOLAMIDE SODIUM 500 MG INJ SOLR,,J1120,HCPCS,Facility,Both,1,Each,,215,182.75,61.619,215,CorVel,Worker's Compensation,215,100,,percent of total billed charges,,
ACETAZOLAMIDE SODIUM 500 MG INJ SOLR,,J1120,HCPCS,Facility,Both,1,Each,,215,182.75,61.619,215,First Health Group Corporation,First Health Network,208.55,97,,percent of total billed charges,,
ACETAZOLAMIDE SODIUM 500 MG INJ SOLR,,J1120,HCPCS,Facility,Both,1,Each,,215,182.75,61.619,215,"Health Partners, Inc.",Commercial,203.39,94.6,,percent of total billed charges,,
ACETAZOLAMIDE SODIUM 500 MG INJ SOLR,,J1120,HCPCS,Facility,Outpatient,1,Each,,215,182.75,61.619,215,"Health Partners, Inc.",Medicare Advantage,105.35,49,,percent of total billed charges,,
ACETAZOLAMIDE SODIUM 500 MG INJ SOLR,,J1120,HCPCS,Facility,Inpatient,1,Each,,215,182.75,61.619,215,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ACETAZOLAMIDE SODIUM 500 MG INJ SOLR,,J1120,HCPCS,Facility,Both,1,Each,,215,182.75,61.619,215,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),129,60,,percent of total billed charges,,
ACETAZOLAMIDE SODIUM 500 MG INJ SOLR,,J1120,HCPCS,Facility,Both,1,Each,,215,182.75,61.619,215,"Health Partners, Inc.",State of Minnesota Advantage Program,175.225,81.5,,percent of total billed charges,,
ACETAZOLAMIDE SODIUM 500 MG INJ SOLR,,J1120,HCPCS,Facility,Both,1,Each,,215,182.75,61.619,215,"Health Partners, Inc.",State Public Programs,107.5,50,,percent of total billed charges,,
ACETAZOLAMIDE SODIUM 500 MG INJ SOLR,,J1120,HCPCS,Facility,Both,1,Each,,215,182.75,61.619,215,Humana Insurance Company,Commercial PPO,204.25,95,,percent of total billed charges,,
ACETAZOLAMIDE SODIUM 500 MG INJ SOLR,,J1120,HCPCS,Facility,Outpatient,1,Each,,215,182.75,61.619,215,Humana Insurance Company,Medicare PPO,105.35,49,,percent of total billed charges,,
ACETAZOLAMIDE SODIUM 500 MG INJ SOLR,,J1120,HCPCS,Facility,Inpatient,1,Each,,215,182.75,61.619,215,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
ACETAZOLAMIDE SODIUM 500 MG INJ SOLR,,J1120,HCPCS,Facility,Both,1,Each,,215,182.75,61.619,215,Medica,Individual & Family,213.065,99.1,,percent of total billed charges,,
ACETAZOLAMIDE SODIUM 500 MG INJ SOLR,,J1120,HCPCS,Facility,Outpatient,1,Each,,215,182.75,61.619,215,Medica,Medica Advantage Solution,107.07,49.8,,percent of total billed charges,,
ACETAZOLAMIDE SODIUM 500 MG INJ SOLR,,J1120,HCPCS,Facility,Inpatient,1,Each,,215,182.75,61.619,215,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
ACETAZOLAMIDE SODIUM 500 MG INJ SOLR,,J1120,HCPCS,Facility,Outpatient,1,Each,,215,182.75,61.619,215,Medica,Medical Assistance,95.89,44.6,,percent of total billed charges,,
ACETAZOLAMIDE SODIUM 500 MG INJ SOLR,,J1120,HCPCS,Facility,Inpatient,1,Each,,215,182.75,61.619,215,Medica,Medical Assistance,,,,,Included in per diem rate,
ACETAZOLAMIDE SODIUM 500 MG INJ SOLR,,J1120,HCPCS,Facility,Outpatient,1,Each,,215,182.75,61.619,215,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,107.07,49.8,,percent of total billed charges,,
ACETAZOLAMIDE SODIUM 500 MG INJ SOLR,,J1120,HCPCS,Facility,Inpatient,1,Each,,215,182.75,61.619,215,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
ACETAZOLAMIDE SODIUM 500 MG INJ SOLR,,J1120,HCPCS,Facility,Both,1,Each,,215,182.75,61.619,215,"Multiplan, Inc.","Multiplan, Inc.",202.1,94,,percent of total billed charges,,
ACETAZOLAMIDE SODIUM 500 MG INJ SOLR,,J1120,HCPCS,Facility,Outpatient,1,Each,,215,182.75,61.619,215,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,193.715,90.1,,percent of total billed charges,,
ACETAZOLAMIDE SODIUM 500 MG INJ SOLR,,J1120,HCPCS,Facility,Inpatient,1,Each,,215,182.75,61.619,215,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
ACETAZOLAMIDE SODIUM 500 MG INJ SOLR,,J1120,HCPCS,Facility,Both,1,Each,,215,182.75,61.619,215,"Preferred One Administrative Services, INC.",PPO,211.99,98.6,,percent of total billed charges,,
ACETAZOLAMIDE SODIUM 500 MG INJ SOLR,,J1120,HCPCS,Facility,Outpatient,1,Each,,215,182.75,61.619,215,PrimeWest Health,Minnesota Senior Health Options (MSHO),110.6175,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
ACETAZOLAMIDE SODIUM 500 MG INJ SOLR,,J1120,HCPCS,Facility,Inpatient,1,Each,,215,182.75,61.619,215,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ACETAZOLAMIDE SODIUM 500 MG INJ SOLR,,J1120,HCPCS,Facility,Outpatient,1,Each,,215,182.75,61.619,215,PrimeWest Health,MinnesotaCare,110.424,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
ACETAZOLAMIDE SODIUM 500 MG INJ SOLR,,J1120,HCPCS,Facility,Inpatient,1,Each,,215,182.75,61.619,215,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
ACETAZOLAMIDE SODIUM 500 MG INJ SOLR,,J1120,HCPCS,Facility,Both,1,Each,,215,182.75,61.619,215,Sanford Health Plan,Sanford Health Plan,197.8,92,,percent of total billed charges,,
ACETAZOLAMIDE SODIUM 500 MG INJ SOLR,,J1120,HCPCS,Facility,Outpatient,1,Each,,215,182.75,61.619,215,"UCare Health, Inc.",Individual & Family Plan,121.1525,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
ACETAZOLAMIDE SODIUM 500 MG INJ SOLR,,J1120,HCPCS,Facility,Inpatient,1,Each,,215,182.75,61.619,215,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
ACETAZOLAMIDE SODIUM 500 MG INJ SOLR,,J1120,HCPCS,Facility,Outpatient,1,Each,,215,182.75,61.619,215,"UCare Health, Inc.",Medical Assistance,108.5105,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ACETAZOLAMIDE SODIUM 500 MG INJ SOLR,,J1120,HCPCS,Facility,Inpatient,1,Each,,215,182.75,61.619,215,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
ACETAZOLAMIDE SODIUM 500 MG INJ SOLR,,J1120,HCPCS,Facility,Outpatient,1,Each,,215,182.75,61.619,215,"UCare Health, Inc.",Medicare Advantage,108.5105,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ACETAZOLAMIDE SODIUM 500 MG INJ SOLR,,J1120,HCPCS,Facility,Inpatient,1,Each,,215,182.75,61.619,215,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ACETAZOLAMIDE SODIUM 500 MG INJ SOLR,,J1120,HCPCS,Facility,Outpatient,1,Each,,215,182.75,61.619,215,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),108.5105,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ACETAZOLAMIDE SODIUM 500 MG INJ SOLR,,J1120,HCPCS,Facility,Inpatient,1,Each,,215,182.75,61.619,215,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ACETAZOLAMIDE SODIUM 500 MG INJ SOLR,,J1120,HCPCS,Facility,Both,1,Each,,215,182.75,61.619,215,UnitedHealthcare,Individual & Family,202.1,94,,percent of total billed charges,,
ACETAZOLAMIDE SODIUM 500 MG INJ SOLR,,J1120,HCPCS,Facility,Outpatient,1,Each,,215,182.75,61.619,215,UnitedHealthcare,Medicare Advantage,105.35,49,,percent of total billed charges,,
ACETAZOLAMIDE SODIUM 500 MG INJ SOLR,,J1120,HCPCS,Facility,Inpatient,1,Each,,215,182.75,61.619,215,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
ACETAZOLAMIDE SODIUM 500 MG INJ SOLR,,J1120,HCPCS,Facility,Outpatient,1,Each,,215,182.75,61.619,215,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,103.2,48,,percent of total billed charges,,100% of DHS outpatient percentage
ACETAZOLAMIDE SODIUM 500 MG INJ SOLR,,J1120,HCPCS,Facility,Inpatient,1,Each,,215,182.75,61.619,215,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
DIGOXIN IMMUNE FAB 40 MG IV SOLR,,J1162,HCPCS,Facility,Both,1,Each,,16557,14073.45,4745.2362,16557,Aetna,Commercial,15232.44,92,,percent of total billed charges,,
DIGOXIN IMMUNE FAB 40 MG IV SOLR,,J1162,HCPCS,Facility,Outpatient,1,Each,,16557,14073.45,4745.2362,16557,Aetna,Medicare Advantage,8112.93,49,,percent of total billed charges,,
DIGOXIN IMMUNE FAB 40 MG IV SOLR,,J1162,HCPCS,Facility,Inpatient,1,Each,,16557,14073.45,4745.2362,16557,Aetna,Medicare Advantage,,,,,Included in per diem rate,
DIGOXIN IMMUNE FAB 40 MG IV SOLR,,J1162,HCPCS,Facility,Both,1,Each,,16557,14073.45,4745.2362,16557,Aetna,PPO,15398.01,93,,percent of total billed charges,,
DIGOXIN IMMUNE FAB 40 MG IV SOLR,,J1162,HCPCS,Facility,Both,1,Each,,16557,14073.45,4745.2362,16557,America's PPO,America's PPO,15899.6871,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
DIGOXIN IMMUNE FAB 40 MG IV SOLR,,J1162,HCPCS,Facility,Both,1,Each,,16557,14073.45,4745.2362,16557,BlueCross BlueShield Minnesota, Federal Employee Program,16292.088,98.4,,percent of total billed charges,,
DIGOXIN IMMUNE FAB 40 MG IV SOLR,,J1162,HCPCS,Facility,Both,1,Each,,16557,14073.45,4745.2362,16557,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,16557,100,,percent of total billed charges,,
DIGOXIN IMMUNE FAB 40 MG IV SOLR,,J1162,HCPCS,Facility,Both,1,Each,,16557,14073.45,4745.2362,16557,BlueCross BlueShield Minnesota,High Value Network Plan,14901.3,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
DIGOXIN IMMUNE FAB 40 MG IV SOLR,,J1162,HCPCS,Facility,Outpatient,1,Each,,16557,14073.45,4745.2362,16557,BlueCross BlueShield Minnesota,Medicare Advantage,8112.93,49,,percent of total billed charges,,
DIGOXIN IMMUNE FAB 40 MG IV SOLR,,J1162,HCPCS,Facility,Inpatient,1,Each,,16557,14073.45,4745.2362,16557,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
DIGOXIN IMMUNE FAB 40 MG IV SOLR,,J1162,HCPCS,Facility,Both,1,Each,,16557,14073.45,4745.2362,16557,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,14664.5349,88.57,,percent of total billed charges,,
DIGOXIN IMMUNE FAB 40 MG IV SOLR,,J1162,HCPCS,Facility,Both,1,Each,,16557,14073.45,4745.2362,16557,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,4745.2362,28.66,,percent of total billed charges,,
DIGOXIN IMMUNE FAB 40 MG IV SOLR,,J1162,HCPCS,Facility,Outpatient,1,Each,,16557,14073.45,4745.2362,16557,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),8112.93,49,,percent of total billed charges,,
DIGOXIN IMMUNE FAB 40 MG IV SOLR,,J1162,HCPCS,Facility,Inpatient,1,Each,,16557,14073.45,4745.2362,16557,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
DIGOXIN IMMUNE FAB 40 MG IV SOLR,,J1162,HCPCS,Facility,Both,1,Each,,16557,14073.45,4745.2362,16557,CorVel,Worker's Compensation,16557,100,,percent of total billed charges,,
DIGOXIN IMMUNE FAB 40 MG IV SOLR,,J1162,HCPCS,Facility,Both,1,Each,,16557,14073.45,4745.2362,16557,First Health Group Corporation,First Health Network,16060.29,97,,percent of total billed charges,,
DIGOXIN IMMUNE FAB 40 MG IV SOLR,,J1162,HCPCS,Facility,Both,1,Each,,16557,14073.45,4745.2362,16557,"Health Partners, Inc.",Commercial,15662.922,94.6,,percent of total billed charges,,
DIGOXIN IMMUNE FAB 40 MG IV SOLR,,J1162,HCPCS,Facility,Outpatient,1,Each,,16557,14073.45,4745.2362,16557,"Health Partners, Inc.",Medicare Advantage,8112.93,49,,percent of total billed charges,,
DIGOXIN IMMUNE FAB 40 MG IV SOLR,,J1162,HCPCS,Facility,Inpatient,1,Each,,16557,14073.45,4745.2362,16557,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DIGOXIN IMMUNE FAB 40 MG IV SOLR,,J1162,HCPCS,Facility,Both,1,Each,,16557,14073.45,4745.2362,16557,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),9934.2,60,,percent of total billed charges,,
DIGOXIN IMMUNE FAB 40 MG IV SOLR,,J1162,HCPCS,Facility,Both,1,Each,,16557,14073.45,4745.2362,16557,"Health Partners, Inc.",State of Minnesota Advantage Program,13493.955,81.5,,percent of total billed charges,,
DIGOXIN IMMUNE FAB 40 MG IV SOLR,,J1162,HCPCS,Facility,Both,1,Each,,16557,14073.45,4745.2362,16557,"Health Partners, Inc.",State Public Programs,8278.5,50,,percent of total billed charges,,
DIGOXIN IMMUNE FAB 40 MG IV SOLR,,J1162,HCPCS,Facility,Both,1,Each,,16557,14073.45,4745.2362,16557,Humana Insurance Company,Commercial PPO,15729.15,95,,percent of total billed charges,,
DIGOXIN IMMUNE FAB 40 MG IV SOLR,,J1162,HCPCS,Facility,Outpatient,1,Each,,16557,14073.45,4745.2362,16557,Humana Insurance Company,Medicare PPO,8112.93,49,,percent of total billed charges,,
DIGOXIN IMMUNE FAB 40 MG IV SOLR,,J1162,HCPCS,Facility,Inpatient,1,Each,,16557,14073.45,4745.2362,16557,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
DIGOXIN IMMUNE FAB 40 MG IV SOLR,,J1162,HCPCS,Facility,Both,1,Each,,16557,14073.45,4745.2362,16557,Medica,Individual & Family,16407.987,99.1,,percent of total billed charges,,
DIGOXIN IMMUNE FAB 40 MG IV SOLR,,J1162,HCPCS,Facility,Outpatient,1,Each,,16557,14073.45,4745.2362,16557,Medica,Medica Advantage Solution,8245.386,49.8,,percent of total billed charges,,
DIGOXIN IMMUNE FAB 40 MG IV SOLR,,J1162,HCPCS,Facility,Inpatient,1,Each,,16557,14073.45,4745.2362,16557,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
DIGOXIN IMMUNE FAB 40 MG IV SOLR,,J1162,HCPCS,Facility,Outpatient,1,Each,,16557,14073.45,4745.2362,16557,Medica,Medical Assistance,7384.422,44.6,,percent of total billed charges,,
DIGOXIN IMMUNE FAB 40 MG IV SOLR,,J1162,HCPCS,Facility,Inpatient,1,Each,,16557,14073.45,4745.2362,16557,Medica,Medical Assistance,,,,,Included in per diem rate,
DIGOXIN IMMUNE FAB 40 MG IV SOLR,,J1162,HCPCS,Facility,Outpatient,1,Each,,16557,14073.45,4745.2362,16557,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,8245.386,49.8,,percent of total billed charges,,
DIGOXIN IMMUNE FAB 40 MG IV SOLR,,J1162,HCPCS,Facility,Inpatient,1,Each,,16557,14073.45,4745.2362,16557,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
DIGOXIN IMMUNE FAB 40 MG IV SOLR,,J1162,HCPCS,Facility,Both,1,Each,,16557,14073.45,4745.2362,16557,"Multiplan, Inc.","Multiplan, Inc.",15563.58,94,,percent of total billed charges,,
DIGOXIN IMMUNE FAB 40 MG IV SOLR,,J1162,HCPCS,Facility,Outpatient,1,Each,,16557,14073.45,4745.2362,16557,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,14917.857,90.1,,percent of total billed charges,,
DIGOXIN IMMUNE FAB 40 MG IV SOLR,,J1162,HCPCS,Facility,Inpatient,1,Each,,16557,14073.45,4745.2362,16557,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
DIGOXIN IMMUNE FAB 40 MG IV SOLR,,J1162,HCPCS,Facility,Both,1,Each,,16557,14073.45,4745.2362,16557,"Preferred One Administrative Services, INC.",PPO,16325.202,98.6,,percent of total billed charges,,
DIGOXIN IMMUNE FAB 40 MG IV SOLR,,J1162,HCPCS,Facility,Outpatient,1,Each,,16557,14073.45,4745.2362,16557,PrimeWest Health,Minnesota Senior Health Options (MSHO),8518.5765,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
DIGOXIN IMMUNE FAB 40 MG IV SOLR,,J1162,HCPCS,Facility,Inpatient,1,Each,,16557,14073.45,4745.2362,16557,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DIGOXIN IMMUNE FAB 40 MG IV SOLR,,J1162,HCPCS,Facility,Outpatient,1,Each,,16557,14073.45,4745.2362,16557,PrimeWest Health,MinnesotaCare,8503.6752,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
DIGOXIN IMMUNE FAB 40 MG IV SOLR,,J1162,HCPCS,Facility,Inpatient,1,Each,,16557,14073.45,4745.2362,16557,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
DIGOXIN IMMUNE FAB 40 MG IV SOLR,,J1162,HCPCS,Facility,Both,1,Each,,16557,14073.45,4745.2362,16557,Sanford Health Plan,Sanford Health Plan,15232.44,92,,percent of total billed charges,,
DIGOXIN IMMUNE FAB 40 MG IV SOLR,,J1162,HCPCS,Facility,Outpatient,1,Each,,16557,14073.45,4745.2362,16557,"UCare Health, Inc.",Individual & Family Plan,9329.8695,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
DIGOXIN IMMUNE FAB 40 MG IV SOLR,,J1162,HCPCS,Facility,Inpatient,1,Each,,16557,14073.45,4745.2362,16557,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
DIGOXIN IMMUNE FAB 40 MG IV SOLR,,J1162,HCPCS,Facility,Outpatient,1,Each,,16557,14073.45,4745.2362,16557,"UCare Health, Inc.",Medical Assistance,8356.3179,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DIGOXIN IMMUNE FAB 40 MG IV SOLR,,J1162,HCPCS,Facility,Inpatient,1,Each,,16557,14073.45,4745.2362,16557,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
DIGOXIN IMMUNE FAB 40 MG IV SOLR,,J1162,HCPCS,Facility,Outpatient,1,Each,,16557,14073.45,4745.2362,16557,"UCare Health, Inc.",Medicare Advantage,8356.3179,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DIGOXIN IMMUNE FAB 40 MG IV SOLR,,J1162,HCPCS,Facility,Inpatient,1,Each,,16557,14073.45,4745.2362,16557,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DIGOXIN IMMUNE FAB 40 MG IV SOLR,,J1162,HCPCS,Facility,Outpatient,1,Each,,16557,14073.45,4745.2362,16557,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),8356.3179,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DIGOXIN IMMUNE FAB 40 MG IV SOLR,,J1162,HCPCS,Facility,Inpatient,1,Each,,16557,14073.45,4745.2362,16557,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DIGOXIN IMMUNE FAB 40 MG IV SOLR,,J1162,HCPCS,Facility,Both,1,Each,,16557,14073.45,4745.2362,16557,UnitedHealthcare,Individual & Family,15563.58,94,,percent of total billed charges,,
DIGOXIN IMMUNE FAB 40 MG IV SOLR,,J1162,HCPCS,Facility,Outpatient,1,Each,,16557,14073.45,4745.2362,16557,UnitedHealthcare,Medicare Advantage,8112.93,49,,percent of total billed charges,,
DIGOXIN IMMUNE FAB 40 MG IV SOLR,,J1162,HCPCS,Facility,Inpatient,1,Each,,16557,14073.45,4745.2362,16557,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
DIGOXIN IMMUNE FAB 40 MG IV SOLR,,J1162,HCPCS,Facility,Outpatient,1,Each,,16557,14073.45,4745.2362,16557,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,7947.36,48,,percent of total billed charges,,100% of DHS outpatient percentage
DIGOXIN IMMUNE FAB 40 MG IV SOLR,,J1162,HCPCS,Facility,Inpatient,1,Each,,16557,14073.45,4745.2362,16557,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
CHLOROTHIAZIDE SODIUM 500 MG IV SOLR,,J1205,HCPCS,Facility,Both,1,Each,,172,146.2,49.2952,172,Aetna,Commercial,158.24,92,,percent of total billed charges,,
CHLOROTHIAZIDE SODIUM 500 MG IV SOLR,,J1205,HCPCS,Facility,Outpatient,1,Each,,172,146.2,49.2952,172,Aetna,Medicare Advantage,84.28,49,,percent of total billed charges,,
CHLOROTHIAZIDE SODIUM 500 MG IV SOLR,,J1205,HCPCS,Facility,Inpatient,1,Each,,172,146.2,49.2952,172,Aetna,Medicare Advantage,,,,,Included in per diem rate,
CHLOROTHIAZIDE SODIUM 500 MG IV SOLR,,J1205,HCPCS,Facility,Both,1,Each,,172,146.2,49.2952,172,Aetna,PPO,159.96,93,,percent of total billed charges,,
CHLOROTHIAZIDE SODIUM 500 MG IV SOLR,,J1205,HCPCS,Facility,Both,1,Each,,172,146.2,49.2952,172,America's PPO,America's PPO,165.1716,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
CHLOROTHIAZIDE SODIUM 500 MG IV SOLR,,J1205,HCPCS,Facility,Both,1,Each,,172,146.2,49.2952,172,BlueCross BlueShield Minnesota, Federal Employee Program,169.248,98.4,,percent of total billed charges,,
CHLOROTHIAZIDE SODIUM 500 MG IV SOLR,,J1205,HCPCS,Facility,Both,1,Each,,172,146.2,49.2952,172,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,172,100,,percent of total billed charges,,
CHLOROTHIAZIDE SODIUM 500 MG IV SOLR,,J1205,HCPCS,Facility,Both,1,Each,,172,146.2,49.2952,172,BlueCross BlueShield Minnesota,High Value Network Plan,154.8,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
CHLOROTHIAZIDE SODIUM 500 MG IV SOLR,,J1205,HCPCS,Facility,Outpatient,1,Each,,172,146.2,49.2952,172,BlueCross BlueShield Minnesota,Medicare Advantage,84.28,49,,percent of total billed charges,,
CHLOROTHIAZIDE SODIUM 500 MG IV SOLR,,J1205,HCPCS,Facility,Inpatient,1,Each,,172,146.2,49.2952,172,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
CHLOROTHIAZIDE SODIUM 500 MG IV SOLR,,J1205,HCPCS,Facility,Both,1,Each,,172,146.2,49.2952,172,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,152.3404,88.57,,percent of total billed charges,,
CHLOROTHIAZIDE SODIUM 500 MG IV SOLR,,J1205,HCPCS,Facility,Both,1,Each,,172,146.2,49.2952,172,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,49.2952,28.66,,percent of total billed charges,,
CHLOROTHIAZIDE SODIUM 500 MG IV SOLR,,J1205,HCPCS,Facility,Outpatient,1,Each,,172,146.2,49.2952,172,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),84.28,49,,percent of total billed charges,,
CHLOROTHIAZIDE SODIUM 500 MG IV SOLR,,J1205,HCPCS,Facility,Inpatient,1,Each,,172,146.2,49.2952,172,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
CHLOROTHIAZIDE SODIUM 500 MG IV SOLR,,J1205,HCPCS,Facility,Both,1,Each,,172,146.2,49.2952,172,CorVel,Worker's Compensation,172,100,,percent of total billed charges,,
CHLOROTHIAZIDE SODIUM 500 MG IV SOLR,,J1205,HCPCS,Facility,Both,1,Each,,172,146.2,49.2952,172,First Health Group Corporation,First Health Network,166.84,97,,percent of total billed charges,,
CHLOROTHIAZIDE SODIUM 500 MG IV SOLR,,J1205,HCPCS,Facility,Both,1,Each,,172,146.2,49.2952,172,"Health Partners, Inc.",Commercial,162.712,94.6,,percent of total billed charges,,
CHLOROTHIAZIDE SODIUM 500 MG IV SOLR,,J1205,HCPCS,Facility,Outpatient,1,Each,,172,146.2,49.2952,172,"Health Partners, Inc.",Medicare Advantage,84.28,49,,percent of total billed charges,,
CHLOROTHIAZIDE SODIUM 500 MG IV SOLR,,J1205,HCPCS,Facility,Inpatient,1,Each,,172,146.2,49.2952,172,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CHLOROTHIAZIDE SODIUM 500 MG IV SOLR,,J1205,HCPCS,Facility,Both,1,Each,,172,146.2,49.2952,172,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),103.2,60,,percent of total billed charges,,
CHLOROTHIAZIDE SODIUM 500 MG IV SOLR,,J1205,HCPCS,Facility,Both,1,Each,,172,146.2,49.2952,172,"Health Partners, Inc.",State of Minnesota Advantage Program,140.18,81.5,,percent of total billed charges,,
CHLOROTHIAZIDE SODIUM 500 MG IV SOLR,,J1205,HCPCS,Facility,Both,1,Each,,172,146.2,49.2952,172,"Health Partners, Inc.",State Public Programs,86,50,,percent of total billed charges,,
CHLOROTHIAZIDE SODIUM 500 MG IV SOLR,,J1205,HCPCS,Facility,Both,1,Each,,172,146.2,49.2952,172,Humana Insurance Company,Commercial PPO,163.4,95,,percent of total billed charges,,
CHLOROTHIAZIDE SODIUM 500 MG IV SOLR,,J1205,HCPCS,Facility,Outpatient,1,Each,,172,146.2,49.2952,172,Humana Insurance Company,Medicare PPO,84.28,49,,percent of total billed charges,,
CHLOROTHIAZIDE SODIUM 500 MG IV SOLR,,J1205,HCPCS,Facility,Inpatient,1,Each,,172,146.2,49.2952,172,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
CHLOROTHIAZIDE SODIUM 500 MG IV SOLR,,J1205,HCPCS,Facility,Both,1,Each,,172,146.2,49.2952,172,Medica,Individual & Family,170.452,99.1,,percent of total billed charges,,
CHLOROTHIAZIDE SODIUM 500 MG IV SOLR,,J1205,HCPCS,Facility,Outpatient,1,Each,,172,146.2,49.2952,172,Medica,Medica Advantage Solution,85.656,49.8,,percent of total billed charges,,
CHLOROTHIAZIDE SODIUM 500 MG IV SOLR,,J1205,HCPCS,Facility,Inpatient,1,Each,,172,146.2,49.2952,172,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
CHLOROTHIAZIDE SODIUM 500 MG IV SOLR,,J1205,HCPCS,Facility,Outpatient,1,Each,,172,146.2,49.2952,172,Medica,Medical Assistance,76.712,44.6,,percent of total billed charges,,
CHLOROTHIAZIDE SODIUM 500 MG IV SOLR,,J1205,HCPCS,Facility,Inpatient,1,Each,,172,146.2,49.2952,172,Medica,Medical Assistance,,,,,Included in per diem rate,
CHLOROTHIAZIDE SODIUM 500 MG IV SOLR,,J1205,HCPCS,Facility,Outpatient,1,Each,,172,146.2,49.2952,172,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,85.656,49.8,,percent of total billed charges,,
CHLOROTHIAZIDE SODIUM 500 MG IV SOLR,,J1205,HCPCS,Facility,Inpatient,1,Each,,172,146.2,49.2952,172,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
CHLOROTHIAZIDE SODIUM 500 MG IV SOLR,,J1205,HCPCS,Facility,Both,1,Each,,172,146.2,49.2952,172,"Multiplan, Inc.","Multiplan, Inc.",161.68,94,,percent of total billed charges,,
CHLOROTHIAZIDE SODIUM 500 MG IV SOLR,,J1205,HCPCS,Facility,Outpatient,1,Each,,172,146.2,49.2952,172,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,154.972,90.1,,percent of total billed charges,,
CHLOROTHIAZIDE SODIUM 500 MG IV SOLR,,J1205,HCPCS,Facility,Inpatient,1,Each,,172,146.2,49.2952,172,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
CHLOROTHIAZIDE SODIUM 500 MG IV SOLR,,J1205,HCPCS,Facility,Both,1,Each,,172,146.2,49.2952,172,"Preferred One Administrative Services, INC.",PPO,169.592,98.6,,percent of total billed charges,,
CHLOROTHIAZIDE SODIUM 500 MG IV SOLR,,J1205,HCPCS,Facility,Outpatient,1,Each,,172,146.2,49.2952,172,PrimeWest Health,Minnesota Senior Health Options (MSHO),88.494,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
CHLOROTHIAZIDE SODIUM 500 MG IV SOLR,,J1205,HCPCS,Facility,Inpatient,1,Each,,172,146.2,49.2952,172,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CHLOROTHIAZIDE SODIUM 500 MG IV SOLR,,J1205,HCPCS,Facility,Outpatient,1,Each,,172,146.2,49.2952,172,PrimeWest Health,MinnesotaCare,88.3392,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
CHLOROTHIAZIDE SODIUM 500 MG IV SOLR,,J1205,HCPCS,Facility,Inpatient,1,Each,,172,146.2,49.2952,172,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
CHLOROTHIAZIDE SODIUM 500 MG IV SOLR,,J1205,HCPCS,Facility,Both,1,Each,,172,146.2,49.2952,172,Sanford Health Plan,Sanford Health Plan,158.24,92,,percent of total billed charges,,
CHLOROTHIAZIDE SODIUM 500 MG IV SOLR,,J1205,HCPCS,Facility,Outpatient,1,Each,,172,146.2,49.2952,172,"UCare Health, Inc.",Individual & Family Plan,96.922,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
CHLOROTHIAZIDE SODIUM 500 MG IV SOLR,,J1205,HCPCS,Facility,Inpatient,1,Each,,172,146.2,49.2952,172,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
CHLOROTHIAZIDE SODIUM 500 MG IV SOLR,,J1205,HCPCS,Facility,Outpatient,1,Each,,172,146.2,49.2952,172,"UCare Health, Inc.",Medical Assistance,86.8084,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CHLOROTHIAZIDE SODIUM 500 MG IV SOLR,,J1205,HCPCS,Facility,Inpatient,1,Each,,172,146.2,49.2952,172,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
CHLOROTHIAZIDE SODIUM 500 MG IV SOLR,,J1205,HCPCS,Facility,Outpatient,1,Each,,172,146.2,49.2952,172,"UCare Health, Inc.",Medicare Advantage,86.8084,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CHLOROTHIAZIDE SODIUM 500 MG IV SOLR,,J1205,HCPCS,Facility,Inpatient,1,Each,,172,146.2,49.2952,172,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CHLOROTHIAZIDE SODIUM 500 MG IV SOLR,,J1205,HCPCS,Facility,Outpatient,1,Each,,172,146.2,49.2952,172,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),86.8084,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CHLOROTHIAZIDE SODIUM 500 MG IV SOLR,,J1205,HCPCS,Facility,Inpatient,1,Each,,172,146.2,49.2952,172,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CHLOROTHIAZIDE SODIUM 500 MG IV SOLR,,J1205,HCPCS,Facility,Both,1,Each,,172,146.2,49.2952,172,UnitedHealthcare,Individual & Family,161.68,94,,percent of total billed charges,,
CHLOROTHIAZIDE SODIUM 500 MG IV SOLR,,J1205,HCPCS,Facility,Outpatient,1,Each,,172,146.2,49.2952,172,UnitedHealthcare,Medicare Advantage,84.28,49,,percent of total billed charges,,
CHLOROTHIAZIDE SODIUM 500 MG IV SOLR,,J1205,HCPCS,Facility,Inpatient,1,Each,,172,146.2,49.2952,172,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
CHLOROTHIAZIDE SODIUM 500 MG IV SOLR,,J1205,HCPCS,Facility,Outpatient,1,Each,,172,146.2,49.2952,172,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,82.56,48,,percent of total billed charges,,100% of DHS outpatient percentage
CHLOROTHIAZIDE SODIUM 500 MG IV SOLR,,J1205,HCPCS,Facility,Inpatient,1,Each,,172,146.2,49.2952,172,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Biopsy, Breast, W/Placement Of Breast Localization Device, When Performed, 1St Lesion, Ultrasound (Pbb)",,19083,CPT,Facility,Outpatient,,,,1193,1014.05,341.9138,1193,Aetna,Commercial,1097.56,92,,percent of total billed charges,,
"Biopsy, Breast, W/Placement Of Breast Localization Device, When Performed, 1St Lesion, Ultrasound (Pbb)",,19083,CPT,Professional,Outpatient,,,,1122,953.7,94.67,1122,Aetna,Commercial,953.7,85,,percent of total billed charges,,
"Biopsy, Breast, W/Placement Of Breast Localization Device, When Performed, 1St Lesion, Ultrasound (Pbb)",,19083,CPT,Facility,Outpatient,,,,1193,1014.05,341.9138,1193,Aetna,Medicare Advantage,584.57,49,,percent of total billed charges,,
"Biopsy, Breast, W/Placement Of Breast Localization Device, When Performed, 1St Lesion, Ultrasound (Pbb)",,19083,CPT,Professional,Outpatient,,,,1122,953.7,94.67,1122,Aetna,Medicare Advantage,151.7,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Biopsy, Breast, W/Placement Of Breast Localization Device, When Performed, 1St Lesion, Ultrasound (Pbb)",,19083,CPT,Facility,Outpatient,,,,1193,1014.05,341.9138,1193,Aetna,PPO,1109.49,93,,percent of total billed charges,,
"Biopsy, Breast, W/Placement Of Breast Localization Device, When Performed, 1St Lesion, Ultrasound (Pbb)",,19083,CPT,Professional,Outpatient,,,,1122,953.7,94.67,1122,Aetna,PPO,1043.46,93,,percent of total billed charges,,
"Biopsy, Breast, W/Placement Of Breast Localization Device, When Performed, 1St Lesion, Ultrasound (Pbb)",,19083,CPT,Facility,Outpatient,,,,1193,1014.05,341.9138,1193,America's PPO,America's PPO,1145.6379,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Biopsy, Breast, W/Placement Of Breast Localization Device, When Performed, 1St Lesion, Ultrasound (Pbb)",,19083,CPT,Professional,Outpatient,,,,1122,953.7,94.67,1122,America's PPO,America's PPO,958.6368,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Biopsy, Breast, W/Placement Of Breast Localization Device, When Performed, 1St Lesion, Ultrasound (Pbb)",,19083,CPT,Facility,Outpatient,,,,1193,1014.05,341.9138,1193,BlueCross BlueShield Minnesota, Federal Employee Program,1173.912,98.4,,percent of total billed charges,,
"Biopsy, Breast, W/Placement Of Breast Localization Device, When Performed, 1St Lesion, Ultrasound (Pbb)",,19083,CPT,Professional,Outpatient,,,,1122,953.7,94.67,1122,BlueCross BlueShield Minnesota, Federal Employee Program,311.94,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Biopsy, Breast, W/Placement Of Breast Localization Device, When Performed, 1St Lesion, Ultrasound (Pbb)",,19083,CPT,Facility,Outpatient,,,,1193,1014.05,341.9138,1193,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1193,100,,percent of total billed charges,,
"Biopsy, Breast, W/Placement Of Breast Localization Device, When Performed, 1St Lesion, Ultrasound (Pbb)",,19083,CPT,Professional,Outpatient,,,,1122,953.7,94.67,1122,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,316.93104,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Biopsy, Breast, W/Placement Of Breast Localization Device, When Performed, 1St Lesion, Ultrasound (Pbb)",,19083,CPT,Facility,Outpatient,,,,1193,1014.05,341.9138,1193,BlueCross BlueShield Minnesota,High Value Network Plan,1073.7,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
"Biopsy, Breast, W/Placement Of Breast Localization Device, When Performed, 1St Lesion, Ultrasound (Pbb)",,19083,CPT,Professional,Outpatient,,,,1122,953.7,94.67,1122,BlueCross BlueShield Minnesota,High Value Network Plan,316.93104,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Biopsy, Breast, W/Placement Of Breast Localization Device, When Performed, 1St Lesion, Ultrasound (Pbb)",,19083,CPT,Facility,Outpatient,,,,1193,1014.05,341.9138,1193,BlueCross BlueShield Minnesota,Medicare Advantage,584.57,49,,percent of total billed charges,,
"Biopsy, Breast, W/Placement Of Breast Localization Device, When Performed, 1St Lesion, Ultrasound (Pbb)",,19083,CPT,Professional,Outpatient,,,,1122,953.7,94.67,1122,BlueCross BlueShield Minnesota,Medicare Advantage,169.2225,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Biopsy, Breast, W/Placement Of Breast Localization Device, When Performed, 1St Lesion, Ultrasound (Pbb)",,19083,CPT,Professional,Outpatient,,,,1122,953.7,94.67,1122,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,316.93104,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Biopsy, Breast, W/Placement Of Breast Localization Device, When Performed, 1St Lesion, Ultrasound (Pbb)",,19083,CPT,Facility,Outpatient,,,,1193,1014.05,341.9138,1193,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,341.9138,28.66,,percent of total billed charges,,
"Biopsy, Breast, W/Placement Of Breast Localization Device, When Performed, 1St Lesion, Ultrasound (Pbb)",,19083,CPT,Professional,Outpatient,,,,1122,953.7,94.67,1122,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,109.30128,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Biopsy, Breast, W/Placement Of Breast Localization Device, When Performed, 1St Lesion, Ultrasound (Pbb)",,19083,CPT,Facility,Outpatient,,,,1193,1014.05,341.9138,1193,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),584.57,49,,percent of total billed charges,,
"Biopsy, Breast, W/Placement Of Breast Localization Device, When Performed, 1St Lesion, Ultrasound (Pbb)",,19083,CPT,Professional,Outpatient,,,,1122,953.7,94.67,1122,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),169.2225,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Biopsy, Breast, W/Placement Of Breast Localization Device, When Performed, 1St Lesion, Ultrasound (Pbb)",,19083,CPT,Facility,Outpatient,,,,1193,1014.05,341.9138,1193,CorVel,Worker's Compensation,1193,100,,percent of total billed charges,,
"Biopsy, Breast, W/Placement Of Breast Localization Device, When Performed, 1St Lesion, Ultrasound (Pbb)",,19083,CPT,Professional,Outpatient,,,,1122,953.7,94.67,1122,CorVel,Worker's Compensation,292.0229184,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Biopsy, Breast, W/Placement Of Breast Localization Device, When Performed, 1St Lesion, Ultrasound (Pbb)",,19083,CPT,Facility,Outpatient,,,,1193,1014.05,341.9138,1193,First Health Group Corporation,First Health Network,1157.21,97,,percent of total billed charges,,
"Biopsy, Breast, W/Placement Of Breast Localization Device, When Performed, 1St Lesion, Ultrasound (Pbb)",,19083,CPT,Professional,Outpatient,,,,1122,953.7,94.67,1122,First Health Group Corporation,First Health Network,1088.34,97,,percent of total billed charges,,
"Biopsy, Breast, W/Placement Of Breast Localization Device, When Performed, 1St Lesion, Ultrasound (Pbb)",,19083,CPT,Facility,Outpatient,,,,1193,1014.05,341.9138,1193,"Health Partners, Inc.",Commercial,1128.578,94.6,,percent of total billed charges,,
"Biopsy, Breast, W/Placement Of Breast Localization Device, When Performed, 1St Lesion, Ultrasound (Pbb)",,19083,CPT,Professional,Outpatient,,,,1122,953.7,94.67,1122,"Health Partners, Inc.",Commercial,314.88,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Biopsy, Breast, W/Placement Of Breast Localization Device, When Performed, 1St Lesion, Ultrasound (Pbb)",,19083,CPT,Facility,Outpatient,,,,1193,1014.05,341.9138,1193,"Health Partners, Inc.",Medicare Advantage,584.57,49,,percent of total billed charges,,
"Biopsy, Breast, W/Placement Of Breast Localization Device, When Performed, 1St Lesion, Ultrasound (Pbb)",,19083,CPT,Professional,Outpatient,,,,1122,953.7,94.67,1122,"Health Partners, Inc.",Medicare Advantage,169.2225,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Biopsy, Breast, W/Placement Of Breast Localization Device, When Performed, 1St Lesion, Ultrasound (Pbb)",,19083,CPT,Facility,Outpatient,,,,1193,1014.05,341.9138,1193,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),715.8,60,,percent of total billed charges,,
"Biopsy, Breast, W/Placement Of Breast Localization Device, When Performed, 1St Lesion, Ultrasound (Pbb)",,19083,CPT,Professional,Outpatient,,,,1122,953.7,94.67,1122,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),147.07,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Biopsy, Breast, W/Placement Of Breast Localization Device, When Performed, 1St Lesion, Ultrasound (Pbb)",,19083,CPT,Facility,Outpatient,,,,1193,1014.05,341.9138,1193,"Health Partners, Inc.",State of Minnesota Advantage Program,972.295,81.5,,percent of total billed charges,,
"Biopsy, Breast, W/Placement Of Breast Localization Device, When Performed, 1St Lesion, Ultrasound (Pbb)",,19083,CPT,Professional,Outpatient,,,,1122,953.7,94.67,1122,"Health Partners, Inc.",State of Minnesota Advantage Program,271.26912,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Biopsy, Breast, W/Placement Of Breast Localization Device, When Performed, 1St Lesion, Ultrasound (Pbb)",,19083,CPT,Facility,Outpatient,,,,1193,1014.05,341.9138,1193,"Health Partners, Inc.",State Public Programs,596.5,50,,percent of total billed charges,,
"Biopsy, Breast, W/Placement Of Breast Localization Device, When Performed, 1St Lesion, Ultrasound (Pbb)",,19083,CPT,Professional,Outpatient,,,,1122,953.7,94.67,1122,"Health Partners, Inc.",State Public Programs,94.67,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Biopsy, Breast, W/Placement Of Breast Localization Device, When Performed, 1St Lesion, Ultrasound (Pbb)",,19083,CPT,Facility,Outpatient,,,,1193,1014.05,341.9138,1193,Humana Insurance Company,Commercial PPO,1133.35,95,,percent of total billed charges,,
"Biopsy, Breast, W/Placement Of Breast Localization Device, When Performed, 1St Lesion, Ultrasound (Pbb)",,19083,CPT,Professional,Outpatient,,,,1122,953.7,94.67,1122,Humana Insurance Company,Commercial PPO,147.15,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Biopsy, Breast, W/Placement Of Breast Localization Device, When Performed, 1St Lesion, Ultrasound (Pbb)",,19083,CPT,Facility,Outpatient,,,,1193,1014.05,341.9138,1193,Humana Insurance Company,Medicare PPO,584.57,49,,percent of total billed charges,,
"Biopsy, Breast, W/Placement Of Breast Localization Device, When Performed, 1St Lesion, Ultrasound (Pbb)",,19083,CPT,Professional,Outpatient,,,,1122,953.7,94.67,1122,Humana Insurance Company,Medicare PPO,1122,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Biopsy, Breast, W/Placement Of Breast Localization Device, When Performed, 1St Lesion, Ultrasound (Pbb)",,19083,CPT,Facility,Outpatient,,,,1193,1014.05,341.9138,1193,Medica,Individual & Family,1182.263,99.1,,percent of total billed charges,,
"Biopsy, Breast, W/Placement Of Breast Localization Device, When Performed, 1St Lesion, Ultrasound (Pbb)",,19083,CPT,Professional,Outpatient,,,,1122,953.7,94.67,1122,Medica,Individual & Family,951.456,84.8,,percent of total billed charges,,
"Biopsy, Breast, W/Placement Of Breast Localization Device, When Performed, 1St Lesion, Ultrasound (Pbb)",,19083,CPT,Facility,Outpatient,,,,1193,1014.05,341.9138,1193,Medica,Medica Advantage Solution,594.114,49.8,,percent of total billed charges,,
"Biopsy, Breast, W/Placement Of Breast Localization Device, When Performed, 1St Lesion, Ultrasound (Pbb)",,19083,CPT,Professional,Outpatient,,,,1122,953.7,94.67,1122,Medica,Medica Advantage Solution,558.756,49.8,,percent of total billed charges,,
"Biopsy, Breast, W/Placement Of Breast Localization Device, When Performed, 1St Lesion, Ultrasound (Pbb)",,19083,CPT,Facility,Outpatient,,,,1193,1014.05,341.9138,1193,Medica,Medical Assistance,532.078,44.6,,percent of total billed charges,,
"Biopsy, Breast, W/Placement Of Breast Localization Device, When Performed, 1St Lesion, Ultrasound (Pbb)",,19083,CPT,Professional,Outpatient,,,,1122,953.7,94.67,1122,Medica,Medical Assistance,109.3,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Biopsy, Breast, W/Placement Of Breast Localization Device, When Performed, 1St Lesion, Ultrasound (Pbb)",,19083,CPT,Facility,Outpatient,,,,1193,1014.05,341.9138,1193,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,594.114,49.8,,percent of total billed charges,,
"Biopsy, Breast, W/Placement Of Breast Localization Device, When Performed, 1St Lesion, Ultrasound (Pbb)",,19083,CPT,Professional,Outpatient,,,,1122,953.7,94.67,1122,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,147.15,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Biopsy, Breast, W/Placement Of Breast Localization Device, When Performed, 1St Lesion, Ultrasound (Pbb)",,19083,CPT,Facility,Outpatient,,,,1193,1014.05,341.9138,1193,"Multiplan, Inc.","Multiplan, Inc.",1121.42,94,,percent of total billed charges,,
"Biopsy, Breast, W/Placement Of Breast Localization Device, When Performed, 1St Lesion, Ultrasound (Pbb)",,19083,CPT,Professional,Outpatient,,,,1122,953.7,94.67,1122,"Multiplan, Inc.","Multiplan, Inc.",1054.68,94,,percent of total billed charges,,
"Biopsy, Breast, W/Placement Of Breast Localization Device, When Performed, 1St Lesion, Ultrasound (Pbb)",,19083,CPT,Facility,Outpatient,,,,1193,1014.05,341.9138,1193,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1074.893,90.1,,percent of total billed charges,,
"Biopsy, Breast, W/Placement Of Breast Localization Device, When Performed, 1St Lesion, Ultrasound (Pbb)",,19083,CPT,Professional,Outpatient,,,,1122,953.7,94.67,1122,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1010.922,90.1,,percent of total billed charges,,
"Biopsy, Breast, W/Placement Of Breast Localization Device, When Performed, 1St Lesion, Ultrasound (Pbb)",,19083,CPT,Facility,Outpatient,,,,1193,1014.05,341.9138,1193,"Preferred One Administrative Services, INC.",PPO,1176.298,98.6,,percent of total billed charges,,
"Biopsy, Breast, W/Placement Of Breast Localization Device, When Performed, 1St Lesion, Ultrasound (Pbb)",,19083,CPT,Professional,Outpatient,,,,1122,953.7,94.67,1122,"Preferred One Administrative Services, INC.",PPO,1106.292,98.6,,percent of total billed charges,,
"Biopsy, Breast, W/Placement Of Breast Localization Device, When Performed, 1St Lesion, Ultrasound (Pbb)",,19083,CPT,Facility,Outpatient,,,,1193,1014.05,341.9138,1193,PrimeWest Health,Minnesota Senior Health Options (MSHO),613.7985,51.45,,percent of total billed charges,,
"Biopsy, Breast, W/Placement Of Breast Localization Device, When Performed, 1St Lesion, Ultrasound (Pbb)",,19083,CPT,Professional,Outpatient,,,,1122,953.7,94.67,1122,PrimeWest Health,Minnesota Senior Health Options (MSHO),169.2225,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Biopsy, Breast, W/Placement Of Breast Localization Device, When Performed, 1St Lesion, Ultrasound (Pbb)",,19083,CPT,Facility,Outpatient,,,,1193,1014.05,341.9138,1193,PrimeWest Health,MinnesotaCare,612.7248,51.36,,percent of total billed charges,,
"Biopsy, Breast, W/Placement Of Breast Localization Device, When Performed, 1St Lesion, Ultrasound (Pbb)",,19083,CPT,Professional,Outpatient,,,,1122,953.7,94.67,1122,PrimeWest Health,MinnesotaCare,116.9523696,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Biopsy, Breast, W/Placement Of Breast Localization Device, When Performed, 1St Lesion, Ultrasound (Pbb)",,19083,CPT,Facility,Outpatient,,,,1193,1014.05,341.9138,1193,Sanford Health Plan,Sanford Health Plan,1097.56,92,,percent of total billed charges,,
"Biopsy, Breast, W/Placement Of Breast Localization Device, When Performed, 1St Lesion, Ultrasound (Pbb)",,19083,CPT,Professional,Outpatient,,,,1122,953.7,94.67,1122,Sanford Health Plan,Sanford Health Plan,987.36,88,,percent of total billed charges,,
"Biopsy, Breast, W/Placement Of Breast Localization Device, When Performed, 1St Lesion, Ultrasound (Pbb)",,19083,CPT,Facility,Outpatient,,,,1193,1014.05,341.9138,1193,"UCare Health, Inc.",Individual & Family Plan,672.2555,56.35,,percent of total billed charges,,
"Biopsy, Breast, W/Placement Of Breast Localization Device, When Performed, 1St Lesion, Ultrasound (Pbb)",,19083,CPT,Professional,Outpatient,,,,1122,953.7,94.67,1122,"UCare Health, Inc.",Individual & Family Plan,239.20704,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Biopsy, Breast, W/Placement Of Breast Localization Device, When Performed, 1St Lesion, Ultrasound (Pbb)",,19083,CPT,Facility,Outpatient,,,,1193,1014.05,341.9138,1193,"UCare Health, Inc.",Medical Assistance,602.1071,50.47,,percent of total billed charges,,
"Biopsy, Breast, W/Placement Of Breast Localization Device, When Performed, 1St Lesion, Ultrasound (Pbb)",,19083,CPT,Professional,Outpatient,,,,1122,953.7,94.67,1122,"UCare Health, Inc.",Medical Assistance,120.231408,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Biopsy, Breast, W/Placement Of Breast Localization Device, When Performed, 1St Lesion, Ultrasound (Pbb)",,19083,CPT,Facility,Outpatient,,,,1193,1014.05,341.9138,1193,"UCare Health, Inc.",Medicare Advantage,602.1071,50.47,,percent of total billed charges,,
"Biopsy, Breast, W/Placement Of Breast Localization Device, When Performed, 1St Lesion, Ultrasound (Pbb)",,19083,CPT,Professional,Outpatient,,,,1122,953.7,94.67,1122,"UCare Health, Inc.",Medicare Advantage,169.2225,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Biopsy, Breast, W/Placement Of Breast Localization Device, When Performed, 1St Lesion, Ultrasound (Pbb)",,19083,CPT,Facility,Outpatient,,,,1193,1014.05,341.9138,1193,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),602.1071,50.47,,percent of total billed charges,,
"Biopsy, Breast, W/Placement Of Breast Localization Device, When Performed, 1St Lesion, Ultrasound (Pbb)",,19083,CPT,Professional,Outpatient,,,,1122,953.7,94.67,1122,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),135.378,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Biopsy, Breast, W/Placement Of Breast Localization Device, When Performed, 1St Lesion, Ultrasound (Pbb)",,19083,CPT,Facility,Outpatient,,,,1193,1014.05,341.9138,1193,UnitedHealthcare,Individual & Family,1121.42,94,,percent of total billed charges,,
"Biopsy, Breast, W/Placement Of Breast Localization Device, When Performed, 1St Lesion, Ultrasound (Pbb)",,19083,CPT,Professional,Outpatient,,,,1122,953.7,94.67,1122,UnitedHealthcare,Individual & Family,1122,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Biopsy, Breast, W/Placement Of Breast Localization Device, When Performed, 1St Lesion, Ultrasound (Pbb)",,19083,CPT,Facility,Outpatient,,,,1193,1014.05,341.9138,1193,UnitedHealthcare,Medicare Advantage,584.57,49,,percent of total billed charges,,
"Biopsy, Breast, W/Placement Of Breast Localization Device, When Performed, 1St Lesion, Ultrasound (Pbb)",,19083,CPT,Professional,Outpatient,,,,1122,953.7,94.67,1122,UnitedHealthcare,Medicare Advantage,169.2225,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Biopsy, Breast, W/Placement Of Breast Localization Device, When Performed, 1St Lesion, Ultrasound (Pbb)",,19083,CPT,Facility,Outpatient,,,,1193,1014.05,341.9138,1193,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,572.64,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Biopsy, Breast, W/Placement Of Breast Localization Device, When Performed, 1St Lesion, Ultrasound (Pbb)",,19083,CPT,Professional,Outpatient,,,,1122,953.7,94.67,1122,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,109.30128,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
ERTAPENEM 1 GRAM INJ SOLR,,J1335,HCPCS,Facility,Both,1,Each,,404,343.4,115.7864,404,Aetna,Commercial,371.68,92,,percent of total billed charges,,
ERTAPENEM 1 GRAM INJ SOLR,,J1335,HCPCS,Facility,Outpatient,1,Each,,404,343.4,115.7864,404,Aetna,Medicare Advantage,197.96,49,,percent of total billed charges,,
ERTAPENEM 1 GRAM INJ SOLR,,J1335,HCPCS,Facility,Inpatient,1,Each,,404,343.4,115.7864,404,Aetna,Medicare Advantage,,,,,Included in per diem rate,
ERTAPENEM 1 GRAM INJ SOLR,,J1335,HCPCS,Facility,Both,1,Each,,404,343.4,115.7864,404,Aetna,PPO,375.72,93,,percent of total billed charges,,
ERTAPENEM 1 GRAM INJ SOLR,,J1335,HCPCS,Facility,Both,1,Each,,404,343.4,115.7864,404,America's PPO,America's PPO,387.9612,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
ERTAPENEM 1 GRAM INJ SOLR,,J1335,HCPCS,Facility,Both,1,Each,,404,343.4,115.7864,404,BlueCross BlueShield Minnesota, Federal Employee Program,397.536,98.4,,percent of total billed charges,,
ERTAPENEM 1 GRAM INJ SOLR,,J1335,HCPCS,Facility,Both,1,Each,,404,343.4,115.7864,404,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,404,100,,percent of total billed charges,,
ERTAPENEM 1 GRAM INJ SOLR,,J1335,HCPCS,Facility,Both,1,Each,,404,343.4,115.7864,404,BlueCross BlueShield Minnesota,High Value Network Plan,363.6,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
ERTAPENEM 1 GRAM INJ SOLR,,J1335,HCPCS,Facility,Outpatient,1,Each,,404,343.4,115.7864,404,BlueCross BlueShield Minnesota,Medicare Advantage,197.96,49,,percent of total billed charges,,
ERTAPENEM 1 GRAM INJ SOLR,,J1335,HCPCS,Facility,Inpatient,1,Each,,404,343.4,115.7864,404,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
ERTAPENEM 1 GRAM INJ SOLR,,J1335,HCPCS,Facility,Both,1,Each,,404,343.4,115.7864,404,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,357.8228,88.57,,percent of total billed charges,,
ERTAPENEM 1 GRAM INJ SOLR,,J1335,HCPCS,Facility,Both,1,Each,,404,343.4,115.7864,404,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,115.7864,28.66,,percent of total billed charges,,
ERTAPENEM 1 GRAM INJ SOLR,,J1335,HCPCS,Facility,Outpatient,1,Each,,404,343.4,115.7864,404,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),197.96,49,,percent of total billed charges,,
ERTAPENEM 1 GRAM INJ SOLR,,J1335,HCPCS,Facility,Inpatient,1,Each,,404,343.4,115.7864,404,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
ERTAPENEM 1 GRAM INJ SOLR,,J1335,HCPCS,Facility,Both,1,Each,,404,343.4,115.7864,404,CorVel,Worker's Compensation,404,100,,percent of total billed charges,,
ERTAPENEM 1 GRAM INJ SOLR,,J1335,HCPCS,Facility,Both,1,Each,,404,343.4,115.7864,404,First Health Group Corporation,First Health Network,391.88,97,,percent of total billed charges,,
ERTAPENEM 1 GRAM INJ SOLR,,J1335,HCPCS,Facility,Both,1,Each,,404,343.4,115.7864,404,"Health Partners, Inc.",Commercial,382.184,94.6,,percent of total billed charges,,
ERTAPENEM 1 GRAM INJ SOLR,,J1335,HCPCS,Facility,Outpatient,1,Each,,404,343.4,115.7864,404,"Health Partners, Inc.",Medicare Advantage,197.96,49,,percent of total billed charges,,
ERTAPENEM 1 GRAM INJ SOLR,,J1335,HCPCS,Facility,Inpatient,1,Each,,404,343.4,115.7864,404,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ERTAPENEM 1 GRAM INJ SOLR,,J1335,HCPCS,Facility,Both,1,Each,,404,343.4,115.7864,404,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),242.4,60,,percent of total billed charges,,
ERTAPENEM 1 GRAM INJ SOLR,,J1335,HCPCS,Facility,Both,1,Each,,404,343.4,115.7864,404,"Health Partners, Inc.",State of Minnesota Advantage Program,329.26,81.5,,percent of total billed charges,,
ERTAPENEM 1 GRAM INJ SOLR,,J1335,HCPCS,Facility,Both,1,Each,,404,343.4,115.7864,404,"Health Partners, Inc.",State Public Programs,202,50,,percent of total billed charges,,
ERTAPENEM 1 GRAM INJ SOLR,,J1335,HCPCS,Facility,Both,1,Each,,404,343.4,115.7864,404,Humana Insurance Company,Commercial PPO,383.8,95,,percent of total billed charges,,
ERTAPENEM 1 GRAM INJ SOLR,,J1335,HCPCS,Facility,Outpatient,1,Each,,404,343.4,115.7864,404,Humana Insurance Company,Medicare PPO,197.96,49,,percent of total billed charges,,
ERTAPENEM 1 GRAM INJ SOLR,,J1335,HCPCS,Facility,Inpatient,1,Each,,404,343.4,115.7864,404,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
ERTAPENEM 1 GRAM INJ SOLR,,J1335,HCPCS,Facility,Both,1,Each,,404,343.4,115.7864,404,Medica,Individual & Family,400.364,99.1,,percent of total billed charges,,
ERTAPENEM 1 GRAM INJ SOLR,,J1335,HCPCS,Facility,Outpatient,1,Each,,404,343.4,115.7864,404,Medica,Medica Advantage Solution,201.192,49.8,,percent of total billed charges,,
ERTAPENEM 1 GRAM INJ SOLR,,J1335,HCPCS,Facility,Inpatient,1,Each,,404,343.4,115.7864,404,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
ERTAPENEM 1 GRAM INJ SOLR,,J1335,HCPCS,Facility,Outpatient,1,Each,,404,343.4,115.7864,404,Medica,Medical Assistance,180.184,44.6,,percent of total billed charges,,
ERTAPENEM 1 GRAM INJ SOLR,,J1335,HCPCS,Facility,Inpatient,1,Each,,404,343.4,115.7864,404,Medica,Medical Assistance,,,,,Included in per diem rate,
ERTAPENEM 1 GRAM INJ SOLR,,J1335,HCPCS,Facility,Outpatient,1,Each,,404,343.4,115.7864,404,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,201.192,49.8,,percent of total billed charges,,
ERTAPENEM 1 GRAM INJ SOLR,,J1335,HCPCS,Facility,Inpatient,1,Each,,404,343.4,115.7864,404,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
ERTAPENEM 1 GRAM INJ SOLR,,J1335,HCPCS,Facility,Both,1,Each,,404,343.4,115.7864,404,"Multiplan, Inc.","Multiplan, Inc.",379.76,94,,percent of total billed charges,,
ERTAPENEM 1 GRAM INJ SOLR,,J1335,HCPCS,Facility,Outpatient,1,Each,,404,343.4,115.7864,404,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,364.004,90.1,,percent of total billed charges,,
ERTAPENEM 1 GRAM INJ SOLR,,J1335,HCPCS,Facility,Inpatient,1,Each,,404,343.4,115.7864,404,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
ERTAPENEM 1 GRAM INJ SOLR,,J1335,HCPCS,Facility,Both,1,Each,,404,343.4,115.7864,404,"Preferred One Administrative Services, INC.",PPO,398.344,98.6,,percent of total billed charges,,
ERTAPENEM 1 GRAM INJ SOLR,,J1335,HCPCS,Facility,Outpatient,1,Each,,404,343.4,115.7864,404,PrimeWest Health,Minnesota Senior Health Options (MSHO),207.858,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
ERTAPENEM 1 GRAM INJ SOLR,,J1335,HCPCS,Facility,Inpatient,1,Each,,404,343.4,115.7864,404,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ERTAPENEM 1 GRAM INJ SOLR,,J1335,HCPCS,Facility,Outpatient,1,Each,,404,343.4,115.7864,404,PrimeWest Health,MinnesotaCare,207.4944,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
ERTAPENEM 1 GRAM INJ SOLR,,J1335,HCPCS,Facility,Inpatient,1,Each,,404,343.4,115.7864,404,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
ERTAPENEM 1 GRAM INJ SOLR,,J1335,HCPCS,Facility,Both,1,Each,,404,343.4,115.7864,404,Sanford Health Plan,Sanford Health Plan,371.68,92,,percent of total billed charges,,
ERTAPENEM 1 GRAM INJ SOLR,,J1335,HCPCS,Facility,Outpatient,1,Each,,404,343.4,115.7864,404,"UCare Health, Inc.",Individual & Family Plan,227.654,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
ERTAPENEM 1 GRAM INJ SOLR,,J1335,HCPCS,Facility,Inpatient,1,Each,,404,343.4,115.7864,404,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
ERTAPENEM 1 GRAM INJ SOLR,,J1335,HCPCS,Facility,Outpatient,1,Each,,404,343.4,115.7864,404,"UCare Health, Inc.",Medical Assistance,203.8988,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ERTAPENEM 1 GRAM INJ SOLR,,J1335,HCPCS,Facility,Inpatient,1,Each,,404,343.4,115.7864,404,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
ERTAPENEM 1 GRAM INJ SOLR,,J1335,HCPCS,Facility,Outpatient,1,Each,,404,343.4,115.7864,404,"UCare Health, Inc.",Medicare Advantage,203.8988,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ERTAPENEM 1 GRAM INJ SOLR,,J1335,HCPCS,Facility,Inpatient,1,Each,,404,343.4,115.7864,404,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ERTAPENEM 1 GRAM INJ SOLR,,J1335,HCPCS,Facility,Outpatient,1,Each,,404,343.4,115.7864,404,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),203.8988,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ERTAPENEM 1 GRAM INJ SOLR,,J1335,HCPCS,Facility,Inpatient,1,Each,,404,343.4,115.7864,404,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ERTAPENEM 1 GRAM INJ SOLR,,J1335,HCPCS,Facility,Both,1,Each,,404,343.4,115.7864,404,UnitedHealthcare,Individual & Family,379.76,94,,percent of total billed charges,,
ERTAPENEM 1 GRAM INJ SOLR,,J1335,HCPCS,Facility,Outpatient,1,Each,,404,343.4,115.7864,404,UnitedHealthcare,Medicare Advantage,197.96,49,,percent of total billed charges,,
ERTAPENEM 1 GRAM INJ SOLR,,J1335,HCPCS,Facility,Inpatient,1,Each,,404,343.4,115.7864,404,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
ERTAPENEM 1 GRAM INJ SOLR,,J1335,HCPCS,Facility,Outpatient,1,Each,,404,343.4,115.7864,404,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,193.92,48,,percent of total billed charges,,100% of DHS outpatient percentage
ERTAPENEM 1 GRAM INJ SOLR,,J1335,HCPCS,Facility,Inpatient,1,Each,,404,343.4,115.7864,404,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
CONJUGATED ESTROGENS 25 MG INJ SOLR,,J1410,HCPCS,Facility,Both,1,Each,,1544,1312.4,442.5104,1544,Aetna,Commercial,1420.48,92,,percent of total billed charges,,
CONJUGATED ESTROGENS 25 MG INJ SOLR,,J1410,HCPCS,Facility,Outpatient,1,Each,,1544,1312.4,442.5104,1544,Aetna,Medicare Advantage,756.56,49,,percent of total billed charges,,
CONJUGATED ESTROGENS 25 MG INJ SOLR,,J1410,HCPCS,Facility,Inpatient,1,Each,,1544,1312.4,442.5104,1544,Aetna,Medicare Advantage,,,,,Included in per diem rate,
CONJUGATED ESTROGENS 25 MG INJ SOLR,,J1410,HCPCS,Facility,Both,1,Each,,1544,1312.4,442.5104,1544,Aetna,PPO,1435.92,93,,percent of total billed charges,,
CONJUGATED ESTROGENS 25 MG INJ SOLR,,J1410,HCPCS,Facility,Both,1,Each,,1544,1312.4,442.5104,1544,America's PPO,America's PPO,1482.7032,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
CONJUGATED ESTROGENS 25 MG INJ SOLR,,J1410,HCPCS,Facility,Both,1,Each,,1544,1312.4,442.5104,1544,BlueCross BlueShield Minnesota, Federal Employee Program,1519.296,98.4,,percent of total billed charges,,
CONJUGATED ESTROGENS 25 MG INJ SOLR,,J1410,HCPCS,Facility,Both,1,Each,,1544,1312.4,442.5104,1544,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1544,100,,percent of total billed charges,,
CONJUGATED ESTROGENS 25 MG INJ SOLR,,J1410,HCPCS,Facility,Both,1,Each,,1544,1312.4,442.5104,1544,BlueCross BlueShield Minnesota,High Value Network Plan,1389.6,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
CONJUGATED ESTROGENS 25 MG INJ SOLR,,J1410,HCPCS,Facility,Outpatient,1,Each,,1544,1312.4,442.5104,1544,BlueCross BlueShield Minnesota,Medicare Advantage,756.56,49,,percent of total billed charges,,
CONJUGATED ESTROGENS 25 MG INJ SOLR,,J1410,HCPCS,Facility,Inpatient,1,Each,,1544,1312.4,442.5104,1544,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
CONJUGATED ESTROGENS 25 MG INJ SOLR,,J1410,HCPCS,Facility,Both,1,Each,,1544,1312.4,442.5104,1544,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1367.5208,88.57,,percent of total billed charges,,
CONJUGATED ESTROGENS 25 MG INJ SOLR,,J1410,HCPCS,Facility,Both,1,Each,,1544,1312.4,442.5104,1544,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,442.5104,28.66,,percent of total billed charges,,
CONJUGATED ESTROGENS 25 MG INJ SOLR,,J1410,HCPCS,Facility,Outpatient,1,Each,,1544,1312.4,442.5104,1544,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),756.56,49,,percent of total billed charges,,
CONJUGATED ESTROGENS 25 MG INJ SOLR,,J1410,HCPCS,Facility,Inpatient,1,Each,,1544,1312.4,442.5104,1544,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
CONJUGATED ESTROGENS 25 MG INJ SOLR,,J1410,HCPCS,Facility,Both,1,Each,,1544,1312.4,442.5104,1544,CorVel,Worker's Compensation,1544,100,,percent of total billed charges,,
CONJUGATED ESTROGENS 25 MG INJ SOLR,,J1410,HCPCS,Facility,Both,1,Each,,1544,1312.4,442.5104,1544,First Health Group Corporation,First Health Network,1497.68,97,,percent of total billed charges,,
CONJUGATED ESTROGENS 25 MG INJ SOLR,,J1410,HCPCS,Facility,Both,1,Each,,1544,1312.4,442.5104,1544,"Health Partners, Inc.",Commercial,1460.624,94.6,,percent of total billed charges,,
CONJUGATED ESTROGENS 25 MG INJ SOLR,,J1410,HCPCS,Facility,Outpatient,1,Each,,1544,1312.4,442.5104,1544,"Health Partners, Inc.",Medicare Advantage,756.56,49,,percent of total billed charges,,
CONJUGATED ESTROGENS 25 MG INJ SOLR,,J1410,HCPCS,Facility,Inpatient,1,Each,,1544,1312.4,442.5104,1544,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CONJUGATED ESTROGENS 25 MG INJ SOLR,,J1410,HCPCS,Facility,Both,1,Each,,1544,1312.4,442.5104,1544,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),926.4,60,,percent of total billed charges,,
CONJUGATED ESTROGENS 25 MG INJ SOLR,,J1410,HCPCS,Facility,Both,1,Each,,1544,1312.4,442.5104,1544,"Health Partners, Inc.",State of Minnesota Advantage Program,1258.36,81.5,,percent of total billed charges,,
CONJUGATED ESTROGENS 25 MG INJ SOLR,,J1410,HCPCS,Facility,Both,1,Each,,1544,1312.4,442.5104,1544,"Health Partners, Inc.",State Public Programs,772,50,,percent of total billed charges,,
CONJUGATED ESTROGENS 25 MG INJ SOLR,,J1410,HCPCS,Facility,Both,1,Each,,1544,1312.4,442.5104,1544,Humana Insurance Company,Commercial PPO,1466.8,95,,percent of total billed charges,,
CONJUGATED ESTROGENS 25 MG INJ SOLR,,J1410,HCPCS,Facility,Outpatient,1,Each,,1544,1312.4,442.5104,1544,Humana Insurance Company,Medicare PPO,756.56,49,,percent of total billed charges,,
CONJUGATED ESTROGENS 25 MG INJ SOLR,,J1410,HCPCS,Facility,Inpatient,1,Each,,1544,1312.4,442.5104,1544,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
CONJUGATED ESTROGENS 25 MG INJ SOLR,,J1410,HCPCS,Facility,Both,1,Each,,1544,1312.4,442.5104,1544,Medica,Individual & Family,1530.104,99.1,,percent of total billed charges,,
CONJUGATED ESTROGENS 25 MG INJ SOLR,,J1410,HCPCS,Facility,Outpatient,1,Each,,1544,1312.4,442.5104,1544,Medica,Medica Advantage Solution,768.912,49.8,,percent of total billed charges,,
CONJUGATED ESTROGENS 25 MG INJ SOLR,,J1410,HCPCS,Facility,Inpatient,1,Each,,1544,1312.4,442.5104,1544,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
CONJUGATED ESTROGENS 25 MG INJ SOLR,,J1410,HCPCS,Facility,Outpatient,1,Each,,1544,1312.4,442.5104,1544,Medica,Medical Assistance,688.624,44.6,,percent of total billed charges,,
CONJUGATED ESTROGENS 25 MG INJ SOLR,,J1410,HCPCS,Facility,Inpatient,1,Each,,1544,1312.4,442.5104,1544,Medica,Medical Assistance,,,,,Included in per diem rate,
CONJUGATED ESTROGENS 25 MG INJ SOLR,,J1410,HCPCS,Facility,Outpatient,1,Each,,1544,1312.4,442.5104,1544,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,768.912,49.8,,percent of total billed charges,,
CONJUGATED ESTROGENS 25 MG INJ SOLR,,J1410,HCPCS,Facility,Inpatient,1,Each,,1544,1312.4,442.5104,1544,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
CONJUGATED ESTROGENS 25 MG INJ SOLR,,J1410,HCPCS,Facility,Both,1,Each,,1544,1312.4,442.5104,1544,"Multiplan, Inc.","Multiplan, Inc.",1451.36,94,,percent of total billed charges,,
CONJUGATED ESTROGENS 25 MG INJ SOLR,,J1410,HCPCS,Facility,Outpatient,1,Each,,1544,1312.4,442.5104,1544,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1391.144,90.1,,percent of total billed charges,,
CONJUGATED ESTROGENS 25 MG INJ SOLR,,J1410,HCPCS,Facility,Inpatient,1,Each,,1544,1312.4,442.5104,1544,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
CONJUGATED ESTROGENS 25 MG INJ SOLR,,J1410,HCPCS,Facility,Both,1,Each,,1544,1312.4,442.5104,1544,"Preferred One Administrative Services, INC.",PPO,1522.384,98.6,,percent of total billed charges,,
CONJUGATED ESTROGENS 25 MG INJ SOLR,,J1410,HCPCS,Facility,Outpatient,1,Each,,1544,1312.4,442.5104,1544,PrimeWest Health,Minnesota Senior Health Options (MSHO),794.388,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
CONJUGATED ESTROGENS 25 MG INJ SOLR,,J1410,HCPCS,Facility,Inpatient,1,Each,,1544,1312.4,442.5104,1544,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CONJUGATED ESTROGENS 25 MG INJ SOLR,,J1410,HCPCS,Facility,Outpatient,1,Each,,1544,1312.4,442.5104,1544,PrimeWest Health,MinnesotaCare,792.9984,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
CONJUGATED ESTROGENS 25 MG INJ SOLR,,J1410,HCPCS,Facility,Inpatient,1,Each,,1544,1312.4,442.5104,1544,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
CONJUGATED ESTROGENS 25 MG INJ SOLR,,J1410,HCPCS,Facility,Both,1,Each,,1544,1312.4,442.5104,1544,Sanford Health Plan,Sanford Health Plan,1420.48,92,,percent of total billed charges,,
CONJUGATED ESTROGENS 25 MG INJ SOLR,,J1410,HCPCS,Facility,Outpatient,1,Each,,1544,1312.4,442.5104,1544,"UCare Health, Inc.",Individual & Family Plan,870.044,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
CONJUGATED ESTROGENS 25 MG INJ SOLR,,J1410,HCPCS,Facility,Inpatient,1,Each,,1544,1312.4,442.5104,1544,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
CONJUGATED ESTROGENS 25 MG INJ SOLR,,J1410,HCPCS,Facility,Outpatient,1,Each,,1544,1312.4,442.5104,1544,"UCare Health, Inc.",Medical Assistance,779.2568,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CONJUGATED ESTROGENS 25 MG INJ SOLR,,J1410,HCPCS,Facility,Inpatient,1,Each,,1544,1312.4,442.5104,1544,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
CONJUGATED ESTROGENS 25 MG INJ SOLR,,J1410,HCPCS,Facility,Outpatient,1,Each,,1544,1312.4,442.5104,1544,"UCare Health, Inc.",Medicare Advantage,779.2568,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CONJUGATED ESTROGENS 25 MG INJ SOLR,,J1410,HCPCS,Facility,Inpatient,1,Each,,1544,1312.4,442.5104,1544,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CONJUGATED ESTROGENS 25 MG INJ SOLR,,J1410,HCPCS,Facility,Outpatient,1,Each,,1544,1312.4,442.5104,1544,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),779.2568,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CONJUGATED ESTROGENS 25 MG INJ SOLR,,J1410,HCPCS,Facility,Inpatient,1,Each,,1544,1312.4,442.5104,1544,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CONJUGATED ESTROGENS 25 MG INJ SOLR,,J1410,HCPCS,Facility,Both,1,Each,,1544,1312.4,442.5104,1544,UnitedHealthcare,Individual & Family,1451.36,94,,percent of total billed charges,,
CONJUGATED ESTROGENS 25 MG INJ SOLR,,J1410,HCPCS,Facility,Outpatient,1,Each,,1544,1312.4,442.5104,1544,UnitedHealthcare,Medicare Advantage,756.56,49,,percent of total billed charges,,
CONJUGATED ESTROGENS 25 MG INJ SOLR,,J1410,HCPCS,Facility,Inpatient,1,Each,,1544,1312.4,442.5104,1544,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
CONJUGATED ESTROGENS 25 MG INJ SOLR,,J1410,HCPCS,Facility,Outpatient,1,Each,,1544,1312.4,442.5104,1544,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,741.12,48,,percent of total billed charges,,100% of DHS outpatient percentage
CONJUGATED ESTROGENS 25 MG INJ SOLR,,J1410,HCPCS,Facility,Inpatient,1,Each,,1544,1312.4,442.5104,1544,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
GLUCAGON 1 MG INJ SOLR,,J1610,HCPCS,Facility,Both,1,Each,,1214,1031.9,347.9324,1214,Aetna,Commercial,1116.88,92,,percent of total billed charges,,
GLUCAGON 1 MG INJ SOLR,,J1610,HCPCS,Facility,Outpatient,1,Each,,1214,1031.9,347.9324,1214,Aetna,Medicare Advantage,594.86,49,,percent of total billed charges,,
GLUCAGON 1 MG INJ SOLR,,J1610,HCPCS,Facility,Inpatient,1,Each,,1214,1031.9,347.9324,1214,Aetna,Medicare Advantage,,,,,Included in per diem rate,
GLUCAGON 1 MG INJ SOLR,,J1610,HCPCS,Facility,Both,1,Each,,1214,1031.9,347.9324,1214,Aetna,PPO,1129.02,93,,percent of total billed charges,,
GLUCAGON 1 MG INJ SOLR,,J1610,HCPCS,Facility,Both,1,Each,,1214,1031.9,347.9324,1214,America's PPO,America's PPO,1165.8042,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
GLUCAGON 1 MG INJ SOLR,,J1610,HCPCS,Facility,Both,1,Each,,1214,1031.9,347.9324,1214,BlueCross BlueShield Minnesota, Federal Employee Program,1194.576,98.4,,percent of total billed charges,,
GLUCAGON 1 MG INJ SOLR,,J1610,HCPCS,Facility,Both,1,Each,,1214,1031.9,347.9324,1214,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1214,100,,percent of total billed charges,,
GLUCAGON 1 MG INJ SOLR,,J1610,HCPCS,Facility,Both,1,Each,,1214,1031.9,347.9324,1214,BlueCross BlueShield Minnesota,High Value Network Plan,1092.6,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
GLUCAGON 1 MG INJ SOLR,,J1610,HCPCS,Facility,Outpatient,1,Each,,1214,1031.9,347.9324,1214,BlueCross BlueShield Minnesota,Medicare Advantage,594.86,49,,percent of total billed charges,,
GLUCAGON 1 MG INJ SOLR,,J1610,HCPCS,Facility,Inpatient,1,Each,,1214,1031.9,347.9324,1214,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
GLUCAGON 1 MG INJ SOLR,,J1610,HCPCS,Facility,Both,1,Each,,1214,1031.9,347.9324,1214,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1075.2398,88.57,,percent of total billed charges,,
GLUCAGON 1 MG INJ SOLR,,J1610,HCPCS,Facility,Both,1,Each,,1214,1031.9,347.9324,1214,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,347.9324,28.66,,percent of total billed charges,,
GLUCAGON 1 MG INJ SOLR,,J1610,HCPCS,Facility,Outpatient,1,Each,,1214,1031.9,347.9324,1214,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),594.86,49,,percent of total billed charges,,
GLUCAGON 1 MG INJ SOLR,,J1610,HCPCS,Facility,Inpatient,1,Each,,1214,1031.9,347.9324,1214,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
GLUCAGON 1 MG INJ SOLR,,J1610,HCPCS,Facility,Both,1,Each,,1214,1031.9,347.9324,1214,CorVel,Worker's Compensation,1214,100,,percent of total billed charges,,
GLUCAGON 1 MG INJ SOLR,,J1610,HCPCS,Facility,Both,1,Each,,1214,1031.9,347.9324,1214,First Health Group Corporation,First Health Network,1177.58,97,,percent of total billed charges,,
GLUCAGON 1 MG INJ SOLR,,J1610,HCPCS,Facility,Both,1,Each,,1214,1031.9,347.9324,1214,"Health Partners, Inc.",Commercial,1148.444,94.6,,percent of total billed charges,,
GLUCAGON 1 MG INJ SOLR,,J1610,HCPCS,Facility,Outpatient,1,Each,,1214,1031.9,347.9324,1214,"Health Partners, Inc.",Medicare Advantage,594.86,49,,percent of total billed charges,,
GLUCAGON 1 MG INJ SOLR,,J1610,HCPCS,Facility,Inpatient,1,Each,,1214,1031.9,347.9324,1214,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
GLUCAGON 1 MG INJ SOLR,,J1610,HCPCS,Facility,Both,1,Each,,1214,1031.9,347.9324,1214,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),728.4,60,,percent of total billed charges,,
GLUCAGON 1 MG INJ SOLR,,J1610,HCPCS,Facility,Both,1,Each,,1214,1031.9,347.9324,1214,"Health Partners, Inc.",State of Minnesota Advantage Program,989.41,81.5,,percent of total billed charges,,
GLUCAGON 1 MG INJ SOLR,,J1610,HCPCS,Facility,Both,1,Each,,1214,1031.9,347.9324,1214,"Health Partners, Inc.",State Public Programs,607,50,,percent of total billed charges,,
GLUCAGON 1 MG INJ SOLR,,J1610,HCPCS,Facility,Both,1,Each,,1214,1031.9,347.9324,1214,Humana Insurance Company,Commercial PPO,1153.3,95,,percent of total billed charges,,
GLUCAGON 1 MG INJ SOLR,,J1610,HCPCS,Facility,Outpatient,1,Each,,1214,1031.9,347.9324,1214,Humana Insurance Company,Medicare PPO,594.86,49,,percent of total billed charges,,
GLUCAGON 1 MG INJ SOLR,,J1610,HCPCS,Facility,Inpatient,1,Each,,1214,1031.9,347.9324,1214,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
GLUCAGON 1 MG INJ SOLR,,J1610,HCPCS,Facility,Both,1,Each,,1214,1031.9,347.9324,1214,Medica,Individual & Family,1203.074,99.1,,percent of total billed charges,,
GLUCAGON 1 MG INJ SOLR,,J1610,HCPCS,Facility,Outpatient,1,Each,,1214,1031.9,347.9324,1214,Medica,Medica Advantage Solution,604.572,49.8,,percent of total billed charges,,
GLUCAGON 1 MG INJ SOLR,,J1610,HCPCS,Facility,Inpatient,1,Each,,1214,1031.9,347.9324,1214,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
GLUCAGON 1 MG INJ SOLR,,J1610,HCPCS,Facility,Outpatient,1,Each,,1214,1031.9,347.9324,1214,Medica,Medical Assistance,541.444,44.6,,percent of total billed charges,,
GLUCAGON 1 MG INJ SOLR,,J1610,HCPCS,Facility,Inpatient,1,Each,,1214,1031.9,347.9324,1214,Medica,Medical Assistance,,,,,Included in per diem rate,
GLUCAGON 1 MG INJ SOLR,,J1610,HCPCS,Facility,Outpatient,1,Each,,1214,1031.9,347.9324,1214,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,604.572,49.8,,percent of total billed charges,,
GLUCAGON 1 MG INJ SOLR,,J1610,HCPCS,Facility,Inpatient,1,Each,,1214,1031.9,347.9324,1214,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
GLUCAGON 1 MG INJ SOLR,,J1610,HCPCS,Facility,Both,1,Each,,1214,1031.9,347.9324,1214,"Multiplan, Inc.","Multiplan, Inc.",1141.16,94,,percent of total billed charges,,
GLUCAGON 1 MG INJ SOLR,,J1610,HCPCS,Facility,Outpatient,1,Each,,1214,1031.9,347.9324,1214,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1093.814,90.1,,percent of total billed charges,,
GLUCAGON 1 MG INJ SOLR,,J1610,HCPCS,Facility,Inpatient,1,Each,,1214,1031.9,347.9324,1214,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
GLUCAGON 1 MG INJ SOLR,,J1610,HCPCS,Facility,Both,1,Each,,1214,1031.9,347.9324,1214,"Preferred One Administrative Services, INC.",PPO,1197.004,98.6,,percent of total billed charges,,
GLUCAGON 1 MG INJ SOLR,,J1610,HCPCS,Facility,Outpatient,1,Each,,1214,1031.9,347.9324,1214,PrimeWest Health,Minnesota Senior Health Options (MSHO),624.603,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
GLUCAGON 1 MG INJ SOLR,,J1610,HCPCS,Facility,Inpatient,1,Each,,1214,1031.9,347.9324,1214,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
GLUCAGON 1 MG INJ SOLR,,J1610,HCPCS,Facility,Outpatient,1,Each,,1214,1031.9,347.9324,1214,PrimeWest Health,MinnesotaCare,623.5104,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
GLUCAGON 1 MG INJ SOLR,,J1610,HCPCS,Facility,Inpatient,1,Each,,1214,1031.9,347.9324,1214,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
GLUCAGON 1 MG INJ SOLR,,J1610,HCPCS,Facility,Both,1,Each,,1214,1031.9,347.9324,1214,Sanford Health Plan,Sanford Health Plan,1116.88,92,,percent of total billed charges,,
GLUCAGON 1 MG INJ SOLR,,J1610,HCPCS,Facility,Outpatient,1,Each,,1214,1031.9,347.9324,1214,"UCare Health, Inc.",Individual & Family Plan,684.089,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
GLUCAGON 1 MG INJ SOLR,,J1610,HCPCS,Facility,Inpatient,1,Each,,1214,1031.9,347.9324,1214,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
GLUCAGON 1 MG INJ SOLR,,J1610,HCPCS,Facility,Outpatient,1,Each,,1214,1031.9,347.9324,1214,"UCare Health, Inc.",Medical Assistance,612.7058,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
GLUCAGON 1 MG INJ SOLR,,J1610,HCPCS,Facility,Inpatient,1,Each,,1214,1031.9,347.9324,1214,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
GLUCAGON 1 MG INJ SOLR,,J1610,HCPCS,Facility,Outpatient,1,Each,,1214,1031.9,347.9324,1214,"UCare Health, Inc.",Medicare Advantage,612.7058,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
GLUCAGON 1 MG INJ SOLR,,J1610,HCPCS,Facility,Inpatient,1,Each,,1214,1031.9,347.9324,1214,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
GLUCAGON 1 MG INJ SOLR,,J1610,HCPCS,Facility,Outpatient,1,Each,,1214,1031.9,347.9324,1214,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),612.7058,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
GLUCAGON 1 MG INJ SOLR,,J1610,HCPCS,Facility,Inpatient,1,Each,,1214,1031.9,347.9324,1214,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
GLUCAGON 1 MG INJ SOLR,,J1610,HCPCS,Facility,Both,1,Each,,1214,1031.9,347.9324,1214,UnitedHealthcare,Individual & Family,1141.16,94,,percent of total billed charges,,
GLUCAGON 1 MG INJ SOLR,,J1610,HCPCS,Facility,Outpatient,1,Each,,1214,1031.9,347.9324,1214,UnitedHealthcare,Medicare Advantage,594.86,49,,percent of total billed charges,,
GLUCAGON 1 MG INJ SOLR,,J1610,HCPCS,Facility,Inpatient,1,Each,,1214,1031.9,347.9324,1214,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
GLUCAGON 1 MG INJ SOLR,,J1610,HCPCS,Facility,Outpatient,1,Each,,1214,1031.9,347.9324,1214,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,582.72,48,,percent of total billed charges,,100% of DHS outpatient percentage
GLUCAGON 1 MG INJ SOLR,,J1610,HCPCS,Facility,Inpatient,1,Each,,1214,1031.9,347.9324,1214,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
GLUCAGON HCL 1 MG INJ SOLR,,J1611,HCPCS,Facility,Both,1,Each,,1209,1027.65,346.4994,1209,Aetna,Commercial,1112.28,92,,percent of total billed charges,,
GLUCAGON HCL 1 MG INJ SOLR,,J1611,HCPCS,Facility,Outpatient,1,Each,,1209,1027.65,346.4994,1209,Aetna,Medicare Advantage,592.41,49,,percent of total billed charges,,
GLUCAGON HCL 1 MG INJ SOLR,,J1611,HCPCS,Facility,Inpatient,1,Each,,1209,1027.65,346.4994,1209,Aetna,Medicare Advantage,,,,,Included in per diem rate,
GLUCAGON HCL 1 MG INJ SOLR,,J1611,HCPCS,Facility,Both,1,Each,,1209,1027.65,346.4994,1209,Aetna,PPO,1124.37,93,,percent of total billed charges,,
GLUCAGON HCL 1 MG INJ SOLR,,J1611,HCPCS,Facility,Both,1,Each,,1209,1027.65,346.4994,1209,America's PPO,America's PPO,1161.0027,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
GLUCAGON HCL 1 MG INJ SOLR,,J1611,HCPCS,Facility,Both,1,Each,,1209,1027.65,346.4994,1209,BlueCross BlueShield Minnesota, Federal Employee Program,1189.656,98.4,,percent of total billed charges,,
GLUCAGON HCL 1 MG INJ SOLR,,J1611,HCPCS,Facility,Both,1,Each,,1209,1027.65,346.4994,1209,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1209,100,,percent of total billed charges,,
GLUCAGON HCL 1 MG INJ SOLR,,J1611,HCPCS,Facility,Both,1,Each,,1209,1027.65,346.4994,1209,BlueCross BlueShield Minnesota,High Value Network Plan,1088.1,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
GLUCAGON HCL 1 MG INJ SOLR,,J1611,HCPCS,Facility,Outpatient,1,Each,,1209,1027.65,346.4994,1209,BlueCross BlueShield Minnesota,Medicare Advantage,592.41,49,,percent of total billed charges,,
GLUCAGON HCL 1 MG INJ SOLR,,J1611,HCPCS,Facility,Inpatient,1,Each,,1209,1027.65,346.4994,1209,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
GLUCAGON HCL 1 MG INJ SOLR,,J1611,HCPCS,Facility,Both,1,Each,,1209,1027.65,346.4994,1209,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1070.8113,88.57,,percent of total billed charges,,
GLUCAGON HCL 1 MG INJ SOLR,,J1611,HCPCS,Facility,Both,1,Each,,1209,1027.65,346.4994,1209,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,346.4994,28.66,,percent of total billed charges,,
GLUCAGON HCL 1 MG INJ SOLR,,J1611,HCPCS,Facility,Outpatient,1,Each,,1209,1027.65,346.4994,1209,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),592.41,49,,percent of total billed charges,,
GLUCAGON HCL 1 MG INJ SOLR,,J1611,HCPCS,Facility,Inpatient,1,Each,,1209,1027.65,346.4994,1209,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
GLUCAGON HCL 1 MG INJ SOLR,,J1611,HCPCS,Facility,Both,1,Each,,1209,1027.65,346.4994,1209,CorVel,Worker's Compensation,1209,100,,percent of total billed charges,,
GLUCAGON HCL 1 MG INJ SOLR,,J1611,HCPCS,Facility,Both,1,Each,,1209,1027.65,346.4994,1209,First Health Group Corporation,First Health Network,1172.73,97,,percent of total billed charges,,
GLUCAGON HCL 1 MG INJ SOLR,,J1611,HCPCS,Facility,Both,1,Each,,1209,1027.65,346.4994,1209,"Health Partners, Inc.",Commercial,1143.714,94.6,,percent of total billed charges,,
GLUCAGON HCL 1 MG INJ SOLR,,J1611,HCPCS,Facility,Outpatient,1,Each,,1209,1027.65,346.4994,1209,"Health Partners, Inc.",Medicare Advantage,592.41,49,,percent of total billed charges,,
GLUCAGON HCL 1 MG INJ SOLR,,J1611,HCPCS,Facility,Inpatient,1,Each,,1209,1027.65,346.4994,1209,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
GLUCAGON HCL 1 MG INJ SOLR,,J1611,HCPCS,Facility,Both,1,Each,,1209,1027.65,346.4994,1209,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),725.4,60,,percent of total billed charges,,
GLUCAGON HCL 1 MG INJ SOLR,,J1611,HCPCS,Facility,Both,1,Each,,1209,1027.65,346.4994,1209,"Health Partners, Inc.",State of Minnesota Advantage Program,985.335,81.5,,percent of total billed charges,,
GLUCAGON HCL 1 MG INJ SOLR,,J1611,HCPCS,Facility,Both,1,Each,,1209,1027.65,346.4994,1209,"Health Partners, Inc.",State Public Programs,604.5,50,,percent of total billed charges,,
GLUCAGON HCL 1 MG INJ SOLR,,J1611,HCPCS,Facility,Both,1,Each,,1209,1027.65,346.4994,1209,Humana Insurance Company,Commercial PPO,1148.55,95,,percent of total billed charges,,
GLUCAGON HCL 1 MG INJ SOLR,,J1611,HCPCS,Facility,Outpatient,1,Each,,1209,1027.65,346.4994,1209,Humana Insurance Company,Medicare PPO,592.41,49,,percent of total billed charges,,
GLUCAGON HCL 1 MG INJ SOLR,,J1611,HCPCS,Facility,Inpatient,1,Each,,1209,1027.65,346.4994,1209,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
GLUCAGON HCL 1 MG INJ SOLR,,J1611,HCPCS,Facility,Both,1,Each,,1209,1027.65,346.4994,1209,Medica,Individual & Family,1198.119,99.1,,percent of total billed charges,,
GLUCAGON HCL 1 MG INJ SOLR,,J1611,HCPCS,Facility,Outpatient,1,Each,,1209,1027.65,346.4994,1209,Medica,Medica Advantage Solution,602.082,49.8,,percent of total billed charges,,
GLUCAGON HCL 1 MG INJ SOLR,,J1611,HCPCS,Facility,Inpatient,1,Each,,1209,1027.65,346.4994,1209,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
GLUCAGON HCL 1 MG INJ SOLR,,J1611,HCPCS,Facility,Outpatient,1,Each,,1209,1027.65,346.4994,1209,Medica,Medical Assistance,539.214,44.6,,percent of total billed charges,,
GLUCAGON HCL 1 MG INJ SOLR,,J1611,HCPCS,Facility,Inpatient,1,Each,,1209,1027.65,346.4994,1209,Medica,Medical Assistance,,,,,Included in per diem rate,
GLUCAGON HCL 1 MG INJ SOLR,,J1611,HCPCS,Facility,Outpatient,1,Each,,1209,1027.65,346.4994,1209,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,602.082,49.8,,percent of total billed charges,,
GLUCAGON HCL 1 MG INJ SOLR,,J1611,HCPCS,Facility,Inpatient,1,Each,,1209,1027.65,346.4994,1209,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
GLUCAGON HCL 1 MG INJ SOLR,,J1611,HCPCS,Facility,Both,1,Each,,1209,1027.65,346.4994,1209,"Multiplan, Inc.","Multiplan, Inc.",1136.46,94,,percent of total billed charges,,
GLUCAGON HCL 1 MG INJ SOLR,,J1611,HCPCS,Facility,Outpatient,1,Each,,1209,1027.65,346.4994,1209,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1089.309,90.1,,percent of total billed charges,,
GLUCAGON HCL 1 MG INJ SOLR,,J1611,HCPCS,Facility,Inpatient,1,Each,,1209,1027.65,346.4994,1209,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
GLUCAGON HCL 1 MG INJ SOLR,,J1611,HCPCS,Facility,Both,1,Each,,1209,1027.65,346.4994,1209,"Preferred One Administrative Services, INC.",PPO,1192.074,98.6,,percent of total billed charges,,
GLUCAGON HCL 1 MG INJ SOLR,,J1611,HCPCS,Facility,Outpatient,1,Each,,1209,1027.65,346.4994,1209,PrimeWest Health,Minnesota Senior Health Options (MSHO),622.0305,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
GLUCAGON HCL 1 MG INJ SOLR,,J1611,HCPCS,Facility,Inpatient,1,Each,,1209,1027.65,346.4994,1209,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
GLUCAGON HCL 1 MG INJ SOLR,,J1611,HCPCS,Facility,Outpatient,1,Each,,1209,1027.65,346.4994,1209,PrimeWest Health,MinnesotaCare,620.9424,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
GLUCAGON HCL 1 MG INJ SOLR,,J1611,HCPCS,Facility,Inpatient,1,Each,,1209,1027.65,346.4994,1209,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
GLUCAGON HCL 1 MG INJ SOLR,,J1611,HCPCS,Facility,Both,1,Each,,1209,1027.65,346.4994,1209,Sanford Health Plan,Sanford Health Plan,1112.28,92,,percent of total billed charges,,
GLUCAGON HCL 1 MG INJ SOLR,,J1611,HCPCS,Facility,Outpatient,1,Each,,1209,1027.65,346.4994,1209,"UCare Health, Inc.",Individual & Family Plan,681.2715,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
GLUCAGON HCL 1 MG INJ SOLR,,J1611,HCPCS,Facility,Inpatient,1,Each,,1209,1027.65,346.4994,1209,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
GLUCAGON HCL 1 MG INJ SOLR,,J1611,HCPCS,Facility,Outpatient,1,Each,,1209,1027.65,346.4994,1209,"UCare Health, Inc.",Medical Assistance,610.1823,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
GLUCAGON HCL 1 MG INJ SOLR,,J1611,HCPCS,Facility,Inpatient,1,Each,,1209,1027.65,346.4994,1209,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
GLUCAGON HCL 1 MG INJ SOLR,,J1611,HCPCS,Facility,Outpatient,1,Each,,1209,1027.65,346.4994,1209,"UCare Health, Inc.",Medicare Advantage,610.1823,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
GLUCAGON HCL 1 MG INJ SOLR,,J1611,HCPCS,Facility,Inpatient,1,Each,,1209,1027.65,346.4994,1209,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
GLUCAGON HCL 1 MG INJ SOLR,,J1611,HCPCS,Facility,Outpatient,1,Each,,1209,1027.65,346.4994,1209,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),610.1823,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
GLUCAGON HCL 1 MG INJ SOLR,,J1611,HCPCS,Facility,Inpatient,1,Each,,1209,1027.65,346.4994,1209,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
GLUCAGON HCL 1 MG INJ SOLR,,J1611,HCPCS,Facility,Both,1,Each,,1209,1027.65,346.4994,1209,UnitedHealthcare,Individual & Family,1136.46,94,,percent of total billed charges,,
GLUCAGON HCL 1 MG INJ SOLR,,J1611,HCPCS,Facility,Outpatient,1,Each,,1209,1027.65,346.4994,1209,UnitedHealthcare,Medicare Advantage,592.41,49,,percent of total billed charges,,
GLUCAGON HCL 1 MG INJ SOLR,,J1611,HCPCS,Facility,Inpatient,1,Each,,1209,1027.65,346.4994,1209,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
GLUCAGON HCL 1 MG INJ SOLR,,J1611,HCPCS,Facility,Outpatient,1,Each,,1209,1027.65,346.4994,1209,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,580.32,48,,percent of total billed charges,,100% of DHS outpatient percentage
GLUCAGON HCL 1 MG INJ SOLR,,J1611,HCPCS,Facility,Inpatient,1,Each,,1209,1027.65,346.4994,1209,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
HYDROCORTISONE SOD SUCC (PF) 100 MG/2 ML INJ SOLR,,J1720,HCPCS,Facility,Both,1,Each,,105,89.25,30.093,105,Aetna,Commercial,96.6,92,,percent of total billed charges,,
HYDROCORTISONE SOD SUCC (PF) 100 MG/2 ML INJ SOLR,,J1720,HCPCS,Facility,Outpatient,1,Each,,105,89.25,30.093,105,Aetna,Medicare Advantage,51.45,49,,percent of total billed charges,,
HYDROCORTISONE SOD SUCC (PF) 100 MG/2 ML INJ SOLR,,J1720,HCPCS,Facility,Inpatient,1,Each,,105,89.25,30.093,105,Aetna,Medicare Advantage,,,,,Included in per diem rate,
HYDROCORTISONE SOD SUCC (PF) 100 MG/2 ML INJ SOLR,,J1720,HCPCS,Facility,Both,1,Each,,105,89.25,30.093,105,Aetna,PPO,97.65,93,,percent of total billed charges,,
HYDROCORTISONE SOD SUCC (PF) 100 MG/2 ML INJ SOLR,,J1720,HCPCS,Facility,Both,1,Each,,105,89.25,30.093,105,America's PPO,America's PPO,100.8315,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
HYDROCORTISONE SOD SUCC (PF) 100 MG/2 ML INJ SOLR,,J1720,HCPCS,Facility,Both,1,Each,,105,89.25,30.093,105,BlueCross BlueShield Minnesota, Federal Employee Program,103.32,98.4,,percent of total billed charges,,
HYDROCORTISONE SOD SUCC (PF) 100 MG/2 ML INJ SOLR,,J1720,HCPCS,Facility,Both,1,Each,,105,89.25,30.093,105,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,105,100,,percent of total billed charges,,
HYDROCORTISONE SOD SUCC (PF) 100 MG/2 ML INJ SOLR,,J1720,HCPCS,Facility,Both,1,Each,,105,89.25,30.093,105,BlueCross BlueShield Minnesota,High Value Network Plan,94.5,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
HYDROCORTISONE SOD SUCC (PF) 100 MG/2 ML INJ SOLR,,J1720,HCPCS,Facility,Outpatient,1,Each,,105,89.25,30.093,105,BlueCross BlueShield Minnesota,Medicare Advantage,51.45,49,,percent of total billed charges,,
HYDROCORTISONE SOD SUCC (PF) 100 MG/2 ML INJ SOLR,,J1720,HCPCS,Facility,Inpatient,1,Each,,105,89.25,30.093,105,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
HYDROCORTISONE SOD SUCC (PF) 100 MG/2 ML INJ SOLR,,J1720,HCPCS,Facility,Both,1,Each,,105,89.25,30.093,105,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,92.9985,88.57,,percent of total billed charges,,
HYDROCORTISONE SOD SUCC (PF) 100 MG/2 ML INJ SOLR,,J1720,HCPCS,Facility,Both,1,Each,,105,89.25,30.093,105,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,30.093,28.66,,percent of total billed charges,,
HYDROCORTISONE SOD SUCC (PF) 100 MG/2 ML INJ SOLR,,J1720,HCPCS,Facility,Outpatient,1,Each,,105,89.25,30.093,105,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),51.45,49,,percent of total billed charges,,
HYDROCORTISONE SOD SUCC (PF) 100 MG/2 ML INJ SOLR,,J1720,HCPCS,Facility,Inpatient,1,Each,,105,89.25,30.093,105,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
HYDROCORTISONE SOD SUCC (PF) 100 MG/2 ML INJ SOLR,,J1720,HCPCS,Facility,Both,1,Each,,105,89.25,30.093,105,CorVel,Worker's Compensation,105,100,,percent of total billed charges,,
HYDROCORTISONE SOD SUCC (PF) 100 MG/2 ML INJ SOLR,,J1720,HCPCS,Facility,Both,1,Each,,105,89.25,30.093,105,First Health Group Corporation,First Health Network,101.85,97,,percent of total billed charges,,
HYDROCORTISONE SOD SUCC (PF) 100 MG/2 ML INJ SOLR,,J1720,HCPCS,Facility,Both,1,Each,,105,89.25,30.093,105,"Health Partners, Inc.",Commercial,99.33,94.6,,percent of total billed charges,,
HYDROCORTISONE SOD SUCC (PF) 100 MG/2 ML INJ SOLR,,J1720,HCPCS,Facility,Outpatient,1,Each,,105,89.25,30.093,105,"Health Partners, Inc.",Medicare Advantage,51.45,49,,percent of total billed charges,,
HYDROCORTISONE SOD SUCC (PF) 100 MG/2 ML INJ SOLR,,J1720,HCPCS,Facility,Inpatient,1,Each,,105,89.25,30.093,105,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
HYDROCORTISONE SOD SUCC (PF) 100 MG/2 ML INJ SOLR,,J1720,HCPCS,Facility,Both,1,Each,,105,89.25,30.093,105,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),63,60,,percent of total billed charges,,
HYDROCORTISONE SOD SUCC (PF) 100 MG/2 ML INJ SOLR,,J1720,HCPCS,Facility,Both,1,Each,,105,89.25,30.093,105,"Health Partners, Inc.",State of Minnesota Advantage Program,85.575,81.5,,percent of total billed charges,,
HYDROCORTISONE SOD SUCC (PF) 100 MG/2 ML INJ SOLR,,J1720,HCPCS,Facility,Both,1,Each,,105,89.25,30.093,105,"Health Partners, Inc.",State Public Programs,52.5,50,,percent of total billed charges,,
HYDROCORTISONE SOD SUCC (PF) 100 MG/2 ML INJ SOLR,,J1720,HCPCS,Facility,Both,1,Each,,105,89.25,30.093,105,Humana Insurance Company,Commercial PPO,99.75,95,,percent of total billed charges,,
HYDROCORTISONE SOD SUCC (PF) 100 MG/2 ML INJ SOLR,,J1720,HCPCS,Facility,Outpatient,1,Each,,105,89.25,30.093,105,Humana Insurance Company,Medicare PPO,51.45,49,,percent of total billed charges,,
HYDROCORTISONE SOD SUCC (PF) 100 MG/2 ML INJ SOLR,,J1720,HCPCS,Facility,Inpatient,1,Each,,105,89.25,30.093,105,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
HYDROCORTISONE SOD SUCC (PF) 100 MG/2 ML INJ SOLR,,J1720,HCPCS,Facility,Both,1,Each,,105,89.25,30.093,105,Medica,Individual & Family,104.055,99.1,,percent of total billed charges,,
HYDROCORTISONE SOD SUCC (PF) 100 MG/2 ML INJ SOLR,,J1720,HCPCS,Facility,Outpatient,1,Each,,105,89.25,30.093,105,Medica,Medica Advantage Solution,52.29,49.8,,percent of total billed charges,,
HYDROCORTISONE SOD SUCC (PF) 100 MG/2 ML INJ SOLR,,J1720,HCPCS,Facility,Inpatient,1,Each,,105,89.25,30.093,105,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
HYDROCORTISONE SOD SUCC (PF) 100 MG/2 ML INJ SOLR,,J1720,HCPCS,Facility,Outpatient,1,Each,,105,89.25,30.093,105,Medica,Medical Assistance,46.83,44.6,,percent of total billed charges,,
HYDROCORTISONE SOD SUCC (PF) 100 MG/2 ML INJ SOLR,,J1720,HCPCS,Facility,Inpatient,1,Each,,105,89.25,30.093,105,Medica,Medical Assistance,,,,,Included in per diem rate,
HYDROCORTISONE SOD SUCC (PF) 100 MG/2 ML INJ SOLR,,J1720,HCPCS,Facility,Outpatient,1,Each,,105,89.25,30.093,105,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,52.29,49.8,,percent of total billed charges,,
HYDROCORTISONE SOD SUCC (PF) 100 MG/2 ML INJ SOLR,,J1720,HCPCS,Facility,Inpatient,1,Each,,105,89.25,30.093,105,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
HYDROCORTISONE SOD SUCC (PF) 100 MG/2 ML INJ SOLR,,J1720,HCPCS,Facility,Both,1,Each,,105,89.25,30.093,105,"Multiplan, Inc.","Multiplan, Inc.",98.7,94,,percent of total billed charges,,
HYDROCORTISONE SOD SUCC (PF) 100 MG/2 ML INJ SOLR,,J1720,HCPCS,Facility,Outpatient,1,Each,,105,89.25,30.093,105,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,94.605,90.1,,percent of total billed charges,,
HYDROCORTISONE SOD SUCC (PF) 100 MG/2 ML INJ SOLR,,J1720,HCPCS,Facility,Inpatient,1,Each,,105,89.25,30.093,105,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
HYDROCORTISONE SOD SUCC (PF) 100 MG/2 ML INJ SOLR,,J1720,HCPCS,Facility,Both,1,Each,,105,89.25,30.093,105,"Preferred One Administrative Services, INC.",PPO,103.53,98.6,,percent of total billed charges,,
HYDROCORTISONE SOD SUCC (PF) 100 MG/2 ML INJ SOLR,,J1720,HCPCS,Facility,Outpatient,1,Each,,105,89.25,30.093,105,PrimeWest Health,Minnesota Senior Health Options (MSHO),54.0225,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
HYDROCORTISONE SOD SUCC (PF) 100 MG/2 ML INJ SOLR,,J1720,HCPCS,Facility,Inpatient,1,Each,,105,89.25,30.093,105,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
HYDROCORTISONE SOD SUCC (PF) 100 MG/2 ML INJ SOLR,,J1720,HCPCS,Facility,Outpatient,1,Each,,105,89.25,30.093,105,PrimeWest Health,MinnesotaCare,53.928,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
HYDROCORTISONE SOD SUCC (PF) 100 MG/2 ML INJ SOLR,,J1720,HCPCS,Facility,Inpatient,1,Each,,105,89.25,30.093,105,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
HYDROCORTISONE SOD SUCC (PF) 100 MG/2 ML INJ SOLR,,J1720,HCPCS,Facility,Both,1,Each,,105,89.25,30.093,105,Sanford Health Plan,Sanford Health Plan,96.6,92,,percent of total billed charges,,
HYDROCORTISONE SOD SUCC (PF) 100 MG/2 ML INJ SOLR,,J1720,HCPCS,Facility,Outpatient,1,Each,,105,89.25,30.093,105,"UCare Health, Inc.",Individual & Family Plan,59.1675,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
HYDROCORTISONE SOD SUCC (PF) 100 MG/2 ML INJ SOLR,,J1720,HCPCS,Facility,Inpatient,1,Each,,105,89.25,30.093,105,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
HYDROCORTISONE SOD SUCC (PF) 100 MG/2 ML INJ SOLR,,J1720,HCPCS,Facility,Outpatient,1,Each,,105,89.25,30.093,105,"UCare Health, Inc.",Medical Assistance,52.9935,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
HYDROCORTISONE SOD SUCC (PF) 100 MG/2 ML INJ SOLR,,J1720,HCPCS,Facility,Inpatient,1,Each,,105,89.25,30.093,105,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
HYDROCORTISONE SOD SUCC (PF) 100 MG/2 ML INJ SOLR,,J1720,HCPCS,Facility,Outpatient,1,Each,,105,89.25,30.093,105,"UCare Health, Inc.",Medicare Advantage,52.9935,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
HYDROCORTISONE SOD SUCC (PF) 100 MG/2 ML INJ SOLR,,J1720,HCPCS,Facility,Inpatient,1,Each,,105,89.25,30.093,105,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
HYDROCORTISONE SOD SUCC (PF) 100 MG/2 ML INJ SOLR,,J1720,HCPCS,Facility,Outpatient,1,Each,,105,89.25,30.093,105,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),52.9935,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
HYDROCORTISONE SOD SUCC (PF) 100 MG/2 ML INJ SOLR,,J1720,HCPCS,Facility,Inpatient,1,Each,,105,89.25,30.093,105,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
HYDROCORTISONE SOD SUCC (PF) 100 MG/2 ML INJ SOLR,,J1720,HCPCS,Facility,Both,1,Each,,105,89.25,30.093,105,UnitedHealthcare,Individual & Family,98.7,94,,percent of total billed charges,,
HYDROCORTISONE SOD SUCC (PF) 100 MG/2 ML INJ SOLR,,J1720,HCPCS,Facility,Outpatient,1,Each,,105,89.25,30.093,105,UnitedHealthcare,Medicare Advantage,51.45,49,,percent of total billed charges,,
HYDROCORTISONE SOD SUCC (PF) 100 MG/2 ML INJ SOLR,,J1720,HCPCS,Facility,Inpatient,1,Each,,105,89.25,30.093,105,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
HYDROCORTISONE SOD SUCC (PF) 100 MG/2 ML INJ SOLR,,J1720,HCPCS,Facility,Outpatient,1,Each,,105,89.25,30.093,105,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,50.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
HYDROCORTISONE SOD SUCC (PF) 100 MG/2 ML INJ SOLR,,J1720,HCPCS,Facility,Inpatient,1,Each,,105,89.25,30.093,105,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
HYDROCORTISONE SOD SUCC (PF) 500 MG/4 ML INJ SOLR,,J1720,HCPCS,Facility,Both,1,Each,,363,308.55,104.0358,363,Aetna,Commercial,333.96,92,,percent of total billed charges,,
HYDROCORTISONE SOD SUCC (PF) 500 MG/4 ML INJ SOLR,,J1720,HCPCS,Facility,Outpatient,1,Each,,363,308.55,104.0358,363,Aetna,Medicare Advantage,177.87,49,,percent of total billed charges,,
HYDROCORTISONE SOD SUCC (PF) 500 MG/4 ML INJ SOLR,,J1720,HCPCS,Facility,Inpatient,1,Each,,363,308.55,104.0358,363,Aetna,Medicare Advantage,,,,,Included in per diem rate,
HYDROCORTISONE SOD SUCC (PF) 500 MG/4 ML INJ SOLR,,J1720,HCPCS,Facility,Both,1,Each,,363,308.55,104.0358,363,Aetna,PPO,337.59,93,,percent of total billed charges,,
HYDROCORTISONE SOD SUCC (PF) 500 MG/4 ML INJ SOLR,,J1720,HCPCS,Facility,Both,1,Each,,363,308.55,104.0358,363,America's PPO,America's PPO,348.5889,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
HYDROCORTISONE SOD SUCC (PF) 500 MG/4 ML INJ SOLR,,J1720,HCPCS,Facility,Both,1,Each,,363,308.55,104.0358,363,BlueCross BlueShield Minnesota, Federal Employee Program,357.192,98.4,,percent of total billed charges,,
HYDROCORTISONE SOD SUCC (PF) 500 MG/4 ML INJ SOLR,,J1720,HCPCS,Facility,Both,1,Each,,363,308.55,104.0358,363,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,363,100,,percent of total billed charges,,
HYDROCORTISONE SOD SUCC (PF) 500 MG/4 ML INJ SOLR,,J1720,HCPCS,Facility,Both,1,Each,,363,308.55,104.0358,363,BlueCross BlueShield Minnesota,High Value Network Plan,326.7,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
HYDROCORTISONE SOD SUCC (PF) 500 MG/4 ML INJ SOLR,,J1720,HCPCS,Facility,Outpatient,1,Each,,363,308.55,104.0358,363,BlueCross BlueShield Minnesota,Medicare Advantage,177.87,49,,percent of total billed charges,,
HYDROCORTISONE SOD SUCC (PF) 500 MG/4 ML INJ SOLR,,J1720,HCPCS,Facility,Inpatient,1,Each,,363,308.55,104.0358,363,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
HYDROCORTISONE SOD SUCC (PF) 500 MG/4 ML INJ SOLR,,J1720,HCPCS,Facility,Both,1,Each,,363,308.55,104.0358,363,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,321.5091,88.57,,percent of total billed charges,,
HYDROCORTISONE SOD SUCC (PF) 500 MG/4 ML INJ SOLR,,J1720,HCPCS,Facility,Both,1,Each,,363,308.55,104.0358,363,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,104.0358,28.66,,percent of total billed charges,,
HYDROCORTISONE SOD SUCC (PF) 500 MG/4 ML INJ SOLR,,J1720,HCPCS,Facility,Outpatient,1,Each,,363,308.55,104.0358,363,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),177.87,49,,percent of total billed charges,,
HYDROCORTISONE SOD SUCC (PF) 500 MG/4 ML INJ SOLR,,J1720,HCPCS,Facility,Inpatient,1,Each,,363,308.55,104.0358,363,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
HYDROCORTISONE SOD SUCC (PF) 500 MG/4 ML INJ SOLR,,J1720,HCPCS,Facility,Both,1,Each,,363,308.55,104.0358,363,CorVel,Worker's Compensation,363,100,,percent of total billed charges,,
HYDROCORTISONE SOD SUCC (PF) 500 MG/4 ML INJ SOLR,,J1720,HCPCS,Facility,Both,1,Each,,363,308.55,104.0358,363,First Health Group Corporation,First Health Network,352.11,97,,percent of total billed charges,,
HYDROCORTISONE SOD SUCC (PF) 500 MG/4 ML INJ SOLR,,J1720,HCPCS,Facility,Both,1,Each,,363,308.55,104.0358,363,"Health Partners, Inc.",Commercial,343.398,94.6,,percent of total billed charges,,
HYDROCORTISONE SOD SUCC (PF) 500 MG/4 ML INJ SOLR,,J1720,HCPCS,Facility,Outpatient,1,Each,,363,308.55,104.0358,363,"Health Partners, Inc.",Medicare Advantage,177.87,49,,percent of total billed charges,,
HYDROCORTISONE SOD SUCC (PF) 500 MG/4 ML INJ SOLR,,J1720,HCPCS,Facility,Inpatient,1,Each,,363,308.55,104.0358,363,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
HYDROCORTISONE SOD SUCC (PF) 500 MG/4 ML INJ SOLR,,J1720,HCPCS,Facility,Both,1,Each,,363,308.55,104.0358,363,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),217.8,60,,percent of total billed charges,,
HYDROCORTISONE SOD SUCC (PF) 500 MG/4 ML INJ SOLR,,J1720,HCPCS,Facility,Both,1,Each,,363,308.55,104.0358,363,"Health Partners, Inc.",State of Minnesota Advantage Program,295.845,81.5,,percent of total billed charges,,
HYDROCORTISONE SOD SUCC (PF) 500 MG/4 ML INJ SOLR,,J1720,HCPCS,Facility,Both,1,Each,,363,308.55,104.0358,363,"Health Partners, Inc.",State Public Programs,181.5,50,,percent of total billed charges,,
HYDROCORTISONE SOD SUCC (PF) 500 MG/4 ML INJ SOLR,,J1720,HCPCS,Facility,Both,1,Each,,363,308.55,104.0358,363,Humana Insurance Company,Commercial PPO,344.85,95,,percent of total billed charges,,
HYDROCORTISONE SOD SUCC (PF) 500 MG/4 ML INJ SOLR,,J1720,HCPCS,Facility,Outpatient,1,Each,,363,308.55,104.0358,363,Humana Insurance Company,Medicare PPO,177.87,49,,percent of total billed charges,,
HYDROCORTISONE SOD SUCC (PF) 500 MG/4 ML INJ SOLR,,J1720,HCPCS,Facility,Inpatient,1,Each,,363,308.55,104.0358,363,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
HYDROCORTISONE SOD SUCC (PF) 500 MG/4 ML INJ SOLR,,J1720,HCPCS,Facility,Both,1,Each,,363,308.55,104.0358,363,Medica,Individual & Family,359.733,99.1,,percent of total billed charges,,
HYDROCORTISONE SOD SUCC (PF) 500 MG/4 ML INJ SOLR,,J1720,HCPCS,Facility,Outpatient,1,Each,,363,308.55,104.0358,363,Medica,Medica Advantage Solution,180.774,49.8,,percent of total billed charges,,
HYDROCORTISONE SOD SUCC (PF) 500 MG/4 ML INJ SOLR,,J1720,HCPCS,Facility,Inpatient,1,Each,,363,308.55,104.0358,363,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
HYDROCORTISONE SOD SUCC (PF) 500 MG/4 ML INJ SOLR,,J1720,HCPCS,Facility,Outpatient,1,Each,,363,308.55,104.0358,363,Medica,Medical Assistance,161.898,44.6,,percent of total billed charges,,
HYDROCORTISONE SOD SUCC (PF) 500 MG/4 ML INJ SOLR,,J1720,HCPCS,Facility,Inpatient,1,Each,,363,308.55,104.0358,363,Medica,Medical Assistance,,,,,Included in per diem rate,
HYDROCORTISONE SOD SUCC (PF) 500 MG/4 ML INJ SOLR,,J1720,HCPCS,Facility,Outpatient,1,Each,,363,308.55,104.0358,363,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,180.774,49.8,,percent of total billed charges,,
HYDROCORTISONE SOD SUCC (PF) 500 MG/4 ML INJ SOLR,,J1720,HCPCS,Facility,Inpatient,1,Each,,363,308.55,104.0358,363,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
HYDROCORTISONE SOD SUCC (PF) 500 MG/4 ML INJ SOLR,,J1720,HCPCS,Facility,Both,1,Each,,363,308.55,104.0358,363,"Multiplan, Inc.","Multiplan, Inc.",341.22,94,,percent of total billed charges,,
HYDROCORTISONE SOD SUCC (PF) 500 MG/4 ML INJ SOLR,,J1720,HCPCS,Facility,Outpatient,1,Each,,363,308.55,104.0358,363,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,327.063,90.1,,percent of total billed charges,,
HYDROCORTISONE SOD SUCC (PF) 500 MG/4 ML INJ SOLR,,J1720,HCPCS,Facility,Inpatient,1,Each,,363,308.55,104.0358,363,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
HYDROCORTISONE SOD SUCC (PF) 500 MG/4 ML INJ SOLR,,J1720,HCPCS,Facility,Both,1,Each,,363,308.55,104.0358,363,"Preferred One Administrative Services, INC.",PPO,357.918,98.6,,percent of total billed charges,,
HYDROCORTISONE SOD SUCC (PF) 500 MG/4 ML INJ SOLR,,J1720,HCPCS,Facility,Outpatient,1,Each,,363,308.55,104.0358,363,PrimeWest Health,Minnesota Senior Health Options (MSHO),186.7635,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
HYDROCORTISONE SOD SUCC (PF) 500 MG/4 ML INJ SOLR,,J1720,HCPCS,Facility,Inpatient,1,Each,,363,308.55,104.0358,363,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
HYDROCORTISONE SOD SUCC (PF) 500 MG/4 ML INJ SOLR,,J1720,HCPCS,Facility,Outpatient,1,Each,,363,308.55,104.0358,363,PrimeWest Health,MinnesotaCare,186.4368,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
HYDROCORTISONE SOD SUCC (PF) 500 MG/4 ML INJ SOLR,,J1720,HCPCS,Facility,Inpatient,1,Each,,363,308.55,104.0358,363,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
HYDROCORTISONE SOD SUCC (PF) 500 MG/4 ML INJ SOLR,,J1720,HCPCS,Facility,Both,1,Each,,363,308.55,104.0358,363,Sanford Health Plan,Sanford Health Plan,333.96,92,,percent of total billed charges,,
HYDROCORTISONE SOD SUCC (PF) 500 MG/4 ML INJ SOLR,,J1720,HCPCS,Facility,Outpatient,1,Each,,363,308.55,104.0358,363,"UCare Health, Inc.",Individual & Family Plan,204.5505,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
HYDROCORTISONE SOD SUCC (PF) 500 MG/4 ML INJ SOLR,,J1720,HCPCS,Facility,Inpatient,1,Each,,363,308.55,104.0358,363,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
HYDROCORTISONE SOD SUCC (PF) 500 MG/4 ML INJ SOLR,,J1720,HCPCS,Facility,Outpatient,1,Each,,363,308.55,104.0358,363,"UCare Health, Inc.",Medical Assistance,183.2061,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
HYDROCORTISONE SOD SUCC (PF) 500 MG/4 ML INJ SOLR,,J1720,HCPCS,Facility,Inpatient,1,Each,,363,308.55,104.0358,363,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
HYDROCORTISONE SOD SUCC (PF) 500 MG/4 ML INJ SOLR,,J1720,HCPCS,Facility,Outpatient,1,Each,,363,308.55,104.0358,363,"UCare Health, Inc.",Medicare Advantage,183.2061,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
HYDROCORTISONE SOD SUCC (PF) 500 MG/4 ML INJ SOLR,,J1720,HCPCS,Facility,Inpatient,1,Each,,363,308.55,104.0358,363,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
HYDROCORTISONE SOD SUCC (PF) 500 MG/4 ML INJ SOLR,,J1720,HCPCS,Facility,Outpatient,1,Each,,363,308.55,104.0358,363,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),183.2061,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
HYDROCORTISONE SOD SUCC (PF) 500 MG/4 ML INJ SOLR,,J1720,HCPCS,Facility,Inpatient,1,Each,,363,308.55,104.0358,363,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
HYDROCORTISONE SOD SUCC (PF) 500 MG/4 ML INJ SOLR,,J1720,HCPCS,Facility,Both,1,Each,,363,308.55,104.0358,363,UnitedHealthcare,Individual & Family,341.22,94,,percent of total billed charges,,
HYDROCORTISONE SOD SUCC (PF) 500 MG/4 ML INJ SOLR,,J1720,HCPCS,Facility,Outpatient,1,Each,,363,308.55,104.0358,363,UnitedHealthcare,Medicare Advantage,177.87,49,,percent of total billed charges,,
HYDROCORTISONE SOD SUCC (PF) 500 MG/4 ML INJ SOLR,,J1720,HCPCS,Facility,Inpatient,1,Each,,363,308.55,104.0358,363,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
HYDROCORTISONE SOD SUCC (PF) 500 MG/4 ML INJ SOLR,,J1720,HCPCS,Facility,Outpatient,1,Each,,363,308.55,104.0358,363,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,174.24,48,,percent of total billed charges,,100% of DHS outpatient percentage
HYDROCORTISONE SOD SUCC (PF) 500 MG/4 ML INJ SOLR,,J1720,HCPCS,Facility,Inpatient,1,Each,,363,308.55,104.0358,363,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
HYDROCORTISONE SOD SUCCINATE 100 MG INJ SOLR,,J1720,HCPCS,Facility,Both,1,Each,,83,70.55,23.7878,83,Aetna,Commercial,76.36,92,,percent of total billed charges,,
HYDROCORTISONE SOD SUCCINATE 100 MG INJ SOLR,,J1720,HCPCS,Facility,Outpatient,1,Each,,83,70.55,23.7878,83,Aetna,Medicare Advantage,40.67,49,,percent of total billed charges,,
HYDROCORTISONE SOD SUCCINATE 100 MG INJ SOLR,,J1720,HCPCS,Facility,Inpatient,1,Each,,83,70.55,23.7878,83,Aetna,Medicare Advantage,,,,,Included in per diem rate,
HYDROCORTISONE SOD SUCCINATE 100 MG INJ SOLR,,J1720,HCPCS,Facility,Both,1,Each,,83,70.55,23.7878,83,Aetna,PPO,77.19,93,,percent of total billed charges,,
HYDROCORTISONE SOD SUCCINATE 100 MG INJ SOLR,,J1720,HCPCS,Facility,Both,1,Each,,83,70.55,23.7878,83,America's PPO,America's PPO,79.7049,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
HYDROCORTISONE SOD SUCCINATE 100 MG INJ SOLR,,J1720,HCPCS,Facility,Both,1,Each,,83,70.55,23.7878,83,BlueCross BlueShield Minnesota, Federal Employee Program,81.672,98.4,,percent of total billed charges,,
HYDROCORTISONE SOD SUCCINATE 100 MG INJ SOLR,,J1720,HCPCS,Facility,Both,1,Each,,83,70.55,23.7878,83,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,83,100,,percent of total billed charges,,
HYDROCORTISONE SOD SUCCINATE 100 MG INJ SOLR,,J1720,HCPCS,Facility,Both,1,Each,,83,70.55,23.7878,83,BlueCross BlueShield Minnesota,High Value Network Plan,74.7,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
HYDROCORTISONE SOD SUCCINATE 100 MG INJ SOLR,,J1720,HCPCS,Facility,Outpatient,1,Each,,83,70.55,23.7878,83,BlueCross BlueShield Minnesota,Medicare Advantage,40.67,49,,percent of total billed charges,,
HYDROCORTISONE SOD SUCCINATE 100 MG INJ SOLR,,J1720,HCPCS,Facility,Inpatient,1,Each,,83,70.55,23.7878,83,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
HYDROCORTISONE SOD SUCCINATE 100 MG INJ SOLR,,J1720,HCPCS,Facility,Both,1,Each,,83,70.55,23.7878,83,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,73.5131,88.57,,percent of total billed charges,,
HYDROCORTISONE SOD SUCCINATE 100 MG INJ SOLR,,J1720,HCPCS,Facility,Both,1,Each,,83,70.55,23.7878,83,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,23.7878,28.66,,percent of total billed charges,,
HYDROCORTISONE SOD SUCCINATE 100 MG INJ SOLR,,J1720,HCPCS,Facility,Outpatient,1,Each,,83,70.55,23.7878,83,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),40.67,49,,percent of total billed charges,,
HYDROCORTISONE SOD SUCCINATE 100 MG INJ SOLR,,J1720,HCPCS,Facility,Inpatient,1,Each,,83,70.55,23.7878,83,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
HYDROCORTISONE SOD SUCCINATE 100 MG INJ SOLR,,J1720,HCPCS,Facility,Both,1,Each,,83,70.55,23.7878,83,CorVel,Worker's Compensation,83,100,,percent of total billed charges,,
HYDROCORTISONE SOD SUCCINATE 100 MG INJ SOLR,,J1720,HCPCS,Facility,Both,1,Each,,83,70.55,23.7878,83,First Health Group Corporation,First Health Network,80.51,97,,percent of total billed charges,,
HYDROCORTISONE SOD SUCCINATE 100 MG INJ SOLR,,J1720,HCPCS,Facility,Both,1,Each,,83,70.55,23.7878,83,"Health Partners, Inc.",Commercial,78.518,94.6,,percent of total billed charges,,
HYDROCORTISONE SOD SUCCINATE 100 MG INJ SOLR,,J1720,HCPCS,Facility,Outpatient,1,Each,,83,70.55,23.7878,83,"Health Partners, Inc.",Medicare Advantage,40.67,49,,percent of total billed charges,,
HYDROCORTISONE SOD SUCCINATE 100 MG INJ SOLR,,J1720,HCPCS,Facility,Inpatient,1,Each,,83,70.55,23.7878,83,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
HYDROCORTISONE SOD SUCCINATE 100 MG INJ SOLR,,J1720,HCPCS,Facility,Both,1,Each,,83,70.55,23.7878,83,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),49.8,60,,percent of total billed charges,,
HYDROCORTISONE SOD SUCCINATE 100 MG INJ SOLR,,J1720,HCPCS,Facility,Both,1,Each,,83,70.55,23.7878,83,"Health Partners, Inc.",State of Minnesota Advantage Program,67.645,81.5,,percent of total billed charges,,
HYDROCORTISONE SOD SUCCINATE 100 MG INJ SOLR,,J1720,HCPCS,Facility,Both,1,Each,,83,70.55,23.7878,83,"Health Partners, Inc.",State Public Programs,41.5,50,,percent of total billed charges,,
HYDROCORTISONE SOD SUCCINATE 100 MG INJ SOLR,,J1720,HCPCS,Facility,Both,1,Each,,83,70.55,23.7878,83,Humana Insurance Company,Commercial PPO,78.85,95,,percent of total billed charges,,
HYDROCORTISONE SOD SUCCINATE 100 MG INJ SOLR,,J1720,HCPCS,Facility,Outpatient,1,Each,,83,70.55,23.7878,83,Humana Insurance Company,Medicare PPO,40.67,49,,percent of total billed charges,,
HYDROCORTISONE SOD SUCCINATE 100 MG INJ SOLR,,J1720,HCPCS,Facility,Inpatient,1,Each,,83,70.55,23.7878,83,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
HYDROCORTISONE SOD SUCCINATE 100 MG INJ SOLR,,J1720,HCPCS,Facility,Both,1,Each,,83,70.55,23.7878,83,Medica,Individual & Family,82.253,99.1,,percent of total billed charges,,
HYDROCORTISONE SOD SUCCINATE 100 MG INJ SOLR,,J1720,HCPCS,Facility,Outpatient,1,Each,,83,70.55,23.7878,83,Medica,Medica Advantage Solution,41.334,49.8,,percent of total billed charges,,
HYDROCORTISONE SOD SUCCINATE 100 MG INJ SOLR,,J1720,HCPCS,Facility,Inpatient,1,Each,,83,70.55,23.7878,83,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
HYDROCORTISONE SOD SUCCINATE 100 MG INJ SOLR,,J1720,HCPCS,Facility,Outpatient,1,Each,,83,70.55,23.7878,83,Medica,Medical Assistance,37.018,44.6,,percent of total billed charges,,
HYDROCORTISONE SOD SUCCINATE 100 MG INJ SOLR,,J1720,HCPCS,Facility,Inpatient,1,Each,,83,70.55,23.7878,83,Medica,Medical Assistance,,,,,Included in per diem rate,
HYDROCORTISONE SOD SUCCINATE 100 MG INJ SOLR,,J1720,HCPCS,Facility,Outpatient,1,Each,,83,70.55,23.7878,83,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,41.334,49.8,,percent of total billed charges,,
HYDROCORTISONE SOD SUCCINATE 100 MG INJ SOLR,,J1720,HCPCS,Facility,Inpatient,1,Each,,83,70.55,23.7878,83,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
HYDROCORTISONE SOD SUCCINATE 100 MG INJ SOLR,,J1720,HCPCS,Facility,Both,1,Each,,83,70.55,23.7878,83,"Multiplan, Inc.","Multiplan, Inc.",78.02,94,,percent of total billed charges,,
HYDROCORTISONE SOD SUCCINATE 100 MG INJ SOLR,,J1720,HCPCS,Facility,Outpatient,1,Each,,83,70.55,23.7878,83,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,74.783,90.1,,percent of total billed charges,,
HYDROCORTISONE SOD SUCCINATE 100 MG INJ SOLR,,J1720,HCPCS,Facility,Inpatient,1,Each,,83,70.55,23.7878,83,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
HYDROCORTISONE SOD SUCCINATE 100 MG INJ SOLR,,J1720,HCPCS,Facility,Both,1,Each,,83,70.55,23.7878,83,"Preferred One Administrative Services, INC.",PPO,81.838,98.6,,percent of total billed charges,,
HYDROCORTISONE SOD SUCCINATE 100 MG INJ SOLR,,J1720,HCPCS,Facility,Outpatient,1,Each,,83,70.55,23.7878,83,PrimeWest Health,Minnesota Senior Health Options (MSHO),42.7035,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
HYDROCORTISONE SOD SUCCINATE 100 MG INJ SOLR,,J1720,HCPCS,Facility,Inpatient,1,Each,,83,70.55,23.7878,83,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
HYDROCORTISONE SOD SUCCINATE 100 MG INJ SOLR,,J1720,HCPCS,Facility,Outpatient,1,Each,,83,70.55,23.7878,83,PrimeWest Health,MinnesotaCare,42.6288,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
HYDROCORTISONE SOD SUCCINATE 100 MG INJ SOLR,,J1720,HCPCS,Facility,Inpatient,1,Each,,83,70.55,23.7878,83,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
HYDROCORTISONE SOD SUCCINATE 100 MG INJ SOLR,,J1720,HCPCS,Facility,Both,1,Each,,83,70.55,23.7878,83,Sanford Health Plan,Sanford Health Plan,76.36,92,,percent of total billed charges,,
HYDROCORTISONE SOD SUCCINATE 100 MG INJ SOLR,,J1720,HCPCS,Facility,Outpatient,1,Each,,83,70.55,23.7878,83,"UCare Health, Inc.",Individual & Family Plan,46.7705,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
HYDROCORTISONE SOD SUCCINATE 100 MG INJ SOLR,,J1720,HCPCS,Facility,Inpatient,1,Each,,83,70.55,23.7878,83,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
HYDROCORTISONE SOD SUCCINATE 100 MG INJ SOLR,,J1720,HCPCS,Facility,Outpatient,1,Each,,83,70.55,23.7878,83,"UCare Health, Inc.",Medical Assistance,41.8901,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
HYDROCORTISONE SOD SUCCINATE 100 MG INJ SOLR,,J1720,HCPCS,Facility,Inpatient,1,Each,,83,70.55,23.7878,83,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
HYDROCORTISONE SOD SUCCINATE 100 MG INJ SOLR,,J1720,HCPCS,Facility,Outpatient,1,Each,,83,70.55,23.7878,83,"UCare Health, Inc.",Medicare Advantage,41.8901,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
HYDROCORTISONE SOD SUCCINATE 100 MG INJ SOLR,,J1720,HCPCS,Facility,Inpatient,1,Each,,83,70.55,23.7878,83,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
HYDROCORTISONE SOD SUCCINATE 100 MG INJ SOLR,,J1720,HCPCS,Facility,Outpatient,1,Each,,83,70.55,23.7878,83,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),41.8901,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
HYDROCORTISONE SOD SUCCINATE 100 MG INJ SOLR,,J1720,HCPCS,Facility,Inpatient,1,Each,,83,70.55,23.7878,83,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
HYDROCORTISONE SOD SUCCINATE 100 MG INJ SOLR,,J1720,HCPCS,Facility,Both,1,Each,,83,70.55,23.7878,83,UnitedHealthcare,Individual & Family,78.02,94,,percent of total billed charges,,
HYDROCORTISONE SOD SUCCINATE 100 MG INJ SOLR,,J1720,HCPCS,Facility,Outpatient,1,Each,,83,70.55,23.7878,83,UnitedHealthcare,Medicare Advantage,40.67,49,,percent of total billed charges,,
HYDROCORTISONE SOD SUCCINATE 100 MG INJ SOLR,,J1720,HCPCS,Facility,Inpatient,1,Each,,83,70.55,23.7878,83,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
HYDROCORTISONE SOD SUCCINATE 100 MG INJ SOLR,,J1720,HCPCS,Facility,Outpatient,1,Each,,83,70.55,23.7878,83,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,39.84,48,,percent of total billed charges,,100% of DHS outpatient percentage
HYDROCORTISONE SOD SUCCINATE 100 MG INJ SOLR,,J1720,HCPCS,Facility,Inpatient,1,Each,,83,70.55,23.7878,83,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
INFLIXIMAB 100 MG IV SOLR,,J1745,HCPCS,Facility,Both,1,Each,,4205,3574.25,44.196,4205,Aetna,Commercial,3868.6,92,,percent of total billed charges,,
INFLIXIMAB 100 MG IV SOLR,,J1745,HCPCS,Facility,Outpatient,1,Each,,4205,3574.25,44.196,4205,Aetna,Medicare Advantage,2060.45,49,,percent of total billed charges,,
INFLIXIMAB 100 MG IV SOLR,,J1745,HCPCS,Facility,Inpatient,1,Each,,4205,3574.25,44.196,4205,Aetna,Medicare Advantage,,,,,Included in per diem rate,
INFLIXIMAB 100 MG IV SOLR,,J1745,HCPCS,Facility,Both,1,Each,,4205,3574.25,44.196,4205,Aetna,PPO,3910.65,93,,percent of total billed charges,,
INFLIXIMAB 100 MG IV SOLR,,J1745,HCPCS,Facility,Both,1,Each,,4205,3574.25,44.196,4205,America's PPO,America's PPO,4038.0615,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
INFLIXIMAB 100 MG IV SOLR,,J1745,HCPCS,Facility,Both,1,Each,,4205,3574.25,44.196,4205,BlueCross BlueShield Minnesota, Federal Employee Program,87,,,Fee schedule,,100% of BCBS commercial commodity fee schedule
INFLIXIMAB 100 MG IV SOLR,,J1745,HCPCS,Facility,Both,1,Each,,4205,3574.25,44.196,4205,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,88.392,,,Fee schedule,,"100% of BCBS commercial commodity fee schedule, plus MN Care tax"
INFLIXIMAB 100 MG IV SOLR,,J1745,HCPCS,Facility,Both,1,Each,,4205,3574.25,44.196,4205,BlueCross BlueShield Minnesota,High Value Network Plan,3784.5,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
INFLIXIMAB 100 MG IV SOLR,,J1745,HCPCS,Facility,Outpatient,1,Each,,4205,3574.25,44.196,4205,BlueCross BlueShield Minnesota,Medicare Advantage,2060.45,49,,percent of total billed charges,,
INFLIXIMAB 100 MG IV SOLR,,J1745,HCPCS,Facility,Inpatient,1,Each,,4205,3574.25,44.196,4205,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
INFLIXIMAB 100 MG IV SOLR,,J1745,HCPCS,Facility,Both,1,Each,,4205,3574.25,44.196,4205,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,78.2887944,,,Fee schedule,,"88.57% of BCBS commercial commodity fee schedule, plus MN Care tax"
INFLIXIMAB 100 MG IV SOLR,,J1745,HCPCS,Facility,Both,1,Each,,4205,3574.25,44.196,4205,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,44.196,,,Fee schedule,,"100% of BCBS Medicaid commodity fee schedule, plus MN Care tax"
INFLIXIMAB 100 MG IV SOLR,,J1745,HCPCS,Facility,Outpatient,1,Each,,4205,3574.25,44.196,4205,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2060.45,49,,percent of total billed charges,,
INFLIXIMAB 100 MG IV SOLR,,J1745,HCPCS,Facility,Inpatient,1,Each,,4205,3574.25,44.196,4205,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
INFLIXIMAB 100 MG IV SOLR,,J1745,HCPCS,Facility,Both,1,Each,,4205,3574.25,44.196,4205,CorVel,Worker's Compensation,4205,100,,percent of total billed charges,,
INFLIXIMAB 100 MG IV SOLR,,J1745,HCPCS,Facility,Both,1,Each,,4205,3574.25,44.196,4205,First Health Group Corporation,First Health Network,4078.85,97,,percent of total billed charges,,
INFLIXIMAB 100 MG IV SOLR,,J1745,HCPCS,Facility,Both,1,Each,,4205,3574.25,44.196,4205,"Health Partners, Inc.",Commercial,3977.93,94.6,,percent of total billed charges,,
INFLIXIMAB 100 MG IV SOLR,,J1745,HCPCS,Facility,Outpatient,1,Each,,4205,3574.25,44.196,4205,"Health Partners, Inc.",Medicare Advantage,2060.45,49,,percent of total billed charges,,
INFLIXIMAB 100 MG IV SOLR,,J1745,HCPCS,Facility,Inpatient,1,Each,,4205,3574.25,44.196,4205,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
INFLIXIMAB 100 MG IV SOLR,,J1745,HCPCS,Facility,Both,1,Each,,4205,3574.25,44.196,4205,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),2523,60,,percent of total billed charges,,
INFLIXIMAB 100 MG IV SOLR,,J1745,HCPCS,Facility,Both,1,Each,,4205,3574.25,44.196,4205,"Health Partners, Inc.",State of Minnesota Advantage Program,3427.075,81.5,,percent of total billed charges,,
INFLIXIMAB 100 MG IV SOLR,,J1745,HCPCS,Facility,Both,1,Each,,4205,3574.25,44.196,4205,"Health Partners, Inc.",State Public Programs,2102.5,50,,percent of total billed charges,,
INFLIXIMAB 100 MG IV SOLR,,J1745,HCPCS,Facility,Both,1,Each,,4205,3574.25,44.196,4205,Humana Insurance Company,Commercial PPO,3994.75,95,,percent of total billed charges,,
INFLIXIMAB 100 MG IV SOLR,,J1745,HCPCS,Facility,Outpatient,1,Each,,4205,3574.25,44.196,4205,Humana Insurance Company,Medicare PPO,2060.45,49,,percent of total billed charges,,
INFLIXIMAB 100 MG IV SOLR,,J1745,HCPCS,Facility,Inpatient,1,Each,,4205,3574.25,44.196,4205,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
INFLIXIMAB 100 MG IV SOLR,,J1745,HCPCS,Facility,Both,1,Each,,4205,3574.25,44.196,4205,Medica,Individual & Family,4167.155,99.1,,percent of total billed charges,,
INFLIXIMAB 100 MG IV SOLR,,J1745,HCPCS,Facility,Outpatient,1,Each,,4205,3574.25,44.196,4205,Medica,Medica Advantage Solution,2094.09,49.8,,percent of total billed charges,,
INFLIXIMAB 100 MG IV SOLR,,J1745,HCPCS,Facility,Inpatient,1,Each,,4205,3574.25,44.196,4205,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
INFLIXIMAB 100 MG IV SOLR,,J1745,HCPCS,Facility,Outpatient,1,Each,,4205,3574.25,44.196,4205,Medica,Medical Assistance,1875.43,44.6,,percent of total billed charges,,
INFLIXIMAB 100 MG IV SOLR,,J1745,HCPCS,Facility,Inpatient,1,Each,,4205,3574.25,44.196,4205,Medica,Medical Assistance,,,,,Included in per diem rate,
INFLIXIMAB 100 MG IV SOLR,,J1745,HCPCS,Facility,Outpatient,1,Each,,4205,3574.25,44.196,4205,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2094.09,49.8,,percent of total billed charges,,
INFLIXIMAB 100 MG IV SOLR,,J1745,HCPCS,Facility,Inpatient,1,Each,,4205,3574.25,44.196,4205,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
INFLIXIMAB 100 MG IV SOLR,,J1745,HCPCS,Facility,Both,1,Each,,4205,3574.25,44.196,4205,"Multiplan, Inc.","Multiplan, Inc.",3952.7,94,,percent of total billed charges,,
INFLIXIMAB 100 MG IV SOLR,,J1745,HCPCS,Facility,Outpatient,1,Each,,4205,3574.25,44.196,4205,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,3788.705,90.1,,percent of total billed charges,,
INFLIXIMAB 100 MG IV SOLR,,J1745,HCPCS,Facility,Inpatient,1,Each,,4205,3574.25,44.196,4205,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
INFLIXIMAB 100 MG IV SOLR,,J1745,HCPCS,Facility,Both,1,Each,,4205,3574.25,44.196,4205,"Preferred One Administrative Services, INC.",PPO,4146.13,98.6,,percent of total billed charges,,
INFLIXIMAB 100 MG IV SOLR,,J1745,HCPCS,Facility,Outpatient,1,Each,,4205,3574.25,44.196,4205,PrimeWest Health,Minnesota Senior Health Options (MSHO),2163.4725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
INFLIXIMAB 100 MG IV SOLR,,J1745,HCPCS,Facility,Inpatient,1,Each,,4205,3574.25,44.196,4205,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
INFLIXIMAB 100 MG IV SOLR,,J1745,HCPCS,Facility,Outpatient,1,Each,,4205,3574.25,44.196,4205,PrimeWest Health,MinnesotaCare,2159.688,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
INFLIXIMAB 100 MG IV SOLR,,J1745,HCPCS,Facility,Inpatient,1,Each,,4205,3574.25,44.196,4205,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
INFLIXIMAB 100 MG IV SOLR,,J1745,HCPCS,Facility,Both,1,Each,,4205,3574.25,44.196,4205,Sanford Health Plan,Sanford Health Plan,3868.6,92,,percent of total billed charges,,
INFLIXIMAB 100 MG IV SOLR,,J1745,HCPCS,Facility,Outpatient,1,Each,,4205,3574.25,44.196,4205,"UCare Health, Inc.",Individual & Family Plan,2369.5175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
INFLIXIMAB 100 MG IV SOLR,,J1745,HCPCS,Facility,Inpatient,1,Each,,4205,3574.25,44.196,4205,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
INFLIXIMAB 100 MG IV SOLR,,J1745,HCPCS,Facility,Outpatient,1,Each,,4205,3574.25,44.196,4205,"UCare Health, Inc.",Medical Assistance,2122.2635,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
INFLIXIMAB 100 MG IV SOLR,,J1745,HCPCS,Facility,Inpatient,1,Each,,4205,3574.25,44.196,4205,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
INFLIXIMAB 100 MG IV SOLR,,J1745,HCPCS,Facility,Outpatient,1,Each,,4205,3574.25,44.196,4205,"UCare Health, Inc.",Medicare Advantage,2122.2635,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
INFLIXIMAB 100 MG IV SOLR,,J1745,HCPCS,Facility,Inpatient,1,Each,,4205,3574.25,44.196,4205,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
INFLIXIMAB 100 MG IV SOLR,,J1745,HCPCS,Facility,Outpatient,1,Each,,4205,3574.25,44.196,4205,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2122.2635,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
INFLIXIMAB 100 MG IV SOLR,,J1745,HCPCS,Facility,Inpatient,1,Each,,4205,3574.25,44.196,4205,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
INFLIXIMAB 100 MG IV SOLR,,J1745,HCPCS,Facility,Both,1,Each,,4205,3574.25,44.196,4205,UnitedHealthcare,Individual & Family,3952.7,94,,percent of total billed charges,,
INFLIXIMAB 100 MG IV SOLR,,J1745,HCPCS,Facility,Outpatient,1,Each,,4205,3574.25,44.196,4205,UnitedHealthcare,Medicare Advantage,2060.45,49,,percent of total billed charges,,
INFLIXIMAB 100 MG IV SOLR,,J1745,HCPCS,Facility,Inpatient,1,Each,,4205,3574.25,44.196,4205,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
INFLIXIMAB 100 MG IV SOLR,,J1745,HCPCS,Facility,Outpatient,1,Each,,4205,3574.25,44.196,4205,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2018.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
INFLIXIMAB 100 MG IV SOLR,,J1745,HCPCS,Facility,Inpatient,1,Each,,4205,3574.25,44.196,4205,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
MEROPENEM 1 GRAM IV SOLR,,J2185,HCPCS,Facility,Both,1,Each,,64,54.4,18.3424,64,Aetna,Commercial,58.88,92,,percent of total billed charges,,
MEROPENEM 1 GRAM IV SOLR,,J2185,HCPCS,Facility,Outpatient,1,Each,,64,54.4,18.3424,64,Aetna,Medicare Advantage,31.36,49,,percent of total billed charges,,
MEROPENEM 1 GRAM IV SOLR,,J2185,HCPCS,Facility,Inpatient,1,Each,,64,54.4,18.3424,64,Aetna,Medicare Advantage,,,,,Included in per diem rate,
MEROPENEM 1 GRAM IV SOLR,,J2185,HCPCS,Facility,Both,1,Each,,64,54.4,18.3424,64,Aetna,PPO,59.52,93,,percent of total billed charges,,
MEROPENEM 1 GRAM IV SOLR,,J2185,HCPCS,Facility,Both,1,Each,,64,54.4,18.3424,64,America's PPO,America's PPO,61.4592,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
MEROPENEM 1 GRAM IV SOLR,,J2185,HCPCS,Facility,Both,1,Each,,64,54.4,18.3424,64,BlueCross BlueShield Minnesota, Federal Employee Program,62.976,98.4,,percent of total billed charges,,
MEROPENEM 1 GRAM IV SOLR,,J2185,HCPCS,Facility,Both,1,Each,,64,54.4,18.3424,64,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,64,100,,percent of total billed charges,,
MEROPENEM 1 GRAM IV SOLR,,J2185,HCPCS,Facility,Both,1,Each,,64,54.4,18.3424,64,BlueCross BlueShield Minnesota,High Value Network Plan,57.6,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
MEROPENEM 1 GRAM IV SOLR,,J2185,HCPCS,Facility,Outpatient,1,Each,,64,54.4,18.3424,64,BlueCross BlueShield Minnesota,Medicare Advantage,31.36,49,,percent of total billed charges,,
MEROPENEM 1 GRAM IV SOLR,,J2185,HCPCS,Facility,Inpatient,1,Each,,64,54.4,18.3424,64,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
MEROPENEM 1 GRAM IV SOLR,,J2185,HCPCS,Facility,Both,1,Each,,64,54.4,18.3424,64,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,56.6848,88.57,,percent of total billed charges,,
MEROPENEM 1 GRAM IV SOLR,,J2185,HCPCS,Facility,Both,1,Each,,64,54.4,18.3424,64,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,18.3424,28.66,,percent of total billed charges,,
MEROPENEM 1 GRAM IV SOLR,,J2185,HCPCS,Facility,Outpatient,1,Each,,64,54.4,18.3424,64,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),31.36,49,,percent of total billed charges,,
MEROPENEM 1 GRAM IV SOLR,,J2185,HCPCS,Facility,Inpatient,1,Each,,64,54.4,18.3424,64,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
MEROPENEM 1 GRAM IV SOLR,,J2185,HCPCS,Facility,Both,1,Each,,64,54.4,18.3424,64,CorVel,Worker's Compensation,64,100,,percent of total billed charges,,
MEROPENEM 1 GRAM IV SOLR,,J2185,HCPCS,Facility,Both,1,Each,,64,54.4,18.3424,64,First Health Group Corporation,First Health Network,62.08,97,,percent of total billed charges,,
MEROPENEM 1 GRAM IV SOLR,,J2185,HCPCS,Facility,Both,1,Each,,64,54.4,18.3424,64,"Health Partners, Inc.",Commercial,60.544,94.6,,percent of total billed charges,,
MEROPENEM 1 GRAM IV SOLR,,J2185,HCPCS,Facility,Outpatient,1,Each,,64,54.4,18.3424,64,"Health Partners, Inc.",Medicare Advantage,31.36,49,,percent of total billed charges,,
MEROPENEM 1 GRAM IV SOLR,,J2185,HCPCS,Facility,Inpatient,1,Each,,64,54.4,18.3424,64,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
MEROPENEM 1 GRAM IV SOLR,,J2185,HCPCS,Facility,Both,1,Each,,64,54.4,18.3424,64,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),38.4,60,,percent of total billed charges,,
MEROPENEM 1 GRAM IV SOLR,,J2185,HCPCS,Facility,Both,1,Each,,64,54.4,18.3424,64,"Health Partners, Inc.",State of Minnesota Advantage Program,52.16,81.5,,percent of total billed charges,,
MEROPENEM 1 GRAM IV SOLR,,J2185,HCPCS,Facility,Both,1,Each,,64,54.4,18.3424,64,"Health Partners, Inc.",State Public Programs,32,50,,percent of total billed charges,,
MEROPENEM 1 GRAM IV SOLR,,J2185,HCPCS,Facility,Both,1,Each,,64,54.4,18.3424,64,Humana Insurance Company,Commercial PPO,60.8,95,,percent of total billed charges,,
MEROPENEM 1 GRAM IV SOLR,,J2185,HCPCS,Facility,Outpatient,1,Each,,64,54.4,18.3424,64,Humana Insurance Company,Medicare PPO,31.36,49,,percent of total billed charges,,
MEROPENEM 1 GRAM IV SOLR,,J2185,HCPCS,Facility,Inpatient,1,Each,,64,54.4,18.3424,64,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
MEROPENEM 1 GRAM IV SOLR,,J2185,HCPCS,Facility,Both,1,Each,,64,54.4,18.3424,64,Medica,Individual & Family,63.424,99.1,,percent of total billed charges,,
MEROPENEM 1 GRAM IV SOLR,,J2185,HCPCS,Facility,Outpatient,1,Each,,64,54.4,18.3424,64,Medica,Medica Advantage Solution,31.872,49.8,,percent of total billed charges,,
MEROPENEM 1 GRAM IV SOLR,,J2185,HCPCS,Facility,Inpatient,1,Each,,64,54.4,18.3424,64,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
MEROPENEM 1 GRAM IV SOLR,,J2185,HCPCS,Facility,Outpatient,1,Each,,64,54.4,18.3424,64,Medica,Medical Assistance,28.544,44.6,,percent of total billed charges,,
MEROPENEM 1 GRAM IV SOLR,,J2185,HCPCS,Facility,Inpatient,1,Each,,64,54.4,18.3424,64,Medica,Medical Assistance,,,,,Included in per diem rate,
MEROPENEM 1 GRAM IV SOLR,,J2185,HCPCS,Facility,Outpatient,1,Each,,64,54.4,18.3424,64,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,31.872,49.8,,percent of total billed charges,,
MEROPENEM 1 GRAM IV SOLR,,J2185,HCPCS,Facility,Inpatient,1,Each,,64,54.4,18.3424,64,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
MEROPENEM 1 GRAM IV SOLR,,J2185,HCPCS,Facility,Both,1,Each,,64,54.4,18.3424,64,"Multiplan, Inc.","Multiplan, Inc.",60.16,94,,percent of total billed charges,,
MEROPENEM 1 GRAM IV SOLR,,J2185,HCPCS,Facility,Outpatient,1,Each,,64,54.4,18.3424,64,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,57.664,90.1,,percent of total billed charges,,
MEROPENEM 1 GRAM IV SOLR,,J2185,HCPCS,Facility,Inpatient,1,Each,,64,54.4,18.3424,64,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
MEROPENEM 1 GRAM IV SOLR,,J2185,HCPCS,Facility,Both,1,Each,,64,54.4,18.3424,64,"Preferred One Administrative Services, INC.",PPO,63.104,98.6,,percent of total billed charges,,
MEROPENEM 1 GRAM IV SOLR,,J2185,HCPCS,Facility,Outpatient,1,Each,,64,54.4,18.3424,64,PrimeWest Health,Minnesota Senior Health Options (MSHO),32.928,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
MEROPENEM 1 GRAM IV SOLR,,J2185,HCPCS,Facility,Inpatient,1,Each,,64,54.4,18.3424,64,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
MEROPENEM 1 GRAM IV SOLR,,J2185,HCPCS,Facility,Outpatient,1,Each,,64,54.4,18.3424,64,PrimeWest Health,MinnesotaCare,32.8704,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
MEROPENEM 1 GRAM IV SOLR,,J2185,HCPCS,Facility,Inpatient,1,Each,,64,54.4,18.3424,64,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
MEROPENEM 1 GRAM IV SOLR,,J2185,HCPCS,Facility,Both,1,Each,,64,54.4,18.3424,64,Sanford Health Plan,Sanford Health Plan,58.88,92,,percent of total billed charges,,
MEROPENEM 1 GRAM IV SOLR,,J2185,HCPCS,Facility,Outpatient,1,Each,,64,54.4,18.3424,64,"UCare Health, Inc.",Individual & Family Plan,36.064,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
MEROPENEM 1 GRAM IV SOLR,,J2185,HCPCS,Facility,Inpatient,1,Each,,64,54.4,18.3424,64,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
MEROPENEM 1 GRAM IV SOLR,,J2185,HCPCS,Facility,Outpatient,1,Each,,64,54.4,18.3424,64,"UCare Health, Inc.",Medical Assistance,32.3008,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MEROPENEM 1 GRAM IV SOLR,,J2185,HCPCS,Facility,Inpatient,1,Each,,64,54.4,18.3424,64,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
MEROPENEM 1 GRAM IV SOLR,,J2185,HCPCS,Facility,Outpatient,1,Each,,64,54.4,18.3424,64,"UCare Health, Inc.",Medicare Advantage,32.3008,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MEROPENEM 1 GRAM IV SOLR,,J2185,HCPCS,Facility,Inpatient,1,Each,,64,54.4,18.3424,64,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
MEROPENEM 1 GRAM IV SOLR,,J2185,HCPCS,Facility,Outpatient,1,Each,,64,54.4,18.3424,64,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),32.3008,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MEROPENEM 1 GRAM IV SOLR,,J2185,HCPCS,Facility,Inpatient,1,Each,,64,54.4,18.3424,64,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
MEROPENEM 1 GRAM IV SOLR,,J2185,HCPCS,Facility,Both,1,Each,,64,54.4,18.3424,64,UnitedHealthcare,Individual & Family,60.16,94,,percent of total billed charges,,
MEROPENEM 1 GRAM IV SOLR,,J2185,HCPCS,Facility,Outpatient,1,Each,,64,54.4,18.3424,64,UnitedHealthcare,Medicare Advantage,31.36,49,,percent of total billed charges,,
MEROPENEM 1 GRAM IV SOLR,,J2185,HCPCS,Facility,Inpatient,1,Each,,64,54.4,18.3424,64,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
MEROPENEM 1 GRAM IV SOLR,,J2185,HCPCS,Facility,Outpatient,1,Each,,64,54.4,18.3424,64,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,30.72,48,,percent of total billed charges,,100% of DHS outpatient percentage
MEROPENEM 1 GRAM IV SOLR,,J2185,HCPCS,Facility,Inpatient,1,Each,,64,54.4,18.3424,64,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
MEROPENEM 500 MG IV SOLR,,J2185,HCPCS,Facility,Both,1,Each,,53,45.05,15.1898,53,Aetna,Commercial,48.76,92,,percent of total billed charges,,
MEROPENEM 500 MG IV SOLR,,J2185,HCPCS,Facility,Outpatient,1,Each,,53,45.05,15.1898,53,Aetna,Medicare Advantage,25.97,49,,percent of total billed charges,,
MEROPENEM 500 MG IV SOLR,,J2185,HCPCS,Facility,Inpatient,1,Each,,53,45.05,15.1898,53,Aetna,Medicare Advantage,,,,,Included in per diem rate,
MEROPENEM 500 MG IV SOLR,,J2185,HCPCS,Facility,Both,1,Each,,53,45.05,15.1898,53,Aetna,PPO,49.29,93,,percent of total billed charges,,
MEROPENEM 500 MG IV SOLR,,J2185,HCPCS,Facility,Both,1,Each,,53,45.05,15.1898,53,America's PPO,America's PPO,50.8959,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
MEROPENEM 500 MG IV SOLR,,J2185,HCPCS,Facility,Both,1,Each,,53,45.05,15.1898,53,BlueCross BlueShield Minnesota, Federal Employee Program,52.152,98.4,,percent of total billed charges,,
MEROPENEM 500 MG IV SOLR,,J2185,HCPCS,Facility,Both,1,Each,,53,45.05,15.1898,53,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,53,100,,percent of total billed charges,,
MEROPENEM 500 MG IV SOLR,,J2185,HCPCS,Facility,Both,1,Each,,53,45.05,15.1898,53,BlueCross BlueShield Minnesota,High Value Network Plan,47.7,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
MEROPENEM 500 MG IV SOLR,,J2185,HCPCS,Facility,Outpatient,1,Each,,53,45.05,15.1898,53,BlueCross BlueShield Minnesota,Medicare Advantage,25.97,49,,percent of total billed charges,,
MEROPENEM 500 MG IV SOLR,,J2185,HCPCS,Facility,Inpatient,1,Each,,53,45.05,15.1898,53,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
MEROPENEM 500 MG IV SOLR,,J2185,HCPCS,Facility,Both,1,Each,,53,45.05,15.1898,53,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,46.9421,88.57,,percent of total billed charges,,
MEROPENEM 500 MG IV SOLR,,J2185,HCPCS,Facility,Both,1,Each,,53,45.05,15.1898,53,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,15.1898,28.66,,percent of total billed charges,,
MEROPENEM 500 MG IV SOLR,,J2185,HCPCS,Facility,Outpatient,1,Each,,53,45.05,15.1898,53,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),25.97,49,,percent of total billed charges,,
MEROPENEM 500 MG IV SOLR,,J2185,HCPCS,Facility,Inpatient,1,Each,,53,45.05,15.1898,53,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
MEROPENEM 500 MG IV SOLR,,J2185,HCPCS,Facility,Both,1,Each,,53,45.05,15.1898,53,CorVel,Worker's Compensation,53,100,,percent of total billed charges,,
MEROPENEM 500 MG IV SOLR,,J2185,HCPCS,Facility,Both,1,Each,,53,45.05,15.1898,53,First Health Group Corporation,First Health Network,51.41,97,,percent of total billed charges,,
MEROPENEM 500 MG IV SOLR,,J2185,HCPCS,Facility,Both,1,Each,,53,45.05,15.1898,53,"Health Partners, Inc.",Commercial,50.138,94.6,,percent of total billed charges,,
MEROPENEM 500 MG IV SOLR,,J2185,HCPCS,Facility,Outpatient,1,Each,,53,45.05,15.1898,53,"Health Partners, Inc.",Medicare Advantage,25.97,49,,percent of total billed charges,,
MEROPENEM 500 MG IV SOLR,,J2185,HCPCS,Facility,Inpatient,1,Each,,53,45.05,15.1898,53,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
MEROPENEM 500 MG IV SOLR,,J2185,HCPCS,Facility,Both,1,Each,,53,45.05,15.1898,53,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),31.8,60,,percent of total billed charges,,
MEROPENEM 500 MG IV SOLR,,J2185,HCPCS,Facility,Both,1,Each,,53,45.05,15.1898,53,"Health Partners, Inc.",State of Minnesota Advantage Program,43.195,81.5,,percent of total billed charges,,
MEROPENEM 500 MG IV SOLR,,J2185,HCPCS,Facility,Both,1,Each,,53,45.05,15.1898,53,"Health Partners, Inc.",State Public Programs,26.5,50,,percent of total billed charges,,
MEROPENEM 500 MG IV SOLR,,J2185,HCPCS,Facility,Both,1,Each,,53,45.05,15.1898,53,Humana Insurance Company,Commercial PPO,50.35,95,,percent of total billed charges,,
MEROPENEM 500 MG IV SOLR,,J2185,HCPCS,Facility,Outpatient,1,Each,,53,45.05,15.1898,53,Humana Insurance Company,Medicare PPO,25.97,49,,percent of total billed charges,,
MEROPENEM 500 MG IV SOLR,,J2185,HCPCS,Facility,Inpatient,1,Each,,53,45.05,15.1898,53,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
MEROPENEM 500 MG IV SOLR,,J2185,HCPCS,Facility,Both,1,Each,,53,45.05,15.1898,53,Medica,Individual & Family,52.523,99.1,,percent of total billed charges,,
MEROPENEM 500 MG IV SOLR,,J2185,HCPCS,Facility,Outpatient,1,Each,,53,45.05,15.1898,53,Medica,Medica Advantage Solution,26.394,49.8,,percent of total billed charges,,
MEROPENEM 500 MG IV SOLR,,J2185,HCPCS,Facility,Inpatient,1,Each,,53,45.05,15.1898,53,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
MEROPENEM 500 MG IV SOLR,,J2185,HCPCS,Facility,Outpatient,1,Each,,53,45.05,15.1898,53,Medica,Medical Assistance,23.638,44.6,,percent of total billed charges,,
MEROPENEM 500 MG IV SOLR,,J2185,HCPCS,Facility,Inpatient,1,Each,,53,45.05,15.1898,53,Medica,Medical Assistance,,,,,Included in per diem rate,
MEROPENEM 500 MG IV SOLR,,J2185,HCPCS,Facility,Outpatient,1,Each,,53,45.05,15.1898,53,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,26.394,49.8,,percent of total billed charges,,
MEROPENEM 500 MG IV SOLR,,J2185,HCPCS,Facility,Inpatient,1,Each,,53,45.05,15.1898,53,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
MEROPENEM 500 MG IV SOLR,,J2185,HCPCS,Facility,Both,1,Each,,53,45.05,15.1898,53,"Multiplan, Inc.","Multiplan, Inc.",49.82,94,,percent of total billed charges,,
MEROPENEM 500 MG IV SOLR,,J2185,HCPCS,Facility,Outpatient,1,Each,,53,45.05,15.1898,53,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,47.753,90.1,,percent of total billed charges,,
MEROPENEM 500 MG IV SOLR,,J2185,HCPCS,Facility,Inpatient,1,Each,,53,45.05,15.1898,53,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
MEROPENEM 500 MG IV SOLR,,J2185,HCPCS,Facility,Both,1,Each,,53,45.05,15.1898,53,"Preferred One Administrative Services, INC.",PPO,52.258,98.6,,percent of total billed charges,,
MEROPENEM 500 MG IV SOLR,,J2185,HCPCS,Facility,Outpatient,1,Each,,53,45.05,15.1898,53,PrimeWest Health,Minnesota Senior Health Options (MSHO),27.2685,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
MEROPENEM 500 MG IV SOLR,,J2185,HCPCS,Facility,Inpatient,1,Each,,53,45.05,15.1898,53,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
MEROPENEM 500 MG IV SOLR,,J2185,HCPCS,Facility,Outpatient,1,Each,,53,45.05,15.1898,53,PrimeWest Health,MinnesotaCare,27.2208,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
MEROPENEM 500 MG IV SOLR,,J2185,HCPCS,Facility,Inpatient,1,Each,,53,45.05,15.1898,53,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
MEROPENEM 500 MG IV SOLR,,J2185,HCPCS,Facility,Both,1,Each,,53,45.05,15.1898,53,Sanford Health Plan,Sanford Health Plan,48.76,92,,percent of total billed charges,,
MEROPENEM 500 MG IV SOLR,,J2185,HCPCS,Facility,Outpatient,1,Each,,53,45.05,15.1898,53,"UCare Health, Inc.",Individual & Family Plan,29.8655,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
MEROPENEM 500 MG IV SOLR,,J2185,HCPCS,Facility,Inpatient,1,Each,,53,45.05,15.1898,53,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
MEROPENEM 500 MG IV SOLR,,J2185,HCPCS,Facility,Outpatient,1,Each,,53,45.05,15.1898,53,"UCare Health, Inc.",Medical Assistance,26.7491,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MEROPENEM 500 MG IV SOLR,,J2185,HCPCS,Facility,Inpatient,1,Each,,53,45.05,15.1898,53,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
MEROPENEM 500 MG IV SOLR,,J2185,HCPCS,Facility,Outpatient,1,Each,,53,45.05,15.1898,53,"UCare Health, Inc.",Medicare Advantage,26.7491,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MEROPENEM 500 MG IV SOLR,,J2185,HCPCS,Facility,Inpatient,1,Each,,53,45.05,15.1898,53,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
MEROPENEM 500 MG IV SOLR,,J2185,HCPCS,Facility,Outpatient,1,Each,,53,45.05,15.1898,53,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),26.7491,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MEROPENEM 500 MG IV SOLR,,J2185,HCPCS,Facility,Inpatient,1,Each,,53,45.05,15.1898,53,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
MEROPENEM 500 MG IV SOLR,,J2185,HCPCS,Facility,Both,1,Each,,53,45.05,15.1898,53,UnitedHealthcare,Individual & Family,49.82,94,,percent of total billed charges,,
MEROPENEM 500 MG IV SOLR,,J2185,HCPCS,Facility,Outpatient,1,Each,,53,45.05,15.1898,53,UnitedHealthcare,Medicare Advantage,25.97,49,,percent of total billed charges,,
MEROPENEM 500 MG IV SOLR,,J2185,HCPCS,Facility,Inpatient,1,Each,,53,45.05,15.1898,53,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
MEROPENEM 500 MG IV SOLR,,J2185,HCPCS,Facility,Outpatient,1,Each,,53,45.05,15.1898,53,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,25.44,48,,percent of total billed charges,,100% of DHS outpatient percentage
MEROPENEM 500 MG IV SOLR,,J2185,HCPCS,Facility,Inpatient,1,Each,,53,45.05,15.1898,53,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
MICAFUNGIN 100 MG IV SOLR,,J2248,HCPCS,Facility,Both,1,Each,,876,744.6,251.0616,876,Aetna,Commercial,805.92,92,,percent of total billed charges,,
MICAFUNGIN 100 MG IV SOLR,,J2248,HCPCS,Facility,Outpatient,1,Each,,876,744.6,251.0616,876,Aetna,Medicare Advantage,429.24,49,,percent of total billed charges,,
MICAFUNGIN 100 MG IV SOLR,,J2248,HCPCS,Facility,Inpatient,1,Each,,876,744.6,251.0616,876,Aetna,Medicare Advantage,,,,,Included in per diem rate,
MICAFUNGIN 100 MG IV SOLR,,J2248,HCPCS,Facility,Both,1,Each,,876,744.6,251.0616,876,Aetna,PPO,814.68,93,,percent of total billed charges,,
MICAFUNGIN 100 MG IV SOLR,,J2248,HCPCS,Facility,Both,1,Each,,876,744.6,251.0616,876,America's PPO,America's PPO,841.2228,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
MICAFUNGIN 100 MG IV SOLR,,J2248,HCPCS,Facility,Both,1,Each,,876,744.6,251.0616,876,BlueCross BlueShield Minnesota, Federal Employee Program,861.984,98.4,,percent of total billed charges,,
MICAFUNGIN 100 MG IV SOLR,,J2248,HCPCS,Facility,Both,1,Each,,876,744.6,251.0616,876,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,876,100,,percent of total billed charges,,
MICAFUNGIN 100 MG IV SOLR,,J2248,HCPCS,Facility,Both,1,Each,,876,744.6,251.0616,876,BlueCross BlueShield Minnesota,High Value Network Plan,788.4,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
MICAFUNGIN 100 MG IV SOLR,,J2248,HCPCS,Facility,Outpatient,1,Each,,876,744.6,251.0616,876,BlueCross BlueShield Minnesota,Medicare Advantage,429.24,49,,percent of total billed charges,,
MICAFUNGIN 100 MG IV SOLR,,J2248,HCPCS,Facility,Inpatient,1,Each,,876,744.6,251.0616,876,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
MICAFUNGIN 100 MG IV SOLR,,J2248,HCPCS,Facility,Both,1,Each,,876,744.6,251.0616,876,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,775.8732,88.57,,percent of total billed charges,,
MICAFUNGIN 100 MG IV SOLR,,J2248,HCPCS,Facility,Both,1,Each,,876,744.6,251.0616,876,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,251.0616,28.66,,percent of total billed charges,,
MICAFUNGIN 100 MG IV SOLR,,J2248,HCPCS,Facility,Outpatient,1,Each,,876,744.6,251.0616,876,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),429.24,49,,percent of total billed charges,,
MICAFUNGIN 100 MG IV SOLR,,J2248,HCPCS,Facility,Inpatient,1,Each,,876,744.6,251.0616,876,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
MICAFUNGIN 100 MG IV SOLR,,J2248,HCPCS,Facility,Both,1,Each,,876,744.6,251.0616,876,CorVel,Worker's Compensation,876,100,,percent of total billed charges,,
MICAFUNGIN 100 MG IV SOLR,,J2248,HCPCS,Facility,Both,1,Each,,876,744.6,251.0616,876,First Health Group Corporation,First Health Network,849.72,97,,percent of total billed charges,,
MICAFUNGIN 100 MG IV SOLR,,J2248,HCPCS,Facility,Both,1,Each,,876,744.6,251.0616,876,"Health Partners, Inc.",Commercial,828.696,94.6,,percent of total billed charges,,
MICAFUNGIN 100 MG IV SOLR,,J2248,HCPCS,Facility,Outpatient,1,Each,,876,744.6,251.0616,876,"Health Partners, Inc.",Medicare Advantage,429.24,49,,percent of total billed charges,,
MICAFUNGIN 100 MG IV SOLR,,J2248,HCPCS,Facility,Inpatient,1,Each,,876,744.6,251.0616,876,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
MICAFUNGIN 100 MG IV SOLR,,J2248,HCPCS,Facility,Both,1,Each,,876,744.6,251.0616,876,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),525.6,60,,percent of total billed charges,,
MICAFUNGIN 100 MG IV SOLR,,J2248,HCPCS,Facility,Both,1,Each,,876,744.6,251.0616,876,"Health Partners, Inc.",State of Minnesota Advantage Program,713.94,81.5,,percent of total billed charges,,
MICAFUNGIN 100 MG IV SOLR,,J2248,HCPCS,Facility,Both,1,Each,,876,744.6,251.0616,876,"Health Partners, Inc.",State Public Programs,438,50,,percent of total billed charges,,
MICAFUNGIN 100 MG IV SOLR,,J2248,HCPCS,Facility,Both,1,Each,,876,744.6,251.0616,876,Humana Insurance Company,Commercial PPO,832.2,95,,percent of total billed charges,,
MICAFUNGIN 100 MG IV SOLR,,J2248,HCPCS,Facility,Outpatient,1,Each,,876,744.6,251.0616,876,Humana Insurance Company,Medicare PPO,429.24,49,,percent of total billed charges,,
MICAFUNGIN 100 MG IV SOLR,,J2248,HCPCS,Facility,Inpatient,1,Each,,876,744.6,251.0616,876,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
MICAFUNGIN 100 MG IV SOLR,,J2248,HCPCS,Facility,Both,1,Each,,876,744.6,251.0616,876,Medica,Individual & Family,868.116,99.1,,percent of total billed charges,,
MICAFUNGIN 100 MG IV SOLR,,J2248,HCPCS,Facility,Outpatient,1,Each,,876,744.6,251.0616,876,Medica,Medica Advantage Solution,436.248,49.8,,percent of total billed charges,,
MICAFUNGIN 100 MG IV SOLR,,J2248,HCPCS,Facility,Inpatient,1,Each,,876,744.6,251.0616,876,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
MICAFUNGIN 100 MG IV SOLR,,J2248,HCPCS,Facility,Outpatient,1,Each,,876,744.6,251.0616,876,Medica,Medical Assistance,390.696,44.6,,percent of total billed charges,,
MICAFUNGIN 100 MG IV SOLR,,J2248,HCPCS,Facility,Inpatient,1,Each,,876,744.6,251.0616,876,Medica,Medical Assistance,,,,,Included in per diem rate,
MICAFUNGIN 100 MG IV SOLR,,J2248,HCPCS,Facility,Outpatient,1,Each,,876,744.6,251.0616,876,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,436.248,49.8,,percent of total billed charges,,
MICAFUNGIN 100 MG IV SOLR,,J2248,HCPCS,Facility,Inpatient,1,Each,,876,744.6,251.0616,876,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
MICAFUNGIN 100 MG IV SOLR,,J2248,HCPCS,Facility,Both,1,Each,,876,744.6,251.0616,876,"Multiplan, Inc.","Multiplan, Inc.",823.44,94,,percent of total billed charges,,
MICAFUNGIN 100 MG IV SOLR,,J2248,HCPCS,Facility,Outpatient,1,Each,,876,744.6,251.0616,876,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,789.276,90.1,,percent of total billed charges,,
MICAFUNGIN 100 MG IV SOLR,,J2248,HCPCS,Facility,Inpatient,1,Each,,876,744.6,251.0616,876,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
MICAFUNGIN 100 MG IV SOLR,,J2248,HCPCS,Facility,Both,1,Each,,876,744.6,251.0616,876,"Preferred One Administrative Services, INC.",PPO,863.736,98.6,,percent of total billed charges,,
MICAFUNGIN 100 MG IV SOLR,,J2248,HCPCS,Facility,Outpatient,1,Each,,876,744.6,251.0616,876,PrimeWest Health,Minnesota Senior Health Options (MSHO),450.702,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
MICAFUNGIN 100 MG IV SOLR,,J2248,HCPCS,Facility,Inpatient,1,Each,,876,744.6,251.0616,876,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
MICAFUNGIN 100 MG IV SOLR,,J2248,HCPCS,Facility,Outpatient,1,Each,,876,744.6,251.0616,876,PrimeWest Health,MinnesotaCare,449.9136,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
MICAFUNGIN 100 MG IV SOLR,,J2248,HCPCS,Facility,Inpatient,1,Each,,876,744.6,251.0616,876,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
MICAFUNGIN 100 MG IV SOLR,,J2248,HCPCS,Facility,Both,1,Each,,876,744.6,251.0616,876,Sanford Health Plan,Sanford Health Plan,805.92,92,,percent of total billed charges,,
MICAFUNGIN 100 MG IV SOLR,,J2248,HCPCS,Facility,Outpatient,1,Each,,876,744.6,251.0616,876,"UCare Health, Inc.",Individual & Family Plan,493.626,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
MICAFUNGIN 100 MG IV SOLR,,J2248,HCPCS,Facility,Inpatient,1,Each,,876,744.6,251.0616,876,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
MICAFUNGIN 100 MG IV SOLR,,J2248,HCPCS,Facility,Outpatient,1,Each,,876,744.6,251.0616,876,"UCare Health, Inc.",Medical Assistance,442.1172,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MICAFUNGIN 100 MG IV SOLR,,J2248,HCPCS,Facility,Inpatient,1,Each,,876,744.6,251.0616,876,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
MICAFUNGIN 100 MG IV SOLR,,J2248,HCPCS,Facility,Outpatient,1,Each,,876,744.6,251.0616,876,"UCare Health, Inc.",Medicare Advantage,442.1172,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MICAFUNGIN 100 MG IV SOLR,,J2248,HCPCS,Facility,Inpatient,1,Each,,876,744.6,251.0616,876,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
MICAFUNGIN 100 MG IV SOLR,,J2248,HCPCS,Facility,Outpatient,1,Each,,876,744.6,251.0616,876,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),442.1172,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MICAFUNGIN 100 MG IV SOLR,,J2248,HCPCS,Facility,Inpatient,1,Each,,876,744.6,251.0616,876,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
MICAFUNGIN 100 MG IV SOLR,,J2248,HCPCS,Facility,Both,1,Each,,876,744.6,251.0616,876,UnitedHealthcare,Individual & Family,823.44,94,,percent of total billed charges,,
MICAFUNGIN 100 MG IV SOLR,,J2248,HCPCS,Facility,Outpatient,1,Each,,876,744.6,251.0616,876,UnitedHealthcare,Medicare Advantage,429.24,49,,percent of total billed charges,,
MICAFUNGIN 100 MG IV SOLR,,J2248,HCPCS,Facility,Inpatient,1,Each,,876,744.6,251.0616,876,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
MICAFUNGIN 100 MG IV SOLR,,J2248,HCPCS,Facility,Outpatient,1,Each,,876,744.6,251.0616,876,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,420.48,48,,percent of total billed charges,,100% of DHS outpatient percentage
MICAFUNGIN 100 MG IV SOLR,,J2248,HCPCS,Facility,Inpatient,1,Each,,876,744.6,251.0616,876,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
NALTREXONE MICROSPHERES 380 MG IM SSRR,,J2315,HCPCS,Facility,Both,1,Each,,5725,4866.25,1640.785,5725,Aetna,Commercial,5267,92,,percent of total billed charges,,
NALTREXONE MICROSPHERES 380 MG IM SSRR,,J2315,HCPCS,Facility,Outpatient,1,Each,,5725,4866.25,1640.785,5725,Aetna,Medicare Advantage,2805.25,49,,percent of total billed charges,,
NALTREXONE MICROSPHERES 380 MG IM SSRR,,J2315,HCPCS,Facility,Inpatient,1,Each,,5725,4866.25,1640.785,5725,Aetna,Medicare Advantage,,,,,Included in per diem rate,
NALTREXONE MICROSPHERES 380 MG IM SSRR,,J2315,HCPCS,Facility,Both,1,Each,,5725,4866.25,1640.785,5725,Aetna,PPO,5324.25,93,,percent of total billed charges,,
NALTREXONE MICROSPHERES 380 MG IM SSRR,,J2315,HCPCS,Facility,Both,1,Each,,5725,4866.25,1640.785,5725,America's PPO,America's PPO,5497.7175,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
NALTREXONE MICROSPHERES 380 MG IM SSRR,,J2315,HCPCS,Facility,Both,1,Each,,5725,4866.25,1640.785,5725,BlueCross BlueShield Minnesota, Federal Employee Program,5633.4,98.4,,percent of total billed charges,,
NALTREXONE MICROSPHERES 380 MG IM SSRR,,J2315,HCPCS,Facility,Both,1,Each,,5725,4866.25,1640.785,5725,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5725,100,,percent of total billed charges,,
NALTREXONE MICROSPHERES 380 MG IM SSRR,,J2315,HCPCS,Facility,Both,1,Each,,5725,4866.25,1640.785,5725,BlueCross BlueShield Minnesota,High Value Network Plan,5152.5,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
NALTREXONE MICROSPHERES 380 MG IM SSRR,,J2315,HCPCS,Facility,Outpatient,1,Each,,5725,4866.25,1640.785,5725,BlueCross BlueShield Minnesota,Medicare Advantage,2805.25,49,,percent of total billed charges,,
NALTREXONE MICROSPHERES 380 MG IM SSRR,,J2315,HCPCS,Facility,Inpatient,1,Each,,5725,4866.25,1640.785,5725,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
NALTREXONE MICROSPHERES 380 MG IM SSRR,,J2315,HCPCS,Facility,Both,1,Each,,5725,4866.25,1640.785,5725,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,5070.6325,88.57,,percent of total billed charges,,
NALTREXONE MICROSPHERES 380 MG IM SSRR,,J2315,HCPCS,Facility,Both,1,Each,,5725,4866.25,1640.785,5725,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1640.785,28.66,,percent of total billed charges,,
NALTREXONE MICROSPHERES 380 MG IM SSRR,,J2315,HCPCS,Facility,Outpatient,1,Each,,5725,4866.25,1640.785,5725,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2805.25,49,,percent of total billed charges,,
NALTREXONE MICROSPHERES 380 MG IM SSRR,,J2315,HCPCS,Facility,Inpatient,1,Each,,5725,4866.25,1640.785,5725,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
NALTREXONE MICROSPHERES 380 MG IM SSRR,,J2315,HCPCS,Facility,Both,1,Each,,5725,4866.25,1640.785,5725,CorVel,Worker's Compensation,5725,100,,percent of total billed charges,,
NALTREXONE MICROSPHERES 380 MG IM SSRR,,J2315,HCPCS,Facility,Both,1,Each,,5725,4866.25,1640.785,5725,First Health Group Corporation,First Health Network,5553.25,97,,percent of total billed charges,,
NALTREXONE MICROSPHERES 380 MG IM SSRR,,J2315,HCPCS,Facility,Both,1,Each,,5725,4866.25,1640.785,5725,"Health Partners, Inc.",Commercial,5415.85,94.6,,percent of total billed charges,,
NALTREXONE MICROSPHERES 380 MG IM SSRR,,J2315,HCPCS,Facility,Outpatient,1,Each,,5725,4866.25,1640.785,5725,"Health Partners, Inc.",Medicare Advantage,2805.25,49,,percent of total billed charges,,
NALTREXONE MICROSPHERES 380 MG IM SSRR,,J2315,HCPCS,Facility,Inpatient,1,Each,,5725,4866.25,1640.785,5725,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
NALTREXONE MICROSPHERES 380 MG IM SSRR,,J2315,HCPCS,Facility,Both,1,Each,,5725,4866.25,1640.785,5725,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3435,60,,percent of total billed charges,,
NALTREXONE MICROSPHERES 380 MG IM SSRR,,J2315,HCPCS,Facility,Both,1,Each,,5725,4866.25,1640.785,5725,"Health Partners, Inc.",State of Minnesota Advantage Program,4665.875,81.5,,percent of total billed charges,,
NALTREXONE MICROSPHERES 380 MG IM SSRR,,J2315,HCPCS,Facility,Both,1,Each,,5725,4866.25,1640.785,5725,"Health Partners, Inc.",State Public Programs,2862.5,50,,percent of total billed charges,,
NALTREXONE MICROSPHERES 380 MG IM SSRR,,J2315,HCPCS,Facility,Both,1,Each,,5725,4866.25,1640.785,5725,Humana Insurance Company,Commercial PPO,5438.75,95,,percent of total billed charges,,
NALTREXONE MICROSPHERES 380 MG IM SSRR,,J2315,HCPCS,Facility,Outpatient,1,Each,,5725,4866.25,1640.785,5725,Humana Insurance Company,Medicare PPO,2805.25,49,,percent of total billed charges,,
NALTREXONE MICROSPHERES 380 MG IM SSRR,,J2315,HCPCS,Facility,Inpatient,1,Each,,5725,4866.25,1640.785,5725,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
NALTREXONE MICROSPHERES 380 MG IM SSRR,,J2315,HCPCS,Facility,Both,1,Each,,5725,4866.25,1640.785,5725,Medica,Individual & Family,5673.475,99.1,,percent of total billed charges,,
NALTREXONE MICROSPHERES 380 MG IM SSRR,,J2315,HCPCS,Facility,Outpatient,1,Each,,5725,4866.25,1640.785,5725,Medica,Medica Advantage Solution,2851.05,49.8,,percent of total billed charges,,
NALTREXONE MICROSPHERES 380 MG IM SSRR,,J2315,HCPCS,Facility,Inpatient,1,Each,,5725,4866.25,1640.785,5725,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
NALTREXONE MICROSPHERES 380 MG IM SSRR,,J2315,HCPCS,Facility,Outpatient,1,Each,,5725,4866.25,1640.785,5725,Medica,Medical Assistance,2553.35,44.6,,percent of total billed charges,,
NALTREXONE MICROSPHERES 380 MG IM SSRR,,J2315,HCPCS,Facility,Inpatient,1,Each,,5725,4866.25,1640.785,5725,Medica,Medical Assistance,,,,,Included in per diem rate,
NALTREXONE MICROSPHERES 380 MG IM SSRR,,J2315,HCPCS,Facility,Outpatient,1,Each,,5725,4866.25,1640.785,5725,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2851.05,49.8,,percent of total billed charges,,
NALTREXONE MICROSPHERES 380 MG IM SSRR,,J2315,HCPCS,Facility,Inpatient,1,Each,,5725,4866.25,1640.785,5725,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
NALTREXONE MICROSPHERES 380 MG IM SSRR,,J2315,HCPCS,Facility,Both,1,Each,,5725,4866.25,1640.785,5725,"Multiplan, Inc.","Multiplan, Inc.",5381.5,94,,percent of total billed charges,,
NALTREXONE MICROSPHERES 380 MG IM SSRR,,J2315,HCPCS,Facility,Outpatient,1,Each,,5725,4866.25,1640.785,5725,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,5158.225,90.1,,percent of total billed charges,,
NALTREXONE MICROSPHERES 380 MG IM SSRR,,J2315,HCPCS,Facility,Inpatient,1,Each,,5725,4866.25,1640.785,5725,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
NALTREXONE MICROSPHERES 380 MG IM SSRR,,J2315,HCPCS,Facility,Both,1,Each,,5725,4866.25,1640.785,5725,"Preferred One Administrative Services, INC.",PPO,5644.85,98.6,,percent of total billed charges,,
NALTREXONE MICROSPHERES 380 MG IM SSRR,,J2315,HCPCS,Facility,Outpatient,1,Each,,5725,4866.25,1640.785,5725,PrimeWest Health,Minnesota Senior Health Options (MSHO),2945.5125,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
NALTREXONE MICROSPHERES 380 MG IM SSRR,,J2315,HCPCS,Facility,Inpatient,1,Each,,5725,4866.25,1640.785,5725,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
NALTREXONE MICROSPHERES 380 MG IM SSRR,,J2315,HCPCS,Facility,Outpatient,1,Each,,5725,4866.25,1640.785,5725,PrimeWest Health,MinnesotaCare,2940.36,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
NALTREXONE MICROSPHERES 380 MG IM SSRR,,J2315,HCPCS,Facility,Inpatient,1,Each,,5725,4866.25,1640.785,5725,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
NALTREXONE MICROSPHERES 380 MG IM SSRR,,J2315,HCPCS,Facility,Both,1,Each,,5725,4866.25,1640.785,5725,Sanford Health Plan,Sanford Health Plan,5267,92,,percent of total billed charges,,
NALTREXONE MICROSPHERES 380 MG IM SSRR,,J2315,HCPCS,Facility,Outpatient,1,Each,,5725,4866.25,1640.785,5725,"UCare Health, Inc.",Individual & Family Plan,3226.0375,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
NALTREXONE MICROSPHERES 380 MG IM SSRR,,J2315,HCPCS,Facility,Inpatient,1,Each,,5725,4866.25,1640.785,5725,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
NALTREXONE MICROSPHERES 380 MG IM SSRR,,J2315,HCPCS,Facility,Outpatient,1,Each,,5725,4866.25,1640.785,5725,"UCare Health, Inc.",Medical Assistance,2889.4075,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
NALTREXONE MICROSPHERES 380 MG IM SSRR,,J2315,HCPCS,Facility,Inpatient,1,Each,,5725,4866.25,1640.785,5725,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
NALTREXONE MICROSPHERES 380 MG IM SSRR,,J2315,HCPCS,Facility,Outpatient,1,Each,,5725,4866.25,1640.785,5725,"UCare Health, Inc.",Medicare Advantage,2889.4075,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
NALTREXONE MICROSPHERES 380 MG IM SSRR,,J2315,HCPCS,Facility,Inpatient,1,Each,,5725,4866.25,1640.785,5725,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
NALTREXONE MICROSPHERES 380 MG IM SSRR,,J2315,HCPCS,Facility,Outpatient,1,Each,,5725,4866.25,1640.785,5725,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2889.4075,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
NALTREXONE MICROSPHERES 380 MG IM SSRR,,J2315,HCPCS,Facility,Inpatient,1,Each,,5725,4866.25,1640.785,5725,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
NALTREXONE MICROSPHERES 380 MG IM SSRR,,J2315,HCPCS,Facility,Both,1,Each,,5725,4866.25,1640.785,5725,UnitedHealthcare,Individual & Family,5381.5,94,,percent of total billed charges,,
NALTREXONE MICROSPHERES 380 MG IM SSRR,,J2315,HCPCS,Facility,Outpatient,1,Each,,5725,4866.25,1640.785,5725,UnitedHealthcare,Medicare Advantage,2805.25,49,,percent of total billed charges,,
NALTREXONE MICROSPHERES 380 MG IM SSRR,,J2315,HCPCS,Facility,Inpatient,1,Each,,5725,4866.25,1640.785,5725,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
NALTREXONE MICROSPHERES 380 MG IM SSRR,,J2315,HCPCS,Facility,Outpatient,1,Each,,5725,4866.25,1640.785,5725,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2748,48,,percent of total billed charges,,100% of DHS outpatient percentage
NALTREXONE MICROSPHERES 380 MG IM SSRR,,J2315,HCPCS,Facility,Inpatient,1,Each,,5725,4866.25,1640.785,5725,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
OMALIZUMAB 150 MG SUBQ SOLR,,J2357,HCPCS,Facility,Both,1,Each,,4704,3998.4,1348.1664,4704,Aetna,Commercial,4327.68,92,,percent of total billed charges,,
OMALIZUMAB 150 MG SUBQ SOLR,,J2357,HCPCS,Facility,Outpatient,1,Each,,4704,3998.4,1348.1664,4704,Aetna,Medicare Advantage,2304.96,49,,percent of total billed charges,,
OMALIZUMAB 150 MG SUBQ SOLR,,J2357,HCPCS,Facility,Inpatient,1,Each,,4704,3998.4,1348.1664,4704,Aetna,Medicare Advantage,,,,,Included in per diem rate,
OMALIZUMAB 150 MG SUBQ SOLR,,J2357,HCPCS,Facility,Both,1,Each,,4704,3998.4,1348.1664,4704,Aetna,PPO,4374.72,93,,percent of total billed charges,,
OMALIZUMAB 150 MG SUBQ SOLR,,J2357,HCPCS,Facility,Both,1,Each,,4704,3998.4,1348.1664,4704,America's PPO,America's PPO,4517.2512,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
OMALIZUMAB 150 MG SUBQ SOLR,,J2357,HCPCS,Facility,Both,1,Each,,4704,3998.4,1348.1664,4704,BlueCross BlueShield Minnesota, Federal Employee Program,4628.736,98.4,,percent of total billed charges,,
OMALIZUMAB 150 MG SUBQ SOLR,,J2357,HCPCS,Facility,Both,1,Each,,4704,3998.4,1348.1664,4704,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,4704,100,,percent of total billed charges,,
OMALIZUMAB 150 MG SUBQ SOLR,,J2357,HCPCS,Facility,Both,1,Each,,4704,3998.4,1348.1664,4704,BlueCross BlueShield Minnesota,High Value Network Plan,4233.6,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
OMALIZUMAB 150 MG SUBQ SOLR,,J2357,HCPCS,Facility,Outpatient,1,Each,,4704,3998.4,1348.1664,4704,BlueCross BlueShield Minnesota,Medicare Advantage,2304.96,49,,percent of total billed charges,,
OMALIZUMAB 150 MG SUBQ SOLR,,J2357,HCPCS,Facility,Inpatient,1,Each,,4704,3998.4,1348.1664,4704,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
OMALIZUMAB 150 MG SUBQ SOLR,,J2357,HCPCS,Facility,Both,1,Each,,4704,3998.4,1348.1664,4704,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4166.3328,88.57,,percent of total billed charges,,
OMALIZUMAB 150 MG SUBQ SOLR,,J2357,HCPCS,Facility,Both,1,Each,,4704,3998.4,1348.1664,4704,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1348.1664,28.66,,percent of total billed charges,,
OMALIZUMAB 150 MG SUBQ SOLR,,J2357,HCPCS,Facility,Outpatient,1,Each,,4704,3998.4,1348.1664,4704,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2304.96,49,,percent of total billed charges,,
OMALIZUMAB 150 MG SUBQ SOLR,,J2357,HCPCS,Facility,Inpatient,1,Each,,4704,3998.4,1348.1664,4704,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
OMALIZUMAB 150 MG SUBQ SOLR,,J2357,HCPCS,Facility,Both,1,Each,,4704,3998.4,1348.1664,4704,CorVel,Worker's Compensation,4704,100,,percent of total billed charges,,
OMALIZUMAB 150 MG SUBQ SOLR,,J2357,HCPCS,Facility,Both,1,Each,,4704,3998.4,1348.1664,4704,First Health Group Corporation,First Health Network,4562.88,97,,percent of total billed charges,,
OMALIZUMAB 150 MG SUBQ SOLR,,J2357,HCPCS,Facility,Both,1,Each,,4704,3998.4,1348.1664,4704,"Health Partners, Inc.",Commercial,4449.984,94.6,,percent of total billed charges,,
OMALIZUMAB 150 MG SUBQ SOLR,,J2357,HCPCS,Facility,Outpatient,1,Each,,4704,3998.4,1348.1664,4704,"Health Partners, Inc.",Medicare Advantage,2304.96,49,,percent of total billed charges,,
OMALIZUMAB 150 MG SUBQ SOLR,,J2357,HCPCS,Facility,Inpatient,1,Each,,4704,3998.4,1348.1664,4704,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
OMALIZUMAB 150 MG SUBQ SOLR,,J2357,HCPCS,Facility,Both,1,Each,,4704,3998.4,1348.1664,4704,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),2822.4,60,,percent of total billed charges,,
OMALIZUMAB 150 MG SUBQ SOLR,,J2357,HCPCS,Facility,Both,1,Each,,4704,3998.4,1348.1664,4704,"Health Partners, Inc.",State of Minnesota Advantage Program,3833.76,81.5,,percent of total billed charges,,
OMALIZUMAB 150 MG SUBQ SOLR,,J2357,HCPCS,Facility,Both,1,Each,,4704,3998.4,1348.1664,4704,"Health Partners, Inc.",State Public Programs,2352,50,,percent of total billed charges,,
OMALIZUMAB 150 MG SUBQ SOLR,,J2357,HCPCS,Facility,Both,1,Each,,4704,3998.4,1348.1664,4704,Humana Insurance Company,Commercial PPO,4468.8,95,,percent of total billed charges,,
OMALIZUMAB 150 MG SUBQ SOLR,,J2357,HCPCS,Facility,Outpatient,1,Each,,4704,3998.4,1348.1664,4704,Humana Insurance Company,Medicare PPO,2304.96,49,,percent of total billed charges,,
OMALIZUMAB 150 MG SUBQ SOLR,,J2357,HCPCS,Facility,Inpatient,1,Each,,4704,3998.4,1348.1664,4704,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
OMALIZUMAB 150 MG SUBQ SOLR,,J2357,HCPCS,Facility,Both,1,Each,,4704,3998.4,1348.1664,4704,Medica,Individual & Family,4661.664,99.1,,percent of total billed charges,,
OMALIZUMAB 150 MG SUBQ SOLR,,J2357,HCPCS,Facility,Outpatient,1,Each,,4704,3998.4,1348.1664,4704,Medica,Medica Advantage Solution,2342.592,49.8,,percent of total billed charges,,
OMALIZUMAB 150 MG SUBQ SOLR,,J2357,HCPCS,Facility,Inpatient,1,Each,,4704,3998.4,1348.1664,4704,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
OMALIZUMAB 150 MG SUBQ SOLR,,J2357,HCPCS,Facility,Outpatient,1,Each,,4704,3998.4,1348.1664,4704,Medica,Medical Assistance,2097.984,44.6,,percent of total billed charges,,
OMALIZUMAB 150 MG SUBQ SOLR,,J2357,HCPCS,Facility,Inpatient,1,Each,,4704,3998.4,1348.1664,4704,Medica,Medical Assistance,,,,,Included in per diem rate,
OMALIZUMAB 150 MG SUBQ SOLR,,J2357,HCPCS,Facility,Outpatient,1,Each,,4704,3998.4,1348.1664,4704,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2342.592,49.8,,percent of total billed charges,,
OMALIZUMAB 150 MG SUBQ SOLR,,J2357,HCPCS,Facility,Inpatient,1,Each,,4704,3998.4,1348.1664,4704,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
OMALIZUMAB 150 MG SUBQ SOLR,,J2357,HCPCS,Facility,Both,1,Each,,4704,3998.4,1348.1664,4704,"Multiplan, Inc.","Multiplan, Inc.",4421.76,94,,percent of total billed charges,,
OMALIZUMAB 150 MG SUBQ SOLR,,J2357,HCPCS,Facility,Outpatient,1,Each,,4704,3998.4,1348.1664,4704,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4238.304,90.1,,percent of total billed charges,,
OMALIZUMAB 150 MG SUBQ SOLR,,J2357,HCPCS,Facility,Inpatient,1,Each,,4704,3998.4,1348.1664,4704,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
OMALIZUMAB 150 MG SUBQ SOLR,,J2357,HCPCS,Facility,Both,1,Each,,4704,3998.4,1348.1664,4704,"Preferred One Administrative Services, INC.",PPO,4638.144,98.6,,percent of total billed charges,,
OMALIZUMAB 150 MG SUBQ SOLR,,J2357,HCPCS,Facility,Outpatient,1,Each,,4704,3998.4,1348.1664,4704,PrimeWest Health,Minnesota Senior Health Options (MSHO),2420.208,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
OMALIZUMAB 150 MG SUBQ SOLR,,J2357,HCPCS,Facility,Inpatient,1,Each,,4704,3998.4,1348.1664,4704,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
OMALIZUMAB 150 MG SUBQ SOLR,,J2357,HCPCS,Facility,Outpatient,1,Each,,4704,3998.4,1348.1664,4704,PrimeWest Health,MinnesotaCare,2415.9744,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
OMALIZUMAB 150 MG SUBQ SOLR,,J2357,HCPCS,Facility,Inpatient,1,Each,,4704,3998.4,1348.1664,4704,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
OMALIZUMAB 150 MG SUBQ SOLR,,J2357,HCPCS,Facility,Both,1,Each,,4704,3998.4,1348.1664,4704,Sanford Health Plan,Sanford Health Plan,4327.68,92,,percent of total billed charges,,
OMALIZUMAB 150 MG SUBQ SOLR,,J2357,HCPCS,Facility,Outpatient,1,Each,,4704,3998.4,1348.1664,4704,"UCare Health, Inc.",Individual & Family Plan,2650.704,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
OMALIZUMAB 150 MG SUBQ SOLR,,J2357,HCPCS,Facility,Inpatient,1,Each,,4704,3998.4,1348.1664,4704,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
OMALIZUMAB 150 MG SUBQ SOLR,,J2357,HCPCS,Facility,Outpatient,1,Each,,4704,3998.4,1348.1664,4704,"UCare Health, Inc.",Medical Assistance,2374.1088,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
OMALIZUMAB 150 MG SUBQ SOLR,,J2357,HCPCS,Facility,Inpatient,1,Each,,4704,3998.4,1348.1664,4704,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
OMALIZUMAB 150 MG SUBQ SOLR,,J2357,HCPCS,Facility,Outpatient,1,Each,,4704,3998.4,1348.1664,4704,"UCare Health, Inc.",Medicare Advantage,2374.1088,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
OMALIZUMAB 150 MG SUBQ SOLR,,J2357,HCPCS,Facility,Inpatient,1,Each,,4704,3998.4,1348.1664,4704,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
OMALIZUMAB 150 MG SUBQ SOLR,,J2357,HCPCS,Facility,Outpatient,1,Each,,4704,3998.4,1348.1664,4704,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2374.1088,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
OMALIZUMAB 150 MG SUBQ SOLR,,J2357,HCPCS,Facility,Inpatient,1,Each,,4704,3998.4,1348.1664,4704,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
OMALIZUMAB 150 MG SUBQ SOLR,,J2357,HCPCS,Facility,Both,1,Each,,4704,3998.4,1348.1664,4704,UnitedHealthcare,Individual & Family,4421.76,94,,percent of total billed charges,,
OMALIZUMAB 150 MG SUBQ SOLR,,J2357,HCPCS,Facility,Outpatient,1,Each,,4704,3998.4,1348.1664,4704,UnitedHealthcare,Medicare Advantage,2304.96,49,,percent of total billed charges,,
OMALIZUMAB 150 MG SUBQ SOLR,,J2357,HCPCS,Facility,Inpatient,1,Each,,4704,3998.4,1348.1664,4704,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
OMALIZUMAB 150 MG SUBQ SOLR,,J2357,HCPCS,Facility,Outpatient,1,Each,,4704,3998.4,1348.1664,4704,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2257.92,48,,percent of total billed charges,,100% of DHS outpatient percentage
OMALIZUMAB 150 MG SUBQ SOLR,,J2357,HCPCS,Facility,Inpatient,1,Each,,4704,3998.4,1348.1664,4704,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
PENICILLIN G POTASSIUM 5 MILLION UNIT INJ SOLR,,J2540,HCPCS,Facility,Both,1,Each,,74,62.9,21.2084,74,Aetna,Commercial,68.08,92,,percent of total billed charges,,
PENICILLIN G POTASSIUM 5 MILLION UNIT INJ SOLR,,J2540,HCPCS,Facility,Outpatient,1,Each,,74,62.9,21.2084,74,Aetna,Medicare Advantage,36.26,49,,percent of total billed charges,,
PENICILLIN G POTASSIUM 5 MILLION UNIT INJ SOLR,,J2540,HCPCS,Facility,Inpatient,1,Each,,74,62.9,21.2084,74,Aetna,Medicare Advantage,,,,,Included in per diem rate,
PENICILLIN G POTASSIUM 5 MILLION UNIT INJ SOLR,,J2540,HCPCS,Facility,Both,1,Each,,74,62.9,21.2084,74,Aetna,PPO,68.82,93,,percent of total billed charges,,
PENICILLIN G POTASSIUM 5 MILLION UNIT INJ SOLR,,J2540,HCPCS,Facility,Both,1,Each,,74,62.9,21.2084,74,America's PPO,America's PPO,71.0622,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
PENICILLIN G POTASSIUM 5 MILLION UNIT INJ SOLR,,J2540,HCPCS,Facility,Both,1,Each,,74,62.9,21.2084,74,BlueCross BlueShield Minnesota, Federal Employee Program,72.816,98.4,,percent of total billed charges,,
PENICILLIN G POTASSIUM 5 MILLION UNIT INJ SOLR,,J2540,HCPCS,Facility,Both,1,Each,,74,62.9,21.2084,74,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,74,100,,percent of total billed charges,,
PENICILLIN G POTASSIUM 5 MILLION UNIT INJ SOLR,,J2540,HCPCS,Facility,Both,1,Each,,74,62.9,21.2084,74,BlueCross BlueShield Minnesota,High Value Network Plan,66.6,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
PENICILLIN G POTASSIUM 5 MILLION UNIT INJ SOLR,,J2540,HCPCS,Facility,Outpatient,1,Each,,74,62.9,21.2084,74,BlueCross BlueShield Minnesota,Medicare Advantage,36.26,49,,percent of total billed charges,,
PENICILLIN G POTASSIUM 5 MILLION UNIT INJ SOLR,,J2540,HCPCS,Facility,Inpatient,1,Each,,74,62.9,21.2084,74,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
PENICILLIN G POTASSIUM 5 MILLION UNIT INJ SOLR,,J2540,HCPCS,Facility,Both,1,Each,,74,62.9,21.2084,74,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,65.5418,88.57,,percent of total billed charges,,
PENICILLIN G POTASSIUM 5 MILLION UNIT INJ SOLR,,J2540,HCPCS,Facility,Both,1,Each,,74,62.9,21.2084,74,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,21.2084,28.66,,percent of total billed charges,,
PENICILLIN G POTASSIUM 5 MILLION UNIT INJ SOLR,,J2540,HCPCS,Facility,Outpatient,1,Each,,74,62.9,21.2084,74,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),36.26,49,,percent of total billed charges,,
PENICILLIN G POTASSIUM 5 MILLION UNIT INJ SOLR,,J2540,HCPCS,Facility,Inpatient,1,Each,,74,62.9,21.2084,74,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
PENICILLIN G POTASSIUM 5 MILLION UNIT INJ SOLR,,J2540,HCPCS,Facility,Both,1,Each,,74,62.9,21.2084,74,CorVel,Worker's Compensation,74,100,,percent of total billed charges,,
PENICILLIN G POTASSIUM 5 MILLION UNIT INJ SOLR,,J2540,HCPCS,Facility,Both,1,Each,,74,62.9,21.2084,74,First Health Group Corporation,First Health Network,71.78,97,,percent of total billed charges,,
PENICILLIN G POTASSIUM 5 MILLION UNIT INJ SOLR,,J2540,HCPCS,Facility,Both,1,Each,,74,62.9,21.2084,74,"Health Partners, Inc.",Commercial,70.004,94.6,,percent of total billed charges,,
PENICILLIN G POTASSIUM 5 MILLION UNIT INJ SOLR,,J2540,HCPCS,Facility,Outpatient,1,Each,,74,62.9,21.2084,74,"Health Partners, Inc.",Medicare Advantage,36.26,49,,percent of total billed charges,,
PENICILLIN G POTASSIUM 5 MILLION UNIT INJ SOLR,,J2540,HCPCS,Facility,Inpatient,1,Each,,74,62.9,21.2084,74,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PENICILLIN G POTASSIUM 5 MILLION UNIT INJ SOLR,,J2540,HCPCS,Facility,Both,1,Each,,74,62.9,21.2084,74,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),44.4,60,,percent of total billed charges,,
PENICILLIN G POTASSIUM 5 MILLION UNIT INJ SOLR,,J2540,HCPCS,Facility,Both,1,Each,,74,62.9,21.2084,74,"Health Partners, Inc.",State of Minnesota Advantage Program,60.31,81.5,,percent of total billed charges,,
PENICILLIN G POTASSIUM 5 MILLION UNIT INJ SOLR,,J2540,HCPCS,Facility,Both,1,Each,,74,62.9,21.2084,74,"Health Partners, Inc.",State Public Programs,37,50,,percent of total billed charges,,
PENICILLIN G POTASSIUM 5 MILLION UNIT INJ SOLR,,J2540,HCPCS,Facility,Both,1,Each,,74,62.9,21.2084,74,Humana Insurance Company,Commercial PPO,70.3,95,,percent of total billed charges,,
PENICILLIN G POTASSIUM 5 MILLION UNIT INJ SOLR,,J2540,HCPCS,Facility,Outpatient,1,Each,,74,62.9,21.2084,74,Humana Insurance Company,Medicare PPO,36.26,49,,percent of total billed charges,,
PENICILLIN G POTASSIUM 5 MILLION UNIT INJ SOLR,,J2540,HCPCS,Facility,Inpatient,1,Each,,74,62.9,21.2084,74,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
PENICILLIN G POTASSIUM 5 MILLION UNIT INJ SOLR,,J2540,HCPCS,Facility,Both,1,Each,,74,62.9,21.2084,74,Medica,Individual & Family,73.334,99.1,,percent of total billed charges,,
PENICILLIN G POTASSIUM 5 MILLION UNIT INJ SOLR,,J2540,HCPCS,Facility,Outpatient,1,Each,,74,62.9,21.2084,74,Medica,Medica Advantage Solution,36.852,49.8,,percent of total billed charges,,
PENICILLIN G POTASSIUM 5 MILLION UNIT INJ SOLR,,J2540,HCPCS,Facility,Inpatient,1,Each,,74,62.9,21.2084,74,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
PENICILLIN G POTASSIUM 5 MILLION UNIT INJ SOLR,,J2540,HCPCS,Facility,Outpatient,1,Each,,74,62.9,21.2084,74,Medica,Medical Assistance,33.004,44.6,,percent of total billed charges,,
PENICILLIN G POTASSIUM 5 MILLION UNIT INJ SOLR,,J2540,HCPCS,Facility,Inpatient,1,Each,,74,62.9,21.2084,74,Medica,Medical Assistance,,,,,Included in per diem rate,
PENICILLIN G POTASSIUM 5 MILLION UNIT INJ SOLR,,J2540,HCPCS,Facility,Outpatient,1,Each,,74,62.9,21.2084,74,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,36.852,49.8,,percent of total billed charges,,
PENICILLIN G POTASSIUM 5 MILLION UNIT INJ SOLR,,J2540,HCPCS,Facility,Inpatient,1,Each,,74,62.9,21.2084,74,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
PENICILLIN G POTASSIUM 5 MILLION UNIT INJ SOLR,,J2540,HCPCS,Facility,Both,1,Each,,74,62.9,21.2084,74,"Multiplan, Inc.","Multiplan, Inc.",69.56,94,,percent of total billed charges,,
PENICILLIN G POTASSIUM 5 MILLION UNIT INJ SOLR,,J2540,HCPCS,Facility,Outpatient,1,Each,,74,62.9,21.2084,74,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,66.674,90.1,,percent of total billed charges,,
PENICILLIN G POTASSIUM 5 MILLION UNIT INJ SOLR,,J2540,HCPCS,Facility,Inpatient,1,Each,,74,62.9,21.2084,74,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
PENICILLIN G POTASSIUM 5 MILLION UNIT INJ SOLR,,J2540,HCPCS,Facility,Both,1,Each,,74,62.9,21.2084,74,"Preferred One Administrative Services, INC.",PPO,72.964,98.6,,percent of total billed charges,,
PENICILLIN G POTASSIUM 5 MILLION UNIT INJ SOLR,,J2540,HCPCS,Facility,Outpatient,1,Each,,74,62.9,21.2084,74,PrimeWest Health,Minnesota Senior Health Options (MSHO),38.073,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
PENICILLIN G POTASSIUM 5 MILLION UNIT INJ SOLR,,J2540,HCPCS,Facility,Inpatient,1,Each,,74,62.9,21.2084,74,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PENICILLIN G POTASSIUM 5 MILLION UNIT INJ SOLR,,J2540,HCPCS,Facility,Outpatient,1,Each,,74,62.9,21.2084,74,PrimeWest Health,MinnesotaCare,38.0064,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
PENICILLIN G POTASSIUM 5 MILLION UNIT INJ SOLR,,J2540,HCPCS,Facility,Inpatient,1,Each,,74,62.9,21.2084,74,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
PENICILLIN G POTASSIUM 5 MILLION UNIT INJ SOLR,,J2540,HCPCS,Facility,Both,1,Each,,74,62.9,21.2084,74,Sanford Health Plan,Sanford Health Plan,68.08,92,,percent of total billed charges,,
PENICILLIN G POTASSIUM 5 MILLION UNIT INJ SOLR,,J2540,HCPCS,Facility,Outpatient,1,Each,,74,62.9,21.2084,74,"UCare Health, Inc.",Individual & Family Plan,41.699,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
PENICILLIN G POTASSIUM 5 MILLION UNIT INJ SOLR,,J2540,HCPCS,Facility,Inpatient,1,Each,,74,62.9,21.2084,74,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
PENICILLIN G POTASSIUM 5 MILLION UNIT INJ SOLR,,J2540,HCPCS,Facility,Outpatient,1,Each,,74,62.9,21.2084,74,"UCare Health, Inc.",Medical Assistance,37.3478,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PENICILLIN G POTASSIUM 5 MILLION UNIT INJ SOLR,,J2540,HCPCS,Facility,Inpatient,1,Each,,74,62.9,21.2084,74,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
PENICILLIN G POTASSIUM 5 MILLION UNIT INJ SOLR,,J2540,HCPCS,Facility,Outpatient,1,Each,,74,62.9,21.2084,74,"UCare Health, Inc.",Medicare Advantage,37.3478,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PENICILLIN G POTASSIUM 5 MILLION UNIT INJ SOLR,,J2540,HCPCS,Facility,Inpatient,1,Each,,74,62.9,21.2084,74,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PENICILLIN G POTASSIUM 5 MILLION UNIT INJ SOLR,,J2540,HCPCS,Facility,Outpatient,1,Each,,74,62.9,21.2084,74,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),37.3478,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PENICILLIN G POTASSIUM 5 MILLION UNIT INJ SOLR,,J2540,HCPCS,Facility,Inpatient,1,Each,,74,62.9,21.2084,74,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PENICILLIN G POTASSIUM 5 MILLION UNIT INJ SOLR,,J2540,HCPCS,Facility,Both,1,Each,,74,62.9,21.2084,74,UnitedHealthcare,Individual & Family,69.56,94,,percent of total billed charges,,
PENICILLIN G POTASSIUM 5 MILLION UNIT INJ SOLR,,J2540,HCPCS,Facility,Outpatient,1,Each,,74,62.9,21.2084,74,UnitedHealthcare,Medicare Advantage,36.26,49,,percent of total billed charges,,
PENICILLIN G POTASSIUM 5 MILLION UNIT INJ SOLR,,J2540,HCPCS,Facility,Inpatient,1,Each,,74,62.9,21.2084,74,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
PENICILLIN G POTASSIUM 5 MILLION UNIT INJ SOLR,,J2540,HCPCS,Facility,Outpatient,1,Each,,74,62.9,21.2084,74,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,35.52,48,,percent of total billed charges,,100% of DHS outpatient percentage
PENICILLIN G POTASSIUM 5 MILLION UNIT INJ SOLR,,J2540,HCPCS,Facility,Inpatient,1,Each,,74,62.9,21.2084,74,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
PIPERACILLIN-TAZOBACTAM 2.25 GRAM IV SOLR,,J2543,HCPCS,Facility,Both,1,Each,,55,46.75,15.763,55,Aetna,Commercial,50.6,92,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 2.25 GRAM IV SOLR,,J2543,HCPCS,Facility,Outpatient,1,Each,,55,46.75,15.763,55,Aetna,Medicare Advantage,26.95,49,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 2.25 GRAM IV SOLR,,J2543,HCPCS,Facility,Inpatient,1,Each,,55,46.75,15.763,55,Aetna,Medicare Advantage,,,,,Included in per diem rate,
PIPERACILLIN-TAZOBACTAM 2.25 GRAM IV SOLR,,J2543,HCPCS,Facility,Both,1,Each,,55,46.75,15.763,55,Aetna,PPO,51.15,93,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 2.25 GRAM IV SOLR,,J2543,HCPCS,Facility,Both,1,Each,,55,46.75,15.763,55,America's PPO,America's PPO,52.8165,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
PIPERACILLIN-TAZOBACTAM 2.25 GRAM IV SOLR,,J2543,HCPCS,Facility,Both,1,Each,,55,46.75,15.763,55,BlueCross BlueShield Minnesota, Federal Employee Program,54.12,98.4,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 2.25 GRAM IV SOLR,,J2543,HCPCS,Facility,Both,1,Each,,55,46.75,15.763,55,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,55,100,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 2.25 GRAM IV SOLR,,J2543,HCPCS,Facility,Both,1,Each,,55,46.75,15.763,55,BlueCross BlueShield Minnesota,High Value Network Plan,49.5,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
PIPERACILLIN-TAZOBACTAM 2.25 GRAM IV SOLR,,J2543,HCPCS,Facility,Outpatient,1,Each,,55,46.75,15.763,55,BlueCross BlueShield Minnesota,Medicare Advantage,26.95,49,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 2.25 GRAM IV SOLR,,J2543,HCPCS,Facility,Inpatient,1,Each,,55,46.75,15.763,55,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
PIPERACILLIN-TAZOBACTAM 2.25 GRAM IV SOLR,,J2543,HCPCS,Facility,Both,1,Each,,55,46.75,15.763,55,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,48.7135,88.57,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 2.25 GRAM IV SOLR,,J2543,HCPCS,Facility,Both,1,Each,,55,46.75,15.763,55,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,15.763,28.66,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 2.25 GRAM IV SOLR,,J2543,HCPCS,Facility,Outpatient,1,Each,,55,46.75,15.763,55,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),26.95,49,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 2.25 GRAM IV SOLR,,J2543,HCPCS,Facility,Inpatient,1,Each,,55,46.75,15.763,55,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
PIPERACILLIN-TAZOBACTAM 2.25 GRAM IV SOLR,,J2543,HCPCS,Facility,Both,1,Each,,55,46.75,15.763,55,CorVel,Worker's Compensation,55,100,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 2.25 GRAM IV SOLR,,J2543,HCPCS,Facility,Both,1,Each,,55,46.75,15.763,55,First Health Group Corporation,First Health Network,53.35,97,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 2.25 GRAM IV SOLR,,J2543,HCPCS,Facility,Both,1,Each,,55,46.75,15.763,55,"Health Partners, Inc.",Commercial,52.03,94.6,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 2.25 GRAM IV SOLR,,J2543,HCPCS,Facility,Outpatient,1,Each,,55,46.75,15.763,55,"Health Partners, Inc.",Medicare Advantage,26.95,49,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 2.25 GRAM IV SOLR,,J2543,HCPCS,Facility,Inpatient,1,Each,,55,46.75,15.763,55,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PIPERACILLIN-TAZOBACTAM 2.25 GRAM IV SOLR,,J2543,HCPCS,Facility,Both,1,Each,,55,46.75,15.763,55,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),33,60,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 2.25 GRAM IV SOLR,,J2543,HCPCS,Facility,Both,1,Each,,55,46.75,15.763,55,"Health Partners, Inc.",State of Minnesota Advantage Program,44.825,81.5,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 2.25 GRAM IV SOLR,,J2543,HCPCS,Facility,Both,1,Each,,55,46.75,15.763,55,"Health Partners, Inc.",State Public Programs,27.5,50,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 2.25 GRAM IV SOLR,,J2543,HCPCS,Facility,Both,1,Each,,55,46.75,15.763,55,Humana Insurance Company,Commercial PPO,52.25,95,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 2.25 GRAM IV SOLR,,J2543,HCPCS,Facility,Outpatient,1,Each,,55,46.75,15.763,55,Humana Insurance Company,Medicare PPO,26.95,49,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 2.25 GRAM IV SOLR,,J2543,HCPCS,Facility,Inpatient,1,Each,,55,46.75,15.763,55,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
PIPERACILLIN-TAZOBACTAM 2.25 GRAM IV SOLR,,J2543,HCPCS,Facility,Both,1,Each,,55,46.75,15.763,55,Medica,Individual & Family,54.505,99.1,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 2.25 GRAM IV SOLR,,J2543,HCPCS,Facility,Outpatient,1,Each,,55,46.75,15.763,55,Medica,Medica Advantage Solution,27.39,49.8,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 2.25 GRAM IV SOLR,,J2543,HCPCS,Facility,Inpatient,1,Each,,55,46.75,15.763,55,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
PIPERACILLIN-TAZOBACTAM 2.25 GRAM IV SOLR,,J2543,HCPCS,Facility,Outpatient,1,Each,,55,46.75,15.763,55,Medica,Medical Assistance,24.53,44.6,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 2.25 GRAM IV SOLR,,J2543,HCPCS,Facility,Inpatient,1,Each,,55,46.75,15.763,55,Medica,Medical Assistance,,,,,Included in per diem rate,
PIPERACILLIN-TAZOBACTAM 2.25 GRAM IV SOLR,,J2543,HCPCS,Facility,Outpatient,1,Each,,55,46.75,15.763,55,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,27.39,49.8,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 2.25 GRAM IV SOLR,,J2543,HCPCS,Facility,Inpatient,1,Each,,55,46.75,15.763,55,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
PIPERACILLIN-TAZOBACTAM 2.25 GRAM IV SOLR,,J2543,HCPCS,Facility,Both,1,Each,,55,46.75,15.763,55,"Multiplan, Inc.","Multiplan, Inc.",51.7,94,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 2.25 GRAM IV SOLR,,J2543,HCPCS,Facility,Outpatient,1,Each,,55,46.75,15.763,55,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,49.555,90.1,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 2.25 GRAM IV SOLR,,J2543,HCPCS,Facility,Inpatient,1,Each,,55,46.75,15.763,55,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
PIPERACILLIN-TAZOBACTAM 2.25 GRAM IV SOLR,,J2543,HCPCS,Facility,Both,1,Each,,55,46.75,15.763,55,"Preferred One Administrative Services, INC.",PPO,54.23,98.6,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 2.25 GRAM IV SOLR,,J2543,HCPCS,Facility,Outpatient,1,Each,,55,46.75,15.763,55,PrimeWest Health,Minnesota Senior Health Options (MSHO),28.2975,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
PIPERACILLIN-TAZOBACTAM 2.25 GRAM IV SOLR,,J2543,HCPCS,Facility,Inpatient,1,Each,,55,46.75,15.763,55,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PIPERACILLIN-TAZOBACTAM 2.25 GRAM IV SOLR,,J2543,HCPCS,Facility,Outpatient,1,Each,,55,46.75,15.763,55,PrimeWest Health,MinnesotaCare,28.248,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
PIPERACILLIN-TAZOBACTAM 2.25 GRAM IV SOLR,,J2543,HCPCS,Facility,Inpatient,1,Each,,55,46.75,15.763,55,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
PIPERACILLIN-TAZOBACTAM 2.25 GRAM IV SOLR,,J2543,HCPCS,Facility,Both,1,Each,,55,46.75,15.763,55,Sanford Health Plan,Sanford Health Plan,50.6,92,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 2.25 GRAM IV SOLR,,J2543,HCPCS,Facility,Outpatient,1,Each,,55,46.75,15.763,55,"UCare Health, Inc.",Individual & Family Plan,30.9925,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
PIPERACILLIN-TAZOBACTAM 2.25 GRAM IV SOLR,,J2543,HCPCS,Facility,Inpatient,1,Each,,55,46.75,15.763,55,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
PIPERACILLIN-TAZOBACTAM 2.25 GRAM IV SOLR,,J2543,HCPCS,Facility,Outpatient,1,Each,,55,46.75,15.763,55,"UCare Health, Inc.",Medical Assistance,27.7585,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PIPERACILLIN-TAZOBACTAM 2.25 GRAM IV SOLR,,J2543,HCPCS,Facility,Inpatient,1,Each,,55,46.75,15.763,55,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
PIPERACILLIN-TAZOBACTAM 2.25 GRAM IV SOLR,,J2543,HCPCS,Facility,Outpatient,1,Each,,55,46.75,15.763,55,"UCare Health, Inc.",Medicare Advantage,27.7585,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PIPERACILLIN-TAZOBACTAM 2.25 GRAM IV SOLR,,J2543,HCPCS,Facility,Inpatient,1,Each,,55,46.75,15.763,55,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PIPERACILLIN-TAZOBACTAM 2.25 GRAM IV SOLR,,J2543,HCPCS,Facility,Outpatient,1,Each,,55,46.75,15.763,55,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),27.7585,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PIPERACILLIN-TAZOBACTAM 2.25 GRAM IV SOLR,,J2543,HCPCS,Facility,Inpatient,1,Each,,55,46.75,15.763,55,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PIPERACILLIN-TAZOBACTAM 2.25 GRAM IV SOLR,,J2543,HCPCS,Facility,Both,1,Each,,55,46.75,15.763,55,UnitedHealthcare,Individual & Family,51.7,94,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 2.25 GRAM IV SOLR,,J2543,HCPCS,Facility,Outpatient,1,Each,,55,46.75,15.763,55,UnitedHealthcare,Medicare Advantage,26.95,49,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 2.25 GRAM IV SOLR,,J2543,HCPCS,Facility,Inpatient,1,Each,,55,46.75,15.763,55,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
PIPERACILLIN-TAZOBACTAM 2.25 GRAM IV SOLR,,J2543,HCPCS,Facility,Outpatient,1,Each,,55,46.75,15.763,55,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,26.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
PIPERACILLIN-TAZOBACTAM 2.25 GRAM IV SOLR,,J2543,HCPCS,Facility,Inpatient,1,Each,,55,46.75,15.763,55,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV SOLR,,J2543,HCPCS,Facility,Both,1,Each,,70,59.5,20.062,70,Aetna,Commercial,64.4,92,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV SOLR,,J2543,HCPCS,Facility,Both,1,Each,,70,59.5,20.062,70,Aetna,Commercial,64.4,92,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV SOLR,,J2543,HCPCS,Facility,Both,1,Each,,98,83.3,28.0868,98,Aetna,Commercial,90.16,92,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV SOLR,,J2543,HCPCS,Facility,Outpatient,1,Each,,70,59.5,20.062,70,Aetna,Medicare Advantage,34.3,49,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV SOLR,,J2543,HCPCS,Facility,Outpatient,1,Each,,70,59.5,20.062,70,Aetna,Medicare Advantage,34.3,49,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV SOLR,,J2543,HCPCS,Facility,Outpatient,1,Each,,98,83.3,28.0868,98,Aetna,Medicare Advantage,48.02,49,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV SOLR,,J2543,HCPCS,Facility,Inpatient,1,Each,,70,59.5,20.062,70,Aetna,Medicare Advantage,,,,,Included in per diem rate,
PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV SOLR,,J2543,HCPCS,Facility,Inpatient,1,Each,,70,59.5,20.062,70,Aetna,Medicare Advantage,,,,,Included in per diem rate,
PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV SOLR,,J2543,HCPCS,Facility,Inpatient,1,Each,,98,83.3,28.0868,98,Aetna,Medicare Advantage,,,,,Included in per diem rate,
PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV SOLR,,J2543,HCPCS,Facility,Both,1,Each,,70,59.5,20.062,70,Aetna,PPO,65.1,93,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV SOLR,,J2543,HCPCS,Facility,Both,1,Each,,70,59.5,20.062,70,Aetna,PPO,65.1,93,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV SOLR,,J2543,HCPCS,Facility,Both,1,Each,,98,83.3,28.0868,98,Aetna,PPO,91.14,93,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV SOLR,,J2543,HCPCS,Facility,Both,1,Each,,70,59.5,20.062,70,America's PPO,America's PPO,67.221,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV SOLR,,J2543,HCPCS,Facility,Both,1,Each,,70,59.5,20.062,70,America's PPO,America's PPO,67.221,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV SOLR,,J2543,HCPCS,Facility,Both,1,Each,,98,83.3,28.0868,98,America's PPO,America's PPO,94.1094,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV SOLR,,J2543,HCPCS,Facility,Both,1,Each,,70,59.5,20.062,70,BlueCross BlueShield Minnesota, Federal Employee Program,68.88,98.4,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV SOLR,,J2543,HCPCS,Facility,Both,1,Each,,70,59.5,20.062,70,BlueCross BlueShield Minnesota, Federal Employee Program,68.88,98.4,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV SOLR,,J2543,HCPCS,Facility,Both,1,Each,,98,83.3,28.0868,98,BlueCross BlueShield Minnesota, Federal Employee Program,96.432,98.4,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV SOLR,,J2543,HCPCS,Facility,Both,1,Each,,70,59.5,20.062,70,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,70,100,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV SOLR,,J2543,HCPCS,Facility,Both,1,Each,,70,59.5,20.062,70,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,70,100,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV SOLR,,J2543,HCPCS,Facility,Both,1,Each,,98,83.3,28.0868,98,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,98,100,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV SOLR,,J2543,HCPCS,Facility,Both,1,Each,,70,59.5,20.062,70,BlueCross BlueShield Minnesota,High Value Network Plan,63,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV SOLR,,J2543,HCPCS,Facility,Both,1,Each,,70,59.5,20.062,70,BlueCross BlueShield Minnesota,High Value Network Plan,63,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV SOLR,,J2543,HCPCS,Facility,Both,1,Each,,98,83.3,28.0868,98,BlueCross BlueShield Minnesota,High Value Network Plan,88.2,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV SOLR,,J2543,HCPCS,Facility,Outpatient,1,Each,,70,59.5,20.062,70,BlueCross BlueShield Minnesota,Medicare Advantage,34.3,49,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV SOLR,,J2543,HCPCS,Facility,Outpatient,1,Each,,70,59.5,20.062,70,BlueCross BlueShield Minnesota,Medicare Advantage,34.3,49,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV SOLR,,J2543,HCPCS,Facility,Outpatient,1,Each,,98,83.3,28.0868,98,BlueCross BlueShield Minnesota,Medicare Advantage,48.02,49,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV SOLR,,J2543,HCPCS,Facility,Inpatient,1,Each,,70,59.5,20.062,70,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV SOLR,,J2543,HCPCS,Facility,Inpatient,1,Each,,70,59.5,20.062,70,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV SOLR,,J2543,HCPCS,Facility,Inpatient,1,Each,,98,83.3,28.0868,98,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV SOLR,,J2543,HCPCS,Facility,Both,1,Each,,70,59.5,20.062,70,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,61.999,88.57,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV SOLR,,J2543,HCPCS,Facility,Both,1,Each,,70,59.5,20.062,70,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,61.999,88.57,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV SOLR,,J2543,HCPCS,Facility,Both,1,Each,,98,83.3,28.0868,98,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,86.7986,88.57,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV SOLR,,J2543,HCPCS,Facility,Both,1,Each,,70,59.5,20.062,70,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,20.062,28.66,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV SOLR,,J2543,HCPCS,Facility,Both,1,Each,,70,59.5,20.062,70,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,20.062,28.66,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV SOLR,,J2543,HCPCS,Facility,Both,1,Each,,98,83.3,28.0868,98,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,28.0868,28.66,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV SOLR,,J2543,HCPCS,Facility,Outpatient,1,Each,,70,59.5,20.062,70,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),34.3,49,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV SOLR,,J2543,HCPCS,Facility,Outpatient,1,Each,,70,59.5,20.062,70,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),34.3,49,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV SOLR,,J2543,HCPCS,Facility,Outpatient,1,Each,,98,83.3,28.0868,98,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),48.02,49,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV SOLR,,J2543,HCPCS,Facility,Inpatient,1,Each,,70,59.5,20.062,70,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV SOLR,,J2543,HCPCS,Facility,Inpatient,1,Each,,70,59.5,20.062,70,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV SOLR,,J2543,HCPCS,Facility,Inpatient,1,Each,,98,83.3,28.0868,98,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV SOLR,,J2543,HCPCS,Facility,Both,1,Each,,70,59.5,20.062,70,CorVel,Worker's Compensation,70,100,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV SOLR,,J2543,HCPCS,Facility,Both,1,Each,,70,59.5,20.062,70,CorVel,Worker's Compensation,70,100,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV SOLR,,J2543,HCPCS,Facility,Both,1,Each,,98,83.3,28.0868,98,CorVel,Worker's Compensation,98,100,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV SOLR,,J2543,HCPCS,Facility,Both,1,Each,,70,59.5,20.062,70,First Health Group Corporation,First Health Network,67.9,97,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV SOLR,,J2543,HCPCS,Facility,Both,1,Each,,70,59.5,20.062,70,First Health Group Corporation,First Health Network,67.9,97,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV SOLR,,J2543,HCPCS,Facility,Both,1,Each,,98,83.3,28.0868,98,First Health Group Corporation,First Health Network,95.06,97,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV SOLR,,J2543,HCPCS,Facility,Both,1,Each,,70,59.5,20.062,70,"Health Partners, Inc.",Commercial,66.22,94.6,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV SOLR,,J2543,HCPCS,Facility,Both,1,Each,,70,59.5,20.062,70,"Health Partners, Inc.",Commercial,66.22,94.6,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV SOLR,,J2543,HCPCS,Facility,Both,1,Each,,98,83.3,28.0868,98,"Health Partners, Inc.",Commercial,92.708,94.6,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV SOLR,,J2543,HCPCS,Facility,Outpatient,1,Each,,70,59.5,20.062,70,"Health Partners, Inc.",Medicare Advantage,34.3,49,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV SOLR,,J2543,HCPCS,Facility,Outpatient,1,Each,,70,59.5,20.062,70,"Health Partners, Inc.",Medicare Advantage,34.3,49,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV SOLR,,J2543,HCPCS,Facility,Outpatient,1,Each,,98,83.3,28.0868,98,"Health Partners, Inc.",Medicare Advantage,48.02,49,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV SOLR,,J2543,HCPCS,Facility,Inpatient,1,Each,,70,59.5,20.062,70,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV SOLR,,J2543,HCPCS,Facility,Inpatient,1,Each,,70,59.5,20.062,70,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV SOLR,,J2543,HCPCS,Facility,Inpatient,1,Each,,98,83.3,28.0868,98,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV SOLR,,J2543,HCPCS,Facility,Both,1,Each,,70,59.5,20.062,70,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),42,60,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV SOLR,,J2543,HCPCS,Facility,Both,1,Each,,70,59.5,20.062,70,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),42,60,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV SOLR,,J2543,HCPCS,Facility,Both,1,Each,,98,83.3,28.0868,98,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),58.8,60,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV SOLR,,J2543,HCPCS,Facility,Both,1,Each,,70,59.5,20.062,70,"Health Partners, Inc.",State of Minnesota Advantage Program,57.05,81.5,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV SOLR,,J2543,HCPCS,Facility,Both,1,Each,,70,59.5,20.062,70,"Health Partners, Inc.",State of Minnesota Advantage Program,57.05,81.5,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV SOLR,,J2543,HCPCS,Facility,Both,1,Each,,98,83.3,28.0868,98,"Health Partners, Inc.",State of Minnesota Advantage Program,79.87,81.5,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV SOLR,,J2543,HCPCS,Facility,Both,1,Each,,70,59.5,20.062,70,"Health Partners, Inc.",State Public Programs,35,50,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV SOLR,,J2543,HCPCS,Facility,Both,1,Each,,70,59.5,20.062,70,"Health Partners, Inc.",State Public Programs,35,50,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV SOLR,,J2543,HCPCS,Facility,Both,1,Each,,98,83.3,28.0868,98,"Health Partners, Inc.",State Public Programs,49,50,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV SOLR,,J2543,HCPCS,Facility,Both,1,Each,,70,59.5,20.062,70,Humana Insurance Company,Commercial PPO,66.5,95,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV SOLR,,J2543,HCPCS,Facility,Both,1,Each,,70,59.5,20.062,70,Humana Insurance Company,Commercial PPO,66.5,95,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV SOLR,,J2543,HCPCS,Facility,Both,1,Each,,98,83.3,28.0868,98,Humana Insurance Company,Commercial PPO,93.1,95,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV SOLR,,J2543,HCPCS,Facility,Outpatient,1,Each,,70,59.5,20.062,70,Humana Insurance Company,Medicare PPO,34.3,49,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV SOLR,,J2543,HCPCS,Facility,Outpatient,1,Each,,70,59.5,20.062,70,Humana Insurance Company,Medicare PPO,34.3,49,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV SOLR,,J2543,HCPCS,Facility,Outpatient,1,Each,,98,83.3,28.0868,98,Humana Insurance Company,Medicare PPO,48.02,49,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV SOLR,,J2543,HCPCS,Facility,Inpatient,1,Each,,70,59.5,20.062,70,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV SOLR,,J2543,HCPCS,Facility,Inpatient,1,Each,,70,59.5,20.062,70,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV SOLR,,J2543,HCPCS,Facility,Inpatient,1,Each,,98,83.3,28.0868,98,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV SOLR,,J2543,HCPCS,Facility,Both,1,Each,,70,59.5,20.062,70,Medica,Individual & Family,69.37,99.1,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV SOLR,,J2543,HCPCS,Facility,Both,1,Each,,70,59.5,20.062,70,Medica,Individual & Family,69.37,99.1,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV SOLR,,J2543,HCPCS,Facility,Both,1,Each,,98,83.3,28.0868,98,Medica,Individual & Family,97.118,99.1,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV SOLR,,J2543,HCPCS,Facility,Outpatient,1,Each,,70,59.5,20.062,70,Medica,Medica Advantage Solution,34.86,49.8,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV SOLR,,J2543,HCPCS,Facility,Outpatient,1,Each,,70,59.5,20.062,70,Medica,Medica Advantage Solution,34.86,49.8,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV SOLR,,J2543,HCPCS,Facility,Outpatient,1,Each,,98,83.3,28.0868,98,Medica,Medica Advantage Solution,48.804,49.8,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV SOLR,,J2543,HCPCS,Facility,Inpatient,1,Each,,70,59.5,20.062,70,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV SOLR,,J2543,HCPCS,Facility,Inpatient,1,Each,,70,59.5,20.062,70,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV SOLR,,J2543,HCPCS,Facility,Inpatient,1,Each,,98,83.3,28.0868,98,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV SOLR,,J2543,HCPCS,Facility,Outpatient,1,Each,,70,59.5,20.062,70,Medica,Medical Assistance,31.22,44.6,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV SOLR,,J2543,HCPCS,Facility,Outpatient,1,Each,,70,59.5,20.062,70,Medica,Medical Assistance,31.22,44.6,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV SOLR,,J2543,HCPCS,Facility,Outpatient,1,Each,,98,83.3,28.0868,98,Medica,Medical Assistance,43.708,44.6,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV SOLR,,J2543,HCPCS,Facility,Inpatient,1,Each,,70,59.5,20.062,70,Medica,Medical Assistance,,,,,Included in per diem rate,
PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV SOLR,,J2543,HCPCS,Facility,Inpatient,1,Each,,70,59.5,20.062,70,Medica,Medical Assistance,,,,,Included in per diem rate,
PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV SOLR,,J2543,HCPCS,Facility,Inpatient,1,Each,,98,83.3,28.0868,98,Medica,Medical Assistance,,,,,Included in per diem rate,
PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV SOLR,,J2543,HCPCS,Facility,Outpatient,1,Each,,70,59.5,20.062,70,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,34.86,49.8,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV SOLR,,J2543,HCPCS,Facility,Outpatient,1,Each,,70,59.5,20.062,70,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,34.86,49.8,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV SOLR,,J2543,HCPCS,Facility,Outpatient,1,Each,,98,83.3,28.0868,98,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,48.804,49.8,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV SOLR,,J2543,HCPCS,Facility,Inpatient,1,Each,,70,59.5,20.062,70,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV SOLR,,J2543,HCPCS,Facility,Inpatient,1,Each,,70,59.5,20.062,70,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV SOLR,,J2543,HCPCS,Facility,Inpatient,1,Each,,98,83.3,28.0868,98,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV SOLR,,J2543,HCPCS,Facility,Both,1,Each,,70,59.5,20.062,70,"Multiplan, Inc.","Multiplan, Inc.",65.8,94,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV SOLR,,J2543,HCPCS,Facility,Both,1,Each,,70,59.5,20.062,70,"Multiplan, Inc.","Multiplan, Inc.",65.8,94,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV SOLR,,J2543,HCPCS,Facility,Both,1,Each,,98,83.3,28.0868,98,"Multiplan, Inc.","Multiplan, Inc.",92.12,94,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV SOLR,,J2543,HCPCS,Facility,Outpatient,1,Each,,70,59.5,20.062,70,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,63.07,90.1,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV SOLR,,J2543,HCPCS,Facility,Outpatient,1,Each,,70,59.5,20.062,70,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,63.07,90.1,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV SOLR,,J2543,HCPCS,Facility,Outpatient,1,Each,,98,83.3,28.0868,98,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,88.298,90.1,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV SOLR,,J2543,HCPCS,Facility,Inpatient,1,Each,,70,59.5,20.062,70,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV SOLR,,J2543,HCPCS,Facility,Inpatient,1,Each,,70,59.5,20.062,70,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV SOLR,,J2543,HCPCS,Facility,Inpatient,1,Each,,98,83.3,28.0868,98,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV SOLR,,J2543,HCPCS,Facility,Both,1,Each,,70,59.5,20.062,70,"Preferred One Administrative Services, INC.",PPO,69.02,98.6,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV SOLR,,J2543,HCPCS,Facility,Both,1,Each,,70,59.5,20.062,70,"Preferred One Administrative Services, INC.",PPO,69.02,98.6,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV SOLR,,J2543,HCPCS,Facility,Both,1,Each,,98,83.3,28.0868,98,"Preferred One Administrative Services, INC.",PPO,96.628,98.6,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV SOLR,,J2543,HCPCS,Facility,Outpatient,1,Each,,70,59.5,20.062,70,PrimeWest Health,Minnesota Senior Health Options (MSHO),36.015,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV SOLR,,J2543,HCPCS,Facility,Outpatient,1,Each,,70,59.5,20.062,70,PrimeWest Health,Minnesota Senior Health Options (MSHO),36.015,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV SOLR,,J2543,HCPCS,Facility,Outpatient,1,Each,,98,83.3,28.0868,98,PrimeWest Health,Minnesota Senior Health Options (MSHO),50.421,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV SOLR,,J2543,HCPCS,Facility,Inpatient,1,Each,,70,59.5,20.062,70,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV SOLR,,J2543,HCPCS,Facility,Inpatient,1,Each,,70,59.5,20.062,70,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV SOLR,,J2543,HCPCS,Facility,Inpatient,1,Each,,98,83.3,28.0868,98,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV SOLR,,J2543,HCPCS,Facility,Outpatient,1,Each,,70,59.5,20.062,70,PrimeWest Health,MinnesotaCare,35.952,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV SOLR,,J2543,HCPCS,Facility,Outpatient,1,Each,,70,59.5,20.062,70,PrimeWest Health,MinnesotaCare,35.952,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV SOLR,,J2543,HCPCS,Facility,Outpatient,1,Each,,98,83.3,28.0868,98,PrimeWest Health,MinnesotaCare,50.3328,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV SOLR,,J2543,HCPCS,Facility,Inpatient,1,Each,,70,59.5,20.062,70,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV SOLR,,J2543,HCPCS,Facility,Inpatient,1,Each,,70,59.5,20.062,70,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV SOLR,,J2543,HCPCS,Facility,Inpatient,1,Each,,98,83.3,28.0868,98,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV SOLR,,J2543,HCPCS,Facility,Both,1,Each,,70,59.5,20.062,70,Sanford Health Plan,Sanford Health Plan,64.4,92,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV SOLR,,J2543,HCPCS,Facility,Both,1,Each,,70,59.5,20.062,70,Sanford Health Plan,Sanford Health Plan,64.4,92,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV SOLR,,J2543,HCPCS,Facility,Both,1,Each,,98,83.3,28.0868,98,Sanford Health Plan,Sanford Health Plan,90.16,92,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV SOLR,,J2543,HCPCS,Facility,Outpatient,1,Each,,70,59.5,20.062,70,"UCare Health, Inc.",Individual & Family Plan,39.445,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV SOLR,,J2543,HCPCS,Facility,Outpatient,1,Each,,70,59.5,20.062,70,"UCare Health, Inc.",Individual & Family Plan,39.445,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV SOLR,,J2543,HCPCS,Facility,Outpatient,1,Each,,98,83.3,28.0868,98,"UCare Health, Inc.",Individual & Family Plan,55.223,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV SOLR,,J2543,HCPCS,Facility,Inpatient,1,Each,,70,59.5,20.062,70,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV SOLR,,J2543,HCPCS,Facility,Inpatient,1,Each,,70,59.5,20.062,70,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV SOLR,,J2543,HCPCS,Facility,Inpatient,1,Each,,98,83.3,28.0868,98,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV SOLR,,J2543,HCPCS,Facility,Outpatient,1,Each,,70,59.5,20.062,70,"UCare Health, Inc.",Medical Assistance,35.329,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV SOLR,,J2543,HCPCS,Facility,Outpatient,1,Each,,70,59.5,20.062,70,"UCare Health, Inc.",Medical Assistance,35.329,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV SOLR,,J2543,HCPCS,Facility,Outpatient,1,Each,,98,83.3,28.0868,98,"UCare Health, Inc.",Medical Assistance,49.4606,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV SOLR,,J2543,HCPCS,Facility,Inpatient,1,Each,,70,59.5,20.062,70,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV SOLR,,J2543,HCPCS,Facility,Inpatient,1,Each,,70,59.5,20.062,70,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV SOLR,,J2543,HCPCS,Facility,Inpatient,1,Each,,98,83.3,28.0868,98,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV SOLR,,J2543,HCPCS,Facility,Outpatient,1,Each,,70,59.5,20.062,70,"UCare Health, Inc.",Medicare Advantage,35.329,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV SOLR,,J2543,HCPCS,Facility,Outpatient,1,Each,,70,59.5,20.062,70,"UCare Health, Inc.",Medicare Advantage,35.329,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV SOLR,,J2543,HCPCS,Facility,Outpatient,1,Each,,98,83.3,28.0868,98,"UCare Health, Inc.",Medicare Advantage,49.4606,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV SOLR,,J2543,HCPCS,Facility,Inpatient,1,Each,,70,59.5,20.062,70,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV SOLR,,J2543,HCPCS,Facility,Inpatient,1,Each,,70,59.5,20.062,70,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV SOLR,,J2543,HCPCS,Facility,Inpatient,1,Each,,98,83.3,28.0868,98,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV SOLR,,J2543,HCPCS,Facility,Outpatient,1,Each,,70,59.5,20.062,70,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),35.329,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV SOLR,,J2543,HCPCS,Facility,Outpatient,1,Each,,70,59.5,20.062,70,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),35.329,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV SOLR,,J2543,HCPCS,Facility,Outpatient,1,Each,,98,83.3,28.0868,98,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),49.4606,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV SOLR,,J2543,HCPCS,Facility,Inpatient,1,Each,,70,59.5,20.062,70,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV SOLR,,J2543,HCPCS,Facility,Inpatient,1,Each,,70,59.5,20.062,70,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV SOLR,,J2543,HCPCS,Facility,Inpatient,1,Each,,98,83.3,28.0868,98,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV SOLR,,J2543,HCPCS,Facility,Both,1,Each,,70,59.5,20.062,70,UnitedHealthcare,Individual & Family,65.8,94,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV SOLR,,J2543,HCPCS,Facility,Both,1,Each,,70,59.5,20.062,70,UnitedHealthcare,Individual & Family,65.8,94,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV SOLR,,J2543,HCPCS,Facility,Both,1,Each,,98,83.3,28.0868,98,UnitedHealthcare,Individual & Family,92.12,94,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV SOLR,,J2543,HCPCS,Facility,Outpatient,1,Each,,70,59.5,20.062,70,UnitedHealthcare,Medicare Advantage,34.3,49,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV SOLR,,J2543,HCPCS,Facility,Outpatient,1,Each,,70,59.5,20.062,70,UnitedHealthcare,Medicare Advantage,34.3,49,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV SOLR,,J2543,HCPCS,Facility,Outpatient,1,Each,,98,83.3,28.0868,98,UnitedHealthcare,Medicare Advantage,48.02,49,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV SOLR,,J2543,HCPCS,Facility,Inpatient,1,Each,,70,59.5,20.062,70,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV SOLR,,J2543,HCPCS,Facility,Inpatient,1,Each,,70,59.5,20.062,70,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV SOLR,,J2543,HCPCS,Facility,Inpatient,1,Each,,98,83.3,28.0868,98,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV SOLR,,J2543,HCPCS,Facility,Outpatient,1,Each,,70,59.5,20.062,70,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,33.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV SOLR,,J2543,HCPCS,Facility,Outpatient,1,Each,,70,59.5,20.062,70,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,33.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV SOLR,,J2543,HCPCS,Facility,Outpatient,1,Each,,98,83.3,28.0868,98,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,47.04,48,,percent of total billed charges,,100% of DHS outpatient percentage
PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV SOLR,,J2543,HCPCS,Facility,Inpatient,1,Each,,70,59.5,20.062,70,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV SOLR,,J2543,HCPCS,Facility,Inpatient,1,Each,,70,59.5,20.062,70,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV SOLR,,J2543,HCPCS,Facility,Inpatient,1,Each,,98,83.3,28.0868,98,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Both,1,Each,,98,83.3,28.0868,98,Aetna,Commercial,90.16,92,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Both,1,Each,,98,83.3,28.0868,98,Aetna,Commercial,90.16,92,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Both,1,Each,,90,76.5,25.794,90,Aetna,Commercial,82.8,92,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Both,1,Each,,90,76.5,25.794,90,Aetna,Commercial,82.8,92,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Outpatient,1,Each,,98,83.3,28.0868,98,Aetna,Medicare Advantage,48.02,49,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Outpatient,1,Each,,98,83.3,28.0868,98,Aetna,Medicare Advantage,48.02,49,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Outpatient,1,Each,,90,76.5,25.794,90,Aetna,Medicare Advantage,44.1,49,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Outpatient,1,Each,,90,76.5,25.794,90,Aetna,Medicare Advantage,44.1,49,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Inpatient,1,Each,,98,83.3,28.0868,98,Aetna,Medicare Advantage,,,,,Included in per diem rate,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Inpatient,1,Each,,98,83.3,28.0868,98,Aetna,Medicare Advantage,,,,,Included in per diem rate,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Inpatient,1,Each,,90,76.5,25.794,90,Aetna,Medicare Advantage,,,,,Included in per diem rate,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Inpatient,1,Each,,90,76.5,25.794,90,Aetna,Medicare Advantage,,,,,Included in per diem rate,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Both,1,Each,,98,83.3,28.0868,98,Aetna,PPO,91.14,93,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Both,1,Each,,98,83.3,28.0868,98,Aetna,PPO,91.14,93,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Both,1,Each,,90,76.5,25.794,90,Aetna,PPO,83.7,93,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Both,1,Each,,90,76.5,25.794,90,Aetna,PPO,83.7,93,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Both,1,Each,,98,83.3,28.0868,98,America's PPO,America's PPO,94.1094,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Both,1,Each,,98,83.3,28.0868,98,America's PPO,America's PPO,94.1094,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Both,1,Each,,90,76.5,25.794,90,America's PPO,America's PPO,86.427,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Both,1,Each,,90,76.5,25.794,90,America's PPO,America's PPO,86.427,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Both,1,Each,,98,83.3,28.0868,98,BlueCross BlueShield Minnesota, Federal Employee Program,96.432,98.4,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Both,1,Each,,98,83.3,28.0868,98,BlueCross BlueShield Minnesota, Federal Employee Program,96.432,98.4,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Both,1,Each,,90,76.5,25.794,90,BlueCross BlueShield Minnesota, Federal Employee Program,88.56,98.4,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Both,1,Each,,90,76.5,25.794,90,BlueCross BlueShield Minnesota, Federal Employee Program,88.56,98.4,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Both,1,Each,,98,83.3,28.0868,98,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,98,100,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Both,1,Each,,98,83.3,28.0868,98,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,98,100,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Both,1,Each,,90,76.5,25.794,90,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,90,100,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Both,1,Each,,90,76.5,25.794,90,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,90,100,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Both,1,Each,,98,83.3,28.0868,98,BlueCross BlueShield Minnesota,High Value Network Plan,88.2,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Both,1,Each,,98,83.3,28.0868,98,BlueCross BlueShield Minnesota,High Value Network Plan,88.2,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Both,1,Each,,90,76.5,25.794,90,BlueCross BlueShield Minnesota,High Value Network Plan,81,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Both,1,Each,,90,76.5,25.794,90,BlueCross BlueShield Minnesota,High Value Network Plan,81,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Outpatient,1,Each,,98,83.3,28.0868,98,BlueCross BlueShield Minnesota,Medicare Advantage,48.02,49,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Outpatient,1,Each,,98,83.3,28.0868,98,BlueCross BlueShield Minnesota,Medicare Advantage,48.02,49,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Outpatient,1,Each,,90,76.5,25.794,90,BlueCross BlueShield Minnesota,Medicare Advantage,44.1,49,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Outpatient,1,Each,,90,76.5,25.794,90,BlueCross BlueShield Minnesota,Medicare Advantage,44.1,49,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Inpatient,1,Each,,98,83.3,28.0868,98,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Inpatient,1,Each,,98,83.3,28.0868,98,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Inpatient,1,Each,,90,76.5,25.794,90,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Inpatient,1,Each,,90,76.5,25.794,90,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Both,1,Each,,98,83.3,28.0868,98,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,86.7986,88.57,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Both,1,Each,,98,83.3,28.0868,98,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,86.7986,88.57,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Both,1,Each,,90,76.5,25.794,90,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,79.713,88.57,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Both,1,Each,,90,76.5,25.794,90,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,79.713,88.57,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Both,1,Each,,98,83.3,28.0868,98,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,28.0868,28.66,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Both,1,Each,,98,83.3,28.0868,98,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,28.0868,28.66,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Both,1,Each,,90,76.5,25.794,90,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,25.794,28.66,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Both,1,Each,,90,76.5,25.794,90,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,25.794,28.66,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Outpatient,1,Each,,98,83.3,28.0868,98,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),48.02,49,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Outpatient,1,Each,,98,83.3,28.0868,98,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),48.02,49,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Outpatient,1,Each,,90,76.5,25.794,90,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),44.1,49,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Outpatient,1,Each,,90,76.5,25.794,90,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),44.1,49,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Inpatient,1,Each,,98,83.3,28.0868,98,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Inpatient,1,Each,,98,83.3,28.0868,98,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Inpatient,1,Each,,90,76.5,25.794,90,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Inpatient,1,Each,,90,76.5,25.794,90,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Both,1,Each,,98,83.3,28.0868,98,CorVel,Worker's Compensation,98,100,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Both,1,Each,,98,83.3,28.0868,98,CorVel,Worker's Compensation,98,100,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Both,1,Each,,90,76.5,25.794,90,CorVel,Worker's Compensation,90,100,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Both,1,Each,,90,76.5,25.794,90,CorVel,Worker's Compensation,90,100,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Both,1,Each,,98,83.3,28.0868,98,First Health Group Corporation,First Health Network,95.06,97,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Both,1,Each,,98,83.3,28.0868,98,First Health Group Corporation,First Health Network,95.06,97,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Both,1,Each,,90,76.5,25.794,90,First Health Group Corporation,First Health Network,87.3,97,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Both,1,Each,,90,76.5,25.794,90,First Health Group Corporation,First Health Network,87.3,97,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Both,1,Each,,98,83.3,28.0868,98,"Health Partners, Inc.",Commercial,92.708,94.6,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Both,1,Each,,98,83.3,28.0868,98,"Health Partners, Inc.",Commercial,92.708,94.6,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Both,1,Each,,90,76.5,25.794,90,"Health Partners, Inc.",Commercial,85.14,94.6,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Both,1,Each,,90,76.5,25.794,90,"Health Partners, Inc.",Commercial,85.14,94.6,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Outpatient,1,Each,,98,83.3,28.0868,98,"Health Partners, Inc.",Medicare Advantage,48.02,49,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Outpatient,1,Each,,98,83.3,28.0868,98,"Health Partners, Inc.",Medicare Advantage,48.02,49,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Outpatient,1,Each,,90,76.5,25.794,90,"Health Partners, Inc.",Medicare Advantage,44.1,49,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Outpatient,1,Each,,90,76.5,25.794,90,"Health Partners, Inc.",Medicare Advantage,44.1,49,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Inpatient,1,Each,,98,83.3,28.0868,98,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Inpatient,1,Each,,98,83.3,28.0868,98,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Inpatient,1,Each,,90,76.5,25.794,90,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Inpatient,1,Each,,90,76.5,25.794,90,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Both,1,Each,,98,83.3,28.0868,98,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),58.8,60,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Both,1,Each,,98,83.3,28.0868,98,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),58.8,60,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Both,1,Each,,90,76.5,25.794,90,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),54,60,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Both,1,Each,,90,76.5,25.794,90,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),54,60,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Both,1,Each,,98,83.3,28.0868,98,"Health Partners, Inc.",State of Minnesota Advantage Program,79.87,81.5,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Both,1,Each,,98,83.3,28.0868,98,"Health Partners, Inc.",State of Minnesota Advantage Program,79.87,81.5,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Both,1,Each,,90,76.5,25.794,90,"Health Partners, Inc.",State of Minnesota Advantage Program,73.35,81.5,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Both,1,Each,,90,76.5,25.794,90,"Health Partners, Inc.",State of Minnesota Advantage Program,73.35,81.5,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Both,1,Each,,98,83.3,28.0868,98,"Health Partners, Inc.",State Public Programs,49,50,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Both,1,Each,,98,83.3,28.0868,98,"Health Partners, Inc.",State Public Programs,49,50,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Both,1,Each,,90,76.5,25.794,90,"Health Partners, Inc.",State Public Programs,45,50,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Both,1,Each,,90,76.5,25.794,90,"Health Partners, Inc.",State Public Programs,45,50,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Both,1,Each,,98,83.3,28.0868,98,Humana Insurance Company,Commercial PPO,93.1,95,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Both,1,Each,,98,83.3,28.0868,98,Humana Insurance Company,Commercial PPO,93.1,95,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Both,1,Each,,90,76.5,25.794,90,Humana Insurance Company,Commercial PPO,85.5,95,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Both,1,Each,,90,76.5,25.794,90,Humana Insurance Company,Commercial PPO,85.5,95,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Outpatient,1,Each,,98,83.3,28.0868,98,Humana Insurance Company,Medicare PPO,48.02,49,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Outpatient,1,Each,,98,83.3,28.0868,98,Humana Insurance Company,Medicare PPO,48.02,49,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Outpatient,1,Each,,90,76.5,25.794,90,Humana Insurance Company,Medicare PPO,44.1,49,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Outpatient,1,Each,,90,76.5,25.794,90,Humana Insurance Company,Medicare PPO,44.1,49,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Inpatient,1,Each,,98,83.3,28.0868,98,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Inpatient,1,Each,,98,83.3,28.0868,98,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Inpatient,1,Each,,90,76.5,25.794,90,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Inpatient,1,Each,,90,76.5,25.794,90,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Both,1,Each,,98,83.3,28.0868,98,Medica,Individual & Family,97.118,99.1,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Both,1,Each,,98,83.3,28.0868,98,Medica,Individual & Family,97.118,99.1,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Both,1,Each,,90,76.5,25.794,90,Medica,Individual & Family,89.19,99.1,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Both,1,Each,,90,76.5,25.794,90,Medica,Individual & Family,89.19,99.1,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Outpatient,1,Each,,98,83.3,28.0868,98,Medica,Medica Advantage Solution,48.804,49.8,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Outpatient,1,Each,,98,83.3,28.0868,98,Medica,Medica Advantage Solution,48.804,49.8,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Outpatient,1,Each,,90,76.5,25.794,90,Medica,Medica Advantage Solution,44.82,49.8,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Outpatient,1,Each,,90,76.5,25.794,90,Medica,Medica Advantage Solution,44.82,49.8,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Inpatient,1,Each,,98,83.3,28.0868,98,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Inpatient,1,Each,,98,83.3,28.0868,98,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Inpatient,1,Each,,90,76.5,25.794,90,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Inpatient,1,Each,,90,76.5,25.794,90,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Outpatient,1,Each,,98,83.3,28.0868,98,Medica,Medical Assistance,43.708,44.6,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Outpatient,1,Each,,98,83.3,28.0868,98,Medica,Medical Assistance,43.708,44.6,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Outpatient,1,Each,,90,76.5,25.794,90,Medica,Medical Assistance,40.14,44.6,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Outpatient,1,Each,,90,76.5,25.794,90,Medica,Medical Assistance,40.14,44.6,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Inpatient,1,Each,,98,83.3,28.0868,98,Medica,Medical Assistance,,,,,Included in per diem rate,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Inpatient,1,Each,,98,83.3,28.0868,98,Medica,Medical Assistance,,,,,Included in per diem rate,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Inpatient,1,Each,,90,76.5,25.794,90,Medica,Medical Assistance,,,,,Included in per diem rate,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Inpatient,1,Each,,90,76.5,25.794,90,Medica,Medical Assistance,,,,,Included in per diem rate,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Outpatient,1,Each,,98,83.3,28.0868,98,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,48.804,49.8,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Outpatient,1,Each,,98,83.3,28.0868,98,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,48.804,49.8,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Outpatient,1,Each,,90,76.5,25.794,90,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,44.82,49.8,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Outpatient,1,Each,,90,76.5,25.794,90,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,44.82,49.8,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Inpatient,1,Each,,98,83.3,28.0868,98,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Inpatient,1,Each,,98,83.3,28.0868,98,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Inpatient,1,Each,,90,76.5,25.794,90,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Inpatient,1,Each,,90,76.5,25.794,90,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Both,1,Each,,98,83.3,28.0868,98,"Multiplan, Inc.","Multiplan, Inc.",92.12,94,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Both,1,Each,,98,83.3,28.0868,98,"Multiplan, Inc.","Multiplan, Inc.",92.12,94,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Both,1,Each,,90,76.5,25.794,90,"Multiplan, Inc.","Multiplan, Inc.",84.6,94,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Both,1,Each,,90,76.5,25.794,90,"Multiplan, Inc.","Multiplan, Inc.",84.6,94,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Outpatient,1,Each,,98,83.3,28.0868,98,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,88.298,90.1,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Outpatient,1,Each,,98,83.3,28.0868,98,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,88.298,90.1,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Outpatient,1,Each,,90,76.5,25.794,90,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,81.09,90.1,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Outpatient,1,Each,,90,76.5,25.794,90,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,81.09,90.1,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Inpatient,1,Each,,98,83.3,28.0868,98,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Inpatient,1,Each,,98,83.3,28.0868,98,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Inpatient,1,Each,,90,76.5,25.794,90,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Inpatient,1,Each,,90,76.5,25.794,90,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Both,1,Each,,98,83.3,28.0868,98,"Preferred One Administrative Services, INC.",PPO,96.628,98.6,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Both,1,Each,,98,83.3,28.0868,98,"Preferred One Administrative Services, INC.",PPO,96.628,98.6,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Both,1,Each,,90,76.5,25.794,90,"Preferred One Administrative Services, INC.",PPO,88.74,98.6,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Both,1,Each,,90,76.5,25.794,90,"Preferred One Administrative Services, INC.",PPO,88.74,98.6,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Outpatient,1,Each,,98,83.3,28.0868,98,PrimeWest Health,Minnesota Senior Health Options (MSHO),50.421,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Outpatient,1,Each,,98,83.3,28.0868,98,PrimeWest Health,Minnesota Senior Health Options (MSHO),50.421,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Outpatient,1,Each,,90,76.5,25.794,90,PrimeWest Health,Minnesota Senior Health Options (MSHO),46.305,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Outpatient,1,Each,,90,76.5,25.794,90,PrimeWest Health,Minnesota Senior Health Options (MSHO),46.305,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Inpatient,1,Each,,98,83.3,28.0868,98,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Inpatient,1,Each,,98,83.3,28.0868,98,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Inpatient,1,Each,,90,76.5,25.794,90,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Inpatient,1,Each,,90,76.5,25.794,90,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Outpatient,1,Each,,98,83.3,28.0868,98,PrimeWest Health,MinnesotaCare,50.3328,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Outpatient,1,Each,,98,83.3,28.0868,98,PrimeWest Health,MinnesotaCare,50.3328,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Outpatient,1,Each,,90,76.5,25.794,90,PrimeWest Health,MinnesotaCare,46.224,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Outpatient,1,Each,,90,76.5,25.794,90,PrimeWest Health,MinnesotaCare,46.224,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Inpatient,1,Each,,98,83.3,28.0868,98,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Inpatient,1,Each,,98,83.3,28.0868,98,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Inpatient,1,Each,,90,76.5,25.794,90,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Inpatient,1,Each,,90,76.5,25.794,90,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Both,1,Each,,98,83.3,28.0868,98,Sanford Health Plan,Sanford Health Plan,90.16,92,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Both,1,Each,,98,83.3,28.0868,98,Sanford Health Plan,Sanford Health Plan,90.16,92,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Both,1,Each,,90,76.5,25.794,90,Sanford Health Plan,Sanford Health Plan,82.8,92,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Both,1,Each,,90,76.5,25.794,90,Sanford Health Plan,Sanford Health Plan,82.8,92,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Outpatient,1,Each,,98,83.3,28.0868,98,"UCare Health, Inc.",Individual & Family Plan,55.223,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Outpatient,1,Each,,98,83.3,28.0868,98,"UCare Health, Inc.",Individual & Family Plan,55.223,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Outpatient,1,Each,,90,76.5,25.794,90,"UCare Health, Inc.",Individual & Family Plan,50.715,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Outpatient,1,Each,,90,76.5,25.794,90,"UCare Health, Inc.",Individual & Family Plan,50.715,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Inpatient,1,Each,,98,83.3,28.0868,98,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Inpatient,1,Each,,98,83.3,28.0868,98,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Inpatient,1,Each,,90,76.5,25.794,90,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Inpatient,1,Each,,90,76.5,25.794,90,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Outpatient,1,Each,,98,83.3,28.0868,98,"UCare Health, Inc.",Medical Assistance,49.4606,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Outpatient,1,Each,,98,83.3,28.0868,98,"UCare Health, Inc.",Medical Assistance,49.4606,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Outpatient,1,Each,,90,76.5,25.794,90,"UCare Health, Inc.",Medical Assistance,45.423,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Outpatient,1,Each,,90,76.5,25.794,90,"UCare Health, Inc.",Medical Assistance,45.423,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Inpatient,1,Each,,98,83.3,28.0868,98,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Inpatient,1,Each,,98,83.3,28.0868,98,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Inpatient,1,Each,,90,76.5,25.794,90,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Inpatient,1,Each,,90,76.5,25.794,90,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Outpatient,1,Each,,98,83.3,28.0868,98,"UCare Health, Inc.",Medicare Advantage,49.4606,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Outpatient,1,Each,,98,83.3,28.0868,98,"UCare Health, Inc.",Medicare Advantage,49.4606,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Outpatient,1,Each,,90,76.5,25.794,90,"UCare Health, Inc.",Medicare Advantage,45.423,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Outpatient,1,Each,,90,76.5,25.794,90,"UCare Health, Inc.",Medicare Advantage,45.423,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Inpatient,1,Each,,98,83.3,28.0868,98,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Inpatient,1,Each,,98,83.3,28.0868,98,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Inpatient,1,Each,,90,76.5,25.794,90,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Inpatient,1,Each,,90,76.5,25.794,90,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Outpatient,1,Each,,98,83.3,28.0868,98,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),49.4606,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Outpatient,1,Each,,98,83.3,28.0868,98,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),49.4606,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Outpatient,1,Each,,90,76.5,25.794,90,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),45.423,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Outpatient,1,Each,,90,76.5,25.794,90,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),45.423,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Inpatient,1,Each,,98,83.3,28.0868,98,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Inpatient,1,Each,,98,83.3,28.0868,98,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Inpatient,1,Each,,90,76.5,25.794,90,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Inpatient,1,Each,,90,76.5,25.794,90,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Both,1,Each,,98,83.3,28.0868,98,UnitedHealthcare,Individual & Family,92.12,94,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Both,1,Each,,98,83.3,28.0868,98,UnitedHealthcare,Individual & Family,92.12,94,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Both,1,Each,,90,76.5,25.794,90,UnitedHealthcare,Individual & Family,84.6,94,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Both,1,Each,,90,76.5,25.794,90,UnitedHealthcare,Individual & Family,84.6,94,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Outpatient,1,Each,,98,83.3,28.0868,98,UnitedHealthcare,Medicare Advantage,48.02,49,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Outpatient,1,Each,,98,83.3,28.0868,98,UnitedHealthcare,Medicare Advantage,48.02,49,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Outpatient,1,Each,,90,76.5,25.794,90,UnitedHealthcare,Medicare Advantage,44.1,49,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Outpatient,1,Each,,90,76.5,25.794,90,UnitedHealthcare,Medicare Advantage,44.1,49,,percent of total billed charges,,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Inpatient,1,Each,,98,83.3,28.0868,98,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Inpatient,1,Each,,98,83.3,28.0868,98,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Inpatient,1,Each,,90,76.5,25.794,90,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Inpatient,1,Each,,90,76.5,25.794,90,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Outpatient,1,Each,,98,83.3,28.0868,98,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,47.04,48,,percent of total billed charges,,100% of DHS outpatient percentage
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Outpatient,1,Each,,98,83.3,28.0868,98,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,47.04,48,,percent of total billed charges,,100% of DHS outpatient percentage
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Outpatient,1,Each,,90,76.5,25.794,90,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,43.2,48,,percent of total billed charges,,100% of DHS outpatient percentage
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Outpatient,1,Each,,90,76.5,25.794,90,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,43.2,48,,percent of total billed charges,,100% of DHS outpatient percentage
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Inpatient,1,Each,,98,83.3,28.0868,98,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Inpatient,1,Each,,98,83.3,28.0868,98,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Inpatient,1,Each,,90,76.5,25.794,90,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV SOLR,,J2543,HCPCS,Facility,Inpatient,1,Each,,90,76.5,25.794,90,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
SINCALIDE 5 MCG INJ SOLR,,J2805,HCPCS,Facility,Both,1,Each,,677,575.45,194.0282,677,Aetna,Commercial,622.84,92,,percent of total billed charges,,
SINCALIDE 5 MCG INJ SOLR,,J2805,HCPCS,Facility,Outpatient,1,Each,,677,575.45,194.0282,677,Aetna,Medicare Advantage,331.73,49,,percent of total billed charges,,
SINCALIDE 5 MCG INJ SOLR,,J2805,HCPCS,Facility,Inpatient,1,Each,,677,575.45,194.0282,677,Aetna,Medicare Advantage,,,,,Included in per diem rate,
SINCALIDE 5 MCG INJ SOLR,,J2805,HCPCS,Facility,Both,1,Each,,677,575.45,194.0282,677,Aetna,PPO,629.61,93,,percent of total billed charges,,
SINCALIDE 5 MCG INJ SOLR,,J2805,HCPCS,Facility,Both,1,Each,,677,575.45,194.0282,677,America's PPO,America's PPO,650.1231,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SINCALIDE 5 MCG INJ SOLR,,J2805,HCPCS,Facility,Both,1,Each,,677,575.45,194.0282,677,BlueCross BlueShield Minnesota, Federal Employee Program,666.168,98.4,,percent of total billed charges,,
SINCALIDE 5 MCG INJ SOLR,,J2805,HCPCS,Facility,Both,1,Each,,677,575.45,194.0282,677,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,677,100,,percent of total billed charges,,
SINCALIDE 5 MCG INJ SOLR,,J2805,HCPCS,Facility,Both,1,Each,,677,575.45,194.0282,677,BlueCross BlueShield Minnesota,High Value Network Plan,609.3,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
SINCALIDE 5 MCG INJ SOLR,,J2805,HCPCS,Facility,Outpatient,1,Each,,677,575.45,194.0282,677,BlueCross BlueShield Minnesota,Medicare Advantage,331.73,49,,percent of total billed charges,,
SINCALIDE 5 MCG INJ SOLR,,J2805,HCPCS,Facility,Inpatient,1,Each,,677,575.45,194.0282,677,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
SINCALIDE 5 MCG INJ SOLR,,J2805,HCPCS,Facility,Both,1,Each,,677,575.45,194.0282,677,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,599.6189,88.57,,percent of total billed charges,,
SINCALIDE 5 MCG INJ SOLR,,J2805,HCPCS,Facility,Both,1,Each,,677,575.45,194.0282,677,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,194.0282,28.66,,percent of total billed charges,,
SINCALIDE 5 MCG INJ SOLR,,J2805,HCPCS,Facility,Outpatient,1,Each,,677,575.45,194.0282,677,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),331.73,49,,percent of total billed charges,,
SINCALIDE 5 MCG INJ SOLR,,J2805,HCPCS,Facility,Inpatient,1,Each,,677,575.45,194.0282,677,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
SINCALIDE 5 MCG INJ SOLR,,J2805,HCPCS,Facility,Both,1,Each,,677,575.45,194.0282,677,CorVel,Worker's Compensation,677,100,,percent of total billed charges,,
SINCALIDE 5 MCG INJ SOLR,,J2805,HCPCS,Facility,Both,1,Each,,677,575.45,194.0282,677,First Health Group Corporation,First Health Network,656.69,97,,percent of total billed charges,,
SINCALIDE 5 MCG INJ SOLR,,J2805,HCPCS,Facility,Both,1,Each,,677,575.45,194.0282,677,"Health Partners, Inc.",Commercial,640.442,94.6,,percent of total billed charges,,
SINCALIDE 5 MCG INJ SOLR,,J2805,HCPCS,Facility,Outpatient,1,Each,,677,575.45,194.0282,677,"Health Partners, Inc.",Medicare Advantage,331.73,49,,percent of total billed charges,,
SINCALIDE 5 MCG INJ SOLR,,J2805,HCPCS,Facility,Inpatient,1,Each,,677,575.45,194.0282,677,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SINCALIDE 5 MCG INJ SOLR,,J2805,HCPCS,Facility,Both,1,Each,,677,575.45,194.0282,677,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),406.2,60,,percent of total billed charges,,
SINCALIDE 5 MCG INJ SOLR,,J2805,HCPCS,Facility,Both,1,Each,,677,575.45,194.0282,677,"Health Partners, Inc.",State of Minnesota Advantage Program,551.755,81.5,,percent of total billed charges,,
SINCALIDE 5 MCG INJ SOLR,,J2805,HCPCS,Facility,Both,1,Each,,677,575.45,194.0282,677,"Health Partners, Inc.",State Public Programs,338.5,50,,percent of total billed charges,,
SINCALIDE 5 MCG INJ SOLR,,J2805,HCPCS,Facility,Both,1,Each,,677,575.45,194.0282,677,Humana Insurance Company,Commercial PPO,643.15,95,,percent of total billed charges,,
SINCALIDE 5 MCG INJ SOLR,,J2805,HCPCS,Facility,Outpatient,1,Each,,677,575.45,194.0282,677,Humana Insurance Company,Medicare PPO,331.73,49,,percent of total billed charges,,
SINCALIDE 5 MCG INJ SOLR,,J2805,HCPCS,Facility,Inpatient,1,Each,,677,575.45,194.0282,677,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
SINCALIDE 5 MCG INJ SOLR,,J2805,HCPCS,Facility,Both,1,Each,,677,575.45,194.0282,677,Medica,Individual & Family,670.907,99.1,,percent of total billed charges,,
SINCALIDE 5 MCG INJ SOLR,,J2805,HCPCS,Facility,Outpatient,1,Each,,677,575.45,194.0282,677,Medica,Medica Advantage Solution,337.146,49.8,,percent of total billed charges,,
SINCALIDE 5 MCG INJ SOLR,,J2805,HCPCS,Facility,Inpatient,1,Each,,677,575.45,194.0282,677,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
SINCALIDE 5 MCG INJ SOLR,,J2805,HCPCS,Facility,Outpatient,1,Each,,677,575.45,194.0282,677,Medica,Medical Assistance,301.942,44.6,,percent of total billed charges,,
SINCALIDE 5 MCG INJ SOLR,,J2805,HCPCS,Facility,Inpatient,1,Each,,677,575.45,194.0282,677,Medica,Medical Assistance,,,,,Included in per diem rate,
SINCALIDE 5 MCG INJ SOLR,,J2805,HCPCS,Facility,Outpatient,1,Each,,677,575.45,194.0282,677,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,337.146,49.8,,percent of total billed charges,,
SINCALIDE 5 MCG INJ SOLR,,J2805,HCPCS,Facility,Inpatient,1,Each,,677,575.45,194.0282,677,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
SINCALIDE 5 MCG INJ SOLR,,J2805,HCPCS,Facility,Both,1,Each,,677,575.45,194.0282,677,"Multiplan, Inc.","Multiplan, Inc.",636.38,94,,percent of total billed charges,,
SINCALIDE 5 MCG INJ SOLR,,J2805,HCPCS,Facility,Outpatient,1,Each,,677,575.45,194.0282,677,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,609.977,90.1,,percent of total billed charges,,
SINCALIDE 5 MCG INJ SOLR,,J2805,HCPCS,Facility,Inpatient,1,Each,,677,575.45,194.0282,677,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
SINCALIDE 5 MCG INJ SOLR,,J2805,HCPCS,Facility,Both,1,Each,,677,575.45,194.0282,677,"Preferred One Administrative Services, INC.",PPO,667.522,98.6,,percent of total billed charges,,
SINCALIDE 5 MCG INJ SOLR,,J2805,HCPCS,Facility,Outpatient,1,Each,,677,575.45,194.0282,677,PrimeWest Health,Minnesota Senior Health Options (MSHO),348.3165,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
SINCALIDE 5 MCG INJ SOLR,,J2805,HCPCS,Facility,Inpatient,1,Each,,677,575.45,194.0282,677,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SINCALIDE 5 MCG INJ SOLR,,J2805,HCPCS,Facility,Outpatient,1,Each,,677,575.45,194.0282,677,PrimeWest Health,MinnesotaCare,347.7072,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
SINCALIDE 5 MCG INJ SOLR,,J2805,HCPCS,Facility,Inpatient,1,Each,,677,575.45,194.0282,677,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
SINCALIDE 5 MCG INJ SOLR,,J2805,HCPCS,Facility,Both,1,Each,,677,575.45,194.0282,677,Sanford Health Plan,Sanford Health Plan,622.84,92,,percent of total billed charges,,
SINCALIDE 5 MCG INJ SOLR,,J2805,HCPCS,Facility,Outpatient,1,Each,,677,575.45,194.0282,677,"UCare Health, Inc.",Individual & Family Plan,381.4895,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
SINCALIDE 5 MCG INJ SOLR,,J2805,HCPCS,Facility,Inpatient,1,Each,,677,575.45,194.0282,677,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
SINCALIDE 5 MCG INJ SOLR,,J2805,HCPCS,Facility,Outpatient,1,Each,,677,575.45,194.0282,677,"UCare Health, Inc.",Medical Assistance,341.6819,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SINCALIDE 5 MCG INJ SOLR,,J2805,HCPCS,Facility,Inpatient,1,Each,,677,575.45,194.0282,677,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
SINCALIDE 5 MCG INJ SOLR,,J2805,HCPCS,Facility,Outpatient,1,Each,,677,575.45,194.0282,677,"UCare Health, Inc.",Medicare Advantage,341.6819,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SINCALIDE 5 MCG INJ SOLR,,J2805,HCPCS,Facility,Inpatient,1,Each,,677,575.45,194.0282,677,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SINCALIDE 5 MCG INJ SOLR,,J2805,HCPCS,Facility,Outpatient,1,Each,,677,575.45,194.0282,677,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),341.6819,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SINCALIDE 5 MCG INJ SOLR,,J2805,HCPCS,Facility,Inpatient,1,Each,,677,575.45,194.0282,677,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SINCALIDE 5 MCG INJ SOLR,,J2805,HCPCS,Facility,Both,1,Each,,677,575.45,194.0282,677,UnitedHealthcare,Individual & Family,636.38,94,,percent of total billed charges,,
SINCALIDE 5 MCG INJ SOLR,,J2805,HCPCS,Facility,Outpatient,1,Each,,677,575.45,194.0282,677,UnitedHealthcare,Medicare Advantage,331.73,49,,percent of total billed charges,,
SINCALIDE 5 MCG INJ SOLR,,J2805,HCPCS,Facility,Inpatient,1,Each,,677,575.45,194.0282,677,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
SINCALIDE 5 MCG INJ SOLR,,J2805,HCPCS,Facility,Outpatient,1,Each,,677,575.45,194.0282,677,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,324.96,48,,percent of total billed charges,,100% of DHS outpatient percentage
SINCALIDE 5 MCG INJ SOLR,,J2805,HCPCS,Facility,Inpatient,1,Each,,677,575.45,194.0282,677,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
METHYLPREDNISOLONE SOD SUC(PF) 40 MG/ML INJ SOLR,,J2920,HCPCS,Facility,Both,1,Each,,37,31.45,10.6042,37,Aetna,Commercial,34.04,92,,percent of total billed charges,,
METHYLPREDNISOLONE SOD SUC(PF) 40 MG/ML INJ SOLR,,J2920,HCPCS,Facility,Outpatient,1,Each,,37,31.45,10.6042,37,Aetna,Medicare Advantage,18.13,49,,percent of total billed charges,,
METHYLPREDNISOLONE SOD SUC(PF) 40 MG/ML INJ SOLR,,J2920,HCPCS,Facility,Inpatient,1,Each,,37,31.45,10.6042,37,Aetna,Medicare Advantage,,,,,Included in per diem rate,
METHYLPREDNISOLONE SOD SUC(PF) 40 MG/ML INJ SOLR,,J2920,HCPCS,Facility,Both,1,Each,,37,31.45,10.6042,37,Aetna,PPO,34.41,93,,percent of total billed charges,,
METHYLPREDNISOLONE SOD SUC(PF) 40 MG/ML INJ SOLR,,J2920,HCPCS,Facility,Both,1,Each,,37,31.45,10.6042,37,America's PPO,America's PPO,35.5311,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
METHYLPREDNISOLONE SOD SUC(PF) 40 MG/ML INJ SOLR,,J2920,HCPCS,Facility,Both,1,Each,,37,31.45,10.6042,37,BlueCross BlueShield Minnesota, Federal Employee Program,36.408,98.4,,percent of total billed charges,,
METHYLPREDNISOLONE SOD SUC(PF) 40 MG/ML INJ SOLR,,J2920,HCPCS,Facility,Both,1,Each,,37,31.45,10.6042,37,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,37,100,,percent of total billed charges,,
METHYLPREDNISOLONE SOD SUC(PF) 40 MG/ML INJ SOLR,,J2920,HCPCS,Facility,Both,1,Each,,37,31.45,10.6042,37,BlueCross BlueShield Minnesota,High Value Network Plan,33.3,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
METHYLPREDNISOLONE SOD SUC(PF) 40 MG/ML INJ SOLR,,J2920,HCPCS,Facility,Outpatient,1,Each,,37,31.45,10.6042,37,BlueCross BlueShield Minnesota,Medicare Advantage,18.13,49,,percent of total billed charges,,
METHYLPREDNISOLONE SOD SUC(PF) 40 MG/ML INJ SOLR,,J2920,HCPCS,Facility,Inpatient,1,Each,,37,31.45,10.6042,37,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
METHYLPREDNISOLONE SOD SUC(PF) 40 MG/ML INJ SOLR,,J2920,HCPCS,Facility,Both,1,Each,,37,31.45,10.6042,37,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,32.7709,88.57,,percent of total billed charges,,
METHYLPREDNISOLONE SOD SUC(PF) 40 MG/ML INJ SOLR,,J2920,HCPCS,Facility,Both,1,Each,,37,31.45,10.6042,37,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,10.6042,28.66,,percent of total billed charges,,
METHYLPREDNISOLONE SOD SUC(PF) 40 MG/ML INJ SOLR,,J2920,HCPCS,Facility,Outpatient,1,Each,,37,31.45,10.6042,37,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),18.13,49,,percent of total billed charges,,
METHYLPREDNISOLONE SOD SUC(PF) 40 MG/ML INJ SOLR,,J2920,HCPCS,Facility,Inpatient,1,Each,,37,31.45,10.6042,37,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
METHYLPREDNISOLONE SOD SUC(PF) 40 MG/ML INJ SOLR,,J2920,HCPCS,Facility,Both,1,Each,,37,31.45,10.6042,37,CorVel,Worker's Compensation,37,100,,percent of total billed charges,,
METHYLPREDNISOLONE SOD SUC(PF) 40 MG/ML INJ SOLR,,J2920,HCPCS,Facility,Both,1,Each,,37,31.45,10.6042,37,First Health Group Corporation,First Health Network,35.89,97,,percent of total billed charges,,
METHYLPREDNISOLONE SOD SUC(PF) 40 MG/ML INJ SOLR,,J2920,HCPCS,Facility,Both,1,Each,,37,31.45,10.6042,37,"Health Partners, Inc.",Commercial,35.002,94.6,,percent of total billed charges,,
METHYLPREDNISOLONE SOD SUC(PF) 40 MG/ML INJ SOLR,,J2920,HCPCS,Facility,Outpatient,1,Each,,37,31.45,10.6042,37,"Health Partners, Inc.",Medicare Advantage,18.13,49,,percent of total billed charges,,
METHYLPREDNISOLONE SOD SUC(PF) 40 MG/ML INJ SOLR,,J2920,HCPCS,Facility,Inpatient,1,Each,,37,31.45,10.6042,37,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
METHYLPREDNISOLONE SOD SUC(PF) 40 MG/ML INJ SOLR,,J2920,HCPCS,Facility,Both,1,Each,,37,31.45,10.6042,37,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),22.2,60,,percent of total billed charges,,
METHYLPREDNISOLONE SOD SUC(PF) 40 MG/ML INJ SOLR,,J2920,HCPCS,Facility,Both,1,Each,,37,31.45,10.6042,37,"Health Partners, Inc.",State of Minnesota Advantage Program,30.155,81.5,,percent of total billed charges,,
METHYLPREDNISOLONE SOD SUC(PF) 40 MG/ML INJ SOLR,,J2920,HCPCS,Facility,Both,1,Each,,37,31.45,10.6042,37,"Health Partners, Inc.",State Public Programs,18.5,50,,percent of total billed charges,,
METHYLPREDNISOLONE SOD SUC(PF) 40 MG/ML INJ SOLR,,J2920,HCPCS,Facility,Both,1,Each,,37,31.45,10.6042,37,Humana Insurance Company,Commercial PPO,35.15,95,,percent of total billed charges,,
METHYLPREDNISOLONE SOD SUC(PF) 40 MG/ML INJ SOLR,,J2920,HCPCS,Facility,Outpatient,1,Each,,37,31.45,10.6042,37,Humana Insurance Company,Medicare PPO,18.13,49,,percent of total billed charges,,
METHYLPREDNISOLONE SOD SUC(PF) 40 MG/ML INJ SOLR,,J2920,HCPCS,Facility,Inpatient,1,Each,,37,31.45,10.6042,37,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
METHYLPREDNISOLONE SOD SUC(PF) 40 MG/ML INJ SOLR,,J2920,HCPCS,Facility,Both,1,Each,,37,31.45,10.6042,37,Medica,Individual & Family,36.667,99.1,,percent of total billed charges,,
METHYLPREDNISOLONE SOD SUC(PF) 40 MG/ML INJ SOLR,,J2920,HCPCS,Facility,Outpatient,1,Each,,37,31.45,10.6042,37,Medica,Medica Advantage Solution,18.426,49.8,,percent of total billed charges,,
METHYLPREDNISOLONE SOD SUC(PF) 40 MG/ML INJ SOLR,,J2920,HCPCS,Facility,Inpatient,1,Each,,37,31.45,10.6042,37,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
METHYLPREDNISOLONE SOD SUC(PF) 40 MG/ML INJ SOLR,,J2920,HCPCS,Facility,Outpatient,1,Each,,37,31.45,10.6042,37,Medica,Medical Assistance,16.502,44.6,,percent of total billed charges,,
METHYLPREDNISOLONE SOD SUC(PF) 40 MG/ML INJ SOLR,,J2920,HCPCS,Facility,Inpatient,1,Each,,37,31.45,10.6042,37,Medica,Medical Assistance,,,,,Included in per diem rate,
METHYLPREDNISOLONE SOD SUC(PF) 40 MG/ML INJ SOLR,,J2920,HCPCS,Facility,Outpatient,1,Each,,37,31.45,10.6042,37,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,18.426,49.8,,percent of total billed charges,,
METHYLPREDNISOLONE SOD SUC(PF) 40 MG/ML INJ SOLR,,J2920,HCPCS,Facility,Inpatient,1,Each,,37,31.45,10.6042,37,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
METHYLPREDNISOLONE SOD SUC(PF) 40 MG/ML INJ SOLR,,J2920,HCPCS,Facility,Both,1,Each,,37,31.45,10.6042,37,"Multiplan, Inc.","Multiplan, Inc.",34.78,94,,percent of total billed charges,,
METHYLPREDNISOLONE SOD SUC(PF) 40 MG/ML INJ SOLR,,J2920,HCPCS,Facility,Outpatient,1,Each,,37,31.45,10.6042,37,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,33.337,90.1,,percent of total billed charges,,
METHYLPREDNISOLONE SOD SUC(PF) 40 MG/ML INJ SOLR,,J2920,HCPCS,Facility,Inpatient,1,Each,,37,31.45,10.6042,37,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
METHYLPREDNISOLONE SOD SUC(PF) 40 MG/ML INJ SOLR,,J2920,HCPCS,Facility,Both,1,Each,,37,31.45,10.6042,37,"Preferred One Administrative Services, INC.",PPO,36.482,98.6,,percent of total billed charges,,
METHYLPREDNISOLONE SOD SUC(PF) 40 MG/ML INJ SOLR,,J2920,HCPCS,Facility,Outpatient,1,Each,,37,31.45,10.6042,37,PrimeWest Health,Minnesota Senior Health Options (MSHO),19.0365,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
METHYLPREDNISOLONE SOD SUC(PF) 40 MG/ML INJ SOLR,,J2920,HCPCS,Facility,Inpatient,1,Each,,37,31.45,10.6042,37,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
METHYLPREDNISOLONE SOD SUC(PF) 40 MG/ML INJ SOLR,,J2920,HCPCS,Facility,Outpatient,1,Each,,37,31.45,10.6042,37,PrimeWest Health,MinnesotaCare,19.0032,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
METHYLPREDNISOLONE SOD SUC(PF) 40 MG/ML INJ SOLR,,J2920,HCPCS,Facility,Inpatient,1,Each,,37,31.45,10.6042,37,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
METHYLPREDNISOLONE SOD SUC(PF) 40 MG/ML INJ SOLR,,J2920,HCPCS,Facility,Both,1,Each,,37,31.45,10.6042,37,Sanford Health Plan,Sanford Health Plan,34.04,92,,percent of total billed charges,,
METHYLPREDNISOLONE SOD SUC(PF) 40 MG/ML INJ SOLR,,J2920,HCPCS,Facility,Outpatient,1,Each,,37,31.45,10.6042,37,"UCare Health, Inc.",Individual & Family Plan,20.8495,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
METHYLPREDNISOLONE SOD SUC(PF) 40 MG/ML INJ SOLR,,J2920,HCPCS,Facility,Inpatient,1,Each,,37,31.45,10.6042,37,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
METHYLPREDNISOLONE SOD SUC(PF) 40 MG/ML INJ SOLR,,J2920,HCPCS,Facility,Outpatient,1,Each,,37,31.45,10.6042,37,"UCare Health, Inc.",Medical Assistance,18.6739,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
METHYLPREDNISOLONE SOD SUC(PF) 40 MG/ML INJ SOLR,,J2920,HCPCS,Facility,Inpatient,1,Each,,37,31.45,10.6042,37,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
METHYLPREDNISOLONE SOD SUC(PF) 40 MG/ML INJ SOLR,,J2920,HCPCS,Facility,Outpatient,1,Each,,37,31.45,10.6042,37,"UCare Health, Inc.",Medicare Advantage,18.6739,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
METHYLPREDNISOLONE SOD SUC(PF) 40 MG/ML INJ SOLR,,J2920,HCPCS,Facility,Inpatient,1,Each,,37,31.45,10.6042,37,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
METHYLPREDNISOLONE SOD SUC(PF) 40 MG/ML INJ SOLR,,J2920,HCPCS,Facility,Outpatient,1,Each,,37,31.45,10.6042,37,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),18.6739,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
METHYLPREDNISOLONE SOD SUC(PF) 40 MG/ML INJ SOLR,,J2920,HCPCS,Facility,Inpatient,1,Each,,37,31.45,10.6042,37,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
METHYLPREDNISOLONE SOD SUC(PF) 40 MG/ML INJ SOLR,,J2920,HCPCS,Facility,Both,1,Each,,37,31.45,10.6042,37,UnitedHealthcare,Individual & Family,34.78,94,,percent of total billed charges,,
METHYLPREDNISOLONE SOD SUC(PF) 40 MG/ML INJ SOLR,,J2920,HCPCS,Facility,Outpatient,1,Each,,37,31.45,10.6042,37,UnitedHealthcare,Medicare Advantage,18.13,49,,percent of total billed charges,,
METHYLPREDNISOLONE SOD SUC(PF) 40 MG/ML INJ SOLR,,J2920,HCPCS,Facility,Inpatient,1,Each,,37,31.45,10.6042,37,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
METHYLPREDNISOLONE SOD SUC(PF) 40 MG/ML INJ SOLR,,J2920,HCPCS,Facility,Outpatient,1,Each,,37,31.45,10.6042,37,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,17.76,48,,percent of total billed charges,,100% of DHS outpatient percentage
METHYLPREDNISOLONE SOD SUC(PF) 40 MG/ML INJ SOLR,,J2920,HCPCS,Facility,Inpatient,1,Each,,37,31.45,10.6042,37,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
METHYLPREDNISOLONE SODIUM SUCC 40 MG INJ SOLR,,J2920,HCPCS,Facility,Both,1,Each,,29,24.65,8.3114,29,Aetna,Commercial,26.68,92,,percent of total billed charges,,
METHYLPREDNISOLONE SODIUM SUCC 40 MG INJ SOLR,,J2920,HCPCS,Facility,Both,1,Each,,29,24.65,8.3114,29,Aetna,Commercial,26.68,92,,percent of total billed charges,,
METHYLPREDNISOLONE SODIUM SUCC 40 MG INJ SOLR,,J2920,HCPCS,Facility,Outpatient,1,Each,,29,24.65,8.3114,29,Aetna,Medicare Advantage,14.21,49,,percent of total billed charges,,
METHYLPREDNISOLONE SODIUM SUCC 40 MG INJ SOLR,,J2920,HCPCS,Facility,Outpatient,1,Each,,29,24.65,8.3114,29,Aetna,Medicare Advantage,14.21,49,,percent of total billed charges,,
METHYLPREDNISOLONE SODIUM SUCC 40 MG INJ SOLR,,J2920,HCPCS,Facility,Inpatient,1,Each,,29,24.65,8.3114,29,Aetna,Medicare Advantage,,,,,Included in per diem rate,
METHYLPREDNISOLONE SODIUM SUCC 40 MG INJ SOLR,,J2920,HCPCS,Facility,Inpatient,1,Each,,29,24.65,8.3114,29,Aetna,Medicare Advantage,,,,,Included in per diem rate,
METHYLPREDNISOLONE SODIUM SUCC 40 MG INJ SOLR,,J2920,HCPCS,Facility,Both,1,Each,,29,24.65,8.3114,29,Aetna,PPO,26.97,93,,percent of total billed charges,,
METHYLPREDNISOLONE SODIUM SUCC 40 MG INJ SOLR,,J2920,HCPCS,Facility,Both,1,Each,,29,24.65,8.3114,29,Aetna,PPO,26.97,93,,percent of total billed charges,,
METHYLPREDNISOLONE SODIUM SUCC 40 MG INJ SOLR,,J2920,HCPCS,Facility,Both,1,Each,,29,24.65,8.3114,29,America's PPO,America's PPO,27.8487,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
METHYLPREDNISOLONE SODIUM SUCC 40 MG INJ SOLR,,J2920,HCPCS,Facility,Both,1,Each,,29,24.65,8.3114,29,America's PPO,America's PPO,27.8487,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
METHYLPREDNISOLONE SODIUM SUCC 40 MG INJ SOLR,,J2920,HCPCS,Facility,Both,1,Each,,29,24.65,8.3114,29,BlueCross BlueShield Minnesota, Federal Employee Program,28.536,98.4,,percent of total billed charges,,
METHYLPREDNISOLONE SODIUM SUCC 40 MG INJ SOLR,,J2920,HCPCS,Facility,Both,1,Each,,29,24.65,8.3114,29,BlueCross BlueShield Minnesota, Federal Employee Program,28.536,98.4,,percent of total billed charges,,
METHYLPREDNISOLONE SODIUM SUCC 40 MG INJ SOLR,,J2920,HCPCS,Facility,Both,1,Each,,29,24.65,8.3114,29,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,29,100,,percent of total billed charges,,
METHYLPREDNISOLONE SODIUM SUCC 40 MG INJ SOLR,,J2920,HCPCS,Facility,Both,1,Each,,29,24.65,8.3114,29,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,29,100,,percent of total billed charges,,
METHYLPREDNISOLONE SODIUM SUCC 40 MG INJ SOLR,,J2920,HCPCS,Facility,Both,1,Each,,29,24.65,8.3114,29,BlueCross BlueShield Minnesota,High Value Network Plan,26.1,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
METHYLPREDNISOLONE SODIUM SUCC 40 MG INJ SOLR,,J2920,HCPCS,Facility,Both,1,Each,,29,24.65,8.3114,29,BlueCross BlueShield Minnesota,High Value Network Plan,26.1,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
METHYLPREDNISOLONE SODIUM SUCC 40 MG INJ SOLR,,J2920,HCPCS,Facility,Outpatient,1,Each,,29,24.65,8.3114,29,BlueCross BlueShield Minnesota,Medicare Advantage,14.21,49,,percent of total billed charges,,
METHYLPREDNISOLONE SODIUM SUCC 40 MG INJ SOLR,,J2920,HCPCS,Facility,Outpatient,1,Each,,29,24.65,8.3114,29,BlueCross BlueShield Minnesota,Medicare Advantage,14.21,49,,percent of total billed charges,,
METHYLPREDNISOLONE SODIUM SUCC 40 MG INJ SOLR,,J2920,HCPCS,Facility,Inpatient,1,Each,,29,24.65,8.3114,29,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
METHYLPREDNISOLONE SODIUM SUCC 40 MG INJ SOLR,,J2920,HCPCS,Facility,Inpatient,1,Each,,29,24.65,8.3114,29,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
METHYLPREDNISOLONE SODIUM SUCC 40 MG INJ SOLR,,J2920,HCPCS,Facility,Both,1,Each,,29,24.65,8.3114,29,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,25.6853,88.57,,percent of total billed charges,,
METHYLPREDNISOLONE SODIUM SUCC 40 MG INJ SOLR,,J2920,HCPCS,Facility,Both,1,Each,,29,24.65,8.3114,29,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,25.6853,88.57,,percent of total billed charges,,
METHYLPREDNISOLONE SODIUM SUCC 40 MG INJ SOLR,,J2920,HCPCS,Facility,Both,1,Each,,29,24.65,8.3114,29,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,8.3114,28.66,,percent of total billed charges,,
METHYLPREDNISOLONE SODIUM SUCC 40 MG INJ SOLR,,J2920,HCPCS,Facility,Both,1,Each,,29,24.65,8.3114,29,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,8.3114,28.66,,percent of total billed charges,,
METHYLPREDNISOLONE SODIUM SUCC 40 MG INJ SOLR,,J2920,HCPCS,Facility,Outpatient,1,Each,,29,24.65,8.3114,29,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),14.21,49,,percent of total billed charges,,
METHYLPREDNISOLONE SODIUM SUCC 40 MG INJ SOLR,,J2920,HCPCS,Facility,Outpatient,1,Each,,29,24.65,8.3114,29,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),14.21,49,,percent of total billed charges,,
METHYLPREDNISOLONE SODIUM SUCC 40 MG INJ SOLR,,J2920,HCPCS,Facility,Inpatient,1,Each,,29,24.65,8.3114,29,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
METHYLPREDNISOLONE SODIUM SUCC 40 MG INJ SOLR,,J2920,HCPCS,Facility,Inpatient,1,Each,,29,24.65,8.3114,29,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
METHYLPREDNISOLONE SODIUM SUCC 40 MG INJ SOLR,,J2920,HCPCS,Facility,Both,1,Each,,29,24.65,8.3114,29,CorVel,Worker's Compensation,29,100,,percent of total billed charges,,
METHYLPREDNISOLONE SODIUM SUCC 40 MG INJ SOLR,,J2920,HCPCS,Facility,Both,1,Each,,29,24.65,8.3114,29,CorVel,Worker's Compensation,29,100,,percent of total billed charges,,
METHYLPREDNISOLONE SODIUM SUCC 40 MG INJ SOLR,,J2920,HCPCS,Facility,Both,1,Each,,29,24.65,8.3114,29,First Health Group Corporation,First Health Network,28.13,97,,percent of total billed charges,,
METHYLPREDNISOLONE SODIUM SUCC 40 MG INJ SOLR,,J2920,HCPCS,Facility,Both,1,Each,,29,24.65,8.3114,29,First Health Group Corporation,First Health Network,28.13,97,,percent of total billed charges,,
METHYLPREDNISOLONE SODIUM SUCC 40 MG INJ SOLR,,J2920,HCPCS,Facility,Both,1,Each,,29,24.65,8.3114,29,"Health Partners, Inc.",Commercial,27.434,94.6,,percent of total billed charges,,
METHYLPREDNISOLONE SODIUM SUCC 40 MG INJ SOLR,,J2920,HCPCS,Facility,Both,1,Each,,29,24.65,8.3114,29,"Health Partners, Inc.",Commercial,27.434,94.6,,percent of total billed charges,,
METHYLPREDNISOLONE SODIUM SUCC 40 MG INJ SOLR,,J2920,HCPCS,Facility,Outpatient,1,Each,,29,24.65,8.3114,29,"Health Partners, Inc.",Medicare Advantage,14.21,49,,percent of total billed charges,,
METHYLPREDNISOLONE SODIUM SUCC 40 MG INJ SOLR,,J2920,HCPCS,Facility,Outpatient,1,Each,,29,24.65,8.3114,29,"Health Partners, Inc.",Medicare Advantage,14.21,49,,percent of total billed charges,,
METHYLPREDNISOLONE SODIUM SUCC 40 MG INJ SOLR,,J2920,HCPCS,Facility,Inpatient,1,Each,,29,24.65,8.3114,29,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
METHYLPREDNISOLONE SODIUM SUCC 40 MG INJ SOLR,,J2920,HCPCS,Facility,Inpatient,1,Each,,29,24.65,8.3114,29,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
METHYLPREDNISOLONE SODIUM SUCC 40 MG INJ SOLR,,J2920,HCPCS,Facility,Both,1,Each,,29,24.65,8.3114,29,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),17.4,60,,percent of total billed charges,,
METHYLPREDNISOLONE SODIUM SUCC 40 MG INJ SOLR,,J2920,HCPCS,Facility,Both,1,Each,,29,24.65,8.3114,29,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),17.4,60,,percent of total billed charges,,
METHYLPREDNISOLONE SODIUM SUCC 40 MG INJ SOLR,,J2920,HCPCS,Facility,Both,1,Each,,29,24.65,8.3114,29,"Health Partners, Inc.",State of Minnesota Advantage Program,23.635,81.5,,percent of total billed charges,,
METHYLPREDNISOLONE SODIUM SUCC 40 MG INJ SOLR,,J2920,HCPCS,Facility,Both,1,Each,,29,24.65,8.3114,29,"Health Partners, Inc.",State of Minnesota Advantage Program,23.635,81.5,,percent of total billed charges,,
METHYLPREDNISOLONE SODIUM SUCC 40 MG INJ SOLR,,J2920,HCPCS,Facility,Both,1,Each,,29,24.65,8.3114,29,"Health Partners, Inc.",State Public Programs,14.5,50,,percent of total billed charges,,
METHYLPREDNISOLONE SODIUM SUCC 40 MG INJ SOLR,,J2920,HCPCS,Facility,Both,1,Each,,29,24.65,8.3114,29,"Health Partners, Inc.",State Public Programs,14.5,50,,percent of total billed charges,,
METHYLPREDNISOLONE SODIUM SUCC 40 MG INJ SOLR,,J2920,HCPCS,Facility,Both,1,Each,,29,24.65,8.3114,29,Humana Insurance Company,Commercial PPO,27.55,95,,percent of total billed charges,,
METHYLPREDNISOLONE SODIUM SUCC 40 MG INJ SOLR,,J2920,HCPCS,Facility,Both,1,Each,,29,24.65,8.3114,29,Humana Insurance Company,Commercial PPO,27.55,95,,percent of total billed charges,,
METHYLPREDNISOLONE SODIUM SUCC 40 MG INJ SOLR,,J2920,HCPCS,Facility,Outpatient,1,Each,,29,24.65,8.3114,29,Humana Insurance Company,Medicare PPO,14.21,49,,percent of total billed charges,,
METHYLPREDNISOLONE SODIUM SUCC 40 MG INJ SOLR,,J2920,HCPCS,Facility,Outpatient,1,Each,,29,24.65,8.3114,29,Humana Insurance Company,Medicare PPO,14.21,49,,percent of total billed charges,,
METHYLPREDNISOLONE SODIUM SUCC 40 MG INJ SOLR,,J2920,HCPCS,Facility,Inpatient,1,Each,,29,24.65,8.3114,29,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
METHYLPREDNISOLONE SODIUM SUCC 40 MG INJ SOLR,,J2920,HCPCS,Facility,Inpatient,1,Each,,29,24.65,8.3114,29,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
METHYLPREDNISOLONE SODIUM SUCC 40 MG INJ SOLR,,J2920,HCPCS,Facility,Both,1,Each,,29,24.65,8.3114,29,Medica,Individual & Family,28.739,99.1,,percent of total billed charges,,
METHYLPREDNISOLONE SODIUM SUCC 40 MG INJ SOLR,,J2920,HCPCS,Facility,Both,1,Each,,29,24.65,8.3114,29,Medica,Individual & Family,28.739,99.1,,percent of total billed charges,,
METHYLPREDNISOLONE SODIUM SUCC 40 MG INJ SOLR,,J2920,HCPCS,Facility,Outpatient,1,Each,,29,24.65,8.3114,29,Medica,Medica Advantage Solution,14.442,49.8,,percent of total billed charges,,
METHYLPREDNISOLONE SODIUM SUCC 40 MG INJ SOLR,,J2920,HCPCS,Facility,Outpatient,1,Each,,29,24.65,8.3114,29,Medica,Medica Advantage Solution,14.442,49.8,,percent of total billed charges,,
METHYLPREDNISOLONE SODIUM SUCC 40 MG INJ SOLR,,J2920,HCPCS,Facility,Inpatient,1,Each,,29,24.65,8.3114,29,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
METHYLPREDNISOLONE SODIUM SUCC 40 MG INJ SOLR,,J2920,HCPCS,Facility,Inpatient,1,Each,,29,24.65,8.3114,29,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
METHYLPREDNISOLONE SODIUM SUCC 40 MG INJ SOLR,,J2920,HCPCS,Facility,Outpatient,1,Each,,29,24.65,8.3114,29,Medica,Medical Assistance,12.934,44.6,,percent of total billed charges,,
METHYLPREDNISOLONE SODIUM SUCC 40 MG INJ SOLR,,J2920,HCPCS,Facility,Outpatient,1,Each,,29,24.65,8.3114,29,Medica,Medical Assistance,12.934,44.6,,percent of total billed charges,,
METHYLPREDNISOLONE SODIUM SUCC 40 MG INJ SOLR,,J2920,HCPCS,Facility,Inpatient,1,Each,,29,24.65,8.3114,29,Medica,Medical Assistance,,,,,Included in per diem rate,
METHYLPREDNISOLONE SODIUM SUCC 40 MG INJ SOLR,,J2920,HCPCS,Facility,Inpatient,1,Each,,29,24.65,8.3114,29,Medica,Medical Assistance,,,,,Included in per diem rate,
METHYLPREDNISOLONE SODIUM SUCC 40 MG INJ SOLR,,J2920,HCPCS,Facility,Outpatient,1,Each,,29,24.65,8.3114,29,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,14.442,49.8,,percent of total billed charges,,
METHYLPREDNISOLONE SODIUM SUCC 40 MG INJ SOLR,,J2920,HCPCS,Facility,Outpatient,1,Each,,29,24.65,8.3114,29,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,14.442,49.8,,percent of total billed charges,,
METHYLPREDNISOLONE SODIUM SUCC 40 MG INJ SOLR,,J2920,HCPCS,Facility,Inpatient,1,Each,,29,24.65,8.3114,29,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
METHYLPREDNISOLONE SODIUM SUCC 40 MG INJ SOLR,,J2920,HCPCS,Facility,Inpatient,1,Each,,29,24.65,8.3114,29,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
METHYLPREDNISOLONE SODIUM SUCC 40 MG INJ SOLR,,J2920,HCPCS,Facility,Both,1,Each,,29,24.65,8.3114,29,"Multiplan, Inc.","Multiplan, Inc.",27.26,94,,percent of total billed charges,,
METHYLPREDNISOLONE SODIUM SUCC 40 MG INJ SOLR,,J2920,HCPCS,Facility,Both,1,Each,,29,24.65,8.3114,29,"Multiplan, Inc.","Multiplan, Inc.",27.26,94,,percent of total billed charges,,
METHYLPREDNISOLONE SODIUM SUCC 40 MG INJ SOLR,,J2920,HCPCS,Facility,Outpatient,1,Each,,29,24.65,8.3114,29,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,26.129,90.1,,percent of total billed charges,,
METHYLPREDNISOLONE SODIUM SUCC 40 MG INJ SOLR,,J2920,HCPCS,Facility,Outpatient,1,Each,,29,24.65,8.3114,29,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,26.129,90.1,,percent of total billed charges,,
METHYLPREDNISOLONE SODIUM SUCC 40 MG INJ SOLR,,J2920,HCPCS,Facility,Inpatient,1,Each,,29,24.65,8.3114,29,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
METHYLPREDNISOLONE SODIUM SUCC 40 MG INJ SOLR,,J2920,HCPCS,Facility,Inpatient,1,Each,,29,24.65,8.3114,29,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
METHYLPREDNISOLONE SODIUM SUCC 40 MG INJ SOLR,,J2920,HCPCS,Facility,Both,1,Each,,29,24.65,8.3114,29,"Preferred One Administrative Services, INC.",PPO,28.594,98.6,,percent of total billed charges,,
METHYLPREDNISOLONE SODIUM SUCC 40 MG INJ SOLR,,J2920,HCPCS,Facility,Both,1,Each,,29,24.65,8.3114,29,"Preferred One Administrative Services, INC.",PPO,28.594,98.6,,percent of total billed charges,,
METHYLPREDNISOLONE SODIUM SUCC 40 MG INJ SOLR,,J2920,HCPCS,Facility,Outpatient,1,Each,,29,24.65,8.3114,29,PrimeWest Health,Minnesota Senior Health Options (MSHO),14.9205,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
METHYLPREDNISOLONE SODIUM SUCC 40 MG INJ SOLR,,J2920,HCPCS,Facility,Outpatient,1,Each,,29,24.65,8.3114,29,PrimeWest Health,Minnesota Senior Health Options (MSHO),14.9205,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
METHYLPREDNISOLONE SODIUM SUCC 40 MG INJ SOLR,,J2920,HCPCS,Facility,Inpatient,1,Each,,29,24.65,8.3114,29,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
METHYLPREDNISOLONE SODIUM SUCC 40 MG INJ SOLR,,J2920,HCPCS,Facility,Inpatient,1,Each,,29,24.65,8.3114,29,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
METHYLPREDNISOLONE SODIUM SUCC 40 MG INJ SOLR,,J2920,HCPCS,Facility,Outpatient,1,Each,,29,24.65,8.3114,29,PrimeWest Health,MinnesotaCare,14.8944,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
METHYLPREDNISOLONE SODIUM SUCC 40 MG INJ SOLR,,J2920,HCPCS,Facility,Outpatient,1,Each,,29,24.65,8.3114,29,PrimeWest Health,MinnesotaCare,14.8944,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
METHYLPREDNISOLONE SODIUM SUCC 40 MG INJ SOLR,,J2920,HCPCS,Facility,Inpatient,1,Each,,29,24.65,8.3114,29,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
METHYLPREDNISOLONE SODIUM SUCC 40 MG INJ SOLR,,J2920,HCPCS,Facility,Inpatient,1,Each,,29,24.65,8.3114,29,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
METHYLPREDNISOLONE SODIUM SUCC 40 MG INJ SOLR,,J2920,HCPCS,Facility,Both,1,Each,,29,24.65,8.3114,29,Sanford Health Plan,Sanford Health Plan,26.68,92,,percent of total billed charges,,
METHYLPREDNISOLONE SODIUM SUCC 40 MG INJ SOLR,,J2920,HCPCS,Facility,Both,1,Each,,29,24.65,8.3114,29,Sanford Health Plan,Sanford Health Plan,26.68,92,,percent of total billed charges,,
METHYLPREDNISOLONE SODIUM SUCC 40 MG INJ SOLR,,J2920,HCPCS,Facility,Outpatient,1,Each,,29,24.65,8.3114,29,"UCare Health, Inc.",Individual & Family Plan,16.3415,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
METHYLPREDNISOLONE SODIUM SUCC 40 MG INJ SOLR,,J2920,HCPCS,Facility,Outpatient,1,Each,,29,24.65,8.3114,29,"UCare Health, Inc.",Individual & Family Plan,16.3415,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
METHYLPREDNISOLONE SODIUM SUCC 40 MG INJ SOLR,,J2920,HCPCS,Facility,Inpatient,1,Each,,29,24.65,8.3114,29,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
METHYLPREDNISOLONE SODIUM SUCC 40 MG INJ SOLR,,J2920,HCPCS,Facility,Inpatient,1,Each,,29,24.65,8.3114,29,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
METHYLPREDNISOLONE SODIUM SUCC 40 MG INJ SOLR,,J2920,HCPCS,Facility,Outpatient,1,Each,,29,24.65,8.3114,29,"UCare Health, Inc.",Medical Assistance,14.6363,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
METHYLPREDNISOLONE SODIUM SUCC 40 MG INJ SOLR,,J2920,HCPCS,Facility,Outpatient,1,Each,,29,24.65,8.3114,29,"UCare Health, Inc.",Medical Assistance,14.6363,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
METHYLPREDNISOLONE SODIUM SUCC 40 MG INJ SOLR,,J2920,HCPCS,Facility,Inpatient,1,Each,,29,24.65,8.3114,29,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
METHYLPREDNISOLONE SODIUM SUCC 40 MG INJ SOLR,,J2920,HCPCS,Facility,Inpatient,1,Each,,29,24.65,8.3114,29,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
METHYLPREDNISOLONE SODIUM SUCC 40 MG INJ SOLR,,J2920,HCPCS,Facility,Outpatient,1,Each,,29,24.65,8.3114,29,"UCare Health, Inc.",Medicare Advantage,14.6363,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
METHYLPREDNISOLONE SODIUM SUCC 40 MG INJ SOLR,,J2920,HCPCS,Facility,Outpatient,1,Each,,29,24.65,8.3114,29,"UCare Health, Inc.",Medicare Advantage,14.6363,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
METHYLPREDNISOLONE SODIUM SUCC 40 MG INJ SOLR,,J2920,HCPCS,Facility,Inpatient,1,Each,,29,24.65,8.3114,29,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
METHYLPREDNISOLONE SODIUM SUCC 40 MG INJ SOLR,,J2920,HCPCS,Facility,Inpatient,1,Each,,29,24.65,8.3114,29,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
METHYLPREDNISOLONE SODIUM SUCC 40 MG INJ SOLR,,J2920,HCPCS,Facility,Outpatient,1,Each,,29,24.65,8.3114,29,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),14.6363,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
METHYLPREDNISOLONE SODIUM SUCC 40 MG INJ SOLR,,J2920,HCPCS,Facility,Outpatient,1,Each,,29,24.65,8.3114,29,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),14.6363,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
METHYLPREDNISOLONE SODIUM SUCC 40 MG INJ SOLR,,J2920,HCPCS,Facility,Inpatient,1,Each,,29,24.65,8.3114,29,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
METHYLPREDNISOLONE SODIUM SUCC 40 MG INJ SOLR,,J2920,HCPCS,Facility,Inpatient,1,Each,,29,24.65,8.3114,29,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
METHYLPREDNISOLONE SODIUM SUCC 40 MG INJ SOLR,,J2920,HCPCS,Facility,Both,1,Each,,29,24.65,8.3114,29,UnitedHealthcare,Individual & Family,27.26,94,,percent of total billed charges,,
METHYLPREDNISOLONE SODIUM SUCC 40 MG INJ SOLR,,J2920,HCPCS,Facility,Both,1,Each,,29,24.65,8.3114,29,UnitedHealthcare,Individual & Family,27.26,94,,percent of total billed charges,,
METHYLPREDNISOLONE SODIUM SUCC 40 MG INJ SOLR,,J2920,HCPCS,Facility,Outpatient,1,Each,,29,24.65,8.3114,29,UnitedHealthcare,Medicare Advantage,14.21,49,,percent of total billed charges,,
METHYLPREDNISOLONE SODIUM SUCC 40 MG INJ SOLR,,J2920,HCPCS,Facility,Outpatient,1,Each,,29,24.65,8.3114,29,UnitedHealthcare,Medicare Advantage,14.21,49,,percent of total billed charges,,
METHYLPREDNISOLONE SODIUM SUCC 40 MG INJ SOLR,,J2920,HCPCS,Facility,Inpatient,1,Each,,29,24.65,8.3114,29,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
METHYLPREDNISOLONE SODIUM SUCC 40 MG INJ SOLR,,J2920,HCPCS,Facility,Inpatient,1,Each,,29,24.65,8.3114,29,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
METHYLPREDNISOLONE SODIUM SUCC 40 MG INJ SOLR,,J2920,HCPCS,Facility,Outpatient,1,Each,,29,24.65,8.3114,29,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,13.92,48,,percent of total billed charges,,100% of DHS outpatient percentage
METHYLPREDNISOLONE SODIUM SUCC 40 MG INJ SOLR,,J2920,HCPCS,Facility,Outpatient,1,Each,,29,24.65,8.3114,29,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,13.92,48,,percent of total billed charges,,100% of DHS outpatient percentage
METHYLPREDNISOLONE SODIUM SUCC 40 MG INJ SOLR,,J2920,HCPCS,Facility,Inpatient,1,Each,,29,24.65,8.3114,29,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
METHYLPREDNISOLONE SODIUM SUCC 40 MG INJ SOLR,,J2920,HCPCS,Facility,Inpatient,1,Each,,29,24.65,8.3114,29,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"METHYLPREDNISOLONE SOD SUC(PF) 1,000 MG/8 ML IV SOLR",,J2930,HCPCS,Facility,Both,1,Each,,325,276.25,93.145,325,Aetna,Commercial,299,92,,percent of total billed charges,,
"METHYLPREDNISOLONE SOD SUC(PF) 1,000 MG/8 ML IV SOLR",,J2930,HCPCS,Facility,Outpatient,1,Each,,325,276.25,93.145,325,Aetna,Medicare Advantage,159.25,49,,percent of total billed charges,,
"METHYLPREDNISOLONE SOD SUC(PF) 1,000 MG/8 ML IV SOLR",,J2930,HCPCS,Facility,Inpatient,1,Each,,325,276.25,93.145,325,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"METHYLPREDNISOLONE SOD SUC(PF) 1,000 MG/8 ML IV SOLR",,J2930,HCPCS,Facility,Both,1,Each,,325,276.25,93.145,325,Aetna,PPO,302.25,93,,percent of total billed charges,,
"METHYLPREDNISOLONE SOD SUC(PF) 1,000 MG/8 ML IV SOLR",,J2930,HCPCS,Facility,Both,1,Each,,325,276.25,93.145,325,America's PPO,America's PPO,312.0975,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"METHYLPREDNISOLONE SOD SUC(PF) 1,000 MG/8 ML IV SOLR",,J2930,HCPCS,Facility,Both,1,Each,,325,276.25,93.145,325,BlueCross BlueShield Minnesota, Federal Employee Program,319.8,98.4,,percent of total billed charges,,
"METHYLPREDNISOLONE SOD SUC(PF) 1,000 MG/8 ML IV SOLR",,J2930,HCPCS,Facility,Both,1,Each,,325,276.25,93.145,325,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,325,100,,percent of total billed charges,,
"METHYLPREDNISOLONE SOD SUC(PF) 1,000 MG/8 ML IV SOLR",,J2930,HCPCS,Facility,Both,1,Each,,325,276.25,93.145,325,BlueCross BlueShield Minnesota,High Value Network Plan,292.5,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
"METHYLPREDNISOLONE SOD SUC(PF) 1,000 MG/8 ML IV SOLR",,J2930,HCPCS,Facility,Outpatient,1,Each,,325,276.25,93.145,325,BlueCross BlueShield Minnesota,Medicare Advantage,159.25,49,,percent of total billed charges,,
"METHYLPREDNISOLONE SOD SUC(PF) 1,000 MG/8 ML IV SOLR",,J2930,HCPCS,Facility,Inpatient,1,Each,,325,276.25,93.145,325,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"METHYLPREDNISOLONE SOD SUC(PF) 1,000 MG/8 ML IV SOLR",,J2930,HCPCS,Facility,Both,1,Each,,325,276.25,93.145,325,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,287.8525,88.57,,percent of total billed charges,,
"METHYLPREDNISOLONE SOD SUC(PF) 1,000 MG/8 ML IV SOLR",,J2930,HCPCS,Facility,Both,1,Each,,325,276.25,93.145,325,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,93.145,28.66,,percent of total billed charges,,
"METHYLPREDNISOLONE SOD SUC(PF) 1,000 MG/8 ML IV SOLR",,J2930,HCPCS,Facility,Outpatient,1,Each,,325,276.25,93.145,325,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),159.25,49,,percent of total billed charges,,
"METHYLPREDNISOLONE SOD SUC(PF) 1,000 MG/8 ML IV SOLR",,J2930,HCPCS,Facility,Inpatient,1,Each,,325,276.25,93.145,325,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"METHYLPREDNISOLONE SOD SUC(PF) 1,000 MG/8 ML IV SOLR",,J2930,HCPCS,Facility,Both,1,Each,,325,276.25,93.145,325,CorVel,Worker's Compensation,325,100,,percent of total billed charges,,
"METHYLPREDNISOLONE SOD SUC(PF) 1,000 MG/8 ML IV SOLR",,J2930,HCPCS,Facility,Both,1,Each,,325,276.25,93.145,325,First Health Group Corporation,First Health Network,315.25,97,,percent of total billed charges,,
"METHYLPREDNISOLONE SOD SUC(PF) 1,000 MG/8 ML IV SOLR",,J2930,HCPCS,Facility,Both,1,Each,,325,276.25,93.145,325,"Health Partners, Inc.",Commercial,307.45,94.6,,percent of total billed charges,,
"METHYLPREDNISOLONE SOD SUC(PF) 1,000 MG/8 ML IV SOLR",,J2930,HCPCS,Facility,Outpatient,1,Each,,325,276.25,93.145,325,"Health Partners, Inc.",Medicare Advantage,159.25,49,,percent of total billed charges,,
"METHYLPREDNISOLONE SOD SUC(PF) 1,000 MG/8 ML IV SOLR",,J2930,HCPCS,Facility,Inpatient,1,Each,,325,276.25,93.145,325,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"METHYLPREDNISOLONE SOD SUC(PF) 1,000 MG/8 ML IV SOLR",,J2930,HCPCS,Facility,Both,1,Each,,325,276.25,93.145,325,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),195,60,,percent of total billed charges,,
"METHYLPREDNISOLONE SOD SUC(PF) 1,000 MG/8 ML IV SOLR",,J2930,HCPCS,Facility,Both,1,Each,,325,276.25,93.145,325,"Health Partners, Inc.",State of Minnesota Advantage Program,264.875,81.5,,percent of total billed charges,,
"METHYLPREDNISOLONE SOD SUC(PF) 1,000 MG/8 ML IV SOLR",,J2930,HCPCS,Facility,Both,1,Each,,325,276.25,93.145,325,"Health Partners, Inc.",State Public Programs,162.5,50,,percent of total billed charges,,
"METHYLPREDNISOLONE SOD SUC(PF) 1,000 MG/8 ML IV SOLR",,J2930,HCPCS,Facility,Both,1,Each,,325,276.25,93.145,325,Humana Insurance Company,Commercial PPO,308.75,95,,percent of total billed charges,,
"METHYLPREDNISOLONE SOD SUC(PF) 1,000 MG/8 ML IV SOLR",,J2930,HCPCS,Facility,Outpatient,1,Each,,325,276.25,93.145,325,Humana Insurance Company,Medicare PPO,159.25,49,,percent of total billed charges,,
"METHYLPREDNISOLONE SOD SUC(PF) 1,000 MG/8 ML IV SOLR",,J2930,HCPCS,Facility,Inpatient,1,Each,,325,276.25,93.145,325,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"METHYLPREDNISOLONE SOD SUC(PF) 1,000 MG/8 ML IV SOLR",,J2930,HCPCS,Facility,Both,1,Each,,325,276.25,93.145,325,Medica,Individual & Family,322.075,99.1,,percent of total billed charges,,
"METHYLPREDNISOLONE SOD SUC(PF) 1,000 MG/8 ML IV SOLR",,J2930,HCPCS,Facility,Outpatient,1,Each,,325,276.25,93.145,325,Medica,Medica Advantage Solution,161.85,49.8,,percent of total billed charges,,
"METHYLPREDNISOLONE SOD SUC(PF) 1,000 MG/8 ML IV SOLR",,J2930,HCPCS,Facility,Inpatient,1,Each,,325,276.25,93.145,325,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"METHYLPREDNISOLONE SOD SUC(PF) 1,000 MG/8 ML IV SOLR",,J2930,HCPCS,Facility,Outpatient,1,Each,,325,276.25,93.145,325,Medica,Medical Assistance,144.95,44.6,,percent of total billed charges,,
"METHYLPREDNISOLONE SOD SUC(PF) 1,000 MG/8 ML IV SOLR",,J2930,HCPCS,Facility,Inpatient,1,Each,,325,276.25,93.145,325,Medica,Medical Assistance,,,,,Included in per diem rate,
"METHYLPREDNISOLONE SOD SUC(PF) 1,000 MG/8 ML IV SOLR",,J2930,HCPCS,Facility,Outpatient,1,Each,,325,276.25,93.145,325,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,161.85,49.8,,percent of total billed charges,,
"METHYLPREDNISOLONE SOD SUC(PF) 1,000 MG/8 ML IV SOLR",,J2930,HCPCS,Facility,Inpatient,1,Each,,325,276.25,93.145,325,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"METHYLPREDNISOLONE SOD SUC(PF) 1,000 MG/8 ML IV SOLR",,J2930,HCPCS,Facility,Both,1,Each,,325,276.25,93.145,325,"Multiplan, Inc.","Multiplan, Inc.",305.5,94,,percent of total billed charges,,
"METHYLPREDNISOLONE SOD SUC(PF) 1,000 MG/8 ML IV SOLR",,J2930,HCPCS,Facility,Outpatient,1,Each,,325,276.25,93.145,325,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,292.825,90.1,,percent of total billed charges,,
"METHYLPREDNISOLONE SOD SUC(PF) 1,000 MG/8 ML IV SOLR",,J2930,HCPCS,Facility,Inpatient,1,Each,,325,276.25,93.145,325,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"METHYLPREDNISOLONE SOD SUC(PF) 1,000 MG/8 ML IV SOLR",,J2930,HCPCS,Facility,Both,1,Each,,325,276.25,93.145,325,"Preferred One Administrative Services, INC.",PPO,320.45,98.6,,percent of total billed charges,,
"METHYLPREDNISOLONE SOD SUC(PF) 1,000 MG/8 ML IV SOLR",,J2930,HCPCS,Facility,Outpatient,1,Each,,325,276.25,93.145,325,PrimeWest Health,Minnesota Senior Health Options (MSHO),167.2125,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"METHYLPREDNISOLONE SOD SUC(PF) 1,000 MG/8 ML IV SOLR",,J2930,HCPCS,Facility,Inpatient,1,Each,,325,276.25,93.145,325,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"METHYLPREDNISOLONE SOD SUC(PF) 1,000 MG/8 ML IV SOLR",,J2930,HCPCS,Facility,Outpatient,1,Each,,325,276.25,93.145,325,PrimeWest Health,MinnesotaCare,166.92,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"METHYLPREDNISOLONE SOD SUC(PF) 1,000 MG/8 ML IV SOLR",,J2930,HCPCS,Facility,Inpatient,1,Each,,325,276.25,93.145,325,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"METHYLPREDNISOLONE SOD SUC(PF) 1,000 MG/8 ML IV SOLR",,J2930,HCPCS,Facility,Both,1,Each,,325,276.25,93.145,325,Sanford Health Plan,Sanford Health Plan,299,92,,percent of total billed charges,,
"METHYLPREDNISOLONE SOD SUC(PF) 1,000 MG/8 ML IV SOLR",,J2930,HCPCS,Facility,Outpatient,1,Each,,325,276.25,93.145,325,"UCare Health, Inc.",Individual & Family Plan,183.1375,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"METHYLPREDNISOLONE SOD SUC(PF) 1,000 MG/8 ML IV SOLR",,J2930,HCPCS,Facility,Inpatient,1,Each,,325,276.25,93.145,325,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"METHYLPREDNISOLONE SOD SUC(PF) 1,000 MG/8 ML IV SOLR",,J2930,HCPCS,Facility,Outpatient,1,Each,,325,276.25,93.145,325,"UCare Health, Inc.",Medical Assistance,164.0275,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"METHYLPREDNISOLONE SOD SUC(PF) 1,000 MG/8 ML IV SOLR",,J2930,HCPCS,Facility,Inpatient,1,Each,,325,276.25,93.145,325,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"METHYLPREDNISOLONE SOD SUC(PF) 1,000 MG/8 ML IV SOLR",,J2930,HCPCS,Facility,Outpatient,1,Each,,325,276.25,93.145,325,"UCare Health, Inc.",Medicare Advantage,164.0275,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"METHYLPREDNISOLONE SOD SUC(PF) 1,000 MG/8 ML IV SOLR",,J2930,HCPCS,Facility,Inpatient,1,Each,,325,276.25,93.145,325,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"METHYLPREDNISOLONE SOD SUC(PF) 1,000 MG/8 ML IV SOLR",,J2930,HCPCS,Facility,Outpatient,1,Each,,325,276.25,93.145,325,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),164.0275,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"METHYLPREDNISOLONE SOD SUC(PF) 1,000 MG/8 ML IV SOLR",,J2930,HCPCS,Facility,Inpatient,1,Each,,325,276.25,93.145,325,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"METHYLPREDNISOLONE SOD SUC(PF) 1,000 MG/8 ML IV SOLR",,J2930,HCPCS,Facility,Both,1,Each,,325,276.25,93.145,325,UnitedHealthcare,Individual & Family,305.5,94,,percent of total billed charges,,
"METHYLPREDNISOLONE SOD SUC(PF) 1,000 MG/8 ML IV SOLR",,J2930,HCPCS,Facility,Outpatient,1,Each,,325,276.25,93.145,325,UnitedHealthcare,Medicare Advantage,159.25,49,,percent of total billed charges,,
"METHYLPREDNISOLONE SOD SUC(PF) 1,000 MG/8 ML IV SOLR",,J2930,HCPCS,Facility,Inpatient,1,Each,,325,276.25,93.145,325,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"METHYLPREDNISOLONE SOD SUC(PF) 1,000 MG/8 ML IV SOLR",,J2930,HCPCS,Facility,Outpatient,1,Each,,325,276.25,93.145,325,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,156,48,,percent of total billed charges,,100% of DHS outpatient percentage
"METHYLPREDNISOLONE SOD SUC(PF) 1,000 MG/8 ML IV SOLR",,J2930,HCPCS,Facility,Inpatient,1,Each,,325,276.25,93.145,325,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
METHYLPREDNISOLONE SOD SUC(PF) 125 MG/2 ML INJ SOLR,,J2930,HCPCS,Facility,Both,1,Each,,57,48.45,16.3362,57,Aetna,Commercial,52.44,92,,percent of total billed charges,,
METHYLPREDNISOLONE SOD SUC(PF) 125 MG/2 ML INJ SOLR,,J2930,HCPCS,Facility,Both,1,Each,,57,48.45,16.3362,57,Aetna,Commercial,52.44,92,,percent of total billed charges,,
METHYLPREDNISOLONE SOD SUC(PF) 125 MG/2 ML INJ SOLR,,J2930,HCPCS,Facility,Outpatient,1,Each,,57,48.45,16.3362,57,Aetna,Medicare Advantage,27.93,49,,percent of total billed charges,,
METHYLPREDNISOLONE SOD SUC(PF) 125 MG/2 ML INJ SOLR,,J2930,HCPCS,Facility,Outpatient,1,Each,,57,48.45,16.3362,57,Aetna,Medicare Advantage,27.93,49,,percent of total billed charges,,
METHYLPREDNISOLONE SOD SUC(PF) 125 MG/2 ML INJ SOLR,,J2930,HCPCS,Facility,Inpatient,1,Each,,57,48.45,16.3362,57,Aetna,Medicare Advantage,,,,,Included in per diem rate,
METHYLPREDNISOLONE SOD SUC(PF) 125 MG/2 ML INJ SOLR,,J2930,HCPCS,Facility,Inpatient,1,Each,,57,48.45,16.3362,57,Aetna,Medicare Advantage,,,,,Included in per diem rate,
METHYLPREDNISOLONE SOD SUC(PF) 125 MG/2 ML INJ SOLR,,J2930,HCPCS,Facility,Both,1,Each,,57,48.45,16.3362,57,Aetna,PPO,53.01,93,,percent of total billed charges,,
METHYLPREDNISOLONE SOD SUC(PF) 125 MG/2 ML INJ SOLR,,J2930,HCPCS,Facility,Both,1,Each,,57,48.45,16.3362,57,Aetna,PPO,53.01,93,,percent of total billed charges,,
METHYLPREDNISOLONE SOD SUC(PF) 125 MG/2 ML INJ SOLR,,J2930,HCPCS,Facility,Both,1,Each,,57,48.45,16.3362,57,America's PPO,America's PPO,54.7371,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
METHYLPREDNISOLONE SOD SUC(PF) 125 MG/2 ML INJ SOLR,,J2930,HCPCS,Facility,Both,1,Each,,57,48.45,16.3362,57,America's PPO,America's PPO,54.7371,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
METHYLPREDNISOLONE SOD SUC(PF) 125 MG/2 ML INJ SOLR,,J2930,HCPCS,Facility,Both,1,Each,,57,48.45,16.3362,57,BlueCross BlueShield Minnesota, Federal Employee Program,56.088,98.4,,percent of total billed charges,,
METHYLPREDNISOLONE SOD SUC(PF) 125 MG/2 ML INJ SOLR,,J2930,HCPCS,Facility,Both,1,Each,,57,48.45,16.3362,57,BlueCross BlueShield Minnesota, Federal Employee Program,56.088,98.4,,percent of total billed charges,,
METHYLPREDNISOLONE SOD SUC(PF) 125 MG/2 ML INJ SOLR,,J2930,HCPCS,Facility,Both,1,Each,,57,48.45,16.3362,57,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,57,100,,percent of total billed charges,,
METHYLPREDNISOLONE SOD SUC(PF) 125 MG/2 ML INJ SOLR,,J2930,HCPCS,Facility,Both,1,Each,,57,48.45,16.3362,57,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,57,100,,percent of total billed charges,,
METHYLPREDNISOLONE SOD SUC(PF) 125 MG/2 ML INJ SOLR,,J2930,HCPCS,Facility,Both,1,Each,,57,48.45,16.3362,57,BlueCross BlueShield Minnesota,High Value Network Plan,51.3,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
METHYLPREDNISOLONE SOD SUC(PF) 125 MG/2 ML INJ SOLR,,J2930,HCPCS,Facility,Both,1,Each,,57,48.45,16.3362,57,BlueCross BlueShield Minnesota,High Value Network Plan,51.3,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
METHYLPREDNISOLONE SOD SUC(PF) 125 MG/2 ML INJ SOLR,,J2930,HCPCS,Facility,Outpatient,1,Each,,57,48.45,16.3362,57,BlueCross BlueShield Minnesota,Medicare Advantage,27.93,49,,percent of total billed charges,,
METHYLPREDNISOLONE SOD SUC(PF) 125 MG/2 ML INJ SOLR,,J2930,HCPCS,Facility,Outpatient,1,Each,,57,48.45,16.3362,57,BlueCross BlueShield Minnesota,Medicare Advantage,27.93,49,,percent of total billed charges,,
METHYLPREDNISOLONE SOD SUC(PF) 125 MG/2 ML INJ SOLR,,J2930,HCPCS,Facility,Inpatient,1,Each,,57,48.45,16.3362,57,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
METHYLPREDNISOLONE SOD SUC(PF) 125 MG/2 ML INJ SOLR,,J2930,HCPCS,Facility,Inpatient,1,Each,,57,48.45,16.3362,57,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
METHYLPREDNISOLONE SOD SUC(PF) 125 MG/2 ML INJ SOLR,,J2930,HCPCS,Facility,Both,1,Each,,57,48.45,16.3362,57,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,50.4849,88.57,,percent of total billed charges,,
METHYLPREDNISOLONE SOD SUC(PF) 125 MG/2 ML INJ SOLR,,J2930,HCPCS,Facility,Both,1,Each,,57,48.45,16.3362,57,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,50.4849,88.57,,percent of total billed charges,,
METHYLPREDNISOLONE SOD SUC(PF) 125 MG/2 ML INJ SOLR,,J2930,HCPCS,Facility,Both,1,Each,,57,48.45,16.3362,57,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,16.3362,28.66,,percent of total billed charges,,
METHYLPREDNISOLONE SOD SUC(PF) 125 MG/2 ML INJ SOLR,,J2930,HCPCS,Facility,Both,1,Each,,57,48.45,16.3362,57,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,16.3362,28.66,,percent of total billed charges,,
METHYLPREDNISOLONE SOD SUC(PF) 125 MG/2 ML INJ SOLR,,J2930,HCPCS,Facility,Outpatient,1,Each,,57,48.45,16.3362,57,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),27.93,49,,percent of total billed charges,,
METHYLPREDNISOLONE SOD SUC(PF) 125 MG/2 ML INJ SOLR,,J2930,HCPCS,Facility,Outpatient,1,Each,,57,48.45,16.3362,57,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),27.93,49,,percent of total billed charges,,
METHYLPREDNISOLONE SOD SUC(PF) 125 MG/2 ML INJ SOLR,,J2930,HCPCS,Facility,Inpatient,1,Each,,57,48.45,16.3362,57,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
METHYLPREDNISOLONE SOD SUC(PF) 125 MG/2 ML INJ SOLR,,J2930,HCPCS,Facility,Inpatient,1,Each,,57,48.45,16.3362,57,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
METHYLPREDNISOLONE SOD SUC(PF) 125 MG/2 ML INJ SOLR,,J2930,HCPCS,Facility,Both,1,Each,,57,48.45,16.3362,57,CorVel,Worker's Compensation,57,100,,percent of total billed charges,,
METHYLPREDNISOLONE SOD SUC(PF) 125 MG/2 ML INJ SOLR,,J2930,HCPCS,Facility,Both,1,Each,,57,48.45,16.3362,57,CorVel,Worker's Compensation,57,100,,percent of total billed charges,,
METHYLPREDNISOLONE SOD SUC(PF) 125 MG/2 ML INJ SOLR,,J2930,HCPCS,Facility,Both,1,Each,,57,48.45,16.3362,57,First Health Group Corporation,First Health Network,55.29,97,,percent of total billed charges,,
METHYLPREDNISOLONE SOD SUC(PF) 125 MG/2 ML INJ SOLR,,J2930,HCPCS,Facility,Both,1,Each,,57,48.45,16.3362,57,First Health Group Corporation,First Health Network,55.29,97,,percent of total billed charges,,
METHYLPREDNISOLONE SOD SUC(PF) 125 MG/2 ML INJ SOLR,,J2930,HCPCS,Facility,Both,1,Each,,57,48.45,16.3362,57,"Health Partners, Inc.",Commercial,53.922,94.6,,percent of total billed charges,,
METHYLPREDNISOLONE SOD SUC(PF) 125 MG/2 ML INJ SOLR,,J2930,HCPCS,Facility,Both,1,Each,,57,48.45,16.3362,57,"Health Partners, Inc.",Commercial,53.922,94.6,,percent of total billed charges,,
METHYLPREDNISOLONE SOD SUC(PF) 125 MG/2 ML INJ SOLR,,J2930,HCPCS,Facility,Outpatient,1,Each,,57,48.45,16.3362,57,"Health Partners, Inc.",Medicare Advantage,27.93,49,,percent of total billed charges,,
METHYLPREDNISOLONE SOD SUC(PF) 125 MG/2 ML INJ SOLR,,J2930,HCPCS,Facility,Outpatient,1,Each,,57,48.45,16.3362,57,"Health Partners, Inc.",Medicare Advantage,27.93,49,,percent of total billed charges,,
METHYLPREDNISOLONE SOD SUC(PF) 125 MG/2 ML INJ SOLR,,J2930,HCPCS,Facility,Inpatient,1,Each,,57,48.45,16.3362,57,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
METHYLPREDNISOLONE SOD SUC(PF) 125 MG/2 ML INJ SOLR,,J2930,HCPCS,Facility,Inpatient,1,Each,,57,48.45,16.3362,57,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
METHYLPREDNISOLONE SOD SUC(PF) 125 MG/2 ML INJ SOLR,,J2930,HCPCS,Facility,Both,1,Each,,57,48.45,16.3362,57,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),34.2,60,,percent of total billed charges,,
METHYLPREDNISOLONE SOD SUC(PF) 125 MG/2 ML INJ SOLR,,J2930,HCPCS,Facility,Both,1,Each,,57,48.45,16.3362,57,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),34.2,60,,percent of total billed charges,,
METHYLPREDNISOLONE SOD SUC(PF) 125 MG/2 ML INJ SOLR,,J2930,HCPCS,Facility,Both,1,Each,,57,48.45,16.3362,57,"Health Partners, Inc.",State of Minnesota Advantage Program,46.455,81.5,,percent of total billed charges,,
METHYLPREDNISOLONE SOD SUC(PF) 125 MG/2 ML INJ SOLR,,J2930,HCPCS,Facility,Both,1,Each,,57,48.45,16.3362,57,"Health Partners, Inc.",State of Minnesota Advantage Program,46.455,81.5,,percent of total billed charges,,
METHYLPREDNISOLONE SOD SUC(PF) 125 MG/2 ML INJ SOLR,,J2930,HCPCS,Facility,Both,1,Each,,57,48.45,16.3362,57,"Health Partners, Inc.",State Public Programs,28.5,50,,percent of total billed charges,,
METHYLPREDNISOLONE SOD SUC(PF) 125 MG/2 ML INJ SOLR,,J2930,HCPCS,Facility,Both,1,Each,,57,48.45,16.3362,57,"Health Partners, Inc.",State Public Programs,28.5,50,,percent of total billed charges,,
METHYLPREDNISOLONE SOD SUC(PF) 125 MG/2 ML INJ SOLR,,J2930,HCPCS,Facility,Both,1,Each,,57,48.45,16.3362,57,Humana Insurance Company,Commercial PPO,54.15,95,,percent of total billed charges,,
METHYLPREDNISOLONE SOD SUC(PF) 125 MG/2 ML INJ SOLR,,J2930,HCPCS,Facility,Both,1,Each,,57,48.45,16.3362,57,Humana Insurance Company,Commercial PPO,54.15,95,,percent of total billed charges,,
METHYLPREDNISOLONE SOD SUC(PF) 125 MG/2 ML INJ SOLR,,J2930,HCPCS,Facility,Outpatient,1,Each,,57,48.45,16.3362,57,Humana Insurance Company,Medicare PPO,27.93,49,,percent of total billed charges,,
METHYLPREDNISOLONE SOD SUC(PF) 125 MG/2 ML INJ SOLR,,J2930,HCPCS,Facility,Outpatient,1,Each,,57,48.45,16.3362,57,Humana Insurance Company,Medicare PPO,27.93,49,,percent of total billed charges,,
METHYLPREDNISOLONE SOD SUC(PF) 125 MG/2 ML INJ SOLR,,J2930,HCPCS,Facility,Inpatient,1,Each,,57,48.45,16.3362,57,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
METHYLPREDNISOLONE SOD SUC(PF) 125 MG/2 ML INJ SOLR,,J2930,HCPCS,Facility,Inpatient,1,Each,,57,48.45,16.3362,57,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
METHYLPREDNISOLONE SOD SUC(PF) 125 MG/2 ML INJ SOLR,,J2930,HCPCS,Facility,Both,1,Each,,57,48.45,16.3362,57,Medica,Individual & Family,56.487,99.1,,percent of total billed charges,,
METHYLPREDNISOLONE SOD SUC(PF) 125 MG/2 ML INJ SOLR,,J2930,HCPCS,Facility,Both,1,Each,,57,48.45,16.3362,57,Medica,Individual & Family,56.487,99.1,,percent of total billed charges,,
METHYLPREDNISOLONE SOD SUC(PF) 125 MG/2 ML INJ SOLR,,J2930,HCPCS,Facility,Outpatient,1,Each,,57,48.45,16.3362,57,Medica,Medica Advantage Solution,28.386,49.8,,percent of total billed charges,,
METHYLPREDNISOLONE SOD SUC(PF) 125 MG/2 ML INJ SOLR,,J2930,HCPCS,Facility,Outpatient,1,Each,,57,48.45,16.3362,57,Medica,Medica Advantage Solution,28.386,49.8,,percent of total billed charges,,
METHYLPREDNISOLONE SOD SUC(PF) 125 MG/2 ML INJ SOLR,,J2930,HCPCS,Facility,Inpatient,1,Each,,57,48.45,16.3362,57,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
METHYLPREDNISOLONE SOD SUC(PF) 125 MG/2 ML INJ SOLR,,J2930,HCPCS,Facility,Inpatient,1,Each,,57,48.45,16.3362,57,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
METHYLPREDNISOLONE SOD SUC(PF) 125 MG/2 ML INJ SOLR,,J2930,HCPCS,Facility,Outpatient,1,Each,,57,48.45,16.3362,57,Medica,Medical Assistance,25.422,44.6,,percent of total billed charges,,
METHYLPREDNISOLONE SOD SUC(PF) 125 MG/2 ML INJ SOLR,,J2930,HCPCS,Facility,Outpatient,1,Each,,57,48.45,16.3362,57,Medica,Medical Assistance,25.422,44.6,,percent of total billed charges,,
METHYLPREDNISOLONE SOD SUC(PF) 125 MG/2 ML INJ SOLR,,J2930,HCPCS,Facility,Inpatient,1,Each,,57,48.45,16.3362,57,Medica,Medical Assistance,,,,,Included in per diem rate,
METHYLPREDNISOLONE SOD SUC(PF) 125 MG/2 ML INJ SOLR,,J2930,HCPCS,Facility,Inpatient,1,Each,,57,48.45,16.3362,57,Medica,Medical Assistance,,,,,Included in per diem rate,
METHYLPREDNISOLONE SOD SUC(PF) 125 MG/2 ML INJ SOLR,,J2930,HCPCS,Facility,Outpatient,1,Each,,57,48.45,16.3362,57,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,28.386,49.8,,percent of total billed charges,,
METHYLPREDNISOLONE SOD SUC(PF) 125 MG/2 ML INJ SOLR,,J2930,HCPCS,Facility,Outpatient,1,Each,,57,48.45,16.3362,57,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,28.386,49.8,,percent of total billed charges,,
METHYLPREDNISOLONE SOD SUC(PF) 125 MG/2 ML INJ SOLR,,J2930,HCPCS,Facility,Inpatient,1,Each,,57,48.45,16.3362,57,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
METHYLPREDNISOLONE SOD SUC(PF) 125 MG/2 ML INJ SOLR,,J2930,HCPCS,Facility,Inpatient,1,Each,,57,48.45,16.3362,57,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
METHYLPREDNISOLONE SOD SUC(PF) 125 MG/2 ML INJ SOLR,,J2930,HCPCS,Facility,Both,1,Each,,57,48.45,16.3362,57,"Multiplan, Inc.","Multiplan, Inc.",53.58,94,,percent of total billed charges,,
METHYLPREDNISOLONE SOD SUC(PF) 125 MG/2 ML INJ SOLR,,J2930,HCPCS,Facility,Both,1,Each,,57,48.45,16.3362,57,"Multiplan, Inc.","Multiplan, Inc.",53.58,94,,percent of total billed charges,,
METHYLPREDNISOLONE SOD SUC(PF) 125 MG/2 ML INJ SOLR,,J2930,HCPCS,Facility,Outpatient,1,Each,,57,48.45,16.3362,57,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,51.357,90.1,,percent of total billed charges,,
METHYLPREDNISOLONE SOD SUC(PF) 125 MG/2 ML INJ SOLR,,J2930,HCPCS,Facility,Outpatient,1,Each,,57,48.45,16.3362,57,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,51.357,90.1,,percent of total billed charges,,
METHYLPREDNISOLONE SOD SUC(PF) 125 MG/2 ML INJ SOLR,,J2930,HCPCS,Facility,Inpatient,1,Each,,57,48.45,16.3362,57,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
METHYLPREDNISOLONE SOD SUC(PF) 125 MG/2 ML INJ SOLR,,J2930,HCPCS,Facility,Inpatient,1,Each,,57,48.45,16.3362,57,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
METHYLPREDNISOLONE SOD SUC(PF) 125 MG/2 ML INJ SOLR,,J2930,HCPCS,Facility,Both,1,Each,,57,48.45,16.3362,57,"Preferred One Administrative Services, INC.",PPO,56.202,98.6,,percent of total billed charges,,
METHYLPREDNISOLONE SOD SUC(PF) 125 MG/2 ML INJ SOLR,,J2930,HCPCS,Facility,Both,1,Each,,57,48.45,16.3362,57,"Preferred One Administrative Services, INC.",PPO,56.202,98.6,,percent of total billed charges,,
METHYLPREDNISOLONE SOD SUC(PF) 125 MG/2 ML INJ SOLR,,J2930,HCPCS,Facility,Outpatient,1,Each,,57,48.45,16.3362,57,PrimeWest Health,Minnesota Senior Health Options (MSHO),29.3265,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
METHYLPREDNISOLONE SOD SUC(PF) 125 MG/2 ML INJ SOLR,,J2930,HCPCS,Facility,Outpatient,1,Each,,57,48.45,16.3362,57,PrimeWest Health,Minnesota Senior Health Options (MSHO),29.3265,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
METHYLPREDNISOLONE SOD SUC(PF) 125 MG/2 ML INJ SOLR,,J2930,HCPCS,Facility,Inpatient,1,Each,,57,48.45,16.3362,57,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
METHYLPREDNISOLONE SOD SUC(PF) 125 MG/2 ML INJ SOLR,,J2930,HCPCS,Facility,Inpatient,1,Each,,57,48.45,16.3362,57,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
METHYLPREDNISOLONE SOD SUC(PF) 125 MG/2 ML INJ SOLR,,J2930,HCPCS,Facility,Outpatient,1,Each,,57,48.45,16.3362,57,PrimeWest Health,MinnesotaCare,29.2752,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
METHYLPREDNISOLONE SOD SUC(PF) 125 MG/2 ML INJ SOLR,,J2930,HCPCS,Facility,Outpatient,1,Each,,57,48.45,16.3362,57,PrimeWest Health,MinnesotaCare,29.2752,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
METHYLPREDNISOLONE SOD SUC(PF) 125 MG/2 ML INJ SOLR,,J2930,HCPCS,Facility,Inpatient,1,Each,,57,48.45,16.3362,57,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
METHYLPREDNISOLONE SOD SUC(PF) 125 MG/2 ML INJ SOLR,,J2930,HCPCS,Facility,Inpatient,1,Each,,57,48.45,16.3362,57,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
METHYLPREDNISOLONE SOD SUC(PF) 125 MG/2 ML INJ SOLR,,J2930,HCPCS,Facility,Both,1,Each,,57,48.45,16.3362,57,Sanford Health Plan,Sanford Health Plan,52.44,92,,percent of total billed charges,,
METHYLPREDNISOLONE SOD SUC(PF) 125 MG/2 ML INJ SOLR,,J2930,HCPCS,Facility,Both,1,Each,,57,48.45,16.3362,57,Sanford Health Plan,Sanford Health Plan,52.44,92,,percent of total billed charges,,
METHYLPREDNISOLONE SOD SUC(PF) 125 MG/2 ML INJ SOLR,,J2930,HCPCS,Facility,Outpatient,1,Each,,57,48.45,16.3362,57,"UCare Health, Inc.",Individual & Family Plan,32.1195,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
METHYLPREDNISOLONE SOD SUC(PF) 125 MG/2 ML INJ SOLR,,J2930,HCPCS,Facility,Outpatient,1,Each,,57,48.45,16.3362,57,"UCare Health, Inc.",Individual & Family Plan,32.1195,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
METHYLPREDNISOLONE SOD SUC(PF) 125 MG/2 ML INJ SOLR,,J2930,HCPCS,Facility,Inpatient,1,Each,,57,48.45,16.3362,57,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
METHYLPREDNISOLONE SOD SUC(PF) 125 MG/2 ML INJ SOLR,,J2930,HCPCS,Facility,Inpatient,1,Each,,57,48.45,16.3362,57,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
METHYLPREDNISOLONE SOD SUC(PF) 125 MG/2 ML INJ SOLR,,J2930,HCPCS,Facility,Outpatient,1,Each,,57,48.45,16.3362,57,"UCare Health, Inc.",Medical Assistance,28.7679,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
METHYLPREDNISOLONE SOD SUC(PF) 125 MG/2 ML INJ SOLR,,J2930,HCPCS,Facility,Outpatient,1,Each,,57,48.45,16.3362,57,"UCare Health, Inc.",Medical Assistance,28.7679,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
METHYLPREDNISOLONE SOD SUC(PF) 125 MG/2 ML INJ SOLR,,J2930,HCPCS,Facility,Inpatient,1,Each,,57,48.45,16.3362,57,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
METHYLPREDNISOLONE SOD SUC(PF) 125 MG/2 ML INJ SOLR,,J2930,HCPCS,Facility,Inpatient,1,Each,,57,48.45,16.3362,57,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
METHYLPREDNISOLONE SOD SUC(PF) 125 MG/2 ML INJ SOLR,,J2930,HCPCS,Facility,Outpatient,1,Each,,57,48.45,16.3362,57,"UCare Health, Inc.",Medicare Advantage,28.7679,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
METHYLPREDNISOLONE SOD SUC(PF) 125 MG/2 ML INJ SOLR,,J2930,HCPCS,Facility,Outpatient,1,Each,,57,48.45,16.3362,57,"UCare Health, Inc.",Medicare Advantage,28.7679,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
METHYLPREDNISOLONE SOD SUC(PF) 125 MG/2 ML INJ SOLR,,J2930,HCPCS,Facility,Inpatient,1,Each,,57,48.45,16.3362,57,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
METHYLPREDNISOLONE SOD SUC(PF) 125 MG/2 ML INJ SOLR,,J2930,HCPCS,Facility,Inpatient,1,Each,,57,48.45,16.3362,57,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
METHYLPREDNISOLONE SOD SUC(PF) 125 MG/2 ML INJ SOLR,,J2930,HCPCS,Facility,Outpatient,1,Each,,57,48.45,16.3362,57,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),28.7679,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
METHYLPREDNISOLONE SOD SUC(PF) 125 MG/2 ML INJ SOLR,,J2930,HCPCS,Facility,Outpatient,1,Each,,57,48.45,16.3362,57,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),28.7679,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
METHYLPREDNISOLONE SOD SUC(PF) 125 MG/2 ML INJ SOLR,,J2930,HCPCS,Facility,Inpatient,1,Each,,57,48.45,16.3362,57,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
METHYLPREDNISOLONE SOD SUC(PF) 125 MG/2 ML INJ SOLR,,J2930,HCPCS,Facility,Inpatient,1,Each,,57,48.45,16.3362,57,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
METHYLPREDNISOLONE SOD SUC(PF) 125 MG/2 ML INJ SOLR,,J2930,HCPCS,Facility,Both,1,Each,,57,48.45,16.3362,57,UnitedHealthcare,Individual & Family,53.58,94,,percent of total billed charges,,
METHYLPREDNISOLONE SOD SUC(PF) 125 MG/2 ML INJ SOLR,,J2930,HCPCS,Facility,Both,1,Each,,57,48.45,16.3362,57,UnitedHealthcare,Individual & Family,53.58,94,,percent of total billed charges,,
METHYLPREDNISOLONE SOD SUC(PF) 125 MG/2 ML INJ SOLR,,J2930,HCPCS,Facility,Outpatient,1,Each,,57,48.45,16.3362,57,UnitedHealthcare,Medicare Advantage,27.93,49,,percent of total billed charges,,
METHYLPREDNISOLONE SOD SUC(PF) 125 MG/2 ML INJ SOLR,,J2930,HCPCS,Facility,Outpatient,1,Each,,57,48.45,16.3362,57,UnitedHealthcare,Medicare Advantage,27.93,49,,percent of total billed charges,,
METHYLPREDNISOLONE SOD SUC(PF) 125 MG/2 ML INJ SOLR,,J2930,HCPCS,Facility,Inpatient,1,Each,,57,48.45,16.3362,57,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
METHYLPREDNISOLONE SOD SUC(PF) 125 MG/2 ML INJ SOLR,,J2930,HCPCS,Facility,Inpatient,1,Each,,57,48.45,16.3362,57,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
METHYLPREDNISOLONE SOD SUC(PF) 125 MG/2 ML INJ SOLR,,J2930,HCPCS,Facility,Outpatient,1,Each,,57,48.45,16.3362,57,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,27.36,48,,percent of total billed charges,,100% of DHS outpatient percentage
METHYLPREDNISOLONE SOD SUC(PF) 125 MG/2 ML INJ SOLR,,J2930,HCPCS,Facility,Outpatient,1,Each,,57,48.45,16.3362,57,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,27.36,48,,percent of total billed charges,,100% of DHS outpatient percentage
METHYLPREDNISOLONE SOD SUC(PF) 125 MG/2 ML INJ SOLR,,J2930,HCPCS,Facility,Inpatient,1,Each,,57,48.45,16.3362,57,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
METHYLPREDNISOLONE SOD SUC(PF) 125 MG/2 ML INJ SOLR,,J2930,HCPCS,Facility,Inpatient,1,Each,,57,48.45,16.3362,57,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
ALTEPLASE 100 MG IV SOLR,,J2997,HCPCS,Facility,Both,1,Each,,31682,26929.7,9080.0612,31682,Aetna,Commercial,29147.44,92,,percent of total billed charges,,
ALTEPLASE 100 MG IV SOLR,,J2997,HCPCS,Facility,Outpatient,1,Each,,31682,26929.7,9080.0612,31682,Aetna,Medicare Advantage,15524.18,49,,percent of total billed charges,,
ALTEPLASE 100 MG IV SOLR,,J2997,HCPCS,Facility,Inpatient,1,Each,,31682,26929.7,9080.0612,31682,Aetna,Medicare Advantage,,,,,Included in per diem rate,
ALTEPLASE 100 MG IV SOLR,,J2997,HCPCS,Facility,Both,1,Each,,31682,26929.7,9080.0612,31682,Aetna,PPO,29464.26,93,,percent of total billed charges,,
ALTEPLASE 100 MG IV SOLR,,J2997,HCPCS,Facility,Both,1,Each,,31682,26929.7,9080.0612,31682,America's PPO,America's PPO,30424.2246,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
ALTEPLASE 100 MG IV SOLR,,J2997,HCPCS,Facility,Both,1,Each,,31682,26929.7,9080.0612,31682,BlueCross BlueShield Minnesota, Federal Employee Program,31175.088,98.4,,percent of total billed charges,,
ALTEPLASE 100 MG IV SOLR,,J2997,HCPCS,Facility,Both,1,Each,,31682,26929.7,9080.0612,31682,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,31682,100,,percent of total billed charges,,
ALTEPLASE 100 MG IV SOLR,,J2997,HCPCS,Facility,Both,1,Each,,31682,26929.7,9080.0612,31682,BlueCross BlueShield Minnesota,High Value Network Plan,28513.8,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
ALTEPLASE 100 MG IV SOLR,,J2997,HCPCS,Facility,Outpatient,1,Each,,31682,26929.7,9080.0612,31682,BlueCross BlueShield Minnesota,Medicare Advantage,15524.18,49,,percent of total billed charges,,
ALTEPLASE 100 MG IV SOLR,,J2997,HCPCS,Facility,Inpatient,1,Each,,31682,26929.7,9080.0612,31682,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
ALTEPLASE 100 MG IV SOLR,,J2997,HCPCS,Facility,Both,1,Each,,31682,26929.7,9080.0612,31682,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,28060.7474,88.57,,percent of total billed charges,,
ALTEPLASE 100 MG IV SOLR,,J2997,HCPCS,Facility,Both,1,Each,,31682,26929.7,9080.0612,31682,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,9080.0612,28.66,,percent of total billed charges,,
ALTEPLASE 100 MG IV SOLR,,J2997,HCPCS,Facility,Outpatient,1,Each,,31682,26929.7,9080.0612,31682,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),15524.18,49,,percent of total billed charges,,
ALTEPLASE 100 MG IV SOLR,,J2997,HCPCS,Facility,Inpatient,1,Each,,31682,26929.7,9080.0612,31682,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
ALTEPLASE 100 MG IV SOLR,,J2997,HCPCS,Facility,Both,1,Each,,31682,26929.7,9080.0612,31682,CorVel,Worker's Compensation,31682,100,,percent of total billed charges,,
ALTEPLASE 100 MG IV SOLR,,J2997,HCPCS,Facility,Both,1,Each,,31682,26929.7,9080.0612,31682,First Health Group Corporation,First Health Network,30731.54,97,,percent of total billed charges,,
ALTEPLASE 100 MG IV SOLR,,J2997,HCPCS,Facility,Both,1,Each,,31682,26929.7,9080.0612,31682,"Health Partners, Inc.",Commercial,29971.172,94.6,,percent of total billed charges,,
ALTEPLASE 100 MG IV SOLR,,J2997,HCPCS,Facility,Outpatient,1,Each,,31682,26929.7,9080.0612,31682,"Health Partners, Inc.",Medicare Advantage,15524.18,49,,percent of total billed charges,,
ALTEPLASE 100 MG IV SOLR,,J2997,HCPCS,Facility,Inpatient,1,Each,,31682,26929.7,9080.0612,31682,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ALTEPLASE 100 MG IV SOLR,,J2997,HCPCS,Facility,Both,1,Each,,31682,26929.7,9080.0612,31682,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),19009.2,60,,percent of total billed charges,,
ALTEPLASE 100 MG IV SOLR,,J2997,HCPCS,Facility,Both,1,Each,,31682,26929.7,9080.0612,31682,"Health Partners, Inc.",State of Minnesota Advantage Program,25820.83,81.5,,percent of total billed charges,,
ALTEPLASE 100 MG IV SOLR,,J2997,HCPCS,Facility,Both,1,Each,,31682,26929.7,9080.0612,31682,"Health Partners, Inc.",State Public Programs,15841,50,,percent of total billed charges,,
ALTEPLASE 100 MG IV SOLR,,J2997,HCPCS,Facility,Both,1,Each,,31682,26929.7,9080.0612,31682,Humana Insurance Company,Commercial PPO,30097.9,95,,percent of total billed charges,,
ALTEPLASE 100 MG IV SOLR,,J2997,HCPCS,Facility,Outpatient,1,Each,,31682,26929.7,9080.0612,31682,Humana Insurance Company,Medicare PPO,15524.18,49,,percent of total billed charges,,
ALTEPLASE 100 MG IV SOLR,,J2997,HCPCS,Facility,Inpatient,1,Each,,31682,26929.7,9080.0612,31682,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
ALTEPLASE 100 MG IV SOLR,,J2997,HCPCS,Facility,Both,1,Each,,31682,26929.7,9080.0612,31682,Medica,Individual & Family,31396.862,99.1,,percent of total billed charges,,
ALTEPLASE 100 MG IV SOLR,,J2997,HCPCS,Facility,Outpatient,1,Each,,31682,26929.7,9080.0612,31682,Medica,Medica Advantage Solution,15777.636,49.8,,percent of total billed charges,,
ALTEPLASE 100 MG IV SOLR,,J2997,HCPCS,Facility,Inpatient,1,Each,,31682,26929.7,9080.0612,31682,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
ALTEPLASE 100 MG IV SOLR,,J2997,HCPCS,Facility,Outpatient,1,Each,,31682,26929.7,9080.0612,31682,Medica,Medical Assistance,14130.172,44.6,,percent of total billed charges,,
ALTEPLASE 100 MG IV SOLR,,J2997,HCPCS,Facility,Inpatient,1,Each,,31682,26929.7,9080.0612,31682,Medica,Medical Assistance,,,,,Included in per diem rate,
ALTEPLASE 100 MG IV SOLR,,J2997,HCPCS,Facility,Outpatient,1,Each,,31682,26929.7,9080.0612,31682,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,15777.636,49.8,,percent of total billed charges,,
ALTEPLASE 100 MG IV SOLR,,J2997,HCPCS,Facility,Inpatient,1,Each,,31682,26929.7,9080.0612,31682,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
ALTEPLASE 100 MG IV SOLR,,J2997,HCPCS,Facility,Both,1,Each,,31682,26929.7,9080.0612,31682,"Multiplan, Inc.","Multiplan, Inc.",29781.08,94,,percent of total billed charges,,
ALTEPLASE 100 MG IV SOLR,,J2997,HCPCS,Facility,Outpatient,1,Each,,31682,26929.7,9080.0612,31682,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,28545.482,90.1,,percent of total billed charges,,
ALTEPLASE 100 MG IV SOLR,,J2997,HCPCS,Facility,Inpatient,1,Each,,31682,26929.7,9080.0612,31682,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
ALTEPLASE 100 MG IV SOLR,,J2997,HCPCS,Facility,Both,1,Each,,31682,26929.7,9080.0612,31682,"Preferred One Administrative Services, INC.",PPO,31238.452,98.6,,percent of total billed charges,,
ALTEPLASE 100 MG IV SOLR,,J2997,HCPCS,Facility,Outpatient,1,Each,,31682,26929.7,9080.0612,31682,PrimeWest Health,Minnesota Senior Health Options (MSHO),16300.389,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
ALTEPLASE 100 MG IV SOLR,,J2997,HCPCS,Facility,Inpatient,1,Each,,31682,26929.7,9080.0612,31682,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ALTEPLASE 100 MG IV SOLR,,J2997,HCPCS,Facility,Outpatient,1,Each,,31682,26929.7,9080.0612,31682,PrimeWest Health,MinnesotaCare,16271.8752,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
ALTEPLASE 100 MG IV SOLR,,J2997,HCPCS,Facility,Inpatient,1,Each,,31682,26929.7,9080.0612,31682,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
ALTEPLASE 100 MG IV SOLR,,J2997,HCPCS,Facility,Both,1,Each,,31682,26929.7,9080.0612,31682,Sanford Health Plan,Sanford Health Plan,29147.44,92,,percent of total billed charges,,
ALTEPLASE 100 MG IV SOLR,,J2997,HCPCS,Facility,Outpatient,1,Each,,31682,26929.7,9080.0612,31682,"UCare Health, Inc.",Individual & Family Plan,17852.807,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
ALTEPLASE 100 MG IV SOLR,,J2997,HCPCS,Facility,Inpatient,1,Each,,31682,26929.7,9080.0612,31682,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
ALTEPLASE 100 MG IV SOLR,,J2997,HCPCS,Facility,Outpatient,1,Each,,31682,26929.7,9080.0612,31682,"UCare Health, Inc.",Medical Assistance,15989.9054,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ALTEPLASE 100 MG IV SOLR,,J2997,HCPCS,Facility,Inpatient,1,Each,,31682,26929.7,9080.0612,31682,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
ALTEPLASE 100 MG IV SOLR,,J2997,HCPCS,Facility,Outpatient,1,Each,,31682,26929.7,9080.0612,31682,"UCare Health, Inc.",Medicare Advantage,15989.9054,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ALTEPLASE 100 MG IV SOLR,,J2997,HCPCS,Facility,Inpatient,1,Each,,31682,26929.7,9080.0612,31682,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ALTEPLASE 100 MG IV SOLR,,J2997,HCPCS,Facility,Outpatient,1,Each,,31682,26929.7,9080.0612,31682,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),15989.9054,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ALTEPLASE 100 MG IV SOLR,,J2997,HCPCS,Facility,Inpatient,1,Each,,31682,26929.7,9080.0612,31682,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ALTEPLASE 100 MG IV SOLR,,J2997,HCPCS,Facility,Both,1,Each,,31682,26929.7,9080.0612,31682,UnitedHealthcare,Individual & Family,29781.08,94,,percent of total billed charges,,
ALTEPLASE 100 MG IV SOLR,,J2997,HCPCS,Facility,Outpatient,1,Each,,31682,26929.7,9080.0612,31682,UnitedHealthcare,Medicare Advantage,15524.18,49,,percent of total billed charges,,
ALTEPLASE 100 MG IV SOLR,,J2997,HCPCS,Facility,Inpatient,1,Each,,31682,26929.7,9080.0612,31682,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
ALTEPLASE 100 MG IV SOLR,,J2997,HCPCS,Facility,Outpatient,1,Each,,31682,26929.7,9080.0612,31682,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,15207.36,48,,percent of total billed charges,,100% of DHS outpatient percentage
ALTEPLASE 100 MG IV SOLR,,J2997,HCPCS,Facility,Inpatient,1,Each,,31682,26929.7,9080.0612,31682,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
ALTEPLASE 2 MG INTRA-CATHET SOLR,,J2997,HCPCS,Facility,Both,1,Each,,787,668.95,225.5542,787,Aetna,Commercial,724.04,92,,percent of total billed charges,,
ALTEPLASE 2 MG INTRA-CATHET SOLR,,J2997,HCPCS,Facility,Outpatient,1,Each,,787,668.95,225.5542,787,Aetna,Medicare Advantage,385.63,49,,percent of total billed charges,,
ALTEPLASE 2 MG INTRA-CATHET SOLR,,J2997,HCPCS,Facility,Inpatient,1,Each,,787,668.95,225.5542,787,Aetna,Medicare Advantage,,,,,Included in per diem rate,
ALTEPLASE 2 MG INTRA-CATHET SOLR,,J2997,HCPCS,Facility,Both,1,Each,,787,668.95,225.5542,787,Aetna,PPO,731.91,93,,percent of total billed charges,,
ALTEPLASE 2 MG INTRA-CATHET SOLR,,J2997,HCPCS,Facility,Both,1,Each,,787,668.95,225.5542,787,America's PPO,America's PPO,755.7561,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
ALTEPLASE 2 MG INTRA-CATHET SOLR,,J2997,HCPCS,Facility,Both,1,Each,,787,668.95,225.5542,787,BlueCross BlueShield Minnesota, Federal Employee Program,774.408,98.4,,percent of total billed charges,,
ALTEPLASE 2 MG INTRA-CATHET SOLR,,J2997,HCPCS,Facility,Both,1,Each,,787,668.95,225.5542,787,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,787,100,,percent of total billed charges,,
ALTEPLASE 2 MG INTRA-CATHET SOLR,,J2997,HCPCS,Facility,Both,1,Each,,787,668.95,225.5542,787,BlueCross BlueShield Minnesota,High Value Network Plan,708.3,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
ALTEPLASE 2 MG INTRA-CATHET SOLR,,J2997,HCPCS,Facility,Outpatient,1,Each,,787,668.95,225.5542,787,BlueCross BlueShield Minnesota,Medicare Advantage,385.63,49,,percent of total billed charges,,
ALTEPLASE 2 MG INTRA-CATHET SOLR,,J2997,HCPCS,Facility,Inpatient,1,Each,,787,668.95,225.5542,787,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
ALTEPLASE 2 MG INTRA-CATHET SOLR,,J2997,HCPCS,Facility,Both,1,Each,,787,668.95,225.5542,787,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,697.0459,88.57,,percent of total billed charges,,
ALTEPLASE 2 MG INTRA-CATHET SOLR,,J2997,HCPCS,Facility,Both,1,Each,,787,668.95,225.5542,787,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,225.5542,28.66,,percent of total billed charges,,
ALTEPLASE 2 MG INTRA-CATHET SOLR,,J2997,HCPCS,Facility,Outpatient,1,Each,,787,668.95,225.5542,787,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),385.63,49,,percent of total billed charges,,
ALTEPLASE 2 MG INTRA-CATHET SOLR,,J2997,HCPCS,Facility,Inpatient,1,Each,,787,668.95,225.5542,787,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
ALTEPLASE 2 MG INTRA-CATHET SOLR,,J2997,HCPCS,Facility,Both,1,Each,,787,668.95,225.5542,787,CorVel,Worker's Compensation,787,100,,percent of total billed charges,,
ALTEPLASE 2 MG INTRA-CATHET SOLR,,J2997,HCPCS,Facility,Both,1,Each,,787,668.95,225.5542,787,First Health Group Corporation,First Health Network,763.39,97,,percent of total billed charges,,
ALTEPLASE 2 MG INTRA-CATHET SOLR,,J2997,HCPCS,Facility,Both,1,Each,,787,668.95,225.5542,787,"Health Partners, Inc.",Commercial,744.502,94.6,,percent of total billed charges,,
ALTEPLASE 2 MG INTRA-CATHET SOLR,,J2997,HCPCS,Facility,Outpatient,1,Each,,787,668.95,225.5542,787,"Health Partners, Inc.",Medicare Advantage,385.63,49,,percent of total billed charges,,
ALTEPLASE 2 MG INTRA-CATHET SOLR,,J2997,HCPCS,Facility,Inpatient,1,Each,,787,668.95,225.5542,787,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ALTEPLASE 2 MG INTRA-CATHET SOLR,,J2997,HCPCS,Facility,Both,1,Each,,787,668.95,225.5542,787,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),472.2,60,,percent of total billed charges,,
ALTEPLASE 2 MG INTRA-CATHET SOLR,,J2997,HCPCS,Facility,Both,1,Each,,787,668.95,225.5542,787,"Health Partners, Inc.",State of Minnesota Advantage Program,641.405,81.5,,percent of total billed charges,,
ALTEPLASE 2 MG INTRA-CATHET SOLR,,J2997,HCPCS,Facility,Both,1,Each,,787,668.95,225.5542,787,"Health Partners, Inc.",State Public Programs,393.5,50,,percent of total billed charges,,
ALTEPLASE 2 MG INTRA-CATHET SOLR,,J2997,HCPCS,Facility,Both,1,Each,,787,668.95,225.5542,787,Humana Insurance Company,Commercial PPO,747.65,95,,percent of total billed charges,,
ALTEPLASE 2 MG INTRA-CATHET SOLR,,J2997,HCPCS,Facility,Outpatient,1,Each,,787,668.95,225.5542,787,Humana Insurance Company,Medicare PPO,385.63,49,,percent of total billed charges,,
ALTEPLASE 2 MG INTRA-CATHET SOLR,,J2997,HCPCS,Facility,Inpatient,1,Each,,787,668.95,225.5542,787,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
ALTEPLASE 2 MG INTRA-CATHET SOLR,,J2997,HCPCS,Facility,Both,1,Each,,787,668.95,225.5542,787,Medica,Individual & Family,779.917,99.1,,percent of total billed charges,,
ALTEPLASE 2 MG INTRA-CATHET SOLR,,J2997,HCPCS,Facility,Outpatient,1,Each,,787,668.95,225.5542,787,Medica,Medica Advantage Solution,391.926,49.8,,percent of total billed charges,,
ALTEPLASE 2 MG INTRA-CATHET SOLR,,J2997,HCPCS,Facility,Inpatient,1,Each,,787,668.95,225.5542,787,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
ALTEPLASE 2 MG INTRA-CATHET SOLR,,J2997,HCPCS,Facility,Outpatient,1,Each,,787,668.95,225.5542,787,Medica,Medical Assistance,351.002,44.6,,percent of total billed charges,,
ALTEPLASE 2 MG INTRA-CATHET SOLR,,J2997,HCPCS,Facility,Inpatient,1,Each,,787,668.95,225.5542,787,Medica,Medical Assistance,,,,,Included in per diem rate,
ALTEPLASE 2 MG INTRA-CATHET SOLR,,J2997,HCPCS,Facility,Outpatient,1,Each,,787,668.95,225.5542,787,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,391.926,49.8,,percent of total billed charges,,
ALTEPLASE 2 MG INTRA-CATHET SOLR,,J2997,HCPCS,Facility,Inpatient,1,Each,,787,668.95,225.5542,787,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
ALTEPLASE 2 MG INTRA-CATHET SOLR,,J2997,HCPCS,Facility,Both,1,Each,,787,668.95,225.5542,787,"Multiplan, Inc.","Multiplan, Inc.",739.78,94,,percent of total billed charges,,
ALTEPLASE 2 MG INTRA-CATHET SOLR,,J2997,HCPCS,Facility,Outpatient,1,Each,,787,668.95,225.5542,787,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,709.087,90.1,,percent of total billed charges,,
ALTEPLASE 2 MG INTRA-CATHET SOLR,,J2997,HCPCS,Facility,Inpatient,1,Each,,787,668.95,225.5542,787,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
ALTEPLASE 2 MG INTRA-CATHET SOLR,,J2997,HCPCS,Facility,Both,1,Each,,787,668.95,225.5542,787,"Preferred One Administrative Services, INC.",PPO,775.982,98.6,,percent of total billed charges,,
ALTEPLASE 2 MG INTRA-CATHET SOLR,,J2997,HCPCS,Facility,Outpatient,1,Each,,787,668.95,225.5542,787,PrimeWest Health,Minnesota Senior Health Options (MSHO),404.9115,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
ALTEPLASE 2 MG INTRA-CATHET SOLR,,J2997,HCPCS,Facility,Inpatient,1,Each,,787,668.95,225.5542,787,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ALTEPLASE 2 MG INTRA-CATHET SOLR,,J2997,HCPCS,Facility,Outpatient,1,Each,,787,668.95,225.5542,787,PrimeWest Health,MinnesotaCare,404.2032,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
ALTEPLASE 2 MG INTRA-CATHET SOLR,,J2997,HCPCS,Facility,Inpatient,1,Each,,787,668.95,225.5542,787,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
ALTEPLASE 2 MG INTRA-CATHET SOLR,,J2997,HCPCS,Facility,Both,1,Each,,787,668.95,225.5542,787,Sanford Health Plan,Sanford Health Plan,724.04,92,,percent of total billed charges,,
ALTEPLASE 2 MG INTRA-CATHET SOLR,,J2997,HCPCS,Facility,Outpatient,1,Each,,787,668.95,225.5542,787,"UCare Health, Inc.",Individual & Family Plan,443.4745,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
ALTEPLASE 2 MG INTRA-CATHET SOLR,,J2997,HCPCS,Facility,Inpatient,1,Each,,787,668.95,225.5542,787,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
ALTEPLASE 2 MG INTRA-CATHET SOLR,,J2997,HCPCS,Facility,Outpatient,1,Each,,787,668.95,225.5542,787,"UCare Health, Inc.",Medical Assistance,397.1989,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ALTEPLASE 2 MG INTRA-CATHET SOLR,,J2997,HCPCS,Facility,Inpatient,1,Each,,787,668.95,225.5542,787,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
ALTEPLASE 2 MG INTRA-CATHET SOLR,,J2997,HCPCS,Facility,Outpatient,1,Each,,787,668.95,225.5542,787,"UCare Health, Inc.",Medicare Advantage,397.1989,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ALTEPLASE 2 MG INTRA-CATHET SOLR,,J2997,HCPCS,Facility,Inpatient,1,Each,,787,668.95,225.5542,787,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ALTEPLASE 2 MG INTRA-CATHET SOLR,,J2997,HCPCS,Facility,Outpatient,1,Each,,787,668.95,225.5542,787,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),397.1989,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ALTEPLASE 2 MG INTRA-CATHET SOLR,,J2997,HCPCS,Facility,Inpatient,1,Each,,787,668.95,225.5542,787,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ALTEPLASE 2 MG INTRA-CATHET SOLR,,J2997,HCPCS,Facility,Both,1,Each,,787,668.95,225.5542,787,UnitedHealthcare,Individual & Family,739.78,94,,percent of total billed charges,,
ALTEPLASE 2 MG INTRA-CATHET SOLR,,J2997,HCPCS,Facility,Outpatient,1,Each,,787,668.95,225.5542,787,UnitedHealthcare,Medicare Advantage,385.63,49,,percent of total billed charges,,
ALTEPLASE 2 MG INTRA-CATHET SOLR,,J2997,HCPCS,Facility,Inpatient,1,Each,,787,668.95,225.5542,787,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
ALTEPLASE 2 MG INTRA-CATHET SOLR,,J2997,HCPCS,Facility,Outpatient,1,Each,,787,668.95,225.5542,787,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,377.76,48,,percent of total billed charges,,100% of DHS outpatient percentage
ALTEPLASE 2 MG INTRA-CATHET SOLR,,J2997,HCPCS,Facility,Inpatient,1,Each,,787,668.95,225.5542,787,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
TENECTEPLASE 50 MG IV SOLR,,J3101,HCPCS,Facility,Both,1,Each,,26562,22577.7,7612.6692,26562,Aetna,Commercial,24437.04,92,,percent of total billed charges,,
TENECTEPLASE 50 MG IV SOLR,,J3101,HCPCS,Facility,Outpatient,1,Each,,26562,22577.7,7612.6692,26562,Aetna,Medicare Advantage,13015.38,49,,percent of total billed charges,,
TENECTEPLASE 50 MG IV SOLR,,J3101,HCPCS,Facility,Inpatient,1,Each,,26562,22577.7,7612.6692,26562,Aetna,Medicare Advantage,,,,,Included in per diem rate,
TENECTEPLASE 50 MG IV SOLR,,J3101,HCPCS,Facility,Both,1,Each,,26562,22577.7,7612.6692,26562,Aetna,PPO,24702.66,93,,percent of total billed charges,,
TENECTEPLASE 50 MG IV SOLR,,J3101,HCPCS,Facility,Both,1,Each,,26562,22577.7,7612.6692,26562,America's PPO,America's PPO,25507.4886,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
TENECTEPLASE 50 MG IV SOLR,,J3101,HCPCS,Facility,Both,1,Each,,26562,22577.7,7612.6692,26562,BlueCross BlueShield Minnesota, Federal Employee Program,26137.008,98.4,,percent of total billed charges,,
TENECTEPLASE 50 MG IV SOLR,,J3101,HCPCS,Facility,Both,1,Each,,26562,22577.7,7612.6692,26562,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,26562,100,,percent of total billed charges,,
TENECTEPLASE 50 MG IV SOLR,,J3101,HCPCS,Facility,Both,1,Each,,26562,22577.7,7612.6692,26562,BlueCross BlueShield Minnesota,High Value Network Plan,23905.8,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
TENECTEPLASE 50 MG IV SOLR,,J3101,HCPCS,Facility,Outpatient,1,Each,,26562,22577.7,7612.6692,26562,BlueCross BlueShield Minnesota,Medicare Advantage,13015.38,49,,percent of total billed charges,,
TENECTEPLASE 50 MG IV SOLR,,J3101,HCPCS,Facility,Inpatient,1,Each,,26562,22577.7,7612.6692,26562,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
TENECTEPLASE 50 MG IV SOLR,,J3101,HCPCS,Facility,Both,1,Each,,26562,22577.7,7612.6692,26562,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,23525.9634,88.57,,percent of total billed charges,,
TENECTEPLASE 50 MG IV SOLR,,J3101,HCPCS,Facility,Both,1,Each,,26562,22577.7,7612.6692,26562,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,7612.6692,28.66,,percent of total billed charges,,
TENECTEPLASE 50 MG IV SOLR,,J3101,HCPCS,Facility,Outpatient,1,Each,,26562,22577.7,7612.6692,26562,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),13015.38,49,,percent of total billed charges,,
TENECTEPLASE 50 MG IV SOLR,,J3101,HCPCS,Facility,Inpatient,1,Each,,26562,22577.7,7612.6692,26562,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
TENECTEPLASE 50 MG IV SOLR,,J3101,HCPCS,Facility,Both,1,Each,,26562,22577.7,7612.6692,26562,CorVel,Worker's Compensation,26562,100,,percent of total billed charges,,
TENECTEPLASE 50 MG IV SOLR,,J3101,HCPCS,Facility,Both,1,Each,,26562,22577.7,7612.6692,26562,First Health Group Corporation,First Health Network,25765.14,97,,percent of total billed charges,,
TENECTEPLASE 50 MG IV SOLR,,J3101,HCPCS,Facility,Both,1,Each,,26562,22577.7,7612.6692,26562,"Health Partners, Inc.",Commercial,25127.652,94.6,,percent of total billed charges,,
TENECTEPLASE 50 MG IV SOLR,,J3101,HCPCS,Facility,Outpatient,1,Each,,26562,22577.7,7612.6692,26562,"Health Partners, Inc.",Medicare Advantage,13015.38,49,,percent of total billed charges,,
TENECTEPLASE 50 MG IV SOLR,,J3101,HCPCS,Facility,Inpatient,1,Each,,26562,22577.7,7612.6692,26562,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
TENECTEPLASE 50 MG IV SOLR,,J3101,HCPCS,Facility,Both,1,Each,,26562,22577.7,7612.6692,26562,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),15937.2,60,,percent of total billed charges,,
TENECTEPLASE 50 MG IV SOLR,,J3101,HCPCS,Facility,Both,1,Each,,26562,22577.7,7612.6692,26562,"Health Partners, Inc.",State of Minnesota Advantage Program,21648.03,81.5,,percent of total billed charges,,
TENECTEPLASE 50 MG IV SOLR,,J3101,HCPCS,Facility,Both,1,Each,,26562,22577.7,7612.6692,26562,"Health Partners, Inc.",State Public Programs,13281,50,,percent of total billed charges,,
TENECTEPLASE 50 MG IV SOLR,,J3101,HCPCS,Facility,Both,1,Each,,26562,22577.7,7612.6692,26562,Humana Insurance Company,Commercial PPO,25233.9,95,,percent of total billed charges,,
TENECTEPLASE 50 MG IV SOLR,,J3101,HCPCS,Facility,Outpatient,1,Each,,26562,22577.7,7612.6692,26562,Humana Insurance Company,Medicare PPO,13015.38,49,,percent of total billed charges,,
TENECTEPLASE 50 MG IV SOLR,,J3101,HCPCS,Facility,Inpatient,1,Each,,26562,22577.7,7612.6692,26562,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
TENECTEPLASE 50 MG IV SOLR,,J3101,HCPCS,Facility,Both,1,Each,,26562,22577.7,7612.6692,26562,Medica,Individual & Family,26322.942,99.1,,percent of total billed charges,,
TENECTEPLASE 50 MG IV SOLR,,J3101,HCPCS,Facility,Outpatient,1,Each,,26562,22577.7,7612.6692,26562,Medica,Medica Advantage Solution,13227.876,49.8,,percent of total billed charges,,
TENECTEPLASE 50 MG IV SOLR,,J3101,HCPCS,Facility,Inpatient,1,Each,,26562,22577.7,7612.6692,26562,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
TENECTEPLASE 50 MG IV SOLR,,J3101,HCPCS,Facility,Outpatient,1,Each,,26562,22577.7,7612.6692,26562,Medica,Medical Assistance,11846.652,44.6,,percent of total billed charges,,
TENECTEPLASE 50 MG IV SOLR,,J3101,HCPCS,Facility,Inpatient,1,Each,,26562,22577.7,7612.6692,26562,Medica,Medical Assistance,,,,,Included in per diem rate,
TENECTEPLASE 50 MG IV SOLR,,J3101,HCPCS,Facility,Outpatient,1,Each,,26562,22577.7,7612.6692,26562,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,13227.876,49.8,,percent of total billed charges,,
TENECTEPLASE 50 MG IV SOLR,,J3101,HCPCS,Facility,Inpatient,1,Each,,26562,22577.7,7612.6692,26562,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
TENECTEPLASE 50 MG IV SOLR,,J3101,HCPCS,Facility,Both,1,Each,,26562,22577.7,7612.6692,26562,"Multiplan, Inc.","Multiplan, Inc.",24968.28,94,,percent of total billed charges,,
TENECTEPLASE 50 MG IV SOLR,,J3101,HCPCS,Facility,Outpatient,1,Each,,26562,22577.7,7612.6692,26562,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,23932.362,90.1,,percent of total billed charges,,
TENECTEPLASE 50 MG IV SOLR,,J3101,HCPCS,Facility,Inpatient,1,Each,,26562,22577.7,7612.6692,26562,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
TENECTEPLASE 50 MG IV SOLR,,J3101,HCPCS,Facility,Both,1,Each,,26562,22577.7,7612.6692,26562,"Preferred One Administrative Services, INC.",PPO,26190.132,98.6,,percent of total billed charges,,
TENECTEPLASE 50 MG IV SOLR,,J3101,HCPCS,Facility,Outpatient,1,Each,,26562,22577.7,7612.6692,26562,PrimeWest Health,Minnesota Senior Health Options (MSHO),13666.149,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
TENECTEPLASE 50 MG IV SOLR,,J3101,HCPCS,Facility,Inpatient,1,Each,,26562,22577.7,7612.6692,26562,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
TENECTEPLASE 50 MG IV SOLR,,J3101,HCPCS,Facility,Outpatient,1,Each,,26562,22577.7,7612.6692,26562,PrimeWest Health,MinnesotaCare,13642.2432,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
TENECTEPLASE 50 MG IV SOLR,,J3101,HCPCS,Facility,Inpatient,1,Each,,26562,22577.7,7612.6692,26562,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
TENECTEPLASE 50 MG IV SOLR,,J3101,HCPCS,Facility,Both,1,Each,,26562,22577.7,7612.6692,26562,Sanford Health Plan,Sanford Health Plan,24437.04,92,,percent of total billed charges,,
TENECTEPLASE 50 MG IV SOLR,,J3101,HCPCS,Facility,Outpatient,1,Each,,26562,22577.7,7612.6692,26562,"UCare Health, Inc.",Individual & Family Plan,14967.687,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
TENECTEPLASE 50 MG IV SOLR,,J3101,HCPCS,Facility,Inpatient,1,Each,,26562,22577.7,7612.6692,26562,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
TENECTEPLASE 50 MG IV SOLR,,J3101,HCPCS,Facility,Outpatient,1,Each,,26562,22577.7,7612.6692,26562,"UCare Health, Inc.",Medical Assistance,13405.8414,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TENECTEPLASE 50 MG IV SOLR,,J3101,HCPCS,Facility,Inpatient,1,Each,,26562,22577.7,7612.6692,26562,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
TENECTEPLASE 50 MG IV SOLR,,J3101,HCPCS,Facility,Outpatient,1,Each,,26562,22577.7,7612.6692,26562,"UCare Health, Inc.",Medicare Advantage,13405.8414,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TENECTEPLASE 50 MG IV SOLR,,J3101,HCPCS,Facility,Inpatient,1,Each,,26562,22577.7,7612.6692,26562,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
TENECTEPLASE 50 MG IV SOLR,,J3101,HCPCS,Facility,Outpatient,1,Each,,26562,22577.7,7612.6692,26562,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),13405.8414,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TENECTEPLASE 50 MG IV SOLR,,J3101,HCPCS,Facility,Inpatient,1,Each,,26562,22577.7,7612.6692,26562,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
TENECTEPLASE 50 MG IV SOLR,,J3101,HCPCS,Facility,Both,1,Each,,26562,22577.7,7612.6692,26562,UnitedHealthcare,Individual & Family,24968.28,94,,percent of total billed charges,,
TENECTEPLASE 50 MG IV SOLR,,J3101,HCPCS,Facility,Outpatient,1,Each,,26562,22577.7,7612.6692,26562,UnitedHealthcare,Medicare Advantage,13015.38,49,,percent of total billed charges,,
TENECTEPLASE 50 MG IV SOLR,,J3101,HCPCS,Facility,Inpatient,1,Each,,26562,22577.7,7612.6692,26562,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
TENECTEPLASE 50 MG IV SOLR,,J3101,HCPCS,Facility,Outpatient,1,Each,,26562,22577.7,7612.6692,26562,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,12749.76,48,,percent of total billed charges,,100% of DHS outpatient percentage
TENECTEPLASE 50 MG IV SOLR,,J3101,HCPCS,Facility,Inpatient,1,Each,,26562,22577.7,7612.6692,26562,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"VANCOMYCIN 1,000 MG IV SOLR",,J3370,HCPCS,Facility,Both,1,Each,,36,30.6,10.3176,36,Aetna,Commercial,33.12,92,,percent of total billed charges,,
"VANCOMYCIN 1,000 MG IV SOLR",,J3370,HCPCS,Facility,Outpatient,1,Each,,36,30.6,10.3176,36,Aetna,Medicare Advantage,17.64,49,,percent of total billed charges,,
"VANCOMYCIN 1,000 MG IV SOLR",,J3370,HCPCS,Facility,Inpatient,1,Each,,36,30.6,10.3176,36,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"VANCOMYCIN 1,000 MG IV SOLR",,J3370,HCPCS,Facility,Both,1,Each,,36,30.6,10.3176,36,Aetna,PPO,33.48,93,,percent of total billed charges,,
"VANCOMYCIN 1,000 MG IV SOLR",,J3370,HCPCS,Facility,Both,1,Each,,36,30.6,10.3176,36,America's PPO,America's PPO,34.5708,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"VANCOMYCIN 1,000 MG IV SOLR",,J3370,HCPCS,Facility,Both,1,Each,,36,30.6,10.3176,36,BlueCross BlueShield Minnesota, Federal Employee Program,35.424,98.4,,percent of total billed charges,,
"VANCOMYCIN 1,000 MG IV SOLR",,J3370,HCPCS,Facility,Both,1,Each,,36,30.6,10.3176,36,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,36,100,,percent of total billed charges,,
"VANCOMYCIN 1,000 MG IV SOLR",,J3370,HCPCS,Facility,Both,1,Each,,36,30.6,10.3176,36,BlueCross BlueShield Minnesota,High Value Network Plan,32.4,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
"VANCOMYCIN 1,000 MG IV SOLR",,J3370,HCPCS,Facility,Outpatient,1,Each,,36,30.6,10.3176,36,BlueCross BlueShield Minnesota,Medicare Advantage,17.64,49,,percent of total billed charges,,
"VANCOMYCIN 1,000 MG IV SOLR",,J3370,HCPCS,Facility,Inpatient,1,Each,,36,30.6,10.3176,36,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"VANCOMYCIN 1,000 MG IV SOLR",,J3370,HCPCS,Facility,Both,1,Each,,36,30.6,10.3176,36,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,31.8852,88.57,,percent of total billed charges,,
"VANCOMYCIN 1,000 MG IV SOLR",,J3370,HCPCS,Facility,Both,1,Each,,36,30.6,10.3176,36,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,10.3176,28.66,,percent of total billed charges,,
"VANCOMYCIN 1,000 MG IV SOLR",,J3370,HCPCS,Facility,Outpatient,1,Each,,36,30.6,10.3176,36,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),17.64,49,,percent of total billed charges,,
"VANCOMYCIN 1,000 MG IV SOLR",,J3370,HCPCS,Facility,Inpatient,1,Each,,36,30.6,10.3176,36,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"VANCOMYCIN 1,000 MG IV SOLR",,J3370,HCPCS,Facility,Both,1,Each,,36,30.6,10.3176,36,CorVel,Worker's Compensation,36,100,,percent of total billed charges,,
"VANCOMYCIN 1,000 MG IV SOLR",,J3370,HCPCS,Facility,Both,1,Each,,36,30.6,10.3176,36,First Health Group Corporation,First Health Network,34.92,97,,percent of total billed charges,,
"VANCOMYCIN 1,000 MG IV SOLR",,J3370,HCPCS,Facility,Both,1,Each,,36,30.6,10.3176,36,"Health Partners, Inc.",Commercial,34.056,94.6,,percent of total billed charges,,
"VANCOMYCIN 1,000 MG IV SOLR",,J3370,HCPCS,Facility,Outpatient,1,Each,,36,30.6,10.3176,36,"Health Partners, Inc.",Medicare Advantage,17.64,49,,percent of total billed charges,,
"VANCOMYCIN 1,000 MG IV SOLR",,J3370,HCPCS,Facility,Inpatient,1,Each,,36,30.6,10.3176,36,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"VANCOMYCIN 1,000 MG IV SOLR",,J3370,HCPCS,Facility,Both,1,Each,,36,30.6,10.3176,36,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),21.6,60,,percent of total billed charges,,
"VANCOMYCIN 1,000 MG IV SOLR",,J3370,HCPCS,Facility,Both,1,Each,,36,30.6,10.3176,36,"Health Partners, Inc.",State of Minnesota Advantage Program,29.34,81.5,,percent of total billed charges,,
"VANCOMYCIN 1,000 MG IV SOLR",,J3370,HCPCS,Facility,Both,1,Each,,36,30.6,10.3176,36,"Health Partners, Inc.",State Public Programs,18,50,,percent of total billed charges,,
"VANCOMYCIN 1,000 MG IV SOLR",,J3370,HCPCS,Facility,Both,1,Each,,36,30.6,10.3176,36,Humana Insurance Company,Commercial PPO,34.2,95,,percent of total billed charges,,
"VANCOMYCIN 1,000 MG IV SOLR",,J3370,HCPCS,Facility,Outpatient,1,Each,,36,30.6,10.3176,36,Humana Insurance Company,Medicare PPO,17.64,49,,percent of total billed charges,,
"VANCOMYCIN 1,000 MG IV SOLR",,J3370,HCPCS,Facility,Inpatient,1,Each,,36,30.6,10.3176,36,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"VANCOMYCIN 1,000 MG IV SOLR",,J3370,HCPCS,Facility,Both,1,Each,,36,30.6,10.3176,36,Medica,Individual & Family,35.676,99.1,,percent of total billed charges,,
"VANCOMYCIN 1,000 MG IV SOLR",,J3370,HCPCS,Facility,Outpatient,1,Each,,36,30.6,10.3176,36,Medica,Medica Advantage Solution,17.928,49.8,,percent of total billed charges,,
"VANCOMYCIN 1,000 MG IV SOLR",,J3370,HCPCS,Facility,Inpatient,1,Each,,36,30.6,10.3176,36,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"VANCOMYCIN 1,000 MG IV SOLR",,J3370,HCPCS,Facility,Outpatient,1,Each,,36,30.6,10.3176,36,Medica,Medical Assistance,16.056,44.6,,percent of total billed charges,,
"VANCOMYCIN 1,000 MG IV SOLR",,J3370,HCPCS,Facility,Inpatient,1,Each,,36,30.6,10.3176,36,Medica,Medical Assistance,,,,,Included in per diem rate,
"VANCOMYCIN 1,000 MG IV SOLR",,J3370,HCPCS,Facility,Outpatient,1,Each,,36,30.6,10.3176,36,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,17.928,49.8,,percent of total billed charges,,
"VANCOMYCIN 1,000 MG IV SOLR",,J3370,HCPCS,Facility,Inpatient,1,Each,,36,30.6,10.3176,36,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"VANCOMYCIN 1,000 MG IV SOLR",,J3370,HCPCS,Facility,Both,1,Each,,36,30.6,10.3176,36,"Multiplan, Inc.","Multiplan, Inc.",33.84,94,,percent of total billed charges,,
"VANCOMYCIN 1,000 MG IV SOLR",,J3370,HCPCS,Facility,Outpatient,1,Each,,36,30.6,10.3176,36,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,32.436,90.1,,percent of total billed charges,,
"VANCOMYCIN 1,000 MG IV SOLR",,J3370,HCPCS,Facility,Inpatient,1,Each,,36,30.6,10.3176,36,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"VANCOMYCIN 1,000 MG IV SOLR",,J3370,HCPCS,Facility,Both,1,Each,,36,30.6,10.3176,36,"Preferred One Administrative Services, INC.",PPO,35.496,98.6,,percent of total billed charges,,
"VANCOMYCIN 1,000 MG IV SOLR",,J3370,HCPCS,Facility,Outpatient,1,Each,,36,30.6,10.3176,36,PrimeWest Health,Minnesota Senior Health Options (MSHO),18.522,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"VANCOMYCIN 1,000 MG IV SOLR",,J3370,HCPCS,Facility,Inpatient,1,Each,,36,30.6,10.3176,36,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"VANCOMYCIN 1,000 MG IV SOLR",,J3370,HCPCS,Facility,Outpatient,1,Each,,36,30.6,10.3176,36,PrimeWest Health,MinnesotaCare,18.4896,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"VANCOMYCIN 1,000 MG IV SOLR",,J3370,HCPCS,Facility,Inpatient,1,Each,,36,30.6,10.3176,36,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"VANCOMYCIN 1,000 MG IV SOLR",,J3370,HCPCS,Facility,Both,1,Each,,36,30.6,10.3176,36,Sanford Health Plan,Sanford Health Plan,33.12,92,,percent of total billed charges,,
"VANCOMYCIN 1,000 MG IV SOLR",,J3370,HCPCS,Facility,Outpatient,1,Each,,36,30.6,10.3176,36,"UCare Health, Inc.",Individual & Family Plan,20.286,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"VANCOMYCIN 1,000 MG IV SOLR",,J3370,HCPCS,Facility,Inpatient,1,Each,,36,30.6,10.3176,36,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"VANCOMYCIN 1,000 MG IV SOLR",,J3370,HCPCS,Facility,Outpatient,1,Each,,36,30.6,10.3176,36,"UCare Health, Inc.",Medical Assistance,18.1692,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"VANCOMYCIN 1,000 MG IV SOLR",,J3370,HCPCS,Facility,Inpatient,1,Each,,36,30.6,10.3176,36,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"VANCOMYCIN 1,000 MG IV SOLR",,J3370,HCPCS,Facility,Outpatient,1,Each,,36,30.6,10.3176,36,"UCare Health, Inc.",Medicare Advantage,18.1692,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"VANCOMYCIN 1,000 MG IV SOLR",,J3370,HCPCS,Facility,Inpatient,1,Each,,36,30.6,10.3176,36,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"VANCOMYCIN 1,000 MG IV SOLR",,J3370,HCPCS,Facility,Outpatient,1,Each,,36,30.6,10.3176,36,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),18.1692,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"VANCOMYCIN 1,000 MG IV SOLR",,J3370,HCPCS,Facility,Inpatient,1,Each,,36,30.6,10.3176,36,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"VANCOMYCIN 1,000 MG IV SOLR",,J3370,HCPCS,Facility,Both,1,Each,,36,30.6,10.3176,36,UnitedHealthcare,Individual & Family,33.84,94,,percent of total billed charges,,
"VANCOMYCIN 1,000 MG IV SOLR",,J3370,HCPCS,Facility,Outpatient,1,Each,,36,30.6,10.3176,36,UnitedHealthcare,Medicare Advantage,17.64,49,,percent of total billed charges,,
"VANCOMYCIN 1,000 MG IV SOLR",,J3370,HCPCS,Facility,Inpatient,1,Each,,36,30.6,10.3176,36,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"VANCOMYCIN 1,000 MG IV SOLR",,J3370,HCPCS,Facility,Outpatient,1,Each,,36,30.6,10.3176,36,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,17.28,48,,percent of total billed charges,,100% of DHS outpatient percentage
"VANCOMYCIN 1,000 MG IV SOLR",,J3370,HCPCS,Facility,Inpatient,1,Each,,36,30.6,10.3176,36,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
VANCOMYCIN 500 MG IV SOLR,,J3370,HCPCS,Facility,Both,1,Each,,18,15.3,5.1588,18,Aetna,Commercial,16.56,92,,percent of total billed charges,,
VANCOMYCIN 500 MG IV SOLR,,J3370,HCPCS,Facility,Outpatient,1,Each,,18,15.3,5.1588,18,Aetna,Medicare Advantage,8.82,49,,percent of total billed charges,,
VANCOMYCIN 500 MG IV SOLR,,J3370,HCPCS,Facility,Inpatient,1,Each,,18,15.3,5.1588,18,Aetna,Medicare Advantage,,,,,Included in per diem rate,
VANCOMYCIN 500 MG IV SOLR,,J3370,HCPCS,Facility,Both,1,Each,,18,15.3,5.1588,18,Aetna,PPO,16.74,93,,percent of total billed charges,,
VANCOMYCIN 500 MG IV SOLR,,J3370,HCPCS,Facility,Both,1,Each,,18,15.3,5.1588,18,America's PPO,America's PPO,17.2854,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
VANCOMYCIN 500 MG IV SOLR,,J3370,HCPCS,Facility,Both,1,Each,,18,15.3,5.1588,18,BlueCross BlueShield Minnesota, Federal Employee Program,17.712,98.4,,percent of total billed charges,,
VANCOMYCIN 500 MG IV SOLR,,J3370,HCPCS,Facility,Both,1,Each,,18,15.3,5.1588,18,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,18,100,,percent of total billed charges,,
VANCOMYCIN 500 MG IV SOLR,,J3370,HCPCS,Facility,Both,1,Each,,18,15.3,5.1588,18,BlueCross BlueShield Minnesota,High Value Network Plan,16.2,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
VANCOMYCIN 500 MG IV SOLR,,J3370,HCPCS,Facility,Outpatient,1,Each,,18,15.3,5.1588,18,BlueCross BlueShield Minnesota,Medicare Advantage,8.82,49,,percent of total billed charges,,
VANCOMYCIN 500 MG IV SOLR,,J3370,HCPCS,Facility,Inpatient,1,Each,,18,15.3,5.1588,18,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
VANCOMYCIN 500 MG IV SOLR,,J3370,HCPCS,Facility,Both,1,Each,,18,15.3,5.1588,18,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,15.9426,88.57,,percent of total billed charges,,
VANCOMYCIN 500 MG IV SOLR,,J3370,HCPCS,Facility,Both,1,Each,,18,15.3,5.1588,18,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,5.1588,28.66,,percent of total billed charges,,
VANCOMYCIN 500 MG IV SOLR,,J3370,HCPCS,Facility,Outpatient,1,Each,,18,15.3,5.1588,18,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),8.82,49,,percent of total billed charges,,
VANCOMYCIN 500 MG IV SOLR,,J3370,HCPCS,Facility,Inpatient,1,Each,,18,15.3,5.1588,18,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
VANCOMYCIN 500 MG IV SOLR,,J3370,HCPCS,Facility,Both,1,Each,,18,15.3,5.1588,18,CorVel,Worker's Compensation,18,100,,percent of total billed charges,,
VANCOMYCIN 500 MG IV SOLR,,J3370,HCPCS,Facility,Both,1,Each,,18,15.3,5.1588,18,First Health Group Corporation,First Health Network,17.46,97,,percent of total billed charges,,
VANCOMYCIN 500 MG IV SOLR,,J3370,HCPCS,Facility,Both,1,Each,,18,15.3,5.1588,18,"Health Partners, Inc.",Commercial,17.028,94.6,,percent of total billed charges,,
VANCOMYCIN 500 MG IV SOLR,,J3370,HCPCS,Facility,Outpatient,1,Each,,18,15.3,5.1588,18,"Health Partners, Inc.",Medicare Advantage,8.82,49,,percent of total billed charges,,
VANCOMYCIN 500 MG IV SOLR,,J3370,HCPCS,Facility,Inpatient,1,Each,,18,15.3,5.1588,18,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
VANCOMYCIN 500 MG IV SOLR,,J3370,HCPCS,Facility,Both,1,Each,,18,15.3,5.1588,18,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),10.8,60,,percent of total billed charges,,
VANCOMYCIN 500 MG IV SOLR,,J3370,HCPCS,Facility,Both,1,Each,,18,15.3,5.1588,18,"Health Partners, Inc.",State of Minnesota Advantage Program,14.67,81.5,,percent of total billed charges,,
VANCOMYCIN 500 MG IV SOLR,,J3370,HCPCS,Facility,Both,1,Each,,18,15.3,5.1588,18,"Health Partners, Inc.",State Public Programs,9,50,,percent of total billed charges,,
VANCOMYCIN 500 MG IV SOLR,,J3370,HCPCS,Facility,Both,1,Each,,18,15.3,5.1588,18,Humana Insurance Company,Commercial PPO,17.1,95,,percent of total billed charges,,
VANCOMYCIN 500 MG IV SOLR,,J3370,HCPCS,Facility,Outpatient,1,Each,,18,15.3,5.1588,18,Humana Insurance Company,Medicare PPO,8.82,49,,percent of total billed charges,,
VANCOMYCIN 500 MG IV SOLR,,J3370,HCPCS,Facility,Inpatient,1,Each,,18,15.3,5.1588,18,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
VANCOMYCIN 500 MG IV SOLR,,J3370,HCPCS,Facility,Both,1,Each,,18,15.3,5.1588,18,Medica,Individual & Family,17.838,99.1,,percent of total billed charges,,
VANCOMYCIN 500 MG IV SOLR,,J3370,HCPCS,Facility,Outpatient,1,Each,,18,15.3,5.1588,18,Medica,Medica Advantage Solution,8.964,49.8,,percent of total billed charges,,
VANCOMYCIN 500 MG IV SOLR,,J3370,HCPCS,Facility,Inpatient,1,Each,,18,15.3,5.1588,18,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
VANCOMYCIN 500 MG IV SOLR,,J3370,HCPCS,Facility,Outpatient,1,Each,,18,15.3,5.1588,18,Medica,Medical Assistance,8.028,44.6,,percent of total billed charges,,
VANCOMYCIN 500 MG IV SOLR,,J3370,HCPCS,Facility,Inpatient,1,Each,,18,15.3,5.1588,18,Medica,Medical Assistance,,,,,Included in per diem rate,
VANCOMYCIN 500 MG IV SOLR,,J3370,HCPCS,Facility,Outpatient,1,Each,,18,15.3,5.1588,18,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,8.964,49.8,,percent of total billed charges,,
VANCOMYCIN 500 MG IV SOLR,,J3370,HCPCS,Facility,Inpatient,1,Each,,18,15.3,5.1588,18,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
VANCOMYCIN 500 MG IV SOLR,,J3370,HCPCS,Facility,Both,1,Each,,18,15.3,5.1588,18,"Multiplan, Inc.","Multiplan, Inc.",16.92,94,,percent of total billed charges,,
VANCOMYCIN 500 MG IV SOLR,,J3370,HCPCS,Facility,Outpatient,1,Each,,18,15.3,5.1588,18,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,16.218,90.1,,percent of total billed charges,,
VANCOMYCIN 500 MG IV SOLR,,J3370,HCPCS,Facility,Inpatient,1,Each,,18,15.3,5.1588,18,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
VANCOMYCIN 500 MG IV SOLR,,J3370,HCPCS,Facility,Both,1,Each,,18,15.3,5.1588,18,"Preferred One Administrative Services, INC.",PPO,17.748,98.6,,percent of total billed charges,,
VANCOMYCIN 500 MG IV SOLR,,J3370,HCPCS,Facility,Outpatient,1,Each,,18,15.3,5.1588,18,PrimeWest Health,Minnesota Senior Health Options (MSHO),9.261,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
VANCOMYCIN 500 MG IV SOLR,,J3370,HCPCS,Facility,Inpatient,1,Each,,18,15.3,5.1588,18,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
VANCOMYCIN 500 MG IV SOLR,,J3370,HCPCS,Facility,Outpatient,1,Each,,18,15.3,5.1588,18,PrimeWest Health,MinnesotaCare,9.2448,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
VANCOMYCIN 500 MG IV SOLR,,J3370,HCPCS,Facility,Inpatient,1,Each,,18,15.3,5.1588,18,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
VANCOMYCIN 500 MG IV SOLR,,J3370,HCPCS,Facility,Both,1,Each,,18,15.3,5.1588,18,Sanford Health Plan,Sanford Health Plan,16.56,92,,percent of total billed charges,,
VANCOMYCIN 500 MG IV SOLR,,J3370,HCPCS,Facility,Outpatient,1,Each,,18,15.3,5.1588,18,"UCare Health, Inc.",Individual & Family Plan,10.143,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
VANCOMYCIN 500 MG IV SOLR,,J3370,HCPCS,Facility,Inpatient,1,Each,,18,15.3,5.1588,18,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
VANCOMYCIN 500 MG IV SOLR,,J3370,HCPCS,Facility,Outpatient,1,Each,,18,15.3,5.1588,18,"UCare Health, Inc.",Medical Assistance,9.0846,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
VANCOMYCIN 500 MG IV SOLR,,J3370,HCPCS,Facility,Inpatient,1,Each,,18,15.3,5.1588,18,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
VANCOMYCIN 500 MG IV SOLR,,J3370,HCPCS,Facility,Outpatient,1,Each,,18,15.3,5.1588,18,"UCare Health, Inc.",Medicare Advantage,9.0846,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
VANCOMYCIN 500 MG IV SOLR,,J3370,HCPCS,Facility,Inpatient,1,Each,,18,15.3,5.1588,18,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
VANCOMYCIN 500 MG IV SOLR,,J3370,HCPCS,Facility,Outpatient,1,Each,,18,15.3,5.1588,18,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),9.0846,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
VANCOMYCIN 500 MG IV SOLR,,J3370,HCPCS,Facility,Inpatient,1,Each,,18,15.3,5.1588,18,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
VANCOMYCIN 500 MG IV SOLR,,J3370,HCPCS,Facility,Both,1,Each,,18,15.3,5.1588,18,UnitedHealthcare,Individual & Family,16.92,94,,percent of total billed charges,,
VANCOMYCIN 500 MG IV SOLR,,J3370,HCPCS,Facility,Outpatient,1,Each,,18,15.3,5.1588,18,UnitedHealthcare,Medicare Advantage,8.82,49,,percent of total billed charges,,
VANCOMYCIN 500 MG IV SOLR,,J3370,HCPCS,Facility,Inpatient,1,Each,,18,15.3,5.1588,18,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
VANCOMYCIN 500 MG IV SOLR,,J3370,HCPCS,Facility,Outpatient,1,Each,,18,15.3,5.1588,18,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,8.64,48,,percent of total billed charges,,100% of DHS outpatient percentage
VANCOMYCIN 500 MG IV SOLR,,J3370,HCPCS,Facility,Inpatient,1,Each,,18,15.3,5.1588,18,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
VANCOMYCIN 750 MG IV SOLR,,J3370,HCPCS,Facility,Both,1,Each,,57,48.45,16.3362,57,Aetna,Commercial,52.44,92,,percent of total billed charges,,
VANCOMYCIN 750 MG IV SOLR,,J3370,HCPCS,Facility,Outpatient,1,Each,,57,48.45,16.3362,57,Aetna,Medicare Advantage,27.93,49,,percent of total billed charges,,
VANCOMYCIN 750 MG IV SOLR,,J3370,HCPCS,Facility,Inpatient,1,Each,,57,48.45,16.3362,57,Aetna,Medicare Advantage,,,,,Included in per diem rate,
VANCOMYCIN 750 MG IV SOLR,,J3370,HCPCS,Facility,Both,1,Each,,57,48.45,16.3362,57,Aetna,PPO,53.01,93,,percent of total billed charges,,
VANCOMYCIN 750 MG IV SOLR,,J3370,HCPCS,Facility,Both,1,Each,,57,48.45,16.3362,57,America's PPO,America's PPO,54.7371,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
VANCOMYCIN 750 MG IV SOLR,,J3370,HCPCS,Facility,Both,1,Each,,57,48.45,16.3362,57,BlueCross BlueShield Minnesota, Federal Employee Program,56.088,98.4,,percent of total billed charges,,
VANCOMYCIN 750 MG IV SOLR,,J3370,HCPCS,Facility,Both,1,Each,,57,48.45,16.3362,57,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,57,100,,percent of total billed charges,,
VANCOMYCIN 750 MG IV SOLR,,J3370,HCPCS,Facility,Both,1,Each,,57,48.45,16.3362,57,BlueCross BlueShield Minnesota,High Value Network Plan,51.3,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
VANCOMYCIN 750 MG IV SOLR,,J3370,HCPCS,Facility,Outpatient,1,Each,,57,48.45,16.3362,57,BlueCross BlueShield Minnesota,Medicare Advantage,27.93,49,,percent of total billed charges,,
VANCOMYCIN 750 MG IV SOLR,,J3370,HCPCS,Facility,Inpatient,1,Each,,57,48.45,16.3362,57,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
VANCOMYCIN 750 MG IV SOLR,,J3370,HCPCS,Facility,Both,1,Each,,57,48.45,16.3362,57,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,50.4849,88.57,,percent of total billed charges,,
VANCOMYCIN 750 MG IV SOLR,,J3370,HCPCS,Facility,Both,1,Each,,57,48.45,16.3362,57,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,16.3362,28.66,,percent of total billed charges,,
VANCOMYCIN 750 MG IV SOLR,,J3370,HCPCS,Facility,Outpatient,1,Each,,57,48.45,16.3362,57,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),27.93,49,,percent of total billed charges,,
VANCOMYCIN 750 MG IV SOLR,,J3370,HCPCS,Facility,Inpatient,1,Each,,57,48.45,16.3362,57,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
VANCOMYCIN 750 MG IV SOLR,,J3370,HCPCS,Facility,Both,1,Each,,57,48.45,16.3362,57,CorVel,Worker's Compensation,57,100,,percent of total billed charges,,
VANCOMYCIN 750 MG IV SOLR,,J3370,HCPCS,Facility,Both,1,Each,,57,48.45,16.3362,57,First Health Group Corporation,First Health Network,55.29,97,,percent of total billed charges,,
VANCOMYCIN 750 MG IV SOLR,,J3370,HCPCS,Facility,Both,1,Each,,57,48.45,16.3362,57,"Health Partners, Inc.",Commercial,53.922,94.6,,percent of total billed charges,,
VANCOMYCIN 750 MG IV SOLR,,J3370,HCPCS,Facility,Outpatient,1,Each,,57,48.45,16.3362,57,"Health Partners, Inc.",Medicare Advantage,27.93,49,,percent of total billed charges,,
VANCOMYCIN 750 MG IV SOLR,,J3370,HCPCS,Facility,Inpatient,1,Each,,57,48.45,16.3362,57,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
VANCOMYCIN 750 MG IV SOLR,,J3370,HCPCS,Facility,Both,1,Each,,57,48.45,16.3362,57,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),34.2,60,,percent of total billed charges,,
VANCOMYCIN 750 MG IV SOLR,,J3370,HCPCS,Facility,Both,1,Each,,57,48.45,16.3362,57,"Health Partners, Inc.",State of Minnesota Advantage Program,46.455,81.5,,percent of total billed charges,,
VANCOMYCIN 750 MG IV SOLR,,J3370,HCPCS,Facility,Both,1,Each,,57,48.45,16.3362,57,"Health Partners, Inc.",State Public Programs,28.5,50,,percent of total billed charges,,
VANCOMYCIN 750 MG IV SOLR,,J3370,HCPCS,Facility,Both,1,Each,,57,48.45,16.3362,57,Humana Insurance Company,Commercial PPO,54.15,95,,percent of total billed charges,,
VANCOMYCIN 750 MG IV SOLR,,J3370,HCPCS,Facility,Outpatient,1,Each,,57,48.45,16.3362,57,Humana Insurance Company,Medicare PPO,27.93,49,,percent of total billed charges,,
VANCOMYCIN 750 MG IV SOLR,,J3370,HCPCS,Facility,Inpatient,1,Each,,57,48.45,16.3362,57,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
VANCOMYCIN 750 MG IV SOLR,,J3370,HCPCS,Facility,Both,1,Each,,57,48.45,16.3362,57,Medica,Individual & Family,56.487,99.1,,percent of total billed charges,,
VANCOMYCIN 750 MG IV SOLR,,J3370,HCPCS,Facility,Outpatient,1,Each,,57,48.45,16.3362,57,Medica,Medica Advantage Solution,28.386,49.8,,percent of total billed charges,,
VANCOMYCIN 750 MG IV SOLR,,J3370,HCPCS,Facility,Inpatient,1,Each,,57,48.45,16.3362,57,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
VANCOMYCIN 750 MG IV SOLR,,J3370,HCPCS,Facility,Outpatient,1,Each,,57,48.45,16.3362,57,Medica,Medical Assistance,25.422,44.6,,percent of total billed charges,,
VANCOMYCIN 750 MG IV SOLR,,J3370,HCPCS,Facility,Inpatient,1,Each,,57,48.45,16.3362,57,Medica,Medical Assistance,,,,,Included in per diem rate,
VANCOMYCIN 750 MG IV SOLR,,J3370,HCPCS,Facility,Outpatient,1,Each,,57,48.45,16.3362,57,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,28.386,49.8,,percent of total billed charges,,
VANCOMYCIN 750 MG IV SOLR,,J3370,HCPCS,Facility,Inpatient,1,Each,,57,48.45,16.3362,57,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
VANCOMYCIN 750 MG IV SOLR,,J3370,HCPCS,Facility,Both,1,Each,,57,48.45,16.3362,57,"Multiplan, Inc.","Multiplan, Inc.",53.58,94,,percent of total billed charges,,
VANCOMYCIN 750 MG IV SOLR,,J3370,HCPCS,Facility,Outpatient,1,Each,,57,48.45,16.3362,57,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,51.357,90.1,,percent of total billed charges,,
VANCOMYCIN 750 MG IV SOLR,,J3370,HCPCS,Facility,Inpatient,1,Each,,57,48.45,16.3362,57,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
VANCOMYCIN 750 MG IV SOLR,,J3370,HCPCS,Facility,Both,1,Each,,57,48.45,16.3362,57,"Preferred One Administrative Services, INC.",PPO,56.202,98.6,,percent of total billed charges,,
VANCOMYCIN 750 MG IV SOLR,,J3370,HCPCS,Facility,Outpatient,1,Each,,57,48.45,16.3362,57,PrimeWest Health,Minnesota Senior Health Options (MSHO),29.3265,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
VANCOMYCIN 750 MG IV SOLR,,J3370,HCPCS,Facility,Inpatient,1,Each,,57,48.45,16.3362,57,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
VANCOMYCIN 750 MG IV SOLR,,J3370,HCPCS,Facility,Outpatient,1,Each,,57,48.45,16.3362,57,PrimeWest Health,MinnesotaCare,29.2752,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
VANCOMYCIN 750 MG IV SOLR,,J3370,HCPCS,Facility,Inpatient,1,Each,,57,48.45,16.3362,57,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
VANCOMYCIN 750 MG IV SOLR,,J3370,HCPCS,Facility,Both,1,Each,,57,48.45,16.3362,57,Sanford Health Plan,Sanford Health Plan,52.44,92,,percent of total billed charges,,
VANCOMYCIN 750 MG IV SOLR,,J3370,HCPCS,Facility,Outpatient,1,Each,,57,48.45,16.3362,57,"UCare Health, Inc.",Individual & Family Plan,32.1195,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
VANCOMYCIN 750 MG IV SOLR,,J3370,HCPCS,Facility,Inpatient,1,Each,,57,48.45,16.3362,57,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
VANCOMYCIN 750 MG IV SOLR,,J3370,HCPCS,Facility,Outpatient,1,Each,,57,48.45,16.3362,57,"UCare Health, Inc.",Medical Assistance,28.7679,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
VANCOMYCIN 750 MG IV SOLR,,J3370,HCPCS,Facility,Inpatient,1,Each,,57,48.45,16.3362,57,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
VANCOMYCIN 750 MG IV SOLR,,J3370,HCPCS,Facility,Outpatient,1,Each,,57,48.45,16.3362,57,"UCare Health, Inc.",Medicare Advantage,28.7679,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
VANCOMYCIN 750 MG IV SOLR,,J3370,HCPCS,Facility,Inpatient,1,Each,,57,48.45,16.3362,57,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
VANCOMYCIN 750 MG IV SOLR,,J3370,HCPCS,Facility,Outpatient,1,Each,,57,48.45,16.3362,57,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),28.7679,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
VANCOMYCIN 750 MG IV SOLR,,J3370,HCPCS,Facility,Inpatient,1,Each,,57,48.45,16.3362,57,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
VANCOMYCIN 750 MG IV SOLR,,J3370,HCPCS,Facility,Both,1,Each,,57,48.45,16.3362,57,UnitedHealthcare,Individual & Family,53.58,94,,percent of total billed charges,,
VANCOMYCIN 750 MG IV SOLR,,J3370,HCPCS,Facility,Outpatient,1,Each,,57,48.45,16.3362,57,UnitedHealthcare,Medicare Advantage,27.93,49,,percent of total billed charges,,
VANCOMYCIN 750 MG IV SOLR,,J3370,HCPCS,Facility,Inpatient,1,Each,,57,48.45,16.3362,57,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
VANCOMYCIN 750 MG IV SOLR,,J3370,HCPCS,Facility,Outpatient,1,Each,,57,48.45,16.3362,57,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,27.36,48,,percent of total billed charges,,100% of DHS outpatient percentage
VANCOMYCIN 750 MG IV SOLR,,J3370,HCPCS,Facility,Inpatient,1,Each,,57,48.45,16.3362,57,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
DILTIAZEM HCL 100 MG IV SOLR,,J3490,HCPCS,Facility,Both,1,Each,,66,56.1,18.9156,66,Aetna,Commercial,60.72,92,,percent of total billed charges,,
DILTIAZEM HCL 100 MG IV SOLR,,J3490,HCPCS,Facility,Both,1,Each,,66,56.1,18.9156,66,Aetna,Commercial,60.72,92,,percent of total billed charges,,
DILTIAZEM HCL 100 MG IV SOLR,,J3490,HCPCS,Facility,Outpatient,1,Each,,66,56.1,18.9156,66,Aetna,Medicare Advantage,32.34,49,,percent of total billed charges,,
DILTIAZEM HCL 100 MG IV SOLR,,J3490,HCPCS,Facility,Outpatient,1,Each,,66,56.1,18.9156,66,Aetna,Medicare Advantage,32.34,49,,percent of total billed charges,,
DILTIAZEM HCL 100 MG IV SOLR,,J3490,HCPCS,Facility,Inpatient,1,Each,,66,56.1,18.9156,66,Aetna,Medicare Advantage,,,,,Included in per diem rate,
DILTIAZEM HCL 100 MG IV SOLR,,J3490,HCPCS,Facility,Inpatient,1,Each,,66,56.1,18.9156,66,Aetna,Medicare Advantage,,,,,Included in per diem rate,
DILTIAZEM HCL 100 MG IV SOLR,,J3490,HCPCS,Facility,Both,1,Each,,66,56.1,18.9156,66,Aetna,PPO,61.38,93,,percent of total billed charges,,
DILTIAZEM HCL 100 MG IV SOLR,,J3490,HCPCS,Facility,Both,1,Each,,66,56.1,18.9156,66,Aetna,PPO,61.38,93,,percent of total billed charges,,
DILTIAZEM HCL 100 MG IV SOLR,,J3490,HCPCS,Facility,Both,1,Each,,66,56.1,18.9156,66,America's PPO,America's PPO,63.3798,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
DILTIAZEM HCL 100 MG IV SOLR,,J3490,HCPCS,Facility,Both,1,Each,,66,56.1,18.9156,66,America's PPO,America's PPO,63.3798,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
DILTIAZEM HCL 100 MG IV SOLR,,J3490,HCPCS,Facility,Both,1,Each,,66,56.1,18.9156,66,BlueCross BlueShield Minnesota, Federal Employee Program,64.944,98.4,,percent of total billed charges,,
DILTIAZEM HCL 100 MG IV SOLR,,J3490,HCPCS,Facility,Both,1,Each,,66,56.1,18.9156,66,BlueCross BlueShield Minnesota, Federal Employee Program,64.944,98.4,,percent of total billed charges,,
DILTIAZEM HCL 100 MG IV SOLR,,J3490,HCPCS,Facility,Both,1,Each,,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,66,100,,percent of total billed charges,,
DILTIAZEM HCL 100 MG IV SOLR,,J3490,HCPCS,Facility,Both,1,Each,,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,66,100,,percent of total billed charges,,
DILTIAZEM HCL 100 MG IV SOLR,,J3490,HCPCS,Facility,Both,1,Each,,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,High Value Network Plan,59.4,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
DILTIAZEM HCL 100 MG IV SOLR,,J3490,HCPCS,Facility,Both,1,Each,,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,High Value Network Plan,59.4,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
DILTIAZEM HCL 100 MG IV SOLR,,J3490,HCPCS,Facility,Outpatient,1,Each,,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,Medicare Advantage,32.34,49,,percent of total billed charges,,
DILTIAZEM HCL 100 MG IV SOLR,,J3490,HCPCS,Facility,Outpatient,1,Each,,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,Medicare Advantage,32.34,49,,percent of total billed charges,,
DILTIAZEM HCL 100 MG IV SOLR,,J3490,HCPCS,Facility,Inpatient,1,Each,,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
DILTIAZEM HCL 100 MG IV SOLR,,J3490,HCPCS,Facility,Inpatient,1,Each,,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
DILTIAZEM HCL 100 MG IV SOLR,,J3490,HCPCS,Facility,Both,1,Each,,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,58.4562,88.57,,percent of total billed charges,,
DILTIAZEM HCL 100 MG IV SOLR,,J3490,HCPCS,Facility,Both,1,Each,,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,58.4562,88.57,,percent of total billed charges,,
DILTIAZEM HCL 100 MG IV SOLR,,J3490,HCPCS,Facility,Both,1,Each,,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,18.9156,28.66,,percent of total billed charges,,
DILTIAZEM HCL 100 MG IV SOLR,,J3490,HCPCS,Facility,Both,1,Each,,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,18.9156,28.66,,percent of total billed charges,,
DILTIAZEM HCL 100 MG IV SOLR,,J3490,HCPCS,Facility,Outpatient,1,Each,,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),32.34,49,,percent of total billed charges,,
DILTIAZEM HCL 100 MG IV SOLR,,J3490,HCPCS,Facility,Outpatient,1,Each,,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),32.34,49,,percent of total billed charges,,
DILTIAZEM HCL 100 MG IV SOLR,,J3490,HCPCS,Facility,Inpatient,1,Each,,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
DILTIAZEM HCL 100 MG IV SOLR,,J3490,HCPCS,Facility,Inpatient,1,Each,,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
DILTIAZEM HCL 100 MG IV SOLR,,J3490,HCPCS,Facility,Both,1,Each,,66,56.1,18.9156,66,CorVel,Worker's Compensation,66,100,,percent of total billed charges,,
DILTIAZEM HCL 100 MG IV SOLR,,J3490,HCPCS,Facility,Both,1,Each,,66,56.1,18.9156,66,CorVel,Worker's Compensation,66,100,,percent of total billed charges,,
DILTIAZEM HCL 100 MG IV SOLR,,J3490,HCPCS,Facility,Both,1,Each,,66,56.1,18.9156,66,First Health Group Corporation,First Health Network,64.02,97,,percent of total billed charges,,
DILTIAZEM HCL 100 MG IV SOLR,,J3490,HCPCS,Facility,Both,1,Each,,66,56.1,18.9156,66,First Health Group Corporation,First Health Network,64.02,97,,percent of total billed charges,,
DILTIAZEM HCL 100 MG IV SOLR,,J3490,HCPCS,Facility,Both,1,Each,,66,56.1,18.9156,66,"Health Partners, Inc.",Commercial,62.436,94.6,,percent of total billed charges,,
DILTIAZEM HCL 100 MG IV SOLR,,J3490,HCPCS,Facility,Both,1,Each,,66,56.1,18.9156,66,"Health Partners, Inc.",Commercial,62.436,94.6,,percent of total billed charges,,
DILTIAZEM HCL 100 MG IV SOLR,,J3490,HCPCS,Facility,Outpatient,1,Each,,66,56.1,18.9156,66,"Health Partners, Inc.",Medicare Advantage,32.34,49,,percent of total billed charges,,
DILTIAZEM HCL 100 MG IV SOLR,,J3490,HCPCS,Facility,Outpatient,1,Each,,66,56.1,18.9156,66,"Health Partners, Inc.",Medicare Advantage,32.34,49,,percent of total billed charges,,
DILTIAZEM HCL 100 MG IV SOLR,,J3490,HCPCS,Facility,Inpatient,1,Each,,66,56.1,18.9156,66,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DILTIAZEM HCL 100 MG IV SOLR,,J3490,HCPCS,Facility,Inpatient,1,Each,,66,56.1,18.9156,66,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DILTIAZEM HCL 100 MG IV SOLR,,J3490,HCPCS,Facility,Both,1,Each,,66,56.1,18.9156,66,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),39.6,60,,percent of total billed charges,,
DILTIAZEM HCL 100 MG IV SOLR,,J3490,HCPCS,Facility,Both,1,Each,,66,56.1,18.9156,66,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),39.6,60,,percent of total billed charges,,
DILTIAZEM HCL 100 MG IV SOLR,,J3490,HCPCS,Facility,Both,1,Each,,66,56.1,18.9156,66,"Health Partners, Inc.",State of Minnesota Advantage Program,53.79,81.5,,percent of total billed charges,,
DILTIAZEM HCL 100 MG IV SOLR,,J3490,HCPCS,Facility,Both,1,Each,,66,56.1,18.9156,66,"Health Partners, Inc.",State of Minnesota Advantage Program,53.79,81.5,,percent of total billed charges,,
DILTIAZEM HCL 100 MG IV SOLR,,J3490,HCPCS,Facility,Both,1,Each,,66,56.1,18.9156,66,"Health Partners, Inc.",State Public Programs,33,50,,percent of total billed charges,,
DILTIAZEM HCL 100 MG IV SOLR,,J3490,HCPCS,Facility,Both,1,Each,,66,56.1,18.9156,66,"Health Partners, Inc.",State Public Programs,33,50,,percent of total billed charges,,
DILTIAZEM HCL 100 MG IV SOLR,,J3490,HCPCS,Facility,Both,1,Each,,66,56.1,18.9156,66,Humana Insurance Company,Commercial PPO,62.7,95,,percent of total billed charges,,
DILTIAZEM HCL 100 MG IV SOLR,,J3490,HCPCS,Facility,Both,1,Each,,66,56.1,18.9156,66,Humana Insurance Company,Commercial PPO,62.7,95,,percent of total billed charges,,
DILTIAZEM HCL 100 MG IV SOLR,,J3490,HCPCS,Facility,Outpatient,1,Each,,66,56.1,18.9156,66,Humana Insurance Company,Medicare PPO,32.34,49,,percent of total billed charges,,
DILTIAZEM HCL 100 MG IV SOLR,,J3490,HCPCS,Facility,Outpatient,1,Each,,66,56.1,18.9156,66,Humana Insurance Company,Medicare PPO,32.34,49,,percent of total billed charges,,
DILTIAZEM HCL 100 MG IV SOLR,,J3490,HCPCS,Facility,Inpatient,1,Each,,66,56.1,18.9156,66,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
DILTIAZEM HCL 100 MG IV SOLR,,J3490,HCPCS,Facility,Inpatient,1,Each,,66,56.1,18.9156,66,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
DILTIAZEM HCL 100 MG IV SOLR,,J3490,HCPCS,Facility,Both,1,Each,,66,56.1,18.9156,66,Medica,Individual & Family,65.406,99.1,,percent of total billed charges,,
DILTIAZEM HCL 100 MG IV SOLR,,J3490,HCPCS,Facility,Both,1,Each,,66,56.1,18.9156,66,Medica,Individual & Family,65.406,99.1,,percent of total billed charges,,
DILTIAZEM HCL 100 MG IV SOLR,,J3490,HCPCS,Facility,Outpatient,1,Each,,66,56.1,18.9156,66,Medica,Medica Advantage Solution,32.868,49.8,,percent of total billed charges,,
DILTIAZEM HCL 100 MG IV SOLR,,J3490,HCPCS,Facility,Outpatient,1,Each,,66,56.1,18.9156,66,Medica,Medica Advantage Solution,32.868,49.8,,percent of total billed charges,,
DILTIAZEM HCL 100 MG IV SOLR,,J3490,HCPCS,Facility,Inpatient,1,Each,,66,56.1,18.9156,66,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
DILTIAZEM HCL 100 MG IV SOLR,,J3490,HCPCS,Facility,Inpatient,1,Each,,66,56.1,18.9156,66,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
DILTIAZEM HCL 100 MG IV SOLR,,J3490,HCPCS,Facility,Outpatient,1,Each,,66,56.1,18.9156,66,Medica,Medical Assistance,29.436,44.6,,percent of total billed charges,,
DILTIAZEM HCL 100 MG IV SOLR,,J3490,HCPCS,Facility,Outpatient,1,Each,,66,56.1,18.9156,66,Medica,Medical Assistance,29.436,44.6,,percent of total billed charges,,
DILTIAZEM HCL 100 MG IV SOLR,,J3490,HCPCS,Facility,Inpatient,1,Each,,66,56.1,18.9156,66,Medica,Medical Assistance,,,,,Included in per diem rate,
DILTIAZEM HCL 100 MG IV SOLR,,J3490,HCPCS,Facility,Inpatient,1,Each,,66,56.1,18.9156,66,Medica,Medical Assistance,,,,,Included in per diem rate,
DILTIAZEM HCL 100 MG IV SOLR,,J3490,HCPCS,Facility,Outpatient,1,Each,,66,56.1,18.9156,66,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,32.868,49.8,,percent of total billed charges,,
DILTIAZEM HCL 100 MG IV SOLR,,J3490,HCPCS,Facility,Outpatient,1,Each,,66,56.1,18.9156,66,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,32.868,49.8,,percent of total billed charges,,
DILTIAZEM HCL 100 MG IV SOLR,,J3490,HCPCS,Facility,Inpatient,1,Each,,66,56.1,18.9156,66,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
DILTIAZEM HCL 100 MG IV SOLR,,J3490,HCPCS,Facility,Inpatient,1,Each,,66,56.1,18.9156,66,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
DILTIAZEM HCL 100 MG IV SOLR,,J3490,HCPCS,Facility,Both,1,Each,,66,56.1,18.9156,66,"Multiplan, Inc.","Multiplan, Inc.",62.04,94,,percent of total billed charges,,
DILTIAZEM HCL 100 MG IV SOLR,,J3490,HCPCS,Facility,Both,1,Each,,66,56.1,18.9156,66,"Multiplan, Inc.","Multiplan, Inc.",62.04,94,,percent of total billed charges,,
DILTIAZEM HCL 100 MG IV SOLR,,J3490,HCPCS,Facility,Outpatient,1,Each,,66,56.1,18.9156,66,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,59.466,90.1,,percent of total billed charges,,
DILTIAZEM HCL 100 MG IV SOLR,,J3490,HCPCS,Facility,Outpatient,1,Each,,66,56.1,18.9156,66,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,59.466,90.1,,percent of total billed charges,,
DILTIAZEM HCL 100 MG IV SOLR,,J3490,HCPCS,Facility,Inpatient,1,Each,,66,56.1,18.9156,66,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
DILTIAZEM HCL 100 MG IV SOLR,,J3490,HCPCS,Facility,Inpatient,1,Each,,66,56.1,18.9156,66,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
DILTIAZEM HCL 100 MG IV SOLR,,J3490,HCPCS,Facility,Both,1,Each,,66,56.1,18.9156,66,"Preferred One Administrative Services, INC.",PPO,65.076,98.6,,percent of total billed charges,,
DILTIAZEM HCL 100 MG IV SOLR,,J3490,HCPCS,Facility,Both,1,Each,,66,56.1,18.9156,66,"Preferred One Administrative Services, INC.",PPO,65.076,98.6,,percent of total billed charges,,
DILTIAZEM HCL 100 MG IV SOLR,,J3490,HCPCS,Facility,Outpatient,1,Each,,66,56.1,18.9156,66,PrimeWest Health,Minnesota Senior Health Options (MSHO),33.957,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
DILTIAZEM HCL 100 MG IV SOLR,,J3490,HCPCS,Facility,Outpatient,1,Each,,66,56.1,18.9156,66,PrimeWest Health,Minnesota Senior Health Options (MSHO),33.957,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
DILTIAZEM HCL 100 MG IV SOLR,,J3490,HCPCS,Facility,Inpatient,1,Each,,66,56.1,18.9156,66,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DILTIAZEM HCL 100 MG IV SOLR,,J3490,HCPCS,Facility,Inpatient,1,Each,,66,56.1,18.9156,66,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DILTIAZEM HCL 100 MG IV SOLR,,J3490,HCPCS,Facility,Outpatient,1,Each,,66,56.1,18.9156,66,PrimeWest Health,MinnesotaCare,33.8976,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
DILTIAZEM HCL 100 MG IV SOLR,,J3490,HCPCS,Facility,Outpatient,1,Each,,66,56.1,18.9156,66,PrimeWest Health,MinnesotaCare,33.8976,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
DILTIAZEM HCL 100 MG IV SOLR,,J3490,HCPCS,Facility,Inpatient,1,Each,,66,56.1,18.9156,66,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
DILTIAZEM HCL 100 MG IV SOLR,,J3490,HCPCS,Facility,Inpatient,1,Each,,66,56.1,18.9156,66,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
DILTIAZEM HCL 100 MG IV SOLR,,J3490,HCPCS,Facility,Both,1,Each,,66,56.1,18.9156,66,Sanford Health Plan,Sanford Health Plan,60.72,92,,percent of total billed charges,,
DILTIAZEM HCL 100 MG IV SOLR,,J3490,HCPCS,Facility,Both,1,Each,,66,56.1,18.9156,66,Sanford Health Plan,Sanford Health Plan,60.72,92,,percent of total billed charges,,
DILTIAZEM HCL 100 MG IV SOLR,,J3490,HCPCS,Facility,Outpatient,1,Each,,66,56.1,18.9156,66,"UCare Health, Inc.",Individual & Family Plan,37.191,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
DILTIAZEM HCL 100 MG IV SOLR,,J3490,HCPCS,Facility,Outpatient,1,Each,,66,56.1,18.9156,66,"UCare Health, Inc.",Individual & Family Plan,37.191,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
DILTIAZEM HCL 100 MG IV SOLR,,J3490,HCPCS,Facility,Inpatient,1,Each,,66,56.1,18.9156,66,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
DILTIAZEM HCL 100 MG IV SOLR,,J3490,HCPCS,Facility,Inpatient,1,Each,,66,56.1,18.9156,66,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
DILTIAZEM HCL 100 MG IV SOLR,,J3490,HCPCS,Facility,Outpatient,1,Each,,66,56.1,18.9156,66,"UCare Health, Inc.",Medical Assistance,33.3102,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DILTIAZEM HCL 100 MG IV SOLR,,J3490,HCPCS,Facility,Outpatient,1,Each,,66,56.1,18.9156,66,"UCare Health, Inc.",Medical Assistance,33.3102,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DILTIAZEM HCL 100 MG IV SOLR,,J3490,HCPCS,Facility,Inpatient,1,Each,,66,56.1,18.9156,66,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
DILTIAZEM HCL 100 MG IV SOLR,,J3490,HCPCS,Facility,Inpatient,1,Each,,66,56.1,18.9156,66,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
DILTIAZEM HCL 100 MG IV SOLR,,J3490,HCPCS,Facility,Outpatient,1,Each,,66,56.1,18.9156,66,"UCare Health, Inc.",Medicare Advantage,33.3102,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DILTIAZEM HCL 100 MG IV SOLR,,J3490,HCPCS,Facility,Outpatient,1,Each,,66,56.1,18.9156,66,"UCare Health, Inc.",Medicare Advantage,33.3102,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DILTIAZEM HCL 100 MG IV SOLR,,J3490,HCPCS,Facility,Inpatient,1,Each,,66,56.1,18.9156,66,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DILTIAZEM HCL 100 MG IV SOLR,,J3490,HCPCS,Facility,Inpatient,1,Each,,66,56.1,18.9156,66,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DILTIAZEM HCL 100 MG IV SOLR,,J3490,HCPCS,Facility,Outpatient,1,Each,,66,56.1,18.9156,66,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),33.3102,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DILTIAZEM HCL 100 MG IV SOLR,,J3490,HCPCS,Facility,Outpatient,1,Each,,66,56.1,18.9156,66,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),33.3102,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DILTIAZEM HCL 100 MG IV SOLR,,J3490,HCPCS,Facility,Inpatient,1,Each,,66,56.1,18.9156,66,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DILTIAZEM HCL 100 MG IV SOLR,,J3490,HCPCS,Facility,Inpatient,1,Each,,66,56.1,18.9156,66,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DILTIAZEM HCL 100 MG IV SOLR,,J3490,HCPCS,Facility,Both,1,Each,,66,56.1,18.9156,66,UnitedHealthcare,Individual & Family,62.04,94,,percent of total billed charges,,
DILTIAZEM HCL 100 MG IV SOLR,,J3490,HCPCS,Facility,Both,1,Each,,66,56.1,18.9156,66,UnitedHealthcare,Individual & Family,62.04,94,,percent of total billed charges,,
DILTIAZEM HCL 100 MG IV SOLR,,J3490,HCPCS,Facility,Outpatient,1,Each,,66,56.1,18.9156,66,UnitedHealthcare,Medicare Advantage,32.34,49,,percent of total billed charges,,
DILTIAZEM HCL 100 MG IV SOLR,,J3490,HCPCS,Facility,Outpatient,1,Each,,66,56.1,18.9156,66,UnitedHealthcare,Medicare Advantage,32.34,49,,percent of total billed charges,,
DILTIAZEM HCL 100 MG IV SOLR,,J3490,HCPCS,Facility,Inpatient,1,Each,,66,56.1,18.9156,66,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
DILTIAZEM HCL 100 MG IV SOLR,,J3490,HCPCS,Facility,Inpatient,1,Each,,66,56.1,18.9156,66,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
DILTIAZEM HCL 100 MG IV SOLR,,J3490,HCPCS,Facility,Outpatient,1,Each,,66,56.1,18.9156,66,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,31.68,48,,percent of total billed charges,,100% of DHS outpatient percentage
DILTIAZEM HCL 100 MG IV SOLR,,J3490,HCPCS,Facility,Outpatient,1,Each,,66,56.1,18.9156,66,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,31.68,48,,percent of total billed charges,,100% of DHS outpatient percentage
DILTIAZEM HCL 100 MG IV SOLR,,J3490,HCPCS,Facility,Inpatient,1,Each,,66,56.1,18.9156,66,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
DILTIAZEM HCL 100 MG IV SOLR,,J3490,HCPCS,Facility,Inpatient,1,Each,,66,56.1,18.9156,66,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
DOXYCYCLINE HYCLATE 100 MG IV SOLR,,J3490,HCPCS,Facility,Both,1,Each,,143,121.55,40.9838,143,Aetna,Commercial,131.56,92,,percent of total billed charges,,
DOXYCYCLINE HYCLATE 100 MG IV SOLR,,J3490,HCPCS,Facility,Outpatient,1,Each,,143,121.55,40.9838,143,Aetna,Medicare Advantage,70.07,49,,percent of total billed charges,,
DOXYCYCLINE HYCLATE 100 MG IV SOLR,,J3490,HCPCS,Facility,Inpatient,1,Each,,143,121.55,40.9838,143,Aetna,Medicare Advantage,,,,,Included in per diem rate,
DOXYCYCLINE HYCLATE 100 MG IV SOLR,,J3490,HCPCS,Facility,Both,1,Each,,143,121.55,40.9838,143,Aetna,PPO,132.99,93,,percent of total billed charges,,
DOXYCYCLINE HYCLATE 100 MG IV SOLR,,J3490,HCPCS,Facility,Both,1,Each,,143,121.55,40.9838,143,America's PPO,America's PPO,137.3229,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
DOXYCYCLINE HYCLATE 100 MG IV SOLR,,J3490,HCPCS,Facility,Both,1,Each,,143,121.55,40.9838,143,BlueCross BlueShield Minnesota, Federal Employee Program,140.712,98.4,,percent of total billed charges,,
DOXYCYCLINE HYCLATE 100 MG IV SOLR,,J3490,HCPCS,Facility,Both,1,Each,,143,121.55,40.9838,143,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,143,100,,percent of total billed charges,,
DOXYCYCLINE HYCLATE 100 MG IV SOLR,,J3490,HCPCS,Facility,Both,1,Each,,143,121.55,40.9838,143,BlueCross BlueShield Minnesota,High Value Network Plan,128.7,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
DOXYCYCLINE HYCLATE 100 MG IV SOLR,,J3490,HCPCS,Facility,Outpatient,1,Each,,143,121.55,40.9838,143,BlueCross BlueShield Minnesota,Medicare Advantage,70.07,49,,percent of total billed charges,,
DOXYCYCLINE HYCLATE 100 MG IV SOLR,,J3490,HCPCS,Facility,Inpatient,1,Each,,143,121.55,40.9838,143,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
DOXYCYCLINE HYCLATE 100 MG IV SOLR,,J3490,HCPCS,Facility,Both,1,Each,,143,121.55,40.9838,143,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,126.6551,88.57,,percent of total billed charges,,
DOXYCYCLINE HYCLATE 100 MG IV SOLR,,J3490,HCPCS,Facility,Both,1,Each,,143,121.55,40.9838,143,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,40.9838,28.66,,percent of total billed charges,,
DOXYCYCLINE HYCLATE 100 MG IV SOLR,,J3490,HCPCS,Facility,Outpatient,1,Each,,143,121.55,40.9838,143,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),70.07,49,,percent of total billed charges,,
DOXYCYCLINE HYCLATE 100 MG IV SOLR,,J3490,HCPCS,Facility,Inpatient,1,Each,,143,121.55,40.9838,143,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
DOXYCYCLINE HYCLATE 100 MG IV SOLR,,J3490,HCPCS,Facility,Both,1,Each,,143,121.55,40.9838,143,CorVel,Worker's Compensation,143,100,,percent of total billed charges,,
DOXYCYCLINE HYCLATE 100 MG IV SOLR,,J3490,HCPCS,Facility,Both,1,Each,,143,121.55,40.9838,143,First Health Group Corporation,First Health Network,138.71,97,,percent of total billed charges,,
DOXYCYCLINE HYCLATE 100 MG IV SOLR,,J3490,HCPCS,Facility,Both,1,Each,,143,121.55,40.9838,143,"Health Partners, Inc.",Commercial,135.278,94.6,,percent of total billed charges,,
DOXYCYCLINE HYCLATE 100 MG IV SOLR,,J3490,HCPCS,Facility,Outpatient,1,Each,,143,121.55,40.9838,143,"Health Partners, Inc.",Medicare Advantage,70.07,49,,percent of total billed charges,,
DOXYCYCLINE HYCLATE 100 MG IV SOLR,,J3490,HCPCS,Facility,Inpatient,1,Each,,143,121.55,40.9838,143,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DOXYCYCLINE HYCLATE 100 MG IV SOLR,,J3490,HCPCS,Facility,Both,1,Each,,143,121.55,40.9838,143,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),85.8,60,,percent of total billed charges,,
DOXYCYCLINE HYCLATE 100 MG IV SOLR,,J3490,HCPCS,Facility,Both,1,Each,,143,121.55,40.9838,143,"Health Partners, Inc.",State of Minnesota Advantage Program,116.545,81.5,,percent of total billed charges,,
DOXYCYCLINE HYCLATE 100 MG IV SOLR,,J3490,HCPCS,Facility,Both,1,Each,,143,121.55,40.9838,143,"Health Partners, Inc.",State Public Programs,71.5,50,,percent of total billed charges,,
DOXYCYCLINE HYCLATE 100 MG IV SOLR,,J3490,HCPCS,Facility,Both,1,Each,,143,121.55,40.9838,143,Humana Insurance Company,Commercial PPO,135.85,95,,percent of total billed charges,,
DOXYCYCLINE HYCLATE 100 MG IV SOLR,,J3490,HCPCS,Facility,Outpatient,1,Each,,143,121.55,40.9838,143,Humana Insurance Company,Medicare PPO,70.07,49,,percent of total billed charges,,
DOXYCYCLINE HYCLATE 100 MG IV SOLR,,J3490,HCPCS,Facility,Inpatient,1,Each,,143,121.55,40.9838,143,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
DOXYCYCLINE HYCLATE 100 MG IV SOLR,,J3490,HCPCS,Facility,Both,1,Each,,143,121.55,40.9838,143,Medica,Individual & Family,141.713,99.1,,percent of total billed charges,,
DOXYCYCLINE HYCLATE 100 MG IV SOLR,,J3490,HCPCS,Facility,Outpatient,1,Each,,143,121.55,40.9838,143,Medica,Medica Advantage Solution,71.214,49.8,,percent of total billed charges,,
DOXYCYCLINE HYCLATE 100 MG IV SOLR,,J3490,HCPCS,Facility,Inpatient,1,Each,,143,121.55,40.9838,143,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
DOXYCYCLINE HYCLATE 100 MG IV SOLR,,J3490,HCPCS,Facility,Outpatient,1,Each,,143,121.55,40.9838,143,Medica,Medical Assistance,63.778,44.6,,percent of total billed charges,,
DOXYCYCLINE HYCLATE 100 MG IV SOLR,,J3490,HCPCS,Facility,Inpatient,1,Each,,143,121.55,40.9838,143,Medica,Medical Assistance,,,,,Included in per diem rate,
DOXYCYCLINE HYCLATE 100 MG IV SOLR,,J3490,HCPCS,Facility,Outpatient,1,Each,,143,121.55,40.9838,143,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,71.214,49.8,,percent of total billed charges,,
DOXYCYCLINE HYCLATE 100 MG IV SOLR,,J3490,HCPCS,Facility,Inpatient,1,Each,,143,121.55,40.9838,143,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
DOXYCYCLINE HYCLATE 100 MG IV SOLR,,J3490,HCPCS,Facility,Both,1,Each,,143,121.55,40.9838,143,"Multiplan, Inc.","Multiplan, Inc.",134.42,94,,percent of total billed charges,,
DOXYCYCLINE HYCLATE 100 MG IV SOLR,,J3490,HCPCS,Facility,Outpatient,1,Each,,143,121.55,40.9838,143,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,128.843,90.1,,percent of total billed charges,,
DOXYCYCLINE HYCLATE 100 MG IV SOLR,,J3490,HCPCS,Facility,Inpatient,1,Each,,143,121.55,40.9838,143,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
DOXYCYCLINE HYCLATE 100 MG IV SOLR,,J3490,HCPCS,Facility,Both,1,Each,,143,121.55,40.9838,143,"Preferred One Administrative Services, INC.",PPO,140.998,98.6,,percent of total billed charges,,
DOXYCYCLINE HYCLATE 100 MG IV SOLR,,J3490,HCPCS,Facility,Outpatient,1,Each,,143,121.55,40.9838,143,PrimeWest Health,Minnesota Senior Health Options (MSHO),73.5735,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
DOXYCYCLINE HYCLATE 100 MG IV SOLR,,J3490,HCPCS,Facility,Inpatient,1,Each,,143,121.55,40.9838,143,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DOXYCYCLINE HYCLATE 100 MG IV SOLR,,J3490,HCPCS,Facility,Outpatient,1,Each,,143,121.55,40.9838,143,PrimeWest Health,MinnesotaCare,73.4448,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
DOXYCYCLINE HYCLATE 100 MG IV SOLR,,J3490,HCPCS,Facility,Inpatient,1,Each,,143,121.55,40.9838,143,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
DOXYCYCLINE HYCLATE 100 MG IV SOLR,,J3490,HCPCS,Facility,Both,1,Each,,143,121.55,40.9838,143,Sanford Health Plan,Sanford Health Plan,131.56,92,,percent of total billed charges,,
DOXYCYCLINE HYCLATE 100 MG IV SOLR,,J3490,HCPCS,Facility,Outpatient,1,Each,,143,121.55,40.9838,143,"UCare Health, Inc.",Individual & Family Plan,80.5805,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
DOXYCYCLINE HYCLATE 100 MG IV SOLR,,J3490,HCPCS,Facility,Inpatient,1,Each,,143,121.55,40.9838,143,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
DOXYCYCLINE HYCLATE 100 MG IV SOLR,,J3490,HCPCS,Facility,Outpatient,1,Each,,143,121.55,40.9838,143,"UCare Health, Inc.",Medical Assistance,72.1721,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DOXYCYCLINE HYCLATE 100 MG IV SOLR,,J3490,HCPCS,Facility,Inpatient,1,Each,,143,121.55,40.9838,143,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
DOXYCYCLINE HYCLATE 100 MG IV SOLR,,J3490,HCPCS,Facility,Outpatient,1,Each,,143,121.55,40.9838,143,"UCare Health, Inc.",Medicare Advantage,72.1721,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DOXYCYCLINE HYCLATE 100 MG IV SOLR,,J3490,HCPCS,Facility,Inpatient,1,Each,,143,121.55,40.9838,143,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DOXYCYCLINE HYCLATE 100 MG IV SOLR,,J3490,HCPCS,Facility,Outpatient,1,Each,,143,121.55,40.9838,143,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),72.1721,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DOXYCYCLINE HYCLATE 100 MG IV SOLR,,J3490,HCPCS,Facility,Inpatient,1,Each,,143,121.55,40.9838,143,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DOXYCYCLINE HYCLATE 100 MG IV SOLR,,J3490,HCPCS,Facility,Both,1,Each,,143,121.55,40.9838,143,UnitedHealthcare,Individual & Family,134.42,94,,percent of total billed charges,,
DOXYCYCLINE HYCLATE 100 MG IV SOLR,,J3490,HCPCS,Facility,Outpatient,1,Each,,143,121.55,40.9838,143,UnitedHealthcare,Medicare Advantage,70.07,49,,percent of total billed charges,,
DOXYCYCLINE HYCLATE 100 MG IV SOLR,,J3490,HCPCS,Facility,Inpatient,1,Each,,143,121.55,40.9838,143,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
DOXYCYCLINE HYCLATE 100 MG IV SOLR,,J3490,HCPCS,Facility,Outpatient,1,Each,,143,121.55,40.9838,143,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,68.64,48,,percent of total billed charges,,100% of DHS outpatient percentage
DOXYCYCLINE HYCLATE 100 MG IV SOLR,,J3490,HCPCS,Facility,Inpatient,1,Each,,143,121.55,40.9838,143,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
OLANZAPINE 10 MG IM SOLR,,J3490,HCPCS,Facility,Both,1,Each,,192,163.2,55.0272,192,Aetna,Commercial,176.64,92,,percent of total billed charges,,
OLANZAPINE 10 MG IM SOLR,,J3490,HCPCS,Facility,Outpatient,1,Each,,192,163.2,55.0272,192,Aetna,Medicare Advantage,94.08,49,,percent of total billed charges,,
OLANZAPINE 10 MG IM SOLR,,J3490,HCPCS,Facility,Inpatient,1,Each,,192,163.2,55.0272,192,Aetna,Medicare Advantage,,,,,Included in per diem rate,
OLANZAPINE 10 MG IM SOLR,,J3490,HCPCS,Facility,Both,1,Each,,192,163.2,55.0272,192,Aetna,PPO,178.56,93,,percent of total billed charges,,
OLANZAPINE 10 MG IM SOLR,,J3490,HCPCS,Facility,Both,1,Each,,192,163.2,55.0272,192,America's PPO,America's PPO,184.3776,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
OLANZAPINE 10 MG IM SOLR,,J3490,HCPCS,Facility,Both,1,Each,,192,163.2,55.0272,192,BlueCross BlueShield Minnesota, Federal Employee Program,188.928,98.4,,percent of total billed charges,,
OLANZAPINE 10 MG IM SOLR,,J3490,HCPCS,Facility,Both,1,Each,,192,163.2,55.0272,192,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,192,100,,percent of total billed charges,,
OLANZAPINE 10 MG IM SOLR,,J3490,HCPCS,Facility,Both,1,Each,,192,163.2,55.0272,192,BlueCross BlueShield Minnesota,High Value Network Plan,172.8,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
OLANZAPINE 10 MG IM SOLR,,J3490,HCPCS,Facility,Outpatient,1,Each,,192,163.2,55.0272,192,BlueCross BlueShield Minnesota,Medicare Advantage,94.08,49,,percent of total billed charges,,
OLANZAPINE 10 MG IM SOLR,,J3490,HCPCS,Facility,Inpatient,1,Each,,192,163.2,55.0272,192,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
OLANZAPINE 10 MG IM SOLR,,J3490,HCPCS,Facility,Both,1,Each,,192,163.2,55.0272,192,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,170.0544,88.57,,percent of total billed charges,,
OLANZAPINE 10 MG IM SOLR,,J3490,HCPCS,Facility,Both,1,Each,,192,163.2,55.0272,192,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,55.0272,28.66,,percent of total billed charges,,
OLANZAPINE 10 MG IM SOLR,,J3490,HCPCS,Facility,Outpatient,1,Each,,192,163.2,55.0272,192,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),94.08,49,,percent of total billed charges,,
OLANZAPINE 10 MG IM SOLR,,J3490,HCPCS,Facility,Inpatient,1,Each,,192,163.2,55.0272,192,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
OLANZAPINE 10 MG IM SOLR,,J3490,HCPCS,Facility,Both,1,Each,,192,163.2,55.0272,192,CorVel,Worker's Compensation,192,100,,percent of total billed charges,,
OLANZAPINE 10 MG IM SOLR,,J3490,HCPCS,Facility,Both,1,Each,,192,163.2,55.0272,192,First Health Group Corporation,First Health Network,186.24,97,,percent of total billed charges,,
OLANZAPINE 10 MG IM SOLR,,J3490,HCPCS,Facility,Both,1,Each,,192,163.2,55.0272,192,"Health Partners, Inc.",Commercial,181.632,94.6,,percent of total billed charges,,
OLANZAPINE 10 MG IM SOLR,,J3490,HCPCS,Facility,Outpatient,1,Each,,192,163.2,55.0272,192,"Health Partners, Inc.",Medicare Advantage,94.08,49,,percent of total billed charges,,
OLANZAPINE 10 MG IM SOLR,,J3490,HCPCS,Facility,Inpatient,1,Each,,192,163.2,55.0272,192,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
OLANZAPINE 10 MG IM SOLR,,J3490,HCPCS,Facility,Both,1,Each,,192,163.2,55.0272,192,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),115.2,60,,percent of total billed charges,,
OLANZAPINE 10 MG IM SOLR,,J3490,HCPCS,Facility,Both,1,Each,,192,163.2,55.0272,192,"Health Partners, Inc.",State of Minnesota Advantage Program,156.48,81.5,,percent of total billed charges,,
OLANZAPINE 10 MG IM SOLR,,J3490,HCPCS,Facility,Both,1,Each,,192,163.2,55.0272,192,"Health Partners, Inc.",State Public Programs,96,50,,percent of total billed charges,,
OLANZAPINE 10 MG IM SOLR,,J3490,HCPCS,Facility,Both,1,Each,,192,163.2,55.0272,192,Humana Insurance Company,Commercial PPO,182.4,95,,percent of total billed charges,,
OLANZAPINE 10 MG IM SOLR,,J3490,HCPCS,Facility,Outpatient,1,Each,,192,163.2,55.0272,192,Humana Insurance Company,Medicare PPO,94.08,49,,percent of total billed charges,,
OLANZAPINE 10 MG IM SOLR,,J3490,HCPCS,Facility,Inpatient,1,Each,,192,163.2,55.0272,192,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
OLANZAPINE 10 MG IM SOLR,,J3490,HCPCS,Facility,Both,1,Each,,192,163.2,55.0272,192,Medica,Individual & Family,190.272,99.1,,percent of total billed charges,,
OLANZAPINE 10 MG IM SOLR,,J3490,HCPCS,Facility,Outpatient,1,Each,,192,163.2,55.0272,192,Medica,Medica Advantage Solution,95.616,49.8,,percent of total billed charges,,
OLANZAPINE 10 MG IM SOLR,,J3490,HCPCS,Facility,Inpatient,1,Each,,192,163.2,55.0272,192,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
OLANZAPINE 10 MG IM SOLR,,J3490,HCPCS,Facility,Outpatient,1,Each,,192,163.2,55.0272,192,Medica,Medical Assistance,85.632,44.6,,percent of total billed charges,,
OLANZAPINE 10 MG IM SOLR,,J3490,HCPCS,Facility,Inpatient,1,Each,,192,163.2,55.0272,192,Medica,Medical Assistance,,,,,Included in per diem rate,
OLANZAPINE 10 MG IM SOLR,,J3490,HCPCS,Facility,Outpatient,1,Each,,192,163.2,55.0272,192,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,95.616,49.8,,percent of total billed charges,,
OLANZAPINE 10 MG IM SOLR,,J3490,HCPCS,Facility,Inpatient,1,Each,,192,163.2,55.0272,192,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
OLANZAPINE 10 MG IM SOLR,,J3490,HCPCS,Facility,Both,1,Each,,192,163.2,55.0272,192,"Multiplan, Inc.","Multiplan, Inc.",180.48,94,,percent of total billed charges,,
OLANZAPINE 10 MG IM SOLR,,J3490,HCPCS,Facility,Outpatient,1,Each,,192,163.2,55.0272,192,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,172.992,90.1,,percent of total billed charges,,
OLANZAPINE 10 MG IM SOLR,,J3490,HCPCS,Facility,Inpatient,1,Each,,192,163.2,55.0272,192,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
OLANZAPINE 10 MG IM SOLR,,J3490,HCPCS,Facility,Both,1,Each,,192,163.2,55.0272,192,"Preferred One Administrative Services, INC.",PPO,189.312,98.6,,percent of total billed charges,,
OLANZAPINE 10 MG IM SOLR,,J3490,HCPCS,Facility,Outpatient,1,Each,,192,163.2,55.0272,192,PrimeWest Health,Minnesota Senior Health Options (MSHO),98.784,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
OLANZAPINE 10 MG IM SOLR,,J3490,HCPCS,Facility,Inpatient,1,Each,,192,163.2,55.0272,192,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
OLANZAPINE 10 MG IM SOLR,,J3490,HCPCS,Facility,Outpatient,1,Each,,192,163.2,55.0272,192,PrimeWest Health,MinnesotaCare,98.6112,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
OLANZAPINE 10 MG IM SOLR,,J3490,HCPCS,Facility,Inpatient,1,Each,,192,163.2,55.0272,192,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
OLANZAPINE 10 MG IM SOLR,,J3490,HCPCS,Facility,Both,1,Each,,192,163.2,55.0272,192,Sanford Health Plan,Sanford Health Plan,176.64,92,,percent of total billed charges,,
OLANZAPINE 10 MG IM SOLR,,J3490,HCPCS,Facility,Outpatient,1,Each,,192,163.2,55.0272,192,"UCare Health, Inc.",Individual & Family Plan,108.192,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
OLANZAPINE 10 MG IM SOLR,,J3490,HCPCS,Facility,Inpatient,1,Each,,192,163.2,55.0272,192,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
OLANZAPINE 10 MG IM SOLR,,J3490,HCPCS,Facility,Outpatient,1,Each,,192,163.2,55.0272,192,"UCare Health, Inc.",Medical Assistance,96.9024,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
OLANZAPINE 10 MG IM SOLR,,J3490,HCPCS,Facility,Inpatient,1,Each,,192,163.2,55.0272,192,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
OLANZAPINE 10 MG IM SOLR,,J3490,HCPCS,Facility,Outpatient,1,Each,,192,163.2,55.0272,192,"UCare Health, Inc.",Medicare Advantage,96.9024,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
OLANZAPINE 10 MG IM SOLR,,J3490,HCPCS,Facility,Inpatient,1,Each,,192,163.2,55.0272,192,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
OLANZAPINE 10 MG IM SOLR,,J3490,HCPCS,Facility,Outpatient,1,Each,,192,163.2,55.0272,192,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),96.9024,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
OLANZAPINE 10 MG IM SOLR,,J3490,HCPCS,Facility,Inpatient,1,Each,,192,163.2,55.0272,192,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
OLANZAPINE 10 MG IM SOLR,,J3490,HCPCS,Facility,Both,1,Each,,192,163.2,55.0272,192,UnitedHealthcare,Individual & Family,180.48,94,,percent of total billed charges,,
OLANZAPINE 10 MG IM SOLR,,J3490,HCPCS,Facility,Outpatient,1,Each,,192,163.2,55.0272,192,UnitedHealthcare,Medicare Advantage,94.08,49,,percent of total billed charges,,
OLANZAPINE 10 MG IM SOLR,,J3490,HCPCS,Facility,Inpatient,1,Each,,192,163.2,55.0272,192,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
OLANZAPINE 10 MG IM SOLR,,J3490,HCPCS,Facility,Outpatient,1,Each,,192,163.2,55.0272,192,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,92.16,48,,percent of total billed charges,,100% of DHS outpatient percentage
OLANZAPINE 10 MG IM SOLR,,J3490,HCPCS,Facility,Inpatient,1,Each,,192,163.2,55.0272,192,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
VECURONIUM BROMIDE 10 MG IV SOLR,,J3490,HCPCS,Facility,Both,1,Each,,30,25.5,8.598,30,Aetna,Commercial,27.6,92,,percent of total billed charges,,
VECURONIUM BROMIDE 10 MG IV SOLR,,J3490,HCPCS,Facility,Outpatient,1,Each,,30,25.5,8.598,30,Aetna,Medicare Advantage,14.7,49,,percent of total billed charges,,
VECURONIUM BROMIDE 10 MG IV SOLR,,J3490,HCPCS,Facility,Inpatient,1,Each,,30,25.5,8.598,30,Aetna,Medicare Advantage,,,,,Included in per diem rate,
VECURONIUM BROMIDE 10 MG IV SOLR,,J3490,HCPCS,Facility,Both,1,Each,,30,25.5,8.598,30,Aetna,PPO,27.9,93,,percent of total billed charges,,
VECURONIUM BROMIDE 10 MG IV SOLR,,J3490,HCPCS,Facility,Both,1,Each,,30,25.5,8.598,30,America's PPO,America's PPO,28.809,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
VECURONIUM BROMIDE 10 MG IV SOLR,,J3490,HCPCS,Facility,Both,1,Each,,30,25.5,8.598,30,BlueCross BlueShield Minnesota, Federal Employee Program,29.52,98.4,,percent of total billed charges,,
VECURONIUM BROMIDE 10 MG IV SOLR,,J3490,HCPCS,Facility,Both,1,Each,,30,25.5,8.598,30,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,30,100,,percent of total billed charges,,
VECURONIUM BROMIDE 10 MG IV SOLR,,J3490,HCPCS,Facility,Both,1,Each,,30,25.5,8.598,30,BlueCross BlueShield Minnesota,High Value Network Plan,27,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
VECURONIUM BROMIDE 10 MG IV SOLR,,J3490,HCPCS,Facility,Outpatient,1,Each,,30,25.5,8.598,30,BlueCross BlueShield Minnesota,Medicare Advantage,14.7,49,,percent of total billed charges,,
VECURONIUM BROMIDE 10 MG IV SOLR,,J3490,HCPCS,Facility,Inpatient,1,Each,,30,25.5,8.598,30,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
VECURONIUM BROMIDE 10 MG IV SOLR,,J3490,HCPCS,Facility,Both,1,Each,,30,25.5,8.598,30,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,26.571,88.57,,percent of total billed charges,,
VECURONIUM BROMIDE 10 MG IV SOLR,,J3490,HCPCS,Facility,Both,1,Each,,30,25.5,8.598,30,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,8.598,28.66,,percent of total billed charges,,
VECURONIUM BROMIDE 10 MG IV SOLR,,J3490,HCPCS,Facility,Outpatient,1,Each,,30,25.5,8.598,30,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),14.7,49,,percent of total billed charges,,
VECURONIUM BROMIDE 10 MG IV SOLR,,J3490,HCPCS,Facility,Inpatient,1,Each,,30,25.5,8.598,30,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
VECURONIUM BROMIDE 10 MG IV SOLR,,J3490,HCPCS,Facility,Both,1,Each,,30,25.5,8.598,30,CorVel,Worker's Compensation,30,100,,percent of total billed charges,,
VECURONIUM BROMIDE 10 MG IV SOLR,,J3490,HCPCS,Facility,Both,1,Each,,30,25.5,8.598,30,First Health Group Corporation,First Health Network,29.1,97,,percent of total billed charges,,
VECURONIUM BROMIDE 10 MG IV SOLR,,J3490,HCPCS,Facility,Both,1,Each,,30,25.5,8.598,30,"Health Partners, Inc.",Commercial,28.38,94.6,,percent of total billed charges,,
VECURONIUM BROMIDE 10 MG IV SOLR,,J3490,HCPCS,Facility,Outpatient,1,Each,,30,25.5,8.598,30,"Health Partners, Inc.",Medicare Advantage,14.7,49,,percent of total billed charges,,
VECURONIUM BROMIDE 10 MG IV SOLR,,J3490,HCPCS,Facility,Inpatient,1,Each,,30,25.5,8.598,30,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
VECURONIUM BROMIDE 10 MG IV SOLR,,J3490,HCPCS,Facility,Both,1,Each,,30,25.5,8.598,30,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),18,60,,percent of total billed charges,,
VECURONIUM BROMIDE 10 MG IV SOLR,,J3490,HCPCS,Facility,Both,1,Each,,30,25.5,8.598,30,"Health Partners, Inc.",State of Minnesota Advantage Program,24.45,81.5,,percent of total billed charges,,
VECURONIUM BROMIDE 10 MG IV SOLR,,J3490,HCPCS,Facility,Both,1,Each,,30,25.5,8.598,30,"Health Partners, Inc.",State Public Programs,15,50,,percent of total billed charges,,
VECURONIUM BROMIDE 10 MG IV SOLR,,J3490,HCPCS,Facility,Both,1,Each,,30,25.5,8.598,30,Humana Insurance Company,Commercial PPO,28.5,95,,percent of total billed charges,,
VECURONIUM BROMIDE 10 MG IV SOLR,,J3490,HCPCS,Facility,Outpatient,1,Each,,30,25.5,8.598,30,Humana Insurance Company,Medicare PPO,14.7,49,,percent of total billed charges,,
VECURONIUM BROMIDE 10 MG IV SOLR,,J3490,HCPCS,Facility,Inpatient,1,Each,,30,25.5,8.598,30,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
VECURONIUM BROMIDE 10 MG IV SOLR,,J3490,HCPCS,Facility,Both,1,Each,,30,25.5,8.598,30,Medica,Individual & Family,29.73,99.1,,percent of total billed charges,,
VECURONIUM BROMIDE 10 MG IV SOLR,,J3490,HCPCS,Facility,Outpatient,1,Each,,30,25.5,8.598,30,Medica,Medica Advantage Solution,14.94,49.8,,percent of total billed charges,,
VECURONIUM BROMIDE 10 MG IV SOLR,,J3490,HCPCS,Facility,Inpatient,1,Each,,30,25.5,8.598,30,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
VECURONIUM BROMIDE 10 MG IV SOLR,,J3490,HCPCS,Facility,Outpatient,1,Each,,30,25.5,8.598,30,Medica,Medical Assistance,13.38,44.6,,percent of total billed charges,,
VECURONIUM BROMIDE 10 MG IV SOLR,,J3490,HCPCS,Facility,Inpatient,1,Each,,30,25.5,8.598,30,Medica,Medical Assistance,,,,,Included in per diem rate,
VECURONIUM BROMIDE 10 MG IV SOLR,,J3490,HCPCS,Facility,Outpatient,1,Each,,30,25.5,8.598,30,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,14.94,49.8,,percent of total billed charges,,
VECURONIUM BROMIDE 10 MG IV SOLR,,J3490,HCPCS,Facility,Inpatient,1,Each,,30,25.5,8.598,30,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
VECURONIUM BROMIDE 10 MG IV SOLR,,J3490,HCPCS,Facility,Both,1,Each,,30,25.5,8.598,30,"Multiplan, Inc.","Multiplan, Inc.",28.2,94,,percent of total billed charges,,
VECURONIUM BROMIDE 10 MG IV SOLR,,J3490,HCPCS,Facility,Outpatient,1,Each,,30,25.5,8.598,30,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,27.03,90.1,,percent of total billed charges,,
VECURONIUM BROMIDE 10 MG IV SOLR,,J3490,HCPCS,Facility,Inpatient,1,Each,,30,25.5,8.598,30,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
VECURONIUM BROMIDE 10 MG IV SOLR,,J3490,HCPCS,Facility,Both,1,Each,,30,25.5,8.598,30,"Preferred One Administrative Services, INC.",PPO,29.58,98.6,,percent of total billed charges,,
VECURONIUM BROMIDE 10 MG IV SOLR,,J3490,HCPCS,Facility,Outpatient,1,Each,,30,25.5,8.598,30,PrimeWest Health,Minnesota Senior Health Options (MSHO),15.435,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
VECURONIUM BROMIDE 10 MG IV SOLR,,J3490,HCPCS,Facility,Inpatient,1,Each,,30,25.5,8.598,30,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
VECURONIUM BROMIDE 10 MG IV SOLR,,J3490,HCPCS,Facility,Outpatient,1,Each,,30,25.5,8.598,30,PrimeWest Health,MinnesotaCare,15.408,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
VECURONIUM BROMIDE 10 MG IV SOLR,,J3490,HCPCS,Facility,Inpatient,1,Each,,30,25.5,8.598,30,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
VECURONIUM BROMIDE 10 MG IV SOLR,,J3490,HCPCS,Facility,Both,1,Each,,30,25.5,8.598,30,Sanford Health Plan,Sanford Health Plan,27.6,92,,percent of total billed charges,,
VECURONIUM BROMIDE 10 MG IV SOLR,,J3490,HCPCS,Facility,Outpatient,1,Each,,30,25.5,8.598,30,"UCare Health, Inc.",Individual & Family Plan,16.905,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
VECURONIUM BROMIDE 10 MG IV SOLR,,J3490,HCPCS,Facility,Inpatient,1,Each,,30,25.5,8.598,30,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
VECURONIUM BROMIDE 10 MG IV SOLR,,J3490,HCPCS,Facility,Outpatient,1,Each,,30,25.5,8.598,30,"UCare Health, Inc.",Medical Assistance,15.141,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
VECURONIUM BROMIDE 10 MG IV SOLR,,J3490,HCPCS,Facility,Inpatient,1,Each,,30,25.5,8.598,30,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
VECURONIUM BROMIDE 10 MG IV SOLR,,J3490,HCPCS,Facility,Outpatient,1,Each,,30,25.5,8.598,30,"UCare Health, Inc.",Medicare Advantage,15.141,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
VECURONIUM BROMIDE 10 MG IV SOLR,,J3490,HCPCS,Facility,Inpatient,1,Each,,30,25.5,8.598,30,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
VECURONIUM BROMIDE 10 MG IV SOLR,,J3490,HCPCS,Facility,Outpatient,1,Each,,30,25.5,8.598,30,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),15.141,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
VECURONIUM BROMIDE 10 MG IV SOLR,,J3490,HCPCS,Facility,Inpatient,1,Each,,30,25.5,8.598,30,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
VECURONIUM BROMIDE 10 MG IV SOLR,,J3490,HCPCS,Facility,Both,1,Each,,30,25.5,8.598,30,UnitedHealthcare,Individual & Family,28.2,94,,percent of total billed charges,,
VECURONIUM BROMIDE 10 MG IV SOLR,,J3490,HCPCS,Facility,Outpatient,1,Each,,30,25.5,8.598,30,UnitedHealthcare,Medicare Advantage,14.7,49,,percent of total billed charges,,
VECURONIUM BROMIDE 10 MG IV SOLR,,J3490,HCPCS,Facility,Inpatient,1,Each,,30,25.5,8.598,30,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
VECURONIUM BROMIDE 10 MG IV SOLR,,J3490,HCPCS,Facility,Outpatient,1,Each,,30,25.5,8.598,30,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,14.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
VECURONIUM BROMIDE 10 MG IV SOLR,,J3490,HCPCS,Facility,Inpatient,1,Each,,30,25.5,8.598,30,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
METHYLPREDNISOLONE 4 MG ORAL DSPK,,J7509,HCPCS,Facility,Both,1,Each,,9,7.65,2.5794,9,Aetna,Commercial,8.28,92,,percent of total billed charges,,
METHYLPREDNISOLONE 4 MG ORAL DSPK,,J7509,HCPCS,Facility,Outpatient,1,Each,,9,7.65,2.5794,9,Aetna,Medicare Advantage,4.41,49,,percent of total billed charges,,
METHYLPREDNISOLONE 4 MG ORAL DSPK,,J7509,HCPCS,Facility,Inpatient,1,Each,,9,7.65,2.5794,9,Aetna,Medicare Advantage,,,,,Included in per diem rate,
METHYLPREDNISOLONE 4 MG ORAL DSPK,,J7509,HCPCS,Facility,Both,1,Each,,9,7.65,2.5794,9,Aetna,PPO,8.37,93,,percent of total billed charges,,
METHYLPREDNISOLONE 4 MG ORAL DSPK,,J7509,HCPCS,Facility,Both,1,Each,,9,7.65,2.5794,9,America's PPO,America's PPO,8.6427,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
METHYLPREDNISOLONE 4 MG ORAL DSPK,,J7509,HCPCS,Facility,Both,1,Each,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota, Federal Employee Program,8.856,98.4,,percent of total billed charges,,
METHYLPREDNISOLONE 4 MG ORAL DSPK,,J7509,HCPCS,Facility,Both,1,Each,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,9,100,,percent of total billed charges,,
METHYLPREDNISOLONE 4 MG ORAL DSPK,,J7509,HCPCS,Facility,Both,1,Each,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota,High Value Network Plan,8.1,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
METHYLPREDNISOLONE 4 MG ORAL DSPK,,J7509,HCPCS,Facility,Outpatient,1,Each,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota,Medicare Advantage,4.41,49,,percent of total billed charges,,
METHYLPREDNISOLONE 4 MG ORAL DSPK,,J7509,HCPCS,Facility,Inpatient,1,Each,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
METHYLPREDNISOLONE 4 MG ORAL DSPK,,J7509,HCPCS,Facility,Both,1,Each,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,7.9713,88.57,,percent of total billed charges,,
METHYLPREDNISOLONE 4 MG ORAL DSPK,,J7509,HCPCS,Facility,Both,1,Each,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,2.5794,28.66,,percent of total billed charges,,
METHYLPREDNISOLONE 4 MG ORAL DSPK,,J7509,HCPCS,Facility,Outpatient,1,Each,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),4.41,49,,percent of total billed charges,,
METHYLPREDNISOLONE 4 MG ORAL DSPK,,J7509,HCPCS,Facility,Inpatient,1,Each,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
METHYLPREDNISOLONE 4 MG ORAL DSPK,,J7509,HCPCS,Facility,Both,1,Each,,9,7.65,2.5794,9,CorVel,Worker's Compensation,9,100,,percent of total billed charges,,
METHYLPREDNISOLONE 4 MG ORAL DSPK,,J7509,HCPCS,Facility,Both,1,Each,,9,7.65,2.5794,9,First Health Group Corporation,First Health Network,8.73,97,,percent of total billed charges,,
METHYLPREDNISOLONE 4 MG ORAL DSPK,,J7509,HCPCS,Facility,Both,1,Each,,9,7.65,2.5794,9,"Health Partners, Inc.",Commercial,8.514,94.6,,percent of total billed charges,,
METHYLPREDNISOLONE 4 MG ORAL DSPK,,J7509,HCPCS,Facility,Outpatient,1,Each,,9,7.65,2.5794,9,"Health Partners, Inc.",Medicare Advantage,4.41,49,,percent of total billed charges,,
METHYLPREDNISOLONE 4 MG ORAL DSPK,,J7509,HCPCS,Facility,Inpatient,1,Each,,9,7.65,2.5794,9,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
METHYLPREDNISOLONE 4 MG ORAL DSPK,,J7509,HCPCS,Facility,Both,1,Each,,9,7.65,2.5794,9,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),5.4,60,,percent of total billed charges,,
METHYLPREDNISOLONE 4 MG ORAL DSPK,,J7509,HCPCS,Facility,Both,1,Each,,9,7.65,2.5794,9,"Health Partners, Inc.",State of Minnesota Advantage Program,7.335,81.5,,percent of total billed charges,,
METHYLPREDNISOLONE 4 MG ORAL DSPK,,J7509,HCPCS,Facility,Both,1,Each,,9,7.65,2.5794,9,"Health Partners, Inc.",State Public Programs,4.5,50,,percent of total billed charges,,
METHYLPREDNISOLONE 4 MG ORAL DSPK,,J7509,HCPCS,Facility,Both,1,Each,,9,7.65,2.5794,9,Humana Insurance Company,Commercial PPO,8.55,95,,percent of total billed charges,,
METHYLPREDNISOLONE 4 MG ORAL DSPK,,J7509,HCPCS,Facility,Outpatient,1,Each,,9,7.65,2.5794,9,Humana Insurance Company,Medicare PPO,4.41,49,,percent of total billed charges,,
METHYLPREDNISOLONE 4 MG ORAL DSPK,,J7509,HCPCS,Facility,Inpatient,1,Each,,9,7.65,2.5794,9,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
METHYLPREDNISOLONE 4 MG ORAL DSPK,,J7509,HCPCS,Facility,Both,1,Each,,9,7.65,2.5794,9,Medica,Individual & Family,8.919,99.1,,percent of total billed charges,,
METHYLPREDNISOLONE 4 MG ORAL DSPK,,J7509,HCPCS,Facility,Outpatient,1,Each,,9,7.65,2.5794,9,Medica,Medica Advantage Solution,4.482,49.8,,percent of total billed charges,,
METHYLPREDNISOLONE 4 MG ORAL DSPK,,J7509,HCPCS,Facility,Inpatient,1,Each,,9,7.65,2.5794,9,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
METHYLPREDNISOLONE 4 MG ORAL DSPK,,J7509,HCPCS,Facility,Outpatient,1,Each,,9,7.65,2.5794,9,Medica,Medical Assistance,4.014,44.6,,percent of total billed charges,,
METHYLPREDNISOLONE 4 MG ORAL DSPK,,J7509,HCPCS,Facility,Inpatient,1,Each,,9,7.65,2.5794,9,Medica,Medical Assistance,,,,,Included in per diem rate,
METHYLPREDNISOLONE 4 MG ORAL DSPK,,J7509,HCPCS,Facility,Outpatient,1,Each,,9,7.65,2.5794,9,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,4.482,49.8,,percent of total billed charges,,
METHYLPREDNISOLONE 4 MG ORAL DSPK,,J7509,HCPCS,Facility,Inpatient,1,Each,,9,7.65,2.5794,9,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
METHYLPREDNISOLONE 4 MG ORAL DSPK,,J7509,HCPCS,Facility,Both,1,Each,,9,7.65,2.5794,9,"Multiplan, Inc.","Multiplan, Inc.",8.46,94,,percent of total billed charges,,
METHYLPREDNISOLONE 4 MG ORAL DSPK,,J7509,HCPCS,Facility,Outpatient,1,Each,,9,7.65,2.5794,9,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,8.109,90.1,,percent of total billed charges,,
METHYLPREDNISOLONE 4 MG ORAL DSPK,,J7509,HCPCS,Facility,Inpatient,1,Each,,9,7.65,2.5794,9,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
METHYLPREDNISOLONE 4 MG ORAL DSPK,,J7509,HCPCS,Facility,Both,1,Each,,9,7.65,2.5794,9,"Preferred One Administrative Services, INC.",PPO,8.874,98.6,,percent of total billed charges,,
METHYLPREDNISOLONE 4 MG ORAL DSPK,,J7509,HCPCS,Facility,Outpatient,1,Each,,9,7.65,2.5794,9,PrimeWest Health,Minnesota Senior Health Options (MSHO),4.6305,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
METHYLPREDNISOLONE 4 MG ORAL DSPK,,J7509,HCPCS,Facility,Inpatient,1,Each,,9,7.65,2.5794,9,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
METHYLPREDNISOLONE 4 MG ORAL DSPK,,J7509,HCPCS,Facility,Outpatient,1,Each,,9,7.65,2.5794,9,PrimeWest Health,MinnesotaCare,4.6224,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
METHYLPREDNISOLONE 4 MG ORAL DSPK,,J7509,HCPCS,Facility,Inpatient,1,Each,,9,7.65,2.5794,9,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
METHYLPREDNISOLONE 4 MG ORAL DSPK,,J7509,HCPCS,Facility,Both,1,Each,,9,7.65,2.5794,9,Sanford Health Plan,Sanford Health Plan,8.28,92,,percent of total billed charges,,
METHYLPREDNISOLONE 4 MG ORAL DSPK,,J7509,HCPCS,Facility,Outpatient,1,Each,,9,7.65,2.5794,9,"UCare Health, Inc.",Individual & Family Plan,5.0715,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
METHYLPREDNISOLONE 4 MG ORAL DSPK,,J7509,HCPCS,Facility,Inpatient,1,Each,,9,7.65,2.5794,9,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
METHYLPREDNISOLONE 4 MG ORAL DSPK,,J7509,HCPCS,Facility,Outpatient,1,Each,,9,7.65,2.5794,9,"UCare Health, Inc.",Medical Assistance,4.5423,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
METHYLPREDNISOLONE 4 MG ORAL DSPK,,J7509,HCPCS,Facility,Inpatient,1,Each,,9,7.65,2.5794,9,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
METHYLPREDNISOLONE 4 MG ORAL DSPK,,J7509,HCPCS,Facility,Outpatient,1,Each,,9,7.65,2.5794,9,"UCare Health, Inc.",Medicare Advantage,4.5423,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
METHYLPREDNISOLONE 4 MG ORAL DSPK,,J7509,HCPCS,Facility,Inpatient,1,Each,,9,7.65,2.5794,9,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
METHYLPREDNISOLONE 4 MG ORAL DSPK,,J7509,HCPCS,Facility,Outpatient,1,Each,,9,7.65,2.5794,9,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),4.5423,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
METHYLPREDNISOLONE 4 MG ORAL DSPK,,J7509,HCPCS,Facility,Inpatient,1,Each,,9,7.65,2.5794,9,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
METHYLPREDNISOLONE 4 MG ORAL DSPK,,J7509,HCPCS,Facility,Both,1,Each,,9,7.65,2.5794,9,UnitedHealthcare,Individual & Family,8.46,94,,percent of total billed charges,,
METHYLPREDNISOLONE 4 MG ORAL DSPK,,J7509,HCPCS,Facility,Outpatient,1,Each,,9,7.65,2.5794,9,UnitedHealthcare,Medicare Advantage,4.41,49,,percent of total billed charges,,
METHYLPREDNISOLONE 4 MG ORAL DSPK,,J7509,HCPCS,Facility,Inpatient,1,Each,,9,7.65,2.5794,9,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
METHYLPREDNISOLONE 4 MG ORAL DSPK,,J7509,HCPCS,Facility,Outpatient,1,Each,,9,7.65,2.5794,9,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,4.32,48,,percent of total billed charges,,100% of DHS outpatient percentage
METHYLPREDNISOLONE 4 MG ORAL DSPK,,J7509,HCPCS,Facility,Inpatient,1,Each,,9,7.65,2.5794,9,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
PREDNISONE 1 MG ORAL TABLET,,J7512,HCPCS,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
PREDNISONE 1 MG ORAL TABLET,,J7512,HCPCS,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
PREDNISONE 1 MG ORAL TABLET,,J7512,HCPCS,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
PREDNISONE 1 MG ORAL TABLET,,J7512,HCPCS,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
PREDNISONE 1 MG ORAL TABLET,,J7512,HCPCS,Facility,Both,1,Each,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
PREDNISONE 1 MG ORAL TABLET,,J7512,HCPCS,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
PREDNISONE 1 MG ORAL TABLET,,J7512,HCPCS,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
PREDNISONE 1 MG ORAL TABLET,,J7512,HCPCS,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
PREDNISONE 1 MG ORAL TABLET,,J7512,HCPCS,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
PREDNISONE 1 MG ORAL TABLET,,J7512,HCPCS,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
PREDNISONE 1 MG ORAL TABLET,,J7512,HCPCS,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
PREDNISONE 1 MG ORAL TABLET,,J7512,HCPCS,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
PREDNISONE 1 MG ORAL TABLET,,J7512,HCPCS,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
PREDNISONE 1 MG ORAL TABLET,,J7512,HCPCS,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
PREDNISONE 1 MG ORAL TABLET,,J7512,HCPCS,Facility,Both,1,Each,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
PREDNISONE 1 MG ORAL TABLET,,J7512,HCPCS,Facility,Both,1,Each,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
PREDNISONE 1 MG ORAL TABLET,,J7512,HCPCS,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
PREDNISONE 1 MG ORAL TABLET,,J7512,HCPCS,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
PREDNISONE 1 MG ORAL TABLET,,J7512,HCPCS,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PREDNISONE 1 MG ORAL TABLET,,J7512,HCPCS,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
PREDNISONE 1 MG ORAL TABLET,,J7512,HCPCS,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
PREDNISONE 1 MG ORAL TABLET,,J7512,HCPCS,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
PREDNISONE 1 MG ORAL TABLET,,J7512,HCPCS,Facility,Both,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
PREDNISONE 1 MG ORAL TABLET,,J7512,HCPCS,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
PREDNISONE 1 MG ORAL TABLET,,J7512,HCPCS,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
PREDNISONE 1 MG ORAL TABLET,,J7512,HCPCS,Facility,Both,1,Each,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
PREDNISONE 1 MG ORAL TABLET,,J7512,HCPCS,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
PREDNISONE 1 MG ORAL TABLET,,J7512,HCPCS,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
PREDNISONE 1 MG ORAL TABLET,,J7512,HCPCS,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
PREDNISONE 1 MG ORAL TABLET,,J7512,HCPCS,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
PREDNISONE 1 MG ORAL TABLET,,J7512,HCPCS,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
PREDNISONE 1 MG ORAL TABLET,,J7512,HCPCS,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
PREDNISONE 1 MG ORAL TABLET,,J7512,HCPCS,Facility,Both,1,Each,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
PREDNISONE 1 MG ORAL TABLET,,J7512,HCPCS,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
PREDNISONE 1 MG ORAL TABLET,,J7512,HCPCS,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
PREDNISONE 1 MG ORAL TABLET,,J7512,HCPCS,Facility,Both,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
PREDNISONE 1 MG ORAL TABLET,,J7512,HCPCS,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
PREDNISONE 1 MG ORAL TABLET,,J7512,HCPCS,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PREDNISONE 1 MG ORAL TABLET,,J7512,HCPCS,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
PREDNISONE 1 MG ORAL TABLET,,J7512,HCPCS,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
PREDNISONE 1 MG ORAL TABLET,,J7512,HCPCS,Facility,Both,1,Each,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
PREDNISONE 1 MG ORAL TABLET,,J7512,HCPCS,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
PREDNISONE 1 MG ORAL TABLET,,J7512,HCPCS,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
PREDNISONE 1 MG ORAL TABLET,,J7512,HCPCS,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PREDNISONE 1 MG ORAL TABLET,,J7512,HCPCS,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
PREDNISONE 1 MG ORAL TABLET,,J7512,HCPCS,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PREDNISONE 1 MG ORAL TABLET,,J7512,HCPCS,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PREDNISONE 1 MG ORAL TABLET,,J7512,HCPCS,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PREDNISONE 1 MG ORAL TABLET,,J7512,HCPCS,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PREDNISONE 1 MG ORAL TABLET,,J7512,HCPCS,Facility,Both,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
PREDNISONE 1 MG ORAL TABLET,,J7512,HCPCS,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
PREDNISONE 1 MG ORAL TABLET,,J7512,HCPCS,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
PREDNISONE 1 MG ORAL TABLET,,J7512,HCPCS,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
PREDNISONE 1 MG ORAL TABLET,,J7512,HCPCS,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
PREDNISONE 10 MG ORAL TABLET,,J7512,HCPCS,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
PREDNISONE 10 MG ORAL TABLET,,J7512,HCPCS,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
PREDNISONE 10 MG ORAL TABLET,,J7512,HCPCS,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
PREDNISONE 10 MG ORAL TABLET,,J7512,HCPCS,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
PREDNISONE 10 MG ORAL TABLET,,J7512,HCPCS,Facility,Both,1,Each,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
PREDNISONE 10 MG ORAL TABLET,,J7512,HCPCS,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
PREDNISONE 10 MG ORAL TABLET,,J7512,HCPCS,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
PREDNISONE 10 MG ORAL TABLET,,J7512,HCPCS,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
PREDNISONE 10 MG ORAL TABLET,,J7512,HCPCS,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
PREDNISONE 10 MG ORAL TABLET,,J7512,HCPCS,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
PREDNISONE 10 MG ORAL TABLET,,J7512,HCPCS,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
PREDNISONE 10 MG ORAL TABLET,,J7512,HCPCS,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
PREDNISONE 10 MG ORAL TABLET,,J7512,HCPCS,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
PREDNISONE 10 MG ORAL TABLET,,J7512,HCPCS,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
PREDNISONE 10 MG ORAL TABLET,,J7512,HCPCS,Facility,Both,1,Each,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
PREDNISONE 10 MG ORAL TABLET,,J7512,HCPCS,Facility,Both,1,Each,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
PREDNISONE 10 MG ORAL TABLET,,J7512,HCPCS,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
PREDNISONE 10 MG ORAL TABLET,,J7512,HCPCS,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
PREDNISONE 10 MG ORAL TABLET,,J7512,HCPCS,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PREDNISONE 10 MG ORAL TABLET,,J7512,HCPCS,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
PREDNISONE 10 MG ORAL TABLET,,J7512,HCPCS,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
PREDNISONE 10 MG ORAL TABLET,,J7512,HCPCS,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
PREDNISONE 10 MG ORAL TABLET,,J7512,HCPCS,Facility,Both,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
PREDNISONE 10 MG ORAL TABLET,,J7512,HCPCS,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
PREDNISONE 10 MG ORAL TABLET,,J7512,HCPCS,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
PREDNISONE 10 MG ORAL TABLET,,J7512,HCPCS,Facility,Both,1,Each,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
PREDNISONE 10 MG ORAL TABLET,,J7512,HCPCS,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
PREDNISONE 10 MG ORAL TABLET,,J7512,HCPCS,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
PREDNISONE 10 MG ORAL TABLET,,J7512,HCPCS,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
PREDNISONE 10 MG ORAL TABLET,,J7512,HCPCS,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
PREDNISONE 10 MG ORAL TABLET,,J7512,HCPCS,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
PREDNISONE 10 MG ORAL TABLET,,J7512,HCPCS,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
PREDNISONE 10 MG ORAL TABLET,,J7512,HCPCS,Facility,Both,1,Each,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
PREDNISONE 10 MG ORAL TABLET,,J7512,HCPCS,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
PREDNISONE 10 MG ORAL TABLET,,J7512,HCPCS,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
PREDNISONE 10 MG ORAL TABLET,,J7512,HCPCS,Facility,Both,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
PREDNISONE 10 MG ORAL TABLET,,J7512,HCPCS,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
PREDNISONE 10 MG ORAL TABLET,,J7512,HCPCS,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PREDNISONE 10 MG ORAL TABLET,,J7512,HCPCS,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
PREDNISONE 10 MG ORAL TABLET,,J7512,HCPCS,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
PREDNISONE 10 MG ORAL TABLET,,J7512,HCPCS,Facility,Both,1,Each,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
PREDNISONE 10 MG ORAL TABLET,,J7512,HCPCS,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
PREDNISONE 10 MG ORAL TABLET,,J7512,HCPCS,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
PREDNISONE 10 MG ORAL TABLET,,J7512,HCPCS,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PREDNISONE 10 MG ORAL TABLET,,J7512,HCPCS,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
PREDNISONE 10 MG ORAL TABLET,,J7512,HCPCS,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PREDNISONE 10 MG ORAL TABLET,,J7512,HCPCS,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PREDNISONE 10 MG ORAL TABLET,,J7512,HCPCS,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PREDNISONE 10 MG ORAL TABLET,,J7512,HCPCS,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PREDNISONE 10 MG ORAL TABLET,,J7512,HCPCS,Facility,Both,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
PREDNISONE 10 MG ORAL TABLET,,J7512,HCPCS,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
PREDNISONE 10 MG ORAL TABLET,,J7512,HCPCS,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
PREDNISONE 10 MG ORAL TABLET,,J7512,HCPCS,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
PREDNISONE 10 MG ORAL TABLET,,J7512,HCPCS,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
PREDNISONE 5 MG ORAL TABLET,,J7512,HCPCS,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
PREDNISONE 5 MG ORAL TABLET,,J7512,HCPCS,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
PREDNISONE 5 MG ORAL TABLET,,J7512,HCPCS,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
PREDNISONE 5 MG ORAL TABLET,,J7512,HCPCS,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
PREDNISONE 5 MG ORAL TABLET,,J7512,HCPCS,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
PREDNISONE 5 MG ORAL TABLET,,J7512,HCPCS,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
PREDNISONE 5 MG ORAL TABLET,,J7512,HCPCS,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
PREDNISONE 5 MG ORAL TABLET,,J7512,HCPCS,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
PREDNISONE 5 MG ORAL TABLET,,J7512,HCPCS,Facility,Both,1,Each,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
PREDNISONE 5 MG ORAL TABLET,,J7512,HCPCS,Facility,Both,1,Each,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
PREDNISONE 5 MG ORAL TABLET,,J7512,HCPCS,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
PREDNISONE 5 MG ORAL TABLET,,J7512,HCPCS,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
PREDNISONE 5 MG ORAL TABLET,,J7512,HCPCS,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
PREDNISONE 5 MG ORAL TABLET,,J7512,HCPCS,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
PREDNISONE 5 MG ORAL TABLET,,J7512,HCPCS,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
PREDNISONE 5 MG ORAL TABLET,,J7512,HCPCS,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
PREDNISONE 5 MG ORAL TABLET,,J7512,HCPCS,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
PREDNISONE 5 MG ORAL TABLET,,J7512,HCPCS,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
PREDNISONE 5 MG ORAL TABLET,,J7512,HCPCS,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
PREDNISONE 5 MG ORAL TABLET,,J7512,HCPCS,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
PREDNISONE 5 MG ORAL TABLET,,J7512,HCPCS,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
PREDNISONE 5 MG ORAL TABLET,,J7512,HCPCS,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
PREDNISONE 5 MG ORAL TABLET,,J7512,HCPCS,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
PREDNISONE 5 MG ORAL TABLET,,J7512,HCPCS,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
PREDNISONE 5 MG ORAL TABLET,,J7512,HCPCS,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
PREDNISONE 5 MG ORAL TABLET,,J7512,HCPCS,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
PREDNISONE 5 MG ORAL TABLET,,J7512,HCPCS,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
PREDNISONE 5 MG ORAL TABLET,,J7512,HCPCS,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
PREDNISONE 5 MG ORAL TABLET,,J7512,HCPCS,Facility,Both,1,Each,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
PREDNISONE 5 MG ORAL TABLET,,J7512,HCPCS,Facility,Both,1,Each,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
PREDNISONE 5 MG ORAL TABLET,,J7512,HCPCS,Facility,Both,1,Each,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
PREDNISONE 5 MG ORAL TABLET,,J7512,HCPCS,Facility,Both,1,Each,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
PREDNISONE 5 MG ORAL TABLET,,J7512,HCPCS,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
PREDNISONE 5 MG ORAL TABLET,,J7512,HCPCS,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
PREDNISONE 5 MG ORAL TABLET,,J7512,HCPCS,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
PREDNISONE 5 MG ORAL TABLET,,J7512,HCPCS,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
PREDNISONE 5 MG ORAL TABLET,,J7512,HCPCS,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PREDNISONE 5 MG ORAL TABLET,,J7512,HCPCS,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PREDNISONE 5 MG ORAL TABLET,,J7512,HCPCS,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
PREDNISONE 5 MG ORAL TABLET,,J7512,HCPCS,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
PREDNISONE 5 MG ORAL TABLET,,J7512,HCPCS,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
PREDNISONE 5 MG ORAL TABLET,,J7512,HCPCS,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
PREDNISONE 5 MG ORAL TABLET,,J7512,HCPCS,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
PREDNISONE 5 MG ORAL TABLET,,J7512,HCPCS,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
PREDNISONE 5 MG ORAL TABLET,,J7512,HCPCS,Facility,Both,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
PREDNISONE 5 MG ORAL TABLET,,J7512,HCPCS,Facility,Both,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
PREDNISONE 5 MG ORAL TABLET,,J7512,HCPCS,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
PREDNISONE 5 MG ORAL TABLET,,J7512,HCPCS,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
PREDNISONE 5 MG ORAL TABLET,,J7512,HCPCS,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
PREDNISONE 5 MG ORAL TABLET,,J7512,HCPCS,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
PREDNISONE 5 MG ORAL TABLET,,J7512,HCPCS,Facility,Both,1,Each,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
PREDNISONE 5 MG ORAL TABLET,,J7512,HCPCS,Facility,Both,1,Each,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
PREDNISONE 5 MG ORAL TABLET,,J7512,HCPCS,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
PREDNISONE 5 MG ORAL TABLET,,J7512,HCPCS,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
Removal Of Foreign Body In Muscle Or Tendon Sheath; Simple (Pro Cah),,20520,CPT,Professional,Both,,,,541,459.85,92.93,541,Aetna,Commercial,459.85,85,,percent of total billed charges,,
Removal Of Foreign Body In Muscle Or Tendon Sheath; Simple (Pro Cah),,20520,CPT,Professional,Both,,,,541,459.85,92.93,541,Aetna,Medicare Advantage,145.62,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Removal Of Foreign Body In Muscle Or Tendon Sheath; Simple (Pro Cah),,20520,CPT,Professional,Both,,,,541,459.85,92.93,541,Aetna,PPO,503.13,93,,percent of total billed charges,,
Removal Of Foreign Body In Muscle Or Tendon Sheath; Simple (Pro Cah),,20520,CPT,Professional,Both,,,,541,459.85,92.93,541,America's PPO,America's PPO,462.2304,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Removal Of Foreign Body In Muscle Or Tendon Sheath; Simple (Pro Cah),,20520,CPT,Professional,Both,,,,541,459.85,92.93,541,BlueCross BlueShield Minnesota, Federal Employee Program,302.98,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Removal Of Foreign Body In Muscle Or Tendon Sheath; Simple (Pro Cah),,20520,CPT,Professional,Both,,,,541,459.85,92.93,541,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,307.82768,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Removal Of Foreign Body In Muscle Or Tendon Sheath; Simple (Pro Cah),,20520,CPT,Professional,Both,,,,541,459.85,92.93,541,BlueCross BlueShield Minnesota,High Value Network Plan,307.82768,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Removal Of Foreign Body In Muscle Or Tendon Sheath; Simple (Pro Cah),,20520,CPT,Professional,Both,,,,541,459.85,92.93,541,BlueCross BlueShield Minnesota,Medicare Advantage,166.0255,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Removal Of Foreign Body In Muscle Or Tendon Sheath; Simple (Pro Cah),,20520,CPT,Professional,Both,,,,541,459.85,92.93,541,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,307.82768,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Removal Of Foreign Body In Muscle Or Tendon Sheath; Simple (Pro Cah),,20520,CPT,Professional,Both,,,,541,459.85,92.93,541,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,107.2896,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Removal Of Foreign Body In Muscle Or Tendon Sheath; Simple (Pro Cah),,20520,CPT,Professional,Both,,,,541,459.85,92.93,541,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),166.0255,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Removal Of Foreign Body In Muscle Or Tendon Sheath; Simple (Pro Cah),,20520,CPT,Professional,Both,,,,541,459.85,92.93,541,CorVel,Worker's Compensation,282.3591705,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Removal Of Foreign Body In Muscle Or Tendon Sheath; Simple (Pro Cah),,20520,CPT,Professional,Both,,,,541,459.85,92.93,541,First Health Group Corporation,First Health Network,524.77,97,,percent of total billed charges,,
Removal Of Foreign Body In Muscle Or Tendon Sheath; Simple (Pro Cah),,20520,CPT,Professional,Both,,,,541,459.85,92.93,541,"Health Partners, Inc.",Commercial,305.45,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Removal Of Foreign Body In Muscle Or Tendon Sheath; Simple (Pro Cah),,20520,CPT,Professional,Both,,,,541,459.85,92.93,541,"Health Partners, Inc.",Medicare Advantage,166.0255,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Removal Of Foreign Body In Muscle Or Tendon Sheath; Simple (Pro Cah),,20520,CPT,Professional,Both,,,,541,459.85,92.93,541,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),144.36,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Removal Of Foreign Body In Muscle Or Tendon Sheath; Simple (Pro Cah),,20520,CPT,Professional,Both,,,,541,459.85,92.93,541,"Health Partners, Inc.",State of Minnesota Advantage Program,263.145175,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Removal Of Foreign Body In Muscle Or Tendon Sheath; Simple (Pro Cah),,20520,CPT,Professional,Both,,,,541,459.85,92.93,541,"Health Partners, Inc.",State Public Programs,92.93,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Removal Of Foreign Body In Muscle Or Tendon Sheath; Simple (Pro Cah),,20520,CPT,Professional,Both,,,,541,459.85,92.93,541,Humana Insurance Company,Commercial PPO,144.37,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Removal Of Foreign Body In Muscle Or Tendon Sheath; Simple (Pro Cah),,20520,CPT,Professional,Both,,,,541,459.85,92.93,541,Humana Insurance Company,Medicare PPO,541,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Removal Of Foreign Body In Muscle Or Tendon Sheath; Simple (Pro Cah),,20520,CPT,Professional,Both,,,,541,459.85,92.93,541,Medica,Individual & Family,458.768,84.8,,percent of total billed charges,,
Removal Of Foreign Body In Muscle Or Tendon Sheath; Simple (Pro Cah),,20520,CPT,Professional,Both,,,,541,459.85,92.93,541,Medica,Medica Advantage Solution,269.418,49.8,,percent of total billed charges,,
Removal Of Foreign Body In Muscle Or Tendon Sheath; Simple (Pro Cah),,20520,CPT,Professional,Both,,,,541,459.85,92.93,541,Medica,Medical Assistance,107.29,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Removal Of Foreign Body In Muscle Or Tendon Sheath; Simple (Pro Cah),,20520,CPT,Professional,Both,,,,541,459.85,92.93,541,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,144.37,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Removal Of Foreign Body In Muscle Or Tendon Sheath; Simple (Pro Cah),,20520,CPT,Professional,Both,,,,541,459.85,92.93,541,"Multiplan, Inc.","Multiplan, Inc.",508.54,94,,percent of total billed charges,,
Removal Of Foreign Body In Muscle Or Tendon Sheath; Simple (Pro Cah),,20520,CPT,Professional,Both,,,,541,459.85,92.93,541,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,487.441,90.1,,percent of total billed charges,,
Removal Of Foreign Body In Muscle Or Tendon Sheath; Simple (Pro Cah),,20520,CPT,Professional,Both,,,,541,459.85,92.93,541,"Preferred One Administrative Services, INC.",PPO,533.426,98.6,,percent of total billed charges,,
Removal Of Foreign Body In Muscle Or Tendon Sheath; Simple (Pro Cah),,20520,CPT,Professional,Both,,,,541,459.85,92.93,541,PrimeWest Health,Minnesota Senior Health Options (MSHO),166.0255,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Removal Of Foreign Body In Muscle Or Tendon Sheath; Simple (Pro Cah),,20520,CPT,Professional,Both,,,,541,459.85,92.93,541,PrimeWest Health,MinnesotaCare,114.799872,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Removal Of Foreign Body In Muscle Or Tendon Sheath; Simple (Pro Cah),,20520,CPT,Professional,Both,,,,541,459.85,92.93,541,Sanford Health Plan,Sanford Health Plan,476.08,88,,percent of total billed charges,,
Removal Of Foreign Body In Muscle Or Tendon Sheath; Simple (Pro Cah),,20520,CPT,Professional,Both,,,,541,459.85,92.93,541,"UCare Health, Inc.",Individual & Family Plan,234.687872,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Removal Of Foreign Body In Muscle Or Tendon Sheath; Simple (Pro Cah),,20520,CPT,Professional,Both,,,,541,459.85,92.93,541,"UCare Health, Inc.",Medical Assistance,118.01856,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Removal Of Foreign Body In Muscle Or Tendon Sheath; Simple (Pro Cah),,20520,CPT,Professional,Both,,,,541,459.85,92.93,541,"UCare Health, Inc.",Medicare Advantage,166.0255,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Removal Of Foreign Body In Muscle Or Tendon Sheath; Simple (Pro Cah),,20520,CPT,Professional,Both,,,,541,459.85,92.93,541,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),132.8204,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Removal Of Foreign Body In Muscle Or Tendon Sheath; Simple (Pro Cah),,20520,CPT,Professional,Both,,,,541,459.85,92.93,541,UnitedHealthcare,Individual & Family,541,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Removal Of Foreign Body In Muscle Or Tendon Sheath; Simple (Pro Cah),,20520,CPT,Professional,Both,,,,541,459.85,92.93,541,UnitedHealthcare,Medicare Advantage,166.0255,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Removal Of Foreign Body In Muscle Or Tendon Sheath; Simple (Pro Cah),,20520,CPT,Professional,Both,,,,541,459.85,92.93,541,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,107.2896,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Injection, Therapeutic (Eg, Local Anesthetic, Corticosteroid), Carpal Tunnel (Pro Cah)",,20526,CPT,Professional,Both,,,,306,260.1,34.46,306,Aetna,Commercial,260.1,85,,percent of total billed charges,,
"Injection, Therapeutic (Eg, Local Anesthetic, Corticosteroid), Carpal Tunnel (Pro Cah)",,20526,CPT,Professional,Both,,,,306,260.1,34.46,306,Aetna,Medicare Advantage,54.92,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Injection, Therapeutic (Eg, Local Anesthetic, Corticosteroid), Carpal Tunnel (Pro Cah)",,20526,CPT,Professional,Both,,,,306,260.1,34.46,306,Aetna,PPO,284.58,93,,percent of total billed charges,,
"Injection, Therapeutic (Eg, Local Anesthetic, Corticosteroid), Carpal Tunnel (Pro Cah)",,20526,CPT,Professional,Both,,,,306,260.1,34.46,306,America's PPO,America's PPO,261.4464,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Injection, Therapeutic (Eg, Local Anesthetic, Corticosteroid), Carpal Tunnel (Pro Cah)",,20526,CPT,Professional,Both,,,,306,260.1,34.46,306,BlueCross BlueShield Minnesota, Federal Employee Program,117.06,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Injection, Therapeutic (Eg, Local Anesthetic, Corticosteroid), Carpal Tunnel (Pro Cah)",,20526,CPT,Professional,Both,,,,306,260.1,34.46,306,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,118.93296,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Injection, Therapeutic (Eg, Local Anesthetic, Corticosteroid), Carpal Tunnel (Pro Cah)",,20526,CPT,Professional,Both,,,,306,260.1,34.46,306,BlueCross BlueShield Minnesota,High Value Network Plan,118.93296,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Injection, Therapeutic (Eg, Local Anesthetic, Corticosteroid), Carpal Tunnel (Pro Cah)",,20526,CPT,Professional,Both,,,,306,260.1,34.46,306,BlueCross BlueShield Minnesota,Medicare Advantage,61.9505,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Injection, Therapeutic (Eg, Local Anesthetic, Corticosteroid), Carpal Tunnel (Pro Cah)",,20526,CPT,Professional,Both,,,,306,260.1,34.46,306,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,118.93296,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Injection, Therapeutic (Eg, Local Anesthetic, Corticosteroid), Carpal Tunnel (Pro Cah)",,20526,CPT,Professional,Both,,,,306,260.1,34.46,306,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,39.78656,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Injection, Therapeutic (Eg, Local Anesthetic, Corticosteroid), Carpal Tunnel (Pro Cah)",,20526,CPT,Professional,Both,,,,306,260.1,34.46,306,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),61.9505,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Injection, Therapeutic (Eg, Local Anesthetic, Corticosteroid), Carpal Tunnel (Pro Cah)",,20526,CPT,Professional,Both,,,,306,260.1,34.46,306,CorVel,Worker's Compensation,106.1924115,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Injection, Therapeutic (Eg, Local Anesthetic, Corticosteroid), Carpal Tunnel (Pro Cah)",,20526,CPT,Professional,Both,,,,306,260.1,34.46,306,First Health Group Corporation,First Health Network,296.82,97,,percent of total billed charges,,
"Injection, Therapeutic (Eg, Local Anesthetic, Corticosteroid), Carpal Tunnel (Pro Cah)",,20526,CPT,Professional,Both,,,,306,260.1,34.46,306,"Health Partners, Inc.",Commercial,114.64,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Injection, Therapeutic (Eg, Local Anesthetic, Corticosteroid), Carpal Tunnel (Pro Cah)",,20526,CPT,Professional,Both,,,,306,260.1,34.46,306,"Health Partners, Inc.",Medicare Advantage,61.9505,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Injection, Therapeutic (Eg, Local Anesthetic, Corticosteroid), Carpal Tunnel (Pro Cah)",,20526,CPT,Professional,Both,,,,306,260.1,34.46,306,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),53.88,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Injection, Therapeutic (Eg, Local Anesthetic, Corticosteroid), Carpal Tunnel (Pro Cah)",,20526,CPT,Professional,Both,,,,306,260.1,34.46,306,"Health Partners, Inc.",State of Minnesota Advantage Program,98.76236,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Injection, Therapeutic (Eg, Local Anesthetic, Corticosteroid), Carpal Tunnel (Pro Cah)",,20526,CPT,Professional,Both,,,,306,260.1,34.46,306,"Health Partners, Inc.",State Public Programs,34.46,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Injection, Therapeutic (Eg, Local Anesthetic, Corticosteroid), Carpal Tunnel (Pro Cah)",,20526,CPT,Professional,Both,,,,306,260.1,34.46,306,Humana Insurance Company,Commercial PPO,53.87,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Injection, Therapeutic (Eg, Local Anesthetic, Corticosteroid), Carpal Tunnel (Pro Cah)",,20526,CPT,Professional,Both,,,,306,260.1,34.46,306,Humana Insurance Company,Medicare PPO,306,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Injection, Therapeutic (Eg, Local Anesthetic, Corticosteroid), Carpal Tunnel (Pro Cah)",,20526,CPT,Professional,Both,,,,306,260.1,34.46,306,Medica,Individual & Family,259.488,84.8,,percent of total billed charges,,
"Injection, Therapeutic (Eg, Local Anesthetic, Corticosteroid), Carpal Tunnel (Pro Cah)",,20526,CPT,Professional,Both,,,,306,260.1,34.46,306,Medica,Medica Advantage Solution,152.388,49.8,,percent of total billed charges,,
"Injection, Therapeutic (Eg, Local Anesthetic, Corticosteroid), Carpal Tunnel (Pro Cah)",,20526,CPT,Professional,Both,,,,306,260.1,34.46,306,Medica,Medical Assistance,39.79,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Injection, Therapeutic (Eg, Local Anesthetic, Corticosteroid), Carpal Tunnel (Pro Cah)",,20526,CPT,Professional,Both,,,,306,260.1,34.46,306,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,53.87,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Injection, Therapeutic (Eg, Local Anesthetic, Corticosteroid), Carpal Tunnel (Pro Cah)",,20526,CPT,Professional,Both,,,,306,260.1,34.46,306,"Multiplan, Inc.","Multiplan, Inc.",287.64,94,,percent of total billed charges,,
"Injection, Therapeutic (Eg, Local Anesthetic, Corticosteroid), Carpal Tunnel (Pro Cah)",,20526,CPT,Professional,Both,,,,306,260.1,34.46,306,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,275.706,90.1,,percent of total billed charges,,
"Injection, Therapeutic (Eg, Local Anesthetic, Corticosteroid), Carpal Tunnel (Pro Cah)",,20526,CPT,Professional,Both,,,,306,260.1,34.46,306,"Preferred One Administrative Services, INC.",PPO,301.716,98.6,,percent of total billed charges,,
"Injection, Therapeutic (Eg, Local Anesthetic, Corticosteroid), Carpal Tunnel (Pro Cah)",,20526,CPT,Professional,Both,,,,306,260.1,34.46,306,PrimeWest Health,Minnesota Senior Health Options (MSHO),61.9505,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Injection, Therapeutic (Eg, Local Anesthetic, Corticosteroid), Carpal Tunnel (Pro Cah)",,20526,CPT,Professional,Both,,,,306,260.1,34.46,306,PrimeWest Health,MinnesotaCare,42.5716192,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Injection, Therapeutic (Eg, Local Anesthetic, Corticosteroid), Carpal Tunnel (Pro Cah)",,20526,CPT,Professional,Both,,,,306,260.1,34.46,306,Sanford Health Plan,Sanford Health Plan,269.28,88,,percent of total billed charges,,
"Injection, Therapeutic (Eg, Local Anesthetic, Corticosteroid), Carpal Tunnel (Pro Cah)",,20526,CPT,Professional,Both,,,,306,260.1,34.46,306,"UCare Health, Inc.",Individual & Family Plan,87.571072,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Injection, Therapeutic (Eg, Local Anesthetic, Corticosteroid), Carpal Tunnel (Pro Cah)",,20526,CPT,Professional,Both,,,,306,260.1,34.46,306,"UCare Health, Inc.",Medical Assistance,43.765216,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Injection, Therapeutic (Eg, Local Anesthetic, Corticosteroid), Carpal Tunnel (Pro Cah)",,20526,CPT,Professional,Both,,,,306,260.1,34.46,306,"UCare Health, Inc.",Medicare Advantage,61.9505,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Injection, Therapeutic (Eg, Local Anesthetic, Corticosteroid), Carpal Tunnel (Pro Cah)",,20526,CPT,Professional,Both,,,,306,260.1,34.46,306,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),49.5604,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Injection, Therapeutic (Eg, Local Anesthetic, Corticosteroid), Carpal Tunnel (Pro Cah)",,20526,CPT,Professional,Both,,,,306,260.1,34.46,306,UnitedHealthcare,Individual & Family,306,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Injection, Therapeutic (Eg, Local Anesthetic, Corticosteroid), Carpal Tunnel (Pro Cah)",,20526,CPT,Professional,Both,,,,306,260.1,34.46,306,UnitedHealthcare,Medicare Advantage,61.9505,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Injection, Therapeutic (Eg, Local Anesthetic, Corticosteroid), Carpal Tunnel (Pro Cah)",,20526,CPT,Professional,Both,,,,306,260.1,34.46,306,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,39.78656,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Injection(S); Single Tendon Sheath, Or Ligament, Aponeurosis (Eg, Plantar ""Fascia"") (Pro Cah)",,20550,CPT,Professional,Both,,,,204,173.4,23.78,204,Aetna,Commercial,173.4,85,,percent of total billed charges,,
"Injection(S); Single Tendon Sheath, Or Ligament, Aponeurosis (Eg, Plantar ""Fascia"") (Pro Cah)",,20550,CPT,Professional,Both,,,,204,173.4,23.78,204,Aetna,Medicare Advantage,37.88,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Injection(S); Single Tendon Sheath, Or Ligament, Aponeurosis (Eg, Plantar ""Fascia"") (Pro Cah)",,20550,CPT,Professional,Both,,,,204,173.4,23.78,204,Aetna,PPO,189.72,93,,percent of total billed charges,,
"Injection(S); Single Tendon Sheath, Or Ligament, Aponeurosis (Eg, Plantar ""Fascia"") (Pro Cah)",,20550,CPT,Professional,Both,,,,204,173.4,23.78,204,America's PPO,America's PPO,174.2976,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Injection(S); Single Tendon Sheath, Or Ligament, Aponeurosis (Eg, Plantar ""Fascia"") (Pro Cah)",,20550,CPT,Professional,Both,,,,204,173.4,23.78,204,BlueCross BlueShield Minnesota, Federal Employee Program,79.88,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Injection(S); Single Tendon Sheath, Or Ligament, Aponeurosis (Eg, Plantar ""Fascia"") (Pro Cah)",,20550,CPT,Professional,Both,,,,204,173.4,23.78,204,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,81.15808,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Injection(S); Single Tendon Sheath, Or Ligament, Aponeurosis (Eg, Plantar ""Fascia"") (Pro Cah)",,20550,CPT,Professional,Both,,,,204,173.4,23.78,204,BlueCross BlueShield Minnesota,High Value Network Plan,81.15808,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Injection(S); Single Tendon Sheath, Or Ligament, Aponeurosis (Eg, Plantar ""Fascia"") (Pro Cah)",,20550,CPT,Professional,Both,,,,204,173.4,23.78,204,BlueCross BlueShield Minnesota,Medicare Advantage,42.803,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Injection(S); Single Tendon Sheath, Or Ligament, Aponeurosis (Eg, Plantar ""Fascia"") (Pro Cah)",,20550,CPT,Professional,Both,,,,204,173.4,23.78,204,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,81.15808,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Injection(S); Single Tendon Sheath, Or Ligament, Aponeurosis (Eg, Plantar ""Fascia"") (Pro Cah)",,20550,CPT,Professional,Both,,,,204,173.4,23.78,204,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,27.45232,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Injection(S); Single Tendon Sheath, Or Ligament, Aponeurosis (Eg, Plantar ""Fascia"") (Pro Cah)",,20550,CPT,Professional,Both,,,,204,173.4,23.78,204,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),42.803,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Injection(S); Single Tendon Sheath, Or Ligament, Aponeurosis (Eg, Plantar ""Fascia"") (Pro Cah)",,20550,CPT,Professional,Both,,,,204,173.4,23.78,204,CorVel,Worker's Compensation,73.161564,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Injection(S); Single Tendon Sheath, Or Ligament, Aponeurosis (Eg, Plantar ""Fascia"") (Pro Cah)",,20550,CPT,Professional,Both,,,,204,173.4,23.78,204,First Health Group Corporation,First Health Network,197.88,97,,percent of total billed charges,,
"Injection(S); Single Tendon Sheath, Or Ligament, Aponeurosis (Eg, Plantar ""Fascia"") (Pro Cah)",,20550,CPT,Professional,Both,,,,204,173.4,23.78,204,"Health Partners, Inc.",Commercial,79.09,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Injection(S); Single Tendon Sheath, Or Ligament, Aponeurosis (Eg, Plantar ""Fascia"") (Pro Cah)",,20550,CPT,Professional,Both,,,,204,173.4,23.78,204,"Health Partners, Inc.",Medicare Advantage,42.803,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Injection(S); Single Tendon Sheath, Or Ligament, Aponeurosis (Eg, Plantar ""Fascia"") (Pro Cah)",,20550,CPT,Professional,Both,,,,204,173.4,23.78,204,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),37.28,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Injection(S); Single Tendon Sheath, Or Ligament, Aponeurosis (Eg, Plantar ""Fascia"") (Pro Cah)",,20550,CPT,Professional,Both,,,,204,173.4,23.78,204,"Health Partners, Inc.",State of Minnesota Advantage Program,68.136035,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Injection(S); Single Tendon Sheath, Or Ligament, Aponeurosis (Eg, Plantar ""Fascia"") (Pro Cah)",,20550,CPT,Professional,Both,,,,204,173.4,23.78,204,"Health Partners, Inc.",State Public Programs,23.78,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Injection(S); Single Tendon Sheath, Or Ligament, Aponeurosis (Eg, Plantar ""Fascia"") (Pro Cah)",,20550,CPT,Professional,Both,,,,204,173.4,23.78,204,Humana Insurance Company,Commercial PPO,37.22,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Injection(S); Single Tendon Sheath, Or Ligament, Aponeurosis (Eg, Plantar ""Fascia"") (Pro Cah)",,20550,CPT,Professional,Both,,,,204,173.4,23.78,204,Humana Insurance Company,Medicare PPO,204,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Injection(S); Single Tendon Sheath, Or Ligament, Aponeurosis (Eg, Plantar ""Fascia"") (Pro Cah)",,20550,CPT,Professional,Both,,,,204,173.4,23.78,204,Medica,Individual & Family,172.992,84.8,,percent of total billed charges,,
"Injection(S); Single Tendon Sheath, Or Ligament, Aponeurosis (Eg, Plantar ""Fascia"") (Pro Cah)",,20550,CPT,Professional,Both,,,,204,173.4,23.78,204,Medica,Medica Advantage Solution,101.592,49.8,,percent of total billed charges,,
"Injection(S); Single Tendon Sheath, Or Ligament, Aponeurosis (Eg, Plantar ""Fascia"") (Pro Cah)",,20550,CPT,Professional,Both,,,,204,173.4,23.78,204,Medica,Medical Assistance,27.45,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Injection(S); Single Tendon Sheath, Or Ligament, Aponeurosis (Eg, Plantar ""Fascia"") (Pro Cah)",,20550,CPT,Professional,Both,,,,204,173.4,23.78,204,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,37.22,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Injection(S); Single Tendon Sheath, Or Ligament, Aponeurosis (Eg, Plantar ""Fascia"") (Pro Cah)",,20550,CPT,Professional,Both,,,,204,173.4,23.78,204,"Multiplan, Inc.","Multiplan, Inc.",191.76,94,,percent of total billed charges,,
"Injection(S); Single Tendon Sheath, Or Ligament, Aponeurosis (Eg, Plantar ""Fascia"") (Pro Cah)",,20550,CPT,Professional,Both,,,,204,173.4,23.78,204,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,183.804,90.1,,percent of total billed charges,,
"Injection(S); Single Tendon Sheath, Or Ligament, Aponeurosis (Eg, Plantar ""Fascia"") (Pro Cah)",,20550,CPT,Professional,Both,,,,204,173.4,23.78,204,"Preferred One Administrative Services, INC.",PPO,201.144,98.6,,percent of total billed charges,,
"Injection(S); Single Tendon Sheath, Or Ligament, Aponeurosis (Eg, Plantar ""Fascia"") (Pro Cah)",,20550,CPT,Professional,Both,,,,204,173.4,23.78,204,PrimeWest Health,Minnesota Senior Health Options (MSHO),42.803,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Injection(S); Single Tendon Sheath, Or Ligament, Aponeurosis (Eg, Plantar ""Fascia"") (Pro Cah)",,20550,CPT,Professional,Both,,,,204,173.4,23.78,204,PrimeWest Health,MinnesotaCare,29.3739824,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Injection(S); Single Tendon Sheath, Or Ligament, Aponeurosis (Eg, Plantar ""Fascia"") (Pro Cah)",,20550,CPT,Professional,Both,,,,204,173.4,23.78,204,Sanford Health Plan,Sanford Health Plan,179.52,88,,percent of total billed charges,,
"Injection(S); Single Tendon Sheath, Or Ligament, Aponeurosis (Eg, Plantar ""Fascia"") (Pro Cah)",,20550,CPT,Professional,Both,,,,204,173.4,23.78,204,"UCare Health, Inc.",Individual & Family Plan,60.504832,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Injection(S); Single Tendon Sheath, Or Ligament, Aponeurosis (Eg, Plantar ""Fascia"") (Pro Cah)",,20550,CPT,Professional,Both,,,,204,173.4,23.78,204,"UCare Health, Inc.",Medical Assistance,30.197552,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Injection(S); Single Tendon Sheath, Or Ligament, Aponeurosis (Eg, Plantar ""Fascia"") (Pro Cah)",,20550,CPT,Professional,Both,,,,204,173.4,23.78,204,"UCare Health, Inc.",Medicare Advantage,42.803,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Injection(S); Single Tendon Sheath, Or Ligament, Aponeurosis (Eg, Plantar ""Fascia"") (Pro Cah)",,20550,CPT,Professional,Both,,,,204,173.4,23.78,204,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),34.2424,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Injection(S); Single Tendon Sheath, Or Ligament, Aponeurosis (Eg, Plantar ""Fascia"") (Pro Cah)",,20550,CPT,Professional,Both,,,,204,173.4,23.78,204,UnitedHealthcare,Individual & Family,204,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Injection(S); Single Tendon Sheath, Or Ligament, Aponeurosis (Eg, Plantar ""Fascia"") (Pro Cah)",,20550,CPT,Professional,Both,,,,204,173.4,23.78,204,UnitedHealthcare,Medicare Advantage,42.803,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Injection(S); Single Tendon Sheath, Or Ligament, Aponeurosis (Eg, Plantar ""Fascia"") (Pro Cah)",,20550,CPT,Professional,Both,,,,204,173.4,23.78,204,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,27.45232,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Sc Inj Tendon Sheath Or Ligament,,20550,CPT,Facility,Both,,,,255,216.75,73.083,299,Aetna,Commercial,234.6,92,,percent of total billed charges,,
Sc Inj Tendon Sheath Or Ligament,,20550,CPT,Facility,Outpatient,,,,255,216.75,73.083,299,Aetna,Medicare Advantage,124.95,49,,percent of total billed charges,,
Sc Inj Tendon Sheath Or Ligament,,20550,CPT,Facility,Inpatient,,,,255,216.75,73.083,299,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Sc Inj Tendon Sheath Or Ligament,,20550,CPT,Facility,Both,,,,255,216.75,73.083,299,Aetna,PPO,237.15,93,,percent of total billed charges,,
Sc Inj Tendon Sheath Or Ligament,,20550,CPT,Facility,Both,,,,255,216.75,73.083,299,America's PPO,America's PPO,244.8765,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Sc Inj Tendon Sheath Or Ligament,,20550,CPT,Facility,Both,,,,255,216.75,73.083,299,BlueCross BlueShield Minnesota, Federal Employee Program,250.92,98.4,,percent of total billed charges,,
Sc Inj Tendon Sheath Or Ligament,,20550,CPT,Facility,Both,,,,255,216.75,73.083,299,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,255,100,,percent of total billed charges,,
Sc Inj Tendon Sheath Or Ligament,,20550,CPT,Facility,Both,,,,255,216.75,73.083,299,BlueCross BlueShield Minnesota,High Value Network Plan,229.5,90,,percent of total billed charges,,
Sc Inj Tendon Sheath Or Ligament,,20550,CPT,Facility,Outpatient,,,,255,216.75,73.083,299,BlueCross BlueShield Minnesota,Medicare Advantage,124.95,49,,percent of total billed charges,,
Sc Inj Tendon Sheath Or Ligament,,20550,CPT,Facility,Inpatient,,,,255,216.75,73.083,299,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Sc Inj Tendon Sheath Or Ligament,,20550,CPT,Facility,Both,,,,255,216.75,73.083,299,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,225.8535,88.57,,percent of total billed charges,,
Sc Inj Tendon Sheath Or Ligament,,20550,CPT,Facility,Both,,,,255,216.75,73.083,299,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,73.083,28.66,,percent of total billed charges,,
Sc Inj Tendon Sheath Or Ligament,,20550,CPT,Facility,Outpatient,,,,255,216.75,73.083,299,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),124.95,49,,percent of total billed charges,,
Sc Inj Tendon Sheath Or Ligament,,20550,CPT,Facility,Inpatient,,,,255,216.75,73.083,299,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Sc Inj Tendon Sheath Or Ligament,,20550,CPT,Facility,Both,,,,255,216.75,73.083,299,CorVel,Worker's Compensation,255,100,,percent of total billed charges,,
Sc Inj Tendon Sheath Or Ligament,,20550,CPT,Facility,Both,,,,255,216.75,73.083,299,First Health Group Corporation,First Health Network,247.35,97,,percent of total billed charges,,
Sc Inj Tendon Sheath Or Ligament,,20550,CPT,Facility,Both,,,,255,216.75,73.083,299,"Health Partners, Inc.",Commercial,241.23,94.6,,percent of total billed charges,,
Sc Inj Tendon Sheath Or Ligament,,20550,CPT,Facility,Outpatient,,,,255,216.75,73.083,299,"Health Partners, Inc.",Medicare Advantage,124.95,49,,percent of total billed charges,,
Sc Inj Tendon Sheath Or Ligament,,20550,CPT,Facility,Inpatient,,,,255,216.75,73.083,299,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sc Inj Tendon Sheath Or Ligament,,20550,CPT,Facility,Both,,,,255,216.75,73.083,299,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),153,60,,percent of total billed charges,,
Sc Inj Tendon Sheath Or Ligament,,20550,CPT,Facility,Both,,,,255,216.75,73.083,299,"Health Partners, Inc.",State of Minnesota Advantage Program,207.825,81.5,,percent of total billed charges,,
Sc Inj Tendon Sheath Or Ligament,,20550,CPT,Facility,Both,,,,255,216.75,73.083,299,"Health Partners, Inc.",State Public Programs,127.5,50,,percent of total billed charges,,
Sc Inj Tendon Sheath Or Ligament,,20550,CPT,Facility,Both,,,,255,216.75,73.083,299,Humana Insurance Company,Commercial PPO,242.25,95,,percent of total billed charges,,
Sc Inj Tendon Sheath Or Ligament,,20550,CPT,Facility,Outpatient,,,,255,216.75,73.083,299,Humana Insurance Company,Medicare PPO,124.95,49,,percent of total billed charges,,
Sc Inj Tendon Sheath Or Ligament,,20550,CPT,Facility,Inpatient,,,,255,216.75,73.083,299,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Sc Inj Tendon Sheath Or Ligament,,20550,CPT,Facility,Both,,,,255,216.75,73.083,299,Medica,Individual & Family,252.705,99.1,,percent of total billed charges,,
Sc Inj Tendon Sheath Or Ligament,,20550,CPT,Facility,Outpatient,,,,255,216.75,73.083,299,Medica,Medica Advantage Solution,126.99,49.8,,percent of total billed charges,,
Sc Inj Tendon Sheath Or Ligament,,20550,CPT,Facility,Inpatient,,,,255,216.75,73.083,299,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Sc Inj Tendon Sheath Or Ligament,,20550,CPT,Facility,Outpatient,,,,255,216.75,73.083,299,Medica,Medical Assistance,299,,,Other,Grouper,All inclusive per visit
Sc Inj Tendon Sheath Or Ligament,,20550,CPT,Facility,Inpatient,,,,255,216.75,73.083,299,Medica,Medical Assistance,,,,,Included in per diem rate,
Sc Inj Tendon Sheath Or Ligament,,20550,CPT,Facility,Outpatient,,,,255,216.75,73.083,299,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,126.99,49.8,,percent of total billed charges,,
Sc Inj Tendon Sheath Or Ligament,,20550,CPT,Facility,Inpatient,,,,255,216.75,73.083,299,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Sc Inj Tendon Sheath Or Ligament,,20550,CPT,Facility,Both,,,,255,216.75,73.083,299,"Multiplan, Inc.","Multiplan, Inc.",239.7,94,,percent of total billed charges,,
Sc Inj Tendon Sheath Or Ligament,,20550,CPT,Facility,Outpatient,,,,255,216.75,73.083,299,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,229.755,90.1,,percent of total billed charges,,
Sc Inj Tendon Sheath Or Ligament,,20550,CPT,Facility,Inpatient,,,,255,216.75,73.083,299,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Sc Inj Tendon Sheath Or Ligament,,20550,CPT,Facility,Both,,,,255,216.75,73.083,299,"Preferred One Administrative Services, INC.",PPO,251.43,98.6,,percent of total billed charges,,
Sc Inj Tendon Sheath Or Ligament,,20550,CPT,Facility,Outpatient,,,,255,216.75,73.083,299,PrimeWest Health,Minnesota Senior Health Options (MSHO),131.1975,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Sc Inj Tendon Sheath Or Ligament,,20550,CPT,Facility,Inpatient,,,,255,216.75,73.083,299,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sc Inj Tendon Sheath Or Ligament,,20550,CPT,Facility,Outpatient,,,,255,216.75,73.083,299,PrimeWest Health,MinnesotaCare,130.968,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Sc Inj Tendon Sheath Or Ligament,,20550,CPT,Facility,Inpatient,,,,255,216.75,73.083,299,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Sc Inj Tendon Sheath Or Ligament,,20550,CPT,Facility,Both,,,,255,216.75,73.083,299,Sanford Health Plan,Sanford Health Plan,234.6,92,,percent of total billed charges,,
Sc Inj Tendon Sheath Or Ligament,,20550,CPT,Facility,Outpatient,,,,255,216.75,73.083,299,"UCare Health, Inc.",Individual & Family Plan,143.6925,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Sc Inj Tendon Sheath Or Ligament,,20550,CPT,Facility,Inpatient,,,,255,216.75,73.083,299,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Sc Inj Tendon Sheath Or Ligament,,20550,CPT,Facility,Outpatient,,,,255,216.75,73.083,299,"UCare Health, Inc.",Medical Assistance,128.6985,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sc Inj Tendon Sheath Or Ligament,,20550,CPT,Facility,Inpatient,,,,255,216.75,73.083,299,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Sc Inj Tendon Sheath Or Ligament,,20550,CPT,Facility,Outpatient,,,,255,216.75,73.083,299,"UCare Health, Inc.",Medicare Advantage,128.6985,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sc Inj Tendon Sheath Or Ligament,,20550,CPT,Facility,Inpatient,,,,255,216.75,73.083,299,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sc Inj Tendon Sheath Or Ligament,,20550,CPT,Facility,Outpatient,,,,255,216.75,73.083,299,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),128.6985,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sc Inj Tendon Sheath Or Ligament,,20550,CPT,Facility,Inpatient,,,,255,216.75,73.083,299,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sc Inj Tendon Sheath Or Ligament,,20550,CPT,Facility,Both,,,,255,216.75,73.083,299,UnitedHealthcare,Individual & Family,239.7,94,,percent of total billed charges,,
Sc Inj Tendon Sheath Or Ligament,,20550,CPT,Facility,Outpatient,,,,255,216.75,73.083,299,UnitedHealthcare,Medicare Advantage,124.95,49,,percent of total billed charges,,
Sc Inj Tendon Sheath Or Ligament,,20550,CPT,Facility,Inpatient,,,,255,216.75,73.083,299,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Sc Inj Tendon Sheath Or Ligament,,20550,CPT,Facility,Outpatient,,,,255,216.75,73.083,299,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,122.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
Sc Inj Tendon Sheath Or Ligament,,20550,CPT,Facility,Inpatient,,,,255,216.75,73.083,299,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Injection(S); Single Or Multiple Trigger Point(S), 1 Or 2 Muscle(S) (Pro Cah)",,20552,CPT,Professional,Both,,,,194,164.9,22.9,194,Aetna,Commercial,164.9,85,,percent of total billed charges,,
"Injection(S); Single Or Multiple Trigger Point(S), 1 Or 2 Muscle(S) (Pro Cah)",,20552,CPT,Professional,Both,,,,194,164.9,22.9,194,Aetna,Medicare Advantage,36.86,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Injection(S); Single Or Multiple Trigger Point(S), 1 Or 2 Muscle(S) (Pro Cah)",,20552,CPT,Professional,Both,,,,194,164.9,22.9,194,Aetna,PPO,180.42,93,,percent of total billed charges,,
"Injection(S); Single Or Multiple Trigger Point(S), 1 Or 2 Muscle(S) (Pro Cah)",,20552,CPT,Professional,Both,,,,194,164.9,22.9,194,America's PPO,America's PPO,165.7536,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Injection(S); Single Or Multiple Trigger Point(S), 1 Or 2 Muscle(S) (Pro Cah)",,20552,CPT,Professional,Both,,,,194,164.9,22.9,194,BlueCross BlueShield Minnesota, Federal Employee Program,75.75,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Injection(S); Single Or Multiple Trigger Point(S), 1 Or 2 Muscle(S) (Pro Cah)",,20552,CPT,Professional,Both,,,,194,164.9,22.9,194,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,76.962,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Injection(S); Single Or Multiple Trigger Point(S), 1 Or 2 Muscle(S) (Pro Cah)",,20552,CPT,Professional,Both,,,,194,164.9,22.9,194,BlueCross BlueShield Minnesota,High Value Network Plan,76.962,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Injection(S); Single Or Multiple Trigger Point(S), 1 Or 2 Muscle(S) (Pro Cah)",,20552,CPT,Professional,Both,,,,194,164.9,22.9,194,BlueCross BlueShield Minnesota,Medicare Advantage,41.032,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Injection(S); Single Or Multiple Trigger Point(S), 1 Or 2 Muscle(S) (Pro Cah)",,20552,CPT,Professional,Both,,,,194,164.9,22.9,194,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,76.962,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Injection(S); Single Or Multiple Trigger Point(S), 1 Or 2 Muscle(S) (Pro Cah)",,20552,CPT,Professional,Both,,,,194,164.9,22.9,194,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,26.43632,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Injection(S); Single Or Multiple Trigger Point(S), 1 Or 2 Muscle(S) (Pro Cah)",,20552,CPT,Professional,Both,,,,194,164.9,22.9,194,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),41.032,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Injection(S); Single Or Multiple Trigger Point(S), 1 Or 2 Muscle(S) (Pro Cah)",,20552,CPT,Professional,Both,,,,194,164.9,22.9,194,CorVel,Worker's Compensation,70.9617465,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Injection(S); Single Or Multiple Trigger Point(S), 1 Or 2 Muscle(S) (Pro Cah)",,20552,CPT,Professional,Both,,,,194,164.9,22.9,194,First Health Group Corporation,First Health Network,188.18,97,,percent of total billed charges,,
"Injection(S); Single Or Multiple Trigger Point(S), 1 Or 2 Muscle(S) (Pro Cah)",,20552,CPT,Professional,Both,,,,194,164.9,22.9,194,"Health Partners, Inc.",Commercial,76.18,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Injection(S); Single Or Multiple Trigger Point(S), 1 Or 2 Muscle(S) (Pro Cah)",,20552,CPT,Professional,Both,,,,194,164.9,22.9,194,"Health Partners, Inc.",Medicare Advantage,41.032,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Injection(S); Single Or Multiple Trigger Point(S), 1 Or 2 Muscle(S) (Pro Cah)",,20552,CPT,Professional,Both,,,,194,164.9,22.9,194,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),35.92,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Injection(S); Single Or Multiple Trigger Point(S), 1 Or 2 Muscle(S) (Pro Cah)",,20552,CPT,Professional,Both,,,,194,164.9,22.9,194,"Health Partners, Inc.",State of Minnesota Advantage Program,65.62907,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Injection(S); Single Or Multiple Trigger Point(S), 1 Or 2 Muscle(S) (Pro Cah)",,20552,CPT,Professional,Both,,,,194,164.9,22.9,194,"Health Partners, Inc.",State Public Programs,22.9,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Injection(S); Single Or Multiple Trigger Point(S), 1 Or 2 Muscle(S) (Pro Cah)",,20552,CPT,Professional,Both,,,,194,164.9,22.9,194,Humana Insurance Company,Commercial PPO,35.68,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Injection(S); Single Or Multiple Trigger Point(S), 1 Or 2 Muscle(S) (Pro Cah)",,20552,CPT,Professional,Both,,,,194,164.9,22.9,194,Humana Insurance Company,Medicare PPO,194,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Injection(S); Single Or Multiple Trigger Point(S), 1 Or 2 Muscle(S) (Pro Cah)",,20552,CPT,Professional,Both,,,,194,164.9,22.9,194,Medica,Individual & Family,164.512,84.8,,percent of total billed charges,,
"Injection(S); Single Or Multiple Trigger Point(S), 1 Or 2 Muscle(S) (Pro Cah)",,20552,CPT,Professional,Both,,,,194,164.9,22.9,194,Medica,Medica Advantage Solution,96.612,49.8,,percent of total billed charges,,
"Injection(S); Single Or Multiple Trigger Point(S), 1 Or 2 Muscle(S) (Pro Cah)",,20552,CPT,Professional,Both,,,,194,164.9,22.9,194,Medica,Medical Assistance,26.44,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Injection(S); Single Or Multiple Trigger Point(S), 1 Or 2 Muscle(S) (Pro Cah)",,20552,CPT,Professional,Both,,,,194,164.9,22.9,194,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,35.68,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Injection(S); Single Or Multiple Trigger Point(S), 1 Or 2 Muscle(S) (Pro Cah)",,20552,CPT,Professional,Both,,,,194,164.9,22.9,194,"Multiplan, Inc.","Multiplan, Inc.",182.36,94,,percent of total billed charges,,
"Injection(S); Single Or Multiple Trigger Point(S), 1 Or 2 Muscle(S) (Pro Cah)",,20552,CPT,Professional,Both,,,,194,164.9,22.9,194,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,174.794,90.1,,percent of total billed charges,,
"Injection(S); Single Or Multiple Trigger Point(S), 1 Or 2 Muscle(S) (Pro Cah)",,20552,CPT,Professional,Both,,,,194,164.9,22.9,194,"Preferred One Administrative Services, INC.",PPO,191.284,98.6,,percent of total billed charges,,
"Injection(S); Single Or Multiple Trigger Point(S), 1 Or 2 Muscle(S) (Pro Cah)",,20552,CPT,Professional,Both,,,,194,164.9,22.9,194,PrimeWest Health,Minnesota Senior Health Options (MSHO),41.032,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Injection(S); Single Or Multiple Trigger Point(S), 1 Or 2 Muscle(S) (Pro Cah)",,20552,CPT,Professional,Both,,,,194,164.9,22.9,194,PrimeWest Health,MinnesotaCare,28.2868624,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Injection(S); Single Or Multiple Trigger Point(S), 1 Or 2 Muscle(S) (Pro Cah)",,20552,CPT,Professional,Both,,,,194,164.9,22.9,194,Sanford Health Plan,Sanford Health Plan,170.72,88,,percent of total billed charges,,
"Injection(S); Single Or Multiple Trigger Point(S), 1 Or 2 Muscle(S) (Pro Cah)",,20552,CPT,Professional,Both,,,,194,164.9,22.9,194,"UCare Health, Inc.",Individual & Family Plan,58.001408,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Injection(S); Single Or Multiple Trigger Point(S), 1 Or 2 Muscle(S) (Pro Cah)",,20552,CPT,Professional,Both,,,,194,164.9,22.9,194,"UCare Health, Inc.",Medical Assistance,29.079952,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Injection(S); Single Or Multiple Trigger Point(S), 1 Or 2 Muscle(S) (Pro Cah)",,20552,CPT,Professional,Both,,,,194,164.9,22.9,194,"UCare Health, Inc.",Medicare Advantage,41.032,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Injection(S); Single Or Multiple Trigger Point(S), 1 Or 2 Muscle(S) (Pro Cah)",,20552,CPT,Professional,Both,,,,194,164.9,22.9,194,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),32.8256,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Injection(S); Single Or Multiple Trigger Point(S), 1 Or 2 Muscle(S) (Pro Cah)",,20552,CPT,Professional,Both,,,,194,164.9,22.9,194,UnitedHealthcare,Individual & Family,194,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Injection(S); Single Or Multiple Trigger Point(S), 1 Or 2 Muscle(S) (Pro Cah)",,20552,CPT,Professional,Both,,,,194,164.9,22.9,194,UnitedHealthcare,Medicare Advantage,41.032,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Injection(S); Single Or Multiple Trigger Point(S), 1 Or 2 Muscle(S) (Pro Cah)",,20552,CPT,Professional,Both,,,,194,164.9,22.9,194,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,26.43632,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Injection(S); Single Or Multiple Trigger Points, 1 Or 2 Muscle(S)",,20552,CPT,Facility,Both,,,,128,108.8,36.6848,299,Aetna,Commercial,117.76,92,,percent of total billed charges,,
"Injection(S); Single Or Multiple Trigger Points, 1 Or 2 Muscle(S)",,20552,CPT,Facility,Outpatient,,,,128,108.8,36.6848,299,Aetna,Medicare Advantage,62.72,49,,percent of total billed charges,,
"Injection(S); Single Or Multiple Trigger Points, 1 Or 2 Muscle(S)",,20552,CPT,Facility,Inpatient,,,,128,108.8,36.6848,299,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Injection(S); Single Or Multiple Trigger Points, 1 Or 2 Muscle(S)",,20552,CPT,Facility,Both,,,,128,108.8,36.6848,299,Aetna,PPO,119.04,93,,percent of total billed charges,,
"Injection(S); Single Or Multiple Trigger Points, 1 Or 2 Muscle(S)",,20552,CPT,Facility,Both,,,,128,108.8,36.6848,299,America's PPO,America's PPO,122.9184,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Injection(S); Single Or Multiple Trigger Points, 1 Or 2 Muscle(S)",,20552,CPT,Facility,Both,,,,128,108.8,36.6848,299,BlueCross BlueShield Minnesota, Federal Employee Program,125.952,98.4,,percent of total billed charges,,
"Injection(S); Single Or Multiple Trigger Points, 1 Or 2 Muscle(S)",,20552,CPT,Facility,Both,,,,128,108.8,36.6848,299,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,128,100,,percent of total billed charges,,
"Injection(S); Single Or Multiple Trigger Points, 1 Or 2 Muscle(S)",,20552,CPT,Facility,Both,,,,128,108.8,36.6848,299,BlueCross BlueShield Minnesota,High Value Network Plan,115.2,90,,percent of total billed charges,,
"Injection(S); Single Or Multiple Trigger Points, 1 Or 2 Muscle(S)",,20552,CPT,Facility,Outpatient,,,,128,108.8,36.6848,299,BlueCross BlueShield Minnesota,Medicare Advantage,62.72,49,,percent of total billed charges,,
"Injection(S); Single Or Multiple Trigger Points, 1 Or 2 Muscle(S)",,20552,CPT,Facility,Inpatient,,,,128,108.8,36.6848,299,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Injection(S); Single Or Multiple Trigger Points, 1 Or 2 Muscle(S)",,20552,CPT,Facility,Both,,,,128,108.8,36.6848,299,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,113.3696,88.57,,percent of total billed charges,,
"Injection(S); Single Or Multiple Trigger Points, 1 Or 2 Muscle(S)",,20552,CPT,Facility,Both,,,,128,108.8,36.6848,299,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,36.6848,28.66,,percent of total billed charges,,
"Injection(S); Single Or Multiple Trigger Points, 1 Or 2 Muscle(S)",,20552,CPT,Facility,Outpatient,,,,128,108.8,36.6848,299,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),62.72,49,,percent of total billed charges,,
"Injection(S); Single Or Multiple Trigger Points, 1 Or 2 Muscle(S)",,20552,CPT,Facility,Inpatient,,,,128,108.8,36.6848,299,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Injection(S); Single Or Multiple Trigger Points, 1 Or 2 Muscle(S)",,20552,CPT,Facility,Both,,,,128,108.8,36.6848,299,CorVel,Worker's Compensation,128,100,,percent of total billed charges,,
"Injection(S); Single Or Multiple Trigger Points, 1 Or 2 Muscle(S)",,20552,CPT,Facility,Both,,,,128,108.8,36.6848,299,First Health Group Corporation,First Health Network,124.16,97,,percent of total billed charges,,
"Injection(S); Single Or Multiple Trigger Points, 1 Or 2 Muscle(S)",,20552,CPT,Facility,Both,,,,128,108.8,36.6848,299,"Health Partners, Inc.",Commercial,121.088,94.6,,percent of total billed charges,,
"Injection(S); Single Or Multiple Trigger Points, 1 Or 2 Muscle(S)",,20552,CPT,Facility,Outpatient,,,,128,108.8,36.6848,299,"Health Partners, Inc.",Medicare Advantage,62.72,49,,percent of total billed charges,,
"Injection(S); Single Or Multiple Trigger Points, 1 Or 2 Muscle(S)",,20552,CPT,Facility,Inpatient,,,,128,108.8,36.6848,299,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Injection(S); Single Or Multiple Trigger Points, 1 Or 2 Muscle(S)",,20552,CPT,Facility,Both,,,,128,108.8,36.6848,299,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),76.8,60,,percent of total billed charges,,
"Injection(S); Single Or Multiple Trigger Points, 1 Or 2 Muscle(S)",,20552,CPT,Facility,Both,,,,128,108.8,36.6848,299,"Health Partners, Inc.",State of Minnesota Advantage Program,104.32,81.5,,percent of total billed charges,,
"Injection(S); Single Or Multiple Trigger Points, 1 Or 2 Muscle(S)",,20552,CPT,Facility,Both,,,,128,108.8,36.6848,299,"Health Partners, Inc.",State Public Programs,64,50,,percent of total billed charges,,
"Injection(S); Single Or Multiple Trigger Points, 1 Or 2 Muscle(S)",,20552,CPT,Facility,Both,,,,128,108.8,36.6848,299,Humana Insurance Company,Commercial PPO,121.6,95,,percent of total billed charges,,
"Injection(S); Single Or Multiple Trigger Points, 1 Or 2 Muscle(S)",,20552,CPT,Facility,Outpatient,,,,128,108.8,36.6848,299,Humana Insurance Company,Medicare PPO,62.72,49,,percent of total billed charges,,
"Injection(S); Single Or Multiple Trigger Points, 1 Or 2 Muscle(S)",,20552,CPT,Facility,Inpatient,,,,128,108.8,36.6848,299,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Injection(S); Single Or Multiple Trigger Points, 1 Or 2 Muscle(S)",,20552,CPT,Facility,Both,,,,128,108.8,36.6848,299,Medica,Individual & Family,126.848,99.1,,percent of total billed charges,,
"Injection(S); Single Or Multiple Trigger Points, 1 Or 2 Muscle(S)",,20552,CPT,Facility,Outpatient,,,,128,108.8,36.6848,299,Medica,Medica Advantage Solution,63.744,49.8,,percent of total billed charges,,
"Injection(S); Single Or Multiple Trigger Points, 1 Or 2 Muscle(S)",,20552,CPT,Facility,Inpatient,,,,128,108.8,36.6848,299,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Injection(S); Single Or Multiple Trigger Points, 1 Or 2 Muscle(S)",,20552,CPT,Facility,Outpatient,,,,128,108.8,36.6848,299,Medica,Medical Assistance,299,,,Other,Grouper,All inclusive per visit
"Injection(S); Single Or Multiple Trigger Points, 1 Or 2 Muscle(S)",,20552,CPT,Facility,Inpatient,,,,128,108.8,36.6848,299,Medica,Medical Assistance,,,,,Included in per diem rate,
"Injection(S); Single Or Multiple Trigger Points, 1 Or 2 Muscle(S)",,20552,CPT,Facility,Outpatient,,,,128,108.8,36.6848,299,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,63.744,49.8,,percent of total billed charges,,
"Injection(S); Single Or Multiple Trigger Points, 1 Or 2 Muscle(S)",,20552,CPT,Facility,Inpatient,,,,128,108.8,36.6848,299,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Injection(S); Single Or Multiple Trigger Points, 1 Or 2 Muscle(S)",,20552,CPT,Facility,Both,,,,128,108.8,36.6848,299,"Multiplan, Inc.","Multiplan, Inc.",120.32,94,,percent of total billed charges,,
"Injection(S); Single Or Multiple Trigger Points, 1 Or 2 Muscle(S)",,20552,CPT,Facility,Outpatient,,,,128,108.8,36.6848,299,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,115.328,90.1,,percent of total billed charges,,
"Injection(S); Single Or Multiple Trigger Points, 1 Or 2 Muscle(S)",,20552,CPT,Facility,Inpatient,,,,128,108.8,36.6848,299,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Injection(S); Single Or Multiple Trigger Points, 1 Or 2 Muscle(S)",,20552,CPT,Facility,Both,,,,128,108.8,36.6848,299,"Preferred One Administrative Services, INC.",PPO,126.208,98.6,,percent of total billed charges,,
"Injection(S); Single Or Multiple Trigger Points, 1 Or 2 Muscle(S)",,20552,CPT,Facility,Outpatient,,,,128,108.8,36.6848,299,PrimeWest Health,Minnesota Senior Health Options (MSHO),65.856,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Injection(S); Single Or Multiple Trigger Points, 1 Or 2 Muscle(S)",,20552,CPT,Facility,Inpatient,,,,128,108.8,36.6848,299,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Injection(S); Single Or Multiple Trigger Points, 1 Or 2 Muscle(S)",,20552,CPT,Facility,Outpatient,,,,128,108.8,36.6848,299,PrimeWest Health,MinnesotaCare,65.7408,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Injection(S); Single Or Multiple Trigger Points, 1 Or 2 Muscle(S)",,20552,CPT,Facility,Inpatient,,,,128,108.8,36.6848,299,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Injection(S); Single Or Multiple Trigger Points, 1 Or 2 Muscle(S)",,20552,CPT,Facility,Both,,,,128,108.8,36.6848,299,Sanford Health Plan,Sanford Health Plan,117.76,92,,percent of total billed charges,,
"Injection(S); Single Or Multiple Trigger Points, 1 Or 2 Muscle(S)",,20552,CPT,Facility,Outpatient,,,,128,108.8,36.6848,299,"UCare Health, Inc.",Individual & Family Plan,72.128,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Injection(S); Single Or Multiple Trigger Points, 1 Or 2 Muscle(S)",,20552,CPT,Facility,Inpatient,,,,128,108.8,36.6848,299,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Injection(S); Single Or Multiple Trigger Points, 1 Or 2 Muscle(S)",,20552,CPT,Facility,Outpatient,,,,128,108.8,36.6848,299,"UCare Health, Inc.",Medical Assistance,64.6016,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Injection(S); Single Or Multiple Trigger Points, 1 Or 2 Muscle(S)",,20552,CPT,Facility,Inpatient,,,,128,108.8,36.6848,299,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Injection(S); Single Or Multiple Trigger Points, 1 Or 2 Muscle(S)",,20552,CPT,Facility,Outpatient,,,,128,108.8,36.6848,299,"UCare Health, Inc.",Medicare Advantage,64.6016,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Injection(S); Single Or Multiple Trigger Points, 1 Or 2 Muscle(S)",,20552,CPT,Facility,Inpatient,,,,128,108.8,36.6848,299,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Injection(S); Single Or Multiple Trigger Points, 1 Or 2 Muscle(S)",,20552,CPT,Facility,Outpatient,,,,128,108.8,36.6848,299,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),64.6016,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Injection(S); Single Or Multiple Trigger Points, 1 Or 2 Muscle(S)",,20552,CPT,Facility,Inpatient,,,,128,108.8,36.6848,299,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Injection(S); Single Or Multiple Trigger Points, 1 Or 2 Muscle(S)",,20552,CPT,Facility,Both,,,,128,108.8,36.6848,299,UnitedHealthcare,Individual & Family,120.32,94,,percent of total billed charges,,
"Injection(S); Single Or Multiple Trigger Points, 1 Or 2 Muscle(S)",,20552,CPT,Facility,Outpatient,,,,128,108.8,36.6848,299,UnitedHealthcare,Medicare Advantage,62.72,49,,percent of total billed charges,,
"Injection(S); Single Or Multiple Trigger Points, 1 Or 2 Muscle(S)",,20552,CPT,Facility,Inpatient,,,,128,108.8,36.6848,299,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Injection(S); Single Or Multiple Trigger Points, 1 Or 2 Muscle(S)",,20552,CPT,Facility,Outpatient,,,,128,108.8,36.6848,299,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,61.44,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Injection(S); Single Or Multiple Trigger Points, 1 Or 2 Muscle(S)",,20552,CPT,Facility,Inpatient,,,,128,108.8,36.6848,299,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
PREDNISONE 5 MG ORAL TABLET,,J7512,HCPCS,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
PREDNISONE 5 MG ORAL TABLET,,J7512,HCPCS,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
PREDNISONE 5 MG ORAL TABLET,,J7512,HCPCS,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
PREDNISONE 5 MG ORAL TABLET,,J7512,HCPCS,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
PREDNISONE 5 MG ORAL TABLET,,J7512,HCPCS,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
PREDNISONE 5 MG ORAL TABLET,,J7512,HCPCS,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
PREDNISONE 5 MG ORAL TABLET,,J7512,HCPCS,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
PREDNISONE 5 MG ORAL TABLET,,J7512,HCPCS,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
PREDNISONE 5 MG ORAL TABLET,,J7512,HCPCS,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
PREDNISONE 5 MG ORAL TABLET,,J7512,HCPCS,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
PREDNISONE 5 MG ORAL TABLET,,J7512,HCPCS,Facility,Both,1,Each,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
PREDNISONE 5 MG ORAL TABLET,,J7512,HCPCS,Facility,Both,1,Each,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
PREDNISONE 5 MG ORAL TABLET,,J7512,HCPCS,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
PREDNISONE 5 MG ORAL TABLET,,J7512,HCPCS,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
PREDNISONE 5 MG ORAL TABLET,,J7512,HCPCS,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
PREDNISONE 5 MG ORAL TABLET,,J7512,HCPCS,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
PREDNISONE 5 MG ORAL TABLET,,J7512,HCPCS,Facility,Both,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
PREDNISONE 5 MG ORAL TABLET,,J7512,HCPCS,Facility,Both,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
PREDNISONE 5 MG ORAL TABLET,,J7512,HCPCS,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
PREDNISONE 5 MG ORAL TABLET,,J7512,HCPCS,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
PREDNISONE 5 MG ORAL TABLET,,J7512,HCPCS,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PREDNISONE 5 MG ORAL TABLET,,J7512,HCPCS,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PREDNISONE 5 MG ORAL TABLET,,J7512,HCPCS,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
PREDNISONE 5 MG ORAL TABLET,,J7512,HCPCS,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
PREDNISONE 5 MG ORAL TABLET,,J7512,HCPCS,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
PREDNISONE 5 MG ORAL TABLET,,J7512,HCPCS,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
PREDNISONE 5 MG ORAL TABLET,,J7512,HCPCS,Facility,Both,1,Each,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
PREDNISONE 5 MG ORAL TABLET,,J7512,HCPCS,Facility,Both,1,Each,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
PREDNISONE 5 MG ORAL TABLET,,J7512,HCPCS,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
PREDNISONE 5 MG ORAL TABLET,,J7512,HCPCS,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
PREDNISONE 5 MG ORAL TABLET,,J7512,HCPCS,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
PREDNISONE 5 MG ORAL TABLET,,J7512,HCPCS,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
PREDNISONE 5 MG ORAL TABLET,,J7512,HCPCS,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PREDNISONE 5 MG ORAL TABLET,,J7512,HCPCS,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PREDNISONE 5 MG ORAL TABLET,,J7512,HCPCS,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
PREDNISONE 5 MG ORAL TABLET,,J7512,HCPCS,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
PREDNISONE 5 MG ORAL TABLET,,J7512,HCPCS,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PREDNISONE 5 MG ORAL TABLET,,J7512,HCPCS,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PREDNISONE 5 MG ORAL TABLET,,J7512,HCPCS,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PREDNISONE 5 MG ORAL TABLET,,J7512,HCPCS,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PREDNISONE 5 MG ORAL TABLET,,J7512,HCPCS,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PREDNISONE 5 MG ORAL TABLET,,J7512,HCPCS,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PREDNISONE 5 MG ORAL TABLET,,J7512,HCPCS,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PREDNISONE 5 MG ORAL TABLET,,J7512,HCPCS,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PREDNISONE 5 MG ORAL TABLET,,J7512,HCPCS,Facility,Both,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
PREDNISONE 5 MG ORAL TABLET,,J7512,HCPCS,Facility,Both,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
PREDNISONE 5 MG ORAL TABLET,,J7512,HCPCS,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
PREDNISONE 5 MG ORAL TABLET,,J7512,HCPCS,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
PREDNISONE 5 MG ORAL TABLET,,J7512,HCPCS,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
PREDNISONE 5 MG ORAL TABLET,,J7512,HCPCS,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
PREDNISONE 5 MG ORAL TABLET,,J7512,HCPCS,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
PREDNISONE 5 MG ORAL TABLET,,J7512,HCPCS,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
PREDNISONE 5 MG ORAL TABLET,,J7512,HCPCS,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
PREDNISONE 5 MG ORAL TABLET,,J7512,HCPCS,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
DEXAMETHASONE 4 MG ORAL TABLET,,J8540,HCPCS,Facility,Both,1,Each,,7,5.95,2.0062,7,Aetna,Commercial,6.44,92,,percent of total billed charges,,
DEXAMETHASONE 4 MG ORAL TABLET,,J8540,HCPCS,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,Aetna,Medicare Advantage,3.43,49,,percent of total billed charges,,
DEXAMETHASONE 4 MG ORAL TABLET,,J8540,HCPCS,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,Aetna,Medicare Advantage,,,,,Included in per diem rate,
DEXAMETHASONE 4 MG ORAL TABLET,,J8540,HCPCS,Facility,Both,1,Each,,7,5.95,2.0062,7,Aetna,PPO,6.51,93,,percent of total billed charges,,
DEXAMETHASONE 4 MG ORAL TABLET,,J8540,HCPCS,Facility,Both,1,Each,,7,5.95,2.0062,7,America's PPO,America's PPO,6.7221,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
DEXAMETHASONE 4 MG ORAL TABLET,,J8540,HCPCS,Facility,Both,1,Each,,7,5.95,2.0062,7,BlueCross BlueShield Minnesota, Federal Employee Program,6.888,98.4,,percent of total billed charges,,
DEXAMETHASONE 4 MG ORAL TABLET,,J8540,HCPCS,Facility,Both,1,Each,,7,5.95,2.0062,7,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,7,100,,percent of total billed charges,,
DEXAMETHASONE 4 MG ORAL TABLET,,J8540,HCPCS,Facility,Both,1,Each,,7,5.95,2.0062,7,BlueCross BlueShield Minnesota,High Value Network Plan,6.3,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
DEXAMETHASONE 4 MG ORAL TABLET,,J8540,HCPCS,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,BlueCross BlueShield Minnesota,Medicare Advantage,3.43,49,,percent of total billed charges,,
DEXAMETHASONE 4 MG ORAL TABLET,,J8540,HCPCS,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
DEXAMETHASONE 4 MG ORAL TABLET,,J8540,HCPCS,Facility,Both,1,Each,,7,5.95,2.0062,7,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,6.1999,88.57,,percent of total billed charges,,
DEXAMETHASONE 4 MG ORAL TABLET,,J8540,HCPCS,Facility,Both,1,Each,,7,5.95,2.0062,7,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,2.0062,28.66,,percent of total billed charges,,
DEXAMETHASONE 4 MG ORAL TABLET,,J8540,HCPCS,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),3.43,49,,percent of total billed charges,,
DEXAMETHASONE 4 MG ORAL TABLET,,J8540,HCPCS,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
DEXAMETHASONE 4 MG ORAL TABLET,,J8540,HCPCS,Facility,Both,1,Each,,7,5.95,2.0062,7,CorVel,Worker's Compensation,7,100,,percent of total billed charges,,
DEXAMETHASONE 4 MG ORAL TABLET,,J8540,HCPCS,Facility,Both,1,Each,,7,5.95,2.0062,7,First Health Group Corporation,First Health Network,6.79,97,,percent of total billed charges,,
DEXAMETHASONE 4 MG ORAL TABLET,,J8540,HCPCS,Facility,Both,1,Each,,7,5.95,2.0062,7,"Health Partners, Inc.",Commercial,6.622,94.6,,percent of total billed charges,,
DEXAMETHASONE 4 MG ORAL TABLET,,J8540,HCPCS,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,"Health Partners, Inc.",Medicare Advantage,3.43,49,,percent of total billed charges,,
DEXAMETHASONE 4 MG ORAL TABLET,,J8540,HCPCS,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DEXAMETHASONE 4 MG ORAL TABLET,,J8540,HCPCS,Facility,Both,1,Each,,7,5.95,2.0062,7,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),4.2,60,,percent of total billed charges,,
DEXAMETHASONE 4 MG ORAL TABLET,,J8540,HCPCS,Facility,Both,1,Each,,7,5.95,2.0062,7,"Health Partners, Inc.",State of Minnesota Advantage Program,5.705,81.5,,percent of total billed charges,,
DEXAMETHASONE 4 MG ORAL TABLET,,J8540,HCPCS,Facility,Both,1,Each,,7,5.95,2.0062,7,"Health Partners, Inc.",State Public Programs,3.5,50,,percent of total billed charges,,
DEXAMETHASONE 4 MG ORAL TABLET,,J8540,HCPCS,Facility,Both,1,Each,,7,5.95,2.0062,7,Humana Insurance Company,Commercial PPO,6.65,95,,percent of total billed charges,,
DEXAMETHASONE 4 MG ORAL TABLET,,J8540,HCPCS,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,Humana Insurance Company,Medicare PPO,3.43,49,,percent of total billed charges,,
DEXAMETHASONE 4 MG ORAL TABLET,,J8540,HCPCS,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
DEXAMETHASONE 4 MG ORAL TABLET,,J8540,HCPCS,Facility,Both,1,Each,,7,5.95,2.0062,7,Medica,Individual & Family,6.937,99.1,,percent of total billed charges,,
DEXAMETHASONE 4 MG ORAL TABLET,,J8540,HCPCS,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,Medica,Medica Advantage Solution,3.486,49.8,,percent of total billed charges,,
DEXAMETHASONE 4 MG ORAL TABLET,,J8540,HCPCS,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
DEXAMETHASONE 4 MG ORAL TABLET,,J8540,HCPCS,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,Medica,Medical Assistance,3.122,44.6,,percent of total billed charges,,
DEXAMETHASONE 4 MG ORAL TABLET,,J8540,HCPCS,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,Medica,Medical Assistance,,,,,Included in per diem rate,
DEXAMETHASONE 4 MG ORAL TABLET,,J8540,HCPCS,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,3.486,49.8,,percent of total billed charges,,
DEXAMETHASONE 4 MG ORAL TABLET,,J8540,HCPCS,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
DEXAMETHASONE 4 MG ORAL TABLET,,J8540,HCPCS,Facility,Both,1,Each,,7,5.95,2.0062,7,"Multiplan, Inc.","Multiplan, Inc.",6.58,94,,percent of total billed charges,,
DEXAMETHASONE 4 MG ORAL TABLET,,J8540,HCPCS,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,6.307,90.1,,percent of total billed charges,,
DEXAMETHASONE 4 MG ORAL TABLET,,J8540,HCPCS,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
DEXAMETHASONE 4 MG ORAL TABLET,,J8540,HCPCS,Facility,Both,1,Each,,7,5.95,2.0062,7,"Preferred One Administrative Services, INC.",PPO,6.902,98.6,,percent of total billed charges,,
DEXAMETHASONE 4 MG ORAL TABLET,,J8540,HCPCS,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,PrimeWest Health,Minnesota Senior Health Options (MSHO),3.6015,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
DEXAMETHASONE 4 MG ORAL TABLET,,J8540,HCPCS,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DEXAMETHASONE 4 MG ORAL TABLET,,J8540,HCPCS,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,PrimeWest Health,MinnesotaCare,3.5952,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
DEXAMETHASONE 4 MG ORAL TABLET,,J8540,HCPCS,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
DEXAMETHASONE 4 MG ORAL TABLET,,J8540,HCPCS,Facility,Both,1,Each,,7,5.95,2.0062,7,Sanford Health Plan,Sanford Health Plan,6.44,92,,percent of total billed charges,,
DEXAMETHASONE 4 MG ORAL TABLET,,J8540,HCPCS,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,"UCare Health, Inc.",Individual & Family Plan,3.9445,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
DEXAMETHASONE 4 MG ORAL TABLET,,J8540,HCPCS,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
DEXAMETHASONE 4 MG ORAL TABLET,,J8540,HCPCS,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,"UCare Health, Inc.",Medical Assistance,3.5329,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DEXAMETHASONE 4 MG ORAL TABLET,,J8540,HCPCS,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
DEXAMETHASONE 4 MG ORAL TABLET,,J8540,HCPCS,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,"UCare Health, Inc.",Medicare Advantage,3.5329,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DEXAMETHASONE 4 MG ORAL TABLET,,J8540,HCPCS,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DEXAMETHASONE 4 MG ORAL TABLET,,J8540,HCPCS,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),3.5329,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DEXAMETHASONE 4 MG ORAL TABLET,,J8540,HCPCS,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DEXAMETHASONE 4 MG ORAL TABLET,,J8540,HCPCS,Facility,Both,1,Each,,7,5.95,2.0062,7,UnitedHealthcare,Individual & Family,6.58,94,,percent of total billed charges,,
DEXAMETHASONE 4 MG ORAL TABLET,,J8540,HCPCS,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,UnitedHealthcare,Medicare Advantage,3.43,49,,percent of total billed charges,,
DEXAMETHASONE 4 MG ORAL TABLET,,J8540,HCPCS,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
DEXAMETHASONE 4 MG ORAL TABLET,,J8540,HCPCS,Facility,Outpatient,1,Each,,7,5.95,2.0062,7,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,3.36,48,,percent of total billed charges,,100% of DHS outpatient percentage
DEXAMETHASONE 4 MG ORAL TABLET,,J8540,HCPCS,Facility,Inpatient,1,Each,,7,5.95,2.0062,7,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Arthrocentesis, Aspiration And/Or Injection, Small Joint/Bursa; Wo Ultrasound Guidance (Pro Cah)",,20600,CPT,Professional,Both,,,,200,170,21.82,200,Aetna,Commercial,170,85,,percent of total billed charges,,
"Arthrocentesis, Aspiration And/Or Injection, Small Joint/Bursa; Wo Ultrasound Guidance (Pro Cah)",,20600,CPT,Professional,Both,,,,200,170,21.82,200,Aetna,Medicare Advantage,34.74,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Arthrocentesis, Aspiration And/Or Injection, Small Joint/Bursa; Wo Ultrasound Guidance (Pro Cah)",,20600,CPT,Professional,Both,,,,200,170,21.82,200,Aetna,PPO,186,93,,percent of total billed charges,,
"Arthrocentesis, Aspiration And/Or Injection, Small Joint/Bursa; Wo Ultrasound Guidance (Pro Cah)",,20600,CPT,Professional,Both,,,,200,170,21.82,200,America's PPO,America's PPO,170.88,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Arthrocentesis, Aspiration And/Or Injection, Small Joint/Bursa; Wo Ultrasound Guidance (Pro Cah)",,20600,CPT,Professional,Both,,,,200,170,21.82,200,BlueCross BlueShield Minnesota, Federal Employee Program,72.3,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Arthrocentesis, Aspiration And/Or Injection, Small Joint/Bursa; Wo Ultrasound Guidance (Pro Cah)",,20600,CPT,Professional,Both,,,,200,170,21.82,200,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,73.4568,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Arthrocentesis, Aspiration And/Or Injection, Small Joint/Bursa; Wo Ultrasound Guidance (Pro Cah)",,20600,CPT,Professional,Both,,,,200,170,21.82,200,BlueCross BlueShield Minnesota,High Value Network Plan,73.4568,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Arthrocentesis, Aspiration And/Or Injection, Small Joint/Bursa; Wo Ultrasound Guidance (Pro Cah)",,20600,CPT,Professional,Both,,,,200,170,21.82,200,BlueCross BlueShield Minnesota,Medicare Advantage,39.0425,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Arthrocentesis, Aspiration And/Or Injection, Small Joint/Bursa; Wo Ultrasound Guidance (Pro Cah)",,20600,CPT,Professional,Both,,,,200,170,21.82,200,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,73.4568,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Arthrocentesis, Aspiration And/Or Injection, Small Joint/Bursa; Wo Ultrasound Guidance (Pro Cah)",,20600,CPT,Professional,Both,,,,200,170,21.82,200,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,25.18664,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Arthrocentesis, Aspiration And/Or Injection, Small Joint/Bursa; Wo Ultrasound Guidance (Pro Cah)",,20600,CPT,Professional,Both,,,,200,170,21.82,200,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),39.0425,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Arthrocentesis, Aspiration And/Or Injection, Small Joint/Bursa; Wo Ultrasound Guidance (Pro Cah)",,20600,CPT,Professional,Both,,,,200,170,21.82,200,CorVel,Worker's Compensation,66.8791539,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Arthrocentesis, Aspiration And/Or Injection, Small Joint/Bursa; Wo Ultrasound Guidance (Pro Cah)",,20600,CPT,Professional,Both,,,,200,170,21.82,200,First Health Group Corporation,First Health Network,194,97,,percent of total billed charges,,
"Arthrocentesis, Aspiration And/Or Injection, Small Joint/Bursa; Wo Ultrasound Guidance (Pro Cah)",,20600,CPT,Professional,Both,,,,200,170,21.82,200,"Health Partners, Inc.",Commercial,71.83,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Arthrocentesis, Aspiration And/Or Injection, Small Joint/Bursa; Wo Ultrasound Guidance (Pro Cah)",,20600,CPT,Professional,Both,,,,200,170,21.82,200,"Health Partners, Inc.",Medicare Advantage,39.0425,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Arthrocentesis, Aspiration And/Or Injection, Small Joint/Bursa; Wo Ultrasound Guidance (Pro Cah)",,20600,CPT,Professional,Both,,,,200,170,21.82,200,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),34.23,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Arthrocentesis, Aspiration And/Or Injection, Small Joint/Bursa; Wo Ultrasound Guidance (Pro Cah)",,20600,CPT,Professional,Both,,,,200,170,21.82,200,"Health Partners, Inc.",State of Minnesota Advantage Program,61.881545,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Arthrocentesis, Aspiration And/Or Injection, Small Joint/Bursa; Wo Ultrasound Guidance (Pro Cah)",,20600,CPT,Professional,Both,,,,200,170,21.82,200,"Health Partners, Inc.",State Public Programs,21.82,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Arthrocentesis, Aspiration And/Or Injection, Small Joint/Bursa; Wo Ultrasound Guidance (Pro Cah)",,20600,CPT,Professional,Both,,,,200,170,21.82,200,Humana Insurance Company,Commercial PPO,33.95,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Arthrocentesis, Aspiration And/Or Injection, Small Joint/Bursa; Wo Ultrasound Guidance (Pro Cah)",,20600,CPT,Professional,Both,,,,200,170,21.82,200,Humana Insurance Company,Medicare PPO,200,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Arthrocentesis, Aspiration And/Or Injection, Small Joint/Bursa; Wo Ultrasound Guidance (Pro Cah)",,20600,CPT,Professional,Both,,,,200,170,21.82,200,Medica,Individual & Family,169.6,84.8,,percent of total billed charges,,
"Arthrocentesis, Aspiration And/Or Injection, Small Joint/Bursa; Wo Ultrasound Guidance (Pro Cah)",,20600,CPT,Professional,Both,,,,200,170,21.82,200,Medica,Medica Advantage Solution,99.6,49.8,,percent of total billed charges,,
"Arthrocentesis, Aspiration And/Or Injection, Small Joint/Bursa; Wo Ultrasound Guidance (Pro Cah)",,20600,CPT,Professional,Both,,,,200,170,21.82,200,Medica,Medical Assistance,25.19,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Arthrocentesis, Aspiration And/Or Injection, Small Joint/Bursa; Wo Ultrasound Guidance (Pro Cah)",,20600,CPT,Professional,Both,,,,200,170,21.82,200,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,33.95,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Arthrocentesis, Aspiration And/Or Injection, Small Joint/Bursa; Wo Ultrasound Guidance (Pro Cah)",,20600,CPT,Professional,Both,,,,200,170,21.82,200,"Multiplan, Inc.","Multiplan, Inc.",188,94,,percent of total billed charges,,
"Arthrocentesis, Aspiration And/Or Injection, Small Joint/Bursa; Wo Ultrasound Guidance (Pro Cah)",,20600,CPT,Professional,Both,,,,200,170,21.82,200,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,180.2,90.1,,percent of total billed charges,,
"Arthrocentesis, Aspiration And/Or Injection, Small Joint/Bursa; Wo Ultrasound Guidance (Pro Cah)",,20600,CPT,Professional,Both,,,,200,170,21.82,200,"Preferred One Administrative Services, INC.",PPO,197.2,98.6,,percent of total billed charges,,
"Arthrocentesis, Aspiration And/Or Injection, Small Joint/Bursa; Wo Ultrasound Guidance (Pro Cah)",,20600,CPT,Professional,Both,,,,200,170,21.82,200,PrimeWest Health,Minnesota Senior Health Options (MSHO),39.0425,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Arthrocentesis, Aspiration And/Or Injection, Small Joint/Bursa; Wo Ultrasound Guidance (Pro Cah)",,20600,CPT,Professional,Both,,,,200,170,21.82,200,PrimeWest Health,MinnesotaCare,26.9497048,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Arthrocentesis, Aspiration And/Or Injection, Small Joint/Bursa; Wo Ultrasound Guidance (Pro Cah)",,20600,CPT,Professional,Both,,,,200,170,21.82,200,Sanford Health Plan,Sanford Health Plan,176,88,,percent of total billed charges,,
"Arthrocentesis, Aspiration And/Or Injection, Small Joint/Bursa; Wo Ultrasound Guidance (Pro Cah)",,20600,CPT,Professional,Both,,,,200,170,21.82,200,"UCare Health, Inc.",Individual & Family Plan,55.18912,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Arthrocentesis, Aspiration And/Or Injection, Small Joint/Bursa; Wo Ultrasound Guidance (Pro Cah)",,20600,CPT,Professional,Both,,,,200,170,21.82,200,"UCare Health, Inc.",Medical Assistance,27.705304,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Arthrocentesis, Aspiration And/Or Injection, Small Joint/Bursa; Wo Ultrasound Guidance (Pro Cah)",,20600,CPT,Professional,Both,,,,200,170,21.82,200,"UCare Health, Inc.",Medicare Advantage,39.0425,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Arthrocentesis, Aspiration And/Or Injection, Small Joint/Bursa; Wo Ultrasound Guidance (Pro Cah)",,20600,CPT,Professional,Both,,,,200,170,21.82,200,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),31.234,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Arthrocentesis, Aspiration And/Or Injection, Small Joint/Bursa; Wo Ultrasound Guidance (Pro Cah)",,20600,CPT,Professional,Both,,,,200,170,21.82,200,UnitedHealthcare,Individual & Family,200,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Arthrocentesis, Aspiration And/Or Injection, Small Joint/Bursa; Wo Ultrasound Guidance (Pro Cah)",,20600,CPT,Professional,Both,,,,200,170,21.82,200,UnitedHealthcare,Medicare Advantage,39.0425,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Arthrocentesis, Aspiration And/Or Injection, Small Joint/Bursa; Wo Ultrasound Guidance (Pro Cah)",,20600,CPT,Professional,Both,,,,200,170,21.82,200,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,25.18664,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Sc Inj Aspirate Small Joint,,20600,CPT,Facility,Both,,,,187,158.95,53.5942,299,Aetna,Commercial,172.04,92,,percent of total billed charges,,
Sc Inj Aspirate Small Joint,,20600,CPT,Facility,Outpatient,,,,187,158.95,53.5942,299,Aetna,Medicare Advantage,91.63,49,,percent of total billed charges,,
Sc Inj Aspirate Small Joint,,20600,CPT,Facility,Inpatient,,,,187,158.95,53.5942,299,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Sc Inj Aspirate Small Joint,,20600,CPT,Facility,Both,,,,187,158.95,53.5942,299,Aetna,PPO,173.91,93,,percent of total billed charges,,
Sc Inj Aspirate Small Joint,,20600,CPT,Facility,Both,,,,187,158.95,53.5942,299,America's PPO,America's PPO,179.5761,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Sc Inj Aspirate Small Joint,,20600,CPT,Facility,Both,,,,187,158.95,53.5942,299,BlueCross BlueShield Minnesota, Federal Employee Program,184.008,98.4,,percent of total billed charges,,
Sc Inj Aspirate Small Joint,,20600,CPT,Facility,Both,,,,187,158.95,53.5942,299,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,187,100,,percent of total billed charges,,
Sc Inj Aspirate Small Joint,,20600,CPT,Facility,Both,,,,187,158.95,53.5942,299,BlueCross BlueShield Minnesota,High Value Network Plan,168.3,90,,percent of total billed charges,,
Sc Inj Aspirate Small Joint,,20600,CPT,Facility,Outpatient,,,,187,158.95,53.5942,299,BlueCross BlueShield Minnesota,Medicare Advantage,91.63,49,,percent of total billed charges,,
Sc Inj Aspirate Small Joint,,20600,CPT,Facility,Inpatient,,,,187,158.95,53.5942,299,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Sc Inj Aspirate Small Joint,,20600,CPT,Facility,Both,,,,187,158.95,53.5942,299,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,165.6259,88.57,,percent of total billed charges,,
Sc Inj Aspirate Small Joint,,20600,CPT,Facility,Both,,,,187,158.95,53.5942,299,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,53.5942,28.66,,percent of total billed charges,,
Sc Inj Aspirate Small Joint,,20600,CPT,Facility,Outpatient,,,,187,158.95,53.5942,299,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),91.63,49,,percent of total billed charges,,
Sc Inj Aspirate Small Joint,,20600,CPT,Facility,Inpatient,,,,187,158.95,53.5942,299,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Sc Inj Aspirate Small Joint,,20600,CPT,Facility,Both,,,,187,158.95,53.5942,299,CorVel,Worker's Compensation,187,100,,percent of total billed charges,,
Sc Inj Aspirate Small Joint,,20600,CPT,Facility,Both,,,,187,158.95,53.5942,299,First Health Group Corporation,First Health Network,181.39,97,,percent of total billed charges,,
Sc Inj Aspirate Small Joint,,20600,CPT,Facility,Both,,,,187,158.95,53.5942,299,"Health Partners, Inc.",Commercial,176.902,94.6,,percent of total billed charges,,
Sc Inj Aspirate Small Joint,,20600,CPT,Facility,Outpatient,,,,187,158.95,53.5942,299,"Health Partners, Inc.",Medicare Advantage,91.63,49,,percent of total billed charges,,
Sc Inj Aspirate Small Joint,,20600,CPT,Facility,Inpatient,,,,187,158.95,53.5942,299,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sc Inj Aspirate Small Joint,,20600,CPT,Facility,Both,,,,187,158.95,53.5942,299,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),112.2,60,,percent of total billed charges,,
Sc Inj Aspirate Small Joint,,20600,CPT,Facility,Both,,,,187,158.95,53.5942,299,"Health Partners, Inc.",State of Minnesota Advantage Program,152.405,81.5,,percent of total billed charges,,
Sc Inj Aspirate Small Joint,,20600,CPT,Facility,Both,,,,187,158.95,53.5942,299,"Health Partners, Inc.",State Public Programs,93.5,50,,percent of total billed charges,,
Sc Inj Aspirate Small Joint,,20600,CPT,Facility,Both,,,,187,158.95,53.5942,299,Humana Insurance Company,Commercial PPO,177.65,95,,percent of total billed charges,,
Sc Inj Aspirate Small Joint,,20600,CPT,Facility,Outpatient,,,,187,158.95,53.5942,299,Humana Insurance Company,Medicare PPO,91.63,49,,percent of total billed charges,,
Sc Inj Aspirate Small Joint,,20600,CPT,Facility,Inpatient,,,,187,158.95,53.5942,299,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Sc Inj Aspirate Small Joint,,20600,CPT,Facility,Both,,,,187,158.95,53.5942,299,Medica,Individual & Family,185.317,99.1,,percent of total billed charges,,
Sc Inj Aspirate Small Joint,,20600,CPT,Facility,Outpatient,,,,187,158.95,53.5942,299,Medica,Medica Advantage Solution,93.126,49.8,,percent of total billed charges,,
Sc Inj Aspirate Small Joint,,20600,CPT,Facility,Inpatient,,,,187,158.95,53.5942,299,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Sc Inj Aspirate Small Joint,,20600,CPT,Facility,Outpatient,,,,187,158.95,53.5942,299,Medica,Medical Assistance,299,,,Other,Grouper,All inclusive per visit
Sc Inj Aspirate Small Joint,,20600,CPT,Facility,Inpatient,,,,187,158.95,53.5942,299,Medica,Medical Assistance,,,,,Included in per diem rate,
Sc Inj Aspirate Small Joint,,20600,CPT,Facility,Outpatient,,,,187,158.95,53.5942,299,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,93.126,49.8,,percent of total billed charges,,
Sc Inj Aspirate Small Joint,,20600,CPT,Facility,Inpatient,,,,187,158.95,53.5942,299,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Sc Inj Aspirate Small Joint,,20600,CPT,Facility,Both,,,,187,158.95,53.5942,299,"Multiplan, Inc.","Multiplan, Inc.",175.78,94,,percent of total billed charges,,
Sc Inj Aspirate Small Joint,,20600,CPT,Facility,Outpatient,,,,187,158.95,53.5942,299,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,168.487,90.1,,percent of total billed charges,,
Sc Inj Aspirate Small Joint,,20600,CPT,Facility,Inpatient,,,,187,158.95,53.5942,299,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Sc Inj Aspirate Small Joint,,20600,CPT,Facility,Both,,,,187,158.95,53.5942,299,"Preferred One Administrative Services, INC.",PPO,184.382,98.6,,percent of total billed charges,,
Sc Inj Aspirate Small Joint,,20600,CPT,Facility,Outpatient,,,,187,158.95,53.5942,299,PrimeWest Health,Minnesota Senior Health Options (MSHO),96.2115,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Sc Inj Aspirate Small Joint,,20600,CPT,Facility,Inpatient,,,,187,158.95,53.5942,299,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sc Inj Aspirate Small Joint,,20600,CPT,Facility,Outpatient,,,,187,158.95,53.5942,299,PrimeWest Health,MinnesotaCare,96.0432,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Sc Inj Aspirate Small Joint,,20600,CPT,Facility,Inpatient,,,,187,158.95,53.5942,299,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Sc Inj Aspirate Small Joint,,20600,CPT,Facility,Both,,,,187,158.95,53.5942,299,Sanford Health Plan,Sanford Health Plan,172.04,92,,percent of total billed charges,,
Sc Inj Aspirate Small Joint,,20600,CPT,Facility,Outpatient,,,,187,158.95,53.5942,299,"UCare Health, Inc.",Individual & Family Plan,105.3745,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Sc Inj Aspirate Small Joint,,20600,CPT,Facility,Inpatient,,,,187,158.95,53.5942,299,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Sc Inj Aspirate Small Joint,,20600,CPT,Facility,Outpatient,,,,187,158.95,53.5942,299,"UCare Health, Inc.",Medical Assistance,94.3789,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sc Inj Aspirate Small Joint,,20600,CPT,Facility,Inpatient,,,,187,158.95,53.5942,299,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Sc Inj Aspirate Small Joint,,20600,CPT,Facility,Outpatient,,,,187,158.95,53.5942,299,"UCare Health, Inc.",Medicare Advantage,94.3789,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sc Inj Aspirate Small Joint,,20600,CPT,Facility,Inpatient,,,,187,158.95,53.5942,299,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sc Inj Aspirate Small Joint,,20600,CPT,Facility,Outpatient,,,,187,158.95,53.5942,299,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),94.3789,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sc Inj Aspirate Small Joint,,20600,CPT,Facility,Inpatient,,,,187,158.95,53.5942,299,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sc Inj Aspirate Small Joint,,20600,CPT,Facility,Both,,,,187,158.95,53.5942,299,UnitedHealthcare,Individual & Family,175.78,94,,percent of total billed charges,,
Sc Inj Aspirate Small Joint,,20600,CPT,Facility,Outpatient,,,,187,158.95,53.5942,299,UnitedHealthcare,Medicare Advantage,91.63,49,,percent of total billed charges,,
Sc Inj Aspirate Small Joint,,20600,CPT,Facility,Inpatient,,,,187,158.95,53.5942,299,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Sc Inj Aspirate Small Joint,,20600,CPT,Facility,Outpatient,,,,187,158.95,53.5942,299,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,89.76,48,,percent of total billed charges,,100% of DHS outpatient percentage
Sc Inj Aspirate Small Joint,,20600,CPT,Facility,Inpatient,,,,187,158.95,53.5942,299,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Arthrocentesis Medium Joint W/O Us Guidance,,20605,CPT,Facility,Both,,,,150,127.5,42.99,150,Aetna,Commercial,138,92,,percent of total billed charges,,
Arthrocentesis Medium Joint W/O Us Guidance,,20605,CPT,Facility,Outpatient,,,,150,127.5,42.99,150,Aetna,Medicare Advantage,73.5,49,,percent of total billed charges,,
Arthrocentesis Medium Joint W/O Us Guidance,,20605,CPT,Facility,Inpatient,,,,150,127.5,42.99,150,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Arthrocentesis Medium Joint W/O Us Guidance,,20605,CPT,Facility,Both,,,,150,127.5,42.99,150,Aetna,PPO,139.5,93,,percent of total billed charges,,
Arthrocentesis Medium Joint W/O Us Guidance,,20605,CPT,Facility,Both,,,,150,127.5,42.99,150,America's PPO,America's PPO,144.045,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Arthrocentesis Medium Joint W/O Us Guidance,,20605,CPT,Facility,Both,,,,150,127.5,42.99,150,BlueCross BlueShield Minnesota, Federal Employee Program,147.6,98.4,,percent of total billed charges,,
Arthrocentesis Medium Joint W/O Us Guidance,,20605,CPT,Facility,Both,,,,150,127.5,42.99,150,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,150,100,,percent of total billed charges,,
Arthrocentesis Medium Joint W/O Us Guidance,,20605,CPT,Facility,Both,,,,150,127.5,42.99,150,BlueCross BlueShield Minnesota,High Value Network Plan,135,90,,percent of total billed charges,,
Arthrocentesis Medium Joint W/O Us Guidance,,20605,CPT,Facility,Outpatient,,,,150,127.5,42.99,150,BlueCross BlueShield Minnesota,Medicare Advantage,73.5,49,,percent of total billed charges,,
Arthrocentesis Medium Joint W/O Us Guidance,,20605,CPT,Facility,Inpatient,,,,150,127.5,42.99,150,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Arthrocentesis Medium Joint W/O Us Guidance,,20605,CPT,Facility,Both,,,,150,127.5,42.99,150,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,132.855,88.57,,percent of total billed charges,,
Arthrocentesis Medium Joint W/O Us Guidance,,20605,CPT,Facility,Both,,,,150,127.5,42.99,150,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,42.99,28.66,,percent of total billed charges,,
Arthrocentesis Medium Joint W/O Us Guidance,,20605,CPT,Facility,Outpatient,,,,150,127.5,42.99,150,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),73.5,49,,percent of total billed charges,,
Arthrocentesis Medium Joint W/O Us Guidance,,20605,CPT,Facility,Inpatient,,,,150,127.5,42.99,150,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Arthrocentesis Medium Joint W/O Us Guidance,,20605,CPT,Facility,Both,,,,150,127.5,42.99,150,CorVel,Worker's Compensation,150,100,,percent of total billed charges,,
Arthrocentesis Medium Joint W/O Us Guidance,,20605,CPT,Facility,Both,,,,150,127.5,42.99,150,First Health Group Corporation,First Health Network,145.5,97,,percent of total billed charges,,
Arthrocentesis Medium Joint W/O Us Guidance,,20605,CPT,Facility,Both,,,,150,127.5,42.99,150,"Health Partners, Inc.",Commercial,141.9,94.6,,percent of total billed charges,,
Arthrocentesis Medium Joint W/O Us Guidance,,20605,CPT,Facility,Outpatient,,,,150,127.5,42.99,150,"Health Partners, Inc.",Medicare Advantage,73.5,49,,percent of total billed charges,,
Arthrocentesis Medium Joint W/O Us Guidance,,20605,CPT,Facility,Inpatient,,,,150,127.5,42.99,150,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Arthrocentesis Medium Joint W/O Us Guidance,,20605,CPT,Facility,Both,,,,150,127.5,42.99,150,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),90,60,,percent of total billed charges,,
Arthrocentesis Medium Joint W/O Us Guidance,,20605,CPT,Facility,Both,,,,150,127.5,42.99,150,"Health Partners, Inc.",State of Minnesota Advantage Program,122.25,81.5,,percent of total billed charges,,
Arthrocentesis Medium Joint W/O Us Guidance,,20605,CPT,Facility,Both,,,,150,127.5,42.99,150,"Health Partners, Inc.",State Public Programs,75,50,,percent of total billed charges,,
Arthrocentesis Medium Joint W/O Us Guidance,,20605,CPT,Facility,Both,,,,150,127.5,42.99,150,Humana Insurance Company,Commercial PPO,142.5,95,,percent of total billed charges,,
Arthrocentesis Medium Joint W/O Us Guidance,,20605,CPT,Facility,Outpatient,,,,150,127.5,42.99,150,Humana Insurance Company,Medicare PPO,73.5,49,,percent of total billed charges,,
Arthrocentesis Medium Joint W/O Us Guidance,,20605,CPT,Facility,Inpatient,,,,150,127.5,42.99,150,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Arthrocentesis Medium Joint W/O Us Guidance,,20605,CPT,Facility,Both,,,,150,127.5,42.99,150,Medica,Individual & Family,148.65,99.1,,percent of total billed charges,,
Arthrocentesis Medium Joint W/O Us Guidance,,20605,CPT,Facility,Outpatient,,,,150,127.5,42.99,150,Medica,Medica Advantage Solution,74.7,49.8,,percent of total billed charges,,
Arthrocentesis Medium Joint W/O Us Guidance,,20605,CPT,Facility,Inpatient,,,,150,127.5,42.99,150,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Arthrocentesis Medium Joint W/O Us Guidance,,20605,CPT,Facility,Outpatient,,,,150,127.5,42.99,150,Medica,Medical Assistance,66.9,44.6,,percent of total billed charges,,
Arthrocentesis Medium Joint W/O Us Guidance,,20605,CPT,Facility,Inpatient,,,,150,127.5,42.99,150,Medica,Medical Assistance,,,,,Included in per diem rate,
Arthrocentesis Medium Joint W/O Us Guidance,,20605,CPT,Facility,Outpatient,,,,150,127.5,42.99,150,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,74.7,49.8,,percent of total billed charges,,
Arthrocentesis Medium Joint W/O Us Guidance,,20605,CPT,Facility,Inpatient,,,,150,127.5,42.99,150,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Arthrocentesis Medium Joint W/O Us Guidance,,20605,CPT,Facility,Both,,,,150,127.5,42.99,150,"Multiplan, Inc.","Multiplan, Inc.",141,94,,percent of total billed charges,,
Arthrocentesis Medium Joint W/O Us Guidance,,20605,CPT,Facility,Outpatient,,,,150,127.5,42.99,150,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,135.15,90.1,,percent of total billed charges,,
Arthrocentesis Medium Joint W/O Us Guidance,,20605,CPT,Facility,Inpatient,,,,150,127.5,42.99,150,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Arthrocentesis Medium Joint W/O Us Guidance,,20605,CPT,Facility,Both,,,,150,127.5,42.99,150,"Preferred One Administrative Services, INC.",PPO,147.9,98.6,,percent of total billed charges,,
Arthrocentesis Medium Joint W/O Us Guidance,,20605,CPT,Facility,Outpatient,,,,150,127.5,42.99,150,PrimeWest Health,Minnesota Senior Health Options (MSHO),77.175,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Arthrocentesis Medium Joint W/O Us Guidance,,20605,CPT,Facility,Inpatient,,,,150,127.5,42.99,150,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Arthrocentesis Medium Joint W/O Us Guidance,,20605,CPT,Facility,Outpatient,,,,150,127.5,42.99,150,PrimeWest Health,MinnesotaCare,77.04,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Arthrocentesis Medium Joint W/O Us Guidance,,20605,CPT,Facility,Inpatient,,,,150,127.5,42.99,150,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Arthrocentesis Medium Joint W/O Us Guidance,,20605,CPT,Facility,Both,,,,150,127.5,42.99,150,Sanford Health Plan,Sanford Health Plan,138,92,,percent of total billed charges,,
Arthrocentesis Medium Joint W/O Us Guidance,,20605,CPT,Facility,Outpatient,,,,150,127.5,42.99,150,"UCare Health, Inc.",Individual & Family Plan,84.525,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Arthrocentesis Medium Joint W/O Us Guidance,,20605,CPT,Facility,Inpatient,,,,150,127.5,42.99,150,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Arthrocentesis Medium Joint W/O Us Guidance,,20605,CPT,Facility,Outpatient,,,,150,127.5,42.99,150,"UCare Health, Inc.",Medical Assistance,75.705,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Arthrocentesis Medium Joint W/O Us Guidance,,20605,CPT,Facility,Inpatient,,,,150,127.5,42.99,150,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Arthrocentesis Medium Joint W/O Us Guidance,,20605,CPT,Facility,Outpatient,,,,150,127.5,42.99,150,"UCare Health, Inc.",Medicare Advantage,75.705,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Arthrocentesis Medium Joint W/O Us Guidance,,20605,CPT,Facility,Inpatient,,,,150,127.5,42.99,150,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Arthrocentesis Medium Joint W/O Us Guidance,,20605,CPT,Facility,Outpatient,,,,150,127.5,42.99,150,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),75.705,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Arthrocentesis Medium Joint W/O Us Guidance,,20605,CPT,Facility,Inpatient,,,,150,127.5,42.99,150,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Arthrocentesis Medium Joint W/O Us Guidance,,20605,CPT,Facility,Both,,,,150,127.5,42.99,150,UnitedHealthcare,Individual & Family,141,94,,percent of total billed charges,,
Arthrocentesis Medium Joint W/O Us Guidance,,20605,CPT,Facility,Outpatient,,,,150,127.5,42.99,150,UnitedHealthcare,Medicare Advantage,73.5,49,,percent of total billed charges,,
Arthrocentesis Medium Joint W/O Us Guidance,,20605,CPT,Facility,Inpatient,,,,150,127.5,42.99,150,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Arthrocentesis Medium Joint W/O Us Guidance,,20605,CPT,Facility,Outpatient,,,,150,127.5,42.99,150,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,72,48,,percent of total billed charges,,100% of DHS outpatient percentage
Arthrocentesis Medium Joint W/O Us Guidance,,20605,CPT,Facility,Inpatient,,,,150,127.5,42.99,150,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Arthrocentesis, Aspiration And/Or Injection, Intermediate Joint/Bursa; Wo Us Guidance (Pro Cah)",,20605,CPT,Professional,Both,,,,225,191.25,22.47,225,Aetna,Commercial,191.25,85,,percent of total billed charges,,
"Arthrocentesis, Aspiration And/Or Injection, Intermediate Joint/Bursa; Wo Us Guidance (Pro Cah)",,20605,CPT,Professional,Both,,,,225,191.25,22.47,225,Aetna,Medicare Advantage,36.15,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Arthrocentesis, Aspiration And/Or Injection, Intermediate Joint/Bursa; Wo Us Guidance (Pro Cah)",,20605,CPT,Professional,Both,,,,225,191.25,22.47,225,Aetna,PPO,209.25,93,,percent of total billed charges,,
"Arthrocentesis, Aspiration And/Or Injection, Intermediate Joint/Bursa; Wo Us Guidance (Pro Cah)",,20605,CPT,Professional,Both,,,,225,191.25,22.47,225,America's PPO,America's PPO,192.24,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Arthrocentesis, Aspiration And/Or Injection, Intermediate Joint/Bursa; Wo Us Guidance (Pro Cah)",,20605,CPT,Professional,Both,,,,225,191.25,22.47,225,BlueCross BlueShield Minnesota, Federal Employee Program,75.75,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Arthrocentesis, Aspiration And/Or Injection, Intermediate Joint/Bursa; Wo Us Guidance (Pro Cah)",,20605,CPT,Professional,Both,,,,225,191.25,22.47,225,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,76.962,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Arthrocentesis, Aspiration And/Or Injection, Intermediate Joint/Bursa; Wo Us Guidance (Pro Cah)",,20605,CPT,Professional,Both,,,,225,191.25,22.47,225,BlueCross BlueShield Minnesota,High Value Network Plan,76.962,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Arthrocentesis, Aspiration And/Or Injection, Intermediate Joint/Bursa; Wo Us Guidance (Pro Cah)",,20605,CPT,Professional,Both,,,,225,191.25,22.47,225,BlueCross BlueShield Minnesota,Medicare Advantage,40.48,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Arthrocentesis, Aspiration And/Or Injection, Intermediate Joint/Bursa; Wo Us Guidance (Pro Cah)",,20605,CPT,Professional,Both,,,,225,191.25,22.47,225,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,76.962,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Arthrocentesis, Aspiration And/Or Injection, Intermediate Joint/Bursa; Wo Us Guidance (Pro Cah)",,20605,CPT,Professional,Both,,,,225,191.25,22.47,225,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,25.93848,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Arthrocentesis, Aspiration And/Or Injection, Intermediate Joint/Bursa; Wo Us Guidance (Pro Cah)",,20605,CPT,Professional,Both,,,,225,191.25,22.47,225,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),40.48,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Arthrocentesis, Aspiration And/Or Injection, Intermediate Joint/Bursa; Wo Us Guidance (Pro Cah)",,20605,CPT,Professional,Both,,,,225,191.25,22.47,225,CorVel,Worker's Compensation,69.5834181,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Arthrocentesis, Aspiration And/Or Injection, Intermediate Joint/Bursa; Wo Us Guidance (Pro Cah)",,20605,CPT,Professional,Both,,,,225,191.25,22.47,225,First Health Group Corporation,First Health Network,218.25,97,,percent of total billed charges,,
"Arthrocentesis, Aspiration And/Or Injection, Intermediate Joint/Bursa; Wo Us Guidance (Pro Cah)",,20605,CPT,Professional,Both,,,,225,191.25,22.47,225,"Health Partners, Inc.",Commercial,74.73,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Arthrocentesis, Aspiration And/Or Injection, Intermediate Joint/Bursa; Wo Us Guidance (Pro Cah)",,20605,CPT,Professional,Both,,,,225,191.25,22.47,225,"Health Partners, Inc.",Medicare Advantage,40.48,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Arthrocentesis, Aspiration And/Or Injection, Intermediate Joint/Bursa; Wo Us Guidance (Pro Cah)",,20605,CPT,Professional,Both,,,,225,191.25,22.47,225,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),35.24,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Arthrocentesis, Aspiration And/Or Injection, Intermediate Joint/Bursa; Wo Us Guidance (Pro Cah)",,20605,CPT,Professional,Both,,,,225,191.25,22.47,225,"Health Partners, Inc.",State of Minnesota Advantage Program,64.379895,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Arthrocentesis, Aspiration And/Or Injection, Intermediate Joint/Bursa; Wo Us Guidance (Pro Cah)",,20605,CPT,Professional,Both,,,,225,191.25,22.47,225,"Health Partners, Inc.",State Public Programs,22.47,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Arthrocentesis, Aspiration And/Or Injection, Intermediate Joint/Bursa; Wo Us Guidance (Pro Cah)",,20605,CPT,Professional,Both,,,,225,191.25,22.47,225,Humana Insurance Company,Commercial PPO,35.2,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Arthrocentesis, Aspiration And/Or Injection, Intermediate Joint/Bursa; Wo Us Guidance (Pro Cah)",,20605,CPT,Professional,Both,,,,225,191.25,22.47,225,Humana Insurance Company,Medicare PPO,225,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Arthrocentesis, Aspiration And/Or Injection, Intermediate Joint/Bursa; Wo Us Guidance (Pro Cah)",,20605,CPT,Professional,Both,,,,225,191.25,22.47,225,Medica,Individual & Family,190.8,84.8,,percent of total billed charges,,
"Arthrocentesis, Aspiration And/Or Injection, Intermediate Joint/Bursa; Wo Us Guidance (Pro Cah)",,20605,CPT,Professional,Both,,,,225,191.25,22.47,225,Medica,Medica Advantage Solution,112.05,49.8,,percent of total billed charges,,
"Arthrocentesis, Aspiration And/Or Injection, Intermediate Joint/Bursa; Wo Us Guidance (Pro Cah)",,20605,CPT,Professional,Both,,,,225,191.25,22.47,225,Medica,Medical Assistance,25.94,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Arthrocentesis, Aspiration And/Or Injection, Intermediate Joint/Bursa; Wo Us Guidance (Pro Cah)",,20605,CPT,Professional,Both,,,,225,191.25,22.47,225,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,35.2,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Arthrocentesis, Aspiration And/Or Injection, Intermediate Joint/Bursa; Wo Us Guidance (Pro Cah)",,20605,CPT,Professional,Both,,,,225,191.25,22.47,225,"Multiplan, Inc.","Multiplan, Inc.",211.5,94,,percent of total billed charges,,
"Arthrocentesis, Aspiration And/Or Injection, Intermediate Joint/Bursa; Wo Us Guidance (Pro Cah)",,20605,CPT,Professional,Both,,,,225,191.25,22.47,225,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,202.725,90.1,,percent of total billed charges,,
"Arthrocentesis, Aspiration And/Or Injection, Intermediate Joint/Bursa; Wo Us Guidance (Pro Cah)",,20605,CPT,Professional,Both,,,,225,191.25,22.47,225,"Preferred One Administrative Services, INC.",PPO,221.85,98.6,,percent of total billed charges,,
"Arthrocentesis, Aspiration And/Or Injection, Intermediate Joint/Bursa; Wo Us Guidance (Pro Cah)",,20605,CPT,Professional,Both,,,,225,191.25,22.47,225,PrimeWest Health,Minnesota Senior Health Options (MSHO),40.48,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Arthrocentesis, Aspiration And/Or Injection, Intermediate Joint/Bursa; Wo Us Guidance (Pro Cah)",,20605,CPT,Professional,Both,,,,225,191.25,22.47,225,PrimeWest Health,MinnesotaCare,27.7541736,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Arthrocentesis, Aspiration And/Or Injection, Intermediate Joint/Bursa; Wo Us Guidance (Pro Cah)",,20605,CPT,Professional,Both,,,,225,191.25,22.47,225,Sanford Health Plan,Sanford Health Plan,198,88,,percent of total billed charges,,
"Arthrocentesis, Aspiration And/Or Injection, Intermediate Joint/Bursa; Wo Us Guidance (Pro Cah)",,20605,CPT,Professional,Both,,,,225,191.25,22.47,225,"UCare Health, Inc.",Individual & Family Plan,57.22112,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Arthrocentesis, Aspiration And/Or Injection, Intermediate Joint/Bursa; Wo Us Guidance (Pro Cah)",,20605,CPT,Professional,Both,,,,225,191.25,22.47,225,"UCare Health, Inc.",Medical Assistance,28.532328,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Arthrocentesis, Aspiration And/Or Injection, Intermediate Joint/Bursa; Wo Us Guidance (Pro Cah)",,20605,CPT,Professional,Both,,,,225,191.25,22.47,225,"UCare Health, Inc.",Medicare Advantage,40.48,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Arthrocentesis, Aspiration And/Or Injection, Intermediate Joint/Bursa; Wo Us Guidance (Pro Cah)",,20605,CPT,Professional,Both,,,,225,191.25,22.47,225,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),32.384,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Arthrocentesis, Aspiration And/Or Injection, Intermediate Joint/Bursa; Wo Us Guidance (Pro Cah)",,20605,CPT,Professional,Both,,,,225,191.25,22.47,225,UnitedHealthcare,Individual & Family,225,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Arthrocentesis, Aspiration And/Or Injection, Intermediate Joint/Bursa; Wo Us Guidance (Pro Cah)",,20605,CPT,Professional,Both,,,,225,191.25,22.47,225,UnitedHealthcare,Medicare Advantage,40.48,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Arthrocentesis, Aspiration And/Or Injection, Intermediate Joint/Bursa; Wo Us Guidance (Pro Cah)",,20605,CPT,Professional,Both,,,,225,191.25,22.47,225,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,25.93848,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Arthrocentesis, Aspiration And/Or Injection, Major Joint Or Bursa W/O Us Guidance",,20610,CPT,Facility,Both,,,,225,191.25,64.485,225,Aetna,Commercial,207,92,,percent of total billed charges,,
"Arthrocentesis, Aspiration And/Or Injection, Major Joint Or Bursa W/O Us Guidance",,20610,CPT,Facility,Outpatient,,,,225,191.25,64.485,225,Aetna,Medicare Advantage,110.25,49,,percent of total billed charges,,
"Arthrocentesis, Aspiration And/Or Injection, Major Joint Or Bursa W/O Us Guidance",,20610,CPT,Facility,Inpatient,,,,225,191.25,64.485,225,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Arthrocentesis, Aspiration And/Or Injection, Major Joint Or Bursa W/O Us Guidance",,20610,CPT,Facility,Both,,,,225,191.25,64.485,225,Aetna,PPO,209.25,93,,percent of total billed charges,,
"Arthrocentesis, Aspiration And/Or Injection, Major Joint Or Bursa W/O Us Guidance",,20610,CPT,Facility,Both,,,,225,191.25,64.485,225,America's PPO,America's PPO,216.0675,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Arthrocentesis, Aspiration And/Or Injection, Major Joint Or Bursa W/O Us Guidance",,20610,CPT,Facility,Both,,,,225,191.25,64.485,225,BlueCross BlueShield Minnesota, Federal Employee Program,221.4,98.4,,percent of total billed charges,,
"Arthrocentesis, Aspiration And/Or Injection, Major Joint Or Bursa W/O Us Guidance",,20610,CPT,Facility,Both,,,,225,191.25,64.485,225,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,225,100,,percent of total billed charges,,
"Arthrocentesis, Aspiration And/Or Injection, Major Joint Or Bursa W/O Us Guidance",,20610,CPT,Facility,Both,,,,225,191.25,64.485,225,BlueCross BlueShield Minnesota,High Value Network Plan,202.5,90,,percent of total billed charges,,
"Arthrocentesis, Aspiration And/Or Injection, Major Joint Or Bursa W/O Us Guidance",,20610,CPT,Facility,Outpatient,,,,225,191.25,64.485,225,BlueCross BlueShield Minnesota,Medicare Advantage,110.25,49,,percent of total billed charges,,
"Arthrocentesis, Aspiration And/Or Injection, Major Joint Or Bursa W/O Us Guidance",,20610,CPT,Facility,Inpatient,,,,225,191.25,64.485,225,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Arthrocentesis, Aspiration And/Or Injection, Major Joint Or Bursa W/O Us Guidance",,20610,CPT,Facility,Both,,,,225,191.25,64.485,225,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,199.2825,88.57,,percent of total billed charges,,
"Arthrocentesis, Aspiration And/Or Injection, Major Joint Or Bursa W/O Us Guidance",,20610,CPT,Facility,Both,,,,225,191.25,64.485,225,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,64.485,28.66,,percent of total billed charges,,
"Arthrocentesis, Aspiration And/Or Injection, Major Joint Or Bursa W/O Us Guidance",,20610,CPT,Facility,Outpatient,,,,225,191.25,64.485,225,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),110.25,49,,percent of total billed charges,,
"Arthrocentesis, Aspiration And/Or Injection, Major Joint Or Bursa W/O Us Guidance",,20610,CPT,Facility,Inpatient,,,,225,191.25,64.485,225,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Arthrocentesis, Aspiration And/Or Injection, Major Joint Or Bursa W/O Us Guidance",,20610,CPT,Facility,Both,,,,225,191.25,64.485,225,CorVel,Worker's Compensation,225,100,,percent of total billed charges,,
"Arthrocentesis, Aspiration And/Or Injection, Major Joint Or Bursa W/O Us Guidance",,20610,CPT,Facility,Both,,,,225,191.25,64.485,225,First Health Group Corporation,First Health Network,218.25,97,,percent of total billed charges,,
"Arthrocentesis, Aspiration And/Or Injection, Major Joint Or Bursa W/O Us Guidance",,20610,CPT,Facility,Both,,,,225,191.25,64.485,225,"Health Partners, Inc.",Commercial,212.85,94.6,,percent of total billed charges,,
"Arthrocentesis, Aspiration And/Or Injection, Major Joint Or Bursa W/O Us Guidance",,20610,CPT,Facility,Outpatient,,,,225,191.25,64.485,225,"Health Partners, Inc.",Medicare Advantage,110.25,49,,percent of total billed charges,,
"Arthrocentesis, Aspiration And/Or Injection, Major Joint Or Bursa W/O Us Guidance",,20610,CPT,Facility,Inpatient,,,,225,191.25,64.485,225,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Arthrocentesis, Aspiration And/Or Injection, Major Joint Or Bursa W/O Us Guidance",,20610,CPT,Facility,Both,,,,225,191.25,64.485,225,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),135,60,,percent of total billed charges,,
"Arthrocentesis, Aspiration And/Or Injection, Major Joint Or Bursa W/O Us Guidance",,20610,CPT,Facility,Both,,,,225,191.25,64.485,225,"Health Partners, Inc.",State of Minnesota Advantage Program,183.375,81.5,,percent of total billed charges,,
"Arthrocentesis, Aspiration And/Or Injection, Major Joint Or Bursa W/O Us Guidance",,20610,CPT,Facility,Both,,,,225,191.25,64.485,225,"Health Partners, Inc.",State Public Programs,112.5,50,,percent of total billed charges,,
"Arthrocentesis, Aspiration And/Or Injection, Major Joint Or Bursa W/O Us Guidance",,20610,CPT,Facility,Both,,,,225,191.25,64.485,225,Humana Insurance Company,Commercial PPO,213.75,95,,percent of total billed charges,,
"Arthrocentesis, Aspiration And/Or Injection, Major Joint Or Bursa W/O Us Guidance",,20610,CPT,Facility,Outpatient,,,,225,191.25,64.485,225,Humana Insurance Company,Medicare PPO,110.25,49,,percent of total billed charges,,
"Arthrocentesis, Aspiration And/Or Injection, Major Joint Or Bursa W/O Us Guidance",,20610,CPT,Facility,Inpatient,,,,225,191.25,64.485,225,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Arthrocentesis, Aspiration And/Or Injection, Major Joint Or Bursa W/O Us Guidance",,20610,CPT,Facility,Both,,,,225,191.25,64.485,225,Medica,Individual & Family,222.975,99.1,,percent of total billed charges,,
"Arthrocentesis, Aspiration And/Or Injection, Major Joint Or Bursa W/O Us Guidance",,20610,CPT,Facility,Outpatient,,,,225,191.25,64.485,225,Medica,Medica Advantage Solution,112.05,49.8,,percent of total billed charges,,
"Arthrocentesis, Aspiration And/Or Injection, Major Joint Or Bursa W/O Us Guidance",,20610,CPT,Facility,Inpatient,,,,225,191.25,64.485,225,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Arthrocentesis, Aspiration And/Or Injection, Major Joint Or Bursa W/O Us Guidance",,20610,CPT,Facility,Outpatient,,,,225,191.25,64.485,225,Medica,Medical Assistance,100.35,44.6,,percent of total billed charges,,
"Arthrocentesis, Aspiration And/Or Injection, Major Joint Or Bursa W/O Us Guidance",,20610,CPT,Facility,Inpatient,,,,225,191.25,64.485,225,Medica,Medical Assistance,,,,,Included in per diem rate,
"Arthrocentesis, Aspiration And/Or Injection, Major Joint Or Bursa W/O Us Guidance",,20610,CPT,Facility,Outpatient,,,,225,191.25,64.485,225,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,112.05,49.8,,percent of total billed charges,,
"Arthrocentesis, Aspiration And/Or Injection, Major Joint Or Bursa W/O Us Guidance",,20610,CPT,Facility,Inpatient,,,,225,191.25,64.485,225,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Arthrocentesis, Aspiration And/Or Injection, Major Joint Or Bursa W/O Us Guidance",,20610,CPT,Facility,Both,,,,225,191.25,64.485,225,"Multiplan, Inc.","Multiplan, Inc.",211.5,94,,percent of total billed charges,,
"Arthrocentesis, Aspiration And/Or Injection, Major Joint Or Bursa W/O Us Guidance",,20610,CPT,Facility,Outpatient,,,,225,191.25,64.485,225,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,202.725,90.1,,percent of total billed charges,,
"Arthrocentesis, Aspiration And/Or Injection, Major Joint Or Bursa W/O Us Guidance",,20610,CPT,Facility,Inpatient,,,,225,191.25,64.485,225,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Arthrocentesis, Aspiration And/Or Injection, Major Joint Or Bursa W/O Us Guidance",,20610,CPT,Facility,Both,,,,225,191.25,64.485,225,"Preferred One Administrative Services, INC.",PPO,221.85,98.6,,percent of total billed charges,,
"Arthrocentesis, Aspiration And/Or Injection, Major Joint Or Bursa W/O Us Guidance",,20610,CPT,Facility,Outpatient,,,,225,191.25,64.485,225,PrimeWest Health,Minnesota Senior Health Options (MSHO),115.7625,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Arthrocentesis, Aspiration And/Or Injection, Major Joint Or Bursa W/O Us Guidance",,20610,CPT,Facility,Inpatient,,,,225,191.25,64.485,225,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Arthrocentesis, Aspiration And/Or Injection, Major Joint Or Bursa W/O Us Guidance",,20610,CPT,Facility,Outpatient,,,,225,191.25,64.485,225,PrimeWest Health,MinnesotaCare,115.56,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Arthrocentesis, Aspiration And/Or Injection, Major Joint Or Bursa W/O Us Guidance",,20610,CPT,Facility,Inpatient,,,,225,191.25,64.485,225,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Arthrocentesis, Aspiration And/Or Injection, Major Joint Or Bursa W/O Us Guidance",,20610,CPT,Facility,Both,,,,225,191.25,64.485,225,Sanford Health Plan,Sanford Health Plan,207,92,,percent of total billed charges,,
"Arthrocentesis, Aspiration And/Or Injection, Major Joint Or Bursa W/O Us Guidance",,20610,CPT,Facility,Outpatient,,,,225,191.25,64.485,225,"UCare Health, Inc.",Individual & Family Plan,126.7875,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Arthrocentesis, Aspiration And/Or Injection, Major Joint Or Bursa W/O Us Guidance",,20610,CPT,Facility,Inpatient,,,,225,191.25,64.485,225,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Arthrocentesis, Aspiration And/Or Injection, Major Joint Or Bursa W/O Us Guidance",,20610,CPT,Facility,Outpatient,,,,225,191.25,64.485,225,"UCare Health, Inc.",Medical Assistance,113.5575,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Arthrocentesis, Aspiration And/Or Injection, Major Joint Or Bursa W/O Us Guidance",,20610,CPT,Facility,Inpatient,,,,225,191.25,64.485,225,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Arthrocentesis, Aspiration And/Or Injection, Major Joint Or Bursa W/O Us Guidance",,20610,CPT,Facility,Outpatient,,,,225,191.25,64.485,225,"UCare Health, Inc.",Medicare Advantage,113.5575,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Arthrocentesis, Aspiration And/Or Injection, Major Joint Or Bursa W/O Us Guidance",,20610,CPT,Facility,Inpatient,,,,225,191.25,64.485,225,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Arthrocentesis, Aspiration And/Or Injection, Major Joint Or Bursa W/O Us Guidance",,20610,CPT,Facility,Outpatient,,,,225,191.25,64.485,225,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),113.5575,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Arthrocentesis, Aspiration And/Or Injection, Major Joint Or Bursa W/O Us Guidance",,20610,CPT,Facility,Inpatient,,,,225,191.25,64.485,225,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Arthrocentesis, Aspiration And/Or Injection, Major Joint Or Bursa W/O Us Guidance",,20610,CPT,Facility,Both,,,,225,191.25,64.485,225,UnitedHealthcare,Individual & Family,211.5,94,,percent of total billed charges,,
"Arthrocentesis, Aspiration And/Or Injection, Major Joint Or Bursa W/O Us Guidance",,20610,CPT,Facility,Outpatient,,,,225,191.25,64.485,225,UnitedHealthcare,Medicare Advantage,110.25,49,,percent of total billed charges,,
"Arthrocentesis, Aspiration And/Or Injection, Major Joint Or Bursa W/O Us Guidance",,20610,CPT,Facility,Inpatient,,,,225,191.25,64.485,225,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Arthrocentesis, Aspiration And/Or Injection, Major Joint Or Bursa W/O Us Guidance",,20610,CPT,Facility,Outpatient,,,,225,191.25,64.485,225,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,108,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Arthrocentesis, Aspiration And/Or Injection, Major Joint Or Bursa W/O Us Guidance",,20610,CPT,Facility,Inpatient,,,,225,191.25,64.485,225,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Arthrocentesis, Aspiration And/Or Injection, Major Joint Or Bursa; Wo Ultrasound Guidance (Pro Cah)",,20610,CPT,Professional,Both,,,,360,306,27.48,360,Aetna,Commercial,306,85,,percent of total billed charges,,
"Arthrocentesis, Aspiration And/Or Injection, Major Joint Or Bursa; Wo Ultrasound Guidance (Pro Cah)",,20610,CPT,Professional,Both,,,,360,306,27.48,360,Aetna,Medicare Advantage,44.01,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Arthrocentesis, Aspiration And/Or Injection, Major Joint Or Bursa; Wo Ultrasound Guidance (Pro Cah)",,20610,CPT,Professional,Both,,,,360,306,27.48,360,Aetna,PPO,334.8,93,,percent of total billed charges,,
"Arthrocentesis, Aspiration And/Or Injection, Major Joint Or Bursa; Wo Ultrasound Guidance (Pro Cah)",,20610,CPT,Professional,Both,,,,360,306,27.48,360,America's PPO,America's PPO,307.584,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Arthrocentesis, Aspiration And/Or Injection, Major Joint Or Bursa; Wo Ultrasound Guidance (Pro Cah)",,20610,CPT,Professional,Both,,,,360,306,27.48,360,BlueCross BlueShield Minnesota, Federal Employee Program,92.27,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Arthrocentesis, Aspiration And/Or Injection, Major Joint Or Bursa; Wo Ultrasound Guidance (Pro Cah)",,20610,CPT,Professional,Both,,,,360,306,27.48,360,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,93.74632,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Arthrocentesis, Aspiration And/Or Injection, Major Joint Or Bursa; Wo Ultrasound Guidance (Pro Cah)",,20610,CPT,Professional,Both,,,,360,306,27.48,360,BlueCross BlueShield Minnesota,High Value Network Plan,93.74632,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Arthrocentesis, Aspiration And/Or Injection, Major Joint Or Bursa; Wo Ultrasound Guidance (Pro Cah)",,20610,CPT,Professional,Both,,,,360,306,27.48,360,BlueCross BlueShield Minnesota,Medicare Advantage,49.381,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Arthrocentesis, Aspiration And/Or Injection, Major Joint Or Bursa; Wo Ultrasound Guidance (Pro Cah)",,20610,CPT,Professional,Both,,,,360,306,27.48,360,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,93.74632,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Arthrocentesis, Aspiration And/Or Injection, Major Joint Or Bursa; Wo Ultrasound Guidance (Pro Cah)",,20610,CPT,Professional,Both,,,,360,306,27.48,360,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,31.72968,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Arthrocentesis, Aspiration And/Or Injection, Major Joint Or Bursa; Wo Ultrasound Guidance (Pro Cah)",,20610,CPT,Professional,Both,,,,360,306,27.48,360,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),49.381,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Arthrocentesis, Aspiration And/Or Injection, Major Joint Or Bursa; Wo Ultrasound Guidance (Pro Cah)",,20610,CPT,Professional,Both,,,,360,306,27.48,360,CorVel,Worker's Compensation,84.4877694,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Arthrocentesis, Aspiration And/Or Injection, Major Joint Or Bursa; Wo Ultrasound Guidance (Pro Cah)",,20610,CPT,Professional,Both,,,,360,306,27.48,360,First Health Group Corporation,First Health Network,349.2,97,,percent of total billed charges,,
"Arthrocentesis, Aspiration And/Or Injection, Major Joint Or Bursa; Wo Ultrasound Guidance (Pro Cah)",,20610,CPT,Professional,Both,,,,360,306,27.48,360,"Health Partners, Inc.",Commercial,91.42,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Arthrocentesis, Aspiration And/Or Injection, Major Joint Or Bursa; Wo Ultrasound Guidance (Pro Cah)",,20610,CPT,Professional,Both,,,,360,306,27.48,360,"Health Partners, Inc.",Medicare Advantage,49.381,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Arthrocentesis, Aspiration And/Or Injection, Major Joint Or Bursa; Wo Ultrasound Guidance (Pro Cah)",,20610,CPT,Professional,Both,,,,360,306,27.48,360,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),43.04,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Arthrocentesis, Aspiration And/Or Injection, Major Joint Or Bursa; Wo Ultrasound Guidance (Pro Cah)",,20610,CPT,Professional,Both,,,,360,306,27.48,360,"Health Partners, Inc.",State of Minnesota Advantage Program,78.75833,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Arthrocentesis, Aspiration And/Or Injection, Major Joint Or Bursa; Wo Ultrasound Guidance (Pro Cah)",,20610,CPT,Professional,Both,,,,360,306,27.48,360,"Health Partners, Inc.",State Public Programs,27.48,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Arthrocentesis, Aspiration And/Or Injection, Major Joint Or Bursa; Wo Ultrasound Guidance (Pro Cah)",,20610,CPT,Professional,Both,,,,360,306,27.48,360,Humana Insurance Company,Commercial PPO,42.94,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Arthrocentesis, Aspiration And/Or Injection, Major Joint Or Bursa; Wo Ultrasound Guidance (Pro Cah)",,20610,CPT,Professional,Both,,,,360,306,27.48,360,Humana Insurance Company,Medicare PPO,360,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Arthrocentesis, Aspiration And/Or Injection, Major Joint Or Bursa; Wo Ultrasound Guidance (Pro Cah)",,20610,CPT,Professional,Both,,,,360,306,27.48,360,Medica,Individual & Family,305.28,84.8,,percent of total billed charges,,
"Arthrocentesis, Aspiration And/Or Injection, Major Joint Or Bursa; Wo Ultrasound Guidance (Pro Cah)",,20610,CPT,Professional,Both,,,,360,306,27.48,360,Medica,Medica Advantage Solution,179.28,49.8,,percent of total billed charges,,
"Arthrocentesis, Aspiration And/Or Injection, Major Joint Or Bursa; Wo Ultrasound Guidance (Pro Cah)",,20610,CPT,Professional,Both,,,,360,306,27.48,360,Medica,Medical Assistance,31.73,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Arthrocentesis, Aspiration And/Or Injection, Major Joint Or Bursa; Wo Ultrasound Guidance (Pro Cah)",,20610,CPT,Professional,Both,,,,360,306,27.48,360,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,42.94,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Arthrocentesis, Aspiration And/Or Injection, Major Joint Or Bursa; Wo Ultrasound Guidance (Pro Cah)",,20610,CPT,Professional,Both,,,,360,306,27.48,360,"Multiplan, Inc.","Multiplan, Inc.",338.4,94,,percent of total billed charges,,
"Arthrocentesis, Aspiration And/Or Injection, Major Joint Or Bursa; Wo Ultrasound Guidance (Pro Cah)",,20610,CPT,Professional,Both,,,,360,306,27.48,360,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,324.36,90.1,,percent of total billed charges,,
"Arthrocentesis, Aspiration And/Or Injection, Major Joint Or Bursa; Wo Ultrasound Guidance (Pro Cah)",,20610,CPT,Professional,Both,,,,360,306,27.48,360,"Preferred One Administrative Services, INC.",PPO,354.96,98.6,,percent of total billed charges,,
"Arthrocentesis, Aspiration And/Or Injection, Major Joint Or Bursa; Wo Ultrasound Guidance (Pro Cah)",,20610,CPT,Professional,Both,,,,360,306,27.48,360,PrimeWest Health,Minnesota Senior Health Options (MSHO),49.381,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Arthrocentesis, Aspiration And/Or Injection, Major Joint Or Bursa; Wo Ultrasound Guidance (Pro Cah)",,20610,CPT,Professional,Both,,,,360,306,27.48,360,PrimeWest Health,MinnesotaCare,33.9507576,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Arthrocentesis, Aspiration And/Or Injection, Major Joint Or Bursa; Wo Ultrasound Guidance (Pro Cah)",,20610,CPT,Professional,Both,,,,360,306,27.48,360,Sanford Health Plan,Sanford Health Plan,316.8,88,,percent of total billed charges,,
"Arthrocentesis, Aspiration And/Or Injection, Major Joint Or Bursa; Wo Ultrasound Guidance (Pro Cah)",,20610,CPT,Professional,Both,,,,360,306,27.48,360,"UCare Health, Inc.",Individual & Family Plan,69.803264,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Arthrocentesis, Aspiration And/Or Injection, Major Joint Or Bursa; Wo Ultrasound Guidance (Pro Cah)",,20610,CPT,Professional,Both,,,,360,306,27.48,360,"UCare Health, Inc.",Medical Assistance,34.902648,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Arthrocentesis, Aspiration And/Or Injection, Major Joint Or Bursa; Wo Ultrasound Guidance (Pro Cah)",,20610,CPT,Professional,Both,,,,360,306,27.48,360,"UCare Health, Inc.",Medicare Advantage,49.381,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Arthrocentesis, Aspiration And/Or Injection, Major Joint Or Bursa; Wo Ultrasound Guidance (Pro Cah)",,20610,CPT,Professional,Both,,,,360,306,27.48,360,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),39.5048,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Arthrocentesis, Aspiration And/Or Injection, Major Joint Or Bursa; Wo Ultrasound Guidance (Pro Cah)",,20610,CPT,Professional,Both,,,,360,306,27.48,360,UnitedHealthcare,Individual & Family,360,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Arthrocentesis, Aspiration And/Or Injection, Major Joint Or Bursa; Wo Ultrasound Guidance (Pro Cah)",,20610,CPT,Professional,Both,,,,360,306,27.48,360,UnitedHealthcare,Medicare Advantage,49.381,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Arthrocentesis, Aspiration And/Or Injection, Major Joint Or Bursa; Wo Ultrasound Guidance (Pro Cah)",,20610,CPT,Professional,Both,,,,360,306,27.48,360,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,31.72968,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Arthrocentesis, Aspiration And/Or Injection, Major Joint Or Bursa; W/Ultrasound Guidance (Pro Cah)",,20611,CPT,Professional,Both,,,,270,229.5,36.42,270,Aetna,Commercial,229.5,85,,percent of total billed charges,,
"Arthrocentesis, Aspiration And/Or Injection, Major Joint Or Bursa; W/Ultrasound Guidance (Pro Cah)",,20611,CPT,Professional,Both,,,,270,229.5,36.42,270,Aetna,Medicare Advantage,58.26,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Arthrocentesis, Aspiration And/Or Injection, Major Joint Or Bursa; W/Ultrasound Guidance (Pro Cah)",,20611,CPT,Professional,Both,,,,270,229.5,36.42,270,Aetna,PPO,251.1,93,,percent of total billed charges,,
"Arthrocentesis, Aspiration And/Or Injection, Major Joint Or Bursa; W/Ultrasound Guidance (Pro Cah)",,20611,CPT,Professional,Both,,,,270,229.5,36.42,270,America's PPO,America's PPO,230.688,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Arthrocentesis, Aspiration And/Or Injection, Major Joint Or Bursa; W/Ultrasound Guidance (Pro Cah)",,20611,CPT,Professional,Both,,,,270,229.5,36.42,270,BlueCross BlueShield Minnesota, Federal Employee Program,122.57,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Arthrocentesis, Aspiration And/Or Injection, Major Joint Or Bursa; W/Ultrasound Guidance (Pro Cah)",,20611,CPT,Professional,Both,,,,270,229.5,36.42,270,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,124.53112,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Arthrocentesis, Aspiration And/Or Injection, Major Joint Or Bursa; W/Ultrasound Guidance (Pro Cah)",,20611,CPT,Professional,Both,,,,270,229.5,36.42,270,BlueCross BlueShield Minnesota,High Value Network Plan,124.53112,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Arthrocentesis, Aspiration And/Or Injection, Major Joint Or Bursa; W/Ultrasound Guidance (Pro Cah)",,20611,CPT,Professional,Both,,,,270,229.5,36.42,270,BlueCross BlueShield Minnesota,Medicare Advantage,65.274,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Arthrocentesis, Aspiration And/Or Injection, Major Joint Or Bursa; W/Ultrasound Guidance (Pro Cah)",,20611,CPT,Professional,Both,,,,270,229.5,36.42,270,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,124.53112,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Arthrocentesis, Aspiration And/Or Injection, Major Joint Or Bursa; W/Ultrasound Guidance (Pro Cah)",,20611,CPT,Professional,Both,,,,270,229.5,36.42,270,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,42.05224,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Arthrocentesis, Aspiration And/Or Injection, Major Joint Or Bursa; W/Ultrasound Guidance (Pro Cah)",,20611,CPT,Professional,Both,,,,270,229.5,36.42,270,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),65.274,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Arthrocentesis, Aspiration And/Or Injection, Major Joint Or Bursa; W/Ultrasound Guidance (Pro Cah)",,20611,CPT,Professional,Both,,,,270,229.5,36.42,270,CorVel,Worker's Compensation,111.2281464,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Arthrocentesis, Aspiration And/Or Injection, Major Joint Or Bursa; W/Ultrasound Guidance (Pro Cah)",,20611,CPT,Professional,Both,,,,270,229.5,36.42,270,First Health Group Corporation,First Health Network,261.9,97,,percent of total billed charges,,
"Arthrocentesis, Aspiration And/Or Injection, Major Joint Or Bursa; W/Ultrasound Guidance (Pro Cah)",,20611,CPT,Professional,Both,,,,270,229.5,36.42,270,"Health Partners, Inc.",Commercial,120.44,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Arthrocentesis, Aspiration And/Or Injection, Major Joint Or Bursa; W/Ultrasound Guidance (Pro Cah)",,20611,CPT,Professional,Both,,,,270,229.5,36.42,270,"Health Partners, Inc.",Medicare Advantage,65.274,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Arthrocentesis, Aspiration And/Or Injection, Major Joint Or Bursa; W/Ultrasound Guidance (Pro Cah)",,20611,CPT,Professional,Both,,,,270,229.5,36.42,270,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),56.93,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Arthrocentesis, Aspiration And/Or Injection, Major Joint Or Bursa; W/Ultrasound Guidance (Pro Cah)",,20611,CPT,Professional,Both,,,,270,229.5,36.42,270,"Health Partners, Inc.",State of Minnesota Advantage Program,103.75906,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Arthrocentesis, Aspiration And/Or Injection, Major Joint Or Bursa; W/Ultrasound Guidance (Pro Cah)",,20611,CPT,Professional,Both,,,,270,229.5,36.42,270,"Health Partners, Inc.",State Public Programs,36.42,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Arthrocentesis, Aspiration And/Or Injection, Major Joint Or Bursa; W/Ultrasound Guidance (Pro Cah)",,20611,CPT,Professional,Both,,,,270,229.5,36.42,270,Humana Insurance Company,Commercial PPO,56.76,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Arthrocentesis, Aspiration And/Or Injection, Major Joint Or Bursa; W/Ultrasound Guidance (Pro Cah)",,20611,CPT,Professional,Both,,,,270,229.5,36.42,270,Humana Insurance Company,Medicare PPO,270,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Arthrocentesis, Aspiration And/Or Injection, Major Joint Or Bursa; W/Ultrasound Guidance (Pro Cah)",,20611,CPT,Professional,Both,,,,270,229.5,36.42,270,Medica,Individual & Family,228.96,84.8,,percent of total billed charges,,
"Arthrocentesis, Aspiration And/Or Injection, Major Joint Or Bursa; W/Ultrasound Guidance (Pro Cah)",,20611,CPT,Professional,Both,,,,270,229.5,36.42,270,Medica,Medica Advantage Solution,134.46,49.8,,percent of total billed charges,,
"Arthrocentesis, Aspiration And/Or Injection, Major Joint Or Bursa; W/Ultrasound Guidance (Pro Cah)",,20611,CPT,Professional,Both,,,,270,229.5,36.42,270,Medica,Medical Assistance,42.05,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Arthrocentesis, Aspiration And/Or Injection, Major Joint Or Bursa; W/Ultrasound Guidance (Pro Cah)",,20611,CPT,Professional,Both,,,,270,229.5,36.42,270,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,56.76,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Arthrocentesis, Aspiration And/Or Injection, Major Joint Or Bursa; W/Ultrasound Guidance (Pro Cah)",,20611,CPT,Professional,Both,,,,270,229.5,36.42,270,"Multiplan, Inc.","Multiplan, Inc.",253.8,94,,percent of total billed charges,,
"Arthrocentesis, Aspiration And/Or Injection, Major Joint Or Bursa; W/Ultrasound Guidance (Pro Cah)",,20611,CPT,Professional,Both,,,,270,229.5,36.42,270,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,243.27,90.1,,percent of total billed charges,,
"Arthrocentesis, Aspiration And/Or Injection, Major Joint Or Bursa; W/Ultrasound Guidance (Pro Cah)",,20611,CPT,Professional,Both,,,,270,229.5,36.42,270,"Preferred One Administrative Services, INC.",PPO,266.22,98.6,,percent of total billed charges,,
"Arthrocentesis, Aspiration And/Or Injection, Major Joint Or Bursa; W/Ultrasound Guidance (Pro Cah)",,20611,CPT,Professional,Both,,,,270,229.5,36.42,270,PrimeWest Health,Minnesota Senior Health Options (MSHO),65.274,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Arthrocentesis, Aspiration And/Or Injection, Major Joint Or Bursa; W/Ultrasound Guidance (Pro Cah)",,20611,CPT,Professional,Both,,,,270,229.5,36.42,270,PrimeWest Health,MinnesotaCare,44.9958968,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Arthrocentesis, Aspiration And/Or Injection, Major Joint Or Bursa; W/Ultrasound Guidance (Pro Cah)",,20611,CPT,Professional,Both,,,,270,229.5,36.42,270,Sanford Health Plan,Sanford Health Plan,237.6,88,,percent of total billed charges,,
"Arthrocentesis, Aspiration And/Or Injection, Major Joint Or Bursa; W/Ultrasound Guidance (Pro Cah)",,20611,CPT,Professional,Both,,,,270,229.5,36.42,270,"UCare Health, Inc.",Individual & Family Plan,92.269056,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Arthrocentesis, Aspiration And/Or Injection, Major Joint Or Bursa; W/Ultrasound Guidance (Pro Cah)",,20611,CPT,Professional,Both,,,,270,229.5,36.42,270,"UCare Health, Inc.",Medical Assistance,46.257464,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Arthrocentesis, Aspiration And/Or Injection, Major Joint Or Bursa; W/Ultrasound Guidance (Pro Cah)",,20611,CPT,Professional,Both,,,,270,229.5,36.42,270,"UCare Health, Inc.",Medicare Advantage,65.274,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Arthrocentesis, Aspiration And/Or Injection, Major Joint Or Bursa; W/Ultrasound Guidance (Pro Cah)",,20611,CPT,Professional,Both,,,,270,229.5,36.42,270,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),52.2192,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Arthrocentesis, Aspiration And/Or Injection, Major Joint Or Bursa; W/Ultrasound Guidance (Pro Cah)",,20611,CPT,Professional,Both,,,,270,229.5,36.42,270,UnitedHealthcare,Individual & Family,270,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Arthrocentesis, Aspiration And/Or Injection, Major Joint Or Bursa; W/Ultrasound Guidance (Pro Cah)",,20611,CPT,Professional,Both,,,,270,229.5,36.42,270,UnitedHealthcare,Medicare Advantage,65.274,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Arthrocentesis, Aspiration And/Or Injection, Major Joint Or Bursa; W/Ultrasound Guidance (Pro Cah)",,20611,CPT,Professional,Both,,,,270,229.5,36.42,270,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,42.05224,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Us Inj Asp Large Joint Incl Us Guidance,,20611,CPT,Facility,Both,,,,786,668.1,225.2676,786,Aetna,Commercial,723.12,92,,percent of total billed charges,,
Us Inj Asp Large Joint Incl Us Guidance,,20611,CPT,Facility,Outpatient,,,,786,668.1,225.2676,786,Aetna,Medicare Advantage,385.14,49,,percent of total billed charges,,
Us Inj Asp Large Joint Incl Us Guidance,,20611,CPT,Facility,Inpatient,,,,786,668.1,225.2676,786,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Us Inj Asp Large Joint Incl Us Guidance,,20611,CPT,Facility,Both,,,,786,668.1,225.2676,786,Aetna,PPO,730.98,93,,percent of total billed charges,,
Us Inj Asp Large Joint Incl Us Guidance,,20611,CPT,Facility,Both,,,,786,668.1,225.2676,786,America's PPO,America's PPO,754.7958,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Us Inj Asp Large Joint Incl Us Guidance,,20611,CPT,Facility,Both,,,,786,668.1,225.2676,786,BlueCross BlueShield Minnesota, Federal Employee Program,773.424,98.4,,percent of total billed charges,,
Us Inj Asp Large Joint Incl Us Guidance,,20611,CPT,Facility,Both,,,,786,668.1,225.2676,786,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,786,100,,percent of total billed charges,,
Us Inj Asp Large Joint Incl Us Guidance,,20611,CPT,Facility,Both,,,,786,668.1,225.2676,786,BlueCross BlueShield Minnesota,High Value Network Plan,707.4,90,,percent of total billed charges,,
Us Inj Asp Large Joint Incl Us Guidance,,20611,CPT,Facility,Outpatient,,,,786,668.1,225.2676,786,BlueCross BlueShield Minnesota,Medicare Advantage,385.14,49,,percent of total billed charges,,
Us Inj Asp Large Joint Incl Us Guidance,,20611,CPT,Facility,Inpatient,,,,786,668.1,225.2676,786,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Us Inj Asp Large Joint Incl Us Guidance,,20611,CPT,Facility,Both,,,,786,668.1,225.2676,786,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,696.1602,88.57,,percent of total billed charges,,
Us Inj Asp Large Joint Incl Us Guidance,,20611,CPT,Facility,Both,,,,786,668.1,225.2676,786,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,225.2676,28.66,,percent of total billed charges,,
Us Inj Asp Large Joint Incl Us Guidance,,20611,CPT,Facility,Outpatient,,,,786,668.1,225.2676,786,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),385.14,49,,percent of total billed charges,,
Us Inj Asp Large Joint Incl Us Guidance,,20611,CPT,Facility,Inpatient,,,,786,668.1,225.2676,786,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Us Inj Asp Large Joint Incl Us Guidance,,20611,CPT,Facility,Both,,,,786,668.1,225.2676,786,CorVel,Worker's Compensation,786,100,,percent of total billed charges,,
Us Inj Asp Large Joint Incl Us Guidance,,20611,CPT,Facility,Both,,,,786,668.1,225.2676,786,First Health Group Corporation,First Health Network,762.42,97,,percent of total billed charges,,
Us Inj Asp Large Joint Incl Us Guidance,,20611,CPT,Facility,Both,,,,786,668.1,225.2676,786,"Health Partners, Inc.",Commercial,743.556,94.6,,percent of total billed charges,,
Us Inj Asp Large Joint Incl Us Guidance,,20611,CPT,Facility,Outpatient,,,,786,668.1,225.2676,786,"Health Partners, Inc.",Medicare Advantage,385.14,49,,percent of total billed charges,,
Us Inj Asp Large Joint Incl Us Guidance,,20611,CPT,Facility,Inpatient,,,,786,668.1,225.2676,786,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Us Inj Asp Large Joint Incl Us Guidance,,20611,CPT,Facility,Both,,,,786,668.1,225.2676,786,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),471.6,60,,percent of total billed charges,,
Us Inj Asp Large Joint Incl Us Guidance,,20611,CPT,Facility,Both,,,,786,668.1,225.2676,786,"Health Partners, Inc.",State of Minnesota Advantage Program,640.59,81.5,,percent of total billed charges,,
Us Inj Asp Large Joint Incl Us Guidance,,20611,CPT,Facility,Both,,,,786,668.1,225.2676,786,"Health Partners, Inc.",State Public Programs,393,50,,percent of total billed charges,,
Us Inj Asp Large Joint Incl Us Guidance,,20611,CPT,Facility,Both,,,,786,668.1,225.2676,786,Humana Insurance Company,Commercial PPO,746.7,95,,percent of total billed charges,,
Us Inj Asp Large Joint Incl Us Guidance,,20611,CPT,Facility,Outpatient,,,,786,668.1,225.2676,786,Humana Insurance Company,Medicare PPO,385.14,49,,percent of total billed charges,,
Us Inj Asp Large Joint Incl Us Guidance,,20611,CPT,Facility,Inpatient,,,,786,668.1,225.2676,786,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Us Inj Asp Large Joint Incl Us Guidance,,20611,CPT,Facility,Both,,,,786,668.1,225.2676,786,Medica,Individual & Family,778.926,99.1,,percent of total billed charges,,
Us Inj Asp Large Joint Incl Us Guidance,,20611,CPT,Facility,Outpatient,,,,786,668.1,225.2676,786,Medica,Medica Advantage Solution,391.428,49.8,,percent of total billed charges,,
Us Inj Asp Large Joint Incl Us Guidance,,20611,CPT,Facility,Inpatient,,,,786,668.1,225.2676,786,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Us Inj Asp Large Joint Incl Us Guidance,,20611,CPT,Facility,Outpatient,,,,786,668.1,225.2676,786,Medica,Medical Assistance,299,,,Other,Grouper,All inclusive per visit
Us Inj Asp Large Joint Incl Us Guidance,,20611,CPT,Facility,Inpatient,,,,786,668.1,225.2676,786,Medica,Medical Assistance,,,,,Included in per diem rate,
Us Inj Asp Large Joint Incl Us Guidance,,20611,CPT,Facility,Outpatient,,,,786,668.1,225.2676,786,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,391.428,49.8,,percent of total billed charges,,
Us Inj Asp Large Joint Incl Us Guidance,,20611,CPT,Facility,Inpatient,,,,786,668.1,225.2676,786,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Us Inj Asp Large Joint Incl Us Guidance,,20611,CPT,Facility,Both,,,,786,668.1,225.2676,786,"Multiplan, Inc.","Multiplan, Inc.",738.84,94,,percent of total billed charges,,
Us Inj Asp Large Joint Incl Us Guidance,,20611,CPT,Facility,Outpatient,,,,786,668.1,225.2676,786,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,708.186,90.1,,percent of total billed charges,,
Us Inj Asp Large Joint Incl Us Guidance,,20611,CPT,Facility,Inpatient,,,,786,668.1,225.2676,786,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Us Inj Asp Large Joint Incl Us Guidance,,20611,CPT,Facility,Both,,,,786,668.1,225.2676,786,"Preferred One Administrative Services, INC.",PPO,774.996,98.6,,percent of total billed charges,,
Us Inj Asp Large Joint Incl Us Guidance,,20611,CPT,Facility,Outpatient,,,,786,668.1,225.2676,786,PrimeWest Health,Minnesota Senior Health Options (MSHO),404.397,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Us Inj Asp Large Joint Incl Us Guidance,,20611,CPT,Facility,Inpatient,,,,786,668.1,225.2676,786,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Us Inj Asp Large Joint Incl Us Guidance,,20611,CPT,Facility,Outpatient,,,,786,668.1,225.2676,786,PrimeWest Health,MinnesotaCare,403.6896,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Us Inj Asp Large Joint Incl Us Guidance,,20611,CPT,Facility,Inpatient,,,,786,668.1,225.2676,786,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Us Inj Asp Large Joint Incl Us Guidance,,20611,CPT,Facility,Both,,,,786,668.1,225.2676,786,Sanford Health Plan,Sanford Health Plan,723.12,92,,percent of total billed charges,,
Us Inj Asp Large Joint Incl Us Guidance,,20611,CPT,Facility,Outpatient,,,,786,668.1,225.2676,786,"UCare Health, Inc.",Individual & Family Plan,442.911,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Us Inj Asp Large Joint Incl Us Guidance,,20611,CPT,Facility,Inpatient,,,,786,668.1,225.2676,786,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Us Inj Asp Large Joint Incl Us Guidance,,20611,CPT,Facility,Outpatient,,,,786,668.1,225.2676,786,"UCare Health, Inc.",Medical Assistance,396.6942,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Inj Asp Large Joint Incl Us Guidance,,20611,CPT,Facility,Inpatient,,,,786,668.1,225.2676,786,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Us Inj Asp Large Joint Incl Us Guidance,,20611,CPT,Facility,Outpatient,,,,786,668.1,225.2676,786,"UCare Health, Inc.",Medicare Advantage,396.6942,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Inj Asp Large Joint Incl Us Guidance,,20611,CPT,Facility,Inpatient,,,,786,668.1,225.2676,786,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Us Inj Asp Large Joint Incl Us Guidance,,20611,CPT,Facility,Outpatient,,,,786,668.1,225.2676,786,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),396.6942,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Inj Asp Large Joint Incl Us Guidance,,20611,CPT,Facility,Inpatient,,,,786,668.1,225.2676,786,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Us Inj Asp Large Joint Incl Us Guidance,,20611,CPT,Facility,Both,,,,786,668.1,225.2676,786,UnitedHealthcare,Individual & Family,738.84,94,,percent of total billed charges,,
Us Inj Asp Large Joint Incl Us Guidance,,20611,CPT,Facility,Outpatient,,,,786,668.1,225.2676,786,UnitedHealthcare,Medicare Advantage,385.14,49,,percent of total billed charges,,
Us Inj Asp Large Joint Incl Us Guidance,,20611,CPT,Facility,Inpatient,,,,786,668.1,225.2676,786,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Us Inj Asp Large Joint Incl Us Guidance,,20611,CPT,Facility,Outpatient,,,,786,668.1,225.2676,786,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,377.28,48,,percent of total billed charges,,100% of DHS outpatient percentage
Us Inj Asp Large Joint Incl Us Guidance,,20611,CPT,Facility,Inpatient,,,,786,668.1,225.2676,786,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Removal Of Implant; Deep (Eg, Buried Wire, Pin, Screw, Metal Band, Nail, Rod Or Plate) (Pro Cah)",,20680,CPT,Professional,Both,,,,1734,1473.9,261.12,1734,Aetna,Commercial,1473.9,85,,percent of total billed charges,,
"Removal Of Implant; Deep (Eg, Buried Wire, Pin, Screw, Metal Band, Nail, Rod Or Plate) (Pro Cah)",,20680,CPT,Professional,Both,,,,1734,1473.9,261.12,1734,Aetna,Medicare Advantage,409.98,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Removal Of Implant; Deep (Eg, Buried Wire, Pin, Screw, Metal Band, Nail, Rod Or Plate) (Pro Cah)",,20680,CPT,Professional,Both,,,,1734,1473.9,261.12,1734,Aetna,PPO,1612.62,93,,percent of total billed charges,,
"Removal Of Implant; Deep (Eg, Buried Wire, Pin, Screw, Metal Band, Nail, Rod Or Plate) (Pro Cah)",,20680,CPT,Professional,Both,,,,1734,1473.9,261.12,1734,America's PPO,America's PPO,1481.5296,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Removal Of Implant; Deep (Eg, Buried Wire, Pin, Screw, Metal Band, Nail, Rod Or Plate) (Pro Cah)",,20680,CPT,Professional,Both,,,,1734,1473.9,261.12,1734,BlueCross BlueShield Minnesota, Federal Employee Program,864.88,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Removal Of Implant; Deep (Eg, Buried Wire, Pin, Screw, Metal Band, Nail, Rod Or Plate) (Pro Cah)",,20680,CPT,Professional,Both,,,,1734,1473.9,261.12,1734,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,878.71808,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Removal Of Implant; Deep (Eg, Buried Wire, Pin, Screw, Metal Band, Nail, Rod Or Plate) (Pro Cah)",,20680,CPT,Professional,Both,,,,1734,1473.9,261.12,1734,BlueCross BlueShield Minnesota,High Value Network Plan,878.71808,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Removal Of Implant; Deep (Eg, Buried Wire, Pin, Screw, Metal Band, Nail, Rod Or Plate) (Pro Cah)",,20680,CPT,Professional,Both,,,,1734,1473.9,261.12,1734,BlueCross BlueShield Minnesota,Medicare Advantage,466.808,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Removal Of Implant; Deep (Eg, Buried Wire, Pin, Screw, Metal Band, Nail, Rod Or Plate) (Pro Cah)",,20680,CPT,Professional,Both,,,,1734,1473.9,261.12,1734,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,878.71808,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Removal Of Implant; Deep (Eg, Buried Wire, Pin, Screw, Metal Band, Nail, Rod Or Plate) (Pro Cah)",,20680,CPT,Professional,Both,,,,1734,1473.9,261.12,1734,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,301.47768,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Removal Of Implant; Deep (Eg, Buried Wire, Pin, Screw, Metal Band, Nail, Rod Or Plate) (Pro Cah)",,20680,CPT,Professional,Both,,,,1734,1473.9,261.12,1734,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),466.808,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Removal Of Implant; Deep (Eg, Buried Wire, Pin, Screw, Metal Band, Nail, Rod Or Plate) (Pro Cah)",,20680,CPT,Professional,Both,,,,1734,1473.9,261.12,1734,CorVel,Worker's Compensation,791.7455523,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Removal Of Implant; Deep (Eg, Buried Wire, Pin, Screw, Metal Band, Nail, Rod Or Plate) (Pro Cah)",,20680,CPT,Professional,Both,,,,1734,1473.9,261.12,1734,First Health Group Corporation,First Health Network,1681.98,97,,percent of total billed charges,,
"Removal Of Implant; Deep (Eg, Buried Wire, Pin, Screw, Metal Band, Nail, Rod Or Plate) (Pro Cah)",,20680,CPT,Professional,Both,,,,1734,1473.9,261.12,1734,"Health Partners, Inc.",Commercial,855.39,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Removal Of Implant; Deep (Eg, Buried Wire, Pin, Screw, Metal Band, Nail, Rod Or Plate) (Pro Cah)",,20680,CPT,Professional,Both,,,,1734,1473.9,261.12,1734,"Health Partners, Inc.",Medicare Advantage,466.808,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Removal Of Implant; Deep (Eg, Buried Wire, Pin, Screw, Metal Band, Nail, Rod Or Plate) (Pro Cah)",,20680,CPT,Professional,Both,,,,1734,1473.9,261.12,1734,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),405.97,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Removal Of Implant; Deep (Eg, Buried Wire, Pin, Screw, Metal Band, Nail, Rod Or Plate) (Pro Cah)",,20680,CPT,Professional,Both,,,,1734,1473.9,261.12,1734,"Health Partners, Inc.",State of Minnesota Advantage Program,736.918485,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Removal Of Implant; Deep (Eg, Buried Wire, Pin, Screw, Metal Band, Nail, Rod Or Plate) (Pro Cah)",,20680,CPT,Professional,Both,,,,1734,1473.9,261.12,1734,"Health Partners, Inc.",State Public Programs,261.12,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Removal Of Implant; Deep (Eg, Buried Wire, Pin, Screw, Metal Band, Nail, Rod Or Plate) (Pro Cah)",,20680,CPT,Professional,Both,,,,1734,1473.9,261.12,1734,Humana Insurance Company,Commercial PPO,405.92,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Removal Of Implant; Deep (Eg, Buried Wire, Pin, Screw, Metal Band, Nail, Rod Or Plate) (Pro Cah)",,20680,CPT,Professional,Both,,,,1734,1473.9,261.12,1734,Humana Insurance Company,Medicare PPO,1734,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Removal Of Implant; Deep (Eg, Buried Wire, Pin, Screw, Metal Band, Nail, Rod Or Plate) (Pro Cah)",,20680,CPT,Professional,Both,,,,1734,1473.9,261.12,1734,Medica,Individual & Family,1470.432,84.8,,percent of total billed charges,,
"Removal Of Implant; Deep (Eg, Buried Wire, Pin, Screw, Metal Band, Nail, Rod Or Plate) (Pro Cah)",,20680,CPT,Professional,Both,,,,1734,1473.9,261.12,1734,Medica,Medica Advantage Solution,863.532,49.8,,percent of total billed charges,,
"Removal Of Implant; Deep (Eg, Buried Wire, Pin, Screw, Metal Band, Nail, Rod Or Plate) (Pro Cah)",,20680,CPT,Professional,Both,,,,1734,1473.9,261.12,1734,Medica,Medical Assistance,301.48,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Removal Of Implant; Deep (Eg, Buried Wire, Pin, Screw, Metal Band, Nail, Rod Or Plate) (Pro Cah)",,20680,CPT,Professional,Both,,,,1734,1473.9,261.12,1734,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,405.92,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Removal Of Implant; Deep (Eg, Buried Wire, Pin, Screw, Metal Band, Nail, Rod Or Plate) (Pro Cah)",,20680,CPT,Professional,Both,,,,1734,1473.9,261.12,1734,"Multiplan, Inc.","Multiplan, Inc.",1629.96,94,,percent of total billed charges,,
"Removal Of Implant; Deep (Eg, Buried Wire, Pin, Screw, Metal Band, Nail, Rod Or Plate) (Pro Cah)",,20680,CPT,Professional,Both,,,,1734,1473.9,261.12,1734,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1562.334,90.1,,percent of total billed charges,,
"Removal Of Implant; Deep (Eg, Buried Wire, Pin, Screw, Metal Band, Nail, Rod Or Plate) (Pro Cah)",,20680,CPT,Professional,Both,,,,1734,1473.9,261.12,1734,"Preferred One Administrative Services, INC.",PPO,1709.724,98.6,,percent of total billed charges,,
"Removal Of Implant; Deep (Eg, Buried Wire, Pin, Screw, Metal Band, Nail, Rod Or Plate) (Pro Cah)",,20680,CPT,Professional,Both,,,,1734,1473.9,261.12,1734,PrimeWest Health,Minnesota Senior Health Options (MSHO),466.808,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Removal Of Implant; Deep (Eg, Buried Wire, Pin, Screw, Metal Band, Nail, Rod Or Plate) (Pro Cah)",,20680,CPT,Professional,Both,,,,1734,1473.9,261.12,1734,PrimeWest Health,MinnesotaCare,322.5811176,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Removal Of Implant; Deep (Eg, Buried Wire, Pin, Screw, Metal Band, Nail, Rod Or Plate) (Pro Cah)",,20680,CPT,Professional,Both,,,,1734,1473.9,261.12,1734,Sanford Health Plan,Sanford Health Plan,1525.92,88,,percent of total billed charges,,
"Removal Of Implant; Deep (Eg, Buried Wire, Pin, Screw, Metal Band, Nail, Rod Or Plate) (Pro Cah)",,20680,CPT,Professional,Both,,,,1734,1473.9,261.12,1734,"UCare Health, Inc.",Individual & Family Plan,659.863552,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Removal Of Implant; Deep (Eg, Buried Wire, Pin, Screw, Metal Band, Nail, Rod Or Plate) (Pro Cah)",,20680,CPT,Professional,Both,,,,1734,1473.9,261.12,1734,"UCare Health, Inc.",Medical Assistance,331.625448,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Removal Of Implant; Deep (Eg, Buried Wire, Pin, Screw, Metal Band, Nail, Rod Or Plate) (Pro Cah)",,20680,CPT,Professional,Both,,,,1734,1473.9,261.12,1734,"UCare Health, Inc.",Medicare Advantage,466.808,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Removal Of Implant; Deep (Eg, Buried Wire, Pin, Screw, Metal Band, Nail, Rod Or Plate) (Pro Cah)",,20680,CPT,Professional,Both,,,,1734,1473.9,261.12,1734,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),373.4464,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Removal Of Implant; Deep (Eg, Buried Wire, Pin, Screw, Metal Band, Nail, Rod Or Plate) (Pro Cah)",,20680,CPT,Professional,Both,,,,1734,1473.9,261.12,1734,UnitedHealthcare,Individual & Family,1734,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Removal Of Implant; Deep (Eg, Buried Wire, Pin, Screw, Metal Band, Nail, Rod Or Plate) (Pro Cah)",,20680,CPT,Professional,Both,,,,1734,1473.9,261.12,1734,UnitedHealthcare,Medicare Advantage,466.808,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Removal Of Implant; Deep (Eg, Buried Wire, Pin, Screw, Metal Band, Nail, Rod Or Plate) (Pro Cah)",,20680,CPT,Professional,Both,,,,1734,1473.9,261.12,1734,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,301.47768,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision, Tumor, Soft Tissue Of Face Or Scalp, Subfascial; Less Than 2 Cm (Pbb)",,21013,CPT,Facility,Outpatient,,,,1632,1387.2,467.7312,1632,Aetna,Commercial,1501.44,92,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Face Or Scalp, Subfascial; Less Than 2 Cm (Pbb)",,21013,CPT,Professional,Outpatient,,,,1632,1387.2,251.96,1632,Aetna,Commercial,1387.2,85,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Face Or Scalp, Subfascial; Less Than 2 Cm (Pbb)",,21013,CPT,Facility,Outpatient,,,,1632,1387.2,467.7312,1632,Aetna,Medicare Advantage,799.68,49,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Face Or Scalp, Subfascial; Less Than 2 Cm (Pbb)",,21013,CPT,Professional,Outpatient,,,,1632,1387.2,251.96,1632,Aetna,Medicare Advantage,391.92,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Tumor, Soft Tissue Of Face Or Scalp, Subfascial; Less Than 2 Cm (Pbb)",,21013,CPT,Facility,Outpatient,,,,1632,1387.2,467.7312,1632,Aetna,PPO,1517.76,93,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Face Or Scalp, Subfascial; Less Than 2 Cm (Pbb)",,21013,CPT,Professional,Outpatient,,,,1632,1387.2,251.96,1632,Aetna,PPO,1517.76,93,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Face Or Scalp, Subfascial; Less Than 2 Cm (Pbb)",,21013,CPT,Facility,Outpatient,,,,1632,1387.2,467.7312,1632,America's PPO,America's PPO,1567.2096,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Excision, Tumor, Soft Tissue Of Face Or Scalp, Subfascial; Less Than 2 Cm (Pbb)",,21013,CPT,Professional,Outpatient,,,,1632,1387.2,251.96,1632,America's PPO,America's PPO,1394.3808,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Excision, Tumor, Soft Tissue Of Face Or Scalp, Subfascial; Less Than 2 Cm (Pbb)",,21013,CPT,Facility,Outpatient,,,,1632,1387.2,467.7312,1632,BlueCross BlueShield Minnesota, Federal Employee Program,1605.888,98.4,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Face Or Scalp, Subfascial; Less Than 2 Cm (Pbb)",,21013,CPT,Professional,Outpatient,,,,1632,1387.2,251.96,1632,BlueCross BlueShield Minnesota, Federal Employee Program,832.52,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Excision, Tumor, Soft Tissue Of Face Or Scalp, Subfascial; Less Than 2 Cm (Pbb)",,21013,CPT,Facility,Outpatient,,,,1632,1387.2,467.7312,1632,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1632,100,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Face Or Scalp, Subfascial; Less Than 2 Cm (Pbb)",,21013,CPT,Professional,Outpatient,,,,1632,1387.2,251.96,1632,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,845.84032,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Tumor, Soft Tissue Of Face Or Scalp, Subfascial; Less Than 2 Cm (Pbb)",,21013,CPT,Facility,Outpatient,,,,1632,1387.2,467.7312,1632,BlueCross BlueShield Minnesota,High Value Network Plan,1468.8,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
"Excision, Tumor, Soft Tissue Of Face Or Scalp, Subfascial; Less Than 2 Cm (Pbb)",,21013,CPT,Professional,Outpatient,,,,1632,1387.2,251.96,1632,BlueCross BlueShield Minnesota,High Value Network Plan,845.84032,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Tumor, Soft Tissue Of Face Or Scalp, Subfascial; Less Than 2 Cm (Pbb)",,21013,CPT,Facility,Outpatient,,,,1632,1387.2,467.7312,1632,BlueCross BlueShield Minnesota,Medicare Advantage,799.68,49,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Face Or Scalp, Subfascial; Less Than 2 Cm (Pbb)",,21013,CPT,Professional,Outpatient,,,,1632,1387.2,251.96,1632,BlueCross BlueShield Minnesota,Medicare Advantage,450.1675,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Tumor, Soft Tissue Of Face Or Scalp, Subfascial; Less Than 2 Cm (Pbb)",,21013,CPT,Professional,Outpatient,,,,1632,1387.2,251.96,1632,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,845.84032,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Tumor, Soft Tissue Of Face Or Scalp, Subfascial; Less Than 2 Cm (Pbb)",,21013,CPT,Facility,Outpatient,,,,1632,1387.2,467.7312,1632,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,467.7312,28.66,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Face Or Scalp, Subfascial; Less Than 2 Cm (Pbb)",,21013,CPT,Professional,Outpatient,,,,1632,1387.2,251.96,1632,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,290.90112,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision, Tumor, Soft Tissue Of Face Or Scalp, Subfascial; Less Than 2 Cm (Pbb)",,21013,CPT,Facility,Outpatient,,,,1632,1387.2,467.7312,1632,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),799.68,49,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Face Or Scalp, Subfascial; Less Than 2 Cm (Pbb)",,21013,CPT,Professional,Outpatient,,,,1632,1387.2,251.96,1632,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),450.1675,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Tumor, Soft Tissue Of Face Or Scalp, Subfascial; Less Than 2 Cm (Pbb)",,21013,CPT,Facility,Outpatient,,,,1632,1387.2,467.7312,1632,CorVel,Worker's Compensation,1632,100,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Face Or Scalp, Subfascial; Less Than 2 Cm (Pbb)",,21013,CPT,Professional,Outpatient,,,,1632,1387.2,251.96,1632,CorVel,Worker's Compensation,761.7420567,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Excision, Tumor, Soft Tissue Of Face Or Scalp, Subfascial; Less Than 2 Cm (Pbb)",,21013,CPT,Facility,Outpatient,,,,1632,1387.2,467.7312,1632,First Health Group Corporation,First Health Network,1583.04,97,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Face Or Scalp, Subfascial; Less Than 2 Cm (Pbb)",,21013,CPT,Professional,Outpatient,,,,1632,1387.2,251.96,1632,First Health Group Corporation,First Health Network,1583.04,97,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Face Or Scalp, Subfascial; Less Than 2 Cm (Pbb)",,21013,CPT,Facility,Outpatient,,,,1632,1387.2,467.7312,1632,"Health Partners, Inc.",Commercial,1543.872,94.6,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Face Or Scalp, Subfascial; Less Than 2 Cm (Pbb)",,21013,CPT,Professional,Outpatient,,,,1632,1387.2,251.96,1632,"Health Partners, Inc.",Commercial,822.75,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision, Tumor, Soft Tissue Of Face Or Scalp, Subfascial; Less Than 2 Cm (Pbb)",,21013,CPT,Facility,Outpatient,,,,1632,1387.2,467.7312,1632,"Health Partners, Inc.",Medicare Advantage,799.68,49,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Face Or Scalp, Subfascial; Less Than 2 Cm (Pbb)",,21013,CPT,Professional,Outpatient,,,,1632,1387.2,251.96,1632,"Health Partners, Inc.",Medicare Advantage,450.1675,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Tumor, Soft Tissue Of Face Or Scalp, Subfascial; Less Than 2 Cm (Pbb)",,21013,CPT,Facility,Outpatient,,,,1632,1387.2,467.7312,1632,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),979.2,60,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Face Or Scalp, Subfascial; Less Than 2 Cm (Pbb)",,21013,CPT,Professional,Outpatient,,,,1632,1387.2,251.96,1632,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),391.4,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Excision, Tumor, Soft Tissue Of Face Or Scalp, Subfascial; Less Than 2 Cm (Pbb)",,21013,CPT,Facility,Outpatient,,,,1632,1387.2,467.7312,1632,"Health Partners, Inc.",State of Minnesota Advantage Program,1330.08,81.5,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Face Or Scalp, Subfascial; Less Than 2 Cm (Pbb)",,21013,CPT,Professional,Outpatient,,,,1632,1387.2,251.96,1632,"Health Partners, Inc.",State of Minnesota Advantage Program,708.799125,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision, Tumor, Soft Tissue Of Face Or Scalp, Subfascial; Less Than 2 Cm (Pbb)",,21013,CPT,Facility,Outpatient,,,,1632,1387.2,467.7312,1632,"Health Partners, Inc.",State Public Programs,816,50,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Face Or Scalp, Subfascial; Less Than 2 Cm (Pbb)",,21013,CPT,Professional,Outpatient,,,,1632,1387.2,251.96,1632,"Health Partners, Inc.",State Public Programs,251.96,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Excision, Tumor, Soft Tissue Of Face Or Scalp, Subfascial; Less Than 2 Cm (Pbb)",,21013,CPT,Facility,Outpatient,,,,1632,1387.2,467.7312,1632,Humana Insurance Company,Commercial PPO,1550.4,95,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Face Or Scalp, Subfascial; Less Than 2 Cm (Pbb)",,21013,CPT,Professional,Outpatient,,,,1632,1387.2,251.96,1632,Humana Insurance Company,Commercial PPO,391.45,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Excision, Tumor, Soft Tissue Of Face Or Scalp, Subfascial; Less Than 2 Cm (Pbb)",,21013,CPT,Facility,Outpatient,,,,1632,1387.2,467.7312,1632,Humana Insurance Company,Medicare PPO,799.68,49,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Face Or Scalp, Subfascial; Less Than 2 Cm (Pbb)",,21013,CPT,Professional,Outpatient,,,,1632,1387.2,251.96,1632,Humana Insurance Company,Medicare PPO,1632,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Excision, Tumor, Soft Tissue Of Face Or Scalp, Subfascial; Less Than 2 Cm (Pbb)",,21013,CPT,Facility,Outpatient,,,,1632,1387.2,467.7312,1632,Medica,Individual & Family,1617.312,99.1,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Face Or Scalp, Subfascial; Less Than 2 Cm (Pbb)",,21013,CPT,Professional,Outpatient,,,,1632,1387.2,251.96,1632,Medica,Individual & Family,1383.936,84.8,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Face Or Scalp, Subfascial; Less Than 2 Cm (Pbb)",,21013,CPT,Facility,Outpatient,,,,1632,1387.2,467.7312,1632,Medica,Medica Advantage Solution,812.736,49.8,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Face Or Scalp, Subfascial; Less Than 2 Cm (Pbb)",,21013,CPT,Professional,Outpatient,,,,1632,1387.2,251.96,1632,Medica,Medica Advantage Solution,812.736,49.8,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Face Or Scalp, Subfascial; Less Than 2 Cm (Pbb)",,21013,CPT,Facility,Outpatient,,,,1632,1387.2,467.7312,1632,Medica,Medical Assistance,727.872,44.6,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Face Or Scalp, Subfascial; Less Than 2 Cm (Pbb)",,21013,CPT,Professional,Outpatient,,,,1632,1387.2,251.96,1632,Medica,Medical Assistance,290.9,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Excision, Tumor, Soft Tissue Of Face Or Scalp, Subfascial; Less Than 2 Cm (Pbb)",,21013,CPT,Facility,Outpatient,,,,1632,1387.2,467.7312,1632,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,812.736,49.8,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Face Or Scalp, Subfascial; Less Than 2 Cm (Pbb)",,21013,CPT,Professional,Outpatient,,,,1632,1387.2,251.96,1632,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,391.45,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Excision, Tumor, Soft Tissue Of Face Or Scalp, Subfascial; Less Than 2 Cm (Pbb)",,21013,CPT,Facility,Outpatient,,,,1632,1387.2,467.7312,1632,"Multiplan, Inc.","Multiplan, Inc.",1534.08,94,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Face Or Scalp, Subfascial; Less Than 2 Cm (Pbb)",,21013,CPT,Professional,Outpatient,,,,1632,1387.2,251.96,1632,"Multiplan, Inc.","Multiplan, Inc.",1534.08,94,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Face Or Scalp, Subfascial; Less Than 2 Cm (Pbb)",,21013,CPT,Facility,Outpatient,,,,1632,1387.2,467.7312,1632,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1470.432,90.1,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Face Or Scalp, Subfascial; Less Than 2 Cm (Pbb)",,21013,CPT,Professional,Outpatient,,,,1632,1387.2,251.96,1632,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1470.432,90.1,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Face Or Scalp, Subfascial; Less Than 2 Cm (Pbb)",,21013,CPT,Facility,Outpatient,,,,1632,1387.2,467.7312,1632,"Preferred One Administrative Services, INC.",PPO,1609.152,98.6,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Face Or Scalp, Subfascial; Less Than 2 Cm (Pbb)",,21013,CPT,Professional,Outpatient,,,,1632,1387.2,251.96,1632,"Preferred One Administrative Services, INC.",PPO,1609.152,98.6,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Face Or Scalp, Subfascial; Less Than 2 Cm (Pbb)",,21013,CPT,Facility,Outpatient,,,,1632,1387.2,467.7312,1632,PrimeWest Health,Minnesota Senior Health Options (MSHO),839.664,51.45,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Face Or Scalp, Subfascial; Less Than 2 Cm (Pbb)",,21013,CPT,Professional,Outpatient,,,,1632,1387.2,251.96,1632,PrimeWest Health,Minnesota Senior Health Options (MSHO),450.1675,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Tumor, Soft Tissue Of Face Or Scalp, Subfascial; Less Than 2 Cm (Pbb)",,21013,CPT,Facility,Outpatient,,,,1632,1387.2,467.7312,1632,PrimeWest Health,MinnesotaCare,838.1952,51.36,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Face Or Scalp, Subfascial; Less Than 2 Cm (Pbb)",,21013,CPT,Professional,Outpatient,,,,1632,1387.2,251.96,1632,PrimeWest Health,MinnesotaCare,311.2641984,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision, Tumor, Soft Tissue Of Face Or Scalp, Subfascial; Less Than 2 Cm (Pbb)",,21013,CPT,Facility,Outpatient,,,,1632,1387.2,467.7312,1632,Sanford Health Plan,Sanford Health Plan,1501.44,92,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Face Or Scalp, Subfascial; Less Than 2 Cm (Pbb)",,21013,CPT,Professional,Outpatient,,,,1632,1387.2,251.96,1632,Sanford Health Plan,Sanford Health Plan,1436.16,88,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Face Or Scalp, Subfascial; Less Than 2 Cm (Pbb)",,21013,CPT,Facility,Outpatient,,,,1632,1387.2,467.7312,1632,"UCare Health, Inc.",Individual & Family Plan,919.632,56.35,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Face Or Scalp, Subfascial; Less Than 2 Cm (Pbb)",,21013,CPT,Professional,Outpatient,,,,1632,1387.2,251.96,1632,"UCare Health, Inc.",Individual & Family Plan,636.34112,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Excision, Tumor, Soft Tissue Of Face Or Scalp, Subfascial; Less Than 2 Cm (Pbb)",,21013,CPT,Facility,Outpatient,,,,1632,1387.2,467.7312,1632,"UCare Health, Inc.",Medical Assistance,823.6704,50.47,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Face Or Scalp, Subfascial; Less Than 2 Cm (Pbb)",,21013,CPT,Professional,Outpatient,,,,1632,1387.2,251.96,1632,"UCare Health, Inc.",Medical Assistance,319.991232,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Excision, Tumor, Soft Tissue Of Face Or Scalp, Subfascial; Less Than 2 Cm (Pbb)",,21013,CPT,Facility,Outpatient,,,,1632,1387.2,467.7312,1632,"UCare Health, Inc.",Medicare Advantage,823.6704,50.47,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Face Or Scalp, Subfascial; Less Than 2 Cm (Pbb)",,21013,CPT,Professional,Outpatient,,,,1632,1387.2,251.96,1632,"UCare Health, Inc.",Medicare Advantage,450.1675,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Excision, Tumor, Soft Tissue Of Face Or Scalp, Subfascial; Less Than 2 Cm (Pbb)",,21013,CPT,Facility,Outpatient,,,,1632,1387.2,467.7312,1632,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),823.6704,50.47,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Face Or Scalp, Subfascial; Less Than 2 Cm (Pbb)",,21013,CPT,Professional,Outpatient,,,,1632,1387.2,251.96,1632,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),360.134,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Excision, Tumor, Soft Tissue Of Face Or Scalp, Subfascial; Less Than 2 Cm (Pbb)",,21013,CPT,Facility,Outpatient,,,,1632,1387.2,467.7312,1632,UnitedHealthcare,Individual & Family,1534.08,94,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Face Or Scalp, Subfascial; Less Than 2 Cm (Pbb)",,21013,CPT,Professional,Outpatient,,,,1632,1387.2,251.96,1632,UnitedHealthcare,Individual & Family,1632,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Excision, Tumor, Soft Tissue Of Face Or Scalp, Subfascial; Less Than 2 Cm (Pbb)",,21013,CPT,Facility,Outpatient,,,,1632,1387.2,467.7312,1632,UnitedHealthcare,Medicare Advantage,799.68,49,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Face Or Scalp, Subfascial; Less Than 2 Cm (Pbb)",,21013,CPT,Professional,Outpatient,,,,1632,1387.2,251.96,1632,UnitedHealthcare,Medicare Advantage,450.1675,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Tumor, Soft Tissue Of Face Or Scalp, Subfascial; Less Than 2 Cm (Pbb)",,21013,CPT,Facility,Outpatient,,,,1632,1387.2,467.7312,1632,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,783.36,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Excision, Tumor, Soft Tissue Of Face Or Scalp, Subfascial; Less Than 2 Cm (Pbb)",,21013,CPT,Professional,Outpatient,,,,1632,1387.2,251.96,1632,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,290.90112,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision, Tumor, Soft Tissue Of Face Or Scalp, Subfascial; Less Than 2 Cm (Procah)",,21013,CPT,Professional,Both,,,,3264,2774.4,251.96,3264,Aetna,Commercial,2774.4,85,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Face Or Scalp, Subfascial; Less Than 2 Cm (Procah)",,21013,CPT,Professional,Both,,,,3264,2774.4,251.96,3264,Aetna,Medicare Advantage,391.92,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Tumor, Soft Tissue Of Face Or Scalp, Subfascial; Less Than 2 Cm (Procah)",,21013,CPT,Professional,Both,,,,3264,2774.4,251.96,3264,Aetna,PPO,3035.52,93,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Face Or Scalp, Subfascial; Less Than 2 Cm (Procah)",,21013,CPT,Professional,Both,,,,3264,2774.4,251.96,3264,America's PPO,America's PPO,2788.7616,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Excision, Tumor, Soft Tissue Of Face Or Scalp, Subfascial; Less Than 2 Cm (Procah)",,21013,CPT,Professional,Both,,,,3264,2774.4,251.96,3264,BlueCross BlueShield Minnesota, Federal Employee Program,832.52,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Excision, Tumor, Soft Tissue Of Face Or Scalp, Subfascial; Less Than 2 Cm (Procah)",,21013,CPT,Professional,Both,,,,3264,2774.4,251.96,3264,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,845.84032,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Tumor, Soft Tissue Of Face Or Scalp, Subfascial; Less Than 2 Cm (Procah)",,21013,CPT,Professional,Both,,,,3264,2774.4,251.96,3264,BlueCross BlueShield Minnesota,High Value Network Plan,845.84032,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Tumor, Soft Tissue Of Face Or Scalp, Subfascial; Less Than 2 Cm (Procah)",,21013,CPT,Professional,Both,,,,3264,2774.4,251.96,3264,BlueCross BlueShield Minnesota,Medicare Advantage,450.1675,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Tumor, Soft Tissue Of Face Or Scalp, Subfascial; Less Than 2 Cm (Procah)",,21013,CPT,Professional,Both,,,,3264,2774.4,251.96,3264,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,845.84032,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Tumor, Soft Tissue Of Face Or Scalp, Subfascial; Less Than 2 Cm (Procah)",,21013,CPT,Professional,Both,,,,3264,2774.4,251.96,3264,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,290.90112,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision, Tumor, Soft Tissue Of Face Or Scalp, Subfascial; Less Than 2 Cm (Procah)",,21013,CPT,Professional,Both,,,,3264,2774.4,251.96,3264,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),450.1675,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Tumor, Soft Tissue Of Face Or Scalp, Subfascial; Less Than 2 Cm (Procah)",,21013,CPT,Professional,Both,,,,3264,2774.4,251.96,3264,CorVel,Worker's Compensation,761.7420567,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Excision, Tumor, Soft Tissue Of Face Or Scalp, Subfascial; Less Than 2 Cm (Procah)",,21013,CPT,Professional,Both,,,,3264,2774.4,251.96,3264,First Health Group Corporation,First Health Network,3166.08,97,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Face Or Scalp, Subfascial; Less Than 2 Cm (Procah)",,21013,CPT,Professional,Both,,,,3264,2774.4,251.96,3264,"Health Partners, Inc.",Commercial,822.75,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision, Tumor, Soft Tissue Of Face Or Scalp, Subfascial; Less Than 2 Cm (Procah)",,21013,CPT,Professional,Both,,,,3264,2774.4,251.96,3264,"Health Partners, Inc.",Medicare Advantage,450.1675,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Tumor, Soft Tissue Of Face Or Scalp, Subfascial; Less Than 2 Cm (Procah)",,21013,CPT,Professional,Both,,,,3264,2774.4,251.96,3264,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),391.4,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Excision, Tumor, Soft Tissue Of Face Or Scalp, Subfascial; Less Than 2 Cm (Procah)",,21013,CPT,Professional,Both,,,,3264,2774.4,251.96,3264,"Health Partners, Inc.",State of Minnesota Advantage Program,708.799125,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision, Tumor, Soft Tissue Of Face Or Scalp, Subfascial; Less Than 2 Cm (Procah)",,21013,CPT,Professional,Both,,,,3264,2774.4,251.96,3264,"Health Partners, Inc.",State Public Programs,251.96,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Excision, Tumor, Soft Tissue Of Face Or Scalp, Subfascial; Less Than 2 Cm (Procah)",,21013,CPT,Professional,Both,,,,3264,2774.4,251.96,3264,Humana Insurance Company,Commercial PPO,391.45,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Excision, Tumor, Soft Tissue Of Face Or Scalp, Subfascial; Less Than 2 Cm (Procah)",,21013,CPT,Professional,Both,,,,3264,2774.4,251.96,3264,Humana Insurance Company,Medicare PPO,3264,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Excision, Tumor, Soft Tissue Of Face Or Scalp, Subfascial; Less Than 2 Cm (Procah)",,21013,CPT,Professional,Both,,,,3264,2774.4,251.96,3264,Medica,Individual & Family,2767.872,84.8,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Face Or Scalp, Subfascial; Less Than 2 Cm (Procah)",,21013,CPT,Professional,Both,,,,3264,2774.4,251.96,3264,Medica,Medica Advantage Solution,1625.472,49.8,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Face Or Scalp, Subfascial; Less Than 2 Cm (Procah)",,21013,CPT,Professional,Both,,,,3264,2774.4,251.96,3264,Medica,Medical Assistance,290.9,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Excision, Tumor, Soft Tissue Of Face Or Scalp, Subfascial; Less Than 2 Cm (Procah)",,21013,CPT,Professional,Both,,,,3264,2774.4,251.96,3264,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,391.45,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Excision, Tumor, Soft Tissue Of Face Or Scalp, Subfascial; Less Than 2 Cm (Procah)",,21013,CPT,Professional,Both,,,,3264,2774.4,251.96,3264,"Multiplan, Inc.","Multiplan, Inc.",3068.16,94,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Face Or Scalp, Subfascial; Less Than 2 Cm (Procah)",,21013,CPT,Professional,Both,,,,3264,2774.4,251.96,3264,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,2940.864,90.1,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Face Or Scalp, Subfascial; Less Than 2 Cm (Procah)",,21013,CPT,Professional,Both,,,,3264,2774.4,251.96,3264,"Preferred One Administrative Services, INC.",PPO,3218.304,98.6,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Face Or Scalp, Subfascial; Less Than 2 Cm (Procah)",,21013,CPT,Professional,Both,,,,3264,2774.4,251.96,3264,PrimeWest Health,Minnesota Senior Health Options (MSHO),450.1675,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Tumor, Soft Tissue Of Face Or Scalp, Subfascial; Less Than 2 Cm (Procah)",,21013,CPT,Professional,Both,,,,3264,2774.4,251.96,3264,PrimeWest Health,MinnesotaCare,311.2641984,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision, Tumor, Soft Tissue Of Face Or Scalp, Subfascial; Less Than 2 Cm (Procah)",,21013,CPT,Professional,Both,,,,3264,2774.4,251.96,3264,Sanford Health Plan,Sanford Health Plan,2872.32,88,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Face Or Scalp, Subfascial; Less Than 2 Cm (Procah)",,21013,CPT,Professional,Both,,,,3264,2774.4,251.96,3264,"UCare Health, Inc.",Individual & Family Plan,636.34112,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Excision, Tumor, Soft Tissue Of Face Or Scalp, Subfascial; Less Than 2 Cm (Procah)",,21013,CPT,Professional,Both,,,,3264,2774.4,251.96,3264,"UCare Health, Inc.",Medical Assistance,319.991232,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Excision, Tumor, Soft Tissue Of Face Or Scalp, Subfascial; Less Than 2 Cm (Procah)",,21013,CPT,Professional,Both,,,,3264,2774.4,251.96,3264,"UCare Health, Inc.",Medicare Advantage,450.1675,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Excision, Tumor, Soft Tissue Of Face Or Scalp, Subfascial; Less Than 2 Cm (Procah)",,21013,CPT,Professional,Both,,,,3264,2774.4,251.96,3264,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),360.134,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Excision, Tumor, Soft Tissue Of Face Or Scalp, Subfascial; Less Than 2 Cm (Procah)",,21013,CPT,Professional,Both,,,,3264,2774.4,251.96,3264,UnitedHealthcare,Individual & Family,3264,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Excision, Tumor, Soft Tissue Of Face Or Scalp, Subfascial; Less Than 2 Cm (Procah)",,21013,CPT,Professional,Both,,,,3264,2774.4,251.96,3264,UnitedHealthcare,Medicare Advantage,450.1675,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Tumor, Soft Tissue Of Face Or Scalp, Subfascial; Less Than 2 Cm (Procah)",,21013,CPT,Professional,Both,,,,3264,2774.4,251.96,3264,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,290.90112,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision, Tumor, Soft Tissue Of Face And Scalp, Subfascial; 2 Cm Or Greater (Pbb)",,21014,CPT,Facility,Outpatient,,,,1811,1539.35,519.0326,1811,Aetna,Commercial,1666.12,92,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Face And Scalp, Subfascial; 2 Cm Or Greater (Pbb)",,21014,CPT,Facility,Outpatient,,,,1811,1539.35,519.0326,1811,Aetna,Medicare Advantage,887.39,49,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Face And Scalp, Subfascial; 2 Cm Or Greater (Pbb)",,21014,CPT,Facility,Outpatient,,,,1811,1539.35,519.0326,1811,Aetna,PPO,1684.23,93,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Face And Scalp, Subfascial; 2 Cm Or Greater (Pbb)",,21014,CPT,Facility,Outpatient,,,,1811,1539.35,519.0326,1811,America's PPO,America's PPO,1739.1033,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Excision, Tumor, Soft Tissue Of Face And Scalp, Subfascial; 2 Cm Or Greater (Pbb)",,21014,CPT,Facility,Outpatient,,,,1811,1539.35,519.0326,1811,BlueCross BlueShield Minnesota, Federal Employee Program,1782.024,98.4,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Face And Scalp, Subfascial; 2 Cm Or Greater (Pbb)",,21014,CPT,Facility,Outpatient,,,,1811,1539.35,519.0326,1811,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1811,100,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Face And Scalp, Subfascial; 2 Cm Or Greater (Pbb)",,21014,CPT,Facility,Outpatient,,,,1811,1539.35,519.0326,1811,BlueCross BlueShield Minnesota,High Value Network Plan,1629.9,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
"Excision, Tumor, Soft Tissue Of Face And Scalp, Subfascial; 2 Cm Or Greater (Pbb)",,21014,CPT,Facility,Outpatient,,,,1811,1539.35,519.0326,1811,BlueCross BlueShield Minnesota,Medicare Advantage,887.39,49,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Face And Scalp, Subfascial; 2 Cm Or Greater (Pbb)",,21014,CPT,Facility,Outpatient,,,,1811,1539.35,519.0326,1811,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,519.0326,28.66,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Face And Scalp, Subfascial; 2 Cm Or Greater (Pbb)",,21014,CPT,Facility,Outpatient,,,,1811,1539.35,519.0326,1811,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),887.39,49,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Face And Scalp, Subfascial; 2 Cm Or Greater (Pbb)",,21014,CPT,Facility,Outpatient,,,,1811,1539.35,519.0326,1811,CorVel,Worker's Compensation,1811,100,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Face And Scalp, Subfascial; 2 Cm Or Greater (Pbb)",,21014,CPT,Facility,Outpatient,,,,1811,1539.35,519.0326,1811,First Health Group Corporation,First Health Network,1756.67,97,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Face And Scalp, Subfascial; 2 Cm Or Greater (Pbb)",,21014,CPT,Facility,Outpatient,,,,1811,1539.35,519.0326,1811,"Health Partners, Inc.",Commercial,1713.206,94.6,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Face And Scalp, Subfascial; 2 Cm Or Greater (Pbb)",,21014,CPT,Facility,Outpatient,,,,1811,1539.35,519.0326,1811,"Health Partners, Inc.",Medicare Advantage,887.39,49,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Face And Scalp, Subfascial; 2 Cm Or Greater (Pbb)",,21014,CPT,Facility,Outpatient,,,,1811,1539.35,519.0326,1811,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1086.6,60,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Face And Scalp, Subfascial; 2 Cm Or Greater (Pbb)",,21014,CPT,Facility,Outpatient,,,,1811,1539.35,519.0326,1811,"Health Partners, Inc.",State of Minnesota Advantage Program,1475.965,81.5,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Face And Scalp, Subfascial; 2 Cm Or Greater (Pbb)",,21014,CPT,Facility,Outpatient,,,,1811,1539.35,519.0326,1811,"Health Partners, Inc.",State Public Programs,905.5,50,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Face And Scalp, Subfascial; 2 Cm Or Greater (Pbb)",,21014,CPT,Facility,Outpatient,,,,1811,1539.35,519.0326,1811,Humana Insurance Company,Commercial PPO,1720.45,95,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Face And Scalp, Subfascial; 2 Cm Or Greater (Pbb)",,21014,CPT,Facility,Outpatient,,,,1811,1539.35,519.0326,1811,Humana Insurance Company,Medicare PPO,887.39,49,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Face And Scalp, Subfascial; 2 Cm Or Greater (Pbb)",,21014,CPT,Facility,Outpatient,,,,1811,1539.35,519.0326,1811,Medica,Individual & Family,1794.701,99.1,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Face And Scalp, Subfascial; 2 Cm Or Greater (Pbb)",,21014,CPT,Facility,Outpatient,,,,1811,1539.35,519.0326,1811,Medica,Medica Advantage Solution,901.878,49.8,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Face And Scalp, Subfascial; 2 Cm Or Greater (Pbb)",,21014,CPT,Facility,Outpatient,,,,1811,1539.35,519.0326,1811,Medica,Medical Assistance,807.706,44.6,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Face And Scalp, Subfascial; 2 Cm Or Greater (Pbb)",,21014,CPT,Facility,Outpatient,,,,1811,1539.35,519.0326,1811,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,901.878,49.8,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Face And Scalp, Subfascial; 2 Cm Or Greater (Pbb)",,21014,CPT,Facility,Outpatient,,,,1811,1539.35,519.0326,1811,"Multiplan, Inc.","Multiplan, Inc.",1702.34,94,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Face And Scalp, Subfascial; 2 Cm Or Greater (Pbb)",,21014,CPT,Facility,Outpatient,,,,1811,1539.35,519.0326,1811,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1631.711,90.1,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Face And Scalp, Subfascial; 2 Cm Or Greater (Pbb)",,21014,CPT,Facility,Outpatient,,,,1811,1539.35,519.0326,1811,"Preferred One Administrative Services, INC.",PPO,1785.646,98.6,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Face And Scalp, Subfascial; 2 Cm Or Greater (Pbb)",,21014,CPT,Facility,Outpatient,,,,1811,1539.35,519.0326,1811,PrimeWest Health,Minnesota Senior Health Options (MSHO),931.7595,51.45,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Face And Scalp, Subfascial; 2 Cm Or Greater (Pbb)",,21014,CPT,Facility,Outpatient,,,,1811,1539.35,519.0326,1811,PrimeWest Health,MinnesotaCare,930.1296,51.36,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Face And Scalp, Subfascial; 2 Cm Or Greater (Pbb)",,21014,CPT,Facility,Outpatient,,,,1811,1539.35,519.0326,1811,Sanford Health Plan,Sanford Health Plan,1666.12,92,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Face And Scalp, Subfascial; 2 Cm Or Greater (Pbb)",,21014,CPT,Facility,Outpatient,,,,1811,1539.35,519.0326,1811,"UCare Health, Inc.",Individual & Family Plan,1020.4985,56.35,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Face And Scalp, Subfascial; 2 Cm Or Greater (Pbb)",,21014,CPT,Facility,Outpatient,,,,1811,1539.35,519.0326,1811,"UCare Health, Inc.",Medical Assistance,914.0117,50.47,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Face And Scalp, Subfascial; 2 Cm Or Greater (Pbb)",,21014,CPT,Facility,Outpatient,,,,1811,1539.35,519.0326,1811,"UCare Health, Inc.",Medicare Advantage,914.0117,50.47,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Face And Scalp, Subfascial; 2 Cm Or Greater (Pbb)",,21014,CPT,Facility,Outpatient,,,,1811,1539.35,519.0326,1811,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),914.0117,50.47,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Face And Scalp, Subfascial; 2 Cm Or Greater (Pbb)",,21014,CPT,Facility,Outpatient,,,,1811,1539.35,519.0326,1811,UnitedHealthcare,Individual & Family,1702.34,94,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Face And Scalp, Subfascial; 2 Cm Or Greater (Pbb)",,21014,CPT,Facility,Outpatient,,,,1811,1539.35,519.0326,1811,UnitedHealthcare,Medicare Advantage,887.39,49,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Face And Scalp, Subfascial; 2 Cm Or Greater (Pbb)",,21014,CPT,Facility,Outpatient,,,,1811,1539.35,519.0326,1811,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,869.28,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Excision, Tumor, Soft Tissue Of Face And Scalp, Subfascial; 2 Cm Or Greater (Pro Cah)",,21014,CPT,Professional,Both,,,,3647,3099.95,325.7,3647,Aetna,Commercial,3099.95,85,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Face And Scalp, Subfascial; 2 Cm Or Greater (Pro Cah)",,21014,CPT,Professional,Both,,,,3647,3099.95,325.7,3647,Aetna,Medicare Advantage,508.48,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Tumor, Soft Tissue Of Face And Scalp, Subfascial; 2 Cm Or Greater (Pro Cah)",,21014,CPT,Professional,Both,,,,3647,3099.95,325.7,3647,Aetna,PPO,3391.71,93,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Face And Scalp, Subfascial; 2 Cm Or Greater (Pro Cah)",,21014,CPT,Professional,Both,,,,3647,3099.95,325.7,3647,America's PPO,America's PPO,3115.9968,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Excision, Tumor, Soft Tissue Of Face And Scalp, Subfascial; 2 Cm Or Greater (Pro Cah)",,21014,CPT,Professional,Both,,,,3647,3099.95,325.7,3647,BlueCross BlueShield Minnesota, Federal Employee Program,1080.41,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Excision, Tumor, Soft Tissue Of Face And Scalp, Subfascial; 2 Cm Or Greater (Pro Cah)",,21014,CPT,Professional,Both,,,,3647,3099.95,325.7,3647,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1097.69656,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Tumor, Soft Tissue Of Face And Scalp, Subfascial; 2 Cm Or Greater (Pro Cah)",,21014,CPT,Professional,Both,,,,3647,3099.95,325.7,3647,BlueCross BlueShield Minnesota,High Value Network Plan,1097.69656,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Tumor, Soft Tissue Of Face And Scalp, Subfascial; 2 Cm Or Greater (Pro Cah)",,21014,CPT,Professional,Both,,,,3647,3099.95,325.7,3647,BlueCross BlueShield Minnesota,Medicare Advantage,582.13,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Tumor, Soft Tissue Of Face And Scalp, Subfascial; 2 Cm Or Greater (Pro Cah)",,21014,CPT,Professional,Both,,,,3647,3099.95,325.7,3647,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1097.69656,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Tumor, Soft Tissue Of Face And Scalp, Subfascial; 2 Cm Or Greater (Pro Cah)",,21014,CPT,Professional,Both,,,,3647,3099.95,325.7,3647,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,376.03176,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision, Tumor, Soft Tissue Of Face And Scalp, Subfascial; 2 Cm Or Greater (Pro Cah)",,21014,CPT,Professional,Both,,,,3647,3099.95,325.7,3647,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),582.13,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Tumor, Soft Tissue Of Face And Scalp, Subfascial; 2 Cm Or Greater (Pro Cah)",,21014,CPT,Professional,Both,,,,3647,3099.95,325.7,3647,CorVel,Worker's Compensation,986.7602133,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Excision, Tumor, Soft Tissue Of Face And Scalp, Subfascial; 2 Cm Or Greater (Pro Cah)",,21014,CPT,Professional,Both,,,,3647,3099.95,325.7,3647,First Health Group Corporation,First Health Network,3537.59,97,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Face And Scalp, Subfascial; 2 Cm Or Greater (Pro Cah)",,21014,CPT,Professional,Both,,,,3647,3099.95,325.7,3647,"Health Partners, Inc.",Commercial,1065.79,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision, Tumor, Soft Tissue Of Face And Scalp, Subfascial; 2 Cm Or Greater (Pro Cah)",,21014,CPT,Professional,Both,,,,3647,3099.95,325.7,3647,"Health Partners, Inc.",Medicare Advantage,582.13,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Tumor, Soft Tissue Of Face And Scalp, Subfascial; 2 Cm Or Greater (Pro Cah)",,21014,CPT,Professional,Both,,,,3647,3099.95,325.7,3647,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),506.27,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Excision, Tumor, Soft Tissue Of Face And Scalp, Subfascial; 2 Cm Or Greater (Pro Cah)",,21014,CPT,Professional,Both,,,,3647,3099.95,325.7,3647,"Health Partners, Inc.",State of Minnesota Advantage Program,918.178085,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision, Tumor, Soft Tissue Of Face And Scalp, Subfascial; 2 Cm Or Greater (Pro Cah)",,21014,CPT,Professional,Both,,,,3647,3099.95,325.7,3647,"Health Partners, Inc.",State Public Programs,325.7,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Excision, Tumor, Soft Tissue Of Face And Scalp, Subfascial; 2 Cm Or Greater (Pro Cah)",,21014,CPT,Professional,Both,,,,3647,3099.95,325.7,3647,Humana Insurance Company,Commercial PPO,506.2,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Excision, Tumor, Soft Tissue Of Face And Scalp, Subfascial; 2 Cm Or Greater (Pro Cah)",,21014,CPT,Professional,Both,,,,3647,3099.95,325.7,3647,Humana Insurance Company,Medicare PPO,3647,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Excision, Tumor, Soft Tissue Of Face And Scalp, Subfascial; 2 Cm Or Greater (Pro Cah)",,21014,CPT,Professional,Both,,,,3647,3099.95,325.7,3647,Medica,Individual & Family,3092.656,84.8,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Face And Scalp, Subfascial; 2 Cm Or Greater (Pro Cah)",,21014,CPT,Professional,Both,,,,3647,3099.95,325.7,3647,Medica,Medica Advantage Solution,1816.206,49.8,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Face And Scalp, Subfascial; 2 Cm Or Greater (Pro Cah)",,21014,CPT,Professional,Both,,,,3647,3099.95,325.7,3647,Medica,Medical Assistance,376.03,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Excision, Tumor, Soft Tissue Of Face And Scalp, Subfascial; 2 Cm Or Greater (Pro Cah)",,21014,CPT,Professional,Both,,,,3647,3099.95,325.7,3647,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,506.2,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Excision, Tumor, Soft Tissue Of Face And Scalp, Subfascial; 2 Cm Or Greater (Pro Cah)",,21014,CPT,Professional,Both,,,,3647,3099.95,325.7,3647,"Multiplan, Inc.","Multiplan, Inc.",3428.18,94,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Face And Scalp, Subfascial; 2 Cm Or Greater (Pro Cah)",,21014,CPT,Professional,Both,,,,3647,3099.95,325.7,3647,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,3285.947,90.1,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Face And Scalp, Subfascial; 2 Cm Or Greater (Pro Cah)",,21014,CPT,Professional,Both,,,,3647,3099.95,325.7,3647,"Preferred One Administrative Services, INC.",PPO,3595.942,98.6,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Face And Scalp, Subfascial; 2 Cm Or Greater (Pro Cah)",,21014,CPT,Professional,Both,,,,3647,3099.95,325.7,3647,PrimeWest Health,Minnesota Senior Health Options (MSHO),582.13,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Tumor, Soft Tissue Of Face And Scalp, Subfascial; 2 Cm Or Greater (Pro Cah)",,21014,CPT,Professional,Both,,,,3647,3099.95,325.7,3647,PrimeWest Health,MinnesotaCare,402.3539832,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision, Tumor, Soft Tissue Of Face And Scalp, Subfascial; 2 Cm Or Greater (Pro Cah)",,21014,CPT,Professional,Both,,,,3647,3099.95,325.7,3647,Sanford Health Plan,Sanford Health Plan,3209.36,88,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Face And Scalp, Subfascial; 2 Cm Or Greater (Pro Cah)",,21014,CPT,Professional,Both,,,,3647,3099.95,325.7,3647,"UCare Health, Inc.",Individual & Family Plan,822.87872,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Excision, Tumor, Soft Tissue Of Face And Scalp, Subfascial; 2 Cm Or Greater (Pro Cah)",,21014,CPT,Professional,Both,,,,3647,3099.95,325.7,3647,"UCare Health, Inc.",Medical Assistance,413.634936,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Excision, Tumor, Soft Tissue Of Face And Scalp, Subfascial; 2 Cm Or Greater (Pro Cah)",,21014,CPT,Professional,Both,,,,3647,3099.95,325.7,3647,"UCare Health, Inc.",Medicare Advantage,582.13,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Excision, Tumor, Soft Tissue Of Face And Scalp, Subfascial; 2 Cm Or Greater (Pro Cah)",,21014,CPT,Professional,Both,,,,3647,3099.95,325.7,3647,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),465.704,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Excision, Tumor, Soft Tissue Of Face And Scalp, Subfascial; 2 Cm Or Greater (Pro Cah)",,21014,CPT,Professional,Both,,,,3647,3099.95,325.7,3647,UnitedHealthcare,Individual & Family,3647,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Excision, Tumor, Soft Tissue Of Face And Scalp, Subfascial; 2 Cm Or Greater (Pro Cah)",,21014,CPT,Professional,Both,,,,3647,3099.95,325.7,3647,UnitedHealthcare,Medicare Advantage,582.13,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Tumor, Soft Tissue Of Face And Scalp, Subfascial; 2 Cm Or Greater (Pro Cah)",,21014,CPT,Professional,Both,,,,3647,3099.95,325.7,3647,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,376.03176,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision, Tumor, Soft Tissue Of Face Or Scalp, Subfascial; 2 Cm Or Greater (Pbb)",,21014,CPT,Professional,Outpatient,,,,1836,1560.6,325.7,1836,Aetna,Commercial,1560.6,85,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Face Or Scalp, Subfascial; 2 Cm Or Greater (Pbb)",,21014,CPT,Professional,Outpatient,,,,1836,1560.6,325.7,1836,Aetna,Medicare Advantage,508.48,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Tumor, Soft Tissue Of Face Or Scalp, Subfascial; 2 Cm Or Greater (Pbb)",,21014,CPT,Professional,Outpatient,,,,1836,1560.6,325.7,1836,Aetna,PPO,1707.48,93,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Face Or Scalp, Subfascial; 2 Cm Or Greater (Pbb)",,21014,CPT,Professional,Outpatient,,,,1836,1560.6,325.7,1836,America's PPO,America's PPO,1568.6784,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Excision, Tumor, Soft Tissue Of Face Or Scalp, Subfascial; 2 Cm Or Greater (Pbb)",,21014,CPT,Professional,Outpatient,,,,1836,1560.6,325.7,1836,BlueCross BlueShield Minnesota, Federal Employee Program,1080.41,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Excision, Tumor, Soft Tissue Of Face Or Scalp, Subfascial; 2 Cm Or Greater (Pbb)",,21014,CPT,Professional,Outpatient,,,,1836,1560.6,325.7,1836,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1097.69656,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Tumor, Soft Tissue Of Face Or Scalp, Subfascial; 2 Cm Or Greater (Pbb)",,21014,CPT,Professional,Outpatient,,,,1836,1560.6,325.7,1836,BlueCross BlueShield Minnesota,High Value Network Plan,1097.69656,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Tumor, Soft Tissue Of Face Or Scalp, Subfascial; 2 Cm Or Greater (Pbb)",,21014,CPT,Professional,Outpatient,,,,1836,1560.6,325.7,1836,BlueCross BlueShield Minnesota,Medicare Advantage,582.13,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Tumor, Soft Tissue Of Face Or Scalp, Subfascial; 2 Cm Or Greater (Pbb)",,21014,CPT,Professional,Outpatient,,,,1836,1560.6,325.7,1836,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1097.69656,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Tumor, Soft Tissue Of Face Or Scalp, Subfascial; 2 Cm Or Greater (Pbb)",,21014,CPT,Professional,Outpatient,,,,1836,1560.6,325.7,1836,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,376.03176,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision, Tumor, Soft Tissue Of Face Or Scalp, Subfascial; 2 Cm Or Greater (Pbb)",,21014,CPT,Professional,Outpatient,,,,1836,1560.6,325.7,1836,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),582.13,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Tumor, Soft Tissue Of Face Or Scalp, Subfascial; 2 Cm Or Greater (Pbb)",,21014,CPT,Professional,Outpatient,,,,1836,1560.6,325.7,1836,CorVel,Worker's Compensation,986.7602133,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Excision, Tumor, Soft Tissue Of Face Or Scalp, Subfascial; 2 Cm Or Greater (Pbb)",,21014,CPT,Professional,Outpatient,,,,1836,1560.6,325.7,1836,First Health Group Corporation,First Health Network,1780.92,97,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Face Or Scalp, Subfascial; 2 Cm Or Greater (Pbb)",,21014,CPT,Professional,Outpatient,,,,1836,1560.6,325.7,1836,"Health Partners, Inc.",Commercial,1065.79,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision, Tumor, Soft Tissue Of Face Or Scalp, Subfascial; 2 Cm Or Greater (Pbb)",,21014,CPT,Professional,Outpatient,,,,1836,1560.6,325.7,1836,"Health Partners, Inc.",Medicare Advantage,582.13,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Tumor, Soft Tissue Of Face Or Scalp, Subfascial; 2 Cm Or Greater (Pbb)",,21014,CPT,Professional,Outpatient,,,,1836,1560.6,325.7,1836,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),506.27,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Excision, Tumor, Soft Tissue Of Face Or Scalp, Subfascial; 2 Cm Or Greater (Pbb)",,21014,CPT,Professional,Outpatient,,,,1836,1560.6,325.7,1836,"Health Partners, Inc.",State of Minnesota Advantage Program,918.178085,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision, Tumor, Soft Tissue Of Face Or Scalp, Subfascial; 2 Cm Or Greater (Pbb)",,21014,CPT,Professional,Outpatient,,,,1836,1560.6,325.7,1836,"Health Partners, Inc.",State Public Programs,325.7,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Excision, Tumor, Soft Tissue Of Face Or Scalp, Subfascial; 2 Cm Or Greater (Pbb)",,21014,CPT,Professional,Outpatient,,,,1836,1560.6,325.7,1836,Humana Insurance Company,Commercial PPO,506.2,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Excision, Tumor, Soft Tissue Of Face Or Scalp, Subfascial; 2 Cm Or Greater (Pbb)",,21014,CPT,Professional,Outpatient,,,,1836,1560.6,325.7,1836,Humana Insurance Company,Medicare PPO,1836,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Excision, Tumor, Soft Tissue Of Face Or Scalp, Subfascial; 2 Cm Or Greater (Pbb)",,21014,CPT,Professional,Outpatient,,,,1836,1560.6,325.7,1836,Medica,Individual & Family,1556.928,84.8,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Face Or Scalp, Subfascial; 2 Cm Or Greater (Pbb)",,21014,CPT,Professional,Outpatient,,,,1836,1560.6,325.7,1836,Medica,Medica Advantage Solution,914.328,49.8,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Face Or Scalp, Subfascial; 2 Cm Or Greater (Pbb)",,21014,CPT,Professional,Outpatient,,,,1836,1560.6,325.7,1836,Medica,Medical Assistance,376.03,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Excision, Tumor, Soft Tissue Of Face Or Scalp, Subfascial; 2 Cm Or Greater (Pbb)",,21014,CPT,Professional,Outpatient,,,,1836,1560.6,325.7,1836,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,506.2,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Excision, Tumor, Soft Tissue Of Face Or Scalp, Subfascial; 2 Cm Or Greater (Pbb)",,21014,CPT,Professional,Outpatient,,,,1836,1560.6,325.7,1836,"Multiplan, Inc.","Multiplan, Inc.",1725.84,94,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Face Or Scalp, Subfascial; 2 Cm Or Greater (Pbb)",,21014,CPT,Professional,Outpatient,,,,1836,1560.6,325.7,1836,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1654.236,90.1,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Face Or Scalp, Subfascial; 2 Cm Or Greater (Pbb)",,21014,CPT,Professional,Outpatient,,,,1836,1560.6,325.7,1836,"Preferred One Administrative Services, INC.",PPO,1810.296,98.6,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Face Or Scalp, Subfascial; 2 Cm Or Greater (Pbb)",,21014,CPT,Professional,Outpatient,,,,1836,1560.6,325.7,1836,PrimeWest Health,Minnesota Senior Health Options (MSHO),582.13,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Tumor, Soft Tissue Of Face Or Scalp, Subfascial; 2 Cm Or Greater (Pbb)",,21014,CPT,Professional,Outpatient,,,,1836,1560.6,325.7,1836,PrimeWest Health,MinnesotaCare,402.3539832,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision, Tumor, Soft Tissue Of Face Or Scalp, Subfascial; 2 Cm Or Greater (Pbb)",,21014,CPT,Professional,Outpatient,,,,1836,1560.6,325.7,1836,Sanford Health Plan,Sanford Health Plan,1615.68,88,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Face Or Scalp, Subfascial; 2 Cm Or Greater (Pbb)",,21014,CPT,Professional,Outpatient,,,,1836,1560.6,325.7,1836,"UCare Health, Inc.",Individual & Family Plan,822.87872,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Excision, Tumor, Soft Tissue Of Face Or Scalp, Subfascial; 2 Cm Or Greater (Pbb)",,21014,CPT,Professional,Outpatient,,,,1836,1560.6,325.7,1836,"UCare Health, Inc.",Medical Assistance,413.634936,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Excision, Tumor, Soft Tissue Of Face Or Scalp, Subfascial; 2 Cm Or Greater (Pbb)",,21014,CPT,Professional,Outpatient,,,,1836,1560.6,325.7,1836,"UCare Health, Inc.",Medicare Advantage,582.13,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Excision, Tumor, Soft Tissue Of Face Or Scalp, Subfascial; 2 Cm Or Greater (Pbb)",,21014,CPT,Professional,Outpatient,,,,1836,1560.6,325.7,1836,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),465.704,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Excision, Tumor, Soft Tissue Of Face Or Scalp, Subfascial; 2 Cm Or Greater (Pbb)",,21014,CPT,Professional,Outpatient,,,,1836,1560.6,325.7,1836,UnitedHealthcare,Individual & Family,1836,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Excision, Tumor, Soft Tissue Of Face Or Scalp, Subfascial; 2 Cm Or Greater (Pbb)",,21014,CPT,Professional,Outpatient,,,,1836,1560.6,325.7,1836,UnitedHealthcare,Medicare Advantage,582.13,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Tumor, Soft Tissue Of Face Or Scalp, Subfascial; 2 Cm Or Greater (Pbb)",,21014,CPT,Professional,Outpatient,,,,1836,1560.6,325.7,1836,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,376.03176,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
METHOTREXATE SODIUM 2.5 MG ORAL TABLET,,J8610,HCPCS,Facility,Both,1,Each,,12,10.2,3.4392,12,Aetna,Commercial,11.04,92,,percent of total billed charges,,
METHOTREXATE SODIUM 2.5 MG ORAL TABLET,,J8610,HCPCS,Facility,Outpatient,1,Each,,12,10.2,3.4392,12,Aetna,Medicare Advantage,5.88,49,,percent of total billed charges,,
METHOTREXATE SODIUM 2.5 MG ORAL TABLET,,J8610,HCPCS,Facility,Inpatient,1,Each,,12,10.2,3.4392,12,Aetna,Medicare Advantage,,,,,Included in per diem rate,
METHOTREXATE SODIUM 2.5 MG ORAL TABLET,,J8610,HCPCS,Facility,Both,1,Each,,12,10.2,3.4392,12,Aetna,PPO,11.16,93,,percent of total billed charges,,
METHOTREXATE SODIUM 2.5 MG ORAL TABLET,,J8610,HCPCS,Facility,Both,1,Each,,12,10.2,3.4392,12,America's PPO,America's PPO,11.5236,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
METHOTREXATE SODIUM 2.5 MG ORAL TABLET,,J8610,HCPCS,Facility,Both,1,Each,,12,10.2,3.4392,12,BlueCross BlueShield Minnesota, Federal Employee Program,11.808,98.4,,percent of total billed charges,,
METHOTREXATE SODIUM 2.5 MG ORAL TABLET,,J8610,HCPCS,Facility,Both,1,Each,,12,10.2,3.4392,12,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,12,100,,percent of total billed charges,,
METHOTREXATE SODIUM 2.5 MG ORAL TABLET,,J8610,HCPCS,Facility,Both,1,Each,,12,10.2,3.4392,12,BlueCross BlueShield Minnesota,High Value Network Plan,10.8,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
METHOTREXATE SODIUM 2.5 MG ORAL TABLET,,J8610,HCPCS,Facility,Outpatient,1,Each,,12,10.2,3.4392,12,BlueCross BlueShield Minnesota,Medicare Advantage,5.88,49,,percent of total billed charges,,
METHOTREXATE SODIUM 2.5 MG ORAL TABLET,,J8610,HCPCS,Facility,Inpatient,1,Each,,12,10.2,3.4392,12,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
METHOTREXATE SODIUM 2.5 MG ORAL TABLET,,J8610,HCPCS,Facility,Both,1,Each,,12,10.2,3.4392,12,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,10.6284,88.57,,percent of total billed charges,,
METHOTREXATE SODIUM 2.5 MG ORAL TABLET,,J8610,HCPCS,Facility,Both,1,Each,,12,10.2,3.4392,12,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,3.4392,28.66,,percent of total billed charges,,
METHOTREXATE SODIUM 2.5 MG ORAL TABLET,,J8610,HCPCS,Facility,Outpatient,1,Each,,12,10.2,3.4392,12,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),5.88,49,,percent of total billed charges,,
METHOTREXATE SODIUM 2.5 MG ORAL TABLET,,J8610,HCPCS,Facility,Inpatient,1,Each,,12,10.2,3.4392,12,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
METHOTREXATE SODIUM 2.5 MG ORAL TABLET,,J8610,HCPCS,Facility,Both,1,Each,,12,10.2,3.4392,12,CorVel,Worker's Compensation,12,100,,percent of total billed charges,,
METHOTREXATE SODIUM 2.5 MG ORAL TABLET,,J8610,HCPCS,Facility,Both,1,Each,,12,10.2,3.4392,12,First Health Group Corporation,First Health Network,11.64,97,,percent of total billed charges,,
METHOTREXATE SODIUM 2.5 MG ORAL TABLET,,J8610,HCPCS,Facility,Both,1,Each,,12,10.2,3.4392,12,"Health Partners, Inc.",Commercial,11.352,94.6,,percent of total billed charges,,
METHOTREXATE SODIUM 2.5 MG ORAL TABLET,,J8610,HCPCS,Facility,Outpatient,1,Each,,12,10.2,3.4392,12,"Health Partners, Inc.",Medicare Advantage,5.88,49,,percent of total billed charges,,
METHOTREXATE SODIUM 2.5 MG ORAL TABLET,,J8610,HCPCS,Facility,Inpatient,1,Each,,12,10.2,3.4392,12,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
METHOTREXATE SODIUM 2.5 MG ORAL TABLET,,J8610,HCPCS,Facility,Both,1,Each,,12,10.2,3.4392,12,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),7.2,60,,percent of total billed charges,,
METHOTREXATE SODIUM 2.5 MG ORAL TABLET,,J8610,HCPCS,Facility,Both,1,Each,,12,10.2,3.4392,12,"Health Partners, Inc.",State of Minnesota Advantage Program,9.78,81.5,,percent of total billed charges,,
METHOTREXATE SODIUM 2.5 MG ORAL TABLET,,J8610,HCPCS,Facility,Both,1,Each,,12,10.2,3.4392,12,"Health Partners, Inc.",State Public Programs,6,50,,percent of total billed charges,,
METHOTREXATE SODIUM 2.5 MG ORAL TABLET,,J8610,HCPCS,Facility,Both,1,Each,,12,10.2,3.4392,12,Humana Insurance Company,Commercial PPO,11.4,95,,percent of total billed charges,,
METHOTREXATE SODIUM 2.5 MG ORAL TABLET,,J8610,HCPCS,Facility,Outpatient,1,Each,,12,10.2,3.4392,12,Humana Insurance Company,Medicare PPO,5.88,49,,percent of total billed charges,,
METHOTREXATE SODIUM 2.5 MG ORAL TABLET,,J8610,HCPCS,Facility,Inpatient,1,Each,,12,10.2,3.4392,12,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
METHOTREXATE SODIUM 2.5 MG ORAL TABLET,,J8610,HCPCS,Facility,Both,1,Each,,12,10.2,3.4392,12,Medica,Individual & Family,11.892,99.1,,percent of total billed charges,,
METHOTREXATE SODIUM 2.5 MG ORAL TABLET,,J8610,HCPCS,Facility,Outpatient,1,Each,,12,10.2,3.4392,12,Medica,Medica Advantage Solution,5.976,49.8,,percent of total billed charges,,
METHOTREXATE SODIUM 2.5 MG ORAL TABLET,,J8610,HCPCS,Facility,Inpatient,1,Each,,12,10.2,3.4392,12,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
METHOTREXATE SODIUM 2.5 MG ORAL TABLET,,J8610,HCPCS,Facility,Outpatient,1,Each,,12,10.2,3.4392,12,Medica,Medical Assistance,5.352,44.6,,percent of total billed charges,,
METHOTREXATE SODIUM 2.5 MG ORAL TABLET,,J8610,HCPCS,Facility,Inpatient,1,Each,,12,10.2,3.4392,12,Medica,Medical Assistance,,,,,Included in per diem rate,
METHOTREXATE SODIUM 2.5 MG ORAL TABLET,,J8610,HCPCS,Facility,Outpatient,1,Each,,12,10.2,3.4392,12,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,5.976,49.8,,percent of total billed charges,,
METHOTREXATE SODIUM 2.5 MG ORAL TABLET,,J8610,HCPCS,Facility,Inpatient,1,Each,,12,10.2,3.4392,12,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
METHOTREXATE SODIUM 2.5 MG ORAL TABLET,,J8610,HCPCS,Facility,Both,1,Each,,12,10.2,3.4392,12,"Multiplan, Inc.","Multiplan, Inc.",11.28,94,,percent of total billed charges,,
METHOTREXATE SODIUM 2.5 MG ORAL TABLET,,J8610,HCPCS,Facility,Outpatient,1,Each,,12,10.2,3.4392,12,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,10.812,90.1,,percent of total billed charges,,
METHOTREXATE SODIUM 2.5 MG ORAL TABLET,,J8610,HCPCS,Facility,Inpatient,1,Each,,12,10.2,3.4392,12,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
METHOTREXATE SODIUM 2.5 MG ORAL TABLET,,J8610,HCPCS,Facility,Both,1,Each,,12,10.2,3.4392,12,"Preferred One Administrative Services, INC.",PPO,11.832,98.6,,percent of total billed charges,,
METHOTREXATE SODIUM 2.5 MG ORAL TABLET,,J8610,HCPCS,Facility,Outpatient,1,Each,,12,10.2,3.4392,12,PrimeWest Health,Minnesota Senior Health Options (MSHO),6.174,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
METHOTREXATE SODIUM 2.5 MG ORAL TABLET,,J8610,HCPCS,Facility,Inpatient,1,Each,,12,10.2,3.4392,12,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
METHOTREXATE SODIUM 2.5 MG ORAL TABLET,,J8610,HCPCS,Facility,Outpatient,1,Each,,12,10.2,3.4392,12,PrimeWest Health,MinnesotaCare,6.1632,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
METHOTREXATE SODIUM 2.5 MG ORAL TABLET,,J8610,HCPCS,Facility,Inpatient,1,Each,,12,10.2,3.4392,12,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
METHOTREXATE SODIUM 2.5 MG ORAL TABLET,,J8610,HCPCS,Facility,Both,1,Each,,12,10.2,3.4392,12,Sanford Health Plan,Sanford Health Plan,11.04,92,,percent of total billed charges,,
METHOTREXATE SODIUM 2.5 MG ORAL TABLET,,J8610,HCPCS,Facility,Outpatient,1,Each,,12,10.2,3.4392,12,"UCare Health, Inc.",Individual & Family Plan,6.762,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
METHOTREXATE SODIUM 2.5 MG ORAL TABLET,,J8610,HCPCS,Facility,Inpatient,1,Each,,12,10.2,3.4392,12,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
METHOTREXATE SODIUM 2.5 MG ORAL TABLET,,J8610,HCPCS,Facility,Outpatient,1,Each,,12,10.2,3.4392,12,"UCare Health, Inc.",Medical Assistance,6.0564,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
METHOTREXATE SODIUM 2.5 MG ORAL TABLET,,J8610,HCPCS,Facility,Inpatient,1,Each,,12,10.2,3.4392,12,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
METHOTREXATE SODIUM 2.5 MG ORAL TABLET,,J8610,HCPCS,Facility,Outpatient,1,Each,,12,10.2,3.4392,12,"UCare Health, Inc.",Medicare Advantage,6.0564,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
METHOTREXATE SODIUM 2.5 MG ORAL TABLET,,J8610,HCPCS,Facility,Inpatient,1,Each,,12,10.2,3.4392,12,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
METHOTREXATE SODIUM 2.5 MG ORAL TABLET,,J8610,HCPCS,Facility,Outpatient,1,Each,,12,10.2,3.4392,12,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),6.0564,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
METHOTREXATE SODIUM 2.5 MG ORAL TABLET,,J8610,HCPCS,Facility,Inpatient,1,Each,,12,10.2,3.4392,12,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
METHOTREXATE SODIUM 2.5 MG ORAL TABLET,,J8610,HCPCS,Facility,Both,1,Each,,12,10.2,3.4392,12,UnitedHealthcare,Individual & Family,11.28,94,,percent of total billed charges,,
METHOTREXATE SODIUM 2.5 MG ORAL TABLET,,J8610,HCPCS,Facility,Outpatient,1,Each,,12,10.2,3.4392,12,UnitedHealthcare,Medicare Advantage,5.88,49,,percent of total billed charges,,
METHOTREXATE SODIUM 2.5 MG ORAL TABLET,,J8610,HCPCS,Facility,Inpatient,1,Each,,12,10.2,3.4392,12,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
METHOTREXATE SODIUM 2.5 MG ORAL TABLET,,J8610,HCPCS,Facility,Outpatient,1,Each,,12,10.2,3.4392,12,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,5.76,48,,percent of total billed charges,,100% of DHS outpatient percentage
METHOTREXATE SODIUM 2.5 MG ORAL TABLET,,J8610,HCPCS,Facility,Inpatient,1,Each,,12,10.2,3.4392,12,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
LEUPROLIDE (3 MONTH) 22.5 MG IM SYKT,,J9217,HCPCS,Facility,Both,1,Each,,21025,17871.25,6025.765,21025,Aetna,Commercial,19343,92,,percent of total billed charges,,
LEUPROLIDE (3 MONTH) 22.5 MG IM SYKT,,J9217,HCPCS,Facility,Outpatient,1,Each,,21025,17871.25,6025.765,21025,Aetna,Medicare Advantage,10302.25,49,,percent of total billed charges,,
LEUPROLIDE (3 MONTH) 22.5 MG IM SYKT,,J9217,HCPCS,Facility,Inpatient,1,Each,,21025,17871.25,6025.765,21025,Aetna,Medicare Advantage,,,,,Included in per diem rate,
LEUPROLIDE (3 MONTH) 22.5 MG IM SYKT,,J9217,HCPCS,Facility,Both,1,Each,,21025,17871.25,6025.765,21025,Aetna,PPO,19553.25,93,,percent of total billed charges,,
LEUPROLIDE (3 MONTH) 22.5 MG IM SYKT,,J9217,HCPCS,Facility,Both,1,Each,,21025,17871.25,6025.765,21025,America's PPO,America's PPO,20190.3075,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
LEUPROLIDE (3 MONTH) 22.5 MG IM SYKT,,J9217,HCPCS,Facility,Both,1,Each,,21025,17871.25,6025.765,21025,BlueCross BlueShield Minnesota, Federal Employee Program,20688.6,98.4,,percent of total billed charges,,
LEUPROLIDE (3 MONTH) 22.5 MG IM SYKT,,J9217,HCPCS,Facility,Both,1,Each,,21025,17871.25,6025.765,21025,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,21025,100,,percent of total billed charges,,
LEUPROLIDE (3 MONTH) 22.5 MG IM SYKT,,J9217,HCPCS,Facility,Both,1,Each,,21025,17871.25,6025.765,21025,BlueCross BlueShield Minnesota,High Value Network Plan,18922.5,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
LEUPROLIDE (3 MONTH) 22.5 MG IM SYKT,,J9217,HCPCS,Facility,Outpatient,1,Each,,21025,17871.25,6025.765,21025,BlueCross BlueShield Minnesota,Medicare Advantage,10302.25,49,,percent of total billed charges,,
LEUPROLIDE (3 MONTH) 22.5 MG IM SYKT,,J9217,HCPCS,Facility,Inpatient,1,Each,,21025,17871.25,6025.765,21025,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
LEUPROLIDE (3 MONTH) 22.5 MG IM SYKT,,J9217,HCPCS,Facility,Both,1,Each,,21025,17871.25,6025.765,21025,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,18621.8425,88.57,,percent of total billed charges,,
LEUPROLIDE (3 MONTH) 22.5 MG IM SYKT,,J9217,HCPCS,Facility,Both,1,Each,,21025,17871.25,6025.765,21025,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,6025.765,28.66,,percent of total billed charges,,
LEUPROLIDE (3 MONTH) 22.5 MG IM SYKT,,J9217,HCPCS,Facility,Outpatient,1,Each,,21025,17871.25,6025.765,21025,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),10302.25,49,,percent of total billed charges,,
LEUPROLIDE (3 MONTH) 22.5 MG IM SYKT,,J9217,HCPCS,Facility,Inpatient,1,Each,,21025,17871.25,6025.765,21025,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
LEUPROLIDE (3 MONTH) 22.5 MG IM SYKT,,J9217,HCPCS,Facility,Both,1,Each,,21025,17871.25,6025.765,21025,CorVel,Worker's Compensation,21025,100,,percent of total billed charges,,
LEUPROLIDE (3 MONTH) 22.5 MG IM SYKT,,J9217,HCPCS,Facility,Both,1,Each,,21025,17871.25,6025.765,21025,First Health Group Corporation,First Health Network,20394.25,97,,percent of total billed charges,,
LEUPROLIDE (3 MONTH) 22.5 MG IM SYKT,,J9217,HCPCS,Facility,Both,1,Each,,21025,17871.25,6025.765,21025,"Health Partners, Inc.",Commercial,19889.65,94.6,,percent of total billed charges,,
LEUPROLIDE (3 MONTH) 22.5 MG IM SYKT,,J9217,HCPCS,Facility,Outpatient,1,Each,,21025,17871.25,6025.765,21025,"Health Partners, Inc.",Medicare Advantage,10302.25,49,,percent of total billed charges,,
LEUPROLIDE (3 MONTH) 22.5 MG IM SYKT,,J9217,HCPCS,Facility,Inpatient,1,Each,,21025,17871.25,6025.765,21025,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LEUPROLIDE (3 MONTH) 22.5 MG IM SYKT,,J9217,HCPCS,Facility,Both,1,Each,,21025,17871.25,6025.765,21025,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),12615,60,,percent of total billed charges,,
LEUPROLIDE (3 MONTH) 22.5 MG IM SYKT,,J9217,HCPCS,Facility,Both,1,Each,,21025,17871.25,6025.765,21025,"Health Partners, Inc.",State of Minnesota Advantage Program,17135.375,81.5,,percent of total billed charges,,
LEUPROLIDE (3 MONTH) 22.5 MG IM SYKT,,J9217,HCPCS,Facility,Both,1,Each,,21025,17871.25,6025.765,21025,"Health Partners, Inc.",State Public Programs,10512.5,50,,percent of total billed charges,,
LEUPROLIDE (3 MONTH) 22.5 MG IM SYKT,,J9217,HCPCS,Facility,Both,1,Each,,21025,17871.25,6025.765,21025,Humana Insurance Company,Commercial PPO,19973.75,95,,percent of total billed charges,,
LEUPROLIDE (3 MONTH) 22.5 MG IM SYKT,,J9217,HCPCS,Facility,Outpatient,1,Each,,21025,17871.25,6025.765,21025,Humana Insurance Company,Medicare PPO,10302.25,49,,percent of total billed charges,,
LEUPROLIDE (3 MONTH) 22.5 MG IM SYKT,,J9217,HCPCS,Facility,Inpatient,1,Each,,21025,17871.25,6025.765,21025,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
LEUPROLIDE (3 MONTH) 22.5 MG IM SYKT,,J9217,HCPCS,Facility,Both,1,Each,,21025,17871.25,6025.765,21025,Medica,Individual & Family,20835.775,99.1,,percent of total billed charges,,
LEUPROLIDE (3 MONTH) 22.5 MG IM SYKT,,J9217,HCPCS,Facility,Outpatient,1,Each,,21025,17871.25,6025.765,21025,Medica,Medica Advantage Solution,10470.45,49.8,,percent of total billed charges,,
LEUPROLIDE (3 MONTH) 22.5 MG IM SYKT,,J9217,HCPCS,Facility,Inpatient,1,Each,,21025,17871.25,6025.765,21025,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
LEUPROLIDE (3 MONTH) 22.5 MG IM SYKT,,J9217,HCPCS,Facility,Outpatient,1,Each,,21025,17871.25,6025.765,21025,Medica,Medical Assistance,9377.15,44.6,,percent of total billed charges,,
LEUPROLIDE (3 MONTH) 22.5 MG IM SYKT,,J9217,HCPCS,Facility,Inpatient,1,Each,,21025,17871.25,6025.765,21025,Medica,Medical Assistance,,,,,Included in per diem rate,
LEUPROLIDE (3 MONTH) 22.5 MG IM SYKT,,J9217,HCPCS,Facility,Outpatient,1,Each,,21025,17871.25,6025.765,21025,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,10470.45,49.8,,percent of total billed charges,,
LEUPROLIDE (3 MONTH) 22.5 MG IM SYKT,,J9217,HCPCS,Facility,Inpatient,1,Each,,21025,17871.25,6025.765,21025,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
LEUPROLIDE (3 MONTH) 22.5 MG IM SYKT,,J9217,HCPCS,Facility,Both,1,Each,,21025,17871.25,6025.765,21025,"Multiplan, Inc.","Multiplan, Inc.",19763.5,94,,percent of total billed charges,,
LEUPROLIDE (3 MONTH) 22.5 MG IM SYKT,,J9217,HCPCS,Facility,Outpatient,1,Each,,21025,17871.25,6025.765,21025,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,18943.525,90.1,,percent of total billed charges,,
LEUPROLIDE (3 MONTH) 22.5 MG IM SYKT,,J9217,HCPCS,Facility,Inpatient,1,Each,,21025,17871.25,6025.765,21025,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
LEUPROLIDE (3 MONTH) 22.5 MG IM SYKT,,J9217,HCPCS,Facility,Both,1,Each,,21025,17871.25,6025.765,21025,"Preferred One Administrative Services, INC.",PPO,20730.65,98.6,,percent of total billed charges,,
LEUPROLIDE (3 MONTH) 22.5 MG IM SYKT,,J9217,HCPCS,Facility,Outpatient,1,Each,,21025,17871.25,6025.765,21025,PrimeWest Health,Minnesota Senior Health Options (MSHO),10817.3625,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
LEUPROLIDE (3 MONTH) 22.5 MG IM SYKT,,J9217,HCPCS,Facility,Inpatient,1,Each,,21025,17871.25,6025.765,21025,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LEUPROLIDE (3 MONTH) 22.5 MG IM SYKT,,J9217,HCPCS,Facility,Outpatient,1,Each,,21025,17871.25,6025.765,21025,PrimeWest Health,MinnesotaCare,10798.44,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
LEUPROLIDE (3 MONTH) 22.5 MG IM SYKT,,J9217,HCPCS,Facility,Inpatient,1,Each,,21025,17871.25,6025.765,21025,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
LEUPROLIDE (3 MONTH) 22.5 MG IM SYKT,,J9217,HCPCS,Facility,Both,1,Each,,21025,17871.25,6025.765,21025,Sanford Health Plan,Sanford Health Plan,19343,92,,percent of total billed charges,,
LEUPROLIDE (3 MONTH) 22.5 MG IM SYKT,,J9217,HCPCS,Facility,Outpatient,1,Each,,21025,17871.25,6025.765,21025,"UCare Health, Inc.",Individual & Family Plan,11847.5875,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
LEUPROLIDE (3 MONTH) 22.5 MG IM SYKT,,J9217,HCPCS,Facility,Inpatient,1,Each,,21025,17871.25,6025.765,21025,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
LEUPROLIDE (3 MONTH) 22.5 MG IM SYKT,,J9217,HCPCS,Facility,Outpatient,1,Each,,21025,17871.25,6025.765,21025,"UCare Health, Inc.",Medical Assistance,10611.3175,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LEUPROLIDE (3 MONTH) 22.5 MG IM SYKT,,J9217,HCPCS,Facility,Inpatient,1,Each,,21025,17871.25,6025.765,21025,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
LEUPROLIDE (3 MONTH) 22.5 MG IM SYKT,,J9217,HCPCS,Facility,Outpatient,1,Each,,21025,17871.25,6025.765,21025,"UCare Health, Inc.",Medicare Advantage,10611.3175,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LEUPROLIDE (3 MONTH) 22.5 MG IM SYKT,,J9217,HCPCS,Facility,Inpatient,1,Each,,21025,17871.25,6025.765,21025,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LEUPROLIDE (3 MONTH) 22.5 MG IM SYKT,,J9217,HCPCS,Facility,Outpatient,1,Each,,21025,17871.25,6025.765,21025,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),10611.3175,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LEUPROLIDE (3 MONTH) 22.5 MG IM SYKT,,J9217,HCPCS,Facility,Inpatient,1,Each,,21025,17871.25,6025.765,21025,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LEUPROLIDE (3 MONTH) 22.5 MG IM SYKT,,J9217,HCPCS,Facility,Both,1,Each,,21025,17871.25,6025.765,21025,UnitedHealthcare,Individual & Family,19763.5,94,,percent of total billed charges,,
LEUPROLIDE (3 MONTH) 22.5 MG IM SYKT,,J9217,HCPCS,Facility,Outpatient,1,Each,,21025,17871.25,6025.765,21025,UnitedHealthcare,Medicare Advantage,10302.25,49,,percent of total billed charges,,
LEUPROLIDE (3 MONTH) 22.5 MG IM SYKT,,J9217,HCPCS,Facility,Inpatient,1,Each,,21025,17871.25,6025.765,21025,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
LEUPROLIDE (3 MONTH) 22.5 MG IM SYKT,,J9217,HCPCS,Facility,Outpatient,1,Each,,21025,17871.25,6025.765,21025,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,10092,48,,percent of total billed charges,,100% of DHS outpatient percentage
LEUPROLIDE (3 MONTH) 22.5 MG IM SYKT,,J9217,HCPCS,Facility,Inpatient,1,Each,,21025,17871.25,6025.765,21025,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
LEUPROLIDE (4 MONTH) 30 MG IM SYKT,,J9217,HCPCS,Facility,Both,1,Each,,28034,23828.9,8034.5444,28034,Aetna,Commercial,25791.28,92,,percent of total billed charges,,
LEUPROLIDE (4 MONTH) 30 MG IM SYKT,,J9217,HCPCS,Facility,Outpatient,1,Each,,28034,23828.9,8034.5444,28034,Aetna,Medicare Advantage,13736.66,49,,percent of total billed charges,,
LEUPROLIDE (4 MONTH) 30 MG IM SYKT,,J9217,HCPCS,Facility,Inpatient,1,Each,,28034,23828.9,8034.5444,28034,Aetna,Medicare Advantage,,,,,Included in per diem rate,
LEUPROLIDE (4 MONTH) 30 MG IM SYKT,,J9217,HCPCS,Facility,Both,1,Each,,28034,23828.9,8034.5444,28034,Aetna,PPO,26071.62,93,,percent of total billed charges,,
LEUPROLIDE (4 MONTH) 30 MG IM SYKT,,J9217,HCPCS,Facility,Both,1,Each,,28034,23828.9,8034.5444,28034,America's PPO,America's PPO,26921.0502,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
LEUPROLIDE (4 MONTH) 30 MG IM SYKT,,J9217,HCPCS,Facility,Both,1,Each,,28034,23828.9,8034.5444,28034,BlueCross BlueShield Minnesota, Federal Employee Program,27585.456,98.4,,percent of total billed charges,,
LEUPROLIDE (4 MONTH) 30 MG IM SYKT,,J9217,HCPCS,Facility,Both,1,Each,,28034,23828.9,8034.5444,28034,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,28034,100,,percent of total billed charges,,
LEUPROLIDE (4 MONTH) 30 MG IM SYKT,,J9217,HCPCS,Facility,Both,1,Each,,28034,23828.9,8034.5444,28034,BlueCross BlueShield Minnesota,High Value Network Plan,25230.6,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
LEUPROLIDE (4 MONTH) 30 MG IM SYKT,,J9217,HCPCS,Facility,Outpatient,1,Each,,28034,23828.9,8034.5444,28034,BlueCross BlueShield Minnesota,Medicare Advantage,13736.66,49,,percent of total billed charges,,
LEUPROLIDE (4 MONTH) 30 MG IM SYKT,,J9217,HCPCS,Facility,Inpatient,1,Each,,28034,23828.9,8034.5444,28034,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
LEUPROLIDE (4 MONTH) 30 MG IM SYKT,,J9217,HCPCS,Facility,Both,1,Each,,28034,23828.9,8034.5444,28034,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,24829.7138,88.57,,percent of total billed charges,,
LEUPROLIDE (4 MONTH) 30 MG IM SYKT,,J9217,HCPCS,Facility,Both,1,Each,,28034,23828.9,8034.5444,28034,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,8034.5444,28.66,,percent of total billed charges,,
LEUPROLIDE (4 MONTH) 30 MG IM SYKT,,J9217,HCPCS,Facility,Outpatient,1,Each,,28034,23828.9,8034.5444,28034,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),13736.66,49,,percent of total billed charges,,
LEUPROLIDE (4 MONTH) 30 MG IM SYKT,,J9217,HCPCS,Facility,Inpatient,1,Each,,28034,23828.9,8034.5444,28034,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
LEUPROLIDE (4 MONTH) 30 MG IM SYKT,,J9217,HCPCS,Facility,Both,1,Each,,28034,23828.9,8034.5444,28034,CorVel,Worker's Compensation,28034,100,,percent of total billed charges,,
LEUPROLIDE (4 MONTH) 30 MG IM SYKT,,J9217,HCPCS,Facility,Both,1,Each,,28034,23828.9,8034.5444,28034,First Health Group Corporation,First Health Network,27192.98,97,,percent of total billed charges,,
LEUPROLIDE (4 MONTH) 30 MG IM SYKT,,J9217,HCPCS,Facility,Both,1,Each,,28034,23828.9,8034.5444,28034,"Health Partners, Inc.",Commercial,26520.164,94.6,,percent of total billed charges,,
LEUPROLIDE (4 MONTH) 30 MG IM SYKT,,J9217,HCPCS,Facility,Outpatient,1,Each,,28034,23828.9,8034.5444,28034,"Health Partners, Inc.",Medicare Advantage,13736.66,49,,percent of total billed charges,,
LEUPROLIDE (4 MONTH) 30 MG IM SYKT,,J9217,HCPCS,Facility,Inpatient,1,Each,,28034,23828.9,8034.5444,28034,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LEUPROLIDE (4 MONTH) 30 MG IM SYKT,,J9217,HCPCS,Facility,Both,1,Each,,28034,23828.9,8034.5444,28034,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),16820.4,60,,percent of total billed charges,,
LEUPROLIDE (4 MONTH) 30 MG IM SYKT,,J9217,HCPCS,Facility,Both,1,Each,,28034,23828.9,8034.5444,28034,"Health Partners, Inc.",State of Minnesota Advantage Program,22847.71,81.5,,percent of total billed charges,,
LEUPROLIDE (4 MONTH) 30 MG IM SYKT,,J9217,HCPCS,Facility,Both,1,Each,,28034,23828.9,8034.5444,28034,"Health Partners, Inc.",State Public Programs,14017,50,,percent of total billed charges,,
LEUPROLIDE (4 MONTH) 30 MG IM SYKT,,J9217,HCPCS,Facility,Both,1,Each,,28034,23828.9,8034.5444,28034,Humana Insurance Company,Commercial PPO,26632.3,95,,percent of total billed charges,,
LEUPROLIDE (4 MONTH) 30 MG IM SYKT,,J9217,HCPCS,Facility,Outpatient,1,Each,,28034,23828.9,8034.5444,28034,Humana Insurance Company,Medicare PPO,13736.66,49,,percent of total billed charges,,
LEUPROLIDE (4 MONTH) 30 MG IM SYKT,,J9217,HCPCS,Facility,Inpatient,1,Each,,28034,23828.9,8034.5444,28034,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
LEUPROLIDE (4 MONTH) 30 MG IM SYKT,,J9217,HCPCS,Facility,Both,1,Each,,28034,23828.9,8034.5444,28034,Medica,Individual & Family,27781.694,99.1,,percent of total billed charges,,
LEUPROLIDE (4 MONTH) 30 MG IM SYKT,,J9217,HCPCS,Facility,Outpatient,1,Each,,28034,23828.9,8034.5444,28034,Medica,Medica Advantage Solution,13960.932,49.8,,percent of total billed charges,,
LEUPROLIDE (4 MONTH) 30 MG IM SYKT,,J9217,HCPCS,Facility,Inpatient,1,Each,,28034,23828.9,8034.5444,28034,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
LEUPROLIDE (4 MONTH) 30 MG IM SYKT,,J9217,HCPCS,Facility,Outpatient,1,Each,,28034,23828.9,8034.5444,28034,Medica,Medical Assistance,12503.164,44.6,,percent of total billed charges,,
LEUPROLIDE (4 MONTH) 30 MG IM SYKT,,J9217,HCPCS,Facility,Inpatient,1,Each,,28034,23828.9,8034.5444,28034,Medica,Medical Assistance,,,,,Included in per diem rate,
LEUPROLIDE (4 MONTH) 30 MG IM SYKT,,J9217,HCPCS,Facility,Outpatient,1,Each,,28034,23828.9,8034.5444,28034,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,13960.932,49.8,,percent of total billed charges,,
LEUPROLIDE (4 MONTH) 30 MG IM SYKT,,J9217,HCPCS,Facility,Inpatient,1,Each,,28034,23828.9,8034.5444,28034,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
LEUPROLIDE (4 MONTH) 30 MG IM SYKT,,J9217,HCPCS,Facility,Both,1,Each,,28034,23828.9,8034.5444,28034,"Multiplan, Inc.","Multiplan, Inc.",26351.96,94,,percent of total billed charges,,
LEUPROLIDE (4 MONTH) 30 MG IM SYKT,,J9217,HCPCS,Facility,Outpatient,1,Each,,28034,23828.9,8034.5444,28034,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,25258.634,90.1,,percent of total billed charges,,
LEUPROLIDE (4 MONTH) 30 MG IM SYKT,,J9217,HCPCS,Facility,Inpatient,1,Each,,28034,23828.9,8034.5444,28034,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
LEUPROLIDE (4 MONTH) 30 MG IM SYKT,,J9217,HCPCS,Facility,Both,1,Each,,28034,23828.9,8034.5444,28034,"Preferred One Administrative Services, INC.",PPO,27641.524,98.6,,percent of total billed charges,,
LEUPROLIDE (4 MONTH) 30 MG IM SYKT,,J9217,HCPCS,Facility,Outpatient,1,Each,,28034,23828.9,8034.5444,28034,PrimeWest Health,Minnesota Senior Health Options (MSHO),14423.493,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
LEUPROLIDE (4 MONTH) 30 MG IM SYKT,,J9217,HCPCS,Facility,Inpatient,1,Each,,28034,23828.9,8034.5444,28034,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LEUPROLIDE (4 MONTH) 30 MG IM SYKT,,J9217,HCPCS,Facility,Outpatient,1,Each,,28034,23828.9,8034.5444,28034,PrimeWest Health,MinnesotaCare,14398.2624,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
LEUPROLIDE (4 MONTH) 30 MG IM SYKT,,J9217,HCPCS,Facility,Inpatient,1,Each,,28034,23828.9,8034.5444,28034,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
LEUPROLIDE (4 MONTH) 30 MG IM SYKT,,J9217,HCPCS,Facility,Both,1,Each,,28034,23828.9,8034.5444,28034,Sanford Health Plan,Sanford Health Plan,25791.28,92,,percent of total billed charges,,
LEUPROLIDE (4 MONTH) 30 MG IM SYKT,,J9217,HCPCS,Facility,Outpatient,1,Each,,28034,23828.9,8034.5444,28034,"UCare Health, Inc.",Individual & Family Plan,15797.159,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
LEUPROLIDE (4 MONTH) 30 MG IM SYKT,,J9217,HCPCS,Facility,Inpatient,1,Each,,28034,23828.9,8034.5444,28034,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
LEUPROLIDE (4 MONTH) 30 MG IM SYKT,,J9217,HCPCS,Facility,Outpatient,1,Each,,28034,23828.9,8034.5444,28034,"UCare Health, Inc.",Medical Assistance,14148.7598,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LEUPROLIDE (4 MONTH) 30 MG IM SYKT,,J9217,HCPCS,Facility,Inpatient,1,Each,,28034,23828.9,8034.5444,28034,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
LEUPROLIDE (4 MONTH) 30 MG IM SYKT,,J9217,HCPCS,Facility,Outpatient,1,Each,,28034,23828.9,8034.5444,28034,"UCare Health, Inc.",Medicare Advantage,14148.7598,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LEUPROLIDE (4 MONTH) 30 MG IM SYKT,,J9217,HCPCS,Facility,Inpatient,1,Each,,28034,23828.9,8034.5444,28034,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LEUPROLIDE (4 MONTH) 30 MG IM SYKT,,J9217,HCPCS,Facility,Outpatient,1,Each,,28034,23828.9,8034.5444,28034,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),14148.7598,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LEUPROLIDE (4 MONTH) 30 MG IM SYKT,,J9217,HCPCS,Facility,Inpatient,1,Each,,28034,23828.9,8034.5444,28034,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LEUPROLIDE (4 MONTH) 30 MG IM SYKT,,J9217,HCPCS,Facility,Both,1,Each,,28034,23828.9,8034.5444,28034,UnitedHealthcare,Individual & Family,26351.96,94,,percent of total billed charges,,
LEUPROLIDE (4 MONTH) 30 MG IM SYKT,,J9217,HCPCS,Facility,Outpatient,1,Each,,28034,23828.9,8034.5444,28034,UnitedHealthcare,Medicare Advantage,13736.66,49,,percent of total billed charges,,
LEUPROLIDE (4 MONTH) 30 MG IM SYKT,,J9217,HCPCS,Facility,Inpatient,1,Each,,28034,23828.9,8034.5444,28034,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
LEUPROLIDE (4 MONTH) 30 MG IM SYKT,,J9217,HCPCS,Facility,Outpatient,1,Each,,28034,23828.9,8034.5444,28034,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,13456.32,48,,percent of total billed charges,,100% of DHS outpatient percentage
LEUPROLIDE (4 MONTH) 30 MG IM SYKT,,J9217,HCPCS,Facility,Inpatient,1,Each,,28034,23828.9,8034.5444,28034,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Closed Treatment Of Nasal Septal Fracture,,21337,CPT,Facility,Both,,,,689,585.65,197.4674,689,Aetna,Commercial,633.88,92,,percent of total billed charges,,
Closed Treatment Of Nasal Septal Fracture,,21337,CPT,Facility,Outpatient,,,,689,585.65,197.4674,689,Aetna,Medicare Advantage,337.61,49,,percent of total billed charges,,
Closed Treatment Of Nasal Septal Fracture,,21337,CPT,Facility,Inpatient,,,,689,585.65,197.4674,689,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Closed Treatment Of Nasal Septal Fracture,,21337,CPT,Facility,Both,,,,689,585.65,197.4674,689,Aetna,PPO,640.77,93,,percent of total billed charges,,
Closed Treatment Of Nasal Septal Fracture,,21337,CPT,Facility,Both,,,,689,585.65,197.4674,689,America's PPO,America's PPO,661.6467,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Closed Treatment Of Nasal Septal Fracture,,21337,CPT,Facility,Both,,,,689,585.65,197.4674,689,BlueCross BlueShield Minnesota, Federal Employee Program,677.976,98.4,,percent of total billed charges,,
Closed Treatment Of Nasal Septal Fracture,,21337,CPT,Facility,Both,,,,689,585.65,197.4674,689,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,689,100,,percent of total billed charges,,
Closed Treatment Of Nasal Septal Fracture,,21337,CPT,Facility,Both,,,,689,585.65,197.4674,689,BlueCross BlueShield Minnesota,High Value Network Plan,620.1,90,,percent of total billed charges,,
Closed Treatment Of Nasal Septal Fracture,,21337,CPT,Facility,Outpatient,,,,689,585.65,197.4674,689,BlueCross BlueShield Minnesota,Medicare Advantage,337.61,49,,percent of total billed charges,,
Closed Treatment Of Nasal Septal Fracture,,21337,CPT,Facility,Inpatient,,,,689,585.65,197.4674,689,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Closed Treatment Of Nasal Septal Fracture,,21337,CPT,Facility,Both,,,,689,585.65,197.4674,689,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,610.2473,88.57,,percent of total billed charges,,
Closed Treatment Of Nasal Septal Fracture,,21337,CPT,Facility,Both,,,,689,585.65,197.4674,689,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,197.4674,28.66,,percent of total billed charges,,
Closed Treatment Of Nasal Septal Fracture,,21337,CPT,Facility,Outpatient,,,,689,585.65,197.4674,689,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),337.61,49,,percent of total billed charges,,
Closed Treatment Of Nasal Septal Fracture,,21337,CPT,Facility,Inpatient,,,,689,585.65,197.4674,689,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Closed Treatment Of Nasal Septal Fracture,,21337,CPT,Facility,Both,,,,689,585.65,197.4674,689,CorVel,Worker's Compensation,689,100,,percent of total billed charges,,
Closed Treatment Of Nasal Septal Fracture,,21337,CPT,Facility,Both,,,,689,585.65,197.4674,689,First Health Group Corporation,First Health Network,668.33,97,,percent of total billed charges,,
Closed Treatment Of Nasal Septal Fracture,,21337,CPT,Facility,Both,,,,689,585.65,197.4674,689,"Health Partners, Inc.",Commercial,651.794,94.6,,percent of total billed charges,,
Closed Treatment Of Nasal Septal Fracture,,21337,CPT,Facility,Outpatient,,,,689,585.65,197.4674,689,"Health Partners, Inc.",Medicare Advantage,337.61,49,,percent of total billed charges,,
Closed Treatment Of Nasal Septal Fracture,,21337,CPT,Facility,Inpatient,,,,689,585.65,197.4674,689,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Closed Treatment Of Nasal Septal Fracture,,21337,CPT,Facility,Both,,,,689,585.65,197.4674,689,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),413.4,60,,percent of total billed charges,,
Closed Treatment Of Nasal Septal Fracture,,21337,CPT,Facility,Both,,,,689,585.65,197.4674,689,"Health Partners, Inc.",State of Minnesota Advantage Program,561.535,81.5,,percent of total billed charges,,
Closed Treatment Of Nasal Septal Fracture,,21337,CPT,Facility,Both,,,,689,585.65,197.4674,689,"Health Partners, Inc.",State Public Programs,344.5,50,,percent of total billed charges,,
Closed Treatment Of Nasal Septal Fracture,,21337,CPT,Facility,Both,,,,689,585.65,197.4674,689,Humana Insurance Company,Commercial PPO,654.55,95,,percent of total billed charges,,
Closed Treatment Of Nasal Septal Fracture,,21337,CPT,Facility,Outpatient,,,,689,585.65,197.4674,689,Humana Insurance Company,Medicare PPO,337.61,49,,percent of total billed charges,,
Closed Treatment Of Nasal Septal Fracture,,21337,CPT,Facility,Inpatient,,,,689,585.65,197.4674,689,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Closed Treatment Of Nasal Septal Fracture,,21337,CPT,Facility,Both,,,,689,585.65,197.4674,689,Medica,Individual & Family,682.799,99.1,,percent of total billed charges,,
Closed Treatment Of Nasal Septal Fracture,,21337,CPT,Facility,Outpatient,,,,689,585.65,197.4674,689,Medica,Medica Advantage Solution,343.122,49.8,,percent of total billed charges,,
Closed Treatment Of Nasal Septal Fracture,,21337,CPT,Facility,Inpatient,,,,689,585.65,197.4674,689,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Closed Treatment Of Nasal Septal Fracture,,21337,CPT,Facility,Outpatient,,,,689,585.65,197.4674,689,Medica,Medical Assistance,307.294,44.6,,percent of total billed charges,,
Closed Treatment Of Nasal Septal Fracture,,21337,CPT,Facility,Inpatient,,,,689,585.65,197.4674,689,Medica,Medical Assistance,,,,,Included in per diem rate,
Closed Treatment Of Nasal Septal Fracture,,21337,CPT,Facility,Outpatient,,,,689,585.65,197.4674,689,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,343.122,49.8,,percent of total billed charges,,
Closed Treatment Of Nasal Septal Fracture,,21337,CPT,Facility,Inpatient,,,,689,585.65,197.4674,689,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Closed Treatment Of Nasal Septal Fracture,,21337,CPT,Facility,Both,,,,689,585.65,197.4674,689,"Multiplan, Inc.","Multiplan, Inc.",647.66,94,,percent of total billed charges,,
Closed Treatment Of Nasal Septal Fracture,,21337,CPT,Facility,Outpatient,,,,689,585.65,197.4674,689,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,620.789,90.1,,percent of total billed charges,,
Closed Treatment Of Nasal Septal Fracture,,21337,CPT,Facility,Inpatient,,,,689,585.65,197.4674,689,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Closed Treatment Of Nasal Septal Fracture,,21337,CPT,Facility,Both,,,,689,585.65,197.4674,689,"Preferred One Administrative Services, INC.",PPO,679.354,98.6,,percent of total billed charges,,
Closed Treatment Of Nasal Septal Fracture,,21337,CPT,Facility,Outpatient,,,,689,585.65,197.4674,689,PrimeWest Health,Minnesota Senior Health Options (MSHO),354.4905,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Closed Treatment Of Nasal Septal Fracture,,21337,CPT,Facility,Inpatient,,,,689,585.65,197.4674,689,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Closed Treatment Of Nasal Septal Fracture,,21337,CPT,Facility,Outpatient,,,,689,585.65,197.4674,689,PrimeWest Health,MinnesotaCare,353.8704,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Closed Treatment Of Nasal Septal Fracture,,21337,CPT,Facility,Inpatient,,,,689,585.65,197.4674,689,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Closed Treatment Of Nasal Septal Fracture,,21337,CPT,Facility,Both,,,,689,585.65,197.4674,689,Sanford Health Plan,Sanford Health Plan,633.88,92,,percent of total billed charges,,
Closed Treatment Of Nasal Septal Fracture,,21337,CPT,Facility,Outpatient,,,,689,585.65,197.4674,689,"UCare Health, Inc.",Individual & Family Plan,388.2515,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Closed Treatment Of Nasal Septal Fracture,,21337,CPT,Facility,Inpatient,,,,689,585.65,197.4674,689,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Closed Treatment Of Nasal Septal Fracture,,21337,CPT,Facility,Outpatient,,,,689,585.65,197.4674,689,"UCare Health, Inc.",Medical Assistance,347.7383,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Closed Treatment Of Nasal Septal Fracture,,21337,CPT,Facility,Inpatient,,,,689,585.65,197.4674,689,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Closed Treatment Of Nasal Septal Fracture,,21337,CPT,Facility,Outpatient,,,,689,585.65,197.4674,689,"UCare Health, Inc.",Medicare Advantage,347.7383,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Closed Treatment Of Nasal Septal Fracture,,21337,CPT,Facility,Inpatient,,,,689,585.65,197.4674,689,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Closed Treatment Of Nasal Septal Fracture,,21337,CPT,Facility,Outpatient,,,,689,585.65,197.4674,689,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),347.7383,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Closed Treatment Of Nasal Septal Fracture,,21337,CPT,Facility,Inpatient,,,,689,585.65,197.4674,689,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Closed Treatment Of Nasal Septal Fracture,,21337,CPT,Facility,Both,,,,689,585.65,197.4674,689,UnitedHealthcare,Individual & Family,647.66,94,,percent of total billed charges,,
Closed Treatment Of Nasal Septal Fracture,,21337,CPT,Facility,Outpatient,,,,689,585.65,197.4674,689,UnitedHealthcare,Medicare Advantage,337.61,49,,percent of total billed charges,,
Closed Treatment Of Nasal Septal Fracture,,21337,CPT,Facility,Inpatient,,,,689,585.65,197.4674,689,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Closed Treatment Of Nasal Septal Fracture,,21337,CPT,Facility,Outpatient,,,,689,585.65,197.4674,689,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,330.72,48,,percent of total billed charges,,100% of DHS outpatient percentage
Closed Treatment Of Nasal Septal Fracture,,21337,CPT,Facility,Inpatient,,,,689,585.65,197.4674,689,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Closed Treatment Of Nasal Septal Fracture, With Or Without Stabilization (Pro Cah)",,21337,CPT,Professional,Both,,,,1030,875.5,191.97,1030,Aetna,Commercial,875.5,85,,percent of total billed charges,,
"Closed Treatment Of Nasal Septal Fracture, With Or Without Stabilization (Pro Cah)",,21337,CPT,Professional,Both,,,,1030,875.5,191.97,1030,Aetna,Medicare Advantage,293.99,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Closed Treatment Of Nasal Septal Fracture, With Or Without Stabilization (Pro Cah)",,21337,CPT,Professional,Both,,,,1030,875.5,191.97,1030,Aetna,PPO,957.9,93,,percent of total billed charges,,
"Closed Treatment Of Nasal Septal Fracture, With Or Without Stabilization (Pro Cah)",,21337,CPT,Professional,Both,,,,1030,875.5,191.97,1030,America's PPO,America's PPO,880.032,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Closed Treatment Of Nasal Septal Fracture, With Or Without Stabilization (Pro Cah)",,21337,CPT,Professional,Both,,,,1030,875.5,191.97,1030,BlueCross BlueShield Minnesota, Federal Employee Program,623.18,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Closed Treatment Of Nasal Septal Fracture, With Or Without Stabilization (Pro Cah)",,21337,CPT,Professional,Both,,,,1030,875.5,191.97,1030,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,633.15088,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Closed Treatment Of Nasal Septal Fracture, With Or Without Stabilization (Pro Cah)",,21337,CPT,Professional,Both,,,,1030,875.5,191.97,1030,BlueCross BlueShield Minnesota,High Value Network Plan,633.15088,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Closed Treatment Of Nasal Septal Fracture, With Or Without Stabilization (Pro Cah)",,21337,CPT,Professional,Both,,,,1030,875.5,191.97,1030,BlueCross BlueShield Minnesota,Medicare Advantage,343.1025,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Closed Treatment Of Nasal Septal Fracture, With Or Without Stabilization (Pro Cah)",,21337,CPT,Professional,Both,,,,1030,875.5,191.97,1030,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,633.15088,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Closed Treatment Of Nasal Septal Fracture, With Or Without Stabilization (Pro Cah)",,21337,CPT,Professional,Both,,,,1030,875.5,191.97,1030,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,221.6404,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Closed Treatment Of Nasal Septal Fracture, With Or Without Stabilization (Pro Cah)",,21337,CPT,Professional,Both,,,,1030,875.5,191.97,1030,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),343.1025,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Closed Treatment Of Nasal Septal Fracture, With Or Without Stabilization (Pro Cah)",,21337,CPT,Professional,Both,,,,1030,875.5,191.97,1030,CorVel,Worker's Compensation,578.2107789,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Closed Treatment Of Nasal Septal Fracture, With Or Without Stabilization (Pro Cah)",,21337,CPT,Professional,Both,,,,1030,875.5,191.97,1030,First Health Group Corporation,First Health Network,999.1,97,,percent of total billed charges,,
"Closed Treatment Of Nasal Septal Fracture, With Or Without Stabilization (Pro Cah)",,21337,CPT,Professional,Both,,,,1030,875.5,191.97,1030,"Health Partners, Inc.",Commercial,623.96,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Closed Treatment Of Nasal Septal Fracture, With Or Without Stabilization (Pro Cah)",,21337,CPT,Professional,Both,,,,1030,875.5,191.97,1030,"Health Partners, Inc.",Medicare Advantage,343.1025,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Closed Treatment Of Nasal Septal Fracture, With Or Without Stabilization (Pro Cah)",,21337,CPT,Professional,Both,,,,1030,875.5,191.97,1030,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),298.55,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Closed Treatment Of Nasal Septal Fracture, With Or Without Stabilization (Pro Cah)",,21337,CPT,Professional,Both,,,,1030,875.5,191.97,1030,"Health Partners, Inc.",State of Minnesota Advantage Program,537.54154,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Closed Treatment Of Nasal Septal Fracture, With Or Without Stabilization (Pro Cah)",,21337,CPT,Professional,Both,,,,1030,875.5,191.97,1030,"Health Partners, Inc.",State Public Programs,191.97,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Closed Treatment Of Nasal Septal Fracture, With Or Without Stabilization (Pro Cah)",,21337,CPT,Professional,Both,,,,1030,875.5,191.97,1030,Humana Insurance Company,Commercial PPO,298.35,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Closed Treatment Of Nasal Septal Fracture, With Or Without Stabilization (Pro Cah)",,21337,CPT,Professional,Both,,,,1030,875.5,191.97,1030,Humana Insurance Company,Medicare PPO,1030,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Closed Treatment Of Nasal Septal Fracture, With Or Without Stabilization (Pro Cah)",,21337,CPT,Professional,Both,,,,1030,875.5,191.97,1030,Medica,Individual & Family,873.44,84.8,,percent of total billed charges,,
"Closed Treatment Of Nasal Septal Fracture, With Or Without Stabilization (Pro Cah)",,21337,CPT,Professional,Both,,,,1030,875.5,191.97,1030,Medica,Medica Advantage Solution,512.94,49.8,,percent of total billed charges,,
"Closed Treatment Of Nasal Septal Fracture, With Or Without Stabilization (Pro Cah)",,21337,CPT,Professional,Both,,,,1030,875.5,191.97,1030,Medica,Medical Assistance,221.64,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Closed Treatment Of Nasal Septal Fracture, With Or Without Stabilization (Pro Cah)",,21337,CPT,Professional,Both,,,,1030,875.5,191.97,1030,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,298.35,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Closed Treatment Of Nasal Septal Fracture, With Or Without Stabilization (Pro Cah)",,21337,CPT,Professional,Both,,,,1030,875.5,191.97,1030,"Multiplan, Inc.","Multiplan, Inc.",968.2,94,,percent of total billed charges,,
"Closed Treatment Of Nasal Septal Fracture, With Or Without Stabilization (Pro Cah)",,21337,CPT,Professional,Both,,,,1030,875.5,191.97,1030,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,928.03,90.1,,percent of total billed charges,,
"Closed Treatment Of Nasal Septal Fracture, With Or Without Stabilization (Pro Cah)",,21337,CPT,Professional,Both,,,,1030,875.5,191.97,1030,"Preferred One Administrative Services, INC.",PPO,1015.58,98.6,,percent of total billed charges,,
"Closed Treatment Of Nasal Septal Fracture, With Or Without Stabilization (Pro Cah)",,21337,CPT,Professional,Both,,,,1030,875.5,191.97,1030,PrimeWest Health,Minnesota Senior Health Options (MSHO),343.1025,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Closed Treatment Of Nasal Septal Fracture, With Or Without Stabilization (Pro Cah)",,21337,CPT,Professional,Both,,,,1030,875.5,191.97,1030,PrimeWest Health,MinnesotaCare,237.155228,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Closed Treatment Of Nasal Septal Fracture, With Or Without Stabilization (Pro Cah)",,21337,CPT,Professional,Both,,,,1030,875.5,191.97,1030,Sanford Health Plan,Sanford Health Plan,906.4,88,,percent of total billed charges,,
"Closed Treatment Of Nasal Septal Fracture, With Or Without Stabilization (Pro Cah)",,21337,CPT,Professional,Both,,,,1030,875.5,191.97,1030,"UCare Health, Inc.",Individual & Family Plan,484.99776,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Closed Treatment Of Nasal Septal Fracture, With Or Without Stabilization (Pro Cah)",,21337,CPT,Professional,Both,,,,1030,875.5,191.97,1030,"UCare Health, Inc.",Medical Assistance,243.80444,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Closed Treatment Of Nasal Septal Fracture, With Or Without Stabilization (Pro Cah)",,21337,CPT,Professional,Both,,,,1030,875.5,191.97,1030,"UCare Health, Inc.",Medicare Advantage,343.1025,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Closed Treatment Of Nasal Septal Fracture, With Or Without Stabilization (Pro Cah)",,21337,CPT,Professional,Both,,,,1030,875.5,191.97,1030,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),274.482,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Closed Treatment Of Nasal Septal Fracture, With Or Without Stabilization (Pro Cah)",,21337,CPT,Professional,Both,,,,1030,875.5,191.97,1030,UnitedHealthcare,Individual & Family,1030,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Closed Treatment Of Nasal Septal Fracture, With Or Without Stabilization (Pro Cah)",,21337,CPT,Professional,Both,,,,1030,875.5,191.97,1030,UnitedHealthcare,Medicare Advantage,343.1025,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Closed Treatment Of Nasal Septal Fracture, With Or Without Stabilization (Pro Cah)",,21337,CPT,Professional,Both,,,,1030,875.5,191.97,1030,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,221.6404,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Incision And Drainage, Deep Abscess Or Hematoma, Soft Tissues Of Neck Or Thorax (Pro Cah)",,21501,CPT,Professional,Both,,,,1428,1213.8,210.51,1428,Aetna,Commercial,1213.8,85,,percent of total billed charges,,
"Incision And Drainage, Deep Abscess Or Hematoma, Soft Tissues Of Neck Or Thorax (Pro Cah)",,21501,CPT,Professional,Both,,,,1428,1213.8,210.51,1428,Aetna,Medicare Advantage,322.49,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Incision And Drainage, Deep Abscess Or Hematoma, Soft Tissues Of Neck Or Thorax (Pro Cah)",,21501,CPT,Professional,Both,,,,1428,1213.8,210.51,1428,Aetna,PPO,1328.04,93,,percent of total billed charges,,
"Incision And Drainage, Deep Abscess Or Hematoma, Soft Tissues Of Neck Or Thorax (Pro Cah)",,21501,CPT,Professional,Both,,,,1428,1213.8,210.51,1428,America's PPO,America's PPO,1220.0832,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Incision And Drainage, Deep Abscess Or Hematoma, Soft Tissues Of Neck Or Thorax (Pro Cah)",,21501,CPT,Professional,Both,,,,1428,1213.8,210.51,1428,BlueCross BlueShield Minnesota, Federal Employee Program,694.8,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Incision And Drainage, Deep Abscess Or Hematoma, Soft Tissues Of Neck Or Thorax (Pro Cah)",,21501,CPT,Professional,Both,,,,1428,1213.8,210.51,1428,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,705.9168,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Incision And Drainage, Deep Abscess Or Hematoma, Soft Tissues Of Neck Or Thorax (Pro Cah)",,21501,CPT,Professional,Both,,,,1428,1213.8,210.51,1428,BlueCross BlueShield Minnesota,High Value Network Plan,705.9168,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Incision And Drainage, Deep Abscess Or Hematoma, Soft Tissues Of Neck Or Thorax (Pro Cah)",,21501,CPT,Professional,Both,,,,1428,1213.8,210.51,1428,BlueCross BlueShield Minnesota,Medicare Advantage,376.395,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Incision And Drainage, Deep Abscess Or Hematoma, Soft Tissues Of Neck Or Thorax (Pro Cah)",,21501,CPT,Professional,Both,,,,1428,1213.8,210.51,1428,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,705.9168,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Incision And Drainage, Deep Abscess Or Hematoma, Soft Tissues Of Neck Or Thorax (Pro Cah)",,21501,CPT,Professional,Both,,,,1428,1213.8,210.51,1428,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,243.04752,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Incision And Drainage, Deep Abscess Or Hematoma, Soft Tissues Of Neck Or Thorax (Pro Cah)",,21501,CPT,Professional,Both,,,,1428,1213.8,210.51,1428,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),376.395,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Incision And Drainage, Deep Abscess Or Hematoma, Soft Tissues Of Neck Or Thorax (Pro Cah)",,21501,CPT,Professional,Both,,,,1428,1213.8,210.51,1428,CorVel,Worker's Compensation,635.1299652,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Incision And Drainage, Deep Abscess Or Hematoma, Soft Tissues Of Neck Or Thorax (Pro Cah)",,21501,CPT,Professional,Both,,,,1428,1213.8,210.51,1428,First Health Group Corporation,First Health Network,1385.16,97,,percent of total billed charges,,
"Incision And Drainage, Deep Abscess Or Hematoma, Soft Tissues Of Neck Or Thorax (Pro Cah)",,21501,CPT,Professional,Both,,,,1428,1213.8,210.51,1428,"Health Partners, Inc.",Commercial,686.35,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Incision And Drainage, Deep Abscess Or Hematoma, Soft Tissues Of Neck Or Thorax (Pro Cah)",,21501,CPT,Professional,Both,,,,1428,1213.8,210.51,1428,"Health Partners, Inc.",Medicare Advantage,376.395,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Incision And Drainage, Deep Abscess Or Hematoma, Soft Tissues Of Neck Or Thorax (Pro Cah)",,21501,CPT,Professional,Both,,,,1428,1213.8,210.51,1428,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),327.35,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Incision And Drainage, Deep Abscess Or Hematoma, Soft Tissues Of Neck Or Thorax (Pro Cah)",,21501,CPT,Professional,Both,,,,1428,1213.8,210.51,1428,"Health Partners, Inc.",State of Minnesota Advantage Program,591.290525,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Incision And Drainage, Deep Abscess Or Hematoma, Soft Tissues Of Neck Or Thorax (Pro Cah)",,21501,CPT,Professional,Both,,,,1428,1213.8,210.51,1428,"Health Partners, Inc.",State Public Programs,210.51,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Incision And Drainage, Deep Abscess Or Hematoma, Soft Tissues Of Neck Or Thorax (Pro Cah)",,21501,CPT,Professional,Both,,,,1428,1213.8,210.51,1428,Humana Insurance Company,Commercial PPO,327.3,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Incision And Drainage, Deep Abscess Or Hematoma, Soft Tissues Of Neck Or Thorax (Pro Cah)",,21501,CPT,Professional,Both,,,,1428,1213.8,210.51,1428,Humana Insurance Company,Medicare PPO,1428,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Incision And Drainage, Deep Abscess Or Hematoma, Soft Tissues Of Neck Or Thorax (Pro Cah)",,21501,CPT,Professional,Both,,,,1428,1213.8,210.51,1428,Medica,Individual & Family,1210.944,84.8,,percent of total billed charges,,
"Incision And Drainage, Deep Abscess Or Hematoma, Soft Tissues Of Neck Or Thorax (Pro Cah)",,21501,CPT,Professional,Both,,,,1428,1213.8,210.51,1428,Medica,Medica Advantage Solution,711.144,49.8,,percent of total billed charges,,
"Incision And Drainage, Deep Abscess Or Hematoma, Soft Tissues Of Neck Or Thorax (Pro Cah)",,21501,CPT,Professional,Both,,,,1428,1213.8,210.51,1428,Medica,Medical Assistance,243.05,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Incision And Drainage, Deep Abscess Or Hematoma, Soft Tissues Of Neck Or Thorax (Pro Cah)",,21501,CPT,Professional,Both,,,,1428,1213.8,210.51,1428,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,327.3,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Incision And Drainage, Deep Abscess Or Hematoma, Soft Tissues Of Neck Or Thorax (Pro Cah)",,21501,CPT,Professional,Both,,,,1428,1213.8,210.51,1428,"Multiplan, Inc.","Multiplan, Inc.",1342.32,94,,percent of total billed charges,,
"Incision And Drainage, Deep Abscess Or Hematoma, Soft Tissues Of Neck Or Thorax (Pro Cah)",,21501,CPT,Professional,Both,,,,1428,1213.8,210.51,1428,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1286.628,90.1,,percent of total billed charges,,
"Incision And Drainage, Deep Abscess Or Hematoma, Soft Tissues Of Neck Or Thorax (Pro Cah)",,21501,CPT,Professional,Both,,,,1428,1213.8,210.51,1428,"Preferred One Administrative Services, INC.",PPO,1408.008,98.6,,percent of total billed charges,,
"Incision And Drainage, Deep Abscess Or Hematoma, Soft Tissues Of Neck Or Thorax (Pro Cah)",,21501,CPT,Professional,Both,,,,1428,1213.8,210.51,1428,PrimeWest Health,Minnesota Senior Health Options (MSHO),376.395,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Incision And Drainage, Deep Abscess Or Hematoma, Soft Tissues Of Neck Or Thorax (Pro Cah)",,21501,CPT,Professional,Both,,,,1428,1213.8,210.51,1428,PrimeWest Health,MinnesotaCare,260.0608464,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Incision And Drainage, Deep Abscess Or Hematoma, Soft Tissues Of Neck Or Thorax (Pro Cah)",,21501,CPT,Professional,Both,,,,1428,1213.8,210.51,1428,Sanford Health Plan,Sanford Health Plan,1256.64,88,,percent of total billed charges,,
"Incision And Drainage, Deep Abscess Or Hematoma, Soft Tissues Of Neck Or Thorax (Pro Cah)",,21501,CPT,Professional,Both,,,,1428,1213.8,210.51,1428,"UCare Health, Inc.",Individual & Family Plan,532.05888,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Incision And Drainage, Deep Abscess Or Hematoma, Soft Tissues Of Neck Or Thorax (Pro Cah)",,21501,CPT,Professional,Both,,,,1428,1213.8,210.51,1428,"UCare Health, Inc.",Medical Assistance,267.352272,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Incision And Drainage, Deep Abscess Or Hematoma, Soft Tissues Of Neck Or Thorax (Pro Cah)",,21501,CPT,Professional,Both,,,,1428,1213.8,210.51,1428,"UCare Health, Inc.",Medicare Advantage,376.395,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Incision And Drainage, Deep Abscess Or Hematoma, Soft Tissues Of Neck Or Thorax (Pro Cah)",,21501,CPT,Professional,Both,,,,1428,1213.8,210.51,1428,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),301.116,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Incision And Drainage, Deep Abscess Or Hematoma, Soft Tissues Of Neck Or Thorax (Pro Cah)",,21501,CPT,Professional,Both,,,,1428,1213.8,210.51,1428,UnitedHealthcare,Individual & Family,1428,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Incision And Drainage, Deep Abscess Or Hematoma, Soft Tissues Of Neck Or Thorax (Pro Cah)",,21501,CPT,Professional,Both,,,,1428,1213.8,210.51,1428,UnitedHealthcare,Medicare Advantage,376.395,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Incision And Drainage, Deep Abscess Or Hematoma, Soft Tissues Of Neck Or Thorax (Pro Cah)",,21501,CPT,Professional,Both,,,,1428,1213.8,210.51,1428,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,243.04752,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"I&D, Deep Abscess Or Hematoma, Soft Tissues Of Neck Or Thorax; With Partial Rib Ostectomy (Pro Cah)",,21502,CPT,Professional,Both,,,,1530,1300.5,307.38,1530,Aetna,Commercial,1300.5,85,,percent of total billed charges,,
"I&D, Deep Abscess Or Hematoma, Soft Tissues Of Neck Or Thorax; With Partial Rib Ostectomy (Pro Cah)",,21502,CPT,Professional,Both,,,,1530,1300.5,307.38,1530,Aetna,Medicare Advantage,487.29,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"I&D, Deep Abscess Or Hematoma, Soft Tissues Of Neck Or Thorax; With Partial Rib Ostectomy (Pro Cah)",,21502,CPT,Professional,Both,,,,1530,1300.5,307.38,1530,Aetna,PPO,1422.9,93,,percent of total billed charges,,
"I&D, Deep Abscess Or Hematoma, Soft Tissues Of Neck Or Thorax; With Partial Rib Ostectomy (Pro Cah)",,21502,CPT,Professional,Both,,,,1530,1300.5,307.38,1530,America's PPO,America's PPO,1307.232,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"I&D, Deep Abscess Or Hematoma, Soft Tissues Of Neck Or Thorax; With Partial Rib Ostectomy (Pro Cah)",,21502,CPT,Professional,Both,,,,1530,1300.5,307.38,1530,BlueCross BlueShield Minnesota, Federal Employee Program,1046.67,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"I&D, Deep Abscess Or Hematoma, Soft Tissues Of Neck Or Thorax; With Partial Rib Ostectomy (Pro Cah)",,21502,CPT,Professional,Both,,,,1530,1300.5,307.38,1530,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1063.41672,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"I&D, Deep Abscess Or Hematoma, Soft Tissues Of Neck Or Thorax; With Partial Rib Ostectomy (Pro Cah)",,21502,CPT,Professional,Both,,,,1530,1300.5,307.38,1530,BlueCross BlueShield Minnesota,High Value Network Plan,1063.41672,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"I&D, Deep Abscess Or Hematoma, Soft Tissues Of Neck Or Thorax; With Partial Rib Ostectomy (Pro Cah)",,21502,CPT,Professional,Both,,,,1530,1300.5,307.38,1530,BlueCross BlueShield Minnesota,Medicare Advantage,549.1365,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"I&D, Deep Abscess Or Hematoma, Soft Tissues Of Neck Or Thorax; With Partial Rib Ostectomy (Pro Cah)",,21502,CPT,Professional,Both,,,,1530,1300.5,307.38,1530,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1063.41672,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"I&D, Deep Abscess Or Hematoma, Soft Tissues Of Neck Or Thorax; With Partial Rib Ostectomy (Pro Cah)",,21502,CPT,Professional,Both,,,,1530,1300.5,307.38,1530,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,354.87864,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"I&D, Deep Abscess Or Hematoma, Soft Tissues Of Neck Or Thorax; With Partial Rib Ostectomy (Pro Cah)",,21502,CPT,Professional,Both,,,,1530,1300.5,307.38,1530,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),549.1365,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"I&D, Deep Abscess Or Hematoma, Soft Tissues Of Neck Or Thorax; With Partial Rib Ostectomy (Pro Cah)",,21502,CPT,Professional,Both,,,,1530,1300.5,307.38,1530,CorVel,Worker's Compensation,946.0310121,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"I&D, Deep Abscess Or Hematoma, Soft Tissues Of Neck Or Thorax; With Partial Rib Ostectomy (Pro Cah)",,21502,CPT,Professional,Both,,,,1530,1300.5,307.38,1530,First Health Group Corporation,First Health Network,1484.1,97,,percent of total billed charges,,
"I&D, Deep Abscess Or Hematoma, Soft Tissues Of Neck Or Thorax; With Partial Rib Ostectomy (Pro Cah)",,21502,CPT,Professional,Both,,,,1530,1300.5,307.38,1530,"Health Partners, Inc.",Commercial,1022.27,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"I&D, Deep Abscess Or Hematoma, Soft Tissues Of Neck Or Thorax; With Partial Rib Ostectomy (Pro Cah)",,21502,CPT,Professional,Both,,,,1530,1300.5,307.38,1530,"Health Partners, Inc.",Medicare Advantage,549.1365,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"I&D, Deep Abscess Or Hematoma, Soft Tissues Of Neck Or Thorax; With Partial Rib Ostectomy (Pro Cah)",,21502,CPT,Professional,Both,,,,1530,1300.5,307.38,1530,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),477.47,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"I&D, Deep Abscess Or Hematoma, Soft Tissues Of Neck Or Thorax; With Partial Rib Ostectomy (Pro Cah)",,21502,CPT,Professional,Both,,,,1530,1300.5,307.38,1530,"Health Partners, Inc.",State of Minnesota Advantage Program,880.685605,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"I&D, Deep Abscess Or Hematoma, Soft Tissues Of Neck Or Thorax; With Partial Rib Ostectomy (Pro Cah)",,21502,CPT,Professional,Both,,,,1530,1300.5,307.38,1530,"Health Partners, Inc.",State Public Programs,307.38,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"I&D, Deep Abscess Or Hematoma, Soft Tissues Of Neck Or Thorax; With Partial Rib Ostectomy (Pro Cah)",,21502,CPT,Professional,Both,,,,1530,1300.5,307.38,1530,Humana Insurance Company,Commercial PPO,477.51,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"I&D, Deep Abscess Or Hematoma, Soft Tissues Of Neck Or Thorax; With Partial Rib Ostectomy (Pro Cah)",,21502,CPT,Professional,Both,,,,1530,1300.5,307.38,1530,Humana Insurance Company,Medicare PPO,1530,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"I&D, Deep Abscess Or Hematoma, Soft Tissues Of Neck Or Thorax; With Partial Rib Ostectomy (Pro Cah)",,21502,CPT,Professional,Both,,,,1530,1300.5,307.38,1530,Medica,Individual & Family,1297.44,84.8,,percent of total billed charges,,
"I&D, Deep Abscess Or Hematoma, Soft Tissues Of Neck Or Thorax; With Partial Rib Ostectomy (Pro Cah)",,21502,CPT,Professional,Both,,,,1530,1300.5,307.38,1530,Medica,Medica Advantage Solution,761.94,49.8,,percent of total billed charges,,
"I&D, Deep Abscess Or Hematoma, Soft Tissues Of Neck Or Thorax; With Partial Rib Ostectomy (Pro Cah)",,21502,CPT,Professional,Both,,,,1530,1300.5,307.38,1530,Medica,Medical Assistance,354.88,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"I&D, Deep Abscess Or Hematoma, Soft Tissues Of Neck Or Thorax; With Partial Rib Ostectomy (Pro Cah)",,21502,CPT,Professional,Both,,,,1530,1300.5,307.38,1530,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,477.51,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"I&D, Deep Abscess Or Hematoma, Soft Tissues Of Neck Or Thorax; With Partial Rib Ostectomy (Pro Cah)",,21502,CPT,Professional,Both,,,,1530,1300.5,307.38,1530,"Multiplan, Inc.","Multiplan, Inc.",1438.2,94,,percent of total billed charges,,
"I&D, Deep Abscess Or Hematoma, Soft Tissues Of Neck Or Thorax; With Partial Rib Ostectomy (Pro Cah)",,21502,CPT,Professional,Both,,,,1530,1300.5,307.38,1530,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1378.53,90.1,,percent of total billed charges,,
"I&D, Deep Abscess Or Hematoma, Soft Tissues Of Neck Or Thorax; With Partial Rib Ostectomy (Pro Cah)",,21502,CPT,Professional,Both,,,,1530,1300.5,307.38,1530,"Preferred One Administrative Services, INC.",PPO,1508.58,98.6,,percent of total billed charges,,
"I&D, Deep Abscess Or Hematoma, Soft Tissues Of Neck Or Thorax; With Partial Rib Ostectomy (Pro Cah)",,21502,CPT,Professional,Both,,,,1530,1300.5,307.38,1530,PrimeWest Health,Minnesota Senior Health Options (MSHO),549.1365,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"I&D, Deep Abscess Or Hematoma, Soft Tissues Of Neck Or Thorax; With Partial Rib Ostectomy (Pro Cah)",,21502,CPT,Professional,Both,,,,1530,1300.5,307.38,1530,PrimeWest Health,MinnesotaCare,379.7201448,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"I&D, Deep Abscess Or Hematoma, Soft Tissues Of Neck Or Thorax; With Partial Rib Ostectomy (Pro Cah)",,21502,CPT,Professional,Both,,,,1530,1300.5,307.38,1530,Sanford Health Plan,Sanford Health Plan,1346.4,88,,percent of total billed charges,,
"I&D, Deep Abscess Or Hematoma, Soft Tissues Of Neck Or Thorax; With Partial Rib Ostectomy (Pro Cah)",,21502,CPT,Professional,Both,,,,1530,1300.5,307.38,1530,"UCare Health, Inc.",Individual & Family Plan,776.240256,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"I&D, Deep Abscess Or Hematoma, Soft Tissues Of Neck Or Thorax; With Partial Rib Ostectomy (Pro Cah)",,21502,CPT,Professional,Both,,,,1530,1300.5,307.38,1530,"UCare Health, Inc.",Medical Assistance,390.366504,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"I&D, Deep Abscess Or Hematoma, Soft Tissues Of Neck Or Thorax; With Partial Rib Ostectomy (Pro Cah)",,21502,CPT,Professional,Both,,,,1530,1300.5,307.38,1530,"UCare Health, Inc.",Medicare Advantage,549.1365,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"I&D, Deep Abscess Or Hematoma, Soft Tissues Of Neck Or Thorax; With Partial Rib Ostectomy (Pro Cah)",,21502,CPT,Professional,Both,,,,1530,1300.5,307.38,1530,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),439.3092,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"I&D, Deep Abscess Or Hematoma, Soft Tissues Of Neck Or Thorax; With Partial Rib Ostectomy (Pro Cah)",,21502,CPT,Professional,Both,,,,1530,1300.5,307.38,1530,UnitedHealthcare,Individual & Family,1530,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"I&D, Deep Abscess Or Hematoma, Soft Tissues Of Neck Or Thorax; With Partial Rib Ostectomy (Pro Cah)",,21502,CPT,Professional,Both,,,,1530,1300.5,307.38,1530,UnitedHealthcare,Medicare Advantage,549.1365,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"I&D, Deep Abscess Or Hematoma, Soft Tissues Of Neck Or Thorax; With Partial Rib Ostectomy (Pro Cah)",,21502,CPT,Professional,Both,,,,1530,1300.5,307.38,1530,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,354.87864,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision, Tumor, Soft Tissue Of Neck Or Anterior Thorax, Subcutaneous; 3 Cm Or Greater (Pbb)",,21552,CPT,Facility,Outpatient,,,,1134,963.9,325.0044,1134,Aetna,Commercial,1043.28,92,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Neck Or Anterior Thorax, Subcutaneous; 3 Cm Or Greater (Pbb)",,21552,CPT,Professional,Outpatient,,,,1173,997.05,273.56,1173,Aetna,Commercial,997.05,85,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Neck Or Anterior Thorax, Subcutaneous; 3 Cm Or Greater (Pbb)",,21552,CPT,Facility,Outpatient,,,,1134,963.9,325.0044,1134,Aetna,Medicare Advantage,555.66,49,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Neck Or Anterior Thorax, Subcutaneous; 3 Cm Or Greater (Pbb)",,21552,CPT,Professional,Outpatient,,,,1173,997.05,273.56,1173,Aetna,Medicare Advantage,429.53,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Tumor, Soft Tissue Of Neck Or Anterior Thorax, Subcutaneous; 3 Cm Or Greater (Pbb)",,21552,CPT,Facility,Outpatient,,,,1134,963.9,325.0044,1134,Aetna,PPO,1054.62,93,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Neck Or Anterior Thorax, Subcutaneous; 3 Cm Or Greater (Pbb)",,21552,CPT,Professional,Outpatient,,,,1173,997.05,273.56,1173,Aetna,PPO,1090.89,93,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Neck Or Anterior Thorax, Subcutaneous; 3 Cm Or Greater (Pbb)",,21552,CPT,Facility,Outpatient,,,,1134,963.9,325.0044,1134,America's PPO,America's PPO,1088.9802,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Excision, Tumor, Soft Tissue Of Neck Or Anterior Thorax, Subcutaneous; 3 Cm Or Greater (Pbb)",,21552,CPT,Professional,Outpatient,,,,1173,997.05,273.56,1173,America's PPO,America's PPO,1002.2112,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Excision, Tumor, Soft Tissue Of Neck Or Anterior Thorax, Subcutaneous; 3 Cm Or Greater (Pbb)",,21552,CPT,Facility,Outpatient,,,,1134,963.9,325.0044,1134,BlueCross BlueShield Minnesota, Federal Employee Program,1115.856,98.4,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Neck Or Anterior Thorax, Subcutaneous; 3 Cm Or Greater (Pbb)",,21552,CPT,Professional,Outpatient,,,,1173,997.05,273.56,1173,BlueCross BlueShield Minnesota, Federal Employee Program,925.48,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Excision, Tumor, Soft Tissue Of Neck Or Anterior Thorax, Subcutaneous; 3 Cm Or Greater (Pbb)",,21552,CPT,Facility,Outpatient,,,,1134,963.9,325.0044,1134,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1134,100,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Neck Or Anterior Thorax, Subcutaneous; 3 Cm Or Greater (Pbb)",,21552,CPT,Professional,Outpatient,,,,1173,997.05,273.56,1173,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,940.28768,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Tumor, Soft Tissue Of Neck Or Anterior Thorax, Subcutaneous; 3 Cm Or Greater (Pbb)",,21552,CPT,Facility,Outpatient,,,,1134,963.9,325.0044,1134,BlueCross BlueShield Minnesota,High Value Network Plan,1020.6,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
"Excision, Tumor, Soft Tissue Of Neck Or Anterior Thorax, Subcutaneous; 3 Cm Or Greater (Pbb)",,21552,CPT,Professional,Outpatient,,,,1173,997.05,273.56,1173,BlueCross BlueShield Minnesota,High Value Network Plan,940.28768,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Tumor, Soft Tissue Of Neck Or Anterior Thorax, Subcutaneous; 3 Cm Or Greater (Pbb)",,21552,CPT,Facility,Outpatient,,,,1134,963.9,325.0044,1134,BlueCross BlueShield Minnesota,Medicare Advantage,555.66,49,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Neck Or Anterior Thorax, Subcutaneous; 3 Cm Or Greater (Pbb)",,21552,CPT,Professional,Outpatient,,,,1173,997.05,273.56,1173,BlueCross BlueShield Minnesota,Medicare Advantage,488.934,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Tumor, Soft Tissue Of Neck Or Anterior Thorax, Subcutaneous; 3 Cm Or Greater (Pbb)",,21552,CPT,Professional,Outpatient,,,,1173,997.05,273.56,1173,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,940.28768,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Tumor, Soft Tissue Of Neck Or Anterior Thorax, Subcutaneous; 3 Cm Or Greater (Pbb)",,21552,CPT,Facility,Outpatient,,,,1134,963.9,325.0044,1134,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,325.0044,28.66,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Neck Or Anterior Thorax, Subcutaneous; 3 Cm Or Greater (Pbb)",,21552,CPT,Professional,Outpatient,,,,1173,997.05,273.56,1173,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,315.83376,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision, Tumor, Soft Tissue Of Neck Or Anterior Thorax, Subcutaneous; 3 Cm Or Greater (Pbb)",,21552,CPT,Facility,Outpatient,,,,1134,963.9,325.0044,1134,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),555.66,49,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Neck Or Anterior Thorax, Subcutaneous; 3 Cm Or Greater (Pbb)",,21552,CPT,Professional,Outpatient,,,,1173,997.05,273.56,1173,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),488.934,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Tumor, Soft Tissue Of Neck Or Anterior Thorax, Subcutaneous; 3 Cm Or Greater (Pbb)",,21552,CPT,Facility,Outpatient,,,,1134,963.9,325.0044,1134,CorVel,Worker's Compensation,1134,100,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Neck Or Anterior Thorax, Subcutaneous; 3 Cm Or Greater (Pbb)",,21552,CPT,Professional,Outpatient,,,,1173,997.05,273.56,1173,CorVel,Worker's Compensation,835.7372004,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Excision, Tumor, Soft Tissue Of Neck Or Anterior Thorax, Subcutaneous; 3 Cm Or Greater (Pbb)",,21552,CPT,Facility,Outpatient,,,,1134,963.9,325.0044,1134,First Health Group Corporation,First Health Network,1099.98,97,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Neck Or Anterior Thorax, Subcutaneous; 3 Cm Or Greater (Pbb)",,21552,CPT,Professional,Outpatient,,,,1173,997.05,273.56,1173,First Health Group Corporation,First Health Network,1137.81,97,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Neck Or Anterior Thorax, Subcutaneous; 3 Cm Or Greater (Pbb)",,21552,CPT,Facility,Outpatient,,,,1134,963.9,325.0044,1134,"Health Partners, Inc.",Commercial,1072.764,94.6,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Neck Or Anterior Thorax, Subcutaneous; 3 Cm Or Greater (Pbb)",,21552,CPT,Professional,Outpatient,,,,1173,997.05,273.56,1173,"Health Partners, Inc.",Commercial,902.55,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision, Tumor, Soft Tissue Of Neck Or Anterior Thorax, Subcutaneous; 3 Cm Or Greater (Pbb)",,21552,CPT,Facility,Outpatient,,,,1134,963.9,325.0044,1134,"Health Partners, Inc.",Medicare Advantage,555.66,49,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Neck Or Anterior Thorax, Subcutaneous; 3 Cm Or Greater (Pbb)",,21552,CPT,Professional,Outpatient,,,,1173,997.05,273.56,1173,"Health Partners, Inc.",Medicare Advantage,488.934,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Tumor, Soft Tissue Of Neck Or Anterior Thorax, Subcutaneous; 3 Cm Or Greater (Pbb)",,21552,CPT,Facility,Outpatient,,,,1134,963.9,325.0044,1134,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),680.4,60,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Neck Or Anterior Thorax, Subcutaneous; 3 Cm Or Greater (Pbb)",,21552,CPT,Professional,Outpatient,,,,1173,997.05,273.56,1173,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),424.95,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Excision, Tumor, Soft Tissue Of Neck Or Anterior Thorax, Subcutaneous; 3 Cm Or Greater (Pbb)",,21552,CPT,Facility,Outpatient,,,,1134,963.9,325.0044,1134,"Health Partners, Inc.",State of Minnesota Advantage Program,924.21,81.5,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Neck Or Anterior Thorax, Subcutaneous; 3 Cm Or Greater (Pbb)",,21552,CPT,Professional,Outpatient,,,,1173,997.05,273.56,1173,"Health Partners, Inc.",State of Minnesota Advantage Program,777.546825,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision, Tumor, Soft Tissue Of Neck Or Anterior Thorax, Subcutaneous; 3 Cm Or Greater (Pbb)",,21552,CPT,Facility,Outpatient,,,,1134,963.9,325.0044,1134,"Health Partners, Inc.",State Public Programs,567,50,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Neck Or Anterior Thorax, Subcutaneous; 3 Cm Or Greater (Pbb)",,21552,CPT,Professional,Outpatient,,,,1173,997.05,273.56,1173,"Health Partners, Inc.",State Public Programs,273.56,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Excision, Tumor, Soft Tissue Of Neck Or Anterior Thorax, Subcutaneous; 3 Cm Or Greater (Pbb)",,21552,CPT,Facility,Outpatient,,,,1134,963.9,325.0044,1134,Humana Insurance Company,Commercial PPO,1077.3,95,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Neck Or Anterior Thorax, Subcutaneous; 3 Cm Or Greater (Pbb)",,21552,CPT,Professional,Outpatient,,,,1173,997.05,273.56,1173,Humana Insurance Company,Commercial PPO,425.16,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Excision, Tumor, Soft Tissue Of Neck Or Anterior Thorax, Subcutaneous; 3 Cm Or Greater (Pbb)",,21552,CPT,Facility,Outpatient,,,,1134,963.9,325.0044,1134,Humana Insurance Company,Medicare PPO,555.66,49,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Neck Or Anterior Thorax, Subcutaneous; 3 Cm Or Greater (Pbb)",,21552,CPT,Professional,Outpatient,,,,1173,997.05,273.56,1173,Humana Insurance Company,Medicare PPO,1173,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Excision, Tumor, Soft Tissue Of Neck Or Anterior Thorax, Subcutaneous; 3 Cm Or Greater (Pbb)",,21552,CPT,Facility,Outpatient,,,,1134,963.9,325.0044,1134,Medica,Individual & Family,1123.794,99.1,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Neck Or Anterior Thorax, Subcutaneous; 3 Cm Or Greater (Pbb)",,21552,CPT,Professional,Outpatient,,,,1173,997.05,273.56,1173,Medica,Individual & Family,994.704,84.8,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Neck Or Anterior Thorax, Subcutaneous; 3 Cm Or Greater (Pbb)",,21552,CPT,Facility,Outpatient,,,,1134,963.9,325.0044,1134,Medica,Medica Advantage Solution,564.732,49.8,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Neck Or Anterior Thorax, Subcutaneous; 3 Cm Or Greater (Pbb)",,21552,CPT,Professional,Outpatient,,,,1173,997.05,273.56,1173,Medica,Medica Advantage Solution,584.154,49.8,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Neck Or Anterior Thorax, Subcutaneous; 3 Cm Or Greater (Pbb)",,21552,CPT,Facility,Outpatient,,,,1134,963.9,325.0044,1134,Medica,Medical Assistance,505.764,44.6,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Neck Or Anterior Thorax, Subcutaneous; 3 Cm Or Greater (Pbb)",,21552,CPT,Professional,Outpatient,,,,1173,997.05,273.56,1173,Medica,Medical Assistance,315.83,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Excision, Tumor, Soft Tissue Of Neck Or Anterior Thorax, Subcutaneous; 3 Cm Or Greater (Pbb)",,21552,CPT,Facility,Outpatient,,,,1134,963.9,325.0044,1134,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,564.732,49.8,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Neck Or Anterior Thorax, Subcutaneous; 3 Cm Or Greater (Pbb)",,21552,CPT,Professional,Outpatient,,,,1173,997.05,273.56,1173,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,425.16,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Excision, Tumor, Soft Tissue Of Neck Or Anterior Thorax, Subcutaneous; 3 Cm Or Greater (Pbb)",,21552,CPT,Facility,Outpatient,,,,1134,963.9,325.0044,1134,"Multiplan, Inc.","Multiplan, Inc.",1065.96,94,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Neck Or Anterior Thorax, Subcutaneous; 3 Cm Or Greater (Pbb)",,21552,CPT,Professional,Outpatient,,,,1173,997.05,273.56,1173,"Multiplan, Inc.","Multiplan, Inc.",1102.62,94,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Neck Or Anterior Thorax, Subcutaneous; 3 Cm Or Greater (Pbb)",,21552,CPT,Facility,Outpatient,,,,1134,963.9,325.0044,1134,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1021.734,90.1,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Neck Or Anterior Thorax, Subcutaneous; 3 Cm Or Greater (Pbb)",,21552,CPT,Professional,Outpatient,,,,1173,997.05,273.56,1173,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1056.873,90.1,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Neck Or Anterior Thorax, Subcutaneous; 3 Cm Or Greater (Pbb)",,21552,CPT,Facility,Outpatient,,,,1134,963.9,325.0044,1134,"Preferred One Administrative Services, INC.",PPO,1118.124,98.6,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Neck Or Anterior Thorax, Subcutaneous; 3 Cm Or Greater (Pbb)",,21552,CPT,Professional,Outpatient,,,,1173,997.05,273.56,1173,"Preferred One Administrative Services, INC.",PPO,1156.578,98.6,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Neck Or Anterior Thorax, Subcutaneous; 3 Cm Or Greater (Pbb)",,21552,CPT,Facility,Outpatient,,,,1134,963.9,325.0044,1134,PrimeWest Health,Minnesota Senior Health Options (MSHO),583.443,51.45,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Neck Or Anterior Thorax, Subcutaneous; 3 Cm Or Greater (Pbb)",,21552,CPT,Professional,Outpatient,,,,1173,997.05,273.56,1173,PrimeWest Health,Minnesota Senior Health Options (MSHO),488.934,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Tumor, Soft Tissue Of Neck Or Anterior Thorax, Subcutaneous; 3 Cm Or Greater (Pbb)",,21552,CPT,Facility,Outpatient,,,,1134,963.9,325.0044,1134,PrimeWest Health,MinnesotaCare,582.4224,51.36,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Neck Or Anterior Thorax, Subcutaneous; 3 Cm Or Greater (Pbb)",,21552,CPT,Professional,Outpatient,,,,1173,997.05,273.56,1173,PrimeWest Health,MinnesotaCare,337.9421232,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision, Tumor, Soft Tissue Of Neck Or Anterior Thorax, Subcutaneous; 3 Cm Or Greater (Pbb)",,21552,CPT,Facility,Outpatient,,,,1134,963.9,325.0044,1134,Sanford Health Plan,Sanford Health Plan,1043.28,92,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Neck Or Anterior Thorax, Subcutaneous; 3 Cm Or Greater (Pbb)",,21552,CPT,Professional,Outpatient,,,,1173,997.05,273.56,1173,Sanford Health Plan,Sanford Health Plan,1032.24,88,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Neck Or Anterior Thorax, Subcutaneous; 3 Cm Or Greater (Pbb)",,21552,CPT,Facility,Outpatient,,,,1134,963.9,325.0044,1134,"UCare Health, Inc.",Individual & Family Plan,639.009,56.35,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Neck Or Anterior Thorax, Subcutaneous; 3 Cm Or Greater (Pbb)",,21552,CPT,Professional,Outpatient,,,,1173,997.05,273.56,1173,"UCare Health, Inc.",Individual & Family Plan,691.140096,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Excision, Tumor, Soft Tissue Of Neck Or Anterior Thorax, Subcutaneous; 3 Cm Or Greater (Pbb)",,21552,CPT,Facility,Outpatient,,,,1134,963.9,325.0044,1134,"UCare Health, Inc.",Medical Assistance,572.3298,50.47,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Neck Or Anterior Thorax, Subcutaneous; 3 Cm Or Greater (Pbb)",,21552,CPT,Professional,Outpatient,,,,1173,997.05,273.56,1173,"UCare Health, Inc.",Medical Assistance,347.417136,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Excision, Tumor, Soft Tissue Of Neck Or Anterior Thorax, Subcutaneous; 3 Cm Or Greater (Pbb)",,21552,CPT,Facility,Outpatient,,,,1134,963.9,325.0044,1134,"UCare Health, Inc.",Medicare Advantage,572.3298,50.47,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Neck Or Anterior Thorax, Subcutaneous; 3 Cm Or Greater (Pbb)",,21552,CPT,Professional,Outpatient,,,,1173,997.05,273.56,1173,"UCare Health, Inc.",Medicare Advantage,488.934,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Excision, Tumor, Soft Tissue Of Neck Or Anterior Thorax, Subcutaneous; 3 Cm Or Greater (Pbb)",,21552,CPT,Facility,Outpatient,,,,1134,963.9,325.0044,1134,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),572.3298,50.47,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Neck Or Anterior Thorax, Subcutaneous; 3 Cm Or Greater (Pbb)",,21552,CPT,Professional,Outpatient,,,,1173,997.05,273.56,1173,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),391.1472,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Excision, Tumor, Soft Tissue Of Neck Or Anterior Thorax, Subcutaneous; 3 Cm Or Greater (Pbb)",,21552,CPT,Facility,Outpatient,,,,1134,963.9,325.0044,1134,UnitedHealthcare,Individual & Family,1065.96,94,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Neck Or Anterior Thorax, Subcutaneous; 3 Cm Or Greater (Pbb)",,21552,CPT,Professional,Outpatient,,,,1173,997.05,273.56,1173,UnitedHealthcare,Individual & Family,1173,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Excision, Tumor, Soft Tissue Of Neck Or Anterior Thorax, Subcutaneous; 3 Cm Or Greater (Pbb)",,21552,CPT,Facility,Outpatient,,,,1134,963.9,325.0044,1134,UnitedHealthcare,Medicare Advantage,555.66,49,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Neck Or Anterior Thorax, Subcutaneous; 3 Cm Or Greater (Pbb)",,21552,CPT,Professional,Outpatient,,,,1173,997.05,273.56,1173,UnitedHealthcare,Medicare Advantage,488.934,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Tumor, Soft Tissue Of Neck Or Anterior Thorax, Subcutaneous; 3 Cm Or Greater (Pbb)",,21552,CPT,Facility,Outpatient,,,,1134,963.9,325.0044,1134,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,544.32,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Excision, Tumor, Soft Tissue Of Neck Or Anterior Thorax, Subcutaneous; 3 Cm Or Greater (Pbb)",,21552,CPT,Professional,Outpatient,,,,1173,997.05,273.56,1173,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,315.83376,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision, Tumor, Soft Tissue Of Neck Or Anterior Thorax, Subcutaneous; 3 Cm Or Greater (Pro Cah)",,21552,CPT,Professional,Both,,,,2307,1960.95,273.56,2307,Aetna,Commercial,1960.95,85,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Neck Or Anterior Thorax, Subcutaneous; 3 Cm Or Greater (Pro Cah)",,21552,CPT,Professional,Both,,,,2307,1960.95,273.56,2307,Aetna,Medicare Advantage,429.53,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Tumor, Soft Tissue Of Neck Or Anterior Thorax, Subcutaneous; 3 Cm Or Greater (Pro Cah)",,21552,CPT,Professional,Both,,,,2307,1960.95,273.56,2307,Aetna,PPO,2145.51,93,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Neck Or Anterior Thorax, Subcutaneous; 3 Cm Or Greater (Pro Cah)",,21552,CPT,Professional,Both,,,,2307,1960.95,273.56,2307,America's PPO,America's PPO,1971.1008,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Excision, Tumor, Soft Tissue Of Neck Or Anterior Thorax, Subcutaneous; 3 Cm Or Greater (Pro Cah)",,21552,CPT,Professional,Both,,,,2307,1960.95,273.56,2307,BlueCross BlueShield Minnesota, Federal Employee Program,925.48,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Excision, Tumor, Soft Tissue Of Neck Or Anterior Thorax, Subcutaneous; 3 Cm Or Greater (Pro Cah)",,21552,CPT,Professional,Both,,,,2307,1960.95,273.56,2307,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,940.28768,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Tumor, Soft Tissue Of Neck Or Anterior Thorax, Subcutaneous; 3 Cm Or Greater (Pro Cah)",,21552,CPT,Professional,Both,,,,2307,1960.95,273.56,2307,BlueCross BlueShield Minnesota,High Value Network Plan,940.28768,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Tumor, Soft Tissue Of Neck Or Anterior Thorax, Subcutaneous; 3 Cm Or Greater (Pro Cah)",,21552,CPT,Professional,Both,,,,2307,1960.95,273.56,2307,BlueCross BlueShield Minnesota,Medicare Advantage,488.934,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Tumor, Soft Tissue Of Neck Or Anterior Thorax, Subcutaneous; 3 Cm Or Greater (Pro Cah)",,21552,CPT,Professional,Both,,,,2307,1960.95,273.56,2307,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,940.28768,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Tumor, Soft Tissue Of Neck Or Anterior Thorax, Subcutaneous; 3 Cm Or Greater (Pro Cah)",,21552,CPT,Professional,Both,,,,2307,1960.95,273.56,2307,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,315.83376,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision, Tumor, Soft Tissue Of Neck Or Anterior Thorax, Subcutaneous; 3 Cm Or Greater (Pro Cah)",,21552,CPT,Professional,Both,,,,2307,1960.95,273.56,2307,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),488.934,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Tumor, Soft Tissue Of Neck Or Anterior Thorax, Subcutaneous; 3 Cm Or Greater (Pro Cah)",,21552,CPT,Professional,Both,,,,2307,1960.95,273.56,2307,CorVel,Worker's Compensation,835.7372004,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Excision, Tumor, Soft Tissue Of Neck Or Anterior Thorax, Subcutaneous; 3 Cm Or Greater (Pro Cah)",,21552,CPT,Professional,Both,,,,2307,1960.95,273.56,2307,First Health Group Corporation,First Health Network,2237.79,97,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Neck Or Anterior Thorax, Subcutaneous; 3 Cm Or Greater (Pro Cah)",,21552,CPT,Professional,Both,,,,2307,1960.95,273.56,2307,"Health Partners, Inc.",Commercial,902.55,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision, Tumor, Soft Tissue Of Neck Or Anterior Thorax, Subcutaneous; 3 Cm Or Greater (Pro Cah)",,21552,CPT,Professional,Both,,,,2307,1960.95,273.56,2307,"Health Partners, Inc.",Medicare Advantage,488.934,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Tumor, Soft Tissue Of Neck Or Anterior Thorax, Subcutaneous; 3 Cm Or Greater (Pro Cah)",,21552,CPT,Professional,Both,,,,2307,1960.95,273.56,2307,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),424.95,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Excision, Tumor, Soft Tissue Of Neck Or Anterior Thorax, Subcutaneous; 3 Cm Or Greater (Pro Cah)",,21552,CPT,Professional,Both,,,,2307,1960.95,273.56,2307,"Health Partners, Inc.",State of Minnesota Advantage Program,777.546825,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision, Tumor, Soft Tissue Of Neck Or Anterior Thorax, Subcutaneous; 3 Cm Or Greater (Pro Cah)",,21552,CPT,Professional,Both,,,,2307,1960.95,273.56,2307,"Health Partners, Inc.",State Public Programs,273.56,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Excision, Tumor, Soft Tissue Of Neck Or Anterior Thorax, Subcutaneous; 3 Cm Or Greater (Pro Cah)",,21552,CPT,Professional,Both,,,,2307,1960.95,273.56,2307,Humana Insurance Company,Commercial PPO,425.16,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Excision, Tumor, Soft Tissue Of Neck Or Anterior Thorax, Subcutaneous; 3 Cm Or Greater (Pro Cah)",,21552,CPT,Professional,Both,,,,2307,1960.95,273.56,2307,Humana Insurance Company,Medicare PPO,2307,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Excision, Tumor, Soft Tissue Of Neck Or Anterior Thorax, Subcutaneous; 3 Cm Or Greater (Pro Cah)",,21552,CPT,Professional,Both,,,,2307,1960.95,273.56,2307,Medica,Individual & Family,1956.336,84.8,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Neck Or Anterior Thorax, Subcutaneous; 3 Cm Or Greater (Pro Cah)",,21552,CPT,Professional,Both,,,,2307,1960.95,273.56,2307,Medica,Medica Advantage Solution,1148.886,49.8,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Neck Or Anterior Thorax, Subcutaneous; 3 Cm Or Greater (Pro Cah)",,21552,CPT,Professional,Both,,,,2307,1960.95,273.56,2307,Medica,Medical Assistance,315.83,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Excision, Tumor, Soft Tissue Of Neck Or Anterior Thorax, Subcutaneous; 3 Cm Or Greater (Pro Cah)",,21552,CPT,Professional,Both,,,,2307,1960.95,273.56,2307,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,425.16,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Excision, Tumor, Soft Tissue Of Neck Or Anterior Thorax, Subcutaneous; 3 Cm Or Greater (Pro Cah)",,21552,CPT,Professional,Both,,,,2307,1960.95,273.56,2307,"Multiplan, Inc.","Multiplan, Inc.",2168.58,94,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Neck Or Anterior Thorax, Subcutaneous; 3 Cm Or Greater (Pro Cah)",,21552,CPT,Professional,Both,,,,2307,1960.95,273.56,2307,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,2078.607,90.1,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Neck Or Anterior Thorax, Subcutaneous; 3 Cm Or Greater (Pro Cah)",,21552,CPT,Professional,Both,,,,2307,1960.95,273.56,2307,"Preferred One Administrative Services, INC.",PPO,2274.702,98.6,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Neck Or Anterior Thorax, Subcutaneous; 3 Cm Or Greater (Pro Cah)",,21552,CPT,Professional,Both,,,,2307,1960.95,273.56,2307,PrimeWest Health,Minnesota Senior Health Options (MSHO),488.934,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Tumor, Soft Tissue Of Neck Or Anterior Thorax, Subcutaneous; 3 Cm Or Greater (Pro Cah)",,21552,CPT,Professional,Both,,,,2307,1960.95,273.56,2307,PrimeWest Health,MinnesotaCare,337.9421232,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision, Tumor, Soft Tissue Of Neck Or Anterior Thorax, Subcutaneous; 3 Cm Or Greater (Pro Cah)",,21552,CPT,Professional,Both,,,,2307,1960.95,273.56,2307,Sanford Health Plan,Sanford Health Plan,2030.16,88,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Neck Or Anterior Thorax, Subcutaneous; 3 Cm Or Greater (Pro Cah)",,21552,CPT,Professional,Both,,,,2307,1960.95,273.56,2307,"UCare Health, Inc.",Individual & Family Plan,691.140096,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Excision, Tumor, Soft Tissue Of Neck Or Anterior Thorax, Subcutaneous; 3 Cm Or Greater (Pro Cah)",,21552,CPT,Professional,Both,,,,2307,1960.95,273.56,2307,"UCare Health, Inc.",Medical Assistance,347.417136,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Excision, Tumor, Soft Tissue Of Neck Or Anterior Thorax, Subcutaneous; 3 Cm Or Greater (Pro Cah)",,21552,CPT,Professional,Both,,,,2307,1960.95,273.56,2307,"UCare Health, Inc.",Medicare Advantage,488.934,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Excision, Tumor, Soft Tissue Of Neck Or Anterior Thorax, Subcutaneous; 3 Cm Or Greater (Pro Cah)",,21552,CPT,Professional,Both,,,,2307,1960.95,273.56,2307,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),391.1472,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Excision, Tumor, Soft Tissue Of Neck Or Anterior Thorax, Subcutaneous; 3 Cm Or Greater (Pro Cah)",,21552,CPT,Professional,Both,,,,2307,1960.95,273.56,2307,UnitedHealthcare,Individual & Family,2307,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Excision, Tumor, Soft Tissue Of Neck Or Anterior Thorax, Subcutaneous; 3 Cm Or Greater (Pro Cah)",,21552,CPT,Professional,Both,,,,2307,1960.95,273.56,2307,UnitedHealthcare,Medicare Advantage,488.934,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Tumor, Soft Tissue Of Neck Or Anterior Thorax, Subcutaneous; 3 Cm Or Greater (Pro Cah)",,21552,CPT,Professional,Both,,,,2307,1960.95,273.56,2307,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,315.83376,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision, Tumor, Soft Tissue Of Back Or Flank, Less Than 3 Cm (Pbb)",,21930,CPT,Facility,Outpatient,,,,1540,1309,441.364,1540,Aetna,Commercial,1416.8,92,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Back Or Flank, Less Than 3 Cm (Pbb)",,21930,CPT,Professional,Outpatient,,,,1020,867,225.35,1020,Aetna,Commercial,867,85,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Back Or Flank, Less Than 3 Cm (Pbb)",,21930,CPT,Facility,Outpatient,,,,1540,1309,441.364,1540,Aetna,Medicare Advantage,754.6,49,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Back Or Flank, Less Than 3 Cm (Pbb)",,21930,CPT,Professional,Outpatient,,,,1020,867,225.35,1020,Aetna,Medicare Advantage,353.31,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Tumor, Soft Tissue Of Back Or Flank, Less Than 3 Cm (Pbb)",,21930,CPT,Facility,Outpatient,,,,1540,1309,441.364,1540,Aetna,PPO,1432.2,93,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Back Or Flank, Less Than 3 Cm (Pbb)",,21930,CPT,Professional,Outpatient,,,,1020,867,225.35,1020,Aetna,PPO,948.6,93,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Back Or Flank, Less Than 3 Cm (Pbb)",,21930,CPT,Facility,Outpatient,,,,1540,1309,441.364,1540,America's PPO,America's PPO,1478.862,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Excision, Tumor, Soft Tissue Of Back Or Flank, Less Than 3 Cm (Pbb)",,21930,CPT,Professional,Outpatient,,,,1020,867,225.35,1020,America's PPO,America's PPO,871.488,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Excision, Tumor, Soft Tissue Of Back Or Flank, Less Than 3 Cm (Pbb)",,21930,CPT,Facility,Outpatient,,,,1540,1309,441.364,1540,BlueCross BlueShield Minnesota, Federal Employee Program,1515.36,98.4,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Back Or Flank, Less Than 3 Cm (Pbb)",,21930,CPT,Professional,Outpatient,,,,1020,867,225.35,1020,BlueCross BlueShield Minnesota, Federal Employee Program,753.33,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Excision, Tumor, Soft Tissue Of Back Or Flank, Less Than 3 Cm (Pbb)",,21930,CPT,Facility,Outpatient,,,,1540,1309,441.364,1540,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1540,100,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Back Or Flank, Less Than 3 Cm (Pbb)",,21930,CPT,Professional,Outpatient,,,,1020,867,225.35,1020,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,765.38328,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Tumor, Soft Tissue Of Back Or Flank, Less Than 3 Cm (Pbb)",,21930,CPT,Facility,Outpatient,,,,1540,1309,441.364,1540,BlueCross BlueShield Minnesota,High Value Network Plan,1386,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
"Excision, Tumor, Soft Tissue Of Back Or Flank, Less Than 3 Cm (Pbb)",,21930,CPT,Professional,Outpatient,,,,1020,867,225.35,1020,BlueCross BlueShield Minnesota,High Value Network Plan,765.38328,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Tumor, Soft Tissue Of Back Or Flank, Less Than 3 Cm (Pbb)",,21930,CPT,Facility,Outpatient,,,,1540,1309,441.364,1540,BlueCross BlueShield Minnesota,Medicare Advantage,754.6,49,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Back Or Flank, Less Than 3 Cm (Pbb)",,21930,CPT,Professional,Outpatient,,,,1020,867,225.35,1020,BlueCross BlueShield Minnesota,Medicare Advantage,402.9485,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Tumor, Soft Tissue Of Back Or Flank, Less Than 3 Cm (Pbb)",,21930,CPT,Professional,Outpatient,,,,1020,867,225.35,1020,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,765.38328,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Tumor, Soft Tissue Of Back Or Flank, Less Than 3 Cm (Pbb)",,21930,CPT,Facility,Outpatient,,,,1540,1309,441.364,1540,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,441.364,28.66,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Back Or Flank, Less Than 3 Cm (Pbb)",,21930,CPT,Professional,Outpatient,,,,1020,867,225.35,1020,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,260.17728,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision, Tumor, Soft Tissue Of Back Or Flank, Less Than 3 Cm (Pbb)",,21930,CPT,Facility,Outpatient,,,,1540,1309,441.364,1540,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),754.6,49,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Back Or Flank, Less Than 3 Cm (Pbb)",,21930,CPT,Professional,Outpatient,,,,1020,867,225.35,1020,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),402.9485,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Tumor, Soft Tissue Of Back Or Flank, Less Than 3 Cm (Pbb)",,21930,CPT,Facility,Outpatient,,,,1540,1309,441.364,1540,CorVel,Worker's Compensation,1540,100,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Back Or Flank, Less Than 3 Cm (Pbb)",,21930,CPT,Professional,Outpatient,,,,1020,867,225.35,1020,CorVel,Worker's Compensation,685.8083868,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Excision, Tumor, Soft Tissue Of Back Or Flank, Less Than 3 Cm (Pbb)",,21930,CPT,Facility,Outpatient,,,,1540,1309,441.364,1540,First Health Group Corporation,First Health Network,1493.8,97,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Back Or Flank, Less Than 3 Cm (Pbb)",,21930,CPT,Professional,Outpatient,,,,1020,867,225.35,1020,First Health Group Corporation,First Health Network,989.4,97,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Back Or Flank, Less Than 3 Cm (Pbb)",,21930,CPT,Facility,Outpatient,,,,1540,1309,441.364,1540,"Health Partners, Inc.",Commercial,1456.84,94.6,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Back Or Flank, Less Than 3 Cm (Pbb)",,21930,CPT,Professional,Outpatient,,,,1020,867,225.35,1020,"Health Partners, Inc.",Commercial,740.77,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision, Tumor, Soft Tissue Of Back Or Flank, Less Than 3 Cm (Pbb)",,21930,CPT,Facility,Outpatient,,,,1540,1309,441.364,1540,"Health Partners, Inc.",Medicare Advantage,754.6,49,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Back Or Flank, Less Than 3 Cm (Pbb)",,21930,CPT,Professional,Outpatient,,,,1020,867,225.35,1020,"Health Partners, Inc.",Medicare Advantage,402.9485,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Tumor, Soft Tissue Of Back Or Flank, Less Than 3 Cm (Pbb)",,21930,CPT,Facility,Outpatient,,,,1540,1309,441.364,1540,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),924,60,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Back Or Flank, Less Than 3 Cm (Pbb)",,21930,CPT,Professional,Outpatient,,,,1020,867,225.35,1020,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),350.39,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Excision, Tumor, Soft Tissue Of Back Or Flank, Less Than 3 Cm (Pbb)",,21930,CPT,Facility,Outpatient,,,,1540,1309,441.364,1540,"Health Partners, Inc.",State of Minnesota Advantage Program,1255.1,81.5,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Back Or Flank, Less Than 3 Cm (Pbb)",,21930,CPT,Professional,Outpatient,,,,1020,867,225.35,1020,"Health Partners, Inc.",State of Minnesota Advantage Program,638.173355,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision, Tumor, Soft Tissue Of Back Or Flank, Less Than 3 Cm (Pbb)",,21930,CPT,Facility,Outpatient,,,,1540,1309,441.364,1540,"Health Partners, Inc.",State Public Programs,770,50,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Back Or Flank, Less Than 3 Cm (Pbb)",,21930,CPT,Professional,Outpatient,,,,1020,867,225.35,1020,"Health Partners, Inc.",State Public Programs,225.35,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Excision, Tumor, Soft Tissue Of Back Or Flank, Less Than 3 Cm (Pbb)",,21930,CPT,Facility,Outpatient,,,,1540,1309,441.364,1540,Humana Insurance Company,Commercial PPO,1463,95,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Back Or Flank, Less Than 3 Cm (Pbb)",,21930,CPT,Professional,Outpatient,,,,1020,867,225.35,1020,Humana Insurance Company,Commercial PPO,350.39,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Excision, Tumor, Soft Tissue Of Back Or Flank, Less Than 3 Cm (Pbb)",,21930,CPT,Facility,Outpatient,,,,1540,1309,441.364,1540,Humana Insurance Company,Medicare PPO,754.6,49,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Back Or Flank, Less Than 3 Cm (Pbb)",,21930,CPT,Professional,Outpatient,,,,1020,867,225.35,1020,Humana Insurance Company,Medicare PPO,1020,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Excision, Tumor, Soft Tissue Of Back Or Flank, Less Than 3 Cm (Pbb)",,21930,CPT,Facility,Outpatient,,,,1540,1309,441.364,1540,Medica,Individual & Family,1526.14,99.1,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Back Or Flank, Less Than 3 Cm (Pbb)",,21930,CPT,Professional,Outpatient,,,,1020,867,225.35,1020,Medica,Individual & Family,864.96,84.8,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Back Or Flank, Less Than 3 Cm (Pbb)",,21930,CPT,Facility,Outpatient,,,,1540,1309,441.364,1540,Medica,Medica Advantage Solution,766.92,49.8,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Back Or Flank, Less Than 3 Cm (Pbb)",,21930,CPT,Professional,Outpatient,,,,1020,867,225.35,1020,Medica,Medica Advantage Solution,507.96,49.8,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Back Or Flank, Less Than 3 Cm (Pbb)",,21930,CPT,Facility,Outpatient,,,,1540,1309,441.364,1540,Medica,Medical Assistance,686.84,44.6,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Back Or Flank, Less Than 3 Cm (Pbb)",,21930,CPT,Professional,Outpatient,,,,1020,867,225.35,1020,Medica,Medical Assistance,260.18,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Excision, Tumor, Soft Tissue Of Back Or Flank, Less Than 3 Cm (Pbb)",,21930,CPT,Facility,Outpatient,,,,1540,1309,441.364,1540,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,766.92,49.8,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Back Or Flank, Less Than 3 Cm (Pbb)",,21930,CPT,Professional,Outpatient,,,,1020,867,225.35,1020,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,350.39,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Excision, Tumor, Soft Tissue Of Back Or Flank, Less Than 3 Cm (Pbb)",,21930,CPT,Facility,Outpatient,,,,1540,1309,441.364,1540,"Multiplan, Inc.","Multiplan, Inc.",1447.6,94,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Back Or Flank, Less Than 3 Cm (Pbb)",,21930,CPT,Professional,Outpatient,,,,1020,867,225.35,1020,"Multiplan, Inc.","Multiplan, Inc.",958.8,94,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Back Or Flank, Less Than 3 Cm (Pbb)",,21930,CPT,Facility,Outpatient,,,,1540,1309,441.364,1540,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1387.54,90.1,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Back Or Flank, Less Than 3 Cm (Pbb)",,21930,CPT,Professional,Outpatient,,,,1020,867,225.35,1020,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,919.02,90.1,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Back Or Flank, Less Than 3 Cm (Pbb)",,21930,CPT,Facility,Outpatient,,,,1540,1309,441.364,1540,"Preferred One Administrative Services, INC.",PPO,1518.44,98.6,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Back Or Flank, Less Than 3 Cm (Pbb)",,21930,CPT,Professional,Outpatient,,,,1020,867,225.35,1020,"Preferred One Administrative Services, INC.",PPO,1005.72,98.6,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Back Or Flank, Less Than 3 Cm (Pbb)",,21930,CPT,Facility,Outpatient,,,,1540,1309,441.364,1540,PrimeWest Health,Minnesota Senior Health Options (MSHO),792.33,51.45,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Back Or Flank, Less Than 3 Cm (Pbb)",,21930,CPT,Professional,Outpatient,,,,1020,867,225.35,1020,PrimeWest Health,Minnesota Senior Health Options (MSHO),402.9485,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Tumor, Soft Tissue Of Back Or Flank, Less Than 3 Cm (Pbb)",,21930,CPT,Facility,Outpatient,,,,1540,1309,441.364,1540,PrimeWest Health,MinnesotaCare,790.944,51.36,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Back Or Flank, Less Than 3 Cm (Pbb)",,21930,CPT,Professional,Outpatient,,,,1020,867,225.35,1020,PrimeWest Health,MinnesotaCare,278.3896896,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision, Tumor, Soft Tissue Of Back Or Flank, Less Than 3 Cm (Pbb)",,21930,CPT,Facility,Outpatient,,,,1540,1309,441.364,1540,Sanford Health Plan,Sanford Health Plan,1416.8,92,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Back Or Flank, Less Than 3 Cm (Pbb)",,21930,CPT,Professional,Outpatient,,,,1020,867,225.35,1020,Sanford Health Plan,Sanford Health Plan,897.6,88,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Back Or Flank, Less Than 3 Cm (Pbb)",,21930,CPT,Facility,Outpatient,,,,1540,1309,441.364,1540,"UCare Health, Inc.",Individual & Family Plan,867.79,56.35,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Back Or Flank, Less Than 3 Cm (Pbb)",,21930,CPT,Professional,Outpatient,,,,1020,867,225.35,1020,"UCare Health, Inc.",Individual & Family Plan,569.593984,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Excision, Tumor, Soft Tissue Of Back Or Flank, Less Than 3 Cm (Pbb)",,21930,CPT,Facility,Outpatient,,,,1540,1309,441.364,1540,"UCare Health, Inc.",Medical Assistance,777.238,50.47,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Back Or Flank, Less Than 3 Cm (Pbb)",,21930,CPT,Professional,Outpatient,,,,1020,867,225.35,1020,"UCare Health, Inc.",Medical Assistance,286.195008,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Excision, Tumor, Soft Tissue Of Back Or Flank, Less Than 3 Cm (Pbb)",,21930,CPT,Facility,Outpatient,,,,1540,1309,441.364,1540,"UCare Health, Inc.",Medicare Advantage,777.238,50.47,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Back Or Flank, Less Than 3 Cm (Pbb)",,21930,CPT,Professional,Outpatient,,,,1020,867,225.35,1020,"UCare Health, Inc.",Medicare Advantage,402.9485,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Excision, Tumor, Soft Tissue Of Back Or Flank, Less Than 3 Cm (Pbb)",,21930,CPT,Facility,Outpatient,,,,1540,1309,441.364,1540,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),777.238,50.47,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Back Or Flank, Less Than 3 Cm (Pbb)",,21930,CPT,Professional,Outpatient,,,,1020,867,225.35,1020,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),322.3588,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Excision, Tumor, Soft Tissue Of Back Or Flank, Less Than 3 Cm (Pbb)",,21930,CPT,Facility,Outpatient,,,,1540,1309,441.364,1540,UnitedHealthcare,Individual & Family,1447.6,94,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Back Or Flank, Less Than 3 Cm (Pbb)",,21930,CPT,Professional,Outpatient,,,,1020,867,225.35,1020,UnitedHealthcare,Individual & Family,1020,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Excision, Tumor, Soft Tissue Of Back Or Flank, Less Than 3 Cm (Pbb)",,21930,CPT,Facility,Outpatient,,,,1540,1309,441.364,1540,UnitedHealthcare,Medicare Advantage,754.6,49,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Back Or Flank, Less Than 3 Cm (Pbb)",,21930,CPT,Professional,Outpatient,,,,1020,867,225.35,1020,UnitedHealthcare,Medicare Advantage,402.9485,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Tumor, Soft Tissue Of Back Or Flank, Less Than 3 Cm (Pbb)",,21930,CPT,Facility,Outpatient,,,,1540,1309,441.364,1540,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,739.2,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Excision, Tumor, Soft Tissue Of Back Or Flank, Less Than 3 Cm (Pbb)",,21930,CPT,Professional,Outpatient,,,,1020,867,225.35,1020,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,260.17728,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision, Tumor, Soft Tissue Of Back Or Flank, Subcutaneous; Less Than 3 Cm (Pro Cah)",,21930,CPT,Professional,Both,,,,2560,2176,225.35,2560,Aetna,Commercial,2176,85,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Back Or Flank, Subcutaneous; Less Than 3 Cm (Pro Cah)",,21930,CPT,Professional,Both,,,,2560,2176,225.35,2560,Aetna,Medicare Advantage,353.31,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Tumor, Soft Tissue Of Back Or Flank, Subcutaneous; Less Than 3 Cm (Pro Cah)",,21930,CPT,Professional,Both,,,,2560,2176,225.35,2560,Aetna,PPO,2380.8,93,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Back Or Flank, Subcutaneous; Less Than 3 Cm (Pro Cah)",,21930,CPT,Professional,Both,,,,2560,2176,225.35,2560,America's PPO,America's PPO,2187.264,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Excision, Tumor, Soft Tissue Of Back Or Flank, Subcutaneous; Less Than 3 Cm (Pro Cah)",,21930,CPT,Professional,Both,,,,2560,2176,225.35,2560,BlueCross BlueShield Minnesota, Federal Employee Program,753.33,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Excision, Tumor, Soft Tissue Of Back Or Flank, Subcutaneous; Less Than 3 Cm (Pro Cah)",,21930,CPT,Professional,Both,,,,2560,2176,225.35,2560,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,765.38328,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Tumor, Soft Tissue Of Back Or Flank, Subcutaneous; Less Than 3 Cm (Pro Cah)",,21930,CPT,Professional,Both,,,,2560,2176,225.35,2560,BlueCross BlueShield Minnesota,High Value Network Plan,765.38328,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Tumor, Soft Tissue Of Back Or Flank, Subcutaneous; Less Than 3 Cm (Pro Cah)",,21930,CPT,Professional,Both,,,,2560,2176,225.35,2560,BlueCross BlueShield Minnesota,Medicare Advantage,402.9485,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Tumor, Soft Tissue Of Back Or Flank, Subcutaneous; Less Than 3 Cm (Pro Cah)",,21930,CPT,Professional,Both,,,,2560,2176,225.35,2560,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,765.38328,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Tumor, Soft Tissue Of Back Or Flank, Subcutaneous; Less Than 3 Cm (Pro Cah)",,21930,CPT,Professional,Both,,,,2560,2176,225.35,2560,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,260.17728,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision, Tumor, Soft Tissue Of Back Or Flank, Subcutaneous; Less Than 3 Cm (Pro Cah)",,21930,CPT,Professional,Both,,,,2560,2176,225.35,2560,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),402.9485,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Tumor, Soft Tissue Of Back Or Flank, Subcutaneous; Less Than 3 Cm (Pro Cah)",,21930,CPT,Professional,Both,,,,2560,2176,225.35,2560,CorVel,Worker's Compensation,685.8083868,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Excision, Tumor, Soft Tissue Of Back Or Flank, Subcutaneous; Less Than 3 Cm (Pro Cah)",,21930,CPT,Professional,Both,,,,2560,2176,225.35,2560,First Health Group Corporation,First Health Network,2483.2,97,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Back Or Flank, Subcutaneous; Less Than 3 Cm (Pro Cah)",,21930,CPT,Professional,Both,,,,2560,2176,225.35,2560,"Health Partners, Inc.",Commercial,740.77,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision, Tumor, Soft Tissue Of Back Or Flank, Subcutaneous; Less Than 3 Cm (Pro Cah)",,21930,CPT,Professional,Both,,,,2560,2176,225.35,2560,"Health Partners, Inc.",Medicare Advantage,402.9485,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Tumor, Soft Tissue Of Back Or Flank, Subcutaneous; Less Than 3 Cm (Pro Cah)",,21930,CPT,Professional,Both,,,,2560,2176,225.35,2560,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),350.39,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Excision, Tumor, Soft Tissue Of Back Or Flank, Subcutaneous; Less Than 3 Cm (Pro Cah)",,21930,CPT,Professional,Both,,,,2560,2176,225.35,2560,"Health Partners, Inc.",State of Minnesota Advantage Program,638.173355,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision, Tumor, Soft Tissue Of Back Or Flank, Subcutaneous; Less Than 3 Cm (Pro Cah)",,21930,CPT,Professional,Both,,,,2560,2176,225.35,2560,"Health Partners, Inc.",State Public Programs,225.35,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Excision, Tumor, Soft Tissue Of Back Or Flank, Subcutaneous; Less Than 3 Cm (Pro Cah)",,21930,CPT,Professional,Both,,,,2560,2176,225.35,2560,Humana Insurance Company,Commercial PPO,350.39,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Excision, Tumor, Soft Tissue Of Back Or Flank, Subcutaneous; Less Than 3 Cm (Pro Cah)",,21930,CPT,Professional,Both,,,,2560,2176,225.35,2560,Humana Insurance Company,Medicare PPO,2560,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Excision, Tumor, Soft Tissue Of Back Or Flank, Subcutaneous; Less Than 3 Cm (Pro Cah)",,21930,CPT,Professional,Both,,,,2560,2176,225.35,2560,Medica,Individual & Family,2170.88,84.8,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Back Or Flank, Subcutaneous; Less Than 3 Cm (Pro Cah)",,21930,CPT,Professional,Both,,,,2560,2176,225.35,2560,Medica,Medica Advantage Solution,1274.88,49.8,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Back Or Flank, Subcutaneous; Less Than 3 Cm (Pro Cah)",,21930,CPT,Professional,Both,,,,2560,2176,225.35,2560,Medica,Medical Assistance,260.18,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Excision, Tumor, Soft Tissue Of Back Or Flank, Subcutaneous; Less Than 3 Cm (Pro Cah)",,21930,CPT,Professional,Both,,,,2560,2176,225.35,2560,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,350.39,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Excision, Tumor, Soft Tissue Of Back Or Flank, Subcutaneous; Less Than 3 Cm (Pro Cah)",,21930,CPT,Professional,Both,,,,2560,2176,225.35,2560,"Multiplan, Inc.","Multiplan, Inc.",2406.4,94,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Back Or Flank, Subcutaneous; Less Than 3 Cm (Pro Cah)",,21930,CPT,Professional,Both,,,,2560,2176,225.35,2560,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,2306.56,90.1,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Back Or Flank, Subcutaneous; Less Than 3 Cm (Pro Cah)",,21930,CPT,Professional,Both,,,,2560,2176,225.35,2560,"Preferred One Administrative Services, INC.",PPO,2524.16,98.6,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Back Or Flank, Subcutaneous; Less Than 3 Cm (Pro Cah)",,21930,CPT,Professional,Both,,,,2560,2176,225.35,2560,PrimeWest Health,Minnesota Senior Health Options (MSHO),402.9485,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Tumor, Soft Tissue Of Back Or Flank, Subcutaneous; Less Than 3 Cm (Pro Cah)",,21930,CPT,Professional,Both,,,,2560,2176,225.35,2560,PrimeWest Health,MinnesotaCare,278.3896896,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision, Tumor, Soft Tissue Of Back Or Flank, Subcutaneous; Less Than 3 Cm (Pro Cah)",,21930,CPT,Professional,Both,,,,2560,2176,225.35,2560,Sanford Health Plan,Sanford Health Plan,2252.8,88,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Back Or Flank, Subcutaneous; Less Than 3 Cm (Pro Cah)",,21930,CPT,Professional,Both,,,,2560,2176,225.35,2560,"UCare Health, Inc.",Individual & Family Plan,569.593984,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Excision, Tumor, Soft Tissue Of Back Or Flank, Subcutaneous; Less Than 3 Cm (Pro Cah)",,21930,CPT,Professional,Both,,,,2560,2176,225.35,2560,"UCare Health, Inc.",Medical Assistance,286.195008,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Excision, Tumor, Soft Tissue Of Back Or Flank, Subcutaneous; Less Than 3 Cm (Pro Cah)",,21930,CPT,Professional,Both,,,,2560,2176,225.35,2560,"UCare Health, Inc.",Medicare Advantage,402.9485,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Excision, Tumor, Soft Tissue Of Back Or Flank, Subcutaneous; Less Than 3 Cm (Pro Cah)",,21930,CPT,Professional,Both,,,,2560,2176,225.35,2560,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),322.3588,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Excision, Tumor, Soft Tissue Of Back Or Flank, Subcutaneous; Less Than 3 Cm (Pro Cah)",,21930,CPT,Professional,Both,,,,2560,2176,225.35,2560,UnitedHealthcare,Individual & Family,2560,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Excision, Tumor, Soft Tissue Of Back Or Flank, Subcutaneous; Less Than 3 Cm (Pro Cah)",,21930,CPT,Professional,Both,,,,2560,2176,225.35,2560,UnitedHealthcare,Medicare Advantage,402.9485,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Tumor, Soft Tissue Of Back Or Flank, Subcutaneous; Less Than 3 Cm (Pro Cah)",,21930,CPT,Professional,Both,,,,2560,2176,225.35,2560,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,260.17728,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision, Tumor, Soft Tissue Of Back Or Flank, Subcutaneous; 3 Cm Or Greater (Pro Cah)",,21931,CPT,Professional,Both,,,,3494,2969.9,286.43,3494,Aetna,Commercial,2969.9,85,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Back Or Flank, Subcutaneous; 3 Cm Or Greater (Pro Cah)",,21931,CPT,Professional,Both,,,,3494,2969.9,286.43,3494,Aetna,Medicare Advantage,451.34,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Tumor, Soft Tissue Of Back Or Flank, Subcutaneous; 3 Cm Or Greater (Pro Cah)",,21931,CPT,Professional,Both,,,,3494,2969.9,286.43,3494,Aetna,PPO,3249.42,93,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Back Or Flank, Subcutaneous; 3 Cm Or Greater (Pro Cah)",,21931,CPT,Professional,Both,,,,3494,2969.9,286.43,3494,America's PPO,America's PPO,2985.2736,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Excision, Tumor, Soft Tissue Of Back Or Flank, Subcutaneous; 3 Cm Or Greater (Pro Cah)",,21931,CPT,Professional,Both,,,,3494,2969.9,286.43,3494,BlueCross BlueShield Minnesota, Federal Employee Program,971.61,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Excision, Tumor, Soft Tissue Of Back Or Flank, Subcutaneous; 3 Cm Or Greater (Pro Cah)",,21931,CPT,Professional,Both,,,,3494,2969.9,286.43,3494,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,987.15576,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Tumor, Soft Tissue Of Back Or Flank, Subcutaneous; 3 Cm Or Greater (Pro Cah)",,21931,CPT,Professional,Both,,,,3494,2969.9,286.43,3494,BlueCross BlueShield Minnesota,High Value Network Plan,987.15576,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Tumor, Soft Tissue Of Back Or Flank, Subcutaneous; 3 Cm Or Greater (Pro Cah)",,21931,CPT,Professional,Both,,,,3494,2969.9,286.43,3494,BlueCross BlueShield Minnesota,Medicare Advantage,512.0145,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Tumor, Soft Tissue Of Back Or Flank, Subcutaneous; 3 Cm Or Greater (Pro Cah)",,21931,CPT,Professional,Both,,,,3494,2969.9,286.43,3494,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,987.15576,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Tumor, Soft Tissue Of Back Or Flank, Subcutaneous; 3 Cm Or Greater (Pro Cah)",,21931,CPT,Professional,Both,,,,3494,2969.9,286.43,3494,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,330.69784,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision, Tumor, Soft Tissue Of Back Or Flank, Subcutaneous; 3 Cm Or Greater (Pro Cah)",,21931,CPT,Professional,Both,,,,3494,2969.9,286.43,3494,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),512.0145,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Tumor, Soft Tissue Of Back Or Flank, Subcutaneous; 3 Cm Or Greater (Pro Cah)",,21931,CPT,Professional,Both,,,,3494,2969.9,286.43,3494,CorVel,Worker's Compensation,876.5832774,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Excision, Tumor, Soft Tissue Of Back Or Flank, Subcutaneous; 3 Cm Or Greater (Pro Cah)",,21931,CPT,Professional,Both,,,,3494,2969.9,286.43,3494,First Health Group Corporation,First Health Network,3389.18,97,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Back Or Flank, Subcutaneous; 3 Cm Or Greater (Pro Cah)",,21931,CPT,Professional,Both,,,,3494,2969.9,286.43,3494,"Health Partners, Inc.",Commercial,946.81,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision, Tumor, Soft Tissue Of Back Or Flank, Subcutaneous; 3 Cm Or Greater (Pro Cah)",,21931,CPT,Professional,Both,,,,3494,2969.9,286.43,3494,"Health Partners, Inc.",Medicare Advantage,512.0145,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Tumor, Soft Tissue Of Back Or Flank, Subcutaneous; 3 Cm Or Greater (Pro Cah)",,21931,CPT,Professional,Both,,,,3494,2969.9,286.43,3494,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),445.28,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Excision, Tumor, Soft Tissue Of Back Or Flank, Subcutaneous; 3 Cm Or Greater (Pro Cah)",,21931,CPT,Professional,Both,,,,3494,2969.9,286.43,3494,"Health Partners, Inc.",State of Minnesota Advantage Program,815.676815,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision, Tumor, Soft Tissue Of Back Or Flank, Subcutaneous; 3 Cm Or Greater (Pro Cah)",,21931,CPT,Professional,Both,,,,3494,2969.9,286.43,3494,"Health Partners, Inc.",State Public Programs,286.43,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Excision, Tumor, Soft Tissue Of Back Or Flank, Subcutaneous; 3 Cm Or Greater (Pro Cah)",,21931,CPT,Professional,Both,,,,3494,2969.9,286.43,3494,Humana Insurance Company,Commercial PPO,445.23,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Excision, Tumor, Soft Tissue Of Back Or Flank, Subcutaneous; 3 Cm Or Greater (Pro Cah)",,21931,CPT,Professional,Both,,,,3494,2969.9,286.43,3494,Humana Insurance Company,Medicare PPO,3494,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Excision, Tumor, Soft Tissue Of Back Or Flank, Subcutaneous; 3 Cm Or Greater (Pro Cah)",,21931,CPT,Professional,Both,,,,3494,2969.9,286.43,3494,Medica,Individual & Family,2962.912,84.8,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Back Or Flank, Subcutaneous; 3 Cm Or Greater (Pro Cah)",,21931,CPT,Professional,Both,,,,3494,2969.9,286.43,3494,Medica,Medica Advantage Solution,1740.012,49.8,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Back Or Flank, Subcutaneous; 3 Cm Or Greater (Pro Cah)",,21931,CPT,Professional,Both,,,,3494,2969.9,286.43,3494,Medica,Medical Assistance,330.7,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Excision, Tumor, Soft Tissue Of Back Or Flank, Subcutaneous; 3 Cm Or Greater (Pro Cah)",,21931,CPT,Professional,Both,,,,3494,2969.9,286.43,3494,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,445.23,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Excision, Tumor, Soft Tissue Of Back Or Flank, Subcutaneous; 3 Cm Or Greater (Pro Cah)",,21931,CPT,Professional,Both,,,,3494,2969.9,286.43,3494,"Multiplan, Inc.","Multiplan, Inc.",3284.36,94,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Back Or Flank, Subcutaneous; 3 Cm Or Greater (Pro Cah)",,21931,CPT,Professional,Both,,,,3494,2969.9,286.43,3494,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,3148.094,90.1,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Back Or Flank, Subcutaneous; 3 Cm Or Greater (Pro Cah)",,21931,CPT,Professional,Both,,,,3494,2969.9,286.43,3494,"Preferred One Administrative Services, INC.",PPO,3445.084,98.6,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Back Or Flank, Subcutaneous; 3 Cm Or Greater (Pro Cah)",,21931,CPT,Professional,Both,,,,3494,2969.9,286.43,3494,PrimeWest Health,Minnesota Senior Health Options (MSHO),512.0145,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Tumor, Soft Tissue Of Back Or Flank, Subcutaneous; 3 Cm Or Greater (Pro Cah)",,21931,CPT,Professional,Both,,,,3494,2969.9,286.43,3494,PrimeWest Health,MinnesotaCare,353.8466888,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision, Tumor, Soft Tissue Of Back Or Flank, Subcutaneous; 3 Cm Or Greater (Pro Cah)",,21931,CPT,Professional,Both,,,,3494,2969.9,286.43,3494,Sanford Health Plan,Sanford Health Plan,3074.72,88,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Back Or Flank, Subcutaneous; 3 Cm Or Greater (Pro Cah)",,21931,CPT,Professional,Both,,,,3494,2969.9,286.43,3494,"UCare Health, Inc.",Individual & Family Plan,723.765888,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Excision, Tumor, Soft Tissue Of Back Or Flank, Subcutaneous; 3 Cm Or Greater (Pro Cah)",,21931,CPT,Professional,Both,,,,3494,2969.9,286.43,3494,"UCare Health, Inc.",Medical Assistance,363.767624,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Excision, Tumor, Soft Tissue Of Back Or Flank, Subcutaneous; 3 Cm Or Greater (Pro Cah)",,21931,CPT,Professional,Both,,,,3494,2969.9,286.43,3494,"UCare Health, Inc.",Medicare Advantage,512.0145,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Excision, Tumor, Soft Tissue Of Back Or Flank, Subcutaneous; 3 Cm Or Greater (Pro Cah)",,21931,CPT,Professional,Both,,,,3494,2969.9,286.43,3494,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),409.6116,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Excision, Tumor, Soft Tissue Of Back Or Flank, Subcutaneous; 3 Cm Or Greater (Pro Cah)",,21931,CPT,Professional,Both,,,,3494,2969.9,286.43,3494,UnitedHealthcare,Individual & Family,3494,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Excision, Tumor, Soft Tissue Of Back Or Flank, Subcutaneous; 3 Cm Or Greater (Pro Cah)",,21931,CPT,Professional,Both,,,,3494,2969.9,286.43,3494,UnitedHealthcare,Medicare Advantage,512.0145,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Tumor, Soft Tissue Of Back Or Flank, Subcutaneous; 3 Cm Or Greater (Pro Cah)",,21931,CPT,Professional,Both,,,,3494,2969.9,286.43,3494,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,330.69784,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision, Tumor, Soft Tissue Of Back Or Flank, Subq; 3 Cm Or Greater (Pbb)",,21931,CPT,Facility,Outpatient,,,,1739,1478.15,498.3974,1739,Aetna,Commercial,1599.88,92,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Back Or Flank, Subq; 3 Cm Or Greater (Pbb)",,21931,CPT,Professional,Outpatient,,,,1755,1491.75,286.43,1755,Aetna,Commercial,1491.75,85,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Back Or Flank, Subq; 3 Cm Or Greater (Pbb)",,21931,CPT,Facility,Outpatient,,,,1739,1478.15,498.3974,1739,Aetna,Medicare Advantage,852.11,49,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Back Or Flank, Subq; 3 Cm Or Greater (Pbb)",,21931,CPT,Professional,Outpatient,,,,1755,1491.75,286.43,1755,Aetna,Medicare Advantage,451.34,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Tumor, Soft Tissue Of Back Or Flank, Subq; 3 Cm Or Greater (Pbb)",,21931,CPT,Facility,Outpatient,,,,1739,1478.15,498.3974,1739,Aetna,PPO,1617.27,93,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Back Or Flank, Subq; 3 Cm Or Greater (Pbb)",,21931,CPT,Professional,Outpatient,,,,1755,1491.75,286.43,1755,Aetna,PPO,1632.15,93,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Back Or Flank, Subq; 3 Cm Or Greater (Pbb)",,21931,CPT,Facility,Outpatient,,,,1739,1478.15,498.3974,1739,America's PPO,America's PPO,1669.9617,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Excision, Tumor, Soft Tissue Of Back Or Flank, Subq; 3 Cm Or Greater (Pbb)",,21931,CPT,Professional,Outpatient,,,,1755,1491.75,286.43,1755,America's PPO,America's PPO,1499.472,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Excision, Tumor, Soft Tissue Of Back Or Flank, Subq; 3 Cm Or Greater (Pbb)",,21931,CPT,Facility,Outpatient,,,,1739,1478.15,498.3974,1739,BlueCross BlueShield Minnesota, Federal Employee Program,1711.176,98.4,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Back Or Flank, Subq; 3 Cm Or Greater (Pbb)",,21931,CPT,Professional,Outpatient,,,,1755,1491.75,286.43,1755,BlueCross BlueShield Minnesota, Federal Employee Program,971.61,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Excision, Tumor, Soft Tissue Of Back Or Flank, Subq; 3 Cm Or Greater (Pbb)",,21931,CPT,Facility,Outpatient,,,,1739,1478.15,498.3974,1739,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1739,100,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Back Or Flank, Subq; 3 Cm Or Greater (Pbb)",,21931,CPT,Professional,Outpatient,,,,1755,1491.75,286.43,1755,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,987.15576,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Tumor, Soft Tissue Of Back Or Flank, Subq; 3 Cm Or Greater (Pbb)",,21931,CPT,Facility,Outpatient,,,,1739,1478.15,498.3974,1739,BlueCross BlueShield Minnesota,High Value Network Plan,1565.1,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
"Excision, Tumor, Soft Tissue Of Back Or Flank, Subq; 3 Cm Or Greater (Pbb)",,21931,CPT,Professional,Outpatient,,,,1755,1491.75,286.43,1755,BlueCross BlueShield Minnesota,High Value Network Plan,987.15576,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Tumor, Soft Tissue Of Back Or Flank, Subq; 3 Cm Or Greater (Pbb)",,21931,CPT,Facility,Outpatient,,,,1739,1478.15,498.3974,1739,BlueCross BlueShield Minnesota,Medicare Advantage,852.11,49,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Back Or Flank, Subq; 3 Cm Or Greater (Pbb)",,21931,CPT,Professional,Outpatient,,,,1755,1491.75,286.43,1755,BlueCross BlueShield Minnesota,Medicare Advantage,512.0145,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Tumor, Soft Tissue Of Back Or Flank, Subq; 3 Cm Or Greater (Pbb)",,21931,CPT,Professional,Outpatient,,,,1755,1491.75,286.43,1755,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,987.15576,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Tumor, Soft Tissue Of Back Or Flank, Subq; 3 Cm Or Greater (Pbb)",,21931,CPT,Facility,Outpatient,,,,1739,1478.15,498.3974,1739,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,498.3974,28.66,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Back Or Flank, Subq; 3 Cm Or Greater (Pbb)",,21931,CPT,Professional,Outpatient,,,,1755,1491.75,286.43,1755,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,330.69784,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision, Tumor, Soft Tissue Of Back Or Flank, Subq; 3 Cm Or Greater (Pbb)",,21931,CPT,Facility,Outpatient,,,,1739,1478.15,498.3974,1739,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),852.11,49,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Back Or Flank, Subq; 3 Cm Or Greater (Pbb)",,21931,CPT,Professional,Outpatient,,,,1755,1491.75,286.43,1755,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),512.0145,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Tumor, Soft Tissue Of Back Or Flank, Subq; 3 Cm Or Greater (Pbb)",,21931,CPT,Facility,Outpatient,,,,1739,1478.15,498.3974,1739,CorVel,Worker's Compensation,1739,100,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Back Or Flank, Subq; 3 Cm Or Greater (Pbb)",,21931,CPT,Professional,Outpatient,,,,1755,1491.75,286.43,1755,CorVel,Worker's Compensation,876.5832774,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Excision, Tumor, Soft Tissue Of Back Or Flank, Subq; 3 Cm Or Greater (Pbb)",,21931,CPT,Facility,Outpatient,,,,1739,1478.15,498.3974,1739,First Health Group Corporation,First Health Network,1686.83,97,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Back Or Flank, Subq; 3 Cm Or Greater (Pbb)",,21931,CPT,Professional,Outpatient,,,,1755,1491.75,286.43,1755,First Health Group Corporation,First Health Network,1702.35,97,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Back Or Flank, Subq; 3 Cm Or Greater (Pbb)",,21931,CPT,Facility,Outpatient,,,,1739,1478.15,498.3974,1739,"Health Partners, Inc.",Commercial,1645.094,94.6,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Back Or Flank, Subq; 3 Cm Or Greater (Pbb)",,21931,CPT,Professional,Outpatient,,,,1755,1491.75,286.43,1755,"Health Partners, Inc.",Commercial,946.81,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision, Tumor, Soft Tissue Of Back Or Flank, Subq; 3 Cm Or Greater (Pbb)",,21931,CPT,Facility,Outpatient,,,,1739,1478.15,498.3974,1739,"Health Partners, Inc.",Medicare Advantage,852.11,49,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Back Or Flank, Subq; 3 Cm Or Greater (Pbb)",,21931,CPT,Professional,Outpatient,,,,1755,1491.75,286.43,1755,"Health Partners, Inc.",Medicare Advantage,512.0145,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Tumor, Soft Tissue Of Back Or Flank, Subq; 3 Cm Or Greater (Pbb)",,21931,CPT,Facility,Outpatient,,,,1739,1478.15,498.3974,1739,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1043.4,60,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Back Or Flank, Subq; 3 Cm Or Greater (Pbb)",,21931,CPT,Professional,Outpatient,,,,1755,1491.75,286.43,1755,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),445.28,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Excision, Tumor, Soft Tissue Of Back Or Flank, Subq; 3 Cm Or Greater (Pbb)",,21931,CPT,Facility,Outpatient,,,,1739,1478.15,498.3974,1739,"Health Partners, Inc.",State of Minnesota Advantage Program,1417.285,81.5,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Back Or Flank, Subq; 3 Cm Or Greater (Pbb)",,21931,CPT,Professional,Outpatient,,,,1755,1491.75,286.43,1755,"Health Partners, Inc.",State of Minnesota Advantage Program,815.676815,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision, Tumor, Soft Tissue Of Back Or Flank, Subq; 3 Cm Or Greater (Pbb)",,21931,CPT,Facility,Outpatient,,,,1739,1478.15,498.3974,1739,"Health Partners, Inc.",State Public Programs,869.5,50,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Back Or Flank, Subq; 3 Cm Or Greater (Pbb)",,21931,CPT,Professional,Outpatient,,,,1755,1491.75,286.43,1755,"Health Partners, Inc.",State Public Programs,286.43,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Excision, Tumor, Soft Tissue Of Back Or Flank, Subq; 3 Cm Or Greater (Pbb)",,21931,CPT,Facility,Outpatient,,,,1739,1478.15,498.3974,1739,Humana Insurance Company,Commercial PPO,1652.05,95,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Back Or Flank, Subq; 3 Cm Or Greater (Pbb)",,21931,CPT,Professional,Outpatient,,,,1755,1491.75,286.43,1755,Humana Insurance Company,Commercial PPO,445.23,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Excision, Tumor, Soft Tissue Of Back Or Flank, Subq; 3 Cm Or Greater (Pbb)",,21931,CPT,Facility,Outpatient,,,,1739,1478.15,498.3974,1739,Humana Insurance Company,Medicare PPO,852.11,49,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Back Or Flank, Subq; 3 Cm Or Greater (Pbb)",,21931,CPT,Professional,Outpatient,,,,1755,1491.75,286.43,1755,Humana Insurance Company,Medicare PPO,1755,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Excision, Tumor, Soft Tissue Of Back Or Flank, Subq; 3 Cm Or Greater (Pbb)",,21931,CPT,Facility,Outpatient,,,,1739,1478.15,498.3974,1739,Medica,Individual & Family,1723.349,99.1,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Back Or Flank, Subq; 3 Cm Or Greater (Pbb)",,21931,CPT,Professional,Outpatient,,,,1755,1491.75,286.43,1755,Medica,Individual & Family,1488.24,84.8,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Back Or Flank, Subq; 3 Cm Or Greater (Pbb)",,21931,CPT,Facility,Outpatient,,,,1739,1478.15,498.3974,1739,Medica,Medica Advantage Solution,866.022,49.8,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Back Or Flank, Subq; 3 Cm Or Greater (Pbb)",,21931,CPT,Professional,Outpatient,,,,1755,1491.75,286.43,1755,Medica,Medica Advantage Solution,873.99,49.8,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Back Or Flank, Subq; 3 Cm Or Greater (Pbb)",,21931,CPT,Facility,Outpatient,,,,1739,1478.15,498.3974,1739,Medica,Medical Assistance,775.594,44.6,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Back Or Flank, Subq; 3 Cm Or Greater (Pbb)",,21931,CPT,Professional,Outpatient,,,,1755,1491.75,286.43,1755,Medica,Medical Assistance,330.7,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Excision, Tumor, Soft Tissue Of Back Or Flank, Subq; 3 Cm Or Greater (Pbb)",,21931,CPT,Facility,Outpatient,,,,1739,1478.15,498.3974,1739,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,866.022,49.8,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Back Or Flank, Subq; 3 Cm Or Greater (Pbb)",,21931,CPT,Professional,Outpatient,,,,1755,1491.75,286.43,1755,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,445.23,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Excision, Tumor, Soft Tissue Of Back Or Flank, Subq; 3 Cm Or Greater (Pbb)",,21931,CPT,Facility,Outpatient,,,,1739,1478.15,498.3974,1739,"Multiplan, Inc.","Multiplan, Inc.",1634.66,94,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Back Or Flank, Subq; 3 Cm Or Greater (Pbb)",,21931,CPT,Professional,Outpatient,,,,1755,1491.75,286.43,1755,"Multiplan, Inc.","Multiplan, Inc.",1649.7,94,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Back Or Flank, Subq; 3 Cm Or Greater (Pbb)",,21931,CPT,Facility,Outpatient,,,,1739,1478.15,498.3974,1739,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1566.839,90.1,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Back Or Flank, Subq; 3 Cm Or Greater (Pbb)",,21931,CPT,Professional,Outpatient,,,,1755,1491.75,286.43,1755,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1581.255,90.1,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Back Or Flank, Subq; 3 Cm Or Greater (Pbb)",,21931,CPT,Facility,Outpatient,,,,1739,1478.15,498.3974,1739,"Preferred One Administrative Services, INC.",PPO,1714.654,98.6,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Back Or Flank, Subq; 3 Cm Or Greater (Pbb)",,21931,CPT,Professional,Outpatient,,,,1755,1491.75,286.43,1755,"Preferred One Administrative Services, INC.",PPO,1730.43,98.6,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Back Or Flank, Subq; 3 Cm Or Greater (Pbb)",,21931,CPT,Facility,Outpatient,,,,1739,1478.15,498.3974,1739,PrimeWest Health,Minnesota Senior Health Options (MSHO),894.7155,51.45,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Back Or Flank, Subq; 3 Cm Or Greater (Pbb)",,21931,CPT,Professional,Outpatient,,,,1755,1491.75,286.43,1755,PrimeWest Health,Minnesota Senior Health Options (MSHO),512.0145,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Tumor, Soft Tissue Of Back Or Flank, Subq; 3 Cm Or Greater (Pbb)",,21931,CPT,Facility,Outpatient,,,,1739,1478.15,498.3974,1739,PrimeWest Health,MinnesotaCare,893.1504,51.36,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Back Or Flank, Subq; 3 Cm Or Greater (Pbb)",,21931,CPT,Professional,Outpatient,,,,1755,1491.75,286.43,1755,PrimeWest Health,MinnesotaCare,353.8466888,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision, Tumor, Soft Tissue Of Back Or Flank, Subq; 3 Cm Or Greater (Pbb)",,21931,CPT,Facility,Outpatient,,,,1739,1478.15,498.3974,1739,Sanford Health Plan,Sanford Health Plan,1599.88,92,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Back Or Flank, Subq; 3 Cm Or Greater (Pbb)",,21931,CPT,Professional,Outpatient,,,,1755,1491.75,286.43,1755,Sanford Health Plan,Sanford Health Plan,1544.4,88,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Back Or Flank, Subq; 3 Cm Or Greater (Pbb)",,21931,CPT,Facility,Outpatient,,,,1739,1478.15,498.3974,1739,"UCare Health, Inc.",Individual & Family Plan,979.9265,56.35,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Back Or Flank, Subq; 3 Cm Or Greater (Pbb)",,21931,CPT,Professional,Outpatient,,,,1755,1491.75,286.43,1755,"UCare Health, Inc.",Individual & Family Plan,723.765888,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Excision, Tumor, Soft Tissue Of Back Or Flank, Subq; 3 Cm Or Greater (Pbb)",,21931,CPT,Facility,Outpatient,,,,1739,1478.15,498.3974,1739,"UCare Health, Inc.",Medical Assistance,877.6733,50.47,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Back Or Flank, Subq; 3 Cm Or Greater (Pbb)",,21931,CPT,Professional,Outpatient,,,,1755,1491.75,286.43,1755,"UCare Health, Inc.",Medical Assistance,363.767624,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Excision, Tumor, Soft Tissue Of Back Or Flank, Subq; 3 Cm Or Greater (Pbb)",,21931,CPT,Facility,Outpatient,,,,1739,1478.15,498.3974,1739,"UCare Health, Inc.",Medicare Advantage,877.6733,50.47,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Back Or Flank, Subq; 3 Cm Or Greater (Pbb)",,21931,CPT,Professional,Outpatient,,,,1755,1491.75,286.43,1755,"UCare Health, Inc.",Medicare Advantage,512.0145,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Excision, Tumor, Soft Tissue Of Back Or Flank, Subq; 3 Cm Or Greater (Pbb)",,21931,CPT,Facility,Outpatient,,,,1739,1478.15,498.3974,1739,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),877.6733,50.47,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Back Or Flank, Subq; 3 Cm Or Greater (Pbb)",,21931,CPT,Professional,Outpatient,,,,1755,1491.75,286.43,1755,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),409.6116,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Excision, Tumor, Soft Tissue Of Back Or Flank, Subq; 3 Cm Or Greater (Pbb)",,21931,CPT,Facility,Outpatient,,,,1739,1478.15,498.3974,1739,UnitedHealthcare,Individual & Family,1634.66,94,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Back Or Flank, Subq; 3 Cm Or Greater (Pbb)",,21931,CPT,Professional,Outpatient,,,,1755,1491.75,286.43,1755,UnitedHealthcare,Individual & Family,1755,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Excision, Tumor, Soft Tissue Of Back Or Flank, Subq; 3 Cm Or Greater (Pbb)",,21931,CPT,Facility,Outpatient,,,,1739,1478.15,498.3974,1739,UnitedHealthcare,Medicare Advantage,852.11,49,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Back Or Flank, Subq; 3 Cm Or Greater (Pbb)",,21931,CPT,Professional,Outpatient,,,,1755,1491.75,286.43,1755,UnitedHealthcare,Medicare Advantage,512.0145,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Tumor, Soft Tissue Of Back Or Flank, Subq; 3 Cm Or Greater (Pbb)",,21931,CPT,Facility,Outpatient,,,,1739,1478.15,498.3974,1739,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,834.72,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Excision, Tumor, Soft Tissue Of Back Or Flank, Subq; 3 Cm Or Greater (Pbb)",,21931,CPT,Professional,Outpatient,,,,1755,1491.75,286.43,1755,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,330.69784,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
LEUPROLIDE 7.5 MG IM SYKT,,J9217,HCPCS,Facility,Both,1,Each,,7009,5957.65,2008.7794,7009,Aetna,Commercial,6448.28,92,,percent of total billed charges,,
LEUPROLIDE 7.5 MG IM SYKT,,J9217,HCPCS,Facility,Outpatient,1,Each,,7009,5957.65,2008.7794,7009,Aetna,Medicare Advantage,3434.41,49,,percent of total billed charges,,
LEUPROLIDE 7.5 MG IM SYKT,,J9217,HCPCS,Facility,Inpatient,1,Each,,7009,5957.65,2008.7794,7009,Aetna,Medicare Advantage,,,,,Included in per diem rate,
LEUPROLIDE 7.5 MG IM SYKT,,J9217,HCPCS,Facility,Both,1,Each,,7009,5957.65,2008.7794,7009,Aetna,PPO,6518.37,93,,percent of total billed charges,,
LEUPROLIDE 7.5 MG IM SYKT,,J9217,HCPCS,Facility,Both,1,Each,,7009,5957.65,2008.7794,7009,America's PPO,America's PPO,6730.7427,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
LEUPROLIDE 7.5 MG IM SYKT,,J9217,HCPCS,Facility,Both,1,Each,,7009,5957.65,2008.7794,7009,BlueCross BlueShield Minnesota, Federal Employee Program,6896.856,98.4,,percent of total billed charges,,
LEUPROLIDE 7.5 MG IM SYKT,,J9217,HCPCS,Facility,Both,1,Each,,7009,5957.65,2008.7794,7009,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,7009,100,,percent of total billed charges,,
LEUPROLIDE 7.5 MG IM SYKT,,J9217,HCPCS,Facility,Both,1,Each,,7009,5957.65,2008.7794,7009,BlueCross BlueShield Minnesota,High Value Network Plan,6308.1,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
LEUPROLIDE 7.5 MG IM SYKT,,J9217,HCPCS,Facility,Outpatient,1,Each,,7009,5957.65,2008.7794,7009,BlueCross BlueShield Minnesota,Medicare Advantage,3434.41,49,,percent of total billed charges,,
LEUPROLIDE 7.5 MG IM SYKT,,J9217,HCPCS,Facility,Inpatient,1,Each,,7009,5957.65,2008.7794,7009,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
LEUPROLIDE 7.5 MG IM SYKT,,J9217,HCPCS,Facility,Both,1,Each,,7009,5957.65,2008.7794,7009,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,6207.8713,88.57,,percent of total billed charges,,
LEUPROLIDE 7.5 MG IM SYKT,,J9217,HCPCS,Facility,Both,1,Each,,7009,5957.65,2008.7794,7009,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,2008.7794,28.66,,percent of total billed charges,,
LEUPROLIDE 7.5 MG IM SYKT,,J9217,HCPCS,Facility,Outpatient,1,Each,,7009,5957.65,2008.7794,7009,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),3434.41,49,,percent of total billed charges,,
LEUPROLIDE 7.5 MG IM SYKT,,J9217,HCPCS,Facility,Inpatient,1,Each,,7009,5957.65,2008.7794,7009,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
LEUPROLIDE 7.5 MG IM SYKT,,J9217,HCPCS,Facility,Both,1,Each,,7009,5957.65,2008.7794,7009,CorVel,Worker's Compensation,7009,100,,percent of total billed charges,,
LEUPROLIDE 7.5 MG IM SYKT,,J9217,HCPCS,Facility,Both,1,Each,,7009,5957.65,2008.7794,7009,First Health Group Corporation,First Health Network,6798.73,97,,percent of total billed charges,,
LEUPROLIDE 7.5 MG IM SYKT,,J9217,HCPCS,Facility,Both,1,Each,,7009,5957.65,2008.7794,7009,"Health Partners, Inc.",Commercial,6630.514,94.6,,percent of total billed charges,,
LEUPROLIDE 7.5 MG IM SYKT,,J9217,HCPCS,Facility,Outpatient,1,Each,,7009,5957.65,2008.7794,7009,"Health Partners, Inc.",Medicare Advantage,3434.41,49,,percent of total billed charges,,
LEUPROLIDE 7.5 MG IM SYKT,,J9217,HCPCS,Facility,Inpatient,1,Each,,7009,5957.65,2008.7794,7009,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LEUPROLIDE 7.5 MG IM SYKT,,J9217,HCPCS,Facility,Both,1,Each,,7009,5957.65,2008.7794,7009,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),4205.4,60,,percent of total billed charges,,
LEUPROLIDE 7.5 MG IM SYKT,,J9217,HCPCS,Facility,Both,1,Each,,7009,5957.65,2008.7794,7009,"Health Partners, Inc.",State of Minnesota Advantage Program,5712.335,81.5,,percent of total billed charges,,
LEUPROLIDE 7.5 MG IM SYKT,,J9217,HCPCS,Facility,Both,1,Each,,7009,5957.65,2008.7794,7009,"Health Partners, Inc.",State Public Programs,3504.5,50,,percent of total billed charges,,
LEUPROLIDE 7.5 MG IM SYKT,,J9217,HCPCS,Facility,Both,1,Each,,7009,5957.65,2008.7794,7009,Humana Insurance Company,Commercial PPO,6658.55,95,,percent of total billed charges,,
LEUPROLIDE 7.5 MG IM SYKT,,J9217,HCPCS,Facility,Outpatient,1,Each,,7009,5957.65,2008.7794,7009,Humana Insurance Company,Medicare PPO,3434.41,49,,percent of total billed charges,,
LEUPROLIDE 7.5 MG IM SYKT,,J9217,HCPCS,Facility,Inpatient,1,Each,,7009,5957.65,2008.7794,7009,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
LEUPROLIDE 7.5 MG IM SYKT,,J9217,HCPCS,Facility,Both,1,Each,,7009,5957.65,2008.7794,7009,Medica,Individual & Family,6945.919,99.1,,percent of total billed charges,,
LEUPROLIDE 7.5 MG IM SYKT,,J9217,HCPCS,Facility,Outpatient,1,Each,,7009,5957.65,2008.7794,7009,Medica,Medica Advantage Solution,3490.482,49.8,,percent of total billed charges,,
LEUPROLIDE 7.5 MG IM SYKT,,J9217,HCPCS,Facility,Inpatient,1,Each,,7009,5957.65,2008.7794,7009,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
LEUPROLIDE 7.5 MG IM SYKT,,J9217,HCPCS,Facility,Outpatient,1,Each,,7009,5957.65,2008.7794,7009,Medica,Medical Assistance,3126.014,44.6,,percent of total billed charges,,
LEUPROLIDE 7.5 MG IM SYKT,,J9217,HCPCS,Facility,Inpatient,1,Each,,7009,5957.65,2008.7794,7009,Medica,Medical Assistance,,,,,Included in per diem rate,
LEUPROLIDE 7.5 MG IM SYKT,,J9217,HCPCS,Facility,Outpatient,1,Each,,7009,5957.65,2008.7794,7009,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,3490.482,49.8,,percent of total billed charges,,
LEUPROLIDE 7.5 MG IM SYKT,,J9217,HCPCS,Facility,Inpatient,1,Each,,7009,5957.65,2008.7794,7009,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
LEUPROLIDE 7.5 MG IM SYKT,,J9217,HCPCS,Facility,Both,1,Each,,7009,5957.65,2008.7794,7009,"Multiplan, Inc.","Multiplan, Inc.",6588.46,94,,percent of total billed charges,,
LEUPROLIDE 7.5 MG IM SYKT,,J9217,HCPCS,Facility,Outpatient,1,Each,,7009,5957.65,2008.7794,7009,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,6315.109,90.1,,percent of total billed charges,,
LEUPROLIDE 7.5 MG IM SYKT,,J9217,HCPCS,Facility,Inpatient,1,Each,,7009,5957.65,2008.7794,7009,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
LEUPROLIDE 7.5 MG IM SYKT,,J9217,HCPCS,Facility,Both,1,Each,,7009,5957.65,2008.7794,7009,"Preferred One Administrative Services, INC.",PPO,6910.874,98.6,,percent of total billed charges,,
LEUPROLIDE 7.5 MG IM SYKT,,J9217,HCPCS,Facility,Outpatient,1,Each,,7009,5957.65,2008.7794,7009,PrimeWest Health,Minnesota Senior Health Options (MSHO),3606.1305,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
LEUPROLIDE 7.5 MG IM SYKT,,J9217,HCPCS,Facility,Inpatient,1,Each,,7009,5957.65,2008.7794,7009,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LEUPROLIDE 7.5 MG IM SYKT,,J9217,HCPCS,Facility,Outpatient,1,Each,,7009,5957.65,2008.7794,7009,PrimeWest Health,MinnesotaCare,3599.8224,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
LEUPROLIDE 7.5 MG IM SYKT,,J9217,HCPCS,Facility,Inpatient,1,Each,,7009,5957.65,2008.7794,7009,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
LEUPROLIDE 7.5 MG IM SYKT,,J9217,HCPCS,Facility,Both,1,Each,,7009,5957.65,2008.7794,7009,Sanford Health Plan,Sanford Health Plan,6448.28,92,,percent of total billed charges,,
LEUPROLIDE 7.5 MG IM SYKT,,J9217,HCPCS,Facility,Outpatient,1,Each,,7009,5957.65,2008.7794,7009,"UCare Health, Inc.",Individual & Family Plan,3949.5715,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
LEUPROLIDE 7.5 MG IM SYKT,,J9217,HCPCS,Facility,Inpatient,1,Each,,7009,5957.65,2008.7794,7009,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
LEUPROLIDE 7.5 MG IM SYKT,,J9217,HCPCS,Facility,Outpatient,1,Each,,7009,5957.65,2008.7794,7009,"UCare Health, Inc.",Medical Assistance,3537.4423,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LEUPROLIDE 7.5 MG IM SYKT,,J9217,HCPCS,Facility,Inpatient,1,Each,,7009,5957.65,2008.7794,7009,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
LEUPROLIDE 7.5 MG IM SYKT,,J9217,HCPCS,Facility,Outpatient,1,Each,,7009,5957.65,2008.7794,7009,"UCare Health, Inc.",Medicare Advantage,3537.4423,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LEUPROLIDE 7.5 MG IM SYKT,,J9217,HCPCS,Facility,Inpatient,1,Each,,7009,5957.65,2008.7794,7009,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LEUPROLIDE 7.5 MG IM SYKT,,J9217,HCPCS,Facility,Outpatient,1,Each,,7009,5957.65,2008.7794,7009,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),3537.4423,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LEUPROLIDE 7.5 MG IM SYKT,,J9217,HCPCS,Facility,Inpatient,1,Each,,7009,5957.65,2008.7794,7009,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LEUPROLIDE 7.5 MG IM SYKT,,J9217,HCPCS,Facility,Both,1,Each,,7009,5957.65,2008.7794,7009,UnitedHealthcare,Individual & Family,6588.46,94,,percent of total billed charges,,
LEUPROLIDE 7.5 MG IM SYKT,,J9217,HCPCS,Facility,Outpatient,1,Each,,7009,5957.65,2008.7794,7009,UnitedHealthcare,Medicare Advantage,3434.41,49,,percent of total billed charges,,
LEUPROLIDE 7.5 MG IM SYKT,,J9217,HCPCS,Facility,Inpatient,1,Each,,7009,5957.65,2008.7794,7009,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
LEUPROLIDE 7.5 MG IM SYKT,,J9217,HCPCS,Facility,Outpatient,1,Each,,7009,5957.65,2008.7794,7009,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,3364.32,48,,percent of total billed charges,,100% of DHS outpatient percentage
LEUPROLIDE 7.5 MG IM SYKT,,J9217,HCPCS,Facility,Inpatient,1,Each,,7009,5957.65,2008.7794,7009,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
LEUPROLIDE ACETATE (6 MONTH) 45 MG IM SYKT,,J9217,HCPCS,Facility,Both,1,Each,,42051,35743.35,12051.8166,42051,Aetna,Commercial,38686.92,92,,percent of total billed charges,,
LEUPROLIDE ACETATE (6 MONTH) 45 MG IM SYKT,,J9217,HCPCS,Facility,Outpatient,1,Each,,42051,35743.35,12051.8166,42051,Aetna,Medicare Advantage,20604.99,49,,percent of total billed charges,,
LEUPROLIDE ACETATE (6 MONTH) 45 MG IM SYKT,,J9217,HCPCS,Facility,Inpatient,1,Each,,42051,35743.35,12051.8166,42051,Aetna,Medicare Advantage,,,,,Included in per diem rate,
LEUPROLIDE ACETATE (6 MONTH) 45 MG IM SYKT,,J9217,HCPCS,Facility,Both,1,Each,,42051,35743.35,12051.8166,42051,Aetna,PPO,39107.43,93,,percent of total billed charges,,
LEUPROLIDE ACETATE (6 MONTH) 45 MG IM SYKT,,J9217,HCPCS,Facility,Both,1,Each,,42051,35743.35,12051.8166,42051,America's PPO,America's PPO,40381.5753,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
LEUPROLIDE ACETATE (6 MONTH) 45 MG IM SYKT,,J9217,HCPCS,Facility,Both,1,Each,,42051,35743.35,12051.8166,42051,BlueCross BlueShield Minnesota, Federal Employee Program,41378.184,98.4,,percent of total billed charges,,
LEUPROLIDE ACETATE (6 MONTH) 45 MG IM SYKT,,J9217,HCPCS,Facility,Both,1,Each,,42051,35743.35,12051.8166,42051,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,42051,100,,percent of total billed charges,,
LEUPROLIDE ACETATE (6 MONTH) 45 MG IM SYKT,,J9217,HCPCS,Facility,Both,1,Each,,42051,35743.35,12051.8166,42051,BlueCross BlueShield Minnesota,High Value Network Plan,37845.9,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
LEUPROLIDE ACETATE (6 MONTH) 45 MG IM SYKT,,J9217,HCPCS,Facility,Outpatient,1,Each,,42051,35743.35,12051.8166,42051,BlueCross BlueShield Minnesota,Medicare Advantage,20604.99,49,,percent of total billed charges,,
LEUPROLIDE ACETATE (6 MONTH) 45 MG IM SYKT,,J9217,HCPCS,Facility,Inpatient,1,Each,,42051,35743.35,12051.8166,42051,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
LEUPROLIDE ACETATE (6 MONTH) 45 MG IM SYKT,,J9217,HCPCS,Facility,Both,1,Each,,42051,35743.35,12051.8166,42051,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,37244.5707,88.57,,percent of total billed charges,,
LEUPROLIDE ACETATE (6 MONTH) 45 MG IM SYKT,,J9217,HCPCS,Facility,Both,1,Each,,42051,35743.35,12051.8166,42051,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,12051.8166,28.66,,percent of total billed charges,,
LEUPROLIDE ACETATE (6 MONTH) 45 MG IM SYKT,,J9217,HCPCS,Facility,Outpatient,1,Each,,42051,35743.35,12051.8166,42051,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),20604.99,49,,percent of total billed charges,,
LEUPROLIDE ACETATE (6 MONTH) 45 MG IM SYKT,,J9217,HCPCS,Facility,Inpatient,1,Each,,42051,35743.35,12051.8166,42051,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
LEUPROLIDE ACETATE (6 MONTH) 45 MG IM SYKT,,J9217,HCPCS,Facility,Both,1,Each,,42051,35743.35,12051.8166,42051,CorVel,Worker's Compensation,42051,100,,percent of total billed charges,,
LEUPROLIDE ACETATE (6 MONTH) 45 MG IM SYKT,,J9217,HCPCS,Facility,Both,1,Each,,42051,35743.35,12051.8166,42051,First Health Group Corporation,First Health Network,40789.47,97,,percent of total billed charges,,
LEUPROLIDE ACETATE (6 MONTH) 45 MG IM SYKT,,J9217,HCPCS,Facility,Both,1,Each,,42051,35743.35,12051.8166,42051,"Health Partners, Inc.",Commercial,39780.246,94.6,,percent of total billed charges,,
LEUPROLIDE ACETATE (6 MONTH) 45 MG IM SYKT,,J9217,HCPCS,Facility,Outpatient,1,Each,,42051,35743.35,12051.8166,42051,"Health Partners, Inc.",Medicare Advantage,20604.99,49,,percent of total billed charges,,
LEUPROLIDE ACETATE (6 MONTH) 45 MG IM SYKT,,J9217,HCPCS,Facility,Inpatient,1,Each,,42051,35743.35,12051.8166,42051,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LEUPROLIDE ACETATE (6 MONTH) 45 MG IM SYKT,,J9217,HCPCS,Facility,Both,1,Each,,42051,35743.35,12051.8166,42051,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),25230.6,60,,percent of total billed charges,,
LEUPROLIDE ACETATE (6 MONTH) 45 MG IM SYKT,,J9217,HCPCS,Facility,Both,1,Each,,42051,35743.35,12051.8166,42051,"Health Partners, Inc.",State of Minnesota Advantage Program,34271.565,81.5,,percent of total billed charges,,
LEUPROLIDE ACETATE (6 MONTH) 45 MG IM SYKT,,J9217,HCPCS,Facility,Both,1,Each,,42051,35743.35,12051.8166,42051,"Health Partners, Inc.",State Public Programs,21025.5,50,,percent of total billed charges,,
LEUPROLIDE ACETATE (6 MONTH) 45 MG IM SYKT,,J9217,HCPCS,Facility,Both,1,Each,,42051,35743.35,12051.8166,42051,Humana Insurance Company,Commercial PPO,39948.45,95,,percent of total billed charges,,
LEUPROLIDE ACETATE (6 MONTH) 45 MG IM SYKT,,J9217,HCPCS,Facility,Outpatient,1,Each,,42051,35743.35,12051.8166,42051,Humana Insurance Company,Medicare PPO,20604.99,49,,percent of total billed charges,,
LEUPROLIDE ACETATE (6 MONTH) 45 MG IM SYKT,,J9217,HCPCS,Facility,Inpatient,1,Each,,42051,35743.35,12051.8166,42051,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
LEUPROLIDE ACETATE (6 MONTH) 45 MG IM SYKT,,J9217,HCPCS,Facility,Both,1,Each,,42051,35743.35,12051.8166,42051,Medica,Individual & Family,41672.541,99.1,,percent of total billed charges,,
LEUPROLIDE ACETATE (6 MONTH) 45 MG IM SYKT,,J9217,HCPCS,Facility,Outpatient,1,Each,,42051,35743.35,12051.8166,42051,Medica,Medica Advantage Solution,20941.398,49.8,,percent of total billed charges,,
LEUPROLIDE ACETATE (6 MONTH) 45 MG IM SYKT,,J9217,HCPCS,Facility,Inpatient,1,Each,,42051,35743.35,12051.8166,42051,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
LEUPROLIDE ACETATE (6 MONTH) 45 MG IM SYKT,,J9217,HCPCS,Facility,Outpatient,1,Each,,42051,35743.35,12051.8166,42051,Medica,Medical Assistance,18754.746,44.6,,percent of total billed charges,,
LEUPROLIDE ACETATE (6 MONTH) 45 MG IM SYKT,,J9217,HCPCS,Facility,Inpatient,1,Each,,42051,35743.35,12051.8166,42051,Medica,Medical Assistance,,,,,Included in per diem rate,
LEUPROLIDE ACETATE (6 MONTH) 45 MG IM SYKT,,J9217,HCPCS,Facility,Outpatient,1,Each,,42051,35743.35,12051.8166,42051,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,20941.398,49.8,,percent of total billed charges,,
LEUPROLIDE ACETATE (6 MONTH) 45 MG IM SYKT,,J9217,HCPCS,Facility,Inpatient,1,Each,,42051,35743.35,12051.8166,42051,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
LEUPROLIDE ACETATE (6 MONTH) 45 MG IM SYKT,,J9217,HCPCS,Facility,Both,1,Each,,42051,35743.35,12051.8166,42051,"Multiplan, Inc.","Multiplan, Inc.",39527.94,94,,percent of total billed charges,,
LEUPROLIDE ACETATE (6 MONTH) 45 MG IM SYKT,,J9217,HCPCS,Facility,Outpatient,1,Each,,42051,35743.35,12051.8166,42051,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,37887.951,90.1,,percent of total billed charges,,
LEUPROLIDE ACETATE (6 MONTH) 45 MG IM SYKT,,J9217,HCPCS,Facility,Inpatient,1,Each,,42051,35743.35,12051.8166,42051,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
LEUPROLIDE ACETATE (6 MONTH) 45 MG IM SYKT,,J9217,HCPCS,Facility,Both,1,Each,,42051,35743.35,12051.8166,42051,"Preferred One Administrative Services, INC.",PPO,41462.286,98.6,,percent of total billed charges,,
LEUPROLIDE ACETATE (6 MONTH) 45 MG IM SYKT,,J9217,HCPCS,Facility,Outpatient,1,Each,,42051,35743.35,12051.8166,42051,PrimeWest Health,Minnesota Senior Health Options (MSHO),21635.2395,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
LEUPROLIDE ACETATE (6 MONTH) 45 MG IM SYKT,,J9217,HCPCS,Facility,Inpatient,1,Each,,42051,35743.35,12051.8166,42051,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LEUPROLIDE ACETATE (6 MONTH) 45 MG IM SYKT,,J9217,HCPCS,Facility,Outpatient,1,Each,,42051,35743.35,12051.8166,42051,PrimeWest Health,MinnesotaCare,21597.3936,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
LEUPROLIDE ACETATE (6 MONTH) 45 MG IM SYKT,,J9217,HCPCS,Facility,Inpatient,1,Each,,42051,35743.35,12051.8166,42051,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
LEUPROLIDE ACETATE (6 MONTH) 45 MG IM SYKT,,J9217,HCPCS,Facility,Both,1,Each,,42051,35743.35,12051.8166,42051,Sanford Health Plan,Sanford Health Plan,38686.92,92,,percent of total billed charges,,
LEUPROLIDE ACETATE (6 MONTH) 45 MG IM SYKT,,J9217,HCPCS,Facility,Outpatient,1,Each,,42051,35743.35,12051.8166,42051,"UCare Health, Inc.",Individual & Family Plan,23695.7385,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
LEUPROLIDE ACETATE (6 MONTH) 45 MG IM SYKT,,J9217,HCPCS,Facility,Inpatient,1,Each,,42051,35743.35,12051.8166,42051,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
LEUPROLIDE ACETATE (6 MONTH) 45 MG IM SYKT,,J9217,HCPCS,Facility,Outpatient,1,Each,,42051,35743.35,12051.8166,42051,"UCare Health, Inc.",Medical Assistance,21223.1397,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LEUPROLIDE ACETATE (6 MONTH) 45 MG IM SYKT,,J9217,HCPCS,Facility,Inpatient,1,Each,,42051,35743.35,12051.8166,42051,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
LEUPROLIDE ACETATE (6 MONTH) 45 MG IM SYKT,,J9217,HCPCS,Facility,Outpatient,1,Each,,42051,35743.35,12051.8166,42051,"UCare Health, Inc.",Medicare Advantage,21223.1397,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LEUPROLIDE ACETATE (6 MONTH) 45 MG IM SYKT,,J9217,HCPCS,Facility,Inpatient,1,Each,,42051,35743.35,12051.8166,42051,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LEUPROLIDE ACETATE (6 MONTH) 45 MG IM SYKT,,J9217,HCPCS,Facility,Outpatient,1,Each,,42051,35743.35,12051.8166,42051,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),21223.1397,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LEUPROLIDE ACETATE (6 MONTH) 45 MG IM SYKT,,J9217,HCPCS,Facility,Inpatient,1,Each,,42051,35743.35,12051.8166,42051,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LEUPROLIDE ACETATE (6 MONTH) 45 MG IM SYKT,,J9217,HCPCS,Facility,Both,1,Each,,42051,35743.35,12051.8166,42051,UnitedHealthcare,Individual & Family,39527.94,94,,percent of total billed charges,,
LEUPROLIDE ACETATE (6 MONTH) 45 MG IM SYKT,,J9217,HCPCS,Facility,Outpatient,1,Each,,42051,35743.35,12051.8166,42051,UnitedHealthcare,Medicare Advantage,20604.99,49,,percent of total billed charges,,
LEUPROLIDE ACETATE (6 MONTH) 45 MG IM SYKT,,J9217,HCPCS,Facility,Inpatient,1,Each,,42051,35743.35,12051.8166,42051,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
LEUPROLIDE ACETATE (6 MONTH) 45 MG IM SYKT,,J9217,HCPCS,Facility,Outpatient,1,Each,,42051,35743.35,12051.8166,42051,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,20184.48,48,,percent of total billed charges,,100% of DHS outpatient percentage
LEUPROLIDE ACETATE (6 MONTH) 45 MG IM SYKT,,J9217,HCPCS,Facility,Inpatient,1,Each,,42051,35743.35,12051.8166,42051,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
PROCHLORPERAZINE MALEATE 10 MG ORAL TABLET,,Q0164,HCPCS,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
PROCHLORPERAZINE MALEATE 10 MG ORAL TABLET,,Q0164,HCPCS,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
PROCHLORPERAZINE MALEATE 10 MG ORAL TABLET,,Q0164,HCPCS,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
PROCHLORPERAZINE MALEATE 10 MG ORAL TABLET,,Q0164,HCPCS,Facility,Both,1,Each,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
PROCHLORPERAZINE MALEATE 10 MG ORAL TABLET,,Q0164,HCPCS,Facility,Both,1,Each,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
PROCHLORPERAZINE MALEATE 10 MG ORAL TABLET,,Q0164,HCPCS,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
PROCHLORPERAZINE MALEATE 10 MG ORAL TABLET,,Q0164,HCPCS,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
PROCHLORPERAZINE MALEATE 10 MG ORAL TABLET,,Q0164,HCPCS,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
PROCHLORPERAZINE MALEATE 10 MG ORAL TABLET,,Q0164,HCPCS,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
PROCHLORPERAZINE MALEATE 10 MG ORAL TABLET,,Q0164,HCPCS,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
PROCHLORPERAZINE MALEATE 10 MG ORAL TABLET,,Q0164,HCPCS,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
PROCHLORPERAZINE MALEATE 10 MG ORAL TABLET,,Q0164,HCPCS,Facility,Both,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
PROCHLORPERAZINE MALEATE 10 MG ORAL TABLET,,Q0164,HCPCS,Facility,Outpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
PROCHLORPERAZINE MALEATE 10 MG ORAL TABLET,,Q0164,HCPCS,Facility,Inpatient,1,Each,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
PROCHLORPERAZINE MALEATE 10 MG ORAL TABLET,,Q0164,HCPCS,Facility,Both,1,Each,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
PROCHLORPERAZINE MALEATE 10 MG ORAL TABLET,,Q0164,HCPCS,Facility,Both,1,Each,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
PROCHLORPERAZINE MALEATE 10 MG ORAL TABLET,,Q0164,HCPCS,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
PROCHLORPERAZINE MALEATE 10 MG ORAL TABLET,,Q0164,HCPCS,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
PROCHLORPERAZINE MALEATE 10 MG ORAL TABLET,,Q0164,HCPCS,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PROCHLORPERAZINE MALEATE 10 MG ORAL TABLET,,Q0164,HCPCS,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
PROCHLORPERAZINE MALEATE 10 MG ORAL TABLET,,Q0164,HCPCS,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
PROCHLORPERAZINE MALEATE 10 MG ORAL TABLET,,Q0164,HCPCS,Facility,Both,1,Each,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
PROCHLORPERAZINE MALEATE 10 MG ORAL TABLET,,Q0164,HCPCS,Facility,Both,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
PROCHLORPERAZINE MALEATE 10 MG ORAL TABLET,,Q0164,HCPCS,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
PROCHLORPERAZINE MALEATE 10 MG ORAL TABLET,,Q0164,HCPCS,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
PROCHLORPERAZINE MALEATE 10 MG ORAL TABLET,,Q0164,HCPCS,Facility,Both,1,Each,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
PROCHLORPERAZINE MALEATE 10 MG ORAL TABLET,,Q0164,HCPCS,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
PROCHLORPERAZINE MALEATE 10 MG ORAL TABLET,,Q0164,HCPCS,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
PROCHLORPERAZINE MALEATE 10 MG ORAL TABLET,,Q0164,HCPCS,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
PROCHLORPERAZINE MALEATE 10 MG ORAL TABLET,,Q0164,HCPCS,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
PROCHLORPERAZINE MALEATE 10 MG ORAL TABLET,,Q0164,HCPCS,Facility,Outpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
PROCHLORPERAZINE MALEATE 10 MG ORAL TABLET,,Q0164,HCPCS,Facility,Inpatient,1,Each,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
PROCHLORPERAZINE MALEATE 10 MG ORAL TABLET,,Q0164,HCPCS,Facility,Both,1,Each,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
PROCHLORPERAZINE MALEATE 10 MG ORAL TABLET,,Q0164,HCPCS,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
PROCHLORPERAZINE MALEATE 10 MG ORAL TABLET,,Q0164,HCPCS,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
PROCHLORPERAZINE MALEATE 10 MG ORAL TABLET,,Q0164,HCPCS,Facility,Both,1,Each,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
PROCHLORPERAZINE MALEATE 10 MG ORAL TABLET,,Q0164,HCPCS,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
PROCHLORPERAZINE MALEATE 10 MG ORAL TABLET,,Q0164,HCPCS,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PROCHLORPERAZINE MALEATE 10 MG ORAL TABLET,,Q0164,HCPCS,Facility,Outpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
PROCHLORPERAZINE MALEATE 10 MG ORAL TABLET,,Q0164,HCPCS,Facility,Inpatient,1,Each,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
PROCHLORPERAZINE MALEATE 10 MG ORAL TABLET,,Q0164,HCPCS,Facility,Both,1,Each,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
PROCHLORPERAZINE MALEATE 10 MG ORAL TABLET,,Q0164,HCPCS,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
PROCHLORPERAZINE MALEATE 10 MG ORAL TABLET,,Q0164,HCPCS,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
PROCHLORPERAZINE MALEATE 10 MG ORAL TABLET,,Q0164,HCPCS,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PROCHLORPERAZINE MALEATE 10 MG ORAL TABLET,,Q0164,HCPCS,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
PROCHLORPERAZINE MALEATE 10 MG ORAL TABLET,,Q0164,HCPCS,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PROCHLORPERAZINE MALEATE 10 MG ORAL TABLET,,Q0164,HCPCS,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PROCHLORPERAZINE MALEATE 10 MG ORAL TABLET,,Q0164,HCPCS,Facility,Outpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PROCHLORPERAZINE MALEATE 10 MG ORAL TABLET,,Q0164,HCPCS,Facility,Inpatient,1,Each,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PROCHLORPERAZINE MALEATE 10 MG ORAL TABLET,,Q0164,HCPCS,Facility,Both,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
PROCHLORPERAZINE MALEATE 10 MG ORAL TABLET,,Q0164,HCPCS,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
PROCHLORPERAZINE MALEATE 10 MG ORAL TABLET,,Q0164,HCPCS,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
PROCHLORPERAZINE MALEATE 10 MG ORAL TABLET,,Q0164,HCPCS,Facility,Outpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
PROCHLORPERAZINE MALEATE 10 MG ORAL TABLET,,Q0164,HCPCS,Facility,Inpatient,1,Each,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Closed Treatment Of Proximal Humeral Fracture; With Manipulation, W/Wo Skeletal Traction (Pro Cah)",,23605,CPT,Professional,Both,,,,1698,1443.3,273.13,1698,Aetna,Commercial,1443.3,85,,percent of total billed charges,,
"Closed Treatment Of Proximal Humeral Fracture; With Manipulation, W/Wo Skeletal Traction (Pro Cah)",,23605,CPT,Professional,Both,,,,1698,1443.3,273.13,1698,Aetna,Medicare Advantage,423.47,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Closed Treatment Of Proximal Humeral Fracture; With Manipulation, W/Wo Skeletal Traction (Pro Cah)",,23605,CPT,Professional,Both,,,,1698,1443.3,273.13,1698,Aetna,PPO,1579.14,93,,percent of total billed charges,,
"Closed Treatment Of Proximal Humeral Fracture; With Manipulation, W/Wo Skeletal Traction (Pro Cah)",,23605,CPT,Professional,Both,,,,1698,1443.3,273.13,1698,America's PPO,America's PPO,1450.7712,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Closed Treatment Of Proximal Humeral Fracture; With Manipulation, W/Wo Skeletal Traction (Pro Cah)",,23605,CPT,Professional,Both,,,,1698,1443.3,273.13,1698,BlueCross BlueShield Minnesota, Federal Employee Program,900,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Closed Treatment Of Proximal Humeral Fracture; With Manipulation, W/Wo Skeletal Traction (Pro Cah)",,23605,CPT,Professional,Both,,,,1698,1443.3,273.13,1698,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,914.4,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Closed Treatment Of Proximal Humeral Fracture; With Manipulation, W/Wo Skeletal Traction (Pro Cah)",,23605,CPT,Professional,Both,,,,1698,1443.3,273.13,1698,BlueCross BlueShield Minnesota,High Value Network Plan,914.4,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Closed Treatment Of Proximal Humeral Fracture; With Manipulation, W/Wo Skeletal Traction (Pro Cah)",,23605,CPT,Professional,Both,,,,1698,1443.3,273.13,1698,BlueCross BlueShield Minnesota,Medicare Advantage,487.991,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Closed Treatment Of Proximal Humeral Fracture; With Manipulation, W/Wo Skeletal Traction (Pro Cah)",,23605,CPT,Professional,Both,,,,1698,1443.3,273.13,1698,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,914.4,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Closed Treatment Of Proximal Humeral Fracture; With Manipulation, W/Wo Skeletal Traction (Pro Cah)",,23605,CPT,Professional,Both,,,,1698,1443.3,273.13,1698,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,315.33592,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Closed Treatment Of Proximal Humeral Fracture; With Manipulation, W/Wo Skeletal Traction (Pro Cah)",,23605,CPT,Professional,Both,,,,1698,1443.3,273.13,1698,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),487.991,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Closed Treatment Of Proximal Humeral Fracture; With Manipulation, W/Wo Skeletal Traction (Pro Cah)",,23605,CPT,Professional,Both,,,,1698,1443.3,273.13,1698,CorVel,Worker's Compensation,822.6766656,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Closed Treatment Of Proximal Humeral Fracture; With Manipulation, W/Wo Skeletal Traction (Pro Cah)",,23605,CPT,Professional,Both,,,,1698,1443.3,273.13,1698,First Health Group Corporation,First Health Network,1647.06,97,,percent of total billed charges,,
"Closed Treatment Of Proximal Humeral Fracture; With Manipulation, W/Wo Skeletal Traction (Pro Cah)",,23605,CPT,Professional,Both,,,,1698,1443.3,273.13,1698,"Health Partners, Inc.",Commercial,888.77,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Closed Treatment Of Proximal Humeral Fracture; With Manipulation, W/Wo Skeletal Traction (Pro Cah)",,23605,CPT,Professional,Both,,,,1698,1443.3,273.13,1698,"Health Partners, Inc.",Medicare Advantage,487.991,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Closed Treatment Of Proximal Humeral Fracture; With Manipulation, W/Wo Skeletal Traction (Pro Cah)",,23605,CPT,Professional,Both,,,,1698,1443.3,273.13,1698,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),424.27,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Closed Treatment Of Proximal Humeral Fracture; With Manipulation, W/Wo Skeletal Traction (Pro Cah)",,23605,CPT,Professional,Both,,,,1698,1443.3,273.13,1698,"Health Partners, Inc.",State of Minnesota Advantage Program,765.675355,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Closed Treatment Of Proximal Humeral Fracture; With Manipulation, W/Wo Skeletal Traction (Pro Cah)",,23605,CPT,Professional,Both,,,,1698,1443.3,273.13,1698,"Health Partners, Inc.",State Public Programs,273.13,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Closed Treatment Of Proximal Humeral Fracture; With Manipulation, W/Wo Skeletal Traction (Pro Cah)",,23605,CPT,Professional,Both,,,,1698,1443.3,273.13,1698,Humana Insurance Company,Commercial PPO,424.34,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Closed Treatment Of Proximal Humeral Fracture; With Manipulation, W/Wo Skeletal Traction (Pro Cah)",,23605,CPT,Professional,Both,,,,1698,1443.3,273.13,1698,Humana Insurance Company,Medicare PPO,1698,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Closed Treatment Of Proximal Humeral Fracture; With Manipulation, W/Wo Skeletal Traction (Pro Cah)",,23605,CPT,Professional,Both,,,,1698,1443.3,273.13,1698,Medica,Individual & Family,1439.904,84.8,,percent of total billed charges,,
"Closed Treatment Of Proximal Humeral Fracture; With Manipulation, W/Wo Skeletal Traction (Pro Cah)",,23605,CPT,Professional,Both,,,,1698,1443.3,273.13,1698,Medica,Medica Advantage Solution,845.604,49.8,,percent of total billed charges,,
"Closed Treatment Of Proximal Humeral Fracture; With Manipulation, W/Wo Skeletal Traction (Pro Cah)",,23605,CPT,Professional,Both,,,,1698,1443.3,273.13,1698,Medica,Medical Assistance,315.34,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Closed Treatment Of Proximal Humeral Fracture; With Manipulation, W/Wo Skeletal Traction (Pro Cah)",,23605,CPT,Professional,Both,,,,1698,1443.3,273.13,1698,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,424.34,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Closed Treatment Of Proximal Humeral Fracture; With Manipulation, W/Wo Skeletal Traction (Pro Cah)",,23605,CPT,Professional,Both,,,,1698,1443.3,273.13,1698,"Multiplan, Inc.","Multiplan, Inc.",1596.12,94,,percent of total billed charges,,
"Closed Treatment Of Proximal Humeral Fracture; With Manipulation, W/Wo Skeletal Traction (Pro Cah)",,23605,CPT,Professional,Both,,,,1698,1443.3,273.13,1698,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1529.898,90.1,,percent of total billed charges,,
"Closed Treatment Of Proximal Humeral Fracture; With Manipulation, W/Wo Skeletal Traction (Pro Cah)",,23605,CPT,Professional,Both,,,,1698,1443.3,273.13,1698,"Preferred One Administrative Services, INC.",PPO,1674.228,98.6,,percent of total billed charges,,
"Closed Treatment Of Proximal Humeral Fracture; With Manipulation, W/Wo Skeletal Traction (Pro Cah)",,23605,CPT,Professional,Both,,,,1698,1443.3,273.13,1698,PrimeWest Health,Minnesota Senior Health Options (MSHO),487.991,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Closed Treatment Of Proximal Humeral Fracture; With Manipulation, W/Wo Skeletal Traction (Pro Cah)",,23605,CPT,Professional,Both,,,,1698,1443.3,273.13,1698,PrimeWest Health,MinnesotaCare,337.4094344,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Closed Treatment Of Proximal Humeral Fracture; With Manipulation, W/Wo Skeletal Traction (Pro Cah)",,23605,CPT,Professional,Both,,,,1698,1443.3,273.13,1698,Sanford Health Plan,Sanford Health Plan,1494.24,88,,percent of total billed charges,,
"Closed Treatment Of Proximal Humeral Fracture; With Manipulation, W/Wo Skeletal Traction (Pro Cah)",,23605,CPT,Professional,Both,,,,1698,1443.3,273.13,1698,"UCare Health, Inc.",Individual & Family Plan,689.807104,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Closed Treatment Of Proximal Humeral Fracture; With Manipulation, W/Wo Skeletal Traction (Pro Cah)",,23605,CPT,Professional,Both,,,,1698,1443.3,273.13,1698,"UCare Health, Inc.",Medical Assistance,346.869512,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Closed Treatment Of Proximal Humeral Fracture; With Manipulation, W/Wo Skeletal Traction (Pro Cah)",,23605,CPT,Professional,Both,,,,1698,1443.3,273.13,1698,"UCare Health, Inc.",Medicare Advantage,487.991,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Closed Treatment Of Proximal Humeral Fracture; With Manipulation, W/Wo Skeletal Traction (Pro Cah)",,23605,CPT,Professional,Both,,,,1698,1443.3,273.13,1698,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),390.3928,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Closed Treatment Of Proximal Humeral Fracture; With Manipulation, W/Wo Skeletal Traction (Pro Cah)",,23605,CPT,Professional,Both,,,,1698,1443.3,273.13,1698,UnitedHealthcare,Individual & Family,1698,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Closed Treatment Of Proximal Humeral Fracture; With Manipulation, W/Wo Skeletal Traction (Pro Cah)",,23605,CPT,Professional,Both,,,,1698,1443.3,273.13,1698,UnitedHealthcare,Medicare Advantage,487.991,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Closed Treatment Of Proximal Humeral Fracture; With Manipulation, W/Wo Skeletal Traction (Pro Cah)",,23605,CPT,Professional,Both,,,,1698,1443.3,273.13,1698,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,315.33592,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision, Tumor, Soft Tissue Of Upper Arm Or Elbow Area, Subcutaneous; 5 Cm Or Greater (Pbb)",,24073,CPT,Facility,Outpatient,,,,2519,2141.15,721.9454,2519,Aetna,Commercial,2317.48,92,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Upper Arm Or Elbow Area, Subcutaneous; 5 Cm Or Greater (Pbb)",,24073,CPT,Professional,Outpatient,,,,2550,2167.5,425.39,2550,Aetna,Commercial,2167.5,85,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Upper Arm Or Elbow Area, Subcutaneous; 5 Cm Or Greater (Pbb)",,24073,CPT,Facility,Outpatient,,,,2519,2141.15,721.9454,2519,Aetna,Medicare Advantage,1234.31,49,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Upper Arm Or Elbow Area, Subcutaneous; 5 Cm Or Greater (Pbb)",,24073,CPT,Professional,Outpatient,,,,2550,2167.5,425.39,2550,Aetna,Medicare Advantage,669.69,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Tumor, Soft Tissue Of Upper Arm Or Elbow Area, Subcutaneous; 5 Cm Or Greater (Pbb)",,24073,CPT,Facility,Outpatient,,,,2519,2141.15,721.9454,2519,Aetna,PPO,2342.67,93,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Upper Arm Or Elbow Area, Subcutaneous; 5 Cm Or Greater (Pbb)",,24073,CPT,Professional,Outpatient,,,,2550,2167.5,425.39,2550,Aetna,PPO,2371.5,93,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Upper Arm Or Elbow Area, Subcutaneous; 5 Cm Or Greater (Pbb)",,24073,CPT,Facility,Outpatient,,,,2519,2141.15,721.9454,2519,America's PPO,America's PPO,2418.9957,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Excision, Tumor, Soft Tissue Of Upper Arm Or Elbow Area, Subcutaneous; 5 Cm Or Greater (Pbb)",,24073,CPT,Professional,Outpatient,,,,2550,2167.5,425.39,2550,America's PPO,America's PPO,2178.72,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Excision, Tumor, Soft Tissue Of Upper Arm Or Elbow Area, Subcutaneous; 5 Cm Or Greater (Pbb)",,24073,CPT,Facility,Outpatient,,,,2519,2141.15,721.9454,2519,BlueCross BlueShield Minnesota, Federal Employee Program,2478.696,98.4,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Upper Arm Or Elbow Area, Subcutaneous; 5 Cm Or Greater (Pbb)",,24073,CPT,Professional,Outpatient,,,,2550,2167.5,425.39,2550,BlueCross BlueShield Minnesota, Federal Employee Program,1433.67,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Excision, Tumor, Soft Tissue Of Upper Arm Or Elbow Area, Subcutaneous; 5 Cm Or Greater (Pbb)",,24073,CPT,Facility,Outpatient,,,,2519,2141.15,721.9454,2519,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,2519,100,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Upper Arm Or Elbow Area, Subcutaneous; 5 Cm Or Greater (Pbb)",,24073,CPT,Professional,Outpatient,,,,2550,2167.5,425.39,2550,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1456.60872,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Tumor, Soft Tissue Of Upper Arm Or Elbow Area, Subcutaneous; 5 Cm Or Greater (Pbb)",,24073,CPT,Facility,Outpatient,,,,2519,2141.15,721.9454,2519,BlueCross BlueShield Minnesota,High Value Network Plan,2267.1,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
"Excision, Tumor, Soft Tissue Of Upper Arm Or Elbow Area, Subcutaneous; 5 Cm Or Greater (Pbb)",,24073,CPT,Professional,Outpatient,,,,2550,2167.5,425.39,2550,BlueCross BlueShield Minnesota,High Value Network Plan,1456.60872,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Tumor, Soft Tissue Of Upper Arm Or Elbow Area, Subcutaneous; 5 Cm Or Greater (Pbb)",,24073,CPT,Facility,Outpatient,,,,2519,2141.15,721.9454,2519,BlueCross BlueShield Minnesota,Medicare Advantage,1234.31,49,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Upper Arm Or Elbow Area, Subcutaneous; 5 Cm Or Greater (Pbb)",,24073,CPT,Professional,Outpatient,,,,2550,2167.5,425.39,2550,BlueCross BlueShield Minnesota,Medicare Advantage,760.127,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Tumor, Soft Tissue Of Upper Arm Or Elbow Area, Subcutaneous; 5 Cm Or Greater (Pbb)",,24073,CPT,Professional,Outpatient,,,,2550,2167.5,425.39,2550,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1456.60872,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Tumor, Soft Tissue Of Upper Arm Or Elbow Area, Subcutaneous; 5 Cm Or Greater (Pbb)",,24073,CPT,Facility,Outpatient,,,,2519,2141.15,721.9454,2519,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,721.9454,28.66,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Upper Arm Or Elbow Area, Subcutaneous; 5 Cm Or Greater (Pbb)",,24073,CPT,Professional,Outpatient,,,,2550,2167.5,425.39,2550,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,491.1344,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision, Tumor, Soft Tissue Of Upper Arm Or Elbow Area, Subcutaneous; 5 Cm Or Greater (Pbb)",,24073,CPT,Facility,Outpatient,,,,2519,2141.15,721.9454,2519,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1234.31,49,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Upper Arm Or Elbow Area, Subcutaneous; 5 Cm Or Greater (Pbb)",,24073,CPT,Professional,Outpatient,,,,2550,2167.5,425.39,2550,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),760.127,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Tumor, Soft Tissue Of Upper Arm Or Elbow Area, Subcutaneous; 5 Cm Or Greater (Pbb)",,24073,CPT,Facility,Outpatient,,,,2519,2141.15,721.9454,2519,CorVel,Worker's Compensation,2519,100,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Upper Arm Or Elbow Area, Subcutaneous; 5 Cm Or Greater (Pbb)",,24073,CPT,Professional,Outpatient,,,,2550,2167.5,425.39,2550,CorVel,Worker's Compensation,1297.354965,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Excision, Tumor, Soft Tissue Of Upper Arm Or Elbow Area, Subcutaneous; 5 Cm Or Greater (Pbb)",,24073,CPT,Facility,Outpatient,,,,2519,2141.15,721.9454,2519,First Health Group Corporation,First Health Network,2443.43,97,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Upper Arm Or Elbow Area, Subcutaneous; 5 Cm Or Greater (Pbb)",,24073,CPT,Professional,Outpatient,,,,2550,2167.5,425.39,2550,First Health Group Corporation,First Health Network,2473.5,97,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Upper Arm Or Elbow Area, Subcutaneous; 5 Cm Or Greater (Pbb)",,24073,CPT,Facility,Outpatient,,,,2519,2141.15,721.9454,2519,"Health Partners, Inc.",Commercial,2382.974,94.6,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Upper Arm Or Elbow Area, Subcutaneous; 5 Cm Or Greater (Pbb)",,24073,CPT,Professional,Outpatient,,,,2550,2167.5,425.39,2550,"Health Partners, Inc.",Commercial,1401.71,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision, Tumor, Soft Tissue Of Upper Arm Or Elbow Area, Subcutaneous; 5 Cm Or Greater (Pbb)",,24073,CPT,Facility,Outpatient,,,,2519,2141.15,721.9454,2519,"Health Partners, Inc.",Medicare Advantage,1234.31,49,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Upper Arm Or Elbow Area, Subcutaneous; 5 Cm Or Greater (Pbb)",,24073,CPT,Professional,Outpatient,,,,2550,2167.5,425.39,2550,"Health Partners, Inc.",Medicare Advantage,760.127,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Tumor, Soft Tissue Of Upper Arm Or Elbow Area, Subcutaneous; 5 Cm Or Greater (Pbb)",,24073,CPT,Facility,Outpatient,,,,2519,2141.15,721.9454,2519,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1511.4,60,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Upper Arm Or Elbow Area, Subcutaneous; 5 Cm Or Greater (Pbb)",,24073,CPT,Professional,Outpatient,,,,2550,2167.5,425.39,2550,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),660.8,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Excision, Tumor, Soft Tissue Of Upper Arm Or Elbow Area, Subcutaneous; 5 Cm Or Greater (Pbb)",,24073,CPT,Facility,Outpatient,,,,2519,2141.15,721.9454,2519,"Health Partners, Inc.",State of Minnesota Advantage Program,2052.985,81.5,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Upper Arm Or Elbow Area, Subcutaneous; 5 Cm Or Greater (Pbb)",,24073,CPT,Professional,Outpatient,,,,2550,2167.5,425.39,2550,"Health Partners, Inc.",State of Minnesota Advantage Program,1207.573165,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision, Tumor, Soft Tissue Of Upper Arm Or Elbow Area, Subcutaneous; 5 Cm Or Greater (Pbb)",,24073,CPT,Facility,Outpatient,,,,2519,2141.15,721.9454,2519,"Health Partners, Inc.",State Public Programs,1259.5,50,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Upper Arm Or Elbow Area, Subcutaneous; 5 Cm Or Greater (Pbb)",,24073,CPT,Professional,Outpatient,,,,2550,2167.5,425.39,2550,"Health Partners, Inc.",State Public Programs,425.39,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Excision, Tumor, Soft Tissue Of Upper Arm Or Elbow Area, Subcutaneous; 5 Cm Or Greater (Pbb)",,24073,CPT,Facility,Outpatient,,,,2519,2141.15,721.9454,2519,Humana Insurance Company,Commercial PPO,2393.05,95,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Upper Arm Or Elbow Area, Subcutaneous; 5 Cm Or Greater (Pbb)",,24073,CPT,Professional,Outpatient,,,,2550,2167.5,425.39,2550,Humana Insurance Company,Commercial PPO,660.98,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Excision, Tumor, Soft Tissue Of Upper Arm Or Elbow Area, Subcutaneous; 5 Cm Or Greater (Pbb)",,24073,CPT,Facility,Outpatient,,,,2519,2141.15,721.9454,2519,Humana Insurance Company,Medicare PPO,1234.31,49,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Upper Arm Or Elbow Area, Subcutaneous; 5 Cm Or Greater (Pbb)",,24073,CPT,Professional,Outpatient,,,,2550,2167.5,425.39,2550,Humana Insurance Company,Medicare PPO,2550,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Excision, Tumor, Soft Tissue Of Upper Arm Or Elbow Area, Subcutaneous; 5 Cm Or Greater (Pbb)",,24073,CPT,Facility,Outpatient,,,,2519,2141.15,721.9454,2519,Medica,Individual & Family,2496.329,99.1,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Upper Arm Or Elbow Area, Subcutaneous; 5 Cm Or Greater (Pbb)",,24073,CPT,Professional,Outpatient,,,,2550,2167.5,425.39,2550,Medica,Individual & Family,2162.4,84.8,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Upper Arm Or Elbow Area, Subcutaneous; 5 Cm Or Greater (Pbb)",,24073,CPT,Facility,Outpatient,,,,2519,2141.15,721.9454,2519,Medica,Medica Advantage Solution,1254.462,49.8,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Upper Arm Or Elbow Area, Subcutaneous; 5 Cm Or Greater (Pbb)",,24073,CPT,Professional,Outpatient,,,,2550,2167.5,425.39,2550,Medica,Medica Advantage Solution,1269.9,49.8,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Upper Arm Or Elbow Area, Subcutaneous; 5 Cm Or Greater (Pbb)",,24073,CPT,Facility,Outpatient,,,,2519,2141.15,721.9454,2519,Medica,Medical Assistance,1123.474,44.6,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Upper Arm Or Elbow Area, Subcutaneous; 5 Cm Or Greater (Pbb)",,24073,CPT,Professional,Outpatient,,,,2550,2167.5,425.39,2550,Medica,Medical Assistance,491.13,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Excision, Tumor, Soft Tissue Of Upper Arm Or Elbow Area, Subcutaneous; 5 Cm Or Greater (Pbb)",,24073,CPT,Facility,Outpatient,,,,2519,2141.15,721.9454,2519,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1254.462,49.8,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Upper Arm Or Elbow Area, Subcutaneous; 5 Cm Or Greater (Pbb)",,24073,CPT,Professional,Outpatient,,,,2550,2167.5,425.39,2550,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,660.98,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Excision, Tumor, Soft Tissue Of Upper Arm Or Elbow Area, Subcutaneous; 5 Cm Or Greater (Pbb)",,24073,CPT,Facility,Outpatient,,,,2519,2141.15,721.9454,2519,"Multiplan, Inc.","Multiplan, Inc.",2367.86,94,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Upper Arm Or Elbow Area, Subcutaneous; 5 Cm Or Greater (Pbb)",,24073,CPT,Professional,Outpatient,,,,2550,2167.5,425.39,2550,"Multiplan, Inc.","Multiplan, Inc.",2397,94,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Upper Arm Or Elbow Area, Subcutaneous; 5 Cm Or Greater (Pbb)",,24073,CPT,Facility,Outpatient,,,,2519,2141.15,721.9454,2519,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,2269.619,90.1,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Upper Arm Or Elbow Area, Subcutaneous; 5 Cm Or Greater (Pbb)",,24073,CPT,Professional,Outpatient,,,,2550,2167.5,425.39,2550,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,2297.55,90.1,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Upper Arm Or Elbow Area, Subcutaneous; 5 Cm Or Greater (Pbb)",,24073,CPT,Facility,Outpatient,,,,2519,2141.15,721.9454,2519,"Preferred One Administrative Services, INC.",PPO,2483.734,98.6,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Upper Arm Or Elbow Area, Subcutaneous; 5 Cm Or Greater (Pbb)",,24073,CPT,Professional,Outpatient,,,,2550,2167.5,425.39,2550,"Preferred One Administrative Services, INC.",PPO,2514.3,98.6,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Upper Arm Or Elbow Area, Subcutaneous; 5 Cm Or Greater (Pbb)",,24073,CPT,Facility,Outpatient,,,,2519,2141.15,721.9454,2519,PrimeWest Health,Minnesota Senior Health Options (MSHO),1296.0255,51.45,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Upper Arm Or Elbow Area, Subcutaneous; 5 Cm Or Greater (Pbb)",,24073,CPT,Professional,Outpatient,,,,2550,2167.5,425.39,2550,PrimeWest Health,Minnesota Senior Health Options (MSHO),760.127,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Tumor, Soft Tissue Of Upper Arm Or Elbow Area, Subcutaneous; 5 Cm Or Greater (Pbb)",,24073,CPT,Facility,Outpatient,,,,2519,2141.15,721.9454,2519,PrimeWest Health,MinnesotaCare,1293.7584,51.36,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Upper Arm Or Elbow Area, Subcutaneous; 5 Cm Or Greater (Pbb)",,24073,CPT,Professional,Outpatient,,,,2550,2167.5,425.39,2550,PrimeWest Health,MinnesotaCare,525.513808,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision, Tumor, Soft Tissue Of Upper Arm Or Elbow Area, Subcutaneous; 5 Cm Or Greater (Pbb)",,24073,CPT,Facility,Outpatient,,,,2519,2141.15,721.9454,2519,Sanford Health Plan,Sanford Health Plan,2317.48,92,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Upper Arm Or Elbow Area, Subcutaneous; 5 Cm Or Greater (Pbb)",,24073,CPT,Professional,Outpatient,,,,2550,2167.5,425.39,2550,Sanford Health Plan,Sanford Health Plan,2244,88,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Upper Arm Or Elbow Area, Subcutaneous; 5 Cm Or Greater (Pbb)",,24073,CPT,Facility,Outpatient,,,,2519,2141.15,721.9454,2519,"UCare Health, Inc.",Individual & Family Plan,1419.4565,56.35,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Upper Arm Or Elbow Area, Subcutaneous; 5 Cm Or Greater (Pbb)",,24073,CPT,Professional,Outpatient,,,,2550,2167.5,425.39,2550,"UCare Health, Inc.",Individual & Family Plan,1074.489088,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Excision, Tumor, Soft Tissue Of Upper Arm Or Elbow Area, Subcutaneous; 5 Cm Or Greater (Pbb)",,24073,CPT,Facility,Outpatient,,,,2519,2141.15,721.9454,2519,"UCare Health, Inc.",Medical Assistance,1271.3393,50.47,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Upper Arm Or Elbow Area, Subcutaneous; 5 Cm Or Greater (Pbb)",,24073,CPT,Professional,Outpatient,,,,2550,2167.5,425.39,2550,"UCare Health, Inc.",Medical Assistance,540.24784,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Excision, Tumor, Soft Tissue Of Upper Arm Or Elbow Area, Subcutaneous; 5 Cm Or Greater (Pbb)",,24073,CPT,Facility,Outpatient,,,,2519,2141.15,721.9454,2519,"UCare Health, Inc.",Medicare Advantage,1271.3393,50.47,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Upper Arm Or Elbow Area, Subcutaneous; 5 Cm Or Greater (Pbb)",,24073,CPT,Professional,Outpatient,,,,2550,2167.5,425.39,2550,"UCare Health, Inc.",Medicare Advantage,760.127,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Excision, Tumor, Soft Tissue Of Upper Arm Or Elbow Area, Subcutaneous; 5 Cm Or Greater (Pbb)",,24073,CPT,Facility,Outpatient,,,,2519,2141.15,721.9454,2519,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1271.3393,50.47,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Upper Arm Or Elbow Area, Subcutaneous; 5 Cm Or Greater (Pbb)",,24073,CPT,Professional,Outpatient,,,,2550,2167.5,425.39,2550,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),608.1016,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Excision, Tumor, Soft Tissue Of Upper Arm Or Elbow Area, Subcutaneous; 5 Cm Or Greater (Pbb)",,24073,CPT,Facility,Outpatient,,,,2519,2141.15,721.9454,2519,UnitedHealthcare,Individual & Family,2367.86,94,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Upper Arm Or Elbow Area, Subcutaneous; 5 Cm Or Greater (Pbb)",,24073,CPT,Professional,Outpatient,,,,2550,2167.5,425.39,2550,UnitedHealthcare,Individual & Family,2550,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Excision, Tumor, Soft Tissue Of Upper Arm Or Elbow Area, Subcutaneous; 5 Cm Or Greater (Pbb)",,24073,CPT,Facility,Outpatient,,,,2519,2141.15,721.9454,2519,UnitedHealthcare,Medicare Advantage,1234.31,49,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Of Upper Arm Or Elbow Area, Subcutaneous; 5 Cm Or Greater (Pbb)",,24073,CPT,Professional,Outpatient,,,,2550,2167.5,425.39,2550,UnitedHealthcare,Medicare Advantage,760.127,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Tumor, Soft Tissue Of Upper Arm Or Elbow Area, Subcutaneous; 5 Cm Or Greater (Pbb)",,24073,CPT,Facility,Outpatient,,,,2519,2141.15,721.9454,2519,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1209.12,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Excision, Tumor, Soft Tissue Of Upper Arm Or Elbow Area, Subcutaneous; 5 Cm Or Greater (Pbb)",,24073,CPT,Professional,Outpatient,,,,2550,2167.5,425.39,2550,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,491.1344,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision, Tumor, Soft Tissue Upper Arm Or Elbow Area, Subfascial; 5 Cm Or Greater (Pro Cah)",,24073,CPT,Professional,Both,,,,5069,4308.65,425.39,5069,Aetna,Commercial,4308.65,85,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Upper Arm Or Elbow Area, Subfascial; 5 Cm Or Greater (Pro Cah)",,24073,CPT,Professional,Both,,,,5069,4308.65,425.39,5069,Aetna,Medicare Advantage,669.69,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Tumor, Soft Tissue Upper Arm Or Elbow Area, Subfascial; 5 Cm Or Greater (Pro Cah)",,24073,CPT,Professional,Both,,,,5069,4308.65,425.39,5069,Aetna,PPO,4714.17,93,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Upper Arm Or Elbow Area, Subfascial; 5 Cm Or Greater (Pro Cah)",,24073,CPT,Professional,Both,,,,5069,4308.65,425.39,5069,America's PPO,America's PPO,4330.9536,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Excision, Tumor, Soft Tissue Upper Arm Or Elbow Area, Subfascial; 5 Cm Or Greater (Pro Cah)",,24073,CPT,Professional,Both,,,,5069,4308.65,425.39,5069,BlueCross BlueShield Minnesota, Federal Employee Program,1433.67,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Excision, Tumor, Soft Tissue Upper Arm Or Elbow Area, Subfascial; 5 Cm Or Greater (Pro Cah)",,24073,CPT,Professional,Both,,,,5069,4308.65,425.39,5069,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1456.60872,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Tumor, Soft Tissue Upper Arm Or Elbow Area, Subfascial; 5 Cm Or Greater (Pro Cah)",,24073,CPT,Professional,Both,,,,5069,4308.65,425.39,5069,BlueCross BlueShield Minnesota,High Value Network Plan,1456.60872,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Tumor, Soft Tissue Upper Arm Or Elbow Area, Subfascial; 5 Cm Or Greater (Pro Cah)",,24073,CPT,Professional,Both,,,,5069,4308.65,425.39,5069,BlueCross BlueShield Minnesota,Medicare Advantage,760.127,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Tumor, Soft Tissue Upper Arm Or Elbow Area, Subfascial; 5 Cm Or Greater (Pro Cah)",,24073,CPT,Professional,Both,,,,5069,4308.65,425.39,5069,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1456.60872,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision, Tumor, Soft Tissue Upper Arm Or Elbow Area, Subfascial; 5 Cm Or Greater (Pro Cah)",,24073,CPT,Professional,Both,,,,5069,4308.65,425.39,5069,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,491.1344,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision, Tumor, Soft Tissue Upper Arm Or Elbow Area, Subfascial; 5 Cm Or Greater (Pro Cah)",,24073,CPT,Professional,Both,,,,5069,4308.65,425.39,5069,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),760.127,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Tumor, Soft Tissue Upper Arm Or Elbow Area, Subfascial; 5 Cm Or Greater (Pro Cah)",,24073,CPT,Professional,Both,,,,5069,4308.65,425.39,5069,CorVel,Worker's Compensation,1297.354965,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Excision, Tumor, Soft Tissue Upper Arm Or Elbow Area, Subfascial; 5 Cm Or Greater (Pro Cah)",,24073,CPT,Professional,Both,,,,5069,4308.65,425.39,5069,First Health Group Corporation,First Health Network,4916.93,97,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Upper Arm Or Elbow Area, Subfascial; 5 Cm Or Greater (Pro Cah)",,24073,CPT,Professional,Both,,,,5069,4308.65,425.39,5069,"Health Partners, Inc.",Commercial,1401.71,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision, Tumor, Soft Tissue Upper Arm Or Elbow Area, Subfascial; 5 Cm Or Greater (Pro Cah)",,24073,CPT,Professional,Both,,,,5069,4308.65,425.39,5069,"Health Partners, Inc.",Medicare Advantage,760.127,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Tumor, Soft Tissue Upper Arm Or Elbow Area, Subfascial; 5 Cm Or Greater (Pro Cah)",,24073,CPT,Professional,Both,,,,5069,4308.65,425.39,5069,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),660.8,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Excision, Tumor, Soft Tissue Upper Arm Or Elbow Area, Subfascial; 5 Cm Or Greater (Pro Cah)",,24073,CPT,Professional,Both,,,,5069,4308.65,425.39,5069,"Health Partners, Inc.",State of Minnesota Advantage Program,1207.573165,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision, Tumor, Soft Tissue Upper Arm Or Elbow Area, Subfascial; 5 Cm Or Greater (Pro Cah)",,24073,CPT,Professional,Both,,,,5069,4308.65,425.39,5069,"Health Partners, Inc.",State Public Programs,425.39,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Excision, Tumor, Soft Tissue Upper Arm Or Elbow Area, Subfascial; 5 Cm Or Greater (Pro Cah)",,24073,CPT,Professional,Both,,,,5069,4308.65,425.39,5069,Humana Insurance Company,Commercial PPO,660.98,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Excision, Tumor, Soft Tissue Upper Arm Or Elbow Area, Subfascial; 5 Cm Or Greater (Pro Cah)",,24073,CPT,Professional,Both,,,,5069,4308.65,425.39,5069,Humana Insurance Company,Medicare PPO,5069,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Excision, Tumor, Soft Tissue Upper Arm Or Elbow Area, Subfascial; 5 Cm Or Greater (Pro Cah)",,24073,CPT,Professional,Both,,,,5069,4308.65,425.39,5069,Medica,Individual & Family,4298.512,84.8,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Upper Arm Or Elbow Area, Subfascial; 5 Cm Or Greater (Pro Cah)",,24073,CPT,Professional,Both,,,,5069,4308.65,425.39,5069,Medica,Medica Advantage Solution,2524.362,49.8,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Upper Arm Or Elbow Area, Subfascial; 5 Cm Or Greater (Pro Cah)",,24073,CPT,Professional,Both,,,,5069,4308.65,425.39,5069,Medica,Medical Assistance,491.13,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Excision, Tumor, Soft Tissue Upper Arm Or Elbow Area, Subfascial; 5 Cm Or Greater (Pro Cah)",,24073,CPT,Professional,Both,,,,5069,4308.65,425.39,5069,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,660.98,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Excision, Tumor, Soft Tissue Upper Arm Or Elbow Area, Subfascial; 5 Cm Or Greater (Pro Cah)",,24073,CPT,Professional,Both,,,,5069,4308.65,425.39,5069,"Multiplan, Inc.","Multiplan, Inc.",4764.86,94,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Upper Arm Or Elbow Area, Subfascial; 5 Cm Or Greater (Pro Cah)",,24073,CPT,Professional,Both,,,,5069,4308.65,425.39,5069,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4567.169,90.1,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Upper Arm Or Elbow Area, Subfascial; 5 Cm Or Greater (Pro Cah)",,24073,CPT,Professional,Both,,,,5069,4308.65,425.39,5069,"Preferred One Administrative Services, INC.",PPO,4998.034,98.6,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Upper Arm Or Elbow Area, Subfascial; 5 Cm Or Greater (Pro Cah)",,24073,CPT,Professional,Both,,,,5069,4308.65,425.39,5069,PrimeWest Health,Minnesota Senior Health Options (MSHO),760.127,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Tumor, Soft Tissue Upper Arm Or Elbow Area, Subfascial; 5 Cm Or Greater (Pro Cah)",,24073,CPT,Professional,Both,,,,5069,4308.65,425.39,5069,PrimeWest Health,MinnesotaCare,525.513808,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision, Tumor, Soft Tissue Upper Arm Or Elbow Area, Subfascial; 5 Cm Or Greater (Pro Cah)",,24073,CPT,Professional,Both,,,,5069,4308.65,425.39,5069,Sanford Health Plan,Sanford Health Plan,4460.72,88,,percent of total billed charges,,
"Excision, Tumor, Soft Tissue Upper Arm Or Elbow Area, Subfascial; 5 Cm Or Greater (Pro Cah)",,24073,CPT,Professional,Both,,,,5069,4308.65,425.39,5069,"UCare Health, Inc.",Individual & Family Plan,1074.489088,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Excision, Tumor, Soft Tissue Upper Arm Or Elbow Area, Subfascial; 5 Cm Or Greater (Pro Cah)",,24073,CPT,Professional,Both,,,,5069,4308.65,425.39,5069,"UCare Health, Inc.",Medical Assistance,540.24784,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Excision, Tumor, Soft Tissue Upper Arm Or Elbow Area, Subfascial; 5 Cm Or Greater (Pro Cah)",,24073,CPT,Professional,Both,,,,5069,4308.65,425.39,5069,"UCare Health, Inc.",Medicare Advantage,760.127,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Excision, Tumor, Soft Tissue Upper Arm Or Elbow Area, Subfascial; 5 Cm Or Greater (Pro Cah)",,24073,CPT,Professional,Both,,,,5069,4308.65,425.39,5069,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),608.1016,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Excision, Tumor, Soft Tissue Upper Arm Or Elbow Area, Subfascial; 5 Cm Or Greater (Pro Cah)",,24073,CPT,Professional,Both,,,,5069,4308.65,425.39,5069,UnitedHealthcare,Individual & Family,5069,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Excision, Tumor, Soft Tissue Upper Arm Or Elbow Area, Subfascial; 5 Cm Or Greater (Pro Cah)",,24073,CPT,Professional,Both,,,,5069,4308.65,425.39,5069,UnitedHealthcare,Medicare Advantage,760.127,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision, Tumor, Soft Tissue Upper Arm Or Elbow Area, Subfascial; 5 Cm Or Greater (Pro Cah)",,24073,CPT,Professional,Both,,,,5069,4308.65,425.39,5069,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,491.1344,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Closed Treatment Supra/Transcondylar Humeral Fx, W/Wo Intercondylar Extension; Wo Manip (Pro Cah)",,24530,CPT,Professional,Both,,,,1122,953.7,227.74,1122,Aetna,Commercial,953.7,85,,percent of total billed charges,,
"Closed Treatment Supra/Transcondylar Humeral Fx, W/Wo Intercondylar Extension; Wo Manip (Pro Cah)",,24530,CPT,Professional,Both,,,,1122,953.7,227.74,1122,Aetna,Medicare Advantage,349.23,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Closed Treatment Supra/Transcondylar Humeral Fx, W/Wo Intercondylar Extension; Wo Manip (Pro Cah)",,24530,CPT,Professional,Both,,,,1122,953.7,227.74,1122,Aetna,PPO,1043.46,93,,percent of total billed charges,,
"Closed Treatment Supra/Transcondylar Humeral Fx, W/Wo Intercondylar Extension; Wo Manip (Pro Cah)",,24530,CPT,Professional,Both,,,,1122,953.7,227.74,1122,America's PPO,America's PPO,958.6368,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Closed Treatment Supra/Transcondylar Humeral Fx, W/Wo Intercondylar Extension; Wo Manip (Pro Cah)",,24530,CPT,Professional,Both,,,,1122,953.7,227.74,1122,BlueCross BlueShield Minnesota, Federal Employee Program,744.38,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Closed Treatment Supra/Transcondylar Humeral Fx, W/Wo Intercondylar Extension; Wo Manip (Pro Cah)",,24530,CPT,Professional,Both,,,,1122,953.7,227.74,1122,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,756.29008,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Closed Treatment Supra/Transcondylar Humeral Fx, W/Wo Intercondylar Extension; Wo Manip (Pro Cah)",,24530,CPT,Professional,Both,,,,1122,953.7,227.74,1122,BlueCross BlueShield Minnesota,High Value Network Plan,756.29008,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Closed Treatment Supra/Transcondylar Humeral Fx, W/Wo Intercondylar Extension; Wo Manip (Pro Cah)",,24530,CPT,Professional,Both,,,,1122,953.7,227.74,1122,BlueCross BlueShield Minnesota,Medicare Advantage,407.1,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Closed Treatment Supra/Transcondylar Humeral Fx, W/Wo Intercondylar Extension; Wo Manip (Pro Cah)",,24530,CPT,Professional,Both,,,,1122,953.7,227.74,1122,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,756.29008,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Closed Treatment Supra/Transcondylar Humeral Fx, W/Wo Intercondylar Extension; Wo Manip (Pro Cah)",,24530,CPT,Professional,Both,,,,1122,953.7,227.74,1122,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,262.9408,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Closed Treatment Supra/Transcondylar Humeral Fx, W/Wo Intercondylar Extension; Wo Manip (Pro Cah)",,24530,CPT,Professional,Both,,,,1122,953.7,227.74,1122,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),407.1,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Closed Treatment Supra/Transcondylar Humeral Fx, W/Wo Intercondylar Extension; Wo Manip (Pro Cah)",,24530,CPT,Professional,Both,,,,1122,953.7,227.74,1122,CorVel,Worker's Compensation,682.9516467,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Closed Treatment Supra/Transcondylar Humeral Fx, W/Wo Intercondylar Extension; Wo Manip (Pro Cah)",,24530,CPT,Professional,Both,,,,1122,953.7,227.74,1122,First Health Group Corporation,First Health Network,1088.34,97,,percent of total billed charges,,
"Closed Treatment Supra/Transcondylar Humeral Fx, W/Wo Intercondylar Extension; Wo Manip (Pro Cah)",,24530,CPT,Professional,Both,,,,1122,953.7,227.74,1122,"Health Partners, Inc.",Commercial,737.86,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Closed Treatment Supra/Transcondylar Humeral Fx, W/Wo Intercondylar Extension; Wo Manip (Pro Cah)",,24530,CPT,Professional,Both,,,,1122,953.7,227.74,1122,"Health Partners, Inc.",Medicare Advantage,407.1,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Closed Treatment Supra/Transcondylar Humeral Fx, W/Wo Intercondylar Extension; Wo Manip (Pro Cah)",,24530,CPT,Professional,Both,,,,1122,953.7,227.74,1122,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),353.78,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Closed Treatment Supra/Transcondylar Humeral Fx, W/Wo Intercondylar Extension; Wo Manip (Pro Cah)",,24530,CPT,Professional,Both,,,,1122,953.7,227.74,1122,"Health Partners, Inc.",State of Minnesota Advantage Program,635.66639,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Closed Treatment Supra/Transcondylar Humeral Fx, W/Wo Intercondylar Extension; Wo Manip (Pro Cah)",,24530,CPT,Professional,Both,,,,1122,953.7,227.74,1122,"Health Partners, Inc.",State Public Programs,227.74,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Closed Treatment Supra/Transcondylar Humeral Fx, W/Wo Intercondylar Extension; Wo Manip (Pro Cah)",,24530,CPT,Professional,Both,,,,1122,953.7,227.74,1122,Humana Insurance Company,Commercial PPO,354,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Closed Treatment Supra/Transcondylar Humeral Fx, W/Wo Intercondylar Extension; Wo Manip (Pro Cah)",,24530,CPT,Professional,Both,,,,1122,953.7,227.74,1122,Humana Insurance Company,Medicare PPO,1122,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Closed Treatment Supra/Transcondylar Humeral Fx, W/Wo Intercondylar Extension; Wo Manip (Pro Cah)",,24530,CPT,Professional,Both,,,,1122,953.7,227.74,1122,Medica,Individual & Family,951.456,84.8,,percent of total billed charges,,
"Closed Treatment Supra/Transcondylar Humeral Fx, W/Wo Intercondylar Extension; Wo Manip (Pro Cah)",,24530,CPT,Professional,Both,,,,1122,953.7,227.74,1122,Medica,Medica Advantage Solution,558.756,49.8,,percent of total billed charges,,
"Closed Treatment Supra/Transcondylar Humeral Fx, W/Wo Intercondylar Extension; Wo Manip (Pro Cah)",,24530,CPT,Professional,Both,,,,1122,953.7,227.74,1122,Medica,Medical Assistance,262.94,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Closed Treatment Supra/Transcondylar Humeral Fx, W/Wo Intercondylar Extension; Wo Manip (Pro Cah)",,24530,CPT,Professional,Both,,,,1122,953.7,227.74,1122,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,354,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Closed Treatment Supra/Transcondylar Humeral Fx, W/Wo Intercondylar Extension; Wo Manip (Pro Cah)",,24530,CPT,Professional,Both,,,,1122,953.7,227.74,1122,"Multiplan, Inc.","Multiplan, Inc.",1054.68,94,,percent of total billed charges,,
"Closed Treatment Supra/Transcondylar Humeral Fx, W/Wo Intercondylar Extension; Wo Manip (Pro Cah)",,24530,CPT,Professional,Both,,,,1122,953.7,227.74,1122,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1010.922,90.1,,percent of total billed charges,,
"Closed Treatment Supra/Transcondylar Humeral Fx, W/Wo Intercondylar Extension; Wo Manip (Pro Cah)",,24530,CPT,Professional,Both,,,,1122,953.7,227.74,1122,"Preferred One Administrative Services, INC.",PPO,1106.292,98.6,,percent of total billed charges,,
"Closed Treatment Supra/Transcondylar Humeral Fx, W/Wo Intercondylar Extension; Wo Manip (Pro Cah)",,24530,CPT,Professional,Both,,,,1122,953.7,227.74,1122,PrimeWest Health,Minnesota Senior Health Options (MSHO),407.1,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Closed Treatment Supra/Transcondylar Humeral Fx, W/Wo Intercondylar Extension; Wo Manip (Pro Cah)",,24530,CPT,Professional,Both,,,,1122,953.7,227.74,1122,PrimeWest Health,MinnesotaCare,281.346656,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Closed Treatment Supra/Transcondylar Humeral Fx, W/Wo Intercondylar Extension; Wo Manip (Pro Cah)",,24530,CPT,Professional,Both,,,,1122,953.7,227.74,1122,Sanford Health Plan,Sanford Health Plan,987.36,88,,percent of total billed charges,,
"Closed Treatment Supra/Transcondylar Humeral Fx, W/Wo Intercondylar Extension; Wo Manip (Pro Cah)",,24530,CPT,Professional,Both,,,,1122,953.7,227.74,1122,"UCare Health, Inc.",Individual & Family Plan,575.4624,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Closed Treatment Supra/Transcondylar Humeral Fx, W/Wo Intercondylar Extension; Wo Manip (Pro Cah)",,24530,CPT,Professional,Both,,,,1122,953.7,227.74,1122,"UCare Health, Inc.",Medical Assistance,289.23488,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Closed Treatment Supra/Transcondylar Humeral Fx, W/Wo Intercondylar Extension; Wo Manip (Pro Cah)",,24530,CPT,Professional,Both,,,,1122,953.7,227.74,1122,"UCare Health, Inc.",Medicare Advantage,407.1,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Closed Treatment Supra/Transcondylar Humeral Fx, W/Wo Intercondylar Extension; Wo Manip (Pro Cah)",,24530,CPT,Professional,Both,,,,1122,953.7,227.74,1122,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),325.68,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Closed Treatment Supra/Transcondylar Humeral Fx, W/Wo Intercondylar Extension; Wo Manip (Pro Cah)",,24530,CPT,Professional,Both,,,,1122,953.7,227.74,1122,UnitedHealthcare,Individual & Family,1122,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Closed Treatment Supra/Transcondylar Humeral Fx, W/Wo Intercondylar Extension; Wo Manip (Pro Cah)",,24530,CPT,Professional,Both,,,,1122,953.7,227.74,1122,UnitedHealthcare,Medicare Advantage,407.1,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Closed Treatment Supra/Transcondylar Humeral Fx, W/Wo Intercondylar Extension; Wo Manip (Pro Cah)",,24530,CPT,Professional,Both,,,,1122,953.7,227.74,1122,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,262.9408,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
NITROGLYCERIN 2 % TD OINT,,15686,LOCAL,Facility,Both,1,g,,14,11.9,4.0124,14,Aetna,Commercial,12.88,92,,percent of total billed charges,,
NITROGLYCERIN 2 % TD OINT,,15686,LOCAL,Facility,Outpatient,1,g,,14,11.9,4.0124,14,Aetna,Medicare Advantage,6.86,49,,percent of total billed charges,,
NITROGLYCERIN 2 % TD OINT,,15686,LOCAL,Facility,Inpatient,1,g,,14,11.9,4.0124,14,Aetna,Medicare Advantage,,,,,Included in per diem rate,
NITROGLYCERIN 2 % TD OINT,,15686,LOCAL,Facility,Both,1,g,,14,11.9,4.0124,14,Aetna,PPO,13.02,93,,percent of total billed charges,,
NITROGLYCERIN 2 % TD OINT,,15686,LOCAL,Facility,Both,1,g,,14,11.9,4.0124,14,America's PPO,America's PPO,13.4442,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
NITROGLYCERIN 2 % TD OINT,,15686,LOCAL,Facility,Both,1,g,,14,11.9,4.0124,14,BlueCross BlueShield Minnesota, Federal Employee Program,13.776,98.4,,percent of total billed charges,,
NITROGLYCERIN 2 % TD OINT,,15686,LOCAL,Facility,Both,1,g,,14,11.9,4.0124,14,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,14,100,,percent of total billed charges,,
NITROGLYCERIN 2 % TD OINT,,15686,LOCAL,Facility,Both,1,g,,14,11.9,4.0124,14,BlueCross BlueShield Minnesota,High Value Network Plan,12.6,90,,percent of total billed charges,,
NITROGLYCERIN 2 % TD OINT,,15686,LOCAL,Facility,Outpatient,1,g,,14,11.9,4.0124,14,BlueCross BlueShield Minnesota,Medicare Advantage,6.86,49,,percent of total billed charges,,
NITROGLYCERIN 2 % TD OINT,,15686,LOCAL,Facility,Inpatient,1,g,,14,11.9,4.0124,14,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
NITROGLYCERIN 2 % TD OINT,,15686,LOCAL,Facility,Both,1,g,,14,11.9,4.0124,14,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,12.3998,88.57,,percent of total billed charges,,
NITROGLYCERIN 2 % TD OINT,,15686,LOCAL,Facility,Both,1,g,,14,11.9,4.0124,14,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,4.0124,28.66,,percent of total billed charges,,
NITROGLYCERIN 2 % TD OINT,,15686,LOCAL,Facility,Outpatient,1,g,,14,11.9,4.0124,14,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),6.86,49,,percent of total billed charges,,
NITROGLYCERIN 2 % TD OINT,,15686,LOCAL,Facility,Inpatient,1,g,,14,11.9,4.0124,14,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
NITROGLYCERIN 2 % TD OINT,,15686,LOCAL,Facility,Both,1,g,,14,11.9,4.0124,14,CorVel,Worker's Compensation,14,100,,percent of total billed charges,,
NITROGLYCERIN 2 % TD OINT,,15686,LOCAL,Facility,Both,1,g,,14,11.9,4.0124,14,First Health Group Corporation,First Health Network,13.58,97,,percent of total billed charges,,
NITROGLYCERIN 2 % TD OINT,,15686,LOCAL,Facility,Both,1,g,,14,11.9,4.0124,14,"Health Partners, Inc.",Commercial,13.244,94.6,,percent of total billed charges,,
NITROGLYCERIN 2 % TD OINT,,15686,LOCAL,Facility,Outpatient,1,g,,14,11.9,4.0124,14,"Health Partners, Inc.",Medicare Advantage,6.86,49,,percent of total billed charges,,
NITROGLYCERIN 2 % TD OINT,,15686,LOCAL,Facility,Inpatient,1,g,,14,11.9,4.0124,14,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
NITROGLYCERIN 2 % TD OINT,,15686,LOCAL,Facility,Both,1,g,,14,11.9,4.0124,14,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),8.4,60,,percent of total billed charges,,
NITROGLYCERIN 2 % TD OINT,,15686,LOCAL,Facility,Both,1,g,,14,11.9,4.0124,14,"Health Partners, Inc.",State of Minnesota Advantage Program,11.41,81.5,,percent of total billed charges,,
NITROGLYCERIN 2 % TD OINT,,15686,LOCAL,Facility,Both,1,g,,14,11.9,4.0124,14,"Health Partners, Inc.",State Public Programs,7,50,,percent of total billed charges,,
NITROGLYCERIN 2 % TD OINT,,15686,LOCAL,Facility,Both,1,g,,14,11.9,4.0124,14,Humana Insurance Company,Commercial PPO,13.3,95,,percent of total billed charges,,
NITROGLYCERIN 2 % TD OINT,,15686,LOCAL,Facility,Outpatient,1,g,,14,11.9,4.0124,14,Humana Insurance Company,Medicare PPO,6.86,49,,percent of total billed charges,,
NITROGLYCERIN 2 % TD OINT,,15686,LOCAL,Facility,Inpatient,1,g,,14,11.9,4.0124,14,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
NITROGLYCERIN 2 % TD OINT,,15686,LOCAL,Facility,Both,1,g,,14,11.9,4.0124,14,Medica,Individual & Family,13.874,99.1,,percent of total billed charges,,
NITROGLYCERIN 2 % TD OINT,,15686,LOCAL,Facility,Outpatient,1,g,,14,11.9,4.0124,14,Medica,Medica Advantage Solution,6.972,49.8,,percent of total billed charges,,
NITROGLYCERIN 2 % TD OINT,,15686,LOCAL,Facility,Inpatient,1,g,,14,11.9,4.0124,14,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
NITROGLYCERIN 2 % TD OINT,,15686,LOCAL,Facility,Outpatient,1,g,,14,11.9,4.0124,14,Medica,Medical Assistance,6.244,44.6,,percent of total billed charges,,
NITROGLYCERIN 2 % TD OINT,,15686,LOCAL,Facility,Inpatient,1,g,,14,11.9,4.0124,14,Medica,Medical Assistance,,,,,Included in per diem rate,
NITROGLYCERIN 2 % TD OINT,,15686,LOCAL,Facility,Outpatient,1,g,,14,11.9,4.0124,14,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,6.972,49.8,,percent of total billed charges,,
NITROGLYCERIN 2 % TD OINT,,15686,LOCAL,Facility,Inpatient,1,g,,14,11.9,4.0124,14,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
NITROGLYCERIN 2 % TD OINT,,15686,LOCAL,Facility,Both,1,g,,14,11.9,4.0124,14,"Multiplan, Inc.","Multiplan, Inc.",13.16,94,,percent of total billed charges,,
NITROGLYCERIN 2 % TD OINT,,15686,LOCAL,Facility,Outpatient,1,g,,14,11.9,4.0124,14,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,12.614,90.1,,percent of total billed charges,,
NITROGLYCERIN 2 % TD OINT,,15686,LOCAL,Facility,Inpatient,1,g,,14,11.9,4.0124,14,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
NITROGLYCERIN 2 % TD OINT,,15686,LOCAL,Facility,Both,1,g,,14,11.9,4.0124,14,"Preferred One Administrative Services, INC.",PPO,13.804,98.6,,percent of total billed charges,,
NITROGLYCERIN 2 % TD OINT,,15686,LOCAL,Facility,Outpatient,1,g,,14,11.9,4.0124,14,PrimeWest Health,Minnesota Senior Health Options (MSHO),7.203,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
NITROGLYCERIN 2 % TD OINT,,15686,LOCAL,Facility,Inpatient,1,g,,14,11.9,4.0124,14,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
NITROGLYCERIN 2 % TD OINT,,15686,LOCAL,Facility,Outpatient,1,g,,14,11.9,4.0124,14,PrimeWest Health,MinnesotaCare,7.1904,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
NITROGLYCERIN 2 % TD OINT,,15686,LOCAL,Facility,Inpatient,1,g,,14,11.9,4.0124,14,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
NITROGLYCERIN 2 % TD OINT,,15686,LOCAL,Facility,Both,1,g,,14,11.9,4.0124,14,Sanford Health Plan,Sanford Health Plan,12.88,92,,percent of total billed charges,,
NITROGLYCERIN 2 % TD OINT,,15686,LOCAL,Facility,Outpatient,1,g,,14,11.9,4.0124,14,"UCare Health, Inc.",Individual & Family Plan,7.889,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
NITROGLYCERIN 2 % TD OINT,,15686,LOCAL,Facility,Inpatient,1,g,,14,11.9,4.0124,14,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
NITROGLYCERIN 2 % TD OINT,,15686,LOCAL,Facility,Outpatient,1,g,,14,11.9,4.0124,14,"UCare Health, Inc.",Medical Assistance,7.0658,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
NITROGLYCERIN 2 % TD OINT,,15686,LOCAL,Facility,Inpatient,1,g,,14,11.9,4.0124,14,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
NITROGLYCERIN 2 % TD OINT,,15686,LOCAL,Facility,Outpatient,1,g,,14,11.9,4.0124,14,"UCare Health, Inc.",Medicare Advantage,7.0658,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
NITROGLYCERIN 2 % TD OINT,,15686,LOCAL,Facility,Inpatient,1,g,,14,11.9,4.0124,14,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
NITROGLYCERIN 2 % TD OINT,,15686,LOCAL,Facility,Outpatient,1,g,,14,11.9,4.0124,14,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),7.0658,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
NITROGLYCERIN 2 % TD OINT,,15686,LOCAL,Facility,Inpatient,1,g,,14,11.9,4.0124,14,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
NITROGLYCERIN 2 % TD OINT,,15686,LOCAL,Facility,Both,1,g,,14,11.9,4.0124,14,UnitedHealthcare,Individual & Family,13.16,94,,percent of total billed charges,,
NITROGLYCERIN 2 % TD OINT,,15686,LOCAL,Facility,Outpatient,1,g,,14,11.9,4.0124,14,UnitedHealthcare,Medicare Advantage,6.86,49,,percent of total billed charges,,
NITROGLYCERIN 2 % TD OINT,,15686,LOCAL,Facility,Inpatient,1,g,,14,11.9,4.0124,14,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
NITROGLYCERIN 2 % TD OINT,,15686,LOCAL,Facility,Outpatient,1,g,,14,11.9,4.0124,14,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,6.72,48,,percent of total billed charges,,100% of DHS outpatient percentage
NITROGLYCERIN 2 % TD OINT,,15686,LOCAL,Facility,Inpatient,1,g,,14,11.9,4.0124,14,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Excision Of Ganglion, Wrist (Dorsal Or Volar); Primary (Pro Cah)",,25111,CPT,Professional,Both,,,,1275,1083.75,208.33,1275,Aetna,Commercial,1083.75,85,,percent of total billed charges,,
"Excision Of Ganglion, Wrist (Dorsal Or Volar); Primary (Pro Cah)",,25111,CPT,Professional,Both,,,,1275,1083.75,208.33,1275,Aetna,Medicare Advantage,322.05,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision Of Ganglion, Wrist (Dorsal Or Volar); Primary (Pro Cah)",,25111,CPT,Professional,Both,,,,1275,1083.75,208.33,1275,Aetna,PPO,1185.75,93,,percent of total billed charges,,
"Excision Of Ganglion, Wrist (Dorsal Or Volar); Primary (Pro Cah)",,25111,CPT,Professional,Both,,,,1275,1083.75,208.33,1275,America's PPO,America's PPO,1089.36,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Excision Of Ganglion, Wrist (Dorsal Or Volar); Primary (Pro Cah)",,25111,CPT,Professional,Both,,,,1275,1083.75,208.33,1275,BlueCross BlueShield Minnesota, Federal Employee Program,681.03,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Excision Of Ganglion, Wrist (Dorsal Or Volar); Primary (Pro Cah)",,25111,CPT,Professional,Both,,,,1275,1083.75,208.33,1275,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,691.92648,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision Of Ganglion, Wrist (Dorsal Or Volar); Primary (Pro Cah)",,25111,CPT,Professional,Both,,,,1275,1083.75,208.33,1275,BlueCross BlueShield Minnesota,High Value Network Plan,691.92648,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision Of Ganglion, Wrist (Dorsal Or Volar); Primary (Pro Cah)",,25111,CPT,Professional,Both,,,,1275,1083.75,208.33,1275,BlueCross BlueShield Minnesota,Medicare Advantage,372.301,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision Of Ganglion, Wrist (Dorsal Or Volar); Primary (Pro Cah)",,25111,CPT,Professional,Both,,,,1275,1083.75,208.33,1275,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,691.92648,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision Of Ganglion, Wrist (Dorsal Or Volar); Primary (Pro Cah)",,25111,CPT,Professional,Both,,,,1275,1083.75,208.33,1275,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,240.52784,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision Of Ganglion, Wrist (Dorsal Or Volar); Primary (Pro Cah)",,25111,CPT,Professional,Both,,,,1275,1083.75,208.33,1275,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),372.301,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision Of Ganglion, Wrist (Dorsal Or Volar); Primary (Pro Cah)",,25111,CPT,Professional,Both,,,,1275,1083.75,208.33,1275,CorVel,Worker's Compensation,626.3165895,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Excision Of Ganglion, Wrist (Dorsal Or Volar); Primary (Pro Cah)",,25111,CPT,Professional,Both,,,,1275,1083.75,208.33,1275,First Health Group Corporation,First Health Network,1236.75,97,,percent of total billed charges,,
"Excision Of Ganglion, Wrist (Dorsal Or Volar); Primary (Pro Cah)",,25111,CPT,Professional,Both,,,,1275,1083.75,208.33,1275,"Health Partners, Inc.",Commercial,676.19,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision Of Ganglion, Wrist (Dorsal Or Volar); Primary (Pro Cah)",,25111,CPT,Professional,Both,,,,1275,1083.75,208.33,1275,"Health Partners, Inc.",Medicare Advantage,372.301,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision Of Ganglion, Wrist (Dorsal Or Volar); Primary (Pro Cah)",,25111,CPT,Professional,Both,,,,1275,1083.75,208.33,1275,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),323.96,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Excision Of Ganglion, Wrist (Dorsal Or Volar); Primary (Pro Cah)",,25111,CPT,Professional,Both,,,,1275,1083.75,208.33,1275,"Health Partners, Inc.",State of Minnesota Advantage Program,582.537685,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision Of Ganglion, Wrist (Dorsal Or Volar); Primary (Pro Cah)",,25111,CPT,Professional,Both,,,,1275,1083.75,208.33,1275,"Health Partners, Inc.",State Public Programs,208.33,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Excision Of Ganglion, Wrist (Dorsal Or Volar); Primary (Pro Cah)",,25111,CPT,Professional,Both,,,,1275,1083.75,208.33,1275,Humana Insurance Company,Commercial PPO,323.74,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Excision Of Ganglion, Wrist (Dorsal Or Volar); Primary (Pro Cah)",,25111,CPT,Professional,Both,,,,1275,1083.75,208.33,1275,Humana Insurance Company,Medicare PPO,1275,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Excision Of Ganglion, Wrist (Dorsal Or Volar); Primary (Pro Cah)",,25111,CPT,Professional,Both,,,,1275,1083.75,208.33,1275,Medica,Individual & Family,1081.2,84.8,,percent of total billed charges,,
"Excision Of Ganglion, Wrist (Dorsal Or Volar); Primary (Pro Cah)",,25111,CPT,Professional,Both,,,,1275,1083.75,208.33,1275,Medica,Medica Advantage Solution,634.95,49.8,,percent of total billed charges,,
"Excision Of Ganglion, Wrist (Dorsal Or Volar); Primary (Pro Cah)",,25111,CPT,Professional,Both,,,,1275,1083.75,208.33,1275,Medica,Medical Assistance,240.53,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Excision Of Ganglion, Wrist (Dorsal Or Volar); Primary (Pro Cah)",,25111,CPT,Professional,Both,,,,1275,1083.75,208.33,1275,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,323.74,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Excision Of Ganglion, Wrist (Dorsal Or Volar); Primary (Pro Cah)",,25111,CPT,Professional,Both,,,,1275,1083.75,208.33,1275,"Multiplan, Inc.","Multiplan, Inc.",1198.5,94,,percent of total billed charges,,
"Excision Of Ganglion, Wrist (Dorsal Or Volar); Primary (Pro Cah)",,25111,CPT,Professional,Both,,,,1275,1083.75,208.33,1275,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1148.775,90.1,,percent of total billed charges,,
"Excision Of Ganglion, Wrist (Dorsal Or Volar); Primary (Pro Cah)",,25111,CPT,Professional,Both,,,,1275,1083.75,208.33,1275,"Preferred One Administrative Services, INC.",PPO,1257.15,98.6,,percent of total billed charges,,
"Excision Of Ganglion, Wrist (Dorsal Or Volar); Primary (Pro Cah)",,25111,CPT,Professional,Both,,,,1275,1083.75,208.33,1275,PrimeWest Health,Minnesota Senior Health Options (MSHO),372.301,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision Of Ganglion, Wrist (Dorsal Or Volar); Primary (Pro Cah)",,25111,CPT,Professional,Both,,,,1275,1083.75,208.33,1275,PrimeWest Health,MinnesotaCare,257.3647888,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision Of Ganglion, Wrist (Dorsal Or Volar); Primary (Pro Cah)",,25111,CPT,Professional,Both,,,,1275,1083.75,208.33,1275,Sanford Health Plan,Sanford Health Plan,1122,88,,percent of total billed charges,,
"Excision Of Ganglion, Wrist (Dorsal Or Volar); Primary (Pro Cah)",,25111,CPT,Professional,Both,,,,1275,1083.75,208.33,1275,"UCare Health, Inc.",Individual & Family Plan,526.271744,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Excision Of Ganglion, Wrist (Dorsal Or Volar); Primary (Pro Cah)",,25111,CPT,Professional,Both,,,,1275,1083.75,208.33,1275,"UCare Health, Inc.",Medical Assistance,264.580624,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Excision Of Ganglion, Wrist (Dorsal Or Volar); Primary (Pro Cah)",,25111,CPT,Professional,Both,,,,1275,1083.75,208.33,1275,"UCare Health, Inc.",Medicare Advantage,372.301,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Excision Of Ganglion, Wrist (Dorsal Or Volar); Primary (Pro Cah)",,25111,CPT,Professional,Both,,,,1275,1083.75,208.33,1275,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),297.8408,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Excision Of Ganglion, Wrist (Dorsal Or Volar); Primary (Pro Cah)",,25111,CPT,Professional,Both,,,,1275,1083.75,208.33,1275,UnitedHealthcare,Individual & Family,1275,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Excision Of Ganglion, Wrist (Dorsal Or Volar); Primary (Pro Cah)",,25111,CPT,Professional,Both,,,,1275,1083.75,208.33,1275,UnitedHealthcare,Medicare Advantage,372.301,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision Of Ganglion, Wrist (Dorsal Or Volar); Primary (Pro Cah)",,25111,CPT,Professional,Both,,,,1275,1083.75,208.33,1275,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,240.52784,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
TUBERCULIN PPD 5 TUB. UNIT /0.1 ML INTRAD SOLN,,1068,LOCAL,Facility,Both,1,mL,,463,393.55,132.6958,463,Aetna,Commercial,425.96,92,,percent of total billed charges,,
TUBERCULIN PPD 5 TUB. UNIT /0.1 ML INTRAD SOLN,,1068,LOCAL,Facility,Outpatient,1,mL,,463,393.55,132.6958,463,Aetna,Medicare Advantage,226.87,49,,percent of total billed charges,,
TUBERCULIN PPD 5 TUB. UNIT /0.1 ML INTRAD SOLN,,1068,LOCAL,Facility,Inpatient,1,mL,,463,393.55,132.6958,463,Aetna,Medicare Advantage,,,,,Included in per diem rate,
TUBERCULIN PPD 5 TUB. UNIT /0.1 ML INTRAD SOLN,,1068,LOCAL,Facility,Both,1,mL,,463,393.55,132.6958,463,Aetna,PPO,430.59,93,,percent of total billed charges,,
TUBERCULIN PPD 5 TUB. UNIT /0.1 ML INTRAD SOLN,,1068,LOCAL,Facility,Both,1,mL,,463,393.55,132.6958,463,America's PPO,America's PPO,444.6189,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
TUBERCULIN PPD 5 TUB. UNIT /0.1 ML INTRAD SOLN,,1068,LOCAL,Facility,Both,1,mL,,463,393.55,132.6958,463,BlueCross BlueShield Minnesota, Federal Employee Program,455.592,98.4,,percent of total billed charges,,
TUBERCULIN PPD 5 TUB. UNIT /0.1 ML INTRAD SOLN,,1068,LOCAL,Facility,Both,1,mL,,463,393.55,132.6958,463,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,463,100,,percent of total billed charges,,
TUBERCULIN PPD 5 TUB. UNIT /0.1 ML INTRAD SOLN,,1068,LOCAL,Facility,Both,1,mL,,463,393.55,132.6958,463,BlueCross BlueShield Minnesota,High Value Network Plan,416.7,90,,percent of total billed charges,,
TUBERCULIN PPD 5 TUB. UNIT /0.1 ML INTRAD SOLN,,1068,LOCAL,Facility,Outpatient,1,mL,,463,393.55,132.6958,463,BlueCross BlueShield Minnesota,Medicare Advantage,226.87,49,,percent of total billed charges,,
TUBERCULIN PPD 5 TUB. UNIT /0.1 ML INTRAD SOLN,,1068,LOCAL,Facility,Inpatient,1,mL,,463,393.55,132.6958,463,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
TUBERCULIN PPD 5 TUB. UNIT /0.1 ML INTRAD SOLN,,1068,LOCAL,Facility,Both,1,mL,,463,393.55,132.6958,463,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,410.0791,88.57,,percent of total billed charges,,
TUBERCULIN PPD 5 TUB. UNIT /0.1 ML INTRAD SOLN,,1068,LOCAL,Facility,Both,1,mL,,463,393.55,132.6958,463,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,132.6958,28.66,,percent of total billed charges,,
TUBERCULIN PPD 5 TUB. UNIT /0.1 ML INTRAD SOLN,,1068,LOCAL,Facility,Outpatient,1,mL,,463,393.55,132.6958,463,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),226.87,49,,percent of total billed charges,,
TUBERCULIN PPD 5 TUB. UNIT /0.1 ML INTRAD SOLN,,1068,LOCAL,Facility,Inpatient,1,mL,,463,393.55,132.6958,463,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
TUBERCULIN PPD 5 TUB. UNIT /0.1 ML INTRAD SOLN,,1068,LOCAL,Facility,Both,1,mL,,463,393.55,132.6958,463,CorVel,Worker's Compensation,463,100,,percent of total billed charges,,
TUBERCULIN PPD 5 TUB. UNIT /0.1 ML INTRAD SOLN,,1068,LOCAL,Facility,Both,1,mL,,463,393.55,132.6958,463,First Health Group Corporation,First Health Network,449.11,97,,percent of total billed charges,,
TUBERCULIN PPD 5 TUB. UNIT /0.1 ML INTRAD SOLN,,1068,LOCAL,Facility,Both,1,mL,,463,393.55,132.6958,463,"Health Partners, Inc.",Commercial,437.998,94.6,,percent of total billed charges,,
TUBERCULIN PPD 5 TUB. UNIT /0.1 ML INTRAD SOLN,,1068,LOCAL,Facility,Outpatient,1,mL,,463,393.55,132.6958,463,"Health Partners, Inc.",Medicare Advantage,226.87,49,,percent of total billed charges,,
TUBERCULIN PPD 5 TUB. UNIT /0.1 ML INTRAD SOLN,,1068,LOCAL,Facility,Inpatient,1,mL,,463,393.55,132.6958,463,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
TUBERCULIN PPD 5 TUB. UNIT /0.1 ML INTRAD SOLN,,1068,LOCAL,Facility,Both,1,mL,,463,393.55,132.6958,463,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),277.8,60,,percent of total billed charges,,
TUBERCULIN PPD 5 TUB. UNIT /0.1 ML INTRAD SOLN,,1068,LOCAL,Facility,Both,1,mL,,463,393.55,132.6958,463,"Health Partners, Inc.",State of Minnesota Advantage Program,377.345,81.5,,percent of total billed charges,,
TUBERCULIN PPD 5 TUB. UNIT /0.1 ML INTRAD SOLN,,1068,LOCAL,Facility,Both,1,mL,,463,393.55,132.6958,463,"Health Partners, Inc.",State Public Programs,231.5,50,,percent of total billed charges,,
TUBERCULIN PPD 5 TUB. UNIT /0.1 ML INTRAD SOLN,,1068,LOCAL,Facility,Both,1,mL,,463,393.55,132.6958,463,Humana Insurance Company,Commercial PPO,439.85,95,,percent of total billed charges,,
TUBERCULIN PPD 5 TUB. UNIT /0.1 ML INTRAD SOLN,,1068,LOCAL,Facility,Outpatient,1,mL,,463,393.55,132.6958,463,Humana Insurance Company,Medicare PPO,226.87,49,,percent of total billed charges,,
TUBERCULIN PPD 5 TUB. UNIT /0.1 ML INTRAD SOLN,,1068,LOCAL,Facility,Inpatient,1,mL,,463,393.55,132.6958,463,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
TUBERCULIN PPD 5 TUB. UNIT /0.1 ML INTRAD SOLN,,1068,LOCAL,Facility,Both,1,mL,,463,393.55,132.6958,463,Medica,Individual & Family,458.833,99.1,,percent of total billed charges,,
TUBERCULIN PPD 5 TUB. UNIT /0.1 ML INTRAD SOLN,,1068,LOCAL,Facility,Outpatient,1,mL,,463,393.55,132.6958,463,Medica,Medica Advantage Solution,230.574,49.8,,percent of total billed charges,,
TUBERCULIN PPD 5 TUB. UNIT /0.1 ML INTRAD SOLN,,1068,LOCAL,Facility,Inpatient,1,mL,,463,393.55,132.6958,463,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
TUBERCULIN PPD 5 TUB. UNIT /0.1 ML INTRAD SOLN,,1068,LOCAL,Facility,Outpatient,1,mL,,463,393.55,132.6958,463,Medica,Medical Assistance,206.498,44.6,,percent of total billed charges,,
TUBERCULIN PPD 5 TUB. UNIT /0.1 ML INTRAD SOLN,,1068,LOCAL,Facility,Inpatient,1,mL,,463,393.55,132.6958,463,Medica,Medical Assistance,,,,,Included in per diem rate,
TUBERCULIN PPD 5 TUB. UNIT /0.1 ML INTRAD SOLN,,1068,LOCAL,Facility,Outpatient,1,mL,,463,393.55,132.6958,463,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,230.574,49.8,,percent of total billed charges,,
TUBERCULIN PPD 5 TUB. UNIT /0.1 ML INTRAD SOLN,,1068,LOCAL,Facility,Inpatient,1,mL,,463,393.55,132.6958,463,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
TUBERCULIN PPD 5 TUB. UNIT /0.1 ML INTRAD SOLN,,1068,LOCAL,Facility,Both,1,mL,,463,393.55,132.6958,463,"Multiplan, Inc.","Multiplan, Inc.",435.22,94,,percent of total billed charges,,
TUBERCULIN PPD 5 TUB. UNIT /0.1 ML INTRAD SOLN,,1068,LOCAL,Facility,Outpatient,1,mL,,463,393.55,132.6958,463,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,417.163,90.1,,percent of total billed charges,,
TUBERCULIN PPD 5 TUB. UNIT /0.1 ML INTRAD SOLN,,1068,LOCAL,Facility,Inpatient,1,mL,,463,393.55,132.6958,463,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
TUBERCULIN PPD 5 TUB. UNIT /0.1 ML INTRAD SOLN,,1068,LOCAL,Facility,Both,1,mL,,463,393.55,132.6958,463,"Preferred One Administrative Services, INC.",PPO,456.518,98.6,,percent of total billed charges,,
TUBERCULIN PPD 5 TUB. UNIT /0.1 ML INTRAD SOLN,,1068,LOCAL,Facility,Outpatient,1,mL,,463,393.55,132.6958,463,PrimeWest Health,Minnesota Senior Health Options (MSHO),238.2135,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
TUBERCULIN PPD 5 TUB. UNIT /0.1 ML INTRAD SOLN,,1068,LOCAL,Facility,Inpatient,1,mL,,463,393.55,132.6958,463,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
TUBERCULIN PPD 5 TUB. UNIT /0.1 ML INTRAD SOLN,,1068,LOCAL,Facility,Outpatient,1,mL,,463,393.55,132.6958,463,PrimeWest Health,MinnesotaCare,237.7968,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
TUBERCULIN PPD 5 TUB. UNIT /0.1 ML INTRAD SOLN,,1068,LOCAL,Facility,Inpatient,1,mL,,463,393.55,132.6958,463,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
TUBERCULIN PPD 5 TUB. UNIT /0.1 ML INTRAD SOLN,,1068,LOCAL,Facility,Both,1,mL,,463,393.55,132.6958,463,Sanford Health Plan,Sanford Health Plan,425.96,92,,percent of total billed charges,,
TUBERCULIN PPD 5 TUB. UNIT /0.1 ML INTRAD SOLN,,1068,LOCAL,Facility,Outpatient,1,mL,,463,393.55,132.6958,463,"UCare Health, Inc.",Individual & Family Plan,260.9005,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
TUBERCULIN PPD 5 TUB. UNIT /0.1 ML INTRAD SOLN,,1068,LOCAL,Facility,Inpatient,1,mL,,463,393.55,132.6958,463,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
TUBERCULIN PPD 5 TUB. UNIT /0.1 ML INTRAD SOLN,,1068,LOCAL,Facility,Outpatient,1,mL,,463,393.55,132.6958,463,"UCare Health, Inc.",Medical Assistance,233.6761,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TUBERCULIN PPD 5 TUB. UNIT /0.1 ML INTRAD SOLN,,1068,LOCAL,Facility,Inpatient,1,mL,,463,393.55,132.6958,463,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
TUBERCULIN PPD 5 TUB. UNIT /0.1 ML INTRAD SOLN,,1068,LOCAL,Facility,Outpatient,1,mL,,463,393.55,132.6958,463,"UCare Health, Inc.",Medicare Advantage,233.6761,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TUBERCULIN PPD 5 TUB. UNIT /0.1 ML INTRAD SOLN,,1068,LOCAL,Facility,Inpatient,1,mL,,463,393.55,132.6958,463,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
TUBERCULIN PPD 5 TUB. UNIT /0.1 ML INTRAD SOLN,,1068,LOCAL,Facility,Outpatient,1,mL,,463,393.55,132.6958,463,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),233.6761,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TUBERCULIN PPD 5 TUB. UNIT /0.1 ML INTRAD SOLN,,1068,LOCAL,Facility,Inpatient,1,mL,,463,393.55,132.6958,463,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
TUBERCULIN PPD 5 TUB. UNIT /0.1 ML INTRAD SOLN,,1068,LOCAL,Facility,Both,1,mL,,463,393.55,132.6958,463,UnitedHealthcare,Individual & Family,435.22,94,,percent of total billed charges,,
TUBERCULIN PPD 5 TUB. UNIT /0.1 ML INTRAD SOLN,,1068,LOCAL,Facility,Outpatient,1,mL,,463,393.55,132.6958,463,UnitedHealthcare,Medicare Advantage,226.87,49,,percent of total billed charges,,
TUBERCULIN PPD 5 TUB. UNIT /0.1 ML INTRAD SOLN,,1068,LOCAL,Facility,Inpatient,1,mL,,463,393.55,132.6958,463,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
TUBERCULIN PPD 5 TUB. UNIT /0.1 ML INTRAD SOLN,,1068,LOCAL,Facility,Outpatient,1,mL,,463,393.55,132.6958,463,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,222.24,48,,percent of total billed charges,,100% of DHS outpatient percentage
TUBERCULIN PPD 5 TUB. UNIT /0.1 ML INTRAD SOLN,,1068,LOCAL,Facility,Inpatient,1,mL,,463,393.55,132.6958,463,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Repair, Tendon Or Muscle, Flexor, Forearm And/Or Wrist; Primary, Sgl, Ea Tendon Or Muscle (Pro Cah)",,25260,CPT,Professional,Both,,,,2453,2085.05,401.17,2453,Aetna,Commercial,2085.05,85,,percent of total billed charges,,
"Repair, Tendon Or Muscle, Flexor, Forearm And/Or Wrist; Primary, Sgl, Ea Tendon Or Muscle (Pro Cah)",,25260,CPT,Professional,Both,,,,2453,2085.05,401.17,2453,Aetna,Medicare Advantage,624.07,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair, Tendon Or Muscle, Flexor, Forearm And/Or Wrist; Primary, Sgl, Ea Tendon Or Muscle (Pro Cah)",,25260,CPT,Professional,Both,,,,2453,2085.05,401.17,2453,Aetna,PPO,2281.29,93,,percent of total billed charges,,
"Repair, Tendon Or Muscle, Flexor, Forearm And/Or Wrist; Primary, Sgl, Ea Tendon Or Muscle (Pro Cah)",,25260,CPT,Professional,Both,,,,2453,2085.05,401.17,2453,America's PPO,America's PPO,2095.8432,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Repair, Tendon Or Muscle, Flexor, Forearm And/Or Wrist; Primary, Sgl, Ea Tendon Or Muscle (Pro Cah)",,25260,CPT,Professional,Both,,,,2453,2085.05,401.17,2453,BlueCross BlueShield Minnesota, Federal Employee Program,1325.56,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Repair, Tendon Or Muscle, Flexor, Forearm And/Or Wrist; Primary, Sgl, Ea Tendon Or Muscle (Pro Cah)",,25260,CPT,Professional,Both,,,,2453,2085.05,401.17,2453,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1346.76896,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Repair, Tendon Or Muscle, Flexor, Forearm And/Or Wrist; Primary, Sgl, Ea Tendon Or Muscle (Pro Cah)",,25260,CPT,Professional,Both,,,,2453,2085.05,401.17,2453,BlueCross BlueShield Minnesota,High Value Network Plan,1346.76896,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Repair, Tendon Or Muscle, Flexor, Forearm And/Or Wrist; Primary, Sgl, Ea Tendon Or Muscle (Pro Cah)",,25260,CPT,Professional,Both,,,,2453,2085.05,401.17,2453,BlueCross BlueShield Minnesota,Medicare Advantage,716.7605,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair, Tendon Or Muscle, Flexor, Forearm And/Or Wrist; Primary, Sgl, Ea Tendon Or Muscle (Pro Cah)",,25260,CPT,Professional,Both,,,,2453,2085.05,401.17,2453,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1346.76896,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Repair, Tendon Or Muscle, Flexor, Forearm And/Or Wrist; Primary, Sgl, Ea Tendon Or Muscle (Pro Cah)",,25260,CPT,Professional,Both,,,,2453,2085.05,401.17,2453,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,463.17408,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Repair, Tendon Or Muscle, Flexor, Forearm And/Or Wrist; Primary, Sgl, Ea Tendon Or Muscle (Pro Cah)",,25260,CPT,Professional,Both,,,,2453,2085.05,401.17,2453,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),716.7605,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair, Tendon Or Muscle, Flexor, Forearm And/Or Wrist; Primary, Sgl, Ea Tendon Or Muscle (Pro Cah)",,25260,CPT,Professional,Both,,,,2453,2085.05,401.17,2453,CorVel,Worker's Compensation,1212.734871,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Repair, Tendon Or Muscle, Flexor, Forearm And/Or Wrist; Primary, Sgl, Ea Tendon Or Muscle (Pro Cah)",,25260,CPT,Professional,Both,,,,2453,2085.05,401.17,2453,First Health Group Corporation,First Health Network,2379.41,97,,percent of total billed charges,,
"Repair, Tendon Or Muscle, Flexor, Forearm And/Or Wrist; Primary, Sgl, Ea Tendon Or Muscle (Pro Cah)",,25260,CPT,Professional,Both,,,,2453,2085.05,401.17,2453,"Health Partners, Inc.",Commercial,1309.57,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Repair, Tendon Or Muscle, Flexor, Forearm And/Or Wrist; Primary, Sgl, Ea Tendon Or Muscle (Pro Cah)",,25260,CPT,Professional,Both,,,,2453,2085.05,401.17,2453,"Health Partners, Inc.",Medicare Advantage,716.7605,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair, Tendon Or Muscle, Flexor, Forearm And/Or Wrist; Primary, Sgl, Ea Tendon Or Muscle (Pro Cah)",,25260,CPT,Professional,Both,,,,2453,2085.05,401.17,2453,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),623.19,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Repair, Tendon Or Muscle, Flexor, Forearm And/Or Wrist; Primary, Sgl, Ea Tendon Or Muscle (Pro Cah)",,25260,CPT,Professional,Both,,,,2453,2085.05,401.17,2453,"Health Partners, Inc.",State of Minnesota Advantage Program,1128.194555,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Repair, Tendon Or Muscle, Flexor, Forearm And/Or Wrist; Primary, Sgl, Ea Tendon Or Muscle (Pro Cah)",,25260,CPT,Professional,Both,,,,2453,2085.05,401.17,2453,"Health Partners, Inc.",State Public Programs,401.17,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Repair, Tendon Or Muscle, Flexor, Forearm And/Or Wrist; Primary, Sgl, Ea Tendon Or Muscle (Pro Cah)",,25260,CPT,Professional,Both,,,,2453,2085.05,401.17,2453,Humana Insurance Company,Commercial PPO,623.27,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Repair, Tendon Or Muscle, Flexor, Forearm And/Or Wrist; Primary, Sgl, Ea Tendon Or Muscle (Pro Cah)",,25260,CPT,Professional,Both,,,,2453,2085.05,401.17,2453,Humana Insurance Company,Medicare PPO,2453,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Repair, Tendon Or Muscle, Flexor, Forearm And/Or Wrist; Primary, Sgl, Ea Tendon Or Muscle (Pro Cah)",,25260,CPT,Professional,Both,,,,2453,2085.05,401.17,2453,Medica,Individual & Family,2080.144,84.8,,percent of total billed charges,,
"Repair, Tendon Or Muscle, Flexor, Forearm And/Or Wrist; Primary, Sgl, Ea Tendon Or Muscle (Pro Cah)",,25260,CPT,Professional,Both,,,,2453,2085.05,401.17,2453,Medica,Medica Advantage Solution,1221.594,49.8,,percent of total billed charges,,
"Repair, Tendon Or Muscle, Flexor, Forearm And/Or Wrist; Primary, Sgl, Ea Tendon Or Muscle (Pro Cah)",,25260,CPT,Professional,Both,,,,2453,2085.05,401.17,2453,Medica,Medical Assistance,463.17,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Repair, Tendon Or Muscle, Flexor, Forearm And/Or Wrist; Primary, Sgl, Ea Tendon Or Muscle (Pro Cah)",,25260,CPT,Professional,Both,,,,2453,2085.05,401.17,2453,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,623.27,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Repair, Tendon Or Muscle, Flexor, Forearm And/Or Wrist; Primary, Sgl, Ea Tendon Or Muscle (Pro Cah)",,25260,CPT,Professional,Both,,,,2453,2085.05,401.17,2453,"Multiplan, Inc.","Multiplan, Inc.",2305.82,94,,percent of total billed charges,,
"Repair, Tendon Or Muscle, Flexor, Forearm And/Or Wrist; Primary, Sgl, Ea Tendon Or Muscle (Pro Cah)",,25260,CPT,Professional,Both,,,,2453,2085.05,401.17,2453,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,2210.153,90.1,,percent of total billed charges,,
"Repair, Tendon Or Muscle, Flexor, Forearm And/Or Wrist; Primary, Sgl, Ea Tendon Or Muscle (Pro Cah)",,25260,CPT,Professional,Both,,,,2453,2085.05,401.17,2453,"Preferred One Administrative Services, INC.",PPO,2418.658,98.6,,percent of total billed charges,,
"Repair, Tendon Or Muscle, Flexor, Forearm And/Or Wrist; Primary, Sgl, Ea Tendon Or Muscle (Pro Cah)",,25260,CPT,Professional,Both,,,,2453,2085.05,401.17,2453,PrimeWest Health,Minnesota Senior Health Options (MSHO),716.7605,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair, Tendon Or Muscle, Flexor, Forearm And/Or Wrist; Primary, Sgl, Ea Tendon Or Muscle (Pro Cah)",,25260,CPT,Professional,Both,,,,2453,2085.05,401.17,2453,PrimeWest Health,MinnesotaCare,495.5962656,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Repair, Tendon Or Muscle, Flexor, Forearm And/Or Wrist; Primary, Sgl, Ea Tendon Or Muscle (Pro Cah)",,25260,CPT,Professional,Both,,,,2453,2085.05,401.17,2453,Sanford Health Plan,Sanford Health Plan,2158.64,88,,percent of total billed charges,,
"Repair, Tendon Or Muscle, Flexor, Forearm And/Or Wrist; Primary, Sgl, Ea Tendon Or Muscle (Pro Cah)",,25260,CPT,Professional,Both,,,,2453,2085.05,401.17,2453,"UCare Health, Inc.",Individual & Family Plan,1013.187712,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Repair, Tendon Or Muscle, Flexor, Forearm And/Or Wrist; Primary, Sgl, Ea Tendon Or Muscle (Pro Cah)",,25260,CPT,Professional,Both,,,,2453,2085.05,401.17,2453,"UCare Health, Inc.",Medical Assistance,509.491488,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Repair, Tendon Or Muscle, Flexor, Forearm And/Or Wrist; Primary, Sgl, Ea Tendon Or Muscle (Pro Cah)",,25260,CPT,Professional,Both,,,,2453,2085.05,401.17,2453,"UCare Health, Inc.",Medicare Advantage,716.7605,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Repair, Tendon Or Muscle, Flexor, Forearm And/Or Wrist; Primary, Sgl, Ea Tendon Or Muscle (Pro Cah)",,25260,CPT,Professional,Both,,,,2453,2085.05,401.17,2453,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),573.4084,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Repair, Tendon Or Muscle, Flexor, Forearm And/Or Wrist; Primary, Sgl, Ea Tendon Or Muscle (Pro Cah)",,25260,CPT,Professional,Both,,,,2453,2085.05,401.17,2453,UnitedHealthcare,Individual & Family,2453,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Repair, Tendon Or Muscle, Flexor, Forearm And/Or Wrist; Primary, Sgl, Ea Tendon Or Muscle (Pro Cah)",,25260,CPT,Professional,Both,,,,2453,2085.05,401.17,2453,UnitedHealthcare,Medicare Advantage,716.7605,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair, Tendon Or Muscle, Flexor, Forearm And/Or Wrist; Primary, Sgl, Ea Tendon Or Muscle (Pro Cah)",,25260,CPT,Professional,Both,,,,2453,2085.05,401.17,2453,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,463.17408,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Repair, Tendon/Muscle, Flexor, Forearm And/Or Wrist; Secondary, Single, Each Tendon/Muscle (Pro Cah)",,25263,CPT,Professional,Both,,,,2392,2033.2,398.99,2392,Aetna,Commercial,2033.2,85,,percent of total billed charges,,
"Repair, Tendon/Muscle, Flexor, Forearm And/Or Wrist; Secondary, Single, Each Tendon/Muscle (Pro Cah)",,25263,CPT,Professional,Both,,,,2392,2033.2,398.99,2392,Aetna,Medicare Advantage,622.38,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair, Tendon/Muscle, Flexor, Forearm And/Or Wrist; Secondary, Single, Each Tendon/Muscle (Pro Cah)",,25263,CPT,Professional,Both,,,,2392,2033.2,398.99,2392,Aetna,PPO,2224.56,93,,percent of total billed charges,,
"Repair, Tendon/Muscle, Flexor, Forearm And/Or Wrist; Secondary, Single, Each Tendon/Muscle (Pro Cah)",,25263,CPT,Professional,Both,,,,2392,2033.2,398.99,2392,America's PPO,America's PPO,2043.7248,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Repair, Tendon/Muscle, Flexor, Forearm And/Or Wrist; Secondary, Single, Each Tendon/Muscle (Pro Cah)",,25263,CPT,Professional,Both,,,,2392,2033.2,398.99,2392,BlueCross BlueShield Minnesota, Federal Employee Program,1322.11,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Repair, Tendon/Muscle, Flexor, Forearm And/Or Wrist; Secondary, Single, Each Tendon/Muscle (Pro Cah)",,25263,CPT,Professional,Both,,,,2392,2033.2,398.99,2392,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1343.26376,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Repair, Tendon/Muscle, Flexor, Forearm And/Or Wrist; Secondary, Single, Each Tendon/Muscle (Pro Cah)",,25263,CPT,Professional,Both,,,,2392,2033.2,398.99,2392,BlueCross BlueShield Minnesota,High Value Network Plan,1343.26376,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Repair, Tendon/Muscle, Flexor, Forearm And/Or Wrist; Secondary, Single, Each Tendon/Muscle (Pro Cah)",,25263,CPT,Professional,Both,,,,2392,2033.2,398.99,2392,BlueCross BlueShield Minnesota,Medicare Advantage,713.0115,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair, Tendon/Muscle, Flexor, Forearm And/Or Wrist; Secondary, Single, Each Tendon/Muscle (Pro Cah)",,25263,CPT,Professional,Both,,,,2392,2033.2,398.99,2392,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1343.26376,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Repair, Tendon/Muscle, Flexor, Forearm And/Or Wrist; Secondary, Single, Each Tendon/Muscle (Pro Cah)",,25263,CPT,Professional,Both,,,,2392,2033.2,398.99,2392,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,460.6544,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Repair, Tendon/Muscle, Flexor, Forearm And/Or Wrist; Secondary, Single, Each Tendon/Muscle (Pro Cah)",,25263,CPT,Professional,Both,,,,2392,2033.2,398.99,2392,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),713.0115,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair, Tendon/Muscle, Flexor, Forearm And/Or Wrist; Secondary, Single, Each Tendon/Muscle (Pro Cah)",,25263,CPT,Professional,Both,,,,2392,2033.2,398.99,2392,CorVel,Worker's Compensation,1208.569659,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Repair, Tendon/Muscle, Flexor, Forearm And/Or Wrist; Secondary, Single, Each Tendon/Muscle (Pro Cah)",,25263,CPT,Professional,Both,,,,2392,2033.2,398.99,2392,First Health Group Corporation,First Health Network,2320.24,97,,percent of total billed charges,,
"Repair, Tendon/Muscle, Flexor, Forearm And/Or Wrist; Secondary, Single, Each Tendon/Muscle (Pro Cah)",,25263,CPT,Professional,Both,,,,2392,2033.2,398.99,2392,"Health Partners, Inc.",Commercial,1305.22,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Repair, Tendon/Muscle, Flexor, Forearm And/Or Wrist; Secondary, Single, Each Tendon/Muscle (Pro Cah)",,25263,CPT,Professional,Both,,,,2392,2033.2,398.99,2392,"Health Partners, Inc.",Medicare Advantage,713.0115,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair, Tendon/Muscle, Flexor, Forearm And/Or Wrist; Secondary, Single, Each Tendon/Muscle (Pro Cah)",,25263,CPT,Professional,Both,,,,2392,2033.2,398.99,2392,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),619.8,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Repair, Tendon/Muscle, Flexor, Forearm And/Or Wrist; Secondary, Single, Each Tendon/Muscle (Pro Cah)",,25263,CPT,Professional,Both,,,,2392,2033.2,398.99,2392,"Health Partners, Inc.",State of Minnesota Advantage Program,1124.44703,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Repair, Tendon/Muscle, Flexor, Forearm And/Or Wrist; Secondary, Single, Each Tendon/Muscle (Pro Cah)",,25263,CPT,Professional,Both,,,,2392,2033.2,398.99,2392,"Health Partners, Inc.",State Public Programs,398.99,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Repair, Tendon/Muscle, Flexor, Forearm And/Or Wrist; Secondary, Single, Each Tendon/Muscle (Pro Cah)",,25263,CPT,Professional,Both,,,,2392,2033.2,398.99,2392,Humana Insurance Company,Commercial PPO,620.01,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Repair, Tendon/Muscle, Flexor, Forearm And/Or Wrist; Secondary, Single, Each Tendon/Muscle (Pro Cah)",,25263,CPT,Professional,Both,,,,2392,2033.2,398.99,2392,Humana Insurance Company,Medicare PPO,2392,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Repair, Tendon/Muscle, Flexor, Forearm And/Or Wrist; Secondary, Single, Each Tendon/Muscle (Pro Cah)",,25263,CPT,Professional,Both,,,,2392,2033.2,398.99,2392,Medica,Individual & Family,2028.416,84.8,,percent of total billed charges,,
"Repair, Tendon/Muscle, Flexor, Forearm And/Or Wrist; Secondary, Single, Each Tendon/Muscle (Pro Cah)",,25263,CPT,Professional,Both,,,,2392,2033.2,398.99,2392,Medica,Medica Advantage Solution,1191.216,49.8,,percent of total billed charges,,
"Repair, Tendon/Muscle, Flexor, Forearm And/Or Wrist; Secondary, Single, Each Tendon/Muscle (Pro Cah)",,25263,CPT,Professional,Both,,,,2392,2033.2,398.99,2392,Medica,Medical Assistance,460.65,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Repair, Tendon/Muscle, Flexor, Forearm And/Or Wrist; Secondary, Single, Each Tendon/Muscle (Pro Cah)",,25263,CPT,Professional,Both,,,,2392,2033.2,398.99,2392,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,620.01,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Repair, Tendon/Muscle, Flexor, Forearm And/Or Wrist; Secondary, Single, Each Tendon/Muscle (Pro Cah)",,25263,CPT,Professional,Both,,,,2392,2033.2,398.99,2392,"Multiplan, Inc.","Multiplan, Inc.",2248.48,94,,percent of total billed charges,,
"Repair, Tendon/Muscle, Flexor, Forearm And/Or Wrist; Secondary, Single, Each Tendon/Muscle (Pro Cah)",,25263,CPT,Professional,Both,,,,2392,2033.2,398.99,2392,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,2155.192,90.1,,percent of total billed charges,,
"Repair, Tendon/Muscle, Flexor, Forearm And/Or Wrist; Secondary, Single, Each Tendon/Muscle (Pro Cah)",,25263,CPT,Professional,Both,,,,2392,2033.2,398.99,2392,"Preferred One Administrative Services, INC.",PPO,2358.512,98.6,,percent of total billed charges,,
"Repair, Tendon/Muscle, Flexor, Forearm And/Or Wrist; Secondary, Single, Each Tendon/Muscle (Pro Cah)",,25263,CPT,Professional,Both,,,,2392,2033.2,398.99,2392,PrimeWest Health,Minnesota Senior Health Options (MSHO),713.0115,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair, Tendon/Muscle, Flexor, Forearm And/Or Wrist; Secondary, Single, Each Tendon/Muscle (Pro Cah)",,25263,CPT,Professional,Both,,,,2392,2033.2,398.99,2392,PrimeWest Health,MinnesotaCare,492.900208,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Repair, Tendon/Muscle, Flexor, Forearm And/Or Wrist; Secondary, Single, Each Tendon/Muscle (Pro Cah)",,25263,CPT,Professional,Both,,,,2392,2033.2,398.99,2392,Sanford Health Plan,Sanford Health Plan,2104.96,88,,percent of total billed charges,,
"Repair, Tendon/Muscle, Flexor, Forearm And/Or Wrist; Secondary, Single, Each Tendon/Muscle (Pro Cah)",,25263,CPT,Professional,Both,,,,2392,2033.2,398.99,2392,"UCare Health, Inc.",Individual & Family Plan,1007.888256,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Repair, Tendon/Muscle, Flexor, Forearm And/Or Wrist; Secondary, Single, Each Tendon/Muscle (Pro Cah)",,25263,CPT,Professional,Both,,,,2392,2033.2,398.99,2392,"UCare Health, Inc.",Medical Assistance,506.71984,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Repair, Tendon/Muscle, Flexor, Forearm And/Or Wrist; Secondary, Single, Each Tendon/Muscle (Pro Cah)",,25263,CPT,Professional,Both,,,,2392,2033.2,398.99,2392,"UCare Health, Inc.",Medicare Advantage,713.0115,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Repair, Tendon/Muscle, Flexor, Forearm And/Or Wrist; Secondary, Single, Each Tendon/Muscle (Pro Cah)",,25263,CPT,Professional,Both,,,,2392,2033.2,398.99,2392,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),570.4092,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Repair, Tendon/Muscle, Flexor, Forearm And/Or Wrist; Secondary, Single, Each Tendon/Muscle (Pro Cah)",,25263,CPT,Professional,Both,,,,2392,2033.2,398.99,2392,UnitedHealthcare,Individual & Family,2392,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Repair, Tendon/Muscle, Flexor, Forearm And/Or Wrist; Secondary, Single, Each Tendon/Muscle (Pro Cah)",,25263,CPT,Professional,Both,,,,2392,2033.2,398.99,2392,UnitedHealthcare,Medicare Advantage,713.0115,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair, Tendon/Muscle, Flexor, Forearm And/Or Wrist; Secondary, Single, Each Tendon/Muscle (Pro Cah)",,25263,CPT,Professional,Both,,,,2392,2033.2,398.99,2392,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,460.6544,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"NEOMYCIN-POLYMYXIN B GU 40 MG-200,000 UNIT/ML IR SOLN",,19490,LOCAL,Facility,Both,1,mL,,63,53.55,18.0558,63,Aetna,Commercial,57.96,92,,percent of total billed charges,,
"NEOMYCIN-POLYMYXIN B GU 40 MG-200,000 UNIT/ML IR SOLN",,19490,LOCAL,Facility,Outpatient,1,mL,,63,53.55,18.0558,63,Aetna,Medicare Advantage,30.87,49,,percent of total billed charges,,
"NEOMYCIN-POLYMYXIN B GU 40 MG-200,000 UNIT/ML IR SOLN",,19490,LOCAL,Facility,Inpatient,1,mL,,63,53.55,18.0558,63,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"NEOMYCIN-POLYMYXIN B GU 40 MG-200,000 UNIT/ML IR SOLN",,19490,LOCAL,Facility,Both,1,mL,,63,53.55,18.0558,63,Aetna,PPO,58.59,93,,percent of total billed charges,,
"NEOMYCIN-POLYMYXIN B GU 40 MG-200,000 UNIT/ML IR SOLN",,19490,LOCAL,Facility,Both,1,mL,,63,53.55,18.0558,63,America's PPO,America's PPO,60.4989,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"NEOMYCIN-POLYMYXIN B GU 40 MG-200,000 UNIT/ML IR SOLN",,19490,LOCAL,Facility,Both,1,mL,,63,53.55,18.0558,63,BlueCross BlueShield Minnesota, Federal Employee Program,61.992,98.4,,percent of total billed charges,,
"NEOMYCIN-POLYMYXIN B GU 40 MG-200,000 UNIT/ML IR SOLN",,19490,LOCAL,Facility,Both,1,mL,,63,53.55,18.0558,63,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,63,100,,percent of total billed charges,,
"NEOMYCIN-POLYMYXIN B GU 40 MG-200,000 UNIT/ML IR SOLN",,19490,LOCAL,Facility,Both,1,mL,,63,53.55,18.0558,63,BlueCross BlueShield Minnesota,High Value Network Plan,56.7,90,,percent of total billed charges,,
"NEOMYCIN-POLYMYXIN B GU 40 MG-200,000 UNIT/ML IR SOLN",,19490,LOCAL,Facility,Outpatient,1,mL,,63,53.55,18.0558,63,BlueCross BlueShield Minnesota,Medicare Advantage,30.87,49,,percent of total billed charges,,
"NEOMYCIN-POLYMYXIN B GU 40 MG-200,000 UNIT/ML IR SOLN",,19490,LOCAL,Facility,Inpatient,1,mL,,63,53.55,18.0558,63,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"NEOMYCIN-POLYMYXIN B GU 40 MG-200,000 UNIT/ML IR SOLN",,19490,LOCAL,Facility,Both,1,mL,,63,53.55,18.0558,63,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,55.7991,88.57,,percent of total billed charges,,
"NEOMYCIN-POLYMYXIN B GU 40 MG-200,000 UNIT/ML IR SOLN",,19490,LOCAL,Facility,Both,1,mL,,63,53.55,18.0558,63,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,18.0558,28.66,,percent of total billed charges,,
"NEOMYCIN-POLYMYXIN B GU 40 MG-200,000 UNIT/ML IR SOLN",,19490,LOCAL,Facility,Outpatient,1,mL,,63,53.55,18.0558,63,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),30.87,49,,percent of total billed charges,,
"NEOMYCIN-POLYMYXIN B GU 40 MG-200,000 UNIT/ML IR SOLN",,19490,LOCAL,Facility,Inpatient,1,mL,,63,53.55,18.0558,63,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"NEOMYCIN-POLYMYXIN B GU 40 MG-200,000 UNIT/ML IR SOLN",,19490,LOCAL,Facility,Both,1,mL,,63,53.55,18.0558,63,CorVel,Worker's Compensation,63,100,,percent of total billed charges,,
"NEOMYCIN-POLYMYXIN B GU 40 MG-200,000 UNIT/ML IR SOLN",,19490,LOCAL,Facility,Both,1,mL,,63,53.55,18.0558,63,First Health Group Corporation,First Health Network,61.11,97,,percent of total billed charges,,
"NEOMYCIN-POLYMYXIN B GU 40 MG-200,000 UNIT/ML IR SOLN",,19490,LOCAL,Facility,Both,1,mL,,63,53.55,18.0558,63,"Health Partners, Inc.",Commercial,59.598,94.6,,percent of total billed charges,,
"NEOMYCIN-POLYMYXIN B GU 40 MG-200,000 UNIT/ML IR SOLN",,19490,LOCAL,Facility,Outpatient,1,mL,,63,53.55,18.0558,63,"Health Partners, Inc.",Medicare Advantage,30.87,49,,percent of total billed charges,,
"NEOMYCIN-POLYMYXIN B GU 40 MG-200,000 UNIT/ML IR SOLN",,19490,LOCAL,Facility,Inpatient,1,mL,,63,53.55,18.0558,63,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"NEOMYCIN-POLYMYXIN B GU 40 MG-200,000 UNIT/ML IR SOLN",,19490,LOCAL,Facility,Both,1,mL,,63,53.55,18.0558,63,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),37.8,60,,percent of total billed charges,,
"NEOMYCIN-POLYMYXIN B GU 40 MG-200,000 UNIT/ML IR SOLN",,19490,LOCAL,Facility,Both,1,mL,,63,53.55,18.0558,63,"Health Partners, Inc.",State of Minnesota Advantage Program,51.345,81.5,,percent of total billed charges,,
"NEOMYCIN-POLYMYXIN B GU 40 MG-200,000 UNIT/ML IR SOLN",,19490,LOCAL,Facility,Both,1,mL,,63,53.55,18.0558,63,"Health Partners, Inc.",State Public Programs,31.5,50,,percent of total billed charges,,
"NEOMYCIN-POLYMYXIN B GU 40 MG-200,000 UNIT/ML IR SOLN",,19490,LOCAL,Facility,Both,1,mL,,63,53.55,18.0558,63,Humana Insurance Company,Commercial PPO,59.85,95,,percent of total billed charges,,
"NEOMYCIN-POLYMYXIN B GU 40 MG-200,000 UNIT/ML IR SOLN",,19490,LOCAL,Facility,Outpatient,1,mL,,63,53.55,18.0558,63,Humana Insurance Company,Medicare PPO,30.87,49,,percent of total billed charges,,
"NEOMYCIN-POLYMYXIN B GU 40 MG-200,000 UNIT/ML IR SOLN",,19490,LOCAL,Facility,Inpatient,1,mL,,63,53.55,18.0558,63,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"NEOMYCIN-POLYMYXIN B GU 40 MG-200,000 UNIT/ML IR SOLN",,19490,LOCAL,Facility,Both,1,mL,,63,53.55,18.0558,63,Medica,Individual & Family,62.433,99.1,,percent of total billed charges,,
"NEOMYCIN-POLYMYXIN B GU 40 MG-200,000 UNIT/ML IR SOLN",,19490,LOCAL,Facility,Outpatient,1,mL,,63,53.55,18.0558,63,Medica,Medica Advantage Solution,31.374,49.8,,percent of total billed charges,,
"NEOMYCIN-POLYMYXIN B GU 40 MG-200,000 UNIT/ML IR SOLN",,19490,LOCAL,Facility,Inpatient,1,mL,,63,53.55,18.0558,63,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"NEOMYCIN-POLYMYXIN B GU 40 MG-200,000 UNIT/ML IR SOLN",,19490,LOCAL,Facility,Outpatient,1,mL,,63,53.55,18.0558,63,Medica,Medical Assistance,28.098,44.6,,percent of total billed charges,,
"NEOMYCIN-POLYMYXIN B GU 40 MG-200,000 UNIT/ML IR SOLN",,19490,LOCAL,Facility,Inpatient,1,mL,,63,53.55,18.0558,63,Medica,Medical Assistance,,,,,Included in per diem rate,
"NEOMYCIN-POLYMYXIN B GU 40 MG-200,000 UNIT/ML IR SOLN",,19490,LOCAL,Facility,Outpatient,1,mL,,63,53.55,18.0558,63,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,31.374,49.8,,percent of total billed charges,,
"NEOMYCIN-POLYMYXIN B GU 40 MG-200,000 UNIT/ML IR SOLN",,19490,LOCAL,Facility,Inpatient,1,mL,,63,53.55,18.0558,63,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"NEOMYCIN-POLYMYXIN B GU 40 MG-200,000 UNIT/ML IR SOLN",,19490,LOCAL,Facility,Both,1,mL,,63,53.55,18.0558,63,"Multiplan, Inc.","Multiplan, Inc.",59.22,94,,percent of total billed charges,,
"NEOMYCIN-POLYMYXIN B GU 40 MG-200,000 UNIT/ML IR SOLN",,19490,LOCAL,Facility,Outpatient,1,mL,,63,53.55,18.0558,63,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,56.763,90.1,,percent of total billed charges,,
"NEOMYCIN-POLYMYXIN B GU 40 MG-200,000 UNIT/ML IR SOLN",,19490,LOCAL,Facility,Inpatient,1,mL,,63,53.55,18.0558,63,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"NEOMYCIN-POLYMYXIN B GU 40 MG-200,000 UNIT/ML IR SOLN",,19490,LOCAL,Facility,Both,1,mL,,63,53.55,18.0558,63,"Preferred One Administrative Services, INC.",PPO,62.118,98.6,,percent of total billed charges,,
"NEOMYCIN-POLYMYXIN B GU 40 MG-200,000 UNIT/ML IR SOLN",,19490,LOCAL,Facility,Outpatient,1,mL,,63,53.55,18.0558,63,PrimeWest Health,Minnesota Senior Health Options (MSHO),32.4135,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"NEOMYCIN-POLYMYXIN B GU 40 MG-200,000 UNIT/ML IR SOLN",,19490,LOCAL,Facility,Inpatient,1,mL,,63,53.55,18.0558,63,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"NEOMYCIN-POLYMYXIN B GU 40 MG-200,000 UNIT/ML IR SOLN",,19490,LOCAL,Facility,Outpatient,1,mL,,63,53.55,18.0558,63,PrimeWest Health,MinnesotaCare,32.3568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"NEOMYCIN-POLYMYXIN B GU 40 MG-200,000 UNIT/ML IR SOLN",,19490,LOCAL,Facility,Inpatient,1,mL,,63,53.55,18.0558,63,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"NEOMYCIN-POLYMYXIN B GU 40 MG-200,000 UNIT/ML IR SOLN",,19490,LOCAL,Facility,Both,1,mL,,63,53.55,18.0558,63,Sanford Health Plan,Sanford Health Plan,57.96,92,,percent of total billed charges,,
"NEOMYCIN-POLYMYXIN B GU 40 MG-200,000 UNIT/ML IR SOLN",,19490,LOCAL,Facility,Outpatient,1,mL,,63,53.55,18.0558,63,"UCare Health, Inc.",Individual & Family Plan,35.5005,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"NEOMYCIN-POLYMYXIN B GU 40 MG-200,000 UNIT/ML IR SOLN",,19490,LOCAL,Facility,Inpatient,1,mL,,63,53.55,18.0558,63,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"NEOMYCIN-POLYMYXIN B GU 40 MG-200,000 UNIT/ML IR SOLN",,19490,LOCAL,Facility,Outpatient,1,mL,,63,53.55,18.0558,63,"UCare Health, Inc.",Medical Assistance,31.7961,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"NEOMYCIN-POLYMYXIN B GU 40 MG-200,000 UNIT/ML IR SOLN",,19490,LOCAL,Facility,Inpatient,1,mL,,63,53.55,18.0558,63,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"NEOMYCIN-POLYMYXIN B GU 40 MG-200,000 UNIT/ML IR SOLN",,19490,LOCAL,Facility,Outpatient,1,mL,,63,53.55,18.0558,63,"UCare Health, Inc.",Medicare Advantage,31.7961,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"NEOMYCIN-POLYMYXIN B GU 40 MG-200,000 UNIT/ML IR SOLN",,19490,LOCAL,Facility,Inpatient,1,mL,,63,53.55,18.0558,63,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"NEOMYCIN-POLYMYXIN B GU 40 MG-200,000 UNIT/ML IR SOLN",,19490,LOCAL,Facility,Outpatient,1,mL,,63,53.55,18.0558,63,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),31.7961,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"NEOMYCIN-POLYMYXIN B GU 40 MG-200,000 UNIT/ML IR SOLN",,19490,LOCAL,Facility,Inpatient,1,mL,,63,53.55,18.0558,63,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"NEOMYCIN-POLYMYXIN B GU 40 MG-200,000 UNIT/ML IR SOLN",,19490,LOCAL,Facility,Both,1,mL,,63,53.55,18.0558,63,UnitedHealthcare,Individual & Family,59.22,94,,percent of total billed charges,,
"NEOMYCIN-POLYMYXIN B GU 40 MG-200,000 UNIT/ML IR SOLN",,19490,LOCAL,Facility,Outpatient,1,mL,,63,53.55,18.0558,63,UnitedHealthcare,Medicare Advantage,30.87,49,,percent of total billed charges,,
"NEOMYCIN-POLYMYXIN B GU 40 MG-200,000 UNIT/ML IR SOLN",,19490,LOCAL,Facility,Inpatient,1,mL,,63,53.55,18.0558,63,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"NEOMYCIN-POLYMYXIN B GU 40 MG-200,000 UNIT/ML IR SOLN",,19490,LOCAL,Facility,Outpatient,1,mL,,63,53.55,18.0558,63,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,30.24,48,,percent of total billed charges,,100% of DHS outpatient percentage
"NEOMYCIN-POLYMYXIN B GU 40 MG-200,000 UNIT/ML IR SOLN",,19490,LOCAL,Facility,Inpatient,1,mL,,63,53.55,18.0558,63,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
CARBOPROST TROMETHAMINE 250 MCG/ML IM SOLN,,20316,LOCAL,Facility,Both,1,mL,,1539,1308.15,441.0774,1539,Aetna,Commercial,1415.88,92,,percent of total billed charges,,
CARBOPROST TROMETHAMINE 250 MCG/ML IM SOLN,,20316,LOCAL,Facility,Outpatient,1,mL,,1539,1308.15,441.0774,1539,Aetna,Medicare Advantage,754.11,49,,percent of total billed charges,,
CARBOPROST TROMETHAMINE 250 MCG/ML IM SOLN,,20316,LOCAL,Facility,Inpatient,1,mL,,1539,1308.15,441.0774,1539,Aetna,Medicare Advantage,,,,,Included in per diem rate,
CARBOPROST TROMETHAMINE 250 MCG/ML IM SOLN,,20316,LOCAL,Facility,Both,1,mL,,1539,1308.15,441.0774,1539,Aetna,PPO,1431.27,93,,percent of total billed charges,,
CARBOPROST TROMETHAMINE 250 MCG/ML IM SOLN,,20316,LOCAL,Facility,Both,1,mL,,1539,1308.15,441.0774,1539,America's PPO,America's PPO,1477.9017,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
CARBOPROST TROMETHAMINE 250 MCG/ML IM SOLN,,20316,LOCAL,Facility,Both,1,mL,,1539,1308.15,441.0774,1539,BlueCross BlueShield Minnesota, Federal Employee Program,1514.376,98.4,,percent of total billed charges,,
CARBOPROST TROMETHAMINE 250 MCG/ML IM SOLN,,20316,LOCAL,Facility,Both,1,mL,,1539,1308.15,441.0774,1539,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1539,100,,percent of total billed charges,,
CARBOPROST TROMETHAMINE 250 MCG/ML IM SOLN,,20316,LOCAL,Facility,Both,1,mL,,1539,1308.15,441.0774,1539,BlueCross BlueShield Minnesota,High Value Network Plan,1385.1,90,,percent of total billed charges,,
CARBOPROST TROMETHAMINE 250 MCG/ML IM SOLN,,20316,LOCAL,Facility,Outpatient,1,mL,,1539,1308.15,441.0774,1539,BlueCross BlueShield Minnesota,Medicare Advantage,754.11,49,,percent of total billed charges,,
CARBOPROST TROMETHAMINE 250 MCG/ML IM SOLN,,20316,LOCAL,Facility,Inpatient,1,mL,,1539,1308.15,441.0774,1539,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
CARBOPROST TROMETHAMINE 250 MCG/ML IM SOLN,,20316,LOCAL,Facility,Both,1,mL,,1539,1308.15,441.0774,1539,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1363.0923,88.57,,percent of total billed charges,,
CARBOPROST TROMETHAMINE 250 MCG/ML IM SOLN,,20316,LOCAL,Facility,Both,1,mL,,1539,1308.15,441.0774,1539,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,441.0774,28.66,,percent of total billed charges,,
CARBOPROST TROMETHAMINE 250 MCG/ML IM SOLN,,20316,LOCAL,Facility,Outpatient,1,mL,,1539,1308.15,441.0774,1539,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),754.11,49,,percent of total billed charges,,
CARBOPROST TROMETHAMINE 250 MCG/ML IM SOLN,,20316,LOCAL,Facility,Inpatient,1,mL,,1539,1308.15,441.0774,1539,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
CARBOPROST TROMETHAMINE 250 MCG/ML IM SOLN,,20316,LOCAL,Facility,Both,1,mL,,1539,1308.15,441.0774,1539,CorVel,Worker's Compensation,1539,100,,percent of total billed charges,,
CARBOPROST TROMETHAMINE 250 MCG/ML IM SOLN,,20316,LOCAL,Facility,Both,1,mL,,1539,1308.15,441.0774,1539,First Health Group Corporation,First Health Network,1492.83,97,,percent of total billed charges,,
CARBOPROST TROMETHAMINE 250 MCG/ML IM SOLN,,20316,LOCAL,Facility,Both,1,mL,,1539,1308.15,441.0774,1539,"Health Partners, Inc.",Commercial,1455.894,94.6,,percent of total billed charges,,
CARBOPROST TROMETHAMINE 250 MCG/ML IM SOLN,,20316,LOCAL,Facility,Outpatient,1,mL,,1539,1308.15,441.0774,1539,"Health Partners, Inc.",Medicare Advantage,754.11,49,,percent of total billed charges,,
CARBOPROST TROMETHAMINE 250 MCG/ML IM SOLN,,20316,LOCAL,Facility,Inpatient,1,mL,,1539,1308.15,441.0774,1539,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CARBOPROST TROMETHAMINE 250 MCG/ML IM SOLN,,20316,LOCAL,Facility,Both,1,mL,,1539,1308.15,441.0774,1539,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),923.4,60,,percent of total billed charges,,
CARBOPROST TROMETHAMINE 250 MCG/ML IM SOLN,,20316,LOCAL,Facility,Both,1,mL,,1539,1308.15,441.0774,1539,"Health Partners, Inc.",State of Minnesota Advantage Program,1254.285,81.5,,percent of total billed charges,,
CARBOPROST TROMETHAMINE 250 MCG/ML IM SOLN,,20316,LOCAL,Facility,Both,1,mL,,1539,1308.15,441.0774,1539,"Health Partners, Inc.",State Public Programs,769.5,50,,percent of total billed charges,,
CARBOPROST TROMETHAMINE 250 MCG/ML IM SOLN,,20316,LOCAL,Facility,Both,1,mL,,1539,1308.15,441.0774,1539,Humana Insurance Company,Commercial PPO,1462.05,95,,percent of total billed charges,,
CARBOPROST TROMETHAMINE 250 MCG/ML IM SOLN,,20316,LOCAL,Facility,Outpatient,1,mL,,1539,1308.15,441.0774,1539,Humana Insurance Company,Medicare PPO,754.11,49,,percent of total billed charges,,
CARBOPROST TROMETHAMINE 250 MCG/ML IM SOLN,,20316,LOCAL,Facility,Inpatient,1,mL,,1539,1308.15,441.0774,1539,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
CARBOPROST TROMETHAMINE 250 MCG/ML IM SOLN,,20316,LOCAL,Facility,Both,1,mL,,1539,1308.15,441.0774,1539,Medica,Individual & Family,1525.149,99.1,,percent of total billed charges,,
CARBOPROST TROMETHAMINE 250 MCG/ML IM SOLN,,20316,LOCAL,Facility,Outpatient,1,mL,,1539,1308.15,441.0774,1539,Medica,Medica Advantage Solution,766.422,49.8,,percent of total billed charges,,
CARBOPROST TROMETHAMINE 250 MCG/ML IM SOLN,,20316,LOCAL,Facility,Inpatient,1,mL,,1539,1308.15,441.0774,1539,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
CARBOPROST TROMETHAMINE 250 MCG/ML IM SOLN,,20316,LOCAL,Facility,Outpatient,1,mL,,1539,1308.15,441.0774,1539,Medica,Medical Assistance,686.394,44.6,,percent of total billed charges,,
CARBOPROST TROMETHAMINE 250 MCG/ML IM SOLN,,20316,LOCAL,Facility,Inpatient,1,mL,,1539,1308.15,441.0774,1539,Medica,Medical Assistance,,,,,Included in per diem rate,
CARBOPROST TROMETHAMINE 250 MCG/ML IM SOLN,,20316,LOCAL,Facility,Outpatient,1,mL,,1539,1308.15,441.0774,1539,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,766.422,49.8,,percent of total billed charges,,
CARBOPROST TROMETHAMINE 250 MCG/ML IM SOLN,,20316,LOCAL,Facility,Inpatient,1,mL,,1539,1308.15,441.0774,1539,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
CARBOPROST TROMETHAMINE 250 MCG/ML IM SOLN,,20316,LOCAL,Facility,Both,1,mL,,1539,1308.15,441.0774,1539,"Multiplan, Inc.","Multiplan, Inc.",1446.66,94,,percent of total billed charges,,
CARBOPROST TROMETHAMINE 250 MCG/ML IM SOLN,,20316,LOCAL,Facility,Outpatient,1,mL,,1539,1308.15,441.0774,1539,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1386.639,90.1,,percent of total billed charges,,
CARBOPROST TROMETHAMINE 250 MCG/ML IM SOLN,,20316,LOCAL,Facility,Inpatient,1,mL,,1539,1308.15,441.0774,1539,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
CARBOPROST TROMETHAMINE 250 MCG/ML IM SOLN,,20316,LOCAL,Facility,Both,1,mL,,1539,1308.15,441.0774,1539,"Preferred One Administrative Services, INC.",PPO,1517.454,98.6,,percent of total billed charges,,
CARBOPROST TROMETHAMINE 250 MCG/ML IM SOLN,,20316,LOCAL,Facility,Outpatient,1,mL,,1539,1308.15,441.0774,1539,PrimeWest Health,Minnesota Senior Health Options (MSHO),791.8155,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
CARBOPROST TROMETHAMINE 250 MCG/ML IM SOLN,,20316,LOCAL,Facility,Inpatient,1,mL,,1539,1308.15,441.0774,1539,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CARBOPROST TROMETHAMINE 250 MCG/ML IM SOLN,,20316,LOCAL,Facility,Outpatient,1,mL,,1539,1308.15,441.0774,1539,PrimeWest Health,MinnesotaCare,790.4304,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
CARBOPROST TROMETHAMINE 250 MCG/ML IM SOLN,,20316,LOCAL,Facility,Inpatient,1,mL,,1539,1308.15,441.0774,1539,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
CARBOPROST TROMETHAMINE 250 MCG/ML IM SOLN,,20316,LOCAL,Facility,Both,1,mL,,1539,1308.15,441.0774,1539,Sanford Health Plan,Sanford Health Plan,1415.88,92,,percent of total billed charges,,
CARBOPROST TROMETHAMINE 250 MCG/ML IM SOLN,,20316,LOCAL,Facility,Outpatient,1,mL,,1539,1308.15,441.0774,1539,"UCare Health, Inc.",Individual & Family Plan,867.2265,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
CARBOPROST TROMETHAMINE 250 MCG/ML IM SOLN,,20316,LOCAL,Facility,Inpatient,1,mL,,1539,1308.15,441.0774,1539,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
CARBOPROST TROMETHAMINE 250 MCG/ML IM SOLN,,20316,LOCAL,Facility,Outpatient,1,mL,,1539,1308.15,441.0774,1539,"UCare Health, Inc.",Medical Assistance,776.7333,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CARBOPROST TROMETHAMINE 250 MCG/ML IM SOLN,,20316,LOCAL,Facility,Inpatient,1,mL,,1539,1308.15,441.0774,1539,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
CARBOPROST TROMETHAMINE 250 MCG/ML IM SOLN,,20316,LOCAL,Facility,Outpatient,1,mL,,1539,1308.15,441.0774,1539,"UCare Health, Inc.",Medicare Advantage,776.7333,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CARBOPROST TROMETHAMINE 250 MCG/ML IM SOLN,,20316,LOCAL,Facility,Inpatient,1,mL,,1539,1308.15,441.0774,1539,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CARBOPROST TROMETHAMINE 250 MCG/ML IM SOLN,,20316,LOCAL,Facility,Outpatient,1,mL,,1539,1308.15,441.0774,1539,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),776.7333,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CARBOPROST TROMETHAMINE 250 MCG/ML IM SOLN,,20316,LOCAL,Facility,Inpatient,1,mL,,1539,1308.15,441.0774,1539,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CARBOPROST TROMETHAMINE 250 MCG/ML IM SOLN,,20316,LOCAL,Facility,Both,1,mL,,1539,1308.15,441.0774,1539,UnitedHealthcare,Individual & Family,1446.66,94,,percent of total billed charges,,
CARBOPROST TROMETHAMINE 250 MCG/ML IM SOLN,,20316,LOCAL,Facility,Outpatient,1,mL,,1539,1308.15,441.0774,1539,UnitedHealthcare,Medicare Advantage,754.11,49,,percent of total billed charges,,
CARBOPROST TROMETHAMINE 250 MCG/ML IM SOLN,,20316,LOCAL,Facility,Inpatient,1,mL,,1539,1308.15,441.0774,1539,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
CARBOPROST TROMETHAMINE 250 MCG/ML IM SOLN,,20316,LOCAL,Facility,Outpatient,1,mL,,1539,1308.15,441.0774,1539,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,738.72,48,,percent of total billed charges,,100% of DHS outpatient percentage
CARBOPROST TROMETHAMINE 250 MCG/ML IM SOLN,,20316,LOCAL,Facility,Inpatient,1,mL,,1539,1308.15,441.0774,1539,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
HEPATITIS B VIRUS VACC.REC(PF) 10 MCG/ML IM SYRG,,76602,LOCAL,Facility,Both,1,mL,,324,275.4,92.8584,324,Aetna,Commercial,298.08,92,,percent of total billed charges,,
HEPATITIS B VIRUS VACC.REC(PF) 10 MCG/ML IM SYRG,,76602,LOCAL,Facility,Outpatient,1,mL,,324,275.4,92.8584,324,Aetna,Medicare Advantage,158.76,49,,percent of total billed charges,,
HEPATITIS B VIRUS VACC.REC(PF) 10 MCG/ML IM SYRG,,76602,LOCAL,Facility,Inpatient,1,mL,,324,275.4,92.8584,324,Aetna,Medicare Advantage,,,,,Included in per diem rate,
HEPATITIS B VIRUS VACC.REC(PF) 10 MCG/ML IM SYRG,,76602,LOCAL,Facility,Both,1,mL,,324,275.4,92.8584,324,Aetna,PPO,301.32,93,,percent of total billed charges,,
HEPATITIS B VIRUS VACC.REC(PF) 10 MCG/ML IM SYRG,,76602,LOCAL,Facility,Both,1,mL,,324,275.4,92.8584,324,America's PPO,America's PPO,311.1372,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
HEPATITIS B VIRUS VACC.REC(PF) 10 MCG/ML IM SYRG,,76602,LOCAL,Facility,Both,1,mL,,324,275.4,92.8584,324,BlueCross BlueShield Minnesota, Federal Employee Program,318.816,98.4,,percent of total billed charges,,
HEPATITIS B VIRUS VACC.REC(PF) 10 MCG/ML IM SYRG,,76602,LOCAL,Facility,Both,1,mL,,324,275.4,92.8584,324,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,324,100,,percent of total billed charges,,
HEPATITIS B VIRUS VACC.REC(PF) 10 MCG/ML IM SYRG,,76602,LOCAL,Facility,Both,1,mL,,324,275.4,92.8584,324,BlueCross BlueShield Minnesota,High Value Network Plan,291.6,90,,percent of total billed charges,,
HEPATITIS B VIRUS VACC.REC(PF) 10 MCG/ML IM SYRG,,76602,LOCAL,Facility,Outpatient,1,mL,,324,275.4,92.8584,324,BlueCross BlueShield Minnesota,Medicare Advantage,158.76,49,,percent of total billed charges,,
HEPATITIS B VIRUS VACC.REC(PF) 10 MCG/ML IM SYRG,,76602,LOCAL,Facility,Inpatient,1,mL,,324,275.4,92.8584,324,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
HEPATITIS B VIRUS VACC.REC(PF) 10 MCG/ML IM SYRG,,76602,LOCAL,Facility,Both,1,mL,,324,275.4,92.8584,324,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,286.9668,88.57,,percent of total billed charges,,
HEPATITIS B VIRUS VACC.REC(PF) 10 MCG/ML IM SYRG,,76602,LOCAL,Facility,Both,1,mL,,324,275.4,92.8584,324,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,92.8584,28.66,,percent of total billed charges,,
HEPATITIS B VIRUS VACC.REC(PF) 10 MCG/ML IM SYRG,,76602,LOCAL,Facility,Outpatient,1,mL,,324,275.4,92.8584,324,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),158.76,49,,percent of total billed charges,,
HEPATITIS B VIRUS VACC.REC(PF) 10 MCG/ML IM SYRG,,76602,LOCAL,Facility,Inpatient,1,mL,,324,275.4,92.8584,324,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
HEPATITIS B VIRUS VACC.REC(PF) 10 MCG/ML IM SYRG,,76602,LOCAL,Facility,Both,1,mL,,324,275.4,92.8584,324,CorVel,Worker's Compensation,324,100,,percent of total billed charges,,
HEPATITIS B VIRUS VACC.REC(PF) 10 MCG/ML IM SYRG,,76602,LOCAL,Facility,Both,1,mL,,324,275.4,92.8584,324,First Health Group Corporation,First Health Network,314.28,97,,percent of total billed charges,,
HEPATITIS B VIRUS VACC.REC(PF) 10 MCG/ML IM SYRG,,76602,LOCAL,Facility,Both,1,mL,,324,275.4,92.8584,324,"Health Partners, Inc.",Commercial,306.504,94.6,,percent of total billed charges,,
HEPATITIS B VIRUS VACC.REC(PF) 10 MCG/ML IM SYRG,,76602,LOCAL,Facility,Outpatient,1,mL,,324,275.4,92.8584,324,"Health Partners, Inc.",Medicare Advantage,158.76,49,,percent of total billed charges,,
HEPATITIS B VIRUS VACC.REC(PF) 10 MCG/ML IM SYRG,,76602,LOCAL,Facility,Inpatient,1,mL,,324,275.4,92.8584,324,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
HEPATITIS B VIRUS VACC.REC(PF) 10 MCG/ML IM SYRG,,76602,LOCAL,Facility,Both,1,mL,,324,275.4,92.8584,324,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),194.4,60,,percent of total billed charges,,
HEPATITIS B VIRUS VACC.REC(PF) 10 MCG/ML IM SYRG,,76602,LOCAL,Facility,Both,1,mL,,324,275.4,92.8584,324,"Health Partners, Inc.",State of Minnesota Advantage Program,264.06,81.5,,percent of total billed charges,,
HEPATITIS B VIRUS VACC.REC(PF) 10 MCG/ML IM SYRG,,76602,LOCAL,Facility,Both,1,mL,,324,275.4,92.8584,324,"Health Partners, Inc.",State Public Programs,162,50,,percent of total billed charges,,
HEPATITIS B VIRUS VACC.REC(PF) 10 MCG/ML IM SYRG,,76602,LOCAL,Facility,Both,1,mL,,324,275.4,92.8584,324,Humana Insurance Company,Commercial PPO,307.8,95,,percent of total billed charges,,
HEPATITIS B VIRUS VACC.REC(PF) 10 MCG/ML IM SYRG,,76602,LOCAL,Facility,Outpatient,1,mL,,324,275.4,92.8584,324,Humana Insurance Company,Medicare PPO,158.76,49,,percent of total billed charges,,
HEPATITIS B VIRUS VACC.REC(PF) 10 MCG/ML IM SYRG,,76602,LOCAL,Facility,Inpatient,1,mL,,324,275.4,92.8584,324,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
HEPATITIS B VIRUS VACC.REC(PF) 10 MCG/ML IM SYRG,,76602,LOCAL,Facility,Both,1,mL,,324,275.4,92.8584,324,Medica,Individual & Family,321.084,99.1,,percent of total billed charges,,
HEPATITIS B VIRUS VACC.REC(PF) 10 MCG/ML IM SYRG,,76602,LOCAL,Facility,Outpatient,1,mL,,324,275.4,92.8584,324,Medica,Medica Advantage Solution,161.352,49.8,,percent of total billed charges,,
HEPATITIS B VIRUS VACC.REC(PF) 10 MCG/ML IM SYRG,,76602,LOCAL,Facility,Inpatient,1,mL,,324,275.4,92.8584,324,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
HEPATITIS B VIRUS VACC.REC(PF) 10 MCG/ML IM SYRG,,76602,LOCAL,Facility,Outpatient,1,mL,,324,275.4,92.8584,324,Medica,Medical Assistance,144.504,44.6,,percent of total billed charges,,
HEPATITIS B VIRUS VACC.REC(PF) 10 MCG/ML IM SYRG,,76602,LOCAL,Facility,Inpatient,1,mL,,324,275.4,92.8584,324,Medica,Medical Assistance,,,,,Included in per diem rate,
HEPATITIS B VIRUS VACC.REC(PF) 10 MCG/ML IM SYRG,,76602,LOCAL,Facility,Outpatient,1,mL,,324,275.4,92.8584,324,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,161.352,49.8,,percent of total billed charges,,
HEPATITIS B VIRUS VACC.REC(PF) 10 MCG/ML IM SYRG,,76602,LOCAL,Facility,Inpatient,1,mL,,324,275.4,92.8584,324,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
HEPATITIS B VIRUS VACC.REC(PF) 10 MCG/ML IM SYRG,,76602,LOCAL,Facility,Both,1,mL,,324,275.4,92.8584,324,"Multiplan, Inc.","Multiplan, Inc.",304.56,94,,percent of total billed charges,,
HEPATITIS B VIRUS VACC.REC(PF) 10 MCG/ML IM SYRG,,76602,LOCAL,Facility,Outpatient,1,mL,,324,275.4,92.8584,324,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,291.924,90.1,,percent of total billed charges,,
HEPATITIS B VIRUS VACC.REC(PF) 10 MCG/ML IM SYRG,,76602,LOCAL,Facility,Inpatient,1,mL,,324,275.4,92.8584,324,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
HEPATITIS B VIRUS VACC.REC(PF) 10 MCG/ML IM SYRG,,76602,LOCAL,Facility,Both,1,mL,,324,275.4,92.8584,324,"Preferred One Administrative Services, INC.",PPO,319.464,98.6,,percent of total billed charges,,
HEPATITIS B VIRUS VACC.REC(PF) 10 MCG/ML IM SYRG,,76602,LOCAL,Facility,Outpatient,1,mL,,324,275.4,92.8584,324,PrimeWest Health,Minnesota Senior Health Options (MSHO),166.698,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
HEPATITIS B VIRUS VACC.REC(PF) 10 MCG/ML IM SYRG,,76602,LOCAL,Facility,Inpatient,1,mL,,324,275.4,92.8584,324,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
HEPATITIS B VIRUS VACC.REC(PF) 10 MCG/ML IM SYRG,,76602,LOCAL,Facility,Outpatient,1,mL,,324,275.4,92.8584,324,PrimeWest Health,MinnesotaCare,166.4064,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
HEPATITIS B VIRUS VACC.REC(PF) 10 MCG/ML IM SYRG,,76602,LOCAL,Facility,Inpatient,1,mL,,324,275.4,92.8584,324,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
HEPATITIS B VIRUS VACC.REC(PF) 10 MCG/ML IM SYRG,,76602,LOCAL,Facility,Both,1,mL,,324,275.4,92.8584,324,Sanford Health Plan,Sanford Health Plan,298.08,92,,percent of total billed charges,,
HEPATITIS B VIRUS VACC.REC(PF) 10 MCG/ML IM SYRG,,76602,LOCAL,Facility,Outpatient,1,mL,,324,275.4,92.8584,324,"UCare Health, Inc.",Individual & Family Plan,182.574,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
HEPATITIS B VIRUS VACC.REC(PF) 10 MCG/ML IM SYRG,,76602,LOCAL,Facility,Inpatient,1,mL,,324,275.4,92.8584,324,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
HEPATITIS B VIRUS VACC.REC(PF) 10 MCG/ML IM SYRG,,76602,LOCAL,Facility,Outpatient,1,mL,,324,275.4,92.8584,324,"UCare Health, Inc.",Medical Assistance,163.5228,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
HEPATITIS B VIRUS VACC.REC(PF) 10 MCG/ML IM SYRG,,76602,LOCAL,Facility,Inpatient,1,mL,,324,275.4,92.8584,324,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
HEPATITIS B VIRUS VACC.REC(PF) 10 MCG/ML IM SYRG,,76602,LOCAL,Facility,Outpatient,1,mL,,324,275.4,92.8584,324,"UCare Health, Inc.",Medicare Advantage,163.5228,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
HEPATITIS B VIRUS VACC.REC(PF) 10 MCG/ML IM SYRG,,76602,LOCAL,Facility,Inpatient,1,mL,,324,275.4,92.8584,324,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
HEPATITIS B VIRUS VACC.REC(PF) 10 MCG/ML IM SYRG,,76602,LOCAL,Facility,Outpatient,1,mL,,324,275.4,92.8584,324,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),163.5228,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
HEPATITIS B VIRUS VACC.REC(PF) 10 MCG/ML IM SYRG,,76602,LOCAL,Facility,Inpatient,1,mL,,324,275.4,92.8584,324,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
HEPATITIS B VIRUS VACC.REC(PF) 10 MCG/ML IM SYRG,,76602,LOCAL,Facility,Both,1,mL,,324,275.4,92.8584,324,UnitedHealthcare,Individual & Family,304.56,94,,percent of total billed charges,,
HEPATITIS B VIRUS VACC.REC(PF) 10 MCG/ML IM SYRG,,76602,LOCAL,Facility,Outpatient,1,mL,,324,275.4,92.8584,324,UnitedHealthcare,Medicare Advantage,158.76,49,,percent of total billed charges,,
HEPATITIS B VIRUS VACC.REC(PF) 10 MCG/ML IM SYRG,,76602,LOCAL,Facility,Inpatient,1,mL,,324,275.4,92.8584,324,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
HEPATITIS B VIRUS VACC.REC(PF) 10 MCG/ML IM SYRG,,76602,LOCAL,Facility,Outpatient,1,mL,,324,275.4,92.8584,324,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,155.52,48,,percent of total billed charges,,100% of DHS outpatient percentage
HEPATITIS B VIRUS VACC.REC(PF) 10 MCG/ML IM SYRG,,76602,LOCAL,Facility,Inpatient,1,mL,,324,275.4,92.8584,324,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Closed Tx Distal Radial Fx/Epiphyseal Separation, Inc Closed Tx Fx Ulnar Styloid; Wo Manip (Pro Cah)",,25600,CPT,Professional,Both,,,,1122,953.7,212.7,1122,Aetna,Commercial,953.7,85,,percent of total billed charges,,
"Closed Tx Distal Radial Fx/Epiphyseal Separation, Inc Closed Tx Fx Ulnar Styloid; Wo Manip (Pro Cah)",,25600,CPT,Professional,Both,,,,1122,953.7,212.7,1122,Aetna,Medicare Advantage,323.97,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Closed Tx Distal Radial Fx/Epiphyseal Separation, Inc Closed Tx Fx Ulnar Styloid; Wo Manip (Pro Cah)",,25600,CPT,Professional,Both,,,,1122,953.7,212.7,1122,Aetna,PPO,1043.46,93,,percent of total billed charges,,
"Closed Tx Distal Radial Fx/Epiphyseal Separation, Inc Closed Tx Fx Ulnar Styloid; Wo Manip (Pro Cah)",,25600,CPT,Professional,Both,,,,1122,953.7,212.7,1122,America's PPO,America's PPO,958.6368,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Closed Tx Distal Radial Fx/Epiphyseal Separation, Inc Closed Tx Fx Ulnar Styloid; Wo Manip (Pro Cah)",,25600,CPT,Professional,Both,,,,1122,953.7,212.7,1122,BlueCross BlueShield Minnesota, Federal Employee Program,687.91,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Closed Tx Distal Radial Fx/Epiphyseal Separation, Inc Closed Tx Fx Ulnar Styloid; Wo Manip (Pro Cah)",,25600,CPT,Professional,Both,,,,1122,953.7,212.7,1122,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,698.91656,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Closed Tx Distal Radial Fx/Epiphyseal Separation, Inc Closed Tx Fx Ulnar Styloid; Wo Manip (Pro Cah)",,25600,CPT,Professional,Both,,,,1122,953.7,212.7,1122,BlueCross BlueShield Minnesota,High Value Network Plan,698.91656,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Closed Tx Distal Radial Fx/Epiphyseal Separation, Inc Closed Tx Fx Ulnar Styloid; Wo Manip (Pro Cah)",,25600,CPT,Professional,Both,,,,1122,953.7,212.7,1122,BlueCross BlueShield Minnesota,Medicare Advantage,380.0635,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Closed Tx Distal Radial Fx/Epiphyseal Separation, Inc Closed Tx Fx Ulnar Styloid; Wo Manip (Pro Cah)",,25600,CPT,Professional,Both,,,,1122,953.7,212.7,1122,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,698.91656,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Closed Tx Distal Radial Fx/Epiphyseal Separation, Inc Closed Tx Fx Ulnar Styloid; Wo Manip (Pro Cah)",,25600,CPT,Professional,Both,,,,1122,953.7,212.7,1122,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,245.5672,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Closed Tx Distal Radial Fx/Epiphyseal Separation, Inc Closed Tx Fx Ulnar Styloid; Wo Manip (Pro Cah)",,25600,CPT,Professional,Both,,,,1122,953.7,212.7,1122,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),380.0635,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Closed Tx Distal Radial Fx/Epiphyseal Separation, Inc Closed Tx Fx Ulnar Styloid; Wo Manip (Pro Cah)",,25600,CPT,Professional,Both,,,,1122,953.7,212.7,1122,CorVel,Worker's Compensation,636.6110637,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Closed Tx Distal Radial Fx/Epiphyseal Separation, Inc Closed Tx Fx Ulnar Styloid; Wo Manip (Pro Cah)",,25600,CPT,Professional,Both,,,,1122,953.7,212.7,1122,First Health Group Corporation,First Health Network,1088.34,97,,percent of total billed charges,,
"Closed Tx Distal Radial Fx/Epiphyseal Separation, Inc Closed Tx Fx Ulnar Styloid; Wo Manip (Pro Cah)",,25600,CPT,Professional,Both,,,,1122,953.7,212.7,1122,"Health Partners, Inc.",Commercial,687.07,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Closed Tx Distal Radial Fx/Epiphyseal Separation, Inc Closed Tx Fx Ulnar Styloid; Wo Manip (Pro Cah)",,25600,CPT,Professional,Both,,,,1122,953.7,212.7,1122,"Health Partners, Inc.",Medicare Advantage,380.0635,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Closed Tx Distal Radial Fx/Epiphyseal Separation, Inc Closed Tx Fx Ulnar Styloid; Wo Manip (Pro Cah)",,25600,CPT,Professional,Both,,,,1122,953.7,212.7,1122,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),330.74,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Closed Tx Distal Radial Fx/Epiphyseal Separation, Inc Closed Tx Fx Ulnar Styloid; Wo Manip (Pro Cah)",,25600,CPT,Professional,Both,,,,1122,953.7,212.7,1122,"Health Partners, Inc.",State of Minnesota Advantage Program,591.910805,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Closed Tx Distal Radial Fx/Epiphyseal Separation, Inc Closed Tx Fx Ulnar Styloid; Wo Manip (Pro Cah)",,25600,CPT,Professional,Both,,,,1122,953.7,212.7,1122,"Health Partners, Inc.",State Public Programs,212.7,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Closed Tx Distal Radial Fx/Epiphyseal Separation, Inc Closed Tx Fx Ulnar Styloid; Wo Manip (Pro Cah)",,25600,CPT,Professional,Both,,,,1122,953.7,212.7,1122,Humana Insurance Company,Commercial PPO,330.49,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Closed Tx Distal Radial Fx/Epiphyseal Separation, Inc Closed Tx Fx Ulnar Styloid; Wo Manip (Pro Cah)",,25600,CPT,Professional,Both,,,,1122,953.7,212.7,1122,Humana Insurance Company,Medicare PPO,1122,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Closed Tx Distal Radial Fx/Epiphyseal Separation, Inc Closed Tx Fx Ulnar Styloid; Wo Manip (Pro Cah)",,25600,CPT,Professional,Both,,,,1122,953.7,212.7,1122,Medica,Individual & Family,951.456,84.8,,percent of total billed charges,,
"Closed Tx Distal Radial Fx/Epiphyseal Separation, Inc Closed Tx Fx Ulnar Styloid; Wo Manip (Pro Cah)",,25600,CPT,Professional,Both,,,,1122,953.7,212.7,1122,Medica,Medica Advantage Solution,558.756,49.8,,percent of total billed charges,,
"Closed Tx Distal Radial Fx/Epiphyseal Separation, Inc Closed Tx Fx Ulnar Styloid; Wo Manip (Pro Cah)",,25600,CPT,Professional,Both,,,,1122,953.7,212.7,1122,Medica,Medical Assistance,245.57,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Closed Tx Distal Radial Fx/Epiphyseal Separation, Inc Closed Tx Fx Ulnar Styloid; Wo Manip (Pro Cah)",,25600,CPT,Professional,Both,,,,1122,953.7,212.7,1122,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,330.49,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Closed Tx Distal Radial Fx/Epiphyseal Separation, Inc Closed Tx Fx Ulnar Styloid; Wo Manip (Pro Cah)",,25600,CPT,Professional,Both,,,,1122,953.7,212.7,1122,"Multiplan, Inc.","Multiplan, Inc.",1054.68,94,,percent of total billed charges,,
"Closed Tx Distal Radial Fx/Epiphyseal Separation, Inc Closed Tx Fx Ulnar Styloid; Wo Manip (Pro Cah)",,25600,CPT,Professional,Both,,,,1122,953.7,212.7,1122,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1010.922,90.1,,percent of total billed charges,,
"Closed Tx Distal Radial Fx/Epiphyseal Separation, Inc Closed Tx Fx Ulnar Styloid; Wo Manip (Pro Cah)",,25600,CPT,Professional,Both,,,,1122,953.7,212.7,1122,"Preferred One Administrative Services, INC.",PPO,1106.292,98.6,,percent of total billed charges,,
"Closed Tx Distal Radial Fx/Epiphyseal Separation, Inc Closed Tx Fx Ulnar Styloid; Wo Manip (Pro Cah)",,25600,CPT,Professional,Both,,,,1122,953.7,212.7,1122,PrimeWest Health,Minnesota Senior Health Options (MSHO),380.0635,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Closed Tx Distal Radial Fx/Epiphyseal Separation, Inc Closed Tx Fx Ulnar Styloid; Wo Manip (Pro Cah)",,25600,CPT,Professional,Both,,,,1122,953.7,212.7,1122,PrimeWest Health,MinnesotaCare,262.756904,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Closed Tx Distal Radial Fx/Epiphyseal Separation, Inc Closed Tx Fx Ulnar Styloid; Wo Manip (Pro Cah)",,25600,CPT,Professional,Both,,,,1122,953.7,212.7,1122,Sanford Health Plan,Sanford Health Plan,987.36,88,,percent of total billed charges,,
"Closed Tx Distal Radial Fx/Epiphyseal Separation, Inc Closed Tx Fx Ulnar Styloid; Wo Manip (Pro Cah)",,25600,CPT,Professional,Both,,,,1122,953.7,212.7,1122,"UCare Health, Inc.",Individual & Family Plan,537.244544,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Closed Tx Distal Radial Fx/Epiphyseal Separation, Inc Closed Tx Fx Ulnar Styloid; Wo Manip (Pro Cah)",,25600,CPT,Professional,Both,,,,1122,953.7,212.7,1122,"UCare Health, Inc.",Medical Assistance,270.12392,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Closed Tx Distal Radial Fx/Epiphyseal Separation, Inc Closed Tx Fx Ulnar Styloid; Wo Manip (Pro Cah)",,25600,CPT,Professional,Both,,,,1122,953.7,212.7,1122,"UCare Health, Inc.",Medicare Advantage,380.0635,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Closed Tx Distal Radial Fx/Epiphyseal Separation, Inc Closed Tx Fx Ulnar Styloid; Wo Manip (Pro Cah)",,25600,CPT,Professional,Both,,,,1122,953.7,212.7,1122,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),304.0508,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Closed Tx Distal Radial Fx/Epiphyseal Separation, Inc Closed Tx Fx Ulnar Styloid; Wo Manip (Pro Cah)",,25600,CPT,Professional,Both,,,,1122,953.7,212.7,1122,UnitedHealthcare,Individual & Family,1122,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Closed Tx Distal Radial Fx/Epiphyseal Separation, Inc Closed Tx Fx Ulnar Styloid; Wo Manip (Pro Cah)",,25600,CPT,Professional,Both,,,,1122,953.7,212.7,1122,UnitedHealthcare,Medicare Advantage,380.0635,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Closed Tx Distal Radial Fx/Epiphyseal Separation, Inc Closed Tx Fx Ulnar Styloid; Wo Manip (Pro Cah)",,25600,CPT,Professional,Both,,,,1122,953.7,212.7,1122,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,245.5672,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Closed Treatment Of Distal Radial Fracture,,25605,CPT,Facility,Both,,,,1122,953.7,321.5652,1122,Aetna,Commercial,1032.24,92,,percent of total billed charges,,
Closed Treatment Of Distal Radial Fracture,,25605,CPT,Facility,Outpatient,,,,1122,953.7,321.5652,1122,Aetna,Medicare Advantage,549.78,49,,percent of total billed charges,,
Closed Treatment Of Distal Radial Fracture,,25605,CPT,Facility,Inpatient,,,,1122,953.7,321.5652,1122,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Closed Treatment Of Distal Radial Fracture,,25605,CPT,Facility,Both,,,,1122,953.7,321.5652,1122,Aetna,PPO,1043.46,93,,percent of total billed charges,,
Closed Treatment Of Distal Radial Fracture,,25605,CPT,Facility,Both,,,,1122,953.7,321.5652,1122,America's PPO,America's PPO,1077.4566,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Closed Treatment Of Distal Radial Fracture,,25605,CPT,Facility,Both,,,,1122,953.7,321.5652,1122,BlueCross BlueShield Minnesota, Federal Employee Program,1104.048,98.4,,percent of total billed charges,,
Closed Treatment Of Distal Radial Fracture,,25605,CPT,Facility,Both,,,,1122,953.7,321.5652,1122,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1122,100,,percent of total billed charges,,
Closed Treatment Of Distal Radial Fracture,,25605,CPT,Facility,Both,,,,1122,953.7,321.5652,1122,BlueCross BlueShield Minnesota,High Value Network Plan,1009.8,90,,percent of total billed charges,,
Closed Treatment Of Distal Radial Fracture,,25605,CPT,Facility,Outpatient,,,,1122,953.7,321.5652,1122,BlueCross BlueShield Minnesota,Medicare Advantage,549.78,49,,percent of total billed charges,,
Closed Treatment Of Distal Radial Fracture,,25605,CPT,Facility,Inpatient,,,,1122,953.7,321.5652,1122,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Closed Treatment Of Distal Radial Fracture,,25605,CPT,Facility,Both,,,,1122,953.7,321.5652,1122,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,993.7554,88.57,,percent of total billed charges,,
Closed Treatment Of Distal Radial Fracture,,25605,CPT,Facility,Both,,,,1122,953.7,321.5652,1122,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,321.5652,28.66,,percent of total billed charges,,
Closed Treatment Of Distal Radial Fracture,,25605,CPT,Facility,Outpatient,,,,1122,953.7,321.5652,1122,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),549.78,49,,percent of total billed charges,,
Closed Treatment Of Distal Radial Fracture,,25605,CPT,Facility,Inpatient,,,,1122,953.7,321.5652,1122,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Closed Treatment Of Distal Radial Fracture,,25605,CPT,Facility,Both,,,,1122,953.7,321.5652,1122,CorVel,Worker's Compensation,1122,100,,percent of total billed charges,,
Closed Treatment Of Distal Radial Fracture,,25605,CPT,Facility,Both,,,,1122,953.7,321.5652,1122,First Health Group Corporation,First Health Network,1088.34,97,,percent of total billed charges,,
Closed Treatment Of Distal Radial Fracture,,25605,CPT,Facility,Both,,,,1122,953.7,321.5652,1122,"Health Partners, Inc.",Commercial,1061.412,94.6,,percent of total billed charges,,
Closed Treatment Of Distal Radial Fracture,,25605,CPT,Facility,Outpatient,,,,1122,953.7,321.5652,1122,"Health Partners, Inc.",Medicare Advantage,549.78,49,,percent of total billed charges,,
Closed Treatment Of Distal Radial Fracture,,25605,CPT,Facility,Inpatient,,,,1122,953.7,321.5652,1122,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Closed Treatment Of Distal Radial Fracture,,25605,CPT,Facility,Both,,,,1122,953.7,321.5652,1122,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),673.2,60,,percent of total billed charges,,
Closed Treatment Of Distal Radial Fracture,,25605,CPT,Facility,Both,,,,1122,953.7,321.5652,1122,"Health Partners, Inc.",State of Minnesota Advantage Program,914.43,81.5,,percent of total billed charges,,
Closed Treatment Of Distal Radial Fracture,,25605,CPT,Facility,Both,,,,1122,953.7,321.5652,1122,"Health Partners, Inc.",State Public Programs,561,50,,percent of total billed charges,,
Closed Treatment Of Distal Radial Fracture,,25605,CPT,Facility,Both,,,,1122,953.7,321.5652,1122,Humana Insurance Company,Commercial PPO,1065.9,95,,percent of total billed charges,,
Closed Treatment Of Distal Radial Fracture,,25605,CPT,Facility,Outpatient,,,,1122,953.7,321.5652,1122,Humana Insurance Company,Medicare PPO,549.78,49,,percent of total billed charges,,
Closed Treatment Of Distal Radial Fracture,,25605,CPT,Facility,Inpatient,,,,1122,953.7,321.5652,1122,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Closed Treatment Of Distal Radial Fracture,,25605,CPT,Facility,Both,,,,1122,953.7,321.5652,1122,Medica,Individual & Family,1111.902,99.1,,percent of total billed charges,,
Closed Treatment Of Distal Radial Fracture,,25605,CPT,Facility,Outpatient,,,,1122,953.7,321.5652,1122,Medica,Medica Advantage Solution,558.756,49.8,,percent of total billed charges,,
Closed Treatment Of Distal Radial Fracture,,25605,CPT,Facility,Inpatient,,,,1122,953.7,321.5652,1122,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Closed Treatment Of Distal Radial Fracture,,25605,CPT,Facility,Outpatient,,,,1122,953.7,321.5652,1122,Medica,Medical Assistance,500.412,44.6,,percent of total billed charges,,
Closed Treatment Of Distal Radial Fracture,,25605,CPT,Facility,Inpatient,,,,1122,953.7,321.5652,1122,Medica,Medical Assistance,,,,,Included in per diem rate,
Closed Treatment Of Distal Radial Fracture,,25605,CPT,Facility,Outpatient,,,,1122,953.7,321.5652,1122,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,558.756,49.8,,percent of total billed charges,,
Closed Treatment Of Distal Radial Fracture,,25605,CPT,Facility,Inpatient,,,,1122,953.7,321.5652,1122,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Closed Treatment Of Distal Radial Fracture,,25605,CPT,Facility,Both,,,,1122,953.7,321.5652,1122,"Multiplan, Inc.","Multiplan, Inc.",1054.68,94,,percent of total billed charges,,
Closed Treatment Of Distal Radial Fracture,,25605,CPT,Facility,Outpatient,,,,1122,953.7,321.5652,1122,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1010.922,90.1,,percent of total billed charges,,
Closed Treatment Of Distal Radial Fracture,,25605,CPT,Facility,Inpatient,,,,1122,953.7,321.5652,1122,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Closed Treatment Of Distal Radial Fracture,,25605,CPT,Facility,Both,,,,1122,953.7,321.5652,1122,"Preferred One Administrative Services, INC.",PPO,1106.292,98.6,,percent of total billed charges,,
Closed Treatment Of Distal Radial Fracture,,25605,CPT,Facility,Outpatient,,,,1122,953.7,321.5652,1122,PrimeWest Health,Minnesota Senior Health Options (MSHO),577.269,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Closed Treatment Of Distal Radial Fracture,,25605,CPT,Facility,Inpatient,,,,1122,953.7,321.5652,1122,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Closed Treatment Of Distal Radial Fracture,,25605,CPT,Facility,Outpatient,,,,1122,953.7,321.5652,1122,PrimeWest Health,MinnesotaCare,576.2592,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Closed Treatment Of Distal Radial Fracture,,25605,CPT,Facility,Inpatient,,,,1122,953.7,321.5652,1122,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Closed Treatment Of Distal Radial Fracture,,25605,CPT,Facility,Both,,,,1122,953.7,321.5652,1122,Sanford Health Plan,Sanford Health Plan,1032.24,92,,percent of total billed charges,,
Closed Treatment Of Distal Radial Fracture,,25605,CPT,Facility,Outpatient,,,,1122,953.7,321.5652,1122,"UCare Health, Inc.",Individual & Family Plan,632.247,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Closed Treatment Of Distal Radial Fracture,,25605,CPT,Facility,Inpatient,,,,1122,953.7,321.5652,1122,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Closed Treatment Of Distal Radial Fracture,,25605,CPT,Facility,Outpatient,,,,1122,953.7,321.5652,1122,"UCare Health, Inc.",Medical Assistance,566.2734,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Closed Treatment Of Distal Radial Fracture,,25605,CPT,Facility,Inpatient,,,,1122,953.7,321.5652,1122,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Closed Treatment Of Distal Radial Fracture,,25605,CPT,Facility,Outpatient,,,,1122,953.7,321.5652,1122,"UCare Health, Inc.",Medicare Advantage,566.2734,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Closed Treatment Of Distal Radial Fracture,,25605,CPT,Facility,Inpatient,,,,1122,953.7,321.5652,1122,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Closed Treatment Of Distal Radial Fracture,,25605,CPT,Facility,Outpatient,,,,1122,953.7,321.5652,1122,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),566.2734,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Closed Treatment Of Distal Radial Fracture,,25605,CPT,Facility,Inpatient,,,,1122,953.7,321.5652,1122,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Closed Treatment Of Distal Radial Fracture,,25605,CPT,Facility,Both,,,,1122,953.7,321.5652,1122,UnitedHealthcare,Individual & Family,1054.68,94,,percent of total billed charges,,
Closed Treatment Of Distal Radial Fracture,,25605,CPT,Facility,Outpatient,,,,1122,953.7,321.5652,1122,UnitedHealthcare,Medicare Advantage,549.78,49,,percent of total billed charges,,
Closed Treatment Of Distal Radial Fracture,,25605,CPT,Facility,Inpatient,,,,1122,953.7,321.5652,1122,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Closed Treatment Of Distal Radial Fracture,,25605,CPT,Facility,Outpatient,,,,1122,953.7,321.5652,1122,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,538.56,48,,percent of total billed charges,,100% of DHS outpatient percentage
Closed Treatment Of Distal Radial Fracture,,25605,CPT,Facility,Inpatient,,,,1122,953.7,321.5652,1122,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Closed Tx Distal Radial Fx/Epiphyseal Separation, Inc Closed Tx Fx Ulnar Styloid; W Manip (Pro Cah)",,25605,CPT,Professional,Both,,,,1683,1430.55,325.92,1683,Aetna,Commercial,1430.55,85,,percent of total billed charges,,
"Closed Tx Distal Radial Fx/Epiphyseal Separation, Inc Closed Tx Fx Ulnar Styloid; W Manip (Pro Cah)",,25605,CPT,Professional,Both,,,,1683,1430.55,325.92,1683,Aetna,Medicare Advantage,504.82,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Closed Tx Distal Radial Fx/Epiphyseal Separation, Inc Closed Tx Fx Ulnar Styloid; W Manip (Pro Cah)",,25605,CPT,Professional,Both,,,,1683,1430.55,325.92,1683,Aetna,PPO,1565.19,93,,percent of total billed charges,,
"Closed Tx Distal Radial Fx/Epiphyseal Separation, Inc Closed Tx Fx Ulnar Styloid; W Manip (Pro Cah)",,25605,CPT,Professional,Both,,,,1683,1430.55,325.92,1683,America's PPO,America's PPO,1437.9552,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Closed Tx Distal Radial Fx/Epiphyseal Separation, Inc Closed Tx Fx Ulnar Styloid; W Manip (Pro Cah)",,25605,CPT,Professional,Both,,,,1683,1430.55,325.92,1683,BlueCross BlueShield Minnesota, Federal Employee Program,1076.28,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Closed Tx Distal Radial Fx/Epiphyseal Separation, Inc Closed Tx Fx Ulnar Styloid; W Manip (Pro Cah)",,25605,CPT,Professional,Both,,,,1683,1430.55,325.92,1683,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1093.50048,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Closed Tx Distal Radial Fx/Epiphyseal Separation, Inc Closed Tx Fx Ulnar Styloid; W Manip (Pro Cah)",,25605,CPT,Professional,Both,,,,1683,1430.55,325.92,1683,BlueCross BlueShield Minnesota,High Value Network Plan,1093.50048,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Closed Tx Distal Radial Fx/Epiphyseal Separation, Inc Closed Tx Fx Ulnar Styloid; W Manip (Pro Cah)",,25605,CPT,Professional,Both,,,,1683,1430.55,325.92,1683,BlueCross BlueShield Minnesota,Medicare Advantage,582.291,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Closed Tx Distal Radial Fx/Epiphyseal Separation, Inc Closed Tx Fx Ulnar Styloid; W Manip (Pro Cah)",,25605,CPT,Professional,Both,,,,1683,1430.55,325.92,1683,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1093.50048,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Closed Tx Distal Radial Fx/Epiphyseal Separation, Inc Closed Tx Fx Ulnar Styloid; W Manip (Pro Cah)",,25605,CPT,Professional,Both,,,,1683,1430.55,325.92,1683,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,376.28576,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Closed Tx Distal Radial Fx/Epiphyseal Separation, Inc Closed Tx Fx Ulnar Styloid; W Manip (Pro Cah)",,25605,CPT,Professional,Both,,,,1683,1430.55,325.92,1683,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),582.291,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Closed Tx Distal Radial Fx/Epiphyseal Separation, Inc Closed Tx Fx Ulnar Styloid; W Manip (Pro Cah)",,25605,CPT,Professional,Both,,,,1683,1430.55,325.92,1683,CorVel,Worker's Compensation,982.0233849,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Closed Tx Distal Radial Fx/Epiphyseal Separation, Inc Closed Tx Fx Ulnar Styloid; W Manip (Pro Cah)",,25605,CPT,Professional,Both,,,,1683,1430.55,325.92,1683,First Health Group Corporation,First Health Network,1632.51,97,,percent of total billed charges,,
"Closed Tx Distal Radial Fx/Epiphyseal Separation, Inc Closed Tx Fx Ulnar Styloid; W Manip (Pro Cah)",,25605,CPT,Professional,Both,,,,1683,1430.55,325.92,1683,"Health Partners, Inc.",Commercial,1060.71,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Closed Tx Distal Radial Fx/Epiphyseal Separation, Inc Closed Tx Fx Ulnar Styloid; W Manip (Pro Cah)",,25605,CPT,Professional,Both,,,,1683,1430.55,325.92,1683,"Health Partners, Inc.",Medicare Advantage,582.291,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Closed Tx Distal Radial Fx/Epiphyseal Separation, Inc Closed Tx Fx Ulnar Styloid; W Manip (Pro Cah)",,25605,CPT,Professional,Both,,,,1683,1430.55,325.92,1683,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),506.27,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Closed Tx Distal Radial Fx/Epiphyseal Separation, Inc Closed Tx Fx Ulnar Styloid; W Manip (Pro Cah)",,25605,CPT,Professional,Both,,,,1683,1430.55,325.92,1683,"Health Partners, Inc.",State of Minnesota Advantage Program,913.801665,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Closed Tx Distal Radial Fx/Epiphyseal Separation, Inc Closed Tx Fx Ulnar Styloid; W Manip (Pro Cah)",,25605,CPT,Professional,Both,,,,1683,1430.55,325.92,1683,"Health Partners, Inc.",State Public Programs,325.92,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Closed Tx Distal Radial Fx/Epiphyseal Separation, Inc Closed Tx Fx Ulnar Styloid; W Manip (Pro Cah)",,25605,CPT,Professional,Both,,,,1683,1430.55,325.92,1683,Humana Insurance Company,Commercial PPO,506.34,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Closed Tx Distal Radial Fx/Epiphyseal Separation, Inc Closed Tx Fx Ulnar Styloid; W Manip (Pro Cah)",,25605,CPT,Professional,Both,,,,1683,1430.55,325.92,1683,Humana Insurance Company,Medicare PPO,1683,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Closed Tx Distal Radial Fx/Epiphyseal Separation, Inc Closed Tx Fx Ulnar Styloid; W Manip (Pro Cah)",,25605,CPT,Professional,Both,,,,1683,1430.55,325.92,1683,Medica,Individual & Family,1427.184,84.8,,percent of total billed charges,,
"Closed Tx Distal Radial Fx/Epiphyseal Separation, Inc Closed Tx Fx Ulnar Styloid; W Manip (Pro Cah)",,25605,CPT,Professional,Both,,,,1683,1430.55,325.92,1683,Medica,Medica Advantage Solution,838.134,49.8,,percent of total billed charges,,
"Closed Tx Distal Radial Fx/Epiphyseal Separation, Inc Closed Tx Fx Ulnar Styloid; W Manip (Pro Cah)",,25605,CPT,Professional,Both,,,,1683,1430.55,325.92,1683,Medica,Medical Assistance,376.29,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Closed Tx Distal Radial Fx/Epiphyseal Separation, Inc Closed Tx Fx Ulnar Styloid; W Manip (Pro Cah)",,25605,CPT,Professional,Both,,,,1683,1430.55,325.92,1683,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,506.34,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Closed Tx Distal Radial Fx/Epiphyseal Separation, Inc Closed Tx Fx Ulnar Styloid; W Manip (Pro Cah)",,25605,CPT,Professional,Both,,,,1683,1430.55,325.92,1683,"Multiplan, Inc.","Multiplan, Inc.",1582.02,94,,percent of total billed charges,,
"Closed Tx Distal Radial Fx/Epiphyseal Separation, Inc Closed Tx Fx Ulnar Styloid; W Manip (Pro Cah)",,25605,CPT,Professional,Both,,,,1683,1430.55,325.92,1683,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1516.383,90.1,,percent of total billed charges,,
"Closed Tx Distal Radial Fx/Epiphyseal Separation, Inc Closed Tx Fx Ulnar Styloid; W Manip (Pro Cah)",,25605,CPT,Professional,Both,,,,1683,1430.55,325.92,1683,"Preferred One Administrative Services, INC.",PPO,1659.438,98.6,,percent of total billed charges,,
"Closed Tx Distal Radial Fx/Epiphyseal Separation, Inc Closed Tx Fx Ulnar Styloid; W Manip (Pro Cah)",,25605,CPT,Professional,Both,,,,1683,1430.55,325.92,1683,PrimeWest Health,Minnesota Senior Health Options (MSHO),582.291,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Closed Tx Distal Radial Fx/Epiphyseal Separation, Inc Closed Tx Fx Ulnar Styloid; W Manip (Pro Cah)",,25605,CPT,Professional,Both,,,,1683,1430.55,325.92,1683,PrimeWest Health,MinnesotaCare,402.6257632,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Closed Tx Distal Radial Fx/Epiphyseal Separation, Inc Closed Tx Fx Ulnar Styloid; W Manip (Pro Cah)",,25605,CPT,Professional,Both,,,,1683,1430.55,325.92,1683,Sanford Health Plan,Sanford Health Plan,1481.04,88,,percent of total billed charges,,
"Closed Tx Distal Radial Fx/Epiphyseal Separation, Inc Closed Tx Fx Ulnar Styloid; W Manip (Pro Cah)",,25605,CPT,Professional,Both,,,,1683,1430.55,325.92,1683,"UCare Health, Inc.",Individual & Family Plan,823.106304,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Closed Tx Distal Radial Fx/Epiphyseal Separation, Inc Closed Tx Fx Ulnar Styloid; W Manip (Pro Cah)",,25605,CPT,Professional,Both,,,,1683,1430.55,325.92,1683,"UCare Health, Inc.",Medical Assistance,413.914336,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Closed Tx Distal Radial Fx/Epiphyseal Separation, Inc Closed Tx Fx Ulnar Styloid; W Manip (Pro Cah)",,25605,CPT,Professional,Both,,,,1683,1430.55,325.92,1683,"UCare Health, Inc.",Medicare Advantage,582.291,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Closed Tx Distal Radial Fx/Epiphyseal Separation, Inc Closed Tx Fx Ulnar Styloid; W Manip (Pro Cah)",,25605,CPT,Professional,Both,,,,1683,1430.55,325.92,1683,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),465.8328,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Closed Tx Distal Radial Fx/Epiphyseal Separation, Inc Closed Tx Fx Ulnar Styloid; W Manip (Pro Cah)",,25605,CPT,Professional,Both,,,,1683,1430.55,325.92,1683,UnitedHealthcare,Individual & Family,1683,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Closed Tx Distal Radial Fx/Epiphyseal Separation, Inc Closed Tx Fx Ulnar Styloid; W Manip (Pro Cah)",,25605,CPT,Professional,Both,,,,1683,1430.55,325.92,1683,UnitedHealthcare,Medicare Advantage,582.291,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Closed Tx Distal Radial Fx/Epiphyseal Separation, Inc Closed Tx Fx Ulnar Styloid; W Manip (Pro Cah)",,25605,CPT,Professional,Both,,,,1683,1430.55,325.92,1683,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,376.28576,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
LIDOCAINE (PF) 3.5 % OPHT GEL,,84483,LOCAL,Facility,Both,1,mL,,132,112.2,37.8312,132,Aetna,Commercial,121.44,92,,percent of total billed charges,,
LIDOCAINE (PF) 3.5 % OPHT GEL,,84483,LOCAL,Facility,Outpatient,1,mL,,132,112.2,37.8312,132,Aetna,Medicare Advantage,64.68,49,,percent of total billed charges,,
LIDOCAINE (PF) 3.5 % OPHT GEL,,84483,LOCAL,Facility,Inpatient,1,mL,,132,112.2,37.8312,132,Aetna,Medicare Advantage,,,,,Included in per diem rate,
LIDOCAINE (PF) 3.5 % OPHT GEL,,84483,LOCAL,Facility,Both,1,mL,,132,112.2,37.8312,132,Aetna,PPO,122.76,93,,percent of total billed charges,,
LIDOCAINE (PF) 3.5 % OPHT GEL,,84483,LOCAL,Facility,Both,1,mL,,132,112.2,37.8312,132,America's PPO,America's PPO,126.7596,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
LIDOCAINE (PF) 3.5 % OPHT GEL,,84483,LOCAL,Facility,Both,1,mL,,132,112.2,37.8312,132,BlueCross BlueShield Minnesota, Federal Employee Program,129.888,98.4,,percent of total billed charges,,
LIDOCAINE (PF) 3.5 % OPHT GEL,,84483,LOCAL,Facility,Both,1,mL,,132,112.2,37.8312,132,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,132,100,,percent of total billed charges,,
LIDOCAINE (PF) 3.5 % OPHT GEL,,84483,LOCAL,Facility,Both,1,mL,,132,112.2,37.8312,132,BlueCross BlueShield Minnesota,High Value Network Plan,118.8,90,,percent of total billed charges,,
LIDOCAINE (PF) 3.5 % OPHT GEL,,84483,LOCAL,Facility,Outpatient,1,mL,,132,112.2,37.8312,132,BlueCross BlueShield Minnesota,Medicare Advantage,64.68,49,,percent of total billed charges,,
LIDOCAINE (PF) 3.5 % OPHT GEL,,84483,LOCAL,Facility,Inpatient,1,mL,,132,112.2,37.8312,132,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
LIDOCAINE (PF) 3.5 % OPHT GEL,,84483,LOCAL,Facility,Both,1,mL,,132,112.2,37.8312,132,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,116.9124,88.57,,percent of total billed charges,,
LIDOCAINE (PF) 3.5 % OPHT GEL,,84483,LOCAL,Facility,Both,1,mL,,132,112.2,37.8312,132,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,37.8312,28.66,,percent of total billed charges,,
LIDOCAINE (PF) 3.5 % OPHT GEL,,84483,LOCAL,Facility,Outpatient,1,mL,,132,112.2,37.8312,132,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),64.68,49,,percent of total billed charges,,
LIDOCAINE (PF) 3.5 % OPHT GEL,,84483,LOCAL,Facility,Inpatient,1,mL,,132,112.2,37.8312,132,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
LIDOCAINE (PF) 3.5 % OPHT GEL,,84483,LOCAL,Facility,Both,1,mL,,132,112.2,37.8312,132,CorVel,Worker's Compensation,132,100,,percent of total billed charges,,
LIDOCAINE (PF) 3.5 % OPHT GEL,,84483,LOCAL,Facility,Both,1,mL,,132,112.2,37.8312,132,First Health Group Corporation,First Health Network,128.04,97,,percent of total billed charges,,
LIDOCAINE (PF) 3.5 % OPHT GEL,,84483,LOCAL,Facility,Both,1,mL,,132,112.2,37.8312,132,"Health Partners, Inc.",Commercial,124.872,94.6,,percent of total billed charges,,
LIDOCAINE (PF) 3.5 % OPHT GEL,,84483,LOCAL,Facility,Outpatient,1,mL,,132,112.2,37.8312,132,"Health Partners, Inc.",Medicare Advantage,64.68,49,,percent of total billed charges,,
LIDOCAINE (PF) 3.5 % OPHT GEL,,84483,LOCAL,Facility,Inpatient,1,mL,,132,112.2,37.8312,132,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LIDOCAINE (PF) 3.5 % OPHT GEL,,84483,LOCAL,Facility,Both,1,mL,,132,112.2,37.8312,132,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),79.2,60,,percent of total billed charges,,
LIDOCAINE (PF) 3.5 % OPHT GEL,,84483,LOCAL,Facility,Both,1,mL,,132,112.2,37.8312,132,"Health Partners, Inc.",State of Minnesota Advantage Program,107.58,81.5,,percent of total billed charges,,
LIDOCAINE (PF) 3.5 % OPHT GEL,,84483,LOCAL,Facility,Both,1,mL,,132,112.2,37.8312,132,"Health Partners, Inc.",State Public Programs,66,50,,percent of total billed charges,,
LIDOCAINE (PF) 3.5 % OPHT GEL,,84483,LOCAL,Facility,Both,1,mL,,132,112.2,37.8312,132,Humana Insurance Company,Commercial PPO,125.4,95,,percent of total billed charges,,
LIDOCAINE (PF) 3.5 % OPHT GEL,,84483,LOCAL,Facility,Outpatient,1,mL,,132,112.2,37.8312,132,Humana Insurance Company,Medicare PPO,64.68,49,,percent of total billed charges,,
LIDOCAINE (PF) 3.5 % OPHT GEL,,84483,LOCAL,Facility,Inpatient,1,mL,,132,112.2,37.8312,132,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
LIDOCAINE (PF) 3.5 % OPHT GEL,,84483,LOCAL,Facility,Both,1,mL,,132,112.2,37.8312,132,Medica,Individual & Family,130.812,99.1,,percent of total billed charges,,
LIDOCAINE (PF) 3.5 % OPHT GEL,,84483,LOCAL,Facility,Outpatient,1,mL,,132,112.2,37.8312,132,Medica,Medica Advantage Solution,65.736,49.8,,percent of total billed charges,,
LIDOCAINE (PF) 3.5 % OPHT GEL,,84483,LOCAL,Facility,Inpatient,1,mL,,132,112.2,37.8312,132,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
LIDOCAINE (PF) 3.5 % OPHT GEL,,84483,LOCAL,Facility,Outpatient,1,mL,,132,112.2,37.8312,132,Medica,Medical Assistance,58.872,44.6,,percent of total billed charges,,
LIDOCAINE (PF) 3.5 % OPHT GEL,,84483,LOCAL,Facility,Inpatient,1,mL,,132,112.2,37.8312,132,Medica,Medical Assistance,,,,,Included in per diem rate,
LIDOCAINE (PF) 3.5 % OPHT GEL,,84483,LOCAL,Facility,Outpatient,1,mL,,132,112.2,37.8312,132,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,65.736,49.8,,percent of total billed charges,,
LIDOCAINE (PF) 3.5 % OPHT GEL,,84483,LOCAL,Facility,Inpatient,1,mL,,132,112.2,37.8312,132,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
LIDOCAINE (PF) 3.5 % OPHT GEL,,84483,LOCAL,Facility,Both,1,mL,,132,112.2,37.8312,132,"Multiplan, Inc.","Multiplan, Inc.",124.08,94,,percent of total billed charges,,
LIDOCAINE (PF) 3.5 % OPHT GEL,,84483,LOCAL,Facility,Outpatient,1,mL,,132,112.2,37.8312,132,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,118.932,90.1,,percent of total billed charges,,
LIDOCAINE (PF) 3.5 % OPHT GEL,,84483,LOCAL,Facility,Inpatient,1,mL,,132,112.2,37.8312,132,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
LIDOCAINE (PF) 3.5 % OPHT GEL,,84483,LOCAL,Facility,Both,1,mL,,132,112.2,37.8312,132,"Preferred One Administrative Services, INC.",PPO,130.152,98.6,,percent of total billed charges,,
LIDOCAINE (PF) 3.5 % OPHT GEL,,84483,LOCAL,Facility,Outpatient,1,mL,,132,112.2,37.8312,132,PrimeWest Health,Minnesota Senior Health Options (MSHO),67.914,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
LIDOCAINE (PF) 3.5 % OPHT GEL,,84483,LOCAL,Facility,Inpatient,1,mL,,132,112.2,37.8312,132,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LIDOCAINE (PF) 3.5 % OPHT GEL,,84483,LOCAL,Facility,Outpatient,1,mL,,132,112.2,37.8312,132,PrimeWest Health,MinnesotaCare,67.7952,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
LIDOCAINE (PF) 3.5 % OPHT GEL,,84483,LOCAL,Facility,Inpatient,1,mL,,132,112.2,37.8312,132,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
LIDOCAINE (PF) 3.5 % OPHT GEL,,84483,LOCAL,Facility,Both,1,mL,,132,112.2,37.8312,132,Sanford Health Plan,Sanford Health Plan,121.44,92,,percent of total billed charges,,
LIDOCAINE (PF) 3.5 % OPHT GEL,,84483,LOCAL,Facility,Outpatient,1,mL,,132,112.2,37.8312,132,"UCare Health, Inc.",Individual & Family Plan,74.382,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
LIDOCAINE (PF) 3.5 % OPHT GEL,,84483,LOCAL,Facility,Inpatient,1,mL,,132,112.2,37.8312,132,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
LIDOCAINE (PF) 3.5 % OPHT GEL,,84483,LOCAL,Facility,Outpatient,1,mL,,132,112.2,37.8312,132,"UCare Health, Inc.",Medical Assistance,66.6204,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LIDOCAINE (PF) 3.5 % OPHT GEL,,84483,LOCAL,Facility,Inpatient,1,mL,,132,112.2,37.8312,132,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
LIDOCAINE (PF) 3.5 % OPHT GEL,,84483,LOCAL,Facility,Outpatient,1,mL,,132,112.2,37.8312,132,"UCare Health, Inc.",Medicare Advantage,66.6204,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LIDOCAINE (PF) 3.5 % OPHT GEL,,84483,LOCAL,Facility,Inpatient,1,mL,,132,112.2,37.8312,132,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LIDOCAINE (PF) 3.5 % OPHT GEL,,84483,LOCAL,Facility,Outpatient,1,mL,,132,112.2,37.8312,132,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),66.6204,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LIDOCAINE (PF) 3.5 % OPHT GEL,,84483,LOCAL,Facility,Inpatient,1,mL,,132,112.2,37.8312,132,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LIDOCAINE (PF) 3.5 % OPHT GEL,,84483,LOCAL,Facility,Both,1,mL,,132,112.2,37.8312,132,UnitedHealthcare,Individual & Family,124.08,94,,percent of total billed charges,,
LIDOCAINE (PF) 3.5 % OPHT GEL,,84483,LOCAL,Facility,Outpatient,1,mL,,132,112.2,37.8312,132,UnitedHealthcare,Medicare Advantage,64.68,49,,percent of total billed charges,,
LIDOCAINE (PF) 3.5 % OPHT GEL,,84483,LOCAL,Facility,Inpatient,1,mL,,132,112.2,37.8312,132,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
LIDOCAINE (PF) 3.5 % OPHT GEL,,84483,LOCAL,Facility,Outpatient,1,mL,,132,112.2,37.8312,132,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,63.36,48,,percent of total billed charges,,100% of DHS outpatient percentage
LIDOCAINE (PF) 3.5 % OPHT GEL,,84483,LOCAL,Facility,Inpatient,1,mL,,132,112.2,37.8312,132,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Tendon Sheath Incision (Eg, For Trigger Finger) (Pro Cah)",,26055,CPT,Professional,Both,,,,1840,1564,186.74,1840,Aetna,Commercial,1564,85,,percent of total billed charges,,
"Tendon Sheath Incision (Eg, For Trigger Finger) (Pro Cah)",,26055,CPT,Professional,Both,,,,1840,1564,186.74,1840,Aetna,Medicare Advantage,289.92,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Tendon Sheath Incision (Eg, For Trigger Finger) (Pro Cah)",,26055,CPT,Professional,Both,,,,1840,1564,186.74,1840,Aetna,PPO,1711.2,93,,percent of total billed charges,,
"Tendon Sheath Incision (Eg, For Trigger Finger) (Pro Cah)",,26055,CPT,Professional,Both,,,,1840,1564,186.74,1840,America's PPO,America's PPO,1572.096,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Tendon Sheath Incision (Eg, For Trigger Finger) (Pro Cah)",,26055,CPT,Professional,Both,,,,1840,1564,186.74,1840,BlueCross BlueShield Minnesota, Federal Employee Program,610.1,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Tendon Sheath Incision (Eg, For Trigger Finger) (Pro Cah)",,26055,CPT,Professional,Both,,,,1840,1564,186.74,1840,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,619.8616,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Tendon Sheath Incision (Eg, For Trigger Finger) (Pro Cah)",,26055,CPT,Professional,Both,,,,1840,1564,186.74,1840,BlueCross BlueShield Minnesota,High Value Network Plan,619.8616,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Tendon Sheath Incision (Eg, For Trigger Finger) (Pro Cah)",,26055,CPT,Professional,Both,,,,1840,1564,186.74,1840,BlueCross BlueShield Minnesota,Medicare Advantage,333.868,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Tendon Sheath Incision (Eg, For Trigger Finger) (Pro Cah)",,26055,CPT,Professional,Both,,,,1840,1564,186.74,1840,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,619.8616,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Tendon Sheath Incision (Eg, For Trigger Finger) (Pro Cah)",,26055,CPT,Professional,Both,,,,1840,1564,186.74,1840,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,215.5952,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Tendon Sheath Incision (Eg, For Trigger Finger) (Pro Cah)",,26055,CPT,Professional,Both,,,,1840,1564,186.74,1840,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),333.868,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Tendon Sheath Incision (Eg, For Trigger Finger) (Pro Cah)",,26055,CPT,Professional,Both,,,,1840,1564,186.74,1840,CorVel,Worker's Compensation,561.9804918,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Tendon Sheath Incision (Eg, For Trigger Finger) (Pro Cah)",,26055,CPT,Professional,Both,,,,1840,1564,186.74,1840,First Health Group Corporation,First Health Network,1784.8,97,,percent of total billed charges,,
"Tendon Sheath Incision (Eg, For Trigger Finger) (Pro Cah)",,26055,CPT,Professional,Both,,,,1840,1564,186.74,1840,"Health Partners, Inc.",Commercial,606.54,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Tendon Sheath Incision (Eg, For Trigger Finger) (Pro Cah)",,26055,CPT,Professional,Both,,,,1840,1564,186.74,1840,"Health Partners, Inc.",Medicare Advantage,333.868,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Tendon Sheath Incision (Eg, For Trigger Finger) (Pro Cah)",,26055,CPT,Professional,Both,,,,1840,1564,186.74,1840,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),290.41,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Tendon Sheath Incision (Eg, For Trigger Finger) (Pro Cah)",,26055,CPT,Professional,Both,,,,1840,1564,186.74,1840,"Health Partners, Inc.",State of Minnesota Advantage Program,522.53421,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Tendon Sheath Incision (Eg, For Trigger Finger) (Pro Cah)",,26055,CPT,Professional,Both,,,,1840,1564,186.74,1840,"Health Partners, Inc.",State Public Programs,186.74,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Tendon Sheath Incision (Eg, For Trigger Finger) (Pro Cah)",,26055,CPT,Professional,Both,,,,1840,1564,186.74,1840,Humana Insurance Company,Commercial PPO,290.32,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Tendon Sheath Incision (Eg, For Trigger Finger) (Pro Cah)",,26055,CPT,Professional,Both,,,,1840,1564,186.74,1840,Humana Insurance Company,Medicare PPO,1840,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Tendon Sheath Incision (Eg, For Trigger Finger) (Pro Cah)",,26055,CPT,Professional,Both,,,,1840,1564,186.74,1840,Medica,Individual & Family,1560.32,84.8,,percent of total billed charges,,
"Tendon Sheath Incision (Eg, For Trigger Finger) (Pro Cah)",,26055,CPT,Professional,Both,,,,1840,1564,186.74,1840,Medica,Medica Advantage Solution,916.32,49.8,,percent of total billed charges,,
"Tendon Sheath Incision (Eg, For Trigger Finger) (Pro Cah)",,26055,CPT,Professional,Both,,,,1840,1564,186.74,1840,Medica,Medical Assistance,215.6,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Tendon Sheath Incision (Eg, For Trigger Finger) (Pro Cah)",,26055,CPT,Professional,Both,,,,1840,1564,186.74,1840,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,290.32,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Tendon Sheath Incision (Eg, For Trigger Finger) (Pro Cah)",,26055,CPT,Professional,Both,,,,1840,1564,186.74,1840,"Multiplan, Inc.","Multiplan, Inc.",1729.6,94,,percent of total billed charges,,
"Tendon Sheath Incision (Eg, For Trigger Finger) (Pro Cah)",,26055,CPT,Professional,Both,,,,1840,1564,186.74,1840,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1657.84,90.1,,percent of total billed charges,,
"Tendon Sheath Incision (Eg, For Trigger Finger) (Pro Cah)",,26055,CPT,Professional,Both,,,,1840,1564,186.74,1840,"Preferred One Administrative Services, INC.",PPO,1814.24,98.6,,percent of total billed charges,,
"Tendon Sheath Incision (Eg, For Trigger Finger) (Pro Cah)",,26055,CPT,Professional,Both,,,,1840,1564,186.74,1840,PrimeWest Health,Minnesota Senior Health Options (MSHO),333.868,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Tendon Sheath Incision (Eg, For Trigger Finger) (Pro Cah)",,26055,CPT,Professional,Both,,,,1840,1564,186.74,1840,PrimeWest Health,MinnesotaCare,230.686864,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Tendon Sheath Incision (Eg, For Trigger Finger) (Pro Cah)",,26055,CPT,Professional,Both,,,,1840,1564,186.74,1840,Sanford Health Plan,Sanford Health Plan,1619.2,88,,percent of total billed charges,,
"Tendon Sheath Incision (Eg, For Trigger Finger) (Pro Cah)",,26055,CPT,Professional,Both,,,,1840,1564,186.74,1840,"UCare Health, Inc.",Individual & Family Plan,471.944192,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Tendon Sheath Incision (Eg, For Trigger Finger) (Pro Cah)",,26055,CPT,Professional,Both,,,,1840,1564,186.74,1840,"UCare Health, Inc.",Medical Assistance,237.15472,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Tendon Sheath Incision (Eg, For Trigger Finger) (Pro Cah)",,26055,CPT,Professional,Both,,,,1840,1564,186.74,1840,"UCare Health, Inc.",Medicare Advantage,333.868,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Tendon Sheath Incision (Eg, For Trigger Finger) (Pro Cah)",,26055,CPT,Professional,Both,,,,1840,1564,186.74,1840,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),267.0944,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Tendon Sheath Incision (Eg, For Trigger Finger) (Pro Cah)",,26055,CPT,Professional,Both,,,,1840,1564,186.74,1840,UnitedHealthcare,Individual & Family,1840,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Tendon Sheath Incision (Eg, For Trigger Finger) (Pro Cah)",,26055,CPT,Professional,Both,,,,1840,1564,186.74,1840,UnitedHealthcare,Medicare Advantage,333.868,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Tendon Sheath Incision (Eg, For Trigger Finger) (Pro Cah)",,26055,CPT,Professional,Both,,,,1840,1564,186.74,1840,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,215.5952,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
EPHEDRINE SULFATE 50 MG/ML IV SOLN,,122153,LOCAL,Facility,Both,1,mL,,239,203.15,68.4974,239,Aetna,Commercial,219.88,92,,percent of total billed charges,,
EPHEDRINE SULFATE 50 MG/ML IV SOLN,,122153,LOCAL,Facility,Outpatient,1,mL,,239,203.15,68.4974,239,Aetna,Medicare Advantage,117.11,49,,percent of total billed charges,,
EPHEDRINE SULFATE 50 MG/ML IV SOLN,,122153,LOCAL,Facility,Inpatient,1,mL,,239,203.15,68.4974,239,Aetna,Medicare Advantage,,,,,Included in per diem rate,
EPHEDRINE SULFATE 50 MG/ML IV SOLN,,122153,LOCAL,Facility,Both,1,mL,,239,203.15,68.4974,239,Aetna,PPO,222.27,93,,percent of total billed charges,,
EPHEDRINE SULFATE 50 MG/ML IV SOLN,,122153,LOCAL,Facility,Both,1,mL,,239,203.15,68.4974,239,America's PPO,America's PPO,229.5117,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
EPHEDRINE SULFATE 50 MG/ML IV SOLN,,122153,LOCAL,Facility,Both,1,mL,,239,203.15,68.4974,239,BlueCross BlueShield Minnesota, Federal Employee Program,235.176,98.4,,percent of total billed charges,,
EPHEDRINE SULFATE 50 MG/ML IV SOLN,,122153,LOCAL,Facility,Both,1,mL,,239,203.15,68.4974,239,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,239,100,,percent of total billed charges,,
EPHEDRINE SULFATE 50 MG/ML IV SOLN,,122153,LOCAL,Facility,Both,1,mL,,239,203.15,68.4974,239,BlueCross BlueShield Minnesota,High Value Network Plan,215.1,90,,percent of total billed charges,,
EPHEDRINE SULFATE 50 MG/ML IV SOLN,,122153,LOCAL,Facility,Outpatient,1,mL,,239,203.15,68.4974,239,BlueCross BlueShield Minnesota,Medicare Advantage,117.11,49,,percent of total billed charges,,
EPHEDRINE SULFATE 50 MG/ML IV SOLN,,122153,LOCAL,Facility,Inpatient,1,mL,,239,203.15,68.4974,239,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
EPHEDRINE SULFATE 50 MG/ML IV SOLN,,122153,LOCAL,Facility,Both,1,mL,,239,203.15,68.4974,239,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,211.6823,88.57,,percent of total billed charges,,
EPHEDRINE SULFATE 50 MG/ML IV SOLN,,122153,LOCAL,Facility,Both,1,mL,,239,203.15,68.4974,239,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,68.4974,28.66,,percent of total billed charges,,
EPHEDRINE SULFATE 50 MG/ML IV SOLN,,122153,LOCAL,Facility,Outpatient,1,mL,,239,203.15,68.4974,239,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),117.11,49,,percent of total billed charges,,
EPHEDRINE SULFATE 50 MG/ML IV SOLN,,122153,LOCAL,Facility,Inpatient,1,mL,,239,203.15,68.4974,239,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
EPHEDRINE SULFATE 50 MG/ML IV SOLN,,122153,LOCAL,Facility,Both,1,mL,,239,203.15,68.4974,239,CorVel,Worker's Compensation,239,100,,percent of total billed charges,,
EPHEDRINE SULFATE 50 MG/ML IV SOLN,,122153,LOCAL,Facility,Both,1,mL,,239,203.15,68.4974,239,First Health Group Corporation,First Health Network,231.83,97,,percent of total billed charges,,
EPHEDRINE SULFATE 50 MG/ML IV SOLN,,122153,LOCAL,Facility,Both,1,mL,,239,203.15,68.4974,239,"Health Partners, Inc.",Commercial,226.094,94.6,,percent of total billed charges,,
EPHEDRINE SULFATE 50 MG/ML IV SOLN,,122153,LOCAL,Facility,Outpatient,1,mL,,239,203.15,68.4974,239,"Health Partners, Inc.",Medicare Advantage,117.11,49,,percent of total billed charges,,
EPHEDRINE SULFATE 50 MG/ML IV SOLN,,122153,LOCAL,Facility,Inpatient,1,mL,,239,203.15,68.4974,239,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
EPHEDRINE SULFATE 50 MG/ML IV SOLN,,122153,LOCAL,Facility,Both,1,mL,,239,203.15,68.4974,239,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),143.4,60,,percent of total billed charges,,
EPHEDRINE SULFATE 50 MG/ML IV SOLN,,122153,LOCAL,Facility,Both,1,mL,,239,203.15,68.4974,239,"Health Partners, Inc.",State of Minnesota Advantage Program,194.785,81.5,,percent of total billed charges,,
EPHEDRINE SULFATE 50 MG/ML IV SOLN,,122153,LOCAL,Facility,Both,1,mL,,239,203.15,68.4974,239,"Health Partners, Inc.",State Public Programs,119.5,50,,percent of total billed charges,,
EPHEDRINE SULFATE 50 MG/ML IV SOLN,,122153,LOCAL,Facility,Both,1,mL,,239,203.15,68.4974,239,Humana Insurance Company,Commercial PPO,227.05,95,,percent of total billed charges,,
EPHEDRINE SULFATE 50 MG/ML IV SOLN,,122153,LOCAL,Facility,Outpatient,1,mL,,239,203.15,68.4974,239,Humana Insurance Company,Medicare PPO,117.11,49,,percent of total billed charges,,
EPHEDRINE SULFATE 50 MG/ML IV SOLN,,122153,LOCAL,Facility,Inpatient,1,mL,,239,203.15,68.4974,239,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
EPHEDRINE SULFATE 50 MG/ML IV SOLN,,122153,LOCAL,Facility,Both,1,mL,,239,203.15,68.4974,239,Medica,Individual & Family,236.849,99.1,,percent of total billed charges,,
EPHEDRINE SULFATE 50 MG/ML IV SOLN,,122153,LOCAL,Facility,Outpatient,1,mL,,239,203.15,68.4974,239,Medica,Medica Advantage Solution,119.022,49.8,,percent of total billed charges,,
EPHEDRINE SULFATE 50 MG/ML IV SOLN,,122153,LOCAL,Facility,Inpatient,1,mL,,239,203.15,68.4974,239,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
EPHEDRINE SULFATE 50 MG/ML IV SOLN,,122153,LOCAL,Facility,Outpatient,1,mL,,239,203.15,68.4974,239,Medica,Medical Assistance,106.594,44.6,,percent of total billed charges,,
EPHEDRINE SULFATE 50 MG/ML IV SOLN,,122153,LOCAL,Facility,Inpatient,1,mL,,239,203.15,68.4974,239,Medica,Medical Assistance,,,,,Included in per diem rate,
EPHEDRINE SULFATE 50 MG/ML IV SOLN,,122153,LOCAL,Facility,Outpatient,1,mL,,239,203.15,68.4974,239,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,119.022,49.8,,percent of total billed charges,,
EPHEDRINE SULFATE 50 MG/ML IV SOLN,,122153,LOCAL,Facility,Inpatient,1,mL,,239,203.15,68.4974,239,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
EPHEDRINE SULFATE 50 MG/ML IV SOLN,,122153,LOCAL,Facility,Both,1,mL,,239,203.15,68.4974,239,"Multiplan, Inc.","Multiplan, Inc.",224.66,94,,percent of total billed charges,,
EPHEDRINE SULFATE 50 MG/ML IV SOLN,,122153,LOCAL,Facility,Outpatient,1,mL,,239,203.15,68.4974,239,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,215.339,90.1,,percent of total billed charges,,
EPHEDRINE SULFATE 50 MG/ML IV SOLN,,122153,LOCAL,Facility,Inpatient,1,mL,,239,203.15,68.4974,239,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
EPHEDRINE SULFATE 50 MG/ML IV SOLN,,122153,LOCAL,Facility,Both,1,mL,,239,203.15,68.4974,239,"Preferred One Administrative Services, INC.",PPO,235.654,98.6,,percent of total billed charges,,
EPHEDRINE SULFATE 50 MG/ML IV SOLN,,122153,LOCAL,Facility,Outpatient,1,mL,,239,203.15,68.4974,239,PrimeWest Health,Minnesota Senior Health Options (MSHO),122.9655,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
EPHEDRINE SULFATE 50 MG/ML IV SOLN,,122153,LOCAL,Facility,Inpatient,1,mL,,239,203.15,68.4974,239,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
EPHEDRINE SULFATE 50 MG/ML IV SOLN,,122153,LOCAL,Facility,Outpatient,1,mL,,239,203.15,68.4974,239,PrimeWest Health,MinnesotaCare,122.7504,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
EPHEDRINE SULFATE 50 MG/ML IV SOLN,,122153,LOCAL,Facility,Inpatient,1,mL,,239,203.15,68.4974,239,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
EPHEDRINE SULFATE 50 MG/ML IV SOLN,,122153,LOCAL,Facility,Both,1,mL,,239,203.15,68.4974,239,Sanford Health Plan,Sanford Health Plan,219.88,92,,percent of total billed charges,,
EPHEDRINE SULFATE 50 MG/ML IV SOLN,,122153,LOCAL,Facility,Outpatient,1,mL,,239,203.15,68.4974,239,"UCare Health, Inc.",Individual & Family Plan,134.6765,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
EPHEDRINE SULFATE 50 MG/ML IV SOLN,,122153,LOCAL,Facility,Inpatient,1,mL,,239,203.15,68.4974,239,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
EPHEDRINE SULFATE 50 MG/ML IV SOLN,,122153,LOCAL,Facility,Outpatient,1,mL,,239,203.15,68.4974,239,"UCare Health, Inc.",Medical Assistance,120.6233,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
EPHEDRINE SULFATE 50 MG/ML IV SOLN,,122153,LOCAL,Facility,Inpatient,1,mL,,239,203.15,68.4974,239,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
EPHEDRINE SULFATE 50 MG/ML IV SOLN,,122153,LOCAL,Facility,Outpatient,1,mL,,239,203.15,68.4974,239,"UCare Health, Inc.",Medicare Advantage,120.6233,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
EPHEDRINE SULFATE 50 MG/ML IV SOLN,,122153,LOCAL,Facility,Inpatient,1,mL,,239,203.15,68.4974,239,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
EPHEDRINE SULFATE 50 MG/ML IV SOLN,,122153,LOCAL,Facility,Outpatient,1,mL,,239,203.15,68.4974,239,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),120.6233,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
EPHEDRINE SULFATE 50 MG/ML IV SOLN,,122153,LOCAL,Facility,Inpatient,1,mL,,239,203.15,68.4974,239,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
EPHEDRINE SULFATE 50 MG/ML IV SOLN,,122153,LOCAL,Facility,Both,1,mL,,239,203.15,68.4974,239,UnitedHealthcare,Individual & Family,224.66,94,,percent of total billed charges,,
EPHEDRINE SULFATE 50 MG/ML IV SOLN,,122153,LOCAL,Facility,Outpatient,1,mL,,239,203.15,68.4974,239,UnitedHealthcare,Medicare Advantage,117.11,49,,percent of total billed charges,,
EPHEDRINE SULFATE 50 MG/ML IV SOLN,,122153,LOCAL,Facility,Inpatient,1,mL,,239,203.15,68.4974,239,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
EPHEDRINE SULFATE 50 MG/ML IV SOLN,,122153,LOCAL,Facility,Outpatient,1,mL,,239,203.15,68.4974,239,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,114.72,48,,percent of total billed charges,,100% of DHS outpatient percentage
EPHEDRINE SULFATE 50 MG/ML IV SOLN,,122153,LOCAL,Facility,Inpatient,1,mL,,239,203.15,68.4974,239,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Excision Of Lesion Of Tendon Sheath Or Joint Capsule, Hand Or Finger (Pro Cah)",,26160,CPT,Professional,Both,,,,1663,1413.55,202,1663,Aetna,Commercial,1413.55,85,,percent of total billed charges,,
"Excision Of Lesion Of Tendon Sheath Or Joint Capsule, Hand Or Finger (Pro Cah)",,26160,CPT,Professional,Both,,,,1663,1413.55,202,1663,Aetna,Medicare Advantage,313.78,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision Of Lesion Of Tendon Sheath Or Joint Capsule, Hand Or Finger (Pro Cah)",,26160,CPT,Professional,Both,,,,1663,1413.55,202,1663,Aetna,PPO,1546.59,93,,percent of total billed charges,,
"Excision Of Lesion Of Tendon Sheath Or Joint Capsule, Hand Or Finger (Pro Cah)",,26160,CPT,Professional,Both,,,,1663,1413.55,202,1663,America's PPO,America's PPO,1420.8672,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Excision Of Lesion Of Tendon Sheath Or Joint Capsule, Hand Or Finger (Pro Cah)",,26160,CPT,Professional,Both,,,,1663,1413.55,202,1663,BlueCross BlueShield Minnesota, Federal Employee Program,661.74,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Excision Of Lesion Of Tendon Sheath Or Joint Capsule, Hand Or Finger (Pro Cah)",,26160,CPT,Professional,Both,,,,1663,1413.55,202,1663,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,672.32784,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision Of Lesion Of Tendon Sheath Or Joint Capsule, Hand Or Finger (Pro Cah)",,26160,CPT,Professional,Both,,,,1663,1413.55,202,1663,BlueCross BlueShield Minnesota,High Value Network Plan,672.32784,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision Of Lesion Of Tendon Sheath Or Joint Capsule, Hand Or Finger (Pro Cah)",,26160,CPT,Professional,Both,,,,1663,1413.55,202,1663,BlueCross BlueShield Minnesota,Medicare Advantage,361.1575,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision Of Lesion Of Tendon Sheath Or Joint Capsule, Hand Or Finger (Pro Cah)",,26160,CPT,Professional,Both,,,,1663,1413.55,202,1663,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,672.32784,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision Of Lesion Of Tendon Sheath Or Joint Capsule, Hand Or Finger (Pro Cah)",,26160,CPT,Professional,Both,,,,1663,1413.55,202,1663,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,233.2228,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision Of Lesion Of Tendon Sheath Or Joint Capsule, Hand Or Finger (Pro Cah)",,26160,CPT,Professional,Both,,,,1663,1413.55,202,1663,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),361.1575,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision Of Lesion Of Tendon Sheath Or Joint Capsule, Hand Or Finger (Pro Cah)",,26160,CPT,Professional,Both,,,,1663,1413.55,202,1663,CorVel,Worker's Compensation,607.9099944,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Excision Of Lesion Of Tendon Sheath Or Joint Capsule, Hand Or Finger (Pro Cah)",,26160,CPT,Professional,Both,,,,1663,1413.55,202,1663,First Health Group Corporation,First Health Network,1613.11,97,,percent of total billed charges,,
"Excision Of Lesion Of Tendon Sheath Or Joint Capsule, Hand Or Finger (Pro Cah)",,26160,CPT,Professional,Both,,,,1663,1413.55,202,1663,"Health Partners, Inc.",Commercial,656.6,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision Of Lesion Of Tendon Sheath Or Joint Capsule, Hand Or Finger (Pro Cah)",,26160,CPT,Professional,Both,,,,1663,1413.55,202,1663,"Health Partners, Inc.",Medicare Advantage,361.1575,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision Of Lesion Of Tendon Sheath Or Joint Capsule, Hand Or Finger (Pro Cah)",,26160,CPT,Professional,Both,,,,1663,1413.55,202,1663,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),314.13,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Excision Of Lesion Of Tendon Sheath Or Joint Capsule, Hand Or Finger (Pro Cah)",,26160,CPT,Professional,Both,,,,1663,1413.55,202,1663,"Health Partners, Inc.",State of Minnesota Advantage Program,565.6609,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision Of Lesion Of Tendon Sheath Or Joint Capsule, Hand Or Finger (Pro Cah)",,26160,CPT,Professional,Both,,,,1663,1413.55,202,1663,"Health Partners, Inc.",State Public Programs,202,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Excision Of Lesion Of Tendon Sheath Or Joint Capsule, Hand Or Finger (Pro Cah)",,26160,CPT,Professional,Both,,,,1663,1413.55,202,1663,Humana Insurance Company,Commercial PPO,314.05,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Excision Of Lesion Of Tendon Sheath Or Joint Capsule, Hand Or Finger (Pro Cah)",,26160,CPT,Professional,Both,,,,1663,1413.55,202,1663,Humana Insurance Company,Medicare PPO,1663,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Excision Of Lesion Of Tendon Sheath Or Joint Capsule, Hand Or Finger (Pro Cah)",,26160,CPT,Professional,Both,,,,1663,1413.55,202,1663,Medica,Individual & Family,1410.224,84.8,,percent of total billed charges,,
"Excision Of Lesion Of Tendon Sheath Or Joint Capsule, Hand Or Finger (Pro Cah)",,26160,CPT,Professional,Both,,,,1663,1413.55,202,1663,Medica,Medica Advantage Solution,828.174,49.8,,percent of total billed charges,,
"Excision Of Lesion Of Tendon Sheath Or Joint Capsule, Hand Or Finger (Pro Cah)",,26160,CPT,Professional,Both,,,,1663,1413.55,202,1663,Medica,Medical Assistance,233.22,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Excision Of Lesion Of Tendon Sheath Or Joint Capsule, Hand Or Finger (Pro Cah)",,26160,CPT,Professional,Both,,,,1663,1413.55,202,1663,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,314.05,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Excision Of Lesion Of Tendon Sheath Or Joint Capsule, Hand Or Finger (Pro Cah)",,26160,CPT,Professional,Both,,,,1663,1413.55,202,1663,"Multiplan, Inc.","Multiplan, Inc.",1563.22,94,,percent of total billed charges,,
"Excision Of Lesion Of Tendon Sheath Or Joint Capsule, Hand Or Finger (Pro Cah)",,26160,CPT,Professional,Both,,,,1663,1413.55,202,1663,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1498.363,90.1,,percent of total billed charges,,
"Excision Of Lesion Of Tendon Sheath Or Joint Capsule, Hand Or Finger (Pro Cah)",,26160,CPT,Professional,Both,,,,1663,1413.55,202,1663,"Preferred One Administrative Services, INC.",PPO,1639.718,98.6,,percent of total billed charges,,
"Excision Of Lesion Of Tendon Sheath Or Joint Capsule, Hand Or Finger (Pro Cah)",,26160,CPT,Professional,Both,,,,1663,1413.55,202,1663,PrimeWest Health,Minnesota Senior Health Options (MSHO),361.1575,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision Of Lesion Of Tendon Sheath Or Joint Capsule, Hand Or Finger (Pro Cah)",,26160,CPT,Professional,Both,,,,1663,1413.55,202,1663,PrimeWest Health,MinnesotaCare,249.548396,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision Of Lesion Of Tendon Sheath Or Joint Capsule, Hand Or Finger (Pro Cah)",,26160,CPT,Professional,Both,,,,1663,1413.55,202,1663,Sanford Health Plan,Sanford Health Plan,1463.44,88,,percent of total billed charges,,
"Excision Of Lesion Of Tendon Sheath Or Joint Capsule, Hand Or Finger (Pro Cah)",,26160,CPT,Professional,Both,,,,1663,1413.55,202,1663,"UCare Health, Inc.",Individual & Family Plan,510.51968,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Excision Of Lesion Of Tendon Sheath Or Joint Capsule, Hand Or Finger (Pro Cah)",,26160,CPT,Professional,Both,,,,1663,1413.55,202,1663,"UCare Health, Inc.",Medical Assistance,256.54508,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Excision Of Lesion Of Tendon Sheath Or Joint Capsule, Hand Or Finger (Pro Cah)",,26160,CPT,Professional,Both,,,,1663,1413.55,202,1663,"UCare Health, Inc.",Medicare Advantage,361.1575,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Excision Of Lesion Of Tendon Sheath Or Joint Capsule, Hand Or Finger (Pro Cah)",,26160,CPT,Professional,Both,,,,1663,1413.55,202,1663,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),288.926,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Excision Of Lesion Of Tendon Sheath Or Joint Capsule, Hand Or Finger (Pro Cah)",,26160,CPT,Professional,Both,,,,1663,1413.55,202,1663,UnitedHealthcare,Individual & Family,1663,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Excision Of Lesion Of Tendon Sheath Or Joint Capsule, Hand Or Finger (Pro Cah)",,26160,CPT,Professional,Both,,,,1663,1413.55,202,1663,UnitedHealthcare,Medicare Advantage,361.1575,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision Of Lesion Of Tendon Sheath Or Joint Capsule, Hand Or Finger (Pro Cah)",,26160,CPT,Professional,Both,,,,1663,1413.55,202,1663,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,233.2228,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
EPINEPHRINE 1 MG/ML (1 ML) INJ SOLN,,J0171,HCPCS,Facility,Both,1,mL,,87,73.95,24.9342,87,Aetna,Commercial,80.04,92,,percent of total billed charges,,
EPINEPHRINE 1 MG/ML (1 ML) INJ SOLN,,J0171,HCPCS,Facility,Outpatient,1,mL,,87,73.95,24.9342,87,Aetna,Medicare Advantage,42.63,49,,percent of total billed charges,,
EPINEPHRINE 1 MG/ML (1 ML) INJ SOLN,,J0171,HCPCS,Facility,Inpatient,1,mL,,87,73.95,24.9342,87,Aetna,Medicare Advantage,,,,,Included in per diem rate,
EPINEPHRINE 1 MG/ML (1 ML) INJ SOLN,,J0171,HCPCS,Facility,Both,1,mL,,87,73.95,24.9342,87,Aetna,PPO,80.91,93,,percent of total billed charges,,
EPINEPHRINE 1 MG/ML (1 ML) INJ SOLN,,J0171,HCPCS,Facility,Both,1,mL,,87,73.95,24.9342,87,America's PPO,America's PPO,83.5461,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
EPINEPHRINE 1 MG/ML (1 ML) INJ SOLN,,J0171,HCPCS,Facility,Both,1,mL,,87,73.95,24.9342,87,BlueCross BlueShield Minnesota, Federal Employee Program,85.608,98.4,,percent of total billed charges,,
EPINEPHRINE 1 MG/ML (1 ML) INJ SOLN,,J0171,HCPCS,Facility,Both,1,mL,,87,73.95,24.9342,87,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,87,100,,percent of total billed charges,,
EPINEPHRINE 1 MG/ML (1 ML) INJ SOLN,,J0171,HCPCS,Facility,Both,1,mL,,87,73.95,24.9342,87,BlueCross BlueShield Minnesota,High Value Network Plan,78.3,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
EPINEPHRINE 1 MG/ML (1 ML) INJ SOLN,,J0171,HCPCS,Facility,Outpatient,1,mL,,87,73.95,24.9342,87,BlueCross BlueShield Minnesota,Medicare Advantage,42.63,49,,percent of total billed charges,,
EPINEPHRINE 1 MG/ML (1 ML) INJ SOLN,,J0171,HCPCS,Facility,Inpatient,1,mL,,87,73.95,24.9342,87,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
EPINEPHRINE 1 MG/ML (1 ML) INJ SOLN,,J0171,HCPCS,Facility,Both,1,mL,,87,73.95,24.9342,87,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,77.0559,88.57,,percent of total billed charges,,
EPINEPHRINE 1 MG/ML (1 ML) INJ SOLN,,J0171,HCPCS,Facility,Both,1,mL,,87,73.95,24.9342,87,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,24.9342,28.66,,percent of total billed charges,,
EPINEPHRINE 1 MG/ML (1 ML) INJ SOLN,,J0171,HCPCS,Facility,Outpatient,1,mL,,87,73.95,24.9342,87,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),42.63,49,,percent of total billed charges,,
EPINEPHRINE 1 MG/ML (1 ML) INJ SOLN,,J0171,HCPCS,Facility,Inpatient,1,mL,,87,73.95,24.9342,87,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
EPINEPHRINE 1 MG/ML (1 ML) INJ SOLN,,J0171,HCPCS,Facility,Both,1,mL,,87,73.95,24.9342,87,CorVel,Worker's Compensation,87,100,,percent of total billed charges,,
EPINEPHRINE 1 MG/ML (1 ML) INJ SOLN,,J0171,HCPCS,Facility,Both,1,mL,,87,73.95,24.9342,87,First Health Group Corporation,First Health Network,84.39,97,,percent of total billed charges,,
EPINEPHRINE 1 MG/ML (1 ML) INJ SOLN,,J0171,HCPCS,Facility,Both,1,mL,,87,73.95,24.9342,87,"Health Partners, Inc.",Commercial,82.302,94.6,,percent of total billed charges,,
EPINEPHRINE 1 MG/ML (1 ML) INJ SOLN,,J0171,HCPCS,Facility,Outpatient,1,mL,,87,73.95,24.9342,87,"Health Partners, Inc.",Medicare Advantage,42.63,49,,percent of total billed charges,,
EPINEPHRINE 1 MG/ML (1 ML) INJ SOLN,,J0171,HCPCS,Facility,Inpatient,1,mL,,87,73.95,24.9342,87,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
EPINEPHRINE 1 MG/ML (1 ML) INJ SOLN,,J0171,HCPCS,Facility,Both,1,mL,,87,73.95,24.9342,87,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),52.2,60,,percent of total billed charges,,
EPINEPHRINE 1 MG/ML (1 ML) INJ SOLN,,J0171,HCPCS,Facility,Both,1,mL,,87,73.95,24.9342,87,"Health Partners, Inc.",State of Minnesota Advantage Program,70.905,81.5,,percent of total billed charges,,
EPINEPHRINE 1 MG/ML (1 ML) INJ SOLN,,J0171,HCPCS,Facility,Both,1,mL,,87,73.95,24.9342,87,"Health Partners, Inc.",State Public Programs,43.5,50,,percent of total billed charges,,
EPINEPHRINE 1 MG/ML (1 ML) INJ SOLN,,J0171,HCPCS,Facility,Both,1,mL,,87,73.95,24.9342,87,Humana Insurance Company,Commercial PPO,82.65,95,,percent of total billed charges,,
EPINEPHRINE 1 MG/ML (1 ML) INJ SOLN,,J0171,HCPCS,Facility,Outpatient,1,mL,,87,73.95,24.9342,87,Humana Insurance Company,Medicare PPO,42.63,49,,percent of total billed charges,,
EPINEPHRINE 1 MG/ML (1 ML) INJ SOLN,,J0171,HCPCS,Facility,Inpatient,1,mL,,87,73.95,24.9342,87,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
EPINEPHRINE 1 MG/ML (1 ML) INJ SOLN,,J0171,HCPCS,Facility,Both,1,mL,,87,73.95,24.9342,87,Medica,Individual & Family,86.217,99.1,,percent of total billed charges,,
EPINEPHRINE 1 MG/ML (1 ML) INJ SOLN,,J0171,HCPCS,Facility,Outpatient,1,mL,,87,73.95,24.9342,87,Medica,Medica Advantage Solution,43.326,49.8,,percent of total billed charges,,
EPINEPHRINE 1 MG/ML (1 ML) INJ SOLN,,J0171,HCPCS,Facility,Inpatient,1,mL,,87,73.95,24.9342,87,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
EPINEPHRINE 1 MG/ML (1 ML) INJ SOLN,,J0171,HCPCS,Facility,Outpatient,1,mL,,87,73.95,24.9342,87,Medica,Medical Assistance,38.802,44.6,,percent of total billed charges,,
EPINEPHRINE 1 MG/ML (1 ML) INJ SOLN,,J0171,HCPCS,Facility,Inpatient,1,mL,,87,73.95,24.9342,87,Medica,Medical Assistance,,,,,Included in per diem rate,
EPINEPHRINE 1 MG/ML (1 ML) INJ SOLN,,J0171,HCPCS,Facility,Outpatient,1,mL,,87,73.95,24.9342,87,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,43.326,49.8,,percent of total billed charges,,
EPINEPHRINE 1 MG/ML (1 ML) INJ SOLN,,J0171,HCPCS,Facility,Inpatient,1,mL,,87,73.95,24.9342,87,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
EPINEPHRINE 1 MG/ML (1 ML) INJ SOLN,,J0171,HCPCS,Facility,Both,1,mL,,87,73.95,24.9342,87,"Multiplan, Inc.","Multiplan, Inc.",81.78,94,,percent of total billed charges,,
EPINEPHRINE 1 MG/ML (1 ML) INJ SOLN,,J0171,HCPCS,Facility,Outpatient,1,mL,,87,73.95,24.9342,87,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,78.387,90.1,,percent of total billed charges,,
EPINEPHRINE 1 MG/ML (1 ML) INJ SOLN,,J0171,HCPCS,Facility,Inpatient,1,mL,,87,73.95,24.9342,87,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
EPINEPHRINE 1 MG/ML (1 ML) INJ SOLN,,J0171,HCPCS,Facility,Both,1,mL,,87,73.95,24.9342,87,"Preferred One Administrative Services, INC.",PPO,85.782,98.6,,percent of total billed charges,,
EPINEPHRINE 1 MG/ML (1 ML) INJ SOLN,,J0171,HCPCS,Facility,Outpatient,1,mL,,87,73.95,24.9342,87,PrimeWest Health,Minnesota Senior Health Options (MSHO),44.7615,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
EPINEPHRINE 1 MG/ML (1 ML) INJ SOLN,,J0171,HCPCS,Facility,Inpatient,1,mL,,87,73.95,24.9342,87,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
EPINEPHRINE 1 MG/ML (1 ML) INJ SOLN,,J0171,HCPCS,Facility,Outpatient,1,mL,,87,73.95,24.9342,87,PrimeWest Health,MinnesotaCare,44.6832,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
EPINEPHRINE 1 MG/ML (1 ML) INJ SOLN,,J0171,HCPCS,Facility,Inpatient,1,mL,,87,73.95,24.9342,87,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
EPINEPHRINE 1 MG/ML (1 ML) INJ SOLN,,J0171,HCPCS,Facility,Both,1,mL,,87,73.95,24.9342,87,Sanford Health Plan,Sanford Health Plan,80.04,92,,percent of total billed charges,,
EPINEPHRINE 1 MG/ML (1 ML) INJ SOLN,,J0171,HCPCS,Facility,Outpatient,1,mL,,87,73.95,24.9342,87,"UCare Health, Inc.",Individual & Family Plan,49.0245,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
EPINEPHRINE 1 MG/ML (1 ML) INJ SOLN,,J0171,HCPCS,Facility,Inpatient,1,mL,,87,73.95,24.9342,87,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
EPINEPHRINE 1 MG/ML (1 ML) INJ SOLN,,J0171,HCPCS,Facility,Outpatient,1,mL,,87,73.95,24.9342,87,"UCare Health, Inc.",Medical Assistance,43.9089,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
EPINEPHRINE 1 MG/ML (1 ML) INJ SOLN,,J0171,HCPCS,Facility,Inpatient,1,mL,,87,73.95,24.9342,87,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
EPINEPHRINE 1 MG/ML (1 ML) INJ SOLN,,J0171,HCPCS,Facility,Outpatient,1,mL,,87,73.95,24.9342,87,"UCare Health, Inc.",Medicare Advantage,43.9089,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
EPINEPHRINE 1 MG/ML (1 ML) INJ SOLN,,J0171,HCPCS,Facility,Inpatient,1,mL,,87,73.95,24.9342,87,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
EPINEPHRINE 1 MG/ML (1 ML) INJ SOLN,,J0171,HCPCS,Facility,Outpatient,1,mL,,87,73.95,24.9342,87,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),43.9089,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
EPINEPHRINE 1 MG/ML (1 ML) INJ SOLN,,J0171,HCPCS,Facility,Inpatient,1,mL,,87,73.95,24.9342,87,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
EPINEPHRINE 1 MG/ML (1 ML) INJ SOLN,,J0171,HCPCS,Facility,Both,1,mL,,87,73.95,24.9342,87,UnitedHealthcare,Individual & Family,81.78,94,,percent of total billed charges,,
EPINEPHRINE 1 MG/ML (1 ML) INJ SOLN,,J0171,HCPCS,Facility,Outpatient,1,mL,,87,73.95,24.9342,87,UnitedHealthcare,Medicare Advantage,42.63,49,,percent of total billed charges,,
EPINEPHRINE 1 MG/ML (1 ML) INJ SOLN,,J0171,HCPCS,Facility,Inpatient,1,mL,,87,73.95,24.9342,87,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
EPINEPHRINE 1 MG/ML (1 ML) INJ SOLN,,J0171,HCPCS,Facility,Outpatient,1,mL,,87,73.95,24.9342,87,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,41.76,48,,percent of total billed charges,,100% of DHS outpatient percentage
EPINEPHRINE 1 MG/ML (1 ML) INJ SOLN,,J0171,HCPCS,Facility,Inpatient,1,mL,,87,73.95,24.9342,87,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJ SOLN,,J0171,HCPCS,Facility,Both,1,mL,,84,71.4,24.0744,84,Aetna,Commercial,77.28,92,,percent of total billed charges,,
EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJ SOLN,,J0171,HCPCS,Facility,Outpatient,1,mL,,84,71.4,24.0744,84,Aetna,Medicare Advantage,41.16,49,,percent of total billed charges,,
EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJ SOLN,,J0171,HCPCS,Facility,Inpatient,1,mL,,84,71.4,24.0744,84,Aetna,Medicare Advantage,,,,,Included in per diem rate,
EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJ SOLN,,J0171,HCPCS,Facility,Both,1,mL,,84,71.4,24.0744,84,Aetna,PPO,78.12,93,,percent of total billed charges,,
EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJ SOLN,,J0171,HCPCS,Facility,Both,1,mL,,84,71.4,24.0744,84,America's PPO,America's PPO,80.6652,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJ SOLN,,J0171,HCPCS,Facility,Both,1,mL,,84,71.4,24.0744,84,BlueCross BlueShield Minnesota, Federal Employee Program,82.656,98.4,,percent of total billed charges,,
EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJ SOLN,,J0171,HCPCS,Facility,Both,1,mL,,84,71.4,24.0744,84,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,84,100,,percent of total billed charges,,
EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJ SOLN,,J0171,HCPCS,Facility,Both,1,mL,,84,71.4,24.0744,84,BlueCross BlueShield Minnesota,High Value Network Plan,75.6,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJ SOLN,,J0171,HCPCS,Facility,Outpatient,1,mL,,84,71.4,24.0744,84,BlueCross BlueShield Minnesota,Medicare Advantage,41.16,49,,percent of total billed charges,,
EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJ SOLN,,J0171,HCPCS,Facility,Inpatient,1,mL,,84,71.4,24.0744,84,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJ SOLN,,J0171,HCPCS,Facility,Both,1,mL,,84,71.4,24.0744,84,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,74.3988,88.57,,percent of total billed charges,,
EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJ SOLN,,J0171,HCPCS,Facility,Both,1,mL,,84,71.4,24.0744,84,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,24.0744,28.66,,percent of total billed charges,,
EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJ SOLN,,J0171,HCPCS,Facility,Outpatient,1,mL,,84,71.4,24.0744,84,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),41.16,49,,percent of total billed charges,,
EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJ SOLN,,J0171,HCPCS,Facility,Inpatient,1,mL,,84,71.4,24.0744,84,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJ SOLN,,J0171,HCPCS,Facility,Both,1,mL,,84,71.4,24.0744,84,CorVel,Worker's Compensation,84,100,,percent of total billed charges,,
EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJ SOLN,,J0171,HCPCS,Facility,Both,1,mL,,84,71.4,24.0744,84,First Health Group Corporation,First Health Network,81.48,97,,percent of total billed charges,,
EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJ SOLN,,J0171,HCPCS,Facility,Both,1,mL,,84,71.4,24.0744,84,"Health Partners, Inc.",Commercial,79.464,94.6,,percent of total billed charges,,
EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJ SOLN,,J0171,HCPCS,Facility,Outpatient,1,mL,,84,71.4,24.0744,84,"Health Partners, Inc.",Medicare Advantage,41.16,49,,percent of total billed charges,,
EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJ SOLN,,J0171,HCPCS,Facility,Inpatient,1,mL,,84,71.4,24.0744,84,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJ SOLN,,J0171,HCPCS,Facility,Both,1,mL,,84,71.4,24.0744,84,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),50.4,60,,percent of total billed charges,,
EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJ SOLN,,J0171,HCPCS,Facility,Both,1,mL,,84,71.4,24.0744,84,"Health Partners, Inc.",State of Minnesota Advantage Program,68.46,81.5,,percent of total billed charges,,
EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJ SOLN,,J0171,HCPCS,Facility,Both,1,mL,,84,71.4,24.0744,84,"Health Partners, Inc.",State Public Programs,42,50,,percent of total billed charges,,
EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJ SOLN,,J0171,HCPCS,Facility,Both,1,mL,,84,71.4,24.0744,84,Humana Insurance Company,Commercial PPO,79.8,95,,percent of total billed charges,,
EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJ SOLN,,J0171,HCPCS,Facility,Outpatient,1,mL,,84,71.4,24.0744,84,Humana Insurance Company,Medicare PPO,41.16,49,,percent of total billed charges,,
EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJ SOLN,,J0171,HCPCS,Facility,Inpatient,1,mL,,84,71.4,24.0744,84,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJ SOLN,,J0171,HCPCS,Facility,Both,1,mL,,84,71.4,24.0744,84,Medica,Individual & Family,83.244,99.1,,percent of total billed charges,,
EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJ SOLN,,J0171,HCPCS,Facility,Outpatient,1,mL,,84,71.4,24.0744,84,Medica,Medica Advantage Solution,41.832,49.8,,percent of total billed charges,,
EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJ SOLN,,J0171,HCPCS,Facility,Inpatient,1,mL,,84,71.4,24.0744,84,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJ SOLN,,J0171,HCPCS,Facility,Outpatient,1,mL,,84,71.4,24.0744,84,Medica,Medical Assistance,37.464,44.6,,percent of total billed charges,,
EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJ SOLN,,J0171,HCPCS,Facility,Inpatient,1,mL,,84,71.4,24.0744,84,Medica,Medical Assistance,,,,,Included in per diem rate,
EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJ SOLN,,J0171,HCPCS,Facility,Outpatient,1,mL,,84,71.4,24.0744,84,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,41.832,49.8,,percent of total billed charges,,
EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJ SOLN,,J0171,HCPCS,Facility,Inpatient,1,mL,,84,71.4,24.0744,84,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJ SOLN,,J0171,HCPCS,Facility,Both,1,mL,,84,71.4,24.0744,84,"Multiplan, Inc.","Multiplan, Inc.",78.96,94,,percent of total billed charges,,
EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJ SOLN,,J0171,HCPCS,Facility,Outpatient,1,mL,,84,71.4,24.0744,84,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,75.684,90.1,,percent of total billed charges,,
EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJ SOLN,,J0171,HCPCS,Facility,Inpatient,1,mL,,84,71.4,24.0744,84,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJ SOLN,,J0171,HCPCS,Facility,Both,1,mL,,84,71.4,24.0744,84,"Preferred One Administrative Services, INC.",PPO,82.824,98.6,,percent of total billed charges,,
EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJ SOLN,,J0171,HCPCS,Facility,Outpatient,1,mL,,84,71.4,24.0744,84,PrimeWest Health,Minnesota Senior Health Options (MSHO),43.218,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJ SOLN,,J0171,HCPCS,Facility,Inpatient,1,mL,,84,71.4,24.0744,84,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJ SOLN,,J0171,HCPCS,Facility,Outpatient,1,mL,,84,71.4,24.0744,84,PrimeWest Health,MinnesotaCare,43.1424,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJ SOLN,,J0171,HCPCS,Facility,Inpatient,1,mL,,84,71.4,24.0744,84,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJ SOLN,,J0171,HCPCS,Facility,Both,1,mL,,84,71.4,24.0744,84,Sanford Health Plan,Sanford Health Plan,77.28,92,,percent of total billed charges,,
EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJ SOLN,,J0171,HCPCS,Facility,Outpatient,1,mL,,84,71.4,24.0744,84,"UCare Health, Inc.",Individual & Family Plan,47.334,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJ SOLN,,J0171,HCPCS,Facility,Inpatient,1,mL,,84,71.4,24.0744,84,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJ SOLN,,J0171,HCPCS,Facility,Outpatient,1,mL,,84,71.4,24.0744,84,"UCare Health, Inc.",Medical Assistance,42.3948,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJ SOLN,,J0171,HCPCS,Facility,Inpatient,1,mL,,84,71.4,24.0744,84,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJ SOLN,,J0171,HCPCS,Facility,Outpatient,1,mL,,84,71.4,24.0744,84,"UCare Health, Inc.",Medicare Advantage,42.3948,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJ SOLN,,J0171,HCPCS,Facility,Inpatient,1,mL,,84,71.4,24.0744,84,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJ SOLN,,J0171,HCPCS,Facility,Outpatient,1,mL,,84,71.4,24.0744,84,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),42.3948,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJ SOLN,,J0171,HCPCS,Facility,Inpatient,1,mL,,84,71.4,24.0744,84,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJ SOLN,,J0171,HCPCS,Facility,Both,1,mL,,84,71.4,24.0744,84,UnitedHealthcare,Individual & Family,78.96,94,,percent of total billed charges,,
EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJ SOLN,,J0171,HCPCS,Facility,Outpatient,1,mL,,84,71.4,24.0744,84,UnitedHealthcare,Medicare Advantage,41.16,49,,percent of total billed charges,,
EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJ SOLN,,J0171,HCPCS,Facility,Inpatient,1,mL,,84,71.4,24.0744,84,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJ SOLN,,J0171,HCPCS,Facility,Outpatient,1,mL,,84,71.4,24.0744,84,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,40.32,48,,percent of total billed charges,,100% of DHS outpatient percentage
EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJ SOLN,,J0171,HCPCS,Facility,Inpatient,1,mL,,84,71.4,24.0744,84,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
HYDRALAZINE 20 MG/ML INJ SOLN,,J0360,HCPCS,Facility,Both,1,mL,,90,76.5,25.794,90,Aetna,Commercial,82.8,92,,percent of total billed charges,,
HYDRALAZINE 20 MG/ML INJ SOLN,,J0360,HCPCS,Facility,Outpatient,1,mL,,90,76.5,25.794,90,Aetna,Medicare Advantage,44.1,49,,percent of total billed charges,,
HYDRALAZINE 20 MG/ML INJ SOLN,,J0360,HCPCS,Facility,Inpatient,1,mL,,90,76.5,25.794,90,Aetna,Medicare Advantage,,,,,Included in per diem rate,
HYDRALAZINE 20 MG/ML INJ SOLN,,J0360,HCPCS,Facility,Both,1,mL,,90,76.5,25.794,90,Aetna,PPO,83.7,93,,percent of total billed charges,,
HYDRALAZINE 20 MG/ML INJ SOLN,,J0360,HCPCS,Facility,Both,1,mL,,90,76.5,25.794,90,America's PPO,America's PPO,86.427,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
HYDRALAZINE 20 MG/ML INJ SOLN,,J0360,HCPCS,Facility,Both,1,mL,,90,76.5,25.794,90,BlueCross BlueShield Minnesota, Federal Employee Program,88.56,98.4,,percent of total billed charges,,
HYDRALAZINE 20 MG/ML INJ SOLN,,J0360,HCPCS,Facility,Both,1,mL,,90,76.5,25.794,90,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,90,100,,percent of total billed charges,,
HYDRALAZINE 20 MG/ML INJ SOLN,,J0360,HCPCS,Facility,Both,1,mL,,90,76.5,25.794,90,BlueCross BlueShield Minnesota,High Value Network Plan,81,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
HYDRALAZINE 20 MG/ML INJ SOLN,,J0360,HCPCS,Facility,Outpatient,1,mL,,90,76.5,25.794,90,BlueCross BlueShield Minnesota,Medicare Advantage,44.1,49,,percent of total billed charges,,
HYDRALAZINE 20 MG/ML INJ SOLN,,J0360,HCPCS,Facility,Inpatient,1,mL,,90,76.5,25.794,90,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
HYDRALAZINE 20 MG/ML INJ SOLN,,J0360,HCPCS,Facility,Both,1,mL,,90,76.5,25.794,90,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,79.713,88.57,,percent of total billed charges,,
HYDRALAZINE 20 MG/ML INJ SOLN,,J0360,HCPCS,Facility,Both,1,mL,,90,76.5,25.794,90,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,25.794,28.66,,percent of total billed charges,,
HYDRALAZINE 20 MG/ML INJ SOLN,,J0360,HCPCS,Facility,Outpatient,1,mL,,90,76.5,25.794,90,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),44.1,49,,percent of total billed charges,,
HYDRALAZINE 20 MG/ML INJ SOLN,,J0360,HCPCS,Facility,Inpatient,1,mL,,90,76.5,25.794,90,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
HYDRALAZINE 20 MG/ML INJ SOLN,,J0360,HCPCS,Facility,Both,1,mL,,90,76.5,25.794,90,CorVel,Worker's Compensation,90,100,,percent of total billed charges,,
HYDRALAZINE 20 MG/ML INJ SOLN,,J0360,HCPCS,Facility,Both,1,mL,,90,76.5,25.794,90,First Health Group Corporation,First Health Network,87.3,97,,percent of total billed charges,,
HYDRALAZINE 20 MG/ML INJ SOLN,,J0360,HCPCS,Facility,Both,1,mL,,90,76.5,25.794,90,"Health Partners, Inc.",Commercial,85.14,94.6,,percent of total billed charges,,
HYDRALAZINE 20 MG/ML INJ SOLN,,J0360,HCPCS,Facility,Outpatient,1,mL,,90,76.5,25.794,90,"Health Partners, Inc.",Medicare Advantage,44.1,49,,percent of total billed charges,,
HYDRALAZINE 20 MG/ML INJ SOLN,,J0360,HCPCS,Facility,Inpatient,1,mL,,90,76.5,25.794,90,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
HYDRALAZINE 20 MG/ML INJ SOLN,,J0360,HCPCS,Facility,Both,1,mL,,90,76.5,25.794,90,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),54,60,,percent of total billed charges,,
HYDRALAZINE 20 MG/ML INJ SOLN,,J0360,HCPCS,Facility,Both,1,mL,,90,76.5,25.794,90,"Health Partners, Inc.",State of Minnesota Advantage Program,73.35,81.5,,percent of total billed charges,,
HYDRALAZINE 20 MG/ML INJ SOLN,,J0360,HCPCS,Facility,Both,1,mL,,90,76.5,25.794,90,"Health Partners, Inc.",State Public Programs,45,50,,percent of total billed charges,,
HYDRALAZINE 20 MG/ML INJ SOLN,,J0360,HCPCS,Facility,Both,1,mL,,90,76.5,25.794,90,Humana Insurance Company,Commercial PPO,85.5,95,,percent of total billed charges,,
HYDRALAZINE 20 MG/ML INJ SOLN,,J0360,HCPCS,Facility,Outpatient,1,mL,,90,76.5,25.794,90,Humana Insurance Company,Medicare PPO,44.1,49,,percent of total billed charges,,
HYDRALAZINE 20 MG/ML INJ SOLN,,J0360,HCPCS,Facility,Inpatient,1,mL,,90,76.5,25.794,90,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
HYDRALAZINE 20 MG/ML INJ SOLN,,J0360,HCPCS,Facility,Both,1,mL,,90,76.5,25.794,90,Medica,Individual & Family,89.19,99.1,,percent of total billed charges,,
HYDRALAZINE 20 MG/ML INJ SOLN,,J0360,HCPCS,Facility,Outpatient,1,mL,,90,76.5,25.794,90,Medica,Medica Advantage Solution,44.82,49.8,,percent of total billed charges,,
HYDRALAZINE 20 MG/ML INJ SOLN,,J0360,HCPCS,Facility,Inpatient,1,mL,,90,76.5,25.794,90,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
HYDRALAZINE 20 MG/ML INJ SOLN,,J0360,HCPCS,Facility,Outpatient,1,mL,,90,76.5,25.794,90,Medica,Medical Assistance,40.14,44.6,,percent of total billed charges,,
HYDRALAZINE 20 MG/ML INJ SOLN,,J0360,HCPCS,Facility,Inpatient,1,mL,,90,76.5,25.794,90,Medica,Medical Assistance,,,,,Included in per diem rate,
HYDRALAZINE 20 MG/ML INJ SOLN,,J0360,HCPCS,Facility,Outpatient,1,mL,,90,76.5,25.794,90,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,44.82,49.8,,percent of total billed charges,,
HYDRALAZINE 20 MG/ML INJ SOLN,,J0360,HCPCS,Facility,Inpatient,1,mL,,90,76.5,25.794,90,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
HYDRALAZINE 20 MG/ML INJ SOLN,,J0360,HCPCS,Facility,Both,1,mL,,90,76.5,25.794,90,"Multiplan, Inc.","Multiplan, Inc.",84.6,94,,percent of total billed charges,,
HYDRALAZINE 20 MG/ML INJ SOLN,,J0360,HCPCS,Facility,Outpatient,1,mL,,90,76.5,25.794,90,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,81.09,90.1,,percent of total billed charges,,
HYDRALAZINE 20 MG/ML INJ SOLN,,J0360,HCPCS,Facility,Inpatient,1,mL,,90,76.5,25.794,90,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
HYDRALAZINE 20 MG/ML INJ SOLN,,J0360,HCPCS,Facility,Both,1,mL,,90,76.5,25.794,90,"Preferred One Administrative Services, INC.",PPO,88.74,98.6,,percent of total billed charges,,
HYDRALAZINE 20 MG/ML INJ SOLN,,J0360,HCPCS,Facility,Outpatient,1,mL,,90,76.5,25.794,90,PrimeWest Health,Minnesota Senior Health Options (MSHO),46.305,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
HYDRALAZINE 20 MG/ML INJ SOLN,,J0360,HCPCS,Facility,Inpatient,1,mL,,90,76.5,25.794,90,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
HYDRALAZINE 20 MG/ML INJ SOLN,,J0360,HCPCS,Facility,Outpatient,1,mL,,90,76.5,25.794,90,PrimeWest Health,MinnesotaCare,46.224,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
HYDRALAZINE 20 MG/ML INJ SOLN,,J0360,HCPCS,Facility,Inpatient,1,mL,,90,76.5,25.794,90,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
HYDRALAZINE 20 MG/ML INJ SOLN,,J0360,HCPCS,Facility,Both,1,mL,,90,76.5,25.794,90,Sanford Health Plan,Sanford Health Plan,82.8,92,,percent of total billed charges,,
HYDRALAZINE 20 MG/ML INJ SOLN,,J0360,HCPCS,Facility,Outpatient,1,mL,,90,76.5,25.794,90,"UCare Health, Inc.",Individual & Family Plan,50.715,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
HYDRALAZINE 20 MG/ML INJ SOLN,,J0360,HCPCS,Facility,Inpatient,1,mL,,90,76.5,25.794,90,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
HYDRALAZINE 20 MG/ML INJ SOLN,,J0360,HCPCS,Facility,Outpatient,1,mL,,90,76.5,25.794,90,"UCare Health, Inc.",Medical Assistance,45.423,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
HYDRALAZINE 20 MG/ML INJ SOLN,,J0360,HCPCS,Facility,Inpatient,1,mL,,90,76.5,25.794,90,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
HYDRALAZINE 20 MG/ML INJ SOLN,,J0360,HCPCS,Facility,Outpatient,1,mL,,90,76.5,25.794,90,"UCare Health, Inc.",Medicare Advantage,45.423,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
HYDRALAZINE 20 MG/ML INJ SOLN,,J0360,HCPCS,Facility,Inpatient,1,mL,,90,76.5,25.794,90,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
HYDRALAZINE 20 MG/ML INJ SOLN,,J0360,HCPCS,Facility,Outpatient,1,mL,,90,76.5,25.794,90,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),45.423,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
HYDRALAZINE 20 MG/ML INJ SOLN,,J0360,HCPCS,Facility,Inpatient,1,mL,,90,76.5,25.794,90,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
HYDRALAZINE 20 MG/ML INJ SOLN,,J0360,HCPCS,Facility,Both,1,mL,,90,76.5,25.794,90,UnitedHealthcare,Individual & Family,84.6,94,,percent of total billed charges,,
HYDRALAZINE 20 MG/ML INJ SOLN,,J0360,HCPCS,Facility,Outpatient,1,mL,,90,76.5,25.794,90,UnitedHealthcare,Medicare Advantage,44.1,49,,percent of total billed charges,,
HYDRALAZINE 20 MG/ML INJ SOLN,,J0360,HCPCS,Facility,Inpatient,1,mL,,90,76.5,25.794,90,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
HYDRALAZINE 20 MG/ML INJ SOLN,,J0360,HCPCS,Facility,Outpatient,1,mL,,90,76.5,25.794,90,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,43.2,48,,percent of total billed charges,,100% of DHS outpatient percentage
HYDRALAZINE 20 MG/ML INJ SOLN,,J0360,HCPCS,Facility,Inpatient,1,mL,,90,76.5,25.794,90,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
ATROPINE 0.4 MG/ML INJ SOLN,,J0461,HCPCS,Facility,Both,1,mL,,48,40.8,13.7568,48,Aetna,Commercial,44.16,92,,percent of total billed charges,,
ATROPINE 0.4 MG/ML INJ SOLN,,J0461,HCPCS,Facility,Outpatient,1,mL,,48,40.8,13.7568,48,Aetna,Medicare Advantage,23.52,49,,percent of total billed charges,,
ATROPINE 0.4 MG/ML INJ SOLN,,J0461,HCPCS,Facility,Inpatient,1,mL,,48,40.8,13.7568,48,Aetna,Medicare Advantage,,,,,Included in per diem rate,
ATROPINE 0.4 MG/ML INJ SOLN,,J0461,HCPCS,Facility,Both,1,mL,,48,40.8,13.7568,48,Aetna,PPO,44.64,93,,percent of total billed charges,,
ATROPINE 0.4 MG/ML INJ SOLN,,J0461,HCPCS,Facility,Both,1,mL,,48,40.8,13.7568,48,America's PPO,America's PPO,46.0944,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
ATROPINE 0.4 MG/ML INJ SOLN,,J0461,HCPCS,Facility,Both,1,mL,,48,40.8,13.7568,48,BlueCross BlueShield Minnesota, Federal Employee Program,47.232,98.4,,percent of total billed charges,,
ATROPINE 0.4 MG/ML INJ SOLN,,J0461,HCPCS,Facility,Both,1,mL,,48,40.8,13.7568,48,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,48,100,,percent of total billed charges,,
ATROPINE 0.4 MG/ML INJ SOLN,,J0461,HCPCS,Facility,Both,1,mL,,48,40.8,13.7568,48,BlueCross BlueShield Minnesota,High Value Network Plan,43.2,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
ATROPINE 0.4 MG/ML INJ SOLN,,J0461,HCPCS,Facility,Outpatient,1,mL,,48,40.8,13.7568,48,BlueCross BlueShield Minnesota,Medicare Advantage,23.52,49,,percent of total billed charges,,
ATROPINE 0.4 MG/ML INJ SOLN,,J0461,HCPCS,Facility,Inpatient,1,mL,,48,40.8,13.7568,48,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
ATROPINE 0.4 MG/ML INJ SOLN,,J0461,HCPCS,Facility,Both,1,mL,,48,40.8,13.7568,48,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,42.5136,88.57,,percent of total billed charges,,
ATROPINE 0.4 MG/ML INJ SOLN,,J0461,HCPCS,Facility,Both,1,mL,,48,40.8,13.7568,48,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,13.7568,28.66,,percent of total billed charges,,
ATROPINE 0.4 MG/ML INJ SOLN,,J0461,HCPCS,Facility,Outpatient,1,mL,,48,40.8,13.7568,48,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),23.52,49,,percent of total billed charges,,
ATROPINE 0.4 MG/ML INJ SOLN,,J0461,HCPCS,Facility,Inpatient,1,mL,,48,40.8,13.7568,48,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
ATROPINE 0.4 MG/ML INJ SOLN,,J0461,HCPCS,Facility,Both,1,mL,,48,40.8,13.7568,48,CorVel,Worker's Compensation,48,100,,percent of total billed charges,,
ATROPINE 0.4 MG/ML INJ SOLN,,J0461,HCPCS,Facility,Both,1,mL,,48,40.8,13.7568,48,First Health Group Corporation,First Health Network,46.56,97,,percent of total billed charges,,
ATROPINE 0.4 MG/ML INJ SOLN,,J0461,HCPCS,Facility,Both,1,mL,,48,40.8,13.7568,48,"Health Partners, Inc.",Commercial,45.408,94.6,,percent of total billed charges,,
ATROPINE 0.4 MG/ML INJ SOLN,,J0461,HCPCS,Facility,Outpatient,1,mL,,48,40.8,13.7568,48,"Health Partners, Inc.",Medicare Advantage,23.52,49,,percent of total billed charges,,
ATROPINE 0.4 MG/ML INJ SOLN,,J0461,HCPCS,Facility,Inpatient,1,mL,,48,40.8,13.7568,48,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ATROPINE 0.4 MG/ML INJ SOLN,,J0461,HCPCS,Facility,Both,1,mL,,48,40.8,13.7568,48,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),28.8,60,,percent of total billed charges,,
ATROPINE 0.4 MG/ML INJ SOLN,,J0461,HCPCS,Facility,Both,1,mL,,48,40.8,13.7568,48,"Health Partners, Inc.",State of Minnesota Advantage Program,39.12,81.5,,percent of total billed charges,,
ATROPINE 0.4 MG/ML INJ SOLN,,J0461,HCPCS,Facility,Both,1,mL,,48,40.8,13.7568,48,"Health Partners, Inc.",State Public Programs,24,50,,percent of total billed charges,,
ATROPINE 0.4 MG/ML INJ SOLN,,J0461,HCPCS,Facility,Both,1,mL,,48,40.8,13.7568,48,Humana Insurance Company,Commercial PPO,45.6,95,,percent of total billed charges,,
ATROPINE 0.4 MG/ML INJ SOLN,,J0461,HCPCS,Facility,Outpatient,1,mL,,48,40.8,13.7568,48,Humana Insurance Company,Medicare PPO,23.52,49,,percent of total billed charges,,
ATROPINE 0.4 MG/ML INJ SOLN,,J0461,HCPCS,Facility,Inpatient,1,mL,,48,40.8,13.7568,48,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
ATROPINE 0.4 MG/ML INJ SOLN,,J0461,HCPCS,Facility,Both,1,mL,,48,40.8,13.7568,48,Medica,Individual & Family,47.568,99.1,,percent of total billed charges,,
ATROPINE 0.4 MG/ML INJ SOLN,,J0461,HCPCS,Facility,Outpatient,1,mL,,48,40.8,13.7568,48,Medica,Medica Advantage Solution,23.904,49.8,,percent of total billed charges,,
ATROPINE 0.4 MG/ML INJ SOLN,,J0461,HCPCS,Facility,Inpatient,1,mL,,48,40.8,13.7568,48,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
ATROPINE 0.4 MG/ML INJ SOLN,,J0461,HCPCS,Facility,Outpatient,1,mL,,48,40.8,13.7568,48,Medica,Medical Assistance,21.408,44.6,,percent of total billed charges,,
ATROPINE 0.4 MG/ML INJ SOLN,,J0461,HCPCS,Facility,Inpatient,1,mL,,48,40.8,13.7568,48,Medica,Medical Assistance,,,,,Included in per diem rate,
ATROPINE 0.4 MG/ML INJ SOLN,,J0461,HCPCS,Facility,Outpatient,1,mL,,48,40.8,13.7568,48,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,23.904,49.8,,percent of total billed charges,,
ATROPINE 0.4 MG/ML INJ SOLN,,J0461,HCPCS,Facility,Inpatient,1,mL,,48,40.8,13.7568,48,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
ATROPINE 0.4 MG/ML INJ SOLN,,J0461,HCPCS,Facility,Both,1,mL,,48,40.8,13.7568,48,"Multiplan, Inc.","Multiplan, Inc.",45.12,94,,percent of total billed charges,,
ATROPINE 0.4 MG/ML INJ SOLN,,J0461,HCPCS,Facility,Outpatient,1,mL,,48,40.8,13.7568,48,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,43.248,90.1,,percent of total billed charges,,
ATROPINE 0.4 MG/ML INJ SOLN,,J0461,HCPCS,Facility,Inpatient,1,mL,,48,40.8,13.7568,48,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
ATROPINE 0.4 MG/ML INJ SOLN,,J0461,HCPCS,Facility,Both,1,mL,,48,40.8,13.7568,48,"Preferred One Administrative Services, INC.",PPO,47.328,98.6,,percent of total billed charges,,
ATROPINE 0.4 MG/ML INJ SOLN,,J0461,HCPCS,Facility,Outpatient,1,mL,,48,40.8,13.7568,48,PrimeWest Health,Minnesota Senior Health Options (MSHO),24.696,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
ATROPINE 0.4 MG/ML INJ SOLN,,J0461,HCPCS,Facility,Inpatient,1,mL,,48,40.8,13.7568,48,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ATROPINE 0.4 MG/ML INJ SOLN,,J0461,HCPCS,Facility,Outpatient,1,mL,,48,40.8,13.7568,48,PrimeWest Health,MinnesotaCare,24.6528,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
ATROPINE 0.4 MG/ML INJ SOLN,,J0461,HCPCS,Facility,Inpatient,1,mL,,48,40.8,13.7568,48,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
ATROPINE 0.4 MG/ML INJ SOLN,,J0461,HCPCS,Facility,Both,1,mL,,48,40.8,13.7568,48,Sanford Health Plan,Sanford Health Plan,44.16,92,,percent of total billed charges,,
ATROPINE 0.4 MG/ML INJ SOLN,,J0461,HCPCS,Facility,Outpatient,1,mL,,48,40.8,13.7568,48,"UCare Health, Inc.",Individual & Family Plan,27.048,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
ATROPINE 0.4 MG/ML INJ SOLN,,J0461,HCPCS,Facility,Inpatient,1,mL,,48,40.8,13.7568,48,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
ATROPINE 0.4 MG/ML INJ SOLN,,J0461,HCPCS,Facility,Outpatient,1,mL,,48,40.8,13.7568,48,"UCare Health, Inc.",Medical Assistance,24.2256,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ATROPINE 0.4 MG/ML INJ SOLN,,J0461,HCPCS,Facility,Inpatient,1,mL,,48,40.8,13.7568,48,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
ATROPINE 0.4 MG/ML INJ SOLN,,J0461,HCPCS,Facility,Outpatient,1,mL,,48,40.8,13.7568,48,"UCare Health, Inc.",Medicare Advantage,24.2256,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ATROPINE 0.4 MG/ML INJ SOLN,,J0461,HCPCS,Facility,Inpatient,1,mL,,48,40.8,13.7568,48,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ATROPINE 0.4 MG/ML INJ SOLN,,J0461,HCPCS,Facility,Outpatient,1,mL,,48,40.8,13.7568,48,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),24.2256,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ATROPINE 0.4 MG/ML INJ SOLN,,J0461,HCPCS,Facility,Inpatient,1,mL,,48,40.8,13.7568,48,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ATROPINE 0.4 MG/ML INJ SOLN,,J0461,HCPCS,Facility,Both,1,mL,,48,40.8,13.7568,48,UnitedHealthcare,Individual & Family,45.12,94,,percent of total billed charges,,
ATROPINE 0.4 MG/ML INJ SOLN,,J0461,HCPCS,Facility,Outpatient,1,mL,,48,40.8,13.7568,48,UnitedHealthcare,Medicare Advantage,23.52,49,,percent of total billed charges,,
ATROPINE 0.4 MG/ML INJ SOLN,,J0461,HCPCS,Facility,Inpatient,1,mL,,48,40.8,13.7568,48,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
ATROPINE 0.4 MG/ML INJ SOLN,,J0461,HCPCS,Facility,Outpatient,1,mL,,48,40.8,13.7568,48,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,23.04,48,,percent of total billed charges,,100% of DHS outpatient percentage
ATROPINE 0.4 MG/ML INJ SOLN,,J0461,HCPCS,Facility,Inpatient,1,mL,,48,40.8,13.7568,48,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Closed Treatment Of Carpometacarpal Dislocation, Thumb, With Manipulation (Pro Cah)",,26641,CPT,Professional,Both,,,,1202,1021.7,246.07,1202,Aetna,Commercial,1021.7,85,,percent of total billed charges,,
"Closed Treatment Of Carpometacarpal Dislocation, Thumb, With Manipulation (Pro Cah)",,26641,CPT,Professional,Both,,,,1202,1021.7,246.07,1202,Aetna,Medicare Advantage,379.24,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Closed Treatment Of Carpometacarpal Dislocation, Thumb, With Manipulation (Pro Cah)",,26641,CPT,Professional,Both,,,,1202,1021.7,246.07,1202,Aetna,PPO,1117.86,93,,percent of total billed charges,,
"Closed Treatment Of Carpometacarpal Dislocation, Thumb, With Manipulation (Pro Cah)",,26641,CPT,Professional,Both,,,,1202,1021.7,246.07,1202,America's PPO,America's PPO,1026.9888,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Closed Treatment Of Carpometacarpal Dislocation, Thumb, With Manipulation (Pro Cah)",,26641,CPT,Professional,Both,,,,1202,1021.7,246.07,1202,BlueCross BlueShield Minnesota, Federal Employee Program,806.35,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Closed Treatment Of Carpometacarpal Dislocation, Thumb, With Manipulation (Pro Cah)",,26641,CPT,Professional,Both,,,,1202,1021.7,246.07,1202,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,819.2516,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Closed Treatment Of Carpometacarpal Dislocation, Thumb, With Manipulation (Pro Cah)",,26641,CPT,Professional,Both,,,,1202,1021.7,246.07,1202,BlueCross BlueShield Minnesota,High Value Network Plan,819.2516,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Closed Treatment Of Carpometacarpal Dislocation, Thumb, With Manipulation (Pro Cah)",,26641,CPT,Professional,Both,,,,1202,1021.7,246.07,1202,BlueCross BlueShield Minnesota,Medicare Advantage,439.806,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Closed Treatment Of Carpometacarpal Dislocation, Thumb, With Manipulation (Pro Cah)",,26641,CPT,Professional,Both,,,,1202,1021.7,246.07,1202,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,819.2516,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Closed Treatment Of Carpometacarpal Dislocation, Thumb, With Manipulation (Pro Cah)",,26641,CPT,Professional,Both,,,,1202,1021.7,246.07,1202,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,284.10408,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Closed Treatment Of Carpometacarpal Dislocation, Thumb, With Manipulation (Pro Cah)",,26641,CPT,Professional,Both,,,,1202,1021.7,246.07,1202,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),439.806,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Closed Treatment Of Carpometacarpal Dislocation, Thumb, With Manipulation (Pro Cah)",,26641,CPT,Professional,Both,,,,1202,1021.7,246.07,1202,CorVel,Worker's Compensation,741.4452978,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Closed Treatment Of Carpometacarpal Dislocation, Thumb, With Manipulation (Pro Cah)",,26641,CPT,Professional,Both,,,,1202,1021.7,246.07,1202,First Health Group Corporation,First Health Network,1165.94,97,,percent of total billed charges,,
"Closed Treatment Of Carpometacarpal Dislocation, Thumb, With Manipulation (Pro Cah)",,26641,CPT,Professional,Both,,,,1202,1021.7,246.07,1202,"Health Partners, Inc.",Commercial,800.25,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Closed Treatment Of Carpometacarpal Dislocation, Thumb, With Manipulation (Pro Cah)",,26641,CPT,Professional,Both,,,,1202,1021.7,246.07,1202,"Health Partners, Inc.",Medicare Advantage,439.806,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Closed Treatment Of Carpometacarpal Dislocation, Thumb, With Manipulation (Pro Cah)",,26641,CPT,Professional,Both,,,,1202,1021.7,246.07,1202,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),382.59,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Closed Treatment Of Carpometacarpal Dislocation, Thumb, With Manipulation (Pro Cah)",,26641,CPT,Professional,Both,,,,1202,1021.7,246.07,1202,"Health Partners, Inc.",State of Minnesota Advantage Program,689.415375,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Closed Treatment Of Carpometacarpal Dislocation, Thumb, With Manipulation (Pro Cah)",,26641,CPT,Professional,Both,,,,1202,1021.7,246.07,1202,"Health Partners, Inc.",State Public Programs,246.07,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Closed Treatment Of Carpometacarpal Dislocation, Thumb, With Manipulation (Pro Cah)",,26641,CPT,Professional,Both,,,,1202,1021.7,246.07,1202,Humana Insurance Company,Commercial PPO,382.44,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Closed Treatment Of Carpometacarpal Dislocation, Thumb, With Manipulation (Pro Cah)",,26641,CPT,Professional,Both,,,,1202,1021.7,246.07,1202,Humana Insurance Company,Medicare PPO,1202,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Closed Treatment Of Carpometacarpal Dislocation, Thumb, With Manipulation (Pro Cah)",,26641,CPT,Professional,Both,,,,1202,1021.7,246.07,1202,Medica,Individual & Family,1019.296,84.8,,percent of total billed charges,,
"Closed Treatment Of Carpometacarpal Dislocation, Thumb, With Manipulation (Pro Cah)",,26641,CPT,Professional,Both,,,,1202,1021.7,246.07,1202,Medica,Medica Advantage Solution,598.596,49.8,,percent of total billed charges,,
"Closed Treatment Of Carpometacarpal Dislocation, Thumb, With Manipulation (Pro Cah)",,26641,CPT,Professional,Both,,,,1202,1021.7,246.07,1202,Medica,Medical Assistance,284.1,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Closed Treatment Of Carpometacarpal Dislocation, Thumb, With Manipulation (Pro Cah)",,26641,CPT,Professional,Both,,,,1202,1021.7,246.07,1202,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,382.44,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Closed Treatment Of Carpometacarpal Dislocation, Thumb, With Manipulation (Pro Cah)",,26641,CPT,Professional,Both,,,,1202,1021.7,246.07,1202,"Multiplan, Inc.","Multiplan, Inc.",1129.88,94,,percent of total billed charges,,
"Closed Treatment Of Carpometacarpal Dislocation, Thumb, With Manipulation (Pro Cah)",,26641,CPT,Professional,Both,,,,1202,1021.7,246.07,1202,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1083.002,90.1,,percent of total billed charges,,
"Closed Treatment Of Carpometacarpal Dislocation, Thumb, With Manipulation (Pro Cah)",,26641,CPT,Professional,Both,,,,1202,1021.7,246.07,1202,"Preferred One Administrative Services, INC.",PPO,1185.172,98.6,,percent of total billed charges,,
"Closed Treatment Of Carpometacarpal Dislocation, Thumb, With Manipulation (Pro Cah)",,26641,CPT,Professional,Both,,,,1202,1021.7,246.07,1202,PrimeWest Health,Minnesota Senior Health Options (MSHO),439.806,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Closed Treatment Of Carpometacarpal Dislocation, Thumb, With Manipulation (Pro Cah)",,26641,CPT,Professional,Both,,,,1202,1021.7,246.07,1202,PrimeWest Health,MinnesotaCare,303.9913656,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Closed Treatment Of Carpometacarpal Dislocation, Thumb, With Manipulation (Pro Cah)",,26641,CPT,Professional,Both,,,,1202,1021.7,246.07,1202,Sanford Health Plan,Sanford Health Plan,1057.76,88,,percent of total billed charges,,
"Closed Treatment Of Carpometacarpal Dislocation, Thumb, With Manipulation (Pro Cah)",,26641,CPT,Professional,Both,,,,1202,1021.7,246.07,1202,"UCare Health, Inc.",Individual & Family Plan,621.694464,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Closed Treatment Of Carpometacarpal Dislocation, Thumb, With Manipulation (Pro Cah)",,26641,CPT,Professional,Both,,,,1202,1021.7,246.07,1202,"UCare Health, Inc.",Medical Assistance,312.514488,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Closed Treatment Of Carpometacarpal Dislocation, Thumb, With Manipulation (Pro Cah)",,26641,CPT,Professional,Both,,,,1202,1021.7,246.07,1202,"UCare Health, Inc.",Medicare Advantage,439.806,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Closed Treatment Of Carpometacarpal Dislocation, Thumb, With Manipulation (Pro Cah)",,26641,CPT,Professional,Both,,,,1202,1021.7,246.07,1202,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),351.8448,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Closed Treatment Of Carpometacarpal Dislocation, Thumb, With Manipulation (Pro Cah)",,26641,CPT,Professional,Both,,,,1202,1021.7,246.07,1202,UnitedHealthcare,Individual & Family,1202,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Closed Treatment Of Carpometacarpal Dislocation, Thumb, With Manipulation (Pro Cah)",,26641,CPT,Professional,Both,,,,1202,1021.7,246.07,1202,UnitedHealthcare,Medicare Advantage,439.806,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Closed Treatment Of Carpometacarpal Dislocation, Thumb, With Manipulation (Pro Cah)",,26641,CPT,Professional,Both,,,,1202,1021.7,246.07,1202,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,284.10408,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Closed Treatment Articular Fracture,Involving Metacarpo/Interphalangeal Joint; Wo Manip,Ea (Pro Cah)",,26740,CPT,Professional,Both,,,,663,563.55,144.85,663,Aetna,Commercial,563.55,85,,percent of total billed charges,,
"Closed Treatment Articular Fracture,Involving Metacarpo/Interphalangeal Joint; Wo Manip,Ea (Pro Cah)",,26740,CPT,Professional,Both,,,,663,563.55,144.85,663,Aetna,Medicare Advantage,221,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Closed Treatment Articular Fracture,Involving Metacarpo/Interphalangeal Joint; Wo Manip,Ea (Pro Cah)",,26740,CPT,Professional,Both,,,,663,563.55,144.85,663,Aetna,PPO,616.59,93,,percent of total billed charges,,
"Closed Treatment Articular Fracture,Involving Metacarpo/Interphalangeal Joint; Wo Manip,Ea (Pro Cah)",,26740,CPT,Professional,Both,,,,663,563.55,144.85,663,America's PPO,America's PPO,566.4672,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Closed Treatment Articular Fracture,Involving Metacarpo/Interphalangeal Joint; Wo Manip,Ea (Pro Cah)",,26740,CPT,Professional,Both,,,,663,563.55,144.85,663,BlueCross BlueShield Minnesota, Federal Employee Program,468.94,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Closed Treatment Articular Fracture,Involving Metacarpo/Interphalangeal Joint; Wo Manip,Ea (Pro Cah)",,26740,CPT,Professional,Both,,,,663,563.55,144.85,663,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,476.44304,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Closed Treatment Articular Fracture,Involving Metacarpo/Interphalangeal Joint; Wo Manip,Ea (Pro Cah)",,26740,CPT,Professional,Both,,,,663,563.55,144.85,663,BlueCross BlueShield Minnesota,High Value Network Plan,476.44304,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Closed Treatment Articular Fracture,Involving Metacarpo/Interphalangeal Joint; Wo Manip,Ea (Pro Cah)",,26740,CPT,Professional,Both,,,,663,563.55,144.85,663,BlueCross BlueShield Minnesota,Medicare Advantage,258.5085,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Closed Treatment Articular Fracture,Involving Metacarpo/Interphalangeal Joint; Wo Manip,Ea (Pro Cah)",,26740,CPT,Professional,Both,,,,663,563.55,144.85,663,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,476.44304,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Closed Treatment Articular Fracture,Involving Metacarpo/Interphalangeal Joint; Wo Manip,Ea (Pro Cah)",,26740,CPT,Professional,Both,,,,663,563.55,144.85,663,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,167.2336,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Closed Treatment Articular Fracture,Involving Metacarpo/Interphalangeal Joint; Wo Manip,Ea (Pro Cah)",,26740,CPT,Professional,Both,,,,663,563.55,144.85,663,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),258.5085,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Closed Treatment Articular Fracture,Involving Metacarpo/Interphalangeal Joint; Wo Manip,Ea (Pro Cah)",,26740,CPT,Professional,Both,,,,663,563.55,144.85,663,CorVel,Worker's Compensation,432.0293796,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Closed Treatment Articular Fracture,Involving Metacarpo/Interphalangeal Joint; Wo Manip,Ea (Pro Cah)",,26740,CPT,Professional,Both,,,,663,563.55,144.85,663,First Health Group Corporation,First Health Network,643.11,97,,percent of total billed charges,,
"Closed Treatment Articular Fracture,Involving Metacarpo/Interphalangeal Joint; Wo Manip,Ea (Pro Cah)",,26740,CPT,Professional,Both,,,,663,563.55,144.85,663,"Health Partners, Inc.",Commercial,466.52,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Closed Treatment Articular Fracture,Involving Metacarpo/Interphalangeal Joint; Wo Manip,Ea (Pro Cah)",,26740,CPT,Professional,Both,,,,663,563.55,144.85,663,"Health Partners, Inc.",Medicare Advantage,258.5085,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Closed Treatment Articular Fracture,Involving Metacarpo/Interphalangeal Joint; Wo Manip,Ea (Pro Cah)",,26740,CPT,Professional,Both,,,,663,563.55,144.85,663,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),224.67,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Closed Treatment Articular Fracture,Involving Metacarpo/Interphalangeal Joint; Wo Manip,Ea (Pro Cah)",,26740,CPT,Professional,Both,,,,663,563.55,144.85,663,"Health Partners, Inc.",State of Minnesota Advantage Program,401.90698,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Closed Treatment Articular Fracture,Involving Metacarpo/Interphalangeal Joint; Wo Manip,Ea (Pro Cah)",,26740,CPT,Professional,Both,,,,663,563.55,144.85,663,"Health Partners, Inc.",State Public Programs,144.85,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Closed Treatment Articular Fracture,Involving Metacarpo/Interphalangeal Joint; Wo Manip,Ea (Pro Cah)",,26740,CPT,Professional,Both,,,,663,563.55,144.85,663,Humana Insurance Company,Commercial PPO,224.79,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Closed Treatment Articular Fracture,Involving Metacarpo/Interphalangeal Joint; Wo Manip,Ea (Pro Cah)",,26740,CPT,Professional,Both,,,,663,563.55,144.85,663,Humana Insurance Company,Medicare PPO,663,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Closed Treatment Articular Fracture,Involving Metacarpo/Interphalangeal Joint; Wo Manip,Ea (Pro Cah)",,26740,CPT,Professional,Both,,,,663,563.55,144.85,663,Medica,Individual & Family,562.224,84.8,,percent of total billed charges,,
"Closed Treatment Articular Fracture,Involving Metacarpo/Interphalangeal Joint; Wo Manip,Ea (Pro Cah)",,26740,CPT,Professional,Both,,,,663,563.55,144.85,663,Medica,Medica Advantage Solution,330.174,49.8,,percent of total billed charges,,
"Closed Treatment Articular Fracture,Involving Metacarpo/Interphalangeal Joint; Wo Manip,Ea (Pro Cah)",,26740,CPT,Professional,Both,,,,663,563.55,144.85,663,Medica,Medical Assistance,167.23,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Closed Treatment Articular Fracture,Involving Metacarpo/Interphalangeal Joint; Wo Manip,Ea (Pro Cah)",,26740,CPT,Professional,Both,,,,663,563.55,144.85,663,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,224.79,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Closed Treatment Articular Fracture,Involving Metacarpo/Interphalangeal Joint; Wo Manip,Ea (Pro Cah)",,26740,CPT,Professional,Both,,,,663,563.55,144.85,663,"Multiplan, Inc.","Multiplan, Inc.",623.22,94,,percent of total billed charges,,
"Closed Treatment Articular Fracture,Involving Metacarpo/Interphalangeal Joint; Wo Manip,Ea (Pro Cah)",,26740,CPT,Professional,Both,,,,663,563.55,144.85,663,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,597.363,90.1,,percent of total billed charges,,
"Closed Treatment Articular Fracture,Involving Metacarpo/Interphalangeal Joint; Wo Manip,Ea (Pro Cah)",,26740,CPT,Professional,Both,,,,663,563.55,144.85,663,"Preferred One Administrative Services, INC.",PPO,653.718,98.6,,percent of total billed charges,,
"Closed Treatment Articular Fracture,Involving Metacarpo/Interphalangeal Joint; Wo Manip,Ea (Pro Cah)",,26740,CPT,Professional,Both,,,,663,563.55,144.85,663,PrimeWest Health,Minnesota Senior Health Options (MSHO),258.5085,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Closed Treatment Articular Fracture,Involving Metacarpo/Interphalangeal Joint; Wo Manip,Ea (Pro Cah)",,26740,CPT,Professional,Both,,,,663,563.55,144.85,663,PrimeWest Health,MinnesotaCare,178.939952,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Closed Treatment Articular Fracture,Involving Metacarpo/Interphalangeal Joint; Wo Manip,Ea (Pro Cah)",,26740,CPT,Professional,Both,,,,663,563.55,144.85,663,Sanford Health Plan,Sanford Health Plan,583.44,88,,percent of total billed charges,,
"Closed Treatment Articular Fracture,Involving Metacarpo/Interphalangeal Joint; Wo Manip,Ea (Pro Cah)",,26740,CPT,Professional,Both,,,,663,563.55,144.85,663,"UCare Health, Inc.",Individual & Family Plan,365.418624,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Closed Treatment Articular Fracture,Involving Metacarpo/Interphalangeal Joint; Wo Manip,Ea (Pro Cah)",,26740,CPT,Professional,Both,,,,663,563.55,144.85,663,"UCare Health, Inc.",Medical Assistance,183.95696,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Closed Treatment Articular Fracture,Involving Metacarpo/Interphalangeal Joint; Wo Manip,Ea (Pro Cah)",,26740,CPT,Professional,Both,,,,663,563.55,144.85,663,"UCare Health, Inc.",Medicare Advantage,258.5085,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Closed Treatment Articular Fracture,Involving Metacarpo/Interphalangeal Joint; Wo Manip,Ea (Pro Cah)",,26740,CPT,Professional,Both,,,,663,563.55,144.85,663,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),206.8068,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Closed Treatment Articular Fracture,Involving Metacarpo/Interphalangeal Joint; Wo Manip,Ea (Pro Cah)",,26740,CPT,Professional,Both,,,,663,563.55,144.85,663,UnitedHealthcare,Individual & Family,663,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Closed Treatment Articular Fracture,Involving Metacarpo/Interphalangeal Joint; Wo Manip,Ea (Pro Cah)",,26740,CPT,Professional,Both,,,,663,563.55,144.85,663,UnitedHealthcare,Medicare Advantage,258.5085,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Closed Treatment Articular Fracture,Involving Metacarpo/Interphalangeal Joint; Wo Manip,Ea (Pro Cah)",,26740,CPT,Professional,Both,,,,663,563.55,144.85,663,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,167.2336,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Arthrotomy, With Synovectomy, Knee; Anterior And Posterior Including Popliteal Area (Pro Cah)",,27335,CPT,Professional,Both,,,,5000,4250,476.66,5000,Aetna,Commercial,4250,85,,percent of total billed charges,,
"Arthrotomy, With Synovectomy, Knee; Anterior And Posterior Including Popliteal Area (Pro Cah)",,27335,CPT,Professional,Both,,,,5000,4250,476.66,5000,Aetna,Medicare Advantage,747.46,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Arthrotomy, With Synovectomy, Knee; Anterior And Posterior Including Popliteal Area (Pro Cah)",,27335,CPT,Professional,Both,,,,5000,4250,476.66,5000,Aetna,PPO,4650,93,,percent of total billed charges,,
"Arthrotomy, With Synovectomy, Knee; Anterior And Posterior Including Popliteal Area (Pro Cah)",,27335,CPT,Professional,Both,,,,5000,4250,476.66,5000,America's PPO,America's PPO,4272,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Arthrotomy, With Synovectomy, Knee; Anterior And Posterior Including Popliteal Area (Pro Cah)",,27335,CPT,Professional,Both,,,,5000,4250,476.66,5000,BlueCross BlueShield Minnesota, Federal Employee Program,1588.6,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Arthrotomy, With Synovectomy, Knee; Anterior And Posterior Including Popliteal Area (Pro Cah)",,27335,CPT,Professional,Both,,,,5000,4250,476.66,5000,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1614.0176,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Arthrotomy, With Synovectomy, Knee; Anterior And Posterior Including Popliteal Area (Pro Cah)",,27335,CPT,Professional,Both,,,,5000,4250,476.66,5000,BlueCross BlueShield Minnesota,High Value Network Plan,1614.0176,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Arthrotomy, With Synovectomy, Knee; Anterior And Posterior Including Popliteal Area (Pro Cah)",,27335,CPT,Professional,Both,,,,5000,4250,476.66,5000,BlueCross BlueShield Minnesota,Medicare Advantage,851.598,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Arthrotomy, With Synovectomy, Knee; Anterior And Posterior Including Popliteal Area (Pro Cah)",,27335,CPT,Professional,Both,,,,5000,4250,476.66,5000,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1614.0176,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Arthrotomy, With Synovectomy, Knee; Anterior And Posterior Including Popliteal Area (Pro Cah)",,27335,CPT,Professional,Both,,,,5000,4250,476.66,5000,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,550.32656,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Arthrotomy, With Synovectomy, Knee; Anterior And Posterior Including Popliteal Area (Pro Cah)",,27335,CPT,Professional,Both,,,,5000,4250,476.66,5000,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),851.598,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Arthrotomy, With Synovectomy, Knee; Anterior And Posterior Including Popliteal Area (Pro Cah)",,27335,CPT,Professional,Both,,,,5000,4250,476.66,5000,CorVel,Worker's Compensation,1446.652381,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Arthrotomy, With Synovectomy, Knee; Anterior And Posterior Including Popliteal Area (Pro Cah)",,27335,CPT,Professional,Both,,,,5000,4250,476.66,5000,First Health Group Corporation,First Health Network,4850,97,,percent of total billed charges,,
"Arthrotomy, With Synovectomy, Knee; Anterior And Posterior Including Popliteal Area (Pro Cah)",,27335,CPT,Professional,Both,,,,5000,4250,476.66,5000,"Health Partners, Inc.",Commercial,1562.78,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Arthrotomy, With Synovectomy, Knee; Anterior And Posterior Including Popliteal Area (Pro Cah)",,27335,CPT,Professional,Both,,,,5000,4250,476.66,5000,"Health Partners, Inc.",Medicare Advantage,851.598,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Arthrotomy, With Synovectomy, Knee; Anterior And Posterior Including Popliteal Area (Pro Cah)",,27335,CPT,Professional,Both,,,,5000,4250,476.66,5000,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),740.44,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Arthrotomy, With Synovectomy, Knee; Anterior And Posterior Including Popliteal Area (Pro Cah)",,27335,CPT,Professional,Both,,,,5000,4250,476.66,5000,"Health Partners, Inc.",State of Minnesota Advantage Program,1346.33497,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Arthrotomy, With Synovectomy, Knee; Anterior And Posterior Including Popliteal Area (Pro Cah)",,27335,CPT,Professional,Both,,,,5000,4250,476.66,5000,"Health Partners, Inc.",State Public Programs,476.66,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Arthrotomy, With Synovectomy, Knee; Anterior And Posterior Including Popliteal Area (Pro Cah)",,27335,CPT,Professional,Both,,,,5000,4250,476.66,5000,Humana Insurance Company,Commercial PPO,740.52,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Arthrotomy, With Synovectomy, Knee; Anterior And Posterior Including Popliteal Area (Pro Cah)",,27335,CPT,Professional,Both,,,,5000,4250,476.66,5000,Humana Insurance Company,Medicare PPO,5000,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Arthrotomy, With Synovectomy, Knee; Anterior And Posterior Including Popliteal Area (Pro Cah)",,27335,CPT,Professional,Both,,,,5000,4250,476.66,5000,Medica,Individual & Family,4240,84.8,,percent of total billed charges,,
"Arthrotomy, With Synovectomy, Knee; Anterior And Posterior Including Popliteal Area (Pro Cah)",,27335,CPT,Professional,Both,,,,5000,4250,476.66,5000,Medica,Medica Advantage Solution,2490,49.8,,percent of total billed charges,,
"Arthrotomy, With Synovectomy, Knee; Anterior And Posterior Including Popliteal Area (Pro Cah)",,27335,CPT,Professional,Both,,,,5000,4250,476.66,5000,Medica,Medical Assistance,550.33,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Arthrotomy, With Synovectomy, Knee; Anterior And Posterior Including Popliteal Area (Pro Cah)",,27335,CPT,Professional,Both,,,,5000,4250,476.66,5000,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,740.52,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Arthrotomy, With Synovectomy, Knee; Anterior And Posterior Including Popliteal Area (Pro Cah)",,27335,CPT,Professional,Both,,,,5000,4250,476.66,5000,"Multiplan, Inc.","Multiplan, Inc.",4700,94,,percent of total billed charges,,
"Arthrotomy, With Synovectomy, Knee; Anterior And Posterior Including Popliteal Area (Pro Cah)",,27335,CPT,Professional,Both,,,,5000,4250,476.66,5000,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4505,90.1,,percent of total billed charges,,
"Arthrotomy, With Synovectomy, Knee; Anterior And Posterior Including Popliteal Area (Pro Cah)",,27335,CPT,Professional,Both,,,,5000,4250,476.66,5000,"Preferred One Administrative Services, INC.",PPO,4930,98.6,,percent of total billed charges,,
"Arthrotomy, With Synovectomy, Knee; Anterior And Posterior Including Popliteal Area (Pro Cah)",,27335,CPT,Professional,Both,,,,5000,4250,476.66,5000,PrimeWest Health,Minnesota Senior Health Options (MSHO),851.598,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Arthrotomy, With Synovectomy, Knee; Anterior And Posterior Including Popliteal Area (Pro Cah)",,27335,CPT,Professional,Both,,,,5000,4250,476.66,5000,PrimeWest Health,MinnesotaCare,588.8494192,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Arthrotomy, With Synovectomy, Knee; Anterior And Posterior Including Popliteal Area (Pro Cah)",,27335,CPT,Professional,Both,,,,5000,4250,476.66,5000,Sanford Health Plan,Sanford Health Plan,4400,88,,percent of total billed charges,,
"Arthrotomy, With Synovectomy, Knee; Anterior And Posterior Including Popliteal Area (Pro Cah)",,27335,CPT,Professional,Both,,,,5000,4250,476.66,5000,"UCare Health, Inc.",Individual & Family Plan,1203.789312,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Arthrotomy, With Synovectomy, Knee; Anterior And Posterior Including Popliteal Area (Pro Cah)",,27335,CPT,Professional,Both,,,,5000,4250,476.66,5000,"UCare Health, Inc.",Medical Assistance,605.359216,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Arthrotomy, With Synovectomy, Knee; Anterior And Posterior Including Popliteal Area (Pro Cah)",,27335,CPT,Professional,Both,,,,5000,4250,476.66,5000,"UCare Health, Inc.",Medicare Advantage,851.598,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Arthrotomy, With Synovectomy, Knee; Anterior And Posterior Including Popliteal Area (Pro Cah)",,27335,CPT,Professional,Both,,,,5000,4250,476.66,5000,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),681.2784,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Arthrotomy, With Synovectomy, Knee; Anterior And Posterior Including Popliteal Area (Pro Cah)",,27335,CPT,Professional,Both,,,,5000,4250,476.66,5000,UnitedHealthcare,Individual & Family,5000,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Arthrotomy, With Synovectomy, Knee; Anterior And Posterior Including Popliteal Area (Pro Cah)",,27335,CPT,Professional,Both,,,,5000,4250,476.66,5000,UnitedHealthcare,Medicare Advantage,851.598,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Arthrotomy, With Synovectomy, Knee; Anterior And Posterior Including Popliteal Area (Pro Cah)",,27335,CPT,Professional,Both,,,,5000,4250,476.66,5000,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,550.32656,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Arthroplasty, Knee, Condyle And Plateau; Medial Or Lateral Compartment (Pro Cah)",,27446,CPT,Professional,Both,,,,5145,4373.25,704.4,5145,Aetna,Commercial,4373.25,85,,percent of total billed charges,,
"Arthroplasty, Knee, Condyle And Plateau; Medial Or Lateral Compartment (Pro Cah)",,27446,CPT,Professional,Both,,,,5145,4373.25,704.4,5145,Aetna,Medicare Advantage,1115.7,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Arthroplasty, Knee, Condyle And Plateau; Medial Or Lateral Compartment (Pro Cah)",,27446,CPT,Professional,Both,,,,5145,4373.25,704.4,5145,Aetna,PPO,4784.85,93,,percent of total billed charges,,
"Arthroplasty, Knee, Condyle And Plateau; Medial Or Lateral Compartment (Pro Cah)",,27446,CPT,Professional,Both,,,,5145,4373.25,704.4,5145,America's PPO,America's PPO,4395.888,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Arthroplasty, Knee, Condyle And Plateau; Medial Or Lateral Compartment (Pro Cah)",,27446,CPT,Professional,Both,,,,5145,4373.25,704.4,5145,BlueCross BlueShield Minnesota, Federal Employee Program,2363.96,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Arthroplasty, Knee, Condyle And Plateau; Medial Or Lateral Compartment (Pro Cah)",,27446,CPT,Professional,Both,,,,5145,4373.25,704.4,5145,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,2401.78336,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Arthroplasty, Knee, Condyle And Plateau; Medial Or Lateral Compartment (Pro Cah)",,27446,CPT,Professional,Both,,,,5145,4373.25,704.4,5145,BlueCross BlueShield Minnesota,High Value Network Plan,2401.78336,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Arthroplasty, Knee, Condyle And Plateau; Medial Or Lateral Compartment (Pro Cah)",,27446,CPT,Professional,Both,,,,5145,4373.25,704.4,5145,BlueCross BlueShield Minnesota,Medicare Advantage,1258.491,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Arthroplasty, Knee, Condyle And Plateau; Medial Or Lateral Compartment (Pro Cah)",,27446,CPT,Professional,Both,,,,5145,4373.25,704.4,5145,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,2401.78336,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Arthroplasty, Knee, Condyle And Plateau; Medial Or Lateral Compartment (Pro Cah)",,27446,CPT,Professional,Both,,,,5145,4373.25,704.4,5145,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,813.26736,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Arthroplasty, Knee, Condyle And Plateau; Medial Or Lateral Compartment (Pro Cah)",,27446,CPT,Professional,Both,,,,5145,4373.25,704.4,5145,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1258.491,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Arthroplasty, Knee, Condyle And Plateau; Medial Or Lateral Compartment (Pro Cah)",,27446,CPT,Professional,Both,,,,5145,4373.25,704.4,5145,CorVel,Worker's Compensation,2152.187253,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Arthroplasty, Knee, Condyle And Plateau; Medial Or Lateral Compartment (Pro Cah)",,27446,CPT,Professional,Both,,,,5145,4373.25,704.4,5145,First Health Group Corporation,First Health Network,4990.65,97,,percent of total billed charges,,
"Arthroplasty, Knee, Condyle And Plateau; Medial Or Lateral Compartment (Pro Cah)",,27446,CPT,Professional,Both,,,,5145,4373.25,704.4,5145,"Health Partners, Inc.",Commercial,2324.59,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Arthroplasty, Knee, Condyle And Plateau; Medial Or Lateral Compartment (Pro Cah)",,27446,CPT,Professional,Both,,,,5145,4373.25,704.4,5145,"Health Partners, Inc.",Medicare Advantage,1258.491,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Arthroplasty, Knee, Condyle And Plateau; Medial Or Lateral Compartment (Pro Cah)",,27446,CPT,Professional,Both,,,,5145,4373.25,704.4,5145,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1094.22,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Arthroplasty, Knee, Condyle And Plateau; Medial Or Lateral Compartment (Pro Cah)",,27446,CPT,Professional,Both,,,,5145,4373.25,704.4,5145,"Health Partners, Inc.",State of Minnesota Advantage Program,2002.634285,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Arthroplasty, Knee, Condyle And Plateau; Medial Or Lateral Compartment (Pro Cah)",,27446,CPT,Professional,Both,,,,5145,4373.25,704.4,5145,"Health Partners, Inc.",State Public Programs,704.4,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Arthroplasty, Knee, Condyle And Plateau; Medial Or Lateral Compartment (Pro Cah)",,27446,CPT,Professional,Both,,,,5145,4373.25,704.4,5145,Humana Insurance Company,Commercial PPO,1094.34,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Arthroplasty, Knee, Condyle And Plateau; Medial Or Lateral Compartment (Pro Cah)",,27446,CPT,Professional,Both,,,,5145,4373.25,704.4,5145,Humana Insurance Company,Medicare PPO,5145,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Arthroplasty, Knee, Condyle And Plateau; Medial Or Lateral Compartment (Pro Cah)",,27446,CPT,Professional,Both,,,,5145,4373.25,704.4,5145,Medica,Individual & Family,4362.96,84.8,,percent of total billed charges,,
"Arthroplasty, Knee, Condyle And Plateau; Medial Or Lateral Compartment (Pro Cah)",,27446,CPT,Professional,Both,,,,5145,4373.25,704.4,5145,Medica,Medica Advantage Solution,2562.21,49.8,,percent of total billed charges,,
"Arthroplasty, Knee, Condyle And Plateau; Medial Or Lateral Compartment (Pro Cah)",,27446,CPT,Professional,Both,,,,5145,4373.25,704.4,5145,Medica,Medical Assistance,813.27,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Arthroplasty, Knee, Condyle And Plateau; Medial Or Lateral Compartment (Pro Cah)",,27446,CPT,Professional,Both,,,,5145,4373.25,704.4,5145,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1094.34,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Arthroplasty, Knee, Condyle And Plateau; Medial Or Lateral Compartment (Pro Cah)",,27446,CPT,Professional,Both,,,,5145,4373.25,704.4,5145,"Multiplan, Inc.","Multiplan, Inc.",4836.3,94,,percent of total billed charges,,
"Arthroplasty, Knee, Condyle And Plateau; Medial Or Lateral Compartment (Pro Cah)",,27446,CPT,Professional,Both,,,,5145,4373.25,704.4,5145,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4635.645,90.1,,percent of total billed charges,,
"Arthroplasty, Knee, Condyle And Plateau; Medial Or Lateral Compartment (Pro Cah)",,27446,CPT,Professional,Both,,,,5145,4373.25,704.4,5145,"Preferred One Administrative Services, INC.",PPO,5072.97,98.6,,percent of total billed charges,,
"Arthroplasty, Knee, Condyle And Plateau; Medial Or Lateral Compartment (Pro Cah)",,27446,CPT,Professional,Both,,,,5145,4373.25,704.4,5145,PrimeWest Health,Minnesota Senior Health Options (MSHO),1258.491,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Arthroplasty, Knee, Condyle And Plateau; Medial Or Lateral Compartment (Pro Cah)",,27446,CPT,Professional,Both,,,,5145,4373.25,704.4,5145,PrimeWest Health,MinnesotaCare,870.1960752,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Arthroplasty, Knee, Condyle And Plateau; Medial Or Lateral Compartment (Pro Cah)",,27446,CPT,Professional,Both,,,,5145,4373.25,704.4,5145,Sanford Health Plan,Sanford Health Plan,4527.6,88,,percent of total billed charges,,
"Arthroplasty, Knee, Condyle And Plateau; Medial Or Lateral Compartment (Pro Cah)",,27446,CPT,Professional,Both,,,,5145,4373.25,704.4,5145,"UCare Health, Inc.",Individual & Family Plan,1778.959104,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Arthroplasty, Knee, Condyle And Plateau; Medial Or Lateral Compartment (Pro Cah)",,27446,CPT,Professional,Both,,,,5145,4373.25,704.4,5145,"UCare Health, Inc.",Medical Assistance,894.594096,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Arthroplasty, Knee, Condyle And Plateau; Medial Or Lateral Compartment (Pro Cah)",,27446,CPT,Professional,Both,,,,5145,4373.25,704.4,5145,"UCare Health, Inc.",Medicare Advantage,1258.491,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Arthroplasty, Knee, Condyle And Plateau; Medial Or Lateral Compartment (Pro Cah)",,27446,CPT,Professional,Both,,,,5145,4373.25,704.4,5145,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1006.7928,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Arthroplasty, Knee, Condyle And Plateau; Medial Or Lateral Compartment (Pro Cah)",,27446,CPT,Professional,Both,,,,5145,4373.25,704.4,5145,UnitedHealthcare,Individual & Family,5145,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Arthroplasty, Knee, Condyle And Plateau; Medial Or Lateral Compartment (Pro Cah)",,27446,CPT,Professional,Both,,,,5145,4373.25,704.4,5145,UnitedHealthcare,Medicare Advantage,1258.491,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Arthroplasty, Knee, Condyle And Plateau; Medial Or Lateral Compartment (Pro Cah)",,27446,CPT,Professional,Both,,,,5145,4373.25,704.4,5145,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,813.26736,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Arthroplasty, Knee, Condyle And Plateau; Medial And Lateral Compart W/Wo Patella Resurface (Pro Cah)",,27447,CPT,Professional,Both,,,,7130,6060.5,784.91,7130,Aetna,Commercial,6060.5,85,,percent of total billed charges,,
"Arthroplasty, Knee, Condyle And Plateau; Medial And Lateral Compart W/Wo Patella Resurface (Pro Cah)",,27447,CPT,Professional,Both,,,,7130,6060.5,784.91,7130,Aetna,Medicare Advantage,1239.63,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Arthroplasty, Knee, Condyle And Plateau; Medial And Lateral Compart W/Wo Patella Resurface (Pro Cah)",,27447,CPT,Professional,Both,,,,7130,6060.5,784.91,7130,Aetna,PPO,6630.9,93,,percent of total billed charges,,
"Arthroplasty, Knee, Condyle And Plateau; Medial And Lateral Compart W/Wo Patella Resurface (Pro Cah)",,27447,CPT,Professional,Both,,,,7130,6060.5,784.91,7130,America's PPO,America's PPO,6091.872,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Arthroplasty, Knee, Condyle And Plateau; Medial And Lateral Compart W/Wo Patella Resurface (Pro Cah)",,27447,CPT,Professional,Both,,,,7130,6060.5,784.91,7130,BlueCross BlueShield Minnesota, Federal Employee Program,2640.78,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Arthroplasty, Knee, Condyle And Plateau; Medial And Lateral Compart W/Wo Patella Resurface (Pro Cah)",,27447,CPT,Professional,Both,,,,7130,6060.5,784.91,7130,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,2683.03248,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Arthroplasty, Knee, Condyle And Plateau; Medial And Lateral Compart W/Wo Patella Resurface (Pro Cah)",,27447,CPT,Professional,Both,,,,7130,6060.5,784.91,7130,BlueCross BlueShield Minnesota,High Value Network Plan,2683.03248,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Arthroplasty, Knee, Condyle And Plateau; Medial And Lateral Compart W/Wo Patella Resurface (Pro Cah)",,27447,CPT,Professional,Both,,,,7130,6060.5,784.91,7130,BlueCross BlueShield Minnesota,Medicare Advantage,1402.2525,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Arthroplasty, Knee, Condyle And Plateau; Medial And Lateral Compart W/Wo Patella Resurface (Pro Cah)",,27447,CPT,Professional,Both,,,,7130,6060.5,784.91,7130,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,2683.03248,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Arthroplasty, Knee, Condyle And Plateau; Medial And Lateral Compart W/Wo Patella Resurface (Pro Cah)",,27447,CPT,Professional,Both,,,,7130,6060.5,784.91,7130,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,906.21104,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Arthroplasty, Knee, Condyle And Plateau; Medial And Lateral Compart W/Wo Patella Resurface (Pro Cah)",,27447,CPT,Professional,Both,,,,7130,6060.5,784.91,7130,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1402.2525,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Arthroplasty, Knee, Condyle And Plateau; Medial And Lateral Compart W/Wo Patella Resurface (Pro Cah)",,27447,CPT,Professional,Both,,,,7130,6060.5,784.91,7130,CorVel,Worker's Compensation,2389.8374,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Arthroplasty, Knee, Condyle And Plateau; Medial And Lateral Compart W/Wo Patella Resurface (Pro Cah)",,27447,CPT,Professional,Both,,,,7130,6060.5,784.91,7130,First Health Group Corporation,First Health Network,6916.1,97,,percent of total billed charges,,
"Arthroplasty, Knee, Condyle And Plateau; Medial And Lateral Compart W/Wo Patella Resurface (Pro Cah)",,27447,CPT,Professional,Both,,,,7130,6060.5,784.91,7130,"Health Partners, Inc.",Commercial,2581.42,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Arthroplasty, Knee, Condyle And Plateau; Medial And Lateral Compart W/Wo Patella Resurface (Pro Cah)",,27447,CPT,Professional,Both,,,,7130,6060.5,784.91,7130,"Health Partners, Inc.",Medicare Advantage,1402.2525,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Arthroplasty, Knee, Condyle And Plateau; Medial And Lateral Compart W/Wo Patella Resurface (Pro Cah)",,27447,CPT,Professional,Both,,,,7130,6060.5,784.91,7130,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1219.26,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Arthroplasty, Knee, Condyle And Plateau; Medial And Lateral Compart W/Wo Patella Resurface (Pro Cah)",,27447,CPT,Professional,Both,,,,7130,6060.5,784.91,7130,"Health Partners, Inc.",State of Minnesota Advantage Program,2223.89333,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Arthroplasty, Knee, Condyle And Plateau; Medial And Lateral Compart W/Wo Patella Resurface (Pro Cah)",,27447,CPT,Professional,Both,,,,7130,6060.5,784.91,7130,"Health Partners, Inc.",State Public Programs,784.91,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Arthroplasty, Knee, Condyle And Plateau; Medial And Lateral Compart W/Wo Patella Resurface (Pro Cah)",,27447,CPT,Professional,Both,,,,7130,6060.5,784.91,7130,Humana Insurance Company,Commercial PPO,1219.35,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Arthroplasty, Knee, Condyle And Plateau; Medial And Lateral Compart W/Wo Patella Resurface (Pro Cah)",,27447,CPT,Professional,Both,,,,7130,6060.5,784.91,7130,Humana Insurance Company,Medicare PPO,7130,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Arthroplasty, Knee, Condyle And Plateau; Medial And Lateral Compart W/Wo Patella Resurface (Pro Cah)",,27447,CPT,Professional,Both,,,,7130,6060.5,784.91,7130,Medica,Individual & Family,6046.24,84.8,,percent of total billed charges,,
"Arthroplasty, Knee, Condyle And Plateau; Medial And Lateral Compart W/Wo Patella Resurface (Pro Cah)",,27447,CPT,Professional,Both,,,,7130,6060.5,784.91,7130,Medica,Medica Advantage Solution,3550.74,49.8,,percent of total billed charges,,
"Arthroplasty, Knee, Condyle And Plateau; Medial And Lateral Compart W/Wo Patella Resurface (Pro Cah)",,27447,CPT,Professional,Both,,,,7130,6060.5,784.91,7130,Medica,Medical Assistance,906.21,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Arthroplasty, Knee, Condyle And Plateau; Medial And Lateral Compart W/Wo Patella Resurface (Pro Cah)",,27447,CPT,Professional,Both,,,,7130,6060.5,784.91,7130,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1219.35,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Arthroplasty, Knee, Condyle And Plateau; Medial And Lateral Compart W/Wo Patella Resurface (Pro Cah)",,27447,CPT,Professional,Both,,,,7130,6060.5,784.91,7130,"Multiplan, Inc.","Multiplan, Inc.",6702.2,94,,percent of total billed charges,,
"Arthroplasty, Knee, Condyle And Plateau; Medial And Lateral Compart W/Wo Patella Resurface (Pro Cah)",,27447,CPT,Professional,Both,,,,7130,6060.5,784.91,7130,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,6424.13,90.1,,percent of total billed charges,,
"Arthroplasty, Knee, Condyle And Plateau; Medial And Lateral Compart W/Wo Patella Resurface (Pro Cah)",,27447,CPT,Professional,Both,,,,7130,6060.5,784.91,7130,"Preferred One Administrative Services, INC.",PPO,7030.18,98.6,,percent of total billed charges,,
"Arthroplasty, Knee, Condyle And Plateau; Medial And Lateral Compart W/Wo Patella Resurface (Pro Cah)",,27447,CPT,Professional,Both,,,,7130,6060.5,784.91,7130,PrimeWest Health,Minnesota Senior Health Options (MSHO),1402.2525,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Arthroplasty, Knee, Condyle And Plateau; Medial And Lateral Compart W/Wo Patella Resurface (Pro Cah)",,27447,CPT,Professional,Both,,,,7130,6060.5,784.91,7130,PrimeWest Health,MinnesotaCare,969.6458128,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Arthroplasty, Knee, Condyle And Plateau; Medial And Lateral Compart W/Wo Patella Resurface (Pro Cah)",,27447,CPT,Professional,Both,,,,7130,6060.5,784.91,7130,Sanford Health Plan,Sanford Health Plan,6274.4,88,,percent of total billed charges,,
"Arthroplasty, Knee, Condyle And Plateau; Medial And Lateral Compart W/Wo Patella Resurface (Pro Cah)",,27447,CPT,Professional,Both,,,,7130,6060.5,784.91,7130,"UCare Health, Inc.",Individual & Family Plan,1982.17536,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Arthroplasty, Knee, Condyle And Plateau; Medial And Lateral Compart W/Wo Patella Resurface (Pro Cah)",,27447,CPT,Professional,Both,,,,7130,6060.5,784.91,7130,"UCare Health, Inc.",Medical Assistance,996.832144,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Arthroplasty, Knee, Condyle And Plateau; Medial And Lateral Compart W/Wo Patella Resurface (Pro Cah)",,27447,CPT,Professional,Both,,,,7130,6060.5,784.91,7130,"UCare Health, Inc.",Medicare Advantage,1402.2525,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Arthroplasty, Knee, Condyle And Plateau; Medial And Lateral Compart W/Wo Patella Resurface (Pro Cah)",,27447,CPT,Professional,Both,,,,7130,6060.5,784.91,7130,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1121.802,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Arthroplasty, Knee, Condyle And Plateau; Medial And Lateral Compart W/Wo Patella Resurface (Pro Cah)",,27447,CPT,Professional,Both,,,,7130,6060.5,784.91,7130,UnitedHealthcare,Individual & Family,7130,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Arthroplasty, Knee, Condyle And Plateau; Medial And Lateral Compart W/Wo Patella Resurface (Pro Cah)",,27447,CPT,Professional,Both,,,,7130,6060.5,784.91,7130,UnitedHealthcare,Medicare Advantage,1402.2525,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Arthroplasty, Knee, Condyle And Plateau; Medial And Lateral Compart W/Wo Patella Resurface (Pro Cah)",,27447,CPT,Professional,Both,,,,7130,6060.5,784.91,7130,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,906.21104,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
BENRALIZUMAB 30 MG/ML SUBQ SYRG,,J0517,HCPCS,Facility,Both,1,mL,,19842,16865.7,5686.7172,19842,Aetna,Commercial,18254.64,92,,percent of total billed charges,,
BENRALIZUMAB 30 MG/ML SUBQ SYRG,,J0517,HCPCS,Facility,Outpatient,1,mL,,19842,16865.7,5686.7172,19842,Aetna,Medicare Advantage,9722.58,49,,percent of total billed charges,,
BENRALIZUMAB 30 MG/ML SUBQ SYRG,,J0517,HCPCS,Facility,Inpatient,1,mL,,19842,16865.7,5686.7172,19842,Aetna,Medicare Advantage,,,,,Included in per diem rate,
BENRALIZUMAB 30 MG/ML SUBQ SYRG,,J0517,HCPCS,Facility,Both,1,mL,,19842,16865.7,5686.7172,19842,Aetna,PPO,18453.06,93,,percent of total billed charges,,
BENRALIZUMAB 30 MG/ML SUBQ SYRG,,J0517,HCPCS,Facility,Both,1,mL,,19842,16865.7,5686.7172,19842,America's PPO,America's PPO,19054.2726,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
BENRALIZUMAB 30 MG/ML SUBQ SYRG,,J0517,HCPCS,Facility,Both,1,mL,,19842,16865.7,5686.7172,19842,BlueCross BlueShield Minnesota, Federal Employee Program,19524.528,98.4,,percent of total billed charges,,
BENRALIZUMAB 30 MG/ML SUBQ SYRG,,J0517,HCPCS,Facility,Both,1,mL,,19842,16865.7,5686.7172,19842,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,19842,100,,percent of total billed charges,,
BENRALIZUMAB 30 MG/ML SUBQ SYRG,,J0517,HCPCS,Facility,Both,1,mL,,19842,16865.7,5686.7172,19842,BlueCross BlueShield Minnesota,High Value Network Plan,17857.8,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
BENRALIZUMAB 30 MG/ML SUBQ SYRG,,J0517,HCPCS,Facility,Outpatient,1,mL,,19842,16865.7,5686.7172,19842,BlueCross BlueShield Minnesota,Medicare Advantage,9722.58,49,,percent of total billed charges,,
BENRALIZUMAB 30 MG/ML SUBQ SYRG,,J0517,HCPCS,Facility,Inpatient,1,mL,,19842,16865.7,5686.7172,19842,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
BENRALIZUMAB 30 MG/ML SUBQ SYRG,,J0517,HCPCS,Facility,Both,1,mL,,19842,16865.7,5686.7172,19842,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,17574.0594,88.57,,percent of total billed charges,,
BENRALIZUMAB 30 MG/ML SUBQ SYRG,,J0517,HCPCS,Facility,Both,1,mL,,19842,16865.7,5686.7172,19842,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,5686.7172,28.66,,percent of total billed charges,,
BENRALIZUMAB 30 MG/ML SUBQ SYRG,,J0517,HCPCS,Facility,Outpatient,1,mL,,19842,16865.7,5686.7172,19842,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),9722.58,49,,percent of total billed charges,,
BENRALIZUMAB 30 MG/ML SUBQ SYRG,,J0517,HCPCS,Facility,Inpatient,1,mL,,19842,16865.7,5686.7172,19842,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
BENRALIZUMAB 30 MG/ML SUBQ SYRG,,J0517,HCPCS,Facility,Both,1,mL,,19842,16865.7,5686.7172,19842,CorVel,Worker's Compensation,19842,100,,percent of total billed charges,,
BENRALIZUMAB 30 MG/ML SUBQ SYRG,,J0517,HCPCS,Facility,Both,1,mL,,19842,16865.7,5686.7172,19842,First Health Group Corporation,First Health Network,19246.74,97,,percent of total billed charges,,
BENRALIZUMAB 30 MG/ML SUBQ SYRG,,J0517,HCPCS,Facility,Both,1,mL,,19842,16865.7,5686.7172,19842,"Health Partners, Inc.",Commercial,18770.532,94.6,,percent of total billed charges,,
BENRALIZUMAB 30 MG/ML SUBQ SYRG,,J0517,HCPCS,Facility,Outpatient,1,mL,,19842,16865.7,5686.7172,19842,"Health Partners, Inc.",Medicare Advantage,9722.58,49,,percent of total billed charges,,
BENRALIZUMAB 30 MG/ML SUBQ SYRG,,J0517,HCPCS,Facility,Inpatient,1,mL,,19842,16865.7,5686.7172,19842,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
BENRALIZUMAB 30 MG/ML SUBQ SYRG,,J0517,HCPCS,Facility,Both,1,mL,,19842,16865.7,5686.7172,19842,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),11905.2,60,,percent of total billed charges,,
BENRALIZUMAB 30 MG/ML SUBQ SYRG,,J0517,HCPCS,Facility,Both,1,mL,,19842,16865.7,5686.7172,19842,"Health Partners, Inc.",State of Minnesota Advantage Program,16171.23,81.5,,percent of total billed charges,,
BENRALIZUMAB 30 MG/ML SUBQ SYRG,,J0517,HCPCS,Facility,Both,1,mL,,19842,16865.7,5686.7172,19842,"Health Partners, Inc.",State Public Programs,9921,50,,percent of total billed charges,,
BENRALIZUMAB 30 MG/ML SUBQ SYRG,,J0517,HCPCS,Facility,Both,1,mL,,19842,16865.7,5686.7172,19842,Humana Insurance Company,Commercial PPO,18849.9,95,,percent of total billed charges,,
BENRALIZUMAB 30 MG/ML SUBQ SYRG,,J0517,HCPCS,Facility,Outpatient,1,mL,,19842,16865.7,5686.7172,19842,Humana Insurance Company,Medicare PPO,9722.58,49,,percent of total billed charges,,
BENRALIZUMAB 30 MG/ML SUBQ SYRG,,J0517,HCPCS,Facility,Inpatient,1,mL,,19842,16865.7,5686.7172,19842,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
BENRALIZUMAB 30 MG/ML SUBQ SYRG,,J0517,HCPCS,Facility,Both,1,mL,,19842,16865.7,5686.7172,19842,Medica,Individual & Family,19663.422,99.1,,percent of total billed charges,,
BENRALIZUMAB 30 MG/ML SUBQ SYRG,,J0517,HCPCS,Facility,Outpatient,1,mL,,19842,16865.7,5686.7172,19842,Medica,Medica Advantage Solution,9881.316,49.8,,percent of total billed charges,,
BENRALIZUMAB 30 MG/ML SUBQ SYRG,,J0517,HCPCS,Facility,Inpatient,1,mL,,19842,16865.7,5686.7172,19842,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
BENRALIZUMAB 30 MG/ML SUBQ SYRG,,J0517,HCPCS,Facility,Outpatient,1,mL,,19842,16865.7,5686.7172,19842,Medica,Medical Assistance,8849.532,44.6,,percent of total billed charges,,
BENRALIZUMAB 30 MG/ML SUBQ SYRG,,J0517,HCPCS,Facility,Inpatient,1,mL,,19842,16865.7,5686.7172,19842,Medica,Medical Assistance,,,,,Included in per diem rate,
BENRALIZUMAB 30 MG/ML SUBQ SYRG,,J0517,HCPCS,Facility,Outpatient,1,mL,,19842,16865.7,5686.7172,19842,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,9881.316,49.8,,percent of total billed charges,,
BENRALIZUMAB 30 MG/ML SUBQ SYRG,,J0517,HCPCS,Facility,Inpatient,1,mL,,19842,16865.7,5686.7172,19842,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
BENRALIZUMAB 30 MG/ML SUBQ SYRG,,J0517,HCPCS,Facility,Both,1,mL,,19842,16865.7,5686.7172,19842,"Multiplan, Inc.","Multiplan, Inc.",18651.48,94,,percent of total billed charges,,
BENRALIZUMAB 30 MG/ML SUBQ SYRG,,J0517,HCPCS,Facility,Outpatient,1,mL,,19842,16865.7,5686.7172,19842,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,17877.642,90.1,,percent of total billed charges,,
BENRALIZUMAB 30 MG/ML SUBQ SYRG,,J0517,HCPCS,Facility,Inpatient,1,mL,,19842,16865.7,5686.7172,19842,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
BENRALIZUMAB 30 MG/ML SUBQ SYRG,,J0517,HCPCS,Facility,Both,1,mL,,19842,16865.7,5686.7172,19842,"Preferred One Administrative Services, INC.",PPO,19564.212,98.6,,percent of total billed charges,,
BENRALIZUMAB 30 MG/ML SUBQ SYRG,,J0517,HCPCS,Facility,Outpatient,1,mL,,19842,16865.7,5686.7172,19842,PrimeWest Health,Minnesota Senior Health Options (MSHO),10208.709,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
BENRALIZUMAB 30 MG/ML SUBQ SYRG,,J0517,HCPCS,Facility,Inpatient,1,mL,,19842,16865.7,5686.7172,19842,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
BENRALIZUMAB 30 MG/ML SUBQ SYRG,,J0517,HCPCS,Facility,Outpatient,1,mL,,19842,16865.7,5686.7172,19842,PrimeWest Health,MinnesotaCare,10190.8512,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
BENRALIZUMAB 30 MG/ML SUBQ SYRG,,J0517,HCPCS,Facility,Inpatient,1,mL,,19842,16865.7,5686.7172,19842,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
BENRALIZUMAB 30 MG/ML SUBQ SYRG,,J0517,HCPCS,Facility,Both,1,mL,,19842,16865.7,5686.7172,19842,Sanford Health Plan,Sanford Health Plan,18254.64,92,,percent of total billed charges,,
BENRALIZUMAB 30 MG/ML SUBQ SYRG,,J0517,HCPCS,Facility,Outpatient,1,mL,,19842,16865.7,5686.7172,19842,"UCare Health, Inc.",Individual & Family Plan,11180.967,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
BENRALIZUMAB 30 MG/ML SUBQ SYRG,,J0517,HCPCS,Facility,Inpatient,1,mL,,19842,16865.7,5686.7172,19842,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
BENRALIZUMAB 30 MG/ML SUBQ SYRG,,J0517,HCPCS,Facility,Outpatient,1,mL,,19842,16865.7,5686.7172,19842,"UCare Health, Inc.",Medical Assistance,10014.2574,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BENRALIZUMAB 30 MG/ML SUBQ SYRG,,J0517,HCPCS,Facility,Inpatient,1,mL,,19842,16865.7,5686.7172,19842,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
BENRALIZUMAB 30 MG/ML SUBQ SYRG,,J0517,HCPCS,Facility,Outpatient,1,mL,,19842,16865.7,5686.7172,19842,"UCare Health, Inc.",Medicare Advantage,10014.2574,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BENRALIZUMAB 30 MG/ML SUBQ SYRG,,J0517,HCPCS,Facility,Inpatient,1,mL,,19842,16865.7,5686.7172,19842,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
BENRALIZUMAB 30 MG/ML SUBQ SYRG,,J0517,HCPCS,Facility,Outpatient,1,mL,,19842,16865.7,5686.7172,19842,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),10014.2574,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BENRALIZUMAB 30 MG/ML SUBQ SYRG,,J0517,HCPCS,Facility,Inpatient,1,mL,,19842,16865.7,5686.7172,19842,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
BENRALIZUMAB 30 MG/ML SUBQ SYRG,,J0517,HCPCS,Facility,Both,1,mL,,19842,16865.7,5686.7172,19842,UnitedHealthcare,Individual & Family,18651.48,94,,percent of total billed charges,,
BENRALIZUMAB 30 MG/ML SUBQ SYRG,,J0517,HCPCS,Facility,Outpatient,1,mL,,19842,16865.7,5686.7172,19842,UnitedHealthcare,Medicare Advantage,9722.58,49,,percent of total billed charges,,
BENRALIZUMAB 30 MG/ML SUBQ SYRG,,J0517,HCPCS,Facility,Inpatient,1,mL,,19842,16865.7,5686.7172,19842,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
BENRALIZUMAB 30 MG/ML SUBQ SYRG,,J0517,HCPCS,Facility,Outpatient,1,mL,,19842,16865.7,5686.7172,19842,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,9524.16,48,,percent of total billed charges,,100% of DHS outpatient percentage
BENRALIZUMAB 30 MG/ML SUBQ SYRG,,J0517,HCPCS,Facility,Inpatient,1,mL,,19842,16865.7,5686.7172,19842,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Amputation, Thigh, Through Femur, Any Level (Procah)",,27590,CPT,Professional,Both,,,,3035,2579.75,464.66,3035,Aetna,Commercial,2579.75,85,,percent of total billed charges,,
"Amputation, Thigh, Through Femur, Any Level (Procah)",,27590,CPT,Professional,Both,,,,3035,2579.75,464.66,3035,Aetna,Medicare Advantage,741.02,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Amputation, Thigh, Through Femur, Any Level (Procah)",,27590,CPT,Professional,Both,,,,3035,2579.75,464.66,3035,Aetna,PPO,2822.55,93,,percent of total billed charges,,
"Amputation, Thigh, Through Femur, Any Level (Procah)",,27590,CPT,Professional,Both,,,,3035,2579.75,464.66,3035,America's PPO,America's PPO,2593.104,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Amputation, Thigh, Through Femur, Any Level (Procah)",,27590,CPT,Professional,Both,,,,3035,2579.75,464.66,3035,BlueCross BlueShield Minnesota, Federal Employee Program,1605.82,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Amputation, Thigh, Through Femur, Any Level (Procah)",,27590,CPT,Professional,Both,,,,3035,2579.75,464.66,3035,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1631.51312,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Amputation, Thigh, Through Femur, Any Level (Procah)",,27590,CPT,Professional,Both,,,,3035,2579.75,464.66,3035,BlueCross BlueShield Minnesota,High Value Network Plan,1631.51312,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Amputation, Thigh, Through Femur, Any Level (Procah)",,27590,CPT,Professional,Both,,,,3035,2579.75,464.66,3035,BlueCross BlueShield Minnesota,Medicare Advantage,830.1965,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Amputation, Thigh, Through Femur, Any Level (Procah)",,27590,CPT,Professional,Both,,,,3035,2579.75,464.66,3035,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1631.51312,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Amputation, Thigh, Through Femur, Any Level (Procah)",,27590,CPT,Professional,Both,,,,3035,2579.75,464.66,3035,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,536.46832,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Amputation, Thigh, Through Femur, Any Level (Procah)",,27590,CPT,Professional,Both,,,,3035,2579.75,464.66,3035,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),830.1965,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Amputation, Thigh, Through Femur, Any Level (Procah)",,27590,CPT,Professional,Both,,,,3035,2579.75,464.66,3035,CorVel,Worker's Compensation,1434.565139,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Amputation, Thigh, Through Femur, Any Level (Procah)",,27590,CPT,Professional,Both,,,,3035,2579.75,464.66,3035,First Health Group Corporation,First Health Network,2943.95,97,,percent of total billed charges,,
"Amputation, Thigh, Through Femur, Any Level (Procah)",,27590,CPT,Professional,Both,,,,3035,2579.75,464.66,3035,"Health Partners, Inc.",Commercial,1549.73,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Amputation, Thigh, Through Femur, Any Level (Procah)",,27590,CPT,Professional,Both,,,,3035,2579.75,464.66,3035,"Health Partners, Inc.",Medicare Advantage,830.1965,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Amputation, Thigh, Through Femur, Any Level (Procah)",,27590,CPT,Professional,Both,,,,3035,2579.75,464.66,3035,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),722.14,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Amputation, Thigh, Through Femur, Any Level (Procah)",,27590,CPT,Professional,Both,,,,3035,2579.75,464.66,3035,"Health Partners, Inc.",State of Minnesota Advantage Program,1335.092395,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Amputation, Thigh, Through Femur, Any Level (Procah)",,27590,CPT,Professional,Both,,,,3035,2579.75,464.66,3035,"Health Partners, Inc.",State Public Programs,464.66,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Amputation, Thigh, Through Femur, Any Level (Procah)",,27590,CPT,Professional,Both,,,,3035,2579.75,464.66,3035,Humana Insurance Company,Commercial PPO,721.91,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Amputation, Thigh, Through Femur, Any Level (Procah)",,27590,CPT,Professional,Both,,,,3035,2579.75,464.66,3035,Humana Insurance Company,Medicare PPO,3035,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Amputation, Thigh, Through Femur, Any Level (Procah)",,27590,CPT,Professional,Both,,,,3035,2579.75,464.66,3035,Medica,Individual & Family,2573.68,84.8,,percent of total billed charges,,
"Amputation, Thigh, Through Femur, Any Level (Procah)",,27590,CPT,Professional,Both,,,,3035,2579.75,464.66,3035,Medica,Medica Advantage Solution,1511.43,49.8,,percent of total billed charges,,
"Amputation, Thigh, Through Femur, Any Level (Procah)",,27590,CPT,Professional,Both,,,,3035,2579.75,464.66,3035,Medica,Medical Assistance,536.47,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Amputation, Thigh, Through Femur, Any Level (Procah)",,27590,CPT,Professional,Both,,,,3035,2579.75,464.66,3035,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,721.91,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Amputation, Thigh, Through Femur, Any Level (Procah)",,27590,CPT,Professional,Both,,,,3035,2579.75,464.66,3035,"Multiplan, Inc.","Multiplan, Inc.",2852.9,94,,percent of total billed charges,,
"Amputation, Thigh, Through Femur, Any Level (Procah)",,27590,CPT,Professional,Both,,,,3035,2579.75,464.66,3035,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,2734.535,90.1,,percent of total billed charges,,
"Amputation, Thigh, Through Femur, Any Level (Procah)",,27590,CPT,Professional,Both,,,,3035,2579.75,464.66,3035,"Preferred One Administrative Services, INC.",PPO,2992.51,98.6,,percent of total billed charges,,
"Amputation, Thigh, Through Femur, Any Level (Procah)",,27590,CPT,Professional,Both,,,,3035,2579.75,464.66,3035,PrimeWest Health,Minnesota Senior Health Options (MSHO),830.1965,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Amputation, Thigh, Through Femur, Any Level (Procah)",,27590,CPT,Professional,Both,,,,3035,2579.75,464.66,3035,PrimeWest Health,MinnesotaCare,574.0211024,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Amputation, Thigh, Through Femur, Any Level (Procah)",,27590,CPT,Professional,Both,,,,3035,2579.75,464.66,3035,Sanford Health Plan,Sanford Health Plan,2670.8,88,,percent of total billed charges,,
"Amputation, Thigh, Through Femur, Any Level (Procah)",,27590,CPT,Professional,Both,,,,3035,2579.75,464.66,3035,"UCare Health, Inc.",Individual & Family Plan,1173.536896,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Amputation, Thigh, Through Femur, Any Level (Procah)",,27590,CPT,Professional,Both,,,,3035,2579.75,464.66,3035,"UCare Health, Inc.",Medical Assistance,590.115152,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Amputation, Thigh, Through Femur, Any Level (Procah)",,27590,CPT,Professional,Both,,,,3035,2579.75,464.66,3035,"UCare Health, Inc.",Medicare Advantage,830.1965,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Amputation, Thigh, Through Femur, Any Level (Procah)",,27590,CPT,Professional,Both,,,,3035,2579.75,464.66,3035,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),664.1572,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Amputation, Thigh, Through Femur, Any Level (Procah)",,27590,CPT,Professional,Both,,,,3035,2579.75,464.66,3035,UnitedHealthcare,Individual & Family,3035,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Amputation, Thigh, Through Femur, Any Level (Procah)",,27590,CPT,Professional,Both,,,,3035,2579.75,464.66,3035,UnitedHealthcare,Medicare Advantage,830.1965,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Amputation, Thigh, Through Femur, Any Level (Procah)",,27590,CPT,Professional,Both,,,,3035,2579.75,464.66,3035,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,536.46832,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Closed Treatment Of Distal Fibular Fracture (Lateral Malleolus); With Manipulation (Pro Cah),,27788,CPT,Professional,Both,,,,1527,1297.95,246.51,1527,Aetna,Commercial,1297.95,85,,percent of total billed charges,,
Closed Treatment Of Distal Fibular Fracture (Lateral Malleolus); With Manipulation (Pro Cah),,27788,CPT,Professional,Both,,,,1527,1297.95,246.51,1527,Aetna,Medicare Advantage,381.75,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Closed Treatment Of Distal Fibular Fracture (Lateral Malleolus); With Manipulation (Pro Cah),,27788,CPT,Professional,Both,,,,1527,1297.95,246.51,1527,Aetna,PPO,1420.11,93,,percent of total billed charges,,
Closed Treatment Of Distal Fibular Fracture (Lateral Malleolus); With Manipulation (Pro Cah),,27788,CPT,Professional,Both,,,,1527,1297.95,246.51,1527,America's PPO,America's PPO,1304.6688,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Closed Treatment Of Distal Fibular Fracture (Lateral Malleolus); With Manipulation (Pro Cah),,27788,CPT,Professional,Both,,,,1527,1297.95,246.51,1527,BlueCross BlueShield Minnesota, Federal Employee Program,811.86,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Closed Treatment Of Distal Fibular Fracture (Lateral Malleolus); With Manipulation (Pro Cah),,27788,CPT,Professional,Both,,,,1527,1297.95,246.51,1527,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,824.84976,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Closed Treatment Of Distal Fibular Fracture (Lateral Malleolus); With Manipulation (Pro Cah),,27788,CPT,Professional,Both,,,,1527,1297.95,246.51,1527,BlueCross BlueShield Minnesota,High Value Network Plan,824.84976,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Closed Treatment Of Distal Fibular Fracture (Lateral Malleolus); With Manipulation (Pro Cah),,27788,CPT,Professional,Both,,,,1527,1297.95,246.51,1527,BlueCross BlueShield Minnesota,Medicare Advantage,440.7145,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Closed Treatment Of Distal Fibular Fracture (Lateral Malleolus); With Manipulation (Pro Cah),,27788,CPT,Professional,Both,,,,1527,1297.95,246.51,1527,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,824.84976,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Closed Treatment Of Distal Fibular Fracture (Lateral Malleolus); With Manipulation (Pro Cah),,27788,CPT,Professional,Both,,,,1527,1297.95,246.51,1527,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,284.60192,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Closed Treatment Of Distal Fibular Fracture (Lateral Malleolus); With Manipulation (Pro Cah),,27788,CPT,Professional,Both,,,,1527,1297.95,246.51,1527,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),440.7145,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Closed Treatment Of Distal Fibular Fracture (Lateral Malleolus); With Manipulation (Pro Cah),,27788,CPT,Professional,Both,,,,1527,1297.95,246.51,1527,CorVel,Worker's Compensation,742.6288332,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Closed Treatment Of Distal Fibular Fracture (Lateral Malleolus); With Manipulation (Pro Cah),,27788,CPT,Professional,Both,,,,1527,1297.95,246.51,1527,First Health Group Corporation,First Health Network,1481.19,97,,percent of total billed charges,,
Closed Treatment Of Distal Fibular Fracture (Lateral Malleolus); With Manipulation (Pro Cah),,27788,CPT,Professional,Both,,,,1527,1297.95,246.51,1527,"Health Partners, Inc.",Commercial,802.43,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Closed Treatment Of Distal Fibular Fracture (Lateral Malleolus); With Manipulation (Pro Cah),,27788,CPT,Professional,Both,,,,1527,1297.95,246.51,1527,"Health Partners, Inc.",Medicare Advantage,440.7145,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Closed Treatment Of Distal Fibular Fracture (Lateral Malleolus); With Manipulation (Pro Cah),,27788,CPT,Professional,Both,,,,1527,1297.95,246.51,1527,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),383.26,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Closed Treatment Of Distal Fibular Fracture (Lateral Malleolus); With Manipulation (Pro Cah),,27788,CPT,Professional,Both,,,,1527,1297.95,246.51,1527,"Health Partners, Inc.",State of Minnesota Advantage Program,691.293445,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Closed Treatment Of Distal Fibular Fracture (Lateral Malleolus); With Manipulation (Pro Cah),,27788,CPT,Professional,Both,,,,1527,1297.95,246.51,1527,"Health Partners, Inc.",State Public Programs,246.51,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Closed Treatment Of Distal Fibular Fracture (Lateral Malleolus); With Manipulation (Pro Cah),,27788,CPT,Professional,Both,,,,1527,1297.95,246.51,1527,Humana Insurance Company,Commercial PPO,383.23,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Closed Treatment Of Distal Fibular Fracture (Lateral Malleolus); With Manipulation (Pro Cah),,27788,CPT,Professional,Both,,,,1527,1297.95,246.51,1527,Humana Insurance Company,Medicare PPO,1527,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Closed Treatment Of Distal Fibular Fracture (Lateral Malleolus); With Manipulation (Pro Cah),,27788,CPT,Professional,Both,,,,1527,1297.95,246.51,1527,Medica,Individual & Family,1294.896,84.8,,percent of total billed charges,,
Closed Treatment Of Distal Fibular Fracture (Lateral Malleolus); With Manipulation (Pro Cah),,27788,CPT,Professional,Both,,,,1527,1297.95,246.51,1527,Medica,Medica Advantage Solution,760.446,49.8,,percent of total billed charges,,
Closed Treatment Of Distal Fibular Fracture (Lateral Malleolus); With Manipulation (Pro Cah),,27788,CPT,Professional,Both,,,,1527,1297.95,246.51,1527,Medica,Medical Assistance,284.6,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Closed Treatment Of Distal Fibular Fracture (Lateral Malleolus); With Manipulation (Pro Cah),,27788,CPT,Professional,Both,,,,1527,1297.95,246.51,1527,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,383.23,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Closed Treatment Of Distal Fibular Fracture (Lateral Malleolus); With Manipulation (Pro Cah),,27788,CPT,Professional,Both,,,,1527,1297.95,246.51,1527,"Multiplan, Inc.","Multiplan, Inc.",1435.38,94,,percent of total billed charges,,
Closed Treatment Of Distal Fibular Fracture (Lateral Malleolus); With Manipulation (Pro Cah),,27788,CPT,Professional,Both,,,,1527,1297.95,246.51,1527,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1375.827,90.1,,percent of total billed charges,,
Closed Treatment Of Distal Fibular Fracture (Lateral Malleolus); With Manipulation (Pro Cah),,27788,CPT,Professional,Both,,,,1527,1297.95,246.51,1527,"Preferred One Administrative Services, INC.",PPO,1505.622,98.6,,percent of total billed charges,,
Closed Treatment Of Distal Fibular Fracture (Lateral Malleolus); With Manipulation (Pro Cah),,27788,CPT,Professional,Both,,,,1527,1297.95,246.51,1527,PrimeWest Health,Minnesota Senior Health Options (MSHO),440.7145,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Closed Treatment Of Distal Fibular Fracture (Lateral Malleolus); With Manipulation (Pro Cah),,27788,CPT,Professional,Both,,,,1527,1297.95,246.51,1527,PrimeWest Health,MinnesotaCare,304.5240544,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Closed Treatment Of Distal Fibular Fracture (Lateral Malleolus); With Manipulation (Pro Cah),,27788,CPT,Professional,Both,,,,1527,1297.95,246.51,1527,Sanford Health Plan,Sanford Health Plan,1343.76,88,,percent of total billed charges,,
Closed Treatment Of Distal Fibular Fracture (Lateral Malleolus); With Manipulation (Pro Cah),,27788,CPT,Professional,Both,,,,1527,1297.95,246.51,1527,"UCare Health, Inc.",Individual & Family Plan,622.978688,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Closed Treatment Of Distal Fibular Fracture (Lateral Malleolus); With Manipulation (Pro Cah),,27788,CPT,Professional,Both,,,,1527,1297.95,246.51,1527,"UCare Health, Inc.",Medical Assistance,313.062112,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Closed Treatment Of Distal Fibular Fracture (Lateral Malleolus); With Manipulation (Pro Cah),,27788,CPT,Professional,Both,,,,1527,1297.95,246.51,1527,"UCare Health, Inc.",Medicare Advantage,440.7145,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Closed Treatment Of Distal Fibular Fracture (Lateral Malleolus); With Manipulation (Pro Cah),,27788,CPT,Professional,Both,,,,1527,1297.95,246.51,1527,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),352.5716,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Closed Treatment Of Distal Fibular Fracture (Lateral Malleolus); With Manipulation (Pro Cah),,27788,CPT,Professional,Both,,,,1527,1297.95,246.51,1527,UnitedHealthcare,Individual & Family,1527,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Closed Treatment Of Distal Fibular Fracture (Lateral Malleolus); With Manipulation (Pro Cah),,27788,CPT,Professional,Both,,,,1527,1297.95,246.51,1527,UnitedHealthcare,Medicare Advantage,440.7145,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Closed Treatment Of Distal Fibular Fracture (Lateral Malleolus); With Manipulation (Pro Cah),,27788,CPT,Professional,Both,,,,1527,1297.95,246.51,1527,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,284.60192,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Closed Treatment Of Ankle Dislocation; Requiring Anesthesia, With Or Without Percutaneous Skeletal Fixation (Pro Cah)",,27842,CPT,Professional,Both,,,,612,520.2,304.776,612,Aetna,Commercial,520.2,85,,percent of total billed charges,,
"Closed Treatment Of Ankle Dislocation; Requiring Anesthesia, With Or Without Percutaneous Skeletal Fixation (Pro Cah)",,27842,CPT,Professional,Both,,,,612,520.2,304.776,612,Aetna,Medicare Advantage,487.39,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Closed Treatment Of Ankle Dislocation; Requiring Anesthesia, With Or Without Percutaneous Skeletal Fixation (Pro Cah)",,27842,CPT,Professional,Both,,,,612,520.2,304.776,612,Aetna,PPO,569.16,93,,percent of total billed charges,,
"Closed Treatment Of Ankle Dislocation; Requiring Anesthesia, With Or Without Percutaneous Skeletal Fixation (Pro Cah)",,27842,CPT,Professional,Both,,,,612,520.2,304.776,612,America's PPO,America's PPO,522.8928,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Closed Treatment Of Ankle Dislocation; Requiring Anesthesia, With Or Without Percutaneous Skeletal Fixation (Pro Cah)",,27842,CPT,Professional,Both,,,,612,520.2,304.776,612,BlueCross BlueShield Minnesota, Federal Employee Program,612,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Closed Treatment Of Ankle Dislocation; Requiring Anesthesia, With Or Without Percutaneous Skeletal Fixation (Pro Cah)",,27842,CPT,Professional,Both,,,,612,520.2,304.776,612,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,612,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Closed Treatment Of Ankle Dislocation; Requiring Anesthesia, With Or Without Percutaneous Skeletal Fixation (Pro Cah)",,27842,CPT,Professional,Both,,,,612,520.2,304.776,612,BlueCross BlueShield Minnesota,High Value Network Plan,612,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Closed Treatment Of Ankle Dislocation; Requiring Anesthesia, With Or Without Percutaneous Skeletal Fixation (Pro Cah)",,27842,CPT,Professional,Both,,,,612,520.2,304.776,612,BlueCross BlueShield Minnesota,Medicare Advantage,554.1045,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Closed Treatment Of Ankle Dislocation; Requiring Anesthesia, With Or Without Percutaneous Skeletal Fixation (Pro Cah)",,27842,CPT,Professional,Both,,,,612,520.2,304.776,612,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,612,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Closed Treatment Of Ankle Dislocation; Requiring Anesthesia, With Or Without Percutaneous Skeletal Fixation (Pro Cah)",,27842,CPT,Professional,Both,,,,612,520.2,304.776,612,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,357.89616,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Closed Treatment Of Ankle Dislocation; Requiring Anesthesia, With Or Without Percutaneous Skeletal Fixation (Pro Cah)",,27842,CPT,Professional,Both,,,,612,520.2,304.776,612,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),554.1045,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Closed Treatment Of Ankle Dislocation; Requiring Anesthesia, With Or Without Percutaneous Skeletal Fixation (Pro Cah)",,27842,CPT,Professional,Both,,,,612,520.2,304.776,612,CorVel,Worker's Compensation,612,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Closed Treatment Of Ankle Dislocation; Requiring Anesthesia, With Or Without Percutaneous Skeletal Fixation (Pro Cah)",,27842,CPT,Professional,Both,,,,612,520.2,304.776,612,First Health Group Corporation,First Health Network,593.64,97,,percent of total billed charges,,
"Closed Treatment Of Ankle Dislocation; Requiring Anesthesia, With Or Without Percutaneous Skeletal Fixation (Pro Cah)",,27842,CPT,Professional,Both,,,,612,520.2,304.776,612,"Health Partners, Inc.",Commercial,612,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Closed Treatment Of Ankle Dislocation; Requiring Anesthesia, With Or Without Percutaneous Skeletal Fixation (Pro Cah)",,27842,CPT,Professional,Both,,,,612,520.2,304.776,612,"Health Partners, Inc.",Medicare Advantage,554.1045,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Closed Treatment Of Ankle Dislocation; Requiring Anesthesia, With Or Without Percutaneous Skeletal Fixation (Pro Cah)",,27842,CPT,Professional,Both,,,,612,520.2,304.776,612,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),481.88,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Closed Treatment Of Ankle Dislocation; Requiring Anesthesia, With Or Without Percutaneous Skeletal Fixation (Pro Cah)",,27842,CPT,Professional,Both,,,,612,520.2,304.776,612,"Health Partners, Inc.",State of Minnesota Advantage Program,612,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Closed Treatment Of Ankle Dislocation; Requiring Anesthesia, With Or Without Percutaneous Skeletal Fixation (Pro Cah)",,27842,CPT,Professional,Both,,,,612,520.2,304.776,612,"Health Partners, Inc.",State Public Programs,309.99,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Closed Treatment Of Ankle Dislocation; Requiring Anesthesia, With Or Without Percutaneous Skeletal Fixation (Pro Cah)",,27842,CPT,Professional,Both,,,,612,520.2,304.776,612,Humana Insurance Company,Commercial PPO,481.83,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Closed Treatment Of Ankle Dislocation; Requiring Anesthesia, With Or Without Percutaneous Skeletal Fixation (Pro Cah)",,27842,CPT,Professional,Both,,,,612,520.2,304.776,612,Humana Insurance Company,Medicare PPO,612,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Closed Treatment Of Ankle Dislocation; Requiring Anesthesia, With Or Without Percutaneous Skeletal Fixation (Pro Cah)",,27842,CPT,Professional,Both,,,,612,520.2,304.776,612,Medica,Individual & Family,518.976,84.8,,percent of total billed charges,,
"Closed Treatment Of Ankle Dislocation; Requiring Anesthesia, With Or Without Percutaneous Skeletal Fixation (Pro Cah)",,27842,CPT,Professional,Both,,,,612,520.2,304.776,612,Medica,Medica Advantage Solution,304.776,49.8,,percent of total billed charges,,
"Closed Treatment Of Ankle Dislocation; Requiring Anesthesia, With Or Without Percutaneous Skeletal Fixation (Pro Cah)",,27842,CPT,Professional,Both,,,,612,520.2,304.776,612,Medica,Medical Assistance,357.9,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Closed Treatment Of Ankle Dislocation; Requiring Anesthesia, With Or Without Percutaneous Skeletal Fixation (Pro Cah)",,27842,CPT,Professional,Both,,,,612,520.2,304.776,612,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,481.83,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Closed Treatment Of Ankle Dislocation; Requiring Anesthesia, With Or Without Percutaneous Skeletal Fixation (Pro Cah)",,27842,CPT,Professional,Both,,,,612,520.2,304.776,612,"Multiplan, Inc.","Multiplan, Inc.",575.28,94,,percent of total billed charges,,
"Closed Treatment Of Ankle Dislocation; Requiring Anesthesia, With Or Without Percutaneous Skeletal Fixation (Pro Cah)",,27842,CPT,Professional,Both,,,,612,520.2,304.776,612,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,551.412,90.1,,percent of total billed charges,,
"Closed Treatment Of Ankle Dislocation; Requiring Anesthesia, With Or Without Percutaneous Skeletal Fixation (Pro Cah)",,27842,CPT,Professional,Both,,,,612,520.2,304.776,612,"Preferred One Administrative Services, INC.",PPO,603.432,98.6,,percent of total billed charges,,
"Closed Treatment Of Ankle Dislocation; Requiring Anesthesia, With Or Without Percutaneous Skeletal Fixation (Pro Cah)",,27842,CPT,Professional,Both,,,,612,520.2,304.776,612,PrimeWest Health,Minnesota Senior Health Options (MSHO),554.1045,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Closed Treatment Of Ankle Dislocation; Requiring Anesthesia, With Or Without Percutaneous Skeletal Fixation (Pro Cah)",,27842,CPT,Professional,Both,,,,612,520.2,304.776,612,PrimeWest Health,MinnesotaCare,382.9488912,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Closed Treatment Of Ankle Dislocation; Requiring Anesthesia, With Or Without Percutaneous Skeletal Fixation (Pro Cah)",,27842,CPT,Professional,Both,,,,612,520.2,304.776,612,Sanford Health Plan,Sanford Health Plan,538.56,88,,percent of total billed charges,,
"Closed Treatment Of Ankle Dislocation; Requiring Anesthesia, With Or Without Percutaneous Skeletal Fixation (Pro Cah)",,27842,CPT,Professional,Both,,,,612,520.2,304.776,612,"UCare Health, Inc.",Individual & Family Plan,612,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Closed Treatment Of Ankle Dislocation; Requiring Anesthesia, With Or Without Percutaneous Skeletal Fixation (Pro Cah)",,27842,CPT,Professional,Both,,,,612,520.2,304.776,612,"UCare Health, Inc.",Medical Assistance,393.685776,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Closed Treatment Of Ankle Dislocation; Requiring Anesthesia, With Or Without Percutaneous Skeletal Fixation (Pro Cah)",,27842,CPT,Professional,Both,,,,612,520.2,304.776,612,"UCare Health, Inc.",Medicare Advantage,554.1045,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Closed Treatment Of Ankle Dislocation; Requiring Anesthesia, With Or Without Percutaneous Skeletal Fixation (Pro Cah)",,27842,CPT,Professional,Both,,,,612,520.2,304.776,612,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),443.2836,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Closed Treatment Of Ankle Dislocation; Requiring Anesthesia, With Or Without Percutaneous Skeletal Fixation (Pro Cah)",,27842,CPT,Professional,Both,,,,612,520.2,304.776,612,UnitedHealthcare,Individual & Family,612,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Closed Treatment Of Ankle Dislocation; Requiring Anesthesia, With Or Without Percutaneous Skeletal Fixation (Pro Cah)",,27842,CPT,Professional,Both,,,,612,520.2,304.776,612,UnitedHealthcare,Medicare Advantage,554.1045,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Closed Treatment Of Ankle Dislocation; Requiring Anesthesia, With Or Without Percutaneous Skeletal Fixation (Pro Cah)",,27842,CPT,Professional,Both,,,,612,520.2,304.776,612,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,357.89616,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
BUTORPHANOL 2 MG/ML INJ SOLN,,J0595,HCPCS,Facility,Both,1,mL,,45,38.25,12.897,45,Aetna,Commercial,41.4,92,,percent of total billed charges,,
BUTORPHANOL 2 MG/ML INJ SOLN,,J0595,HCPCS,Facility,Outpatient,1,mL,,45,38.25,12.897,45,Aetna,Medicare Advantage,22.05,49,,percent of total billed charges,,
BUTORPHANOL 2 MG/ML INJ SOLN,,J0595,HCPCS,Facility,Inpatient,1,mL,,45,38.25,12.897,45,Aetna,Medicare Advantage,,,,,Included in per diem rate,
BUTORPHANOL 2 MG/ML INJ SOLN,,J0595,HCPCS,Facility,Both,1,mL,,45,38.25,12.897,45,Aetna,PPO,41.85,93,,percent of total billed charges,,
BUTORPHANOL 2 MG/ML INJ SOLN,,J0595,HCPCS,Facility,Both,1,mL,,45,38.25,12.897,45,America's PPO,America's PPO,43.2135,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
BUTORPHANOL 2 MG/ML INJ SOLN,,J0595,HCPCS,Facility,Both,1,mL,,45,38.25,12.897,45,BlueCross BlueShield Minnesota, Federal Employee Program,44.28,98.4,,percent of total billed charges,,
BUTORPHANOL 2 MG/ML INJ SOLN,,J0595,HCPCS,Facility,Both,1,mL,,45,38.25,12.897,45,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,45,100,,percent of total billed charges,,
BUTORPHANOL 2 MG/ML INJ SOLN,,J0595,HCPCS,Facility,Both,1,mL,,45,38.25,12.897,45,BlueCross BlueShield Minnesota,High Value Network Plan,40.5,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
BUTORPHANOL 2 MG/ML INJ SOLN,,J0595,HCPCS,Facility,Outpatient,1,mL,,45,38.25,12.897,45,BlueCross BlueShield Minnesota,Medicare Advantage,22.05,49,,percent of total billed charges,,
BUTORPHANOL 2 MG/ML INJ SOLN,,J0595,HCPCS,Facility,Inpatient,1,mL,,45,38.25,12.897,45,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
BUTORPHANOL 2 MG/ML INJ SOLN,,J0595,HCPCS,Facility,Both,1,mL,,45,38.25,12.897,45,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,39.8565,88.57,,percent of total billed charges,,
BUTORPHANOL 2 MG/ML INJ SOLN,,J0595,HCPCS,Facility,Both,1,mL,,45,38.25,12.897,45,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,12.897,28.66,,percent of total billed charges,,
BUTORPHANOL 2 MG/ML INJ SOLN,,J0595,HCPCS,Facility,Outpatient,1,mL,,45,38.25,12.897,45,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),22.05,49,,percent of total billed charges,,
BUTORPHANOL 2 MG/ML INJ SOLN,,J0595,HCPCS,Facility,Inpatient,1,mL,,45,38.25,12.897,45,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
BUTORPHANOL 2 MG/ML INJ SOLN,,J0595,HCPCS,Facility,Both,1,mL,,45,38.25,12.897,45,CorVel,Worker's Compensation,45,100,,percent of total billed charges,,
BUTORPHANOL 2 MG/ML INJ SOLN,,J0595,HCPCS,Facility,Both,1,mL,,45,38.25,12.897,45,First Health Group Corporation,First Health Network,43.65,97,,percent of total billed charges,,
BUTORPHANOL 2 MG/ML INJ SOLN,,J0595,HCPCS,Facility,Both,1,mL,,45,38.25,12.897,45,"Health Partners, Inc.",Commercial,42.57,94.6,,percent of total billed charges,,
BUTORPHANOL 2 MG/ML INJ SOLN,,J0595,HCPCS,Facility,Outpatient,1,mL,,45,38.25,12.897,45,"Health Partners, Inc.",Medicare Advantage,22.05,49,,percent of total billed charges,,
BUTORPHANOL 2 MG/ML INJ SOLN,,J0595,HCPCS,Facility,Inpatient,1,mL,,45,38.25,12.897,45,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
BUTORPHANOL 2 MG/ML INJ SOLN,,J0595,HCPCS,Facility,Both,1,mL,,45,38.25,12.897,45,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),27,60,,percent of total billed charges,,
BUTORPHANOL 2 MG/ML INJ SOLN,,J0595,HCPCS,Facility,Both,1,mL,,45,38.25,12.897,45,"Health Partners, Inc.",State of Minnesota Advantage Program,36.675,81.5,,percent of total billed charges,,
BUTORPHANOL 2 MG/ML INJ SOLN,,J0595,HCPCS,Facility,Both,1,mL,,45,38.25,12.897,45,"Health Partners, Inc.",State Public Programs,22.5,50,,percent of total billed charges,,
BUTORPHANOL 2 MG/ML INJ SOLN,,J0595,HCPCS,Facility,Both,1,mL,,45,38.25,12.897,45,Humana Insurance Company,Commercial PPO,42.75,95,,percent of total billed charges,,
BUTORPHANOL 2 MG/ML INJ SOLN,,J0595,HCPCS,Facility,Outpatient,1,mL,,45,38.25,12.897,45,Humana Insurance Company,Medicare PPO,22.05,49,,percent of total billed charges,,
BUTORPHANOL 2 MG/ML INJ SOLN,,J0595,HCPCS,Facility,Inpatient,1,mL,,45,38.25,12.897,45,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
BUTORPHANOL 2 MG/ML INJ SOLN,,J0595,HCPCS,Facility,Both,1,mL,,45,38.25,12.897,45,Medica,Individual & Family,44.595,99.1,,percent of total billed charges,,
BUTORPHANOL 2 MG/ML INJ SOLN,,J0595,HCPCS,Facility,Outpatient,1,mL,,45,38.25,12.897,45,Medica,Medica Advantage Solution,22.41,49.8,,percent of total billed charges,,
BUTORPHANOL 2 MG/ML INJ SOLN,,J0595,HCPCS,Facility,Inpatient,1,mL,,45,38.25,12.897,45,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
BUTORPHANOL 2 MG/ML INJ SOLN,,J0595,HCPCS,Facility,Outpatient,1,mL,,45,38.25,12.897,45,Medica,Medical Assistance,20.07,44.6,,percent of total billed charges,,
BUTORPHANOL 2 MG/ML INJ SOLN,,J0595,HCPCS,Facility,Inpatient,1,mL,,45,38.25,12.897,45,Medica,Medical Assistance,,,,,Included in per diem rate,
BUTORPHANOL 2 MG/ML INJ SOLN,,J0595,HCPCS,Facility,Outpatient,1,mL,,45,38.25,12.897,45,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,22.41,49.8,,percent of total billed charges,,
BUTORPHANOL 2 MG/ML INJ SOLN,,J0595,HCPCS,Facility,Inpatient,1,mL,,45,38.25,12.897,45,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
BUTORPHANOL 2 MG/ML INJ SOLN,,J0595,HCPCS,Facility,Both,1,mL,,45,38.25,12.897,45,"Multiplan, Inc.","Multiplan, Inc.",42.3,94,,percent of total billed charges,,
BUTORPHANOL 2 MG/ML INJ SOLN,,J0595,HCPCS,Facility,Outpatient,1,mL,,45,38.25,12.897,45,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,40.545,90.1,,percent of total billed charges,,
BUTORPHANOL 2 MG/ML INJ SOLN,,J0595,HCPCS,Facility,Inpatient,1,mL,,45,38.25,12.897,45,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
BUTORPHANOL 2 MG/ML INJ SOLN,,J0595,HCPCS,Facility,Both,1,mL,,45,38.25,12.897,45,"Preferred One Administrative Services, INC.",PPO,44.37,98.6,,percent of total billed charges,,
BUTORPHANOL 2 MG/ML INJ SOLN,,J0595,HCPCS,Facility,Outpatient,1,mL,,45,38.25,12.897,45,PrimeWest Health,Minnesota Senior Health Options (MSHO),23.1525,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
BUTORPHANOL 2 MG/ML INJ SOLN,,J0595,HCPCS,Facility,Inpatient,1,mL,,45,38.25,12.897,45,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
BUTORPHANOL 2 MG/ML INJ SOLN,,J0595,HCPCS,Facility,Outpatient,1,mL,,45,38.25,12.897,45,PrimeWest Health,MinnesotaCare,23.112,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
BUTORPHANOL 2 MG/ML INJ SOLN,,J0595,HCPCS,Facility,Inpatient,1,mL,,45,38.25,12.897,45,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
BUTORPHANOL 2 MG/ML INJ SOLN,,J0595,HCPCS,Facility,Both,1,mL,,45,38.25,12.897,45,Sanford Health Plan,Sanford Health Plan,41.4,92,,percent of total billed charges,,
BUTORPHANOL 2 MG/ML INJ SOLN,,J0595,HCPCS,Facility,Outpatient,1,mL,,45,38.25,12.897,45,"UCare Health, Inc.",Individual & Family Plan,25.3575,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
BUTORPHANOL 2 MG/ML INJ SOLN,,J0595,HCPCS,Facility,Inpatient,1,mL,,45,38.25,12.897,45,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
BUTORPHANOL 2 MG/ML INJ SOLN,,J0595,HCPCS,Facility,Outpatient,1,mL,,45,38.25,12.897,45,"UCare Health, Inc.",Medical Assistance,22.7115,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BUTORPHANOL 2 MG/ML INJ SOLN,,J0595,HCPCS,Facility,Inpatient,1,mL,,45,38.25,12.897,45,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
BUTORPHANOL 2 MG/ML INJ SOLN,,J0595,HCPCS,Facility,Outpatient,1,mL,,45,38.25,12.897,45,"UCare Health, Inc.",Medicare Advantage,22.7115,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BUTORPHANOL 2 MG/ML INJ SOLN,,J0595,HCPCS,Facility,Inpatient,1,mL,,45,38.25,12.897,45,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
BUTORPHANOL 2 MG/ML INJ SOLN,,J0595,HCPCS,Facility,Outpatient,1,mL,,45,38.25,12.897,45,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),22.7115,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BUTORPHANOL 2 MG/ML INJ SOLN,,J0595,HCPCS,Facility,Inpatient,1,mL,,45,38.25,12.897,45,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
BUTORPHANOL 2 MG/ML INJ SOLN,,J0595,HCPCS,Facility,Both,1,mL,,45,38.25,12.897,45,UnitedHealthcare,Individual & Family,42.3,94,,percent of total billed charges,,
BUTORPHANOL 2 MG/ML INJ SOLN,,J0595,HCPCS,Facility,Outpatient,1,mL,,45,38.25,12.897,45,UnitedHealthcare,Medicare Advantage,22.05,49,,percent of total billed charges,,
BUTORPHANOL 2 MG/ML INJ SOLN,,J0595,HCPCS,Facility,Inpatient,1,mL,,45,38.25,12.897,45,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
BUTORPHANOL 2 MG/ML INJ SOLN,,J0595,HCPCS,Facility,Outpatient,1,mL,,45,38.25,12.897,45,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,21.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
BUTORPHANOL 2 MG/ML INJ SOLN,,J0595,HCPCS,Facility,Inpatient,1,mL,,45,38.25,12.897,45,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
DARBEPOETIN ALFA IN POLYSORBAT 500 MCG/ML INJ SYRG,,J0881,HCPCS,Facility,Both,1,mL,,13932,11842.2,3992.9112,13932,Aetna,Commercial,12817.44,92,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 500 MCG/ML INJ SYRG,,J0881,HCPCS,Facility,Outpatient,1,mL,,13932,11842.2,3992.9112,13932,Aetna,Medicare Advantage,6826.68,49,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 500 MCG/ML INJ SYRG,,J0881,HCPCS,Facility,Inpatient,1,mL,,13932,11842.2,3992.9112,13932,Aetna,Medicare Advantage,,,,,Included in per diem rate,
DARBEPOETIN ALFA IN POLYSORBAT 500 MCG/ML INJ SYRG,,J0881,HCPCS,Facility,Both,1,mL,,13932,11842.2,3992.9112,13932,Aetna,PPO,12956.76,93,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 500 MCG/ML INJ SYRG,,J0881,HCPCS,Facility,Both,1,mL,,13932,11842.2,3992.9112,13932,America's PPO,America's PPO,13378.8996,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
DARBEPOETIN ALFA IN POLYSORBAT 500 MCG/ML INJ SYRG,,J0881,HCPCS,Facility,Both,1,mL,,13932,11842.2,3992.9112,13932,BlueCross BlueShield Minnesota, Federal Employee Program,13709.088,98.4,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 500 MCG/ML INJ SYRG,,J0881,HCPCS,Facility,Both,1,mL,,13932,11842.2,3992.9112,13932,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,13932,100,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 500 MCG/ML INJ SYRG,,J0881,HCPCS,Facility,Both,1,mL,,13932,11842.2,3992.9112,13932,BlueCross BlueShield Minnesota,High Value Network Plan,12538.8,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
DARBEPOETIN ALFA IN POLYSORBAT 500 MCG/ML INJ SYRG,,J0881,HCPCS,Facility,Outpatient,1,mL,,13932,11842.2,3992.9112,13932,BlueCross BlueShield Minnesota,Medicare Advantage,6826.68,49,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 500 MCG/ML INJ SYRG,,J0881,HCPCS,Facility,Inpatient,1,mL,,13932,11842.2,3992.9112,13932,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
DARBEPOETIN ALFA IN POLYSORBAT 500 MCG/ML INJ SYRG,,J0881,HCPCS,Facility,Both,1,mL,,13932,11842.2,3992.9112,13932,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,12339.5724,88.57,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 500 MCG/ML INJ SYRG,,J0881,HCPCS,Facility,Both,1,mL,,13932,11842.2,3992.9112,13932,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,3992.9112,28.66,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 500 MCG/ML INJ SYRG,,J0881,HCPCS,Facility,Outpatient,1,mL,,13932,11842.2,3992.9112,13932,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),6826.68,49,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 500 MCG/ML INJ SYRG,,J0881,HCPCS,Facility,Inpatient,1,mL,,13932,11842.2,3992.9112,13932,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
DARBEPOETIN ALFA IN POLYSORBAT 500 MCG/ML INJ SYRG,,J0881,HCPCS,Facility,Both,1,mL,,13932,11842.2,3992.9112,13932,CorVel,Worker's Compensation,13932,100,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 500 MCG/ML INJ SYRG,,J0881,HCPCS,Facility,Both,1,mL,,13932,11842.2,3992.9112,13932,First Health Group Corporation,First Health Network,13514.04,97,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 500 MCG/ML INJ SYRG,,J0881,HCPCS,Facility,Both,1,mL,,13932,11842.2,3992.9112,13932,"Health Partners, Inc.",Commercial,13179.672,94.6,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 500 MCG/ML INJ SYRG,,J0881,HCPCS,Facility,Outpatient,1,mL,,13932,11842.2,3992.9112,13932,"Health Partners, Inc.",Medicare Advantage,6826.68,49,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 500 MCG/ML INJ SYRG,,J0881,HCPCS,Facility,Inpatient,1,mL,,13932,11842.2,3992.9112,13932,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DARBEPOETIN ALFA IN POLYSORBAT 500 MCG/ML INJ SYRG,,J0881,HCPCS,Facility,Both,1,mL,,13932,11842.2,3992.9112,13932,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),8359.2,60,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 500 MCG/ML INJ SYRG,,J0881,HCPCS,Facility,Both,1,mL,,13932,11842.2,3992.9112,13932,"Health Partners, Inc.",State of Minnesota Advantage Program,11354.58,81.5,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 500 MCG/ML INJ SYRG,,J0881,HCPCS,Facility,Both,1,mL,,13932,11842.2,3992.9112,13932,"Health Partners, Inc.",State Public Programs,6966,50,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 500 MCG/ML INJ SYRG,,J0881,HCPCS,Facility,Both,1,mL,,13932,11842.2,3992.9112,13932,Humana Insurance Company,Commercial PPO,13235.4,95,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 500 MCG/ML INJ SYRG,,J0881,HCPCS,Facility,Outpatient,1,mL,,13932,11842.2,3992.9112,13932,Humana Insurance Company,Medicare PPO,6826.68,49,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 500 MCG/ML INJ SYRG,,J0881,HCPCS,Facility,Inpatient,1,mL,,13932,11842.2,3992.9112,13932,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
DARBEPOETIN ALFA IN POLYSORBAT 500 MCG/ML INJ SYRG,,J0881,HCPCS,Facility,Both,1,mL,,13932,11842.2,3992.9112,13932,Medica,Individual & Family,13806.612,99.1,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 500 MCG/ML INJ SYRG,,J0881,HCPCS,Facility,Outpatient,1,mL,,13932,11842.2,3992.9112,13932,Medica,Medica Advantage Solution,6938.136,49.8,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 500 MCG/ML INJ SYRG,,J0881,HCPCS,Facility,Inpatient,1,mL,,13932,11842.2,3992.9112,13932,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
DARBEPOETIN ALFA IN POLYSORBAT 500 MCG/ML INJ SYRG,,J0881,HCPCS,Facility,Outpatient,1,mL,,13932,11842.2,3992.9112,13932,Medica,Medical Assistance,6213.672,44.6,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 500 MCG/ML INJ SYRG,,J0881,HCPCS,Facility,Inpatient,1,mL,,13932,11842.2,3992.9112,13932,Medica,Medical Assistance,,,,,Included in per diem rate,
DARBEPOETIN ALFA IN POLYSORBAT 500 MCG/ML INJ SYRG,,J0881,HCPCS,Facility,Outpatient,1,mL,,13932,11842.2,3992.9112,13932,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,6938.136,49.8,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 500 MCG/ML INJ SYRG,,J0881,HCPCS,Facility,Inpatient,1,mL,,13932,11842.2,3992.9112,13932,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
DARBEPOETIN ALFA IN POLYSORBAT 500 MCG/ML INJ SYRG,,J0881,HCPCS,Facility,Both,1,mL,,13932,11842.2,3992.9112,13932,"Multiplan, Inc.","Multiplan, Inc.",13096.08,94,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 500 MCG/ML INJ SYRG,,J0881,HCPCS,Facility,Outpatient,1,mL,,13932,11842.2,3992.9112,13932,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,12552.732,90.1,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 500 MCG/ML INJ SYRG,,J0881,HCPCS,Facility,Inpatient,1,mL,,13932,11842.2,3992.9112,13932,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
DARBEPOETIN ALFA IN POLYSORBAT 500 MCG/ML INJ SYRG,,J0881,HCPCS,Facility,Both,1,mL,,13932,11842.2,3992.9112,13932,"Preferred One Administrative Services, INC.",PPO,13736.952,98.6,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 500 MCG/ML INJ SYRG,,J0881,HCPCS,Facility,Outpatient,1,mL,,13932,11842.2,3992.9112,13932,PrimeWest Health,Minnesota Senior Health Options (MSHO),7168.014,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
DARBEPOETIN ALFA IN POLYSORBAT 500 MCG/ML INJ SYRG,,J0881,HCPCS,Facility,Inpatient,1,mL,,13932,11842.2,3992.9112,13932,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DARBEPOETIN ALFA IN POLYSORBAT 500 MCG/ML INJ SYRG,,J0881,HCPCS,Facility,Outpatient,1,mL,,13932,11842.2,3992.9112,13932,PrimeWest Health,MinnesotaCare,7155.4752,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
DARBEPOETIN ALFA IN POLYSORBAT 500 MCG/ML INJ SYRG,,J0881,HCPCS,Facility,Inpatient,1,mL,,13932,11842.2,3992.9112,13932,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
DARBEPOETIN ALFA IN POLYSORBAT 500 MCG/ML INJ SYRG,,J0881,HCPCS,Facility,Both,1,mL,,13932,11842.2,3992.9112,13932,Sanford Health Plan,Sanford Health Plan,12817.44,92,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 500 MCG/ML INJ SYRG,,J0881,HCPCS,Facility,Outpatient,1,mL,,13932,11842.2,3992.9112,13932,"UCare Health, Inc.",Individual & Family Plan,7850.682,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
DARBEPOETIN ALFA IN POLYSORBAT 500 MCG/ML INJ SYRG,,J0881,HCPCS,Facility,Inpatient,1,mL,,13932,11842.2,3992.9112,13932,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
DARBEPOETIN ALFA IN POLYSORBAT 500 MCG/ML INJ SYRG,,J0881,HCPCS,Facility,Outpatient,1,mL,,13932,11842.2,3992.9112,13932,"UCare Health, Inc.",Medical Assistance,7031.4804,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DARBEPOETIN ALFA IN POLYSORBAT 500 MCG/ML INJ SYRG,,J0881,HCPCS,Facility,Inpatient,1,mL,,13932,11842.2,3992.9112,13932,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
DARBEPOETIN ALFA IN POLYSORBAT 500 MCG/ML INJ SYRG,,J0881,HCPCS,Facility,Outpatient,1,mL,,13932,11842.2,3992.9112,13932,"UCare Health, Inc.",Medicare Advantage,7031.4804,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DARBEPOETIN ALFA IN POLYSORBAT 500 MCG/ML INJ SYRG,,J0881,HCPCS,Facility,Inpatient,1,mL,,13932,11842.2,3992.9112,13932,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DARBEPOETIN ALFA IN POLYSORBAT 500 MCG/ML INJ SYRG,,J0881,HCPCS,Facility,Outpatient,1,mL,,13932,11842.2,3992.9112,13932,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),7031.4804,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DARBEPOETIN ALFA IN POLYSORBAT 500 MCG/ML INJ SYRG,,J0881,HCPCS,Facility,Inpatient,1,mL,,13932,11842.2,3992.9112,13932,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DARBEPOETIN ALFA IN POLYSORBAT 500 MCG/ML INJ SYRG,,J0881,HCPCS,Facility,Both,1,mL,,13932,11842.2,3992.9112,13932,UnitedHealthcare,Individual & Family,13096.08,94,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 500 MCG/ML INJ SYRG,,J0881,HCPCS,Facility,Outpatient,1,mL,,13932,11842.2,3992.9112,13932,UnitedHealthcare,Medicare Advantage,6826.68,49,,percent of total billed charges,,
DARBEPOETIN ALFA IN POLYSORBAT 500 MCG/ML INJ SYRG,,J0881,HCPCS,Facility,Inpatient,1,mL,,13932,11842.2,3992.9112,13932,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
DARBEPOETIN ALFA IN POLYSORBAT 500 MCG/ML INJ SYRG,,J0881,HCPCS,Facility,Outpatient,1,mL,,13932,11842.2,3992.9112,13932,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,6687.36,48,,percent of total billed charges,,100% of DHS outpatient percentage
DARBEPOETIN ALFA IN POLYSORBAT 500 MCG/ML INJ SYRG,,J0881,HCPCS,Facility,Inpatient,1,mL,,13932,11842.2,3992.9112,13932,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
DENOSUMAB 60 MG/ML SUBQ SYRG,,J0897,HCPCS,Facility,Both,1,mL,,5849,4971.65,1676.3234,5849,Aetna,Commercial,5381.08,92,,percent of total billed charges,,
DENOSUMAB 60 MG/ML SUBQ SYRG,,J0897,HCPCS,Facility,Outpatient,1,mL,,5849,4971.65,1676.3234,5849,Aetna,Medicare Advantage,2866.01,49,,percent of total billed charges,,
DENOSUMAB 60 MG/ML SUBQ SYRG,,J0897,HCPCS,Facility,Inpatient,1,mL,,5849,4971.65,1676.3234,5849,Aetna,Medicare Advantage,,,,,Included in per diem rate,
DENOSUMAB 60 MG/ML SUBQ SYRG,,J0897,HCPCS,Facility,Both,1,mL,,5849,4971.65,1676.3234,5849,Aetna,PPO,5439.57,93,,percent of total billed charges,,
DENOSUMAB 60 MG/ML SUBQ SYRG,,J0897,HCPCS,Facility,Both,1,mL,,5849,4971.65,1676.3234,5849,America's PPO,America's PPO,5616.7947,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
DENOSUMAB 60 MG/ML SUBQ SYRG,,J0897,HCPCS,Facility,Both,1,mL,,5849,4971.65,1676.3234,5849,BlueCross BlueShield Minnesota, Federal Employee Program,5755.416,98.4,,percent of total billed charges,,
DENOSUMAB 60 MG/ML SUBQ SYRG,,J0897,HCPCS,Facility,Both,1,mL,,5849,4971.65,1676.3234,5849,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5849,100,,percent of total billed charges,,
DENOSUMAB 60 MG/ML SUBQ SYRG,,J0897,HCPCS,Facility,Both,1,mL,,5849,4971.65,1676.3234,5849,BlueCross BlueShield Minnesota,High Value Network Plan,5264.1,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
DENOSUMAB 60 MG/ML SUBQ SYRG,,J0897,HCPCS,Facility,Outpatient,1,mL,,5849,4971.65,1676.3234,5849,BlueCross BlueShield Minnesota,Medicare Advantage,2866.01,49,,percent of total billed charges,,
DENOSUMAB 60 MG/ML SUBQ SYRG,,J0897,HCPCS,Facility,Inpatient,1,mL,,5849,4971.65,1676.3234,5849,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
DENOSUMAB 60 MG/ML SUBQ SYRG,,J0897,HCPCS,Facility,Both,1,mL,,5849,4971.65,1676.3234,5849,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,5180.4593,88.57,,percent of total billed charges,,
DENOSUMAB 60 MG/ML SUBQ SYRG,,J0897,HCPCS,Facility,Both,1,mL,,5849,4971.65,1676.3234,5849,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1676.3234,28.66,,percent of total billed charges,,
DENOSUMAB 60 MG/ML SUBQ SYRG,,J0897,HCPCS,Facility,Outpatient,1,mL,,5849,4971.65,1676.3234,5849,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2866.01,49,,percent of total billed charges,,
DENOSUMAB 60 MG/ML SUBQ SYRG,,J0897,HCPCS,Facility,Inpatient,1,mL,,5849,4971.65,1676.3234,5849,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
DENOSUMAB 60 MG/ML SUBQ SYRG,,J0897,HCPCS,Facility,Both,1,mL,,5849,4971.65,1676.3234,5849,CorVel,Worker's Compensation,5849,100,,percent of total billed charges,,
DENOSUMAB 60 MG/ML SUBQ SYRG,,J0897,HCPCS,Facility,Both,1,mL,,5849,4971.65,1676.3234,5849,First Health Group Corporation,First Health Network,5673.53,97,,percent of total billed charges,,
DENOSUMAB 60 MG/ML SUBQ SYRG,,J0897,HCPCS,Facility,Both,1,mL,,5849,4971.65,1676.3234,5849,"Health Partners, Inc.",Commercial,5533.154,94.6,,percent of total billed charges,,
DENOSUMAB 60 MG/ML SUBQ SYRG,,J0897,HCPCS,Facility,Outpatient,1,mL,,5849,4971.65,1676.3234,5849,"Health Partners, Inc.",Medicare Advantage,2866.01,49,,percent of total billed charges,,
DENOSUMAB 60 MG/ML SUBQ SYRG,,J0897,HCPCS,Facility,Inpatient,1,mL,,5849,4971.65,1676.3234,5849,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DENOSUMAB 60 MG/ML SUBQ SYRG,,J0897,HCPCS,Facility,Both,1,mL,,5849,4971.65,1676.3234,5849,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3509.4,60,,percent of total billed charges,,
DENOSUMAB 60 MG/ML SUBQ SYRG,,J0897,HCPCS,Facility,Both,1,mL,,5849,4971.65,1676.3234,5849,"Health Partners, Inc.",State of Minnesota Advantage Program,4766.935,81.5,,percent of total billed charges,,
DENOSUMAB 60 MG/ML SUBQ SYRG,,J0897,HCPCS,Facility,Both,1,mL,,5849,4971.65,1676.3234,5849,"Health Partners, Inc.",State Public Programs,2924.5,50,,percent of total billed charges,,
DENOSUMAB 60 MG/ML SUBQ SYRG,,J0897,HCPCS,Facility,Both,1,mL,,5849,4971.65,1676.3234,5849,Humana Insurance Company,Commercial PPO,5556.55,95,,percent of total billed charges,,
DENOSUMAB 60 MG/ML SUBQ SYRG,,J0897,HCPCS,Facility,Outpatient,1,mL,,5849,4971.65,1676.3234,5849,Humana Insurance Company,Medicare PPO,2866.01,49,,percent of total billed charges,,
DENOSUMAB 60 MG/ML SUBQ SYRG,,J0897,HCPCS,Facility,Inpatient,1,mL,,5849,4971.65,1676.3234,5849,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
DENOSUMAB 60 MG/ML SUBQ SYRG,,J0897,HCPCS,Facility,Both,1,mL,,5849,4971.65,1676.3234,5849,Medica,Individual & Family,5796.359,99.1,,percent of total billed charges,,
DENOSUMAB 60 MG/ML SUBQ SYRG,,J0897,HCPCS,Facility,Outpatient,1,mL,,5849,4971.65,1676.3234,5849,Medica,Medica Advantage Solution,2912.802,49.8,,percent of total billed charges,,
DENOSUMAB 60 MG/ML SUBQ SYRG,,J0897,HCPCS,Facility,Inpatient,1,mL,,5849,4971.65,1676.3234,5849,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
DENOSUMAB 60 MG/ML SUBQ SYRG,,J0897,HCPCS,Facility,Outpatient,1,mL,,5849,4971.65,1676.3234,5849,Medica,Medical Assistance,2608.654,44.6,,percent of total billed charges,,
DENOSUMAB 60 MG/ML SUBQ SYRG,,J0897,HCPCS,Facility,Inpatient,1,mL,,5849,4971.65,1676.3234,5849,Medica,Medical Assistance,,,,,Included in per diem rate,
DENOSUMAB 60 MG/ML SUBQ SYRG,,J0897,HCPCS,Facility,Outpatient,1,mL,,5849,4971.65,1676.3234,5849,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2912.802,49.8,,percent of total billed charges,,
DENOSUMAB 60 MG/ML SUBQ SYRG,,J0897,HCPCS,Facility,Inpatient,1,mL,,5849,4971.65,1676.3234,5849,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
DENOSUMAB 60 MG/ML SUBQ SYRG,,J0897,HCPCS,Facility,Both,1,mL,,5849,4971.65,1676.3234,5849,"Multiplan, Inc.","Multiplan, Inc.",5498.06,94,,percent of total billed charges,,
DENOSUMAB 60 MG/ML SUBQ SYRG,,J0897,HCPCS,Facility,Outpatient,1,mL,,5849,4971.65,1676.3234,5849,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,5269.949,90.1,,percent of total billed charges,,
DENOSUMAB 60 MG/ML SUBQ SYRG,,J0897,HCPCS,Facility,Inpatient,1,mL,,5849,4971.65,1676.3234,5849,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
DENOSUMAB 60 MG/ML SUBQ SYRG,,J0897,HCPCS,Facility,Both,1,mL,,5849,4971.65,1676.3234,5849,"Preferred One Administrative Services, INC.",PPO,5767.114,98.6,,percent of total billed charges,,
DENOSUMAB 60 MG/ML SUBQ SYRG,,J0897,HCPCS,Facility,Outpatient,1,mL,,5849,4971.65,1676.3234,5849,PrimeWest Health,Minnesota Senior Health Options (MSHO),3009.3105,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
DENOSUMAB 60 MG/ML SUBQ SYRG,,J0897,HCPCS,Facility,Inpatient,1,mL,,5849,4971.65,1676.3234,5849,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DENOSUMAB 60 MG/ML SUBQ SYRG,,J0897,HCPCS,Facility,Outpatient,1,mL,,5849,4971.65,1676.3234,5849,PrimeWest Health,MinnesotaCare,3004.0464,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
DENOSUMAB 60 MG/ML SUBQ SYRG,,J0897,HCPCS,Facility,Inpatient,1,mL,,5849,4971.65,1676.3234,5849,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
DENOSUMAB 60 MG/ML SUBQ SYRG,,J0897,HCPCS,Facility,Both,1,mL,,5849,4971.65,1676.3234,5849,Sanford Health Plan,Sanford Health Plan,5381.08,92,,percent of total billed charges,,
DENOSUMAB 60 MG/ML SUBQ SYRG,,J0897,HCPCS,Facility,Outpatient,1,mL,,5849,4971.65,1676.3234,5849,"UCare Health, Inc.",Individual & Family Plan,3295.9115,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
DENOSUMAB 60 MG/ML SUBQ SYRG,,J0897,HCPCS,Facility,Inpatient,1,mL,,5849,4971.65,1676.3234,5849,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
DENOSUMAB 60 MG/ML SUBQ SYRG,,J0897,HCPCS,Facility,Outpatient,1,mL,,5849,4971.65,1676.3234,5849,"UCare Health, Inc.",Medical Assistance,2951.9903,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DENOSUMAB 60 MG/ML SUBQ SYRG,,J0897,HCPCS,Facility,Inpatient,1,mL,,5849,4971.65,1676.3234,5849,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
DENOSUMAB 60 MG/ML SUBQ SYRG,,J0897,HCPCS,Facility,Outpatient,1,mL,,5849,4971.65,1676.3234,5849,"UCare Health, Inc.",Medicare Advantage,2951.9903,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DENOSUMAB 60 MG/ML SUBQ SYRG,,J0897,HCPCS,Facility,Inpatient,1,mL,,5849,4971.65,1676.3234,5849,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DENOSUMAB 60 MG/ML SUBQ SYRG,,J0897,HCPCS,Facility,Outpatient,1,mL,,5849,4971.65,1676.3234,5849,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2951.9903,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DENOSUMAB 60 MG/ML SUBQ SYRG,,J0897,HCPCS,Facility,Inpatient,1,mL,,5849,4971.65,1676.3234,5849,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DENOSUMAB 60 MG/ML SUBQ SYRG,,J0897,HCPCS,Facility,Both,1,mL,,5849,4971.65,1676.3234,5849,UnitedHealthcare,Individual & Family,5498.06,94,,percent of total billed charges,,
DENOSUMAB 60 MG/ML SUBQ SYRG,,J0897,HCPCS,Facility,Outpatient,1,mL,,5849,4971.65,1676.3234,5849,UnitedHealthcare,Medicare Advantage,2866.01,49,,percent of total billed charges,,
DENOSUMAB 60 MG/ML SUBQ SYRG,,J0897,HCPCS,Facility,Inpatient,1,mL,,5849,4971.65,1676.3234,5849,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
DENOSUMAB 60 MG/ML SUBQ SYRG,,J0897,HCPCS,Facility,Outpatient,1,mL,,5849,4971.65,1676.3234,5849,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2807.52,48,,percent of total billed charges,,100% of DHS outpatient percentage
DENOSUMAB 60 MG/ML SUBQ SYRG,,J0897,HCPCS,Facility,Inpatient,1,mL,,5849,4971.65,1676.3234,5849,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
METHYLPREDNISOLONE ACETATE 40 MG/ML INJ SUSP,,J1030,HCPCS,Facility,Both,1,mL,,66,56.1,18.9156,66,Aetna,Commercial,60.72,92,,percent of total billed charges,,
METHYLPREDNISOLONE ACETATE 40 MG/ML INJ SUSP,,J1030,HCPCS,Facility,Both,1,mL,,66,56.1,18.9156,66,Aetna,Commercial,60.72,92,,percent of total billed charges,,
METHYLPREDNISOLONE ACETATE 40 MG/ML INJ SUSP,,J1030,HCPCS,Facility,Outpatient,1,mL,,66,56.1,18.9156,66,Aetna,Medicare Advantage,32.34,49,,percent of total billed charges,,
METHYLPREDNISOLONE ACETATE 40 MG/ML INJ SUSP,,J1030,HCPCS,Facility,Outpatient,1,mL,,66,56.1,18.9156,66,Aetna,Medicare Advantage,32.34,49,,percent of total billed charges,,
METHYLPREDNISOLONE ACETATE 40 MG/ML INJ SUSP,,J1030,HCPCS,Facility,Inpatient,1,mL,,66,56.1,18.9156,66,Aetna,Medicare Advantage,,,,,Included in per diem rate,
METHYLPREDNISOLONE ACETATE 40 MG/ML INJ SUSP,,J1030,HCPCS,Facility,Inpatient,1,mL,,66,56.1,18.9156,66,Aetna,Medicare Advantage,,,,,Included in per diem rate,
METHYLPREDNISOLONE ACETATE 40 MG/ML INJ SUSP,,J1030,HCPCS,Facility,Both,1,mL,,66,56.1,18.9156,66,Aetna,PPO,61.38,93,,percent of total billed charges,,
METHYLPREDNISOLONE ACETATE 40 MG/ML INJ SUSP,,J1030,HCPCS,Facility,Both,1,mL,,66,56.1,18.9156,66,Aetna,PPO,61.38,93,,percent of total billed charges,,
METHYLPREDNISOLONE ACETATE 40 MG/ML INJ SUSP,,J1030,HCPCS,Facility,Both,1,mL,,66,56.1,18.9156,66,America's PPO,America's PPO,63.3798,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
METHYLPREDNISOLONE ACETATE 40 MG/ML INJ SUSP,,J1030,HCPCS,Facility,Both,1,mL,,66,56.1,18.9156,66,America's PPO,America's PPO,63.3798,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
METHYLPREDNISOLONE ACETATE 40 MG/ML INJ SUSP,,J1030,HCPCS,Facility,Both,1,mL,,66,56.1,18.9156,66,BlueCross BlueShield Minnesota, Federal Employee Program,64.944,98.4,,percent of total billed charges,,
METHYLPREDNISOLONE ACETATE 40 MG/ML INJ SUSP,,J1030,HCPCS,Facility,Both,1,mL,,66,56.1,18.9156,66,BlueCross BlueShield Minnesota, Federal Employee Program,64.944,98.4,,percent of total billed charges,,
METHYLPREDNISOLONE ACETATE 40 MG/ML INJ SUSP,,J1030,HCPCS,Facility,Both,1,mL,,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,66,100,,percent of total billed charges,,
METHYLPREDNISOLONE ACETATE 40 MG/ML INJ SUSP,,J1030,HCPCS,Facility,Both,1,mL,,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,66,100,,percent of total billed charges,,
METHYLPREDNISOLONE ACETATE 40 MG/ML INJ SUSP,,J1030,HCPCS,Facility,Both,1,mL,,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,High Value Network Plan,59.4,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
METHYLPREDNISOLONE ACETATE 40 MG/ML INJ SUSP,,J1030,HCPCS,Facility,Both,1,mL,,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,High Value Network Plan,59.4,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
METHYLPREDNISOLONE ACETATE 40 MG/ML INJ SUSP,,J1030,HCPCS,Facility,Outpatient,1,mL,,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,Medicare Advantage,32.34,49,,percent of total billed charges,,
METHYLPREDNISOLONE ACETATE 40 MG/ML INJ SUSP,,J1030,HCPCS,Facility,Outpatient,1,mL,,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,Medicare Advantage,32.34,49,,percent of total billed charges,,
METHYLPREDNISOLONE ACETATE 40 MG/ML INJ SUSP,,J1030,HCPCS,Facility,Inpatient,1,mL,,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
METHYLPREDNISOLONE ACETATE 40 MG/ML INJ SUSP,,J1030,HCPCS,Facility,Inpatient,1,mL,,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
METHYLPREDNISOLONE ACETATE 40 MG/ML INJ SUSP,,J1030,HCPCS,Facility,Both,1,mL,,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,58.4562,88.57,,percent of total billed charges,,
METHYLPREDNISOLONE ACETATE 40 MG/ML INJ SUSP,,J1030,HCPCS,Facility,Both,1,mL,,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,58.4562,88.57,,percent of total billed charges,,
METHYLPREDNISOLONE ACETATE 40 MG/ML INJ SUSP,,J1030,HCPCS,Facility,Both,1,mL,,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,18.9156,28.66,,percent of total billed charges,,
METHYLPREDNISOLONE ACETATE 40 MG/ML INJ SUSP,,J1030,HCPCS,Facility,Both,1,mL,,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,18.9156,28.66,,percent of total billed charges,,
METHYLPREDNISOLONE ACETATE 40 MG/ML INJ SUSP,,J1030,HCPCS,Facility,Outpatient,1,mL,,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),32.34,49,,percent of total billed charges,,
METHYLPREDNISOLONE ACETATE 40 MG/ML INJ SUSP,,J1030,HCPCS,Facility,Outpatient,1,mL,,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),32.34,49,,percent of total billed charges,,
METHYLPREDNISOLONE ACETATE 40 MG/ML INJ SUSP,,J1030,HCPCS,Facility,Inpatient,1,mL,,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
METHYLPREDNISOLONE ACETATE 40 MG/ML INJ SUSP,,J1030,HCPCS,Facility,Inpatient,1,mL,,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
METHYLPREDNISOLONE ACETATE 40 MG/ML INJ SUSP,,J1030,HCPCS,Facility,Both,1,mL,,66,56.1,18.9156,66,CorVel,Worker's Compensation,66,100,,percent of total billed charges,,
METHYLPREDNISOLONE ACETATE 40 MG/ML INJ SUSP,,J1030,HCPCS,Facility,Both,1,mL,,66,56.1,18.9156,66,CorVel,Worker's Compensation,66,100,,percent of total billed charges,,
METHYLPREDNISOLONE ACETATE 40 MG/ML INJ SUSP,,J1030,HCPCS,Facility,Both,1,mL,,66,56.1,18.9156,66,First Health Group Corporation,First Health Network,64.02,97,,percent of total billed charges,,
METHYLPREDNISOLONE ACETATE 40 MG/ML INJ SUSP,,J1030,HCPCS,Facility,Both,1,mL,,66,56.1,18.9156,66,First Health Group Corporation,First Health Network,64.02,97,,percent of total billed charges,,
METHYLPREDNISOLONE ACETATE 40 MG/ML INJ SUSP,,J1030,HCPCS,Facility,Both,1,mL,,66,56.1,18.9156,66,"Health Partners, Inc.",Commercial,62.436,94.6,,percent of total billed charges,,
METHYLPREDNISOLONE ACETATE 40 MG/ML INJ SUSP,,J1030,HCPCS,Facility,Both,1,mL,,66,56.1,18.9156,66,"Health Partners, Inc.",Commercial,62.436,94.6,,percent of total billed charges,,
METHYLPREDNISOLONE ACETATE 40 MG/ML INJ SUSP,,J1030,HCPCS,Facility,Outpatient,1,mL,,66,56.1,18.9156,66,"Health Partners, Inc.",Medicare Advantage,32.34,49,,percent of total billed charges,,
METHYLPREDNISOLONE ACETATE 40 MG/ML INJ SUSP,,J1030,HCPCS,Facility,Outpatient,1,mL,,66,56.1,18.9156,66,"Health Partners, Inc.",Medicare Advantage,32.34,49,,percent of total billed charges,,
METHYLPREDNISOLONE ACETATE 40 MG/ML INJ SUSP,,J1030,HCPCS,Facility,Inpatient,1,mL,,66,56.1,18.9156,66,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
METHYLPREDNISOLONE ACETATE 40 MG/ML INJ SUSP,,J1030,HCPCS,Facility,Inpatient,1,mL,,66,56.1,18.9156,66,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
METHYLPREDNISOLONE ACETATE 40 MG/ML INJ SUSP,,J1030,HCPCS,Facility,Both,1,mL,,66,56.1,18.9156,66,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),39.6,60,,percent of total billed charges,,
METHYLPREDNISOLONE ACETATE 40 MG/ML INJ SUSP,,J1030,HCPCS,Facility,Both,1,mL,,66,56.1,18.9156,66,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),39.6,60,,percent of total billed charges,,
METHYLPREDNISOLONE ACETATE 40 MG/ML INJ SUSP,,J1030,HCPCS,Facility,Both,1,mL,,66,56.1,18.9156,66,"Health Partners, Inc.",State of Minnesota Advantage Program,53.79,81.5,,percent of total billed charges,,
METHYLPREDNISOLONE ACETATE 40 MG/ML INJ SUSP,,J1030,HCPCS,Facility,Both,1,mL,,66,56.1,18.9156,66,"Health Partners, Inc.",State of Minnesota Advantage Program,53.79,81.5,,percent of total billed charges,,
METHYLPREDNISOLONE ACETATE 40 MG/ML INJ SUSP,,J1030,HCPCS,Facility,Both,1,mL,,66,56.1,18.9156,66,"Health Partners, Inc.",State Public Programs,33,50,,percent of total billed charges,,
METHYLPREDNISOLONE ACETATE 40 MG/ML INJ SUSP,,J1030,HCPCS,Facility,Both,1,mL,,66,56.1,18.9156,66,"Health Partners, Inc.",State Public Programs,33,50,,percent of total billed charges,,
METHYLPREDNISOLONE ACETATE 40 MG/ML INJ SUSP,,J1030,HCPCS,Facility,Both,1,mL,,66,56.1,18.9156,66,Humana Insurance Company,Commercial PPO,62.7,95,,percent of total billed charges,,
METHYLPREDNISOLONE ACETATE 40 MG/ML INJ SUSP,,J1030,HCPCS,Facility,Both,1,mL,,66,56.1,18.9156,66,Humana Insurance Company,Commercial PPO,62.7,95,,percent of total billed charges,,
METHYLPREDNISOLONE ACETATE 40 MG/ML INJ SUSP,,J1030,HCPCS,Facility,Outpatient,1,mL,,66,56.1,18.9156,66,Humana Insurance Company,Medicare PPO,32.34,49,,percent of total billed charges,,
METHYLPREDNISOLONE ACETATE 40 MG/ML INJ SUSP,,J1030,HCPCS,Facility,Outpatient,1,mL,,66,56.1,18.9156,66,Humana Insurance Company,Medicare PPO,32.34,49,,percent of total billed charges,,
METHYLPREDNISOLONE ACETATE 40 MG/ML INJ SUSP,,J1030,HCPCS,Facility,Inpatient,1,mL,,66,56.1,18.9156,66,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
METHYLPREDNISOLONE ACETATE 40 MG/ML INJ SUSP,,J1030,HCPCS,Facility,Inpatient,1,mL,,66,56.1,18.9156,66,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
METHYLPREDNISOLONE ACETATE 40 MG/ML INJ SUSP,,J1030,HCPCS,Facility,Both,1,mL,,66,56.1,18.9156,66,Medica,Individual & Family,65.406,99.1,,percent of total billed charges,,
METHYLPREDNISOLONE ACETATE 40 MG/ML INJ SUSP,,J1030,HCPCS,Facility,Both,1,mL,,66,56.1,18.9156,66,Medica,Individual & Family,65.406,99.1,,percent of total billed charges,,
METHYLPREDNISOLONE ACETATE 40 MG/ML INJ SUSP,,J1030,HCPCS,Facility,Outpatient,1,mL,,66,56.1,18.9156,66,Medica,Medica Advantage Solution,32.868,49.8,,percent of total billed charges,,
METHYLPREDNISOLONE ACETATE 40 MG/ML INJ SUSP,,J1030,HCPCS,Facility,Outpatient,1,mL,,66,56.1,18.9156,66,Medica,Medica Advantage Solution,32.868,49.8,,percent of total billed charges,,
METHYLPREDNISOLONE ACETATE 40 MG/ML INJ SUSP,,J1030,HCPCS,Facility,Inpatient,1,mL,,66,56.1,18.9156,66,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
METHYLPREDNISOLONE ACETATE 40 MG/ML INJ SUSP,,J1030,HCPCS,Facility,Inpatient,1,mL,,66,56.1,18.9156,66,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
METHYLPREDNISOLONE ACETATE 40 MG/ML INJ SUSP,,J1030,HCPCS,Facility,Outpatient,1,mL,,66,56.1,18.9156,66,Medica,Medical Assistance,29.436,44.6,,percent of total billed charges,,
METHYLPREDNISOLONE ACETATE 40 MG/ML INJ SUSP,,J1030,HCPCS,Facility,Outpatient,1,mL,,66,56.1,18.9156,66,Medica,Medical Assistance,29.436,44.6,,percent of total billed charges,,
METHYLPREDNISOLONE ACETATE 40 MG/ML INJ SUSP,,J1030,HCPCS,Facility,Inpatient,1,mL,,66,56.1,18.9156,66,Medica,Medical Assistance,,,,,Included in per diem rate,
METHYLPREDNISOLONE ACETATE 40 MG/ML INJ SUSP,,J1030,HCPCS,Facility,Inpatient,1,mL,,66,56.1,18.9156,66,Medica,Medical Assistance,,,,,Included in per diem rate,
METHYLPREDNISOLONE ACETATE 40 MG/ML INJ SUSP,,J1030,HCPCS,Facility,Outpatient,1,mL,,66,56.1,18.9156,66,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,32.868,49.8,,percent of total billed charges,,
METHYLPREDNISOLONE ACETATE 40 MG/ML INJ SUSP,,J1030,HCPCS,Facility,Outpatient,1,mL,,66,56.1,18.9156,66,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,32.868,49.8,,percent of total billed charges,,
METHYLPREDNISOLONE ACETATE 40 MG/ML INJ SUSP,,J1030,HCPCS,Facility,Inpatient,1,mL,,66,56.1,18.9156,66,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
METHYLPREDNISOLONE ACETATE 40 MG/ML INJ SUSP,,J1030,HCPCS,Facility,Inpatient,1,mL,,66,56.1,18.9156,66,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
METHYLPREDNISOLONE ACETATE 40 MG/ML INJ SUSP,,J1030,HCPCS,Facility,Both,1,mL,,66,56.1,18.9156,66,"Multiplan, Inc.","Multiplan, Inc.",62.04,94,,percent of total billed charges,,
METHYLPREDNISOLONE ACETATE 40 MG/ML INJ SUSP,,J1030,HCPCS,Facility,Both,1,mL,,66,56.1,18.9156,66,"Multiplan, Inc.","Multiplan, Inc.",62.04,94,,percent of total billed charges,,
METHYLPREDNISOLONE ACETATE 40 MG/ML INJ SUSP,,J1030,HCPCS,Facility,Outpatient,1,mL,,66,56.1,18.9156,66,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,59.466,90.1,,percent of total billed charges,,
METHYLPREDNISOLONE ACETATE 40 MG/ML INJ SUSP,,J1030,HCPCS,Facility,Outpatient,1,mL,,66,56.1,18.9156,66,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,59.466,90.1,,percent of total billed charges,,
METHYLPREDNISOLONE ACETATE 40 MG/ML INJ SUSP,,J1030,HCPCS,Facility,Inpatient,1,mL,,66,56.1,18.9156,66,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
METHYLPREDNISOLONE ACETATE 40 MG/ML INJ SUSP,,J1030,HCPCS,Facility,Inpatient,1,mL,,66,56.1,18.9156,66,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
METHYLPREDNISOLONE ACETATE 40 MG/ML INJ SUSP,,J1030,HCPCS,Facility,Both,1,mL,,66,56.1,18.9156,66,"Preferred One Administrative Services, INC.",PPO,65.076,98.6,,percent of total billed charges,,
METHYLPREDNISOLONE ACETATE 40 MG/ML INJ SUSP,,J1030,HCPCS,Facility,Both,1,mL,,66,56.1,18.9156,66,"Preferred One Administrative Services, INC.",PPO,65.076,98.6,,percent of total billed charges,,
METHYLPREDNISOLONE ACETATE 40 MG/ML INJ SUSP,,J1030,HCPCS,Facility,Outpatient,1,mL,,66,56.1,18.9156,66,PrimeWest Health,Minnesota Senior Health Options (MSHO),33.957,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
METHYLPREDNISOLONE ACETATE 40 MG/ML INJ SUSP,,J1030,HCPCS,Facility,Outpatient,1,mL,,66,56.1,18.9156,66,PrimeWest Health,Minnesota Senior Health Options (MSHO),33.957,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
METHYLPREDNISOLONE ACETATE 40 MG/ML INJ SUSP,,J1030,HCPCS,Facility,Inpatient,1,mL,,66,56.1,18.9156,66,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
METHYLPREDNISOLONE ACETATE 40 MG/ML INJ SUSP,,J1030,HCPCS,Facility,Inpatient,1,mL,,66,56.1,18.9156,66,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
METHYLPREDNISOLONE ACETATE 40 MG/ML INJ SUSP,,J1030,HCPCS,Facility,Outpatient,1,mL,,66,56.1,18.9156,66,PrimeWest Health,MinnesotaCare,33.8976,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
METHYLPREDNISOLONE ACETATE 40 MG/ML INJ SUSP,,J1030,HCPCS,Facility,Outpatient,1,mL,,66,56.1,18.9156,66,PrimeWest Health,MinnesotaCare,33.8976,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
METHYLPREDNISOLONE ACETATE 40 MG/ML INJ SUSP,,J1030,HCPCS,Facility,Inpatient,1,mL,,66,56.1,18.9156,66,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
METHYLPREDNISOLONE ACETATE 40 MG/ML INJ SUSP,,J1030,HCPCS,Facility,Inpatient,1,mL,,66,56.1,18.9156,66,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
METHYLPREDNISOLONE ACETATE 40 MG/ML INJ SUSP,,J1030,HCPCS,Facility,Both,1,mL,,66,56.1,18.9156,66,Sanford Health Plan,Sanford Health Plan,60.72,92,,percent of total billed charges,,
METHYLPREDNISOLONE ACETATE 40 MG/ML INJ SUSP,,J1030,HCPCS,Facility,Both,1,mL,,66,56.1,18.9156,66,Sanford Health Plan,Sanford Health Plan,60.72,92,,percent of total billed charges,,
METHYLPREDNISOLONE ACETATE 40 MG/ML INJ SUSP,,J1030,HCPCS,Facility,Outpatient,1,mL,,66,56.1,18.9156,66,"UCare Health, Inc.",Individual & Family Plan,37.191,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
METHYLPREDNISOLONE ACETATE 40 MG/ML INJ SUSP,,J1030,HCPCS,Facility,Outpatient,1,mL,,66,56.1,18.9156,66,"UCare Health, Inc.",Individual & Family Plan,37.191,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
METHYLPREDNISOLONE ACETATE 40 MG/ML INJ SUSP,,J1030,HCPCS,Facility,Inpatient,1,mL,,66,56.1,18.9156,66,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
METHYLPREDNISOLONE ACETATE 40 MG/ML INJ SUSP,,J1030,HCPCS,Facility,Inpatient,1,mL,,66,56.1,18.9156,66,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
METHYLPREDNISOLONE ACETATE 40 MG/ML INJ SUSP,,J1030,HCPCS,Facility,Outpatient,1,mL,,66,56.1,18.9156,66,"UCare Health, Inc.",Medical Assistance,33.3102,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
METHYLPREDNISOLONE ACETATE 40 MG/ML INJ SUSP,,J1030,HCPCS,Facility,Outpatient,1,mL,,66,56.1,18.9156,66,"UCare Health, Inc.",Medical Assistance,33.3102,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
METHYLPREDNISOLONE ACETATE 40 MG/ML INJ SUSP,,J1030,HCPCS,Facility,Inpatient,1,mL,,66,56.1,18.9156,66,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
METHYLPREDNISOLONE ACETATE 40 MG/ML INJ SUSP,,J1030,HCPCS,Facility,Inpatient,1,mL,,66,56.1,18.9156,66,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
METHYLPREDNISOLONE ACETATE 40 MG/ML INJ SUSP,,J1030,HCPCS,Facility,Outpatient,1,mL,,66,56.1,18.9156,66,"UCare Health, Inc.",Medicare Advantage,33.3102,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
METHYLPREDNISOLONE ACETATE 40 MG/ML INJ SUSP,,J1030,HCPCS,Facility,Outpatient,1,mL,,66,56.1,18.9156,66,"UCare Health, Inc.",Medicare Advantage,33.3102,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
METHYLPREDNISOLONE ACETATE 40 MG/ML INJ SUSP,,J1030,HCPCS,Facility,Inpatient,1,mL,,66,56.1,18.9156,66,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
METHYLPREDNISOLONE ACETATE 40 MG/ML INJ SUSP,,J1030,HCPCS,Facility,Inpatient,1,mL,,66,56.1,18.9156,66,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
METHYLPREDNISOLONE ACETATE 40 MG/ML INJ SUSP,,J1030,HCPCS,Facility,Outpatient,1,mL,,66,56.1,18.9156,66,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),33.3102,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
METHYLPREDNISOLONE ACETATE 40 MG/ML INJ SUSP,,J1030,HCPCS,Facility,Outpatient,1,mL,,66,56.1,18.9156,66,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),33.3102,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
METHYLPREDNISOLONE ACETATE 40 MG/ML INJ SUSP,,J1030,HCPCS,Facility,Inpatient,1,mL,,66,56.1,18.9156,66,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
METHYLPREDNISOLONE ACETATE 40 MG/ML INJ SUSP,,J1030,HCPCS,Facility,Inpatient,1,mL,,66,56.1,18.9156,66,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
METHYLPREDNISOLONE ACETATE 40 MG/ML INJ SUSP,,J1030,HCPCS,Facility,Both,1,mL,,66,56.1,18.9156,66,UnitedHealthcare,Individual & Family,62.04,94,,percent of total billed charges,,
METHYLPREDNISOLONE ACETATE 40 MG/ML INJ SUSP,,J1030,HCPCS,Facility,Both,1,mL,,66,56.1,18.9156,66,UnitedHealthcare,Individual & Family,62.04,94,,percent of total billed charges,,
METHYLPREDNISOLONE ACETATE 40 MG/ML INJ SUSP,,J1030,HCPCS,Facility,Outpatient,1,mL,,66,56.1,18.9156,66,UnitedHealthcare,Medicare Advantage,32.34,49,,percent of total billed charges,,
METHYLPREDNISOLONE ACETATE 40 MG/ML INJ SUSP,,J1030,HCPCS,Facility,Outpatient,1,mL,,66,56.1,18.9156,66,UnitedHealthcare,Medicare Advantage,32.34,49,,percent of total billed charges,,
METHYLPREDNISOLONE ACETATE 40 MG/ML INJ SUSP,,J1030,HCPCS,Facility,Inpatient,1,mL,,66,56.1,18.9156,66,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
METHYLPREDNISOLONE ACETATE 40 MG/ML INJ SUSP,,J1030,HCPCS,Facility,Inpatient,1,mL,,66,56.1,18.9156,66,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
METHYLPREDNISOLONE ACETATE 40 MG/ML INJ SUSP,,J1030,HCPCS,Facility,Outpatient,1,mL,,66,56.1,18.9156,66,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,31.68,48,,percent of total billed charges,,100% of DHS outpatient percentage
METHYLPREDNISOLONE ACETATE 40 MG/ML INJ SUSP,,J1030,HCPCS,Facility,Outpatient,1,mL,,66,56.1,18.9156,66,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,31.68,48,,percent of total billed charges,,100% of DHS outpatient percentage
METHYLPREDNISOLONE ACETATE 40 MG/ML INJ SUSP,,J1030,HCPCS,Facility,Inpatient,1,mL,,66,56.1,18.9156,66,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
METHYLPREDNISOLONE ACETATE 40 MG/ML INJ SUSP,,J1030,HCPCS,Facility,Inpatient,1,mL,,66,56.1,18.9156,66,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
METHYLPREDNISOLONE ACETATE 80 MG/ML INJ SUSP,,J1040,HCPCS,Facility,Both,1,mL,,95,80.75,27.227,95,Aetna,Commercial,87.4,92,,percent of total billed charges,,
METHYLPREDNISOLONE ACETATE 80 MG/ML INJ SUSP,,J1040,HCPCS,Facility,Outpatient,1,mL,,95,80.75,27.227,95,Aetna,Medicare Advantage,46.55,49,,percent of total billed charges,,
METHYLPREDNISOLONE ACETATE 80 MG/ML INJ SUSP,,J1040,HCPCS,Facility,Inpatient,1,mL,,95,80.75,27.227,95,Aetna,Medicare Advantage,,,,,Included in per diem rate,
METHYLPREDNISOLONE ACETATE 80 MG/ML INJ SUSP,,J1040,HCPCS,Facility,Both,1,mL,,95,80.75,27.227,95,Aetna,PPO,88.35,93,,percent of total billed charges,,
METHYLPREDNISOLONE ACETATE 80 MG/ML INJ SUSP,,J1040,HCPCS,Facility,Both,1,mL,,95,80.75,27.227,95,America's PPO,America's PPO,91.2285,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
METHYLPREDNISOLONE ACETATE 80 MG/ML INJ SUSP,,J1040,HCPCS,Facility,Both,1,mL,,95,80.75,27.227,95,BlueCross BlueShield Minnesota, Federal Employee Program,93.48,98.4,,percent of total billed charges,,
METHYLPREDNISOLONE ACETATE 80 MG/ML INJ SUSP,,J1040,HCPCS,Facility,Both,1,mL,,95,80.75,27.227,95,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,95,100,,percent of total billed charges,,
METHYLPREDNISOLONE ACETATE 80 MG/ML INJ SUSP,,J1040,HCPCS,Facility,Both,1,mL,,95,80.75,27.227,95,BlueCross BlueShield Minnesota,High Value Network Plan,85.5,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
METHYLPREDNISOLONE ACETATE 80 MG/ML INJ SUSP,,J1040,HCPCS,Facility,Outpatient,1,mL,,95,80.75,27.227,95,BlueCross BlueShield Minnesota,Medicare Advantage,46.55,49,,percent of total billed charges,,
METHYLPREDNISOLONE ACETATE 80 MG/ML INJ SUSP,,J1040,HCPCS,Facility,Inpatient,1,mL,,95,80.75,27.227,95,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
METHYLPREDNISOLONE ACETATE 80 MG/ML INJ SUSP,,J1040,HCPCS,Facility,Both,1,mL,,95,80.75,27.227,95,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,84.1415,88.57,,percent of total billed charges,,
METHYLPREDNISOLONE ACETATE 80 MG/ML INJ SUSP,,J1040,HCPCS,Facility,Both,1,mL,,95,80.75,27.227,95,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,27.227,28.66,,percent of total billed charges,,
METHYLPREDNISOLONE ACETATE 80 MG/ML INJ SUSP,,J1040,HCPCS,Facility,Outpatient,1,mL,,95,80.75,27.227,95,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),46.55,49,,percent of total billed charges,,
METHYLPREDNISOLONE ACETATE 80 MG/ML INJ SUSP,,J1040,HCPCS,Facility,Inpatient,1,mL,,95,80.75,27.227,95,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
METHYLPREDNISOLONE ACETATE 80 MG/ML INJ SUSP,,J1040,HCPCS,Facility,Both,1,mL,,95,80.75,27.227,95,CorVel,Worker's Compensation,95,100,,percent of total billed charges,,
METHYLPREDNISOLONE ACETATE 80 MG/ML INJ SUSP,,J1040,HCPCS,Facility,Both,1,mL,,95,80.75,27.227,95,First Health Group Corporation,First Health Network,92.15,97,,percent of total billed charges,,
METHYLPREDNISOLONE ACETATE 80 MG/ML INJ SUSP,,J1040,HCPCS,Facility,Both,1,mL,,95,80.75,27.227,95,"Health Partners, Inc.",Commercial,89.87,94.6,,percent of total billed charges,,
METHYLPREDNISOLONE ACETATE 80 MG/ML INJ SUSP,,J1040,HCPCS,Facility,Outpatient,1,mL,,95,80.75,27.227,95,"Health Partners, Inc.",Medicare Advantage,46.55,49,,percent of total billed charges,,
METHYLPREDNISOLONE ACETATE 80 MG/ML INJ SUSP,,J1040,HCPCS,Facility,Inpatient,1,mL,,95,80.75,27.227,95,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
METHYLPREDNISOLONE ACETATE 80 MG/ML INJ SUSP,,J1040,HCPCS,Facility,Both,1,mL,,95,80.75,27.227,95,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),57,60,,percent of total billed charges,,
METHYLPREDNISOLONE ACETATE 80 MG/ML INJ SUSP,,J1040,HCPCS,Facility,Both,1,mL,,95,80.75,27.227,95,"Health Partners, Inc.",State of Minnesota Advantage Program,77.425,81.5,,percent of total billed charges,,
METHYLPREDNISOLONE ACETATE 80 MG/ML INJ SUSP,,J1040,HCPCS,Facility,Both,1,mL,,95,80.75,27.227,95,"Health Partners, Inc.",State Public Programs,47.5,50,,percent of total billed charges,,
METHYLPREDNISOLONE ACETATE 80 MG/ML INJ SUSP,,J1040,HCPCS,Facility,Both,1,mL,,95,80.75,27.227,95,Humana Insurance Company,Commercial PPO,90.25,95,,percent of total billed charges,,
METHYLPREDNISOLONE ACETATE 80 MG/ML INJ SUSP,,J1040,HCPCS,Facility,Outpatient,1,mL,,95,80.75,27.227,95,Humana Insurance Company,Medicare PPO,46.55,49,,percent of total billed charges,,
METHYLPREDNISOLONE ACETATE 80 MG/ML INJ SUSP,,J1040,HCPCS,Facility,Inpatient,1,mL,,95,80.75,27.227,95,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
METHYLPREDNISOLONE ACETATE 80 MG/ML INJ SUSP,,J1040,HCPCS,Facility,Both,1,mL,,95,80.75,27.227,95,Medica,Individual & Family,94.145,99.1,,percent of total billed charges,,
METHYLPREDNISOLONE ACETATE 80 MG/ML INJ SUSP,,J1040,HCPCS,Facility,Outpatient,1,mL,,95,80.75,27.227,95,Medica,Medica Advantage Solution,47.31,49.8,,percent of total billed charges,,
METHYLPREDNISOLONE ACETATE 80 MG/ML INJ SUSP,,J1040,HCPCS,Facility,Inpatient,1,mL,,95,80.75,27.227,95,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
METHYLPREDNISOLONE ACETATE 80 MG/ML INJ SUSP,,J1040,HCPCS,Facility,Outpatient,1,mL,,95,80.75,27.227,95,Medica,Medical Assistance,42.37,44.6,,percent of total billed charges,,
METHYLPREDNISOLONE ACETATE 80 MG/ML INJ SUSP,,J1040,HCPCS,Facility,Inpatient,1,mL,,95,80.75,27.227,95,Medica,Medical Assistance,,,,,Included in per diem rate,
METHYLPREDNISOLONE ACETATE 80 MG/ML INJ SUSP,,J1040,HCPCS,Facility,Outpatient,1,mL,,95,80.75,27.227,95,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,47.31,49.8,,percent of total billed charges,,
METHYLPREDNISOLONE ACETATE 80 MG/ML INJ SUSP,,J1040,HCPCS,Facility,Inpatient,1,mL,,95,80.75,27.227,95,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
METHYLPREDNISOLONE ACETATE 80 MG/ML INJ SUSP,,J1040,HCPCS,Facility,Both,1,mL,,95,80.75,27.227,95,"Multiplan, Inc.","Multiplan, Inc.",89.3,94,,percent of total billed charges,,
METHYLPREDNISOLONE ACETATE 80 MG/ML INJ SUSP,,J1040,HCPCS,Facility,Outpatient,1,mL,,95,80.75,27.227,95,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,85.595,90.1,,percent of total billed charges,,
METHYLPREDNISOLONE ACETATE 80 MG/ML INJ SUSP,,J1040,HCPCS,Facility,Inpatient,1,mL,,95,80.75,27.227,95,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
METHYLPREDNISOLONE ACETATE 80 MG/ML INJ SUSP,,J1040,HCPCS,Facility,Both,1,mL,,95,80.75,27.227,95,"Preferred One Administrative Services, INC.",PPO,93.67,98.6,,percent of total billed charges,,
METHYLPREDNISOLONE ACETATE 80 MG/ML INJ SUSP,,J1040,HCPCS,Facility,Outpatient,1,mL,,95,80.75,27.227,95,PrimeWest Health,Minnesota Senior Health Options (MSHO),48.8775,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
METHYLPREDNISOLONE ACETATE 80 MG/ML INJ SUSP,,J1040,HCPCS,Facility,Inpatient,1,mL,,95,80.75,27.227,95,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
METHYLPREDNISOLONE ACETATE 80 MG/ML INJ SUSP,,J1040,HCPCS,Facility,Outpatient,1,mL,,95,80.75,27.227,95,PrimeWest Health,MinnesotaCare,48.792,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
METHYLPREDNISOLONE ACETATE 80 MG/ML INJ SUSP,,J1040,HCPCS,Facility,Inpatient,1,mL,,95,80.75,27.227,95,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
METHYLPREDNISOLONE ACETATE 80 MG/ML INJ SUSP,,J1040,HCPCS,Facility,Both,1,mL,,95,80.75,27.227,95,Sanford Health Plan,Sanford Health Plan,87.4,92,,percent of total billed charges,,
METHYLPREDNISOLONE ACETATE 80 MG/ML INJ SUSP,,J1040,HCPCS,Facility,Outpatient,1,mL,,95,80.75,27.227,95,"UCare Health, Inc.",Individual & Family Plan,53.5325,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
METHYLPREDNISOLONE ACETATE 80 MG/ML INJ SUSP,,J1040,HCPCS,Facility,Inpatient,1,mL,,95,80.75,27.227,95,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
METHYLPREDNISOLONE ACETATE 80 MG/ML INJ SUSP,,J1040,HCPCS,Facility,Outpatient,1,mL,,95,80.75,27.227,95,"UCare Health, Inc.",Medical Assistance,47.9465,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
METHYLPREDNISOLONE ACETATE 80 MG/ML INJ SUSP,,J1040,HCPCS,Facility,Inpatient,1,mL,,95,80.75,27.227,95,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
METHYLPREDNISOLONE ACETATE 80 MG/ML INJ SUSP,,J1040,HCPCS,Facility,Outpatient,1,mL,,95,80.75,27.227,95,"UCare Health, Inc.",Medicare Advantage,47.9465,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
METHYLPREDNISOLONE ACETATE 80 MG/ML INJ SUSP,,J1040,HCPCS,Facility,Inpatient,1,mL,,95,80.75,27.227,95,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
METHYLPREDNISOLONE ACETATE 80 MG/ML INJ SUSP,,J1040,HCPCS,Facility,Outpatient,1,mL,,95,80.75,27.227,95,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),47.9465,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
METHYLPREDNISOLONE ACETATE 80 MG/ML INJ SUSP,,J1040,HCPCS,Facility,Inpatient,1,mL,,95,80.75,27.227,95,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
METHYLPREDNISOLONE ACETATE 80 MG/ML INJ SUSP,,J1040,HCPCS,Facility,Both,1,mL,,95,80.75,27.227,95,UnitedHealthcare,Individual & Family,89.3,94,,percent of total billed charges,,
METHYLPREDNISOLONE ACETATE 80 MG/ML INJ SUSP,,J1040,HCPCS,Facility,Outpatient,1,mL,,95,80.75,27.227,95,UnitedHealthcare,Medicare Advantage,46.55,49,,percent of total billed charges,,
METHYLPREDNISOLONE ACETATE 80 MG/ML INJ SUSP,,J1040,HCPCS,Facility,Inpatient,1,mL,,95,80.75,27.227,95,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
METHYLPREDNISOLONE ACETATE 80 MG/ML INJ SUSP,,J1040,HCPCS,Facility,Outpatient,1,mL,,95,80.75,27.227,95,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,45.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
METHYLPREDNISOLONE ACETATE 80 MG/ML INJ SUSP,,J1040,HCPCS,Facility,Inpatient,1,mL,,95,80.75,27.227,95,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
MEDROXYPROGESTERONE 150 MG/ML IM SYRG,,J1050,HCPCS,Facility,Both,1,mL,,278,236.3,79.6748,278,Aetna,Commercial,255.76,92,,percent of total billed charges,,
MEDROXYPROGESTERONE 150 MG/ML IM SYRG,,J1050,HCPCS,Facility,Outpatient,1,mL,,278,236.3,79.6748,278,Aetna,Medicare Advantage,136.22,49,,percent of total billed charges,,
MEDROXYPROGESTERONE 150 MG/ML IM SYRG,,J1050,HCPCS,Facility,Inpatient,1,mL,,278,236.3,79.6748,278,Aetna,Medicare Advantage,,,,,Included in per diem rate,
MEDROXYPROGESTERONE 150 MG/ML IM SYRG,,J1050,HCPCS,Facility,Both,1,mL,,278,236.3,79.6748,278,Aetna,PPO,258.54,93,,percent of total billed charges,,
MEDROXYPROGESTERONE 150 MG/ML IM SYRG,,J1050,HCPCS,Facility,Both,1,mL,,278,236.3,79.6748,278,America's PPO,America's PPO,266.9634,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
MEDROXYPROGESTERONE 150 MG/ML IM SYRG,,J1050,HCPCS,Facility,Both,1,mL,,278,236.3,79.6748,278,BlueCross BlueShield Minnesota, Federal Employee Program,273.552,98.4,,percent of total billed charges,,
MEDROXYPROGESTERONE 150 MG/ML IM SYRG,,J1050,HCPCS,Facility,Both,1,mL,,278,236.3,79.6748,278,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,278,100,,percent of total billed charges,,
MEDROXYPROGESTERONE 150 MG/ML IM SYRG,,J1050,HCPCS,Facility,Both,1,mL,,278,236.3,79.6748,278,BlueCross BlueShield Minnesota,High Value Network Plan,250.2,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
MEDROXYPROGESTERONE 150 MG/ML IM SYRG,,J1050,HCPCS,Facility,Outpatient,1,mL,,278,236.3,79.6748,278,BlueCross BlueShield Minnesota,Medicare Advantage,136.22,49,,percent of total billed charges,,
MEDROXYPROGESTERONE 150 MG/ML IM SYRG,,J1050,HCPCS,Facility,Inpatient,1,mL,,278,236.3,79.6748,278,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
MEDROXYPROGESTERONE 150 MG/ML IM SYRG,,J1050,HCPCS,Facility,Both,1,mL,,278,236.3,79.6748,278,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,246.2246,88.57,,percent of total billed charges,,
MEDROXYPROGESTERONE 150 MG/ML IM SYRG,,J1050,HCPCS,Facility,Both,1,mL,,278,236.3,79.6748,278,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,79.6748,28.66,,percent of total billed charges,,
MEDROXYPROGESTERONE 150 MG/ML IM SYRG,,J1050,HCPCS,Facility,Outpatient,1,mL,,278,236.3,79.6748,278,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),136.22,49,,percent of total billed charges,,
MEDROXYPROGESTERONE 150 MG/ML IM SYRG,,J1050,HCPCS,Facility,Inpatient,1,mL,,278,236.3,79.6748,278,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
MEDROXYPROGESTERONE 150 MG/ML IM SYRG,,J1050,HCPCS,Facility,Both,1,mL,,278,236.3,79.6748,278,CorVel,Worker's Compensation,278,100,,percent of total billed charges,,
MEDROXYPROGESTERONE 150 MG/ML IM SYRG,,J1050,HCPCS,Facility,Both,1,mL,,278,236.3,79.6748,278,First Health Group Corporation,First Health Network,269.66,97,,percent of total billed charges,,
MEDROXYPROGESTERONE 150 MG/ML IM SYRG,,J1050,HCPCS,Facility,Both,1,mL,,278,236.3,79.6748,278,"Health Partners, Inc.",Commercial,262.988,94.6,,percent of total billed charges,,
MEDROXYPROGESTERONE 150 MG/ML IM SYRG,,J1050,HCPCS,Facility,Outpatient,1,mL,,278,236.3,79.6748,278,"Health Partners, Inc.",Medicare Advantage,136.22,49,,percent of total billed charges,,
MEDROXYPROGESTERONE 150 MG/ML IM SYRG,,J1050,HCPCS,Facility,Inpatient,1,mL,,278,236.3,79.6748,278,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
MEDROXYPROGESTERONE 150 MG/ML IM SYRG,,J1050,HCPCS,Facility,Both,1,mL,,278,236.3,79.6748,278,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),166.8,60,,percent of total billed charges,,
MEDROXYPROGESTERONE 150 MG/ML IM SYRG,,J1050,HCPCS,Facility,Both,1,mL,,278,236.3,79.6748,278,"Health Partners, Inc.",State of Minnesota Advantage Program,226.57,81.5,,percent of total billed charges,,
MEDROXYPROGESTERONE 150 MG/ML IM SYRG,,J1050,HCPCS,Facility,Both,1,mL,,278,236.3,79.6748,278,"Health Partners, Inc.",State Public Programs,139,50,,percent of total billed charges,,
MEDROXYPROGESTERONE 150 MG/ML IM SYRG,,J1050,HCPCS,Facility,Both,1,mL,,278,236.3,79.6748,278,Humana Insurance Company,Commercial PPO,264.1,95,,percent of total billed charges,,
MEDROXYPROGESTERONE 150 MG/ML IM SYRG,,J1050,HCPCS,Facility,Outpatient,1,mL,,278,236.3,79.6748,278,Humana Insurance Company,Medicare PPO,136.22,49,,percent of total billed charges,,
MEDROXYPROGESTERONE 150 MG/ML IM SYRG,,J1050,HCPCS,Facility,Inpatient,1,mL,,278,236.3,79.6748,278,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
MEDROXYPROGESTERONE 150 MG/ML IM SYRG,,J1050,HCPCS,Facility,Both,1,mL,,278,236.3,79.6748,278,Medica,Individual & Family,275.498,99.1,,percent of total billed charges,,
MEDROXYPROGESTERONE 150 MG/ML IM SYRG,,J1050,HCPCS,Facility,Outpatient,1,mL,,278,236.3,79.6748,278,Medica,Medica Advantage Solution,138.444,49.8,,percent of total billed charges,,
MEDROXYPROGESTERONE 150 MG/ML IM SYRG,,J1050,HCPCS,Facility,Inpatient,1,mL,,278,236.3,79.6748,278,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
MEDROXYPROGESTERONE 150 MG/ML IM SYRG,,J1050,HCPCS,Facility,Outpatient,1,mL,,278,236.3,79.6748,278,Medica,Medical Assistance,123.988,44.6,,percent of total billed charges,,
MEDROXYPROGESTERONE 150 MG/ML IM SYRG,,J1050,HCPCS,Facility,Inpatient,1,mL,,278,236.3,79.6748,278,Medica,Medical Assistance,,,,,Included in per diem rate,
MEDROXYPROGESTERONE 150 MG/ML IM SYRG,,J1050,HCPCS,Facility,Outpatient,1,mL,,278,236.3,79.6748,278,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,138.444,49.8,,percent of total billed charges,,
MEDROXYPROGESTERONE 150 MG/ML IM SYRG,,J1050,HCPCS,Facility,Inpatient,1,mL,,278,236.3,79.6748,278,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
MEDROXYPROGESTERONE 150 MG/ML IM SYRG,,J1050,HCPCS,Facility,Both,1,mL,,278,236.3,79.6748,278,"Multiplan, Inc.","Multiplan, Inc.",261.32,94,,percent of total billed charges,,
MEDROXYPROGESTERONE 150 MG/ML IM SYRG,,J1050,HCPCS,Facility,Outpatient,1,mL,,278,236.3,79.6748,278,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,250.478,90.1,,percent of total billed charges,,
MEDROXYPROGESTERONE 150 MG/ML IM SYRG,,J1050,HCPCS,Facility,Inpatient,1,mL,,278,236.3,79.6748,278,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
MEDROXYPROGESTERONE 150 MG/ML IM SYRG,,J1050,HCPCS,Facility,Both,1,mL,,278,236.3,79.6748,278,"Preferred One Administrative Services, INC.",PPO,274.108,98.6,,percent of total billed charges,,
MEDROXYPROGESTERONE 150 MG/ML IM SYRG,,J1050,HCPCS,Facility,Outpatient,1,mL,,278,236.3,79.6748,278,PrimeWest Health,Minnesota Senior Health Options (MSHO),143.031,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
MEDROXYPROGESTERONE 150 MG/ML IM SYRG,,J1050,HCPCS,Facility,Inpatient,1,mL,,278,236.3,79.6748,278,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
MEDROXYPROGESTERONE 150 MG/ML IM SYRG,,J1050,HCPCS,Facility,Outpatient,1,mL,,278,236.3,79.6748,278,PrimeWest Health,MinnesotaCare,142.7808,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
MEDROXYPROGESTERONE 150 MG/ML IM SYRG,,J1050,HCPCS,Facility,Inpatient,1,mL,,278,236.3,79.6748,278,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
MEDROXYPROGESTERONE 150 MG/ML IM SYRG,,J1050,HCPCS,Facility,Both,1,mL,,278,236.3,79.6748,278,Sanford Health Plan,Sanford Health Plan,255.76,92,,percent of total billed charges,,
MEDROXYPROGESTERONE 150 MG/ML IM SYRG,,J1050,HCPCS,Facility,Outpatient,1,mL,,278,236.3,79.6748,278,"UCare Health, Inc.",Individual & Family Plan,156.653,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
MEDROXYPROGESTERONE 150 MG/ML IM SYRG,,J1050,HCPCS,Facility,Inpatient,1,mL,,278,236.3,79.6748,278,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
MEDROXYPROGESTERONE 150 MG/ML IM SYRG,,J1050,HCPCS,Facility,Outpatient,1,mL,,278,236.3,79.6748,278,"UCare Health, Inc.",Medical Assistance,140.3066,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MEDROXYPROGESTERONE 150 MG/ML IM SYRG,,J1050,HCPCS,Facility,Inpatient,1,mL,,278,236.3,79.6748,278,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
MEDROXYPROGESTERONE 150 MG/ML IM SYRG,,J1050,HCPCS,Facility,Outpatient,1,mL,,278,236.3,79.6748,278,"UCare Health, Inc.",Medicare Advantage,140.3066,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MEDROXYPROGESTERONE 150 MG/ML IM SYRG,,J1050,HCPCS,Facility,Inpatient,1,mL,,278,236.3,79.6748,278,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
MEDROXYPROGESTERONE 150 MG/ML IM SYRG,,J1050,HCPCS,Facility,Outpatient,1,mL,,278,236.3,79.6748,278,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),140.3066,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MEDROXYPROGESTERONE 150 MG/ML IM SYRG,,J1050,HCPCS,Facility,Inpatient,1,mL,,278,236.3,79.6748,278,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
MEDROXYPROGESTERONE 150 MG/ML IM SYRG,,J1050,HCPCS,Facility,Both,1,mL,,278,236.3,79.6748,278,UnitedHealthcare,Individual & Family,261.32,94,,percent of total billed charges,,
MEDROXYPROGESTERONE 150 MG/ML IM SYRG,,J1050,HCPCS,Facility,Outpatient,1,mL,,278,236.3,79.6748,278,UnitedHealthcare,Medicare Advantage,136.22,49,,percent of total billed charges,,
MEDROXYPROGESTERONE 150 MG/ML IM SYRG,,J1050,HCPCS,Facility,Inpatient,1,mL,,278,236.3,79.6748,278,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
MEDROXYPROGESTERONE 150 MG/ML IM SYRG,,J1050,HCPCS,Facility,Outpatient,1,mL,,278,236.3,79.6748,278,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,133.44,48,,percent of total billed charges,,100% of DHS outpatient percentage
MEDROXYPROGESTERONE 150 MG/ML IM SYRG,,J1050,HCPCS,Facility,Inpatient,1,mL,,278,236.3,79.6748,278,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
DEXAMETHASONE SODIUM PHOS (PF) 10 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Both,1,mL,,32,27.2,9.1712,32,Aetna,Commercial,29.44,92,,percent of total billed charges,,
DEXAMETHASONE SODIUM PHOS (PF) 10 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Both,1,mL,,32,27.2,9.1712,32,Aetna,Commercial,29.44,92,,percent of total billed charges,,
DEXAMETHASONE SODIUM PHOS (PF) 10 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Outpatient,1,mL,,32,27.2,9.1712,32,Aetna,Medicare Advantage,15.68,49,,percent of total billed charges,,
DEXAMETHASONE SODIUM PHOS (PF) 10 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Outpatient,1,mL,,32,27.2,9.1712,32,Aetna,Medicare Advantage,15.68,49,,percent of total billed charges,,
DEXAMETHASONE SODIUM PHOS (PF) 10 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Inpatient,1,mL,,32,27.2,9.1712,32,Aetna,Medicare Advantage,,,,,Included in per diem rate,
DEXAMETHASONE SODIUM PHOS (PF) 10 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Inpatient,1,mL,,32,27.2,9.1712,32,Aetna,Medicare Advantage,,,,,Included in per diem rate,
DEXAMETHASONE SODIUM PHOS (PF) 10 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Both,1,mL,,32,27.2,9.1712,32,Aetna,PPO,29.76,93,,percent of total billed charges,,
DEXAMETHASONE SODIUM PHOS (PF) 10 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Both,1,mL,,32,27.2,9.1712,32,Aetna,PPO,29.76,93,,percent of total billed charges,,
DEXAMETHASONE SODIUM PHOS (PF) 10 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Both,1,mL,,32,27.2,9.1712,32,America's PPO,America's PPO,30.7296,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
DEXAMETHASONE SODIUM PHOS (PF) 10 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Both,1,mL,,32,27.2,9.1712,32,America's PPO,America's PPO,30.7296,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
DEXAMETHASONE SODIUM PHOS (PF) 10 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Both,1,mL,,32,27.2,9.1712,32,BlueCross BlueShield Minnesota, Federal Employee Program,31.488,98.4,,percent of total billed charges,,
DEXAMETHASONE SODIUM PHOS (PF) 10 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Both,1,mL,,32,27.2,9.1712,32,BlueCross BlueShield Minnesota, Federal Employee Program,31.488,98.4,,percent of total billed charges,,
DEXAMETHASONE SODIUM PHOS (PF) 10 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Both,1,mL,,32,27.2,9.1712,32,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,32,100,,percent of total billed charges,,
DEXAMETHASONE SODIUM PHOS (PF) 10 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Both,1,mL,,32,27.2,9.1712,32,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,32,100,,percent of total billed charges,,
DEXAMETHASONE SODIUM PHOS (PF) 10 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Both,1,mL,,32,27.2,9.1712,32,BlueCross BlueShield Minnesota,High Value Network Plan,28.8,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
DEXAMETHASONE SODIUM PHOS (PF) 10 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Both,1,mL,,32,27.2,9.1712,32,BlueCross BlueShield Minnesota,High Value Network Plan,28.8,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
DEXAMETHASONE SODIUM PHOS (PF) 10 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Outpatient,1,mL,,32,27.2,9.1712,32,BlueCross BlueShield Minnesota,Medicare Advantage,15.68,49,,percent of total billed charges,,
DEXAMETHASONE SODIUM PHOS (PF) 10 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Outpatient,1,mL,,32,27.2,9.1712,32,BlueCross BlueShield Minnesota,Medicare Advantage,15.68,49,,percent of total billed charges,,
DEXAMETHASONE SODIUM PHOS (PF) 10 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Inpatient,1,mL,,32,27.2,9.1712,32,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
DEXAMETHASONE SODIUM PHOS (PF) 10 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Inpatient,1,mL,,32,27.2,9.1712,32,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
DEXAMETHASONE SODIUM PHOS (PF) 10 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Both,1,mL,,32,27.2,9.1712,32,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,28.3424,88.57,,percent of total billed charges,,
DEXAMETHASONE SODIUM PHOS (PF) 10 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Both,1,mL,,32,27.2,9.1712,32,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,28.3424,88.57,,percent of total billed charges,,
DEXAMETHASONE SODIUM PHOS (PF) 10 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Both,1,mL,,32,27.2,9.1712,32,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,9.1712,28.66,,percent of total billed charges,,
DEXAMETHASONE SODIUM PHOS (PF) 10 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Both,1,mL,,32,27.2,9.1712,32,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,9.1712,28.66,,percent of total billed charges,,
DEXAMETHASONE SODIUM PHOS (PF) 10 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Outpatient,1,mL,,32,27.2,9.1712,32,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),15.68,49,,percent of total billed charges,,
DEXAMETHASONE SODIUM PHOS (PF) 10 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Outpatient,1,mL,,32,27.2,9.1712,32,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),15.68,49,,percent of total billed charges,,
DEXAMETHASONE SODIUM PHOS (PF) 10 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Inpatient,1,mL,,32,27.2,9.1712,32,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
DEXAMETHASONE SODIUM PHOS (PF) 10 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Inpatient,1,mL,,32,27.2,9.1712,32,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
DEXAMETHASONE SODIUM PHOS (PF) 10 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Both,1,mL,,32,27.2,9.1712,32,CorVel,Worker's Compensation,32,100,,percent of total billed charges,,
DEXAMETHASONE SODIUM PHOS (PF) 10 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Both,1,mL,,32,27.2,9.1712,32,CorVel,Worker's Compensation,32,100,,percent of total billed charges,,
DEXAMETHASONE SODIUM PHOS (PF) 10 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Both,1,mL,,32,27.2,9.1712,32,First Health Group Corporation,First Health Network,31.04,97,,percent of total billed charges,,
DEXAMETHASONE SODIUM PHOS (PF) 10 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Both,1,mL,,32,27.2,9.1712,32,First Health Group Corporation,First Health Network,31.04,97,,percent of total billed charges,,
DEXAMETHASONE SODIUM PHOS (PF) 10 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Both,1,mL,,32,27.2,9.1712,32,"Health Partners, Inc.",Commercial,30.272,94.6,,percent of total billed charges,,
DEXAMETHASONE SODIUM PHOS (PF) 10 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Both,1,mL,,32,27.2,9.1712,32,"Health Partners, Inc.",Commercial,30.272,94.6,,percent of total billed charges,,
DEXAMETHASONE SODIUM PHOS (PF) 10 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Outpatient,1,mL,,32,27.2,9.1712,32,"Health Partners, Inc.",Medicare Advantage,15.68,49,,percent of total billed charges,,
DEXAMETHASONE SODIUM PHOS (PF) 10 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Outpatient,1,mL,,32,27.2,9.1712,32,"Health Partners, Inc.",Medicare Advantage,15.68,49,,percent of total billed charges,,
DEXAMETHASONE SODIUM PHOS (PF) 10 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Inpatient,1,mL,,32,27.2,9.1712,32,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DEXAMETHASONE SODIUM PHOS (PF) 10 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Inpatient,1,mL,,32,27.2,9.1712,32,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DEXAMETHASONE SODIUM PHOS (PF) 10 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Both,1,mL,,32,27.2,9.1712,32,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),19.2,60,,percent of total billed charges,,
DEXAMETHASONE SODIUM PHOS (PF) 10 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Both,1,mL,,32,27.2,9.1712,32,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),19.2,60,,percent of total billed charges,,
DEXAMETHASONE SODIUM PHOS (PF) 10 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Both,1,mL,,32,27.2,9.1712,32,"Health Partners, Inc.",State of Minnesota Advantage Program,26.08,81.5,,percent of total billed charges,,
DEXAMETHASONE SODIUM PHOS (PF) 10 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Both,1,mL,,32,27.2,9.1712,32,"Health Partners, Inc.",State of Minnesota Advantage Program,26.08,81.5,,percent of total billed charges,,
DEXAMETHASONE SODIUM PHOS (PF) 10 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Both,1,mL,,32,27.2,9.1712,32,"Health Partners, Inc.",State Public Programs,16,50,,percent of total billed charges,,
DEXAMETHASONE SODIUM PHOS (PF) 10 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Both,1,mL,,32,27.2,9.1712,32,"Health Partners, Inc.",State Public Programs,16,50,,percent of total billed charges,,
DEXAMETHASONE SODIUM PHOS (PF) 10 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Both,1,mL,,32,27.2,9.1712,32,Humana Insurance Company,Commercial PPO,30.4,95,,percent of total billed charges,,
DEXAMETHASONE SODIUM PHOS (PF) 10 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Both,1,mL,,32,27.2,9.1712,32,Humana Insurance Company,Commercial PPO,30.4,95,,percent of total billed charges,,
DEXAMETHASONE SODIUM PHOS (PF) 10 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Outpatient,1,mL,,32,27.2,9.1712,32,Humana Insurance Company,Medicare PPO,15.68,49,,percent of total billed charges,,
DEXAMETHASONE SODIUM PHOS (PF) 10 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Outpatient,1,mL,,32,27.2,9.1712,32,Humana Insurance Company,Medicare PPO,15.68,49,,percent of total billed charges,,
DEXAMETHASONE SODIUM PHOS (PF) 10 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Inpatient,1,mL,,32,27.2,9.1712,32,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
DEXAMETHASONE SODIUM PHOS (PF) 10 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Inpatient,1,mL,,32,27.2,9.1712,32,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
DEXAMETHASONE SODIUM PHOS (PF) 10 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Both,1,mL,,32,27.2,9.1712,32,Medica,Individual & Family,31.712,99.1,,percent of total billed charges,,
DEXAMETHASONE SODIUM PHOS (PF) 10 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Both,1,mL,,32,27.2,9.1712,32,Medica,Individual & Family,31.712,99.1,,percent of total billed charges,,
DEXAMETHASONE SODIUM PHOS (PF) 10 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Outpatient,1,mL,,32,27.2,9.1712,32,Medica,Medica Advantage Solution,15.936,49.8,,percent of total billed charges,,
DEXAMETHASONE SODIUM PHOS (PF) 10 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Outpatient,1,mL,,32,27.2,9.1712,32,Medica,Medica Advantage Solution,15.936,49.8,,percent of total billed charges,,
DEXAMETHASONE SODIUM PHOS (PF) 10 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Inpatient,1,mL,,32,27.2,9.1712,32,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
DEXAMETHASONE SODIUM PHOS (PF) 10 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Inpatient,1,mL,,32,27.2,9.1712,32,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
DEXAMETHASONE SODIUM PHOS (PF) 10 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Outpatient,1,mL,,32,27.2,9.1712,32,Medica,Medical Assistance,14.272,44.6,,percent of total billed charges,,
DEXAMETHASONE SODIUM PHOS (PF) 10 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Outpatient,1,mL,,32,27.2,9.1712,32,Medica,Medical Assistance,14.272,44.6,,percent of total billed charges,,
DEXAMETHASONE SODIUM PHOS (PF) 10 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Inpatient,1,mL,,32,27.2,9.1712,32,Medica,Medical Assistance,,,,,Included in per diem rate,
DEXAMETHASONE SODIUM PHOS (PF) 10 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Inpatient,1,mL,,32,27.2,9.1712,32,Medica,Medical Assistance,,,,,Included in per diem rate,
DEXAMETHASONE SODIUM PHOS (PF) 10 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Outpatient,1,mL,,32,27.2,9.1712,32,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,15.936,49.8,,percent of total billed charges,,
DEXAMETHASONE SODIUM PHOS (PF) 10 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Outpatient,1,mL,,32,27.2,9.1712,32,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,15.936,49.8,,percent of total billed charges,,
DEXAMETHASONE SODIUM PHOS (PF) 10 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Inpatient,1,mL,,32,27.2,9.1712,32,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
DEXAMETHASONE SODIUM PHOS (PF) 10 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Inpatient,1,mL,,32,27.2,9.1712,32,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
DEXAMETHASONE SODIUM PHOS (PF) 10 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Both,1,mL,,32,27.2,9.1712,32,"Multiplan, Inc.","Multiplan, Inc.",30.08,94,,percent of total billed charges,,
DEXAMETHASONE SODIUM PHOS (PF) 10 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Both,1,mL,,32,27.2,9.1712,32,"Multiplan, Inc.","Multiplan, Inc.",30.08,94,,percent of total billed charges,,
DEXAMETHASONE SODIUM PHOS (PF) 10 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Outpatient,1,mL,,32,27.2,9.1712,32,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,28.832,90.1,,percent of total billed charges,,
DEXAMETHASONE SODIUM PHOS (PF) 10 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Outpatient,1,mL,,32,27.2,9.1712,32,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,28.832,90.1,,percent of total billed charges,,
DEXAMETHASONE SODIUM PHOS (PF) 10 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Inpatient,1,mL,,32,27.2,9.1712,32,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
DEXAMETHASONE SODIUM PHOS (PF) 10 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Inpatient,1,mL,,32,27.2,9.1712,32,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
DEXAMETHASONE SODIUM PHOS (PF) 10 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Both,1,mL,,32,27.2,9.1712,32,"Preferred One Administrative Services, INC.",PPO,31.552,98.6,,percent of total billed charges,,
DEXAMETHASONE SODIUM PHOS (PF) 10 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Both,1,mL,,32,27.2,9.1712,32,"Preferred One Administrative Services, INC.",PPO,31.552,98.6,,percent of total billed charges,,
DEXAMETHASONE SODIUM PHOS (PF) 10 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Outpatient,1,mL,,32,27.2,9.1712,32,PrimeWest Health,Minnesota Senior Health Options (MSHO),16.464,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
DEXAMETHASONE SODIUM PHOS (PF) 10 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Outpatient,1,mL,,32,27.2,9.1712,32,PrimeWest Health,Minnesota Senior Health Options (MSHO),16.464,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
DEXAMETHASONE SODIUM PHOS (PF) 10 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Inpatient,1,mL,,32,27.2,9.1712,32,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DEXAMETHASONE SODIUM PHOS (PF) 10 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Inpatient,1,mL,,32,27.2,9.1712,32,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DEXAMETHASONE SODIUM PHOS (PF) 10 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Outpatient,1,mL,,32,27.2,9.1712,32,PrimeWest Health,MinnesotaCare,16.4352,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
DEXAMETHASONE SODIUM PHOS (PF) 10 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Outpatient,1,mL,,32,27.2,9.1712,32,PrimeWest Health,MinnesotaCare,16.4352,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
DEXAMETHASONE SODIUM PHOS (PF) 10 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Inpatient,1,mL,,32,27.2,9.1712,32,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
DEXAMETHASONE SODIUM PHOS (PF) 10 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Inpatient,1,mL,,32,27.2,9.1712,32,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
DEXAMETHASONE SODIUM PHOS (PF) 10 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Both,1,mL,,32,27.2,9.1712,32,Sanford Health Plan,Sanford Health Plan,29.44,92,,percent of total billed charges,,
DEXAMETHASONE SODIUM PHOS (PF) 10 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Both,1,mL,,32,27.2,9.1712,32,Sanford Health Plan,Sanford Health Plan,29.44,92,,percent of total billed charges,,
DEXAMETHASONE SODIUM PHOS (PF) 10 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Outpatient,1,mL,,32,27.2,9.1712,32,"UCare Health, Inc.",Individual & Family Plan,18.032,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
DEXAMETHASONE SODIUM PHOS (PF) 10 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Outpatient,1,mL,,32,27.2,9.1712,32,"UCare Health, Inc.",Individual & Family Plan,18.032,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
DEXAMETHASONE SODIUM PHOS (PF) 10 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Inpatient,1,mL,,32,27.2,9.1712,32,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
DEXAMETHASONE SODIUM PHOS (PF) 10 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Inpatient,1,mL,,32,27.2,9.1712,32,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
DEXAMETHASONE SODIUM PHOS (PF) 10 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Outpatient,1,mL,,32,27.2,9.1712,32,"UCare Health, Inc.",Medical Assistance,16.1504,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DEXAMETHASONE SODIUM PHOS (PF) 10 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Outpatient,1,mL,,32,27.2,9.1712,32,"UCare Health, Inc.",Medical Assistance,16.1504,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DEXAMETHASONE SODIUM PHOS (PF) 10 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Inpatient,1,mL,,32,27.2,9.1712,32,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
DEXAMETHASONE SODIUM PHOS (PF) 10 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Inpatient,1,mL,,32,27.2,9.1712,32,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
DEXAMETHASONE SODIUM PHOS (PF) 10 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Outpatient,1,mL,,32,27.2,9.1712,32,"UCare Health, Inc.",Medicare Advantage,16.1504,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DEXAMETHASONE SODIUM PHOS (PF) 10 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Outpatient,1,mL,,32,27.2,9.1712,32,"UCare Health, Inc.",Medicare Advantage,16.1504,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DEXAMETHASONE SODIUM PHOS (PF) 10 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Inpatient,1,mL,,32,27.2,9.1712,32,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DEXAMETHASONE SODIUM PHOS (PF) 10 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Inpatient,1,mL,,32,27.2,9.1712,32,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DEXAMETHASONE SODIUM PHOS (PF) 10 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Outpatient,1,mL,,32,27.2,9.1712,32,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),16.1504,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DEXAMETHASONE SODIUM PHOS (PF) 10 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Outpatient,1,mL,,32,27.2,9.1712,32,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),16.1504,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DEXAMETHASONE SODIUM PHOS (PF) 10 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Inpatient,1,mL,,32,27.2,9.1712,32,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DEXAMETHASONE SODIUM PHOS (PF) 10 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Inpatient,1,mL,,32,27.2,9.1712,32,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DEXAMETHASONE SODIUM PHOS (PF) 10 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Both,1,mL,,32,27.2,9.1712,32,UnitedHealthcare,Individual & Family,30.08,94,,percent of total billed charges,,
DEXAMETHASONE SODIUM PHOS (PF) 10 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Both,1,mL,,32,27.2,9.1712,32,UnitedHealthcare,Individual & Family,30.08,94,,percent of total billed charges,,
DEXAMETHASONE SODIUM PHOS (PF) 10 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Outpatient,1,mL,,32,27.2,9.1712,32,UnitedHealthcare,Medicare Advantage,15.68,49,,percent of total billed charges,,
DEXAMETHASONE SODIUM PHOS (PF) 10 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Outpatient,1,mL,,32,27.2,9.1712,32,UnitedHealthcare,Medicare Advantage,15.68,49,,percent of total billed charges,,
DEXAMETHASONE SODIUM PHOS (PF) 10 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Inpatient,1,mL,,32,27.2,9.1712,32,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
DEXAMETHASONE SODIUM PHOS (PF) 10 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Inpatient,1,mL,,32,27.2,9.1712,32,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
DEXAMETHASONE SODIUM PHOS (PF) 10 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Outpatient,1,mL,,32,27.2,9.1712,32,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,15.36,48,,percent of total billed charges,,100% of DHS outpatient percentage
DEXAMETHASONE SODIUM PHOS (PF) 10 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Outpatient,1,mL,,32,27.2,9.1712,32,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,15.36,48,,percent of total billed charges,,100% of DHS outpatient percentage
DEXAMETHASONE SODIUM PHOS (PF) 10 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Inpatient,1,mL,,32,27.2,9.1712,32,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
DEXAMETHASONE SODIUM PHOS (PF) 10 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Inpatient,1,mL,,32,27.2,9.1712,32,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Closed Treatment Of Metatarsophalangeal Joint Dislocation; Without Anesthesia (Pro Cah),,28630,CPT,Professional,Both,,,,459,390.15,68.93,459,Aetna,Commercial,390.15,85,,percent of total billed charges,,
Closed Treatment Of Metatarsophalangeal Joint Dislocation; Without Anesthesia (Pro Cah),,28630,CPT,Professional,Both,,,,459,390.15,68.93,459,Aetna,Medicare Advantage,107.62,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Closed Treatment Of Metatarsophalangeal Joint Dislocation; Without Anesthesia (Pro Cah),,28630,CPT,Professional,Both,,,,459,390.15,68.93,459,Aetna,PPO,426.87,93,,percent of total billed charges,,
Closed Treatment Of Metatarsophalangeal Joint Dislocation; Without Anesthesia (Pro Cah),,28630,CPT,Professional,Both,,,,459,390.15,68.93,459,America's PPO,America's PPO,392.1696,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Closed Treatment Of Metatarsophalangeal Joint Dislocation; Without Anesthesia (Pro Cah),,28630,CPT,Professional,Both,,,,459,390.15,68.93,459,BlueCross BlueShield Minnesota, Federal Employee Program,228.62,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Closed Treatment Of Metatarsophalangeal Joint Dislocation; Without Anesthesia (Pro Cah),,28630,CPT,Professional,Both,,,,459,390.15,68.93,459,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,232.27792,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Closed Treatment Of Metatarsophalangeal Joint Dislocation; Without Anesthesia (Pro Cah),,28630,CPT,Professional,Both,,,,459,390.15,68.93,459,BlueCross BlueShield Minnesota,High Value Network Plan,232.27792,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Closed Treatment Of Metatarsophalangeal Joint Dislocation; Without Anesthesia (Pro Cah),,28630,CPT,Professional,Both,,,,459,390.15,68.93,459,BlueCross BlueShield Minnesota,Medicare Advantage,123.5215,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Closed Treatment Of Metatarsophalangeal Joint Dislocation; Without Anesthesia (Pro Cah),,28630,CPT,Professional,Both,,,,459,390.15,68.93,459,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,232.27792,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Closed Treatment Of Metatarsophalangeal Joint Dislocation; Without Anesthesia (Pro Cah),,28630,CPT,Professional,Both,,,,459,390.15,68.93,459,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,79.58328,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Closed Treatment Of Metatarsophalangeal Joint Dislocation; Without Anesthesia (Pro Cah),,28630,CPT,Professional,Both,,,,459,390.15,68.93,459,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),123.5215,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Closed Treatment Of Metatarsophalangeal Joint Dislocation; Without Anesthesia (Pro Cah),,28630,CPT,Professional,Both,,,,459,390.15,68.93,459,CorVel,Worker's Compensation,209.2096971,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Closed Treatment Of Metatarsophalangeal Joint Dislocation; Without Anesthesia (Pro Cah),,28630,CPT,Professional,Both,,,,459,390.15,68.93,459,First Health Group Corporation,First Health Network,445.23,97,,percent of total billed charges,,
Closed Treatment Of Metatarsophalangeal Joint Dislocation; Without Anesthesia (Pro Cah),,28630,CPT,Professional,Both,,,,459,390.15,68.93,459,"Health Partners, Inc.",Commercial,226.36,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Closed Treatment Of Metatarsophalangeal Joint Dislocation; Without Anesthesia (Pro Cah),,28630,CPT,Professional,Both,,,,459,390.15,68.93,459,"Health Partners, Inc.",Medicare Advantage,123.5215,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Closed Treatment Of Metatarsophalangeal Joint Dislocation; Without Anesthesia (Pro Cah),,28630,CPT,Professional,Both,,,,459,390.15,68.93,459,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),107.08,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Closed Treatment Of Metatarsophalangeal Joint Dislocation; Without Anesthesia (Pro Cah),,28630,CPT,Professional,Both,,,,459,390.15,68.93,459,"Health Partners, Inc.",State of Minnesota Advantage Program,195.00914,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Closed Treatment Of Metatarsophalangeal Joint Dislocation; Without Anesthesia (Pro Cah),,28630,CPT,Professional,Both,,,,459,390.15,68.93,459,"Health Partners, Inc.",State Public Programs,68.93,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Closed Treatment Of Metatarsophalangeal Joint Dislocation; Without Anesthesia (Pro Cah),,28630,CPT,Professional,Both,,,,459,390.15,68.93,459,Humana Insurance Company,Commercial PPO,107.41,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Closed Treatment Of Metatarsophalangeal Joint Dislocation; Without Anesthesia (Pro Cah),,28630,CPT,Professional,Both,,,,459,390.15,68.93,459,Humana Insurance Company,Medicare PPO,459,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Closed Treatment Of Metatarsophalangeal Joint Dislocation; Without Anesthesia (Pro Cah),,28630,CPT,Professional,Both,,,,459,390.15,68.93,459,Medica,Individual & Family,389.232,84.8,,percent of total billed charges,,
Closed Treatment Of Metatarsophalangeal Joint Dislocation; Without Anesthesia (Pro Cah),,28630,CPT,Professional,Both,,,,459,390.15,68.93,459,Medica,Medica Advantage Solution,228.582,49.8,,percent of total billed charges,,
Closed Treatment Of Metatarsophalangeal Joint Dislocation; Without Anesthesia (Pro Cah),,28630,CPT,Professional,Both,,,,459,390.15,68.93,459,Medica,Medical Assistance,79.58,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Closed Treatment Of Metatarsophalangeal Joint Dislocation; Without Anesthesia (Pro Cah),,28630,CPT,Professional,Both,,,,459,390.15,68.93,459,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,107.41,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Closed Treatment Of Metatarsophalangeal Joint Dislocation; Without Anesthesia (Pro Cah),,28630,CPT,Professional,Both,,,,459,390.15,68.93,459,"Multiplan, Inc.","Multiplan, Inc.",431.46,94,,percent of total billed charges,,
Closed Treatment Of Metatarsophalangeal Joint Dislocation; Without Anesthesia (Pro Cah),,28630,CPT,Professional,Both,,,,459,390.15,68.93,459,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,413.559,90.1,,percent of total billed charges,,
Closed Treatment Of Metatarsophalangeal Joint Dislocation; Without Anesthesia (Pro Cah),,28630,CPT,Professional,Both,,,,459,390.15,68.93,459,"Preferred One Administrative Services, INC.",PPO,452.574,98.6,,percent of total billed charges,,
Closed Treatment Of Metatarsophalangeal Joint Dislocation; Without Anesthesia (Pro Cah),,28630,CPT,Professional,Both,,,,459,390.15,68.93,459,PrimeWest Health,Minnesota Senior Health Options (MSHO),123.5215,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Closed Treatment Of Metatarsophalangeal Joint Dislocation; Without Anesthesia (Pro Cah),,28630,CPT,Professional,Both,,,,459,390.15,68.93,459,PrimeWest Health,MinnesotaCare,85.1541096,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Closed Treatment Of Metatarsophalangeal Joint Dislocation; Without Anesthesia (Pro Cah),,28630,CPT,Professional,Both,,,,459,390.15,68.93,459,Sanford Health Plan,Sanford Health Plan,403.92,88,,percent of total billed charges,,
Closed Treatment Of Metatarsophalangeal Joint Dislocation; Without Anesthesia (Pro Cah),,28630,CPT,Professional,Both,,,,459,390.15,68.93,459,"UCare Health, Inc.",Individual & Family Plan,174.605696,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Closed Treatment Of Metatarsophalangeal Joint Dislocation; Without Anesthesia (Pro Cah),,28630,CPT,Professional,Both,,,,459,390.15,68.93,459,"UCare Health, Inc.",Medical Assistance,87.541608,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Closed Treatment Of Metatarsophalangeal Joint Dislocation; Without Anesthesia (Pro Cah),,28630,CPT,Professional,Both,,,,459,390.15,68.93,459,"UCare Health, Inc.",Medicare Advantage,123.5215,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Closed Treatment Of Metatarsophalangeal Joint Dislocation; Without Anesthesia (Pro Cah),,28630,CPT,Professional,Both,,,,459,390.15,68.93,459,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),98.8172,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Closed Treatment Of Metatarsophalangeal Joint Dislocation; Without Anesthesia (Pro Cah),,28630,CPT,Professional,Both,,,,459,390.15,68.93,459,UnitedHealthcare,Individual & Family,459,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Closed Treatment Of Metatarsophalangeal Joint Dislocation; Without Anesthesia (Pro Cah),,28630,CPT,Professional,Both,,,,459,390.15,68.93,459,UnitedHealthcare,Medicare Advantage,123.5215,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Closed Treatment Of Metatarsophalangeal Joint Dislocation; Without Anesthesia (Pro Cah),,28630,CPT,Professional,Both,,,,459,390.15,68.93,459,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,79.58328,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Amputation, Toe; Metatarsophalangeal Joint (Pro Cah)",,28820,CPT,Professional,Both,,,,1642,1395.7,109.51,1642,Aetna,Commercial,1395.7,85,,percent of total billed charges,,
"Amputation, Toe; Metatarsophalangeal Joint (Pro Cah)",,28820,CPT,Professional,Both,,,,1642,1395.7,109.51,1642,Aetna,Medicare Advantage,175.26,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Amputation, Toe; Metatarsophalangeal Joint (Pro Cah)",,28820,CPT,Professional,Both,,,,1642,1395.7,109.51,1642,Aetna,PPO,1527.06,93,,percent of total billed charges,,
"Amputation, Toe; Metatarsophalangeal Joint (Pro Cah)",,28820,CPT,Professional,Both,,,,1642,1395.7,109.51,1642,America's PPO,America's PPO,1402.9248,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Amputation, Toe; Metatarsophalangeal Joint (Pro Cah)",,28820,CPT,Professional,Both,,,,1642,1395.7,109.51,1642,BlueCross BlueShield Minnesota, Federal Employee Program,363.58,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Amputation, Toe; Metatarsophalangeal Joint (Pro Cah)",,28820,CPT,Professional,Both,,,,1642,1395.7,109.51,1642,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,369.39728,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Amputation, Toe; Metatarsophalangeal Joint (Pro Cah)",,28820,CPT,Professional,Both,,,,1642,1395.7,109.51,1642,BlueCross BlueShield Minnesota,High Value Network Plan,369.39728,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Amputation, Toe; Metatarsophalangeal Joint (Pro Cah)",,28820,CPT,Professional,Both,,,,1642,1395.7,109.51,1642,BlueCross BlueShield Minnesota,Medicare Advantage,195.73,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Amputation, Toe; Metatarsophalangeal Joint (Pro Cah)",,28820,CPT,Professional,Both,,,,1642,1395.7,109.51,1642,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,369.39728,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Amputation, Toe; Metatarsophalangeal Joint (Pro Cah)",,28820,CPT,Professional,Both,,,,1642,1395.7,109.51,1642,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,126.43104,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Amputation, Toe; Metatarsophalangeal Joint (Pro Cah)",,28820,CPT,Professional,Both,,,,1642,1395.7,109.51,1642,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),195.73,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Amputation, Toe; Metatarsophalangeal Joint (Pro Cah)",,28820,CPT,Professional,Both,,,,1642,1395.7,109.51,1642,CorVel,Worker's Compensation,335.5423614,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Amputation, Toe; Metatarsophalangeal Joint (Pro Cah)",,28820,CPT,Professional,Both,,,,1642,1395.7,109.51,1642,First Health Group Corporation,First Health Network,1592.74,97,,percent of total billed charges,,
"Amputation, Toe; Metatarsophalangeal Joint (Pro Cah)",,28820,CPT,Professional,Both,,,,1642,1395.7,109.51,1642,"Health Partners, Inc.",Commercial,362.76,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Amputation, Toe; Metatarsophalangeal Joint (Pro Cah)",,28820,CPT,Professional,Both,,,,1642,1395.7,109.51,1642,"Health Partners, Inc.",Medicare Advantage,195.73,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Amputation, Toe; Metatarsophalangeal Joint (Pro Cah)",,28820,CPT,Professional,Both,,,,1642,1395.7,109.51,1642,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),170.45,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Amputation, Toe; Metatarsophalangeal Joint (Pro Cah)",,28820,CPT,Professional,Both,,,,1642,1395.7,109.51,1642,"Health Partners, Inc.",State of Minnesota Advantage Program,312.51774,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Amputation, Toe; Metatarsophalangeal Joint (Pro Cah)",,28820,CPT,Professional,Both,,,,1642,1395.7,109.51,1642,"Health Partners, Inc.",State Public Programs,109.51,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Amputation, Toe; Metatarsophalangeal Joint (Pro Cah)",,28820,CPT,Professional,Both,,,,1642,1395.7,109.51,1642,Humana Insurance Company,Commercial PPO,170.2,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Amputation, Toe; Metatarsophalangeal Joint (Pro Cah)",,28820,CPT,Professional,Both,,,,1642,1395.7,109.51,1642,Humana Insurance Company,Medicare PPO,1642,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Amputation, Toe; Metatarsophalangeal Joint (Pro Cah)",,28820,CPT,Professional,Both,,,,1642,1395.7,109.51,1642,Medica,Individual & Family,1392.416,84.8,,percent of total billed charges,,
"Amputation, Toe; Metatarsophalangeal Joint (Pro Cah)",,28820,CPT,Professional,Both,,,,1642,1395.7,109.51,1642,Medica,Medica Advantage Solution,817.716,49.8,,percent of total billed charges,,
"Amputation, Toe; Metatarsophalangeal Joint (Pro Cah)",,28820,CPT,Professional,Both,,,,1642,1395.7,109.51,1642,Medica,Medical Assistance,126.43,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Amputation, Toe; Metatarsophalangeal Joint (Pro Cah)",,28820,CPT,Professional,Both,,,,1642,1395.7,109.51,1642,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,170.2,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Amputation, Toe; Metatarsophalangeal Joint (Pro Cah)",,28820,CPT,Professional,Both,,,,1642,1395.7,109.51,1642,"Multiplan, Inc.","Multiplan, Inc.",1543.48,94,,percent of total billed charges,,
"Amputation, Toe; Metatarsophalangeal Joint (Pro Cah)",,28820,CPT,Professional,Both,,,,1642,1395.7,109.51,1642,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1479.442,90.1,,percent of total billed charges,,
"Amputation, Toe; Metatarsophalangeal Joint (Pro Cah)",,28820,CPT,Professional,Both,,,,1642,1395.7,109.51,1642,"Preferred One Administrative Services, INC.",PPO,1619.012,98.6,,percent of total billed charges,,
"Amputation, Toe; Metatarsophalangeal Joint (Pro Cah)",,28820,CPT,Professional,Both,,,,1642,1395.7,109.51,1642,PrimeWest Health,Minnesota Senior Health Options (MSHO),195.73,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Amputation, Toe; Metatarsophalangeal Joint (Pro Cah)",,28820,CPT,Professional,Both,,,,1642,1395.7,109.51,1642,PrimeWest Health,MinnesotaCare,135.2812128,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Amputation, Toe; Metatarsophalangeal Joint (Pro Cah)",,28820,CPT,Professional,Both,,,,1642,1395.7,109.51,1642,Sanford Health Plan,Sanford Health Plan,1444.96,88,,percent of total billed charges,,
"Amputation, Toe; Metatarsophalangeal Joint (Pro Cah)",,28820,CPT,Professional,Both,,,,1642,1395.7,109.51,1642,"UCare Health, Inc.",Individual & Family Plan,276.67712,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Amputation, Toe; Metatarsophalangeal Joint (Pro Cah)",,28820,CPT,Professional,Both,,,,1642,1395.7,109.51,1642,"UCare Health, Inc.",Medical Assistance,139.074144,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Amputation, Toe; Metatarsophalangeal Joint (Pro Cah)",,28820,CPT,Professional,Both,,,,1642,1395.7,109.51,1642,"UCare Health, Inc.",Medicare Advantage,195.73,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Amputation, Toe; Metatarsophalangeal Joint (Pro Cah)",,28820,CPT,Professional,Both,,,,1642,1395.7,109.51,1642,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),156.584,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Amputation, Toe; Metatarsophalangeal Joint (Pro Cah)",,28820,CPT,Professional,Both,,,,1642,1395.7,109.51,1642,UnitedHealthcare,Individual & Family,1642,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Amputation, Toe; Metatarsophalangeal Joint (Pro Cah)",,28820,CPT,Professional,Both,,,,1642,1395.7,109.51,1642,UnitedHealthcare,Medicare Advantage,195.73,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Amputation, Toe; Metatarsophalangeal Joint (Pro Cah)",,28820,CPT,Professional,Both,,,,1642,1395.7,109.51,1642,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,126.43104,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Both,1,mL,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Outpatient,1,mL,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Inpatient,1,mL,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Both,1,mL,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Both,1,mL,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Both,1,mL,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Both,1,mL,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Both,1,mL,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Outpatient,1,mL,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Inpatient,1,mL,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Both,1,mL,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Both,1,mL,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Outpatient,1,mL,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Inpatient,1,mL,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Both,1,mL,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Both,1,mL,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Both,1,mL,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Outpatient,1,mL,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Inpatient,1,mL,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Both,1,mL,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Both,1,mL,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Both,1,mL,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Both,1,mL,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Outpatient,1,mL,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Inpatient,1,mL,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Both,1,mL,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Outpatient,1,mL,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Inpatient,1,mL,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Outpatient,1,mL,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Inpatient,1,mL,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Outpatient,1,mL,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Inpatient,1,mL,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Both,1,mL,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Outpatient,1,mL,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Inpatient,1,mL,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Both,1,mL,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Outpatient,1,mL,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Inpatient,1,mL,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Outpatient,1,mL,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Inpatient,1,mL,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Both,1,mL,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Outpatient,1,mL,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Inpatient,1,mL,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Outpatient,1,mL,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Inpatient,1,mL,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Outpatient,1,mL,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Inpatient,1,mL,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Outpatient,1,mL,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Inpatient,1,mL,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Both,1,mL,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Outpatient,1,mL,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Inpatient,1,mL,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Outpatient,1,mL,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Inpatient,1,mL,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Application, Cast; Shoulder Spica (Pro Cah)",,29055,CPT,Professional,Both,,,,1607,1365.95,84.86,1607,Aetna,Commercial,1365.95,85,,percent of total billed charges,,
"Application, Cast; Shoulder Spica (Pro Cah)",,29055,CPT,Professional,Both,,,,1607,1365.95,84.86,1607,Aetna,Medicare Advantage,130.63,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Application, Cast; Shoulder Spica (Pro Cah)",,29055,CPT,Professional,Both,,,,1607,1365.95,84.86,1607,Aetna,PPO,1494.51,93,,percent of total billed charges,,
"Application, Cast; Shoulder Spica (Pro Cah)",,29055,CPT,Professional,Both,,,,1607,1365.95,84.86,1607,America's PPO,America's PPO,1373.0208,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Application, Cast; Shoulder Spica (Pro Cah)",,29055,CPT,Professional,Both,,,,1607,1365.95,84.86,1607,BlueCross BlueShield Minnesota, Federal Employee Program,282.33,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Application, Cast; Shoulder Spica (Pro Cah)",,29055,CPT,Professional,Both,,,,1607,1365.95,84.86,1607,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,286.84728,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Application, Cast; Shoulder Spica (Pro Cah)",,29055,CPT,Professional,Both,,,,1607,1365.95,84.86,1607,BlueCross BlueShield Minnesota,High Value Network Plan,286.84728,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Application, Cast; Shoulder Spica (Pro Cah)",,29055,CPT,Professional,Both,,,,1607,1365.95,84.86,1607,BlueCross BlueShield Minnesota,Medicare Advantage,151.777,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Application, Cast; Shoulder Spica (Pro Cah)",,29055,CPT,Professional,Both,,,,1607,1365.95,84.86,1607,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,286.84728,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Application, Cast; Shoulder Spica (Pro Cah)",,29055,CPT,Professional,Both,,,,1607,1365.95,84.86,1607,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,97.97288,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Application, Cast; Shoulder Spica (Pro Cah)",,29055,CPT,Professional,Both,,,,1607,1365.95,84.86,1607,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),151.777,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Application, Cast; Shoulder Spica (Pro Cah)",,29055,CPT,Professional,Both,,,,1607,1365.95,84.86,1607,CorVel,Worker's Compensation,255.5764764,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Application, Cast; Shoulder Spica (Pro Cah)",,29055,CPT,Professional,Both,,,,1607,1365.95,84.86,1607,First Health Group Corporation,First Health Network,1558.79,97,,percent of total billed charges,,
"Application, Cast; Shoulder Spica (Pro Cah)",,29055,CPT,Professional,Both,,,,1607,1365.95,84.86,1607,"Health Partners, Inc.",Commercial,275.7,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Application, Cast; Shoulder Spica (Pro Cah)",,29055,CPT,Professional,Both,,,,1607,1365.95,84.86,1607,"Health Partners, Inc.",Medicare Advantage,151.777,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Application, Cast; Shoulder Spica (Pro Cah)",,29055,CPT,Professional,Both,,,,1607,1365.95,84.86,1607,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),132.16,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Application, Cast; Shoulder Spica (Pro Cah)",,29055,CPT,Professional,Both,,,,1607,1365.95,84.86,1607,"Health Partners, Inc.",State of Minnesota Advantage Program,237.51555,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Application, Cast; Shoulder Spica (Pro Cah)",,29055,CPT,Professional,Both,,,,1607,1365.95,84.86,1607,"Health Partners, Inc.",State Public Programs,84.86,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Application, Cast; Shoulder Spica (Pro Cah)",,29055,CPT,Professional,Both,,,,1607,1365.95,84.86,1607,Humana Insurance Company,Commercial PPO,131.98,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Application, Cast; Shoulder Spica (Pro Cah)",,29055,CPT,Professional,Both,,,,1607,1365.95,84.86,1607,Humana Insurance Company,Medicare PPO,1607,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Application, Cast; Shoulder Spica (Pro Cah)",,29055,CPT,Professional,Both,,,,1607,1365.95,84.86,1607,Medica,Individual & Family,1362.736,84.8,,percent of total billed charges,,
"Application, Cast; Shoulder Spica (Pro Cah)",,29055,CPT,Professional,Both,,,,1607,1365.95,84.86,1607,Medica,Medica Advantage Solution,800.286,49.8,,percent of total billed charges,,
"Application, Cast; Shoulder Spica (Pro Cah)",,29055,CPT,Professional,Both,,,,1607,1365.95,84.86,1607,Medica,Medical Assistance,97.97,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Application, Cast; Shoulder Spica (Pro Cah)",,29055,CPT,Professional,Both,,,,1607,1365.95,84.86,1607,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,131.98,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Application, Cast; Shoulder Spica (Pro Cah)",,29055,CPT,Professional,Both,,,,1607,1365.95,84.86,1607,"Multiplan, Inc.","Multiplan, Inc.",1510.58,94,,percent of total billed charges,,
"Application, Cast; Shoulder Spica (Pro Cah)",,29055,CPT,Professional,Both,,,,1607,1365.95,84.86,1607,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1447.907,90.1,,percent of total billed charges,,
"Application, Cast; Shoulder Spica (Pro Cah)",,29055,CPT,Professional,Both,,,,1607,1365.95,84.86,1607,"Preferred One Administrative Services, INC.",PPO,1584.502,98.6,,percent of total billed charges,,
"Application, Cast; Shoulder Spica (Pro Cah)",,29055,CPT,Professional,Both,,,,1607,1365.95,84.86,1607,PrimeWest Health,Minnesota Senior Health Options (MSHO),151.777,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Application, Cast; Shoulder Spica (Pro Cah)",,29055,CPT,Professional,Both,,,,1607,1365.95,84.86,1607,PrimeWest Health,MinnesotaCare,104.8309816,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Application, Cast; Shoulder Spica (Pro Cah)",,29055,CPT,Professional,Both,,,,1607,1365.95,84.86,1607,Sanford Health Plan,Sanford Health Plan,1414.16,88,,percent of total billed charges,,
"Application, Cast; Shoulder Spica (Pro Cah)",,29055,CPT,Professional,Both,,,,1607,1365.95,84.86,1607,"UCare Health, Inc.",Individual & Family Plan,214.546688,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Application, Cast; Shoulder Spica (Pro Cah)",,29055,CPT,Professional,Both,,,,1607,1365.95,84.86,1607,"UCare Health, Inc.",Medical Assistance,107.770168,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Application, Cast; Shoulder Spica (Pro Cah)",,29055,CPT,Professional,Both,,,,1607,1365.95,84.86,1607,"UCare Health, Inc.",Medicare Advantage,151.777,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Application, Cast; Shoulder Spica (Pro Cah)",,29055,CPT,Professional,Both,,,,1607,1365.95,84.86,1607,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),121.4216,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Application, Cast; Shoulder Spica (Pro Cah)",,29055,CPT,Professional,Both,,,,1607,1365.95,84.86,1607,UnitedHealthcare,Individual & Family,1607,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Application, Cast; Shoulder Spica (Pro Cah)",,29055,CPT,Professional,Both,,,,1607,1365.95,84.86,1607,UnitedHealthcare,Medicare Advantage,151.777,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Application, Cast; Shoulder Spica (Pro Cah)",,29055,CPT,Professional,Both,,,,1607,1365.95,84.86,1607,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,97.97288,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Application, Cast; Shoulder To Hand (Long Arm) (Pro Cah)",,29065,CPT,Professional,Both,,,,332,282.2,42.1,332,Aetna,Commercial,282.2,85,,percent of total billed charges,,
"Application, Cast; Shoulder To Hand (Long Arm) (Pro Cah)",,29065,CPT,Professional,Both,,,,332,282.2,42.1,332,Aetna,Medicare Advantage,65.91,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Application, Cast; Shoulder To Hand (Long Arm) (Pro Cah)",,29065,CPT,Professional,Both,,,,332,282.2,42.1,332,Aetna,PPO,308.76,93,,percent of total billed charges,,
"Application, Cast; Shoulder To Hand (Long Arm) (Pro Cah)",,29065,CPT,Professional,Both,,,,332,282.2,42.1,332,America's PPO,America's PPO,283.6608,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Application, Cast; Shoulder To Hand (Long Arm) (Pro Cah)",,29065,CPT,Professional,Both,,,,332,282.2,42.1,332,BlueCross BlueShield Minnesota, Federal Employee Program,140.47,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Application, Cast; Shoulder To Hand (Long Arm) (Pro Cah)",,29065,CPT,Professional,Both,,,,332,282.2,42.1,332,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,142.71752,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Application, Cast; Shoulder To Hand (Long Arm) (Pro Cah)",,29065,CPT,Professional,Both,,,,332,282.2,42.1,332,BlueCross BlueShield Minnesota,High Value Network Plan,142.71752,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Application, Cast; Shoulder To Hand (Long Arm) (Pro Cah)",,29065,CPT,Professional,Both,,,,332,282.2,42.1,332,BlueCross BlueShield Minnesota,Medicare Advantage,75.509,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Application, Cast; Shoulder To Hand (Long Arm) (Pro Cah)",,29065,CPT,Professional,Both,,,,332,282.2,42.1,332,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,142.71752,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Application, Cast; Shoulder To Hand (Long Arm) (Pro Cah)",,29065,CPT,Professional,Both,,,,332,282.2,42.1,332,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,48.60544,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Application, Cast; Shoulder To Hand (Long Arm) (Pro Cah)",,29065,CPT,Professional,Both,,,,332,282.2,42.1,332,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),75.509,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Application, Cast; Shoulder To Hand (Long Arm) (Pro Cah)",,29065,CPT,Professional,Both,,,,332,282.2,42.1,332,CorVel,Worker's Compensation,128.0273634,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Application, Cast; Shoulder To Hand (Long Arm) (Pro Cah)",,29065,CPT,Professional,Both,,,,332,282.2,42.1,332,First Health Group Corporation,First Health Network,322.04,97,,percent of total billed charges,,
"Application, Cast; Shoulder To Hand (Long Arm) (Pro Cah)",,29065,CPT,Professional,Both,,,,332,282.2,42.1,332,"Health Partners, Inc.",Commercial,137.85,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Application, Cast; Shoulder To Hand (Long Arm) (Pro Cah)",,29065,CPT,Professional,Both,,,,332,282.2,42.1,332,"Health Partners, Inc.",Medicare Advantage,75.509,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Application, Cast; Shoulder To Hand (Long Arm) (Pro Cah)",,29065,CPT,Professional,Both,,,,332,282.2,42.1,332,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),65.74,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Application, Cast; Shoulder To Hand (Long Arm) (Pro Cah)",,29065,CPT,Professional,Both,,,,332,282.2,42.1,332,"Health Partners, Inc.",State of Minnesota Advantage Program,118.757775,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Application, Cast; Shoulder To Hand (Long Arm) (Pro Cah)",,29065,CPT,Professional,Both,,,,332,282.2,42.1,332,"Health Partners, Inc.",State Public Programs,42.1,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Application, Cast; Shoulder To Hand (Long Arm) (Pro Cah)",,29065,CPT,Professional,Both,,,,332,282.2,42.1,332,Humana Insurance Company,Commercial PPO,65.66,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Application, Cast; Shoulder To Hand (Long Arm) (Pro Cah)",,29065,CPT,Professional,Both,,,,332,282.2,42.1,332,Humana Insurance Company,Medicare PPO,332,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Application, Cast; Shoulder To Hand (Long Arm) (Pro Cah)",,29065,CPT,Professional,Both,,,,332,282.2,42.1,332,Medica,Individual & Family,281.536,84.8,,percent of total billed charges,,
"Application, Cast; Shoulder To Hand (Long Arm) (Pro Cah)",,29065,CPT,Professional,Both,,,,332,282.2,42.1,332,Medica,Medica Advantage Solution,165.336,49.8,,percent of total billed charges,,
"Application, Cast; Shoulder To Hand (Long Arm) (Pro Cah)",,29065,CPT,Professional,Both,,,,332,282.2,42.1,332,Medica,Medical Assistance,48.61,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Application, Cast; Shoulder To Hand (Long Arm) (Pro Cah)",,29065,CPT,Professional,Both,,,,332,282.2,42.1,332,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,65.66,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Application, Cast; Shoulder To Hand (Long Arm) (Pro Cah)",,29065,CPT,Professional,Both,,,,332,282.2,42.1,332,"Multiplan, Inc.","Multiplan, Inc.",312.08,94,,percent of total billed charges,,
"Application, Cast; Shoulder To Hand (Long Arm) (Pro Cah)",,29065,CPT,Professional,Both,,,,332,282.2,42.1,332,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,299.132,90.1,,percent of total billed charges,,
"Application, Cast; Shoulder To Hand (Long Arm) (Pro Cah)",,29065,CPT,Professional,Both,,,,332,282.2,42.1,332,"Preferred One Administrative Services, INC.",PPO,327.352,98.6,,percent of total billed charges,,
"Application, Cast; Shoulder To Hand (Long Arm) (Pro Cah)",,29065,CPT,Professional,Both,,,,332,282.2,42.1,332,PrimeWest Health,Minnesota Senior Health Options (MSHO),75.509,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Application, Cast; Shoulder To Hand (Long Arm) (Pro Cah)",,29065,CPT,Professional,Both,,,,332,282.2,42.1,332,PrimeWest Health,MinnesotaCare,52.0078208,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Application, Cast; Shoulder To Hand (Long Arm) (Pro Cah)",,29065,CPT,Professional,Both,,,,332,282.2,42.1,332,Sanford Health Plan,Sanford Health Plan,292.16,88,,percent of total billed charges,,
"Application, Cast; Shoulder To Hand (Long Arm) (Pro Cah)",,29065,CPT,Professional,Both,,,,332,282.2,42.1,332,"UCare Health, Inc.",Individual & Family Plan,106.736896,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Application, Cast; Shoulder To Hand (Long Arm) (Pro Cah)",,29065,CPT,Professional,Both,,,,332,282.2,42.1,332,"UCare Health, Inc.",Medical Assistance,53.465984,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Application, Cast; Shoulder To Hand (Long Arm) (Pro Cah)",,29065,CPT,Professional,Both,,,,332,282.2,42.1,332,"UCare Health, Inc.",Medicare Advantage,75.509,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Application, Cast; Shoulder To Hand (Long Arm) (Pro Cah)",,29065,CPT,Professional,Both,,,,332,282.2,42.1,332,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),60.4072,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Application, Cast; Shoulder To Hand (Long Arm) (Pro Cah)",,29065,CPT,Professional,Both,,,,332,282.2,42.1,332,UnitedHealthcare,Individual & Family,332,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Application, Cast; Shoulder To Hand (Long Arm) (Pro Cah)",,29065,CPT,Professional,Both,,,,332,282.2,42.1,332,UnitedHealthcare,Medicare Advantage,75.509,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Application, Cast; Shoulder To Hand (Long Arm) (Pro Cah)",,29065,CPT,Professional,Both,,,,332,282.2,42.1,332,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,48.60544,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Application, Cast; Elbow To Finger (Short Arm) (Pro Cah)",,29075,CPT,Professional,Both,,,,306,260.1,38.83,306,Aetna,Commercial,260.1,85,,percent of total billed charges,,
"Application, Cast; Elbow To Finger (Short Arm) (Pro Cah)",,29075,CPT,Professional,Both,,,,306,260.1,38.83,306,Aetna,Medicare Advantage,60.53,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Application, Cast; Elbow To Finger (Short Arm) (Pro Cah)",,29075,CPT,Professional,Both,,,,306,260.1,38.83,306,Aetna,PPO,284.58,93,,percent of total billed charges,,
"Application, Cast; Elbow To Finger (Short Arm) (Pro Cah)",,29075,CPT,Professional,Both,,,,306,260.1,38.83,306,America's PPO,America's PPO,261.4464,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Application, Cast; Elbow To Finger (Short Arm) (Pro Cah)",,29075,CPT,Professional,Both,,,,306,260.1,38.83,306,BlueCross BlueShield Minnesota, Federal Employee Program,129.46,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Application, Cast; Elbow To Finger (Short Arm) (Pro Cah)",,29075,CPT,Professional,Both,,,,306,260.1,38.83,306,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,131.53136,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Application, Cast; Elbow To Finger (Short Arm) (Pro Cah)",,29075,CPT,Professional,Both,,,,306,260.1,38.83,306,BlueCross BlueShield Minnesota,High Value Network Plan,131.53136,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Application, Cast; Elbow To Finger (Short Arm) (Pro Cah)",,29075,CPT,Professional,Both,,,,306,260.1,38.83,306,BlueCross BlueShield Minnesota,Medicare Advantage,69.4945,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Application, Cast; Elbow To Finger (Short Arm) (Pro Cah)",,29075,CPT,Professional,Both,,,,306,260.1,38.83,306,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,131.53136,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Application, Cast; Elbow To Finger (Short Arm) (Pro Cah)",,29075,CPT,Professional,Both,,,,306,260.1,38.83,306,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,44.82592,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Application, Cast; Elbow To Finger (Short Arm) (Pro Cah)",,29075,CPT,Professional,Both,,,,306,260.1,38.83,306,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),69.4945,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Application, Cast; Elbow To Finger (Short Arm) (Pro Cah)",,29075,CPT,Professional,Both,,,,306,260.1,38.83,306,CorVel,Worker's Compensation,116.2793304,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Application, Cast; Elbow To Finger (Short Arm) (Pro Cah)",,29075,CPT,Professional,Both,,,,306,260.1,38.83,306,First Health Group Corporation,First Health Network,296.82,97,,percent of total billed charges,,
"Application, Cast; Elbow To Finger (Short Arm) (Pro Cah)",,29075,CPT,Professional,Both,,,,306,260.1,38.83,306,"Health Partners, Inc.",Commercial,125.52,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Application, Cast; Elbow To Finger (Short Arm) (Pro Cah)",,29075,CPT,Professional,Both,,,,306,260.1,38.83,306,"Health Partners, Inc.",Medicare Advantage,69.4945,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Application, Cast; Elbow To Finger (Short Arm) (Pro Cah)",,29075,CPT,Professional,Both,,,,306,260.1,38.83,306,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),60.66,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Application, Cast; Elbow To Finger (Short Arm) (Pro Cah)",,29075,CPT,Professional,Both,,,,306,260.1,38.83,306,"Health Partners, Inc.",State of Minnesota Advantage Program,108.13548,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Application, Cast; Elbow To Finger (Short Arm) (Pro Cah)",,29075,CPT,Professional,Both,,,,306,260.1,38.83,306,"Health Partners, Inc.",State Public Programs,38.83,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Application, Cast; Elbow To Finger (Short Arm) (Pro Cah)",,29075,CPT,Professional,Both,,,,306,260.1,38.83,306,Humana Insurance Company,Commercial PPO,60.43,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Application, Cast; Elbow To Finger (Short Arm) (Pro Cah)",,29075,CPT,Professional,Both,,,,306,260.1,38.83,306,Humana Insurance Company,Medicare PPO,306,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Application, Cast; Elbow To Finger (Short Arm) (Pro Cah)",,29075,CPT,Professional,Both,,,,306,260.1,38.83,306,Medica,Individual & Family,259.488,84.8,,percent of total billed charges,,
"Application, Cast; Elbow To Finger (Short Arm) (Pro Cah)",,29075,CPT,Professional,Both,,,,306,260.1,38.83,306,Medica,Medica Advantage Solution,152.388,49.8,,percent of total billed charges,,
"Application, Cast; Elbow To Finger (Short Arm) (Pro Cah)",,29075,CPT,Professional,Both,,,,306,260.1,38.83,306,Medica,Medical Assistance,44.83,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Application, Cast; Elbow To Finger (Short Arm) (Pro Cah)",,29075,CPT,Professional,Both,,,,306,260.1,38.83,306,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,60.43,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Application, Cast; Elbow To Finger (Short Arm) (Pro Cah)",,29075,CPT,Professional,Both,,,,306,260.1,38.83,306,"Multiplan, Inc.","Multiplan, Inc.",287.64,94,,percent of total billed charges,,
"Application, Cast; Elbow To Finger (Short Arm) (Pro Cah)",,29075,CPT,Professional,Both,,,,306,260.1,38.83,306,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,275.706,90.1,,percent of total billed charges,,
"Application, Cast; Elbow To Finger (Short Arm) (Pro Cah)",,29075,CPT,Professional,Both,,,,306,260.1,38.83,306,"Preferred One Administrative Services, INC.",PPO,301.716,98.6,,percent of total billed charges,,
"Application, Cast; Elbow To Finger (Short Arm) (Pro Cah)",,29075,CPT,Professional,Both,,,,306,260.1,38.83,306,PrimeWest Health,Minnesota Senior Health Options (MSHO),69.4945,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Application, Cast; Elbow To Finger (Short Arm) (Pro Cah)",,29075,CPT,Professional,Both,,,,306,260.1,38.83,306,PrimeWest Health,MinnesotaCare,47.9637344,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Application, Cast; Elbow To Finger (Short Arm) (Pro Cah)",,29075,CPT,Professional,Both,,,,306,260.1,38.83,306,Sanford Health Plan,Sanford Health Plan,269.28,88,,percent of total billed charges,,
"Application, Cast; Elbow To Finger (Short Arm) (Pro Cah)",,29075,CPT,Professional,Both,,,,306,260.1,38.83,306,"UCare Health, Inc.",Individual & Family Plan,98.235008,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Application, Cast; Elbow To Finger (Short Arm) (Pro Cah)",,29075,CPT,Professional,Both,,,,306,260.1,38.83,306,"UCare Health, Inc.",Medical Assistance,49.308512,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Application, Cast; Elbow To Finger (Short Arm) (Pro Cah)",,29075,CPT,Professional,Both,,,,306,260.1,38.83,306,"UCare Health, Inc.",Medicare Advantage,69.4945,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Application, Cast; Elbow To Finger (Short Arm) (Pro Cah)",,29075,CPT,Professional,Both,,,,306,260.1,38.83,306,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),55.5956,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Application, Cast; Elbow To Finger (Short Arm) (Pro Cah)",,29075,CPT,Professional,Both,,,,306,260.1,38.83,306,UnitedHealthcare,Individual & Family,306,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Application, Cast; Elbow To Finger (Short Arm) (Pro Cah)",,29075,CPT,Professional,Both,,,,306,260.1,38.83,306,UnitedHealthcare,Medicare Advantage,69.4945,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Application, Cast; Elbow To Finger (Short Arm) (Pro Cah)",,29075,CPT,Professional,Both,,,,306,260.1,38.83,306,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,44.82592,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Application, Cast; Hand And Lower Forearm (Gauntlet) (Pro Cah)",,29085,CPT,Professional,Both,,,,285,242.25,41.66,285,Aetna,Commercial,242.25,85,,percent of total billed charges,,
"Application, Cast; Hand And Lower Forearm (Gauntlet) (Pro Cah)",,29085,CPT,Professional,Both,,,,285,242.25,41.66,285,Aetna,Medicare Advantage,65.08,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Application, Cast; Hand And Lower Forearm (Gauntlet) (Pro Cah)",,29085,CPT,Professional,Both,,,,285,242.25,41.66,285,Aetna,PPO,265.05,93,,percent of total billed charges,,
"Application, Cast; Hand And Lower Forearm (Gauntlet) (Pro Cah)",,29085,CPT,Professional,Both,,,,285,242.25,41.66,285,America's PPO,America's PPO,243.504,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Application, Cast; Hand And Lower Forearm (Gauntlet) (Pro Cah)",,29085,CPT,Professional,Both,,,,285,242.25,41.66,285,BlueCross BlueShield Minnesota, Federal Employee Program,138.41,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Application, Cast; Hand And Lower Forearm (Gauntlet) (Pro Cah)",,29085,CPT,Professional,Both,,,,285,242.25,41.66,285,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,140.62456,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Application, Cast; Hand And Lower Forearm (Gauntlet) (Pro Cah)",,29085,CPT,Professional,Both,,,,285,242.25,41.66,285,BlueCross BlueShield Minnesota,High Value Network Plan,140.62456,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Application, Cast; Hand And Lower Forearm (Gauntlet) (Pro Cah)",,29085,CPT,Professional,Both,,,,285,242.25,41.66,285,BlueCross BlueShield Minnesota,Medicare Advantage,74.589,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Application, Cast; Hand And Lower Forearm (Gauntlet) (Pro Cah)",,29085,CPT,Professional,Both,,,,285,242.25,41.66,285,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,140.62456,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Application, Cast; Hand And Lower Forearm (Gauntlet) (Pro Cah)",,29085,CPT,Professional,Both,,,,285,242.25,41.66,285,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,48.09744,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Application, Cast; Hand And Lower Forearm (Gauntlet) (Pro Cah)",,29085,CPT,Professional,Both,,,,285,242.25,41.66,285,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),74.589,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Application, Cast; Hand And Lower Forearm (Gauntlet) (Pro Cah)",,29085,CPT,Professional,Both,,,,285,242.25,41.66,285,CorVel,Worker's Compensation,126.4293891,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Application, Cast; Hand And Lower Forearm (Gauntlet) (Pro Cah)",,29085,CPT,Professional,Both,,,,285,242.25,41.66,285,First Health Group Corporation,First Health Network,276.45,97,,percent of total billed charges,,
"Application, Cast; Hand And Lower Forearm (Gauntlet) (Pro Cah)",,29085,CPT,Professional,Both,,,,285,242.25,41.66,285,"Health Partners, Inc.",Commercial,136.4,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Application, Cast; Hand And Lower Forearm (Gauntlet) (Pro Cah)",,29085,CPT,Professional,Both,,,,285,242.25,41.66,285,"Health Partners, Inc.",Medicare Advantage,74.589,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Application, Cast; Hand And Lower Forearm (Gauntlet) (Pro Cah)",,29085,CPT,Professional,Both,,,,285,242.25,41.66,285,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),65.06,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Application, Cast; Hand And Lower Forearm (Gauntlet) (Pro Cah)",,29085,CPT,Professional,Both,,,,285,242.25,41.66,285,"Health Partners, Inc.",State of Minnesota Advantage Program,117.5086,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Application, Cast; Hand And Lower Forearm (Gauntlet) (Pro Cah)",,29085,CPT,Professional,Both,,,,285,242.25,41.66,285,"Health Partners, Inc.",State Public Programs,41.66,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Application, Cast; Hand And Lower Forearm (Gauntlet) (Pro Cah)",,29085,CPT,Professional,Both,,,,285,242.25,41.66,285,Humana Insurance Company,Commercial PPO,64.86,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Application, Cast; Hand And Lower Forearm (Gauntlet) (Pro Cah)",,29085,CPT,Professional,Both,,,,285,242.25,41.66,285,Humana Insurance Company,Medicare PPO,285,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Application, Cast; Hand And Lower Forearm (Gauntlet) (Pro Cah)",,29085,CPT,Professional,Both,,,,285,242.25,41.66,285,Medica,Individual & Family,241.68,84.8,,percent of total billed charges,,
"Application, Cast; Hand And Lower Forearm (Gauntlet) (Pro Cah)",,29085,CPT,Professional,Both,,,,285,242.25,41.66,285,Medica,Medica Advantage Solution,141.93,49.8,,percent of total billed charges,,
"Application, Cast; Hand And Lower Forearm (Gauntlet) (Pro Cah)",,29085,CPT,Professional,Both,,,,285,242.25,41.66,285,Medica,Medical Assistance,48.1,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Application, Cast; Hand And Lower Forearm (Gauntlet) (Pro Cah)",,29085,CPT,Professional,Both,,,,285,242.25,41.66,285,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,64.86,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Application, Cast; Hand And Lower Forearm (Gauntlet) (Pro Cah)",,29085,CPT,Professional,Both,,,,285,242.25,41.66,285,"Multiplan, Inc.","Multiplan, Inc.",267.9,94,,percent of total billed charges,,
"Application, Cast; Hand And Lower Forearm (Gauntlet) (Pro Cah)",,29085,CPT,Professional,Both,,,,285,242.25,41.66,285,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,256.785,90.1,,percent of total billed charges,,
"Application, Cast; Hand And Lower Forearm (Gauntlet) (Pro Cah)",,29085,CPT,Professional,Both,,,,285,242.25,41.66,285,"Preferred One Administrative Services, INC.",PPO,281.01,98.6,,percent of total billed charges,,
"Application, Cast; Hand And Lower Forearm (Gauntlet) (Pro Cah)",,29085,CPT,Professional,Both,,,,285,242.25,41.66,285,PrimeWest Health,Minnesota Senior Health Options (MSHO),74.589,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Application, Cast; Hand And Lower Forearm (Gauntlet) (Pro Cah)",,29085,CPT,Professional,Both,,,,285,242.25,41.66,285,PrimeWest Health,MinnesotaCare,51.4642608,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Application, Cast; Hand And Lower Forearm (Gauntlet) (Pro Cah)",,29085,CPT,Professional,Both,,,,285,242.25,41.66,285,Sanford Health Plan,Sanford Health Plan,250.8,88,,percent of total billed charges,,
"Application, Cast; Hand And Lower Forearm (Gauntlet) (Pro Cah)",,29085,CPT,Professional,Both,,,,285,242.25,41.66,285,"UCare Health, Inc.",Individual & Family Plan,105.436416,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Application, Cast; Hand And Lower Forearm (Gauntlet) (Pro Cah)",,29085,CPT,Professional,Both,,,,285,242.25,41.66,285,"UCare Health, Inc.",Medical Assistance,52.907184,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Application, Cast; Hand And Lower Forearm (Gauntlet) (Pro Cah)",,29085,CPT,Professional,Both,,,,285,242.25,41.66,285,"UCare Health, Inc.",Medicare Advantage,74.589,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Application, Cast; Hand And Lower Forearm (Gauntlet) (Pro Cah)",,29085,CPT,Professional,Both,,,,285,242.25,41.66,285,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),59.6712,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Application, Cast; Hand And Lower Forearm (Gauntlet) (Pro Cah)",,29085,CPT,Professional,Both,,,,285,242.25,41.66,285,UnitedHealthcare,Individual & Family,285,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Application, Cast; Hand And Lower Forearm (Gauntlet) (Pro Cah)",,29085,CPT,Professional,Both,,,,285,242.25,41.66,285,UnitedHealthcare,Medicare Advantage,74.589,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Application, Cast; Hand And Lower Forearm (Gauntlet) (Pro Cah)",,29085,CPT,Professional,Both,,,,285,242.25,41.66,285,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,48.09744,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Application Of Long Arm Splint,,29105,CPT,Facility,Outpatient,,,,234,198.9,67.0644,234,Aetna,Commercial,215.28,92,,percent of total billed charges,,
Application Of Long Arm Splint,,29105,CPT,Facility,Outpatient,,,,234,198.9,67.0644,234,Aetna,Medicare Advantage,114.66,49,,percent of total billed charges,,
Application Of Long Arm Splint,,29105,CPT,Facility,Outpatient,,,,234,198.9,67.0644,234,Aetna,PPO,217.62,93,,percent of total billed charges,,
Application Of Long Arm Splint,,29105,CPT,Facility,Outpatient,,,,234,198.9,67.0644,234,America's PPO,America's PPO,224.7102,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Application Of Long Arm Splint,,29105,CPT,Facility,Outpatient,,,,234,198.9,67.0644,234,BlueCross BlueShield Minnesota, Federal Employee Program,230.256,98.4,,percent of total billed charges,,
Application Of Long Arm Splint,,29105,CPT,Facility,Outpatient,,,,234,198.9,67.0644,234,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,234,100,,percent of total billed charges,,
Application Of Long Arm Splint,,29105,CPT,Facility,Outpatient,,,,234,198.9,67.0644,234,BlueCross BlueShield Minnesota,High Value Network Plan,210.6,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
Application Of Long Arm Splint,,29105,CPT,Facility,Outpatient,,,,234,198.9,67.0644,234,BlueCross BlueShield Minnesota,Medicare Advantage,114.66,49,,percent of total billed charges,,
Application Of Long Arm Splint,,29105,CPT,Facility,Outpatient,,,,234,198.9,67.0644,234,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,67.0644,28.66,,percent of total billed charges,,
Application Of Long Arm Splint,,29105,CPT,Facility,Outpatient,,,,234,198.9,67.0644,234,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),114.66,49,,percent of total billed charges,,
Application Of Long Arm Splint,,29105,CPT,Facility,Outpatient,,,,234,198.9,67.0644,234,CorVel,Worker's Compensation,234,100,,percent of total billed charges,,
Application Of Long Arm Splint,,29105,CPT,Facility,Outpatient,,,,234,198.9,67.0644,234,First Health Group Corporation,First Health Network,226.98,97,,percent of total billed charges,,
Application Of Long Arm Splint,,29105,CPT,Facility,Outpatient,,,,234,198.9,67.0644,234,"Health Partners, Inc.",Commercial,221.364,94.6,,percent of total billed charges,,
Application Of Long Arm Splint,,29105,CPT,Facility,Outpatient,,,,234,198.9,67.0644,234,"Health Partners, Inc.",Medicare Advantage,114.66,49,,percent of total billed charges,,
Application Of Long Arm Splint,,29105,CPT,Facility,Outpatient,,,,234,198.9,67.0644,234,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),140.4,60,,percent of total billed charges,,
Application Of Long Arm Splint,,29105,CPT,Facility,Outpatient,,,,234,198.9,67.0644,234,"Health Partners, Inc.",State of Minnesota Advantage Program,190.71,81.5,,percent of total billed charges,,
Application Of Long Arm Splint,,29105,CPT,Facility,Outpatient,,,,234,198.9,67.0644,234,"Health Partners, Inc.",State Public Programs,117,50,,percent of total billed charges,,
Application Of Long Arm Splint,,29105,CPT,Facility,Outpatient,,,,234,198.9,67.0644,234,Humana Insurance Company,Commercial PPO,222.3,95,,percent of total billed charges,,
Application Of Long Arm Splint,,29105,CPT,Facility,Outpatient,,,,234,198.9,67.0644,234,Humana Insurance Company,Medicare PPO,114.66,49,,percent of total billed charges,,
Application Of Long Arm Splint,,29105,CPT,Facility,Outpatient,,,,234,198.9,67.0644,234,Medica,Individual & Family,218.088,93.2,,percent of total billed charges,,
Application Of Long Arm Splint,,29105,CPT,Facility,Outpatient,,,,234,198.9,67.0644,234,Medica,Medica Advantage Solution,116.532,49.8,,percent of total billed charges,,
Application Of Long Arm Splint,,29105,CPT,Facility,Outpatient,,,,234,198.9,67.0644,234,Medica,Medical Assistance,104.364,44.6,,percent of total billed charges,,
Application Of Long Arm Splint,,29105,CPT,Facility,Outpatient,,,,234,198.9,67.0644,234,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,116.532,49.8,,percent of total billed charges,,
Application Of Long Arm Splint,,29105,CPT,Facility,Outpatient,,,,234,198.9,67.0644,234,"Multiplan, Inc.","Multiplan, Inc.",219.96,94,,percent of total billed charges,,
Application Of Long Arm Splint,,29105,CPT,Facility,Outpatient,,,,234,198.9,67.0644,234,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,210.834,90.1,,percent of total billed charges,,
Application Of Long Arm Splint,,29105,CPT,Facility,Outpatient,,,,234,198.9,67.0644,234,"Preferred One Administrative Services, INC.",PPO,230.724,98.6,,percent of total billed charges,,
Application Of Long Arm Splint,,29105,CPT,Facility,Outpatient,,,,234,198.9,67.0644,234,PrimeWest Health,Minnesota Senior Health Options (MSHO),120.393,51.45,,percent of total billed charges,,
Application Of Long Arm Splint,,29105,CPT,Facility,Outpatient,,,,234,198.9,67.0644,234,PrimeWest Health,MinnesotaCare,120.1824,51.36,,percent of total billed charges,,
Application Of Long Arm Splint,,29105,CPT,Facility,Outpatient,,,,234,198.9,67.0644,234,Sanford Health Plan,Sanford Health Plan,215.28,92,,percent of total billed charges,,
Application Of Long Arm Splint,,29105,CPT,Facility,Outpatient,,,,234,198.9,67.0644,234,"UCare Health, Inc.",Individual & Family Plan,131.859,56.35,,percent of total billed charges,,
Application Of Long Arm Splint,,29105,CPT,Facility,Outpatient,,,,234,198.9,67.0644,234,"UCare Health, Inc.",Medical Assistance,118.0998,50.47,,percent of total billed charges,,
Application Of Long Arm Splint,,29105,CPT,Facility,Outpatient,,,,234,198.9,67.0644,234,"UCare Health, Inc.",Medicare Advantage,118.0998,50.47,,percent of total billed charges,,
Application Of Long Arm Splint,,29105,CPT,Facility,Outpatient,,,,234,198.9,67.0644,234,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),118.0998,50.47,,percent of total billed charges,,
Application Of Long Arm Splint,,29105,CPT,Facility,Outpatient,,,,234,198.9,67.0644,234,UnitedHealthcare,Individual & Family,219.96,94,,percent of total billed charges,,
Application Of Long Arm Splint,,29105,CPT,Facility,Outpatient,,,,234,198.9,67.0644,234,UnitedHealthcare,Medicare Advantage,114.66,49,,percent of total billed charges,,
Application Of Long Arm Splint,,29105,CPT,Facility,Outpatient,,,,234,198.9,67.0644,234,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,112.32,48,,percent of total billed charges,,100% of DHS outpatient percentage
Application Of Long Arm Splint (Shoulder To Hand) (Pro Cah),,29105,CPT,Professional,Both,,,,281,238.85,25.08,281,Aetna,Commercial,238.85,85,,percent of total billed charges,,
Application Of Long Arm Splint (Shoulder To Hand) (Pro Cah),,29105,CPT,Professional,Both,,,,281,238.85,25.08,281,Aetna,Medicare Advantage,40.01,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Application Of Long Arm Splint (Shoulder To Hand) (Pro Cah),,29105,CPT,Professional,Both,,,,281,238.85,25.08,281,Aetna,PPO,261.33,93,,percent of total billed charges,,
Application Of Long Arm Splint (Shoulder To Hand) (Pro Cah),,29105,CPT,Professional,Both,,,,281,238.85,25.08,281,America's PPO,America's PPO,240.0864,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Application Of Long Arm Splint (Shoulder To Hand) (Pro Cah),,29105,CPT,Professional,Both,,,,281,238.85,25.08,281,BlueCross BlueShield Minnesota, Federal Employee Program,86.76,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Application Of Long Arm Splint (Shoulder To Hand) (Pro Cah),,29105,CPT,Professional,Both,,,,281,238.85,25.08,281,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,88.14816,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Application Of Long Arm Splint (Shoulder To Hand) (Pro Cah),,29105,CPT,Professional,Both,,,,281,238.85,25.08,281,BlueCross BlueShield Minnesota,High Value Network Plan,88.14816,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Application Of Long Arm Splint (Shoulder To Hand) (Pro Cah),,29105,CPT,Professional,Both,,,,281,238.85,25.08,281,BlueCross BlueShield Minnesota,Medicare Advantage,44.85,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Application Of Long Arm Splint (Shoulder To Hand) (Pro Cah),,29105,CPT,Professional,Both,,,,281,238.85,25.08,281,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,88.14816,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Application Of Long Arm Splint (Shoulder To Hand) (Pro Cah),,29105,CPT,Professional,Both,,,,281,238.85,25.08,281,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,28.956,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Application Of Long Arm Splint (Shoulder To Hand) (Pro Cah),,29105,CPT,Professional,Both,,,,281,238.85,25.08,281,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),44.85,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Application Of Long Arm Splint (Shoulder To Hand) (Pro Cah),,29105,CPT,Professional,Both,,,,281,238.85,25.08,281,CorVel,Worker's Compensation,76.1076402,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Application Of Long Arm Splint (Shoulder To Hand) (Pro Cah),,29105,CPT,Professional,Both,,,,281,238.85,25.08,281,First Health Group Corporation,First Health Network,272.57,97,,percent of total billed charges,,
Application Of Long Arm Splint (Shoulder To Hand) (Pro Cah),,29105,CPT,Professional,Both,,,,281,238.85,25.08,281,"Health Partners, Inc.",Commercial,81.98,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Application Of Long Arm Splint (Shoulder To Hand) (Pro Cah),,29105,CPT,Professional,Both,,,,281,238.85,25.08,281,"Health Partners, Inc.",Medicare Advantage,44.85,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Application Of Long Arm Splint (Shoulder To Hand) (Pro Cah),,29105,CPT,Professional,Both,,,,281,238.85,25.08,281,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),39.31,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Application Of Long Arm Splint (Shoulder To Hand) (Pro Cah),,29105,CPT,Professional,Both,,,,281,238.85,25.08,281,"Health Partners, Inc.",State of Minnesota Advantage Program,70.62577,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Application Of Long Arm Splint (Shoulder To Hand) (Pro Cah),,29105,CPT,Professional,Both,,,,281,238.85,25.08,281,"Health Partners, Inc.",State Public Programs,25.08,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Application Of Long Arm Splint (Shoulder To Hand) (Pro Cah),,29105,CPT,Professional,Both,,,,281,238.85,25.08,281,Humana Insurance Company,Commercial PPO,39,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Application Of Long Arm Splint (Shoulder To Hand) (Pro Cah),,29105,CPT,Professional,Both,,,,281,238.85,25.08,281,Humana Insurance Company,Medicare PPO,281,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Application Of Long Arm Splint (Shoulder To Hand) (Pro Cah),,29105,CPT,Professional,Both,,,,281,238.85,25.08,281,Medica,Individual & Family,238.288,84.8,,percent of total billed charges,,
Application Of Long Arm Splint (Shoulder To Hand) (Pro Cah),,29105,CPT,Professional,Both,,,,281,238.85,25.08,281,Medica,Medica Advantage Solution,139.938,49.8,,percent of total billed charges,,
Application Of Long Arm Splint (Shoulder To Hand) (Pro Cah),,29105,CPT,Professional,Both,,,,281,238.85,25.08,281,Medica,Medical Assistance,28.96,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Application Of Long Arm Splint (Shoulder To Hand) (Pro Cah),,29105,CPT,Professional,Both,,,,281,238.85,25.08,281,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,39,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Application Of Long Arm Splint (Shoulder To Hand) (Pro Cah),,29105,CPT,Professional,Both,,,,281,238.85,25.08,281,"Multiplan, Inc.","Multiplan, Inc.",264.14,94,,percent of total billed charges,,
Application Of Long Arm Splint (Shoulder To Hand) (Pro Cah),,29105,CPT,Professional,Both,,,,281,238.85,25.08,281,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,253.181,90.1,,percent of total billed charges,,
Application Of Long Arm Splint (Shoulder To Hand) (Pro Cah),,29105,CPT,Professional,Both,,,,281,238.85,25.08,281,"Preferred One Administrative Services, INC.",PPO,277.066,98.6,,percent of total billed charges,,
Application Of Long Arm Splint (Shoulder To Hand) (Pro Cah),,29105,CPT,Professional,Both,,,,281,238.85,25.08,281,PrimeWest Health,Minnesota Senior Health Options (MSHO),44.85,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Application Of Long Arm Splint (Shoulder To Hand) (Pro Cah),,29105,CPT,Professional,Both,,,,281,238.85,25.08,281,PrimeWest Health,MinnesotaCare,30.98292,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Application Of Long Arm Splint (Shoulder To Hand) (Pro Cah),,29105,CPT,Professional,Both,,,,281,238.85,25.08,281,Sanford Health Plan,Sanford Health Plan,247.28,88,,percent of total billed charges,,
Application Of Long Arm Splint (Shoulder To Hand) (Pro Cah),,29105,CPT,Professional,Both,,,,281,238.85,25.08,281,"UCare Health, Inc.",Individual & Family Plan,63.3984,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Application Of Long Arm Splint (Shoulder To Hand) (Pro Cah),,29105,CPT,Professional,Both,,,,281,238.85,25.08,281,"UCare Health, Inc.",Medical Assistance,31.8516,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Application Of Long Arm Splint (Shoulder To Hand) (Pro Cah),,29105,CPT,Professional,Both,,,,281,238.85,25.08,281,"UCare Health, Inc.",Medicare Advantage,44.85,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Application Of Long Arm Splint (Shoulder To Hand) (Pro Cah),,29105,CPT,Professional,Both,,,,281,238.85,25.08,281,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),35.88,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Application Of Long Arm Splint (Shoulder To Hand) (Pro Cah),,29105,CPT,Professional,Both,,,,281,238.85,25.08,281,UnitedHealthcare,Individual & Family,281,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Application Of Long Arm Splint (Shoulder To Hand) (Pro Cah),,29105,CPT,Professional,Both,,,,281,238.85,25.08,281,UnitedHealthcare,Medicare Advantage,44.85,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Application Of Long Arm Splint (Shoulder To Hand) (Pro Cah),,29105,CPT,Professional,Both,,,,281,238.85,25.08,281,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,28.956,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Application Of Short Arm Splint (Forearm To Hand); Static (Pro Cah),,29125,CPT,Professional,Both,,,,281,238.85,25.08,281,Aetna,Commercial,238.85,85,,percent of total billed charges,,
Application Of Short Arm Splint (Forearm To Hand); Static (Pro Cah),,29125,CPT,Professional,Both,,,,281,238.85,25.08,281,Aetna,Medicare Advantage,38.7,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Application Of Short Arm Splint (Forearm To Hand); Static (Pro Cah),,29125,CPT,Professional,Both,,,,281,238.85,25.08,281,Aetna,PPO,261.33,93,,percent of total billed charges,,
Application Of Short Arm Splint (Forearm To Hand); Static (Pro Cah),,29125,CPT,Professional,Both,,,,281,238.85,25.08,281,America's PPO,America's PPO,240.0864,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Application Of Short Arm Splint (Forearm To Hand); Static (Pro Cah),,29125,CPT,Professional,Both,,,,281,238.85,25.08,281,BlueCross BlueShield Minnesota, Federal Employee Program,83.32,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Application Of Short Arm Splint (Forearm To Hand); Static (Pro Cah),,29125,CPT,Professional,Both,,,,281,238.85,25.08,281,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,84.65312,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Application Of Short Arm Splint (Forearm To Hand); Static (Pro Cah),,29125,CPT,Professional,Both,,,,281,238.85,25.08,281,BlueCross BlueShield Minnesota,High Value Network Plan,84.65312,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Application Of Short Arm Splint (Forearm To Hand); Static (Pro Cah),,29125,CPT,Professional,Both,,,,281,238.85,25.08,281,BlueCross BlueShield Minnesota,Medicare Advantage,44.9765,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Application Of Short Arm Splint (Forearm To Hand); Static (Pro Cah),,29125,CPT,Professional,Both,,,,281,238.85,25.08,281,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,84.65312,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Application Of Short Arm Splint (Forearm To Hand); Static (Pro Cah),,29125,CPT,Professional,Both,,,,281,238.85,25.08,281,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,28.956,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Application Of Short Arm Splint (Forearm To Hand); Static (Pro Cah),,29125,CPT,Professional,Both,,,,281,238.85,25.08,281,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),44.9765,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Application Of Short Arm Splint (Forearm To Hand); Static (Pro Cah),,29125,CPT,Professional,Both,,,,281,238.85,25.08,281,CorVel,Worker's Compensation,75.1840527,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Application Of Short Arm Splint (Forearm To Hand); Static (Pro Cah),,29125,CPT,Professional,Both,,,,281,238.85,25.08,281,First Health Group Corporation,First Health Network,272.57,97,,percent of total billed charges,,
Application Of Short Arm Splint (Forearm To Hand); Static (Pro Cah),,29125,CPT,Professional,Both,,,,281,238.85,25.08,281,"Health Partners, Inc.",Commercial,81.26,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Application Of Short Arm Splint (Forearm To Hand); Static (Pro Cah),,29125,CPT,Professional,Both,,,,281,238.85,25.08,281,"Health Partners, Inc.",Medicare Advantage,44.9765,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Application Of Short Arm Splint (Forearm To Hand); Static (Pro Cah),,29125,CPT,Professional,Both,,,,281,238.85,25.08,281,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),38.97,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Application Of Short Arm Splint (Forearm To Hand); Static (Pro Cah),,29125,CPT,Professional,Both,,,,281,238.85,25.08,281,"Health Partners, Inc.",State of Minnesota Advantage Program,70.00549,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Application Of Short Arm Splint (Forearm To Hand); Static (Pro Cah),,29125,CPT,Professional,Both,,,,281,238.85,25.08,281,"Health Partners, Inc.",State Public Programs,25.08,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Application Of Short Arm Splint (Forearm To Hand); Static (Pro Cah),,29125,CPT,Professional,Both,,,,281,238.85,25.08,281,Humana Insurance Company,Commercial PPO,39.11,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Application Of Short Arm Splint (Forearm To Hand); Static (Pro Cah),,29125,CPT,Professional,Both,,,,281,238.85,25.08,281,Humana Insurance Company,Medicare PPO,281,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Application Of Short Arm Splint (Forearm To Hand); Static (Pro Cah),,29125,CPT,Professional,Both,,,,281,238.85,25.08,281,Medica,Individual & Family,238.288,84.8,,percent of total billed charges,,
Application Of Short Arm Splint (Forearm To Hand); Static (Pro Cah),,29125,CPT,Professional,Both,,,,281,238.85,25.08,281,Medica,Medica Advantage Solution,139.938,49.8,,percent of total billed charges,,
Application Of Short Arm Splint (Forearm To Hand); Static (Pro Cah),,29125,CPT,Professional,Both,,,,281,238.85,25.08,281,Medica,Medical Assistance,28.96,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Application Of Short Arm Splint (Forearm To Hand); Static (Pro Cah),,29125,CPT,Professional,Both,,,,281,238.85,25.08,281,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,39.11,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Application Of Short Arm Splint (Forearm To Hand); Static (Pro Cah),,29125,CPT,Professional,Both,,,,281,238.85,25.08,281,"Multiplan, Inc.","Multiplan, Inc.",264.14,94,,percent of total billed charges,,
Application Of Short Arm Splint (Forearm To Hand); Static (Pro Cah),,29125,CPT,Professional,Both,,,,281,238.85,25.08,281,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,253.181,90.1,,percent of total billed charges,,
Application Of Short Arm Splint (Forearm To Hand); Static (Pro Cah),,29125,CPT,Professional,Both,,,,281,238.85,25.08,281,"Preferred One Administrative Services, INC.",PPO,277.066,98.6,,percent of total billed charges,,
Application Of Short Arm Splint (Forearm To Hand); Static (Pro Cah),,29125,CPT,Professional,Both,,,,281,238.85,25.08,281,PrimeWest Health,Minnesota Senior Health Options (MSHO),44.9765,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Application Of Short Arm Splint (Forearm To Hand); Static (Pro Cah),,29125,CPT,Professional,Both,,,,281,238.85,25.08,281,PrimeWest Health,MinnesotaCare,30.98292,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Application Of Short Arm Splint (Forearm To Hand); Static (Pro Cah),,29125,CPT,Professional,Both,,,,281,238.85,25.08,281,Sanford Health Plan,Sanford Health Plan,247.28,88,,percent of total billed charges,,
Application Of Short Arm Splint (Forearm To Hand); Static (Pro Cah),,29125,CPT,Professional,Both,,,,281,238.85,25.08,281,"UCare Health, Inc.",Individual & Family Plan,63.577216,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Application Of Short Arm Splint (Forearm To Hand); Static (Pro Cah),,29125,CPT,Professional,Both,,,,281,238.85,25.08,281,"UCare Health, Inc.",Medical Assistance,31.8516,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Application Of Short Arm Splint (Forearm To Hand); Static (Pro Cah),,29125,CPT,Professional,Both,,,,281,238.85,25.08,281,"UCare Health, Inc.",Medicare Advantage,44.9765,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Application Of Short Arm Splint (Forearm To Hand); Static (Pro Cah),,29125,CPT,Professional,Both,,,,281,238.85,25.08,281,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),35.9812,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Application Of Short Arm Splint (Forearm To Hand); Static (Pro Cah),,29125,CPT,Professional,Both,,,,281,238.85,25.08,281,UnitedHealthcare,Individual & Family,281,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Application Of Short Arm Splint (Forearm To Hand); Static (Pro Cah),,29125,CPT,Professional,Both,,,,281,238.85,25.08,281,UnitedHealthcare,Medicare Advantage,44.9765,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Application Of Short Arm Splint (Forearm To Hand); Static (Pro Cah),,29125,CPT,Professional,Both,,,,281,238.85,25.08,281,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,28.956,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Application Of Finger Splint; Static (Pro Cah),,29130,CPT,Professional,Both,,,,153,130.05,17.66,153,Aetna,Commercial,130.05,85,,percent of total billed charges,,
Application Of Finger Splint; Static (Pro Cah),,29130,CPT,Professional,Both,,,,153,130.05,17.66,153,Aetna,Medicare Advantage,27.75,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Application Of Finger Splint; Static (Pro Cah),,29130,CPT,Professional,Both,,,,153,130.05,17.66,153,Aetna,PPO,142.29,93,,percent of total billed charges,,
Application Of Finger Splint; Static (Pro Cah),,29130,CPT,Professional,Both,,,,153,130.05,17.66,153,America's PPO,America's PPO,130.7232,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Application Of Finger Splint; Static (Pro Cah),,29130,CPT,Professional,Both,,,,153,130.05,17.66,153,BlueCross BlueShield Minnesota, Federal Employee Program,60.6,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Application Of Finger Splint; Static (Pro Cah),,29130,CPT,Professional,Both,,,,153,130.05,17.66,153,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,61.5696,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Application Of Finger Splint; Static (Pro Cah),,29130,CPT,Professional,Both,,,,153,130.05,17.66,153,BlueCross BlueShield Minnesota,High Value Network Plan,61.5696,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Application Of Finger Splint; Static (Pro Cah),,29130,CPT,Professional,Both,,,,153,130.05,17.66,153,BlueCross BlueShield Minnesota,Medicare Advantage,31.878,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Application Of Finger Splint; Static (Pro Cah),,29130,CPT,Professional,Both,,,,153,130.05,17.66,153,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,61.5696,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Application Of Finger Splint; Static (Pro Cah),,29130,CPT,Professional,Both,,,,153,130.05,17.66,153,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,20.39112,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Application Of Finger Splint; Static (Pro Cah),,29130,CPT,Professional,Both,,,,153,130.05,17.66,153,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),31.878,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Application Of Finger Splint; Static (Pro Cah),,29130,CPT,Professional,Both,,,,153,130.05,17.66,153,CorVel,Worker's Compensation,54.0906576,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Application Of Finger Splint; Static (Pro Cah),,29130,CPT,Professional,Both,,,,153,130.05,17.66,153,First Health Group Corporation,First Health Network,148.41,97,,percent of total billed charges,,
Application Of Finger Splint; Static (Pro Cah),,29130,CPT,Professional,Both,,,,153,130.05,17.66,153,"Health Partners, Inc.",Commercial,58.04,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Application Of Finger Splint; Static (Pro Cah),,29130,CPT,Professional,Both,,,,153,130.05,17.66,153,"Health Partners, Inc.",Medicare Advantage,31.878,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Application Of Finger Splint; Static (Pro Cah),,29130,CPT,Professional,Both,,,,153,130.05,17.66,153,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),27.79,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Application Of Finger Splint; Static (Pro Cah),,29130,CPT,Professional,Both,,,,153,130.05,17.66,153,"Health Partners, Inc.",State of Minnesota Advantage Program,50.00146,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Application Of Finger Splint; Static (Pro Cah),,29130,CPT,Professional,Both,,,,153,130.05,17.66,153,"Health Partners, Inc.",State Public Programs,17.66,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Application Of Finger Splint; Static (Pro Cah),,29130,CPT,Professional,Both,,,,153,130.05,17.66,153,Humana Insurance Company,Commercial PPO,27.72,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Application Of Finger Splint; Static (Pro Cah),,29130,CPT,Professional,Both,,,,153,130.05,17.66,153,Humana Insurance Company,Medicare PPO,153,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Application Of Finger Splint; Static (Pro Cah),,29130,CPT,Professional,Both,,,,153,130.05,17.66,153,Medica,Individual & Family,129.744,84.8,,percent of total billed charges,,
Application Of Finger Splint; Static (Pro Cah),,29130,CPT,Professional,Both,,,,153,130.05,17.66,153,Medica,Medica Advantage Solution,76.194,49.8,,percent of total billed charges,,
Application Of Finger Splint; Static (Pro Cah),,29130,CPT,Professional,Both,,,,153,130.05,17.66,153,Medica,Medical Assistance,20.39,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Application Of Finger Splint; Static (Pro Cah),,29130,CPT,Professional,Both,,,,153,130.05,17.66,153,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,27.72,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Application Of Finger Splint; Static (Pro Cah),,29130,CPT,Professional,Both,,,,153,130.05,17.66,153,"Multiplan, Inc.","Multiplan, Inc.",143.82,94,,percent of total billed charges,,
Application Of Finger Splint; Static (Pro Cah),,29130,CPT,Professional,Both,,,,153,130.05,17.66,153,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,137.853,90.1,,percent of total billed charges,,
Application Of Finger Splint; Static (Pro Cah),,29130,CPT,Professional,Both,,,,153,130.05,17.66,153,"Preferred One Administrative Services, INC.",PPO,150.858,98.6,,percent of total billed charges,,
Application Of Finger Splint; Static (Pro Cah),,29130,CPT,Professional,Both,,,,153,130.05,17.66,153,PrimeWest Health,Minnesota Senior Health Options (MSHO),31.878,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Application Of Finger Splint; Static (Pro Cah),,29130,CPT,Professional,Both,,,,153,130.05,17.66,153,PrimeWest Health,MinnesotaCare,21.8184984,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Application Of Finger Splint; Static (Pro Cah),,29130,CPT,Professional,Both,,,,153,130.05,17.66,153,Sanford Health Plan,Sanford Health Plan,134.64,88,,percent of total billed charges,,
Application Of Finger Splint; Static (Pro Cah),,29130,CPT,Professional,Both,,,,153,130.05,17.66,153,"UCare Health, Inc.",Individual & Family Plan,45.061632,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Application Of Finger Splint; Static (Pro Cah),,29130,CPT,Professional,Both,,,,153,130.05,17.66,153,"UCare Health, Inc.",Medical Assistance,22.430232,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Application Of Finger Splint; Static (Pro Cah),,29130,CPT,Professional,Both,,,,153,130.05,17.66,153,"UCare Health, Inc.",Medicare Advantage,31.878,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Application Of Finger Splint; Static (Pro Cah),,29130,CPT,Professional,Both,,,,153,130.05,17.66,153,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),25.5024,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Application Of Finger Splint; Static (Pro Cah),,29130,CPT,Professional,Both,,,,153,130.05,17.66,153,UnitedHealthcare,Individual & Family,153,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Application Of Finger Splint; Static (Pro Cah),,29130,CPT,Professional,Both,,,,153,130.05,17.66,153,UnitedHealthcare,Medicare Advantage,31.878,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Application Of Finger Splint; Static (Pro Cah),,29130,CPT,Professional,Both,,,,153,130.05,17.66,153,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,20.39112,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
DIHYDROERGOTAMINE 1 MG/ML INJ SOLN,,J1110,HCPCS,Facility,Both,1,mL,,615,522.75,176.259,615,Aetna,Commercial,565.8,92,,percent of total billed charges,,
DIHYDROERGOTAMINE 1 MG/ML INJ SOLN,,J1110,HCPCS,Facility,Outpatient,1,mL,,615,522.75,176.259,615,Aetna,Medicare Advantage,301.35,49,,percent of total billed charges,,
DIHYDROERGOTAMINE 1 MG/ML INJ SOLN,,J1110,HCPCS,Facility,Inpatient,1,mL,,615,522.75,176.259,615,Aetna,Medicare Advantage,,,,,Included in per diem rate,
DIHYDROERGOTAMINE 1 MG/ML INJ SOLN,,J1110,HCPCS,Facility,Both,1,mL,,615,522.75,176.259,615,Aetna,PPO,571.95,93,,percent of total billed charges,,
DIHYDROERGOTAMINE 1 MG/ML INJ SOLN,,J1110,HCPCS,Facility,Both,1,mL,,615,522.75,176.259,615,America's PPO,America's PPO,590.5845,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
DIHYDROERGOTAMINE 1 MG/ML INJ SOLN,,J1110,HCPCS,Facility,Both,1,mL,,615,522.75,176.259,615,BlueCross BlueShield Minnesota, Federal Employee Program,605.16,98.4,,percent of total billed charges,,
DIHYDROERGOTAMINE 1 MG/ML INJ SOLN,,J1110,HCPCS,Facility,Both,1,mL,,615,522.75,176.259,615,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,615,100,,percent of total billed charges,,
DIHYDROERGOTAMINE 1 MG/ML INJ SOLN,,J1110,HCPCS,Facility,Both,1,mL,,615,522.75,176.259,615,BlueCross BlueShield Minnesota,High Value Network Plan,553.5,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
DIHYDROERGOTAMINE 1 MG/ML INJ SOLN,,J1110,HCPCS,Facility,Outpatient,1,mL,,615,522.75,176.259,615,BlueCross BlueShield Minnesota,Medicare Advantage,301.35,49,,percent of total billed charges,,
DIHYDROERGOTAMINE 1 MG/ML INJ SOLN,,J1110,HCPCS,Facility,Inpatient,1,mL,,615,522.75,176.259,615,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
DIHYDROERGOTAMINE 1 MG/ML INJ SOLN,,J1110,HCPCS,Facility,Both,1,mL,,615,522.75,176.259,615,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,544.7055,88.57,,percent of total billed charges,,
DIHYDROERGOTAMINE 1 MG/ML INJ SOLN,,J1110,HCPCS,Facility,Both,1,mL,,615,522.75,176.259,615,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,176.259,28.66,,percent of total billed charges,,
DIHYDROERGOTAMINE 1 MG/ML INJ SOLN,,J1110,HCPCS,Facility,Outpatient,1,mL,,615,522.75,176.259,615,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),301.35,49,,percent of total billed charges,,
DIHYDROERGOTAMINE 1 MG/ML INJ SOLN,,J1110,HCPCS,Facility,Inpatient,1,mL,,615,522.75,176.259,615,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
DIHYDROERGOTAMINE 1 MG/ML INJ SOLN,,J1110,HCPCS,Facility,Both,1,mL,,615,522.75,176.259,615,CorVel,Worker's Compensation,615,100,,percent of total billed charges,,
DIHYDROERGOTAMINE 1 MG/ML INJ SOLN,,J1110,HCPCS,Facility,Both,1,mL,,615,522.75,176.259,615,First Health Group Corporation,First Health Network,596.55,97,,percent of total billed charges,,
DIHYDROERGOTAMINE 1 MG/ML INJ SOLN,,J1110,HCPCS,Facility,Both,1,mL,,615,522.75,176.259,615,"Health Partners, Inc.",Commercial,581.79,94.6,,percent of total billed charges,,
DIHYDROERGOTAMINE 1 MG/ML INJ SOLN,,J1110,HCPCS,Facility,Outpatient,1,mL,,615,522.75,176.259,615,"Health Partners, Inc.",Medicare Advantage,301.35,49,,percent of total billed charges,,
DIHYDROERGOTAMINE 1 MG/ML INJ SOLN,,J1110,HCPCS,Facility,Inpatient,1,mL,,615,522.75,176.259,615,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DIHYDROERGOTAMINE 1 MG/ML INJ SOLN,,J1110,HCPCS,Facility,Both,1,mL,,615,522.75,176.259,615,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),369,60,,percent of total billed charges,,
DIHYDROERGOTAMINE 1 MG/ML INJ SOLN,,J1110,HCPCS,Facility,Both,1,mL,,615,522.75,176.259,615,"Health Partners, Inc.",State of Minnesota Advantage Program,501.225,81.5,,percent of total billed charges,,
DIHYDROERGOTAMINE 1 MG/ML INJ SOLN,,J1110,HCPCS,Facility,Both,1,mL,,615,522.75,176.259,615,"Health Partners, Inc.",State Public Programs,307.5,50,,percent of total billed charges,,
DIHYDROERGOTAMINE 1 MG/ML INJ SOLN,,J1110,HCPCS,Facility,Both,1,mL,,615,522.75,176.259,615,Humana Insurance Company,Commercial PPO,584.25,95,,percent of total billed charges,,
DIHYDROERGOTAMINE 1 MG/ML INJ SOLN,,J1110,HCPCS,Facility,Outpatient,1,mL,,615,522.75,176.259,615,Humana Insurance Company,Medicare PPO,301.35,49,,percent of total billed charges,,
DIHYDROERGOTAMINE 1 MG/ML INJ SOLN,,J1110,HCPCS,Facility,Inpatient,1,mL,,615,522.75,176.259,615,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
DIHYDROERGOTAMINE 1 MG/ML INJ SOLN,,J1110,HCPCS,Facility,Both,1,mL,,615,522.75,176.259,615,Medica,Individual & Family,609.465,99.1,,percent of total billed charges,,
DIHYDROERGOTAMINE 1 MG/ML INJ SOLN,,J1110,HCPCS,Facility,Outpatient,1,mL,,615,522.75,176.259,615,Medica,Medica Advantage Solution,306.27,49.8,,percent of total billed charges,,
DIHYDROERGOTAMINE 1 MG/ML INJ SOLN,,J1110,HCPCS,Facility,Inpatient,1,mL,,615,522.75,176.259,615,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
DIHYDROERGOTAMINE 1 MG/ML INJ SOLN,,J1110,HCPCS,Facility,Outpatient,1,mL,,615,522.75,176.259,615,Medica,Medical Assistance,274.29,44.6,,percent of total billed charges,,
DIHYDROERGOTAMINE 1 MG/ML INJ SOLN,,J1110,HCPCS,Facility,Inpatient,1,mL,,615,522.75,176.259,615,Medica,Medical Assistance,,,,,Included in per diem rate,
DIHYDROERGOTAMINE 1 MG/ML INJ SOLN,,J1110,HCPCS,Facility,Outpatient,1,mL,,615,522.75,176.259,615,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,306.27,49.8,,percent of total billed charges,,
DIHYDROERGOTAMINE 1 MG/ML INJ SOLN,,J1110,HCPCS,Facility,Inpatient,1,mL,,615,522.75,176.259,615,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
DIHYDROERGOTAMINE 1 MG/ML INJ SOLN,,J1110,HCPCS,Facility,Both,1,mL,,615,522.75,176.259,615,"Multiplan, Inc.","Multiplan, Inc.",578.1,94,,percent of total billed charges,,
DIHYDROERGOTAMINE 1 MG/ML INJ SOLN,,J1110,HCPCS,Facility,Outpatient,1,mL,,615,522.75,176.259,615,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,554.115,90.1,,percent of total billed charges,,
DIHYDROERGOTAMINE 1 MG/ML INJ SOLN,,J1110,HCPCS,Facility,Inpatient,1,mL,,615,522.75,176.259,615,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
DIHYDROERGOTAMINE 1 MG/ML INJ SOLN,,J1110,HCPCS,Facility,Both,1,mL,,615,522.75,176.259,615,"Preferred One Administrative Services, INC.",PPO,606.39,98.6,,percent of total billed charges,,
DIHYDROERGOTAMINE 1 MG/ML INJ SOLN,,J1110,HCPCS,Facility,Outpatient,1,mL,,615,522.75,176.259,615,PrimeWest Health,Minnesota Senior Health Options (MSHO),316.4175,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
DIHYDROERGOTAMINE 1 MG/ML INJ SOLN,,J1110,HCPCS,Facility,Inpatient,1,mL,,615,522.75,176.259,615,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DIHYDROERGOTAMINE 1 MG/ML INJ SOLN,,J1110,HCPCS,Facility,Outpatient,1,mL,,615,522.75,176.259,615,PrimeWest Health,MinnesotaCare,315.864,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
DIHYDROERGOTAMINE 1 MG/ML INJ SOLN,,J1110,HCPCS,Facility,Inpatient,1,mL,,615,522.75,176.259,615,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
DIHYDROERGOTAMINE 1 MG/ML INJ SOLN,,J1110,HCPCS,Facility,Both,1,mL,,615,522.75,176.259,615,Sanford Health Plan,Sanford Health Plan,565.8,92,,percent of total billed charges,,
DIHYDROERGOTAMINE 1 MG/ML INJ SOLN,,J1110,HCPCS,Facility,Outpatient,1,mL,,615,522.75,176.259,615,"UCare Health, Inc.",Individual & Family Plan,346.5525,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
DIHYDROERGOTAMINE 1 MG/ML INJ SOLN,,J1110,HCPCS,Facility,Inpatient,1,mL,,615,522.75,176.259,615,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
DIHYDROERGOTAMINE 1 MG/ML INJ SOLN,,J1110,HCPCS,Facility,Outpatient,1,mL,,615,522.75,176.259,615,"UCare Health, Inc.",Medical Assistance,310.3905,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DIHYDROERGOTAMINE 1 MG/ML INJ SOLN,,J1110,HCPCS,Facility,Inpatient,1,mL,,615,522.75,176.259,615,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
DIHYDROERGOTAMINE 1 MG/ML INJ SOLN,,J1110,HCPCS,Facility,Outpatient,1,mL,,615,522.75,176.259,615,"UCare Health, Inc.",Medicare Advantage,310.3905,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DIHYDROERGOTAMINE 1 MG/ML INJ SOLN,,J1110,HCPCS,Facility,Inpatient,1,mL,,615,522.75,176.259,615,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DIHYDROERGOTAMINE 1 MG/ML INJ SOLN,,J1110,HCPCS,Facility,Outpatient,1,mL,,615,522.75,176.259,615,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),310.3905,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DIHYDROERGOTAMINE 1 MG/ML INJ SOLN,,J1110,HCPCS,Facility,Inpatient,1,mL,,615,522.75,176.259,615,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DIHYDROERGOTAMINE 1 MG/ML INJ SOLN,,J1110,HCPCS,Facility,Both,1,mL,,615,522.75,176.259,615,UnitedHealthcare,Individual & Family,578.1,94,,percent of total billed charges,,
DIHYDROERGOTAMINE 1 MG/ML INJ SOLN,,J1110,HCPCS,Facility,Outpatient,1,mL,,615,522.75,176.259,615,UnitedHealthcare,Medicare Advantage,301.35,49,,percent of total billed charges,,
DIHYDROERGOTAMINE 1 MG/ML INJ SOLN,,J1110,HCPCS,Facility,Inpatient,1,mL,,615,522.75,176.259,615,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
DIHYDROERGOTAMINE 1 MG/ML INJ SOLN,,J1110,HCPCS,Facility,Outpatient,1,mL,,615,522.75,176.259,615,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,295.2,48,,percent of total billed charges,,100% of DHS outpatient percentage
DIHYDROERGOTAMINE 1 MG/ML INJ SOLN,,J1110,HCPCS,Facility,Inpatient,1,mL,,615,522.75,176.259,615,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
HYDROMORPHONE 1 MG/ML (1 ML) INJ WRAPPER,,J1170,HCPCS,Facility,Both,1,mL,,16,13.6,4.5856,16,Aetna,Commercial,14.72,92,,percent of total billed charges,,
HYDROMORPHONE 1 MG/ML (1 ML) INJ WRAPPER,,J1170,HCPCS,Facility,Outpatient,1,mL,,16,13.6,4.5856,16,Aetna,Medicare Advantage,7.84,49,,percent of total billed charges,,
HYDROMORPHONE 1 MG/ML (1 ML) INJ WRAPPER,,J1170,HCPCS,Facility,Inpatient,1,mL,,16,13.6,4.5856,16,Aetna,Medicare Advantage,,,,,Included in per diem rate,
HYDROMORPHONE 1 MG/ML (1 ML) INJ WRAPPER,,J1170,HCPCS,Facility,Both,1,mL,,16,13.6,4.5856,16,Aetna,PPO,14.88,93,,percent of total billed charges,,
HYDROMORPHONE 1 MG/ML (1 ML) INJ WRAPPER,,J1170,HCPCS,Facility,Both,1,mL,,16,13.6,4.5856,16,America's PPO,America's PPO,15.3648,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
HYDROMORPHONE 1 MG/ML (1 ML) INJ WRAPPER,,J1170,HCPCS,Facility,Both,1,mL,,16,13.6,4.5856,16,BlueCross BlueShield Minnesota, Federal Employee Program,15.744,98.4,,percent of total billed charges,,
HYDROMORPHONE 1 MG/ML (1 ML) INJ WRAPPER,,J1170,HCPCS,Facility,Both,1,mL,,16,13.6,4.5856,16,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,16,100,,percent of total billed charges,,
HYDROMORPHONE 1 MG/ML (1 ML) INJ WRAPPER,,J1170,HCPCS,Facility,Both,1,mL,,16,13.6,4.5856,16,BlueCross BlueShield Minnesota,High Value Network Plan,14.4,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
HYDROMORPHONE 1 MG/ML (1 ML) INJ WRAPPER,,J1170,HCPCS,Facility,Outpatient,1,mL,,16,13.6,4.5856,16,BlueCross BlueShield Minnesota,Medicare Advantage,7.84,49,,percent of total billed charges,,
HYDROMORPHONE 1 MG/ML (1 ML) INJ WRAPPER,,J1170,HCPCS,Facility,Inpatient,1,mL,,16,13.6,4.5856,16,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
HYDROMORPHONE 1 MG/ML (1 ML) INJ WRAPPER,,J1170,HCPCS,Facility,Both,1,mL,,16,13.6,4.5856,16,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,14.1712,88.57,,percent of total billed charges,,
HYDROMORPHONE 1 MG/ML (1 ML) INJ WRAPPER,,J1170,HCPCS,Facility,Both,1,mL,,16,13.6,4.5856,16,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,4.5856,28.66,,percent of total billed charges,,
HYDROMORPHONE 1 MG/ML (1 ML) INJ WRAPPER,,J1170,HCPCS,Facility,Outpatient,1,mL,,16,13.6,4.5856,16,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),7.84,49,,percent of total billed charges,,
HYDROMORPHONE 1 MG/ML (1 ML) INJ WRAPPER,,J1170,HCPCS,Facility,Inpatient,1,mL,,16,13.6,4.5856,16,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
HYDROMORPHONE 1 MG/ML (1 ML) INJ WRAPPER,,J1170,HCPCS,Facility,Both,1,mL,,16,13.6,4.5856,16,CorVel,Worker's Compensation,16,100,,percent of total billed charges,,
HYDROMORPHONE 1 MG/ML (1 ML) INJ WRAPPER,,J1170,HCPCS,Facility,Both,1,mL,,16,13.6,4.5856,16,First Health Group Corporation,First Health Network,15.52,97,,percent of total billed charges,,
HYDROMORPHONE 1 MG/ML (1 ML) INJ WRAPPER,,J1170,HCPCS,Facility,Both,1,mL,,16,13.6,4.5856,16,"Health Partners, Inc.",Commercial,15.136,94.6,,percent of total billed charges,,
HYDROMORPHONE 1 MG/ML (1 ML) INJ WRAPPER,,J1170,HCPCS,Facility,Outpatient,1,mL,,16,13.6,4.5856,16,"Health Partners, Inc.",Medicare Advantage,7.84,49,,percent of total billed charges,,
HYDROMORPHONE 1 MG/ML (1 ML) INJ WRAPPER,,J1170,HCPCS,Facility,Inpatient,1,mL,,16,13.6,4.5856,16,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
HYDROMORPHONE 1 MG/ML (1 ML) INJ WRAPPER,,J1170,HCPCS,Facility,Both,1,mL,,16,13.6,4.5856,16,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),9.6,60,,percent of total billed charges,,
HYDROMORPHONE 1 MG/ML (1 ML) INJ WRAPPER,,J1170,HCPCS,Facility,Both,1,mL,,16,13.6,4.5856,16,"Health Partners, Inc.",State of Minnesota Advantage Program,13.04,81.5,,percent of total billed charges,,
HYDROMORPHONE 1 MG/ML (1 ML) INJ WRAPPER,,J1170,HCPCS,Facility,Both,1,mL,,16,13.6,4.5856,16,"Health Partners, Inc.",State Public Programs,8,50,,percent of total billed charges,,
HYDROMORPHONE 1 MG/ML (1 ML) INJ WRAPPER,,J1170,HCPCS,Facility,Both,1,mL,,16,13.6,4.5856,16,Humana Insurance Company,Commercial PPO,15.2,95,,percent of total billed charges,,
HYDROMORPHONE 1 MG/ML (1 ML) INJ WRAPPER,,J1170,HCPCS,Facility,Outpatient,1,mL,,16,13.6,4.5856,16,Humana Insurance Company,Medicare PPO,7.84,49,,percent of total billed charges,,
HYDROMORPHONE 1 MG/ML (1 ML) INJ WRAPPER,,J1170,HCPCS,Facility,Inpatient,1,mL,,16,13.6,4.5856,16,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
HYDROMORPHONE 1 MG/ML (1 ML) INJ WRAPPER,,J1170,HCPCS,Facility,Both,1,mL,,16,13.6,4.5856,16,Medica,Individual & Family,15.856,99.1,,percent of total billed charges,,
HYDROMORPHONE 1 MG/ML (1 ML) INJ WRAPPER,,J1170,HCPCS,Facility,Outpatient,1,mL,,16,13.6,4.5856,16,Medica,Medica Advantage Solution,7.968,49.8,,percent of total billed charges,,
HYDROMORPHONE 1 MG/ML (1 ML) INJ WRAPPER,,J1170,HCPCS,Facility,Inpatient,1,mL,,16,13.6,4.5856,16,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
HYDROMORPHONE 1 MG/ML (1 ML) INJ WRAPPER,,J1170,HCPCS,Facility,Outpatient,1,mL,,16,13.6,4.5856,16,Medica,Medical Assistance,7.136,44.6,,percent of total billed charges,,
HYDROMORPHONE 1 MG/ML (1 ML) INJ WRAPPER,,J1170,HCPCS,Facility,Inpatient,1,mL,,16,13.6,4.5856,16,Medica,Medical Assistance,,,,,Included in per diem rate,
HYDROMORPHONE 1 MG/ML (1 ML) INJ WRAPPER,,J1170,HCPCS,Facility,Outpatient,1,mL,,16,13.6,4.5856,16,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,7.968,49.8,,percent of total billed charges,,
HYDROMORPHONE 1 MG/ML (1 ML) INJ WRAPPER,,J1170,HCPCS,Facility,Inpatient,1,mL,,16,13.6,4.5856,16,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
HYDROMORPHONE 1 MG/ML (1 ML) INJ WRAPPER,,J1170,HCPCS,Facility,Both,1,mL,,16,13.6,4.5856,16,"Multiplan, Inc.","Multiplan, Inc.",15.04,94,,percent of total billed charges,,
HYDROMORPHONE 1 MG/ML (1 ML) INJ WRAPPER,,J1170,HCPCS,Facility,Outpatient,1,mL,,16,13.6,4.5856,16,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,14.416,90.1,,percent of total billed charges,,
HYDROMORPHONE 1 MG/ML (1 ML) INJ WRAPPER,,J1170,HCPCS,Facility,Inpatient,1,mL,,16,13.6,4.5856,16,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
HYDROMORPHONE 1 MG/ML (1 ML) INJ WRAPPER,,J1170,HCPCS,Facility,Both,1,mL,,16,13.6,4.5856,16,"Preferred One Administrative Services, INC.",PPO,15.776,98.6,,percent of total billed charges,,
HYDROMORPHONE 1 MG/ML (1 ML) INJ WRAPPER,,J1170,HCPCS,Facility,Outpatient,1,mL,,16,13.6,4.5856,16,PrimeWest Health,Minnesota Senior Health Options (MSHO),8.232,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
HYDROMORPHONE 1 MG/ML (1 ML) INJ WRAPPER,,J1170,HCPCS,Facility,Inpatient,1,mL,,16,13.6,4.5856,16,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
HYDROMORPHONE 1 MG/ML (1 ML) INJ WRAPPER,,J1170,HCPCS,Facility,Outpatient,1,mL,,16,13.6,4.5856,16,PrimeWest Health,MinnesotaCare,8.2176,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
HYDROMORPHONE 1 MG/ML (1 ML) INJ WRAPPER,,J1170,HCPCS,Facility,Inpatient,1,mL,,16,13.6,4.5856,16,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
HYDROMORPHONE 1 MG/ML (1 ML) INJ WRAPPER,,J1170,HCPCS,Facility,Both,1,mL,,16,13.6,4.5856,16,Sanford Health Plan,Sanford Health Plan,14.72,92,,percent of total billed charges,,
HYDROMORPHONE 1 MG/ML (1 ML) INJ WRAPPER,,J1170,HCPCS,Facility,Outpatient,1,mL,,16,13.6,4.5856,16,"UCare Health, Inc.",Individual & Family Plan,9.016,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
HYDROMORPHONE 1 MG/ML (1 ML) INJ WRAPPER,,J1170,HCPCS,Facility,Inpatient,1,mL,,16,13.6,4.5856,16,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
HYDROMORPHONE 1 MG/ML (1 ML) INJ WRAPPER,,J1170,HCPCS,Facility,Outpatient,1,mL,,16,13.6,4.5856,16,"UCare Health, Inc.",Medical Assistance,8.0752,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
HYDROMORPHONE 1 MG/ML (1 ML) INJ WRAPPER,,J1170,HCPCS,Facility,Inpatient,1,mL,,16,13.6,4.5856,16,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
HYDROMORPHONE 1 MG/ML (1 ML) INJ WRAPPER,,J1170,HCPCS,Facility,Outpatient,1,mL,,16,13.6,4.5856,16,"UCare Health, Inc.",Medicare Advantage,8.0752,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
HYDROMORPHONE 1 MG/ML (1 ML) INJ WRAPPER,,J1170,HCPCS,Facility,Inpatient,1,mL,,16,13.6,4.5856,16,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
HYDROMORPHONE 1 MG/ML (1 ML) INJ WRAPPER,,J1170,HCPCS,Facility,Outpatient,1,mL,,16,13.6,4.5856,16,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),8.0752,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
HYDROMORPHONE 1 MG/ML (1 ML) INJ WRAPPER,,J1170,HCPCS,Facility,Inpatient,1,mL,,16,13.6,4.5856,16,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
HYDROMORPHONE 1 MG/ML (1 ML) INJ WRAPPER,,J1170,HCPCS,Facility,Both,1,mL,,16,13.6,4.5856,16,UnitedHealthcare,Individual & Family,15.04,94,,percent of total billed charges,,
HYDROMORPHONE 1 MG/ML (1 ML) INJ WRAPPER,,J1170,HCPCS,Facility,Outpatient,1,mL,,16,13.6,4.5856,16,UnitedHealthcare,Medicare Advantage,7.84,49,,percent of total billed charges,,
HYDROMORPHONE 1 MG/ML (1 ML) INJ WRAPPER,,J1170,HCPCS,Facility,Inpatient,1,mL,,16,13.6,4.5856,16,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
HYDROMORPHONE 1 MG/ML (1 ML) INJ WRAPPER,,J1170,HCPCS,Facility,Outpatient,1,mL,,16,13.6,4.5856,16,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,7.68,48,,percent of total billed charges,,100% of DHS outpatient percentage
HYDROMORPHONE 1 MG/ML (1 ML) INJ WRAPPER,,J1170,HCPCS,Facility,Inpatient,1,mL,,16,13.6,4.5856,16,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Application Of Long Leg Cast (Thigh To Toes) (Pro Cah),,29345,CPT,Professional,Both,,,,485,412.25,61.29,485,Aetna,Commercial,412.25,85,,percent of total billed charges,,
Application Of Long Leg Cast (Thigh To Toes) (Pro Cah),,29345,CPT,Professional,Both,,,,485,412.25,61.29,485,Aetna,Medicare Advantage,96.24,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Application Of Long Leg Cast (Thigh To Toes) (Pro Cah),,29345,CPT,Professional,Both,,,,485,412.25,61.29,485,Aetna,PPO,451.05,93,,percent of total billed charges,,
Application Of Long Leg Cast (Thigh To Toes) (Pro Cah),,29345,CPT,Professional,Both,,,,485,412.25,61.29,485,America's PPO,America's PPO,414.384,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Application Of Long Leg Cast (Thigh To Toes) (Pro Cah),,29345,CPT,Professional,Both,,,,485,412.25,61.29,485,BlueCross BlueShield Minnesota, Federal Employee Program,204.51,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Application Of Long Leg Cast (Thigh To Toes) (Pro Cah),,29345,CPT,Professional,Both,,,,485,412.25,61.29,485,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,207.78216,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Application Of Long Leg Cast (Thigh To Toes) (Pro Cah),,29345,CPT,Professional,Both,,,,485,412.25,61.29,485,BlueCross BlueShield Minnesota,High Value Network Plan,207.78216,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Application Of Long Leg Cast (Thigh To Toes) (Pro Cah),,29345,CPT,Professional,Both,,,,485,412.25,61.29,485,BlueCross BlueShield Minnesota,Medicare Advantage,109.618,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Application Of Long Leg Cast (Thigh To Toes) (Pro Cah),,29345,CPT,Professional,Both,,,,485,412.25,61.29,485,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,207.78216,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Application Of Long Leg Cast (Thigh To Toes) (Pro Cah),,29345,CPT,Professional,Both,,,,485,412.25,61.29,485,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,70.7644,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Application Of Long Leg Cast (Thigh To Toes) (Pro Cah),,29345,CPT,Professional,Both,,,,485,412.25,61.29,485,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),109.618,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Application Of Long Leg Cast (Thigh To Toes) (Pro Cah),,29345,CPT,Professional,Both,,,,485,412.25,61.29,485,CorVel,Worker's Compensation,185.4939852,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Application Of Long Leg Cast (Thigh To Toes) (Pro Cah),,29345,CPT,Professional,Both,,,,485,412.25,61.29,485,First Health Group Corporation,First Health Network,470.45,97,,percent of total billed charges,,
Application Of Long Leg Cast (Thigh To Toes) (Pro Cah),,29345,CPT,Professional,Both,,,,485,412.25,61.29,485,"Health Partners, Inc.",Commercial,200.97,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Application Of Long Leg Cast (Thigh To Toes) (Pro Cah),,29345,CPT,Professional,Both,,,,485,412.25,61.29,485,"Health Partners, Inc.",Medicare Advantage,109.618,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Application Of Long Leg Cast (Thigh To Toes) (Pro Cah),,29345,CPT,Professional,Both,,,,485,412.25,61.29,485,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),95.22,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Application Of Long Leg Cast (Thigh To Toes) (Pro Cah),,29345,CPT,Professional,Both,,,,485,412.25,61.29,485,"Health Partners, Inc.",State of Minnesota Advantage Program,173.135655,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Application Of Long Leg Cast (Thigh To Toes) (Pro Cah),,29345,CPT,Professional,Both,,,,485,412.25,61.29,485,"Health Partners, Inc.",State Public Programs,61.29,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Application Of Long Leg Cast (Thigh To Toes) (Pro Cah),,29345,CPT,Professional,Both,,,,485,412.25,61.29,485,Humana Insurance Company,Commercial PPO,95.32,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Application Of Long Leg Cast (Thigh To Toes) (Pro Cah),,29345,CPT,Professional,Both,,,,485,412.25,61.29,485,Humana Insurance Company,Medicare PPO,485,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Application Of Long Leg Cast (Thigh To Toes) (Pro Cah),,29345,CPT,Professional,Both,,,,485,412.25,61.29,485,Medica,Individual & Family,411.28,84.8,,percent of total billed charges,,
Application Of Long Leg Cast (Thigh To Toes) (Pro Cah),,29345,CPT,Professional,Both,,,,485,412.25,61.29,485,Medica,Medica Advantage Solution,241.53,49.8,,percent of total billed charges,,
Application Of Long Leg Cast (Thigh To Toes) (Pro Cah),,29345,CPT,Professional,Both,,,,485,412.25,61.29,485,Medica,Medical Assistance,70.76,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Application Of Long Leg Cast (Thigh To Toes) (Pro Cah),,29345,CPT,Professional,Both,,,,485,412.25,61.29,485,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,95.32,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Application Of Long Leg Cast (Thigh To Toes) (Pro Cah),,29345,CPT,Professional,Both,,,,485,412.25,61.29,485,"Multiplan, Inc.","Multiplan, Inc.",455.9,94,,percent of total billed charges,,
Application Of Long Leg Cast (Thigh To Toes) (Pro Cah),,29345,CPT,Professional,Both,,,,485,412.25,61.29,485,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,436.985,90.1,,percent of total billed charges,,
Application Of Long Leg Cast (Thigh To Toes) (Pro Cah),,29345,CPT,Professional,Both,,,,485,412.25,61.29,485,"Preferred One Administrative Services, INC.",PPO,478.21,98.6,,percent of total billed charges,,
Application Of Long Leg Cast (Thigh To Toes) (Pro Cah),,29345,CPT,Professional,Both,,,,485,412.25,61.29,485,PrimeWest Health,Minnesota Senior Health Options (MSHO),109.618,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Application Of Long Leg Cast (Thigh To Toes) (Pro Cah),,29345,CPT,Professional,Both,,,,485,412.25,61.29,485,PrimeWest Health,MinnesotaCare,75.717908,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Application Of Long Leg Cast (Thigh To Toes) (Pro Cah),,29345,CPT,Professional,Both,,,,485,412.25,61.29,485,Sanford Health Plan,Sanford Health Plan,426.8,88,,percent of total billed charges,,
Application Of Long Leg Cast (Thigh To Toes) (Pro Cah),,29345,CPT,Professional,Both,,,,485,412.25,61.29,485,"UCare Health, Inc.",Individual & Family Plan,154.952192,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Application Of Long Leg Cast (Thigh To Toes) (Pro Cah),,29345,CPT,Professional,Both,,,,485,412.25,61.29,485,"UCare Health, Inc.",Medical Assistance,77.84084,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Application Of Long Leg Cast (Thigh To Toes) (Pro Cah),,29345,CPT,Professional,Both,,,,485,412.25,61.29,485,"UCare Health, Inc.",Medicare Advantage,109.618,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Application Of Long Leg Cast (Thigh To Toes) (Pro Cah),,29345,CPT,Professional,Both,,,,485,412.25,61.29,485,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),87.6944,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Application Of Long Leg Cast (Thigh To Toes) (Pro Cah),,29345,CPT,Professional,Both,,,,485,412.25,61.29,485,UnitedHealthcare,Individual & Family,485,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Application Of Long Leg Cast (Thigh To Toes) (Pro Cah),,29345,CPT,Professional,Both,,,,485,412.25,61.29,485,UnitedHealthcare,Medicare Advantage,109.618,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Application Of Long Leg Cast (Thigh To Toes) (Pro Cah),,29345,CPT,Professional,Both,,,,485,412.25,61.29,485,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,70.7644,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Application Of Short Leg Cast (Below Knee To Toes) (Pro Cah),,29405,CPT,Professional,Both,,,,332,282.2,36.42,332,Aetna,Commercial,282.2,85,,percent of total billed charges,,
Application Of Short Leg Cast (Below Knee To Toes) (Pro Cah),,29405,CPT,Professional,Both,,,,332,282.2,36.42,332,Aetna,Medicare Advantage,57.09,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Application Of Short Leg Cast (Below Knee To Toes) (Pro Cah),,29405,CPT,Professional,Both,,,,332,282.2,36.42,332,Aetna,PPO,308.76,93,,percent of total billed charges,,
Application Of Short Leg Cast (Below Knee To Toes) (Pro Cah),,29405,CPT,Professional,Both,,,,332,282.2,36.42,332,America's PPO,America's PPO,283.6608,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Application Of Short Leg Cast (Below Knee To Toes) (Pro Cah),,29405,CPT,Professional,Both,,,,332,282.2,36.42,332,BlueCross BlueShield Minnesota, Federal Employee Program,119.82,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Application Of Short Leg Cast (Below Knee To Toes) (Pro Cah),,29405,CPT,Professional,Both,,,,332,282.2,36.42,332,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,121.73712,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Application Of Short Leg Cast (Below Knee To Toes) (Pro Cah),,29405,CPT,Professional,Both,,,,332,282.2,36.42,332,BlueCross BlueShield Minnesota,High Value Network Plan,121.73712,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Application Of Short Leg Cast (Below Knee To Toes) (Pro Cah),,29405,CPT,Professional,Both,,,,332,282.2,36.42,332,BlueCross BlueShield Minnesota,Medicare Advantage,65.2625,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Application Of Short Leg Cast (Below Knee To Toes) (Pro Cah),,29405,CPT,Professional,Both,,,,332,282.2,36.42,332,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,121.73712,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Application Of Short Leg Cast (Below Knee To Toes) (Pro Cah),,29405,CPT,Professional,Both,,,,332,282.2,36.42,332,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,42.05224,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Application Of Short Leg Cast (Below Knee To Toes) (Pro Cah),,29405,CPT,Professional,Both,,,,332,282.2,36.42,332,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),65.2625,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Application Of Short Leg Cast (Below Knee To Toes) (Pro Cah),,29405,CPT,Professional,Both,,,,332,282.2,36.42,332,CorVel,Worker's Compensation,109.655025,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Application Of Short Leg Cast (Below Knee To Toes) (Pro Cah),,29405,CPT,Professional,Both,,,,332,282.2,36.42,332,First Health Group Corporation,First Health Network,322.04,97,,percent of total billed charges,,
Application Of Short Leg Cast (Below Knee To Toes) (Pro Cah),,29405,CPT,Professional,Both,,,,332,282.2,36.42,332,"Health Partners, Inc.",Commercial,118.26,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Application Of Short Leg Cast (Below Knee To Toes) (Pro Cah),,29405,CPT,Professional,Both,,,,332,282.2,36.42,332,"Health Partners, Inc.",Medicare Advantage,65.2625,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Application Of Short Leg Cast (Below Knee To Toes) (Pro Cah),,29405,CPT,Professional,Both,,,,332,282.2,36.42,332,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),56.93,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Application Of Short Leg Cast (Below Knee To Toes) (Pro Cah),,29405,CPT,Professional,Both,,,,332,282.2,36.42,332,"Health Partners, Inc.",State of Minnesota Advantage Program,101.88099,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Application Of Short Leg Cast (Below Knee To Toes) (Pro Cah),,29405,CPT,Professional,Both,,,,332,282.2,36.42,332,"Health Partners, Inc.",State Public Programs,36.42,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Application Of Short Leg Cast (Below Knee To Toes) (Pro Cah),,29405,CPT,Professional,Both,,,,332,282.2,36.42,332,Humana Insurance Company,Commercial PPO,56.75,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Application Of Short Leg Cast (Below Knee To Toes) (Pro Cah),,29405,CPT,Professional,Both,,,,332,282.2,36.42,332,Humana Insurance Company,Medicare PPO,332,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Application Of Short Leg Cast (Below Knee To Toes) (Pro Cah),,29405,CPT,Professional,Both,,,,332,282.2,36.42,332,Medica,Individual & Family,281.536,84.8,,percent of total billed charges,,
Application Of Short Leg Cast (Below Knee To Toes) (Pro Cah),,29405,CPT,Professional,Both,,,,332,282.2,36.42,332,Medica,Medica Advantage Solution,165.336,49.8,,percent of total billed charges,,
Application Of Short Leg Cast (Below Knee To Toes) (Pro Cah),,29405,CPT,Professional,Both,,,,332,282.2,36.42,332,Medica,Medical Assistance,42.05,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Application Of Short Leg Cast (Below Knee To Toes) (Pro Cah),,29405,CPT,Professional,Both,,,,332,282.2,36.42,332,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,56.75,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Application Of Short Leg Cast (Below Knee To Toes) (Pro Cah),,29405,CPT,Professional,Both,,,,332,282.2,36.42,332,"Multiplan, Inc.","Multiplan, Inc.",312.08,94,,percent of total billed charges,,
Application Of Short Leg Cast (Below Knee To Toes) (Pro Cah),,29405,CPT,Professional,Both,,,,332,282.2,36.42,332,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,299.132,90.1,,percent of total billed charges,,
Application Of Short Leg Cast (Below Knee To Toes) (Pro Cah),,29405,CPT,Professional,Both,,,,332,282.2,36.42,332,"Preferred One Administrative Services, INC.",PPO,327.352,98.6,,percent of total billed charges,,
Application Of Short Leg Cast (Below Knee To Toes) (Pro Cah),,29405,CPT,Professional,Both,,,,332,282.2,36.42,332,PrimeWest Health,Minnesota Senior Health Options (MSHO),65.2625,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Application Of Short Leg Cast (Below Knee To Toes) (Pro Cah),,29405,CPT,Professional,Both,,,,332,282.2,36.42,332,PrimeWest Health,MinnesotaCare,44.9958968,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Application Of Short Leg Cast (Below Knee To Toes) (Pro Cah),,29405,CPT,Professional,Both,,,,332,282.2,36.42,332,Sanford Health Plan,Sanford Health Plan,292.16,88,,percent of total billed charges,,
Application Of Short Leg Cast (Below Knee To Toes) (Pro Cah),,29405,CPT,Professional,Both,,,,332,282.2,36.42,332,"UCare Health, Inc.",Individual & Family Plan,92.2528,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Application Of Short Leg Cast (Below Knee To Toes) (Pro Cah),,29405,CPT,Professional,Both,,,,332,282.2,36.42,332,"UCare Health, Inc.",Medical Assistance,46.257464,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Application Of Short Leg Cast (Below Knee To Toes) (Pro Cah),,29405,CPT,Professional,Both,,,,332,282.2,36.42,332,"UCare Health, Inc.",Medicare Advantage,65.2625,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Application Of Short Leg Cast (Below Knee To Toes) (Pro Cah),,29405,CPT,Professional,Both,,,,332,282.2,36.42,332,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),52.21,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Application Of Short Leg Cast (Below Knee To Toes) (Pro Cah),,29405,CPT,Professional,Both,,,,332,282.2,36.42,332,UnitedHealthcare,Individual & Family,332,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Application Of Short Leg Cast (Below Knee To Toes) (Pro Cah),,29405,CPT,Professional,Both,,,,332,282.2,36.42,332,UnitedHealthcare,Medicare Advantage,65.2625,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Application Of Short Leg Cast (Below Knee To Toes) (Pro Cah),,29405,CPT,Professional,Both,,,,332,282.2,36.42,332,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,42.05224,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
DIPHENHYDRAMINE HCL 50 MG/ML INJ SOLN,,J1200,HCPCS,Facility,Both,1,mL,,8,6.8,2.2928,8,Aetna,Commercial,7.36,92,,percent of total billed charges,,
DIPHENHYDRAMINE HCL 50 MG/ML INJ SOLN,,J1200,HCPCS,Facility,Outpatient,1,mL,,8,6.8,2.2928,8,Aetna,Medicare Advantage,3.92,49,,percent of total billed charges,,
DIPHENHYDRAMINE HCL 50 MG/ML INJ SOLN,,J1200,HCPCS,Facility,Inpatient,1,mL,,8,6.8,2.2928,8,Aetna,Medicare Advantage,,,,,Included in per diem rate,
DIPHENHYDRAMINE HCL 50 MG/ML INJ SOLN,,J1200,HCPCS,Facility,Both,1,mL,,8,6.8,2.2928,8,Aetna,PPO,7.44,93,,percent of total billed charges,,
DIPHENHYDRAMINE HCL 50 MG/ML INJ SOLN,,J1200,HCPCS,Facility,Both,1,mL,,8,6.8,2.2928,8,America's PPO,America's PPO,7.6824,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
DIPHENHYDRAMINE HCL 50 MG/ML INJ SOLN,,J1200,HCPCS,Facility,Both,1,mL,,8,6.8,2.2928,8,BlueCross BlueShield Minnesota, Federal Employee Program,7.872,98.4,,percent of total billed charges,,
DIPHENHYDRAMINE HCL 50 MG/ML INJ SOLN,,J1200,HCPCS,Facility,Both,1,mL,,8,6.8,2.2928,8,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,8,100,,percent of total billed charges,,
DIPHENHYDRAMINE HCL 50 MG/ML INJ SOLN,,J1200,HCPCS,Facility,Both,1,mL,,8,6.8,2.2928,8,BlueCross BlueShield Minnesota,High Value Network Plan,7.2,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
DIPHENHYDRAMINE HCL 50 MG/ML INJ SOLN,,J1200,HCPCS,Facility,Outpatient,1,mL,,8,6.8,2.2928,8,BlueCross BlueShield Minnesota,Medicare Advantage,3.92,49,,percent of total billed charges,,
DIPHENHYDRAMINE HCL 50 MG/ML INJ SOLN,,J1200,HCPCS,Facility,Inpatient,1,mL,,8,6.8,2.2928,8,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
DIPHENHYDRAMINE HCL 50 MG/ML INJ SOLN,,J1200,HCPCS,Facility,Both,1,mL,,8,6.8,2.2928,8,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,7.0856,88.57,,percent of total billed charges,,
DIPHENHYDRAMINE HCL 50 MG/ML INJ SOLN,,J1200,HCPCS,Facility,Both,1,mL,,8,6.8,2.2928,8,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,2.2928,28.66,,percent of total billed charges,,
DIPHENHYDRAMINE HCL 50 MG/ML INJ SOLN,,J1200,HCPCS,Facility,Outpatient,1,mL,,8,6.8,2.2928,8,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),3.92,49,,percent of total billed charges,,
DIPHENHYDRAMINE HCL 50 MG/ML INJ SOLN,,J1200,HCPCS,Facility,Inpatient,1,mL,,8,6.8,2.2928,8,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
DIPHENHYDRAMINE HCL 50 MG/ML INJ SOLN,,J1200,HCPCS,Facility,Both,1,mL,,8,6.8,2.2928,8,CorVel,Worker's Compensation,8,100,,percent of total billed charges,,
DIPHENHYDRAMINE HCL 50 MG/ML INJ SOLN,,J1200,HCPCS,Facility,Both,1,mL,,8,6.8,2.2928,8,First Health Group Corporation,First Health Network,7.76,97,,percent of total billed charges,,
DIPHENHYDRAMINE HCL 50 MG/ML INJ SOLN,,J1200,HCPCS,Facility,Both,1,mL,,8,6.8,2.2928,8,"Health Partners, Inc.",Commercial,7.568,94.6,,percent of total billed charges,,
DIPHENHYDRAMINE HCL 50 MG/ML INJ SOLN,,J1200,HCPCS,Facility,Outpatient,1,mL,,8,6.8,2.2928,8,"Health Partners, Inc.",Medicare Advantage,3.92,49,,percent of total billed charges,,
DIPHENHYDRAMINE HCL 50 MG/ML INJ SOLN,,J1200,HCPCS,Facility,Inpatient,1,mL,,8,6.8,2.2928,8,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DIPHENHYDRAMINE HCL 50 MG/ML INJ SOLN,,J1200,HCPCS,Facility,Both,1,mL,,8,6.8,2.2928,8,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),4.8,60,,percent of total billed charges,,
DIPHENHYDRAMINE HCL 50 MG/ML INJ SOLN,,J1200,HCPCS,Facility,Both,1,mL,,8,6.8,2.2928,8,"Health Partners, Inc.",State of Minnesota Advantage Program,6.52,81.5,,percent of total billed charges,,
DIPHENHYDRAMINE HCL 50 MG/ML INJ SOLN,,J1200,HCPCS,Facility,Both,1,mL,,8,6.8,2.2928,8,"Health Partners, Inc.",State Public Programs,4,50,,percent of total billed charges,,
DIPHENHYDRAMINE HCL 50 MG/ML INJ SOLN,,J1200,HCPCS,Facility,Both,1,mL,,8,6.8,2.2928,8,Humana Insurance Company,Commercial PPO,7.6,95,,percent of total billed charges,,
DIPHENHYDRAMINE HCL 50 MG/ML INJ SOLN,,J1200,HCPCS,Facility,Outpatient,1,mL,,8,6.8,2.2928,8,Humana Insurance Company,Medicare PPO,3.92,49,,percent of total billed charges,,
DIPHENHYDRAMINE HCL 50 MG/ML INJ SOLN,,J1200,HCPCS,Facility,Inpatient,1,mL,,8,6.8,2.2928,8,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
DIPHENHYDRAMINE HCL 50 MG/ML INJ SOLN,,J1200,HCPCS,Facility,Both,1,mL,,8,6.8,2.2928,8,Medica,Individual & Family,7.928,99.1,,percent of total billed charges,,
DIPHENHYDRAMINE HCL 50 MG/ML INJ SOLN,,J1200,HCPCS,Facility,Outpatient,1,mL,,8,6.8,2.2928,8,Medica,Medica Advantage Solution,3.984,49.8,,percent of total billed charges,,
DIPHENHYDRAMINE HCL 50 MG/ML INJ SOLN,,J1200,HCPCS,Facility,Inpatient,1,mL,,8,6.8,2.2928,8,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
DIPHENHYDRAMINE HCL 50 MG/ML INJ SOLN,,J1200,HCPCS,Facility,Outpatient,1,mL,,8,6.8,2.2928,8,Medica,Medical Assistance,3.568,44.6,,percent of total billed charges,,
DIPHENHYDRAMINE HCL 50 MG/ML INJ SOLN,,J1200,HCPCS,Facility,Inpatient,1,mL,,8,6.8,2.2928,8,Medica,Medical Assistance,,,,,Included in per diem rate,
DIPHENHYDRAMINE HCL 50 MG/ML INJ SOLN,,J1200,HCPCS,Facility,Outpatient,1,mL,,8,6.8,2.2928,8,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,3.984,49.8,,percent of total billed charges,,
DIPHENHYDRAMINE HCL 50 MG/ML INJ SOLN,,J1200,HCPCS,Facility,Inpatient,1,mL,,8,6.8,2.2928,8,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
DIPHENHYDRAMINE HCL 50 MG/ML INJ SOLN,,J1200,HCPCS,Facility,Both,1,mL,,8,6.8,2.2928,8,"Multiplan, Inc.","Multiplan, Inc.",7.52,94,,percent of total billed charges,,
DIPHENHYDRAMINE HCL 50 MG/ML INJ SOLN,,J1200,HCPCS,Facility,Outpatient,1,mL,,8,6.8,2.2928,8,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,7.208,90.1,,percent of total billed charges,,
DIPHENHYDRAMINE HCL 50 MG/ML INJ SOLN,,J1200,HCPCS,Facility,Inpatient,1,mL,,8,6.8,2.2928,8,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
DIPHENHYDRAMINE HCL 50 MG/ML INJ SOLN,,J1200,HCPCS,Facility,Both,1,mL,,8,6.8,2.2928,8,"Preferred One Administrative Services, INC.",PPO,7.888,98.6,,percent of total billed charges,,
DIPHENHYDRAMINE HCL 50 MG/ML INJ SOLN,,J1200,HCPCS,Facility,Outpatient,1,mL,,8,6.8,2.2928,8,PrimeWest Health,Minnesota Senior Health Options (MSHO),4.116,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
DIPHENHYDRAMINE HCL 50 MG/ML INJ SOLN,,J1200,HCPCS,Facility,Inpatient,1,mL,,8,6.8,2.2928,8,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DIPHENHYDRAMINE HCL 50 MG/ML INJ SOLN,,J1200,HCPCS,Facility,Outpatient,1,mL,,8,6.8,2.2928,8,PrimeWest Health,MinnesotaCare,4.1088,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
DIPHENHYDRAMINE HCL 50 MG/ML INJ SOLN,,J1200,HCPCS,Facility,Inpatient,1,mL,,8,6.8,2.2928,8,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
DIPHENHYDRAMINE HCL 50 MG/ML INJ SOLN,,J1200,HCPCS,Facility,Both,1,mL,,8,6.8,2.2928,8,Sanford Health Plan,Sanford Health Plan,7.36,92,,percent of total billed charges,,
DIPHENHYDRAMINE HCL 50 MG/ML INJ SOLN,,J1200,HCPCS,Facility,Outpatient,1,mL,,8,6.8,2.2928,8,"UCare Health, Inc.",Individual & Family Plan,4.508,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
DIPHENHYDRAMINE HCL 50 MG/ML INJ SOLN,,J1200,HCPCS,Facility,Inpatient,1,mL,,8,6.8,2.2928,8,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
DIPHENHYDRAMINE HCL 50 MG/ML INJ SOLN,,J1200,HCPCS,Facility,Outpatient,1,mL,,8,6.8,2.2928,8,"UCare Health, Inc.",Medical Assistance,4.0376,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DIPHENHYDRAMINE HCL 50 MG/ML INJ SOLN,,J1200,HCPCS,Facility,Inpatient,1,mL,,8,6.8,2.2928,8,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
DIPHENHYDRAMINE HCL 50 MG/ML INJ SOLN,,J1200,HCPCS,Facility,Outpatient,1,mL,,8,6.8,2.2928,8,"UCare Health, Inc.",Medicare Advantage,4.0376,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DIPHENHYDRAMINE HCL 50 MG/ML INJ SOLN,,J1200,HCPCS,Facility,Inpatient,1,mL,,8,6.8,2.2928,8,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DIPHENHYDRAMINE HCL 50 MG/ML INJ SOLN,,J1200,HCPCS,Facility,Outpatient,1,mL,,8,6.8,2.2928,8,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),4.0376,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DIPHENHYDRAMINE HCL 50 MG/ML INJ SOLN,,J1200,HCPCS,Facility,Inpatient,1,mL,,8,6.8,2.2928,8,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DIPHENHYDRAMINE HCL 50 MG/ML INJ SOLN,,J1200,HCPCS,Facility,Both,1,mL,,8,6.8,2.2928,8,UnitedHealthcare,Individual & Family,7.52,94,,percent of total billed charges,,
DIPHENHYDRAMINE HCL 50 MG/ML INJ SOLN,,J1200,HCPCS,Facility,Outpatient,1,mL,,8,6.8,2.2928,8,UnitedHealthcare,Medicare Advantage,3.92,49,,percent of total billed charges,,
DIPHENHYDRAMINE HCL 50 MG/ML INJ SOLN,,J1200,HCPCS,Facility,Inpatient,1,mL,,8,6.8,2.2928,8,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
DIPHENHYDRAMINE HCL 50 MG/ML INJ SOLN,,J1200,HCPCS,Facility,Outpatient,1,mL,,8,6.8,2.2928,8,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,3.84,48,,percent of total billed charges,,100% of DHS outpatient percentage
DIPHENHYDRAMINE HCL 50 MG/ML INJ SOLN,,J1200,HCPCS,Facility,Inpatient,1,mL,,8,6.8,2.2928,8,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
HALOPERIDOL LACTATE 5 MG/ML INJ SOLN,,J1630,HCPCS,Facility,Both,1,mL,,36,30.6,10.3176,36,Aetna,Commercial,33.12,92,,percent of total billed charges,,
HALOPERIDOL LACTATE 5 MG/ML INJ SOLN,,J1630,HCPCS,Facility,Outpatient,1,mL,,36,30.6,10.3176,36,Aetna,Medicare Advantage,17.64,49,,percent of total billed charges,,
HALOPERIDOL LACTATE 5 MG/ML INJ SOLN,,J1630,HCPCS,Facility,Inpatient,1,mL,,36,30.6,10.3176,36,Aetna,Medicare Advantage,,,,,Included in per diem rate,
HALOPERIDOL LACTATE 5 MG/ML INJ SOLN,,J1630,HCPCS,Facility,Both,1,mL,,36,30.6,10.3176,36,Aetna,PPO,33.48,93,,percent of total billed charges,,
HALOPERIDOL LACTATE 5 MG/ML INJ SOLN,,J1630,HCPCS,Facility,Both,1,mL,,36,30.6,10.3176,36,America's PPO,America's PPO,34.5708,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
HALOPERIDOL LACTATE 5 MG/ML INJ SOLN,,J1630,HCPCS,Facility,Both,1,mL,,36,30.6,10.3176,36,BlueCross BlueShield Minnesota, Federal Employee Program,35.424,98.4,,percent of total billed charges,,
HALOPERIDOL LACTATE 5 MG/ML INJ SOLN,,J1630,HCPCS,Facility,Both,1,mL,,36,30.6,10.3176,36,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,36,100,,percent of total billed charges,,
HALOPERIDOL LACTATE 5 MG/ML INJ SOLN,,J1630,HCPCS,Facility,Both,1,mL,,36,30.6,10.3176,36,BlueCross BlueShield Minnesota,High Value Network Plan,32.4,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
HALOPERIDOL LACTATE 5 MG/ML INJ SOLN,,J1630,HCPCS,Facility,Outpatient,1,mL,,36,30.6,10.3176,36,BlueCross BlueShield Minnesota,Medicare Advantage,17.64,49,,percent of total billed charges,,
HALOPERIDOL LACTATE 5 MG/ML INJ SOLN,,J1630,HCPCS,Facility,Inpatient,1,mL,,36,30.6,10.3176,36,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
HALOPERIDOL LACTATE 5 MG/ML INJ SOLN,,J1630,HCPCS,Facility,Both,1,mL,,36,30.6,10.3176,36,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,31.8852,88.57,,percent of total billed charges,,
HALOPERIDOL LACTATE 5 MG/ML INJ SOLN,,J1630,HCPCS,Facility,Both,1,mL,,36,30.6,10.3176,36,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,10.3176,28.66,,percent of total billed charges,,
HALOPERIDOL LACTATE 5 MG/ML INJ SOLN,,J1630,HCPCS,Facility,Outpatient,1,mL,,36,30.6,10.3176,36,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),17.64,49,,percent of total billed charges,,
HALOPERIDOL LACTATE 5 MG/ML INJ SOLN,,J1630,HCPCS,Facility,Inpatient,1,mL,,36,30.6,10.3176,36,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
HALOPERIDOL LACTATE 5 MG/ML INJ SOLN,,J1630,HCPCS,Facility,Both,1,mL,,36,30.6,10.3176,36,CorVel,Worker's Compensation,36,100,,percent of total billed charges,,
HALOPERIDOL LACTATE 5 MG/ML INJ SOLN,,J1630,HCPCS,Facility,Both,1,mL,,36,30.6,10.3176,36,First Health Group Corporation,First Health Network,34.92,97,,percent of total billed charges,,
HALOPERIDOL LACTATE 5 MG/ML INJ SOLN,,J1630,HCPCS,Facility,Both,1,mL,,36,30.6,10.3176,36,"Health Partners, Inc.",Commercial,34.056,94.6,,percent of total billed charges,,
HALOPERIDOL LACTATE 5 MG/ML INJ SOLN,,J1630,HCPCS,Facility,Outpatient,1,mL,,36,30.6,10.3176,36,"Health Partners, Inc.",Medicare Advantage,17.64,49,,percent of total billed charges,,
HALOPERIDOL LACTATE 5 MG/ML INJ SOLN,,J1630,HCPCS,Facility,Inpatient,1,mL,,36,30.6,10.3176,36,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
HALOPERIDOL LACTATE 5 MG/ML INJ SOLN,,J1630,HCPCS,Facility,Both,1,mL,,36,30.6,10.3176,36,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),21.6,60,,percent of total billed charges,,
HALOPERIDOL LACTATE 5 MG/ML INJ SOLN,,J1630,HCPCS,Facility,Both,1,mL,,36,30.6,10.3176,36,"Health Partners, Inc.",State of Minnesota Advantage Program,29.34,81.5,,percent of total billed charges,,
HALOPERIDOL LACTATE 5 MG/ML INJ SOLN,,J1630,HCPCS,Facility,Both,1,mL,,36,30.6,10.3176,36,"Health Partners, Inc.",State Public Programs,18,50,,percent of total billed charges,,
HALOPERIDOL LACTATE 5 MG/ML INJ SOLN,,J1630,HCPCS,Facility,Both,1,mL,,36,30.6,10.3176,36,Humana Insurance Company,Commercial PPO,34.2,95,,percent of total billed charges,,
HALOPERIDOL LACTATE 5 MG/ML INJ SOLN,,J1630,HCPCS,Facility,Outpatient,1,mL,,36,30.6,10.3176,36,Humana Insurance Company,Medicare PPO,17.64,49,,percent of total billed charges,,
HALOPERIDOL LACTATE 5 MG/ML INJ SOLN,,J1630,HCPCS,Facility,Inpatient,1,mL,,36,30.6,10.3176,36,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
HALOPERIDOL LACTATE 5 MG/ML INJ SOLN,,J1630,HCPCS,Facility,Both,1,mL,,36,30.6,10.3176,36,Medica,Individual & Family,35.676,99.1,,percent of total billed charges,,
HALOPERIDOL LACTATE 5 MG/ML INJ SOLN,,J1630,HCPCS,Facility,Outpatient,1,mL,,36,30.6,10.3176,36,Medica,Medica Advantage Solution,17.928,49.8,,percent of total billed charges,,
HALOPERIDOL LACTATE 5 MG/ML INJ SOLN,,J1630,HCPCS,Facility,Inpatient,1,mL,,36,30.6,10.3176,36,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
HALOPERIDOL LACTATE 5 MG/ML INJ SOLN,,J1630,HCPCS,Facility,Outpatient,1,mL,,36,30.6,10.3176,36,Medica,Medical Assistance,16.056,44.6,,percent of total billed charges,,
HALOPERIDOL LACTATE 5 MG/ML INJ SOLN,,J1630,HCPCS,Facility,Inpatient,1,mL,,36,30.6,10.3176,36,Medica,Medical Assistance,,,,,Included in per diem rate,
HALOPERIDOL LACTATE 5 MG/ML INJ SOLN,,J1630,HCPCS,Facility,Outpatient,1,mL,,36,30.6,10.3176,36,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,17.928,49.8,,percent of total billed charges,,
HALOPERIDOL LACTATE 5 MG/ML INJ SOLN,,J1630,HCPCS,Facility,Inpatient,1,mL,,36,30.6,10.3176,36,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
HALOPERIDOL LACTATE 5 MG/ML INJ SOLN,,J1630,HCPCS,Facility,Both,1,mL,,36,30.6,10.3176,36,"Multiplan, Inc.","Multiplan, Inc.",33.84,94,,percent of total billed charges,,
HALOPERIDOL LACTATE 5 MG/ML INJ SOLN,,J1630,HCPCS,Facility,Outpatient,1,mL,,36,30.6,10.3176,36,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,32.436,90.1,,percent of total billed charges,,
HALOPERIDOL LACTATE 5 MG/ML INJ SOLN,,J1630,HCPCS,Facility,Inpatient,1,mL,,36,30.6,10.3176,36,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
HALOPERIDOL LACTATE 5 MG/ML INJ SOLN,,J1630,HCPCS,Facility,Both,1,mL,,36,30.6,10.3176,36,"Preferred One Administrative Services, INC.",PPO,35.496,98.6,,percent of total billed charges,,
HALOPERIDOL LACTATE 5 MG/ML INJ SOLN,,J1630,HCPCS,Facility,Outpatient,1,mL,,36,30.6,10.3176,36,PrimeWest Health,Minnesota Senior Health Options (MSHO),18.522,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
HALOPERIDOL LACTATE 5 MG/ML INJ SOLN,,J1630,HCPCS,Facility,Inpatient,1,mL,,36,30.6,10.3176,36,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
HALOPERIDOL LACTATE 5 MG/ML INJ SOLN,,J1630,HCPCS,Facility,Outpatient,1,mL,,36,30.6,10.3176,36,PrimeWest Health,MinnesotaCare,18.4896,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
HALOPERIDOL LACTATE 5 MG/ML INJ SOLN,,J1630,HCPCS,Facility,Inpatient,1,mL,,36,30.6,10.3176,36,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
HALOPERIDOL LACTATE 5 MG/ML INJ SOLN,,J1630,HCPCS,Facility,Both,1,mL,,36,30.6,10.3176,36,Sanford Health Plan,Sanford Health Plan,33.12,92,,percent of total billed charges,,
HALOPERIDOL LACTATE 5 MG/ML INJ SOLN,,J1630,HCPCS,Facility,Outpatient,1,mL,,36,30.6,10.3176,36,"UCare Health, Inc.",Individual & Family Plan,20.286,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
HALOPERIDOL LACTATE 5 MG/ML INJ SOLN,,J1630,HCPCS,Facility,Inpatient,1,mL,,36,30.6,10.3176,36,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
HALOPERIDOL LACTATE 5 MG/ML INJ SOLN,,J1630,HCPCS,Facility,Outpatient,1,mL,,36,30.6,10.3176,36,"UCare Health, Inc.",Medical Assistance,18.1692,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
HALOPERIDOL LACTATE 5 MG/ML INJ SOLN,,J1630,HCPCS,Facility,Inpatient,1,mL,,36,30.6,10.3176,36,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
HALOPERIDOL LACTATE 5 MG/ML INJ SOLN,,J1630,HCPCS,Facility,Outpatient,1,mL,,36,30.6,10.3176,36,"UCare Health, Inc.",Medicare Advantage,18.1692,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
HALOPERIDOL LACTATE 5 MG/ML INJ SOLN,,J1630,HCPCS,Facility,Inpatient,1,mL,,36,30.6,10.3176,36,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
HALOPERIDOL LACTATE 5 MG/ML INJ SOLN,,J1630,HCPCS,Facility,Outpatient,1,mL,,36,30.6,10.3176,36,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),18.1692,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
HALOPERIDOL LACTATE 5 MG/ML INJ SOLN,,J1630,HCPCS,Facility,Inpatient,1,mL,,36,30.6,10.3176,36,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
HALOPERIDOL LACTATE 5 MG/ML INJ SOLN,,J1630,HCPCS,Facility,Both,1,mL,,36,30.6,10.3176,36,UnitedHealthcare,Individual & Family,33.84,94,,percent of total billed charges,,
HALOPERIDOL LACTATE 5 MG/ML INJ SOLN,,J1630,HCPCS,Facility,Outpatient,1,mL,,36,30.6,10.3176,36,UnitedHealthcare,Medicare Advantage,17.64,49,,percent of total billed charges,,
HALOPERIDOL LACTATE 5 MG/ML INJ SOLN,,J1630,HCPCS,Facility,Inpatient,1,mL,,36,30.6,10.3176,36,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
HALOPERIDOL LACTATE 5 MG/ML INJ SOLN,,J1630,HCPCS,Facility,Outpatient,1,mL,,36,30.6,10.3176,36,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,17.28,48,,percent of total billed charges,,100% of DHS outpatient percentage
HALOPERIDOL LACTATE 5 MG/ML INJ SOLN,,J1630,HCPCS,Facility,Inpatient,1,mL,,36,30.6,10.3176,36,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
HALOPERIDOL LACTATE 5 MG/ML IV INJ,,J1630,HCPCS,Facility,Both,1,mL,,30,25.5,8.598,30,Aetna,Commercial,27.6,92,,percent of total billed charges,,
HALOPERIDOL LACTATE 5 MG/ML IV INJ,,J1630,HCPCS,Facility,Outpatient,1,mL,,30,25.5,8.598,30,Aetna,Medicare Advantage,14.7,49,,percent of total billed charges,,
HALOPERIDOL LACTATE 5 MG/ML IV INJ,,J1630,HCPCS,Facility,Inpatient,1,mL,,30,25.5,8.598,30,Aetna,Medicare Advantage,,,,,Included in per diem rate,
HALOPERIDOL LACTATE 5 MG/ML IV INJ,,J1630,HCPCS,Facility,Both,1,mL,,30,25.5,8.598,30,Aetna,PPO,27.9,93,,percent of total billed charges,,
HALOPERIDOL LACTATE 5 MG/ML IV INJ,,J1630,HCPCS,Facility,Both,1,mL,,30,25.5,8.598,30,America's PPO,America's PPO,28.809,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
HALOPERIDOL LACTATE 5 MG/ML IV INJ,,J1630,HCPCS,Facility,Both,1,mL,,30,25.5,8.598,30,BlueCross BlueShield Minnesota, Federal Employee Program,29.52,98.4,,percent of total billed charges,,
HALOPERIDOL LACTATE 5 MG/ML IV INJ,,J1630,HCPCS,Facility,Both,1,mL,,30,25.5,8.598,30,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,30,100,,percent of total billed charges,,
HALOPERIDOL LACTATE 5 MG/ML IV INJ,,J1630,HCPCS,Facility,Both,1,mL,,30,25.5,8.598,30,BlueCross BlueShield Minnesota,High Value Network Plan,27,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
HALOPERIDOL LACTATE 5 MG/ML IV INJ,,J1630,HCPCS,Facility,Outpatient,1,mL,,30,25.5,8.598,30,BlueCross BlueShield Minnesota,Medicare Advantage,14.7,49,,percent of total billed charges,,
HALOPERIDOL LACTATE 5 MG/ML IV INJ,,J1630,HCPCS,Facility,Inpatient,1,mL,,30,25.5,8.598,30,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
HALOPERIDOL LACTATE 5 MG/ML IV INJ,,J1630,HCPCS,Facility,Both,1,mL,,30,25.5,8.598,30,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,26.571,88.57,,percent of total billed charges,,
HALOPERIDOL LACTATE 5 MG/ML IV INJ,,J1630,HCPCS,Facility,Both,1,mL,,30,25.5,8.598,30,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,8.598,28.66,,percent of total billed charges,,
HALOPERIDOL LACTATE 5 MG/ML IV INJ,,J1630,HCPCS,Facility,Outpatient,1,mL,,30,25.5,8.598,30,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),14.7,49,,percent of total billed charges,,
HALOPERIDOL LACTATE 5 MG/ML IV INJ,,J1630,HCPCS,Facility,Inpatient,1,mL,,30,25.5,8.598,30,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
HALOPERIDOL LACTATE 5 MG/ML IV INJ,,J1630,HCPCS,Facility,Both,1,mL,,30,25.5,8.598,30,CorVel,Worker's Compensation,30,100,,percent of total billed charges,,
HALOPERIDOL LACTATE 5 MG/ML IV INJ,,J1630,HCPCS,Facility,Both,1,mL,,30,25.5,8.598,30,First Health Group Corporation,First Health Network,29.1,97,,percent of total billed charges,,
HALOPERIDOL LACTATE 5 MG/ML IV INJ,,J1630,HCPCS,Facility,Both,1,mL,,30,25.5,8.598,30,"Health Partners, Inc.",Commercial,28.38,94.6,,percent of total billed charges,,
HALOPERIDOL LACTATE 5 MG/ML IV INJ,,J1630,HCPCS,Facility,Outpatient,1,mL,,30,25.5,8.598,30,"Health Partners, Inc.",Medicare Advantage,14.7,49,,percent of total billed charges,,
HALOPERIDOL LACTATE 5 MG/ML IV INJ,,J1630,HCPCS,Facility,Inpatient,1,mL,,30,25.5,8.598,30,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
HALOPERIDOL LACTATE 5 MG/ML IV INJ,,J1630,HCPCS,Facility,Both,1,mL,,30,25.5,8.598,30,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),18,60,,percent of total billed charges,,
HALOPERIDOL LACTATE 5 MG/ML IV INJ,,J1630,HCPCS,Facility,Both,1,mL,,30,25.5,8.598,30,"Health Partners, Inc.",State of Minnesota Advantage Program,24.45,81.5,,percent of total billed charges,,
HALOPERIDOL LACTATE 5 MG/ML IV INJ,,J1630,HCPCS,Facility,Both,1,mL,,30,25.5,8.598,30,"Health Partners, Inc.",State Public Programs,15,50,,percent of total billed charges,,
HALOPERIDOL LACTATE 5 MG/ML IV INJ,,J1630,HCPCS,Facility,Both,1,mL,,30,25.5,8.598,30,Humana Insurance Company,Commercial PPO,28.5,95,,percent of total billed charges,,
HALOPERIDOL LACTATE 5 MG/ML IV INJ,,J1630,HCPCS,Facility,Outpatient,1,mL,,30,25.5,8.598,30,Humana Insurance Company,Medicare PPO,14.7,49,,percent of total billed charges,,
HALOPERIDOL LACTATE 5 MG/ML IV INJ,,J1630,HCPCS,Facility,Inpatient,1,mL,,30,25.5,8.598,30,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
HALOPERIDOL LACTATE 5 MG/ML IV INJ,,J1630,HCPCS,Facility,Both,1,mL,,30,25.5,8.598,30,Medica,Individual & Family,29.73,99.1,,percent of total billed charges,,
HALOPERIDOL LACTATE 5 MG/ML IV INJ,,J1630,HCPCS,Facility,Outpatient,1,mL,,30,25.5,8.598,30,Medica,Medica Advantage Solution,14.94,49.8,,percent of total billed charges,,
HALOPERIDOL LACTATE 5 MG/ML IV INJ,,J1630,HCPCS,Facility,Inpatient,1,mL,,30,25.5,8.598,30,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
HALOPERIDOL LACTATE 5 MG/ML IV INJ,,J1630,HCPCS,Facility,Outpatient,1,mL,,30,25.5,8.598,30,Medica,Medical Assistance,13.38,44.6,,percent of total billed charges,,
HALOPERIDOL LACTATE 5 MG/ML IV INJ,,J1630,HCPCS,Facility,Inpatient,1,mL,,30,25.5,8.598,30,Medica,Medical Assistance,,,,,Included in per diem rate,
HALOPERIDOL LACTATE 5 MG/ML IV INJ,,J1630,HCPCS,Facility,Outpatient,1,mL,,30,25.5,8.598,30,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,14.94,49.8,,percent of total billed charges,,
HALOPERIDOL LACTATE 5 MG/ML IV INJ,,J1630,HCPCS,Facility,Inpatient,1,mL,,30,25.5,8.598,30,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
HALOPERIDOL LACTATE 5 MG/ML IV INJ,,J1630,HCPCS,Facility,Both,1,mL,,30,25.5,8.598,30,"Multiplan, Inc.","Multiplan, Inc.",28.2,94,,percent of total billed charges,,
HALOPERIDOL LACTATE 5 MG/ML IV INJ,,J1630,HCPCS,Facility,Outpatient,1,mL,,30,25.5,8.598,30,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,27.03,90.1,,percent of total billed charges,,
HALOPERIDOL LACTATE 5 MG/ML IV INJ,,J1630,HCPCS,Facility,Inpatient,1,mL,,30,25.5,8.598,30,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
HALOPERIDOL LACTATE 5 MG/ML IV INJ,,J1630,HCPCS,Facility,Both,1,mL,,30,25.5,8.598,30,"Preferred One Administrative Services, INC.",PPO,29.58,98.6,,percent of total billed charges,,
HALOPERIDOL LACTATE 5 MG/ML IV INJ,,J1630,HCPCS,Facility,Outpatient,1,mL,,30,25.5,8.598,30,PrimeWest Health,Minnesota Senior Health Options (MSHO),15.435,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
HALOPERIDOL LACTATE 5 MG/ML IV INJ,,J1630,HCPCS,Facility,Inpatient,1,mL,,30,25.5,8.598,30,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
HALOPERIDOL LACTATE 5 MG/ML IV INJ,,J1630,HCPCS,Facility,Outpatient,1,mL,,30,25.5,8.598,30,PrimeWest Health,MinnesotaCare,15.408,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
HALOPERIDOL LACTATE 5 MG/ML IV INJ,,J1630,HCPCS,Facility,Inpatient,1,mL,,30,25.5,8.598,30,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
HALOPERIDOL LACTATE 5 MG/ML IV INJ,,J1630,HCPCS,Facility,Both,1,mL,,30,25.5,8.598,30,Sanford Health Plan,Sanford Health Plan,27.6,92,,percent of total billed charges,,
HALOPERIDOL LACTATE 5 MG/ML IV INJ,,J1630,HCPCS,Facility,Outpatient,1,mL,,30,25.5,8.598,30,"UCare Health, Inc.",Individual & Family Plan,16.905,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
HALOPERIDOL LACTATE 5 MG/ML IV INJ,,J1630,HCPCS,Facility,Inpatient,1,mL,,30,25.5,8.598,30,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
HALOPERIDOL LACTATE 5 MG/ML IV INJ,,J1630,HCPCS,Facility,Outpatient,1,mL,,30,25.5,8.598,30,"UCare Health, Inc.",Medical Assistance,15.141,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
HALOPERIDOL LACTATE 5 MG/ML IV INJ,,J1630,HCPCS,Facility,Inpatient,1,mL,,30,25.5,8.598,30,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
HALOPERIDOL LACTATE 5 MG/ML IV INJ,,J1630,HCPCS,Facility,Outpatient,1,mL,,30,25.5,8.598,30,"UCare Health, Inc.",Medicare Advantage,15.141,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
HALOPERIDOL LACTATE 5 MG/ML IV INJ,,J1630,HCPCS,Facility,Inpatient,1,mL,,30,25.5,8.598,30,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
HALOPERIDOL LACTATE 5 MG/ML IV INJ,,J1630,HCPCS,Facility,Outpatient,1,mL,,30,25.5,8.598,30,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),15.141,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
HALOPERIDOL LACTATE 5 MG/ML IV INJ,,J1630,HCPCS,Facility,Inpatient,1,mL,,30,25.5,8.598,30,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
HALOPERIDOL LACTATE 5 MG/ML IV INJ,,J1630,HCPCS,Facility,Both,1,mL,,30,25.5,8.598,30,UnitedHealthcare,Individual & Family,28.2,94,,percent of total billed charges,,
HALOPERIDOL LACTATE 5 MG/ML IV INJ,,J1630,HCPCS,Facility,Outpatient,1,mL,,30,25.5,8.598,30,UnitedHealthcare,Medicare Advantage,14.7,49,,percent of total billed charges,,
HALOPERIDOL LACTATE 5 MG/ML IV INJ,,J1630,HCPCS,Facility,Inpatient,1,mL,,30,25.5,8.598,30,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
HALOPERIDOL LACTATE 5 MG/ML IV INJ,,J1630,HCPCS,Facility,Outpatient,1,mL,,30,25.5,8.598,30,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,14.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
HALOPERIDOL LACTATE 5 MG/ML IV INJ,,J1630,HCPCS,Facility,Inpatient,1,mL,,30,25.5,8.598,30,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Application Of Long Leg Splint (Thigh To Ankle Or Toes) (Pro Cah),,29505,CPT,Professional,Both,,,,281,238.85,32.28,281,Aetna,Commercial,238.85,85,,percent of total billed charges,,
Application Of Long Leg Splint (Thigh To Ankle Or Toes) (Pro Cah),,29505,CPT,Professional,Both,,,,281,238.85,32.28,281,Aetna,Medicare Advantage,50.07,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Application Of Long Leg Splint (Thigh To Ankle Or Toes) (Pro Cah),,29505,CPT,Professional,Both,,,,281,238.85,32.28,281,Aetna,PPO,261.33,93,,percent of total billed charges,,
Application Of Long Leg Splint (Thigh To Ankle Or Toes) (Pro Cah),,29505,CPT,Professional,Both,,,,281,238.85,32.28,281,America's PPO,America's PPO,240.0864,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Application Of Long Leg Splint (Thigh To Ankle Or Toes) (Pro Cah),,29505,CPT,Professional,Both,,,,281,238.85,32.28,281,BlueCross BlueShield Minnesota, Federal Employee Program,106.73,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Application Of Long Leg Splint (Thigh To Ankle Or Toes) (Pro Cah),,29505,CPT,Professional,Both,,,,281,238.85,32.28,281,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,108.43768,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Application Of Long Leg Splint (Thigh To Ankle Or Toes) (Pro Cah),,29505,CPT,Professional,Both,,,,281,238.85,32.28,281,BlueCross BlueShield Minnesota,High Value Network Plan,108.43768,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Application Of Long Leg Splint (Thigh To Ankle Or Toes) (Pro Cah),,29505,CPT,Professional,Both,,,,281,238.85,32.28,281,BlueCross BlueShield Minnesota,Medicare Advantage,57.799,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Application Of Long Leg Splint (Thigh To Ankle Or Toes) (Pro Cah),,29505,CPT,Professional,Both,,,,281,238.85,32.28,281,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,108.43768,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Application Of Long Leg Splint (Thigh To Ankle Or Toes) (Pro Cah),,29505,CPT,Professional,Both,,,,281,238.85,32.28,281,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,37.26688,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Application Of Long Leg Splint (Thigh To Ankle Or Toes) (Pro Cah),,29505,CPT,Professional,Both,,,,281,238.85,32.28,281,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),57.799,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Application Of Long Leg Splint (Thigh To Ankle Or Toes) (Pro Cah),,29505,CPT,Professional,Both,,,,281,238.85,32.28,281,CorVel,Worker's Compensation,96.5857581,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Application Of Long Leg Splint (Thigh To Ankle Or Toes) (Pro Cah),,29505,CPT,Professional,Both,,,,281,238.85,32.28,281,First Health Group Corporation,First Health Network,272.57,97,,percent of total billed charges,,
Application Of Long Leg Splint (Thigh To Ankle Or Toes) (Pro Cah),,29505,CPT,Professional,Both,,,,281,238.85,32.28,281,"Health Partners, Inc.",Commercial,104.48,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Application Of Long Leg Splint (Thigh To Ankle Or Toes) (Pro Cah),,29505,CPT,Professional,Both,,,,281,238.85,32.28,281,"Health Partners, Inc.",Medicare Advantage,57.799,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Application Of Long Leg Splint (Thigh To Ankle Or Toes) (Pro Cah),,29505,CPT,Professional,Both,,,,281,238.85,32.28,281,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),50.15,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Application Of Long Leg Splint (Thigh To Ankle Or Toes) (Pro Cah),,29505,CPT,Professional,Both,,,,281,238.85,32.28,281,"Health Partners, Inc.",State of Minnesota Advantage Program,90.00952,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Application Of Long Leg Splint (Thigh To Ankle Or Toes) (Pro Cah),,29505,CPT,Professional,Both,,,,281,238.85,32.28,281,"Health Partners, Inc.",State Public Programs,32.28,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Application Of Long Leg Splint (Thigh To Ankle Or Toes) (Pro Cah),,29505,CPT,Professional,Both,,,,281,238.85,32.28,281,Humana Insurance Company,Commercial PPO,50.26,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Application Of Long Leg Splint (Thigh To Ankle Or Toes) (Pro Cah),,29505,CPT,Professional,Both,,,,281,238.85,32.28,281,Humana Insurance Company,Medicare PPO,281,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Application Of Long Leg Splint (Thigh To Ankle Or Toes) (Pro Cah),,29505,CPT,Professional,Both,,,,281,238.85,32.28,281,Medica,Individual & Family,238.288,84.8,,percent of total billed charges,,
Application Of Long Leg Splint (Thigh To Ankle Or Toes) (Pro Cah),,29505,CPT,Professional,Both,,,,281,238.85,32.28,281,Medica,Medica Advantage Solution,139.938,49.8,,percent of total billed charges,,
Application Of Long Leg Splint (Thigh To Ankle Or Toes) (Pro Cah),,29505,CPT,Professional,Both,,,,281,238.85,32.28,281,Medica,Medical Assistance,37.27,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Application Of Long Leg Splint (Thigh To Ankle Or Toes) (Pro Cah),,29505,CPT,Professional,Both,,,,281,238.85,32.28,281,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,50.26,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Application Of Long Leg Splint (Thigh To Ankle Or Toes) (Pro Cah),,29505,CPT,Professional,Both,,,,281,238.85,32.28,281,"Multiplan, Inc.","Multiplan, Inc.",264.14,94,,percent of total billed charges,,
Application Of Long Leg Splint (Thigh To Ankle Or Toes) (Pro Cah),,29505,CPT,Professional,Both,,,,281,238.85,32.28,281,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,253.181,90.1,,percent of total billed charges,,
Application Of Long Leg Splint (Thigh To Ankle Or Toes) (Pro Cah),,29505,CPT,Professional,Both,,,,281,238.85,32.28,281,"Preferred One Administrative Services, INC.",PPO,277.066,98.6,,percent of total billed charges,,
Application Of Long Leg Splint (Thigh To Ankle Or Toes) (Pro Cah),,29505,CPT,Professional,Both,,,,281,238.85,32.28,281,PrimeWest Health,Minnesota Senior Health Options (MSHO),57.799,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Application Of Long Leg Splint (Thigh To Ankle Or Toes) (Pro Cah),,29505,CPT,Professional,Both,,,,281,238.85,32.28,281,PrimeWest Health,MinnesotaCare,39.8755616,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Application Of Long Leg Splint (Thigh To Ankle Or Toes) (Pro Cah),,29505,CPT,Professional,Both,,,,281,238.85,32.28,281,Sanford Health Plan,Sanford Health Plan,247.28,88,,percent of total billed charges,,
Application Of Long Leg Splint (Thigh To Ankle Or Toes) (Pro Cah),,29505,CPT,Professional,Both,,,,281,238.85,32.28,281,"UCare Health, Inc.",Individual & Family Plan,81.702656,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Application Of Long Leg Splint (Thigh To Ankle Or Toes) (Pro Cah),,29505,CPT,Professional,Both,,,,281,238.85,32.28,281,"UCare Health, Inc.",Medical Assistance,40.993568,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Application Of Long Leg Splint (Thigh To Ankle Or Toes) (Pro Cah),,29505,CPT,Professional,Both,,,,281,238.85,32.28,281,"UCare Health, Inc.",Medicare Advantage,57.799,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Application Of Long Leg Splint (Thigh To Ankle Or Toes) (Pro Cah),,29505,CPT,Professional,Both,,,,281,238.85,32.28,281,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),46.2392,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Application Of Long Leg Splint (Thigh To Ankle Or Toes) (Pro Cah),,29505,CPT,Professional,Both,,,,281,238.85,32.28,281,UnitedHealthcare,Individual & Family,281,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Application Of Long Leg Splint (Thigh To Ankle Or Toes) (Pro Cah),,29505,CPT,Professional,Both,,,,281,238.85,32.28,281,UnitedHealthcare,Medicare Advantage,57.799,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Application Of Long Leg Splint (Thigh To Ankle Or Toes) (Pro Cah),,29505,CPT,Professional,Both,,,,281,238.85,32.28,281,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,37.26688,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Application Of Short Leg Splint (Calf To Foot) (Pro Cah),,29515,CPT,Professional,Both,,,,265,225.25,30.54,265,Aetna,Commercial,225.25,85,,percent of total billed charges,,
Application Of Short Leg Splint (Calf To Foot) (Pro Cah),,29515,CPT,Professional,Both,,,,265,225.25,30.54,265,Aetna,Medicare Advantage,47.68,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Application Of Short Leg Splint (Calf To Foot) (Pro Cah),,29515,CPT,Professional,Both,,,,265,225.25,30.54,265,Aetna,PPO,246.45,93,,percent of total billed charges,,
Application Of Short Leg Splint (Calf To Foot) (Pro Cah),,29515,CPT,Professional,Both,,,,265,225.25,30.54,265,America's PPO,America's PPO,226.416,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Application Of Short Leg Splint (Calf To Foot) (Pro Cah),,29515,CPT,Professional,Both,,,,265,225.25,30.54,265,BlueCross BlueShield Minnesota, Federal Employee Program,101.22,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Application Of Short Leg Splint (Calf To Foot) (Pro Cah),,29515,CPT,Professional,Both,,,,265,225.25,30.54,265,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,102.83952,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Application Of Short Leg Splint (Calf To Foot) (Pro Cah),,29515,CPT,Professional,Both,,,,265,225.25,30.54,265,BlueCross BlueShield Minnesota,High Value Network Plan,102.83952,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Application Of Short Leg Splint (Calf To Foot) (Pro Cah),,29515,CPT,Professional,Both,,,,265,225.25,30.54,265,BlueCross BlueShield Minnesota,Medicare Advantage,54.8665,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Application Of Short Leg Splint (Calf To Foot) (Pro Cah),,29515,CPT,Professional,Both,,,,265,225.25,30.54,265,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,102.83952,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Application Of Short Leg Splint (Calf To Foot) (Pro Cah),,29515,CPT,Professional,Both,,,,265,225.25,30.54,265,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,35.2552,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Application Of Short Leg Splint (Calf To Foot) (Pro Cah),,29515,CPT,Professional,Both,,,,265,225.25,30.54,265,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),54.8665,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Application Of Short Leg Splint (Calf To Foot) (Pro Cah),,29515,CPT,Professional,Both,,,,265,225.25,30.54,265,CorVel,Worker's Compensation,92.4682371,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Application Of Short Leg Splint (Calf To Foot) (Pro Cah),,29515,CPT,Professional,Both,,,,265,225.25,30.54,265,First Health Group Corporation,First Health Network,257.05,97,,percent of total billed charges,,
Application Of Short Leg Splint (Calf To Foot) (Pro Cah),,29515,CPT,Professional,Both,,,,265,225.25,30.54,265,"Health Partners, Inc.",Commercial,100.13,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Application Of Short Leg Splint (Calf To Foot) (Pro Cah),,29515,CPT,Professional,Both,,,,265,225.25,30.54,265,"Health Partners, Inc.",Medicare Advantage,54.8665,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Application Of Short Leg Splint (Calf To Foot) (Pro Cah),,29515,CPT,Professional,Both,,,,265,225.25,30.54,265,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),47.78,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Application Of Short Leg Splint (Calf To Foot) (Pro Cah),,29515,CPT,Professional,Both,,,,265,225.25,30.54,265,"Health Partners, Inc.",State of Minnesota Advantage Program,86.261995,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Application Of Short Leg Splint (Calf To Foot) (Pro Cah),,29515,CPT,Professional,Both,,,,265,225.25,30.54,265,"Health Partners, Inc.",State Public Programs,30.54,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Application Of Short Leg Splint (Calf To Foot) (Pro Cah),,29515,CPT,Professional,Both,,,,265,225.25,30.54,265,Humana Insurance Company,Commercial PPO,47.71,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Application Of Short Leg Splint (Calf To Foot) (Pro Cah),,29515,CPT,Professional,Both,,,,265,225.25,30.54,265,Humana Insurance Company,Medicare PPO,265,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Application Of Short Leg Splint (Calf To Foot) (Pro Cah),,29515,CPT,Professional,Both,,,,265,225.25,30.54,265,Medica,Individual & Family,224.72,84.8,,percent of total billed charges,,
Application Of Short Leg Splint (Calf To Foot) (Pro Cah),,29515,CPT,Professional,Both,,,,265,225.25,30.54,265,Medica,Medica Advantage Solution,131.97,49.8,,percent of total billed charges,,
Application Of Short Leg Splint (Calf To Foot) (Pro Cah),,29515,CPT,Professional,Both,,,,265,225.25,30.54,265,Medica,Medical Assistance,35.26,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Application Of Short Leg Splint (Calf To Foot) (Pro Cah),,29515,CPT,Professional,Both,,,,265,225.25,30.54,265,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,47.71,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Application Of Short Leg Splint (Calf To Foot) (Pro Cah),,29515,CPT,Professional,Both,,,,265,225.25,30.54,265,"Multiplan, Inc.","Multiplan, Inc.",249.1,94,,percent of total billed charges,,
Application Of Short Leg Splint (Calf To Foot) (Pro Cah),,29515,CPT,Professional,Both,,,,265,225.25,30.54,265,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,238.765,90.1,,percent of total billed charges,,
Application Of Short Leg Splint (Calf To Foot) (Pro Cah),,29515,CPT,Professional,Both,,,,265,225.25,30.54,265,"Preferred One Administrative Services, INC.",PPO,261.29,98.6,,percent of total billed charges,,
Application Of Short Leg Splint (Calf To Foot) (Pro Cah),,29515,CPT,Professional,Both,,,,265,225.25,30.54,265,PrimeWest Health,Minnesota Senior Health Options (MSHO),54.8665,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Application Of Short Leg Splint (Calf To Foot) (Pro Cah),,29515,CPT,Professional,Both,,,,265,225.25,30.54,265,PrimeWest Health,MinnesotaCare,37.723064,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Application Of Short Leg Splint (Calf To Foot) (Pro Cah),,29515,CPT,Professional,Both,,,,265,225.25,30.54,265,Sanford Health Plan,Sanford Health Plan,233.2,88,,percent of total billed charges,,
Application Of Short Leg Splint (Calf To Foot) (Pro Cah),,29515,CPT,Professional,Both,,,,265,225.25,30.54,265,"UCare Health, Inc.",Individual & Family Plan,77.557376,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Application Of Short Leg Splint (Calf To Foot) (Pro Cah),,29515,CPT,Professional,Both,,,,265,225.25,30.54,265,"UCare Health, Inc.",Medical Assistance,38.78072,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Application Of Short Leg Splint (Calf To Foot) (Pro Cah),,29515,CPT,Professional,Both,,,,265,225.25,30.54,265,"UCare Health, Inc.",Medicare Advantage,54.8665,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Application Of Short Leg Splint (Calf To Foot) (Pro Cah),,29515,CPT,Professional,Both,,,,265,225.25,30.54,265,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),43.8932,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Application Of Short Leg Splint (Calf To Foot) (Pro Cah),,29515,CPT,Professional,Both,,,,265,225.25,30.54,265,UnitedHealthcare,Individual & Family,265,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Application Of Short Leg Splint (Calf To Foot) (Pro Cah),,29515,CPT,Professional,Both,,,,265,225.25,30.54,265,UnitedHealthcare,Medicare Advantage,54.8665,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Application Of Short Leg Splint (Calf To Foot) (Pro Cah),,29515,CPT,Professional,Both,,,,265,225.25,30.54,265,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,35.2552,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Application Of Unna Boot,,29580,CPT,Facility,Both,,,,50,42.5,14.33,50,Aetna,Commercial,46,92,,percent of total billed charges,,
Application Of Unna Boot,,29580,CPT,Facility,Outpatient,,,,50,42.5,14.33,50,Aetna,Medicare Advantage,24.5,49,,percent of total billed charges,,
Application Of Unna Boot,,29580,CPT,Facility,Inpatient,,,,50,42.5,14.33,50,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Application Of Unna Boot,,29580,CPT,Facility,Both,,,,50,42.5,14.33,50,Aetna,PPO,46.5,93,,percent of total billed charges,,
Application Of Unna Boot,,29580,CPT,Facility,Both,,,,50,42.5,14.33,50,America's PPO,America's PPO,48.015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Application Of Unna Boot,,29580,CPT,Facility,Both,,,,50,42.5,14.33,50,BlueCross BlueShield Minnesota, Federal Employee Program,49.2,98.4,,percent of total billed charges,,
Application Of Unna Boot,,29580,CPT,Facility,Both,,,,50,42.5,14.33,50,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,50,100,,percent of total billed charges,,
Application Of Unna Boot,,29580,CPT,Facility,Both,,,,50,42.5,14.33,50,BlueCross BlueShield Minnesota,High Value Network Plan,45,90,,percent of total billed charges,,
Application Of Unna Boot,,29580,CPT,Facility,Outpatient,,,,50,42.5,14.33,50,BlueCross BlueShield Minnesota,Medicare Advantage,24.5,49,,percent of total billed charges,,
Application Of Unna Boot,,29580,CPT,Facility,Inpatient,,,,50,42.5,14.33,50,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Application Of Unna Boot,,29580,CPT,Facility,Both,,,,50,42.5,14.33,50,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,44.285,88.57,,percent of total billed charges,,
Application Of Unna Boot,,29580,CPT,Facility,Both,,,,50,42.5,14.33,50,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,14.33,28.66,,percent of total billed charges,,
Application Of Unna Boot,,29580,CPT,Facility,Outpatient,,,,50,42.5,14.33,50,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),24.5,49,,percent of total billed charges,,
Application Of Unna Boot,,29580,CPT,Facility,Inpatient,,,,50,42.5,14.33,50,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Application Of Unna Boot,,29580,CPT,Facility,Both,,,,50,42.5,14.33,50,CorVel,Worker's Compensation,50,100,,percent of total billed charges,,
Application Of Unna Boot,,29580,CPT,Facility,Both,,,,50,42.5,14.33,50,First Health Group Corporation,First Health Network,48.5,97,,percent of total billed charges,,
Application Of Unna Boot,,29580,CPT,Facility,Both,,,,50,42.5,14.33,50,"Health Partners, Inc.",Commercial,47.3,94.6,,percent of total billed charges,,
Application Of Unna Boot,,29580,CPT,Facility,Outpatient,,,,50,42.5,14.33,50,"Health Partners, Inc.",Medicare Advantage,24.5,49,,percent of total billed charges,,
Application Of Unna Boot,,29580,CPT,Facility,Inpatient,,,,50,42.5,14.33,50,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Application Of Unna Boot,,29580,CPT,Facility,Both,,,,50,42.5,14.33,50,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),30,60,,percent of total billed charges,,
Application Of Unna Boot,,29580,CPT,Facility,Both,,,,50,42.5,14.33,50,"Health Partners, Inc.",State of Minnesota Advantage Program,40.75,81.5,,percent of total billed charges,,
Application Of Unna Boot,,29580,CPT,Facility,Both,,,,50,42.5,14.33,50,"Health Partners, Inc.",State Public Programs,25,50,,percent of total billed charges,,
Application Of Unna Boot,,29580,CPT,Facility,Both,,,,50,42.5,14.33,50,Humana Insurance Company,Commercial PPO,47.5,95,,percent of total billed charges,,
Application Of Unna Boot,,29580,CPT,Facility,Outpatient,,,,50,42.5,14.33,50,Humana Insurance Company,Medicare PPO,24.5,49,,percent of total billed charges,,
Application Of Unna Boot,,29580,CPT,Facility,Inpatient,,,,50,42.5,14.33,50,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Application Of Unna Boot,,29580,CPT,Facility,Both,,,,50,42.5,14.33,50,Medica,Individual & Family,49.55,99.1,,percent of total billed charges,,
Application Of Unna Boot,,29580,CPT,Facility,Outpatient,,,,50,42.5,14.33,50,Medica,Medica Advantage Solution,24.9,49.8,,percent of total billed charges,,
Application Of Unna Boot,,29580,CPT,Facility,Inpatient,,,,50,42.5,14.33,50,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Application Of Unna Boot,,29580,CPT,Facility,Outpatient,,,,50,42.5,14.33,50,Medica,Medical Assistance,22.3,44.6,,percent of total billed charges,,
Application Of Unna Boot,,29580,CPT,Facility,Inpatient,,,,50,42.5,14.33,50,Medica,Medical Assistance,,,,,Included in per diem rate,
Application Of Unna Boot,,29580,CPT,Facility,Outpatient,,,,50,42.5,14.33,50,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,24.9,49.8,,percent of total billed charges,,
Application Of Unna Boot,,29580,CPT,Facility,Inpatient,,,,50,42.5,14.33,50,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Application Of Unna Boot,,29580,CPT,Facility,Both,,,,50,42.5,14.33,50,"Multiplan, Inc.","Multiplan, Inc.",47,94,,percent of total billed charges,,
Application Of Unna Boot,,29580,CPT,Facility,Outpatient,,,,50,42.5,14.33,50,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,45.05,90.1,,percent of total billed charges,,
Application Of Unna Boot,,29580,CPT,Facility,Inpatient,,,,50,42.5,14.33,50,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Application Of Unna Boot,,29580,CPT,Facility,Both,,,,50,42.5,14.33,50,"Preferred One Administrative Services, INC.",PPO,49.3,98.6,,percent of total billed charges,,
Application Of Unna Boot,,29580,CPT,Facility,Outpatient,,,,50,42.5,14.33,50,PrimeWest Health,Minnesota Senior Health Options (MSHO),25.725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Application Of Unna Boot,,29580,CPT,Facility,Inpatient,,,,50,42.5,14.33,50,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Application Of Unna Boot,,29580,CPT,Facility,Outpatient,,,,50,42.5,14.33,50,PrimeWest Health,MinnesotaCare,25.68,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Application Of Unna Boot,,29580,CPT,Facility,Inpatient,,,,50,42.5,14.33,50,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Application Of Unna Boot,,29580,CPT,Facility,Both,,,,50,42.5,14.33,50,Sanford Health Plan,Sanford Health Plan,46,92,,percent of total billed charges,,
Application Of Unna Boot,,29580,CPT,Facility,Outpatient,,,,50,42.5,14.33,50,"UCare Health, Inc.",Individual & Family Plan,28.175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Application Of Unna Boot,,29580,CPT,Facility,Inpatient,,,,50,42.5,14.33,50,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Application Of Unna Boot,,29580,CPT,Facility,Outpatient,,,,50,42.5,14.33,50,"UCare Health, Inc.",Medical Assistance,25.235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Application Of Unna Boot,,29580,CPT,Facility,Inpatient,,,,50,42.5,14.33,50,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Application Of Unna Boot,,29580,CPT,Facility,Outpatient,,,,50,42.5,14.33,50,"UCare Health, Inc.",Medicare Advantage,25.235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Application Of Unna Boot,,29580,CPT,Facility,Inpatient,,,,50,42.5,14.33,50,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Application Of Unna Boot,,29580,CPT,Facility,Outpatient,,,,50,42.5,14.33,50,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),25.235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Application Of Unna Boot,,29580,CPT,Facility,Inpatient,,,,50,42.5,14.33,50,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Application Of Unna Boot,,29580,CPT,Facility,Both,,,,50,42.5,14.33,50,UnitedHealthcare,Individual & Family,47,94,,percent of total billed charges,,
Application Of Unna Boot,,29580,CPT,Facility,Outpatient,,,,50,42.5,14.33,50,UnitedHealthcare,Medicare Advantage,24.5,49,,percent of total billed charges,,
Application Of Unna Boot,,29580,CPT,Facility,Inpatient,,,,50,42.5,14.33,50,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Application Of Unna Boot,,29580,CPT,Facility,Outpatient,,,,50,42.5,14.33,50,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,24,48,,percent of total billed charges,,100% of DHS outpatient percentage
Application Of Unna Boot,,29580,CPT,Facility,Inpatient,,,,50,42.5,14.33,50,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Strapping; Unna Boot (Pro Cah),,29580,CPT,Professional,Both,,,,165,140.25,15.92,165,Aetna,Commercial,140.25,85,,percent of total billed charges,,
Strapping; Unna Boot (Pro Cah),,29580,CPT,Professional,Both,,,,165,140.25,15.92,165,Aetna,Medicare Advantage,25.59,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Strapping; Unna Boot (Pro Cah),,29580,CPT,Professional,Both,,,,165,140.25,15.92,165,Aetna,PPO,153.45,93,,percent of total billed charges,,
Strapping; Unna Boot (Pro Cah),,29580,CPT,Professional,Both,,,,165,140.25,15.92,165,America's PPO,America's PPO,140.976,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Strapping; Unna Boot (Pro Cah),,29580,CPT,Professional,Both,,,,165,140.25,15.92,165,BlueCross BlueShield Minnesota, Federal Employee Program,53.71,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Strapping; Unna Boot (Pro Cah),,29580,CPT,Professional,Both,,,,165,140.25,15.92,165,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,54.56936,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Strapping; Unna Boot (Pro Cah),,29580,CPT,Professional,Both,,,,165,140.25,15.92,165,BlueCross BlueShield Minnesota,High Value Network Plan,54.56936,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Strapping; Unna Boot (Pro Cah),,29580,CPT,Professional,Both,,,,165,140.25,15.92,165,BlueCross BlueShield Minnesota,Medicare Advantage,28.681,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Strapping; Unna Boot (Pro Cah),,29580,CPT,Professional,Both,,,,165,140.25,15.92,165,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,54.56936,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Strapping; Unna Boot (Pro Cah),,29580,CPT,Professional,Both,,,,165,140.25,15.92,165,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,18.37944,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Strapping; Unna Boot (Pro Cah),,29580,CPT,Professional,Both,,,,165,140.25,15.92,165,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),28.681,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Strapping; Unna Boot (Pro Cah),,29580,CPT,Professional,Both,,,,165,140.25,15.92,165,CorVel,Worker's Compensation,49.7272944,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Strapping; Unna Boot (Pro Cah),,29580,CPT,Professional,Both,,,,165,140.25,15.92,165,First Health Group Corporation,First Health Network,160.05,97,,percent of total billed charges,,
Strapping; Unna Boot (Pro Cah),,29580,CPT,Professional,Both,,,,165,140.25,15.92,165,"Health Partners, Inc.",Commercial,53.69,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Strapping; Unna Boot (Pro Cah),,29580,CPT,Professional,Both,,,,165,140.25,15.92,165,"Health Partners, Inc.",Medicare Advantage,28.681,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Strapping; Unna Boot (Pro Cah),,29580,CPT,Professional,Both,,,,165,140.25,15.92,165,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),24.74,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Strapping; Unna Boot (Pro Cah),,29580,CPT,Professional,Both,,,,165,140.25,15.92,165,"Health Partners, Inc.",State of Minnesota Advantage Program,46.253935,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Strapping; Unna Boot (Pro Cah),,29580,CPT,Professional,Both,,,,165,140.25,15.92,165,"Health Partners, Inc.",State Public Programs,15.92,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Strapping; Unna Boot (Pro Cah),,29580,CPT,Professional,Both,,,,165,140.25,15.92,165,Humana Insurance Company,Commercial PPO,24.94,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Strapping; Unna Boot (Pro Cah),,29580,CPT,Professional,Both,,,,165,140.25,15.92,165,Humana Insurance Company,Medicare PPO,165,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Strapping; Unna Boot (Pro Cah),,29580,CPT,Professional,Both,,,,165,140.25,15.92,165,Medica,Individual & Family,139.92,84.8,,percent of total billed charges,,
Strapping; Unna Boot (Pro Cah),,29580,CPT,Professional,Both,,,,165,140.25,15.92,165,Medica,Medica Advantage Solution,82.17,49.8,,percent of total billed charges,,
Strapping; Unna Boot (Pro Cah),,29580,CPT,Professional,Both,,,,165,140.25,15.92,165,Medica,Medical Assistance,18.38,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Strapping; Unna Boot (Pro Cah),,29580,CPT,Professional,Both,,,,165,140.25,15.92,165,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,24.94,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Strapping; Unna Boot (Pro Cah),,29580,CPT,Professional,Both,,,,165,140.25,15.92,165,"Multiplan, Inc.","Multiplan, Inc.",155.1,94,,percent of total billed charges,,
Strapping; Unna Boot (Pro Cah),,29580,CPT,Professional,Both,,,,165,140.25,15.92,165,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,148.665,90.1,,percent of total billed charges,,
Strapping; Unna Boot (Pro Cah),,29580,CPT,Professional,Both,,,,165,140.25,15.92,165,"Preferred One Administrative Services, INC.",PPO,162.69,98.6,,percent of total billed charges,,
Strapping; Unna Boot (Pro Cah),,29580,CPT,Professional,Both,,,,165,140.25,15.92,165,PrimeWest Health,Minnesota Senior Health Options (MSHO),28.681,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Strapping; Unna Boot (Pro Cah),,29580,CPT,Professional,Both,,,,165,140.25,15.92,165,PrimeWest Health,MinnesotaCare,19.6660008,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Strapping; Unna Boot (Pro Cah),,29580,CPT,Professional,Both,,,,165,140.25,15.92,165,Sanford Health Plan,Sanford Health Plan,145.2,88,,percent of total billed charges,,
Strapping; Unna Boot (Pro Cah),,29580,CPT,Professional,Both,,,,165,140.25,15.92,165,"UCare Health, Inc.",Individual & Family Plan,40.542464,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Strapping; Unna Boot (Pro Cah),,29580,CPT,Professional,Both,,,,165,140.25,15.92,165,"UCare Health, Inc.",Medical Assistance,20.217384,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Strapping; Unna Boot (Pro Cah),,29580,CPT,Professional,Both,,,,165,140.25,15.92,165,"UCare Health, Inc.",Medicare Advantage,28.681,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Strapping; Unna Boot (Pro Cah),,29580,CPT,Professional,Both,,,,165,140.25,15.92,165,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),22.9448,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Strapping; Unna Boot (Pro Cah),,29580,CPT,Professional,Both,,,,165,140.25,15.92,165,UnitedHealthcare,Individual & Family,165,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Strapping; Unna Boot (Pro Cah),,29580,CPT,Professional,Both,,,,165,140.25,15.92,165,UnitedHealthcare,Medicare Advantage,28.681,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Strapping; Unna Boot (Pro Cah),,29580,CPT,Professional,Both,,,,165,140.25,15.92,165,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,18.37944,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Application Multi-Layer Compress Sys; Leg (Below Knee) Incl Ankle Foot,,29581,CPT,Facility,Both,,,,157,133.45,44.9962,157,Aetna,Commercial,144.44,92,,percent of total billed charges,,
Application Multi-Layer Compress Sys; Leg (Below Knee) Incl Ankle Foot,,29581,CPT,Facility,Outpatient,,,,157,133.45,44.9962,157,Aetna,Medicare Advantage,76.93,49,,percent of total billed charges,,
Application Multi-Layer Compress Sys; Leg (Below Knee) Incl Ankle Foot,,29581,CPT,Facility,Inpatient,,,,157,133.45,44.9962,157,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Application Multi-Layer Compress Sys; Leg (Below Knee) Incl Ankle Foot,,29581,CPT,Facility,Both,,,,157,133.45,44.9962,157,Aetna,PPO,146.01,93,,percent of total billed charges,,
Application Multi-Layer Compress Sys; Leg (Below Knee) Incl Ankle Foot,,29581,CPT,Facility,Both,,,,157,133.45,44.9962,157,America's PPO,America's PPO,150.7671,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Application Multi-Layer Compress Sys; Leg (Below Knee) Incl Ankle Foot,,29581,CPT,Facility,Both,,,,157,133.45,44.9962,157,BlueCross BlueShield Minnesota, Federal Employee Program,154.488,98.4,,percent of total billed charges,,
Application Multi-Layer Compress Sys; Leg (Below Knee) Incl Ankle Foot,,29581,CPT,Facility,Both,,,,157,133.45,44.9962,157,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,157,100,,percent of total billed charges,,
Application Multi-Layer Compress Sys; Leg (Below Knee) Incl Ankle Foot,,29581,CPT,Facility,Both,,,,157,133.45,44.9962,157,BlueCross BlueShield Minnesota,High Value Network Plan,141.3,90,,percent of total billed charges,,
Application Multi-Layer Compress Sys; Leg (Below Knee) Incl Ankle Foot,,29581,CPT,Facility,Outpatient,,,,157,133.45,44.9962,157,BlueCross BlueShield Minnesota,Medicare Advantage,76.93,49,,percent of total billed charges,,
Application Multi-Layer Compress Sys; Leg (Below Knee) Incl Ankle Foot,,29581,CPT,Facility,Inpatient,,,,157,133.45,44.9962,157,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Application Multi-Layer Compress Sys; Leg (Below Knee) Incl Ankle Foot,,29581,CPT,Facility,Both,,,,157,133.45,44.9962,157,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,139.0549,88.57,,percent of total billed charges,,
Application Multi-Layer Compress Sys; Leg (Below Knee) Incl Ankle Foot,,29581,CPT,Facility,Both,,,,157,133.45,44.9962,157,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,44.9962,28.66,,percent of total billed charges,,
Application Multi-Layer Compress Sys; Leg (Below Knee) Incl Ankle Foot,,29581,CPT,Facility,Outpatient,,,,157,133.45,44.9962,157,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),76.93,49,,percent of total billed charges,,
Application Multi-Layer Compress Sys; Leg (Below Knee) Incl Ankle Foot,,29581,CPT,Facility,Inpatient,,,,157,133.45,44.9962,157,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Application Multi-Layer Compress Sys; Leg (Below Knee) Incl Ankle Foot,,29581,CPT,Facility,Both,,,,157,133.45,44.9962,157,CorVel,Worker's Compensation,157,100,,percent of total billed charges,,
Application Multi-Layer Compress Sys; Leg (Below Knee) Incl Ankle Foot,,29581,CPT,Facility,Both,,,,157,133.45,44.9962,157,First Health Group Corporation,First Health Network,152.29,97,,percent of total billed charges,,
Application Multi-Layer Compress Sys; Leg (Below Knee) Incl Ankle Foot,,29581,CPT,Facility,Both,,,,157,133.45,44.9962,157,"Health Partners, Inc.",Commercial,148.522,94.6,,percent of total billed charges,,
Application Multi-Layer Compress Sys; Leg (Below Knee) Incl Ankle Foot,,29581,CPT,Facility,Outpatient,,,,157,133.45,44.9962,157,"Health Partners, Inc.",Medicare Advantage,76.93,49,,percent of total billed charges,,
Application Multi-Layer Compress Sys; Leg (Below Knee) Incl Ankle Foot,,29581,CPT,Facility,Inpatient,,,,157,133.45,44.9962,157,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Application Multi-Layer Compress Sys; Leg (Below Knee) Incl Ankle Foot,,29581,CPT,Facility,Both,,,,157,133.45,44.9962,157,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),94.2,60,,percent of total billed charges,,
Application Multi-Layer Compress Sys; Leg (Below Knee) Incl Ankle Foot,,29581,CPT,Facility,Both,,,,157,133.45,44.9962,157,"Health Partners, Inc.",State of Minnesota Advantage Program,127.955,81.5,,percent of total billed charges,,
Application Multi-Layer Compress Sys; Leg (Below Knee) Incl Ankle Foot,,29581,CPT,Facility,Both,,,,157,133.45,44.9962,157,"Health Partners, Inc.",State Public Programs,78.5,50,,percent of total billed charges,,
Application Multi-Layer Compress Sys; Leg (Below Knee) Incl Ankle Foot,,29581,CPT,Facility,Both,,,,157,133.45,44.9962,157,Humana Insurance Company,Commercial PPO,149.15,95,,percent of total billed charges,,
Application Multi-Layer Compress Sys; Leg (Below Knee) Incl Ankle Foot,,29581,CPT,Facility,Outpatient,,,,157,133.45,44.9962,157,Humana Insurance Company,Medicare PPO,76.93,49,,percent of total billed charges,,
Application Multi-Layer Compress Sys; Leg (Below Knee) Incl Ankle Foot,,29581,CPT,Facility,Inpatient,,,,157,133.45,44.9962,157,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Application Multi-Layer Compress Sys; Leg (Below Knee) Incl Ankle Foot,,29581,CPT,Facility,Both,,,,157,133.45,44.9962,157,Medica,Individual & Family,155.587,99.1,,percent of total billed charges,,
Application Multi-Layer Compress Sys; Leg (Below Knee) Incl Ankle Foot,,29581,CPT,Facility,Outpatient,,,,157,133.45,44.9962,157,Medica,Medica Advantage Solution,78.186,49.8,,percent of total billed charges,,
Application Multi-Layer Compress Sys; Leg (Below Knee) Incl Ankle Foot,,29581,CPT,Facility,Inpatient,,,,157,133.45,44.9962,157,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Application Multi-Layer Compress Sys; Leg (Below Knee) Incl Ankle Foot,,29581,CPT,Facility,Outpatient,,,,157,133.45,44.9962,157,Medica,Medical Assistance,70.022,44.6,,percent of total billed charges,,
Application Multi-Layer Compress Sys; Leg (Below Knee) Incl Ankle Foot,,29581,CPT,Facility,Inpatient,,,,157,133.45,44.9962,157,Medica,Medical Assistance,,,,,Included in per diem rate,
Application Multi-Layer Compress Sys; Leg (Below Knee) Incl Ankle Foot,,29581,CPT,Facility,Outpatient,,,,157,133.45,44.9962,157,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,78.186,49.8,,percent of total billed charges,,
Application Multi-Layer Compress Sys; Leg (Below Knee) Incl Ankle Foot,,29581,CPT,Facility,Inpatient,,,,157,133.45,44.9962,157,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Application Multi-Layer Compress Sys; Leg (Below Knee) Incl Ankle Foot,,29581,CPT,Facility,Both,,,,157,133.45,44.9962,157,"Multiplan, Inc.","Multiplan, Inc.",147.58,94,,percent of total billed charges,,
Application Multi-Layer Compress Sys; Leg (Below Knee) Incl Ankle Foot,,29581,CPT,Facility,Outpatient,,,,157,133.45,44.9962,157,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,141.457,90.1,,percent of total billed charges,,
Application Multi-Layer Compress Sys; Leg (Below Knee) Incl Ankle Foot,,29581,CPT,Facility,Inpatient,,,,157,133.45,44.9962,157,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Application Multi-Layer Compress Sys; Leg (Below Knee) Incl Ankle Foot,,29581,CPT,Facility,Both,,,,157,133.45,44.9962,157,"Preferred One Administrative Services, INC.",PPO,154.802,98.6,,percent of total billed charges,,
Application Multi-Layer Compress Sys; Leg (Below Knee) Incl Ankle Foot,,29581,CPT,Facility,Outpatient,,,,157,133.45,44.9962,157,PrimeWest Health,Minnesota Senior Health Options (MSHO),80.7765,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Application Multi-Layer Compress Sys; Leg (Below Knee) Incl Ankle Foot,,29581,CPT,Facility,Inpatient,,,,157,133.45,44.9962,157,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Application Multi-Layer Compress Sys; Leg (Below Knee) Incl Ankle Foot,,29581,CPT,Facility,Outpatient,,,,157,133.45,44.9962,157,PrimeWest Health,MinnesotaCare,80.6352,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Application Multi-Layer Compress Sys; Leg (Below Knee) Incl Ankle Foot,,29581,CPT,Facility,Inpatient,,,,157,133.45,44.9962,157,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Application Multi-Layer Compress Sys; Leg (Below Knee) Incl Ankle Foot,,29581,CPT,Facility,Both,,,,157,133.45,44.9962,157,Sanford Health Plan,Sanford Health Plan,144.44,92,,percent of total billed charges,,
Application Multi-Layer Compress Sys; Leg (Below Knee) Incl Ankle Foot,,29581,CPT,Facility,Outpatient,,,,157,133.45,44.9962,157,"UCare Health, Inc.",Individual & Family Plan,88.4695,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Application Multi-Layer Compress Sys; Leg (Below Knee) Incl Ankle Foot,,29581,CPT,Facility,Inpatient,,,,157,133.45,44.9962,157,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Application Multi-Layer Compress Sys; Leg (Below Knee) Incl Ankle Foot,,29581,CPT,Facility,Outpatient,,,,157,133.45,44.9962,157,"UCare Health, Inc.",Medical Assistance,79.2379,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Application Multi-Layer Compress Sys; Leg (Below Knee) Incl Ankle Foot,,29581,CPT,Facility,Inpatient,,,,157,133.45,44.9962,157,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Application Multi-Layer Compress Sys; Leg (Below Knee) Incl Ankle Foot,,29581,CPT,Facility,Outpatient,,,,157,133.45,44.9962,157,"UCare Health, Inc.",Medicare Advantage,79.2379,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Application Multi-Layer Compress Sys; Leg (Below Knee) Incl Ankle Foot,,29581,CPT,Facility,Inpatient,,,,157,133.45,44.9962,157,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Application Multi-Layer Compress Sys; Leg (Below Knee) Incl Ankle Foot,,29581,CPT,Facility,Outpatient,,,,157,133.45,44.9962,157,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),79.2379,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Application Multi-Layer Compress Sys; Leg (Below Knee) Incl Ankle Foot,,29581,CPT,Facility,Inpatient,,,,157,133.45,44.9962,157,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Application Multi-Layer Compress Sys; Leg (Below Knee) Incl Ankle Foot,,29581,CPT,Facility,Both,,,,157,133.45,44.9962,157,UnitedHealthcare,Individual & Family,147.58,94,,percent of total billed charges,,
Application Multi-Layer Compress Sys; Leg (Below Knee) Incl Ankle Foot,,29581,CPT,Facility,Outpatient,,,,157,133.45,44.9962,157,UnitedHealthcare,Medicare Advantage,76.93,49,,percent of total billed charges,,
Application Multi-Layer Compress Sys; Leg (Below Knee) Incl Ankle Foot,,29581,CPT,Facility,Inpatient,,,,157,133.45,44.9962,157,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Application Multi-Layer Compress Sys; Leg (Below Knee) Incl Ankle Foot,,29581,CPT,Facility,Outpatient,,,,157,133.45,44.9962,157,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,75.36,48,,percent of total billed charges,,100% of DHS outpatient percentage
Application Multi-Layer Compress Sys; Leg (Below Knee) Incl Ankle Foot,,29581,CPT,Facility,Inpatient,,,,157,133.45,44.9962,157,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Removal Or Bivavling; Guantlet, Boot Or Body Cast",,29700,CPT,Facility,Both,,,,60,51,17.196,60,Aetna,Commercial,55.2,92,,percent of total billed charges,,
"Removal Or Bivavling; Guantlet, Boot Or Body Cast",,29700,CPT,Facility,Outpatient,,,,60,51,17.196,60,Aetna,Medicare Advantage,29.4,49,,percent of total billed charges,,
"Removal Or Bivavling; Guantlet, Boot Or Body Cast",,29700,CPT,Facility,Inpatient,,,,60,51,17.196,60,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Removal Or Bivavling; Guantlet, Boot Or Body Cast",,29700,CPT,Facility,Both,,,,60,51,17.196,60,Aetna,PPO,55.8,93,,percent of total billed charges,,
"Removal Or Bivavling; Guantlet, Boot Or Body Cast",,29700,CPT,Facility,Both,,,,60,51,17.196,60,America's PPO,America's PPO,57.618,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Removal Or Bivavling; Guantlet, Boot Or Body Cast",,29700,CPT,Facility,Both,,,,60,51,17.196,60,BlueCross BlueShield Minnesota, Federal Employee Program,59.04,98.4,,percent of total billed charges,,
"Removal Or Bivavling; Guantlet, Boot Or Body Cast",,29700,CPT,Facility,Both,,,,60,51,17.196,60,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,60,100,,percent of total billed charges,,
"Removal Or Bivavling; Guantlet, Boot Or Body Cast",,29700,CPT,Facility,Both,,,,60,51,17.196,60,BlueCross BlueShield Minnesota,High Value Network Plan,54,90,,percent of total billed charges,,
"Removal Or Bivavling; Guantlet, Boot Or Body Cast",,29700,CPT,Facility,Outpatient,,,,60,51,17.196,60,BlueCross BlueShield Minnesota,Medicare Advantage,29.4,49,,percent of total billed charges,,
"Removal Or Bivavling; Guantlet, Boot Or Body Cast",,29700,CPT,Facility,Inpatient,,,,60,51,17.196,60,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Removal Or Bivavling; Guantlet, Boot Or Body Cast",,29700,CPT,Facility,Both,,,,60,51,17.196,60,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,53.142,88.57,,percent of total billed charges,,
"Removal Or Bivavling; Guantlet, Boot Or Body Cast",,29700,CPT,Facility,Both,,,,60,51,17.196,60,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,17.196,28.66,,percent of total billed charges,,
"Removal Or Bivavling; Guantlet, Boot Or Body Cast",,29700,CPT,Facility,Outpatient,,,,60,51,17.196,60,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),29.4,49,,percent of total billed charges,,
"Removal Or Bivavling; Guantlet, Boot Or Body Cast",,29700,CPT,Facility,Inpatient,,,,60,51,17.196,60,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Removal Or Bivavling; Guantlet, Boot Or Body Cast",,29700,CPT,Facility,Both,,,,60,51,17.196,60,CorVel,Worker's Compensation,60,100,,percent of total billed charges,,
"Removal Or Bivavling; Guantlet, Boot Or Body Cast",,29700,CPT,Facility,Both,,,,60,51,17.196,60,First Health Group Corporation,First Health Network,58.2,97,,percent of total billed charges,,
"Removal Or Bivavling; Guantlet, Boot Or Body Cast",,29700,CPT,Facility,Both,,,,60,51,17.196,60,"Health Partners, Inc.",Commercial,56.76,94.6,,percent of total billed charges,,
"Removal Or Bivavling; Guantlet, Boot Or Body Cast",,29700,CPT,Facility,Outpatient,,,,60,51,17.196,60,"Health Partners, Inc.",Medicare Advantage,29.4,49,,percent of total billed charges,,
"Removal Or Bivavling; Guantlet, Boot Or Body Cast",,29700,CPT,Facility,Inpatient,,,,60,51,17.196,60,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Removal Or Bivavling; Guantlet, Boot Or Body Cast",,29700,CPT,Facility,Both,,,,60,51,17.196,60,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),36,60,,percent of total billed charges,,
"Removal Or Bivavling; Guantlet, Boot Or Body Cast",,29700,CPT,Facility,Both,,,,60,51,17.196,60,"Health Partners, Inc.",State of Minnesota Advantage Program,48.9,81.5,,percent of total billed charges,,
"Removal Or Bivavling; Guantlet, Boot Or Body Cast",,29700,CPT,Facility,Both,,,,60,51,17.196,60,"Health Partners, Inc.",State Public Programs,30,50,,percent of total billed charges,,
"Removal Or Bivavling; Guantlet, Boot Or Body Cast",,29700,CPT,Facility,Both,,,,60,51,17.196,60,Humana Insurance Company,Commercial PPO,57,95,,percent of total billed charges,,
"Removal Or Bivavling; Guantlet, Boot Or Body Cast",,29700,CPT,Facility,Outpatient,,,,60,51,17.196,60,Humana Insurance Company,Medicare PPO,29.4,49,,percent of total billed charges,,
"Removal Or Bivavling; Guantlet, Boot Or Body Cast",,29700,CPT,Facility,Inpatient,,,,60,51,17.196,60,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Removal Or Bivavling; Guantlet, Boot Or Body Cast",,29700,CPT,Facility,Both,,,,60,51,17.196,60,Medica,Individual & Family,59.46,99.1,,percent of total billed charges,,
"Removal Or Bivavling; Guantlet, Boot Or Body Cast",,29700,CPT,Facility,Outpatient,,,,60,51,17.196,60,Medica,Medica Advantage Solution,29.88,49.8,,percent of total billed charges,,
"Removal Or Bivavling; Guantlet, Boot Or Body Cast",,29700,CPT,Facility,Inpatient,,,,60,51,17.196,60,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Removal Or Bivavling; Guantlet, Boot Or Body Cast",,29700,CPT,Facility,Outpatient,,,,60,51,17.196,60,Medica,Medical Assistance,26.76,44.6,,percent of total billed charges,,
"Removal Or Bivavling; Guantlet, Boot Or Body Cast",,29700,CPT,Facility,Inpatient,,,,60,51,17.196,60,Medica,Medical Assistance,,,,,Included in per diem rate,
"Removal Or Bivavling; Guantlet, Boot Or Body Cast",,29700,CPT,Facility,Outpatient,,,,60,51,17.196,60,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,29.88,49.8,,percent of total billed charges,,
"Removal Or Bivavling; Guantlet, Boot Or Body Cast",,29700,CPT,Facility,Inpatient,,,,60,51,17.196,60,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Removal Or Bivavling; Guantlet, Boot Or Body Cast",,29700,CPT,Facility,Both,,,,60,51,17.196,60,"Multiplan, Inc.","Multiplan, Inc.",56.4,94,,percent of total billed charges,,
"Removal Or Bivavling; Guantlet, Boot Or Body Cast",,29700,CPT,Facility,Outpatient,,,,60,51,17.196,60,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,54.06,90.1,,percent of total billed charges,,
"Removal Or Bivavling; Guantlet, Boot Or Body Cast",,29700,CPT,Facility,Inpatient,,,,60,51,17.196,60,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Removal Or Bivavling; Guantlet, Boot Or Body Cast",,29700,CPT,Facility,Both,,,,60,51,17.196,60,"Preferred One Administrative Services, INC.",PPO,59.16,98.6,,percent of total billed charges,,
"Removal Or Bivavling; Guantlet, Boot Or Body Cast",,29700,CPT,Facility,Outpatient,,,,60,51,17.196,60,PrimeWest Health,Minnesota Senior Health Options (MSHO),30.87,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Removal Or Bivavling; Guantlet, Boot Or Body Cast",,29700,CPT,Facility,Inpatient,,,,60,51,17.196,60,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Removal Or Bivavling; Guantlet, Boot Or Body Cast",,29700,CPT,Facility,Outpatient,,,,60,51,17.196,60,PrimeWest Health,MinnesotaCare,30.816,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Removal Or Bivavling; Guantlet, Boot Or Body Cast",,29700,CPT,Facility,Inpatient,,,,60,51,17.196,60,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Removal Or Bivavling; Guantlet, Boot Or Body Cast",,29700,CPT,Facility,Both,,,,60,51,17.196,60,Sanford Health Plan,Sanford Health Plan,55.2,92,,percent of total billed charges,,
"Removal Or Bivavling; Guantlet, Boot Or Body Cast",,29700,CPT,Facility,Outpatient,,,,60,51,17.196,60,"UCare Health, Inc.",Individual & Family Plan,33.81,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Removal Or Bivavling; Guantlet, Boot Or Body Cast",,29700,CPT,Facility,Inpatient,,,,60,51,17.196,60,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Removal Or Bivavling; Guantlet, Boot Or Body Cast",,29700,CPT,Facility,Outpatient,,,,60,51,17.196,60,"UCare Health, Inc.",Medical Assistance,30.282,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Removal Or Bivavling; Guantlet, Boot Or Body Cast",,29700,CPT,Facility,Inpatient,,,,60,51,17.196,60,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Removal Or Bivavling; Guantlet, Boot Or Body Cast",,29700,CPT,Facility,Outpatient,,,,60,51,17.196,60,"UCare Health, Inc.",Medicare Advantage,30.282,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Removal Or Bivavling; Guantlet, Boot Or Body Cast",,29700,CPT,Facility,Inpatient,,,,60,51,17.196,60,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Removal Or Bivavling; Guantlet, Boot Or Body Cast",,29700,CPT,Facility,Outpatient,,,,60,51,17.196,60,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),30.282,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Removal Or Bivavling; Guantlet, Boot Or Body Cast",,29700,CPT,Facility,Inpatient,,,,60,51,17.196,60,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Removal Or Bivavling; Guantlet, Boot Or Body Cast",,29700,CPT,Facility,Both,,,,60,51,17.196,60,UnitedHealthcare,Individual & Family,56.4,94,,percent of total billed charges,,
"Removal Or Bivavling; Guantlet, Boot Or Body Cast",,29700,CPT,Facility,Outpatient,,,,60,51,17.196,60,UnitedHealthcare,Medicare Advantage,29.4,49,,percent of total billed charges,,
"Removal Or Bivavling; Guantlet, Boot Or Body Cast",,29700,CPT,Facility,Inpatient,,,,60,51,17.196,60,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Removal Or Bivavling; Guantlet, Boot Or Body Cast",,29700,CPT,Facility,Outpatient,,,,60,51,17.196,60,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,28.8,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Removal Or Bivavling; Guantlet, Boot Or Body Cast",,29700,CPT,Facility,Inpatient,,,,60,51,17.196,60,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"HEPARIN (PORCINE) 5,000 UNIT/ML INJ SOLN",,J1644,HCPCS,Facility,Both,1,mL,,16,13.6,4.5856,16,Aetna,Commercial,14.72,92,,percent of total billed charges,,
"HEPARIN (PORCINE) 5,000 UNIT/ML INJ SOLN",,J1644,HCPCS,Facility,Outpatient,1,mL,,16,13.6,4.5856,16,Aetna,Medicare Advantage,7.84,49,,percent of total billed charges,,
"HEPARIN (PORCINE) 5,000 UNIT/ML INJ SOLN",,J1644,HCPCS,Facility,Inpatient,1,mL,,16,13.6,4.5856,16,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"HEPARIN (PORCINE) 5,000 UNIT/ML INJ SOLN",,J1644,HCPCS,Facility,Both,1,mL,,16,13.6,4.5856,16,Aetna,PPO,14.88,93,,percent of total billed charges,,
"HEPARIN (PORCINE) 5,000 UNIT/ML INJ SOLN",,J1644,HCPCS,Facility,Both,1,mL,,16,13.6,4.5856,16,America's PPO,America's PPO,15.3648,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"HEPARIN (PORCINE) 5,000 UNIT/ML INJ SOLN",,J1644,HCPCS,Facility,Both,1,mL,,16,13.6,4.5856,16,BlueCross BlueShield Minnesota, Federal Employee Program,15.744,98.4,,percent of total billed charges,,
"HEPARIN (PORCINE) 5,000 UNIT/ML INJ SOLN",,J1644,HCPCS,Facility,Both,1,mL,,16,13.6,4.5856,16,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,16,100,,percent of total billed charges,,
"HEPARIN (PORCINE) 5,000 UNIT/ML INJ SOLN",,J1644,HCPCS,Facility,Both,1,mL,,16,13.6,4.5856,16,BlueCross BlueShield Minnesota,High Value Network Plan,14.4,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
"HEPARIN (PORCINE) 5,000 UNIT/ML INJ SOLN",,J1644,HCPCS,Facility,Outpatient,1,mL,,16,13.6,4.5856,16,BlueCross BlueShield Minnesota,Medicare Advantage,7.84,49,,percent of total billed charges,,
"HEPARIN (PORCINE) 5,000 UNIT/ML INJ SOLN",,J1644,HCPCS,Facility,Inpatient,1,mL,,16,13.6,4.5856,16,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"HEPARIN (PORCINE) 5,000 UNIT/ML INJ SOLN",,J1644,HCPCS,Facility,Both,1,mL,,16,13.6,4.5856,16,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,14.1712,88.57,,percent of total billed charges,,
"HEPARIN (PORCINE) 5,000 UNIT/ML INJ SOLN",,J1644,HCPCS,Facility,Both,1,mL,,16,13.6,4.5856,16,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,4.5856,28.66,,percent of total billed charges,,
"HEPARIN (PORCINE) 5,000 UNIT/ML INJ SOLN",,J1644,HCPCS,Facility,Outpatient,1,mL,,16,13.6,4.5856,16,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),7.84,49,,percent of total billed charges,,
"HEPARIN (PORCINE) 5,000 UNIT/ML INJ SOLN",,J1644,HCPCS,Facility,Inpatient,1,mL,,16,13.6,4.5856,16,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"HEPARIN (PORCINE) 5,000 UNIT/ML INJ SOLN",,J1644,HCPCS,Facility,Both,1,mL,,16,13.6,4.5856,16,CorVel,Worker's Compensation,16,100,,percent of total billed charges,,
"HEPARIN (PORCINE) 5,000 UNIT/ML INJ SOLN",,J1644,HCPCS,Facility,Both,1,mL,,16,13.6,4.5856,16,First Health Group Corporation,First Health Network,15.52,97,,percent of total billed charges,,
"HEPARIN (PORCINE) 5,000 UNIT/ML INJ SOLN",,J1644,HCPCS,Facility,Both,1,mL,,16,13.6,4.5856,16,"Health Partners, Inc.",Commercial,15.136,94.6,,percent of total billed charges,,
"HEPARIN (PORCINE) 5,000 UNIT/ML INJ SOLN",,J1644,HCPCS,Facility,Outpatient,1,mL,,16,13.6,4.5856,16,"Health Partners, Inc.",Medicare Advantage,7.84,49,,percent of total billed charges,,
"HEPARIN (PORCINE) 5,000 UNIT/ML INJ SOLN",,J1644,HCPCS,Facility,Inpatient,1,mL,,16,13.6,4.5856,16,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"HEPARIN (PORCINE) 5,000 UNIT/ML INJ SOLN",,J1644,HCPCS,Facility,Both,1,mL,,16,13.6,4.5856,16,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),9.6,60,,percent of total billed charges,,
"HEPARIN (PORCINE) 5,000 UNIT/ML INJ SOLN",,J1644,HCPCS,Facility,Both,1,mL,,16,13.6,4.5856,16,"Health Partners, Inc.",State of Minnesota Advantage Program,13.04,81.5,,percent of total billed charges,,
"HEPARIN (PORCINE) 5,000 UNIT/ML INJ SOLN",,J1644,HCPCS,Facility,Both,1,mL,,16,13.6,4.5856,16,"Health Partners, Inc.",State Public Programs,8,50,,percent of total billed charges,,
"HEPARIN (PORCINE) 5,000 UNIT/ML INJ SOLN",,J1644,HCPCS,Facility,Both,1,mL,,16,13.6,4.5856,16,Humana Insurance Company,Commercial PPO,15.2,95,,percent of total billed charges,,
"HEPARIN (PORCINE) 5,000 UNIT/ML INJ SOLN",,J1644,HCPCS,Facility,Outpatient,1,mL,,16,13.6,4.5856,16,Humana Insurance Company,Medicare PPO,7.84,49,,percent of total billed charges,,
"HEPARIN (PORCINE) 5,000 UNIT/ML INJ SOLN",,J1644,HCPCS,Facility,Inpatient,1,mL,,16,13.6,4.5856,16,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"HEPARIN (PORCINE) 5,000 UNIT/ML INJ SOLN",,J1644,HCPCS,Facility,Both,1,mL,,16,13.6,4.5856,16,Medica,Individual & Family,15.856,99.1,,percent of total billed charges,,
"HEPARIN (PORCINE) 5,000 UNIT/ML INJ SOLN",,J1644,HCPCS,Facility,Outpatient,1,mL,,16,13.6,4.5856,16,Medica,Medica Advantage Solution,7.968,49.8,,percent of total billed charges,,
"HEPARIN (PORCINE) 5,000 UNIT/ML INJ SOLN",,J1644,HCPCS,Facility,Inpatient,1,mL,,16,13.6,4.5856,16,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"HEPARIN (PORCINE) 5,000 UNIT/ML INJ SOLN",,J1644,HCPCS,Facility,Outpatient,1,mL,,16,13.6,4.5856,16,Medica,Medical Assistance,7.136,44.6,,percent of total billed charges,,
"HEPARIN (PORCINE) 5,000 UNIT/ML INJ SOLN",,J1644,HCPCS,Facility,Inpatient,1,mL,,16,13.6,4.5856,16,Medica,Medical Assistance,,,,,Included in per diem rate,
"HEPARIN (PORCINE) 5,000 UNIT/ML INJ SOLN",,J1644,HCPCS,Facility,Outpatient,1,mL,,16,13.6,4.5856,16,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,7.968,49.8,,percent of total billed charges,,
"HEPARIN (PORCINE) 5,000 UNIT/ML INJ SOLN",,J1644,HCPCS,Facility,Inpatient,1,mL,,16,13.6,4.5856,16,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"HEPARIN (PORCINE) 5,000 UNIT/ML INJ SOLN",,J1644,HCPCS,Facility,Both,1,mL,,16,13.6,4.5856,16,"Multiplan, Inc.","Multiplan, Inc.",15.04,94,,percent of total billed charges,,
"HEPARIN (PORCINE) 5,000 UNIT/ML INJ SOLN",,J1644,HCPCS,Facility,Outpatient,1,mL,,16,13.6,4.5856,16,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,14.416,90.1,,percent of total billed charges,,
"HEPARIN (PORCINE) 5,000 UNIT/ML INJ SOLN",,J1644,HCPCS,Facility,Inpatient,1,mL,,16,13.6,4.5856,16,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"HEPARIN (PORCINE) 5,000 UNIT/ML INJ SOLN",,J1644,HCPCS,Facility,Both,1,mL,,16,13.6,4.5856,16,"Preferred One Administrative Services, INC.",PPO,15.776,98.6,,percent of total billed charges,,
"HEPARIN (PORCINE) 5,000 UNIT/ML INJ SOLN",,J1644,HCPCS,Facility,Outpatient,1,mL,,16,13.6,4.5856,16,PrimeWest Health,Minnesota Senior Health Options (MSHO),8.232,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"HEPARIN (PORCINE) 5,000 UNIT/ML INJ SOLN",,J1644,HCPCS,Facility,Inpatient,1,mL,,16,13.6,4.5856,16,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"HEPARIN (PORCINE) 5,000 UNIT/ML INJ SOLN",,J1644,HCPCS,Facility,Outpatient,1,mL,,16,13.6,4.5856,16,PrimeWest Health,MinnesotaCare,8.2176,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"HEPARIN (PORCINE) 5,000 UNIT/ML INJ SOLN",,J1644,HCPCS,Facility,Inpatient,1,mL,,16,13.6,4.5856,16,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"HEPARIN (PORCINE) 5,000 UNIT/ML INJ SOLN",,J1644,HCPCS,Facility,Both,1,mL,,16,13.6,4.5856,16,Sanford Health Plan,Sanford Health Plan,14.72,92,,percent of total billed charges,,
"HEPARIN (PORCINE) 5,000 UNIT/ML INJ SOLN",,J1644,HCPCS,Facility,Outpatient,1,mL,,16,13.6,4.5856,16,"UCare Health, Inc.",Individual & Family Plan,9.016,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"HEPARIN (PORCINE) 5,000 UNIT/ML INJ SOLN",,J1644,HCPCS,Facility,Inpatient,1,mL,,16,13.6,4.5856,16,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"HEPARIN (PORCINE) 5,000 UNIT/ML INJ SOLN",,J1644,HCPCS,Facility,Outpatient,1,mL,,16,13.6,4.5856,16,"UCare Health, Inc.",Medical Assistance,8.0752,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"HEPARIN (PORCINE) 5,000 UNIT/ML INJ SOLN",,J1644,HCPCS,Facility,Inpatient,1,mL,,16,13.6,4.5856,16,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"HEPARIN (PORCINE) 5,000 UNIT/ML INJ SOLN",,J1644,HCPCS,Facility,Outpatient,1,mL,,16,13.6,4.5856,16,"UCare Health, Inc.",Medicare Advantage,8.0752,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"HEPARIN (PORCINE) 5,000 UNIT/ML INJ SOLN",,J1644,HCPCS,Facility,Inpatient,1,mL,,16,13.6,4.5856,16,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"HEPARIN (PORCINE) 5,000 UNIT/ML INJ SOLN",,J1644,HCPCS,Facility,Outpatient,1,mL,,16,13.6,4.5856,16,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),8.0752,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"HEPARIN (PORCINE) 5,000 UNIT/ML INJ SOLN",,J1644,HCPCS,Facility,Inpatient,1,mL,,16,13.6,4.5856,16,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"HEPARIN (PORCINE) 5,000 UNIT/ML INJ SOLN",,J1644,HCPCS,Facility,Both,1,mL,,16,13.6,4.5856,16,UnitedHealthcare,Individual & Family,15.04,94,,percent of total billed charges,,
"HEPARIN (PORCINE) 5,000 UNIT/ML INJ SOLN",,J1644,HCPCS,Facility,Outpatient,1,mL,,16,13.6,4.5856,16,UnitedHealthcare,Medicare Advantage,7.84,49,,percent of total billed charges,,
"HEPARIN (PORCINE) 5,000 UNIT/ML INJ SOLN",,J1644,HCPCS,Facility,Inpatient,1,mL,,16,13.6,4.5856,16,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"HEPARIN (PORCINE) 5,000 UNIT/ML INJ SOLN",,J1644,HCPCS,Facility,Outpatient,1,mL,,16,13.6,4.5856,16,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,7.68,48,,percent of total billed charges,,100% of DHS outpatient percentage
"HEPARIN (PORCINE) 5,000 UNIT/ML INJ SOLN",,J1644,HCPCS,Facility,Inpatient,1,mL,,16,13.6,4.5856,16,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Arthroscopy, Knee; W Meniscectomy Inc Debride/Shave Articular Cartilage, Same/Sep Compart (Pro Cah)",,29880,CPT,Professional,Both,,,,4300,3655,351.88,4300,Aetna,Commercial,3655,85,,percent of total billed charges,,
"Arthroscopy, Knee; W Meniscectomy Inc Debride/Shave Articular Cartilage, Same/Sep Compart (Pro Cah)",,29880,CPT,Professional,Both,,,,4300,3655,351.88,4300,Aetna,Medicare Advantage,551.07,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Arthroscopy, Knee; W Meniscectomy Inc Debride/Shave Articular Cartilage, Same/Sep Compart (Pro Cah)",,29880,CPT,Professional,Both,,,,4300,3655,351.88,4300,Aetna,PPO,3999,93,,percent of total billed charges,,
"Arthroscopy, Knee; W Meniscectomy Inc Debride/Shave Articular Cartilage, Same/Sep Compart (Pro Cah)",,29880,CPT,Professional,Both,,,,4300,3655,351.88,4300,America's PPO,America's PPO,3673.92,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Arthroscopy, Knee; W Meniscectomy Inc Debride/Shave Articular Cartilage, Same/Sep Compart (Pro Cah)",,29880,CPT,Professional,Both,,,,4300,3655,351.88,4300,BlueCross BlueShield Minnesota, Federal Employee Program,1167.87,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Arthroscopy, Knee; W Meniscectomy Inc Debride/Shave Articular Cartilage, Same/Sep Compart (Pro Cah)",,29880,CPT,Professional,Both,,,,4300,3655,351.88,4300,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1186.55592,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Arthroscopy, Knee; W Meniscectomy Inc Debride/Shave Articular Cartilage, Same/Sep Compart (Pro Cah)",,29880,CPT,Professional,Both,,,,4300,3655,351.88,4300,BlueCross BlueShield Minnesota,High Value Network Plan,1186.55592,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Arthroscopy, Knee; W Meniscectomy Inc Debride/Shave Articular Cartilage, Same/Sep Compart (Pro Cah)",,29880,CPT,Professional,Both,,,,4300,3655,351.88,4300,BlueCross BlueShield Minnesota,Medicare Advantage,628.866,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Arthroscopy, Knee; W Meniscectomy Inc Debride/Shave Articular Cartilage, Same/Sep Compart (Pro Cah)",,29880,CPT,Professional,Both,,,,4300,3655,351.88,4300,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1186.55592,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Arthroscopy, Knee; W Meniscectomy Inc Debride/Shave Articular Cartilage, Same/Sep Compart (Pro Cah)",,29880,CPT,Professional,Both,,,,4300,3655,351.88,4300,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,406.25776,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Arthroscopy, Knee; W Meniscectomy Inc Debride/Shave Articular Cartilage, Same/Sep Compart (Pro Cah)",,29880,CPT,Professional,Both,,,,4300,3655,351.88,4300,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),628.866,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Arthroscopy, Knee; W Meniscectomy Inc Debride/Shave Articular Cartilage, Same/Sep Compart (Pro Cah)",,29880,CPT,Professional,Both,,,,4300,3655,351.88,4300,CorVel,Worker's Compensation,1066.298225,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Arthroscopy, Knee; W Meniscectomy Inc Debride/Shave Articular Cartilage, Same/Sep Compart (Pro Cah)",,29880,CPT,Professional,Both,,,,4300,3655,351.88,4300,First Health Group Corporation,First Health Network,4171,97,,percent of total billed charges,,
"Arthroscopy, Knee; W Meniscectomy Inc Debride/Shave Articular Cartilage, Same/Sep Compart (Pro Cah)",,29880,CPT,Professional,Both,,,,4300,3655,351.88,4300,"Health Partners, Inc.",Commercial,1151.41,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Arthroscopy, Knee; W Meniscectomy Inc Debride/Shave Articular Cartilage, Same/Sep Compart (Pro Cah)",,29880,CPT,Professional,Both,,,,4300,3655,351.88,4300,"Health Partners, Inc.",Medicare Advantage,628.866,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Arthroscopy, Knee; W Meniscectomy Inc Debride/Shave Articular Cartilage, Same/Sep Compart (Pro Cah)",,29880,CPT,Professional,Both,,,,4300,3655,351.88,4300,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),546.6,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Arthroscopy, Knee; W Meniscectomy Inc Debride/Shave Articular Cartilage, Same/Sep Compart (Pro Cah)",,29880,CPT,Professional,Both,,,,4300,3655,351.88,4300,"Health Partners, Inc.",State of Minnesota Advantage Program,991.939715,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Arthroscopy, Knee; W Meniscectomy Inc Debride/Shave Articular Cartilage, Same/Sep Compart (Pro Cah)",,29880,CPT,Professional,Both,,,,4300,3655,351.88,4300,"Health Partners, Inc.",State Public Programs,351.88,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Arthroscopy, Knee; W Meniscectomy Inc Debride/Shave Articular Cartilage, Same/Sep Compart (Pro Cah)",,29880,CPT,Professional,Both,,,,4300,3655,351.88,4300,Humana Insurance Company,Commercial PPO,546.84,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Arthroscopy, Knee; W Meniscectomy Inc Debride/Shave Articular Cartilage, Same/Sep Compart (Pro Cah)",,29880,CPT,Professional,Both,,,,4300,3655,351.88,4300,Humana Insurance Company,Medicare PPO,4300,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Arthroscopy, Knee; W Meniscectomy Inc Debride/Shave Articular Cartilage, Same/Sep Compart (Pro Cah)",,29880,CPT,Professional,Both,,,,4300,3655,351.88,4300,Medica,Individual & Family,3646.4,84.8,,percent of total billed charges,,
"Arthroscopy, Knee; W Meniscectomy Inc Debride/Shave Articular Cartilage, Same/Sep Compart (Pro Cah)",,29880,CPT,Professional,Both,,,,4300,3655,351.88,4300,Medica,Medica Advantage Solution,2141.4,49.8,,percent of total billed charges,,
"Arthroscopy, Knee; W Meniscectomy Inc Debride/Shave Articular Cartilage, Same/Sep Compart (Pro Cah)",,29880,CPT,Professional,Both,,,,4300,3655,351.88,4300,Medica,Medical Assistance,406.26,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Arthroscopy, Knee; W Meniscectomy Inc Debride/Shave Articular Cartilage, Same/Sep Compart (Pro Cah)",,29880,CPT,Professional,Both,,,,4300,3655,351.88,4300,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,546.84,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Arthroscopy, Knee; W Meniscectomy Inc Debride/Shave Articular Cartilage, Same/Sep Compart (Pro Cah)",,29880,CPT,Professional,Both,,,,4300,3655,351.88,4300,"Multiplan, Inc.","Multiplan, Inc.",4042,94,,percent of total billed charges,,
"Arthroscopy, Knee; W Meniscectomy Inc Debride/Shave Articular Cartilage, Same/Sep Compart (Pro Cah)",,29880,CPT,Professional,Both,,,,4300,3655,351.88,4300,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,3874.3,90.1,,percent of total billed charges,,
"Arthroscopy, Knee; W Meniscectomy Inc Debride/Shave Articular Cartilage, Same/Sep Compart (Pro Cah)",,29880,CPT,Professional,Both,,,,4300,3655,351.88,4300,"Preferred One Administrative Services, INC.",PPO,4239.8,98.6,,percent of total billed charges,,
"Arthroscopy, Knee; W Meniscectomy Inc Debride/Shave Articular Cartilage, Same/Sep Compart (Pro Cah)",,29880,CPT,Professional,Both,,,,4300,3655,351.88,4300,PrimeWest Health,Minnesota Senior Health Options (MSHO),628.866,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Arthroscopy, Knee; W Meniscectomy Inc Debride/Shave Articular Cartilage, Same/Sep Compart (Pro Cah)",,29880,CPT,Professional,Both,,,,4300,3655,351.88,4300,PrimeWest Health,MinnesotaCare,434.6958032,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Arthroscopy, Knee; W Meniscectomy Inc Debride/Shave Articular Cartilage, Same/Sep Compart (Pro Cah)",,29880,CPT,Professional,Both,,,,4300,3655,351.88,4300,Sanford Health Plan,Sanford Health Plan,3784,88,,percent of total billed charges,,
"Arthroscopy, Knee; W Meniscectomy Inc Debride/Shave Articular Cartilage, Same/Sep Compart (Pro Cah)",,29880,CPT,Professional,Both,,,,4300,3655,351.88,4300,"UCare Health, Inc.",Individual & Family Plan,888.943104,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Arthroscopy, Knee; W Meniscectomy Inc Debride/Shave Articular Cartilage, Same/Sep Compart (Pro Cah)",,29880,CPT,Professional,Both,,,,4300,3655,351.88,4300,"UCare Health, Inc.",Medical Assistance,446.883536,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Arthroscopy, Knee; W Meniscectomy Inc Debride/Shave Articular Cartilage, Same/Sep Compart (Pro Cah)",,29880,CPT,Professional,Both,,,,4300,3655,351.88,4300,"UCare Health, Inc.",Medicare Advantage,628.866,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Arthroscopy, Knee; W Meniscectomy Inc Debride/Shave Articular Cartilage, Same/Sep Compart (Pro Cah)",,29880,CPT,Professional,Both,,,,4300,3655,351.88,4300,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),503.0928,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Arthroscopy, Knee; W Meniscectomy Inc Debride/Shave Articular Cartilage, Same/Sep Compart (Pro Cah)",,29880,CPT,Professional,Both,,,,4300,3655,351.88,4300,UnitedHealthcare,Individual & Family,4300,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Arthroscopy, Knee; W Meniscectomy Inc Debride/Shave Articular Cartilage, Same/Sep Compart (Pro Cah)",,29880,CPT,Professional,Both,,,,4300,3655,351.88,4300,UnitedHealthcare,Medicare Advantage,628.866,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Arthroscopy, Knee; W Meniscectomy Inc Debride/Shave Articular Cartilage, Same/Sep Compart (Pro Cah)",,29880,CPT,Professional,Both,,,,4300,3655,351.88,4300,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,406.25776,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Knee Arthroscopy; W/ Meniscectomy, Medial Or Lateral (Pro Cah)",,29881,CPT,Professional,Both,,,,3600,3060,339.44,3600,Aetna,Commercial,3060,85,,percent of total billed charges,,
"Knee Arthroscopy; W/ Meniscectomy, Medial Or Lateral (Pro Cah)",,29881,CPT,Professional,Both,,,,3600,3060,339.44,3600,Aetna,Medicare Advantage,531.76,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Knee Arthroscopy; W/ Meniscectomy, Medial Or Lateral (Pro Cah)",,29881,CPT,Professional,Both,,,,3600,3060,339.44,3600,Aetna,PPO,3348,93,,percent of total billed charges,,
"Knee Arthroscopy; W/ Meniscectomy, Medial Or Lateral (Pro Cah)",,29881,CPT,Professional,Both,,,,3600,3060,339.44,3600,America's PPO,America's PPO,3075.84,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Knee Arthroscopy; W/ Meniscectomy, Medial Or Lateral (Pro Cah)",,29881,CPT,Professional,Both,,,,3600,3060,339.44,3600,BlueCross BlueShield Minnesota, Federal Employee Program,1124.48,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Knee Arthroscopy; W/ Meniscectomy, Medial Or Lateral (Pro Cah)",,29881,CPT,Professional,Both,,,,3600,3060,339.44,3600,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1142.47168,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Knee Arthroscopy; W/ Meniscectomy, Medial Or Lateral (Pro Cah)",,29881,CPT,Professional,Both,,,,3600,3060,339.44,3600,BlueCross BlueShield Minnesota,High Value Network Plan,1142.47168,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Knee Arthroscopy; W/ Meniscectomy, Medial Or Lateral (Pro Cah)",,29881,CPT,Professional,Both,,,,3600,3060,339.44,3600,BlueCross BlueShield Minnesota,Medicare Advantage,606.5445,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Knee Arthroscopy; W/ Meniscectomy, Medial Or Lateral (Pro Cah)",,29881,CPT,Professional,Both,,,,3600,3060,339.44,3600,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1142.47168,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Knee Arthroscopy; W/ Meniscectomy, Medial Or Lateral (Pro Cah)",,29881,CPT,Professional,Both,,,,3600,3060,339.44,3600,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,391.90168,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Knee Arthroscopy; W/ Meniscectomy, Medial Or Lateral (Pro Cah)",,29881,CPT,Professional,Both,,,,3600,3060,339.44,3600,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),606.5445,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Knee Arthroscopy; W/ Meniscectomy, Medial Or Lateral (Pro Cah)",,29881,CPT,Professional,Both,,,,3600,3060,339.44,3600,CorVel,Worker's Compensation,1028.209477,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Knee Arthroscopy; W/ Meniscectomy, Medial Or Lateral (Pro Cah)",,29881,CPT,Professional,Both,,,,3600,3060,339.44,3600,First Health Group Corporation,First Health Network,3492,97,,percent of total billed charges,,
"Knee Arthroscopy; W/ Meniscectomy, Medial Or Lateral (Pro Cah)",,29881,CPT,Professional,Both,,,,3600,3060,339.44,3600,"Health Partners, Inc.",Commercial,1110.78,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Knee Arthroscopy; W/ Meniscectomy, Medial Or Lateral (Pro Cah)",,29881,CPT,Professional,Both,,,,3600,3060,339.44,3600,"Health Partners, Inc.",Medicare Advantage,606.5445,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Knee Arthroscopy; W/ Meniscectomy, Medial Or Lateral (Pro Cah)",,29881,CPT,Professional,Both,,,,3600,3060,339.44,3600,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),527.28,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Knee Arthroscopy; W/ Meniscectomy, Medial Or Lateral (Pro Cah)",,29881,CPT,Professional,Both,,,,3600,3060,339.44,3600,"Health Partners, Inc.",State of Minnesota Advantage Program,956.93697,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Knee Arthroscopy; W/ Meniscectomy, Medial Or Lateral (Pro Cah)",,29881,CPT,Professional,Both,,,,3600,3060,339.44,3600,"Health Partners, Inc.",State Public Programs,339.44,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Knee Arthroscopy; W/ Meniscectomy, Medial Or Lateral (Pro Cah)",,29881,CPT,Professional,Both,,,,3600,3060,339.44,3600,Humana Insurance Company,Commercial PPO,527.43,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Knee Arthroscopy; W/ Meniscectomy, Medial Or Lateral (Pro Cah)",,29881,CPT,Professional,Both,,,,3600,3060,339.44,3600,Humana Insurance Company,Medicare PPO,3600,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Knee Arthroscopy; W/ Meniscectomy, Medial Or Lateral (Pro Cah)",,29881,CPT,Professional,Both,,,,3600,3060,339.44,3600,Medica,Individual & Family,3052.8,84.8,,percent of total billed charges,,
"Knee Arthroscopy; W/ Meniscectomy, Medial Or Lateral (Pro Cah)",,29881,CPT,Professional,Both,,,,3600,3060,339.44,3600,Medica,Medica Advantage Solution,1792.8,49.8,,percent of total billed charges,,
"Knee Arthroscopy; W/ Meniscectomy, Medial Or Lateral (Pro Cah)",,29881,CPT,Professional,Both,,,,3600,3060,339.44,3600,Medica,Medical Assistance,391.9,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Knee Arthroscopy; W/ Meniscectomy, Medial Or Lateral (Pro Cah)",,29881,CPT,Professional,Both,,,,3600,3060,339.44,3600,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,527.43,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Knee Arthroscopy; W/ Meniscectomy, Medial Or Lateral (Pro Cah)",,29881,CPT,Professional,Both,,,,3600,3060,339.44,3600,"Multiplan, Inc.","Multiplan, Inc.",3384,94,,percent of total billed charges,,
"Knee Arthroscopy; W/ Meniscectomy, Medial Or Lateral (Pro Cah)",,29881,CPT,Professional,Both,,,,3600,3060,339.44,3600,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,3243.6,90.1,,percent of total billed charges,,
"Knee Arthroscopy; W/ Meniscectomy, Medial Or Lateral (Pro Cah)",,29881,CPT,Professional,Both,,,,3600,3060,339.44,3600,"Preferred One Administrative Services, INC.",PPO,3549.6,98.6,,percent of total billed charges,,
"Knee Arthroscopy; W/ Meniscectomy, Medial Or Lateral (Pro Cah)",,29881,CPT,Professional,Both,,,,3600,3060,339.44,3600,PrimeWest Health,Minnesota Senior Health Options (MSHO),606.5445,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Knee Arthroscopy; W/ Meniscectomy, Medial Or Lateral (Pro Cah)",,29881,CPT,Professional,Both,,,,3600,3060,339.44,3600,PrimeWest Health,MinnesotaCare,419.3347976,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Knee Arthroscopy; W/ Meniscectomy, Medial Or Lateral (Pro Cah)",,29881,CPT,Professional,Both,,,,3600,3060,339.44,3600,Sanford Health Plan,Sanford Health Plan,3168,88,,percent of total billed charges,,
"Knee Arthroscopy; W/ Meniscectomy, Medial Or Lateral (Pro Cah)",,29881,CPT,Professional,Both,,,,3600,3060,339.44,3600,"UCare Health, Inc.",Individual & Family Plan,857.390208,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Knee Arthroscopy; W/ Meniscectomy, Medial Or Lateral (Pro Cah)",,29881,CPT,Professional,Both,,,,3600,3060,339.44,3600,"UCare Health, Inc.",Medical Assistance,431.091848,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Knee Arthroscopy; W/ Meniscectomy, Medial Or Lateral (Pro Cah)",,29881,CPT,Professional,Both,,,,3600,3060,339.44,3600,"UCare Health, Inc.",Medicare Advantage,606.5445,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Knee Arthroscopy; W/ Meniscectomy, Medial Or Lateral (Pro Cah)",,29881,CPT,Professional,Both,,,,3600,3060,339.44,3600,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),485.2356,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Knee Arthroscopy; W/ Meniscectomy, Medial Or Lateral (Pro Cah)",,29881,CPT,Professional,Both,,,,3600,3060,339.44,3600,UnitedHealthcare,Individual & Family,3600,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Knee Arthroscopy; W/ Meniscectomy, Medial Or Lateral (Pro Cah)",,29881,CPT,Professional,Both,,,,3600,3060,339.44,3600,UnitedHealthcare,Medicare Advantage,606.5445,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Knee Arthroscopy; W/ Meniscectomy, Medial Or Lateral (Pro Cah)",,29881,CPT,Professional,Both,,,,3600,3060,339.44,3600,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,391.90168,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision Inferior Turbinate, Partial Or Complete, Any Method (Pro Cah)",,30130,CPT,Professional,Both,,,,1326,1127.1,272.69,1326,Aetna,Commercial,1127.1,85,,percent of total billed charges,,
"Excision Inferior Turbinate, Partial Or Complete, Any Method (Pro Cah)",,30130,CPT,Professional,Both,,,,1326,1127.1,272.69,1326,Aetna,Medicare Advantage,421.89,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision Inferior Turbinate, Partial Or Complete, Any Method (Pro Cah)",,30130,CPT,Professional,Both,,,,1326,1127.1,272.69,1326,Aetna,PPO,1233.18,93,,percent of total billed charges,,
"Excision Inferior Turbinate, Partial Or Complete, Any Method (Pro Cah)",,30130,CPT,Professional,Both,,,,1326,1127.1,272.69,1326,America's PPO,America's PPO,1132.9344,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Excision Inferior Turbinate, Partial Or Complete, Any Method (Pro Cah)",,30130,CPT,Professional,Both,,,,1326,1127.1,272.69,1326,BlueCross BlueShield Minnesota, Federal Employee Program,872.46,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Excision Inferior Turbinate, Partial Or Complete, Any Method (Pro Cah)",,30130,CPT,Professional,Both,,,,1326,1127.1,272.69,1326,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,886.41936,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision Inferior Turbinate, Partial Or Complete, Any Method (Pro Cah)",,30130,CPT,Professional,Both,,,,1326,1127.1,272.69,1326,BlueCross BlueShield Minnesota,High Value Network Plan,886.41936,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision Inferior Turbinate, Partial Or Complete, Any Method (Pro Cah)",,30130,CPT,Professional,Both,,,,1326,1127.1,272.69,1326,BlueCross BlueShield Minnesota,Medicare Advantage,487.3355,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision Inferior Turbinate, Partial Or Complete, Any Method (Pro Cah)",,30130,CPT,Professional,Both,,,,1326,1127.1,272.69,1326,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,886.41936,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision Inferior Turbinate, Partial Or Complete, Any Method (Pro Cah)",,30130,CPT,Professional,Both,,,,1326,1127.1,272.69,1326,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,314.82792,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision Inferior Turbinate, Partial Or Complete, Any Method (Pro Cah)",,30130,CPT,Professional,Both,,,,1326,1127.1,272.69,1326,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),487.3355,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision Inferior Turbinate, Partial Or Complete, Any Method (Pro Cah)",,30130,CPT,Professional,Both,,,,1326,1127.1,272.69,1326,CorVel,Worker's Compensation,834.1587054,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Excision Inferior Turbinate, Partial Or Complete, Any Method (Pro Cah)",,30130,CPT,Professional,Both,,,,1326,1127.1,272.69,1326,First Health Group Corporation,First Health Network,1286.22,97,,percent of total billed charges,,
"Excision Inferior Turbinate, Partial Or Complete, Any Method (Pro Cah)",,30130,CPT,Professional,Both,,,,1326,1127.1,272.69,1326,"Health Partners, Inc.",Commercial,901.1,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision Inferior Turbinate, Partial Or Complete, Any Method (Pro Cah)",,30130,CPT,Professional,Both,,,,1326,1127.1,272.69,1326,"Health Partners, Inc.",Medicare Advantage,487.3355,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision Inferior Turbinate, Partial Or Complete, Any Method (Pro Cah)",,30130,CPT,Professional,Both,,,,1326,1127.1,272.69,1326,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),423.93,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Excision Inferior Turbinate, Partial Or Complete, Any Method (Pro Cah)",,30130,CPT,Professional,Both,,,,1326,1127.1,272.69,1326,"Health Partners, Inc.",State of Minnesota Advantage Program,776.29765,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision Inferior Turbinate, Partial Or Complete, Any Method (Pro Cah)",,30130,CPT,Professional,Both,,,,1326,1127.1,272.69,1326,"Health Partners, Inc.",State Public Programs,272.69,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Excision Inferior Turbinate, Partial Or Complete, Any Method (Pro Cah)",,30130,CPT,Professional,Both,,,,1326,1127.1,272.69,1326,Humana Insurance Company,Commercial PPO,423.77,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Excision Inferior Turbinate, Partial Or Complete, Any Method (Pro Cah)",,30130,CPT,Professional,Both,,,,1326,1127.1,272.69,1326,Humana Insurance Company,Medicare PPO,1326,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Excision Inferior Turbinate, Partial Or Complete, Any Method (Pro Cah)",,30130,CPT,Professional,Both,,,,1326,1127.1,272.69,1326,Medica,Individual & Family,1124.448,84.8,,percent of total billed charges,,
"Excision Inferior Turbinate, Partial Or Complete, Any Method (Pro Cah)",,30130,CPT,Professional,Both,,,,1326,1127.1,272.69,1326,Medica,Medica Advantage Solution,660.348,49.8,,percent of total billed charges,,
"Excision Inferior Turbinate, Partial Or Complete, Any Method (Pro Cah)",,30130,CPT,Professional,Both,,,,1326,1127.1,272.69,1326,Medica,Medical Assistance,314.83,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Excision Inferior Turbinate, Partial Or Complete, Any Method (Pro Cah)",,30130,CPT,Professional,Both,,,,1326,1127.1,272.69,1326,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,423.77,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Excision Inferior Turbinate, Partial Or Complete, Any Method (Pro Cah)",,30130,CPT,Professional,Both,,,,1326,1127.1,272.69,1326,"Multiplan, Inc.","Multiplan, Inc.",1246.44,94,,percent of total billed charges,,
"Excision Inferior Turbinate, Partial Or Complete, Any Method (Pro Cah)",,30130,CPT,Professional,Both,,,,1326,1127.1,272.69,1326,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1194.726,90.1,,percent of total billed charges,,
"Excision Inferior Turbinate, Partial Or Complete, Any Method (Pro Cah)",,30130,CPT,Professional,Both,,,,1326,1127.1,272.69,1326,"Preferred One Administrative Services, INC.",PPO,1307.436,98.6,,percent of total billed charges,,
"Excision Inferior Turbinate, Partial Or Complete, Any Method (Pro Cah)",,30130,CPT,Professional,Both,,,,1326,1127.1,272.69,1326,PrimeWest Health,Minnesota Senior Health Options (MSHO),487.3355,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision Inferior Turbinate, Partial Or Complete, Any Method (Pro Cah)",,30130,CPT,Professional,Both,,,,1326,1127.1,272.69,1326,PrimeWest Health,MinnesotaCare,336.8658744,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision Inferior Turbinate, Partial Or Complete, Any Method (Pro Cah)",,30130,CPT,Professional,Both,,,,1326,1127.1,272.69,1326,Sanford Health Plan,Sanford Health Plan,1166.88,88,,percent of total billed charges,,
"Excision Inferior Turbinate, Partial Or Complete, Any Method (Pro Cah)",,30130,CPT,Professional,Both,,,,1326,1127.1,272.69,1326,"UCare Health, Inc.",Individual & Family Plan,688.880512,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Excision Inferior Turbinate, Partial Or Complete, Any Method (Pro Cah)",,30130,CPT,Professional,Both,,,,1326,1127.1,272.69,1326,"UCare Health, Inc.",Medical Assistance,346.310712,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Excision Inferior Turbinate, Partial Or Complete, Any Method (Pro Cah)",,30130,CPT,Professional,Both,,,,1326,1127.1,272.69,1326,"UCare Health, Inc.",Medicare Advantage,487.3355,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Excision Inferior Turbinate, Partial Or Complete, Any Method (Pro Cah)",,30130,CPT,Professional,Both,,,,1326,1127.1,272.69,1326,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),389.8684,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Excision Inferior Turbinate, Partial Or Complete, Any Method (Pro Cah)",,30130,CPT,Professional,Both,,,,1326,1127.1,272.69,1326,UnitedHealthcare,Individual & Family,1326,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Excision Inferior Turbinate, Partial Or Complete, Any Method (Pro Cah)",,30130,CPT,Professional,Both,,,,1326,1127.1,272.69,1326,UnitedHealthcare,Medicare Advantage,487.3355,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision Inferior Turbinate, Partial Or Complete, Any Method (Pro Cah)",,30130,CPT,Professional,Both,,,,1326,1127.1,272.69,1326,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,314.82792,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Removal Foreign Body, Intranasal",,30300,CPT,Facility,Both,,,,291,247.35,83.4006,291,Aetna,Commercial,267.72,92,,percent of total billed charges,,
"Removal Foreign Body, Intranasal",,30300,CPT,Facility,Outpatient,,,,291,247.35,83.4006,291,Aetna,Medicare Advantage,142.59,49,,percent of total billed charges,,
"Removal Foreign Body, Intranasal",,30300,CPT,Facility,Inpatient,,,,291,247.35,83.4006,291,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Removal Foreign Body, Intranasal",,30300,CPT,Facility,Both,,,,291,247.35,83.4006,291,Aetna,PPO,270.63,93,,percent of total billed charges,,
"Removal Foreign Body, Intranasal",,30300,CPT,Facility,Both,,,,291,247.35,83.4006,291,America's PPO,America's PPO,279.4473,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Removal Foreign Body, Intranasal",,30300,CPT,Facility,Both,,,,291,247.35,83.4006,291,BlueCross BlueShield Minnesota, Federal Employee Program,286.344,98.4,,percent of total billed charges,,
"Removal Foreign Body, Intranasal",,30300,CPT,Facility,Both,,,,291,247.35,83.4006,291,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,291,100,,percent of total billed charges,,
"Removal Foreign Body, Intranasal",,30300,CPT,Facility,Both,,,,291,247.35,83.4006,291,BlueCross BlueShield Minnesota,High Value Network Plan,261.9,90,,percent of total billed charges,,
"Removal Foreign Body, Intranasal",,30300,CPT,Facility,Outpatient,,,,291,247.35,83.4006,291,BlueCross BlueShield Minnesota,Medicare Advantage,142.59,49,,percent of total billed charges,,
"Removal Foreign Body, Intranasal",,30300,CPT,Facility,Inpatient,,,,291,247.35,83.4006,291,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Removal Foreign Body, Intranasal",,30300,CPT,Facility,Both,,,,291,247.35,83.4006,291,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,257.7387,88.57,,percent of total billed charges,,
"Removal Foreign Body, Intranasal",,30300,CPT,Facility,Both,,,,291,247.35,83.4006,291,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,83.4006,28.66,,percent of total billed charges,,
"Removal Foreign Body, Intranasal",,30300,CPT,Facility,Outpatient,,,,291,247.35,83.4006,291,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),142.59,49,,percent of total billed charges,,
"Removal Foreign Body, Intranasal",,30300,CPT,Facility,Inpatient,,,,291,247.35,83.4006,291,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Removal Foreign Body, Intranasal",,30300,CPT,Facility,Both,,,,291,247.35,83.4006,291,CorVel,Worker's Compensation,291,100,,percent of total billed charges,,
"Removal Foreign Body, Intranasal",,30300,CPT,Facility,Both,,,,291,247.35,83.4006,291,First Health Group Corporation,First Health Network,282.27,97,,percent of total billed charges,,
"Removal Foreign Body, Intranasal",,30300,CPT,Facility,Both,,,,291,247.35,83.4006,291,"Health Partners, Inc.",Commercial,275.286,94.6,,percent of total billed charges,,
"Removal Foreign Body, Intranasal",,30300,CPT,Facility,Outpatient,,,,291,247.35,83.4006,291,"Health Partners, Inc.",Medicare Advantage,142.59,49,,percent of total billed charges,,
"Removal Foreign Body, Intranasal",,30300,CPT,Facility,Inpatient,,,,291,247.35,83.4006,291,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Removal Foreign Body, Intranasal",,30300,CPT,Facility,Both,,,,291,247.35,83.4006,291,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),174.6,60,,percent of total billed charges,,
"Removal Foreign Body, Intranasal",,30300,CPT,Facility,Both,,,,291,247.35,83.4006,291,"Health Partners, Inc.",State of Minnesota Advantage Program,237.165,81.5,,percent of total billed charges,,
"Removal Foreign Body, Intranasal",,30300,CPT,Facility,Both,,,,291,247.35,83.4006,291,"Health Partners, Inc.",State Public Programs,145.5,50,,percent of total billed charges,,
"Removal Foreign Body, Intranasal",,30300,CPT,Facility,Both,,,,291,247.35,83.4006,291,Humana Insurance Company,Commercial PPO,276.45,95,,percent of total billed charges,,
"Removal Foreign Body, Intranasal",,30300,CPT,Facility,Outpatient,,,,291,247.35,83.4006,291,Humana Insurance Company,Medicare PPO,142.59,49,,percent of total billed charges,,
"Removal Foreign Body, Intranasal",,30300,CPT,Facility,Inpatient,,,,291,247.35,83.4006,291,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Removal Foreign Body, Intranasal",,30300,CPT,Facility,Both,,,,291,247.35,83.4006,291,Medica,Individual & Family,288.381,99.1,,percent of total billed charges,,
"Removal Foreign Body, Intranasal",,30300,CPT,Facility,Outpatient,,,,291,247.35,83.4006,291,Medica,Medica Advantage Solution,144.918,49.8,,percent of total billed charges,,
"Removal Foreign Body, Intranasal",,30300,CPT,Facility,Inpatient,,,,291,247.35,83.4006,291,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Removal Foreign Body, Intranasal",,30300,CPT,Facility,Outpatient,,,,291,247.35,83.4006,291,Medica,Medical Assistance,129.786,44.6,,percent of total billed charges,,
"Removal Foreign Body, Intranasal",,30300,CPT,Facility,Inpatient,,,,291,247.35,83.4006,291,Medica,Medical Assistance,,,,,Included in per diem rate,
"Removal Foreign Body, Intranasal",,30300,CPT,Facility,Outpatient,,,,291,247.35,83.4006,291,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,144.918,49.8,,percent of total billed charges,,
"Removal Foreign Body, Intranasal",,30300,CPT,Facility,Inpatient,,,,291,247.35,83.4006,291,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Removal Foreign Body, Intranasal",,30300,CPT,Facility,Both,,,,291,247.35,83.4006,291,"Multiplan, Inc.","Multiplan, Inc.",273.54,94,,percent of total billed charges,,
"Removal Foreign Body, Intranasal",,30300,CPT,Facility,Outpatient,,,,291,247.35,83.4006,291,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,262.191,90.1,,percent of total billed charges,,
"Removal Foreign Body, Intranasal",,30300,CPT,Facility,Inpatient,,,,291,247.35,83.4006,291,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Removal Foreign Body, Intranasal",,30300,CPT,Facility,Both,,,,291,247.35,83.4006,291,"Preferred One Administrative Services, INC.",PPO,286.926,98.6,,percent of total billed charges,,
"Removal Foreign Body, Intranasal",,30300,CPT,Facility,Outpatient,,,,291,247.35,83.4006,291,PrimeWest Health,Minnesota Senior Health Options (MSHO),149.7195,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Removal Foreign Body, Intranasal",,30300,CPT,Facility,Inpatient,,,,291,247.35,83.4006,291,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Removal Foreign Body, Intranasal",,30300,CPT,Facility,Outpatient,,,,291,247.35,83.4006,291,PrimeWest Health,MinnesotaCare,149.4576,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Removal Foreign Body, Intranasal",,30300,CPT,Facility,Inpatient,,,,291,247.35,83.4006,291,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Removal Foreign Body, Intranasal",,30300,CPT,Facility,Both,,,,291,247.35,83.4006,291,Sanford Health Plan,Sanford Health Plan,267.72,92,,percent of total billed charges,,
"Removal Foreign Body, Intranasal",,30300,CPT,Facility,Outpatient,,,,291,247.35,83.4006,291,"UCare Health, Inc.",Individual & Family Plan,163.9785,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Removal Foreign Body, Intranasal",,30300,CPT,Facility,Inpatient,,,,291,247.35,83.4006,291,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Removal Foreign Body, Intranasal",,30300,CPT,Facility,Outpatient,,,,291,247.35,83.4006,291,"UCare Health, Inc.",Medical Assistance,146.8677,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Removal Foreign Body, Intranasal",,30300,CPT,Facility,Inpatient,,,,291,247.35,83.4006,291,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Removal Foreign Body, Intranasal",,30300,CPT,Facility,Outpatient,,,,291,247.35,83.4006,291,"UCare Health, Inc.",Medicare Advantage,146.8677,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Removal Foreign Body, Intranasal",,30300,CPT,Facility,Inpatient,,,,291,247.35,83.4006,291,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Removal Foreign Body, Intranasal",,30300,CPT,Facility,Outpatient,,,,291,247.35,83.4006,291,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),146.8677,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Removal Foreign Body, Intranasal",,30300,CPT,Facility,Inpatient,,,,291,247.35,83.4006,291,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Removal Foreign Body, Intranasal",,30300,CPT,Facility,Both,,,,291,247.35,83.4006,291,UnitedHealthcare,Individual & Family,273.54,94,,percent of total billed charges,,
"Removal Foreign Body, Intranasal",,30300,CPT,Facility,Outpatient,,,,291,247.35,83.4006,291,UnitedHealthcare,Medicare Advantage,142.59,49,,percent of total billed charges,,
"Removal Foreign Body, Intranasal",,30300,CPT,Facility,Inpatient,,,,291,247.35,83.4006,291,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Removal Foreign Body, Intranasal",,30300,CPT,Facility,Outpatient,,,,291,247.35,83.4006,291,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,139.68,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Removal Foreign Body, Intranasal",,30300,CPT,Facility,Inpatient,,,,291,247.35,83.4006,291,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Removal Foreign Body, Intranasal; Office Type Procedure (Pro Cah)",,30300,CPT,Professional,Both,,,,439,373.15,80.27,439,Aetna,Commercial,373.15,85,,percent of total billed charges,,
"Removal Foreign Body, Intranasal; Office Type Procedure (Pro Cah)",,30300,CPT,Professional,Both,,,,439,373.15,80.27,439,Aetna,Medicare Advantage,121.18,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Removal Foreign Body, Intranasal; Office Type Procedure (Pro Cah)",,30300,CPT,Professional,Both,,,,439,373.15,80.27,439,Aetna,PPO,408.27,93,,percent of total billed charges,,
"Removal Foreign Body, Intranasal; Office Type Procedure (Pro Cah)",,30300,CPT,Professional,Both,,,,439,373.15,80.27,439,America's PPO,America's PPO,375.0816,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Removal Foreign Body, Intranasal; Office Type Procedure (Pro Cah)",,30300,CPT,Professional,Both,,,,439,373.15,80.27,439,BlueCross BlueShield Minnesota, Federal Employee Program,258.23,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Removal Foreign Body, Intranasal; Office Type Procedure (Pro Cah)",,30300,CPT,Professional,Both,,,,439,373.15,80.27,439,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,262.36168,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Removal Foreign Body, Intranasal; Office Type Procedure (Pro Cah)",,30300,CPT,Professional,Both,,,,439,373.15,80.27,439,BlueCross BlueShield Minnesota,High Value Network Plan,262.36168,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Removal Foreign Body, Intranasal; Office Type Procedure (Pro Cah)",,30300,CPT,Professional,Both,,,,439,373.15,80.27,439,BlueCross BlueShield Minnesota,Medicare Advantage,143.52,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Removal Foreign Body, Intranasal; Office Type Procedure (Pro Cah)",,30300,CPT,Professional,Both,,,,439,373.15,80.27,439,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,262.36168,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Removal Foreign Body, Intranasal; Office Type Procedure (Pro Cah)",,30300,CPT,Professional,Both,,,,439,373.15,80.27,439,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,92.67952,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Removal Foreign Body, Intranasal; Office Type Procedure (Pro Cah)",,30300,CPT,Professional,Both,,,,439,373.15,80.27,439,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),143.52,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Removal Foreign Body, Intranasal; Office Type Procedure (Pro Cah)",,30300,CPT,Professional,Both,,,,439,373.15,80.27,439,CorVel,Worker's Compensation,244.6015701,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Removal Foreign Body, Intranasal; Office Type Procedure (Pro Cah)",,30300,CPT,Professional,Both,,,,439,373.15,80.27,439,First Health Group Corporation,First Health Network,425.83,97,,percent of total billed charges,,
"Removal Foreign Body, Intranasal; Office Type Procedure (Pro Cah)",,30300,CPT,Professional,Both,,,,439,373.15,80.27,439,"Health Partners, Inc.",Commercial,264.09,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Removal Foreign Body, Intranasal; Office Type Procedure (Pro Cah)",,30300,CPT,Professional,Both,,,,439,373.15,80.27,439,"Health Partners, Inc.",Medicare Advantage,143.52,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Removal Foreign Body, Intranasal; Office Type Procedure (Pro Cah)",,30300,CPT,Professional,Both,,,,439,373.15,80.27,439,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),125.04,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Removal Foreign Body, Intranasal; Office Type Procedure (Pro Cah)",,30300,CPT,Professional,Both,,,,439,373.15,80.27,439,"Health Partners, Inc.",State of Minnesota Advantage Program,227.513535,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Removal Foreign Body, Intranasal; Office Type Procedure (Pro Cah)",,30300,CPT,Professional,Both,,,,439,373.15,80.27,439,"Health Partners, Inc.",State Public Programs,80.27,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Removal Foreign Body, Intranasal; Office Type Procedure (Pro Cah)",,30300,CPT,Professional,Both,,,,439,373.15,80.27,439,Humana Insurance Company,Commercial PPO,124.8,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Removal Foreign Body, Intranasal; Office Type Procedure (Pro Cah)",,30300,CPT,Professional,Both,,,,439,373.15,80.27,439,Humana Insurance Company,Medicare PPO,439,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Removal Foreign Body, Intranasal; Office Type Procedure (Pro Cah)",,30300,CPT,Professional,Both,,,,439,373.15,80.27,439,Medica,Individual & Family,372.272,84.8,,percent of total billed charges,,
"Removal Foreign Body, Intranasal; Office Type Procedure (Pro Cah)",,30300,CPT,Professional,Both,,,,439,373.15,80.27,439,Medica,Medica Advantage Solution,218.622,49.8,,percent of total billed charges,,
"Removal Foreign Body, Intranasal; Office Type Procedure (Pro Cah)",,30300,CPT,Professional,Both,,,,439,373.15,80.27,439,Medica,Medical Assistance,92.68,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Removal Foreign Body, Intranasal; Office Type Procedure (Pro Cah)",,30300,CPT,Professional,Both,,,,439,373.15,80.27,439,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,124.8,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Removal Foreign Body, Intranasal; Office Type Procedure (Pro Cah)",,30300,CPT,Professional,Both,,,,439,373.15,80.27,439,"Multiplan, Inc.","Multiplan, Inc.",412.66,94,,percent of total billed charges,,
"Removal Foreign Body, Intranasal; Office Type Procedure (Pro Cah)",,30300,CPT,Professional,Both,,,,439,373.15,80.27,439,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,395.539,90.1,,percent of total billed charges,,
"Removal Foreign Body, Intranasal; Office Type Procedure (Pro Cah)",,30300,CPT,Professional,Both,,,,439,373.15,80.27,439,"Preferred One Administrative Services, INC.",PPO,432.854,98.6,,percent of total billed charges,,
"Removal Foreign Body, Intranasal; Office Type Procedure (Pro Cah)",,30300,CPT,Professional,Both,,,,439,373.15,80.27,439,PrimeWest Health,Minnesota Senior Health Options (MSHO),143.52,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Removal Foreign Body, Intranasal; Office Type Procedure (Pro Cah)",,30300,CPT,Professional,Both,,,,439,373.15,80.27,439,PrimeWest Health,MinnesotaCare,99.1670864,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Removal Foreign Body, Intranasal; Office Type Procedure (Pro Cah)",,30300,CPT,Professional,Both,,,,439,373.15,80.27,439,Sanford Health Plan,Sanford Health Plan,386.32,88,,percent of total billed charges,,
"Removal Foreign Body, Intranasal; Office Type Procedure (Pro Cah)",,30300,CPT,Professional,Both,,,,439,373.15,80.27,439,"UCare Health, Inc.",Individual & Family Plan,202.87488,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Removal Foreign Body, Intranasal; Office Type Procedure (Pro Cah)",,30300,CPT,Professional,Both,,,,439,373.15,80.27,439,"UCare Health, Inc.",Medical Assistance,101.947472,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Removal Foreign Body, Intranasal; Office Type Procedure (Pro Cah)",,30300,CPT,Professional,Both,,,,439,373.15,80.27,439,"UCare Health, Inc.",Medicare Advantage,143.52,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Removal Foreign Body, Intranasal; Office Type Procedure (Pro Cah)",,30300,CPT,Professional,Both,,,,439,373.15,80.27,439,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),114.816,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Removal Foreign Body, Intranasal; Office Type Procedure (Pro Cah)",,30300,CPT,Professional,Both,,,,439,373.15,80.27,439,UnitedHealthcare,Individual & Family,439,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Removal Foreign Body, Intranasal; Office Type Procedure (Pro Cah)",,30300,CPT,Professional,Both,,,,439,373.15,80.27,439,UnitedHealthcare,Medicare Advantage,143.52,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Removal Foreign Body, Intranasal; Office Type Procedure (Pro Cah)",,30300,CPT,Professional,Both,,,,439,373.15,80.27,439,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,92.67952,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Rhinoplasty, Primary; Lateral And Alar Cartilages And/Or Elevation Of Nasal Tip (Pro Cah)",,30400,CPT,Professional,Both,,,,3475,2953.75,794.51,3475,Aetna,Commercial,2953.75,85,,percent of total billed charges,,
"Rhinoplasty, Primary; Lateral And Alar Cartilages And/Or Elevation Of Nasal Tip (Pro Cah)",,30400,CPT,Professional,Both,,,,3475,2953.75,794.51,3475,Aetna,Medicare Advantage,1253.38,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Rhinoplasty, Primary; Lateral And Alar Cartilages And/Or Elevation Of Nasal Tip (Pro Cah)",,30400,CPT,Professional,Both,,,,3475,2953.75,794.51,3475,Aetna,PPO,3231.75,93,,percent of total billed charges,,
"Rhinoplasty, Primary; Lateral And Alar Cartilages And/Or Elevation Of Nasal Tip (Pro Cah)",,30400,CPT,Professional,Both,,,,3475,2953.75,794.51,3475,America's PPO,America's PPO,2969.04,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Rhinoplasty, Primary; Lateral And Alar Cartilages And/Or Elevation Of Nasal Tip (Pro Cah)",,30400,CPT,Professional,Both,,,,3475,2953.75,794.51,3475,BlueCross BlueShield Minnesota, Federal Employee Program,2567.1,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Rhinoplasty, Primary; Lateral And Alar Cartilages And/Or Elevation Of Nasal Tip (Pro Cah)",,30400,CPT,Professional,Both,,,,3475,2953.75,794.51,3475,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,2608.1736,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Rhinoplasty, Primary; Lateral And Alar Cartilages And/Or Elevation Of Nasal Tip (Pro Cah)",,30400,CPT,Professional,Both,,,,3475,2953.75,794.51,3475,BlueCross BlueShield Minnesota,High Value Network Plan,2608.1736,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Rhinoplasty, Primary; Lateral And Alar Cartilages And/Or Elevation Of Nasal Tip (Pro Cah)",,30400,CPT,Professional,Both,,,,3475,2953.75,794.51,3475,BlueCross BlueShield Minnesota,Medicare Advantage,1419.445,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Rhinoplasty, Primary; Lateral And Alar Cartilages And/Or Elevation Of Nasal Tip (Pro Cah)",,30400,CPT,Professional,Both,,,,3475,2953.75,794.51,3475,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,2608.1736,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Rhinoplasty, Primary; Lateral And Alar Cartilages And/Or Elevation Of Nasal Tip (Pro Cah)",,30400,CPT,Professional,Both,,,,3475,2953.75,794.51,3475,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,917.2956,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Rhinoplasty, Primary; Lateral And Alar Cartilages And/Or Elevation Of Nasal Tip (Pro Cah)",,30400,CPT,Professional,Both,,,,3475,2953.75,794.51,3475,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1419.445,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Rhinoplasty, Primary; Lateral And Alar Cartilages And/Or Elevation Of Nasal Tip (Pro Cah)",,30400,CPT,Professional,Both,,,,3475,2953.75,794.51,3475,CorVel,Worker's Compensation,2434.864138,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Rhinoplasty, Primary; Lateral And Alar Cartilages And/Or Elevation Of Nasal Tip (Pro Cah)",,30400,CPT,Professional,Both,,,,3475,2953.75,794.51,3475,First Health Group Corporation,First Health Network,3370.75,97,,percent of total billed charges,,
"Rhinoplasty, Primary; Lateral And Alar Cartilages And/Or Elevation Of Nasal Tip (Pro Cah)",,30400,CPT,Professional,Both,,,,3475,2953.75,794.51,3475,"Health Partners, Inc.",Commercial,2630.03,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Rhinoplasty, Primary; Lateral And Alar Cartilages And/Or Elevation Of Nasal Tip (Pro Cah)",,30400,CPT,Professional,Both,,,,3475,2953.75,794.51,3475,"Health Partners, Inc.",Medicare Advantage,1419.445,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Rhinoplasty, Primary; Lateral And Alar Cartilages And/Or Elevation Of Nasal Tip (Pro Cah)",,30400,CPT,Professional,Both,,,,3475,2953.75,794.51,3475,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1234.17,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Rhinoplasty, Primary; Lateral And Alar Cartilages And/Or Elevation Of Nasal Tip (Pro Cah)",,30400,CPT,Professional,Both,,,,3475,2953.75,794.51,3475,"Health Partners, Inc.",State of Minnesota Advantage Program,2265.770845,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Rhinoplasty, Primary; Lateral And Alar Cartilages And/Or Elevation Of Nasal Tip (Pro Cah)",,30400,CPT,Professional,Both,,,,3475,2953.75,794.51,3475,"Health Partners, Inc.",State Public Programs,794.51,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Rhinoplasty, Primary; Lateral And Alar Cartilages And/Or Elevation Of Nasal Tip (Pro Cah)",,30400,CPT,Professional,Both,,,,3475,2953.75,794.51,3475,Humana Insurance Company,Commercial PPO,1234.3,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Rhinoplasty, Primary; Lateral And Alar Cartilages And/Or Elevation Of Nasal Tip (Pro Cah)",,30400,CPT,Professional,Both,,,,3475,2953.75,794.51,3475,Humana Insurance Company,Medicare PPO,3475,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Rhinoplasty, Primary; Lateral And Alar Cartilages And/Or Elevation Of Nasal Tip (Pro Cah)",,30400,CPT,Professional,Both,,,,3475,2953.75,794.51,3475,Medica,Individual & Family,2946.8,84.8,,percent of total billed charges,,
"Rhinoplasty, Primary; Lateral And Alar Cartilages And/Or Elevation Of Nasal Tip (Pro Cah)",,30400,CPT,Professional,Both,,,,3475,2953.75,794.51,3475,Medica,Medica Advantage Solution,1730.55,49.8,,percent of total billed charges,,
"Rhinoplasty, Primary; Lateral And Alar Cartilages And/Or Elevation Of Nasal Tip (Pro Cah)",,30400,CPT,Professional,Both,,,,3475,2953.75,794.51,3475,Medica,Medical Assistance,917.3,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Rhinoplasty, Primary; Lateral And Alar Cartilages And/Or Elevation Of Nasal Tip (Pro Cah)",,30400,CPT,Professional,Both,,,,3475,2953.75,794.51,3475,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1234.3,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Rhinoplasty, Primary; Lateral And Alar Cartilages And/Or Elevation Of Nasal Tip (Pro Cah)",,30400,CPT,Professional,Both,,,,3475,2953.75,794.51,3475,"Multiplan, Inc.","Multiplan, Inc.",3266.5,94,,percent of total billed charges,,
"Rhinoplasty, Primary; Lateral And Alar Cartilages And/Or Elevation Of Nasal Tip (Pro Cah)",,30400,CPT,Professional,Both,,,,3475,2953.75,794.51,3475,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,3130.975,90.1,,percent of total billed charges,,
"Rhinoplasty, Primary; Lateral And Alar Cartilages And/Or Elevation Of Nasal Tip (Pro Cah)",,30400,CPT,Professional,Both,,,,3475,2953.75,794.51,3475,"Preferred One Administrative Services, INC.",PPO,3426.35,98.6,,percent of total billed charges,,
"Rhinoplasty, Primary; Lateral And Alar Cartilages And/Or Elevation Of Nasal Tip (Pro Cah)",,30400,CPT,Professional,Both,,,,3475,2953.75,794.51,3475,PrimeWest Health,Minnesota Senior Health Options (MSHO),1419.445,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Rhinoplasty, Primary; Lateral And Alar Cartilages And/Or Elevation Of Nasal Tip (Pro Cah)",,30400,CPT,Professional,Both,,,,3475,2953.75,794.51,3475,PrimeWest Health,MinnesotaCare,981.506292,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Rhinoplasty, Primary; Lateral And Alar Cartilages And/Or Elevation Of Nasal Tip (Pro Cah)",,30400,CPT,Professional,Both,,,,3475,2953.75,794.51,3475,Sanford Health Plan,Sanford Health Plan,3058,88,,percent of total billed charges,,
"Rhinoplasty, Primary; Lateral And Alar Cartilages And/Or Elevation Of Nasal Tip (Pro Cah)",,30400,CPT,Professional,Both,,,,3475,2953.75,794.51,3475,"UCare Health, Inc.",Individual & Family Plan,2006.47808,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Rhinoplasty, Primary; Lateral And Alar Cartilages And/Or Elevation Of Nasal Tip (Pro Cah)",,30400,CPT,Professional,Both,,,,3475,2953.75,794.51,3475,"UCare Health, Inc.",Medical Assistance,1009.02516,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Rhinoplasty, Primary; Lateral And Alar Cartilages And/Or Elevation Of Nasal Tip (Pro Cah)",,30400,CPT,Professional,Both,,,,3475,2953.75,794.51,3475,"UCare Health, Inc.",Medicare Advantage,1419.445,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Rhinoplasty, Primary; Lateral And Alar Cartilages And/Or Elevation Of Nasal Tip (Pro Cah)",,30400,CPT,Professional,Both,,,,3475,2953.75,794.51,3475,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1135.556,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Rhinoplasty, Primary; Lateral And Alar Cartilages And/Or Elevation Of Nasal Tip (Pro Cah)",,30400,CPT,Professional,Both,,,,3475,2953.75,794.51,3475,UnitedHealthcare,Individual & Family,3475,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Rhinoplasty, Primary; Lateral And Alar Cartilages And/Or Elevation Of Nasal Tip (Pro Cah)",,30400,CPT,Professional,Both,,,,3475,2953.75,794.51,3475,UnitedHealthcare,Medicare Advantage,1419.445,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Rhinoplasty, Primary; Lateral And Alar Cartilages And/Or Elevation Of Nasal Tip (Pro Cah)",,30400,CPT,Professional,Both,,,,3475,2953.75,794.51,3475,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,917.2956,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Rhinoplasty, Primary; Including Major Septal Repair (Pro Cah)",,30420,CPT,Professional,Both,,,,5000,4250,933.69,5000,Aetna,Commercial,4250,85,,percent of total billed charges,,
"Rhinoplasty, Primary; Including Major Septal Repair (Pro Cah)",,30420,CPT,Professional,Both,,,,5000,4250,933.69,5000,Aetna,Medicare Advantage,1450.38,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Rhinoplasty, Primary; Including Major Septal Repair (Pro Cah)",,30420,CPT,Professional,Both,,,,5000,4250,933.69,5000,Aetna,PPO,4650,93,,percent of total billed charges,,
"Rhinoplasty, Primary; Including Major Septal Repair (Pro Cah)",,30420,CPT,Professional,Both,,,,5000,4250,933.69,5000,America's PPO,America's PPO,4272,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Rhinoplasty, Primary; Including Major Septal Repair (Pro Cah)",,30420,CPT,Professional,Both,,,,5000,4250,933.69,5000,BlueCross BlueShield Minnesota, Federal Employee Program,3029.84,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Rhinoplasty, Primary; Including Major Septal Repair (Pro Cah)",,30420,CPT,Professional,Both,,,,5000,4250,933.69,5000,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,3078.31744,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Rhinoplasty, Primary; Including Major Septal Repair (Pro Cah)",,30420,CPT,Professional,Both,,,,5000,4250,933.69,5000,BlueCross BlueShield Minnesota,High Value Network Plan,3078.31744,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Rhinoplasty, Primary; Including Major Septal Repair (Pro Cah)",,30420,CPT,Professional,Both,,,,5000,4250,933.69,5000,BlueCross BlueShield Minnesota,Medicare Advantage,1668.052,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Rhinoplasty, Primary; Including Major Septal Repair (Pro Cah)",,30420,CPT,Professional,Both,,,,5000,4250,933.69,5000,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,3078.31744,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Rhinoplasty, Primary; Including Major Septal Repair (Pro Cah)",,30420,CPT,Professional,Both,,,,5000,4250,933.69,5000,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1077.98616,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Rhinoplasty, Primary; Including Major Septal Repair (Pro Cah)",,30420,CPT,Professional,Both,,,,5000,4250,933.69,5000,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1668.052,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Rhinoplasty, Primary; Including Major Septal Repair (Pro Cah)",,30420,CPT,Professional,Both,,,,5000,4250,933.69,5000,CorVel,Worker's Compensation,2854.673951,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Rhinoplasty, Primary; Including Major Septal Repair (Pro Cah)",,30420,CPT,Professional,Both,,,,5000,4250,933.69,5000,First Health Group Corporation,First Health Network,4850,97,,percent of total billed charges,,
"Rhinoplasty, Primary; Including Major Septal Repair (Pro Cah)",,30420,CPT,Professional,Both,,,,5000,4250,933.69,5000,"Health Partners, Inc.",Commercial,3083.49,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Rhinoplasty, Primary; Including Major Septal Repair (Pro Cah)",,30420,CPT,Professional,Both,,,,5000,4250,933.69,5000,"Health Partners, Inc.",Medicare Advantage,1668.052,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Rhinoplasty, Primary; Including Major Septal Repair (Pro Cah)",,30420,CPT,Professional,Both,,,,5000,4250,933.69,5000,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1450.71,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Rhinoplasty, Primary; Including Major Septal Repair (Pro Cah)",,30420,CPT,Professional,Both,,,,5000,4250,933.69,5000,"Health Partners, Inc.",State of Minnesota Advantage Program,2656.426635,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Rhinoplasty, Primary; Including Major Septal Repair (Pro Cah)",,30420,CPT,Professional,Both,,,,5000,4250,933.69,5000,"Health Partners, Inc.",State Public Programs,933.69,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Rhinoplasty, Primary; Including Major Septal Repair (Pro Cah)",,30420,CPT,Professional,Both,,,,5000,4250,933.69,5000,Humana Insurance Company,Commercial PPO,1450.48,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Rhinoplasty, Primary; Including Major Septal Repair (Pro Cah)",,30420,CPT,Professional,Both,,,,5000,4250,933.69,5000,Humana Insurance Company,Medicare PPO,5000,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Rhinoplasty, Primary; Including Major Septal Repair (Pro Cah)",,30420,CPT,Professional,Both,,,,5000,4250,933.69,5000,Medica,Individual & Family,4240,84.8,,percent of total billed charges,,
"Rhinoplasty, Primary; Including Major Septal Repair (Pro Cah)",,30420,CPT,Professional,Both,,,,5000,4250,933.69,5000,Medica,Medica Advantage Solution,2490,49.8,,percent of total billed charges,,
"Rhinoplasty, Primary; Including Major Septal Repair (Pro Cah)",,30420,CPT,Professional,Both,,,,5000,4250,933.69,5000,Medica,Medical Assistance,1077.99,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Rhinoplasty, Primary; Including Major Septal Repair (Pro Cah)",,30420,CPT,Professional,Both,,,,5000,4250,933.69,5000,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1450.48,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Rhinoplasty, Primary; Including Major Septal Repair (Pro Cah)",,30420,CPT,Professional,Both,,,,5000,4250,933.69,5000,"Multiplan, Inc.","Multiplan, Inc.",4700,94,,percent of total billed charges,,
"Rhinoplasty, Primary; Including Major Septal Repair (Pro Cah)",,30420,CPT,Professional,Both,,,,5000,4250,933.69,5000,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4505,90.1,,percent of total billed charges,,
"Rhinoplasty, Primary; Including Major Septal Repair (Pro Cah)",,30420,CPT,Professional,Both,,,,5000,4250,933.69,5000,"Preferred One Administrative Services, INC.",PPO,4930,98.6,,percent of total billed charges,,
"Rhinoplasty, Primary; Including Major Septal Repair (Pro Cah)",,30420,CPT,Professional,Both,,,,5000,4250,933.69,5000,PrimeWest Health,Minnesota Senior Health Options (MSHO),1668.052,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Rhinoplasty, Primary; Including Major Septal Repair (Pro Cah)",,30420,CPT,Professional,Both,,,,5000,4250,933.69,5000,PrimeWest Health,MinnesotaCare,1153.445191,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Rhinoplasty, Primary; Including Major Septal Repair (Pro Cah)",,30420,CPT,Professional,Both,,,,5000,4250,933.69,5000,Sanford Health Plan,Sanford Health Plan,4400,88,,percent of total billed charges,,
"Rhinoplasty, Primary; Including Major Septal Repair (Pro Cah)",,30420,CPT,Professional,Both,,,,5000,4250,933.69,5000,"UCare Health, Inc.",Individual & Family Plan,2357.900288,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Rhinoplasty, Primary; Including Major Septal Repair (Pro Cah)",,30420,CPT,Professional,Both,,,,5000,4250,933.69,5000,"UCare Health, Inc.",Medical Assistance,1185.784776,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Rhinoplasty, Primary; Including Major Septal Repair (Pro Cah)",,30420,CPT,Professional,Both,,,,5000,4250,933.69,5000,"UCare Health, Inc.",Medicare Advantage,1668.052,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Rhinoplasty, Primary; Including Major Septal Repair (Pro Cah)",,30420,CPT,Professional,Both,,,,5000,4250,933.69,5000,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1334.4416,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Rhinoplasty, Primary; Including Major Septal Repair (Pro Cah)",,30420,CPT,Professional,Both,,,,5000,4250,933.69,5000,UnitedHealthcare,Individual & Family,5000,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Rhinoplasty, Primary; Including Major Septal Repair (Pro Cah)",,30420,CPT,Professional,Both,,,,5000,4250,933.69,5000,UnitedHealthcare,Medicare Advantage,1668.052,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Rhinoplasty, Primary; Including Major Septal Repair (Pro Cah)",,30420,CPT,Professional,Both,,,,5000,4250,933.69,5000,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1077.98616,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Septoplasty/Submucous Resection, W W/O Cartilage Scoring, Contouring/Replacement W/Graft (Pro Cah)",,30520,CPT,Professional,Both,,,,2729,2319.65,436.74,2729,Aetna,Commercial,2319.65,85,,percent of total billed charges,,
"Septoplasty/Submucous Resection, W W/O Cartilage Scoring, Contouring/Replacement W/Graft (Pro Cah)",,30520,CPT,Professional,Both,,,,2729,2319.65,436.74,2729,Aetna,Medicare Advantage,673.64,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Septoplasty/Submucous Resection, W W/O Cartilage Scoring, Contouring/Replacement W/Graft (Pro Cah)",,30520,CPT,Professional,Both,,,,2729,2319.65,436.74,2729,Aetna,PPO,2537.97,93,,percent of total billed charges,,
"Septoplasty/Submucous Resection, W W/O Cartilage Scoring, Contouring/Replacement W/Graft (Pro Cah)",,30520,CPT,Professional,Both,,,,2729,2319.65,436.74,2729,America's PPO,America's PPO,2331.6576,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Septoplasty/Submucous Resection, W W/O Cartilage Scoring, Contouring/Replacement W/Graft (Pro Cah)",,30520,CPT,Professional,Both,,,,2729,2319.65,436.74,2729,BlueCross BlueShield Minnesota, Federal Employee Program,1408.88,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Septoplasty/Submucous Resection, W W/O Cartilage Scoring, Contouring/Replacement W/Graft (Pro Cah)",,30520,CPT,Professional,Both,,,,2729,2319.65,436.74,2729,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1431.42208,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Septoplasty/Submucous Resection, W W/O Cartilage Scoring, Contouring/Replacement W/Graft (Pro Cah)",,30520,CPT,Professional,Both,,,,2729,2319.65,436.74,2729,BlueCross BlueShield Minnesota,High Value Network Plan,1431.42208,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Septoplasty/Submucous Resection, W W/O Cartilage Scoring, Contouring/Replacement W/Graft (Pro Cah)",,30520,CPT,Professional,Both,,,,2729,2319.65,436.74,2729,BlueCross BlueShield Minnesota,Medicare Advantage,780.2865,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Septoplasty/Submucous Resection, W W/O Cartilage Scoring, Contouring/Replacement W/Graft (Pro Cah)",,30520,CPT,Professional,Both,,,,2729,2319.65,436.74,2729,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1431.42208,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Septoplasty/Submucous Resection, W W/O Cartilage Scoring, Contouring/Replacement W/Graft (Pro Cah)",,30520,CPT,Professional,Both,,,,2729,2319.65,436.74,2729,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,504.23064,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Septoplasty/Submucous Resection, W W/O Cartilage Scoring, Contouring/Replacement W/Graft (Pro Cah)",,30520,CPT,Professional,Both,,,,2729,2319.65,436.74,2729,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),780.2865,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Septoplasty/Submucous Resection, W W/O Cartilage Scoring, Contouring/Replacement W/Graft (Pro Cah)",,30520,CPT,Professional,Both,,,,2729,2319.65,436.74,2729,CorVel,Worker's Compensation,1331.504193,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Septoplasty/Submucous Resection, W W/O Cartilage Scoring, Contouring/Replacement W/Graft (Pro Cah)",,30520,CPT,Professional,Both,,,,2729,2319.65,436.74,2729,First Health Group Corporation,First Health Network,2647.13,97,,percent of total billed charges,,
"Septoplasty/Submucous Resection, W W/O Cartilage Scoring, Contouring/Replacement W/Graft (Pro Cah)",,30520,CPT,Professional,Both,,,,2729,2319.65,436.74,2729,"Health Partners, Inc.",Commercial,1438,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Septoplasty/Submucous Resection, W W/O Cartilage Scoring, Contouring/Replacement W/Graft (Pro Cah)",,30520,CPT,Professional,Both,,,,2729,2319.65,436.74,2729,"Health Partners, Inc.",Medicare Advantage,780.2865,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Septoplasty/Submucous Resection, W W/O Cartilage Scoring, Contouring/Replacement W/Graft (Pro Cah)",,30520,CPT,Professional,Both,,,,2729,2319.65,436.74,2729,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),678.76,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Septoplasty/Submucous Resection, W W/O Cartilage Scoring, Contouring/Replacement W/Graft (Pro Cah)",,30520,CPT,Professional,Both,,,,2729,2319.65,436.74,2729,"Health Partners, Inc.",State of Minnesota Advantage Program,1238.837,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Septoplasty/Submucous Resection, W W/O Cartilage Scoring, Contouring/Replacement W/Graft (Pro Cah)",,30520,CPT,Professional,Both,,,,2729,2319.65,436.74,2729,"Health Partners, Inc.",State Public Programs,436.74,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Septoplasty/Submucous Resection, W W/O Cartilage Scoring, Contouring/Replacement W/Graft (Pro Cah)",,30520,CPT,Professional,Both,,,,2729,2319.65,436.74,2729,Humana Insurance Company,Commercial PPO,678.51,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Septoplasty/Submucous Resection, W W/O Cartilage Scoring, Contouring/Replacement W/Graft (Pro Cah)",,30520,CPT,Professional,Both,,,,2729,2319.65,436.74,2729,Humana Insurance Company,Medicare PPO,2729,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Septoplasty/Submucous Resection, W W/O Cartilage Scoring, Contouring/Replacement W/Graft (Pro Cah)",,30520,CPT,Professional,Both,,,,2729,2319.65,436.74,2729,Medica,Individual & Family,2314.192,84.8,,percent of total billed charges,,
"Septoplasty/Submucous Resection, W W/O Cartilage Scoring, Contouring/Replacement W/Graft (Pro Cah)",,30520,CPT,Professional,Both,,,,2729,2319.65,436.74,2729,Medica,Medica Advantage Solution,1359.042,49.8,,percent of total billed charges,,
"Septoplasty/Submucous Resection, W W/O Cartilage Scoring, Contouring/Replacement W/Graft (Pro Cah)",,30520,CPT,Professional,Both,,,,2729,2319.65,436.74,2729,Medica,Medical Assistance,504.23,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Septoplasty/Submucous Resection, W W/O Cartilage Scoring, Contouring/Replacement W/Graft (Pro Cah)",,30520,CPT,Professional,Both,,,,2729,2319.65,436.74,2729,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,678.51,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Septoplasty/Submucous Resection, W W/O Cartilage Scoring, Contouring/Replacement W/Graft (Pro Cah)",,30520,CPT,Professional,Both,,,,2729,2319.65,436.74,2729,"Multiplan, Inc.","Multiplan, Inc.",2565.26,94,,percent of total billed charges,,
"Septoplasty/Submucous Resection, W W/O Cartilage Scoring, Contouring/Replacement W/Graft (Pro Cah)",,30520,CPT,Professional,Both,,,,2729,2319.65,436.74,2729,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,2458.829,90.1,,percent of total billed charges,,
"Septoplasty/Submucous Resection, W W/O Cartilage Scoring, Contouring/Replacement W/Graft (Pro Cah)",,30520,CPT,Professional,Both,,,,2729,2319.65,436.74,2729,"Preferred One Administrative Services, INC.",PPO,2690.794,98.6,,percent of total billed charges,,
"Septoplasty/Submucous Resection, W W/O Cartilage Scoring, Contouring/Replacement W/Graft (Pro Cah)",,30520,CPT,Professional,Both,,,,2729,2319.65,436.74,2729,PrimeWest Health,Minnesota Senior Health Options (MSHO),780.2865,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Septoplasty/Submucous Resection, W W/O Cartilage Scoring, Contouring/Replacement W/Graft (Pro Cah)",,30520,CPT,Professional,Both,,,,2729,2319.65,436.74,2729,PrimeWest Health,MinnesotaCare,539.5267848,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Septoplasty/Submucous Resection, W W/O Cartilage Scoring, Contouring/Replacement W/Graft (Pro Cah)",,30520,CPT,Professional,Both,,,,2729,2319.65,436.74,2729,Sanford Health Plan,Sanford Health Plan,2401.52,88,,percent of total billed charges,,
"Septoplasty/Submucous Resection, W W/O Cartilage Scoring, Contouring/Replacement W/Graft (Pro Cah)",,30520,CPT,Professional,Both,,,,2729,2319.65,436.74,2729,"UCare Health, Inc.",Individual & Family Plan,1102.985856,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Septoplasty/Submucous Resection, W W/O Cartilage Scoring, Contouring/Replacement W/Graft (Pro Cah)",,30520,CPT,Professional,Both,,,,2729,2319.65,436.74,2729,"UCare Health, Inc.",Medical Assistance,554.653704,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Septoplasty/Submucous Resection, W W/O Cartilage Scoring, Contouring/Replacement W/Graft (Pro Cah)",,30520,CPT,Professional,Both,,,,2729,2319.65,436.74,2729,"UCare Health, Inc.",Medicare Advantage,780.2865,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Septoplasty/Submucous Resection, W W/O Cartilage Scoring, Contouring/Replacement W/Graft (Pro Cah)",,30520,CPT,Professional,Both,,,,2729,2319.65,436.74,2729,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),624.2292,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Septoplasty/Submucous Resection, W W/O Cartilage Scoring, Contouring/Replacement W/Graft (Pro Cah)",,30520,CPT,Professional,Both,,,,2729,2319.65,436.74,2729,UnitedHealthcare,Individual & Family,2729,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Septoplasty/Submucous Resection, W W/O Cartilage Scoring, Contouring/Replacement W/Graft (Pro Cah)",,30520,CPT,Professional,Both,,,,2729,2319.65,436.74,2729,UnitedHealthcare,Medicare Advantage,780.2865,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Septoplasty/Submucous Resection, W W/O Cartilage Scoring, Contouring/Replacement W/Graft (Pro Cah)",,30520,CPT,Professional,Both,,,,2729,2319.65,436.74,2729,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,504.23064,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Ablation, Soft Tissue Inferior Turbinates, Unilateral Or Bilateral,Any Method; Superficial (Pro Cah)",,30801,CPT,Professional,Both,,,,1173,997.05,99.48,1173,Aetna,Commercial,997.05,85,,percent of total billed charges,,
"Ablation, Soft Tissue Inferior Turbinates, Unilateral Or Bilateral,Any Method; Superficial (Pro Cah)",,30801,CPT,Professional,Both,,,,1173,997.05,99.48,1173,Aetna,Medicare Advantage,154.38,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Ablation, Soft Tissue Inferior Turbinates, Unilateral Or Bilateral,Any Method; Superficial (Pro Cah)",,30801,CPT,Professional,Both,,,,1173,997.05,99.48,1173,Aetna,PPO,1090.89,93,,percent of total billed charges,,
"Ablation, Soft Tissue Inferior Turbinates, Unilateral Or Bilateral,Any Method; Superficial (Pro Cah)",,30801,CPT,Professional,Both,,,,1173,997.05,99.48,1173,America's PPO,America's PPO,1002.2112,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Ablation, Soft Tissue Inferior Turbinates, Unilateral Or Bilateral,Any Method; Superficial (Pro Cah)",,30801,CPT,Professional,Both,,,,1173,997.05,99.48,1173,BlueCross BlueShield Minnesota, Federal Employee Program,318.13,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Ablation, Soft Tissue Inferior Turbinates, Unilateral Or Bilateral,Any Method; Superficial (Pro Cah)",,30801,CPT,Professional,Both,,,,1173,997.05,99.48,1173,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,323.22008,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Ablation, Soft Tissue Inferior Turbinates, Unilateral Or Bilateral,Any Method; Superficial (Pro Cah)",,30801,CPT,Professional,Both,,,,1173,997.05,99.48,1173,BlueCross BlueShield Minnesota,High Value Network Plan,323.22008,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Ablation, Soft Tissue Inferior Turbinates, Unilateral Or Bilateral,Any Method; Superficial (Pro Cah)",,30801,CPT,Professional,Both,,,,1173,997.05,99.48,1173,BlueCross BlueShield Minnesota,Medicare Advantage,178.0315,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Ablation, Soft Tissue Inferior Turbinates, Unilateral Or Bilateral,Any Method; Superficial (Pro Cah)",,30801,CPT,Professional,Both,,,,1173,997.05,99.48,1173,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,323.22008,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Ablation, Soft Tissue Inferior Turbinates, Unilateral Or Bilateral,Any Method; Superficial (Pro Cah)",,30801,CPT,Professional,Both,,,,1173,997.05,99.48,1173,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,114.84864,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Ablation, Soft Tissue Inferior Turbinates, Unilateral Or Bilateral,Any Method; Superficial (Pro Cah)",,30801,CPT,Professional,Both,,,,1173,997.05,99.48,1173,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),178.0315,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Ablation, Soft Tissue Inferior Turbinates, Unilateral Or Bilateral,Any Method; Superficial (Pro Cah)",,30801,CPT,Professional,Both,,,,1173,997.05,99.48,1173,CorVel,Worker's Compensation,305.1472647,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Ablation, Soft Tissue Inferior Turbinates, Unilateral Or Bilateral,Any Method; Superficial (Pro Cah)",,30801,CPT,Professional,Both,,,,1173,997.05,99.48,1173,First Health Group Corporation,First Health Network,1137.81,97,,percent of total billed charges,,
"Ablation, Soft Tissue Inferior Turbinates, Unilateral Or Bilateral,Any Method; Superficial (Pro Cah)",,30801,CPT,Professional,Both,,,,1173,997.05,99.48,1173,"Health Partners, Inc.",Commercial,329.39,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Ablation, Soft Tissue Inferior Turbinates, Unilateral Or Bilateral,Any Method; Superficial (Pro Cah)",,30801,CPT,Professional,Both,,,,1173,997.05,99.48,1173,"Health Partners, Inc.",Medicare Advantage,178.0315,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Ablation, Soft Tissue Inferior Turbinates, Unilateral Or Bilateral,Any Method; Superficial (Pro Cah)",,30801,CPT,Professional,Both,,,,1173,997.05,99.48,1173,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),154.86,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Ablation, Soft Tissue Inferior Turbinates, Unilateral Or Bilateral,Any Method; Superficial (Pro Cah)",,30801,CPT,Professional,Both,,,,1173,997.05,99.48,1173,"Health Partners, Inc.",State of Minnesota Advantage Program,283.769485,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Ablation, Soft Tissue Inferior Turbinates, Unilateral Or Bilateral,Any Method; Superficial (Pro Cah)",,30801,CPT,Professional,Both,,,,1173,997.05,99.48,1173,"Health Partners, Inc.",State Public Programs,99.48,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Ablation, Soft Tissue Inferior Turbinates, Unilateral Or Bilateral,Any Method; Superficial (Pro Cah)",,30801,CPT,Professional,Both,,,,1173,997.05,99.48,1173,Humana Insurance Company,Commercial PPO,154.81,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Ablation, Soft Tissue Inferior Turbinates, Unilateral Or Bilateral,Any Method; Superficial (Pro Cah)",,30801,CPT,Professional,Both,,,,1173,997.05,99.48,1173,Humana Insurance Company,Medicare PPO,1173,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Ablation, Soft Tissue Inferior Turbinates, Unilateral Or Bilateral,Any Method; Superficial (Pro Cah)",,30801,CPT,Professional,Both,,,,1173,997.05,99.48,1173,Medica,Individual & Family,994.704,84.8,,percent of total billed charges,,
"Ablation, Soft Tissue Inferior Turbinates, Unilateral Or Bilateral,Any Method; Superficial (Pro Cah)",,30801,CPT,Professional,Both,,,,1173,997.05,99.48,1173,Medica,Medica Advantage Solution,584.154,49.8,,percent of total billed charges,,
"Ablation, Soft Tissue Inferior Turbinates, Unilateral Or Bilateral,Any Method; Superficial (Pro Cah)",,30801,CPT,Professional,Both,,,,1173,997.05,99.48,1173,Medica,Medical Assistance,114.85,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Ablation, Soft Tissue Inferior Turbinates, Unilateral Or Bilateral,Any Method; Superficial (Pro Cah)",,30801,CPT,Professional,Both,,,,1173,997.05,99.48,1173,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,154.81,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Ablation, Soft Tissue Inferior Turbinates, Unilateral Or Bilateral,Any Method; Superficial (Pro Cah)",,30801,CPT,Professional,Both,,,,1173,997.05,99.48,1173,"Multiplan, Inc.","Multiplan, Inc.",1102.62,94,,percent of total billed charges,,
"Ablation, Soft Tissue Inferior Turbinates, Unilateral Or Bilateral,Any Method; Superficial (Pro Cah)",,30801,CPT,Professional,Both,,,,1173,997.05,99.48,1173,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1056.873,90.1,,percent of total billed charges,,
"Ablation, Soft Tissue Inferior Turbinates, Unilateral Or Bilateral,Any Method; Superficial (Pro Cah)",,30801,CPT,Professional,Both,,,,1173,997.05,99.48,1173,"Preferred One Administrative Services, INC.",PPO,1156.578,98.6,,percent of total billed charges,,
"Ablation, Soft Tissue Inferior Turbinates, Unilateral Or Bilateral,Any Method; Superficial (Pro Cah)",,30801,CPT,Professional,Both,,,,1173,997.05,99.48,1173,PrimeWest Health,Minnesota Senior Health Options (MSHO),178.0315,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Ablation, Soft Tissue Inferior Turbinates, Unilateral Or Bilateral,Any Method; Superficial (Pro Cah)",,30801,CPT,Professional,Both,,,,1173,997.05,99.48,1173,PrimeWest Health,MinnesotaCare,122.8880448,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Ablation, Soft Tissue Inferior Turbinates, Unilateral Or Bilateral,Any Method; Superficial (Pro Cah)",,30801,CPT,Professional,Both,,,,1173,997.05,99.48,1173,Sanford Health Plan,Sanford Health Plan,1032.24,88,,percent of total billed charges,,
"Ablation, Soft Tissue Inferior Turbinates, Unilateral Or Bilateral,Any Method; Superficial (Pro Cah)",,30801,CPT,Professional,Both,,,,1173,997.05,99.48,1173,"UCare Health, Inc.",Individual & Family Plan,251.659136,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Ablation, Soft Tissue Inferior Turbinates, Unilateral Or Bilateral,Any Method; Superficial (Pro Cah)",,30801,CPT,Professional,Both,,,,1173,997.05,99.48,1173,"UCare Health, Inc.",Medical Assistance,126.333504,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Ablation, Soft Tissue Inferior Turbinates, Unilateral Or Bilateral,Any Method; Superficial (Pro Cah)",,30801,CPT,Professional,Both,,,,1173,997.05,99.48,1173,"UCare Health, Inc.",Medicare Advantage,178.0315,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Ablation, Soft Tissue Inferior Turbinates, Unilateral Or Bilateral,Any Method; Superficial (Pro Cah)",,30801,CPT,Professional,Both,,,,1173,997.05,99.48,1173,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),142.4252,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Ablation, Soft Tissue Inferior Turbinates, Unilateral Or Bilateral,Any Method; Superficial (Pro Cah)",,30801,CPT,Professional,Both,,,,1173,997.05,99.48,1173,UnitedHealthcare,Individual & Family,1173,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Ablation, Soft Tissue Inferior Turbinates, Unilateral Or Bilateral,Any Method; Superficial (Pro Cah)",,30801,CPT,Professional,Both,,,,1173,997.05,99.48,1173,UnitedHealthcare,Medicare Advantage,178.0315,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Ablation, Soft Tissue Inferior Turbinates, Unilateral Or Bilateral,Any Method; Superficial (Pro Cah)",,30801,CPT,Professional,Both,,,,1173,997.05,99.48,1173,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,114.84864,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Ablation, Soft Tissue Inferior Turbinates, Unilateral Or Bilateral, Any Method; Intramural (Pro Cah)",,30802,CPT,Professional,Both,,,,1897,1612.45,131.1,1897,Aetna,Commercial,1612.45,85,,percent of total billed charges,,
"Ablation, Soft Tissue Inferior Turbinates, Unilateral Or Bilateral, Any Method; Intramural (Pro Cah)",,30802,CPT,Professional,Both,,,,1897,1612.45,131.1,1897,Aetna,Medicare Advantage,203.63,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Ablation, Soft Tissue Inferior Turbinates, Unilateral Or Bilateral, Any Method; Intramural (Pro Cah)",,30802,CPT,Professional,Both,,,,1897,1612.45,131.1,1897,Aetna,PPO,1764.21,93,,percent of total billed charges,,
"Ablation, Soft Tissue Inferior Turbinates, Unilateral Or Bilateral, Any Method; Intramural (Pro Cah)",,30802,CPT,Professional,Both,,,,1897,1612.45,131.1,1897,America's PPO,America's PPO,1620.7968,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Ablation, Soft Tissue Inferior Turbinates, Unilateral Or Bilateral, Any Method; Intramural (Pro Cah)",,30802,CPT,Professional,Both,,,,1897,1612.45,131.1,1897,BlueCross BlueShield Minnesota, Federal Employee Program,422.8,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Ablation, Soft Tissue Inferior Turbinates, Unilateral Or Bilateral, Any Method; Intramural (Pro Cah)",,30802,CPT,Professional,Both,,,,1897,1612.45,131.1,1897,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,429.5648,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Ablation, Soft Tissue Inferior Turbinates, Unilateral Or Bilateral, Any Method; Intramural (Pro Cah)",,30802,CPT,Professional,Both,,,,1897,1612.45,131.1,1897,BlueCross BlueShield Minnesota,High Value Network Plan,429.5648,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Ablation, Soft Tissue Inferior Turbinates, Unilateral Or Bilateral, Any Method; Intramural (Pro Cah)",,30802,CPT,Professional,Both,,,,1897,1612.45,131.1,1897,BlueCross BlueShield Minnesota,Medicare Advantage,234.4505,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Ablation, Soft Tissue Inferior Turbinates, Unilateral Or Bilateral, Any Method; Intramural (Pro Cah)",,30802,CPT,Professional,Both,,,,1897,1612.45,131.1,1897,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,429.5648,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Ablation, Soft Tissue Inferior Turbinates, Unilateral Or Bilateral, Any Method; Intramural (Pro Cah)",,30802,CPT,Professional,Both,,,,1897,1612.45,131.1,1897,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,151.36368,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Ablation, Soft Tissue Inferior Turbinates, Unilateral Or Bilateral, Any Method; Intramural (Pro Cah)",,30802,CPT,Professional,Both,,,,1897,1612.45,131.1,1897,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),234.4505,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Ablation, Soft Tissue Inferior Turbinates, Unilateral Or Bilateral, Any Method; Intramural (Pro Cah)",,30802,CPT,Professional,Both,,,,1897,1612.45,131.1,1897,CorVel,Worker's Compensation,401.0713983,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Ablation, Soft Tissue Inferior Turbinates, Unilateral Or Bilateral, Any Method; Intramural (Pro Cah)",,30802,CPT,Professional,Both,,,,1897,1612.45,131.1,1897,First Health Group Corporation,First Health Network,1840.09,97,,percent of total billed charges,,
"Ablation, Soft Tissue Inferior Turbinates, Unilateral Or Bilateral, Any Method; Intramural (Pro Cah)",,30802,CPT,Professional,Both,,,,1897,1612.45,131.1,1897,"Health Partners, Inc.",Commercial,433.14,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Ablation, Soft Tissue Inferior Turbinates, Unilateral Or Bilateral, Any Method; Intramural (Pro Cah)",,30802,CPT,Professional,Both,,,,1897,1612.45,131.1,1897,"Health Partners, Inc.",Medicare Advantage,234.4505,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Ablation, Soft Tissue Inferior Turbinates, Unilateral Or Bilateral, Any Method; Intramural (Pro Cah)",,30802,CPT,Professional,Both,,,,1897,1612.45,131.1,1897,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),203.66,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Ablation, Soft Tissue Inferior Turbinates, Unilateral Or Bilateral, Any Method; Intramural (Pro Cah)",,30802,CPT,Professional,Both,,,,1897,1612.45,131.1,1897,"Health Partners, Inc.",State of Minnesota Advantage Program,373.15011,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Ablation, Soft Tissue Inferior Turbinates, Unilateral Or Bilateral, Any Method; Intramural (Pro Cah)",,30802,CPT,Professional,Both,,,,1897,1612.45,131.1,1897,"Health Partners, Inc.",State Public Programs,131.1,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Ablation, Soft Tissue Inferior Turbinates, Unilateral Or Bilateral, Any Method; Intramural (Pro Cah)",,30802,CPT,Professional,Both,,,,1897,1612.45,131.1,1897,Humana Insurance Company,Commercial PPO,203.87,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Ablation, Soft Tissue Inferior Turbinates, Unilateral Or Bilateral, Any Method; Intramural (Pro Cah)",,30802,CPT,Professional,Both,,,,1897,1612.45,131.1,1897,Humana Insurance Company,Medicare PPO,1897,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Ablation, Soft Tissue Inferior Turbinates, Unilateral Or Bilateral, Any Method; Intramural (Pro Cah)",,30802,CPT,Professional,Both,,,,1897,1612.45,131.1,1897,Medica,Individual & Family,1608.656,84.8,,percent of total billed charges,,
"Ablation, Soft Tissue Inferior Turbinates, Unilateral Or Bilateral, Any Method; Intramural (Pro Cah)",,30802,CPT,Professional,Both,,,,1897,1612.45,131.1,1897,Medica,Medica Advantage Solution,944.706,49.8,,percent of total billed charges,,
"Ablation, Soft Tissue Inferior Turbinates, Unilateral Or Bilateral, Any Method; Intramural (Pro Cah)",,30802,CPT,Professional,Both,,,,1897,1612.45,131.1,1897,Medica,Medical Assistance,151.36,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Ablation, Soft Tissue Inferior Turbinates, Unilateral Or Bilateral, Any Method; Intramural (Pro Cah)",,30802,CPT,Professional,Both,,,,1897,1612.45,131.1,1897,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,203.87,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Ablation, Soft Tissue Inferior Turbinates, Unilateral Or Bilateral, Any Method; Intramural (Pro Cah)",,30802,CPT,Professional,Both,,,,1897,1612.45,131.1,1897,"Multiplan, Inc.","Multiplan, Inc.",1783.18,94,,percent of total billed charges,,
"Ablation, Soft Tissue Inferior Turbinates, Unilateral Or Bilateral, Any Method; Intramural (Pro Cah)",,30802,CPT,Professional,Both,,,,1897,1612.45,131.1,1897,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1709.197,90.1,,percent of total billed charges,,
"Ablation, Soft Tissue Inferior Turbinates, Unilateral Or Bilateral, Any Method; Intramural (Pro Cah)",,30802,CPT,Professional,Both,,,,1897,1612.45,131.1,1897,"Preferred One Administrative Services, INC.",PPO,1870.442,98.6,,percent of total billed charges,,
"Ablation, Soft Tissue Inferior Turbinates, Unilateral Or Bilateral, Any Method; Intramural (Pro Cah)",,30802,CPT,Professional,Both,,,,1897,1612.45,131.1,1897,PrimeWest Health,Minnesota Senior Health Options (MSHO),234.4505,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Ablation, Soft Tissue Inferior Turbinates, Unilateral Or Bilateral, Any Method; Intramural (Pro Cah)",,30802,CPT,Professional,Both,,,,1897,1612.45,131.1,1897,PrimeWest Health,MinnesotaCare,161.9591376,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Ablation, Soft Tissue Inferior Turbinates, Unilateral Or Bilateral, Any Method; Intramural (Pro Cah)",,30802,CPT,Professional,Both,,,,1897,1612.45,131.1,1897,Sanford Health Plan,Sanford Health Plan,1669.36,88,,percent of total billed charges,,
"Ablation, Soft Tissue Inferior Turbinates, Unilateral Or Bilateral, Any Method; Intramural (Pro Cah)",,30802,CPT,Professional,Both,,,,1897,1612.45,131.1,1897,"UCare Health, Inc.",Individual & Family Plan,331.411072,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Ablation, Soft Tissue Inferior Turbinates, Unilateral Or Bilateral, Any Method; Intramural (Pro Cah)",,30802,CPT,Professional,Both,,,,1897,1612.45,131.1,1897,"UCare Health, Inc.",Medical Assistance,166.500048,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Ablation, Soft Tissue Inferior Turbinates, Unilateral Or Bilateral, Any Method; Intramural (Pro Cah)",,30802,CPT,Professional,Both,,,,1897,1612.45,131.1,1897,"UCare Health, Inc.",Medicare Advantage,234.4505,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Ablation, Soft Tissue Inferior Turbinates, Unilateral Or Bilateral, Any Method; Intramural (Pro Cah)",,30802,CPT,Professional,Both,,,,1897,1612.45,131.1,1897,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),187.5604,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Ablation, Soft Tissue Inferior Turbinates, Unilateral Or Bilateral, Any Method; Intramural (Pro Cah)",,30802,CPT,Professional,Both,,,,1897,1612.45,131.1,1897,UnitedHealthcare,Individual & Family,1897,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Ablation, Soft Tissue Inferior Turbinates, Unilateral Or Bilateral, Any Method; Intramural (Pro Cah)",,30802,CPT,Professional,Both,,,,1897,1612.45,131.1,1897,UnitedHealthcare,Medicare Advantage,234.4505,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Ablation, Soft Tissue Inferior Turbinates, Unilateral Or Bilateral, Any Method; Intramural (Pro Cah)",,30802,CPT,Professional,Both,,,,1897,1612.45,131.1,1897,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,151.36368,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Control Nasal Hemorrhage, Anterior, Simple (Limited Cautery And/Or Packing) Any Method (Pro Cah)",,30901,CPT,Professional,Both,,,,299,254.15,34.03,299,Aetna,Commercial,254.15,85,,percent of total billed charges,,
"Control Nasal Hemorrhage, Anterior, Simple (Limited Cautery And/Or Packing) Any Method (Pro Cah)",,30901,CPT,Professional,Both,,,,299,254.15,34.03,299,Aetna,Medicare Advantage,53.55,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Control Nasal Hemorrhage, Anterior, Simple (Limited Cautery And/Or Packing) Any Method (Pro Cah)",,30901,CPT,Professional,Both,,,,299,254.15,34.03,299,Aetna,PPO,278.07,93,,percent of total billed charges,,
"Control Nasal Hemorrhage, Anterior, Simple (Limited Cautery And/Or Packing) Any Method (Pro Cah)",,30901,CPT,Professional,Both,,,,299,254.15,34.03,299,America's PPO,America's PPO,255.4656,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Control Nasal Hemorrhage, Anterior, Simple (Limited Cautery And/Or Packing) Any Method (Pro Cah)",,30901,CPT,Professional,Both,,,,299,254.15,34.03,299,BlueCross BlueShield Minnesota, Federal Employee Program,116.37,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Control Nasal Hemorrhage, Anterior, Simple (Limited Cautery And/Or Packing) Any Method (Pro Cah)",,30901,CPT,Professional,Both,,,,299,254.15,34.03,299,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,118.23192,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Control Nasal Hemorrhage, Anterior, Simple (Limited Cautery And/Or Packing) Any Method (Pro Cah)",,30901,CPT,Professional,Both,,,,299,254.15,34.03,299,BlueCross BlueShield Minnesota,High Value Network Plan,118.23192,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Control Nasal Hemorrhage, Anterior, Simple (Limited Cautery And/Or Packing) Any Method (Pro Cah)",,30901,CPT,Professional,Both,,,,299,254.15,34.03,299,BlueCross BlueShield Minnesota,Medicare Advantage,61.1685,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Control Nasal Hemorrhage, Anterior, Simple (Limited Cautery And/Or Packing) Any Method (Pro Cah)",,30901,CPT,Professional,Both,,,,299,254.15,34.03,299,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,118.23192,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Control Nasal Hemorrhage, Anterior, Simple (Limited Cautery And/Or Packing) Any Method (Pro Cah)",,30901,CPT,Professional,Both,,,,299,254.15,34.03,299,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,39.28872,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Control Nasal Hemorrhage, Anterior, Simple (Limited Cautery And/Or Packing) Any Method (Pro Cah)",,30901,CPT,Professional,Both,,,,299,254.15,34.03,299,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),61.1685,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Control Nasal Hemorrhage, Anterior, Simple (Limited Cautery And/Or Packing) Any Method (Pro Cah)",,30901,CPT,Professional,Both,,,,299,254.15,34.03,299,CorVel,Worker's Compensation,104.2485117,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Control Nasal Hemorrhage, Anterior, Simple (Limited Cautery And/Or Packing) Any Method (Pro Cah)",,30901,CPT,Professional,Both,,,,299,254.15,34.03,299,First Health Group Corporation,First Health Network,290.03,97,,percent of total billed charges,,
"Control Nasal Hemorrhage, Anterior, Simple (Limited Cautery And/Or Packing) Any Method (Pro Cah)",,30901,CPT,Professional,Both,,,,299,254.15,34.03,299,"Health Partners, Inc.",Commercial,112.46,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Control Nasal Hemorrhage, Anterior, Simple (Limited Cautery And/Or Packing) Any Method (Pro Cah)",,30901,CPT,Professional,Both,,,,299,254.15,34.03,299,"Health Partners, Inc.",Medicare Advantage,61.1685,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Control Nasal Hemorrhage, Anterior, Simple (Limited Cautery And/Or Packing) Any Method (Pro Cah)",,30901,CPT,Professional,Both,,,,299,254.15,34.03,299,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),53.2,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Control Nasal Hemorrhage, Anterior, Simple (Limited Cautery And/Or Packing) Any Method (Pro Cah)",,30901,CPT,Professional,Both,,,,299,254.15,34.03,299,"Health Partners, Inc.",State of Minnesota Advantage Program,96.88429,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Control Nasal Hemorrhage, Anterior, Simple (Limited Cautery And/Or Packing) Any Method (Pro Cah)",,30901,CPT,Professional,Both,,,,299,254.15,34.03,299,"Health Partners, Inc.",State Public Programs,34.03,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Control Nasal Hemorrhage, Anterior, Simple (Limited Cautery And/Or Packing) Any Method (Pro Cah)",,30901,CPT,Professional,Both,,,,299,254.15,34.03,299,Humana Insurance Company,Commercial PPO,53.19,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Control Nasal Hemorrhage, Anterior, Simple (Limited Cautery And/Or Packing) Any Method (Pro Cah)",,30901,CPT,Professional,Both,,,,299,254.15,34.03,299,Humana Insurance Company,Medicare PPO,299,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Control Nasal Hemorrhage, Anterior, Simple (Limited Cautery And/Or Packing) Any Method (Pro Cah)",,30901,CPT,Professional,Both,,,,299,254.15,34.03,299,Medica,Individual & Family,253.552,84.8,,percent of total billed charges,,
"Control Nasal Hemorrhage, Anterior, Simple (Limited Cautery And/Or Packing) Any Method (Pro Cah)",,30901,CPT,Professional,Both,,,,299,254.15,34.03,299,Medica,Medica Advantage Solution,148.902,49.8,,percent of total billed charges,,
"Control Nasal Hemorrhage, Anterior, Simple (Limited Cautery And/Or Packing) Any Method (Pro Cah)",,30901,CPT,Professional,Both,,,,299,254.15,34.03,299,Medica,Medical Assistance,39.29,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Control Nasal Hemorrhage, Anterior, Simple (Limited Cautery And/Or Packing) Any Method (Pro Cah)",,30901,CPT,Professional,Both,,,,299,254.15,34.03,299,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,53.19,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Control Nasal Hemorrhage, Anterior, Simple (Limited Cautery And/Or Packing) Any Method (Pro Cah)",,30901,CPT,Professional,Both,,,,299,254.15,34.03,299,"Multiplan, Inc.","Multiplan, Inc.",281.06,94,,percent of total billed charges,,
"Control Nasal Hemorrhage, Anterior, Simple (Limited Cautery And/Or Packing) Any Method (Pro Cah)",,30901,CPT,Professional,Both,,,,299,254.15,34.03,299,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,269.399,90.1,,percent of total billed charges,,
"Control Nasal Hemorrhage, Anterior, Simple (Limited Cautery And/Or Packing) Any Method (Pro Cah)",,30901,CPT,Professional,Both,,,,299,254.15,34.03,299,"Preferred One Administrative Services, INC.",PPO,294.814,98.6,,percent of total billed charges,,
"Control Nasal Hemorrhage, Anterior, Simple (Limited Cautery And/Or Packing) Any Method (Pro Cah)",,30901,CPT,Professional,Both,,,,299,254.15,34.03,299,PrimeWest Health,Minnesota Senior Health Options (MSHO),61.1685,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Control Nasal Hemorrhage, Anterior, Simple (Limited Cautery And/Or Packing) Any Method (Pro Cah)",,30901,CPT,Professional,Both,,,,299,254.15,34.03,299,PrimeWest Health,MinnesotaCare,42.0389304,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Control Nasal Hemorrhage, Anterior, Simple (Limited Cautery And/Or Packing) Any Method (Pro Cah)",,30901,CPT,Professional,Both,,,,299,254.15,34.03,299,Sanford Health Plan,Sanford Health Plan,263.12,88,,percent of total billed charges,,
"Control Nasal Hemorrhage, Anterior, Simple (Limited Cautery And/Or Packing) Any Method (Pro Cah)",,30901,CPT,Professional,Both,,,,299,254.15,34.03,299,"UCare Health, Inc.",Individual & Family Plan,86.465664,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Control Nasal Hemorrhage, Anterior, Simple (Limited Cautery And/Or Packing) Any Method (Pro Cah)",,30901,CPT,Professional,Both,,,,299,254.15,34.03,299,"UCare Health, Inc.",Medical Assistance,43.217592,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Control Nasal Hemorrhage, Anterior, Simple (Limited Cautery And/Or Packing) Any Method (Pro Cah)",,30901,CPT,Professional,Both,,,,299,254.15,34.03,299,"UCare Health, Inc.",Medicare Advantage,61.1685,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Control Nasal Hemorrhage, Anterior, Simple (Limited Cautery And/Or Packing) Any Method (Pro Cah)",,30901,CPT,Professional,Both,,,,299,254.15,34.03,299,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),48.9348,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Control Nasal Hemorrhage, Anterior, Simple (Limited Cautery And/Or Packing) Any Method (Pro Cah)",,30901,CPT,Professional,Both,,,,299,254.15,34.03,299,UnitedHealthcare,Individual & Family,299,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Control Nasal Hemorrhage, Anterior, Simple (Limited Cautery And/Or Packing) Any Method (Pro Cah)",,30901,CPT,Professional,Both,,,,299,254.15,34.03,299,UnitedHealthcare,Medicare Advantage,61.1685,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Control Nasal Hemorrhage, Anterior, Simple (Limited Cautery And/Or Packing) Any Method (Pro Cah)",,30901,CPT,Professional,Both,,,,299,254.15,34.03,299,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,39.28872,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Control Nasal Hemorrhage Anterior Complex,,30903,CPT,Facility,Outpatient,,,,364,309.4,104.3224,364,Aetna,Commercial,334.88,92,,percent of total billed charges,,
Control Nasal Hemorrhage Anterior Complex,,30903,CPT,Facility,Outpatient,,,,364,309.4,104.3224,364,Aetna,Medicare Advantage,178.36,49,,percent of total billed charges,,
Control Nasal Hemorrhage Anterior Complex,,30903,CPT,Facility,Outpatient,,,,364,309.4,104.3224,364,Aetna,PPO,338.52,93,,percent of total billed charges,,
Control Nasal Hemorrhage Anterior Complex,,30903,CPT,Facility,Outpatient,,,,364,309.4,104.3224,364,America's PPO,America's PPO,349.5492,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Control Nasal Hemorrhage Anterior Complex,,30903,CPT,Facility,Outpatient,,,,364,309.4,104.3224,364,BlueCross BlueShield Minnesota, Federal Employee Program,358.176,98.4,,percent of total billed charges,,
Control Nasal Hemorrhage Anterior Complex,,30903,CPT,Facility,Outpatient,,,,364,309.4,104.3224,364,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,364,100,,percent of total billed charges,,
Control Nasal Hemorrhage Anterior Complex,,30903,CPT,Facility,Outpatient,,,,364,309.4,104.3224,364,BlueCross BlueShield Minnesota,High Value Network Plan,327.6,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
Control Nasal Hemorrhage Anterior Complex,,30903,CPT,Facility,Outpatient,,,,364,309.4,104.3224,364,BlueCross BlueShield Minnesota,Medicare Advantage,178.36,49,,percent of total billed charges,,
Control Nasal Hemorrhage Anterior Complex,,30903,CPT,Facility,Outpatient,,,,364,309.4,104.3224,364,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,104.3224,28.66,,percent of total billed charges,,
Control Nasal Hemorrhage Anterior Complex,,30903,CPT,Facility,Outpatient,,,,364,309.4,104.3224,364,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),178.36,49,,percent of total billed charges,,
Control Nasal Hemorrhage Anterior Complex,,30903,CPT,Facility,Outpatient,,,,364,309.4,104.3224,364,CorVel,Worker's Compensation,364,100,,percent of total billed charges,,
Control Nasal Hemorrhage Anterior Complex,,30903,CPT,Facility,Outpatient,,,,364,309.4,104.3224,364,First Health Group Corporation,First Health Network,353.08,97,,percent of total billed charges,,
Control Nasal Hemorrhage Anterior Complex,,30903,CPT,Facility,Outpatient,,,,364,309.4,104.3224,364,"Health Partners, Inc.",Commercial,344.344,94.6,,percent of total billed charges,,
Control Nasal Hemorrhage Anterior Complex,,30903,CPT,Facility,Outpatient,,,,364,309.4,104.3224,364,"Health Partners, Inc.",Medicare Advantage,178.36,49,,percent of total billed charges,,
Control Nasal Hemorrhage Anterior Complex,,30903,CPT,Facility,Outpatient,,,,364,309.4,104.3224,364,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),218.4,60,,percent of total billed charges,,
Control Nasal Hemorrhage Anterior Complex,,30903,CPT,Facility,Outpatient,,,,364,309.4,104.3224,364,"Health Partners, Inc.",State of Minnesota Advantage Program,296.66,81.5,,percent of total billed charges,,
Control Nasal Hemorrhage Anterior Complex,,30903,CPT,Facility,Outpatient,,,,364,309.4,104.3224,364,"Health Partners, Inc.",State Public Programs,182,50,,percent of total billed charges,,
Control Nasal Hemorrhage Anterior Complex,,30903,CPT,Facility,Outpatient,,,,364,309.4,104.3224,364,Humana Insurance Company,Commercial PPO,345.8,95,,percent of total billed charges,,
Control Nasal Hemorrhage Anterior Complex,,30903,CPT,Facility,Outpatient,,,,364,309.4,104.3224,364,Humana Insurance Company,Medicare PPO,178.36,49,,percent of total billed charges,,
Control Nasal Hemorrhage Anterior Complex,,30903,CPT,Facility,Outpatient,,,,364,309.4,104.3224,364,Medica,Individual & Family,339.248,93.2,,percent of total billed charges,,
Control Nasal Hemorrhage Anterior Complex,,30903,CPT,Facility,Outpatient,,,,364,309.4,104.3224,364,Medica,Medica Advantage Solution,181.272,49.8,,percent of total billed charges,,
Control Nasal Hemorrhage Anterior Complex,,30903,CPT,Facility,Outpatient,,,,364,309.4,104.3224,364,Medica,Medical Assistance,162.344,44.6,,percent of total billed charges,,
Control Nasal Hemorrhage Anterior Complex,,30903,CPT,Facility,Outpatient,,,,364,309.4,104.3224,364,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,181.272,49.8,,percent of total billed charges,,
Control Nasal Hemorrhage Anterior Complex,,30903,CPT,Facility,Outpatient,,,,364,309.4,104.3224,364,"Multiplan, Inc.","Multiplan, Inc.",342.16,94,,percent of total billed charges,,
Control Nasal Hemorrhage Anterior Complex,,30903,CPT,Facility,Outpatient,,,,364,309.4,104.3224,364,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,327.964,90.1,,percent of total billed charges,,
Control Nasal Hemorrhage Anterior Complex,,30903,CPT,Facility,Outpatient,,,,364,309.4,104.3224,364,"Preferred One Administrative Services, INC.",PPO,358.904,98.6,,percent of total billed charges,,
Control Nasal Hemorrhage Anterior Complex,,30903,CPT,Facility,Outpatient,,,,364,309.4,104.3224,364,PrimeWest Health,Minnesota Senior Health Options (MSHO),187.278,51.45,,percent of total billed charges,,
Control Nasal Hemorrhage Anterior Complex,,30903,CPT,Facility,Outpatient,,,,364,309.4,104.3224,364,PrimeWest Health,MinnesotaCare,186.9504,51.36,,percent of total billed charges,,
Control Nasal Hemorrhage Anterior Complex,,30903,CPT,Facility,Outpatient,,,,364,309.4,104.3224,364,Sanford Health Plan,Sanford Health Plan,334.88,92,,percent of total billed charges,,
Control Nasal Hemorrhage Anterior Complex,,30903,CPT,Facility,Outpatient,,,,364,309.4,104.3224,364,"UCare Health, Inc.",Individual & Family Plan,205.114,56.35,,percent of total billed charges,,
Control Nasal Hemorrhage Anterior Complex,,30903,CPT,Facility,Outpatient,,,,364,309.4,104.3224,364,"UCare Health, Inc.",Medical Assistance,183.7108,50.47,,percent of total billed charges,,
Control Nasal Hemorrhage Anterior Complex,,30903,CPT,Facility,Outpatient,,,,364,309.4,104.3224,364,"UCare Health, Inc.",Medicare Advantage,183.7108,50.47,,percent of total billed charges,,
Control Nasal Hemorrhage Anterior Complex,,30903,CPT,Facility,Outpatient,,,,364,309.4,104.3224,364,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),183.7108,50.47,,percent of total billed charges,,
Control Nasal Hemorrhage Anterior Complex,,30903,CPT,Facility,Outpatient,,,,364,309.4,104.3224,364,UnitedHealthcare,Individual & Family,342.16,94,,percent of total billed charges,,
Control Nasal Hemorrhage Anterior Complex,,30903,CPT,Facility,Outpatient,,,,364,309.4,104.3224,364,UnitedHealthcare,Medicare Advantage,178.36,49,,percent of total billed charges,,
Control Nasal Hemorrhage Anterior Complex,,30903,CPT,Facility,Outpatient,,,,364,309.4,104.3224,364,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,174.72,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Control Nasal Hemorrhage, Anterior, Complex (Extensive Cautery And/Or Packing) Any Method (Pro Cah)",,30903,CPT,Professional,Both,,,,587,498.95,46.68,587,Aetna,Commercial,498.95,85,,percent of total billed charges,,
"Control Nasal Hemorrhage, Anterior, Complex (Extensive Cautery And/Or Packing) Any Method (Pro Cah)",,30903,CPT,Professional,Both,,,,587,498.95,46.68,587,Aetna,Medicare Advantage,73.55,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Control Nasal Hemorrhage, Anterior, Complex (Extensive Cautery And/Or Packing) Any Method (Pro Cah)",,30903,CPT,Professional,Both,,,,587,498.95,46.68,587,Aetna,PPO,545.91,93,,percent of total billed charges,,
"Control Nasal Hemorrhage, Anterior, Complex (Extensive Cautery And/Or Packing) Any Method (Pro Cah)",,30903,CPT,Professional,Both,,,,587,498.95,46.68,587,America's PPO,America's PPO,501.5328,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Control Nasal Hemorrhage, Anterior, Complex (Extensive Cautery And/Or Packing) Any Method (Pro Cah)",,30903,CPT,Professional,Both,,,,587,498.95,46.68,587,BlueCross BlueShield Minnesota, Federal Employee Program,159.07,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Control Nasal Hemorrhage, Anterior, Complex (Extensive Cautery And/Or Packing) Any Method (Pro Cah)",,30903,CPT,Professional,Both,,,,587,498.95,46.68,587,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,161.61512,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Control Nasal Hemorrhage, Anterior, Complex (Extensive Cautery And/Or Packing) Any Method (Pro Cah)",,30903,CPT,Professional,Both,,,,587,498.95,46.68,587,BlueCross BlueShield Minnesota,High Value Network Plan,161.61512,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Control Nasal Hemorrhage, Anterior, Complex (Extensive Cautery And/Or Packing) Any Method (Pro Cah)",,30903,CPT,Professional,Both,,,,587,498.95,46.68,587,BlueCross BlueShield Minnesota,Medicare Advantage,83.5705,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Control Nasal Hemorrhage, Anterior, Complex (Extensive Cautery And/Or Packing) Any Method (Pro Cah)",,30903,CPT,Professional,Both,,,,587,498.95,46.68,587,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,161.61512,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Control Nasal Hemorrhage, Anterior, Complex (Extensive Cautery And/Or Packing) Any Method (Pro Cah)",,30903,CPT,Professional,Both,,,,587,498.95,46.68,587,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,53.8988,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Control Nasal Hemorrhage, Anterior, Complex (Extensive Cautery And/Or Packing) Any Method (Pro Cah)",,30903,CPT,Professional,Both,,,,587,498.95,46.68,587,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),83.5705,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Control Nasal Hemorrhage, Anterior, Complex (Extensive Cautery And/Or Packing) Any Method (Pro Cah)",,30903,CPT,Professional,Both,,,,587,498.95,46.68,587,CorVel,Worker's Compensation,142.0302933,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Control Nasal Hemorrhage, Anterior, Complex (Extensive Cautery And/Or Packing) Any Method (Pro Cah)",,30903,CPT,Professional,Both,,,,587,498.95,46.68,587,First Health Group Corporation,First Health Network,569.39,97,,percent of total billed charges,,
"Control Nasal Hemorrhage, Anterior, Complex (Extensive Cautery And/Or Packing) Any Method (Pro Cah)",,30903,CPT,Professional,Both,,,,587,498.95,46.68,587,"Health Partners, Inc.",Commercial,153.81,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Control Nasal Hemorrhage, Anterior, Complex (Extensive Cautery And/Or Packing) Any Method (Pro Cah)",,30903,CPT,Professional,Both,,,,587,498.95,46.68,587,"Health Partners, Inc.",Medicare Advantage,83.5705,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Control Nasal Hemorrhage, Anterior, Complex (Extensive Cautery And/Or Packing) Any Method (Pro Cah)",,30903,CPT,Professional,Both,,,,587,498.95,46.68,587,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),72.52,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Control Nasal Hemorrhage, Anterior, Complex (Extensive Cautery And/Or Packing) Any Method (Pro Cah)",,30903,CPT,Professional,Both,,,,587,498.95,46.68,587,"Health Partners, Inc.",State of Minnesota Advantage Program,132.507315,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Control Nasal Hemorrhage, Anterior, Complex (Extensive Cautery And/Or Packing) Any Method (Pro Cah)",,30903,CPT,Professional,Both,,,,587,498.95,46.68,587,"Health Partners, Inc.",State Public Programs,46.68,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Control Nasal Hemorrhage, Anterior, Complex (Extensive Cautery And/Or Packing) Any Method (Pro Cah)",,30903,CPT,Professional,Both,,,,587,498.95,46.68,587,Humana Insurance Company,Commercial PPO,72.67,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Control Nasal Hemorrhage, Anterior, Complex (Extensive Cautery And/Or Packing) Any Method (Pro Cah)",,30903,CPT,Professional,Both,,,,587,498.95,46.68,587,Humana Insurance Company,Medicare PPO,587,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Control Nasal Hemorrhage, Anterior, Complex (Extensive Cautery And/Or Packing) Any Method (Pro Cah)",,30903,CPT,Professional,Both,,,,587,498.95,46.68,587,Medica,Individual & Family,497.776,84.8,,percent of total billed charges,,
"Control Nasal Hemorrhage, Anterior, Complex (Extensive Cautery And/Or Packing) Any Method (Pro Cah)",,30903,CPT,Professional,Both,,,,587,498.95,46.68,587,Medica,Medica Advantage Solution,292.326,49.8,,percent of total billed charges,,
"Control Nasal Hemorrhage, Anterior, Complex (Extensive Cautery And/Or Packing) Any Method (Pro Cah)",,30903,CPT,Professional,Both,,,,587,498.95,46.68,587,Medica,Medical Assistance,53.9,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Control Nasal Hemorrhage, Anterior, Complex (Extensive Cautery And/Or Packing) Any Method (Pro Cah)",,30903,CPT,Professional,Both,,,,587,498.95,46.68,587,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,72.67,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Control Nasal Hemorrhage, Anterior, Complex (Extensive Cautery And/Or Packing) Any Method (Pro Cah)",,30903,CPT,Professional,Both,,,,587,498.95,46.68,587,"Multiplan, Inc.","Multiplan, Inc.",551.78,94,,percent of total billed charges,,
"Control Nasal Hemorrhage, Anterior, Complex (Extensive Cautery And/Or Packing) Any Method (Pro Cah)",,30903,CPT,Professional,Both,,,,587,498.95,46.68,587,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,528.887,90.1,,percent of total billed charges,,
"Control Nasal Hemorrhage, Anterior, Complex (Extensive Cautery And/Or Packing) Any Method (Pro Cah)",,30903,CPT,Professional,Both,,,,587,498.95,46.68,587,"Preferred One Administrative Services, INC.",PPO,578.782,98.6,,percent of total billed charges,,
"Control Nasal Hemorrhage, Anterior, Complex (Extensive Cautery And/Or Packing) Any Method (Pro Cah)",,30903,CPT,Professional,Both,,,,587,498.95,46.68,587,PrimeWest Health,Minnesota Senior Health Options (MSHO),83.5705,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Control Nasal Hemorrhage, Anterior, Complex (Extensive Cautery And/Or Packing) Any Method (Pro Cah)",,30903,CPT,Professional,Both,,,,587,498.95,46.68,587,PrimeWest Health,MinnesotaCare,57.671716,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Control Nasal Hemorrhage, Anterior, Complex (Extensive Cautery And/Or Packing) Any Method (Pro Cah)",,30903,CPT,Professional,Both,,,,587,498.95,46.68,587,Sanford Health Plan,Sanford Health Plan,516.56,88,,percent of total billed charges,,
"Control Nasal Hemorrhage, Anterior, Complex (Extensive Cautery And/Or Packing) Any Method (Pro Cah)",,30903,CPT,Professional,Both,,,,587,498.95,46.68,587,"UCare Health, Inc.",Individual & Family Plan,118.132352,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Control Nasal Hemorrhage, Anterior, Complex (Extensive Cautery And/Or Packing) Any Method (Pro Cah)",,30903,CPT,Professional,Both,,,,587,498.95,46.68,587,"UCare Health, Inc.",Medical Assistance,59.28868,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Control Nasal Hemorrhage, Anterior, Complex (Extensive Cautery And/Or Packing) Any Method (Pro Cah)",,30903,CPT,Professional,Both,,,,587,498.95,46.68,587,"UCare Health, Inc.",Medicare Advantage,83.5705,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Control Nasal Hemorrhage, Anterior, Complex (Extensive Cautery And/Or Packing) Any Method (Pro Cah)",,30903,CPT,Professional,Both,,,,587,498.95,46.68,587,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),66.8564,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Control Nasal Hemorrhage, Anterior, Complex (Extensive Cautery And/Or Packing) Any Method (Pro Cah)",,30903,CPT,Professional,Both,,,,587,498.95,46.68,587,UnitedHealthcare,Individual & Family,587,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Control Nasal Hemorrhage, Anterior, Complex (Extensive Cautery And/Or Packing) Any Method (Pro Cah)",,30903,CPT,Professional,Both,,,,587,498.95,46.68,587,UnitedHealthcare,Medicare Advantage,83.5705,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Control Nasal Hemorrhage, Anterior, Complex (Extensive Cautery And/Or Packing) Any Method (Pro Cah)",,30903,CPT,Professional,Both,,,,587,498.95,46.68,587,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,53.8988,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Control Nasal Hemorrhage, Posterior, With Posterior Nasal Packs And/Or Cautery; Initial (Pro Cah)",,30905,CPT,Professional,Both,,,,585,497.25,64.13,585,Aetna,Commercial,497.25,85,,percent of total billed charges,,
"Control Nasal Hemorrhage, Posterior, With Posterior Nasal Packs And/Or Cautery; Initial (Pro Cah)",,30905,CPT,Professional,Both,,,,585,497.25,64.13,585,Aetna,Medicare Advantage,100.5,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Control Nasal Hemorrhage, Posterior, With Posterior Nasal Packs And/Or Cautery; Initial (Pro Cah)",,30905,CPT,Professional,Both,,,,585,497.25,64.13,585,Aetna,PPO,544.05,93,,percent of total billed charges,,
"Control Nasal Hemorrhage, Posterior, With Posterior Nasal Packs And/Or Cautery; Initial (Pro Cah)",,30905,CPT,Professional,Both,,,,585,497.25,64.13,585,America's PPO,America's PPO,499.824,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Control Nasal Hemorrhage, Posterior, With Posterior Nasal Packs And/Or Cautery; Initial (Pro Cah)",,30905,CPT,Professional,Both,,,,585,497.25,64.13,585,BlueCross BlueShield Minnesota, Federal Employee Program,217.6,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Control Nasal Hemorrhage, Posterior, With Posterior Nasal Packs And/Or Cautery; Initial (Pro Cah)",,30905,CPT,Professional,Both,,,,585,497.25,64.13,585,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,221.0816,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Control Nasal Hemorrhage, Posterior, With Posterior Nasal Packs And/Or Cautery; Initial (Pro Cah)",,30905,CPT,Professional,Both,,,,585,497.25,64.13,585,BlueCross BlueShield Minnesota,High Value Network Plan,221.0816,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Control Nasal Hemorrhage, Posterior, With Posterior Nasal Packs And/Or Cautery; Initial (Pro Cah)",,30905,CPT,Professional,Both,,,,585,497.25,64.13,585,BlueCross BlueShield Minnesota,Medicare Advantage,114.5745,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Control Nasal Hemorrhage, Posterior, With Posterior Nasal Packs And/Or Cautery; Initial (Pro Cah)",,30905,CPT,Professional,Both,,,,585,497.25,64.13,585,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,221.0816,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Control Nasal Hemorrhage, Posterior, With Posterior Nasal Packs And/Or Cautery; Initial (Pro Cah)",,30905,CPT,Professional,Both,,,,585,497.25,64.13,585,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,74.04608,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Control Nasal Hemorrhage, Posterior, With Posterior Nasal Packs And/Or Cautery; Initial (Pro Cah)",,30905,CPT,Professional,Both,,,,585,497.25,64.13,585,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),114.5745,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Control Nasal Hemorrhage, Posterior, With Posterior Nasal Packs And/Or Cautery; Initial (Pro Cah)",,30905,CPT,Professional,Both,,,,585,497.25,64.13,585,CorVel,Worker's Compensation,194.8212114,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Control Nasal Hemorrhage, Posterior, With Posterior Nasal Packs And/Or Cautery; Initial (Pro Cah)",,30905,CPT,Professional,Both,,,,585,497.25,64.13,585,First Health Group Corporation,First Health Network,567.45,97,,percent of total billed charges,,
"Control Nasal Hemorrhage, Posterior, With Posterior Nasal Packs And/Or Cautery; Initial (Pro Cah)",,30905,CPT,Professional,Both,,,,585,497.25,64.13,585,"Health Partners, Inc.",Commercial,210.4,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Control Nasal Hemorrhage, Posterior, With Posterior Nasal Packs And/Or Cautery; Initial (Pro Cah)",,30905,CPT,Professional,Both,,,,585,497.25,64.13,585,"Health Partners, Inc.",Medicare Advantage,114.5745,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Control Nasal Hemorrhage, Posterior, With Posterior Nasal Packs And/Or Cautery; Initial (Pro Cah)",,30905,CPT,Professional,Both,,,,585,497.25,64.13,585,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),99.63,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Control Nasal Hemorrhage, Posterior, With Posterior Nasal Packs And/Or Cautery; Initial (Pro Cah)",,30905,CPT,Professional,Both,,,,585,497.25,64.13,585,"Health Partners, Inc.",State of Minnesota Advantage Program,181.2596,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Control Nasal Hemorrhage, Posterior, With Posterior Nasal Packs And/Or Cautery; Initial (Pro Cah)",,30905,CPT,Professional,Both,,,,585,497.25,64.13,585,"Health Partners, Inc.",State Public Programs,64.13,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Control Nasal Hemorrhage, Posterior, With Posterior Nasal Packs And/Or Cautery; Initial (Pro Cah)",,30905,CPT,Professional,Both,,,,585,497.25,64.13,585,Humana Insurance Company,Commercial PPO,99.63,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Control Nasal Hemorrhage, Posterior, With Posterior Nasal Packs And/Or Cautery; Initial (Pro Cah)",,30905,CPT,Professional,Both,,,,585,497.25,64.13,585,Humana Insurance Company,Medicare PPO,585,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Control Nasal Hemorrhage, Posterior, With Posterior Nasal Packs And/Or Cautery; Initial (Pro Cah)",,30905,CPT,Professional,Both,,,,585,497.25,64.13,585,Medica,Individual & Family,496.08,84.8,,percent of total billed charges,,
"Control Nasal Hemorrhage, Posterior, With Posterior Nasal Packs And/Or Cautery; Initial (Pro Cah)",,30905,CPT,Professional,Both,,,,585,497.25,64.13,585,Medica,Medica Advantage Solution,291.33,49.8,,percent of total billed charges,,
"Control Nasal Hemorrhage, Posterior, With Posterior Nasal Packs And/Or Cautery; Initial (Pro Cah)",,30905,CPT,Professional,Both,,,,585,497.25,64.13,585,Medica,Medical Assistance,74.05,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Control Nasal Hemorrhage, Posterior, With Posterior Nasal Packs And/Or Cautery; Initial (Pro Cah)",,30905,CPT,Professional,Both,,,,585,497.25,64.13,585,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,99.63,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Control Nasal Hemorrhage, Posterior, With Posterior Nasal Packs And/Or Cautery; Initial (Pro Cah)",,30905,CPT,Professional,Both,,,,585,497.25,64.13,585,"Multiplan, Inc.","Multiplan, Inc.",549.9,94,,percent of total billed charges,,
"Control Nasal Hemorrhage, Posterior, With Posterior Nasal Packs And/Or Cautery; Initial (Pro Cah)",,30905,CPT,Professional,Both,,,,585,497.25,64.13,585,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,527.085,90.1,,percent of total billed charges,,
"Control Nasal Hemorrhage, Posterior, With Posterior Nasal Packs And/Or Cautery; Initial (Pro Cah)",,30905,CPT,Professional,Both,,,,585,497.25,64.13,585,"Preferred One Administrative Services, INC.",PPO,576.81,98.6,,percent of total billed charges,,
"Control Nasal Hemorrhage, Posterior, With Posterior Nasal Packs And/Or Cautery; Initial (Pro Cah)",,30905,CPT,Professional,Both,,,,585,497.25,64.13,585,PrimeWest Health,Minnesota Senior Health Options (MSHO),114.5745,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Control Nasal Hemorrhage, Posterior, With Posterior Nasal Packs And/Or Cautery; Initial (Pro Cah)",,30905,CPT,Professional,Both,,,,585,497.25,64.13,585,PrimeWest Health,MinnesotaCare,79.2293056,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Control Nasal Hemorrhage, Posterior, With Posterior Nasal Packs And/Or Cautery; Initial (Pro Cah)",,30905,CPT,Professional,Both,,,,585,497.25,64.13,585,Sanford Health Plan,Sanford Health Plan,514.8,88,,percent of total billed charges,,
"Control Nasal Hemorrhage, Posterior, With Posterior Nasal Packs And/Or Cautery; Initial (Pro Cah)",,30905,CPT,Professional,Both,,,,585,497.25,64.13,585,"UCare Health, Inc.",Individual & Family Plan,161.958528,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Control Nasal Hemorrhage, Posterior, With Posterior Nasal Packs And/Or Cautery; Initial (Pro Cah)",,30905,CPT,Professional,Both,,,,585,497.25,64.13,585,"UCare Health, Inc.",Medical Assistance,81.450688,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Control Nasal Hemorrhage, Posterior, With Posterior Nasal Packs And/Or Cautery; Initial (Pro Cah)",,30905,CPT,Professional,Both,,,,585,497.25,64.13,585,"UCare Health, Inc.",Medicare Advantage,114.5745,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Control Nasal Hemorrhage, Posterior, With Posterior Nasal Packs And/Or Cautery; Initial (Pro Cah)",,30905,CPT,Professional,Both,,,,585,497.25,64.13,585,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),91.6596,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Control Nasal Hemorrhage, Posterior, With Posterior Nasal Packs And/Or Cautery; Initial (Pro Cah)",,30905,CPT,Professional,Both,,,,585,497.25,64.13,585,UnitedHealthcare,Individual & Family,585,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Control Nasal Hemorrhage, Posterior, With Posterior Nasal Packs And/Or Cautery; Initial (Pro Cah)",,30905,CPT,Professional,Both,,,,585,497.25,64.13,585,UnitedHealthcare,Medicare Advantage,114.5745,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Control Nasal Hemorrhage, Posterior, With Posterior Nasal Packs And/Or Cautery; Initial (Pro Cah)",,30905,CPT,Professional,Both,,,,585,497.25,64.13,585,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,74.04608,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Fracture Nasal Inferior Turbinate(S), Therapeutic",,30930,CPT,Facility,Both,,,,536,455.6,153.6176,536,Aetna,Commercial,493.12,92,,percent of total billed charges,,
"Fracture Nasal Inferior Turbinate(S), Therapeutic",,30930,CPT,Facility,Outpatient,,,,536,455.6,153.6176,536,Aetna,Medicare Advantage,262.64,49,,percent of total billed charges,,
"Fracture Nasal Inferior Turbinate(S), Therapeutic",,30930,CPT,Facility,Inpatient,,,,536,455.6,153.6176,536,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Fracture Nasal Inferior Turbinate(S), Therapeutic",,30930,CPT,Facility,Both,,,,536,455.6,153.6176,536,Aetna,PPO,498.48,93,,percent of total billed charges,,
"Fracture Nasal Inferior Turbinate(S), Therapeutic",,30930,CPT,Facility,Both,,,,536,455.6,153.6176,536,America's PPO,America's PPO,514.7208,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Fracture Nasal Inferior Turbinate(S), Therapeutic",,30930,CPT,Facility,Both,,,,536,455.6,153.6176,536,BlueCross BlueShield Minnesota, Federal Employee Program,527.424,98.4,,percent of total billed charges,,
"Fracture Nasal Inferior Turbinate(S), Therapeutic",,30930,CPT,Facility,Both,,,,536,455.6,153.6176,536,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,536,100,,percent of total billed charges,,
"Fracture Nasal Inferior Turbinate(S), Therapeutic",,30930,CPT,Facility,Both,,,,536,455.6,153.6176,536,BlueCross BlueShield Minnesota,High Value Network Plan,482.4,90,,percent of total billed charges,,
"Fracture Nasal Inferior Turbinate(S), Therapeutic",,30930,CPT,Facility,Outpatient,,,,536,455.6,153.6176,536,BlueCross BlueShield Minnesota,Medicare Advantage,262.64,49,,percent of total billed charges,,
"Fracture Nasal Inferior Turbinate(S), Therapeutic",,30930,CPT,Facility,Inpatient,,,,536,455.6,153.6176,536,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Fracture Nasal Inferior Turbinate(S), Therapeutic",,30930,CPT,Facility,Both,,,,536,455.6,153.6176,536,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,474.7352,88.57,,percent of total billed charges,,
"Fracture Nasal Inferior Turbinate(S), Therapeutic",,30930,CPT,Facility,Both,,,,536,455.6,153.6176,536,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,153.6176,28.66,,percent of total billed charges,,
"Fracture Nasal Inferior Turbinate(S), Therapeutic",,30930,CPT,Facility,Outpatient,,,,536,455.6,153.6176,536,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),262.64,49,,percent of total billed charges,,
"Fracture Nasal Inferior Turbinate(S), Therapeutic",,30930,CPT,Facility,Inpatient,,,,536,455.6,153.6176,536,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Fracture Nasal Inferior Turbinate(S), Therapeutic",,30930,CPT,Facility,Both,,,,536,455.6,153.6176,536,CorVel,Worker's Compensation,536,100,,percent of total billed charges,,
"Fracture Nasal Inferior Turbinate(S), Therapeutic",,30930,CPT,Facility,Both,,,,536,455.6,153.6176,536,First Health Group Corporation,First Health Network,519.92,97,,percent of total billed charges,,
"Fracture Nasal Inferior Turbinate(S), Therapeutic",,30930,CPT,Facility,Both,,,,536,455.6,153.6176,536,"Health Partners, Inc.",Commercial,507.056,94.6,,percent of total billed charges,,
"Fracture Nasal Inferior Turbinate(S), Therapeutic",,30930,CPT,Facility,Outpatient,,,,536,455.6,153.6176,536,"Health Partners, Inc.",Medicare Advantage,262.64,49,,percent of total billed charges,,
"Fracture Nasal Inferior Turbinate(S), Therapeutic",,30930,CPT,Facility,Inpatient,,,,536,455.6,153.6176,536,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Fracture Nasal Inferior Turbinate(S), Therapeutic",,30930,CPT,Facility,Both,,,,536,455.6,153.6176,536,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),321.6,60,,percent of total billed charges,,
"Fracture Nasal Inferior Turbinate(S), Therapeutic",,30930,CPT,Facility,Both,,,,536,455.6,153.6176,536,"Health Partners, Inc.",State of Minnesota Advantage Program,436.84,81.5,,percent of total billed charges,,
"Fracture Nasal Inferior Turbinate(S), Therapeutic",,30930,CPT,Facility,Both,,,,536,455.6,153.6176,536,"Health Partners, Inc.",State Public Programs,268,50,,percent of total billed charges,,
"Fracture Nasal Inferior Turbinate(S), Therapeutic",,30930,CPT,Facility,Both,,,,536,455.6,153.6176,536,Humana Insurance Company,Commercial PPO,509.2,95,,percent of total billed charges,,
"Fracture Nasal Inferior Turbinate(S), Therapeutic",,30930,CPT,Facility,Outpatient,,,,536,455.6,153.6176,536,Humana Insurance Company,Medicare PPO,262.64,49,,percent of total billed charges,,
"Fracture Nasal Inferior Turbinate(S), Therapeutic",,30930,CPT,Facility,Inpatient,,,,536,455.6,153.6176,536,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Fracture Nasal Inferior Turbinate(S), Therapeutic",,30930,CPT,Facility,Both,,,,536,455.6,153.6176,536,Medica,Individual & Family,531.176,99.1,,percent of total billed charges,,
"Fracture Nasal Inferior Turbinate(S), Therapeutic",,30930,CPT,Facility,Outpatient,,,,536,455.6,153.6176,536,Medica,Medica Advantage Solution,266.928,49.8,,percent of total billed charges,,
"Fracture Nasal Inferior Turbinate(S), Therapeutic",,30930,CPT,Facility,Inpatient,,,,536,455.6,153.6176,536,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Fracture Nasal Inferior Turbinate(S), Therapeutic",,30930,CPT,Facility,Outpatient,,,,536,455.6,153.6176,536,Medica,Medical Assistance,239.056,44.6,,percent of total billed charges,,
"Fracture Nasal Inferior Turbinate(S), Therapeutic",,30930,CPT,Facility,Inpatient,,,,536,455.6,153.6176,536,Medica,Medical Assistance,,,,,Included in per diem rate,
"Fracture Nasal Inferior Turbinate(S), Therapeutic",,30930,CPT,Facility,Outpatient,,,,536,455.6,153.6176,536,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,266.928,49.8,,percent of total billed charges,,
"Fracture Nasal Inferior Turbinate(S), Therapeutic",,30930,CPT,Facility,Inpatient,,,,536,455.6,153.6176,536,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Fracture Nasal Inferior Turbinate(S), Therapeutic",,30930,CPT,Facility,Both,,,,536,455.6,153.6176,536,"Multiplan, Inc.","Multiplan, Inc.",503.84,94,,percent of total billed charges,,
"Fracture Nasal Inferior Turbinate(S), Therapeutic",,30930,CPT,Facility,Outpatient,,,,536,455.6,153.6176,536,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,482.936,90.1,,percent of total billed charges,,
"Fracture Nasal Inferior Turbinate(S), Therapeutic",,30930,CPT,Facility,Inpatient,,,,536,455.6,153.6176,536,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Fracture Nasal Inferior Turbinate(S), Therapeutic",,30930,CPT,Facility,Both,,,,536,455.6,153.6176,536,"Preferred One Administrative Services, INC.",PPO,528.496,98.6,,percent of total billed charges,,
"Fracture Nasal Inferior Turbinate(S), Therapeutic",,30930,CPT,Facility,Outpatient,,,,536,455.6,153.6176,536,PrimeWest Health,Minnesota Senior Health Options (MSHO),275.772,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Fracture Nasal Inferior Turbinate(S), Therapeutic",,30930,CPT,Facility,Inpatient,,,,536,455.6,153.6176,536,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Fracture Nasal Inferior Turbinate(S), Therapeutic",,30930,CPT,Facility,Outpatient,,,,536,455.6,153.6176,536,PrimeWest Health,MinnesotaCare,275.2896,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Fracture Nasal Inferior Turbinate(S), Therapeutic",,30930,CPT,Facility,Inpatient,,,,536,455.6,153.6176,536,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Fracture Nasal Inferior Turbinate(S), Therapeutic",,30930,CPT,Facility,Both,,,,536,455.6,153.6176,536,Sanford Health Plan,Sanford Health Plan,493.12,92,,percent of total billed charges,,
"Fracture Nasal Inferior Turbinate(S), Therapeutic",,30930,CPT,Facility,Outpatient,,,,536,455.6,153.6176,536,"UCare Health, Inc.",Individual & Family Plan,302.036,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Fracture Nasal Inferior Turbinate(S), Therapeutic",,30930,CPT,Facility,Inpatient,,,,536,455.6,153.6176,536,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Fracture Nasal Inferior Turbinate(S), Therapeutic",,30930,CPT,Facility,Outpatient,,,,536,455.6,153.6176,536,"UCare Health, Inc.",Medical Assistance,270.5192,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Fracture Nasal Inferior Turbinate(S), Therapeutic",,30930,CPT,Facility,Inpatient,,,,536,455.6,153.6176,536,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Fracture Nasal Inferior Turbinate(S), Therapeutic",,30930,CPT,Facility,Outpatient,,,,536,455.6,153.6176,536,"UCare Health, Inc.",Medicare Advantage,270.5192,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Fracture Nasal Inferior Turbinate(S), Therapeutic",,30930,CPT,Facility,Inpatient,,,,536,455.6,153.6176,536,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Fracture Nasal Inferior Turbinate(S), Therapeutic",,30930,CPT,Facility,Outpatient,,,,536,455.6,153.6176,536,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),270.5192,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Fracture Nasal Inferior Turbinate(S), Therapeutic",,30930,CPT,Facility,Inpatient,,,,536,455.6,153.6176,536,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Fracture Nasal Inferior Turbinate(S), Therapeutic",,30930,CPT,Facility,Both,,,,536,455.6,153.6176,536,UnitedHealthcare,Individual & Family,503.84,94,,percent of total billed charges,,
"Fracture Nasal Inferior Turbinate(S), Therapeutic",,30930,CPT,Facility,Outpatient,,,,536,455.6,153.6176,536,UnitedHealthcare,Medicare Advantage,262.64,49,,percent of total billed charges,,
"Fracture Nasal Inferior Turbinate(S), Therapeutic",,30930,CPT,Facility,Inpatient,,,,536,455.6,153.6176,536,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Fracture Nasal Inferior Turbinate(S), Therapeutic",,30930,CPT,Facility,Outpatient,,,,536,455.6,153.6176,536,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,257.28,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Fracture Nasal Inferior Turbinate(S), Therapeutic",,30930,CPT,Facility,Inpatient,,,,536,455.6,153.6176,536,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Fracture Nasal Inferior Turbinate(S), Therapeutic (Pro Cah)",,30930,CPT,Professional,Both,,,,806,685.1,75.48,806,Aetna,Commercial,685.1,85,,percent of total billed charges,,
"Fracture Nasal Inferior Turbinate(S), Therapeutic (Pro Cah)",,30930,CPT,Professional,Both,,,,806,685.1,75.48,806,Aetna,Medicare Advantage,116.73,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Fracture Nasal Inferior Turbinate(S), Therapeutic (Pro Cah)",,30930,CPT,Professional,Both,,,,806,685.1,75.48,806,Aetna,PPO,749.58,93,,percent of total billed charges,,
"Fracture Nasal Inferior Turbinate(S), Therapeutic (Pro Cah)",,30930,CPT,Professional,Both,,,,806,685.1,75.48,806,America's PPO,America's PPO,688.6464,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Fracture Nasal Inferior Turbinate(S), Therapeutic (Pro Cah)",,30930,CPT,Professional,Both,,,,806,685.1,75.48,806,BlueCross BlueShield Minnesota, Federal Employee Program,244.45,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Fracture Nasal Inferior Turbinate(S), Therapeutic (Pro Cah)",,30930,CPT,Professional,Both,,,,806,685.1,75.48,806,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,248.3612,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Fracture Nasal Inferior Turbinate(S), Therapeutic (Pro Cah)",,30930,CPT,Professional,Both,,,,806,685.1,75.48,806,BlueCross BlueShield Minnesota,High Value Network Plan,248.3612,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Fracture Nasal Inferior Turbinate(S), Therapeutic (Pro Cah)",,30930,CPT,Professional,Both,,,,806,685.1,75.48,806,BlueCross BlueShield Minnesota,Medicare Advantage,134.872,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Fracture Nasal Inferior Turbinate(S), Therapeutic (Pro Cah)",,30930,CPT,Professional,Both,,,,806,685.1,75.48,806,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,248.3612,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Fracture Nasal Inferior Turbinate(S), Therapeutic (Pro Cah)",,30930,CPT,Professional,Both,,,,806,685.1,75.48,806,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,87.14232,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Fracture Nasal Inferior Turbinate(S), Therapeutic (Pro Cah)",,30930,CPT,Professional,Both,,,,806,685.1,75.48,806,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),134.872,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Fracture Nasal Inferior Turbinate(S), Therapeutic (Pro Cah)",,30930,CPT,Professional,Both,,,,806,685.1,75.48,806,CorVel,Worker's Compensation,227.2233477,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Fracture Nasal Inferior Turbinate(S), Therapeutic (Pro Cah)",,30930,CPT,Professional,Both,,,,806,685.1,75.48,806,First Health Group Corporation,First Health Network,781.82,97,,percent of total billed charges,,
"Fracture Nasal Inferior Turbinate(S), Therapeutic (Pro Cah)",,30930,CPT,Professional,Both,,,,806,685.1,75.48,806,"Health Partners, Inc.",Commercial,245.95,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Fracture Nasal Inferior Turbinate(S), Therapeutic (Pro Cah)",,30930,CPT,Professional,Both,,,,806,685.1,75.48,806,"Health Partners, Inc.",Medicare Advantage,134.872,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Fracture Nasal Inferior Turbinate(S), Therapeutic (Pro Cah)",,30930,CPT,Professional,Both,,,,806,685.1,75.48,806,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),117.25,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Fracture Nasal Inferior Turbinate(S), Therapeutic (Pro Cah)",,30930,CPT,Professional,Both,,,,806,685.1,75.48,806,"Health Partners, Inc.",State of Minnesota Advantage Program,211.885925,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Fracture Nasal Inferior Turbinate(S), Therapeutic (Pro Cah)",,30930,CPT,Professional,Both,,,,806,685.1,75.48,806,"Health Partners, Inc.",State Public Programs,75.48,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Fracture Nasal Inferior Turbinate(S), Therapeutic (Pro Cah)",,30930,CPT,Professional,Both,,,,806,685.1,75.48,806,Humana Insurance Company,Commercial PPO,117.28,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Fracture Nasal Inferior Turbinate(S), Therapeutic (Pro Cah)",,30930,CPT,Professional,Both,,,,806,685.1,75.48,806,Humana Insurance Company,Medicare PPO,806,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Fracture Nasal Inferior Turbinate(S), Therapeutic (Pro Cah)",,30930,CPT,Professional,Both,,,,806,685.1,75.48,806,Medica,Individual & Family,683.488,84.8,,percent of total billed charges,,
"Fracture Nasal Inferior Turbinate(S), Therapeutic (Pro Cah)",,30930,CPT,Professional,Both,,,,806,685.1,75.48,806,Medica,Medica Advantage Solution,401.388,49.8,,percent of total billed charges,,
"Fracture Nasal Inferior Turbinate(S), Therapeutic (Pro Cah)",,30930,CPT,Professional,Both,,,,806,685.1,75.48,806,Medica,Medical Assistance,87.14,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Fracture Nasal Inferior Turbinate(S), Therapeutic (Pro Cah)",,30930,CPT,Professional,Both,,,,806,685.1,75.48,806,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,117.28,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Fracture Nasal Inferior Turbinate(S), Therapeutic (Pro Cah)",,30930,CPT,Professional,Both,,,,806,685.1,75.48,806,"Multiplan, Inc.","Multiplan, Inc.",757.64,94,,percent of total billed charges,,
"Fracture Nasal Inferior Turbinate(S), Therapeutic (Pro Cah)",,30930,CPT,Professional,Both,,,,806,685.1,75.48,806,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,726.206,90.1,,percent of total billed charges,,
"Fracture Nasal Inferior Turbinate(S), Therapeutic (Pro Cah)",,30930,CPT,Professional,Both,,,,806,685.1,75.48,806,"Preferred One Administrative Services, INC.",PPO,794.716,98.6,,percent of total billed charges,,
"Fracture Nasal Inferior Turbinate(S), Therapeutic (Pro Cah)",,30930,CPT,Professional,Both,,,,806,685.1,75.48,806,PrimeWest Health,Minnesota Senior Health Options (MSHO),134.872,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Fracture Nasal Inferior Turbinate(S), Therapeutic (Pro Cah)",,30930,CPT,Professional,Both,,,,806,685.1,75.48,806,PrimeWest Health,MinnesotaCare,93.2422824,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Fracture Nasal Inferior Turbinate(S), Therapeutic (Pro Cah)",,30930,CPT,Professional,Both,,,,806,685.1,75.48,806,Sanford Health Plan,Sanford Health Plan,709.28,88,,percent of total billed charges,,
"Fracture Nasal Inferior Turbinate(S), Therapeutic (Pro Cah)",,30930,CPT,Professional,Both,,,,806,685.1,75.48,806,"UCare Health, Inc.",Individual & Family Plan,190.650368,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Fracture Nasal Inferior Turbinate(S), Therapeutic (Pro Cah)",,30930,CPT,Professional,Both,,,,806,685.1,75.48,806,"UCare Health, Inc.",Medical Assistance,95.856552,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Fracture Nasal Inferior Turbinate(S), Therapeutic (Pro Cah)",,30930,CPT,Professional,Both,,,,806,685.1,75.48,806,"UCare Health, Inc.",Medicare Advantage,134.872,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Fracture Nasal Inferior Turbinate(S), Therapeutic (Pro Cah)",,30930,CPT,Professional,Both,,,,806,685.1,75.48,806,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),107.8976,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Fracture Nasal Inferior Turbinate(S), Therapeutic (Pro Cah)",,30930,CPT,Professional,Both,,,,806,685.1,75.48,806,UnitedHealthcare,Individual & Family,806,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Fracture Nasal Inferior Turbinate(S), Therapeutic (Pro Cah)",,30930,CPT,Professional,Both,,,,806,685.1,75.48,806,UnitedHealthcare,Medicare Advantage,134.872,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Fracture Nasal Inferior Turbinate(S), Therapeutic (Pro Cah)",,30930,CPT,Professional,Both,,,,806,685.1,75.48,806,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,87.14232,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"HEPARIN (PORCINE) 5,000 UNIT/ML INJ SOLN - BOLUS CALCULATOR",,J1644,HCPCS,Facility,Both,1,mL,,9,7.65,2.5794,9,Aetna,Commercial,8.28,92,,percent of total billed charges,,
"HEPARIN (PORCINE) 5,000 UNIT/ML INJ SOLN - BOLUS CALCULATOR",,J1644,HCPCS,Facility,Outpatient,1,mL,,9,7.65,2.5794,9,Aetna,Medicare Advantage,4.41,49,,percent of total billed charges,,
"HEPARIN (PORCINE) 5,000 UNIT/ML INJ SOLN - BOLUS CALCULATOR",,J1644,HCPCS,Facility,Inpatient,1,mL,,9,7.65,2.5794,9,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"HEPARIN (PORCINE) 5,000 UNIT/ML INJ SOLN - BOLUS CALCULATOR",,J1644,HCPCS,Facility,Both,1,mL,,9,7.65,2.5794,9,Aetna,PPO,8.37,93,,percent of total billed charges,,
"HEPARIN (PORCINE) 5,000 UNIT/ML INJ SOLN - BOLUS CALCULATOR",,J1644,HCPCS,Facility,Both,1,mL,,9,7.65,2.5794,9,America's PPO,America's PPO,8.6427,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"HEPARIN (PORCINE) 5,000 UNIT/ML INJ SOLN - BOLUS CALCULATOR",,J1644,HCPCS,Facility,Both,1,mL,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota, Federal Employee Program,8.856,98.4,,percent of total billed charges,,
"HEPARIN (PORCINE) 5,000 UNIT/ML INJ SOLN - BOLUS CALCULATOR",,J1644,HCPCS,Facility,Both,1,mL,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,9,100,,percent of total billed charges,,
"HEPARIN (PORCINE) 5,000 UNIT/ML INJ SOLN - BOLUS CALCULATOR",,J1644,HCPCS,Facility,Both,1,mL,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota,High Value Network Plan,8.1,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
"HEPARIN (PORCINE) 5,000 UNIT/ML INJ SOLN - BOLUS CALCULATOR",,J1644,HCPCS,Facility,Outpatient,1,mL,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota,Medicare Advantage,4.41,49,,percent of total billed charges,,
"HEPARIN (PORCINE) 5,000 UNIT/ML INJ SOLN - BOLUS CALCULATOR",,J1644,HCPCS,Facility,Inpatient,1,mL,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"HEPARIN (PORCINE) 5,000 UNIT/ML INJ SOLN - BOLUS CALCULATOR",,J1644,HCPCS,Facility,Both,1,mL,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,7.9713,88.57,,percent of total billed charges,,
"HEPARIN (PORCINE) 5,000 UNIT/ML INJ SOLN - BOLUS CALCULATOR",,J1644,HCPCS,Facility,Both,1,mL,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,2.5794,28.66,,percent of total billed charges,,
"HEPARIN (PORCINE) 5,000 UNIT/ML INJ SOLN - BOLUS CALCULATOR",,J1644,HCPCS,Facility,Outpatient,1,mL,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),4.41,49,,percent of total billed charges,,
"HEPARIN (PORCINE) 5,000 UNIT/ML INJ SOLN - BOLUS CALCULATOR",,J1644,HCPCS,Facility,Inpatient,1,mL,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"HEPARIN (PORCINE) 5,000 UNIT/ML INJ SOLN - BOLUS CALCULATOR",,J1644,HCPCS,Facility,Both,1,mL,,9,7.65,2.5794,9,CorVel,Worker's Compensation,9,100,,percent of total billed charges,,
"HEPARIN (PORCINE) 5,000 UNIT/ML INJ SOLN - BOLUS CALCULATOR",,J1644,HCPCS,Facility,Both,1,mL,,9,7.65,2.5794,9,First Health Group Corporation,First Health Network,8.73,97,,percent of total billed charges,,
"HEPARIN (PORCINE) 5,000 UNIT/ML INJ SOLN - BOLUS CALCULATOR",,J1644,HCPCS,Facility,Both,1,mL,,9,7.65,2.5794,9,"Health Partners, Inc.",Commercial,8.514,94.6,,percent of total billed charges,,
"HEPARIN (PORCINE) 5,000 UNIT/ML INJ SOLN - BOLUS CALCULATOR",,J1644,HCPCS,Facility,Outpatient,1,mL,,9,7.65,2.5794,9,"Health Partners, Inc.",Medicare Advantage,4.41,49,,percent of total billed charges,,
"HEPARIN (PORCINE) 5,000 UNIT/ML INJ SOLN - BOLUS CALCULATOR",,J1644,HCPCS,Facility,Inpatient,1,mL,,9,7.65,2.5794,9,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"HEPARIN (PORCINE) 5,000 UNIT/ML INJ SOLN - BOLUS CALCULATOR",,J1644,HCPCS,Facility,Both,1,mL,,9,7.65,2.5794,9,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),5.4,60,,percent of total billed charges,,
"HEPARIN (PORCINE) 5,000 UNIT/ML INJ SOLN - BOLUS CALCULATOR",,J1644,HCPCS,Facility,Both,1,mL,,9,7.65,2.5794,9,"Health Partners, Inc.",State of Minnesota Advantage Program,7.335,81.5,,percent of total billed charges,,
"HEPARIN (PORCINE) 5,000 UNIT/ML INJ SOLN - BOLUS CALCULATOR",,J1644,HCPCS,Facility,Both,1,mL,,9,7.65,2.5794,9,"Health Partners, Inc.",State Public Programs,4.5,50,,percent of total billed charges,,
"HEPARIN (PORCINE) 5,000 UNIT/ML INJ SOLN - BOLUS CALCULATOR",,J1644,HCPCS,Facility,Both,1,mL,,9,7.65,2.5794,9,Humana Insurance Company,Commercial PPO,8.55,95,,percent of total billed charges,,
"HEPARIN (PORCINE) 5,000 UNIT/ML INJ SOLN - BOLUS CALCULATOR",,J1644,HCPCS,Facility,Outpatient,1,mL,,9,7.65,2.5794,9,Humana Insurance Company,Medicare PPO,4.41,49,,percent of total billed charges,,
"HEPARIN (PORCINE) 5,000 UNIT/ML INJ SOLN - BOLUS CALCULATOR",,J1644,HCPCS,Facility,Inpatient,1,mL,,9,7.65,2.5794,9,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"HEPARIN (PORCINE) 5,000 UNIT/ML INJ SOLN - BOLUS CALCULATOR",,J1644,HCPCS,Facility,Both,1,mL,,9,7.65,2.5794,9,Medica,Individual & Family,8.919,99.1,,percent of total billed charges,,
"HEPARIN (PORCINE) 5,000 UNIT/ML INJ SOLN - BOLUS CALCULATOR",,J1644,HCPCS,Facility,Outpatient,1,mL,,9,7.65,2.5794,9,Medica,Medica Advantage Solution,4.482,49.8,,percent of total billed charges,,
"HEPARIN (PORCINE) 5,000 UNIT/ML INJ SOLN - BOLUS CALCULATOR",,J1644,HCPCS,Facility,Inpatient,1,mL,,9,7.65,2.5794,9,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"HEPARIN (PORCINE) 5,000 UNIT/ML INJ SOLN - BOLUS CALCULATOR",,J1644,HCPCS,Facility,Outpatient,1,mL,,9,7.65,2.5794,9,Medica,Medical Assistance,4.014,44.6,,percent of total billed charges,,
"HEPARIN (PORCINE) 5,000 UNIT/ML INJ SOLN - BOLUS CALCULATOR",,J1644,HCPCS,Facility,Inpatient,1,mL,,9,7.65,2.5794,9,Medica,Medical Assistance,,,,,Included in per diem rate,
"HEPARIN (PORCINE) 5,000 UNIT/ML INJ SOLN - BOLUS CALCULATOR",,J1644,HCPCS,Facility,Outpatient,1,mL,,9,7.65,2.5794,9,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,4.482,49.8,,percent of total billed charges,,
"HEPARIN (PORCINE) 5,000 UNIT/ML INJ SOLN - BOLUS CALCULATOR",,J1644,HCPCS,Facility,Inpatient,1,mL,,9,7.65,2.5794,9,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"HEPARIN (PORCINE) 5,000 UNIT/ML INJ SOLN - BOLUS CALCULATOR",,J1644,HCPCS,Facility,Both,1,mL,,9,7.65,2.5794,9,"Multiplan, Inc.","Multiplan, Inc.",8.46,94,,percent of total billed charges,,
"HEPARIN (PORCINE) 5,000 UNIT/ML INJ SOLN - BOLUS CALCULATOR",,J1644,HCPCS,Facility,Outpatient,1,mL,,9,7.65,2.5794,9,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,8.109,90.1,,percent of total billed charges,,
"HEPARIN (PORCINE) 5,000 UNIT/ML INJ SOLN - BOLUS CALCULATOR",,J1644,HCPCS,Facility,Inpatient,1,mL,,9,7.65,2.5794,9,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"HEPARIN (PORCINE) 5,000 UNIT/ML INJ SOLN - BOLUS CALCULATOR",,J1644,HCPCS,Facility,Both,1,mL,,9,7.65,2.5794,9,"Preferred One Administrative Services, INC.",PPO,8.874,98.6,,percent of total billed charges,,
"HEPARIN (PORCINE) 5,000 UNIT/ML INJ SOLN - BOLUS CALCULATOR",,J1644,HCPCS,Facility,Outpatient,1,mL,,9,7.65,2.5794,9,PrimeWest Health,Minnesota Senior Health Options (MSHO),4.6305,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"HEPARIN (PORCINE) 5,000 UNIT/ML INJ SOLN - BOLUS CALCULATOR",,J1644,HCPCS,Facility,Inpatient,1,mL,,9,7.65,2.5794,9,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"HEPARIN (PORCINE) 5,000 UNIT/ML INJ SOLN - BOLUS CALCULATOR",,J1644,HCPCS,Facility,Outpatient,1,mL,,9,7.65,2.5794,9,PrimeWest Health,MinnesotaCare,4.6224,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"HEPARIN (PORCINE) 5,000 UNIT/ML INJ SOLN - BOLUS CALCULATOR",,J1644,HCPCS,Facility,Inpatient,1,mL,,9,7.65,2.5794,9,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"HEPARIN (PORCINE) 5,000 UNIT/ML INJ SOLN - BOLUS CALCULATOR",,J1644,HCPCS,Facility,Both,1,mL,,9,7.65,2.5794,9,Sanford Health Plan,Sanford Health Plan,8.28,92,,percent of total billed charges,,
"HEPARIN (PORCINE) 5,000 UNIT/ML INJ SOLN - BOLUS CALCULATOR",,J1644,HCPCS,Facility,Outpatient,1,mL,,9,7.65,2.5794,9,"UCare Health, Inc.",Individual & Family Plan,5.0715,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"HEPARIN (PORCINE) 5,000 UNIT/ML INJ SOLN - BOLUS CALCULATOR",,J1644,HCPCS,Facility,Inpatient,1,mL,,9,7.65,2.5794,9,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"HEPARIN (PORCINE) 5,000 UNIT/ML INJ SOLN - BOLUS CALCULATOR",,J1644,HCPCS,Facility,Outpatient,1,mL,,9,7.65,2.5794,9,"UCare Health, Inc.",Medical Assistance,4.5423,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"HEPARIN (PORCINE) 5,000 UNIT/ML INJ SOLN - BOLUS CALCULATOR",,J1644,HCPCS,Facility,Inpatient,1,mL,,9,7.65,2.5794,9,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"HEPARIN (PORCINE) 5,000 UNIT/ML INJ SOLN - BOLUS CALCULATOR",,J1644,HCPCS,Facility,Outpatient,1,mL,,9,7.65,2.5794,9,"UCare Health, Inc.",Medicare Advantage,4.5423,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"HEPARIN (PORCINE) 5,000 UNIT/ML INJ SOLN - BOLUS CALCULATOR",,J1644,HCPCS,Facility,Inpatient,1,mL,,9,7.65,2.5794,9,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"HEPARIN (PORCINE) 5,000 UNIT/ML INJ SOLN - BOLUS CALCULATOR",,J1644,HCPCS,Facility,Outpatient,1,mL,,9,7.65,2.5794,9,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),4.5423,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"HEPARIN (PORCINE) 5,000 UNIT/ML INJ SOLN - BOLUS CALCULATOR",,J1644,HCPCS,Facility,Inpatient,1,mL,,9,7.65,2.5794,9,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"HEPARIN (PORCINE) 5,000 UNIT/ML INJ SOLN - BOLUS CALCULATOR",,J1644,HCPCS,Facility,Both,1,mL,,9,7.65,2.5794,9,UnitedHealthcare,Individual & Family,8.46,94,,percent of total billed charges,,
"HEPARIN (PORCINE) 5,000 UNIT/ML INJ SOLN - BOLUS CALCULATOR",,J1644,HCPCS,Facility,Outpatient,1,mL,,9,7.65,2.5794,9,UnitedHealthcare,Medicare Advantage,4.41,49,,percent of total billed charges,,
"HEPARIN (PORCINE) 5,000 UNIT/ML INJ SOLN - BOLUS CALCULATOR",,J1644,HCPCS,Facility,Inpatient,1,mL,,9,7.65,2.5794,9,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"HEPARIN (PORCINE) 5,000 UNIT/ML INJ SOLN - BOLUS CALCULATOR",,J1644,HCPCS,Facility,Outpatient,1,mL,,9,7.65,2.5794,9,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,4.32,48,,percent of total billed charges,,100% of DHS outpatient percentage
"HEPARIN (PORCINE) 5,000 UNIT/ML INJ SOLN - BOLUS CALCULATOR",,J1644,HCPCS,Facility,Inpatient,1,mL,,9,7.65,2.5794,9,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Pterygomaxillary Fossa Surgery, Any Approach (Pro Cah)",,31040,CPT,Professional,Both,,,,3060,2601,516.58,3060,Aetna,Commercial,2601,85,,percent of total billed charges,,
"Pterygomaxillary Fossa Surgery, Any Approach (Pro Cah)",,31040,CPT,Professional,Both,,,,3060,2601,516.58,3060,Aetna,Medicare Advantage,802.58,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Pterygomaxillary Fossa Surgery, Any Approach (Pro Cah)",,31040,CPT,Professional,Both,,,,3060,2601,516.58,3060,Aetna,PPO,2845.8,93,,percent of total billed charges,,
"Pterygomaxillary Fossa Surgery, Any Approach (Pro Cah)",,31040,CPT,Professional,Both,,,,3060,2601,516.58,3060,America's PPO,America's PPO,2614.464,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Pterygomaxillary Fossa Surgery, Any Approach (Pro Cah)",,31040,CPT,Professional,Both,,,,3060,2601,516.58,3060,BlueCross BlueShield Minnesota, Federal Employee Program,1678.12,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Pterygomaxillary Fossa Surgery, Any Approach (Pro Cah)",,31040,CPT,Professional,Both,,,,3060,2601,516.58,3060,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1704.96992,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Pterygomaxillary Fossa Surgery, Any Approach (Pro Cah)",,31040,CPT,Professional,Both,,,,3060,2601,516.58,3060,BlueCross BlueShield Minnesota,High Value Network Plan,1704.96992,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Pterygomaxillary Fossa Surgery, Any Approach (Pro Cah)",,31040,CPT,Professional,Both,,,,3060,2601,516.58,3060,BlueCross BlueShield Minnesota,Medicare Advantage,922.9785,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Pterygomaxillary Fossa Surgery, Any Approach (Pro Cah)",,31040,CPT,Professional,Both,,,,3060,2601,516.58,3060,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1704.96992,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Pterygomaxillary Fossa Surgery, Any Approach (Pro Cah)",,31040,CPT,Professional,Both,,,,3060,2601,516.58,3060,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,596.41232,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Pterygomaxillary Fossa Surgery, Any Approach (Pro Cah)",,31040,CPT,Professional,Both,,,,3060,2601,516.58,3060,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),922.9785,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Pterygomaxillary Fossa Surgery, Any Approach (Pro Cah)",,31040,CPT,Professional,Both,,,,3060,2601,516.58,3060,CorVel,Worker's Compensation,1577.173094,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Pterygomaxillary Fossa Surgery, Any Approach (Pro Cah)",,31040,CPT,Professional,Both,,,,3060,2601,516.58,3060,First Health Group Corporation,First Health Network,2968.2,97,,percent of total billed charges,,
"Pterygomaxillary Fossa Surgery, Any Approach (Pro Cah)",,31040,CPT,Professional,Both,,,,3060,2601,516.58,3060,"Health Partners, Inc.",Commercial,1703.54,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Pterygomaxillary Fossa Surgery, Any Approach (Pro Cah)",,31040,CPT,Professional,Both,,,,3060,2601,516.58,3060,"Health Partners, Inc.",Medicare Advantage,922.9785,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Pterygomaxillary Fossa Surgery, Any Approach (Pro Cah)",,31040,CPT,Professional,Both,,,,3060,2601,516.58,3060,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),802.45,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Pterygomaxillary Fossa Surgery, Any Approach (Pro Cah)",,31040,CPT,Professional,Both,,,,3060,2601,516.58,3060,"Health Partners, Inc.",State of Minnesota Advantage Program,1467.59971,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Pterygomaxillary Fossa Surgery, Any Approach (Pro Cah)",,31040,CPT,Professional,Both,,,,3060,2601,516.58,3060,"Health Partners, Inc.",State Public Programs,516.58,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Pterygomaxillary Fossa Surgery, Any Approach (Pro Cah)",,31040,CPT,Professional,Both,,,,3060,2601,516.58,3060,Humana Insurance Company,Commercial PPO,802.59,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Pterygomaxillary Fossa Surgery, Any Approach (Pro Cah)",,31040,CPT,Professional,Both,,,,3060,2601,516.58,3060,Humana Insurance Company,Medicare PPO,3060,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Pterygomaxillary Fossa Surgery, Any Approach (Pro Cah)",,31040,CPT,Professional,Both,,,,3060,2601,516.58,3060,Medica,Individual & Family,2594.88,84.8,,percent of total billed charges,,
"Pterygomaxillary Fossa Surgery, Any Approach (Pro Cah)",,31040,CPT,Professional,Both,,,,3060,2601,516.58,3060,Medica,Medica Advantage Solution,1523.88,49.8,,percent of total billed charges,,
"Pterygomaxillary Fossa Surgery, Any Approach (Pro Cah)",,31040,CPT,Professional,Both,,,,3060,2601,516.58,3060,Medica,Medical Assistance,596.41,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Pterygomaxillary Fossa Surgery, Any Approach (Pro Cah)",,31040,CPT,Professional,Both,,,,3060,2601,516.58,3060,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,802.59,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Pterygomaxillary Fossa Surgery, Any Approach (Pro Cah)",,31040,CPT,Professional,Both,,,,3060,2601,516.58,3060,"Multiplan, Inc.","Multiplan, Inc.",2876.4,94,,percent of total billed charges,,
"Pterygomaxillary Fossa Surgery, Any Approach (Pro Cah)",,31040,CPT,Professional,Both,,,,3060,2601,516.58,3060,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,2757.06,90.1,,percent of total billed charges,,
"Pterygomaxillary Fossa Surgery, Any Approach (Pro Cah)",,31040,CPT,Professional,Both,,,,3060,2601,516.58,3060,"Preferred One Administrative Services, INC.",PPO,3017.16,98.6,,percent of total billed charges,,
"Pterygomaxillary Fossa Surgery, Any Approach (Pro Cah)",,31040,CPT,Professional,Both,,,,3060,2601,516.58,3060,PrimeWest Health,Minnesota Senior Health Options (MSHO),922.9785,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Pterygomaxillary Fossa Surgery, Any Approach (Pro Cah)",,31040,CPT,Professional,Both,,,,3060,2601,516.58,3060,PrimeWest Health,MinnesotaCare,638.1611824,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Pterygomaxillary Fossa Surgery, Any Approach (Pro Cah)",,31040,CPT,Professional,Both,,,,3060,2601,516.58,3060,Sanford Health Plan,Sanford Health Plan,2692.8,88,,percent of total billed charges,,
"Pterygomaxillary Fossa Surgery, Any Approach (Pro Cah)",,31040,CPT,Professional,Both,,,,3060,2601,516.58,3060,"UCare Health, Inc.",Individual & Family Plan,1304.690304,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Pterygomaxillary Fossa Surgery, Any Approach (Pro Cah)",,31040,CPT,Professional,Both,,,,3060,2601,516.58,3060,"UCare Health, Inc.",Medical Assistance,656.053552,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Pterygomaxillary Fossa Surgery, Any Approach (Pro Cah)",,31040,CPT,Professional,Both,,,,3060,2601,516.58,3060,"UCare Health, Inc.",Medicare Advantage,922.9785,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Pterygomaxillary Fossa Surgery, Any Approach (Pro Cah)",,31040,CPT,Professional,Both,,,,3060,2601,516.58,3060,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),738.3828,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Pterygomaxillary Fossa Surgery, Any Approach (Pro Cah)",,31040,CPT,Professional,Both,,,,3060,2601,516.58,3060,UnitedHealthcare,Individual & Family,3060,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Pterygomaxillary Fossa Surgery, Any Approach (Pro Cah)",,31040,CPT,Professional,Both,,,,3060,2601,516.58,3060,UnitedHealthcare,Medicare Advantage,922.9785,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Pterygomaxillary Fossa Surgery, Any Approach (Pro Cah)",,31040,CPT,Professional,Both,,,,3060,2601,516.58,3060,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,596.41232,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Nasal Endoscopy,,31231,CPT,Facility,Both,,,,296,251.6,84.8336,296,Aetna,Commercial,272.32,92,,percent of total billed charges,,
Nasal Endoscopy,,31231,CPT,Facility,Outpatient,,,,296,251.6,84.8336,296,Aetna,Medicare Advantage,145.04,49,,percent of total billed charges,,
Nasal Endoscopy,,31231,CPT,Facility,Inpatient,,,,296,251.6,84.8336,296,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Nasal Endoscopy,,31231,CPT,Facility,Both,,,,296,251.6,84.8336,296,Aetna,PPO,275.28,93,,percent of total billed charges,,
Nasal Endoscopy,,31231,CPT,Facility,Both,,,,296,251.6,84.8336,296,America's PPO,America's PPO,284.2488,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Nasal Endoscopy,,31231,CPT,Facility,Both,,,,296,251.6,84.8336,296,BlueCross BlueShield Minnesota, Federal Employee Program,291.264,98.4,,percent of total billed charges,,
Nasal Endoscopy,,31231,CPT,Facility,Both,,,,296,251.6,84.8336,296,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,296,100,,percent of total billed charges,,
Nasal Endoscopy,,31231,CPT,Facility,Both,,,,296,251.6,84.8336,296,BlueCross BlueShield Minnesota,High Value Network Plan,266.4,90,,percent of total billed charges,,
Nasal Endoscopy,,31231,CPT,Facility,Outpatient,,,,296,251.6,84.8336,296,BlueCross BlueShield Minnesota,Medicare Advantage,145.04,49,,percent of total billed charges,,
Nasal Endoscopy,,31231,CPT,Facility,Inpatient,,,,296,251.6,84.8336,296,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Nasal Endoscopy,,31231,CPT,Facility,Both,,,,296,251.6,84.8336,296,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,262.1672,88.57,,percent of total billed charges,,
Nasal Endoscopy,,31231,CPT,Facility,Both,,,,296,251.6,84.8336,296,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,84.8336,28.66,,percent of total billed charges,,
Nasal Endoscopy,,31231,CPT,Facility,Outpatient,,,,296,251.6,84.8336,296,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),145.04,49,,percent of total billed charges,,
Nasal Endoscopy,,31231,CPT,Facility,Inpatient,,,,296,251.6,84.8336,296,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Nasal Endoscopy,,31231,CPT,Facility,Both,,,,296,251.6,84.8336,296,CorVel,Worker's Compensation,296,100,,percent of total billed charges,,
Nasal Endoscopy,,31231,CPT,Facility,Both,,,,296,251.6,84.8336,296,First Health Group Corporation,First Health Network,287.12,97,,percent of total billed charges,,
Nasal Endoscopy,,31231,CPT,Facility,Both,,,,296,251.6,84.8336,296,"Health Partners, Inc.",Commercial,280.016,94.6,,percent of total billed charges,,
Nasal Endoscopy,,31231,CPT,Facility,Outpatient,,,,296,251.6,84.8336,296,"Health Partners, Inc.",Medicare Advantage,145.04,49,,percent of total billed charges,,
Nasal Endoscopy,,31231,CPT,Facility,Inpatient,,,,296,251.6,84.8336,296,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Nasal Endoscopy,,31231,CPT,Facility,Both,,,,296,251.6,84.8336,296,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),177.6,60,,percent of total billed charges,,
Nasal Endoscopy,,31231,CPT,Facility,Both,,,,296,251.6,84.8336,296,"Health Partners, Inc.",State of Minnesota Advantage Program,241.24,81.5,,percent of total billed charges,,
Nasal Endoscopy,,31231,CPT,Facility,Both,,,,296,251.6,84.8336,296,"Health Partners, Inc.",State Public Programs,148,50,,percent of total billed charges,,
Nasal Endoscopy,,31231,CPT,Facility,Both,,,,296,251.6,84.8336,296,Humana Insurance Company,Commercial PPO,281.2,95,,percent of total billed charges,,
Nasal Endoscopy,,31231,CPT,Facility,Outpatient,,,,296,251.6,84.8336,296,Humana Insurance Company,Medicare PPO,145.04,49,,percent of total billed charges,,
Nasal Endoscopy,,31231,CPT,Facility,Inpatient,,,,296,251.6,84.8336,296,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Nasal Endoscopy,,31231,CPT,Facility,Both,,,,296,251.6,84.8336,296,Medica,Individual & Family,293.336,99.1,,percent of total billed charges,,
Nasal Endoscopy,,31231,CPT,Facility,Outpatient,,,,296,251.6,84.8336,296,Medica,Medica Advantage Solution,147.408,49.8,,percent of total billed charges,,
Nasal Endoscopy,,31231,CPT,Facility,Inpatient,,,,296,251.6,84.8336,296,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Nasal Endoscopy,,31231,CPT,Facility,Outpatient,,,,296,251.6,84.8336,296,Medica,Medical Assistance,132.016,44.6,,percent of total billed charges,,
Nasal Endoscopy,,31231,CPT,Facility,Inpatient,,,,296,251.6,84.8336,296,Medica,Medical Assistance,,,,,Included in per diem rate,
Nasal Endoscopy,,31231,CPT,Facility,Outpatient,,,,296,251.6,84.8336,296,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,147.408,49.8,,percent of total billed charges,,
Nasal Endoscopy,,31231,CPT,Facility,Inpatient,,,,296,251.6,84.8336,296,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Nasal Endoscopy,,31231,CPT,Facility,Both,,,,296,251.6,84.8336,296,"Multiplan, Inc.","Multiplan, Inc.",278.24,94,,percent of total billed charges,,
Nasal Endoscopy,,31231,CPT,Facility,Outpatient,,,,296,251.6,84.8336,296,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,266.696,90.1,,percent of total billed charges,,
Nasal Endoscopy,,31231,CPT,Facility,Inpatient,,,,296,251.6,84.8336,296,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Nasal Endoscopy,,31231,CPT,Facility,Both,,,,296,251.6,84.8336,296,"Preferred One Administrative Services, INC.",PPO,291.856,98.6,,percent of total billed charges,,
Nasal Endoscopy,,31231,CPT,Facility,Outpatient,,,,296,251.6,84.8336,296,PrimeWest Health,Minnesota Senior Health Options (MSHO),152.292,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Nasal Endoscopy,,31231,CPT,Facility,Inpatient,,,,296,251.6,84.8336,296,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Nasal Endoscopy,,31231,CPT,Facility,Outpatient,,,,296,251.6,84.8336,296,PrimeWest Health,MinnesotaCare,152.0256,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Nasal Endoscopy,,31231,CPT,Facility,Inpatient,,,,296,251.6,84.8336,296,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Nasal Endoscopy,,31231,CPT,Facility,Both,,,,296,251.6,84.8336,296,Sanford Health Plan,Sanford Health Plan,272.32,92,,percent of total billed charges,,
Nasal Endoscopy,,31231,CPT,Facility,Outpatient,,,,296,251.6,84.8336,296,"UCare Health, Inc.",Individual & Family Plan,166.796,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Nasal Endoscopy,,31231,CPT,Facility,Inpatient,,,,296,251.6,84.8336,296,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Nasal Endoscopy,,31231,CPT,Facility,Outpatient,,,,296,251.6,84.8336,296,"UCare Health, Inc.",Medical Assistance,149.3912,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Nasal Endoscopy,,31231,CPT,Facility,Inpatient,,,,296,251.6,84.8336,296,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Nasal Endoscopy,,31231,CPT,Facility,Outpatient,,,,296,251.6,84.8336,296,"UCare Health, Inc.",Medicare Advantage,149.3912,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Nasal Endoscopy,,31231,CPT,Facility,Inpatient,,,,296,251.6,84.8336,296,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Nasal Endoscopy,,31231,CPT,Facility,Outpatient,,,,296,251.6,84.8336,296,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),149.3912,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Nasal Endoscopy,,31231,CPT,Facility,Inpatient,,,,296,251.6,84.8336,296,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Nasal Endoscopy,,31231,CPT,Facility,Both,,,,296,251.6,84.8336,296,UnitedHealthcare,Individual & Family,278.24,94,,percent of total billed charges,,
Nasal Endoscopy,,31231,CPT,Facility,Outpatient,,,,296,251.6,84.8336,296,UnitedHealthcare,Medicare Advantage,145.04,49,,percent of total billed charges,,
Nasal Endoscopy,,31231,CPT,Facility,Inpatient,,,,296,251.6,84.8336,296,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Nasal Endoscopy,,31231,CPT,Facility,Outpatient,,,,296,251.6,84.8336,296,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,142.08,48,,percent of total billed charges,,100% of DHS outpatient percentage
Nasal Endoscopy,,31231,CPT,Facility,Inpatient,,,,296,251.6,84.8336,296,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Nasal Endoscopy, Diagnostic, Unilateral Or Bilateral (Separate Procedure) (Pro Cah)",,31231,CPT,Professional,Both,,,,444,377.4,39.7,444,Aetna,Commercial,377.4,85,,percent of total billed charges,,
"Nasal Endoscopy, Diagnostic, Unilateral Or Bilateral (Separate Procedure) (Pro Cah)",,31231,CPT,Professional,Both,,,,444,377.4,39.7,444,Aetna,Medicare Advantage,61.79,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Nasal Endoscopy, Diagnostic, Unilateral Or Bilateral (Separate Procedure) (Pro Cah)",,31231,CPT,Professional,Both,,,,444,377.4,39.7,444,Aetna,PPO,412.92,93,,percent of total billed charges,,
"Nasal Endoscopy, Diagnostic, Unilateral Or Bilateral (Separate Procedure) (Pro Cah)",,31231,CPT,Professional,Both,,,,444,377.4,39.7,444,America's PPO,America's PPO,379.3536,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Nasal Endoscopy, Diagnostic, Unilateral Or Bilateral (Separate Procedure) (Pro Cah)",,31231,CPT,Professional,Both,,,,444,377.4,39.7,444,BlueCross BlueShield Minnesota, Federal Employee Program,132.9,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Nasal Endoscopy, Diagnostic, Unilateral Or Bilateral (Separate Procedure) (Pro Cah)",,31231,CPT,Professional,Both,,,,444,377.4,39.7,444,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,135.0264,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Nasal Endoscopy, Diagnostic, Unilateral Or Bilateral (Separate Procedure) (Pro Cah)",,31231,CPT,Professional,Both,,,,444,377.4,39.7,444,BlueCross BlueShield Minnesota,High Value Network Plan,135.0264,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Nasal Endoscopy, Diagnostic, Unilateral Or Bilateral (Separate Procedure) (Pro Cah)",,31231,CPT,Professional,Both,,,,444,377.4,39.7,444,BlueCross BlueShield Minnesota,Medicare Advantage,71.231,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Nasal Endoscopy, Diagnostic, Unilateral Or Bilateral (Separate Procedure) (Pro Cah)",,31231,CPT,Professional,Both,,,,444,377.4,39.7,444,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,135.0264,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Nasal Endoscopy, Diagnostic, Unilateral Or Bilateral (Separate Procedure) (Pro Cah)",,31231,CPT,Professional,Both,,,,444,377.4,39.7,444,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,45.83176,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Nasal Endoscopy, Diagnostic, Unilateral Or Bilateral (Separate Procedure) (Pro Cah)",,31231,CPT,Professional,Both,,,,444,377.4,39.7,444,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),71.231,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Nasal Endoscopy, Diagnostic, Unilateral Or Bilateral (Separate Procedure) (Pro Cah)",,31231,CPT,Professional,Both,,,,444,377.4,39.7,444,CorVel,Worker's Compensation,120.0737637,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Nasal Endoscopy, Diagnostic, Unilateral Or Bilateral (Separate Procedure) (Pro Cah)",,31231,CPT,Professional,Both,,,,444,377.4,39.7,444,First Health Group Corporation,First Health Network,430.68,97,,percent of total billed charges,,
"Nasal Endoscopy, Diagnostic, Unilateral Or Bilateral (Separate Procedure) (Pro Cah)",,31231,CPT,Professional,Both,,,,444,377.4,39.7,444,"Health Partners, Inc.",Commercial,129.87,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Nasal Endoscopy, Diagnostic, Unilateral Or Bilateral (Separate Procedure) (Pro Cah)",,31231,CPT,Professional,Both,,,,444,377.4,39.7,444,"Health Partners, Inc.",Medicare Advantage,71.231,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Nasal Endoscopy, Diagnostic, Unilateral Or Bilateral (Separate Procedure) (Pro Cah)",,31231,CPT,Professional,Both,,,,444,377.4,39.7,444,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),62.01,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Nasal Endoscopy, Diagnostic, Unilateral Or Bilateral (Separate Procedure) (Pro Cah)",,31231,CPT,Professional,Both,,,,444,377.4,39.7,444,"Health Partners, Inc.",State of Minnesota Advantage Program,111.883005,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Nasal Endoscopy, Diagnostic, Unilateral Or Bilateral (Separate Procedure) (Pro Cah)",,31231,CPT,Professional,Both,,,,444,377.4,39.7,444,"Health Partners, Inc.",State Public Programs,39.7,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Nasal Endoscopy, Diagnostic, Unilateral Or Bilateral (Separate Procedure) (Pro Cah)",,31231,CPT,Professional,Both,,,,444,377.4,39.7,444,Humana Insurance Company,Commercial PPO,61.94,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Nasal Endoscopy, Diagnostic, Unilateral Or Bilateral (Separate Procedure) (Pro Cah)",,31231,CPT,Professional,Both,,,,444,377.4,39.7,444,Humana Insurance Company,Medicare PPO,444,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Nasal Endoscopy, Diagnostic, Unilateral Or Bilateral (Separate Procedure) (Pro Cah)",,31231,CPT,Professional,Both,,,,444,377.4,39.7,444,Medica,Individual & Family,376.512,84.8,,percent of total billed charges,,
"Nasal Endoscopy, Diagnostic, Unilateral Or Bilateral (Separate Procedure) (Pro Cah)",,31231,CPT,Professional,Both,,,,444,377.4,39.7,444,Medica,Medica Advantage Solution,221.112,49.8,,percent of total billed charges,,
"Nasal Endoscopy, Diagnostic, Unilateral Or Bilateral (Separate Procedure) (Pro Cah)",,31231,CPT,Professional,Both,,,,444,377.4,39.7,444,Medica,Medical Assistance,45.83,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Nasal Endoscopy, Diagnostic, Unilateral Or Bilateral (Separate Procedure) (Pro Cah)",,31231,CPT,Professional,Both,,,,444,377.4,39.7,444,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,61.94,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Nasal Endoscopy, Diagnostic, Unilateral Or Bilateral (Separate Procedure) (Pro Cah)",,31231,CPT,Professional,Both,,,,444,377.4,39.7,444,"Multiplan, Inc.","Multiplan, Inc.",417.36,94,,percent of total billed charges,,
"Nasal Endoscopy, Diagnostic, Unilateral Or Bilateral (Separate Procedure) (Pro Cah)",,31231,CPT,Professional,Both,,,,444,377.4,39.7,444,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,400.044,90.1,,percent of total billed charges,,
"Nasal Endoscopy, Diagnostic, Unilateral Or Bilateral (Separate Procedure) (Pro Cah)",,31231,CPT,Professional,Both,,,,444,377.4,39.7,444,"Preferred One Administrative Services, INC.",PPO,437.784,98.6,,percent of total billed charges,,
"Nasal Endoscopy, Diagnostic, Unilateral Or Bilateral (Separate Procedure) (Pro Cah)",,31231,CPT,Professional,Both,,,,444,377.4,39.7,444,PrimeWest Health,Minnesota Senior Health Options (MSHO),71.231,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Nasal Endoscopy, Diagnostic, Unilateral Or Bilateral (Separate Procedure) (Pro Cah)",,31231,CPT,Professional,Both,,,,444,377.4,39.7,444,PrimeWest Health,MinnesotaCare,49.0399832,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Nasal Endoscopy, Diagnostic, Unilateral Or Bilateral (Separate Procedure) (Pro Cah)",,31231,CPT,Professional,Both,,,,444,377.4,39.7,444,Sanford Health Plan,Sanford Health Plan,390.72,88,,percent of total billed charges,,
"Nasal Endoscopy, Diagnostic, Unilateral Or Bilateral (Separate Procedure) (Pro Cah)",,31231,CPT,Professional,Both,,,,444,377.4,39.7,444,"UCare Health, Inc.",Individual & Family Plan,100.689664,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Nasal Endoscopy, Diagnostic, Unilateral Or Bilateral (Separate Procedure) (Pro Cah)",,31231,CPT,Professional,Both,,,,444,377.4,39.7,444,"UCare Health, Inc.",Medical Assistance,50.414936,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Nasal Endoscopy, Diagnostic, Unilateral Or Bilateral (Separate Procedure) (Pro Cah)",,31231,CPT,Professional,Both,,,,444,377.4,39.7,444,"UCare Health, Inc.",Medicare Advantage,71.231,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Nasal Endoscopy, Diagnostic, Unilateral Or Bilateral (Separate Procedure) (Pro Cah)",,31231,CPT,Professional,Both,,,,444,377.4,39.7,444,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),56.9848,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Nasal Endoscopy, Diagnostic, Unilateral Or Bilateral (Separate Procedure) (Pro Cah)",,31231,CPT,Professional,Both,,,,444,377.4,39.7,444,UnitedHealthcare,Individual & Family,444,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Nasal Endoscopy, Diagnostic, Unilateral Or Bilateral (Separate Procedure) (Pro Cah)",,31231,CPT,Professional,Both,,,,444,377.4,39.7,444,UnitedHealthcare,Medicare Advantage,71.231,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Nasal Endoscopy, Diagnostic, Unilateral Or Bilateral (Separate Procedure) (Pro Cah)",,31231,CPT,Professional,Both,,,,444,377.4,39.7,444,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,45.83176,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
ENOXAPARIN 100 MG/ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,1,mL,,54,45.9,15.4764,54,Aetna,Commercial,49.68,92,,percent of total billed charges,,
ENOXAPARIN 100 MG/ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,1,mL,,54,45.9,15.4764,54,Aetna,Commercial,49.68,92,,percent of total billed charges,,
ENOXAPARIN 100 MG/ML SUBQ SYRG,,J1650,HCPCS,Facility,Outpatient,1,mL,,54,45.9,15.4764,54,Aetna,Medicare Advantage,26.46,49,,percent of total billed charges,,
ENOXAPARIN 100 MG/ML SUBQ SYRG,,J1650,HCPCS,Facility,Outpatient,1,mL,,54,45.9,15.4764,54,Aetna,Medicare Advantage,26.46,49,,percent of total billed charges,,
ENOXAPARIN 100 MG/ML SUBQ SYRG,,J1650,HCPCS,Facility,Inpatient,1,mL,,54,45.9,15.4764,54,Aetna,Medicare Advantage,,,,,Included in per diem rate,
ENOXAPARIN 100 MG/ML SUBQ SYRG,,J1650,HCPCS,Facility,Inpatient,1,mL,,54,45.9,15.4764,54,Aetna,Medicare Advantage,,,,,Included in per diem rate,
ENOXAPARIN 100 MG/ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,1,mL,,54,45.9,15.4764,54,Aetna,PPO,50.22,93,,percent of total billed charges,,
ENOXAPARIN 100 MG/ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,1,mL,,54,45.9,15.4764,54,Aetna,PPO,50.22,93,,percent of total billed charges,,
ENOXAPARIN 100 MG/ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,1,mL,,54,45.9,15.4764,54,America's PPO,America's PPO,51.8562,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
ENOXAPARIN 100 MG/ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,1,mL,,54,45.9,15.4764,54,America's PPO,America's PPO,51.8562,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
ENOXAPARIN 100 MG/ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,1,mL,,54,45.9,15.4764,54,BlueCross BlueShield Minnesota, Federal Employee Program,53.136,98.4,,percent of total billed charges,,
ENOXAPARIN 100 MG/ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,1,mL,,54,45.9,15.4764,54,BlueCross BlueShield Minnesota, Federal Employee Program,53.136,98.4,,percent of total billed charges,,
ENOXAPARIN 100 MG/ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,1,mL,,54,45.9,15.4764,54,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,54,100,,percent of total billed charges,,
ENOXAPARIN 100 MG/ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,1,mL,,54,45.9,15.4764,54,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,54,100,,percent of total billed charges,,
ENOXAPARIN 100 MG/ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,1,mL,,54,45.9,15.4764,54,BlueCross BlueShield Minnesota,High Value Network Plan,48.6,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
ENOXAPARIN 100 MG/ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,1,mL,,54,45.9,15.4764,54,BlueCross BlueShield Minnesota,High Value Network Plan,48.6,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
ENOXAPARIN 100 MG/ML SUBQ SYRG,,J1650,HCPCS,Facility,Outpatient,1,mL,,54,45.9,15.4764,54,BlueCross BlueShield Minnesota,Medicare Advantage,26.46,49,,percent of total billed charges,,
ENOXAPARIN 100 MG/ML SUBQ SYRG,,J1650,HCPCS,Facility,Outpatient,1,mL,,54,45.9,15.4764,54,BlueCross BlueShield Minnesota,Medicare Advantage,26.46,49,,percent of total billed charges,,
ENOXAPARIN 100 MG/ML SUBQ SYRG,,J1650,HCPCS,Facility,Inpatient,1,mL,,54,45.9,15.4764,54,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
ENOXAPARIN 100 MG/ML SUBQ SYRG,,J1650,HCPCS,Facility,Inpatient,1,mL,,54,45.9,15.4764,54,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
ENOXAPARIN 100 MG/ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,1,mL,,54,45.9,15.4764,54,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,47.8278,88.57,,percent of total billed charges,,
ENOXAPARIN 100 MG/ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,1,mL,,54,45.9,15.4764,54,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,47.8278,88.57,,percent of total billed charges,,
ENOXAPARIN 100 MG/ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,1,mL,,54,45.9,15.4764,54,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,15.4764,28.66,,percent of total billed charges,,
ENOXAPARIN 100 MG/ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,1,mL,,54,45.9,15.4764,54,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,15.4764,28.66,,percent of total billed charges,,
ENOXAPARIN 100 MG/ML SUBQ SYRG,,J1650,HCPCS,Facility,Outpatient,1,mL,,54,45.9,15.4764,54,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),26.46,49,,percent of total billed charges,,
ENOXAPARIN 100 MG/ML SUBQ SYRG,,J1650,HCPCS,Facility,Outpatient,1,mL,,54,45.9,15.4764,54,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),26.46,49,,percent of total billed charges,,
ENOXAPARIN 100 MG/ML SUBQ SYRG,,J1650,HCPCS,Facility,Inpatient,1,mL,,54,45.9,15.4764,54,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
ENOXAPARIN 100 MG/ML SUBQ SYRG,,J1650,HCPCS,Facility,Inpatient,1,mL,,54,45.9,15.4764,54,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
ENOXAPARIN 100 MG/ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,1,mL,,54,45.9,15.4764,54,CorVel,Worker's Compensation,54,100,,percent of total billed charges,,
ENOXAPARIN 100 MG/ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,1,mL,,54,45.9,15.4764,54,CorVel,Worker's Compensation,54,100,,percent of total billed charges,,
ENOXAPARIN 100 MG/ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,1,mL,,54,45.9,15.4764,54,First Health Group Corporation,First Health Network,52.38,97,,percent of total billed charges,,
ENOXAPARIN 100 MG/ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,1,mL,,54,45.9,15.4764,54,First Health Group Corporation,First Health Network,52.38,97,,percent of total billed charges,,
ENOXAPARIN 100 MG/ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,1,mL,,54,45.9,15.4764,54,"Health Partners, Inc.",Commercial,51.084,94.6,,percent of total billed charges,,
ENOXAPARIN 100 MG/ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,1,mL,,54,45.9,15.4764,54,"Health Partners, Inc.",Commercial,51.084,94.6,,percent of total billed charges,,
ENOXAPARIN 100 MG/ML SUBQ SYRG,,J1650,HCPCS,Facility,Outpatient,1,mL,,54,45.9,15.4764,54,"Health Partners, Inc.",Medicare Advantage,26.46,49,,percent of total billed charges,,
ENOXAPARIN 100 MG/ML SUBQ SYRG,,J1650,HCPCS,Facility,Outpatient,1,mL,,54,45.9,15.4764,54,"Health Partners, Inc.",Medicare Advantage,26.46,49,,percent of total billed charges,,
ENOXAPARIN 100 MG/ML SUBQ SYRG,,J1650,HCPCS,Facility,Inpatient,1,mL,,54,45.9,15.4764,54,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ENOXAPARIN 100 MG/ML SUBQ SYRG,,J1650,HCPCS,Facility,Inpatient,1,mL,,54,45.9,15.4764,54,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ENOXAPARIN 100 MG/ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,1,mL,,54,45.9,15.4764,54,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),32.4,60,,percent of total billed charges,,
ENOXAPARIN 100 MG/ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,1,mL,,54,45.9,15.4764,54,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),32.4,60,,percent of total billed charges,,
ENOXAPARIN 100 MG/ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,1,mL,,54,45.9,15.4764,54,"Health Partners, Inc.",State of Minnesota Advantage Program,44.01,81.5,,percent of total billed charges,,
ENOXAPARIN 100 MG/ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,1,mL,,54,45.9,15.4764,54,"Health Partners, Inc.",State of Minnesota Advantage Program,44.01,81.5,,percent of total billed charges,,
ENOXAPARIN 100 MG/ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,1,mL,,54,45.9,15.4764,54,"Health Partners, Inc.",State Public Programs,27,50,,percent of total billed charges,,
ENOXAPARIN 100 MG/ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,1,mL,,54,45.9,15.4764,54,"Health Partners, Inc.",State Public Programs,27,50,,percent of total billed charges,,
ENOXAPARIN 100 MG/ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,1,mL,,54,45.9,15.4764,54,Humana Insurance Company,Commercial PPO,51.3,95,,percent of total billed charges,,
ENOXAPARIN 100 MG/ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,1,mL,,54,45.9,15.4764,54,Humana Insurance Company,Commercial PPO,51.3,95,,percent of total billed charges,,
ENOXAPARIN 100 MG/ML SUBQ SYRG,,J1650,HCPCS,Facility,Outpatient,1,mL,,54,45.9,15.4764,54,Humana Insurance Company,Medicare PPO,26.46,49,,percent of total billed charges,,
ENOXAPARIN 100 MG/ML SUBQ SYRG,,J1650,HCPCS,Facility,Outpatient,1,mL,,54,45.9,15.4764,54,Humana Insurance Company,Medicare PPO,26.46,49,,percent of total billed charges,,
ENOXAPARIN 100 MG/ML SUBQ SYRG,,J1650,HCPCS,Facility,Inpatient,1,mL,,54,45.9,15.4764,54,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
ENOXAPARIN 100 MG/ML SUBQ SYRG,,J1650,HCPCS,Facility,Inpatient,1,mL,,54,45.9,15.4764,54,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
ENOXAPARIN 100 MG/ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,1,mL,,54,45.9,15.4764,54,Medica,Individual & Family,53.514,99.1,,percent of total billed charges,,
ENOXAPARIN 100 MG/ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,1,mL,,54,45.9,15.4764,54,Medica,Individual & Family,53.514,99.1,,percent of total billed charges,,
ENOXAPARIN 100 MG/ML SUBQ SYRG,,J1650,HCPCS,Facility,Outpatient,1,mL,,54,45.9,15.4764,54,Medica,Medica Advantage Solution,26.892,49.8,,percent of total billed charges,,
ENOXAPARIN 100 MG/ML SUBQ SYRG,,J1650,HCPCS,Facility,Outpatient,1,mL,,54,45.9,15.4764,54,Medica,Medica Advantage Solution,26.892,49.8,,percent of total billed charges,,
ENOXAPARIN 100 MG/ML SUBQ SYRG,,J1650,HCPCS,Facility,Inpatient,1,mL,,54,45.9,15.4764,54,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
ENOXAPARIN 100 MG/ML SUBQ SYRG,,J1650,HCPCS,Facility,Inpatient,1,mL,,54,45.9,15.4764,54,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
ENOXAPARIN 100 MG/ML SUBQ SYRG,,J1650,HCPCS,Facility,Outpatient,1,mL,,54,45.9,15.4764,54,Medica,Medical Assistance,24.084,44.6,,percent of total billed charges,,
ENOXAPARIN 100 MG/ML SUBQ SYRG,,J1650,HCPCS,Facility,Outpatient,1,mL,,54,45.9,15.4764,54,Medica,Medical Assistance,24.084,44.6,,percent of total billed charges,,
ENOXAPARIN 100 MG/ML SUBQ SYRG,,J1650,HCPCS,Facility,Inpatient,1,mL,,54,45.9,15.4764,54,Medica,Medical Assistance,,,,,Included in per diem rate,
ENOXAPARIN 100 MG/ML SUBQ SYRG,,J1650,HCPCS,Facility,Inpatient,1,mL,,54,45.9,15.4764,54,Medica,Medical Assistance,,,,,Included in per diem rate,
ENOXAPARIN 100 MG/ML SUBQ SYRG,,J1650,HCPCS,Facility,Outpatient,1,mL,,54,45.9,15.4764,54,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,26.892,49.8,,percent of total billed charges,,
ENOXAPARIN 100 MG/ML SUBQ SYRG,,J1650,HCPCS,Facility,Outpatient,1,mL,,54,45.9,15.4764,54,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,26.892,49.8,,percent of total billed charges,,
ENOXAPARIN 100 MG/ML SUBQ SYRG,,J1650,HCPCS,Facility,Inpatient,1,mL,,54,45.9,15.4764,54,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
ENOXAPARIN 100 MG/ML SUBQ SYRG,,J1650,HCPCS,Facility,Inpatient,1,mL,,54,45.9,15.4764,54,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
ENOXAPARIN 100 MG/ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,1,mL,,54,45.9,15.4764,54,"Multiplan, Inc.","Multiplan, Inc.",50.76,94,,percent of total billed charges,,
ENOXAPARIN 100 MG/ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,1,mL,,54,45.9,15.4764,54,"Multiplan, Inc.","Multiplan, Inc.",50.76,94,,percent of total billed charges,,
ENOXAPARIN 100 MG/ML SUBQ SYRG,,J1650,HCPCS,Facility,Outpatient,1,mL,,54,45.9,15.4764,54,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,48.654,90.1,,percent of total billed charges,,
ENOXAPARIN 100 MG/ML SUBQ SYRG,,J1650,HCPCS,Facility,Outpatient,1,mL,,54,45.9,15.4764,54,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,48.654,90.1,,percent of total billed charges,,
ENOXAPARIN 100 MG/ML SUBQ SYRG,,J1650,HCPCS,Facility,Inpatient,1,mL,,54,45.9,15.4764,54,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
ENOXAPARIN 100 MG/ML SUBQ SYRG,,J1650,HCPCS,Facility,Inpatient,1,mL,,54,45.9,15.4764,54,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
ENOXAPARIN 100 MG/ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,1,mL,,54,45.9,15.4764,54,"Preferred One Administrative Services, INC.",PPO,53.244,98.6,,percent of total billed charges,,
ENOXAPARIN 100 MG/ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,1,mL,,54,45.9,15.4764,54,"Preferred One Administrative Services, INC.",PPO,53.244,98.6,,percent of total billed charges,,
ENOXAPARIN 100 MG/ML SUBQ SYRG,,J1650,HCPCS,Facility,Outpatient,1,mL,,54,45.9,15.4764,54,PrimeWest Health,Minnesota Senior Health Options (MSHO),27.783,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
ENOXAPARIN 100 MG/ML SUBQ SYRG,,J1650,HCPCS,Facility,Outpatient,1,mL,,54,45.9,15.4764,54,PrimeWest Health,Minnesota Senior Health Options (MSHO),27.783,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
ENOXAPARIN 100 MG/ML SUBQ SYRG,,J1650,HCPCS,Facility,Inpatient,1,mL,,54,45.9,15.4764,54,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ENOXAPARIN 100 MG/ML SUBQ SYRG,,J1650,HCPCS,Facility,Inpatient,1,mL,,54,45.9,15.4764,54,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ENOXAPARIN 100 MG/ML SUBQ SYRG,,J1650,HCPCS,Facility,Outpatient,1,mL,,54,45.9,15.4764,54,PrimeWest Health,MinnesotaCare,27.7344,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
ENOXAPARIN 100 MG/ML SUBQ SYRG,,J1650,HCPCS,Facility,Outpatient,1,mL,,54,45.9,15.4764,54,PrimeWest Health,MinnesotaCare,27.7344,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
ENOXAPARIN 100 MG/ML SUBQ SYRG,,J1650,HCPCS,Facility,Inpatient,1,mL,,54,45.9,15.4764,54,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
ENOXAPARIN 100 MG/ML SUBQ SYRG,,J1650,HCPCS,Facility,Inpatient,1,mL,,54,45.9,15.4764,54,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
ENOXAPARIN 100 MG/ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,1,mL,,54,45.9,15.4764,54,Sanford Health Plan,Sanford Health Plan,49.68,92,,percent of total billed charges,,
ENOXAPARIN 100 MG/ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,1,mL,,54,45.9,15.4764,54,Sanford Health Plan,Sanford Health Plan,49.68,92,,percent of total billed charges,,
ENOXAPARIN 100 MG/ML SUBQ SYRG,,J1650,HCPCS,Facility,Outpatient,1,mL,,54,45.9,15.4764,54,"UCare Health, Inc.",Individual & Family Plan,30.429,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
ENOXAPARIN 100 MG/ML SUBQ SYRG,,J1650,HCPCS,Facility,Outpatient,1,mL,,54,45.9,15.4764,54,"UCare Health, Inc.",Individual & Family Plan,30.429,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
ENOXAPARIN 100 MG/ML SUBQ SYRG,,J1650,HCPCS,Facility,Inpatient,1,mL,,54,45.9,15.4764,54,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
ENOXAPARIN 100 MG/ML SUBQ SYRG,,J1650,HCPCS,Facility,Inpatient,1,mL,,54,45.9,15.4764,54,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
ENOXAPARIN 100 MG/ML SUBQ SYRG,,J1650,HCPCS,Facility,Outpatient,1,mL,,54,45.9,15.4764,54,"UCare Health, Inc.",Medical Assistance,27.2538,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ENOXAPARIN 100 MG/ML SUBQ SYRG,,J1650,HCPCS,Facility,Outpatient,1,mL,,54,45.9,15.4764,54,"UCare Health, Inc.",Medical Assistance,27.2538,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ENOXAPARIN 100 MG/ML SUBQ SYRG,,J1650,HCPCS,Facility,Inpatient,1,mL,,54,45.9,15.4764,54,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
ENOXAPARIN 100 MG/ML SUBQ SYRG,,J1650,HCPCS,Facility,Inpatient,1,mL,,54,45.9,15.4764,54,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
ENOXAPARIN 100 MG/ML SUBQ SYRG,,J1650,HCPCS,Facility,Outpatient,1,mL,,54,45.9,15.4764,54,"UCare Health, Inc.",Medicare Advantage,27.2538,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ENOXAPARIN 100 MG/ML SUBQ SYRG,,J1650,HCPCS,Facility,Outpatient,1,mL,,54,45.9,15.4764,54,"UCare Health, Inc.",Medicare Advantage,27.2538,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ENOXAPARIN 100 MG/ML SUBQ SYRG,,J1650,HCPCS,Facility,Inpatient,1,mL,,54,45.9,15.4764,54,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ENOXAPARIN 100 MG/ML SUBQ SYRG,,J1650,HCPCS,Facility,Inpatient,1,mL,,54,45.9,15.4764,54,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ENOXAPARIN 100 MG/ML SUBQ SYRG,,J1650,HCPCS,Facility,Outpatient,1,mL,,54,45.9,15.4764,54,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),27.2538,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ENOXAPARIN 100 MG/ML SUBQ SYRG,,J1650,HCPCS,Facility,Outpatient,1,mL,,54,45.9,15.4764,54,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),27.2538,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ENOXAPARIN 100 MG/ML SUBQ SYRG,,J1650,HCPCS,Facility,Inpatient,1,mL,,54,45.9,15.4764,54,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ENOXAPARIN 100 MG/ML SUBQ SYRG,,J1650,HCPCS,Facility,Inpatient,1,mL,,54,45.9,15.4764,54,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ENOXAPARIN 100 MG/ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,1,mL,,54,45.9,15.4764,54,UnitedHealthcare,Individual & Family,50.76,94,,percent of total billed charges,,
ENOXAPARIN 100 MG/ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,1,mL,,54,45.9,15.4764,54,UnitedHealthcare,Individual & Family,50.76,94,,percent of total billed charges,,
ENOXAPARIN 100 MG/ML SUBQ SYRG,,J1650,HCPCS,Facility,Outpatient,1,mL,,54,45.9,15.4764,54,UnitedHealthcare,Medicare Advantage,26.46,49,,percent of total billed charges,,
ENOXAPARIN 100 MG/ML SUBQ SYRG,,J1650,HCPCS,Facility,Outpatient,1,mL,,54,45.9,15.4764,54,UnitedHealthcare,Medicare Advantage,26.46,49,,percent of total billed charges,,
ENOXAPARIN 100 MG/ML SUBQ SYRG,,J1650,HCPCS,Facility,Inpatient,1,mL,,54,45.9,15.4764,54,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
ENOXAPARIN 100 MG/ML SUBQ SYRG,,J1650,HCPCS,Facility,Inpatient,1,mL,,54,45.9,15.4764,54,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
ENOXAPARIN 100 MG/ML SUBQ SYRG,,J1650,HCPCS,Facility,Outpatient,1,mL,,54,45.9,15.4764,54,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,25.92,48,,percent of total billed charges,,100% of DHS outpatient percentage
ENOXAPARIN 100 MG/ML SUBQ SYRG,,J1650,HCPCS,Facility,Outpatient,1,mL,,54,45.9,15.4764,54,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,25.92,48,,percent of total billed charges,,100% of DHS outpatient percentage
ENOXAPARIN 100 MG/ML SUBQ SYRG,,J1650,HCPCS,Facility,Inpatient,1,mL,,54,45.9,15.4764,54,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
ENOXAPARIN 100 MG/ML SUBQ SYRG,,J1650,HCPCS,Facility,Inpatient,1,mL,,54,45.9,15.4764,54,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
ENOXAPARIN 150 MG/ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,1,mL,,189,160.65,54.1674,189,Aetna,Commercial,173.88,92,,percent of total billed charges,,
ENOXAPARIN 150 MG/ML SUBQ SYRG,,J1650,HCPCS,Facility,Outpatient,1,mL,,189,160.65,54.1674,189,Aetna,Medicare Advantage,92.61,49,,percent of total billed charges,,
ENOXAPARIN 150 MG/ML SUBQ SYRG,,J1650,HCPCS,Facility,Inpatient,1,mL,,189,160.65,54.1674,189,Aetna,Medicare Advantage,,,,,Included in per diem rate,
ENOXAPARIN 150 MG/ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,1,mL,,189,160.65,54.1674,189,Aetna,PPO,175.77,93,,percent of total billed charges,,
ENOXAPARIN 150 MG/ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,1,mL,,189,160.65,54.1674,189,America's PPO,America's PPO,181.4967,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
ENOXAPARIN 150 MG/ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,1,mL,,189,160.65,54.1674,189,BlueCross BlueShield Minnesota, Federal Employee Program,185.976,98.4,,percent of total billed charges,,
ENOXAPARIN 150 MG/ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,1,mL,,189,160.65,54.1674,189,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,189,100,,percent of total billed charges,,
ENOXAPARIN 150 MG/ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,1,mL,,189,160.65,54.1674,189,BlueCross BlueShield Minnesota,High Value Network Plan,170.1,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
ENOXAPARIN 150 MG/ML SUBQ SYRG,,J1650,HCPCS,Facility,Outpatient,1,mL,,189,160.65,54.1674,189,BlueCross BlueShield Minnesota,Medicare Advantage,92.61,49,,percent of total billed charges,,
ENOXAPARIN 150 MG/ML SUBQ SYRG,,J1650,HCPCS,Facility,Inpatient,1,mL,,189,160.65,54.1674,189,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
ENOXAPARIN 150 MG/ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,1,mL,,189,160.65,54.1674,189,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,167.3973,88.57,,percent of total billed charges,,
ENOXAPARIN 150 MG/ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,1,mL,,189,160.65,54.1674,189,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,54.1674,28.66,,percent of total billed charges,,
ENOXAPARIN 150 MG/ML SUBQ SYRG,,J1650,HCPCS,Facility,Outpatient,1,mL,,189,160.65,54.1674,189,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),92.61,49,,percent of total billed charges,,
ENOXAPARIN 150 MG/ML SUBQ SYRG,,J1650,HCPCS,Facility,Inpatient,1,mL,,189,160.65,54.1674,189,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
ENOXAPARIN 150 MG/ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,1,mL,,189,160.65,54.1674,189,CorVel,Worker's Compensation,189,100,,percent of total billed charges,,
ENOXAPARIN 150 MG/ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,1,mL,,189,160.65,54.1674,189,First Health Group Corporation,First Health Network,183.33,97,,percent of total billed charges,,
ENOXAPARIN 150 MG/ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,1,mL,,189,160.65,54.1674,189,"Health Partners, Inc.",Commercial,178.794,94.6,,percent of total billed charges,,
ENOXAPARIN 150 MG/ML SUBQ SYRG,,J1650,HCPCS,Facility,Outpatient,1,mL,,189,160.65,54.1674,189,"Health Partners, Inc.",Medicare Advantage,92.61,49,,percent of total billed charges,,
ENOXAPARIN 150 MG/ML SUBQ SYRG,,J1650,HCPCS,Facility,Inpatient,1,mL,,189,160.65,54.1674,189,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ENOXAPARIN 150 MG/ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,1,mL,,189,160.65,54.1674,189,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),113.4,60,,percent of total billed charges,,
ENOXAPARIN 150 MG/ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,1,mL,,189,160.65,54.1674,189,"Health Partners, Inc.",State of Minnesota Advantage Program,154.035,81.5,,percent of total billed charges,,
ENOXAPARIN 150 MG/ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,1,mL,,189,160.65,54.1674,189,"Health Partners, Inc.",State Public Programs,94.5,50,,percent of total billed charges,,
ENOXAPARIN 150 MG/ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,1,mL,,189,160.65,54.1674,189,Humana Insurance Company,Commercial PPO,179.55,95,,percent of total billed charges,,
ENOXAPARIN 150 MG/ML SUBQ SYRG,,J1650,HCPCS,Facility,Outpatient,1,mL,,189,160.65,54.1674,189,Humana Insurance Company,Medicare PPO,92.61,49,,percent of total billed charges,,
ENOXAPARIN 150 MG/ML SUBQ SYRG,,J1650,HCPCS,Facility,Inpatient,1,mL,,189,160.65,54.1674,189,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
ENOXAPARIN 150 MG/ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,1,mL,,189,160.65,54.1674,189,Medica,Individual & Family,187.299,99.1,,percent of total billed charges,,
ENOXAPARIN 150 MG/ML SUBQ SYRG,,J1650,HCPCS,Facility,Outpatient,1,mL,,189,160.65,54.1674,189,Medica,Medica Advantage Solution,94.122,49.8,,percent of total billed charges,,
ENOXAPARIN 150 MG/ML SUBQ SYRG,,J1650,HCPCS,Facility,Inpatient,1,mL,,189,160.65,54.1674,189,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
ENOXAPARIN 150 MG/ML SUBQ SYRG,,J1650,HCPCS,Facility,Outpatient,1,mL,,189,160.65,54.1674,189,Medica,Medical Assistance,84.294,44.6,,percent of total billed charges,,
ENOXAPARIN 150 MG/ML SUBQ SYRG,,J1650,HCPCS,Facility,Inpatient,1,mL,,189,160.65,54.1674,189,Medica,Medical Assistance,,,,,Included in per diem rate,
ENOXAPARIN 150 MG/ML SUBQ SYRG,,J1650,HCPCS,Facility,Outpatient,1,mL,,189,160.65,54.1674,189,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,94.122,49.8,,percent of total billed charges,,
ENOXAPARIN 150 MG/ML SUBQ SYRG,,J1650,HCPCS,Facility,Inpatient,1,mL,,189,160.65,54.1674,189,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
ENOXAPARIN 150 MG/ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,1,mL,,189,160.65,54.1674,189,"Multiplan, Inc.","Multiplan, Inc.",177.66,94,,percent of total billed charges,,
ENOXAPARIN 150 MG/ML SUBQ SYRG,,J1650,HCPCS,Facility,Outpatient,1,mL,,189,160.65,54.1674,189,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,170.289,90.1,,percent of total billed charges,,
ENOXAPARIN 150 MG/ML SUBQ SYRG,,J1650,HCPCS,Facility,Inpatient,1,mL,,189,160.65,54.1674,189,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
ENOXAPARIN 150 MG/ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,1,mL,,189,160.65,54.1674,189,"Preferred One Administrative Services, INC.",PPO,186.354,98.6,,percent of total billed charges,,
ENOXAPARIN 150 MG/ML SUBQ SYRG,,J1650,HCPCS,Facility,Outpatient,1,mL,,189,160.65,54.1674,189,PrimeWest Health,Minnesota Senior Health Options (MSHO),97.2405,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
ENOXAPARIN 150 MG/ML SUBQ SYRG,,J1650,HCPCS,Facility,Inpatient,1,mL,,189,160.65,54.1674,189,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ENOXAPARIN 150 MG/ML SUBQ SYRG,,J1650,HCPCS,Facility,Outpatient,1,mL,,189,160.65,54.1674,189,PrimeWest Health,MinnesotaCare,97.0704,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
ENOXAPARIN 150 MG/ML SUBQ SYRG,,J1650,HCPCS,Facility,Inpatient,1,mL,,189,160.65,54.1674,189,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
ENOXAPARIN 150 MG/ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,1,mL,,189,160.65,54.1674,189,Sanford Health Plan,Sanford Health Plan,173.88,92,,percent of total billed charges,,
ENOXAPARIN 150 MG/ML SUBQ SYRG,,J1650,HCPCS,Facility,Outpatient,1,mL,,189,160.65,54.1674,189,"UCare Health, Inc.",Individual & Family Plan,106.5015,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
ENOXAPARIN 150 MG/ML SUBQ SYRG,,J1650,HCPCS,Facility,Inpatient,1,mL,,189,160.65,54.1674,189,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
ENOXAPARIN 150 MG/ML SUBQ SYRG,,J1650,HCPCS,Facility,Outpatient,1,mL,,189,160.65,54.1674,189,"UCare Health, Inc.",Medical Assistance,95.3883,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ENOXAPARIN 150 MG/ML SUBQ SYRG,,J1650,HCPCS,Facility,Inpatient,1,mL,,189,160.65,54.1674,189,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
ENOXAPARIN 150 MG/ML SUBQ SYRG,,J1650,HCPCS,Facility,Outpatient,1,mL,,189,160.65,54.1674,189,"UCare Health, Inc.",Medicare Advantage,95.3883,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ENOXAPARIN 150 MG/ML SUBQ SYRG,,J1650,HCPCS,Facility,Inpatient,1,mL,,189,160.65,54.1674,189,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ENOXAPARIN 150 MG/ML SUBQ SYRG,,J1650,HCPCS,Facility,Outpatient,1,mL,,189,160.65,54.1674,189,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),95.3883,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ENOXAPARIN 150 MG/ML SUBQ SYRG,,J1650,HCPCS,Facility,Inpatient,1,mL,,189,160.65,54.1674,189,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ENOXAPARIN 150 MG/ML SUBQ SYRG,,J1650,HCPCS,Facility,Both,1,mL,,189,160.65,54.1674,189,UnitedHealthcare,Individual & Family,177.66,94,,percent of total billed charges,,
ENOXAPARIN 150 MG/ML SUBQ SYRG,,J1650,HCPCS,Facility,Outpatient,1,mL,,189,160.65,54.1674,189,UnitedHealthcare,Medicare Advantage,92.61,49,,percent of total billed charges,,
ENOXAPARIN 150 MG/ML SUBQ SYRG,,J1650,HCPCS,Facility,Inpatient,1,mL,,189,160.65,54.1674,189,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
ENOXAPARIN 150 MG/ML SUBQ SYRG,,J1650,HCPCS,Facility,Outpatient,1,mL,,189,160.65,54.1674,189,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,90.72,48,,percent of total billed charges,,100% of DHS outpatient percentage
ENOXAPARIN 150 MG/ML SUBQ SYRG,,J1650,HCPCS,Facility,Inpatient,1,mL,,189,160.65,54.1674,189,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Intubation Airway - Emergency Insertion Non Er,,31500,CPT,Facility,Both,,,,179,152.15,51.3014,179,Aetna,Commercial,164.68,92,,percent of total billed charges,,
Intubation Airway - Emergency Insertion Non Er,,31500,CPT,Facility,Outpatient,,,,179,152.15,51.3014,179,Aetna,Medicare Advantage,87.71,49,,percent of total billed charges,,
Intubation Airway - Emergency Insertion Non Er,,31500,CPT,Facility,Inpatient,,,,179,152.15,51.3014,179,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Intubation Airway - Emergency Insertion Non Er,,31500,CPT,Facility,Both,,,,179,152.15,51.3014,179,Aetna,PPO,166.47,93,,percent of total billed charges,,
Intubation Airway - Emergency Insertion Non Er,,31500,CPT,Facility,Both,,,,179,152.15,51.3014,179,America's PPO,America's PPO,171.8937,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Intubation Airway - Emergency Insertion Non Er,,31500,CPT,Facility,Both,,,,179,152.15,51.3014,179,BlueCross BlueShield Minnesota, Federal Employee Program,176.136,98.4,,percent of total billed charges,,
Intubation Airway - Emergency Insertion Non Er,,31500,CPT,Facility,Both,,,,179,152.15,51.3014,179,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,179,100,,percent of total billed charges,,
Intubation Airway - Emergency Insertion Non Er,,31500,CPT,Facility,Both,,,,179,152.15,51.3014,179,BlueCross BlueShield Minnesota,High Value Network Plan,161.1,90,,percent of total billed charges,,
Intubation Airway - Emergency Insertion Non Er,,31500,CPT,Facility,Outpatient,,,,179,152.15,51.3014,179,BlueCross BlueShield Minnesota,Medicare Advantage,87.71,49,,percent of total billed charges,,
Intubation Airway - Emergency Insertion Non Er,,31500,CPT,Facility,Inpatient,,,,179,152.15,51.3014,179,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Intubation Airway - Emergency Insertion Non Er,,31500,CPT,Facility,Both,,,,179,152.15,51.3014,179,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,158.5403,88.57,,percent of total billed charges,,
Intubation Airway - Emergency Insertion Non Er,,31500,CPT,Facility,Both,,,,179,152.15,51.3014,179,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,51.3014,28.66,,percent of total billed charges,,
Intubation Airway - Emergency Insertion Non Er,,31500,CPT,Facility,Outpatient,,,,179,152.15,51.3014,179,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),87.71,49,,percent of total billed charges,,
Intubation Airway - Emergency Insertion Non Er,,31500,CPT,Facility,Inpatient,,,,179,152.15,51.3014,179,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Intubation Airway - Emergency Insertion Non Er,,31500,CPT,Facility,Both,,,,179,152.15,51.3014,179,CorVel,Worker's Compensation,179,100,,percent of total billed charges,,
Intubation Airway - Emergency Insertion Non Er,,31500,CPT,Facility,Both,,,,179,152.15,51.3014,179,First Health Group Corporation,First Health Network,173.63,97,,percent of total billed charges,,
Intubation Airway - Emergency Insertion Non Er,,31500,CPT,Facility,Both,,,,179,152.15,51.3014,179,"Health Partners, Inc.",Commercial,169.334,94.6,,percent of total billed charges,,
Intubation Airway - Emergency Insertion Non Er,,31500,CPT,Facility,Outpatient,,,,179,152.15,51.3014,179,"Health Partners, Inc.",Medicare Advantage,87.71,49,,percent of total billed charges,,
Intubation Airway - Emergency Insertion Non Er,,31500,CPT,Facility,Inpatient,,,,179,152.15,51.3014,179,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Intubation Airway - Emergency Insertion Non Er,,31500,CPT,Facility,Both,,,,179,152.15,51.3014,179,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),107.4,60,,percent of total billed charges,,
Intubation Airway - Emergency Insertion Non Er,,31500,CPT,Facility,Both,,,,179,152.15,51.3014,179,"Health Partners, Inc.",State of Minnesota Advantage Program,145.885,81.5,,percent of total billed charges,,
Intubation Airway - Emergency Insertion Non Er,,31500,CPT,Facility,Both,,,,179,152.15,51.3014,179,"Health Partners, Inc.",State Public Programs,89.5,50,,percent of total billed charges,,
Intubation Airway - Emergency Insertion Non Er,,31500,CPT,Facility,Both,,,,179,152.15,51.3014,179,Humana Insurance Company,Commercial PPO,170.05,95,,percent of total billed charges,,
Intubation Airway - Emergency Insertion Non Er,,31500,CPT,Facility,Outpatient,,,,179,152.15,51.3014,179,Humana Insurance Company,Medicare PPO,87.71,49,,percent of total billed charges,,
Intubation Airway - Emergency Insertion Non Er,,31500,CPT,Facility,Inpatient,,,,179,152.15,51.3014,179,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Intubation Airway - Emergency Insertion Non Er,,31500,CPT,Facility,Both,,,,179,152.15,51.3014,179,Medica,Individual & Family,177.389,99.1,,percent of total billed charges,,
Intubation Airway - Emergency Insertion Non Er,,31500,CPT,Facility,Outpatient,,,,179,152.15,51.3014,179,Medica,Medica Advantage Solution,89.142,49.8,,percent of total billed charges,,
Intubation Airway - Emergency Insertion Non Er,,31500,CPT,Facility,Inpatient,,,,179,152.15,51.3014,179,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Intubation Airway - Emergency Insertion Non Er,,31500,CPT,Facility,Outpatient,,,,179,152.15,51.3014,179,Medica,Medical Assistance,79.834,44.6,,percent of total billed charges,,
Intubation Airway - Emergency Insertion Non Er,,31500,CPT,Facility,Inpatient,,,,179,152.15,51.3014,179,Medica,Medical Assistance,,,,,Included in per diem rate,
Intubation Airway - Emergency Insertion Non Er,,31500,CPT,Facility,Outpatient,,,,179,152.15,51.3014,179,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,89.142,49.8,,percent of total billed charges,,
Intubation Airway - Emergency Insertion Non Er,,31500,CPT,Facility,Inpatient,,,,179,152.15,51.3014,179,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Intubation Airway - Emergency Insertion Non Er,,31500,CPT,Facility,Both,,,,179,152.15,51.3014,179,"Multiplan, Inc.","Multiplan, Inc.",168.26,94,,percent of total billed charges,,
Intubation Airway - Emergency Insertion Non Er,,31500,CPT,Facility,Outpatient,,,,179,152.15,51.3014,179,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,161.279,90.1,,percent of total billed charges,,
Intubation Airway - Emergency Insertion Non Er,,31500,CPT,Facility,Inpatient,,,,179,152.15,51.3014,179,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Intubation Airway - Emergency Insertion Non Er,,31500,CPT,Facility,Both,,,,179,152.15,51.3014,179,"Preferred One Administrative Services, INC.",PPO,176.494,98.6,,percent of total billed charges,,
Intubation Airway - Emergency Insertion Non Er,,31500,CPT,Facility,Outpatient,,,,179,152.15,51.3014,179,PrimeWest Health,Minnesota Senior Health Options (MSHO),92.0955,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Intubation Airway - Emergency Insertion Non Er,,31500,CPT,Facility,Inpatient,,,,179,152.15,51.3014,179,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Intubation Airway - Emergency Insertion Non Er,,31500,CPT,Facility,Outpatient,,,,179,152.15,51.3014,179,PrimeWest Health,MinnesotaCare,91.9344,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Intubation Airway - Emergency Insertion Non Er,,31500,CPT,Facility,Inpatient,,,,179,152.15,51.3014,179,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Intubation Airway - Emergency Insertion Non Er,,31500,CPT,Facility,Both,,,,179,152.15,51.3014,179,Sanford Health Plan,Sanford Health Plan,164.68,92,,percent of total billed charges,,
Intubation Airway - Emergency Insertion Non Er,,31500,CPT,Facility,Outpatient,,,,179,152.15,51.3014,179,"UCare Health, Inc.",Individual & Family Plan,100.8665,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Intubation Airway - Emergency Insertion Non Er,,31500,CPT,Facility,Inpatient,,,,179,152.15,51.3014,179,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Intubation Airway - Emergency Insertion Non Er,,31500,CPT,Facility,Outpatient,,,,179,152.15,51.3014,179,"UCare Health, Inc.",Medical Assistance,90.3413,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Intubation Airway - Emergency Insertion Non Er,,31500,CPT,Facility,Inpatient,,,,179,152.15,51.3014,179,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Intubation Airway - Emergency Insertion Non Er,,31500,CPT,Facility,Outpatient,,,,179,152.15,51.3014,179,"UCare Health, Inc.",Medicare Advantage,90.3413,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Intubation Airway - Emergency Insertion Non Er,,31500,CPT,Facility,Inpatient,,,,179,152.15,51.3014,179,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Intubation Airway - Emergency Insertion Non Er,,31500,CPT,Facility,Outpatient,,,,179,152.15,51.3014,179,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),90.3413,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Intubation Airway - Emergency Insertion Non Er,,31500,CPT,Facility,Inpatient,,,,179,152.15,51.3014,179,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Intubation Airway - Emergency Insertion Non Er,,31500,CPT,Facility,Both,,,,179,152.15,51.3014,179,UnitedHealthcare,Individual & Family,168.26,94,,percent of total billed charges,,
Intubation Airway - Emergency Insertion Non Er,,31500,CPT,Facility,Outpatient,,,,179,152.15,51.3014,179,UnitedHealthcare,Medicare Advantage,87.71,49,,percent of total billed charges,,
Intubation Airway - Emergency Insertion Non Er,,31500,CPT,Facility,Inpatient,,,,179,152.15,51.3014,179,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Intubation Airway - Emergency Insertion Non Er,,31500,CPT,Facility,Outpatient,,,,179,152.15,51.3014,179,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,85.92,48,,percent of total billed charges,,100% of DHS outpatient percentage
Intubation Airway - Emergency Insertion Non Er,,31500,CPT,Facility,Inpatient,,,,179,152.15,51.3014,179,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Intubation, Endotracheal, Emergency Procedure (Pro Cah)",,31500,CPT,Professional,Outpatient,,,,515,437.75,84.86,515,Aetna,Commercial,437.75,85,,percent of total billed charges,,
"Intubation, Endotracheal, Emergency Procedure (Pro Cah)",,31500,CPT,Professional,Outpatient,,,,515,437.75,84.86,515,Aetna,Medicare Advantage,135.43,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Intubation, Endotracheal, Emergency Procedure (Pro Cah)",,31500,CPT,Professional,Outpatient,,,,515,437.75,84.86,515,Aetna,PPO,478.95,93,,percent of total billed charges,,
"Intubation, Endotracheal, Emergency Procedure (Pro Cah)",,31500,CPT,Professional,Outpatient,,,,515,437.75,84.86,515,America's PPO,America's PPO,440.016,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Intubation, Endotracheal, Emergency Procedure (Pro Cah)",,31500,CPT,Professional,Outpatient,,,,515,437.75,84.86,515,BlueCross BlueShield Minnesota, Federal Employee Program,287.15,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Intubation, Endotracheal, Emergency Procedure (Pro Cah)",,31500,CPT,Professional,Outpatient,,,,515,437.75,84.86,515,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,291.7444,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Intubation, Endotracheal, Emergency Procedure (Pro Cah)",,31500,CPT,Professional,Outpatient,,,,515,437.75,84.86,515,BlueCross BlueShield Minnesota,High Value Network Plan,291.7444,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Intubation, Endotracheal, Emergency Procedure (Pro Cah)",,31500,CPT,Professional,Outpatient,,,,515,437.75,84.86,515,BlueCross BlueShield Minnesota,Medicare Advantage,151.754,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Intubation, Endotracheal, Emergency Procedure (Pro Cah)",,31500,CPT,Professional,Outpatient,,,,515,437.75,84.86,515,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,291.7444,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Intubation, Endotracheal, Emergency Procedure (Pro Cah)",,31500,CPT,Professional,Outpatient,,,,515,437.75,84.86,515,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,97.97288,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Intubation, Endotracheal, Emergency Procedure (Pro Cah)",,31500,CPT,Professional,Outpatient,,,,515,437.75,84.86,515,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),151.754,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Intubation, Endotracheal, Emergency Procedure (Pro Cah)",,31500,CPT,Professional,Outpatient,,,,515,437.75,84.86,515,CorVel,Worker's Compensation,261.1401675,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Intubation, Endotracheal, Emergency Procedure (Pro Cah)",,31500,CPT,Professional,Outpatient,,,,515,437.75,84.86,515,First Health Group Corporation,First Health Network,499.55,97,,percent of total billed charges,,
"Intubation, Endotracheal, Emergency Procedure (Pro Cah)",,31500,CPT,Professional,Outpatient,,,,515,437.75,84.86,515,"Health Partners, Inc.",Commercial,282.22,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Intubation, Endotracheal, Emergency Procedure (Pro Cah)",,31500,CPT,Professional,Outpatient,,,,515,437.75,84.86,515,"Health Partners, Inc.",Medicare Advantage,151.754,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Intubation, Endotracheal, Emergency Procedure (Pro Cah)",,31500,CPT,Professional,Outpatient,,,,515,437.75,84.86,515,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),131.82,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Intubation, Endotracheal, Emergency Procedure (Pro Cah)",,31500,CPT,Professional,Outpatient,,,,515,437.75,84.86,515,"Health Partners, Inc.",State of Minnesota Advantage Program,243.13253,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Intubation, Endotracheal, Emergency Procedure (Pro Cah)",,31500,CPT,Professional,Outpatient,,,,515,437.75,84.86,515,"Health Partners, Inc.",State Public Programs,84.86,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Intubation, Endotracheal, Emergency Procedure (Pro Cah)",,31500,CPT,Professional,Outpatient,,,,515,437.75,84.86,515,Humana Insurance Company,Commercial PPO,131.96,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Intubation, Endotracheal, Emergency Procedure (Pro Cah)",,31500,CPT,Professional,Outpatient,,,,515,437.75,84.86,515,Humana Insurance Company,Medicare PPO,515,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Intubation, Endotracheal, Emergency Procedure (Pro Cah)",,31500,CPT,Professional,Outpatient,,,,515,437.75,84.86,515,Medica,Individual & Family,436.72,84.8,,percent of total billed charges,,
"Intubation, Endotracheal, Emergency Procedure (Pro Cah)",,31500,CPT,Professional,Outpatient,,,,515,437.75,84.86,515,Medica,Medica Advantage Solution,256.47,49.8,,percent of total billed charges,,
"Intubation, Endotracheal, Emergency Procedure (Pro Cah)",,31500,CPT,Professional,Outpatient,,,,515,437.75,84.86,515,Medica,Medical Assistance,97.97,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Intubation, Endotracheal, Emergency Procedure (Pro Cah)",,31500,CPT,Professional,Outpatient,,,,515,437.75,84.86,515,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,131.96,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Intubation, Endotracheal, Emergency Procedure (Pro Cah)",,31500,CPT,Professional,Outpatient,,,,515,437.75,84.86,515,"Multiplan, Inc.","Multiplan, Inc.",484.1,94,,percent of total billed charges,,
"Intubation, Endotracheal, Emergency Procedure (Pro Cah)",,31500,CPT,Professional,Outpatient,,,,515,437.75,84.86,515,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,464.015,90.1,,percent of total billed charges,,
"Intubation, Endotracheal, Emergency Procedure (Pro Cah)",,31500,CPT,Professional,Outpatient,,,,515,437.75,84.86,515,"Preferred One Administrative Services, INC.",PPO,507.79,98.6,,percent of total billed charges,,
"Intubation, Endotracheal, Emergency Procedure (Pro Cah)",,31500,CPT,Professional,Outpatient,,,,515,437.75,84.86,515,PrimeWest Health,Minnesota Senior Health Options (MSHO),151.754,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Intubation, Endotracheal, Emergency Procedure (Pro Cah)",,31500,CPT,Professional,Outpatient,,,,515,437.75,84.86,515,PrimeWest Health,MinnesotaCare,104.8309816,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Intubation, Endotracheal, Emergency Procedure (Pro Cah)",,31500,CPT,Professional,Outpatient,,,,515,437.75,84.86,515,Sanford Health Plan,Sanford Health Plan,453.2,88,,percent of total billed charges,,
"Intubation, Endotracheal, Emergency Procedure (Pro Cah)",,31500,CPT,Professional,Outpatient,,,,515,437.75,84.86,515,"UCare Health, Inc.",Individual & Family Plan,214.514176,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Intubation, Endotracheal, Emergency Procedure (Pro Cah)",,31500,CPT,Professional,Outpatient,,,,515,437.75,84.86,515,"UCare Health, Inc.",Medical Assistance,107.770168,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Intubation, Endotracheal, Emergency Procedure (Pro Cah)",,31500,CPT,Professional,Outpatient,,,,515,437.75,84.86,515,"UCare Health, Inc.",Medicare Advantage,151.754,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Intubation, Endotracheal, Emergency Procedure (Pro Cah)",,31500,CPT,Professional,Outpatient,,,,515,437.75,84.86,515,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),121.4032,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Intubation, Endotracheal, Emergency Procedure (Pro Cah)",,31500,CPT,Professional,Outpatient,,,,515,437.75,84.86,515,UnitedHealthcare,Individual & Family,515,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Intubation, Endotracheal, Emergency Procedure (Pro Cah)",,31500,CPT,Professional,Outpatient,,,,515,437.75,84.86,515,UnitedHealthcare,Medicare Advantage,151.754,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Intubation, Endotracheal, Emergency Procedure (Pro Cah)",,31500,CPT,Professional,Outpatient,,,,515,437.75,84.86,515,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,97.97288,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Laryngoscopy, Indirect; Diagnostic",,31505,CPT,Facility,Both,,,,125,106.25,35.825,125,Aetna,Commercial,115,92,,percent of total billed charges,,
"Laryngoscopy, Indirect; Diagnostic",,31505,CPT,Facility,Outpatient,,,,125,106.25,35.825,125,Aetna,Medicare Advantage,61.25,49,,percent of total billed charges,,
"Laryngoscopy, Indirect; Diagnostic",,31505,CPT,Facility,Inpatient,,,,125,106.25,35.825,125,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Laryngoscopy, Indirect; Diagnostic",,31505,CPT,Facility,Both,,,,125,106.25,35.825,125,Aetna,PPO,116.25,93,,percent of total billed charges,,
"Laryngoscopy, Indirect; Diagnostic",,31505,CPT,Facility,Both,,,,125,106.25,35.825,125,America's PPO,America's PPO,120.0375,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Laryngoscopy, Indirect; Diagnostic",,31505,CPT,Facility,Both,,,,125,106.25,35.825,125,BlueCross BlueShield Minnesota, Federal Employee Program,123,98.4,,percent of total billed charges,,
"Laryngoscopy, Indirect; Diagnostic",,31505,CPT,Facility,Both,,,,125,106.25,35.825,125,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,125,100,,percent of total billed charges,,
"Laryngoscopy, Indirect; Diagnostic",,31505,CPT,Facility,Both,,,,125,106.25,35.825,125,BlueCross BlueShield Minnesota,High Value Network Plan,112.5,90,,percent of total billed charges,,
"Laryngoscopy, Indirect; Diagnostic",,31505,CPT,Facility,Outpatient,,,,125,106.25,35.825,125,BlueCross BlueShield Minnesota,Medicare Advantage,61.25,49,,percent of total billed charges,,
"Laryngoscopy, Indirect; Diagnostic",,31505,CPT,Facility,Inpatient,,,,125,106.25,35.825,125,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Laryngoscopy, Indirect; Diagnostic",,31505,CPT,Facility,Both,,,,125,106.25,35.825,125,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,110.7125,88.57,,percent of total billed charges,,
"Laryngoscopy, Indirect; Diagnostic",,31505,CPT,Facility,Both,,,,125,106.25,35.825,125,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,35.825,28.66,,percent of total billed charges,,
"Laryngoscopy, Indirect; Diagnostic",,31505,CPT,Facility,Outpatient,,,,125,106.25,35.825,125,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),61.25,49,,percent of total billed charges,,
"Laryngoscopy, Indirect; Diagnostic",,31505,CPT,Facility,Inpatient,,,,125,106.25,35.825,125,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Laryngoscopy, Indirect; Diagnostic",,31505,CPT,Facility,Both,,,,125,106.25,35.825,125,CorVel,Worker's Compensation,125,100,,percent of total billed charges,,
"Laryngoscopy, Indirect; Diagnostic",,31505,CPT,Facility,Both,,,,125,106.25,35.825,125,First Health Group Corporation,First Health Network,121.25,97,,percent of total billed charges,,
"Laryngoscopy, Indirect; Diagnostic",,31505,CPT,Facility,Both,,,,125,106.25,35.825,125,"Health Partners, Inc.",Commercial,118.25,94.6,,percent of total billed charges,,
"Laryngoscopy, Indirect; Diagnostic",,31505,CPT,Facility,Outpatient,,,,125,106.25,35.825,125,"Health Partners, Inc.",Medicare Advantage,61.25,49,,percent of total billed charges,,
"Laryngoscopy, Indirect; Diagnostic",,31505,CPT,Facility,Inpatient,,,,125,106.25,35.825,125,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Laryngoscopy, Indirect; Diagnostic",,31505,CPT,Facility,Both,,,,125,106.25,35.825,125,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),75,60,,percent of total billed charges,,
"Laryngoscopy, Indirect; Diagnostic",,31505,CPT,Facility,Both,,,,125,106.25,35.825,125,"Health Partners, Inc.",State of Minnesota Advantage Program,101.875,81.5,,percent of total billed charges,,
"Laryngoscopy, Indirect; Diagnostic",,31505,CPT,Facility,Both,,,,125,106.25,35.825,125,"Health Partners, Inc.",State Public Programs,62.5,50,,percent of total billed charges,,
"Laryngoscopy, Indirect; Diagnostic",,31505,CPT,Facility,Both,,,,125,106.25,35.825,125,Humana Insurance Company,Commercial PPO,118.75,95,,percent of total billed charges,,
"Laryngoscopy, Indirect; Diagnostic",,31505,CPT,Facility,Outpatient,,,,125,106.25,35.825,125,Humana Insurance Company,Medicare PPO,61.25,49,,percent of total billed charges,,
"Laryngoscopy, Indirect; Diagnostic",,31505,CPT,Facility,Inpatient,,,,125,106.25,35.825,125,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Laryngoscopy, Indirect; Diagnostic",,31505,CPT,Facility,Both,,,,125,106.25,35.825,125,Medica,Individual & Family,123.875,99.1,,percent of total billed charges,,
"Laryngoscopy, Indirect; Diagnostic",,31505,CPT,Facility,Outpatient,,,,125,106.25,35.825,125,Medica,Medica Advantage Solution,62.25,49.8,,percent of total billed charges,,
"Laryngoscopy, Indirect; Diagnostic",,31505,CPT,Facility,Inpatient,,,,125,106.25,35.825,125,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Laryngoscopy, Indirect; Diagnostic",,31505,CPT,Facility,Outpatient,,,,125,106.25,35.825,125,Medica,Medical Assistance,55.75,44.6,,percent of total billed charges,,
"Laryngoscopy, Indirect; Diagnostic",,31505,CPT,Facility,Inpatient,,,,125,106.25,35.825,125,Medica,Medical Assistance,,,,,Included in per diem rate,
"Laryngoscopy, Indirect; Diagnostic",,31505,CPT,Facility,Outpatient,,,,125,106.25,35.825,125,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,62.25,49.8,,percent of total billed charges,,
"Laryngoscopy, Indirect; Diagnostic",,31505,CPT,Facility,Inpatient,,,,125,106.25,35.825,125,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Laryngoscopy, Indirect; Diagnostic",,31505,CPT,Facility,Both,,,,125,106.25,35.825,125,"Multiplan, Inc.","Multiplan, Inc.",117.5,94,,percent of total billed charges,,
"Laryngoscopy, Indirect; Diagnostic",,31505,CPT,Facility,Outpatient,,,,125,106.25,35.825,125,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,112.625,90.1,,percent of total billed charges,,
"Laryngoscopy, Indirect; Diagnostic",,31505,CPT,Facility,Inpatient,,,,125,106.25,35.825,125,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Laryngoscopy, Indirect; Diagnostic",,31505,CPT,Facility,Both,,,,125,106.25,35.825,125,"Preferred One Administrative Services, INC.",PPO,123.25,98.6,,percent of total billed charges,,
"Laryngoscopy, Indirect; Diagnostic",,31505,CPT,Facility,Outpatient,,,,125,106.25,35.825,125,PrimeWest Health,Minnesota Senior Health Options (MSHO),64.3125,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Laryngoscopy, Indirect; Diagnostic",,31505,CPT,Facility,Inpatient,,,,125,106.25,35.825,125,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Laryngoscopy, Indirect; Diagnostic",,31505,CPT,Facility,Outpatient,,,,125,106.25,35.825,125,PrimeWest Health,MinnesotaCare,64.2,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Laryngoscopy, Indirect; Diagnostic",,31505,CPT,Facility,Inpatient,,,,125,106.25,35.825,125,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Laryngoscopy, Indirect; Diagnostic",,31505,CPT,Facility,Both,,,,125,106.25,35.825,125,Sanford Health Plan,Sanford Health Plan,115,92,,percent of total billed charges,,
"Laryngoscopy, Indirect; Diagnostic",,31505,CPT,Facility,Outpatient,,,,125,106.25,35.825,125,"UCare Health, Inc.",Individual & Family Plan,70.4375,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Laryngoscopy, Indirect; Diagnostic",,31505,CPT,Facility,Inpatient,,,,125,106.25,35.825,125,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Laryngoscopy, Indirect; Diagnostic",,31505,CPT,Facility,Outpatient,,,,125,106.25,35.825,125,"UCare Health, Inc.",Medical Assistance,63.0875,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Laryngoscopy, Indirect; Diagnostic",,31505,CPT,Facility,Inpatient,,,,125,106.25,35.825,125,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Laryngoscopy, Indirect; Diagnostic",,31505,CPT,Facility,Outpatient,,,,125,106.25,35.825,125,"UCare Health, Inc.",Medicare Advantage,63.0875,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Laryngoscopy, Indirect; Diagnostic",,31505,CPT,Facility,Inpatient,,,,125,106.25,35.825,125,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Laryngoscopy, Indirect; Diagnostic",,31505,CPT,Facility,Outpatient,,,,125,106.25,35.825,125,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),63.0875,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Laryngoscopy, Indirect; Diagnostic",,31505,CPT,Facility,Inpatient,,,,125,106.25,35.825,125,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Laryngoscopy, Indirect; Diagnostic",,31505,CPT,Facility,Both,,,,125,106.25,35.825,125,UnitedHealthcare,Individual & Family,117.5,94,,percent of total billed charges,,
"Laryngoscopy, Indirect; Diagnostic",,31505,CPT,Facility,Outpatient,,,,125,106.25,35.825,125,UnitedHealthcare,Medicare Advantage,61.25,49,,percent of total billed charges,,
"Laryngoscopy, Indirect; Diagnostic",,31505,CPT,Facility,Inpatient,,,,125,106.25,35.825,125,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Laryngoscopy, Indirect; Diagnostic",,31505,CPT,Facility,Outpatient,,,,125,106.25,35.825,125,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,60,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Laryngoscopy, Indirect; Diagnostic",,31505,CPT,Facility,Inpatient,,,,125,106.25,35.825,125,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Laryngoscopy, Indirect; Diagnostic (Separate Procedure) (Pro Cah)",,31505,CPT,Professional,Both,,,,210,178.5,31.19,210,Aetna,Commercial,178.5,85,,percent of total billed charges,,
"Laryngoscopy, Indirect; Diagnostic (Separate Procedure) (Pro Cah)",,31505,CPT,Professional,Both,,,,210,178.5,31.19,210,Aetna,Medicare Advantage,47.49,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Laryngoscopy, Indirect; Diagnostic (Separate Procedure) (Pro Cah)",,31505,CPT,Professional,Both,,,,210,178.5,31.19,210,Aetna,PPO,195.3,93,,percent of total billed charges,,
"Laryngoscopy, Indirect; Diagnostic (Separate Procedure) (Pro Cah)",,31505,CPT,Professional,Both,,,,210,178.5,31.19,210,America's PPO,America's PPO,179.424,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Laryngoscopy, Indirect; Diagnostic (Separate Procedure) (Pro Cah)",,31505,CPT,Professional,Both,,,,210,178.5,31.19,210,BlueCross BlueShield Minnesota, Federal Employee Program,101.22,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Laryngoscopy, Indirect; Diagnostic (Separate Procedure) (Pro Cah)",,31505,CPT,Professional,Both,,,,210,178.5,31.19,210,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,102.83952,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Laryngoscopy, Indirect; Diagnostic (Separate Procedure) (Pro Cah)",,31505,CPT,Professional,Both,,,,210,178.5,31.19,210,BlueCross BlueShield Minnesota,High Value Network Plan,102.83952,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Laryngoscopy, Indirect; Diagnostic (Separate Procedure) (Pro Cah)",,31505,CPT,Professional,Both,,,,210,178.5,31.19,210,BlueCross BlueShield Minnesota,Medicare Advantage,55.7635,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Laryngoscopy, Indirect; Diagnostic (Separate Procedure) (Pro Cah)",,31505,CPT,Professional,Both,,,,210,178.5,31.19,210,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,102.83952,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Laryngoscopy, Indirect; Diagnostic (Separate Procedure) (Pro Cah)",,31505,CPT,Professional,Both,,,,210,178.5,31.19,210,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,36.00704,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Laryngoscopy, Indirect; Diagnostic (Separate Procedure) (Pro Cah)",,31505,CPT,Professional,Both,,,,210,178.5,31.19,210,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),55.7635,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Laryngoscopy, Indirect; Diagnostic (Separate Procedure) (Pro Cah)",,31505,CPT,Professional,Both,,,,210,178.5,31.19,210,CorVel,Worker's Compensation,93.4596663,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Laryngoscopy, Indirect; Diagnostic (Separate Procedure) (Pro Cah)",,31505,CPT,Professional,Both,,,,210,178.5,31.19,210,First Health Group Corporation,First Health Network,203.7,97,,percent of total billed charges,,
"Laryngoscopy, Indirect; Diagnostic (Separate Procedure) (Pro Cah)",,31505,CPT,Professional,Both,,,,210,178.5,31.19,210,"Health Partners, Inc.",Commercial,100.85,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Laryngoscopy, Indirect; Diagnostic (Separate Procedure) (Pro Cah)",,31505,CPT,Professional,Both,,,,210,178.5,31.19,210,"Health Partners, Inc.",Medicare Advantage,55.7635,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Laryngoscopy, Indirect; Diagnostic (Separate Procedure) (Pro Cah)",,31505,CPT,Professional,Both,,,,210,178.5,31.19,210,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),48.46,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Laryngoscopy, Indirect; Diagnostic (Separate Procedure) (Pro Cah)",,31505,CPT,Professional,Both,,,,210,178.5,31.19,210,"Health Partners, Inc.",State of Minnesota Advantage Program,86.882275,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Laryngoscopy, Indirect; Diagnostic (Separate Procedure) (Pro Cah)",,31505,CPT,Professional,Both,,,,210,178.5,31.19,210,"Health Partners, Inc.",State Public Programs,31.19,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Laryngoscopy, Indirect; Diagnostic (Separate Procedure) (Pro Cah)",,31505,CPT,Professional,Both,,,,210,178.5,31.19,210,Humana Insurance Company,Commercial PPO,48.49,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Laryngoscopy, Indirect; Diagnostic (Separate Procedure) (Pro Cah)",,31505,CPT,Professional,Both,,,,210,178.5,31.19,210,Humana Insurance Company,Medicare PPO,210,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Laryngoscopy, Indirect; Diagnostic (Separate Procedure) (Pro Cah)",,31505,CPT,Professional,Both,,,,210,178.5,31.19,210,Medica,Individual & Family,178.08,84.8,,percent of total billed charges,,
"Laryngoscopy, Indirect; Diagnostic (Separate Procedure) (Pro Cah)",,31505,CPT,Professional,Both,,,,210,178.5,31.19,210,Medica,Medica Advantage Solution,104.58,49.8,,percent of total billed charges,,
"Laryngoscopy, Indirect; Diagnostic (Separate Procedure) (Pro Cah)",,31505,CPT,Professional,Both,,,,210,178.5,31.19,210,Medica,Medical Assistance,36.01,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Laryngoscopy, Indirect; Diagnostic (Separate Procedure) (Pro Cah)",,31505,CPT,Professional,Both,,,,210,178.5,31.19,210,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,48.49,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Laryngoscopy, Indirect; Diagnostic (Separate Procedure) (Pro Cah)",,31505,CPT,Professional,Both,,,,210,178.5,31.19,210,"Multiplan, Inc.","Multiplan, Inc.",197.4,94,,percent of total billed charges,,
"Laryngoscopy, Indirect; Diagnostic (Separate Procedure) (Pro Cah)",,31505,CPT,Professional,Both,,,,210,178.5,31.19,210,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,189.21,90.1,,percent of total billed charges,,
"Laryngoscopy, Indirect; Diagnostic (Separate Procedure) (Pro Cah)",,31505,CPT,Professional,Both,,,,210,178.5,31.19,210,"Preferred One Administrative Services, INC.",PPO,207.06,98.6,,percent of total billed charges,,
"Laryngoscopy, Indirect; Diagnostic (Separate Procedure) (Pro Cah)",,31505,CPT,Professional,Both,,,,210,178.5,31.19,210,PrimeWest Health,Minnesota Senior Health Options (MSHO),55.7635,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Laryngoscopy, Indirect; Diagnostic (Separate Procedure) (Pro Cah)",,31505,CPT,Professional,Both,,,,210,178.5,31.19,210,PrimeWest Health,MinnesotaCare,38.5275328,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Laryngoscopy, Indirect; Diagnostic (Separate Procedure) (Pro Cah)",,31505,CPT,Professional,Both,,,,210,178.5,31.19,210,Sanford Health Plan,Sanford Health Plan,184.8,88,,percent of total billed charges,,
"Laryngoscopy, Indirect; Diagnostic (Separate Procedure) (Pro Cah)",,31505,CPT,Professional,Both,,,,210,178.5,31.19,210,"UCare Health, Inc.",Individual & Family Plan,78.825344,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Laryngoscopy, Indirect; Diagnostic (Separate Procedure) (Pro Cah)",,31505,CPT,Professional,Both,,,,210,178.5,31.19,210,"UCare Health, Inc.",Medical Assistance,39.607744,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Laryngoscopy, Indirect; Diagnostic (Separate Procedure) (Pro Cah)",,31505,CPT,Professional,Both,,,,210,178.5,31.19,210,"UCare Health, Inc.",Medicare Advantage,55.7635,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Laryngoscopy, Indirect; Diagnostic (Separate Procedure) (Pro Cah)",,31505,CPT,Professional,Both,,,,210,178.5,31.19,210,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),44.6108,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Laryngoscopy, Indirect; Diagnostic (Separate Procedure) (Pro Cah)",,31505,CPT,Professional,Both,,,,210,178.5,31.19,210,UnitedHealthcare,Individual & Family,210,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Laryngoscopy, Indirect; Diagnostic (Separate Procedure) (Pro Cah)",,31505,CPT,Professional,Both,,,,210,178.5,31.19,210,UnitedHealthcare,Medicare Advantage,55.7635,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Laryngoscopy, Indirect; Diagnostic (Separate Procedure) (Pro Cah)",,31505,CPT,Professional,Both,,,,210,178.5,31.19,210,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,36.00704,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Laryngoscopy Indirect; With Biopsy,,31510,CPT,Facility,Both,,,,326,277.1,93.4316,724,Aetna,Commercial,299.92,92,,percent of total billed charges,,
Laryngoscopy Indirect; With Biopsy,,31510,CPT,Facility,Outpatient,,,,326,277.1,93.4316,724,Aetna,Medicare Advantage,159.74,49,,percent of total billed charges,,
Laryngoscopy Indirect; With Biopsy,,31510,CPT,Facility,Inpatient,,,,326,277.1,93.4316,724,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Laryngoscopy Indirect; With Biopsy,,31510,CPT,Facility,Both,,,,326,277.1,93.4316,724,Aetna,PPO,303.18,93,,percent of total billed charges,,
Laryngoscopy Indirect; With Biopsy,,31510,CPT,Facility,Both,,,,326,277.1,93.4316,724,America's PPO,America's PPO,313.0578,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Laryngoscopy Indirect; With Biopsy,,31510,CPT,Facility,Both,,,,326,277.1,93.4316,724,BlueCross BlueShield Minnesota, Federal Employee Program,320.784,98.4,,percent of total billed charges,,
Laryngoscopy Indirect; With Biopsy,,31510,CPT,Facility,Both,,,,326,277.1,93.4316,724,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,326,100,,percent of total billed charges,,
Laryngoscopy Indirect; With Biopsy,,31510,CPT,Facility,Both,,,,326,277.1,93.4316,724,BlueCross BlueShield Minnesota,High Value Network Plan,293.4,90,,percent of total billed charges,,
Laryngoscopy Indirect; With Biopsy,,31510,CPT,Facility,Outpatient,,,,326,277.1,93.4316,724,BlueCross BlueShield Minnesota,Medicare Advantage,159.74,49,,percent of total billed charges,,
Laryngoscopy Indirect; With Biopsy,,31510,CPT,Facility,Inpatient,,,,326,277.1,93.4316,724,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Laryngoscopy Indirect; With Biopsy,,31510,CPT,Facility,Both,,,,326,277.1,93.4316,724,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,288.7382,88.57,,percent of total billed charges,,
Laryngoscopy Indirect; With Biopsy,,31510,CPT,Facility,Both,,,,326,277.1,93.4316,724,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,93.4316,28.66,,percent of total billed charges,,
Laryngoscopy Indirect; With Biopsy,,31510,CPT,Facility,Outpatient,,,,326,277.1,93.4316,724,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),159.74,49,,percent of total billed charges,,
Laryngoscopy Indirect; With Biopsy,,31510,CPT,Facility,Inpatient,,,,326,277.1,93.4316,724,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Laryngoscopy Indirect; With Biopsy,,31510,CPT,Facility,Both,,,,326,277.1,93.4316,724,CorVel,Worker's Compensation,326,100,,percent of total billed charges,,
Laryngoscopy Indirect; With Biopsy,,31510,CPT,Facility,Both,,,,326,277.1,93.4316,724,First Health Group Corporation,First Health Network,316.22,97,,percent of total billed charges,,
Laryngoscopy Indirect; With Biopsy,,31510,CPT,Facility,Both,,,,326,277.1,93.4316,724,"Health Partners, Inc.",Commercial,308.396,94.6,,percent of total billed charges,,
Laryngoscopy Indirect; With Biopsy,,31510,CPT,Facility,Outpatient,,,,326,277.1,93.4316,724,"Health Partners, Inc.",Medicare Advantage,159.74,49,,percent of total billed charges,,
Laryngoscopy Indirect; With Biopsy,,31510,CPT,Facility,Inpatient,,,,326,277.1,93.4316,724,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Laryngoscopy Indirect; With Biopsy,,31510,CPT,Facility,Both,,,,326,277.1,93.4316,724,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),195.6,60,,percent of total billed charges,,
Laryngoscopy Indirect; With Biopsy,,31510,CPT,Facility,Both,,,,326,277.1,93.4316,724,"Health Partners, Inc.",State of Minnesota Advantage Program,265.69,81.5,,percent of total billed charges,,
Laryngoscopy Indirect; With Biopsy,,31510,CPT,Facility,Both,,,,326,277.1,93.4316,724,"Health Partners, Inc.",State Public Programs,163,50,,percent of total billed charges,,
Laryngoscopy Indirect; With Biopsy,,31510,CPT,Facility,Both,,,,326,277.1,93.4316,724,Humana Insurance Company,Commercial PPO,309.7,95,,percent of total billed charges,,
Laryngoscopy Indirect; With Biopsy,,31510,CPT,Facility,Outpatient,,,,326,277.1,93.4316,724,Humana Insurance Company,Medicare PPO,159.74,49,,percent of total billed charges,,
Laryngoscopy Indirect; With Biopsy,,31510,CPT,Facility,Inpatient,,,,326,277.1,93.4316,724,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Laryngoscopy Indirect; With Biopsy,,31510,CPT,Facility,Both,,,,326,277.1,93.4316,724,Medica,Individual & Family,323.066,99.1,,percent of total billed charges,,
Laryngoscopy Indirect; With Biopsy,,31510,CPT,Facility,Outpatient,,,,326,277.1,93.4316,724,Medica,Medica Advantage Solution,162.348,49.8,,percent of total billed charges,,
Laryngoscopy Indirect; With Biopsy,,31510,CPT,Facility,Inpatient,,,,326,277.1,93.4316,724,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Laryngoscopy Indirect; With Biopsy,,31510,CPT,Facility,Outpatient,,,,326,277.1,93.4316,724,Medica,Medical Assistance,724,,,Other,Grouper,All inclusive per visit
Laryngoscopy Indirect; With Biopsy,,31510,CPT,Facility,Inpatient,,,,326,277.1,93.4316,724,Medica,Medical Assistance,,,,,Included in per diem rate,
Laryngoscopy Indirect; With Biopsy,,31510,CPT,Facility,Outpatient,,,,326,277.1,93.4316,724,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,162.348,49.8,,percent of total billed charges,,
Laryngoscopy Indirect; With Biopsy,,31510,CPT,Facility,Inpatient,,,,326,277.1,93.4316,724,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Laryngoscopy Indirect; With Biopsy,,31510,CPT,Facility,Both,,,,326,277.1,93.4316,724,"Multiplan, Inc.","Multiplan, Inc.",306.44,94,,percent of total billed charges,,
Laryngoscopy Indirect; With Biopsy,,31510,CPT,Facility,Outpatient,,,,326,277.1,93.4316,724,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,293.726,90.1,,percent of total billed charges,,
Laryngoscopy Indirect; With Biopsy,,31510,CPT,Facility,Inpatient,,,,326,277.1,93.4316,724,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Laryngoscopy Indirect; With Biopsy,,31510,CPT,Facility,Both,,,,326,277.1,93.4316,724,"Preferred One Administrative Services, INC.",PPO,321.436,98.6,,percent of total billed charges,,
Laryngoscopy Indirect; With Biopsy,,31510,CPT,Facility,Outpatient,,,,326,277.1,93.4316,724,PrimeWest Health,Minnesota Senior Health Options (MSHO),167.727,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Laryngoscopy Indirect; With Biopsy,,31510,CPT,Facility,Inpatient,,,,326,277.1,93.4316,724,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Laryngoscopy Indirect; With Biopsy,,31510,CPT,Facility,Outpatient,,,,326,277.1,93.4316,724,PrimeWest Health,MinnesotaCare,167.4336,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Laryngoscopy Indirect; With Biopsy,,31510,CPT,Facility,Inpatient,,,,326,277.1,93.4316,724,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Laryngoscopy Indirect; With Biopsy,,31510,CPT,Facility,Both,,,,326,277.1,93.4316,724,Sanford Health Plan,Sanford Health Plan,299.92,92,,percent of total billed charges,,
Laryngoscopy Indirect; With Biopsy,,31510,CPT,Facility,Outpatient,,,,326,277.1,93.4316,724,"UCare Health, Inc.",Individual & Family Plan,183.701,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Laryngoscopy Indirect; With Biopsy,,31510,CPT,Facility,Inpatient,,,,326,277.1,93.4316,724,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Laryngoscopy Indirect; With Biopsy,,31510,CPT,Facility,Outpatient,,,,326,277.1,93.4316,724,"UCare Health, Inc.",Medical Assistance,164.5322,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Laryngoscopy Indirect; With Biopsy,,31510,CPT,Facility,Inpatient,,,,326,277.1,93.4316,724,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Laryngoscopy Indirect; With Biopsy,,31510,CPT,Facility,Outpatient,,,,326,277.1,93.4316,724,"UCare Health, Inc.",Medicare Advantage,164.5322,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Laryngoscopy Indirect; With Biopsy,,31510,CPT,Facility,Inpatient,,,,326,277.1,93.4316,724,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Laryngoscopy Indirect; With Biopsy,,31510,CPT,Facility,Outpatient,,,,326,277.1,93.4316,724,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),164.5322,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Laryngoscopy Indirect; With Biopsy,,31510,CPT,Facility,Inpatient,,,,326,277.1,93.4316,724,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Laryngoscopy Indirect; With Biopsy,,31510,CPT,Facility,Both,,,,326,277.1,93.4316,724,UnitedHealthcare,Individual & Family,306.44,94,,percent of total billed charges,,
Laryngoscopy Indirect; With Biopsy,,31510,CPT,Facility,Outpatient,,,,326,277.1,93.4316,724,UnitedHealthcare,Medicare Advantage,159.74,49,,percent of total billed charges,,
Laryngoscopy Indirect; With Biopsy,,31510,CPT,Facility,Inpatient,,,,326,277.1,93.4316,724,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Laryngoscopy Indirect; With Biopsy,,31510,CPT,Facility,Outpatient,,,,326,277.1,93.4316,724,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,156.48,48,,percent of total billed charges,,100% of DHS outpatient percentage
Laryngoscopy Indirect; With Biopsy,,31510,CPT,Facility,Inpatient,,,,326,277.1,93.4316,724,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Laryngoscopy Indirect; With Biopsy (Procah),,31510,CPT,Professional,Both,,,,490,416.5,75.26,490,Aetna,Commercial,416.5,85,,percent of total billed charges,,
Laryngoscopy Indirect; With Biopsy (Procah),,31510,CPT,Professional,Both,,,,490,416.5,75.26,490,Aetna,Medicare Advantage,116.5,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Laryngoscopy Indirect; With Biopsy (Procah),,31510,CPT,Professional,Both,,,,490,416.5,75.26,490,Aetna,PPO,455.7,93,,percent of total billed charges,,
Laryngoscopy Indirect; With Biopsy (Procah),,31510,CPT,Professional,Both,,,,490,416.5,75.26,490,America's PPO,America's PPO,418.656,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Laryngoscopy Indirect; With Biopsy (Procah),,31510,CPT,Professional,Both,,,,490,416.5,75.26,490,BlueCross BlueShield Minnesota, Federal Employee Program,248.58,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Laryngoscopy Indirect; With Biopsy (Procah),,31510,CPT,Professional,Both,,,,490,416.5,75.26,490,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,252.55728,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Laryngoscopy Indirect; With Biopsy (Procah),,31510,CPT,Professional,Both,,,,490,416.5,75.26,490,BlueCross BlueShield Minnesota,High Value Network Plan,252.55728,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Laryngoscopy Indirect; With Biopsy (Procah),,31510,CPT,Professional,Both,,,,490,416.5,75.26,490,BlueCross BlueShield Minnesota,Medicare Advantage,134.642,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Laryngoscopy Indirect; With Biopsy (Procah),,31510,CPT,Professional,Both,,,,490,416.5,75.26,490,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,252.55728,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Laryngoscopy Indirect; With Biopsy (Procah),,31510,CPT,Professional,Both,,,,490,416.5,75.26,490,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,86.88832,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Laryngoscopy Indirect; With Biopsy (Procah),,31510,CPT,Professional,Both,,,,490,416.5,75.26,490,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),134.642,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Laryngoscopy Indirect; With Biopsy (Procah),,31510,CPT,Professional,Both,,,,490,416.5,75.26,490,CorVel,Worker's Compensation,226.752486,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Laryngoscopy Indirect; With Biopsy (Procah),,31510,CPT,Professional,Both,,,,490,416.5,75.26,490,First Health Group Corporation,First Health Network,475.3,97,,percent of total billed charges,,
Laryngoscopy Indirect; With Biopsy (Procah),,31510,CPT,Professional,Both,,,,490,416.5,75.26,490,"Health Partners, Inc.",Commercial,245.23,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Laryngoscopy Indirect; With Biopsy (Procah),,31510,CPT,Professional,Both,,,,490,416.5,75.26,490,"Health Partners, Inc.",Medicare Advantage,134.642,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Laryngoscopy Indirect; With Biopsy (Procah),,31510,CPT,Professional,Both,,,,490,416.5,75.26,490,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),117.25,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Laryngoscopy Indirect; With Biopsy (Procah),,31510,CPT,Professional,Both,,,,490,416.5,75.26,490,"Health Partners, Inc.",State of Minnesota Advantage Program,211.265645,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Laryngoscopy Indirect; With Biopsy (Procah),,31510,CPT,Professional,Both,,,,490,416.5,75.26,490,"Health Partners, Inc.",State Public Programs,75.26,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Laryngoscopy Indirect; With Biopsy (Procah),,31510,CPT,Professional,Both,,,,490,416.5,75.26,490,Humana Insurance Company,Commercial PPO,117.08,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Laryngoscopy Indirect; With Biopsy (Procah),,31510,CPT,Professional,Both,,,,490,416.5,75.26,490,Humana Insurance Company,Medicare PPO,490,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Laryngoscopy Indirect; With Biopsy (Procah),,31510,CPT,Professional,Both,,,,490,416.5,75.26,490,Medica,Individual & Family,415.52,84.8,,percent of total billed charges,,
Laryngoscopy Indirect; With Biopsy (Procah),,31510,CPT,Professional,Both,,,,490,416.5,75.26,490,Medica,Medica Advantage Solution,244.02,49.8,,percent of total billed charges,,
Laryngoscopy Indirect; With Biopsy (Procah),,31510,CPT,Professional,Both,,,,490,416.5,75.26,490,Medica,Medical Assistance,86.89,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Laryngoscopy Indirect; With Biopsy (Procah),,31510,CPT,Professional,Both,,,,490,416.5,75.26,490,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,117.08,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Laryngoscopy Indirect; With Biopsy (Procah),,31510,CPT,Professional,Both,,,,490,416.5,75.26,490,"Multiplan, Inc.","Multiplan, Inc.",460.6,94,,percent of total billed charges,,
Laryngoscopy Indirect; With Biopsy (Procah),,31510,CPT,Professional,Both,,,,490,416.5,75.26,490,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,441.49,90.1,,percent of total billed charges,,
Laryngoscopy Indirect; With Biopsy (Procah),,31510,CPT,Professional,Both,,,,490,416.5,75.26,490,"Preferred One Administrative Services, INC.",PPO,483.14,98.6,,percent of total billed charges,,
Laryngoscopy Indirect; With Biopsy (Procah),,31510,CPT,Professional,Both,,,,490,416.5,75.26,490,PrimeWest Health,Minnesota Senior Health Options (MSHO),134.642,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Laryngoscopy Indirect; With Biopsy (Procah),,31510,CPT,Professional,Both,,,,490,416.5,75.26,490,PrimeWest Health,MinnesotaCare,92.9705024,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Laryngoscopy Indirect; With Biopsy (Procah),,31510,CPT,Professional,Both,,,,490,416.5,75.26,490,Sanford Health Plan,Sanford Health Plan,431.2,88,,percent of total billed charges,,
Laryngoscopy Indirect; With Biopsy (Procah),,31510,CPT,Professional,Both,,,,490,416.5,75.26,490,"UCare Health, Inc.",Individual & Family Plan,190.325248,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Laryngoscopy Indirect; With Biopsy (Procah),,31510,CPT,Professional,Both,,,,490,416.5,75.26,490,"UCare Health, Inc.",Medical Assistance,95.577152,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Laryngoscopy Indirect; With Biopsy (Procah),,31510,CPT,Professional,Both,,,,490,416.5,75.26,490,"UCare Health, Inc.",Medicare Advantage,134.642,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Laryngoscopy Indirect; With Biopsy (Procah),,31510,CPT,Professional,Both,,,,490,416.5,75.26,490,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),107.7136,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Laryngoscopy Indirect; With Biopsy (Procah),,31510,CPT,Professional,Both,,,,490,416.5,75.26,490,UnitedHealthcare,Individual & Family,490,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Laryngoscopy Indirect; With Biopsy (Procah),,31510,CPT,Professional,Both,,,,490,416.5,75.26,490,UnitedHealthcare,Medicare Advantage,134.642,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Laryngoscopy Indirect; With Biopsy (Procah),,31510,CPT,Professional,Both,,,,490,416.5,75.26,490,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,86.88832,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Laryngoscopy Direct, With Or Without Tracheoscopy; Diagnostic, Except Newborn (Pro Cah)",,31525,CPT,Professional,Both,,,,765,650.25,98.6,765,Aetna,Commercial,650.25,85,,percent of total billed charges,,
"Laryngoscopy Direct, With Or Without Tracheoscopy; Diagnostic, Except Newborn (Pro Cah)",,31525,CPT,Professional,Both,,,,765,650.25,98.6,765,Aetna,Medicare Advantage,153.23,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Laryngoscopy Direct, With Or Without Tracheoscopy; Diagnostic, Except Newborn (Pro Cah)",,31525,CPT,Professional,Both,,,,765,650.25,98.6,765,Aetna,PPO,711.45,93,,percent of total billed charges,,
"Laryngoscopy Direct, With Or Without Tracheoscopy; Diagnostic, Except Newborn (Pro Cah)",,31525,CPT,Professional,Both,,,,765,650.25,98.6,765,America's PPO,America's PPO,653.616,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Laryngoscopy Direct, With Or Without Tracheoscopy; Diagnostic, Except Newborn (Pro Cah)",,31525,CPT,Professional,Both,,,,765,650.25,98.6,765,BlueCross BlueShield Minnesota, Federal Employee Program,326.4,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Laryngoscopy Direct, With Or Without Tracheoscopy; Diagnostic, Except Newborn (Pro Cah)",,31525,CPT,Professional,Both,,,,765,650.25,98.6,765,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,331.6224,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Laryngoscopy Direct, With Or Without Tracheoscopy; Diagnostic, Except Newborn (Pro Cah)",,31525,CPT,Professional,Both,,,,765,650.25,98.6,765,BlueCross BlueShield Minnesota,High Value Network Plan,331.6224,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Laryngoscopy Direct, With Or Without Tracheoscopy; Diagnostic, Except Newborn (Pro Cah)",,31525,CPT,Professional,Both,,,,765,650.25,98.6,765,BlueCross BlueShield Minnesota,Medicare Advantage,176.2835,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Laryngoscopy Direct, With Or Without Tracheoscopy; Diagnostic, Except Newborn (Pro Cah)",,31525,CPT,Professional,Both,,,,765,650.25,98.6,765,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,331.6224,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Laryngoscopy Direct, With Or Without Tracheoscopy; Diagnostic, Except Newborn (Pro Cah)",,31525,CPT,Professional,Both,,,,765,650.25,98.6,765,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,113.8428,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Laryngoscopy Direct, With Or Without Tracheoscopy; Diagnostic, Except Newborn (Pro Cah)",,31525,CPT,Professional,Both,,,,765,650.25,98.6,765,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),176.2835,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Laryngoscopy Direct, With Or Without Tracheoscopy; Diagnostic, Except Newborn (Pro Cah)",,31525,CPT,Professional,Both,,,,765,650.25,98.6,765,CorVel,Worker's Compensation,299.5365546,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Laryngoscopy Direct, With Or Without Tracheoscopy; Diagnostic, Except Newborn (Pro Cah)",,31525,CPT,Professional,Both,,,,765,650.25,98.6,765,First Health Group Corporation,First Health Network,742.05,97,,percent of total billed charges,,
"Laryngoscopy Direct, With Or Without Tracheoscopy; Diagnostic, Except Newborn (Pro Cah)",,31525,CPT,Professional,Both,,,,765,650.25,98.6,765,"Health Partners, Inc.",Commercial,323.59,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Laryngoscopy Direct, With Or Without Tracheoscopy; Diagnostic, Except Newborn (Pro Cah)",,31525,CPT,Professional,Both,,,,765,650.25,98.6,765,"Health Partners, Inc.",Medicare Advantage,176.2835,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Laryngoscopy Direct, With Or Without Tracheoscopy; Diagnostic, Except Newborn (Pro Cah)",,31525,CPT,Professional,Both,,,,765,650.25,98.6,765,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),153.17,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Laryngoscopy Direct, With Or Without Tracheoscopy; Diagnostic, Except Newborn (Pro Cah)",,31525,CPT,Professional,Both,,,,765,650.25,98.6,765,"Health Partners, Inc.",State of Minnesota Advantage Program,278.772785,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Laryngoscopy Direct, With Or Without Tracheoscopy; Diagnostic, Except Newborn (Pro Cah)",,31525,CPT,Professional,Both,,,,765,650.25,98.6,765,"Health Partners, Inc.",State Public Programs,98.6,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Laryngoscopy Direct, With Or Without Tracheoscopy; Diagnostic, Except Newborn (Pro Cah)",,31525,CPT,Professional,Both,,,,765,650.25,98.6,765,Humana Insurance Company,Commercial PPO,153.29,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Laryngoscopy Direct, With Or Without Tracheoscopy; Diagnostic, Except Newborn (Pro Cah)",,31525,CPT,Professional,Both,,,,765,650.25,98.6,765,Humana Insurance Company,Medicare PPO,765,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Laryngoscopy Direct, With Or Without Tracheoscopy; Diagnostic, Except Newborn (Pro Cah)",,31525,CPT,Professional,Both,,,,765,650.25,98.6,765,Medica,Individual & Family,648.72,84.8,,percent of total billed charges,,
"Laryngoscopy Direct, With Or Without Tracheoscopy; Diagnostic, Except Newborn (Pro Cah)",,31525,CPT,Professional,Both,,,,765,650.25,98.6,765,Medica,Medica Advantage Solution,380.97,49.8,,percent of total billed charges,,
"Laryngoscopy Direct, With Or Without Tracheoscopy; Diagnostic, Except Newborn (Pro Cah)",,31525,CPT,Professional,Both,,,,765,650.25,98.6,765,Medica,Medical Assistance,113.84,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Laryngoscopy Direct, With Or Without Tracheoscopy; Diagnostic, Except Newborn (Pro Cah)",,31525,CPT,Professional,Both,,,,765,650.25,98.6,765,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,153.29,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Laryngoscopy Direct, With Or Without Tracheoscopy; Diagnostic, Except Newborn (Pro Cah)",,31525,CPT,Professional,Both,,,,765,650.25,98.6,765,"Multiplan, Inc.","Multiplan, Inc.",719.1,94,,percent of total billed charges,,
"Laryngoscopy Direct, With Or Without Tracheoscopy; Diagnostic, Except Newborn (Pro Cah)",,31525,CPT,Professional,Both,,,,765,650.25,98.6,765,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,689.265,90.1,,percent of total billed charges,,
"Laryngoscopy Direct, With Or Without Tracheoscopy; Diagnostic, Except Newborn (Pro Cah)",,31525,CPT,Professional,Both,,,,765,650.25,98.6,765,"Preferred One Administrative Services, INC.",PPO,754.29,98.6,,percent of total billed charges,,
"Laryngoscopy Direct, With Or Without Tracheoscopy; Diagnostic, Except Newborn (Pro Cah)",,31525,CPT,Professional,Both,,,,765,650.25,98.6,765,PrimeWest Health,Minnesota Senior Health Options (MSHO),176.2835,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Laryngoscopy Direct, With Or Without Tracheoscopy; Diagnostic, Except Newborn (Pro Cah)",,31525,CPT,Professional,Both,,,,765,650.25,98.6,765,PrimeWest Health,MinnesotaCare,121.811796,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Laryngoscopy Direct, With Or Without Tracheoscopy; Diagnostic, Except Newborn (Pro Cah)",,31525,CPT,Professional,Both,,,,765,650.25,98.6,765,Sanford Health Plan,Sanford Health Plan,673.2,88,,percent of total billed charges,,
"Laryngoscopy Direct, With Or Without Tracheoscopy; Diagnostic, Except Newborn (Pro Cah)",,31525,CPT,Professional,Both,,,,765,650.25,98.6,765,"UCare Health, Inc.",Individual & Family Plan,249.188224,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Laryngoscopy Direct, With Or Without Tracheoscopy; Diagnostic, Except Newborn (Pro Cah)",,31525,CPT,Professional,Both,,,,765,650.25,98.6,765,"UCare Health, Inc.",Medical Assistance,125.22708,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Laryngoscopy Direct, With Or Without Tracheoscopy; Diagnostic, Except Newborn (Pro Cah)",,31525,CPT,Professional,Both,,,,765,650.25,98.6,765,"UCare Health, Inc.",Medicare Advantage,176.2835,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Laryngoscopy Direct, With Or Without Tracheoscopy; Diagnostic, Except Newborn (Pro Cah)",,31525,CPT,Professional,Both,,,,765,650.25,98.6,765,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),141.0268,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Laryngoscopy Direct, With Or Without Tracheoscopy; Diagnostic, Except Newborn (Pro Cah)",,31525,CPT,Professional,Both,,,,765,650.25,98.6,765,UnitedHealthcare,Individual & Family,765,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Laryngoscopy Direct, With Or Without Tracheoscopy; Diagnostic, Except Newborn (Pro Cah)",,31525,CPT,Professional,Both,,,,765,650.25,98.6,765,UnitedHealthcare,Medicare Advantage,176.2835,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Laryngoscopy Direct, With Or Without Tracheoscopy; Diagnostic, Except Newborn (Pro Cah)",,31525,CPT,Professional,Both,,,,765,650.25,98.6,765,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,113.8428,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Laryngoscopy, Direct, Operative, With Biopsy; With Operating Microscope Or Telescope (Pro Cah)",,31536,CPT,Professional,Both,,,,1326,1127.1,129.58,1326,Aetna,Commercial,1127.1,85,,percent of total billed charges,,
"Laryngoscopy, Direct, Operative, With Biopsy; With Operating Microscope Or Telescope (Pro Cah)",,31536,CPT,Professional,Both,,,,1326,1127.1,129.58,1326,Aetna,Medicare Advantage,201.18,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Laryngoscopy, Direct, Operative, With Biopsy; With Operating Microscope Or Telescope (Pro Cah)",,31536,CPT,Professional,Both,,,,1326,1127.1,129.58,1326,Aetna,PPO,1233.18,93,,percent of total billed charges,,
"Laryngoscopy, Direct, Operative, With Biopsy; With Operating Microscope Or Telescope (Pro Cah)",,31536,CPT,Professional,Both,,,,1326,1127.1,129.58,1326,America's PPO,America's PPO,1132.9344,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Laryngoscopy, Direct, Operative, With Biopsy; With Operating Microscope Or Telescope (Pro Cah)",,31536,CPT,Professional,Both,,,,1326,1127.1,129.58,1326,BlueCross BlueShield Minnesota, Federal Employee Program,430.38,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Laryngoscopy, Direct, Operative, With Biopsy; With Operating Microscope Or Telescope (Pro Cah)",,31536,CPT,Professional,Both,,,,1326,1127.1,129.58,1326,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,437.26608,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Laryngoscopy, Direct, Operative, With Biopsy; With Operating Microscope Or Telescope (Pro Cah)",,31536,CPT,Professional,Both,,,,1326,1127.1,129.58,1326,BlueCross BlueShield Minnesota,High Value Network Plan,437.26608,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Laryngoscopy, Direct, Operative, With Biopsy; With Operating Microscope Or Telescope (Pro Cah)",,31536,CPT,Professional,Both,,,,1326,1127.1,129.58,1326,BlueCross BlueShield Minnesota,Medicare Advantage,231.794,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Laryngoscopy, Direct, Operative, With Biopsy; With Operating Microscope Or Telescope (Pro Cah)",,31536,CPT,Professional,Both,,,,1326,1127.1,129.58,1326,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,437.26608,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Laryngoscopy, Direct, Operative, With Biopsy; With Operating Microscope Or Telescope (Pro Cah)",,31536,CPT,Professional,Both,,,,1326,1127.1,129.58,1326,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,149.606,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Laryngoscopy, Direct, Operative, With Biopsy; With Operating Microscope Or Telescope (Pro Cah)",,31536,CPT,Professional,Both,,,,1326,1127.1,129.58,1326,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),231.794,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Laryngoscopy, Direct, Operative, With Biopsy; With Operating Microscope Or Telescope (Pro Cah)",,31536,CPT,Professional,Both,,,,1326,1127.1,129.58,1326,CorVel,Worker's Compensation,393.4368561,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Laryngoscopy, Direct, Operative, With Biopsy; With Operating Microscope Or Telescope (Pro Cah)",,31536,CPT,Professional,Both,,,,1326,1127.1,129.58,1326,First Health Group Corporation,First Health Network,1286.22,97,,percent of total billed charges,,
"Laryngoscopy, Direct, Operative, With Biopsy; With Operating Microscope Or Telescope (Pro Cah)",,31536,CPT,Professional,Both,,,,1326,1127.1,129.58,1326,"Health Partners, Inc.",Commercial,425.16,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Laryngoscopy, Direct, Operative, With Biopsy; With Operating Microscope Or Telescope (Pro Cah)",,31536,CPT,Professional,Both,,,,1326,1127.1,129.58,1326,"Health Partners, Inc.",Medicare Advantage,231.794,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Laryngoscopy, Direct, Operative, With Biopsy; With Operating Microscope Or Telescope (Pro Cah)",,31536,CPT,Professional,Both,,,,1326,1127.1,129.58,1326,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),201.63,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Laryngoscopy, Direct, Operative, With Biopsy; With Operating Microscope Or Telescope (Pro Cah)",,31536,CPT,Professional,Both,,,,1326,1127.1,129.58,1326,"Health Partners, Inc.",State of Minnesota Advantage Program,366.27534,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Laryngoscopy, Direct, Operative, With Biopsy; With Operating Microscope Or Telescope (Pro Cah)",,31536,CPT,Professional,Both,,,,1326,1127.1,129.58,1326,"Health Partners, Inc.",State Public Programs,129.58,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Laryngoscopy, Direct, Operative, With Biopsy; With Operating Microscope Or Telescope (Pro Cah)",,31536,CPT,Professional,Both,,,,1326,1127.1,129.58,1326,Humana Insurance Company,Commercial PPO,201.56,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Laryngoscopy, Direct, Operative, With Biopsy; With Operating Microscope Or Telescope (Pro Cah)",,31536,CPT,Professional,Both,,,,1326,1127.1,129.58,1326,Humana Insurance Company,Medicare PPO,1326,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Laryngoscopy, Direct, Operative, With Biopsy; With Operating Microscope Or Telescope (Pro Cah)",,31536,CPT,Professional,Both,,,,1326,1127.1,129.58,1326,Medica,Individual & Family,1124.448,84.8,,percent of total billed charges,,
"Laryngoscopy, Direct, Operative, With Biopsy; With Operating Microscope Or Telescope (Pro Cah)",,31536,CPT,Professional,Both,,,,1326,1127.1,129.58,1326,Medica,Medica Advantage Solution,660.348,49.8,,percent of total billed charges,,
"Laryngoscopy, Direct, Operative, With Biopsy; With Operating Microscope Or Telescope (Pro Cah)",,31536,CPT,Professional,Both,,,,1326,1127.1,129.58,1326,Medica,Medical Assistance,149.61,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Laryngoscopy, Direct, Operative, With Biopsy; With Operating Microscope Or Telescope (Pro Cah)",,31536,CPT,Professional,Both,,,,1326,1127.1,129.58,1326,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,201.56,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Laryngoscopy, Direct, Operative, With Biopsy; With Operating Microscope Or Telescope (Pro Cah)",,31536,CPT,Professional,Both,,,,1326,1127.1,129.58,1326,"Multiplan, Inc.","Multiplan, Inc.",1246.44,94,,percent of total billed charges,,
"Laryngoscopy, Direct, Operative, With Biopsy; With Operating Microscope Or Telescope (Pro Cah)",,31536,CPT,Professional,Both,,,,1326,1127.1,129.58,1326,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1194.726,90.1,,percent of total billed charges,,
"Laryngoscopy, Direct, Operative, With Biopsy; With Operating Microscope Or Telescope (Pro Cah)",,31536,CPT,Professional,Both,,,,1326,1127.1,129.58,1326,"Preferred One Administrative Services, INC.",PPO,1307.436,98.6,,percent of total billed charges,,
"Laryngoscopy, Direct, Operative, With Biopsy; With Operating Microscope Or Telescope (Pro Cah)",,31536,CPT,Professional,Both,,,,1326,1127.1,129.58,1326,PrimeWest Health,Minnesota Senior Health Options (MSHO),231.794,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Laryngoscopy, Direct, Operative, With Biopsy; With Operating Microscope Or Telescope (Pro Cah)",,31536,CPT,Professional,Both,,,,1326,1127.1,129.58,1326,PrimeWest Health,MinnesotaCare,160.07842,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Laryngoscopy, Direct, Operative, With Biopsy; With Operating Microscope Or Telescope (Pro Cah)",,31536,CPT,Professional,Both,,,,1326,1127.1,129.58,1326,Sanford Health Plan,Sanford Health Plan,1166.88,88,,percent of total billed charges,,
"Laryngoscopy, Direct, Operative, With Biopsy; With Operating Microscope Or Telescope (Pro Cah)",,31536,CPT,Professional,Both,,,,1326,1127.1,129.58,1326,"UCare Health, Inc.",Individual & Family Plan,327.655936,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Laryngoscopy, Direct, Operative, With Biopsy; With Operating Microscope Or Telescope (Pro Cah)",,31536,CPT,Professional,Both,,,,1326,1127.1,129.58,1326,"UCare Health, Inc.",Medical Assistance,164.5666,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Laryngoscopy, Direct, Operative, With Biopsy; With Operating Microscope Or Telescope (Pro Cah)",,31536,CPT,Professional,Both,,,,1326,1127.1,129.58,1326,"UCare Health, Inc.",Medicare Advantage,231.794,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Laryngoscopy, Direct, Operative, With Biopsy; With Operating Microscope Or Telescope (Pro Cah)",,31536,CPT,Professional,Both,,,,1326,1127.1,129.58,1326,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),185.4352,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Laryngoscopy, Direct, Operative, With Biopsy; With Operating Microscope Or Telescope (Pro Cah)",,31536,CPT,Professional,Both,,,,1326,1127.1,129.58,1326,UnitedHealthcare,Individual & Family,1326,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Laryngoscopy, Direct, Operative, With Biopsy; With Operating Microscope Or Telescope (Pro Cah)",,31536,CPT,Professional,Both,,,,1326,1127.1,129.58,1326,UnitedHealthcare,Medicare Advantage,231.794,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Laryngoscopy, Direct, Operative, With Biopsy; With Operating Microscope Or Telescope (Pro Cah)",,31536,CPT,Professional,Both,,,,1326,1127.1,129.58,1326,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,149.606,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Laryngoscopy,,31575,CPT,Facility,Both,,,,291,247.35,83.4006,291,Aetna,Commercial,267.72,92,,percent of total billed charges,,
Laryngoscopy,,31575,CPT,Facility,Outpatient,,,,291,247.35,83.4006,291,Aetna,Medicare Advantage,142.59,49,,percent of total billed charges,,
Laryngoscopy,,31575,CPT,Facility,Inpatient,,,,291,247.35,83.4006,291,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Laryngoscopy,,31575,CPT,Facility,Both,,,,291,247.35,83.4006,291,Aetna,PPO,270.63,93,,percent of total billed charges,,
Laryngoscopy,,31575,CPT,Facility,Both,,,,291,247.35,83.4006,291,America's PPO,America's PPO,279.4473,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Laryngoscopy,,31575,CPT,Facility,Both,,,,291,247.35,83.4006,291,BlueCross BlueShield Minnesota, Federal Employee Program,286.344,98.4,,percent of total billed charges,,
Laryngoscopy,,31575,CPT,Facility,Both,,,,291,247.35,83.4006,291,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,291,100,,percent of total billed charges,,
Laryngoscopy,,31575,CPT,Facility,Both,,,,291,247.35,83.4006,291,BlueCross BlueShield Minnesota,High Value Network Plan,261.9,90,,percent of total billed charges,,
Laryngoscopy,,31575,CPT,Facility,Outpatient,,,,291,247.35,83.4006,291,BlueCross BlueShield Minnesota,Medicare Advantage,142.59,49,,percent of total billed charges,,
Laryngoscopy,,31575,CPT,Facility,Inpatient,,,,291,247.35,83.4006,291,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Laryngoscopy,,31575,CPT,Facility,Both,,,,291,247.35,83.4006,291,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,257.7387,88.57,,percent of total billed charges,,
Laryngoscopy,,31575,CPT,Facility,Both,,,,291,247.35,83.4006,291,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,83.4006,28.66,,percent of total billed charges,,
Laryngoscopy,,31575,CPT,Facility,Outpatient,,,,291,247.35,83.4006,291,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),142.59,49,,percent of total billed charges,,
Laryngoscopy,,31575,CPT,Facility,Inpatient,,,,291,247.35,83.4006,291,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Laryngoscopy,,31575,CPT,Facility,Both,,,,291,247.35,83.4006,291,CorVel,Worker's Compensation,291,100,,percent of total billed charges,,
Laryngoscopy,,31575,CPT,Facility,Both,,,,291,247.35,83.4006,291,First Health Group Corporation,First Health Network,282.27,97,,percent of total billed charges,,
Laryngoscopy,,31575,CPT,Facility,Both,,,,291,247.35,83.4006,291,"Health Partners, Inc.",Commercial,275.286,94.6,,percent of total billed charges,,
Laryngoscopy,,31575,CPT,Facility,Outpatient,,,,291,247.35,83.4006,291,"Health Partners, Inc.",Medicare Advantage,142.59,49,,percent of total billed charges,,
Laryngoscopy,,31575,CPT,Facility,Inpatient,,,,291,247.35,83.4006,291,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Laryngoscopy,,31575,CPT,Facility,Both,,,,291,247.35,83.4006,291,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),174.6,60,,percent of total billed charges,,
Laryngoscopy,,31575,CPT,Facility,Both,,,,291,247.35,83.4006,291,"Health Partners, Inc.",State of Minnesota Advantage Program,237.165,81.5,,percent of total billed charges,,
Laryngoscopy,,31575,CPT,Facility,Both,,,,291,247.35,83.4006,291,"Health Partners, Inc.",State Public Programs,145.5,50,,percent of total billed charges,,
Laryngoscopy,,31575,CPT,Facility,Both,,,,291,247.35,83.4006,291,Humana Insurance Company,Commercial PPO,276.45,95,,percent of total billed charges,,
Laryngoscopy,,31575,CPT,Facility,Outpatient,,,,291,247.35,83.4006,291,Humana Insurance Company,Medicare PPO,142.59,49,,percent of total billed charges,,
Laryngoscopy,,31575,CPT,Facility,Inpatient,,,,291,247.35,83.4006,291,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Laryngoscopy,,31575,CPT,Facility,Both,,,,291,247.35,83.4006,291,Medica,Individual & Family,288.381,99.1,,percent of total billed charges,,
Laryngoscopy,,31575,CPT,Facility,Outpatient,,,,291,247.35,83.4006,291,Medica,Medica Advantage Solution,144.918,49.8,,percent of total billed charges,,
Laryngoscopy,,31575,CPT,Facility,Inpatient,,,,291,247.35,83.4006,291,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Laryngoscopy,,31575,CPT,Facility,Outpatient,,,,291,247.35,83.4006,291,Medica,Medical Assistance,129.786,44.6,,percent of total billed charges,,
Laryngoscopy,,31575,CPT,Facility,Inpatient,,,,291,247.35,83.4006,291,Medica,Medical Assistance,,,,,Included in per diem rate,
Laryngoscopy,,31575,CPT,Facility,Outpatient,,,,291,247.35,83.4006,291,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,144.918,49.8,,percent of total billed charges,,
Laryngoscopy,,31575,CPT,Facility,Inpatient,,,,291,247.35,83.4006,291,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Laryngoscopy,,31575,CPT,Facility,Both,,,,291,247.35,83.4006,291,"Multiplan, Inc.","Multiplan, Inc.",273.54,94,,percent of total billed charges,,
Laryngoscopy,,31575,CPT,Facility,Outpatient,,,,291,247.35,83.4006,291,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,262.191,90.1,,percent of total billed charges,,
Laryngoscopy,,31575,CPT,Facility,Inpatient,,,,291,247.35,83.4006,291,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Laryngoscopy,,31575,CPT,Facility,Both,,,,291,247.35,83.4006,291,"Preferred One Administrative Services, INC.",PPO,286.926,98.6,,percent of total billed charges,,
Laryngoscopy,,31575,CPT,Facility,Outpatient,,,,291,247.35,83.4006,291,PrimeWest Health,Minnesota Senior Health Options (MSHO),149.7195,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Laryngoscopy,,31575,CPT,Facility,Inpatient,,,,291,247.35,83.4006,291,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Laryngoscopy,,31575,CPT,Facility,Outpatient,,,,291,247.35,83.4006,291,PrimeWest Health,MinnesotaCare,149.4576,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Laryngoscopy,,31575,CPT,Facility,Inpatient,,,,291,247.35,83.4006,291,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Laryngoscopy,,31575,CPT,Facility,Both,,,,291,247.35,83.4006,291,Sanford Health Plan,Sanford Health Plan,267.72,92,,percent of total billed charges,,
Laryngoscopy,,31575,CPT,Facility,Outpatient,,,,291,247.35,83.4006,291,"UCare Health, Inc.",Individual & Family Plan,163.9785,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Laryngoscopy,,31575,CPT,Facility,Inpatient,,,,291,247.35,83.4006,291,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Laryngoscopy,,31575,CPT,Facility,Outpatient,,,,291,247.35,83.4006,291,"UCare Health, Inc.",Medical Assistance,146.8677,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Laryngoscopy,,31575,CPT,Facility,Inpatient,,,,291,247.35,83.4006,291,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Laryngoscopy,,31575,CPT,Facility,Outpatient,,,,291,247.35,83.4006,291,"UCare Health, Inc.",Medicare Advantage,146.8677,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Laryngoscopy,,31575,CPT,Facility,Inpatient,,,,291,247.35,83.4006,291,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Laryngoscopy,,31575,CPT,Facility,Outpatient,,,,291,247.35,83.4006,291,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),146.8677,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Laryngoscopy,,31575,CPT,Facility,Inpatient,,,,291,247.35,83.4006,291,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Laryngoscopy,,31575,CPT,Facility,Both,,,,291,247.35,83.4006,291,UnitedHealthcare,Individual & Family,273.54,94,,percent of total billed charges,,
Laryngoscopy,,31575,CPT,Facility,Outpatient,,,,291,247.35,83.4006,291,UnitedHealthcare,Medicare Advantage,142.59,49,,percent of total billed charges,,
Laryngoscopy,,31575,CPT,Facility,Inpatient,,,,291,247.35,83.4006,291,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Laryngoscopy,,31575,CPT,Facility,Outpatient,,,,291,247.35,83.4006,291,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,139.68,48,,percent of total billed charges,,100% of DHS outpatient percentage
Laryngoscopy,,31575,CPT,Facility,Inpatient,,,,291,247.35,83.4006,291,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Laryngoscopy, Flexible; Diagnostic (Pro Cah)",,31575,CPT,Professional,Both,,,,434,368.9,42.54,434,Aetna,Commercial,368.9,85,,percent of total billed charges,,
"Laryngoscopy, Flexible; Diagnostic (Pro Cah)",,31575,CPT,Professional,Both,,,,434,368.9,42.54,434,Aetna,Medicare Advantage,65.15,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Laryngoscopy, Flexible; Diagnostic (Pro Cah)",,31575,CPT,Professional,Both,,,,434,368.9,42.54,434,Aetna,PPO,403.62,93,,percent of total billed charges,,
"Laryngoscopy, Flexible; Diagnostic (Pro Cah)",,31575,CPT,Professional,Both,,,,434,368.9,42.54,434,America's PPO,America's PPO,370.8096,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Laryngoscopy, Flexible; Diagnostic (Pro Cah)",,31575,CPT,Professional,Both,,,,434,368.9,42.54,434,BlueCross BlueShield Minnesota, Federal Employee Program,139.79,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Laryngoscopy, Flexible; Diagnostic (Pro Cah)",,31575,CPT,Professional,Both,,,,434,368.9,42.54,434,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,142.02664,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Laryngoscopy, Flexible; Diagnostic (Pro Cah)",,31575,CPT,Professional,Both,,,,434,368.9,42.54,434,BlueCross BlueShield Minnesota,High Value Network Plan,142.02664,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Laryngoscopy, Flexible; Diagnostic (Pro Cah)",,31575,CPT,Professional,Both,,,,434,368.9,42.54,434,BlueCross BlueShield Minnesota,Medicare Advantage,76.1415,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Laryngoscopy, Flexible; Diagnostic (Pro Cah)",,31575,CPT,Professional,Both,,,,434,368.9,42.54,434,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,142.02664,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Laryngoscopy, Flexible; Diagnostic (Pro Cah)",,31575,CPT,Professional,Both,,,,434,368.9,42.54,434,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,49.11344,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Laryngoscopy, Flexible; Diagnostic (Pro Cah)",,31575,CPT,Professional,Both,,,,434,368.9,42.54,434,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),76.1415,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Laryngoscopy, Flexible; Diagnostic (Pro Cah)",,31575,CPT,Professional,Both,,,,434,368.9,42.54,434,CorVel,Worker's Compensation,127.9044423,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Laryngoscopy, Flexible; Diagnostic (Pro Cah)",,31575,CPT,Professional,Both,,,,434,368.9,42.54,434,First Health Group Corporation,First Health Network,420.98,97,,percent of total billed charges,,
"Laryngoscopy, Flexible; Diagnostic (Pro Cah)",,31575,CPT,Professional,Both,,,,434,368.9,42.54,434,"Health Partners, Inc.",Commercial,137.85,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Laryngoscopy, Flexible; Diagnostic (Pro Cah)",,31575,CPT,Professional,Both,,,,434,368.9,42.54,434,"Health Partners, Inc.",Medicare Advantage,76.1415,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Laryngoscopy, Flexible; Diagnostic (Pro Cah)",,31575,CPT,Professional,Both,,,,434,368.9,42.54,434,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),66.42,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Laryngoscopy, Flexible; Diagnostic (Pro Cah)",,31575,CPT,Professional,Both,,,,434,368.9,42.54,434,"Health Partners, Inc.",State of Minnesota Advantage Program,118.757775,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Laryngoscopy, Flexible; Diagnostic (Pro Cah)",,31575,CPT,Professional,Both,,,,434,368.9,42.54,434,"Health Partners, Inc.",State Public Programs,42.54,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Laryngoscopy, Flexible; Diagnostic (Pro Cah)",,31575,CPT,Professional,Both,,,,434,368.9,42.54,434,Humana Insurance Company,Commercial PPO,66.21,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Laryngoscopy, Flexible; Diagnostic (Pro Cah)",,31575,CPT,Professional,Both,,,,434,368.9,42.54,434,Humana Insurance Company,Medicare PPO,434,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Laryngoscopy, Flexible; Diagnostic (Pro Cah)",,31575,CPT,Professional,Both,,,,434,368.9,42.54,434,Medica,Individual & Family,368.032,84.8,,percent of total billed charges,,
"Laryngoscopy, Flexible; Diagnostic (Pro Cah)",,31575,CPT,Professional,Both,,,,434,368.9,42.54,434,Medica,Medica Advantage Solution,216.132,49.8,,percent of total billed charges,,
"Laryngoscopy, Flexible; Diagnostic (Pro Cah)",,31575,CPT,Professional,Both,,,,434,368.9,42.54,434,Medica,Medical Assistance,49.11,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Laryngoscopy, Flexible; Diagnostic (Pro Cah)",,31575,CPT,Professional,Both,,,,434,368.9,42.54,434,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,66.21,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Laryngoscopy, Flexible; Diagnostic (Pro Cah)",,31575,CPT,Professional,Both,,,,434,368.9,42.54,434,"Multiplan, Inc.","Multiplan, Inc.",407.96,94,,percent of total billed charges,,
"Laryngoscopy, Flexible; Diagnostic (Pro Cah)",,31575,CPT,Professional,Both,,,,434,368.9,42.54,434,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,391.034,90.1,,percent of total billed charges,,
"Laryngoscopy, Flexible; Diagnostic (Pro Cah)",,31575,CPT,Professional,Both,,,,434,368.9,42.54,434,"Preferred One Administrative Services, INC.",PPO,427.924,98.6,,percent of total billed charges,,
"Laryngoscopy, Flexible; Diagnostic (Pro Cah)",,31575,CPT,Professional,Both,,,,434,368.9,42.54,434,PrimeWest Health,Minnesota Senior Health Options (MSHO),76.1415,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Laryngoscopy, Flexible; Diagnostic (Pro Cah)",,31575,CPT,Professional,Both,,,,434,368.9,42.54,434,PrimeWest Health,MinnesotaCare,52.5513808,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Laryngoscopy, Flexible; Diagnostic (Pro Cah)",,31575,CPT,Professional,Both,,,,434,368.9,42.54,434,Sanford Health Plan,Sanford Health Plan,381.92,88,,percent of total billed charges,,
"Laryngoscopy, Flexible; Diagnostic (Pro Cah)",,31575,CPT,Professional,Both,,,,434,368.9,42.54,434,"UCare Health, Inc.",Individual & Family Plan,107.630976,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Laryngoscopy, Flexible; Diagnostic (Pro Cah)",,31575,CPT,Professional,Both,,,,434,368.9,42.54,434,"UCare Health, Inc.",Medical Assistance,54.024784,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Laryngoscopy, Flexible; Diagnostic (Pro Cah)",,31575,CPT,Professional,Both,,,,434,368.9,42.54,434,"UCare Health, Inc.",Medicare Advantage,76.1415,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Laryngoscopy, Flexible; Diagnostic (Pro Cah)",,31575,CPT,Professional,Both,,,,434,368.9,42.54,434,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),60.9132,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Laryngoscopy, Flexible; Diagnostic (Pro Cah)",,31575,CPT,Professional,Both,,,,434,368.9,42.54,434,UnitedHealthcare,Individual & Family,434,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Laryngoscopy, Flexible; Diagnostic (Pro Cah)",,31575,CPT,Professional,Both,,,,434,368.9,42.54,434,UnitedHealthcare,Medicare Advantage,76.1415,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Laryngoscopy, Flexible; Diagnostic (Pro Cah)",,31575,CPT,Professional,Both,,,,434,368.9,42.54,434,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,49.11344,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Chest Tube Insertion,,32551,CPT,Facility,Both,,,,1326,1127.1,380.0316,1326,Aetna,Commercial,1219.92,92,,percent of total billed charges,,
Chest Tube Insertion,,32551,CPT,Facility,Outpatient,,,,1326,1127.1,380.0316,1326,Aetna,Medicare Advantage,649.74,49,,percent of total billed charges,,
Chest Tube Insertion,,32551,CPT,Facility,Inpatient,,,,1326,1127.1,380.0316,1326,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Chest Tube Insertion,,32551,CPT,Facility,Both,,,,1326,1127.1,380.0316,1326,Aetna,PPO,1233.18,93,,percent of total billed charges,,
Chest Tube Insertion,,32551,CPT,Facility,Both,,,,1326,1127.1,380.0316,1326,America's PPO,America's PPO,1273.3578,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Chest Tube Insertion,,32551,CPT,Facility,Both,,,,1326,1127.1,380.0316,1326,BlueCross BlueShield Minnesota, Federal Employee Program,1304.784,98.4,,percent of total billed charges,,
Chest Tube Insertion,,32551,CPT,Facility,Both,,,,1326,1127.1,380.0316,1326,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1326,100,,percent of total billed charges,,
Chest Tube Insertion,,32551,CPT,Facility,Both,,,,1326,1127.1,380.0316,1326,BlueCross BlueShield Minnesota,High Value Network Plan,1193.4,90,,percent of total billed charges,,
Chest Tube Insertion,,32551,CPT,Facility,Outpatient,,,,1326,1127.1,380.0316,1326,BlueCross BlueShield Minnesota,Medicare Advantage,649.74,49,,percent of total billed charges,,
Chest Tube Insertion,,32551,CPT,Facility,Inpatient,,,,1326,1127.1,380.0316,1326,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Chest Tube Insertion,,32551,CPT,Facility,Both,,,,1326,1127.1,380.0316,1326,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1174.4382,88.57,,percent of total billed charges,,
Chest Tube Insertion,,32551,CPT,Facility,Both,,,,1326,1127.1,380.0316,1326,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,380.0316,28.66,,percent of total billed charges,,
Chest Tube Insertion,,32551,CPT,Facility,Outpatient,,,,1326,1127.1,380.0316,1326,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),649.74,49,,percent of total billed charges,,
Chest Tube Insertion,,32551,CPT,Facility,Inpatient,,,,1326,1127.1,380.0316,1326,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Chest Tube Insertion,,32551,CPT,Facility,Both,,,,1326,1127.1,380.0316,1326,CorVel,Worker's Compensation,1326,100,,percent of total billed charges,,
Chest Tube Insertion,,32551,CPT,Facility,Both,,,,1326,1127.1,380.0316,1326,First Health Group Corporation,First Health Network,1286.22,97,,percent of total billed charges,,
Chest Tube Insertion,,32551,CPT,Facility,Both,,,,1326,1127.1,380.0316,1326,"Health Partners, Inc.",Commercial,1254.396,94.6,,percent of total billed charges,,
Chest Tube Insertion,,32551,CPT,Facility,Outpatient,,,,1326,1127.1,380.0316,1326,"Health Partners, Inc.",Medicare Advantage,649.74,49,,percent of total billed charges,,
Chest Tube Insertion,,32551,CPT,Facility,Inpatient,,,,1326,1127.1,380.0316,1326,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Chest Tube Insertion,,32551,CPT,Facility,Both,,,,1326,1127.1,380.0316,1326,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),795.6,60,,percent of total billed charges,,
Chest Tube Insertion,,32551,CPT,Facility,Both,,,,1326,1127.1,380.0316,1326,"Health Partners, Inc.",State of Minnesota Advantage Program,1080.69,81.5,,percent of total billed charges,,
Chest Tube Insertion,,32551,CPT,Facility,Both,,,,1326,1127.1,380.0316,1326,"Health Partners, Inc.",State Public Programs,663,50,,percent of total billed charges,,
Chest Tube Insertion,,32551,CPT,Facility,Both,,,,1326,1127.1,380.0316,1326,Humana Insurance Company,Commercial PPO,1259.7,95,,percent of total billed charges,,
Chest Tube Insertion,,32551,CPT,Facility,Outpatient,,,,1326,1127.1,380.0316,1326,Humana Insurance Company,Medicare PPO,649.74,49,,percent of total billed charges,,
Chest Tube Insertion,,32551,CPT,Facility,Inpatient,,,,1326,1127.1,380.0316,1326,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Chest Tube Insertion,,32551,CPT,Facility,Both,,,,1326,1127.1,380.0316,1326,Medica,Individual & Family,1314.066,99.1,,percent of total billed charges,,
Chest Tube Insertion,,32551,CPT,Facility,Outpatient,,,,1326,1127.1,380.0316,1326,Medica,Medica Advantage Solution,660.348,49.8,,percent of total billed charges,,
Chest Tube Insertion,,32551,CPT,Facility,Inpatient,,,,1326,1127.1,380.0316,1326,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Chest Tube Insertion,,32551,CPT,Facility,Outpatient,,,,1326,1127.1,380.0316,1326,Medica,Medical Assistance,449,,,Other,Grouper,All inclusive per visit
Chest Tube Insertion,,32551,CPT,Facility,Inpatient,,,,1326,1127.1,380.0316,1326,Medica,Medical Assistance,,,,,Included in per diem rate,
Chest Tube Insertion,,32551,CPT,Facility,Outpatient,,,,1326,1127.1,380.0316,1326,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,660.348,49.8,,percent of total billed charges,,
Chest Tube Insertion,,32551,CPT,Facility,Inpatient,,,,1326,1127.1,380.0316,1326,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Chest Tube Insertion,,32551,CPT,Facility,Both,,,,1326,1127.1,380.0316,1326,"Multiplan, Inc.","Multiplan, Inc.",1246.44,94,,percent of total billed charges,,
Chest Tube Insertion,,32551,CPT,Facility,Outpatient,,,,1326,1127.1,380.0316,1326,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1194.726,90.1,,percent of total billed charges,,
Chest Tube Insertion,,32551,CPT,Facility,Inpatient,,,,1326,1127.1,380.0316,1326,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Chest Tube Insertion,,32551,CPT,Facility,Both,,,,1326,1127.1,380.0316,1326,"Preferred One Administrative Services, INC.",PPO,1307.436,98.6,,percent of total billed charges,,
Chest Tube Insertion,,32551,CPT,Facility,Outpatient,,,,1326,1127.1,380.0316,1326,PrimeWest Health,Minnesota Senior Health Options (MSHO),682.227,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Chest Tube Insertion,,32551,CPT,Facility,Inpatient,,,,1326,1127.1,380.0316,1326,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Chest Tube Insertion,,32551,CPT,Facility,Outpatient,,,,1326,1127.1,380.0316,1326,PrimeWest Health,MinnesotaCare,681.0336,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Chest Tube Insertion,,32551,CPT,Facility,Inpatient,,,,1326,1127.1,380.0316,1326,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Chest Tube Insertion,,32551,CPT,Facility,Both,,,,1326,1127.1,380.0316,1326,Sanford Health Plan,Sanford Health Plan,1219.92,92,,percent of total billed charges,,
Chest Tube Insertion,,32551,CPT,Facility,Outpatient,,,,1326,1127.1,380.0316,1326,"UCare Health, Inc.",Individual & Family Plan,747.201,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Chest Tube Insertion,,32551,CPT,Facility,Inpatient,,,,1326,1127.1,380.0316,1326,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Chest Tube Insertion,,32551,CPT,Facility,Outpatient,,,,1326,1127.1,380.0316,1326,"UCare Health, Inc.",Medical Assistance,669.2322,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Chest Tube Insertion,,32551,CPT,Facility,Inpatient,,,,1326,1127.1,380.0316,1326,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Chest Tube Insertion,,32551,CPT,Facility,Outpatient,,,,1326,1127.1,380.0316,1326,"UCare Health, Inc.",Medicare Advantage,669.2322,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Chest Tube Insertion,,32551,CPT,Facility,Inpatient,,,,1326,1127.1,380.0316,1326,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Chest Tube Insertion,,32551,CPT,Facility,Outpatient,,,,1326,1127.1,380.0316,1326,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),669.2322,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Chest Tube Insertion,,32551,CPT,Facility,Inpatient,,,,1326,1127.1,380.0316,1326,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Chest Tube Insertion,,32551,CPT,Facility,Both,,,,1326,1127.1,380.0316,1326,UnitedHealthcare,Individual & Family,1246.44,94,,percent of total billed charges,,
Chest Tube Insertion,,32551,CPT,Facility,Outpatient,,,,1326,1127.1,380.0316,1326,UnitedHealthcare,Medicare Advantage,649.74,49,,percent of total billed charges,,
Chest Tube Insertion,,32551,CPT,Facility,Inpatient,,,,1326,1127.1,380.0316,1326,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Chest Tube Insertion,,32551,CPT,Facility,Outpatient,,,,1326,1127.1,380.0316,1326,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,636.48,48,,percent of total billed charges,,100% of DHS outpatient percentage
Chest Tube Insertion,,32551,CPT,Facility,Inpatient,,,,1326,1127.1,380.0316,1326,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Thoracentesis W/O Imaging,,32554,CPT,Facility,Both,,,,1016,863.6,291.1856,1016,Aetna,Commercial,934.72,92,,percent of total billed charges,,
Thoracentesis W/O Imaging,,32554,CPT,Facility,Outpatient,,,,1016,863.6,291.1856,1016,Aetna,Medicare Advantage,497.84,49,,percent of total billed charges,,
Thoracentesis W/O Imaging,,32554,CPT,Facility,Inpatient,,,,1016,863.6,291.1856,1016,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Thoracentesis W/O Imaging,,32554,CPT,Facility,Both,,,,1016,863.6,291.1856,1016,Aetna,PPO,944.88,93,,percent of total billed charges,,
Thoracentesis W/O Imaging,,32554,CPT,Facility,Both,,,,1016,863.6,291.1856,1016,America's PPO,America's PPO,975.6648,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Thoracentesis W/O Imaging,,32554,CPT,Facility,Both,,,,1016,863.6,291.1856,1016,BlueCross BlueShield Minnesota, Federal Employee Program,999.744,98.4,,percent of total billed charges,,
Thoracentesis W/O Imaging,,32554,CPT,Facility,Both,,,,1016,863.6,291.1856,1016,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1016,100,,percent of total billed charges,,
Thoracentesis W/O Imaging,,32554,CPT,Facility,Both,,,,1016,863.6,291.1856,1016,BlueCross BlueShield Minnesota,High Value Network Plan,914.4,90,,percent of total billed charges,,
Thoracentesis W/O Imaging,,32554,CPT,Facility,Outpatient,,,,1016,863.6,291.1856,1016,BlueCross BlueShield Minnesota,Medicare Advantage,497.84,49,,percent of total billed charges,,
Thoracentesis W/O Imaging,,32554,CPT,Facility,Inpatient,,,,1016,863.6,291.1856,1016,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Thoracentesis W/O Imaging,,32554,CPT,Facility,Both,,,,1016,863.6,291.1856,1016,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,899.8712,88.57,,percent of total billed charges,,
Thoracentesis W/O Imaging,,32554,CPT,Facility,Both,,,,1016,863.6,291.1856,1016,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,291.1856,28.66,,percent of total billed charges,,
Thoracentesis W/O Imaging,,32554,CPT,Facility,Outpatient,,,,1016,863.6,291.1856,1016,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),497.84,49,,percent of total billed charges,,
Thoracentesis W/O Imaging,,32554,CPT,Facility,Inpatient,,,,1016,863.6,291.1856,1016,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Thoracentesis W/O Imaging,,32554,CPT,Facility,Both,,,,1016,863.6,291.1856,1016,CorVel,Worker's Compensation,1016,100,,percent of total billed charges,,
Thoracentesis W/O Imaging,,32554,CPT,Facility,Both,,,,1016,863.6,291.1856,1016,First Health Group Corporation,First Health Network,985.52,97,,percent of total billed charges,,
Thoracentesis W/O Imaging,,32554,CPT,Facility,Both,,,,1016,863.6,291.1856,1016,"Health Partners, Inc.",Commercial,961.136,94.6,,percent of total billed charges,,
Thoracentesis W/O Imaging,,32554,CPT,Facility,Outpatient,,,,1016,863.6,291.1856,1016,"Health Partners, Inc.",Medicare Advantage,497.84,49,,percent of total billed charges,,
Thoracentesis W/O Imaging,,32554,CPT,Facility,Inpatient,,,,1016,863.6,291.1856,1016,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Thoracentesis W/O Imaging,,32554,CPT,Facility,Both,,,,1016,863.6,291.1856,1016,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),609.6,60,,percent of total billed charges,,
Thoracentesis W/O Imaging,,32554,CPT,Facility,Both,,,,1016,863.6,291.1856,1016,"Health Partners, Inc.",State of Minnesota Advantage Program,828.04,81.5,,percent of total billed charges,,
Thoracentesis W/O Imaging,,32554,CPT,Facility,Both,,,,1016,863.6,291.1856,1016,"Health Partners, Inc.",State Public Programs,508,50,,percent of total billed charges,,
Thoracentesis W/O Imaging,,32554,CPT,Facility,Both,,,,1016,863.6,291.1856,1016,Humana Insurance Company,Commercial PPO,965.2,95,,percent of total billed charges,,
Thoracentesis W/O Imaging,,32554,CPT,Facility,Outpatient,,,,1016,863.6,291.1856,1016,Humana Insurance Company,Medicare PPO,497.84,49,,percent of total billed charges,,
Thoracentesis W/O Imaging,,32554,CPT,Facility,Inpatient,,,,1016,863.6,291.1856,1016,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Thoracentesis W/O Imaging,,32554,CPT,Facility,Both,,,,1016,863.6,291.1856,1016,Medica,Individual & Family,1006.856,99.1,,percent of total billed charges,,
Thoracentesis W/O Imaging,,32554,CPT,Facility,Outpatient,,,,1016,863.6,291.1856,1016,Medica,Medica Advantage Solution,505.968,49.8,,percent of total billed charges,,
Thoracentesis W/O Imaging,,32554,CPT,Facility,Inpatient,,,,1016,863.6,291.1856,1016,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Thoracentesis W/O Imaging,,32554,CPT,Facility,Outpatient,,,,1016,863.6,291.1856,1016,Medica,Medical Assistance,449,,,Other,Grouper,All inclusive per visit
Thoracentesis W/O Imaging,,32554,CPT,Facility,Inpatient,,,,1016,863.6,291.1856,1016,Medica,Medical Assistance,,,,,Included in per diem rate,
Thoracentesis W/O Imaging,,32554,CPT,Facility,Outpatient,,,,1016,863.6,291.1856,1016,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,505.968,49.8,,percent of total billed charges,,
Thoracentesis W/O Imaging,,32554,CPT,Facility,Inpatient,,,,1016,863.6,291.1856,1016,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Thoracentesis W/O Imaging,,32554,CPT,Facility,Both,,,,1016,863.6,291.1856,1016,"Multiplan, Inc.","Multiplan, Inc.",955.04,94,,percent of total billed charges,,
Thoracentesis W/O Imaging,,32554,CPT,Facility,Outpatient,,,,1016,863.6,291.1856,1016,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,915.416,90.1,,percent of total billed charges,,
Thoracentesis W/O Imaging,,32554,CPT,Facility,Inpatient,,,,1016,863.6,291.1856,1016,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Thoracentesis W/O Imaging,,32554,CPT,Facility,Both,,,,1016,863.6,291.1856,1016,"Preferred One Administrative Services, INC.",PPO,1001.776,98.6,,percent of total billed charges,,
Thoracentesis W/O Imaging,,32554,CPT,Facility,Outpatient,,,,1016,863.6,291.1856,1016,PrimeWest Health,Minnesota Senior Health Options (MSHO),522.732,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Thoracentesis W/O Imaging,,32554,CPT,Facility,Inpatient,,,,1016,863.6,291.1856,1016,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Thoracentesis W/O Imaging,,32554,CPT,Facility,Outpatient,,,,1016,863.6,291.1856,1016,PrimeWest Health,MinnesotaCare,521.8176,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Thoracentesis W/O Imaging,,32554,CPT,Facility,Inpatient,,,,1016,863.6,291.1856,1016,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Thoracentesis W/O Imaging,,32554,CPT,Facility,Both,,,,1016,863.6,291.1856,1016,Sanford Health Plan,Sanford Health Plan,934.72,92,,percent of total billed charges,,
Thoracentesis W/O Imaging,,32554,CPT,Facility,Outpatient,,,,1016,863.6,291.1856,1016,"UCare Health, Inc.",Individual & Family Plan,572.516,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Thoracentesis W/O Imaging,,32554,CPT,Facility,Inpatient,,,,1016,863.6,291.1856,1016,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Thoracentesis W/O Imaging,,32554,CPT,Facility,Outpatient,,,,1016,863.6,291.1856,1016,"UCare Health, Inc.",Medical Assistance,512.7752,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Thoracentesis W/O Imaging,,32554,CPT,Facility,Inpatient,,,,1016,863.6,291.1856,1016,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Thoracentesis W/O Imaging,,32554,CPT,Facility,Outpatient,,,,1016,863.6,291.1856,1016,"UCare Health, Inc.",Medicare Advantage,512.7752,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Thoracentesis W/O Imaging,,32554,CPT,Facility,Inpatient,,,,1016,863.6,291.1856,1016,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Thoracentesis W/O Imaging,,32554,CPT,Facility,Outpatient,,,,1016,863.6,291.1856,1016,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),512.7752,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Thoracentesis W/O Imaging,,32554,CPT,Facility,Inpatient,,,,1016,863.6,291.1856,1016,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Thoracentesis W/O Imaging,,32554,CPT,Facility,Both,,,,1016,863.6,291.1856,1016,UnitedHealthcare,Individual & Family,955.04,94,,percent of total billed charges,,
Thoracentesis W/O Imaging,,32554,CPT,Facility,Outpatient,,,,1016,863.6,291.1856,1016,UnitedHealthcare,Medicare Advantage,497.84,49,,percent of total billed charges,,
Thoracentesis W/O Imaging,,32554,CPT,Facility,Inpatient,,,,1016,863.6,291.1856,1016,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Thoracentesis W/O Imaging,,32554,CPT,Facility,Outpatient,,,,1016,863.6,291.1856,1016,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,487.68,48,,percent of total billed charges,,100% of DHS outpatient percentage
Thoracentesis W/O Imaging,,32554,CPT,Facility,Inpatient,,,,1016,863.6,291.1856,1016,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Thoracentesis,Needle Or Catheter,Aspiration Of The Pleural Space; Without Imaging Guidance (Pro Cah)",,32554,CPT,Professional,Both,,,,485,412.25,53.88,485,Aetna,Commercial,412.25,85,,percent of total billed charges,,
"Thoracentesis,Needle Or Catheter,Aspiration Of The Pleural Space; Without Imaging Guidance (Pro Cah)",,32554,CPT,Professional,Both,,,,485,412.25,53.88,485,Aetna,Medicare Advantage,87.05,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Thoracentesis,Needle Or Catheter,Aspiration Of The Pleural Space; Without Imaging Guidance (Pro Cah)",,32554,CPT,Professional,Both,,,,485,412.25,53.88,485,Aetna,PPO,451.05,93,,percent of total billed charges,,
"Thoracentesis,Needle Or Catheter,Aspiration Of The Pleural Space; Without Imaging Guidance (Pro Cah)",,32554,CPT,Professional,Both,,,,485,412.25,53.88,485,America's PPO,America's PPO,414.384,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Thoracentesis,Needle Or Catheter,Aspiration Of The Pleural Space; Without Imaging Guidance (Pro Cah)",,32554,CPT,Professional,Both,,,,485,412.25,53.88,485,BlueCross BlueShield Minnesota, Federal Employee Program,179.04,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Thoracentesis,Needle Or Catheter,Aspiration Of The Pleural Space; Without Imaging Guidance (Pro Cah)",,32554,CPT,Professional,Both,,,,485,412.25,53.88,485,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,181.90464,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Thoracentesis,Needle Or Catheter,Aspiration Of The Pleural Space; Without Imaging Guidance (Pro Cah)",,32554,CPT,Professional,Both,,,,485,412.25,53.88,485,BlueCross BlueShield Minnesota,High Value Network Plan,181.90464,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Thoracentesis,Needle Or Catheter,Aspiration Of The Pleural Space; Without Imaging Guidance (Pro Cah)",,32554,CPT,Professional,Both,,,,485,412.25,53.88,485,BlueCross BlueShield Minnesota,Medicare Advantage,96.4965,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Thoracentesis,Needle Or Catheter,Aspiration Of The Pleural Space; Without Imaging Guidance (Pro Cah)",,32554,CPT,Professional,Both,,,,485,412.25,53.88,485,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,181.90464,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Thoracentesis,Needle Or Catheter,Aspiration Of The Pleural Space; Without Imaging Guidance (Pro Cah)",,32554,CPT,Professional,Both,,,,485,412.25,53.88,485,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,62.20968,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Thoracentesis,Needle Or Catheter,Aspiration Of The Pleural Space; Without Imaging Guidance (Pro Cah)",,32554,CPT,Professional,Both,,,,485,412.25,53.88,485,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),96.4965,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Thoracentesis,Needle Or Catheter,Aspiration Of The Pleural Space; Without Imaging Guidance (Pro Cah)",,32554,CPT,Professional,Both,,,,485,412.25,53.88,485,CorVel,Worker's Compensation,167.817528,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Thoracentesis,Needle Or Catheter,Aspiration Of The Pleural Space; Without Imaging Guidance (Pro Cah)",,32554,CPT,Professional,Both,,,,485,412.25,53.88,485,First Health Group Corporation,First Health Network,470.45,97,,percent of total billed charges,,
"Thoracentesis,Needle Or Catheter,Aspiration Of The Pleural Space; Without Imaging Guidance (Pro Cah)",,32554,CPT,Professional,Both,,,,485,412.25,53.88,485,"Health Partners, Inc.",Commercial,181.39,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Thoracentesis,Needle Or Catheter,Aspiration Of The Pleural Space; Without Imaging Guidance (Pro Cah)",,32554,CPT,Professional,Both,,,,485,412.25,53.88,485,"Health Partners, Inc.",Medicare Advantage,96.4965,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Thoracentesis,Needle Or Catheter,Aspiration Of The Pleural Space; Without Imaging Guidance (Pro Cah)",,32554,CPT,Professional,Both,,,,485,412.25,53.88,485,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),84.04,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Thoracentesis,Needle Or Catheter,Aspiration Of The Pleural Space; Without Imaging Guidance (Pro Cah)",,32554,CPT,Professional,Both,,,,485,412.25,53.88,485,"Health Partners, Inc.",State of Minnesota Advantage Program,156.267485,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Thoracentesis,Needle Or Catheter,Aspiration Of The Pleural Space; Without Imaging Guidance (Pro Cah)",,32554,CPT,Professional,Both,,,,485,412.25,53.88,485,"Health Partners, Inc.",State Public Programs,53.88,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Thoracentesis,Needle Or Catheter,Aspiration Of The Pleural Space; Without Imaging Guidance (Pro Cah)",,32554,CPT,Professional,Both,,,,485,412.25,53.88,485,Humana Insurance Company,Commercial PPO,83.91,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Thoracentesis,Needle Or Catheter,Aspiration Of The Pleural Space; Without Imaging Guidance (Pro Cah)",,32554,CPT,Professional,Both,,,,485,412.25,53.88,485,Humana Insurance Company,Medicare PPO,485,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Thoracentesis,Needle Or Catheter,Aspiration Of The Pleural Space; Without Imaging Guidance (Pro Cah)",,32554,CPT,Professional,Both,,,,485,412.25,53.88,485,Medica,Individual & Family,411.28,84.8,,percent of total billed charges,,
"Thoracentesis,Needle Or Catheter,Aspiration Of The Pleural Space; Without Imaging Guidance (Pro Cah)",,32554,CPT,Professional,Both,,,,485,412.25,53.88,485,Medica,Medica Advantage Solution,241.53,49.8,,percent of total billed charges,,
"Thoracentesis,Needle Or Catheter,Aspiration Of The Pleural Space; Without Imaging Guidance (Pro Cah)",,32554,CPT,Professional,Both,,,,485,412.25,53.88,485,Medica,Medical Assistance,62.21,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Thoracentesis,Needle Or Catheter,Aspiration Of The Pleural Space; Without Imaging Guidance (Pro Cah)",,32554,CPT,Professional,Both,,,,485,412.25,53.88,485,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,83.91,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Thoracentesis,Needle Or Catheter,Aspiration Of The Pleural Space; Without Imaging Guidance (Pro Cah)",,32554,CPT,Professional,Both,,,,485,412.25,53.88,485,"Multiplan, Inc.","Multiplan, Inc.",455.9,94,,percent of total billed charges,,
"Thoracentesis,Needle Or Catheter,Aspiration Of The Pleural Space; Without Imaging Guidance (Pro Cah)",,32554,CPT,Professional,Both,,,,485,412.25,53.88,485,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,436.985,90.1,,percent of total billed charges,,
"Thoracentesis,Needle Or Catheter,Aspiration Of The Pleural Space; Without Imaging Guidance (Pro Cah)",,32554,CPT,Professional,Both,,,,485,412.25,53.88,485,"Preferred One Administrative Services, INC.",PPO,478.21,98.6,,percent of total billed charges,,
"Thoracentesis,Needle Or Catheter,Aspiration Of The Pleural Space; Without Imaging Guidance (Pro Cah)",,32554,CPT,Professional,Both,,,,485,412.25,53.88,485,PrimeWest Health,Minnesota Senior Health Options (MSHO),96.4965,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Thoracentesis,Needle Or Catheter,Aspiration Of The Pleural Space; Without Imaging Guidance (Pro Cah)",,32554,CPT,Professional,Both,,,,485,412.25,53.88,485,PrimeWest Health,MinnesotaCare,66.5643576,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Thoracentesis,Needle Or Catheter,Aspiration Of The Pleural Space; Without Imaging Guidance (Pro Cah)",,32554,CPT,Professional,Both,,,,485,412.25,53.88,485,Sanford Health Plan,Sanford Health Plan,426.8,88,,percent of total billed charges,,
"Thoracentesis,Needle Or Catheter,Aspiration Of The Pleural Space; Without Imaging Guidance (Pro Cah)",,32554,CPT,Professional,Both,,,,485,412.25,53.88,485,"UCare Health, Inc.",Individual & Family Plan,136.404096,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Thoracentesis,Needle Or Catheter,Aspiration Of The Pleural Space; Without Imaging Guidance (Pro Cah)",,32554,CPT,Professional,Both,,,,485,412.25,53.88,485,"UCare Health, Inc.",Medical Assistance,68.430648,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Thoracentesis,Needle Or Catheter,Aspiration Of The Pleural Space; Without Imaging Guidance (Pro Cah)",,32554,CPT,Professional,Both,,,,485,412.25,53.88,485,"UCare Health, Inc.",Medicare Advantage,96.4965,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Thoracentesis,Needle Or Catheter,Aspiration Of The Pleural Space; Without Imaging Guidance (Pro Cah)",,32554,CPT,Professional,Both,,,,485,412.25,53.88,485,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),77.1972,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Thoracentesis,Needle Or Catheter,Aspiration Of The Pleural Space; Without Imaging Guidance (Pro Cah)",,32554,CPT,Professional,Both,,,,485,412.25,53.88,485,UnitedHealthcare,Individual & Family,485,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Thoracentesis,Needle Or Catheter,Aspiration Of The Pleural Space; Without Imaging Guidance (Pro Cah)",,32554,CPT,Professional,Both,,,,485,412.25,53.88,485,UnitedHealthcare,Medicare Advantage,96.4965,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Thoracentesis,Needle Or Catheter,Aspiration Of The Pleural Space; Without Imaging Guidance (Pro Cah)",,32554,CPT,Professional,Both,,,,485,412.25,53.88,485,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,62.20968,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Thoracentesis, Needle Or Catheter, Aspiration Of The Pleural Space; With Image Guidance (Pbb)",,32555,CPT,Facility,Outpatient,,,,586,498.1,167.9476,586,Aetna,Commercial,539.12,92,,percent of total billed charges,,
"Thoracentesis, Needle Or Catheter, Aspiration Of The Pleural Space; With Image Guidance (Pbb)",,32555,CPT,Professional,Outpatient,,,,485,412.25,67.19,485,Aetna,Commercial,412.25,85,,percent of total billed charges,,
"Thoracentesis, Needle Or Catheter, Aspiration Of The Pleural Space; With Image Guidance (Pbb)",,32555,CPT,Facility,Outpatient,,,,586,498.1,167.9476,586,Aetna,Medicare Advantage,287.14,49,,percent of total billed charges,,
"Thoracentesis, Needle Or Catheter, Aspiration Of The Pleural Space; With Image Guidance (Pbb)",,32555,CPT,Professional,Outpatient,,,,485,412.25,67.19,485,Aetna,Medicare Advantage,108.18,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Thoracentesis, Needle Or Catheter, Aspiration Of The Pleural Space; With Image Guidance (Pbb)",,32555,CPT,Facility,Outpatient,,,,586,498.1,167.9476,586,Aetna,PPO,544.98,93,,percent of total billed charges,,
"Thoracentesis, Needle Or Catheter, Aspiration Of The Pleural Space; With Image Guidance (Pbb)",,32555,CPT,Professional,Outpatient,,,,485,412.25,67.19,485,Aetna,PPO,451.05,93,,percent of total billed charges,,
"Thoracentesis, Needle Or Catheter, Aspiration Of The Pleural Space; With Image Guidance (Pbb)",,32555,CPT,Facility,Outpatient,,,,586,498.1,167.9476,586,America's PPO,America's PPO,562.7358,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Thoracentesis, Needle Or Catheter, Aspiration Of The Pleural Space; With Image Guidance (Pbb)",,32555,CPT,Professional,Outpatient,,,,485,412.25,67.19,485,America's PPO,America's PPO,414.384,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Thoracentesis, Needle Or Catheter, Aspiration Of The Pleural Space; With Image Guidance (Pbb)",,32555,CPT,Facility,Outpatient,,,,586,498.1,167.9476,586,BlueCross BlueShield Minnesota, Federal Employee Program,576.624,98.4,,percent of total billed charges,,
"Thoracentesis, Needle Or Catheter, Aspiration Of The Pleural Space; With Image Guidance (Pbb)",,32555,CPT,Professional,Outpatient,,,,485,412.25,67.19,485,BlueCross BlueShield Minnesota, Federal Employee Program,221.04,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Thoracentesis, Needle Or Catheter, Aspiration Of The Pleural Space; With Image Guidance (Pbb)",,32555,CPT,Facility,Outpatient,,,,586,498.1,167.9476,586,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,586,100,,percent of total billed charges,,
"Thoracentesis, Needle Or Catheter, Aspiration Of The Pleural Space; With Image Guidance (Pbb)",,32555,CPT,Professional,Outpatient,,,,485,412.25,67.19,485,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,224.57664,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Thoracentesis, Needle Or Catheter, Aspiration Of The Pleural Space; With Image Guidance (Pbb)",,32555,CPT,Facility,Outpatient,,,,586,498.1,167.9476,586,BlueCross BlueShield Minnesota,High Value Network Plan,527.4,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
"Thoracentesis, Needle Or Catheter, Aspiration Of The Pleural Space; With Image Guidance (Pbb)",,32555,CPT,Professional,Outpatient,,,,485,412.25,67.19,485,BlueCross BlueShield Minnesota,High Value Network Plan,224.57664,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Thoracentesis, Needle Or Catheter, Aspiration Of The Pleural Space; With Image Guidance (Pbb)",,32555,CPT,Facility,Outpatient,,,,586,498.1,167.9476,586,BlueCross BlueShield Minnesota,Medicare Advantage,287.14,49,,percent of total billed charges,,
"Thoracentesis, Needle Or Catheter, Aspiration Of The Pleural Space; With Image Guidance (Pbb)",,32555,CPT,Professional,Outpatient,,,,485,412.25,67.19,485,BlueCross BlueShield Minnesota,Medicare Advantage,120.3935,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Thoracentesis, Needle Or Catheter, Aspiration Of The Pleural Space; With Image Guidance (Pbb)",,32555,CPT,Professional,Outpatient,,,,485,412.25,67.19,485,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,224.57664,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Thoracentesis, Needle Or Catheter, Aspiration Of The Pleural Space; With Image Guidance (Pbb)",,32555,CPT,Facility,Outpatient,,,,586,498.1,167.9476,586,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,167.9476,28.66,,percent of total billed charges,,
"Thoracentesis, Needle Or Catheter, Aspiration Of The Pleural Space; With Image Guidance (Pbb)",,32555,CPT,Professional,Outpatient,,,,485,412.25,67.19,485,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,77.5716,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Thoracentesis, Needle Or Catheter, Aspiration Of The Pleural Space; With Image Guidance (Pbb)",,32555,CPT,Facility,Outpatient,,,,586,498.1,167.9476,586,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),287.14,49,,percent of total billed charges,,
"Thoracentesis, Needle Or Catheter, Aspiration Of The Pleural Space; With Image Guidance (Pbb)",,32555,CPT,Professional,Outpatient,,,,485,412.25,67.19,485,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),120.3935,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Thoracentesis, Needle Or Catheter, Aspiration Of The Pleural Space; With Image Guidance (Pbb)",,32555,CPT,Facility,Outpatient,,,,586,498.1,167.9476,586,CorVel,Worker's Compensation,586,100,,percent of total billed charges,,
"Thoracentesis, Needle Or Catheter, Aspiration Of The Pleural Space; With Image Guidance (Pbb)",,32555,CPT,Professional,Outpatient,,,,485,412.25,67.19,485,CorVel,Worker's Compensation,207.5700774,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Thoracentesis, Needle Or Catheter, Aspiration Of The Pleural Space; With Image Guidance (Pbb)",,32555,CPT,Facility,Outpatient,,,,586,498.1,167.9476,586,First Health Group Corporation,First Health Network,568.42,97,,percent of total billed charges,,
"Thoracentesis, Needle Or Catheter, Aspiration Of The Pleural Space; With Image Guidance (Pbb)",,32555,CPT,Professional,Outpatient,,,,485,412.25,67.19,485,First Health Group Corporation,First Health Network,470.45,97,,percent of total billed charges,,
"Thoracentesis, Needle Or Catheter, Aspiration Of The Pleural Space; With Image Guidance (Pbb)",,32555,CPT,Facility,Outpatient,,,,586,498.1,167.9476,586,"Health Partners, Inc.",Commercial,554.356,94.6,,percent of total billed charges,,
"Thoracentesis, Needle Or Catheter, Aspiration Of The Pleural Space; With Image Guidance (Pbb)",,32555,CPT,Professional,Outpatient,,,,485,412.25,67.19,485,"Health Partners, Inc.",Commercial,224.19,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Thoracentesis, Needle Or Catheter, Aspiration Of The Pleural Space; With Image Guidance (Pbb)",,32555,CPT,Facility,Outpatient,,,,586,498.1,167.9476,586,"Health Partners, Inc.",Medicare Advantage,287.14,49,,percent of total billed charges,,
"Thoracentesis, Needle Or Catheter, Aspiration Of The Pleural Space; With Image Guidance (Pbb)",,32555,CPT,Professional,Outpatient,,,,485,412.25,67.19,485,"Health Partners, Inc.",Medicare Advantage,120.3935,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Thoracentesis, Needle Or Catheter, Aspiration Of The Pleural Space; With Image Guidance (Pbb)",,32555,CPT,Facility,Outpatient,,,,586,498.1,167.9476,586,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),351.6,60,,percent of total billed charges,,
"Thoracentesis, Needle Or Catheter, Aspiration Of The Pleural Space; With Image Guidance (Pbb)",,32555,CPT,Professional,Outpatient,,,,485,412.25,67.19,485,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),104.71,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Thoracentesis, Needle Or Catheter, Aspiration Of The Pleural Space; With Image Guidance (Pbb)",,32555,CPT,Facility,Outpatient,,,,586,498.1,167.9476,586,"Health Partners, Inc.",State of Minnesota Advantage Program,477.59,81.5,,percent of total billed charges,,
"Thoracentesis, Needle Or Catheter, Aspiration Of The Pleural Space; With Image Guidance (Pbb)",,32555,CPT,Professional,Outpatient,,,,485,412.25,67.19,485,"Health Partners, Inc.",State of Minnesota Advantage Program,193.139685,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Thoracentesis, Needle Or Catheter, Aspiration Of The Pleural Space; With Image Guidance (Pbb)",,32555,CPT,Facility,Outpatient,,,,586,498.1,167.9476,586,"Health Partners, Inc.",State Public Programs,293,50,,percent of total billed charges,,
"Thoracentesis, Needle Or Catheter, Aspiration Of The Pleural Space; With Image Guidance (Pbb)",,32555,CPT,Professional,Outpatient,,,,485,412.25,67.19,485,"Health Partners, Inc.",State Public Programs,67.19,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Thoracentesis, Needle Or Catheter, Aspiration Of The Pleural Space; With Image Guidance (Pbb)",,32555,CPT,Facility,Outpatient,,,,586,498.1,167.9476,586,Humana Insurance Company,Commercial PPO,556.7,95,,percent of total billed charges,,
"Thoracentesis, Needle Or Catheter, Aspiration Of The Pleural Space; With Image Guidance (Pbb)",,32555,CPT,Professional,Outpatient,,,,485,412.25,67.19,485,Humana Insurance Company,Commercial PPO,104.69,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Thoracentesis, Needle Or Catheter, Aspiration Of The Pleural Space; With Image Guidance (Pbb)",,32555,CPT,Facility,Outpatient,,,,586,498.1,167.9476,586,Humana Insurance Company,Medicare PPO,287.14,49,,percent of total billed charges,,
"Thoracentesis, Needle Or Catheter, Aspiration Of The Pleural Space; With Image Guidance (Pbb)",,32555,CPT,Professional,Outpatient,,,,485,412.25,67.19,485,Humana Insurance Company,Medicare PPO,485,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Thoracentesis, Needle Or Catheter, Aspiration Of The Pleural Space; With Image Guidance (Pbb)",,32555,CPT,Facility,Outpatient,,,,586,498.1,167.9476,586,Medica,Individual & Family,580.726,99.1,,percent of total billed charges,,
"Thoracentesis, Needle Or Catheter, Aspiration Of The Pleural Space; With Image Guidance (Pbb)",,32555,CPT,Professional,Outpatient,,,,485,412.25,67.19,485,Medica,Individual & Family,411.28,84.8,,percent of total billed charges,,
"Thoracentesis, Needle Or Catheter, Aspiration Of The Pleural Space; With Image Guidance (Pbb)",,32555,CPT,Facility,Outpatient,,,,586,498.1,167.9476,586,Medica,Medica Advantage Solution,291.828,49.8,,percent of total billed charges,,
"Thoracentesis, Needle Or Catheter, Aspiration Of The Pleural Space; With Image Guidance (Pbb)",,32555,CPT,Professional,Outpatient,,,,485,412.25,67.19,485,Medica,Medica Advantage Solution,241.53,49.8,,percent of total billed charges,,
"Thoracentesis, Needle Or Catheter, Aspiration Of The Pleural Space; With Image Guidance (Pbb)",,32555,CPT,Facility,Outpatient,,,,586,498.1,167.9476,586,Medica,Medical Assistance,261.356,44.6,,percent of total billed charges,,
"Thoracentesis, Needle Or Catheter, Aspiration Of The Pleural Space; With Image Guidance (Pbb)",,32555,CPT,Professional,Outpatient,,,,485,412.25,67.19,485,Medica,Medical Assistance,77.57,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Thoracentesis, Needle Or Catheter, Aspiration Of The Pleural Space; With Image Guidance (Pbb)",,32555,CPT,Facility,Outpatient,,,,586,498.1,167.9476,586,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,291.828,49.8,,percent of total billed charges,,
"Thoracentesis, Needle Or Catheter, Aspiration Of The Pleural Space; With Image Guidance (Pbb)",,32555,CPT,Professional,Outpatient,,,,485,412.25,67.19,485,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,104.69,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Thoracentesis, Needle Or Catheter, Aspiration Of The Pleural Space; With Image Guidance (Pbb)",,32555,CPT,Facility,Outpatient,,,,586,498.1,167.9476,586,"Multiplan, Inc.","Multiplan, Inc.",550.84,94,,percent of total billed charges,,
"Thoracentesis, Needle Or Catheter, Aspiration Of The Pleural Space; With Image Guidance (Pbb)",,32555,CPT,Professional,Outpatient,,,,485,412.25,67.19,485,"Multiplan, Inc.","Multiplan, Inc.",455.9,94,,percent of total billed charges,,
"Thoracentesis, Needle Or Catheter, Aspiration Of The Pleural Space; With Image Guidance (Pbb)",,32555,CPT,Facility,Outpatient,,,,586,498.1,167.9476,586,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,527.986,90.1,,percent of total billed charges,,
"Thoracentesis, Needle Or Catheter, Aspiration Of The Pleural Space; With Image Guidance (Pbb)",,32555,CPT,Professional,Outpatient,,,,485,412.25,67.19,485,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,436.985,90.1,,percent of total billed charges,,
"Thoracentesis, Needle Or Catheter, Aspiration Of The Pleural Space; With Image Guidance (Pbb)",,32555,CPT,Facility,Outpatient,,,,586,498.1,167.9476,586,"Preferred One Administrative Services, INC.",PPO,577.796,98.6,,percent of total billed charges,,
"Thoracentesis, Needle Or Catheter, Aspiration Of The Pleural Space; With Image Guidance (Pbb)",,32555,CPT,Professional,Outpatient,,,,485,412.25,67.19,485,"Preferred One Administrative Services, INC.",PPO,478.21,98.6,,percent of total billed charges,,
"Thoracentesis, Needle Or Catheter, Aspiration Of The Pleural Space; With Image Guidance (Pbb)",,32555,CPT,Facility,Outpatient,,,,586,498.1,167.9476,586,PrimeWest Health,Minnesota Senior Health Options (MSHO),301.497,51.45,,percent of total billed charges,,
"Thoracentesis, Needle Or Catheter, Aspiration Of The Pleural Space; With Image Guidance (Pbb)",,32555,CPT,Professional,Outpatient,,,,485,412.25,67.19,485,PrimeWest Health,Minnesota Senior Health Options (MSHO),120.3935,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Thoracentesis, Needle Or Catheter, Aspiration Of The Pleural Space; With Image Guidance (Pbb)",,32555,CPT,Facility,Outpatient,,,,586,498.1,167.9476,586,PrimeWest Health,MinnesotaCare,300.9696,51.36,,percent of total billed charges,,
"Thoracentesis, Needle Or Catheter, Aspiration Of The Pleural Space; With Image Guidance (Pbb)",,32555,CPT,Professional,Outpatient,,,,485,412.25,67.19,485,PrimeWest Health,MinnesotaCare,83.001612,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Thoracentesis, Needle Or Catheter, Aspiration Of The Pleural Space; With Image Guidance (Pbb)",,32555,CPT,Facility,Outpatient,,,,586,498.1,167.9476,586,Sanford Health Plan,Sanford Health Plan,539.12,92,,percent of total billed charges,,
"Thoracentesis, Needle Or Catheter, Aspiration Of The Pleural Space; With Image Guidance (Pbb)",,32555,CPT,Professional,Outpatient,,,,485,412.25,67.19,485,Sanford Health Plan,Sanford Health Plan,426.8,88,,percent of total billed charges,,
"Thoracentesis, Needle Or Catheter, Aspiration Of The Pleural Space; With Image Guidance (Pbb)",,32555,CPT,Facility,Outpatient,,,,586,498.1,167.9476,586,"UCare Health, Inc.",Individual & Family Plan,330.211,56.35,,percent of total billed charges,,
"Thoracentesis, Needle Or Catheter, Aspiration Of The Pleural Space; With Image Guidance (Pbb)",,32555,CPT,Professional,Outpatient,,,,485,412.25,67.19,485,"UCare Health, Inc.",Individual & Family Plan,170.184064,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Thoracentesis, Needle Or Catheter, Aspiration Of The Pleural Space; With Image Guidance (Pbb)",,32555,CPT,Facility,Outpatient,,,,586,498.1,167.9476,586,"UCare Health, Inc.",Medical Assistance,295.7542,50.47,,percent of total billed charges,,
"Thoracentesis, Needle Or Catheter, Aspiration Of The Pleural Space; With Image Guidance (Pbb)",,32555,CPT,Professional,Outpatient,,,,485,412.25,67.19,485,"UCare Health, Inc.",Medical Assistance,85.32876,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Thoracentesis, Needle Or Catheter, Aspiration Of The Pleural Space; With Image Guidance (Pbb)",,32555,CPT,Facility,Outpatient,,,,586,498.1,167.9476,586,"UCare Health, Inc.",Medicare Advantage,295.7542,50.47,,percent of total billed charges,,
"Thoracentesis, Needle Or Catheter, Aspiration Of The Pleural Space; With Image Guidance (Pbb)",,32555,CPT,Professional,Outpatient,,,,485,412.25,67.19,485,"UCare Health, Inc.",Medicare Advantage,120.3935,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Thoracentesis, Needle Or Catheter, Aspiration Of The Pleural Space; With Image Guidance (Pbb)",,32555,CPT,Facility,Outpatient,,,,586,498.1,167.9476,586,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),295.7542,50.47,,percent of total billed charges,,
"Thoracentesis, Needle Or Catheter, Aspiration Of The Pleural Space; With Image Guidance (Pbb)",,32555,CPT,Professional,Outpatient,,,,485,412.25,67.19,485,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),96.3148,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Thoracentesis, Needle Or Catheter, Aspiration Of The Pleural Space; With Image Guidance (Pbb)",,32555,CPT,Facility,Outpatient,,,,586,498.1,167.9476,586,UnitedHealthcare,Individual & Family,550.84,94,,percent of total billed charges,,
"Thoracentesis, Needle Or Catheter, Aspiration Of The Pleural Space; With Image Guidance (Pbb)",,32555,CPT,Professional,Outpatient,,,,485,412.25,67.19,485,UnitedHealthcare,Individual & Family,485,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Thoracentesis, Needle Or Catheter, Aspiration Of The Pleural Space; With Image Guidance (Pbb)",,32555,CPT,Facility,Outpatient,,,,586,498.1,167.9476,586,UnitedHealthcare,Medicare Advantage,287.14,49,,percent of total billed charges,,
"Thoracentesis, Needle Or Catheter, Aspiration Of The Pleural Space; With Image Guidance (Pbb)",,32555,CPT,Professional,Outpatient,,,,485,412.25,67.19,485,UnitedHealthcare,Medicare Advantage,120.3935,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Thoracentesis, Needle Or Catheter, Aspiration Of The Pleural Space; With Image Guidance (Pbb)",,32555,CPT,Facility,Outpatient,,,,586,498.1,167.9476,586,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,281.28,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Thoracentesis, Needle Or Catheter, Aspiration Of The Pleural Space; With Image Guidance (Pbb)",,32555,CPT,Professional,Outpatient,,,,485,412.25,67.19,485,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,77.5716,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Thoracentesis, Needle Or Catheter, Aspiration Of The Pleural Space; With Imaging Guidance (Pro Cah)",,32555,CPT,Professional,Both,,,,1071,910.35,67.19,1071,Aetna,Commercial,910.35,85,,percent of total billed charges,,
"Thoracentesis, Needle Or Catheter, Aspiration Of The Pleural Space; With Imaging Guidance (Pro Cah)",,32555,CPT,Professional,Both,,,,1071,910.35,67.19,1071,Aetna,Medicare Advantage,108.18,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Thoracentesis, Needle Or Catheter, Aspiration Of The Pleural Space; With Imaging Guidance (Pro Cah)",,32555,CPT,Professional,Both,,,,1071,910.35,67.19,1071,Aetna,PPO,996.03,93,,percent of total billed charges,,
"Thoracentesis, Needle Or Catheter, Aspiration Of The Pleural Space; With Imaging Guidance (Pro Cah)",,32555,CPT,Professional,Both,,,,1071,910.35,67.19,1071,America's PPO,America's PPO,915.0624,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Thoracentesis, Needle Or Catheter, Aspiration Of The Pleural Space; With Imaging Guidance (Pro Cah)",,32555,CPT,Professional,Both,,,,1071,910.35,67.19,1071,BlueCross BlueShield Minnesota, Federal Employee Program,221.04,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Thoracentesis, Needle Or Catheter, Aspiration Of The Pleural Space; With Imaging Guidance (Pro Cah)",,32555,CPT,Professional,Both,,,,1071,910.35,67.19,1071,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,224.57664,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Thoracentesis, Needle Or Catheter, Aspiration Of The Pleural Space; With Imaging Guidance (Pro Cah)",,32555,CPT,Professional,Both,,,,1071,910.35,67.19,1071,BlueCross BlueShield Minnesota,High Value Network Plan,224.57664,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Thoracentesis, Needle Or Catheter, Aspiration Of The Pleural Space; With Imaging Guidance (Pro Cah)",,32555,CPT,Professional,Both,,,,1071,910.35,67.19,1071,BlueCross BlueShield Minnesota,Medicare Advantage,120.3935,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Thoracentesis, Needle Or Catheter, Aspiration Of The Pleural Space; With Imaging Guidance (Pro Cah)",,32555,CPT,Professional,Both,,,,1071,910.35,67.19,1071,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,224.57664,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Thoracentesis, Needle Or Catheter, Aspiration Of The Pleural Space; With Imaging Guidance (Pro Cah)",,32555,CPT,Professional,Both,,,,1071,910.35,67.19,1071,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,77.5716,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Thoracentesis, Needle Or Catheter, Aspiration Of The Pleural Space; With Imaging Guidance (Pro Cah)",,32555,CPT,Professional,Both,,,,1071,910.35,67.19,1071,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),120.3935,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Thoracentesis, Needle Or Catheter, Aspiration Of The Pleural Space; With Imaging Guidance (Pro Cah)",,32555,CPT,Professional,Both,,,,1071,910.35,67.19,1071,CorVel,Worker's Compensation,207.5700774,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Thoracentesis, Needle Or Catheter, Aspiration Of The Pleural Space; With Imaging Guidance (Pro Cah)",,32555,CPT,Professional,Both,,,,1071,910.35,67.19,1071,First Health Group Corporation,First Health Network,1038.87,97,,percent of total billed charges,,
"Thoracentesis, Needle Or Catheter, Aspiration Of The Pleural Space; With Imaging Guidance (Pro Cah)",,32555,CPT,Professional,Both,,,,1071,910.35,67.19,1071,"Health Partners, Inc.",Commercial,224.19,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Thoracentesis, Needle Or Catheter, Aspiration Of The Pleural Space; With Imaging Guidance (Pro Cah)",,32555,CPT,Professional,Both,,,,1071,910.35,67.19,1071,"Health Partners, Inc.",Medicare Advantage,120.3935,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Thoracentesis, Needle Or Catheter, Aspiration Of The Pleural Space; With Imaging Guidance (Pro Cah)",,32555,CPT,Professional,Both,,,,1071,910.35,67.19,1071,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),104.71,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Thoracentesis, Needle Or Catheter, Aspiration Of The Pleural Space; With Imaging Guidance (Pro Cah)",,32555,CPT,Professional,Both,,,,1071,910.35,67.19,1071,"Health Partners, Inc.",State of Minnesota Advantage Program,193.139685,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Thoracentesis, Needle Or Catheter, Aspiration Of The Pleural Space; With Imaging Guidance (Pro Cah)",,32555,CPT,Professional,Both,,,,1071,910.35,67.19,1071,"Health Partners, Inc.",State Public Programs,67.19,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Thoracentesis, Needle Or Catheter, Aspiration Of The Pleural Space; With Imaging Guidance (Pro Cah)",,32555,CPT,Professional,Both,,,,1071,910.35,67.19,1071,Humana Insurance Company,Commercial PPO,104.69,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Thoracentesis, Needle Or Catheter, Aspiration Of The Pleural Space; With Imaging Guidance (Pro Cah)",,32555,CPT,Professional,Both,,,,1071,910.35,67.19,1071,Humana Insurance Company,Medicare PPO,1071,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Thoracentesis, Needle Or Catheter, Aspiration Of The Pleural Space; With Imaging Guidance (Pro Cah)",,32555,CPT,Professional,Both,,,,1071,910.35,67.19,1071,Medica,Individual & Family,908.208,84.8,,percent of total billed charges,,
"Thoracentesis, Needle Or Catheter, Aspiration Of The Pleural Space; With Imaging Guidance (Pro Cah)",,32555,CPT,Professional,Both,,,,1071,910.35,67.19,1071,Medica,Medica Advantage Solution,533.358,49.8,,percent of total billed charges,,
"Thoracentesis, Needle Or Catheter, Aspiration Of The Pleural Space; With Imaging Guidance (Pro Cah)",,32555,CPT,Professional,Both,,,,1071,910.35,67.19,1071,Medica,Medical Assistance,77.57,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Thoracentesis, Needle Or Catheter, Aspiration Of The Pleural Space; With Imaging Guidance (Pro Cah)",,32555,CPT,Professional,Both,,,,1071,910.35,67.19,1071,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,104.69,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Thoracentesis, Needle Or Catheter, Aspiration Of The Pleural Space; With Imaging Guidance (Pro Cah)",,32555,CPT,Professional,Both,,,,1071,910.35,67.19,1071,"Multiplan, Inc.","Multiplan, Inc.",1006.74,94,,percent of total billed charges,,
"Thoracentesis, Needle Or Catheter, Aspiration Of The Pleural Space; With Imaging Guidance (Pro Cah)",,32555,CPT,Professional,Both,,,,1071,910.35,67.19,1071,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,964.971,90.1,,percent of total billed charges,,
"Thoracentesis, Needle Or Catheter, Aspiration Of The Pleural Space; With Imaging Guidance (Pro Cah)",,32555,CPT,Professional,Both,,,,1071,910.35,67.19,1071,"Preferred One Administrative Services, INC.",PPO,1056.006,98.6,,percent of total billed charges,,
"Thoracentesis, Needle Or Catheter, Aspiration Of The Pleural Space; With Imaging Guidance (Pro Cah)",,32555,CPT,Professional,Both,,,,1071,910.35,67.19,1071,PrimeWest Health,Minnesota Senior Health Options (MSHO),120.3935,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Thoracentesis, Needle Or Catheter, Aspiration Of The Pleural Space; With Imaging Guidance (Pro Cah)",,32555,CPT,Professional,Both,,,,1071,910.35,67.19,1071,PrimeWest Health,MinnesotaCare,83.001612,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Thoracentesis, Needle Or Catheter, Aspiration Of The Pleural Space; With Imaging Guidance (Pro Cah)",,32555,CPT,Professional,Both,,,,1071,910.35,67.19,1071,Sanford Health Plan,Sanford Health Plan,942.48,88,,percent of total billed charges,,
"Thoracentesis, Needle Or Catheter, Aspiration Of The Pleural Space; With Imaging Guidance (Pro Cah)",,32555,CPT,Professional,Both,,,,1071,910.35,67.19,1071,"UCare Health, Inc.",Individual & Family Plan,170.184064,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Thoracentesis, Needle Or Catheter, Aspiration Of The Pleural Space; With Imaging Guidance (Pro Cah)",,32555,CPT,Professional,Both,,,,1071,910.35,67.19,1071,"UCare Health, Inc.",Medical Assistance,85.32876,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Thoracentesis, Needle Or Catheter, Aspiration Of The Pleural Space; With Imaging Guidance (Pro Cah)",,32555,CPT,Professional,Both,,,,1071,910.35,67.19,1071,"UCare Health, Inc.",Medicare Advantage,120.3935,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Thoracentesis, Needle Or Catheter, Aspiration Of The Pleural Space; With Imaging Guidance (Pro Cah)",,32555,CPT,Professional,Both,,,,1071,910.35,67.19,1071,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),96.3148,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Thoracentesis, Needle Or Catheter, Aspiration Of The Pleural Space; With Imaging Guidance (Pro Cah)",,32555,CPT,Professional,Both,,,,1071,910.35,67.19,1071,UnitedHealthcare,Individual & Family,1071,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Thoracentesis, Needle Or Catheter, Aspiration Of The Pleural Space; With Imaging Guidance (Pro Cah)",,32555,CPT,Professional,Both,,,,1071,910.35,67.19,1071,UnitedHealthcare,Medicare Advantage,120.3935,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Thoracentesis, Needle Or Catheter, Aspiration Of The Pleural Space; With Imaging Guidance (Pro Cah)",,32555,CPT,Professional,Both,,,,1071,910.35,67.19,1071,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,77.5716,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Us Thoracentesis W Imaging Guidance,,32555,CPT,Facility,Both,,,,1685,1432.25,482.921,1685,Aetna,Commercial,1550.2,92,,percent of total billed charges,,
Us Thoracentesis W Imaging Guidance,,32555,CPT,Facility,Outpatient,,,,1685,1432.25,482.921,1685,Aetna,Medicare Advantage,825.65,49,,percent of total billed charges,,
Us Thoracentesis W Imaging Guidance,,32555,CPT,Facility,Inpatient,,,,1685,1432.25,482.921,1685,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Us Thoracentesis W Imaging Guidance,,32555,CPT,Facility,Both,,,,1685,1432.25,482.921,1685,Aetna,PPO,1567.05,93,,percent of total billed charges,,
Us Thoracentesis W Imaging Guidance,,32555,CPT,Facility,Both,,,,1685,1432.25,482.921,1685,America's PPO,America's PPO,1618.1055,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Us Thoracentesis W Imaging Guidance,,32555,CPT,Facility,Both,,,,1685,1432.25,482.921,1685,BlueCross BlueShield Minnesota, Federal Employee Program,1658.04,98.4,,percent of total billed charges,,
Us Thoracentesis W Imaging Guidance,,32555,CPT,Facility,Both,,,,1685,1432.25,482.921,1685,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1685,100,,percent of total billed charges,,
Us Thoracentesis W Imaging Guidance,,32555,CPT,Facility,Both,,,,1685,1432.25,482.921,1685,BlueCross BlueShield Minnesota,High Value Network Plan,1516.5,90,,percent of total billed charges,,
Us Thoracentesis W Imaging Guidance,,32555,CPT,Facility,Outpatient,,,,1685,1432.25,482.921,1685,BlueCross BlueShield Minnesota,Medicare Advantage,825.65,49,,percent of total billed charges,,
Us Thoracentesis W Imaging Guidance,,32555,CPT,Facility,Inpatient,,,,1685,1432.25,482.921,1685,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Us Thoracentesis W Imaging Guidance,,32555,CPT,Facility,Both,,,,1685,1432.25,482.921,1685,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1492.4045,88.57,,percent of total billed charges,,
Us Thoracentesis W Imaging Guidance,,32555,CPT,Facility,Both,,,,1685,1432.25,482.921,1685,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,482.921,28.66,,percent of total billed charges,,
Us Thoracentesis W Imaging Guidance,,32555,CPT,Facility,Outpatient,,,,1685,1432.25,482.921,1685,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),825.65,49,,percent of total billed charges,,
Us Thoracentesis W Imaging Guidance,,32555,CPT,Facility,Inpatient,,,,1685,1432.25,482.921,1685,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Us Thoracentesis W Imaging Guidance,,32555,CPT,Facility,Both,,,,1685,1432.25,482.921,1685,CorVel,Worker's Compensation,1685,100,,percent of total billed charges,,
Us Thoracentesis W Imaging Guidance,,32555,CPT,Facility,Both,,,,1685,1432.25,482.921,1685,First Health Group Corporation,First Health Network,1634.45,97,,percent of total billed charges,,
Us Thoracentesis W Imaging Guidance,,32555,CPT,Facility,Both,,,,1685,1432.25,482.921,1685,"Health Partners, Inc.",Commercial,1594.01,94.6,,percent of total billed charges,,
Us Thoracentesis W Imaging Guidance,,32555,CPT,Facility,Outpatient,,,,1685,1432.25,482.921,1685,"Health Partners, Inc.",Medicare Advantage,825.65,49,,percent of total billed charges,,
Us Thoracentesis W Imaging Guidance,,32555,CPT,Facility,Inpatient,,,,1685,1432.25,482.921,1685,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Us Thoracentesis W Imaging Guidance,,32555,CPT,Facility,Both,,,,1685,1432.25,482.921,1685,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1011,60,,percent of total billed charges,,
Us Thoracentesis W Imaging Guidance,,32555,CPT,Facility,Both,,,,1685,1432.25,482.921,1685,"Health Partners, Inc.",State of Minnesota Advantage Program,1373.275,81.5,,percent of total billed charges,,
Us Thoracentesis W Imaging Guidance,,32555,CPT,Facility,Both,,,,1685,1432.25,482.921,1685,"Health Partners, Inc.",State Public Programs,842.5,50,,percent of total billed charges,,
Us Thoracentesis W Imaging Guidance,,32555,CPT,Facility,Both,,,,1685,1432.25,482.921,1685,Humana Insurance Company,Commercial PPO,1600.75,95,,percent of total billed charges,,
Us Thoracentesis W Imaging Guidance,,32555,CPT,Facility,Outpatient,,,,1685,1432.25,482.921,1685,Humana Insurance Company,Medicare PPO,825.65,49,,percent of total billed charges,,
Us Thoracentesis W Imaging Guidance,,32555,CPT,Facility,Inpatient,,,,1685,1432.25,482.921,1685,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Us Thoracentesis W Imaging Guidance,,32555,CPT,Facility,Both,,,,1685,1432.25,482.921,1685,Medica,Individual & Family,1669.835,99.1,,percent of total billed charges,,
Us Thoracentesis W Imaging Guidance,,32555,CPT,Facility,Outpatient,,,,1685,1432.25,482.921,1685,Medica,Medica Advantage Solution,839.13,49.8,,percent of total billed charges,,
Us Thoracentesis W Imaging Guidance,,32555,CPT,Facility,Inpatient,,,,1685,1432.25,482.921,1685,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Us Thoracentesis W Imaging Guidance,,32555,CPT,Facility,Outpatient,,,,1685,1432.25,482.921,1685,Medica,Medical Assistance,751.51,44.6,,percent of total billed charges,,
Us Thoracentesis W Imaging Guidance,,32555,CPT,Facility,Inpatient,,,,1685,1432.25,482.921,1685,Medica,Medical Assistance,,,,,Included in per diem rate,
Us Thoracentesis W Imaging Guidance,,32555,CPT,Facility,Outpatient,,,,1685,1432.25,482.921,1685,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,839.13,49.8,,percent of total billed charges,,
Us Thoracentesis W Imaging Guidance,,32555,CPT,Facility,Inpatient,,,,1685,1432.25,482.921,1685,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Us Thoracentesis W Imaging Guidance,,32555,CPT,Facility,Both,,,,1685,1432.25,482.921,1685,"Multiplan, Inc.","Multiplan, Inc.",1583.9,94,,percent of total billed charges,,
Us Thoracentesis W Imaging Guidance,,32555,CPT,Facility,Outpatient,,,,1685,1432.25,482.921,1685,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1518.185,90.1,,percent of total billed charges,,
Us Thoracentesis W Imaging Guidance,,32555,CPT,Facility,Inpatient,,,,1685,1432.25,482.921,1685,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Us Thoracentesis W Imaging Guidance,,32555,CPT,Facility,Both,,,,1685,1432.25,482.921,1685,"Preferred One Administrative Services, INC.",PPO,1661.41,98.6,,percent of total billed charges,,
Us Thoracentesis W Imaging Guidance,,32555,CPT,Facility,Outpatient,,,,1685,1432.25,482.921,1685,PrimeWest Health,Minnesota Senior Health Options (MSHO),866.9325,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Us Thoracentesis W Imaging Guidance,,32555,CPT,Facility,Inpatient,,,,1685,1432.25,482.921,1685,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Us Thoracentesis W Imaging Guidance,,32555,CPT,Facility,Outpatient,,,,1685,1432.25,482.921,1685,PrimeWest Health,MinnesotaCare,865.416,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Us Thoracentesis W Imaging Guidance,,32555,CPT,Facility,Inpatient,,,,1685,1432.25,482.921,1685,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Us Thoracentesis W Imaging Guidance,,32555,CPT,Facility,Both,,,,1685,1432.25,482.921,1685,Sanford Health Plan,Sanford Health Plan,1550.2,92,,percent of total billed charges,,
Us Thoracentesis W Imaging Guidance,,32555,CPT,Facility,Outpatient,,,,1685,1432.25,482.921,1685,"UCare Health, Inc.",Individual & Family Plan,949.4975,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Us Thoracentesis W Imaging Guidance,,32555,CPT,Facility,Inpatient,,,,1685,1432.25,482.921,1685,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Us Thoracentesis W Imaging Guidance,,32555,CPT,Facility,Outpatient,,,,1685,1432.25,482.921,1685,"UCare Health, Inc.",Medical Assistance,850.4195,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Thoracentesis W Imaging Guidance,,32555,CPT,Facility,Inpatient,,,,1685,1432.25,482.921,1685,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Us Thoracentesis W Imaging Guidance,,32555,CPT,Facility,Outpatient,,,,1685,1432.25,482.921,1685,"UCare Health, Inc.",Medicare Advantage,850.4195,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Thoracentesis W Imaging Guidance,,32555,CPT,Facility,Inpatient,,,,1685,1432.25,482.921,1685,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Us Thoracentesis W Imaging Guidance,,32555,CPT,Facility,Outpatient,,,,1685,1432.25,482.921,1685,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),850.4195,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Thoracentesis W Imaging Guidance,,32555,CPT,Facility,Inpatient,,,,1685,1432.25,482.921,1685,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Us Thoracentesis W Imaging Guidance,,32555,CPT,Facility,Both,,,,1685,1432.25,482.921,1685,UnitedHealthcare,Individual & Family,1583.9,94,,percent of total billed charges,,
Us Thoracentesis W Imaging Guidance,,32555,CPT,Facility,Outpatient,,,,1685,1432.25,482.921,1685,UnitedHealthcare,Medicare Advantage,825.65,49,,percent of total billed charges,,
Us Thoracentesis W Imaging Guidance,,32555,CPT,Facility,Inpatient,,,,1685,1432.25,482.921,1685,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Us Thoracentesis W Imaging Guidance,,32555,CPT,Facility,Outpatient,,,,1685,1432.25,482.921,1685,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,808.8,48,,percent of total billed charges,,100% of DHS outpatient percentage
Us Thoracentesis W Imaging Guidance,,32555,CPT,Facility,Inpatient,,,,1685,1432.25,482.921,1685,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Pleural Drainage, Percutaneous, With Insertion Of Indwelling Catheter; W Img Guidance (Pro Cah)",,32557,CPT,Professional,Both,,,,1729,1469.65,91.41,1729,Aetna,Commercial,1469.65,85,,percent of total billed charges,,
"Pleural Drainage, Percutaneous, With Insertion Of Indwelling Catheter; W Img Guidance (Pro Cah)",,32557,CPT,Professional,Both,,,,1729,1469.65,91.41,1729,Aetna,Medicare Advantage,146.71,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Pleural Drainage, Percutaneous, With Insertion Of Indwelling Catheter; W Img Guidance (Pro Cah)",,32557,CPT,Professional,Both,,,,1729,1469.65,91.41,1729,Aetna,PPO,1607.97,93,,percent of total billed charges,,
"Pleural Drainage, Percutaneous, With Insertion Of Indwelling Catheter; W Img Guidance (Pro Cah)",,32557,CPT,Professional,Both,,,,1729,1469.65,91.41,1729,America's PPO,America's PPO,1477.2576,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Pleural Drainage, Percutaneous, With Insertion Of Indwelling Catheter; W Img Guidance (Pro Cah)",,32557,CPT,Professional,Both,,,,1729,1469.65,91.41,1729,BlueCross BlueShield Minnesota, Federal Employee Program,301.61,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Pleural Drainage, Percutaneous, With Insertion Of Indwelling Catheter; W Img Guidance (Pro Cah)",,32557,CPT,Professional,Both,,,,1729,1469.65,91.41,1729,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,306.43576,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Pleural Drainage, Percutaneous, With Insertion Of Indwelling Catheter; W Img Guidance (Pro Cah)",,32557,CPT,Professional,Both,,,,1729,1469.65,91.41,1729,BlueCross BlueShield Minnesota,High Value Network Plan,306.43576,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Pleural Drainage, Percutaneous, With Insertion Of Indwelling Catheter; W Img Guidance (Pro Cah)",,32557,CPT,Professional,Both,,,,1729,1469.65,91.41,1729,BlueCross BlueShield Minnesota,Medicare Advantage,163.5185,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Pleural Drainage, Percutaneous, With Insertion Of Indwelling Catheter; W Img Guidance (Pro Cah)",,32557,CPT,Professional,Both,,,,1729,1469.65,91.41,1729,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,306.43576,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Pleural Drainage, Percutaneous, With Insertion Of Indwelling Catheter; W Img Guidance (Pro Cah)",,32557,CPT,Professional,Both,,,,1729,1469.65,91.41,1729,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,105.53192,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Pleural Drainage, Percutaneous, With Insertion Of Indwelling Catheter; W Img Guidance (Pro Cah)",,32557,CPT,Professional,Both,,,,1729,1469.65,91.41,1729,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),163.5185,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Pleural Drainage, Percutaneous, With Insertion Of Indwelling Catheter; W Img Guidance (Pro Cah)",,32557,CPT,Professional,Both,,,,1729,1469.65,91.41,1729,CorVel,Worker's Compensation,281.9742864,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Pleural Drainage, Percutaneous, With Insertion Of Indwelling Catheter; W Img Guidance (Pro Cah)",,32557,CPT,Professional,Both,,,,1729,1469.65,91.41,1729,First Health Group Corporation,First Health Network,1677.13,97,,percent of total billed charges,,
"Pleural Drainage, Percutaneous, With Insertion Of Indwelling Catheter; W Img Guidance (Pro Cah)",,32557,CPT,Professional,Both,,,,1729,1469.65,91.41,1729,"Health Partners, Inc.",Commercial,304.72,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Pleural Drainage, Percutaneous, With Insertion Of Indwelling Catheter; W Img Guidance (Pro Cah)",,32557,CPT,Professional,Both,,,,1729,1469.65,91.41,1729,"Health Partners, Inc.",Medicare Advantage,163.5185,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Pleural Drainage, Percutaneous, With Insertion Of Indwelling Catheter; W Img Guidance (Pro Cah)",,32557,CPT,Professional,Both,,,,1729,1469.65,91.41,1729,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),142.33,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Pleural Drainage, Percutaneous, With Insertion Of Indwelling Catheter; W Img Guidance (Pro Cah)",,32557,CPT,Professional,Both,,,,1729,1469.65,91.41,1729,"Health Partners, Inc.",State of Minnesota Advantage Program,262.51628,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Pleural Drainage, Percutaneous, With Insertion Of Indwelling Catheter; W Img Guidance (Pro Cah)",,32557,CPT,Professional,Both,,,,1729,1469.65,91.41,1729,"Health Partners, Inc.",State Public Programs,91.41,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Pleural Drainage, Percutaneous, With Insertion Of Indwelling Catheter; W Img Guidance (Pro Cah)",,32557,CPT,Professional,Both,,,,1729,1469.65,91.41,1729,Humana Insurance Company,Commercial PPO,142.19,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Pleural Drainage, Percutaneous, With Insertion Of Indwelling Catheter; W Img Guidance (Pro Cah)",,32557,CPT,Professional,Both,,,,1729,1469.65,91.41,1729,Humana Insurance Company,Medicare PPO,1729,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Pleural Drainage, Percutaneous, With Insertion Of Indwelling Catheter; W Img Guidance (Pro Cah)",,32557,CPT,Professional,Both,,,,1729,1469.65,91.41,1729,Medica,Individual & Family,1466.192,84.8,,percent of total billed charges,,
"Pleural Drainage, Percutaneous, With Insertion Of Indwelling Catheter; W Img Guidance (Pro Cah)",,32557,CPT,Professional,Both,,,,1729,1469.65,91.41,1729,Medica,Medica Advantage Solution,861.042,49.8,,percent of total billed charges,,
"Pleural Drainage, Percutaneous, With Insertion Of Indwelling Catheter; W Img Guidance (Pro Cah)",,32557,CPT,Professional,Both,,,,1729,1469.65,91.41,1729,Medica,Medical Assistance,105.53,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Pleural Drainage, Percutaneous, With Insertion Of Indwelling Catheter; W Img Guidance (Pro Cah)",,32557,CPT,Professional,Both,,,,1729,1469.65,91.41,1729,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,142.19,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Pleural Drainage, Percutaneous, With Insertion Of Indwelling Catheter; W Img Guidance (Pro Cah)",,32557,CPT,Professional,Both,,,,1729,1469.65,91.41,1729,"Multiplan, Inc.","Multiplan, Inc.",1625.26,94,,percent of total billed charges,,
"Pleural Drainage, Percutaneous, With Insertion Of Indwelling Catheter; W Img Guidance (Pro Cah)",,32557,CPT,Professional,Both,,,,1729,1469.65,91.41,1729,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1557.829,90.1,,percent of total billed charges,,
"Pleural Drainage, Percutaneous, With Insertion Of Indwelling Catheter; W Img Guidance (Pro Cah)",,32557,CPT,Professional,Both,,,,1729,1469.65,91.41,1729,"Preferred One Administrative Services, INC.",PPO,1704.794,98.6,,percent of total billed charges,,
"Pleural Drainage, Percutaneous, With Insertion Of Indwelling Catheter; W Img Guidance (Pro Cah)",,32557,CPT,Professional,Both,,,,1729,1469.65,91.41,1729,PrimeWest Health,Minnesota Senior Health Options (MSHO),163.5185,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Pleural Drainage, Percutaneous, With Insertion Of Indwelling Catheter; W Img Guidance (Pro Cah)",,32557,CPT,Professional,Both,,,,1729,1469.65,91.41,1729,PrimeWest Health,MinnesotaCare,112.9191544,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Pleural Drainage, Percutaneous, With Insertion Of Indwelling Catheter; W Img Guidance (Pro Cah)",,32557,CPT,Professional,Both,,,,1729,1469.65,91.41,1729,Sanford Health Plan,Sanford Health Plan,1521.52,88,,percent of total billed charges,,
"Pleural Drainage, Percutaneous, With Insertion Of Indwelling Catheter; W Img Guidance (Pro Cah)",,32557,CPT,Professional,Both,,,,1729,1469.65,91.41,1729,"UCare Health, Inc.",Individual & Family Plan,231.144064,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Pleural Drainage, Percutaneous, With Insertion Of Indwelling Catheter; W Img Guidance (Pro Cah)",,32557,CPT,Professional,Both,,,,1729,1469.65,91.41,1729,"UCare Health, Inc.",Medical Assistance,116.085112,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Pleural Drainage, Percutaneous, With Insertion Of Indwelling Catheter; W Img Guidance (Pro Cah)",,32557,CPT,Professional,Both,,,,1729,1469.65,91.41,1729,"UCare Health, Inc.",Medicare Advantage,163.5185,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Pleural Drainage, Percutaneous, With Insertion Of Indwelling Catheter; W Img Guidance (Pro Cah)",,32557,CPT,Professional,Both,,,,1729,1469.65,91.41,1729,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),130.8148,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Pleural Drainage, Percutaneous, With Insertion Of Indwelling Catheter; W Img Guidance (Pro Cah)",,32557,CPT,Professional,Both,,,,1729,1469.65,91.41,1729,UnitedHealthcare,Individual & Family,1729,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Pleural Drainage, Percutaneous, With Insertion Of Indwelling Catheter; W Img Guidance (Pro Cah)",,32557,CPT,Professional,Both,,,,1729,1469.65,91.41,1729,UnitedHealthcare,Medicare Advantage,163.5185,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Pleural Drainage, Percutaneous, With Insertion Of Indwelling Catheter; W Img Guidance (Pro Cah)",,32557,CPT,Professional,Both,,,,1729,1469.65,91.41,1729,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,105.53192,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Pleural Drainage, Percutaneous, With Insertion Of Indwelling Catheter; With Image Guidance (Pbb)",,32557,CPT,Facility,Outpatient,,,,862,732.7,247.0492,862,Aetna,Commercial,793.04,92,,percent of total billed charges,,
"Pleural Drainage, Percutaneous, With Insertion Of Indwelling Catheter; With Image Guidance (Pbb)",,32557,CPT,Professional,Outpatient,,,,867,736.95,91.41,867,Aetna,Commercial,736.95,85,,percent of total billed charges,,
"Pleural Drainage, Percutaneous, With Insertion Of Indwelling Catheter; With Image Guidance (Pbb)",,32557,CPT,Facility,Outpatient,,,,862,732.7,247.0492,862,Aetna,Medicare Advantage,422.38,49,,percent of total billed charges,,
"Pleural Drainage, Percutaneous, With Insertion Of Indwelling Catheter; With Image Guidance (Pbb)",,32557,CPT,Professional,Outpatient,,,,867,736.95,91.41,867,Aetna,Medicare Advantage,146.71,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Pleural Drainage, Percutaneous, With Insertion Of Indwelling Catheter; With Image Guidance (Pbb)",,32557,CPT,Facility,Outpatient,,,,862,732.7,247.0492,862,Aetna,PPO,801.66,93,,percent of total billed charges,,
"Pleural Drainage, Percutaneous, With Insertion Of Indwelling Catheter; With Image Guidance (Pbb)",,32557,CPT,Professional,Outpatient,,,,867,736.95,91.41,867,Aetna,PPO,806.31,93,,percent of total billed charges,,
"Pleural Drainage, Percutaneous, With Insertion Of Indwelling Catheter; With Image Guidance (Pbb)",,32557,CPT,Facility,Outpatient,,,,862,732.7,247.0492,862,America's PPO,America's PPO,827.7786,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Pleural Drainage, Percutaneous, With Insertion Of Indwelling Catheter; With Image Guidance (Pbb)",,32557,CPT,Professional,Outpatient,,,,867,736.95,91.41,867,America's PPO,America's PPO,740.7648,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Pleural Drainage, Percutaneous, With Insertion Of Indwelling Catheter; With Image Guidance (Pbb)",,32557,CPT,Facility,Outpatient,,,,862,732.7,247.0492,862,BlueCross BlueShield Minnesota, Federal Employee Program,848.208,98.4,,percent of total billed charges,,
"Pleural Drainage, Percutaneous, With Insertion Of Indwelling Catheter; With Image Guidance (Pbb)",,32557,CPT,Professional,Outpatient,,,,867,736.95,91.41,867,BlueCross BlueShield Minnesota, Federal Employee Program,301.61,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Pleural Drainage, Percutaneous, With Insertion Of Indwelling Catheter; With Image Guidance (Pbb)",,32557,CPT,Facility,Outpatient,,,,862,732.7,247.0492,862,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,862,100,,percent of total billed charges,,
"Pleural Drainage, Percutaneous, With Insertion Of Indwelling Catheter; With Image Guidance (Pbb)",,32557,CPT,Professional,Outpatient,,,,867,736.95,91.41,867,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,306.43576,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Pleural Drainage, Percutaneous, With Insertion Of Indwelling Catheter; With Image Guidance (Pbb)",,32557,CPT,Facility,Outpatient,,,,862,732.7,247.0492,862,BlueCross BlueShield Minnesota,High Value Network Plan,775.8,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
"Pleural Drainage, Percutaneous, With Insertion Of Indwelling Catheter; With Image Guidance (Pbb)",,32557,CPT,Professional,Outpatient,,,,867,736.95,91.41,867,BlueCross BlueShield Minnesota,High Value Network Plan,306.43576,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Pleural Drainage, Percutaneous, With Insertion Of Indwelling Catheter; With Image Guidance (Pbb)",,32557,CPT,Facility,Outpatient,,,,862,732.7,247.0492,862,BlueCross BlueShield Minnesota,Medicare Advantage,422.38,49,,percent of total billed charges,,
"Pleural Drainage, Percutaneous, With Insertion Of Indwelling Catheter; With Image Guidance (Pbb)",,32557,CPT,Professional,Outpatient,,,,867,736.95,91.41,867,BlueCross BlueShield Minnesota,Medicare Advantage,163.5185,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Pleural Drainage, Percutaneous, With Insertion Of Indwelling Catheter; With Image Guidance (Pbb)",,32557,CPT,Professional,Outpatient,,,,867,736.95,91.41,867,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,306.43576,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Pleural Drainage, Percutaneous, With Insertion Of Indwelling Catheter; With Image Guidance (Pbb)",,32557,CPT,Facility,Outpatient,,,,862,732.7,247.0492,862,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,247.0492,28.66,,percent of total billed charges,,
"Pleural Drainage, Percutaneous, With Insertion Of Indwelling Catheter; With Image Guidance (Pbb)",,32557,CPT,Professional,Outpatient,,,,867,736.95,91.41,867,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,105.53192,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Pleural Drainage, Percutaneous, With Insertion Of Indwelling Catheter; With Image Guidance (Pbb)",,32557,CPT,Facility,Outpatient,,,,862,732.7,247.0492,862,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),422.38,49,,percent of total billed charges,,
"Pleural Drainage, Percutaneous, With Insertion Of Indwelling Catheter; With Image Guidance (Pbb)",,32557,CPT,Professional,Outpatient,,,,867,736.95,91.41,867,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),163.5185,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Pleural Drainage, Percutaneous, With Insertion Of Indwelling Catheter; With Image Guidance (Pbb)",,32557,CPT,Facility,Outpatient,,,,862,732.7,247.0492,862,CorVel,Worker's Compensation,862,100,,percent of total billed charges,,
"Pleural Drainage, Percutaneous, With Insertion Of Indwelling Catheter; With Image Guidance (Pbb)",,32557,CPT,Professional,Outpatient,,,,867,736.95,91.41,867,CorVel,Worker's Compensation,281.9742864,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Pleural Drainage, Percutaneous, With Insertion Of Indwelling Catheter; With Image Guidance (Pbb)",,32557,CPT,Facility,Outpatient,,,,862,732.7,247.0492,862,First Health Group Corporation,First Health Network,836.14,97,,percent of total billed charges,,
"Pleural Drainage, Percutaneous, With Insertion Of Indwelling Catheter; With Image Guidance (Pbb)",,32557,CPT,Professional,Outpatient,,,,867,736.95,91.41,867,First Health Group Corporation,First Health Network,840.99,97,,percent of total billed charges,,
"Pleural Drainage, Percutaneous, With Insertion Of Indwelling Catheter; With Image Guidance (Pbb)",,32557,CPT,Facility,Outpatient,,,,862,732.7,247.0492,862,"Health Partners, Inc.",Commercial,815.452,94.6,,percent of total billed charges,,
"Pleural Drainage, Percutaneous, With Insertion Of Indwelling Catheter; With Image Guidance (Pbb)",,32557,CPT,Professional,Outpatient,,,,867,736.95,91.41,867,"Health Partners, Inc.",Commercial,304.72,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Pleural Drainage, Percutaneous, With Insertion Of Indwelling Catheter; With Image Guidance (Pbb)",,32557,CPT,Facility,Outpatient,,,,862,732.7,247.0492,862,"Health Partners, Inc.",Medicare Advantage,422.38,49,,percent of total billed charges,,
"Pleural Drainage, Percutaneous, With Insertion Of Indwelling Catheter; With Image Guidance (Pbb)",,32557,CPT,Professional,Outpatient,,,,867,736.95,91.41,867,"Health Partners, Inc.",Medicare Advantage,163.5185,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Pleural Drainage, Percutaneous, With Insertion Of Indwelling Catheter; With Image Guidance (Pbb)",,32557,CPT,Facility,Outpatient,,,,862,732.7,247.0492,862,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),517.2,60,,percent of total billed charges,,
"Pleural Drainage, Percutaneous, With Insertion Of Indwelling Catheter; With Image Guidance (Pbb)",,32557,CPT,Professional,Outpatient,,,,867,736.95,91.41,867,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),142.33,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Pleural Drainage, Percutaneous, With Insertion Of Indwelling Catheter; With Image Guidance (Pbb)",,32557,CPT,Facility,Outpatient,,,,862,732.7,247.0492,862,"Health Partners, Inc.",State of Minnesota Advantage Program,702.53,81.5,,percent of total billed charges,,
"Pleural Drainage, Percutaneous, With Insertion Of Indwelling Catheter; With Image Guidance (Pbb)",,32557,CPT,Professional,Outpatient,,,,867,736.95,91.41,867,"Health Partners, Inc.",State of Minnesota Advantage Program,262.51628,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Pleural Drainage, Percutaneous, With Insertion Of Indwelling Catheter; With Image Guidance (Pbb)",,32557,CPT,Facility,Outpatient,,,,862,732.7,247.0492,862,"Health Partners, Inc.",State Public Programs,431,50,,percent of total billed charges,,
"Pleural Drainage, Percutaneous, With Insertion Of Indwelling Catheter; With Image Guidance (Pbb)",,32557,CPT,Professional,Outpatient,,,,867,736.95,91.41,867,"Health Partners, Inc.",State Public Programs,91.41,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Pleural Drainage, Percutaneous, With Insertion Of Indwelling Catheter; With Image Guidance (Pbb)",,32557,CPT,Facility,Outpatient,,,,862,732.7,247.0492,862,Humana Insurance Company,Commercial PPO,818.9,95,,percent of total billed charges,,
"Pleural Drainage, Percutaneous, With Insertion Of Indwelling Catheter; With Image Guidance (Pbb)",,32557,CPT,Professional,Outpatient,,,,867,736.95,91.41,867,Humana Insurance Company,Commercial PPO,142.19,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Pleural Drainage, Percutaneous, With Insertion Of Indwelling Catheter; With Image Guidance (Pbb)",,32557,CPT,Facility,Outpatient,,,,862,732.7,247.0492,862,Humana Insurance Company,Medicare PPO,422.38,49,,percent of total billed charges,,
"Pleural Drainage, Percutaneous, With Insertion Of Indwelling Catheter; With Image Guidance (Pbb)",,32557,CPT,Professional,Outpatient,,,,867,736.95,91.41,867,Humana Insurance Company,Medicare PPO,867,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Pleural Drainage, Percutaneous, With Insertion Of Indwelling Catheter; With Image Guidance (Pbb)",,32557,CPT,Facility,Outpatient,,,,862,732.7,247.0492,862,Medica,Individual & Family,854.242,99.1,,percent of total billed charges,,
"Pleural Drainage, Percutaneous, With Insertion Of Indwelling Catheter; With Image Guidance (Pbb)",,32557,CPT,Professional,Outpatient,,,,867,736.95,91.41,867,Medica,Individual & Family,735.216,84.8,,percent of total billed charges,,
"Pleural Drainage, Percutaneous, With Insertion Of Indwelling Catheter; With Image Guidance (Pbb)",,32557,CPT,Facility,Outpatient,,,,862,732.7,247.0492,862,Medica,Medica Advantage Solution,429.276,49.8,,percent of total billed charges,,
"Pleural Drainage, Percutaneous, With Insertion Of Indwelling Catheter; With Image Guidance (Pbb)",,32557,CPT,Professional,Outpatient,,,,867,736.95,91.41,867,Medica,Medica Advantage Solution,431.766,49.8,,percent of total billed charges,,
"Pleural Drainage, Percutaneous, With Insertion Of Indwelling Catheter; With Image Guidance (Pbb)",,32557,CPT,Facility,Outpatient,,,,862,732.7,247.0492,862,Medica,Medical Assistance,384.452,44.6,,percent of total billed charges,,
"Pleural Drainage, Percutaneous, With Insertion Of Indwelling Catheter; With Image Guidance (Pbb)",,32557,CPT,Professional,Outpatient,,,,867,736.95,91.41,867,Medica,Medical Assistance,105.53,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Pleural Drainage, Percutaneous, With Insertion Of Indwelling Catheter; With Image Guidance (Pbb)",,32557,CPT,Facility,Outpatient,,,,862,732.7,247.0492,862,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,429.276,49.8,,percent of total billed charges,,
"Pleural Drainage, Percutaneous, With Insertion Of Indwelling Catheter; With Image Guidance (Pbb)",,32557,CPT,Professional,Outpatient,,,,867,736.95,91.41,867,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,142.19,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Pleural Drainage, Percutaneous, With Insertion Of Indwelling Catheter; With Image Guidance (Pbb)",,32557,CPT,Facility,Outpatient,,,,862,732.7,247.0492,862,"Multiplan, Inc.","Multiplan, Inc.",810.28,94,,percent of total billed charges,,
"Pleural Drainage, Percutaneous, With Insertion Of Indwelling Catheter; With Image Guidance (Pbb)",,32557,CPT,Professional,Outpatient,,,,867,736.95,91.41,867,"Multiplan, Inc.","Multiplan, Inc.",814.98,94,,percent of total billed charges,,
"Pleural Drainage, Percutaneous, With Insertion Of Indwelling Catheter; With Image Guidance (Pbb)",,32557,CPT,Facility,Outpatient,,,,862,732.7,247.0492,862,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,776.662,90.1,,percent of total billed charges,,
"Pleural Drainage, Percutaneous, With Insertion Of Indwelling Catheter; With Image Guidance (Pbb)",,32557,CPT,Professional,Outpatient,,,,867,736.95,91.41,867,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,781.167,90.1,,percent of total billed charges,,
"Pleural Drainage, Percutaneous, With Insertion Of Indwelling Catheter; With Image Guidance (Pbb)",,32557,CPT,Facility,Outpatient,,,,862,732.7,247.0492,862,"Preferred One Administrative Services, INC.",PPO,849.932,98.6,,percent of total billed charges,,
"Pleural Drainage, Percutaneous, With Insertion Of Indwelling Catheter; With Image Guidance (Pbb)",,32557,CPT,Professional,Outpatient,,,,867,736.95,91.41,867,"Preferred One Administrative Services, INC.",PPO,854.862,98.6,,percent of total billed charges,,
"Pleural Drainage, Percutaneous, With Insertion Of Indwelling Catheter; With Image Guidance (Pbb)",,32557,CPT,Facility,Outpatient,,,,862,732.7,247.0492,862,PrimeWest Health,Minnesota Senior Health Options (MSHO),443.499,51.45,,percent of total billed charges,,
"Pleural Drainage, Percutaneous, With Insertion Of Indwelling Catheter; With Image Guidance (Pbb)",,32557,CPT,Professional,Outpatient,,,,867,736.95,91.41,867,PrimeWest Health,Minnesota Senior Health Options (MSHO),163.5185,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Pleural Drainage, Percutaneous, With Insertion Of Indwelling Catheter; With Image Guidance (Pbb)",,32557,CPT,Facility,Outpatient,,,,862,732.7,247.0492,862,PrimeWest Health,MinnesotaCare,442.7232,51.36,,percent of total billed charges,,
"Pleural Drainage, Percutaneous, With Insertion Of Indwelling Catheter; With Image Guidance (Pbb)",,32557,CPT,Professional,Outpatient,,,,867,736.95,91.41,867,PrimeWest Health,MinnesotaCare,112.9191544,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Pleural Drainage, Percutaneous, With Insertion Of Indwelling Catheter; With Image Guidance (Pbb)",,32557,CPT,Facility,Outpatient,,,,862,732.7,247.0492,862,Sanford Health Plan,Sanford Health Plan,793.04,92,,percent of total billed charges,,
"Pleural Drainage, Percutaneous, With Insertion Of Indwelling Catheter; With Image Guidance (Pbb)",,32557,CPT,Professional,Outpatient,,,,867,736.95,91.41,867,Sanford Health Plan,Sanford Health Plan,762.96,88,,percent of total billed charges,,
"Pleural Drainage, Percutaneous, With Insertion Of Indwelling Catheter; With Image Guidance (Pbb)",,32557,CPT,Facility,Outpatient,,,,862,732.7,247.0492,862,"UCare Health, Inc.",Individual & Family Plan,485.737,56.35,,percent of total billed charges,,
"Pleural Drainage, Percutaneous, With Insertion Of Indwelling Catheter; With Image Guidance (Pbb)",,32557,CPT,Professional,Outpatient,,,,867,736.95,91.41,867,"UCare Health, Inc.",Individual & Family Plan,231.144064,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Pleural Drainage, Percutaneous, With Insertion Of Indwelling Catheter; With Image Guidance (Pbb)",,32557,CPT,Facility,Outpatient,,,,862,732.7,247.0492,862,"UCare Health, Inc.",Medical Assistance,435.0514,50.47,,percent of total billed charges,,
"Pleural Drainage, Percutaneous, With Insertion Of Indwelling Catheter; With Image Guidance (Pbb)",,32557,CPT,Professional,Outpatient,,,,867,736.95,91.41,867,"UCare Health, Inc.",Medical Assistance,116.085112,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Pleural Drainage, Percutaneous, With Insertion Of Indwelling Catheter; With Image Guidance (Pbb)",,32557,CPT,Facility,Outpatient,,,,862,732.7,247.0492,862,"UCare Health, Inc.",Medicare Advantage,435.0514,50.47,,percent of total billed charges,,
"Pleural Drainage, Percutaneous, With Insertion Of Indwelling Catheter; With Image Guidance (Pbb)",,32557,CPT,Professional,Outpatient,,,,867,736.95,91.41,867,"UCare Health, Inc.",Medicare Advantage,163.5185,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Pleural Drainage, Percutaneous, With Insertion Of Indwelling Catheter; With Image Guidance (Pbb)",,32557,CPT,Facility,Outpatient,,,,862,732.7,247.0492,862,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),435.0514,50.47,,percent of total billed charges,,
"Pleural Drainage, Percutaneous, With Insertion Of Indwelling Catheter; With Image Guidance (Pbb)",,32557,CPT,Professional,Outpatient,,,,867,736.95,91.41,867,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),130.8148,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Pleural Drainage, Percutaneous, With Insertion Of Indwelling Catheter; With Image Guidance (Pbb)",,32557,CPT,Facility,Outpatient,,,,862,732.7,247.0492,862,UnitedHealthcare,Individual & Family,810.28,94,,percent of total billed charges,,
"Pleural Drainage, Percutaneous, With Insertion Of Indwelling Catheter; With Image Guidance (Pbb)",,32557,CPT,Professional,Outpatient,,,,867,736.95,91.41,867,UnitedHealthcare,Individual & Family,867,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Pleural Drainage, Percutaneous, With Insertion Of Indwelling Catheter; With Image Guidance (Pbb)",,32557,CPT,Facility,Outpatient,,,,862,732.7,247.0492,862,UnitedHealthcare,Medicare Advantage,422.38,49,,percent of total billed charges,,
"Pleural Drainage, Percutaneous, With Insertion Of Indwelling Catheter; With Image Guidance (Pbb)",,32557,CPT,Professional,Outpatient,,,,867,736.95,91.41,867,UnitedHealthcare,Medicare Advantage,163.5185,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Pleural Drainage, Percutaneous, With Insertion Of Indwelling Catheter; With Image Guidance (Pbb)",,32557,CPT,Facility,Outpatient,,,,862,732.7,247.0492,862,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,413.76,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Pleural Drainage, Percutaneous, With Insertion Of Indwelling Catheter; With Image Guidance (Pbb)",,32557,CPT,Professional,Outpatient,,,,867,736.95,91.41,867,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,105.53192,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
TETANUS IMMUNE GLOBULIN (PF) 250 UNIT/ML IM SYRG,,J1670,HCPCS,Facility,Both,1,mL,,2496,2121.6,715.3536,2496,Aetna,Commercial,2296.32,92,,percent of total billed charges,,
TETANUS IMMUNE GLOBULIN (PF) 250 UNIT/ML IM SYRG,,J1670,HCPCS,Facility,Outpatient,1,mL,,2496,2121.6,715.3536,2496,Aetna,Medicare Advantage,1223.04,49,,percent of total billed charges,,
TETANUS IMMUNE GLOBULIN (PF) 250 UNIT/ML IM SYRG,,J1670,HCPCS,Facility,Inpatient,1,mL,,2496,2121.6,715.3536,2496,Aetna,Medicare Advantage,,,,,Included in per diem rate,
TETANUS IMMUNE GLOBULIN (PF) 250 UNIT/ML IM SYRG,,J1670,HCPCS,Facility,Both,1,mL,,2496,2121.6,715.3536,2496,Aetna,PPO,2321.28,93,,percent of total billed charges,,
TETANUS IMMUNE GLOBULIN (PF) 250 UNIT/ML IM SYRG,,J1670,HCPCS,Facility,Both,1,mL,,2496,2121.6,715.3536,2496,America's PPO,America's PPO,2396.9088,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
TETANUS IMMUNE GLOBULIN (PF) 250 UNIT/ML IM SYRG,,J1670,HCPCS,Facility,Both,1,mL,,2496,2121.6,715.3536,2496,BlueCross BlueShield Minnesota, Federal Employee Program,2456.064,98.4,,percent of total billed charges,,
TETANUS IMMUNE GLOBULIN (PF) 250 UNIT/ML IM SYRG,,J1670,HCPCS,Facility,Both,1,mL,,2496,2121.6,715.3536,2496,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,2496,100,,percent of total billed charges,,
TETANUS IMMUNE GLOBULIN (PF) 250 UNIT/ML IM SYRG,,J1670,HCPCS,Facility,Both,1,mL,,2496,2121.6,715.3536,2496,BlueCross BlueShield Minnesota,High Value Network Plan,2246.4,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
TETANUS IMMUNE GLOBULIN (PF) 250 UNIT/ML IM SYRG,,J1670,HCPCS,Facility,Outpatient,1,mL,,2496,2121.6,715.3536,2496,BlueCross BlueShield Minnesota,Medicare Advantage,1223.04,49,,percent of total billed charges,,
TETANUS IMMUNE GLOBULIN (PF) 250 UNIT/ML IM SYRG,,J1670,HCPCS,Facility,Inpatient,1,mL,,2496,2121.6,715.3536,2496,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
TETANUS IMMUNE GLOBULIN (PF) 250 UNIT/ML IM SYRG,,J1670,HCPCS,Facility,Both,1,mL,,2496,2121.6,715.3536,2496,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,2210.7072,88.57,,percent of total billed charges,,
TETANUS IMMUNE GLOBULIN (PF) 250 UNIT/ML IM SYRG,,J1670,HCPCS,Facility,Both,1,mL,,2496,2121.6,715.3536,2496,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,715.3536,28.66,,percent of total billed charges,,
TETANUS IMMUNE GLOBULIN (PF) 250 UNIT/ML IM SYRG,,J1670,HCPCS,Facility,Outpatient,1,mL,,2496,2121.6,715.3536,2496,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1223.04,49,,percent of total billed charges,,
TETANUS IMMUNE GLOBULIN (PF) 250 UNIT/ML IM SYRG,,J1670,HCPCS,Facility,Inpatient,1,mL,,2496,2121.6,715.3536,2496,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
TETANUS IMMUNE GLOBULIN (PF) 250 UNIT/ML IM SYRG,,J1670,HCPCS,Facility,Both,1,mL,,2496,2121.6,715.3536,2496,CorVel,Worker's Compensation,2496,100,,percent of total billed charges,,
TETANUS IMMUNE GLOBULIN (PF) 250 UNIT/ML IM SYRG,,J1670,HCPCS,Facility,Both,1,mL,,2496,2121.6,715.3536,2496,First Health Group Corporation,First Health Network,2421.12,97,,percent of total billed charges,,
TETANUS IMMUNE GLOBULIN (PF) 250 UNIT/ML IM SYRG,,J1670,HCPCS,Facility,Both,1,mL,,2496,2121.6,715.3536,2496,"Health Partners, Inc.",Commercial,2361.216,94.6,,percent of total billed charges,,
TETANUS IMMUNE GLOBULIN (PF) 250 UNIT/ML IM SYRG,,J1670,HCPCS,Facility,Outpatient,1,mL,,2496,2121.6,715.3536,2496,"Health Partners, Inc.",Medicare Advantage,1223.04,49,,percent of total billed charges,,
TETANUS IMMUNE GLOBULIN (PF) 250 UNIT/ML IM SYRG,,J1670,HCPCS,Facility,Inpatient,1,mL,,2496,2121.6,715.3536,2496,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
TETANUS IMMUNE GLOBULIN (PF) 250 UNIT/ML IM SYRG,,J1670,HCPCS,Facility,Both,1,mL,,2496,2121.6,715.3536,2496,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1497.6,60,,percent of total billed charges,,
TETANUS IMMUNE GLOBULIN (PF) 250 UNIT/ML IM SYRG,,J1670,HCPCS,Facility,Both,1,mL,,2496,2121.6,715.3536,2496,"Health Partners, Inc.",State of Minnesota Advantage Program,2034.24,81.5,,percent of total billed charges,,
TETANUS IMMUNE GLOBULIN (PF) 250 UNIT/ML IM SYRG,,J1670,HCPCS,Facility,Both,1,mL,,2496,2121.6,715.3536,2496,"Health Partners, Inc.",State Public Programs,1248,50,,percent of total billed charges,,
TETANUS IMMUNE GLOBULIN (PF) 250 UNIT/ML IM SYRG,,J1670,HCPCS,Facility,Both,1,mL,,2496,2121.6,715.3536,2496,Humana Insurance Company,Commercial PPO,2371.2,95,,percent of total billed charges,,
TETANUS IMMUNE GLOBULIN (PF) 250 UNIT/ML IM SYRG,,J1670,HCPCS,Facility,Outpatient,1,mL,,2496,2121.6,715.3536,2496,Humana Insurance Company,Medicare PPO,1223.04,49,,percent of total billed charges,,
TETANUS IMMUNE GLOBULIN (PF) 250 UNIT/ML IM SYRG,,J1670,HCPCS,Facility,Inpatient,1,mL,,2496,2121.6,715.3536,2496,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
TETANUS IMMUNE GLOBULIN (PF) 250 UNIT/ML IM SYRG,,J1670,HCPCS,Facility,Both,1,mL,,2496,2121.6,715.3536,2496,Medica,Individual & Family,2473.536,99.1,,percent of total billed charges,,
TETANUS IMMUNE GLOBULIN (PF) 250 UNIT/ML IM SYRG,,J1670,HCPCS,Facility,Outpatient,1,mL,,2496,2121.6,715.3536,2496,Medica,Medica Advantage Solution,1243.008,49.8,,percent of total billed charges,,
TETANUS IMMUNE GLOBULIN (PF) 250 UNIT/ML IM SYRG,,J1670,HCPCS,Facility,Inpatient,1,mL,,2496,2121.6,715.3536,2496,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
TETANUS IMMUNE GLOBULIN (PF) 250 UNIT/ML IM SYRG,,J1670,HCPCS,Facility,Outpatient,1,mL,,2496,2121.6,715.3536,2496,Medica,Medical Assistance,1113.216,44.6,,percent of total billed charges,,
TETANUS IMMUNE GLOBULIN (PF) 250 UNIT/ML IM SYRG,,J1670,HCPCS,Facility,Inpatient,1,mL,,2496,2121.6,715.3536,2496,Medica,Medical Assistance,,,,,Included in per diem rate,
TETANUS IMMUNE GLOBULIN (PF) 250 UNIT/ML IM SYRG,,J1670,HCPCS,Facility,Outpatient,1,mL,,2496,2121.6,715.3536,2496,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1243.008,49.8,,percent of total billed charges,,
TETANUS IMMUNE GLOBULIN (PF) 250 UNIT/ML IM SYRG,,J1670,HCPCS,Facility,Inpatient,1,mL,,2496,2121.6,715.3536,2496,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
TETANUS IMMUNE GLOBULIN (PF) 250 UNIT/ML IM SYRG,,J1670,HCPCS,Facility,Both,1,mL,,2496,2121.6,715.3536,2496,"Multiplan, Inc.","Multiplan, Inc.",2346.24,94,,percent of total billed charges,,
TETANUS IMMUNE GLOBULIN (PF) 250 UNIT/ML IM SYRG,,J1670,HCPCS,Facility,Outpatient,1,mL,,2496,2121.6,715.3536,2496,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,2248.896,90.1,,percent of total billed charges,,
TETANUS IMMUNE GLOBULIN (PF) 250 UNIT/ML IM SYRG,,J1670,HCPCS,Facility,Inpatient,1,mL,,2496,2121.6,715.3536,2496,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
TETANUS IMMUNE GLOBULIN (PF) 250 UNIT/ML IM SYRG,,J1670,HCPCS,Facility,Both,1,mL,,2496,2121.6,715.3536,2496,"Preferred One Administrative Services, INC.",PPO,2461.056,98.6,,percent of total billed charges,,
TETANUS IMMUNE GLOBULIN (PF) 250 UNIT/ML IM SYRG,,J1670,HCPCS,Facility,Outpatient,1,mL,,2496,2121.6,715.3536,2496,PrimeWest Health,Minnesota Senior Health Options (MSHO),1284.192,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
TETANUS IMMUNE GLOBULIN (PF) 250 UNIT/ML IM SYRG,,J1670,HCPCS,Facility,Inpatient,1,mL,,2496,2121.6,715.3536,2496,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
TETANUS IMMUNE GLOBULIN (PF) 250 UNIT/ML IM SYRG,,J1670,HCPCS,Facility,Outpatient,1,mL,,2496,2121.6,715.3536,2496,PrimeWest Health,MinnesotaCare,1281.9456,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
TETANUS IMMUNE GLOBULIN (PF) 250 UNIT/ML IM SYRG,,J1670,HCPCS,Facility,Inpatient,1,mL,,2496,2121.6,715.3536,2496,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
TETANUS IMMUNE GLOBULIN (PF) 250 UNIT/ML IM SYRG,,J1670,HCPCS,Facility,Both,1,mL,,2496,2121.6,715.3536,2496,Sanford Health Plan,Sanford Health Plan,2296.32,92,,percent of total billed charges,,
TETANUS IMMUNE GLOBULIN (PF) 250 UNIT/ML IM SYRG,,J1670,HCPCS,Facility,Outpatient,1,mL,,2496,2121.6,715.3536,2496,"UCare Health, Inc.",Individual & Family Plan,1406.496,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
TETANUS IMMUNE GLOBULIN (PF) 250 UNIT/ML IM SYRG,,J1670,HCPCS,Facility,Inpatient,1,mL,,2496,2121.6,715.3536,2496,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
TETANUS IMMUNE GLOBULIN (PF) 250 UNIT/ML IM SYRG,,J1670,HCPCS,Facility,Outpatient,1,mL,,2496,2121.6,715.3536,2496,"UCare Health, Inc.",Medical Assistance,1259.7312,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TETANUS IMMUNE GLOBULIN (PF) 250 UNIT/ML IM SYRG,,J1670,HCPCS,Facility,Inpatient,1,mL,,2496,2121.6,715.3536,2496,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
TETANUS IMMUNE GLOBULIN (PF) 250 UNIT/ML IM SYRG,,J1670,HCPCS,Facility,Outpatient,1,mL,,2496,2121.6,715.3536,2496,"UCare Health, Inc.",Medicare Advantage,1259.7312,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TETANUS IMMUNE GLOBULIN (PF) 250 UNIT/ML IM SYRG,,J1670,HCPCS,Facility,Inpatient,1,mL,,2496,2121.6,715.3536,2496,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
TETANUS IMMUNE GLOBULIN (PF) 250 UNIT/ML IM SYRG,,J1670,HCPCS,Facility,Outpatient,1,mL,,2496,2121.6,715.3536,2496,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1259.7312,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TETANUS IMMUNE GLOBULIN (PF) 250 UNIT/ML IM SYRG,,J1670,HCPCS,Facility,Inpatient,1,mL,,2496,2121.6,715.3536,2496,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
TETANUS IMMUNE GLOBULIN (PF) 250 UNIT/ML IM SYRG,,J1670,HCPCS,Facility,Both,1,mL,,2496,2121.6,715.3536,2496,UnitedHealthcare,Individual & Family,2346.24,94,,percent of total billed charges,,
TETANUS IMMUNE GLOBULIN (PF) 250 UNIT/ML IM SYRG,,J1670,HCPCS,Facility,Outpatient,1,mL,,2496,2121.6,715.3536,2496,UnitedHealthcare,Medicare Advantage,1223.04,49,,percent of total billed charges,,
TETANUS IMMUNE GLOBULIN (PF) 250 UNIT/ML IM SYRG,,J1670,HCPCS,Facility,Inpatient,1,mL,,2496,2121.6,715.3536,2496,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
TETANUS IMMUNE GLOBULIN (PF) 250 UNIT/ML IM SYRG,,J1670,HCPCS,Facility,Outpatient,1,mL,,2496,2121.6,715.3536,2496,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1198.08,48,,percent of total billed charges,,100% of DHS outpatient percentage
TETANUS IMMUNE GLOBULIN (PF) 250 UNIT/ML IM SYRG,,J1670,HCPCS,Facility,Inpatient,1,mL,,2496,2121.6,715.3536,2496,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
KETOROLAC 15 MG/ML INJ SOLN,,J1885,HCPCS,Facility,Both,1,mL,,23,19.55,6.5918,23,Aetna,Commercial,21.16,92,,percent of total billed charges,,
KETOROLAC 15 MG/ML INJ SOLN,,J1885,HCPCS,Facility,Outpatient,1,mL,,23,19.55,6.5918,23,Aetna,Medicare Advantage,11.27,49,,percent of total billed charges,,
KETOROLAC 15 MG/ML INJ SOLN,,J1885,HCPCS,Facility,Inpatient,1,mL,,23,19.55,6.5918,23,Aetna,Medicare Advantage,,,,,Included in per diem rate,
KETOROLAC 15 MG/ML INJ SOLN,,J1885,HCPCS,Facility,Both,1,mL,,23,19.55,6.5918,23,Aetna,PPO,21.39,93,,percent of total billed charges,,
KETOROLAC 15 MG/ML INJ SOLN,,J1885,HCPCS,Facility,Both,1,mL,,23,19.55,6.5918,23,America's PPO,America's PPO,22.0869,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
KETOROLAC 15 MG/ML INJ SOLN,,J1885,HCPCS,Facility,Both,1,mL,,23,19.55,6.5918,23,BlueCross BlueShield Minnesota, Federal Employee Program,22.632,98.4,,percent of total billed charges,,
KETOROLAC 15 MG/ML INJ SOLN,,J1885,HCPCS,Facility,Both,1,mL,,23,19.55,6.5918,23,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,23,100,,percent of total billed charges,,
KETOROLAC 15 MG/ML INJ SOLN,,J1885,HCPCS,Facility,Both,1,mL,,23,19.55,6.5918,23,BlueCross BlueShield Minnesota,High Value Network Plan,20.7,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
KETOROLAC 15 MG/ML INJ SOLN,,J1885,HCPCS,Facility,Outpatient,1,mL,,23,19.55,6.5918,23,BlueCross BlueShield Minnesota,Medicare Advantage,11.27,49,,percent of total billed charges,,
KETOROLAC 15 MG/ML INJ SOLN,,J1885,HCPCS,Facility,Inpatient,1,mL,,23,19.55,6.5918,23,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
KETOROLAC 15 MG/ML INJ SOLN,,J1885,HCPCS,Facility,Both,1,mL,,23,19.55,6.5918,23,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,20.3711,88.57,,percent of total billed charges,,
KETOROLAC 15 MG/ML INJ SOLN,,J1885,HCPCS,Facility,Both,1,mL,,23,19.55,6.5918,23,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,6.5918,28.66,,percent of total billed charges,,
KETOROLAC 15 MG/ML INJ SOLN,,J1885,HCPCS,Facility,Outpatient,1,mL,,23,19.55,6.5918,23,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),11.27,49,,percent of total billed charges,,
KETOROLAC 15 MG/ML INJ SOLN,,J1885,HCPCS,Facility,Inpatient,1,mL,,23,19.55,6.5918,23,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
KETOROLAC 15 MG/ML INJ SOLN,,J1885,HCPCS,Facility,Both,1,mL,,23,19.55,6.5918,23,CorVel,Worker's Compensation,23,100,,percent of total billed charges,,
KETOROLAC 15 MG/ML INJ SOLN,,J1885,HCPCS,Facility,Both,1,mL,,23,19.55,6.5918,23,First Health Group Corporation,First Health Network,22.31,97,,percent of total billed charges,,
KETOROLAC 15 MG/ML INJ SOLN,,J1885,HCPCS,Facility,Both,1,mL,,23,19.55,6.5918,23,"Health Partners, Inc.",Commercial,21.758,94.6,,percent of total billed charges,,
KETOROLAC 15 MG/ML INJ SOLN,,J1885,HCPCS,Facility,Outpatient,1,mL,,23,19.55,6.5918,23,"Health Partners, Inc.",Medicare Advantage,11.27,49,,percent of total billed charges,,
KETOROLAC 15 MG/ML INJ SOLN,,J1885,HCPCS,Facility,Inpatient,1,mL,,23,19.55,6.5918,23,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
KETOROLAC 15 MG/ML INJ SOLN,,J1885,HCPCS,Facility,Both,1,mL,,23,19.55,6.5918,23,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),13.8,60,,percent of total billed charges,,
KETOROLAC 15 MG/ML INJ SOLN,,J1885,HCPCS,Facility,Both,1,mL,,23,19.55,6.5918,23,"Health Partners, Inc.",State of Minnesota Advantage Program,18.745,81.5,,percent of total billed charges,,
KETOROLAC 15 MG/ML INJ SOLN,,J1885,HCPCS,Facility,Both,1,mL,,23,19.55,6.5918,23,"Health Partners, Inc.",State Public Programs,11.5,50,,percent of total billed charges,,
KETOROLAC 15 MG/ML INJ SOLN,,J1885,HCPCS,Facility,Both,1,mL,,23,19.55,6.5918,23,Humana Insurance Company,Commercial PPO,21.85,95,,percent of total billed charges,,
KETOROLAC 15 MG/ML INJ SOLN,,J1885,HCPCS,Facility,Outpatient,1,mL,,23,19.55,6.5918,23,Humana Insurance Company,Medicare PPO,11.27,49,,percent of total billed charges,,
KETOROLAC 15 MG/ML INJ SOLN,,J1885,HCPCS,Facility,Inpatient,1,mL,,23,19.55,6.5918,23,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
KETOROLAC 15 MG/ML INJ SOLN,,J1885,HCPCS,Facility,Both,1,mL,,23,19.55,6.5918,23,Medica,Individual & Family,22.793,99.1,,percent of total billed charges,,
KETOROLAC 15 MG/ML INJ SOLN,,J1885,HCPCS,Facility,Outpatient,1,mL,,23,19.55,6.5918,23,Medica,Medica Advantage Solution,11.454,49.8,,percent of total billed charges,,
KETOROLAC 15 MG/ML INJ SOLN,,J1885,HCPCS,Facility,Inpatient,1,mL,,23,19.55,6.5918,23,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
KETOROLAC 15 MG/ML INJ SOLN,,J1885,HCPCS,Facility,Outpatient,1,mL,,23,19.55,6.5918,23,Medica,Medical Assistance,10.258,44.6,,percent of total billed charges,,
KETOROLAC 15 MG/ML INJ SOLN,,J1885,HCPCS,Facility,Inpatient,1,mL,,23,19.55,6.5918,23,Medica,Medical Assistance,,,,,Included in per diem rate,
KETOROLAC 15 MG/ML INJ SOLN,,J1885,HCPCS,Facility,Outpatient,1,mL,,23,19.55,6.5918,23,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,11.454,49.8,,percent of total billed charges,,
KETOROLAC 15 MG/ML INJ SOLN,,J1885,HCPCS,Facility,Inpatient,1,mL,,23,19.55,6.5918,23,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
KETOROLAC 15 MG/ML INJ SOLN,,J1885,HCPCS,Facility,Both,1,mL,,23,19.55,6.5918,23,"Multiplan, Inc.","Multiplan, Inc.",21.62,94,,percent of total billed charges,,
KETOROLAC 15 MG/ML INJ SOLN,,J1885,HCPCS,Facility,Outpatient,1,mL,,23,19.55,6.5918,23,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,20.723,90.1,,percent of total billed charges,,
KETOROLAC 15 MG/ML INJ SOLN,,J1885,HCPCS,Facility,Inpatient,1,mL,,23,19.55,6.5918,23,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
KETOROLAC 15 MG/ML INJ SOLN,,J1885,HCPCS,Facility,Both,1,mL,,23,19.55,6.5918,23,"Preferred One Administrative Services, INC.",PPO,22.678,98.6,,percent of total billed charges,,
KETOROLAC 15 MG/ML INJ SOLN,,J1885,HCPCS,Facility,Outpatient,1,mL,,23,19.55,6.5918,23,PrimeWest Health,Minnesota Senior Health Options (MSHO),11.8335,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
KETOROLAC 15 MG/ML INJ SOLN,,J1885,HCPCS,Facility,Inpatient,1,mL,,23,19.55,6.5918,23,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
KETOROLAC 15 MG/ML INJ SOLN,,J1885,HCPCS,Facility,Outpatient,1,mL,,23,19.55,6.5918,23,PrimeWest Health,MinnesotaCare,11.8128,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
KETOROLAC 15 MG/ML INJ SOLN,,J1885,HCPCS,Facility,Inpatient,1,mL,,23,19.55,6.5918,23,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
KETOROLAC 15 MG/ML INJ SOLN,,J1885,HCPCS,Facility,Both,1,mL,,23,19.55,6.5918,23,Sanford Health Plan,Sanford Health Plan,21.16,92,,percent of total billed charges,,
KETOROLAC 15 MG/ML INJ SOLN,,J1885,HCPCS,Facility,Outpatient,1,mL,,23,19.55,6.5918,23,"UCare Health, Inc.",Individual & Family Plan,12.9605,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
KETOROLAC 15 MG/ML INJ SOLN,,J1885,HCPCS,Facility,Inpatient,1,mL,,23,19.55,6.5918,23,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
KETOROLAC 15 MG/ML INJ SOLN,,J1885,HCPCS,Facility,Outpatient,1,mL,,23,19.55,6.5918,23,"UCare Health, Inc.",Medical Assistance,11.6081,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
KETOROLAC 15 MG/ML INJ SOLN,,J1885,HCPCS,Facility,Inpatient,1,mL,,23,19.55,6.5918,23,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
KETOROLAC 15 MG/ML INJ SOLN,,J1885,HCPCS,Facility,Outpatient,1,mL,,23,19.55,6.5918,23,"UCare Health, Inc.",Medicare Advantage,11.6081,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
KETOROLAC 15 MG/ML INJ SOLN,,J1885,HCPCS,Facility,Inpatient,1,mL,,23,19.55,6.5918,23,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
KETOROLAC 15 MG/ML INJ SOLN,,J1885,HCPCS,Facility,Outpatient,1,mL,,23,19.55,6.5918,23,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),11.6081,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
KETOROLAC 15 MG/ML INJ SOLN,,J1885,HCPCS,Facility,Inpatient,1,mL,,23,19.55,6.5918,23,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
KETOROLAC 15 MG/ML INJ SOLN,,J1885,HCPCS,Facility,Both,1,mL,,23,19.55,6.5918,23,UnitedHealthcare,Individual & Family,21.62,94,,percent of total billed charges,,
KETOROLAC 15 MG/ML INJ SOLN,,J1885,HCPCS,Facility,Outpatient,1,mL,,23,19.55,6.5918,23,UnitedHealthcare,Medicare Advantage,11.27,49,,percent of total billed charges,,
KETOROLAC 15 MG/ML INJ SOLN,,J1885,HCPCS,Facility,Inpatient,1,mL,,23,19.55,6.5918,23,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
KETOROLAC 15 MG/ML INJ SOLN,,J1885,HCPCS,Facility,Outpatient,1,mL,,23,19.55,6.5918,23,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,11.04,48,,percent of total billed charges,,100% of DHS outpatient percentage
KETOROLAC 15 MG/ML INJ SOLN,,J1885,HCPCS,Facility,Inpatient,1,mL,,23,19.55,6.5918,23,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
KETOROLAC 30 MG/ML (1 ML) INJ SOLN,,J1885,HCPCS,Facility,Both,1,mL,,11,9.35,3.1526,11,Aetna,Commercial,10.12,92,,percent of total billed charges,,
KETOROLAC 30 MG/ML (1 ML) INJ SOLN,,J1885,HCPCS,Facility,Outpatient,1,mL,,11,9.35,3.1526,11,Aetna,Medicare Advantage,5.39,49,,percent of total billed charges,,
KETOROLAC 30 MG/ML (1 ML) INJ SOLN,,J1885,HCPCS,Facility,Inpatient,1,mL,,11,9.35,3.1526,11,Aetna,Medicare Advantage,,,,,Included in per diem rate,
KETOROLAC 30 MG/ML (1 ML) INJ SOLN,,J1885,HCPCS,Facility,Both,1,mL,,11,9.35,3.1526,11,Aetna,PPO,10.23,93,,percent of total billed charges,,
KETOROLAC 30 MG/ML (1 ML) INJ SOLN,,J1885,HCPCS,Facility,Both,1,mL,,11,9.35,3.1526,11,America's PPO,America's PPO,10.5633,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
KETOROLAC 30 MG/ML (1 ML) INJ SOLN,,J1885,HCPCS,Facility,Both,1,mL,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota, Federal Employee Program,10.824,98.4,,percent of total billed charges,,
KETOROLAC 30 MG/ML (1 ML) INJ SOLN,,J1885,HCPCS,Facility,Both,1,mL,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,11,100,,percent of total billed charges,,
KETOROLAC 30 MG/ML (1 ML) INJ SOLN,,J1885,HCPCS,Facility,Both,1,mL,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,High Value Network Plan,9.9,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
KETOROLAC 30 MG/ML (1 ML) INJ SOLN,,J1885,HCPCS,Facility,Outpatient,1,mL,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,Medicare Advantage,5.39,49,,percent of total billed charges,,
KETOROLAC 30 MG/ML (1 ML) INJ SOLN,,J1885,HCPCS,Facility,Inpatient,1,mL,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
KETOROLAC 30 MG/ML (1 ML) INJ SOLN,,J1885,HCPCS,Facility,Both,1,mL,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,9.7427,88.57,,percent of total billed charges,,
KETOROLAC 30 MG/ML (1 ML) INJ SOLN,,J1885,HCPCS,Facility,Both,1,mL,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,3.1526,28.66,,percent of total billed charges,,
KETOROLAC 30 MG/ML (1 ML) INJ SOLN,,J1885,HCPCS,Facility,Outpatient,1,mL,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),5.39,49,,percent of total billed charges,,
KETOROLAC 30 MG/ML (1 ML) INJ SOLN,,J1885,HCPCS,Facility,Inpatient,1,mL,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
KETOROLAC 30 MG/ML (1 ML) INJ SOLN,,J1885,HCPCS,Facility,Both,1,mL,,11,9.35,3.1526,11,CorVel,Worker's Compensation,11,100,,percent of total billed charges,,
KETOROLAC 30 MG/ML (1 ML) INJ SOLN,,J1885,HCPCS,Facility,Both,1,mL,,11,9.35,3.1526,11,First Health Group Corporation,First Health Network,10.67,97,,percent of total billed charges,,
KETOROLAC 30 MG/ML (1 ML) INJ SOLN,,J1885,HCPCS,Facility,Both,1,mL,,11,9.35,3.1526,11,"Health Partners, Inc.",Commercial,10.406,94.6,,percent of total billed charges,,
KETOROLAC 30 MG/ML (1 ML) INJ SOLN,,J1885,HCPCS,Facility,Outpatient,1,mL,,11,9.35,3.1526,11,"Health Partners, Inc.",Medicare Advantage,5.39,49,,percent of total billed charges,,
KETOROLAC 30 MG/ML (1 ML) INJ SOLN,,J1885,HCPCS,Facility,Inpatient,1,mL,,11,9.35,3.1526,11,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
KETOROLAC 30 MG/ML (1 ML) INJ SOLN,,J1885,HCPCS,Facility,Both,1,mL,,11,9.35,3.1526,11,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),6.6,60,,percent of total billed charges,,
KETOROLAC 30 MG/ML (1 ML) INJ SOLN,,J1885,HCPCS,Facility,Both,1,mL,,11,9.35,3.1526,11,"Health Partners, Inc.",State of Minnesota Advantage Program,8.965,81.5,,percent of total billed charges,,
KETOROLAC 30 MG/ML (1 ML) INJ SOLN,,J1885,HCPCS,Facility,Both,1,mL,,11,9.35,3.1526,11,"Health Partners, Inc.",State Public Programs,5.5,50,,percent of total billed charges,,
KETOROLAC 30 MG/ML (1 ML) INJ SOLN,,J1885,HCPCS,Facility,Both,1,mL,,11,9.35,3.1526,11,Humana Insurance Company,Commercial PPO,10.45,95,,percent of total billed charges,,
KETOROLAC 30 MG/ML (1 ML) INJ SOLN,,J1885,HCPCS,Facility,Outpatient,1,mL,,11,9.35,3.1526,11,Humana Insurance Company,Medicare PPO,5.39,49,,percent of total billed charges,,
KETOROLAC 30 MG/ML (1 ML) INJ SOLN,,J1885,HCPCS,Facility,Inpatient,1,mL,,11,9.35,3.1526,11,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
KETOROLAC 30 MG/ML (1 ML) INJ SOLN,,J1885,HCPCS,Facility,Both,1,mL,,11,9.35,3.1526,11,Medica,Individual & Family,10.901,99.1,,percent of total billed charges,,
KETOROLAC 30 MG/ML (1 ML) INJ SOLN,,J1885,HCPCS,Facility,Outpatient,1,mL,,11,9.35,3.1526,11,Medica,Medica Advantage Solution,5.478,49.8,,percent of total billed charges,,
KETOROLAC 30 MG/ML (1 ML) INJ SOLN,,J1885,HCPCS,Facility,Inpatient,1,mL,,11,9.35,3.1526,11,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
KETOROLAC 30 MG/ML (1 ML) INJ SOLN,,J1885,HCPCS,Facility,Outpatient,1,mL,,11,9.35,3.1526,11,Medica,Medical Assistance,4.906,44.6,,percent of total billed charges,,
KETOROLAC 30 MG/ML (1 ML) INJ SOLN,,J1885,HCPCS,Facility,Inpatient,1,mL,,11,9.35,3.1526,11,Medica,Medical Assistance,,,,,Included in per diem rate,
KETOROLAC 30 MG/ML (1 ML) INJ SOLN,,J1885,HCPCS,Facility,Outpatient,1,mL,,11,9.35,3.1526,11,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,5.478,49.8,,percent of total billed charges,,
KETOROLAC 30 MG/ML (1 ML) INJ SOLN,,J1885,HCPCS,Facility,Inpatient,1,mL,,11,9.35,3.1526,11,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
KETOROLAC 30 MG/ML (1 ML) INJ SOLN,,J1885,HCPCS,Facility,Both,1,mL,,11,9.35,3.1526,11,"Multiplan, Inc.","Multiplan, Inc.",10.34,94,,percent of total billed charges,,
KETOROLAC 30 MG/ML (1 ML) INJ SOLN,,J1885,HCPCS,Facility,Outpatient,1,mL,,11,9.35,3.1526,11,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,9.911,90.1,,percent of total billed charges,,
KETOROLAC 30 MG/ML (1 ML) INJ SOLN,,J1885,HCPCS,Facility,Inpatient,1,mL,,11,9.35,3.1526,11,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
KETOROLAC 30 MG/ML (1 ML) INJ SOLN,,J1885,HCPCS,Facility,Both,1,mL,,11,9.35,3.1526,11,"Preferred One Administrative Services, INC.",PPO,10.846,98.6,,percent of total billed charges,,
KETOROLAC 30 MG/ML (1 ML) INJ SOLN,,J1885,HCPCS,Facility,Outpatient,1,mL,,11,9.35,3.1526,11,PrimeWest Health,Minnesota Senior Health Options (MSHO),5.6595,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
KETOROLAC 30 MG/ML (1 ML) INJ SOLN,,J1885,HCPCS,Facility,Inpatient,1,mL,,11,9.35,3.1526,11,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
KETOROLAC 30 MG/ML (1 ML) INJ SOLN,,J1885,HCPCS,Facility,Outpatient,1,mL,,11,9.35,3.1526,11,PrimeWest Health,MinnesotaCare,5.6496,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
KETOROLAC 30 MG/ML (1 ML) INJ SOLN,,J1885,HCPCS,Facility,Inpatient,1,mL,,11,9.35,3.1526,11,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
KETOROLAC 30 MG/ML (1 ML) INJ SOLN,,J1885,HCPCS,Facility,Both,1,mL,,11,9.35,3.1526,11,Sanford Health Plan,Sanford Health Plan,10.12,92,,percent of total billed charges,,
KETOROLAC 30 MG/ML (1 ML) INJ SOLN,,J1885,HCPCS,Facility,Outpatient,1,mL,,11,9.35,3.1526,11,"UCare Health, Inc.",Individual & Family Plan,6.1985,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
KETOROLAC 30 MG/ML (1 ML) INJ SOLN,,J1885,HCPCS,Facility,Inpatient,1,mL,,11,9.35,3.1526,11,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
KETOROLAC 30 MG/ML (1 ML) INJ SOLN,,J1885,HCPCS,Facility,Outpatient,1,mL,,11,9.35,3.1526,11,"UCare Health, Inc.",Medical Assistance,5.5517,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
KETOROLAC 30 MG/ML (1 ML) INJ SOLN,,J1885,HCPCS,Facility,Inpatient,1,mL,,11,9.35,3.1526,11,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
KETOROLAC 30 MG/ML (1 ML) INJ SOLN,,J1885,HCPCS,Facility,Outpatient,1,mL,,11,9.35,3.1526,11,"UCare Health, Inc.",Medicare Advantage,5.5517,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
KETOROLAC 30 MG/ML (1 ML) INJ SOLN,,J1885,HCPCS,Facility,Inpatient,1,mL,,11,9.35,3.1526,11,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
KETOROLAC 30 MG/ML (1 ML) INJ SOLN,,J1885,HCPCS,Facility,Outpatient,1,mL,,11,9.35,3.1526,11,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),5.5517,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
KETOROLAC 30 MG/ML (1 ML) INJ SOLN,,J1885,HCPCS,Facility,Inpatient,1,mL,,11,9.35,3.1526,11,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
KETOROLAC 30 MG/ML (1 ML) INJ SOLN,,J1885,HCPCS,Facility,Both,1,mL,,11,9.35,3.1526,11,UnitedHealthcare,Individual & Family,10.34,94,,percent of total billed charges,,
KETOROLAC 30 MG/ML (1 ML) INJ SOLN,,J1885,HCPCS,Facility,Outpatient,1,mL,,11,9.35,3.1526,11,UnitedHealthcare,Medicare Advantage,5.39,49,,percent of total billed charges,,
KETOROLAC 30 MG/ML (1 ML) INJ SOLN,,J1885,HCPCS,Facility,Inpatient,1,mL,,11,9.35,3.1526,11,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
KETOROLAC 30 MG/ML (1 ML) INJ SOLN,,J1885,HCPCS,Facility,Outpatient,1,mL,,11,9.35,3.1526,11,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,5.28,48,,percent of total billed charges,,100% of DHS outpatient percentage
KETOROLAC 30 MG/ML (1 ML) INJ SOLN,,J1885,HCPCS,Facility,Inpatient,1,mL,,11,9.35,3.1526,11,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
LORAZEPAM 2 MG/ML INJ SOLN,,J2060,HCPCS,Facility,Both,1,mL,,8,6.8,2.2928,8,Aetna,Commercial,7.36,92,,percent of total billed charges,,
LORAZEPAM 2 MG/ML INJ SOLN,,J2060,HCPCS,Facility,Outpatient,1,mL,,8,6.8,2.2928,8,Aetna,Medicare Advantage,3.92,49,,percent of total billed charges,,
LORAZEPAM 2 MG/ML INJ SOLN,,J2060,HCPCS,Facility,Inpatient,1,mL,,8,6.8,2.2928,8,Aetna,Medicare Advantage,,,,,Included in per diem rate,
LORAZEPAM 2 MG/ML INJ SOLN,,J2060,HCPCS,Facility,Both,1,mL,,8,6.8,2.2928,8,Aetna,PPO,7.44,93,,percent of total billed charges,,
LORAZEPAM 2 MG/ML INJ SOLN,,J2060,HCPCS,Facility,Both,1,mL,,8,6.8,2.2928,8,America's PPO,America's PPO,7.6824,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
LORAZEPAM 2 MG/ML INJ SOLN,,J2060,HCPCS,Facility,Both,1,mL,,8,6.8,2.2928,8,BlueCross BlueShield Minnesota, Federal Employee Program,7.872,98.4,,percent of total billed charges,,
LORAZEPAM 2 MG/ML INJ SOLN,,J2060,HCPCS,Facility,Both,1,mL,,8,6.8,2.2928,8,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,8,100,,percent of total billed charges,,
LORAZEPAM 2 MG/ML INJ SOLN,,J2060,HCPCS,Facility,Both,1,mL,,8,6.8,2.2928,8,BlueCross BlueShield Minnesota,High Value Network Plan,7.2,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
LORAZEPAM 2 MG/ML INJ SOLN,,J2060,HCPCS,Facility,Outpatient,1,mL,,8,6.8,2.2928,8,BlueCross BlueShield Minnesota,Medicare Advantage,3.92,49,,percent of total billed charges,,
LORAZEPAM 2 MG/ML INJ SOLN,,J2060,HCPCS,Facility,Inpatient,1,mL,,8,6.8,2.2928,8,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
LORAZEPAM 2 MG/ML INJ SOLN,,J2060,HCPCS,Facility,Both,1,mL,,8,6.8,2.2928,8,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,7.0856,88.57,,percent of total billed charges,,
LORAZEPAM 2 MG/ML INJ SOLN,,J2060,HCPCS,Facility,Both,1,mL,,8,6.8,2.2928,8,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,2.2928,28.66,,percent of total billed charges,,
LORAZEPAM 2 MG/ML INJ SOLN,,J2060,HCPCS,Facility,Outpatient,1,mL,,8,6.8,2.2928,8,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),3.92,49,,percent of total billed charges,,
LORAZEPAM 2 MG/ML INJ SOLN,,J2060,HCPCS,Facility,Inpatient,1,mL,,8,6.8,2.2928,8,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
LORAZEPAM 2 MG/ML INJ SOLN,,J2060,HCPCS,Facility,Both,1,mL,,8,6.8,2.2928,8,CorVel,Worker's Compensation,8,100,,percent of total billed charges,,
LORAZEPAM 2 MG/ML INJ SOLN,,J2060,HCPCS,Facility,Both,1,mL,,8,6.8,2.2928,8,First Health Group Corporation,First Health Network,7.76,97,,percent of total billed charges,,
LORAZEPAM 2 MG/ML INJ SOLN,,J2060,HCPCS,Facility,Both,1,mL,,8,6.8,2.2928,8,"Health Partners, Inc.",Commercial,7.568,94.6,,percent of total billed charges,,
LORAZEPAM 2 MG/ML INJ SOLN,,J2060,HCPCS,Facility,Outpatient,1,mL,,8,6.8,2.2928,8,"Health Partners, Inc.",Medicare Advantage,3.92,49,,percent of total billed charges,,
LORAZEPAM 2 MG/ML INJ SOLN,,J2060,HCPCS,Facility,Inpatient,1,mL,,8,6.8,2.2928,8,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LORAZEPAM 2 MG/ML INJ SOLN,,J2060,HCPCS,Facility,Both,1,mL,,8,6.8,2.2928,8,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),4.8,60,,percent of total billed charges,,
LORAZEPAM 2 MG/ML INJ SOLN,,J2060,HCPCS,Facility,Both,1,mL,,8,6.8,2.2928,8,"Health Partners, Inc.",State of Minnesota Advantage Program,6.52,81.5,,percent of total billed charges,,
LORAZEPAM 2 MG/ML INJ SOLN,,J2060,HCPCS,Facility,Both,1,mL,,8,6.8,2.2928,8,"Health Partners, Inc.",State Public Programs,4,50,,percent of total billed charges,,
LORAZEPAM 2 MG/ML INJ SOLN,,J2060,HCPCS,Facility,Both,1,mL,,8,6.8,2.2928,8,Humana Insurance Company,Commercial PPO,7.6,95,,percent of total billed charges,,
LORAZEPAM 2 MG/ML INJ SOLN,,J2060,HCPCS,Facility,Outpatient,1,mL,,8,6.8,2.2928,8,Humana Insurance Company,Medicare PPO,3.92,49,,percent of total billed charges,,
LORAZEPAM 2 MG/ML INJ SOLN,,J2060,HCPCS,Facility,Inpatient,1,mL,,8,6.8,2.2928,8,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
LORAZEPAM 2 MG/ML INJ SOLN,,J2060,HCPCS,Facility,Both,1,mL,,8,6.8,2.2928,8,Medica,Individual & Family,7.928,99.1,,percent of total billed charges,,
LORAZEPAM 2 MG/ML INJ SOLN,,J2060,HCPCS,Facility,Outpatient,1,mL,,8,6.8,2.2928,8,Medica,Medica Advantage Solution,3.984,49.8,,percent of total billed charges,,
LORAZEPAM 2 MG/ML INJ SOLN,,J2060,HCPCS,Facility,Inpatient,1,mL,,8,6.8,2.2928,8,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
LORAZEPAM 2 MG/ML INJ SOLN,,J2060,HCPCS,Facility,Outpatient,1,mL,,8,6.8,2.2928,8,Medica,Medical Assistance,3.568,44.6,,percent of total billed charges,,
LORAZEPAM 2 MG/ML INJ SOLN,,J2060,HCPCS,Facility,Inpatient,1,mL,,8,6.8,2.2928,8,Medica,Medical Assistance,,,,,Included in per diem rate,
LORAZEPAM 2 MG/ML INJ SOLN,,J2060,HCPCS,Facility,Outpatient,1,mL,,8,6.8,2.2928,8,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,3.984,49.8,,percent of total billed charges,,
LORAZEPAM 2 MG/ML INJ SOLN,,J2060,HCPCS,Facility,Inpatient,1,mL,,8,6.8,2.2928,8,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
LORAZEPAM 2 MG/ML INJ SOLN,,J2060,HCPCS,Facility,Both,1,mL,,8,6.8,2.2928,8,"Multiplan, Inc.","Multiplan, Inc.",7.52,94,,percent of total billed charges,,
LORAZEPAM 2 MG/ML INJ SOLN,,J2060,HCPCS,Facility,Outpatient,1,mL,,8,6.8,2.2928,8,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,7.208,90.1,,percent of total billed charges,,
LORAZEPAM 2 MG/ML INJ SOLN,,J2060,HCPCS,Facility,Inpatient,1,mL,,8,6.8,2.2928,8,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
LORAZEPAM 2 MG/ML INJ SOLN,,J2060,HCPCS,Facility,Both,1,mL,,8,6.8,2.2928,8,"Preferred One Administrative Services, INC.",PPO,7.888,98.6,,percent of total billed charges,,
LORAZEPAM 2 MG/ML INJ SOLN,,J2060,HCPCS,Facility,Outpatient,1,mL,,8,6.8,2.2928,8,PrimeWest Health,Minnesota Senior Health Options (MSHO),4.116,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
LORAZEPAM 2 MG/ML INJ SOLN,,J2060,HCPCS,Facility,Inpatient,1,mL,,8,6.8,2.2928,8,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LORAZEPAM 2 MG/ML INJ SOLN,,J2060,HCPCS,Facility,Outpatient,1,mL,,8,6.8,2.2928,8,PrimeWest Health,MinnesotaCare,4.1088,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
LORAZEPAM 2 MG/ML INJ SOLN,,J2060,HCPCS,Facility,Inpatient,1,mL,,8,6.8,2.2928,8,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
LORAZEPAM 2 MG/ML INJ SOLN,,J2060,HCPCS,Facility,Both,1,mL,,8,6.8,2.2928,8,Sanford Health Plan,Sanford Health Plan,7.36,92,,percent of total billed charges,,
LORAZEPAM 2 MG/ML INJ SOLN,,J2060,HCPCS,Facility,Outpatient,1,mL,,8,6.8,2.2928,8,"UCare Health, Inc.",Individual & Family Plan,4.508,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
LORAZEPAM 2 MG/ML INJ SOLN,,J2060,HCPCS,Facility,Inpatient,1,mL,,8,6.8,2.2928,8,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
LORAZEPAM 2 MG/ML INJ SOLN,,J2060,HCPCS,Facility,Outpatient,1,mL,,8,6.8,2.2928,8,"UCare Health, Inc.",Medical Assistance,4.0376,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LORAZEPAM 2 MG/ML INJ SOLN,,J2060,HCPCS,Facility,Inpatient,1,mL,,8,6.8,2.2928,8,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
LORAZEPAM 2 MG/ML INJ SOLN,,J2060,HCPCS,Facility,Outpatient,1,mL,,8,6.8,2.2928,8,"UCare Health, Inc.",Medicare Advantage,4.0376,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LORAZEPAM 2 MG/ML INJ SOLN,,J2060,HCPCS,Facility,Inpatient,1,mL,,8,6.8,2.2928,8,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LORAZEPAM 2 MG/ML INJ SOLN,,J2060,HCPCS,Facility,Outpatient,1,mL,,8,6.8,2.2928,8,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),4.0376,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LORAZEPAM 2 MG/ML INJ SOLN,,J2060,HCPCS,Facility,Inpatient,1,mL,,8,6.8,2.2928,8,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LORAZEPAM 2 MG/ML INJ SOLN,,J2060,HCPCS,Facility,Both,1,mL,,8,6.8,2.2928,8,UnitedHealthcare,Individual & Family,7.52,94,,percent of total billed charges,,
LORAZEPAM 2 MG/ML INJ SOLN,,J2060,HCPCS,Facility,Outpatient,1,mL,,8,6.8,2.2928,8,UnitedHealthcare,Medicare Advantage,3.92,49,,percent of total billed charges,,
LORAZEPAM 2 MG/ML INJ SOLN,,J2060,HCPCS,Facility,Inpatient,1,mL,,8,6.8,2.2928,8,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
LORAZEPAM 2 MG/ML INJ SOLN,,J2060,HCPCS,Facility,Outpatient,1,mL,,8,6.8,2.2928,8,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,3.84,48,,percent of total billed charges,,100% of DHS outpatient percentage
LORAZEPAM 2 MG/ML INJ SOLN,,J2060,HCPCS,Facility,Inpatient,1,mL,,8,6.8,2.2928,8,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
MEPERIDINE (PF) 100 MG/ML INJ SOLN,,J2175,HCPCS,Facility,Both,1,mL,,18,15.3,5.1588,18,Aetna,Commercial,16.56,92,,percent of total billed charges,,
MEPERIDINE (PF) 100 MG/ML INJ SOLN,,J2175,HCPCS,Facility,Outpatient,1,mL,,18,15.3,5.1588,18,Aetna,Medicare Advantage,8.82,49,,percent of total billed charges,,
MEPERIDINE (PF) 100 MG/ML INJ SOLN,,J2175,HCPCS,Facility,Inpatient,1,mL,,18,15.3,5.1588,18,Aetna,Medicare Advantage,,,,,Included in per diem rate,
MEPERIDINE (PF) 100 MG/ML INJ SOLN,,J2175,HCPCS,Facility,Both,1,mL,,18,15.3,5.1588,18,Aetna,PPO,16.74,93,,percent of total billed charges,,
MEPERIDINE (PF) 100 MG/ML INJ SOLN,,J2175,HCPCS,Facility,Both,1,mL,,18,15.3,5.1588,18,America's PPO,America's PPO,17.2854,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
MEPERIDINE (PF) 100 MG/ML INJ SOLN,,J2175,HCPCS,Facility,Both,1,mL,,18,15.3,5.1588,18,BlueCross BlueShield Minnesota, Federal Employee Program,17.712,98.4,,percent of total billed charges,,
MEPERIDINE (PF) 100 MG/ML INJ SOLN,,J2175,HCPCS,Facility,Both,1,mL,,18,15.3,5.1588,18,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,18,100,,percent of total billed charges,,
MEPERIDINE (PF) 100 MG/ML INJ SOLN,,J2175,HCPCS,Facility,Both,1,mL,,18,15.3,5.1588,18,BlueCross BlueShield Minnesota,High Value Network Plan,16.2,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
MEPERIDINE (PF) 100 MG/ML INJ SOLN,,J2175,HCPCS,Facility,Outpatient,1,mL,,18,15.3,5.1588,18,BlueCross BlueShield Minnesota,Medicare Advantage,8.82,49,,percent of total billed charges,,
MEPERIDINE (PF) 100 MG/ML INJ SOLN,,J2175,HCPCS,Facility,Inpatient,1,mL,,18,15.3,5.1588,18,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
MEPERIDINE (PF) 100 MG/ML INJ SOLN,,J2175,HCPCS,Facility,Both,1,mL,,18,15.3,5.1588,18,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,15.9426,88.57,,percent of total billed charges,,
MEPERIDINE (PF) 100 MG/ML INJ SOLN,,J2175,HCPCS,Facility,Both,1,mL,,18,15.3,5.1588,18,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,5.1588,28.66,,percent of total billed charges,,
MEPERIDINE (PF) 100 MG/ML INJ SOLN,,J2175,HCPCS,Facility,Outpatient,1,mL,,18,15.3,5.1588,18,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),8.82,49,,percent of total billed charges,,
MEPERIDINE (PF) 100 MG/ML INJ SOLN,,J2175,HCPCS,Facility,Inpatient,1,mL,,18,15.3,5.1588,18,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
MEPERIDINE (PF) 100 MG/ML INJ SOLN,,J2175,HCPCS,Facility,Both,1,mL,,18,15.3,5.1588,18,CorVel,Worker's Compensation,18,100,,percent of total billed charges,,
MEPERIDINE (PF) 100 MG/ML INJ SOLN,,J2175,HCPCS,Facility,Both,1,mL,,18,15.3,5.1588,18,First Health Group Corporation,First Health Network,17.46,97,,percent of total billed charges,,
MEPERIDINE (PF) 100 MG/ML INJ SOLN,,J2175,HCPCS,Facility,Both,1,mL,,18,15.3,5.1588,18,"Health Partners, Inc.",Commercial,17.028,94.6,,percent of total billed charges,,
MEPERIDINE (PF) 100 MG/ML INJ SOLN,,J2175,HCPCS,Facility,Outpatient,1,mL,,18,15.3,5.1588,18,"Health Partners, Inc.",Medicare Advantage,8.82,49,,percent of total billed charges,,
MEPERIDINE (PF) 100 MG/ML INJ SOLN,,J2175,HCPCS,Facility,Inpatient,1,mL,,18,15.3,5.1588,18,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
MEPERIDINE (PF) 100 MG/ML INJ SOLN,,J2175,HCPCS,Facility,Both,1,mL,,18,15.3,5.1588,18,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),10.8,60,,percent of total billed charges,,
MEPERIDINE (PF) 100 MG/ML INJ SOLN,,J2175,HCPCS,Facility,Both,1,mL,,18,15.3,5.1588,18,"Health Partners, Inc.",State of Minnesota Advantage Program,14.67,81.5,,percent of total billed charges,,
MEPERIDINE (PF) 100 MG/ML INJ SOLN,,J2175,HCPCS,Facility,Both,1,mL,,18,15.3,5.1588,18,"Health Partners, Inc.",State Public Programs,9,50,,percent of total billed charges,,
MEPERIDINE (PF) 100 MG/ML INJ SOLN,,J2175,HCPCS,Facility,Both,1,mL,,18,15.3,5.1588,18,Humana Insurance Company,Commercial PPO,17.1,95,,percent of total billed charges,,
MEPERIDINE (PF) 100 MG/ML INJ SOLN,,J2175,HCPCS,Facility,Outpatient,1,mL,,18,15.3,5.1588,18,Humana Insurance Company,Medicare PPO,8.82,49,,percent of total billed charges,,
MEPERIDINE (PF) 100 MG/ML INJ SOLN,,J2175,HCPCS,Facility,Inpatient,1,mL,,18,15.3,5.1588,18,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
MEPERIDINE (PF) 100 MG/ML INJ SOLN,,J2175,HCPCS,Facility,Both,1,mL,,18,15.3,5.1588,18,Medica,Individual & Family,17.838,99.1,,percent of total billed charges,,
MEPERIDINE (PF) 100 MG/ML INJ SOLN,,J2175,HCPCS,Facility,Outpatient,1,mL,,18,15.3,5.1588,18,Medica,Medica Advantage Solution,8.964,49.8,,percent of total billed charges,,
MEPERIDINE (PF) 100 MG/ML INJ SOLN,,J2175,HCPCS,Facility,Inpatient,1,mL,,18,15.3,5.1588,18,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
MEPERIDINE (PF) 100 MG/ML INJ SOLN,,J2175,HCPCS,Facility,Outpatient,1,mL,,18,15.3,5.1588,18,Medica,Medical Assistance,8.028,44.6,,percent of total billed charges,,
MEPERIDINE (PF) 100 MG/ML INJ SOLN,,J2175,HCPCS,Facility,Inpatient,1,mL,,18,15.3,5.1588,18,Medica,Medical Assistance,,,,,Included in per diem rate,
MEPERIDINE (PF) 100 MG/ML INJ SOLN,,J2175,HCPCS,Facility,Outpatient,1,mL,,18,15.3,5.1588,18,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,8.964,49.8,,percent of total billed charges,,
MEPERIDINE (PF) 100 MG/ML INJ SOLN,,J2175,HCPCS,Facility,Inpatient,1,mL,,18,15.3,5.1588,18,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
MEPERIDINE (PF) 100 MG/ML INJ SOLN,,J2175,HCPCS,Facility,Both,1,mL,,18,15.3,5.1588,18,"Multiplan, Inc.","Multiplan, Inc.",16.92,94,,percent of total billed charges,,
MEPERIDINE (PF) 100 MG/ML INJ SOLN,,J2175,HCPCS,Facility,Outpatient,1,mL,,18,15.3,5.1588,18,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,16.218,90.1,,percent of total billed charges,,
MEPERIDINE (PF) 100 MG/ML INJ SOLN,,J2175,HCPCS,Facility,Inpatient,1,mL,,18,15.3,5.1588,18,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
MEPERIDINE (PF) 100 MG/ML INJ SOLN,,J2175,HCPCS,Facility,Both,1,mL,,18,15.3,5.1588,18,"Preferred One Administrative Services, INC.",PPO,17.748,98.6,,percent of total billed charges,,
MEPERIDINE (PF) 100 MG/ML INJ SOLN,,J2175,HCPCS,Facility,Outpatient,1,mL,,18,15.3,5.1588,18,PrimeWest Health,Minnesota Senior Health Options (MSHO),9.261,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
MEPERIDINE (PF) 100 MG/ML INJ SOLN,,J2175,HCPCS,Facility,Inpatient,1,mL,,18,15.3,5.1588,18,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
MEPERIDINE (PF) 100 MG/ML INJ SOLN,,J2175,HCPCS,Facility,Outpatient,1,mL,,18,15.3,5.1588,18,PrimeWest Health,MinnesotaCare,9.2448,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
MEPERIDINE (PF) 100 MG/ML INJ SOLN,,J2175,HCPCS,Facility,Inpatient,1,mL,,18,15.3,5.1588,18,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
MEPERIDINE (PF) 100 MG/ML INJ SOLN,,J2175,HCPCS,Facility,Both,1,mL,,18,15.3,5.1588,18,Sanford Health Plan,Sanford Health Plan,16.56,92,,percent of total billed charges,,
MEPERIDINE (PF) 100 MG/ML INJ SOLN,,J2175,HCPCS,Facility,Outpatient,1,mL,,18,15.3,5.1588,18,"UCare Health, Inc.",Individual & Family Plan,10.143,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
MEPERIDINE (PF) 100 MG/ML INJ SOLN,,J2175,HCPCS,Facility,Inpatient,1,mL,,18,15.3,5.1588,18,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
MEPERIDINE (PF) 100 MG/ML INJ SOLN,,J2175,HCPCS,Facility,Outpatient,1,mL,,18,15.3,5.1588,18,"UCare Health, Inc.",Medical Assistance,9.0846,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MEPERIDINE (PF) 100 MG/ML INJ SOLN,,J2175,HCPCS,Facility,Inpatient,1,mL,,18,15.3,5.1588,18,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
MEPERIDINE (PF) 100 MG/ML INJ SOLN,,J2175,HCPCS,Facility,Outpatient,1,mL,,18,15.3,5.1588,18,"UCare Health, Inc.",Medicare Advantage,9.0846,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MEPERIDINE (PF) 100 MG/ML INJ SOLN,,J2175,HCPCS,Facility,Inpatient,1,mL,,18,15.3,5.1588,18,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
MEPERIDINE (PF) 100 MG/ML INJ SOLN,,J2175,HCPCS,Facility,Outpatient,1,mL,,18,15.3,5.1588,18,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),9.0846,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MEPERIDINE (PF) 100 MG/ML INJ SOLN,,J2175,HCPCS,Facility,Inpatient,1,mL,,18,15.3,5.1588,18,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
MEPERIDINE (PF) 100 MG/ML INJ SOLN,,J2175,HCPCS,Facility,Both,1,mL,,18,15.3,5.1588,18,UnitedHealthcare,Individual & Family,16.92,94,,percent of total billed charges,,
MEPERIDINE (PF) 100 MG/ML INJ SOLN,,J2175,HCPCS,Facility,Outpatient,1,mL,,18,15.3,5.1588,18,UnitedHealthcare,Medicare Advantage,8.82,49,,percent of total billed charges,,
MEPERIDINE (PF) 100 MG/ML INJ SOLN,,J2175,HCPCS,Facility,Inpatient,1,mL,,18,15.3,5.1588,18,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
MEPERIDINE (PF) 100 MG/ML INJ SOLN,,J2175,HCPCS,Facility,Outpatient,1,mL,,18,15.3,5.1588,18,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,8.64,48,,percent of total billed charges,,100% of DHS outpatient percentage
MEPERIDINE (PF) 100 MG/ML INJ SOLN,,J2175,HCPCS,Facility,Inpatient,1,mL,,18,15.3,5.1588,18,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
METHYLERGONOVINE 0.2 MG/ML (1 ML) INJ SOLN,,J2210,HCPCS,Facility,Both,1,mL,,107,90.95,30.6662,107,Aetna,Commercial,98.44,92,,percent of total billed charges,,
METHYLERGONOVINE 0.2 MG/ML (1 ML) INJ SOLN,,J2210,HCPCS,Facility,Outpatient,1,mL,,107,90.95,30.6662,107,Aetna,Medicare Advantage,52.43,49,,percent of total billed charges,,
METHYLERGONOVINE 0.2 MG/ML (1 ML) INJ SOLN,,J2210,HCPCS,Facility,Inpatient,1,mL,,107,90.95,30.6662,107,Aetna,Medicare Advantage,,,,,Included in per diem rate,
METHYLERGONOVINE 0.2 MG/ML (1 ML) INJ SOLN,,J2210,HCPCS,Facility,Both,1,mL,,107,90.95,30.6662,107,Aetna,PPO,99.51,93,,percent of total billed charges,,
METHYLERGONOVINE 0.2 MG/ML (1 ML) INJ SOLN,,J2210,HCPCS,Facility,Both,1,mL,,107,90.95,30.6662,107,America's PPO,America's PPO,102.7521,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
METHYLERGONOVINE 0.2 MG/ML (1 ML) INJ SOLN,,J2210,HCPCS,Facility,Both,1,mL,,107,90.95,30.6662,107,BlueCross BlueShield Minnesota, Federal Employee Program,105.288,98.4,,percent of total billed charges,,
METHYLERGONOVINE 0.2 MG/ML (1 ML) INJ SOLN,,J2210,HCPCS,Facility,Both,1,mL,,107,90.95,30.6662,107,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,107,100,,percent of total billed charges,,
METHYLERGONOVINE 0.2 MG/ML (1 ML) INJ SOLN,,J2210,HCPCS,Facility,Both,1,mL,,107,90.95,30.6662,107,BlueCross BlueShield Minnesota,High Value Network Plan,96.3,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
METHYLERGONOVINE 0.2 MG/ML (1 ML) INJ SOLN,,J2210,HCPCS,Facility,Outpatient,1,mL,,107,90.95,30.6662,107,BlueCross BlueShield Minnesota,Medicare Advantage,52.43,49,,percent of total billed charges,,
METHYLERGONOVINE 0.2 MG/ML (1 ML) INJ SOLN,,J2210,HCPCS,Facility,Inpatient,1,mL,,107,90.95,30.6662,107,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
METHYLERGONOVINE 0.2 MG/ML (1 ML) INJ SOLN,,J2210,HCPCS,Facility,Both,1,mL,,107,90.95,30.6662,107,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,94.7699,88.57,,percent of total billed charges,,
METHYLERGONOVINE 0.2 MG/ML (1 ML) INJ SOLN,,J2210,HCPCS,Facility,Both,1,mL,,107,90.95,30.6662,107,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,30.6662,28.66,,percent of total billed charges,,
METHYLERGONOVINE 0.2 MG/ML (1 ML) INJ SOLN,,J2210,HCPCS,Facility,Outpatient,1,mL,,107,90.95,30.6662,107,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),52.43,49,,percent of total billed charges,,
METHYLERGONOVINE 0.2 MG/ML (1 ML) INJ SOLN,,J2210,HCPCS,Facility,Inpatient,1,mL,,107,90.95,30.6662,107,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
METHYLERGONOVINE 0.2 MG/ML (1 ML) INJ SOLN,,J2210,HCPCS,Facility,Both,1,mL,,107,90.95,30.6662,107,CorVel,Worker's Compensation,107,100,,percent of total billed charges,,
METHYLERGONOVINE 0.2 MG/ML (1 ML) INJ SOLN,,J2210,HCPCS,Facility,Both,1,mL,,107,90.95,30.6662,107,First Health Group Corporation,First Health Network,103.79,97,,percent of total billed charges,,
METHYLERGONOVINE 0.2 MG/ML (1 ML) INJ SOLN,,J2210,HCPCS,Facility,Both,1,mL,,107,90.95,30.6662,107,"Health Partners, Inc.",Commercial,101.222,94.6,,percent of total billed charges,,
METHYLERGONOVINE 0.2 MG/ML (1 ML) INJ SOLN,,J2210,HCPCS,Facility,Outpatient,1,mL,,107,90.95,30.6662,107,"Health Partners, Inc.",Medicare Advantage,52.43,49,,percent of total billed charges,,
METHYLERGONOVINE 0.2 MG/ML (1 ML) INJ SOLN,,J2210,HCPCS,Facility,Inpatient,1,mL,,107,90.95,30.6662,107,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
METHYLERGONOVINE 0.2 MG/ML (1 ML) INJ SOLN,,J2210,HCPCS,Facility,Both,1,mL,,107,90.95,30.6662,107,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),64.2,60,,percent of total billed charges,,
METHYLERGONOVINE 0.2 MG/ML (1 ML) INJ SOLN,,J2210,HCPCS,Facility,Both,1,mL,,107,90.95,30.6662,107,"Health Partners, Inc.",State of Minnesota Advantage Program,87.205,81.5,,percent of total billed charges,,
METHYLERGONOVINE 0.2 MG/ML (1 ML) INJ SOLN,,J2210,HCPCS,Facility,Both,1,mL,,107,90.95,30.6662,107,"Health Partners, Inc.",State Public Programs,53.5,50,,percent of total billed charges,,
METHYLERGONOVINE 0.2 MG/ML (1 ML) INJ SOLN,,J2210,HCPCS,Facility,Both,1,mL,,107,90.95,30.6662,107,Humana Insurance Company,Commercial PPO,101.65,95,,percent of total billed charges,,
METHYLERGONOVINE 0.2 MG/ML (1 ML) INJ SOLN,,J2210,HCPCS,Facility,Outpatient,1,mL,,107,90.95,30.6662,107,Humana Insurance Company,Medicare PPO,52.43,49,,percent of total billed charges,,
METHYLERGONOVINE 0.2 MG/ML (1 ML) INJ SOLN,,J2210,HCPCS,Facility,Inpatient,1,mL,,107,90.95,30.6662,107,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
METHYLERGONOVINE 0.2 MG/ML (1 ML) INJ SOLN,,J2210,HCPCS,Facility,Both,1,mL,,107,90.95,30.6662,107,Medica,Individual & Family,106.037,99.1,,percent of total billed charges,,
METHYLERGONOVINE 0.2 MG/ML (1 ML) INJ SOLN,,J2210,HCPCS,Facility,Outpatient,1,mL,,107,90.95,30.6662,107,Medica,Medica Advantage Solution,53.286,49.8,,percent of total billed charges,,
METHYLERGONOVINE 0.2 MG/ML (1 ML) INJ SOLN,,J2210,HCPCS,Facility,Inpatient,1,mL,,107,90.95,30.6662,107,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
METHYLERGONOVINE 0.2 MG/ML (1 ML) INJ SOLN,,J2210,HCPCS,Facility,Outpatient,1,mL,,107,90.95,30.6662,107,Medica,Medical Assistance,47.722,44.6,,percent of total billed charges,,
METHYLERGONOVINE 0.2 MG/ML (1 ML) INJ SOLN,,J2210,HCPCS,Facility,Inpatient,1,mL,,107,90.95,30.6662,107,Medica,Medical Assistance,,,,,Included in per diem rate,
METHYLERGONOVINE 0.2 MG/ML (1 ML) INJ SOLN,,J2210,HCPCS,Facility,Outpatient,1,mL,,107,90.95,30.6662,107,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,53.286,49.8,,percent of total billed charges,,
METHYLERGONOVINE 0.2 MG/ML (1 ML) INJ SOLN,,J2210,HCPCS,Facility,Inpatient,1,mL,,107,90.95,30.6662,107,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
METHYLERGONOVINE 0.2 MG/ML (1 ML) INJ SOLN,,J2210,HCPCS,Facility,Both,1,mL,,107,90.95,30.6662,107,"Multiplan, Inc.","Multiplan, Inc.",100.58,94,,percent of total billed charges,,
METHYLERGONOVINE 0.2 MG/ML (1 ML) INJ SOLN,,J2210,HCPCS,Facility,Outpatient,1,mL,,107,90.95,30.6662,107,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,96.407,90.1,,percent of total billed charges,,
METHYLERGONOVINE 0.2 MG/ML (1 ML) INJ SOLN,,J2210,HCPCS,Facility,Inpatient,1,mL,,107,90.95,30.6662,107,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
METHYLERGONOVINE 0.2 MG/ML (1 ML) INJ SOLN,,J2210,HCPCS,Facility,Both,1,mL,,107,90.95,30.6662,107,"Preferred One Administrative Services, INC.",PPO,105.502,98.6,,percent of total billed charges,,
METHYLERGONOVINE 0.2 MG/ML (1 ML) INJ SOLN,,J2210,HCPCS,Facility,Outpatient,1,mL,,107,90.95,30.6662,107,PrimeWest Health,Minnesota Senior Health Options (MSHO),55.0515,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
METHYLERGONOVINE 0.2 MG/ML (1 ML) INJ SOLN,,J2210,HCPCS,Facility,Inpatient,1,mL,,107,90.95,30.6662,107,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
METHYLERGONOVINE 0.2 MG/ML (1 ML) INJ SOLN,,J2210,HCPCS,Facility,Outpatient,1,mL,,107,90.95,30.6662,107,PrimeWest Health,MinnesotaCare,54.9552,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
METHYLERGONOVINE 0.2 MG/ML (1 ML) INJ SOLN,,J2210,HCPCS,Facility,Inpatient,1,mL,,107,90.95,30.6662,107,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
METHYLERGONOVINE 0.2 MG/ML (1 ML) INJ SOLN,,J2210,HCPCS,Facility,Both,1,mL,,107,90.95,30.6662,107,Sanford Health Plan,Sanford Health Plan,98.44,92,,percent of total billed charges,,
METHYLERGONOVINE 0.2 MG/ML (1 ML) INJ SOLN,,J2210,HCPCS,Facility,Outpatient,1,mL,,107,90.95,30.6662,107,"UCare Health, Inc.",Individual & Family Plan,60.2945,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
METHYLERGONOVINE 0.2 MG/ML (1 ML) INJ SOLN,,J2210,HCPCS,Facility,Inpatient,1,mL,,107,90.95,30.6662,107,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
METHYLERGONOVINE 0.2 MG/ML (1 ML) INJ SOLN,,J2210,HCPCS,Facility,Outpatient,1,mL,,107,90.95,30.6662,107,"UCare Health, Inc.",Medical Assistance,54.0029,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
METHYLERGONOVINE 0.2 MG/ML (1 ML) INJ SOLN,,J2210,HCPCS,Facility,Inpatient,1,mL,,107,90.95,30.6662,107,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
METHYLERGONOVINE 0.2 MG/ML (1 ML) INJ SOLN,,J2210,HCPCS,Facility,Outpatient,1,mL,,107,90.95,30.6662,107,"UCare Health, Inc.",Medicare Advantage,54.0029,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
METHYLERGONOVINE 0.2 MG/ML (1 ML) INJ SOLN,,J2210,HCPCS,Facility,Inpatient,1,mL,,107,90.95,30.6662,107,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
METHYLERGONOVINE 0.2 MG/ML (1 ML) INJ SOLN,,J2210,HCPCS,Facility,Outpatient,1,mL,,107,90.95,30.6662,107,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),54.0029,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
METHYLERGONOVINE 0.2 MG/ML (1 ML) INJ SOLN,,J2210,HCPCS,Facility,Inpatient,1,mL,,107,90.95,30.6662,107,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
METHYLERGONOVINE 0.2 MG/ML (1 ML) INJ SOLN,,J2210,HCPCS,Facility,Both,1,mL,,107,90.95,30.6662,107,UnitedHealthcare,Individual & Family,100.58,94,,percent of total billed charges,,
METHYLERGONOVINE 0.2 MG/ML (1 ML) INJ SOLN,,J2210,HCPCS,Facility,Outpatient,1,mL,,107,90.95,30.6662,107,UnitedHealthcare,Medicare Advantage,52.43,49,,percent of total billed charges,,
METHYLERGONOVINE 0.2 MG/ML (1 ML) INJ SOLN,,J2210,HCPCS,Facility,Inpatient,1,mL,,107,90.95,30.6662,107,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
METHYLERGONOVINE 0.2 MG/ML (1 ML) INJ SOLN,,J2210,HCPCS,Facility,Outpatient,1,mL,,107,90.95,30.6662,107,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,51.36,48,,percent of total billed charges,,100% of DHS outpatient percentage
METHYLERGONOVINE 0.2 MG/ML (1 ML) INJ SOLN,,J2210,HCPCS,Facility,Inpatient,1,mL,,107,90.95,30.6662,107,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
MORPHINE 2 MG/ML (1 ML) INJ WRAPPER,,J2270,HCPCS,Facility,Both,1,mL,,13,11.05,3.7258,13,Aetna,Commercial,11.96,92,,percent of total billed charges,,
MORPHINE 2 MG/ML (1 ML) INJ WRAPPER,,J2270,HCPCS,Facility,Outpatient,1,mL,,13,11.05,3.7258,13,Aetna,Medicare Advantage,6.37,49,,percent of total billed charges,,
MORPHINE 2 MG/ML (1 ML) INJ WRAPPER,,J2270,HCPCS,Facility,Inpatient,1,mL,,13,11.05,3.7258,13,Aetna,Medicare Advantage,,,,,Included in per diem rate,
MORPHINE 2 MG/ML (1 ML) INJ WRAPPER,,J2270,HCPCS,Facility,Both,1,mL,,13,11.05,3.7258,13,Aetna,PPO,12.09,93,,percent of total billed charges,,
MORPHINE 2 MG/ML (1 ML) INJ WRAPPER,,J2270,HCPCS,Facility,Both,1,mL,,13,11.05,3.7258,13,America's PPO,America's PPO,12.4839,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
MORPHINE 2 MG/ML (1 ML) INJ WRAPPER,,J2270,HCPCS,Facility,Both,1,mL,,13,11.05,3.7258,13,BlueCross BlueShield Minnesota, Federal Employee Program,12.792,98.4,,percent of total billed charges,,
MORPHINE 2 MG/ML (1 ML) INJ WRAPPER,,J2270,HCPCS,Facility,Both,1,mL,,13,11.05,3.7258,13,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,13,100,,percent of total billed charges,,
MORPHINE 2 MG/ML (1 ML) INJ WRAPPER,,J2270,HCPCS,Facility,Both,1,mL,,13,11.05,3.7258,13,BlueCross BlueShield Minnesota,High Value Network Plan,11.7,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
MORPHINE 2 MG/ML (1 ML) INJ WRAPPER,,J2270,HCPCS,Facility,Outpatient,1,mL,,13,11.05,3.7258,13,BlueCross BlueShield Minnesota,Medicare Advantage,6.37,49,,percent of total billed charges,,
MORPHINE 2 MG/ML (1 ML) INJ WRAPPER,,J2270,HCPCS,Facility,Inpatient,1,mL,,13,11.05,3.7258,13,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
MORPHINE 2 MG/ML (1 ML) INJ WRAPPER,,J2270,HCPCS,Facility,Both,1,mL,,13,11.05,3.7258,13,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,11.5141,88.57,,percent of total billed charges,,
MORPHINE 2 MG/ML (1 ML) INJ WRAPPER,,J2270,HCPCS,Facility,Both,1,mL,,13,11.05,3.7258,13,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,3.7258,28.66,,percent of total billed charges,,
MORPHINE 2 MG/ML (1 ML) INJ WRAPPER,,J2270,HCPCS,Facility,Outpatient,1,mL,,13,11.05,3.7258,13,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),6.37,49,,percent of total billed charges,,
MORPHINE 2 MG/ML (1 ML) INJ WRAPPER,,J2270,HCPCS,Facility,Inpatient,1,mL,,13,11.05,3.7258,13,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
MORPHINE 2 MG/ML (1 ML) INJ WRAPPER,,J2270,HCPCS,Facility,Both,1,mL,,13,11.05,3.7258,13,CorVel,Worker's Compensation,13,100,,percent of total billed charges,,
MORPHINE 2 MG/ML (1 ML) INJ WRAPPER,,J2270,HCPCS,Facility,Both,1,mL,,13,11.05,3.7258,13,First Health Group Corporation,First Health Network,12.61,97,,percent of total billed charges,,
MORPHINE 2 MG/ML (1 ML) INJ WRAPPER,,J2270,HCPCS,Facility,Both,1,mL,,13,11.05,3.7258,13,"Health Partners, Inc.",Commercial,12.298,94.6,,percent of total billed charges,,
MORPHINE 2 MG/ML (1 ML) INJ WRAPPER,,J2270,HCPCS,Facility,Outpatient,1,mL,,13,11.05,3.7258,13,"Health Partners, Inc.",Medicare Advantage,6.37,49,,percent of total billed charges,,
MORPHINE 2 MG/ML (1 ML) INJ WRAPPER,,J2270,HCPCS,Facility,Inpatient,1,mL,,13,11.05,3.7258,13,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
MORPHINE 2 MG/ML (1 ML) INJ WRAPPER,,J2270,HCPCS,Facility,Both,1,mL,,13,11.05,3.7258,13,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),7.8,60,,percent of total billed charges,,
MORPHINE 2 MG/ML (1 ML) INJ WRAPPER,,J2270,HCPCS,Facility,Both,1,mL,,13,11.05,3.7258,13,"Health Partners, Inc.",State of Minnesota Advantage Program,10.595,81.5,,percent of total billed charges,,
MORPHINE 2 MG/ML (1 ML) INJ WRAPPER,,J2270,HCPCS,Facility,Both,1,mL,,13,11.05,3.7258,13,"Health Partners, Inc.",State Public Programs,6.5,50,,percent of total billed charges,,
MORPHINE 2 MG/ML (1 ML) INJ WRAPPER,,J2270,HCPCS,Facility,Both,1,mL,,13,11.05,3.7258,13,Humana Insurance Company,Commercial PPO,12.35,95,,percent of total billed charges,,
MORPHINE 2 MG/ML (1 ML) INJ WRAPPER,,J2270,HCPCS,Facility,Outpatient,1,mL,,13,11.05,3.7258,13,Humana Insurance Company,Medicare PPO,6.37,49,,percent of total billed charges,,
MORPHINE 2 MG/ML (1 ML) INJ WRAPPER,,J2270,HCPCS,Facility,Inpatient,1,mL,,13,11.05,3.7258,13,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
MORPHINE 2 MG/ML (1 ML) INJ WRAPPER,,J2270,HCPCS,Facility,Both,1,mL,,13,11.05,3.7258,13,Medica,Individual & Family,12.883,99.1,,percent of total billed charges,,
MORPHINE 2 MG/ML (1 ML) INJ WRAPPER,,J2270,HCPCS,Facility,Outpatient,1,mL,,13,11.05,3.7258,13,Medica,Medica Advantage Solution,6.474,49.8,,percent of total billed charges,,
MORPHINE 2 MG/ML (1 ML) INJ WRAPPER,,J2270,HCPCS,Facility,Inpatient,1,mL,,13,11.05,3.7258,13,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
MORPHINE 2 MG/ML (1 ML) INJ WRAPPER,,J2270,HCPCS,Facility,Outpatient,1,mL,,13,11.05,3.7258,13,Medica,Medical Assistance,5.798,44.6,,percent of total billed charges,,
MORPHINE 2 MG/ML (1 ML) INJ WRAPPER,,J2270,HCPCS,Facility,Inpatient,1,mL,,13,11.05,3.7258,13,Medica,Medical Assistance,,,,,Included in per diem rate,
MORPHINE 2 MG/ML (1 ML) INJ WRAPPER,,J2270,HCPCS,Facility,Outpatient,1,mL,,13,11.05,3.7258,13,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,6.474,49.8,,percent of total billed charges,,
MORPHINE 2 MG/ML (1 ML) INJ WRAPPER,,J2270,HCPCS,Facility,Inpatient,1,mL,,13,11.05,3.7258,13,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
MORPHINE 2 MG/ML (1 ML) INJ WRAPPER,,J2270,HCPCS,Facility,Both,1,mL,,13,11.05,3.7258,13,"Multiplan, Inc.","Multiplan, Inc.",12.22,94,,percent of total billed charges,,
MORPHINE 2 MG/ML (1 ML) INJ WRAPPER,,J2270,HCPCS,Facility,Outpatient,1,mL,,13,11.05,3.7258,13,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,11.713,90.1,,percent of total billed charges,,
MORPHINE 2 MG/ML (1 ML) INJ WRAPPER,,J2270,HCPCS,Facility,Inpatient,1,mL,,13,11.05,3.7258,13,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
MORPHINE 2 MG/ML (1 ML) INJ WRAPPER,,J2270,HCPCS,Facility,Both,1,mL,,13,11.05,3.7258,13,"Preferred One Administrative Services, INC.",PPO,12.818,98.6,,percent of total billed charges,,
MORPHINE 2 MG/ML (1 ML) INJ WRAPPER,,J2270,HCPCS,Facility,Outpatient,1,mL,,13,11.05,3.7258,13,PrimeWest Health,Minnesota Senior Health Options (MSHO),6.6885,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
MORPHINE 2 MG/ML (1 ML) INJ WRAPPER,,J2270,HCPCS,Facility,Inpatient,1,mL,,13,11.05,3.7258,13,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
MORPHINE 2 MG/ML (1 ML) INJ WRAPPER,,J2270,HCPCS,Facility,Outpatient,1,mL,,13,11.05,3.7258,13,PrimeWest Health,MinnesotaCare,6.6768,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
MORPHINE 2 MG/ML (1 ML) INJ WRAPPER,,J2270,HCPCS,Facility,Inpatient,1,mL,,13,11.05,3.7258,13,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
MORPHINE 2 MG/ML (1 ML) INJ WRAPPER,,J2270,HCPCS,Facility,Both,1,mL,,13,11.05,3.7258,13,Sanford Health Plan,Sanford Health Plan,11.96,92,,percent of total billed charges,,
MORPHINE 2 MG/ML (1 ML) INJ WRAPPER,,J2270,HCPCS,Facility,Outpatient,1,mL,,13,11.05,3.7258,13,"UCare Health, Inc.",Individual & Family Plan,7.3255,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
MORPHINE 2 MG/ML (1 ML) INJ WRAPPER,,J2270,HCPCS,Facility,Inpatient,1,mL,,13,11.05,3.7258,13,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
MORPHINE 2 MG/ML (1 ML) INJ WRAPPER,,J2270,HCPCS,Facility,Outpatient,1,mL,,13,11.05,3.7258,13,"UCare Health, Inc.",Medical Assistance,6.5611,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MORPHINE 2 MG/ML (1 ML) INJ WRAPPER,,J2270,HCPCS,Facility,Inpatient,1,mL,,13,11.05,3.7258,13,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
MORPHINE 2 MG/ML (1 ML) INJ WRAPPER,,J2270,HCPCS,Facility,Outpatient,1,mL,,13,11.05,3.7258,13,"UCare Health, Inc.",Medicare Advantage,6.5611,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MORPHINE 2 MG/ML (1 ML) INJ WRAPPER,,J2270,HCPCS,Facility,Inpatient,1,mL,,13,11.05,3.7258,13,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
MORPHINE 2 MG/ML (1 ML) INJ WRAPPER,,J2270,HCPCS,Facility,Outpatient,1,mL,,13,11.05,3.7258,13,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),6.5611,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MORPHINE 2 MG/ML (1 ML) INJ WRAPPER,,J2270,HCPCS,Facility,Inpatient,1,mL,,13,11.05,3.7258,13,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
MORPHINE 2 MG/ML (1 ML) INJ WRAPPER,,J2270,HCPCS,Facility,Both,1,mL,,13,11.05,3.7258,13,UnitedHealthcare,Individual & Family,12.22,94,,percent of total billed charges,,
MORPHINE 2 MG/ML (1 ML) INJ WRAPPER,,J2270,HCPCS,Facility,Outpatient,1,mL,,13,11.05,3.7258,13,UnitedHealthcare,Medicare Advantage,6.37,49,,percent of total billed charges,,
MORPHINE 2 MG/ML (1 ML) INJ WRAPPER,,J2270,HCPCS,Facility,Inpatient,1,mL,,13,11.05,3.7258,13,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
MORPHINE 2 MG/ML (1 ML) INJ WRAPPER,,J2270,HCPCS,Facility,Outpatient,1,mL,,13,11.05,3.7258,13,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,6.24,48,,percent of total billed charges,,100% of DHS outpatient percentage
MORPHINE 2 MG/ML (1 ML) INJ WRAPPER,,J2270,HCPCS,Facility,Inpatient,1,mL,,13,11.05,3.7258,13,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
MORPHINE 4 MG/ML (1 ML) INJ WRAPPER,,J2270,HCPCS,Facility,Both,1,mL,,12,10.2,3.4392,12,Aetna,Commercial,11.04,92,,percent of total billed charges,,
MORPHINE 4 MG/ML (1 ML) INJ WRAPPER,,J2270,HCPCS,Facility,Outpatient,1,mL,,12,10.2,3.4392,12,Aetna,Medicare Advantage,5.88,49,,percent of total billed charges,,
MORPHINE 4 MG/ML (1 ML) INJ WRAPPER,,J2270,HCPCS,Facility,Inpatient,1,mL,,12,10.2,3.4392,12,Aetna,Medicare Advantage,,,,,Included in per diem rate,
MORPHINE 4 MG/ML (1 ML) INJ WRAPPER,,J2270,HCPCS,Facility,Both,1,mL,,12,10.2,3.4392,12,Aetna,PPO,11.16,93,,percent of total billed charges,,
MORPHINE 4 MG/ML (1 ML) INJ WRAPPER,,J2270,HCPCS,Facility,Both,1,mL,,12,10.2,3.4392,12,America's PPO,America's PPO,11.5236,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
MORPHINE 4 MG/ML (1 ML) INJ WRAPPER,,J2270,HCPCS,Facility,Both,1,mL,,12,10.2,3.4392,12,BlueCross BlueShield Minnesota, Federal Employee Program,11.808,98.4,,percent of total billed charges,,
MORPHINE 4 MG/ML (1 ML) INJ WRAPPER,,J2270,HCPCS,Facility,Both,1,mL,,12,10.2,3.4392,12,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,12,100,,percent of total billed charges,,
MORPHINE 4 MG/ML (1 ML) INJ WRAPPER,,J2270,HCPCS,Facility,Both,1,mL,,12,10.2,3.4392,12,BlueCross BlueShield Minnesota,High Value Network Plan,10.8,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
MORPHINE 4 MG/ML (1 ML) INJ WRAPPER,,J2270,HCPCS,Facility,Outpatient,1,mL,,12,10.2,3.4392,12,BlueCross BlueShield Minnesota,Medicare Advantage,5.88,49,,percent of total billed charges,,
MORPHINE 4 MG/ML (1 ML) INJ WRAPPER,,J2270,HCPCS,Facility,Inpatient,1,mL,,12,10.2,3.4392,12,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
MORPHINE 4 MG/ML (1 ML) INJ WRAPPER,,J2270,HCPCS,Facility,Both,1,mL,,12,10.2,3.4392,12,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,10.6284,88.57,,percent of total billed charges,,
MORPHINE 4 MG/ML (1 ML) INJ WRAPPER,,J2270,HCPCS,Facility,Both,1,mL,,12,10.2,3.4392,12,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,3.4392,28.66,,percent of total billed charges,,
MORPHINE 4 MG/ML (1 ML) INJ WRAPPER,,J2270,HCPCS,Facility,Outpatient,1,mL,,12,10.2,3.4392,12,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),5.88,49,,percent of total billed charges,,
MORPHINE 4 MG/ML (1 ML) INJ WRAPPER,,J2270,HCPCS,Facility,Inpatient,1,mL,,12,10.2,3.4392,12,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
MORPHINE 4 MG/ML (1 ML) INJ WRAPPER,,J2270,HCPCS,Facility,Both,1,mL,,12,10.2,3.4392,12,CorVel,Worker's Compensation,12,100,,percent of total billed charges,,
MORPHINE 4 MG/ML (1 ML) INJ WRAPPER,,J2270,HCPCS,Facility,Both,1,mL,,12,10.2,3.4392,12,First Health Group Corporation,First Health Network,11.64,97,,percent of total billed charges,,
MORPHINE 4 MG/ML (1 ML) INJ WRAPPER,,J2270,HCPCS,Facility,Both,1,mL,,12,10.2,3.4392,12,"Health Partners, Inc.",Commercial,11.352,94.6,,percent of total billed charges,,
MORPHINE 4 MG/ML (1 ML) INJ WRAPPER,,J2270,HCPCS,Facility,Outpatient,1,mL,,12,10.2,3.4392,12,"Health Partners, Inc.",Medicare Advantage,5.88,49,,percent of total billed charges,,
MORPHINE 4 MG/ML (1 ML) INJ WRAPPER,,J2270,HCPCS,Facility,Inpatient,1,mL,,12,10.2,3.4392,12,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
MORPHINE 4 MG/ML (1 ML) INJ WRAPPER,,J2270,HCPCS,Facility,Both,1,mL,,12,10.2,3.4392,12,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),7.2,60,,percent of total billed charges,,
MORPHINE 4 MG/ML (1 ML) INJ WRAPPER,,J2270,HCPCS,Facility,Both,1,mL,,12,10.2,3.4392,12,"Health Partners, Inc.",State of Minnesota Advantage Program,9.78,81.5,,percent of total billed charges,,
MORPHINE 4 MG/ML (1 ML) INJ WRAPPER,,J2270,HCPCS,Facility,Both,1,mL,,12,10.2,3.4392,12,"Health Partners, Inc.",State Public Programs,6,50,,percent of total billed charges,,
MORPHINE 4 MG/ML (1 ML) INJ WRAPPER,,J2270,HCPCS,Facility,Both,1,mL,,12,10.2,3.4392,12,Humana Insurance Company,Commercial PPO,11.4,95,,percent of total billed charges,,
MORPHINE 4 MG/ML (1 ML) INJ WRAPPER,,J2270,HCPCS,Facility,Outpatient,1,mL,,12,10.2,3.4392,12,Humana Insurance Company,Medicare PPO,5.88,49,,percent of total billed charges,,
MORPHINE 4 MG/ML (1 ML) INJ WRAPPER,,J2270,HCPCS,Facility,Inpatient,1,mL,,12,10.2,3.4392,12,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
MORPHINE 4 MG/ML (1 ML) INJ WRAPPER,,J2270,HCPCS,Facility,Both,1,mL,,12,10.2,3.4392,12,Medica,Individual & Family,11.892,99.1,,percent of total billed charges,,
MORPHINE 4 MG/ML (1 ML) INJ WRAPPER,,J2270,HCPCS,Facility,Outpatient,1,mL,,12,10.2,3.4392,12,Medica,Medica Advantage Solution,5.976,49.8,,percent of total billed charges,,
MORPHINE 4 MG/ML (1 ML) INJ WRAPPER,,J2270,HCPCS,Facility,Inpatient,1,mL,,12,10.2,3.4392,12,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
MORPHINE 4 MG/ML (1 ML) INJ WRAPPER,,J2270,HCPCS,Facility,Outpatient,1,mL,,12,10.2,3.4392,12,Medica,Medical Assistance,5.352,44.6,,percent of total billed charges,,
MORPHINE 4 MG/ML (1 ML) INJ WRAPPER,,J2270,HCPCS,Facility,Inpatient,1,mL,,12,10.2,3.4392,12,Medica,Medical Assistance,,,,,Included in per diem rate,
MORPHINE 4 MG/ML (1 ML) INJ WRAPPER,,J2270,HCPCS,Facility,Outpatient,1,mL,,12,10.2,3.4392,12,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,5.976,49.8,,percent of total billed charges,,
MORPHINE 4 MG/ML (1 ML) INJ WRAPPER,,J2270,HCPCS,Facility,Inpatient,1,mL,,12,10.2,3.4392,12,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
MORPHINE 4 MG/ML (1 ML) INJ WRAPPER,,J2270,HCPCS,Facility,Both,1,mL,,12,10.2,3.4392,12,"Multiplan, Inc.","Multiplan, Inc.",11.28,94,,percent of total billed charges,,
MORPHINE 4 MG/ML (1 ML) INJ WRAPPER,,J2270,HCPCS,Facility,Outpatient,1,mL,,12,10.2,3.4392,12,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,10.812,90.1,,percent of total billed charges,,
MORPHINE 4 MG/ML (1 ML) INJ WRAPPER,,J2270,HCPCS,Facility,Inpatient,1,mL,,12,10.2,3.4392,12,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
MORPHINE 4 MG/ML (1 ML) INJ WRAPPER,,J2270,HCPCS,Facility,Both,1,mL,,12,10.2,3.4392,12,"Preferred One Administrative Services, INC.",PPO,11.832,98.6,,percent of total billed charges,,
MORPHINE 4 MG/ML (1 ML) INJ WRAPPER,,J2270,HCPCS,Facility,Outpatient,1,mL,,12,10.2,3.4392,12,PrimeWest Health,Minnesota Senior Health Options (MSHO),6.174,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
MORPHINE 4 MG/ML (1 ML) INJ WRAPPER,,J2270,HCPCS,Facility,Inpatient,1,mL,,12,10.2,3.4392,12,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
MORPHINE 4 MG/ML (1 ML) INJ WRAPPER,,J2270,HCPCS,Facility,Outpatient,1,mL,,12,10.2,3.4392,12,PrimeWest Health,MinnesotaCare,6.1632,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
MORPHINE 4 MG/ML (1 ML) INJ WRAPPER,,J2270,HCPCS,Facility,Inpatient,1,mL,,12,10.2,3.4392,12,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
MORPHINE 4 MG/ML (1 ML) INJ WRAPPER,,J2270,HCPCS,Facility,Both,1,mL,,12,10.2,3.4392,12,Sanford Health Plan,Sanford Health Plan,11.04,92,,percent of total billed charges,,
MORPHINE 4 MG/ML (1 ML) INJ WRAPPER,,J2270,HCPCS,Facility,Outpatient,1,mL,,12,10.2,3.4392,12,"UCare Health, Inc.",Individual & Family Plan,6.762,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
MORPHINE 4 MG/ML (1 ML) INJ WRAPPER,,J2270,HCPCS,Facility,Inpatient,1,mL,,12,10.2,3.4392,12,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
MORPHINE 4 MG/ML (1 ML) INJ WRAPPER,,J2270,HCPCS,Facility,Outpatient,1,mL,,12,10.2,3.4392,12,"UCare Health, Inc.",Medical Assistance,6.0564,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MORPHINE 4 MG/ML (1 ML) INJ WRAPPER,,J2270,HCPCS,Facility,Inpatient,1,mL,,12,10.2,3.4392,12,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
MORPHINE 4 MG/ML (1 ML) INJ WRAPPER,,J2270,HCPCS,Facility,Outpatient,1,mL,,12,10.2,3.4392,12,"UCare Health, Inc.",Medicare Advantage,6.0564,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MORPHINE 4 MG/ML (1 ML) INJ WRAPPER,,J2270,HCPCS,Facility,Inpatient,1,mL,,12,10.2,3.4392,12,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
MORPHINE 4 MG/ML (1 ML) INJ WRAPPER,,J2270,HCPCS,Facility,Outpatient,1,mL,,12,10.2,3.4392,12,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),6.0564,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MORPHINE 4 MG/ML (1 ML) INJ WRAPPER,,J2270,HCPCS,Facility,Inpatient,1,mL,,12,10.2,3.4392,12,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
MORPHINE 4 MG/ML (1 ML) INJ WRAPPER,,J2270,HCPCS,Facility,Both,1,mL,,12,10.2,3.4392,12,UnitedHealthcare,Individual & Family,11.28,94,,percent of total billed charges,,
MORPHINE 4 MG/ML (1 ML) INJ WRAPPER,,J2270,HCPCS,Facility,Outpatient,1,mL,,12,10.2,3.4392,12,UnitedHealthcare,Medicare Advantage,5.88,49,,percent of total billed charges,,
MORPHINE 4 MG/ML (1 ML) INJ WRAPPER,,J2270,HCPCS,Facility,Inpatient,1,mL,,12,10.2,3.4392,12,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
MORPHINE 4 MG/ML (1 ML) INJ WRAPPER,,J2270,HCPCS,Facility,Outpatient,1,mL,,12,10.2,3.4392,12,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,5.76,48,,percent of total billed charges,,100% of DHS outpatient percentage
MORPHINE 4 MG/ML (1 ML) INJ WRAPPER,,J2270,HCPCS,Facility,Inpatient,1,mL,,12,10.2,3.4392,12,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
MORPHINE 4 MG/ML (1 ML) INJ WRAPPER,,J2272,HCPCS,Facility,Both,1,mL,,18,15.3,5.1588,18,Aetna,Commercial,16.56,92,,percent of total billed charges,,
MORPHINE 4 MG/ML (1 ML) INJ WRAPPER,,J2272,HCPCS,Facility,Outpatient,1,mL,,18,15.3,5.1588,18,Aetna,Medicare Advantage,8.82,49,,percent of total billed charges,,
MORPHINE 4 MG/ML (1 ML) INJ WRAPPER,,J2272,HCPCS,Facility,Inpatient,1,mL,,18,15.3,5.1588,18,Aetna,Medicare Advantage,,,,,Included in per diem rate,
MORPHINE 4 MG/ML (1 ML) INJ WRAPPER,,J2272,HCPCS,Facility,Both,1,mL,,18,15.3,5.1588,18,Aetna,PPO,16.74,93,,percent of total billed charges,,
MORPHINE 4 MG/ML (1 ML) INJ WRAPPER,,J2272,HCPCS,Facility,Both,1,mL,,18,15.3,5.1588,18,America's PPO,America's PPO,17.2854,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
MORPHINE 4 MG/ML (1 ML) INJ WRAPPER,,J2272,HCPCS,Facility,Both,1,mL,,18,15.3,5.1588,18,BlueCross BlueShield Minnesota, Federal Employee Program,17.712,98.4,,percent of total billed charges,,
MORPHINE 4 MG/ML (1 ML) INJ WRAPPER,,J2272,HCPCS,Facility,Both,1,mL,,18,15.3,5.1588,18,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,18,100,,percent of total billed charges,,
MORPHINE 4 MG/ML (1 ML) INJ WRAPPER,,J2272,HCPCS,Facility,Both,1,mL,,18,15.3,5.1588,18,BlueCross BlueShield Minnesota,High Value Network Plan,16.2,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
MORPHINE 4 MG/ML (1 ML) INJ WRAPPER,,J2272,HCPCS,Facility,Outpatient,1,mL,,18,15.3,5.1588,18,BlueCross BlueShield Minnesota,Medicare Advantage,8.82,49,,percent of total billed charges,,
MORPHINE 4 MG/ML (1 ML) INJ WRAPPER,,J2272,HCPCS,Facility,Inpatient,1,mL,,18,15.3,5.1588,18,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
MORPHINE 4 MG/ML (1 ML) INJ WRAPPER,,J2272,HCPCS,Facility,Both,1,mL,,18,15.3,5.1588,18,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,15.9426,88.57,,percent of total billed charges,,
MORPHINE 4 MG/ML (1 ML) INJ WRAPPER,,J2272,HCPCS,Facility,Both,1,mL,,18,15.3,5.1588,18,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,5.1588,28.66,,percent of total billed charges,,
MORPHINE 4 MG/ML (1 ML) INJ WRAPPER,,J2272,HCPCS,Facility,Outpatient,1,mL,,18,15.3,5.1588,18,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),8.82,49,,percent of total billed charges,,
MORPHINE 4 MG/ML (1 ML) INJ WRAPPER,,J2272,HCPCS,Facility,Inpatient,1,mL,,18,15.3,5.1588,18,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
MORPHINE 4 MG/ML (1 ML) INJ WRAPPER,,J2272,HCPCS,Facility,Both,1,mL,,18,15.3,5.1588,18,CorVel,Worker's Compensation,18,100,,percent of total billed charges,,
MORPHINE 4 MG/ML (1 ML) INJ WRAPPER,,J2272,HCPCS,Facility,Both,1,mL,,18,15.3,5.1588,18,First Health Group Corporation,First Health Network,17.46,97,,percent of total billed charges,,
MORPHINE 4 MG/ML (1 ML) INJ WRAPPER,,J2272,HCPCS,Facility,Both,1,mL,,18,15.3,5.1588,18,"Health Partners, Inc.",Commercial,17.028,94.6,,percent of total billed charges,,
MORPHINE 4 MG/ML (1 ML) INJ WRAPPER,,J2272,HCPCS,Facility,Outpatient,1,mL,,18,15.3,5.1588,18,"Health Partners, Inc.",Medicare Advantage,8.82,49,,percent of total billed charges,,
MORPHINE 4 MG/ML (1 ML) INJ WRAPPER,,J2272,HCPCS,Facility,Inpatient,1,mL,,18,15.3,5.1588,18,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
MORPHINE 4 MG/ML (1 ML) INJ WRAPPER,,J2272,HCPCS,Facility,Both,1,mL,,18,15.3,5.1588,18,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),10.8,60,,percent of total billed charges,,
MORPHINE 4 MG/ML (1 ML) INJ WRAPPER,,J2272,HCPCS,Facility,Both,1,mL,,18,15.3,5.1588,18,"Health Partners, Inc.",State of Minnesota Advantage Program,14.67,81.5,,percent of total billed charges,,
MORPHINE 4 MG/ML (1 ML) INJ WRAPPER,,J2272,HCPCS,Facility,Both,1,mL,,18,15.3,5.1588,18,"Health Partners, Inc.",State Public Programs,9,50,,percent of total billed charges,,
MORPHINE 4 MG/ML (1 ML) INJ WRAPPER,,J2272,HCPCS,Facility,Both,1,mL,,18,15.3,5.1588,18,Humana Insurance Company,Commercial PPO,17.1,95,,percent of total billed charges,,
MORPHINE 4 MG/ML (1 ML) INJ WRAPPER,,J2272,HCPCS,Facility,Outpatient,1,mL,,18,15.3,5.1588,18,Humana Insurance Company,Medicare PPO,8.82,49,,percent of total billed charges,,
MORPHINE 4 MG/ML (1 ML) INJ WRAPPER,,J2272,HCPCS,Facility,Inpatient,1,mL,,18,15.3,5.1588,18,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
MORPHINE 4 MG/ML (1 ML) INJ WRAPPER,,J2272,HCPCS,Facility,Both,1,mL,,18,15.3,5.1588,18,Medica,Individual & Family,17.838,99.1,,percent of total billed charges,,
MORPHINE 4 MG/ML (1 ML) INJ WRAPPER,,J2272,HCPCS,Facility,Outpatient,1,mL,,18,15.3,5.1588,18,Medica,Medica Advantage Solution,8.964,49.8,,percent of total billed charges,,
MORPHINE 4 MG/ML (1 ML) INJ WRAPPER,,J2272,HCPCS,Facility,Inpatient,1,mL,,18,15.3,5.1588,18,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
MORPHINE 4 MG/ML (1 ML) INJ WRAPPER,,J2272,HCPCS,Facility,Outpatient,1,mL,,18,15.3,5.1588,18,Medica,Medical Assistance,8.028,44.6,,percent of total billed charges,,
MORPHINE 4 MG/ML (1 ML) INJ WRAPPER,,J2272,HCPCS,Facility,Inpatient,1,mL,,18,15.3,5.1588,18,Medica,Medical Assistance,,,,,Included in per diem rate,
MORPHINE 4 MG/ML (1 ML) INJ WRAPPER,,J2272,HCPCS,Facility,Outpatient,1,mL,,18,15.3,5.1588,18,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,8.964,49.8,,percent of total billed charges,,
MORPHINE 4 MG/ML (1 ML) INJ WRAPPER,,J2272,HCPCS,Facility,Inpatient,1,mL,,18,15.3,5.1588,18,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
MORPHINE 4 MG/ML (1 ML) INJ WRAPPER,,J2272,HCPCS,Facility,Both,1,mL,,18,15.3,5.1588,18,"Multiplan, Inc.","Multiplan, Inc.",16.92,94,,percent of total billed charges,,
MORPHINE 4 MG/ML (1 ML) INJ WRAPPER,,J2272,HCPCS,Facility,Outpatient,1,mL,,18,15.3,5.1588,18,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,16.218,90.1,,percent of total billed charges,,
MORPHINE 4 MG/ML (1 ML) INJ WRAPPER,,J2272,HCPCS,Facility,Inpatient,1,mL,,18,15.3,5.1588,18,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
MORPHINE 4 MG/ML (1 ML) INJ WRAPPER,,J2272,HCPCS,Facility,Both,1,mL,,18,15.3,5.1588,18,"Preferred One Administrative Services, INC.",PPO,17.748,98.6,,percent of total billed charges,,
MORPHINE 4 MG/ML (1 ML) INJ WRAPPER,,J2272,HCPCS,Facility,Outpatient,1,mL,,18,15.3,5.1588,18,PrimeWest Health,Minnesota Senior Health Options (MSHO),9.261,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
MORPHINE 4 MG/ML (1 ML) INJ WRAPPER,,J2272,HCPCS,Facility,Inpatient,1,mL,,18,15.3,5.1588,18,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
MORPHINE 4 MG/ML (1 ML) INJ WRAPPER,,J2272,HCPCS,Facility,Outpatient,1,mL,,18,15.3,5.1588,18,PrimeWest Health,MinnesotaCare,9.2448,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
MORPHINE 4 MG/ML (1 ML) INJ WRAPPER,,J2272,HCPCS,Facility,Inpatient,1,mL,,18,15.3,5.1588,18,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
MORPHINE 4 MG/ML (1 ML) INJ WRAPPER,,J2272,HCPCS,Facility,Both,1,mL,,18,15.3,5.1588,18,Sanford Health Plan,Sanford Health Plan,16.56,92,,percent of total billed charges,,
MORPHINE 4 MG/ML (1 ML) INJ WRAPPER,,J2272,HCPCS,Facility,Outpatient,1,mL,,18,15.3,5.1588,18,"UCare Health, Inc.",Individual & Family Plan,10.143,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
MORPHINE 4 MG/ML (1 ML) INJ WRAPPER,,J2272,HCPCS,Facility,Inpatient,1,mL,,18,15.3,5.1588,18,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
MORPHINE 4 MG/ML (1 ML) INJ WRAPPER,,J2272,HCPCS,Facility,Outpatient,1,mL,,18,15.3,5.1588,18,"UCare Health, Inc.",Medical Assistance,9.0846,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MORPHINE 4 MG/ML (1 ML) INJ WRAPPER,,J2272,HCPCS,Facility,Inpatient,1,mL,,18,15.3,5.1588,18,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
MORPHINE 4 MG/ML (1 ML) INJ WRAPPER,,J2272,HCPCS,Facility,Outpatient,1,mL,,18,15.3,5.1588,18,"UCare Health, Inc.",Medicare Advantage,9.0846,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MORPHINE 4 MG/ML (1 ML) INJ WRAPPER,,J2272,HCPCS,Facility,Inpatient,1,mL,,18,15.3,5.1588,18,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
MORPHINE 4 MG/ML (1 ML) INJ WRAPPER,,J2272,HCPCS,Facility,Outpatient,1,mL,,18,15.3,5.1588,18,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),9.0846,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MORPHINE 4 MG/ML (1 ML) INJ WRAPPER,,J2272,HCPCS,Facility,Inpatient,1,mL,,18,15.3,5.1588,18,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
MORPHINE 4 MG/ML (1 ML) INJ WRAPPER,,J2272,HCPCS,Facility,Both,1,mL,,18,15.3,5.1588,18,UnitedHealthcare,Individual & Family,16.92,94,,percent of total billed charges,,
MORPHINE 4 MG/ML (1 ML) INJ WRAPPER,,J2272,HCPCS,Facility,Outpatient,1,mL,,18,15.3,5.1588,18,UnitedHealthcare,Medicare Advantage,8.82,49,,percent of total billed charges,,
MORPHINE 4 MG/ML (1 ML) INJ WRAPPER,,J2272,HCPCS,Facility,Inpatient,1,mL,,18,15.3,5.1588,18,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
MORPHINE 4 MG/ML (1 ML) INJ WRAPPER,,J2272,HCPCS,Facility,Outpatient,1,mL,,18,15.3,5.1588,18,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,8.64,48,,percent of total billed charges,,100% of DHS outpatient percentage
MORPHINE 4 MG/ML (1 ML) INJ WRAPPER,,J2272,HCPCS,Facility,Inpatient,1,mL,,18,15.3,5.1588,18,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
NALBUPHINE 20 MG/ML INJ SOLN,,J2300,HCPCS,Facility,Both,1,mL,,42,35.7,12.0372,42,Aetna,Commercial,38.64,92,,percent of total billed charges,,
NALBUPHINE 20 MG/ML INJ SOLN,,J2300,HCPCS,Facility,Outpatient,1,mL,,42,35.7,12.0372,42,Aetna,Medicare Advantage,20.58,49,,percent of total billed charges,,
NALBUPHINE 20 MG/ML INJ SOLN,,J2300,HCPCS,Facility,Inpatient,1,mL,,42,35.7,12.0372,42,Aetna,Medicare Advantage,,,,,Included in per diem rate,
NALBUPHINE 20 MG/ML INJ SOLN,,J2300,HCPCS,Facility,Both,1,mL,,42,35.7,12.0372,42,Aetna,PPO,39.06,93,,percent of total billed charges,,
NALBUPHINE 20 MG/ML INJ SOLN,,J2300,HCPCS,Facility,Both,1,mL,,42,35.7,12.0372,42,America's PPO,America's PPO,40.3326,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
NALBUPHINE 20 MG/ML INJ SOLN,,J2300,HCPCS,Facility,Both,1,mL,,42,35.7,12.0372,42,BlueCross BlueShield Minnesota, Federal Employee Program,41.328,98.4,,percent of total billed charges,,
NALBUPHINE 20 MG/ML INJ SOLN,,J2300,HCPCS,Facility,Both,1,mL,,42,35.7,12.0372,42,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,42,100,,percent of total billed charges,,
NALBUPHINE 20 MG/ML INJ SOLN,,J2300,HCPCS,Facility,Both,1,mL,,42,35.7,12.0372,42,BlueCross BlueShield Minnesota,High Value Network Plan,37.8,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
NALBUPHINE 20 MG/ML INJ SOLN,,J2300,HCPCS,Facility,Outpatient,1,mL,,42,35.7,12.0372,42,BlueCross BlueShield Minnesota,Medicare Advantage,20.58,49,,percent of total billed charges,,
NALBUPHINE 20 MG/ML INJ SOLN,,J2300,HCPCS,Facility,Inpatient,1,mL,,42,35.7,12.0372,42,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
NALBUPHINE 20 MG/ML INJ SOLN,,J2300,HCPCS,Facility,Both,1,mL,,42,35.7,12.0372,42,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,37.1994,88.57,,percent of total billed charges,,
NALBUPHINE 20 MG/ML INJ SOLN,,J2300,HCPCS,Facility,Both,1,mL,,42,35.7,12.0372,42,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,12.0372,28.66,,percent of total billed charges,,
NALBUPHINE 20 MG/ML INJ SOLN,,J2300,HCPCS,Facility,Outpatient,1,mL,,42,35.7,12.0372,42,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),20.58,49,,percent of total billed charges,,
NALBUPHINE 20 MG/ML INJ SOLN,,J2300,HCPCS,Facility,Inpatient,1,mL,,42,35.7,12.0372,42,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
NALBUPHINE 20 MG/ML INJ SOLN,,J2300,HCPCS,Facility,Both,1,mL,,42,35.7,12.0372,42,CorVel,Worker's Compensation,42,100,,percent of total billed charges,,
NALBUPHINE 20 MG/ML INJ SOLN,,J2300,HCPCS,Facility,Both,1,mL,,42,35.7,12.0372,42,First Health Group Corporation,First Health Network,40.74,97,,percent of total billed charges,,
NALBUPHINE 20 MG/ML INJ SOLN,,J2300,HCPCS,Facility,Both,1,mL,,42,35.7,12.0372,42,"Health Partners, Inc.",Commercial,39.732,94.6,,percent of total billed charges,,
NALBUPHINE 20 MG/ML INJ SOLN,,J2300,HCPCS,Facility,Outpatient,1,mL,,42,35.7,12.0372,42,"Health Partners, Inc.",Medicare Advantage,20.58,49,,percent of total billed charges,,
NALBUPHINE 20 MG/ML INJ SOLN,,J2300,HCPCS,Facility,Inpatient,1,mL,,42,35.7,12.0372,42,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
NALBUPHINE 20 MG/ML INJ SOLN,,J2300,HCPCS,Facility,Both,1,mL,,42,35.7,12.0372,42,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),25.2,60,,percent of total billed charges,,
NALBUPHINE 20 MG/ML INJ SOLN,,J2300,HCPCS,Facility,Both,1,mL,,42,35.7,12.0372,42,"Health Partners, Inc.",State of Minnesota Advantage Program,34.23,81.5,,percent of total billed charges,,
NALBUPHINE 20 MG/ML INJ SOLN,,J2300,HCPCS,Facility,Both,1,mL,,42,35.7,12.0372,42,"Health Partners, Inc.",State Public Programs,21,50,,percent of total billed charges,,
NALBUPHINE 20 MG/ML INJ SOLN,,J2300,HCPCS,Facility,Both,1,mL,,42,35.7,12.0372,42,Humana Insurance Company,Commercial PPO,39.9,95,,percent of total billed charges,,
NALBUPHINE 20 MG/ML INJ SOLN,,J2300,HCPCS,Facility,Outpatient,1,mL,,42,35.7,12.0372,42,Humana Insurance Company,Medicare PPO,20.58,49,,percent of total billed charges,,
NALBUPHINE 20 MG/ML INJ SOLN,,J2300,HCPCS,Facility,Inpatient,1,mL,,42,35.7,12.0372,42,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
NALBUPHINE 20 MG/ML INJ SOLN,,J2300,HCPCS,Facility,Both,1,mL,,42,35.7,12.0372,42,Medica,Individual & Family,41.622,99.1,,percent of total billed charges,,
NALBUPHINE 20 MG/ML INJ SOLN,,J2300,HCPCS,Facility,Outpatient,1,mL,,42,35.7,12.0372,42,Medica,Medica Advantage Solution,20.916,49.8,,percent of total billed charges,,
NALBUPHINE 20 MG/ML INJ SOLN,,J2300,HCPCS,Facility,Inpatient,1,mL,,42,35.7,12.0372,42,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
NALBUPHINE 20 MG/ML INJ SOLN,,J2300,HCPCS,Facility,Outpatient,1,mL,,42,35.7,12.0372,42,Medica,Medical Assistance,18.732,44.6,,percent of total billed charges,,
NALBUPHINE 20 MG/ML INJ SOLN,,J2300,HCPCS,Facility,Inpatient,1,mL,,42,35.7,12.0372,42,Medica,Medical Assistance,,,,,Included in per diem rate,
NALBUPHINE 20 MG/ML INJ SOLN,,J2300,HCPCS,Facility,Outpatient,1,mL,,42,35.7,12.0372,42,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,20.916,49.8,,percent of total billed charges,,
NALBUPHINE 20 MG/ML INJ SOLN,,J2300,HCPCS,Facility,Inpatient,1,mL,,42,35.7,12.0372,42,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
NALBUPHINE 20 MG/ML INJ SOLN,,J2300,HCPCS,Facility,Both,1,mL,,42,35.7,12.0372,42,"Multiplan, Inc.","Multiplan, Inc.",39.48,94,,percent of total billed charges,,
NALBUPHINE 20 MG/ML INJ SOLN,,J2300,HCPCS,Facility,Outpatient,1,mL,,42,35.7,12.0372,42,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,37.842,90.1,,percent of total billed charges,,
NALBUPHINE 20 MG/ML INJ SOLN,,J2300,HCPCS,Facility,Inpatient,1,mL,,42,35.7,12.0372,42,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
NALBUPHINE 20 MG/ML INJ SOLN,,J2300,HCPCS,Facility,Both,1,mL,,42,35.7,12.0372,42,"Preferred One Administrative Services, INC.",PPO,41.412,98.6,,percent of total billed charges,,
NALBUPHINE 20 MG/ML INJ SOLN,,J2300,HCPCS,Facility,Outpatient,1,mL,,42,35.7,12.0372,42,PrimeWest Health,Minnesota Senior Health Options (MSHO),21.609,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
NALBUPHINE 20 MG/ML INJ SOLN,,J2300,HCPCS,Facility,Inpatient,1,mL,,42,35.7,12.0372,42,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
NALBUPHINE 20 MG/ML INJ SOLN,,J2300,HCPCS,Facility,Outpatient,1,mL,,42,35.7,12.0372,42,PrimeWest Health,MinnesotaCare,21.5712,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
NALBUPHINE 20 MG/ML INJ SOLN,,J2300,HCPCS,Facility,Inpatient,1,mL,,42,35.7,12.0372,42,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
NALBUPHINE 20 MG/ML INJ SOLN,,J2300,HCPCS,Facility,Both,1,mL,,42,35.7,12.0372,42,Sanford Health Plan,Sanford Health Plan,38.64,92,,percent of total billed charges,,
NALBUPHINE 20 MG/ML INJ SOLN,,J2300,HCPCS,Facility,Outpatient,1,mL,,42,35.7,12.0372,42,"UCare Health, Inc.",Individual & Family Plan,23.667,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
NALBUPHINE 20 MG/ML INJ SOLN,,J2300,HCPCS,Facility,Inpatient,1,mL,,42,35.7,12.0372,42,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
NALBUPHINE 20 MG/ML INJ SOLN,,J2300,HCPCS,Facility,Outpatient,1,mL,,42,35.7,12.0372,42,"UCare Health, Inc.",Medical Assistance,21.1974,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
NALBUPHINE 20 MG/ML INJ SOLN,,J2300,HCPCS,Facility,Inpatient,1,mL,,42,35.7,12.0372,42,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
NALBUPHINE 20 MG/ML INJ SOLN,,J2300,HCPCS,Facility,Outpatient,1,mL,,42,35.7,12.0372,42,"UCare Health, Inc.",Medicare Advantage,21.1974,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
NALBUPHINE 20 MG/ML INJ SOLN,,J2300,HCPCS,Facility,Inpatient,1,mL,,42,35.7,12.0372,42,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
NALBUPHINE 20 MG/ML INJ SOLN,,J2300,HCPCS,Facility,Outpatient,1,mL,,42,35.7,12.0372,42,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),21.1974,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
NALBUPHINE 20 MG/ML INJ SOLN,,J2300,HCPCS,Facility,Inpatient,1,mL,,42,35.7,12.0372,42,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
NALBUPHINE 20 MG/ML INJ SOLN,,J2300,HCPCS,Facility,Both,1,mL,,42,35.7,12.0372,42,UnitedHealthcare,Individual & Family,39.48,94,,percent of total billed charges,,
NALBUPHINE 20 MG/ML INJ SOLN,,J2300,HCPCS,Facility,Outpatient,1,mL,,42,35.7,12.0372,42,UnitedHealthcare,Medicare Advantage,20.58,49,,percent of total billed charges,,
NALBUPHINE 20 MG/ML INJ SOLN,,J2300,HCPCS,Facility,Inpatient,1,mL,,42,35.7,12.0372,42,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
NALBUPHINE 20 MG/ML INJ SOLN,,J2300,HCPCS,Facility,Outpatient,1,mL,,42,35.7,12.0372,42,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,20.16,48,,percent of total billed charges,,100% of DHS outpatient percentage
NALBUPHINE 20 MG/ML INJ SOLN,,J2300,HCPCS,Facility,Inpatient,1,mL,,42,35.7,12.0372,42,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Venipuncture, Age 3 Years Or Older, Necessitating Physician'S Skill",,36410,CPT,Facility,Both,,,,41,34.85,11.7506,41,Aetna,Commercial,37.72,92,,percent of total billed charges,,
"Venipuncture, Age 3 Years Or Older, Necessitating Physician'S Skill",,36410,CPT,Facility,Outpatient,,,,41,34.85,11.7506,41,Aetna,Medicare Advantage,20.09,49,,percent of total billed charges,,
"Venipuncture, Age 3 Years Or Older, Necessitating Physician'S Skill",,36410,CPT,Facility,Inpatient,,,,41,34.85,11.7506,41,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Venipuncture, Age 3 Years Or Older, Necessitating Physician'S Skill",,36410,CPT,Facility,Both,,,,41,34.85,11.7506,41,Aetna,PPO,38.13,93,,percent of total billed charges,,
"Venipuncture, Age 3 Years Or Older, Necessitating Physician'S Skill",,36410,CPT,Facility,Both,,,,41,34.85,11.7506,41,America's PPO,America's PPO,39.3723,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Venipuncture, Age 3 Years Or Older, Necessitating Physician'S Skill",,36410,CPT,Facility,Both,,,,41,34.85,11.7506,41,BlueCross BlueShield Minnesota, Federal Employee Program,40.344,98.4,,percent of total billed charges,,
"Venipuncture, Age 3 Years Or Older, Necessitating Physician'S Skill",,36410,CPT,Facility,Both,,,,41,34.85,11.7506,41,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,41,100,,percent of total billed charges,,
"Venipuncture, Age 3 Years Or Older, Necessitating Physician'S Skill",,36410,CPT,Facility,Both,,,,41,34.85,11.7506,41,BlueCross BlueShield Minnesota,High Value Network Plan,36.9,90,,percent of total billed charges,,
"Venipuncture, Age 3 Years Or Older, Necessitating Physician'S Skill",,36410,CPT,Facility,Outpatient,,,,41,34.85,11.7506,41,BlueCross BlueShield Minnesota,Medicare Advantage,20.09,49,,percent of total billed charges,,
"Venipuncture, Age 3 Years Or Older, Necessitating Physician'S Skill",,36410,CPT,Facility,Inpatient,,,,41,34.85,11.7506,41,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Venipuncture, Age 3 Years Or Older, Necessitating Physician'S Skill",,36410,CPT,Facility,Both,,,,41,34.85,11.7506,41,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,36.3137,88.57,,percent of total billed charges,,
"Venipuncture, Age 3 Years Or Older, Necessitating Physician'S Skill",,36410,CPT,Facility,Both,,,,41,34.85,11.7506,41,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,11.7506,28.66,,percent of total billed charges,,
"Venipuncture, Age 3 Years Or Older, Necessitating Physician'S Skill",,36410,CPT,Facility,Outpatient,,,,41,34.85,11.7506,41,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),20.09,49,,percent of total billed charges,,
"Venipuncture, Age 3 Years Or Older, Necessitating Physician'S Skill",,36410,CPT,Facility,Inpatient,,,,41,34.85,11.7506,41,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Venipuncture, Age 3 Years Or Older, Necessitating Physician'S Skill",,36410,CPT,Facility,Both,,,,41,34.85,11.7506,41,CorVel,Worker's Compensation,41,100,,percent of total billed charges,,
"Venipuncture, Age 3 Years Or Older, Necessitating Physician'S Skill",,36410,CPT,Facility,Both,,,,41,34.85,11.7506,41,First Health Group Corporation,First Health Network,39.77,97,,percent of total billed charges,,
"Venipuncture, Age 3 Years Or Older, Necessitating Physician'S Skill",,36410,CPT,Facility,Both,,,,41,34.85,11.7506,41,"Health Partners, Inc.",Commercial,38.786,94.6,,percent of total billed charges,,
"Venipuncture, Age 3 Years Or Older, Necessitating Physician'S Skill",,36410,CPT,Facility,Outpatient,,,,41,34.85,11.7506,41,"Health Partners, Inc.",Medicare Advantage,20.09,49,,percent of total billed charges,,
"Venipuncture, Age 3 Years Or Older, Necessitating Physician'S Skill",,36410,CPT,Facility,Inpatient,,,,41,34.85,11.7506,41,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Venipuncture, Age 3 Years Or Older, Necessitating Physician'S Skill",,36410,CPT,Facility,Both,,,,41,34.85,11.7506,41,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),24.6,60,,percent of total billed charges,,
"Venipuncture, Age 3 Years Or Older, Necessitating Physician'S Skill",,36410,CPT,Facility,Both,,,,41,34.85,11.7506,41,"Health Partners, Inc.",State of Minnesota Advantage Program,33.415,81.5,,percent of total billed charges,,
"Venipuncture, Age 3 Years Or Older, Necessitating Physician'S Skill",,36410,CPT,Facility,Both,,,,41,34.85,11.7506,41,"Health Partners, Inc.",State Public Programs,20.5,50,,percent of total billed charges,,
"Venipuncture, Age 3 Years Or Older, Necessitating Physician'S Skill",,36410,CPT,Facility,Both,,,,41,34.85,11.7506,41,Humana Insurance Company,Commercial PPO,38.95,95,,percent of total billed charges,,
"Venipuncture, Age 3 Years Or Older, Necessitating Physician'S Skill",,36410,CPT,Facility,Outpatient,,,,41,34.85,11.7506,41,Humana Insurance Company,Medicare PPO,20.09,49,,percent of total billed charges,,
"Venipuncture, Age 3 Years Or Older, Necessitating Physician'S Skill",,36410,CPT,Facility,Inpatient,,,,41,34.85,11.7506,41,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Venipuncture, Age 3 Years Or Older, Necessitating Physician'S Skill",,36410,CPT,Facility,Both,,,,41,34.85,11.7506,41,Medica,Individual & Family,40.631,99.1,,percent of total billed charges,,
"Venipuncture, Age 3 Years Or Older, Necessitating Physician'S Skill",,36410,CPT,Facility,Outpatient,,,,41,34.85,11.7506,41,Medica,Medica Advantage Solution,20.418,49.8,,percent of total billed charges,,
"Venipuncture, Age 3 Years Or Older, Necessitating Physician'S Skill",,36410,CPT,Facility,Inpatient,,,,41,34.85,11.7506,41,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Venipuncture, Age 3 Years Or Older, Necessitating Physician'S Skill",,36410,CPT,Facility,Outpatient,,,,41,34.85,11.7506,41,Medica,Medical Assistance,18.286,44.6,,percent of total billed charges,,
"Venipuncture, Age 3 Years Or Older, Necessitating Physician'S Skill",,36410,CPT,Facility,Inpatient,,,,41,34.85,11.7506,41,Medica,Medical Assistance,,,,,Included in per diem rate,
"Venipuncture, Age 3 Years Or Older, Necessitating Physician'S Skill",,36410,CPT,Facility,Outpatient,,,,41,34.85,11.7506,41,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,20.418,49.8,,percent of total billed charges,,
"Venipuncture, Age 3 Years Or Older, Necessitating Physician'S Skill",,36410,CPT,Facility,Inpatient,,,,41,34.85,11.7506,41,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Venipuncture, Age 3 Years Or Older, Necessitating Physician'S Skill",,36410,CPT,Facility,Both,,,,41,34.85,11.7506,41,"Multiplan, Inc.","Multiplan, Inc.",38.54,94,,percent of total billed charges,,
"Venipuncture, Age 3 Years Or Older, Necessitating Physician'S Skill",,36410,CPT,Facility,Outpatient,,,,41,34.85,11.7506,41,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,36.941,90.1,,percent of total billed charges,,
"Venipuncture, Age 3 Years Or Older, Necessitating Physician'S Skill",,36410,CPT,Facility,Inpatient,,,,41,34.85,11.7506,41,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Venipuncture, Age 3 Years Or Older, Necessitating Physician'S Skill",,36410,CPT,Facility,Both,,,,41,34.85,11.7506,41,"Preferred One Administrative Services, INC.",PPO,40.426,98.6,,percent of total billed charges,,
"Venipuncture, Age 3 Years Or Older, Necessitating Physician'S Skill",,36410,CPT,Facility,Outpatient,,,,41,34.85,11.7506,41,PrimeWest Health,Minnesota Senior Health Options (MSHO),21.0945,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Venipuncture, Age 3 Years Or Older, Necessitating Physician'S Skill",,36410,CPT,Facility,Inpatient,,,,41,34.85,11.7506,41,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Venipuncture, Age 3 Years Or Older, Necessitating Physician'S Skill",,36410,CPT,Facility,Outpatient,,,,41,34.85,11.7506,41,PrimeWest Health,MinnesotaCare,21.0576,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Venipuncture, Age 3 Years Or Older, Necessitating Physician'S Skill",,36410,CPT,Facility,Inpatient,,,,41,34.85,11.7506,41,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Venipuncture, Age 3 Years Or Older, Necessitating Physician'S Skill",,36410,CPT,Facility,Both,,,,41,34.85,11.7506,41,Sanford Health Plan,Sanford Health Plan,37.72,92,,percent of total billed charges,,
"Venipuncture, Age 3 Years Or Older, Necessitating Physician'S Skill",,36410,CPT,Facility,Outpatient,,,,41,34.85,11.7506,41,"UCare Health, Inc.",Individual & Family Plan,23.1035,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Venipuncture, Age 3 Years Or Older, Necessitating Physician'S Skill",,36410,CPT,Facility,Inpatient,,,,41,34.85,11.7506,41,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Venipuncture, Age 3 Years Or Older, Necessitating Physician'S Skill",,36410,CPT,Facility,Outpatient,,,,41,34.85,11.7506,41,"UCare Health, Inc.",Medical Assistance,20.6927,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Venipuncture, Age 3 Years Or Older, Necessitating Physician'S Skill",,36410,CPT,Facility,Inpatient,,,,41,34.85,11.7506,41,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Venipuncture, Age 3 Years Or Older, Necessitating Physician'S Skill",,36410,CPT,Facility,Outpatient,,,,41,34.85,11.7506,41,"UCare Health, Inc.",Medicare Advantage,20.6927,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Venipuncture, Age 3 Years Or Older, Necessitating Physician'S Skill",,36410,CPT,Facility,Inpatient,,,,41,34.85,11.7506,41,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Venipuncture, Age 3 Years Or Older, Necessitating Physician'S Skill",,36410,CPT,Facility,Outpatient,,,,41,34.85,11.7506,41,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),20.6927,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Venipuncture, Age 3 Years Or Older, Necessitating Physician'S Skill",,36410,CPT,Facility,Inpatient,,,,41,34.85,11.7506,41,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Venipuncture, Age 3 Years Or Older, Necessitating Physician'S Skill",,36410,CPT,Facility,Both,,,,41,34.85,11.7506,41,UnitedHealthcare,Individual & Family,38.54,94,,percent of total billed charges,,
"Venipuncture, Age 3 Years Or Older, Necessitating Physician'S Skill",,36410,CPT,Facility,Outpatient,,,,41,34.85,11.7506,41,UnitedHealthcare,Medicare Advantage,20.09,49,,percent of total billed charges,,
"Venipuncture, Age 3 Years Or Older, Necessitating Physician'S Skill",,36410,CPT,Facility,Inpatient,,,,41,34.85,11.7506,41,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Venipuncture, Age 3 Years Or Older, Necessitating Physician'S Skill",,36410,CPT,Facility,Outpatient,,,,41,34.85,11.7506,41,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,19.68,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Venipuncture, Age 3 Years Or Older, Necessitating Physician'S Skill",,36410,CPT,Facility,Inpatient,,,,41,34.85,11.7506,41,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Blood Alcohol Collection-Er (Bill Only),,36415,CPT,Facility,Both,,,,61,51.85,17.78,61,Aetna,Commercial,56.12,92,,percent of total billed charges,,
Blood Alcohol Collection-Er (Bill Only),,36415,CPT,Facility,Outpatient,,,,61,51.85,17.78,61,Aetna,Medicare Advantage,29.89,49,,percent of total billed charges,,
Blood Alcohol Collection-Er (Bill Only),,36415,CPT,Facility,Inpatient,,,,61,51.85,17.78,61,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Blood Alcohol Collection-Er (Bill Only),,36415,CPT,Facility,Both,,,,61,51.85,17.78,61,Aetna,PPO,56.73,93,,percent of total billed charges,,
Blood Alcohol Collection-Er (Bill Only),,36415,CPT,Facility,Both,,,,61,51.85,17.78,61,America's PPO,America's PPO,58.5783,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Blood Alcohol Collection-Er (Bill Only),,36415,CPT,Facility,Both,,,,61,51.85,17.78,61,BlueCross BlueShield Minnesota, Federal Employee Program,35,,,Fee schedule,,100% of BCBS commercial commodity fee schedule
Blood Alcohol Collection-Er (Bill Only),,36415,CPT,Facility,Both,,,,61,51.85,17.78,61,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,35.56,,,Fee schedule,,"100% of BCBS commercial commodity fee schedule, plus MN Care tax"
Blood Alcohol Collection-Er (Bill Only),,36415,CPT,Facility,Both,,,,61,51.85,17.78,61,BlueCross BlueShield Minnesota,High Value Network Plan,32.004,,,Fee schedule,,"90% of BCBS commercial commodity fee schedule, plus MN Care tax; see disclaimer for more information"
Blood Alcohol Collection-Er (Bill Only),,36415,CPT,Facility,Outpatient,,,,61,51.85,17.78,61,BlueCross BlueShield Minnesota,Medicare Advantage,29.89,49,,percent of total billed charges,,
Blood Alcohol Collection-Er (Bill Only),,36415,CPT,Facility,Inpatient,,,,61,51.85,17.78,61,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Blood Alcohol Collection-Er (Bill Only),,36415,CPT,Facility,Both,,,,61,51.85,17.78,61,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,31.495492,,,Fee schedule,,"88.57% of BCBS commercial commodity fee schedule, plus MN Care tax"
Blood Alcohol Collection-Er (Bill Only),,36415,CPT,Facility,Both,,,,61,51.85,17.78,61,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,17.78,,,Fee schedule,,"100% of BCBS Medicaid commodity fee schedule, plus MN Care tax"
Blood Alcohol Collection-Er (Bill Only),,36415,CPT,Facility,Outpatient,,,,61,51.85,17.78,61,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),29.89,49,,percent of total billed charges,,
Blood Alcohol Collection-Er (Bill Only),,36415,CPT,Facility,Inpatient,,,,61,51.85,17.78,61,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Blood Alcohol Collection-Er (Bill Only),,36415,CPT,Facility,Both,,,,61,51.85,17.78,61,CorVel,Worker's Compensation,61,100,,percent of total billed charges,,
Blood Alcohol Collection-Er (Bill Only),,36415,CPT,Facility,Both,,,,61,51.85,17.78,61,First Health Group Corporation,First Health Network,59.17,97,,percent of total billed charges,,
Blood Alcohol Collection-Er (Bill Only),,36415,CPT,Facility,Both,,,,61,51.85,17.78,61,"Health Partners, Inc.",Commercial,57.706,94.6,,percent of total billed charges,,
Blood Alcohol Collection-Er (Bill Only),,36415,CPT,Facility,Outpatient,,,,61,51.85,17.78,61,"Health Partners, Inc.",Medicare Advantage,29.89,49,,percent of total billed charges,,
Blood Alcohol Collection-Er (Bill Only),,36415,CPT,Facility,Inpatient,,,,61,51.85,17.78,61,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Blood Alcohol Collection-Er (Bill Only),,36415,CPT,Facility,Both,,,,61,51.85,17.78,61,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),36.6,60,,percent of total billed charges,,
Blood Alcohol Collection-Er (Bill Only),,36415,CPT,Facility,Both,,,,61,51.85,17.78,61,"Health Partners, Inc.",State of Minnesota Advantage Program,49.715,81.5,,percent of total billed charges,,
Blood Alcohol Collection-Er (Bill Only),,36415,CPT,Facility,Both,,,,61,51.85,17.78,61,"Health Partners, Inc.",State Public Programs,30.5,50,,percent of total billed charges,,
Blood Alcohol Collection-Er (Bill Only),,36415,CPT,Facility,Both,,,,61,51.85,17.78,61,Humana Insurance Company,Commercial PPO,57.95,95,,percent of total billed charges,,
Blood Alcohol Collection-Er (Bill Only),,36415,CPT,Facility,Outpatient,,,,61,51.85,17.78,61,Humana Insurance Company,Medicare PPO,29.89,49,,percent of total billed charges,,
Blood Alcohol Collection-Er (Bill Only),,36415,CPT,Facility,Inpatient,,,,61,51.85,17.78,61,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Blood Alcohol Collection-Er (Bill Only),,36415,CPT,Facility,Both,,,,61,51.85,17.78,61,Medica,Individual & Family,60.451,99.1,,percent of total billed charges,,
Blood Alcohol Collection-Er (Bill Only),,36415,CPT,Facility,Outpatient,,,,61,51.85,17.78,61,Medica,Medica Advantage Solution,30.378,49.8,,percent of total billed charges,,
Blood Alcohol Collection-Er (Bill Only),,36415,CPT,Facility,Inpatient,,,,61,51.85,17.78,61,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Blood Alcohol Collection-Er (Bill Only),,36415,CPT,Facility,Outpatient,,,,61,51.85,17.78,61,Medica,Medical Assistance,27.206,44.6,,percent of total billed charges,,
Blood Alcohol Collection-Er (Bill Only),,36415,CPT,Facility,Inpatient,,,,61,51.85,17.78,61,Medica,Medical Assistance,,,,,Included in per diem rate,
Blood Alcohol Collection-Er (Bill Only),,36415,CPT,Facility,Outpatient,,,,61,51.85,17.78,61,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,30.378,49.8,,percent of total billed charges,,
Blood Alcohol Collection-Er (Bill Only),,36415,CPT,Facility,Inpatient,,,,61,51.85,17.78,61,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Blood Alcohol Collection-Er (Bill Only),,36415,CPT,Facility,Both,,,,61,51.85,17.78,61,"Multiplan, Inc.","Multiplan, Inc.",57.34,94,,percent of total billed charges,,
Blood Alcohol Collection-Er (Bill Only),,36415,CPT,Facility,Outpatient,,,,61,51.85,17.78,61,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,52.704,86.4,,percent of total billed charges,,
Blood Alcohol Collection-Er (Bill Only),,36415,CPT,Facility,Inpatient,,,,61,51.85,17.78,61,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Blood Alcohol Collection-Er (Bill Only),,36415,CPT,Facility,Both,,,,61,51.85,17.78,61,"Preferred One Administrative Services, INC.",PPO,60.146,98.6,,percent of total billed charges,,
Blood Alcohol Collection-Er (Bill Only),,36415,CPT,Facility,Outpatient,,,,61,51.85,17.78,61,PrimeWest Health,Minnesota Senior Health Options (MSHO),31.3845,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Blood Alcohol Collection-Er (Bill Only),,36415,CPT,Facility,Inpatient,,,,61,51.85,17.78,61,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Blood Alcohol Collection-Er (Bill Only),,36415,CPT,Facility,Outpatient,,,,61,51.85,17.78,61,PrimeWest Health,MinnesotaCare,31.3296,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Blood Alcohol Collection-Er (Bill Only),,36415,CPT,Facility,Inpatient,,,,61,51.85,17.78,61,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Blood Alcohol Collection-Er (Bill Only),,36415,CPT,Facility,Both,,,,61,51.85,17.78,61,Sanford Health Plan,Sanford Health Plan,56.12,92,,percent of total billed charges,,
Blood Alcohol Collection-Er (Bill Only),,36415,CPT,Facility,Outpatient,,,,61,51.85,17.78,61,"UCare Health, Inc.",Individual & Family Plan,34.3735,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Blood Alcohol Collection-Er (Bill Only),,36415,CPT,Facility,Inpatient,,,,61,51.85,17.78,61,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Blood Alcohol Collection-Er (Bill Only),,36415,CPT,Facility,Outpatient,,,,61,51.85,17.78,61,"UCare Health, Inc.",Medical Assistance,30.7867,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Blood Alcohol Collection-Er (Bill Only),,36415,CPT,Facility,Inpatient,,,,61,51.85,17.78,61,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Blood Alcohol Collection-Er (Bill Only),,36415,CPT,Facility,Outpatient,,,,61,51.85,17.78,61,"UCare Health, Inc.",Medicare Advantage,30.7867,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Blood Alcohol Collection-Er (Bill Only),,36415,CPT,Facility,Inpatient,,,,61,51.85,17.78,61,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Blood Alcohol Collection-Er (Bill Only),,36415,CPT,Facility,Outpatient,,,,61,51.85,17.78,61,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),30.7867,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Blood Alcohol Collection-Er (Bill Only),,36415,CPT,Facility,Inpatient,,,,61,51.85,17.78,61,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Blood Alcohol Collection-Er (Bill Only),,36415,CPT,Facility,Both,,,,61,51.85,17.78,61,UnitedHealthcare,Individual & Family,57.34,94,,percent of total billed charges,,
Blood Alcohol Collection-Er (Bill Only),,36415,CPT,Facility,Outpatient,,,,61,51.85,17.78,61,UnitedHealthcare,Medicare Advantage,29.89,49,,percent of total billed charges,,
Blood Alcohol Collection-Er (Bill Only),,36415,CPT,Facility,Inpatient,,,,61,51.85,17.78,61,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Blood Alcohol Collection-Er (Bill Only),,36415,CPT,Facility,Outpatient,,,,61,51.85,17.78,61,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,29.28,48,,percent of total billed charges,,100% of DHS outpatient percentage
Blood Alcohol Collection-Er (Bill Only),,36415,CPT,Facility,Inpatient,,,,61,51.85,17.78,61,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Venipuncture,,36415,CPT,Facility,Both,,,,34,28.9,15.164,35.56,Aetna,Commercial,31.28,92,,percent of total billed charges,,
Venipuncture,,36415,CPT,Facility,Outpatient,,,,34,28.9,15.164,35.56,Aetna,Medicare Advantage,16.66,49,,percent of total billed charges,,
Venipuncture,,36415,CPT,Facility,Inpatient,,,,34,28.9,15.164,35.56,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Venipuncture,,36415,CPT,Facility,Both,,,,34,28.9,15.164,35.56,Aetna,PPO,31.62,93,,percent of total billed charges,,
Venipuncture,,36415,CPT,Facility,Both,,,,34,28.9,15.164,35.56,America's PPO,America's PPO,32.6502,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Venipuncture,,36415,CPT,Facility,Both,,,,34,28.9,15.164,35.56,BlueCross BlueShield Minnesota, Federal Employee Program,35,,,Fee schedule,,100% of BCBS commercial commodity fee schedule
Venipuncture,,36415,CPT,Facility,Both,,,,34,28.9,15.164,35.56,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,35.56,,,Fee schedule,,"100% of BCBS commercial commodity fee schedule, plus MN Care tax"
Venipuncture,,36415,CPT,Facility,Both,,,,34,28.9,15.164,35.56,BlueCross BlueShield Minnesota,High Value Network Plan,32.004,,,Fee schedule,,"90% of BCBS commercial commodity fee schedule, plus MN Care tax; see disclaimer for more information"
Venipuncture,,36415,CPT,Facility,Outpatient,,,,34,28.9,15.164,35.56,BlueCross BlueShield Minnesota,Medicare Advantage,16.66,49,,percent of total billed charges,,
Venipuncture,,36415,CPT,Facility,Inpatient,,,,34,28.9,15.164,35.56,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Venipuncture,,36415,CPT,Facility,Both,,,,34,28.9,15.164,35.56,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,31.495492,,,Fee schedule,,"88.57% of BCBS commercial commodity fee schedule, plus MN Care tax"
Venipuncture,,36415,CPT,Facility,Both,,,,34,28.9,15.164,35.56,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,17.78,,,Fee schedule,,"100% of BCBS Medicaid commodity fee schedule, plus MN Care tax"
Venipuncture,,36415,CPT,Facility,Outpatient,,,,34,28.9,15.164,35.56,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),16.66,49,,percent of total billed charges,,
Venipuncture,,36415,CPT,Facility,Inpatient,,,,34,28.9,15.164,35.56,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Venipuncture,,36415,CPT,Facility,Both,,,,34,28.9,15.164,35.56,CorVel,Worker's Compensation,34,100,,percent of total billed charges,,
Venipuncture,,36415,CPT,Facility,Both,,,,34,28.9,15.164,35.56,First Health Group Corporation,First Health Network,32.98,97,,percent of total billed charges,,
Venipuncture,,36415,CPT,Facility,Both,,,,34,28.9,15.164,35.56,"Health Partners, Inc.",Commercial,32.164,94.6,,percent of total billed charges,,
Venipuncture,,36415,CPT,Facility,Outpatient,,,,34,28.9,15.164,35.56,"Health Partners, Inc.",Medicare Advantage,16.66,49,,percent of total billed charges,,
Venipuncture,,36415,CPT,Facility,Inpatient,,,,34,28.9,15.164,35.56,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Venipuncture,,36415,CPT,Facility,Both,,,,34,28.9,15.164,35.56,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),20.4,60,,percent of total billed charges,,
Venipuncture,,36415,CPT,Facility,Both,,,,34,28.9,15.164,35.56,"Health Partners, Inc.",State of Minnesota Advantage Program,27.71,81.5,,percent of total billed charges,,
Venipuncture,,36415,CPT,Facility,Both,,,,34,28.9,15.164,35.56,"Health Partners, Inc.",State Public Programs,17,50,,percent of total billed charges,,
Venipuncture,,36415,CPT,Facility,Both,,,,34,28.9,15.164,35.56,Humana Insurance Company,Commercial PPO,32.3,95,,percent of total billed charges,,
Venipuncture,,36415,CPT,Facility,Outpatient,,,,34,28.9,15.164,35.56,Humana Insurance Company,Medicare PPO,16.66,49,,percent of total billed charges,,
Venipuncture,,36415,CPT,Facility,Inpatient,,,,34,28.9,15.164,35.56,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Venipuncture,,36415,CPT,Facility,Both,,,,34,28.9,15.164,35.56,Medica,Individual & Family,33.694,99.1,,percent of total billed charges,,
Venipuncture,,36415,CPT,Facility,Outpatient,,,,34,28.9,15.164,35.56,Medica,Medica Advantage Solution,16.932,49.8,,percent of total billed charges,,
Venipuncture,,36415,CPT,Facility,Inpatient,,,,34,28.9,15.164,35.56,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Venipuncture,,36415,CPT,Facility,Outpatient,,,,34,28.9,15.164,35.56,Medica,Medical Assistance,15.164,44.6,,percent of total billed charges,,
Venipuncture,,36415,CPT,Facility,Inpatient,,,,34,28.9,15.164,35.56,Medica,Medical Assistance,,,,,Included in per diem rate,
Venipuncture,,36415,CPT,Facility,Outpatient,,,,34,28.9,15.164,35.56,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,16.932,49.8,,percent of total billed charges,,
Venipuncture,,36415,CPT,Facility,Inpatient,,,,34,28.9,15.164,35.56,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Venipuncture,,36415,CPT,Facility,Both,,,,34,28.9,15.164,35.56,"Multiplan, Inc.","Multiplan, Inc.",31.96,94,,percent of total billed charges,,
Venipuncture,,36415,CPT,Facility,Outpatient,,,,34,28.9,15.164,35.56,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,29.376,86.4,,percent of total billed charges,,
Venipuncture,,36415,CPT,Facility,Inpatient,,,,34,28.9,15.164,35.56,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Venipuncture,,36415,CPT,Facility,Both,,,,34,28.9,15.164,35.56,"Preferred One Administrative Services, INC.",PPO,33.524,98.6,,percent of total billed charges,,
Venipuncture,,36415,CPT,Facility,Outpatient,,,,34,28.9,15.164,35.56,PrimeWest Health,Minnesota Senior Health Options (MSHO),17.493,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Venipuncture,,36415,CPT,Facility,Inpatient,,,,34,28.9,15.164,35.56,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Venipuncture,,36415,CPT,Facility,Outpatient,,,,34,28.9,15.164,35.56,PrimeWest Health,MinnesotaCare,17.4624,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Venipuncture,,36415,CPT,Facility,Inpatient,,,,34,28.9,15.164,35.56,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Venipuncture,,36415,CPT,Facility,Both,,,,34,28.9,15.164,35.56,Sanford Health Plan,Sanford Health Plan,31.28,92,,percent of total billed charges,,
Venipuncture,,36415,CPT,Facility,Outpatient,,,,34,28.9,15.164,35.56,"UCare Health, Inc.",Individual & Family Plan,19.159,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Venipuncture,,36415,CPT,Facility,Inpatient,,,,34,28.9,15.164,35.56,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Venipuncture,,36415,CPT,Facility,Outpatient,,,,34,28.9,15.164,35.56,"UCare Health, Inc.",Medical Assistance,17.1598,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Venipuncture,,36415,CPT,Facility,Inpatient,,,,34,28.9,15.164,35.56,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Venipuncture,,36415,CPT,Facility,Outpatient,,,,34,28.9,15.164,35.56,"UCare Health, Inc.",Medicare Advantage,17.1598,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Venipuncture,,36415,CPT,Facility,Inpatient,,,,34,28.9,15.164,35.56,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Venipuncture,,36415,CPT,Facility,Outpatient,,,,34,28.9,15.164,35.56,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),17.1598,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Venipuncture,,36415,CPT,Facility,Inpatient,,,,34,28.9,15.164,35.56,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Venipuncture,,36415,CPT,Facility,Both,,,,34,28.9,15.164,35.56,UnitedHealthcare,Individual & Family,31.96,94,,percent of total billed charges,,
Venipuncture,,36415,CPT,Facility,Outpatient,,,,34,28.9,15.164,35.56,UnitedHealthcare,Medicare Advantage,16.66,49,,percent of total billed charges,,
Venipuncture,,36415,CPT,Facility,Inpatient,,,,34,28.9,15.164,35.56,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Venipuncture,,36415,CPT,Facility,Outpatient,,,,34,28.9,15.164,35.56,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,16.32,48,,percent of total billed charges,,100% of DHS outpatient percentage
Venipuncture,,36415,CPT,Facility,Inpatient,,,,34,28.9,15.164,35.56,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Capillary Puncture,,36416,CPT,Facility,Both,,,,26,22.1,7.4516,26,Aetna,Commercial,23.92,92,,percent of total billed charges,,
Capillary Puncture,,36416,CPT,Facility,Outpatient,,,,26,22.1,7.4516,26,Aetna,Medicare Advantage,12.74,49,,percent of total billed charges,,
Capillary Puncture,,36416,CPT,Facility,Inpatient,,,,26,22.1,7.4516,26,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Capillary Puncture,,36416,CPT,Facility,Both,,,,26,22.1,7.4516,26,Aetna,PPO,24.18,93,,percent of total billed charges,,
Capillary Puncture,,36416,CPT,Facility,Both,,,,26,22.1,7.4516,26,America's PPO,America's PPO,24.9678,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Capillary Puncture,,36416,CPT,Facility,Both,,,,26,22.1,7.4516,26,BlueCross BlueShield Minnesota, Federal Employee Program,25.584,98.4,,percent of total billed charges,,
Capillary Puncture,,36416,CPT,Facility,Both,,,,26,22.1,7.4516,26,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,26,100,,percent of total billed charges,,
Capillary Puncture,,36416,CPT,Facility,Both,,,,26,22.1,7.4516,26,BlueCross BlueShield Minnesota,High Value Network Plan,23.4,90,,percent of total billed charges,,
Capillary Puncture,,36416,CPT,Facility,Outpatient,,,,26,22.1,7.4516,26,BlueCross BlueShield Minnesota,Medicare Advantage,12.74,49,,percent of total billed charges,,
Capillary Puncture,,36416,CPT,Facility,Inpatient,,,,26,22.1,7.4516,26,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Capillary Puncture,,36416,CPT,Facility,Both,,,,26,22.1,7.4516,26,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,23.0282,88.57,,percent of total billed charges,,
Capillary Puncture,,36416,CPT,Facility,Both,,,,26,22.1,7.4516,26,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,7.4516,28.66,,percent of total billed charges,,
Capillary Puncture,,36416,CPT,Facility,Outpatient,,,,26,22.1,7.4516,26,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),12.74,49,,percent of total billed charges,,
Capillary Puncture,,36416,CPT,Facility,Inpatient,,,,26,22.1,7.4516,26,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Capillary Puncture,,36416,CPT,Facility,Both,,,,26,22.1,7.4516,26,CorVel,Worker's Compensation,26,100,,percent of total billed charges,,
Capillary Puncture,,36416,CPT,Facility,Both,,,,26,22.1,7.4516,26,First Health Group Corporation,First Health Network,25.22,97,,percent of total billed charges,,
Capillary Puncture,,36416,CPT,Facility,Both,,,,26,22.1,7.4516,26,"Health Partners, Inc.",Commercial,24.596,94.6,,percent of total billed charges,,
Capillary Puncture,,36416,CPT,Facility,Outpatient,,,,26,22.1,7.4516,26,"Health Partners, Inc.",Medicare Advantage,12.74,49,,percent of total billed charges,,
Capillary Puncture,,36416,CPT,Facility,Inpatient,,,,26,22.1,7.4516,26,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Capillary Puncture,,36416,CPT,Facility,Both,,,,26,22.1,7.4516,26,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),15.6,60,,percent of total billed charges,,
Capillary Puncture,,36416,CPT,Facility,Both,,,,26,22.1,7.4516,26,"Health Partners, Inc.",State of Minnesota Advantage Program,21.19,81.5,,percent of total billed charges,,
Capillary Puncture,,36416,CPT,Facility,Both,,,,26,22.1,7.4516,26,"Health Partners, Inc.",State Public Programs,13,50,,percent of total billed charges,,
Capillary Puncture,,36416,CPT,Facility,Both,,,,26,22.1,7.4516,26,Humana Insurance Company,Commercial PPO,24.7,95,,percent of total billed charges,,
Capillary Puncture,,36416,CPT,Facility,Outpatient,,,,26,22.1,7.4516,26,Humana Insurance Company,Medicare PPO,12.74,49,,percent of total billed charges,,
Capillary Puncture,,36416,CPT,Facility,Inpatient,,,,26,22.1,7.4516,26,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Capillary Puncture,,36416,CPT,Facility,Both,,,,26,22.1,7.4516,26,Medica,Individual & Family,25.766,99.1,,percent of total billed charges,,
Capillary Puncture,,36416,CPT,Facility,Outpatient,,,,26,22.1,7.4516,26,Medica,Medica Advantage Solution,12.948,49.8,,percent of total billed charges,,
Capillary Puncture,,36416,CPT,Facility,Inpatient,,,,26,22.1,7.4516,26,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Capillary Puncture,,36416,CPT,Facility,Outpatient,,,,26,22.1,7.4516,26,Medica,Medical Assistance,11.596,44.6,,percent of total billed charges,,
Capillary Puncture,,36416,CPT,Facility,Inpatient,,,,26,22.1,7.4516,26,Medica,Medical Assistance,,,,,Included in per diem rate,
Capillary Puncture,,36416,CPT,Facility,Outpatient,,,,26,22.1,7.4516,26,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,12.948,49.8,,percent of total billed charges,,
Capillary Puncture,,36416,CPT,Facility,Inpatient,,,,26,22.1,7.4516,26,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Capillary Puncture,,36416,CPT,Facility,Both,,,,26,22.1,7.4516,26,"Multiplan, Inc.","Multiplan, Inc.",24.44,94,,percent of total billed charges,,
Capillary Puncture,,36416,CPT,Facility,Outpatient,,,,26,22.1,7.4516,26,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,22.464,86.4,,percent of total billed charges,,
Capillary Puncture,,36416,CPT,Facility,Inpatient,,,,26,22.1,7.4516,26,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Capillary Puncture,,36416,CPT,Facility,Both,,,,26,22.1,7.4516,26,"Preferred One Administrative Services, INC.",PPO,25.636,98.6,,percent of total billed charges,,
Capillary Puncture,,36416,CPT,Facility,Outpatient,,,,26,22.1,7.4516,26,PrimeWest Health,Minnesota Senior Health Options (MSHO),13.377,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Capillary Puncture,,36416,CPT,Facility,Inpatient,,,,26,22.1,7.4516,26,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Capillary Puncture,,36416,CPT,Facility,Outpatient,,,,26,22.1,7.4516,26,PrimeWest Health,MinnesotaCare,13.3536,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Capillary Puncture,,36416,CPT,Facility,Inpatient,,,,26,22.1,7.4516,26,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Capillary Puncture,,36416,CPT,Facility,Both,,,,26,22.1,7.4516,26,Sanford Health Plan,Sanford Health Plan,23.92,92,,percent of total billed charges,,
Capillary Puncture,,36416,CPT,Facility,Outpatient,,,,26,22.1,7.4516,26,"UCare Health, Inc.",Individual & Family Plan,14.651,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Capillary Puncture,,36416,CPT,Facility,Inpatient,,,,26,22.1,7.4516,26,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Capillary Puncture,,36416,CPT,Facility,Outpatient,,,,26,22.1,7.4516,26,"UCare Health, Inc.",Medical Assistance,13.1222,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Capillary Puncture,,36416,CPT,Facility,Inpatient,,,,26,22.1,7.4516,26,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Capillary Puncture,,36416,CPT,Facility,Outpatient,,,,26,22.1,7.4516,26,"UCare Health, Inc.",Medicare Advantage,13.1222,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Capillary Puncture,,36416,CPT,Facility,Inpatient,,,,26,22.1,7.4516,26,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Capillary Puncture,,36416,CPT,Facility,Outpatient,,,,26,22.1,7.4516,26,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),13.1222,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Capillary Puncture,,36416,CPT,Facility,Inpatient,,,,26,22.1,7.4516,26,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Capillary Puncture,,36416,CPT,Facility,Both,,,,26,22.1,7.4516,26,UnitedHealthcare,Individual & Family,24.44,94,,percent of total billed charges,,
Capillary Puncture,,36416,CPT,Facility,Outpatient,,,,26,22.1,7.4516,26,UnitedHealthcare,Medicare Advantage,12.74,49,,percent of total billed charges,,
Capillary Puncture,,36416,CPT,Facility,Inpatient,,,,26,22.1,7.4516,26,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Capillary Puncture,,36416,CPT,Facility,Outpatient,,,,26,22.1,7.4516,26,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,12.48,48,,percent of total billed charges,,100% of DHS outpatient percentage
Capillary Puncture,,36416,CPT,Facility,Inpatient,,,,26,22.1,7.4516,26,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Blood/Blood Product Administration,,36430,CPT,Facility,Both,,,,816,693.6,233.8656,816,Aetna,Commercial,750.72,92,,percent of total billed charges,,
Blood/Blood Product Administration,,36430,CPT,Facility,Outpatient,,,,816,693.6,233.8656,816,Aetna,Medicare Advantage,399.84,49,,percent of total billed charges,,
Blood/Blood Product Administration,,36430,CPT,Facility,Inpatient,,,,816,693.6,233.8656,816,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Blood/Blood Product Administration,,36430,CPT,Facility,Both,,,,816,693.6,233.8656,816,Aetna,PPO,758.88,93,,percent of total billed charges,,
Blood/Blood Product Administration,,36430,CPT,Facility,Both,,,,816,693.6,233.8656,816,America's PPO,America's PPO,783.6048,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Blood/Blood Product Administration,,36430,CPT,Facility,Both,,,,816,693.6,233.8656,816,BlueCross BlueShield Minnesota, Federal Employee Program,802.944,98.4,,percent of total billed charges,,
Blood/Blood Product Administration,,36430,CPT,Facility,Both,,,,816,693.6,233.8656,816,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,816,100,,percent of total billed charges,,
Blood/Blood Product Administration,,36430,CPT,Facility,Both,,,,816,693.6,233.8656,816,BlueCross BlueShield Minnesota,High Value Network Plan,734.4,90,,percent of total billed charges,,
Blood/Blood Product Administration,,36430,CPT,Facility,Outpatient,,,,816,693.6,233.8656,816,BlueCross BlueShield Minnesota,Medicare Advantage,399.84,49,,percent of total billed charges,,
Blood/Blood Product Administration,,36430,CPT,Facility,Inpatient,,,,816,693.6,233.8656,816,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Blood/Blood Product Administration,,36430,CPT,Facility,Both,,,,816,693.6,233.8656,816,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,722.7312,88.57,,percent of total billed charges,,
Blood/Blood Product Administration,,36430,CPT,Facility,Both,,,,816,693.6,233.8656,816,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,233.8656,28.66,,percent of total billed charges,,
Blood/Blood Product Administration,,36430,CPT,Facility,Outpatient,,,,816,693.6,233.8656,816,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),399.84,49,,percent of total billed charges,,
Blood/Blood Product Administration,,36430,CPT,Facility,Inpatient,,,,816,693.6,233.8656,816,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Blood/Blood Product Administration,,36430,CPT,Facility,Both,,,,816,693.6,233.8656,816,CorVel,Worker's Compensation,816,100,,percent of total billed charges,,
Blood/Blood Product Administration,,36430,CPT,Facility,Both,,,,816,693.6,233.8656,816,First Health Group Corporation,First Health Network,791.52,97,,percent of total billed charges,,
Blood/Blood Product Administration,,36430,CPT,Facility,Both,,,,816,693.6,233.8656,816,"Health Partners, Inc.",Commercial,771.936,94.6,,percent of total billed charges,,
Blood/Blood Product Administration,,36430,CPT,Facility,Outpatient,,,,816,693.6,233.8656,816,"Health Partners, Inc.",Medicare Advantage,399.84,49,,percent of total billed charges,,
Blood/Blood Product Administration,,36430,CPT,Facility,Inpatient,,,,816,693.6,233.8656,816,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Blood/Blood Product Administration,,36430,CPT,Facility,Both,,,,816,693.6,233.8656,816,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),489.6,60,,percent of total billed charges,,
Blood/Blood Product Administration,,36430,CPT,Facility,Both,,,,816,693.6,233.8656,816,"Health Partners, Inc.",State of Minnesota Advantage Program,665.04,81.5,,percent of total billed charges,,
Blood/Blood Product Administration,,36430,CPT,Facility,Both,,,,816,693.6,233.8656,816,"Health Partners, Inc.",State Public Programs,408,50,,percent of total billed charges,,
Blood/Blood Product Administration,,36430,CPT,Facility,Both,,,,816,693.6,233.8656,816,Humana Insurance Company,Commercial PPO,775.2,95,,percent of total billed charges,,
Blood/Blood Product Administration,,36430,CPT,Facility,Outpatient,,,,816,693.6,233.8656,816,Humana Insurance Company,Medicare PPO,399.84,49,,percent of total billed charges,,
Blood/Blood Product Administration,,36430,CPT,Facility,Inpatient,,,,816,693.6,233.8656,816,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Blood/Blood Product Administration,,36430,CPT,Facility,Both,,,,816,693.6,233.8656,816,Medica,Individual & Family,808.656,99.1,,percent of total billed charges,,
Blood/Blood Product Administration,,36430,CPT,Facility,Outpatient,,,,816,693.6,233.8656,816,Medica,Medica Advantage Solution,406.368,49.8,,percent of total billed charges,,
Blood/Blood Product Administration,,36430,CPT,Facility,Inpatient,,,,816,693.6,233.8656,816,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Blood/Blood Product Administration,,36430,CPT,Facility,Outpatient,,,,816,693.6,233.8656,816,Medica,Medical Assistance,363.936,44.6,,percent of total billed charges,,
Blood/Blood Product Administration,,36430,CPT,Facility,Inpatient,,,,816,693.6,233.8656,816,Medica,Medical Assistance,,,,,Included in per diem rate,
Blood/Blood Product Administration,,36430,CPT,Facility,Outpatient,,,,816,693.6,233.8656,816,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,406.368,49.8,,percent of total billed charges,,
Blood/Blood Product Administration,,36430,CPT,Facility,Inpatient,,,,816,693.6,233.8656,816,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Blood/Blood Product Administration,,36430,CPT,Facility,Both,,,,816,693.6,233.8656,816,"Multiplan, Inc.","Multiplan, Inc.",767.04,94,,percent of total billed charges,,
Blood/Blood Product Administration,,36430,CPT,Facility,Outpatient,,,,816,693.6,233.8656,816,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,735.216,90.1,,percent of total billed charges,,
Blood/Blood Product Administration,,36430,CPT,Facility,Inpatient,,,,816,693.6,233.8656,816,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Blood/Blood Product Administration,,36430,CPT,Facility,Both,,,,816,693.6,233.8656,816,"Preferred One Administrative Services, INC.",PPO,804.576,98.6,,percent of total billed charges,,
Blood/Blood Product Administration,,36430,CPT,Facility,Outpatient,,,,816,693.6,233.8656,816,PrimeWest Health,Minnesota Senior Health Options (MSHO),419.832,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Blood/Blood Product Administration,,36430,CPT,Facility,Inpatient,,,,816,693.6,233.8656,816,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Blood/Blood Product Administration,,36430,CPT,Facility,Outpatient,,,,816,693.6,233.8656,816,PrimeWest Health,MinnesotaCare,419.0976,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Blood/Blood Product Administration,,36430,CPT,Facility,Inpatient,,,,816,693.6,233.8656,816,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Blood/Blood Product Administration,,36430,CPT,Facility,Both,,,,816,693.6,233.8656,816,Sanford Health Plan,Sanford Health Plan,750.72,92,,percent of total billed charges,,
Blood/Blood Product Administration,,36430,CPT,Facility,Outpatient,,,,816,693.6,233.8656,816,"UCare Health, Inc.",Individual & Family Plan,459.816,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Blood/Blood Product Administration,,36430,CPT,Facility,Inpatient,,,,816,693.6,233.8656,816,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Blood/Blood Product Administration,,36430,CPT,Facility,Outpatient,,,,816,693.6,233.8656,816,"UCare Health, Inc.",Medical Assistance,411.8352,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Blood/Blood Product Administration,,36430,CPT,Facility,Inpatient,,,,816,693.6,233.8656,816,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Blood/Blood Product Administration,,36430,CPT,Facility,Outpatient,,,,816,693.6,233.8656,816,"UCare Health, Inc.",Medicare Advantage,411.8352,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Blood/Blood Product Administration,,36430,CPT,Facility,Inpatient,,,,816,693.6,233.8656,816,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Blood/Blood Product Administration,,36430,CPT,Facility,Outpatient,,,,816,693.6,233.8656,816,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),411.8352,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Blood/Blood Product Administration,,36430,CPT,Facility,Inpatient,,,,816,693.6,233.8656,816,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Blood/Blood Product Administration,,36430,CPT,Facility,Both,,,,816,693.6,233.8656,816,UnitedHealthcare,Individual & Family,767.04,94,,percent of total billed charges,,
Blood/Blood Product Administration,,36430,CPT,Facility,Outpatient,,,,816,693.6,233.8656,816,UnitedHealthcare,Medicare Advantage,399.84,49,,percent of total billed charges,,
Blood/Blood Product Administration,,36430,CPT,Facility,Inpatient,,,,816,693.6,233.8656,816,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Blood/Blood Product Administration,,36430,CPT,Facility,Outpatient,,,,816,693.6,233.8656,816,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,391.68,48,,percent of total billed charges,,100% of DHS outpatient percentage
Blood/Blood Product Administration,,36430,CPT,Facility,Inpatient,,,,816,693.6,233.8656,816,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Endovenous Ablation Therapy Of Incompetent Vein, Extremity, First Vein Treated (Pro Cah)",,36475,CPT,Professional,Both,,,,2443,2076.55,161.65,2443,Aetna,Commercial,2076.55,85,,percent of total billed charges,,
"Endovenous Ablation Therapy Of Incompetent Vein, Extremity, First Vein Treated (Pro Cah)",,36475,CPT,Professional,Both,,,,2443,2076.55,161.65,2443,Aetna,Medicare Advantage,259.63,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Endovenous Ablation Therapy Of Incompetent Vein, Extremity, First Vein Treated (Pro Cah)",,36475,CPT,Professional,Both,,,,2443,2076.55,161.65,2443,Aetna,PPO,2271.99,93,,percent of total billed charges,,
"Endovenous Ablation Therapy Of Incompetent Vein, Extremity, First Vein Treated (Pro Cah)",,36475,CPT,Professional,Both,,,,2443,2076.55,161.65,2443,America's PPO,America's PPO,2087.2992,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Endovenous Ablation Therapy Of Incompetent Vein, Extremity, First Vein Treated (Pro Cah)",,36475,CPT,Professional,Both,,,,2443,2076.55,161.65,2443,BlueCross BlueShield Minnesota, Federal Employee Program,559.83,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Endovenous Ablation Therapy Of Incompetent Vein, Extremity, First Vein Treated (Pro Cah)",,36475,CPT,Professional,Both,,,,2443,2076.55,161.65,2443,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,568.78728,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Endovenous Ablation Therapy Of Incompetent Vein, Extremity, First Vein Treated (Pro Cah)",,36475,CPT,Professional,Both,,,,2443,2076.55,161.65,2443,BlueCross BlueShield Minnesota,High Value Network Plan,568.78728,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Endovenous Ablation Therapy Of Incompetent Vein, Extremity, First Vein Treated (Pro Cah)",,36475,CPT,Professional,Both,,,,2443,2076.55,161.65,2443,BlueCross BlueShield Minnesota,Medicare Advantage,288.949,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Endovenous Ablation Therapy Of Incompetent Vein, Extremity, First Vein Treated (Pro Cah)",,36475,CPT,Professional,Both,,,,2443,2076.55,161.65,2443,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,568.78728,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Endovenous Ablation Therapy Of Incompetent Vein, Extremity, First Vein Treated (Pro Cah)",,36475,CPT,Professional,Both,,,,2443,2076.55,161.65,2443,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,186.62904,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Endovenous Ablation Therapy Of Incompetent Vein, Extremity, First Vein Treated (Pro Cah)",,36475,CPT,Professional,Both,,,,2443,2076.55,161.65,2443,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),288.949,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Endovenous Ablation Therapy Of Incompetent Vein, Extremity, First Vein Treated (Pro Cah)",,36475,CPT,Professional,Both,,,,2443,2076.55,161.65,2443,CorVel,Worker's Compensation,499.3545423,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Endovenous Ablation Therapy Of Incompetent Vein, Extremity, First Vein Treated (Pro Cah)",,36475,CPT,Professional,Both,,,,2443,2076.55,161.65,2443,First Health Group Corporation,First Health Network,2369.71,97,,percent of total billed charges,,
"Endovenous Ablation Therapy Of Incompetent Vein, Extremity, First Vein Treated (Pro Cah)",,36475,CPT,Professional,Both,,,,2443,2076.55,161.65,2443,"Health Partners, Inc.",Commercial,539.07,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Endovenous Ablation Therapy Of Incompetent Vein, Extremity, First Vein Treated (Pro Cah)",,36475,CPT,Professional,Both,,,,2443,2076.55,161.65,2443,"Health Partners, Inc.",Medicare Advantage,288.949,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Endovenous Ablation Therapy Of Incompetent Vein, Extremity, First Vein Treated (Pro Cah)",,36475,CPT,Professional,Both,,,,2443,2076.55,161.65,2443,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),251.1,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Endovenous Ablation Therapy Of Incompetent Vein, Extremity, First Vein Treated (Pro Cah)",,36475,CPT,Professional,Both,,,,2443,2076.55,161.65,2443,"Health Partners, Inc.",State of Minnesota Advantage Program,464.408805,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Endovenous Ablation Therapy Of Incompetent Vein, Extremity, First Vein Treated (Pro Cah)",,36475,CPT,Professional,Both,,,,2443,2076.55,161.65,2443,"Health Partners, Inc.",State Public Programs,161.65,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Endovenous Ablation Therapy Of Incompetent Vein, Extremity, First Vein Treated (Pro Cah)",,36475,CPT,Professional,Both,,,,2443,2076.55,161.65,2443,Humana Insurance Company,Commercial PPO,251.26,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Endovenous Ablation Therapy Of Incompetent Vein, Extremity, First Vein Treated (Pro Cah)",,36475,CPT,Professional,Both,,,,2443,2076.55,161.65,2443,Humana Insurance Company,Medicare PPO,2443,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Endovenous Ablation Therapy Of Incompetent Vein, Extremity, First Vein Treated (Pro Cah)",,36475,CPT,Professional,Both,,,,2443,2076.55,161.65,2443,Medica,Individual & Family,2071.664,84.8,,percent of total billed charges,,
"Endovenous Ablation Therapy Of Incompetent Vein, Extremity, First Vein Treated (Pro Cah)",,36475,CPT,Professional,Both,,,,2443,2076.55,161.65,2443,Medica,Medica Advantage Solution,1216.614,49.8,,percent of total billed charges,,
"Endovenous Ablation Therapy Of Incompetent Vein, Extremity, First Vein Treated (Pro Cah)",,36475,CPT,Professional,Both,,,,2443,2076.55,161.65,2443,Medica,Medical Assistance,186.63,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Endovenous Ablation Therapy Of Incompetent Vein, Extremity, First Vein Treated (Pro Cah)",,36475,CPT,Professional,Both,,,,2443,2076.55,161.65,2443,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,251.26,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Endovenous Ablation Therapy Of Incompetent Vein, Extremity, First Vein Treated (Pro Cah)",,36475,CPT,Professional,Both,,,,2443,2076.55,161.65,2443,"Multiplan, Inc.","Multiplan, Inc.",2296.42,94,,percent of total billed charges,,
"Endovenous Ablation Therapy Of Incompetent Vein, Extremity, First Vein Treated (Pro Cah)",,36475,CPT,Professional,Both,,,,2443,2076.55,161.65,2443,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,2201.143,90.1,,percent of total billed charges,,
"Endovenous Ablation Therapy Of Incompetent Vein, Extremity, First Vein Treated (Pro Cah)",,36475,CPT,Professional,Both,,,,2443,2076.55,161.65,2443,"Preferred One Administrative Services, INC.",PPO,2408.798,98.6,,percent of total billed charges,,
"Endovenous Ablation Therapy Of Incompetent Vein, Extremity, First Vein Treated (Pro Cah)",,36475,CPT,Professional,Both,,,,2443,2076.55,161.65,2443,PrimeWest Health,Minnesota Senior Health Options (MSHO),288.949,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Endovenous Ablation Therapy Of Incompetent Vein, Extremity, First Vein Treated (Pro Cah)",,36475,CPT,Professional,Both,,,,2443,2076.55,161.65,2443,PrimeWest Health,MinnesotaCare,199.6930728,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Endovenous Ablation Therapy Of Incompetent Vein, Extremity, First Vein Treated (Pro Cah)",,36475,CPT,Professional,Both,,,,2443,2076.55,161.65,2443,Sanford Health Plan,Sanford Health Plan,2149.84,88,,percent of total billed charges,,
"Endovenous Ablation Therapy Of Incompetent Vein, Extremity, First Vein Treated (Pro Cah)",,36475,CPT,Professional,Both,,,,2443,2076.55,161.65,2443,"UCare Health, Inc.",Individual & Family Plan,408.448256,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Endovenous Ablation Therapy Of Incompetent Vein, Extremity, First Vein Treated (Pro Cah)",,36475,CPT,Professional,Both,,,,2443,2076.55,161.65,2443,"UCare Health, Inc.",Medical Assistance,205.291944,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Endovenous Ablation Therapy Of Incompetent Vein, Extremity, First Vein Treated (Pro Cah)",,36475,CPT,Professional,Both,,,,2443,2076.55,161.65,2443,"UCare Health, Inc.",Medicare Advantage,288.949,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Endovenous Ablation Therapy Of Incompetent Vein, Extremity, First Vein Treated (Pro Cah)",,36475,CPT,Professional,Both,,,,2443,2076.55,161.65,2443,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),231.1592,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Endovenous Ablation Therapy Of Incompetent Vein, Extremity, First Vein Treated (Pro Cah)",,36475,CPT,Professional,Both,,,,2443,2076.55,161.65,2443,UnitedHealthcare,Individual & Family,2443,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Endovenous Ablation Therapy Of Incompetent Vein, Extremity, First Vein Treated (Pro Cah)",,36475,CPT,Professional,Both,,,,2443,2076.55,161.65,2443,UnitedHealthcare,Medicare Advantage,288.949,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Endovenous Ablation Therapy Of Incompetent Vein, Extremity, First Vein Treated (Pro Cah)",,36475,CPT,Professional,Both,,,,2443,2076.55,161.65,2443,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,186.62904,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Endovenous Ablation Therapy Of Incompetent Vein Subsequent Vein(S) Treated In Same Extremity (Pro Cah),,36476,CPT,Professional,Both,,,,1158,984.3,77.44,1158,Aetna,Commercial,984.3,85,,percent of total billed charges,,
Endovenous Ablation Therapy Of Incompetent Vein Subsequent Vein(S) Treated In Same Extremity (Pro Cah),,36476,CPT,Professional,Both,,,,1158,984.3,77.44,1158,Aetna,Medicare Advantage,124.57,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Endovenous Ablation Therapy Of Incompetent Vein Subsequent Vein(S) Treated In Same Extremity (Pro Cah),,36476,CPT,Professional,Both,,,,1158,984.3,77.44,1158,Aetna,PPO,1076.94,93,,percent of total billed charges,,
Endovenous Ablation Therapy Of Incompetent Vein Subsequent Vein(S) Treated In Same Extremity (Pro Cah),,36476,CPT,Professional,Both,,,,1158,984.3,77.44,1158,America's PPO,America's PPO,989.3952,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Endovenous Ablation Therapy Of Incompetent Vein Subsequent Vein(S) Treated In Same Extremity (Pro Cah),,36476,CPT,Professional,Both,,,,1158,984.3,77.44,1158,BlueCross BlueShield Minnesota, Federal Employee Program,269.93,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Endovenous Ablation Therapy Of Incompetent Vein Subsequent Vein(S) Treated In Same Extremity (Pro Cah),,36476,CPT,Professional,Both,,,,1158,984.3,77.44,1158,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,274.24888,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Endovenous Ablation Therapy Of Incompetent Vein Subsequent Vein(S) Treated In Same Extremity (Pro Cah),,36476,CPT,Professional,Both,,,,1158,984.3,77.44,1158,BlueCross BlueShield Minnesota,High Value Network Plan,274.24888,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Endovenous Ablation Therapy Of Incompetent Vein Subsequent Vein(S) Treated In Same Extremity (Pro Cah),,36476,CPT,Professional,Both,,,,1158,984.3,77.44,1158,BlueCross BlueShield Minnesota,Medicare Advantage,138.575,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Endovenous Ablation Therapy Of Incompetent Vein Subsequent Vein(S) Treated In Same Extremity (Pro Cah),,36476,CPT,Professional,Both,,,,1158,984.3,77.44,1158,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,274.24888,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Endovenous Ablation Therapy Of Incompetent Vein Subsequent Vein(S) Treated In Same Extremity (Pro Cah),,36476,CPT,Professional,Both,,,,1158,984.3,77.44,1158,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,89.408,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Endovenous Ablation Therapy Of Incompetent Vein Subsequent Vein(S) Treated In Same Extremity (Pro Cah),,36476,CPT,Professional,Both,,,,1158,984.3,77.44,1158,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),138.575,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Endovenous Ablation Therapy Of Incompetent Vein Subsequent Vein(S) Treated In Same Extremity (Pro Cah),,36476,CPT,Professional,Both,,,,1158,984.3,77.44,1158,CorVel,Worker's Compensation,240.5068869,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Endovenous Ablation Therapy Of Incompetent Vein Subsequent Vein(S) Treated In Same Extremity (Pro Cah),,36476,CPT,Professional,Both,,,,1158,984.3,77.44,1158,First Health Group Corporation,First Health Network,1123.26,97,,percent of total billed charges,,
Endovenous Ablation Therapy Of Incompetent Vein Subsequent Vein(S) Treated In Same Extremity (Pro Cah),,36476,CPT,Professional,Both,,,,1158,984.3,77.44,1158,"Health Partners, Inc.",Commercial,259.74,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Endovenous Ablation Therapy Of Incompetent Vein Subsequent Vein(S) Treated In Same Extremity (Pro Cah),,36476,CPT,Professional,Both,,,,1158,984.3,77.44,1158,"Health Partners, Inc.",Medicare Advantage,138.575,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Endovenous Ablation Therapy Of Incompetent Vein Subsequent Vein(S) Treated In Same Extremity (Pro Cah),,36476,CPT,Professional,Both,,,,1158,984.3,77.44,1158,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),120.3,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Endovenous Ablation Therapy Of Incompetent Vein Subsequent Vein(S) Treated In Same Extremity (Pro Cah),,36476,CPT,Professional,Both,,,,1158,984.3,77.44,1158,"Health Partners, Inc.",State of Minnesota Advantage Program,223.76601,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Endovenous Ablation Therapy Of Incompetent Vein Subsequent Vein(S) Treated In Same Extremity (Pro Cah),,36476,CPT,Professional,Both,,,,1158,984.3,77.44,1158,"Health Partners, Inc.",State Public Programs,77.44,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Endovenous Ablation Therapy Of Incompetent Vein Subsequent Vein(S) Treated In Same Extremity (Pro Cah),,36476,CPT,Professional,Both,,,,1158,984.3,77.44,1158,Humana Insurance Company,Commercial PPO,120.5,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Endovenous Ablation Therapy Of Incompetent Vein Subsequent Vein(S) Treated In Same Extremity (Pro Cah),,36476,CPT,Professional,Both,,,,1158,984.3,77.44,1158,Humana Insurance Company,Medicare PPO,1158,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Endovenous Ablation Therapy Of Incompetent Vein Subsequent Vein(S) Treated In Same Extremity (Pro Cah),,36476,CPT,Professional,Both,,,,1158,984.3,77.44,1158,Medica,Individual & Family,981.984,84.8,,percent of total billed charges,,
Endovenous Ablation Therapy Of Incompetent Vein Subsequent Vein(S) Treated In Same Extremity (Pro Cah),,36476,CPT,Professional,Both,,,,1158,984.3,77.44,1158,Medica,Medica Advantage Solution,576.684,49.8,,percent of total billed charges,,
Endovenous Ablation Therapy Of Incompetent Vein Subsequent Vein(S) Treated In Same Extremity (Pro Cah),,36476,CPT,Professional,Both,,,,1158,984.3,77.44,1158,Medica,Medical Assistance,89.41,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Endovenous Ablation Therapy Of Incompetent Vein Subsequent Vein(S) Treated In Same Extremity (Pro Cah),,36476,CPT,Professional,Both,,,,1158,984.3,77.44,1158,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,120.5,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Endovenous Ablation Therapy Of Incompetent Vein Subsequent Vein(S) Treated In Same Extremity (Pro Cah),,36476,CPT,Professional,Both,,,,1158,984.3,77.44,1158,"Multiplan, Inc.","Multiplan, Inc.",1088.52,94,,percent of total billed charges,,
Endovenous Ablation Therapy Of Incompetent Vein Subsequent Vein(S) Treated In Same Extremity (Pro Cah),,36476,CPT,Professional,Both,,,,1158,984.3,77.44,1158,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1043.358,90.1,,percent of total billed charges,,
Endovenous Ablation Therapy Of Incompetent Vein Subsequent Vein(S) Treated In Same Extremity (Pro Cah),,36476,CPT,Professional,Both,,,,1158,984.3,77.44,1158,"Preferred One Administrative Services, INC.",PPO,1141.788,98.6,,percent of total billed charges,,
Endovenous Ablation Therapy Of Incompetent Vein Subsequent Vein(S) Treated In Same Extremity (Pro Cah),,36476,CPT,Professional,Both,,,,1158,984.3,77.44,1158,PrimeWest Health,Minnesota Senior Health Options (MSHO),138.575,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Endovenous Ablation Therapy Of Incompetent Vein Subsequent Vein(S) Treated In Same Extremity (Pro Cah),,36476,CPT,Professional,Both,,,,1158,984.3,77.44,1158,PrimeWest Health,MinnesotaCare,95.66656,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Endovenous Ablation Therapy Of Incompetent Vein Subsequent Vein(S) Treated In Same Extremity (Pro Cah),,36476,CPT,Professional,Both,,,,1158,984.3,77.44,1158,Sanford Health Plan,Sanford Health Plan,1019.04,88,,percent of total billed charges,,
Endovenous Ablation Therapy Of Incompetent Vein Subsequent Vein(S) Treated In Same Extremity (Pro Cah),,36476,CPT,Professional,Both,,,,1158,984.3,77.44,1158,"UCare Health, Inc.",Individual & Family Plan,195.8848,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Endovenous Ablation Therapy Of Incompetent Vein Subsequent Vein(S) Treated In Same Extremity (Pro Cah),,36476,CPT,Professional,Both,,,,1158,984.3,77.44,1158,"UCare Health, Inc.",Medical Assistance,98.3488,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Endovenous Ablation Therapy Of Incompetent Vein Subsequent Vein(S) Treated In Same Extremity (Pro Cah),,36476,CPT,Professional,Both,,,,1158,984.3,77.44,1158,"UCare Health, Inc.",Medicare Advantage,138.575,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Endovenous Ablation Therapy Of Incompetent Vein Subsequent Vein(S) Treated In Same Extremity (Pro Cah),,36476,CPT,Professional,Both,,,,1158,984.3,77.44,1158,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),110.86,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Endovenous Ablation Therapy Of Incompetent Vein Subsequent Vein(S) Treated In Same Extremity (Pro Cah),,36476,CPT,Professional,Both,,,,1158,984.3,77.44,1158,UnitedHealthcare,Individual & Family,1158,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Endovenous Ablation Therapy Of Incompetent Vein Subsequent Vein(S) Treated In Same Extremity (Pro Cah),,36476,CPT,Professional,Both,,,,1158,984.3,77.44,1158,UnitedHealthcare,Medicare Advantage,138.575,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Endovenous Ablation Therapy Of Incompetent Vein Subsequent Vein(S) Treated In Same Extremity (Pro Cah),,36476,CPT,Professional,Both,,,,1158,984.3,77.44,1158,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,89.408,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
NALOXONE 0.4 MG/ML INJ SOLN,,J2310,HCPCS,Facility,Both,1,mL,,107,90.95,30.6662,107,Aetna,Commercial,98.44,92,,percent of total billed charges,,
NALOXONE 0.4 MG/ML INJ SOLN,,J2310,HCPCS,Facility,Both,1,mL,,107,90.95,30.6662,107,Aetna,Commercial,98.44,92,,percent of total billed charges,,
NALOXONE 0.4 MG/ML INJ SOLN,,J2310,HCPCS,Facility,Outpatient,1,mL,,107,90.95,30.6662,107,Aetna,Medicare Advantage,52.43,49,,percent of total billed charges,,
NALOXONE 0.4 MG/ML INJ SOLN,,J2310,HCPCS,Facility,Outpatient,1,mL,,107,90.95,30.6662,107,Aetna,Medicare Advantage,52.43,49,,percent of total billed charges,,
NALOXONE 0.4 MG/ML INJ SOLN,,J2310,HCPCS,Facility,Inpatient,1,mL,,107,90.95,30.6662,107,Aetna,Medicare Advantage,,,,,Included in per diem rate,
NALOXONE 0.4 MG/ML INJ SOLN,,J2310,HCPCS,Facility,Inpatient,1,mL,,107,90.95,30.6662,107,Aetna,Medicare Advantage,,,,,Included in per diem rate,
NALOXONE 0.4 MG/ML INJ SOLN,,J2310,HCPCS,Facility,Both,1,mL,,107,90.95,30.6662,107,Aetna,PPO,99.51,93,,percent of total billed charges,,
NALOXONE 0.4 MG/ML INJ SOLN,,J2310,HCPCS,Facility,Both,1,mL,,107,90.95,30.6662,107,Aetna,PPO,99.51,93,,percent of total billed charges,,
NALOXONE 0.4 MG/ML INJ SOLN,,J2310,HCPCS,Facility,Both,1,mL,,107,90.95,30.6662,107,America's PPO,America's PPO,102.7521,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
NALOXONE 0.4 MG/ML INJ SOLN,,J2310,HCPCS,Facility,Both,1,mL,,107,90.95,30.6662,107,America's PPO,America's PPO,102.7521,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
NALOXONE 0.4 MG/ML INJ SOLN,,J2310,HCPCS,Facility,Both,1,mL,,107,90.95,30.6662,107,BlueCross BlueShield Minnesota, Federal Employee Program,105.288,98.4,,percent of total billed charges,,
NALOXONE 0.4 MG/ML INJ SOLN,,J2310,HCPCS,Facility,Both,1,mL,,107,90.95,30.6662,107,BlueCross BlueShield Minnesota, Federal Employee Program,105.288,98.4,,percent of total billed charges,,
NALOXONE 0.4 MG/ML INJ SOLN,,J2310,HCPCS,Facility,Both,1,mL,,107,90.95,30.6662,107,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,107,100,,percent of total billed charges,,
NALOXONE 0.4 MG/ML INJ SOLN,,J2310,HCPCS,Facility,Both,1,mL,,107,90.95,30.6662,107,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,107,100,,percent of total billed charges,,
NALOXONE 0.4 MG/ML INJ SOLN,,J2310,HCPCS,Facility,Both,1,mL,,107,90.95,30.6662,107,BlueCross BlueShield Minnesota,High Value Network Plan,96.3,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
NALOXONE 0.4 MG/ML INJ SOLN,,J2310,HCPCS,Facility,Both,1,mL,,107,90.95,30.6662,107,BlueCross BlueShield Minnesota,High Value Network Plan,96.3,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
NALOXONE 0.4 MG/ML INJ SOLN,,J2310,HCPCS,Facility,Outpatient,1,mL,,107,90.95,30.6662,107,BlueCross BlueShield Minnesota,Medicare Advantage,52.43,49,,percent of total billed charges,,
NALOXONE 0.4 MG/ML INJ SOLN,,J2310,HCPCS,Facility,Outpatient,1,mL,,107,90.95,30.6662,107,BlueCross BlueShield Minnesota,Medicare Advantage,52.43,49,,percent of total billed charges,,
NALOXONE 0.4 MG/ML INJ SOLN,,J2310,HCPCS,Facility,Inpatient,1,mL,,107,90.95,30.6662,107,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
NALOXONE 0.4 MG/ML INJ SOLN,,J2310,HCPCS,Facility,Inpatient,1,mL,,107,90.95,30.6662,107,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
NALOXONE 0.4 MG/ML INJ SOLN,,J2310,HCPCS,Facility,Both,1,mL,,107,90.95,30.6662,107,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,94.7699,88.57,,percent of total billed charges,,
NALOXONE 0.4 MG/ML INJ SOLN,,J2310,HCPCS,Facility,Both,1,mL,,107,90.95,30.6662,107,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,94.7699,88.57,,percent of total billed charges,,
NALOXONE 0.4 MG/ML INJ SOLN,,J2310,HCPCS,Facility,Both,1,mL,,107,90.95,30.6662,107,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,30.6662,28.66,,percent of total billed charges,,
NALOXONE 0.4 MG/ML INJ SOLN,,J2310,HCPCS,Facility,Both,1,mL,,107,90.95,30.6662,107,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,30.6662,28.66,,percent of total billed charges,,
NALOXONE 0.4 MG/ML INJ SOLN,,J2310,HCPCS,Facility,Outpatient,1,mL,,107,90.95,30.6662,107,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),52.43,49,,percent of total billed charges,,
NALOXONE 0.4 MG/ML INJ SOLN,,J2310,HCPCS,Facility,Outpatient,1,mL,,107,90.95,30.6662,107,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),52.43,49,,percent of total billed charges,,
NALOXONE 0.4 MG/ML INJ SOLN,,J2310,HCPCS,Facility,Inpatient,1,mL,,107,90.95,30.6662,107,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
NALOXONE 0.4 MG/ML INJ SOLN,,J2310,HCPCS,Facility,Inpatient,1,mL,,107,90.95,30.6662,107,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
NALOXONE 0.4 MG/ML INJ SOLN,,J2310,HCPCS,Facility,Both,1,mL,,107,90.95,30.6662,107,CorVel,Worker's Compensation,107,100,,percent of total billed charges,,
NALOXONE 0.4 MG/ML INJ SOLN,,J2310,HCPCS,Facility,Both,1,mL,,107,90.95,30.6662,107,CorVel,Worker's Compensation,107,100,,percent of total billed charges,,
NALOXONE 0.4 MG/ML INJ SOLN,,J2310,HCPCS,Facility,Both,1,mL,,107,90.95,30.6662,107,First Health Group Corporation,First Health Network,103.79,97,,percent of total billed charges,,
NALOXONE 0.4 MG/ML INJ SOLN,,J2310,HCPCS,Facility,Both,1,mL,,107,90.95,30.6662,107,First Health Group Corporation,First Health Network,103.79,97,,percent of total billed charges,,
NALOXONE 0.4 MG/ML INJ SOLN,,J2310,HCPCS,Facility,Both,1,mL,,107,90.95,30.6662,107,"Health Partners, Inc.",Commercial,101.222,94.6,,percent of total billed charges,,
NALOXONE 0.4 MG/ML INJ SOLN,,J2310,HCPCS,Facility,Both,1,mL,,107,90.95,30.6662,107,"Health Partners, Inc.",Commercial,101.222,94.6,,percent of total billed charges,,
NALOXONE 0.4 MG/ML INJ SOLN,,J2310,HCPCS,Facility,Outpatient,1,mL,,107,90.95,30.6662,107,"Health Partners, Inc.",Medicare Advantage,52.43,49,,percent of total billed charges,,
NALOXONE 0.4 MG/ML INJ SOLN,,J2310,HCPCS,Facility,Outpatient,1,mL,,107,90.95,30.6662,107,"Health Partners, Inc.",Medicare Advantage,52.43,49,,percent of total billed charges,,
NALOXONE 0.4 MG/ML INJ SOLN,,J2310,HCPCS,Facility,Inpatient,1,mL,,107,90.95,30.6662,107,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
NALOXONE 0.4 MG/ML INJ SOLN,,J2310,HCPCS,Facility,Inpatient,1,mL,,107,90.95,30.6662,107,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
NALOXONE 0.4 MG/ML INJ SOLN,,J2310,HCPCS,Facility,Both,1,mL,,107,90.95,30.6662,107,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),64.2,60,,percent of total billed charges,,
NALOXONE 0.4 MG/ML INJ SOLN,,J2310,HCPCS,Facility,Both,1,mL,,107,90.95,30.6662,107,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),64.2,60,,percent of total billed charges,,
NALOXONE 0.4 MG/ML INJ SOLN,,J2310,HCPCS,Facility,Both,1,mL,,107,90.95,30.6662,107,"Health Partners, Inc.",State of Minnesota Advantage Program,87.205,81.5,,percent of total billed charges,,
NALOXONE 0.4 MG/ML INJ SOLN,,J2310,HCPCS,Facility,Both,1,mL,,107,90.95,30.6662,107,"Health Partners, Inc.",State of Minnesota Advantage Program,87.205,81.5,,percent of total billed charges,,
NALOXONE 0.4 MG/ML INJ SOLN,,J2310,HCPCS,Facility,Both,1,mL,,107,90.95,30.6662,107,"Health Partners, Inc.",State Public Programs,53.5,50,,percent of total billed charges,,
NALOXONE 0.4 MG/ML INJ SOLN,,J2310,HCPCS,Facility,Both,1,mL,,107,90.95,30.6662,107,"Health Partners, Inc.",State Public Programs,53.5,50,,percent of total billed charges,,
NALOXONE 0.4 MG/ML INJ SOLN,,J2310,HCPCS,Facility,Both,1,mL,,107,90.95,30.6662,107,Humana Insurance Company,Commercial PPO,101.65,95,,percent of total billed charges,,
NALOXONE 0.4 MG/ML INJ SOLN,,J2310,HCPCS,Facility,Both,1,mL,,107,90.95,30.6662,107,Humana Insurance Company,Commercial PPO,101.65,95,,percent of total billed charges,,
NALOXONE 0.4 MG/ML INJ SOLN,,J2310,HCPCS,Facility,Outpatient,1,mL,,107,90.95,30.6662,107,Humana Insurance Company,Medicare PPO,52.43,49,,percent of total billed charges,,
NALOXONE 0.4 MG/ML INJ SOLN,,J2310,HCPCS,Facility,Outpatient,1,mL,,107,90.95,30.6662,107,Humana Insurance Company,Medicare PPO,52.43,49,,percent of total billed charges,,
NALOXONE 0.4 MG/ML INJ SOLN,,J2310,HCPCS,Facility,Inpatient,1,mL,,107,90.95,30.6662,107,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
NALOXONE 0.4 MG/ML INJ SOLN,,J2310,HCPCS,Facility,Inpatient,1,mL,,107,90.95,30.6662,107,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
NALOXONE 0.4 MG/ML INJ SOLN,,J2310,HCPCS,Facility,Both,1,mL,,107,90.95,30.6662,107,Medica,Individual & Family,106.037,99.1,,percent of total billed charges,,
NALOXONE 0.4 MG/ML INJ SOLN,,J2310,HCPCS,Facility,Both,1,mL,,107,90.95,30.6662,107,Medica,Individual & Family,106.037,99.1,,percent of total billed charges,,
NALOXONE 0.4 MG/ML INJ SOLN,,J2310,HCPCS,Facility,Outpatient,1,mL,,107,90.95,30.6662,107,Medica,Medica Advantage Solution,53.286,49.8,,percent of total billed charges,,
NALOXONE 0.4 MG/ML INJ SOLN,,J2310,HCPCS,Facility,Outpatient,1,mL,,107,90.95,30.6662,107,Medica,Medica Advantage Solution,53.286,49.8,,percent of total billed charges,,
"Insertion Of Tunneled Centerally Inserted Venous Access Device, W/ Subcutaneous Port; Age 5 Or Older (Pbb)",,36561,CPT,Facility,Outpatient,,,,2254,1915.9,645.9964,2254,Aetna,Commercial,2073.68,92,,percent of total billed charges,,
"Insertion Of Tunneled Centerally Inserted Venous Access Device, W/ Subcutaneous Port; Age 5 Or Older (Pbb)",,36561,CPT,Professional,Outpatient,,,,2244,1907.4,201.35,2244,Aetna,Commercial,1907.4,85,,percent of total billed charges,,
"Insertion Of Tunneled Centerally Inserted Venous Access Device, W/ Subcutaneous Port; Age 5 Or Older (Pbb)",,36561,CPT,Facility,Outpatient,,,,2254,1915.9,645.9964,2254,Aetna,Medicare Advantage,1104.46,49,,percent of total billed charges,,
"Insertion Of Tunneled Centerally Inserted Venous Access Device, W/ Subcutaneous Port; Age 5 Or Older (Pbb)",,36561,CPT,Professional,Outpatient,,,,2244,1907.4,201.35,2244,Aetna,Medicare Advantage,321.29,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Insertion Of Tunneled Centerally Inserted Venous Access Device, W/ Subcutaneous Port; Age 5 Or Older (Pbb)",,36561,CPT,Facility,Outpatient,,,,2254,1915.9,645.9964,2254,Aetna,PPO,2096.22,93,,percent of total billed charges,,
"Insertion Of Tunneled Centerally Inserted Venous Access Device, W/ Subcutaneous Port; Age 5 Or Older (Pbb)",,36561,CPT,Professional,Outpatient,,,,2244,1907.4,201.35,2244,Aetna,PPO,2086.92,93,,percent of total billed charges,,
"Insertion Of Tunneled Centerally Inserted Venous Access Device, W/ Subcutaneous Port; Age 5 Or Older (Pbb)",,36561,CPT,Facility,Outpatient,,,,2254,1915.9,645.9964,2254,America's PPO,America's PPO,2164.5162,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Insertion Of Tunneled Centerally Inserted Venous Access Device, W/ Subcutaneous Port; Age 5 Or Older (Pbb)",,36561,CPT,Professional,Outpatient,,,,2244,1907.4,201.35,2244,America's PPO,America's PPO,1917.2736,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Insertion Of Tunneled Centerally Inserted Venous Access Device, W/ Subcutaneous Port; Age 5 Or Older (Pbb)",,36561,CPT,Facility,Outpatient,,,,2254,1915.9,645.9964,2254,BlueCross BlueShield Minnesota, Federal Employee Program,2217.936,98.4,,percent of total billed charges,,
"Insertion Of Tunneled Centerally Inserted Venous Access Device, W/ Subcutaneous Port; Age 5 Or Older (Pbb)",,36561,CPT,Professional,Outpatient,,,,2244,1907.4,201.35,2244,BlueCross BlueShield Minnesota, Federal Employee Program,675.52,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Insertion Of Tunneled Centerally Inserted Venous Access Device, W/ Subcutaneous Port; Age 5 Or Older (Pbb)",,36561,CPT,Facility,Outpatient,,,,2254,1915.9,645.9964,2254,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,2254,100,,percent of total billed charges,,
"Insertion Of Tunneled Centerally Inserted Venous Access Device, W/ Subcutaneous Port; Age 5 Or Older (Pbb)",,36561,CPT,Professional,Outpatient,,,,2244,1907.4,201.35,2244,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,686.32832,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Insertion Of Tunneled Centerally Inserted Venous Access Device, W/ Subcutaneous Port; Age 5 Or Older (Pbb)",,36561,CPT,Facility,Outpatient,,,,2254,1915.9,645.9964,2254,BlueCross BlueShield Minnesota,High Value Network Plan,2028.6,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
"Insertion Of Tunneled Centerally Inserted Venous Access Device, W/ Subcutaneous Port; Age 5 Or Older (Pbb)",,36561,CPT,Professional,Outpatient,,,,2244,1907.4,201.35,2244,BlueCross BlueShield Minnesota,High Value Network Plan,686.32832,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Insertion Of Tunneled Centerally Inserted Venous Access Device, W/ Subcutaneous Port; Age 5 Or Older (Pbb)",,36561,CPT,Facility,Outpatient,,,,2254,1915.9,645.9964,2254,BlueCross BlueShield Minnesota,Medicare Advantage,1104.46,49,,percent of total billed charges,,
"Insertion Of Tunneled Centerally Inserted Venous Access Device, W/ Subcutaneous Port; Age 5 Or Older (Pbb)",,36561,CPT,Professional,Outpatient,,,,2244,1907.4,201.35,2244,BlueCross BlueShield Minnesota,Medicare Advantage,359.8925,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Insertion Of Tunneled Centerally Inserted Venous Access Device, W/ Subcutaneous Port; Age 5 Or Older (Pbb)",,36561,CPT,Professional,Outpatient,,,,2244,1907.4,201.35,2244,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,686.32832,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Insertion Of Tunneled Centerally Inserted Venous Access Device, W/ Subcutaneous Port; Age 5 Or Older (Pbb)",,36561,CPT,Facility,Outpatient,,,,2254,1915.9,645.9964,2254,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,645.9964,28.66,,percent of total billed charges,,
"Insertion Of Tunneled Centerally Inserted Venous Access Device, W/ Subcutaneous Port; Age 5 Or Older (Pbb)",,36561,CPT,Professional,Outpatient,,,,2244,1907.4,201.35,2244,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,232.47096,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Insertion Of Tunneled Centerally Inserted Venous Access Device, W/ Subcutaneous Port; Age 5 Or Older (Pbb)",,36561,CPT,Facility,Outpatient,,,,2254,1915.9,645.9964,2254,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1104.46,49,,percent of total billed charges,,
"Insertion Of Tunneled Centerally Inserted Venous Access Device, W/ Subcutaneous Port; Age 5 Or Older (Pbb)",,36561,CPT,Professional,Outpatient,,,,2244,1907.4,201.35,2244,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),359.8925,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Insertion Of Tunneled Centerally Inserted Venous Access Device, W/ Subcutaneous Port; Age 5 Or Older (Pbb)",,36561,CPT,Facility,Outpatient,,,,2254,1915.9,645.9964,2254,CorVel,Worker's Compensation,2254,100,,percent of total billed charges,,
"Insertion Of Tunneled Centerally Inserted Venous Access Device, W/ Subcutaneous Port; Age 5 Or Older (Pbb)",,36561,CPT,Professional,Outpatient,,,,2244,1907.4,201.35,2244,CorVel,Worker's Compensation,620.3324142,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Insertion Of Tunneled Centerally Inserted Venous Access Device, W/ Subcutaneous Port; Age 5 Or Older (Pbb)",,36561,CPT,Facility,Outpatient,,,,2254,1915.9,645.9964,2254,First Health Group Corporation,First Health Network,2186.38,97,,percent of total billed charges,,
"Insertion Of Tunneled Centerally Inserted Venous Access Device, W/ Subcutaneous Port; Age 5 Or Older (Pbb)",,36561,CPT,Professional,Outpatient,,,,2244,1907.4,201.35,2244,First Health Group Corporation,First Health Network,2176.68,97,,percent of total billed charges,,
"Insertion Of Tunneled Centerally Inserted Venous Access Device, W/ Subcutaneous Port; Age 5 Or Older (Pbb)",,36561,CPT,Facility,Outpatient,,,,2254,1915.9,645.9964,2254,"Health Partners, Inc.",Commercial,2132.284,94.6,,percent of total billed charges,,
"Insertion Of Tunneled Centerally Inserted Venous Access Device, W/ Subcutaneous Port; Age 5 Or Older (Pbb)",,36561,CPT,Professional,Outpatient,,,,2244,1907.4,201.35,2244,"Health Partners, Inc.",Commercial,670.39,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Insertion Of Tunneled Centerally Inserted Venous Access Device, W/ Subcutaneous Port; Age 5 Or Older (Pbb)",,36561,CPT,Facility,Outpatient,,,,2254,1915.9,645.9964,2254,"Health Partners, Inc.",Medicare Advantage,1104.46,49,,percent of total billed charges,,
"Insertion Of Tunneled Centerally Inserted Venous Access Device, W/ Subcutaneous Port; Age 5 Or Older (Pbb)",,36561,CPT,Professional,Outpatient,,,,2244,1907.4,201.35,2244,"Health Partners, Inc.",Medicare Advantage,359.8925,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Insertion Of Tunneled Centerally Inserted Venous Access Device, W/ Subcutaneous Port; Age 5 Or Older (Pbb)",,36561,CPT,Facility,Outpatient,,,,2254,1915.9,645.9964,2254,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1352.4,60,,percent of total billed charges,,
"Insertion Of Tunneled Centerally Inserted Venous Access Device, W/ Subcutaneous Port; Age 5 Or Older (Pbb)",,36561,CPT,Professional,Outpatient,,,,2244,1907.4,201.35,2244,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),313.12,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Insertion Of Tunneled Centerally Inserted Venous Access Device, W/ Subcutaneous Port; Age 5 Or Older (Pbb)",,36561,CPT,Facility,Outpatient,,,,2254,1915.9,645.9964,2254,"Health Partners, Inc.",State of Minnesota Advantage Program,1837.01,81.5,,percent of total billed charges,,
"Insertion Of Tunneled Centerally Inserted Venous Access Device, W/ Subcutaneous Port; Age 5 Or Older (Pbb)",,36561,CPT,Professional,Outpatient,,,,2244,1907.4,201.35,2244,"Health Partners, Inc.",State of Minnesota Advantage Program,577.540985,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Insertion Of Tunneled Centerally Inserted Venous Access Device, W/ Subcutaneous Port; Age 5 Or Older (Pbb)",,36561,CPT,Facility,Outpatient,,,,2254,1915.9,645.9964,2254,"Health Partners, Inc.",State Public Programs,1127,50,,percent of total billed charges,,
"Insertion Of Tunneled Centerally Inserted Venous Access Device, W/ Subcutaneous Port; Age 5 Or Older (Pbb)",,36561,CPT,Professional,Outpatient,,,,2244,1907.4,201.35,2244,"Health Partners, Inc.",State Public Programs,201.35,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Insertion Of Tunneled Centerally Inserted Venous Access Device, W/ Subcutaneous Port; Age 5 Or Older (Pbb)",,36561,CPT,Facility,Outpatient,,,,2254,1915.9,645.9964,2254,Humana Insurance Company,Commercial PPO,2141.3,95,,percent of total billed charges,,
"Insertion Of Tunneled Centerally Inserted Venous Access Device, W/ Subcutaneous Port; Age 5 Or Older (Pbb)",,36561,CPT,Professional,Outpatient,,,,2244,1907.4,201.35,2244,Humana Insurance Company,Commercial PPO,312.95,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Insertion Of Tunneled Centerally Inserted Venous Access Device, W/ Subcutaneous Port; Age 5 Or Older (Pbb)",,36561,CPT,Facility,Outpatient,,,,2254,1915.9,645.9964,2254,Humana Insurance Company,Medicare PPO,1104.46,49,,percent of total billed charges,,
"Insertion Of Tunneled Centerally Inserted Venous Access Device, W/ Subcutaneous Port; Age 5 Or Older (Pbb)",,36561,CPT,Professional,Outpatient,,,,2244,1907.4,201.35,2244,Humana Insurance Company,Medicare PPO,2244,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Insertion Of Tunneled Centerally Inserted Venous Access Device, W/ Subcutaneous Port; Age 5 Or Older (Pbb)",,36561,CPT,Facility,Outpatient,,,,2254,1915.9,645.9964,2254,Medica,Individual & Family,2233.714,99.1,,percent of total billed charges,,
"Insertion Of Tunneled Centerally Inserted Venous Access Device, W/ Subcutaneous Port; Age 5 Or Older (Pbb)",,36561,CPT,Professional,Outpatient,,,,2244,1907.4,201.35,2244,Medica,Individual & Family,1902.912,84.8,,percent of total billed charges,,
"Insertion Of Tunneled Centerally Inserted Venous Access Device, W/ Subcutaneous Port; Age 5 Or Older (Pbb)",,36561,CPT,Facility,Outpatient,,,,2254,1915.9,645.9964,2254,Medica,Medica Advantage Solution,1122.492,49.8,,percent of total billed charges,,
"Insertion Of Tunneled Centerally Inserted Venous Access Device, W/ Subcutaneous Port; Age 5 Or Older (Pbb)",,36561,CPT,Professional,Outpatient,,,,2244,1907.4,201.35,2244,Medica,Medica Advantage Solution,1117.512,49.8,,percent of total billed charges,,
"Insertion Of Tunneled Centerally Inserted Venous Access Device, W/ Subcutaneous Port; Age 5 Or Older (Pbb)",,36561,CPT,Facility,Outpatient,,,,2254,1915.9,645.9964,2254,Medica,Medical Assistance,1005.284,44.6,,percent of total billed charges,,
"Insertion Of Tunneled Centerally Inserted Venous Access Device, W/ Subcutaneous Port; Age 5 Or Older (Pbb)",,36561,CPT,Professional,Outpatient,,,,2244,1907.4,201.35,2244,Medica,Medical Assistance,232.47,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Insertion Of Tunneled Centerally Inserted Venous Access Device, W/ Subcutaneous Port; Age 5 Or Older (Pbb)",,36561,CPT,Facility,Outpatient,,,,2254,1915.9,645.9964,2254,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1122.492,49.8,,percent of total billed charges,,
"Insertion Of Tunneled Centerally Inserted Venous Access Device, W/ Subcutaneous Port; Age 5 Or Older (Pbb)",,36561,CPT,Professional,Outpatient,,,,2244,1907.4,201.35,2244,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,312.95,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Insertion Of Tunneled Centerally Inserted Venous Access Device, W/ Subcutaneous Port; Age 5 Or Older (Pbb)",,36561,CPT,Facility,Outpatient,,,,2254,1915.9,645.9964,2254,"Multiplan, Inc.","Multiplan, Inc.",2118.76,94,,percent of total billed charges,,
"Insertion Of Tunneled Centerally Inserted Venous Access Device, W/ Subcutaneous Port; Age 5 Or Older (Pbb)",,36561,CPT,Professional,Outpatient,,,,2244,1907.4,201.35,2244,"Multiplan, Inc.","Multiplan, Inc.",2109.36,94,,percent of total billed charges,,
"Insertion Of Tunneled Centerally Inserted Venous Access Device, W/ Subcutaneous Port; Age 5 Or Older (Pbb)",,36561,CPT,Facility,Outpatient,,,,2254,1915.9,645.9964,2254,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,2030.854,90.1,,percent of total billed charges,,
"Insertion Of Tunneled Centerally Inserted Venous Access Device, W/ Subcutaneous Port; Age 5 Or Older (Pbb)",,36561,CPT,Professional,Outpatient,,,,2244,1907.4,201.35,2244,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,2021.844,90.1,,percent of total billed charges,,
"Insertion Of Tunneled Centerally Inserted Venous Access Device, W/ Subcutaneous Port; Age 5 Or Older (Pbb)",,36561,CPT,Facility,Outpatient,,,,2254,1915.9,645.9964,2254,"Preferred One Administrative Services, INC.",PPO,2222.444,98.6,,percent of total billed charges,,
"Insertion Of Tunneled Centerally Inserted Venous Access Device, W/ Subcutaneous Port; Age 5 Or Older (Pbb)",,36561,CPT,Professional,Outpatient,,,,2244,1907.4,201.35,2244,"Preferred One Administrative Services, INC.",PPO,2212.584,98.6,,percent of total billed charges,,
"Insertion Of Tunneled Centerally Inserted Venous Access Device, W/ Subcutaneous Port; Age 5 Or Older (Pbb)",,36561,CPT,Facility,Outpatient,,,,2254,1915.9,645.9964,2254,PrimeWest Health,Minnesota Senior Health Options (MSHO),1159.683,51.45,,percent of total billed charges,,
"Insertion Of Tunneled Centerally Inserted Venous Access Device, W/ Subcutaneous Port; Age 5 Or Older (Pbb)",,36561,CPT,Professional,Outpatient,,,,2244,1907.4,201.35,2244,PrimeWest Health,Minnesota Senior Health Options (MSHO),359.8925,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Insertion Of Tunneled Centerally Inserted Venous Access Device, W/ Subcutaneous Port; Age 5 Or Older (Pbb)",,36561,CPT,Facility,Outpatient,,,,2254,1915.9,645.9964,2254,PrimeWest Health,MinnesotaCare,1157.6544,51.36,,percent of total billed charges,,
"Insertion Of Tunneled Centerally Inserted Venous Access Device, W/ Subcutaneous Port; Age 5 Or Older (Pbb)",,36561,CPT,Professional,Outpatient,,,,2244,1907.4,201.35,2244,PrimeWest Health,MinnesotaCare,248.7439272,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Insertion Of Tunneled Centerally Inserted Venous Access Device, W/ Subcutaneous Port; Age 5 Or Older (Pbb)",,36561,CPT,Facility,Outpatient,,,,2254,1915.9,645.9964,2254,Sanford Health Plan,Sanford Health Plan,2073.68,92,,percent of total billed charges,,
"Insertion Of Tunneled Centerally Inserted Venous Access Device, W/ Subcutaneous Port; Age 5 Or Older (Pbb)",,36561,CPT,Professional,Outpatient,,,,2244,1907.4,201.35,2244,Sanford Health Plan,Sanford Health Plan,1974.72,88,,percent of total billed charges,,
"Insertion Of Tunneled Centerally Inserted Venous Access Device, W/ Subcutaneous Port; Age 5 Or Older (Pbb)",,36561,CPT,Facility,Outpatient,,,,2254,1915.9,645.9964,2254,"UCare Health, Inc.",Individual & Family Plan,1270.129,56.35,,percent of total billed charges,,
"Insertion Of Tunneled Centerally Inserted Venous Access Device, W/ Subcutaneous Port; Age 5 Or Older (Pbb)",,36561,CPT,Professional,Outpatient,,,,2244,1907.4,201.35,2244,"UCare Health, Inc.",Individual & Family Plan,508.73152,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Insertion Of Tunneled Centerally Inserted Venous Access Device, W/ Subcutaneous Port; Age 5 Or Older (Pbb)",,36561,CPT,Facility,Outpatient,,,,2254,1915.9,645.9964,2254,"UCare Health, Inc.",Medical Assistance,1137.5938,50.47,,percent of total billed charges,,
"Insertion Of Tunneled Centerally Inserted Venous Access Device, W/ Subcutaneous Port; Age 5 Or Older (Pbb)",,36561,CPT,Professional,Outpatient,,,,2244,1907.4,201.35,2244,"UCare Health, Inc.",Medical Assistance,255.718056,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Insertion Of Tunneled Centerally Inserted Venous Access Device, W/ Subcutaneous Port; Age 5 Or Older (Pbb)",,36561,CPT,Facility,Outpatient,,,,2254,1915.9,645.9964,2254,"UCare Health, Inc.",Medicare Advantage,1137.5938,50.47,,percent of total billed charges,,
"Insertion Of Tunneled Centerally Inserted Venous Access Device, W/ Subcutaneous Port; Age 5 Or Older (Pbb)",,36561,CPT,Professional,Outpatient,,,,2244,1907.4,201.35,2244,"UCare Health, Inc.",Medicare Advantage,359.8925,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Insertion Of Tunneled Centerally Inserted Venous Access Device, W/ Subcutaneous Port; Age 5 Or Older (Pbb)",,36561,CPT,Facility,Outpatient,,,,2254,1915.9,645.9964,2254,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1137.5938,50.47,,percent of total billed charges,,
"Insertion Of Tunneled Centerally Inserted Venous Access Device, W/ Subcutaneous Port; Age 5 Or Older (Pbb)",,36561,CPT,Professional,Outpatient,,,,2244,1907.4,201.35,2244,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),287.914,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Insertion Of Tunneled Centerally Inserted Venous Access Device, W/ Subcutaneous Port; Age 5 Or Older (Pbb)",,36561,CPT,Facility,Outpatient,,,,2254,1915.9,645.9964,2254,UnitedHealthcare,Individual & Family,2118.76,94,,percent of total billed charges,,
"Insertion Of Tunneled Centerally Inserted Venous Access Device, W/ Subcutaneous Port; Age 5 Or Older (Pbb)",,36561,CPT,Professional,Outpatient,,,,2244,1907.4,201.35,2244,UnitedHealthcare,Individual & Family,2244,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Insertion Of Tunneled Centerally Inserted Venous Access Device, W/ Subcutaneous Port; Age 5 Or Older (Pbb)",,36561,CPT,Facility,Outpatient,,,,2254,1915.9,645.9964,2254,UnitedHealthcare,Medicare Advantage,1104.46,49,,percent of total billed charges,,
"Insertion Of Tunneled Centerally Inserted Venous Access Device, W/ Subcutaneous Port; Age 5 Or Older (Pbb)",,36561,CPT,Professional,Outpatient,,,,2244,1907.4,201.35,2244,UnitedHealthcare,Medicare Advantage,359.8925,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Insertion Of Tunneled Centerally Inserted Venous Access Device, W/ Subcutaneous Port; Age 5 Or Older (Pbb)",,36561,CPT,Facility,Outpatient,,,,2254,1915.9,645.9964,2254,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1081.92,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Insertion Of Tunneled Centerally Inserted Venous Access Device, W/ Subcutaneous Port; Age 5 Or Older (Pbb)",,36561,CPT,Professional,Outpatient,,,,2244,1907.4,201.35,2244,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,232.47096,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Insertion Tunneled Centrally Central Venous Access Device, W Subq Port; Age 5 Years Or + (Pro Cah)",,36561,CPT,Professional,Both,,,,4498,3823.3,201.35,4498,Aetna,Commercial,3823.3,85,,percent of total billed charges,,
"Insertion Tunneled Centrally Central Venous Access Device, W Subq Port; Age 5 Years Or + (Pro Cah)",,36561,CPT,Professional,Both,,,,4498,3823.3,201.35,4498,Aetna,Medicare Advantage,321.29,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Insertion Tunneled Centrally Central Venous Access Device, W Subq Port; Age 5 Years Or + (Pro Cah)",,36561,CPT,Professional,Both,,,,4498,3823.3,201.35,4498,Aetna,PPO,4183.14,93,,percent of total billed charges,,
"Insertion Tunneled Centrally Central Venous Access Device, W Subq Port; Age 5 Years Or + (Pro Cah)",,36561,CPT,Professional,Both,,,,4498,3823.3,201.35,4498,America's PPO,America's PPO,3843.0912,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Insertion Tunneled Centrally Central Venous Access Device, W Subq Port; Age 5 Years Or + (Pro Cah)",,36561,CPT,Professional,Both,,,,4498,3823.3,201.35,4498,BlueCross BlueShield Minnesota, Federal Employee Program,675.52,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Insertion Tunneled Centrally Central Venous Access Device, W Subq Port; Age 5 Years Or + (Pro Cah)",,36561,CPT,Professional,Both,,,,4498,3823.3,201.35,4498,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,686.32832,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Insertion Tunneled Centrally Central Venous Access Device, W Subq Port; Age 5 Years Or + (Pro Cah)",,36561,CPT,Professional,Both,,,,4498,3823.3,201.35,4498,BlueCross BlueShield Minnesota,High Value Network Plan,686.32832,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Insertion Tunneled Centrally Central Venous Access Device, W Subq Port; Age 5 Years Or + (Pro Cah)",,36561,CPT,Professional,Both,,,,4498,3823.3,201.35,4498,BlueCross BlueShield Minnesota,Medicare Advantage,359.8925,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Insertion Tunneled Centrally Central Venous Access Device, W Subq Port; Age 5 Years Or + (Pro Cah)",,36561,CPT,Professional,Both,,,,4498,3823.3,201.35,4498,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,686.32832,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Insertion Tunneled Centrally Central Venous Access Device, W Subq Port; Age 5 Years Or + (Pro Cah)",,36561,CPT,Professional,Both,,,,4498,3823.3,201.35,4498,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,232.47096,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Insertion Tunneled Centrally Central Venous Access Device, W Subq Port; Age 5 Years Or + (Pro Cah)",,36561,CPT,Professional,Both,,,,4498,3823.3,201.35,4498,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),359.8925,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Insertion Tunneled Centrally Central Venous Access Device, W Subq Port; Age 5 Years Or + (Pro Cah)",,36561,CPT,Professional,Both,,,,4498,3823.3,201.35,4498,CorVel,Worker's Compensation,620.3324142,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Insertion Tunneled Centrally Central Venous Access Device, W Subq Port; Age 5 Years Or + (Pro Cah)",,36561,CPT,Professional,Both,,,,4498,3823.3,201.35,4498,First Health Group Corporation,First Health Network,4363.06,97,,percent of total billed charges,,
"Insertion Tunneled Centrally Central Venous Access Device, W Subq Port; Age 5 Years Or + (Pro Cah)",,36561,CPT,Professional,Both,,,,4498,3823.3,201.35,4498,"Health Partners, Inc.",Commercial,670.39,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Insertion Tunneled Centrally Central Venous Access Device, W Subq Port; Age 5 Years Or + (Pro Cah)",,36561,CPT,Professional,Both,,,,4498,3823.3,201.35,4498,"Health Partners, Inc.",Medicare Advantage,359.8925,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Insertion Tunneled Centrally Central Venous Access Device, W Subq Port; Age 5 Years Or + (Pro Cah)",,36561,CPT,Professional,Both,,,,4498,3823.3,201.35,4498,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),313.12,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Insertion Tunneled Centrally Central Venous Access Device, W Subq Port; Age 5 Years Or + (Pro Cah)",,36561,CPT,Professional,Both,,,,4498,3823.3,201.35,4498,"Health Partners, Inc.",State of Minnesota Advantage Program,577.540985,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Insertion Tunneled Centrally Central Venous Access Device, W Subq Port; Age 5 Years Or + (Pro Cah)",,36561,CPT,Professional,Both,,,,4498,3823.3,201.35,4498,"Health Partners, Inc.",State Public Programs,201.35,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Insertion Tunneled Centrally Central Venous Access Device, W Subq Port; Age 5 Years Or + (Pro Cah)",,36561,CPT,Professional,Both,,,,4498,3823.3,201.35,4498,Humana Insurance Company,Commercial PPO,312.95,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Insertion Tunneled Centrally Central Venous Access Device, W Subq Port; Age 5 Years Or + (Pro Cah)",,36561,CPT,Professional,Both,,,,4498,3823.3,201.35,4498,Humana Insurance Company,Medicare PPO,4498,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Insertion Tunneled Centrally Central Venous Access Device, W Subq Port; Age 5 Years Or + (Pro Cah)",,36561,CPT,Professional,Both,,,,4498,3823.3,201.35,4498,Medica,Individual & Family,3814.304,84.8,,percent of total billed charges,,
"Insertion Tunneled Centrally Central Venous Access Device, W Subq Port; Age 5 Years Or + (Pro Cah)",,36561,CPT,Professional,Both,,,,4498,3823.3,201.35,4498,Medica,Medica Advantage Solution,2240.004,49.8,,percent of total billed charges,,
"Insertion Tunneled Centrally Central Venous Access Device, W Subq Port; Age 5 Years Or + (Pro Cah)",,36561,CPT,Professional,Both,,,,4498,3823.3,201.35,4498,Medica,Medical Assistance,232.47,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Insertion Tunneled Centrally Central Venous Access Device, W Subq Port; Age 5 Years Or + (Pro Cah)",,36561,CPT,Professional,Both,,,,4498,3823.3,201.35,4498,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,312.95,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Insertion Tunneled Centrally Central Venous Access Device, W Subq Port; Age 5 Years Or + (Pro Cah)",,36561,CPT,Professional,Both,,,,4498,3823.3,201.35,4498,"Multiplan, Inc.","Multiplan, Inc.",4228.12,94,,percent of total billed charges,,
"Insertion Tunneled Centrally Central Venous Access Device, W Subq Port; Age 5 Years Or + (Pro Cah)",,36561,CPT,Professional,Both,,,,4498,3823.3,201.35,4498,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4052.698,90.1,,percent of total billed charges,,
"Insertion Tunneled Centrally Central Venous Access Device, W Subq Port; Age 5 Years Or + (Pro Cah)",,36561,CPT,Professional,Both,,,,4498,3823.3,201.35,4498,"Preferred One Administrative Services, INC.",PPO,4435.028,98.6,,percent of total billed charges,,
"Insertion Tunneled Centrally Central Venous Access Device, W Subq Port; Age 5 Years Or + (Pro Cah)",,36561,CPT,Professional,Both,,,,4498,3823.3,201.35,4498,PrimeWest Health,Minnesota Senior Health Options (MSHO),359.8925,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Insertion Tunneled Centrally Central Venous Access Device, W Subq Port; Age 5 Years Or + (Pro Cah)",,36561,CPT,Professional,Both,,,,4498,3823.3,201.35,4498,PrimeWest Health,MinnesotaCare,248.7439272,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Insertion Tunneled Centrally Central Venous Access Device, W Subq Port; Age 5 Years Or + (Pro Cah)",,36561,CPT,Professional,Both,,,,4498,3823.3,201.35,4498,Sanford Health Plan,Sanford Health Plan,3958.24,88,,percent of total billed charges,,
"Insertion Tunneled Centrally Central Venous Access Device, W Subq Port; Age 5 Years Or + (Pro Cah)",,36561,CPT,Professional,Both,,,,4498,3823.3,201.35,4498,"UCare Health, Inc.",Individual & Family Plan,508.73152,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Insertion Tunneled Centrally Central Venous Access Device, W Subq Port; Age 5 Years Or + (Pro Cah)",,36561,CPT,Professional,Both,,,,4498,3823.3,201.35,4498,"UCare Health, Inc.",Medical Assistance,255.718056,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Insertion Tunneled Centrally Central Venous Access Device, W Subq Port; Age 5 Years Or + (Pro Cah)",,36561,CPT,Professional,Both,,,,4498,3823.3,201.35,4498,"UCare Health, Inc.",Medicare Advantage,359.8925,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Insertion Tunneled Centrally Central Venous Access Device, W Subq Port; Age 5 Years Or + (Pro Cah)",,36561,CPT,Professional,Both,,,,4498,3823.3,201.35,4498,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),287.914,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Insertion Tunneled Centrally Central Venous Access Device, W Subq Port; Age 5 Years Or + (Pro Cah)",,36561,CPT,Professional,Both,,,,4498,3823.3,201.35,4498,UnitedHealthcare,Individual & Family,4498,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Insertion Tunneled Centrally Central Venous Access Device, W Subq Port; Age 5 Years Or + (Pro Cah)",,36561,CPT,Professional,Both,,,,4498,3823.3,201.35,4498,UnitedHealthcare,Medicare Advantage,359.8925,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Insertion Tunneled Centrally Central Venous Access Device, W Subq Port; Age 5 Years Or + (Pro Cah)",,36561,CPT,Professional,Both,,,,4498,3823.3,201.35,4498,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,232.47096,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Picc Line Placement, Less Than 5 Years Old, Without Imaging Guidance",,36568,CPT,Facility,Both,,,,2856,2427.6,449,2856,Aetna,Commercial,2627.52,92,,percent of total billed charges,,
"Picc Line Placement, Less Than 5 Years Old, Without Imaging Guidance",,36568,CPT,Facility,Outpatient,,,,2856,2427.6,449,2856,Aetna,Medicare Advantage,1399.44,49,,percent of total billed charges,,
"Picc Line Placement, Less Than 5 Years Old, Without Imaging Guidance",,36568,CPT,Facility,Inpatient,,,,2856,2427.6,449,2856,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Picc Line Placement, Less Than 5 Years Old, Without Imaging Guidance",,36568,CPT,Facility,Both,,,,2856,2427.6,449,2856,Aetna,PPO,2656.08,93,,percent of total billed charges,,
"Picc Line Placement, Less Than 5 Years Old, Without Imaging Guidance",,36568,CPT,Facility,Both,,,,2856,2427.6,449,2856,America's PPO,America's PPO,2742.6168,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Picc Line Placement, Less Than 5 Years Old, Without Imaging Guidance",,36568,CPT,Facility,Both,,,,2856,2427.6,449,2856,BlueCross BlueShield Minnesota, Federal Employee Program,2810.304,98.4,,percent of total billed charges,,
"Picc Line Placement, Less Than 5 Years Old, Without Imaging Guidance",,36568,CPT,Facility,Both,,,,2856,2427.6,449,2856,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,2856,100,,percent of total billed charges,,
"Picc Line Placement, Less Than 5 Years Old, Without Imaging Guidance",,36568,CPT,Facility,Both,,,,2856,2427.6,449,2856,BlueCross BlueShield Minnesota,High Value Network Plan,2570.4,90,,percent of total billed charges,,
"Picc Line Placement, Less Than 5 Years Old, Without Imaging Guidance",,36568,CPT,Facility,Outpatient,,,,2856,2427.6,449,2856,BlueCross BlueShield Minnesota,Medicare Advantage,1399.44,49,,percent of total billed charges,,
"Picc Line Placement, Less Than 5 Years Old, Without Imaging Guidance",,36568,CPT,Facility,Inpatient,,,,2856,2427.6,449,2856,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Picc Line Placement, Less Than 5 Years Old, Without Imaging Guidance",,36568,CPT,Facility,Both,,,,2856,2427.6,449,2856,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,2529.5592,88.57,,percent of total billed charges,,
"Picc Line Placement, Less Than 5 Years Old, Without Imaging Guidance",,36568,CPT,Facility,Both,,,,2856,2427.6,449,2856,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,818.5296,28.66,,percent of total billed charges,,
"Picc Line Placement, Less Than 5 Years Old, Without Imaging Guidance",,36568,CPT,Facility,Outpatient,,,,2856,2427.6,449,2856,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1399.44,49,,percent of total billed charges,,
"Picc Line Placement, Less Than 5 Years Old, Without Imaging Guidance",,36568,CPT,Facility,Inpatient,,,,2856,2427.6,449,2856,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Picc Line Placement, Less Than 5 Years Old, Without Imaging Guidance",,36568,CPT,Facility,Both,,,,2856,2427.6,449,2856,CorVel,Worker's Compensation,2856,100,,percent of total billed charges,,
"Picc Line Placement, Less Than 5 Years Old, Without Imaging Guidance",,36568,CPT,Facility,Both,,,,2856,2427.6,449,2856,First Health Group Corporation,First Health Network,2770.32,97,,percent of total billed charges,,
"Picc Line Placement, Less Than 5 Years Old, Without Imaging Guidance",,36568,CPT,Facility,Both,,,,2856,2427.6,449,2856,"Health Partners, Inc.",Commercial,2701.776,94.6,,percent of total billed charges,,
"Picc Line Placement, Less Than 5 Years Old, Without Imaging Guidance",,36568,CPT,Facility,Outpatient,,,,2856,2427.6,449,2856,"Health Partners, Inc.",Medicare Advantage,1399.44,49,,percent of total billed charges,,
"Picc Line Placement, Less Than 5 Years Old, Without Imaging Guidance",,36568,CPT,Facility,Inpatient,,,,2856,2427.6,449,2856,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Picc Line Placement, Less Than 5 Years Old, Without Imaging Guidance",,36568,CPT,Facility,Both,,,,2856,2427.6,449,2856,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1713.6,60,,percent of total billed charges,,
"Picc Line Placement, Less Than 5 Years Old, Without Imaging Guidance",,36568,CPT,Facility,Both,,,,2856,2427.6,449,2856,"Health Partners, Inc.",State of Minnesota Advantage Program,2327.64,81.5,,percent of total billed charges,,
"Picc Line Placement, Less Than 5 Years Old, Without Imaging Guidance",,36568,CPT,Facility,Both,,,,2856,2427.6,449,2856,"Health Partners, Inc.",State Public Programs,1428,50,,percent of total billed charges,,
"Picc Line Placement, Less Than 5 Years Old, Without Imaging Guidance",,36568,CPT,Facility,Both,,,,2856,2427.6,449,2856,Humana Insurance Company,Commercial PPO,2713.2,95,,percent of total billed charges,,
"Picc Line Placement, Less Than 5 Years Old, Without Imaging Guidance",,36568,CPT,Facility,Outpatient,,,,2856,2427.6,449,2856,Humana Insurance Company,Medicare PPO,1399.44,49,,percent of total billed charges,,
"Picc Line Placement, Less Than 5 Years Old, Without Imaging Guidance",,36568,CPT,Facility,Inpatient,,,,2856,2427.6,449,2856,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Picc Line Placement, Less Than 5 Years Old, Without Imaging Guidance",,36568,CPT,Facility,Both,,,,2856,2427.6,449,2856,Medica,Individual & Family,2830.296,99.1,,percent of total billed charges,,
"Picc Line Placement, Less Than 5 Years Old, Without Imaging Guidance",,36568,CPT,Facility,Outpatient,,,,2856,2427.6,449,2856,Medica,Medica Advantage Solution,1422.288,49.8,,percent of total billed charges,,
"Picc Line Placement, Less Than 5 Years Old, Without Imaging Guidance",,36568,CPT,Facility,Inpatient,,,,2856,2427.6,449,2856,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Picc Line Placement, Less Than 5 Years Old, Without Imaging Guidance",,36568,CPT,Facility,Outpatient,,,,2856,2427.6,449,2856,Medica,Medical Assistance,449,,,Other,Grouper,All inclusive per visit
"Picc Line Placement, Less Than 5 Years Old, Without Imaging Guidance",,36568,CPT,Facility,Inpatient,,,,2856,2427.6,449,2856,Medica,Medical Assistance,,,,,Included in per diem rate,
"Picc Line Placement, Less Than 5 Years Old, Without Imaging Guidance",,36568,CPT,Facility,Outpatient,,,,2856,2427.6,449,2856,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1422.288,49.8,,percent of total billed charges,,
"Picc Line Placement, Less Than 5 Years Old, Without Imaging Guidance",,36568,CPT,Facility,Inpatient,,,,2856,2427.6,449,2856,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Picc Line Placement, Less Than 5 Years Old, Without Imaging Guidance",,36568,CPT,Facility,Both,,,,2856,2427.6,449,2856,"Multiplan, Inc.","Multiplan, Inc.",2684.64,94,,percent of total billed charges,,
"Picc Line Placement, Less Than 5 Years Old, Without Imaging Guidance",,36568,CPT,Facility,Outpatient,,,,2856,2427.6,449,2856,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,2573.256,90.1,,percent of total billed charges,,
"Picc Line Placement, Less Than 5 Years Old, Without Imaging Guidance",,36568,CPT,Facility,Inpatient,,,,2856,2427.6,449,2856,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Picc Line Placement, Less Than 5 Years Old, Without Imaging Guidance",,36568,CPT,Facility,Both,,,,2856,2427.6,449,2856,"Preferred One Administrative Services, INC.",PPO,2816.016,98.6,,percent of total billed charges,,
"Picc Line Placement, Less Than 5 Years Old, Without Imaging Guidance",,36568,CPT,Facility,Outpatient,,,,2856,2427.6,449,2856,PrimeWest Health,Minnesota Senior Health Options (MSHO),1469.412,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Picc Line Placement, Less Than 5 Years Old, Without Imaging Guidance",,36568,CPT,Facility,Inpatient,,,,2856,2427.6,449,2856,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Picc Line Placement, Less Than 5 Years Old, Without Imaging Guidance",,36568,CPT,Facility,Outpatient,,,,2856,2427.6,449,2856,PrimeWest Health,MinnesotaCare,1466.8416,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Picc Line Placement, Less Than 5 Years Old, Without Imaging Guidance",,36568,CPT,Facility,Inpatient,,,,2856,2427.6,449,2856,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Picc Line Placement, Less Than 5 Years Old, Without Imaging Guidance",,36568,CPT,Facility,Both,,,,2856,2427.6,449,2856,Sanford Health Plan,Sanford Health Plan,2627.52,92,,percent of total billed charges,,
"Picc Line Placement, Less Than 5 Years Old, Without Imaging Guidance",,36568,CPT,Facility,Outpatient,,,,2856,2427.6,449,2856,"UCare Health, Inc.",Individual & Family Plan,1609.356,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Picc Line Placement, Less Than 5 Years Old, Without Imaging Guidance",,36568,CPT,Facility,Inpatient,,,,2856,2427.6,449,2856,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Picc Line Placement, Less Than 5 Years Old, Without Imaging Guidance",,36568,CPT,Facility,Outpatient,,,,2856,2427.6,449,2856,"UCare Health, Inc.",Medical Assistance,1441.4232,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Picc Line Placement, Less Than 5 Years Old, Without Imaging Guidance",,36568,CPT,Facility,Inpatient,,,,2856,2427.6,449,2856,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Picc Line Placement, Less Than 5 Years Old, Without Imaging Guidance",,36568,CPT,Facility,Outpatient,,,,2856,2427.6,449,2856,"UCare Health, Inc.",Medicare Advantage,1441.4232,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Picc Line Placement, Less Than 5 Years Old, Without Imaging Guidance",,36568,CPT,Facility,Inpatient,,,,2856,2427.6,449,2856,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Picc Line Placement, Less Than 5 Years Old, Without Imaging Guidance",,36568,CPT,Facility,Outpatient,,,,2856,2427.6,449,2856,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1441.4232,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Picc Line Placement, Less Than 5 Years Old, Without Imaging Guidance",,36568,CPT,Facility,Inpatient,,,,2856,2427.6,449,2856,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Picc Line Placement, Less Than 5 Years Old, Without Imaging Guidance",,36568,CPT,Facility,Both,,,,2856,2427.6,449,2856,UnitedHealthcare,Individual & Family,2684.64,94,,percent of total billed charges,,
"Picc Line Placement, Less Than 5 Years Old, Without Imaging Guidance",,36568,CPT,Facility,Outpatient,,,,2856,2427.6,449,2856,UnitedHealthcare,Medicare Advantage,1399.44,49,,percent of total billed charges,,
"Picc Line Placement, Less Than 5 Years Old, Without Imaging Guidance",,36568,CPT,Facility,Inpatient,,,,2856,2427.6,449,2856,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Picc Line Placement, Less Than 5 Years Old, Without Imaging Guidance",,36568,CPT,Facility,Outpatient,,,,2856,2427.6,449,2856,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1370.88,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Picc Line Placement, Less Than 5 Years Old, Without Imaging Guidance",,36568,CPT,Facility,Inpatient,,,,2856,2427.6,449,2856,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Insert Peripherally Central Venous Catheter,Wo Subq Port/Pump,Wo Imag Guid;Age 5 Year Or + (Pro Cah)",,36569,CPT,Professional,Both,,,,612,520.2,56.28,612,Aetna,Commercial,520.2,85,,percent of total billed charges,,
"Insert Peripherally Central Venous Catheter,Wo Subq Port/Pump,Wo Imag Guid;Age 5 Year Or + (Pro Cah)",,36569,CPT,Professional,Both,,,,612,520.2,56.28,612,Aetna,Medicare Advantage,90.45,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Insert Peripherally Central Venous Catheter,Wo Subq Port/Pump,Wo Imag Guid;Age 5 Year Or + (Pro Cah)",,36569,CPT,Professional,Both,,,,612,520.2,56.28,612,Aetna,PPO,569.16,93,,percent of total billed charges,,
"Insert Peripherally Central Venous Catheter,Wo Subq Port/Pump,Wo Imag Guid;Age 5 Year Or + (Pro Cah)",,36569,CPT,Professional,Both,,,,612,520.2,56.28,612,America's PPO,America's PPO,522.8928,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Insert Peripherally Central Venous Catheter,Wo Subq Port/Pump,Wo Imag Guid;Age 5 Year Or + (Pro Cah)",,36569,CPT,Professional,Both,,,,612,520.2,56.28,612,BlueCross BlueShield Minnesota, Federal Employee Program,189.37,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Insert Peripherally Central Venous Catheter,Wo Subq Port/Pump,Wo Imag Guid;Age 5 Year Or + (Pro Cah)",,36569,CPT,Professional,Both,,,,612,520.2,56.28,612,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,192.39992,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Insert Peripherally Central Venous Catheter,Wo Subq Port/Pump,Wo Imag Guid;Age 5 Year Or + (Pro Cah)",,36569,CPT,Professional,Both,,,,612,520.2,56.28,612,BlueCross BlueShield Minnesota,High Value Network Plan,192.39992,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Insert Peripherally Central Venous Catheter,Wo Subq Port/Pump,Wo Imag Guid;Age 5 Year Or + (Pro Cah)",,36569,CPT,Professional,Both,,,,612,520.2,56.28,612,BlueCross BlueShield Minnesota,Medicare Advantage,100.7745,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Insert Peripherally Central Venous Catheter,Wo Subq Port/Pump,Wo Imag Guid;Age 5 Year Or + (Pro Cah)",,36569,CPT,Professional,Both,,,,612,520.2,56.28,612,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,192.39992,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Insert Peripherally Central Venous Catheter,Wo Subq Port/Pump,Wo Imag Guid;Age 5 Year Or + (Pro Cah)",,36569,CPT,Professional,Both,,,,612,520.2,56.28,612,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,64.9732,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Insert Peripherally Central Venous Catheter,Wo Subq Port/Pump,Wo Imag Guid;Age 5 Year Or + (Pro Cah)",,36569,CPT,Professional,Both,,,,612,520.2,56.28,612,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),100.7745,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Insert Peripherally Central Venous Catheter,Wo Subq Port/Pump,Wo Imag Guid;Age 5 Year Or + (Pro Cah)",,36569,CPT,Professional,Both,,,,612,520.2,56.28,612,CorVel,Worker's Compensation,174.1395684,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Insert Peripherally Central Venous Catheter,Wo Subq Port/Pump,Wo Imag Guid;Age 5 Year Or + (Pro Cah)",,36569,CPT,Professional,Both,,,,612,520.2,56.28,612,First Health Group Corporation,First Health Network,593.64,97,,percent of total billed charges,,
"Insert Peripherally Central Venous Catheter,Wo Subq Port/Pump,Wo Imag Guid;Age 5 Year Or + (Pro Cah)",,36569,CPT,Professional,Both,,,,612,520.2,56.28,612,"Health Partners, Inc.",Commercial,187.91,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Insert Peripherally Central Venous Catheter,Wo Subq Port/Pump,Wo Imag Guid;Age 5 Year Or + (Pro Cah)",,36569,CPT,Professional,Both,,,,612,520.2,56.28,612,"Health Partners, Inc.",Medicare Advantage,100.7745,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Insert Peripherally Central Venous Catheter,Wo Subq Port/Pump,Wo Imag Guid;Age 5 Year Or + (Pro Cah)",,36569,CPT,Professional,Both,,,,612,520.2,56.28,612,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),87.43,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Insert Peripherally Central Venous Catheter,Wo Subq Port/Pump,Wo Imag Guid;Age 5 Year Or + (Pro Cah)",,36569,CPT,Professional,Both,,,,612,520.2,56.28,612,"Health Partners, Inc.",State of Minnesota Advantage Program,161.884465,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Insert Peripherally Central Venous Catheter,Wo Subq Port/Pump,Wo Imag Guid;Age 5 Year Or + (Pro Cah)",,36569,CPT,Professional,Both,,,,612,520.2,56.28,612,"Health Partners, Inc.",State Public Programs,56.28,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Insert Peripherally Central Venous Catheter,Wo Subq Port/Pump,Wo Imag Guid;Age 5 Year Or + (Pro Cah)",,36569,CPT,Professional,Both,,,,612,520.2,56.28,612,Humana Insurance Company,Commercial PPO,87.63,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Insert Peripherally Central Venous Catheter,Wo Subq Port/Pump,Wo Imag Guid;Age 5 Year Or + (Pro Cah)",,36569,CPT,Professional,Both,,,,612,520.2,56.28,612,Humana Insurance Company,Medicare PPO,612,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Insert Peripherally Central Venous Catheter,Wo Subq Port/Pump,Wo Imag Guid;Age 5 Year Or + (Pro Cah)",,36569,CPT,Professional,Both,,,,612,520.2,56.28,612,Medica,Individual & Family,518.976,84.8,,percent of total billed charges,,
"Insert Peripherally Central Venous Catheter,Wo Subq Port/Pump,Wo Imag Guid;Age 5 Year Or + (Pro Cah)",,36569,CPT,Professional,Both,,,,612,520.2,56.28,612,Medica,Medica Advantage Solution,304.776,49.8,,percent of total billed charges,,
"Insert Peripherally Central Venous Catheter,Wo Subq Port/Pump,Wo Imag Guid;Age 5 Year Or + (Pro Cah)",,36569,CPT,Professional,Both,,,,612,520.2,56.28,612,Medica,Medical Assistance,64.97,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Insert Peripherally Central Venous Catheter,Wo Subq Port/Pump,Wo Imag Guid;Age 5 Year Or + (Pro Cah)",,36569,CPT,Professional,Both,,,,612,520.2,56.28,612,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,87.63,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Insert Peripherally Central Venous Catheter,Wo Subq Port/Pump,Wo Imag Guid;Age 5 Year Or + (Pro Cah)",,36569,CPT,Professional,Both,,,,612,520.2,56.28,612,"Multiplan, Inc.","Multiplan, Inc.",575.28,94,,percent of total billed charges,,
"Insert Peripherally Central Venous Catheter,Wo Subq Port/Pump,Wo Imag Guid;Age 5 Year Or + (Pro Cah)",,36569,CPT,Professional,Both,,,,612,520.2,56.28,612,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,551.412,90.1,,percent of total billed charges,,
"Insert Peripherally Central Venous Catheter,Wo Subq Port/Pump,Wo Imag Guid;Age 5 Year Or + (Pro Cah)",,36569,CPT,Professional,Both,,,,612,520.2,56.28,612,"Preferred One Administrative Services, INC.",PPO,603.432,98.6,,percent of total billed charges,,
"Insert Peripherally Central Venous Catheter,Wo Subq Port/Pump,Wo Imag Guid;Age 5 Year Or + (Pro Cah)",,36569,CPT,Professional,Both,,,,612,520.2,56.28,612,PrimeWest Health,Minnesota Senior Health Options (MSHO),100.7745,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Insert Peripherally Central Venous Catheter,Wo Subq Port/Pump,Wo Imag Guid;Age 5 Year Or + (Pro Cah)",,36569,CPT,Professional,Both,,,,612,520.2,56.28,612,PrimeWest Health,MinnesotaCare,69.521324,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Insert Peripherally Central Venous Catheter,Wo Subq Port/Pump,Wo Imag Guid;Age 5 Year Or + (Pro Cah)",,36569,CPT,Professional,Both,,,,612,520.2,56.28,612,Sanford Health Plan,Sanford Health Plan,538.56,88,,percent of total billed charges,,
"Insert Peripherally Central Venous Catheter,Wo Subq Port/Pump,Wo Imag Guid;Age 5 Year Or + (Pro Cah)",,36569,CPT,Professional,Both,,,,612,520.2,56.28,612,"UCare Health, Inc.",Individual & Family Plan,142.451328,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Insert Peripherally Central Venous Catheter,Wo Subq Port/Pump,Wo Imag Guid;Age 5 Year Or + (Pro Cah)",,36569,CPT,Professional,Both,,,,612,520.2,56.28,612,"UCare Health, Inc.",Medical Assistance,71.47052,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Insert Peripherally Central Venous Catheter,Wo Subq Port/Pump,Wo Imag Guid;Age 5 Year Or + (Pro Cah)",,36569,CPT,Professional,Both,,,,612,520.2,56.28,612,"UCare Health, Inc.",Medicare Advantage,100.7745,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Insert Peripherally Central Venous Catheter,Wo Subq Port/Pump,Wo Imag Guid;Age 5 Year Or + (Pro Cah)",,36569,CPT,Professional,Both,,,,612,520.2,56.28,612,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),80.6196,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Insert Peripherally Central Venous Catheter,Wo Subq Port/Pump,Wo Imag Guid;Age 5 Year Or + (Pro Cah)",,36569,CPT,Professional,Both,,,,612,520.2,56.28,612,UnitedHealthcare,Individual & Family,612,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Insert Peripherally Central Venous Catheter,Wo Subq Port/Pump,Wo Imag Guid;Age 5 Year Or + (Pro Cah)",,36569,CPT,Professional,Both,,,,612,520.2,56.28,612,UnitedHealthcare,Medicare Advantage,100.7745,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Insert Peripherally Central Venous Catheter,Wo Subq Port/Pump,Wo Imag Guid;Age 5 Year Or + (Pro Cah)",,36569,CPT,Professional,Both,,,,612,520.2,56.28,612,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,64.9732,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Picc Line Placement, Age 5 Or Older, Without Imaging Guidance",,36569,CPT,Facility,Both,,,,2652,2254.2,449,2652,Aetna,Commercial,2439.84,92,,percent of total billed charges,,
"Picc Line Placement, Age 5 Or Older, Without Imaging Guidance",,36569,CPT,Facility,Outpatient,,,,2652,2254.2,449,2652,Aetna,Medicare Advantage,1299.48,49,,percent of total billed charges,,
"Picc Line Placement, Age 5 Or Older, Without Imaging Guidance",,36569,CPT,Facility,Inpatient,,,,2652,2254.2,449,2652,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Picc Line Placement, Age 5 Or Older, Without Imaging Guidance",,36569,CPT,Facility,Both,,,,2652,2254.2,449,2652,Aetna,PPO,2466.36,93,,percent of total billed charges,,
"Picc Line Placement, Age 5 Or Older, Without Imaging Guidance",,36569,CPT,Facility,Both,,,,2652,2254.2,449,2652,America's PPO,America's PPO,2546.7156,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Picc Line Placement, Age 5 Or Older, Without Imaging Guidance",,36569,CPT,Facility,Both,,,,2652,2254.2,449,2652,BlueCross BlueShield Minnesota, Federal Employee Program,2609.568,98.4,,percent of total billed charges,,
"Picc Line Placement, Age 5 Or Older, Without Imaging Guidance",,36569,CPT,Facility,Both,,,,2652,2254.2,449,2652,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,2652,100,,percent of total billed charges,,
"Picc Line Placement, Age 5 Or Older, Without Imaging Guidance",,36569,CPT,Facility,Both,,,,2652,2254.2,449,2652,BlueCross BlueShield Minnesota,High Value Network Plan,2386.8,90,,percent of total billed charges,,
"Picc Line Placement, Age 5 Or Older, Without Imaging Guidance",,36569,CPT,Facility,Outpatient,,,,2652,2254.2,449,2652,BlueCross BlueShield Minnesota,Medicare Advantage,1299.48,49,,percent of total billed charges,,
"Picc Line Placement, Age 5 Or Older, Without Imaging Guidance",,36569,CPT,Facility,Inpatient,,,,2652,2254.2,449,2652,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Picc Line Placement, Age 5 Or Older, Without Imaging Guidance",,36569,CPT,Facility,Both,,,,2652,2254.2,449,2652,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,2348.8764,88.57,,percent of total billed charges,,
"Picc Line Placement, Age 5 Or Older, Without Imaging Guidance",,36569,CPT,Facility,Both,,,,2652,2254.2,449,2652,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,760.0632,28.66,,percent of total billed charges,,
"Picc Line Placement, Age 5 Or Older, Without Imaging Guidance",,36569,CPT,Facility,Outpatient,,,,2652,2254.2,449,2652,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1299.48,49,,percent of total billed charges,,
"Picc Line Placement, Age 5 Or Older, Without Imaging Guidance",,36569,CPT,Facility,Inpatient,,,,2652,2254.2,449,2652,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Picc Line Placement, Age 5 Or Older, Without Imaging Guidance",,36569,CPT,Facility,Both,,,,2652,2254.2,449,2652,CorVel,Worker's Compensation,2652,100,,percent of total billed charges,,
"Picc Line Placement, Age 5 Or Older, Without Imaging Guidance",,36569,CPT,Facility,Both,,,,2652,2254.2,449,2652,First Health Group Corporation,First Health Network,2572.44,97,,percent of total billed charges,,
"Picc Line Placement, Age 5 Or Older, Without Imaging Guidance",,36569,CPT,Facility,Both,,,,2652,2254.2,449,2652,"Health Partners, Inc.",Commercial,2508.792,94.6,,percent of total billed charges,,
"Picc Line Placement, Age 5 Or Older, Without Imaging Guidance",,36569,CPT,Facility,Outpatient,,,,2652,2254.2,449,2652,"Health Partners, Inc.",Medicare Advantage,1299.48,49,,percent of total billed charges,,
"Picc Line Placement, Age 5 Or Older, Without Imaging Guidance",,36569,CPT,Facility,Inpatient,,,,2652,2254.2,449,2652,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Picc Line Placement, Age 5 Or Older, Without Imaging Guidance",,36569,CPT,Facility,Both,,,,2652,2254.2,449,2652,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1591.2,60,,percent of total billed charges,,
"Picc Line Placement, Age 5 Or Older, Without Imaging Guidance",,36569,CPT,Facility,Both,,,,2652,2254.2,449,2652,"Health Partners, Inc.",State of Minnesota Advantage Program,2161.38,81.5,,percent of total billed charges,,
"Picc Line Placement, Age 5 Or Older, Without Imaging Guidance",,36569,CPT,Facility,Both,,,,2652,2254.2,449,2652,"Health Partners, Inc.",State Public Programs,1326,50,,percent of total billed charges,,
"Picc Line Placement, Age 5 Or Older, Without Imaging Guidance",,36569,CPT,Facility,Both,,,,2652,2254.2,449,2652,Humana Insurance Company,Commercial PPO,2519.4,95,,percent of total billed charges,,
"Picc Line Placement, Age 5 Or Older, Without Imaging Guidance",,36569,CPT,Facility,Outpatient,,,,2652,2254.2,449,2652,Humana Insurance Company,Medicare PPO,1299.48,49,,percent of total billed charges,,
"Picc Line Placement, Age 5 Or Older, Without Imaging Guidance",,36569,CPT,Facility,Inpatient,,,,2652,2254.2,449,2652,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Picc Line Placement, Age 5 Or Older, Without Imaging Guidance",,36569,CPT,Facility,Both,,,,2652,2254.2,449,2652,Medica,Individual & Family,2628.132,99.1,,percent of total billed charges,,
"Picc Line Placement, Age 5 Or Older, Without Imaging Guidance",,36569,CPT,Facility,Outpatient,,,,2652,2254.2,449,2652,Medica,Medica Advantage Solution,1320.696,49.8,,percent of total billed charges,,
"Picc Line Placement, Age 5 Or Older, Without Imaging Guidance",,36569,CPT,Facility,Inpatient,,,,2652,2254.2,449,2652,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Picc Line Placement, Age 5 Or Older, Without Imaging Guidance",,36569,CPT,Facility,Outpatient,,,,2652,2254.2,449,2652,Medica,Medical Assistance,449,,,Other,Grouper,All inclusive per visit
"Picc Line Placement, Age 5 Or Older, Without Imaging Guidance",,36569,CPT,Facility,Inpatient,,,,2652,2254.2,449,2652,Medica,Medical Assistance,,,,,Included in per diem rate,
"Picc Line Placement, Age 5 Or Older, Without Imaging Guidance",,36569,CPT,Facility,Outpatient,,,,2652,2254.2,449,2652,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1320.696,49.8,,percent of total billed charges,,
"Picc Line Placement, Age 5 Or Older, Without Imaging Guidance",,36569,CPT,Facility,Inpatient,,,,2652,2254.2,449,2652,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Picc Line Placement, Age 5 Or Older, Without Imaging Guidance",,36569,CPT,Facility,Both,,,,2652,2254.2,449,2652,"Multiplan, Inc.","Multiplan, Inc.",2492.88,94,,percent of total billed charges,,
"Picc Line Placement, Age 5 Or Older, Without Imaging Guidance",,36569,CPT,Facility,Outpatient,,,,2652,2254.2,449,2652,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,2389.452,90.1,,percent of total billed charges,,
"Picc Line Placement, Age 5 Or Older, Without Imaging Guidance",,36569,CPT,Facility,Inpatient,,,,2652,2254.2,449,2652,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Picc Line Placement, Age 5 Or Older, Without Imaging Guidance",,36569,CPT,Facility,Both,,,,2652,2254.2,449,2652,"Preferred One Administrative Services, INC.",PPO,2614.872,98.6,,percent of total billed charges,,
"Picc Line Placement, Age 5 Or Older, Without Imaging Guidance",,36569,CPT,Facility,Outpatient,,,,2652,2254.2,449,2652,PrimeWest Health,Minnesota Senior Health Options (MSHO),1364.454,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Picc Line Placement, Age 5 Or Older, Without Imaging Guidance",,36569,CPT,Facility,Inpatient,,,,2652,2254.2,449,2652,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Picc Line Placement, Age 5 Or Older, Without Imaging Guidance",,36569,CPT,Facility,Outpatient,,,,2652,2254.2,449,2652,PrimeWest Health,MinnesotaCare,1362.0672,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Picc Line Placement, Age 5 Or Older, Without Imaging Guidance",,36569,CPT,Facility,Inpatient,,,,2652,2254.2,449,2652,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Picc Line Placement, Age 5 Or Older, Without Imaging Guidance",,36569,CPT,Facility,Both,,,,2652,2254.2,449,2652,Sanford Health Plan,Sanford Health Plan,2439.84,92,,percent of total billed charges,,
"Picc Line Placement, Age 5 Or Older, Without Imaging Guidance",,36569,CPT,Facility,Outpatient,,,,2652,2254.2,449,2652,"UCare Health, Inc.",Individual & Family Plan,1494.402,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Picc Line Placement, Age 5 Or Older, Without Imaging Guidance",,36569,CPT,Facility,Inpatient,,,,2652,2254.2,449,2652,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Picc Line Placement, Age 5 Or Older, Without Imaging Guidance",,36569,CPT,Facility,Outpatient,,,,2652,2254.2,449,2652,"UCare Health, Inc.",Medical Assistance,1338.4644,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Picc Line Placement, Age 5 Or Older, Without Imaging Guidance",,36569,CPT,Facility,Inpatient,,,,2652,2254.2,449,2652,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Picc Line Placement, Age 5 Or Older, Without Imaging Guidance",,36569,CPT,Facility,Outpatient,,,,2652,2254.2,449,2652,"UCare Health, Inc.",Medicare Advantage,1338.4644,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Picc Line Placement, Age 5 Or Older, Without Imaging Guidance",,36569,CPT,Facility,Inpatient,,,,2652,2254.2,449,2652,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Picc Line Placement, Age 5 Or Older, Without Imaging Guidance",,36569,CPT,Facility,Outpatient,,,,2652,2254.2,449,2652,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1338.4644,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Picc Line Placement, Age 5 Or Older, Without Imaging Guidance",,36569,CPT,Facility,Inpatient,,,,2652,2254.2,449,2652,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Picc Line Placement, Age 5 Or Older, Without Imaging Guidance",,36569,CPT,Facility,Both,,,,2652,2254.2,449,2652,UnitedHealthcare,Individual & Family,2492.88,94,,percent of total billed charges,,
"Picc Line Placement, Age 5 Or Older, Without Imaging Guidance",,36569,CPT,Facility,Outpatient,,,,2652,2254.2,449,2652,UnitedHealthcare,Medicare Advantage,1299.48,49,,percent of total billed charges,,
"Picc Line Placement, Age 5 Or Older, Without Imaging Guidance",,36569,CPT,Facility,Inpatient,,,,2652,2254.2,449,2652,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Picc Line Placement, Age 5 Or Older, Without Imaging Guidance",,36569,CPT,Facility,Outpatient,,,,2652,2254.2,449,2652,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1272.96,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Picc Line Placement, Age 5 Or Older, Without Imaging Guidance",,36569,CPT,Facility,Inpatient,,,,2652,2254.2,449,2652,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Insertion Peripherally Inserted Central Venous Access Device, W Subq Port;Age 5 Yrs Or Older (Pro Cah)",,36571,CPT,Professional,Both,,,,1530,1300.5,187.83,1530,Aetna,Commercial,1300.5,85,,percent of total billed charges,,
"Insertion Peripherally Inserted Central Venous Access Device, W Subq Port;Age 5 Yrs Or Older (Pro Cah)",,36571,CPT,Professional,Both,,,,1530,1300.5,187.83,1530,Aetna,Medicare Advantage,299.73,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Insertion Peripherally Inserted Central Venous Access Device, W Subq Port;Age 5 Yrs Or Older (Pro Cah)",,36571,CPT,Professional,Both,,,,1530,1300.5,187.83,1530,Aetna,PPO,1422.9,93,,percent of total billed charges,,
"Insertion Peripherally Inserted Central Venous Access Device, W Subq Port;Age 5 Yrs Or Older (Pro Cah)",,36571,CPT,Professional,Both,,,,1530,1300.5,187.83,1530,America's PPO,America's PPO,1307.232,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Insertion Peripherally Inserted Central Venous Access Device, W Subq Port;Age 5 Yrs Or Older (Pro Cah)",,36571,CPT,Professional,Both,,,,1530,1300.5,187.83,1530,BlueCross BlueShield Minnesota, Federal Employee Program,636.27,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Insertion Peripherally Inserted Central Venous Access Device, W Subq Port;Age 5 Yrs Or Older (Pro Cah)",,36571,CPT,Professional,Both,,,,1530,1300.5,187.83,1530,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,646.45032,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Insertion Peripherally Inserted Central Venous Access Device, W Subq Port;Age 5 Yrs Or Older (Pro Cah)",,36571,CPT,Professional,Both,,,,1530,1300.5,187.83,1530,BlueCross BlueShield Minnesota,High Value Network Plan,646.45032,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Insertion Peripherally Inserted Central Venous Access Device, W Subq Port;Age 5 Yrs Or Older (Pro Cah)",,36571,CPT,Professional,Both,,,,1530,1300.5,187.83,1530,BlueCross BlueShield Minnesota,Medicare Advantage,335.616,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Insertion Peripherally Inserted Central Venous Access Device, W Subq Port;Age 5 Yrs Or Older (Pro Cah)",,36571,CPT,Professional,Both,,,,1530,1300.5,187.83,1530,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,646.45032,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Insertion Peripherally Inserted Central Venous Access Device, W Subq Port;Age 5 Yrs Or Older (Pro Cah)",,36571,CPT,Professional,Both,,,,1530,1300.5,187.83,1530,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,216.85504,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Insertion Peripherally Inserted Central Venous Access Device, W Subq Port;Age 5 Yrs Or Older (Pro Cah)",,36571,CPT,Professional,Both,,,,1530,1300.5,187.83,1530,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),335.616,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Insertion Peripherally Inserted Central Venous Access Device, W Subq Port;Age 5 Yrs Or Older (Pro Cah)",,36571,CPT,Professional,Both,,,,1530,1300.5,187.83,1530,CorVel,Worker's Compensation,580.8599637,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Insertion Peripherally Inserted Central Venous Access Device, W Subq Port;Age 5 Yrs Or Older (Pro Cah)",,36571,CPT,Professional,Both,,,,1530,1300.5,187.83,1530,First Health Group Corporation,First Health Network,1484.1,97,,percent of total billed charges,,
"Insertion Peripherally Inserted Central Venous Access Device, W Subq Port;Age 5 Yrs Or Older (Pro Cah)",,36571,CPT,Professional,Both,,,,1530,1300.5,187.83,1530,"Health Partners, Inc.",Commercial,627.58,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Insertion Peripherally Inserted Central Venous Access Device, W Subq Port;Age 5 Yrs Or Older (Pro Cah)",,36571,CPT,Professional,Both,,,,1530,1300.5,187.83,1530,"Health Partners, Inc.",Medicare Advantage,335.616,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Insertion Peripherally Inserted Central Venous Access Device, W Subq Port;Age 5 Yrs Or Older (Pro Cah)",,36571,CPT,Professional,Both,,,,1530,1300.5,187.83,1530,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),291.77,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Insertion Peripherally Inserted Central Venous Access Device, W Subq Port;Age 5 Yrs Or Older (Pro Cah)",,36571,CPT,Professional,Both,,,,1530,1300.5,187.83,1530,"Health Partners, Inc.",State of Minnesota Advantage Program,540.66017,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Insertion Peripherally Inserted Central Venous Access Device, W Subq Port;Age 5 Yrs Or Older (Pro Cah)",,36571,CPT,Professional,Both,,,,1530,1300.5,187.83,1530,"Health Partners, Inc.",State Public Programs,187.83,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Insertion Peripherally Inserted Central Venous Access Device, W Subq Port;Age 5 Yrs Or Older (Pro Cah)",,36571,CPT,Professional,Both,,,,1530,1300.5,187.83,1530,Humana Insurance Company,Commercial PPO,291.84,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Insertion Peripherally Inserted Central Venous Access Device, W Subq Port;Age 5 Yrs Or Older (Pro Cah)",,36571,CPT,Professional,Both,,,,1530,1300.5,187.83,1530,Humana Insurance Company,Medicare PPO,1530,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Insertion Peripherally Inserted Central Venous Access Device, W Subq Port;Age 5 Yrs Or Older (Pro Cah)",,36571,CPT,Professional,Both,,,,1530,1300.5,187.83,1530,Medica,Individual & Family,1297.44,84.8,,percent of total billed charges,,
"Insertion Peripherally Inserted Central Venous Access Device, W Subq Port;Age 5 Yrs Or Older (Pro Cah)",,36571,CPT,Professional,Both,,,,1530,1300.5,187.83,1530,Medica,Medica Advantage Solution,761.94,49.8,,percent of total billed charges,,
"Insertion Peripherally Inserted Central Venous Access Device, W Subq Port;Age 5 Yrs Or Older (Pro Cah)",,36571,CPT,Professional,Both,,,,1530,1300.5,187.83,1530,Medica,Medical Assistance,216.86,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Insertion Peripherally Inserted Central Venous Access Device, W Subq Port;Age 5 Yrs Or Older (Pro Cah)",,36571,CPT,Professional,Both,,,,1530,1300.5,187.83,1530,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,291.84,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Insertion Peripherally Inserted Central Venous Access Device, W Subq Port;Age 5 Yrs Or Older (Pro Cah)",,36571,CPT,Professional,Both,,,,1530,1300.5,187.83,1530,"Multiplan, Inc.","Multiplan, Inc.",1438.2,94,,percent of total billed charges,,
"Insertion Peripherally Inserted Central Venous Access Device, W Subq Port;Age 5 Yrs Or Older (Pro Cah)",,36571,CPT,Professional,Both,,,,1530,1300.5,187.83,1530,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1378.53,90.1,,percent of total billed charges,,
"Insertion Peripherally Inserted Central Venous Access Device, W Subq Port;Age 5 Yrs Or Older (Pro Cah)",,36571,CPT,Professional,Both,,,,1530,1300.5,187.83,1530,"Preferred One Administrative Services, INC.",PPO,1508.58,98.6,,percent of total billed charges,,
"Insertion Peripherally Inserted Central Venous Access Device, W Subq Port;Age 5 Yrs Or Older (Pro Cah)",,36571,CPT,Professional,Both,,,,1530,1300.5,187.83,1530,PrimeWest Health,Minnesota Senior Health Options (MSHO),335.616,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Insertion Peripherally Inserted Central Venous Access Device, W Subq Port;Age 5 Yrs Or Older (Pro Cah)",,36571,CPT,Professional,Both,,,,1530,1300.5,187.83,1530,PrimeWest Health,MinnesotaCare,232.0348928,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Insertion Peripherally Inserted Central Venous Access Device, W Subq Port;Age 5 Yrs Or Older (Pro Cah)",,36571,CPT,Professional,Both,,,,1530,1300.5,187.83,1530,Sanford Health Plan,Sanford Health Plan,1346.4,88,,percent of total billed charges,,
"Insertion Peripherally Inserted Central Venous Access Device, W Subq Port;Age 5 Yrs Or Older (Pro Cah)",,36571,CPT,Professional,Both,,,,1530,1300.5,187.83,1530,"UCare Health, Inc.",Individual & Family Plan,474.415104,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Insertion Peripherally Inserted Central Venous Access Device, W Subq Port;Age 5 Yrs Or Older (Pro Cah)",,36571,CPT,Professional,Both,,,,1530,1300.5,187.83,1530,"UCare Health, Inc.",Medical Assistance,238.540544,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Insertion Peripherally Inserted Central Venous Access Device, W Subq Port;Age 5 Yrs Or Older (Pro Cah)",,36571,CPT,Professional,Both,,,,1530,1300.5,187.83,1530,"UCare Health, Inc.",Medicare Advantage,335.616,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Insertion Peripherally Inserted Central Venous Access Device, W Subq Port;Age 5 Yrs Or Older (Pro Cah)",,36571,CPT,Professional,Both,,,,1530,1300.5,187.83,1530,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),268.4928,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Insertion Peripherally Inserted Central Venous Access Device, W Subq Port;Age 5 Yrs Or Older (Pro Cah)",,36571,CPT,Professional,Both,,,,1530,1300.5,187.83,1530,UnitedHealthcare,Individual & Family,1530,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Insertion Peripherally Inserted Central Venous Access Device, W Subq Port;Age 5 Yrs Or Older (Pro Cah)",,36571,CPT,Professional,Both,,,,1530,1300.5,187.83,1530,UnitedHealthcare,Medicare Advantage,335.616,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Insertion Peripherally Inserted Central Venous Access Device, W Subq Port;Age 5 Yrs Or Older (Pro Cah)",,36571,CPT,Professional,Both,,,,1530,1300.5,187.83,1530,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,216.85504,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Insert Picc W/O Subq Port Or Pump, Incl All Imaging Guidance Age 5 Years And Older",,36573,CPT,Facility,Both,,,,2162,1837.7,619.6292,2162,Aetna,Commercial,1989.04,92,,percent of total billed charges,,
"Insert Picc W/O Subq Port Or Pump, Incl All Imaging Guidance Age 5 Years And Older",,36573,CPT,Facility,Outpatient,,,,2162,1837.7,619.6292,2162,Aetna,Medicare Advantage,1059.38,49,,percent of total billed charges,,
"Insert Picc W/O Subq Port Or Pump, Incl All Imaging Guidance Age 5 Years And Older",,36573,CPT,Facility,Inpatient,,,,2162,1837.7,619.6292,2162,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Insert Picc W/O Subq Port Or Pump, Incl All Imaging Guidance Age 5 Years And Older",,36573,CPT,Facility,Both,,,,2162,1837.7,619.6292,2162,Aetna,PPO,2010.66,93,,percent of total billed charges,,
"Insert Picc W/O Subq Port Or Pump, Incl All Imaging Guidance Age 5 Years And Older",,36573,CPT,Facility,Both,,,,2162,1837.7,619.6292,2162,America's PPO,America's PPO,2076.1686,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Insert Picc W/O Subq Port Or Pump, Incl All Imaging Guidance Age 5 Years And Older",,36573,CPT,Facility,Both,,,,2162,1837.7,619.6292,2162,BlueCross BlueShield Minnesota, Federal Employee Program,2127.408,98.4,,percent of total billed charges,,
"Insert Picc W/O Subq Port Or Pump, Incl All Imaging Guidance Age 5 Years And Older",,36573,CPT,Facility,Both,,,,2162,1837.7,619.6292,2162,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,2162,100,,percent of total billed charges,,
"Insert Picc W/O Subq Port Or Pump, Incl All Imaging Guidance Age 5 Years And Older",,36573,CPT,Facility,Both,,,,2162,1837.7,619.6292,2162,BlueCross BlueShield Minnesota,High Value Network Plan,1945.8,90,,percent of total billed charges,,
"Insert Picc W/O Subq Port Or Pump, Incl All Imaging Guidance Age 5 Years And Older",,36573,CPT,Facility,Outpatient,,,,2162,1837.7,619.6292,2162,BlueCross BlueShield Minnesota,Medicare Advantage,1059.38,49,,percent of total billed charges,,
"Insert Picc W/O Subq Port Or Pump, Incl All Imaging Guidance Age 5 Years And Older",,36573,CPT,Facility,Inpatient,,,,2162,1837.7,619.6292,2162,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Insert Picc W/O Subq Port Or Pump, Incl All Imaging Guidance Age 5 Years And Older",,36573,CPT,Facility,Both,,,,2162,1837.7,619.6292,2162,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1914.8834,88.57,,percent of total billed charges,,
"Insert Picc W/O Subq Port Or Pump, Incl All Imaging Guidance Age 5 Years And Older",,36573,CPT,Facility,Both,,,,2162,1837.7,619.6292,2162,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,619.6292,28.66,,percent of total billed charges,,
"Insert Picc W/O Subq Port Or Pump, Incl All Imaging Guidance Age 5 Years And Older",,36573,CPT,Facility,Outpatient,,,,2162,1837.7,619.6292,2162,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1059.38,49,,percent of total billed charges,,
"Insert Picc W/O Subq Port Or Pump, Incl All Imaging Guidance Age 5 Years And Older",,36573,CPT,Facility,Inpatient,,,,2162,1837.7,619.6292,2162,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Insert Picc W/O Subq Port Or Pump, Incl All Imaging Guidance Age 5 Years And Older",,36573,CPT,Facility,Both,,,,2162,1837.7,619.6292,2162,CorVel,Worker's Compensation,2162,100,,percent of total billed charges,,
"Insert Picc W/O Subq Port Or Pump, Incl All Imaging Guidance Age 5 Years And Older",,36573,CPT,Facility,Both,,,,2162,1837.7,619.6292,2162,First Health Group Corporation,First Health Network,2097.14,97,,percent of total billed charges,,
"Insert Picc W/O Subq Port Or Pump, Incl All Imaging Guidance Age 5 Years And Older",,36573,CPT,Facility,Both,,,,2162,1837.7,619.6292,2162,"Health Partners, Inc.",Commercial,2045.252,94.6,,percent of total billed charges,,
"Insert Picc W/O Subq Port Or Pump, Incl All Imaging Guidance Age 5 Years And Older",,36573,CPT,Facility,Outpatient,,,,2162,1837.7,619.6292,2162,"Health Partners, Inc.",Medicare Advantage,1059.38,49,,percent of total billed charges,,
"Insert Picc W/O Subq Port Or Pump, Incl All Imaging Guidance Age 5 Years And Older",,36573,CPT,Facility,Inpatient,,,,2162,1837.7,619.6292,2162,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Insert Picc W/O Subq Port Or Pump, Incl All Imaging Guidance Age 5 Years And Older",,36573,CPT,Facility,Both,,,,2162,1837.7,619.6292,2162,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1297.2,60,,percent of total billed charges,,
"Insert Picc W/O Subq Port Or Pump, Incl All Imaging Guidance Age 5 Years And Older",,36573,CPT,Facility,Both,,,,2162,1837.7,619.6292,2162,"Health Partners, Inc.",State of Minnesota Advantage Program,1762.03,81.5,,percent of total billed charges,,
"Insert Picc W/O Subq Port Or Pump, Incl All Imaging Guidance Age 5 Years And Older",,36573,CPT,Facility,Both,,,,2162,1837.7,619.6292,2162,"Health Partners, Inc.",State Public Programs,1081,50,,percent of total billed charges,,
"Insert Picc W/O Subq Port Or Pump, Incl All Imaging Guidance Age 5 Years And Older",,36573,CPT,Facility,Both,,,,2162,1837.7,619.6292,2162,Humana Insurance Company,Commercial PPO,2053.9,95,,percent of total billed charges,,
"Insert Picc W/O Subq Port Or Pump, Incl All Imaging Guidance Age 5 Years And Older",,36573,CPT,Facility,Outpatient,,,,2162,1837.7,619.6292,2162,Humana Insurance Company,Medicare PPO,1059.38,49,,percent of total billed charges,,
"Insert Picc W/O Subq Port Or Pump, Incl All Imaging Guidance Age 5 Years And Older",,36573,CPT,Facility,Inpatient,,,,2162,1837.7,619.6292,2162,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Insert Picc W/O Subq Port Or Pump, Incl All Imaging Guidance Age 5 Years And Older",,36573,CPT,Facility,Both,,,,2162,1837.7,619.6292,2162,Medica,Individual & Family,2142.542,99.1,,percent of total billed charges,,
"Insert Picc W/O Subq Port Or Pump, Incl All Imaging Guidance Age 5 Years And Older",,36573,CPT,Facility,Outpatient,,,,2162,1837.7,619.6292,2162,Medica,Medica Advantage Solution,1076.676,49.8,,percent of total billed charges,,
"Insert Picc W/O Subq Port Or Pump, Incl All Imaging Guidance Age 5 Years And Older",,36573,CPT,Facility,Inpatient,,,,2162,1837.7,619.6292,2162,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Insert Picc W/O Subq Port Or Pump, Incl All Imaging Guidance Age 5 Years And Older",,36573,CPT,Facility,Outpatient,,,,2162,1837.7,619.6292,2162,Medica,Medical Assistance,724,,,Other,Grouper,All inclusive per visit
"Insert Picc W/O Subq Port Or Pump, Incl All Imaging Guidance Age 5 Years And Older",,36573,CPT,Facility,Inpatient,,,,2162,1837.7,619.6292,2162,Medica,Medical Assistance,,,,,Included in per diem rate,
"Insert Picc W/O Subq Port Or Pump, Incl All Imaging Guidance Age 5 Years And Older",,36573,CPT,Facility,Outpatient,,,,2162,1837.7,619.6292,2162,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1076.676,49.8,,percent of total billed charges,,
"Insert Picc W/O Subq Port Or Pump, Incl All Imaging Guidance Age 5 Years And Older",,36573,CPT,Facility,Inpatient,,,,2162,1837.7,619.6292,2162,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Insert Picc W/O Subq Port Or Pump, Incl All Imaging Guidance Age 5 Years And Older",,36573,CPT,Facility,Both,,,,2162,1837.7,619.6292,2162,"Multiplan, Inc.","Multiplan, Inc.",2032.28,94,,percent of total billed charges,,
"Insert Picc W/O Subq Port Or Pump, Incl All Imaging Guidance Age 5 Years And Older",,36573,CPT,Facility,Outpatient,,,,2162,1837.7,619.6292,2162,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1947.962,90.1,,percent of total billed charges,,
"Insert Picc W/O Subq Port Or Pump, Incl All Imaging Guidance Age 5 Years And Older",,36573,CPT,Facility,Inpatient,,,,2162,1837.7,619.6292,2162,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Insert Picc W/O Subq Port Or Pump, Incl All Imaging Guidance Age 5 Years And Older",,36573,CPT,Facility,Both,,,,2162,1837.7,619.6292,2162,"Preferred One Administrative Services, INC.",PPO,2131.732,98.6,,percent of total billed charges,,
"Insert Picc W/O Subq Port Or Pump, Incl All Imaging Guidance Age 5 Years And Older",,36573,CPT,Facility,Outpatient,,,,2162,1837.7,619.6292,2162,PrimeWest Health,Minnesota Senior Health Options (MSHO),1112.349,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Insert Picc W/O Subq Port Or Pump, Incl All Imaging Guidance Age 5 Years And Older",,36573,CPT,Facility,Inpatient,,,,2162,1837.7,619.6292,2162,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Insert Picc W/O Subq Port Or Pump, Incl All Imaging Guidance Age 5 Years And Older",,36573,CPT,Facility,Outpatient,,,,2162,1837.7,619.6292,2162,PrimeWest Health,MinnesotaCare,1110.4032,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Insert Picc W/O Subq Port Or Pump, Incl All Imaging Guidance Age 5 Years And Older",,36573,CPT,Facility,Inpatient,,,,2162,1837.7,619.6292,2162,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Insert Picc W/O Subq Port Or Pump, Incl All Imaging Guidance Age 5 Years And Older",,36573,CPT,Facility,Both,,,,2162,1837.7,619.6292,2162,Sanford Health Plan,Sanford Health Plan,1989.04,92,,percent of total billed charges,,
"Insert Picc W/O Subq Port Or Pump, Incl All Imaging Guidance Age 5 Years And Older",,36573,CPT,Facility,Outpatient,,,,2162,1837.7,619.6292,2162,"UCare Health, Inc.",Individual & Family Plan,1218.287,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Insert Picc W/O Subq Port Or Pump, Incl All Imaging Guidance Age 5 Years And Older",,36573,CPT,Facility,Inpatient,,,,2162,1837.7,619.6292,2162,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Insert Picc W/O Subq Port Or Pump, Incl All Imaging Guidance Age 5 Years And Older",,36573,CPT,Facility,Outpatient,,,,2162,1837.7,619.6292,2162,"UCare Health, Inc.",Medical Assistance,1091.1614,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Insert Picc W/O Subq Port Or Pump, Incl All Imaging Guidance Age 5 Years And Older",,36573,CPT,Facility,Inpatient,,,,2162,1837.7,619.6292,2162,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Insert Picc W/O Subq Port Or Pump, Incl All Imaging Guidance Age 5 Years And Older",,36573,CPT,Facility,Outpatient,,,,2162,1837.7,619.6292,2162,"UCare Health, Inc.",Medicare Advantage,1091.1614,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Insert Picc W/O Subq Port Or Pump, Incl All Imaging Guidance Age 5 Years And Older",,36573,CPT,Facility,Inpatient,,,,2162,1837.7,619.6292,2162,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Insert Picc W/O Subq Port Or Pump, Incl All Imaging Guidance Age 5 Years And Older",,36573,CPT,Facility,Outpatient,,,,2162,1837.7,619.6292,2162,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1091.1614,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Insert Picc W/O Subq Port Or Pump, Incl All Imaging Guidance Age 5 Years And Older",,36573,CPT,Facility,Inpatient,,,,2162,1837.7,619.6292,2162,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Insert Picc W/O Subq Port Or Pump, Incl All Imaging Guidance Age 5 Years And Older",,36573,CPT,Facility,Both,,,,2162,1837.7,619.6292,2162,UnitedHealthcare,Individual & Family,2032.28,94,,percent of total billed charges,,
"Insert Picc W/O Subq Port Or Pump, Incl All Imaging Guidance Age 5 Years And Older",,36573,CPT,Facility,Outpatient,,,,2162,1837.7,619.6292,2162,UnitedHealthcare,Medicare Advantage,1059.38,49,,percent of total billed charges,,
"Insert Picc W/O Subq Port Or Pump, Incl All Imaging Guidance Age 5 Years And Older",,36573,CPT,Facility,Inpatient,,,,2162,1837.7,619.6292,2162,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Insert Picc W/O Subq Port Or Pump, Incl All Imaging Guidance Age 5 Years And Older",,36573,CPT,Facility,Outpatient,,,,2162,1837.7,619.6292,2162,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1037.76,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Insert Picc W/O Subq Port Or Pump, Incl All Imaging Guidance Age 5 Years And Older",,36573,CPT,Facility,Inpatient,,,,2162,1837.7,619.6292,2162,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Draw Fee Porta Cath,,36591,CPT,Facility,Both,,,,87,73.95,24.9342,87,Aetna,Commercial,80.04,92,,percent of total billed charges,,
Draw Fee Porta Cath,,36591,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,Aetna,Medicare Advantage,42.63,49,,percent of total billed charges,,
Draw Fee Porta Cath,,36591,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Draw Fee Porta Cath,,36591,CPT,Facility,Both,,,,87,73.95,24.9342,87,Aetna,PPO,80.91,93,,percent of total billed charges,,
Draw Fee Porta Cath,,36591,CPT,Facility,Both,,,,87,73.95,24.9342,87,America's PPO,America's PPO,83.5461,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Draw Fee Porta Cath,,36591,CPT,Facility,Both,,,,87,73.95,24.9342,87,BlueCross BlueShield Minnesota, Federal Employee Program,85.608,98.4,,percent of total billed charges,,
Draw Fee Porta Cath,,36591,CPT,Facility,Both,,,,87,73.95,24.9342,87,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,87,100,,percent of total billed charges,,
Draw Fee Porta Cath,,36591,CPT,Facility,Both,,,,87,73.95,24.9342,87,BlueCross BlueShield Minnesota,High Value Network Plan,78.3,90,,percent of total billed charges,,
Draw Fee Porta Cath,,36591,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,BlueCross BlueShield Minnesota,Medicare Advantage,42.63,49,,percent of total billed charges,,
Draw Fee Porta Cath,,36591,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Draw Fee Porta Cath,,36591,CPT,Facility,Both,,,,87,73.95,24.9342,87,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,77.0559,88.57,,percent of total billed charges,,
Draw Fee Porta Cath,,36591,CPT,Facility,Both,,,,87,73.95,24.9342,87,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,24.9342,28.66,,percent of total billed charges,,
Draw Fee Porta Cath,,36591,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),42.63,49,,percent of total billed charges,,
Draw Fee Porta Cath,,36591,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Draw Fee Porta Cath,,36591,CPT,Facility,Both,,,,87,73.95,24.9342,87,CorVel,Worker's Compensation,87,100,,percent of total billed charges,,
Draw Fee Porta Cath,,36591,CPT,Facility,Both,,,,87,73.95,24.9342,87,First Health Group Corporation,First Health Network,84.39,97,,percent of total billed charges,,
Draw Fee Porta Cath,,36591,CPT,Facility,Both,,,,87,73.95,24.9342,87,"Health Partners, Inc.",Commercial,82.302,94.6,,percent of total billed charges,,
Draw Fee Porta Cath,,36591,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,"Health Partners, Inc.",Medicare Advantage,42.63,49,,percent of total billed charges,,
Draw Fee Porta Cath,,36591,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Draw Fee Porta Cath,,36591,CPT,Facility,Both,,,,87,73.95,24.9342,87,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),52.2,60,,percent of total billed charges,,
Draw Fee Porta Cath,,36591,CPT,Facility,Both,,,,87,73.95,24.9342,87,"Health Partners, Inc.",State of Minnesota Advantage Program,70.905,81.5,,percent of total billed charges,,
Draw Fee Porta Cath,,36591,CPT,Facility,Both,,,,87,73.95,24.9342,87,"Health Partners, Inc.",State Public Programs,43.5,50,,percent of total billed charges,,
Draw Fee Porta Cath,,36591,CPT,Facility,Both,,,,87,73.95,24.9342,87,Humana Insurance Company,Commercial PPO,82.65,95,,percent of total billed charges,,
Draw Fee Porta Cath,,36591,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,Humana Insurance Company,Medicare PPO,42.63,49,,percent of total billed charges,,
Draw Fee Porta Cath,,36591,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Draw Fee Porta Cath,,36591,CPT,Facility,Both,,,,87,73.95,24.9342,87,Medica,Individual & Family,86.217,99.1,,percent of total billed charges,,
Draw Fee Porta Cath,,36591,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,Medica,Medica Advantage Solution,43.326,49.8,,percent of total billed charges,,
Draw Fee Porta Cath,,36591,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Draw Fee Porta Cath,,36591,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,Medica,Medical Assistance,38.802,44.6,,percent of total billed charges,,
Draw Fee Porta Cath,,36591,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,Medica,Medical Assistance,,,,,Included in per diem rate,
Draw Fee Porta Cath,,36591,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,43.326,49.8,,percent of total billed charges,,
Draw Fee Porta Cath,,36591,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Draw Fee Porta Cath,,36591,CPT,Facility,Both,,,,87,73.95,24.9342,87,"Multiplan, Inc.","Multiplan, Inc.",81.78,94,,percent of total billed charges,,
Draw Fee Porta Cath,,36591,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,75.168,86.4,,percent of total billed charges,,
Draw Fee Porta Cath,,36591,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Draw Fee Porta Cath,,36591,CPT,Facility,Both,,,,87,73.95,24.9342,87,"Preferred One Administrative Services, INC.",PPO,85.782,98.6,,percent of total billed charges,,
Draw Fee Porta Cath,,36591,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,PrimeWest Health,Minnesota Senior Health Options (MSHO),44.7615,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Draw Fee Porta Cath,,36591,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Draw Fee Porta Cath,,36591,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,PrimeWest Health,MinnesotaCare,44.6832,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Draw Fee Porta Cath,,36591,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Draw Fee Porta Cath,,36591,CPT,Facility,Both,,,,87,73.95,24.9342,87,Sanford Health Plan,Sanford Health Plan,80.04,92,,percent of total billed charges,,
Draw Fee Porta Cath,,36591,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,"UCare Health, Inc.",Individual & Family Plan,49.0245,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Draw Fee Porta Cath,,36591,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Draw Fee Porta Cath,,36591,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,"UCare Health, Inc.",Medical Assistance,43.9089,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Draw Fee Porta Cath,,36591,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Draw Fee Porta Cath,,36591,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,"UCare Health, Inc.",Medicare Advantage,43.9089,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Draw Fee Porta Cath,,36591,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Draw Fee Porta Cath,,36591,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),43.9089,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Draw Fee Porta Cath,,36591,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Draw Fee Porta Cath,,36591,CPT,Facility,Both,,,,87,73.95,24.9342,87,UnitedHealthcare,Individual & Family,81.78,94,,percent of total billed charges,,
Draw Fee Porta Cath,,36591,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,UnitedHealthcare,Medicare Advantage,42.63,49,,percent of total billed charges,,
Draw Fee Porta Cath,,36591,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Draw Fee Porta Cath,,36591,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,41.76,48,,percent of total billed charges,,100% of DHS outpatient percentage
Draw Fee Porta Cath,,36591,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Implantable Venous Access Blood Draw,,36591,CPT,Facility,Both,,,,87,73.95,24.9342,87,Aetna,Commercial,80.04,92,,percent of total billed charges,,
Implantable Venous Access Blood Draw,,36591,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,Aetna,Medicare Advantage,42.63,49,,percent of total billed charges,,
Implantable Venous Access Blood Draw,,36591,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Implantable Venous Access Blood Draw,,36591,CPT,Facility,Both,,,,87,73.95,24.9342,87,Aetna,PPO,80.91,93,,percent of total billed charges,,
Implantable Venous Access Blood Draw,,36591,CPT,Facility,Both,,,,87,73.95,24.9342,87,America's PPO,America's PPO,83.5461,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Implantable Venous Access Blood Draw,,36591,CPT,Facility,Both,,,,87,73.95,24.9342,87,BlueCross BlueShield Minnesota, Federal Employee Program,85.608,98.4,,percent of total billed charges,,
Implantable Venous Access Blood Draw,,36591,CPT,Facility,Both,,,,87,73.95,24.9342,87,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,87,100,,percent of total billed charges,,
Implantable Venous Access Blood Draw,,36591,CPT,Facility,Both,,,,87,73.95,24.9342,87,BlueCross BlueShield Minnesota,High Value Network Plan,78.3,90,,percent of total billed charges,,
Implantable Venous Access Blood Draw,,36591,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,BlueCross BlueShield Minnesota,Medicare Advantage,42.63,49,,percent of total billed charges,,
Implantable Venous Access Blood Draw,,36591,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Implantable Venous Access Blood Draw,,36591,CPT,Facility,Both,,,,87,73.95,24.9342,87,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,77.0559,88.57,,percent of total billed charges,,
Implantable Venous Access Blood Draw,,36591,CPT,Facility,Both,,,,87,73.95,24.9342,87,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,24.9342,28.66,,percent of total billed charges,,
Implantable Venous Access Blood Draw,,36591,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),42.63,49,,percent of total billed charges,,
Implantable Venous Access Blood Draw,,36591,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Implantable Venous Access Blood Draw,,36591,CPT,Facility,Both,,,,87,73.95,24.9342,87,CorVel,Worker's Compensation,87,100,,percent of total billed charges,,
Implantable Venous Access Blood Draw,,36591,CPT,Facility,Both,,,,87,73.95,24.9342,87,First Health Group Corporation,First Health Network,84.39,97,,percent of total billed charges,,
Implantable Venous Access Blood Draw,,36591,CPT,Facility,Both,,,,87,73.95,24.9342,87,"Health Partners, Inc.",Commercial,82.302,94.6,,percent of total billed charges,,
Implantable Venous Access Blood Draw,,36591,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,"Health Partners, Inc.",Medicare Advantage,42.63,49,,percent of total billed charges,,
Implantable Venous Access Blood Draw,,36591,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Implantable Venous Access Blood Draw,,36591,CPT,Facility,Both,,,,87,73.95,24.9342,87,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),52.2,60,,percent of total billed charges,,
Implantable Venous Access Blood Draw,,36591,CPT,Facility,Both,,,,87,73.95,24.9342,87,"Health Partners, Inc.",State of Minnesota Advantage Program,70.905,81.5,,percent of total billed charges,,
Implantable Venous Access Blood Draw,,36591,CPT,Facility,Both,,,,87,73.95,24.9342,87,"Health Partners, Inc.",State Public Programs,43.5,50,,percent of total billed charges,,
Implantable Venous Access Blood Draw,,36591,CPT,Facility,Both,,,,87,73.95,24.9342,87,Humana Insurance Company,Commercial PPO,82.65,95,,percent of total billed charges,,
Implantable Venous Access Blood Draw,,36591,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,Humana Insurance Company,Medicare PPO,42.63,49,,percent of total billed charges,,
Implantable Venous Access Blood Draw,,36591,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Implantable Venous Access Blood Draw,,36591,CPT,Facility,Both,,,,87,73.95,24.9342,87,Medica,Individual & Family,86.217,99.1,,percent of total billed charges,,
Implantable Venous Access Blood Draw,,36591,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,Medica,Medica Advantage Solution,43.326,49.8,,percent of total billed charges,,
Implantable Venous Access Blood Draw,,36591,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Implantable Venous Access Blood Draw,,36591,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,Medica,Medical Assistance,38.802,44.6,,percent of total billed charges,,
Implantable Venous Access Blood Draw,,36591,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,Medica,Medical Assistance,,,,,Included in per diem rate,
Implantable Venous Access Blood Draw,,36591,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,43.326,49.8,,percent of total billed charges,,
Implantable Venous Access Blood Draw,,36591,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Implantable Venous Access Blood Draw,,36591,CPT,Facility,Both,,,,87,73.95,24.9342,87,"Multiplan, Inc.","Multiplan, Inc.",81.78,94,,percent of total billed charges,,
Implantable Venous Access Blood Draw,,36591,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,75.168,86.4,,percent of total billed charges,,
Implantable Venous Access Blood Draw,,36591,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Implantable Venous Access Blood Draw,,36591,CPT,Facility,Both,,,,87,73.95,24.9342,87,"Preferred One Administrative Services, INC.",PPO,85.782,98.6,,percent of total billed charges,,
Implantable Venous Access Blood Draw,,36591,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,PrimeWest Health,Minnesota Senior Health Options (MSHO),44.7615,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Implantable Venous Access Blood Draw,,36591,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Implantable Venous Access Blood Draw,,36591,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,PrimeWest Health,MinnesotaCare,44.6832,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Implantable Venous Access Blood Draw,,36591,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Implantable Venous Access Blood Draw,,36591,CPT,Facility,Both,,,,87,73.95,24.9342,87,Sanford Health Plan,Sanford Health Plan,80.04,92,,percent of total billed charges,,
Implantable Venous Access Blood Draw,,36591,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,"UCare Health, Inc.",Individual & Family Plan,49.0245,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Implantable Venous Access Blood Draw,,36591,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Implantable Venous Access Blood Draw,,36591,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,"UCare Health, Inc.",Medical Assistance,43.9089,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Implantable Venous Access Blood Draw,,36591,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Implantable Venous Access Blood Draw,,36591,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,"UCare Health, Inc.",Medicare Advantage,43.9089,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Implantable Venous Access Blood Draw,,36591,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Implantable Venous Access Blood Draw,,36591,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),43.9089,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Implantable Venous Access Blood Draw,,36591,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Implantable Venous Access Blood Draw,,36591,CPT,Facility,Both,,,,87,73.95,24.9342,87,UnitedHealthcare,Individual & Family,81.78,94,,percent of total billed charges,,
Implantable Venous Access Blood Draw,,36591,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,UnitedHealthcare,Medicare Advantage,42.63,49,,percent of total billed charges,,
Implantable Venous Access Blood Draw,,36591,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Implantable Venous Access Blood Draw,,36591,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,41.76,48,,percent of total billed charges,,100% of DHS outpatient percentage
Implantable Venous Access Blood Draw,,36591,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Draw Fee Picc,,36592,CPT,Facility,Both,,,,87,73.95,24.9342,87,Aetna,Commercial,80.04,92,,percent of total billed charges,,
Draw Fee Picc,,36592,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,Aetna,Medicare Advantage,42.63,49,,percent of total billed charges,,
Draw Fee Picc,,36592,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Draw Fee Picc,,36592,CPT,Facility,Both,,,,87,73.95,24.9342,87,Aetna,PPO,80.91,93,,percent of total billed charges,,
Draw Fee Picc,,36592,CPT,Facility,Both,,,,87,73.95,24.9342,87,America's PPO,America's PPO,83.5461,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Draw Fee Picc,,36592,CPT,Facility,Both,,,,87,73.95,24.9342,87,BlueCross BlueShield Minnesota, Federal Employee Program,85.608,98.4,,percent of total billed charges,,
Draw Fee Picc,,36592,CPT,Facility,Both,,,,87,73.95,24.9342,87,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,87,100,,percent of total billed charges,,
Draw Fee Picc,,36592,CPT,Facility,Both,,,,87,73.95,24.9342,87,BlueCross BlueShield Minnesota,High Value Network Plan,78.3,90,,percent of total billed charges,,
Draw Fee Picc,,36592,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,BlueCross BlueShield Minnesota,Medicare Advantage,42.63,49,,percent of total billed charges,,
Draw Fee Picc,,36592,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Draw Fee Picc,,36592,CPT,Facility,Both,,,,87,73.95,24.9342,87,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,77.0559,88.57,,percent of total billed charges,,
Draw Fee Picc,,36592,CPT,Facility,Both,,,,87,73.95,24.9342,87,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,24.9342,28.66,,percent of total billed charges,,
Draw Fee Picc,,36592,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),42.63,49,,percent of total billed charges,,
Draw Fee Picc,,36592,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Draw Fee Picc,,36592,CPT,Facility,Both,,,,87,73.95,24.9342,87,CorVel,Worker's Compensation,87,100,,percent of total billed charges,,
Draw Fee Picc,,36592,CPT,Facility,Both,,,,87,73.95,24.9342,87,First Health Group Corporation,First Health Network,84.39,97,,percent of total billed charges,,
Draw Fee Picc,,36592,CPT,Facility,Both,,,,87,73.95,24.9342,87,"Health Partners, Inc.",Commercial,82.302,94.6,,percent of total billed charges,,
Draw Fee Picc,,36592,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,"Health Partners, Inc.",Medicare Advantage,42.63,49,,percent of total billed charges,,
Draw Fee Picc,,36592,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Draw Fee Picc,,36592,CPT,Facility,Both,,,,87,73.95,24.9342,87,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),52.2,60,,percent of total billed charges,,
Draw Fee Picc,,36592,CPT,Facility,Both,,,,87,73.95,24.9342,87,"Health Partners, Inc.",State of Minnesota Advantage Program,70.905,81.5,,percent of total billed charges,,
Draw Fee Picc,,36592,CPT,Facility,Both,,,,87,73.95,24.9342,87,"Health Partners, Inc.",State Public Programs,43.5,50,,percent of total billed charges,,
Draw Fee Picc,,36592,CPT,Facility,Both,,,,87,73.95,24.9342,87,Humana Insurance Company,Commercial PPO,82.65,95,,percent of total billed charges,,
Draw Fee Picc,,36592,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,Humana Insurance Company,Medicare PPO,42.63,49,,percent of total billed charges,,
Draw Fee Picc,,36592,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Draw Fee Picc,,36592,CPT,Facility,Both,,,,87,73.95,24.9342,87,Medica,Individual & Family,86.217,99.1,,percent of total billed charges,,
Draw Fee Picc,,36592,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,Medica,Medica Advantage Solution,43.326,49.8,,percent of total billed charges,,
Draw Fee Picc,,36592,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Draw Fee Picc,,36592,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,Medica,Medical Assistance,38.802,44.6,,percent of total billed charges,,
Draw Fee Picc,,36592,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,Medica,Medical Assistance,,,,,Included in per diem rate,
Draw Fee Picc,,36592,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,43.326,49.8,,percent of total billed charges,,
Draw Fee Picc,,36592,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Draw Fee Picc,,36592,CPT,Facility,Both,,,,87,73.95,24.9342,87,"Multiplan, Inc.","Multiplan, Inc.",81.78,94,,percent of total billed charges,,
Draw Fee Picc,,36592,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,75.168,86.4,,percent of total billed charges,,
Draw Fee Picc,,36592,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Draw Fee Picc,,36592,CPT,Facility,Both,,,,87,73.95,24.9342,87,"Preferred One Administrative Services, INC.",PPO,85.782,98.6,,percent of total billed charges,,
Draw Fee Picc,,36592,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,PrimeWest Health,Minnesota Senior Health Options (MSHO),44.7615,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Draw Fee Picc,,36592,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Draw Fee Picc,,36592,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,PrimeWest Health,MinnesotaCare,44.6832,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Draw Fee Picc,,36592,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Draw Fee Picc,,36592,CPT,Facility,Both,,,,87,73.95,24.9342,87,Sanford Health Plan,Sanford Health Plan,80.04,92,,percent of total billed charges,,
Draw Fee Picc,,36592,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,"UCare Health, Inc.",Individual & Family Plan,49.0245,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Draw Fee Picc,,36592,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Draw Fee Picc,,36592,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,"UCare Health, Inc.",Medical Assistance,43.9089,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Draw Fee Picc,,36592,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Draw Fee Picc,,36592,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,"UCare Health, Inc.",Medicare Advantage,43.9089,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Draw Fee Picc,,36592,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Draw Fee Picc,,36592,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),43.9089,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Draw Fee Picc,,36592,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Draw Fee Picc,,36592,CPT,Facility,Both,,,,87,73.95,24.9342,87,UnitedHealthcare,Individual & Family,81.78,94,,percent of total billed charges,,
Draw Fee Picc,,36592,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,UnitedHealthcare,Medicare Advantage,42.63,49,,percent of total billed charges,,
Draw Fee Picc,,36592,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Draw Fee Picc,,36592,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,41.76,48,,percent of total billed charges,,100% of DHS outpatient percentage
Draw Fee Picc,,36592,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Declotting Of Implanted Port,,36593,CPT,Facility,Both,,,,179,152.15,51.3014,299,Aetna,Commercial,164.68,92,,percent of total billed charges,,
Declotting Of Implanted Port,,36593,CPT,Facility,Outpatient,,,,179,152.15,51.3014,299,Aetna,Medicare Advantage,87.71,49,,percent of total billed charges,,
Declotting Of Implanted Port,,36593,CPT,Facility,Inpatient,,,,179,152.15,51.3014,299,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Declotting Of Implanted Port,,36593,CPT,Facility,Both,,,,179,152.15,51.3014,299,Aetna,PPO,166.47,93,,percent of total billed charges,,
Declotting Of Implanted Port,,36593,CPT,Facility,Both,,,,179,152.15,51.3014,299,America's PPO,America's PPO,171.8937,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Declotting Of Implanted Port,,36593,CPT,Facility,Both,,,,179,152.15,51.3014,299,BlueCross BlueShield Minnesota, Federal Employee Program,176.136,98.4,,percent of total billed charges,,
Declotting Of Implanted Port,,36593,CPT,Facility,Both,,,,179,152.15,51.3014,299,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,179,100,,percent of total billed charges,,
Declotting Of Implanted Port,,36593,CPT,Facility,Both,,,,179,152.15,51.3014,299,BlueCross BlueShield Minnesota,High Value Network Plan,161.1,90,,percent of total billed charges,,
Declotting Of Implanted Port,,36593,CPT,Facility,Outpatient,,,,179,152.15,51.3014,299,BlueCross BlueShield Minnesota,Medicare Advantage,87.71,49,,percent of total billed charges,,
Declotting Of Implanted Port,,36593,CPT,Facility,Inpatient,,,,179,152.15,51.3014,299,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Declotting Of Implanted Port,,36593,CPT,Facility,Both,,,,179,152.15,51.3014,299,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,158.5403,88.57,,percent of total billed charges,,
Declotting Of Implanted Port,,36593,CPT,Facility,Both,,,,179,152.15,51.3014,299,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,51.3014,28.66,,percent of total billed charges,,
Declotting Of Implanted Port,,36593,CPT,Facility,Outpatient,,,,179,152.15,51.3014,299,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),87.71,49,,percent of total billed charges,,
Declotting Of Implanted Port,,36593,CPT,Facility,Inpatient,,,,179,152.15,51.3014,299,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Declotting Of Implanted Port,,36593,CPT,Facility,Both,,,,179,152.15,51.3014,299,CorVel,Worker's Compensation,179,100,,percent of total billed charges,,
Declotting Of Implanted Port,,36593,CPT,Facility,Both,,,,179,152.15,51.3014,299,First Health Group Corporation,First Health Network,173.63,97,,percent of total billed charges,,
Declotting Of Implanted Port,,36593,CPT,Facility,Both,,,,179,152.15,51.3014,299,"Health Partners, Inc.",Commercial,169.334,94.6,,percent of total billed charges,,
Declotting Of Implanted Port,,36593,CPT,Facility,Outpatient,,,,179,152.15,51.3014,299,"Health Partners, Inc.",Medicare Advantage,87.71,49,,percent of total billed charges,,
Declotting Of Implanted Port,,36593,CPT,Facility,Inpatient,,,,179,152.15,51.3014,299,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Declotting Of Implanted Port,,36593,CPT,Facility,Both,,,,179,152.15,51.3014,299,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),107.4,60,,percent of total billed charges,,
Declotting Of Implanted Port,,36593,CPT,Facility,Both,,,,179,152.15,51.3014,299,"Health Partners, Inc.",State of Minnesota Advantage Program,145.885,81.5,,percent of total billed charges,,
Declotting Of Implanted Port,,36593,CPT,Facility,Both,,,,179,152.15,51.3014,299,"Health Partners, Inc.",State Public Programs,89.5,50,,percent of total billed charges,,
Declotting Of Implanted Port,,36593,CPT,Facility,Both,,,,179,152.15,51.3014,299,Humana Insurance Company,Commercial PPO,170.05,95,,percent of total billed charges,,
Declotting Of Implanted Port,,36593,CPT,Facility,Outpatient,,,,179,152.15,51.3014,299,Humana Insurance Company,Medicare PPO,87.71,49,,percent of total billed charges,,
Declotting Of Implanted Port,,36593,CPT,Facility,Inpatient,,,,179,152.15,51.3014,299,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Declotting Of Implanted Port,,36593,CPT,Facility,Both,,,,179,152.15,51.3014,299,Medica,Individual & Family,177.389,99.1,,percent of total billed charges,,
Declotting Of Implanted Port,,36593,CPT,Facility,Outpatient,,,,179,152.15,51.3014,299,Medica,Medica Advantage Solution,89.142,49.8,,percent of total billed charges,,
Declotting Of Implanted Port,,36593,CPT,Facility,Inpatient,,,,179,152.15,51.3014,299,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Declotting Of Implanted Port,,36593,CPT,Facility,Outpatient,,,,179,152.15,51.3014,299,Medica,Medical Assistance,299,,,Other,Grouper,All inclusive per visit
Declotting Of Implanted Port,,36593,CPT,Facility,Inpatient,,,,179,152.15,51.3014,299,Medica,Medical Assistance,,,,,Included in per diem rate,
Declotting Of Implanted Port,,36593,CPT,Facility,Outpatient,,,,179,152.15,51.3014,299,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,89.142,49.8,,percent of total billed charges,,
Declotting Of Implanted Port,,36593,CPT,Facility,Inpatient,,,,179,152.15,51.3014,299,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Declotting Of Implanted Port,,36593,CPT,Facility,Both,,,,179,152.15,51.3014,299,"Multiplan, Inc.","Multiplan, Inc.",168.26,94,,percent of total billed charges,,
Declotting Of Implanted Port,,36593,CPT,Facility,Outpatient,,,,179,152.15,51.3014,299,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,161.279,90.1,,percent of total billed charges,,
Declotting Of Implanted Port,,36593,CPT,Facility,Inpatient,,,,179,152.15,51.3014,299,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Declotting Of Implanted Port,,36593,CPT,Facility,Both,,,,179,152.15,51.3014,299,"Preferred One Administrative Services, INC.",PPO,176.494,98.6,,percent of total billed charges,,
Declotting Of Implanted Port,,36593,CPT,Facility,Outpatient,,,,179,152.15,51.3014,299,PrimeWest Health,Minnesota Senior Health Options (MSHO),92.0955,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Declotting Of Implanted Port,,36593,CPT,Facility,Inpatient,,,,179,152.15,51.3014,299,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Declotting Of Implanted Port,,36593,CPT,Facility,Outpatient,,,,179,152.15,51.3014,299,PrimeWest Health,MinnesotaCare,91.9344,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Declotting Of Implanted Port,,36593,CPT,Facility,Inpatient,,,,179,152.15,51.3014,299,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Declotting Of Implanted Port,,36593,CPT,Facility,Both,,,,179,152.15,51.3014,299,Sanford Health Plan,Sanford Health Plan,164.68,92,,percent of total billed charges,,
Declotting Of Implanted Port,,36593,CPT,Facility,Outpatient,,,,179,152.15,51.3014,299,"UCare Health, Inc.",Individual & Family Plan,100.8665,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Declotting Of Implanted Port,,36593,CPT,Facility,Inpatient,,,,179,152.15,51.3014,299,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Declotting Of Implanted Port,,36593,CPT,Facility,Outpatient,,,,179,152.15,51.3014,299,"UCare Health, Inc.",Medical Assistance,90.3413,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Declotting Of Implanted Port,,36593,CPT,Facility,Inpatient,,,,179,152.15,51.3014,299,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Declotting Of Implanted Port,,36593,CPT,Facility,Outpatient,,,,179,152.15,51.3014,299,"UCare Health, Inc.",Medicare Advantage,90.3413,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Declotting Of Implanted Port,,36593,CPT,Facility,Inpatient,,,,179,152.15,51.3014,299,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Declotting Of Implanted Port,,36593,CPT,Facility,Outpatient,,,,179,152.15,51.3014,299,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),90.3413,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Declotting Of Implanted Port,,36593,CPT,Facility,Inpatient,,,,179,152.15,51.3014,299,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Declotting Of Implanted Port,,36593,CPT,Facility,Both,,,,179,152.15,51.3014,299,UnitedHealthcare,Individual & Family,168.26,94,,percent of total billed charges,,
Declotting Of Implanted Port,,36593,CPT,Facility,Outpatient,,,,179,152.15,51.3014,299,UnitedHealthcare,Medicare Advantage,87.71,49,,percent of total billed charges,,
Declotting Of Implanted Port,,36593,CPT,Facility,Inpatient,,,,179,152.15,51.3014,299,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Declotting Of Implanted Port,,36593,CPT,Facility,Outpatient,,,,179,152.15,51.3014,299,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,85.92,48,,percent of total billed charges,,100% of DHS outpatient percentage
Declotting Of Implanted Port,,36593,CPT,Facility,Inpatient,,,,179,152.15,51.3014,299,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Arterial Puncture,,36600,CPT,Facility,Both,,,,92,78.2,26.3672,92,Aetna,Commercial,84.64,92,,percent of total billed charges,,
Arterial Puncture,,36600,CPT,Facility,Outpatient,,,,92,78.2,26.3672,92,Aetna,Medicare Advantage,45.08,49,,percent of total billed charges,,
Arterial Puncture,,36600,CPT,Facility,Inpatient,,,,92,78.2,26.3672,92,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Arterial Puncture,,36600,CPT,Facility,Both,,,,92,78.2,26.3672,92,Aetna,PPO,85.56,93,,percent of total billed charges,,
Arterial Puncture,,36600,CPT,Facility,Both,,,,92,78.2,26.3672,92,America's PPO,America's PPO,88.3476,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Arterial Puncture,,36600,CPT,Facility,Both,,,,92,78.2,26.3672,92,BlueCross BlueShield Minnesota, Federal Employee Program,90.528,98.4,,percent of total billed charges,,
Arterial Puncture,,36600,CPT,Facility,Both,,,,92,78.2,26.3672,92,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,92,100,,percent of total billed charges,,
Arterial Puncture,,36600,CPT,Facility,Both,,,,92,78.2,26.3672,92,BlueCross BlueShield Minnesota,High Value Network Plan,82.8,90,,percent of total billed charges,,
Arterial Puncture,,36600,CPT,Facility,Outpatient,,,,92,78.2,26.3672,92,BlueCross BlueShield Minnesota,Medicare Advantage,45.08,49,,percent of total billed charges,,
Arterial Puncture,,36600,CPT,Facility,Inpatient,,,,92,78.2,26.3672,92,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Arterial Puncture,,36600,CPT,Facility,Both,,,,92,78.2,26.3672,92,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,81.4844,88.57,,percent of total billed charges,,
Arterial Puncture,,36600,CPT,Facility,Both,,,,92,78.2,26.3672,92,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,26.3672,28.66,,percent of total billed charges,,
Arterial Puncture,,36600,CPT,Facility,Outpatient,,,,92,78.2,26.3672,92,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),45.08,49,,percent of total billed charges,,
Arterial Puncture,,36600,CPT,Facility,Inpatient,,,,92,78.2,26.3672,92,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Arterial Puncture,,36600,CPT,Facility,Both,,,,92,78.2,26.3672,92,CorVel,Worker's Compensation,92,100,,percent of total billed charges,,
Arterial Puncture,,36600,CPT,Facility,Both,,,,92,78.2,26.3672,92,First Health Group Corporation,First Health Network,89.24,97,,percent of total billed charges,,
Arterial Puncture,,36600,CPT,Facility,Both,,,,92,78.2,26.3672,92,"Health Partners, Inc.",Commercial,87.032,94.6,,percent of total billed charges,,
Arterial Puncture,,36600,CPT,Facility,Outpatient,,,,92,78.2,26.3672,92,"Health Partners, Inc.",Medicare Advantage,45.08,49,,percent of total billed charges,,
Arterial Puncture,,36600,CPT,Facility,Inpatient,,,,92,78.2,26.3672,92,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Arterial Puncture,,36600,CPT,Facility,Both,,,,92,78.2,26.3672,92,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),55.2,60,,percent of total billed charges,,
Arterial Puncture,,36600,CPT,Facility,Both,,,,92,78.2,26.3672,92,"Health Partners, Inc.",State of Minnesota Advantage Program,74.98,81.5,,percent of total billed charges,,
Arterial Puncture,,36600,CPT,Facility,Both,,,,92,78.2,26.3672,92,"Health Partners, Inc.",State Public Programs,46,50,,percent of total billed charges,,
Arterial Puncture,,36600,CPT,Facility,Both,,,,92,78.2,26.3672,92,Humana Insurance Company,Commercial PPO,87.4,95,,percent of total billed charges,,
Arterial Puncture,,36600,CPT,Facility,Outpatient,,,,92,78.2,26.3672,92,Humana Insurance Company,Medicare PPO,45.08,49,,percent of total billed charges,,
Arterial Puncture,,36600,CPT,Facility,Inpatient,,,,92,78.2,26.3672,92,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Arterial Puncture,,36600,CPT,Facility,Both,,,,92,78.2,26.3672,92,Medica,Individual & Family,91.172,99.1,,percent of total billed charges,,
Arterial Puncture,,36600,CPT,Facility,Outpatient,,,,92,78.2,26.3672,92,Medica,Medica Advantage Solution,45.816,49.8,,percent of total billed charges,,
Arterial Puncture,,36600,CPT,Facility,Inpatient,,,,92,78.2,26.3672,92,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Arterial Puncture,,36600,CPT,Facility,Outpatient,,,,92,78.2,26.3672,92,Medica,Medical Assistance,41.032,44.6,,percent of total billed charges,,
Arterial Puncture,,36600,CPT,Facility,Inpatient,,,,92,78.2,26.3672,92,Medica,Medical Assistance,,,,,Included in per diem rate,
Arterial Puncture,,36600,CPT,Facility,Outpatient,,,,92,78.2,26.3672,92,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,45.816,49.8,,percent of total billed charges,,
Arterial Puncture,,36600,CPT,Facility,Inpatient,,,,92,78.2,26.3672,92,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Arterial Puncture,,36600,CPT,Facility,Both,,,,92,78.2,26.3672,92,"Multiplan, Inc.","Multiplan, Inc.",86.48,94,,percent of total billed charges,,
Arterial Puncture,,36600,CPT,Facility,Outpatient,,,,92,78.2,26.3672,92,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,79.488,86.4,,percent of total billed charges,,
Arterial Puncture,,36600,CPT,Facility,Inpatient,,,,92,78.2,26.3672,92,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Arterial Puncture,,36600,CPT,Facility,Both,,,,92,78.2,26.3672,92,"Preferred One Administrative Services, INC.",PPO,90.712,98.6,,percent of total billed charges,,
Arterial Puncture,,36600,CPT,Facility,Outpatient,,,,92,78.2,26.3672,92,PrimeWest Health,Minnesota Senior Health Options (MSHO),47.334,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Arterial Puncture,,36600,CPT,Facility,Inpatient,,,,92,78.2,26.3672,92,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Arterial Puncture,,36600,CPT,Facility,Outpatient,,,,92,78.2,26.3672,92,PrimeWest Health,MinnesotaCare,47.2512,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Arterial Puncture,,36600,CPT,Facility,Inpatient,,,,92,78.2,26.3672,92,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Arterial Puncture,,36600,CPT,Facility,Both,,,,92,78.2,26.3672,92,Sanford Health Plan,Sanford Health Plan,84.64,92,,percent of total billed charges,,
Arterial Puncture,,36600,CPT,Facility,Outpatient,,,,92,78.2,26.3672,92,"UCare Health, Inc.",Individual & Family Plan,51.842,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Arterial Puncture,,36600,CPT,Facility,Inpatient,,,,92,78.2,26.3672,92,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Arterial Puncture,,36600,CPT,Facility,Outpatient,,,,92,78.2,26.3672,92,"UCare Health, Inc.",Medical Assistance,46.4324,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Arterial Puncture,,36600,CPT,Facility,Inpatient,,,,92,78.2,26.3672,92,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Arterial Puncture,,36600,CPT,Facility,Outpatient,,,,92,78.2,26.3672,92,"UCare Health, Inc.",Medicare Advantage,46.4324,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Arterial Puncture,,36600,CPT,Facility,Inpatient,,,,92,78.2,26.3672,92,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Arterial Puncture,,36600,CPT,Facility,Outpatient,,,,92,78.2,26.3672,92,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),46.4324,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Arterial Puncture,,36600,CPT,Facility,Inpatient,,,,92,78.2,26.3672,92,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Arterial Puncture,,36600,CPT,Facility,Both,,,,92,78.2,26.3672,92,UnitedHealthcare,Individual & Family,86.48,94,,percent of total billed charges,,
Arterial Puncture,,36600,CPT,Facility,Outpatient,,,,92,78.2,26.3672,92,UnitedHealthcare,Medicare Advantage,45.08,49,,percent of total billed charges,,
Arterial Puncture,,36600,CPT,Facility,Inpatient,,,,92,78.2,26.3672,92,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Arterial Puncture,,36600,CPT,Facility,Outpatient,,,,92,78.2,26.3672,92,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,44.16,48,,percent of total billed charges,,100% of DHS outpatient percentage
Arterial Puncture,,36600,CPT,Facility,Inpatient,,,,92,78.2,26.3672,92,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Needle Placement For Intraosseous Infusion,,36680,CPT,Facility,Both,,,,617,524.45,176.8322,617,Aetna,Commercial,567.64,92,,percent of total billed charges,,
Needle Placement For Intraosseous Infusion,,36680,CPT,Facility,Outpatient,,,,617,524.45,176.8322,617,Aetna,Medicare Advantage,302.33,49,,percent of total billed charges,,
Needle Placement For Intraosseous Infusion,,36680,CPT,Facility,Inpatient,,,,617,524.45,176.8322,617,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Needle Placement For Intraosseous Infusion,,36680,CPT,Facility,Both,,,,617,524.45,176.8322,617,Aetna,PPO,573.81,93,,percent of total billed charges,,
Needle Placement For Intraosseous Infusion,,36680,CPT,Facility,Both,,,,617,524.45,176.8322,617,America's PPO,America's PPO,592.5051,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Needle Placement For Intraosseous Infusion,,36680,CPT,Facility,Both,,,,617,524.45,176.8322,617,BlueCross BlueShield Minnesota, Federal Employee Program,607.128,98.4,,percent of total billed charges,,
Needle Placement For Intraosseous Infusion,,36680,CPT,Facility,Both,,,,617,524.45,176.8322,617,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,617,100,,percent of total billed charges,,
Needle Placement For Intraosseous Infusion,,36680,CPT,Facility,Both,,,,617,524.45,176.8322,617,BlueCross BlueShield Minnesota,High Value Network Plan,555.3,90,,percent of total billed charges,,
Needle Placement For Intraosseous Infusion,,36680,CPT,Facility,Outpatient,,,,617,524.45,176.8322,617,BlueCross BlueShield Minnesota,Medicare Advantage,302.33,49,,percent of total billed charges,,
Needle Placement For Intraosseous Infusion,,36680,CPT,Facility,Inpatient,,,,617,524.45,176.8322,617,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Needle Placement For Intraosseous Infusion,,36680,CPT,Facility,Both,,,,617,524.45,176.8322,617,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,546.4769,88.57,,percent of total billed charges,,
Needle Placement For Intraosseous Infusion,,36680,CPT,Facility,Both,,,,617,524.45,176.8322,617,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,176.8322,28.66,,percent of total billed charges,,
Needle Placement For Intraosseous Infusion,,36680,CPT,Facility,Outpatient,,,,617,524.45,176.8322,617,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),302.33,49,,percent of total billed charges,,
Needle Placement For Intraosseous Infusion,,36680,CPT,Facility,Inpatient,,,,617,524.45,176.8322,617,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Needle Placement For Intraosseous Infusion,,36680,CPT,Facility,Both,,,,617,524.45,176.8322,617,CorVel,Worker's Compensation,617,100,,percent of total billed charges,,
Needle Placement For Intraosseous Infusion,,36680,CPT,Facility,Both,,,,617,524.45,176.8322,617,First Health Group Corporation,First Health Network,598.49,97,,percent of total billed charges,,
Needle Placement For Intraosseous Infusion,,36680,CPT,Facility,Both,,,,617,524.45,176.8322,617,"Health Partners, Inc.",Commercial,583.682,94.6,,percent of total billed charges,,
Needle Placement For Intraosseous Infusion,,36680,CPT,Facility,Outpatient,,,,617,524.45,176.8322,617,"Health Partners, Inc.",Medicare Advantage,302.33,49,,percent of total billed charges,,
Needle Placement For Intraosseous Infusion,,36680,CPT,Facility,Inpatient,,,,617,524.45,176.8322,617,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Needle Placement For Intraosseous Infusion,,36680,CPT,Facility,Both,,,,617,524.45,176.8322,617,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),370.2,60,,percent of total billed charges,,
Needle Placement For Intraosseous Infusion,,36680,CPT,Facility,Both,,,,617,524.45,176.8322,617,"Health Partners, Inc.",State of Minnesota Advantage Program,502.855,81.5,,percent of total billed charges,,
Needle Placement For Intraosseous Infusion,,36680,CPT,Facility,Both,,,,617,524.45,176.8322,617,"Health Partners, Inc.",State Public Programs,308.5,50,,percent of total billed charges,,
Needle Placement For Intraosseous Infusion,,36680,CPT,Facility,Both,,,,617,524.45,176.8322,617,Humana Insurance Company,Commercial PPO,586.15,95,,percent of total billed charges,,
Needle Placement For Intraosseous Infusion,,36680,CPT,Facility,Outpatient,,,,617,524.45,176.8322,617,Humana Insurance Company,Medicare PPO,302.33,49,,percent of total billed charges,,
Needle Placement For Intraosseous Infusion,,36680,CPT,Facility,Inpatient,,,,617,524.45,176.8322,617,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Needle Placement For Intraosseous Infusion,,36680,CPT,Facility,Both,,,,617,524.45,176.8322,617,Medica,Individual & Family,611.447,99.1,,percent of total billed charges,,
Needle Placement For Intraosseous Infusion,,36680,CPT,Facility,Outpatient,,,,617,524.45,176.8322,617,Medica,Medica Advantage Solution,307.266,49.8,,percent of total billed charges,,
Needle Placement For Intraosseous Infusion,,36680,CPT,Facility,Inpatient,,,,617,524.45,176.8322,617,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Needle Placement For Intraosseous Infusion,,36680,CPT,Facility,Outpatient,,,,617,524.45,176.8322,617,Medica,Medical Assistance,275.182,44.6,,percent of total billed charges,,
Needle Placement For Intraosseous Infusion,,36680,CPT,Facility,Inpatient,,,,617,524.45,176.8322,617,Medica,Medical Assistance,,,,,Included in per diem rate,
Needle Placement For Intraosseous Infusion,,36680,CPT,Facility,Outpatient,,,,617,524.45,176.8322,617,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,307.266,49.8,,percent of total billed charges,,
Needle Placement For Intraosseous Infusion,,36680,CPT,Facility,Inpatient,,,,617,524.45,176.8322,617,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Needle Placement For Intraosseous Infusion,,36680,CPT,Facility,Both,,,,617,524.45,176.8322,617,"Multiplan, Inc.","Multiplan, Inc.",579.98,94,,percent of total billed charges,,
Needle Placement For Intraosseous Infusion,,36680,CPT,Facility,Outpatient,,,,617,524.45,176.8322,617,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,555.917,90.1,,percent of total billed charges,,
Needle Placement For Intraosseous Infusion,,36680,CPT,Facility,Inpatient,,,,617,524.45,176.8322,617,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Needle Placement For Intraosseous Infusion,,36680,CPT,Facility,Both,,,,617,524.45,176.8322,617,"Preferred One Administrative Services, INC.",PPO,608.362,98.6,,percent of total billed charges,,
Needle Placement For Intraosseous Infusion,,36680,CPT,Facility,Outpatient,,,,617,524.45,176.8322,617,PrimeWest Health,Minnesota Senior Health Options (MSHO),317.4465,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Needle Placement For Intraosseous Infusion,,36680,CPT,Facility,Inpatient,,,,617,524.45,176.8322,617,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Needle Placement For Intraosseous Infusion,,36680,CPT,Facility,Outpatient,,,,617,524.45,176.8322,617,PrimeWest Health,MinnesotaCare,316.8912,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Needle Placement For Intraosseous Infusion,,36680,CPT,Facility,Inpatient,,,,617,524.45,176.8322,617,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Needle Placement For Intraosseous Infusion,,36680,CPT,Facility,Both,,,,617,524.45,176.8322,617,Sanford Health Plan,Sanford Health Plan,567.64,92,,percent of total billed charges,,
Needle Placement For Intraosseous Infusion,,36680,CPT,Facility,Outpatient,,,,617,524.45,176.8322,617,"UCare Health, Inc.",Individual & Family Plan,347.6795,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Needle Placement For Intraosseous Infusion,,36680,CPT,Facility,Inpatient,,,,617,524.45,176.8322,617,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Needle Placement For Intraosseous Infusion,,36680,CPT,Facility,Outpatient,,,,617,524.45,176.8322,617,"UCare Health, Inc.",Medical Assistance,311.3999,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Needle Placement For Intraosseous Infusion,,36680,CPT,Facility,Inpatient,,,,617,524.45,176.8322,617,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Needle Placement For Intraosseous Infusion,,36680,CPT,Facility,Outpatient,,,,617,524.45,176.8322,617,"UCare Health, Inc.",Medicare Advantage,311.3999,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Needle Placement For Intraosseous Infusion,,36680,CPT,Facility,Inpatient,,,,617,524.45,176.8322,617,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Needle Placement For Intraosseous Infusion,,36680,CPT,Facility,Outpatient,,,,617,524.45,176.8322,617,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),311.3999,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Needle Placement For Intraosseous Infusion,,36680,CPT,Facility,Inpatient,,,,617,524.45,176.8322,617,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Needle Placement For Intraosseous Infusion,,36680,CPT,Facility,Both,,,,617,524.45,176.8322,617,UnitedHealthcare,Individual & Family,579.98,94,,percent of total billed charges,,
Needle Placement For Intraosseous Infusion,,36680,CPT,Facility,Outpatient,,,,617,524.45,176.8322,617,UnitedHealthcare,Medicare Advantage,302.33,49,,percent of total billed charges,,
Needle Placement For Intraosseous Infusion,,36680,CPT,Facility,Inpatient,,,,617,524.45,176.8322,617,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Needle Placement For Intraosseous Infusion,,36680,CPT,Facility,Outpatient,,,,617,524.45,176.8322,617,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,296.16,48,,percent of total billed charges,,100% of DHS outpatient percentage
Needle Placement For Intraosseous Infusion,,36680,CPT,Facility,Inpatient,,,,617,524.45,176.8322,617,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
NALOXONE 0.4 MG/ML INJ SOLN,,J2310,HCPCS,Facility,Inpatient,1,mL,,107,90.95,30.6662,107,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
NALOXONE 0.4 MG/ML INJ SOLN,,J2310,HCPCS,Facility,Inpatient,1,mL,,107,90.95,30.6662,107,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
NALOXONE 0.4 MG/ML INJ SOLN,,J2310,HCPCS,Facility,Outpatient,1,mL,,107,90.95,30.6662,107,Medica,Medical Assistance,47.722,44.6,,percent of total billed charges,,
NALOXONE 0.4 MG/ML INJ SOLN,,J2310,HCPCS,Facility,Outpatient,1,mL,,107,90.95,30.6662,107,Medica,Medical Assistance,47.722,44.6,,percent of total billed charges,,
NALOXONE 0.4 MG/ML INJ SOLN,,J2310,HCPCS,Facility,Inpatient,1,mL,,107,90.95,30.6662,107,Medica,Medical Assistance,,,,,Included in per diem rate,
NALOXONE 0.4 MG/ML INJ SOLN,,J2310,HCPCS,Facility,Inpatient,1,mL,,107,90.95,30.6662,107,Medica,Medical Assistance,,,,,Included in per diem rate,
NALOXONE 0.4 MG/ML INJ SOLN,,J2310,HCPCS,Facility,Outpatient,1,mL,,107,90.95,30.6662,107,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,53.286,49.8,,percent of total billed charges,,
NALOXONE 0.4 MG/ML INJ SOLN,,J2310,HCPCS,Facility,Outpatient,1,mL,,107,90.95,30.6662,107,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,53.286,49.8,,percent of total billed charges,,
NALOXONE 0.4 MG/ML INJ SOLN,,J2310,HCPCS,Facility,Inpatient,1,mL,,107,90.95,30.6662,107,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
NALOXONE 0.4 MG/ML INJ SOLN,,J2310,HCPCS,Facility,Inpatient,1,mL,,107,90.95,30.6662,107,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
NALOXONE 0.4 MG/ML INJ SOLN,,J2310,HCPCS,Facility,Both,1,mL,,107,90.95,30.6662,107,"Multiplan, Inc.","Multiplan, Inc.",100.58,94,,percent of total billed charges,,
NALOXONE 0.4 MG/ML INJ SOLN,,J2310,HCPCS,Facility,Both,1,mL,,107,90.95,30.6662,107,"Multiplan, Inc.","Multiplan, Inc.",100.58,94,,percent of total billed charges,,
NALOXONE 0.4 MG/ML INJ SOLN,,J2310,HCPCS,Facility,Outpatient,1,mL,,107,90.95,30.6662,107,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,96.407,90.1,,percent of total billed charges,,
NALOXONE 0.4 MG/ML INJ SOLN,,J2310,HCPCS,Facility,Outpatient,1,mL,,107,90.95,30.6662,107,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,96.407,90.1,,percent of total billed charges,,
NALOXONE 0.4 MG/ML INJ SOLN,,J2310,HCPCS,Facility,Inpatient,1,mL,,107,90.95,30.6662,107,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
NALOXONE 0.4 MG/ML INJ SOLN,,J2310,HCPCS,Facility,Inpatient,1,mL,,107,90.95,30.6662,107,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
NALOXONE 0.4 MG/ML INJ SOLN,,J2310,HCPCS,Facility,Both,1,mL,,107,90.95,30.6662,107,"Preferred One Administrative Services, INC.",PPO,105.502,98.6,,percent of total billed charges,,
NALOXONE 0.4 MG/ML INJ SOLN,,J2310,HCPCS,Facility,Both,1,mL,,107,90.95,30.6662,107,"Preferred One Administrative Services, INC.",PPO,105.502,98.6,,percent of total billed charges,,
NALOXONE 0.4 MG/ML INJ SOLN,,J2310,HCPCS,Facility,Outpatient,1,mL,,107,90.95,30.6662,107,PrimeWest Health,Minnesota Senior Health Options (MSHO),55.0515,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
NALOXONE 0.4 MG/ML INJ SOLN,,J2310,HCPCS,Facility,Outpatient,1,mL,,107,90.95,30.6662,107,PrimeWest Health,Minnesota Senior Health Options (MSHO),55.0515,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
NALOXONE 0.4 MG/ML INJ SOLN,,J2310,HCPCS,Facility,Inpatient,1,mL,,107,90.95,30.6662,107,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
NALOXONE 0.4 MG/ML INJ SOLN,,J2310,HCPCS,Facility,Inpatient,1,mL,,107,90.95,30.6662,107,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
NALOXONE 0.4 MG/ML INJ SOLN,,J2310,HCPCS,Facility,Outpatient,1,mL,,107,90.95,30.6662,107,PrimeWest Health,MinnesotaCare,54.9552,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
NALOXONE 0.4 MG/ML INJ SOLN,,J2310,HCPCS,Facility,Outpatient,1,mL,,107,90.95,30.6662,107,PrimeWest Health,MinnesotaCare,54.9552,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
NALOXONE 0.4 MG/ML INJ SOLN,,J2310,HCPCS,Facility,Inpatient,1,mL,,107,90.95,30.6662,107,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
NALOXONE 0.4 MG/ML INJ SOLN,,J2310,HCPCS,Facility,Inpatient,1,mL,,107,90.95,30.6662,107,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
NALOXONE 0.4 MG/ML INJ SOLN,,J2310,HCPCS,Facility,Both,1,mL,,107,90.95,30.6662,107,Sanford Health Plan,Sanford Health Plan,98.44,92,,percent of total billed charges,,
NALOXONE 0.4 MG/ML INJ SOLN,,J2310,HCPCS,Facility,Both,1,mL,,107,90.95,30.6662,107,Sanford Health Plan,Sanford Health Plan,98.44,92,,percent of total billed charges,,
NALOXONE 0.4 MG/ML INJ SOLN,,J2310,HCPCS,Facility,Outpatient,1,mL,,107,90.95,30.6662,107,"UCare Health, Inc.",Individual & Family Plan,60.2945,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
NALOXONE 0.4 MG/ML INJ SOLN,,J2310,HCPCS,Facility,Outpatient,1,mL,,107,90.95,30.6662,107,"UCare Health, Inc.",Individual & Family Plan,60.2945,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
NALOXONE 0.4 MG/ML INJ SOLN,,J2310,HCPCS,Facility,Inpatient,1,mL,,107,90.95,30.6662,107,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
NALOXONE 0.4 MG/ML INJ SOLN,,J2310,HCPCS,Facility,Inpatient,1,mL,,107,90.95,30.6662,107,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
NALOXONE 0.4 MG/ML INJ SOLN,,J2310,HCPCS,Facility,Outpatient,1,mL,,107,90.95,30.6662,107,"UCare Health, Inc.",Medical Assistance,54.0029,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
NALOXONE 0.4 MG/ML INJ SOLN,,J2310,HCPCS,Facility,Outpatient,1,mL,,107,90.95,30.6662,107,"UCare Health, Inc.",Medical Assistance,54.0029,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
NALOXONE 0.4 MG/ML INJ SOLN,,J2310,HCPCS,Facility,Inpatient,1,mL,,107,90.95,30.6662,107,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
NALOXONE 0.4 MG/ML INJ SOLN,,J2310,HCPCS,Facility,Inpatient,1,mL,,107,90.95,30.6662,107,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
NALOXONE 0.4 MG/ML INJ SOLN,,J2310,HCPCS,Facility,Outpatient,1,mL,,107,90.95,30.6662,107,"UCare Health, Inc.",Medicare Advantage,54.0029,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
NALOXONE 0.4 MG/ML INJ SOLN,,J2310,HCPCS,Facility,Outpatient,1,mL,,107,90.95,30.6662,107,"UCare Health, Inc.",Medicare Advantage,54.0029,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
NALOXONE 0.4 MG/ML INJ SOLN,,J2310,HCPCS,Facility,Inpatient,1,mL,,107,90.95,30.6662,107,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
NALOXONE 0.4 MG/ML INJ SOLN,,J2310,HCPCS,Facility,Inpatient,1,mL,,107,90.95,30.6662,107,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
NALOXONE 0.4 MG/ML INJ SOLN,,J2310,HCPCS,Facility,Outpatient,1,mL,,107,90.95,30.6662,107,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),54.0029,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
NALOXONE 0.4 MG/ML INJ SOLN,,J2310,HCPCS,Facility,Outpatient,1,mL,,107,90.95,30.6662,107,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),54.0029,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
NALOXONE 0.4 MG/ML INJ SOLN,,J2310,HCPCS,Facility,Inpatient,1,mL,,107,90.95,30.6662,107,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
NALOXONE 0.4 MG/ML INJ SOLN,,J2310,HCPCS,Facility,Inpatient,1,mL,,107,90.95,30.6662,107,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
NALOXONE 0.4 MG/ML INJ SOLN,,J2310,HCPCS,Facility,Both,1,mL,,107,90.95,30.6662,107,UnitedHealthcare,Individual & Family,100.58,94,,percent of total billed charges,,
NALOXONE 0.4 MG/ML INJ SOLN,,J2310,HCPCS,Facility,Both,1,mL,,107,90.95,30.6662,107,UnitedHealthcare,Individual & Family,100.58,94,,percent of total billed charges,,
NALOXONE 0.4 MG/ML INJ SOLN,,J2310,HCPCS,Facility,Outpatient,1,mL,,107,90.95,30.6662,107,UnitedHealthcare,Medicare Advantage,52.43,49,,percent of total billed charges,,
NALOXONE 0.4 MG/ML INJ SOLN,,J2310,HCPCS,Facility,Outpatient,1,mL,,107,90.95,30.6662,107,UnitedHealthcare,Medicare Advantage,52.43,49,,percent of total billed charges,,
NALOXONE 0.4 MG/ML INJ SOLN,,J2310,HCPCS,Facility,Inpatient,1,mL,,107,90.95,30.6662,107,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
NALOXONE 0.4 MG/ML INJ SOLN,,J2310,HCPCS,Facility,Inpatient,1,mL,,107,90.95,30.6662,107,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
NALOXONE 0.4 MG/ML INJ SOLN,,J2310,HCPCS,Facility,Outpatient,1,mL,,107,90.95,30.6662,107,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,51.36,48,,percent of total billed charges,,100% of DHS outpatient percentage
NALOXONE 0.4 MG/ML INJ SOLN,,J2310,HCPCS,Facility,Outpatient,1,mL,,107,90.95,30.6662,107,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,51.36,48,,percent of total billed charges,,100% of DHS outpatient percentage
NALOXONE 0.4 MG/ML INJ SOLN,,J2310,HCPCS,Facility,Inpatient,1,mL,,107,90.95,30.6662,107,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
NALOXONE 0.4 MG/ML INJ SOLN,,J2310,HCPCS,Facility,Inpatient,1,mL,,107,90.95,30.6662,107,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
NALOXONE 0.4 MG/ML INJ SYRG,,J2310,HCPCS,Facility,Both,1,mL,,89,75.65,25.5074,89,Aetna,Commercial,81.88,92,,percent of total billed charges,,
NALOXONE 0.4 MG/ML INJ SYRG,,J2310,HCPCS,Facility,Outpatient,1,mL,,89,75.65,25.5074,89,Aetna,Medicare Advantage,43.61,49,,percent of total billed charges,,
NALOXONE 0.4 MG/ML INJ SYRG,,J2310,HCPCS,Facility,Inpatient,1,mL,,89,75.65,25.5074,89,Aetna,Medicare Advantage,,,,,Included in per diem rate,
NALOXONE 0.4 MG/ML INJ SYRG,,J2310,HCPCS,Facility,Both,1,mL,,89,75.65,25.5074,89,Aetna,PPO,82.77,93,,percent of total billed charges,,
NALOXONE 0.4 MG/ML INJ SYRG,,J2310,HCPCS,Facility,Both,1,mL,,89,75.65,25.5074,89,America's PPO,America's PPO,85.4667,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
NALOXONE 0.4 MG/ML INJ SYRG,,J2310,HCPCS,Facility,Both,1,mL,,89,75.65,25.5074,89,BlueCross BlueShield Minnesota, Federal Employee Program,87.576,98.4,,percent of total billed charges,,
NALOXONE 0.4 MG/ML INJ SYRG,,J2310,HCPCS,Facility,Both,1,mL,,89,75.65,25.5074,89,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,89,100,,percent of total billed charges,,
NALOXONE 0.4 MG/ML INJ SYRG,,J2310,HCPCS,Facility,Both,1,mL,,89,75.65,25.5074,89,BlueCross BlueShield Minnesota,High Value Network Plan,80.1,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
NALOXONE 0.4 MG/ML INJ SYRG,,J2310,HCPCS,Facility,Outpatient,1,mL,,89,75.65,25.5074,89,BlueCross BlueShield Minnesota,Medicare Advantage,43.61,49,,percent of total billed charges,,
NALOXONE 0.4 MG/ML INJ SYRG,,J2310,HCPCS,Facility,Inpatient,1,mL,,89,75.65,25.5074,89,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
NALOXONE 0.4 MG/ML INJ SYRG,,J2310,HCPCS,Facility,Both,1,mL,,89,75.65,25.5074,89,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,78.8273,88.57,,percent of total billed charges,,
NALOXONE 0.4 MG/ML INJ SYRG,,J2310,HCPCS,Facility,Both,1,mL,,89,75.65,25.5074,89,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,25.5074,28.66,,percent of total billed charges,,
NALOXONE 0.4 MG/ML INJ SYRG,,J2310,HCPCS,Facility,Outpatient,1,mL,,89,75.65,25.5074,89,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),43.61,49,,percent of total billed charges,,
NALOXONE 0.4 MG/ML INJ SYRG,,J2310,HCPCS,Facility,Inpatient,1,mL,,89,75.65,25.5074,89,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
NALOXONE 0.4 MG/ML INJ SYRG,,J2310,HCPCS,Facility,Both,1,mL,,89,75.65,25.5074,89,CorVel,Worker's Compensation,89,100,,percent of total billed charges,,
NALOXONE 0.4 MG/ML INJ SYRG,,J2310,HCPCS,Facility,Both,1,mL,,89,75.65,25.5074,89,First Health Group Corporation,First Health Network,86.33,97,,percent of total billed charges,,
NALOXONE 0.4 MG/ML INJ SYRG,,J2310,HCPCS,Facility,Both,1,mL,,89,75.65,25.5074,89,"Health Partners, Inc.",Commercial,84.194,94.6,,percent of total billed charges,,
NALOXONE 0.4 MG/ML INJ SYRG,,J2310,HCPCS,Facility,Outpatient,1,mL,,89,75.65,25.5074,89,"Health Partners, Inc.",Medicare Advantage,43.61,49,,percent of total billed charges,,
NALOXONE 0.4 MG/ML INJ SYRG,,J2310,HCPCS,Facility,Inpatient,1,mL,,89,75.65,25.5074,89,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
NALOXONE 0.4 MG/ML INJ SYRG,,J2310,HCPCS,Facility,Both,1,mL,,89,75.65,25.5074,89,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),53.4,60,,percent of total billed charges,,
NALOXONE 0.4 MG/ML INJ SYRG,,J2310,HCPCS,Facility,Both,1,mL,,89,75.65,25.5074,89,"Health Partners, Inc.",State of Minnesota Advantage Program,72.535,81.5,,percent of total billed charges,,
NALOXONE 0.4 MG/ML INJ SYRG,,J2310,HCPCS,Facility,Both,1,mL,,89,75.65,25.5074,89,"Health Partners, Inc.",State Public Programs,44.5,50,,percent of total billed charges,,
NALOXONE 0.4 MG/ML INJ SYRG,,J2310,HCPCS,Facility,Both,1,mL,,89,75.65,25.5074,89,Humana Insurance Company,Commercial PPO,84.55,95,,percent of total billed charges,,
NALOXONE 0.4 MG/ML INJ SYRG,,J2310,HCPCS,Facility,Outpatient,1,mL,,89,75.65,25.5074,89,Humana Insurance Company,Medicare PPO,43.61,49,,percent of total billed charges,,
NALOXONE 0.4 MG/ML INJ SYRG,,J2310,HCPCS,Facility,Inpatient,1,mL,,89,75.65,25.5074,89,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
NALOXONE 0.4 MG/ML INJ SYRG,,J2310,HCPCS,Facility,Both,1,mL,,89,75.65,25.5074,89,Medica,Individual & Family,88.199,99.1,,percent of total billed charges,,
NALOXONE 0.4 MG/ML INJ SYRG,,J2310,HCPCS,Facility,Outpatient,1,mL,,89,75.65,25.5074,89,Medica,Medica Advantage Solution,44.322,49.8,,percent of total billed charges,,
NALOXONE 0.4 MG/ML INJ SYRG,,J2310,HCPCS,Facility,Inpatient,1,mL,,89,75.65,25.5074,89,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
NALOXONE 0.4 MG/ML INJ SYRG,,J2310,HCPCS,Facility,Outpatient,1,mL,,89,75.65,25.5074,89,Medica,Medical Assistance,39.694,44.6,,percent of total billed charges,,
NALOXONE 0.4 MG/ML INJ SYRG,,J2310,HCPCS,Facility,Inpatient,1,mL,,89,75.65,25.5074,89,Medica,Medical Assistance,,,,,Included in per diem rate,
NALOXONE 0.4 MG/ML INJ SYRG,,J2310,HCPCS,Facility,Outpatient,1,mL,,89,75.65,25.5074,89,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,44.322,49.8,,percent of total billed charges,,
NALOXONE 0.4 MG/ML INJ SYRG,,J2310,HCPCS,Facility,Inpatient,1,mL,,89,75.65,25.5074,89,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
NALOXONE 0.4 MG/ML INJ SYRG,,J2310,HCPCS,Facility,Both,1,mL,,89,75.65,25.5074,89,"Multiplan, Inc.","Multiplan, Inc.",83.66,94,,percent of total billed charges,,
NALOXONE 0.4 MG/ML INJ SYRG,,J2310,HCPCS,Facility,Outpatient,1,mL,,89,75.65,25.5074,89,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,80.189,90.1,,percent of total billed charges,,
NALOXONE 0.4 MG/ML INJ SYRG,,J2310,HCPCS,Facility,Inpatient,1,mL,,89,75.65,25.5074,89,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
NALOXONE 0.4 MG/ML INJ SYRG,,J2310,HCPCS,Facility,Both,1,mL,,89,75.65,25.5074,89,"Preferred One Administrative Services, INC.",PPO,87.754,98.6,,percent of total billed charges,,
NALOXONE 0.4 MG/ML INJ SYRG,,J2310,HCPCS,Facility,Outpatient,1,mL,,89,75.65,25.5074,89,PrimeWest Health,Minnesota Senior Health Options (MSHO),45.7905,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
NALOXONE 0.4 MG/ML INJ SYRG,,J2310,HCPCS,Facility,Inpatient,1,mL,,89,75.65,25.5074,89,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
NALOXONE 0.4 MG/ML INJ SYRG,,J2310,HCPCS,Facility,Outpatient,1,mL,,89,75.65,25.5074,89,PrimeWest Health,MinnesotaCare,45.7104,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
NALOXONE 0.4 MG/ML INJ SYRG,,J2310,HCPCS,Facility,Inpatient,1,mL,,89,75.65,25.5074,89,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
NALOXONE 0.4 MG/ML INJ SYRG,,J2310,HCPCS,Facility,Both,1,mL,,89,75.65,25.5074,89,Sanford Health Plan,Sanford Health Plan,81.88,92,,percent of total billed charges,,
NALOXONE 0.4 MG/ML INJ SYRG,,J2310,HCPCS,Facility,Outpatient,1,mL,,89,75.65,25.5074,89,"UCare Health, Inc.",Individual & Family Plan,50.1515,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
NALOXONE 0.4 MG/ML INJ SYRG,,J2310,HCPCS,Facility,Inpatient,1,mL,,89,75.65,25.5074,89,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
NALOXONE 0.4 MG/ML INJ SYRG,,J2310,HCPCS,Facility,Outpatient,1,mL,,89,75.65,25.5074,89,"UCare Health, Inc.",Medical Assistance,44.9183,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
NALOXONE 0.4 MG/ML INJ SYRG,,J2310,HCPCS,Facility,Inpatient,1,mL,,89,75.65,25.5074,89,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
NALOXONE 0.4 MG/ML INJ SYRG,,J2310,HCPCS,Facility,Outpatient,1,mL,,89,75.65,25.5074,89,"UCare Health, Inc.",Medicare Advantage,44.9183,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
NALOXONE 0.4 MG/ML INJ SYRG,,J2310,HCPCS,Facility,Inpatient,1,mL,,89,75.65,25.5074,89,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
NALOXONE 0.4 MG/ML INJ SYRG,,J2310,HCPCS,Facility,Outpatient,1,mL,,89,75.65,25.5074,89,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),44.9183,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
NALOXONE 0.4 MG/ML INJ SYRG,,J2310,HCPCS,Facility,Inpatient,1,mL,,89,75.65,25.5074,89,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
NALOXONE 0.4 MG/ML INJ SYRG,,J2310,HCPCS,Facility,Both,1,mL,,89,75.65,25.5074,89,UnitedHealthcare,Individual & Family,83.66,94,,percent of total billed charges,,
NALOXONE 0.4 MG/ML INJ SYRG,,J2310,HCPCS,Facility,Outpatient,1,mL,,89,75.65,25.5074,89,UnitedHealthcare,Medicare Advantage,43.61,49,,percent of total billed charges,,
NALOXONE 0.4 MG/ML INJ SYRG,,J2310,HCPCS,Facility,Inpatient,1,mL,,89,75.65,25.5074,89,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
NALOXONE 0.4 MG/ML INJ SYRG,,J2310,HCPCS,Facility,Outpatient,1,mL,,89,75.65,25.5074,89,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,42.72,48,,percent of total billed charges,,100% of DHS outpatient percentage
NALOXONE 0.4 MG/ML INJ SYRG,,J2310,HCPCS,Facility,Inpatient,1,mL,,89,75.65,25.5074,89,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
PHENYLEPHRINE HCL 10 MG/ML INJ SOLN,,J2371,HCPCS,Facility,Both,1,mL,,22,18.7,6.3052,22,Aetna,Commercial,20.24,92,,percent of total billed charges,,
PHENYLEPHRINE HCL 10 MG/ML INJ SOLN,,J2371,HCPCS,Facility,Outpatient,1,mL,,22,18.7,6.3052,22,Aetna,Medicare Advantage,10.78,49,,percent of total billed charges,,
PHENYLEPHRINE HCL 10 MG/ML INJ SOLN,,J2371,HCPCS,Facility,Inpatient,1,mL,,22,18.7,6.3052,22,Aetna,Medicare Advantage,,,,,Included in per diem rate,
PHENYLEPHRINE HCL 10 MG/ML INJ SOLN,,J2371,HCPCS,Facility,Both,1,mL,,22,18.7,6.3052,22,Aetna,PPO,20.46,93,,percent of total billed charges,,
PHENYLEPHRINE HCL 10 MG/ML INJ SOLN,,J2371,HCPCS,Facility,Both,1,mL,,22,18.7,6.3052,22,America's PPO,America's PPO,21.1266,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
PHENYLEPHRINE HCL 10 MG/ML INJ SOLN,,J2371,HCPCS,Facility,Both,1,mL,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota, Federal Employee Program,21.648,98.4,,percent of total billed charges,,
PHENYLEPHRINE HCL 10 MG/ML INJ SOLN,,J2371,HCPCS,Facility,Both,1,mL,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,22,100,,percent of total billed charges,,
PHENYLEPHRINE HCL 10 MG/ML INJ SOLN,,J2371,HCPCS,Facility,Both,1,mL,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota,High Value Network Plan,19.8,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
PHENYLEPHRINE HCL 10 MG/ML INJ SOLN,,J2371,HCPCS,Facility,Outpatient,1,mL,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota,Medicare Advantage,10.78,49,,percent of total billed charges,,
PHENYLEPHRINE HCL 10 MG/ML INJ SOLN,,J2371,HCPCS,Facility,Inpatient,1,mL,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
PHENYLEPHRINE HCL 10 MG/ML INJ SOLN,,J2371,HCPCS,Facility,Both,1,mL,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,19.4854,88.57,,percent of total billed charges,,
PHENYLEPHRINE HCL 10 MG/ML INJ SOLN,,J2371,HCPCS,Facility,Both,1,mL,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,6.3052,28.66,,percent of total billed charges,,
PHENYLEPHRINE HCL 10 MG/ML INJ SOLN,,J2371,HCPCS,Facility,Outpatient,1,mL,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),10.78,49,,percent of total billed charges,,
PHENYLEPHRINE HCL 10 MG/ML INJ SOLN,,J2371,HCPCS,Facility,Inpatient,1,mL,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
PHENYLEPHRINE HCL 10 MG/ML INJ SOLN,,J2371,HCPCS,Facility,Both,1,mL,,22,18.7,6.3052,22,CorVel,Worker's Compensation,22,100,,percent of total billed charges,,
PHENYLEPHRINE HCL 10 MG/ML INJ SOLN,,J2371,HCPCS,Facility,Both,1,mL,,22,18.7,6.3052,22,First Health Group Corporation,First Health Network,21.34,97,,percent of total billed charges,,
PHENYLEPHRINE HCL 10 MG/ML INJ SOLN,,J2371,HCPCS,Facility,Both,1,mL,,22,18.7,6.3052,22,"Health Partners, Inc.",Commercial,20.812,94.6,,percent of total billed charges,,
PHENYLEPHRINE HCL 10 MG/ML INJ SOLN,,J2371,HCPCS,Facility,Outpatient,1,mL,,22,18.7,6.3052,22,"Health Partners, Inc.",Medicare Advantage,10.78,49,,percent of total billed charges,,
PHENYLEPHRINE HCL 10 MG/ML INJ SOLN,,J2371,HCPCS,Facility,Inpatient,1,mL,,22,18.7,6.3052,22,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PHENYLEPHRINE HCL 10 MG/ML INJ SOLN,,J2371,HCPCS,Facility,Both,1,mL,,22,18.7,6.3052,22,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),13.2,60,,percent of total billed charges,,
PHENYLEPHRINE HCL 10 MG/ML INJ SOLN,,J2371,HCPCS,Facility,Both,1,mL,,22,18.7,6.3052,22,"Health Partners, Inc.",State of Minnesota Advantage Program,17.93,81.5,,percent of total billed charges,,
PHENYLEPHRINE HCL 10 MG/ML INJ SOLN,,J2371,HCPCS,Facility,Both,1,mL,,22,18.7,6.3052,22,"Health Partners, Inc.",State Public Programs,11,50,,percent of total billed charges,,
PHENYLEPHRINE HCL 10 MG/ML INJ SOLN,,J2371,HCPCS,Facility,Both,1,mL,,22,18.7,6.3052,22,Humana Insurance Company,Commercial PPO,20.9,95,,percent of total billed charges,,
PHENYLEPHRINE HCL 10 MG/ML INJ SOLN,,J2371,HCPCS,Facility,Outpatient,1,mL,,22,18.7,6.3052,22,Humana Insurance Company,Medicare PPO,10.78,49,,percent of total billed charges,,
PHENYLEPHRINE HCL 10 MG/ML INJ SOLN,,J2371,HCPCS,Facility,Inpatient,1,mL,,22,18.7,6.3052,22,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
PHENYLEPHRINE HCL 10 MG/ML INJ SOLN,,J2371,HCPCS,Facility,Both,1,mL,,22,18.7,6.3052,22,Medica,Individual & Family,21.802,99.1,,percent of total billed charges,,
PHENYLEPHRINE HCL 10 MG/ML INJ SOLN,,J2371,HCPCS,Facility,Outpatient,1,mL,,22,18.7,6.3052,22,Medica,Medica Advantage Solution,10.956,49.8,,percent of total billed charges,,
PHENYLEPHRINE HCL 10 MG/ML INJ SOLN,,J2371,HCPCS,Facility,Inpatient,1,mL,,22,18.7,6.3052,22,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
PHENYLEPHRINE HCL 10 MG/ML INJ SOLN,,J2371,HCPCS,Facility,Outpatient,1,mL,,22,18.7,6.3052,22,Medica,Medical Assistance,9.812,44.6,,percent of total billed charges,,
PHENYLEPHRINE HCL 10 MG/ML INJ SOLN,,J2371,HCPCS,Facility,Inpatient,1,mL,,22,18.7,6.3052,22,Medica,Medical Assistance,,,,,Included in per diem rate,
PHENYLEPHRINE HCL 10 MG/ML INJ SOLN,,J2371,HCPCS,Facility,Outpatient,1,mL,,22,18.7,6.3052,22,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,10.956,49.8,,percent of total billed charges,,
PHENYLEPHRINE HCL 10 MG/ML INJ SOLN,,J2371,HCPCS,Facility,Inpatient,1,mL,,22,18.7,6.3052,22,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
PHENYLEPHRINE HCL 10 MG/ML INJ SOLN,,J2371,HCPCS,Facility,Both,1,mL,,22,18.7,6.3052,22,"Multiplan, Inc.","Multiplan, Inc.",20.68,94,,percent of total billed charges,,
PHENYLEPHRINE HCL 10 MG/ML INJ SOLN,,J2371,HCPCS,Facility,Outpatient,1,mL,,22,18.7,6.3052,22,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,19.822,90.1,,percent of total billed charges,,
PHENYLEPHRINE HCL 10 MG/ML INJ SOLN,,J2371,HCPCS,Facility,Inpatient,1,mL,,22,18.7,6.3052,22,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
PHENYLEPHRINE HCL 10 MG/ML INJ SOLN,,J2371,HCPCS,Facility,Both,1,mL,,22,18.7,6.3052,22,"Preferred One Administrative Services, INC.",PPO,21.692,98.6,,percent of total billed charges,,
PHENYLEPHRINE HCL 10 MG/ML INJ SOLN,,J2371,HCPCS,Facility,Outpatient,1,mL,,22,18.7,6.3052,22,PrimeWest Health,Minnesota Senior Health Options (MSHO),11.319,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
PHENYLEPHRINE HCL 10 MG/ML INJ SOLN,,J2371,HCPCS,Facility,Inpatient,1,mL,,22,18.7,6.3052,22,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PHENYLEPHRINE HCL 10 MG/ML INJ SOLN,,J2371,HCPCS,Facility,Outpatient,1,mL,,22,18.7,6.3052,22,PrimeWest Health,MinnesotaCare,11.2992,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
PHENYLEPHRINE HCL 10 MG/ML INJ SOLN,,J2371,HCPCS,Facility,Inpatient,1,mL,,22,18.7,6.3052,22,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
PHENYLEPHRINE HCL 10 MG/ML INJ SOLN,,J2371,HCPCS,Facility,Both,1,mL,,22,18.7,6.3052,22,Sanford Health Plan,Sanford Health Plan,20.24,92,,percent of total billed charges,,
PHENYLEPHRINE HCL 10 MG/ML INJ SOLN,,J2371,HCPCS,Facility,Outpatient,1,mL,,22,18.7,6.3052,22,"UCare Health, Inc.",Individual & Family Plan,12.397,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
PHENYLEPHRINE HCL 10 MG/ML INJ SOLN,,J2371,HCPCS,Facility,Inpatient,1,mL,,22,18.7,6.3052,22,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
PHENYLEPHRINE HCL 10 MG/ML INJ SOLN,,J2371,HCPCS,Facility,Outpatient,1,mL,,22,18.7,6.3052,22,"UCare Health, Inc.",Medical Assistance,11.1034,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PHENYLEPHRINE HCL 10 MG/ML INJ SOLN,,J2371,HCPCS,Facility,Inpatient,1,mL,,22,18.7,6.3052,22,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
PHENYLEPHRINE HCL 10 MG/ML INJ SOLN,,J2371,HCPCS,Facility,Outpatient,1,mL,,22,18.7,6.3052,22,"UCare Health, Inc.",Medicare Advantage,11.1034,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PHENYLEPHRINE HCL 10 MG/ML INJ SOLN,,J2371,HCPCS,Facility,Inpatient,1,mL,,22,18.7,6.3052,22,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PHENYLEPHRINE HCL 10 MG/ML INJ SOLN,,J2371,HCPCS,Facility,Outpatient,1,mL,,22,18.7,6.3052,22,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),11.1034,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PHENYLEPHRINE HCL 10 MG/ML INJ SOLN,,J2371,HCPCS,Facility,Inpatient,1,mL,,22,18.7,6.3052,22,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PHENYLEPHRINE HCL 10 MG/ML INJ SOLN,,J2371,HCPCS,Facility,Both,1,mL,,22,18.7,6.3052,22,UnitedHealthcare,Individual & Family,20.68,94,,percent of total billed charges,,
PHENYLEPHRINE HCL 10 MG/ML INJ SOLN,,J2371,HCPCS,Facility,Outpatient,1,mL,,22,18.7,6.3052,22,UnitedHealthcare,Medicare Advantage,10.78,49,,percent of total billed charges,,
PHENYLEPHRINE HCL 10 MG/ML INJ SOLN,,J2371,HCPCS,Facility,Inpatient,1,mL,,22,18.7,6.3052,22,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
PHENYLEPHRINE HCL 10 MG/ML INJ SOLN,,J2371,HCPCS,Facility,Outpatient,1,mL,,22,18.7,6.3052,22,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,10.56,48,,percent of total billed charges,,100% of DHS outpatient percentage
PHENYLEPHRINE HCL 10 MG/ML INJ SOLN,,J2371,HCPCS,Facility,Inpatient,1,mL,,22,18.7,6.3052,22,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
PALIPERIDONE PALMITATE 156 MG/ML IM SYRG,,J2426,HCPCS,Facility,Both,1,mL,,8036,6830.6,2303.1176,8036,Aetna,Commercial,7393.12,92,,percent of total billed charges,,
PALIPERIDONE PALMITATE 156 MG/ML IM SYRG,,J2426,HCPCS,Facility,Outpatient,1,mL,,8036,6830.6,2303.1176,8036,Aetna,Medicare Advantage,3937.64,49,,percent of total billed charges,,
PALIPERIDONE PALMITATE 156 MG/ML IM SYRG,,J2426,HCPCS,Facility,Inpatient,1,mL,,8036,6830.6,2303.1176,8036,Aetna,Medicare Advantage,,,,,Included in per diem rate,
PALIPERIDONE PALMITATE 156 MG/ML IM SYRG,,J2426,HCPCS,Facility,Both,1,mL,,8036,6830.6,2303.1176,8036,Aetna,PPO,7473.48,93,,percent of total billed charges,,
PALIPERIDONE PALMITATE 156 MG/ML IM SYRG,,J2426,HCPCS,Facility,Both,1,mL,,8036,6830.6,2303.1176,8036,America's PPO,America's PPO,7716.9708,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
PALIPERIDONE PALMITATE 156 MG/ML IM SYRG,,J2426,HCPCS,Facility,Both,1,mL,,8036,6830.6,2303.1176,8036,BlueCross BlueShield Minnesota, Federal Employee Program,7907.424,98.4,,percent of total billed charges,,
PALIPERIDONE PALMITATE 156 MG/ML IM SYRG,,J2426,HCPCS,Facility,Both,1,mL,,8036,6830.6,2303.1176,8036,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,8036,100,,percent of total billed charges,,
PALIPERIDONE PALMITATE 156 MG/ML IM SYRG,,J2426,HCPCS,Facility,Both,1,mL,,8036,6830.6,2303.1176,8036,BlueCross BlueShield Minnesota,High Value Network Plan,7232.4,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
PALIPERIDONE PALMITATE 156 MG/ML IM SYRG,,J2426,HCPCS,Facility,Outpatient,1,mL,,8036,6830.6,2303.1176,8036,BlueCross BlueShield Minnesota,Medicare Advantage,3937.64,49,,percent of total billed charges,,
PALIPERIDONE PALMITATE 156 MG/ML IM SYRG,,J2426,HCPCS,Facility,Inpatient,1,mL,,8036,6830.6,2303.1176,8036,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
PALIPERIDONE PALMITATE 156 MG/ML IM SYRG,,J2426,HCPCS,Facility,Both,1,mL,,8036,6830.6,2303.1176,8036,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,7117.4852,88.57,,percent of total billed charges,,
PALIPERIDONE PALMITATE 156 MG/ML IM SYRG,,J2426,HCPCS,Facility,Both,1,mL,,8036,6830.6,2303.1176,8036,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,2303.1176,28.66,,percent of total billed charges,,
PALIPERIDONE PALMITATE 156 MG/ML IM SYRG,,J2426,HCPCS,Facility,Outpatient,1,mL,,8036,6830.6,2303.1176,8036,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),3937.64,49,,percent of total billed charges,,
PALIPERIDONE PALMITATE 156 MG/ML IM SYRG,,J2426,HCPCS,Facility,Inpatient,1,mL,,8036,6830.6,2303.1176,8036,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
PALIPERIDONE PALMITATE 156 MG/ML IM SYRG,,J2426,HCPCS,Facility,Both,1,mL,,8036,6830.6,2303.1176,8036,CorVel,Worker's Compensation,8036,100,,percent of total billed charges,,
PALIPERIDONE PALMITATE 156 MG/ML IM SYRG,,J2426,HCPCS,Facility,Both,1,mL,,8036,6830.6,2303.1176,8036,First Health Group Corporation,First Health Network,7794.92,97,,percent of total billed charges,,
PALIPERIDONE PALMITATE 156 MG/ML IM SYRG,,J2426,HCPCS,Facility,Both,1,mL,,8036,6830.6,2303.1176,8036,"Health Partners, Inc.",Commercial,7602.056,94.6,,percent of total billed charges,,
PALIPERIDONE PALMITATE 156 MG/ML IM SYRG,,J2426,HCPCS,Facility,Outpatient,1,mL,,8036,6830.6,2303.1176,8036,"Health Partners, Inc.",Medicare Advantage,3937.64,49,,percent of total billed charges,,
PALIPERIDONE PALMITATE 156 MG/ML IM SYRG,,J2426,HCPCS,Facility,Inpatient,1,mL,,8036,6830.6,2303.1176,8036,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PALIPERIDONE PALMITATE 156 MG/ML IM SYRG,,J2426,HCPCS,Facility,Both,1,mL,,8036,6830.6,2303.1176,8036,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),4821.6,60,,percent of total billed charges,,
PALIPERIDONE PALMITATE 156 MG/ML IM SYRG,,J2426,HCPCS,Facility,Both,1,mL,,8036,6830.6,2303.1176,8036,"Health Partners, Inc.",State of Minnesota Advantage Program,6549.34,81.5,,percent of total billed charges,,
PALIPERIDONE PALMITATE 156 MG/ML IM SYRG,,J2426,HCPCS,Facility,Both,1,mL,,8036,6830.6,2303.1176,8036,"Health Partners, Inc.",State Public Programs,4018,50,,percent of total billed charges,,
PALIPERIDONE PALMITATE 156 MG/ML IM SYRG,,J2426,HCPCS,Facility,Both,1,mL,,8036,6830.6,2303.1176,8036,Humana Insurance Company,Commercial PPO,7634.2,95,,percent of total billed charges,,
PALIPERIDONE PALMITATE 156 MG/ML IM SYRG,,J2426,HCPCS,Facility,Outpatient,1,mL,,8036,6830.6,2303.1176,8036,Humana Insurance Company,Medicare PPO,3937.64,49,,percent of total billed charges,,
PALIPERIDONE PALMITATE 156 MG/ML IM SYRG,,J2426,HCPCS,Facility,Inpatient,1,mL,,8036,6830.6,2303.1176,8036,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
PALIPERIDONE PALMITATE 156 MG/ML IM SYRG,,J2426,HCPCS,Facility,Both,1,mL,,8036,6830.6,2303.1176,8036,Medica,Individual & Family,7963.676,99.1,,percent of total billed charges,,
PALIPERIDONE PALMITATE 156 MG/ML IM SYRG,,J2426,HCPCS,Facility,Outpatient,1,mL,,8036,6830.6,2303.1176,8036,Medica,Medica Advantage Solution,4001.928,49.8,,percent of total billed charges,,
PALIPERIDONE PALMITATE 156 MG/ML IM SYRG,,J2426,HCPCS,Facility,Inpatient,1,mL,,8036,6830.6,2303.1176,8036,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
PALIPERIDONE PALMITATE 156 MG/ML IM SYRG,,J2426,HCPCS,Facility,Outpatient,1,mL,,8036,6830.6,2303.1176,8036,Medica,Medical Assistance,3584.056,44.6,,percent of total billed charges,,
PALIPERIDONE PALMITATE 156 MG/ML IM SYRG,,J2426,HCPCS,Facility,Inpatient,1,mL,,8036,6830.6,2303.1176,8036,Medica,Medical Assistance,,,,,Included in per diem rate,
PALIPERIDONE PALMITATE 156 MG/ML IM SYRG,,J2426,HCPCS,Facility,Outpatient,1,mL,,8036,6830.6,2303.1176,8036,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,4001.928,49.8,,percent of total billed charges,,
PALIPERIDONE PALMITATE 156 MG/ML IM SYRG,,J2426,HCPCS,Facility,Inpatient,1,mL,,8036,6830.6,2303.1176,8036,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
PALIPERIDONE PALMITATE 156 MG/ML IM SYRG,,J2426,HCPCS,Facility,Both,1,mL,,8036,6830.6,2303.1176,8036,"Multiplan, Inc.","Multiplan, Inc.",7553.84,94,,percent of total billed charges,,
PALIPERIDONE PALMITATE 156 MG/ML IM SYRG,,J2426,HCPCS,Facility,Outpatient,1,mL,,8036,6830.6,2303.1176,8036,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,7240.436,90.1,,percent of total billed charges,,
PALIPERIDONE PALMITATE 156 MG/ML IM SYRG,,J2426,HCPCS,Facility,Inpatient,1,mL,,8036,6830.6,2303.1176,8036,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
PALIPERIDONE PALMITATE 156 MG/ML IM SYRG,,J2426,HCPCS,Facility,Both,1,mL,,8036,6830.6,2303.1176,8036,"Preferred One Administrative Services, INC.",PPO,7923.496,98.6,,percent of total billed charges,,
PALIPERIDONE PALMITATE 156 MG/ML IM SYRG,,J2426,HCPCS,Facility,Outpatient,1,mL,,8036,6830.6,2303.1176,8036,PrimeWest Health,Minnesota Senior Health Options (MSHO),4134.522,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
PALIPERIDONE PALMITATE 156 MG/ML IM SYRG,,J2426,HCPCS,Facility,Inpatient,1,mL,,8036,6830.6,2303.1176,8036,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PALIPERIDONE PALMITATE 156 MG/ML IM SYRG,,J2426,HCPCS,Facility,Outpatient,1,mL,,8036,6830.6,2303.1176,8036,PrimeWest Health,MinnesotaCare,4127.2896,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
PALIPERIDONE PALMITATE 156 MG/ML IM SYRG,,J2426,HCPCS,Facility,Inpatient,1,mL,,8036,6830.6,2303.1176,8036,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
PALIPERIDONE PALMITATE 156 MG/ML IM SYRG,,J2426,HCPCS,Facility,Both,1,mL,,8036,6830.6,2303.1176,8036,Sanford Health Plan,Sanford Health Plan,7393.12,92,,percent of total billed charges,,
PALIPERIDONE PALMITATE 156 MG/ML IM SYRG,,J2426,HCPCS,Facility,Outpatient,1,mL,,8036,6830.6,2303.1176,8036,"UCare Health, Inc.",Individual & Family Plan,4528.286,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
PALIPERIDONE PALMITATE 156 MG/ML IM SYRG,,J2426,HCPCS,Facility,Inpatient,1,mL,,8036,6830.6,2303.1176,8036,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
PALIPERIDONE PALMITATE 156 MG/ML IM SYRG,,J2426,HCPCS,Facility,Outpatient,1,mL,,8036,6830.6,2303.1176,8036,"UCare Health, Inc.",Medical Assistance,4055.7692,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PALIPERIDONE PALMITATE 156 MG/ML IM SYRG,,J2426,HCPCS,Facility,Inpatient,1,mL,,8036,6830.6,2303.1176,8036,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
PALIPERIDONE PALMITATE 156 MG/ML IM SYRG,,J2426,HCPCS,Facility,Outpatient,1,mL,,8036,6830.6,2303.1176,8036,"UCare Health, Inc.",Medicare Advantage,4055.7692,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PALIPERIDONE PALMITATE 156 MG/ML IM SYRG,,J2426,HCPCS,Facility,Inpatient,1,mL,,8036,6830.6,2303.1176,8036,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PALIPERIDONE PALMITATE 156 MG/ML IM SYRG,,J2426,HCPCS,Facility,Outpatient,1,mL,,8036,6830.6,2303.1176,8036,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),4055.7692,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PALIPERIDONE PALMITATE 156 MG/ML IM SYRG,,J2426,HCPCS,Facility,Inpatient,1,mL,,8036,6830.6,2303.1176,8036,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PALIPERIDONE PALMITATE 156 MG/ML IM SYRG,,J2426,HCPCS,Facility,Both,1,mL,,8036,6830.6,2303.1176,8036,UnitedHealthcare,Individual & Family,7553.84,94,,percent of total billed charges,,
PALIPERIDONE PALMITATE 156 MG/ML IM SYRG,,J2426,HCPCS,Facility,Outpatient,1,mL,,8036,6830.6,2303.1176,8036,UnitedHealthcare,Medicare Advantage,3937.64,49,,percent of total billed charges,,
PALIPERIDONE PALMITATE 156 MG/ML IM SYRG,,J2426,HCPCS,Facility,Inpatient,1,mL,,8036,6830.6,2303.1176,8036,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
PALIPERIDONE PALMITATE 156 MG/ML IM SYRG,,J2426,HCPCS,Facility,Outpatient,1,mL,,8036,6830.6,2303.1176,8036,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,3857.28,48,,percent of total billed charges,,100% of DHS outpatient percentage
PALIPERIDONE PALMITATE 156 MG/ML IM SYRG,,J2426,HCPCS,Facility,Inpatient,1,mL,,8036,6830.6,2303.1176,8036,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
PHENOBARBITAL SODIUM 65 MG/ML INJ SOLN,,J2560,HCPCS,Facility,Both,1,mL,,118,100.3,33.8188,118,Aetna,Commercial,108.56,92,,percent of total billed charges,,
PHENOBARBITAL SODIUM 65 MG/ML INJ SOLN,,J2560,HCPCS,Facility,Outpatient,1,mL,,118,100.3,33.8188,118,Aetna,Medicare Advantage,57.82,49,,percent of total billed charges,,
PHENOBARBITAL SODIUM 65 MG/ML INJ SOLN,,J2560,HCPCS,Facility,Inpatient,1,mL,,118,100.3,33.8188,118,Aetna,Medicare Advantage,,,,,Included in per diem rate,
PHENOBARBITAL SODIUM 65 MG/ML INJ SOLN,,J2560,HCPCS,Facility,Both,1,mL,,118,100.3,33.8188,118,Aetna,PPO,109.74,93,,percent of total billed charges,,
PHENOBARBITAL SODIUM 65 MG/ML INJ SOLN,,J2560,HCPCS,Facility,Both,1,mL,,118,100.3,33.8188,118,America's PPO,America's PPO,113.3154,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
PHENOBARBITAL SODIUM 65 MG/ML INJ SOLN,,J2560,HCPCS,Facility,Both,1,mL,,118,100.3,33.8188,118,BlueCross BlueShield Minnesota, Federal Employee Program,116.112,98.4,,percent of total billed charges,,
PHENOBARBITAL SODIUM 65 MG/ML INJ SOLN,,J2560,HCPCS,Facility,Both,1,mL,,118,100.3,33.8188,118,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,118,100,,percent of total billed charges,,
PHENOBARBITAL SODIUM 65 MG/ML INJ SOLN,,J2560,HCPCS,Facility,Both,1,mL,,118,100.3,33.8188,118,BlueCross BlueShield Minnesota,High Value Network Plan,106.2,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
PHENOBARBITAL SODIUM 65 MG/ML INJ SOLN,,J2560,HCPCS,Facility,Outpatient,1,mL,,118,100.3,33.8188,118,BlueCross BlueShield Minnesota,Medicare Advantage,57.82,49,,percent of total billed charges,,
PHENOBARBITAL SODIUM 65 MG/ML INJ SOLN,,J2560,HCPCS,Facility,Inpatient,1,mL,,118,100.3,33.8188,118,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
PHENOBARBITAL SODIUM 65 MG/ML INJ SOLN,,J2560,HCPCS,Facility,Both,1,mL,,118,100.3,33.8188,118,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,104.5126,88.57,,percent of total billed charges,,
PHENOBARBITAL SODIUM 65 MG/ML INJ SOLN,,J2560,HCPCS,Facility,Both,1,mL,,118,100.3,33.8188,118,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,33.8188,28.66,,percent of total billed charges,,
PHENOBARBITAL SODIUM 65 MG/ML INJ SOLN,,J2560,HCPCS,Facility,Outpatient,1,mL,,118,100.3,33.8188,118,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),57.82,49,,percent of total billed charges,,
PHENOBARBITAL SODIUM 65 MG/ML INJ SOLN,,J2560,HCPCS,Facility,Inpatient,1,mL,,118,100.3,33.8188,118,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
PHENOBARBITAL SODIUM 65 MG/ML INJ SOLN,,J2560,HCPCS,Facility,Both,1,mL,,118,100.3,33.8188,118,CorVel,Worker's Compensation,118,100,,percent of total billed charges,,
PHENOBARBITAL SODIUM 65 MG/ML INJ SOLN,,J2560,HCPCS,Facility,Both,1,mL,,118,100.3,33.8188,118,First Health Group Corporation,First Health Network,114.46,97,,percent of total billed charges,,
PHENOBARBITAL SODIUM 65 MG/ML INJ SOLN,,J2560,HCPCS,Facility,Both,1,mL,,118,100.3,33.8188,118,"Health Partners, Inc.",Commercial,111.628,94.6,,percent of total billed charges,,
PHENOBARBITAL SODIUM 65 MG/ML INJ SOLN,,J2560,HCPCS,Facility,Outpatient,1,mL,,118,100.3,33.8188,118,"Health Partners, Inc.",Medicare Advantage,57.82,49,,percent of total billed charges,,
PHENOBARBITAL SODIUM 65 MG/ML INJ SOLN,,J2560,HCPCS,Facility,Inpatient,1,mL,,118,100.3,33.8188,118,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PHENOBARBITAL SODIUM 65 MG/ML INJ SOLN,,J2560,HCPCS,Facility,Both,1,mL,,118,100.3,33.8188,118,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),70.8,60,,percent of total billed charges,,
PHENOBARBITAL SODIUM 65 MG/ML INJ SOLN,,J2560,HCPCS,Facility,Both,1,mL,,118,100.3,33.8188,118,"Health Partners, Inc.",State of Minnesota Advantage Program,96.17,81.5,,percent of total billed charges,,
PHENOBARBITAL SODIUM 65 MG/ML INJ SOLN,,J2560,HCPCS,Facility,Both,1,mL,,118,100.3,33.8188,118,"Health Partners, Inc.",State Public Programs,59,50,,percent of total billed charges,,
PHENOBARBITAL SODIUM 65 MG/ML INJ SOLN,,J2560,HCPCS,Facility,Both,1,mL,,118,100.3,33.8188,118,Humana Insurance Company,Commercial PPO,112.1,95,,percent of total billed charges,,
PHENOBARBITAL SODIUM 65 MG/ML INJ SOLN,,J2560,HCPCS,Facility,Outpatient,1,mL,,118,100.3,33.8188,118,Humana Insurance Company,Medicare PPO,57.82,49,,percent of total billed charges,,
PHENOBARBITAL SODIUM 65 MG/ML INJ SOLN,,J2560,HCPCS,Facility,Inpatient,1,mL,,118,100.3,33.8188,118,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
PHENOBARBITAL SODIUM 65 MG/ML INJ SOLN,,J2560,HCPCS,Facility,Both,1,mL,,118,100.3,33.8188,118,Medica,Individual & Family,116.938,99.1,,percent of total billed charges,,
PHENOBARBITAL SODIUM 65 MG/ML INJ SOLN,,J2560,HCPCS,Facility,Outpatient,1,mL,,118,100.3,33.8188,118,Medica,Medica Advantage Solution,58.764,49.8,,percent of total billed charges,,
PHENOBARBITAL SODIUM 65 MG/ML INJ SOLN,,J2560,HCPCS,Facility,Inpatient,1,mL,,118,100.3,33.8188,118,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
PHENOBARBITAL SODIUM 65 MG/ML INJ SOLN,,J2560,HCPCS,Facility,Outpatient,1,mL,,118,100.3,33.8188,118,Medica,Medical Assistance,52.628,44.6,,percent of total billed charges,,
PHENOBARBITAL SODIUM 65 MG/ML INJ SOLN,,J2560,HCPCS,Facility,Inpatient,1,mL,,118,100.3,33.8188,118,Medica,Medical Assistance,,,,,Included in per diem rate,
PHENOBARBITAL SODIUM 65 MG/ML INJ SOLN,,J2560,HCPCS,Facility,Outpatient,1,mL,,118,100.3,33.8188,118,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,58.764,49.8,,percent of total billed charges,,
PHENOBARBITAL SODIUM 65 MG/ML INJ SOLN,,J2560,HCPCS,Facility,Inpatient,1,mL,,118,100.3,33.8188,118,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
PHENOBARBITAL SODIUM 65 MG/ML INJ SOLN,,J2560,HCPCS,Facility,Both,1,mL,,118,100.3,33.8188,118,"Multiplan, Inc.","Multiplan, Inc.",110.92,94,,percent of total billed charges,,
PHENOBARBITAL SODIUM 65 MG/ML INJ SOLN,,J2560,HCPCS,Facility,Outpatient,1,mL,,118,100.3,33.8188,118,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,106.318,90.1,,percent of total billed charges,,
PHENOBARBITAL SODIUM 65 MG/ML INJ SOLN,,J2560,HCPCS,Facility,Inpatient,1,mL,,118,100.3,33.8188,118,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
PHENOBARBITAL SODIUM 65 MG/ML INJ SOLN,,J2560,HCPCS,Facility,Both,1,mL,,118,100.3,33.8188,118,"Preferred One Administrative Services, INC.",PPO,116.348,98.6,,percent of total billed charges,,
PHENOBARBITAL SODIUM 65 MG/ML INJ SOLN,,J2560,HCPCS,Facility,Outpatient,1,mL,,118,100.3,33.8188,118,PrimeWest Health,Minnesota Senior Health Options (MSHO),60.711,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
PHENOBARBITAL SODIUM 65 MG/ML INJ SOLN,,J2560,HCPCS,Facility,Inpatient,1,mL,,118,100.3,33.8188,118,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PHENOBARBITAL SODIUM 65 MG/ML INJ SOLN,,J2560,HCPCS,Facility,Outpatient,1,mL,,118,100.3,33.8188,118,PrimeWest Health,MinnesotaCare,60.6048,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
PHENOBARBITAL SODIUM 65 MG/ML INJ SOLN,,J2560,HCPCS,Facility,Inpatient,1,mL,,118,100.3,33.8188,118,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
PHENOBARBITAL SODIUM 65 MG/ML INJ SOLN,,J2560,HCPCS,Facility,Both,1,mL,,118,100.3,33.8188,118,Sanford Health Plan,Sanford Health Plan,108.56,92,,percent of total billed charges,,
PHENOBARBITAL SODIUM 65 MG/ML INJ SOLN,,J2560,HCPCS,Facility,Outpatient,1,mL,,118,100.3,33.8188,118,"UCare Health, Inc.",Individual & Family Plan,66.493,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
PHENOBARBITAL SODIUM 65 MG/ML INJ SOLN,,J2560,HCPCS,Facility,Inpatient,1,mL,,118,100.3,33.8188,118,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
PHENOBARBITAL SODIUM 65 MG/ML INJ SOLN,,J2560,HCPCS,Facility,Outpatient,1,mL,,118,100.3,33.8188,118,"UCare Health, Inc.",Medical Assistance,59.5546,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PHENOBARBITAL SODIUM 65 MG/ML INJ SOLN,,J2560,HCPCS,Facility,Inpatient,1,mL,,118,100.3,33.8188,118,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
PHENOBARBITAL SODIUM 65 MG/ML INJ SOLN,,J2560,HCPCS,Facility,Outpatient,1,mL,,118,100.3,33.8188,118,"UCare Health, Inc.",Medicare Advantage,59.5546,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PHENOBARBITAL SODIUM 65 MG/ML INJ SOLN,,J2560,HCPCS,Facility,Inpatient,1,mL,,118,100.3,33.8188,118,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PHENOBARBITAL SODIUM 65 MG/ML INJ SOLN,,J2560,HCPCS,Facility,Outpatient,1,mL,,118,100.3,33.8188,118,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),59.5546,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PHENOBARBITAL SODIUM 65 MG/ML INJ SOLN,,J2560,HCPCS,Facility,Inpatient,1,mL,,118,100.3,33.8188,118,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PHENOBARBITAL SODIUM 65 MG/ML INJ SOLN,,J2560,HCPCS,Facility,Both,1,mL,,118,100.3,33.8188,118,UnitedHealthcare,Individual & Family,110.92,94,,percent of total billed charges,,
PHENOBARBITAL SODIUM 65 MG/ML INJ SOLN,,J2560,HCPCS,Facility,Outpatient,1,mL,,118,100.3,33.8188,118,UnitedHealthcare,Medicare Advantage,57.82,49,,percent of total billed charges,,
PHENOBARBITAL SODIUM 65 MG/ML INJ SOLN,,J2560,HCPCS,Facility,Inpatient,1,mL,,118,100.3,33.8188,118,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
PHENOBARBITAL SODIUM 65 MG/ML INJ SOLN,,J2560,HCPCS,Facility,Outpatient,1,mL,,118,100.3,33.8188,118,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,56.64,48,,percent of total billed charges,,100% of DHS outpatient percentage
PHENOBARBITAL SODIUM 65 MG/ML INJ SOLN,,J2560,HCPCS,Facility,Inpatient,1,mL,,118,100.3,33.8188,118,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
OXYTOCIN 10 UNIT/ML INJ SOLN,,J2590,HCPCS,Facility,Both,1,mL,,9,7.65,2.5794,9,Aetna,Commercial,8.28,92,,percent of total billed charges,,
OXYTOCIN 10 UNIT/ML INJ SOLN,,J2590,HCPCS,Facility,Outpatient,1,mL,,9,7.65,2.5794,9,Aetna,Medicare Advantage,4.41,49,,percent of total billed charges,,
OXYTOCIN 10 UNIT/ML INJ SOLN,,J2590,HCPCS,Facility,Inpatient,1,mL,,9,7.65,2.5794,9,Aetna,Medicare Advantage,,,,,Included in per diem rate,
OXYTOCIN 10 UNIT/ML INJ SOLN,,J2590,HCPCS,Facility,Both,1,mL,,9,7.65,2.5794,9,Aetna,PPO,8.37,93,,percent of total billed charges,,
OXYTOCIN 10 UNIT/ML INJ SOLN,,J2590,HCPCS,Facility,Both,1,mL,,9,7.65,2.5794,9,America's PPO,America's PPO,8.6427,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
OXYTOCIN 10 UNIT/ML INJ SOLN,,J2590,HCPCS,Facility,Both,1,mL,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota, Federal Employee Program,8.856,98.4,,percent of total billed charges,,
OXYTOCIN 10 UNIT/ML INJ SOLN,,J2590,HCPCS,Facility,Both,1,mL,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,9,100,,percent of total billed charges,,
OXYTOCIN 10 UNIT/ML INJ SOLN,,J2590,HCPCS,Facility,Both,1,mL,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota,High Value Network Plan,8.1,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
OXYTOCIN 10 UNIT/ML INJ SOLN,,J2590,HCPCS,Facility,Outpatient,1,mL,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota,Medicare Advantage,4.41,49,,percent of total billed charges,,
OXYTOCIN 10 UNIT/ML INJ SOLN,,J2590,HCPCS,Facility,Inpatient,1,mL,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
OXYTOCIN 10 UNIT/ML INJ SOLN,,J2590,HCPCS,Facility,Both,1,mL,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,7.9713,88.57,,percent of total billed charges,,
OXYTOCIN 10 UNIT/ML INJ SOLN,,J2590,HCPCS,Facility,Both,1,mL,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,2.5794,28.66,,percent of total billed charges,,
OXYTOCIN 10 UNIT/ML INJ SOLN,,J2590,HCPCS,Facility,Outpatient,1,mL,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),4.41,49,,percent of total billed charges,,
OXYTOCIN 10 UNIT/ML INJ SOLN,,J2590,HCPCS,Facility,Inpatient,1,mL,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
OXYTOCIN 10 UNIT/ML INJ SOLN,,J2590,HCPCS,Facility,Both,1,mL,,9,7.65,2.5794,9,CorVel,Worker's Compensation,9,100,,percent of total billed charges,,
OXYTOCIN 10 UNIT/ML INJ SOLN,,J2590,HCPCS,Facility,Both,1,mL,,9,7.65,2.5794,9,First Health Group Corporation,First Health Network,8.73,97,,percent of total billed charges,,
OXYTOCIN 10 UNIT/ML INJ SOLN,,J2590,HCPCS,Facility,Both,1,mL,,9,7.65,2.5794,9,"Health Partners, Inc.",Commercial,8.514,94.6,,percent of total billed charges,,
OXYTOCIN 10 UNIT/ML INJ SOLN,,J2590,HCPCS,Facility,Outpatient,1,mL,,9,7.65,2.5794,9,"Health Partners, Inc.",Medicare Advantage,4.41,49,,percent of total billed charges,,
OXYTOCIN 10 UNIT/ML INJ SOLN,,J2590,HCPCS,Facility,Inpatient,1,mL,,9,7.65,2.5794,9,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
OXYTOCIN 10 UNIT/ML INJ SOLN,,J2590,HCPCS,Facility,Both,1,mL,,9,7.65,2.5794,9,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),5.4,60,,percent of total billed charges,,
OXYTOCIN 10 UNIT/ML INJ SOLN,,J2590,HCPCS,Facility,Both,1,mL,,9,7.65,2.5794,9,"Health Partners, Inc.",State of Minnesota Advantage Program,7.335,81.5,,percent of total billed charges,,
OXYTOCIN 10 UNIT/ML INJ SOLN,,J2590,HCPCS,Facility,Both,1,mL,,9,7.65,2.5794,9,"Health Partners, Inc.",State Public Programs,4.5,50,,percent of total billed charges,,
OXYTOCIN 10 UNIT/ML INJ SOLN,,J2590,HCPCS,Facility,Both,1,mL,,9,7.65,2.5794,9,Humana Insurance Company,Commercial PPO,8.55,95,,percent of total billed charges,,
OXYTOCIN 10 UNIT/ML INJ SOLN,,J2590,HCPCS,Facility,Outpatient,1,mL,,9,7.65,2.5794,9,Humana Insurance Company,Medicare PPO,4.41,49,,percent of total billed charges,,
OXYTOCIN 10 UNIT/ML INJ SOLN,,J2590,HCPCS,Facility,Inpatient,1,mL,,9,7.65,2.5794,9,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
OXYTOCIN 10 UNIT/ML INJ SOLN,,J2590,HCPCS,Facility,Both,1,mL,,9,7.65,2.5794,9,Medica,Individual & Family,8.919,99.1,,percent of total billed charges,,
OXYTOCIN 10 UNIT/ML INJ SOLN,,J2590,HCPCS,Facility,Outpatient,1,mL,,9,7.65,2.5794,9,Medica,Medica Advantage Solution,4.482,49.8,,percent of total billed charges,,
OXYTOCIN 10 UNIT/ML INJ SOLN,,J2590,HCPCS,Facility,Inpatient,1,mL,,9,7.65,2.5794,9,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
OXYTOCIN 10 UNIT/ML INJ SOLN,,J2590,HCPCS,Facility,Outpatient,1,mL,,9,7.65,2.5794,9,Medica,Medical Assistance,4.014,44.6,,percent of total billed charges,,
OXYTOCIN 10 UNIT/ML INJ SOLN,,J2590,HCPCS,Facility,Inpatient,1,mL,,9,7.65,2.5794,9,Medica,Medical Assistance,,,,,Included in per diem rate,
OXYTOCIN 10 UNIT/ML INJ SOLN,,J2590,HCPCS,Facility,Outpatient,1,mL,,9,7.65,2.5794,9,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,4.482,49.8,,percent of total billed charges,,
OXYTOCIN 10 UNIT/ML INJ SOLN,,J2590,HCPCS,Facility,Inpatient,1,mL,,9,7.65,2.5794,9,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
OXYTOCIN 10 UNIT/ML INJ SOLN,,J2590,HCPCS,Facility,Both,1,mL,,9,7.65,2.5794,9,"Multiplan, Inc.","Multiplan, Inc.",8.46,94,,percent of total billed charges,,
OXYTOCIN 10 UNIT/ML INJ SOLN,,J2590,HCPCS,Facility,Outpatient,1,mL,,9,7.65,2.5794,9,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,8.109,90.1,,percent of total billed charges,,
OXYTOCIN 10 UNIT/ML INJ SOLN,,J2590,HCPCS,Facility,Inpatient,1,mL,,9,7.65,2.5794,9,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
OXYTOCIN 10 UNIT/ML INJ SOLN,,J2590,HCPCS,Facility,Both,1,mL,,9,7.65,2.5794,9,"Preferred One Administrative Services, INC.",PPO,8.874,98.6,,percent of total billed charges,,
OXYTOCIN 10 UNIT/ML INJ SOLN,,J2590,HCPCS,Facility,Outpatient,1,mL,,9,7.65,2.5794,9,PrimeWest Health,Minnesota Senior Health Options (MSHO),4.6305,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
OXYTOCIN 10 UNIT/ML INJ SOLN,,J2590,HCPCS,Facility,Inpatient,1,mL,,9,7.65,2.5794,9,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
OXYTOCIN 10 UNIT/ML INJ SOLN,,J2590,HCPCS,Facility,Outpatient,1,mL,,9,7.65,2.5794,9,PrimeWest Health,MinnesotaCare,4.6224,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
OXYTOCIN 10 UNIT/ML INJ SOLN,,J2590,HCPCS,Facility,Inpatient,1,mL,,9,7.65,2.5794,9,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
OXYTOCIN 10 UNIT/ML INJ SOLN,,J2590,HCPCS,Facility,Both,1,mL,,9,7.65,2.5794,9,Sanford Health Plan,Sanford Health Plan,8.28,92,,percent of total billed charges,,
OXYTOCIN 10 UNIT/ML INJ SOLN,,J2590,HCPCS,Facility,Outpatient,1,mL,,9,7.65,2.5794,9,"UCare Health, Inc.",Individual & Family Plan,5.0715,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
OXYTOCIN 10 UNIT/ML INJ SOLN,,J2590,HCPCS,Facility,Inpatient,1,mL,,9,7.65,2.5794,9,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
OXYTOCIN 10 UNIT/ML INJ SOLN,,J2590,HCPCS,Facility,Outpatient,1,mL,,9,7.65,2.5794,9,"UCare Health, Inc.",Medical Assistance,4.5423,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
OXYTOCIN 10 UNIT/ML INJ SOLN,,J2590,HCPCS,Facility,Inpatient,1,mL,,9,7.65,2.5794,9,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
OXYTOCIN 10 UNIT/ML INJ SOLN,,J2590,HCPCS,Facility,Outpatient,1,mL,,9,7.65,2.5794,9,"UCare Health, Inc.",Medicare Advantage,4.5423,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
OXYTOCIN 10 UNIT/ML INJ SOLN,,J2590,HCPCS,Facility,Inpatient,1,mL,,9,7.65,2.5794,9,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
OXYTOCIN 10 UNIT/ML INJ SOLN,,J2590,HCPCS,Facility,Outpatient,1,mL,,9,7.65,2.5794,9,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),4.5423,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
OXYTOCIN 10 UNIT/ML INJ SOLN,,J2590,HCPCS,Facility,Inpatient,1,mL,,9,7.65,2.5794,9,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
OXYTOCIN 10 UNIT/ML INJ SOLN,,J2590,HCPCS,Facility,Both,1,mL,,9,7.65,2.5794,9,UnitedHealthcare,Individual & Family,8.46,94,,percent of total billed charges,,
OXYTOCIN 10 UNIT/ML INJ SOLN,,J2590,HCPCS,Facility,Outpatient,1,mL,,9,7.65,2.5794,9,UnitedHealthcare,Medicare Advantage,4.41,49,,percent of total billed charges,,
OXYTOCIN 10 UNIT/ML INJ SOLN,,J2590,HCPCS,Facility,Inpatient,1,mL,,9,7.65,2.5794,9,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
OXYTOCIN 10 UNIT/ML INJ SOLN,,J2590,HCPCS,Facility,Outpatient,1,mL,,9,7.65,2.5794,9,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,4.32,48,,percent of total billed charges,,100% of DHS outpatient percentage
OXYTOCIN 10 UNIT/ML INJ SOLN,,J2590,HCPCS,Facility,Inpatient,1,mL,,9,7.65,2.5794,9,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
VASOPRESSIN 20 UNIT/ML IV SOLN,,J2598,HCPCS,Facility,Both,1,mL,,409,347.65,117.2194,409,Aetna,Commercial,376.28,92,,percent of total billed charges,,
VASOPRESSIN 20 UNIT/ML IV SOLN,,J2598,HCPCS,Facility,Outpatient,1,mL,,409,347.65,117.2194,409,Aetna,Medicare Advantage,200.41,49,,percent of total billed charges,,
VASOPRESSIN 20 UNIT/ML IV SOLN,,J2598,HCPCS,Facility,Inpatient,1,mL,,409,347.65,117.2194,409,Aetna,Medicare Advantage,,,,,Included in per diem rate,
VASOPRESSIN 20 UNIT/ML IV SOLN,,J2598,HCPCS,Facility,Both,1,mL,,409,347.65,117.2194,409,Aetna,PPO,380.37,93,,percent of total billed charges,,
VASOPRESSIN 20 UNIT/ML IV SOLN,,J2598,HCPCS,Facility,Both,1,mL,,409,347.65,117.2194,409,America's PPO,America's PPO,392.7627,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
VASOPRESSIN 20 UNIT/ML IV SOLN,,J2598,HCPCS,Facility,Both,1,mL,,409,347.65,117.2194,409,BlueCross BlueShield Minnesota, Federal Employee Program,402.456,98.4,,percent of total billed charges,,
VASOPRESSIN 20 UNIT/ML IV SOLN,,J2598,HCPCS,Facility,Both,1,mL,,409,347.65,117.2194,409,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,409,100,,percent of total billed charges,,
VASOPRESSIN 20 UNIT/ML IV SOLN,,J2598,HCPCS,Facility,Both,1,mL,,409,347.65,117.2194,409,BlueCross BlueShield Minnesota,High Value Network Plan,368.1,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
VASOPRESSIN 20 UNIT/ML IV SOLN,,J2598,HCPCS,Facility,Outpatient,1,mL,,409,347.65,117.2194,409,BlueCross BlueShield Minnesota,Medicare Advantage,200.41,49,,percent of total billed charges,,
VASOPRESSIN 20 UNIT/ML IV SOLN,,J2598,HCPCS,Facility,Inpatient,1,mL,,409,347.65,117.2194,409,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
VASOPRESSIN 20 UNIT/ML IV SOLN,,J2598,HCPCS,Facility,Both,1,mL,,409,347.65,117.2194,409,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,362.2513,88.57,,percent of total billed charges,,
VASOPRESSIN 20 UNIT/ML IV SOLN,,J2598,HCPCS,Facility,Both,1,mL,,409,347.65,117.2194,409,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,117.2194,28.66,,percent of total billed charges,,
VASOPRESSIN 20 UNIT/ML IV SOLN,,J2598,HCPCS,Facility,Outpatient,1,mL,,409,347.65,117.2194,409,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),200.41,49,,percent of total billed charges,,
VASOPRESSIN 20 UNIT/ML IV SOLN,,J2598,HCPCS,Facility,Inpatient,1,mL,,409,347.65,117.2194,409,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
VASOPRESSIN 20 UNIT/ML IV SOLN,,J2598,HCPCS,Facility,Both,1,mL,,409,347.65,117.2194,409,CorVel,Worker's Compensation,409,100,,percent of total billed charges,,
VASOPRESSIN 20 UNIT/ML IV SOLN,,J2598,HCPCS,Facility,Both,1,mL,,409,347.65,117.2194,409,First Health Group Corporation,First Health Network,396.73,97,,percent of total billed charges,,
VASOPRESSIN 20 UNIT/ML IV SOLN,,J2598,HCPCS,Facility,Both,1,mL,,409,347.65,117.2194,409,"Health Partners, Inc.",Commercial,386.914,94.6,,percent of total billed charges,,
VASOPRESSIN 20 UNIT/ML IV SOLN,,J2598,HCPCS,Facility,Outpatient,1,mL,,409,347.65,117.2194,409,"Health Partners, Inc.",Medicare Advantage,200.41,49,,percent of total billed charges,,
VASOPRESSIN 20 UNIT/ML IV SOLN,,J2598,HCPCS,Facility,Inpatient,1,mL,,409,347.65,117.2194,409,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
VASOPRESSIN 20 UNIT/ML IV SOLN,,J2598,HCPCS,Facility,Both,1,mL,,409,347.65,117.2194,409,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),245.4,60,,percent of total billed charges,,
VASOPRESSIN 20 UNIT/ML IV SOLN,,J2598,HCPCS,Facility,Both,1,mL,,409,347.65,117.2194,409,"Health Partners, Inc.",State of Minnesota Advantage Program,333.335,81.5,,percent of total billed charges,,
VASOPRESSIN 20 UNIT/ML IV SOLN,,J2598,HCPCS,Facility,Both,1,mL,,409,347.65,117.2194,409,"Health Partners, Inc.",State Public Programs,204.5,50,,percent of total billed charges,,
VASOPRESSIN 20 UNIT/ML IV SOLN,,J2598,HCPCS,Facility,Both,1,mL,,409,347.65,117.2194,409,Humana Insurance Company,Commercial PPO,388.55,95,,percent of total billed charges,,
VASOPRESSIN 20 UNIT/ML IV SOLN,,J2598,HCPCS,Facility,Outpatient,1,mL,,409,347.65,117.2194,409,Humana Insurance Company,Medicare PPO,200.41,49,,percent of total billed charges,,
VASOPRESSIN 20 UNIT/ML IV SOLN,,J2598,HCPCS,Facility,Inpatient,1,mL,,409,347.65,117.2194,409,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
VASOPRESSIN 20 UNIT/ML IV SOLN,,J2598,HCPCS,Facility,Both,1,mL,,409,347.65,117.2194,409,Medica,Individual & Family,405.319,99.1,,percent of total billed charges,,
VASOPRESSIN 20 UNIT/ML IV SOLN,,J2598,HCPCS,Facility,Outpatient,1,mL,,409,347.65,117.2194,409,Medica,Medica Advantage Solution,203.682,49.8,,percent of total billed charges,,
VASOPRESSIN 20 UNIT/ML IV SOLN,,J2598,HCPCS,Facility,Inpatient,1,mL,,409,347.65,117.2194,409,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
VASOPRESSIN 20 UNIT/ML IV SOLN,,J2598,HCPCS,Facility,Outpatient,1,mL,,409,347.65,117.2194,409,Medica,Medical Assistance,182.414,44.6,,percent of total billed charges,,
VASOPRESSIN 20 UNIT/ML IV SOLN,,J2598,HCPCS,Facility,Inpatient,1,mL,,409,347.65,117.2194,409,Medica,Medical Assistance,,,,,Included in per diem rate,
VASOPRESSIN 20 UNIT/ML IV SOLN,,J2598,HCPCS,Facility,Outpatient,1,mL,,409,347.65,117.2194,409,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,203.682,49.8,,percent of total billed charges,,
VASOPRESSIN 20 UNIT/ML IV SOLN,,J2598,HCPCS,Facility,Inpatient,1,mL,,409,347.65,117.2194,409,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
VASOPRESSIN 20 UNIT/ML IV SOLN,,J2598,HCPCS,Facility,Both,1,mL,,409,347.65,117.2194,409,"Multiplan, Inc.","Multiplan, Inc.",384.46,94,,percent of total billed charges,,
VASOPRESSIN 20 UNIT/ML IV SOLN,,J2598,HCPCS,Facility,Outpatient,1,mL,,409,347.65,117.2194,409,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,368.509,90.1,,percent of total billed charges,,
VASOPRESSIN 20 UNIT/ML IV SOLN,,J2598,HCPCS,Facility,Inpatient,1,mL,,409,347.65,117.2194,409,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
VASOPRESSIN 20 UNIT/ML IV SOLN,,J2598,HCPCS,Facility,Both,1,mL,,409,347.65,117.2194,409,"Preferred One Administrative Services, INC.",PPO,403.274,98.6,,percent of total billed charges,,
VASOPRESSIN 20 UNIT/ML IV SOLN,,J2598,HCPCS,Facility,Outpatient,1,mL,,409,347.65,117.2194,409,PrimeWest Health,Minnesota Senior Health Options (MSHO),210.4305,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
VASOPRESSIN 20 UNIT/ML IV SOLN,,J2598,HCPCS,Facility,Inpatient,1,mL,,409,347.65,117.2194,409,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
VASOPRESSIN 20 UNIT/ML IV SOLN,,J2598,HCPCS,Facility,Outpatient,1,mL,,409,347.65,117.2194,409,PrimeWest Health,MinnesotaCare,210.0624,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
VASOPRESSIN 20 UNIT/ML IV SOLN,,J2598,HCPCS,Facility,Inpatient,1,mL,,409,347.65,117.2194,409,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
VASOPRESSIN 20 UNIT/ML IV SOLN,,J2598,HCPCS,Facility,Both,1,mL,,409,347.65,117.2194,409,Sanford Health Plan,Sanford Health Plan,376.28,92,,percent of total billed charges,,
VASOPRESSIN 20 UNIT/ML IV SOLN,,J2598,HCPCS,Facility,Outpatient,1,mL,,409,347.65,117.2194,409,"UCare Health, Inc.",Individual & Family Plan,230.4715,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
VASOPRESSIN 20 UNIT/ML IV SOLN,,J2598,HCPCS,Facility,Inpatient,1,mL,,409,347.65,117.2194,409,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
VASOPRESSIN 20 UNIT/ML IV SOLN,,J2598,HCPCS,Facility,Outpatient,1,mL,,409,347.65,117.2194,409,"UCare Health, Inc.",Medical Assistance,206.4223,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
VASOPRESSIN 20 UNIT/ML IV SOLN,,J2598,HCPCS,Facility,Inpatient,1,mL,,409,347.65,117.2194,409,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
VASOPRESSIN 20 UNIT/ML IV SOLN,,J2598,HCPCS,Facility,Outpatient,1,mL,,409,347.65,117.2194,409,"UCare Health, Inc.",Medicare Advantage,206.4223,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
VASOPRESSIN 20 UNIT/ML IV SOLN,,J2598,HCPCS,Facility,Inpatient,1,mL,,409,347.65,117.2194,409,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
VASOPRESSIN 20 UNIT/ML IV SOLN,,J2598,HCPCS,Facility,Outpatient,1,mL,,409,347.65,117.2194,409,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),206.4223,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
VASOPRESSIN 20 UNIT/ML IV SOLN,,J2598,HCPCS,Facility,Inpatient,1,mL,,409,347.65,117.2194,409,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
VASOPRESSIN 20 UNIT/ML IV SOLN,,J2598,HCPCS,Facility,Both,1,mL,,409,347.65,117.2194,409,UnitedHealthcare,Individual & Family,384.46,94,,percent of total billed charges,,
VASOPRESSIN 20 UNIT/ML IV SOLN,,J2598,HCPCS,Facility,Outpatient,1,mL,,409,347.65,117.2194,409,UnitedHealthcare,Medicare Advantage,200.41,49,,percent of total billed charges,,
VASOPRESSIN 20 UNIT/ML IV SOLN,,J2598,HCPCS,Facility,Inpatient,1,mL,,409,347.65,117.2194,409,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
VASOPRESSIN 20 UNIT/ML IV SOLN,,J2598,HCPCS,Facility,Outpatient,1,mL,,409,347.65,117.2194,409,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,196.32,48,,percent of total billed charges,,100% of DHS outpatient percentage
VASOPRESSIN 20 UNIT/ML IV SOLN,,J2598,HCPCS,Facility,Inpatient,1,mL,,409,347.65,117.2194,409,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Bone Marrow Biopsy,,38221,CPT,Facility,Both,,,,1224,1040.4,350.7984,1224,Aetna,Commercial,1126.08,92,,percent of total billed charges,,
Bone Marrow Biopsy,,38221,CPT,Facility,Outpatient,,,,1224,1040.4,350.7984,1224,Aetna,Medicare Advantage,599.76,49,,percent of total billed charges,,
Bone Marrow Biopsy,,38221,CPT,Facility,Inpatient,,,,1224,1040.4,350.7984,1224,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Bone Marrow Biopsy,,38221,CPT,Facility,Both,,,,1224,1040.4,350.7984,1224,Aetna,PPO,1138.32,93,,percent of total billed charges,,
Bone Marrow Biopsy,,38221,CPT,Facility,Both,,,,1224,1040.4,350.7984,1224,America's PPO,America's PPO,1175.4072,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Bone Marrow Biopsy,,38221,CPT,Facility,Both,,,,1224,1040.4,350.7984,1224,BlueCross BlueShield Minnesota, Federal Employee Program,1204.416,98.4,,percent of total billed charges,,
Bone Marrow Biopsy,,38221,CPT,Facility,Both,,,,1224,1040.4,350.7984,1224,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1224,100,,percent of total billed charges,,
Bone Marrow Biopsy,,38221,CPT,Facility,Both,,,,1224,1040.4,350.7984,1224,BlueCross BlueShield Minnesota,High Value Network Plan,1101.6,90,,percent of total billed charges,,
Bone Marrow Biopsy,,38221,CPT,Facility,Outpatient,,,,1224,1040.4,350.7984,1224,BlueCross BlueShield Minnesota,Medicare Advantage,599.76,49,,percent of total billed charges,,
Bone Marrow Biopsy,,38221,CPT,Facility,Inpatient,,,,1224,1040.4,350.7984,1224,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Bone Marrow Biopsy,,38221,CPT,Facility,Both,,,,1224,1040.4,350.7984,1224,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1084.0968,88.57,,percent of total billed charges,,
Bone Marrow Biopsy,,38221,CPT,Facility,Both,,,,1224,1040.4,350.7984,1224,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,350.7984,28.66,,percent of total billed charges,,
Bone Marrow Biopsy,,38221,CPT,Facility,Outpatient,,,,1224,1040.4,350.7984,1224,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),599.76,49,,percent of total billed charges,,
Bone Marrow Biopsy,,38221,CPT,Facility,Inpatient,,,,1224,1040.4,350.7984,1224,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Bone Marrow Biopsy,,38221,CPT,Facility,Both,,,,1224,1040.4,350.7984,1224,CorVel,Worker's Compensation,1224,100,,percent of total billed charges,,
Bone Marrow Biopsy,,38221,CPT,Facility,Both,,,,1224,1040.4,350.7984,1224,First Health Group Corporation,First Health Network,1187.28,97,,percent of total billed charges,,
Bone Marrow Biopsy,,38221,CPT,Facility,Both,,,,1224,1040.4,350.7984,1224,"Health Partners, Inc.",Commercial,1157.904,94.6,,percent of total billed charges,,
Bone Marrow Biopsy,,38221,CPT,Facility,Outpatient,,,,1224,1040.4,350.7984,1224,"Health Partners, Inc.",Medicare Advantage,599.76,49,,percent of total billed charges,,
Bone Marrow Biopsy,,38221,CPT,Facility,Inpatient,,,,1224,1040.4,350.7984,1224,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Bone Marrow Biopsy,,38221,CPT,Facility,Both,,,,1224,1040.4,350.7984,1224,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),734.4,60,,percent of total billed charges,,
Bone Marrow Biopsy,,38221,CPT,Facility,Both,,,,1224,1040.4,350.7984,1224,"Health Partners, Inc.",State of Minnesota Advantage Program,997.56,81.5,,percent of total billed charges,,
Bone Marrow Biopsy,,38221,CPT,Facility,Both,,,,1224,1040.4,350.7984,1224,"Health Partners, Inc.",State Public Programs,612,50,,percent of total billed charges,,
Bone Marrow Biopsy,,38221,CPT,Facility,Both,,,,1224,1040.4,350.7984,1224,Humana Insurance Company,Commercial PPO,1162.8,95,,percent of total billed charges,,
Bone Marrow Biopsy,,38221,CPT,Facility,Outpatient,,,,1224,1040.4,350.7984,1224,Humana Insurance Company,Medicare PPO,599.76,49,,percent of total billed charges,,
Bone Marrow Biopsy,,38221,CPT,Facility,Inpatient,,,,1224,1040.4,350.7984,1224,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Bone Marrow Biopsy,,38221,CPT,Facility,Both,,,,1224,1040.4,350.7984,1224,Medica,Individual & Family,1212.984,99.1,,percent of total billed charges,,
Bone Marrow Biopsy,,38221,CPT,Facility,Outpatient,,,,1224,1040.4,350.7984,1224,Medica,Medica Advantage Solution,609.552,49.8,,percent of total billed charges,,
Bone Marrow Biopsy,,38221,CPT,Facility,Inpatient,,,,1224,1040.4,350.7984,1224,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Bone Marrow Biopsy,,38221,CPT,Facility,Outpatient,,,,1224,1040.4,350.7984,1224,Medica,Medical Assistance,449,,,Other,Grouper,All inclusive per visit
Bone Marrow Biopsy,,38221,CPT,Facility,Inpatient,,,,1224,1040.4,350.7984,1224,Medica,Medical Assistance,,,,,Included in per diem rate,
Bone Marrow Biopsy,,38221,CPT,Facility,Outpatient,,,,1224,1040.4,350.7984,1224,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,609.552,49.8,,percent of total billed charges,,
Bone Marrow Biopsy,,38221,CPT,Facility,Inpatient,,,,1224,1040.4,350.7984,1224,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Bone Marrow Biopsy,,38221,CPT,Facility,Both,,,,1224,1040.4,350.7984,1224,"Multiplan, Inc.","Multiplan, Inc.",1150.56,94,,percent of total billed charges,,
Bone Marrow Biopsy,,38221,CPT,Facility,Outpatient,,,,1224,1040.4,350.7984,1224,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1102.824,90.1,,percent of total billed charges,,
Bone Marrow Biopsy,,38221,CPT,Facility,Inpatient,,,,1224,1040.4,350.7984,1224,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Bone Marrow Biopsy,,38221,CPT,Facility,Both,,,,1224,1040.4,350.7984,1224,"Preferred One Administrative Services, INC.",PPO,1206.864,98.6,,percent of total billed charges,,
Bone Marrow Biopsy,,38221,CPT,Facility,Outpatient,,,,1224,1040.4,350.7984,1224,PrimeWest Health,Minnesota Senior Health Options (MSHO),629.748,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Bone Marrow Biopsy,,38221,CPT,Facility,Inpatient,,,,1224,1040.4,350.7984,1224,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Bone Marrow Biopsy,,38221,CPT,Facility,Outpatient,,,,1224,1040.4,350.7984,1224,PrimeWest Health,MinnesotaCare,628.6464,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Bone Marrow Biopsy,,38221,CPT,Facility,Inpatient,,,,1224,1040.4,350.7984,1224,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Bone Marrow Biopsy,,38221,CPT,Facility,Both,,,,1224,1040.4,350.7984,1224,Sanford Health Plan,Sanford Health Plan,1126.08,92,,percent of total billed charges,,
Bone Marrow Biopsy,,38221,CPT,Facility,Outpatient,,,,1224,1040.4,350.7984,1224,"UCare Health, Inc.",Individual & Family Plan,689.724,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Bone Marrow Biopsy,,38221,CPT,Facility,Inpatient,,,,1224,1040.4,350.7984,1224,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Bone Marrow Biopsy,,38221,CPT,Facility,Outpatient,,,,1224,1040.4,350.7984,1224,"UCare Health, Inc.",Medical Assistance,617.7528,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Bone Marrow Biopsy,,38221,CPT,Facility,Inpatient,,,,1224,1040.4,350.7984,1224,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Bone Marrow Biopsy,,38221,CPT,Facility,Outpatient,,,,1224,1040.4,350.7984,1224,"UCare Health, Inc.",Medicare Advantage,617.7528,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Bone Marrow Biopsy,,38221,CPT,Facility,Inpatient,,,,1224,1040.4,350.7984,1224,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Bone Marrow Biopsy,,38221,CPT,Facility,Outpatient,,,,1224,1040.4,350.7984,1224,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),617.7528,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Bone Marrow Biopsy,,38221,CPT,Facility,Inpatient,,,,1224,1040.4,350.7984,1224,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Bone Marrow Biopsy,,38221,CPT,Facility,Both,,,,1224,1040.4,350.7984,1224,UnitedHealthcare,Individual & Family,1150.56,94,,percent of total billed charges,,
Bone Marrow Biopsy,,38221,CPT,Facility,Outpatient,,,,1224,1040.4,350.7984,1224,UnitedHealthcare,Medicare Advantage,599.76,49,,percent of total billed charges,,
Bone Marrow Biopsy,,38221,CPT,Facility,Inpatient,,,,1224,1040.4,350.7984,1224,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Bone Marrow Biopsy,,38221,CPT,Facility,Outpatient,,,,1224,1040.4,350.7984,1224,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,587.52,48,,percent of total billed charges,,100% of DHS outpatient percentage
Bone Marrow Biopsy,,38221,CPT,Facility,Inpatient,,,,1224,1040.4,350.7984,1224,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Diagnostic Bone Marrow; Biopsy(Ies) (Pro Cah),,38221,CPT,Professional,Both,,,,788,669.8,43.84,788,Aetna,Commercial,669.8,85,,percent of total billed charges,,
Diagnostic Bone Marrow; Biopsy(Ies) (Pro Cah),,38221,CPT,Professional,Both,,,,788,669.8,43.84,788,Aetna,Medicare Advantage,69.1,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Diagnostic Bone Marrow; Biopsy(Ies) (Pro Cah),,38221,CPT,Professional,Both,,,,788,669.8,43.84,788,Aetna,PPO,732.84,93,,percent of total billed charges,,
Diagnostic Bone Marrow; Biopsy(Ies) (Pro Cah),,38221,CPT,Professional,Both,,,,788,669.8,43.84,788,America's PPO,America's PPO,673.2672,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Diagnostic Bone Marrow; Biopsy(Ies) (Pro Cah),,38221,CPT,Professional,Both,,,,788,669.8,43.84,788,BlueCross BlueShield Minnesota, Federal Employee Program,142.54,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Diagnostic Bone Marrow; Biopsy(Ies) (Pro Cah),,38221,CPT,Professional,Both,,,,788,669.8,43.84,788,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,144.82064,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Diagnostic Bone Marrow; Biopsy(Ies) (Pro Cah),,38221,CPT,Professional,Both,,,,788,669.8,43.84,788,BlueCross BlueShield Minnesota,High Value Network Plan,144.82064,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Diagnostic Bone Marrow; Biopsy(Ies) (Pro Cah),,38221,CPT,Professional,Both,,,,788,669.8,43.84,788,BlueCross BlueShield Minnesota,Medicare Advantage,78.5565,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Diagnostic Bone Marrow; Biopsy(Ies) (Pro Cah),,38221,CPT,Professional,Both,,,,788,669.8,43.84,788,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,144.82064,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Diagnostic Bone Marrow; Biopsy(Ies) (Pro Cah),,38221,CPT,Professional,Both,,,,788,669.8,43.84,788,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,50.61712,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Diagnostic Bone Marrow; Biopsy(Ies) (Pro Cah),,38221,CPT,Professional,Both,,,,788,669.8,43.84,788,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),78.5565,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Diagnostic Bone Marrow; Biopsy(Ies) (Pro Cah),,38221,CPT,Professional,Both,,,,788,669.8,43.84,788,CorVel,Worker's Compensation,135.7418379,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Diagnostic Bone Marrow; Biopsy(Ies) (Pro Cah),,38221,CPT,Professional,Both,,,,788,669.8,43.84,788,First Health Group Corporation,First Health Network,764.36,97,,percent of total billed charges,,
Diagnostic Bone Marrow; Biopsy(Ies) (Pro Cah),,38221,CPT,Professional,Both,,,,788,669.8,43.84,788,"Health Partners, Inc.",Commercial,146.56,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Diagnostic Bone Marrow; Biopsy(Ies) (Pro Cah),,38221,CPT,Professional,Both,,,,788,669.8,43.84,788,"Health Partners, Inc.",Medicare Advantage,78.5565,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Diagnostic Bone Marrow; Biopsy(Ies) (Pro Cah),,38221,CPT,Professional,Both,,,,788,669.8,43.84,788,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),68.11,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Diagnostic Bone Marrow; Biopsy(Ies) (Pro Cah),,38221,CPT,Professional,Both,,,,788,669.8,43.84,788,"Health Partners, Inc.",State of Minnesota Advantage Program,126.26144,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Diagnostic Bone Marrow; Biopsy(Ies) (Pro Cah),,38221,CPT,Professional,Both,,,,788,669.8,43.84,788,"Health Partners, Inc.",State Public Programs,43.84,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Diagnostic Bone Marrow; Biopsy(Ies) (Pro Cah),,38221,CPT,Professional,Both,,,,788,669.8,43.84,788,Humana Insurance Company,Commercial PPO,68.31,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Diagnostic Bone Marrow; Biopsy(Ies) (Pro Cah),,38221,CPT,Professional,Both,,,,788,669.8,43.84,788,Humana Insurance Company,Medicare PPO,788,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Diagnostic Bone Marrow; Biopsy(Ies) (Pro Cah),,38221,CPT,Professional,Both,,,,788,669.8,43.84,788,Medica,Individual & Family,668.224,84.8,,percent of total billed charges,,
Diagnostic Bone Marrow; Biopsy(Ies) (Pro Cah),,38221,CPT,Professional,Both,,,,788,669.8,43.84,788,Medica,Medica Advantage Solution,392.424,49.8,,percent of total billed charges,,
Diagnostic Bone Marrow; Biopsy(Ies) (Pro Cah),,38221,CPT,Professional,Both,,,,788,669.8,43.84,788,Medica,Medical Assistance,50.62,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Diagnostic Bone Marrow; Biopsy(Ies) (Pro Cah),,38221,CPT,Professional,Both,,,,788,669.8,43.84,788,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,68.31,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Diagnostic Bone Marrow; Biopsy(Ies) (Pro Cah),,38221,CPT,Professional,Both,,,,788,669.8,43.84,788,"Multiplan, Inc.","Multiplan, Inc.",740.72,94,,percent of total billed charges,,
Diagnostic Bone Marrow; Biopsy(Ies) (Pro Cah),,38221,CPT,Professional,Both,,,,788,669.8,43.84,788,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,709.988,90.1,,percent of total billed charges,,
Diagnostic Bone Marrow; Biopsy(Ies) (Pro Cah),,38221,CPT,Professional,Both,,,,788,669.8,43.84,788,"Preferred One Administrative Services, INC.",PPO,776.968,98.6,,percent of total billed charges,,
Diagnostic Bone Marrow; Biopsy(Ies) (Pro Cah),,38221,CPT,Professional,Both,,,,788,669.8,43.84,788,PrimeWest Health,Minnesota Senior Health Options (MSHO),78.5565,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Diagnostic Bone Marrow; Biopsy(Ies) (Pro Cah),,38221,CPT,Professional,Both,,,,788,669.8,43.84,788,PrimeWest Health,MinnesotaCare,54.1603184,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Diagnostic Bone Marrow; Biopsy(Ies) (Pro Cah),,38221,CPT,Professional,Both,,,,788,669.8,43.84,788,Sanford Health Plan,Sanford Health Plan,693.44,88,,percent of total billed charges,,
Diagnostic Bone Marrow; Biopsy(Ies) (Pro Cah),,38221,CPT,Professional,Both,,,,788,669.8,43.84,788,"UCare Health, Inc.",Individual & Family Plan,111.044736,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Diagnostic Bone Marrow; Biopsy(Ies) (Pro Cah),,38221,CPT,Professional,Both,,,,788,669.8,43.84,788,"UCare Health, Inc.",Medical Assistance,55.678832,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Diagnostic Bone Marrow; Biopsy(Ies) (Pro Cah),,38221,CPT,Professional,Both,,,,788,669.8,43.84,788,"UCare Health, Inc.",Medicare Advantage,78.5565,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Diagnostic Bone Marrow; Biopsy(Ies) (Pro Cah),,38221,CPT,Professional,Both,,,,788,669.8,43.84,788,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),62.8452,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Diagnostic Bone Marrow; Biopsy(Ies) (Pro Cah),,38221,CPT,Professional,Both,,,,788,669.8,43.84,788,UnitedHealthcare,Individual & Family,788,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Diagnostic Bone Marrow; Biopsy(Ies) (Pro Cah),,38221,CPT,Professional,Both,,,,788,669.8,43.84,788,UnitedHealthcare,Medicare Advantage,78.5565,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Diagnostic Bone Marrow; Biopsy(Ies) (Pro Cah),,38221,CPT,Professional,Both,,,,788,669.8,43.84,788,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,50.61712,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Bone Marrow Biopsy And Aspiration,,38222,CPT,Facility,Both,,,,2040,1734,584.664,2040,Aetna,Commercial,1876.8,92,,percent of total billed charges,,
Bone Marrow Biopsy And Aspiration,,38222,CPT,Facility,Outpatient,,,,2040,1734,584.664,2040,Aetna,Medicare Advantage,999.6,49,,percent of total billed charges,,
Bone Marrow Biopsy And Aspiration,,38222,CPT,Facility,Inpatient,,,,2040,1734,584.664,2040,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Bone Marrow Biopsy And Aspiration,,38222,CPT,Facility,Both,,,,2040,1734,584.664,2040,Aetna,PPO,1897.2,93,,percent of total billed charges,,
Bone Marrow Biopsy And Aspiration,,38222,CPT,Facility,Both,,,,2040,1734,584.664,2040,America's PPO,America's PPO,1959.012,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Bone Marrow Biopsy And Aspiration,,38222,CPT,Facility,Both,,,,2040,1734,584.664,2040,BlueCross BlueShield Minnesota, Federal Employee Program,2007.36,98.4,,percent of total billed charges,,
Bone Marrow Biopsy And Aspiration,,38222,CPT,Facility,Both,,,,2040,1734,584.664,2040,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,2040,100,,percent of total billed charges,,
Bone Marrow Biopsy And Aspiration,,38222,CPT,Facility,Both,,,,2040,1734,584.664,2040,BlueCross BlueShield Minnesota,High Value Network Plan,1836,90,,percent of total billed charges,,
Bone Marrow Biopsy And Aspiration,,38222,CPT,Facility,Outpatient,,,,2040,1734,584.664,2040,BlueCross BlueShield Minnesota,Medicare Advantage,999.6,49,,percent of total billed charges,,
Bone Marrow Biopsy And Aspiration,,38222,CPT,Facility,Inpatient,,,,2040,1734,584.664,2040,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Bone Marrow Biopsy And Aspiration,,38222,CPT,Facility,Both,,,,2040,1734,584.664,2040,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1806.828,88.57,,percent of total billed charges,,
Bone Marrow Biopsy And Aspiration,,38222,CPT,Facility,Both,,,,2040,1734,584.664,2040,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,584.664,28.66,,percent of total billed charges,,
Bone Marrow Biopsy And Aspiration,,38222,CPT,Facility,Outpatient,,,,2040,1734,584.664,2040,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),999.6,49,,percent of total billed charges,,
Bone Marrow Biopsy And Aspiration,,38222,CPT,Facility,Inpatient,,,,2040,1734,584.664,2040,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Bone Marrow Biopsy And Aspiration,,38222,CPT,Facility,Both,,,,2040,1734,584.664,2040,CorVel,Worker's Compensation,2040,100,,percent of total billed charges,,
Bone Marrow Biopsy And Aspiration,,38222,CPT,Facility,Both,,,,2040,1734,584.664,2040,First Health Group Corporation,First Health Network,1978.8,97,,percent of total billed charges,,
Bone Marrow Biopsy And Aspiration,,38222,CPT,Facility,Both,,,,2040,1734,584.664,2040,"Health Partners, Inc.",Commercial,1929.84,94.6,,percent of total billed charges,,
Bone Marrow Biopsy And Aspiration,,38222,CPT,Facility,Outpatient,,,,2040,1734,584.664,2040,"Health Partners, Inc.",Medicare Advantage,999.6,49,,percent of total billed charges,,
Bone Marrow Biopsy And Aspiration,,38222,CPT,Facility,Inpatient,,,,2040,1734,584.664,2040,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Bone Marrow Biopsy And Aspiration,,38222,CPT,Facility,Both,,,,2040,1734,584.664,2040,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1224,60,,percent of total billed charges,,
Bone Marrow Biopsy And Aspiration,,38222,CPT,Facility,Both,,,,2040,1734,584.664,2040,"Health Partners, Inc.",State of Minnesota Advantage Program,1662.6,81.5,,percent of total billed charges,,
Bone Marrow Biopsy And Aspiration,,38222,CPT,Facility,Both,,,,2040,1734,584.664,2040,"Health Partners, Inc.",State Public Programs,1020,50,,percent of total billed charges,,
Bone Marrow Biopsy And Aspiration,,38222,CPT,Facility,Both,,,,2040,1734,584.664,2040,Humana Insurance Company,Commercial PPO,1938,95,,percent of total billed charges,,
Bone Marrow Biopsy And Aspiration,,38222,CPT,Facility,Outpatient,,,,2040,1734,584.664,2040,Humana Insurance Company,Medicare PPO,999.6,49,,percent of total billed charges,,
Bone Marrow Biopsy And Aspiration,,38222,CPT,Facility,Inpatient,,,,2040,1734,584.664,2040,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Bone Marrow Biopsy And Aspiration,,38222,CPT,Facility,Both,,,,2040,1734,584.664,2040,Medica,Individual & Family,2021.64,99.1,,percent of total billed charges,,
Bone Marrow Biopsy And Aspiration,,38222,CPT,Facility,Outpatient,,,,2040,1734,584.664,2040,Medica,Medica Advantage Solution,1015.92,49.8,,percent of total billed charges,,
Bone Marrow Biopsy And Aspiration,,38222,CPT,Facility,Inpatient,,,,2040,1734,584.664,2040,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Bone Marrow Biopsy And Aspiration,,38222,CPT,Facility,Outpatient,,,,2040,1734,584.664,2040,Medica,Medical Assistance,724,,,Other,Grouper,All inclusive per visit
Bone Marrow Biopsy And Aspiration,,38222,CPT,Facility,Inpatient,,,,2040,1734,584.664,2040,Medica,Medical Assistance,,,,,Included in per diem rate,
Bone Marrow Biopsy And Aspiration,,38222,CPT,Facility,Outpatient,,,,2040,1734,584.664,2040,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1015.92,49.8,,percent of total billed charges,,
Bone Marrow Biopsy And Aspiration,,38222,CPT,Facility,Inpatient,,,,2040,1734,584.664,2040,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Bone Marrow Biopsy And Aspiration,,38222,CPT,Facility,Both,,,,2040,1734,584.664,2040,"Multiplan, Inc.","Multiplan, Inc.",1917.6,94,,percent of total billed charges,,
Bone Marrow Biopsy And Aspiration,,38222,CPT,Facility,Outpatient,,,,2040,1734,584.664,2040,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1838.04,90.1,,percent of total billed charges,,
Bone Marrow Biopsy And Aspiration,,38222,CPT,Facility,Inpatient,,,,2040,1734,584.664,2040,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Bone Marrow Biopsy And Aspiration,,38222,CPT,Facility,Both,,,,2040,1734,584.664,2040,"Preferred One Administrative Services, INC.",PPO,2011.44,98.6,,percent of total billed charges,,
Bone Marrow Biopsy And Aspiration,,38222,CPT,Facility,Outpatient,,,,2040,1734,584.664,2040,PrimeWest Health,Minnesota Senior Health Options (MSHO),1049.58,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Bone Marrow Biopsy And Aspiration,,38222,CPT,Facility,Inpatient,,,,2040,1734,584.664,2040,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Bone Marrow Biopsy And Aspiration,,38222,CPT,Facility,Outpatient,,,,2040,1734,584.664,2040,PrimeWest Health,MinnesotaCare,1047.744,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Bone Marrow Biopsy And Aspiration,,38222,CPT,Facility,Inpatient,,,,2040,1734,584.664,2040,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Bone Marrow Biopsy And Aspiration,,38222,CPT,Facility,Both,,,,2040,1734,584.664,2040,Sanford Health Plan,Sanford Health Plan,1876.8,92,,percent of total billed charges,,
Bone Marrow Biopsy And Aspiration,,38222,CPT,Facility,Outpatient,,,,2040,1734,584.664,2040,"UCare Health, Inc.",Individual & Family Plan,1149.54,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Bone Marrow Biopsy And Aspiration,,38222,CPT,Facility,Inpatient,,,,2040,1734,584.664,2040,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Bone Marrow Biopsy And Aspiration,,38222,CPT,Facility,Outpatient,,,,2040,1734,584.664,2040,"UCare Health, Inc.",Medical Assistance,1029.588,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Bone Marrow Biopsy And Aspiration,,38222,CPT,Facility,Inpatient,,,,2040,1734,584.664,2040,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Bone Marrow Biopsy And Aspiration,,38222,CPT,Facility,Outpatient,,,,2040,1734,584.664,2040,"UCare Health, Inc.",Medicare Advantage,1029.588,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Bone Marrow Biopsy And Aspiration,,38222,CPT,Facility,Inpatient,,,,2040,1734,584.664,2040,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Bone Marrow Biopsy And Aspiration,,38222,CPT,Facility,Outpatient,,,,2040,1734,584.664,2040,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1029.588,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Bone Marrow Biopsy And Aspiration,,38222,CPT,Facility,Inpatient,,,,2040,1734,584.664,2040,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Bone Marrow Biopsy And Aspiration,,38222,CPT,Facility,Both,,,,2040,1734,584.664,2040,UnitedHealthcare,Individual & Family,1917.6,94,,percent of total billed charges,,
Bone Marrow Biopsy And Aspiration,,38222,CPT,Facility,Outpatient,,,,2040,1734,584.664,2040,UnitedHealthcare,Medicare Advantage,999.6,49,,percent of total billed charges,,
Bone Marrow Biopsy And Aspiration,,38222,CPT,Facility,Inpatient,,,,2040,1734,584.664,2040,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Bone Marrow Biopsy And Aspiration,,38222,CPT,Facility,Outpatient,,,,2040,1734,584.664,2040,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,979.2,48,,percent of total billed charges,,100% of DHS outpatient percentage
Bone Marrow Biopsy And Aspiration,,38222,CPT,Facility,Inpatient,,,,2040,1734,584.664,2040,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Diagnostic Bone Marrow Biopsy And Aspiration,,38222,CPT,Facility,Both,,,,2448,2080.8,701.5968,2448,Aetna,Commercial,2252.16,92,,percent of total billed charges,,
Diagnostic Bone Marrow Biopsy And Aspiration,,38222,CPT,Facility,Outpatient,,,,2448,2080.8,701.5968,2448,Aetna,Medicare Advantage,1199.52,49,,percent of total billed charges,,
Diagnostic Bone Marrow Biopsy And Aspiration,,38222,CPT,Facility,Inpatient,,,,2448,2080.8,701.5968,2448,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Diagnostic Bone Marrow Biopsy And Aspiration,,38222,CPT,Facility,Both,,,,2448,2080.8,701.5968,2448,Aetna,PPO,2276.64,93,,percent of total billed charges,,
Diagnostic Bone Marrow Biopsy And Aspiration,,38222,CPT,Facility,Both,,,,2448,2080.8,701.5968,2448,America's PPO,America's PPO,2350.8144,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Diagnostic Bone Marrow Biopsy And Aspiration,,38222,CPT,Facility,Both,,,,2448,2080.8,701.5968,2448,BlueCross BlueShield Minnesota, Federal Employee Program,2408.832,98.4,,percent of total billed charges,,
Diagnostic Bone Marrow Biopsy And Aspiration,,38222,CPT,Facility,Both,,,,2448,2080.8,701.5968,2448,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,2448,100,,percent of total billed charges,,
Diagnostic Bone Marrow Biopsy And Aspiration,,38222,CPT,Facility,Both,,,,2448,2080.8,701.5968,2448,BlueCross BlueShield Minnesota,High Value Network Plan,2203.2,90,,percent of total billed charges,,
Diagnostic Bone Marrow Biopsy And Aspiration,,38222,CPT,Facility,Outpatient,,,,2448,2080.8,701.5968,2448,BlueCross BlueShield Minnesota,Medicare Advantage,1199.52,49,,percent of total billed charges,,
Diagnostic Bone Marrow Biopsy And Aspiration,,38222,CPT,Facility,Inpatient,,,,2448,2080.8,701.5968,2448,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Diagnostic Bone Marrow Biopsy And Aspiration,,38222,CPT,Facility,Both,,,,2448,2080.8,701.5968,2448,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,2168.1936,88.57,,percent of total billed charges,,
Diagnostic Bone Marrow Biopsy And Aspiration,,38222,CPT,Facility,Both,,,,2448,2080.8,701.5968,2448,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,701.5968,28.66,,percent of total billed charges,,
Diagnostic Bone Marrow Biopsy And Aspiration,,38222,CPT,Facility,Outpatient,,,,2448,2080.8,701.5968,2448,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1199.52,49,,percent of total billed charges,,
Diagnostic Bone Marrow Biopsy And Aspiration,,38222,CPT,Facility,Inpatient,,,,2448,2080.8,701.5968,2448,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Diagnostic Bone Marrow Biopsy And Aspiration,,38222,CPT,Facility,Both,,,,2448,2080.8,701.5968,2448,CorVel,Worker's Compensation,2448,100,,percent of total billed charges,,
Diagnostic Bone Marrow Biopsy And Aspiration,,38222,CPT,Facility,Both,,,,2448,2080.8,701.5968,2448,First Health Group Corporation,First Health Network,2374.56,97,,percent of total billed charges,,
Diagnostic Bone Marrow Biopsy And Aspiration,,38222,CPT,Facility,Both,,,,2448,2080.8,701.5968,2448,"Health Partners, Inc.",Commercial,2315.808,94.6,,percent of total billed charges,,
Diagnostic Bone Marrow Biopsy And Aspiration,,38222,CPT,Facility,Outpatient,,,,2448,2080.8,701.5968,2448,"Health Partners, Inc.",Medicare Advantage,1199.52,49,,percent of total billed charges,,
Diagnostic Bone Marrow Biopsy And Aspiration,,38222,CPT,Facility,Inpatient,,,,2448,2080.8,701.5968,2448,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Diagnostic Bone Marrow Biopsy And Aspiration,,38222,CPT,Facility,Both,,,,2448,2080.8,701.5968,2448,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1468.8,60,,percent of total billed charges,,
Diagnostic Bone Marrow Biopsy And Aspiration,,38222,CPT,Facility,Both,,,,2448,2080.8,701.5968,2448,"Health Partners, Inc.",State of Minnesota Advantage Program,1995.12,81.5,,percent of total billed charges,,
Diagnostic Bone Marrow Biopsy And Aspiration,,38222,CPT,Facility,Both,,,,2448,2080.8,701.5968,2448,"Health Partners, Inc.",State Public Programs,1224,50,,percent of total billed charges,,
Diagnostic Bone Marrow Biopsy And Aspiration,,38222,CPT,Facility,Both,,,,2448,2080.8,701.5968,2448,Humana Insurance Company,Commercial PPO,2325.6,95,,percent of total billed charges,,
Diagnostic Bone Marrow Biopsy And Aspiration,,38222,CPT,Facility,Outpatient,,,,2448,2080.8,701.5968,2448,Humana Insurance Company,Medicare PPO,1199.52,49,,percent of total billed charges,,
Diagnostic Bone Marrow Biopsy And Aspiration,,38222,CPT,Facility,Inpatient,,,,2448,2080.8,701.5968,2448,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Diagnostic Bone Marrow Biopsy And Aspiration,,38222,CPT,Facility,Both,,,,2448,2080.8,701.5968,2448,Medica,Individual & Family,2425.968,99.1,,percent of total billed charges,,
Diagnostic Bone Marrow Biopsy And Aspiration,,38222,CPT,Facility,Outpatient,,,,2448,2080.8,701.5968,2448,Medica,Medica Advantage Solution,1219.104,49.8,,percent of total billed charges,,
Diagnostic Bone Marrow Biopsy And Aspiration,,38222,CPT,Facility,Inpatient,,,,2448,2080.8,701.5968,2448,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Diagnostic Bone Marrow Biopsy And Aspiration,,38222,CPT,Facility,Outpatient,,,,2448,2080.8,701.5968,2448,Medica,Medical Assistance,724,,,Other,Grouper,All inclusive per visit
Diagnostic Bone Marrow Biopsy And Aspiration,,38222,CPT,Facility,Inpatient,,,,2448,2080.8,701.5968,2448,Medica,Medical Assistance,,,,,Included in per diem rate,
Diagnostic Bone Marrow Biopsy And Aspiration,,38222,CPT,Facility,Outpatient,,,,2448,2080.8,701.5968,2448,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1219.104,49.8,,percent of total billed charges,,
Diagnostic Bone Marrow Biopsy And Aspiration,,38222,CPT,Facility,Inpatient,,,,2448,2080.8,701.5968,2448,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Diagnostic Bone Marrow Biopsy And Aspiration,,38222,CPT,Facility,Both,,,,2448,2080.8,701.5968,2448,"Multiplan, Inc.","Multiplan, Inc.",2301.12,94,,percent of total billed charges,,
Diagnostic Bone Marrow Biopsy And Aspiration,,38222,CPT,Facility,Outpatient,,,,2448,2080.8,701.5968,2448,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,2205.648,90.1,,percent of total billed charges,,
Diagnostic Bone Marrow Biopsy And Aspiration,,38222,CPT,Facility,Inpatient,,,,2448,2080.8,701.5968,2448,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Diagnostic Bone Marrow Biopsy And Aspiration,,38222,CPT,Facility,Both,,,,2448,2080.8,701.5968,2448,"Preferred One Administrative Services, INC.",PPO,2413.728,98.6,,percent of total billed charges,,
Diagnostic Bone Marrow Biopsy And Aspiration,,38222,CPT,Facility,Outpatient,,,,2448,2080.8,701.5968,2448,PrimeWest Health,Minnesota Senior Health Options (MSHO),1259.496,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Diagnostic Bone Marrow Biopsy And Aspiration,,38222,CPT,Facility,Inpatient,,,,2448,2080.8,701.5968,2448,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Diagnostic Bone Marrow Biopsy And Aspiration,,38222,CPT,Facility,Outpatient,,,,2448,2080.8,701.5968,2448,PrimeWest Health,MinnesotaCare,1257.2928,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Diagnostic Bone Marrow Biopsy And Aspiration,,38222,CPT,Facility,Inpatient,,,,2448,2080.8,701.5968,2448,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Diagnostic Bone Marrow Biopsy And Aspiration,,38222,CPT,Facility,Both,,,,2448,2080.8,701.5968,2448,Sanford Health Plan,Sanford Health Plan,2252.16,92,,percent of total billed charges,,
Diagnostic Bone Marrow Biopsy And Aspiration,,38222,CPT,Facility,Outpatient,,,,2448,2080.8,701.5968,2448,"UCare Health, Inc.",Individual & Family Plan,1379.448,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Diagnostic Bone Marrow Biopsy And Aspiration,,38222,CPT,Facility,Inpatient,,,,2448,2080.8,701.5968,2448,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Diagnostic Bone Marrow Biopsy And Aspiration,,38222,CPT,Facility,Outpatient,,,,2448,2080.8,701.5968,2448,"UCare Health, Inc.",Medical Assistance,1235.5056,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Diagnostic Bone Marrow Biopsy And Aspiration,,38222,CPT,Facility,Inpatient,,,,2448,2080.8,701.5968,2448,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Diagnostic Bone Marrow Biopsy And Aspiration,,38222,CPT,Facility,Outpatient,,,,2448,2080.8,701.5968,2448,"UCare Health, Inc.",Medicare Advantage,1235.5056,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Diagnostic Bone Marrow Biopsy And Aspiration,,38222,CPT,Facility,Inpatient,,,,2448,2080.8,701.5968,2448,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Diagnostic Bone Marrow Biopsy And Aspiration,,38222,CPT,Facility,Outpatient,,,,2448,2080.8,701.5968,2448,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1235.5056,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Diagnostic Bone Marrow Biopsy And Aspiration,,38222,CPT,Facility,Inpatient,,,,2448,2080.8,701.5968,2448,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Diagnostic Bone Marrow Biopsy And Aspiration,,38222,CPT,Facility,Both,,,,2448,2080.8,701.5968,2448,UnitedHealthcare,Individual & Family,2301.12,94,,percent of total billed charges,,
Diagnostic Bone Marrow Biopsy And Aspiration,,38222,CPT,Facility,Outpatient,,,,2448,2080.8,701.5968,2448,UnitedHealthcare,Medicare Advantage,1199.52,49,,percent of total billed charges,,
Diagnostic Bone Marrow Biopsy And Aspiration,,38222,CPT,Facility,Inpatient,,,,2448,2080.8,701.5968,2448,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Diagnostic Bone Marrow Biopsy And Aspiration,,38222,CPT,Facility,Outpatient,,,,2448,2080.8,701.5968,2448,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1175.04,48,,percent of total billed charges,,100% of DHS outpatient percentage
Diagnostic Bone Marrow Biopsy And Aspiration,,38222,CPT,Facility,Inpatient,,,,2448,2080.8,701.5968,2448,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Diagnostic Bone Marrow; Biopsy(Ies) And Aspiration(S) (Pbb),,38222,CPT,Facility,Outpatient,,,,637,541.45,182.5642,637,Aetna,Commercial,586.04,92,,percent of total billed charges,,
Diagnostic Bone Marrow; Biopsy(Ies) And Aspiration(S) (Pbb),,38222,CPT,Professional,Outpatient,,,,689,585.65,47.12,689,Aetna,Commercial,585.65,85,,percent of total billed charges,,
Diagnostic Bone Marrow; Biopsy(Ies) And Aspiration(S) (Pbb),,38222,CPT,Facility,Outpatient,,,,637,541.45,182.5642,637,Aetna,Medicare Advantage,312.13,49,,percent of total billed charges,,
Diagnostic Bone Marrow; Biopsy(Ies) And Aspiration(S) (Pbb),,38222,CPT,Professional,Outpatient,,,,689,585.65,47.12,689,Aetna,Medicare Advantage,75.99,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Diagnostic Bone Marrow; Biopsy(Ies) And Aspiration(S) (Pbb),,38222,CPT,Facility,Outpatient,,,,637,541.45,182.5642,637,Aetna,PPO,592.41,93,,percent of total billed charges,,
Diagnostic Bone Marrow; Biopsy(Ies) And Aspiration(S) (Pbb),,38222,CPT,Professional,Outpatient,,,,689,585.65,47.12,689,Aetna,PPO,640.77,93,,percent of total billed charges,,
Diagnostic Bone Marrow; Biopsy(Ies) And Aspiration(S) (Pbb),,38222,CPT,Facility,Outpatient,,,,637,541.45,182.5642,637,America's PPO,America's PPO,611.7111,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Diagnostic Bone Marrow; Biopsy(Ies) And Aspiration(S) (Pbb),,38222,CPT,Professional,Outpatient,,,,689,585.65,47.12,689,America's PPO,America's PPO,588.6816,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Diagnostic Bone Marrow; Biopsy(Ies) And Aspiration(S) (Pbb),,38222,CPT,Facility,Outpatient,,,,637,541.45,182.5642,637,BlueCross BlueShield Minnesota, Federal Employee Program,626.808,98.4,,percent of total billed charges,,
Diagnostic Bone Marrow; Biopsy(Ies) And Aspiration(S) (Pbb),,38222,CPT,Professional,Outpatient,,,,689,585.65,47.12,689,BlueCross BlueShield Minnesota, Federal Employee Program,153.56,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Diagnostic Bone Marrow; Biopsy(Ies) And Aspiration(S) (Pbb),,38222,CPT,Facility,Outpatient,,,,637,541.45,182.5642,637,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,637,100,,percent of total billed charges,,
Diagnostic Bone Marrow; Biopsy(Ies) And Aspiration(S) (Pbb),,38222,CPT,Professional,Outpatient,,,,689,585.65,47.12,689,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,156.01696,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Diagnostic Bone Marrow; Biopsy(Ies) And Aspiration(S) (Pbb),,38222,CPT,Facility,Outpatient,,,,637,541.45,182.5642,637,BlueCross BlueShield Minnesota,High Value Network Plan,573.3,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
Diagnostic Bone Marrow; Biopsy(Ies) And Aspiration(S) (Pbb),,38222,CPT,Professional,Outpatient,,,,689,585.65,47.12,689,BlueCross BlueShield Minnesota,High Value Network Plan,156.01696,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Diagnostic Bone Marrow; Biopsy(Ies) And Aspiration(S) (Pbb),,38222,CPT,Facility,Outpatient,,,,637,541.45,182.5642,637,BlueCross BlueShield Minnesota,Medicare Advantage,312.13,49,,percent of total billed charges,,
Diagnostic Bone Marrow; Biopsy(Ies) And Aspiration(S) (Pbb),,38222,CPT,Professional,Outpatient,,,,689,585.65,47.12,689,BlueCross BlueShield Minnesota,Medicare Advantage,84.249,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Diagnostic Bone Marrow; Biopsy(Ies) And Aspiration(S) (Pbb),,38222,CPT,Professional,Outpatient,,,,689,585.65,47.12,689,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,156.01696,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Diagnostic Bone Marrow; Biopsy(Ies) And Aspiration(S) (Pbb),,38222,CPT,Facility,Outpatient,,,,637,541.45,182.5642,637,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,182.5642,28.66,,percent of total billed charges,,
Diagnostic Bone Marrow; Biopsy(Ies) And Aspiration(S) (Pbb),,38222,CPT,Professional,Outpatient,,,,689,585.65,47.12,689,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,54.39664,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Diagnostic Bone Marrow; Biopsy(Ies) And Aspiration(S) (Pbb),,38222,CPT,Facility,Outpatient,,,,637,541.45,182.5642,637,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),312.13,49,,percent of total billed charges,,
Diagnostic Bone Marrow; Biopsy(Ies) And Aspiration(S) (Pbb),,38222,CPT,Professional,Outpatient,,,,689,585.65,47.12,689,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),84.249,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Diagnostic Bone Marrow; Biopsy(Ies) And Aspiration(S) (Pbb),,38222,CPT,Facility,Outpatient,,,,637,541.45,182.5642,637,CorVel,Worker's Compensation,637,100,,percent of total billed charges,,
Diagnostic Bone Marrow; Biopsy(Ies) And Aspiration(S) (Pbb),,38222,CPT,Professional,Outpatient,,,,689,585.65,47.12,689,CorVel,Worker's Compensation,145.6023939,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Diagnostic Bone Marrow; Biopsy(Ies) And Aspiration(S) (Pbb),,38222,CPT,Facility,Outpatient,,,,637,541.45,182.5642,637,First Health Group Corporation,First Health Network,617.89,97,,percent of total billed charges,,
Diagnostic Bone Marrow; Biopsy(Ies) And Aspiration(S) (Pbb),,38222,CPT,Professional,Outpatient,,,,689,585.65,47.12,689,First Health Group Corporation,First Health Network,668.33,97,,percent of total billed charges,,
Diagnostic Bone Marrow; Biopsy(Ies) And Aspiration(S) (Pbb),,38222,CPT,Facility,Outpatient,,,,637,541.45,182.5642,637,"Health Partners, Inc.",Commercial,602.602,94.6,,percent of total billed charges,,
Diagnostic Bone Marrow; Biopsy(Ies) And Aspiration(S) (Pbb),,38222,CPT,Professional,Outpatient,,,,689,585.65,47.12,689,"Health Partners, Inc.",Commercial,157.44,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Diagnostic Bone Marrow; Biopsy(Ies) And Aspiration(S) (Pbb),,38222,CPT,Facility,Outpatient,,,,637,541.45,182.5642,637,"Health Partners, Inc.",Medicare Advantage,312.13,49,,percent of total billed charges,,
Diagnostic Bone Marrow; Biopsy(Ies) And Aspiration(S) (Pbb),,38222,CPT,Professional,Outpatient,,,,689,585.65,47.12,689,"Health Partners, Inc.",Medicare Advantage,84.249,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Diagnostic Bone Marrow; Biopsy(Ies) And Aspiration(S) (Pbb),,38222,CPT,Facility,Outpatient,,,,637,541.45,182.5642,637,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),382.2,60,,percent of total billed charges,,
Diagnostic Bone Marrow; Biopsy(Ies) And Aspiration(S) (Pbb),,38222,CPT,Professional,Outpatient,,,,689,585.65,47.12,689,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),73.2,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Diagnostic Bone Marrow; Biopsy(Ies) And Aspiration(S) (Pbb),,38222,CPT,Facility,Outpatient,,,,637,541.45,182.5642,637,"Health Partners, Inc.",State of Minnesota Advantage Program,519.155,81.5,,percent of total billed charges,,
Diagnostic Bone Marrow; Biopsy(Ies) And Aspiration(S) (Pbb),,38222,CPT,Professional,Outpatient,,,,689,585.65,47.12,689,"Health Partners, Inc.",State of Minnesota Advantage Program,135.63456,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Diagnostic Bone Marrow; Biopsy(Ies) And Aspiration(S) (Pbb),,38222,CPT,Facility,Outpatient,,,,637,541.45,182.5642,637,"Health Partners, Inc.",State Public Programs,318.5,50,,percent of total billed charges,,
Diagnostic Bone Marrow; Biopsy(Ies) And Aspiration(S) (Pbb),,38222,CPT,Professional,Outpatient,,,,689,585.65,47.12,689,"Health Partners, Inc.",State Public Programs,47.12,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Diagnostic Bone Marrow; Biopsy(Ies) And Aspiration(S) (Pbb),,38222,CPT,Facility,Outpatient,,,,637,541.45,182.5642,637,Humana Insurance Company,Commercial PPO,605.15,95,,percent of total billed charges,,
Diagnostic Bone Marrow; Biopsy(Ies) And Aspiration(S) (Pbb),,38222,CPT,Professional,Outpatient,,,,689,585.65,47.12,689,Humana Insurance Company,Commercial PPO,73.26,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Diagnostic Bone Marrow; Biopsy(Ies) And Aspiration(S) (Pbb),,38222,CPT,Facility,Outpatient,,,,637,541.45,182.5642,637,Humana Insurance Company,Medicare PPO,312.13,49,,percent of total billed charges,,
Diagnostic Bone Marrow; Biopsy(Ies) And Aspiration(S) (Pbb),,38222,CPT,Professional,Outpatient,,,,689,585.65,47.12,689,Humana Insurance Company,Medicare PPO,689,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Diagnostic Bone Marrow; Biopsy(Ies) And Aspiration(S) (Pbb),,38222,CPT,Facility,Outpatient,,,,637,541.45,182.5642,637,Medica,Individual & Family,631.267,99.1,,percent of total billed charges,,
Diagnostic Bone Marrow; Biopsy(Ies) And Aspiration(S) (Pbb),,38222,CPT,Professional,Outpatient,,,,689,585.65,47.12,689,Medica,Individual & Family,584.272,84.8,,percent of total billed charges,,
Diagnostic Bone Marrow; Biopsy(Ies) And Aspiration(S) (Pbb),,38222,CPT,Facility,Outpatient,,,,637,541.45,182.5642,637,Medica,Medica Advantage Solution,317.226,49.8,,percent of total billed charges,,
Diagnostic Bone Marrow; Biopsy(Ies) And Aspiration(S) (Pbb),,38222,CPT,Professional,Outpatient,,,,689,585.65,47.12,689,Medica,Medica Advantage Solution,343.122,49.8,,percent of total billed charges,,
Diagnostic Bone Marrow; Biopsy(Ies) And Aspiration(S) (Pbb),,38222,CPT,Facility,Outpatient,,,,637,541.45,182.5642,637,Medica,Medical Assistance,284.102,44.6,,percent of total billed charges,,
Diagnostic Bone Marrow; Biopsy(Ies) And Aspiration(S) (Pbb),,38222,CPT,Professional,Outpatient,,,,689,585.65,47.12,689,Medica,Medical Assistance,54.4,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Diagnostic Bone Marrow; Biopsy(Ies) And Aspiration(S) (Pbb),,38222,CPT,Facility,Outpatient,,,,637,541.45,182.5642,637,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,317.226,49.8,,percent of total billed charges,,
Diagnostic Bone Marrow; Biopsy(Ies) And Aspiration(S) (Pbb),,38222,CPT,Professional,Outpatient,,,,689,585.65,47.12,689,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,73.26,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Diagnostic Bone Marrow; Biopsy(Ies) And Aspiration(S) (Pbb),,38222,CPT,Facility,Outpatient,,,,637,541.45,182.5642,637,"Multiplan, Inc.","Multiplan, Inc.",598.78,94,,percent of total billed charges,,
Diagnostic Bone Marrow; Biopsy(Ies) And Aspiration(S) (Pbb),,38222,CPT,Professional,Outpatient,,,,689,585.65,47.12,689,"Multiplan, Inc.","Multiplan, Inc.",647.66,94,,percent of total billed charges,,
Diagnostic Bone Marrow; Biopsy(Ies) And Aspiration(S) (Pbb),,38222,CPT,Facility,Outpatient,,,,637,541.45,182.5642,637,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,573.937,90.1,,percent of total billed charges,,
Diagnostic Bone Marrow; Biopsy(Ies) And Aspiration(S) (Pbb),,38222,CPT,Professional,Outpatient,,,,689,585.65,47.12,689,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,620.789,90.1,,percent of total billed charges,,
Diagnostic Bone Marrow; Biopsy(Ies) And Aspiration(S) (Pbb),,38222,CPT,Facility,Outpatient,,,,637,541.45,182.5642,637,"Preferred One Administrative Services, INC.",PPO,628.082,98.6,,percent of total billed charges,,
Diagnostic Bone Marrow; Biopsy(Ies) And Aspiration(S) (Pbb),,38222,CPT,Professional,Outpatient,,,,689,585.65,47.12,689,"Preferred One Administrative Services, INC.",PPO,679.354,98.6,,percent of total billed charges,,
Diagnostic Bone Marrow; Biopsy(Ies) And Aspiration(S) (Pbb),,38222,CPT,Facility,Outpatient,,,,637,541.45,182.5642,637,PrimeWest Health,Minnesota Senior Health Options (MSHO),327.7365,51.45,,percent of total billed charges,,
Diagnostic Bone Marrow; Biopsy(Ies) And Aspiration(S) (Pbb),,38222,CPT,Professional,Outpatient,,,,689,585.65,47.12,689,PrimeWest Health,Minnesota Senior Health Options (MSHO),84.249,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Diagnostic Bone Marrow; Biopsy(Ies) And Aspiration(S) (Pbb),,38222,CPT,Facility,Outpatient,,,,637,541.45,182.5642,637,PrimeWest Health,MinnesotaCare,327.1632,51.36,,percent of total billed charges,,
Diagnostic Bone Marrow; Biopsy(Ies) And Aspiration(S) (Pbb),,38222,CPT,Professional,Outpatient,,,,689,585.65,47.12,689,PrimeWest Health,MinnesotaCare,58.2044048,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Diagnostic Bone Marrow; Biopsy(Ies) And Aspiration(S) (Pbb),,38222,CPT,Facility,Outpatient,,,,637,541.45,182.5642,637,Sanford Health Plan,Sanford Health Plan,586.04,92,,percent of total billed charges,,
Diagnostic Bone Marrow; Biopsy(Ies) And Aspiration(S) (Pbb),,38222,CPT,Professional,Outpatient,,,,689,585.65,47.12,689,Sanford Health Plan,Sanford Health Plan,606.32,88,,percent of total billed charges,,
Diagnostic Bone Marrow; Biopsy(Ies) And Aspiration(S) (Pbb),,38222,CPT,Facility,Outpatient,,,,637,541.45,182.5642,637,"UCare Health, Inc.",Individual & Family Plan,358.9495,56.35,,percent of total billed charges,,
Diagnostic Bone Marrow; Biopsy(Ies) And Aspiration(S) (Pbb),,38222,CPT,Professional,Outpatient,,,,689,585.65,47.12,689,"UCare Health, Inc.",Individual & Family Plan,119.091456,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Diagnostic Bone Marrow; Biopsy(Ies) And Aspiration(S) (Pbb),,38222,CPT,Facility,Outpatient,,,,637,541.45,182.5642,637,"UCare Health, Inc.",Medical Assistance,321.4939,50.47,,percent of total billed charges,,
Diagnostic Bone Marrow; Biopsy(Ies) And Aspiration(S) (Pbb),,38222,CPT,Professional,Outpatient,,,,689,585.65,47.12,689,"UCare Health, Inc.",Medical Assistance,59.836304,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Diagnostic Bone Marrow; Biopsy(Ies) And Aspiration(S) (Pbb),,38222,CPT,Facility,Outpatient,,,,637,541.45,182.5642,637,"UCare Health, Inc.",Medicare Advantage,321.4939,50.47,,percent of total billed charges,,
Diagnostic Bone Marrow; Biopsy(Ies) And Aspiration(S) (Pbb),,38222,CPT,Professional,Outpatient,,,,689,585.65,47.12,689,"UCare Health, Inc.",Medicare Advantage,84.249,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Diagnostic Bone Marrow; Biopsy(Ies) And Aspiration(S) (Pbb),,38222,CPT,Facility,Outpatient,,,,637,541.45,182.5642,637,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),321.4939,50.47,,percent of total billed charges,,
Diagnostic Bone Marrow; Biopsy(Ies) And Aspiration(S) (Pbb),,38222,CPT,Professional,Outpatient,,,,689,585.65,47.12,689,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),67.3992,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Diagnostic Bone Marrow; Biopsy(Ies) And Aspiration(S) (Pbb),,38222,CPT,Facility,Outpatient,,,,637,541.45,182.5642,637,UnitedHealthcare,Individual & Family,598.78,94,,percent of total billed charges,,
Diagnostic Bone Marrow; Biopsy(Ies) And Aspiration(S) (Pbb),,38222,CPT,Professional,Outpatient,,,,689,585.65,47.12,689,UnitedHealthcare,Individual & Family,689,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Diagnostic Bone Marrow; Biopsy(Ies) And Aspiration(S) (Pbb),,38222,CPT,Facility,Outpatient,,,,637,541.45,182.5642,637,UnitedHealthcare,Medicare Advantage,312.13,49,,percent of total billed charges,,
Diagnostic Bone Marrow; Biopsy(Ies) And Aspiration(S) (Pbb),,38222,CPT,Professional,Outpatient,,,,689,585.65,47.12,689,UnitedHealthcare,Medicare Advantage,84.249,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Diagnostic Bone Marrow; Biopsy(Ies) And Aspiration(S) (Pbb),,38222,CPT,Facility,Outpatient,,,,637,541.45,182.5642,637,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,305.76,48,,percent of total billed charges,,100% of DHS outpatient percentage
Diagnostic Bone Marrow; Biopsy(Ies) And Aspiration(S) (Pbb),,38222,CPT,Professional,Outpatient,,,,689,585.65,47.12,689,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,54.39664,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Diagnostic Bone Marrow; Biopsy(Ies) And Aspiration(S) (Pro Cah),,38222,CPT,Professional,Both,,,,1326,1127.1,47.12,1326,Aetna,Commercial,1127.1,85,,percent of total billed charges,,
Diagnostic Bone Marrow; Biopsy(Ies) And Aspiration(S) (Pro Cah),,38222,CPT,Professional,Both,,,,1326,1127.1,47.12,1326,Aetna,Medicare Advantage,75.99,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Diagnostic Bone Marrow; Biopsy(Ies) And Aspiration(S) (Pro Cah),,38222,CPT,Professional,Both,,,,1326,1127.1,47.12,1326,Aetna,PPO,1233.18,93,,percent of total billed charges,,
Diagnostic Bone Marrow; Biopsy(Ies) And Aspiration(S) (Pro Cah),,38222,CPT,Professional,Both,,,,1326,1127.1,47.12,1326,America's PPO,America's PPO,1132.9344,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Diagnostic Bone Marrow; Biopsy(Ies) And Aspiration(S) (Pro Cah),,38222,CPT,Professional,Both,,,,1326,1127.1,47.12,1326,BlueCross BlueShield Minnesota, Federal Employee Program,153.56,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Diagnostic Bone Marrow; Biopsy(Ies) And Aspiration(S) (Pro Cah),,38222,CPT,Professional,Both,,,,1326,1127.1,47.12,1326,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,156.01696,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Diagnostic Bone Marrow; Biopsy(Ies) And Aspiration(S) (Pro Cah),,38222,CPT,Professional,Both,,,,1326,1127.1,47.12,1326,BlueCross BlueShield Minnesota,High Value Network Plan,156.01696,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Diagnostic Bone Marrow; Biopsy(Ies) And Aspiration(S) (Pro Cah),,38222,CPT,Professional,Both,,,,1326,1127.1,47.12,1326,BlueCross BlueShield Minnesota,Medicare Advantage,84.249,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Diagnostic Bone Marrow; Biopsy(Ies) And Aspiration(S) (Pro Cah),,38222,CPT,Professional,Both,,,,1326,1127.1,47.12,1326,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,156.01696,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Diagnostic Bone Marrow; Biopsy(Ies) And Aspiration(S) (Pro Cah),,38222,CPT,Professional,Both,,,,1326,1127.1,47.12,1326,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,54.39664,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Diagnostic Bone Marrow; Biopsy(Ies) And Aspiration(S) (Pro Cah),,38222,CPT,Professional,Both,,,,1326,1127.1,47.12,1326,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),84.249,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Diagnostic Bone Marrow; Biopsy(Ies) And Aspiration(S) (Pro Cah),,38222,CPT,Professional,Both,,,,1326,1127.1,47.12,1326,CorVel,Worker's Compensation,145.6023939,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Diagnostic Bone Marrow; Biopsy(Ies) And Aspiration(S) (Pro Cah),,38222,CPT,Professional,Both,,,,1326,1127.1,47.12,1326,First Health Group Corporation,First Health Network,1286.22,97,,percent of total billed charges,,
Diagnostic Bone Marrow; Biopsy(Ies) And Aspiration(S) (Pro Cah),,38222,CPT,Professional,Both,,,,1326,1127.1,47.12,1326,"Health Partners, Inc.",Commercial,157.44,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Diagnostic Bone Marrow; Biopsy(Ies) And Aspiration(S) (Pro Cah),,38222,CPT,Professional,Both,,,,1326,1127.1,47.12,1326,"Health Partners, Inc.",Medicare Advantage,84.249,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Diagnostic Bone Marrow; Biopsy(Ies) And Aspiration(S) (Pro Cah),,38222,CPT,Professional,Both,,,,1326,1127.1,47.12,1326,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),73.2,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Diagnostic Bone Marrow; Biopsy(Ies) And Aspiration(S) (Pro Cah),,38222,CPT,Professional,Both,,,,1326,1127.1,47.12,1326,"Health Partners, Inc.",State of Minnesota Advantage Program,135.63456,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Diagnostic Bone Marrow; Biopsy(Ies) And Aspiration(S) (Pro Cah),,38222,CPT,Professional,Both,,,,1326,1127.1,47.12,1326,"Health Partners, Inc.",State Public Programs,47.12,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Diagnostic Bone Marrow; Biopsy(Ies) And Aspiration(S) (Pro Cah),,38222,CPT,Professional,Both,,,,1326,1127.1,47.12,1326,Humana Insurance Company,Commercial PPO,73.26,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Diagnostic Bone Marrow; Biopsy(Ies) And Aspiration(S) (Pro Cah),,38222,CPT,Professional,Both,,,,1326,1127.1,47.12,1326,Humana Insurance Company,Medicare PPO,1326,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Diagnostic Bone Marrow; Biopsy(Ies) And Aspiration(S) (Pro Cah),,38222,CPT,Professional,Both,,,,1326,1127.1,47.12,1326,Medica,Individual & Family,1124.448,84.8,,percent of total billed charges,,
Diagnostic Bone Marrow; Biopsy(Ies) And Aspiration(S) (Pro Cah),,38222,CPT,Professional,Both,,,,1326,1127.1,47.12,1326,Medica,Medica Advantage Solution,660.348,49.8,,percent of total billed charges,,
Diagnostic Bone Marrow; Biopsy(Ies) And Aspiration(S) (Pro Cah),,38222,CPT,Professional,Both,,,,1326,1127.1,47.12,1326,Medica,Medical Assistance,54.4,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Diagnostic Bone Marrow; Biopsy(Ies) And Aspiration(S) (Pro Cah),,38222,CPT,Professional,Both,,,,1326,1127.1,47.12,1326,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,73.26,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Diagnostic Bone Marrow; Biopsy(Ies) And Aspiration(S) (Pro Cah),,38222,CPT,Professional,Both,,,,1326,1127.1,47.12,1326,"Multiplan, Inc.","Multiplan, Inc.",1246.44,94,,percent of total billed charges,,
Diagnostic Bone Marrow; Biopsy(Ies) And Aspiration(S) (Pro Cah),,38222,CPT,Professional,Both,,,,1326,1127.1,47.12,1326,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1194.726,90.1,,percent of total billed charges,,
Diagnostic Bone Marrow; Biopsy(Ies) And Aspiration(S) (Pro Cah),,38222,CPT,Professional,Both,,,,1326,1127.1,47.12,1326,"Preferred One Administrative Services, INC.",PPO,1307.436,98.6,,percent of total billed charges,,
Diagnostic Bone Marrow; Biopsy(Ies) And Aspiration(S) (Pro Cah),,38222,CPT,Professional,Both,,,,1326,1127.1,47.12,1326,PrimeWest Health,Minnesota Senior Health Options (MSHO),84.249,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Diagnostic Bone Marrow; Biopsy(Ies) And Aspiration(S) (Pro Cah),,38222,CPT,Professional,Both,,,,1326,1127.1,47.12,1326,PrimeWest Health,MinnesotaCare,58.2044048,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Diagnostic Bone Marrow; Biopsy(Ies) And Aspiration(S) (Pro Cah),,38222,CPT,Professional,Both,,,,1326,1127.1,47.12,1326,Sanford Health Plan,Sanford Health Plan,1166.88,88,,percent of total billed charges,,
Diagnostic Bone Marrow; Biopsy(Ies) And Aspiration(S) (Pro Cah),,38222,CPT,Professional,Both,,,,1326,1127.1,47.12,1326,"UCare Health, Inc.",Individual & Family Plan,119.091456,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Diagnostic Bone Marrow; Biopsy(Ies) And Aspiration(S) (Pro Cah),,38222,CPT,Professional,Both,,,,1326,1127.1,47.12,1326,"UCare Health, Inc.",Medical Assistance,59.836304,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Diagnostic Bone Marrow; Biopsy(Ies) And Aspiration(S) (Pro Cah),,38222,CPT,Professional,Both,,,,1326,1127.1,47.12,1326,"UCare Health, Inc.",Medicare Advantage,84.249,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Diagnostic Bone Marrow; Biopsy(Ies) And Aspiration(S) (Pro Cah),,38222,CPT,Professional,Both,,,,1326,1127.1,47.12,1326,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),67.3992,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Diagnostic Bone Marrow; Biopsy(Ies) And Aspiration(S) (Pro Cah),,38222,CPT,Professional,Both,,,,1326,1127.1,47.12,1326,UnitedHealthcare,Individual & Family,1326,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Diagnostic Bone Marrow; Biopsy(Ies) And Aspiration(S) (Pro Cah),,38222,CPT,Professional,Both,,,,1326,1127.1,47.12,1326,UnitedHealthcare,Medicare Advantage,84.249,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Diagnostic Bone Marrow; Biopsy(Ies) And Aspiration(S) (Pro Cah),,38222,CPT,Professional,Both,,,,1326,1127.1,47.12,1326,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,54.39664,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Drainage Of Lymph Node Abscess Or Lymphadenitis; Simple (Pro Cah),,38300,CPT,Professional,Both,,,,658,559.3,129.58,658,Aetna,Commercial,559.3,85,,percent of total billed charges,,
Drainage Of Lymph Node Abscess Or Lymphadenitis; Simple (Pro Cah),,38300,CPT,Professional,Both,,,,658,559.3,129.58,658,Aetna,Medicare Advantage,203.08,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Drainage Of Lymph Node Abscess Or Lymphadenitis; Simple (Pro Cah),,38300,CPT,Professional,Both,,,,658,559.3,129.58,658,Aetna,PPO,611.94,93,,percent of total billed charges,,
Drainage Of Lymph Node Abscess Or Lymphadenitis; Simple (Pro Cah),,38300,CPT,Professional,Both,,,,658,559.3,129.58,658,America's PPO,America's PPO,562.1952,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Drainage Of Lymph Node Abscess Or Lymphadenitis; Simple (Pro Cah),,38300,CPT,Professional,Both,,,,658,559.3,129.58,658,BlueCross BlueShield Minnesota, Federal Employee Program,432.44,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Drainage Of Lymph Node Abscess Or Lymphadenitis; Simple (Pro Cah),,38300,CPT,Professional,Both,,,,658,559.3,129.58,658,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,439.35904,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Drainage Of Lymph Node Abscess Or Lymphadenitis; Simple (Pro Cah),,38300,CPT,Professional,Both,,,,658,559.3,129.58,658,BlueCross BlueShield Minnesota,High Value Network Plan,439.35904,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Drainage Of Lymph Node Abscess Or Lymphadenitis; Simple (Pro Cah),,38300,CPT,Professional,Both,,,,658,559.3,129.58,658,BlueCross BlueShield Minnesota,Medicare Advantage,231.702,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Drainage Of Lymph Node Abscess Or Lymphadenitis; Simple (Pro Cah),,38300,CPT,Professional,Both,,,,658,559.3,129.58,658,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,439.35904,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Drainage Of Lymph Node Abscess Or Lymphadenitis; Simple (Pro Cah),,38300,CPT,Professional,Both,,,,658,559.3,129.58,658,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,149.606,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Drainage Of Lymph Node Abscess Or Lymphadenitis; Simple (Pro Cah),,38300,CPT,Professional,Both,,,,658,559.3,129.58,658,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),231.702,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Drainage Of Lymph Node Abscess Or Lymphadenitis; Simple (Pro Cah),,38300,CPT,Professional,Both,,,,658,559.3,129.58,658,CorVel,Worker's Compensation,397.290399,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Drainage Of Lymph Node Abscess Or Lymphadenitis; Simple (Pro Cah),,38300,CPT,Professional,Both,,,,658,559.3,129.58,658,First Health Group Corporation,First Health Network,638.26,97,,percent of total billed charges,,
Drainage Of Lymph Node Abscess Or Lymphadenitis; Simple (Pro Cah),,38300,CPT,Professional,Both,,,,658,559.3,129.58,658,"Health Partners, Inc.",Commercial,428.78,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Drainage Of Lymph Node Abscess Or Lymphadenitis; Simple (Pro Cah),,38300,CPT,Professional,Both,,,,658,559.3,129.58,658,"Health Partners, Inc.",Medicare Advantage,231.702,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Drainage Of Lymph Node Abscess Or Lymphadenitis; Simple (Pro Cah),,38300,CPT,Professional,Both,,,,658,559.3,129.58,658,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),201.29,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Drainage Of Lymph Node Abscess Or Lymphadenitis; Simple (Pro Cah),,38300,CPT,Professional,Both,,,,658,559.3,129.58,658,"Health Partners, Inc.",State of Minnesota Advantage Program,369.39397,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Drainage Of Lymph Node Abscess Or Lymphadenitis; Simple (Pro Cah),,38300,CPT,Professional,Both,,,,658,559.3,129.58,658,"Health Partners, Inc.",State Public Programs,129.58,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Drainage Of Lymph Node Abscess Or Lymphadenitis; Simple (Pro Cah),,38300,CPT,Professional,Both,,,,658,559.3,129.58,658,Humana Insurance Company,Commercial PPO,201.48,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Drainage Of Lymph Node Abscess Or Lymphadenitis; Simple (Pro Cah),,38300,CPT,Professional,Both,,,,658,559.3,129.58,658,Humana Insurance Company,Medicare PPO,658,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Drainage Of Lymph Node Abscess Or Lymphadenitis; Simple (Pro Cah),,38300,CPT,Professional,Both,,,,658,559.3,129.58,658,Medica,Individual & Family,557.984,84.8,,percent of total billed charges,,
Drainage Of Lymph Node Abscess Or Lymphadenitis; Simple (Pro Cah),,38300,CPT,Professional,Both,,,,658,559.3,129.58,658,Medica,Medica Advantage Solution,327.684,49.8,,percent of total billed charges,,
Drainage Of Lymph Node Abscess Or Lymphadenitis; Simple (Pro Cah),,38300,CPT,Professional,Both,,,,658,559.3,129.58,658,Medica,Medical Assistance,149.61,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Drainage Of Lymph Node Abscess Or Lymphadenitis; Simple (Pro Cah),,38300,CPT,Professional,Both,,,,658,559.3,129.58,658,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,201.48,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Drainage Of Lymph Node Abscess Or Lymphadenitis; Simple (Pro Cah),,38300,CPT,Professional,Both,,,,658,559.3,129.58,658,"Multiplan, Inc.","Multiplan, Inc.",618.52,94,,percent of total billed charges,,
Drainage Of Lymph Node Abscess Or Lymphadenitis; Simple (Pro Cah),,38300,CPT,Professional,Both,,,,658,559.3,129.58,658,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,592.858,90.1,,percent of total billed charges,,
Drainage Of Lymph Node Abscess Or Lymphadenitis; Simple (Pro Cah),,38300,CPT,Professional,Both,,,,658,559.3,129.58,658,"Preferred One Administrative Services, INC.",PPO,648.788,98.6,,percent of total billed charges,,
Drainage Of Lymph Node Abscess Or Lymphadenitis; Simple (Pro Cah),,38300,CPT,Professional,Both,,,,658,559.3,129.58,658,PrimeWest Health,Minnesota Senior Health Options (MSHO),231.702,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Drainage Of Lymph Node Abscess Or Lymphadenitis; Simple (Pro Cah),,38300,CPT,Professional,Both,,,,658,559.3,129.58,658,PrimeWest Health,MinnesotaCare,160.07842,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Drainage Of Lymph Node Abscess Or Lymphadenitis; Simple (Pro Cah),,38300,CPT,Professional,Both,,,,658,559.3,129.58,658,Sanford Health Plan,Sanford Health Plan,579.04,88,,percent of total billed charges,,
Drainage Of Lymph Node Abscess Or Lymphadenitis; Simple (Pro Cah),,38300,CPT,Professional,Both,,,,658,559.3,129.58,658,"UCare Health, Inc.",Individual & Family Plan,327.525888,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Drainage Of Lymph Node Abscess Or Lymphadenitis; Simple (Pro Cah),,38300,CPT,Professional,Both,,,,658,559.3,129.58,658,"UCare Health, Inc.",Medical Assistance,164.5666,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Drainage Of Lymph Node Abscess Or Lymphadenitis; Simple (Pro Cah),,38300,CPT,Professional,Both,,,,658,559.3,129.58,658,"UCare Health, Inc.",Medicare Advantage,231.702,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Drainage Of Lymph Node Abscess Or Lymphadenitis; Simple (Pro Cah),,38300,CPT,Professional,Both,,,,658,559.3,129.58,658,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),185.3616,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Drainage Of Lymph Node Abscess Or Lymphadenitis; Simple (Pro Cah),,38300,CPT,Professional,Both,,,,658,559.3,129.58,658,UnitedHealthcare,Individual & Family,658,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Drainage Of Lymph Node Abscess Or Lymphadenitis; Simple (Pro Cah),,38300,CPT,Professional,Both,,,,658,559.3,129.58,658,UnitedHealthcare,Medicare Advantage,231.702,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Drainage Of Lymph Node Abscess Or Lymphadenitis; Simple (Pro Cah),,38300,CPT,Professional,Both,,,,658,559.3,129.58,658,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,149.606,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
TERBUTALINE 1 MG/ML SUBQ SOLN,,J3105,HCPCS,Facility,Both,1,mL,,8,6.8,2.2928,8,Aetna,Commercial,7.36,92,,percent of total billed charges,,
TERBUTALINE 1 MG/ML SUBQ SOLN,,J3105,HCPCS,Facility,Outpatient,1,mL,,8,6.8,2.2928,8,Aetna,Medicare Advantage,3.92,49,,percent of total billed charges,,
TERBUTALINE 1 MG/ML SUBQ SOLN,,J3105,HCPCS,Facility,Inpatient,1,mL,,8,6.8,2.2928,8,Aetna,Medicare Advantage,,,,,Included in per diem rate,
TERBUTALINE 1 MG/ML SUBQ SOLN,,J3105,HCPCS,Facility,Both,1,mL,,8,6.8,2.2928,8,Aetna,PPO,7.44,93,,percent of total billed charges,,
TERBUTALINE 1 MG/ML SUBQ SOLN,,J3105,HCPCS,Facility,Both,1,mL,,8,6.8,2.2928,8,America's PPO,America's PPO,7.6824,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
TERBUTALINE 1 MG/ML SUBQ SOLN,,J3105,HCPCS,Facility,Both,1,mL,,8,6.8,2.2928,8,BlueCross BlueShield Minnesota, Federal Employee Program,7.872,98.4,,percent of total billed charges,,
TERBUTALINE 1 MG/ML SUBQ SOLN,,J3105,HCPCS,Facility,Both,1,mL,,8,6.8,2.2928,8,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,8,100,,percent of total billed charges,,
TERBUTALINE 1 MG/ML SUBQ SOLN,,J3105,HCPCS,Facility,Both,1,mL,,8,6.8,2.2928,8,BlueCross BlueShield Minnesota,High Value Network Plan,7.2,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
TERBUTALINE 1 MG/ML SUBQ SOLN,,J3105,HCPCS,Facility,Outpatient,1,mL,,8,6.8,2.2928,8,BlueCross BlueShield Minnesota,Medicare Advantage,3.92,49,,percent of total billed charges,,
TERBUTALINE 1 MG/ML SUBQ SOLN,,J3105,HCPCS,Facility,Inpatient,1,mL,,8,6.8,2.2928,8,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
TERBUTALINE 1 MG/ML SUBQ SOLN,,J3105,HCPCS,Facility,Both,1,mL,,8,6.8,2.2928,8,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,7.0856,88.57,,percent of total billed charges,,
TERBUTALINE 1 MG/ML SUBQ SOLN,,J3105,HCPCS,Facility,Both,1,mL,,8,6.8,2.2928,8,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,2.2928,28.66,,percent of total billed charges,,
TERBUTALINE 1 MG/ML SUBQ SOLN,,J3105,HCPCS,Facility,Outpatient,1,mL,,8,6.8,2.2928,8,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),3.92,49,,percent of total billed charges,,
TERBUTALINE 1 MG/ML SUBQ SOLN,,J3105,HCPCS,Facility,Inpatient,1,mL,,8,6.8,2.2928,8,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
TERBUTALINE 1 MG/ML SUBQ SOLN,,J3105,HCPCS,Facility,Both,1,mL,,8,6.8,2.2928,8,CorVel,Worker's Compensation,8,100,,percent of total billed charges,,
TERBUTALINE 1 MG/ML SUBQ SOLN,,J3105,HCPCS,Facility,Both,1,mL,,8,6.8,2.2928,8,First Health Group Corporation,First Health Network,7.76,97,,percent of total billed charges,,
TERBUTALINE 1 MG/ML SUBQ SOLN,,J3105,HCPCS,Facility,Both,1,mL,,8,6.8,2.2928,8,"Health Partners, Inc.",Commercial,7.568,94.6,,percent of total billed charges,,
TERBUTALINE 1 MG/ML SUBQ SOLN,,J3105,HCPCS,Facility,Outpatient,1,mL,,8,6.8,2.2928,8,"Health Partners, Inc.",Medicare Advantage,3.92,49,,percent of total billed charges,,
TERBUTALINE 1 MG/ML SUBQ SOLN,,J3105,HCPCS,Facility,Inpatient,1,mL,,8,6.8,2.2928,8,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
TERBUTALINE 1 MG/ML SUBQ SOLN,,J3105,HCPCS,Facility,Both,1,mL,,8,6.8,2.2928,8,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),4.8,60,,percent of total billed charges,,
TERBUTALINE 1 MG/ML SUBQ SOLN,,J3105,HCPCS,Facility,Both,1,mL,,8,6.8,2.2928,8,"Health Partners, Inc.",State of Minnesota Advantage Program,6.52,81.5,,percent of total billed charges,,
TERBUTALINE 1 MG/ML SUBQ SOLN,,J3105,HCPCS,Facility,Both,1,mL,,8,6.8,2.2928,8,"Health Partners, Inc.",State Public Programs,4,50,,percent of total billed charges,,
TERBUTALINE 1 MG/ML SUBQ SOLN,,J3105,HCPCS,Facility,Both,1,mL,,8,6.8,2.2928,8,Humana Insurance Company,Commercial PPO,7.6,95,,percent of total billed charges,,
TERBUTALINE 1 MG/ML SUBQ SOLN,,J3105,HCPCS,Facility,Outpatient,1,mL,,8,6.8,2.2928,8,Humana Insurance Company,Medicare PPO,3.92,49,,percent of total billed charges,,
TERBUTALINE 1 MG/ML SUBQ SOLN,,J3105,HCPCS,Facility,Inpatient,1,mL,,8,6.8,2.2928,8,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
TERBUTALINE 1 MG/ML SUBQ SOLN,,J3105,HCPCS,Facility,Both,1,mL,,8,6.8,2.2928,8,Medica,Individual & Family,7.928,99.1,,percent of total billed charges,,
TERBUTALINE 1 MG/ML SUBQ SOLN,,J3105,HCPCS,Facility,Outpatient,1,mL,,8,6.8,2.2928,8,Medica,Medica Advantage Solution,3.984,49.8,,percent of total billed charges,,
TERBUTALINE 1 MG/ML SUBQ SOLN,,J3105,HCPCS,Facility,Inpatient,1,mL,,8,6.8,2.2928,8,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
TERBUTALINE 1 MG/ML SUBQ SOLN,,J3105,HCPCS,Facility,Outpatient,1,mL,,8,6.8,2.2928,8,Medica,Medical Assistance,3.568,44.6,,percent of total billed charges,,
TERBUTALINE 1 MG/ML SUBQ SOLN,,J3105,HCPCS,Facility,Inpatient,1,mL,,8,6.8,2.2928,8,Medica,Medical Assistance,,,,,Included in per diem rate,
TERBUTALINE 1 MG/ML SUBQ SOLN,,J3105,HCPCS,Facility,Outpatient,1,mL,,8,6.8,2.2928,8,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,3.984,49.8,,percent of total billed charges,,
TERBUTALINE 1 MG/ML SUBQ SOLN,,J3105,HCPCS,Facility,Inpatient,1,mL,,8,6.8,2.2928,8,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
TERBUTALINE 1 MG/ML SUBQ SOLN,,J3105,HCPCS,Facility,Both,1,mL,,8,6.8,2.2928,8,"Multiplan, Inc.","Multiplan, Inc.",7.52,94,,percent of total billed charges,,
TERBUTALINE 1 MG/ML SUBQ SOLN,,J3105,HCPCS,Facility,Outpatient,1,mL,,8,6.8,2.2928,8,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,7.208,90.1,,percent of total billed charges,,
TERBUTALINE 1 MG/ML SUBQ SOLN,,J3105,HCPCS,Facility,Inpatient,1,mL,,8,6.8,2.2928,8,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
TERBUTALINE 1 MG/ML SUBQ SOLN,,J3105,HCPCS,Facility,Both,1,mL,,8,6.8,2.2928,8,"Preferred One Administrative Services, INC.",PPO,7.888,98.6,,percent of total billed charges,,
TERBUTALINE 1 MG/ML SUBQ SOLN,,J3105,HCPCS,Facility,Outpatient,1,mL,,8,6.8,2.2928,8,PrimeWest Health,Minnesota Senior Health Options (MSHO),4.116,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
TERBUTALINE 1 MG/ML SUBQ SOLN,,J3105,HCPCS,Facility,Inpatient,1,mL,,8,6.8,2.2928,8,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
TERBUTALINE 1 MG/ML SUBQ SOLN,,J3105,HCPCS,Facility,Outpatient,1,mL,,8,6.8,2.2928,8,PrimeWest Health,MinnesotaCare,4.1088,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
TERBUTALINE 1 MG/ML SUBQ SOLN,,J3105,HCPCS,Facility,Inpatient,1,mL,,8,6.8,2.2928,8,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
TERBUTALINE 1 MG/ML SUBQ SOLN,,J3105,HCPCS,Facility,Both,1,mL,,8,6.8,2.2928,8,Sanford Health Plan,Sanford Health Plan,7.36,92,,percent of total billed charges,,
TERBUTALINE 1 MG/ML SUBQ SOLN,,J3105,HCPCS,Facility,Outpatient,1,mL,,8,6.8,2.2928,8,"UCare Health, Inc.",Individual & Family Plan,4.508,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
TERBUTALINE 1 MG/ML SUBQ SOLN,,J3105,HCPCS,Facility,Inpatient,1,mL,,8,6.8,2.2928,8,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
TERBUTALINE 1 MG/ML SUBQ SOLN,,J3105,HCPCS,Facility,Outpatient,1,mL,,8,6.8,2.2928,8,"UCare Health, Inc.",Medical Assistance,4.0376,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TERBUTALINE 1 MG/ML SUBQ SOLN,,J3105,HCPCS,Facility,Inpatient,1,mL,,8,6.8,2.2928,8,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
TERBUTALINE 1 MG/ML SUBQ SOLN,,J3105,HCPCS,Facility,Outpatient,1,mL,,8,6.8,2.2928,8,"UCare Health, Inc.",Medicare Advantage,4.0376,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TERBUTALINE 1 MG/ML SUBQ SOLN,,J3105,HCPCS,Facility,Inpatient,1,mL,,8,6.8,2.2928,8,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
TERBUTALINE 1 MG/ML SUBQ SOLN,,J3105,HCPCS,Facility,Outpatient,1,mL,,8,6.8,2.2928,8,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),4.0376,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TERBUTALINE 1 MG/ML SUBQ SOLN,,J3105,HCPCS,Facility,Inpatient,1,mL,,8,6.8,2.2928,8,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
TERBUTALINE 1 MG/ML SUBQ SOLN,,J3105,HCPCS,Facility,Both,1,mL,,8,6.8,2.2928,8,UnitedHealthcare,Individual & Family,7.52,94,,percent of total billed charges,,
TERBUTALINE 1 MG/ML SUBQ SOLN,,J3105,HCPCS,Facility,Outpatient,1,mL,,8,6.8,2.2928,8,UnitedHealthcare,Medicare Advantage,3.92,49,,percent of total billed charges,,
TERBUTALINE 1 MG/ML SUBQ SOLN,,J3105,HCPCS,Facility,Inpatient,1,mL,,8,6.8,2.2928,8,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
TERBUTALINE 1 MG/ML SUBQ SOLN,,J3105,HCPCS,Facility,Outpatient,1,mL,,8,6.8,2.2928,8,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,3.84,48,,percent of total billed charges,,100% of DHS outpatient percentage
TERBUTALINE 1 MG/ML SUBQ SOLN,,J3105,HCPCS,Facility,Inpatient,1,mL,,8,6.8,2.2928,8,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
TRIAMCINOLONE ACETONIDE 40 MG/ML INJ SUSP,,J3301,HCPCS,Facility,Both,1,mL,,49,41.65,14.0434,49,Aetna,Commercial,45.08,92,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 40 MG/ML INJ SUSP,,J3301,HCPCS,Facility,Outpatient,1,mL,,49,41.65,14.0434,49,Aetna,Medicare Advantage,24.01,49,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 40 MG/ML INJ SUSP,,J3301,HCPCS,Facility,Inpatient,1,mL,,49,41.65,14.0434,49,Aetna,Medicare Advantage,,,,,Included in per diem rate,
TRIAMCINOLONE ACETONIDE 40 MG/ML INJ SUSP,,J3301,HCPCS,Facility,Both,1,mL,,49,41.65,14.0434,49,Aetna,PPO,45.57,93,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 40 MG/ML INJ SUSP,,J3301,HCPCS,Facility,Both,1,mL,,49,41.65,14.0434,49,America's PPO,America's PPO,47.0547,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
TRIAMCINOLONE ACETONIDE 40 MG/ML INJ SUSP,,J3301,HCPCS,Facility,Both,1,mL,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota, Federal Employee Program,48.216,98.4,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 40 MG/ML INJ SUSP,,J3301,HCPCS,Facility,Both,1,mL,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,49,100,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 40 MG/ML INJ SUSP,,J3301,HCPCS,Facility,Both,1,mL,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,High Value Network Plan,44.1,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
TRIAMCINOLONE ACETONIDE 40 MG/ML INJ SUSP,,J3301,HCPCS,Facility,Outpatient,1,mL,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Medicare Advantage,24.01,49,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 40 MG/ML INJ SUSP,,J3301,HCPCS,Facility,Inpatient,1,mL,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
TRIAMCINOLONE ACETONIDE 40 MG/ML INJ SUSP,,J3301,HCPCS,Facility,Both,1,mL,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,43.3993,88.57,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 40 MG/ML INJ SUSP,,J3301,HCPCS,Facility,Both,1,mL,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,14.0434,28.66,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 40 MG/ML INJ SUSP,,J3301,HCPCS,Facility,Outpatient,1,mL,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),24.01,49,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 40 MG/ML INJ SUSP,,J3301,HCPCS,Facility,Inpatient,1,mL,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
TRIAMCINOLONE ACETONIDE 40 MG/ML INJ SUSP,,J3301,HCPCS,Facility,Both,1,mL,,49,41.65,14.0434,49,CorVel,Worker's Compensation,49,100,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 40 MG/ML INJ SUSP,,J3301,HCPCS,Facility,Both,1,mL,,49,41.65,14.0434,49,First Health Group Corporation,First Health Network,47.53,97,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 40 MG/ML INJ SUSP,,J3301,HCPCS,Facility,Both,1,mL,,49,41.65,14.0434,49,"Health Partners, Inc.",Commercial,46.354,94.6,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 40 MG/ML INJ SUSP,,J3301,HCPCS,Facility,Outpatient,1,mL,,49,41.65,14.0434,49,"Health Partners, Inc.",Medicare Advantage,24.01,49,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 40 MG/ML INJ SUSP,,J3301,HCPCS,Facility,Inpatient,1,mL,,49,41.65,14.0434,49,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
TRIAMCINOLONE ACETONIDE 40 MG/ML INJ SUSP,,J3301,HCPCS,Facility,Both,1,mL,,49,41.65,14.0434,49,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),29.4,60,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 40 MG/ML INJ SUSP,,J3301,HCPCS,Facility,Both,1,mL,,49,41.65,14.0434,49,"Health Partners, Inc.",State of Minnesota Advantage Program,39.935,81.5,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 40 MG/ML INJ SUSP,,J3301,HCPCS,Facility,Both,1,mL,,49,41.65,14.0434,49,"Health Partners, Inc.",State Public Programs,24.5,50,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 40 MG/ML INJ SUSP,,J3301,HCPCS,Facility,Both,1,mL,,49,41.65,14.0434,49,Humana Insurance Company,Commercial PPO,46.55,95,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 40 MG/ML INJ SUSP,,J3301,HCPCS,Facility,Outpatient,1,mL,,49,41.65,14.0434,49,Humana Insurance Company,Medicare PPO,24.01,49,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 40 MG/ML INJ SUSP,,J3301,HCPCS,Facility,Inpatient,1,mL,,49,41.65,14.0434,49,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
TRIAMCINOLONE ACETONIDE 40 MG/ML INJ SUSP,,J3301,HCPCS,Facility,Both,1,mL,,49,41.65,14.0434,49,Medica,Individual & Family,48.559,99.1,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 40 MG/ML INJ SUSP,,J3301,HCPCS,Facility,Outpatient,1,mL,,49,41.65,14.0434,49,Medica,Medica Advantage Solution,24.402,49.8,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 40 MG/ML INJ SUSP,,J3301,HCPCS,Facility,Inpatient,1,mL,,49,41.65,14.0434,49,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
TRIAMCINOLONE ACETONIDE 40 MG/ML INJ SUSP,,J3301,HCPCS,Facility,Outpatient,1,mL,,49,41.65,14.0434,49,Medica,Medical Assistance,21.854,44.6,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 40 MG/ML INJ SUSP,,J3301,HCPCS,Facility,Inpatient,1,mL,,49,41.65,14.0434,49,Medica,Medical Assistance,,,,,Included in per diem rate,
TRIAMCINOLONE ACETONIDE 40 MG/ML INJ SUSP,,J3301,HCPCS,Facility,Outpatient,1,mL,,49,41.65,14.0434,49,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,24.402,49.8,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 40 MG/ML INJ SUSP,,J3301,HCPCS,Facility,Inpatient,1,mL,,49,41.65,14.0434,49,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
TRIAMCINOLONE ACETONIDE 40 MG/ML INJ SUSP,,J3301,HCPCS,Facility,Both,1,mL,,49,41.65,14.0434,49,"Multiplan, Inc.","Multiplan, Inc.",46.06,94,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 40 MG/ML INJ SUSP,,J3301,HCPCS,Facility,Outpatient,1,mL,,49,41.65,14.0434,49,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,44.149,90.1,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 40 MG/ML INJ SUSP,,J3301,HCPCS,Facility,Inpatient,1,mL,,49,41.65,14.0434,49,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
TRIAMCINOLONE ACETONIDE 40 MG/ML INJ SUSP,,J3301,HCPCS,Facility,Both,1,mL,,49,41.65,14.0434,49,"Preferred One Administrative Services, INC.",PPO,48.314,98.6,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 40 MG/ML INJ SUSP,,J3301,HCPCS,Facility,Outpatient,1,mL,,49,41.65,14.0434,49,PrimeWest Health,Minnesota Senior Health Options (MSHO),25.2105,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
TRIAMCINOLONE ACETONIDE 40 MG/ML INJ SUSP,,J3301,HCPCS,Facility,Inpatient,1,mL,,49,41.65,14.0434,49,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
TRIAMCINOLONE ACETONIDE 40 MG/ML INJ SUSP,,J3301,HCPCS,Facility,Outpatient,1,mL,,49,41.65,14.0434,49,PrimeWest Health,MinnesotaCare,25.1664,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
TRIAMCINOLONE ACETONIDE 40 MG/ML INJ SUSP,,J3301,HCPCS,Facility,Inpatient,1,mL,,49,41.65,14.0434,49,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
TRIAMCINOLONE ACETONIDE 40 MG/ML INJ SUSP,,J3301,HCPCS,Facility,Both,1,mL,,49,41.65,14.0434,49,Sanford Health Plan,Sanford Health Plan,45.08,92,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 40 MG/ML INJ SUSP,,J3301,HCPCS,Facility,Outpatient,1,mL,,49,41.65,14.0434,49,"UCare Health, Inc.",Individual & Family Plan,27.6115,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
TRIAMCINOLONE ACETONIDE 40 MG/ML INJ SUSP,,J3301,HCPCS,Facility,Inpatient,1,mL,,49,41.65,14.0434,49,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
TRIAMCINOLONE ACETONIDE 40 MG/ML INJ SUSP,,J3301,HCPCS,Facility,Outpatient,1,mL,,49,41.65,14.0434,49,"UCare Health, Inc.",Medical Assistance,24.7303,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TRIAMCINOLONE ACETONIDE 40 MG/ML INJ SUSP,,J3301,HCPCS,Facility,Inpatient,1,mL,,49,41.65,14.0434,49,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
TRIAMCINOLONE ACETONIDE 40 MG/ML INJ SUSP,,J3301,HCPCS,Facility,Outpatient,1,mL,,49,41.65,14.0434,49,"UCare Health, Inc.",Medicare Advantage,24.7303,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TRIAMCINOLONE ACETONIDE 40 MG/ML INJ SUSP,,J3301,HCPCS,Facility,Inpatient,1,mL,,49,41.65,14.0434,49,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
TRIAMCINOLONE ACETONIDE 40 MG/ML INJ SUSP,,J3301,HCPCS,Facility,Outpatient,1,mL,,49,41.65,14.0434,49,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),24.7303,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TRIAMCINOLONE ACETONIDE 40 MG/ML INJ SUSP,,J3301,HCPCS,Facility,Inpatient,1,mL,,49,41.65,14.0434,49,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
TRIAMCINOLONE ACETONIDE 40 MG/ML INJ SUSP,,J3301,HCPCS,Facility,Both,1,mL,,49,41.65,14.0434,49,UnitedHealthcare,Individual & Family,46.06,94,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 40 MG/ML INJ SUSP,,J3301,HCPCS,Facility,Outpatient,1,mL,,49,41.65,14.0434,49,UnitedHealthcare,Medicare Advantage,24.01,49,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 40 MG/ML INJ SUSP,,J3301,HCPCS,Facility,Inpatient,1,mL,,49,41.65,14.0434,49,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
TRIAMCINOLONE ACETONIDE 40 MG/ML INJ SUSP,,J3301,HCPCS,Facility,Outpatient,1,mL,,49,41.65,14.0434,49,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,23.52,48,,percent of total billed charges,,100% of DHS outpatient percentage
TRIAMCINOLONE ACETONIDE 40 MG/ML INJ SUSP,,J3301,HCPCS,Facility,Inpatient,1,mL,,49,41.65,14.0434,49,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Biopsy Or Excision Of Lymph Node(S); By Needle, Superficial (Pro Cah)",,38505,CPT,Professional,Both,,,,862,732.7,53.22,862,Aetna,Commercial,732.7,85,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Node(S); By Needle, Superficial (Pro Cah)",,38505,CPT,Professional,Both,,,,862,732.7,53.22,862,Aetna,Medicare Advantage,68.35,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Biopsy Or Excision Of Lymph Node(S); By Needle, Superficial (Pro Cah)",,38505,CPT,Professional,Both,,,,862,732.7,53.22,862,Aetna,PPO,801.66,93,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Node(S); By Needle, Superficial (Pro Cah)",,38505,CPT,Professional,Both,,,,862,732.7,53.22,862,America's PPO,America's PPO,736.4928,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Biopsy Or Excision Of Lymph Node(S); By Needle, Superficial (Pro Cah)",,38505,CPT,Professional,Both,,,,862,732.7,53.22,862,BlueCross BlueShield Minnesota, Federal Employee Program,174.9,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Biopsy Or Excision Of Lymph Node(S); By Needle, Superficial (Pro Cah)",,38505,CPT,Professional,Both,,,,862,732.7,53.22,862,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,177.6984,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Biopsy Or Excision Of Lymph Node(S); By Needle, Superficial (Pro Cah)",,38505,CPT,Professional,Both,,,,862,732.7,53.22,862,BlueCross BlueShield Minnesota,High Value Network Plan,177.6984,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Biopsy Or Excision Of Lymph Node(S); By Needle, Superficial (Pro Cah)",,38505,CPT,Professional,Both,,,,862,732.7,53.22,862,BlueCross BlueShield Minnesota,Medicare Advantage,95.0935,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Biopsy Or Excision Of Lymph Node(S); By Needle, Superficial (Pro Cah)",,38505,CPT,Professional,Both,,,,862,732.7,53.22,862,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,177.6984,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Biopsy Or Excision Of Lymph Node(S); By Needle, Superficial (Pro Cah)",,38505,CPT,Professional,Both,,,,862,732.7,53.22,862,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,61.44768,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Biopsy Or Excision Of Lymph Node(S); By Needle, Superficial (Pro Cah)",,38505,CPT,Professional,Both,,,,862,732.7,53.22,862,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),95.0935,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Biopsy Or Excision Of Lymph Node(S); By Needle, Superficial (Pro Cah)",,38505,CPT,Professional,Both,,,,862,732.7,53.22,862,CorVel,Worker's Compensation,162.5131131,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Biopsy Or Excision Of Lymph Node(S); By Needle, Superficial (Pro Cah)",,38505,CPT,Professional,Both,,,,862,732.7,53.22,862,First Health Group Corporation,First Health Network,836.14,97,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Node(S); By Needle, Superficial (Pro Cah)",,38505,CPT,Professional,Both,,,,862,732.7,53.22,862,"Health Partners, Inc.",Commercial,175.57,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Biopsy Or Excision Of Lymph Node(S); By Needle, Superficial (Pro Cah)",,38505,CPT,Professional,Both,,,,862,732.7,53.22,862,"Health Partners, Inc.",Medicare Advantage,95.0935,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Biopsy Or Excision Of Lymph Node(S); By Needle, Superficial (Pro Cah)",,38505,CPT,Professional,Both,,,,862,732.7,53.22,862,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),82.68,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Biopsy Or Excision Of Lymph Node(S); By Needle, Superficial (Pro Cah)",,38505,CPT,Professional,Both,,,,862,732.7,53.22,862,"Health Partners, Inc.",State of Minnesota Advantage Program,151.253555,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Biopsy Or Excision Of Lymph Node(S); By Needle, Superficial (Pro Cah)",,38505,CPT,Professional,Both,,,,862,732.7,53.22,862,"Health Partners, Inc.",State Public Programs,53.22,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Biopsy Or Excision Of Lymph Node(S); By Needle, Superficial (Pro Cah)",,38505,CPT,Professional,Both,,,,862,732.7,53.22,862,Humana Insurance Company,Commercial PPO,82.69,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Biopsy Or Excision Of Lymph Node(S); By Needle, Superficial (Pro Cah)",,38505,CPT,Professional,Both,,,,862,732.7,53.22,862,Humana Insurance Company,Medicare PPO,862,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Biopsy Or Excision Of Lymph Node(S); By Needle, Superficial (Pro Cah)",,38505,CPT,Professional,Both,,,,862,732.7,53.22,862,Medica,Individual & Family,730.976,84.8,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Node(S); By Needle, Superficial (Pro Cah)",,38505,CPT,Professional,Both,,,,862,732.7,53.22,862,Medica,Medica Advantage Solution,429.276,49.8,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Node(S); By Needle, Superficial (Pro Cah)",,38505,CPT,Professional,Both,,,,862,732.7,53.22,862,Medica,Medical Assistance,61.45,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Biopsy Or Excision Of Lymph Node(S); By Needle, Superficial (Pro Cah)",,38505,CPT,Professional,Both,,,,862,732.7,53.22,862,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,82.69,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Biopsy Or Excision Of Lymph Node(S); By Needle, Superficial (Pro Cah)",,38505,CPT,Professional,Both,,,,862,732.7,53.22,862,"Multiplan, Inc.","Multiplan, Inc.",810.28,94,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Node(S); By Needle, Superficial (Pro Cah)",,38505,CPT,Professional,Both,,,,862,732.7,53.22,862,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,776.662,90.1,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Node(S); By Needle, Superficial (Pro Cah)",,38505,CPT,Professional,Both,,,,862,732.7,53.22,862,"Preferred One Administrative Services, INC.",PPO,849.932,98.6,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Node(S); By Needle, Superficial (Pro Cah)",,38505,CPT,Professional,Both,,,,862,732.7,53.22,862,PrimeWest Health,Minnesota Senior Health Options (MSHO),95.0935,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Biopsy Or Excision Of Lymph Node(S); By Needle, Superficial (Pro Cah)",,38505,CPT,Professional,Both,,,,862,732.7,53.22,862,PrimeWest Health,MinnesotaCare,65.7490176,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Biopsy Or Excision Of Lymph Node(S); By Needle, Superficial (Pro Cah)",,38505,CPT,Professional,Both,,,,862,732.7,53.22,862,Sanford Health Plan,Sanford Health Plan,758.56,88,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Node(S); By Needle, Superficial (Pro Cah)",,38505,CPT,Professional,Both,,,,862,732.7,53.22,862,"UCare Health, Inc.",Individual & Family Plan,134.420864,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Biopsy Or Excision Of Lymph Node(S); By Needle, Superficial (Pro Cah)",,38505,CPT,Professional,Both,,,,862,732.7,53.22,862,"UCare Health, Inc.",Medical Assistance,67.592448,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Biopsy Or Excision Of Lymph Node(S); By Needle, Superficial (Pro Cah)",,38505,CPT,Professional,Both,,,,862,732.7,53.22,862,"UCare Health, Inc.",Medicare Advantage,95.0935,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Biopsy Or Excision Of Lymph Node(S); By Needle, Superficial (Pro Cah)",,38505,CPT,Professional,Both,,,,862,732.7,53.22,862,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),76.0748,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Biopsy Or Excision Of Lymph Node(S); By Needle, Superficial (Pro Cah)",,38505,CPT,Professional,Both,,,,862,732.7,53.22,862,UnitedHealthcare,Individual & Family,862,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Biopsy Or Excision Of Lymph Node(S); By Needle, Superficial (Pro Cah)",,38505,CPT,Professional,Both,,,,862,732.7,53.22,862,UnitedHealthcare,Medicare Advantage,95.0935,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Biopsy Or Excision Of Lymph Node(S); By Needle, Superficial (Pro Cah)",,38505,CPT,Professional,Both,,,,862,732.7,53.22,862,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,61.44768,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Biopsy Or Excision Of Lymph Nodes; By Needle, Superficial (Pbb)",,38505,CPT,Facility,Outpatient,,,,454,385.9,130.1164,454,Aetna,Commercial,417.68,92,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Nodes; By Needle, Superficial (Pbb)",,38505,CPT,Professional,Outpatient,,,,408,346.8,53.22,408,Aetna,Commercial,346.8,85,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Nodes; By Needle, Superficial (Pbb)",,38505,CPT,Facility,Outpatient,,,,454,385.9,130.1164,454,Aetna,Medicare Advantage,222.46,49,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Nodes; By Needle, Superficial (Pbb)",,38505,CPT,Professional,Outpatient,,,,408,346.8,53.22,408,Aetna,Medicare Advantage,68.35,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Biopsy Or Excision Of Lymph Nodes; By Needle, Superficial (Pbb)",,38505,CPT,Facility,Outpatient,,,,454,385.9,130.1164,454,Aetna,PPO,422.22,93,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Nodes; By Needle, Superficial (Pbb)",,38505,CPT,Professional,Outpatient,,,,408,346.8,53.22,408,Aetna,PPO,379.44,93,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Nodes; By Needle, Superficial (Pbb)",,38505,CPT,Facility,Outpatient,,,,454,385.9,130.1164,454,America's PPO,America's PPO,435.9762,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Biopsy Or Excision Of Lymph Nodes; By Needle, Superficial (Pbb)",,38505,CPT,Professional,Outpatient,,,,408,346.8,53.22,408,America's PPO,America's PPO,348.5952,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Biopsy Or Excision Of Lymph Nodes; By Needle, Superficial (Pbb)",,38505,CPT,Facility,Outpatient,,,,454,385.9,130.1164,454,BlueCross BlueShield Minnesota, Federal Employee Program,446.736,98.4,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Nodes; By Needle, Superficial (Pbb)",,38505,CPT,Professional,Outpatient,,,,408,346.8,53.22,408,BlueCross BlueShield Minnesota, Federal Employee Program,174.9,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Biopsy Or Excision Of Lymph Nodes; By Needle, Superficial (Pbb)",,38505,CPT,Facility,Outpatient,,,,454,385.9,130.1164,454,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,454,100,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Nodes; By Needle, Superficial (Pbb)",,38505,CPT,Professional,Outpatient,,,,408,346.8,53.22,408,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,177.6984,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Biopsy Or Excision Of Lymph Nodes; By Needle, Superficial (Pbb)",,38505,CPT,Facility,Outpatient,,,,454,385.9,130.1164,454,BlueCross BlueShield Minnesota,High Value Network Plan,408.6,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
"Biopsy Or Excision Of Lymph Nodes; By Needle, Superficial (Pbb)",,38505,CPT,Professional,Outpatient,,,,408,346.8,53.22,408,BlueCross BlueShield Minnesota,High Value Network Plan,177.6984,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Biopsy Or Excision Of Lymph Nodes; By Needle, Superficial (Pbb)",,38505,CPT,Facility,Outpatient,,,,454,385.9,130.1164,454,BlueCross BlueShield Minnesota,Medicare Advantage,222.46,49,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Nodes; By Needle, Superficial (Pbb)",,38505,CPT,Professional,Outpatient,,,,408,346.8,53.22,408,BlueCross BlueShield Minnesota,Medicare Advantage,95.0935,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Biopsy Or Excision Of Lymph Nodes; By Needle, Superficial (Pbb)",,38505,CPT,Professional,Outpatient,,,,408,346.8,53.22,408,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,177.6984,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Biopsy Or Excision Of Lymph Nodes; By Needle, Superficial (Pbb)",,38505,CPT,Facility,Outpatient,,,,454,385.9,130.1164,454,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,130.1164,28.66,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Nodes; By Needle, Superficial (Pbb)",,38505,CPT,Professional,Outpatient,,,,408,346.8,53.22,408,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,61.44768,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Biopsy Or Excision Of Lymph Nodes; By Needle, Superficial (Pbb)",,38505,CPT,Facility,Outpatient,,,,454,385.9,130.1164,454,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),222.46,49,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Nodes; By Needle, Superficial (Pbb)",,38505,CPT,Professional,Outpatient,,,,408,346.8,53.22,408,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),95.0935,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Biopsy Or Excision Of Lymph Nodes; By Needle, Superficial (Pbb)",,38505,CPT,Facility,Outpatient,,,,454,385.9,130.1164,454,CorVel,Worker's Compensation,454,100,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Nodes; By Needle, Superficial (Pbb)",,38505,CPT,Professional,Outpatient,,,,408,346.8,53.22,408,CorVel,Worker's Compensation,162.5131131,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Biopsy Or Excision Of Lymph Nodes; By Needle, Superficial (Pbb)",,38505,CPT,Facility,Outpatient,,,,454,385.9,130.1164,454,First Health Group Corporation,First Health Network,440.38,97,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Nodes; By Needle, Superficial (Pbb)",,38505,CPT,Professional,Outpatient,,,,408,346.8,53.22,408,First Health Group Corporation,First Health Network,395.76,97,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Nodes; By Needle, Superficial (Pbb)",,38505,CPT,Facility,Outpatient,,,,454,385.9,130.1164,454,"Health Partners, Inc.",Commercial,429.484,94.6,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Nodes; By Needle, Superficial (Pbb)",,38505,CPT,Professional,Outpatient,,,,408,346.8,53.22,408,"Health Partners, Inc.",Commercial,175.57,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Biopsy Or Excision Of Lymph Nodes; By Needle, Superficial (Pbb)",,38505,CPT,Facility,Outpatient,,,,454,385.9,130.1164,454,"Health Partners, Inc.",Medicare Advantage,222.46,49,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Nodes; By Needle, Superficial (Pbb)",,38505,CPT,Professional,Outpatient,,,,408,346.8,53.22,408,"Health Partners, Inc.",Medicare Advantage,95.0935,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Biopsy Or Excision Of Lymph Nodes; By Needle, Superficial (Pbb)",,38505,CPT,Facility,Outpatient,,,,454,385.9,130.1164,454,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),272.4,60,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Nodes; By Needle, Superficial (Pbb)",,38505,CPT,Professional,Outpatient,,,,408,346.8,53.22,408,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),82.68,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Biopsy Or Excision Of Lymph Nodes; By Needle, Superficial (Pbb)",,38505,CPT,Facility,Outpatient,,,,454,385.9,130.1164,454,"Health Partners, Inc.",State of Minnesota Advantage Program,370.01,81.5,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Nodes; By Needle, Superficial (Pbb)",,38505,CPT,Professional,Outpatient,,,,408,346.8,53.22,408,"Health Partners, Inc.",State of Minnesota Advantage Program,151.253555,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Biopsy Or Excision Of Lymph Nodes; By Needle, Superficial (Pbb)",,38505,CPT,Facility,Outpatient,,,,454,385.9,130.1164,454,"Health Partners, Inc.",State Public Programs,227,50,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Nodes; By Needle, Superficial (Pbb)",,38505,CPT,Professional,Outpatient,,,,408,346.8,53.22,408,"Health Partners, Inc.",State Public Programs,53.22,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Biopsy Or Excision Of Lymph Nodes; By Needle, Superficial (Pbb)",,38505,CPT,Facility,Outpatient,,,,454,385.9,130.1164,454,Humana Insurance Company,Commercial PPO,431.3,95,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Nodes; By Needle, Superficial (Pbb)",,38505,CPT,Professional,Outpatient,,,,408,346.8,53.22,408,Humana Insurance Company,Commercial PPO,82.69,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Biopsy Or Excision Of Lymph Nodes; By Needle, Superficial (Pbb)",,38505,CPT,Facility,Outpatient,,,,454,385.9,130.1164,454,Humana Insurance Company,Medicare PPO,222.46,49,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Nodes; By Needle, Superficial (Pbb)",,38505,CPT,Professional,Outpatient,,,,408,346.8,53.22,408,Humana Insurance Company,Medicare PPO,408,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Biopsy Or Excision Of Lymph Nodes; By Needle, Superficial (Pbb)",,38505,CPT,Facility,Outpatient,,,,454,385.9,130.1164,454,Medica,Individual & Family,449.914,99.1,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Nodes; By Needle, Superficial (Pbb)",,38505,CPT,Professional,Outpatient,,,,408,346.8,53.22,408,Medica,Individual & Family,345.984,84.8,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Nodes; By Needle, Superficial (Pbb)",,38505,CPT,Facility,Outpatient,,,,454,385.9,130.1164,454,Medica,Medica Advantage Solution,226.092,49.8,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Nodes; By Needle, Superficial (Pbb)",,38505,CPT,Professional,Outpatient,,,,408,346.8,53.22,408,Medica,Medica Advantage Solution,203.184,49.8,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Nodes; By Needle, Superficial (Pbb)",,38505,CPT,Facility,Outpatient,,,,454,385.9,130.1164,454,Medica,Medical Assistance,202.484,44.6,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Nodes; By Needle, Superficial (Pbb)",,38505,CPT,Professional,Outpatient,,,,408,346.8,53.22,408,Medica,Medical Assistance,61.45,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Biopsy Or Excision Of Lymph Nodes; By Needle, Superficial (Pbb)",,38505,CPT,Facility,Outpatient,,,,454,385.9,130.1164,454,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,226.092,49.8,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Nodes; By Needle, Superficial (Pbb)",,38505,CPT,Professional,Outpatient,,,,408,346.8,53.22,408,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,82.69,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Biopsy Or Excision Of Lymph Nodes; By Needle, Superficial (Pbb)",,38505,CPT,Facility,Outpatient,,,,454,385.9,130.1164,454,"Multiplan, Inc.","Multiplan, Inc.",426.76,94,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Nodes; By Needle, Superficial (Pbb)",,38505,CPT,Professional,Outpatient,,,,408,346.8,53.22,408,"Multiplan, Inc.","Multiplan, Inc.",383.52,94,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Nodes; By Needle, Superficial (Pbb)",,38505,CPT,Facility,Outpatient,,,,454,385.9,130.1164,454,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,409.054,90.1,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Nodes; By Needle, Superficial (Pbb)",,38505,CPT,Professional,Outpatient,,,,408,346.8,53.22,408,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,367.608,90.1,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Nodes; By Needle, Superficial (Pbb)",,38505,CPT,Facility,Outpatient,,,,454,385.9,130.1164,454,"Preferred One Administrative Services, INC.",PPO,447.644,98.6,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Nodes; By Needle, Superficial (Pbb)",,38505,CPT,Professional,Outpatient,,,,408,346.8,53.22,408,"Preferred One Administrative Services, INC.",PPO,402.288,98.6,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Nodes; By Needle, Superficial (Pbb)",,38505,CPT,Facility,Outpatient,,,,454,385.9,130.1164,454,PrimeWest Health,Minnesota Senior Health Options (MSHO),233.583,51.45,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Nodes; By Needle, Superficial (Pbb)",,38505,CPT,Professional,Outpatient,,,,408,346.8,53.22,408,PrimeWest Health,Minnesota Senior Health Options (MSHO),95.0935,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Biopsy Or Excision Of Lymph Nodes; By Needle, Superficial (Pbb)",,38505,CPT,Facility,Outpatient,,,,454,385.9,130.1164,454,PrimeWest Health,MinnesotaCare,233.1744,51.36,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Nodes; By Needle, Superficial (Pbb)",,38505,CPT,Professional,Outpatient,,,,408,346.8,53.22,408,PrimeWest Health,MinnesotaCare,65.7490176,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Biopsy Or Excision Of Lymph Nodes; By Needle, Superficial (Pbb)",,38505,CPT,Facility,Outpatient,,,,454,385.9,130.1164,454,Sanford Health Plan,Sanford Health Plan,417.68,92,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Nodes; By Needle, Superficial (Pbb)",,38505,CPT,Professional,Outpatient,,,,408,346.8,53.22,408,Sanford Health Plan,Sanford Health Plan,359.04,88,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Nodes; By Needle, Superficial (Pbb)",,38505,CPT,Facility,Outpatient,,,,454,385.9,130.1164,454,"UCare Health, Inc.",Individual & Family Plan,255.829,56.35,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Nodes; By Needle, Superficial (Pbb)",,38505,CPT,Professional,Outpatient,,,,408,346.8,53.22,408,"UCare Health, Inc.",Individual & Family Plan,134.420864,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Biopsy Or Excision Of Lymph Nodes; By Needle, Superficial (Pbb)",,38505,CPT,Facility,Outpatient,,,,454,385.9,130.1164,454,"UCare Health, Inc.",Medical Assistance,229.1338,50.47,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Nodes; By Needle, Superficial (Pbb)",,38505,CPT,Professional,Outpatient,,,,408,346.8,53.22,408,"UCare Health, Inc.",Medical Assistance,67.592448,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Biopsy Or Excision Of Lymph Nodes; By Needle, Superficial (Pbb)",,38505,CPT,Facility,Outpatient,,,,454,385.9,130.1164,454,"UCare Health, Inc.",Medicare Advantage,229.1338,50.47,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Nodes; By Needle, Superficial (Pbb)",,38505,CPT,Professional,Outpatient,,,,408,346.8,53.22,408,"UCare Health, Inc.",Medicare Advantage,95.0935,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Biopsy Or Excision Of Lymph Nodes; By Needle, Superficial (Pbb)",,38505,CPT,Facility,Outpatient,,,,454,385.9,130.1164,454,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),229.1338,50.47,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Nodes; By Needle, Superficial (Pbb)",,38505,CPT,Professional,Outpatient,,,,408,346.8,53.22,408,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),76.0748,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Biopsy Or Excision Of Lymph Nodes; By Needle, Superficial (Pbb)",,38505,CPT,Facility,Outpatient,,,,454,385.9,130.1164,454,UnitedHealthcare,Individual & Family,426.76,94,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Nodes; By Needle, Superficial (Pbb)",,38505,CPT,Professional,Outpatient,,,,408,346.8,53.22,408,UnitedHealthcare,Individual & Family,408,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Biopsy Or Excision Of Lymph Nodes; By Needle, Superficial (Pbb)",,38505,CPT,Facility,Outpatient,,,,454,385.9,130.1164,454,UnitedHealthcare,Medicare Advantage,222.46,49,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Nodes; By Needle, Superficial (Pbb)",,38505,CPT,Professional,Outpatient,,,,408,346.8,53.22,408,UnitedHealthcare,Medicare Advantage,95.0935,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Biopsy Or Excision Of Lymph Nodes; By Needle, Superficial (Pbb)",,38505,CPT,Facility,Outpatient,,,,454,385.9,130.1164,454,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,217.92,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Biopsy Or Excision Of Lymph Nodes; By Needle, Superficial (Pbb)",,38505,CPT,Professional,Outpatient,,,,408,346.8,53.22,408,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,61.44768,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Biopsy Or Excision Of Lymph Node(S); Open, Deep Cervical Node(S) (Pro Cah)",,38510,CPT,Professional,Both,,,,3361,2856.85,256.55,3361,Aetna,Commercial,2856.85,85,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Node(S); Open, Deep Cervical Node(S) (Pro Cah)",,38510,CPT,Professional,Both,,,,3361,2856.85,256.55,3361,Aetna,Medicare Advantage,401.86,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Biopsy Or Excision Of Lymph Node(S); Open, Deep Cervical Node(S) (Pro Cah)",,38510,CPT,Professional,Both,,,,3361,2856.85,256.55,3361,Aetna,PPO,3125.73,93,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Node(S); Open, Deep Cervical Node(S) (Pro Cah)",,38510,CPT,Professional,Both,,,,3361,2856.85,256.55,3361,America's PPO,America's PPO,2871.6384,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Biopsy Or Excision Of Lymph Node(S); Open, Deep Cervical Node(S) (Pro Cah)",,38510,CPT,Professional,Both,,,,3361,2856.85,256.55,3361,BlueCross BlueShield Minnesota, Federal Employee Program,863.5,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Biopsy Or Excision Of Lymph Node(S); Open, Deep Cervical Node(S) (Pro Cah)",,38510,CPT,Professional,Both,,,,3361,2856.85,256.55,3361,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,877.316,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Biopsy Or Excision Of Lymph Node(S); Open, Deep Cervical Node(S) (Pro Cah)",,38510,CPT,Professional,Both,,,,3361,2856.85,256.55,3361,BlueCross BlueShield Minnesota,High Value Network Plan,877.316,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Biopsy Or Excision Of Lymph Node(S); Open, Deep Cervical Node(S) (Pro Cah)",,38510,CPT,Professional,Both,,,,3361,2856.85,256.55,3361,BlueCross BlueShield Minnesota,Medicare Advantage,458.413,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Biopsy Or Excision Of Lymph Node(S); Open, Deep Cervical Node(S) (Pro Cah)",,38510,CPT,Professional,Both,,,,3361,2856.85,256.55,3361,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,877.316,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Biopsy Or Excision Of Lymph Node(S); Open, Deep Cervical Node(S) (Pro Cah)",,38510,CPT,Professional,Both,,,,3361,2856.85,256.55,3361,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,296.19448,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Biopsy Or Excision Of Lymph Node(S); Open, Deep Cervical Node(S) (Pro Cah)",,38510,CPT,Professional,Both,,,,3361,2856.85,256.55,3361,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),458.413,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Biopsy Or Excision Of Lymph Node(S); Open, Deep Cervical Node(S) (Pro Cah)",,38510,CPT,Professional,Both,,,,3361,2856.85,256.55,3361,CorVel,Worker's Compensation,782.0226948,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Biopsy Or Excision Of Lymph Node(S); Open, Deep Cervical Node(S) (Pro Cah)",,38510,CPT,Professional,Both,,,,3361,2856.85,256.55,3361,First Health Group Corporation,First Health Network,3260.17,97,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Node(S); Open, Deep Cervical Node(S) (Pro Cah)",,38510,CPT,Professional,Both,,,,3361,2856.85,256.55,3361,"Health Partners, Inc.",Commercial,845.24,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Biopsy Or Excision Of Lymph Node(S); Open, Deep Cervical Node(S) (Pro Cah)",,38510,CPT,Professional,Both,,,,3361,2856.85,256.55,3361,"Health Partners, Inc.",Medicare Advantage,458.413,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Biopsy Or Excision Of Lymph Node(S); Open, Deep Cervical Node(S) (Pro Cah)",,38510,CPT,Professional,Both,,,,3361,2856.85,256.55,3361,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),398.85,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Biopsy Or Excision Of Lymph Node(S); Open, Deep Cervical Node(S) (Pro Cah)",,38510,CPT,Professional,Both,,,,3361,2856.85,256.55,3361,"Health Partners, Inc.",State of Minnesota Advantage Program,728.17426,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Biopsy Or Excision Of Lymph Node(S); Open, Deep Cervical Node(S) (Pro Cah)",,38510,CPT,Professional,Both,,,,3361,2856.85,256.55,3361,"Health Partners, Inc.",State Public Programs,256.55,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Biopsy Or Excision Of Lymph Node(S); Open, Deep Cervical Node(S) (Pro Cah)",,38510,CPT,Professional,Both,,,,3361,2856.85,256.55,3361,Humana Insurance Company,Commercial PPO,398.62,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Biopsy Or Excision Of Lymph Node(S); Open, Deep Cervical Node(S) (Pro Cah)",,38510,CPT,Professional,Both,,,,3361,2856.85,256.55,3361,Humana Insurance Company,Medicare PPO,3361,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Biopsy Or Excision Of Lymph Node(S); Open, Deep Cervical Node(S) (Pro Cah)",,38510,CPT,Professional,Both,,,,3361,2856.85,256.55,3361,Medica,Individual & Family,2850.128,84.8,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Node(S); Open, Deep Cervical Node(S) (Pro Cah)",,38510,CPT,Professional,Both,,,,3361,2856.85,256.55,3361,Medica,Medica Advantage Solution,1673.778,49.8,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Node(S); Open, Deep Cervical Node(S) (Pro Cah)",,38510,CPT,Professional,Both,,,,3361,2856.85,256.55,3361,Medica,Medical Assistance,296.19,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Biopsy Or Excision Of Lymph Node(S); Open, Deep Cervical Node(S) (Pro Cah)",,38510,CPT,Professional,Both,,,,3361,2856.85,256.55,3361,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,398.62,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Biopsy Or Excision Of Lymph Node(S); Open, Deep Cervical Node(S) (Pro Cah)",,38510,CPT,Professional,Both,,,,3361,2856.85,256.55,3361,"Multiplan, Inc.","Multiplan, Inc.",3159.34,94,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Node(S); Open, Deep Cervical Node(S) (Pro Cah)",,38510,CPT,Professional,Both,,,,3361,2856.85,256.55,3361,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,3028.261,90.1,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Node(S); Open, Deep Cervical Node(S) (Pro Cah)",,38510,CPT,Professional,Both,,,,3361,2856.85,256.55,3361,"Preferred One Administrative Services, INC.",PPO,3313.946,98.6,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Node(S); Open, Deep Cervical Node(S) (Pro Cah)",,38510,CPT,Professional,Both,,,,3361,2856.85,256.55,3361,PrimeWest Health,Minnesota Senior Health Options (MSHO),458.413,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Biopsy Or Excision Of Lymph Node(S); Open, Deep Cervical Node(S) (Pro Cah)",,38510,CPT,Professional,Both,,,,3361,2856.85,256.55,3361,PrimeWest Health,MinnesotaCare,316.9280936,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Biopsy Or Excision Of Lymph Node(S); Open, Deep Cervical Node(S) (Pro Cah)",,38510,CPT,Professional,Both,,,,3361,2856.85,256.55,3361,Sanford Health Plan,Sanford Health Plan,2957.68,88,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Node(S); Open, Deep Cervical Node(S) (Pro Cah)",,38510,CPT,Professional,Both,,,,3361,2856.85,256.55,3361,"UCare Health, Inc.",Individual & Family Plan,647.996672,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Biopsy Or Excision Of Lymph Node(S); Open, Deep Cervical Node(S) (Pro Cah)",,38510,CPT,Professional,Both,,,,3361,2856.85,256.55,3361,"UCare Health, Inc.",Medical Assistance,325.813928,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Biopsy Or Excision Of Lymph Node(S); Open, Deep Cervical Node(S) (Pro Cah)",,38510,CPT,Professional,Both,,,,3361,2856.85,256.55,3361,"UCare Health, Inc.",Medicare Advantage,458.413,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Biopsy Or Excision Of Lymph Node(S); Open, Deep Cervical Node(S) (Pro Cah)",,38510,CPT,Professional,Both,,,,3361,2856.85,256.55,3361,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),366.7304,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Biopsy Or Excision Of Lymph Node(S); Open, Deep Cervical Node(S) (Pro Cah)",,38510,CPT,Professional,Both,,,,3361,2856.85,256.55,3361,UnitedHealthcare,Individual & Family,3361,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Biopsy Or Excision Of Lymph Node(S); Open, Deep Cervical Node(S) (Pro Cah)",,38510,CPT,Professional,Both,,,,3361,2856.85,256.55,3361,UnitedHealthcare,Medicare Advantage,458.413,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Biopsy Or Excision Of Lymph Node(S); Open, Deep Cervical Node(S) (Pro Cah)",,38510,CPT,Professional,Both,,,,3361,2856.85,256.55,3361,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,296.19448,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Biopsy Or Excision Of Lymph Nodes; Open, Deep Cervical Node(S) (Pbb)",,38510,CPT,Facility,Outpatient,,,,1678,1426.3,480.9148,1678,Aetna,Commercial,1543.76,92,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Nodes; Open, Deep Cervical Node(S) (Pbb)",,38510,CPT,Professional,Outpatient,,,,1683,1430.55,256.55,1683,Aetna,Commercial,1430.55,85,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Nodes; Open, Deep Cervical Node(S) (Pbb)",,38510,CPT,Facility,Outpatient,,,,1678,1426.3,480.9148,1678,Aetna,Medicare Advantage,822.22,49,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Nodes; Open, Deep Cervical Node(S) (Pbb)",,38510,CPT,Professional,Outpatient,,,,1683,1430.55,256.55,1683,Aetna,Medicare Advantage,401.86,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Biopsy Or Excision Of Lymph Nodes; Open, Deep Cervical Node(S) (Pbb)",,38510,CPT,Facility,Outpatient,,,,1678,1426.3,480.9148,1678,Aetna,PPO,1560.54,93,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Nodes; Open, Deep Cervical Node(S) (Pbb)",,38510,CPT,Professional,Outpatient,,,,1683,1430.55,256.55,1683,Aetna,PPO,1565.19,93,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Nodes; Open, Deep Cervical Node(S) (Pbb)",,38510,CPT,Facility,Outpatient,,,,1678,1426.3,480.9148,1678,America's PPO,America's PPO,1611.3834,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Biopsy Or Excision Of Lymph Nodes; Open, Deep Cervical Node(S) (Pbb)",,38510,CPT,Professional,Outpatient,,,,1683,1430.55,256.55,1683,America's PPO,America's PPO,1437.9552,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Biopsy Or Excision Of Lymph Nodes; Open, Deep Cervical Node(S) (Pbb)",,38510,CPT,Facility,Outpatient,,,,1678,1426.3,480.9148,1678,BlueCross BlueShield Minnesota, Federal Employee Program,1651.152,98.4,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Nodes; Open, Deep Cervical Node(S) (Pbb)",,38510,CPT,Professional,Outpatient,,,,1683,1430.55,256.55,1683,BlueCross BlueShield Minnesota, Federal Employee Program,863.5,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Biopsy Or Excision Of Lymph Nodes; Open, Deep Cervical Node(S) (Pbb)",,38510,CPT,Facility,Outpatient,,,,1678,1426.3,480.9148,1678,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1678,100,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Nodes; Open, Deep Cervical Node(S) (Pbb)",,38510,CPT,Professional,Outpatient,,,,1683,1430.55,256.55,1683,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,877.316,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Biopsy Or Excision Of Lymph Nodes; Open, Deep Cervical Node(S) (Pbb)",,38510,CPT,Facility,Outpatient,,,,1678,1426.3,480.9148,1678,BlueCross BlueShield Minnesota,High Value Network Plan,1510.2,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
"Biopsy Or Excision Of Lymph Nodes; Open, Deep Cervical Node(S) (Pbb)",,38510,CPT,Professional,Outpatient,,,,1683,1430.55,256.55,1683,BlueCross BlueShield Minnesota,High Value Network Plan,877.316,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Biopsy Or Excision Of Lymph Nodes; Open, Deep Cervical Node(S) (Pbb)",,38510,CPT,Facility,Outpatient,,,,1678,1426.3,480.9148,1678,BlueCross BlueShield Minnesota,Medicare Advantage,822.22,49,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Nodes; Open, Deep Cervical Node(S) (Pbb)",,38510,CPT,Professional,Outpatient,,,,1683,1430.55,256.55,1683,BlueCross BlueShield Minnesota,Medicare Advantage,458.413,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Biopsy Or Excision Of Lymph Nodes; Open, Deep Cervical Node(S) (Pbb)",,38510,CPT,Professional,Outpatient,,,,1683,1430.55,256.55,1683,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,877.316,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Biopsy Or Excision Of Lymph Nodes; Open, Deep Cervical Node(S) (Pbb)",,38510,CPT,Facility,Outpatient,,,,1678,1426.3,480.9148,1678,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,480.9148,28.66,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Nodes; Open, Deep Cervical Node(S) (Pbb)",,38510,CPT,Professional,Outpatient,,,,1683,1430.55,256.55,1683,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,296.19448,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Biopsy Or Excision Of Lymph Nodes; Open, Deep Cervical Node(S) (Pbb)",,38510,CPT,Facility,Outpatient,,,,1678,1426.3,480.9148,1678,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),822.22,49,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Nodes; Open, Deep Cervical Node(S) (Pbb)",,38510,CPT,Professional,Outpatient,,,,1683,1430.55,256.55,1683,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),458.413,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Biopsy Or Excision Of Lymph Nodes; Open, Deep Cervical Node(S) (Pbb)",,38510,CPT,Facility,Outpatient,,,,1678,1426.3,480.9148,1678,CorVel,Worker's Compensation,1678,100,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Nodes; Open, Deep Cervical Node(S) (Pbb)",,38510,CPT,Professional,Outpatient,,,,1683,1430.55,256.55,1683,CorVel,Worker's Compensation,782.0226948,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Biopsy Or Excision Of Lymph Nodes; Open, Deep Cervical Node(S) (Pbb)",,38510,CPT,Facility,Outpatient,,,,1678,1426.3,480.9148,1678,First Health Group Corporation,First Health Network,1627.66,97,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Nodes; Open, Deep Cervical Node(S) (Pbb)",,38510,CPT,Professional,Outpatient,,,,1683,1430.55,256.55,1683,First Health Group Corporation,First Health Network,1632.51,97,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Nodes; Open, Deep Cervical Node(S) (Pbb)",,38510,CPT,Facility,Outpatient,,,,1678,1426.3,480.9148,1678,"Health Partners, Inc.",Commercial,1587.388,94.6,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Nodes; Open, Deep Cervical Node(S) (Pbb)",,38510,CPT,Professional,Outpatient,,,,1683,1430.55,256.55,1683,"Health Partners, Inc.",Commercial,845.24,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Biopsy Or Excision Of Lymph Nodes; Open, Deep Cervical Node(S) (Pbb)",,38510,CPT,Facility,Outpatient,,,,1678,1426.3,480.9148,1678,"Health Partners, Inc.",Medicare Advantage,822.22,49,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Nodes; Open, Deep Cervical Node(S) (Pbb)",,38510,CPT,Professional,Outpatient,,,,1683,1430.55,256.55,1683,"Health Partners, Inc.",Medicare Advantage,458.413,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Biopsy Or Excision Of Lymph Nodes; Open, Deep Cervical Node(S) (Pbb)",,38510,CPT,Facility,Outpatient,,,,1678,1426.3,480.9148,1678,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1006.8,60,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Nodes; Open, Deep Cervical Node(S) (Pbb)",,38510,CPT,Professional,Outpatient,,,,1683,1430.55,256.55,1683,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),398.85,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Biopsy Or Excision Of Lymph Nodes; Open, Deep Cervical Node(S) (Pbb)",,38510,CPT,Facility,Outpatient,,,,1678,1426.3,480.9148,1678,"Health Partners, Inc.",State of Minnesota Advantage Program,1367.57,81.5,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Nodes; Open, Deep Cervical Node(S) (Pbb)",,38510,CPT,Professional,Outpatient,,,,1683,1430.55,256.55,1683,"Health Partners, Inc.",State of Minnesota Advantage Program,728.17426,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Biopsy Or Excision Of Lymph Nodes; Open, Deep Cervical Node(S) (Pbb)",,38510,CPT,Facility,Outpatient,,,,1678,1426.3,480.9148,1678,"Health Partners, Inc.",State Public Programs,839,50,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Nodes; Open, Deep Cervical Node(S) (Pbb)",,38510,CPT,Professional,Outpatient,,,,1683,1430.55,256.55,1683,"Health Partners, Inc.",State Public Programs,256.55,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Biopsy Or Excision Of Lymph Nodes; Open, Deep Cervical Node(S) (Pbb)",,38510,CPT,Facility,Outpatient,,,,1678,1426.3,480.9148,1678,Humana Insurance Company,Commercial PPO,1594.1,95,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Nodes; Open, Deep Cervical Node(S) (Pbb)",,38510,CPT,Professional,Outpatient,,,,1683,1430.55,256.55,1683,Humana Insurance Company,Commercial PPO,398.62,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Biopsy Or Excision Of Lymph Nodes; Open, Deep Cervical Node(S) (Pbb)",,38510,CPT,Facility,Outpatient,,,,1678,1426.3,480.9148,1678,Humana Insurance Company,Medicare PPO,822.22,49,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Nodes; Open, Deep Cervical Node(S) (Pbb)",,38510,CPT,Professional,Outpatient,,,,1683,1430.55,256.55,1683,Humana Insurance Company,Medicare PPO,1683,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Biopsy Or Excision Of Lymph Nodes; Open, Deep Cervical Node(S) (Pbb)",,38510,CPT,Facility,Outpatient,,,,1678,1426.3,480.9148,1678,Medica,Individual & Family,1662.898,99.1,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Nodes; Open, Deep Cervical Node(S) (Pbb)",,38510,CPT,Professional,Outpatient,,,,1683,1430.55,256.55,1683,Medica,Individual & Family,1427.184,84.8,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Nodes; Open, Deep Cervical Node(S) (Pbb)",,38510,CPT,Facility,Outpatient,,,,1678,1426.3,480.9148,1678,Medica,Medica Advantage Solution,835.644,49.8,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Nodes; Open, Deep Cervical Node(S) (Pbb)",,38510,CPT,Professional,Outpatient,,,,1683,1430.55,256.55,1683,Medica,Medica Advantage Solution,838.134,49.8,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Nodes; Open, Deep Cervical Node(S) (Pbb)",,38510,CPT,Facility,Outpatient,,,,1678,1426.3,480.9148,1678,Medica,Medical Assistance,748.388,44.6,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Nodes; Open, Deep Cervical Node(S) (Pbb)",,38510,CPT,Professional,Outpatient,,,,1683,1430.55,256.55,1683,Medica,Medical Assistance,296.19,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Biopsy Or Excision Of Lymph Nodes; Open, Deep Cervical Node(S) (Pbb)",,38510,CPT,Facility,Outpatient,,,,1678,1426.3,480.9148,1678,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,835.644,49.8,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Nodes; Open, Deep Cervical Node(S) (Pbb)",,38510,CPT,Professional,Outpatient,,,,1683,1430.55,256.55,1683,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,398.62,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Biopsy Or Excision Of Lymph Nodes; Open, Deep Cervical Node(S) (Pbb)",,38510,CPT,Facility,Outpatient,,,,1678,1426.3,480.9148,1678,"Multiplan, Inc.","Multiplan, Inc.",1577.32,94,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Nodes; Open, Deep Cervical Node(S) (Pbb)",,38510,CPT,Professional,Outpatient,,,,1683,1430.55,256.55,1683,"Multiplan, Inc.","Multiplan, Inc.",1582.02,94,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Nodes; Open, Deep Cervical Node(S) (Pbb)",,38510,CPT,Facility,Outpatient,,,,1678,1426.3,480.9148,1678,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1511.878,90.1,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Nodes; Open, Deep Cervical Node(S) (Pbb)",,38510,CPT,Professional,Outpatient,,,,1683,1430.55,256.55,1683,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1516.383,90.1,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Nodes; Open, Deep Cervical Node(S) (Pbb)",,38510,CPT,Facility,Outpatient,,,,1678,1426.3,480.9148,1678,"Preferred One Administrative Services, INC.",PPO,1654.508,98.6,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Nodes; Open, Deep Cervical Node(S) (Pbb)",,38510,CPT,Professional,Outpatient,,,,1683,1430.55,256.55,1683,"Preferred One Administrative Services, INC.",PPO,1659.438,98.6,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Nodes; Open, Deep Cervical Node(S) (Pbb)",,38510,CPT,Facility,Outpatient,,,,1678,1426.3,480.9148,1678,PrimeWest Health,Minnesota Senior Health Options (MSHO),863.331,51.45,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Nodes; Open, Deep Cervical Node(S) (Pbb)",,38510,CPT,Professional,Outpatient,,,,1683,1430.55,256.55,1683,PrimeWest Health,Minnesota Senior Health Options (MSHO),458.413,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Biopsy Or Excision Of Lymph Nodes; Open, Deep Cervical Node(S) (Pbb)",,38510,CPT,Facility,Outpatient,,,,1678,1426.3,480.9148,1678,PrimeWest Health,MinnesotaCare,861.8208,51.36,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Nodes; Open, Deep Cervical Node(S) (Pbb)",,38510,CPT,Professional,Outpatient,,,,1683,1430.55,256.55,1683,PrimeWest Health,MinnesotaCare,316.9280936,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Biopsy Or Excision Of Lymph Nodes; Open, Deep Cervical Node(S) (Pbb)",,38510,CPT,Facility,Outpatient,,,,1678,1426.3,480.9148,1678,Sanford Health Plan,Sanford Health Plan,1543.76,92,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Nodes; Open, Deep Cervical Node(S) (Pbb)",,38510,CPT,Professional,Outpatient,,,,1683,1430.55,256.55,1683,Sanford Health Plan,Sanford Health Plan,1481.04,88,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Nodes; Open, Deep Cervical Node(S) (Pbb)",,38510,CPT,Facility,Outpatient,,,,1678,1426.3,480.9148,1678,"UCare Health, Inc.",Individual & Family Plan,945.553,56.35,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Nodes; Open, Deep Cervical Node(S) (Pbb)",,38510,CPT,Professional,Outpatient,,,,1683,1430.55,256.55,1683,"UCare Health, Inc.",Individual & Family Plan,647.996672,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Biopsy Or Excision Of Lymph Nodes; Open, Deep Cervical Node(S) (Pbb)",,38510,CPT,Facility,Outpatient,,,,1678,1426.3,480.9148,1678,"UCare Health, Inc.",Medical Assistance,846.8866,50.47,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Nodes; Open, Deep Cervical Node(S) (Pbb)",,38510,CPT,Professional,Outpatient,,,,1683,1430.55,256.55,1683,"UCare Health, Inc.",Medical Assistance,325.813928,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Biopsy Or Excision Of Lymph Nodes; Open, Deep Cervical Node(S) (Pbb)",,38510,CPT,Facility,Outpatient,,,,1678,1426.3,480.9148,1678,"UCare Health, Inc.",Medicare Advantage,846.8866,50.47,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Nodes; Open, Deep Cervical Node(S) (Pbb)",,38510,CPT,Professional,Outpatient,,,,1683,1430.55,256.55,1683,"UCare Health, Inc.",Medicare Advantage,458.413,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Biopsy Or Excision Of Lymph Nodes; Open, Deep Cervical Node(S) (Pbb)",,38510,CPT,Facility,Outpatient,,,,1678,1426.3,480.9148,1678,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),846.8866,50.47,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Nodes; Open, Deep Cervical Node(S) (Pbb)",,38510,CPT,Professional,Outpatient,,,,1683,1430.55,256.55,1683,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),366.7304,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Biopsy Or Excision Of Lymph Nodes; Open, Deep Cervical Node(S) (Pbb)",,38510,CPT,Facility,Outpatient,,,,1678,1426.3,480.9148,1678,UnitedHealthcare,Individual & Family,1577.32,94,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Nodes; Open, Deep Cervical Node(S) (Pbb)",,38510,CPT,Professional,Outpatient,,,,1683,1430.55,256.55,1683,UnitedHealthcare,Individual & Family,1683,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Biopsy Or Excision Of Lymph Nodes; Open, Deep Cervical Node(S) (Pbb)",,38510,CPT,Facility,Outpatient,,,,1678,1426.3,480.9148,1678,UnitedHealthcare,Medicare Advantage,822.22,49,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Nodes; Open, Deep Cervical Node(S) (Pbb)",,38510,CPT,Professional,Outpatient,,,,1683,1430.55,256.55,1683,UnitedHealthcare,Medicare Advantage,458.413,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Biopsy Or Excision Of Lymph Nodes; Open, Deep Cervical Node(S) (Pbb)",,38510,CPT,Facility,Outpatient,,,,1678,1426.3,480.9148,1678,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,805.44,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Biopsy Or Excision Of Lymph Nodes; Open, Deep Cervical Node(S) (Pbb)",,38510,CPT,Professional,Outpatient,,,,1683,1430.55,256.55,1683,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,296.19448,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Biopsy Or Excision Of Lymph Node(S); Open, Deep Axillary Node(S) (Pro Cah)",,38525,CPT,Professional,Both,,,,2525,2146.25,267.45,2525,Aetna,Commercial,2146.25,85,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Node(S); Open, Deep Axillary Node(S) (Pro Cah)",,38525,CPT,Professional,Both,,,,2525,2146.25,267.45,2525,Aetna,Medicare Advantage,421,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Biopsy Or Excision Of Lymph Node(S); Open, Deep Axillary Node(S) (Pro Cah)",,38525,CPT,Professional,Both,,,,2525,2146.25,267.45,2525,Aetna,PPO,2348.25,93,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Node(S); Open, Deep Axillary Node(S) (Pro Cah)",,38525,CPT,Professional,Both,,,,2525,2146.25,267.45,2525,America's PPO,America's PPO,2157.36,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Biopsy Or Excision Of Lymph Node(S); Open, Deep Axillary Node(S) (Pro Cah)",,38525,CPT,Professional,Both,,,,2525,2146.25,267.45,2525,BlueCross BlueShield Minnesota, Federal Employee Program,910.33,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Biopsy Or Excision Of Lymph Node(S); Open, Deep Axillary Node(S) (Pro Cah)",,38525,CPT,Professional,Both,,,,2525,2146.25,267.45,2525,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,924.89528,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Biopsy Or Excision Of Lymph Node(S); Open, Deep Axillary Node(S) (Pro Cah)",,38525,CPT,Professional,Both,,,,2525,2146.25,267.45,2525,BlueCross BlueShield Minnesota,High Value Network Plan,924.89528,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Biopsy Or Excision Of Lymph Node(S); Open, Deep Axillary Node(S) (Pro Cah)",,38525,CPT,Professional,Both,,,,2525,2146.25,267.45,2525,BlueCross BlueShield Minnesota,Medicare Advantage,477.8135,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Biopsy Or Excision Of Lymph Node(S); Open, Deep Axillary Node(S) (Pro Cah)",,38525,CPT,Professional,Both,,,,2525,2146.25,267.45,2525,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,924.89528,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Biopsy Or Excision Of Lymph Node(S); Open, Deep Axillary Node(S) (Pro Cah)",,38525,CPT,Professional,Both,,,,2525,2146.25,267.45,2525,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,308.78272,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Biopsy Or Excision Of Lymph Node(S); Open, Deep Axillary Node(S) (Pro Cah)",,38525,CPT,Professional,Both,,,,2525,2146.25,267.45,2525,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),477.8135,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Biopsy Or Excision Of Lymph Node(S); Open, Deep Axillary Node(S) (Pro Cah)",,38525,CPT,Professional,Both,,,,2525,2146.25,267.45,2525,CorVel,Worker's Compensation,818.6652732,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Biopsy Or Excision Of Lymph Node(S); Open, Deep Axillary Node(S) (Pro Cah)",,38525,CPT,Professional,Both,,,,2525,2146.25,267.45,2525,First Health Group Corporation,First Health Network,2449.25,97,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Node(S); Open, Deep Axillary Node(S) (Pro Cah)",,38525,CPT,Professional,Both,,,,2525,2146.25,267.45,2525,"Health Partners, Inc.",Commercial,884.42,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Biopsy Or Excision Of Lymph Node(S); Open, Deep Axillary Node(S) (Pro Cah)",,38525,CPT,Professional,Both,,,,2525,2146.25,267.45,2525,"Health Partners, Inc.",Medicare Advantage,477.8135,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Biopsy Or Excision Of Lymph Node(S); Open, Deep Axillary Node(S) (Pro Cah)",,38525,CPT,Professional,Both,,,,2525,2146.25,267.45,2525,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),415.46,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Biopsy Or Excision Of Lymph Node(S); Open, Deep Axillary Node(S) (Pro Cah)",,38525,CPT,Professional,Both,,,,2525,2146.25,267.45,2525,"Health Partners, Inc.",State of Minnesota Advantage Program,761.92783,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Biopsy Or Excision Of Lymph Node(S); Open, Deep Axillary Node(S) (Pro Cah)",,38525,CPT,Professional,Both,,,,2525,2146.25,267.45,2525,"Health Partners, Inc.",State Public Programs,267.45,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Biopsy Or Excision Of Lymph Node(S); Open, Deep Axillary Node(S) (Pro Cah)",,38525,CPT,Professional,Both,,,,2525,2146.25,267.45,2525,Humana Insurance Company,Commercial PPO,415.49,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Biopsy Or Excision Of Lymph Node(S); Open, Deep Axillary Node(S) (Pro Cah)",,38525,CPT,Professional,Both,,,,2525,2146.25,267.45,2525,Humana Insurance Company,Medicare PPO,2525,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Biopsy Or Excision Of Lymph Node(S); Open, Deep Axillary Node(S) (Pro Cah)",,38525,CPT,Professional,Both,,,,2525,2146.25,267.45,2525,Medica,Individual & Family,2141.2,84.8,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Node(S); Open, Deep Axillary Node(S) (Pro Cah)",,38525,CPT,Professional,Both,,,,2525,2146.25,267.45,2525,Medica,Medica Advantage Solution,1257.45,49.8,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Node(S); Open, Deep Axillary Node(S) (Pro Cah)",,38525,CPT,Professional,Both,,,,2525,2146.25,267.45,2525,Medica,Medical Assistance,308.78,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Biopsy Or Excision Of Lymph Node(S); Open, Deep Axillary Node(S) (Pro Cah)",,38525,CPT,Professional,Both,,,,2525,2146.25,267.45,2525,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,415.49,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Biopsy Or Excision Of Lymph Node(S); Open, Deep Axillary Node(S) (Pro Cah)",,38525,CPT,Professional,Both,,,,2525,2146.25,267.45,2525,"Multiplan, Inc.","Multiplan, Inc.",2373.5,94,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Node(S); Open, Deep Axillary Node(S) (Pro Cah)",,38525,CPT,Professional,Both,,,,2525,2146.25,267.45,2525,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,2275.025,90.1,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Node(S); Open, Deep Axillary Node(S) (Pro Cah)",,38525,CPT,Professional,Both,,,,2525,2146.25,267.45,2525,"Preferred One Administrative Services, INC.",PPO,2489.65,98.6,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Node(S); Open, Deep Axillary Node(S) (Pro Cah)",,38525,CPT,Professional,Both,,,,2525,2146.25,267.45,2525,PrimeWest Health,Minnesota Senior Health Options (MSHO),477.8135,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Biopsy Or Excision Of Lymph Node(S); Open, Deep Axillary Node(S) (Pro Cah)",,38525,CPT,Professional,Both,,,,2525,2146.25,267.45,2525,PrimeWest Health,MinnesotaCare,330.3975104,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Biopsy Or Excision Of Lymph Node(S); Open, Deep Axillary Node(S) (Pro Cah)",,38525,CPT,Professional,Both,,,,2525,2146.25,267.45,2525,Sanford Health Plan,Sanford Health Plan,2222,88,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Node(S); Open, Deep Axillary Node(S) (Pro Cah)",,38525,CPT,Professional,Both,,,,2525,2146.25,267.45,2525,"UCare Health, Inc.",Individual & Family Plan,675.420544,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Biopsy Or Excision Of Lymph Node(S); Open, Deep Axillary Node(S) (Pro Cah)",,38525,CPT,Professional,Both,,,,2525,2146.25,267.45,2525,"UCare Health, Inc.",Medical Assistance,339.660992,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Biopsy Or Excision Of Lymph Node(S); Open, Deep Axillary Node(S) (Pro Cah)",,38525,CPT,Professional,Both,,,,2525,2146.25,267.45,2525,"UCare Health, Inc.",Medicare Advantage,477.8135,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Biopsy Or Excision Of Lymph Node(S); Open, Deep Axillary Node(S) (Pro Cah)",,38525,CPT,Professional,Both,,,,2525,2146.25,267.45,2525,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),382.2508,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Biopsy Or Excision Of Lymph Node(S); Open, Deep Axillary Node(S) (Pro Cah)",,38525,CPT,Professional,Both,,,,2525,2146.25,267.45,2525,UnitedHealthcare,Individual & Family,2525,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Biopsy Or Excision Of Lymph Node(S); Open, Deep Axillary Node(S) (Pro Cah)",,38525,CPT,Professional,Both,,,,2525,2146.25,267.45,2525,UnitedHealthcare,Medicare Advantage,477.8135,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Biopsy Or Excision Of Lymph Node(S); Open, Deep Axillary Node(S) (Pro Cah)",,38525,CPT,Professional,Both,,,,2525,2146.25,267.45,2525,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,308.78272,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Biopsy Or Excision Of Lymph Nodes; Open, Deep Axillary Node(S) (Pbb)",,38525,CPT,Facility,Outpatient,,,,1000,850,286.6,1000,Aetna,Commercial,920,92,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Nodes; Open, Deep Axillary Node(S) (Pbb)",,38525,CPT,Professional,Outpatient,,,,1525,1296.25,267.45,1525,Aetna,Commercial,1296.25,85,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Nodes; Open, Deep Axillary Node(S) (Pbb)",,38525,CPT,Facility,Outpatient,,,,1000,850,286.6,1000,Aetna,Medicare Advantage,490,49,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Nodes; Open, Deep Axillary Node(S) (Pbb)",,38525,CPT,Professional,Outpatient,,,,1525,1296.25,267.45,1525,Aetna,Medicare Advantage,421,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Biopsy Or Excision Of Lymph Nodes; Open, Deep Axillary Node(S) (Pbb)",,38525,CPT,Facility,Outpatient,,,,1000,850,286.6,1000,Aetna,PPO,930,93,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Nodes; Open, Deep Axillary Node(S) (Pbb)",,38525,CPT,Professional,Outpatient,,,,1525,1296.25,267.45,1525,Aetna,PPO,1418.25,93,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Nodes; Open, Deep Axillary Node(S) (Pbb)",,38525,CPT,Facility,Outpatient,,,,1000,850,286.6,1000,America's PPO,America's PPO,960.3,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Biopsy Or Excision Of Lymph Nodes; Open, Deep Axillary Node(S) (Pbb)",,38525,CPT,Professional,Outpatient,,,,1525,1296.25,267.45,1525,America's PPO,America's PPO,1302.96,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Biopsy Or Excision Of Lymph Nodes; Open, Deep Axillary Node(S) (Pbb)",,38525,CPT,Facility,Outpatient,,,,1000,850,286.6,1000,BlueCross BlueShield Minnesota, Federal Employee Program,984,98.4,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Nodes; Open, Deep Axillary Node(S) (Pbb)",,38525,CPT,Professional,Outpatient,,,,1525,1296.25,267.45,1525,BlueCross BlueShield Minnesota, Federal Employee Program,910.33,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Biopsy Or Excision Of Lymph Nodes; Open, Deep Axillary Node(S) (Pbb)",,38525,CPT,Facility,Outpatient,,,,1000,850,286.6,1000,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1000,100,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Nodes; Open, Deep Axillary Node(S) (Pbb)",,38525,CPT,Professional,Outpatient,,,,1525,1296.25,267.45,1525,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,924.89528,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Biopsy Or Excision Of Lymph Nodes; Open, Deep Axillary Node(S) (Pbb)",,38525,CPT,Facility,Outpatient,,,,1000,850,286.6,1000,BlueCross BlueShield Minnesota,High Value Network Plan,900,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
"Biopsy Or Excision Of Lymph Nodes; Open, Deep Axillary Node(S) (Pbb)",,38525,CPT,Professional,Outpatient,,,,1525,1296.25,267.45,1525,BlueCross BlueShield Minnesota,High Value Network Plan,924.89528,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Biopsy Or Excision Of Lymph Nodes; Open, Deep Axillary Node(S) (Pbb)",,38525,CPT,Facility,Outpatient,,,,1000,850,286.6,1000,BlueCross BlueShield Minnesota,Medicare Advantage,490,49,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Nodes; Open, Deep Axillary Node(S) (Pbb)",,38525,CPT,Professional,Outpatient,,,,1525,1296.25,267.45,1525,BlueCross BlueShield Minnesota,Medicare Advantage,477.8135,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Biopsy Or Excision Of Lymph Nodes; Open, Deep Axillary Node(S) (Pbb)",,38525,CPT,Professional,Outpatient,,,,1525,1296.25,267.45,1525,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,924.89528,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Biopsy Or Excision Of Lymph Nodes; Open, Deep Axillary Node(S) (Pbb)",,38525,CPT,Facility,Outpatient,,,,1000,850,286.6,1000,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,286.6,28.66,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Nodes; Open, Deep Axillary Node(S) (Pbb)",,38525,CPT,Professional,Outpatient,,,,1525,1296.25,267.45,1525,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,308.78272,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Biopsy Or Excision Of Lymph Nodes; Open, Deep Axillary Node(S) (Pbb)",,38525,CPT,Facility,Outpatient,,,,1000,850,286.6,1000,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),490,49,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Nodes; Open, Deep Axillary Node(S) (Pbb)",,38525,CPT,Professional,Outpatient,,,,1525,1296.25,267.45,1525,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),477.8135,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Biopsy Or Excision Of Lymph Nodes; Open, Deep Axillary Node(S) (Pbb)",,38525,CPT,Facility,Outpatient,,,,1000,850,286.6,1000,CorVel,Worker's Compensation,1000,100,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Nodes; Open, Deep Axillary Node(S) (Pbb)",,38525,CPT,Professional,Outpatient,,,,1525,1296.25,267.45,1525,CorVel,Worker's Compensation,818.6652732,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Biopsy Or Excision Of Lymph Nodes; Open, Deep Axillary Node(S) (Pbb)",,38525,CPT,Facility,Outpatient,,,,1000,850,286.6,1000,First Health Group Corporation,First Health Network,970,97,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Nodes; Open, Deep Axillary Node(S) (Pbb)",,38525,CPT,Professional,Outpatient,,,,1525,1296.25,267.45,1525,First Health Group Corporation,First Health Network,1479.25,97,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Nodes; Open, Deep Axillary Node(S) (Pbb)",,38525,CPT,Facility,Outpatient,,,,1000,850,286.6,1000,"Health Partners, Inc.",Commercial,946,94.6,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Nodes; Open, Deep Axillary Node(S) (Pbb)",,38525,CPT,Professional,Outpatient,,,,1525,1296.25,267.45,1525,"Health Partners, Inc.",Commercial,884.42,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Biopsy Or Excision Of Lymph Nodes; Open, Deep Axillary Node(S) (Pbb)",,38525,CPT,Facility,Outpatient,,,,1000,850,286.6,1000,"Health Partners, Inc.",Medicare Advantage,490,49,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Nodes; Open, Deep Axillary Node(S) (Pbb)",,38525,CPT,Professional,Outpatient,,,,1525,1296.25,267.45,1525,"Health Partners, Inc.",Medicare Advantage,477.8135,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Biopsy Or Excision Of Lymph Nodes; Open, Deep Axillary Node(S) (Pbb)",,38525,CPT,Facility,Outpatient,,,,1000,850,286.6,1000,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),600,60,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Nodes; Open, Deep Axillary Node(S) (Pbb)",,38525,CPT,Professional,Outpatient,,,,1525,1296.25,267.45,1525,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),415.46,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Biopsy Or Excision Of Lymph Nodes; Open, Deep Axillary Node(S) (Pbb)",,38525,CPT,Facility,Outpatient,,,,1000,850,286.6,1000,"Health Partners, Inc.",State of Minnesota Advantage Program,815,81.5,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Nodes; Open, Deep Axillary Node(S) (Pbb)",,38525,CPT,Professional,Outpatient,,,,1525,1296.25,267.45,1525,"Health Partners, Inc.",State of Minnesota Advantage Program,761.92783,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Biopsy Or Excision Of Lymph Nodes; Open, Deep Axillary Node(S) (Pbb)",,38525,CPT,Facility,Outpatient,,,,1000,850,286.6,1000,"Health Partners, Inc.",State Public Programs,500,50,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Nodes; Open, Deep Axillary Node(S) (Pbb)",,38525,CPT,Professional,Outpatient,,,,1525,1296.25,267.45,1525,"Health Partners, Inc.",State Public Programs,267.45,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Biopsy Or Excision Of Lymph Nodes; Open, Deep Axillary Node(S) (Pbb)",,38525,CPT,Facility,Outpatient,,,,1000,850,286.6,1000,Humana Insurance Company,Commercial PPO,950,95,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Nodes; Open, Deep Axillary Node(S) (Pbb)",,38525,CPT,Professional,Outpatient,,,,1525,1296.25,267.45,1525,Humana Insurance Company,Commercial PPO,415.49,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Biopsy Or Excision Of Lymph Nodes; Open, Deep Axillary Node(S) (Pbb)",,38525,CPT,Facility,Outpatient,,,,1000,850,286.6,1000,Humana Insurance Company,Medicare PPO,490,49,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Nodes; Open, Deep Axillary Node(S) (Pbb)",,38525,CPT,Professional,Outpatient,,,,1525,1296.25,267.45,1525,Humana Insurance Company,Medicare PPO,1525,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Biopsy Or Excision Of Lymph Nodes; Open, Deep Axillary Node(S) (Pbb)",,38525,CPT,Facility,Outpatient,,,,1000,850,286.6,1000,Medica,Individual & Family,991,99.1,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Nodes; Open, Deep Axillary Node(S) (Pbb)",,38525,CPT,Professional,Outpatient,,,,1525,1296.25,267.45,1525,Medica,Individual & Family,1293.2,84.8,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Nodes; Open, Deep Axillary Node(S) (Pbb)",,38525,CPT,Facility,Outpatient,,,,1000,850,286.6,1000,Medica,Medica Advantage Solution,498,49.8,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Nodes; Open, Deep Axillary Node(S) (Pbb)",,38525,CPT,Professional,Outpatient,,,,1525,1296.25,267.45,1525,Medica,Medica Advantage Solution,759.45,49.8,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Nodes; Open, Deep Axillary Node(S) (Pbb)",,38525,CPT,Facility,Outpatient,,,,1000,850,286.6,1000,Medica,Medical Assistance,446,44.6,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Nodes; Open, Deep Axillary Node(S) (Pbb)",,38525,CPT,Professional,Outpatient,,,,1525,1296.25,267.45,1525,Medica,Medical Assistance,308.78,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Biopsy Or Excision Of Lymph Nodes; Open, Deep Axillary Node(S) (Pbb)",,38525,CPT,Facility,Outpatient,,,,1000,850,286.6,1000,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,498,49.8,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Nodes; Open, Deep Axillary Node(S) (Pbb)",,38525,CPT,Professional,Outpatient,,,,1525,1296.25,267.45,1525,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,415.49,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Biopsy Or Excision Of Lymph Nodes; Open, Deep Axillary Node(S) (Pbb)",,38525,CPT,Facility,Outpatient,,,,1000,850,286.6,1000,"Multiplan, Inc.","Multiplan, Inc.",940,94,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Nodes; Open, Deep Axillary Node(S) (Pbb)",,38525,CPT,Professional,Outpatient,,,,1525,1296.25,267.45,1525,"Multiplan, Inc.","Multiplan, Inc.",1433.5,94,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Nodes; Open, Deep Axillary Node(S) (Pbb)",,38525,CPT,Facility,Outpatient,,,,1000,850,286.6,1000,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,901,90.1,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Nodes; Open, Deep Axillary Node(S) (Pbb)",,38525,CPT,Professional,Outpatient,,,,1525,1296.25,267.45,1525,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1374.025,90.1,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Nodes; Open, Deep Axillary Node(S) (Pbb)",,38525,CPT,Facility,Outpatient,,,,1000,850,286.6,1000,"Preferred One Administrative Services, INC.",PPO,986,98.6,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Nodes; Open, Deep Axillary Node(S) (Pbb)",,38525,CPT,Professional,Outpatient,,,,1525,1296.25,267.45,1525,"Preferred One Administrative Services, INC.",PPO,1503.65,98.6,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Nodes; Open, Deep Axillary Node(S) (Pbb)",,38525,CPT,Facility,Outpatient,,,,1000,850,286.6,1000,PrimeWest Health,Minnesota Senior Health Options (MSHO),514.5,51.45,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Nodes; Open, Deep Axillary Node(S) (Pbb)",,38525,CPT,Professional,Outpatient,,,,1525,1296.25,267.45,1525,PrimeWest Health,Minnesota Senior Health Options (MSHO),477.8135,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Biopsy Or Excision Of Lymph Nodes; Open, Deep Axillary Node(S) (Pbb)",,38525,CPT,Facility,Outpatient,,,,1000,850,286.6,1000,PrimeWest Health,MinnesotaCare,513.6,51.36,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Nodes; Open, Deep Axillary Node(S) (Pbb)",,38525,CPT,Professional,Outpatient,,,,1525,1296.25,267.45,1525,PrimeWest Health,MinnesotaCare,330.3975104,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Biopsy Or Excision Of Lymph Nodes; Open, Deep Axillary Node(S) (Pbb)",,38525,CPT,Facility,Outpatient,,,,1000,850,286.6,1000,Sanford Health Plan,Sanford Health Plan,920,92,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Nodes; Open, Deep Axillary Node(S) (Pbb)",,38525,CPT,Professional,Outpatient,,,,1525,1296.25,267.45,1525,Sanford Health Plan,Sanford Health Plan,1342,88,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Nodes; Open, Deep Axillary Node(S) (Pbb)",,38525,CPT,Facility,Outpatient,,,,1000,850,286.6,1000,"UCare Health, Inc.",Individual & Family Plan,563.5,56.35,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Nodes; Open, Deep Axillary Node(S) (Pbb)",,38525,CPT,Professional,Outpatient,,,,1525,1296.25,267.45,1525,"UCare Health, Inc.",Individual & Family Plan,675.420544,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Biopsy Or Excision Of Lymph Nodes; Open, Deep Axillary Node(S) (Pbb)",,38525,CPT,Facility,Outpatient,,,,1000,850,286.6,1000,"UCare Health, Inc.",Medical Assistance,504.7,50.47,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Nodes; Open, Deep Axillary Node(S) (Pbb)",,38525,CPT,Professional,Outpatient,,,,1525,1296.25,267.45,1525,"UCare Health, Inc.",Medical Assistance,339.660992,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Biopsy Or Excision Of Lymph Nodes; Open, Deep Axillary Node(S) (Pbb)",,38525,CPT,Facility,Outpatient,,,,1000,850,286.6,1000,"UCare Health, Inc.",Medicare Advantage,504.7,50.47,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Nodes; Open, Deep Axillary Node(S) (Pbb)",,38525,CPT,Professional,Outpatient,,,,1525,1296.25,267.45,1525,"UCare Health, Inc.",Medicare Advantage,477.8135,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Biopsy Or Excision Of Lymph Nodes; Open, Deep Axillary Node(S) (Pbb)",,38525,CPT,Facility,Outpatient,,,,1000,850,286.6,1000,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),504.7,50.47,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Nodes; Open, Deep Axillary Node(S) (Pbb)",,38525,CPT,Professional,Outpatient,,,,1525,1296.25,267.45,1525,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),382.2508,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Biopsy Or Excision Of Lymph Nodes; Open, Deep Axillary Node(S) (Pbb)",,38525,CPT,Facility,Outpatient,,,,1000,850,286.6,1000,UnitedHealthcare,Individual & Family,940,94,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Nodes; Open, Deep Axillary Node(S) (Pbb)",,38525,CPT,Professional,Outpatient,,,,1525,1296.25,267.45,1525,UnitedHealthcare,Individual & Family,1525,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Biopsy Or Excision Of Lymph Nodes; Open, Deep Axillary Node(S) (Pbb)",,38525,CPT,Facility,Outpatient,,,,1000,850,286.6,1000,UnitedHealthcare,Medicare Advantage,490,49,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Nodes; Open, Deep Axillary Node(S) (Pbb)",,38525,CPT,Professional,Outpatient,,,,1525,1296.25,267.45,1525,UnitedHealthcare,Medicare Advantage,477.8135,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Biopsy Or Excision Of Lymph Nodes; Open, Deep Axillary Node(S) (Pbb)",,38525,CPT,Facility,Outpatient,,,,1000,850,286.6,1000,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,480,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Biopsy Or Excision Of Lymph Nodes; Open, Deep Axillary Node(S) (Pbb)",,38525,CPT,Professional,Outpatient,,,,1525,1296.25,267.45,1525,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,308.78272,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Biopsy Or Excision Of Lymph Node(S); Open, Inguinofemoral Node(S) (Pbb)",,38531,CPT,Facility,Outpatient,,,,1393,1184.05,399.2338,1393,Aetna,Commercial,1281.56,92,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Node(S); Open, Inguinofemoral Node(S) (Pbb)",,38531,CPT,Professional,Outpatient,,,,1398,1188.3,271.37,1398,Aetna,Commercial,1188.3,85,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Node(S); Open, Inguinofemoral Node(S) (Pbb)",,38531,CPT,Facility,Outpatient,,,,1393,1184.05,399.2338,1393,Aetna,Medicare Advantage,682.57,49,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Node(S); Open, Inguinofemoral Node(S) (Pbb)",,38531,CPT,Professional,Outpatient,,,,1398,1188.3,271.37,1398,Aetna,Medicare Advantage,426.72,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Biopsy Or Excision Of Lymph Node(S); Open, Inguinofemoral Node(S) (Pbb)",,38531,CPT,Facility,Outpatient,,,,1393,1184.05,399.2338,1393,Aetna,PPO,1295.49,93,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Node(S); Open, Inguinofemoral Node(S) (Pbb)",,38531,CPT,Professional,Outpatient,,,,1398,1188.3,271.37,1398,Aetna,PPO,1300.14,93,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Node(S); Open, Inguinofemoral Node(S) (Pbb)",,38531,CPT,Facility,Outpatient,,,,1393,1184.05,399.2338,1393,America's PPO,America's PPO,1337.6979,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Biopsy Or Excision Of Lymph Node(S); Open, Inguinofemoral Node(S) (Pbb)",,38531,CPT,Professional,Outpatient,,,,1398,1188.3,271.37,1398,America's PPO,America's PPO,1194.4512,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Biopsy Or Excision Of Lymph Node(S); Open, Inguinofemoral Node(S) (Pbb)",,38531,CPT,Facility,Outpatient,,,,1393,1184.05,399.2338,1393,BlueCross BlueShield Minnesota, Federal Employee Program,1370.712,98.4,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Node(S); Open, Inguinofemoral Node(S) (Pbb)",,38531,CPT,Professional,Outpatient,,,,1398,1188.3,271.37,1398,BlueCross BlueShield Minnesota, Federal Employee Program,923.41,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Biopsy Or Excision Of Lymph Node(S); Open, Inguinofemoral Node(S) (Pbb)",,38531,CPT,Facility,Outpatient,,,,1393,1184.05,399.2338,1393,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1393,100,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Node(S); Open, Inguinofemoral Node(S) (Pbb)",,38531,CPT,Professional,Outpatient,,,,1398,1188.3,271.37,1398,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,938.18456,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Biopsy Or Excision Of Lymph Node(S); Open, Inguinofemoral Node(S) (Pbb)",,38531,CPT,Facility,Outpatient,,,,1393,1184.05,399.2338,1393,BlueCross BlueShield Minnesota,High Value Network Plan,1253.7,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
"Biopsy Or Excision Of Lymph Node(S); Open, Inguinofemoral Node(S) (Pbb)",,38531,CPT,Professional,Outpatient,,,,1398,1188.3,271.37,1398,BlueCross BlueShield Minnesota,High Value Network Plan,938.18456,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Biopsy Or Excision Of Lymph Node(S); Open, Inguinofemoral Node(S) (Pbb)",,38531,CPT,Facility,Outpatient,,,,1393,1184.05,399.2338,1393,BlueCross BlueShield Minnesota,Medicare Advantage,682.57,49,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Node(S); Open, Inguinofemoral Node(S) (Pbb)",,38531,CPT,Professional,Outpatient,,,,1398,1188.3,271.37,1398,BlueCross BlueShield Minnesota,Medicare Advantage,485.001,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Biopsy Or Excision Of Lymph Node(S); Open, Inguinofemoral Node(S) (Pbb)",,38531,CPT,Professional,Outpatient,,,,1398,1188.3,271.37,1398,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,938.18456,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Biopsy Or Excision Of Lymph Node(S); Open, Inguinofemoral Node(S) (Pbb)",,38531,CPT,Facility,Outpatient,,,,1393,1184.05,399.2338,1393,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,399.2338,28.66,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Node(S); Open, Inguinofemoral Node(S) (Pbb)",,38531,CPT,Professional,Outpatient,,,,1398,1188.3,271.37,1398,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,313.31408,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Biopsy Or Excision Of Lymph Node(S); Open, Inguinofemoral Node(S) (Pbb)",,38531,CPT,Facility,Outpatient,,,,1393,1184.05,399.2338,1393,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),682.57,49,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Node(S); Open, Inguinofemoral Node(S) (Pbb)",,38531,CPT,Professional,Outpatient,,,,1398,1188.3,271.37,1398,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),485.001,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Biopsy Or Excision Of Lymph Node(S); Open, Inguinofemoral Node(S) (Pbb)",,38531,CPT,Facility,Outpatient,,,,1393,1184.05,399.2338,1393,CorVel,Worker's Compensation,1393,100,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Node(S); Open, Inguinofemoral Node(S) (Pbb)",,38531,CPT,Professional,Outpatient,,,,1398,1188.3,271.37,1398,CorVel,Worker's Compensation,829.6939155,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Biopsy Or Excision Of Lymph Node(S); Open, Inguinofemoral Node(S) (Pbb)",,38531,CPT,Facility,Outpatient,,,,1393,1184.05,399.2338,1393,First Health Group Corporation,First Health Network,1351.21,97,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Node(S); Open, Inguinofemoral Node(S) (Pbb)",,38531,CPT,Professional,Outpatient,,,,1398,1188.3,271.37,1398,First Health Group Corporation,First Health Network,1356.06,97,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Node(S); Open, Inguinofemoral Node(S) (Pbb)",,38531,CPT,Facility,Outpatient,,,,1393,1184.05,399.2338,1393,"Health Partners, Inc.",Commercial,1317.778,94.6,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Node(S); Open, Inguinofemoral Node(S) (Pbb)",,38531,CPT,Professional,Outpatient,,,,1398,1188.3,271.37,1398,"Health Partners, Inc.",Commercial,896.75,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Biopsy Or Excision Of Lymph Node(S); Open, Inguinofemoral Node(S) (Pbb)",,38531,CPT,Facility,Outpatient,,,,1393,1184.05,399.2338,1393,"Health Partners, Inc.",Medicare Advantage,682.57,49,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Node(S); Open, Inguinofemoral Node(S) (Pbb)",,38531,CPT,Professional,Outpatient,,,,1398,1188.3,271.37,1398,"Health Partners, Inc.",Medicare Advantage,485.001,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Biopsy Or Excision Of Lymph Node(S); Open, Inguinofemoral Node(S) (Pbb)",,38531,CPT,Facility,Outpatient,,,,1393,1184.05,399.2338,1393,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),835.8,60,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Node(S); Open, Inguinofemoral Node(S) (Pbb)",,38531,CPT,Professional,Outpatient,,,,1398,1188.3,271.37,1398,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),421.9,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Biopsy Or Excision Of Lymph Node(S); Open, Inguinofemoral Node(S) (Pbb)",,38531,CPT,Facility,Outpatient,,,,1393,1184.05,399.2338,1393,"Health Partners, Inc.",State of Minnesota Advantage Program,1135.295,81.5,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Node(S); Open, Inguinofemoral Node(S) (Pbb)",,38531,CPT,Professional,Outpatient,,,,1398,1188.3,271.37,1398,"Health Partners, Inc.",State of Minnesota Advantage Program,772.550125,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Biopsy Or Excision Of Lymph Node(S); Open, Inguinofemoral Node(S) (Pbb)",,38531,CPT,Facility,Outpatient,,,,1393,1184.05,399.2338,1393,"Health Partners, Inc.",State Public Programs,696.5,50,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Node(S); Open, Inguinofemoral Node(S) (Pbb)",,38531,CPT,Professional,Outpatient,,,,1398,1188.3,271.37,1398,"Health Partners, Inc.",State Public Programs,271.37,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Biopsy Or Excision Of Lymph Node(S); Open, Inguinofemoral Node(S) (Pbb)",,38531,CPT,Facility,Outpatient,,,,1393,1184.05,399.2338,1393,Humana Insurance Company,Commercial PPO,1323.35,95,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Node(S); Open, Inguinofemoral Node(S) (Pbb)",,38531,CPT,Professional,Outpatient,,,,1398,1188.3,271.37,1398,Humana Insurance Company,Commercial PPO,421.74,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Biopsy Or Excision Of Lymph Node(S); Open, Inguinofemoral Node(S) (Pbb)",,38531,CPT,Facility,Outpatient,,,,1393,1184.05,399.2338,1393,Humana Insurance Company,Medicare PPO,682.57,49,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Node(S); Open, Inguinofemoral Node(S) (Pbb)",,38531,CPT,Professional,Outpatient,,,,1398,1188.3,271.37,1398,Humana Insurance Company,Medicare PPO,1398,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Biopsy Or Excision Of Lymph Node(S); Open, Inguinofemoral Node(S) (Pbb)",,38531,CPT,Facility,Outpatient,,,,1393,1184.05,399.2338,1393,Medica,Individual & Family,1380.463,99.1,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Node(S); Open, Inguinofemoral Node(S) (Pbb)",,38531,CPT,Professional,Outpatient,,,,1398,1188.3,271.37,1398,Medica,Individual & Family,1185.504,84.8,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Node(S); Open, Inguinofemoral Node(S) (Pbb)",,38531,CPT,Facility,Outpatient,,,,1393,1184.05,399.2338,1393,Medica,Medica Advantage Solution,693.714,49.8,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Node(S); Open, Inguinofemoral Node(S) (Pbb)",,38531,CPT,Professional,Outpatient,,,,1398,1188.3,271.37,1398,Medica,Medica Advantage Solution,696.204,49.8,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Node(S); Open, Inguinofemoral Node(S) (Pbb)",,38531,CPT,Facility,Outpatient,,,,1393,1184.05,399.2338,1393,Medica,Medical Assistance,621.278,44.6,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Node(S); Open, Inguinofemoral Node(S) (Pbb)",,38531,CPT,Professional,Outpatient,,,,1398,1188.3,271.37,1398,Medica,Medical Assistance,313.31,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Biopsy Or Excision Of Lymph Node(S); Open, Inguinofemoral Node(S) (Pbb)",,38531,CPT,Facility,Outpatient,,,,1393,1184.05,399.2338,1393,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,693.714,49.8,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Node(S); Open, Inguinofemoral Node(S) (Pbb)",,38531,CPT,Professional,Outpatient,,,,1398,1188.3,271.37,1398,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,421.74,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Biopsy Or Excision Of Lymph Node(S); Open, Inguinofemoral Node(S) (Pbb)",,38531,CPT,Facility,Outpatient,,,,1393,1184.05,399.2338,1393,"Multiplan, Inc.","Multiplan, Inc.",1309.42,94,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Node(S); Open, Inguinofemoral Node(S) (Pbb)",,38531,CPT,Professional,Outpatient,,,,1398,1188.3,271.37,1398,"Multiplan, Inc.","Multiplan, Inc.",1314.12,94,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Node(S); Open, Inguinofemoral Node(S) (Pbb)",,38531,CPT,Facility,Outpatient,,,,1393,1184.05,399.2338,1393,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1255.093,90.1,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Node(S); Open, Inguinofemoral Node(S) (Pbb)",,38531,CPT,Professional,Outpatient,,,,1398,1188.3,271.37,1398,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1259.598,90.1,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Node(S); Open, Inguinofemoral Node(S) (Pbb)",,38531,CPT,Facility,Outpatient,,,,1393,1184.05,399.2338,1393,"Preferred One Administrative Services, INC.",PPO,1373.498,98.6,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Node(S); Open, Inguinofemoral Node(S) (Pbb)",,38531,CPT,Professional,Outpatient,,,,1398,1188.3,271.37,1398,"Preferred One Administrative Services, INC.",PPO,1378.428,98.6,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Node(S); Open, Inguinofemoral Node(S) (Pbb)",,38531,CPT,Facility,Outpatient,,,,1393,1184.05,399.2338,1393,PrimeWest Health,Minnesota Senior Health Options (MSHO),716.6985,51.45,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Node(S); Open, Inguinofemoral Node(S) (Pbb)",,38531,CPT,Professional,Outpatient,,,,1398,1188.3,271.37,1398,PrimeWest Health,Minnesota Senior Health Options (MSHO),485.001,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Biopsy Or Excision Of Lymph Node(S); Open, Inguinofemoral Node(S) (Pbb)",,38531,CPT,Facility,Outpatient,,,,1393,1184.05,399.2338,1393,PrimeWest Health,MinnesotaCare,715.4448,51.36,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Node(S); Open, Inguinofemoral Node(S) (Pbb)",,38531,CPT,Professional,Outpatient,,,,1398,1188.3,271.37,1398,PrimeWest Health,MinnesotaCare,335.2460656,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Biopsy Or Excision Of Lymph Node(S); Open, Inguinofemoral Node(S) (Pbb)",,38531,CPT,Facility,Outpatient,,,,1393,1184.05,399.2338,1393,Sanford Health Plan,Sanford Health Plan,1281.56,92,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Node(S); Open, Inguinofemoral Node(S) (Pbb)",,38531,CPT,Professional,Outpatient,,,,1398,1188.3,271.37,1398,Sanford Health Plan,Sanford Health Plan,1230.24,88,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Node(S); Open, Inguinofemoral Node(S) (Pbb)",,38531,CPT,Facility,Outpatient,,,,1393,1184.05,399.2338,1393,"UCare Health, Inc.",Individual & Family Plan,784.9555,56.35,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Node(S); Open, Inguinofemoral Node(S) (Pbb)",,38531,CPT,Professional,Outpatient,,,,1398,1188.3,271.37,1398,"UCare Health, Inc.",Individual & Family Plan,685.580544,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Biopsy Or Excision Of Lymph Node(S); Open, Inguinofemoral Node(S) (Pbb)",,38531,CPT,Facility,Outpatient,,,,1393,1184.05,399.2338,1393,"UCare Health, Inc.",Medical Assistance,703.0471,50.47,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Node(S); Open, Inguinofemoral Node(S) (Pbb)",,38531,CPT,Professional,Outpatient,,,,1398,1188.3,271.37,1398,"UCare Health, Inc.",Medical Assistance,344.645488,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Biopsy Or Excision Of Lymph Node(S); Open, Inguinofemoral Node(S) (Pbb)",,38531,CPT,Facility,Outpatient,,,,1393,1184.05,399.2338,1393,"UCare Health, Inc.",Medicare Advantage,703.0471,50.47,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Node(S); Open, Inguinofemoral Node(S) (Pbb)",,38531,CPT,Professional,Outpatient,,,,1398,1188.3,271.37,1398,"UCare Health, Inc.",Medicare Advantage,485.001,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Biopsy Or Excision Of Lymph Node(S); Open, Inguinofemoral Node(S) (Pbb)",,38531,CPT,Facility,Outpatient,,,,1393,1184.05,399.2338,1393,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),703.0471,50.47,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Node(S); Open, Inguinofemoral Node(S) (Pbb)",,38531,CPT,Professional,Outpatient,,,,1398,1188.3,271.37,1398,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),388.0008,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Biopsy Or Excision Of Lymph Node(S); Open, Inguinofemoral Node(S) (Pbb)",,38531,CPT,Facility,Outpatient,,,,1393,1184.05,399.2338,1393,UnitedHealthcare,Individual & Family,1309.42,94,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Node(S); Open, Inguinofemoral Node(S) (Pbb)",,38531,CPT,Professional,Outpatient,,,,1398,1188.3,271.37,1398,UnitedHealthcare,Individual & Family,1398,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Biopsy Or Excision Of Lymph Node(S); Open, Inguinofemoral Node(S) (Pbb)",,38531,CPT,Facility,Outpatient,,,,1393,1184.05,399.2338,1393,UnitedHealthcare,Medicare Advantage,682.57,49,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Node(S); Open, Inguinofemoral Node(S) (Pbb)",,38531,CPT,Professional,Outpatient,,,,1398,1188.3,271.37,1398,UnitedHealthcare,Medicare Advantage,485.001,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Biopsy Or Excision Of Lymph Node(S); Open, Inguinofemoral Node(S) (Pbb)",,38531,CPT,Facility,Outpatient,,,,1393,1184.05,399.2338,1393,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,668.64,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Biopsy Or Excision Of Lymph Node(S); Open, Inguinofemoral Node(S) (Pbb)",,38531,CPT,Professional,Outpatient,,,,1398,1188.3,271.37,1398,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,313.31408,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Biopsy Or Excision Of Lymph Node(S); Open, Inguinofemoral Node(S) (Pro Cah)",,38531,CPT,Professional,Both,,,,2791,2372.35,271.37,2791,Aetna,Commercial,2372.35,85,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Node(S); Open, Inguinofemoral Node(S) (Pro Cah)",,38531,CPT,Professional,Both,,,,2791,2372.35,271.37,2791,Aetna,Medicare Advantage,426.72,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Biopsy Or Excision Of Lymph Node(S); Open, Inguinofemoral Node(S) (Pro Cah)",,38531,CPT,Professional,Both,,,,2791,2372.35,271.37,2791,Aetna,PPO,2595.63,93,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Node(S); Open, Inguinofemoral Node(S) (Pro Cah)",,38531,CPT,Professional,Both,,,,2791,2372.35,271.37,2791,America's PPO,America's PPO,2384.6304,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Biopsy Or Excision Of Lymph Node(S); Open, Inguinofemoral Node(S) (Pro Cah)",,38531,CPT,Professional,Both,,,,2791,2372.35,271.37,2791,BlueCross BlueShield Minnesota, Federal Employee Program,923.41,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Biopsy Or Excision Of Lymph Node(S); Open, Inguinofemoral Node(S) (Pro Cah)",,38531,CPT,Professional,Both,,,,2791,2372.35,271.37,2791,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,938.18456,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Biopsy Or Excision Of Lymph Node(S); Open, Inguinofemoral Node(S) (Pro Cah)",,38531,CPT,Professional,Both,,,,2791,2372.35,271.37,2791,BlueCross BlueShield Minnesota,High Value Network Plan,938.18456,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Biopsy Or Excision Of Lymph Node(S); Open, Inguinofemoral Node(S) (Pro Cah)",,38531,CPT,Professional,Both,,,,2791,2372.35,271.37,2791,BlueCross BlueShield Minnesota,Medicare Advantage,485.001,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Biopsy Or Excision Of Lymph Node(S); Open, Inguinofemoral Node(S) (Pro Cah)",,38531,CPT,Professional,Both,,,,2791,2372.35,271.37,2791,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,938.18456,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Biopsy Or Excision Of Lymph Node(S); Open, Inguinofemoral Node(S) (Pro Cah)",,38531,CPT,Professional,Both,,,,2791,2372.35,271.37,2791,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,313.31408,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Biopsy Or Excision Of Lymph Node(S); Open, Inguinofemoral Node(S) (Pro Cah)",,38531,CPT,Professional,Both,,,,2791,2372.35,271.37,2791,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),485.001,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Biopsy Or Excision Of Lymph Node(S); Open, Inguinofemoral Node(S) (Pro Cah)",,38531,CPT,Professional,Both,,,,2791,2372.35,271.37,2791,CorVel,Worker's Compensation,829.6939155,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Biopsy Or Excision Of Lymph Node(S); Open, Inguinofemoral Node(S) (Pro Cah)",,38531,CPT,Professional,Both,,,,2791,2372.35,271.37,2791,First Health Group Corporation,First Health Network,2707.27,97,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Node(S); Open, Inguinofemoral Node(S) (Pro Cah)",,38531,CPT,Professional,Both,,,,2791,2372.35,271.37,2791,"Health Partners, Inc.",Commercial,896.75,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Biopsy Or Excision Of Lymph Node(S); Open, Inguinofemoral Node(S) (Pro Cah)",,38531,CPT,Professional,Both,,,,2791,2372.35,271.37,2791,"Health Partners, Inc.",Medicare Advantage,485.001,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Biopsy Or Excision Of Lymph Node(S); Open, Inguinofemoral Node(S) (Pro Cah)",,38531,CPT,Professional,Both,,,,2791,2372.35,271.37,2791,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),421.9,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Biopsy Or Excision Of Lymph Node(S); Open, Inguinofemoral Node(S) (Pro Cah)",,38531,CPT,Professional,Both,,,,2791,2372.35,271.37,2791,"Health Partners, Inc.",State of Minnesota Advantage Program,772.550125,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Biopsy Or Excision Of Lymph Node(S); Open, Inguinofemoral Node(S) (Pro Cah)",,38531,CPT,Professional,Both,,,,2791,2372.35,271.37,2791,"Health Partners, Inc.",State Public Programs,271.37,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Biopsy Or Excision Of Lymph Node(S); Open, Inguinofemoral Node(S) (Pro Cah)",,38531,CPT,Professional,Both,,,,2791,2372.35,271.37,2791,Humana Insurance Company,Commercial PPO,421.74,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Biopsy Or Excision Of Lymph Node(S); Open, Inguinofemoral Node(S) (Pro Cah)",,38531,CPT,Professional,Both,,,,2791,2372.35,271.37,2791,Humana Insurance Company,Medicare PPO,2791,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Biopsy Or Excision Of Lymph Node(S); Open, Inguinofemoral Node(S) (Pro Cah)",,38531,CPT,Professional,Both,,,,2791,2372.35,271.37,2791,Medica,Individual & Family,2366.768,84.8,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Node(S); Open, Inguinofemoral Node(S) (Pro Cah)",,38531,CPT,Professional,Both,,,,2791,2372.35,271.37,2791,Medica,Medica Advantage Solution,1389.918,49.8,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Node(S); Open, Inguinofemoral Node(S) (Pro Cah)",,38531,CPT,Professional,Both,,,,2791,2372.35,271.37,2791,Medica,Medical Assistance,313.31,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Biopsy Or Excision Of Lymph Node(S); Open, Inguinofemoral Node(S) (Pro Cah)",,38531,CPT,Professional,Both,,,,2791,2372.35,271.37,2791,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,421.74,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Biopsy Or Excision Of Lymph Node(S); Open, Inguinofemoral Node(S) (Pro Cah)",,38531,CPT,Professional,Both,,,,2791,2372.35,271.37,2791,"Multiplan, Inc.","Multiplan, Inc.",2623.54,94,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Node(S); Open, Inguinofemoral Node(S) (Pro Cah)",,38531,CPT,Professional,Both,,,,2791,2372.35,271.37,2791,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,2514.691,90.1,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Node(S); Open, Inguinofemoral Node(S) (Pro Cah)",,38531,CPT,Professional,Both,,,,2791,2372.35,271.37,2791,"Preferred One Administrative Services, INC.",PPO,2751.926,98.6,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Node(S); Open, Inguinofemoral Node(S) (Pro Cah)",,38531,CPT,Professional,Both,,,,2791,2372.35,271.37,2791,PrimeWest Health,Minnesota Senior Health Options (MSHO),485.001,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Biopsy Or Excision Of Lymph Node(S); Open, Inguinofemoral Node(S) (Pro Cah)",,38531,CPT,Professional,Both,,,,2791,2372.35,271.37,2791,PrimeWest Health,MinnesotaCare,335.2460656,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Biopsy Or Excision Of Lymph Node(S); Open, Inguinofemoral Node(S) (Pro Cah)",,38531,CPT,Professional,Both,,,,2791,2372.35,271.37,2791,Sanford Health Plan,Sanford Health Plan,2456.08,88,,percent of total billed charges,,
"Biopsy Or Excision Of Lymph Node(S); Open, Inguinofemoral Node(S) (Pro Cah)",,38531,CPT,Professional,Both,,,,2791,2372.35,271.37,2791,"UCare Health, Inc.",Individual & Family Plan,685.580544,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Biopsy Or Excision Of Lymph Node(S); Open, Inguinofemoral Node(S) (Pro Cah)",,38531,CPT,Professional,Both,,,,2791,2372.35,271.37,2791,"UCare Health, Inc.",Medical Assistance,344.645488,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Biopsy Or Excision Of Lymph Node(S); Open, Inguinofemoral Node(S) (Pro Cah)",,38531,CPT,Professional,Both,,,,2791,2372.35,271.37,2791,"UCare Health, Inc.",Medicare Advantage,485.001,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Biopsy Or Excision Of Lymph Node(S); Open, Inguinofemoral Node(S) (Pro Cah)",,38531,CPT,Professional,Both,,,,2791,2372.35,271.37,2791,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),388.0008,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Biopsy Or Excision Of Lymph Node(S); Open, Inguinofemoral Node(S) (Pro Cah)",,38531,CPT,Professional,Both,,,,2791,2372.35,271.37,2791,UnitedHealthcare,Individual & Family,2791,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Biopsy Or Excision Of Lymph Node(S); Open, Inguinofemoral Node(S) (Pro Cah)",,38531,CPT,Professional,Both,,,,2791,2372.35,271.37,2791,UnitedHealthcare,Medicare Advantage,485.001,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Biopsy Or Excision Of Lymph Node(S); Open, Inguinofemoral Node(S) (Pro Cah)",,38531,CPT,Professional,Both,,,,2791,2372.35,271.37,2791,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,313.31408,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Axillary Lymphadenectomy; Complete (Pro Cah),,38745,CPT,Professional,Both,,,,3213,2731.05,529.88,3213,Aetna,Commercial,2731.05,85,,percent of total billed charges,,
Axillary Lymphadenectomy; Complete (Pro Cah),,38745,CPT,Professional,Both,,,,3213,2731.05,529.88,3213,Aetna,Medicare Advantage,836.73,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Axillary Lymphadenectomy; Complete (Pro Cah),,38745,CPT,Professional,Both,,,,3213,2731.05,529.88,3213,Aetna,PPO,2988.09,93,,percent of total billed charges,,
Axillary Lymphadenectomy; Complete (Pro Cah),,38745,CPT,Professional,Both,,,,3213,2731.05,529.88,3213,America's PPO,America's PPO,2745.1872,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Axillary Lymphadenectomy; Complete (Pro Cah),,38745,CPT,Professional,Both,,,,3213,2731.05,529.88,3213,BlueCross BlueShield Minnesota, Federal Employee Program,1817.22,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Axillary Lymphadenectomy; Complete (Pro Cah),,38745,CPT,Professional,Both,,,,3213,2731.05,529.88,3213,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1846.29552,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Axillary Lymphadenectomy; Complete (Pro Cah),,38745,CPT,Professional,Both,,,,3213,2731.05,529.88,3213,BlueCross BlueShield Minnesota,High Value Network Plan,1846.29552,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Axillary Lymphadenectomy; Complete (Pro Cah),,38745,CPT,Professional,Both,,,,3213,2731.05,529.88,3213,BlueCross BlueShield Minnesota,Medicare Advantage,946.68,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Axillary Lymphadenectomy; Complete (Pro Cah),,38745,CPT,Professional,Both,,,,3213,2731.05,529.88,3213,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1846.29552,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Axillary Lymphadenectomy; Complete (Pro Cah),,38745,CPT,Professional,Both,,,,3213,2731.05,529.88,3213,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,611.77424,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Axillary Lymphadenectomy; Complete (Pro Cah),,38745,CPT,Professional,Both,,,,3213,2731.05,529.88,3213,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),946.68,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Axillary Lymphadenectomy; Complete (Pro Cah),,38745,CPT,Professional,Both,,,,3213,2731.05,529.88,3213,CorVel,Worker's Compensation,1624.891334,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Axillary Lymphadenectomy; Complete (Pro Cah),,38745,CPT,Professional,Both,,,,3213,2731.05,529.88,3213,First Health Group Corporation,First Health Network,3116.61,97,,percent of total billed charges,,
Axillary Lymphadenectomy; Complete (Pro Cah),,38745,CPT,Professional,Both,,,,3213,2731.05,529.88,3213,"Health Partners, Inc.",Commercial,1755.05,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Axillary Lymphadenectomy; Complete (Pro Cah),,38745,CPT,Professional,Both,,,,3213,2731.05,529.88,3213,"Health Partners, Inc.",Medicare Advantage,946.68,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Axillary Lymphadenectomy; Complete (Pro Cah),,38745,CPT,Professional,Both,,,,3213,2731.05,529.88,3213,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),823.12,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Axillary Lymphadenectomy; Complete (Pro Cah),,38745,CPT,Professional,Both,,,,3213,2731.05,529.88,3213,"Health Partners, Inc.",State of Minnesota Advantage Program,1511.975575,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Axillary Lymphadenectomy; Complete (Pro Cah),,38745,CPT,Professional,Both,,,,3213,2731.05,529.88,3213,"Health Partners, Inc.",State Public Programs,529.88,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Axillary Lymphadenectomy; Complete (Pro Cah),,38745,CPT,Professional,Both,,,,3213,2731.05,529.88,3213,Humana Insurance Company,Commercial PPO,823.2,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Axillary Lymphadenectomy; Complete (Pro Cah),,38745,CPT,Professional,Both,,,,3213,2731.05,529.88,3213,Humana Insurance Company,Medicare PPO,3213,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Axillary Lymphadenectomy; Complete (Pro Cah),,38745,CPT,Professional,Both,,,,3213,2731.05,529.88,3213,Medica,Individual & Family,2724.624,84.8,,percent of total billed charges,,
Axillary Lymphadenectomy; Complete (Pro Cah),,38745,CPT,Professional,Both,,,,3213,2731.05,529.88,3213,Medica,Medica Advantage Solution,1600.074,49.8,,percent of total billed charges,,
Axillary Lymphadenectomy; Complete (Pro Cah),,38745,CPT,Professional,Both,,,,3213,2731.05,529.88,3213,Medica,Medical Assistance,611.77,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Axillary Lymphadenectomy; Complete (Pro Cah),,38745,CPT,Professional,Both,,,,3213,2731.05,529.88,3213,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,823.2,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Axillary Lymphadenectomy; Complete (Pro Cah),,38745,CPT,Professional,Both,,,,3213,2731.05,529.88,3213,"Multiplan, Inc.","Multiplan, Inc.",3020.22,94,,percent of total billed charges,,
Axillary Lymphadenectomy; Complete (Pro Cah),,38745,CPT,Professional,Both,,,,3213,2731.05,529.88,3213,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,2894.913,90.1,,percent of total billed charges,,
Axillary Lymphadenectomy; Complete (Pro Cah),,38745,CPT,Professional,Both,,,,3213,2731.05,529.88,3213,"Preferred One Administrative Services, INC.",PPO,3168.018,98.6,,percent of total billed charges,,
Axillary Lymphadenectomy; Complete (Pro Cah),,38745,CPT,Professional,Both,,,,3213,2731.05,529.88,3213,PrimeWest Health,Minnesota Senior Health Options (MSHO),946.68,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Axillary Lymphadenectomy; Complete (Pro Cah),,38745,CPT,Professional,Both,,,,3213,2731.05,529.88,3213,PrimeWest Health,MinnesotaCare,654.5984368,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Axillary Lymphadenectomy; Complete (Pro Cah),,38745,CPT,Professional,Both,,,,3213,2731.05,529.88,3213,Sanford Health Plan,Sanford Health Plan,2827.44,88,,percent of total billed charges,,
Axillary Lymphadenectomy; Complete (Pro Cah),,38745,CPT,Professional,Both,,,,3213,2731.05,529.88,3213,"UCare Health, Inc.",Individual & Family Plan,1338.19392,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Axillary Lymphadenectomy; Complete (Pro Cah),,38745,CPT,Professional,Both,,,,3213,2731.05,529.88,3213,"UCare Health, Inc.",Medical Assistance,672.951664,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Axillary Lymphadenectomy; Complete (Pro Cah),,38745,CPT,Professional,Both,,,,3213,2731.05,529.88,3213,"UCare Health, Inc.",Medicare Advantage,946.68,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Axillary Lymphadenectomy; Complete (Pro Cah),,38745,CPT,Professional,Both,,,,3213,2731.05,529.88,3213,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),757.344,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Axillary Lymphadenectomy; Complete (Pro Cah),,38745,CPT,Professional,Both,,,,3213,2731.05,529.88,3213,UnitedHealthcare,Individual & Family,3213,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Axillary Lymphadenectomy; Complete (Pro Cah),,38745,CPT,Professional,Both,,,,3213,2731.05,529.88,3213,UnitedHealthcare,Medicare Advantage,946.68,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Axillary Lymphadenectomy; Complete (Pro Cah),,38745,CPT,Professional,Both,,,,3213,2731.05,529.88,3213,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,611.77424,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
HYDROXYZINE HCL 25 MG/ML IM SOLN,,J3410,HCPCS,Facility,Both,1,mL,,138,117.3,39.5508,138,Aetna,Commercial,126.96,92,,percent of total billed charges,,
HYDROXYZINE HCL 25 MG/ML IM SOLN,,J3410,HCPCS,Facility,Outpatient,1,mL,,138,117.3,39.5508,138,Aetna,Medicare Advantage,67.62,49,,percent of total billed charges,,
HYDROXYZINE HCL 25 MG/ML IM SOLN,,J3410,HCPCS,Facility,Inpatient,1,mL,,138,117.3,39.5508,138,Aetna,Medicare Advantage,,,,,Included in per diem rate,
HYDROXYZINE HCL 25 MG/ML IM SOLN,,J3410,HCPCS,Facility,Both,1,mL,,138,117.3,39.5508,138,Aetna,PPO,128.34,93,,percent of total billed charges,,
HYDROXYZINE HCL 25 MG/ML IM SOLN,,J3410,HCPCS,Facility,Both,1,mL,,138,117.3,39.5508,138,America's PPO,America's PPO,132.5214,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
HYDROXYZINE HCL 25 MG/ML IM SOLN,,J3410,HCPCS,Facility,Both,1,mL,,138,117.3,39.5508,138,BlueCross BlueShield Minnesota, Federal Employee Program,135.792,98.4,,percent of total billed charges,,
HYDROXYZINE HCL 25 MG/ML IM SOLN,,J3410,HCPCS,Facility,Both,1,mL,,138,117.3,39.5508,138,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,138,100,,percent of total billed charges,,
HYDROXYZINE HCL 25 MG/ML IM SOLN,,J3410,HCPCS,Facility,Both,1,mL,,138,117.3,39.5508,138,BlueCross BlueShield Minnesota,High Value Network Plan,124.2,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
HYDROXYZINE HCL 25 MG/ML IM SOLN,,J3410,HCPCS,Facility,Outpatient,1,mL,,138,117.3,39.5508,138,BlueCross BlueShield Minnesota,Medicare Advantage,67.62,49,,percent of total billed charges,,
HYDROXYZINE HCL 25 MG/ML IM SOLN,,J3410,HCPCS,Facility,Inpatient,1,mL,,138,117.3,39.5508,138,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
HYDROXYZINE HCL 25 MG/ML IM SOLN,,J3410,HCPCS,Facility,Both,1,mL,,138,117.3,39.5508,138,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,122.2266,88.57,,percent of total billed charges,,
HYDROXYZINE HCL 25 MG/ML IM SOLN,,J3410,HCPCS,Facility,Both,1,mL,,138,117.3,39.5508,138,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,39.5508,28.66,,percent of total billed charges,,
HYDROXYZINE HCL 25 MG/ML IM SOLN,,J3410,HCPCS,Facility,Outpatient,1,mL,,138,117.3,39.5508,138,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),67.62,49,,percent of total billed charges,,
HYDROXYZINE HCL 25 MG/ML IM SOLN,,J3410,HCPCS,Facility,Inpatient,1,mL,,138,117.3,39.5508,138,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
HYDROXYZINE HCL 25 MG/ML IM SOLN,,J3410,HCPCS,Facility,Both,1,mL,,138,117.3,39.5508,138,CorVel,Worker's Compensation,138,100,,percent of total billed charges,,
HYDROXYZINE HCL 25 MG/ML IM SOLN,,J3410,HCPCS,Facility,Both,1,mL,,138,117.3,39.5508,138,First Health Group Corporation,First Health Network,133.86,97,,percent of total billed charges,,
HYDROXYZINE HCL 25 MG/ML IM SOLN,,J3410,HCPCS,Facility,Both,1,mL,,138,117.3,39.5508,138,"Health Partners, Inc.",Commercial,130.548,94.6,,percent of total billed charges,,
HYDROXYZINE HCL 25 MG/ML IM SOLN,,J3410,HCPCS,Facility,Outpatient,1,mL,,138,117.3,39.5508,138,"Health Partners, Inc.",Medicare Advantage,67.62,49,,percent of total billed charges,,
HYDROXYZINE HCL 25 MG/ML IM SOLN,,J3410,HCPCS,Facility,Inpatient,1,mL,,138,117.3,39.5508,138,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
HYDROXYZINE HCL 25 MG/ML IM SOLN,,J3410,HCPCS,Facility,Both,1,mL,,138,117.3,39.5508,138,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),82.8,60,,percent of total billed charges,,
HYDROXYZINE HCL 25 MG/ML IM SOLN,,J3410,HCPCS,Facility,Both,1,mL,,138,117.3,39.5508,138,"Health Partners, Inc.",State of Minnesota Advantage Program,112.47,81.5,,percent of total billed charges,,
HYDROXYZINE HCL 25 MG/ML IM SOLN,,J3410,HCPCS,Facility,Both,1,mL,,138,117.3,39.5508,138,"Health Partners, Inc.",State Public Programs,69,50,,percent of total billed charges,,
HYDROXYZINE HCL 25 MG/ML IM SOLN,,J3410,HCPCS,Facility,Both,1,mL,,138,117.3,39.5508,138,Humana Insurance Company,Commercial PPO,131.1,95,,percent of total billed charges,,
HYDROXYZINE HCL 25 MG/ML IM SOLN,,J3410,HCPCS,Facility,Outpatient,1,mL,,138,117.3,39.5508,138,Humana Insurance Company,Medicare PPO,67.62,49,,percent of total billed charges,,
HYDROXYZINE HCL 25 MG/ML IM SOLN,,J3410,HCPCS,Facility,Inpatient,1,mL,,138,117.3,39.5508,138,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
HYDROXYZINE HCL 25 MG/ML IM SOLN,,J3410,HCPCS,Facility,Both,1,mL,,138,117.3,39.5508,138,Medica,Individual & Family,136.758,99.1,,percent of total billed charges,,
HYDROXYZINE HCL 25 MG/ML IM SOLN,,J3410,HCPCS,Facility,Outpatient,1,mL,,138,117.3,39.5508,138,Medica,Medica Advantage Solution,68.724,49.8,,percent of total billed charges,,
HYDROXYZINE HCL 25 MG/ML IM SOLN,,J3410,HCPCS,Facility,Inpatient,1,mL,,138,117.3,39.5508,138,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
HYDROXYZINE HCL 25 MG/ML IM SOLN,,J3410,HCPCS,Facility,Outpatient,1,mL,,138,117.3,39.5508,138,Medica,Medical Assistance,61.548,44.6,,percent of total billed charges,,
HYDROXYZINE HCL 25 MG/ML IM SOLN,,J3410,HCPCS,Facility,Inpatient,1,mL,,138,117.3,39.5508,138,Medica,Medical Assistance,,,,,Included in per diem rate,
HYDROXYZINE HCL 25 MG/ML IM SOLN,,J3410,HCPCS,Facility,Outpatient,1,mL,,138,117.3,39.5508,138,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,68.724,49.8,,percent of total billed charges,,
HYDROXYZINE HCL 25 MG/ML IM SOLN,,J3410,HCPCS,Facility,Inpatient,1,mL,,138,117.3,39.5508,138,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
HYDROXYZINE HCL 25 MG/ML IM SOLN,,J3410,HCPCS,Facility,Both,1,mL,,138,117.3,39.5508,138,"Multiplan, Inc.","Multiplan, Inc.",129.72,94,,percent of total billed charges,,
HYDROXYZINE HCL 25 MG/ML IM SOLN,,J3410,HCPCS,Facility,Outpatient,1,mL,,138,117.3,39.5508,138,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,124.338,90.1,,percent of total billed charges,,
HYDROXYZINE HCL 25 MG/ML IM SOLN,,J3410,HCPCS,Facility,Inpatient,1,mL,,138,117.3,39.5508,138,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
HYDROXYZINE HCL 25 MG/ML IM SOLN,,J3410,HCPCS,Facility,Both,1,mL,,138,117.3,39.5508,138,"Preferred One Administrative Services, INC.",PPO,136.068,98.6,,percent of total billed charges,,
HYDROXYZINE HCL 25 MG/ML IM SOLN,,J3410,HCPCS,Facility,Outpatient,1,mL,,138,117.3,39.5508,138,PrimeWest Health,Minnesota Senior Health Options (MSHO),71.001,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
HYDROXYZINE HCL 25 MG/ML IM SOLN,,J3410,HCPCS,Facility,Inpatient,1,mL,,138,117.3,39.5508,138,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
HYDROXYZINE HCL 25 MG/ML IM SOLN,,J3410,HCPCS,Facility,Outpatient,1,mL,,138,117.3,39.5508,138,PrimeWest Health,MinnesotaCare,70.8768,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
HYDROXYZINE HCL 25 MG/ML IM SOLN,,J3410,HCPCS,Facility,Inpatient,1,mL,,138,117.3,39.5508,138,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
HYDROXYZINE HCL 25 MG/ML IM SOLN,,J3410,HCPCS,Facility,Both,1,mL,,138,117.3,39.5508,138,Sanford Health Plan,Sanford Health Plan,126.96,92,,percent of total billed charges,,
HYDROXYZINE HCL 25 MG/ML IM SOLN,,J3410,HCPCS,Facility,Outpatient,1,mL,,138,117.3,39.5508,138,"UCare Health, Inc.",Individual & Family Plan,77.763,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
HYDROXYZINE HCL 25 MG/ML IM SOLN,,J3410,HCPCS,Facility,Inpatient,1,mL,,138,117.3,39.5508,138,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
HYDROXYZINE HCL 25 MG/ML IM SOLN,,J3410,HCPCS,Facility,Outpatient,1,mL,,138,117.3,39.5508,138,"UCare Health, Inc.",Medical Assistance,69.6486,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
HYDROXYZINE HCL 25 MG/ML IM SOLN,,J3410,HCPCS,Facility,Inpatient,1,mL,,138,117.3,39.5508,138,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
HYDROXYZINE HCL 25 MG/ML IM SOLN,,J3410,HCPCS,Facility,Outpatient,1,mL,,138,117.3,39.5508,138,"UCare Health, Inc.",Medicare Advantage,69.6486,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
HYDROXYZINE HCL 25 MG/ML IM SOLN,,J3410,HCPCS,Facility,Inpatient,1,mL,,138,117.3,39.5508,138,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
HYDROXYZINE HCL 25 MG/ML IM SOLN,,J3410,HCPCS,Facility,Outpatient,1,mL,,138,117.3,39.5508,138,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),69.6486,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
HYDROXYZINE HCL 25 MG/ML IM SOLN,,J3410,HCPCS,Facility,Inpatient,1,mL,,138,117.3,39.5508,138,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
HYDROXYZINE HCL 25 MG/ML IM SOLN,,J3410,HCPCS,Facility,Both,1,mL,,138,117.3,39.5508,138,UnitedHealthcare,Individual & Family,129.72,94,,percent of total billed charges,,
HYDROXYZINE HCL 25 MG/ML IM SOLN,,J3410,HCPCS,Facility,Outpatient,1,mL,,138,117.3,39.5508,138,UnitedHealthcare,Medicare Advantage,67.62,49,,percent of total billed charges,,
HYDROXYZINE HCL 25 MG/ML IM SOLN,,J3410,HCPCS,Facility,Inpatient,1,mL,,138,117.3,39.5508,138,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
HYDROXYZINE HCL 25 MG/ML IM SOLN,,J3410,HCPCS,Facility,Outpatient,1,mL,,138,117.3,39.5508,138,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,66.24,48,,percent of total billed charges,,100% of DHS outpatient percentage
HYDROXYZINE HCL 25 MG/ML IM SOLN,,J3410,HCPCS,Facility,Inpatient,1,mL,,138,117.3,39.5508,138,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"CYANOCOBALAMIN (VITAMIN B-12) 1,000 MCG/ML INJ SOLN",,J3420,HCPCS,Facility,Both,1,mL,,20,17,5.732,20,Aetna,Commercial,18.4,92,,percent of total billed charges,,
"CYANOCOBALAMIN (VITAMIN B-12) 1,000 MCG/ML INJ SOLN",,J3420,HCPCS,Facility,Outpatient,1,mL,,20,17,5.732,20,Aetna,Medicare Advantage,9.8,49,,percent of total billed charges,,
"CYANOCOBALAMIN (VITAMIN B-12) 1,000 MCG/ML INJ SOLN",,J3420,HCPCS,Facility,Inpatient,1,mL,,20,17,5.732,20,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"CYANOCOBALAMIN (VITAMIN B-12) 1,000 MCG/ML INJ SOLN",,J3420,HCPCS,Facility,Both,1,mL,,20,17,5.732,20,Aetna,PPO,18.6,93,,percent of total billed charges,,
"CYANOCOBALAMIN (VITAMIN B-12) 1,000 MCG/ML INJ SOLN",,J3420,HCPCS,Facility,Both,1,mL,,20,17,5.732,20,America's PPO,America's PPO,19.206,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"CYANOCOBALAMIN (VITAMIN B-12) 1,000 MCG/ML INJ SOLN",,J3420,HCPCS,Facility,Both,1,mL,,20,17,5.732,20,BlueCross BlueShield Minnesota, Federal Employee Program,19.68,98.4,,percent of total billed charges,,
"CYANOCOBALAMIN (VITAMIN B-12) 1,000 MCG/ML INJ SOLN",,J3420,HCPCS,Facility,Both,1,mL,,20,17,5.732,20,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,20,100,,percent of total billed charges,,
"CYANOCOBALAMIN (VITAMIN B-12) 1,000 MCG/ML INJ SOLN",,J3420,HCPCS,Facility,Both,1,mL,,20,17,5.732,20,BlueCross BlueShield Minnesota,High Value Network Plan,18,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
"CYANOCOBALAMIN (VITAMIN B-12) 1,000 MCG/ML INJ SOLN",,J3420,HCPCS,Facility,Outpatient,1,mL,,20,17,5.732,20,BlueCross BlueShield Minnesota,Medicare Advantage,9.8,49,,percent of total billed charges,,
"CYANOCOBALAMIN (VITAMIN B-12) 1,000 MCG/ML INJ SOLN",,J3420,HCPCS,Facility,Inpatient,1,mL,,20,17,5.732,20,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"CYANOCOBALAMIN (VITAMIN B-12) 1,000 MCG/ML INJ SOLN",,J3420,HCPCS,Facility,Both,1,mL,,20,17,5.732,20,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,17.714,88.57,,percent of total billed charges,,
"CYANOCOBALAMIN (VITAMIN B-12) 1,000 MCG/ML INJ SOLN",,J3420,HCPCS,Facility,Both,1,mL,,20,17,5.732,20,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,5.732,28.66,,percent of total billed charges,,
"CYANOCOBALAMIN (VITAMIN B-12) 1,000 MCG/ML INJ SOLN",,J3420,HCPCS,Facility,Outpatient,1,mL,,20,17,5.732,20,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),9.8,49,,percent of total billed charges,,
"CYANOCOBALAMIN (VITAMIN B-12) 1,000 MCG/ML INJ SOLN",,J3420,HCPCS,Facility,Inpatient,1,mL,,20,17,5.732,20,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"CYANOCOBALAMIN (VITAMIN B-12) 1,000 MCG/ML INJ SOLN",,J3420,HCPCS,Facility,Both,1,mL,,20,17,5.732,20,CorVel,Worker's Compensation,20,100,,percent of total billed charges,,
"CYANOCOBALAMIN (VITAMIN B-12) 1,000 MCG/ML INJ SOLN",,J3420,HCPCS,Facility,Both,1,mL,,20,17,5.732,20,First Health Group Corporation,First Health Network,19.4,97,,percent of total billed charges,,
"CYANOCOBALAMIN (VITAMIN B-12) 1,000 MCG/ML INJ SOLN",,J3420,HCPCS,Facility,Both,1,mL,,20,17,5.732,20,"Health Partners, Inc.",Commercial,18.92,94.6,,percent of total billed charges,,
"CYANOCOBALAMIN (VITAMIN B-12) 1,000 MCG/ML INJ SOLN",,J3420,HCPCS,Facility,Outpatient,1,mL,,20,17,5.732,20,"Health Partners, Inc.",Medicare Advantage,9.8,49,,percent of total billed charges,,
"CYANOCOBALAMIN (VITAMIN B-12) 1,000 MCG/ML INJ SOLN",,J3420,HCPCS,Facility,Inpatient,1,mL,,20,17,5.732,20,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"CYANOCOBALAMIN (VITAMIN B-12) 1,000 MCG/ML INJ SOLN",,J3420,HCPCS,Facility,Both,1,mL,,20,17,5.732,20,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),12,60,,percent of total billed charges,,
"CYANOCOBALAMIN (VITAMIN B-12) 1,000 MCG/ML INJ SOLN",,J3420,HCPCS,Facility,Both,1,mL,,20,17,5.732,20,"Health Partners, Inc.",State of Minnesota Advantage Program,16.3,81.5,,percent of total billed charges,,
"CYANOCOBALAMIN (VITAMIN B-12) 1,000 MCG/ML INJ SOLN",,J3420,HCPCS,Facility,Both,1,mL,,20,17,5.732,20,"Health Partners, Inc.",State Public Programs,10,50,,percent of total billed charges,,
"CYANOCOBALAMIN (VITAMIN B-12) 1,000 MCG/ML INJ SOLN",,J3420,HCPCS,Facility,Both,1,mL,,20,17,5.732,20,Humana Insurance Company,Commercial PPO,19,95,,percent of total billed charges,,
"CYANOCOBALAMIN (VITAMIN B-12) 1,000 MCG/ML INJ SOLN",,J3420,HCPCS,Facility,Outpatient,1,mL,,20,17,5.732,20,Humana Insurance Company,Medicare PPO,9.8,49,,percent of total billed charges,,
"CYANOCOBALAMIN (VITAMIN B-12) 1,000 MCG/ML INJ SOLN",,J3420,HCPCS,Facility,Inpatient,1,mL,,20,17,5.732,20,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"CYANOCOBALAMIN (VITAMIN B-12) 1,000 MCG/ML INJ SOLN",,J3420,HCPCS,Facility,Both,1,mL,,20,17,5.732,20,Medica,Individual & Family,19.82,99.1,,percent of total billed charges,,
"CYANOCOBALAMIN (VITAMIN B-12) 1,000 MCG/ML INJ SOLN",,J3420,HCPCS,Facility,Outpatient,1,mL,,20,17,5.732,20,Medica,Medica Advantage Solution,9.96,49.8,,percent of total billed charges,,
"CYANOCOBALAMIN (VITAMIN B-12) 1,000 MCG/ML INJ SOLN",,J3420,HCPCS,Facility,Inpatient,1,mL,,20,17,5.732,20,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"CYANOCOBALAMIN (VITAMIN B-12) 1,000 MCG/ML INJ SOLN",,J3420,HCPCS,Facility,Outpatient,1,mL,,20,17,5.732,20,Medica,Medical Assistance,8.92,44.6,,percent of total billed charges,,
"CYANOCOBALAMIN (VITAMIN B-12) 1,000 MCG/ML INJ SOLN",,J3420,HCPCS,Facility,Inpatient,1,mL,,20,17,5.732,20,Medica,Medical Assistance,,,,,Included in per diem rate,
"CYANOCOBALAMIN (VITAMIN B-12) 1,000 MCG/ML INJ SOLN",,J3420,HCPCS,Facility,Outpatient,1,mL,,20,17,5.732,20,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,9.96,49.8,,percent of total billed charges,,
"CYANOCOBALAMIN (VITAMIN B-12) 1,000 MCG/ML INJ SOLN",,J3420,HCPCS,Facility,Inpatient,1,mL,,20,17,5.732,20,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"CYANOCOBALAMIN (VITAMIN B-12) 1,000 MCG/ML INJ SOLN",,J3420,HCPCS,Facility,Both,1,mL,,20,17,5.732,20,"Multiplan, Inc.","Multiplan, Inc.",18.8,94,,percent of total billed charges,,
"CYANOCOBALAMIN (VITAMIN B-12) 1,000 MCG/ML INJ SOLN",,J3420,HCPCS,Facility,Outpatient,1,mL,,20,17,5.732,20,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,18.02,90.1,,percent of total billed charges,,
"CYANOCOBALAMIN (VITAMIN B-12) 1,000 MCG/ML INJ SOLN",,J3420,HCPCS,Facility,Inpatient,1,mL,,20,17,5.732,20,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"CYANOCOBALAMIN (VITAMIN B-12) 1,000 MCG/ML INJ SOLN",,J3420,HCPCS,Facility,Both,1,mL,,20,17,5.732,20,"Preferred One Administrative Services, INC.",PPO,19.72,98.6,,percent of total billed charges,,
"CYANOCOBALAMIN (VITAMIN B-12) 1,000 MCG/ML INJ SOLN",,J3420,HCPCS,Facility,Outpatient,1,mL,,20,17,5.732,20,PrimeWest Health,Minnesota Senior Health Options (MSHO),10.29,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"CYANOCOBALAMIN (VITAMIN B-12) 1,000 MCG/ML INJ SOLN",,J3420,HCPCS,Facility,Inpatient,1,mL,,20,17,5.732,20,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"CYANOCOBALAMIN (VITAMIN B-12) 1,000 MCG/ML INJ SOLN",,J3420,HCPCS,Facility,Outpatient,1,mL,,20,17,5.732,20,PrimeWest Health,MinnesotaCare,10.272,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"CYANOCOBALAMIN (VITAMIN B-12) 1,000 MCG/ML INJ SOLN",,J3420,HCPCS,Facility,Inpatient,1,mL,,20,17,5.732,20,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"CYANOCOBALAMIN (VITAMIN B-12) 1,000 MCG/ML INJ SOLN",,J3420,HCPCS,Facility,Both,1,mL,,20,17,5.732,20,Sanford Health Plan,Sanford Health Plan,18.4,92,,percent of total billed charges,,
"CYANOCOBALAMIN (VITAMIN B-12) 1,000 MCG/ML INJ SOLN",,J3420,HCPCS,Facility,Outpatient,1,mL,,20,17,5.732,20,"UCare Health, Inc.",Individual & Family Plan,11.27,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"CYANOCOBALAMIN (VITAMIN B-12) 1,000 MCG/ML INJ SOLN",,J3420,HCPCS,Facility,Inpatient,1,mL,,20,17,5.732,20,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"CYANOCOBALAMIN (VITAMIN B-12) 1,000 MCG/ML INJ SOLN",,J3420,HCPCS,Facility,Outpatient,1,mL,,20,17,5.732,20,"UCare Health, Inc.",Medical Assistance,10.094,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"CYANOCOBALAMIN (VITAMIN B-12) 1,000 MCG/ML INJ SOLN",,J3420,HCPCS,Facility,Inpatient,1,mL,,20,17,5.732,20,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"CYANOCOBALAMIN (VITAMIN B-12) 1,000 MCG/ML INJ SOLN",,J3420,HCPCS,Facility,Outpatient,1,mL,,20,17,5.732,20,"UCare Health, Inc.",Medicare Advantage,10.094,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"CYANOCOBALAMIN (VITAMIN B-12) 1,000 MCG/ML INJ SOLN",,J3420,HCPCS,Facility,Inpatient,1,mL,,20,17,5.732,20,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"CYANOCOBALAMIN (VITAMIN B-12) 1,000 MCG/ML INJ SOLN",,J3420,HCPCS,Facility,Outpatient,1,mL,,20,17,5.732,20,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),10.094,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"CYANOCOBALAMIN (VITAMIN B-12) 1,000 MCG/ML INJ SOLN",,J3420,HCPCS,Facility,Inpatient,1,mL,,20,17,5.732,20,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"CYANOCOBALAMIN (VITAMIN B-12) 1,000 MCG/ML INJ SOLN",,J3420,HCPCS,Facility,Both,1,mL,,20,17,5.732,20,UnitedHealthcare,Individual & Family,18.8,94,,percent of total billed charges,,
"CYANOCOBALAMIN (VITAMIN B-12) 1,000 MCG/ML INJ SOLN",,J3420,HCPCS,Facility,Outpatient,1,mL,,20,17,5.732,20,UnitedHealthcare,Medicare Advantage,9.8,49,,percent of total billed charges,,
"CYANOCOBALAMIN (VITAMIN B-12) 1,000 MCG/ML INJ SOLN",,J3420,HCPCS,Facility,Inpatient,1,mL,,20,17,5.732,20,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"CYANOCOBALAMIN (VITAMIN B-12) 1,000 MCG/ML INJ SOLN",,J3420,HCPCS,Facility,Outpatient,1,mL,,20,17,5.732,20,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,9.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
"CYANOCOBALAMIN (VITAMIN B-12) 1,000 MCG/ML INJ SOLN",,J3420,HCPCS,Facility,Inpatient,1,mL,,20,17,5.732,20,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
PHYTONADIONE (VITAMIN K1) 10 MG/ML INJ SOLN,,J3430,HCPCS,Facility,Both,1,mL,,247,209.95,70.7902,247,Aetna,Commercial,227.24,92,,percent of total billed charges,,
PHYTONADIONE (VITAMIN K1) 10 MG/ML INJ SOLN,,J3430,HCPCS,Facility,Outpatient,1,mL,,247,209.95,70.7902,247,Aetna,Medicare Advantage,121.03,49,,percent of total billed charges,,
PHYTONADIONE (VITAMIN K1) 10 MG/ML INJ SOLN,,J3430,HCPCS,Facility,Inpatient,1,mL,,247,209.95,70.7902,247,Aetna,Medicare Advantage,,,,,Included in per diem rate,
PHYTONADIONE (VITAMIN K1) 10 MG/ML INJ SOLN,,J3430,HCPCS,Facility,Both,1,mL,,247,209.95,70.7902,247,Aetna,PPO,229.71,93,,percent of total billed charges,,
PHYTONADIONE (VITAMIN K1) 10 MG/ML INJ SOLN,,J3430,HCPCS,Facility,Both,1,mL,,247,209.95,70.7902,247,America's PPO,America's PPO,237.1941,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
PHYTONADIONE (VITAMIN K1) 10 MG/ML INJ SOLN,,J3430,HCPCS,Facility,Both,1,mL,,247,209.95,70.7902,247,BlueCross BlueShield Minnesota, Federal Employee Program,243.048,98.4,,percent of total billed charges,,
PHYTONADIONE (VITAMIN K1) 10 MG/ML INJ SOLN,,J3430,HCPCS,Facility,Both,1,mL,,247,209.95,70.7902,247,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,247,100,,percent of total billed charges,,
PHYTONADIONE (VITAMIN K1) 10 MG/ML INJ SOLN,,J3430,HCPCS,Facility,Both,1,mL,,247,209.95,70.7902,247,BlueCross BlueShield Minnesota,High Value Network Plan,222.3,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
PHYTONADIONE (VITAMIN K1) 10 MG/ML INJ SOLN,,J3430,HCPCS,Facility,Outpatient,1,mL,,247,209.95,70.7902,247,BlueCross BlueShield Minnesota,Medicare Advantage,121.03,49,,percent of total billed charges,,
PHYTONADIONE (VITAMIN K1) 10 MG/ML INJ SOLN,,J3430,HCPCS,Facility,Inpatient,1,mL,,247,209.95,70.7902,247,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
PHYTONADIONE (VITAMIN K1) 10 MG/ML INJ SOLN,,J3430,HCPCS,Facility,Both,1,mL,,247,209.95,70.7902,247,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,218.7679,88.57,,percent of total billed charges,,
PHYTONADIONE (VITAMIN K1) 10 MG/ML INJ SOLN,,J3430,HCPCS,Facility,Both,1,mL,,247,209.95,70.7902,247,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,70.7902,28.66,,percent of total billed charges,,
PHYTONADIONE (VITAMIN K1) 10 MG/ML INJ SOLN,,J3430,HCPCS,Facility,Outpatient,1,mL,,247,209.95,70.7902,247,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),121.03,49,,percent of total billed charges,,
PHYTONADIONE (VITAMIN K1) 10 MG/ML INJ SOLN,,J3430,HCPCS,Facility,Inpatient,1,mL,,247,209.95,70.7902,247,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
PHYTONADIONE (VITAMIN K1) 10 MG/ML INJ SOLN,,J3430,HCPCS,Facility,Both,1,mL,,247,209.95,70.7902,247,CorVel,Worker's Compensation,247,100,,percent of total billed charges,,
PHYTONADIONE (VITAMIN K1) 10 MG/ML INJ SOLN,,J3430,HCPCS,Facility,Both,1,mL,,247,209.95,70.7902,247,First Health Group Corporation,First Health Network,239.59,97,,percent of total billed charges,,
PHYTONADIONE (VITAMIN K1) 10 MG/ML INJ SOLN,,J3430,HCPCS,Facility,Both,1,mL,,247,209.95,70.7902,247,"Health Partners, Inc.",Commercial,233.662,94.6,,percent of total billed charges,,
PHYTONADIONE (VITAMIN K1) 10 MG/ML INJ SOLN,,J3430,HCPCS,Facility,Outpatient,1,mL,,247,209.95,70.7902,247,"Health Partners, Inc.",Medicare Advantage,121.03,49,,percent of total billed charges,,
PHYTONADIONE (VITAMIN K1) 10 MG/ML INJ SOLN,,J3430,HCPCS,Facility,Inpatient,1,mL,,247,209.95,70.7902,247,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PHYTONADIONE (VITAMIN K1) 10 MG/ML INJ SOLN,,J3430,HCPCS,Facility,Both,1,mL,,247,209.95,70.7902,247,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),148.2,60,,percent of total billed charges,,
PHYTONADIONE (VITAMIN K1) 10 MG/ML INJ SOLN,,J3430,HCPCS,Facility,Both,1,mL,,247,209.95,70.7902,247,"Health Partners, Inc.",State of Minnesota Advantage Program,201.305,81.5,,percent of total billed charges,,
PHYTONADIONE (VITAMIN K1) 10 MG/ML INJ SOLN,,J3430,HCPCS,Facility,Both,1,mL,,247,209.95,70.7902,247,"Health Partners, Inc.",State Public Programs,123.5,50,,percent of total billed charges,,
PHYTONADIONE (VITAMIN K1) 10 MG/ML INJ SOLN,,J3430,HCPCS,Facility,Both,1,mL,,247,209.95,70.7902,247,Humana Insurance Company,Commercial PPO,234.65,95,,percent of total billed charges,,
PHYTONADIONE (VITAMIN K1) 10 MG/ML INJ SOLN,,J3430,HCPCS,Facility,Outpatient,1,mL,,247,209.95,70.7902,247,Humana Insurance Company,Medicare PPO,121.03,49,,percent of total billed charges,,
PHYTONADIONE (VITAMIN K1) 10 MG/ML INJ SOLN,,J3430,HCPCS,Facility,Inpatient,1,mL,,247,209.95,70.7902,247,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
PHYTONADIONE (VITAMIN K1) 10 MG/ML INJ SOLN,,J3430,HCPCS,Facility,Both,1,mL,,247,209.95,70.7902,247,Medica,Individual & Family,244.777,99.1,,percent of total billed charges,,
PHYTONADIONE (VITAMIN K1) 10 MG/ML INJ SOLN,,J3430,HCPCS,Facility,Outpatient,1,mL,,247,209.95,70.7902,247,Medica,Medica Advantage Solution,123.006,49.8,,percent of total billed charges,,
PHYTONADIONE (VITAMIN K1) 10 MG/ML INJ SOLN,,J3430,HCPCS,Facility,Inpatient,1,mL,,247,209.95,70.7902,247,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
PHYTONADIONE (VITAMIN K1) 10 MG/ML INJ SOLN,,J3430,HCPCS,Facility,Outpatient,1,mL,,247,209.95,70.7902,247,Medica,Medical Assistance,110.162,44.6,,percent of total billed charges,,
PHYTONADIONE (VITAMIN K1) 10 MG/ML INJ SOLN,,J3430,HCPCS,Facility,Inpatient,1,mL,,247,209.95,70.7902,247,Medica,Medical Assistance,,,,,Included in per diem rate,
PHYTONADIONE (VITAMIN K1) 10 MG/ML INJ SOLN,,J3430,HCPCS,Facility,Outpatient,1,mL,,247,209.95,70.7902,247,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,123.006,49.8,,percent of total billed charges,,
PHYTONADIONE (VITAMIN K1) 10 MG/ML INJ SOLN,,J3430,HCPCS,Facility,Inpatient,1,mL,,247,209.95,70.7902,247,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
PHYTONADIONE (VITAMIN K1) 10 MG/ML INJ SOLN,,J3430,HCPCS,Facility,Both,1,mL,,247,209.95,70.7902,247,"Multiplan, Inc.","Multiplan, Inc.",232.18,94,,percent of total billed charges,,
PHYTONADIONE (VITAMIN K1) 10 MG/ML INJ SOLN,,J3430,HCPCS,Facility,Outpatient,1,mL,,247,209.95,70.7902,247,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,222.547,90.1,,percent of total billed charges,,
PHYTONADIONE (VITAMIN K1) 10 MG/ML INJ SOLN,,J3430,HCPCS,Facility,Inpatient,1,mL,,247,209.95,70.7902,247,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
PHYTONADIONE (VITAMIN K1) 10 MG/ML INJ SOLN,,J3430,HCPCS,Facility,Both,1,mL,,247,209.95,70.7902,247,"Preferred One Administrative Services, INC.",PPO,243.542,98.6,,percent of total billed charges,,
PHYTONADIONE (VITAMIN K1) 10 MG/ML INJ SOLN,,J3430,HCPCS,Facility,Outpatient,1,mL,,247,209.95,70.7902,247,PrimeWest Health,Minnesota Senior Health Options (MSHO),127.0815,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
PHYTONADIONE (VITAMIN K1) 10 MG/ML INJ SOLN,,J3430,HCPCS,Facility,Inpatient,1,mL,,247,209.95,70.7902,247,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PHYTONADIONE (VITAMIN K1) 10 MG/ML INJ SOLN,,J3430,HCPCS,Facility,Outpatient,1,mL,,247,209.95,70.7902,247,PrimeWest Health,MinnesotaCare,126.8592,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
PHYTONADIONE (VITAMIN K1) 10 MG/ML INJ SOLN,,J3430,HCPCS,Facility,Inpatient,1,mL,,247,209.95,70.7902,247,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
PHYTONADIONE (VITAMIN K1) 10 MG/ML INJ SOLN,,J3430,HCPCS,Facility,Both,1,mL,,247,209.95,70.7902,247,Sanford Health Plan,Sanford Health Plan,227.24,92,,percent of total billed charges,,
PHYTONADIONE (VITAMIN K1) 10 MG/ML INJ SOLN,,J3430,HCPCS,Facility,Outpatient,1,mL,,247,209.95,70.7902,247,"UCare Health, Inc.",Individual & Family Plan,139.1845,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
PHYTONADIONE (VITAMIN K1) 10 MG/ML INJ SOLN,,J3430,HCPCS,Facility,Inpatient,1,mL,,247,209.95,70.7902,247,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
PHYTONADIONE (VITAMIN K1) 10 MG/ML INJ SOLN,,J3430,HCPCS,Facility,Outpatient,1,mL,,247,209.95,70.7902,247,"UCare Health, Inc.",Medical Assistance,124.6609,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PHYTONADIONE (VITAMIN K1) 10 MG/ML INJ SOLN,,J3430,HCPCS,Facility,Inpatient,1,mL,,247,209.95,70.7902,247,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
PHYTONADIONE (VITAMIN K1) 10 MG/ML INJ SOLN,,J3430,HCPCS,Facility,Outpatient,1,mL,,247,209.95,70.7902,247,"UCare Health, Inc.",Medicare Advantage,124.6609,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PHYTONADIONE (VITAMIN K1) 10 MG/ML INJ SOLN,,J3430,HCPCS,Facility,Inpatient,1,mL,,247,209.95,70.7902,247,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PHYTONADIONE (VITAMIN K1) 10 MG/ML INJ SOLN,,J3430,HCPCS,Facility,Outpatient,1,mL,,247,209.95,70.7902,247,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),124.6609,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PHYTONADIONE (VITAMIN K1) 10 MG/ML INJ SOLN,,J3430,HCPCS,Facility,Inpatient,1,mL,,247,209.95,70.7902,247,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PHYTONADIONE (VITAMIN K1) 10 MG/ML INJ SOLN,,J3430,HCPCS,Facility,Both,1,mL,,247,209.95,70.7902,247,UnitedHealthcare,Individual & Family,232.18,94,,percent of total billed charges,,
PHYTONADIONE (VITAMIN K1) 10 MG/ML INJ SOLN,,J3430,HCPCS,Facility,Outpatient,1,mL,,247,209.95,70.7902,247,UnitedHealthcare,Medicare Advantage,121.03,49,,percent of total billed charges,,
PHYTONADIONE (VITAMIN K1) 10 MG/ML INJ SOLN,,J3430,HCPCS,Facility,Inpatient,1,mL,,247,209.95,70.7902,247,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
PHYTONADIONE (VITAMIN K1) 10 MG/ML INJ SOLN,,J3430,HCPCS,Facility,Outpatient,1,mL,,247,209.95,70.7902,247,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,118.56,48,,percent of total billed charges,,100% of DHS outpatient percentage
PHYTONADIONE (VITAMIN K1) 10 MG/ML INJ SOLN,,J3430,HCPCS,Facility,Inpatient,1,mL,,247,209.95,70.7902,247,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
HYALURONIDASE (OVINE) 200 UNIT/ML INJ SOLN,,J3471,HCPCS,Facility,Both,1.2,mL,,566,481.1,162.2156,566,Aetna,Commercial,520.72,92,,percent of total billed charges,,
HYALURONIDASE (OVINE) 200 UNIT/ML INJ SOLN,,J3471,HCPCS,Facility,Outpatient,1.2,mL,,566,481.1,162.2156,566,Aetna,Medicare Advantage,277.34,49,,percent of total billed charges,,
HYALURONIDASE (OVINE) 200 UNIT/ML INJ SOLN,,J3471,HCPCS,Facility,Inpatient,1.2,mL,,566,481.1,162.2156,566,Aetna,Medicare Advantage,,,,,Included in per diem rate,
HYALURONIDASE (OVINE) 200 UNIT/ML INJ SOLN,,J3471,HCPCS,Facility,Both,1.2,mL,,566,481.1,162.2156,566,Aetna,PPO,526.38,93,,percent of total billed charges,,
HYALURONIDASE (OVINE) 200 UNIT/ML INJ SOLN,,J3471,HCPCS,Facility,Both,1.2,mL,,566,481.1,162.2156,566,America's PPO,America's PPO,543.5298,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
HYALURONIDASE (OVINE) 200 UNIT/ML INJ SOLN,,J3471,HCPCS,Facility,Both,1.2,mL,,566,481.1,162.2156,566,BlueCross BlueShield Minnesota, Federal Employee Program,556.944,98.4,,percent of total billed charges,,
HYALURONIDASE (OVINE) 200 UNIT/ML INJ SOLN,,J3471,HCPCS,Facility,Both,1.2,mL,,566,481.1,162.2156,566,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,566,100,,percent of total billed charges,,
HYALURONIDASE (OVINE) 200 UNIT/ML INJ SOLN,,J3471,HCPCS,Facility,Both,1.2,mL,,566,481.1,162.2156,566,BlueCross BlueShield Minnesota,High Value Network Plan,509.4,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
HYALURONIDASE (OVINE) 200 UNIT/ML INJ SOLN,,J3471,HCPCS,Facility,Outpatient,1.2,mL,,566,481.1,162.2156,566,BlueCross BlueShield Minnesota,Medicare Advantage,277.34,49,,percent of total billed charges,,
HYALURONIDASE (OVINE) 200 UNIT/ML INJ SOLN,,J3471,HCPCS,Facility,Inpatient,1.2,mL,,566,481.1,162.2156,566,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
HYALURONIDASE (OVINE) 200 UNIT/ML INJ SOLN,,J3471,HCPCS,Facility,Both,1.2,mL,,566,481.1,162.2156,566,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,501.3062,88.57,,percent of total billed charges,,
HYALURONIDASE (OVINE) 200 UNIT/ML INJ SOLN,,J3471,HCPCS,Facility,Both,1.2,mL,,566,481.1,162.2156,566,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,162.2156,28.66,,percent of total billed charges,,
HYALURONIDASE (OVINE) 200 UNIT/ML INJ SOLN,,J3471,HCPCS,Facility,Outpatient,1.2,mL,,566,481.1,162.2156,566,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),277.34,49,,percent of total billed charges,,
HYALURONIDASE (OVINE) 200 UNIT/ML INJ SOLN,,J3471,HCPCS,Facility,Inpatient,1.2,mL,,566,481.1,162.2156,566,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
HYALURONIDASE (OVINE) 200 UNIT/ML INJ SOLN,,J3471,HCPCS,Facility,Both,1.2,mL,,566,481.1,162.2156,566,CorVel,Worker's Compensation,566,100,,percent of total billed charges,,
HYALURONIDASE (OVINE) 200 UNIT/ML INJ SOLN,,J3471,HCPCS,Facility,Both,1.2,mL,,566,481.1,162.2156,566,First Health Group Corporation,First Health Network,549.02,97,,percent of total billed charges,,
HYALURONIDASE (OVINE) 200 UNIT/ML INJ SOLN,,J3471,HCPCS,Facility,Both,1.2,mL,,566,481.1,162.2156,566,"Health Partners, Inc.",Commercial,535.436,94.6,,percent of total billed charges,,
HYALURONIDASE (OVINE) 200 UNIT/ML INJ SOLN,,J3471,HCPCS,Facility,Outpatient,1.2,mL,,566,481.1,162.2156,566,"Health Partners, Inc.",Medicare Advantage,277.34,49,,percent of total billed charges,,
HYALURONIDASE (OVINE) 200 UNIT/ML INJ SOLN,,J3471,HCPCS,Facility,Inpatient,1.2,mL,,566,481.1,162.2156,566,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
HYALURONIDASE (OVINE) 200 UNIT/ML INJ SOLN,,J3471,HCPCS,Facility,Both,1.2,mL,,566,481.1,162.2156,566,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),339.6,60,,percent of total billed charges,,
HYALURONIDASE (OVINE) 200 UNIT/ML INJ SOLN,,J3471,HCPCS,Facility,Both,1.2,mL,,566,481.1,162.2156,566,"Health Partners, Inc.",State of Minnesota Advantage Program,461.29,81.5,,percent of total billed charges,,
HYALURONIDASE (OVINE) 200 UNIT/ML INJ SOLN,,J3471,HCPCS,Facility,Both,1.2,mL,,566,481.1,162.2156,566,"Health Partners, Inc.",State Public Programs,283,50,,percent of total billed charges,,
HYALURONIDASE (OVINE) 200 UNIT/ML INJ SOLN,,J3471,HCPCS,Facility,Both,1.2,mL,,566,481.1,162.2156,566,Humana Insurance Company,Commercial PPO,537.7,95,,percent of total billed charges,,
HYALURONIDASE (OVINE) 200 UNIT/ML INJ SOLN,,J3471,HCPCS,Facility,Outpatient,1.2,mL,,566,481.1,162.2156,566,Humana Insurance Company,Medicare PPO,277.34,49,,percent of total billed charges,,
HYALURONIDASE (OVINE) 200 UNIT/ML INJ SOLN,,J3471,HCPCS,Facility,Inpatient,1.2,mL,,566,481.1,162.2156,566,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
HYALURONIDASE (OVINE) 200 UNIT/ML INJ SOLN,,J3471,HCPCS,Facility,Both,1.2,mL,,566,481.1,162.2156,566,Medica,Individual & Family,560.906,99.1,,percent of total billed charges,,
HYALURONIDASE (OVINE) 200 UNIT/ML INJ SOLN,,J3471,HCPCS,Facility,Outpatient,1.2,mL,,566,481.1,162.2156,566,Medica,Medica Advantage Solution,281.868,49.8,,percent of total billed charges,,
HYALURONIDASE (OVINE) 200 UNIT/ML INJ SOLN,,J3471,HCPCS,Facility,Inpatient,1.2,mL,,566,481.1,162.2156,566,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
HYALURONIDASE (OVINE) 200 UNIT/ML INJ SOLN,,J3471,HCPCS,Facility,Outpatient,1.2,mL,,566,481.1,162.2156,566,Medica,Medical Assistance,252.436,44.6,,percent of total billed charges,,
HYALURONIDASE (OVINE) 200 UNIT/ML INJ SOLN,,J3471,HCPCS,Facility,Inpatient,1.2,mL,,566,481.1,162.2156,566,Medica,Medical Assistance,,,,,Included in per diem rate,
HYALURONIDASE (OVINE) 200 UNIT/ML INJ SOLN,,J3471,HCPCS,Facility,Outpatient,1.2,mL,,566,481.1,162.2156,566,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,281.868,49.8,,percent of total billed charges,,
HYALURONIDASE (OVINE) 200 UNIT/ML INJ SOLN,,J3471,HCPCS,Facility,Inpatient,1.2,mL,,566,481.1,162.2156,566,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
HYALURONIDASE (OVINE) 200 UNIT/ML INJ SOLN,,J3471,HCPCS,Facility,Both,1.2,mL,,566,481.1,162.2156,566,"Multiplan, Inc.","Multiplan, Inc.",532.04,94,,percent of total billed charges,,
HYALURONIDASE (OVINE) 200 UNIT/ML INJ SOLN,,J3471,HCPCS,Facility,Outpatient,1.2,mL,,566,481.1,162.2156,566,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,509.966,90.1,,percent of total billed charges,,
HYALURONIDASE (OVINE) 200 UNIT/ML INJ SOLN,,J3471,HCPCS,Facility,Inpatient,1.2,mL,,566,481.1,162.2156,566,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
HYALURONIDASE (OVINE) 200 UNIT/ML INJ SOLN,,J3471,HCPCS,Facility,Both,1.2,mL,,566,481.1,162.2156,566,"Preferred One Administrative Services, INC.",PPO,558.076,98.6,,percent of total billed charges,,
HYALURONIDASE (OVINE) 200 UNIT/ML INJ SOLN,,J3471,HCPCS,Facility,Outpatient,1.2,mL,,566,481.1,162.2156,566,PrimeWest Health,Minnesota Senior Health Options (MSHO),291.207,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
HYALURONIDASE (OVINE) 200 UNIT/ML INJ SOLN,,J3471,HCPCS,Facility,Inpatient,1.2,mL,,566,481.1,162.2156,566,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
HYALURONIDASE (OVINE) 200 UNIT/ML INJ SOLN,,J3471,HCPCS,Facility,Outpatient,1.2,mL,,566,481.1,162.2156,566,PrimeWest Health,MinnesotaCare,290.6976,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
HYALURONIDASE (OVINE) 200 UNIT/ML INJ SOLN,,J3471,HCPCS,Facility,Inpatient,1.2,mL,,566,481.1,162.2156,566,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
HYALURONIDASE (OVINE) 200 UNIT/ML INJ SOLN,,J3471,HCPCS,Facility,Both,1.2,mL,,566,481.1,162.2156,566,Sanford Health Plan,Sanford Health Plan,520.72,92,,percent of total billed charges,,
HYALURONIDASE (OVINE) 200 UNIT/ML INJ SOLN,,J3471,HCPCS,Facility,Outpatient,1.2,mL,,566,481.1,162.2156,566,"UCare Health, Inc.",Individual & Family Plan,318.941,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
HYALURONIDASE (OVINE) 200 UNIT/ML INJ SOLN,,J3471,HCPCS,Facility,Inpatient,1.2,mL,,566,481.1,162.2156,566,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
HYALURONIDASE (OVINE) 200 UNIT/ML INJ SOLN,,J3471,HCPCS,Facility,Outpatient,1.2,mL,,566,481.1,162.2156,566,"UCare Health, Inc.",Medical Assistance,285.6602,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
HYALURONIDASE (OVINE) 200 UNIT/ML INJ SOLN,,J3471,HCPCS,Facility,Inpatient,1.2,mL,,566,481.1,162.2156,566,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
HYALURONIDASE (OVINE) 200 UNIT/ML INJ SOLN,,J3471,HCPCS,Facility,Outpatient,1.2,mL,,566,481.1,162.2156,566,"UCare Health, Inc.",Medicare Advantage,285.6602,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
HYALURONIDASE (OVINE) 200 UNIT/ML INJ SOLN,,J3471,HCPCS,Facility,Inpatient,1.2,mL,,566,481.1,162.2156,566,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
HYALURONIDASE (OVINE) 200 UNIT/ML INJ SOLN,,J3471,HCPCS,Facility,Outpatient,1.2,mL,,566,481.1,162.2156,566,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),285.6602,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
HYALURONIDASE (OVINE) 200 UNIT/ML INJ SOLN,,J3471,HCPCS,Facility,Inpatient,1.2,mL,,566,481.1,162.2156,566,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
HYALURONIDASE (OVINE) 200 UNIT/ML INJ SOLN,,J3471,HCPCS,Facility,Both,1.2,mL,,566,481.1,162.2156,566,UnitedHealthcare,Individual & Family,532.04,94,,percent of total billed charges,,
HYALURONIDASE (OVINE) 200 UNIT/ML INJ SOLN,,J3471,HCPCS,Facility,Outpatient,1.2,mL,,566,481.1,162.2156,566,UnitedHealthcare,Medicare Advantage,277.34,49,,percent of total billed charges,,
HYALURONIDASE (OVINE) 200 UNIT/ML INJ SOLN,,J3471,HCPCS,Facility,Inpatient,1.2,mL,,566,481.1,162.2156,566,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
HYALURONIDASE (OVINE) 200 UNIT/ML INJ SOLN,,J3471,HCPCS,Facility,Outpatient,1.2,mL,,566,481.1,162.2156,566,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,271.68,48,,percent of total billed charges,,100% of DHS outpatient percentage
HYALURONIDASE (OVINE) 200 UNIT/ML INJ SOLN,,J3471,HCPCS,Facility,Inpatient,1.2,mL,,566,481.1,162.2156,566,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
CARBACHOL 0.01 % IO SOLN,,13345,LOCAL,Facility,Both,1.5,mL,,213,181.05,61.0458,213,Aetna,Commercial,195.96,92,,percent of total billed charges,,
CARBACHOL 0.01 % IO SOLN,,13345,LOCAL,Facility,Outpatient,1.5,mL,,213,181.05,61.0458,213,Aetna,Medicare Advantage,104.37,49,,percent of total billed charges,,
CARBACHOL 0.01 % IO SOLN,,13345,LOCAL,Facility,Inpatient,1.5,mL,,213,181.05,61.0458,213,Aetna,Medicare Advantage,,,,,Included in per diem rate,
CARBACHOL 0.01 % IO SOLN,,13345,LOCAL,Facility,Both,1.5,mL,,213,181.05,61.0458,213,Aetna,PPO,198.09,93,,percent of total billed charges,,
CARBACHOL 0.01 % IO SOLN,,13345,LOCAL,Facility,Both,1.5,mL,,213,181.05,61.0458,213,America's PPO,America's PPO,204.5439,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
CARBACHOL 0.01 % IO SOLN,,13345,LOCAL,Facility,Both,1.5,mL,,213,181.05,61.0458,213,BlueCross BlueShield Minnesota, Federal Employee Program,209.592,98.4,,percent of total billed charges,,
CARBACHOL 0.01 % IO SOLN,,13345,LOCAL,Facility,Both,1.5,mL,,213,181.05,61.0458,213,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,213,100,,percent of total billed charges,,
CARBACHOL 0.01 % IO SOLN,,13345,LOCAL,Facility,Both,1.5,mL,,213,181.05,61.0458,213,BlueCross BlueShield Minnesota,High Value Network Plan,191.7,90,,percent of total billed charges,,
CARBACHOL 0.01 % IO SOLN,,13345,LOCAL,Facility,Outpatient,1.5,mL,,213,181.05,61.0458,213,BlueCross BlueShield Minnesota,Medicare Advantage,104.37,49,,percent of total billed charges,,
CARBACHOL 0.01 % IO SOLN,,13345,LOCAL,Facility,Inpatient,1.5,mL,,213,181.05,61.0458,213,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
CARBACHOL 0.01 % IO SOLN,,13345,LOCAL,Facility,Both,1.5,mL,,213,181.05,61.0458,213,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,188.6541,88.57,,percent of total billed charges,,
CARBACHOL 0.01 % IO SOLN,,13345,LOCAL,Facility,Both,1.5,mL,,213,181.05,61.0458,213,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,61.0458,28.66,,percent of total billed charges,,
CARBACHOL 0.01 % IO SOLN,,13345,LOCAL,Facility,Outpatient,1.5,mL,,213,181.05,61.0458,213,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),104.37,49,,percent of total billed charges,,
CARBACHOL 0.01 % IO SOLN,,13345,LOCAL,Facility,Inpatient,1.5,mL,,213,181.05,61.0458,213,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
CARBACHOL 0.01 % IO SOLN,,13345,LOCAL,Facility,Both,1.5,mL,,213,181.05,61.0458,213,CorVel,Worker's Compensation,213,100,,percent of total billed charges,,
CARBACHOL 0.01 % IO SOLN,,13345,LOCAL,Facility,Both,1.5,mL,,213,181.05,61.0458,213,First Health Group Corporation,First Health Network,206.61,97,,percent of total billed charges,,
CARBACHOL 0.01 % IO SOLN,,13345,LOCAL,Facility,Both,1.5,mL,,213,181.05,61.0458,213,"Health Partners, Inc.",Commercial,201.498,94.6,,percent of total billed charges,,
CARBACHOL 0.01 % IO SOLN,,13345,LOCAL,Facility,Outpatient,1.5,mL,,213,181.05,61.0458,213,"Health Partners, Inc.",Medicare Advantage,104.37,49,,percent of total billed charges,,
CARBACHOL 0.01 % IO SOLN,,13345,LOCAL,Facility,Inpatient,1.5,mL,,213,181.05,61.0458,213,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CARBACHOL 0.01 % IO SOLN,,13345,LOCAL,Facility,Both,1.5,mL,,213,181.05,61.0458,213,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),127.8,60,,percent of total billed charges,,
CARBACHOL 0.01 % IO SOLN,,13345,LOCAL,Facility,Both,1.5,mL,,213,181.05,61.0458,213,"Health Partners, Inc.",State of Minnesota Advantage Program,173.595,81.5,,percent of total billed charges,,
CARBACHOL 0.01 % IO SOLN,,13345,LOCAL,Facility,Both,1.5,mL,,213,181.05,61.0458,213,"Health Partners, Inc.",State Public Programs,106.5,50,,percent of total billed charges,,
CARBACHOL 0.01 % IO SOLN,,13345,LOCAL,Facility,Both,1.5,mL,,213,181.05,61.0458,213,Humana Insurance Company,Commercial PPO,202.35,95,,percent of total billed charges,,
CARBACHOL 0.01 % IO SOLN,,13345,LOCAL,Facility,Outpatient,1.5,mL,,213,181.05,61.0458,213,Humana Insurance Company,Medicare PPO,104.37,49,,percent of total billed charges,,
CARBACHOL 0.01 % IO SOLN,,13345,LOCAL,Facility,Inpatient,1.5,mL,,213,181.05,61.0458,213,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
CARBACHOL 0.01 % IO SOLN,,13345,LOCAL,Facility,Both,1.5,mL,,213,181.05,61.0458,213,Medica,Individual & Family,211.083,99.1,,percent of total billed charges,,
CARBACHOL 0.01 % IO SOLN,,13345,LOCAL,Facility,Outpatient,1.5,mL,,213,181.05,61.0458,213,Medica,Medica Advantage Solution,106.074,49.8,,percent of total billed charges,,
CARBACHOL 0.01 % IO SOLN,,13345,LOCAL,Facility,Inpatient,1.5,mL,,213,181.05,61.0458,213,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
CARBACHOL 0.01 % IO SOLN,,13345,LOCAL,Facility,Outpatient,1.5,mL,,213,181.05,61.0458,213,Medica,Medical Assistance,94.998,44.6,,percent of total billed charges,,
CARBACHOL 0.01 % IO SOLN,,13345,LOCAL,Facility,Inpatient,1.5,mL,,213,181.05,61.0458,213,Medica,Medical Assistance,,,,,Included in per diem rate,
CARBACHOL 0.01 % IO SOLN,,13345,LOCAL,Facility,Outpatient,1.5,mL,,213,181.05,61.0458,213,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,106.074,49.8,,percent of total billed charges,,
CARBACHOL 0.01 % IO SOLN,,13345,LOCAL,Facility,Inpatient,1.5,mL,,213,181.05,61.0458,213,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
CARBACHOL 0.01 % IO SOLN,,13345,LOCAL,Facility,Both,1.5,mL,,213,181.05,61.0458,213,"Multiplan, Inc.","Multiplan, Inc.",200.22,94,,percent of total billed charges,,
CARBACHOL 0.01 % IO SOLN,,13345,LOCAL,Facility,Outpatient,1.5,mL,,213,181.05,61.0458,213,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,191.913,90.1,,percent of total billed charges,,
CARBACHOL 0.01 % IO SOLN,,13345,LOCAL,Facility,Inpatient,1.5,mL,,213,181.05,61.0458,213,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
CARBACHOL 0.01 % IO SOLN,,13345,LOCAL,Facility,Both,1.5,mL,,213,181.05,61.0458,213,"Preferred One Administrative Services, INC.",PPO,210.018,98.6,,percent of total billed charges,,
CARBACHOL 0.01 % IO SOLN,,13345,LOCAL,Facility,Outpatient,1.5,mL,,213,181.05,61.0458,213,PrimeWest Health,Minnesota Senior Health Options (MSHO),109.5885,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
CARBACHOL 0.01 % IO SOLN,,13345,LOCAL,Facility,Inpatient,1.5,mL,,213,181.05,61.0458,213,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CARBACHOL 0.01 % IO SOLN,,13345,LOCAL,Facility,Outpatient,1.5,mL,,213,181.05,61.0458,213,PrimeWest Health,MinnesotaCare,109.3968,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
CARBACHOL 0.01 % IO SOLN,,13345,LOCAL,Facility,Inpatient,1.5,mL,,213,181.05,61.0458,213,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
CARBACHOL 0.01 % IO SOLN,,13345,LOCAL,Facility,Both,1.5,mL,,213,181.05,61.0458,213,Sanford Health Plan,Sanford Health Plan,195.96,92,,percent of total billed charges,,
CARBACHOL 0.01 % IO SOLN,,13345,LOCAL,Facility,Outpatient,1.5,mL,,213,181.05,61.0458,213,"UCare Health, Inc.",Individual & Family Plan,120.0255,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
CARBACHOL 0.01 % IO SOLN,,13345,LOCAL,Facility,Inpatient,1.5,mL,,213,181.05,61.0458,213,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
CARBACHOL 0.01 % IO SOLN,,13345,LOCAL,Facility,Outpatient,1.5,mL,,213,181.05,61.0458,213,"UCare Health, Inc.",Medical Assistance,107.5011,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CARBACHOL 0.01 % IO SOLN,,13345,LOCAL,Facility,Inpatient,1.5,mL,,213,181.05,61.0458,213,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
CARBACHOL 0.01 % IO SOLN,,13345,LOCAL,Facility,Outpatient,1.5,mL,,213,181.05,61.0458,213,"UCare Health, Inc.",Medicare Advantage,107.5011,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CARBACHOL 0.01 % IO SOLN,,13345,LOCAL,Facility,Inpatient,1.5,mL,,213,181.05,61.0458,213,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CARBACHOL 0.01 % IO SOLN,,13345,LOCAL,Facility,Outpatient,1.5,mL,,213,181.05,61.0458,213,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),107.5011,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CARBACHOL 0.01 % IO SOLN,,13345,LOCAL,Facility,Inpatient,1.5,mL,,213,181.05,61.0458,213,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CARBACHOL 0.01 % IO SOLN,,13345,LOCAL,Facility,Both,1.5,mL,,213,181.05,61.0458,213,UnitedHealthcare,Individual & Family,200.22,94,,percent of total billed charges,,
CARBACHOL 0.01 % IO SOLN,,13345,LOCAL,Facility,Outpatient,1.5,mL,,213,181.05,61.0458,213,UnitedHealthcare,Medicare Advantage,104.37,49,,percent of total billed charges,,
CARBACHOL 0.01 % IO SOLN,,13345,LOCAL,Facility,Inpatient,1.5,mL,,213,181.05,61.0458,213,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
CARBACHOL 0.01 % IO SOLN,,13345,LOCAL,Facility,Outpatient,1.5,mL,,213,181.05,61.0458,213,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,102.24,48,,percent of total billed charges,,100% of DHS outpatient percentage
CARBACHOL 0.01 % IO SOLN,,13345,LOCAL,Facility,Inpatient,1.5,mL,,213,181.05,61.0458,213,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Incision Labial Frenum (Frenotomy),,40806,CPT,Facility,Both,,,,190,161.5,54.454,190,Aetna,Commercial,174.8,92,,percent of total billed charges,,
Incision Labial Frenum (Frenotomy),,40806,CPT,Facility,Outpatient,,,,190,161.5,54.454,190,Aetna,Medicare Advantage,93.1,49,,percent of total billed charges,,
Incision Labial Frenum (Frenotomy),,40806,CPT,Facility,Inpatient,,,,190,161.5,54.454,190,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Incision Labial Frenum (Frenotomy),,40806,CPT,Facility,Both,,,,190,161.5,54.454,190,Aetna,PPO,176.7,93,,percent of total billed charges,,
Incision Labial Frenum (Frenotomy),,40806,CPT,Facility,Both,,,,190,161.5,54.454,190,America's PPO,America's PPO,182.457,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Incision Labial Frenum (Frenotomy),,40806,CPT,Facility,Both,,,,190,161.5,54.454,190,BlueCross BlueShield Minnesota, Federal Employee Program,186.96,98.4,,percent of total billed charges,,
Incision Labial Frenum (Frenotomy),,40806,CPT,Facility,Both,,,,190,161.5,54.454,190,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,190,100,,percent of total billed charges,,
Incision Labial Frenum (Frenotomy),,40806,CPT,Facility,Both,,,,190,161.5,54.454,190,BlueCross BlueShield Minnesota,High Value Network Plan,171,90,,percent of total billed charges,,
Incision Labial Frenum (Frenotomy),,40806,CPT,Facility,Outpatient,,,,190,161.5,54.454,190,BlueCross BlueShield Minnesota,Medicare Advantage,93.1,49,,percent of total billed charges,,
Incision Labial Frenum (Frenotomy),,40806,CPT,Facility,Inpatient,,,,190,161.5,54.454,190,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Incision Labial Frenum (Frenotomy),,40806,CPT,Facility,Both,,,,190,161.5,54.454,190,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,168.283,88.57,,percent of total billed charges,,
Incision Labial Frenum (Frenotomy),,40806,CPT,Facility,Both,,,,190,161.5,54.454,190,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,54.454,28.66,,percent of total billed charges,,
Incision Labial Frenum (Frenotomy),,40806,CPT,Facility,Outpatient,,,,190,161.5,54.454,190,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),93.1,49,,percent of total billed charges,,
Incision Labial Frenum (Frenotomy),,40806,CPT,Facility,Inpatient,,,,190,161.5,54.454,190,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Incision Labial Frenum (Frenotomy),,40806,CPT,Facility,Both,,,,190,161.5,54.454,190,CorVel,Worker's Compensation,190,100,,percent of total billed charges,,
Incision Labial Frenum (Frenotomy),,40806,CPT,Facility,Both,,,,190,161.5,54.454,190,First Health Group Corporation,First Health Network,184.3,97,,percent of total billed charges,,
Incision Labial Frenum (Frenotomy),,40806,CPT,Facility,Both,,,,190,161.5,54.454,190,"Health Partners, Inc.",Commercial,179.74,94.6,,percent of total billed charges,,
Incision Labial Frenum (Frenotomy),,40806,CPT,Facility,Outpatient,,,,190,161.5,54.454,190,"Health Partners, Inc.",Medicare Advantage,93.1,49,,percent of total billed charges,,
Incision Labial Frenum (Frenotomy),,40806,CPT,Facility,Inpatient,,,,190,161.5,54.454,190,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Incision Labial Frenum (Frenotomy),,40806,CPT,Facility,Both,,,,190,161.5,54.454,190,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),114,60,,percent of total billed charges,,
Incision Labial Frenum (Frenotomy),,40806,CPT,Facility,Both,,,,190,161.5,54.454,190,"Health Partners, Inc.",State of Minnesota Advantage Program,154.85,81.5,,percent of total billed charges,,
Incision Labial Frenum (Frenotomy),,40806,CPT,Facility,Both,,,,190,161.5,54.454,190,"Health Partners, Inc.",State Public Programs,95,50,,percent of total billed charges,,
Incision Labial Frenum (Frenotomy),,40806,CPT,Facility,Both,,,,190,161.5,54.454,190,Humana Insurance Company,Commercial PPO,180.5,95,,percent of total billed charges,,
Incision Labial Frenum (Frenotomy),,40806,CPT,Facility,Outpatient,,,,190,161.5,54.454,190,Humana Insurance Company,Medicare PPO,93.1,49,,percent of total billed charges,,
Incision Labial Frenum (Frenotomy),,40806,CPT,Facility,Inpatient,,,,190,161.5,54.454,190,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Incision Labial Frenum (Frenotomy),,40806,CPT,Facility,Both,,,,190,161.5,54.454,190,Medica,Individual & Family,188.29,99.1,,percent of total billed charges,,
Incision Labial Frenum (Frenotomy),,40806,CPT,Facility,Outpatient,,,,190,161.5,54.454,190,Medica,Medica Advantage Solution,94.62,49.8,,percent of total billed charges,,
Incision Labial Frenum (Frenotomy),,40806,CPT,Facility,Inpatient,,,,190,161.5,54.454,190,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Incision Labial Frenum (Frenotomy),,40806,CPT,Facility,Outpatient,,,,190,161.5,54.454,190,Medica,Medical Assistance,84.74,44.6,,percent of total billed charges,,
Incision Labial Frenum (Frenotomy),,40806,CPT,Facility,Inpatient,,,,190,161.5,54.454,190,Medica,Medical Assistance,,,,,Included in per diem rate,
Incision Labial Frenum (Frenotomy),,40806,CPT,Facility,Outpatient,,,,190,161.5,54.454,190,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,94.62,49.8,,percent of total billed charges,,
Incision Labial Frenum (Frenotomy),,40806,CPT,Facility,Inpatient,,,,190,161.5,54.454,190,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Incision Labial Frenum (Frenotomy),,40806,CPT,Facility,Both,,,,190,161.5,54.454,190,"Multiplan, Inc.","Multiplan, Inc.",178.6,94,,percent of total billed charges,,
Incision Labial Frenum (Frenotomy),,40806,CPT,Facility,Outpatient,,,,190,161.5,54.454,190,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,171.19,90.1,,percent of total billed charges,,
Incision Labial Frenum (Frenotomy),,40806,CPT,Facility,Inpatient,,,,190,161.5,54.454,190,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Incision Labial Frenum (Frenotomy),,40806,CPT,Facility,Both,,,,190,161.5,54.454,190,"Preferred One Administrative Services, INC.",PPO,187.34,98.6,,percent of total billed charges,,
Incision Labial Frenum (Frenotomy),,40806,CPT,Facility,Outpatient,,,,190,161.5,54.454,190,PrimeWest Health,Minnesota Senior Health Options (MSHO),97.755,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Incision Labial Frenum (Frenotomy),,40806,CPT,Facility,Inpatient,,,,190,161.5,54.454,190,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Incision Labial Frenum (Frenotomy),,40806,CPT,Facility,Outpatient,,,,190,161.5,54.454,190,PrimeWest Health,MinnesotaCare,97.584,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Incision Labial Frenum (Frenotomy),,40806,CPT,Facility,Inpatient,,,,190,161.5,54.454,190,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Incision Labial Frenum (Frenotomy),,40806,CPT,Facility,Both,,,,190,161.5,54.454,190,Sanford Health Plan,Sanford Health Plan,174.8,92,,percent of total billed charges,,
Incision Labial Frenum (Frenotomy),,40806,CPT,Facility,Outpatient,,,,190,161.5,54.454,190,"UCare Health, Inc.",Individual & Family Plan,107.065,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Incision Labial Frenum (Frenotomy),,40806,CPT,Facility,Inpatient,,,,190,161.5,54.454,190,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Incision Labial Frenum (Frenotomy),,40806,CPT,Facility,Outpatient,,,,190,161.5,54.454,190,"UCare Health, Inc.",Medical Assistance,95.893,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Incision Labial Frenum (Frenotomy),,40806,CPT,Facility,Inpatient,,,,190,161.5,54.454,190,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Incision Labial Frenum (Frenotomy),,40806,CPT,Facility,Outpatient,,,,190,161.5,54.454,190,"UCare Health, Inc.",Medicare Advantage,95.893,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Incision Labial Frenum (Frenotomy),,40806,CPT,Facility,Inpatient,,,,190,161.5,54.454,190,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Incision Labial Frenum (Frenotomy),,40806,CPT,Facility,Outpatient,,,,190,161.5,54.454,190,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),95.893,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Incision Labial Frenum (Frenotomy),,40806,CPT,Facility,Inpatient,,,,190,161.5,54.454,190,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Incision Labial Frenum (Frenotomy),,40806,CPT,Facility,Both,,,,190,161.5,54.454,190,UnitedHealthcare,Individual & Family,178.6,94,,percent of total billed charges,,
Incision Labial Frenum (Frenotomy),,40806,CPT,Facility,Outpatient,,,,190,161.5,54.454,190,UnitedHealthcare,Medicare Advantage,93.1,49,,percent of total billed charges,,
Incision Labial Frenum (Frenotomy),,40806,CPT,Facility,Inpatient,,,,190,161.5,54.454,190,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Incision Labial Frenum (Frenotomy),,40806,CPT,Facility,Outpatient,,,,190,161.5,54.454,190,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,91.2,48,,percent of total billed charges,,100% of DHS outpatient percentage
Incision Labial Frenum (Frenotomy),,40806,CPT,Facility,Inpatient,,,,190,161.5,54.454,190,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Incision Of Labial Frenum (Frenotomy) (Pro Cah),,40806,CPT,Professional,Both,,,,315,267.75,18.32,315,Aetna,Commercial,267.75,85,,percent of total billed charges,,
Incision Of Labial Frenum (Frenotomy) (Pro Cah),,40806,CPT,Professional,Both,,,,315,267.75,18.32,315,Aetna,Medicare Advantage,28.28,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Incision Of Labial Frenum (Frenotomy) (Pro Cah),,40806,CPT,Professional,Both,,,,315,267.75,18.32,315,Aetna,PPO,292.95,93,,percent of total billed charges,,
Incision Of Labial Frenum (Frenotomy) (Pro Cah),,40806,CPT,Professional,Both,,,,315,267.75,18.32,315,America's PPO,America's PPO,269.136,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Incision Of Labial Frenum (Frenotomy) (Pro Cah),,40806,CPT,Professional,Both,,,,315,267.75,18.32,315,BlueCross BlueShield Minnesota, Federal Employee Program,59.22,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Incision Of Labial Frenum (Frenotomy) (Pro Cah),,40806,CPT,Professional,Both,,,,315,267.75,18.32,315,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,60.16752,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Incision Of Labial Frenum (Frenotomy) (Pro Cah),,40806,CPT,Professional,Both,,,,315,267.75,18.32,315,BlueCross BlueShield Minnesota,High Value Network Plan,60.16752,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Incision Of Labial Frenum (Frenotomy) (Pro Cah),,40806,CPT,Professional,Both,,,,315,267.75,18.32,315,BlueCross BlueShield Minnesota,Medicare Advantage,32.844,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Incision Of Labial Frenum (Frenotomy) (Pro Cah),,40806,CPT,Professional,Both,,,,315,267.75,18.32,315,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,60.16752,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Incision Of Labial Frenum (Frenotomy) (Pro Cah),,40806,CPT,Professional,Both,,,,315,267.75,18.32,315,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,21.15312,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Incision Of Labial Frenum (Frenotomy) (Pro Cah),,40806,CPT,Professional,Both,,,,315,267.75,18.32,315,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),32.844,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Incision Of Labial Frenum (Frenotomy) (Pro Cah),,40806,CPT,Professional,Both,,,,315,267.75,18.32,315,CorVel,Worker's Compensation,54.4318812,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Incision Of Labial Frenum (Frenotomy) (Pro Cah),,40806,CPT,Professional,Both,,,,315,267.75,18.32,315,First Health Group Corporation,First Health Network,305.55,97,,percent of total billed charges,,
Incision Of Labial Frenum (Frenotomy) (Pro Cah),,40806,CPT,Professional,Both,,,,315,267.75,18.32,315,"Health Partners, Inc.",Commercial,58.77,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Incision Of Labial Frenum (Frenotomy) (Pro Cah),,40806,CPT,Professional,Both,,,,315,267.75,18.32,315,"Health Partners, Inc.",Medicare Advantage,32.844,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Incision Of Labial Frenum (Frenotomy) (Pro Cah),,40806,CPT,Professional,Both,,,,315,267.75,18.32,315,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),28.47,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Incision Of Labial Frenum (Frenotomy) (Pro Cah),,40806,CPT,Professional,Both,,,,315,267.75,18.32,315,"Health Partners, Inc.",State of Minnesota Advantage Program,50.630355,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Incision Of Labial Frenum (Frenotomy) (Pro Cah),,40806,CPT,Professional,Both,,,,315,267.75,18.32,315,"Health Partners, Inc.",State Public Programs,18.32,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Incision Of Labial Frenum (Frenotomy) (Pro Cah),,40806,CPT,Professional,Both,,,,315,267.75,18.32,315,Humana Insurance Company,Commercial PPO,28.56,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Incision Of Labial Frenum (Frenotomy) (Pro Cah),,40806,CPT,Professional,Both,,,,315,267.75,18.32,315,Humana Insurance Company,Medicare PPO,315,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Incision Of Labial Frenum (Frenotomy) (Pro Cah),,40806,CPT,Professional,Both,,,,315,267.75,18.32,315,Medica,Individual & Family,267.12,84.8,,percent of total billed charges,,
Incision Of Labial Frenum (Frenotomy) (Pro Cah),,40806,CPT,Professional,Both,,,,315,267.75,18.32,315,Medica,Medica Advantage Solution,156.87,49.8,,percent of total billed charges,,
Incision Of Labial Frenum (Frenotomy) (Pro Cah),,40806,CPT,Professional,Both,,,,315,267.75,18.32,315,Medica,Medical Assistance,21.15,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Incision Of Labial Frenum (Frenotomy) (Pro Cah),,40806,CPT,Professional,Both,,,,315,267.75,18.32,315,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,28.56,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Incision Of Labial Frenum (Frenotomy) (Pro Cah),,40806,CPT,Professional,Both,,,,315,267.75,18.32,315,"Multiplan, Inc.","Multiplan, Inc.",296.1,94,,percent of total billed charges,,
Incision Of Labial Frenum (Frenotomy) (Pro Cah),,40806,CPT,Professional,Both,,,,315,267.75,18.32,315,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,283.815,90.1,,percent of total billed charges,,
Incision Of Labial Frenum (Frenotomy) (Pro Cah),,40806,CPT,Professional,Both,,,,315,267.75,18.32,315,"Preferred One Administrative Services, INC.",PPO,310.59,98.6,,percent of total billed charges,,
Incision Of Labial Frenum (Frenotomy) (Pro Cah),,40806,CPT,Professional,Both,,,,315,267.75,18.32,315,PrimeWest Health,Minnesota Senior Health Options (MSHO),32.844,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Incision Of Labial Frenum (Frenotomy) (Pro Cah),,40806,CPT,Professional,Both,,,,315,267.75,18.32,315,PrimeWest Health,MinnesotaCare,22.6338384,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Incision Of Labial Frenum (Frenotomy) (Pro Cah),,40806,CPT,Professional,Both,,,,315,267.75,18.32,315,Sanford Health Plan,Sanford Health Plan,277.2,88,,percent of total billed charges,,
Incision Of Labial Frenum (Frenotomy) (Pro Cah),,40806,CPT,Professional,Both,,,,315,267.75,18.32,315,"UCare Health, Inc.",Individual & Family Plan,46.427136,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Incision Of Labial Frenum (Frenotomy) (Pro Cah),,40806,CPT,Professional,Both,,,,315,267.75,18.32,315,"UCare Health, Inc.",Medical Assistance,23.268432,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Incision Of Labial Frenum (Frenotomy) (Pro Cah),,40806,CPT,Professional,Both,,,,315,267.75,18.32,315,"UCare Health, Inc.",Medicare Advantage,32.844,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Incision Of Labial Frenum (Frenotomy) (Pro Cah),,40806,CPT,Professional,Both,,,,315,267.75,18.32,315,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),26.2752,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Incision Of Labial Frenum (Frenotomy) (Pro Cah),,40806,CPT,Professional,Both,,,,315,267.75,18.32,315,UnitedHealthcare,Individual & Family,315,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Incision Of Labial Frenum (Frenotomy) (Pro Cah),,40806,CPT,Professional,Both,,,,315,267.75,18.32,315,UnitedHealthcare,Medicare Advantage,32.844,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Incision Of Labial Frenum (Frenotomy) (Pro Cah),,40806,CPT,Professional,Both,,,,315,267.75,18.32,315,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,21.15312,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision Of Frenum Labial, Or Buccal",,40819,CPT,Facility,Both,,,,469,398.65,134.4154,469,Aetna,Commercial,431.48,92,,percent of total billed charges,,
"Excision Of Frenum Labial, Or Buccal",,40819,CPT,Facility,Outpatient,,,,469,398.65,134.4154,469,Aetna,Medicare Advantage,229.81,49,,percent of total billed charges,,
"Excision Of Frenum Labial, Or Buccal",,40819,CPT,Facility,Inpatient,,,,469,398.65,134.4154,469,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Excision Of Frenum Labial, Or Buccal",,40819,CPT,Facility,Both,,,,469,398.65,134.4154,469,Aetna,PPO,436.17,93,,percent of total billed charges,,
"Excision Of Frenum Labial, Or Buccal",,40819,CPT,Facility,Both,,,,469,398.65,134.4154,469,America's PPO,America's PPO,450.3807,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Excision Of Frenum Labial, Or Buccal",,40819,CPT,Facility,Both,,,,469,398.65,134.4154,469,BlueCross BlueShield Minnesota, Federal Employee Program,461.496,98.4,,percent of total billed charges,,
"Excision Of Frenum Labial, Or Buccal",,40819,CPT,Facility,Both,,,,469,398.65,134.4154,469,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,469,100,,percent of total billed charges,,
"Excision Of Frenum Labial, Or Buccal",,40819,CPT,Facility,Both,,,,469,398.65,134.4154,469,BlueCross BlueShield Minnesota,High Value Network Plan,422.1,90,,percent of total billed charges,,
"Excision Of Frenum Labial, Or Buccal",,40819,CPT,Facility,Outpatient,,,,469,398.65,134.4154,469,BlueCross BlueShield Minnesota,Medicare Advantage,229.81,49,,percent of total billed charges,,
"Excision Of Frenum Labial, Or Buccal",,40819,CPT,Facility,Inpatient,,,,469,398.65,134.4154,469,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Excision Of Frenum Labial, Or Buccal",,40819,CPT,Facility,Both,,,,469,398.65,134.4154,469,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,415.3933,88.57,,percent of total billed charges,,
"Excision Of Frenum Labial, Or Buccal",,40819,CPT,Facility,Both,,,,469,398.65,134.4154,469,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,134.4154,28.66,,percent of total billed charges,,
"Excision Of Frenum Labial, Or Buccal",,40819,CPT,Facility,Outpatient,,,,469,398.65,134.4154,469,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),229.81,49,,percent of total billed charges,,
"Excision Of Frenum Labial, Or Buccal",,40819,CPT,Facility,Inpatient,,,,469,398.65,134.4154,469,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Excision Of Frenum Labial, Or Buccal",,40819,CPT,Facility,Both,,,,469,398.65,134.4154,469,CorVel,Worker's Compensation,469,100,,percent of total billed charges,,
"Excision Of Frenum Labial, Or Buccal",,40819,CPT,Facility,Both,,,,469,398.65,134.4154,469,First Health Group Corporation,First Health Network,454.93,97,,percent of total billed charges,,
"Excision Of Frenum Labial, Or Buccal",,40819,CPT,Facility,Both,,,,469,398.65,134.4154,469,"Health Partners, Inc.",Commercial,443.674,94.6,,percent of total billed charges,,
"Excision Of Frenum Labial, Or Buccal",,40819,CPT,Facility,Outpatient,,,,469,398.65,134.4154,469,"Health Partners, Inc.",Medicare Advantage,229.81,49,,percent of total billed charges,,
"Excision Of Frenum Labial, Or Buccal",,40819,CPT,Facility,Inpatient,,,,469,398.65,134.4154,469,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Excision Of Frenum Labial, Or Buccal",,40819,CPT,Facility,Both,,,,469,398.65,134.4154,469,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),281.4,60,,percent of total billed charges,,
"Excision Of Frenum Labial, Or Buccal",,40819,CPT,Facility,Both,,,,469,398.65,134.4154,469,"Health Partners, Inc.",State of Minnesota Advantage Program,382.235,81.5,,percent of total billed charges,,
"Excision Of Frenum Labial, Or Buccal",,40819,CPT,Facility,Both,,,,469,398.65,134.4154,469,"Health Partners, Inc.",State Public Programs,234.5,50,,percent of total billed charges,,
"Excision Of Frenum Labial, Or Buccal",,40819,CPT,Facility,Both,,,,469,398.65,134.4154,469,Humana Insurance Company,Commercial PPO,445.55,95,,percent of total billed charges,,
"Excision Of Frenum Labial, Or Buccal",,40819,CPT,Facility,Outpatient,,,,469,398.65,134.4154,469,Humana Insurance Company,Medicare PPO,229.81,49,,percent of total billed charges,,
"Excision Of Frenum Labial, Or Buccal",,40819,CPT,Facility,Inpatient,,,,469,398.65,134.4154,469,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Excision Of Frenum Labial, Or Buccal",,40819,CPT,Facility,Both,,,,469,398.65,134.4154,469,Medica,Individual & Family,464.779,99.1,,percent of total billed charges,,
"Excision Of Frenum Labial, Or Buccal",,40819,CPT,Facility,Outpatient,,,,469,398.65,134.4154,469,Medica,Medica Advantage Solution,233.562,49.8,,percent of total billed charges,,
"Excision Of Frenum Labial, Or Buccal",,40819,CPT,Facility,Inpatient,,,,469,398.65,134.4154,469,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Excision Of Frenum Labial, Or Buccal",,40819,CPT,Facility,Outpatient,,,,469,398.65,134.4154,469,Medica,Medical Assistance,209.174,44.6,,percent of total billed charges,,
"Excision Of Frenum Labial, Or Buccal",,40819,CPT,Facility,Inpatient,,,,469,398.65,134.4154,469,Medica,Medical Assistance,,,,,Included in per diem rate,
"Excision Of Frenum Labial, Or Buccal",,40819,CPT,Facility,Outpatient,,,,469,398.65,134.4154,469,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,233.562,49.8,,percent of total billed charges,,
"Excision Of Frenum Labial, Or Buccal",,40819,CPT,Facility,Inpatient,,,,469,398.65,134.4154,469,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Excision Of Frenum Labial, Or Buccal",,40819,CPT,Facility,Both,,,,469,398.65,134.4154,469,"Multiplan, Inc.","Multiplan, Inc.",440.86,94,,percent of total billed charges,,
"Excision Of Frenum Labial, Or Buccal",,40819,CPT,Facility,Outpatient,,,,469,398.65,134.4154,469,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,422.569,90.1,,percent of total billed charges,,
"Excision Of Frenum Labial, Or Buccal",,40819,CPT,Facility,Inpatient,,,,469,398.65,134.4154,469,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Excision Of Frenum Labial, Or Buccal",,40819,CPT,Facility,Both,,,,469,398.65,134.4154,469,"Preferred One Administrative Services, INC.",PPO,462.434,98.6,,percent of total billed charges,,
"Excision Of Frenum Labial, Or Buccal",,40819,CPT,Facility,Outpatient,,,,469,398.65,134.4154,469,PrimeWest Health,Minnesota Senior Health Options (MSHO),241.3005,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Excision Of Frenum Labial, Or Buccal",,40819,CPT,Facility,Inpatient,,,,469,398.65,134.4154,469,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Excision Of Frenum Labial, Or Buccal",,40819,CPT,Facility,Outpatient,,,,469,398.65,134.4154,469,PrimeWest Health,MinnesotaCare,240.8784,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Excision Of Frenum Labial, Or Buccal",,40819,CPT,Facility,Inpatient,,,,469,398.65,134.4154,469,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Excision Of Frenum Labial, Or Buccal",,40819,CPT,Facility,Both,,,,469,398.65,134.4154,469,Sanford Health Plan,Sanford Health Plan,431.48,92,,percent of total billed charges,,
"Excision Of Frenum Labial, Or Buccal",,40819,CPT,Facility,Outpatient,,,,469,398.65,134.4154,469,"UCare Health, Inc.",Individual & Family Plan,264.2815,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Excision Of Frenum Labial, Or Buccal",,40819,CPT,Facility,Inpatient,,,,469,398.65,134.4154,469,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Excision Of Frenum Labial, Or Buccal",,40819,CPT,Facility,Outpatient,,,,469,398.65,134.4154,469,"UCare Health, Inc.",Medical Assistance,236.7043,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Excision Of Frenum Labial, Or Buccal",,40819,CPT,Facility,Inpatient,,,,469,398.65,134.4154,469,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Excision Of Frenum Labial, Or Buccal",,40819,CPT,Facility,Outpatient,,,,469,398.65,134.4154,469,"UCare Health, Inc.",Medicare Advantage,236.7043,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Excision Of Frenum Labial, Or Buccal",,40819,CPT,Facility,Inpatient,,,,469,398.65,134.4154,469,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Excision Of Frenum Labial, Or Buccal",,40819,CPT,Facility,Outpatient,,,,469,398.65,134.4154,469,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),236.7043,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Excision Of Frenum Labial, Or Buccal",,40819,CPT,Facility,Inpatient,,,,469,398.65,134.4154,469,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Excision Of Frenum Labial, Or Buccal",,40819,CPT,Facility,Both,,,,469,398.65,134.4154,469,UnitedHealthcare,Individual & Family,440.86,94,,percent of total billed charges,,
"Excision Of Frenum Labial, Or Buccal",,40819,CPT,Facility,Outpatient,,,,469,398.65,134.4154,469,UnitedHealthcare,Medicare Advantage,229.81,49,,percent of total billed charges,,
"Excision Of Frenum Labial, Or Buccal",,40819,CPT,Facility,Inpatient,,,,469,398.65,134.4154,469,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Excision Of Frenum Labial, Or Buccal",,40819,CPT,Facility,Outpatient,,,,469,398.65,134.4154,469,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,225.12,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Excision Of Frenum Labial, Or Buccal",,40819,CPT,Facility,Inpatient,,,,469,398.65,134.4154,469,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Excision Of Frenum, Labial Or Buccal (Frenumectomy, Frenulectomy, Frenectomy) (Pro Cah)",,40819,CPT,Professional,Both,,,,704,598.4,127.18,704,Aetna,Commercial,598.4,85,,percent of total billed charges,,
"Excision Of Frenum, Labial Or Buccal (Frenumectomy, Frenulectomy, Frenectomy) (Pro Cah)",,40819,CPT,Professional,Both,,,,704,598.4,127.18,704,Aetna,Medicare Advantage,202.92,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision Of Frenum, Labial Or Buccal (Frenumectomy, Frenulectomy, Frenectomy) (Pro Cah)",,40819,CPT,Professional,Both,,,,704,598.4,127.18,704,Aetna,PPO,654.72,93,,percent of total billed charges,,
"Excision Of Frenum, Labial Or Buccal (Frenumectomy, Frenulectomy, Frenectomy) (Pro Cah)",,40819,CPT,Professional,Both,,,,704,598.4,127.18,704,America's PPO,America's PPO,601.4976,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Excision Of Frenum, Labial Or Buccal (Frenumectomy, Frenulectomy, Frenectomy) (Pro Cah)",,40819,CPT,Professional,Both,,,,704,598.4,127.18,704,BlueCross BlueShield Minnesota, Federal Employee Program,408.34,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Excision Of Frenum, Labial Or Buccal (Frenumectomy, Frenulectomy, Frenectomy) (Pro Cah)",,40819,CPT,Professional,Both,,,,704,598.4,127.18,704,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,414.87344,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision Of Frenum, Labial Or Buccal (Frenumectomy, Frenulectomy, Frenectomy) (Pro Cah)",,40819,CPT,Professional,Both,,,,704,598.4,127.18,704,BlueCross BlueShield Minnesota,High Value Network Plan,414.87344,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision Of Frenum, Labial Or Buccal (Frenumectomy, Frenulectomy, Frenectomy) (Pro Cah)",,40819,CPT,Professional,Both,,,,704,598.4,127.18,704,BlueCross BlueShield Minnesota,Medicare Advantage,227.4125,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision Of Frenum, Labial Or Buccal (Frenumectomy, Frenulectomy, Frenectomy) (Pro Cah)",,40819,CPT,Professional,Both,,,,704,598.4,127.18,704,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,414.87344,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision Of Frenum, Labial Or Buccal (Frenumectomy, Frenulectomy, Frenectomy) (Pro Cah)",,40819,CPT,Professional,Both,,,,704,598.4,127.18,704,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,146.83232,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision Of Frenum, Labial Or Buccal (Frenumectomy, Frenulectomy, Frenectomy) (Pro Cah)",,40819,CPT,Professional,Both,,,,704,598.4,127.18,704,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),227.4125,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision Of Frenum, Labial Or Buccal (Frenumectomy, Frenulectomy, Frenectomy) (Pro Cah)",,40819,CPT,Professional,Both,,,,704,598.4,127.18,704,CorVel,Worker's Compensation,385.4275053,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Excision Of Frenum, Labial Or Buccal (Frenumectomy, Frenulectomy, Frenectomy) (Pro Cah)",,40819,CPT,Professional,Both,,,,704,598.4,127.18,704,First Health Group Corporation,First Health Network,682.88,97,,percent of total billed charges,,
"Excision Of Frenum, Labial Or Buccal (Frenumectomy, Frenulectomy, Frenectomy) (Pro Cah)",,40819,CPT,Professional,Both,,,,704,598.4,127.18,704,"Health Partners, Inc.",Commercial,416.45,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision Of Frenum, Labial Or Buccal (Frenumectomy, Frenulectomy, Frenectomy) (Pro Cah)",,40819,CPT,Professional,Both,,,,704,598.4,127.18,704,"Health Partners, Inc.",Medicare Advantage,227.4125,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision Of Frenum, Labial Or Buccal (Frenumectomy, Frenulectomy, Frenectomy) (Pro Cah)",,40819,CPT,Professional,Both,,,,704,598.4,127.18,704,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),197.56,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Excision Of Frenum, Labial Or Buccal (Frenumectomy, Frenulectomy, Frenectomy) (Pro Cah)",,40819,CPT,Professional,Both,,,,704,598.4,127.18,704,"Health Partners, Inc.",State of Minnesota Advantage Program,358.771675,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision Of Frenum, Labial Or Buccal (Frenumectomy, Frenulectomy, Frenectomy) (Pro Cah)",,40819,CPT,Professional,Both,,,,704,598.4,127.18,704,"Health Partners, Inc.",State Public Programs,127.18,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Excision Of Frenum, Labial Or Buccal (Frenumectomy, Frenulectomy, Frenectomy) (Pro Cah)",,40819,CPT,Professional,Both,,,,704,598.4,127.18,704,Humana Insurance Company,Commercial PPO,197.75,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Excision Of Frenum, Labial Or Buccal (Frenumectomy, Frenulectomy, Frenectomy) (Pro Cah)",,40819,CPT,Professional,Both,,,,704,598.4,127.18,704,Humana Insurance Company,Medicare PPO,704,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Excision Of Frenum, Labial Or Buccal (Frenumectomy, Frenulectomy, Frenectomy) (Pro Cah)",,40819,CPT,Professional,Both,,,,704,598.4,127.18,704,Medica,Individual & Family,596.992,84.8,,percent of total billed charges,,
"Excision Of Frenum, Labial Or Buccal (Frenumectomy, Frenulectomy, Frenectomy) (Pro Cah)",,40819,CPT,Professional,Both,,,,704,598.4,127.18,704,Medica,Medica Advantage Solution,350.592,49.8,,percent of total billed charges,,
"Excision Of Frenum, Labial Or Buccal (Frenumectomy, Frenulectomy, Frenectomy) (Pro Cah)",,40819,CPT,Professional,Both,,,,704,598.4,127.18,704,Medica,Medical Assistance,146.83,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Excision Of Frenum, Labial Or Buccal (Frenumectomy, Frenulectomy, Frenectomy) (Pro Cah)",,40819,CPT,Professional,Both,,,,704,598.4,127.18,704,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,197.75,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Excision Of Frenum, Labial Or Buccal (Frenumectomy, Frenulectomy, Frenectomy) (Pro Cah)",,40819,CPT,Professional,Both,,,,704,598.4,127.18,704,"Multiplan, Inc.","Multiplan, Inc.",661.76,94,,percent of total billed charges,,
"Excision Of Frenum, Labial Or Buccal (Frenumectomy, Frenulectomy, Frenectomy) (Pro Cah)",,40819,CPT,Professional,Both,,,,704,598.4,127.18,704,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,634.304,90.1,,percent of total billed charges,,
"Excision Of Frenum, Labial Or Buccal (Frenumectomy, Frenulectomy, Frenectomy) (Pro Cah)",,40819,CPT,Professional,Both,,,,704,598.4,127.18,704,"Preferred One Administrative Services, INC.",PPO,694.144,98.6,,percent of total billed charges,,
"Excision Of Frenum, Labial Or Buccal (Frenumectomy, Frenulectomy, Frenectomy) (Pro Cah)",,40819,CPT,Professional,Both,,,,704,598.4,127.18,704,PrimeWest Health,Minnesota Senior Health Options (MSHO),227.4125,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision Of Frenum, Labial Or Buccal (Frenumectomy, Frenulectomy, Frenectomy) (Pro Cah)",,40819,CPT,Professional,Both,,,,704,598.4,127.18,704,PrimeWest Health,MinnesotaCare,157.1105824,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision Of Frenum, Labial Or Buccal (Frenumectomy, Frenulectomy, Frenectomy) (Pro Cah)",,40819,CPT,Professional,Both,,,,704,598.4,127.18,704,Sanford Health Plan,Sanford Health Plan,619.52,88,,percent of total billed charges,,
"Excision Of Frenum, Labial Or Buccal (Frenumectomy, Frenulectomy, Frenectomy) (Pro Cah)",,40819,CPT,Professional,Both,,,,704,598.4,127.18,704,"UCare Health, Inc.",Individual & Family Plan,321.4624,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Excision Of Frenum, Labial Or Buccal (Frenumectomy, Frenulectomy, Frenectomy) (Pro Cah)",,40819,CPT,Professional,Both,,,,704,598.4,127.18,704,"UCare Health, Inc.",Medical Assistance,161.515552,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Excision Of Frenum, Labial Or Buccal (Frenumectomy, Frenulectomy, Frenectomy) (Pro Cah)",,40819,CPT,Professional,Both,,,,704,598.4,127.18,704,"UCare Health, Inc.",Medicare Advantage,227.4125,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Excision Of Frenum, Labial Or Buccal (Frenumectomy, Frenulectomy, Frenectomy) (Pro Cah)",,40819,CPT,Professional,Both,,,,704,598.4,127.18,704,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),181.93,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Excision Of Frenum, Labial Or Buccal (Frenumectomy, Frenulectomy, Frenectomy) (Pro Cah)",,40819,CPT,Professional,Both,,,,704,598.4,127.18,704,UnitedHealthcare,Individual & Family,704,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Excision Of Frenum, Labial Or Buccal (Frenumectomy, Frenulectomy, Frenectomy) (Pro Cah)",,40819,CPT,Professional,Both,,,,704,598.4,127.18,704,UnitedHealthcare,Medicare Advantage,227.4125,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision Of Frenum, Labial Or Buccal (Frenumectomy, Frenulectomy, Frenectomy) (Pro Cah)",,40819,CPT,Professional,Both,,,,704,598.4,127.18,704,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,146.83232,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Biopsy Of Floor Of Mouth (Pro Cah),,41108,CPT,Professional,Both,,,,357,303.45,58.03,357,Aetna,Commercial,303.45,85,,percent of total billed charges,,
Biopsy Of Floor Of Mouth (Pro Cah),,41108,CPT,Professional,Both,,,,357,303.45,58.03,357,Aetna,Medicare Advantage,90.07,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Biopsy Of Floor Of Mouth (Pro Cah),,41108,CPT,Professional,Both,,,,357,303.45,58.03,357,Aetna,PPO,332.01,93,,percent of total billed charges,,
Biopsy Of Floor Of Mouth (Pro Cah),,41108,CPT,Professional,Both,,,,357,303.45,58.03,357,America's PPO,America's PPO,305.0208,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Biopsy Of Floor Of Mouth (Pro Cah),,41108,CPT,Professional,Both,,,,357,303.45,58.03,357,BlueCross BlueShield Minnesota, Federal Employee Program,189.37,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Biopsy Of Floor Of Mouth (Pro Cah),,41108,CPT,Professional,Both,,,,357,303.45,58.03,357,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,192.39992,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Biopsy Of Floor Of Mouth (Pro Cah),,41108,CPT,Professional,Both,,,,357,303.45,58.03,357,BlueCross BlueShield Minnesota,High Value Network Plan,192.39992,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Biopsy Of Floor Of Mouth (Pro Cah),,41108,CPT,Professional,Both,,,,357,303.45,58.03,357,BlueCross BlueShield Minnesota,Medicare Advantage,103.799,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Biopsy Of Floor Of Mouth (Pro Cah),,41108,CPT,Professional,Both,,,,357,303.45,58.03,357,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,192.39992,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Biopsy Of Floor Of Mouth (Pro Cah),,41108,CPT,Professional,Both,,,,357,303.45,58.03,357,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,66.99504,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Biopsy Of Floor Of Mouth (Pro Cah),,41108,CPT,Professional,Both,,,,357,303.45,58.03,357,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),103.799,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Biopsy Of Floor Of Mouth (Pro Cah),,41108,CPT,Professional,Both,,,,357,303.45,58.03,357,CorVel,Worker's Compensation,173.8278996,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Biopsy Of Floor Of Mouth (Pro Cah),,41108,CPT,Professional,Both,,,,357,303.45,58.03,357,First Health Group Corporation,First Health Network,346.29,97,,percent of total billed charges,,
Biopsy Of Floor Of Mouth (Pro Cah),,41108,CPT,Professional,Both,,,,357,303.45,58.03,357,"Health Partners, Inc.",Commercial,187.91,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Biopsy Of Floor Of Mouth (Pro Cah),,41108,CPT,Professional,Both,,,,357,303.45,58.03,357,"Health Partners, Inc.",Medicare Advantage,103.799,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Biopsy Of Floor Of Mouth (Pro Cah),,41108,CPT,Professional,Both,,,,357,303.45,58.03,357,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),90.48,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Biopsy Of Floor Of Mouth (Pro Cah),,41108,CPT,Professional,Both,,,,357,303.45,58.03,357,"Health Partners, Inc.",State of Minnesota Advantage Program,161.884465,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Biopsy Of Floor Of Mouth (Pro Cah),,41108,CPT,Professional,Both,,,,357,303.45,58.03,357,"Health Partners, Inc.",State Public Programs,58.03,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Biopsy Of Floor Of Mouth (Pro Cah),,41108,CPT,Professional,Both,,,,357,303.45,58.03,357,Humana Insurance Company,Commercial PPO,90.26,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Biopsy Of Floor Of Mouth (Pro Cah),,41108,CPT,Professional,Both,,,,357,303.45,58.03,357,Humana Insurance Company,Medicare PPO,357,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Biopsy Of Floor Of Mouth (Pro Cah),,41108,CPT,Professional,Both,,,,357,303.45,58.03,357,Medica,Individual & Family,302.736,84.8,,percent of total billed charges,,
Biopsy Of Floor Of Mouth (Pro Cah),,41108,CPT,Professional,Both,,,,357,303.45,58.03,357,Medica,Medica Advantage Solution,177.786,49.8,,percent of total billed charges,,
Biopsy Of Floor Of Mouth (Pro Cah),,41108,CPT,Professional,Both,,,,357,303.45,58.03,357,Medica,Medical Assistance,67,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Biopsy Of Floor Of Mouth (Pro Cah),,41108,CPT,Professional,Both,,,,357,303.45,58.03,357,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,90.26,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Biopsy Of Floor Of Mouth (Pro Cah),,41108,CPT,Professional,Both,,,,357,303.45,58.03,357,"Multiplan, Inc.","Multiplan, Inc.",335.58,94,,percent of total billed charges,,
Biopsy Of Floor Of Mouth (Pro Cah),,41108,CPT,Professional,Both,,,,357,303.45,58.03,357,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,321.657,90.1,,percent of total billed charges,,
Biopsy Of Floor Of Mouth (Pro Cah),,41108,CPT,Professional,Both,,,,357,303.45,58.03,357,"Preferred One Administrative Services, INC.",PPO,352.002,98.6,,percent of total billed charges,,
Biopsy Of Floor Of Mouth (Pro Cah),,41108,CPT,Professional,Both,,,,357,303.45,58.03,357,PrimeWest Health,Minnesota Senior Health Options (MSHO),103.799,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Biopsy Of Floor Of Mouth (Pro Cah),,41108,CPT,Professional,Both,,,,357,303.45,58.03,357,PrimeWest Health,MinnesotaCare,71.6846928,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Biopsy Of Floor Of Mouth (Pro Cah),,41108,CPT,Professional,Both,,,,357,303.45,58.03,357,Sanford Health Plan,Sanford Health Plan,314.16,88,,percent of total billed charges,,
Biopsy Of Floor Of Mouth (Pro Cah),,41108,CPT,Professional,Both,,,,357,303.45,58.03,357,"UCare Health, Inc.",Individual & Family Plan,146.726656,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Biopsy Of Floor Of Mouth (Pro Cah),,41108,CPT,Professional,Both,,,,357,303.45,58.03,357,"UCare Health, Inc.",Medical Assistance,73.694544,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Biopsy Of Floor Of Mouth (Pro Cah),,41108,CPT,Professional,Both,,,,357,303.45,58.03,357,"UCare Health, Inc.",Medicare Advantage,103.799,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Biopsy Of Floor Of Mouth (Pro Cah),,41108,CPT,Professional,Both,,,,357,303.45,58.03,357,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),83.0392,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Biopsy Of Floor Of Mouth (Pro Cah),,41108,CPT,Professional,Both,,,,357,303.45,58.03,357,UnitedHealthcare,Individual & Family,357,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Biopsy Of Floor Of Mouth (Pro Cah),,41108,CPT,Professional,Both,,,,357,303.45,58.03,357,UnitedHealthcare,Medicare Advantage,103.799,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Biopsy Of Floor Of Mouth (Pro Cah),,41108,CPT,Professional,Both,,,,357,303.45,58.03,357,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,66.99504,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Palatopharyngoplasty (Eg, Uvulopalatopharyngoplasty, Uvulopharyngoplasty) (Pro Cah)",,42145,CPT,Professional,Both,,,,3060,2601,434.99,3060,Aetna,Commercial,2601,85,,percent of total billed charges,,
"Palatopharyngoplasty (Eg, Uvulopalatopharyngoplasty, Uvulopharyngoplasty) (Pro Cah)",,42145,CPT,Professional,Both,,,,3060,2601,434.99,3060,Aetna,Medicare Advantage,680.48,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Palatopharyngoplasty (Eg, Uvulopalatopharyngoplasty, Uvulopharyngoplasty) (Pro Cah)",,42145,CPT,Professional,Both,,,,3060,2601,434.99,3060,Aetna,PPO,2845.8,93,,percent of total billed charges,,
"Palatopharyngoplasty (Eg, Uvulopalatopharyngoplasty, Uvulopharyngoplasty) (Pro Cah)",,42145,CPT,Professional,Both,,,,3060,2601,434.99,3060,America's PPO,America's PPO,2614.464,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Palatopharyngoplasty (Eg, Uvulopalatopharyngoplasty, Uvulopharyngoplasty) (Pro Cah)",,42145,CPT,Professional,Both,,,,3060,2601,434.99,3060,BlueCross BlueShield Minnesota, Federal Employee Program,1424.71,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Palatopharyngoplasty (Eg, Uvulopalatopharyngoplasty, Uvulopharyngoplasty) (Pro Cah)",,42145,CPT,Professional,Both,,,,3060,2601,434.99,3060,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1447.50536,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Palatopharyngoplasty (Eg, Uvulopalatopharyngoplasty, Uvulopharyngoplasty) (Pro Cah)",,42145,CPT,Professional,Both,,,,3060,2601,434.99,3060,BlueCross BlueShield Minnesota,High Value Network Plan,1447.50536,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Palatopharyngoplasty (Eg, Uvulopalatopharyngoplasty, Uvulopharyngoplasty) (Pro Cah)",,42145,CPT,Professional,Both,,,,3060,2601,434.99,3060,BlueCross BlueShield Minnesota,Medicare Advantage,777.101,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Palatopharyngoplasty (Eg, Uvulopalatopharyngoplasty, Uvulopharyngoplasty) (Pro Cah)",,42145,CPT,Professional,Both,,,,3060,2601,434.99,3060,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1447.50536,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Palatopharyngoplasty (Eg, Uvulopalatopharyngoplasty, Uvulopharyngoplasty) (Pro Cah)",,42145,CPT,Professional,Both,,,,3060,2601,434.99,3060,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,502.21896,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Palatopharyngoplasty (Eg, Uvulopalatopharyngoplasty, Uvulopharyngoplasty) (Pro Cah)",,42145,CPT,Professional,Both,,,,3060,2601,434.99,3060,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),777.101,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Palatopharyngoplasty (Eg, Uvulopalatopharyngoplasty, Uvulopharyngoplasty) (Pro Cah)",,42145,CPT,Professional,Both,,,,3060,2601,434.99,3060,CorVel,Worker's Compensation,1319.280596,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Palatopharyngoplasty (Eg, Uvulopalatopharyngoplasty, Uvulopharyngoplasty) (Pro Cah)",,42145,CPT,Professional,Both,,,,3060,2601,434.99,3060,First Health Group Corporation,First Health Network,2968.2,97,,percent of total billed charges,,
"Palatopharyngoplasty (Eg, Uvulopalatopharyngoplasty, Uvulopharyngoplasty) (Pro Cah)",,42145,CPT,Professional,Both,,,,3060,2601,434.99,3060,"Health Partners, Inc.",Commercial,1424.93,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Palatopharyngoplasty (Eg, Uvulopalatopharyngoplasty, Uvulopharyngoplasty) (Pro Cah)",,42145,CPT,Professional,Both,,,,3060,2601,434.99,3060,"Health Partners, Inc.",Medicare Advantage,777.101,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Palatopharyngoplasty (Eg, Uvulopalatopharyngoplasty, Uvulopharyngoplasty) (Pro Cah)",,42145,CPT,Professional,Both,,,,3060,2601,434.99,3060,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),675.71,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Palatopharyngoplasty (Eg, Uvulopalatopharyngoplasty, Uvulopharyngoplasty) (Pro Cah)",,42145,CPT,Professional,Both,,,,3060,2601,434.99,3060,"Health Partners, Inc.",State of Minnesota Advantage Program,1227.577195,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Palatopharyngoplasty (Eg, Uvulopalatopharyngoplasty, Uvulopharyngoplasty) (Pro Cah)",,42145,CPT,Professional,Both,,,,3060,2601,434.99,3060,"Health Partners, Inc.",State Public Programs,434.99,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Palatopharyngoplasty (Eg, Uvulopalatopharyngoplasty, Uvulopharyngoplasty) (Pro Cah)",,42145,CPT,Professional,Both,,,,3060,2601,434.99,3060,Humana Insurance Company,Commercial PPO,675.74,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Palatopharyngoplasty (Eg, Uvulopalatopharyngoplasty, Uvulopharyngoplasty) (Pro Cah)",,42145,CPT,Professional,Both,,,,3060,2601,434.99,3060,Humana Insurance Company,Medicare PPO,3060,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Palatopharyngoplasty (Eg, Uvulopalatopharyngoplasty, Uvulopharyngoplasty) (Pro Cah)",,42145,CPT,Professional,Both,,,,3060,2601,434.99,3060,Medica,Individual & Family,2594.88,84.8,,percent of total billed charges,,
"Palatopharyngoplasty (Eg, Uvulopalatopharyngoplasty, Uvulopharyngoplasty) (Pro Cah)",,42145,CPT,Professional,Both,,,,3060,2601,434.99,3060,Medica,Medica Advantage Solution,1523.88,49.8,,percent of total billed charges,,
"Palatopharyngoplasty (Eg, Uvulopalatopharyngoplasty, Uvulopharyngoplasty) (Pro Cah)",,42145,CPT,Professional,Both,,,,3060,2601,434.99,3060,Medica,Medical Assistance,502.22,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Palatopharyngoplasty (Eg, Uvulopalatopharyngoplasty, Uvulopharyngoplasty) (Pro Cah)",,42145,CPT,Professional,Both,,,,3060,2601,434.99,3060,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,675.74,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Palatopharyngoplasty (Eg, Uvulopalatopharyngoplasty, Uvulopharyngoplasty) (Pro Cah)",,42145,CPT,Professional,Both,,,,3060,2601,434.99,3060,"Multiplan, Inc.","Multiplan, Inc.",2876.4,94,,percent of total billed charges,,
"Palatopharyngoplasty (Eg, Uvulopalatopharyngoplasty, Uvulopharyngoplasty) (Pro Cah)",,42145,CPT,Professional,Both,,,,3060,2601,434.99,3060,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,2757.06,90.1,,percent of total billed charges,,
"Palatopharyngoplasty (Eg, Uvulopalatopharyngoplasty, Uvulopharyngoplasty) (Pro Cah)",,42145,CPT,Professional,Both,,,,3060,2601,434.99,3060,"Preferred One Administrative Services, INC.",PPO,3017.16,98.6,,percent of total billed charges,,
"Palatopharyngoplasty (Eg, Uvulopalatopharyngoplasty, Uvulopharyngoplasty) (Pro Cah)",,42145,CPT,Professional,Both,,,,3060,2601,434.99,3060,PrimeWest Health,Minnesota Senior Health Options (MSHO),777.101,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Palatopharyngoplasty (Eg, Uvulopalatopharyngoplasty, Uvulopharyngoplasty) (Pro Cah)",,42145,CPT,Professional,Both,,,,3060,2601,434.99,3060,PrimeWest Health,MinnesotaCare,537.3742872,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Palatopharyngoplasty (Eg, Uvulopalatopharyngoplasty, Uvulopharyngoplasty) (Pro Cah)",,42145,CPT,Professional,Both,,,,3060,2601,434.99,3060,Sanford Health Plan,Sanford Health Plan,2692.8,88,,percent of total billed charges,,
"Palatopharyngoplasty (Eg, Uvulopalatopharyngoplasty, Uvulopharyngoplasty) (Pro Cah)",,42145,CPT,Professional,Both,,,,3060,2601,434.99,3060,"UCare Health, Inc.",Individual & Family Plan,1098.482944,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Palatopharyngoplasty (Eg, Uvulopalatopharyngoplasty, Uvulopharyngoplasty) (Pro Cah)",,42145,CPT,Professional,Both,,,,3060,2601,434.99,3060,"UCare Health, Inc.",Medical Assistance,552.440856,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Palatopharyngoplasty (Eg, Uvulopalatopharyngoplasty, Uvulopharyngoplasty) (Pro Cah)",,42145,CPT,Professional,Both,,,,3060,2601,434.99,3060,"UCare Health, Inc.",Medicare Advantage,777.101,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Palatopharyngoplasty (Eg, Uvulopalatopharyngoplasty, Uvulopharyngoplasty) (Pro Cah)",,42145,CPT,Professional,Both,,,,3060,2601,434.99,3060,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),621.6808,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Palatopharyngoplasty (Eg, Uvulopalatopharyngoplasty, Uvulopharyngoplasty) (Pro Cah)",,42145,CPT,Professional,Both,,,,3060,2601,434.99,3060,UnitedHealthcare,Individual & Family,3060,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Palatopharyngoplasty (Eg, Uvulopalatopharyngoplasty, Uvulopharyngoplasty) (Pro Cah)",,42145,CPT,Professional,Both,,,,3060,2601,434.99,3060,UnitedHealthcare,Medicare Advantage,777.101,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Palatopharyngoplasty (Eg, Uvulopalatopharyngoplasty, Uvulopharyngoplasty) (Pro Cah)",,42145,CPT,Professional,Both,,,,3060,2601,434.99,3060,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,502.21896,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Excision Of Submandibular (Submaxillary) Gland (Pro Cah),,42440,CPT,Professional,Both,,,,2616,2223.6,261.99,2616,Aetna,Commercial,2223.6,85,,percent of total billed charges,,
Excision Of Submandibular (Submaxillary) Gland (Pro Cah),,42440,CPT,Professional,Both,,,,2616,2223.6,261.99,2616,Aetna,Medicare Advantage,403.69,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Excision Of Submandibular (Submaxillary) Gland (Pro Cah),,42440,CPT,Professional,Both,,,,2616,2223.6,261.99,2616,Aetna,PPO,2432.88,93,,percent of total billed charges,,
Excision Of Submandibular (Submaxillary) Gland (Pro Cah),,42440,CPT,Professional,Both,,,,2616,2223.6,261.99,2616,America's PPO,America's PPO,2235.1104,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Excision Of Submandibular (Submaxillary) Gland (Pro Cah),,42440,CPT,Professional,Both,,,,2616,2223.6,261.99,2616,BlueCross BlueShield Minnesota, Federal Employee Program,862.13,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Excision Of Submandibular (Submaxillary) Gland (Pro Cah),,42440,CPT,Professional,Both,,,,2616,2223.6,261.99,2616,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,875.92408,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Excision Of Submandibular (Submaxillary) Gland (Pro Cah),,42440,CPT,Professional,Both,,,,2616,2223.6,261.99,2616,BlueCross BlueShield Minnesota,High Value Network Plan,875.92408,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Excision Of Submandibular (Submaxillary) Gland (Pro Cah),,42440,CPT,Professional,Both,,,,2616,2223.6,261.99,2616,BlueCross BlueShield Minnesota,Medicare Advantage,468.326,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Excision Of Submandibular (Submaxillary) Gland (Pro Cah),,42440,CPT,Professional,Both,,,,2616,2223.6,261.99,2616,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,875.92408,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Excision Of Submandibular (Submaxillary) Gland (Pro Cah),,42440,CPT,Professional,Both,,,,2616,2223.6,261.99,2616,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,302.48352,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Excision Of Submandibular (Submaxillary) Gland (Pro Cah),,42440,CPT,Professional,Both,,,,2616,2223.6,261.99,2616,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),468.326,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Excision Of Submandibular (Submaxillary) Gland (Pro Cah),,42440,CPT,Professional,Both,,,,2616,2223.6,261.99,2616,CorVel,Worker's Compensation,792.1143156,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Excision Of Submandibular (Submaxillary) Gland (Pro Cah),,42440,CPT,Professional,Both,,,,2616,2223.6,261.99,2616,First Health Group Corporation,First Health Network,2537.52,97,,percent of total billed charges,,
Excision Of Submandibular (Submaxillary) Gland (Pro Cah),,42440,CPT,Professional,Both,,,,2616,2223.6,261.99,2616,"Health Partners, Inc.",Commercial,855.39,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Excision Of Submandibular (Submaxillary) Gland (Pro Cah),,42440,CPT,Professional,Both,,,,2616,2223.6,261.99,2616,"Health Partners, Inc.",Medicare Advantage,468.326,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Excision Of Submandibular (Submaxillary) Gland (Pro Cah),,42440,CPT,Professional,Both,,,,2616,2223.6,261.99,2616,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),406.99,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Excision Of Submandibular (Submaxillary) Gland (Pro Cah),,42440,CPT,Professional,Both,,,,2616,2223.6,261.99,2616,"Health Partners, Inc.",State of Minnesota Advantage Program,736.918485,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Excision Of Submandibular (Submaxillary) Gland (Pro Cah),,42440,CPT,Professional,Both,,,,2616,2223.6,261.99,2616,"Health Partners, Inc.",State Public Programs,261.99,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Excision Of Submandibular (Submaxillary) Gland (Pro Cah),,42440,CPT,Professional,Both,,,,2616,2223.6,261.99,2616,Humana Insurance Company,Commercial PPO,407.24,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Excision Of Submandibular (Submaxillary) Gland (Pro Cah),,42440,CPT,Professional,Both,,,,2616,2223.6,261.99,2616,Humana Insurance Company,Medicare PPO,2616,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Excision Of Submandibular (Submaxillary) Gland (Pro Cah),,42440,CPT,Professional,Both,,,,2616,2223.6,261.99,2616,Medica,Individual & Family,2218.368,84.8,,percent of total billed charges,,
Excision Of Submandibular (Submaxillary) Gland (Pro Cah),,42440,CPT,Professional,Both,,,,2616,2223.6,261.99,2616,Medica,Medica Advantage Solution,1302.768,49.8,,percent of total billed charges,,
Excision Of Submandibular (Submaxillary) Gland (Pro Cah),,42440,CPT,Professional,Both,,,,2616,2223.6,261.99,2616,Medica,Medical Assistance,302.48,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Excision Of Submandibular (Submaxillary) Gland (Pro Cah),,42440,CPT,Professional,Both,,,,2616,2223.6,261.99,2616,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,407.24,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Excision Of Submandibular (Submaxillary) Gland (Pro Cah),,42440,CPT,Professional,Both,,,,2616,2223.6,261.99,2616,"Multiplan, Inc.","Multiplan, Inc.",2459.04,94,,percent of total billed charges,,
Excision Of Submandibular (Submaxillary) Gland (Pro Cah),,42440,CPT,Professional,Both,,,,2616,2223.6,261.99,2616,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,2357.016,90.1,,percent of total billed charges,,
Excision Of Submandibular (Submaxillary) Gland (Pro Cah),,42440,CPT,Professional,Both,,,,2616,2223.6,261.99,2616,"Preferred One Administrative Services, INC.",PPO,2579.376,98.6,,percent of total billed charges,,
Excision Of Submandibular (Submaxillary) Gland (Pro Cah),,42440,CPT,Professional,Both,,,,2616,2223.6,261.99,2616,PrimeWest Health,Minnesota Senior Health Options (MSHO),468.326,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Excision Of Submandibular (Submaxillary) Gland (Pro Cah),,42440,CPT,Professional,Both,,,,2616,2223.6,261.99,2616,PrimeWest Health,MinnesotaCare,323.6573664,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Excision Of Submandibular (Submaxillary) Gland (Pro Cah),,42440,CPT,Professional,Both,,,,2616,2223.6,261.99,2616,Sanford Health Plan,Sanford Health Plan,2302.08,88,,percent of total billed charges,,
Excision Of Submandibular (Submaxillary) Gland (Pro Cah),,42440,CPT,Professional,Both,,,,2616,2223.6,261.99,2616,"UCare Health, Inc.",Individual & Family Plan,662.009344,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Excision Of Submandibular (Submaxillary) Gland (Pro Cah),,42440,CPT,Professional,Both,,,,2616,2223.6,261.99,2616,"UCare Health, Inc.",Medical Assistance,332.731872,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Excision Of Submandibular (Submaxillary) Gland (Pro Cah),,42440,CPT,Professional,Both,,,,2616,2223.6,261.99,2616,"UCare Health, Inc.",Medicare Advantage,468.326,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Excision Of Submandibular (Submaxillary) Gland (Pro Cah),,42440,CPT,Professional,Both,,,,2616,2223.6,261.99,2616,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),374.6608,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Excision Of Submandibular (Submaxillary) Gland (Pro Cah),,42440,CPT,Professional,Both,,,,2616,2223.6,261.99,2616,UnitedHealthcare,Individual & Family,2616,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Excision Of Submandibular (Submaxillary) Gland (Pro Cah),,42440,CPT,Professional,Both,,,,2616,2223.6,261.99,2616,UnitedHealthcare,Medicare Advantage,468.326,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Excision Of Submandibular (Submaxillary) Gland (Pro Cah),,42440,CPT,Professional,Both,,,,2616,2223.6,261.99,2616,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,302.48352,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Biopsy; Nasopharynx, Visible Lesion, Simple (Pro Cah)",,42804,CPT,Professional,Both,,,,408,346.8,78.75,408,Aetna,Commercial,346.8,85,,percent of total billed charges,,
"Biopsy; Nasopharynx, Visible Lesion, Simple (Pro Cah)",,42804,CPT,Professional,Both,,,,408,346.8,78.75,408,Aetna,Medicare Advantage,117.09,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Biopsy; Nasopharynx, Visible Lesion, Simple (Pro Cah)",,42804,CPT,Professional,Both,,,,408,346.8,78.75,408,Aetna,PPO,379.44,93,,percent of total billed charges,,
"Biopsy; Nasopharynx, Visible Lesion, Simple (Pro Cah)",,42804,CPT,Professional,Both,,,,408,346.8,78.75,408,America's PPO,America's PPO,348.5952,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Biopsy; Nasopharynx, Visible Lesion, Simple (Pro Cah)",,42804,CPT,Professional,Both,,,,408,346.8,78.75,408,BlueCross BlueShield Minnesota, Federal Employee Program,254.78,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Biopsy; Nasopharynx, Visible Lesion, Simple (Pro Cah)",,42804,CPT,Professional,Both,,,,408,346.8,78.75,408,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,258.85648,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Biopsy; Nasopharynx, Visible Lesion, Simple (Pro Cah)",,42804,CPT,Professional,Both,,,,408,346.8,78.75,408,BlueCross BlueShield Minnesota,High Value Network Plan,258.85648,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Biopsy; Nasopharynx, Visible Lesion, Simple (Pro Cah)",,42804,CPT,Professional,Both,,,,408,346.8,78.75,408,BlueCross BlueShield Minnesota,Medicare Advantage,140.8405,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Biopsy; Nasopharynx, Visible Lesion, Simple (Pro Cah)",,42804,CPT,Professional,Both,,,,408,346.8,78.75,408,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,258.85648,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Biopsy; Nasopharynx, Visible Lesion, Simple (Pro Cah)",,42804,CPT,Professional,Both,,,,408,346.8,78.75,408,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,90.92184,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Biopsy; Nasopharynx, Visible Lesion, Simple (Pro Cah)",,42804,CPT,Professional,Both,,,,408,346.8,78.75,408,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),140.8405,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Biopsy; Nasopharynx, Visible Lesion, Simple (Pro Cah)",,42804,CPT,Professional,Both,,,,408,346.8,78.75,408,CorVel,Worker's Compensation,237.0039714,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Biopsy; Nasopharynx, Visible Lesion, Simple (Pro Cah)",,42804,CPT,Professional,Both,,,,408,346.8,78.75,408,First Health Group Corporation,First Health Network,395.76,97,,percent of total billed charges,,
"Biopsy; Nasopharynx, Visible Lesion, Simple (Pro Cah)",,42804,CPT,Professional,Both,,,,408,346.8,78.75,408,"Health Partners, Inc.",Commercial,256.11,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Biopsy; Nasopharynx, Visible Lesion, Simple (Pro Cah)",,42804,CPT,Professional,Both,,,,408,346.8,78.75,408,"Health Partners, Inc.",Medicare Advantage,140.8405,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Biopsy; Nasopharynx, Visible Lesion, Simple (Pro Cah)",,42804,CPT,Professional,Both,,,,408,346.8,78.75,408,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),122.33,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Biopsy; Nasopharynx, Visible Lesion, Simple (Pro Cah)",,42804,CPT,Professional,Both,,,,408,346.8,78.75,408,"Health Partners, Inc.",State of Minnesota Advantage Program,220.638765,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Biopsy; Nasopharynx, Visible Lesion, Simple (Pro Cah)",,42804,CPT,Professional,Both,,,,408,346.8,78.75,408,"Health Partners, Inc.",State Public Programs,78.75,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Biopsy; Nasopharynx, Visible Lesion, Simple (Pro Cah)",,42804,CPT,Professional,Both,,,,408,346.8,78.75,408,Humana Insurance Company,Commercial PPO,122.47,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Biopsy; Nasopharynx, Visible Lesion, Simple (Pro Cah)",,42804,CPT,Professional,Both,,,,408,346.8,78.75,408,Humana Insurance Company,Medicare PPO,408,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Biopsy; Nasopharynx, Visible Lesion, Simple (Pro Cah)",,42804,CPT,Professional,Both,,,,408,346.8,78.75,408,Medica,Individual & Family,345.984,84.8,,percent of total billed charges,,
"Biopsy; Nasopharynx, Visible Lesion, Simple (Pro Cah)",,42804,CPT,Professional,Both,,,,408,346.8,78.75,408,Medica,Medica Advantage Solution,203.184,49.8,,percent of total billed charges,,
"Biopsy; Nasopharynx, Visible Lesion, Simple (Pro Cah)",,42804,CPT,Professional,Both,,,,408,346.8,78.75,408,Medica,Medical Assistance,90.92,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Biopsy; Nasopharynx, Visible Lesion, Simple (Pro Cah)",,42804,CPT,Professional,Both,,,,408,346.8,78.75,408,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,122.47,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Biopsy; Nasopharynx, Visible Lesion, Simple (Pro Cah)",,42804,CPT,Professional,Both,,,,408,346.8,78.75,408,"Multiplan, Inc.","Multiplan, Inc.",383.52,94,,percent of total billed charges,,
"Biopsy; Nasopharynx, Visible Lesion, Simple (Pro Cah)",,42804,CPT,Professional,Both,,,,408,346.8,78.75,408,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,367.608,90.1,,percent of total billed charges,,
"Biopsy; Nasopharynx, Visible Lesion, Simple (Pro Cah)",,42804,CPT,Professional,Both,,,,408,346.8,78.75,408,"Preferred One Administrative Services, INC.",PPO,402.288,98.6,,percent of total billed charges,,
"Biopsy; Nasopharynx, Visible Lesion, Simple (Pro Cah)",,42804,CPT,Professional,Both,,,,408,346.8,78.75,408,PrimeWest Health,Minnesota Senior Health Options (MSHO),140.8405,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Biopsy; Nasopharynx, Visible Lesion, Simple (Pro Cah)",,42804,CPT,Professional,Both,,,,408,346.8,78.75,408,PrimeWest Health,MinnesotaCare,97.2863688,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Biopsy; Nasopharynx, Visible Lesion, Simple (Pro Cah)",,42804,CPT,Professional,Both,,,,408,346.8,78.75,408,Sanford Health Plan,Sanford Health Plan,359.04,88,,percent of total billed charges,,
"Biopsy; Nasopharynx, Visible Lesion, Simple (Pro Cah)",,42804,CPT,Professional,Both,,,,408,346.8,78.75,408,"UCare Health, Inc.",Individual & Family Plan,199.087232,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Biopsy; Nasopharynx, Visible Lesion, Simple (Pro Cah)",,42804,CPT,Professional,Both,,,,408,346.8,78.75,408,"UCare Health, Inc.",Medical Assistance,100.014024,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Biopsy; Nasopharynx, Visible Lesion, Simple (Pro Cah)",,42804,CPT,Professional,Both,,,,408,346.8,78.75,408,"UCare Health, Inc.",Medicare Advantage,140.8405,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Biopsy; Nasopharynx, Visible Lesion, Simple (Pro Cah)",,42804,CPT,Professional,Both,,,,408,346.8,78.75,408,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),112.6724,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Biopsy; Nasopharynx, Visible Lesion, Simple (Pro Cah)",,42804,CPT,Professional,Both,,,,408,346.8,78.75,408,UnitedHealthcare,Individual & Family,408,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Biopsy; Nasopharynx, Visible Lesion, Simple (Pro Cah)",,42804,CPT,Professional,Both,,,,408,346.8,78.75,408,UnitedHealthcare,Medicare Advantage,140.8405,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Biopsy; Nasopharynx, Visible Lesion, Simple (Pro Cah)",,42804,CPT,Professional,Both,,,,408,346.8,78.75,408,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,90.92184,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Tonsillectomy And Adenoidectomy; Younger Than Age 12 (Pro Cah),,42820,CPT,Professional,Both,,,,1071,910.35,183.89,1071,Aetna,Commercial,910.35,85,,percent of total billed charges,,
Tonsillectomy And Adenoidectomy; Younger Than Age 12 (Pro Cah),,42820,CPT,Professional,Both,,,,1071,910.35,183.89,1071,Aetna,Medicare Advantage,282.82,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Tonsillectomy And Adenoidectomy; Younger Than Age 12 (Pro Cah),,42820,CPT,Professional,Both,,,,1071,910.35,183.89,1071,Aetna,PPO,996.03,93,,percent of total billed charges,,
Tonsillectomy And Adenoidectomy; Younger Than Age 12 (Pro Cah),,42820,CPT,Professional,Both,,,,1071,910.35,183.89,1071,America's PPO,America's PPO,915.0624,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Tonsillectomy And Adenoidectomy; Younger Than Age 12 (Pro Cah),,42820,CPT,Professional,Both,,,,1071,910.35,183.89,1071,BlueCross BlueShield Minnesota, Federal Employee Program,603.21,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Tonsillectomy And Adenoidectomy; Younger Than Age 12 (Pro Cah),,42820,CPT,Professional,Both,,,,1071,910.35,183.89,1071,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,612.86136,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Tonsillectomy And Adenoidectomy; Younger Than Age 12 (Pro Cah),,42820,CPT,Professional,Both,,,,1071,910.35,183.89,1071,BlueCross BlueShield Minnesota,High Value Network Plan,612.86136,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Tonsillectomy And Adenoidectomy; Younger Than Age 12 (Pro Cah),,42820,CPT,Professional,Both,,,,1071,910.35,183.89,1071,BlueCross BlueShield Minnesota,Medicare Advantage,328.808,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Tonsillectomy And Adenoidectomy; Younger Than Age 12 (Pro Cah),,42820,CPT,Professional,Both,,,,1071,910.35,183.89,1071,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,612.86136,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Tonsillectomy And Adenoidectomy; Younger Than Age 12 (Pro Cah),,42820,CPT,Professional,Both,,,,1071,910.35,183.89,1071,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,212.31352,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Tonsillectomy And Adenoidectomy; Younger Than Age 12 (Pro Cah),,42820,CPT,Professional,Both,,,,1071,910.35,183.89,1071,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),328.808,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Tonsillectomy And Adenoidectomy; Younger Than Age 12 (Pro Cah),,42820,CPT,Professional,Both,,,,1071,910.35,183.89,1071,CorVel,Worker's Compensation,555.5677719,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Tonsillectomy And Adenoidectomy; Younger Than Age 12 (Pro Cah),,42820,CPT,Professional,Both,,,,1071,910.35,183.89,1071,First Health Group Corporation,First Health Network,1038.87,97,,percent of total billed charges,,
Tonsillectomy And Adenoidectomy; Younger Than Age 12 (Pro Cah),,42820,CPT,Professional,Both,,,,1071,910.35,183.89,1071,"Health Partners, Inc.",Commercial,600.01,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Tonsillectomy And Adenoidectomy; Younger Than Age 12 (Pro Cah),,42820,CPT,Professional,Both,,,,1071,910.35,183.89,1071,"Health Partners, Inc.",Medicare Advantage,328.808,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Tonsillectomy And Adenoidectomy; Younger Than Age 12 (Pro Cah),,42820,CPT,Professional,Both,,,,1071,910.35,183.89,1071,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),286.01,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Tonsillectomy And Adenoidectomy; Younger Than Age 12 (Pro Cah),,42820,CPT,Professional,Both,,,,1071,910.35,183.89,1071,"Health Partners, Inc.",State of Minnesota Advantage Program,516.908615,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Tonsillectomy And Adenoidectomy; Younger Than Age 12 (Pro Cah),,42820,CPT,Professional,Both,,,,1071,910.35,183.89,1071,"Health Partners, Inc.",State Public Programs,183.89,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Tonsillectomy And Adenoidectomy; Younger Than Age 12 (Pro Cah),,42820,CPT,Professional,Both,,,,1071,910.35,183.89,1071,Humana Insurance Company,Commercial PPO,285.92,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Tonsillectomy And Adenoidectomy; Younger Than Age 12 (Pro Cah),,42820,CPT,Professional,Both,,,,1071,910.35,183.89,1071,Humana Insurance Company,Medicare PPO,1071,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Tonsillectomy And Adenoidectomy; Younger Than Age 12 (Pro Cah),,42820,CPT,Professional,Both,,,,1071,910.35,183.89,1071,Medica,Individual & Family,908.208,84.8,,percent of total billed charges,,
Tonsillectomy And Adenoidectomy; Younger Than Age 12 (Pro Cah),,42820,CPT,Professional,Both,,,,1071,910.35,183.89,1071,Medica,Medica Advantage Solution,533.358,49.8,,percent of total billed charges,,
Tonsillectomy And Adenoidectomy; Younger Than Age 12 (Pro Cah),,42820,CPT,Professional,Both,,,,1071,910.35,183.89,1071,Medica,Medical Assistance,212.31,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Tonsillectomy And Adenoidectomy; Younger Than Age 12 (Pro Cah),,42820,CPT,Professional,Both,,,,1071,910.35,183.89,1071,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,285.92,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Tonsillectomy And Adenoidectomy; Younger Than Age 12 (Pro Cah),,42820,CPT,Professional,Both,,,,1071,910.35,183.89,1071,"Multiplan, Inc.","Multiplan, Inc.",1006.74,94,,percent of total billed charges,,
Tonsillectomy And Adenoidectomy; Younger Than Age 12 (Pro Cah),,42820,CPT,Professional,Both,,,,1071,910.35,183.89,1071,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,964.971,90.1,,percent of total billed charges,,
Tonsillectomy And Adenoidectomy; Younger Than Age 12 (Pro Cah),,42820,CPT,Professional,Both,,,,1071,910.35,183.89,1071,"Preferred One Administrative Services, INC.",PPO,1056.006,98.6,,percent of total billed charges,,
Tonsillectomy And Adenoidectomy; Younger Than Age 12 (Pro Cah),,42820,CPT,Professional,Both,,,,1071,910.35,183.89,1071,PrimeWest Health,Minnesota Senior Health Options (MSHO),328.808,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Tonsillectomy And Adenoidectomy; Younger Than Age 12 (Pro Cah),,42820,CPT,Professional,Both,,,,1071,910.35,183.89,1071,PrimeWest Health,MinnesotaCare,227.1754664,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Tonsillectomy And Adenoidectomy; Younger Than Age 12 (Pro Cah),,42820,CPT,Professional,Both,,,,1071,910.35,183.89,1071,Sanford Health Plan,Sanford Health Plan,942.48,88,,percent of total billed charges,,
Tonsillectomy And Adenoidectomy; Younger Than Age 12 (Pro Cah),,42820,CPT,Professional,Both,,,,1071,910.35,183.89,1071,"UCare Health, Inc.",Individual & Family Plan,464.791552,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Tonsillectomy And Adenoidectomy; Younger Than Age 12 (Pro Cah),,42820,CPT,Professional,Both,,,,1071,910.35,183.89,1071,"UCare Health, Inc.",Medical Assistance,233.544872,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Tonsillectomy And Adenoidectomy; Younger Than Age 12 (Pro Cah),,42820,CPT,Professional,Both,,,,1071,910.35,183.89,1071,"UCare Health, Inc.",Medicare Advantage,328.808,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Tonsillectomy And Adenoidectomy; Younger Than Age 12 (Pro Cah),,42820,CPT,Professional,Both,,,,1071,910.35,183.89,1071,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),263.0464,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Tonsillectomy And Adenoidectomy; Younger Than Age 12 (Pro Cah),,42820,CPT,Professional,Both,,,,1071,910.35,183.89,1071,UnitedHealthcare,Individual & Family,1071,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Tonsillectomy And Adenoidectomy; Younger Than Age 12 (Pro Cah),,42820,CPT,Professional,Both,,,,1071,910.35,183.89,1071,UnitedHealthcare,Medicare Advantage,328.808,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Tonsillectomy And Adenoidectomy; Younger Than Age 12 (Pro Cah),,42820,CPT,Professional,Both,,,,1071,910.35,183.89,1071,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,212.31352,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Tonsillectomy And Adenoidectomy; Age 12 Or Over (Pro Cah),,42821,CPT,Professional,Both,,,,1224,1040.4,192.4,1224,Aetna,Commercial,1040.4,85,,percent of total billed charges,,
Tonsillectomy And Adenoidectomy; Age 12 Or Over (Pro Cah),,42821,CPT,Professional,Both,,,,1224,1040.4,192.4,1224,Aetna,Medicare Advantage,295.73,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Tonsillectomy And Adenoidectomy; Age 12 Or Over (Pro Cah),,42821,CPT,Professional,Both,,,,1224,1040.4,192.4,1224,Aetna,PPO,1138.32,93,,percent of total billed charges,,
Tonsillectomy And Adenoidectomy; Age 12 Or Over (Pro Cah),,42821,CPT,Professional,Both,,,,1224,1040.4,192.4,1224,America's PPO,America's PPO,1045.7856,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Tonsillectomy And Adenoidectomy; Age 12 Or Over (Pro Cah),,42821,CPT,Professional,Both,,,,1224,1040.4,192.4,1224,BlueCross BlueShield Minnesota, Federal Employee Program,632.13,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Tonsillectomy And Adenoidectomy; Age 12 Or Over (Pro Cah),,42821,CPT,Professional,Both,,,,1224,1040.4,192.4,1224,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,642.24408,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Tonsillectomy And Adenoidectomy; Age 12 Or Over (Pro Cah),,42821,CPT,Professional,Both,,,,1224,1040.4,192.4,1224,BlueCross BlueShield Minnesota,High Value Network Plan,642.24408,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Tonsillectomy And Adenoidectomy; Age 12 Or Over (Pro Cah),,42821,CPT,Professional,Both,,,,1224,1040.4,192.4,1224,BlueCross BlueShield Minnesota,Medicare Advantage,344.034,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Tonsillectomy And Adenoidectomy; Age 12 Or Over (Pro Cah),,42821,CPT,Professional,Both,,,,1224,1040.4,192.4,1224,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,642.24408,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Tonsillectomy And Adenoidectomy; Age 12 Or Over (Pro Cah),,42821,CPT,Professional,Both,,,,1224,1040.4,192.4,1224,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,222.13824,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Tonsillectomy And Adenoidectomy; Age 12 Or Over (Pro Cah),,42821,CPT,Professional,Both,,,,1224,1040.4,192.4,1224,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),344.034,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Tonsillectomy And Adenoidectomy; Age 12 Or Over (Pro Cah),,42821,CPT,Professional,Both,,,,1224,1040.4,192.4,1224,CorVel,Worker's Compensation,580.8586203,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Tonsillectomy And Adenoidectomy; Age 12 Or Over (Pro Cah),,42821,CPT,Professional,Both,,,,1224,1040.4,192.4,1224,First Health Group Corporation,First Health Network,1187.28,97,,percent of total billed charges,,
Tonsillectomy And Adenoidectomy; Age 12 Or Over (Pro Cah),,42821,CPT,Professional,Both,,,,1224,1040.4,192.4,1224,"Health Partners, Inc.",Commercial,627.58,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Tonsillectomy And Adenoidectomy; Age 12 Or Over (Pro Cah),,42821,CPT,Professional,Both,,,,1224,1040.4,192.4,1224,"Health Partners, Inc.",Medicare Advantage,344.034,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Tonsillectomy And Adenoidectomy; Age 12 Or Over (Pro Cah),,42821,CPT,Professional,Both,,,,1224,1040.4,192.4,1224,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),299.22,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Tonsillectomy And Adenoidectomy; Age 12 Or Over (Pro Cah),,42821,CPT,Professional,Both,,,,1224,1040.4,192.4,1224,"Health Partners, Inc.",State of Minnesota Advantage Program,540.66017,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Tonsillectomy And Adenoidectomy; Age 12 Or Over (Pro Cah),,42821,CPT,Professional,Both,,,,1224,1040.4,192.4,1224,"Health Partners, Inc.",State Public Programs,192.4,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Tonsillectomy And Adenoidectomy; Age 12 Or Over (Pro Cah),,42821,CPT,Professional,Both,,,,1224,1040.4,192.4,1224,Humana Insurance Company,Commercial PPO,299.16,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Tonsillectomy And Adenoidectomy; Age 12 Or Over (Pro Cah),,42821,CPT,Professional,Both,,,,1224,1040.4,192.4,1224,Humana Insurance Company,Medicare PPO,1224,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Tonsillectomy And Adenoidectomy; Age 12 Or Over (Pro Cah),,42821,CPT,Professional,Both,,,,1224,1040.4,192.4,1224,Medica,Individual & Family,1037.952,84.8,,percent of total billed charges,,
Tonsillectomy And Adenoidectomy; Age 12 Or Over (Pro Cah),,42821,CPT,Professional,Both,,,,1224,1040.4,192.4,1224,Medica,Medica Advantage Solution,609.552,49.8,,percent of total billed charges,,
Tonsillectomy And Adenoidectomy; Age 12 Or Over (Pro Cah),,42821,CPT,Professional,Both,,,,1224,1040.4,192.4,1224,Medica,Medical Assistance,222.14,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Tonsillectomy And Adenoidectomy; Age 12 Or Over (Pro Cah),,42821,CPT,Professional,Both,,,,1224,1040.4,192.4,1224,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,299.16,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Tonsillectomy And Adenoidectomy; Age 12 Or Over (Pro Cah),,42821,CPT,Professional,Both,,,,1224,1040.4,192.4,1224,"Multiplan, Inc.","Multiplan, Inc.",1150.56,94,,percent of total billed charges,,
Tonsillectomy And Adenoidectomy; Age 12 Or Over (Pro Cah),,42821,CPT,Professional,Both,,,,1224,1040.4,192.4,1224,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1102.824,90.1,,percent of total billed charges,,
Tonsillectomy And Adenoidectomy; Age 12 Or Over (Pro Cah),,42821,CPT,Professional,Both,,,,1224,1040.4,192.4,1224,"Preferred One Administrative Services, INC.",PPO,1206.864,98.6,,percent of total billed charges,,
Tonsillectomy And Adenoidectomy; Age 12 Or Over (Pro Cah),,42821,CPT,Professional,Both,,,,1224,1040.4,192.4,1224,PrimeWest Health,Minnesota Senior Health Options (MSHO),344.034,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Tonsillectomy And Adenoidectomy; Age 12 Or Over (Pro Cah),,42821,CPT,Professional,Both,,,,1224,1040.4,192.4,1224,PrimeWest Health,MinnesotaCare,237.6879168,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Tonsillectomy And Adenoidectomy; Age 12 Or Over (Pro Cah),,42821,CPT,Professional,Both,,,,1224,1040.4,192.4,1224,Sanford Health Plan,Sanford Health Plan,1077.12,88,,percent of total billed charges,,
Tonsillectomy And Adenoidectomy; Age 12 Or Over (Pro Cah),,42821,CPT,Professional,Both,,,,1224,1040.4,192.4,1224,"UCare Health, Inc.",Individual & Family Plan,486.314496,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Tonsillectomy And Adenoidectomy; Age 12 Or Over (Pro Cah),,42821,CPT,Professional,Both,,,,1224,1040.4,192.4,1224,"UCare Health, Inc.",Medical Assistance,244.352064,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Tonsillectomy And Adenoidectomy; Age 12 Or Over (Pro Cah),,42821,CPT,Professional,Both,,,,1224,1040.4,192.4,1224,"UCare Health, Inc.",Medicare Advantage,344.034,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Tonsillectomy And Adenoidectomy; Age 12 Or Over (Pro Cah),,42821,CPT,Professional,Both,,,,1224,1040.4,192.4,1224,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),275.2272,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Tonsillectomy And Adenoidectomy; Age 12 Or Over (Pro Cah),,42821,CPT,Professional,Both,,,,1224,1040.4,192.4,1224,UnitedHealthcare,Individual & Family,1224,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Tonsillectomy And Adenoidectomy; Age 12 Or Over (Pro Cah),,42821,CPT,Professional,Both,,,,1224,1040.4,192.4,1224,UnitedHealthcare,Medicare Advantage,344.034,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Tonsillectomy And Adenoidectomy; Age 12 Or Over (Pro Cah),,42821,CPT,Professional,Both,,,,1224,1040.4,192.4,1224,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,222.13824,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Tonsillectomy, Primary Or Secondary; Younger Than Age 12 (Pro Cah)",,42825,CPT,Professional,Both,,,,1097,932.45,171.03,1097,Aetna,Commercial,932.45,85,,percent of total billed charges,,
"Tonsillectomy, Primary Or Secondary; Younger Than Age 12 (Pro Cah)",,42825,CPT,Professional,Both,,,,1097,932.45,171.03,1097,Aetna,Medicare Advantage,260.58,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Tonsillectomy, Primary Or Secondary; Younger Than Age 12 (Pro Cah)",,42825,CPT,Professional,Both,,,,1097,932.45,171.03,1097,Aetna,PPO,1020.21,93,,percent of total billed charges,,
"Tonsillectomy, Primary Or Secondary; Younger Than Age 12 (Pro Cah)",,42825,CPT,Professional,Both,,,,1097,932.45,171.03,1097,America's PPO,America's PPO,937.2768,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Tonsillectomy, Primary Or Secondary; Younger Than Age 12 (Pro Cah)",,42825,CPT,Professional,Both,,,,1097,932.45,171.03,1097,BlueCross BlueShield Minnesota, Federal Employee Program,557.77,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Tonsillectomy, Primary Or Secondary; Younger Than Age 12 (Pro Cah)",,42825,CPT,Professional,Both,,,,1097,932.45,171.03,1097,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,566.69432,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Tonsillectomy, Primary Or Secondary; Younger Than Age 12 (Pro Cah)",,42825,CPT,Professional,Both,,,,1097,932.45,171.03,1097,BlueCross BlueShield Minnesota,High Value Network Plan,566.69432,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Tonsillectomy, Primary Or Secondary; Younger Than Age 12 (Pro Cah)",,42825,CPT,Professional,Both,,,,1097,932.45,171.03,1097,BlueCross BlueShield Minnesota,Medicare Advantage,305.555,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Tonsillectomy, Primary Or Secondary; Younger Than Age 12 (Pro Cah)",,42825,CPT,Professional,Both,,,,1097,932.45,171.03,1097,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,566.69432,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Tonsillectomy, Primary Or Secondary; Younger Than Age 12 (Pro Cah)",,42825,CPT,Professional,Both,,,,1097,932.45,171.03,1097,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,197.4596,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Tonsillectomy, Primary Or Secondary; Younger Than Age 12 (Pro Cah)",,42825,CPT,Professional,Both,,,,1097,932.45,171.03,1097,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),305.555,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Tonsillectomy, Primary Or Secondary; Younger Than Age 12 (Pro Cah)",,42825,CPT,Professional,Both,,,,1097,932.45,171.03,1097,CorVel,Worker's Compensation,515.0320203,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Tonsillectomy, Primary Or Secondary; Younger Than Age 12 (Pro Cah)",,42825,CPT,Professional,Both,,,,1097,932.45,171.03,1097,First Health Group Corporation,First Health Network,1064.09,97,,percent of total billed charges,,
"Tonsillectomy, Primary Or Secondary; Younger Than Age 12 (Pro Cah)",,42825,CPT,Professional,Both,,,,1097,932.45,171.03,1097,"Health Partners, Inc.",Commercial,556.47,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Tonsillectomy, Primary Or Secondary; Younger Than Age 12 (Pro Cah)",,42825,CPT,Professional,Both,,,,1097,932.45,171.03,1097,"Health Partners, Inc.",Medicare Advantage,305.555,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Tonsillectomy, Primary Or Secondary; Younger Than Age 12 (Pro Cah)",,42825,CPT,Professional,Both,,,,1097,932.45,171.03,1097,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),265.68,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Tonsillectomy, Primary Or Secondary; Younger Than Age 12 (Pro Cah)",,42825,CPT,Professional,Both,,,,1097,932.45,171.03,1097,"Health Partners, Inc.",State of Minnesota Advantage Program,479.398905,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Tonsillectomy, Primary Or Secondary; Younger Than Age 12 (Pro Cah)",,42825,CPT,Professional,Both,,,,1097,932.45,171.03,1097,"Health Partners, Inc.",State Public Programs,171.03,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Tonsillectomy, Primary Or Secondary; Younger Than Age 12 (Pro Cah)",,42825,CPT,Professional,Both,,,,1097,932.45,171.03,1097,Humana Insurance Company,Commercial PPO,265.7,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Tonsillectomy, Primary Or Secondary; Younger Than Age 12 (Pro Cah)",,42825,CPT,Professional,Both,,,,1097,932.45,171.03,1097,Humana Insurance Company,Medicare PPO,1097,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Tonsillectomy, Primary Or Secondary; Younger Than Age 12 (Pro Cah)",,42825,CPT,Professional,Both,,,,1097,932.45,171.03,1097,Medica,Individual & Family,930.256,84.8,,percent of total billed charges,,
"Tonsillectomy, Primary Or Secondary; Younger Than Age 12 (Pro Cah)",,42825,CPT,Professional,Both,,,,1097,932.45,171.03,1097,Medica,Medica Advantage Solution,546.306,49.8,,percent of total billed charges,,
"Tonsillectomy, Primary Or Secondary; Younger Than Age 12 (Pro Cah)",,42825,CPT,Professional,Both,,,,1097,932.45,171.03,1097,Medica,Medical Assistance,197.46,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Tonsillectomy, Primary Or Secondary; Younger Than Age 12 (Pro Cah)",,42825,CPT,Professional,Both,,,,1097,932.45,171.03,1097,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,265.7,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Tonsillectomy, Primary Or Secondary; Younger Than Age 12 (Pro Cah)",,42825,CPT,Professional,Both,,,,1097,932.45,171.03,1097,"Multiplan, Inc.","Multiplan, Inc.",1031.18,94,,percent of total billed charges,,
"Tonsillectomy, Primary Or Secondary; Younger Than Age 12 (Pro Cah)",,42825,CPT,Professional,Both,,,,1097,932.45,171.03,1097,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,988.397,90.1,,percent of total billed charges,,
"Tonsillectomy, Primary Or Secondary; Younger Than Age 12 (Pro Cah)",,42825,CPT,Professional,Both,,,,1097,932.45,171.03,1097,"Preferred One Administrative Services, INC.",PPO,1081.642,98.6,,percent of total billed charges,,
"Tonsillectomy, Primary Or Secondary; Younger Than Age 12 (Pro Cah)",,42825,CPT,Professional,Both,,,,1097,932.45,171.03,1097,PrimeWest Health,Minnesota Senior Health Options (MSHO),305.555,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Tonsillectomy, Primary Or Secondary; Younger Than Age 12 (Pro Cah)",,42825,CPT,Professional,Both,,,,1097,932.45,171.03,1097,PrimeWest Health,MinnesotaCare,211.281772,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Tonsillectomy, Primary Or Secondary; Younger Than Age 12 (Pro Cah)",,42825,CPT,Professional,Both,,,,1097,932.45,171.03,1097,Sanford Health Plan,Sanford Health Plan,965.36,88,,percent of total billed charges,,
"Tonsillectomy, Primary Or Secondary; Younger Than Age 12 (Pro Cah)",,42825,CPT,Professional,Both,,,,1097,932.45,171.03,1097,"UCare Health, Inc.",Individual & Family Plan,431.92192,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Tonsillectomy, Primary Or Secondary; Younger Than Age 12 (Pro Cah)",,42825,CPT,Professional,Both,,,,1097,932.45,171.03,1097,"UCare Health, Inc.",Medical Assistance,217.20556,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Tonsillectomy, Primary Or Secondary; Younger Than Age 12 (Pro Cah)",,42825,CPT,Professional,Both,,,,1097,932.45,171.03,1097,"UCare Health, Inc.",Medicare Advantage,305.555,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Tonsillectomy, Primary Or Secondary; Younger Than Age 12 (Pro Cah)",,42825,CPT,Professional,Both,,,,1097,932.45,171.03,1097,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),244.444,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Tonsillectomy, Primary Or Secondary; Younger Than Age 12 (Pro Cah)",,42825,CPT,Professional,Both,,,,1097,932.45,171.03,1097,UnitedHealthcare,Individual & Family,1097,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Tonsillectomy, Primary Or Secondary; Younger Than Age 12 (Pro Cah)",,42825,CPT,Professional,Both,,,,1097,932.45,171.03,1097,UnitedHealthcare,Medicare Advantage,305.555,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Tonsillectomy, Primary Or Secondary; Younger Than Age 12 (Pro Cah)",,42825,CPT,Professional,Both,,,,1097,932.45,171.03,1097,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,197.4596,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Tonsillectomy, Primary Or Secondary; Age 12 Or Over (Pro Cah)",,42826,CPT,Professional,Both,,,,1102,936.7,162.3,1102,Aetna,Commercial,936.7,85,,percent of total billed charges,,
"Tonsillectomy, Primary Or Secondary; Age 12 Or Over (Pro Cah)",,42826,CPT,Professional,Both,,,,1102,936.7,162.3,1102,Aetna,Medicare Advantage,248.12,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Tonsillectomy, Primary Or Secondary; Age 12 Or Over (Pro Cah)",,42826,CPT,Professional,Both,,,,1102,936.7,162.3,1102,Aetna,PPO,1024.86,93,,percent of total billed charges,,
"Tonsillectomy, Primary Or Secondary; Age 12 Or Over (Pro Cah)",,42826,CPT,Professional,Both,,,,1102,936.7,162.3,1102,America's PPO,America's PPO,941.5488,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Tonsillectomy, Primary Or Secondary; Age 12 Or Over (Pro Cah)",,42826,CPT,Professional,Both,,,,1102,936.7,162.3,1102,BlueCross BlueShield Minnesota, Federal Employee Program,530.91,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Tonsillectomy, Primary Or Secondary; Age 12 Or Over (Pro Cah)",,42826,CPT,Professional,Both,,,,1102,936.7,162.3,1102,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,539.40456,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Tonsillectomy, Primary Or Secondary; Age 12 Or Over (Pro Cah)",,42826,CPT,Professional,Both,,,,1102,936.7,162.3,1102,BlueCross BlueShield Minnesota,High Value Network Plan,539.40456,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Tonsillectomy, Primary Or Secondary; Age 12 Or Over (Pro Cah)",,42826,CPT,Professional,Both,,,,1102,936.7,162.3,1102,BlueCross BlueShield Minnesota,Medicare Advantage,290.1105,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Tonsillectomy, Primary Or Secondary; Age 12 Or Over (Pro Cah)",,42826,CPT,Professional,Both,,,,1102,936.7,162.3,1102,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,539.40456,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Tonsillectomy, Primary Or Secondary; Age 12 Or Over (Pro Cah)",,42826,CPT,Professional,Both,,,,1102,936.7,162.3,1102,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,187.38088,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Tonsillectomy, Primary Or Secondary; Age 12 Or Over (Pro Cah)",,42826,CPT,Professional,Both,,,,1102,936.7,162.3,1102,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),290.1105,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Tonsillectomy, Primary Or Secondary; Age 12 Or Over (Pro Cah)",,42826,CPT,Professional,Both,,,,1102,936.7,162.3,1102,CorVel,Worker's Compensation,489.2279931,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Tonsillectomy, Primary Or Secondary; Age 12 Or Over (Pro Cah)",,42826,CPT,Professional,Both,,,,1102,936.7,162.3,1102,First Health Group Corporation,First Health Network,1068.94,97,,percent of total billed charges,,
"Tonsillectomy, Primary Or Secondary; Age 12 Or Over (Pro Cah)",,42826,CPT,Professional,Both,,,,1102,936.7,162.3,1102,"Health Partners, Inc.",Commercial,528.91,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Tonsillectomy, Primary Or Secondary; Age 12 Or Over (Pro Cah)",,42826,CPT,Professional,Both,,,,1102,936.7,162.3,1102,"Health Partners, Inc.",Medicare Advantage,290.1105,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Tonsillectomy, Primary Or Secondary; Age 12 Or Over (Pro Cah)",,42826,CPT,Professional,Both,,,,1102,936.7,162.3,1102,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),252.12,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Tonsillectomy, Primary Or Secondary; Age 12 Or Over (Pro Cah)",,42826,CPT,Professional,Both,,,,1102,936.7,162.3,1102,"Health Partners, Inc.",State of Minnesota Advantage Program,455.655965,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Tonsillectomy, Primary Or Secondary; Age 12 Or Over (Pro Cah)",,42826,CPT,Professional,Both,,,,1102,936.7,162.3,1102,"Health Partners, Inc.",State Public Programs,162.3,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Tonsillectomy, Primary Or Secondary; Age 12 Or Over (Pro Cah)",,42826,CPT,Professional,Both,,,,1102,936.7,162.3,1102,Humana Insurance Company,Commercial PPO,252.27,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Tonsillectomy, Primary Or Secondary; Age 12 Or Over (Pro Cah)",,42826,CPT,Professional,Both,,,,1102,936.7,162.3,1102,Humana Insurance Company,Medicare PPO,1102,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Tonsillectomy, Primary Or Secondary; Age 12 Or Over (Pro Cah)",,42826,CPT,Professional,Both,,,,1102,936.7,162.3,1102,Medica,Individual & Family,934.496,84.8,,percent of total billed charges,,
"Tonsillectomy, Primary Or Secondary; Age 12 Or Over (Pro Cah)",,42826,CPT,Professional,Both,,,,1102,936.7,162.3,1102,Medica,Medica Advantage Solution,548.796,49.8,,percent of total billed charges,,
"Tonsillectomy, Primary Or Secondary; Age 12 Or Over (Pro Cah)",,42826,CPT,Professional,Both,,,,1102,936.7,162.3,1102,Medica,Medical Assistance,187.38,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Tonsillectomy, Primary Or Secondary; Age 12 Or Over (Pro Cah)",,42826,CPT,Professional,Both,,,,1102,936.7,162.3,1102,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,252.27,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Tonsillectomy, Primary Or Secondary; Age 12 Or Over (Pro Cah)",,42826,CPT,Professional,Both,,,,1102,936.7,162.3,1102,"Multiplan, Inc.","Multiplan, Inc.",1035.88,94,,percent of total billed charges,,
"Tonsillectomy, Primary Or Secondary; Age 12 Or Over (Pro Cah)",,42826,CPT,Professional,Both,,,,1102,936.7,162.3,1102,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,992.902,90.1,,percent of total billed charges,,
"Tonsillectomy, Primary Or Secondary; Age 12 Or Over (Pro Cah)",,42826,CPT,Professional,Both,,,,1102,936.7,162.3,1102,"Preferred One Administrative Services, INC.",PPO,1086.572,98.6,,percent of total billed charges,,
"Tonsillectomy, Primary Or Secondary; Age 12 Or Over (Pro Cah)",,42826,CPT,Professional,Both,,,,1102,936.7,162.3,1102,PrimeWest Health,Minnesota Senior Health Options (MSHO),290.1105,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Tonsillectomy, Primary Or Secondary; Age 12 Or Over (Pro Cah)",,42826,CPT,Professional,Both,,,,1102,936.7,162.3,1102,PrimeWest Health,MinnesotaCare,200.4975416,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Tonsillectomy, Primary Or Secondary; Age 12 Or Over (Pro Cah)",,42826,CPT,Professional,Both,,,,1102,936.7,162.3,1102,Sanford Health Plan,Sanford Health Plan,969.76,88,,percent of total billed charges,,
"Tonsillectomy, Primary Or Secondary; Age 12 Or Over (Pro Cah)",,42826,CPT,Professional,Both,,,,1102,936.7,162.3,1102,"UCare Health, Inc.",Individual & Family Plan,410.090112,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Tonsillectomy, Primary Or Secondary; Age 12 Or Over (Pro Cah)",,42826,CPT,Professional,Both,,,,1102,936.7,162.3,1102,"UCare Health, Inc.",Medical Assistance,206.118968,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Tonsillectomy, Primary Or Secondary; Age 12 Or Over (Pro Cah)",,42826,CPT,Professional,Both,,,,1102,936.7,162.3,1102,"UCare Health, Inc.",Medicare Advantage,290.1105,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Tonsillectomy, Primary Or Secondary; Age 12 Or Over (Pro Cah)",,42826,CPT,Professional,Both,,,,1102,936.7,162.3,1102,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),232.0884,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Tonsillectomy, Primary Or Secondary; Age 12 Or Over (Pro Cah)",,42826,CPT,Professional,Both,,,,1102,936.7,162.3,1102,UnitedHealthcare,Individual & Family,1102,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Tonsillectomy, Primary Or Secondary; Age 12 Or Over (Pro Cah)",,42826,CPT,Professional,Both,,,,1102,936.7,162.3,1102,UnitedHealthcare,Medicare Advantage,290.1105,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Tonsillectomy, Primary Or Secondary; Age 12 Or Over (Pro Cah)",,42826,CPT,Professional,Both,,,,1102,936.7,162.3,1102,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,187.38088,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Adenoidectomy, Primary; Younger Than Age 12 (Pro Cah)",,42830,CPT,Professional,Both,,,,1071,910.35,135.47,1071,Aetna,Commercial,910.35,85,,percent of total billed charges,,
"Adenoidectomy, Primary; Younger Than Age 12 (Pro Cah)",,42830,CPT,Professional,Both,,,,1071,910.35,135.47,1071,Aetna,Medicare Advantage,206.25,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Adenoidectomy, Primary; Younger Than Age 12 (Pro Cah)",,42830,CPT,Professional,Both,,,,1071,910.35,135.47,1071,Aetna,PPO,996.03,93,,percent of total billed charges,,
"Adenoidectomy, Primary; Younger Than Age 12 (Pro Cah)",,42830,CPT,Professional,Both,,,,1071,910.35,135.47,1071,America's PPO,America's PPO,915.0624,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Adenoidectomy, Primary; Younger Than Age 12 (Pro Cah)",,42830,CPT,Professional,Both,,,,1071,910.35,135.47,1071,BlueCross BlueShield Minnesota, Federal Employee Program,440.7,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Adenoidectomy, Primary; Younger Than Age 12 (Pro Cah)",,42830,CPT,Professional,Both,,,,1071,910.35,135.47,1071,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,447.7512,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Adenoidectomy, Primary; Younger Than Age 12 (Pro Cah)",,42830,CPT,Professional,Both,,,,1071,910.35,135.47,1071,BlueCross BlueShield Minnesota,High Value Network Plan,447.7512,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Adenoidectomy, Primary; Younger Than Age 12 (Pro Cah)",,42830,CPT,Professional,Both,,,,1071,910.35,135.47,1071,BlueCross BlueShield Minnesota,Medicare Advantage,242.19,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Adenoidectomy, Primary; Younger Than Age 12 (Pro Cah)",,42830,CPT,Professional,Both,,,,1071,910.35,135.47,1071,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,447.7512,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Adenoidectomy, Primary; Younger Than Age 12 (Pro Cah)",,42830,CPT,Professional,Both,,,,1071,910.35,135.47,1071,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,156.40304,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Adenoidectomy, Primary; Younger Than Age 12 (Pro Cah)",,42830,CPT,Professional,Both,,,,1071,910.35,135.47,1071,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),242.19,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Adenoidectomy, Primary; Younger Than Age 12 (Pro Cah)",,42830,CPT,Professional,Both,,,,1071,910.35,135.47,1071,CorVel,Worker's Compensation,407.7077943,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Adenoidectomy, Primary; Younger Than Age 12 (Pro Cah)",,42830,CPT,Professional,Both,,,,1071,910.35,135.47,1071,First Health Group Corporation,First Health Network,1038.87,97,,percent of total billed charges,,
"Adenoidectomy, Primary; Younger Than Age 12 (Pro Cah)",,42830,CPT,Professional,Both,,,,1071,910.35,135.47,1071,"Health Partners, Inc.",Commercial,440.4,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Adenoidectomy, Primary; Younger Than Age 12 (Pro Cah)",,42830,CPT,Professional,Both,,,,1071,910.35,135.47,1071,"Health Partners, Inc.",Medicare Advantage,242.19,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Adenoidectomy, Primary; Younger Than Age 12 (Pro Cah)",,42830,CPT,Professional,Both,,,,1071,910.35,135.47,1071,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),210.44,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Adenoidectomy, Primary; Younger Than Age 12 (Pro Cah)",,42830,CPT,Professional,Both,,,,1071,910.35,135.47,1071,"Health Partners, Inc.",State of Minnesota Advantage Program,379.4046,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Adenoidectomy, Primary; Younger Than Age 12 (Pro Cah)",,42830,CPT,Professional,Both,,,,1071,910.35,135.47,1071,"Health Partners, Inc.",State Public Programs,135.47,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Adenoidectomy, Primary; Younger Than Age 12 (Pro Cah)",,42830,CPT,Professional,Both,,,,1071,910.35,135.47,1071,Humana Insurance Company,Commercial PPO,210.6,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Adenoidectomy, Primary; Younger Than Age 12 (Pro Cah)",,42830,CPT,Professional,Both,,,,1071,910.35,135.47,1071,Humana Insurance Company,Medicare PPO,1071,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Adenoidectomy, Primary; Younger Than Age 12 (Pro Cah)",,42830,CPT,Professional,Both,,,,1071,910.35,135.47,1071,Medica,Individual & Family,908.208,84.8,,percent of total billed charges,,
"Adenoidectomy, Primary; Younger Than Age 12 (Pro Cah)",,42830,CPT,Professional,Both,,,,1071,910.35,135.47,1071,Medica,Medica Advantage Solution,533.358,49.8,,percent of total billed charges,,
"Adenoidectomy, Primary; Younger Than Age 12 (Pro Cah)",,42830,CPT,Professional,Both,,,,1071,910.35,135.47,1071,Medica,Medical Assistance,156.4,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Adenoidectomy, Primary; Younger Than Age 12 (Pro Cah)",,42830,CPT,Professional,Both,,,,1071,910.35,135.47,1071,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,210.6,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Adenoidectomy, Primary; Younger Than Age 12 (Pro Cah)",,42830,CPT,Professional,Both,,,,1071,910.35,135.47,1071,"Multiplan, Inc.","Multiplan, Inc.",1006.74,94,,percent of total billed charges,,
"Adenoidectomy, Primary; Younger Than Age 12 (Pro Cah)",,42830,CPT,Professional,Both,,,,1071,910.35,135.47,1071,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,964.971,90.1,,percent of total billed charges,,
"Adenoidectomy, Primary; Younger Than Age 12 (Pro Cah)",,42830,CPT,Professional,Both,,,,1071,910.35,135.47,1071,"Preferred One Administrative Services, INC.",PPO,1056.006,98.6,,percent of total billed charges,,
"Adenoidectomy, Primary; Younger Than Age 12 (Pro Cah)",,42830,CPT,Professional,Both,,,,1071,910.35,135.47,1071,PrimeWest Health,Minnesota Senior Health Options (MSHO),242.19,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Adenoidectomy, Primary; Younger Than Age 12 (Pro Cah)",,42830,CPT,Professional,Both,,,,1071,910.35,135.47,1071,PrimeWest Health,MinnesotaCare,167.3512528,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Adenoidectomy, Primary; Younger Than Age 12 (Pro Cah)",,42830,CPT,Professional,Both,,,,1071,910.35,135.47,1071,Sanford Health Plan,Sanford Health Plan,942.48,88,,percent of total billed charges,,
"Adenoidectomy, Primary; Younger Than Age 12 (Pro Cah)",,42830,CPT,Professional,Both,,,,1071,910.35,135.47,1071,"UCare Health, Inc.",Individual & Family Plan,342.35136,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Adenoidectomy, Primary; Younger Than Age 12 (Pro Cah)",,42830,CPT,Professional,Both,,,,1071,910.35,135.47,1071,"UCare Health, Inc.",Medical Assistance,172.043344,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Adenoidectomy, Primary; Younger Than Age 12 (Pro Cah)",,42830,CPT,Professional,Both,,,,1071,910.35,135.47,1071,"UCare Health, Inc.",Medicare Advantage,242.19,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Adenoidectomy, Primary; Younger Than Age 12 (Pro Cah)",,42830,CPT,Professional,Both,,,,1071,910.35,135.47,1071,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),193.752,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Adenoidectomy, Primary; Younger Than Age 12 (Pro Cah)",,42830,CPT,Professional,Both,,,,1071,910.35,135.47,1071,UnitedHealthcare,Individual & Family,1071,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Adenoidectomy, Primary; Younger Than Age 12 (Pro Cah)",,42830,CPT,Professional,Both,,,,1071,910.35,135.47,1071,UnitedHealthcare,Medicare Advantage,242.19,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Adenoidectomy, Primary; Younger Than Age 12 (Pro Cah)",,42830,CPT,Professional,Both,,,,1071,910.35,135.47,1071,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,156.40304,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Adenoidectomy, Primary; Age 12 Or Over (Procah)",,42831,CPT,Professional,Both,,,,1071,910.35,147.68,1071,Aetna,Commercial,910.35,85,,percent of total billed charges,,
"Adenoidectomy, Primary; Age 12 Or Over (Procah)",,42831,CPT,Professional,Both,,,,1071,910.35,147.68,1071,Aetna,Medicare Advantage,224.45,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Adenoidectomy, Primary; Age 12 Or Over (Procah)",,42831,CPT,Professional,Both,,,,1071,910.35,147.68,1071,Aetna,PPO,996.03,93,,percent of total billed charges,,
"Adenoidectomy, Primary; Age 12 Or Over (Procah)",,42831,CPT,Professional,Both,,,,1071,910.35,147.68,1071,America's PPO,America's PPO,915.0624,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Adenoidectomy, Primary; Age 12 Or Over (Procah)",,42831,CPT,Professional,Both,,,,1071,910.35,147.68,1071,BlueCross BlueShield Minnesota, Federal Employee Program,479.95,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Adenoidectomy, Primary; Age 12 Or Over (Procah)",,42831,CPT,Professional,Both,,,,1071,910.35,147.68,1071,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,487.6292,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Adenoidectomy, Primary; Age 12 Or Over (Procah)",,42831,CPT,Professional,Both,,,,1071,910.35,147.68,1071,BlueCross BlueShield Minnesota,High Value Network Plan,487.6292,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Adenoidectomy, Primary; Age 12 Or Over (Procah)",,42831,CPT,Professional,Both,,,,1071,910.35,147.68,1071,BlueCross BlueShield Minnesota,Medicare Advantage,263.902,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Adenoidectomy, Primary; Age 12 Or Over (Procah)",,42831,CPT,Professional,Both,,,,1071,910.35,147.68,1071,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,487.6292,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Adenoidectomy, Primary; Age 12 Or Over (Procah)",,42831,CPT,Professional,Both,,,,1071,910.35,147.68,1071,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,170.50512,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Adenoidectomy, Primary; Age 12 Or Over (Procah)",,42831,CPT,Professional,Both,,,,1071,910.35,147.68,1071,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),263.902,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Adenoidectomy, Primary; Age 12 Or Over (Procah)",,42831,CPT,Professional,Both,,,,1071,910.35,147.68,1071,CorVel,Worker's Compensation,443.8680921,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Adenoidectomy, Primary; Age 12 Or Over (Procah)",,42831,CPT,Professional,Both,,,,1071,910.35,147.68,1071,First Health Group Corporation,First Health Network,1038.87,97,,percent of total billed charges,,
"Adenoidectomy, Primary; Age 12 Or Over (Procah)",,42831,CPT,Professional,Both,,,,1071,910.35,147.68,1071,"Health Partners, Inc.",Commercial,479.57,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Adenoidectomy, Primary; Age 12 Or Over (Procah)",,42831,CPT,Professional,Both,,,,1071,910.35,147.68,1071,"Health Partners, Inc.",Medicare Advantage,263.902,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Adenoidectomy, Primary; Age 12 Or Over (Procah)",,42831,CPT,Professional,Both,,,,1071,910.35,147.68,1071,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),229.42,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Adenoidectomy, Primary; Age 12 Or Over (Procah)",,42831,CPT,Professional,Both,,,,1071,910.35,147.68,1071,"Health Partners, Inc.",State of Minnesota Advantage Program,413.149555,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Adenoidectomy, Primary; Age 12 Or Over (Procah)",,42831,CPT,Professional,Both,,,,1071,910.35,147.68,1071,"Health Partners, Inc.",State Public Programs,147.68,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Adenoidectomy, Primary; Age 12 Or Over (Procah)",,42831,CPT,Professional,Both,,,,1071,910.35,147.68,1071,Humana Insurance Company,Commercial PPO,229.48,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Adenoidectomy, Primary; Age 12 Or Over (Procah)",,42831,CPT,Professional,Both,,,,1071,910.35,147.68,1071,Humana Insurance Company,Medicare PPO,1071,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Adenoidectomy, Primary; Age 12 Or Over (Procah)",,42831,CPT,Professional,Both,,,,1071,910.35,147.68,1071,Medica,Individual & Family,908.208,84.8,,percent of total billed charges,,
"Adenoidectomy, Primary; Age 12 Or Over (Procah)",,42831,CPT,Professional,Both,,,,1071,910.35,147.68,1071,Medica,Medica Advantage Solution,533.358,49.8,,percent of total billed charges,,
"Adenoidectomy, Primary; Age 12 Or Over (Procah)",,42831,CPT,Professional,Both,,,,1071,910.35,147.68,1071,Medica,Medical Assistance,170.51,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Adenoidectomy, Primary; Age 12 Or Over (Procah)",,42831,CPT,Professional,Both,,,,1071,910.35,147.68,1071,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,229.48,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Adenoidectomy, Primary; Age 12 Or Over (Procah)",,42831,CPT,Professional,Both,,,,1071,910.35,147.68,1071,"Multiplan, Inc.","Multiplan, Inc.",1006.74,94,,percent of total billed charges,,
"Adenoidectomy, Primary; Age 12 Or Over (Procah)",,42831,CPT,Professional,Both,,,,1071,910.35,147.68,1071,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,964.971,90.1,,percent of total billed charges,,
"Adenoidectomy, Primary; Age 12 Or Over (Procah)",,42831,CPT,Professional,Both,,,,1071,910.35,147.68,1071,"Preferred One Administrative Services, INC.",PPO,1056.006,98.6,,percent of total billed charges,,
"Adenoidectomy, Primary; Age 12 Or Over (Procah)",,42831,CPT,Professional,Both,,,,1071,910.35,147.68,1071,PrimeWest Health,Minnesota Senior Health Options (MSHO),263.902,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Adenoidectomy, Primary; Age 12 Or Over (Procah)",,42831,CPT,Professional,Both,,,,1071,910.35,147.68,1071,PrimeWest Health,MinnesotaCare,182.4404784,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Adenoidectomy, Primary; Age 12 Or Over (Procah)",,42831,CPT,Professional,Both,,,,1071,910.35,147.68,1071,Sanford Health Plan,Sanford Health Plan,942.48,88,,percent of total billed charges,,
"Adenoidectomy, Primary; Age 12 Or Over (Procah)",,42831,CPT,Professional,Both,,,,1071,910.35,147.68,1071,"UCare Health, Inc.",Individual & Family Plan,373.042688,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Adenoidectomy, Primary; Age 12 Or Over (Procah)",,42831,CPT,Professional,Both,,,,1071,910.35,147.68,1071,"UCare Health, Inc.",Medical Assistance,187.555632,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Adenoidectomy, Primary; Age 12 Or Over (Procah)",,42831,CPT,Professional,Both,,,,1071,910.35,147.68,1071,"UCare Health, Inc.",Medicare Advantage,263.902,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Adenoidectomy, Primary; Age 12 Or Over (Procah)",,42831,CPT,Professional,Both,,,,1071,910.35,147.68,1071,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),211.1216,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Adenoidectomy, Primary; Age 12 Or Over (Procah)",,42831,CPT,Professional,Both,,,,1071,910.35,147.68,1071,UnitedHealthcare,Individual & Family,1071,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Adenoidectomy, Primary; Age 12 Or Over (Procah)",,42831,CPT,Professional,Both,,,,1071,910.35,147.68,1071,UnitedHealthcare,Medicare Advantage,263.902,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Adenoidectomy, Primary; Age 12 Or Over (Procah)",,42831,CPT,Professional,Both,,,,1071,910.35,147.68,1071,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,170.50512,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Adenoidectomy, Secondary; Younger Than Age 12 (Pro Cah)",,42835,CPT,Professional,Both,,,,974,827.9,126.53,974,Aetna,Commercial,827.9,85,,percent of total billed charges,,
"Adenoidectomy, Secondary; Younger Than Age 12 (Pro Cah)",,42835,CPT,Professional,Both,,,,974,827.9,126.53,974,Aetna,Medicare Advantage,192.09,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Adenoidectomy, Secondary; Younger Than Age 12 (Pro Cah)",,42835,CPT,Professional,Both,,,,974,827.9,126.53,974,Aetna,PPO,905.82,93,,percent of total billed charges,,
"Adenoidectomy, Secondary; Younger Than Age 12 (Pro Cah)",,42835,CPT,Professional,Both,,,,974,827.9,126.53,974,America's PPO,America's PPO,832.1856,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Adenoidectomy, Secondary; Younger Than Age 12 (Pro Cah)",,42835,CPT,Professional,Both,,,,974,827.9,126.53,974,BlueCross BlueShield Minnesota, Federal Employee Program,411.78,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Adenoidectomy, Secondary; Younger Than Age 12 (Pro Cah)",,42835,CPT,Professional,Both,,,,974,827.9,126.53,974,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,418.36848,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Adenoidectomy, Secondary; Younger Than Age 12 (Pro Cah)",,42835,CPT,Professional,Both,,,,974,827.9,126.53,974,BlueCross BlueShield Minnesota,High Value Network Plan,418.36848,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Adenoidectomy, Secondary; Younger Than Age 12 (Pro Cah)",,42835,CPT,Professional,Both,,,,974,827.9,126.53,974,BlueCross BlueShield Minnesota,Medicare Advantage,226.251,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Adenoidectomy, Secondary; Younger Than Age 12 (Pro Cah)",,42835,CPT,Professional,Both,,,,974,827.9,126.53,974,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,418.36848,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Adenoidectomy, Secondary; Younger Than Age 12 (Pro Cah)",,42835,CPT,Professional,Both,,,,974,827.9,126.53,974,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,146.08048,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Adenoidectomy, Secondary; Younger Than Age 12 (Pro Cah)",,42835,CPT,Professional,Both,,,,974,827.9,126.53,974,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),226.251,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Adenoidectomy, Secondary; Younger Than Age 12 (Pro Cah)",,42835,CPT,Professional,Both,,,,974,827.9,126.53,974,CorVel,Worker's Compensation,380.2211586,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Adenoidectomy, Secondary; Younger Than Age 12 (Pro Cah)",,42835,CPT,Professional,Both,,,,974,827.9,126.53,974,First Health Group Corporation,First Health Network,944.78,97,,percent of total billed charges,,
"Adenoidectomy, Secondary; Younger Than Age 12 (Pro Cah)",,42835,CPT,Professional,Both,,,,974,827.9,126.53,974,"Health Partners, Inc.",Commercial,410.65,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Adenoidectomy, Secondary; Younger Than Age 12 (Pro Cah)",,42835,CPT,Professional,Both,,,,974,827.9,126.53,974,"Health Partners, Inc.",Medicare Advantage,226.251,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Adenoidectomy, Secondary; Younger Than Age 12 (Pro Cah)",,42835,CPT,Professional,Both,,,,974,827.9,126.53,974,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),196.55,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Adenoidectomy, Secondary; Younger Than Age 12 (Pro Cah)",,42835,CPT,Professional,Both,,,,974,827.9,126.53,974,"Health Partners, Inc.",State of Minnesota Advantage Program,353.774975,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Adenoidectomy, Secondary; Younger Than Age 12 (Pro Cah)",,42835,CPT,Professional,Both,,,,974,827.9,126.53,974,"Health Partners, Inc.",State Public Programs,126.53,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Adenoidectomy, Secondary; Younger Than Age 12 (Pro Cah)",,42835,CPT,Professional,Both,,,,974,827.9,126.53,974,Humana Insurance Company,Commercial PPO,196.74,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Adenoidectomy, Secondary; Younger Than Age 12 (Pro Cah)",,42835,CPT,Professional,Both,,,,974,827.9,126.53,974,Humana Insurance Company,Medicare PPO,974,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Adenoidectomy, Secondary; Younger Than Age 12 (Pro Cah)",,42835,CPT,Professional,Both,,,,974,827.9,126.53,974,Medica,Individual & Family,825.952,84.8,,percent of total billed charges,,
"Adenoidectomy, Secondary; Younger Than Age 12 (Pro Cah)",,42835,CPT,Professional,Both,,,,974,827.9,126.53,974,Medica,Medica Advantage Solution,485.052,49.8,,percent of total billed charges,,
"Adenoidectomy, Secondary; Younger Than Age 12 (Pro Cah)",,42835,CPT,Professional,Both,,,,974,827.9,126.53,974,Medica,Medical Assistance,146.08,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Adenoidectomy, Secondary; Younger Than Age 12 (Pro Cah)",,42835,CPT,Professional,Both,,,,974,827.9,126.53,974,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,196.74,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Adenoidectomy, Secondary; Younger Than Age 12 (Pro Cah)",,42835,CPT,Professional,Both,,,,974,827.9,126.53,974,"Multiplan, Inc.","Multiplan, Inc.",915.56,94,,percent of total billed charges,,
"Adenoidectomy, Secondary; Younger Than Age 12 (Pro Cah)",,42835,CPT,Professional,Both,,,,974,827.9,126.53,974,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,877.574,90.1,,percent of total billed charges,,
"Adenoidectomy, Secondary; Younger Than Age 12 (Pro Cah)",,42835,CPT,Professional,Both,,,,974,827.9,126.53,974,"Preferred One Administrative Services, INC.",PPO,960.364,98.6,,percent of total billed charges,,
"Adenoidectomy, Secondary; Younger Than Age 12 (Pro Cah)",,42835,CPT,Professional,Both,,,,974,827.9,126.53,974,PrimeWest Health,Minnesota Senior Health Options (MSHO),226.251,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Adenoidectomy, Secondary; Younger Than Age 12 (Pro Cah)",,42835,CPT,Professional,Both,,,,974,827.9,126.53,974,PrimeWest Health,MinnesotaCare,156.3061136,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Adenoidectomy, Secondary; Younger Than Age 12 (Pro Cah)",,42835,CPT,Professional,Both,,,,974,827.9,126.53,974,Sanford Health Plan,Sanford Health Plan,857.12,88,,percent of total billed charges,,
"Adenoidectomy, Secondary; Younger Than Age 12 (Pro Cah)",,42835,CPT,Professional,Both,,,,974,827.9,126.53,974,"UCare Health, Inc.",Individual & Family Plan,319.820544,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Adenoidectomy, Secondary; Younger Than Age 12 (Pro Cah)",,42835,CPT,Professional,Both,,,,974,827.9,126.53,974,"UCare Health, Inc.",Medical Assistance,160.688528,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Adenoidectomy, Secondary; Younger Than Age 12 (Pro Cah)",,42835,CPT,Professional,Both,,,,974,827.9,126.53,974,"UCare Health, Inc.",Medicare Advantage,226.251,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Adenoidectomy, Secondary; Younger Than Age 12 (Pro Cah)",,42835,CPT,Professional,Both,,,,974,827.9,126.53,974,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),181.0008,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Adenoidectomy, Secondary; Younger Than Age 12 (Pro Cah)",,42835,CPT,Professional,Both,,,,974,827.9,126.53,974,UnitedHealthcare,Individual & Family,974,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Adenoidectomy, Secondary; Younger Than Age 12 (Pro Cah)",,42835,CPT,Professional,Both,,,,974,827.9,126.53,974,UnitedHealthcare,Medicare Advantage,226.251,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Adenoidectomy, Secondary; Younger Than Age 12 (Pro Cah)",,42835,CPT,Professional,Both,,,,974,827.9,126.53,974,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,146.08048,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Adenoidectomy, Secondary; Age 12 Or Over (Procah)",,42836,CPT,Professional,Both,,,,974,827.9,155.76,974,Aetna,Commercial,827.9,85,,percent of total billed charges,,
"Adenoidectomy, Secondary; Age 12 Or Over (Procah)",,42836,CPT,Professional,Both,,,,974,827.9,155.76,974,Aetna,Medicare Advantage,238.06,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Adenoidectomy, Secondary; Age 12 Or Over (Procah)",,42836,CPT,Professional,Both,,,,974,827.9,155.76,974,Aetna,PPO,905.82,93,,percent of total billed charges,,
"Adenoidectomy, Secondary; Age 12 Or Over (Procah)",,42836,CPT,Professional,Both,,,,974,827.9,155.76,974,America's PPO,America's PPO,832.1856,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Adenoidectomy, Secondary; Age 12 Or Over (Procah)",,42836,CPT,Professional,Both,,,,974,827.9,155.76,974,BlueCross BlueShield Minnesota, Federal Employee Program,508.88,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Adenoidectomy, Secondary; Age 12 Or Over (Procah)",,42836,CPT,Professional,Both,,,,974,827.9,155.76,974,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,517.02208,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Adenoidectomy, Secondary; Age 12 Or Over (Procah)",,42836,CPT,Professional,Both,,,,974,827.9,155.76,974,BlueCross BlueShield Minnesota,High Value Network Plan,517.02208,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Adenoidectomy, Secondary; Age 12 Or Over (Procah)",,42836,CPT,Professional,Both,,,,974,827.9,155.76,974,BlueCross BlueShield Minnesota,Medicare Advantage,278.622,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Adenoidectomy, Secondary; Age 12 Or Over (Procah)",,42836,CPT,Professional,Both,,,,974,827.9,155.76,974,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,517.02208,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Adenoidectomy, Secondary; Age 12 Or Over (Procah)",,42836,CPT,Professional,Both,,,,974,827.9,155.76,974,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,179.832,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Adenoidectomy, Secondary; Age 12 Or Over (Procah)",,42836,CPT,Professional,Both,,,,974,827.9,155.76,974,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),278.622,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Adenoidectomy, Secondary; Age 12 Or Over (Procah)",,42836,CPT,Professional,Both,,,,974,827.9,155.76,974,CorVel,Worker's Compensation,468.9191436,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Adenoidectomy, Secondary; Age 12 Or Over (Procah)",,42836,CPT,Professional,Both,,,,974,827.9,155.76,974,First Health Group Corporation,First Health Network,944.78,97,,percent of total billed charges,,
"Adenoidectomy, Secondary; Age 12 Or Over (Procah)",,42836,CPT,Professional,Both,,,,974,827.9,155.76,974,"Health Partners, Inc.",Commercial,507.15,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Adenoidectomy, Secondary; Age 12 Or Over (Procah)",,42836,CPT,Professional,Both,,,,974,827.9,155.76,974,"Health Partners, Inc.",Medicare Advantage,278.622,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Adenoidectomy, Secondary; Age 12 Or Over (Procah)",,42836,CPT,Professional,Both,,,,974,827.9,155.76,974,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),242.29,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Adenoidectomy, Secondary; Age 12 Or Over (Procah)",,42836,CPT,Professional,Both,,,,974,827.9,155.76,974,"Health Partners, Inc.",State of Minnesota Advantage Program,436.909725,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Adenoidectomy, Secondary; Age 12 Or Over (Procah)",,42836,CPT,Professional,Both,,,,974,827.9,155.76,974,"Health Partners, Inc.",State Public Programs,155.76,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Adenoidectomy, Secondary; Age 12 Or Over (Procah)",,42836,CPT,Professional,Both,,,,974,827.9,155.76,974,Humana Insurance Company,Commercial PPO,242.28,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Adenoidectomy, Secondary; Age 12 Or Over (Procah)",,42836,CPT,Professional,Both,,,,974,827.9,155.76,974,Humana Insurance Company,Medicare PPO,974,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Adenoidectomy, Secondary; Age 12 Or Over (Procah)",,42836,CPT,Professional,Both,,,,974,827.9,155.76,974,Medica,Individual & Family,825.952,84.8,,percent of total billed charges,,
"Adenoidectomy, Secondary; Age 12 Or Over (Procah)",,42836,CPT,Professional,Both,,,,974,827.9,155.76,974,Medica,Medica Advantage Solution,485.052,49.8,,percent of total billed charges,,
"Adenoidectomy, Secondary; Age 12 Or Over (Procah)",,42836,CPT,Professional,Both,,,,974,827.9,155.76,974,Medica,Medical Assistance,179.83,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Adenoidectomy, Secondary; Age 12 Or Over (Procah)",,42836,CPT,Professional,Both,,,,974,827.9,155.76,974,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,242.28,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Adenoidectomy, Secondary; Age 12 Or Over (Procah)",,42836,CPT,Professional,Both,,,,974,827.9,155.76,974,"Multiplan, Inc.","Multiplan, Inc.",915.56,94,,percent of total billed charges,,
"Adenoidectomy, Secondary; Age 12 Or Over (Procah)",,42836,CPT,Professional,Both,,,,974,827.9,155.76,974,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,877.574,90.1,,percent of total billed charges,,
"Adenoidectomy, Secondary; Age 12 Or Over (Procah)",,42836,CPT,Professional,Both,,,,974,827.9,155.76,974,"Preferred One Administrative Services, INC.",PPO,960.364,98.6,,percent of total billed charges,,
"Adenoidectomy, Secondary; Age 12 Or Over (Procah)",,42836,CPT,Professional,Both,,,,974,827.9,155.76,974,PrimeWest Health,Minnesota Senior Health Options (MSHO),278.622,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Adenoidectomy, Secondary; Age 12 Or Over (Procah)",,42836,CPT,Professional,Both,,,,974,827.9,155.76,974,PrimeWest Health,MinnesotaCare,192.42024,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Adenoidectomy, Secondary; Age 12 Or Over (Procah)",,42836,CPT,Professional,Both,,,,974,827.9,155.76,974,Sanford Health Plan,Sanford Health Plan,857.12,88,,percent of total billed charges,,
"Adenoidectomy, Secondary; Age 12 Or Over (Procah)",,42836,CPT,Professional,Both,,,,974,827.9,155.76,974,"UCare Health, Inc.",Individual & Family Plan,393.850368,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Adenoidectomy, Secondary; Age 12 Or Over (Procah)",,42836,CPT,Professional,Both,,,,974,827.9,155.76,974,"UCare Health, Inc.",Medical Assistance,197.8152,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Adenoidectomy, Secondary; Age 12 Or Over (Procah)",,42836,CPT,Professional,Both,,,,974,827.9,155.76,974,"UCare Health, Inc.",Medicare Advantage,278.622,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Adenoidectomy, Secondary; Age 12 Or Over (Procah)",,42836,CPT,Professional,Both,,,,974,827.9,155.76,974,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),222.8976,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Adenoidectomy, Secondary; Age 12 Or Over (Procah)",,42836,CPT,Professional,Both,,,,974,827.9,155.76,974,UnitedHealthcare,Individual & Family,974,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Adenoidectomy, Secondary; Age 12 Or Over (Procah)",,42836,CPT,Professional,Both,,,,974,827.9,155.76,974,UnitedHealthcare,Medicare Advantage,278.622,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Adenoidectomy, Secondary; Age 12 Or Over (Procah)",,42836,CPT,Professional,Both,,,,974,827.9,155.76,974,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,179.832,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Excision Of Tonsil Tags (Pro Cah),,42860,CPT,Professional,Both,,,,673,572.05,124.12,673,Aetna,Commercial,572.05,85,,percent of total billed charges,,
Excision Of Tonsil Tags (Pro Cah),,42860,CPT,Professional,Both,,,,673,572.05,124.12,673,Aetna,Medicare Advantage,188.11,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Excision Of Tonsil Tags (Pro Cah),,42860,CPT,Professional,Both,,,,673,572.05,124.12,673,Aetna,PPO,625.89,93,,percent of total billed charges,,
Excision Of Tonsil Tags (Pro Cah),,42860,CPT,Professional,Both,,,,673,572.05,124.12,673,America's PPO,America's PPO,575.0112,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Excision Of Tonsil Tags (Pro Cah),,42860,CPT,Professional,Both,,,,673,572.05,124.12,673,BlueCross BlueShield Minnesota, Federal Employee Program,403.52,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Excision Of Tonsil Tags (Pro Cah),,42860,CPT,Professional,Both,,,,673,572.05,124.12,673,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,409.97632,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Excision Of Tonsil Tags (Pro Cah),,42860,CPT,Professional,Both,,,,673,572.05,124.12,673,BlueCross BlueShield Minnesota,High Value Network Plan,409.97632,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Excision Of Tonsil Tags (Pro Cah),,42860,CPT,Professional,Both,,,,673,572.05,124.12,673,BlueCross BlueShield Minnesota,Medicare Advantage,221.8235,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Excision Of Tonsil Tags (Pro Cah),,42860,CPT,Professional,Both,,,,673,572.05,124.12,673,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,409.97632,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Excision Of Tonsil Tags (Pro Cah),,42860,CPT,Professional,Both,,,,673,572.05,124.12,673,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,143.3068,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Excision Of Tonsil Tags (Pro Cah),,42860,CPT,Professional,Both,,,,673,572.05,124.12,673,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),221.8235,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Excision Of Tonsil Tags (Pro Cah),,42860,CPT,Professional,Both,,,,673,572.05,124.12,673,CorVel,Worker's Compensation,371.8887201,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Excision Of Tonsil Tags (Pro Cah),,42860,CPT,Professional,Both,,,,673,572.05,124.12,673,First Health Group Corporation,First Health Network,652.81,97,,percent of total billed charges,,
Excision Of Tonsil Tags (Pro Cah),,42860,CPT,Professional,Both,,,,673,572.05,124.12,673,"Health Partners, Inc.",Commercial,401.94,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Excision Of Tonsil Tags (Pro Cah),,42860,CPT,Professional,Both,,,,673,572.05,124.12,673,"Health Partners, Inc.",Medicare Advantage,221.8235,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Excision Of Tonsil Tags (Pro Cah),,42860,CPT,Professional,Both,,,,673,572.05,124.12,673,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),192.82,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Excision Of Tonsil Tags (Pro Cah),,42860,CPT,Professional,Both,,,,673,572.05,124.12,673,"Health Partners, Inc.",State of Minnesota Advantage Program,346.27131,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Excision Of Tonsil Tags (Pro Cah),,42860,CPT,Professional,Both,,,,673,572.05,124.12,673,"Health Partners, Inc.",State Public Programs,124.12,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Excision Of Tonsil Tags (Pro Cah),,42860,CPT,Professional,Both,,,,673,572.05,124.12,673,Humana Insurance Company,Commercial PPO,192.89,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Excision Of Tonsil Tags (Pro Cah),,42860,CPT,Professional,Both,,,,673,572.05,124.12,673,Humana Insurance Company,Medicare PPO,673,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Excision Of Tonsil Tags (Pro Cah),,42860,CPT,Professional,Both,,,,673,572.05,124.12,673,Medica,Individual & Family,570.704,84.8,,percent of total billed charges,,
Excision Of Tonsil Tags (Pro Cah),,42860,CPT,Professional,Both,,,,673,572.05,124.12,673,Medica,Medica Advantage Solution,335.154,49.8,,percent of total billed charges,,
Excision Of Tonsil Tags (Pro Cah),,42860,CPT,Professional,Both,,,,673,572.05,124.12,673,Medica,Medical Assistance,143.31,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Excision Of Tonsil Tags (Pro Cah),,42860,CPT,Professional,Both,,,,673,572.05,124.12,673,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,192.89,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Excision Of Tonsil Tags (Pro Cah),,42860,CPT,Professional,Both,,,,673,572.05,124.12,673,"Multiplan, Inc.","Multiplan, Inc.",632.62,94,,percent of total billed charges,,
Excision Of Tonsil Tags (Pro Cah),,42860,CPT,Professional,Both,,,,673,572.05,124.12,673,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,606.373,90.1,,percent of total billed charges,,
Excision Of Tonsil Tags (Pro Cah),,42860,CPT,Professional,Both,,,,673,572.05,124.12,673,"Preferred One Administrative Services, INC.",PPO,663.578,98.6,,percent of total billed charges,,
Excision Of Tonsil Tags (Pro Cah),,42860,CPT,Professional,Both,,,,673,572.05,124.12,673,PrimeWest Health,Minnesota Senior Health Options (MSHO),221.8235,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Excision Of Tonsil Tags (Pro Cah),,42860,CPT,Professional,Both,,,,673,572.05,124.12,673,PrimeWest Health,MinnesotaCare,153.338276,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Excision Of Tonsil Tags (Pro Cah),,42860,CPT,Professional,Both,,,,673,572.05,124.12,673,Sanford Health Plan,Sanford Health Plan,592.24,88,,percent of total billed charges,,
Excision Of Tonsil Tags (Pro Cah),,42860,CPT,Professional,Both,,,,673,572.05,124.12,673,"UCare Health, Inc.",Individual & Family Plan,313.561984,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Excision Of Tonsil Tags (Pro Cah),,42860,CPT,Professional,Both,,,,673,572.05,124.12,673,"UCare Health, Inc.",Medical Assistance,157.63748,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Excision Of Tonsil Tags (Pro Cah),,42860,CPT,Professional,Both,,,,673,572.05,124.12,673,"UCare Health, Inc.",Medicare Advantage,221.8235,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Excision Of Tonsil Tags (Pro Cah),,42860,CPT,Professional,Both,,,,673,572.05,124.12,673,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),177.4588,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Excision Of Tonsil Tags (Pro Cah),,42860,CPT,Professional,Both,,,,673,572.05,124.12,673,UnitedHealthcare,Individual & Family,673,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Excision Of Tonsil Tags (Pro Cah),,42860,CPT,Professional,Both,,,,673,572.05,124.12,673,UnitedHealthcare,Medicare Advantage,221.8235,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Excision Of Tonsil Tags (Pro Cah),,42860,CPT,Professional,Both,,,,673,572.05,124.12,673,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,143.3068,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Esophagoscopy, Rigid, Transoral; With Removal Of Foreign Body(S) (Pro Cah)",,43194,CPT,Professional,Both,,,,1148,975.8,116.93,1148,Aetna,Commercial,975.8,85,,percent of total billed charges,,
"Esophagoscopy, Rigid, Transoral; With Removal Of Foreign Body(S) (Pro Cah)",,43194,CPT,Professional,Both,,,,1148,975.8,116.93,1148,Aetna,Medicare Advantage,183.79,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Esophagoscopy, Rigid, Transoral; With Removal Of Foreign Body(S) (Pro Cah)",,43194,CPT,Professional,Both,,,,1148,975.8,116.93,1148,Aetna,PPO,1067.64,93,,percent of total billed charges,,
"Esophagoscopy, Rigid, Transoral; With Removal Of Foreign Body(S) (Pro Cah)",,43194,CPT,Professional,Both,,,,1148,975.8,116.93,1148,America's PPO,America's PPO,980.8512,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Esophagoscopy, Rigid, Transoral; With Removal Of Foreign Body(S) (Pro Cah)",,43194,CPT,Professional,Both,,,,1148,975.8,116.93,1148,BlueCross BlueShield Minnesota, Federal Employee Program,393.88,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Esophagoscopy, Rigid, Transoral; With Removal Of Foreign Body(S) (Pro Cah)",,43194,CPT,Professional,Both,,,,1148,975.8,116.93,1148,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,400.18208,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Esophagoscopy, Rigid, Transoral; With Removal Of Foreign Body(S) (Pro Cah)",,43194,CPT,Professional,Both,,,,1148,975.8,116.93,1148,BlueCross BlueShield Minnesota,High Value Network Plan,400.18208,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Esophagoscopy, Rigid, Transoral; With Removal Of Foreign Body(S) (Pro Cah)",,43194,CPT,Professional,Both,,,,1148,975.8,116.93,1148,BlueCross BlueShield Minnesota,Medicare Advantage,208.886,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Esophagoscopy, Rigid, Transoral; With Removal Of Foreign Body(S) (Pro Cah)",,43194,CPT,Professional,Both,,,,1148,975.8,116.93,1148,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,400.18208,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Esophagoscopy, Rigid, Transoral; With Removal Of Foreign Body(S) (Pro Cah)",,43194,CPT,Professional,Both,,,,1148,975.8,116.93,1148,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,134.99592,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Esophagoscopy, Rigid, Transoral; With Removal Of Foreign Body(S) (Pro Cah)",,43194,CPT,Professional,Both,,,,1148,975.8,116.93,1148,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),208.886,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Esophagoscopy, Rigid, Transoral; With Removal Of Foreign Body(S) (Pro Cah)",,43194,CPT,Professional,Both,,,,1148,975.8,116.93,1148,CorVel,Worker's Compensation,358.1511117,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Esophagoscopy, Rigid, Transoral; With Removal Of Foreign Body(S) (Pro Cah)",,43194,CPT,Professional,Both,,,,1148,975.8,116.93,1148,First Health Group Corporation,First Health Network,1113.56,97,,percent of total billed charges,,
"Esophagoscopy, Rigid, Transoral; With Removal Of Foreign Body(S) (Pro Cah)",,43194,CPT,Professional,Both,,,,1148,975.8,116.93,1148,"Health Partners, Inc.",Commercial,386.71,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Esophagoscopy, Rigid, Transoral; With Removal Of Foreign Body(S) (Pro Cah)",,43194,CPT,Professional,Both,,,,1148,975.8,116.93,1148,"Health Partners, Inc.",Medicare Advantage,208.886,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Esophagoscopy, Rigid, Transoral; With Removal Of Foreign Body(S) (Pro Cah)",,43194,CPT,Professional,Both,,,,1148,975.8,116.93,1148,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),181.64,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Esophagoscopy, Rigid, Transoral; With Removal Of Foreign Body(S) (Pro Cah)",,43194,CPT,Professional,Both,,,,1148,975.8,116.93,1148,"Health Partners, Inc.",State of Minnesota Advantage Program,333.150665,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Esophagoscopy, Rigid, Transoral; With Removal Of Foreign Body(S) (Pro Cah)",,43194,CPT,Professional,Both,,,,1148,975.8,116.93,1148,"Health Partners, Inc.",State Public Programs,116.93,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Esophagoscopy, Rigid, Transoral; With Removal Of Foreign Body(S) (Pro Cah)",,43194,CPT,Professional,Both,,,,1148,975.8,116.93,1148,Humana Insurance Company,Commercial PPO,181.64,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Esophagoscopy, Rigid, Transoral; With Removal Of Foreign Body(S) (Pro Cah)",,43194,CPT,Professional,Both,,,,1148,975.8,116.93,1148,Humana Insurance Company,Medicare PPO,1148,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Esophagoscopy, Rigid, Transoral; With Removal Of Foreign Body(S) (Pro Cah)",,43194,CPT,Professional,Both,,,,1148,975.8,116.93,1148,Medica,Individual & Family,973.504,84.8,,percent of total billed charges,,
"Esophagoscopy, Rigid, Transoral; With Removal Of Foreign Body(S) (Pro Cah)",,43194,CPT,Professional,Both,,,,1148,975.8,116.93,1148,Medica,Medica Advantage Solution,571.704,49.8,,percent of total billed charges,,
"Esophagoscopy, Rigid, Transoral; With Removal Of Foreign Body(S) (Pro Cah)",,43194,CPT,Professional,Both,,,,1148,975.8,116.93,1148,Medica,Medical Assistance,135,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Esophagoscopy, Rigid, Transoral; With Removal Of Foreign Body(S) (Pro Cah)",,43194,CPT,Professional,Both,,,,1148,975.8,116.93,1148,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,181.64,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Esophagoscopy, Rigid, Transoral; With Removal Of Foreign Body(S) (Pro Cah)",,43194,CPT,Professional,Both,,,,1148,975.8,116.93,1148,"Multiplan, Inc.","Multiplan, Inc.",1079.12,94,,percent of total billed charges,,
"Esophagoscopy, Rigid, Transoral; With Removal Of Foreign Body(S) (Pro Cah)",,43194,CPT,Professional,Both,,,,1148,975.8,116.93,1148,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1034.348,90.1,,percent of total billed charges,,
"Esophagoscopy, Rigid, Transoral; With Removal Of Foreign Body(S) (Pro Cah)",,43194,CPT,Professional,Both,,,,1148,975.8,116.93,1148,"Preferred One Administrative Services, INC.",PPO,1131.928,98.6,,percent of total billed charges,,
"Esophagoscopy, Rigid, Transoral; With Removal Of Foreign Body(S) (Pro Cah)",,43194,CPT,Professional,Both,,,,1148,975.8,116.93,1148,PrimeWest Health,Minnesota Senior Health Options (MSHO),208.886,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Esophagoscopy, Rigid, Transoral; With Removal Of Foreign Body(S) (Pro Cah)",,43194,CPT,Professional,Both,,,,1148,975.8,116.93,1148,PrimeWest Health,MinnesotaCare,144.4456344,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Esophagoscopy, Rigid, Transoral; With Removal Of Foreign Body(S) (Pro Cah)",,43194,CPT,Professional,Both,,,,1148,975.8,116.93,1148,Sanford Health Plan,Sanford Health Plan,1010.24,88,,percent of total billed charges,,
"Esophagoscopy, Rigid, Transoral; With Removal Of Foreign Body(S) (Pro Cah)",,43194,CPT,Professional,Both,,,,1148,975.8,116.93,1148,"UCare Health, Inc.",Individual & Family Plan,295.273984,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Esophagoscopy, Rigid, Transoral; With Removal Of Foreign Body(S) (Pro Cah)",,43194,CPT,Professional,Both,,,,1148,975.8,116.93,1148,"UCare Health, Inc.",Medical Assistance,148.495512,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Esophagoscopy, Rigid, Transoral; With Removal Of Foreign Body(S) (Pro Cah)",,43194,CPT,Professional,Both,,,,1148,975.8,116.93,1148,"UCare Health, Inc.",Medicare Advantage,208.886,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Esophagoscopy, Rigid, Transoral; With Removal Of Foreign Body(S) (Pro Cah)",,43194,CPT,Professional,Both,,,,1148,975.8,116.93,1148,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),167.1088,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Esophagoscopy, Rigid, Transoral; With Removal Of Foreign Body(S) (Pro Cah)",,43194,CPT,Professional,Both,,,,1148,975.8,116.93,1148,UnitedHealthcare,Individual & Family,1148,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Esophagoscopy, Rigid, Transoral; With Removal Of Foreign Body(S) (Pro Cah)",,43194,CPT,Professional,Both,,,,1148,975.8,116.93,1148,UnitedHealthcare,Medicare Advantage,208.886,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Esophagoscopy, Rigid, Transoral; With Removal Of Foreign Body(S) (Pro Cah)",,43194,CPT,Professional,Both,,,,1148,975.8,116.93,1148,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,134.99592,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Egd, Flexible, Transoral; Diag, Incl Collect Specimen Brush/Wash (Pro Cah)",,43235,CPT,Professional,Both,,,,1011,859.35,75.04,1011,Aetna,Commercial,859.35,85,,percent of total billed charges,,
"Egd, Flexible, Transoral; Diag, Incl Collect Specimen Brush/Wash (Pro Cah)",,43235,CPT,Professional,Both,,,,1011,859.35,75.04,1011,Aetna,Medicare Advantage,119.48,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Egd, Flexible, Transoral; Diag, Incl Collect Specimen Brush/Wash (Pro Cah)",,43235,CPT,Professional,Both,,,,1011,859.35,75.04,1011,Aetna,PPO,940.23,93,,percent of total billed charges,,
"Egd, Flexible, Transoral; Diag, Incl Collect Specimen Brush/Wash (Pro Cah)",,43235,CPT,Professional,Both,,,,1011,859.35,75.04,1011,America's PPO,America's PPO,863.7984,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Egd, Flexible, Transoral; Diag, Incl Collect Specimen Brush/Wash (Pro Cah)",,43235,CPT,Professional,Both,,,,1011,859.35,75.04,1011,BlueCross BlueShield Minnesota, Federal Employee Program,247.9,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Egd, Flexible, Transoral; Diag, Incl Collect Specimen Brush/Wash (Pro Cah)",,43235,CPT,Professional,Both,,,,1011,859.35,75.04,1011,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,251.8664,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Egd, Flexible, Transoral; Diag, Incl Collect Specimen Brush/Wash (Pro Cah)",,43235,CPT,Professional,Both,,,,1011,859.35,75.04,1011,BlueCross BlueShield Minnesota,High Value Network Plan,251.8664,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Egd, Flexible, Transoral; Diag, Incl Collect Specimen Brush/Wash (Pro Cah)",,43235,CPT,Professional,Both,,,,1011,859.35,75.04,1011,BlueCross BlueShield Minnesota,Medicare Advantage,134.389,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Egd, Flexible, Transoral; Diag, Incl Collect Specimen Brush/Wash (Pro Cah)",,43235,CPT,Professional,Both,,,,1011,859.35,75.04,1011,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,251.8664,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Egd, Flexible, Transoral; Diag, Incl Collect Specimen Brush/Wash (Pro Cah)",,43235,CPT,Professional,Both,,,,1011,859.35,75.04,1011,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,86.63432,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Egd, Flexible, Transoral; Diag, Incl Collect Specimen Brush/Wash (Pro Cah)",,43235,CPT,Professional,Both,,,,1011,859.35,75.04,1011,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),134.389,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Egd, Flexible, Transoral; Diag, Incl Collect Specimen Brush/Wash (Pro Cah)",,43235,CPT,Professional,Both,,,,1011,859.35,75.04,1011,CorVel,Worker's Compensation,231.367065,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Egd, Flexible, Transoral; Diag, Incl Collect Specimen Brush/Wash (Pro Cah)",,43235,CPT,Professional,Both,,,,1011,859.35,75.04,1011,First Health Group Corporation,First Health Network,980.67,97,,percent of total billed charges,,
"Egd, Flexible, Transoral; Diag, Incl Collect Specimen Brush/Wash (Pro Cah)",,43235,CPT,Professional,Both,,,,1011,859.35,75.04,1011,"Health Partners, Inc.",Commercial,250.3,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Egd, Flexible, Transoral; Diag, Incl Collect Specimen Brush/Wash (Pro Cah)",,43235,CPT,Professional,Both,,,,1011,859.35,75.04,1011,"Health Partners, Inc.",Medicare Advantage,134.389,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Egd, Flexible, Transoral; Diag, Incl Collect Specimen Brush/Wash (Pro Cah)",,43235,CPT,Professional,Both,,,,1011,859.35,75.04,1011,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),116.57,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Egd, Flexible, Transoral; Diag, Incl Collect Specimen Brush/Wash (Pro Cah)",,43235,CPT,Professional,Both,,,,1011,859.35,75.04,1011,"Health Partners, Inc.",State of Minnesota Advantage Program,215.63345,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Egd, Flexible, Transoral; Diag, Incl Collect Specimen Brush/Wash (Pro Cah)",,43235,CPT,Professional,Both,,,,1011,859.35,75.04,1011,"Health Partners, Inc.",State Public Programs,75.04,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Egd, Flexible, Transoral; Diag, Incl Collect Specimen Brush/Wash (Pro Cah)",,43235,CPT,Professional,Both,,,,1011,859.35,75.04,1011,Humana Insurance Company,Commercial PPO,116.86,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Egd, Flexible, Transoral; Diag, Incl Collect Specimen Brush/Wash (Pro Cah)",,43235,CPT,Professional,Both,,,,1011,859.35,75.04,1011,Humana Insurance Company,Medicare PPO,1011,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Egd, Flexible, Transoral; Diag, Incl Collect Specimen Brush/Wash (Pro Cah)",,43235,CPT,Professional,Both,,,,1011,859.35,75.04,1011,Medica,Individual & Family,857.328,84.8,,percent of total billed charges,,
"Egd, Flexible, Transoral; Diag, Incl Collect Specimen Brush/Wash (Pro Cah)",,43235,CPT,Professional,Both,,,,1011,859.35,75.04,1011,Medica,Medica Advantage Solution,503.478,49.8,,percent of total billed charges,,
"Egd, Flexible, Transoral; Diag, Incl Collect Specimen Brush/Wash (Pro Cah)",,43235,CPT,Professional,Both,,,,1011,859.35,75.04,1011,Medica,Medical Assistance,86.63,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Egd, Flexible, Transoral; Diag, Incl Collect Specimen Brush/Wash (Pro Cah)",,43235,CPT,Professional,Both,,,,1011,859.35,75.04,1011,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,116.86,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Egd, Flexible, Transoral; Diag, Incl Collect Specimen Brush/Wash (Pro Cah)",,43235,CPT,Professional,Both,,,,1011,859.35,75.04,1011,"Multiplan, Inc.","Multiplan, Inc.",950.34,94,,percent of total billed charges,,
"Egd, Flexible, Transoral; Diag, Incl Collect Specimen Brush/Wash (Pro Cah)",,43235,CPT,Professional,Both,,,,1011,859.35,75.04,1011,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,910.911,90.1,,percent of total billed charges,,
"Egd, Flexible, Transoral; Diag, Incl Collect Specimen Brush/Wash (Pro Cah)",,43235,CPT,Professional,Both,,,,1011,859.35,75.04,1011,"Preferred One Administrative Services, INC.",PPO,996.846,98.6,,percent of total billed charges,,
"Egd, Flexible, Transoral; Diag, Incl Collect Specimen Brush/Wash (Pro Cah)",,43235,CPT,Professional,Both,,,,1011,859.35,75.04,1011,PrimeWest Health,Minnesota Senior Health Options (MSHO),134.389,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Egd, Flexible, Transoral; Diag, Incl Collect Specimen Brush/Wash (Pro Cah)",,43235,CPT,Professional,Both,,,,1011,859.35,75.04,1011,PrimeWest Health,MinnesotaCare,92.6987224,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Egd, Flexible, Transoral; Diag, Incl Collect Specimen Brush/Wash (Pro Cah)",,43235,CPT,Professional,Both,,,,1011,859.35,75.04,1011,Sanford Health Plan,Sanford Health Plan,889.68,88,,percent of total billed charges,,
"Egd, Flexible, Transoral; Diag, Incl Collect Specimen Brush/Wash (Pro Cah)",,43235,CPT,Professional,Both,,,,1011,859.35,75.04,1011,"UCare Health, Inc.",Individual & Family Plan,189.967616,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Egd, Flexible, Transoral; Diag, Incl Collect Specimen Brush/Wash (Pro Cah)",,43235,CPT,Professional,Both,,,,1011,859.35,75.04,1011,"UCare Health, Inc.",Medical Assistance,95.297752,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Egd, Flexible, Transoral; Diag, Incl Collect Specimen Brush/Wash (Pro Cah)",,43235,CPT,Professional,Both,,,,1011,859.35,75.04,1011,"UCare Health, Inc.",Medicare Advantage,134.389,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Egd, Flexible, Transoral; Diag, Incl Collect Specimen Brush/Wash (Pro Cah)",,43235,CPT,Professional,Both,,,,1011,859.35,75.04,1011,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),107.5112,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Egd, Flexible, Transoral; Diag, Incl Collect Specimen Brush/Wash (Pro Cah)",,43235,CPT,Professional,Both,,,,1011,859.35,75.04,1011,UnitedHealthcare,Individual & Family,1011,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Egd, Flexible, Transoral; Diag, Incl Collect Specimen Brush/Wash (Pro Cah)",,43235,CPT,Professional,Both,,,,1011,859.35,75.04,1011,UnitedHealthcare,Medicare Advantage,134.389,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Egd, Flexible, Transoral; Diag, Incl Collect Specimen Brush/Wash (Pro Cah)",,43235,CPT,Professional,Both,,,,1011,859.35,75.04,1011,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,86.63432,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Egd, Flexible, Transoral; With Biopsy, Single Or Multiple (Pro Cah)",,43239,CPT,Professional,Both,,,,425,361.25,84.86,425,Aetna,Commercial,361.25,85,,percent of total billed charges,,
"Egd, Flexible, Transoral; With Biopsy, Single Or Multiple (Pro Cah)",,43239,CPT,Professional,Both,,,,425,361.25,84.86,425,Aetna,Medicare Advantage,135.02,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Egd, Flexible, Transoral; With Biopsy, Single Or Multiple (Pro Cah)",,43239,CPT,Professional,Both,,,,425,361.25,84.86,425,Aetna,PPO,395.25,93,,percent of total billed charges,,
"Egd, Flexible, Transoral; With Biopsy, Single Or Multiple (Pro Cah)",,43239,CPT,Professional,Both,,,,425,361.25,84.86,425,America's PPO,America's PPO,363.12,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Egd, Flexible, Transoral; With Biopsy, Single Or Multiple (Pro Cah)",,43239,CPT,Professional,Both,,,,425,361.25,84.86,425,BlueCross BlueShield Minnesota, Federal Employee Program,279.57,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Egd, Flexible, Transoral; With Biopsy, Single Or Multiple (Pro Cah)",,43239,CPT,Professional,Both,,,,425,361.25,84.86,425,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,284.04312,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Egd, Flexible, Transoral; With Biopsy, Single Or Multiple (Pro Cah)",,43239,CPT,Professional,Both,,,,425,361.25,84.86,425,BlueCross BlueShield Minnesota,High Value Network Plan,284.04312,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Egd, Flexible, Transoral; With Biopsy, Single Or Multiple (Pro Cah)",,43239,CPT,Professional,Both,,,,425,361.25,84.86,425,BlueCross BlueShield Minnesota,Medicare Advantage,151.6275,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Egd, Flexible, Transoral; With Biopsy, Single Or Multiple (Pro Cah)",,43239,CPT,Professional,Both,,,,425,361.25,84.86,425,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,284.04312,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Egd, Flexible, Transoral; With Biopsy, Single Or Multiple (Pro Cah)",,43239,CPT,Professional,Both,,,,425,361.25,84.86,425,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,97.97288,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Egd, Flexible, Transoral; With Biopsy, Single Or Multiple (Pro Cah)",,43239,CPT,Professional,Both,,,,425,361.25,84.86,425,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),151.6275,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Egd, Flexible, Transoral; With Biopsy, Single Or Multiple (Pro Cah)",,43239,CPT,Professional,Both,,,,425,361.25,84.86,425,CorVel,Worker's Compensation,260.8379025,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Egd, Flexible, Transoral; With Biopsy, Single Or Multiple (Pro Cah)",,43239,CPT,Professional,Both,,,,425,361.25,84.86,425,First Health Group Corporation,First Health Network,412.25,97,,percent of total billed charges,,
"Egd, Flexible, Transoral; With Biopsy, Single Or Multiple (Pro Cah)",,43239,CPT,Professional,Both,,,,425,361.25,84.86,425,"Health Partners, Inc.",Commercial,282.22,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Egd, Flexible, Transoral; With Biopsy, Single Or Multiple (Pro Cah)",,43239,CPT,Professional,Both,,,,425,361.25,84.86,425,"Health Partners, Inc.",Medicare Advantage,151.6275,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Egd, Flexible, Transoral; With Biopsy, Single Or Multiple (Pro Cah)",,43239,CPT,Professional,Both,,,,425,361.25,84.86,425,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),131.82,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Egd, Flexible, Transoral; With Biopsy, Single Or Multiple (Pro Cah)",,43239,CPT,Professional,Both,,,,425,361.25,84.86,425,"Health Partners, Inc.",State of Minnesota Advantage Program,243.13253,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Egd, Flexible, Transoral; With Biopsy, Single Or Multiple (Pro Cah)",,43239,CPT,Professional,Both,,,,425,361.25,84.86,425,"Health Partners, Inc.",State Public Programs,84.86,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Egd, Flexible, Transoral; With Biopsy, Single Or Multiple (Pro Cah)",,43239,CPT,Professional,Both,,,,425,361.25,84.86,425,Humana Insurance Company,Commercial PPO,131.85,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Egd, Flexible, Transoral; With Biopsy, Single Or Multiple (Pro Cah)",,43239,CPT,Professional,Both,,,,425,361.25,84.86,425,Humana Insurance Company,Medicare PPO,425,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Egd, Flexible, Transoral; With Biopsy, Single Or Multiple (Pro Cah)",,43239,CPT,Professional,Both,,,,425,361.25,84.86,425,Medica,Individual & Family,360.4,84.8,,percent of total billed charges,,
"Egd, Flexible, Transoral; With Biopsy, Single Or Multiple (Pro Cah)",,43239,CPT,Professional,Both,,,,425,361.25,84.86,425,Medica,Medica Advantage Solution,211.65,49.8,,percent of total billed charges,,
"Egd, Flexible, Transoral; With Biopsy, Single Or Multiple (Pro Cah)",,43239,CPT,Professional,Both,,,,425,361.25,84.86,425,Medica,Medical Assistance,97.97,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Egd, Flexible, Transoral; With Biopsy, Single Or Multiple (Pro Cah)",,43239,CPT,Professional,Both,,,,425,361.25,84.86,425,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,131.85,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Egd, Flexible, Transoral; With Biopsy, Single Or Multiple (Pro Cah)",,43239,CPT,Professional,Both,,,,425,361.25,84.86,425,"Multiplan, Inc.","Multiplan, Inc.",399.5,94,,percent of total billed charges,,
"Egd, Flexible, Transoral; With Biopsy, Single Or Multiple (Pro Cah)",,43239,CPT,Professional,Both,,,,425,361.25,84.86,425,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,382.925,90.1,,percent of total billed charges,,
"Egd, Flexible, Transoral; With Biopsy, Single Or Multiple (Pro Cah)",,43239,CPT,Professional,Both,,,,425,361.25,84.86,425,"Preferred One Administrative Services, INC.",PPO,419.05,98.6,,percent of total billed charges,,
"Egd, Flexible, Transoral; With Biopsy, Single Or Multiple (Pro Cah)",,43239,CPT,Professional,Both,,,,425,361.25,84.86,425,PrimeWest Health,Minnesota Senior Health Options (MSHO),151.6275,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Egd, Flexible, Transoral; With Biopsy, Single Or Multiple (Pro Cah)",,43239,CPT,Professional,Both,,,,425,361.25,84.86,425,PrimeWest Health,MinnesotaCare,104.8309816,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Egd, Flexible, Transoral; With Biopsy, Single Or Multiple (Pro Cah)",,43239,CPT,Professional,Both,,,,425,361.25,84.86,425,Sanford Health Plan,Sanford Health Plan,374,88,,percent of total billed charges,,
"Egd, Flexible, Transoral; With Biopsy, Single Or Multiple (Pro Cah)",,43239,CPT,Professional,Both,,,,425,361.25,84.86,425,"UCare Health, Inc.",Individual & Family Plan,214.33536,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Egd, Flexible, Transoral; With Biopsy, Single Or Multiple (Pro Cah)",,43239,CPT,Professional,Both,,,,425,361.25,84.86,425,"UCare Health, Inc.",Medical Assistance,107.770168,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Egd, Flexible, Transoral; With Biopsy, Single Or Multiple (Pro Cah)",,43239,CPT,Professional,Both,,,,425,361.25,84.86,425,"UCare Health, Inc.",Medicare Advantage,151.6275,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Egd, Flexible, Transoral; With Biopsy, Single Or Multiple (Pro Cah)",,43239,CPT,Professional,Both,,,,425,361.25,84.86,425,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),121.302,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Egd, Flexible, Transoral; With Biopsy, Single Or Multiple (Pro Cah)",,43239,CPT,Professional,Both,,,,425,361.25,84.86,425,UnitedHealthcare,Individual & Family,425,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Egd, Flexible, Transoral; With Biopsy, Single Or Multiple (Pro Cah)",,43239,CPT,Professional,Both,,,,425,361.25,84.86,425,UnitedHealthcare,Medicare Advantage,151.6275,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Egd, Flexible, Transoral; With Biopsy, Single Or Multiple (Pro Cah)",,43239,CPT,Professional,Both,,,,425,361.25,84.86,425,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,97.97288,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Egd, Flexible, Transoral;W Dilation Of Gastric/Duodenal Stricture (Pro Cah)",,43245,CPT,Professional,Both,,,,860,731,106.89,860,Aetna,Commercial,731,85,,percent of total billed charges,,
"Egd, Flexible, Transoral;W Dilation Of Gastric/Duodenal Stricture (Pro Cah)",,43245,CPT,Professional,Both,,,,860,731,106.89,860,Aetna,Medicare Advantage,170.61,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Egd, Flexible, Transoral;W Dilation Of Gastric/Duodenal Stricture (Pro Cah)",,43245,CPT,Professional,Both,,,,860,731,106.89,860,Aetna,PPO,799.8,93,,percent of total billed charges,,
"Egd, Flexible, Transoral;W Dilation Of Gastric/Duodenal Stricture (Pro Cah)",,43245,CPT,Professional,Both,,,,860,731,106.89,860,America's PPO,America's PPO,734.784,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Egd, Flexible, Transoral;W Dilation Of Gastric/Duodenal Stricture (Pro Cah)",,43245,CPT,Professional,Both,,,,860,731,106.89,860,BlueCross BlueShield Minnesota, Federal Employee Program,355.32,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Egd, Flexible, Transoral;W Dilation Of Gastric/Duodenal Stricture (Pro Cah)",,43245,CPT,Professional,Both,,,,860,731,106.89,860,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,361.00512,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Egd, Flexible, Transoral;W Dilation Of Gastric/Duodenal Stricture (Pro Cah)",,43245,CPT,Professional,Both,,,,860,731,106.89,860,BlueCross BlueShield Minnesota,High Value Network Plan,361.00512,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Egd, Flexible, Transoral;W Dilation Of Gastric/Duodenal Stricture (Pro Cah)",,43245,CPT,Professional,Both,,,,860,731,106.89,860,BlueCross BlueShield Minnesota,Medicare Advantage,191.015,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Egd, Flexible, Transoral;W Dilation Of Gastric/Duodenal Stricture (Pro Cah)",,43245,CPT,Professional,Both,,,,860,731,106.89,860,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,361.00512,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Egd, Flexible, Transoral;W Dilation Of Gastric/Duodenal Stricture (Pro Cah)",,43245,CPT,Professional,Both,,,,860,731,106.89,860,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,123.41352,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Egd, Flexible, Transoral;W Dilation Of Gastric/Duodenal Stricture (Pro Cah)",,43245,CPT,Professional,Both,,,,860,731,106.89,860,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),191.015,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Egd, Flexible, Transoral;W Dilation Of Gastric/Duodenal Stricture (Pro Cah)",,43245,CPT,Professional,Both,,,,860,731,106.89,860,CorVel,Worker's Compensation,328.8764106,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Egd, Flexible, Transoral;W Dilation Of Gastric/Duodenal Stricture (Pro Cah)",,43245,CPT,Professional,Both,,,,860,731,106.89,860,First Health Group Corporation,First Health Network,834.2,97,,percent of total billed charges,,
"Egd, Flexible, Transoral;W Dilation Of Gastric/Duodenal Stricture (Pro Cah)",,43245,CPT,Professional,Both,,,,860,731,106.89,860,"Health Partners, Inc.",Commercial,354.78,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Egd, Flexible, Transoral;W Dilation Of Gastric/Duodenal Stricture (Pro Cah)",,43245,CPT,Professional,Both,,,,860,731,106.89,860,"Health Partners, Inc.",Medicare Advantage,191.015,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Egd, Flexible, Transoral;W Dilation Of Gastric/Duodenal Stricture (Pro Cah)",,43245,CPT,Professional,Both,,,,860,731,106.89,860,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),166.05,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Egd, Flexible, Transoral;W Dilation Of Gastric/Duodenal Stricture (Pro Cah)",,43245,CPT,Professional,Both,,,,860,731,106.89,860,"Health Partners, Inc.",State of Minnesota Advantage Program,305.64297,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Egd, Flexible, Transoral;W Dilation Of Gastric/Duodenal Stricture (Pro Cah)",,43245,CPT,Professional,Both,,,,860,731,106.89,860,"Health Partners, Inc.",State Public Programs,106.89,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Egd, Flexible, Transoral;W Dilation Of Gastric/Duodenal Stricture (Pro Cah)",,43245,CPT,Professional,Both,,,,860,731,106.89,860,Humana Insurance Company,Commercial PPO,166.1,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Egd, Flexible, Transoral;W Dilation Of Gastric/Duodenal Stricture (Pro Cah)",,43245,CPT,Professional,Both,,,,860,731,106.89,860,Humana Insurance Company,Medicare PPO,860,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Egd, Flexible, Transoral;W Dilation Of Gastric/Duodenal Stricture (Pro Cah)",,43245,CPT,Professional,Both,,,,860,731,106.89,860,Medica,Individual & Family,729.28,84.8,,percent of total billed charges,,
"Egd, Flexible, Transoral;W Dilation Of Gastric/Duodenal Stricture (Pro Cah)",,43245,CPT,Professional,Both,,,,860,731,106.89,860,Medica,Medica Advantage Solution,428.28,49.8,,percent of total billed charges,,
"Egd, Flexible, Transoral;W Dilation Of Gastric/Duodenal Stricture (Pro Cah)",,43245,CPT,Professional,Both,,,,860,731,106.89,860,Medica,Medical Assistance,123.41,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Egd, Flexible, Transoral;W Dilation Of Gastric/Duodenal Stricture (Pro Cah)",,43245,CPT,Professional,Both,,,,860,731,106.89,860,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,166.1,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Egd, Flexible, Transoral;W Dilation Of Gastric/Duodenal Stricture (Pro Cah)",,43245,CPT,Professional,Both,,,,860,731,106.89,860,"Multiplan, Inc.","Multiplan, Inc.",808.4,94,,percent of total billed charges,,
"Egd, Flexible, Transoral;W Dilation Of Gastric/Duodenal Stricture (Pro Cah)",,43245,CPT,Professional,Both,,,,860,731,106.89,860,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,774.86,90.1,,percent of total billed charges,,
"Egd, Flexible, Transoral;W Dilation Of Gastric/Duodenal Stricture (Pro Cah)",,43245,CPT,Professional,Both,,,,860,731,106.89,860,"Preferred One Administrative Services, INC.",PPO,847.96,98.6,,percent of total billed charges,,
"Egd, Flexible, Transoral;W Dilation Of Gastric/Duodenal Stricture (Pro Cah)",,43245,CPT,Professional,Both,,,,860,731,106.89,860,PrimeWest Health,Minnesota Senior Health Options (MSHO),191.015,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Egd, Flexible, Transoral;W Dilation Of Gastric/Duodenal Stricture (Pro Cah)",,43245,CPT,Professional,Both,,,,860,731,106.89,860,PrimeWest Health,MinnesotaCare,132.0524664,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Egd, Flexible, Transoral;W Dilation Of Gastric/Duodenal Stricture (Pro Cah)",,43245,CPT,Professional,Both,,,,860,731,106.89,860,Sanford Health Plan,Sanford Health Plan,756.8,88,,percent of total billed charges,,
"Egd, Flexible, Transoral;W Dilation Of Gastric/Duodenal Stricture (Pro Cah)",,43245,CPT,Professional,Both,,,,860,731,106.89,860,"UCare Health, Inc.",Individual & Family Plan,270.01216,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Egd, Flexible, Transoral;W Dilation Of Gastric/Duodenal Stricture (Pro Cah)",,43245,CPT,Professional,Both,,,,860,731,106.89,860,"UCare Health, Inc.",Medical Assistance,135.754872,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Egd, Flexible, Transoral;W Dilation Of Gastric/Duodenal Stricture (Pro Cah)",,43245,CPT,Professional,Both,,,,860,731,106.89,860,"UCare Health, Inc.",Medicare Advantage,191.015,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Egd, Flexible, Transoral;W Dilation Of Gastric/Duodenal Stricture (Pro Cah)",,43245,CPT,Professional,Both,,,,860,731,106.89,860,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),152.812,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Egd, Flexible, Transoral;W Dilation Of Gastric/Duodenal Stricture (Pro Cah)",,43245,CPT,Professional,Both,,,,860,731,106.89,860,UnitedHealthcare,Individual & Family,860,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Egd, Flexible, Transoral;W Dilation Of Gastric/Duodenal Stricture (Pro Cah)",,43245,CPT,Professional,Both,,,,860,731,106.89,860,UnitedHealthcare,Medicare Advantage,191.015,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Egd, Flexible, Transoral;W Dilation Of Gastric/Duodenal Stricture (Pro Cah)",,43245,CPT,Professional,Both,,,,860,731,106.89,860,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,123.41352,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Egd, Flexible, Transoral; W Dir Placement Percutaneous Gastro Tube (Pro Cah)",,43246,CPT,Professional,Both,,,,1525,1296.25,121.29,1525,Aetna,Commercial,1296.25,85,,percent of total billed charges,,
"Egd, Flexible, Transoral; W Dir Placement Percutaneous Gastro Tube (Pro Cah)",,43246,CPT,Professional,Both,,,,1525,1296.25,121.29,1525,Aetna,Medicare Advantage,193.17,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Egd, Flexible, Transoral; W Dir Placement Percutaneous Gastro Tube (Pro Cah)",,43246,CPT,Professional,Both,,,,1525,1296.25,121.29,1525,Aetna,PPO,1418.25,93,,percent of total billed charges,,
"Egd, Flexible, Transoral; W Dir Placement Percutaneous Gastro Tube (Pro Cah)",,43246,CPT,Professional,Both,,,,1525,1296.25,121.29,1525,America's PPO,America's PPO,1302.96,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Egd, Flexible, Transoral; W Dir Placement Percutaneous Gastro Tube (Pro Cah)",,43246,CPT,Professional,Both,,,,1525,1296.25,121.29,1525,BlueCross BlueShield Minnesota, Federal Employee Program,405.59,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Egd, Flexible, Transoral; W Dir Placement Percutaneous Gastro Tube (Pro Cah)",,43246,CPT,Professional,Both,,,,1525,1296.25,121.29,1525,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,412.07944,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Egd, Flexible, Transoral; W Dir Placement Percutaneous Gastro Tube (Pro Cah)",,43246,CPT,Professional,Both,,,,1525,1296.25,121.29,1525,BlueCross BlueShield Minnesota,High Value Network Plan,412.07944,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Egd, Flexible, Transoral; W Dir Placement Percutaneous Gastro Tube (Pro Cah)",,43246,CPT,Professional,Both,,,,1525,1296.25,121.29,1525,BlueCross BlueShield Minnesota,Medicare Advantage,216.6715,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Egd, Flexible, Transoral; W Dir Placement Percutaneous Gastro Tube (Pro Cah)",,43246,CPT,Professional,Both,,,,1525,1296.25,121.29,1525,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,412.07944,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Egd, Flexible, Transoral; W Dir Placement Percutaneous Gastro Tube (Pro Cah)",,43246,CPT,Professional,Both,,,,1525,1296.25,121.29,1525,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,140.03528,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Egd, Flexible, Transoral; W Dir Placement Percutaneous Gastro Tube (Pro Cah)",,43246,CPT,Professional,Both,,,,1525,1296.25,121.29,1525,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),216.6715,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Egd, Flexible, Transoral; W Dir Placement Percutaneous Gastro Tube (Pro Cah)",,43246,CPT,Professional,Both,,,,1525,1296.25,121.29,1525,CorVel,Worker's Compensation,373.2522711,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Egd, Flexible, Transoral; W Dir Placement Percutaneous Gastro Tube (Pro Cah)",,43246,CPT,Professional,Both,,,,1525,1296.25,121.29,1525,First Health Group Corporation,First Health Network,1479.25,97,,percent of total billed charges,,
"Egd, Flexible, Transoral; W Dir Placement Percutaneous Gastro Tube (Pro Cah)",,43246,CPT,Professional,Both,,,,1525,1296.25,121.29,1525,"Health Partners, Inc.",Commercial,402.67,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Egd, Flexible, Transoral; W Dir Placement Percutaneous Gastro Tube (Pro Cah)",,43246,CPT,Professional,Both,,,,1525,1296.25,121.29,1525,"Health Partners, Inc.",Medicare Advantage,216.6715,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Egd, Flexible, Transoral; W Dir Placement Percutaneous Gastro Tube (Pro Cah)",,43246,CPT,Professional,Both,,,,1525,1296.25,121.29,1525,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),188.41,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Egd, Flexible, Transoral; W Dir Placement Percutaneous Gastro Tube (Pro Cah)",,43246,CPT,Professional,Both,,,,1525,1296.25,121.29,1525,"Health Partners, Inc.",State of Minnesota Advantage Program,346.900205,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Egd, Flexible, Transoral; W Dir Placement Percutaneous Gastro Tube (Pro Cah)",,43246,CPT,Professional,Both,,,,1525,1296.25,121.29,1525,"Health Partners, Inc.",State Public Programs,121.29,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Egd, Flexible, Transoral; W Dir Placement Percutaneous Gastro Tube (Pro Cah)",,43246,CPT,Professional,Both,,,,1525,1296.25,121.29,1525,Humana Insurance Company,Commercial PPO,188.41,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Egd, Flexible, Transoral; W Dir Placement Percutaneous Gastro Tube (Pro Cah)",,43246,CPT,Professional,Both,,,,1525,1296.25,121.29,1525,Humana Insurance Company,Medicare PPO,1525,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Egd, Flexible, Transoral; W Dir Placement Percutaneous Gastro Tube (Pro Cah)",,43246,CPT,Professional,Both,,,,1525,1296.25,121.29,1525,Medica,Individual & Family,1293.2,84.8,,percent of total billed charges,,
"Egd, Flexible, Transoral; W Dir Placement Percutaneous Gastro Tube (Pro Cah)",,43246,CPT,Professional,Both,,,,1525,1296.25,121.29,1525,Medica,Medica Advantage Solution,759.45,49.8,,percent of total billed charges,,
"Egd, Flexible, Transoral; W Dir Placement Percutaneous Gastro Tube (Pro Cah)",,43246,CPT,Professional,Both,,,,1525,1296.25,121.29,1525,Medica,Medical Assistance,140.04,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Egd, Flexible, Transoral; W Dir Placement Percutaneous Gastro Tube (Pro Cah)",,43246,CPT,Professional,Both,,,,1525,1296.25,121.29,1525,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,188.41,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Egd, Flexible, Transoral; W Dir Placement Percutaneous Gastro Tube (Pro Cah)",,43246,CPT,Professional,Both,,,,1525,1296.25,121.29,1525,"Multiplan, Inc.","Multiplan, Inc.",1433.5,94,,percent of total billed charges,,
"Egd, Flexible, Transoral; W Dir Placement Percutaneous Gastro Tube (Pro Cah)",,43246,CPT,Professional,Both,,,,1525,1296.25,121.29,1525,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1374.025,90.1,,percent of total billed charges,,
"Egd, Flexible, Transoral; W Dir Placement Percutaneous Gastro Tube (Pro Cah)",,43246,CPT,Professional,Both,,,,1525,1296.25,121.29,1525,"Preferred One Administrative Services, INC.",PPO,1503.65,98.6,,percent of total billed charges,,
"Egd, Flexible, Transoral; W Dir Placement Percutaneous Gastro Tube (Pro Cah)",,43246,CPT,Professional,Both,,,,1525,1296.25,121.29,1525,PrimeWest Health,Minnesota Senior Health Options (MSHO),216.6715,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Egd, Flexible, Transoral; W Dir Placement Percutaneous Gastro Tube (Pro Cah)",,43246,CPT,Professional,Both,,,,1525,1296.25,121.29,1525,PrimeWest Health,MinnesotaCare,149.8377496,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Egd, Flexible, Transoral; W Dir Placement Percutaneous Gastro Tube (Pro Cah)",,43246,CPT,Professional,Both,,,,1525,1296.25,121.29,1525,Sanford Health Plan,Sanford Health Plan,1342,88,,percent of total billed charges,,
"Egd, Flexible, Transoral; W Dir Placement Percutaneous Gastro Tube (Pro Cah)",,43246,CPT,Professional,Both,,,,1525,1296.25,121.29,1525,"UCare Health, Inc.",Individual & Family Plan,306.279296,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Egd, Flexible, Transoral; W Dir Placement Percutaneous Gastro Tube (Pro Cah)",,43246,CPT,Professional,Both,,,,1525,1296.25,121.29,1525,"UCare Health, Inc.",Medical Assistance,154.038808,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Egd, Flexible, Transoral; W Dir Placement Percutaneous Gastro Tube (Pro Cah)",,43246,CPT,Professional,Both,,,,1525,1296.25,121.29,1525,"UCare Health, Inc.",Medicare Advantage,216.6715,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Egd, Flexible, Transoral; W Dir Placement Percutaneous Gastro Tube (Pro Cah)",,43246,CPT,Professional,Both,,,,1525,1296.25,121.29,1525,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),173.3372,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Egd, Flexible, Transoral; W Dir Placement Percutaneous Gastro Tube (Pro Cah)",,43246,CPT,Professional,Both,,,,1525,1296.25,121.29,1525,UnitedHealthcare,Individual & Family,1525,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Egd, Flexible, Transoral; W Dir Placement Percutaneous Gastro Tube (Pro Cah)",,43246,CPT,Professional,Both,,,,1525,1296.25,121.29,1525,UnitedHealthcare,Medicare Advantage,216.6715,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Egd, Flexible, Transoral; W Dir Placement Percutaneous Gastro Tube (Pro Cah)",,43246,CPT,Professional,Both,,,,1525,1296.25,121.29,1525,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,140.03528,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Egd, Flexible, Transoral; With Removal Of Foreign Body(S) (Pro Cah)",,43247,CPT,Professional,Both,,,,996,846.6,107.98,996,Aetna,Commercial,846.6,85,,percent of total billed charges,,
"Egd, Flexible, Transoral; With Removal Of Foreign Body(S) (Pro Cah)",,43247,CPT,Professional,Both,,,,996,846.6,107.98,996,Aetna,Medicare Advantage,172.1,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Egd, Flexible, Transoral; With Removal Of Foreign Body(S) (Pro Cah)",,43247,CPT,Professional,Both,,,,996,846.6,107.98,996,Aetna,PPO,926.28,93,,percent of total billed charges,,
"Egd, Flexible, Transoral; With Removal Of Foreign Body(S) (Pro Cah)",,43247,CPT,Professional,Both,,,,996,846.6,107.98,996,America's PPO,America's PPO,850.9824,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Egd, Flexible, Transoral; With Removal Of Foreign Body(S) (Pro Cah)",,43247,CPT,Professional,Both,,,,996,846.6,107.98,996,BlueCross BlueShield Minnesota, Federal Employee Program,357.38,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Egd, Flexible, Transoral; With Removal Of Foreign Body(S) (Pro Cah)",,43247,CPT,Professional,Both,,,,996,846.6,107.98,996,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,363.09808,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Egd, Flexible, Transoral; With Removal Of Foreign Body(S) (Pro Cah)",,43247,CPT,Professional,Both,,,,996,846.6,107.98,996,BlueCross BlueShield Minnesota,High Value Network Plan,363.09808,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Egd, Flexible, Transoral; With Removal Of Foreign Body(S) (Pro Cah)",,43247,CPT,Professional,Both,,,,996,846.6,107.98,996,BlueCross BlueShield Minnesota,Medicare Advantage,192.993,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Egd, Flexible, Transoral; With Removal Of Foreign Body(S) (Pro Cah)",,43247,CPT,Professional,Both,,,,996,846.6,107.98,996,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,363.09808,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Egd, Flexible, Transoral; With Removal Of Foreign Body(S) (Pro Cah)",,43247,CPT,Professional,Both,,,,996,846.6,107.98,996,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,124.67336,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Egd, Flexible, Transoral; With Removal Of Foreign Body(S) (Pro Cah)",,43247,CPT,Professional,Both,,,,996,846.6,107.98,996,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),192.993,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Egd, Flexible, Transoral; With Removal Of Foreign Body(S) (Pro Cah)",,43247,CPT,Professional,Both,,,,996,846.6,107.98,996,CorVel,Worker's Compensation,332.4585867,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Egd, Flexible, Transoral; With Removal Of Foreign Body(S) (Pro Cah)",,43247,CPT,Professional,Both,,,,996,846.6,107.98,996,First Health Group Corporation,First Health Network,966.12,97,,percent of total billed charges,,
"Egd, Flexible, Transoral; With Removal Of Foreign Body(S) (Pro Cah)",,43247,CPT,Professional,Both,,,,996,846.6,107.98,996,"Health Partners, Inc.",Commercial,359.14,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Egd, Flexible, Transoral; With Removal Of Foreign Body(S) (Pro Cah)",,43247,CPT,Professional,Both,,,,996,846.6,107.98,996,"Health Partners, Inc.",Medicare Advantage,192.993,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Egd, Flexible, Transoral; With Removal Of Foreign Body(S) (Pro Cah)",,43247,CPT,Professional,Both,,,,996,846.6,107.98,996,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),167.74,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Egd, Flexible, Transoral; With Removal Of Foreign Body(S) (Pro Cah)",,43247,CPT,Professional,Both,,,,996,846.6,107.98,996,"Health Partners, Inc.",State of Minnesota Advantage Program,309.39911,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Egd, Flexible, Transoral; With Removal Of Foreign Body(S) (Pro Cah)",,43247,CPT,Professional,Both,,,,996,846.6,107.98,996,"Health Partners, Inc.",State Public Programs,107.98,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Egd, Flexible, Transoral; With Removal Of Foreign Body(S) (Pro Cah)",,43247,CPT,Professional,Both,,,,996,846.6,107.98,996,Humana Insurance Company,Commercial PPO,167.82,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Egd, Flexible, Transoral; With Removal Of Foreign Body(S) (Pro Cah)",,43247,CPT,Professional,Both,,,,996,846.6,107.98,996,Humana Insurance Company,Medicare PPO,996,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Egd, Flexible, Transoral; With Removal Of Foreign Body(S) (Pro Cah)",,43247,CPT,Professional,Both,,,,996,846.6,107.98,996,Medica,Individual & Family,844.608,84.8,,percent of total billed charges,,
"Egd, Flexible, Transoral; With Removal Of Foreign Body(S) (Pro Cah)",,43247,CPT,Professional,Both,,,,996,846.6,107.98,996,Medica,Medica Advantage Solution,496.008,49.8,,percent of total billed charges,,
"Egd, Flexible, Transoral; With Removal Of Foreign Body(S) (Pro Cah)",,43247,CPT,Professional,Both,,,,996,846.6,107.98,996,Medica,Medical Assistance,124.67,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Egd, Flexible, Transoral; With Removal Of Foreign Body(S) (Pro Cah)",,43247,CPT,Professional,Both,,,,996,846.6,107.98,996,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,167.82,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Egd, Flexible, Transoral; With Removal Of Foreign Body(S) (Pro Cah)",,43247,CPT,Professional,Both,,,,996,846.6,107.98,996,"Multiplan, Inc.","Multiplan, Inc.",936.24,94,,percent of total billed charges,,
"Egd, Flexible, Transoral; With Removal Of Foreign Body(S) (Pro Cah)",,43247,CPT,Professional,Both,,,,996,846.6,107.98,996,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,897.396,90.1,,percent of total billed charges,,
"Egd, Flexible, Transoral; With Removal Of Foreign Body(S) (Pro Cah)",,43247,CPT,Professional,Both,,,,996,846.6,107.98,996,"Preferred One Administrative Services, INC.",PPO,982.056,98.6,,percent of total billed charges,,
"Egd, Flexible, Transoral; With Removal Of Foreign Body(S) (Pro Cah)",,43247,CPT,Professional,Both,,,,996,846.6,107.98,996,PrimeWest Health,Minnesota Senior Health Options (MSHO),192.993,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Egd, Flexible, Transoral; With Removal Of Foreign Body(S) (Pro Cah)",,43247,CPT,Professional,Both,,,,996,846.6,107.98,996,PrimeWest Health,MinnesotaCare,133.4004952,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Egd, Flexible, Transoral; With Removal Of Foreign Body(S) (Pro Cah)",,43247,CPT,Professional,Both,,,,996,846.6,107.98,996,Sanford Health Plan,Sanford Health Plan,876.48,88,,percent of total billed charges,,
"Egd, Flexible, Transoral; With Removal Of Foreign Body(S) (Pro Cah)",,43247,CPT,Professional,Both,,,,996,846.6,107.98,996,"UCare Health, Inc.",Individual & Family Plan,272.808192,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Egd, Flexible, Transoral; With Removal Of Foreign Body(S) (Pro Cah)",,43247,CPT,Professional,Both,,,,996,846.6,107.98,996,"UCare Health, Inc.",Medical Assistance,137.140696,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Egd, Flexible, Transoral; With Removal Of Foreign Body(S) (Pro Cah)",,43247,CPT,Professional,Both,,,,996,846.6,107.98,996,"UCare Health, Inc.",Medicare Advantage,192.993,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Egd, Flexible, Transoral; With Removal Of Foreign Body(S) (Pro Cah)",,43247,CPT,Professional,Both,,,,996,846.6,107.98,996,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),154.3944,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Egd, Flexible, Transoral; With Removal Of Foreign Body(S) (Pro Cah)",,43247,CPT,Professional,Both,,,,996,846.6,107.98,996,UnitedHealthcare,Individual & Family,996,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Egd, Flexible, Transoral; With Removal Of Foreign Body(S) (Pro Cah)",,43247,CPT,Professional,Both,,,,996,846.6,107.98,996,UnitedHealthcare,Medicare Advantage,192.993,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Egd, Flexible, Transoral; With Removal Of Foreign Body(S) (Pro Cah)",,43247,CPT,Professional,Both,,,,996,846.6,107.98,996,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,124.67336,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Egd, Flexible, Transoral; W Transendoscopic Balloon Dilation Of Esophagus (Less Than 30 Mm Diameter) (Pro Cah)",,43249,CPT,Professional,Both,,,,1188,1009.8,93.8,1188,Aetna,Commercial,1009.8,85,,percent of total billed charges,,
"Egd, Flexible, Transoral; W Transendoscopic Balloon Dilation Of Esophagus (Less Than 30 Mm Diameter) (Pro Cah)",,43249,CPT,Professional,Both,,,,1188,1009.8,93.8,1188,Aetna,Medicare Advantage,149.65,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Egd, Flexible, Transoral; W Transendoscopic Balloon Dilation Of Esophagus (Less Than 30 Mm Diameter) (Pro Cah)",,43249,CPT,Professional,Both,,,,1188,1009.8,93.8,1188,Aetna,PPO,1104.84,93,,percent of total billed charges,,
"Egd, Flexible, Transoral; W Transendoscopic Balloon Dilation Of Esophagus (Less Than 30 Mm Diameter) (Pro Cah)",,43249,CPT,Professional,Both,,,,1188,1009.8,93.8,1188,America's PPO,America's PPO,1015.0272,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Egd, Flexible, Transoral; W Transendoscopic Balloon Dilation Of Esophagus (Less Than 30 Mm Diameter) (Pro Cah)",,43249,CPT,Professional,Both,,,,1188,1009.8,93.8,1188,BlueCross BlueShield Minnesota, Federal Employee Program,310.56,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Egd, Flexible, Transoral; W Transendoscopic Balloon Dilation Of Esophagus (Less Than 30 Mm Diameter) (Pro Cah)",,43249,CPT,Professional,Both,,,,1188,1009.8,93.8,1188,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,315.52896,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Egd, Flexible, Transoral; W Transendoscopic Balloon Dilation Of Esophagus (Less Than 30 Mm Diameter) (Pro Cah)",,43249,CPT,Professional,Both,,,,1188,1009.8,93.8,1188,BlueCross BlueShield Minnesota,High Value Network Plan,315.52896,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Egd, Flexible, Transoral; W Transendoscopic Balloon Dilation Of Esophagus (Less Than 30 Mm Diameter) (Pro Cah)",,43249,CPT,Professional,Both,,,,1188,1009.8,93.8,1188,BlueCross BlueShield Minnesota,Medicare Advantage,167.9345,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Egd, Flexible, Transoral; W Transendoscopic Balloon Dilation Of Esophagus (Less Than 30 Mm Diameter) (Pro Cah)",,43249,CPT,Professional,Both,,,,1188,1009.8,93.8,1188,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,315.52896,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Egd, Flexible, Transoral; W Transendoscopic Balloon Dilation Of Esophagus (Less Than 30 Mm Diameter) (Pro Cah)",,43249,CPT,Professional,Both,,,,1188,1009.8,93.8,1188,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,108.29544,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Egd, Flexible, Transoral; W Transendoscopic Balloon Dilation Of Esophagus (Less Than 30 Mm Diameter) (Pro Cah)",,43249,CPT,Professional,Both,,,,1188,1009.8,93.8,1188,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),167.9345,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Egd, Flexible, Transoral; W Transendoscopic Balloon Dilation Of Esophagus (Less Than 30 Mm Diameter) (Pro Cah)",,43249,CPT,Professional,Both,,,,1188,1009.8,93.8,1188,CorVel,Worker's Compensation,288.9962382,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Egd, Flexible, Transoral; W Transendoscopic Balloon Dilation Of Esophagus (Less Than 30 Mm Diameter) (Pro Cah)",,43249,CPT,Professional,Both,,,,1188,1009.8,93.8,1188,First Health Group Corporation,First Health Network,1152.36,97,,percent of total billed charges,,
"Egd, Flexible, Transoral; W Transendoscopic Balloon Dilation Of Esophagus (Less Than 30 Mm Diameter) (Pro Cah)",,43249,CPT,Professional,Both,,,,1188,1009.8,93.8,1188,"Health Partners, Inc.",Commercial,311.97,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Egd, Flexible, Transoral; W Transendoscopic Balloon Dilation Of Esophagus (Less Than 30 Mm Diameter) (Pro Cah)",,43249,CPT,Professional,Both,,,,1188,1009.8,93.8,1188,"Health Partners, Inc.",Medicare Advantage,167.9345,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Egd, Flexible, Transoral; W Transendoscopic Balloon Dilation Of Esophagus (Less Than 30 Mm Diameter) (Pro Cah)",,43249,CPT,Professional,Both,,,,1188,1009.8,93.8,1188,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),146.05,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Egd, Flexible, Transoral; W Transendoscopic Balloon Dilation Of Esophagus (Less Than 30 Mm Diameter) (Pro Cah)",,43249,CPT,Professional,Both,,,,1188,1009.8,93.8,1188,"Health Partners, Inc.",State of Minnesota Advantage Program,268.762155,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Egd, Flexible, Transoral; W Transendoscopic Balloon Dilation Of Esophagus (Less Than 30 Mm Diameter) (Pro Cah)",,43249,CPT,Professional,Both,,,,1188,1009.8,93.8,1188,"Health Partners, Inc.",State Public Programs,93.8,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Egd, Flexible, Transoral; W Transendoscopic Balloon Dilation Of Esophagus (Less Than 30 Mm Diameter) (Pro Cah)",,43249,CPT,Professional,Both,,,,1188,1009.8,93.8,1188,Humana Insurance Company,Commercial PPO,146.03,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Egd, Flexible, Transoral; W Transendoscopic Balloon Dilation Of Esophagus (Less Than 30 Mm Diameter) (Pro Cah)",,43249,CPT,Professional,Both,,,,1188,1009.8,93.8,1188,Humana Insurance Company,Medicare PPO,1188,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Egd, Flexible, Transoral; W Transendoscopic Balloon Dilation Of Esophagus (Less Than 30 Mm Diameter) (Pro Cah)",,43249,CPT,Professional,Both,,,,1188,1009.8,93.8,1188,Medica,Individual & Family,1007.424,84.8,,percent of total billed charges,,
"Egd, Flexible, Transoral; W Transendoscopic Balloon Dilation Of Esophagus (Less Than 30 Mm Diameter) (Pro Cah)",,43249,CPT,Professional,Both,,,,1188,1009.8,93.8,1188,Medica,Medica Advantage Solution,591.624,49.8,,percent of total billed charges,,
"Egd, Flexible, Transoral; W Transendoscopic Balloon Dilation Of Esophagus (Less Than 30 Mm Diameter) (Pro Cah)",,43249,CPT,Professional,Both,,,,1188,1009.8,93.8,1188,Medica,Medical Assistance,108.3,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Egd, Flexible, Transoral; W Transendoscopic Balloon Dilation Of Esophagus (Less Than 30 Mm Diameter) (Pro Cah)",,43249,CPT,Professional,Both,,,,1188,1009.8,93.8,1188,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,146.03,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Egd, Flexible, Transoral; W Transendoscopic Balloon Dilation Of Esophagus (Less Than 30 Mm Diameter) (Pro Cah)",,43249,CPT,Professional,Both,,,,1188,1009.8,93.8,1188,"Multiplan, Inc.","Multiplan, Inc.",1116.72,94,,percent of total billed charges,,
"Egd, Flexible, Transoral; W Transendoscopic Balloon Dilation Of Esophagus (Less Than 30 Mm Diameter) (Pro Cah)",,43249,CPT,Professional,Both,,,,1188,1009.8,93.8,1188,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1070.388,90.1,,percent of total billed charges,,
"Egd, Flexible, Transoral; W Transendoscopic Balloon Dilation Of Esophagus (Less Than 30 Mm Diameter) (Pro Cah)",,43249,CPT,Professional,Both,,,,1188,1009.8,93.8,1188,"Preferred One Administrative Services, INC.",PPO,1171.368,98.6,,percent of total billed charges,,
"Egd, Flexible, Transoral; W Transendoscopic Balloon Dilation Of Esophagus (Less Than 30 Mm Diameter) (Pro Cah)",,43249,CPT,Professional,Both,,,,1188,1009.8,93.8,1188,PrimeWest Health,Minnesota Senior Health Options (MSHO),167.9345,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Egd, Flexible, Transoral; W Transendoscopic Balloon Dilation Of Esophagus (Less Than 30 Mm Diameter) (Pro Cah)",,43249,CPT,Professional,Both,,,,1188,1009.8,93.8,1188,PrimeWest Health,MinnesotaCare,115.8761208,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Egd, Flexible, Transoral; W Transendoscopic Balloon Dilation Of Esophagus (Less Than 30 Mm Diameter) (Pro Cah)",,43249,CPT,Professional,Both,,,,1188,1009.8,93.8,1188,Sanford Health Plan,Sanford Health Plan,1045.44,88,,percent of total billed charges,,
"Egd, Flexible, Transoral; W Transendoscopic Balloon Dilation Of Esophagus (Less Than 30 Mm Diameter) (Pro Cah)",,43249,CPT,Professional,Both,,,,1188,1009.8,93.8,1188,"UCare Health, Inc.",Individual & Family Plan,237.386368,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Egd, Flexible, Transoral; W Transendoscopic Balloon Dilation Of Esophagus (Less Than 30 Mm Diameter) (Pro Cah)",,43249,CPT,Professional,Both,,,,1188,1009.8,93.8,1188,"UCare Health, Inc.",Medical Assistance,119.124984,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Egd, Flexible, Transoral; W Transendoscopic Balloon Dilation Of Esophagus (Less Than 30 Mm Diameter) (Pro Cah)",,43249,CPT,Professional,Both,,,,1188,1009.8,93.8,1188,"UCare Health, Inc.",Medicare Advantage,167.9345,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Egd, Flexible, Transoral; W Transendoscopic Balloon Dilation Of Esophagus (Less Than 30 Mm Diameter) (Pro Cah)",,43249,CPT,Professional,Both,,,,1188,1009.8,93.8,1188,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),134.3476,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Egd, Flexible, Transoral; W Transendoscopic Balloon Dilation Of Esophagus (Less Than 30 Mm Diameter) (Pro Cah)",,43249,CPT,Professional,Both,,,,1188,1009.8,93.8,1188,UnitedHealthcare,Individual & Family,1188,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Egd, Flexible, Transoral; W Transendoscopic Balloon Dilation Of Esophagus (Less Than 30 Mm Diameter) (Pro Cah)",,43249,CPT,Professional,Both,,,,1188,1009.8,93.8,1188,UnitedHealthcare,Medicare Advantage,167.9345,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Egd, Flexible, Transoral; W Transendoscopic Balloon Dilation Of Esophagus (Less Than 30 Mm Diameter) (Pro Cah)",,43249,CPT,Professional,Both,,,,1188,1009.8,93.8,1188,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,108.29544,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Egd, Flexible, Transoral; W Removal Of Tumor(S), Polyp(S), Or Other Lesion(S) By Snare Technique (Pro Cah)",,43251,CPT,Professional,Both,,,,1326,1127.1,119.98,1326,Aetna,Commercial,1127.1,85,,percent of total billed charges,,
"Egd, Flexible, Transoral; W Removal Of Tumor(S), Polyp(S), Or Other Lesion(S) By Snare Technique (Pro Cah)",,43251,CPT,Professional,Both,,,,1326,1127.1,119.98,1326,Aetna,Medicare Advantage,190.92,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Egd, Flexible, Transoral; W Removal Of Tumor(S), Polyp(S), Or Other Lesion(S) By Snare Technique (Pro Cah)",,43251,CPT,Professional,Both,,,,1326,1127.1,119.98,1326,Aetna,PPO,1233.18,93,,percent of total billed charges,,
"Egd, Flexible, Transoral; W Removal Of Tumor(S), Polyp(S), Or Other Lesion(S) By Snare Technique (Pro Cah)",,43251,CPT,Professional,Both,,,,1326,1127.1,119.98,1326,America's PPO,America's PPO,1132.9344,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Egd, Flexible, Transoral; W Removal Of Tumor(S), Polyp(S), Or Other Lesion(S) By Snare Technique (Pro Cah)",,43251,CPT,Professional,Both,,,,1326,1127.1,119.98,1326,BlueCross BlueShield Minnesota, Federal Employee Program,395.95,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Egd, Flexible, Transoral; W Removal Of Tumor(S), Polyp(S), Or Other Lesion(S) By Snare Technique (Pro Cah)",,43251,CPT,Professional,Both,,,,1326,1127.1,119.98,1326,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,402.2852,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Egd, Flexible, Transoral; W Removal Of Tumor(S), Polyp(S), Or Other Lesion(S) By Snare Technique (Pro Cah)",,43251,CPT,Professional,Both,,,,1326,1127.1,119.98,1326,BlueCross BlueShield Minnesota,High Value Network Plan,402.2852,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Egd, Flexible, Transoral; W Removal Of Tumor(S), Polyp(S), Or Other Lesion(S) By Snare Technique (Pro Cah)",,43251,CPT,Professional,Both,,,,1326,1127.1,119.98,1326,BlueCross BlueShield Minnesota,Medicare Advantage,214.429,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Egd, Flexible, Transoral; W Removal Of Tumor(S), Polyp(S), Or Other Lesion(S) By Snare Technique (Pro Cah)",,43251,CPT,Professional,Both,,,,1326,1127.1,119.98,1326,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,402.2852,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Egd, Flexible, Transoral; W Removal Of Tumor(S), Polyp(S), Or Other Lesion(S) By Snare Technique (Pro Cah)",,43251,CPT,Professional,Both,,,,1326,1127.1,119.98,1326,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,138.52144,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Egd, Flexible, Transoral; W Removal Of Tumor(S), Polyp(S), Or Other Lesion(S) By Snare Technique (Pro Cah)",,43251,CPT,Professional,Both,,,,1326,1127.1,119.98,1326,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),214.429,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Egd, Flexible, Transoral; W Removal Of Tumor(S), Polyp(S), Or Other Lesion(S) By Snare Technique (Pro Cah)",,43251,CPT,Professional,Both,,,,1326,1127.1,119.98,1326,CorVel,Worker's Compensation,369.1246746,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Egd, Flexible, Transoral; W Removal Of Tumor(S), Polyp(S), Or Other Lesion(S) By Snare Technique (Pro Cah)",,43251,CPT,Professional,Both,,,,1326,1127.1,119.98,1326,First Health Group Corporation,First Health Network,1286.22,97,,percent of total billed charges,,
"Egd, Flexible, Transoral; W Removal Of Tumor(S), Polyp(S), Or Other Lesion(S) By Snare Technique (Pro Cah)",,43251,CPT,Professional,Both,,,,1326,1127.1,119.98,1326,"Health Partners, Inc.",Commercial,398.31,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Egd, Flexible, Transoral; W Removal Of Tumor(S), Polyp(S), Or Other Lesion(S) By Snare Technique (Pro Cah)",,43251,CPT,Professional,Both,,,,1326,1127.1,119.98,1326,"Health Partners, Inc.",Medicare Advantage,214.429,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Egd, Flexible, Transoral; W Removal Of Tumor(S), Polyp(S), Or Other Lesion(S) By Snare Technique (Pro Cah)",,43251,CPT,Professional,Both,,,,1326,1127.1,119.98,1326,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),186.72,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Egd, Flexible, Transoral; W Removal Of Tumor(S), Polyp(S), Or Other Lesion(S) By Snare Technique (Pro Cah)",,43251,CPT,Professional,Both,,,,1326,1127.1,119.98,1326,"Health Partners, Inc.",State of Minnesota Advantage Program,343.144065,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Egd, Flexible, Transoral; W Removal Of Tumor(S), Polyp(S), Or Other Lesion(S) By Snare Technique (Pro Cah)",,43251,CPT,Professional,Both,,,,1326,1127.1,119.98,1326,"Health Partners, Inc.",State Public Programs,119.98,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Egd, Flexible, Transoral; W Removal Of Tumor(S), Polyp(S), Or Other Lesion(S) By Snare Technique (Pro Cah)",,43251,CPT,Professional,Both,,,,1326,1127.1,119.98,1326,Humana Insurance Company,Commercial PPO,186.46,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Egd, Flexible, Transoral; W Removal Of Tumor(S), Polyp(S), Or Other Lesion(S) By Snare Technique (Pro Cah)",,43251,CPT,Professional,Both,,,,1326,1127.1,119.98,1326,Humana Insurance Company,Medicare PPO,1326,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Egd, Flexible, Transoral; W Removal Of Tumor(S), Polyp(S), Or Other Lesion(S) By Snare Technique (Pro Cah)",,43251,CPT,Professional,Both,,,,1326,1127.1,119.98,1326,Medica,Individual & Family,1124.448,84.8,,percent of total billed charges,,
"Egd, Flexible, Transoral; W Removal Of Tumor(S), Polyp(S), Or Other Lesion(S) By Snare Technique (Pro Cah)",,43251,CPT,Professional,Both,,,,1326,1127.1,119.98,1326,Medica,Medica Advantage Solution,660.348,49.8,,percent of total billed charges,,
"Egd, Flexible, Transoral; W Removal Of Tumor(S), Polyp(S), Or Other Lesion(S) By Snare Technique (Pro Cah)",,43251,CPT,Professional,Both,,,,1326,1127.1,119.98,1326,Medica,Medical Assistance,138.52,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Egd, Flexible, Transoral; W Removal Of Tumor(S), Polyp(S), Or Other Lesion(S) By Snare Technique (Pro Cah)",,43251,CPT,Professional,Both,,,,1326,1127.1,119.98,1326,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,186.46,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Egd, Flexible, Transoral; W Removal Of Tumor(S), Polyp(S), Or Other Lesion(S) By Snare Technique (Pro Cah)",,43251,CPT,Professional,Both,,,,1326,1127.1,119.98,1326,"Multiplan, Inc.","Multiplan, Inc.",1246.44,94,,percent of total billed charges,,
"Egd, Flexible, Transoral; W Removal Of Tumor(S), Polyp(S), Or Other Lesion(S) By Snare Technique (Pro Cah)",,43251,CPT,Professional,Both,,,,1326,1127.1,119.98,1326,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1194.726,90.1,,percent of total billed charges,,
"Egd, Flexible, Transoral; W Removal Of Tumor(S), Polyp(S), Or Other Lesion(S) By Snare Technique (Pro Cah)",,43251,CPT,Professional,Both,,,,1326,1127.1,119.98,1326,"Preferred One Administrative Services, INC.",PPO,1307.436,98.6,,percent of total billed charges,,
"Egd, Flexible, Transoral; W Removal Of Tumor(S), Polyp(S), Or Other Lesion(S) By Snare Technique (Pro Cah)",,43251,CPT,Professional,Both,,,,1326,1127.1,119.98,1326,PrimeWest Health,Minnesota Senior Health Options (MSHO),214.429,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Egd, Flexible, Transoral; W Removal Of Tumor(S), Polyp(S), Or Other Lesion(S) By Snare Technique (Pro Cah)",,43251,CPT,Professional,Both,,,,1326,1127.1,119.98,1326,PrimeWest Health,MinnesotaCare,148.2179408,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Egd, Flexible, Transoral; W Removal Of Tumor(S), Polyp(S), Or Other Lesion(S) By Snare Technique (Pro Cah)",,43251,CPT,Professional,Both,,,,1326,1127.1,119.98,1326,Sanford Health Plan,Sanford Health Plan,1166.88,88,,percent of total billed charges,,
"Egd, Flexible, Transoral; W Removal Of Tumor(S), Polyp(S), Or Other Lesion(S) By Snare Technique (Pro Cah)",,43251,CPT,Professional,Both,,,,1326,1127.1,119.98,1326,"UCare Health, Inc.",Individual & Family Plan,303.109376,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Egd, Flexible, Transoral; W Removal Of Tumor(S), Polyp(S), Or Other Lesion(S) By Snare Technique (Pro Cah)",,43251,CPT,Professional,Both,,,,1326,1127.1,119.98,1326,"UCare Health, Inc.",Medical Assistance,152.373584,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Egd, Flexible, Transoral; W Removal Of Tumor(S), Polyp(S), Or Other Lesion(S) By Snare Technique (Pro Cah)",,43251,CPT,Professional,Both,,,,1326,1127.1,119.98,1326,"UCare Health, Inc.",Medicare Advantage,214.429,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Egd, Flexible, Transoral; W Removal Of Tumor(S), Polyp(S), Or Other Lesion(S) By Snare Technique (Pro Cah)",,43251,CPT,Professional,Both,,,,1326,1127.1,119.98,1326,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),171.5432,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Egd, Flexible, Transoral; W Removal Of Tumor(S), Polyp(S), Or Other Lesion(S) By Snare Technique (Pro Cah)",,43251,CPT,Professional,Both,,,,1326,1127.1,119.98,1326,UnitedHealthcare,Individual & Family,1326,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Egd, Flexible, Transoral; W Removal Of Tumor(S), Polyp(S), Or Other Lesion(S) By Snare Technique (Pro Cah)",,43251,CPT,Professional,Both,,,,1326,1127.1,119.98,1326,UnitedHealthcare,Medicare Advantage,214.429,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Egd, Flexible, Transoral; W Removal Of Tumor(S), Polyp(S), Or Other Lesion(S) By Snare Technique (Pro Cah)",,43251,CPT,Professional,Both,,,,1326,1127.1,119.98,1326,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,138.52144,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Laparoscopy, Surgical, Esophagogastric Fundoplasty (Pro Cah)",,43280,CPT,Professional,Both,,,,4274,3632.9,640.49,4274,Aetna,Commercial,3632.9,85,,percent of total billed charges,,
"Laparoscopy, Surgical, Esophagogastric Fundoplasty (Pro Cah)",,43280,CPT,Professional,Both,,,,4274,3632.9,640.49,4274,Aetna,Medicare Advantage,1019.28,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Laparoscopy, Surgical, Esophagogastric Fundoplasty (Pro Cah)",,43280,CPT,Professional,Both,,,,4274,3632.9,640.49,4274,Aetna,PPO,3974.82,93,,percent of total billed charges,,
"Laparoscopy, Surgical, Esophagogastric Fundoplasty (Pro Cah)",,43280,CPT,Professional,Both,,,,4274,3632.9,640.49,4274,America's PPO,America's PPO,3651.7056,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Laparoscopy, Surgical, Esophagogastric Fundoplasty (Pro Cah)",,43280,CPT,Professional,Both,,,,4274,3632.9,640.49,4274,BlueCross BlueShield Minnesota, Federal Employee Program,2215.23,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Laparoscopy, Surgical, Esophagogastric Fundoplasty (Pro Cah)",,43280,CPT,Professional,Both,,,,4274,3632.9,640.49,4274,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,2250.67368,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Laparoscopy, Surgical, Esophagogastric Fundoplasty (Pro Cah)",,43280,CPT,Professional,Both,,,,4274,3632.9,640.49,4274,BlueCross BlueShield Minnesota,High Value Network Plan,2250.67368,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Laparoscopy, Surgical, Esophagogastric Fundoplasty (Pro Cah)",,43280,CPT,Professional,Both,,,,4274,3632.9,640.49,4274,BlueCross BlueShield Minnesota,Medicare Advantage,1144.0545,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Laparoscopy, Surgical, Esophagogastric Fundoplasty (Pro Cah)",,43280,CPT,Professional,Both,,,,4274,3632.9,640.49,4274,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,2250.67368,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Laparoscopy, Surgical, Esophagogastric Fundoplasty (Pro Cah)",,43280,CPT,Professional,Both,,,,4274,3632.9,640.49,4274,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,739.47528,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Laparoscopy, Surgical, Esophagogastric Fundoplasty (Pro Cah)",,43280,CPT,Professional,Both,,,,4274,3632.9,640.49,4274,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1144.0545,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Laparoscopy, Surgical, Esophagogastric Fundoplasty (Pro Cah)",,43280,CPT,Professional,Both,,,,4274,3632.9,640.49,4274,CorVel,Worker's Compensation,1974.062489,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Laparoscopy, Surgical, Esophagogastric Fundoplasty (Pro Cah)",,43280,CPT,Professional,Both,,,,4274,3632.9,640.49,4274,First Health Group Corporation,First Health Network,4145.78,97,,percent of total billed charges,,
"Laparoscopy, Surgical, Esophagogastric Fundoplasty (Pro Cah)",,43280,CPT,Professional,Both,,,,4274,3632.9,640.49,4274,"Health Partners, Inc.",Commercial,2131.6,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Laparoscopy, Surgical, Esophagogastric Fundoplasty (Pro Cah)",,43280,CPT,Professional,Both,,,,4274,3632.9,640.49,4274,"Health Partners, Inc.",Medicare Advantage,1144.0545,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Laparoscopy, Surgical, Esophagogastric Fundoplasty (Pro Cah)",,43280,CPT,Professional,Both,,,,4274,3632.9,640.49,4274,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),994.59,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Laparoscopy, Surgical, Esophagogastric Fundoplasty (Pro Cah)",,43280,CPT,Professional,Both,,,,4274,3632.9,640.49,4274,"Health Partners, Inc.",State of Minnesota Advantage Program,1836.3734,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Laparoscopy, Surgical, Esophagogastric Fundoplasty (Pro Cah)",,43280,CPT,Professional,Both,,,,4274,3632.9,640.49,4274,"Health Partners, Inc.",State Public Programs,640.49,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Laparoscopy, Surgical, Esophagogastric Fundoplasty (Pro Cah)",,43280,CPT,Professional,Both,,,,4274,3632.9,640.49,4274,Humana Insurance Company,Commercial PPO,994.83,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Laparoscopy, Surgical, Esophagogastric Fundoplasty (Pro Cah)",,43280,CPT,Professional,Both,,,,4274,3632.9,640.49,4274,Humana Insurance Company,Medicare PPO,4274,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Laparoscopy, Surgical, Esophagogastric Fundoplasty (Pro Cah)",,43280,CPT,Professional,Both,,,,4274,3632.9,640.49,4274,Medica,Individual & Family,3624.352,84.8,,percent of total billed charges,,
"Laparoscopy, Surgical, Esophagogastric Fundoplasty (Pro Cah)",,43280,CPT,Professional,Both,,,,4274,3632.9,640.49,4274,Medica,Medica Advantage Solution,2128.452,49.8,,percent of total billed charges,,
"Laparoscopy, Surgical, Esophagogastric Fundoplasty (Pro Cah)",,43280,CPT,Professional,Both,,,,4274,3632.9,640.49,4274,Medica,Medical Assistance,739.48,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Laparoscopy, Surgical, Esophagogastric Fundoplasty (Pro Cah)",,43280,CPT,Professional,Both,,,,4274,3632.9,640.49,4274,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,994.83,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Laparoscopy, Surgical, Esophagogastric Fundoplasty (Pro Cah)",,43280,CPT,Professional,Both,,,,4274,3632.9,640.49,4274,"Multiplan, Inc.","Multiplan, Inc.",4017.56,94,,percent of total billed charges,,
"Laparoscopy, Surgical, Esophagogastric Fundoplasty (Pro Cah)",,43280,CPT,Professional,Both,,,,4274,3632.9,640.49,4274,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,3850.874,90.1,,percent of total billed charges,,
"Laparoscopy, Surgical, Esophagogastric Fundoplasty (Pro Cah)",,43280,CPT,Professional,Both,,,,4274,3632.9,640.49,4274,"Preferred One Administrative Services, INC.",PPO,4214.164,98.6,,percent of total billed charges,,
"Laparoscopy, Surgical, Esophagogastric Fundoplasty (Pro Cah)",,43280,CPT,Professional,Both,,,,4274,3632.9,640.49,4274,PrimeWest Health,Minnesota Senior Health Options (MSHO),1144.0545,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Laparoscopy, Surgical, Esophagogastric Fundoplasty (Pro Cah)",,43280,CPT,Professional,Both,,,,4274,3632.9,640.49,4274,PrimeWest Health,MinnesotaCare,791.2385496,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Laparoscopy, Surgical, Esophagogastric Fundoplasty (Pro Cah)",,43280,CPT,Professional,Both,,,,4274,3632.9,640.49,4274,Sanford Health Plan,Sanford Health Plan,3761.12,88,,percent of total billed charges,,
"Laparoscopy, Surgical, Esophagogastric Fundoplasty (Pro Cah)",,43280,CPT,Professional,Both,,,,4274,3632.9,640.49,4274,"UCare Health, Inc.",Individual & Family Plan,1617.195648,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Laparoscopy, Surgical, Esophagogastric Fundoplasty (Pro Cah)",,43280,CPT,Professional,Both,,,,4274,3632.9,640.49,4274,"UCare Health, Inc.",Medical Assistance,813.422808,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Laparoscopy, Surgical, Esophagogastric Fundoplasty (Pro Cah)",,43280,CPT,Professional,Both,,,,4274,3632.9,640.49,4274,"UCare Health, Inc.",Medicare Advantage,1144.0545,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Laparoscopy, Surgical, Esophagogastric Fundoplasty (Pro Cah)",,43280,CPT,Professional,Both,,,,4274,3632.9,640.49,4274,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),915.2436,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Laparoscopy, Surgical, Esophagogastric Fundoplasty (Pro Cah)",,43280,CPT,Professional,Both,,,,4274,3632.9,640.49,4274,UnitedHealthcare,Individual & Family,4274,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Laparoscopy, Surgical, Esophagogastric Fundoplasty (Pro Cah)",,43280,CPT,Professional,Both,,,,4274,3632.9,640.49,4274,UnitedHealthcare,Medicare Advantage,1144.0545,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Laparoscopy, Surgical, Esophagogastric Fundoplasty (Pro Cah)",,43280,CPT,Professional,Both,,,,4274,3632.9,640.49,4274,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,739.47528,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Laproscopy, Surgical, Repair Paraesophagel Hernia, Includes Fundoplasty, W/O Mesh (Pro Cah)",,43281,CPT,Professional,Both,,,,6482,5509.7,907.51,6482,Aetna,Commercial,5509.7,85,,percent of total billed charges,,
"Laproscopy, Surgical, Repair Paraesophagel Hernia, Includes Fundoplasty, W/O Mesh (Pro Cah)",,43281,CPT,Professional,Both,,,,6482,5509.7,907.51,6482,Aetna,Medicare Advantage,1449.63,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Laproscopy, Surgical, Repair Paraesophagel Hernia, Includes Fundoplasty, W/O Mesh (Pro Cah)",,43281,CPT,Professional,Both,,,,6482,5509.7,907.51,6482,Aetna,PPO,6028.26,93,,percent of total billed charges,,
"Laproscopy, Surgical, Repair Paraesophagel Hernia, Includes Fundoplasty, W/O Mesh (Pro Cah)",,43281,CPT,Professional,Both,,,,6482,5509.7,907.51,6482,America's PPO,America's PPO,5538.2208,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Laproscopy, Surgical, Repair Paraesophagel Hernia, Includes Fundoplasty, W/O Mesh (Pro Cah)",,43281,CPT,Professional,Both,,,,6482,5509.7,907.51,6482,BlueCross BlueShield Minnesota, Federal Employee Program,3151.72,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Laproscopy, Surgical, Repair Paraesophagel Hernia, Includes Fundoplasty, W/O Mesh (Pro Cah)",,43281,CPT,Professional,Both,,,,6482,5509.7,907.51,6482,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,3202.14752,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Laproscopy, Surgical, Repair Paraesophagel Hernia, Includes Fundoplasty, W/O Mesh (Pro Cah)",,43281,CPT,Professional,Both,,,,6482,5509.7,907.51,6482,BlueCross BlueShield Minnesota,High Value Network Plan,3202.14752,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Laproscopy, Surgical, Repair Paraesophagel Hernia, Includes Fundoplasty, W/O Mesh (Pro Cah)",,43281,CPT,Professional,Both,,,,6482,5509.7,907.51,6482,BlueCross BlueShield Minnesota,Medicare Advantage,1621.891,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Laproscopy, Surgical, Repair Paraesophagel Hernia, Includes Fundoplasty, W/O Mesh (Pro Cah)",,43281,CPT,Professional,Both,,,,6482,5509.7,907.51,6482,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,3202.14752,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Laproscopy, Surgical, Repair Paraesophagel Hernia, Includes Fundoplasty, W/O Mesh (Pro Cah)",,43281,CPT,Professional,Both,,,,6482,5509.7,907.51,6482,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1047.76016,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Laproscopy, Surgical, Repair Paraesophagel Hernia, Includes Fundoplasty, W/O Mesh (Pro Cah)",,43281,CPT,Professional,Both,,,,6482,5509.7,907.51,6482,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1621.891,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Laproscopy, Surgical, Repair Paraesophagel Hernia, Includes Fundoplasty, W/O Mesh (Pro Cah)",,43281,CPT,Professional,Both,,,,6482,5509.7,907.51,6482,CorVel,Worker's Compensation,2802.80662,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Laproscopy, Surgical, Repair Paraesophagel Hernia, Includes Fundoplasty, W/O Mesh (Pro Cah)",,43281,CPT,Professional,Both,,,,6482,5509.7,907.51,6482,First Health Group Corporation,First Health Network,6287.54,97,,percent of total billed charges,,
"Laproscopy, Surgical, Repair Paraesophagel Hernia, Includes Fundoplasty, W/O Mesh (Pro Cah)",,43281,CPT,Professional,Both,,,,6482,5509.7,907.51,6482,"Health Partners, Inc.",Commercial,3026.9,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Laproscopy, Surgical, Repair Paraesophagel Hernia, Includes Fundoplasty, W/O Mesh (Pro Cah)",,43281,CPT,Professional,Both,,,,6482,5509.7,907.51,6482,"Health Partners, Inc.",Medicare Advantage,1621.891,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Laproscopy, Surgical, Repair Paraesophagel Hernia, Includes Fundoplasty, W/O Mesh (Pro Cah)",,43281,CPT,Professional,Both,,,,6482,5509.7,907.51,6482,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1410.39,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Laproscopy, Surgical, Repair Paraesophagel Hernia, Includes Fundoplasty, W/O Mesh (Pro Cah)",,43281,CPT,Professional,Both,,,,6482,5509.7,907.51,6482,"Health Partners, Inc.",State of Minnesota Advantage Program,2607.67435,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Laproscopy, Surgical, Repair Paraesophagel Hernia, Includes Fundoplasty, W/O Mesh (Pro Cah)",,43281,CPT,Professional,Both,,,,6482,5509.7,907.51,6482,"Health Partners, Inc.",State Public Programs,907.51,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Laproscopy, Surgical, Repair Paraesophagel Hernia, Includes Fundoplasty, W/O Mesh (Pro Cah)",,43281,CPT,Professional,Both,,,,6482,5509.7,907.51,6482,Humana Insurance Company,Commercial PPO,1410.34,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Laproscopy, Surgical, Repair Paraesophagel Hernia, Includes Fundoplasty, W/O Mesh (Pro Cah)",,43281,CPT,Professional,Both,,,,6482,5509.7,907.51,6482,Humana Insurance Company,Medicare PPO,6482,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Laproscopy, Surgical, Repair Paraesophagel Hernia, Includes Fundoplasty, W/O Mesh (Pro Cah)",,43281,CPT,Professional,Both,,,,6482,5509.7,907.51,6482,Medica,Individual & Family,5496.736,84.8,,percent of total billed charges,,
"Laproscopy, Surgical, Repair Paraesophagel Hernia, Includes Fundoplasty, W/O Mesh (Pro Cah)",,43281,CPT,Professional,Both,,,,6482,5509.7,907.51,6482,Medica,Medica Advantage Solution,3228.036,49.8,,percent of total billed charges,,
"Laproscopy, Surgical, Repair Paraesophagel Hernia, Includes Fundoplasty, W/O Mesh (Pro Cah)",,43281,CPT,Professional,Both,,,,6482,5509.7,907.51,6482,Medica,Medical Assistance,1047.76,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Laproscopy, Surgical, Repair Paraesophagel Hernia, Includes Fundoplasty, W/O Mesh (Pro Cah)",,43281,CPT,Professional,Both,,,,6482,5509.7,907.51,6482,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1410.34,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Laproscopy, Surgical, Repair Paraesophagel Hernia, Includes Fundoplasty, W/O Mesh (Pro Cah)",,43281,CPT,Professional,Both,,,,6482,5509.7,907.51,6482,"Multiplan, Inc.","Multiplan, Inc.",6093.08,94,,percent of total billed charges,,
"Laproscopy, Surgical, Repair Paraesophagel Hernia, Includes Fundoplasty, W/O Mesh (Pro Cah)",,43281,CPT,Professional,Both,,,,6482,5509.7,907.51,6482,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,5840.282,90.1,,percent of total billed charges,,
"Laproscopy, Surgical, Repair Paraesophagel Hernia, Includes Fundoplasty, W/O Mesh (Pro Cah)",,43281,CPT,Professional,Both,,,,6482,5509.7,907.51,6482,"Preferred One Administrative Services, INC.",PPO,6391.252,98.6,,percent of total billed charges,,
"Laproscopy, Surgical, Repair Paraesophagel Hernia, Includes Fundoplasty, W/O Mesh (Pro Cah)",,43281,CPT,Professional,Both,,,,6482,5509.7,907.51,6482,PrimeWest Health,Minnesota Senior Health Options (MSHO),1621.891,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Laproscopy, Surgical, Repair Paraesophagel Hernia, Includes Fundoplasty, W/O Mesh (Pro Cah)",,43281,CPT,Professional,Both,,,,6482,5509.7,907.51,6482,PrimeWest Health,MinnesotaCare,1121.103371,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Laproscopy, Surgical, Repair Paraesophagel Hernia, Includes Fundoplasty, W/O Mesh (Pro Cah)",,43281,CPT,Professional,Both,,,,6482,5509.7,907.51,6482,Sanford Health Plan,Sanford Health Plan,5704.16,88,,percent of total billed charges,,
"Laproscopy, Surgical, Repair Paraesophagel Hernia, Includes Fundoplasty, W/O Mesh (Pro Cah)",,43281,CPT,Professional,Both,,,,6482,5509.7,907.51,6482,"UCare Health, Inc.",Individual & Family Plan,2292.648704,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Laproscopy, Surgical, Repair Paraesophagel Hernia, Includes Fundoplasty, W/O Mesh (Pro Cah)",,43281,CPT,Professional,Both,,,,6482,5509.7,907.51,6482,"UCare Health, Inc.",Medical Assistance,1152.536176,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Laproscopy, Surgical, Repair Paraesophagel Hernia, Includes Fundoplasty, W/O Mesh (Pro Cah)",,43281,CPT,Professional,Both,,,,6482,5509.7,907.51,6482,"UCare Health, Inc.",Medicare Advantage,1621.891,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Laproscopy, Surgical, Repair Paraesophagel Hernia, Includes Fundoplasty, W/O Mesh (Pro Cah)",,43281,CPT,Professional,Both,,,,6482,5509.7,907.51,6482,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1297.5128,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Laproscopy, Surgical, Repair Paraesophagel Hernia, Includes Fundoplasty, W/O Mesh (Pro Cah)",,43281,CPT,Professional,Both,,,,6482,5509.7,907.51,6482,UnitedHealthcare,Individual & Family,6482,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Laproscopy, Surgical, Repair Paraesophagel Hernia, Includes Fundoplasty, W/O Mesh (Pro Cah)",,43281,CPT,Professional,Both,,,,6482,5509.7,907.51,6482,UnitedHealthcare,Medicare Advantage,1621.891,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Laproscopy, Surgical, Repair Paraesophagel Hernia, Includes Fundoplasty, W/O Mesh (Pro Cah)",,43281,CPT,Professional,Both,,,,6482,5509.7,907.51,6482,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1047.76016,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Dilation Of Esophagus, By Unguided Sound Or Bougie, Single Or Multiple Passes (Pro Cah)",,43450,CPT,Professional,Both,,,,459,390.15,49.3,459,Aetna,Commercial,390.15,85,,percent of total billed charges,,
"Dilation Of Esophagus, By Unguided Sound Or Bougie, Single Or Multiple Passes (Pro Cah)",,43450,CPT,Professional,Both,,,,459,390.15,49.3,459,Aetna,Medicare Advantage,77.62,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Dilation Of Esophagus, By Unguided Sound Or Bougie, Single Or Multiple Passes (Pro Cah)",,43450,CPT,Professional,Both,,,,459,390.15,49.3,459,Aetna,PPO,426.87,93,,percent of total billed charges,,
"Dilation Of Esophagus, By Unguided Sound Or Bougie, Single Or Multiple Passes (Pro Cah)",,43450,CPT,Professional,Both,,,,459,390.15,49.3,459,America's PPO,America's PPO,392.1696,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Dilation Of Esophagus, By Unguided Sound Or Bougie, Single Or Multiple Passes (Pro Cah)",,43450,CPT,Professional,Both,,,,459,390.15,49.3,459,BlueCross BlueShield Minnesota, Federal Employee Program,162.51,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Dilation Of Esophagus, By Unguided Sound Or Bougie, Single Or Multiple Passes (Pro Cah)",,43450,CPT,Professional,Both,,,,459,390.15,49.3,459,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,165.11016,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Dilation Of Esophagus, By Unguided Sound Or Bougie, Single Or Multiple Passes (Pro Cah)",,43450,CPT,Professional,Both,,,,459,390.15,49.3,459,BlueCross BlueShield Minnesota,High Value Network Plan,165.11016,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Dilation Of Esophagus, By Unguided Sound Or Bougie, Single Or Multiple Passes (Pro Cah)",,43450,CPT,Professional,Both,,,,459,390.15,49.3,459,BlueCross BlueShield Minnesota,Medicare Advantage,88.182,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Dilation Of Esophagus, By Unguided Sound Or Bougie, Single Or Multiple Passes (Pro Cah)",,43450,CPT,Professional,Both,,,,459,390.15,49.3,459,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,165.11016,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Dilation Of Esophagus, By Unguided Sound Or Bougie, Single Or Multiple Passes (Pro Cah)",,43450,CPT,Professional,Both,,,,459,390.15,49.3,459,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,56.91632,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Dilation Of Esophagus, By Unguided Sound Or Bougie, Single Or Multiple Passes (Pro Cah)",,43450,CPT,Professional,Both,,,,459,390.15,49.3,459,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),88.182,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Dilation Of Esophagus, By Unguided Sound Or Bougie, Single Or Multiple Passes (Pro Cah)",,43450,CPT,Professional,Both,,,,459,390.15,49.3,459,CorVel,Worker's Compensation,150.5360304,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Dilation Of Esophagus, By Unguided Sound Or Bougie, Single Or Multiple Passes (Pro Cah)",,43450,CPT,Professional,Both,,,,459,390.15,49.3,459,First Health Group Corporation,First Health Network,445.23,97,,percent of total billed charges,,
"Dilation Of Esophagus, By Unguided Sound Or Bougie, Single Or Multiple Passes (Pro Cah)",,43450,CPT,Professional,Both,,,,459,390.15,49.3,459,"Health Partners, Inc.",Commercial,162.52,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Dilation Of Esophagus, By Unguided Sound Or Bougie, Single Or Multiple Passes (Pro Cah)",,43450,CPT,Professional,Both,,,,459,390.15,49.3,459,"Health Partners, Inc.",Medicare Advantage,88.182,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Dilation Of Esophagus, By Unguided Sound Or Bougie, Single Or Multiple Passes (Pro Cah)",,43450,CPT,Professional,Both,,,,459,390.15,49.3,459,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),76.92,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Dilation Of Esophagus, By Unguided Sound Or Bougie, Single Or Multiple Passes (Pro Cah)",,43450,CPT,Professional,Both,,,,459,390.15,49.3,459,"Health Partners, Inc.",State of Minnesota Advantage Program,140.01098,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Dilation Of Esophagus, By Unguided Sound Or Bougie, Single Or Multiple Passes (Pro Cah)",,43450,CPT,Professional,Both,,,,459,390.15,49.3,459,"Health Partners, Inc.",State Public Programs,49.3,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Dilation Of Esophagus, By Unguided Sound Or Bougie, Single Or Multiple Passes (Pro Cah)",,43450,CPT,Professional,Both,,,,459,390.15,49.3,459,Humana Insurance Company,Commercial PPO,76.68,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Dilation Of Esophagus, By Unguided Sound Or Bougie, Single Or Multiple Passes (Pro Cah)",,43450,CPT,Professional,Both,,,,459,390.15,49.3,459,Humana Insurance Company,Medicare PPO,459,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Dilation Of Esophagus, By Unguided Sound Or Bougie, Single Or Multiple Passes (Pro Cah)",,43450,CPT,Professional,Both,,,,459,390.15,49.3,459,Medica,Individual & Family,389.232,84.8,,percent of total billed charges,,
"Dilation Of Esophagus, By Unguided Sound Or Bougie, Single Or Multiple Passes (Pro Cah)",,43450,CPT,Professional,Both,,,,459,390.15,49.3,459,Medica,Medica Advantage Solution,228.582,49.8,,percent of total billed charges,,
"Dilation Of Esophagus, By Unguided Sound Or Bougie, Single Or Multiple Passes (Pro Cah)",,43450,CPT,Professional,Both,,,,459,390.15,49.3,459,Medica,Medical Assistance,56.92,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Dilation Of Esophagus, By Unguided Sound Or Bougie, Single Or Multiple Passes (Pro Cah)",,43450,CPT,Professional,Both,,,,459,390.15,49.3,459,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,76.68,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Dilation Of Esophagus, By Unguided Sound Or Bougie, Single Or Multiple Passes (Pro Cah)",,43450,CPT,Professional,Both,,,,459,390.15,49.3,459,"Multiplan, Inc.","Multiplan, Inc.",431.46,94,,percent of total billed charges,,
"Dilation Of Esophagus, By Unguided Sound Or Bougie, Single Or Multiple Passes (Pro Cah)",,43450,CPT,Professional,Both,,,,459,390.15,49.3,459,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,413.559,90.1,,percent of total billed charges,,
"Dilation Of Esophagus, By Unguided Sound Or Bougie, Single Or Multiple Passes (Pro Cah)",,43450,CPT,Professional,Both,,,,459,390.15,49.3,459,"Preferred One Administrative Services, INC.",PPO,452.574,98.6,,percent of total billed charges,,
"Dilation Of Esophagus, By Unguided Sound Or Bougie, Single Or Multiple Passes (Pro Cah)",,43450,CPT,Professional,Both,,,,459,390.15,49.3,459,PrimeWest Health,Minnesota Senior Health Options (MSHO),88.182,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Dilation Of Esophagus, By Unguided Sound Or Bougie, Single Or Multiple Passes (Pro Cah)",,43450,CPT,Professional,Both,,,,459,390.15,49.3,459,PrimeWest Health,MinnesotaCare,60.9004624,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Dilation Of Esophagus, By Unguided Sound Or Bougie, Single Or Multiple Passes (Pro Cah)",,43450,CPT,Professional,Both,,,,459,390.15,49.3,459,Sanford Health Plan,Sanford Health Plan,403.92,88,,percent of total billed charges,,
"Dilation Of Esophagus, By Unguided Sound Or Bougie, Single Or Multiple Passes (Pro Cah)",,43450,CPT,Professional,Both,,,,459,390.15,49.3,459,"UCare Health, Inc.",Individual & Family Plan,124.651008,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Dilation Of Esophagus, By Unguided Sound Or Bougie, Single Or Multiple Passes (Pro Cah)",,43450,CPT,Professional,Both,,,,459,390.15,49.3,459,"UCare Health, Inc.",Medical Assistance,62.607952,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Dilation Of Esophagus, By Unguided Sound Or Bougie, Single Or Multiple Passes (Pro Cah)",,43450,CPT,Professional,Both,,,,459,390.15,49.3,459,"UCare Health, Inc.",Medicare Advantage,88.182,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Dilation Of Esophagus, By Unguided Sound Or Bougie, Single Or Multiple Passes (Pro Cah)",,43450,CPT,Professional,Both,,,,459,390.15,49.3,459,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),70.5456,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Dilation Of Esophagus, By Unguided Sound Or Bougie, Single Or Multiple Passes (Pro Cah)",,43450,CPT,Professional,Both,,,,459,390.15,49.3,459,UnitedHealthcare,Individual & Family,459,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Dilation Of Esophagus, By Unguided Sound Or Bougie, Single Or Multiple Passes (Pro Cah)",,43450,CPT,Professional,Both,,,,459,390.15,49.3,459,UnitedHealthcare,Medicare Advantage,88.182,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Dilation Of Esophagus, By Unguided Sound Or Bougie, Single Or Multiple Passes (Pro Cah)",,43450,CPT,Professional,Both,,,,459,390.15,49.3,459,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,56.91632,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Colectomy, Partial; With End Colostomy And Closure Of Distal Segment (Pro Cah)",,44143,CPT,Professional,Both,,,,4881,4148.85,985.61,4881,Aetna,Commercial,4148.85,85,,percent of total billed charges,,
"Colectomy, Partial; With End Colostomy And Closure Of Distal Segment (Pro Cah)",,44143,CPT,Professional,Both,,,,4881,4148.85,985.61,4881,Aetna,Medicare Advantage,1575.11,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Colectomy, Partial; With End Colostomy And Closure Of Distal Segment (Pro Cah)",,44143,CPT,Professional,Both,,,,4881,4148.85,985.61,4881,Aetna,PPO,4539.33,93,,percent of total billed charges,,
"Colectomy, Partial; With End Colostomy And Closure Of Distal Segment (Pro Cah)",,44143,CPT,Professional,Both,,,,4881,4148.85,985.61,4881,America's PPO,America's PPO,4170.3264,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Colectomy, Partial; With End Colostomy And Closure Of Distal Segment (Pro Cah)",,44143,CPT,Professional,Both,,,,4881,4148.85,985.61,4881,BlueCross BlueShield Minnesota, Federal Employee Program,3388.6,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Colectomy, Partial; With End Colostomy And Closure Of Distal Segment (Pro Cah)",,44143,CPT,Professional,Both,,,,4881,4148.85,985.61,4881,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,3442.8176,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Colectomy, Partial; With End Colostomy And Closure Of Distal Segment (Pro Cah)",,44143,CPT,Professional,Both,,,,4881,4148.85,985.61,4881,BlueCross BlueShield Minnesota,High Value Network Plan,3442.8176,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Colectomy, Partial; With End Colostomy And Closure Of Distal Segment (Pro Cah)",,44143,CPT,Professional,Both,,,,4881,4148.85,985.61,4881,BlueCross BlueShield Minnesota,Medicare Advantage,1760.742,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Colectomy, Partial; With End Colostomy And Closure Of Distal Segment (Pro Cah)",,44143,CPT,Professional,Both,,,,4881,4148.85,985.61,4881,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,3442.8176,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Colectomy, Partial; With End Colostomy And Closure Of Distal Segment (Pro Cah)",,44143,CPT,Professional,Both,,,,4881,4148.85,985.61,4881,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1137.93016,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Colectomy, Partial; With End Colostomy And Closure Of Distal Segment (Pro Cah)",,44143,CPT,Professional,Both,,,,4881,4148.85,985.61,4881,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1760.742,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Colectomy, Partial; With End Colostomy And Closure Of Distal Segment (Pro Cah)",,44143,CPT,Professional,Both,,,,4881,4148.85,985.61,4881,CorVel,Worker's Compensation,3040.475575,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Colectomy, Partial; With End Colostomy And Closure Of Distal Segment (Pro Cah)",,44143,CPT,Professional,Both,,,,4881,4148.85,985.61,4881,First Health Group Corporation,First Health Network,4734.57,97,,percent of total billed charges,,
"Colectomy, Partial; With End Colostomy And Closure Of Distal Segment (Pro Cah)",,44143,CPT,Professional,Both,,,,4881,4148.85,985.61,4881,"Health Partners, Inc.",Commercial,3284.45,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Colectomy, Partial; With End Colostomy And Closure Of Distal Segment (Pro Cah)",,44143,CPT,Professional,Both,,,,4881,4148.85,985.61,4881,"Health Partners, Inc.",Medicare Advantage,1760.742,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Colectomy, Partial; With End Colostomy And Closure Of Distal Segment (Pro Cah)",,44143,CPT,Professional,Both,,,,4881,4148.85,985.61,4881,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1531.36,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Colectomy, Partial; With End Colostomy And Closure Of Distal Segment (Pro Cah)",,44143,CPT,Professional,Both,,,,4881,4148.85,985.61,4881,"Health Partners, Inc.",State of Minnesota Advantage Program,2829.553675,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Colectomy, Partial; With End Colostomy And Closure Of Distal Segment (Pro Cah)",,44143,CPT,Professional,Both,,,,4881,4148.85,985.61,4881,"Health Partners, Inc.",State Public Programs,985.61,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Colectomy, Partial; With End Colostomy And Closure Of Distal Segment (Pro Cah)",,44143,CPT,Professional,Both,,,,4881,4148.85,985.61,4881,Humana Insurance Company,Commercial PPO,1531.08,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Colectomy, Partial; With End Colostomy And Closure Of Distal Segment (Pro Cah)",,44143,CPT,Professional,Both,,,,4881,4148.85,985.61,4881,Humana Insurance Company,Medicare PPO,4881,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Colectomy, Partial; With End Colostomy And Closure Of Distal Segment (Pro Cah)",,44143,CPT,Professional,Both,,,,4881,4148.85,985.61,4881,Medica,Individual & Family,4139.088,84.8,,percent of total billed charges,,
"Colectomy, Partial; With End Colostomy And Closure Of Distal Segment (Pro Cah)",,44143,CPT,Professional,Both,,,,4881,4148.85,985.61,4881,Medica,Medica Advantage Solution,2430.738,49.8,,percent of total billed charges,,
"Colectomy, Partial; With End Colostomy And Closure Of Distal Segment (Pro Cah)",,44143,CPT,Professional,Both,,,,4881,4148.85,985.61,4881,Medica,Medical Assistance,1137.93,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Colectomy, Partial; With End Colostomy And Closure Of Distal Segment (Pro Cah)",,44143,CPT,Professional,Both,,,,4881,4148.85,985.61,4881,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1531.08,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Colectomy, Partial; With End Colostomy And Closure Of Distal Segment (Pro Cah)",,44143,CPT,Professional,Both,,,,4881,4148.85,985.61,4881,"Multiplan, Inc.","Multiplan, Inc.",4588.14,94,,percent of total billed charges,,
"Colectomy, Partial; With End Colostomy And Closure Of Distal Segment (Pro Cah)",,44143,CPT,Professional,Both,,,,4881,4148.85,985.61,4881,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4397.781,90.1,,percent of total billed charges,,
"Colectomy, Partial; With End Colostomy And Closure Of Distal Segment (Pro Cah)",,44143,CPT,Professional,Both,,,,4881,4148.85,985.61,4881,"Preferred One Administrative Services, INC.",PPO,4812.666,98.6,,percent of total billed charges,,
"Colectomy, Partial; With End Colostomy And Closure Of Distal Segment (Pro Cah)",,44143,CPT,Professional,Both,,,,4881,4148.85,985.61,4881,PrimeWest Health,Minnesota Senior Health Options (MSHO),1760.742,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Colectomy, Partial; With End Colostomy And Closure Of Distal Segment (Pro Cah)",,44143,CPT,Professional,Both,,,,4881,4148.85,985.61,4881,PrimeWest Health,MinnesotaCare,1217.585271,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Colectomy, Partial; With End Colostomy And Closure Of Distal Segment (Pro Cah)",,44143,CPT,Professional,Both,,,,4881,4148.85,985.61,4881,Sanford Health Plan,Sanford Health Plan,4295.28,88,,percent of total billed charges,,
"Colectomy, Partial; With End Colostomy And Closure Of Distal Segment (Pro Cah)",,44143,CPT,Professional,Both,,,,4881,4148.85,985.61,4881,"UCare Health, Inc.",Individual & Family Plan,2488.923648,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Colectomy, Partial; With End Colostomy And Closure Of Distal Segment (Pro Cah)",,44143,CPT,Professional,Both,,,,4881,4148.85,985.61,4881,"UCare Health, Inc.",Medical Assistance,1251.723176,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Colectomy, Partial; With End Colostomy And Closure Of Distal Segment (Pro Cah)",,44143,CPT,Professional,Both,,,,4881,4148.85,985.61,4881,"UCare Health, Inc.",Medicare Advantage,1760.742,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Colectomy, Partial; With End Colostomy And Closure Of Distal Segment (Pro Cah)",,44143,CPT,Professional,Both,,,,4881,4148.85,985.61,4881,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1408.5936,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Colectomy, Partial; With End Colostomy And Closure Of Distal Segment (Pro Cah)",,44143,CPT,Professional,Both,,,,4881,4148.85,985.61,4881,UnitedHealthcare,Individual & Family,4881,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Colectomy, Partial; With End Colostomy And Closure Of Distal Segment (Pro Cah)",,44143,CPT,Professional,Both,,,,4881,4148.85,985.61,4881,UnitedHealthcare,Medicare Advantage,1760.742,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Colectomy, Partial; With End Colostomy And Closure Of Distal Segment (Pro Cah)",,44143,CPT,Professional,Both,,,,4881,4148.85,985.61,4881,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1137.93016,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Colectomy, Partial, With Removal Of Terminal Ileum With Ileocolostomy (Pro Cah)",,44160,CPT,Professional,Both,,,,4259,3620.15,741.72,4259,Aetna,Commercial,3620.15,85,,percent of total billed charges,,
"Colectomy, Partial, With Removal Of Terminal Ileum With Ileocolostomy (Pro Cah)",,44160,CPT,Professional,Both,,,,4259,3620.15,741.72,4259,Aetna,Medicare Advantage,1176.74,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Colectomy, Partial, With Removal Of Terminal Ileum With Ileocolostomy (Pro Cah)",,44160,CPT,Professional,Both,,,,4259,3620.15,741.72,4259,Aetna,PPO,3960.87,93,,percent of total billed charges,,
"Colectomy, Partial, With Removal Of Terminal Ileum With Ileocolostomy (Pro Cah)",,44160,CPT,Professional,Both,,,,4259,3620.15,741.72,4259,America's PPO,America's PPO,3638.8896,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Colectomy, Partial, With Removal Of Terminal Ileum With Ileocolostomy (Pro Cah)",,44160,CPT,Professional,Both,,,,4259,3620.15,741.72,4259,BlueCross BlueShield Minnesota, Federal Employee Program,2546.44,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Colectomy, Partial, With Removal Of Terminal Ileum With Ileocolostomy (Pro Cah)",,44160,CPT,Professional,Both,,,,4259,3620.15,741.72,4259,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,2587.18304,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Colectomy, Partial, With Removal Of Terminal Ileum With Ileocolostomy (Pro Cah)",,44160,CPT,Professional,Both,,,,4259,3620.15,741.72,4259,BlueCross BlueShield Minnesota,High Value Network Plan,2587.18304,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Colectomy, Partial, With Removal Of Terminal Ileum With Ileocolostomy (Pro Cah)",,44160,CPT,Professional,Both,,,,4259,3620.15,741.72,4259,BlueCross BlueShield Minnesota,Medicare Advantage,1325.2945,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Colectomy, Partial, With Removal Of Terminal Ileum With Ileocolostomy (Pro Cah)",,44160,CPT,Professional,Both,,,,4259,3620.15,741.72,4259,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,2587.18304,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Colectomy, Partial, With Removal Of Terminal Ileum With Ileocolostomy (Pro Cah)",,44160,CPT,Professional,Both,,,,4259,3620.15,741.72,4259,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,856.34576,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Colectomy, Partial, With Removal Of Terminal Ileum With Ileocolostomy (Pro Cah)",,44160,CPT,Professional,Both,,,,4259,3620.15,741.72,4259,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1325.2945,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Colectomy, Partial, With Removal Of Terminal Ileum With Ileocolostomy (Pro Cah)",,44160,CPT,Professional,Both,,,,4259,3620.15,741.72,4259,CorVel,Worker's Compensation,2281.76893,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Colectomy, Partial, With Removal Of Terminal Ileum With Ileocolostomy (Pro Cah)",,44160,CPT,Professional,Both,,,,4259,3620.15,741.72,4259,First Health Group Corporation,First Health Network,4131.23,97,,percent of total billed charges,,
"Colectomy, Partial, With Removal Of Terminal Ileum With Ileocolostomy (Pro Cah)",,44160,CPT,Professional,Both,,,,4259,3620.15,741.72,4259,"Health Partners, Inc.",Commercial,2464.61,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Colectomy, Partial, With Removal Of Terminal Ileum With Ileocolostomy (Pro Cah)",,44160,CPT,Professional,Both,,,,4259,3620.15,741.72,4259,"Health Partners, Inc.",Medicare Advantage,1325.2945,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Colectomy, Partial, With Removal Of Terminal Ileum With Ileocolostomy (Pro Cah)",,44160,CPT,Professional,Both,,,,4259,3620.15,741.72,4259,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1152.5,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Colectomy, Partial, With Removal Of Terminal Ileum With Ileocolostomy (Pro Cah)",,44160,CPT,Professional,Both,,,,4259,3620.15,741.72,4259,"Health Partners, Inc.",State of Minnesota Advantage Program,2123.261515,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Colectomy, Partial, With Removal Of Terminal Ileum With Ileocolostomy (Pro Cah)",,44160,CPT,Professional,Both,,,,4259,3620.15,741.72,4259,"Health Partners, Inc.",State Public Programs,741.72,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Colectomy, Partial, With Removal Of Terminal Ileum With Ileocolostomy (Pro Cah)",,44160,CPT,Professional,Both,,,,4259,3620.15,741.72,4259,Humana Insurance Company,Commercial PPO,1152.43,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Colectomy, Partial, With Removal Of Terminal Ileum With Ileocolostomy (Pro Cah)",,44160,CPT,Professional,Both,,,,4259,3620.15,741.72,4259,Humana Insurance Company,Medicare PPO,4259,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Colectomy, Partial, With Removal Of Terminal Ileum With Ileocolostomy (Pro Cah)",,44160,CPT,Professional,Both,,,,4259,3620.15,741.72,4259,Medica,Individual & Family,3611.632,84.8,,percent of total billed charges,,
"Colectomy, Partial, With Removal Of Terminal Ileum With Ileocolostomy (Pro Cah)",,44160,CPT,Professional,Both,,,,4259,3620.15,741.72,4259,Medica,Medica Advantage Solution,2120.982,49.8,,percent of total billed charges,,
"Colectomy, Partial, With Removal Of Terminal Ileum With Ileocolostomy (Pro Cah)",,44160,CPT,Professional,Both,,,,4259,3620.15,741.72,4259,Medica,Medical Assistance,856.35,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Colectomy, Partial, With Removal Of Terminal Ileum With Ileocolostomy (Pro Cah)",,44160,CPT,Professional,Both,,,,4259,3620.15,741.72,4259,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1152.43,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Colectomy, Partial, With Removal Of Terminal Ileum With Ileocolostomy (Pro Cah)",,44160,CPT,Professional,Both,,,,4259,3620.15,741.72,4259,"Multiplan, Inc.","Multiplan, Inc.",4003.46,94,,percent of total billed charges,,
"Colectomy, Partial, With Removal Of Terminal Ileum With Ileocolostomy (Pro Cah)",,44160,CPT,Professional,Both,,,,4259,3620.15,741.72,4259,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,3837.359,90.1,,percent of total billed charges,,
"Colectomy, Partial, With Removal Of Terminal Ileum With Ileocolostomy (Pro Cah)",,44160,CPT,Professional,Both,,,,4259,3620.15,741.72,4259,"Preferred One Administrative Services, INC.",PPO,4199.374,98.6,,percent of total billed charges,,
"Colectomy, Partial, With Removal Of Terminal Ileum With Ileocolostomy (Pro Cah)",,44160,CPT,Professional,Both,,,,4259,3620.15,741.72,4259,PrimeWest Health,Minnesota Senior Health Options (MSHO),1325.2945,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Colectomy, Partial, With Removal Of Terminal Ileum With Ileocolostomy (Pro Cah)",,44160,CPT,Professional,Both,,,,4259,3620.15,741.72,4259,PrimeWest Health,MinnesotaCare,916.2899632,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Colectomy, Partial, With Removal Of Terminal Ileum With Ileocolostomy (Pro Cah)",,44160,CPT,Professional,Both,,,,4259,3620.15,741.72,4259,Sanford Health Plan,Sanford Health Plan,3747.92,88,,percent of total billed charges,,
"Colectomy, Partial, With Removal Of Terminal Ileum With Ileocolostomy (Pro Cah)",,44160,CPT,Professional,Both,,,,4259,3620.15,741.72,4259,"UCare Health, Inc.",Individual & Family Plan,1873.390208,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Colectomy, Partial, With Removal Of Terminal Ileum With Ileocolostomy (Pro Cah)",,44160,CPT,Professional,Both,,,,4259,3620.15,741.72,4259,"UCare Health, Inc.",Medical Assistance,941.980336,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Colectomy, Partial, With Removal Of Terminal Ileum With Ileocolostomy (Pro Cah)",,44160,CPT,Professional,Both,,,,4259,3620.15,741.72,4259,"UCare Health, Inc.",Medicare Advantage,1325.2945,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Colectomy, Partial, With Removal Of Terminal Ileum With Ileocolostomy (Pro Cah)",,44160,CPT,Professional,Both,,,,4259,3620.15,741.72,4259,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1060.2356,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Colectomy, Partial, With Removal Of Terminal Ileum With Ileocolostomy (Pro Cah)",,44160,CPT,Professional,Both,,,,4259,3620.15,741.72,4259,UnitedHealthcare,Individual & Family,4259,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Colectomy, Partial, With Removal Of Terminal Ileum With Ileocolostomy (Pro Cah)",,44160,CPT,Professional,Both,,,,4259,3620.15,741.72,4259,UnitedHealthcare,Medicare Advantage,1325.2945,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Colectomy, Partial, With Removal Of Terminal Ileum With Ileocolostomy (Pro Cah)",,44160,CPT,Professional,Both,,,,4259,3620.15,741.72,4259,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,856.34576,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Appendectomy (Pro Cah),,44950,CPT,Professional,Both,,,,2091,1777.35,383.94,2091,Aetna,Commercial,1777.35,85,,percent of total billed charges,,
Appendectomy (Pro Cah),,44950,CPT,Professional,Both,,,,2091,1777.35,383.94,2091,Aetna,Medicare Advantage,609.91,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Appendectomy (Pro Cah),,44950,CPT,Professional,Both,,,,2091,1777.35,383.94,2091,Aetna,PPO,1944.63,93,,percent of total billed charges,,
Appendectomy (Pro Cah),,44950,CPT,Professional,Both,,,,2091,1777.35,383.94,2091,America's PPO,America's PPO,1786.5504,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Appendectomy (Pro Cah),,44950,CPT,Professional,Both,,,,2091,1777.35,383.94,2091,BlueCross BlueShield Minnesota, Federal Employee Program,1322.8,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Appendectomy (Pro Cah),,44950,CPT,Professional,Both,,,,2091,1777.35,383.94,2091,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1343.9648,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Appendectomy (Pro Cah),,44950,CPT,Professional,Both,,,,2091,1777.35,383.94,2091,BlueCross BlueShield Minnesota,High Value Network Plan,1343.9648,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Appendectomy (Pro Cah),,44950,CPT,Professional,Both,,,,2091,1777.35,383.94,2091,BlueCross BlueShield Minnesota,Medicare Advantage,686.1245,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Appendectomy (Pro Cah),,44950,CPT,Professional,Both,,,,2091,1777.35,383.94,2091,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1343.9648,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Appendectomy (Pro Cah),,44950,CPT,Professional,Both,,,,2091,1777.35,383.94,2091,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,443.2808,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Appendectomy (Pro Cah),,44950,CPT,Professional,Both,,,,2091,1777.35,383.94,2091,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),686.1245,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Appendectomy (Pro Cah),,44950,CPT,Professional,Both,,,,2091,1777.35,383.94,2091,CorVel,Worker's Compensation,1181.878988,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Appendectomy (Pro Cah),,44950,CPT,Professional,Both,,,,2091,1777.35,383.94,2091,First Health Group Corporation,First Health Network,2028.27,97,,percent of total billed charges,,
Appendectomy (Pro Cah),,44950,CPT,Professional,Both,,,,2091,1777.35,383.94,2091,"Health Partners, Inc.",Commercial,1276.93,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Appendectomy (Pro Cah),,44950,CPT,Professional,Both,,,,2091,1777.35,383.94,2091,"Health Partners, Inc.",Medicare Advantage,686.1245,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Appendectomy (Pro Cah),,44950,CPT,Professional,Both,,,,2091,1777.35,383.94,2091,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),596.75,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Appendectomy (Pro Cah),,44950,CPT,Professional,Both,,,,2091,1777.35,383.94,2091,"Health Partners, Inc.",State of Minnesota Advantage Program,1100.075195,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Appendectomy (Pro Cah),,44950,CPT,Professional,Both,,,,2091,1777.35,383.94,2091,"Health Partners, Inc.",State Public Programs,383.94,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Appendectomy (Pro Cah),,44950,CPT,Professional,Both,,,,2091,1777.35,383.94,2091,Humana Insurance Company,Commercial PPO,596.63,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Appendectomy (Pro Cah),,44950,CPT,Professional,Both,,,,2091,1777.35,383.94,2091,Humana Insurance Company,Medicare PPO,2091,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Appendectomy (Pro Cah),,44950,CPT,Professional,Both,,,,2091,1777.35,383.94,2091,Medica,Individual & Family,1773.168,84.8,,percent of total billed charges,,
Appendectomy (Pro Cah),,44950,CPT,Professional,Both,,,,2091,1777.35,383.94,2091,Medica,Medica Advantage Solution,1041.318,49.8,,percent of total billed charges,,
Appendectomy (Pro Cah),,44950,CPT,Professional,Both,,,,2091,1777.35,383.94,2091,Medica,Medical Assistance,443.28,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Appendectomy (Pro Cah),,44950,CPT,Professional,Both,,,,2091,1777.35,383.94,2091,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,596.63,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Appendectomy (Pro Cah),,44950,CPT,Professional,Both,,,,2091,1777.35,383.94,2091,"Multiplan, Inc.","Multiplan, Inc.",1965.54,94,,percent of total billed charges,,
Appendectomy (Pro Cah),,44950,CPT,Professional,Both,,,,2091,1777.35,383.94,2091,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1883.991,90.1,,percent of total billed charges,,
Appendectomy (Pro Cah),,44950,CPT,Professional,Both,,,,2091,1777.35,383.94,2091,"Preferred One Administrative Services, INC.",PPO,2061.726,98.6,,percent of total billed charges,,
Appendectomy (Pro Cah),,44950,CPT,Professional,Both,,,,2091,1777.35,383.94,2091,PrimeWest Health,Minnesota Senior Health Options (MSHO),686.1245,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Appendectomy (Pro Cah),,44950,CPT,Professional,Both,,,,2091,1777.35,383.94,2091,PrimeWest Health,MinnesotaCare,474.310456,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Appendectomy (Pro Cah),,44950,CPT,Professional,Both,,,,2091,1777.35,383.94,2091,Sanford Health Plan,Sanford Health Plan,1840.08,88,,percent of total billed charges,,
Appendectomy (Pro Cah),,44950,CPT,Professional,Both,,,,2091,1777.35,383.94,2091,"UCare Health, Inc.",Individual & Family Plan,969.881728,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Appendectomy (Pro Cah),,44950,CPT,Professional,Both,,,,2091,1777.35,383.94,2091,"UCare Health, Inc.",Medical Assistance,487.60888,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Appendectomy (Pro Cah),,44950,CPT,Professional,Both,,,,2091,1777.35,383.94,2091,"UCare Health, Inc.",Medicare Advantage,686.1245,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Appendectomy (Pro Cah),,44950,CPT,Professional,Both,,,,2091,1777.35,383.94,2091,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),548.8996,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Appendectomy (Pro Cah),,44950,CPT,Professional,Both,,,,2091,1777.35,383.94,2091,UnitedHealthcare,Individual & Family,2091,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Appendectomy (Pro Cah),,44950,CPT,Professional,Both,,,,2091,1777.35,383.94,2091,UnitedHealthcare,Medicare Advantage,686.1245,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Appendectomy (Pro Cah),,44950,CPT,Professional,Both,,,,2091,1777.35,383.94,2091,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,443.2808,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Laparoscopy, Surgical, Appendectomy (Pro Cah)",,44970,CPT,Professional,Both,,,,329,279.65,163.842,518.6684,Aetna,Commercial,279.65,85,,percent of total billed charges,,
"Laparoscopy, Surgical, Appendectomy (Pro Cah)",,44970,CPT,Professional,Both,,,,329,279.65,163.842,518.6684,Aetna,Medicare Advantage,329,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Laparoscopy, Surgical, Appendectomy (Pro Cah)",,44970,CPT,Professional,Both,,,,329,279.65,163.842,518.6684,Aetna,PPO,305.97,93,,percent of total billed charges,,
"Laparoscopy, Surgical, Appendectomy (Pro Cah)",,44970,CPT,Professional,Both,,,,329,279.65,163.842,518.6684,America's PPO,America's PPO,281.0976,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Laparoscopy, Surgical, Appendectomy (Pro Cah)",,44970,CPT,Professional,Both,,,,329,279.65,163.842,518.6684,BlueCross BlueShield Minnesota, Federal Employee Program,329,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Laparoscopy, Surgical, Appendectomy (Pro Cah)",,44970,CPT,Professional,Both,,,,329,279.65,163.842,518.6684,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,329,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Laparoscopy, Surgical, Appendectomy (Pro Cah)",,44970,CPT,Professional,Both,,,,329,279.65,163.842,518.6684,BlueCross BlueShield Minnesota,High Value Network Plan,329,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Laparoscopy, Surgical, Appendectomy (Pro Cah)",,44970,CPT,Professional,Both,,,,329,279.65,163.842,518.6684,BlueCross BlueShield Minnesota,Medicare Advantage,329,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Laparoscopy, Surgical, Appendectomy (Pro Cah)",,44970,CPT,Professional,Both,,,,329,279.65,163.842,518.6684,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,329,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Laparoscopy, Surgical, Appendectomy (Pro Cah)",,44970,CPT,Professional,Both,,,,329,279.65,163.842,518.6684,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,329,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Laparoscopy, Surgical, Appendectomy (Pro Cah)",,44970,CPT,Professional,Both,,,,329,279.65,163.842,518.6684,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),329,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Laparoscopy, Surgical, Appendectomy (Pro Cah)",,44970,CPT,Professional,Both,,,,329,279.65,163.842,518.6684,CorVel,Worker's Compensation,329,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Laparoscopy, Surgical, Appendectomy (Pro Cah)",,44970,CPT,Professional,Both,,,,329,279.65,163.842,518.6684,First Health Group Corporation,First Health Network,319.13,97,,percent of total billed charges,,
"Laparoscopy, Surgical, Appendectomy (Pro Cah)",,44970,CPT,Professional,Both,,,,329,279.65,163.842,518.6684,"Health Partners, Inc.",Commercial,329,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Laparoscopy, Surgical, Appendectomy (Pro Cah)",,44970,CPT,Professional,Both,,,,329,279.65,163.842,518.6684,"Health Partners, Inc.",Medicare Advantage,329,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Laparoscopy, Surgical, Appendectomy (Pro Cah)",,44970,CPT,Professional,Both,,,,329,279.65,163.842,518.6684,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),329,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Laparoscopy, Surgical, Appendectomy (Pro Cah)",,44970,CPT,Professional,Both,,,,329,279.65,163.842,518.6684,"Health Partners, Inc.",State of Minnesota Advantage Program,329,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Laparoscopy, Surgical, Appendectomy (Pro Cah)",,44970,CPT,Professional,Both,,,,329,279.65,163.842,518.6684,"Health Partners, Inc.",State Public Programs,329,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Laparoscopy, Surgical, Appendectomy (Pro Cah)",,44970,CPT,Professional,Both,,,,329,279.65,163.842,518.6684,Humana Insurance Company,Commercial PPO,329,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Laparoscopy, Surgical, Appendectomy (Pro Cah)",,44970,CPT,Professional,Both,,,,329,279.65,163.842,518.6684,Humana Insurance Company,Medicare PPO,329,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Laparoscopy, Surgical, Appendectomy (Pro Cah)",,44970,CPT,Professional,Both,,,,329,279.65,163.842,518.6684,Medica,Individual & Family,278.992,84.8,,percent of total billed charges,,
"Laparoscopy, Surgical, Appendectomy (Pro Cah)",,44970,CPT,Professional,Both,,,,329,279.65,163.842,518.6684,Medica,Medica Advantage Solution,163.842,49.8,,percent of total billed charges,,
"Laparoscopy, Surgical, Appendectomy (Pro Cah)",,44970,CPT,Professional,Both,,,,329,279.65,163.842,518.6684,Medica,Medical Assistance,329,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Laparoscopy, Surgical, Appendectomy (Pro Cah)",,44970,CPT,Professional,Both,,,,329,279.65,163.842,518.6684,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,329,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Laparoscopy, Surgical, Appendectomy (Pro Cah)",,44970,CPT,Professional,Both,,,,329,279.65,163.842,518.6684,"Multiplan, Inc.","Multiplan, Inc.",309.26,94,,percent of total billed charges,,
"Laparoscopy, Surgical, Appendectomy (Pro Cah)",,44970,CPT,Professional,Both,,,,329,279.65,163.842,518.6684,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,296.429,90.1,,percent of total billed charges,,
"Laparoscopy, Surgical, Appendectomy (Pro Cah)",,44970,CPT,Professional,Both,,,,329,279.65,163.842,518.6684,"Preferred One Administrative Services, INC.",PPO,324.394,98.6,,percent of total billed charges,,
"Laparoscopy, Surgical, Appendectomy (Pro Cah)",,44970,CPT,Professional,Both,,,,329,279.65,163.842,518.6684,PrimeWest Health,Minnesota Senior Health Options (MSHO),329,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Laparoscopy, Surgical, Appendectomy (Pro Cah)",,44970,CPT,Professional,Both,,,,329,279.65,163.842,518.6684,PrimeWest Health,MinnesotaCare,329,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Laparoscopy, Surgical, Appendectomy (Pro Cah)",,44970,CPT,Professional,Both,,,,329,279.65,163.842,518.6684,Sanford Health Plan,Sanford Health Plan,289.52,88,,percent of total billed charges,,
"Laparoscopy, Surgical, Appendectomy (Pro Cah)",,44970,CPT,Professional,Both,,,,329,279.65,163.842,518.6684,"UCare Health, Inc.",Individual & Family Plan,329,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Laparoscopy, Surgical, Appendectomy (Pro Cah)",,44970,CPT,Professional,Both,,,,329,279.65,163.842,518.6684,"UCare Health, Inc.",Medical Assistance,329,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Laparoscopy, Surgical, Appendectomy (Pro Cah)",,44970,CPT,Professional,Both,,,,329,279.65,163.842,518.6684,"UCare Health, Inc.",Medicare Advantage,329,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Laparoscopy, Surgical, Appendectomy (Pro Cah)",,44970,CPT,Professional,Both,,,,329,279.65,163.842,518.6684,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),518.6684,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Laparoscopy, Surgical, Appendectomy (Pro Cah)",,44970,CPT,Professional,Both,,,,329,279.65,163.842,518.6684,UnitedHealthcare,Individual & Family,329,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Laparoscopy, Surgical, Appendectomy (Pro Cah)",,44970,CPT,Professional,Both,,,,329,279.65,163.842,518.6684,UnitedHealthcare,Medicare Advantage,329,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Laparoscopy, Surgical, Appendectomy (Pro Cah)",,44970,CPT,Professional,Both,,,,329,279.65,163.842,518.6684,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,329,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision Of Rectal Tumor, Transanal Approach; Not Including Muscularis Propria (Pro Cah)",,45171,CPT,Professional,Both,,,,2015,1712.75,385.26,2015,Aetna,Commercial,1712.75,85,,percent of total billed charges,,
"Excision Of Rectal Tumor, Transanal Approach; Not Including Muscularis Propria (Pro Cah)",,45171,CPT,Professional,Both,,,,2015,1712.75,385.26,2015,Aetna,Medicare Advantage,610.26,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision Of Rectal Tumor, Transanal Approach; Not Including Muscularis Propria (Pro Cah)",,45171,CPT,Professional,Both,,,,2015,1712.75,385.26,2015,Aetna,PPO,1873.95,93,,percent of total billed charges,,
"Excision Of Rectal Tumor, Transanal Approach; Not Including Muscularis Propria (Pro Cah)",,45171,CPT,Professional,Both,,,,2015,1712.75,385.26,2015,America's PPO,America's PPO,1721.616,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Excision Of Rectal Tumor, Transanal Approach; Not Including Muscularis Propria (Pro Cah)",,45171,CPT,Professional,Both,,,,2015,1712.75,385.26,2015,BlueCross BlueShield Minnesota, Federal Employee Program,1275.98,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Excision Of Rectal Tumor, Transanal Approach; Not Including Muscularis Propria (Pro Cah)",,45171,CPT,Professional,Both,,,,2015,1712.75,385.26,2015,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1296.39568,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision Of Rectal Tumor, Transanal Approach; Not Including Muscularis Propria (Pro Cah)",,45171,CPT,Professional,Both,,,,2015,1712.75,385.26,2015,BlueCross BlueShield Minnesota,High Value Network Plan,1296.39568,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision Of Rectal Tumor, Transanal Approach; Not Including Muscularis Propria (Pro Cah)",,45171,CPT,Professional,Both,,,,2015,1712.75,385.26,2015,BlueCross BlueShield Minnesota,Medicare Advantage,688.1025,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision Of Rectal Tumor, Transanal Approach; Not Including Muscularis Propria (Pro Cah)",,45171,CPT,Professional,Both,,,,2015,1712.75,385.26,2015,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1296.39568,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision Of Rectal Tumor, Transanal Approach; Not Including Muscularis Propria (Pro Cah)",,45171,CPT,Professional,Both,,,,2015,1712.75,385.26,2015,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,444.79464,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision Of Rectal Tumor, Transanal Approach; Not Including Muscularis Propria (Pro Cah)",,45171,CPT,Professional,Both,,,,2015,1712.75,385.26,2015,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),688.1025,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision Of Rectal Tumor, Transanal Approach; Not Including Muscularis Propria (Pro Cah)",,45171,CPT,Professional,Both,,,,2015,1712.75,385.26,2015,CorVel,Worker's Compensation,1181.593515,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Excision Of Rectal Tumor, Transanal Approach; Not Including Muscularis Propria (Pro Cah)",,45171,CPT,Professional,Both,,,,2015,1712.75,385.26,2015,First Health Group Corporation,First Health Network,1954.55,97,,percent of total billed charges,,
"Excision Of Rectal Tumor, Transanal Approach; Not Including Muscularis Propria (Pro Cah)",,45171,CPT,Professional,Both,,,,2015,1712.75,385.26,2015,"Health Partners, Inc.",Commercial,1276.2,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision Of Rectal Tumor, Transanal Approach; Not Including Muscularis Propria (Pro Cah)",,45171,CPT,Professional,Both,,,,2015,1712.75,385.26,2015,"Health Partners, Inc.",Medicare Advantage,688.1025,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision Of Rectal Tumor, Transanal Approach; Not Including Muscularis Propria (Pro Cah)",,45171,CPT,Professional,Both,,,,2015,1712.75,385.26,2015,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),598.45,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Excision Of Rectal Tumor, Transanal Approach; Not Including Muscularis Propria (Pro Cah)",,45171,CPT,Professional,Both,,,,2015,1712.75,385.26,2015,"Health Partners, Inc.",State of Minnesota Advantage Program,1099.4463,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision Of Rectal Tumor, Transanal Approach; Not Including Muscularis Propria (Pro Cah)",,45171,CPT,Professional,Both,,,,2015,1712.75,385.26,2015,"Health Partners, Inc.",State Public Programs,385.26,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Excision Of Rectal Tumor, Transanal Approach; Not Including Muscularis Propria (Pro Cah)",,45171,CPT,Professional,Both,,,,2015,1712.75,385.26,2015,Humana Insurance Company,Commercial PPO,598.35,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Excision Of Rectal Tumor, Transanal Approach; Not Including Muscularis Propria (Pro Cah)",,45171,CPT,Professional,Both,,,,2015,1712.75,385.26,2015,Humana Insurance Company,Medicare PPO,2015,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Excision Of Rectal Tumor, Transanal Approach; Not Including Muscularis Propria (Pro Cah)",,45171,CPT,Professional,Both,,,,2015,1712.75,385.26,2015,Medica,Individual & Family,1708.72,84.8,,percent of total billed charges,,
"Excision Of Rectal Tumor, Transanal Approach; Not Including Muscularis Propria (Pro Cah)",,45171,CPT,Professional,Both,,,,2015,1712.75,385.26,2015,Medica,Medica Advantage Solution,1003.47,49.8,,percent of total billed charges,,
"Excision Of Rectal Tumor, Transanal Approach; Not Including Muscularis Propria (Pro Cah)",,45171,CPT,Professional,Both,,,,2015,1712.75,385.26,2015,Medica,Medical Assistance,444.79,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Excision Of Rectal Tumor, Transanal Approach; Not Including Muscularis Propria (Pro Cah)",,45171,CPT,Professional,Both,,,,2015,1712.75,385.26,2015,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,598.35,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Excision Of Rectal Tumor, Transanal Approach; Not Including Muscularis Propria (Pro Cah)",,45171,CPT,Professional,Both,,,,2015,1712.75,385.26,2015,"Multiplan, Inc.","Multiplan, Inc.",1894.1,94,,percent of total billed charges,,
"Excision Of Rectal Tumor, Transanal Approach; Not Including Muscularis Propria (Pro Cah)",,45171,CPT,Professional,Both,,,,2015,1712.75,385.26,2015,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1815.515,90.1,,percent of total billed charges,,
"Excision Of Rectal Tumor, Transanal Approach; Not Including Muscularis Propria (Pro Cah)",,45171,CPT,Professional,Both,,,,2015,1712.75,385.26,2015,"Preferred One Administrative Services, INC.",PPO,1986.79,98.6,,percent of total billed charges,,
"Excision Of Rectal Tumor, Transanal Approach; Not Including Muscularis Propria (Pro Cah)",,45171,CPT,Professional,Both,,,,2015,1712.75,385.26,2015,PrimeWest Health,Minnesota Senior Health Options (MSHO),688.1025,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision Of Rectal Tumor, Transanal Approach; Not Including Muscularis Propria (Pro Cah)",,45171,CPT,Professional,Both,,,,2015,1712.75,385.26,2015,PrimeWest Health,MinnesotaCare,475.9302648,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision Of Rectal Tumor, Transanal Approach; Not Including Muscularis Propria (Pro Cah)",,45171,CPT,Professional,Both,,,,2015,1712.75,385.26,2015,Sanford Health Plan,Sanford Health Plan,1773.2,88,,percent of total billed charges,,
"Excision Of Rectal Tumor, Transanal Approach; Not Including Muscularis Propria (Pro Cah)",,45171,CPT,Professional,Both,,,,2015,1712.75,385.26,2015,"UCare Health, Inc.",Individual & Family Plan,972.67776,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Excision Of Rectal Tumor, Transanal Approach; Not Including Muscularis Propria (Pro Cah)",,45171,CPT,Professional,Both,,,,2015,1712.75,385.26,2015,"UCare Health, Inc.",Medical Assistance,489.274104,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Excision Of Rectal Tumor, Transanal Approach; Not Including Muscularis Propria (Pro Cah)",,45171,CPT,Professional,Both,,,,2015,1712.75,385.26,2015,"UCare Health, Inc.",Medicare Advantage,688.1025,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Excision Of Rectal Tumor, Transanal Approach; Not Including Muscularis Propria (Pro Cah)",,45171,CPT,Professional,Both,,,,2015,1712.75,385.26,2015,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),550.482,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Excision Of Rectal Tumor, Transanal Approach; Not Including Muscularis Propria (Pro Cah)",,45171,CPT,Professional,Both,,,,2015,1712.75,385.26,2015,UnitedHealthcare,Individual & Family,2015,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Excision Of Rectal Tumor, Transanal Approach; Not Including Muscularis Propria (Pro Cah)",,45171,CPT,Professional,Both,,,,2015,1712.75,385.26,2015,UnitedHealthcare,Medicare Advantage,688.1025,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision Of Rectal Tumor, Transanal Approach; Not Including Muscularis Propria (Pro Cah)",,45171,CPT,Professional,Both,,,,2015,1712.75,385.26,2015,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,444.79464,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Colonoscopy, Flexible; Diagnostic, Including Collection Specimen(S) By Brushing Or Washing (Pro Cah)",,45378,CPT,Professional,Both,,,,768,652.8,112.56,768,Aetna,Commercial,652.8,85,,percent of total billed charges,,
"Colonoscopy, Flexible; Diagnostic, Including Collection Specimen(S) By Brushing Or Washing (Pro Cah)",,45378,CPT,Professional,Both,,,,768,652.8,112.56,768,Aetna,Medicare Advantage,179.95,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Colonoscopy, Flexible; Diagnostic, Including Collection Specimen(S) By Brushing Or Washing (Pro Cah)",,45378,CPT,Professional,Both,,,,768,652.8,112.56,768,Aetna,PPO,714.24,93,,percent of total billed charges,,
"Colonoscopy, Flexible; Diagnostic, Including Collection Specimen(S) By Brushing Or Washing (Pro Cah)",,45378,CPT,Professional,Both,,,,768,652.8,112.56,768,America's PPO,America's PPO,656.1792,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Colonoscopy, Flexible; Diagnostic, Including Collection Specimen(S) By Brushing Or Washing (Pro Cah)",,45378,CPT,Professional,Both,,,,768,652.8,112.56,768,BlueCross BlueShield Minnesota, Federal Employee Program,373.22,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Colonoscopy, Flexible; Diagnostic, Including Collection Specimen(S) By Brushing Or Washing (Pro Cah)",,45378,CPT,Professional,Both,,,,768,652.8,112.56,768,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,379.19152,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Colonoscopy, Flexible; Diagnostic, Including Collection Specimen(S) By Brushing Or Washing (Pro Cah)",,45378,CPT,Professional,Both,,,,768,652.8,112.56,768,BlueCross BlueShield Minnesota,High Value Network Plan,379.19152,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Colonoscopy, Flexible; Diagnostic, Including Collection Specimen(S) By Brushing Or Washing (Pro Cah)",,45378,CPT,Professional,Both,,,,768,652.8,112.56,768,BlueCross BlueShield Minnesota,Medicare Advantage,201.48,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Colonoscopy, Flexible; Diagnostic, Including Collection Specimen(S) By Brushing Or Washing (Pro Cah)",,45378,CPT,Professional,Both,,,,768,652.8,112.56,768,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,379.19152,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Colonoscopy, Flexible; Diagnostic, Including Collection Specimen(S) By Brushing Or Washing (Pro Cah)",,45378,CPT,Professional,Both,,,,768,652.8,112.56,768,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,129.95656,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Colonoscopy, Flexible; Diagnostic, Including Collection Specimen(S) By Brushing Or Washing (Pro Cah)",,45378,CPT,Professional,Both,,,,768,652.8,112.56,768,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),201.48,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Colonoscopy, Flexible; Diagnostic, Including Collection Specimen(S) By Brushing Or Washing (Pro Cah)",,45378,CPT,Professional,Both,,,,768,652.8,112.56,768,CorVel,Worker's Compensation,346.8537894,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Colonoscopy, Flexible; Diagnostic, Including Collection Specimen(S) By Brushing Or Washing (Pro Cah)",,45378,CPT,Professional,Both,,,,768,652.8,112.56,768,First Health Group Corporation,First Health Network,744.96,97,,percent of total billed charges,,
"Colonoscopy, Flexible; Diagnostic, Including Collection Specimen(S) By Brushing Or Washing (Pro Cah)",,45378,CPT,Professional,Both,,,,768,652.8,112.56,768,"Health Partners, Inc.",Commercial,374.38,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Colonoscopy, Flexible; Diagnostic, Including Collection Specimen(S) By Brushing Or Washing (Pro Cah)",,45378,CPT,Professional,Both,,,,768,652.8,112.56,768,"Health Partners, Inc.",Medicare Advantage,201.48,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Colonoscopy, Flexible; Diagnostic, Including Collection Specimen(S) By Brushing Or Washing (Pro Cah)",,45378,CPT,Professional,Both,,,,768,652.8,112.56,768,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),175.2,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Colonoscopy, Flexible; Diagnostic, Including Collection Specimen(S) By Brushing Or Washing (Pro Cah)",,45378,CPT,Professional,Both,,,,768,652.8,112.56,768,"Health Partners, Inc.",State of Minnesota Advantage Program,322.52837,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Colonoscopy, Flexible; Diagnostic, Including Collection Specimen(S) By Brushing Or Washing (Pro Cah)",,45378,CPT,Professional,Both,,,,768,652.8,112.56,768,"Health Partners, Inc.",State Public Programs,112.56,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Colonoscopy, Flexible; Diagnostic, Including Collection Specimen(S) By Brushing Or Washing (Pro Cah)",,45378,CPT,Professional,Both,,,,768,652.8,112.56,768,Humana Insurance Company,Commercial PPO,175.2,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Colonoscopy, Flexible; Diagnostic, Including Collection Specimen(S) By Brushing Or Washing (Pro Cah)",,45378,CPT,Professional,Both,,,,768,652.8,112.56,768,Humana Insurance Company,Medicare PPO,768,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Colonoscopy, Flexible; Diagnostic, Including Collection Specimen(S) By Brushing Or Washing (Pro Cah)",,45378,CPT,Professional,Both,,,,768,652.8,112.56,768,Medica,Individual & Family,651.264,84.8,,percent of total billed charges,,
"Colonoscopy, Flexible; Diagnostic, Including Collection Specimen(S) By Brushing Or Washing (Pro Cah)",,45378,CPT,Professional,Both,,,,768,652.8,112.56,768,Medica,Medica Advantage Solution,382.464,49.8,,percent of total billed charges,,
"Colonoscopy, Flexible; Diagnostic, Including Collection Specimen(S) By Brushing Or Washing (Pro Cah)",,45378,CPT,Professional,Both,,,,768,652.8,112.56,768,Medica,Medical Assistance,129.96,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Colonoscopy, Flexible; Diagnostic, Including Collection Specimen(S) By Brushing Or Washing (Pro Cah)",,45378,CPT,Professional,Both,,,,768,652.8,112.56,768,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,175.2,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Colonoscopy, Flexible; Diagnostic, Including Collection Specimen(S) By Brushing Or Washing (Pro Cah)",,45378,CPT,Professional,Both,,,,768,652.8,112.56,768,"Multiplan, Inc.","Multiplan, Inc.",721.92,94,,percent of total billed charges,,
"Colonoscopy, Flexible; Diagnostic, Including Collection Specimen(S) By Brushing Or Washing (Pro Cah)",,45378,CPT,Professional,Both,,,,768,652.8,112.56,768,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,691.968,90.1,,percent of total billed charges,,
"Colonoscopy, Flexible; Diagnostic, Including Collection Specimen(S) By Brushing Or Washing (Pro Cah)",,45378,CPT,Professional,Both,,,,768,652.8,112.56,768,"Preferred One Administrative Services, INC.",PPO,757.248,98.6,,percent of total billed charges,,
"Colonoscopy, Flexible; Diagnostic, Including Collection Specimen(S) By Brushing Or Washing (Pro Cah)",,45378,CPT,Professional,Both,,,,768,652.8,112.56,768,PrimeWest Health,Minnesota Senior Health Options (MSHO),201.48,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Colonoscopy, Flexible; Diagnostic, Including Collection Specimen(S) By Brushing Or Washing (Pro Cah)",,45378,CPT,Professional,Both,,,,768,652.8,112.56,768,PrimeWest Health,MinnesotaCare,139.0535192,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Colonoscopy, Flexible; Diagnostic, Including Collection Specimen(S) By Brushing Or Washing (Pro Cah)",,45378,CPT,Professional,Both,,,,768,652.8,112.56,768,Sanford Health Plan,Sanford Health Plan,675.84,88,,percent of total billed charges,,
"Colonoscopy, Flexible; Diagnostic, Including Collection Specimen(S) By Brushing Or Washing (Pro Cah)",,45378,CPT,Professional,Both,,,,768,652.8,112.56,768,"UCare Health, Inc.",Individual & Family Plan,284.80512,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Colonoscopy, Flexible; Diagnostic, Including Collection Specimen(S) By Brushing Or Washing (Pro Cah)",,45378,CPT,Professional,Both,,,,768,652.8,112.56,768,"UCare Health, Inc.",Medical Assistance,142.952216,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Colonoscopy, Flexible; Diagnostic, Including Collection Specimen(S) By Brushing Or Washing (Pro Cah)",,45378,CPT,Professional,Both,,,,768,652.8,112.56,768,"UCare Health, Inc.",Medicare Advantage,201.48,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Colonoscopy, Flexible; Diagnostic, Including Collection Specimen(S) By Brushing Or Washing (Pro Cah)",,45378,CPT,Professional,Both,,,,768,652.8,112.56,768,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),161.184,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Colonoscopy, Flexible; Diagnostic, Including Collection Specimen(S) By Brushing Or Washing (Pro Cah)",,45378,CPT,Professional,Both,,,,768,652.8,112.56,768,UnitedHealthcare,Individual & Family,768,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Colonoscopy, Flexible; Diagnostic, Including Collection Specimen(S) By Brushing Or Washing (Pro Cah)",,45378,CPT,Professional,Both,,,,768,652.8,112.56,768,UnitedHealthcare,Medicare Advantage,201.48,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Colonoscopy, Flexible; Diagnostic, Including Collection Specimen(S) By Brushing Or Washing (Pro Cah)",,45378,CPT,Professional,Both,,,,768,652.8,112.56,768,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,129.95656,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Colonoscopy, Flexible; With Biopsy, Single Or Multiple (Pro Cah)",,45380,CPT,Professional,Both,,,,672,571.2,122.59,672,Aetna,Commercial,571.2,85,,percent of total billed charges,,
"Colonoscopy, Flexible; With Biopsy, Single Or Multiple (Pro Cah)",,45380,CPT,Professional,Both,,,,672,571.2,122.59,672,Aetna,Medicare Advantage,195.49,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Colonoscopy, Flexible; With Biopsy, Single Or Multiple (Pro Cah)",,45380,CPT,Professional,Both,,,,672,571.2,122.59,672,Aetna,PPO,624.96,93,,percent of total billed charges,,
"Colonoscopy, Flexible; With Biopsy, Single Or Multiple (Pro Cah)",,45380,CPT,Professional,Both,,,,672,571.2,122.59,672,America's PPO,America's PPO,574.1568,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Colonoscopy, Flexible; With Biopsy, Single Or Multiple (Pro Cah)",,45380,CPT,Professional,Both,,,,672,571.2,122.59,672,BlueCross BlueShield Minnesota, Federal Employee Program,405.59,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Colonoscopy, Flexible; With Biopsy, Single Or Multiple (Pro Cah)",,45380,CPT,Professional,Both,,,,672,571.2,122.59,672,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,412.07944,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Colonoscopy, Flexible; With Biopsy, Single Or Multiple (Pro Cah)",,45380,CPT,Professional,Both,,,,672,571.2,122.59,672,BlueCross BlueShield Minnesota,High Value Network Plan,412.07944,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Colonoscopy, Flexible; With Biopsy, Single Or Multiple (Pro Cah)",,45380,CPT,Professional,Both,,,,672,571.2,122.59,672,BlueCross BlueShield Minnesota,Medicare Advantage,219.374,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Colonoscopy, Flexible; With Biopsy, Single Or Multiple (Pro Cah)",,45380,CPT,Professional,Both,,,,672,571.2,122.59,672,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,412.07944,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Colonoscopy, Flexible; With Biopsy, Single Or Multiple (Pro Cah)",,45380,CPT,Professional,Both,,,,672,571.2,122.59,672,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,141.53896,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Colonoscopy, Flexible; With Biopsy, Single Or Multiple (Pro Cah)",,45380,CPT,Professional,Both,,,,672,571.2,122.59,672,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),219.374,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Colonoscopy, Flexible; With Biopsy, Single Or Multiple (Pro Cah)",,45380,CPT,Professional,Both,,,,672,571.2,122.59,672,CorVel,Worker's Compensation,377.448381,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Colonoscopy, Flexible; With Biopsy, Single Or Multiple (Pro Cah)",,45380,CPT,Professional,Both,,,,672,571.2,122.59,672,First Health Group Corporation,First Health Network,651.84,97,,percent of total billed charges,,
"Colonoscopy, Flexible; With Biopsy, Single Or Multiple (Pro Cah)",,45380,CPT,Professional,Both,,,,672,571.2,122.59,672,"Health Partners, Inc.",Commercial,407.02,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Colonoscopy, Flexible; With Biopsy, Single Or Multiple (Pro Cah)",,45380,CPT,Professional,Both,,,,672,571.2,122.59,672,"Health Partners, Inc.",Medicare Advantage,219.374,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Colonoscopy, Flexible; With Biopsy, Single Or Multiple (Pro Cah)",,45380,CPT,Professional,Both,,,,672,571.2,122.59,672,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),190.78,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Colonoscopy, Flexible; With Biopsy, Single Or Multiple (Pro Cah)",,45380,CPT,Professional,Both,,,,672,571.2,122.59,672,"Health Partners, Inc.",State of Minnesota Advantage Program,350.64773,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Colonoscopy, Flexible; With Biopsy, Single Or Multiple (Pro Cah)",,45380,CPT,Professional,Both,,,,672,571.2,122.59,672,"Health Partners, Inc.",State Public Programs,122.59,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Colonoscopy, Flexible; With Biopsy, Single Or Multiple (Pro Cah)",,45380,CPT,Professional,Both,,,,672,571.2,122.59,672,Humana Insurance Company,Commercial PPO,190.76,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Colonoscopy, Flexible; With Biopsy, Single Or Multiple (Pro Cah)",,45380,CPT,Professional,Both,,,,672,571.2,122.59,672,Humana Insurance Company,Medicare PPO,672,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Colonoscopy, Flexible; With Biopsy, Single Or Multiple (Pro Cah)",,45380,CPT,Professional,Both,,,,672,571.2,122.59,672,Medica,Individual & Family,569.856,84.8,,percent of total billed charges,,
"Colonoscopy, Flexible; With Biopsy, Single Or Multiple (Pro Cah)",,45380,CPT,Professional,Both,,,,672,571.2,122.59,672,Medica,Medica Advantage Solution,334.656,49.8,,percent of total billed charges,,
"Colonoscopy, Flexible; With Biopsy, Single Or Multiple (Pro Cah)",,45380,CPT,Professional,Both,,,,672,571.2,122.59,672,Medica,Medical Assistance,141.54,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Colonoscopy, Flexible; With Biopsy, Single Or Multiple (Pro Cah)",,45380,CPT,Professional,Both,,,,672,571.2,122.59,672,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,190.76,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Colonoscopy, Flexible; With Biopsy, Single Or Multiple (Pro Cah)",,45380,CPT,Professional,Both,,,,672,571.2,122.59,672,"Multiplan, Inc.","Multiplan, Inc.",631.68,94,,percent of total billed charges,,
"Colonoscopy, Flexible; With Biopsy, Single Or Multiple (Pro Cah)",,45380,CPT,Professional,Both,,,,672,571.2,122.59,672,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,605.472,90.1,,percent of total billed charges,,
"Colonoscopy, Flexible; With Biopsy, Single Or Multiple (Pro Cah)",,45380,CPT,Professional,Both,,,,672,571.2,122.59,672,"Preferred One Administrative Services, INC.",PPO,662.592,98.6,,percent of total billed charges,,
"Colonoscopy, Flexible; With Biopsy, Single Or Multiple (Pro Cah)",,45380,CPT,Professional,Both,,,,672,571.2,122.59,672,PrimeWest Health,Minnesota Senior Health Options (MSHO),219.374,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Colonoscopy, Flexible; With Biopsy, Single Or Multiple (Pro Cah)",,45380,CPT,Professional,Both,,,,672,571.2,122.59,672,PrimeWest Health,MinnesotaCare,151.4466872,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Colonoscopy, Flexible; With Biopsy, Single Or Multiple (Pro Cah)",,45380,CPT,Professional,Both,,,,672,571.2,122.59,672,Sanford Health Plan,Sanford Health Plan,591.36,88,,percent of total billed charges,,
"Colonoscopy, Flexible; With Biopsy, Single Or Multiple (Pro Cah)",,45380,CPT,Professional,Both,,,,672,571.2,122.59,672,"UCare Health, Inc.",Individual & Family Plan,310.099456,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Colonoscopy, Flexible; With Biopsy, Single Or Multiple (Pro Cah)",,45380,CPT,Professional,Both,,,,672,571.2,122.59,672,"UCare Health, Inc.",Medical Assistance,155.692856,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Colonoscopy, Flexible; With Biopsy, Single Or Multiple (Pro Cah)",,45380,CPT,Professional,Both,,,,672,571.2,122.59,672,"UCare Health, Inc.",Medicare Advantage,219.374,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Colonoscopy, Flexible; With Biopsy, Single Or Multiple (Pro Cah)",,45380,CPT,Professional,Both,,,,672,571.2,122.59,672,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),175.4992,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Colonoscopy, Flexible; With Biopsy, Single Or Multiple (Pro Cah)",,45380,CPT,Professional,Both,,,,672,571.2,122.59,672,UnitedHealthcare,Individual & Family,672,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Colonoscopy, Flexible; With Biopsy, Single Or Multiple (Pro Cah)",,45380,CPT,Professional,Both,,,,672,571.2,122.59,672,UnitedHealthcare,Medicare Advantage,219.374,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Colonoscopy, Flexible; With Biopsy, Single Or Multiple (Pro Cah)",,45380,CPT,Professional,Both,,,,672,571.2,122.59,672,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,141.53896,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Colonoscopy,Flexible;W Removal Tumor, Polyp,Or Other Lesion By Hot Biopsy Forceps (Pro Cah)",,45384,CPT,Professional,Both,,,,816,693.6,138.09,816,Aetna,Commercial,693.6,85,,percent of total billed charges,,
"Colonoscopy,Flexible;W Removal Tumor, Polyp,Or Other Lesion By Hot Biopsy Forceps (Pro Cah)",,45384,CPT,Professional,Both,,,,816,693.6,138.09,816,Aetna,Medicare Advantage,219.96,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Colonoscopy,Flexible;W Removal Tumor, Polyp,Or Other Lesion By Hot Biopsy Forceps (Pro Cah)",,45384,CPT,Professional,Both,,,,816,693.6,138.09,816,Aetna,PPO,758.88,93,,percent of total billed charges,,
"Colonoscopy,Flexible;W Removal Tumor, Polyp,Or Other Lesion By Hot Biopsy Forceps (Pro Cah)",,45384,CPT,Professional,Both,,,,816,693.6,138.09,816,America's PPO,America's PPO,697.1904,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Colonoscopy,Flexible;W Removal Tumor, Polyp,Or Other Lesion By Hot Biopsy Forceps (Pro Cah)",,45384,CPT,Professional,Both,,,,816,693.6,138.09,816,BlueCross BlueShield Minnesota, Federal Employee Program,460.67,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Colonoscopy,Flexible;W Removal Tumor, Polyp,Or Other Lesion By Hot Biopsy Forceps (Pro Cah)",,45384,CPT,Professional,Both,,,,816,693.6,138.09,816,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,468.04072,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Colonoscopy,Flexible;W Removal Tumor, Polyp,Or Other Lesion By Hot Biopsy Forceps (Pro Cah)",,45384,CPT,Professional,Both,,,,816,693.6,138.09,816,BlueCross BlueShield Minnesota,High Value Network Plan,468.04072,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Colonoscopy,Flexible;W Removal Tumor, Polyp,Or Other Lesion By Hot Biopsy Forceps (Pro Cah)",,45384,CPT,Professional,Both,,,,816,693.6,138.09,816,BlueCross BlueShield Minnesota,Medicare Advantage,246.721,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Colonoscopy,Flexible;W Removal Tumor, Polyp,Or Other Lesion By Hot Biopsy Forceps (Pro Cah)",,45384,CPT,Professional,Both,,,,816,693.6,138.09,816,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,468.04072,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Colonoscopy,Flexible;W Removal Tumor, Polyp,Or Other Lesion By Hot Biopsy Forceps (Pro Cah)",,45384,CPT,Professional,Both,,,,816,693.6,138.09,816,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,159.43072,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Colonoscopy,Flexible;W Removal Tumor, Polyp,Or Other Lesion By Hot Biopsy Forceps (Pro Cah)",,45384,CPT,Professional,Both,,,,816,693.6,138.09,816,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),246.721,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Colonoscopy,Flexible;W Removal Tumor, Polyp,Or Other Lesion By Hot Biopsy Forceps (Pro Cah)",,45384,CPT,Professional,Both,,,,816,693.6,138.09,816,CorVel,Worker's Compensation,425.7362223,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Colonoscopy,Flexible;W Removal Tumor, Polyp,Or Other Lesion By Hot Biopsy Forceps (Pro Cah)",,45384,CPT,Professional,Both,,,,816,693.6,138.09,816,First Health Group Corporation,First Health Network,791.52,97,,percent of total billed charges,,
"Colonoscopy,Flexible;W Removal Tumor, Polyp,Or Other Lesion By Hot Biopsy Forceps (Pro Cah)",,45384,CPT,Professional,Both,,,,816,693.6,138.09,816,"Health Partners, Inc.",Commercial,459.98,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Colonoscopy,Flexible;W Removal Tumor, Polyp,Or Other Lesion By Hot Biopsy Forceps (Pro Cah)",,45384,CPT,Professional,Both,,,,816,693.6,138.09,816,"Health Partners, Inc.",Medicare Advantage,246.721,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Colonoscopy,Flexible;W Removal Tumor, Polyp,Or Other Lesion By Hot Biopsy Forceps (Pro Cah)",,45384,CPT,Professional,Both,,,,816,693.6,138.09,816,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),214.51,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Colonoscopy,Flexible;W Removal Tumor, Polyp,Or Other Lesion By Hot Biopsy Forceps (Pro Cah)",,45384,CPT,Professional,Both,,,,816,693.6,138.09,816,"Health Partners, Inc.",State of Minnesota Advantage Program,396.27277,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Colonoscopy,Flexible;W Removal Tumor, Polyp,Or Other Lesion By Hot Biopsy Forceps (Pro Cah)",,45384,CPT,Professional,Both,,,,816,693.6,138.09,816,"Health Partners, Inc.",State Public Programs,138.09,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Colonoscopy,Flexible;W Removal Tumor, Polyp,Or Other Lesion By Hot Biopsy Forceps (Pro Cah)",,45384,CPT,Professional,Both,,,,816,693.6,138.09,816,Humana Insurance Company,Commercial PPO,214.54,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Colonoscopy,Flexible;W Removal Tumor, Polyp,Or Other Lesion By Hot Biopsy Forceps (Pro Cah)",,45384,CPT,Professional,Both,,,,816,693.6,138.09,816,Humana Insurance Company,Medicare PPO,816,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Colonoscopy,Flexible;W Removal Tumor, Polyp,Or Other Lesion By Hot Biopsy Forceps (Pro Cah)",,45384,CPT,Professional,Both,,,,816,693.6,138.09,816,Medica,Individual & Family,691.968,84.8,,percent of total billed charges,,
"Colonoscopy,Flexible;W Removal Tumor, Polyp,Or Other Lesion By Hot Biopsy Forceps (Pro Cah)",,45384,CPT,Professional,Both,,,,816,693.6,138.09,816,Medica,Medica Advantage Solution,406.368,49.8,,percent of total billed charges,,
"Colonoscopy,Flexible;W Removal Tumor, Polyp,Or Other Lesion By Hot Biopsy Forceps (Pro Cah)",,45384,CPT,Professional,Both,,,,816,693.6,138.09,816,Medica,Medical Assistance,159.43,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Colonoscopy,Flexible;W Removal Tumor, Polyp,Or Other Lesion By Hot Biopsy Forceps (Pro Cah)",,45384,CPT,Professional,Both,,,,816,693.6,138.09,816,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,214.54,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Colonoscopy,Flexible;W Removal Tumor, Polyp,Or Other Lesion By Hot Biopsy Forceps (Pro Cah)",,45384,CPT,Professional,Both,,,,816,693.6,138.09,816,"Multiplan, Inc.","Multiplan, Inc.",767.04,94,,percent of total billed charges,,
"Colonoscopy,Flexible;W Removal Tumor, Polyp,Or Other Lesion By Hot Biopsy Forceps (Pro Cah)",,45384,CPT,Professional,Both,,,,816,693.6,138.09,816,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,735.216,90.1,,percent of total billed charges,,
"Colonoscopy,Flexible;W Removal Tumor, Polyp,Or Other Lesion By Hot Biopsy Forceps (Pro Cah)",,45384,CPT,Professional,Both,,,,816,693.6,138.09,816,"Preferred One Administrative Services, INC.",PPO,804.576,98.6,,percent of total billed charges,,
"Colonoscopy,Flexible;W Removal Tumor, Polyp,Or Other Lesion By Hot Biopsy Forceps (Pro Cah)",,45384,CPT,Professional,Both,,,,816,693.6,138.09,816,PrimeWest Health,Minnesota Senior Health Options (MSHO),246.721,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Colonoscopy,Flexible;W Removal Tumor, Polyp,Or Other Lesion By Hot Biopsy Forceps (Pro Cah)",,45384,CPT,Professional,Both,,,,816,693.6,138.09,816,PrimeWest Health,MinnesotaCare,170.5908704,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Colonoscopy,Flexible;W Removal Tumor, Polyp,Or Other Lesion By Hot Biopsy Forceps (Pro Cah)",,45384,CPT,Professional,Both,,,,816,693.6,138.09,816,Sanford Health Plan,Sanford Health Plan,718.08,88,,percent of total billed charges,,
"Colonoscopy,Flexible;W Removal Tumor, Polyp,Or Other Lesion By Hot Biopsy Forceps (Pro Cah)",,45384,CPT,Professional,Both,,,,816,693.6,138.09,816,"UCare Health, Inc.",Individual & Family Plan,348.756224,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Colonoscopy,Flexible;W Removal Tumor, Polyp,Or Other Lesion By Hot Biopsy Forceps (Pro Cah)",,45384,CPT,Professional,Both,,,,816,693.6,138.09,816,"UCare Health, Inc.",Medical Assistance,175.373792,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Colonoscopy,Flexible;W Removal Tumor, Polyp,Or Other Lesion By Hot Biopsy Forceps (Pro Cah)",,45384,CPT,Professional,Both,,,,816,693.6,138.09,816,"UCare Health, Inc.",Medicare Advantage,246.721,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Colonoscopy,Flexible;W Removal Tumor, Polyp,Or Other Lesion By Hot Biopsy Forceps (Pro Cah)",,45384,CPT,Professional,Both,,,,816,693.6,138.09,816,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),197.3768,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Colonoscopy,Flexible;W Removal Tumor, Polyp,Or Other Lesion By Hot Biopsy Forceps (Pro Cah)",,45384,CPT,Professional,Both,,,,816,693.6,138.09,816,UnitedHealthcare,Individual & Family,816,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Colonoscopy,Flexible;W Removal Tumor, Polyp,Or Other Lesion By Hot Biopsy Forceps (Pro Cah)",,45384,CPT,Professional,Both,,,,816,693.6,138.09,816,UnitedHealthcare,Medicare Advantage,246.721,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Colonoscopy,Flexible;W Removal Tumor, Polyp,Or Other Lesion By Hot Biopsy Forceps (Pro Cah)",,45384,CPT,Professional,Both,,,,816,693.6,138.09,816,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,159.43072,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Colonoscopy, Flexible;With Removal Of Tumor,Polyp,Or Other Lesion Snare Technique (Pro Cah)",,45385,CPT,Professional,Both,,,,960,816,155.32,960,Aetna,Commercial,816,85,,percent of total billed charges,,
"Colonoscopy, Flexible;With Removal Of Tumor,Polyp,Or Other Lesion Snare Technique (Pro Cah)",,45385,CPT,Professional,Both,,,,960,816,155.32,960,Aetna,Medicare Advantage,247.39,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Colonoscopy, Flexible;With Removal Of Tumor,Polyp,Or Other Lesion Snare Technique (Pro Cah)",,45385,CPT,Professional,Both,,,,960,816,155.32,960,Aetna,PPO,892.8,93,,percent of total billed charges,,
"Colonoscopy, Flexible;With Removal Of Tumor,Polyp,Or Other Lesion Snare Technique (Pro Cah)",,45385,CPT,Professional,Both,,,,960,816,155.32,960,America's PPO,America's PPO,820.224,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Colonoscopy, Flexible;With Removal Of Tumor,Polyp,Or Other Lesion Snare Technique (Pro Cah)",,45385,CPT,Professional,Both,,,,960,816,155.32,960,BlueCross BlueShield Minnesota, Federal Employee Program,513.01,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Colonoscopy, Flexible;With Removal Of Tumor,Polyp,Or Other Lesion Snare Technique (Pro Cah)",,45385,CPT,Professional,Both,,,,960,816,155.32,960,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,521.21816,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Colonoscopy, Flexible;With Removal Of Tumor,Polyp,Or Other Lesion Snare Technique (Pro Cah)",,45385,CPT,Professional,Both,,,,960,816,155.32,960,BlueCross BlueShield Minnesota,High Value Network Plan,521.21816,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Colonoscopy, Flexible;With Removal Of Tumor,Polyp,Or Other Lesion Snare Technique (Pro Cah)",,45385,CPT,Professional,Both,,,,960,816,155.32,960,BlueCross BlueShield Minnesota,Medicare Advantage,277.61,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Colonoscopy, Flexible;With Removal Of Tumor,Polyp,Or Other Lesion Snare Technique (Pro Cah)",,45385,CPT,Professional,Both,,,,960,816,155.32,960,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,521.21816,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Colonoscopy, Flexible;With Removal Of Tumor,Polyp,Or Other Lesion Snare Technique (Pro Cah)",,45385,CPT,Professional,Both,,,,960,816,155.32,960,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,179.324,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Colonoscopy, Flexible;With Removal Of Tumor,Polyp,Or Other Lesion Snare Technique (Pro Cah)",,45385,CPT,Professional,Both,,,,960,816,155.32,960,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),277.61,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Colonoscopy, Flexible;With Removal Of Tumor,Polyp,Or Other Lesion Snare Technique (Pro Cah)",,45385,CPT,Professional,Both,,,,960,816,155.32,960,CorVel,Worker's Compensation,478.9919568,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Colonoscopy, Flexible;With Removal Of Tumor,Polyp,Or Other Lesion Snare Technique (Pro Cah)",,45385,CPT,Professional,Both,,,,960,816,155.32,960,First Health Group Corporation,First Health Network,931.2,97,,percent of total billed charges,,
"Colonoscopy, Flexible;With Removal Of Tumor,Polyp,Or Other Lesion Snare Technique (Pro Cah)",,45385,CPT,Professional,Both,,,,960,816,155.32,960,"Health Partners, Inc.",Commercial,517.3,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Colonoscopy, Flexible;With Removal Of Tumor,Polyp,Or Other Lesion Snare Technique (Pro Cah)",,45385,CPT,Professional,Both,,,,960,816,155.32,960,"Health Partners, Inc.",Medicare Advantage,277.61,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Colonoscopy, Flexible;With Removal Of Tumor,Polyp,Or Other Lesion Snare Technique (Pro Cah)",,45385,CPT,Professional,Both,,,,960,816,155.32,960,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),241.28,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Colonoscopy, Flexible;With Removal Of Tumor,Polyp,Or Other Lesion Snare Technique (Pro Cah)",,45385,CPT,Professional,Both,,,,960,816,155.32,960,"Health Partners, Inc.",State of Minnesota Advantage Program,445.65395,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Colonoscopy, Flexible;With Removal Of Tumor,Polyp,Or Other Lesion Snare Technique (Pro Cah)",,45385,CPT,Professional,Both,,,,960,816,155.32,960,"Health Partners, Inc.",State Public Programs,155.32,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Colonoscopy, Flexible;With Removal Of Tumor,Polyp,Or Other Lesion Snare Technique (Pro Cah)",,45385,CPT,Professional,Both,,,,960,816,155.32,960,Humana Insurance Company,Commercial PPO,241.4,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Colonoscopy, Flexible;With Removal Of Tumor,Polyp,Or Other Lesion Snare Technique (Pro Cah)",,45385,CPT,Professional,Both,,,,960,816,155.32,960,Humana Insurance Company,Medicare PPO,960,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Colonoscopy, Flexible;With Removal Of Tumor,Polyp,Or Other Lesion Snare Technique (Pro Cah)",,45385,CPT,Professional,Both,,,,960,816,155.32,960,Medica,Individual & Family,814.08,84.8,,percent of total billed charges,,
"Colonoscopy, Flexible;With Removal Of Tumor,Polyp,Or Other Lesion Snare Technique (Pro Cah)",,45385,CPT,Professional,Both,,,,960,816,155.32,960,Medica,Medica Advantage Solution,478.08,49.8,,percent of total billed charges,,
"Colonoscopy, Flexible;With Removal Of Tumor,Polyp,Or Other Lesion Snare Technique (Pro Cah)",,45385,CPT,Professional,Both,,,,960,816,155.32,960,Medica,Medical Assistance,179.32,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Colonoscopy, Flexible;With Removal Of Tumor,Polyp,Or Other Lesion Snare Technique (Pro Cah)",,45385,CPT,Professional,Both,,,,960,816,155.32,960,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,241.4,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Colonoscopy, Flexible;With Removal Of Tumor,Polyp,Or Other Lesion Snare Technique (Pro Cah)",,45385,CPT,Professional,Both,,,,960,816,155.32,960,"Multiplan, Inc.","Multiplan, Inc.",902.4,94,,percent of total billed charges,,
"Colonoscopy, Flexible;With Removal Of Tumor,Polyp,Or Other Lesion Snare Technique (Pro Cah)",,45385,CPT,Professional,Both,,,,960,816,155.32,960,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,864.96,90.1,,percent of total billed charges,,
"Colonoscopy, Flexible;With Removal Of Tumor,Polyp,Or Other Lesion Snare Technique (Pro Cah)",,45385,CPT,Professional,Both,,,,960,816,155.32,960,"Preferred One Administrative Services, INC.",PPO,946.56,98.6,,percent of total billed charges,,
"Colonoscopy, Flexible;With Removal Of Tumor,Polyp,Or Other Lesion Snare Technique (Pro Cah)",,45385,CPT,Professional,Both,,,,960,816,155.32,960,PrimeWest Health,Minnesota Senior Health Options (MSHO),277.61,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Colonoscopy, Flexible;With Removal Of Tumor,Polyp,Or Other Lesion Snare Technique (Pro Cah)",,45385,CPT,Professional,Both,,,,960,816,155.32,960,PrimeWest Health,MinnesotaCare,191.87668,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Colonoscopy, Flexible;With Removal Of Tumor,Polyp,Or Other Lesion Snare Technique (Pro Cah)",,45385,CPT,Professional,Both,,,,960,816,155.32,960,Sanford Health Plan,Sanford Health Plan,844.8,88,,percent of total billed charges,,
"Colonoscopy, Flexible;With Removal Of Tumor,Polyp,Or Other Lesion Snare Technique (Pro Cah)",,45385,CPT,Professional,Both,,,,960,816,155.32,960,"UCare Health, Inc.",Individual & Family Plan,392.41984,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Colonoscopy, Flexible;With Removal Of Tumor,Polyp,Or Other Lesion Snare Technique (Pro Cah)",,45385,CPT,Professional,Both,,,,960,816,155.32,960,"UCare Health, Inc.",Medical Assistance,197.2564,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Colonoscopy, Flexible;With Removal Of Tumor,Polyp,Or Other Lesion Snare Technique (Pro Cah)",,45385,CPT,Professional,Both,,,,960,816,155.32,960,"UCare Health, Inc.",Medicare Advantage,277.61,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Colonoscopy, Flexible;With Removal Of Tumor,Polyp,Or Other Lesion Snare Technique (Pro Cah)",,45385,CPT,Professional,Both,,,,960,816,155.32,960,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),222.088,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Colonoscopy, Flexible;With Removal Of Tumor,Polyp,Or Other Lesion Snare Technique (Pro Cah)",,45385,CPT,Professional,Both,,,,960,816,155.32,960,UnitedHealthcare,Individual & Family,960,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Colonoscopy, Flexible;With Removal Of Tumor,Polyp,Or Other Lesion Snare Technique (Pro Cah)",,45385,CPT,Professional,Both,,,,960,816,155.32,960,UnitedHealthcare,Medicare Advantage,277.61,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Colonoscopy, Flexible;With Removal Of Tumor,Polyp,Or Other Lesion Snare Technique (Pro Cah)",,45385,CPT,Professional,Both,,,,960,816,155.32,960,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,179.324,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Removal Of Fecal Impaction Or Foreign Body (Separate Procedure) Under Anesthesia (Pro Cah),,45915,CPT,Professional,Both,,,,675,573.75,142.23,675,Aetna,Commercial,573.75,85,,percent of total billed charges,,
Removal Of Fecal Impaction Or Foreign Body (Separate Procedure) Under Anesthesia (Pro Cah),,45915,CPT,Professional,Both,,,,675,573.75,142.23,675,Aetna,Medicare Advantage,227.07,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Removal Of Fecal Impaction Or Foreign Body (Separate Procedure) Under Anesthesia (Pro Cah),,45915,CPT,Professional,Both,,,,675,573.75,142.23,675,Aetna,PPO,627.75,93,,percent of total billed charges,,
Removal Of Fecal Impaction Or Foreign Body (Separate Procedure) Under Anesthesia (Pro Cah),,45915,CPT,Professional,Both,,,,675,573.75,142.23,675,America's PPO,America's PPO,576.72,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Removal Of Fecal Impaction Or Foreign Body (Separate Procedure) Under Anesthesia (Pro Cah),,45915,CPT,Professional,Both,,,,675,573.75,142.23,675,BlueCross BlueShield Minnesota, Federal Employee Program,472.38,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Removal Of Fecal Impaction Or Foreign Body (Separate Procedure) Under Anesthesia (Pro Cah),,45915,CPT,Professional,Both,,,,675,573.75,142.23,675,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,479.93808,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Removal Of Fecal Impaction Or Foreign Body (Separate Procedure) Under Anesthesia (Pro Cah),,45915,CPT,Professional,Both,,,,675,573.75,142.23,675,BlueCross BlueShield Minnesota,High Value Network Plan,479.93808,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Removal Of Fecal Impaction Or Foreign Body (Separate Procedure) Under Anesthesia (Pro Cah),,45915,CPT,Professional,Both,,,,675,573.75,142.23,675,BlueCross BlueShield Minnesota,Medicare Advantage,254.3915,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Removal Of Fecal Impaction Or Foreign Body (Separate Procedure) Under Anesthesia (Pro Cah),,45915,CPT,Professional,Both,,,,675,573.75,142.23,675,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,479.93808,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Removal Of Fecal Impaction Or Foreign Body (Separate Procedure) Under Anesthesia (Pro Cah),,45915,CPT,Professional,Both,,,,675,573.75,142.23,675,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,164.21608,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Removal Of Fecal Impaction Or Foreign Body (Separate Procedure) Under Anesthesia (Pro Cah),,45915,CPT,Professional,Both,,,,675,573.75,142.23,675,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),254.3915,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Removal Of Fecal Impaction Or Foreign Body (Separate Procedure) Under Anesthesia (Pro Cah),,45915,CPT,Professional,Both,,,,675,573.75,142.23,675,CorVel,Worker's Compensation,438.0410946,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Removal Of Fecal Impaction Or Foreign Body (Separate Procedure) Under Anesthesia (Pro Cah),,45915,CPT,Professional,Both,,,,675,573.75,142.23,675,First Health Group Corporation,First Health Network,654.75,97,,percent of total billed charges,,
Removal Of Fecal Impaction Or Foreign Body (Separate Procedure) Under Anesthesia (Pro Cah),,45915,CPT,Professional,Both,,,,675,573.75,142.23,675,"Health Partners, Inc.",Commercial,473.04,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Removal Of Fecal Impaction Or Foreign Body (Separate Procedure) Under Anesthesia (Pro Cah),,45915,CPT,Professional,Both,,,,675,573.75,142.23,675,"Health Partners, Inc.",Medicare Advantage,254.3915,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Removal Of Fecal Impaction Or Foreign Body (Separate Procedure) Under Anesthesia (Pro Cah),,45915,CPT,Professional,Both,,,,675,573.75,142.23,675,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),221.28,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Removal Of Fecal Impaction Or Foreign Body (Separate Procedure) Under Anesthesia (Pro Cah),,45915,CPT,Professional,Both,,,,675,573.75,142.23,675,"Health Partners, Inc.",State of Minnesota Advantage Program,407.52396,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Removal Of Fecal Impaction Or Foreign Body (Separate Procedure) Under Anesthesia (Pro Cah),,45915,CPT,Professional,Both,,,,675,573.75,142.23,675,"Health Partners, Inc.",State Public Programs,142.23,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Removal Of Fecal Impaction Or Foreign Body (Separate Procedure) Under Anesthesia (Pro Cah),,45915,CPT,Professional,Both,,,,675,573.75,142.23,675,Humana Insurance Company,Commercial PPO,221.21,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Removal Of Fecal Impaction Or Foreign Body (Separate Procedure) Under Anesthesia (Pro Cah),,45915,CPT,Professional,Both,,,,675,573.75,142.23,675,Humana Insurance Company,Medicare PPO,675,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Removal Of Fecal Impaction Or Foreign Body (Separate Procedure) Under Anesthesia (Pro Cah),,45915,CPT,Professional,Both,,,,675,573.75,142.23,675,Medica,Individual & Family,572.4,84.8,,percent of total billed charges,,
Removal Of Fecal Impaction Or Foreign Body (Separate Procedure) Under Anesthesia (Pro Cah),,45915,CPT,Professional,Both,,,,675,573.75,142.23,675,Medica,Medica Advantage Solution,336.15,49.8,,percent of total billed charges,,
Removal Of Fecal Impaction Or Foreign Body (Separate Procedure) Under Anesthesia (Pro Cah),,45915,CPT,Professional,Both,,,,675,573.75,142.23,675,Medica,Medical Assistance,164.22,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Removal Of Fecal Impaction Or Foreign Body (Separate Procedure) Under Anesthesia (Pro Cah),,45915,CPT,Professional,Both,,,,675,573.75,142.23,675,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,221.21,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Removal Of Fecal Impaction Or Foreign Body (Separate Procedure) Under Anesthesia (Pro Cah),,45915,CPT,Professional,Both,,,,675,573.75,142.23,675,"Multiplan, Inc.","Multiplan, Inc.",634.5,94,,percent of total billed charges,,
Removal Of Fecal Impaction Or Foreign Body (Separate Procedure) Under Anesthesia (Pro Cah),,45915,CPT,Professional,Both,,,,675,573.75,142.23,675,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,608.175,90.1,,percent of total billed charges,,
Removal Of Fecal Impaction Or Foreign Body (Separate Procedure) Under Anesthesia (Pro Cah),,45915,CPT,Professional,Both,,,,675,573.75,142.23,675,"Preferred One Administrative Services, INC.",PPO,665.55,98.6,,percent of total billed charges,,
Removal Of Fecal Impaction Or Foreign Body (Separate Procedure) Under Anesthesia (Pro Cah),,45915,CPT,Professional,Both,,,,675,573.75,142.23,675,PrimeWest Health,Minnesota Senior Health Options (MSHO),254.3915,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Removal Of Fecal Impaction Or Foreign Body (Separate Procedure) Under Anesthesia (Pro Cah),,45915,CPT,Professional,Both,,,,675,573.75,142.23,675,PrimeWest Health,MinnesotaCare,175.7112056,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Removal Of Fecal Impaction Or Foreign Body (Separate Procedure) Under Anesthesia (Pro Cah),,45915,CPT,Professional,Both,,,,675,573.75,142.23,675,Sanford Health Plan,Sanford Health Plan,594,88,,percent of total billed charges,,
Removal Of Fecal Impaction Or Foreign Body (Separate Procedure) Under Anesthesia (Pro Cah),,45915,CPT,Professional,Both,,,,675,573.75,142.23,675,"UCare Health, Inc.",Individual & Family Plan,359.598976,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Removal Of Fecal Impaction Or Foreign Body (Separate Procedure) Under Anesthesia (Pro Cah),,45915,CPT,Professional,Both,,,,675,573.75,142.23,675,"UCare Health, Inc.",Medical Assistance,180.637688,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Removal Of Fecal Impaction Or Foreign Body (Separate Procedure) Under Anesthesia (Pro Cah),,45915,CPT,Professional,Both,,,,675,573.75,142.23,675,"UCare Health, Inc.",Medicare Advantage,254.3915,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Removal Of Fecal Impaction Or Foreign Body (Separate Procedure) Under Anesthesia (Pro Cah),,45915,CPT,Professional,Both,,,,675,573.75,142.23,675,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),203.5132,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Removal Of Fecal Impaction Or Foreign Body (Separate Procedure) Under Anesthesia (Pro Cah),,45915,CPT,Professional,Both,,,,675,573.75,142.23,675,UnitedHealthcare,Individual & Family,675,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Removal Of Fecal Impaction Or Foreign Body (Separate Procedure) Under Anesthesia (Pro Cah),,45915,CPT,Professional,Both,,,,675,573.75,142.23,675,UnitedHealthcare,Medicare Advantage,254.3915,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Removal Of Fecal Impaction Or Foreign Body (Separate Procedure) Under Anesthesia (Pro Cah),,45915,CPT,Professional,Both,,,,675,573.75,142.23,675,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,164.21608,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Incision And Drainage Of Ischiorectal And Or Perirectal Abscess (Separate Procedure) (Pro Cah),,46040,CPT,Professional,Both,,,,806,685.1,264.62,806,Aetna,Commercial,685.1,85,,percent of total billed charges,,
Incision And Drainage Of Ischiorectal And Or Perirectal Abscess (Separate Procedure) (Pro Cah),,46040,CPT,Professional,Both,,,,806,685.1,264.62,806,Aetna,Medicare Advantage,415.37,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Incision And Drainage Of Ischiorectal And Or Perirectal Abscess (Separate Procedure) (Pro Cah),,46040,CPT,Professional,Both,,,,806,685.1,264.62,806,Aetna,PPO,749.58,93,,percent of total billed charges,,
Incision And Drainage Of Ischiorectal And Or Perirectal Abscess (Separate Procedure) (Pro Cah),,46040,CPT,Professional,Both,,,,806,685.1,264.62,806,America's PPO,America's PPO,688.6464,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Incision And Drainage Of Ischiorectal And Or Perirectal Abscess (Separate Procedure) (Pro Cah),,46040,CPT,Professional,Both,,,,806,685.1,264.62,806,BlueCross BlueShield Minnesota, Federal Employee Program,806,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Incision And Drainage Of Ischiorectal And Or Perirectal Abscess (Separate Procedure) (Pro Cah),,46040,CPT,Professional,Both,,,,806,685.1,264.62,806,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,806,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Incision And Drainage Of Ischiorectal And Or Perirectal Abscess (Separate Procedure) (Pro Cah),,46040,CPT,Professional,Both,,,,806,685.1,264.62,806,BlueCross BlueShield Minnesota,High Value Network Plan,806,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Incision And Drainage Of Ischiorectal And Or Perirectal Abscess (Separate Procedure) (Pro Cah),,46040,CPT,Professional,Both,,,,806,685.1,264.62,806,BlueCross BlueShield Minnesota,Medicare Advantage,473.0065,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Incision And Drainage Of Ischiorectal And Or Perirectal Abscess (Separate Procedure) (Pro Cah),,46040,CPT,Professional,Both,,,,806,685.1,264.62,806,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,806,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Incision And Drainage Of Ischiorectal And Or Perirectal Abscess (Separate Procedure) (Pro Cah),,46040,CPT,Professional,Both,,,,806,685.1,264.62,806,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,305.5112,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Incision And Drainage Of Ischiorectal And Or Perirectal Abscess (Separate Procedure) (Pro Cah),,46040,CPT,Professional,Both,,,,806,685.1,264.62,806,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),473.0065,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Incision And Drainage Of Ischiorectal And Or Perirectal Abscess (Separate Procedure) (Pro Cah),,46040,CPT,Professional,Both,,,,806,685.1,264.62,806,CorVel,Worker's Compensation,806,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Incision And Drainage Of Ischiorectal And Or Perirectal Abscess (Separate Procedure) (Pro Cah),,46040,CPT,Professional,Both,,,,806,685.1,264.62,806,First Health Group Corporation,First Health Network,781.82,97,,percent of total billed charges,,
Incision And Drainage Of Ischiorectal And Or Perirectal Abscess (Separate Procedure) (Pro Cah),,46040,CPT,Professional,Both,,,,806,685.1,264.62,806,"Health Partners, Inc.",Commercial,806,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Incision And Drainage Of Ischiorectal And Or Perirectal Abscess (Separate Procedure) (Pro Cah),,46040,CPT,Professional,Both,,,,806,685.1,264.62,806,"Health Partners, Inc.",Medicare Advantage,473.0065,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Incision And Drainage Of Ischiorectal And Or Perirectal Abscess (Separate Procedure) (Pro Cah),,46040,CPT,Professional,Both,,,,806,685.1,264.62,806,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),411.39,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Incision And Drainage Of Ischiorectal And Or Perirectal Abscess (Separate Procedure) (Pro Cah),,46040,CPT,Professional,Both,,,,806,685.1,264.62,806,"Health Partners, Inc.",State of Minnesota Advantage Program,753.79527,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Incision And Drainage Of Ischiorectal And Or Perirectal Abscess (Separate Procedure) (Pro Cah),,46040,CPT,Professional,Both,,,,806,685.1,264.62,806,"Health Partners, Inc.",State Public Programs,264.62,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Incision And Drainage Of Ischiorectal And Or Perirectal Abscess (Separate Procedure) (Pro Cah),,46040,CPT,Professional,Both,,,,806,685.1,264.62,806,Humana Insurance Company,Commercial PPO,411.31,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Incision And Drainage Of Ischiorectal And Or Perirectal Abscess (Separate Procedure) (Pro Cah),,46040,CPT,Professional,Both,,,,806,685.1,264.62,806,Humana Insurance Company,Medicare PPO,806,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Incision And Drainage Of Ischiorectal And Or Perirectal Abscess (Separate Procedure) (Pro Cah),,46040,CPT,Professional,Both,,,,806,685.1,264.62,806,Medica,Individual & Family,683.488,84.8,,percent of total billed charges,,
Incision And Drainage Of Ischiorectal And Or Perirectal Abscess (Separate Procedure) (Pro Cah),,46040,CPT,Professional,Both,,,,806,685.1,264.62,806,Medica,Medica Advantage Solution,401.388,49.8,,percent of total billed charges,,
Incision And Drainage Of Ischiorectal And Or Perirectal Abscess (Separate Procedure) (Pro Cah),,46040,CPT,Professional,Both,,,,806,685.1,264.62,806,Medica,Medical Assistance,305.51,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Incision And Drainage Of Ischiorectal And Or Perirectal Abscess (Separate Procedure) (Pro Cah),,46040,CPT,Professional,Both,,,,806,685.1,264.62,806,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,411.31,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Incision And Drainage Of Ischiorectal And Or Perirectal Abscess (Separate Procedure) (Pro Cah),,46040,CPT,Professional,Both,,,,806,685.1,264.62,806,"Multiplan, Inc.","Multiplan, Inc.",757.64,94,,percent of total billed charges,,
Incision And Drainage Of Ischiorectal And Or Perirectal Abscess (Separate Procedure) (Pro Cah),,46040,CPT,Professional,Both,,,,806,685.1,264.62,806,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,726.206,90.1,,percent of total billed charges,,
Incision And Drainage Of Ischiorectal And Or Perirectal Abscess (Separate Procedure) (Pro Cah),,46040,CPT,Professional,Both,,,,806,685.1,264.62,806,"Preferred One Administrative Services, INC.",PPO,794.716,98.6,,percent of total billed charges,,
Incision And Drainage Of Ischiorectal And Or Perirectal Abscess (Separate Procedure) (Pro Cah),,46040,CPT,Professional,Both,,,,806,685.1,264.62,806,PrimeWest Health,Minnesota Senior Health Options (MSHO),473.0065,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Incision And Drainage Of Ischiorectal And Or Perirectal Abscess (Separate Procedure) (Pro Cah),,46040,CPT,Professional,Both,,,,806,685.1,264.62,806,PrimeWest Health,MinnesotaCare,326.896984,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Incision And Drainage Of Ischiorectal And Or Perirectal Abscess (Separate Procedure) (Pro Cah),,46040,CPT,Professional,Both,,,,806,685.1,264.62,806,Sanford Health Plan,Sanford Health Plan,709.28,88,,percent of total billed charges,,
Incision And Drainage Of Ischiorectal And Or Perirectal Abscess (Separate Procedure) (Pro Cah),,46040,CPT,Professional,Both,,,,806,685.1,264.62,806,"UCare Health, Inc.",Individual & Family Plan,668.625536,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Incision And Drainage Of Ischiorectal And Or Perirectal Abscess (Separate Procedure) (Pro Cah),,46040,CPT,Professional,Both,,,,806,685.1,264.62,806,"UCare Health, Inc.",Medical Assistance,336.06232,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Incision And Drainage Of Ischiorectal And Or Perirectal Abscess (Separate Procedure) (Pro Cah),,46040,CPT,Professional,Both,,,,806,685.1,264.62,806,"UCare Health, Inc.",Medicare Advantage,473.0065,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Incision And Drainage Of Ischiorectal And Or Perirectal Abscess (Separate Procedure) (Pro Cah),,46040,CPT,Professional,Both,,,,806,685.1,264.62,806,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),378.4052,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Incision And Drainage Of Ischiorectal And Or Perirectal Abscess (Separate Procedure) (Pro Cah),,46040,CPT,Professional,Both,,,,806,685.1,264.62,806,UnitedHealthcare,Individual & Family,806,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Incision And Drainage Of Ischiorectal And Or Perirectal Abscess (Separate Procedure) (Pro Cah),,46040,CPT,Professional,Both,,,,806,685.1,264.62,806,UnitedHealthcare,Medicare Advantage,473.0065,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Incision And Drainage Of Ischiorectal And Or Perirectal Abscess (Separate Procedure) (Pro Cah),,46040,CPT,Professional,Both,,,,806,685.1,264.62,806,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,305.5112,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Incision And Drainage Intramural/Intramuscular/Submucosal Abscess/Transanal, W Anesthesia (Pro Cah)",,46045,CPT,Professional,Both,,,,1125,956.25,273.34,1125,Aetna,Commercial,956.25,85,,percent of total billed charges,,
"Incision And Drainage Intramural/Intramuscular/Submucosal Abscess/Transanal, W Anesthesia (Pro Cah)",,46045,CPT,Professional,Both,,,,1125,956.25,273.34,1125,Aetna,Medicare Advantage,432.13,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Incision And Drainage Intramural/Intramuscular/Submucosal Abscess/Transanal, W Anesthesia (Pro Cah)",,46045,CPT,Professional,Both,,,,1125,956.25,273.34,1125,Aetna,PPO,1046.25,93,,percent of total billed charges,,
"Incision And Drainage Intramural/Intramuscular/Submucosal Abscess/Transanal, W Anesthesia (Pro Cah)",,46045,CPT,Professional,Both,,,,1125,956.25,273.34,1125,America's PPO,America's PPO,961.2,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Incision And Drainage Intramural/Intramuscular/Submucosal Abscess/Transanal, W Anesthesia (Pro Cah)",,46045,CPT,Professional,Both,,,,1125,956.25,273.34,1125,BlueCross BlueShield Minnesota, Federal Employee Program,907.57,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Incision And Drainage Intramural/Intramuscular/Submucosal Abscess/Transanal, W Anesthesia (Pro Cah)",,46045,CPT,Professional,Both,,,,1125,956.25,273.34,1125,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,922.09112,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Incision And Drainage Intramural/Intramuscular/Submucosal Abscess/Transanal, W Anesthesia (Pro Cah)",,46045,CPT,Professional,Both,,,,1125,956.25,273.34,1125,BlueCross BlueShield Minnesota,High Value Network Plan,922.09112,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Incision And Drainage Intramural/Intramuscular/Submucosal Abscess/Transanal, W Anesthesia (Pro Cah)",,46045,CPT,Professional,Both,,,,1125,956.25,273.34,1125,BlueCross BlueShield Minnesota,Medicare Advantage,488.52,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Incision And Drainage Intramural/Intramuscular/Submucosal Abscess/Transanal, W Anesthesia (Pro Cah)",,46045,CPT,Professional,Both,,,,1125,956.25,273.34,1125,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,922.09112,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Incision And Drainage Intramural/Intramuscular/Submucosal Abscess/Transanal, W Anesthesia (Pro Cah)",,46045,CPT,Professional,Both,,,,1125,956.25,273.34,1125,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,315.57976,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Incision And Drainage Intramural/Intramuscular/Submucosal Abscess/Transanal, W Anesthesia (Pro Cah)",,46045,CPT,Professional,Both,,,,1125,956.25,273.34,1125,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),488.52,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Incision And Drainage Intramural/Intramuscular/Submucosal Abscess/Transanal, W Anesthesia (Pro Cah)",,46045,CPT,Professional,Both,,,,1125,956.25,273.34,1125,CorVel,Worker's Compensation,838.8975489,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Incision And Drainage Intramural/Intramuscular/Submucosal Abscess/Transanal, W Anesthesia (Pro Cah)",,46045,CPT,Professional,Both,,,,1125,956.25,273.34,1125,First Health Group Corporation,First Health Network,1091.25,97,,percent of total billed charges,,
"Incision And Drainage Intramural/Intramuscular/Submucosal Abscess/Transanal, W Anesthesia (Pro Cah)",,46045,CPT,Professional,Both,,,,1125,956.25,273.34,1125,"Health Partners, Inc.",Commercial,906.18,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Incision And Drainage Intramural/Intramuscular/Submucosal Abscess/Transanal, W Anesthesia (Pro Cah)",,46045,CPT,Professional,Both,,,,1125,956.25,273.34,1125,"Health Partners, Inc.",Medicare Advantage,488.52,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Incision And Drainage Intramural/Intramuscular/Submucosal Abscess/Transanal, W Anesthesia (Pro Cah)",,46045,CPT,Professional,Both,,,,1125,956.25,273.34,1125,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),424.95,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Incision And Drainage Intramural/Intramuscular/Submucosal Abscess/Transanal, W Anesthesia (Pro Cah)",,46045,CPT,Professional,Both,,,,1125,956.25,273.34,1125,"Health Partners, Inc.",State of Minnesota Advantage Program,780.67407,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Incision And Drainage Intramural/Intramuscular/Submucosal Abscess/Transanal, W Anesthesia (Pro Cah)",,46045,CPT,Professional,Both,,,,1125,956.25,273.34,1125,"Health Partners, Inc.",State Public Programs,273.34,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Incision And Drainage Intramural/Intramuscular/Submucosal Abscess/Transanal, W Anesthesia (Pro Cah)",,46045,CPT,Professional,Both,,,,1125,956.25,273.34,1125,Humana Insurance Company,Commercial PPO,424.8,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Incision And Drainage Intramural/Intramuscular/Submucosal Abscess/Transanal, W Anesthesia (Pro Cah)",,46045,CPT,Professional,Both,,,,1125,956.25,273.34,1125,Humana Insurance Company,Medicare PPO,1125,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Incision And Drainage Intramural/Intramuscular/Submucosal Abscess/Transanal, W Anesthesia (Pro Cah)",,46045,CPT,Professional,Both,,,,1125,956.25,273.34,1125,Medica,Individual & Family,954,84.8,,percent of total billed charges,,
"Incision And Drainage Intramural/Intramuscular/Submucosal Abscess/Transanal, W Anesthesia (Pro Cah)",,46045,CPT,Professional,Both,,,,1125,956.25,273.34,1125,Medica,Medica Advantage Solution,560.25,49.8,,percent of total billed charges,,
"Incision And Drainage Intramural/Intramuscular/Submucosal Abscess/Transanal, W Anesthesia (Pro Cah)",,46045,CPT,Professional,Both,,,,1125,956.25,273.34,1125,Medica,Medical Assistance,315.58,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Incision And Drainage Intramural/Intramuscular/Submucosal Abscess/Transanal, W Anesthesia (Pro Cah)",,46045,CPT,Professional,Both,,,,1125,956.25,273.34,1125,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,424.8,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Incision And Drainage Intramural/Intramuscular/Submucosal Abscess/Transanal, W Anesthesia (Pro Cah)",,46045,CPT,Professional,Both,,,,1125,956.25,273.34,1125,"Multiplan, Inc.","Multiplan, Inc.",1057.5,94,,percent of total billed charges,,
"Incision And Drainage Intramural/Intramuscular/Submucosal Abscess/Transanal, W Anesthesia (Pro Cah)",,46045,CPT,Professional,Both,,,,1125,956.25,273.34,1125,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1013.625,90.1,,percent of total billed charges,,
"Incision And Drainage Intramural/Intramuscular/Submucosal Abscess/Transanal, W Anesthesia (Pro Cah)",,46045,CPT,Professional,Both,,,,1125,956.25,273.34,1125,"Preferred One Administrative Services, INC.",PPO,1109.25,98.6,,percent of total billed charges,,
"Incision And Drainage Intramural/Intramuscular/Submucosal Abscess/Transanal, W Anesthesia (Pro Cah)",,46045,CPT,Professional,Both,,,,1125,956.25,273.34,1125,PrimeWest Health,Minnesota Senior Health Options (MSHO),488.52,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Incision And Drainage Intramural/Intramuscular/Submucosal Abscess/Transanal, W Anesthesia (Pro Cah)",,46045,CPT,Professional,Both,,,,1125,956.25,273.34,1125,PrimeWest Health,MinnesotaCare,337.6703432,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Incision And Drainage Intramural/Intramuscular/Submucosal Abscess/Transanal, W Anesthesia (Pro Cah)",,46045,CPT,Professional,Both,,,,1125,956.25,273.34,1125,Sanford Health Plan,Sanford Health Plan,990,88,,percent of total billed charges,,
"Incision And Drainage Intramural/Intramuscular/Submucosal Abscess/Transanal, W Anesthesia (Pro Cah)",,46045,CPT,Professional,Both,,,,1125,956.25,273.34,1125,"UCare Health, Inc.",Individual & Family Plan,690.55488,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Incision And Drainage Intramural/Intramuscular/Submucosal Abscess/Transanal, W Anesthesia (Pro Cah)",,46045,CPT,Professional,Both,,,,1125,956.25,273.34,1125,"UCare Health, Inc.",Medical Assistance,347.137736,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Incision And Drainage Intramural/Intramuscular/Submucosal Abscess/Transanal, W Anesthesia (Pro Cah)",,46045,CPT,Professional,Both,,,,1125,956.25,273.34,1125,"UCare Health, Inc.",Medicare Advantage,488.52,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Incision And Drainage Intramural/Intramuscular/Submucosal Abscess/Transanal, W Anesthesia (Pro Cah)",,46045,CPT,Professional,Both,,,,1125,956.25,273.34,1125,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),390.816,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Incision And Drainage Intramural/Intramuscular/Submucosal Abscess/Transanal, W Anesthesia (Pro Cah)",,46045,CPT,Professional,Both,,,,1125,956.25,273.34,1125,UnitedHealthcare,Individual & Family,1125,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Incision And Drainage Intramural/Intramuscular/Submucosal Abscess/Transanal, W Anesthesia (Pro Cah)",,46045,CPT,Professional,Both,,,,1125,956.25,273.34,1125,UnitedHealthcare,Medicare Advantage,488.52,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Incision And Drainage Intramural/Intramuscular/Submucosal Abscess/Transanal, W Anesthesia (Pro Cah)",,46045,CPT,Professional,Both,,,,1125,956.25,273.34,1125,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,315.57976,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Incision Of Thrombosed Hemorrhoid, External (Pro Cah)",,46083,CPT,Professional,Both,,,,296,251.6,68.28,296,Aetna,Commercial,251.6,85,,percent of total billed charges,,
"Incision Of Thrombosed Hemorrhoid, External (Pro Cah)",,46083,CPT,Professional,Both,,,,296,251.6,68.28,296,Aetna,Medicare Advantage,107.17,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Incision Of Thrombosed Hemorrhoid, External (Pro Cah)",,46083,CPT,Professional,Both,,,,296,251.6,68.28,296,Aetna,PPO,275.28,93,,percent of total billed charges,,
"Incision Of Thrombosed Hemorrhoid, External (Pro Cah)",,46083,CPT,Professional,Both,,,,296,251.6,68.28,296,America's PPO,America's PPO,252.9024,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Incision Of Thrombosed Hemorrhoid, External (Pro Cah)",,46083,CPT,Professional,Both,,,,296,251.6,68.28,296,BlueCross BlueShield Minnesota, Federal Employee Program,226.55,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Incision Of Thrombosed Hemorrhoid, External (Pro Cah)",,46083,CPT,Professional,Both,,,,296,251.6,68.28,296,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,230.1748,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Incision Of Thrombosed Hemorrhoid, External (Pro Cah)",,46083,CPT,Professional,Both,,,,296,251.6,68.28,296,BlueCross BlueShield Minnesota,High Value Network Plan,230.1748,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Incision Of Thrombosed Hemorrhoid, External (Pro Cah)",,46083,CPT,Professional,Both,,,,296,251.6,68.28,296,BlueCross BlueShield Minnesota,Medicare Advantage,122.2795,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Incision Of Thrombosed Hemorrhoid, External (Pro Cah)",,46083,CPT,Professional,Both,,,,296,251.6,68.28,296,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,230.1748,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Incision Of Thrombosed Hemorrhoid, External (Pro Cah)",,46083,CPT,Professional,Both,,,,296,251.6,68.28,296,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,78.83144,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Incision Of Thrombosed Hemorrhoid, External (Pro Cah)",,46083,CPT,Professional,Both,,,,296,251.6,68.28,296,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),122.2795,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Incision Of Thrombosed Hemorrhoid, External (Pro Cah)",,46083,CPT,Professional,Both,,,,296,251.6,68.28,296,CorVel,Worker's Compensation,209.2654482,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Incision Of Thrombosed Hemorrhoid, External (Pro Cah)",,46083,CPT,Professional,Both,,,,296,251.6,68.28,296,First Health Group Corporation,First Health Network,287.12,97,,percent of total billed charges,,
"Incision Of Thrombosed Hemorrhoid, External (Pro Cah)",,46083,CPT,Professional,Both,,,,296,251.6,68.28,296,"Health Partners, Inc.",Commercial,226.36,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Incision Of Thrombosed Hemorrhoid, External (Pro Cah)",,46083,CPT,Professional,Both,,,,296,251.6,68.28,296,"Health Partners, Inc.",Medicare Advantage,122.2795,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Incision Of Thrombosed Hemorrhoid, External (Pro Cah)",,46083,CPT,Professional,Both,,,,296,251.6,68.28,296,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),106.41,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Incision Of Thrombosed Hemorrhoid, External (Pro Cah)",,46083,CPT,Professional,Both,,,,296,251.6,68.28,296,"Health Partners, Inc.",State of Minnesota Advantage Program,195.00914,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Incision Of Thrombosed Hemorrhoid, External (Pro Cah)",,46083,CPT,Professional,Both,,,,296,251.6,68.28,296,"Health Partners, Inc.",State Public Programs,68.28,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Incision Of Thrombosed Hemorrhoid, External (Pro Cah)",,46083,CPT,Professional,Both,,,,296,251.6,68.28,296,Humana Insurance Company,Commercial PPO,106.33,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Incision Of Thrombosed Hemorrhoid, External (Pro Cah)",,46083,CPT,Professional,Both,,,,296,251.6,68.28,296,Humana Insurance Company,Medicare PPO,296,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Incision Of Thrombosed Hemorrhoid, External (Pro Cah)",,46083,CPT,Professional,Both,,,,296,251.6,68.28,296,Medica,Individual & Family,251.008,84.8,,percent of total billed charges,,
"Incision Of Thrombosed Hemorrhoid, External (Pro Cah)",,46083,CPT,Professional,Both,,,,296,251.6,68.28,296,Medica,Medica Advantage Solution,147.408,49.8,,percent of total billed charges,,
"Incision Of Thrombosed Hemorrhoid, External (Pro Cah)",,46083,CPT,Professional,Both,,,,296,251.6,68.28,296,Medica,Medical Assistance,78.83,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Incision Of Thrombosed Hemorrhoid, External (Pro Cah)",,46083,CPT,Professional,Both,,,,296,251.6,68.28,296,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,106.33,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Incision Of Thrombosed Hemorrhoid, External (Pro Cah)",,46083,CPT,Professional,Both,,,,296,251.6,68.28,296,"Multiplan, Inc.","Multiplan, Inc.",278.24,94,,percent of total billed charges,,
"Incision Of Thrombosed Hemorrhoid, External (Pro Cah)",,46083,CPT,Professional,Both,,,,296,251.6,68.28,296,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,266.696,90.1,,percent of total billed charges,,
"Incision Of Thrombosed Hemorrhoid, External (Pro Cah)",,46083,CPT,Professional,Both,,,,296,251.6,68.28,296,"Preferred One Administrative Services, INC.",PPO,291.856,98.6,,percent of total billed charges,,
"Incision Of Thrombosed Hemorrhoid, External (Pro Cah)",,46083,CPT,Professional,Both,,,,296,251.6,68.28,296,PrimeWest Health,Minnesota Senior Health Options (MSHO),122.2795,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Incision Of Thrombosed Hemorrhoid, External (Pro Cah)",,46083,CPT,Professional,Both,,,,296,251.6,68.28,296,PrimeWest Health,MinnesotaCare,84.3496408,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Incision Of Thrombosed Hemorrhoid, External (Pro Cah)",,46083,CPT,Professional,Both,,,,296,251.6,68.28,296,Sanford Health Plan,Sanford Health Plan,260.48,88,,percent of total billed charges,,
"Incision Of Thrombosed Hemorrhoid, External (Pro Cah)",,46083,CPT,Professional,Both,,,,296,251.6,68.28,296,"UCare Health, Inc.",Individual & Family Plan,172.850048,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Incision Of Thrombosed Hemorrhoid, External (Pro Cah)",,46083,CPT,Professional,Both,,,,296,251.6,68.28,296,"UCare Health, Inc.",Medical Assistance,86.714584,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Incision Of Thrombosed Hemorrhoid, External (Pro Cah)",,46083,CPT,Professional,Both,,,,296,251.6,68.28,296,"UCare Health, Inc.",Medicare Advantage,122.2795,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Incision Of Thrombosed Hemorrhoid, External (Pro Cah)",,46083,CPT,Professional,Both,,,,296,251.6,68.28,296,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),97.8236,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Incision Of Thrombosed Hemorrhoid, External (Pro Cah)",,46083,CPT,Professional,Both,,,,296,251.6,68.28,296,UnitedHealthcare,Individual & Family,296,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Incision Of Thrombosed Hemorrhoid, External (Pro Cah)",,46083,CPT,Professional,Both,,,,296,251.6,68.28,296,UnitedHealthcare,Medicare Advantage,122.2795,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Incision Of Thrombosed Hemorrhoid, External (Pro Cah)",,46083,CPT,Professional,Both,,,,296,251.6,68.28,296,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,78.83144,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Hemorrhoidectomy Ext-Complete (Pro Cah),,46250,CPT,Professional,Both,,,,1685,1432.25,199.17,1685,Aetna,Commercial,1432.25,85,,percent of total billed charges,,
Hemorrhoidectomy Ext-Complete (Pro Cah),,46250,CPT,Professional,Both,,,,1685,1432.25,199.17,1685,Aetna,Medicare Advantage,314.83,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Hemorrhoidectomy Ext-Complete (Pro Cah),,46250,CPT,Professional,Both,,,,1685,1432.25,199.17,1685,Aetna,PPO,1567.05,93,,percent of total billed charges,,
Hemorrhoidectomy Ext-Complete (Pro Cah),,46250,CPT,Professional,Both,,,,1685,1432.25,199.17,1685,America's PPO,America's PPO,1439.664,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Hemorrhoidectomy Ext-Complete (Pro Cah),,46250,CPT,Professional,Both,,,,1685,1432.25,199.17,1685,BlueCross BlueShield Minnesota, Federal Employee Program,659.68,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Hemorrhoidectomy Ext-Complete (Pro Cah),,46250,CPT,Professional,Both,,,,1685,1432.25,199.17,1685,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,670.23488,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Hemorrhoidectomy Ext-Complete (Pro Cah),,46250,CPT,Professional,Both,,,,1685,1432.25,199.17,1685,BlueCross BlueShield Minnesota,High Value Network Plan,670.23488,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Hemorrhoidectomy Ext-Complete (Pro Cah),,46250,CPT,Professional,Both,,,,1685,1432.25,199.17,1685,BlueCross BlueShield Minnesota,Medicare Advantage,355.948,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Hemorrhoidectomy Ext-Complete (Pro Cah),,46250,CPT,Professional,Both,,,,1685,1432.25,199.17,1685,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,670.23488,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Hemorrhoidectomy Ext-Complete (Pro Cah),,46250,CPT,Professional,Both,,,,1685,1432.25,199.17,1685,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,229.95128,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Hemorrhoidectomy Ext-Complete (Pro Cah),,46250,CPT,Professional,Both,,,,1685,1432.25,199.17,1685,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),355.948,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Hemorrhoidectomy Ext-Complete (Pro Cah),,46250,CPT,Professional,Both,,,,1685,1432.25,199.17,1685,CorVel,Worker's Compensation,611.2852869,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Hemorrhoidectomy Ext-Complete (Pro Cah),,46250,CPT,Professional,Both,,,,1685,1432.25,199.17,1685,First Health Group Corporation,First Health Network,1634.45,97,,percent of total billed charges,,
Hemorrhoidectomy Ext-Complete (Pro Cah),,46250,CPT,Professional,Both,,,,1685,1432.25,199.17,1685,"Health Partners, Inc.",Commercial,660.23,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Hemorrhoidectomy Ext-Complete (Pro Cah),,46250,CPT,Professional,Both,,,,1685,1432.25,199.17,1685,"Health Partners, Inc.",Medicare Advantage,355.948,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Hemorrhoidectomy Ext-Complete (Pro Cah),,46250,CPT,Professional,Both,,,,1685,1432.25,199.17,1685,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),309.73,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Hemorrhoidectomy Ext-Complete (Pro Cah),,46250,CPT,Professional,Both,,,,1685,1432.25,199.17,1685,"Health Partners, Inc.",State of Minnesota Advantage Program,568.788145,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Hemorrhoidectomy Ext-Complete (Pro Cah),,46250,CPT,Professional,Both,,,,1685,1432.25,199.17,1685,"Health Partners, Inc.",State Public Programs,199.17,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Hemorrhoidectomy Ext-Complete (Pro Cah),,46250,CPT,Professional,Both,,,,1685,1432.25,199.17,1685,Humana Insurance Company,Commercial PPO,309.52,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Hemorrhoidectomy Ext-Complete (Pro Cah),,46250,CPT,Professional,Both,,,,1685,1432.25,199.17,1685,Humana Insurance Company,Medicare PPO,1685,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Hemorrhoidectomy Ext-Complete (Pro Cah),,46250,CPT,Professional,Both,,,,1685,1432.25,199.17,1685,Medica,Individual & Family,1428.88,84.8,,percent of total billed charges,,
Hemorrhoidectomy Ext-Complete (Pro Cah),,46250,CPT,Professional,Both,,,,1685,1432.25,199.17,1685,Medica,Medica Advantage Solution,839.13,49.8,,percent of total billed charges,,
Hemorrhoidectomy Ext-Complete (Pro Cah),,46250,CPT,Professional,Both,,,,1685,1432.25,199.17,1685,Medica,Medical Assistance,229.95,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Hemorrhoidectomy Ext-Complete (Pro Cah),,46250,CPT,Professional,Both,,,,1685,1432.25,199.17,1685,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,309.52,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Hemorrhoidectomy Ext-Complete (Pro Cah),,46250,CPT,Professional,Both,,,,1685,1432.25,199.17,1685,"Multiplan, Inc.","Multiplan, Inc.",1583.9,94,,percent of total billed charges,,
Hemorrhoidectomy Ext-Complete (Pro Cah),,46250,CPT,Professional,Both,,,,1685,1432.25,199.17,1685,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1518.185,90.1,,percent of total billed charges,,
Hemorrhoidectomy Ext-Complete (Pro Cah),,46250,CPT,Professional,Both,,,,1685,1432.25,199.17,1685,"Preferred One Administrative Services, INC.",PPO,1661.41,98.6,,percent of total billed charges,,
Hemorrhoidectomy Ext-Complete (Pro Cah),,46250,CPT,Professional,Both,,,,1685,1432.25,199.17,1685,PrimeWest Health,Minnesota Senior Health Options (MSHO),355.948,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Hemorrhoidectomy Ext-Complete (Pro Cah),,46250,CPT,Professional,Both,,,,1685,1432.25,199.17,1685,PrimeWest Health,MinnesotaCare,246.0478696,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Hemorrhoidectomy Ext-Complete (Pro Cah),,46250,CPT,Professional,Both,,,,1685,1432.25,199.17,1685,Sanford Health Plan,Sanford Health Plan,1482.8,88,,percent of total billed charges,,
Hemorrhoidectomy Ext-Complete (Pro Cah),,46250,CPT,Professional,Both,,,,1685,1432.25,199.17,1685,"UCare Health, Inc.",Individual & Family Plan,503.155712,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Hemorrhoidectomy Ext-Complete (Pro Cah),,46250,CPT,Professional,Both,,,,1685,1432.25,199.17,1685,"UCare Health, Inc.",Medical Assistance,252.946408,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Hemorrhoidectomy Ext-Complete (Pro Cah),,46250,CPT,Professional,Both,,,,1685,1432.25,199.17,1685,"UCare Health, Inc.",Medicare Advantage,355.948,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Hemorrhoidectomy Ext-Complete (Pro Cah),,46250,CPT,Professional,Both,,,,1685,1432.25,199.17,1685,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),284.7584,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Hemorrhoidectomy Ext-Complete (Pro Cah),,46250,CPT,Professional,Both,,,,1685,1432.25,199.17,1685,UnitedHealthcare,Individual & Family,1685,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Hemorrhoidectomy Ext-Complete (Pro Cah),,46250,CPT,Professional,Both,,,,1685,1432.25,199.17,1685,UnitedHealthcare,Medicare Advantage,355.948,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Hemorrhoidectomy Ext-Complete (Pro Cah),,46250,CPT,Professional,Both,,,,1685,1432.25,199.17,1685,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,229.95128,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Hemorrhoidectomy, Internal & External, Simple (Pro Cah)",,46255,CPT,Professional,Both,,,,2245,1908.25,221.21,2245,Aetna,Commercial,1908.25,85,,percent of total billed charges,,
"Hemorrhoidectomy, Internal & External, Simple (Pro Cah)",,46255,CPT,Professional,Both,,,,2245,1908.25,221.21,2245,Aetna,Medicare Advantage,350.41,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Hemorrhoidectomy, Internal & External, Simple (Pro Cah)",,46255,CPT,Professional,Both,,,,2245,1908.25,221.21,2245,Aetna,PPO,2087.85,93,,percent of total billed charges,,
"Hemorrhoidectomy, Internal & External, Simple (Pro Cah)",,46255,CPT,Professional,Both,,,,2245,1908.25,221.21,2245,America's PPO,America's PPO,1918.128,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Hemorrhoidectomy, Internal & External, Simple (Pro Cah)",,46255,CPT,Professional,Both,,,,2245,1908.25,221.21,2245,BlueCross BlueShield Minnesota, Federal Employee Program,734.74,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Hemorrhoidectomy, Internal & External, Simple (Pro Cah)",,46255,CPT,Professional,Both,,,,2245,1908.25,221.21,2245,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,746.49584,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Hemorrhoidectomy, Internal & External, Simple (Pro Cah)",,46255,CPT,Professional,Both,,,,2245,1908.25,221.21,2245,BlueCross BlueShield Minnesota,High Value Network Plan,746.49584,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Hemorrhoidectomy, Internal & External, Simple (Pro Cah)",,46255,CPT,Professional,Both,,,,2245,1908.25,221.21,2245,BlueCross BlueShield Minnesota,Medicare Advantage,395.462,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Hemorrhoidectomy, Internal & External, Simple (Pro Cah)",,46255,CPT,Professional,Both,,,,2245,1908.25,221.21,2245,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,746.49584,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Hemorrhoidectomy, Internal & External, Simple (Pro Cah)",,46255,CPT,Professional,Both,,,,2245,1908.25,221.21,2245,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,255.39192,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Hemorrhoidectomy, Internal & External, Simple (Pro Cah)",,46255,CPT,Professional,Both,,,,2245,1908.25,221.21,2245,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),395.462,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Hemorrhoidectomy, Internal & External, Simple (Pro Cah)",,46255,CPT,Professional,Both,,,,2245,1908.25,221.21,2245,CorVel,Worker's Compensation,679.780551,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Hemorrhoidectomy, Internal & External, Simple (Pro Cah)",,46255,CPT,Professional,Both,,,,2245,1908.25,221.21,2245,First Health Group Corporation,First Health Network,2177.65,97,,percent of total billed charges,,
"Hemorrhoidectomy, Internal & External, Simple (Pro Cah)",,46255,CPT,Professional,Both,,,,2245,1908.25,221.21,2245,"Health Partners, Inc.",Commercial,734.23,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Hemorrhoidectomy, Internal & External, Simple (Pro Cah)",,46255,CPT,Professional,Both,,,,2245,1908.25,221.21,2245,"Health Partners, Inc.",Medicare Advantage,395.462,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Hemorrhoidectomy, Internal & External, Simple (Pro Cah)",,46255,CPT,Professional,Both,,,,2245,1908.25,221.21,2245,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),343.96,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Hemorrhoidectomy, Internal & External, Simple (Pro Cah)",,46255,CPT,Professional,Both,,,,2245,1908.25,221.21,2245,"Health Partners, Inc.",State of Minnesota Advantage Program,632.539145,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Hemorrhoidectomy, Internal & External, Simple (Pro Cah)",,46255,CPT,Professional,Both,,,,2245,1908.25,221.21,2245,"Health Partners, Inc.",State Public Programs,221.21,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Hemorrhoidectomy, Internal & External, Simple (Pro Cah)",,46255,CPT,Professional,Both,,,,2245,1908.25,221.21,2245,Humana Insurance Company,Commercial PPO,343.88,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Hemorrhoidectomy, Internal & External, Simple (Pro Cah)",,46255,CPT,Professional,Both,,,,2245,1908.25,221.21,2245,Humana Insurance Company,Medicare PPO,2245,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Hemorrhoidectomy, Internal & External, Simple (Pro Cah)",,46255,CPT,Professional,Both,,,,2245,1908.25,221.21,2245,Medica,Individual & Family,1903.76,84.8,,percent of total billed charges,,
"Hemorrhoidectomy, Internal & External, Simple (Pro Cah)",,46255,CPT,Professional,Both,,,,2245,1908.25,221.21,2245,Medica,Medica Advantage Solution,1118.01,49.8,,percent of total billed charges,,
"Hemorrhoidectomy, Internal & External, Simple (Pro Cah)",,46255,CPT,Professional,Both,,,,2245,1908.25,221.21,2245,Medica,Medical Assistance,255.39,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Hemorrhoidectomy, Internal & External, Simple (Pro Cah)",,46255,CPT,Professional,Both,,,,2245,1908.25,221.21,2245,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,343.88,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Hemorrhoidectomy, Internal & External, Simple (Pro Cah)",,46255,CPT,Professional,Both,,,,2245,1908.25,221.21,2245,"Multiplan, Inc.","Multiplan, Inc.",2110.3,94,,percent of total billed charges,,
"Hemorrhoidectomy, Internal & External, Simple (Pro Cah)",,46255,CPT,Professional,Both,,,,2245,1908.25,221.21,2245,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,2022.745,90.1,,percent of total billed charges,,
"Hemorrhoidectomy, Internal & External, Simple (Pro Cah)",,46255,CPT,Professional,Both,,,,2245,1908.25,221.21,2245,"Preferred One Administrative Services, INC.",PPO,2213.57,98.6,,percent of total billed charges,,
"Hemorrhoidectomy, Internal & External, Simple (Pro Cah)",,46255,CPT,Professional,Both,,,,2245,1908.25,221.21,2245,PrimeWest Health,Minnesota Senior Health Options (MSHO),395.462,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Hemorrhoidectomy, Internal & External, Simple (Pro Cah)",,46255,CPT,Professional,Both,,,,2245,1908.25,221.21,2245,PrimeWest Health,MinnesotaCare,273.2693544,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Hemorrhoidectomy, Internal & External, Simple (Pro Cah)",,46255,CPT,Professional,Both,,,,2245,1908.25,221.21,2245,Sanford Health Plan,Sanford Health Plan,1975.6,88,,percent of total billed charges,,
"Hemorrhoidectomy, Internal & External, Simple (Pro Cah)",,46255,CPT,Professional,Both,,,,2245,1908.25,221.21,2245,"UCare Health, Inc.",Individual & Family Plan,559.011328,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Hemorrhoidectomy, Internal & External, Simple (Pro Cah)",,46255,CPT,Professional,Both,,,,2245,1908.25,221.21,2245,"UCare Health, Inc.",Medical Assistance,280.931112,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Hemorrhoidectomy, Internal & External, Simple (Pro Cah)",,46255,CPT,Professional,Both,,,,2245,1908.25,221.21,2245,"UCare Health, Inc.",Medicare Advantage,395.462,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Hemorrhoidectomy, Internal & External, Simple (Pro Cah)",,46255,CPT,Professional,Both,,,,2245,1908.25,221.21,2245,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),316.3696,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Hemorrhoidectomy, Internal & External, Simple (Pro Cah)",,46255,CPT,Professional,Both,,,,2245,1908.25,221.21,2245,UnitedHealthcare,Individual & Family,2245,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Hemorrhoidectomy, Internal & External, Simple (Pro Cah)",,46255,CPT,Professional,Both,,,,2245,1908.25,221.21,2245,UnitedHealthcare,Medicare Advantage,395.462,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Hemorrhoidectomy, Internal & External, Simple (Pro Cah)",,46255,CPT,Professional,Both,,,,2245,1908.25,221.21,2245,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,255.39192,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Hemorrhoidectomy, Internal And External, Single Column/Group (Pbb)",,46255,CPT,Facility,Outpatient,,,,785,667.25,224.981,785,Aetna,Commercial,722.2,92,,percent of total billed charges,,
"Hemorrhoidectomy, Internal And External, Single Column/Group (Pbb)",,46255,CPT,Professional,Outpatient,,,,1460,1241,221.21,1460,Aetna,Commercial,1241,85,,percent of total billed charges,,
"Hemorrhoidectomy, Internal And External, Single Column/Group (Pbb)",,46255,CPT,Facility,Outpatient,,,,785,667.25,224.981,785,Aetna,Medicare Advantage,384.65,49,,percent of total billed charges,,
"Hemorrhoidectomy, Internal And External, Single Column/Group (Pbb)",,46255,CPT,Professional,Outpatient,,,,1460,1241,221.21,1460,Aetna,Medicare Advantage,350.41,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Hemorrhoidectomy, Internal And External, Single Column/Group (Pbb)",,46255,CPT,Facility,Outpatient,,,,785,667.25,224.981,785,Aetna,PPO,730.05,93,,percent of total billed charges,,
"Hemorrhoidectomy, Internal And External, Single Column/Group (Pbb)",,46255,CPT,Professional,Outpatient,,,,1460,1241,221.21,1460,Aetna,PPO,1357.8,93,,percent of total billed charges,,
"Hemorrhoidectomy, Internal And External, Single Column/Group (Pbb)",,46255,CPT,Facility,Outpatient,,,,785,667.25,224.981,785,America's PPO,America's PPO,753.8355,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Hemorrhoidectomy, Internal And External, Single Column/Group (Pbb)",,46255,CPT,Professional,Outpatient,,,,1460,1241,221.21,1460,America's PPO,America's PPO,1247.424,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Hemorrhoidectomy, Internal And External, Single Column/Group (Pbb)",,46255,CPT,Facility,Outpatient,,,,785,667.25,224.981,785,BlueCross BlueShield Minnesota, Federal Employee Program,772.44,98.4,,percent of total billed charges,,
"Hemorrhoidectomy, Internal And External, Single Column/Group (Pbb)",,46255,CPT,Professional,Outpatient,,,,1460,1241,221.21,1460,BlueCross BlueShield Minnesota, Federal Employee Program,734.74,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Hemorrhoidectomy, Internal And External, Single Column/Group (Pbb)",,46255,CPT,Facility,Outpatient,,,,785,667.25,224.981,785,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,785,100,,percent of total billed charges,,
"Hemorrhoidectomy, Internal And External, Single Column/Group (Pbb)",,46255,CPT,Professional,Outpatient,,,,1460,1241,221.21,1460,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,746.49584,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Hemorrhoidectomy, Internal And External, Single Column/Group (Pbb)",,46255,CPT,Facility,Outpatient,,,,785,667.25,224.981,785,BlueCross BlueShield Minnesota,High Value Network Plan,706.5,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
"Hemorrhoidectomy, Internal And External, Single Column/Group (Pbb)",,46255,CPT,Professional,Outpatient,,,,1460,1241,221.21,1460,BlueCross BlueShield Minnesota,High Value Network Plan,746.49584,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Hemorrhoidectomy, Internal And External, Single Column/Group (Pbb)",,46255,CPT,Facility,Outpatient,,,,785,667.25,224.981,785,BlueCross BlueShield Minnesota,Medicare Advantage,384.65,49,,percent of total billed charges,,
"Hemorrhoidectomy, Internal And External, Single Column/Group (Pbb)",,46255,CPT,Professional,Outpatient,,,,1460,1241,221.21,1460,BlueCross BlueShield Minnesota,Medicare Advantage,395.462,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Hemorrhoidectomy, Internal And External, Single Column/Group (Pbb)",,46255,CPT,Professional,Outpatient,,,,1460,1241,221.21,1460,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,746.49584,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Hemorrhoidectomy, Internal And External, Single Column/Group (Pbb)",,46255,CPT,Facility,Outpatient,,,,785,667.25,224.981,785,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,224.981,28.66,,percent of total billed charges,,
"Hemorrhoidectomy, Internal And External, Single Column/Group (Pbb)",,46255,CPT,Professional,Outpatient,,,,1460,1241,221.21,1460,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,255.39192,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Hemorrhoidectomy, Internal And External, Single Column/Group (Pbb)",,46255,CPT,Facility,Outpatient,,,,785,667.25,224.981,785,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),384.65,49,,percent of total billed charges,,
"Hemorrhoidectomy, Internal And External, Single Column/Group (Pbb)",,46255,CPT,Professional,Outpatient,,,,1460,1241,221.21,1460,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),395.462,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Hemorrhoidectomy, Internal And External, Single Column/Group (Pbb)",,46255,CPT,Facility,Outpatient,,,,785,667.25,224.981,785,CorVel,Worker's Compensation,785,100,,percent of total billed charges,,
"Hemorrhoidectomy, Internal And External, Single Column/Group (Pbb)",,46255,CPT,Professional,Outpatient,,,,1460,1241,221.21,1460,CorVel,Worker's Compensation,679.780551,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Hemorrhoidectomy, Internal And External, Single Column/Group (Pbb)",,46255,CPT,Facility,Outpatient,,,,785,667.25,224.981,785,First Health Group Corporation,First Health Network,761.45,97,,percent of total billed charges,,
"Hemorrhoidectomy, Internal And External, Single Column/Group (Pbb)",,46255,CPT,Professional,Outpatient,,,,1460,1241,221.21,1460,First Health Group Corporation,First Health Network,1416.2,97,,percent of total billed charges,,
"Hemorrhoidectomy, Internal And External, Single Column/Group (Pbb)",,46255,CPT,Facility,Outpatient,,,,785,667.25,224.981,785,"Health Partners, Inc.",Commercial,742.61,94.6,,percent of total billed charges,,
"Hemorrhoidectomy, Internal And External, Single Column/Group (Pbb)",,46255,CPT,Professional,Outpatient,,,,1460,1241,221.21,1460,"Health Partners, Inc.",Commercial,734.23,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Hemorrhoidectomy, Internal And External, Single Column/Group (Pbb)",,46255,CPT,Facility,Outpatient,,,,785,667.25,224.981,785,"Health Partners, Inc.",Medicare Advantage,384.65,49,,percent of total billed charges,,
"Hemorrhoidectomy, Internal And External, Single Column/Group (Pbb)",,46255,CPT,Professional,Outpatient,,,,1460,1241,221.21,1460,"Health Partners, Inc.",Medicare Advantage,395.462,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Hemorrhoidectomy, Internal And External, Single Column/Group (Pbb)",,46255,CPT,Facility,Outpatient,,,,785,667.25,224.981,785,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),471,60,,percent of total billed charges,,
"Hemorrhoidectomy, Internal And External, Single Column/Group (Pbb)",,46255,CPT,Professional,Outpatient,,,,1460,1241,221.21,1460,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),343.96,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Hemorrhoidectomy, Internal And External, Single Column/Group (Pbb)",,46255,CPT,Facility,Outpatient,,,,785,667.25,224.981,785,"Health Partners, Inc.",State of Minnesota Advantage Program,639.775,81.5,,percent of total billed charges,,
"Hemorrhoidectomy, Internal And External, Single Column/Group (Pbb)",,46255,CPT,Professional,Outpatient,,,,1460,1241,221.21,1460,"Health Partners, Inc.",State of Minnesota Advantage Program,632.539145,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Hemorrhoidectomy, Internal And External, Single Column/Group (Pbb)",,46255,CPT,Facility,Outpatient,,,,785,667.25,224.981,785,"Health Partners, Inc.",State Public Programs,392.5,50,,percent of total billed charges,,
"Hemorrhoidectomy, Internal And External, Single Column/Group (Pbb)",,46255,CPT,Professional,Outpatient,,,,1460,1241,221.21,1460,"Health Partners, Inc.",State Public Programs,221.21,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Hemorrhoidectomy, Internal And External, Single Column/Group (Pbb)",,46255,CPT,Facility,Outpatient,,,,785,667.25,224.981,785,Humana Insurance Company,Commercial PPO,745.75,95,,percent of total billed charges,,
"Hemorrhoidectomy, Internal And External, Single Column/Group (Pbb)",,46255,CPT,Professional,Outpatient,,,,1460,1241,221.21,1460,Humana Insurance Company,Commercial PPO,343.88,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Hemorrhoidectomy, Internal And External, Single Column/Group (Pbb)",,46255,CPT,Facility,Outpatient,,,,785,667.25,224.981,785,Humana Insurance Company,Medicare PPO,384.65,49,,percent of total billed charges,,
"Hemorrhoidectomy, Internal And External, Single Column/Group (Pbb)",,46255,CPT,Professional,Outpatient,,,,1460,1241,221.21,1460,Humana Insurance Company,Medicare PPO,1460,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Hemorrhoidectomy, Internal And External, Single Column/Group (Pbb)",,46255,CPT,Facility,Outpatient,,,,785,667.25,224.981,785,Medica,Individual & Family,777.935,99.1,,percent of total billed charges,,
"Hemorrhoidectomy, Internal And External, Single Column/Group (Pbb)",,46255,CPT,Professional,Outpatient,,,,1460,1241,221.21,1460,Medica,Individual & Family,1238.08,84.8,,percent of total billed charges,,
"Hemorrhoidectomy, Internal And External, Single Column/Group (Pbb)",,46255,CPT,Facility,Outpatient,,,,785,667.25,224.981,785,Medica,Medica Advantage Solution,390.93,49.8,,percent of total billed charges,,
"Hemorrhoidectomy, Internal And External, Single Column/Group (Pbb)",,46255,CPT,Professional,Outpatient,,,,1460,1241,221.21,1460,Medica,Medica Advantage Solution,727.08,49.8,,percent of total billed charges,,
"Hemorrhoidectomy, Internal And External, Single Column/Group (Pbb)",,46255,CPT,Facility,Outpatient,,,,785,667.25,224.981,785,Medica,Medical Assistance,350.11,44.6,,percent of total billed charges,,
"Hemorrhoidectomy, Internal And External, Single Column/Group (Pbb)",,46255,CPT,Professional,Outpatient,,,,1460,1241,221.21,1460,Medica,Medical Assistance,255.39,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Hemorrhoidectomy, Internal And External, Single Column/Group (Pbb)",,46255,CPT,Facility,Outpatient,,,,785,667.25,224.981,785,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,390.93,49.8,,percent of total billed charges,,
"Hemorrhoidectomy, Internal And External, Single Column/Group (Pbb)",,46255,CPT,Professional,Outpatient,,,,1460,1241,221.21,1460,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,343.88,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Hemorrhoidectomy, Internal And External, Single Column/Group (Pbb)",,46255,CPT,Facility,Outpatient,,,,785,667.25,224.981,785,"Multiplan, Inc.","Multiplan, Inc.",737.9,94,,percent of total billed charges,,
"Hemorrhoidectomy, Internal And External, Single Column/Group (Pbb)",,46255,CPT,Professional,Outpatient,,,,1460,1241,221.21,1460,"Multiplan, Inc.","Multiplan, Inc.",1372.4,94,,percent of total billed charges,,
"Hemorrhoidectomy, Internal And External, Single Column/Group (Pbb)",,46255,CPT,Facility,Outpatient,,,,785,667.25,224.981,785,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,707.285,90.1,,percent of total billed charges,,
"Hemorrhoidectomy, Internal And External, Single Column/Group (Pbb)",,46255,CPT,Professional,Outpatient,,,,1460,1241,221.21,1460,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1315.46,90.1,,percent of total billed charges,,
"Hemorrhoidectomy, Internal And External, Single Column/Group (Pbb)",,46255,CPT,Facility,Outpatient,,,,785,667.25,224.981,785,"Preferred One Administrative Services, INC.",PPO,774.01,98.6,,percent of total billed charges,,
"Hemorrhoidectomy, Internal And External, Single Column/Group (Pbb)",,46255,CPT,Professional,Outpatient,,,,1460,1241,221.21,1460,"Preferred One Administrative Services, INC.",PPO,1439.56,98.6,,percent of total billed charges,,
"Hemorrhoidectomy, Internal And External, Single Column/Group (Pbb)",,46255,CPT,Facility,Outpatient,,,,785,667.25,224.981,785,PrimeWest Health,Minnesota Senior Health Options (MSHO),403.8825,51.45,,percent of total billed charges,,
"Hemorrhoidectomy, Internal And External, Single Column/Group (Pbb)",,46255,CPT,Professional,Outpatient,,,,1460,1241,221.21,1460,PrimeWest Health,Minnesota Senior Health Options (MSHO),395.462,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Hemorrhoidectomy, Internal And External, Single Column/Group (Pbb)",,46255,CPT,Facility,Outpatient,,,,785,667.25,224.981,785,PrimeWest Health,MinnesotaCare,403.176,51.36,,percent of total billed charges,,
"Hemorrhoidectomy, Internal And External, Single Column/Group (Pbb)",,46255,CPT,Professional,Outpatient,,,,1460,1241,221.21,1460,PrimeWest Health,MinnesotaCare,273.2693544,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Hemorrhoidectomy, Internal And External, Single Column/Group (Pbb)",,46255,CPT,Facility,Outpatient,,,,785,667.25,224.981,785,Sanford Health Plan,Sanford Health Plan,722.2,92,,percent of total billed charges,,
"Hemorrhoidectomy, Internal And External, Single Column/Group (Pbb)",,46255,CPT,Professional,Outpatient,,,,1460,1241,221.21,1460,Sanford Health Plan,Sanford Health Plan,1284.8,88,,percent of total billed charges,,
"Hemorrhoidectomy, Internal And External, Single Column/Group (Pbb)",,46255,CPT,Facility,Outpatient,,,,785,667.25,224.981,785,"UCare Health, Inc.",Individual & Family Plan,442.3475,56.35,,percent of total billed charges,,
"Hemorrhoidectomy, Internal And External, Single Column/Group (Pbb)",,46255,CPT,Professional,Outpatient,,,,1460,1241,221.21,1460,"UCare Health, Inc.",Individual & Family Plan,559.011328,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Hemorrhoidectomy, Internal And External, Single Column/Group (Pbb)",,46255,CPT,Facility,Outpatient,,,,785,667.25,224.981,785,"UCare Health, Inc.",Medical Assistance,396.1895,50.47,,percent of total billed charges,,
"Hemorrhoidectomy, Internal And External, Single Column/Group (Pbb)",,46255,CPT,Professional,Outpatient,,,,1460,1241,221.21,1460,"UCare Health, Inc.",Medical Assistance,280.931112,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Hemorrhoidectomy, Internal And External, Single Column/Group (Pbb)",,46255,CPT,Facility,Outpatient,,,,785,667.25,224.981,785,"UCare Health, Inc.",Medicare Advantage,396.1895,50.47,,percent of total billed charges,,
"Hemorrhoidectomy, Internal And External, Single Column/Group (Pbb)",,46255,CPT,Professional,Outpatient,,,,1460,1241,221.21,1460,"UCare Health, Inc.",Medicare Advantage,395.462,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Hemorrhoidectomy, Internal And External, Single Column/Group (Pbb)",,46255,CPT,Facility,Outpatient,,,,785,667.25,224.981,785,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),396.1895,50.47,,percent of total billed charges,,
"Hemorrhoidectomy, Internal And External, Single Column/Group (Pbb)",,46255,CPT,Professional,Outpatient,,,,1460,1241,221.21,1460,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),316.3696,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Hemorrhoidectomy, Internal And External, Single Column/Group (Pbb)",,46255,CPT,Facility,Outpatient,,,,785,667.25,224.981,785,UnitedHealthcare,Individual & Family,737.9,94,,percent of total billed charges,,
"Hemorrhoidectomy, Internal And External, Single Column/Group (Pbb)",,46255,CPT,Professional,Outpatient,,,,1460,1241,221.21,1460,UnitedHealthcare,Individual & Family,1460,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Hemorrhoidectomy, Internal And External, Single Column/Group (Pbb)",,46255,CPT,Facility,Outpatient,,,,785,667.25,224.981,785,UnitedHealthcare,Medicare Advantage,384.65,49,,percent of total billed charges,,
"Hemorrhoidectomy, Internal And External, Single Column/Group (Pbb)",,46255,CPT,Professional,Outpatient,,,,1460,1241,221.21,1460,UnitedHealthcare,Medicare Advantage,395.462,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Hemorrhoidectomy, Internal And External, Single Column/Group (Pbb)",,46255,CPT,Facility,Outpatient,,,,785,667.25,224.981,785,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,376.8,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Hemorrhoidectomy, Internal And External, Single Column/Group (Pbb)",,46255,CPT,Professional,Outpatient,,,,1460,1241,221.21,1460,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,255.39192,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Hemorrhoidectomy (Pro Cah),,46260,CPT,Professional,Both,,,,2040,1734,299.3,2040,Aetna,Commercial,1734,85,,percent of total billed charges,,
Hemorrhoidectomy (Pro Cah),,46260,CPT,Professional,Both,,,,2040,1734,299.3,2040,Aetna,Medicare Advantage,471.51,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Hemorrhoidectomy (Pro Cah),,46260,CPT,Professional,Both,,,,2040,1734,299.3,2040,Aetna,PPO,1897.2,93,,percent of total billed charges,,
Hemorrhoidectomy (Pro Cah),,46260,CPT,Professional,Both,,,,2040,1734,299.3,2040,America's PPO,America's PPO,1742.976,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Hemorrhoidectomy (Pro Cah),,46260,CPT,Professional,Both,,,,2040,1734,299.3,2040,BlueCross BlueShield Minnesota, Federal Employee Program,997.09,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Hemorrhoidectomy (Pro Cah),,46260,CPT,Professional,Both,,,,2040,1734,299.3,2040,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1013.04344,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Hemorrhoidectomy (Pro Cah),,46260,CPT,Professional,Both,,,,2040,1734,299.3,2040,BlueCross BlueShield Minnesota,High Value Network Plan,1013.04344,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Hemorrhoidectomy (Pro Cah),,46260,CPT,Professional,Both,,,,2040,1734,299.3,2040,BlueCross BlueShield Minnesota,Medicare Advantage,534.9225,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Hemorrhoidectomy (Pro Cah),,46260,CPT,Professional,Both,,,,2040,1734,299.3,2040,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1013.04344,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Hemorrhoidectomy (Pro Cah),,46260,CPT,Professional,Both,,,,2040,1734,299.3,2040,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,345.55176,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Hemorrhoidectomy (Pro Cah),,46260,CPT,Professional,Both,,,,2040,1734,299.3,2040,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),534.9225,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Hemorrhoidectomy (Pro Cah),,46260,CPT,Professional,Both,,,,2040,1734,299.3,2040,CorVel,Worker's Compensation,918.1487451,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Hemorrhoidectomy (Pro Cah),,46260,CPT,Professional,Both,,,,2040,1734,299.3,2040,First Health Group Corporation,First Health Network,1978.8,97,,percent of total billed charges,,
Hemorrhoidectomy (Pro Cah),,46260,CPT,Professional,Both,,,,2040,1734,299.3,2040,"Health Partners, Inc.",Commercial,991.79,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Hemorrhoidectomy (Pro Cah),,46260,CPT,Professional,Both,,,,2040,1734,299.3,2040,"Health Partners, Inc.",Medicare Advantage,534.9225,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Hemorrhoidectomy (Pro Cah),,46260,CPT,Professional,Both,,,,2040,1734,299.3,2040,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),464.93,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Hemorrhoidectomy (Pro Cah),,46260,CPT,Professional,Both,,,,2040,1734,299.3,2040,"Health Partners, Inc.",State of Minnesota Advantage Program,854.427085,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Hemorrhoidectomy (Pro Cah),,46260,CPT,Professional,Both,,,,2040,1734,299.3,2040,"Health Partners, Inc.",State Public Programs,299.3,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Hemorrhoidectomy (Pro Cah),,46260,CPT,Professional,Both,,,,2040,1734,299.3,2040,Humana Insurance Company,Commercial PPO,465.15,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Hemorrhoidectomy (Pro Cah),,46260,CPT,Professional,Both,,,,2040,1734,299.3,2040,Humana Insurance Company,Medicare PPO,2040,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Hemorrhoidectomy (Pro Cah),,46260,CPT,Professional,Both,,,,2040,1734,299.3,2040,Medica,Individual & Family,1729.92,84.8,,percent of total billed charges,,
Hemorrhoidectomy (Pro Cah),,46260,CPT,Professional,Both,,,,2040,1734,299.3,2040,Medica,Medica Advantage Solution,1015.92,49.8,,percent of total billed charges,,
Hemorrhoidectomy (Pro Cah),,46260,CPT,Professional,Both,,,,2040,1734,299.3,2040,Medica,Medical Assistance,345.55,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Hemorrhoidectomy (Pro Cah),,46260,CPT,Professional,Both,,,,2040,1734,299.3,2040,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,465.15,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Hemorrhoidectomy (Pro Cah),,46260,CPT,Professional,Both,,,,2040,1734,299.3,2040,"Multiplan, Inc.","Multiplan, Inc.",1917.6,94,,percent of total billed charges,,
Hemorrhoidectomy (Pro Cah),,46260,CPT,Professional,Both,,,,2040,1734,299.3,2040,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1838.04,90.1,,percent of total billed charges,,
Hemorrhoidectomy (Pro Cah),,46260,CPT,Professional,Both,,,,2040,1734,299.3,2040,"Preferred One Administrative Services, INC.",PPO,2011.44,98.6,,percent of total billed charges,,
Hemorrhoidectomy (Pro Cah),,46260,CPT,Professional,Both,,,,2040,1734,299.3,2040,PrimeWest Health,Minnesota Senior Health Options (MSHO),534.9225,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Hemorrhoidectomy (Pro Cah),,46260,CPT,Professional,Both,,,,2040,1734,299.3,2040,PrimeWest Health,MinnesotaCare,369.7403832,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Hemorrhoidectomy (Pro Cah),,46260,CPT,Professional,Both,,,,2040,1734,299.3,2040,Sanford Health Plan,Sanford Health Plan,1795.2,88,,percent of total billed charges,,
Hemorrhoidectomy (Pro Cah),,46260,CPT,Professional,Both,,,,2040,1734,299.3,2040,"UCare Health, Inc.",Individual & Family Plan,756.14784,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Hemorrhoidectomy (Pro Cah),,46260,CPT,Professional,Both,,,,2040,1734,299.3,2040,"UCare Health, Inc.",Medical Assistance,380.106936,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Hemorrhoidectomy (Pro Cah),,46260,CPT,Professional,Both,,,,2040,1734,299.3,2040,"UCare Health, Inc.",Medicare Advantage,534.9225,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Hemorrhoidectomy (Pro Cah),,46260,CPT,Professional,Both,,,,2040,1734,299.3,2040,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),427.938,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Hemorrhoidectomy (Pro Cah),,46260,CPT,Professional,Both,,,,2040,1734,299.3,2040,UnitedHealthcare,Individual & Family,2040,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Hemorrhoidectomy (Pro Cah),,46260,CPT,Professional,Both,,,,2040,1734,299.3,2040,UnitedHealthcare,Medicare Advantage,534.9225,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Hemorrhoidectomy (Pro Cah),,46260,CPT,Professional,Both,,,,2040,1734,299.3,2040,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,345.55176,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Hemorrhoidopexy By Stapling (Pro Cah),,46947,CPT,Professional,Both,,,,1199,1019.15,239.09,1199,Aetna,Commercial,1019.15,85,,percent of total billed charges,,
Hemorrhoidopexy By Stapling (Pro Cah),,46947,CPT,Professional,Both,,,,1199,1019.15,239.09,1199,Aetna,Medicare Advantage,374.42,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Hemorrhoidopexy By Stapling (Pro Cah),,46947,CPT,Professional,Both,,,,1199,1019.15,239.09,1199,Aetna,PPO,1115.07,93,,percent of total billed charges,,
Hemorrhoidopexy By Stapling (Pro Cah),,46947,CPT,Professional,Both,,,,1199,1019.15,239.09,1199,America's PPO,America's PPO,1024.4256,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Hemorrhoidopexy By Stapling (Pro Cah),,46947,CPT,Professional,Both,,,,1199,1019.15,239.09,1199,BlueCross BlueShield Minnesota, Federal Employee Program,803.6,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Hemorrhoidopexy By Stapling (Pro Cah),,46947,CPT,Professional,Both,,,,1199,1019.15,239.09,1199,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,816.4576,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Hemorrhoidopexy By Stapling (Pro Cah),,46947,CPT,Professional,Both,,,,1199,1019.15,239.09,1199,BlueCross BlueShield Minnesota,High Value Network Plan,816.4576,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Hemorrhoidopexy By Stapling (Pro Cah),,46947,CPT,Professional,Both,,,,1199,1019.15,239.09,1199,BlueCross BlueShield Minnesota,Medicare Advantage,427.1675,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Hemorrhoidopexy By Stapling (Pro Cah),,46947,CPT,Professional,Both,,,,1199,1019.15,239.09,1199,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,816.4576,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Hemorrhoidopexy By Stapling (Pro Cah),,46947,CPT,Professional,Both,,,,1199,1019.15,239.09,1199,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,276.03704,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Hemorrhoidopexy By Stapling (Pro Cah),,46947,CPT,Professional,Both,,,,1199,1019.15,239.09,1199,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),427.1675,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Hemorrhoidopexy By Stapling (Pro Cah),,46947,CPT,Professional,Both,,,,1199,1019.15,239.09,1199,CorVel,Worker's Compensation,731.2388163,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Hemorrhoidopexy By Stapling (Pro Cah),,46947,CPT,Professional,Both,,,,1199,1019.15,239.09,1199,First Health Group Corporation,First Health Network,1163.03,97,,percent of total billed charges,,
Hemorrhoidopexy By Stapling (Pro Cah),,46947,CPT,Professional,Both,,,,1199,1019.15,239.09,1199,"Health Partners, Inc.",Commercial,789.37,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Hemorrhoidopexy By Stapling (Pro Cah),,46947,CPT,Professional,Both,,,,1199,1019.15,239.09,1199,"Health Partners, Inc.",Medicare Advantage,427.1675,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Hemorrhoidopexy By Stapling (Pro Cah),,46947,CPT,Professional,Both,,,,1199,1019.15,239.09,1199,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),371.4,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Hemorrhoidopexy By Stapling (Pro Cah),,46947,CPT,Professional,Both,,,,1199,1019.15,239.09,1199,"Health Partners, Inc.",State of Minnesota Advantage Program,680.042255,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Hemorrhoidopexy By Stapling (Pro Cah),,46947,CPT,Professional,Both,,,,1199,1019.15,239.09,1199,"Health Partners, Inc.",State Public Programs,239.09,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Hemorrhoidopexy By Stapling (Pro Cah),,46947,CPT,Professional,Both,,,,1199,1019.15,239.09,1199,Humana Insurance Company,Commercial PPO,371.45,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Hemorrhoidopexy By Stapling (Pro Cah),,46947,CPT,Professional,Both,,,,1199,1019.15,239.09,1199,Humana Insurance Company,Medicare PPO,1199,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Hemorrhoidopexy By Stapling (Pro Cah),,46947,CPT,Professional,Both,,,,1199,1019.15,239.09,1199,Medica,Individual & Family,1016.752,84.8,,percent of total billed charges,,
Hemorrhoidopexy By Stapling (Pro Cah),,46947,CPT,Professional,Both,,,,1199,1019.15,239.09,1199,Medica,Medica Advantage Solution,597.102,49.8,,percent of total billed charges,,
Hemorrhoidopexy By Stapling (Pro Cah),,46947,CPT,Professional,Both,,,,1199,1019.15,239.09,1199,Medica,Medical Assistance,276.04,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Hemorrhoidopexy By Stapling (Pro Cah),,46947,CPT,Professional,Both,,,,1199,1019.15,239.09,1199,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,371.45,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Hemorrhoidopexy By Stapling (Pro Cah),,46947,CPT,Professional,Both,,,,1199,1019.15,239.09,1199,"Multiplan, Inc.","Multiplan, Inc.",1127.06,94,,percent of total billed charges,,
Hemorrhoidopexy By Stapling (Pro Cah),,46947,CPT,Professional,Both,,,,1199,1019.15,239.09,1199,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1080.299,90.1,,percent of total billed charges,,
Hemorrhoidopexy By Stapling (Pro Cah),,46947,CPT,Professional,Both,,,,1199,1019.15,239.09,1199,"Preferred One Administrative Services, INC.",PPO,1182.214,98.6,,percent of total billed charges,,
Hemorrhoidopexy By Stapling (Pro Cah),,46947,CPT,Professional,Both,,,,1199,1019.15,239.09,1199,PrimeWest Health,Minnesota Senior Health Options (MSHO),427.1675,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Hemorrhoidopexy By Stapling (Pro Cah),,46947,CPT,Professional,Both,,,,1199,1019.15,239.09,1199,PrimeWest Health,MinnesotaCare,295.3596328,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Hemorrhoidopexy By Stapling (Pro Cah),,46947,CPT,Professional,Both,,,,1199,1019.15,239.09,1199,Sanford Health Plan,Sanford Health Plan,1055.12,88,,percent of total billed charges,,
Hemorrhoidopexy By Stapling (Pro Cah),,46947,CPT,Professional,Both,,,,1199,1019.15,239.09,1199,"UCare Health, Inc.",Individual & Family Plan,603.82912,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Hemorrhoidopexy By Stapling (Pro Cah),,46947,CPT,Professional,Both,,,,1199,1019.15,239.09,1199,"UCare Health, Inc.",Medical Assistance,303.640744,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Hemorrhoidopexy By Stapling (Pro Cah),,46947,CPT,Professional,Both,,,,1199,1019.15,239.09,1199,"UCare Health, Inc.",Medicare Advantage,427.1675,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Hemorrhoidopexy By Stapling (Pro Cah),,46947,CPT,Professional,Both,,,,1199,1019.15,239.09,1199,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),341.734,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Hemorrhoidopexy By Stapling (Pro Cah),,46947,CPT,Professional,Both,,,,1199,1019.15,239.09,1199,UnitedHealthcare,Individual & Family,1199,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Hemorrhoidopexy By Stapling (Pro Cah),,46947,CPT,Professional,Both,,,,1199,1019.15,239.09,1199,UnitedHealthcare,Medicare Advantage,427.1675,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Hemorrhoidopexy By Stapling (Pro Cah),,46947,CPT,Professional,Both,,,,1199,1019.15,239.09,1199,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,276.03704,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Laparoscopy, Surgical; Cholecystectomy (Pro Cah)",,47562,CPT,Professional,Both,,,,3500,2975,396.16,3500,Aetna,Commercial,2975,85,,percent of total billed charges,,
"Laparoscopy, Surgical; Cholecystectomy (Pro Cah)",,47562,CPT,Professional,Both,,,,3500,2975,396.16,3500,Aetna,Medicare Advantage,627.66,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Laparoscopy, Surgical; Cholecystectomy (Pro Cah)",,47562,CPT,Professional,Both,,,,3500,2975,396.16,3500,Aetna,PPO,3255,93,,percent of total billed charges,,
"Laparoscopy, Surgical; Cholecystectomy (Pro Cah)",,47562,CPT,Professional,Both,,,,3500,2975,396.16,3500,America's PPO,America's PPO,2990.4,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Laparoscopy, Surgical; Cholecystectomy (Pro Cah)",,47562,CPT,Professional,Both,,,,3500,2975,396.16,3500,BlueCross BlueShield Minnesota, Federal Employee Program,1360.67,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Laparoscopy, Surgical; Cholecystectomy (Pro Cah)",,47562,CPT,Professional,Both,,,,3500,2975,396.16,3500,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1382.44072,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Laparoscopy, Surgical; Cholecystectomy (Pro Cah)",,47562,CPT,Professional,Both,,,,3500,2975,396.16,3500,BlueCross BlueShield Minnesota,High Value Network Plan,1382.44072,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Laparoscopy, Surgical; Cholecystectomy (Pro Cah)",,47562,CPT,Professional,Both,,,,3500,2975,396.16,3500,BlueCross BlueShield Minnesota,Medicare Advantage,707.7905,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Laparoscopy, Surgical; Cholecystectomy (Pro Cah)",,47562,CPT,Professional,Both,,,,3500,2975,396.16,3500,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1382.44072,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Laparoscopy, Surgical; Cholecystectomy (Pro Cah)",,47562,CPT,Professional,Both,,,,3500,2975,396.16,3500,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,457.38288,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Laparoscopy, Surgical; Cholecystectomy (Pro Cah)",,47562,CPT,Professional,Both,,,,3500,2975,396.16,3500,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),707.7905,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Laparoscopy, Surgical; Cholecystectomy (Pro Cah)",,47562,CPT,Professional,Both,,,,3500,2975,396.16,3500,CorVel,Worker's Compensation,1219.684279,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Laparoscopy, Surgical; Cholecystectomy (Pro Cah)",,47562,CPT,Professional,Both,,,,3500,2975,396.16,3500,First Health Group Corporation,First Health Network,3395,97,,percent of total billed charges,,
"Laparoscopy, Surgical; Cholecystectomy (Pro Cah)",,47562,CPT,Professional,Both,,,,3500,2975,396.16,3500,"Health Partners, Inc.",Commercial,1317.56,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Laparoscopy, Surgical; Cholecystectomy (Pro Cah)",,47562,CPT,Professional,Both,,,,3500,2975,396.16,3500,"Health Partners, Inc.",Medicare Advantage,707.7905,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Laparoscopy, Surgical; Cholecystectomy (Pro Cah)",,47562,CPT,Professional,Both,,,,3500,2975,396.16,3500,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),615.39,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Laparoscopy, Surgical; Cholecystectomy (Pro Cah)",,47562,CPT,Professional,Both,,,,3500,2975,396.16,3500,"Health Partners, Inc.",State of Minnesota Advantage Program,1135.07794,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Laparoscopy, Surgical; Cholecystectomy (Pro Cah)",,47562,CPT,Professional,Both,,,,3500,2975,396.16,3500,"Health Partners, Inc.",State Public Programs,396.16,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Laparoscopy, Surgical; Cholecystectomy (Pro Cah)",,47562,CPT,Professional,Both,,,,3500,2975,396.16,3500,Humana Insurance Company,Commercial PPO,615.47,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Laparoscopy, Surgical; Cholecystectomy (Pro Cah)",,47562,CPT,Professional,Both,,,,3500,2975,396.16,3500,Humana Insurance Company,Medicare PPO,3500,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Laparoscopy, Surgical; Cholecystectomy (Pro Cah)",,47562,CPT,Professional,Both,,,,3500,2975,396.16,3500,Medica,Individual & Family,2968,84.8,,percent of total billed charges,,
"Laparoscopy, Surgical; Cholecystectomy (Pro Cah)",,47562,CPT,Professional,Both,,,,3500,2975,396.16,3500,Medica,Medica Advantage Solution,1743,49.8,,percent of total billed charges,,
"Laparoscopy, Surgical; Cholecystectomy (Pro Cah)",,47562,CPT,Professional,Both,,,,3500,2975,396.16,3500,Medica,Medical Assistance,457.38,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Laparoscopy, Surgical; Cholecystectomy (Pro Cah)",,47562,CPT,Professional,Both,,,,3500,2975,396.16,3500,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,615.47,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Laparoscopy, Surgical; Cholecystectomy (Pro Cah)",,47562,CPT,Professional,Both,,,,3500,2975,396.16,3500,"Multiplan, Inc.","Multiplan, Inc.",3290,94,,percent of total billed charges,,
"Laparoscopy, Surgical; Cholecystectomy (Pro Cah)",,47562,CPT,Professional,Both,,,,3500,2975,396.16,3500,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,3153.5,90.1,,percent of total billed charges,,
"Laparoscopy, Surgical; Cholecystectomy (Pro Cah)",,47562,CPT,Professional,Both,,,,3500,2975,396.16,3500,"Preferred One Administrative Services, INC.",PPO,3451,98.6,,percent of total billed charges,,
"Laparoscopy, Surgical; Cholecystectomy (Pro Cah)",,47562,CPT,Professional,Both,,,,3500,2975,396.16,3500,PrimeWest Health,Minnesota Senior Health Options (MSHO),707.7905,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Laparoscopy, Surgical; Cholecystectomy (Pro Cah)",,47562,CPT,Professional,Both,,,,3500,2975,396.16,3500,PrimeWest Health,MinnesotaCare,489.3996816,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Laparoscopy, Surgical; Cholecystectomy (Pro Cah)",,47562,CPT,Professional,Both,,,,3500,2975,396.16,3500,Sanford Health Plan,Sanford Health Plan,3080,88,,percent of total billed charges,,
"Laparoscopy, Surgical; Cholecystectomy (Pro Cah)",,47562,CPT,Professional,Both,,,,3500,2975,396.16,3500,"UCare Health, Inc.",Individual & Family Plan,1000.508032,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Laparoscopy, Surgical; Cholecystectomy (Pro Cah)",,47562,CPT,Professional,Both,,,,3500,2975,396.16,3500,"UCare Health, Inc.",Medical Assistance,503.121168,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Laparoscopy, Surgical; Cholecystectomy (Pro Cah)",,47562,CPT,Professional,Both,,,,3500,2975,396.16,3500,"UCare Health, Inc.",Medicare Advantage,707.7905,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Laparoscopy, Surgical; Cholecystectomy (Pro Cah)",,47562,CPT,Professional,Both,,,,3500,2975,396.16,3500,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),566.2324,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Laparoscopy, Surgical; Cholecystectomy (Pro Cah)",,47562,CPT,Professional,Both,,,,3500,2975,396.16,3500,UnitedHealthcare,Individual & Family,3500,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Laparoscopy, Surgical; Cholecystectomy (Pro Cah)",,47562,CPT,Professional,Both,,,,3500,2975,396.16,3500,UnitedHealthcare,Medicare Advantage,707.7905,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Laparoscopy, Surgical; Cholecystectomy (Pro Cah)",,47562,CPT,Professional,Both,,,,3500,2975,396.16,3500,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,457.38288,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Laparoscopy, Surgical; Cholecystectomy With Cholangiography (Pro Cah)",,47563,CPT,Professional,Both,,,,3750,3187.5,431.28,3750,Aetna,Commercial,3187.5,85,,percent of total billed charges,,
"Laparoscopy, Surgical; Cholecystectomy With Cholangiography (Pro Cah)",,47563,CPT,Professional,Both,,,,3750,3187.5,431.28,3750,Aetna,Medicare Advantage,682.94,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Laparoscopy, Surgical; Cholecystectomy With Cholangiography (Pro Cah)",,47563,CPT,Professional,Both,,,,3750,3187.5,431.28,3750,Aetna,PPO,3487.5,93,,percent of total billed charges,,
"Laparoscopy, Surgical; Cholecystectomy With Cholangiography (Pro Cah)",,47563,CPT,Professional,Both,,,,3750,3187.5,431.28,3750,America's PPO,America's PPO,3204,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Laparoscopy, Surgical; Cholecystectomy With Cholangiography (Pro Cah)",,47563,CPT,Professional,Both,,,,3750,3187.5,431.28,3750,BlueCross BlueShield Minnesota, Federal Employee Program,1483.24,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Laparoscopy, Surgical; Cholecystectomy With Cholangiography (Pro Cah)",,47563,CPT,Professional,Both,,,,3750,3187.5,431.28,3750,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1506.97184,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Laparoscopy, Surgical; Cholecystectomy With Cholangiography (Pro Cah)",,47563,CPT,Professional,Both,,,,3750,3187.5,431.28,3750,BlueCross BlueShield Minnesota,High Value Network Plan,1506.97184,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Laparoscopy, Surgical; Cholecystectomy With Cholangiography (Pro Cah)",,47563,CPT,Professional,Both,,,,3750,3187.5,431.28,3750,BlueCross BlueShield Minnesota,Medicare Advantage,770.4425,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Laparoscopy, Surgical; Cholecystectomy With Cholangiography (Pro Cah)",,47563,CPT,Professional,Both,,,,3750,3187.5,431.28,3750,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1506.97184,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Laparoscopy, Surgical; Cholecystectomy With Cholangiography (Pro Cah)",,47563,CPT,Professional,Both,,,,3750,3187.5,431.28,3750,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,497.93144,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Laparoscopy, Surgical; Cholecystectomy With Cholangiography (Pro Cah)",,47563,CPT,Professional,Both,,,,3750,3187.5,431.28,3750,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),770.4425,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Laparoscopy, Surgical; Cholecystectomy With Cholangiography (Pro Cah)",,47563,CPT,Professional,Both,,,,3750,3187.5,431.28,3750,CorVel,Worker's Compensation,1326.566526,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Laparoscopy, Surgical; Cholecystectomy With Cholangiography (Pro Cah)",,47563,CPT,Professional,Both,,,,3750,3187.5,431.28,3750,First Health Group Corporation,First Health Network,3637.5,97,,percent of total billed charges,,
"Laparoscopy, Surgical; Cholecystectomy With Cholangiography (Pro Cah)",,47563,CPT,Professional,Both,,,,3750,3187.5,431.28,3750,"Health Partners, Inc.",Commercial,1432.92,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Laparoscopy, Surgical; Cholecystectomy With Cholangiography (Pro Cah)",,47563,CPT,Professional,Both,,,,3750,3187.5,431.28,3750,"Health Partners, Inc.",Medicare Advantage,770.4425,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Laparoscopy, Surgical; Cholecystectomy With Cholangiography (Pro Cah)",,47563,CPT,Professional,Both,,,,3750,3187.5,431.28,3750,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),669.95,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Laparoscopy, Surgical; Cholecystectomy With Cholangiography (Pro Cah)",,47563,CPT,Professional,Both,,,,3750,3187.5,431.28,3750,"Health Partners, Inc.",State of Minnesota Advantage Program,1234.46058,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Laparoscopy, Surgical; Cholecystectomy With Cholangiography (Pro Cah)",,47563,CPT,Professional,Both,,,,3750,3187.5,431.28,3750,"Health Partners, Inc.",State Public Programs,431.28,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Laparoscopy, Surgical; Cholecystectomy With Cholangiography (Pro Cah)",,47563,CPT,Professional,Both,,,,3750,3187.5,431.28,3750,Humana Insurance Company,Commercial PPO,669.95,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Laparoscopy, Surgical; Cholecystectomy With Cholangiography (Pro Cah)",,47563,CPT,Professional,Both,,,,3750,3187.5,431.28,3750,Humana Insurance Company,Medicare PPO,3750,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Laparoscopy, Surgical; Cholecystectomy With Cholangiography (Pro Cah)",,47563,CPT,Professional,Both,,,,3750,3187.5,431.28,3750,Medica,Individual & Family,3180,84.8,,percent of total billed charges,,
"Laparoscopy, Surgical; Cholecystectomy With Cholangiography (Pro Cah)",,47563,CPT,Professional,Both,,,,3750,3187.5,431.28,3750,Medica,Medica Advantage Solution,1867.5,49.8,,percent of total billed charges,,
"Laparoscopy, Surgical; Cholecystectomy With Cholangiography (Pro Cah)",,47563,CPT,Professional,Both,,,,3750,3187.5,431.28,3750,Medica,Medical Assistance,497.93,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Laparoscopy, Surgical; Cholecystectomy With Cholangiography (Pro Cah)",,47563,CPT,Professional,Both,,,,3750,3187.5,431.28,3750,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,669.95,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Laparoscopy, Surgical; Cholecystectomy With Cholangiography (Pro Cah)",,47563,CPT,Professional,Both,,,,3750,3187.5,431.28,3750,"Multiplan, Inc.","Multiplan, Inc.",3525,94,,percent of total billed charges,,
"Laparoscopy, Surgical; Cholecystectomy With Cholangiography (Pro Cah)",,47563,CPT,Professional,Both,,,,3750,3187.5,431.28,3750,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,3378.75,90.1,,percent of total billed charges,,
"Laparoscopy, Surgical; Cholecystectomy With Cholangiography (Pro Cah)",,47563,CPT,Professional,Both,,,,3750,3187.5,431.28,3750,"Preferred One Administrative Services, INC.",PPO,3697.5,98.6,,percent of total billed charges,,
"Laparoscopy, Surgical; Cholecystectomy With Cholangiography (Pro Cah)",,47563,CPT,Professional,Both,,,,3750,3187.5,431.28,3750,PrimeWest Health,Minnesota Senior Health Options (MSHO),770.4425,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Laparoscopy, Surgical; Cholecystectomy With Cholangiography (Pro Cah)",,47563,CPT,Professional,Both,,,,3750,3187.5,431.28,3750,PrimeWest Health,MinnesotaCare,532.7866408,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Laparoscopy, Surgical; Cholecystectomy With Cholangiography (Pro Cah)",,47563,CPT,Professional,Both,,,,3750,3187.5,431.28,3750,Sanford Health Plan,Sanford Health Plan,3300,88,,percent of total billed charges,,
"Laparoscopy, Surgical; Cholecystectomy With Cholangiography (Pro Cah)",,47563,CPT,Professional,Both,,,,3750,3187.5,431.28,3750,"UCare Health, Inc.",Individual & Family Plan,1089.07072,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Laparoscopy, Surgical; Cholecystectomy With Cholangiography (Pro Cah)",,47563,CPT,Professional,Both,,,,3750,3187.5,431.28,3750,"UCare Health, Inc.",Medical Assistance,547.724584,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Laparoscopy, Surgical; Cholecystectomy With Cholangiography (Pro Cah)",,47563,CPT,Professional,Both,,,,3750,3187.5,431.28,3750,"UCare Health, Inc.",Medicare Advantage,770.4425,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Laparoscopy, Surgical; Cholecystectomy With Cholangiography (Pro Cah)",,47563,CPT,Professional,Both,,,,3750,3187.5,431.28,3750,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),616.354,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Laparoscopy, Surgical; Cholecystectomy With Cholangiography (Pro Cah)",,47563,CPT,Professional,Both,,,,3750,3187.5,431.28,3750,UnitedHealthcare,Individual & Family,3750,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Laparoscopy, Surgical; Cholecystectomy With Cholangiography (Pro Cah)",,47563,CPT,Professional,Both,,,,3750,3187.5,431.28,3750,UnitedHealthcare,Medicare Advantage,770.4425,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Laparoscopy, Surgical; Cholecystectomy With Cholangiography (Pro Cah)",,47563,CPT,Professional,Both,,,,3750,3187.5,431.28,3750,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,497.93144,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Abdominal Paracentesis (Diagnostic Or Therapeutic); Without Imaging Guidance (Pro Cah),,49082,CPT,Professional,Both,,,,485,412.25,44.5,485,Aetna,Commercial,412.25,85,,percent of total billed charges,,
Abdominal Paracentesis (Diagnostic Or Therapeutic); Without Imaging Guidance (Pro Cah),,49082,CPT,Professional,Both,,,,485,412.25,44.5,485,Aetna,Medicare Advantage,70.81,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Abdominal Paracentesis (Diagnostic Or Therapeutic); Without Imaging Guidance (Pro Cah),,49082,CPT,Professional,Both,,,,485,412.25,44.5,485,Aetna,PPO,451.05,93,,percent of total billed charges,,
Abdominal Paracentesis (Diagnostic Or Therapeutic); Without Imaging Guidance (Pro Cah),,49082,CPT,Professional,Both,,,,485,412.25,44.5,485,America's PPO,America's PPO,414.384,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Abdominal Paracentesis (Diagnostic Or Therapeutic); Without Imaging Guidance (Pro Cah),,49082,CPT,Professional,Both,,,,485,412.25,44.5,485,BlueCross BlueShield Minnesota, Federal Employee Program,148.74,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Abdominal Paracentesis (Diagnostic Or Therapeutic); Without Imaging Guidance (Pro Cah),,49082,CPT,Professional,Both,,,,485,412.25,44.5,485,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,151.11984,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Abdominal Paracentesis (Diagnostic Or Therapeutic); Without Imaging Guidance (Pro Cah),,49082,CPT,Professional,Both,,,,485,412.25,44.5,485,BlueCross BlueShield Minnesota,High Value Network Plan,151.11984,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Abdominal Paracentesis (Diagnostic Or Therapeutic); Without Imaging Guidance (Pro Cah),,49082,CPT,Professional,Both,,,,485,412.25,44.5,485,BlueCross BlueShield Minnesota,Medicare Advantage,79.7295,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Abdominal Paracentesis (Diagnostic Or Therapeutic); Without Imaging Guidance (Pro Cah),,49082,CPT,Professional,Both,,,,485,412.25,44.5,485,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,151.11984,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Abdominal Paracentesis (Diagnostic Or Therapeutic); Without Imaging Guidance (Pro Cah),,49082,CPT,Professional,Both,,,,485,412.25,44.5,485,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,51.37912,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Abdominal Paracentesis (Diagnostic Or Therapeutic); Without Imaging Guidance (Pro Cah),,49082,CPT,Professional,Both,,,,485,412.25,44.5,485,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),79.7295,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Abdominal Paracentesis (Diagnostic Or Therapeutic); Without Imaging Guidance (Pro Cah),,49082,CPT,Professional,Both,,,,485,412.25,44.5,485,CorVel,Worker's Compensation,137.4674352,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Abdominal Paracentesis (Diagnostic Or Therapeutic); Without Imaging Guidance (Pro Cah),,49082,CPT,Professional,Both,,,,485,412.25,44.5,485,First Health Group Corporation,First Health Network,470.45,97,,percent of total billed charges,,
Abdominal Paracentesis (Diagnostic Or Therapeutic); Without Imaging Guidance (Pro Cah),,49082,CPT,Professional,Both,,,,485,412.25,44.5,485,"Health Partners, Inc.",Commercial,148.73,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Abdominal Paracentesis (Diagnostic Or Therapeutic); Without Imaging Guidance (Pro Cah),,49082,CPT,Professional,Both,,,,485,412.25,44.5,485,"Health Partners, Inc.",Medicare Advantage,79.7295,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Abdominal Paracentesis (Diagnostic Or Therapeutic); Without Imaging Guidance (Pro Cah),,49082,CPT,Professional,Both,,,,485,412.25,44.5,485,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),69.13,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Abdominal Paracentesis (Diagnostic Or Therapeutic); Without Imaging Guidance (Pro Cah),,49082,CPT,Professional,Both,,,,485,412.25,44.5,485,"Health Partners, Inc.",State of Minnesota Advantage Program,128.130895,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Abdominal Paracentesis (Diagnostic Or Therapeutic); Without Imaging Guidance (Pro Cah),,49082,CPT,Professional,Both,,,,485,412.25,44.5,485,"Health Partners, Inc.",State Public Programs,44.5,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Abdominal Paracentesis (Diagnostic Or Therapeutic); Without Imaging Guidance (Pro Cah),,49082,CPT,Professional,Both,,,,485,412.25,44.5,485,Humana Insurance Company,Commercial PPO,69.33,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Abdominal Paracentesis (Diagnostic Or Therapeutic); Without Imaging Guidance (Pro Cah),,49082,CPT,Professional,Both,,,,485,412.25,44.5,485,Humana Insurance Company,Medicare PPO,485,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Abdominal Paracentesis (Diagnostic Or Therapeutic); Without Imaging Guidance (Pro Cah),,49082,CPT,Professional,Both,,,,485,412.25,44.5,485,Medica,Individual & Family,411.28,84.8,,percent of total billed charges,,
Abdominal Paracentesis (Diagnostic Or Therapeutic); Without Imaging Guidance (Pro Cah),,49082,CPT,Professional,Both,,,,485,412.25,44.5,485,Medica,Medica Advantage Solution,241.53,49.8,,percent of total billed charges,,
Abdominal Paracentesis (Diagnostic Or Therapeutic); Without Imaging Guidance (Pro Cah),,49082,CPT,Professional,Both,,,,485,412.25,44.5,485,Medica,Medical Assistance,51.38,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Abdominal Paracentesis (Diagnostic Or Therapeutic); Without Imaging Guidance (Pro Cah),,49082,CPT,Professional,Both,,,,485,412.25,44.5,485,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,69.33,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Abdominal Paracentesis (Diagnostic Or Therapeutic); Without Imaging Guidance (Pro Cah),,49082,CPT,Professional,Both,,,,485,412.25,44.5,485,"Multiplan, Inc.","Multiplan, Inc.",455.9,94,,percent of total billed charges,,
Abdominal Paracentesis (Diagnostic Or Therapeutic); Without Imaging Guidance (Pro Cah),,49082,CPT,Professional,Both,,,,485,412.25,44.5,485,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,436.985,90.1,,percent of total billed charges,,
Abdominal Paracentesis (Diagnostic Or Therapeutic); Without Imaging Guidance (Pro Cah),,49082,CPT,Professional,Both,,,,485,412.25,44.5,485,"Preferred One Administrative Services, INC.",PPO,478.21,98.6,,percent of total billed charges,,
Abdominal Paracentesis (Diagnostic Or Therapeutic); Without Imaging Guidance (Pro Cah),,49082,CPT,Professional,Both,,,,485,412.25,44.5,485,PrimeWest Health,Minnesota Senior Health Options (MSHO),79.7295,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Abdominal Paracentesis (Diagnostic Or Therapeutic); Without Imaging Guidance (Pro Cah),,49082,CPT,Professional,Both,,,,485,412.25,44.5,485,PrimeWest Health,MinnesotaCare,54.9756584,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Abdominal Paracentesis (Diagnostic Or Therapeutic); Without Imaging Guidance (Pro Cah),,49082,CPT,Professional,Both,,,,485,412.25,44.5,485,Sanford Health Plan,Sanford Health Plan,426.8,88,,percent of total billed charges,,
Abdominal Paracentesis (Diagnostic Or Therapeutic); Without Imaging Guidance (Pro Cah),,49082,CPT,Professional,Both,,,,485,412.25,44.5,485,"UCare Health, Inc.",Individual & Family Plan,112.702848,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Abdominal Paracentesis (Diagnostic Or Therapeutic); Without Imaging Guidance (Pro Cah),,49082,CPT,Professional,Both,,,,485,412.25,44.5,485,"UCare Health, Inc.",Medical Assistance,56.517032,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Abdominal Paracentesis (Diagnostic Or Therapeutic); Without Imaging Guidance (Pro Cah),,49082,CPT,Professional,Both,,,,485,412.25,44.5,485,"UCare Health, Inc.",Medicare Advantage,79.7295,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Abdominal Paracentesis (Diagnostic Or Therapeutic); Without Imaging Guidance (Pro Cah),,49082,CPT,Professional,Both,,,,485,412.25,44.5,485,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),63.7836,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Abdominal Paracentesis (Diagnostic Or Therapeutic); Without Imaging Guidance (Pro Cah),,49082,CPT,Professional,Both,,,,485,412.25,44.5,485,UnitedHealthcare,Individual & Family,485,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Abdominal Paracentesis (Diagnostic Or Therapeutic); Without Imaging Guidance (Pro Cah),,49082,CPT,Professional,Both,,,,485,412.25,44.5,485,UnitedHealthcare,Medicare Advantage,79.7295,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Abdominal Paracentesis (Diagnostic Or Therapeutic); Without Imaging Guidance (Pro Cah),,49082,CPT,Professional,Both,,,,485,412.25,44.5,485,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,51.37912,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Abdominal Paracentesis, Wo Imaging Guidance, Dx Or Therapeutic",,49082,CPT,Facility,Both,,,,1016,863.6,291.1856,1016,Aetna,Commercial,934.72,92,,percent of total billed charges,,
"Abdominal Paracentesis, Wo Imaging Guidance, Dx Or Therapeutic",,49082,CPT,Facility,Outpatient,,,,1016,863.6,291.1856,1016,Aetna,Medicare Advantage,497.84,49,,percent of total billed charges,,
"Abdominal Paracentesis, Wo Imaging Guidance, Dx Or Therapeutic",,49082,CPT,Facility,Inpatient,,,,1016,863.6,291.1856,1016,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Abdominal Paracentesis, Wo Imaging Guidance, Dx Or Therapeutic",,49082,CPT,Facility,Both,,,,1016,863.6,291.1856,1016,Aetna,PPO,944.88,93,,percent of total billed charges,,
"Abdominal Paracentesis, Wo Imaging Guidance, Dx Or Therapeutic",,49082,CPT,Facility,Both,,,,1016,863.6,291.1856,1016,America's PPO,America's PPO,975.6648,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Abdominal Paracentesis, Wo Imaging Guidance, Dx Or Therapeutic",,49082,CPT,Facility,Both,,,,1016,863.6,291.1856,1016,BlueCross BlueShield Minnesota, Federal Employee Program,999.744,98.4,,percent of total billed charges,,
"Abdominal Paracentesis, Wo Imaging Guidance, Dx Or Therapeutic",,49082,CPT,Facility,Both,,,,1016,863.6,291.1856,1016,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1016,100,,percent of total billed charges,,
"Abdominal Paracentesis, Wo Imaging Guidance, Dx Or Therapeutic",,49082,CPT,Facility,Both,,,,1016,863.6,291.1856,1016,BlueCross BlueShield Minnesota,High Value Network Plan,914.4,90,,percent of total billed charges,,
"Abdominal Paracentesis, Wo Imaging Guidance, Dx Or Therapeutic",,49082,CPT,Facility,Outpatient,,,,1016,863.6,291.1856,1016,BlueCross BlueShield Minnesota,Medicare Advantage,497.84,49,,percent of total billed charges,,
"Abdominal Paracentesis, Wo Imaging Guidance, Dx Or Therapeutic",,49082,CPT,Facility,Inpatient,,,,1016,863.6,291.1856,1016,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Abdominal Paracentesis, Wo Imaging Guidance, Dx Or Therapeutic",,49082,CPT,Facility,Both,,,,1016,863.6,291.1856,1016,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,899.8712,88.57,,percent of total billed charges,,
"Abdominal Paracentesis, Wo Imaging Guidance, Dx Or Therapeutic",,49082,CPT,Facility,Both,,,,1016,863.6,291.1856,1016,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,291.1856,28.66,,percent of total billed charges,,
"Abdominal Paracentesis, Wo Imaging Guidance, Dx Or Therapeutic",,49082,CPT,Facility,Outpatient,,,,1016,863.6,291.1856,1016,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),497.84,49,,percent of total billed charges,,
"Abdominal Paracentesis, Wo Imaging Guidance, Dx Or Therapeutic",,49082,CPT,Facility,Inpatient,,,,1016,863.6,291.1856,1016,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Abdominal Paracentesis, Wo Imaging Guidance, Dx Or Therapeutic",,49082,CPT,Facility,Both,,,,1016,863.6,291.1856,1016,CorVel,Worker's Compensation,1016,100,,percent of total billed charges,,
"Abdominal Paracentesis, Wo Imaging Guidance, Dx Or Therapeutic",,49082,CPT,Facility,Both,,,,1016,863.6,291.1856,1016,First Health Group Corporation,First Health Network,985.52,97,,percent of total billed charges,,
"Abdominal Paracentesis, Wo Imaging Guidance, Dx Or Therapeutic",,49082,CPT,Facility,Both,,,,1016,863.6,291.1856,1016,"Health Partners, Inc.",Commercial,961.136,94.6,,percent of total billed charges,,
"Abdominal Paracentesis, Wo Imaging Guidance, Dx Or Therapeutic",,49082,CPT,Facility,Outpatient,,,,1016,863.6,291.1856,1016,"Health Partners, Inc.",Medicare Advantage,497.84,49,,percent of total billed charges,,
"Abdominal Paracentesis, Wo Imaging Guidance, Dx Or Therapeutic",,49082,CPT,Facility,Inpatient,,,,1016,863.6,291.1856,1016,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Abdominal Paracentesis, Wo Imaging Guidance, Dx Or Therapeutic",,49082,CPT,Facility,Both,,,,1016,863.6,291.1856,1016,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),609.6,60,,percent of total billed charges,,
"Abdominal Paracentesis, Wo Imaging Guidance, Dx Or Therapeutic",,49082,CPT,Facility,Both,,,,1016,863.6,291.1856,1016,"Health Partners, Inc.",State of Minnesota Advantage Program,828.04,81.5,,percent of total billed charges,,
"Abdominal Paracentesis, Wo Imaging Guidance, Dx Or Therapeutic",,49082,CPT,Facility,Both,,,,1016,863.6,291.1856,1016,"Health Partners, Inc.",State Public Programs,508,50,,percent of total billed charges,,
"Abdominal Paracentesis, Wo Imaging Guidance, Dx Or Therapeutic",,49082,CPT,Facility,Both,,,,1016,863.6,291.1856,1016,Humana Insurance Company,Commercial PPO,965.2,95,,percent of total billed charges,,
"Abdominal Paracentesis, Wo Imaging Guidance, Dx Or Therapeutic",,49082,CPT,Facility,Outpatient,,,,1016,863.6,291.1856,1016,Humana Insurance Company,Medicare PPO,497.84,49,,percent of total billed charges,,
"Abdominal Paracentesis, Wo Imaging Guidance, Dx Or Therapeutic",,49082,CPT,Facility,Inpatient,,,,1016,863.6,291.1856,1016,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Abdominal Paracentesis, Wo Imaging Guidance, Dx Or Therapeutic",,49082,CPT,Facility,Both,,,,1016,863.6,291.1856,1016,Medica,Individual & Family,1006.856,99.1,,percent of total billed charges,,
"Abdominal Paracentesis, Wo Imaging Guidance, Dx Or Therapeutic",,49082,CPT,Facility,Outpatient,,,,1016,863.6,291.1856,1016,Medica,Medica Advantage Solution,505.968,49.8,,percent of total billed charges,,
"Abdominal Paracentesis, Wo Imaging Guidance, Dx Or Therapeutic",,49082,CPT,Facility,Inpatient,,,,1016,863.6,291.1856,1016,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Abdominal Paracentesis, Wo Imaging Guidance, Dx Or Therapeutic",,49082,CPT,Facility,Outpatient,,,,1016,863.6,291.1856,1016,Medica,Medical Assistance,724,,,Other,Grouper,All inclusive per visit
"Abdominal Paracentesis, Wo Imaging Guidance, Dx Or Therapeutic",,49082,CPT,Facility,Inpatient,,,,1016,863.6,291.1856,1016,Medica,Medical Assistance,,,,,Included in per diem rate,
"Abdominal Paracentesis, Wo Imaging Guidance, Dx Or Therapeutic",,49082,CPT,Facility,Outpatient,,,,1016,863.6,291.1856,1016,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,505.968,49.8,,percent of total billed charges,,
"Abdominal Paracentesis, Wo Imaging Guidance, Dx Or Therapeutic",,49082,CPT,Facility,Inpatient,,,,1016,863.6,291.1856,1016,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Abdominal Paracentesis, Wo Imaging Guidance, Dx Or Therapeutic",,49082,CPT,Facility,Both,,,,1016,863.6,291.1856,1016,"Multiplan, Inc.","Multiplan, Inc.",955.04,94,,percent of total billed charges,,
"Abdominal Paracentesis, Wo Imaging Guidance, Dx Or Therapeutic",,49082,CPT,Facility,Outpatient,,,,1016,863.6,291.1856,1016,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,915.416,90.1,,percent of total billed charges,,
"Abdominal Paracentesis, Wo Imaging Guidance, Dx Or Therapeutic",,49082,CPT,Facility,Inpatient,,,,1016,863.6,291.1856,1016,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Abdominal Paracentesis, Wo Imaging Guidance, Dx Or Therapeutic",,49082,CPT,Facility,Both,,,,1016,863.6,291.1856,1016,"Preferred One Administrative Services, INC.",PPO,1001.776,98.6,,percent of total billed charges,,
"Abdominal Paracentesis, Wo Imaging Guidance, Dx Or Therapeutic",,49082,CPT,Facility,Outpatient,,,,1016,863.6,291.1856,1016,PrimeWest Health,Minnesota Senior Health Options (MSHO),522.732,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Abdominal Paracentesis, Wo Imaging Guidance, Dx Or Therapeutic",,49082,CPT,Facility,Inpatient,,,,1016,863.6,291.1856,1016,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Abdominal Paracentesis, Wo Imaging Guidance, Dx Or Therapeutic",,49082,CPT,Facility,Outpatient,,,,1016,863.6,291.1856,1016,PrimeWest Health,MinnesotaCare,521.8176,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Abdominal Paracentesis, Wo Imaging Guidance, Dx Or Therapeutic",,49082,CPT,Facility,Inpatient,,,,1016,863.6,291.1856,1016,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Abdominal Paracentesis, Wo Imaging Guidance, Dx Or Therapeutic",,49082,CPT,Facility,Both,,,,1016,863.6,291.1856,1016,Sanford Health Plan,Sanford Health Plan,934.72,92,,percent of total billed charges,,
"Abdominal Paracentesis, Wo Imaging Guidance, Dx Or Therapeutic",,49082,CPT,Facility,Outpatient,,,,1016,863.6,291.1856,1016,"UCare Health, Inc.",Individual & Family Plan,572.516,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Abdominal Paracentesis, Wo Imaging Guidance, Dx Or Therapeutic",,49082,CPT,Facility,Inpatient,,,,1016,863.6,291.1856,1016,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Abdominal Paracentesis, Wo Imaging Guidance, Dx Or Therapeutic",,49082,CPT,Facility,Outpatient,,,,1016,863.6,291.1856,1016,"UCare Health, Inc.",Medical Assistance,512.7752,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Abdominal Paracentesis, Wo Imaging Guidance, Dx Or Therapeutic",,49082,CPT,Facility,Inpatient,,,,1016,863.6,291.1856,1016,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Abdominal Paracentesis, Wo Imaging Guidance, Dx Or Therapeutic",,49082,CPT,Facility,Outpatient,,,,1016,863.6,291.1856,1016,"UCare Health, Inc.",Medicare Advantage,512.7752,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Abdominal Paracentesis, Wo Imaging Guidance, Dx Or Therapeutic",,49082,CPT,Facility,Inpatient,,,,1016,863.6,291.1856,1016,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Abdominal Paracentesis, Wo Imaging Guidance, Dx Or Therapeutic",,49082,CPT,Facility,Outpatient,,,,1016,863.6,291.1856,1016,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),512.7752,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Abdominal Paracentesis, Wo Imaging Guidance, Dx Or Therapeutic",,49082,CPT,Facility,Inpatient,,,,1016,863.6,291.1856,1016,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Abdominal Paracentesis, Wo Imaging Guidance, Dx Or Therapeutic",,49082,CPT,Facility,Both,,,,1016,863.6,291.1856,1016,UnitedHealthcare,Individual & Family,955.04,94,,percent of total billed charges,,
"Abdominal Paracentesis, Wo Imaging Guidance, Dx Or Therapeutic",,49082,CPT,Facility,Outpatient,,,,1016,863.6,291.1856,1016,UnitedHealthcare,Medicare Advantage,497.84,49,,percent of total billed charges,,
"Abdominal Paracentesis, Wo Imaging Guidance, Dx Or Therapeutic",,49082,CPT,Facility,Inpatient,,,,1016,863.6,291.1856,1016,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Abdominal Paracentesis, Wo Imaging Guidance, Dx Or Therapeutic",,49082,CPT,Facility,Outpatient,,,,1016,863.6,291.1856,1016,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,487.68,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Abdominal Paracentesis, Wo Imaging Guidance, Dx Or Therapeutic",,49082,CPT,Facility,Inpatient,,,,1016,863.6,291.1856,1016,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Abdominal Paracentesis (Diag Or Therapeutic) W Imaging Guidance (Pro Cah),,49083,CPT,Professional,Both,,,,816,693.6,65.45,816,Aetna,Commercial,693.6,85,,percent of total billed charges,,
Abdominal Paracentesis (Diag Or Therapeutic) W Imaging Guidance (Pro Cah),,49083,CPT,Professional,Both,,,,816,693.6,65.45,816,Aetna,Medicare Advantage,104.05,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Abdominal Paracentesis (Diag Or Therapeutic) W Imaging Guidance (Pro Cah),,49083,CPT,Professional,Both,,,,816,693.6,65.45,816,Aetna,PPO,758.88,93,,percent of total billed charges,,
Abdominal Paracentesis (Diag Or Therapeutic) W Imaging Guidance (Pro Cah),,49083,CPT,Professional,Both,,,,816,693.6,65.45,816,America's PPO,America's PPO,697.1904,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Abdominal Paracentesis (Diag Or Therapeutic) W Imaging Guidance (Pro Cah),,49083,CPT,Professional,Both,,,,816,693.6,65.45,816,BlueCross BlueShield Minnesota, Federal Employee Program,214.84,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Abdominal Paracentesis (Diag Or Therapeutic) W Imaging Guidance (Pro Cah),,49083,CPT,Professional,Both,,,,816,693.6,65.45,816,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,218.27744,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Abdominal Paracentesis (Diag Or Therapeutic) W Imaging Guidance (Pro Cah),,49083,CPT,Professional,Both,,,,816,693.6,65.45,816,BlueCross BlueShield Minnesota,High Value Network Plan,218.27744,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Abdominal Paracentesis (Diag Or Therapeutic) W Imaging Guidance (Pro Cah),,49083,CPT,Professional,Both,,,,816,693.6,65.45,816,BlueCross BlueShield Minnesota,Medicare Advantage,117.2885,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Abdominal Paracentesis (Diag Or Therapeutic) W Imaging Guidance (Pro Cah),,49083,CPT,Professional,Both,,,,816,693.6,65.45,816,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,218.27744,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Abdominal Paracentesis (Diag Or Therapeutic) W Imaging Guidance (Pro Cah),,49083,CPT,Professional,Both,,,,816,693.6,65.45,816,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,75.55992,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Abdominal Paracentesis (Diag Or Therapeutic) W Imaging Guidance (Pro Cah),,49083,CPT,Professional,Both,,,,816,693.6,65.45,816,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),117.2885,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Abdominal Paracentesis (Diag Or Therapeutic) W Imaging Guidance (Pro Cah),,49083,CPT,Professional,Both,,,,816,693.6,65.45,816,CorVel,Worker's Compensation,200.764413,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Abdominal Paracentesis (Diag Or Therapeutic) W Imaging Guidance (Pro Cah),,49083,CPT,Professional,Both,,,,816,693.6,65.45,816,First Health Group Corporation,First Health Network,791.52,97,,percent of total billed charges,,
Abdominal Paracentesis (Diag Or Therapeutic) W Imaging Guidance (Pro Cah),,49083,CPT,Professional,Both,,,,816,693.6,65.45,816,"Health Partners, Inc.",Commercial,216.94,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Abdominal Paracentesis (Diag Or Therapeutic) W Imaging Guidance (Pro Cah),,49083,CPT,Professional,Both,,,,816,693.6,65.45,816,"Health Partners, Inc.",Medicare Advantage,117.2885,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Abdominal Paracentesis (Diag Or Therapeutic) W Imaging Guidance (Pro Cah),,49083,CPT,Professional,Both,,,,816,693.6,65.45,816,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),102,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Abdominal Paracentesis (Diag Or Therapeutic) W Imaging Guidance (Pro Cah),,49083,CPT,Professional,Both,,,,816,693.6,65.45,816,"Health Partners, Inc.",State of Minnesota Advantage Program,186.89381,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Abdominal Paracentesis (Diag Or Therapeutic) W Imaging Guidance (Pro Cah),,49083,CPT,Professional,Both,,,,816,693.6,65.45,816,"Health Partners, Inc.",State Public Programs,65.45,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Abdominal Paracentesis (Diag Or Therapeutic) W Imaging Guidance (Pro Cah),,49083,CPT,Professional,Both,,,,816,693.6,65.45,816,Humana Insurance Company,Commercial PPO,101.99,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Abdominal Paracentesis (Diag Or Therapeutic) W Imaging Guidance (Pro Cah),,49083,CPT,Professional,Both,,,,816,693.6,65.45,816,Humana Insurance Company,Medicare PPO,816,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Abdominal Paracentesis (Diag Or Therapeutic) W Imaging Guidance (Pro Cah),,49083,CPT,Professional,Both,,,,816,693.6,65.45,816,Medica,Individual & Family,691.968,84.8,,percent of total billed charges,,
Abdominal Paracentesis (Diag Or Therapeutic) W Imaging Guidance (Pro Cah),,49083,CPT,Professional,Both,,,,816,693.6,65.45,816,Medica,Medica Advantage Solution,406.368,49.8,,percent of total billed charges,,
Abdominal Paracentesis (Diag Or Therapeutic) W Imaging Guidance (Pro Cah),,49083,CPT,Professional,Both,,,,816,693.6,65.45,816,Medica,Medical Assistance,75.56,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Abdominal Paracentesis (Diag Or Therapeutic) W Imaging Guidance (Pro Cah),,49083,CPT,Professional,Both,,,,816,693.6,65.45,816,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,101.99,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Abdominal Paracentesis (Diag Or Therapeutic) W Imaging Guidance (Pro Cah),,49083,CPT,Professional,Both,,,,816,693.6,65.45,816,"Multiplan, Inc.","Multiplan, Inc.",767.04,94,,percent of total billed charges,,
Abdominal Paracentesis (Diag Or Therapeutic) W Imaging Guidance (Pro Cah),,49083,CPT,Professional,Both,,,,816,693.6,65.45,816,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,735.216,90.1,,percent of total billed charges,,
Abdominal Paracentesis (Diag Or Therapeutic) W Imaging Guidance (Pro Cah),,49083,CPT,Professional,Both,,,,816,693.6,65.45,816,"Preferred One Administrative Services, INC.",PPO,804.576,98.6,,percent of total billed charges,,
Abdominal Paracentesis (Diag Or Therapeutic) W Imaging Guidance (Pro Cah),,49083,CPT,Professional,Both,,,,816,693.6,65.45,816,PrimeWest Health,Minnesota Senior Health Options (MSHO),117.2885,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Abdominal Paracentesis (Diag Or Therapeutic) W Imaging Guidance (Pro Cah),,49083,CPT,Professional,Both,,,,816,693.6,65.45,816,PrimeWest Health,MinnesotaCare,80.8491144,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Abdominal Paracentesis (Diag Or Therapeutic) W Imaging Guidance (Pro Cah),,49083,CPT,Professional,Both,,,,816,693.6,65.45,816,Sanford Health Plan,Sanford Health Plan,718.08,88,,percent of total billed charges,,
Abdominal Paracentesis (Diag Or Therapeutic) W Imaging Guidance (Pro Cah),,49083,CPT,Professional,Both,,,,816,693.6,65.45,816,"UCare Health, Inc.",Individual & Family Plan,165.794944,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Abdominal Paracentesis (Diag Or Therapeutic) W Imaging Guidance (Pro Cah),,49083,CPT,Professional,Both,,,,816,693.6,65.45,816,"UCare Health, Inc.",Medical Assistance,83.115912,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Abdominal Paracentesis (Diag Or Therapeutic) W Imaging Guidance (Pro Cah),,49083,CPT,Professional,Both,,,,816,693.6,65.45,816,"UCare Health, Inc.",Medicare Advantage,117.2885,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Abdominal Paracentesis (Diag Or Therapeutic) W Imaging Guidance (Pro Cah),,49083,CPT,Professional,Both,,,,816,693.6,65.45,816,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),93.8308,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Abdominal Paracentesis (Diag Or Therapeutic) W Imaging Guidance (Pro Cah),,49083,CPT,Professional,Both,,,,816,693.6,65.45,816,UnitedHealthcare,Individual & Family,816,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Abdominal Paracentesis (Diag Or Therapeutic) W Imaging Guidance (Pro Cah),,49083,CPT,Professional,Both,,,,816,693.6,65.45,816,UnitedHealthcare,Medicare Advantage,117.2885,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Abdominal Paracentesis (Diag Or Therapeutic) W Imaging Guidance (Pro Cah),,49083,CPT,Professional,Both,,,,816,693.6,65.45,816,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,75.55992,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Abdominal Paracentesis (Diagnostic Or Therapeutic); With Imaging Guidance (Pbb),,49083,CPT,Facility,Outpatient,,,,306,260.1,87.6996,306,Aetna,Commercial,281.52,92,,percent of total billed charges,,
Abdominal Paracentesis (Diagnostic Or Therapeutic); With Imaging Guidance (Pbb),,49083,CPT,Facility,Outpatient,,,,306,260.1,87.6996,306,Aetna,Medicare Advantage,149.94,49,,percent of total billed charges,,
Abdominal Paracentesis (Diagnostic Or Therapeutic); With Imaging Guidance (Pbb),,49083,CPT,Facility,Outpatient,,,,306,260.1,87.6996,306,Aetna,PPO,284.58,93,,percent of total billed charges,,
Abdominal Paracentesis (Diagnostic Or Therapeutic); With Imaging Guidance (Pbb),,49083,CPT,Facility,Outpatient,,,,306,260.1,87.6996,306,America's PPO,America's PPO,293.8518,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Abdominal Paracentesis (Diagnostic Or Therapeutic); With Imaging Guidance (Pbb),,49083,CPT,Facility,Outpatient,,,,306,260.1,87.6996,306,BlueCross BlueShield Minnesota, Federal Employee Program,301.104,98.4,,percent of total billed charges,,
Abdominal Paracentesis (Diagnostic Or Therapeutic); With Imaging Guidance (Pbb),,49083,CPT,Facility,Outpatient,,,,306,260.1,87.6996,306,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,306,100,,percent of total billed charges,,
Abdominal Paracentesis (Diagnostic Or Therapeutic); With Imaging Guidance (Pbb),,49083,CPT,Facility,Outpatient,,,,306,260.1,87.6996,306,BlueCross BlueShield Minnesota,High Value Network Plan,275.4,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
Abdominal Paracentesis (Diagnostic Or Therapeutic); With Imaging Guidance (Pbb),,49083,CPT,Facility,Outpatient,,,,306,260.1,87.6996,306,BlueCross BlueShield Minnesota,Medicare Advantage,149.94,49,,percent of total billed charges,,
Abdominal Paracentesis (Diagnostic Or Therapeutic); With Imaging Guidance (Pbb),,49083,CPT,Facility,Outpatient,,,,306,260.1,87.6996,306,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,87.6996,28.66,,percent of total billed charges,,
Abdominal Paracentesis (Diagnostic Or Therapeutic); With Imaging Guidance (Pbb),,49083,CPT,Facility,Outpatient,,,,306,260.1,87.6996,306,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),149.94,49,,percent of total billed charges,,
Abdominal Paracentesis (Diagnostic Or Therapeutic); With Imaging Guidance (Pbb),,49083,CPT,Facility,Outpatient,,,,306,260.1,87.6996,306,CorVel,Worker's Compensation,306,100,,percent of total billed charges,,
Abdominal Paracentesis (Diagnostic Or Therapeutic); With Imaging Guidance (Pbb),,49083,CPT,Facility,Outpatient,,,,306,260.1,87.6996,306,First Health Group Corporation,First Health Network,296.82,97,,percent of total billed charges,,
Abdominal Paracentesis (Diagnostic Or Therapeutic); With Imaging Guidance (Pbb),,49083,CPT,Facility,Outpatient,,,,306,260.1,87.6996,306,"Health Partners, Inc.",Commercial,289.476,94.6,,percent of total billed charges,,
Abdominal Paracentesis (Diagnostic Or Therapeutic); With Imaging Guidance (Pbb),,49083,CPT,Facility,Outpatient,,,,306,260.1,87.6996,306,"Health Partners, Inc.",Medicare Advantage,149.94,49,,percent of total billed charges,,
Abdominal Paracentesis (Diagnostic Or Therapeutic); With Imaging Guidance (Pbb),,49083,CPT,Facility,Outpatient,,,,306,260.1,87.6996,306,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),183.6,60,,percent of total billed charges,,
Abdominal Paracentesis (Diagnostic Or Therapeutic); With Imaging Guidance (Pbb),,49083,CPT,Facility,Outpatient,,,,306,260.1,87.6996,306,"Health Partners, Inc.",State of Minnesota Advantage Program,249.39,81.5,,percent of total billed charges,,
Abdominal Paracentesis (Diagnostic Or Therapeutic); With Imaging Guidance (Pbb),,49083,CPT,Facility,Outpatient,,,,306,260.1,87.6996,306,"Health Partners, Inc.",State Public Programs,153,50,,percent of total billed charges,,
Abdominal Paracentesis (Diagnostic Or Therapeutic); With Imaging Guidance (Pbb),,49083,CPT,Facility,Outpatient,,,,306,260.1,87.6996,306,Humana Insurance Company,Commercial PPO,290.7,95,,percent of total billed charges,,
Abdominal Paracentesis (Diagnostic Or Therapeutic); With Imaging Guidance (Pbb),,49083,CPT,Facility,Outpatient,,,,306,260.1,87.6996,306,Humana Insurance Company,Medicare PPO,149.94,49,,percent of total billed charges,,
Abdominal Paracentesis (Diagnostic Or Therapeutic); With Imaging Guidance (Pbb),,49083,CPT,Facility,Outpatient,,,,306,260.1,87.6996,306,Medica,Individual & Family,303.246,99.1,,percent of total billed charges,,
Abdominal Paracentesis (Diagnostic Or Therapeutic); With Imaging Guidance (Pbb),,49083,CPT,Facility,Outpatient,,,,306,260.1,87.6996,306,Medica,Medica Advantage Solution,152.388,49.8,,percent of total billed charges,,
Abdominal Paracentesis (Diagnostic Or Therapeutic); With Imaging Guidance (Pbb),,49083,CPT,Facility,Outpatient,,,,306,260.1,87.6996,306,Medica,Medical Assistance,136.476,44.6,,percent of total billed charges,,
Abdominal Paracentesis (Diagnostic Or Therapeutic); With Imaging Guidance (Pbb),,49083,CPT,Facility,Outpatient,,,,306,260.1,87.6996,306,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,152.388,49.8,,percent of total billed charges,,
Abdominal Paracentesis (Diagnostic Or Therapeutic); With Imaging Guidance (Pbb),,49083,CPT,Facility,Outpatient,,,,306,260.1,87.6996,306,"Multiplan, Inc.","Multiplan, Inc.",287.64,94,,percent of total billed charges,,
Abdominal Paracentesis (Diagnostic Or Therapeutic); With Imaging Guidance (Pbb),,49083,CPT,Facility,Outpatient,,,,306,260.1,87.6996,306,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,275.706,90.1,,percent of total billed charges,,
Abdominal Paracentesis (Diagnostic Or Therapeutic); With Imaging Guidance (Pbb),,49083,CPT,Facility,Outpatient,,,,306,260.1,87.6996,306,"Preferred One Administrative Services, INC.",PPO,301.716,98.6,,percent of total billed charges,,
Abdominal Paracentesis (Diagnostic Or Therapeutic); With Imaging Guidance (Pbb),,49083,CPT,Facility,Outpatient,,,,306,260.1,87.6996,306,PrimeWest Health,Minnesota Senior Health Options (MSHO),157.437,51.45,,percent of total billed charges,,
Abdominal Paracentesis (Diagnostic Or Therapeutic); With Imaging Guidance (Pbb),,49083,CPT,Facility,Outpatient,,,,306,260.1,87.6996,306,PrimeWest Health,MinnesotaCare,157.1616,51.36,,percent of total billed charges,,
Abdominal Paracentesis (Diagnostic Or Therapeutic); With Imaging Guidance (Pbb),,49083,CPT,Facility,Outpatient,,,,306,260.1,87.6996,306,Sanford Health Plan,Sanford Health Plan,281.52,92,,percent of total billed charges,,
Abdominal Paracentesis (Diagnostic Or Therapeutic); With Imaging Guidance (Pbb),,49083,CPT,Facility,Outpatient,,,,306,260.1,87.6996,306,"UCare Health, Inc.",Individual & Family Plan,172.431,56.35,,percent of total billed charges,,
Abdominal Paracentesis (Diagnostic Or Therapeutic); With Imaging Guidance (Pbb),,49083,CPT,Facility,Outpatient,,,,306,260.1,87.6996,306,"UCare Health, Inc.",Medical Assistance,154.4382,50.47,,percent of total billed charges,,
Abdominal Paracentesis (Diagnostic Or Therapeutic); With Imaging Guidance (Pbb),,49083,CPT,Facility,Outpatient,,,,306,260.1,87.6996,306,"UCare Health, Inc.",Medicare Advantage,154.4382,50.47,,percent of total billed charges,,
Abdominal Paracentesis (Diagnostic Or Therapeutic); With Imaging Guidance (Pbb),,49083,CPT,Facility,Outpatient,,,,306,260.1,87.6996,306,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),154.4382,50.47,,percent of total billed charges,,
Abdominal Paracentesis (Diagnostic Or Therapeutic); With Imaging Guidance (Pbb),,49083,CPT,Facility,Outpatient,,,,306,260.1,87.6996,306,UnitedHealthcare,Individual & Family,287.64,94,,percent of total billed charges,,
Abdominal Paracentesis (Diagnostic Or Therapeutic); With Imaging Guidance (Pbb),,49083,CPT,Facility,Outpatient,,,,306,260.1,87.6996,306,UnitedHealthcare,Medicare Advantage,149.94,49,,percent of total billed charges,,
Abdominal Paracentesis (Diagnostic Or Therapeutic); With Imaging Guidance (Pbb),,49083,CPT,Facility,Outpatient,,,,306,260.1,87.6996,306,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,146.88,48,,percent of total billed charges,,100% of DHS outpatient percentage
Us Guide Paracentesis Abdomen,,49083,CPT,Facility,Both,,,,1685,1432.25,482.921,1685,Aetna,Commercial,1550.2,92,,percent of total billed charges,,
Us Guide Paracentesis Abdomen,,49083,CPT,Facility,Outpatient,,,,1685,1432.25,482.921,1685,Aetna,Medicare Advantage,825.65,49,,percent of total billed charges,,
Us Guide Paracentesis Abdomen,,49083,CPT,Facility,Inpatient,,,,1685,1432.25,482.921,1685,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Us Guide Paracentesis Abdomen,,49083,CPT,Facility,Both,,,,1685,1432.25,482.921,1685,Aetna,PPO,1567.05,93,,percent of total billed charges,,
Us Guide Paracentesis Abdomen,,49083,CPT,Facility,Both,,,,1685,1432.25,482.921,1685,America's PPO,America's PPO,1618.1055,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Us Guide Paracentesis Abdomen,,49083,CPT,Facility,Both,,,,1685,1432.25,482.921,1685,BlueCross BlueShield Minnesota, Federal Employee Program,1658.04,98.4,,percent of total billed charges,,
Us Guide Paracentesis Abdomen,,49083,CPT,Facility,Both,,,,1685,1432.25,482.921,1685,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1685,100,,percent of total billed charges,,
Us Guide Paracentesis Abdomen,,49083,CPT,Facility,Both,,,,1685,1432.25,482.921,1685,BlueCross BlueShield Minnesota,High Value Network Plan,1516.5,90,,percent of total billed charges,,
Us Guide Paracentesis Abdomen,,49083,CPT,Facility,Outpatient,,,,1685,1432.25,482.921,1685,BlueCross BlueShield Minnesota,Medicare Advantage,825.65,49,,percent of total billed charges,,
Us Guide Paracentesis Abdomen,,49083,CPT,Facility,Inpatient,,,,1685,1432.25,482.921,1685,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Us Guide Paracentesis Abdomen,,49083,CPT,Facility,Both,,,,1685,1432.25,482.921,1685,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1492.4045,88.57,,percent of total billed charges,,
Us Guide Paracentesis Abdomen,,49083,CPT,Facility,Both,,,,1685,1432.25,482.921,1685,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,482.921,28.66,,percent of total billed charges,,
Us Guide Paracentesis Abdomen,,49083,CPT,Facility,Outpatient,,,,1685,1432.25,482.921,1685,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),825.65,49,,percent of total billed charges,,
Us Guide Paracentesis Abdomen,,49083,CPT,Facility,Inpatient,,,,1685,1432.25,482.921,1685,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Us Guide Paracentesis Abdomen,,49083,CPT,Facility,Both,,,,1685,1432.25,482.921,1685,CorVel,Worker's Compensation,1685,100,,percent of total billed charges,,
Us Guide Paracentesis Abdomen,,49083,CPT,Facility,Both,,,,1685,1432.25,482.921,1685,First Health Group Corporation,First Health Network,1634.45,97,,percent of total billed charges,,
Us Guide Paracentesis Abdomen,,49083,CPT,Facility,Both,,,,1685,1432.25,482.921,1685,"Health Partners, Inc.",Commercial,1594.01,94.6,,percent of total billed charges,,
Us Guide Paracentesis Abdomen,,49083,CPT,Facility,Outpatient,,,,1685,1432.25,482.921,1685,"Health Partners, Inc.",Medicare Advantage,825.65,49,,percent of total billed charges,,
Us Guide Paracentesis Abdomen,,49083,CPT,Facility,Inpatient,,,,1685,1432.25,482.921,1685,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Us Guide Paracentesis Abdomen,,49083,CPT,Facility,Both,,,,1685,1432.25,482.921,1685,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1011,60,,percent of total billed charges,,
Us Guide Paracentesis Abdomen,,49083,CPT,Facility,Both,,,,1685,1432.25,482.921,1685,"Health Partners, Inc.",State of Minnesota Advantage Program,1373.275,81.5,,percent of total billed charges,,
Us Guide Paracentesis Abdomen,,49083,CPT,Facility,Both,,,,1685,1432.25,482.921,1685,"Health Partners, Inc.",State Public Programs,842.5,50,,percent of total billed charges,,
Us Guide Paracentesis Abdomen,,49083,CPT,Facility,Both,,,,1685,1432.25,482.921,1685,Humana Insurance Company,Commercial PPO,1600.75,95,,percent of total billed charges,,
Us Guide Paracentesis Abdomen,,49083,CPT,Facility,Outpatient,,,,1685,1432.25,482.921,1685,Humana Insurance Company,Medicare PPO,825.65,49,,percent of total billed charges,,
Us Guide Paracentesis Abdomen,,49083,CPT,Facility,Inpatient,,,,1685,1432.25,482.921,1685,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Us Guide Paracentesis Abdomen,,49083,CPT,Facility,Both,,,,1685,1432.25,482.921,1685,Medica,Individual & Family,1669.835,99.1,,percent of total billed charges,,
Us Guide Paracentesis Abdomen,,49083,CPT,Facility,Outpatient,,,,1685,1432.25,482.921,1685,Medica,Medica Advantage Solution,839.13,49.8,,percent of total billed charges,,
Us Guide Paracentesis Abdomen,,49083,CPT,Facility,Inpatient,,,,1685,1432.25,482.921,1685,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Us Guide Paracentesis Abdomen,,49083,CPT,Facility,Outpatient,,,,1685,1432.25,482.921,1685,Medica,Medical Assistance,724,,,Other,Grouper,All inclusive per visit
Us Guide Paracentesis Abdomen,,49083,CPT,Facility,Inpatient,,,,1685,1432.25,482.921,1685,Medica,Medical Assistance,,,,,Included in per diem rate,
Us Guide Paracentesis Abdomen,,49083,CPT,Facility,Outpatient,,,,1685,1432.25,482.921,1685,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,839.13,49.8,,percent of total billed charges,,
Us Guide Paracentesis Abdomen,,49083,CPT,Facility,Inpatient,,,,1685,1432.25,482.921,1685,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Us Guide Paracentesis Abdomen,,49083,CPT,Facility,Both,,,,1685,1432.25,482.921,1685,"Multiplan, Inc.","Multiplan, Inc.",1583.9,94,,percent of total billed charges,,
Us Guide Paracentesis Abdomen,,49083,CPT,Facility,Outpatient,,,,1685,1432.25,482.921,1685,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1518.185,90.1,,percent of total billed charges,,
Us Guide Paracentesis Abdomen,,49083,CPT,Facility,Inpatient,,,,1685,1432.25,482.921,1685,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Us Guide Paracentesis Abdomen,,49083,CPT,Facility,Both,,,,1685,1432.25,482.921,1685,"Preferred One Administrative Services, INC.",PPO,1661.41,98.6,,percent of total billed charges,,
Us Guide Paracentesis Abdomen,,49083,CPT,Facility,Outpatient,,,,1685,1432.25,482.921,1685,PrimeWest Health,Minnesota Senior Health Options (MSHO),866.9325,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Us Guide Paracentesis Abdomen,,49083,CPT,Facility,Inpatient,,,,1685,1432.25,482.921,1685,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Us Guide Paracentesis Abdomen,,49083,CPT,Facility,Outpatient,,,,1685,1432.25,482.921,1685,PrimeWest Health,MinnesotaCare,865.416,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Us Guide Paracentesis Abdomen,,49083,CPT,Facility,Inpatient,,,,1685,1432.25,482.921,1685,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Us Guide Paracentesis Abdomen,,49083,CPT,Facility,Both,,,,1685,1432.25,482.921,1685,Sanford Health Plan,Sanford Health Plan,1550.2,92,,percent of total billed charges,,
Us Guide Paracentesis Abdomen,,49083,CPT,Facility,Outpatient,,,,1685,1432.25,482.921,1685,"UCare Health, Inc.",Individual & Family Plan,949.4975,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Us Guide Paracentesis Abdomen,,49083,CPT,Facility,Inpatient,,,,1685,1432.25,482.921,1685,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Us Guide Paracentesis Abdomen,,49083,CPT,Facility,Outpatient,,,,1685,1432.25,482.921,1685,"UCare Health, Inc.",Medical Assistance,850.4195,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Guide Paracentesis Abdomen,,49083,CPT,Facility,Inpatient,,,,1685,1432.25,482.921,1685,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Us Guide Paracentesis Abdomen,,49083,CPT,Facility,Outpatient,,,,1685,1432.25,482.921,1685,"UCare Health, Inc.",Medicare Advantage,850.4195,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Guide Paracentesis Abdomen,,49083,CPT,Facility,Inpatient,,,,1685,1432.25,482.921,1685,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Us Guide Paracentesis Abdomen,,49083,CPT,Facility,Outpatient,,,,1685,1432.25,482.921,1685,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),850.4195,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Guide Paracentesis Abdomen,,49083,CPT,Facility,Inpatient,,,,1685,1432.25,482.921,1685,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Us Guide Paracentesis Abdomen,,49083,CPT,Facility,Both,,,,1685,1432.25,482.921,1685,UnitedHealthcare,Individual & Family,1583.9,94,,percent of total billed charges,,
Us Guide Paracentesis Abdomen,,49083,CPT,Facility,Outpatient,,,,1685,1432.25,482.921,1685,UnitedHealthcare,Medicare Advantage,825.65,49,,percent of total billed charges,,
Us Guide Paracentesis Abdomen,,49083,CPT,Facility,Inpatient,,,,1685,1432.25,482.921,1685,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Us Guide Paracentesis Abdomen,,49083,CPT,Facility,Outpatient,,,,1685,1432.25,482.921,1685,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,808.8,48,,percent of total billed charges,,100% of DHS outpatient percentage
Us Guide Paracentesis Abdomen,,49083,CPT,Facility,Inpatient,,,,1685,1432.25,482.921,1685,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Omentectomy, Epiploectomy, Resection Of Omentum (Separate Procedure) (Pro Cah)",,49255,CPT,Professional,Both,,,,2040,1734,480.81,2040,Aetna,Commercial,1734,85,,percent of total billed charges,,
"Omentectomy, Epiploectomy, Resection Of Omentum (Separate Procedure) (Pro Cah)",,49255,CPT,Professional,Both,,,,2040,1734,480.81,2040,Aetna,Medicare Advantage,757.88,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Omentectomy, Epiploectomy, Resection Of Omentum (Separate Procedure) (Pro Cah)",,49255,CPT,Professional,Both,,,,2040,1734,480.81,2040,Aetna,PPO,1897.2,93,,percent of total billed charges,,
"Omentectomy, Epiploectomy, Resection Of Omentum (Separate Procedure) (Pro Cah)",,49255,CPT,Professional,Both,,,,2040,1734,480.81,2040,America's PPO,America's PPO,1742.976,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Omentectomy, Epiploectomy, Resection Of Omentum (Separate Procedure) (Pro Cah)",,49255,CPT,Professional,Both,,,,2040,1734,480.81,2040,BlueCross BlueShield Minnesota, Federal Employee Program,1631.29,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Omentectomy, Epiploectomy, Resection Of Omentum (Separate Procedure) (Pro Cah)",,49255,CPT,Professional,Both,,,,2040,1734,480.81,2040,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1657.39064,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Omentectomy, Epiploectomy, Resection Of Omentum (Separate Procedure) (Pro Cah)",,49255,CPT,Professional,Both,,,,2040,1734,480.81,2040,BlueCross BlueShield Minnesota,High Value Network Plan,1657.39064,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Omentectomy, Epiploectomy, Resection Of Omentum (Separate Procedure) (Pro Cah)",,49255,CPT,Professional,Both,,,,2040,1734,480.81,2040,BlueCross BlueShield Minnesota,Medicare Advantage,859.073,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Omentectomy, Epiploectomy, Resection Of Omentum (Separate Procedure) (Pro Cah)",,49255,CPT,Professional,Both,,,,2040,1734,480.81,2040,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1657.39064,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Omentectomy, Epiploectomy, Resection Of Omentum (Separate Procedure) (Pro Cah)",,49255,CPT,Professional,Both,,,,2040,1734,480.81,2040,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,555.11192,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Omentectomy, Epiploectomy, Resection Of Omentum (Separate Procedure) (Pro Cah)",,49255,CPT,Professional,Both,,,,2040,1734,480.81,2040,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),859.073,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Omentectomy, Epiploectomy, Resection Of Omentum (Separate Procedure) (Pro Cah)",,49255,CPT,Professional,Both,,,,2040,1734,480.81,2040,CorVel,Worker's Compensation,1471.278918,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Omentectomy, Epiploectomy, Resection Of Omentum (Separate Procedure) (Pro Cah)",,49255,CPT,Professional,Both,,,,2040,1734,480.81,2040,First Health Group Corporation,First Health Network,1978.8,97,,percent of total billed charges,,
"Omentectomy, Epiploectomy, Resection Of Omentum (Separate Procedure) (Pro Cah)",,49255,CPT,Professional,Both,,,,2040,1734,480.81,2040,"Health Partners, Inc.",Commercial,1589.62,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Omentectomy, Epiploectomy, Resection Of Omentum (Separate Procedure) (Pro Cah)",,49255,CPT,Professional,Both,,,,2040,1734,480.81,2040,"Health Partners, Inc.",Medicare Advantage,859.073,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Omentectomy, Epiploectomy, Resection Of Omentum (Separate Procedure) (Pro Cah)",,49255,CPT,Professional,Both,,,,2040,1734,480.81,2040,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),746.87,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Omentectomy, Epiploectomy, Resection Of Omentum (Separate Procedure) (Pro Cah)",,49255,CPT,Professional,Both,,,,2040,1734,480.81,2040,"Health Partners, Inc.",State of Minnesota Advantage Program,1369.45763,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Omentectomy, Epiploectomy, Resection Of Omentum (Separate Procedure) (Pro Cah)",,49255,CPT,Professional,Both,,,,2040,1734,480.81,2040,"Health Partners, Inc.",State Public Programs,480.81,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Omentectomy, Epiploectomy, Resection Of Omentum (Separate Procedure) (Pro Cah)",,49255,CPT,Professional,Both,,,,2040,1734,480.81,2040,Humana Insurance Company,Commercial PPO,747.02,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Omentectomy, Epiploectomy, Resection Of Omentum (Separate Procedure) (Pro Cah)",,49255,CPT,Professional,Both,,,,2040,1734,480.81,2040,Humana Insurance Company,Medicare PPO,2040,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Omentectomy, Epiploectomy, Resection Of Omentum (Separate Procedure) (Pro Cah)",,49255,CPT,Professional,Both,,,,2040,1734,480.81,2040,Medica,Individual & Family,1729.92,84.8,,percent of total billed charges,,
"Omentectomy, Epiploectomy, Resection Of Omentum (Separate Procedure) (Pro Cah)",,49255,CPT,Professional,Both,,,,2040,1734,480.81,2040,Medica,Medica Advantage Solution,1015.92,49.8,,percent of total billed charges,,
"Omentectomy, Epiploectomy, Resection Of Omentum (Separate Procedure) (Pro Cah)",,49255,CPT,Professional,Both,,,,2040,1734,480.81,2040,Medica,Medical Assistance,555.11,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Omentectomy, Epiploectomy, Resection Of Omentum (Separate Procedure) (Pro Cah)",,49255,CPT,Professional,Both,,,,2040,1734,480.81,2040,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,747.02,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Omentectomy, Epiploectomy, Resection Of Omentum (Separate Procedure) (Pro Cah)",,49255,CPT,Professional,Both,,,,2040,1734,480.81,2040,"Multiplan, Inc.","Multiplan, Inc.",1917.6,94,,percent of total billed charges,,
"Omentectomy, Epiploectomy, Resection Of Omentum (Separate Procedure) (Pro Cah)",,49255,CPT,Professional,Both,,,,2040,1734,480.81,2040,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1838.04,90.1,,percent of total billed charges,,
"Omentectomy, Epiploectomy, Resection Of Omentum (Separate Procedure) (Pro Cah)",,49255,CPT,Professional,Both,,,,2040,1734,480.81,2040,"Preferred One Administrative Services, INC.",PPO,2011.44,98.6,,percent of total billed charges,,
"Omentectomy, Epiploectomy, Resection Of Omentum (Separate Procedure) (Pro Cah)",,49255,CPT,Professional,Both,,,,2040,1734,480.81,2040,PrimeWest Health,Minnesota Senior Health Options (MSHO),859.073,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Omentectomy, Epiploectomy, Resection Of Omentum (Separate Procedure) (Pro Cah)",,49255,CPT,Professional,Both,,,,2040,1734,480.81,2040,PrimeWest Health,MinnesotaCare,593.9697544,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Omentectomy, Epiploectomy, Resection Of Omentum (Separate Procedure) (Pro Cah)",,49255,CPT,Professional,Both,,,,2040,1734,480.81,2040,Sanford Health Plan,Sanford Health Plan,1795.2,88,,percent of total billed charges,,
"Omentectomy, Epiploectomy, Resection Of Omentum (Separate Procedure) (Pro Cah)",,49255,CPT,Professional,Both,,,,2040,1734,480.81,2040,"UCare Health, Inc.",Individual & Family Plan,1214.355712,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Omentectomy, Epiploectomy, Resection Of Omentum (Separate Procedure) (Pro Cah)",,49255,CPT,Professional,Both,,,,2040,1734,480.81,2040,"UCare Health, Inc.",Medical Assistance,610.623112,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Omentectomy, Epiploectomy, Resection Of Omentum (Separate Procedure) (Pro Cah)",,49255,CPT,Professional,Both,,,,2040,1734,480.81,2040,"UCare Health, Inc.",Medicare Advantage,859.073,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Omentectomy, Epiploectomy, Resection Of Omentum (Separate Procedure) (Pro Cah)",,49255,CPT,Professional,Both,,,,2040,1734,480.81,2040,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),687.2584,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Omentectomy, Epiploectomy, Resection Of Omentum (Separate Procedure) (Pro Cah)",,49255,CPT,Professional,Both,,,,2040,1734,480.81,2040,UnitedHealthcare,Individual & Family,2040,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Omentectomy, Epiploectomy, Resection Of Omentum (Separate Procedure) (Pro Cah)",,49255,CPT,Professional,Both,,,,2040,1734,480.81,2040,UnitedHealthcare,Medicare Advantage,859.073,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Omentectomy, Epiploectomy, Resection Of Omentum (Separate Procedure) (Pro Cah)",,49255,CPT,Professional,Both,,,,2040,1734,480.81,2040,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,555.11192,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Laparoscopy, Surgical; With Aspiration Of Cavity Or Cyst (Single Or Multiple) (Pro Cah)",,49322,CPT,Professional,Both,,,,2076,1764.6,226.44,2076,Aetna,Commercial,1764.6,85,,percent of total billed charges,,
"Laparoscopy, Surgical; With Aspiration Of Cavity Or Cyst (Single Or Multiple) (Pro Cah)",,49322,CPT,Professional,Both,,,,2076,1764.6,226.44,2076,Aetna,Medicare Advantage,358.06,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Laparoscopy, Surgical; With Aspiration Of Cavity Or Cyst (Single Or Multiple) (Pro Cah)",,49322,CPT,Professional,Both,,,,2076,1764.6,226.44,2076,Aetna,PPO,1930.68,93,,percent of total billed charges,,
"Laparoscopy, Surgical; With Aspiration Of Cavity Or Cyst (Single Or Multiple) (Pro Cah)",,49322,CPT,Professional,Both,,,,2076,1764.6,226.44,2076,America's PPO,America's PPO,1773.7344,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Laparoscopy, Surgical; With Aspiration Of Cavity Or Cyst (Single Or Multiple) (Pro Cah)",,49322,CPT,Professional,Both,,,,2076,1764.6,226.44,2076,BlueCross BlueShield Minnesota, Federal Employee Program,773.3,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Laparoscopy, Surgical; With Aspiration Of Cavity Or Cyst (Single Or Multiple) (Pro Cah)",,49322,CPT,Professional,Both,,,,2076,1764.6,226.44,2076,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,785.6728,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Laparoscopy, Surgical; With Aspiration Of Cavity Or Cyst (Single Or Multiple) (Pro Cah)",,49322,CPT,Professional,Both,,,,2076,1764.6,226.44,2076,BlueCross BlueShield Minnesota,High Value Network Plan,785.6728,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Laparoscopy, Surgical; With Aspiration Of Cavity Or Cyst (Single Or Multiple) (Pro Cah)",,49322,CPT,Professional,Both,,,,2076,1764.6,226.44,2076,BlueCross BlueShield Minnesota,Medicare Advantage,404.777,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Laparoscopy, Surgical; With Aspiration Of Cavity Or Cyst (Single Or Multiple) (Pro Cah)",,49322,CPT,Professional,Both,,,,2076,1764.6,226.44,2076,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,785.6728,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Laparoscopy, Surgical; With Aspiration Of Cavity Or Cyst (Single Or Multiple) (Pro Cah)",,49322,CPT,Professional,Both,,,,2076,1764.6,226.44,2076,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,261.43712,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Laparoscopy, Surgical; With Aspiration Of Cavity Or Cyst (Single Or Multiple) (Pro Cah)",,49322,CPT,Professional,Both,,,,2076,1764.6,226.44,2076,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),404.777,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Laparoscopy, Surgical; With Aspiration Of Cavity Or Cyst (Single Or Multiple) (Pro Cah)",,49322,CPT,Professional,Both,,,,2076,1764.6,226.44,2076,CorVel,Worker's Compensation,694.7399817,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Laparoscopy, Surgical; With Aspiration Of Cavity Or Cyst (Single Or Multiple) (Pro Cah)",,49322,CPT,Professional,Both,,,,2076,1764.6,226.44,2076,First Health Group Corporation,First Health Network,2013.72,97,,percent of total billed charges,,
"Laparoscopy, Surgical; With Aspiration Of Cavity Or Cyst (Single Or Multiple) (Pro Cah)",,49322,CPT,Professional,Both,,,,2076,1764.6,226.44,2076,"Health Partners, Inc.",Commercial,750.19,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Laparoscopy, Surgical; With Aspiration Of Cavity Or Cyst (Single Or Multiple) (Pro Cah)",,49322,CPT,Professional,Both,,,,2076,1764.6,226.44,2076,"Health Partners, Inc.",Medicare Advantage,404.777,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Laparoscopy, Surgical; With Aspiration Of Cavity Or Cyst (Single Or Multiple) (Pro Cah)",,49322,CPT,Professional,Both,,,,2076,1764.6,226.44,2076,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),351.75,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Laparoscopy, Surgical; With Aspiration Of Cavity Or Cyst (Single Or Multiple) (Pro Cah)",,49322,CPT,Professional,Both,,,,2076,1764.6,226.44,2076,"Health Partners, Inc.",State of Minnesota Advantage Program,646.288685,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Laparoscopy, Surgical; With Aspiration Of Cavity Or Cyst (Single Or Multiple) (Pro Cah)",,49322,CPT,Professional,Both,,,,2076,1764.6,226.44,2076,"Health Partners, Inc.",State Public Programs,226.44,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Laparoscopy, Surgical; With Aspiration Of Cavity Or Cyst (Single Or Multiple) (Pro Cah)",,49322,CPT,Professional,Both,,,,2076,1764.6,226.44,2076,Humana Insurance Company,Commercial PPO,351.98,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Laparoscopy, Surgical; With Aspiration Of Cavity Or Cyst (Single Or Multiple) (Pro Cah)",,49322,CPT,Professional,Both,,,,2076,1764.6,226.44,2076,Humana Insurance Company,Medicare PPO,2076,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Laparoscopy, Surgical; With Aspiration Of Cavity Or Cyst (Single Or Multiple) (Pro Cah)",,49322,CPT,Professional,Both,,,,2076,1764.6,226.44,2076,Medica,Individual & Family,1760.448,84.8,,percent of total billed charges,,
"Laparoscopy, Surgical; With Aspiration Of Cavity Or Cyst (Single Or Multiple) (Pro Cah)",,49322,CPT,Professional,Both,,,,2076,1764.6,226.44,2076,Medica,Medica Advantage Solution,1033.848,49.8,,percent of total billed charges,,
"Laparoscopy, Surgical; With Aspiration Of Cavity Or Cyst (Single Or Multiple) (Pro Cah)",,49322,CPT,Professional,Both,,,,2076,1764.6,226.44,2076,Medica,Medical Assistance,261.44,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Laparoscopy, Surgical; With Aspiration Of Cavity Or Cyst (Single Or Multiple) (Pro Cah)",,49322,CPT,Professional,Both,,,,2076,1764.6,226.44,2076,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,351.98,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Laparoscopy, Surgical; With Aspiration Of Cavity Or Cyst (Single Or Multiple) (Pro Cah)",,49322,CPT,Professional,Both,,,,2076,1764.6,226.44,2076,"Multiplan, Inc.","Multiplan, Inc.",1951.44,94,,percent of total billed charges,,
"Laparoscopy, Surgical; With Aspiration Of Cavity Or Cyst (Single Or Multiple) (Pro Cah)",,49322,CPT,Professional,Both,,,,2076,1764.6,226.44,2076,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1870.476,90.1,,percent of total billed charges,,
"Laparoscopy, Surgical; With Aspiration Of Cavity Or Cyst (Single Or Multiple) (Pro Cah)",,49322,CPT,Professional,Both,,,,2076,1764.6,226.44,2076,"Preferred One Administrative Services, INC.",PPO,2046.936,98.6,,percent of total billed charges,,
"Laparoscopy, Surgical; With Aspiration Of Cavity Or Cyst (Single Or Multiple) (Pro Cah)",,49322,CPT,Professional,Both,,,,2076,1764.6,226.44,2076,PrimeWest Health,Minnesota Senior Health Options (MSHO),404.777,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Laparoscopy, Surgical; With Aspiration Of Cavity Or Cyst (Single Or Multiple) (Pro Cah)",,49322,CPT,Professional,Both,,,,2076,1764.6,226.44,2076,PrimeWest Health,MinnesotaCare,279.7377184,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Laparoscopy, Surgical; With Aspiration Of Cavity Or Cyst (Single Or Multiple) (Pro Cah)",,49322,CPT,Professional,Both,,,,2076,1764.6,226.44,2076,Sanford Health Plan,Sanford Health Plan,1826.88,88,,percent of total billed charges,,
"Laparoscopy, Surgical; With Aspiration Of Cavity Or Cyst (Single Or Multiple) (Pro Cah)",,49322,CPT,Professional,Both,,,,2076,1764.6,226.44,2076,"UCare Health, Inc.",Individual & Family Plan,572.178688,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Laparoscopy, Surgical; With Aspiration Of Cavity Or Cyst (Single Or Multiple) (Pro Cah)",,49322,CPT,Professional,Both,,,,2076,1764.6,226.44,2076,"UCare Health, Inc.",Medical Assistance,287.580832,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Laparoscopy, Surgical; With Aspiration Of Cavity Or Cyst (Single Or Multiple) (Pro Cah)",,49322,CPT,Professional,Both,,,,2076,1764.6,226.44,2076,"UCare Health, Inc.",Medicare Advantage,404.777,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Laparoscopy, Surgical; With Aspiration Of Cavity Or Cyst (Single Or Multiple) (Pro Cah)",,49322,CPT,Professional,Both,,,,2076,1764.6,226.44,2076,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),323.8216,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Laparoscopy, Surgical; With Aspiration Of Cavity Or Cyst (Single Or Multiple) (Pro Cah)",,49322,CPT,Professional,Both,,,,2076,1764.6,226.44,2076,UnitedHealthcare,Individual & Family,2076,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Laparoscopy, Surgical; With Aspiration Of Cavity Or Cyst (Single Or Multiple) (Pro Cah)",,49322,CPT,Professional,Both,,,,2076,1764.6,226.44,2076,UnitedHealthcare,Medicare Advantage,404.777,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Laparoscopy, Surgical; With Aspiration Of Cavity Or Cyst (Single Or Multiple) (Pro Cah)",,49322,CPT,Professional,Both,,,,2076,1764.6,226.44,2076,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,261.43712,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Repair Initial Inguinal Hernia, Age 5 Years Or Older; Reducible (Pro Cah)",,49505,CPT,Professional,Both,,,,2299,1954.15,315.88,2299,Aetna,Commercial,1954.15,85,,percent of total billed charges,,
"Repair Initial Inguinal Hernia, Age 5 Years Or Older; Reducible (Pro Cah)",,49505,CPT,Professional,Both,,,,2299,1954.15,315.88,2299,Aetna,Medicare Advantage,499.34,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair Initial Inguinal Hernia, Age 5 Years Or Older; Reducible (Pro Cah)",,49505,CPT,Professional,Both,,,,2299,1954.15,315.88,2299,Aetna,PPO,2138.07,93,,percent of total billed charges,,
"Repair Initial Inguinal Hernia, Age 5 Years Or Older; Reducible (Pro Cah)",,49505,CPT,Professional,Both,,,,2299,1954.15,315.88,2299,America's PPO,America's PPO,1964.2656,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Repair Initial Inguinal Hernia, Age 5 Years Or Older; Reducible (Pro Cah)",,49505,CPT,Professional,Both,,,,2299,1954.15,315.88,2299,BlueCross BlueShield Minnesota, Federal Employee Program,1081.1,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Repair Initial Inguinal Hernia, Age 5 Years Or Older; Reducible (Pro Cah)",,49505,CPT,Professional,Both,,,,2299,1954.15,315.88,2299,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1098.3976,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Repair Initial Inguinal Hernia, Age 5 Years Or Older; Reducible (Pro Cah)",,49505,CPT,Professional,Both,,,,2299,1954.15,315.88,2299,BlueCross BlueShield Minnesota,High Value Network Plan,1098.3976,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Repair Initial Inguinal Hernia, Age 5 Years Or Older; Reducible (Pro Cah)",,49505,CPT,Professional,Both,,,,2299,1954.15,315.88,2299,BlueCross BlueShield Minnesota,Medicare Advantage,564.7535,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair Initial Inguinal Hernia, Age 5 Years Or Older; Reducible (Pro Cah)",,49505,CPT,Professional,Both,,,,2299,1954.15,315.88,2299,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1098.3976,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Repair Initial Inguinal Hernia, Age 5 Years Or Older; Reducible (Pro Cah)",,49505,CPT,Professional,Both,,,,2299,1954.15,315.88,2299,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,364.6932,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Repair Initial Inguinal Hernia, Age 5 Years Or Older; Reducible (Pro Cah)",,49505,CPT,Professional,Both,,,,2299,1954.15,315.88,2299,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),564.7535,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair Initial Inguinal Hernia, Age 5 Years Or Older; Reducible (Pro Cah)",,49505,CPT,Professional,Both,,,,2299,1954.15,315.88,2299,CorVel,Worker's Compensation,970.828161,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Repair Initial Inguinal Hernia, Age 5 Years Or Older; Reducible (Pro Cah)",,49505,CPT,Professional,Both,,,,2299,1954.15,315.88,2299,First Health Group Corporation,First Health Network,2230.03,97,,percent of total billed charges,,
"Repair Initial Inguinal Hernia, Age 5 Years Or Older; Reducible (Pro Cah)",,49505,CPT,Professional,Both,,,,2299,1954.15,315.88,2299,"Health Partners, Inc.",Commercial,1048.38,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Repair Initial Inguinal Hernia, Age 5 Years Or Older; Reducible (Pro Cah)",,49505,CPT,Professional,Both,,,,2299,1954.15,315.88,2299,"Health Partners, Inc.",Medicare Advantage,564.7535,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair Initial Inguinal Hernia, Age 5 Years Or Older; Reducible (Pro Cah)",,49505,CPT,Professional,Both,,,,2299,1954.15,315.88,2299,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),491.03,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Repair Initial Inguinal Hernia, Age 5 Years Or Older; Reducible (Pro Cah)",,49505,CPT,Professional,Both,,,,2299,1954.15,315.88,2299,"Health Partners, Inc.",State of Minnesota Advantage Program,903.17937,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Repair Initial Inguinal Hernia, Age 5 Years Or Older; Reducible (Pro Cah)",,49505,CPT,Professional,Both,,,,2299,1954.15,315.88,2299,"Health Partners, Inc.",State Public Programs,315.88,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Repair Initial Inguinal Hernia, Age 5 Years Or Older; Reducible (Pro Cah)",,49505,CPT,Professional,Both,,,,2299,1954.15,315.88,2299,Humana Insurance Company,Commercial PPO,491.09,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Repair Initial Inguinal Hernia, Age 5 Years Or Older; Reducible (Pro Cah)",,49505,CPT,Professional,Both,,,,2299,1954.15,315.88,2299,Humana Insurance Company,Medicare PPO,2299,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Repair Initial Inguinal Hernia, Age 5 Years Or Older; Reducible (Pro Cah)",,49505,CPT,Professional,Both,,,,2299,1954.15,315.88,2299,Medica,Individual & Family,1949.552,84.8,,percent of total billed charges,,
"Repair Initial Inguinal Hernia, Age 5 Years Or Older; Reducible (Pro Cah)",,49505,CPT,Professional,Both,,,,2299,1954.15,315.88,2299,Medica,Medica Advantage Solution,1144.902,49.8,,percent of total billed charges,,
"Repair Initial Inguinal Hernia, Age 5 Years Or Older; Reducible (Pro Cah)",,49505,CPT,Professional,Both,,,,2299,1954.15,315.88,2299,Medica,Medical Assistance,364.69,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Repair Initial Inguinal Hernia, Age 5 Years Or Older; Reducible (Pro Cah)",,49505,CPT,Professional,Both,,,,2299,1954.15,315.88,2299,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,491.09,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Repair Initial Inguinal Hernia, Age 5 Years Or Older; Reducible (Pro Cah)",,49505,CPT,Professional,Both,,,,2299,1954.15,315.88,2299,"Multiplan, Inc.","Multiplan, Inc.",2161.06,94,,percent of total billed charges,,
"Repair Initial Inguinal Hernia, Age 5 Years Or Older; Reducible (Pro Cah)",,49505,CPT,Professional,Both,,,,2299,1954.15,315.88,2299,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,2071.399,90.1,,percent of total billed charges,,
"Repair Initial Inguinal Hernia, Age 5 Years Or Older; Reducible (Pro Cah)",,49505,CPT,Professional,Both,,,,2299,1954.15,315.88,2299,"Preferred One Administrative Services, INC.",PPO,2266.814,98.6,,percent of total billed charges,,
"Repair Initial Inguinal Hernia, Age 5 Years Or Older; Reducible (Pro Cah)",,49505,CPT,Professional,Both,,,,2299,1954.15,315.88,2299,PrimeWest Health,Minnesota Senior Health Options (MSHO),564.7535,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair Initial Inguinal Hernia, Age 5 Years Or Older; Reducible (Pro Cah)",,49505,CPT,Professional,Both,,,,2299,1954.15,315.88,2299,PrimeWest Health,MinnesotaCare,390.221724,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Repair Initial Inguinal Hernia, Age 5 Years Or Older; Reducible (Pro Cah)",,49505,CPT,Professional,Both,,,,2299,1954.15,315.88,2299,Sanford Health Plan,Sanford Health Plan,2023.12,88,,percent of total billed charges,,
"Repair Initial Inguinal Hernia, Age 5 Years Or Older; Reducible (Pro Cah)",,49505,CPT,Professional,Both,,,,2299,1954.15,315.88,2299,"UCare Health, Inc.",Individual & Family Plan,798.315904,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Repair Initial Inguinal Hernia, Age 5 Years Or Older; Reducible (Pro Cah)",,49505,CPT,Professional,Both,,,,2299,1954.15,315.88,2299,"UCare Health, Inc.",Medical Assistance,401.16252,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Repair Initial Inguinal Hernia, Age 5 Years Or Older; Reducible (Pro Cah)",,49505,CPT,Professional,Both,,,,2299,1954.15,315.88,2299,"UCare Health, Inc.",Medicare Advantage,564.7535,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Repair Initial Inguinal Hernia, Age 5 Years Or Older; Reducible (Pro Cah)",,49505,CPT,Professional,Both,,,,2299,1954.15,315.88,2299,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),451.8028,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Repair Initial Inguinal Hernia, Age 5 Years Or Older; Reducible (Pro Cah)",,49505,CPT,Professional,Both,,,,2299,1954.15,315.88,2299,UnitedHealthcare,Individual & Family,2299,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Repair Initial Inguinal Hernia, Age 5 Years Or Older; Reducible (Pro Cah)",,49505,CPT,Professional,Both,,,,2299,1954.15,315.88,2299,UnitedHealthcare,Medicare Advantage,564.7535,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair Initial Inguinal Hernia, Age 5 Years Or Older; Reducible (Pro Cah)",,49505,CPT,Professional,Both,,,,2299,1954.15,315.88,2299,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,364.6932,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Repair Initial Inguinal Hernia, Age 5 Years Or Older; Incarcerated Or Strangulated (Pro Cah)",,49507,CPT,Professional,Both,,,,2438,2072.3,354.93,2438,Aetna,Commercial,2072.3,85,,percent of total billed charges,,
"Repair Initial Inguinal Hernia, Age 5 Years Or Older; Incarcerated Or Strangulated (Pro Cah)",,49507,CPT,Professional,Both,,,,2438,2072.3,354.93,2438,Aetna,Medicare Advantage,560.11,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair Initial Inguinal Hernia, Age 5 Years Or Older; Incarcerated Or Strangulated (Pro Cah)",,49507,CPT,Professional,Both,,,,2438,2072.3,354.93,2438,Aetna,PPO,2267.34,93,,percent of total billed charges,,
"Repair Initial Inguinal Hernia, Age 5 Years Or Older; Incarcerated Or Strangulated (Pro Cah)",,49507,CPT,Professional,Both,,,,2438,2072.3,354.93,2438,America's PPO,America's PPO,2083.0272,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Repair Initial Inguinal Hernia, Age 5 Years Or Older; Incarcerated Or Strangulated (Pro Cah)",,49507,CPT,Professional,Both,,,,2438,2072.3,354.93,2438,BlueCross BlueShield Minnesota, Federal Employee Program,1216.07,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Repair Initial Inguinal Hernia, Age 5 Years Or Older; Incarcerated Or Strangulated (Pro Cah)",,49507,CPT,Professional,Both,,,,2438,2072.3,354.93,2438,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1235.52712,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Repair Initial Inguinal Hernia, Age 5 Years Or Older; Incarcerated Or Strangulated (Pro Cah)",,49507,CPT,Professional,Both,,,,2438,2072.3,354.93,2438,BlueCross BlueShield Minnesota,High Value Network Plan,1235.52712,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Repair Initial Inguinal Hernia, Age 5 Years Or Older; Incarcerated Or Strangulated (Pro Cah)",,49507,CPT,Professional,Both,,,,2438,2072.3,354.93,2438,BlueCross BlueShield Minnesota,Medicare Advantage,634.064,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair Initial Inguinal Hernia, Age 5 Years Or Older; Incarcerated Or Strangulated (Pro Cah)",,49507,CPT,Professional,Both,,,,2438,2072.3,354.93,2438,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1235.52712,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Repair Initial Inguinal Hernia, Age 5 Years Or Older; Incarcerated Or Strangulated (Pro Cah)",,49507,CPT,Professional,Both,,,,2438,2072.3,354.93,2438,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,409.78328,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Repair Initial Inguinal Hernia, Age 5 Years Or Older; Incarcerated Or Strangulated (Pro Cah)",,49507,CPT,Professional,Both,,,,2438,2072.3,354.93,2438,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),634.064,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair Initial Inguinal Hernia, Age 5 Years Or Older; Incarcerated Or Strangulated (Pro Cah)",,49507,CPT,Professional,Both,,,,2438,2072.3,354.93,2438,CorVel,Worker's Compensation,1089.401347,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Repair Initial Inguinal Hernia, Age 5 Years Or Older; Incarcerated Or Strangulated (Pro Cah)",,49507,CPT,Professional,Both,,,,2438,2072.3,354.93,2438,First Health Group Corporation,First Health Network,2364.86,97,,percent of total billed charges,,
"Repair Initial Inguinal Hernia, Age 5 Years Or Older; Incarcerated Or Strangulated (Pro Cah)",,49507,CPT,Professional,Both,,,,2438,2072.3,354.93,2438,"Health Partners, Inc.",Commercial,1176.8,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Repair Initial Inguinal Hernia, Age 5 Years Or Older; Incarcerated Or Strangulated (Pro Cah)",,49507,CPT,Professional,Both,,,,2438,2072.3,354.93,2438,"Health Partners, Inc.",Medicare Advantage,634.064,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair Initial Inguinal Hernia, Age 5 Years Or Older; Incarcerated Or Strangulated (Pro Cah)",,49507,CPT,Professional,Both,,,,2438,2072.3,354.93,2438,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),551.34,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Repair Initial Inguinal Hernia, Age 5 Years Or Older; Incarcerated Or Strangulated (Pro Cah)",,49507,CPT,Professional,Both,,,,2438,2072.3,354.93,2438,"Health Partners, Inc.",State of Minnesota Advantage Program,1013.8132,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Repair Initial Inguinal Hernia, Age 5 Years Or Older; Incarcerated Or Strangulated (Pro Cah)",,49507,CPT,Professional,Both,,,,2438,2072.3,354.93,2438,"Health Partners, Inc.",State Public Programs,354.93,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Repair Initial Inguinal Hernia, Age 5 Years Or Older; Incarcerated Or Strangulated (Pro Cah)",,49507,CPT,Professional,Both,,,,2438,2072.3,354.93,2438,Humana Insurance Company,Commercial PPO,551.36,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Repair Initial Inguinal Hernia, Age 5 Years Or Older; Incarcerated Or Strangulated (Pro Cah)",,49507,CPT,Professional,Both,,,,2438,2072.3,354.93,2438,Humana Insurance Company,Medicare PPO,2438,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Repair Initial Inguinal Hernia, Age 5 Years Or Older; Incarcerated Or Strangulated (Pro Cah)",,49507,CPT,Professional,Both,,,,2438,2072.3,354.93,2438,Medica,Individual & Family,2067.424,84.8,,percent of total billed charges,,
"Repair Initial Inguinal Hernia, Age 5 Years Or Older; Incarcerated Or Strangulated (Pro Cah)",,49507,CPT,Professional,Both,,,,2438,2072.3,354.93,2438,Medica,Medica Advantage Solution,1214.124,49.8,,percent of total billed charges,,
"Repair Initial Inguinal Hernia, Age 5 Years Or Older; Incarcerated Or Strangulated (Pro Cah)",,49507,CPT,Professional,Both,,,,2438,2072.3,354.93,2438,Medica,Medical Assistance,409.78,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Repair Initial Inguinal Hernia, Age 5 Years Or Older; Incarcerated Or Strangulated (Pro Cah)",,49507,CPT,Professional,Both,,,,2438,2072.3,354.93,2438,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,551.36,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Repair Initial Inguinal Hernia, Age 5 Years Or Older; Incarcerated Or Strangulated (Pro Cah)",,49507,CPT,Professional,Both,,,,2438,2072.3,354.93,2438,"Multiplan, Inc.","Multiplan, Inc.",2291.72,94,,percent of total billed charges,,
"Repair Initial Inguinal Hernia, Age 5 Years Or Older; Incarcerated Or Strangulated (Pro Cah)",,49507,CPT,Professional,Both,,,,2438,2072.3,354.93,2438,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,2196.638,90.1,,percent of total billed charges,,
"Repair Initial Inguinal Hernia, Age 5 Years Or Older; Incarcerated Or Strangulated (Pro Cah)",,49507,CPT,Professional,Both,,,,2438,2072.3,354.93,2438,"Preferred One Administrative Services, INC.",PPO,2403.868,98.6,,percent of total billed charges,,
"Repair Initial Inguinal Hernia, Age 5 Years Or Older; Incarcerated Or Strangulated (Pro Cah)",,49507,CPT,Professional,Both,,,,2438,2072.3,354.93,2438,PrimeWest Health,Minnesota Senior Health Options (MSHO),634.064,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair Initial Inguinal Hernia, Age 5 Years Or Older; Incarcerated Or Strangulated (Pro Cah)",,49507,CPT,Professional,Both,,,,2438,2072.3,354.93,2438,PrimeWest Health,MinnesotaCare,438.4681096,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Repair Initial Inguinal Hernia, Age 5 Years Or Older; Incarcerated Or Strangulated (Pro Cah)",,49507,CPT,Professional,Both,,,,2438,2072.3,354.93,2438,Sanford Health Plan,Sanford Health Plan,2145.44,88,,percent of total billed charges,,
"Repair Initial Inguinal Hernia, Age 5 Years Or Older; Incarcerated Or Strangulated (Pro Cah)",,49507,CPT,Professional,Both,,,,2438,2072.3,354.93,2438,"UCare Health, Inc.",Individual & Family Plan,896.290816,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Repair Initial Inguinal Hernia, Age 5 Years Or Older; Incarcerated Or Strangulated (Pro Cah)",,49507,CPT,Professional,Both,,,,2438,2072.3,354.93,2438,"UCare Health, Inc.",Medical Assistance,450.761608,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Repair Initial Inguinal Hernia, Age 5 Years Or Older; Incarcerated Or Strangulated (Pro Cah)",,49507,CPT,Professional,Both,,,,2438,2072.3,354.93,2438,"UCare Health, Inc.",Medicare Advantage,634.064,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Repair Initial Inguinal Hernia, Age 5 Years Or Older; Incarcerated Or Strangulated (Pro Cah)",,49507,CPT,Professional,Both,,,,2438,2072.3,354.93,2438,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),507.2512,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Repair Initial Inguinal Hernia, Age 5 Years Or Older; Incarcerated Or Strangulated (Pro Cah)",,49507,CPT,Professional,Both,,,,2438,2072.3,354.93,2438,UnitedHealthcare,Individual & Family,2438,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Repair Initial Inguinal Hernia, Age 5 Years Or Older; Incarcerated Or Strangulated (Pro Cah)",,49507,CPT,Professional,Both,,,,2438,2072.3,354.93,2438,UnitedHealthcare,Medicare Advantage,634.064,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair Initial Inguinal Hernia, Age 5 Years Or Older; Incarcerated Or Strangulated (Pro Cah)",,49507,CPT,Professional,Both,,,,2438,2072.3,354.93,2438,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,409.78328,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Repair Recurrent Inguinal Hernia, Any Age; Reducible (Pro Cah)",,49520,CPT,Professional,Both,,,,1734,1473.9,380.89,1734,Aetna,Commercial,1473.9,85,,percent of total billed charges,,
"Repair Recurrent Inguinal Hernia, Any Age; Reducible (Pro Cah)",,49520,CPT,Professional,Both,,,,1734,1473.9,380.89,1734,Aetna,Medicare Advantage,602.6,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair Recurrent Inguinal Hernia, Any Age; Reducible (Pro Cah)",,49520,CPT,Professional,Both,,,,1734,1473.9,380.89,1734,Aetna,PPO,1612.62,93,,percent of total billed charges,,
"Repair Recurrent Inguinal Hernia, Any Age; Reducible (Pro Cah)",,49520,CPT,Professional,Both,,,,1734,1473.9,380.89,1734,America's PPO,America's PPO,1481.5296,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Repair Recurrent Inguinal Hernia, Any Age; Reducible (Pro Cah)",,49520,CPT,Professional,Both,,,,1734,1473.9,380.89,1734,BlueCross BlueShield Minnesota, Federal Employee Program,1309.03,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Repair Recurrent Inguinal Hernia, Any Age; Reducible (Pro Cah)",,49520,CPT,Professional,Both,,,,1734,1473.9,380.89,1734,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1329.97448,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Repair Recurrent Inguinal Hernia, Any Age; Reducible (Pro Cah)",,49520,CPT,Professional,Both,,,,1734,1473.9,380.89,1734,BlueCross BlueShield Minnesota,High Value Network Plan,1329.97448,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Repair Recurrent Inguinal Hernia, Any Age; Reducible (Pro Cah)",,49520,CPT,Professional,Both,,,,1734,1473.9,380.89,1734,BlueCross BlueShield Minnesota,Medicare Advantage,680.6735,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair Recurrent Inguinal Hernia, Any Age; Reducible (Pro Cah)",,49520,CPT,Professional,Both,,,,1734,1473.9,380.89,1734,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1329.97448,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Repair Recurrent Inguinal Hernia, Any Age; Reducible (Pro Cah)",,49520,CPT,Professional,Both,,,,1734,1473.9,380.89,1734,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,439.75528,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Repair Recurrent Inguinal Hernia, Any Age; Reducible (Pro Cah)",,49520,CPT,Professional,Both,,,,1734,1473.9,380.89,1734,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),680.6735,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair Recurrent Inguinal Hernia, Any Age; Reducible (Pro Cah)",,49520,CPT,Professional,Both,,,,1734,1473.9,380.89,1734,CorVel,Worker's Compensation,1171.669148,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Repair Recurrent Inguinal Hernia, Any Age; Reducible (Pro Cah)",,49520,CPT,Professional,Both,,,,1734,1473.9,380.89,1734,First Health Group Corporation,First Health Network,1681.98,97,,percent of total billed charges,,
"Repair Recurrent Inguinal Hernia, Any Age; Reducible (Pro Cah)",,49520,CPT,Professional,Both,,,,1734,1473.9,380.89,1734,"Health Partners, Inc.",Commercial,1265.32,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Repair Recurrent Inguinal Hernia, Any Age; Reducible (Pro Cah)",,49520,CPT,Professional,Both,,,,1734,1473.9,380.89,1734,"Health Partners, Inc.",Medicare Advantage,680.6735,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair Recurrent Inguinal Hernia, Any Age; Reducible (Pro Cah)",,49520,CPT,Professional,Both,,,,1734,1473.9,380.89,1734,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),591.67,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Repair Recurrent Inguinal Hernia, Any Age; Reducible (Pro Cah)",,49520,CPT,Professional,Both,,,,1734,1473.9,380.89,1734,"Health Partners, Inc.",State of Minnesota Advantage Program,1090.07318,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Repair Recurrent Inguinal Hernia, Any Age; Reducible (Pro Cah)",,49520,CPT,Professional,Both,,,,1734,1473.9,380.89,1734,"Health Partners, Inc.",State Public Programs,380.89,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Repair Recurrent Inguinal Hernia, Any Age; Reducible (Pro Cah)",,49520,CPT,Professional,Both,,,,1734,1473.9,380.89,1734,Humana Insurance Company,Commercial PPO,591.89,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Repair Recurrent Inguinal Hernia, Any Age; Reducible (Pro Cah)",,49520,CPT,Professional,Both,,,,1734,1473.9,380.89,1734,Humana Insurance Company,Medicare PPO,1734,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Repair Recurrent Inguinal Hernia, Any Age; Reducible (Pro Cah)",,49520,CPT,Professional,Both,,,,1734,1473.9,380.89,1734,Medica,Individual & Family,1470.432,84.8,,percent of total billed charges,,
"Repair Recurrent Inguinal Hernia, Any Age; Reducible (Pro Cah)",,49520,CPT,Professional,Both,,,,1734,1473.9,380.89,1734,Medica,Medica Advantage Solution,863.532,49.8,,percent of total billed charges,,
"Repair Recurrent Inguinal Hernia, Any Age; Reducible (Pro Cah)",,49520,CPT,Professional,Both,,,,1734,1473.9,380.89,1734,Medica,Medical Assistance,439.76,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Repair Recurrent Inguinal Hernia, Any Age; Reducible (Pro Cah)",,49520,CPT,Professional,Both,,,,1734,1473.9,380.89,1734,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,591.89,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Repair Recurrent Inguinal Hernia, Any Age; Reducible (Pro Cah)",,49520,CPT,Professional,Both,,,,1734,1473.9,380.89,1734,"Multiplan, Inc.","Multiplan, Inc.",1629.96,94,,percent of total billed charges,,
"Repair Recurrent Inguinal Hernia, Any Age; Reducible (Pro Cah)",,49520,CPT,Professional,Both,,,,1734,1473.9,380.89,1734,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1562.334,90.1,,percent of total billed charges,,
"Repair Recurrent Inguinal Hernia, Any Age; Reducible (Pro Cah)",,49520,CPT,Professional,Both,,,,1734,1473.9,380.89,1734,"Preferred One Administrative Services, INC.",PPO,1709.724,98.6,,percent of total billed charges,,
"Repair Recurrent Inguinal Hernia, Any Age; Reducible (Pro Cah)",,49520,CPT,Professional,Both,,,,1734,1473.9,380.89,1734,PrimeWest Health,Minnesota Senior Health Options (MSHO),680.6735,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair Recurrent Inguinal Hernia, Any Age; Reducible (Pro Cah)",,49520,CPT,Professional,Both,,,,1734,1473.9,380.89,1734,PrimeWest Health,MinnesotaCare,470.5381496,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Repair Recurrent Inguinal Hernia, Any Age; Reducible (Pro Cah)",,49520,CPT,Professional,Both,,,,1734,1473.9,380.89,1734,Sanford Health Plan,Sanford Health Plan,1525.92,88,,percent of total billed charges,,
"Repair Recurrent Inguinal Hernia, Any Age; Reducible (Pro Cah)",,49520,CPT,Professional,Both,,,,1734,1473.9,380.89,1734,"UCare Health, Inc.",Individual & Family Plan,962.176384,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Repair Recurrent Inguinal Hernia, Any Age; Reducible (Pro Cah)",,49520,CPT,Professional,Both,,,,1734,1473.9,380.89,1734,"UCare Health, Inc.",Medical Assistance,483.730808,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Repair Recurrent Inguinal Hernia, Any Age; Reducible (Pro Cah)",,49520,CPT,Professional,Both,,,,1734,1473.9,380.89,1734,"UCare Health, Inc.",Medicare Advantage,680.6735,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Repair Recurrent Inguinal Hernia, Any Age; Reducible (Pro Cah)",,49520,CPT,Professional,Both,,,,1734,1473.9,380.89,1734,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),544.5388,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Repair Recurrent Inguinal Hernia, Any Age; Reducible (Pro Cah)",,49520,CPT,Professional,Both,,,,1734,1473.9,380.89,1734,UnitedHealthcare,Individual & Family,1734,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Repair Recurrent Inguinal Hernia, Any Age; Reducible (Pro Cah)",,49520,CPT,Professional,Both,,,,1734,1473.9,380.89,1734,UnitedHealthcare,Medicare Advantage,680.6735,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair Recurrent Inguinal Hernia, Any Age; Reducible (Pro Cah)",,49520,CPT,Professional,Both,,,,1734,1473.9,380.89,1734,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,439.75528,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Repair Recurrent Inguinal Hernia; Incarcerated Or Strangulated (Pro Cah),,49521,CPT,Professional,Both,,,,3165,2690.25,430.41,3165,Aetna,Commercial,2690.25,85,,percent of total billed charges,,
Repair Recurrent Inguinal Hernia; Incarcerated Or Strangulated (Pro Cah),,49521,CPT,Professional,Both,,,,3165,2690.25,430.41,3165,Aetna,Medicare Advantage,681.75,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Repair Recurrent Inguinal Hernia; Incarcerated Or Strangulated (Pro Cah),,49521,CPT,Professional,Both,,,,3165,2690.25,430.41,3165,Aetna,PPO,2943.45,93,,percent of total billed charges,,
Repair Recurrent Inguinal Hernia; Incarcerated Or Strangulated (Pro Cah),,49521,CPT,Professional,Both,,,,3165,2690.25,430.41,3165,America's PPO,America's PPO,2704.176,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Repair Recurrent Inguinal Hernia; Incarcerated Or Strangulated (Pro Cah),,49521,CPT,Professional,Both,,,,3165,2690.25,430.41,3165,BlueCross BlueShield Minnesota, Federal Employee Program,1480.49,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Repair Recurrent Inguinal Hernia; Incarcerated Or Strangulated (Pro Cah),,49521,CPT,Professional,Both,,,,3165,2690.25,430.41,3165,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1504.17784,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Repair Recurrent Inguinal Hernia; Incarcerated Or Strangulated (Pro Cah),,49521,CPT,Professional,Both,,,,3165,2690.25,430.41,3165,BlueCross BlueShield Minnesota,High Value Network Plan,1504.17784,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Repair Recurrent Inguinal Hernia; Incarcerated Or Strangulated (Pro Cah),,49521,CPT,Professional,Both,,,,3165,2690.25,430.41,3165,BlueCross BlueShield Minnesota,Medicare Advantage,769.12,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Repair Recurrent Inguinal Hernia; Incarcerated Or Strangulated (Pro Cah),,49521,CPT,Professional,Both,,,,3165,2690.25,430.41,3165,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1504.17784,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Repair Recurrent Inguinal Hernia; Incarcerated Or Strangulated (Pro Cah),,49521,CPT,Professional,Both,,,,3165,2690.25,430.41,3165,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,496.9256,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Repair Recurrent Inguinal Hernia; Incarcerated Or Strangulated (Pro Cah),,49521,CPT,Professional,Both,,,,3165,2690.25,430.41,3165,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),769.12,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Repair Recurrent Inguinal Hernia; Incarcerated Or Strangulated (Pro Cah),,49521,CPT,Professional,Both,,,,3165,2690.25,430.41,3165,CorVel,Worker's Compensation,1322.238092,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Repair Recurrent Inguinal Hernia; Incarcerated Or Strangulated (Pro Cah),,49521,CPT,Professional,Both,,,,3165,2690.25,430.41,3165,First Health Group Corporation,First Health Network,3070.05,97,,percent of total billed charges,,
Repair Recurrent Inguinal Hernia; Incarcerated Or Strangulated (Pro Cah),,49521,CPT,Professional,Both,,,,3165,2690.25,430.41,3165,"Health Partners, Inc.",Commercial,1427.84,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Repair Recurrent Inguinal Hernia; Incarcerated Or Strangulated (Pro Cah),,49521,CPT,Professional,Both,,,,3165,2690.25,430.41,3165,"Health Partners, Inc.",Medicare Advantage,769.12,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Repair Recurrent Inguinal Hernia; Incarcerated Or Strangulated (Pro Cah),,49521,CPT,Professional,Both,,,,3165,2690.25,430.41,3165,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),668.93,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Repair Recurrent Inguinal Hernia; Incarcerated Or Strangulated (Pro Cah),,49521,CPT,Professional,Both,,,,3165,2690.25,430.41,3165,"Health Partners, Inc.",State of Minnesota Advantage Program,1230.08416,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Repair Recurrent Inguinal Hernia; Incarcerated Or Strangulated (Pro Cah),,49521,CPT,Professional,Both,,,,3165,2690.25,430.41,3165,"Health Partners, Inc.",State Public Programs,430.41,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Repair Recurrent Inguinal Hernia; Incarcerated Or Strangulated (Pro Cah),,49521,CPT,Professional,Both,,,,3165,2690.25,430.41,3165,Humana Insurance Company,Commercial PPO,668.8,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Repair Recurrent Inguinal Hernia; Incarcerated Or Strangulated (Pro Cah),,49521,CPT,Professional,Both,,,,3165,2690.25,430.41,3165,Humana Insurance Company,Medicare PPO,3165,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Repair Recurrent Inguinal Hernia; Incarcerated Or Strangulated (Pro Cah),,49521,CPT,Professional,Both,,,,3165,2690.25,430.41,3165,Medica,Individual & Family,2683.92,84.8,,percent of total billed charges,,
Repair Recurrent Inguinal Hernia; Incarcerated Or Strangulated (Pro Cah),,49521,CPT,Professional,Both,,,,3165,2690.25,430.41,3165,Medica,Medica Advantage Solution,1576.17,49.8,,percent of total billed charges,,
Repair Recurrent Inguinal Hernia; Incarcerated Or Strangulated (Pro Cah),,49521,CPT,Professional,Both,,,,3165,2690.25,430.41,3165,Medica,Medical Assistance,496.93,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Repair Recurrent Inguinal Hernia; Incarcerated Or Strangulated (Pro Cah),,49521,CPT,Professional,Both,,,,3165,2690.25,430.41,3165,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,668.8,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Repair Recurrent Inguinal Hernia; Incarcerated Or Strangulated (Pro Cah),,49521,CPT,Professional,Both,,,,3165,2690.25,430.41,3165,"Multiplan, Inc.","Multiplan, Inc.",2975.1,94,,percent of total billed charges,,
Repair Recurrent Inguinal Hernia; Incarcerated Or Strangulated (Pro Cah),,49521,CPT,Professional,Both,,,,3165,2690.25,430.41,3165,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,2851.665,90.1,,percent of total billed charges,,
Repair Recurrent Inguinal Hernia; Incarcerated Or Strangulated (Pro Cah),,49521,CPT,Professional,Both,,,,3165,2690.25,430.41,3165,"Preferred One Administrative Services, INC.",PPO,3120.69,98.6,,percent of total billed charges,,
Repair Recurrent Inguinal Hernia; Incarcerated Or Strangulated (Pro Cah),,49521,CPT,Professional,Both,,,,3165,2690.25,430.41,3165,PrimeWest Health,Minnesota Senior Health Options (MSHO),769.12,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Repair Recurrent Inguinal Hernia; Incarcerated Or Strangulated (Pro Cah),,49521,CPT,Professional,Both,,,,3165,2690.25,430.41,3165,PrimeWest Health,MinnesotaCare,531.710392,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Repair Recurrent Inguinal Hernia; Incarcerated Or Strangulated (Pro Cah),,49521,CPT,Professional,Both,,,,3165,2690.25,430.41,3165,Sanford Health Plan,Sanford Health Plan,2785.2,88,,percent of total billed charges,,
Repair Recurrent Inguinal Hernia; Incarcerated Or Strangulated (Pro Cah),,49521,CPT,Professional,Both,,,,3165,2690.25,430.41,3165,"UCare Health, Inc.",Individual & Family Plan,1087.20128,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Repair Recurrent Inguinal Hernia; Incarcerated Or Strangulated (Pro Cah),,49521,CPT,Professional,Both,,,,3165,2690.25,430.41,3165,"UCare Health, Inc.",Medical Assistance,546.61816,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Repair Recurrent Inguinal Hernia; Incarcerated Or Strangulated (Pro Cah),,49521,CPT,Professional,Both,,,,3165,2690.25,430.41,3165,"UCare Health, Inc.",Medicare Advantage,769.12,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Repair Recurrent Inguinal Hernia; Incarcerated Or Strangulated (Pro Cah),,49521,CPT,Professional,Both,,,,3165,2690.25,430.41,3165,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),615.296,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Repair Recurrent Inguinal Hernia; Incarcerated Or Strangulated (Pro Cah),,49521,CPT,Professional,Both,,,,3165,2690.25,430.41,3165,UnitedHealthcare,Individual & Family,3165,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Repair Recurrent Inguinal Hernia; Incarcerated Or Strangulated (Pro Cah),,49521,CPT,Professional,Both,,,,3165,2690.25,430.41,3165,UnitedHealthcare,Medicare Advantage,769.12,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Repair Recurrent Inguinal Hernia; Incarcerated Or Strangulated (Pro Cah),,49521,CPT,Professional,Both,,,,3165,2690.25,430.41,3165,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,496.9256,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Repair Anterior Abd Hernia, Any Approach, Initial, Incl Implant Mesh, Less Than 3 Cm, Reducible (Pro Cah)",,49591,CPT,Professional,Both,,,,761,646.85,202.22,761,Aetna,Commercial,646.85,85,,percent of total billed charges,,
"Repair Anterior Abd Hernia, Any Approach, Initial, Incl Implant Mesh, Less Than 3 Cm, Reducible (Pro Cah)",,49591,CPT,Professional,Both,,,,761,646.85,202.22,761,Aetna,Medicare Advantage,761,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair Anterior Abd Hernia, Any Approach, Initial, Incl Implant Mesh, Less Than 3 Cm, Reducible (Pro Cah)",,49591,CPT,Professional,Both,,,,761,646.85,202.22,761,Aetna,PPO,707.73,93,,percent of total billed charges,,
"Repair Anterior Abd Hernia, Any Approach, Initial, Incl Implant Mesh, Less Than 3 Cm, Reducible (Pro Cah)",,49591,CPT,Professional,Both,,,,761,646.85,202.22,761,America's PPO,America's PPO,650.1984,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Repair Anterior Abd Hernia, Any Approach, Initial, Incl Implant Mesh, Less Than 3 Cm, Reducible (Pro Cah)",,49591,CPT,Professional,Both,,,,761,646.85,202.22,761,BlueCross BlueShield Minnesota, Federal Employee Program,702.37,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Repair Anterior Abd Hernia, Any Approach, Initial, Incl Implant Mesh, Less Than 3 Cm, Reducible (Pro Cah)",,49591,CPT,Professional,Both,,,,761,646.85,202.22,761,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,713.60792,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Repair Anterior Abd Hernia, Any Approach, Initial, Incl Implant Mesh, Less Than 3 Cm, Reducible (Pro Cah)",,49591,CPT,Professional,Both,,,,761,646.85,202.22,761,BlueCross BlueShield Minnesota,High Value Network Plan,713.60792,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Repair Anterior Abd Hernia, Any Approach, Initial, Incl Implant Mesh, Less Than 3 Cm, Reducible (Pro Cah)",,49591,CPT,Professional,Both,,,,761,646.85,202.22,761,BlueCross BlueShield Minnesota,Medicare Advantage,361.4795,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair Anterior Abd Hernia, Any Approach, Initial, Incl Implant Mesh, Less Than 3 Cm, Reducible (Pro Cah)",,49591,CPT,Professional,Both,,,,761,646.85,202.22,761,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,713.60792,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Repair Anterior Abd Hernia, Any Approach, Initial, Incl Implant Mesh, Less Than 3 Cm, Reducible (Pro Cah)",,49591,CPT,Professional,Both,,,,761,646.85,202.22,761,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,233.4768,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Repair Anterior Abd Hernia, Any Approach, Initial, Incl Implant Mesh, Less Than 3 Cm, Reducible (Pro Cah)",,49591,CPT,Professional,Both,,,,761,646.85,202.22,761,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),361.4795,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair Anterior Abd Hernia, Any Approach, Initial, Incl Implant Mesh, Less Than 3 Cm, Reducible (Pro Cah)",,49591,CPT,Professional,Both,,,,761,646.85,202.22,761,CorVel,Worker's Compensation,,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Repair Anterior Abd Hernia, Any Approach, Initial, Incl Implant Mesh, Less Than 3 Cm, Reducible (Pro Cah)",,49591,CPT,Professional,Both,,,,761,646.85,202.22,761,First Health Group Corporation,First Health Network,738.17,97,,percent of total billed charges,,
"Repair Anterior Abd Hernia, Any Approach, Initial, Incl Implant Mesh, Less Than 3 Cm, Reducible (Pro Cah)",,49591,CPT,Professional,Both,,,,761,646.85,202.22,761,"Health Partners, Inc.",Commercial,672.56,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Repair Anterior Abd Hernia, Any Approach, Initial, Incl Implant Mesh, Less Than 3 Cm, Reducible (Pro Cah)",,49591,CPT,Professional,Both,,,,761,646.85,202.22,761,"Health Partners, Inc.",Medicare Advantage,361.4795,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair Anterior Abd Hernia, Any Approach, Initial, Incl Implant Mesh, Less Than 3 Cm, Reducible (Pro Cah)",,49591,CPT,Professional,Both,,,,761,646.85,202.22,761,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),314.13,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Repair Anterior Abd Hernia, Any Approach, Initial, Incl Implant Mesh, Less Than 3 Cm, Reducible (Pro Cah)",,49591,CPT,Professional,Both,,,,761,646.85,202.22,761,"Health Partners, Inc.",State of Minnesota Advantage Program,579.41044,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Repair Anterior Abd Hernia, Any Approach, Initial, Incl Implant Mesh, Less Than 3 Cm, Reducible (Pro Cah)",,49591,CPT,Professional,Both,,,,761,646.85,202.22,761,"Health Partners, Inc.",State Public Programs,202.22,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Repair Anterior Abd Hernia, Any Approach, Initial, Incl Implant Mesh, Less Than 3 Cm, Reducible (Pro Cah)",,49591,CPT,Professional,Both,,,,761,646.85,202.22,761,Humana Insurance Company,Commercial PPO,314.33,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Repair Anterior Abd Hernia, Any Approach, Initial, Incl Implant Mesh, Less Than 3 Cm, Reducible (Pro Cah)",,49591,CPT,Professional,Both,,,,761,646.85,202.22,761,Humana Insurance Company,Medicare PPO,761,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Repair Anterior Abd Hernia, Any Approach, Initial, Incl Implant Mesh, Less Than 3 Cm, Reducible (Pro Cah)",,49591,CPT,Professional,Both,,,,761,646.85,202.22,761,Medica,Individual & Family,645.328,84.8,,percent of total billed charges,,
"Repair Anterior Abd Hernia, Any Approach, Initial, Incl Implant Mesh, Less Than 3 Cm, Reducible (Pro Cah)",,49591,CPT,Professional,Both,,,,761,646.85,202.22,761,Medica,Medica Advantage Solution,378.978,49.8,,percent of total billed charges,,
"Repair Anterior Abd Hernia, Any Approach, Initial, Incl Implant Mesh, Less Than 3 Cm, Reducible (Pro Cah)",,49591,CPT,Professional,Both,,,,761,646.85,202.22,761,Medica,Medical Assistance,233.48,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Repair Anterior Abd Hernia, Any Approach, Initial, Incl Implant Mesh, Less Than 3 Cm, Reducible (Pro Cah)",,49591,CPT,Professional,Both,,,,761,646.85,202.22,761,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,314.33,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Repair Anterior Abd Hernia, Any Approach, Initial, Incl Implant Mesh, Less Than 3 Cm, Reducible (Pro Cah)",,49591,CPT,Professional,Both,,,,761,646.85,202.22,761,"Multiplan, Inc.","Multiplan, Inc.",715.34,94,,percent of total billed charges,,
"Repair Anterior Abd Hernia, Any Approach, Initial, Incl Implant Mesh, Less Than 3 Cm, Reducible (Pro Cah)",,49591,CPT,Professional,Both,,,,761,646.85,202.22,761,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,685.661,90.1,,percent of total billed charges,,
"Repair Anterior Abd Hernia, Any Approach, Initial, Incl Implant Mesh, Less Than 3 Cm, Reducible (Pro Cah)",,49591,CPT,Professional,Both,,,,761,646.85,202.22,761,"Preferred One Administrative Services, INC.",PPO,750.346,98.6,,percent of total billed charges,,
"Repair Anterior Abd Hernia, Any Approach, Initial, Incl Implant Mesh, Less Than 3 Cm, Reducible (Pro Cah)",,49591,CPT,Professional,Both,,,,761,646.85,202.22,761,PrimeWest Health,Minnesota Senior Health Options (MSHO),361.4795,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair Anterior Abd Hernia, Any Approach, Initial, Incl Implant Mesh, Less Than 3 Cm, Reducible (Pro Cah)",,49591,CPT,Professional,Both,,,,761,646.85,202.22,761,PrimeWest Health,MinnesotaCare,249.820176,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Repair Anterior Abd Hernia, Any Approach, Initial, Incl Implant Mesh, Less Than 3 Cm, Reducible (Pro Cah)",,49591,CPT,Professional,Both,,,,761,646.85,202.22,761,Sanford Health Plan,Sanford Health Plan,669.68,88,,percent of total billed charges,,
"Repair Anterior Abd Hernia, Any Approach, Initial, Incl Implant Mesh, Less Than 3 Cm, Reducible (Pro Cah)",,49591,CPT,Professional,Both,,,,761,646.85,202.22,761,"UCare Health, Inc.",Individual & Family Plan,510.974848,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Repair Anterior Abd Hernia, Any Approach, Initial, Incl Implant Mesh, Less Than 3 Cm, Reducible (Pro Cah)",,49591,CPT,Professional,Both,,,,761,646.85,202.22,761,"UCare Health, Inc.",Medical Assistance,256.82448,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Repair Anterior Abd Hernia, Any Approach, Initial, Incl Implant Mesh, Less Than 3 Cm, Reducible (Pro Cah)",,49591,CPT,Professional,Both,,,,761,646.85,202.22,761,"UCare Health, Inc.",Medicare Advantage,361.4795,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Repair Anterior Abd Hernia, Any Approach, Initial, Incl Implant Mesh, Less Than 3 Cm, Reducible (Pro Cah)",,49591,CPT,Professional,Both,,,,761,646.85,202.22,761,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),289.1836,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Repair Anterior Abd Hernia, Any Approach, Initial, Incl Implant Mesh, Less Than 3 Cm, Reducible (Pro Cah)",,49591,CPT,Professional,Both,,,,761,646.85,202.22,761,UnitedHealthcare,Individual & Family,761,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Repair Anterior Abd Hernia, Any Approach, Initial, Incl Implant Mesh, Less Than 3 Cm, Reducible (Pro Cah)",,49591,CPT,Professional,Both,,,,761,646.85,202.22,761,UnitedHealthcare,Medicare Advantage,361.4795,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair Anterior Abd Hernia, Any Approach, Initial, Incl Implant Mesh, Less Than 3 Cm, Reducible (Pro Cah)",,49591,CPT,Professional,Both,,,,761,646.85,202.22,761,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,233.4768,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Repair Ant Abd Hernia, Any Approach, Initial, Incl Implant Mesh,Less Than 3 Cm, Incarcerated/Strang (Pro Cah)",,49592,CPT,Professional,Both,,,,1080,918,280.32,1080,Aetna,Commercial,918,85,,percent of total billed charges,,
"Repair Ant Abd Hernia, Any Approach, Initial, Incl Implant Mesh,Less Than 3 Cm, Incarcerated/Strang (Pro Cah)",,49592,CPT,Professional,Both,,,,1080,918,280.32,1080,Aetna,Medicare Advantage,1080,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair Ant Abd Hernia, Any Approach, Initial, Incl Implant Mesh,Less Than 3 Cm, Incarcerated/Strang (Pro Cah)",,49592,CPT,Professional,Both,,,,1080,918,280.32,1080,Aetna,PPO,1004.4,93,,percent of total billed charges,,
"Repair Ant Abd Hernia, Any Approach, Initial, Incl Implant Mesh,Less Than 3 Cm, Incarcerated/Strang (Pro Cah)",,49592,CPT,Professional,Both,,,,1080,918,280.32,1080,America's PPO,America's PPO,922.752,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Repair Ant Abd Hernia, Any Approach, Initial, Incl Implant Mesh,Less Than 3 Cm, Incarcerated/Strang (Pro Cah)",,49592,CPT,Professional,Both,,,,1080,918,280.32,1080,BlueCross BlueShield Minnesota, Federal Employee Program,977.12,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Repair Ant Abd Hernia, Any Approach, Initial, Incl Implant Mesh,Less Than 3 Cm, Incarcerated/Strang (Pro Cah)",,49592,CPT,Professional,Both,,,,1080,918,280.32,1080,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,992.75392,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Repair Ant Abd Hernia, Any Approach, Initial, Incl Implant Mesh,Less Than 3 Cm, Incarcerated/Strang (Pro Cah)",,49592,CPT,Professional,Both,,,,1080,918,280.32,1080,BlueCross BlueShield Minnesota,High Value Network Plan,992.75392,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Repair Ant Abd Hernia, Any Approach, Initial, Incl Implant Mesh,Less Than 3 Cm, Incarcerated/Strang (Pro Cah)",,49592,CPT,Professional,Both,,,,1080,918,280.32,1080,BlueCross BlueShield Minnesota,Medicare Advantage,501.055,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair Ant Abd Hernia, Any Approach, Initial, Incl Implant Mesh,Less Than 3 Cm, Incarcerated/Strang (Pro Cah)",,49592,CPT,Professional,Both,,,,1080,918,280.32,1080,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,992.75392,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Repair Ant Abd Hernia, Any Approach, Initial, Incl Implant Mesh,Less Than 3 Cm, Incarcerated/Strang (Pro Cah)",,49592,CPT,Professional,Both,,,,1080,918,280.32,1080,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,323.6468,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Repair Ant Abd Hernia, Any Approach, Initial, Incl Implant Mesh,Less Than 3 Cm, Incarcerated/Strang (Pro Cah)",,49592,CPT,Professional,Both,,,,1080,918,280.32,1080,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),501.055,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair Ant Abd Hernia, Any Approach, Initial, Incl Implant Mesh,Less Than 3 Cm, Incarcerated/Strang (Pro Cah)",,49592,CPT,Professional,Both,,,,1080,918,280.32,1080,CorVel,Worker's Compensation,,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Repair Ant Abd Hernia, Any Approach, Initial, Incl Implant Mesh,Less Than 3 Cm, Incarcerated/Strang (Pro Cah)",,49592,CPT,Professional,Both,,,,1080,918,280.32,1080,First Health Group Corporation,First Health Network,1047.6,97,,percent of total billed charges,,
"Repair Ant Abd Hernia, Any Approach, Initial, Incl Implant Mesh,Less Than 3 Cm, Incarcerated/Strang (Pro Cah)",,49592,CPT,Professional,Both,,,,1080,918,280.32,1080,"Health Partners, Inc.",Commercial,933.02,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Repair Ant Abd Hernia, Any Approach, Initial, Incl Implant Mesh,Less Than 3 Cm, Incarcerated/Strang (Pro Cah)",,49592,CPT,Professional,Both,,,,1080,918,280.32,1080,"Health Partners, Inc.",Medicare Advantage,501.055,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair Ant Abd Hernia, Any Approach, Initial, Incl Implant Mesh,Less Than 3 Cm, Incarcerated/Strang (Pro Cah)",,49592,CPT,Professional,Both,,,,1080,918,280.32,1080,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),435.79,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Repair Ant Abd Hernia, Any Approach, Initial, Incl Implant Mesh,Less Than 3 Cm, Incarcerated/Strang (Pro Cah)",,49592,CPT,Professional,Both,,,,1080,918,280.32,1080,"Health Partners, Inc.",State of Minnesota Advantage Program,803.79673,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Repair Ant Abd Hernia, Any Approach, Initial, Incl Implant Mesh,Less Than 3 Cm, Incarcerated/Strang (Pro Cah)",,49592,CPT,Professional,Both,,,,1080,918,280.32,1080,"Health Partners, Inc.",State Public Programs,280.32,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Repair Ant Abd Hernia, Any Approach, Initial, Incl Implant Mesh,Less Than 3 Cm, Incarcerated/Strang (Pro Cah)",,49592,CPT,Professional,Both,,,,1080,918,280.32,1080,Humana Insurance Company,Commercial PPO,435.7,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Repair Ant Abd Hernia, Any Approach, Initial, Incl Implant Mesh,Less Than 3 Cm, Incarcerated/Strang (Pro Cah)",,49592,CPT,Professional,Both,,,,1080,918,280.32,1080,Humana Insurance Company,Medicare PPO,1080,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Repair Ant Abd Hernia, Any Approach, Initial, Incl Implant Mesh,Less Than 3 Cm, Incarcerated/Strang (Pro Cah)",,49592,CPT,Professional,Both,,,,1080,918,280.32,1080,Medica,Individual & Family,915.84,84.8,,percent of total billed charges,,
"Repair Ant Abd Hernia, Any Approach, Initial, Incl Implant Mesh,Less Than 3 Cm, Incarcerated/Strang (Pro Cah)",,49592,CPT,Professional,Both,,,,1080,918,280.32,1080,Medica,Medica Advantage Solution,537.84,49.8,,percent of total billed charges,,
"Repair Ant Abd Hernia, Any Approach, Initial, Incl Implant Mesh,Less Than 3 Cm, Incarcerated/Strang (Pro Cah)",,49592,CPT,Professional,Both,,,,1080,918,280.32,1080,Medica,Medical Assistance,323.65,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Repair Ant Abd Hernia, Any Approach, Initial, Incl Implant Mesh,Less Than 3 Cm, Incarcerated/Strang (Pro Cah)",,49592,CPT,Professional,Both,,,,1080,918,280.32,1080,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,435.7,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Repair Ant Abd Hernia, Any Approach, Initial, Incl Implant Mesh,Less Than 3 Cm, Incarcerated/Strang (Pro Cah)",,49592,CPT,Professional,Both,,,,1080,918,280.32,1080,"Multiplan, Inc.","Multiplan, Inc.",1015.2,94,,percent of total billed charges,,
"Repair Ant Abd Hernia, Any Approach, Initial, Incl Implant Mesh,Less Than 3 Cm, Incarcerated/Strang (Pro Cah)",,49592,CPT,Professional,Both,,,,1080,918,280.32,1080,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,973.08,90.1,,percent of total billed charges,,
"Repair Ant Abd Hernia, Any Approach, Initial, Incl Implant Mesh,Less Than 3 Cm, Incarcerated/Strang (Pro Cah)",,49592,CPT,Professional,Both,,,,1080,918,280.32,1080,"Preferred One Administrative Services, INC.",PPO,1064.88,98.6,,percent of total billed charges,,
"Repair Ant Abd Hernia, Any Approach, Initial, Incl Implant Mesh,Less Than 3 Cm, Incarcerated/Strang (Pro Cah)",,49592,CPT,Professional,Both,,,,1080,918,280.32,1080,PrimeWest Health,Minnesota Senior Health Options (MSHO),501.055,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair Ant Abd Hernia, Any Approach, Initial, Incl Implant Mesh,Less Than 3 Cm, Incarcerated/Strang (Pro Cah)",,49592,CPT,Professional,Both,,,,1080,918,280.32,1080,PrimeWest Health,MinnesotaCare,346.302076,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Repair Ant Abd Hernia, Any Approach, Initial, Incl Implant Mesh,Less Than 3 Cm, Incarcerated/Strang (Pro Cah)",,49592,CPT,Professional,Both,,,,1080,918,280.32,1080,Sanford Health Plan,Sanford Health Plan,950.4,88,,percent of total billed charges,,
"Repair Ant Abd Hernia, Any Approach, Initial, Incl Implant Mesh,Less Than 3 Cm, Incarcerated/Strang (Pro Cah)",,49592,CPT,Professional,Both,,,,1080,918,280.32,1080,"UCare Health, Inc.",Individual & Family Plan,708.27392,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Repair Ant Abd Hernia, Any Approach, Initial, Incl Implant Mesh,Less Than 3 Cm, Incarcerated/Strang (Pro Cah)",,49592,CPT,Professional,Both,,,,1080,918,280.32,1080,"UCare Health, Inc.",Medical Assistance,356.01148,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Repair Ant Abd Hernia, Any Approach, Initial, Incl Implant Mesh,Less Than 3 Cm, Incarcerated/Strang (Pro Cah)",,49592,CPT,Professional,Both,,,,1080,918,280.32,1080,"UCare Health, Inc.",Medicare Advantage,501.055,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Repair Ant Abd Hernia, Any Approach, Initial, Incl Implant Mesh,Less Than 3 Cm, Incarcerated/Strang (Pro Cah)",,49592,CPT,Professional,Both,,,,1080,918,280.32,1080,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),400.844,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Repair Ant Abd Hernia, Any Approach, Initial, Incl Implant Mesh,Less Than 3 Cm, Incarcerated/Strang (Pro Cah)",,49592,CPT,Professional,Both,,,,1080,918,280.32,1080,UnitedHealthcare,Individual & Family,1080,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Repair Ant Abd Hernia, Any Approach, Initial, Incl Implant Mesh,Less Than 3 Cm, Incarcerated/Strang (Pro Cah)",,49592,CPT,Professional,Both,,,,1080,918,280.32,1080,UnitedHealthcare,Medicare Advantage,501.055,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair Ant Abd Hernia, Any Approach, Initial, Incl Implant Mesh,Less Than 3 Cm, Incarcerated/Strang (Pro Cah)",,49592,CPT,Professional,Both,,,,1080,918,280.32,1080,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,323.6468,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Repair Anterior Abd Hernia, Any Approach, Initial, Incl Implant Of Mesh, 3 Cm To 10 Cm, Reducible (Pro Cah)",,49593,CPT,Professional,Both,,,,1310,1113.5,337.91,1310,Aetna,Commercial,1113.5,85,,percent of total billed charges,,
"Repair Anterior Abd Hernia, Any Approach, Initial, Incl Implant Of Mesh, 3 Cm To 10 Cm, Reducible (Pro Cah)",,49593,CPT,Professional,Both,,,,1310,1113.5,337.91,1310,Aetna,Medicare Advantage,1310,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair Anterior Abd Hernia, Any Approach, Initial, Incl Implant Of Mesh, 3 Cm To 10 Cm, Reducible (Pro Cah)",,49593,CPT,Professional,Both,,,,1310,1113.5,337.91,1310,Aetna,PPO,1218.3,93,,percent of total billed charges,,
"Repair Anterior Abd Hernia, Any Approach, Initial, Incl Implant Of Mesh, 3 Cm To 10 Cm, Reducible (Pro Cah)",,49593,CPT,Professional,Both,,,,1310,1113.5,337.91,1310,America's PPO,America's PPO,1119.264,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Repair Anterior Abd Hernia, Any Approach, Initial, Incl Implant Of Mesh, 3 Cm To 10 Cm, Reducible (Pro Cah)",,49593,CPT,Professional,Both,,,,1310,1113.5,337.91,1310,BlueCross BlueShield Minnesota, Federal Employee Program,1176.13,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Repair Anterior Abd Hernia, Any Approach, Initial, Incl Implant Of Mesh, 3 Cm To 10 Cm, Reducible (Pro Cah)",,49593,CPT,Professional,Both,,,,1310,1113.5,337.91,1310,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1194.94808,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Repair Anterior Abd Hernia, Any Approach, Initial, Incl Implant Of Mesh, 3 Cm To 10 Cm, Reducible (Pro Cah)",,49593,CPT,Professional,Both,,,,1310,1113.5,337.91,1310,BlueCross BlueShield Minnesota,High Value Network Plan,1194.94808,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Repair Anterior Abd Hernia, Any Approach, Initial, Incl Implant Of Mesh, 3 Cm To 10 Cm, Reducible (Pro Cah)",,49593,CPT,Professional,Both,,,,1310,1113.5,337.91,1310,BlueCross BlueShield Minnesota,Medicare Advantage,604.0835,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair Anterior Abd Hernia, Any Approach, Initial, Incl Implant Of Mesh, 3 Cm To 10 Cm, Reducible (Pro Cah)",,49593,CPT,Professional,Both,,,,1310,1113.5,337.91,1310,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1194.94808,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Repair Anterior Abd Hernia, Any Approach, Initial, Incl Implant Of Mesh, 3 Cm To 10 Cm, Reducible (Pro Cah)",,49593,CPT,Professional,Both,,,,1310,1113.5,337.91,1310,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,390.13384,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Repair Anterior Abd Hernia, Any Approach, Initial, Incl Implant Of Mesh, 3 Cm To 10 Cm, Reducible (Pro Cah)",,49593,CPT,Professional,Both,,,,1310,1113.5,337.91,1310,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),604.0835,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair Anterior Abd Hernia, Any Approach, Initial, Incl Implant Of Mesh, 3 Cm To 10 Cm, Reducible (Pro Cah)",,49593,CPT,Professional,Both,,,,1310,1113.5,337.91,1310,CorVel,Worker's Compensation,,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Repair Anterior Abd Hernia, Any Approach, Initial, Incl Implant Of Mesh, 3 Cm To 10 Cm, Reducible (Pro Cah)",,49593,CPT,Professional,Both,,,,1310,1113.5,337.91,1310,First Health Group Corporation,First Health Network,1270.7,97,,percent of total billed charges,,
"Repair Anterior Abd Hernia, Any Approach, Initial, Incl Implant Of Mesh, 3 Cm To 10 Cm, Reducible (Pro Cah)",,49593,CPT,Professional,Both,,,,1310,1113.5,337.91,1310,"Health Partners, Inc.",Commercial,1124.57,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Repair Anterior Abd Hernia, Any Approach, Initial, Incl Implant Of Mesh, 3 Cm To 10 Cm, Reducible (Pro Cah)",,49593,CPT,Professional,Both,,,,1310,1113.5,337.91,1310,"Health Partners, Inc.",Medicare Advantage,604.0835,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair Anterior Abd Hernia, Any Approach, Initial, Incl Implant Of Mesh, 3 Cm To 10 Cm, Reducible (Pro Cah)",,49593,CPT,Professional,Both,,,,1310,1113.5,337.91,1310,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),525.25,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Repair Anterior Abd Hernia, Any Approach, Initial, Incl Implant Of Mesh, 3 Cm To 10 Cm, Reducible (Pro Cah)",,49593,CPT,Professional,Both,,,,1310,1113.5,337.91,1310,"Health Partners, Inc.",State of Minnesota Advantage Program,968.817055,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Repair Anterior Abd Hernia, Any Approach, Initial, Incl Implant Of Mesh, 3 Cm To 10 Cm, Reducible (Pro Cah)",,49593,CPT,Professional,Both,,,,1310,1113.5,337.91,1310,"Health Partners, Inc.",State Public Programs,337.91,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Repair Anterior Abd Hernia, Any Approach, Initial, Incl Implant Of Mesh, 3 Cm To 10 Cm, Reducible (Pro Cah)",,49593,CPT,Professional,Both,,,,1310,1113.5,337.91,1310,Humana Insurance Company,Commercial PPO,525.29,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Repair Anterior Abd Hernia, Any Approach, Initial, Incl Implant Of Mesh, 3 Cm To 10 Cm, Reducible (Pro Cah)",,49593,CPT,Professional,Both,,,,1310,1113.5,337.91,1310,Humana Insurance Company,Medicare PPO,1310,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Repair Anterior Abd Hernia, Any Approach, Initial, Incl Implant Of Mesh, 3 Cm To 10 Cm, Reducible (Pro Cah)",,49593,CPT,Professional,Both,,,,1310,1113.5,337.91,1310,Medica,Individual & Family,1110.88,84.8,,percent of total billed charges,,
"Repair Anterior Abd Hernia, Any Approach, Initial, Incl Implant Of Mesh, 3 Cm To 10 Cm, Reducible (Pro Cah)",,49593,CPT,Professional,Both,,,,1310,1113.5,337.91,1310,Medica,Medica Advantage Solution,652.38,49.8,,percent of total billed charges,,
"Repair Anterior Abd Hernia, Any Approach, Initial, Incl Implant Of Mesh, 3 Cm To 10 Cm, Reducible (Pro Cah)",,49593,CPT,Professional,Both,,,,1310,1113.5,337.91,1310,Medica,Medical Assistance,390.13,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Repair Anterior Abd Hernia, Any Approach, Initial, Incl Implant Of Mesh, 3 Cm To 10 Cm, Reducible (Pro Cah)",,49593,CPT,Professional,Both,,,,1310,1113.5,337.91,1310,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,525.29,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Repair Anterior Abd Hernia, Any Approach, Initial, Incl Implant Of Mesh, 3 Cm To 10 Cm, Reducible (Pro Cah)",,49593,CPT,Professional,Both,,,,1310,1113.5,337.91,1310,"Multiplan, Inc.","Multiplan, Inc.",1231.4,94,,percent of total billed charges,,
"Repair Anterior Abd Hernia, Any Approach, Initial, Incl Implant Of Mesh, 3 Cm To 10 Cm, Reducible (Pro Cah)",,49593,CPT,Professional,Both,,,,1310,1113.5,337.91,1310,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1180.31,90.1,,percent of total billed charges,,
"Repair Anterior Abd Hernia, Any Approach, Initial, Incl Implant Of Mesh, 3 Cm To 10 Cm, Reducible (Pro Cah)",,49593,CPT,Professional,Both,,,,1310,1113.5,337.91,1310,"Preferred One Administrative Services, INC.",PPO,1291.66,98.6,,percent of total billed charges,,
"Repair Anterior Abd Hernia, Any Approach, Initial, Incl Implant Of Mesh, 3 Cm To 10 Cm, Reducible (Pro Cah)",,49593,CPT,Professional,Both,,,,1310,1113.5,337.91,1310,PrimeWest Health,Minnesota Senior Health Options (MSHO),604.0835,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair Anterior Abd Hernia, Any Approach, Initial, Incl Implant Of Mesh, 3 Cm To 10 Cm, Reducible (Pro Cah)",,49593,CPT,Professional,Both,,,,1310,1113.5,337.91,1310,PrimeWest Health,MinnesotaCare,417.4432088,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Repair Anterior Abd Hernia, Any Approach, Initial, Incl Implant Of Mesh, 3 Cm To 10 Cm, Reducible (Pro Cah)",,49593,CPT,Professional,Both,,,,1310,1113.5,337.91,1310,Sanford Health Plan,Sanford Health Plan,1152.8,88,,percent of total billed charges,,
"Repair Anterior Abd Hernia, Any Approach, Initial, Incl Implant Of Mesh, 3 Cm To 10 Cm, Reducible (Pro Cah)",,49593,CPT,Professional,Both,,,,1310,1113.5,337.91,1310,"UCare Health, Inc.",Individual & Family Plan,853.911424,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Repair Anterior Abd Hernia, Any Approach, Initial, Incl Implant Of Mesh, 3 Cm To 10 Cm, Reducible (Pro Cah)",,49593,CPT,Professional,Both,,,,1310,1113.5,337.91,1310,"UCare Health, Inc.",Medical Assistance,429.147224,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Repair Anterior Abd Hernia, Any Approach, Initial, Incl Implant Of Mesh, 3 Cm To 10 Cm, Reducible (Pro Cah)",,49593,CPT,Professional,Both,,,,1310,1113.5,337.91,1310,"UCare Health, Inc.",Medicare Advantage,604.0835,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Repair Anterior Abd Hernia, Any Approach, Initial, Incl Implant Of Mesh, 3 Cm To 10 Cm, Reducible (Pro Cah)",,49593,CPT,Professional,Both,,,,1310,1113.5,337.91,1310,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),483.2668,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Repair Anterior Abd Hernia, Any Approach, Initial, Incl Implant Of Mesh, 3 Cm To 10 Cm, Reducible (Pro Cah)",,49593,CPT,Professional,Both,,,,1310,1113.5,337.91,1310,UnitedHealthcare,Individual & Family,1310,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Repair Anterior Abd Hernia, Any Approach, Initial, Incl Implant Of Mesh, 3 Cm To 10 Cm, Reducible (Pro Cah)",,49593,CPT,Professional,Both,,,,1310,1113.5,337.91,1310,UnitedHealthcare,Medicare Advantage,604.0835,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair Anterior Abd Hernia, Any Approach, Initial, Incl Implant Of Mesh, 3 Cm To 10 Cm, Reducible (Pro Cah)",,49593,CPT,Professional,Both,,,,1310,1113.5,337.91,1310,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,390.13384,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Repair Ant Abd Hernia,Any Approach, Initial, Incl Implant Of Mesh;3 Cm To 10 Cm, Incarcerated/Strang (Pro Cah)",,49594,CPT,Professional,Both,,,,1719,1461.15,439.14,1719,Aetna,Commercial,1461.15,85,,percent of total billed charges,,
"Repair Ant Abd Hernia,Any Approach, Initial, Incl Implant Of Mesh;3 Cm To 10 Cm, Incarcerated/Strang (Pro Cah)",,49594,CPT,Professional,Both,,,,1719,1461.15,439.14,1719,Aetna,Medicare Advantage,1719,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair Ant Abd Hernia,Any Approach, Initial, Incl Implant Of Mesh;3 Cm To 10 Cm, Incarcerated/Strang (Pro Cah)",,49594,CPT,Professional,Both,,,,1719,1461.15,439.14,1719,Aetna,PPO,1598.67,93,,percent of total billed charges,,
"Repair Ant Abd Hernia,Any Approach, Initial, Incl Implant Of Mesh;3 Cm To 10 Cm, Incarcerated/Strang (Pro Cah)",,49594,CPT,Professional,Both,,,,1719,1461.15,439.14,1719,America's PPO,America's PPO,1468.7136,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Repair Ant Abd Hernia,Any Approach, Initial, Incl Implant Of Mesh;3 Cm To 10 Cm, Incarcerated/Strang (Pro Cah)",,49594,CPT,Professional,Both,,,,1719,1461.15,439.14,1719,BlueCross BlueShield Minnesota, Federal Employee Program,1532.14,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Repair Ant Abd Hernia,Any Approach, Initial, Incl Implant Of Mesh;3 Cm To 10 Cm, Incarcerated/Strang (Pro Cah)",,49594,CPT,Professional,Both,,,,1719,1461.15,439.14,1719,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1556.65424,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Repair Ant Abd Hernia,Any Approach, Initial, Incl Implant Of Mesh;3 Cm To 10 Cm, Incarcerated/Strang (Pro Cah)",,49594,CPT,Professional,Both,,,,1719,1461.15,439.14,1719,BlueCross BlueShield Minnesota,High Value Network Plan,1556.65424,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Repair Ant Abd Hernia,Any Approach, Initial, Incl Implant Of Mesh;3 Cm To 10 Cm, Incarcerated/Strang (Pro Cah)",,49594,CPT,Professional,Both,,,,1719,1461.15,439.14,1719,BlueCross BlueShield Minnesota,Medicare Advantage,784.7485,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair Ant Abd Hernia,Any Approach, Initial, Incl Implant Of Mesh;3 Cm To 10 Cm, Incarcerated/Strang (Pro Cah)",,49594,CPT,Professional,Both,,,,1719,1461.15,439.14,1719,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1556.65424,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Repair Ant Abd Hernia,Any Approach, Initial, Incl Implant Of Mesh;3 Cm To 10 Cm, Incarcerated/Strang (Pro Cah)",,49594,CPT,Professional,Both,,,,1719,1461.15,439.14,1719,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,507.00432,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Repair Ant Abd Hernia,Any Approach, Initial, Incl Implant Of Mesh;3 Cm To 10 Cm, Incarcerated/Strang (Pro Cah)",,49594,CPT,Professional,Both,,,,1719,1461.15,439.14,1719,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),784.7485,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair Ant Abd Hernia,Any Approach, Initial, Incl Implant Of Mesh;3 Cm To 10 Cm, Incarcerated/Strang (Pro Cah)",,49594,CPT,Professional,Both,,,,1719,1461.15,439.14,1719,CorVel,Worker's Compensation,,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Repair Ant Abd Hernia,Any Approach, Initial, Incl Implant Of Mesh;3 Cm To 10 Cm, Incarcerated/Strang (Pro Cah)",,49594,CPT,Professional,Both,,,,1719,1461.15,439.14,1719,First Health Group Corporation,First Health Network,1667.43,97,,percent of total billed charges,,
"Repair Ant Abd Hernia,Any Approach, Initial, Incl Implant Of Mesh;3 Cm To 10 Cm, Incarcerated/Strang (Pro Cah)",,49594,CPT,Professional,Both,,,,1719,1461.15,439.14,1719,"Health Partners, Inc.",Commercial,1460.48,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Repair Ant Abd Hernia,Any Approach, Initial, Incl Implant Of Mesh;3 Cm To 10 Cm, Incarcerated/Strang (Pro Cah)",,49594,CPT,Professional,Both,,,,1719,1461.15,439.14,1719,"Health Partners, Inc.",Medicare Advantage,784.7485,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair Ant Abd Hernia,Any Approach, Initial, Incl Implant Of Mesh;3 Cm To 10 Cm, Incarcerated/Strang (Pro Cah)",,49594,CPT,Professional,Both,,,,1719,1461.15,439.14,1719,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),682.15,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Repair Ant Abd Hernia,Any Approach, Initial, Incl Implant Of Mesh;3 Cm To 10 Cm, Incarcerated/Strang (Pro Cah)",,49594,CPT,Professional,Both,,,,1719,1461.15,439.14,1719,"Health Partners, Inc.",State of Minnesota Advantage Program,1258.20352,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Repair Ant Abd Hernia,Any Approach, Initial, Incl Implant Of Mesh;3 Cm To 10 Cm, Incarcerated/Strang (Pro Cah)",,49594,CPT,Professional,Both,,,,1719,1461.15,439.14,1719,"Health Partners, Inc.",State Public Programs,439.14,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Repair Ant Abd Hernia,Any Approach, Initial, Incl Implant Of Mesh;3 Cm To 10 Cm, Incarcerated/Strang (Pro Cah)",,49594,CPT,Professional,Both,,,,1719,1461.15,439.14,1719,Humana Insurance Company,Commercial PPO,682.39,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Repair Ant Abd Hernia,Any Approach, Initial, Incl Implant Of Mesh;3 Cm To 10 Cm, Incarcerated/Strang (Pro Cah)",,49594,CPT,Professional,Both,,,,1719,1461.15,439.14,1719,Humana Insurance Company,Medicare PPO,1719,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Repair Ant Abd Hernia,Any Approach, Initial, Incl Implant Of Mesh;3 Cm To 10 Cm, Incarcerated/Strang (Pro Cah)",,49594,CPT,Professional,Both,,,,1719,1461.15,439.14,1719,Medica,Individual & Family,1457.712,84.8,,percent of total billed charges,,
"Repair Ant Abd Hernia,Any Approach, Initial, Incl Implant Of Mesh;3 Cm To 10 Cm, Incarcerated/Strang (Pro Cah)",,49594,CPT,Professional,Both,,,,1719,1461.15,439.14,1719,Medica,Medica Advantage Solution,856.062,49.8,,percent of total billed charges,,
"Repair Ant Abd Hernia,Any Approach, Initial, Incl Implant Of Mesh;3 Cm To 10 Cm, Incarcerated/Strang (Pro Cah)",,49594,CPT,Professional,Both,,,,1719,1461.15,439.14,1719,Medica,Medical Assistance,507,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Repair Ant Abd Hernia,Any Approach, Initial, Incl Implant Of Mesh;3 Cm To 10 Cm, Incarcerated/Strang (Pro Cah)",,49594,CPT,Professional,Both,,,,1719,1461.15,439.14,1719,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,682.39,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Repair Ant Abd Hernia,Any Approach, Initial, Incl Implant Of Mesh;3 Cm To 10 Cm, Incarcerated/Strang (Pro Cah)",,49594,CPT,Professional,Both,,,,1719,1461.15,439.14,1719,"Multiplan, Inc.","Multiplan, Inc.",1615.86,94,,percent of total billed charges,,
"Repair Ant Abd Hernia,Any Approach, Initial, Incl Implant Of Mesh;3 Cm To 10 Cm, Incarcerated/Strang (Pro Cah)",,49594,CPT,Professional,Both,,,,1719,1461.15,439.14,1719,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1548.819,90.1,,percent of total billed charges,,
"Repair Ant Abd Hernia,Any Approach, Initial, Incl Implant Of Mesh;3 Cm To 10 Cm, Incarcerated/Strang (Pro Cah)",,49594,CPT,Professional,Both,,,,1719,1461.15,439.14,1719,"Preferred One Administrative Services, INC.",PPO,1694.934,98.6,,percent of total billed charges,,
"Repair Ant Abd Hernia,Any Approach, Initial, Incl Implant Of Mesh;3 Cm To 10 Cm, Incarcerated/Strang (Pro Cah)",,49594,CPT,Professional,Both,,,,1719,1461.15,439.14,1719,PrimeWest Health,Minnesota Senior Health Options (MSHO),784.7485,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair Ant Abd Hernia,Any Approach, Initial, Incl Implant Of Mesh;3 Cm To 10 Cm, Incarcerated/Strang (Pro Cah)",,49594,CPT,Professional,Both,,,,1719,1461.15,439.14,1719,PrimeWest Health,MinnesotaCare,542.4946224,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Repair Ant Abd Hernia,Any Approach, Initial, Incl Implant Of Mesh;3 Cm To 10 Cm, Incarcerated/Strang (Pro Cah)",,49594,CPT,Professional,Both,,,,1719,1461.15,439.14,1719,Sanford Health Plan,Sanford Health Plan,1512.72,88,,percent of total billed charges,,
"Repair Ant Abd Hernia,Any Approach, Initial, Incl Implant Of Mesh;3 Cm To 10 Cm, Incarcerated/Strang (Pro Cah)",,49594,CPT,Professional,Both,,,,1719,1461.15,439.14,1719,"UCare Health, Inc.",Individual & Family Plan,1109.293184,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Repair Ant Abd Hernia,Any Approach, Initial, Incl Implant Of Mesh;3 Cm To 10 Cm, Incarcerated/Strang (Pro Cah)",,49594,CPT,Professional,Both,,,,1719,1461.15,439.14,1719,"UCare Health, Inc.",Medical Assistance,557.704752,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Repair Ant Abd Hernia,Any Approach, Initial, Incl Implant Of Mesh;3 Cm To 10 Cm, Incarcerated/Strang (Pro Cah)",,49594,CPT,Professional,Both,,,,1719,1461.15,439.14,1719,"UCare Health, Inc.",Medicare Advantage,784.7485,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Repair Ant Abd Hernia,Any Approach, Initial, Incl Implant Of Mesh;3 Cm To 10 Cm, Incarcerated/Strang (Pro Cah)",,49594,CPT,Professional,Both,,,,1719,1461.15,439.14,1719,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),627.7988,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Repair Ant Abd Hernia,Any Approach, Initial, Incl Implant Of Mesh;3 Cm To 10 Cm, Incarcerated/Strang (Pro Cah)",,49594,CPT,Professional,Both,,,,1719,1461.15,439.14,1719,UnitedHealthcare,Individual & Family,1719,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Repair Ant Abd Hernia,Any Approach, Initial, Incl Implant Of Mesh;3 Cm To 10 Cm, Incarcerated/Strang (Pro Cah)",,49594,CPT,Professional,Both,,,,1719,1461.15,439.14,1719,UnitedHealthcare,Medicare Advantage,784.7485,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair Ant Abd Hernia,Any Approach, Initial, Incl Implant Of Mesh;3 Cm To 10 Cm, Incarcerated/Strang (Pro Cah)",,49594,CPT,Professional,Both,,,,1719,1461.15,439.14,1719,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,507.00432,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Repair Ant Abd Hernia, Any Approach, Initial, Incl Implantation Mesh; Greater Than 10 Cm, Reducible (Pro Cah)",,49595,CPT,Professional,Both,,,,1780,1513,454.41,1780,Aetna,Commercial,1513,85,,percent of total billed charges,,
"Repair Ant Abd Hernia, Any Approach, Initial, Incl Implantation Mesh; Greater Than 10 Cm, Reducible (Pro Cah)",,49595,CPT,Professional,Both,,,,1780,1513,454.41,1780,Aetna,Medicare Advantage,1780,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair Ant Abd Hernia, Any Approach, Initial, Incl Implantation Mesh; Greater Than 10 Cm, Reducible (Pro Cah)",,49595,CPT,Professional,Both,,,,1780,1513,454.41,1780,Aetna,PPO,1655.4,93,,percent of total billed charges,,
"Repair Ant Abd Hernia, Any Approach, Initial, Incl Implantation Mesh; Greater Than 10 Cm, Reducible (Pro Cah)",,49595,CPT,Professional,Both,,,,1780,1513,454.41,1780,America's PPO,America's PPO,1520.832,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Repair Ant Abd Hernia, Any Approach, Initial, Incl Implantation Mesh; Greater Than 10 Cm, Reducible (Pro Cah)",,49595,CPT,Professional,Both,,,,1780,1513,454.41,1780,BlueCross BlueShield Minnesota, Federal Employee Program,1581.71,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Repair Ant Abd Hernia, Any Approach, Initial, Incl Implantation Mesh; Greater Than 10 Cm, Reducible (Pro Cah)",,49595,CPT,Professional,Both,,,,1780,1513,454.41,1780,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1607.01736,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Repair Ant Abd Hernia, Any Approach, Initial, Incl Implantation Mesh; Greater Than 10 Cm, Reducible (Pro Cah)",,49595,CPT,Professional,Both,,,,1780,1513,454.41,1780,BlueCross BlueShield Minnesota,High Value Network Plan,1607.01736,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Repair Ant Abd Hernia, Any Approach, Initial, Incl Implantation Mesh; Greater Than 10 Cm, Reducible (Pro Cah)",,49595,CPT,Professional,Both,,,,1780,1513,454.41,1780,BlueCross BlueShield Minnesota,Medicare Advantage,811.9,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair Ant Abd Hernia, Any Approach, Initial, Incl Implantation Mesh; Greater Than 10 Cm, Reducible (Pro Cah)",,49595,CPT,Professional,Both,,,,1780,1513,454.41,1780,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1607.01736,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Repair Ant Abd Hernia, Any Approach, Initial, Incl Implantation Mesh; Greater Than 10 Cm, Reducible (Pro Cah)",,49595,CPT,Professional,Both,,,,1780,1513,454.41,1780,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,524.63192,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Repair Ant Abd Hernia, Any Approach, Initial, Incl Implantation Mesh; Greater Than 10 Cm, Reducible (Pro Cah)",,49595,CPT,Professional,Both,,,,1780,1513,454.41,1780,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),811.9,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair Ant Abd Hernia, Any Approach, Initial, Incl Implantation Mesh; Greater Than 10 Cm, Reducible (Pro Cah)",,49595,CPT,Professional,Both,,,,1780,1513,454.41,1780,CorVel,Worker's Compensation,,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Repair Ant Abd Hernia, Any Approach, Initial, Incl Implantation Mesh; Greater Than 10 Cm, Reducible (Pro Cah)",,49595,CPT,Professional,Both,,,,1780,1513,454.41,1780,First Health Group Corporation,First Health Network,1726.6,97,,percent of total billed charges,,
"Repair Ant Abd Hernia, Any Approach, Initial, Incl Implantation Mesh; Greater Than 10 Cm, Reducible (Pro Cah)",,49595,CPT,Professional,Both,,,,1780,1513,454.41,1780,"Health Partners, Inc.",Commercial,1511.99,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Repair Ant Abd Hernia, Any Approach, Initial, Incl Implantation Mesh; Greater Than 10 Cm, Reducible (Pro Cah)",,49595,CPT,Professional,Both,,,,1780,1513,454.41,1780,"Health Partners, Inc.",Medicare Advantage,811.9,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair Ant Abd Hernia, Any Approach, Initial, Incl Implantation Mesh; Greater Than 10 Cm, Reducible (Pro Cah)",,49595,CPT,Professional,Both,,,,1780,1513,454.41,1780,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),706.21,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Repair Ant Abd Hernia, Any Approach, Initial, Incl Implantation Mesh; Greater Than 10 Cm, Reducible (Pro Cah)",,49595,CPT,Professional,Both,,,,1780,1513,454.41,1780,"Health Partners, Inc.",State of Minnesota Advantage Program,1302.579385,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Repair Ant Abd Hernia, Any Approach, Initial, Incl Implantation Mesh; Greater Than 10 Cm, Reducible (Pro Cah)",,49595,CPT,Professional,Both,,,,1780,1513,454.41,1780,"Health Partners, Inc.",State Public Programs,454.41,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Repair Ant Abd Hernia, Any Approach, Initial, Incl Implantation Mesh; Greater Than 10 Cm, Reducible (Pro Cah)",,49595,CPT,Professional,Both,,,,1780,1513,454.41,1780,Humana Insurance Company,Commercial PPO,706,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Repair Ant Abd Hernia, Any Approach, Initial, Incl Implantation Mesh; Greater Than 10 Cm, Reducible (Pro Cah)",,49595,CPT,Professional,Both,,,,1780,1513,454.41,1780,Humana Insurance Company,Medicare PPO,1780,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Repair Ant Abd Hernia, Any Approach, Initial, Incl Implantation Mesh; Greater Than 10 Cm, Reducible (Pro Cah)",,49595,CPT,Professional,Both,,,,1780,1513,454.41,1780,Medica,Individual & Family,1509.44,84.8,,percent of total billed charges,,
"Repair Ant Abd Hernia, Any Approach, Initial, Incl Implantation Mesh; Greater Than 10 Cm, Reducible (Pro Cah)",,49595,CPT,Professional,Both,,,,1780,1513,454.41,1780,Medica,Medica Advantage Solution,886.44,49.8,,percent of total billed charges,,
"Repair Ant Abd Hernia, Any Approach, Initial, Incl Implantation Mesh; Greater Than 10 Cm, Reducible (Pro Cah)",,49595,CPT,Professional,Both,,,,1780,1513,454.41,1780,Medica,Medical Assistance,524.63,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Repair Ant Abd Hernia, Any Approach, Initial, Incl Implantation Mesh; Greater Than 10 Cm, Reducible (Pro Cah)",,49595,CPT,Professional,Both,,,,1780,1513,454.41,1780,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,706,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Repair Ant Abd Hernia, Any Approach, Initial, Incl Implantation Mesh; Greater Than 10 Cm, Reducible (Pro Cah)",,49595,CPT,Professional,Both,,,,1780,1513,454.41,1780,"Multiplan, Inc.","Multiplan, Inc.",1673.2,94,,percent of total billed charges,,
"Repair Ant Abd Hernia, Any Approach, Initial, Incl Implantation Mesh; Greater Than 10 Cm, Reducible (Pro Cah)",,49595,CPT,Professional,Both,,,,1780,1513,454.41,1780,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1603.78,90.1,,percent of total billed charges,,
"Repair Ant Abd Hernia, Any Approach, Initial, Incl Implantation Mesh; Greater Than 10 Cm, Reducible (Pro Cah)",,49595,CPT,Professional,Both,,,,1780,1513,454.41,1780,"Preferred One Administrative Services, INC.",PPO,1755.08,98.6,,percent of total billed charges,,
"Repair Ant Abd Hernia, Any Approach, Initial, Incl Implantation Mesh; Greater Than 10 Cm, Reducible (Pro Cah)",,49595,CPT,Professional,Both,,,,1780,1513,454.41,1780,PrimeWest Health,Minnesota Senior Health Options (MSHO),811.9,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair Ant Abd Hernia, Any Approach, Initial, Incl Implantation Mesh; Greater Than 10 Cm, Reducible (Pro Cah)",,49595,CPT,Professional,Both,,,,1780,1513,454.41,1780,PrimeWest Health,MinnesotaCare,561.3561544,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Repair Ant Abd Hernia, Any Approach, Initial, Incl Implantation Mesh; Greater Than 10 Cm, Reducible (Pro Cah)",,49595,CPT,Professional,Both,,,,1780,1513,454.41,1780,Sanford Health Plan,Sanford Health Plan,1566.4,88,,percent of total billed charges,,
"Repair Ant Abd Hernia, Any Approach, Initial, Incl Implantation Mesh; Greater Than 10 Cm, Reducible (Pro Cah)",,49595,CPT,Professional,Both,,,,1780,1513,454.41,1780,"UCare Health, Inc.",Individual & Family Plan,1147.6736,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Repair Ant Abd Hernia, Any Approach, Initial, Incl Implantation Mesh; Greater Than 10 Cm, Reducible (Pro Cah)",,49595,CPT,Professional,Both,,,,1780,1513,454.41,1780,"UCare Health, Inc.",Medical Assistance,577.095112,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Repair Ant Abd Hernia, Any Approach, Initial, Incl Implantation Mesh; Greater Than 10 Cm, Reducible (Pro Cah)",,49595,CPT,Professional,Both,,,,1780,1513,454.41,1780,"UCare Health, Inc.",Medicare Advantage,811.9,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Repair Ant Abd Hernia, Any Approach, Initial, Incl Implantation Mesh; Greater Than 10 Cm, Reducible (Pro Cah)",,49595,CPT,Professional,Both,,,,1780,1513,454.41,1780,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),649.52,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Repair Ant Abd Hernia, Any Approach, Initial, Incl Implantation Mesh; Greater Than 10 Cm, Reducible (Pro Cah)",,49595,CPT,Professional,Both,,,,1780,1513,454.41,1780,UnitedHealthcare,Individual & Family,1780,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Repair Ant Abd Hernia, Any Approach, Initial, Incl Implantation Mesh; Greater Than 10 Cm, Reducible (Pro Cah)",,49595,CPT,Professional,Both,,,,1780,1513,454.41,1780,UnitedHealthcare,Medicare Advantage,811.9,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair Ant Abd Hernia, Any Approach, Initial, Incl Implantation Mesh; Greater Than 10 Cm, Reducible (Pro Cah)",,49595,CPT,Professional,Both,,,,1780,1513,454.41,1780,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,524.63192,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Repair Ant Abd Hernia, Any Approach, Initial, Incl Implant Mesh;More Than 10 Cm, Incarcerated/Strang (Pro Cah)",,49596,CPT,Professional,Both,,,,2385,2027.25,603.41,2385,Aetna,Commercial,2027.25,85,,percent of total billed charges,,
"Repair Ant Abd Hernia, Any Approach, Initial, Incl Implant Mesh;More Than 10 Cm, Incarcerated/Strang (Pro Cah)",,49596,CPT,Professional,Both,,,,2385,2027.25,603.41,2385,Aetna,Medicare Advantage,2385,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair Ant Abd Hernia, Any Approach, Initial, Incl Implant Mesh;More Than 10 Cm, Incarcerated/Strang (Pro Cah)",,49596,CPT,Professional,Both,,,,2385,2027.25,603.41,2385,Aetna,PPO,2218.05,93,,percent of total billed charges,,
"Repair Ant Abd Hernia, Any Approach, Initial, Incl Implant Mesh;More Than 10 Cm, Incarcerated/Strang (Pro Cah)",,49596,CPT,Professional,Both,,,,2385,2027.25,603.41,2385,America's PPO,America's PPO,2037.744,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Repair Ant Abd Hernia, Any Approach, Initial, Incl Implant Mesh;More Than 10 Cm, Incarcerated/Strang (Pro Cah)",,49596,CPT,Professional,Both,,,,2385,2027.25,603.41,2385,BlueCross BlueShield Minnesota, Federal Employee Program,2100.23,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Repair Ant Abd Hernia, Any Approach, Initial, Incl Implant Mesh;More Than 10 Cm, Incarcerated/Strang (Pro Cah)",,49596,CPT,Professional,Both,,,,2385,2027.25,603.41,2385,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,2133.83368,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Repair Ant Abd Hernia, Any Approach, Initial, Incl Implant Mesh;More Than 10 Cm, Incarcerated/Strang (Pro Cah)",,49596,CPT,Professional,Both,,,,2385,2027.25,603.41,2385,BlueCross BlueShield Minnesota,High Value Network Plan,2133.83368,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Repair Ant Abd Hernia, Any Approach, Initial, Incl Implant Mesh;More Than 10 Cm, Incarcerated/Strang (Pro Cah)",,49596,CPT,Professional,Both,,,,2385,2027.25,603.41,2385,BlueCross BlueShield Minnesota,Medicare Advantage,1078.2515,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair Ant Abd Hernia, Any Approach, Initial, Incl Implant Mesh;More Than 10 Cm, Incarcerated/Strang (Pro Cah)",,49596,CPT,Professional,Both,,,,2385,2027.25,603.41,2385,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,2133.83368,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Repair Ant Abd Hernia, Any Approach, Initial, Incl Implant Mesh;More Than 10 Cm, Incarcerated/Strang (Pro Cah)",,49596,CPT,Professional,Both,,,,2385,2027.25,603.41,2385,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,696.66104,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Repair Ant Abd Hernia, Any Approach, Initial, Incl Implant Mesh;More Than 10 Cm, Incarcerated/Strang (Pro Cah)",,49596,CPT,Professional,Both,,,,2385,2027.25,603.41,2385,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1078.2515,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair Ant Abd Hernia, Any Approach, Initial, Incl Implant Mesh;More Than 10 Cm, Incarcerated/Strang (Pro Cah)",,49596,CPT,Professional,Both,,,,2385,2027.25,603.41,2385,CorVel,Worker's Compensation,,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Repair Ant Abd Hernia, Any Approach, Initial, Incl Implant Mesh;More Than 10 Cm, Incarcerated/Strang (Pro Cah)",,49596,CPT,Professional,Both,,,,2385,2027.25,603.41,2385,First Health Group Corporation,First Health Network,2313.45,97,,percent of total billed charges,,
"Repair Ant Abd Hernia, Any Approach, Initial, Incl Implant Mesh;More Than 10 Cm, Incarcerated/Strang (Pro Cah)",,49596,CPT,Professional,Both,,,,2385,2027.25,603.41,2385,"Health Partners, Inc.",Commercial,2007.52,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Repair Ant Abd Hernia, Any Approach, Initial, Incl Implant Mesh;More Than 10 Cm, Incarcerated/Strang (Pro Cah)",,49596,CPT,Professional,Both,,,,2385,2027.25,603.41,2385,"Health Partners, Inc.",Medicare Advantage,1078.2515,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair Ant Abd Hernia, Any Approach, Initial, Incl Implant Mesh;More Than 10 Cm, Incarcerated/Strang (Pro Cah)",,49596,CPT,Professional,Both,,,,2385,2027.25,603.41,2385,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),937.66,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Repair Ant Abd Hernia, Any Approach, Initial, Incl Implant Mesh;More Than 10 Cm, Incarcerated/Strang (Pro Cah)",,49596,CPT,Professional,Both,,,,2385,2027.25,603.41,2385,"Health Partners, Inc.",State of Minnesota Advantage Program,1729.47848,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Repair Ant Abd Hernia, Any Approach, Initial, Incl Implant Mesh;More Than 10 Cm, Incarcerated/Strang (Pro Cah)",,49596,CPT,Professional,Both,,,,2385,2027.25,603.41,2385,"Health Partners, Inc.",State Public Programs,603.41,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Repair Ant Abd Hernia, Any Approach, Initial, Incl Implant Mesh;More Than 10 Cm, Incarcerated/Strang (Pro Cah)",,49596,CPT,Professional,Both,,,,2385,2027.25,603.41,2385,Humana Insurance Company,Commercial PPO,937.61,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Repair Ant Abd Hernia, Any Approach, Initial, Incl Implant Mesh;More Than 10 Cm, Incarcerated/Strang (Pro Cah)",,49596,CPT,Professional,Both,,,,2385,2027.25,603.41,2385,Humana Insurance Company,Medicare PPO,2385,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Repair Ant Abd Hernia, Any Approach, Initial, Incl Implant Mesh;More Than 10 Cm, Incarcerated/Strang (Pro Cah)",,49596,CPT,Professional,Both,,,,2385,2027.25,603.41,2385,Medica,Individual & Family,2022.48,84.8,,percent of total billed charges,,
"Repair Ant Abd Hernia, Any Approach, Initial, Incl Implant Mesh;More Than 10 Cm, Incarcerated/Strang (Pro Cah)",,49596,CPT,Professional,Both,,,,2385,2027.25,603.41,2385,Medica,Medica Advantage Solution,1187.73,49.8,,percent of total billed charges,,
"Repair Ant Abd Hernia, Any Approach, Initial, Incl Implant Mesh;More Than 10 Cm, Incarcerated/Strang (Pro Cah)",,49596,CPT,Professional,Both,,,,2385,2027.25,603.41,2385,Medica,Medical Assistance,696.66,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Repair Ant Abd Hernia, Any Approach, Initial, Incl Implant Mesh;More Than 10 Cm, Incarcerated/Strang (Pro Cah)",,49596,CPT,Professional,Both,,,,2385,2027.25,603.41,2385,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,937.61,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Repair Ant Abd Hernia, Any Approach, Initial, Incl Implant Mesh;More Than 10 Cm, Incarcerated/Strang (Pro Cah)",,49596,CPT,Professional,Both,,,,2385,2027.25,603.41,2385,"Multiplan, Inc.","Multiplan, Inc.",2241.9,94,,percent of total billed charges,,
"Repair Ant Abd Hernia, Any Approach, Initial, Incl Implant Mesh;More Than 10 Cm, Incarcerated/Strang (Pro Cah)",,49596,CPT,Professional,Both,,,,2385,2027.25,603.41,2385,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,2148.885,90.1,,percent of total billed charges,,
"Repair Ant Abd Hernia, Any Approach, Initial, Incl Implant Mesh;More Than 10 Cm, Incarcerated/Strang (Pro Cah)",,49596,CPT,Professional,Both,,,,2385,2027.25,603.41,2385,"Preferred One Administrative Services, INC.",PPO,2351.61,98.6,,percent of total billed charges,,
"Repair Ant Abd Hernia, Any Approach, Initial, Incl Implant Mesh;More Than 10 Cm, Incarcerated/Strang (Pro Cah)",,49596,CPT,Professional,Both,,,,2385,2027.25,603.41,2385,PrimeWest Health,Minnesota Senior Health Options (MSHO),1078.2515,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair Ant Abd Hernia, Any Approach, Initial, Incl Implant Mesh;More Than 10 Cm, Incarcerated/Strang (Pro Cah)",,49596,CPT,Professional,Both,,,,2385,2027.25,603.41,2385,PrimeWest Health,MinnesotaCare,745.4273128,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Repair Ant Abd Hernia, Any Approach, Initial, Incl Implant Mesh;More Than 10 Cm, Incarcerated/Strang (Pro Cah)",,49596,CPT,Professional,Both,,,,2385,2027.25,603.41,2385,Sanford Health Plan,Sanford Health Plan,2098.8,88,,percent of total billed charges,,
"Repair Ant Abd Hernia, Any Approach, Initial, Incl Implant Mesh;More Than 10 Cm, Incarcerated/Strang (Pro Cah)",,49596,CPT,Professional,Both,,,,2385,2027.25,603.41,2385,"UCare Health, Inc.",Individual & Family Plan,1524.178816,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Repair Ant Abd Hernia, Any Approach, Initial, Incl Implant Mesh;More Than 10 Cm, Incarcerated/Strang (Pro Cah)",,49596,CPT,Professional,Both,,,,2385,2027.25,603.41,2385,"UCare Health, Inc.",Medical Assistance,766.327144,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Repair Ant Abd Hernia, Any Approach, Initial, Incl Implant Mesh;More Than 10 Cm, Incarcerated/Strang (Pro Cah)",,49596,CPT,Professional,Both,,,,2385,2027.25,603.41,2385,"UCare Health, Inc.",Medicare Advantage,1078.2515,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Repair Ant Abd Hernia, Any Approach, Initial, Incl Implant Mesh;More Than 10 Cm, Incarcerated/Strang (Pro Cah)",,49596,CPT,Professional,Both,,,,2385,2027.25,603.41,2385,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),862.6012,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Repair Ant Abd Hernia, Any Approach, Initial, Incl Implant Mesh;More Than 10 Cm, Incarcerated/Strang (Pro Cah)",,49596,CPT,Professional,Both,,,,2385,2027.25,603.41,2385,UnitedHealthcare,Individual & Family,2385,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Repair Ant Abd Hernia, Any Approach, Initial, Incl Implant Mesh;More Than 10 Cm, Incarcerated/Strang (Pro Cah)",,49596,CPT,Professional,Both,,,,2385,2027.25,603.41,2385,UnitedHealthcare,Medicare Advantage,1078.2515,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair Ant Abd Hernia, Any Approach, Initial, Incl Implant Mesh;More Than 10 Cm, Incarcerated/Strang (Pro Cah)",,49596,CPT,Professional,Both,,,,2385,2027.25,603.41,2385,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,696.66104,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Repair Anterior Abd Hernia, Any Approach,Recurrent, Incl Implant Mesh, Less Than 3 Cm, Reducible (Pro Cah)",,49613,CPT,Professional,Both,,,,950,807.5,249.56,950,Aetna,Commercial,807.5,85,,percent of total billed charges,,
"Repair Anterior Abd Hernia, Any Approach,Recurrent, Incl Implant Mesh, Less Than 3 Cm, Reducible (Pro Cah)",,49613,CPT,Professional,Both,,,,950,807.5,249.56,950,Aetna,Medicare Advantage,950,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair Anterior Abd Hernia, Any Approach,Recurrent, Incl Implant Mesh, Less Than 3 Cm, Reducible (Pro Cah)",,49613,CPT,Professional,Both,,,,950,807.5,249.56,950,Aetna,PPO,883.5,93,,percent of total billed charges,,
"Repair Anterior Abd Hernia, Any Approach,Recurrent, Incl Implant Mesh, Less Than 3 Cm, Reducible (Pro Cah)",,49613,CPT,Professional,Both,,,,950,807.5,249.56,950,America's PPO,America's PPO,811.68,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Repair Anterior Abd Hernia, Any Approach,Recurrent, Incl Implant Mesh, Less Than 3 Cm, Reducible (Pro Cah)",,49613,CPT,Professional,Both,,,,950,807.5,249.56,950,BlueCross BlueShield Minnesota, Federal Employee Program,865.57,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Repair Anterior Abd Hernia, Any Approach,Recurrent, Incl Implant Mesh, Less Than 3 Cm, Reducible (Pro Cah)",,49613,CPT,Professional,Both,,,,950,807.5,249.56,950,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,879.41912,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Repair Anterior Abd Hernia, Any Approach,Recurrent, Incl Implant Mesh, Less Than 3 Cm, Reducible (Pro Cah)",,49613,CPT,Professional,Both,,,,950,807.5,249.56,950,BlueCross BlueShield Minnesota,High Value Network Plan,879.41912,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Repair Anterior Abd Hernia, Any Approach,Recurrent, Incl Implant Mesh, Less Than 3 Cm, Reducible (Pro Cah)",,49613,CPT,Professional,Both,,,,950,807.5,249.56,950,BlueCross BlueShield Minnesota,Medicare Advantage,445.8665,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair Anterior Abd Hernia, Any Approach,Recurrent, Incl Implant Mesh, Less Than 3 Cm, Reducible (Pro Cah)",,49613,CPT,Professional,Both,,,,950,807.5,249.56,950,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,879.41912,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Repair Anterior Abd Hernia, Any Approach,Recurrent, Incl Implant Mesh, Less Than 3 Cm, Reducible (Pro Cah)",,49613,CPT,Professional,Both,,,,950,807.5,249.56,950,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,288.12744,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Repair Anterior Abd Hernia, Any Approach,Recurrent, Incl Implant Mesh, Less Than 3 Cm, Reducible (Pro Cah)",,49613,CPT,Professional,Both,,,,950,807.5,249.56,950,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),445.8665,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair Anterior Abd Hernia, Any Approach,Recurrent, Incl Implant Mesh, Less Than 3 Cm, Reducible (Pro Cah)",,49613,CPT,Professional,Both,,,,950,807.5,249.56,950,CorVel,Worker's Compensation,,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Repair Anterior Abd Hernia, Any Approach,Recurrent, Incl Implant Mesh, Less Than 3 Cm, Reducible (Pro Cah)",,49613,CPT,Professional,Both,,,,950,807.5,249.56,950,First Health Group Corporation,First Health Network,921.5,97,,percent of total billed charges,,
"Repair Anterior Abd Hernia, Any Approach,Recurrent, Incl Implant Mesh, Less Than 3 Cm, Reducible (Pro Cah)",,49613,CPT,Professional,Both,,,,950,807.5,249.56,950,"Health Partners, Inc.",Commercial,830,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Repair Anterior Abd Hernia, Any Approach,Recurrent, Incl Implant Mesh, Less Than 3 Cm, Reducible (Pro Cah)",,49613,CPT,Professional,Both,,,,950,807.5,249.56,950,"Health Partners, Inc.",Medicare Advantage,445.8665,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair Anterior Abd Hernia, Any Approach,Recurrent, Incl Implant Mesh, Less Than 3 Cm, Reducible (Pro Cah)",,49613,CPT,Professional,Both,,,,950,807.5,249.56,950,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),387.67,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Repair Anterior Abd Hernia, Any Approach,Recurrent, Incl Implant Mesh, Less Than 3 Cm, Reducible (Pro Cah)",,49613,CPT,Professional,Both,,,,950,807.5,249.56,950,"Health Partners, Inc.",State of Minnesota Advantage Program,715.045,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Repair Anterior Abd Hernia, Any Approach,Recurrent, Incl Implant Mesh, Less Than 3 Cm, Reducible (Pro Cah)",,49613,CPT,Professional,Both,,,,950,807.5,249.56,950,"Health Partners, Inc.",State Public Programs,249.56,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Repair Anterior Abd Hernia, Any Approach,Recurrent, Incl Implant Mesh, Less Than 3 Cm, Reducible (Pro Cah)",,49613,CPT,Professional,Both,,,,950,807.5,249.56,950,Humana Insurance Company,Commercial PPO,387.71,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Repair Anterior Abd Hernia, Any Approach,Recurrent, Incl Implant Mesh, Less Than 3 Cm, Reducible (Pro Cah)",,49613,CPT,Professional,Both,,,,950,807.5,249.56,950,Humana Insurance Company,Medicare PPO,950,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Repair Anterior Abd Hernia, Any Approach,Recurrent, Incl Implant Mesh, Less Than 3 Cm, Reducible (Pro Cah)",,49613,CPT,Professional,Both,,,,950,807.5,249.56,950,Medica,Individual & Family,805.6,84.8,,percent of total billed charges,,
"Repair Anterior Abd Hernia, Any Approach,Recurrent, Incl Implant Mesh, Less Than 3 Cm, Reducible (Pro Cah)",,49613,CPT,Professional,Both,,,,950,807.5,249.56,950,Medica,Medica Advantage Solution,473.1,49.8,,percent of total billed charges,,
"Repair Anterior Abd Hernia, Any Approach,Recurrent, Incl Implant Mesh, Less Than 3 Cm, Reducible (Pro Cah)",,49613,CPT,Professional,Both,,,,950,807.5,249.56,950,Medica,Medical Assistance,288.13,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Repair Anterior Abd Hernia, Any Approach,Recurrent, Incl Implant Mesh, Less Than 3 Cm, Reducible (Pro Cah)",,49613,CPT,Professional,Both,,,,950,807.5,249.56,950,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,387.71,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Repair Anterior Abd Hernia, Any Approach,Recurrent, Incl Implant Mesh, Less Than 3 Cm, Reducible (Pro Cah)",,49613,CPT,Professional,Both,,,,950,807.5,249.56,950,"Multiplan, Inc.","Multiplan, Inc.",893,94,,percent of total billed charges,,
"Repair Anterior Abd Hernia, Any Approach,Recurrent, Incl Implant Mesh, Less Than 3 Cm, Reducible (Pro Cah)",,49613,CPT,Professional,Both,,,,950,807.5,249.56,950,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,855.95,90.1,,percent of total billed charges,,
"Repair Anterior Abd Hernia, Any Approach,Recurrent, Incl Implant Mesh, Less Than 3 Cm, Reducible (Pro Cah)",,49613,CPT,Professional,Both,,,,950,807.5,249.56,950,"Preferred One Administrative Services, INC.",PPO,936.7,98.6,,percent of total billed charges,,
"Repair Anterior Abd Hernia, Any Approach,Recurrent, Incl Implant Mesh, Less Than 3 Cm, Reducible (Pro Cah)",,49613,CPT,Professional,Both,,,,950,807.5,249.56,950,PrimeWest Health,Minnesota Senior Health Options (MSHO),445.8665,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair Anterior Abd Hernia, Any Approach,Recurrent, Incl Implant Mesh, Less Than 3 Cm, Reducible (Pro Cah)",,49613,CPT,Professional,Both,,,,950,807.5,249.56,950,PrimeWest Health,MinnesotaCare,308.2963608,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Repair Anterior Abd Hernia, Any Approach,Recurrent, Incl Implant Mesh, Less Than 3 Cm, Reducible (Pro Cah)",,49613,CPT,Professional,Both,,,,950,807.5,249.56,950,Sanford Health Plan,Sanford Health Plan,836,88,,percent of total billed charges,,
"Repair Anterior Abd Hernia, Any Approach,Recurrent, Incl Implant Mesh, Less Than 3 Cm, Reducible (Pro Cah)",,49613,CPT,Professional,Both,,,,950,807.5,249.56,950,"UCare Health, Inc.",Individual & Family Plan,630.261376,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Repair Anterior Abd Hernia, Any Approach,Recurrent, Incl Implant Mesh, Less Than 3 Cm, Reducible (Pro Cah)",,49613,CPT,Professional,Both,,,,950,807.5,249.56,950,"UCare Health, Inc.",Medical Assistance,316.940184,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Repair Anterior Abd Hernia, Any Approach,Recurrent, Incl Implant Mesh, Less Than 3 Cm, Reducible (Pro Cah)",,49613,CPT,Professional,Both,,,,950,807.5,249.56,950,"UCare Health, Inc.",Medicare Advantage,445.8665,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Repair Anterior Abd Hernia, Any Approach,Recurrent, Incl Implant Mesh, Less Than 3 Cm, Reducible (Pro Cah)",,49613,CPT,Professional,Both,,,,950,807.5,249.56,950,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),356.6932,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Repair Anterior Abd Hernia, Any Approach,Recurrent, Incl Implant Mesh, Less Than 3 Cm, Reducible (Pro Cah)",,49613,CPT,Professional,Both,,,,950,807.5,249.56,950,UnitedHealthcare,Individual & Family,950,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Repair Anterior Abd Hernia, Any Approach,Recurrent, Incl Implant Mesh, Less Than 3 Cm, Reducible (Pro Cah)",,49613,CPT,Professional,Both,,,,950,807.5,249.56,950,UnitedHealthcare,Medicare Advantage,445.8665,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair Anterior Abd Hernia, Any Approach,Recurrent, Incl Implant Mesh, Less Than 3 Cm, Reducible (Pro Cah)",,49613,CPT,Professional,Both,,,,950,807.5,249.56,950,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,288.12744,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Repair Ant Abd Hernia, Any Approach,Recurrent, Incl Implant Mesh,Less Than 3 Cm, Incarcerated/Strang (Pro Cah)",,49614,CPT,Professional,Both,,,,1310,1113.5,337.04,1310,Aetna,Commercial,1113.5,85,,percent of total billed charges,,
"Repair Ant Abd Hernia, Any Approach,Recurrent, Incl Implant Mesh,Less Than 3 Cm, Incarcerated/Strang (Pro Cah)",,49614,CPT,Professional,Both,,,,1310,1113.5,337.04,1310,Aetna,Medicare Advantage,1310,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair Ant Abd Hernia, Any Approach,Recurrent, Incl Implant Mesh,Less Than 3 Cm, Incarcerated/Strang (Pro Cah)",,49614,CPT,Professional,Both,,,,1310,1113.5,337.04,1310,Aetna,PPO,1218.3,93,,percent of total billed charges,,
"Repair Ant Abd Hernia, Any Approach,Recurrent, Incl Implant Mesh,Less Than 3 Cm, Incarcerated/Strang (Pro Cah)",,49614,CPT,Professional,Both,,,,1310,1113.5,337.04,1310,America's PPO,America's PPO,1119.264,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Repair Ant Abd Hernia, Any Approach,Recurrent, Incl Implant Mesh,Less Than 3 Cm, Incarcerated/Strang (Pro Cah)",,49614,CPT,Professional,Both,,,,1310,1113.5,337.04,1310,BlueCross BlueShield Minnesota, Federal Employee Program,1173.37,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Repair Ant Abd Hernia, Any Approach,Recurrent, Incl Implant Mesh,Less Than 3 Cm, Incarcerated/Strang (Pro Cah)",,49614,CPT,Professional,Both,,,,1310,1113.5,337.04,1310,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1192.14392,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Repair Ant Abd Hernia, Any Approach,Recurrent, Incl Implant Mesh,Less Than 3 Cm, Incarcerated/Strang (Pro Cah)",,49614,CPT,Professional,Both,,,,1310,1113.5,337.04,1310,BlueCross BlueShield Minnesota,High Value Network Plan,1192.14392,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Repair Ant Abd Hernia, Any Approach,Recurrent, Incl Implant Mesh,Less Than 3 Cm, Incarcerated/Strang (Pro Cah)",,49614,CPT,Professional,Both,,,,1310,1113.5,337.04,1310,BlueCross BlueShield Minnesota,Medicare Advantage,602.508,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair Ant Abd Hernia, Any Approach,Recurrent, Incl Implant Mesh,Less Than 3 Cm, Incarcerated/Strang (Pro Cah)",,49614,CPT,Professional,Both,,,,1310,1113.5,337.04,1310,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1192.14392,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Repair Ant Abd Hernia, Any Approach,Recurrent, Incl Implant Mesh,Less Than 3 Cm, Incarcerated/Strang (Pro Cah)",,49614,CPT,Professional,Both,,,,1310,1113.5,337.04,1310,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,389.128,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Repair Ant Abd Hernia, Any Approach,Recurrent, Incl Implant Mesh,Less Than 3 Cm, Incarcerated/Strang (Pro Cah)",,49614,CPT,Professional,Both,,,,1310,1113.5,337.04,1310,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),602.508,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair Ant Abd Hernia, Any Approach,Recurrent, Incl Implant Mesh,Less Than 3 Cm, Incarcerated/Strang (Pro Cah)",,49614,CPT,Professional,Both,,,,1310,1113.5,337.04,1310,CorVel,Worker's Compensation,,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Repair Ant Abd Hernia, Any Approach,Recurrent, Incl Implant Mesh,Less Than 3 Cm, Incarcerated/Strang (Pro Cah)",,49614,CPT,Professional,Both,,,,1310,1113.5,337.04,1310,First Health Group Corporation,First Health Network,1270.7,97,,percent of total billed charges,,
"Repair Ant Abd Hernia, Any Approach,Recurrent, Incl Implant Mesh,Less Than 3 Cm, Incarcerated/Strang (Pro Cah)",,49614,CPT,Professional,Both,,,,1310,1113.5,337.04,1310,"Health Partners, Inc.",Commercial,1121.66,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Repair Ant Abd Hernia, Any Approach,Recurrent, Incl Implant Mesh,Less Than 3 Cm, Incarcerated/Strang (Pro Cah)",,49614,CPT,Professional,Both,,,,1310,1113.5,337.04,1310,"Health Partners, Inc.",Medicare Advantage,602.508,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair Ant Abd Hernia, Any Approach,Recurrent, Incl Implant Mesh,Less Than 3 Cm, Incarcerated/Strang (Pro Cah)",,49614,CPT,Professional,Both,,,,1310,1113.5,337.04,1310,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),523.9,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Repair Ant Abd Hernia, Any Approach,Recurrent, Incl Implant Mesh,Less Than 3 Cm, Incarcerated/Strang (Pro Cah)",,49614,CPT,Professional,Both,,,,1310,1113.5,337.04,1310,"Health Partners, Inc.",State of Minnesota Advantage Program,966.31009,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Repair Ant Abd Hernia, Any Approach,Recurrent, Incl Implant Mesh,Less Than 3 Cm, Incarcerated/Strang (Pro Cah)",,49614,CPT,Professional,Both,,,,1310,1113.5,337.04,1310,"Health Partners, Inc.",State Public Programs,337.04,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Repair Ant Abd Hernia, Any Approach,Recurrent, Incl Implant Mesh,Less Than 3 Cm, Incarcerated/Strang (Pro Cah)",,49614,CPT,Professional,Both,,,,1310,1113.5,337.04,1310,Humana Insurance Company,Commercial PPO,523.92,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Repair Ant Abd Hernia, Any Approach,Recurrent, Incl Implant Mesh,Less Than 3 Cm, Incarcerated/Strang (Pro Cah)",,49614,CPT,Professional,Both,,,,1310,1113.5,337.04,1310,Humana Insurance Company,Medicare PPO,1310,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Repair Ant Abd Hernia, Any Approach,Recurrent, Incl Implant Mesh,Less Than 3 Cm, Incarcerated/Strang (Pro Cah)",,49614,CPT,Professional,Both,,,,1310,1113.5,337.04,1310,Medica,Individual & Family,1110.88,84.8,,percent of total billed charges,,
"Repair Ant Abd Hernia, Any Approach,Recurrent, Incl Implant Mesh,Less Than 3 Cm, Incarcerated/Strang (Pro Cah)",,49614,CPT,Professional,Both,,,,1310,1113.5,337.04,1310,Medica,Medica Advantage Solution,652.38,49.8,,percent of total billed charges,,
"Repair Ant Abd Hernia, Any Approach,Recurrent, Incl Implant Mesh,Less Than 3 Cm, Incarcerated/Strang (Pro Cah)",,49614,CPT,Professional,Both,,,,1310,1113.5,337.04,1310,Medica,Medical Assistance,389.13,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Repair Ant Abd Hernia, Any Approach,Recurrent, Incl Implant Mesh,Less Than 3 Cm, Incarcerated/Strang (Pro Cah)",,49614,CPT,Professional,Both,,,,1310,1113.5,337.04,1310,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,523.92,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Repair Ant Abd Hernia, Any Approach,Recurrent, Incl Implant Mesh,Less Than 3 Cm, Incarcerated/Strang (Pro Cah)",,49614,CPT,Professional,Both,,,,1310,1113.5,337.04,1310,"Multiplan, Inc.","Multiplan, Inc.",1231.4,94,,percent of total billed charges,,
"Repair Ant Abd Hernia, Any Approach,Recurrent, Incl Implant Mesh,Less Than 3 Cm, Incarcerated/Strang (Pro Cah)",,49614,CPT,Professional,Both,,,,1310,1113.5,337.04,1310,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1180.31,90.1,,percent of total billed charges,,
"Repair Ant Abd Hernia, Any Approach,Recurrent, Incl Implant Mesh,Less Than 3 Cm, Incarcerated/Strang (Pro Cah)",,49614,CPT,Professional,Both,,,,1310,1113.5,337.04,1310,"Preferred One Administrative Services, INC.",PPO,1291.66,98.6,,percent of total billed charges,,
"Repair Ant Abd Hernia, Any Approach,Recurrent, Incl Implant Mesh,Less Than 3 Cm, Incarcerated/Strang (Pro Cah)",,49614,CPT,Professional,Both,,,,1310,1113.5,337.04,1310,PrimeWest Health,Minnesota Senior Health Options (MSHO),602.508,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair Ant Abd Hernia, Any Approach,Recurrent, Incl Implant Mesh,Less Than 3 Cm, Incarcerated/Strang (Pro Cah)",,49614,CPT,Professional,Both,,,,1310,1113.5,337.04,1310,PrimeWest Health,MinnesotaCare,416.36696,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Repair Ant Abd Hernia, Any Approach,Recurrent, Incl Implant Mesh,Less Than 3 Cm, Incarcerated/Strang (Pro Cah)",,49614,CPT,Professional,Both,,,,1310,1113.5,337.04,1310,Sanford Health Plan,Sanford Health Plan,1152.8,88,,percent of total billed charges,,
"Repair Ant Abd Hernia, Any Approach,Recurrent, Incl Implant Mesh,Less Than 3 Cm, Incarcerated/Strang (Pro Cah)",,49614,CPT,Professional,Both,,,,1310,1113.5,337.04,1310,"UCare Health, Inc.",Individual & Family Plan,851.684352,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Repair Ant Abd Hernia, Any Approach,Recurrent, Incl Implant Mesh,Less Than 3 Cm, Incarcerated/Strang (Pro Cah)",,49614,CPT,Professional,Both,,,,1310,1113.5,337.04,1310,"UCare Health, Inc.",Medical Assistance,428.0408,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Repair Ant Abd Hernia, Any Approach,Recurrent, Incl Implant Mesh,Less Than 3 Cm, Incarcerated/Strang (Pro Cah)",,49614,CPT,Professional,Both,,,,1310,1113.5,337.04,1310,"UCare Health, Inc.",Medicare Advantage,602.508,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Repair Ant Abd Hernia, Any Approach,Recurrent, Incl Implant Mesh,Less Than 3 Cm, Incarcerated/Strang (Pro Cah)",,49614,CPT,Professional,Both,,,,1310,1113.5,337.04,1310,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),482.0064,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Repair Ant Abd Hernia, Any Approach,Recurrent, Incl Implant Mesh,Less Than 3 Cm, Incarcerated/Strang (Pro Cah)",,49614,CPT,Professional,Both,,,,1310,1113.5,337.04,1310,UnitedHealthcare,Individual & Family,1310,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Repair Ant Abd Hernia, Any Approach,Recurrent, Incl Implant Mesh,Less Than 3 Cm, Incarcerated/Strang (Pro Cah)",,49614,CPT,Professional,Both,,,,1310,1113.5,337.04,1310,UnitedHealthcare,Medicare Advantage,602.508,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair Ant Abd Hernia, Any Approach,Recurrent, Incl Implant Mesh,Less Than 3 Cm, Incarcerated/Strang (Pro Cah)",,49614,CPT,Professional,Both,,,,1310,1113.5,337.04,1310,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,389.128,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Repair Anterior Abd Hernia, Any Approach,Recurrent, Incl Implant Of Mesh, 3 Cm To 10 Cm, Reducible (Pro Cah)",,49615,CPT,Professional,Both,,,,1465,1245.25,377.18,1465,Aetna,Commercial,1245.25,85,,percent of total billed charges,,
"Repair Anterior Abd Hernia, Any Approach,Recurrent, Incl Implant Of Mesh, 3 Cm To 10 Cm, Reducible (Pro Cah)",,49615,CPT,Professional,Both,,,,1465,1245.25,377.18,1465,Aetna,Medicare Advantage,1465,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair Anterior Abd Hernia, Any Approach,Recurrent, Incl Implant Of Mesh, 3 Cm To 10 Cm, Reducible (Pro Cah)",,49615,CPT,Professional,Both,,,,1465,1245.25,377.18,1465,Aetna,PPO,1362.45,93,,percent of total billed charges,,
"Repair Anterior Abd Hernia, Any Approach,Recurrent, Incl Implant Of Mesh, 3 Cm To 10 Cm, Reducible (Pro Cah)",,49615,CPT,Professional,Both,,,,1465,1245.25,377.18,1465,America's PPO,America's PPO,1251.696,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Repair Anterior Abd Hernia, Any Approach,Recurrent, Incl Implant Of Mesh, 3 Cm To 10 Cm, Reducible (Pro Cah)",,49615,CPT,Professional,Both,,,,1465,1245.25,377.18,1465,BlueCross BlueShield Minnesota, Federal Employee Program,1313.16,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Repair Anterior Abd Hernia, Any Approach,Recurrent, Incl Implant Of Mesh, 3 Cm To 10 Cm, Reducible (Pro Cah)",,49615,CPT,Professional,Both,,,,1465,1245.25,377.18,1465,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1334.17056,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Repair Anterior Abd Hernia, Any Approach,Recurrent, Incl Implant Of Mesh, 3 Cm To 10 Cm, Reducible (Pro Cah)",,49615,CPT,Professional,Both,,,,1465,1245.25,377.18,1465,BlueCross BlueShield Minnesota,High Value Network Plan,1334.17056,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Repair Anterior Abd Hernia, Any Approach,Recurrent, Incl Implant Of Mesh, 3 Cm To 10 Cm, Reducible (Pro Cah)",,49615,CPT,Professional,Both,,,,1465,1245.25,377.18,1465,BlueCross BlueShield Minnesota,Medicare Advantage,673.992,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair Anterior Abd Hernia, Any Approach,Recurrent, Incl Implant Of Mesh, 3 Cm To 10 Cm, Reducible (Pro Cah)",,49615,CPT,Professional,Both,,,,1465,1245.25,377.18,1465,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1334.17056,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Repair Anterior Abd Hernia, Any Approach,Recurrent, Incl Implant Of Mesh, 3 Cm To 10 Cm, Reducible (Pro Cah)",,49615,CPT,Professional,Both,,,,1465,1245.25,377.18,1465,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,435.46776,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Repair Anterior Abd Hernia, Any Approach,Recurrent, Incl Implant Of Mesh, 3 Cm To 10 Cm, Reducible (Pro Cah)",,49615,CPT,Professional,Both,,,,1465,1245.25,377.18,1465,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),673.992,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair Anterior Abd Hernia, Any Approach,Recurrent, Incl Implant Of Mesh, 3 Cm To 10 Cm, Reducible (Pro Cah)",,49615,CPT,Professional,Both,,,,1465,1245.25,377.18,1465,CorVel,Worker's Compensation,,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Repair Anterior Abd Hernia, Any Approach,Recurrent, Incl Implant Of Mesh, 3 Cm To 10 Cm, Reducible (Pro Cah)",,49615,CPT,Professional,Both,,,,1465,1245.25,377.18,1465,First Health Group Corporation,First Health Network,1421.05,97,,percent of total billed charges,,
"Repair Anterior Abd Hernia, Any Approach,Recurrent, Incl Implant Of Mesh, 3 Cm To 10 Cm, Reducible (Pro Cah)",,49615,CPT,Professional,Both,,,,1465,1245.25,377.18,1465,"Health Partners, Inc.",Commercial,1254.43,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Repair Anterior Abd Hernia, Any Approach,Recurrent, Incl Implant Of Mesh, 3 Cm To 10 Cm, Reducible (Pro Cah)",,49615,CPT,Professional,Both,,,,1465,1245.25,377.18,1465,"Health Partners, Inc.",Medicare Advantage,673.992,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair Anterior Abd Hernia, Any Approach,Recurrent, Incl Implant Of Mesh, 3 Cm To 10 Cm, Reducible (Pro Cah)",,49615,CPT,Professional,Both,,,,1465,1245.25,377.18,1465,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),585.91,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Repair Anterior Abd Hernia, Any Approach,Recurrent, Incl Implant Of Mesh, 3 Cm To 10 Cm, Reducible (Pro Cah)",,49615,CPT,Professional,Both,,,,1465,1245.25,377.18,1465,"Health Partners, Inc.",State of Minnesota Advantage Program,1080.691445,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Repair Anterior Abd Hernia, Any Approach,Recurrent, Incl Implant Of Mesh, 3 Cm To 10 Cm, Reducible (Pro Cah)",,49615,CPT,Professional,Both,,,,1465,1245.25,377.18,1465,"Health Partners, Inc.",State Public Programs,377.18,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Repair Anterior Abd Hernia, Any Approach,Recurrent, Incl Implant Of Mesh, 3 Cm To 10 Cm, Reducible (Pro Cah)",,49615,CPT,Professional,Both,,,,1465,1245.25,377.18,1465,Humana Insurance Company,Commercial PPO,586.08,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Repair Anterior Abd Hernia, Any Approach,Recurrent, Incl Implant Of Mesh, 3 Cm To 10 Cm, Reducible (Pro Cah)",,49615,CPT,Professional,Both,,,,1465,1245.25,377.18,1465,Humana Insurance Company,Medicare PPO,1465,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Repair Anterior Abd Hernia, Any Approach,Recurrent, Incl Implant Of Mesh, 3 Cm To 10 Cm, Reducible (Pro Cah)",,49615,CPT,Professional,Both,,,,1465,1245.25,377.18,1465,Medica,Individual & Family,1242.32,84.8,,percent of total billed charges,,
"Repair Anterior Abd Hernia, Any Approach,Recurrent, Incl Implant Of Mesh, 3 Cm To 10 Cm, Reducible (Pro Cah)",,49615,CPT,Professional,Both,,,,1465,1245.25,377.18,1465,Medica,Medica Advantage Solution,729.57,49.8,,percent of total billed charges,,
"Repair Anterior Abd Hernia, Any Approach,Recurrent, Incl Implant Of Mesh, 3 Cm To 10 Cm, Reducible (Pro Cah)",,49615,CPT,Professional,Both,,,,1465,1245.25,377.18,1465,Medica,Medical Assistance,435.47,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Repair Anterior Abd Hernia, Any Approach,Recurrent, Incl Implant Of Mesh, 3 Cm To 10 Cm, Reducible (Pro Cah)",,49615,CPT,Professional,Both,,,,1465,1245.25,377.18,1465,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,586.08,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Repair Anterior Abd Hernia, Any Approach,Recurrent, Incl Implant Of Mesh, 3 Cm To 10 Cm, Reducible (Pro Cah)",,49615,CPT,Professional,Both,,,,1465,1245.25,377.18,1465,"Multiplan, Inc.","Multiplan, Inc.",1377.1,94,,percent of total billed charges,,
"Repair Anterior Abd Hernia, Any Approach,Recurrent, Incl Implant Of Mesh, 3 Cm To 10 Cm, Reducible (Pro Cah)",,49615,CPT,Professional,Both,,,,1465,1245.25,377.18,1465,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1319.965,90.1,,percent of total billed charges,,
"Repair Anterior Abd Hernia, Any Approach,Recurrent, Incl Implant Of Mesh, 3 Cm To 10 Cm, Reducible (Pro Cah)",,49615,CPT,Professional,Both,,,,1465,1245.25,377.18,1465,"Preferred One Administrative Services, INC.",PPO,1444.49,98.6,,percent of total billed charges,,
"Repair Anterior Abd Hernia, Any Approach,Recurrent, Incl Implant Of Mesh, 3 Cm To 10 Cm, Reducible (Pro Cah)",,49615,CPT,Professional,Both,,,,1465,1245.25,377.18,1465,PrimeWest Health,Minnesota Senior Health Options (MSHO),673.992,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair Anterior Abd Hernia, Any Approach,Recurrent, Incl Implant Of Mesh, 3 Cm To 10 Cm, Reducible (Pro Cah)",,49615,CPT,Professional,Both,,,,1465,1245.25,377.18,1465,PrimeWest Health,MinnesotaCare,465.9505032,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Repair Anterior Abd Hernia, Any Approach,Recurrent, Incl Implant Of Mesh, 3 Cm To 10 Cm, Reducible (Pro Cah)",,49615,CPT,Professional,Both,,,,1465,1245.25,377.18,1465,Sanford Health Plan,Sanford Health Plan,1289.2,88,,percent of total billed charges,,
"Repair Anterior Abd Hernia, Any Approach,Recurrent, Incl Implant Of Mesh, 3 Cm To 10 Cm, Reducible (Pro Cah)",,49615,CPT,Professional,Both,,,,1465,1245.25,377.18,1465,"UCare Health, Inc.",Individual & Family Plan,952.731648,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Repair Anterior Abd Hernia, Any Approach,Recurrent, Incl Implant Of Mesh, 3 Cm To 10 Cm, Reducible (Pro Cah)",,49615,CPT,Professional,Both,,,,1465,1245.25,377.18,1465,"UCare Health, Inc.",Medical Assistance,479.014536,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Repair Anterior Abd Hernia, Any Approach,Recurrent, Incl Implant Of Mesh, 3 Cm To 10 Cm, Reducible (Pro Cah)",,49615,CPT,Professional,Both,,,,1465,1245.25,377.18,1465,"UCare Health, Inc.",Medicare Advantage,673.992,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Repair Anterior Abd Hernia, Any Approach,Recurrent, Incl Implant Of Mesh, 3 Cm To 10 Cm, Reducible (Pro Cah)",,49615,CPT,Professional,Both,,,,1465,1245.25,377.18,1465,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),539.1936,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Repair Anterior Abd Hernia, Any Approach,Recurrent, Incl Implant Of Mesh, 3 Cm To 10 Cm, Reducible (Pro Cah)",,49615,CPT,Professional,Both,,,,1465,1245.25,377.18,1465,UnitedHealthcare,Individual & Family,1465,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Repair Anterior Abd Hernia, Any Approach,Recurrent, Incl Implant Of Mesh, 3 Cm To 10 Cm, Reducible (Pro Cah)",,49615,CPT,Professional,Both,,,,1465,1245.25,377.18,1465,UnitedHealthcare,Medicare Advantage,673.992,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair Anterior Abd Hernia, Any Approach,Recurrent, Incl Implant Of Mesh, 3 Cm To 10 Cm, Reducible (Pro Cah)",,49615,CPT,Professional,Both,,,,1465,1245.25,377.18,1465,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,435.46776,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Repair Ant Abd Hernia,Any Approach,Recurrent, Incl Implant Of Mesh;3 Cm To 10 Cm,Incarcerated/Strang (Pro Cah)",,49616,CPT,Professional,Both,,,,1985,1687.25,505.67,1985,Aetna,Commercial,1687.25,85,,percent of total billed charges,,
"Repair Ant Abd Hernia,Any Approach,Recurrent, Incl Implant Of Mesh;3 Cm To 10 Cm,Incarcerated/Strang (Pro Cah)",,49616,CPT,Professional,Both,,,,1985,1687.25,505.67,1985,Aetna,Medicare Advantage,1985,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair Ant Abd Hernia,Any Approach,Recurrent, Incl Implant Of Mesh;3 Cm To 10 Cm,Incarcerated/Strang (Pro Cah)",,49616,CPT,Professional,Both,,,,1985,1687.25,505.67,1985,Aetna,PPO,1846.05,93,,percent of total billed charges,,
"Repair Ant Abd Hernia,Any Approach,Recurrent, Incl Implant Of Mesh;3 Cm To 10 Cm,Incarcerated/Strang (Pro Cah)",,49616,CPT,Professional,Both,,,,1985,1687.25,505.67,1985,America's PPO,America's PPO,1695.984,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Repair Ant Abd Hernia,Any Approach,Recurrent, Incl Implant Of Mesh;3 Cm To 10 Cm,Incarcerated/Strang (Pro Cah)",,49616,CPT,Professional,Both,,,,1985,1687.25,505.67,1985,BlueCross BlueShield Minnesota, Federal Employee Program,1763.5,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Repair Ant Abd Hernia,Any Approach,Recurrent, Incl Implant Of Mesh;3 Cm To 10 Cm,Incarcerated/Strang (Pro Cah)",,49616,CPT,Professional,Both,,,,1985,1687.25,505.67,1985,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1791.716,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Repair Ant Abd Hernia,Any Approach,Recurrent, Incl Implant Of Mesh;3 Cm To 10 Cm,Incarcerated/Strang (Pro Cah)",,49616,CPT,Professional,Both,,,,1985,1687.25,505.67,1985,BlueCross BlueShield Minnesota,High Value Network Plan,1791.716,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Repair Ant Abd Hernia,Any Approach,Recurrent, Incl Implant Of Mesh;3 Cm To 10 Cm,Incarcerated/Strang (Pro Cah)",,49616,CPT,Professional,Both,,,,1985,1687.25,505.67,1985,BlueCross BlueShield Minnesota,Medicare Advantage,903.394,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair Ant Abd Hernia,Any Approach,Recurrent, Incl Implant Of Mesh;3 Cm To 10 Cm,Incarcerated/Strang (Pro Cah)",,49616,CPT,Professional,Both,,,,1985,1687.25,505.67,1985,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1791.716,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Repair Ant Abd Hernia,Any Approach,Recurrent, Incl Implant Of Mesh;3 Cm To 10 Cm,Incarcerated/Strang (Pro Cah)",,49616,CPT,Professional,Both,,,,1985,1687.25,505.67,1985,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,583.82408,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Repair Ant Abd Hernia,Any Approach,Recurrent, Incl Implant Of Mesh;3 Cm To 10 Cm,Incarcerated/Strang (Pro Cah)",,49616,CPT,Professional,Both,,,,1985,1687.25,505.67,1985,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),903.394,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair Ant Abd Hernia,Any Approach,Recurrent, Incl Implant Of Mesh;3 Cm To 10 Cm,Incarcerated/Strang (Pro Cah)",,49616,CPT,Professional,Both,,,,1985,1687.25,505.67,1985,CorVel,Worker's Compensation,,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Repair Ant Abd Hernia,Any Approach,Recurrent, Incl Implant Of Mesh;3 Cm To 10 Cm,Incarcerated/Strang (Pro Cah)",,49616,CPT,Professional,Both,,,,1985,1687.25,505.67,1985,First Health Group Corporation,First Health Network,1925.45,97,,percent of total billed charges,,
"Repair Ant Abd Hernia,Any Approach,Recurrent, Incl Implant Of Mesh;3 Cm To 10 Cm,Incarcerated/Strang (Pro Cah)",,49616,CPT,Professional,Both,,,,1985,1687.25,505.67,1985,"Health Partners, Inc.",Commercial,1681.76,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Repair Ant Abd Hernia,Any Approach,Recurrent, Incl Implant Of Mesh;3 Cm To 10 Cm,Incarcerated/Strang (Pro Cah)",,49616,CPT,Professional,Both,,,,1985,1687.25,505.67,1985,"Health Partners, Inc.",Medicare Advantage,903.394,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair Ant Abd Hernia,Any Approach,Recurrent, Incl Implant Of Mesh;3 Cm To 10 Cm,Incarcerated/Strang (Pro Cah)",,49616,CPT,Professional,Both,,,,1985,1687.25,505.67,1985,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),785.51,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Repair Ant Abd Hernia,Any Approach,Recurrent, Incl Implant Of Mesh;3 Cm To 10 Cm,Incarcerated/Strang (Pro Cah)",,49616,CPT,Professional,Both,,,,1985,1687.25,505.67,1985,"Health Partners, Inc.",State of Minnesota Advantage Program,1448.83624,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Repair Ant Abd Hernia,Any Approach,Recurrent, Incl Implant Of Mesh;3 Cm To 10 Cm,Incarcerated/Strang (Pro Cah)",,49616,CPT,Professional,Both,,,,1985,1687.25,505.67,1985,"Health Partners, Inc.",State Public Programs,505.67,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Repair Ant Abd Hernia,Any Approach,Recurrent, Incl Implant Of Mesh;3 Cm To 10 Cm,Incarcerated/Strang (Pro Cah)",,49616,CPT,Professional,Both,,,,1985,1687.25,505.67,1985,Humana Insurance Company,Commercial PPO,785.56,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Repair Ant Abd Hernia,Any Approach,Recurrent, Incl Implant Of Mesh;3 Cm To 10 Cm,Incarcerated/Strang (Pro Cah)",,49616,CPT,Professional,Both,,,,1985,1687.25,505.67,1985,Humana Insurance Company,Medicare PPO,1985,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Repair Ant Abd Hernia,Any Approach,Recurrent, Incl Implant Of Mesh;3 Cm To 10 Cm,Incarcerated/Strang (Pro Cah)",,49616,CPT,Professional,Both,,,,1985,1687.25,505.67,1985,Medica,Individual & Family,1683.28,84.8,,percent of total billed charges,,
"Repair Ant Abd Hernia,Any Approach,Recurrent, Incl Implant Of Mesh;3 Cm To 10 Cm,Incarcerated/Strang (Pro Cah)",,49616,CPT,Professional,Both,,,,1985,1687.25,505.67,1985,Medica,Medica Advantage Solution,988.53,49.8,,percent of total billed charges,,
"Repair Ant Abd Hernia,Any Approach,Recurrent, Incl Implant Of Mesh;3 Cm To 10 Cm,Incarcerated/Strang (Pro Cah)",,49616,CPT,Professional,Both,,,,1985,1687.25,505.67,1985,Medica,Medical Assistance,583.82,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Repair Ant Abd Hernia,Any Approach,Recurrent, Incl Implant Of Mesh;3 Cm To 10 Cm,Incarcerated/Strang (Pro Cah)",,49616,CPT,Professional,Both,,,,1985,1687.25,505.67,1985,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,785.56,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Repair Ant Abd Hernia,Any Approach,Recurrent, Incl Implant Of Mesh;3 Cm To 10 Cm,Incarcerated/Strang (Pro Cah)",,49616,CPT,Professional,Both,,,,1985,1687.25,505.67,1985,"Multiplan, Inc.","Multiplan, Inc.",1865.9,94,,percent of total billed charges,,
"Repair Ant Abd Hernia,Any Approach,Recurrent, Incl Implant Of Mesh;3 Cm To 10 Cm,Incarcerated/Strang (Pro Cah)",,49616,CPT,Professional,Both,,,,1985,1687.25,505.67,1985,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1788.485,90.1,,percent of total billed charges,,
"Repair Ant Abd Hernia,Any Approach,Recurrent, Incl Implant Of Mesh;3 Cm To 10 Cm,Incarcerated/Strang (Pro Cah)",,49616,CPT,Professional,Both,,,,1985,1687.25,505.67,1985,"Preferred One Administrative Services, INC.",PPO,1957.21,98.6,,percent of total billed charges,,
"Repair Ant Abd Hernia,Any Approach,Recurrent, Incl Implant Of Mesh;3 Cm To 10 Cm,Incarcerated/Strang (Pro Cah)",,49616,CPT,Professional,Both,,,,1985,1687.25,505.67,1985,PrimeWest Health,Minnesota Senior Health Options (MSHO),903.394,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair Ant Abd Hernia,Any Approach,Recurrent, Incl Implant Of Mesh;3 Cm To 10 Cm,Incarcerated/Strang (Pro Cah)",,49616,CPT,Professional,Both,,,,1985,1687.25,505.67,1985,PrimeWest Health,MinnesotaCare,624.6917656,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Repair Ant Abd Hernia,Any Approach,Recurrent, Incl Implant Of Mesh;3 Cm To 10 Cm,Incarcerated/Strang (Pro Cah)",,49616,CPT,Professional,Both,,,,1985,1687.25,505.67,1985,Sanford Health Plan,Sanford Health Plan,1746.8,88,,percent of total billed charges,,
"Repair Ant Abd Hernia,Any Approach,Recurrent, Incl Implant Of Mesh;3 Cm To 10 Cm,Incarcerated/Strang (Pro Cah)",,49616,CPT,Professional,Both,,,,1985,1687.25,505.67,1985,"UCare Health, Inc.",Individual & Family Plan,1277.006336,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Repair Ant Abd Hernia,Any Approach,Recurrent, Incl Implant Of Mesh;3 Cm To 10 Cm,Incarcerated/Strang (Pro Cah)",,49616,CPT,Professional,Both,,,,1985,1687.25,505.67,1985,"UCare Health, Inc.",Medical Assistance,642.206488,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Repair Ant Abd Hernia,Any Approach,Recurrent, Incl Implant Of Mesh;3 Cm To 10 Cm,Incarcerated/Strang (Pro Cah)",,49616,CPT,Professional,Both,,,,1985,1687.25,505.67,1985,"UCare Health, Inc.",Medicare Advantage,903.394,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Repair Ant Abd Hernia,Any Approach,Recurrent, Incl Implant Of Mesh;3 Cm To 10 Cm,Incarcerated/Strang (Pro Cah)",,49616,CPT,Professional,Both,,,,1985,1687.25,505.67,1985,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),722.7152,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Repair Ant Abd Hernia,Any Approach,Recurrent, Incl Implant Of Mesh;3 Cm To 10 Cm,Incarcerated/Strang (Pro Cah)",,49616,CPT,Professional,Both,,,,1985,1687.25,505.67,1985,UnitedHealthcare,Individual & Family,1985,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Repair Ant Abd Hernia,Any Approach,Recurrent, Incl Implant Of Mesh;3 Cm To 10 Cm,Incarcerated/Strang (Pro Cah)",,49616,CPT,Professional,Both,,,,1985,1687.25,505.67,1985,UnitedHealthcare,Medicare Advantage,903.394,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair Ant Abd Hernia,Any Approach,Recurrent, Incl Implant Of Mesh;3 Cm To 10 Cm,Incarcerated/Strang (Pro Cah)",,49616,CPT,Professional,Both,,,,1985,1687.25,505.67,1985,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,583.82408,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Repair Ant Abd Hernia, Any Approach,Recurrent, Incl Implantation Mesh; Greater Than 10 Cm, Reducible (Pro Cah)",,49617,CPT,Professional,Both,,,,2045,1738.25,522.47,2045,Aetna,Commercial,1738.25,85,,percent of total billed charges,,
"Repair Ant Abd Hernia, Any Approach,Recurrent, Incl Implantation Mesh; Greater Than 10 Cm, Reducible (Pro Cah)",,49617,CPT,Professional,Both,,,,2045,1738.25,522.47,2045,Aetna,Medicare Advantage,2045,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair Ant Abd Hernia, Any Approach,Recurrent, Incl Implantation Mesh; Greater Than 10 Cm, Reducible (Pro Cah)",,49617,CPT,Professional,Both,,,,2045,1738.25,522.47,2045,Aetna,PPO,1901.85,93,,percent of total billed charges,,
"Repair Ant Abd Hernia, Any Approach,Recurrent, Incl Implantation Mesh; Greater Than 10 Cm, Reducible (Pro Cah)",,49617,CPT,Professional,Both,,,,2045,1738.25,522.47,2045,America's PPO,America's PPO,1747.248,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Repair Ant Abd Hernia, Any Approach,Recurrent, Incl Implantation Mesh; Greater Than 10 Cm, Reducible (Pro Cah)",,49617,CPT,Professional,Both,,,,2045,1738.25,522.47,2045,BlueCross BlueShield Minnesota, Federal Employee Program,1816.53,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Repair Ant Abd Hernia, Any Approach,Recurrent, Incl Implantation Mesh; Greater Than 10 Cm, Reducible (Pro Cah)",,49617,CPT,Professional,Both,,,,2045,1738.25,522.47,2045,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1845.59448,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Repair Ant Abd Hernia, Any Approach,Recurrent, Incl Implantation Mesh; Greater Than 10 Cm, Reducible (Pro Cah)",,49617,CPT,Professional,Both,,,,2045,1738.25,522.47,2045,BlueCross BlueShield Minnesota,High Value Network Plan,1845.59448,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Repair Ant Abd Hernia, Any Approach,Recurrent, Incl Implantation Mesh; Greater Than 10 Cm, Reducible (Pro Cah)",,49617,CPT,Professional,Both,,,,2045,1738.25,522.47,2045,BlueCross BlueShield Minnesota,Medicare Advantage,933.616,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair Ant Abd Hernia, Any Approach,Recurrent, Incl Implantation Mesh; Greater Than 10 Cm, Reducible (Pro Cah)",,49617,CPT,Professional,Both,,,,2045,1738.25,522.47,2045,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1845.59448,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Repair Ant Abd Hernia, Any Approach,Recurrent, Incl Implantation Mesh; Greater Than 10 Cm, Reducible (Pro Cah)",,49617,CPT,Professional,Both,,,,2045,1738.25,522.47,2045,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,603.21952,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Repair Ant Abd Hernia, Any Approach,Recurrent, Incl Implantation Mesh; Greater Than 10 Cm, Reducible (Pro Cah)",,49617,CPT,Professional,Both,,,,2045,1738.25,522.47,2045,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),933.616,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair Ant Abd Hernia, Any Approach,Recurrent, Incl Implantation Mesh; Greater Than 10 Cm, Reducible (Pro Cah)",,49617,CPT,Professional,Both,,,,2045,1738.25,522.47,2045,CorVel,Worker's Compensation,,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Repair Ant Abd Hernia, Any Approach,Recurrent, Incl Implantation Mesh; Greater Than 10 Cm, Reducible (Pro Cah)",,49617,CPT,Professional,Both,,,,2045,1738.25,522.47,2045,First Health Group Corporation,First Health Network,1983.65,97,,percent of total billed charges,,
"Repair Ant Abd Hernia, Any Approach,Recurrent, Incl Implantation Mesh; Greater Than 10 Cm, Reducible (Pro Cah)",,49617,CPT,Professional,Both,,,,2045,1738.25,522.47,2045,"Health Partners, Inc.",Commercial,1737.63,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Repair Ant Abd Hernia, Any Approach,Recurrent, Incl Implantation Mesh; Greater Than 10 Cm, Reducible (Pro Cah)",,49617,CPT,Professional,Both,,,,2045,1738.25,522.47,2045,"Health Partners, Inc.",Medicare Advantage,933.616,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair Ant Abd Hernia, Any Approach,Recurrent, Incl Implantation Mesh; Greater Than 10 Cm, Reducible (Pro Cah)",,49617,CPT,Professional,Both,,,,2045,1738.25,522.47,2045,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),811.6,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Repair Ant Abd Hernia, Any Approach,Recurrent, Incl Implantation Mesh; Greater Than 10 Cm, Reducible (Pro Cah)",,49617,CPT,Professional,Both,,,,2045,1738.25,522.47,2045,"Health Partners, Inc.",State of Minnesota Advantage Program,1496.968245,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Repair Ant Abd Hernia, Any Approach,Recurrent, Incl Implantation Mesh; Greater Than 10 Cm, Reducible (Pro Cah)",,49617,CPT,Professional,Both,,,,2045,1738.25,522.47,2045,"Health Partners, Inc.",State Public Programs,522.47,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Repair Ant Abd Hernia, Any Approach,Recurrent, Incl Implantation Mesh; Greater Than 10 Cm, Reducible (Pro Cah)",,49617,CPT,Professional,Both,,,,2045,1738.25,522.47,2045,Humana Insurance Company,Commercial PPO,811.84,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Repair Ant Abd Hernia, Any Approach,Recurrent, Incl Implantation Mesh; Greater Than 10 Cm, Reducible (Pro Cah)",,49617,CPT,Professional,Both,,,,2045,1738.25,522.47,2045,Humana Insurance Company,Medicare PPO,2045,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Repair Ant Abd Hernia, Any Approach,Recurrent, Incl Implantation Mesh; Greater Than 10 Cm, Reducible (Pro Cah)",,49617,CPT,Professional,Both,,,,2045,1738.25,522.47,2045,Medica,Individual & Family,1734.16,84.8,,percent of total billed charges,,
"Repair Ant Abd Hernia, Any Approach,Recurrent, Incl Implantation Mesh; Greater Than 10 Cm, Reducible (Pro Cah)",,49617,CPT,Professional,Both,,,,2045,1738.25,522.47,2045,Medica,Medica Advantage Solution,1018.41,49.8,,percent of total billed charges,,
"Repair Ant Abd Hernia, Any Approach,Recurrent, Incl Implantation Mesh; Greater Than 10 Cm, Reducible (Pro Cah)",,49617,CPT,Professional,Both,,,,2045,1738.25,522.47,2045,Medica,Medical Assistance,603.22,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Repair Ant Abd Hernia, Any Approach,Recurrent, Incl Implantation Mesh; Greater Than 10 Cm, Reducible (Pro Cah)",,49617,CPT,Professional,Both,,,,2045,1738.25,522.47,2045,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,811.84,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Repair Ant Abd Hernia, Any Approach,Recurrent, Incl Implantation Mesh; Greater Than 10 Cm, Reducible (Pro Cah)",,49617,CPT,Professional,Both,,,,2045,1738.25,522.47,2045,"Multiplan, Inc.","Multiplan, Inc.",1922.3,94,,percent of total billed charges,,
"Repair Ant Abd Hernia, Any Approach,Recurrent, Incl Implantation Mesh; Greater Than 10 Cm, Reducible (Pro Cah)",,49617,CPT,Professional,Both,,,,2045,1738.25,522.47,2045,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1842.545,90.1,,percent of total billed charges,,
"Repair Ant Abd Hernia, Any Approach,Recurrent, Incl Implantation Mesh; Greater Than 10 Cm, Reducible (Pro Cah)",,49617,CPT,Professional,Both,,,,2045,1738.25,522.47,2045,"Preferred One Administrative Services, INC.",PPO,2016.37,98.6,,percent of total billed charges,,
"Repair Ant Abd Hernia, Any Approach,Recurrent, Incl Implantation Mesh; Greater Than 10 Cm, Reducible (Pro Cah)",,49617,CPT,Professional,Both,,,,2045,1738.25,522.47,2045,PrimeWest Health,Minnesota Senior Health Options (MSHO),933.616,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair Ant Abd Hernia, Any Approach,Recurrent, Incl Implantation Mesh; Greater Than 10 Cm, Reducible (Pro Cah)",,49617,CPT,Professional,Both,,,,2045,1738.25,522.47,2045,PrimeWest Health,MinnesotaCare,645.4448864,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Repair Ant Abd Hernia, Any Approach,Recurrent, Incl Implantation Mesh; Greater Than 10 Cm, Reducible (Pro Cah)",,49617,CPT,Professional,Both,,,,2045,1738.25,522.47,2045,Sanford Health Plan,Sanford Health Plan,1799.6,88,,percent of total billed charges,,
"Repair Ant Abd Hernia, Any Approach,Recurrent, Incl Implantation Mesh; Greater Than 10 Cm, Reducible (Pro Cah)",,49617,CPT,Professional,Both,,,,2045,1738.25,522.47,2045,"UCare Health, Inc.",Individual & Family Plan,1319.727104,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Repair Ant Abd Hernia, Any Approach,Recurrent, Incl Implantation Mesh; Greater Than 10 Cm, Reducible (Pro Cah)",,49617,CPT,Professional,Both,,,,2045,1738.25,522.47,2045,"UCare Health, Inc.",Medical Assistance,663.541472,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Repair Ant Abd Hernia, Any Approach,Recurrent, Incl Implantation Mesh; Greater Than 10 Cm, Reducible (Pro Cah)",,49617,CPT,Professional,Both,,,,2045,1738.25,522.47,2045,"UCare Health, Inc.",Medicare Advantage,933.616,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Repair Ant Abd Hernia, Any Approach,Recurrent, Incl Implantation Mesh; Greater Than 10 Cm, Reducible (Pro Cah)",,49617,CPT,Professional,Both,,,,2045,1738.25,522.47,2045,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),746.8928,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Repair Ant Abd Hernia, Any Approach,Recurrent, Incl Implantation Mesh; Greater Than 10 Cm, Reducible (Pro Cah)",,49617,CPT,Professional,Both,,,,2045,1738.25,522.47,2045,UnitedHealthcare,Individual & Family,2045,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Repair Ant Abd Hernia, Any Approach,Recurrent, Incl Implantation Mesh; Greater Than 10 Cm, Reducible (Pro Cah)",,49617,CPT,Professional,Both,,,,2045,1738.25,522.47,2045,UnitedHealthcare,Medicare Advantage,933.616,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair Ant Abd Hernia, Any Approach,Recurrent, Incl Implantation Mesh; Greater Than 10 Cm, Reducible (Pro Cah)",,49617,CPT,Professional,Both,,,,2045,1738.25,522.47,2045,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,603.21952,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Repair Ant Abd Hernia, Any Approach,Recurrent, Incl Implant Mesh;More Than 10 Cm,Incarcerated/Strang (Pro Cah)",,49618,CPT,Professional,Both,,,,2895,2460.75,730.58,2895,Aetna,Commercial,2460.75,85,,percent of total billed charges,,
"Repair Ant Abd Hernia, Any Approach,Recurrent, Incl Implant Mesh;More Than 10 Cm,Incarcerated/Strang (Pro Cah)",,49618,CPT,Professional,Both,,,,2895,2460.75,730.58,2895,Aetna,Medicare Advantage,2895,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair Ant Abd Hernia, Any Approach,Recurrent, Incl Implant Mesh;More Than 10 Cm,Incarcerated/Strang (Pro Cah)",,49618,CPT,Professional,Both,,,,2895,2460.75,730.58,2895,Aetna,PPO,2692.35,93,,percent of total billed charges,,
"Repair Ant Abd Hernia, Any Approach,Recurrent, Incl Implant Mesh;More Than 10 Cm,Incarcerated/Strang (Pro Cah)",,49618,CPT,Professional,Both,,,,2895,2460.75,730.58,2895,America's PPO,America's PPO,2473.488,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Repair Ant Abd Hernia, Any Approach,Recurrent, Incl Implant Mesh;More Than 10 Cm,Incarcerated/Strang (Pro Cah)",,49618,CPT,Professional,Both,,,,2895,2460.75,730.58,2895,BlueCross BlueShield Minnesota, Federal Employee Program,2545.07,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Repair Ant Abd Hernia, Any Approach,Recurrent, Incl Implant Mesh;More Than 10 Cm,Incarcerated/Strang (Pro Cah)",,49618,CPT,Professional,Both,,,,2895,2460.75,730.58,2895,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,2585.79112,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Repair Ant Abd Hernia, Any Approach,Recurrent, Incl Implant Mesh;More Than 10 Cm,Incarcerated/Strang (Pro Cah)",,49618,CPT,Professional,Both,,,,2895,2460.75,730.58,2895,BlueCross BlueShield Minnesota,High Value Network Plan,2585.79112,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Repair Ant Abd Hernia, Any Approach,Recurrent, Incl Implant Mesh;More Than 10 Cm,Incarcerated/Strang (Pro Cah)",,49618,CPT,Professional,Both,,,,2895,2460.75,730.58,2895,BlueCross BlueShield Minnesota,Medicare Advantage,1305.3535,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair Ant Abd Hernia, Any Approach,Recurrent, Incl Implant Mesh;More Than 10 Cm,Incarcerated/Strang (Pro Cah)",,49618,CPT,Professional,Both,,,,2895,2460.75,730.58,2895,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,2585.79112,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Repair Ant Abd Hernia, Any Approach,Recurrent, Incl Implant Mesh;More Than 10 Cm,Incarcerated/Strang (Pro Cah)",,49618,CPT,Professional,Both,,,,2895,2460.75,730.58,2895,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,843.49336,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Repair Ant Abd Hernia, Any Approach,Recurrent, Incl Implant Mesh;More Than 10 Cm,Incarcerated/Strang (Pro Cah)",,49618,CPT,Professional,Both,,,,2895,2460.75,730.58,2895,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1305.3535,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair Ant Abd Hernia, Any Approach,Recurrent, Incl Implant Mesh;More Than 10 Cm,Incarcerated/Strang (Pro Cah)",,49618,CPT,Professional,Both,,,,2895,2460.75,730.58,2895,CorVel,Worker's Compensation,,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Repair Ant Abd Hernia, Any Approach,Recurrent, Incl Implant Mesh;More Than 10 Cm,Incarcerated/Strang (Pro Cah)",,49618,CPT,Professional,Both,,,,2895,2460.75,730.58,2895,First Health Group Corporation,First Health Network,2808.15,97,,percent of total billed charges,,
"Repair Ant Abd Hernia, Any Approach,Recurrent, Incl Implant Mesh;More Than 10 Cm,Incarcerated/Strang (Pro Cah)",,49618,CPT,Professional,Both,,,,2895,2460.75,730.58,2895,"Health Partners, Inc.",Commercial,2430.52,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Repair Ant Abd Hernia, Any Approach,Recurrent, Incl Implant Mesh;More Than 10 Cm,Incarcerated/Strang (Pro Cah)",,49618,CPT,Professional,Both,,,,2895,2460.75,730.58,2895,"Health Partners, Inc.",Medicare Advantage,1305.3535,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair Ant Abd Hernia, Any Approach,Recurrent, Incl Implant Mesh;More Than 10 Cm,Incarcerated/Strang (Pro Cah)",,49618,CPT,Professional,Both,,,,2895,2460.75,730.58,2895,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1135.22,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Repair Ant Abd Hernia, Any Approach,Recurrent, Incl Implant Mesh;More Than 10 Cm,Incarcerated/Strang (Pro Cah)",,49618,CPT,Professional,Both,,,,2895,2460.75,730.58,2895,"Health Partners, Inc.",State of Minnesota Advantage Program,2093.89298,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Repair Ant Abd Hernia, Any Approach,Recurrent, Incl Implant Mesh;More Than 10 Cm,Incarcerated/Strang (Pro Cah)",,49618,CPT,Professional,Both,,,,2895,2460.75,730.58,2895,"Health Partners, Inc.",State Public Programs,730.58,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Repair Ant Abd Hernia, Any Approach,Recurrent, Incl Implant Mesh;More Than 10 Cm,Incarcerated/Strang (Pro Cah)",,49618,CPT,Professional,Both,,,,2895,2460.75,730.58,2895,Humana Insurance Company,Commercial PPO,1135.09,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Repair Ant Abd Hernia, Any Approach,Recurrent, Incl Implant Mesh;More Than 10 Cm,Incarcerated/Strang (Pro Cah)",,49618,CPT,Professional,Both,,,,2895,2460.75,730.58,2895,Humana Insurance Company,Medicare PPO,2895,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Repair Ant Abd Hernia, Any Approach,Recurrent, Incl Implant Mesh;More Than 10 Cm,Incarcerated/Strang (Pro Cah)",,49618,CPT,Professional,Both,,,,2895,2460.75,730.58,2895,Medica,Individual & Family,2454.96,84.8,,percent of total billed charges,,
"Repair Ant Abd Hernia, Any Approach,Recurrent, Incl Implant Mesh;More Than 10 Cm,Incarcerated/Strang (Pro Cah)",,49618,CPT,Professional,Both,,,,2895,2460.75,730.58,2895,Medica,Medica Advantage Solution,1441.71,49.8,,percent of total billed charges,,
"Repair Ant Abd Hernia, Any Approach,Recurrent, Incl Implant Mesh;More Than 10 Cm,Incarcerated/Strang (Pro Cah)",,49618,CPT,Professional,Both,,,,2895,2460.75,730.58,2895,Medica,Medical Assistance,843.49,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Repair Ant Abd Hernia, Any Approach,Recurrent, Incl Implant Mesh;More Than 10 Cm,Incarcerated/Strang (Pro Cah)",,49618,CPT,Professional,Both,,,,2895,2460.75,730.58,2895,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1135.09,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Repair Ant Abd Hernia, Any Approach,Recurrent, Incl Implant Mesh;More Than 10 Cm,Incarcerated/Strang (Pro Cah)",,49618,CPT,Professional,Both,,,,2895,2460.75,730.58,2895,"Multiplan, Inc.","Multiplan, Inc.",2721.3,94,,percent of total billed charges,,
"Repair Ant Abd Hernia, Any Approach,Recurrent, Incl Implant Mesh;More Than 10 Cm,Incarcerated/Strang (Pro Cah)",,49618,CPT,Professional,Both,,,,2895,2460.75,730.58,2895,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,2608.395,90.1,,percent of total billed charges,,
"Repair Ant Abd Hernia, Any Approach,Recurrent, Incl Implant Mesh;More Than 10 Cm,Incarcerated/Strang (Pro Cah)",,49618,CPT,Professional,Both,,,,2895,2460.75,730.58,2895,"Preferred One Administrative Services, INC.",PPO,2854.47,98.6,,percent of total billed charges,,
"Repair Ant Abd Hernia, Any Approach,Recurrent, Incl Implant Mesh;More Than 10 Cm,Incarcerated/Strang (Pro Cah)",,49618,CPT,Professional,Both,,,,2895,2460.75,730.58,2895,PrimeWest Health,Minnesota Senior Health Options (MSHO),1305.3535,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair Ant Abd Hernia, Any Approach,Recurrent, Incl Implant Mesh;More Than 10 Cm,Incarcerated/Strang (Pro Cah)",,49618,CPT,Professional,Both,,,,2895,2460.75,730.58,2895,PrimeWest Health,MinnesotaCare,902.5378952,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Repair Ant Abd Hernia, Any Approach,Recurrent, Incl Implant Mesh;More Than 10 Cm,Incarcerated/Strang (Pro Cah)",,49618,CPT,Professional,Both,,,,2895,2460.75,730.58,2895,Sanford Health Plan,Sanford Health Plan,2547.6,88,,percent of total billed charges,,
"Repair Ant Abd Hernia, Any Approach,Recurrent, Incl Implant Mesh;More Than 10 Cm,Incarcerated/Strang (Pro Cah)",,49618,CPT,Professional,Both,,,,2895,2460.75,730.58,2895,"UCare Health, Inc.",Individual & Family Plan,1845.202304,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Repair Ant Abd Hernia, Any Approach,Recurrent, Incl Implant Mesh;More Than 10 Cm,Incarcerated/Strang (Pro Cah)",,49618,CPT,Professional,Both,,,,2895,2460.75,730.58,2895,"UCare Health, Inc.",Medical Assistance,927.842696,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Repair Ant Abd Hernia, Any Approach,Recurrent, Incl Implant Mesh;More Than 10 Cm,Incarcerated/Strang (Pro Cah)",,49618,CPT,Professional,Both,,,,2895,2460.75,730.58,2895,"UCare Health, Inc.",Medicare Advantage,1305.3535,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Repair Ant Abd Hernia, Any Approach,Recurrent, Incl Implant Mesh;More Than 10 Cm,Incarcerated/Strang (Pro Cah)",,49618,CPT,Professional,Both,,,,2895,2460.75,730.58,2895,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1044.2828,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Repair Ant Abd Hernia, Any Approach,Recurrent, Incl Implant Mesh;More Than 10 Cm,Incarcerated/Strang (Pro Cah)",,49618,CPT,Professional,Both,,,,2895,2460.75,730.58,2895,UnitedHealthcare,Individual & Family,2895,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Repair Ant Abd Hernia, Any Approach,Recurrent, Incl Implant Mesh;More Than 10 Cm,Incarcerated/Strang (Pro Cah)",,49618,CPT,Professional,Both,,,,2895,2460.75,730.58,2895,UnitedHealthcare,Medicare Advantage,1305.3535,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Repair Ant Abd Hernia, Any Approach,Recurrent, Incl Implant Mesh;More Than 10 Cm,Incarcerated/Strang (Pro Cah)",,49618,CPT,Professional,Both,,,,2895,2460.75,730.58,2895,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,843.49336,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Removal Non-Infected Mesh During Initial/Recurrent Ant Abd/Parastomal Hernia Repair, Any Approach (Pro Cah)",,49623,CPT,Professional,Both,,,,480,408,117.15,480,Aetna,Commercial,408,85,,percent of total billed charges,,
"Removal Non-Infected Mesh During Initial/Recurrent Ant Abd/Parastomal Hernia Repair, Any Approach (Pro Cah)",,49623,CPT,Professional,Both,,,,480,408,117.15,480,Aetna,Medicare Advantage,480,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Removal Non-Infected Mesh During Initial/Recurrent Ant Abd/Parastomal Hernia Repair, Any Approach (Pro Cah)",,49623,CPT,Professional,Both,,,,480,408,117.15,480,Aetna,PPO,446.4,93,,percent of total billed charges,,
"Removal Non-Infected Mesh During Initial/Recurrent Ant Abd/Parastomal Hernia Repair, Any Approach (Pro Cah)",,49623,CPT,Professional,Both,,,,480,408,117.15,480,America's PPO,America's PPO,410.112,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Removal Non-Infected Mesh During Initial/Recurrent Ant Abd/Parastomal Hernia Repair, Any Approach (Pro Cah)",,49623,CPT,Professional,Both,,,,480,408,117.15,480,BlueCross BlueShield Minnesota, Federal Employee Program,404.9,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Removal Non-Infected Mesh During Initial/Recurrent Ant Abd/Parastomal Hernia Repair, Any Approach (Pro Cah)",,49623,CPT,Professional,Both,,,,480,408,117.15,480,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,411.3784,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Removal Non-Infected Mesh During Initial/Recurrent Ant Abd/Parastomal Hernia Repair, Any Approach (Pro Cah)",,49623,CPT,Professional,Both,,,,480,408,117.15,480,BlueCross BlueShield Minnesota,High Value Network Plan,411.3784,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Removal Non-Infected Mesh During Initial/Recurrent Ant Abd/Parastomal Hernia Repair, Any Approach (Pro Cah)",,49623,CPT,Professional,Both,,,,480,408,117.15,480,BlueCross BlueShield Minnesota,Medicare Advantage,209.392,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Removal Non-Infected Mesh During Initial/Recurrent Ant Abd/Parastomal Hernia Repair, Any Approach (Pro Cah)",,49623,CPT,Professional,Both,,,,480,408,117.15,480,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,411.3784,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Removal Non-Infected Mesh During Initial/Recurrent Ant Abd/Parastomal Hernia Repair, Any Approach (Pro Cah)",,49623,CPT,Professional,Both,,,,480,408,117.15,480,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,135.24992,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Removal Non-Infected Mesh During Initial/Recurrent Ant Abd/Parastomal Hernia Repair, Any Approach (Pro Cah)",,49623,CPT,Professional,Both,,,,480,408,117.15,480,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),209.392,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Removal Non-Infected Mesh During Initial/Recurrent Ant Abd/Parastomal Hernia Repair, Any Approach (Pro Cah)",,49623,CPT,Professional,Both,,,,480,408,117.15,480,CorVel,Worker's Compensation,,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Removal Non-Infected Mesh During Initial/Recurrent Ant Abd/Parastomal Hernia Repair, Any Approach (Pro Cah)",,49623,CPT,Professional,Both,,,,480,408,117.15,480,First Health Group Corporation,First Health Network,465.6,97,,percent of total billed charges,,
"Removal Non-Infected Mesh During Initial/Recurrent Ant Abd/Parastomal Hernia Repair, Any Approach (Pro Cah)",,49623,CPT,Professional,Both,,,,480,408,117.15,480,"Health Partners, Inc.",Commercial,390.34,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Removal Non-Infected Mesh During Initial/Recurrent Ant Abd/Parastomal Hernia Repair, Any Approach (Pro Cah)",,49623,CPT,Professional,Both,,,,480,408,117.15,480,"Health Partners, Inc.",Medicare Advantage,209.392,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Removal Non-Infected Mesh During Initial/Recurrent Ant Abd/Parastomal Hernia Repair, Any Approach (Pro Cah)",,49623,CPT,Professional,Both,,,,480,408,117.15,480,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),182.31,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Removal Non-Infected Mesh During Initial/Recurrent Ant Abd/Parastomal Hernia Repair, Any Approach (Pro Cah)",,49623,CPT,Professional,Both,,,,480,408,117.15,480,"Health Partners, Inc.",State of Minnesota Advantage Program,336.27791,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Removal Non-Infected Mesh During Initial/Recurrent Ant Abd/Parastomal Hernia Repair, Any Approach (Pro Cah)",,49623,CPT,Professional,Both,,,,480,408,117.15,480,"Health Partners, Inc.",State Public Programs,117.15,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Removal Non-Infected Mesh During Initial/Recurrent Ant Abd/Parastomal Hernia Repair, Any Approach (Pro Cah)",,49623,CPT,Professional,Both,,,,480,408,117.15,480,Humana Insurance Company,Commercial PPO,182.08,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Removal Non-Infected Mesh During Initial/Recurrent Ant Abd/Parastomal Hernia Repair, Any Approach (Pro Cah)",,49623,CPT,Professional,Both,,,,480,408,117.15,480,Humana Insurance Company,Medicare PPO,480,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Removal Non-Infected Mesh During Initial/Recurrent Ant Abd/Parastomal Hernia Repair, Any Approach (Pro Cah)",,49623,CPT,Professional,Both,,,,480,408,117.15,480,Medica,Individual & Family,407.04,84.8,,percent of total billed charges,,
"Removal Non-Infected Mesh During Initial/Recurrent Ant Abd/Parastomal Hernia Repair, Any Approach (Pro Cah)",,49623,CPT,Professional,Both,,,,480,408,117.15,480,Medica,Medica Advantage Solution,239.04,49.8,,percent of total billed charges,,
"Removal Non-Infected Mesh During Initial/Recurrent Ant Abd/Parastomal Hernia Repair, Any Approach (Pro Cah)",,49623,CPT,Professional,Both,,,,480,408,117.15,480,Medica,Medical Assistance,135.25,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Removal Non-Infected Mesh During Initial/Recurrent Ant Abd/Parastomal Hernia Repair, Any Approach (Pro Cah)",,49623,CPT,Professional,Both,,,,480,408,117.15,480,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,182.08,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Removal Non-Infected Mesh During Initial/Recurrent Ant Abd/Parastomal Hernia Repair, Any Approach (Pro Cah)",,49623,CPT,Professional,Both,,,,480,408,117.15,480,"Multiplan, Inc.","Multiplan, Inc.",451.2,94,,percent of total billed charges,,
"Removal Non-Infected Mesh During Initial/Recurrent Ant Abd/Parastomal Hernia Repair, Any Approach (Pro Cah)",,49623,CPT,Professional,Both,,,,480,408,117.15,480,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,432.48,90.1,,percent of total billed charges,,
"Removal Non-Infected Mesh During Initial/Recurrent Ant Abd/Parastomal Hernia Repair, Any Approach (Pro Cah)",,49623,CPT,Professional,Both,,,,480,408,117.15,480,"Preferred One Administrative Services, INC.",PPO,473.28,98.6,,percent of total billed charges,,
"Removal Non-Infected Mesh During Initial/Recurrent Ant Abd/Parastomal Hernia Repair, Any Approach (Pro Cah)",,49623,CPT,Professional,Both,,,,480,408,117.15,480,PrimeWest Health,Minnesota Senior Health Options (MSHO),209.392,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Removal Non-Infected Mesh During Initial/Recurrent Ant Abd/Parastomal Hernia Repair, Any Approach (Pro Cah)",,49623,CPT,Professional,Both,,,,480,408,117.15,480,PrimeWest Health,MinnesotaCare,144.7174144,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Removal Non-Infected Mesh During Initial/Recurrent Ant Abd/Parastomal Hernia Repair, Any Approach (Pro Cah)",,49623,CPT,Professional,Both,,,,480,408,117.15,480,Sanford Health Plan,Sanford Health Plan,422.4,88,,percent of total billed charges,,
"Removal Non-Infected Mesh During Initial/Recurrent Ant Abd/Parastomal Hernia Repair, Any Approach (Pro Cah)",,49623,CPT,Professional,Both,,,,480,408,117.15,480,"UCare Health, Inc.",Individual & Family Plan,295.989248,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Removal Non-Infected Mesh During Initial/Recurrent Ant Abd/Parastomal Hernia Repair, Any Approach (Pro Cah)",,49623,CPT,Professional,Both,,,,480,408,117.15,480,"UCare Health, Inc.",Medical Assistance,148.774912,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Removal Non-Infected Mesh During Initial/Recurrent Ant Abd/Parastomal Hernia Repair, Any Approach (Pro Cah)",,49623,CPT,Professional,Both,,,,480,408,117.15,480,"UCare Health, Inc.",Medicare Advantage,209.392,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Removal Non-Infected Mesh During Initial/Recurrent Ant Abd/Parastomal Hernia Repair, Any Approach (Pro Cah)",,49623,CPT,Professional,Both,,,,480,408,117.15,480,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),167.5136,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Removal Non-Infected Mesh During Initial/Recurrent Ant Abd/Parastomal Hernia Repair, Any Approach (Pro Cah)",,49623,CPT,Professional,Both,,,,480,408,117.15,480,UnitedHealthcare,Individual & Family,480,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Removal Non-Infected Mesh During Initial/Recurrent Ant Abd/Parastomal Hernia Repair, Any Approach (Pro Cah)",,49623,CPT,Professional,Both,,,,480,408,117.15,480,UnitedHealthcare,Medicare Advantage,209.392,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Removal Non-Infected Mesh During Initial/Recurrent Ant Abd/Parastomal Hernia Repair, Any Approach (Pro Cah)",,49623,CPT,Professional,Both,,,,480,408,117.15,480,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,135.24992,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Laparoscopy, Surgical; Repair Initial Inguinal (Pro Cah)",,49650,CPT,Professional,Both,,,,2244,1907.4,262.65,2244,Aetna,Commercial,1907.4,85,,percent of total billed charges,,
"Laparoscopy, Surgical; Repair Initial Inguinal (Pro Cah)",,49650,CPT,Professional,Both,,,,2244,1907.4,262.65,2244,Aetna,Medicare Advantage,414.19,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Laparoscopy, Surgical; Repair Initial Inguinal (Pro Cah)",,49650,CPT,Professional,Both,,,,2244,1907.4,262.65,2244,Aetna,PPO,2086.92,93,,percent of total billed charges,,
"Laparoscopy, Surgical; Repair Initial Inguinal (Pro Cah)",,49650,CPT,Professional,Both,,,,2244,1907.4,262.65,2244,America's PPO,America's PPO,1917.2736,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Laparoscopy, Surgical; Repair Initial Inguinal (Pro Cah)",,49650,CPT,Professional,Both,,,,2244,1907.4,262.65,2244,BlueCross BlueShield Minnesota, Federal Employee Program,895.18,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Laparoscopy, Surgical; Repair Initial Inguinal (Pro Cah)",,49650,CPT,Professional,Both,,,,2244,1907.4,262.65,2244,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,909.50288,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Laparoscopy, Surgical; Repair Initial Inguinal (Pro Cah)",,49650,CPT,Professional,Both,,,,2244,1907.4,262.65,2244,BlueCross BlueShield Minnesota,High Value Network Plan,909.50288,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Laparoscopy, Surgical; Repair Initial Inguinal (Pro Cah)",,49650,CPT,Professional,Both,,,,2244,1907.4,262.65,2244,BlueCross BlueShield Minnesota,Medicare Advantage,469.3955,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Laparoscopy, Surgical; Repair Initial Inguinal (Pro Cah)",,49650,CPT,Professional,Both,,,,2244,1907.4,262.65,2244,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,909.50288,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Laparoscopy, Surgical; Repair Initial Inguinal (Pro Cah)",,49650,CPT,Professional,Both,,,,2244,1907.4,262.65,2244,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,303.24552,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Laparoscopy, Surgical; Repair Initial Inguinal (Pro Cah)",,49650,CPT,Professional,Both,,,,2244,1907.4,262.65,2244,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),469.3955,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Laparoscopy, Surgical; Repair Initial Inguinal (Pro Cah)",,49650,CPT,Professional,Both,,,,2244,1907.4,262.65,2244,CorVel,Worker's Compensation,806.0043999,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Laparoscopy, Surgical; Repair Initial Inguinal (Pro Cah)",,49650,CPT,Professional,Both,,,,2244,1907.4,262.65,2244,First Health Group Corporation,First Health Network,2176.68,97,,percent of total billed charges,,
"Laparoscopy, Surgical; Repair Initial Inguinal (Pro Cah)",,49650,CPT,Professional,Both,,,,2244,1907.4,262.65,2244,"Health Partners, Inc.",Commercial,870.63,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Laparoscopy, Surgical; Repair Initial Inguinal (Pro Cah)",,49650,CPT,Professional,Both,,,,2244,1907.4,262.65,2244,"Health Partners, Inc.",Medicare Advantage,469.3955,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Laparoscopy, Surgical; Repair Initial Inguinal (Pro Cah)",,49650,CPT,Professional,Both,,,,2244,1907.4,262.65,2244,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),408.34,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Laparoscopy, Surgical; Repair Initial Inguinal (Pro Cah)",,49650,CPT,Professional,Both,,,,2244,1907.4,262.65,2244,"Health Partners, Inc.",State of Minnesota Advantage Program,750.047745,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Laparoscopy, Surgical; Repair Initial Inguinal (Pro Cah)",,49650,CPT,Professional,Both,,,,2244,1907.4,262.65,2244,"Health Partners, Inc.",State Public Programs,262.65,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Laparoscopy, Surgical; Repair Initial Inguinal (Pro Cah)",,49650,CPT,Professional,Both,,,,2244,1907.4,262.65,2244,Humana Insurance Company,Commercial PPO,408.17,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Laparoscopy, Surgical; Repair Initial Inguinal (Pro Cah)",,49650,CPT,Professional,Both,,,,2244,1907.4,262.65,2244,Humana Insurance Company,Medicare PPO,2244,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Laparoscopy, Surgical; Repair Initial Inguinal (Pro Cah)",,49650,CPT,Professional,Both,,,,2244,1907.4,262.65,2244,Medica,Individual & Family,1902.912,84.8,,percent of total billed charges,,
"Laparoscopy, Surgical; Repair Initial Inguinal (Pro Cah)",,49650,CPT,Professional,Both,,,,2244,1907.4,262.65,2244,Medica,Medica Advantage Solution,1117.512,49.8,,percent of total billed charges,,
"Laparoscopy, Surgical; Repair Initial Inguinal (Pro Cah)",,49650,CPT,Professional,Both,,,,2244,1907.4,262.65,2244,Medica,Medical Assistance,303.25,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Laparoscopy, Surgical; Repair Initial Inguinal (Pro Cah)",,49650,CPT,Professional,Both,,,,2244,1907.4,262.65,2244,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,408.17,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Laparoscopy, Surgical; Repair Initial Inguinal (Pro Cah)",,49650,CPT,Professional,Both,,,,2244,1907.4,262.65,2244,"Multiplan, Inc.","Multiplan, Inc.",2109.36,94,,percent of total billed charges,,
"Laparoscopy, Surgical; Repair Initial Inguinal (Pro Cah)",,49650,CPT,Professional,Both,,,,2244,1907.4,262.65,2244,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,2021.844,90.1,,percent of total billed charges,,
"Laparoscopy, Surgical; Repair Initial Inguinal (Pro Cah)",,49650,CPT,Professional,Both,,,,2244,1907.4,262.65,2244,"Preferred One Administrative Services, INC.",PPO,2212.584,98.6,,percent of total billed charges,,
"Laparoscopy, Surgical; Repair Initial Inguinal (Pro Cah)",,49650,CPT,Professional,Both,,,,2244,1907.4,262.65,2244,PrimeWest Health,Minnesota Senior Health Options (MSHO),469.3955,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Laparoscopy, Surgical; Repair Initial Inguinal (Pro Cah)",,49650,CPT,Professional,Both,,,,2244,1907.4,262.65,2244,PrimeWest Health,MinnesotaCare,324.4727064,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Laparoscopy, Surgical; Repair Initial Inguinal (Pro Cah)",,49650,CPT,Professional,Both,,,,2244,1907.4,262.65,2244,Sanford Health Plan,Sanford Health Plan,1974.72,88,,percent of total billed charges,,
"Laparoscopy, Surgical; Repair Initial Inguinal (Pro Cah)",,49650,CPT,Professional,Both,,,,2244,1907.4,262.65,2244,"UCare Health, Inc.",Individual & Family Plan,663.521152,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Laparoscopy, Surgical; Repair Initial Inguinal (Pro Cah)",,49650,CPT,Professional,Both,,,,2244,1907.4,262.65,2244,"UCare Health, Inc.",Medical Assistance,333.570072,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Laparoscopy, Surgical; Repair Initial Inguinal (Pro Cah)",,49650,CPT,Professional,Both,,,,2244,1907.4,262.65,2244,"UCare Health, Inc.",Medicare Advantage,469.3955,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Laparoscopy, Surgical; Repair Initial Inguinal (Pro Cah)",,49650,CPT,Professional,Both,,,,2244,1907.4,262.65,2244,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),375.5164,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Laparoscopy, Surgical; Repair Initial Inguinal (Pro Cah)",,49650,CPT,Professional,Both,,,,2244,1907.4,262.65,2244,UnitedHealthcare,Individual & Family,2244,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Laparoscopy, Surgical; Repair Initial Inguinal (Pro Cah)",,49650,CPT,Professional,Both,,,,2244,1907.4,262.65,2244,UnitedHealthcare,Medicare Advantage,469.3955,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Laparoscopy, Surgical; Repair Initial Inguinal (Pro Cah)",,49650,CPT,Professional,Both,,,,2244,1907.4,262.65,2244,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,303.24552,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Laparoscopy, Surgical; Repair Recurrent Inguinal Hernia (Pro Cah)",,49651,CPT,Professional,Both,,,,2611,2219.35,342.5,2611,Aetna,Commercial,2219.35,85,,percent of total billed charges,,
"Laparoscopy, Surgical; Repair Recurrent Inguinal Hernia (Pro Cah)",,49651,CPT,Professional,Both,,,,2611,2219.35,342.5,2611,Aetna,Medicare Advantage,538.89,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Laparoscopy, Surgical; Repair Recurrent Inguinal Hernia (Pro Cah)",,49651,CPT,Professional,Both,,,,2611,2219.35,342.5,2611,Aetna,PPO,2428.23,93,,percent of total billed charges,,
"Laparoscopy, Surgical; Repair Recurrent Inguinal Hernia (Pro Cah)",,49651,CPT,Professional,Both,,,,2611,2219.35,342.5,2611,America's PPO,America's PPO,2230.8384,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Laparoscopy, Surgical; Repair Recurrent Inguinal Hernia (Pro Cah)",,49651,CPT,Professional,Both,,,,2611,2219.35,342.5,2611,BlueCross BlueShield Minnesota, Federal Employee Program,1169.24,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Laparoscopy, Surgical; Repair Recurrent Inguinal Hernia (Pro Cah)",,49651,CPT,Professional,Both,,,,2611,2219.35,342.5,2611,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1187.94784,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Laparoscopy, Surgical; Repair Recurrent Inguinal Hernia (Pro Cah)",,49651,CPT,Professional,Both,,,,2611,2219.35,342.5,2611,BlueCross BlueShield Minnesota,High Value Network Plan,1187.94784,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Laparoscopy, Surgical; Repair Recurrent Inguinal Hernia (Pro Cah)",,49651,CPT,Professional,Both,,,,2611,2219.35,342.5,2611,BlueCross BlueShield Minnesota,Medicare Advantage,611.915,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Laparoscopy, Surgical; Repair Recurrent Inguinal Hernia (Pro Cah)",,49651,CPT,Professional,Both,,,,2611,2219.35,342.5,2611,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1187.94784,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Laparoscopy, Surgical; Repair Recurrent Inguinal Hernia (Pro Cah)",,49651,CPT,Professional,Both,,,,2611,2219.35,342.5,2611,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,395.4272,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Laparoscopy, Surgical; Repair Recurrent Inguinal Hernia (Pro Cah)",,49651,CPT,Professional,Both,,,,2611,2219.35,342.5,2611,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),611.915,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Laparoscopy, Surgical; Repair Recurrent Inguinal Hernia (Pro Cah)",,49651,CPT,Professional,Both,,,,2611,2219.35,342.5,2611,CorVel,Worker's Compensation,1051.082205,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Laparoscopy, Surgical; Repair Recurrent Inguinal Hernia (Pro Cah)",,49651,CPT,Professional,Both,,,,2611,2219.35,342.5,2611,First Health Group Corporation,First Health Network,2532.67,97,,percent of total billed charges,,
"Laparoscopy, Surgical; Repair Recurrent Inguinal Hernia (Pro Cah)",,49651,CPT,Professional,Both,,,,2611,2219.35,342.5,2611,"Health Partners, Inc.",Commercial,1134.72,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Laparoscopy, Surgical; Repair Recurrent Inguinal Hernia (Pro Cah)",,49651,CPT,Professional,Both,,,,2611,2219.35,342.5,2611,"Health Partners, Inc.",Medicare Advantage,611.915,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Laparoscopy, Surgical; Repair Recurrent Inguinal Hernia (Pro Cah)",,49651,CPT,Professional,Both,,,,2611,2219.35,342.5,2611,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),532.03,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Laparoscopy, Surgical; Repair Recurrent Inguinal Hernia (Pro Cah)",,49651,CPT,Professional,Both,,,,2611,2219.35,342.5,2611,"Health Partners, Inc.",State of Minnesota Advantage Program,977.56128,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Laparoscopy, Surgical; Repair Recurrent Inguinal Hernia (Pro Cah)",,49651,CPT,Professional,Both,,,,2611,2219.35,342.5,2611,"Health Partners, Inc.",State Public Programs,342.5,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Laparoscopy, Surgical; Repair Recurrent Inguinal Hernia (Pro Cah)",,49651,CPT,Professional,Both,,,,2611,2219.35,342.5,2611,Humana Insurance Company,Commercial PPO,532.1,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Laparoscopy, Surgical; Repair Recurrent Inguinal Hernia (Pro Cah)",,49651,CPT,Professional,Both,,,,2611,2219.35,342.5,2611,Humana Insurance Company,Medicare PPO,2611,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Laparoscopy, Surgical; Repair Recurrent Inguinal Hernia (Pro Cah)",,49651,CPT,Professional,Both,,,,2611,2219.35,342.5,2611,Medica,Individual & Family,2214.128,84.8,,percent of total billed charges,,
"Laparoscopy, Surgical; Repair Recurrent Inguinal Hernia (Pro Cah)",,49651,CPT,Professional,Both,,,,2611,2219.35,342.5,2611,Medica,Medica Advantage Solution,1300.278,49.8,,percent of total billed charges,,
"Laparoscopy, Surgical; Repair Recurrent Inguinal Hernia (Pro Cah)",,49651,CPT,Professional,Both,,,,2611,2219.35,342.5,2611,Medica,Medical Assistance,395.43,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Laparoscopy, Surgical; Repair Recurrent Inguinal Hernia (Pro Cah)",,49651,CPT,Professional,Both,,,,2611,2219.35,342.5,2611,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,532.1,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Laparoscopy, Surgical; Repair Recurrent Inguinal Hernia (Pro Cah)",,49651,CPT,Professional,Both,,,,2611,2219.35,342.5,2611,"Multiplan, Inc.","Multiplan, Inc.",2454.34,94,,percent of total billed charges,,
"Laparoscopy, Surgical; Repair Recurrent Inguinal Hernia (Pro Cah)",,49651,CPT,Professional,Both,,,,2611,2219.35,342.5,2611,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,2352.511,90.1,,percent of total billed charges,,
"Laparoscopy, Surgical; Repair Recurrent Inguinal Hernia (Pro Cah)",,49651,CPT,Professional,Both,,,,2611,2219.35,342.5,2611,"Preferred One Administrative Services, INC.",PPO,2574.446,98.6,,percent of total billed charges,,
"Laparoscopy, Surgical; Repair Recurrent Inguinal Hernia (Pro Cah)",,49651,CPT,Professional,Both,,,,2611,2219.35,342.5,2611,PrimeWest Health,Minnesota Senior Health Options (MSHO),611.915,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Laparoscopy, Surgical; Repair Recurrent Inguinal Hernia (Pro Cah)",,49651,CPT,Professional,Both,,,,2611,2219.35,342.5,2611,PrimeWest Health,MinnesotaCare,423.107104,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Laparoscopy, Surgical; Repair Recurrent Inguinal Hernia (Pro Cah)",,49651,CPT,Professional,Both,,,,2611,2219.35,342.5,2611,Sanford Health Plan,Sanford Health Plan,2297.68,88,,percent of total billed charges,,
"Laparoscopy, Surgical; Repair Recurrent Inguinal Hernia (Pro Cah)",,49651,CPT,Professional,Both,,,,2611,2219.35,342.5,2611,"UCare Health, Inc.",Individual & Family Plan,864.98176,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Laparoscopy, Surgical; Repair Recurrent Inguinal Hernia (Pro Cah)",,49651,CPT,Professional,Both,,,,2611,2219.35,342.5,2611,"UCare Health, Inc.",Medical Assistance,434.96992,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Laparoscopy, Surgical; Repair Recurrent Inguinal Hernia (Pro Cah)",,49651,CPT,Professional,Both,,,,2611,2219.35,342.5,2611,"UCare Health, Inc.",Medicare Advantage,611.915,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Laparoscopy, Surgical; Repair Recurrent Inguinal Hernia (Pro Cah)",,49651,CPT,Professional,Both,,,,2611,2219.35,342.5,2611,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),489.532,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Laparoscopy, Surgical; Repair Recurrent Inguinal Hernia (Pro Cah)",,49651,CPT,Professional,Both,,,,2611,2219.35,342.5,2611,UnitedHealthcare,Individual & Family,2611,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Laparoscopy, Surgical; Repair Recurrent Inguinal Hernia (Pro Cah)",,49651,CPT,Professional,Both,,,,2611,2219.35,342.5,2611,UnitedHealthcare,Medicare Advantage,611.915,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Laparoscopy, Surgical; Repair Recurrent Inguinal Hernia (Pro Cah)",,49651,CPT,Professional,Both,,,,2611,2219.35,342.5,2611,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,395.4272,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Aspiration Of Bladder; With Insertion Of Suprapubic Catheter (Pro Cah),,51102,CPT,Professional,Both,,,,867,736.95,88.13,867,Aetna,Commercial,736.95,85,,percent of total billed charges,,
Aspiration Of Bladder; With Insertion Of Suprapubic Catheter (Pro Cah),,51102,CPT,Professional,Both,,,,867,736.95,88.13,867,Aetna,Medicare Advantage,141.14,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Aspiration Of Bladder; With Insertion Of Suprapubic Catheter (Pro Cah),,51102,CPT,Professional,Both,,,,867,736.95,88.13,867,Aetna,PPO,806.31,93,,percent of total billed charges,,
Aspiration Of Bladder; With Insertion Of Suprapubic Catheter (Pro Cah),,51102,CPT,Professional,Both,,,,867,736.95,88.13,867,America's PPO,America's PPO,740.7648,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Aspiration Of Bladder; With Insertion Of Suprapubic Catheter (Pro Cah),,51102,CPT,Professional,Both,,,,867,736.95,88.13,867,BlueCross BlueShield Minnesota, Federal Employee Program,290.59,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Aspiration Of Bladder; With Insertion Of Suprapubic Catheter (Pro Cah),,51102,CPT,Professional,Both,,,,867,736.95,88.13,867,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,295.23944,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Aspiration Of Bladder; With Insertion Of Suprapubic Catheter (Pro Cah),,51102,CPT,Professional,Both,,,,867,736.95,88.13,867,BlueCross BlueShield Minnesota,High Value Network Plan,295.23944,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Aspiration Of Bladder; With Insertion Of Suprapubic Catheter (Pro Cah),,51102,CPT,Professional,Both,,,,867,736.95,88.13,867,BlueCross BlueShield Minnesota,Medicare Advantage,157.481,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Aspiration Of Bladder; With Insertion Of Suprapubic Catheter (Pro Cah),,51102,CPT,Professional,Both,,,,867,736.95,88.13,867,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,295.23944,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Aspiration Of Bladder; With Insertion Of Suprapubic Catheter (Pro Cah),,51102,CPT,Professional,Both,,,,867,736.95,88.13,867,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,101.7524,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Aspiration Of Bladder; With Insertion Of Suprapubic Catheter (Pro Cah),,51102,CPT,Professional,Both,,,,867,736.95,88.13,867,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),157.481,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Aspiration Of Bladder; With Insertion Of Suprapubic Catheter (Pro Cah),,51102,CPT,Professional,Both,,,,867,736.95,88.13,867,CorVel,Worker's Compensation,271.2479091,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Aspiration Of Bladder; With Insertion Of Suprapubic Catheter (Pro Cah),,51102,CPT,Professional,Both,,,,867,736.95,88.13,867,First Health Group Corporation,First Health Network,840.99,97,,percent of total billed charges,,
Aspiration Of Bladder; With Insertion Of Suprapubic Catheter (Pro Cah),,51102,CPT,Professional,Both,,,,867,736.95,88.13,867,"Health Partners, Inc.",Commercial,293.12,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Aspiration Of Bladder; With Insertion Of Suprapubic Catheter (Pro Cah),,51102,CPT,Professional,Both,,,,867,736.95,88.13,867,"Health Partners, Inc.",Medicare Advantage,157.481,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Aspiration Of Bladder; With Insertion Of Suprapubic Catheter (Pro Cah),,51102,CPT,Professional,Both,,,,867,736.95,88.13,867,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),136.9,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Aspiration Of Bladder; With Insertion Of Suprapubic Catheter (Pro Cah),,51102,CPT,Professional,Both,,,,867,736.95,88.13,867,"Health Partners, Inc.",State of Minnesota Advantage Program,252.52288,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Aspiration Of Bladder; With Insertion Of Suprapubic Catheter (Pro Cah),,51102,CPT,Professional,Both,,,,867,736.95,88.13,867,"Health Partners, Inc.",State Public Programs,88.13,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Aspiration Of Bladder; With Insertion Of Suprapubic Catheter (Pro Cah),,51102,CPT,Professional,Both,,,,867,736.95,88.13,867,Humana Insurance Company,Commercial PPO,136.94,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Aspiration Of Bladder; With Insertion Of Suprapubic Catheter (Pro Cah),,51102,CPT,Professional,Both,,,,867,736.95,88.13,867,Humana Insurance Company,Medicare PPO,867,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Aspiration Of Bladder; With Insertion Of Suprapubic Catheter (Pro Cah),,51102,CPT,Professional,Both,,,,867,736.95,88.13,867,Medica,Individual & Family,735.216,84.8,,percent of total billed charges,,
Aspiration Of Bladder; With Insertion Of Suprapubic Catheter (Pro Cah),,51102,CPT,Professional,Both,,,,867,736.95,88.13,867,Medica,Medica Advantage Solution,431.766,49.8,,percent of total billed charges,,
Aspiration Of Bladder; With Insertion Of Suprapubic Catheter (Pro Cah),,51102,CPT,Professional,Both,,,,867,736.95,88.13,867,Medica,Medical Assistance,101.75,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Aspiration Of Bladder; With Insertion Of Suprapubic Catheter (Pro Cah),,51102,CPT,Professional,Both,,,,867,736.95,88.13,867,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,136.94,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Aspiration Of Bladder; With Insertion Of Suprapubic Catheter (Pro Cah),,51102,CPT,Professional,Both,,,,867,736.95,88.13,867,"Multiplan, Inc.","Multiplan, Inc.",814.98,94,,percent of total billed charges,,
Aspiration Of Bladder; With Insertion Of Suprapubic Catheter (Pro Cah),,51102,CPT,Professional,Both,,,,867,736.95,88.13,867,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,781.167,90.1,,percent of total billed charges,,
Aspiration Of Bladder; With Insertion Of Suprapubic Catheter (Pro Cah),,51102,CPT,Professional,Both,,,,867,736.95,88.13,867,"Preferred One Administrative Services, INC.",PPO,854.862,98.6,,percent of total billed charges,,
Aspiration Of Bladder; With Insertion Of Suprapubic Catheter (Pro Cah),,51102,CPT,Professional,Both,,,,867,736.95,88.13,867,PrimeWest Health,Minnesota Senior Health Options (MSHO),157.481,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Aspiration Of Bladder; With Insertion Of Suprapubic Catheter (Pro Cah),,51102,CPT,Professional,Both,,,,867,736.95,88.13,867,PrimeWest Health,MinnesotaCare,108.875068,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Aspiration Of Bladder; With Insertion Of Suprapubic Catheter (Pro Cah),,51102,CPT,Professional,Both,,,,867,736.95,88.13,867,Sanford Health Plan,Sanford Health Plan,762.96,88,,percent of total billed charges,,
Aspiration Of Bladder; With Insertion Of Suprapubic Catheter (Pro Cah),,51102,CPT,Professional,Both,,,,867,736.95,88.13,867,"UCare Health, Inc.",Individual & Family Plan,222.609664,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Aspiration Of Bladder; With Insertion Of Suprapubic Catheter (Pro Cah),,51102,CPT,Professional,Both,,,,867,736.95,88.13,867,"UCare Health, Inc.",Medical Assistance,111.92764,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Aspiration Of Bladder; With Insertion Of Suprapubic Catheter (Pro Cah),,51102,CPT,Professional,Both,,,,867,736.95,88.13,867,"UCare Health, Inc.",Medicare Advantage,157.481,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Aspiration Of Bladder; With Insertion Of Suprapubic Catheter (Pro Cah),,51102,CPT,Professional,Both,,,,867,736.95,88.13,867,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),125.9848,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Aspiration Of Bladder; With Insertion Of Suprapubic Catheter (Pro Cah),,51102,CPT,Professional,Both,,,,867,736.95,88.13,867,UnitedHealthcare,Individual & Family,867,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Aspiration Of Bladder; With Insertion Of Suprapubic Catheter (Pro Cah),,51102,CPT,Professional,Both,,,,867,736.95,88.13,867,UnitedHealthcare,Medicare Advantage,157.481,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Aspiration Of Bladder; With Insertion Of Suprapubic Catheter (Pro Cah),,51102,CPT,Professional,Both,,,,867,736.95,88.13,867,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,101.7524,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Cystotomy; For Excision Of Bladder Tumor (Procah),,51530,CPT,Professional,Both,,,,2882,2449.7,474.7,2882,Aetna,Commercial,2449.7,85,,percent of total billed charges,,
Cystotomy; For Excision Of Bladder Tumor (Procah),,51530,CPT,Professional,Both,,,,2882,2449.7,474.7,2882,Aetna,Medicare Advantage,751.28,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Cystotomy; For Excision Of Bladder Tumor (Procah),,51530,CPT,Professional,Both,,,,2882,2449.7,474.7,2882,Aetna,PPO,2680.26,93,,percent of total billed charges,,
Cystotomy; For Excision Of Bladder Tumor (Procah),,51530,CPT,Professional,Both,,,,2882,2449.7,474.7,2882,America's PPO,America's PPO,2462.3808,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Cystotomy; For Excision Of Bladder Tumor (Procah),,51530,CPT,Professional,Both,,,,2882,2449.7,474.7,2882,BlueCross BlueShield Minnesota, Federal Employee Program,1564.5,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Cystotomy; For Excision Of Bladder Tumor (Procah),,51530,CPT,Professional,Both,,,,2882,2449.7,474.7,2882,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1589.532,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Cystotomy; For Excision Of Bladder Tumor (Procah),,51530,CPT,Professional,Both,,,,2882,2449.7,474.7,2882,BlueCross BlueShield Minnesota,High Value Network Plan,1589.532,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Cystotomy; For Excision Of Bladder Tumor (Procah),,51530,CPT,Professional,Both,,,,2882,2449.7,474.7,2882,BlueCross BlueShield Minnesota,Medicare Advantage,848.056,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Cystotomy; For Excision Of Bladder Tumor (Procah),,51530,CPT,Professional,Both,,,,2882,2449.7,474.7,2882,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1589.532,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Cystotomy; For Excision Of Bladder Tumor (Procah),,51530,CPT,Professional,Both,,,,2882,2449.7,474.7,2882,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,548.06088,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Cystotomy; For Excision Of Bladder Tumor (Procah),,51530,CPT,Professional,Both,,,,2882,2449.7,474.7,2882,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),848.056,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Cystotomy; For Excision Of Bladder Tumor (Procah),,51530,CPT,Professional,Both,,,,2882,2449.7,474.7,2882,CorVel,Worker's Compensation,1449.697868,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Cystotomy; For Excision Of Bladder Tumor (Procah),,51530,CPT,Professional,Both,,,,2882,2449.7,474.7,2882,First Health Group Corporation,First Health Network,2795.54,97,,percent of total billed charges,,
Cystotomy; For Excision Of Bladder Tumor (Procah),,51530,CPT,Professional,Both,,,,2882,2449.7,474.7,2882,"Health Partners, Inc.",Commercial,1565.69,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Cystotomy; For Excision Of Bladder Tumor (Procah),,51530,CPT,Professional,Both,,,,2882,2449.7,474.7,2882,"Health Partners, Inc.",Medicare Advantage,848.056,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Cystotomy; For Excision Of Bladder Tumor (Procah),,51530,CPT,Professional,Both,,,,2882,2449.7,474.7,2882,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),737.39,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Cystotomy; For Excision Of Bladder Tumor (Procah),,51530,CPT,Professional,Both,,,,2882,2449.7,474.7,2882,"Health Partners, Inc.",State of Minnesota Advantage Program,1348.841935,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Cystotomy; For Excision Of Bladder Tumor (Procah),,51530,CPT,Professional,Both,,,,2882,2449.7,474.7,2882,"Health Partners, Inc.",State Public Programs,474.7,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Cystotomy; For Excision Of Bladder Tumor (Procah),,51530,CPT,Professional,Both,,,,2882,2449.7,474.7,2882,Humana Insurance Company,Commercial PPO,737.44,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Cystotomy; For Excision Of Bladder Tumor (Procah),,51530,CPT,Professional,Both,,,,2882,2449.7,474.7,2882,Humana Insurance Company,Medicare PPO,2882,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Cystotomy; For Excision Of Bladder Tumor (Procah),,51530,CPT,Professional,Both,,,,2882,2449.7,474.7,2882,Medica,Individual & Family,2443.936,84.8,,percent of total billed charges,,
Cystotomy; For Excision Of Bladder Tumor (Procah),,51530,CPT,Professional,Both,,,,2882,2449.7,474.7,2882,Medica,Medica Advantage Solution,1435.236,49.8,,percent of total billed charges,,
Cystotomy; For Excision Of Bladder Tumor (Procah),,51530,CPT,Professional,Both,,,,2882,2449.7,474.7,2882,Medica,Medical Assistance,548.06,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Cystotomy; For Excision Of Bladder Tumor (Procah),,51530,CPT,Professional,Both,,,,2882,2449.7,474.7,2882,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,737.44,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Cystotomy; For Excision Of Bladder Tumor (Procah),,51530,CPT,Professional,Both,,,,2882,2449.7,474.7,2882,"Multiplan, Inc.","Multiplan, Inc.",2709.08,94,,percent of total billed charges,,
Cystotomy; For Excision Of Bladder Tumor (Procah),,51530,CPT,Professional,Both,,,,2882,2449.7,474.7,2882,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,2596.682,90.1,,percent of total billed charges,,
Cystotomy; For Excision Of Bladder Tumor (Procah),,51530,CPT,Professional,Both,,,,2882,2449.7,474.7,2882,"Preferred One Administrative Services, INC.",PPO,2841.652,98.6,,percent of total billed charges,,
Cystotomy; For Excision Of Bladder Tumor (Procah),,51530,CPT,Professional,Both,,,,2882,2449.7,474.7,2882,PrimeWest Health,Minnesota Senior Health Options (MSHO),848.056,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Cystotomy; For Excision Of Bladder Tumor (Procah),,51530,CPT,Professional,Both,,,,2882,2449.7,474.7,2882,PrimeWest Health,MinnesotaCare,586.4251416,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Cystotomy; For Excision Of Bladder Tumor (Procah),,51530,CPT,Professional,Both,,,,2882,2449.7,474.7,2882,Sanford Health Plan,Sanford Health Plan,2536.16,88,,percent of total billed charges,,
Cystotomy; For Excision Of Bladder Tumor (Procah),,51530,CPT,Professional,Both,,,,2882,2449.7,474.7,2882,"UCare Health, Inc.",Individual & Family Plan,1198.782464,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Cystotomy; For Excision Of Bladder Tumor (Procah),,51530,CPT,Professional,Both,,,,2882,2449.7,474.7,2882,"UCare Health, Inc.",Medical Assistance,602.866968,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Cystotomy; For Excision Of Bladder Tumor (Procah),,51530,CPT,Professional,Both,,,,2882,2449.7,474.7,2882,"UCare Health, Inc.",Medicare Advantage,848.056,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Cystotomy; For Excision Of Bladder Tumor (Procah),,51530,CPT,Professional,Both,,,,2882,2449.7,474.7,2882,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),678.4448,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Cystotomy; For Excision Of Bladder Tumor (Procah),,51530,CPT,Professional,Both,,,,2882,2449.7,474.7,2882,UnitedHealthcare,Individual & Family,2882,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Cystotomy; For Excision Of Bladder Tumor (Procah),,51530,CPT,Professional,Both,,,,2882,2449.7,474.7,2882,UnitedHealthcare,Medicare Advantage,848.056,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Cystotomy; For Excision Of Bladder Tumor (Procah),,51530,CPT,Professional,Both,,,,2882,2449.7,474.7,2882,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,548.06088,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Excision Benign Lesion,,51530,CPT,Facility,Both,,,,1765,1500.25,505.849,1765,Aetna,Commercial,1623.8,92,,percent of total billed charges,,
Excision Benign Lesion,,51530,CPT,Facility,Outpatient,,,,1765,1500.25,505.849,1765,Aetna,Medicare Advantage,864.85,49,,percent of total billed charges,,
Excision Benign Lesion,,51530,CPT,Facility,Inpatient,,,,1765,1500.25,505.849,1765,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Excision Benign Lesion,,51530,CPT,Facility,Both,,,,1765,1500.25,505.849,1765,Aetna,PPO,1641.45,93,,percent of total billed charges,,
Excision Benign Lesion,,51530,CPT,Facility,Both,,,,1765,1500.25,505.849,1765,America's PPO,America's PPO,1694.9295,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Excision Benign Lesion,,51530,CPT,Facility,Both,,,,1765,1500.25,505.849,1765,BlueCross BlueShield Minnesota, Federal Employee Program,1736.76,98.4,,percent of total billed charges,,
Excision Benign Lesion,,51530,CPT,Facility,Both,,,,1765,1500.25,505.849,1765,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1765,100,,percent of total billed charges,,
Excision Benign Lesion,,51530,CPT,Facility,Both,,,,1765,1500.25,505.849,1765,BlueCross BlueShield Minnesota,High Value Network Plan,1588.5,90,,percent of total billed charges,,
Excision Benign Lesion,,51530,CPT,Facility,Outpatient,,,,1765,1500.25,505.849,1765,BlueCross BlueShield Minnesota,Medicare Advantage,864.85,49,,percent of total billed charges,,
Excision Benign Lesion,,51530,CPT,Facility,Inpatient,,,,1765,1500.25,505.849,1765,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Excision Benign Lesion,,51530,CPT,Facility,Both,,,,1765,1500.25,505.849,1765,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1563.2605,88.57,,percent of total billed charges,,
Excision Benign Lesion,,51530,CPT,Facility,Both,,,,1765,1500.25,505.849,1765,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,505.849,28.66,,percent of total billed charges,,
Excision Benign Lesion,,51530,CPT,Facility,Outpatient,,,,1765,1500.25,505.849,1765,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),864.85,49,,percent of total billed charges,,
Excision Benign Lesion,,51530,CPT,Facility,Inpatient,,,,1765,1500.25,505.849,1765,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Excision Benign Lesion,,51530,CPT,Facility,Both,,,,1765,1500.25,505.849,1765,CorVel,Worker's Compensation,1765,100,,percent of total billed charges,,
Excision Benign Lesion,,51530,CPT,Facility,Both,,,,1765,1500.25,505.849,1765,First Health Group Corporation,First Health Network,1712.05,97,,percent of total billed charges,,
Excision Benign Lesion,,51530,CPT,Facility,Both,,,,1765,1500.25,505.849,1765,"Health Partners, Inc.",Commercial,1669.69,94.6,,percent of total billed charges,,
Excision Benign Lesion,,51530,CPT,Facility,Outpatient,,,,1765,1500.25,505.849,1765,"Health Partners, Inc.",Medicare Advantage,864.85,49,,percent of total billed charges,,
Excision Benign Lesion,,51530,CPT,Facility,Inpatient,,,,1765,1500.25,505.849,1765,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Excision Benign Lesion,,51530,CPT,Facility,Both,,,,1765,1500.25,505.849,1765,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1059,60,,percent of total billed charges,,
Excision Benign Lesion,,51530,CPT,Facility,Both,,,,1765,1500.25,505.849,1765,"Health Partners, Inc.",State of Minnesota Advantage Program,1438.475,81.5,,percent of total billed charges,,
Excision Benign Lesion,,51530,CPT,Facility,Both,,,,1765,1500.25,505.849,1765,"Health Partners, Inc.",State Public Programs,882.5,50,,percent of total billed charges,,
Excision Benign Lesion,,51530,CPT,Facility,Both,,,,1765,1500.25,505.849,1765,Humana Insurance Company,Commercial PPO,1676.75,95,,percent of total billed charges,,
Excision Benign Lesion,,51530,CPT,Facility,Outpatient,,,,1765,1500.25,505.849,1765,Humana Insurance Company,Medicare PPO,864.85,49,,percent of total billed charges,,
Excision Benign Lesion,,51530,CPT,Facility,Inpatient,,,,1765,1500.25,505.849,1765,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Excision Benign Lesion,,51530,CPT,Facility,Both,,,,1765,1500.25,505.849,1765,Medica,Individual & Family,1749.115,99.1,,percent of total billed charges,,
Excision Benign Lesion,,51530,CPT,Facility,Outpatient,,,,1765,1500.25,505.849,1765,Medica,Medica Advantage Solution,878.97,49.8,,percent of total billed charges,,
Excision Benign Lesion,,51530,CPT,Facility,Inpatient,,,,1765,1500.25,505.849,1765,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Excision Benign Lesion,,51530,CPT,Facility,Outpatient,,,,1765,1500.25,505.849,1765,Medica,Medical Assistance,1497,,,Other,Grouper,All inclusive per visit
Excision Benign Lesion,,51530,CPT,Facility,Inpatient,,,,1765,1500.25,505.849,1765,Medica,Medical Assistance,,,,,Included in per diem rate,
Excision Benign Lesion,,51530,CPT,Facility,Outpatient,,,,1765,1500.25,505.849,1765,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,878.97,49.8,,percent of total billed charges,,
Excision Benign Lesion,,51530,CPT,Facility,Inpatient,,,,1765,1500.25,505.849,1765,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Excision Benign Lesion,,51530,CPT,Facility,Both,,,,1765,1500.25,505.849,1765,"Multiplan, Inc.","Multiplan, Inc.",1659.1,94,,percent of total billed charges,,
Excision Benign Lesion,,51530,CPT,Facility,Outpatient,,,,1765,1500.25,505.849,1765,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1590.265,90.1,,percent of total billed charges,,
Excision Benign Lesion,,51530,CPT,Facility,Inpatient,,,,1765,1500.25,505.849,1765,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Excision Benign Lesion,,51530,CPT,Facility,Both,,,,1765,1500.25,505.849,1765,"Preferred One Administrative Services, INC.",PPO,1740.29,98.6,,percent of total billed charges,,
Excision Benign Lesion,,51530,CPT,Facility,Outpatient,,,,1765,1500.25,505.849,1765,PrimeWest Health,Minnesota Senior Health Options (MSHO),908.0925,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Excision Benign Lesion,,51530,CPT,Facility,Inpatient,,,,1765,1500.25,505.849,1765,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Excision Benign Lesion,,51530,CPT,Facility,Outpatient,,,,1765,1500.25,505.849,1765,PrimeWest Health,MinnesotaCare,906.504,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Excision Benign Lesion,,51530,CPT,Facility,Inpatient,,,,1765,1500.25,505.849,1765,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Excision Benign Lesion,,51530,CPT,Facility,Both,,,,1765,1500.25,505.849,1765,Sanford Health Plan,Sanford Health Plan,1623.8,92,,percent of total billed charges,,
Excision Benign Lesion,,51530,CPT,Facility,Outpatient,,,,1765,1500.25,505.849,1765,"UCare Health, Inc.",Individual & Family Plan,994.5775,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Excision Benign Lesion,,51530,CPT,Facility,Inpatient,,,,1765,1500.25,505.849,1765,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Excision Benign Lesion,,51530,CPT,Facility,Outpatient,,,,1765,1500.25,505.849,1765,"UCare Health, Inc.",Medical Assistance,890.7955,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Excision Benign Lesion,,51530,CPT,Facility,Inpatient,,,,1765,1500.25,505.849,1765,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Excision Benign Lesion,,51530,CPT,Facility,Outpatient,,,,1765,1500.25,505.849,1765,"UCare Health, Inc.",Medicare Advantage,890.7955,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Excision Benign Lesion,,51530,CPT,Facility,Inpatient,,,,1765,1500.25,505.849,1765,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Excision Benign Lesion,,51530,CPT,Facility,Outpatient,,,,1765,1500.25,505.849,1765,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),890.7955,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Excision Benign Lesion,,51530,CPT,Facility,Inpatient,,,,1765,1500.25,505.849,1765,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Excision Benign Lesion,,51530,CPT,Facility,Both,,,,1765,1500.25,505.849,1765,UnitedHealthcare,Individual & Family,1659.1,94,,percent of total billed charges,,
Excision Benign Lesion,,51530,CPT,Facility,Outpatient,,,,1765,1500.25,505.849,1765,UnitedHealthcare,Medicare Advantage,864.85,49,,percent of total billed charges,,
Excision Benign Lesion,,51530,CPT,Facility,Inpatient,,,,1765,1500.25,505.849,1765,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Excision Benign Lesion,,51530,CPT,Facility,Outpatient,,,,1765,1500.25,505.849,1765,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,847.2,48,,percent of total billed charges,,100% of DHS outpatient percentage
Excision Benign Lesion,,51530,CPT,Facility,Inpatient,,,,1765,1500.25,505.849,1765,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Excision Of Malignant Lesion,,51530,CPT,Facility,Both,,,,1015,862.75,290.899,1497,Aetna,Commercial,933.8,92,,percent of total billed charges,,
Excision Of Malignant Lesion,,51530,CPT,Facility,Outpatient,,,,1015,862.75,290.899,1497,Aetna,Medicare Advantage,497.35,49,,percent of total billed charges,,
Excision Of Malignant Lesion,,51530,CPT,Facility,Inpatient,,,,1015,862.75,290.899,1497,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Excision Of Malignant Lesion,,51530,CPT,Facility,Both,,,,1015,862.75,290.899,1497,Aetna,PPO,943.95,93,,percent of total billed charges,,
Excision Of Malignant Lesion,,51530,CPT,Facility,Both,,,,1015,862.75,290.899,1497,America's PPO,America's PPO,974.7045,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Excision Of Malignant Lesion,,51530,CPT,Facility,Both,,,,1015,862.75,290.899,1497,BlueCross BlueShield Minnesota, Federal Employee Program,998.76,98.4,,percent of total billed charges,,
Excision Of Malignant Lesion,,51530,CPT,Facility,Both,,,,1015,862.75,290.899,1497,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1015,100,,percent of total billed charges,,
Excision Of Malignant Lesion,,51530,CPT,Facility,Both,,,,1015,862.75,290.899,1497,BlueCross BlueShield Minnesota,High Value Network Plan,913.5,90,,percent of total billed charges,,
Excision Of Malignant Lesion,,51530,CPT,Facility,Outpatient,,,,1015,862.75,290.899,1497,BlueCross BlueShield Minnesota,Medicare Advantage,497.35,49,,percent of total billed charges,,
Excision Of Malignant Lesion,,51530,CPT,Facility,Inpatient,,,,1015,862.75,290.899,1497,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Excision Of Malignant Lesion,,51530,CPT,Facility,Both,,,,1015,862.75,290.899,1497,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,898.9855,88.57,,percent of total billed charges,,
Excision Of Malignant Lesion,,51530,CPT,Facility,Both,,,,1015,862.75,290.899,1497,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,290.899,28.66,,percent of total billed charges,,
Excision Of Malignant Lesion,,51530,CPT,Facility,Outpatient,,,,1015,862.75,290.899,1497,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),497.35,49,,percent of total billed charges,,
Excision Of Malignant Lesion,,51530,CPT,Facility,Inpatient,,,,1015,862.75,290.899,1497,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Excision Of Malignant Lesion,,51530,CPT,Facility,Both,,,,1015,862.75,290.899,1497,CorVel,Worker's Compensation,1015,100,,percent of total billed charges,,
Excision Of Malignant Lesion,,51530,CPT,Facility,Both,,,,1015,862.75,290.899,1497,First Health Group Corporation,First Health Network,984.55,97,,percent of total billed charges,,
Excision Of Malignant Lesion,,51530,CPT,Facility,Both,,,,1015,862.75,290.899,1497,"Health Partners, Inc.",Commercial,960.19,94.6,,percent of total billed charges,,
Excision Of Malignant Lesion,,51530,CPT,Facility,Outpatient,,,,1015,862.75,290.899,1497,"Health Partners, Inc.",Medicare Advantage,497.35,49,,percent of total billed charges,,
Excision Of Malignant Lesion,,51530,CPT,Facility,Inpatient,,,,1015,862.75,290.899,1497,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Excision Of Malignant Lesion,,51530,CPT,Facility,Both,,,,1015,862.75,290.899,1497,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),609,60,,percent of total billed charges,,
Excision Of Malignant Lesion,,51530,CPT,Facility,Both,,,,1015,862.75,290.899,1497,"Health Partners, Inc.",State of Minnesota Advantage Program,827.225,81.5,,percent of total billed charges,,
Excision Of Malignant Lesion,,51530,CPT,Facility,Both,,,,1015,862.75,290.899,1497,"Health Partners, Inc.",State Public Programs,507.5,50,,percent of total billed charges,,
Excision Of Malignant Lesion,,51530,CPT,Facility,Both,,,,1015,862.75,290.899,1497,Humana Insurance Company,Commercial PPO,964.25,95,,percent of total billed charges,,
Excision Of Malignant Lesion,,51530,CPT,Facility,Outpatient,,,,1015,862.75,290.899,1497,Humana Insurance Company,Medicare PPO,497.35,49,,percent of total billed charges,,
Excision Of Malignant Lesion,,51530,CPT,Facility,Inpatient,,,,1015,862.75,290.899,1497,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Excision Of Malignant Lesion,,51530,CPT,Facility,Both,,,,1015,862.75,290.899,1497,Medica,Individual & Family,1005.865,99.1,,percent of total billed charges,,
Excision Of Malignant Lesion,,51530,CPT,Facility,Outpatient,,,,1015,862.75,290.899,1497,Medica,Medica Advantage Solution,505.47,49.8,,percent of total billed charges,,
Excision Of Malignant Lesion,,51530,CPT,Facility,Inpatient,,,,1015,862.75,290.899,1497,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Excision Of Malignant Lesion,,51530,CPT,Facility,Outpatient,,,,1015,862.75,290.899,1497,Medica,Medical Assistance,1497,,,Other,Grouper,All inclusive per visit
Excision Of Malignant Lesion,,51530,CPT,Facility,Inpatient,,,,1015,862.75,290.899,1497,Medica,Medical Assistance,,,,,Included in per diem rate,
Excision Of Malignant Lesion,,51530,CPT,Facility,Outpatient,,,,1015,862.75,290.899,1497,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,505.47,49.8,,percent of total billed charges,,
Excision Of Malignant Lesion,,51530,CPT,Facility,Inpatient,,,,1015,862.75,290.899,1497,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Excision Of Malignant Lesion,,51530,CPT,Facility,Both,,,,1015,862.75,290.899,1497,"Multiplan, Inc.","Multiplan, Inc.",954.1,94,,percent of total billed charges,,
Excision Of Malignant Lesion,,51530,CPT,Facility,Outpatient,,,,1015,862.75,290.899,1497,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,914.515,90.1,,percent of total billed charges,,
Excision Of Malignant Lesion,,51530,CPT,Facility,Inpatient,,,,1015,862.75,290.899,1497,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Excision Of Malignant Lesion,,51530,CPT,Facility,Both,,,,1015,862.75,290.899,1497,"Preferred One Administrative Services, INC.",PPO,1000.79,98.6,,percent of total billed charges,,
Excision Of Malignant Lesion,,51530,CPT,Facility,Outpatient,,,,1015,862.75,290.899,1497,PrimeWest Health,Minnesota Senior Health Options (MSHO),522.2175,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Excision Of Malignant Lesion,,51530,CPT,Facility,Inpatient,,,,1015,862.75,290.899,1497,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Excision Of Malignant Lesion,,51530,CPT,Facility,Outpatient,,,,1015,862.75,290.899,1497,PrimeWest Health,MinnesotaCare,521.304,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Excision Of Malignant Lesion,,51530,CPT,Facility,Inpatient,,,,1015,862.75,290.899,1497,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Excision Of Malignant Lesion,,51530,CPT,Facility,Both,,,,1015,862.75,290.899,1497,Sanford Health Plan,Sanford Health Plan,933.8,92,,percent of total billed charges,,
Excision Of Malignant Lesion,,51530,CPT,Facility,Outpatient,,,,1015,862.75,290.899,1497,"UCare Health, Inc.",Individual & Family Plan,571.9525,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Excision Of Malignant Lesion,,51530,CPT,Facility,Inpatient,,,,1015,862.75,290.899,1497,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Excision Of Malignant Lesion,,51530,CPT,Facility,Outpatient,,,,1015,862.75,290.899,1497,"UCare Health, Inc.",Medical Assistance,512.2705,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Excision Of Malignant Lesion,,51530,CPT,Facility,Inpatient,,,,1015,862.75,290.899,1497,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Excision Of Malignant Lesion,,51530,CPT,Facility,Outpatient,,,,1015,862.75,290.899,1497,"UCare Health, Inc.",Medicare Advantage,512.2705,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Excision Of Malignant Lesion,,51530,CPT,Facility,Inpatient,,,,1015,862.75,290.899,1497,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Excision Of Malignant Lesion,,51530,CPT,Facility,Outpatient,,,,1015,862.75,290.899,1497,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),512.2705,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Excision Of Malignant Lesion,,51530,CPT,Facility,Inpatient,,,,1015,862.75,290.899,1497,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Excision Of Malignant Lesion,,51530,CPT,Facility,Both,,,,1015,862.75,290.899,1497,UnitedHealthcare,Individual & Family,954.1,94,,percent of total billed charges,,
Excision Of Malignant Lesion,,51530,CPT,Facility,Outpatient,,,,1015,862.75,290.899,1497,UnitedHealthcare,Medicare Advantage,497.35,49,,percent of total billed charges,,
Excision Of Malignant Lesion,,51530,CPT,Facility,Inpatient,,,,1015,862.75,290.899,1497,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Excision Of Malignant Lesion,,51530,CPT,Facility,Outpatient,,,,1015,862.75,290.899,1497,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,487.2,48,,percent of total billed charges,,100% of DHS outpatient percentage
Excision Of Malignant Lesion,,51530,CPT,Facility,Inpatient,,,,1015,862.75,290.899,1497,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Injection Procedure For Cystography Or Voiding Urethrocystography (Pro Cah),,51600,CPT,Professional,Both,,,,663,563.55,26.61,663,Aetna,Commercial,563.55,85,,percent of total billed charges,,
Injection Procedure For Cystography Or Voiding Urethrocystography (Pro Cah),,51600,CPT,Professional,Both,,,,663,563.55,26.61,663,Aetna,Medicare Advantage,42.77,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Injection Procedure For Cystography Or Voiding Urethrocystography (Pro Cah),,51600,CPT,Professional,Both,,,,663,563.55,26.61,663,Aetna,PPO,616.59,93,,percent of total billed charges,,
Injection Procedure For Cystography Or Voiding Urethrocystography (Pro Cah),,51600,CPT,Professional,Both,,,,663,563.55,26.61,663,America's PPO,America's PPO,566.4672,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Injection Procedure For Cystography Or Voiding Urethrocystography (Pro Cah),,51600,CPT,Professional,Both,,,,663,563.55,26.61,663,BlueCross BlueShield Minnesota, Federal Employee Program,88.83,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Injection Procedure For Cystography Or Voiding Urethrocystography (Pro Cah),,51600,CPT,Professional,Both,,,,663,563.55,26.61,663,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,90.25128,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Injection Procedure For Cystography Or Voiding Urethrocystography (Pro Cah),,51600,CPT,Professional,Both,,,,663,563.55,26.61,663,BlueCross BlueShield Minnesota,High Value Network Plan,90.25128,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Injection Procedure For Cystography Or Voiding Urethrocystography (Pro Cah),,51600,CPT,Professional,Both,,,,663,563.55,26.61,663,BlueCross BlueShield Minnesota,Medicare Advantage,47.8745,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Injection Procedure For Cystography Or Voiding Urethrocystography (Pro Cah),,51600,CPT,Professional,Both,,,,663,563.55,26.61,663,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,90.25128,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Injection Procedure For Cystography Or Voiding Urethrocystography (Pro Cah),,51600,CPT,Professional,Both,,,,663,563.55,26.61,663,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,30.72384,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Injection Procedure For Cystography Or Voiding Urethrocystography (Pro Cah),,51600,CPT,Professional,Both,,,,663,563.55,26.61,663,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),47.8745,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Injection Procedure For Cystography Or Voiding Urethrocystography (Pro Cah),,51600,CPT,Professional,Both,,,,663,563.55,26.61,663,CorVel,Worker's Compensation,82.336986,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Injection Procedure For Cystography Or Voiding Urethrocystography (Pro Cah),,51600,CPT,Professional,Both,,,,663,563.55,26.61,663,First Health Group Corporation,First Health Network,643.11,97,,percent of total billed charges,,
Injection Procedure For Cystography Or Voiding Urethrocystography (Pro Cah),,51600,CPT,Professional,Both,,,,663,563.55,26.61,663,"Health Partners, Inc.",Commercial,88.51,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Injection Procedure For Cystography Or Voiding Urethrocystography (Pro Cah),,51600,CPT,Professional,Both,,,,663,563.55,26.61,663,"Health Partners, Inc.",Medicare Advantage,47.8745,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Injection Procedure For Cystography Or Voiding Urethrocystography (Pro Cah),,51600,CPT,Professional,Both,,,,663,563.55,26.61,663,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),41.68,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Injection Procedure For Cystography Or Voiding Urethrocystography (Pro Cah),,51600,CPT,Professional,Both,,,,663,563.55,26.61,663,"Health Partners, Inc.",State of Minnesota Advantage Program,76.251365,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Injection Procedure For Cystography Or Voiding Urethrocystography (Pro Cah),,51600,CPT,Professional,Both,,,,663,563.55,26.61,663,"Health Partners, Inc.",State Public Programs,26.61,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Injection Procedure For Cystography Or Voiding Urethrocystography (Pro Cah),,51600,CPT,Professional,Both,,,,663,563.55,26.61,663,Humana Insurance Company,Commercial PPO,41.63,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Injection Procedure For Cystography Or Voiding Urethrocystography (Pro Cah),,51600,CPT,Professional,Both,,,,663,563.55,26.61,663,Humana Insurance Company,Medicare PPO,663,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Injection Procedure For Cystography Or Voiding Urethrocystography (Pro Cah),,51600,CPT,Professional,Both,,,,663,563.55,26.61,663,Medica,Individual & Family,562.224,84.8,,percent of total billed charges,,
Injection Procedure For Cystography Or Voiding Urethrocystography (Pro Cah),,51600,CPT,Professional,Both,,,,663,563.55,26.61,663,Medica,Medica Advantage Solution,330.174,49.8,,percent of total billed charges,,
Injection Procedure For Cystography Or Voiding Urethrocystography (Pro Cah),,51600,CPT,Professional,Both,,,,663,563.55,26.61,663,Medica,Medical Assistance,30.72,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Injection Procedure For Cystography Or Voiding Urethrocystography (Pro Cah),,51600,CPT,Professional,Both,,,,663,563.55,26.61,663,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,41.63,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Injection Procedure For Cystography Or Voiding Urethrocystography (Pro Cah),,51600,CPT,Professional,Both,,,,663,563.55,26.61,663,"Multiplan, Inc.","Multiplan, Inc.",623.22,94,,percent of total billed charges,,
Injection Procedure For Cystography Or Voiding Urethrocystography (Pro Cah),,51600,CPT,Professional,Both,,,,663,563.55,26.61,663,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,597.363,90.1,,percent of total billed charges,,
Injection Procedure For Cystography Or Voiding Urethrocystography (Pro Cah),,51600,CPT,Professional,Both,,,,663,563.55,26.61,663,"Preferred One Administrative Services, INC.",PPO,653.718,98.6,,percent of total billed charges,,
Injection Procedure For Cystography Or Voiding Urethrocystography (Pro Cah),,51600,CPT,Professional,Both,,,,663,563.55,26.61,663,PrimeWest Health,Minnesota Senior Health Options (MSHO),47.8745,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Injection Procedure For Cystography Or Voiding Urethrocystography (Pro Cah),,51600,CPT,Professional,Both,,,,663,563.55,26.61,663,PrimeWest Health,MinnesotaCare,32.8745088,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Injection Procedure For Cystography Or Voiding Urethrocystography (Pro Cah),,51600,CPT,Professional,Both,,,,663,563.55,26.61,663,Sanford Health Plan,Sanford Health Plan,583.44,88,,percent of total billed charges,,
Injection Procedure For Cystography Or Voiding Urethrocystography (Pro Cah),,51600,CPT,Professional,Both,,,,663,563.55,26.61,663,"UCare Health, Inc.",Individual & Family Plan,67.673728,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Injection Procedure For Cystography Or Voiding Urethrocystography (Pro Cah),,51600,CPT,Professional,Both,,,,663,563.55,26.61,663,"UCare Health, Inc.",Medical Assistance,33.796224,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Injection Procedure For Cystography Or Voiding Urethrocystography (Pro Cah),,51600,CPT,Professional,Both,,,,663,563.55,26.61,663,"UCare Health, Inc.",Medicare Advantage,47.8745,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Injection Procedure For Cystography Or Voiding Urethrocystography (Pro Cah),,51600,CPT,Professional,Both,,,,663,563.55,26.61,663,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),38.2996,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Injection Procedure For Cystography Or Voiding Urethrocystography (Pro Cah),,51600,CPT,Professional,Both,,,,663,563.55,26.61,663,UnitedHealthcare,Individual & Family,663,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Injection Procedure For Cystography Or Voiding Urethrocystography (Pro Cah),,51600,CPT,Professional,Both,,,,663,563.55,26.61,663,UnitedHealthcare,Medicare Advantage,47.8745,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Injection Procedure For Cystography Or Voiding Urethrocystography (Pro Cah),,51600,CPT,Professional,Both,,,,663,563.55,26.61,663,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,30.72384,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Bladder Irrigation, Simple, Lavage And Or Instillation",,51700,CPT,Facility,Both,,,,140,119,40.124,299,Aetna,Commercial,128.8,92,,percent of total billed charges,,
"Bladder Irrigation, Simple, Lavage And Or Instillation",,51700,CPT,Facility,Outpatient,,,,140,119,40.124,299,Aetna,Medicare Advantage,68.6,49,,percent of total billed charges,,
"Bladder Irrigation, Simple, Lavage And Or Instillation",,51700,CPT,Facility,Inpatient,,,,140,119,40.124,299,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Bladder Irrigation, Simple, Lavage And Or Instillation",,51700,CPT,Facility,Both,,,,140,119,40.124,299,Aetna,PPO,130.2,93,,percent of total billed charges,,
"Bladder Irrigation, Simple, Lavage And Or Instillation",,51700,CPT,Facility,Both,,,,140,119,40.124,299,America's PPO,America's PPO,134.442,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Bladder Irrigation, Simple, Lavage And Or Instillation",,51700,CPT,Facility,Both,,,,140,119,40.124,299,BlueCross BlueShield Minnesota, Federal Employee Program,137.76,98.4,,percent of total billed charges,,
"Bladder Irrigation, Simple, Lavage And Or Instillation",,51700,CPT,Facility,Both,,,,140,119,40.124,299,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,140,100,,percent of total billed charges,,
"Bladder Irrigation, Simple, Lavage And Or Instillation",,51700,CPT,Facility,Both,,,,140,119,40.124,299,BlueCross BlueShield Minnesota,High Value Network Plan,126,90,,percent of total billed charges,,
"Bladder Irrigation, Simple, Lavage And Or Instillation",,51700,CPT,Facility,Outpatient,,,,140,119,40.124,299,BlueCross BlueShield Minnesota,Medicare Advantage,68.6,49,,percent of total billed charges,,
"Bladder Irrigation, Simple, Lavage And Or Instillation",,51700,CPT,Facility,Inpatient,,,,140,119,40.124,299,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Bladder Irrigation, Simple, Lavage And Or Instillation",,51700,CPT,Facility,Both,,,,140,119,40.124,299,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,123.998,88.57,,percent of total billed charges,,
"Bladder Irrigation, Simple, Lavage And Or Instillation",,51700,CPT,Facility,Both,,,,140,119,40.124,299,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,40.124,28.66,,percent of total billed charges,,
"Bladder Irrigation, Simple, Lavage And Or Instillation",,51700,CPT,Facility,Outpatient,,,,140,119,40.124,299,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),68.6,49,,percent of total billed charges,,
"Bladder Irrigation, Simple, Lavage And Or Instillation",,51700,CPT,Facility,Inpatient,,,,140,119,40.124,299,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Bladder Irrigation, Simple, Lavage And Or Instillation",,51700,CPT,Facility,Both,,,,140,119,40.124,299,CorVel,Worker's Compensation,140,100,,percent of total billed charges,,
"Bladder Irrigation, Simple, Lavage And Or Instillation",,51700,CPT,Facility,Both,,,,140,119,40.124,299,First Health Group Corporation,First Health Network,135.8,97,,percent of total billed charges,,
"Bladder Irrigation, Simple, Lavage And Or Instillation",,51700,CPT,Facility,Both,,,,140,119,40.124,299,"Health Partners, Inc.",Commercial,132.44,94.6,,percent of total billed charges,,
"Bladder Irrigation, Simple, Lavage And Or Instillation",,51700,CPT,Facility,Outpatient,,,,140,119,40.124,299,"Health Partners, Inc.",Medicare Advantage,68.6,49,,percent of total billed charges,,
"Bladder Irrigation, Simple, Lavage And Or Instillation",,51700,CPT,Facility,Inpatient,,,,140,119,40.124,299,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Bladder Irrigation, Simple, Lavage And Or Instillation",,51700,CPT,Facility,Both,,,,140,119,40.124,299,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),84,60,,percent of total billed charges,,
"Bladder Irrigation, Simple, Lavage And Or Instillation",,51700,CPT,Facility,Both,,,,140,119,40.124,299,"Health Partners, Inc.",State of Minnesota Advantage Program,114.1,81.5,,percent of total billed charges,,
"Bladder Irrigation, Simple, Lavage And Or Instillation",,51700,CPT,Facility,Both,,,,140,119,40.124,299,"Health Partners, Inc.",State Public Programs,70,50,,percent of total billed charges,,
"Bladder Irrigation, Simple, Lavage And Or Instillation",,51700,CPT,Facility,Both,,,,140,119,40.124,299,Humana Insurance Company,Commercial PPO,133,95,,percent of total billed charges,,
"Bladder Irrigation, Simple, Lavage And Or Instillation",,51700,CPT,Facility,Outpatient,,,,140,119,40.124,299,Humana Insurance Company,Medicare PPO,68.6,49,,percent of total billed charges,,
"Bladder Irrigation, Simple, Lavage And Or Instillation",,51700,CPT,Facility,Inpatient,,,,140,119,40.124,299,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Bladder Irrigation, Simple, Lavage And Or Instillation",,51700,CPT,Facility,Both,,,,140,119,40.124,299,Medica,Individual & Family,138.74,99.1,,percent of total billed charges,,
"Bladder Irrigation, Simple, Lavage And Or Instillation",,51700,CPT,Facility,Outpatient,,,,140,119,40.124,299,Medica,Medica Advantage Solution,69.72,49.8,,percent of total billed charges,,
"Bladder Irrigation, Simple, Lavage And Or Instillation",,51700,CPT,Facility,Inpatient,,,,140,119,40.124,299,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Bladder Irrigation, Simple, Lavage And Or Instillation",,51700,CPT,Facility,Outpatient,,,,140,119,40.124,299,Medica,Medical Assistance,299,,,Other,Grouper,All inclusive per visit
"Bladder Irrigation, Simple, Lavage And Or Instillation",,51700,CPT,Facility,Inpatient,,,,140,119,40.124,299,Medica,Medical Assistance,,,,,Included in per diem rate,
"Bladder Irrigation, Simple, Lavage And Or Instillation",,51700,CPT,Facility,Outpatient,,,,140,119,40.124,299,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,69.72,49.8,,percent of total billed charges,,
"Bladder Irrigation, Simple, Lavage And Or Instillation",,51700,CPT,Facility,Inpatient,,,,140,119,40.124,299,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Bladder Irrigation, Simple, Lavage And Or Instillation",,51700,CPT,Facility,Both,,,,140,119,40.124,299,"Multiplan, Inc.","Multiplan, Inc.",131.6,94,,percent of total billed charges,,
"Bladder Irrigation, Simple, Lavage And Or Instillation",,51700,CPT,Facility,Outpatient,,,,140,119,40.124,299,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,126.14,90.1,,percent of total billed charges,,
"Bladder Irrigation, Simple, Lavage And Or Instillation",,51700,CPT,Facility,Inpatient,,,,140,119,40.124,299,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Bladder Irrigation, Simple, Lavage And Or Instillation",,51700,CPT,Facility,Both,,,,140,119,40.124,299,"Preferred One Administrative Services, INC.",PPO,138.04,98.6,,percent of total billed charges,,
"Bladder Irrigation, Simple, Lavage And Or Instillation",,51700,CPT,Facility,Outpatient,,,,140,119,40.124,299,PrimeWest Health,Minnesota Senior Health Options (MSHO),72.03,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Bladder Irrigation, Simple, Lavage And Or Instillation",,51700,CPT,Facility,Inpatient,,,,140,119,40.124,299,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Bladder Irrigation, Simple, Lavage And Or Instillation",,51700,CPT,Facility,Outpatient,,,,140,119,40.124,299,PrimeWest Health,MinnesotaCare,71.904,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Bladder Irrigation, Simple, Lavage And Or Instillation",,51700,CPT,Facility,Inpatient,,,,140,119,40.124,299,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Bladder Irrigation, Simple, Lavage And Or Instillation",,51700,CPT,Facility,Both,,,,140,119,40.124,299,Sanford Health Plan,Sanford Health Plan,128.8,92,,percent of total billed charges,,
"Bladder Irrigation, Simple, Lavage And Or Instillation",,51700,CPT,Facility,Outpatient,,,,140,119,40.124,299,"UCare Health, Inc.",Individual & Family Plan,78.89,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Bladder Irrigation, Simple, Lavage And Or Instillation",,51700,CPT,Facility,Inpatient,,,,140,119,40.124,299,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Bladder Irrigation, Simple, Lavage And Or Instillation",,51700,CPT,Facility,Outpatient,,,,140,119,40.124,299,"UCare Health, Inc.",Medical Assistance,70.658,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Bladder Irrigation, Simple, Lavage And Or Instillation",,51700,CPT,Facility,Inpatient,,,,140,119,40.124,299,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Bladder Irrigation, Simple, Lavage And Or Instillation",,51700,CPT,Facility,Outpatient,,,,140,119,40.124,299,"UCare Health, Inc.",Medicare Advantage,70.658,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Bladder Irrigation, Simple, Lavage And Or Instillation",,51700,CPT,Facility,Inpatient,,,,140,119,40.124,299,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Bladder Irrigation, Simple, Lavage And Or Instillation",,51700,CPT,Facility,Outpatient,,,,140,119,40.124,299,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),70.658,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Bladder Irrigation, Simple, Lavage And Or Instillation",,51700,CPT,Facility,Inpatient,,,,140,119,40.124,299,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Bladder Irrigation, Simple, Lavage And Or Instillation",,51700,CPT,Facility,Both,,,,140,119,40.124,299,UnitedHealthcare,Individual & Family,131.6,94,,percent of total billed charges,,
"Bladder Irrigation, Simple, Lavage And Or Instillation",,51700,CPT,Facility,Outpatient,,,,140,119,40.124,299,UnitedHealthcare,Medicare Advantage,68.6,49,,percent of total billed charges,,
"Bladder Irrigation, Simple, Lavage And Or Instillation",,51700,CPT,Facility,Inpatient,,,,140,119,40.124,299,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Bladder Irrigation, Simple, Lavage And Or Instillation",,51700,CPT,Facility,Outpatient,,,,140,119,40.124,299,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,67.2,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Bladder Irrigation, Simple, Lavage And Or Instillation",,51700,CPT,Facility,Inpatient,,,,140,119,40.124,299,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Bladder Irrigation, Simple, Lavage And/Or Instillation (Pro Cah)",,51700,CPT,Professional,Both,,,,227,192.95,18.32,227,Aetna,Commercial,192.95,85,,percent of total billed charges,,
"Bladder Irrigation, Simple, Lavage And/Or Instillation (Pro Cah)",,51700,CPT,Professional,Both,,,,227,192.95,18.32,227,Aetna,Medicare Advantage,29.47,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Bladder Irrigation, Simple, Lavage And/Or Instillation (Pro Cah)",,51700,CPT,Professional,Both,,,,227,192.95,18.32,227,Aetna,PPO,211.11,93,,percent of total billed charges,,
"Bladder Irrigation, Simple, Lavage And/Or Instillation (Pro Cah)",,51700,CPT,Professional,Both,,,,227,192.95,18.32,227,America's PPO,America's PPO,193.9488,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Bladder Irrigation, Simple, Lavage And/Or Instillation (Pro Cah)",,51700,CPT,Professional,Both,,,,227,192.95,18.32,227,BlueCross BlueShield Minnesota, Federal Employee Program,61.29,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Bladder Irrigation, Simple, Lavage And/Or Instillation (Pro Cah)",,51700,CPT,Professional,Both,,,,227,192.95,18.32,227,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,62.27064,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Bladder Irrigation, Simple, Lavage And/Or Instillation (Pro Cah)",,51700,CPT,Professional,Both,,,,227,192.95,18.32,227,BlueCross BlueShield Minnesota,High Value Network Plan,62.27064,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Bladder Irrigation, Simple, Lavage And/Or Instillation (Pro Cah)",,51700,CPT,Professional,Both,,,,227,192.95,18.32,227,BlueCross BlueShield Minnesota,Medicare Advantage,32.7405,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Bladder Irrigation, Simple, Lavage And/Or Instillation (Pro Cah)",,51700,CPT,Professional,Both,,,,227,192.95,18.32,227,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,62.27064,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Bladder Irrigation, Simple, Lavage And/Or Instillation (Pro Cah)",,51700,CPT,Professional,Both,,,,227,192.95,18.32,227,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,21.15312,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Bladder Irrigation, Simple, Lavage And/Or Instillation (Pro Cah)",,51700,CPT,Professional,Both,,,,227,192.95,18.32,227,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),32.7405,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Bladder Irrigation, Simple, Lavage And/Or Instillation (Pro Cah)",,51700,CPT,Professional,Both,,,,227,192.95,18.32,227,CorVel,Worker's Compensation,56.725065,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Bladder Irrigation, Simple, Lavage And/Or Instillation (Pro Cah)",,51700,CPT,Professional,Both,,,,227,192.95,18.32,227,First Health Group Corporation,First Health Network,220.19,97,,percent of total billed charges,,
"Bladder Irrigation, Simple, Lavage And/Or Instillation (Pro Cah)",,51700,CPT,Professional,Both,,,,227,192.95,18.32,227,"Health Partners, Inc.",Commercial,60.94,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Bladder Irrigation, Simple, Lavage And/Or Instillation (Pro Cah)",,51700,CPT,Professional,Both,,,,227,192.95,18.32,227,"Health Partners, Inc.",Medicare Advantage,32.7405,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Bladder Irrigation, Simple, Lavage And/Or Instillation (Pro Cah)",,51700,CPT,Professional,Both,,,,227,192.95,18.32,227,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),28.47,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Bladder Irrigation, Simple, Lavage And/Or Instillation (Pro Cah)",,51700,CPT,Professional,Both,,,,227,192.95,18.32,227,"Health Partners, Inc.",State of Minnesota Advantage Program,52.49981,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Bladder Irrigation, Simple, Lavage And/Or Instillation (Pro Cah)",,51700,CPT,Professional,Both,,,,227,192.95,18.32,227,"Health Partners, Inc.",State Public Programs,18.32,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Bladder Irrigation, Simple, Lavage And/Or Instillation (Pro Cah)",,51700,CPT,Professional,Both,,,,227,192.95,18.32,227,Humana Insurance Company,Commercial PPO,28.47,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Bladder Irrigation, Simple, Lavage And/Or Instillation (Pro Cah)",,51700,CPT,Professional,Both,,,,227,192.95,18.32,227,Humana Insurance Company,Medicare PPO,227,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Bladder Irrigation, Simple, Lavage And/Or Instillation (Pro Cah)",,51700,CPT,Professional,Both,,,,227,192.95,18.32,227,Medica,Individual & Family,192.496,84.8,,percent of total billed charges,,
"Bladder Irrigation, Simple, Lavage And/Or Instillation (Pro Cah)",,51700,CPT,Professional,Both,,,,227,192.95,18.32,227,Medica,Medica Advantage Solution,113.046,49.8,,percent of total billed charges,,
"Bladder Irrigation, Simple, Lavage And/Or Instillation (Pro Cah)",,51700,CPT,Professional,Both,,,,227,192.95,18.32,227,Medica,Medical Assistance,21.15,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Bladder Irrigation, Simple, Lavage And/Or Instillation (Pro Cah)",,51700,CPT,Professional,Both,,,,227,192.95,18.32,227,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,28.47,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Bladder Irrigation, Simple, Lavage And/Or Instillation (Pro Cah)",,51700,CPT,Professional,Both,,,,227,192.95,18.32,227,"Multiplan, Inc.","Multiplan, Inc.",213.38,94,,percent of total billed charges,,
"Bladder Irrigation, Simple, Lavage And/Or Instillation (Pro Cah)",,51700,CPT,Professional,Both,,,,227,192.95,18.32,227,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,204.527,90.1,,percent of total billed charges,,
"Bladder Irrigation, Simple, Lavage And/Or Instillation (Pro Cah)",,51700,CPT,Professional,Both,,,,227,192.95,18.32,227,"Preferred One Administrative Services, INC.",PPO,223.822,98.6,,percent of total billed charges,,
"Bladder Irrigation, Simple, Lavage And/Or Instillation (Pro Cah)",,51700,CPT,Professional,Both,,,,227,192.95,18.32,227,PrimeWest Health,Minnesota Senior Health Options (MSHO),32.7405,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Bladder Irrigation, Simple, Lavage And/Or Instillation (Pro Cah)",,51700,CPT,Professional,Both,,,,227,192.95,18.32,227,PrimeWest Health,MinnesotaCare,22.6338384,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Bladder Irrigation, Simple, Lavage And/Or Instillation (Pro Cah)",,51700,CPT,Professional,Both,,,,227,192.95,18.32,227,Sanford Health Plan,Sanford Health Plan,199.76,88,,percent of total billed charges,,
"Bladder Irrigation, Simple, Lavage And/Or Instillation (Pro Cah)",,51700,CPT,Professional,Both,,,,227,192.95,18.32,227,"UCare Health, Inc.",Individual & Family Plan,46.280832,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Bladder Irrigation, Simple, Lavage And/Or Instillation (Pro Cah)",,51700,CPT,Professional,Both,,,,227,192.95,18.32,227,"UCare Health, Inc.",Medical Assistance,23.268432,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Bladder Irrigation, Simple, Lavage And/Or Instillation (Pro Cah)",,51700,CPT,Professional,Both,,,,227,192.95,18.32,227,"UCare Health, Inc.",Medicare Advantage,32.7405,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Bladder Irrigation, Simple, Lavage And/Or Instillation (Pro Cah)",,51700,CPT,Professional,Both,,,,227,192.95,18.32,227,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),26.1924,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Bladder Irrigation, Simple, Lavage And/Or Instillation (Pro Cah)",,51700,CPT,Professional,Both,,,,227,192.95,18.32,227,UnitedHealthcare,Individual & Family,227,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Bladder Irrigation, Simple, Lavage And/Or Instillation (Pro Cah)",,51700,CPT,Professional,Both,,,,227,192.95,18.32,227,UnitedHealthcare,Medicare Advantage,32.7405,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Bladder Irrigation, Simple, Lavage And/Or Instillation (Pro Cah)",,51700,CPT,Professional,Both,,,,227,192.95,18.32,227,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,21.15312,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Bladder Catheter (Foley),,51702,CPT,Facility,Both,,,,204,173.4,58.4664,299,Aetna,Commercial,187.68,92,,percent of total billed charges,,
Bladder Catheter (Foley),,51702,CPT,Facility,Outpatient,,,,204,173.4,58.4664,299,Aetna,Medicare Advantage,99.96,49,,percent of total billed charges,,
Bladder Catheter (Foley),,51702,CPT,Facility,Inpatient,,,,204,173.4,58.4664,299,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Bladder Catheter (Foley),,51702,CPT,Facility,Both,,,,204,173.4,58.4664,299,Aetna,PPO,189.72,93,,percent of total billed charges,,
Bladder Catheter (Foley),,51702,CPT,Facility,Both,,,,204,173.4,58.4664,299,America's PPO,America's PPO,195.9012,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Bladder Catheter (Foley),,51702,CPT,Facility,Both,,,,204,173.4,58.4664,299,BlueCross BlueShield Minnesota, Federal Employee Program,200.736,98.4,,percent of total billed charges,,
Bladder Catheter (Foley),,51702,CPT,Facility,Both,,,,204,173.4,58.4664,299,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,204,100,,percent of total billed charges,,
Bladder Catheter (Foley),,51702,CPT,Facility,Both,,,,204,173.4,58.4664,299,BlueCross BlueShield Minnesota,High Value Network Plan,183.6,90,,percent of total billed charges,,
Bladder Catheter (Foley),,51702,CPT,Facility,Outpatient,,,,204,173.4,58.4664,299,BlueCross BlueShield Minnesota,Medicare Advantage,99.96,49,,percent of total billed charges,,
Bladder Catheter (Foley),,51702,CPT,Facility,Inpatient,,,,204,173.4,58.4664,299,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Bladder Catheter (Foley),,51702,CPT,Facility,Both,,,,204,173.4,58.4664,299,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,180.6828,88.57,,percent of total billed charges,,
Bladder Catheter (Foley),,51702,CPT,Facility,Both,,,,204,173.4,58.4664,299,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,58.4664,28.66,,percent of total billed charges,,
Bladder Catheter (Foley),,51702,CPT,Facility,Outpatient,,,,204,173.4,58.4664,299,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),99.96,49,,percent of total billed charges,,
Bladder Catheter (Foley),,51702,CPT,Facility,Inpatient,,,,204,173.4,58.4664,299,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Bladder Catheter (Foley),,51702,CPT,Facility,Both,,,,204,173.4,58.4664,299,CorVel,Worker's Compensation,204,100,,percent of total billed charges,,
Bladder Catheter (Foley),,51702,CPT,Facility,Both,,,,204,173.4,58.4664,299,First Health Group Corporation,First Health Network,197.88,97,,percent of total billed charges,,
Bladder Catheter (Foley),,51702,CPT,Facility,Both,,,,204,173.4,58.4664,299,"Health Partners, Inc.",Commercial,192.984,94.6,,percent of total billed charges,,
Bladder Catheter (Foley),,51702,CPT,Facility,Outpatient,,,,204,173.4,58.4664,299,"Health Partners, Inc.",Medicare Advantage,99.96,49,,percent of total billed charges,,
Bladder Catheter (Foley),,51702,CPT,Facility,Inpatient,,,,204,173.4,58.4664,299,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Bladder Catheter (Foley),,51702,CPT,Facility,Both,,,,204,173.4,58.4664,299,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),122.4,60,,percent of total billed charges,,
Bladder Catheter (Foley),,51702,CPT,Facility,Both,,,,204,173.4,58.4664,299,"Health Partners, Inc.",State of Minnesota Advantage Program,166.26,81.5,,percent of total billed charges,,
Bladder Catheter (Foley),,51702,CPT,Facility,Both,,,,204,173.4,58.4664,299,"Health Partners, Inc.",State Public Programs,102,50,,percent of total billed charges,,
Bladder Catheter (Foley),,51702,CPT,Facility,Both,,,,204,173.4,58.4664,299,Humana Insurance Company,Commercial PPO,193.8,95,,percent of total billed charges,,
Bladder Catheter (Foley),,51702,CPT,Facility,Outpatient,,,,204,173.4,58.4664,299,Humana Insurance Company,Medicare PPO,99.96,49,,percent of total billed charges,,
Bladder Catheter (Foley),,51702,CPT,Facility,Inpatient,,,,204,173.4,58.4664,299,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Bladder Catheter (Foley),,51702,CPT,Facility,Both,,,,204,173.4,58.4664,299,Medica,Individual & Family,202.164,99.1,,percent of total billed charges,,
Bladder Catheter (Foley),,51702,CPT,Facility,Outpatient,,,,204,173.4,58.4664,299,Medica,Medica Advantage Solution,101.592,49.8,,percent of total billed charges,,
Bladder Catheter (Foley),,51702,CPT,Facility,Inpatient,,,,204,173.4,58.4664,299,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Bladder Catheter (Foley),,51702,CPT,Facility,Outpatient,,,,204,173.4,58.4664,299,Medica,Medical Assistance,299,,,Other,Grouper,All inclusive per visit
Bladder Catheter (Foley),,51702,CPT,Facility,Inpatient,,,,204,173.4,58.4664,299,Medica,Medical Assistance,,,,,Included in per diem rate,
Bladder Catheter (Foley),,51702,CPT,Facility,Outpatient,,,,204,173.4,58.4664,299,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,101.592,49.8,,percent of total billed charges,,
Bladder Catheter (Foley),,51702,CPT,Facility,Inpatient,,,,204,173.4,58.4664,299,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Bladder Catheter (Foley),,51702,CPT,Facility,Both,,,,204,173.4,58.4664,299,"Multiplan, Inc.","Multiplan, Inc.",191.76,94,,percent of total billed charges,,
Bladder Catheter (Foley),,51702,CPT,Facility,Outpatient,,,,204,173.4,58.4664,299,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,183.804,90.1,,percent of total billed charges,,
Bladder Catheter (Foley),,51702,CPT,Facility,Inpatient,,,,204,173.4,58.4664,299,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Bladder Catheter (Foley),,51702,CPT,Facility,Both,,,,204,173.4,58.4664,299,"Preferred One Administrative Services, INC.",PPO,201.144,98.6,,percent of total billed charges,,
Bladder Catheter (Foley),,51702,CPT,Facility,Outpatient,,,,204,173.4,58.4664,299,PrimeWest Health,Minnesota Senior Health Options (MSHO),104.958,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Bladder Catheter (Foley),,51702,CPT,Facility,Inpatient,,,,204,173.4,58.4664,299,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Bladder Catheter (Foley),,51702,CPT,Facility,Outpatient,,,,204,173.4,58.4664,299,PrimeWest Health,MinnesotaCare,104.7744,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Bladder Catheter (Foley),,51702,CPT,Facility,Inpatient,,,,204,173.4,58.4664,299,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Bladder Catheter (Foley),,51702,CPT,Facility,Both,,,,204,173.4,58.4664,299,Sanford Health Plan,Sanford Health Plan,187.68,92,,percent of total billed charges,,
Bladder Catheter (Foley),,51702,CPT,Facility,Outpatient,,,,204,173.4,58.4664,299,"UCare Health, Inc.",Individual & Family Plan,114.954,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Bladder Catheter (Foley),,51702,CPT,Facility,Inpatient,,,,204,173.4,58.4664,299,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Bladder Catheter (Foley),,51702,CPT,Facility,Outpatient,,,,204,173.4,58.4664,299,"UCare Health, Inc.",Medical Assistance,102.9588,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Bladder Catheter (Foley),,51702,CPT,Facility,Inpatient,,,,204,173.4,58.4664,299,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Bladder Catheter (Foley),,51702,CPT,Facility,Outpatient,,,,204,173.4,58.4664,299,"UCare Health, Inc.",Medicare Advantage,102.9588,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Bladder Catheter (Foley),,51702,CPT,Facility,Inpatient,,,,204,173.4,58.4664,299,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Bladder Catheter (Foley),,51702,CPT,Facility,Outpatient,,,,204,173.4,58.4664,299,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),102.9588,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Bladder Catheter (Foley),,51702,CPT,Facility,Inpatient,,,,204,173.4,58.4664,299,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Bladder Catheter (Foley),,51702,CPT,Facility,Both,,,,204,173.4,58.4664,299,UnitedHealthcare,Individual & Family,191.76,94,,percent of total billed charges,,
Bladder Catheter (Foley),,51702,CPT,Facility,Outpatient,,,,204,173.4,58.4664,299,UnitedHealthcare,Medicare Advantage,99.96,49,,percent of total billed charges,,
Bladder Catheter (Foley),,51702,CPT,Facility,Inpatient,,,,204,173.4,58.4664,299,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Bladder Catheter (Foley),,51702,CPT,Facility,Outpatient,,,,204,173.4,58.4664,299,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,97.92,48,,percent of total billed charges,,100% of DHS outpatient percentage
Bladder Catheter (Foley),,51702,CPT,Facility,Inpatient,,,,204,173.4,58.4664,299,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Insertion Of Temporary Indwelling Bladder Catheter; Simple (Eg, Foley) (Pro Cah)",,51702,CPT,Professional,Both,,,,306,260.1,15.27,306,Aetna,Commercial,260.1,85,,percent of total billed charges,,
"Insertion Of Temporary Indwelling Bladder Catheter; Simple (Eg, Foley) (Pro Cah)",,51702,CPT,Professional,Both,,,,306,260.1,15.27,306,Aetna,Medicare Advantage,24.42,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Insertion Of Temporary Indwelling Bladder Catheter; Simple (Eg, Foley) (Pro Cah)",,51702,CPT,Professional,Both,,,,306,260.1,15.27,306,Aetna,PPO,284.58,93,,percent of total billed charges,,
"Insertion Of Temporary Indwelling Bladder Catheter; Simple (Eg, Foley) (Pro Cah)",,51702,CPT,Professional,Both,,,,306,260.1,15.27,306,America's PPO,America's PPO,261.4464,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Insertion Of Temporary Indwelling Bladder Catheter; Simple (Eg, Foley) (Pro Cah)",,51702,CPT,Professional,Both,,,,306,260.1,15.27,306,BlueCross BlueShield Minnesota, Federal Employee Program,50.96,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Insertion Of Temporary Indwelling Bladder Catheter; Simple (Eg, Foley) (Pro Cah)",,51702,CPT,Professional,Both,,,,306,260.1,15.27,306,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,51.77536,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Insertion Of Temporary Indwelling Bladder Catheter; Simple (Eg, Foley) (Pro Cah)",,51702,CPT,Professional,Both,,,,306,260.1,15.27,306,BlueCross BlueShield Minnesota,High Value Network Plan,51.77536,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Insertion Of Temporary Indwelling Bladder Catheter; Simple (Eg, Foley) (Pro Cah)",,51702,CPT,Professional,Both,,,,306,260.1,15.27,306,BlueCross BlueShield Minnesota,Medicare Advantage,27.393,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Insertion Of Temporary Indwelling Bladder Catheter; Simple (Eg, Foley) (Pro Cah)",,51702,CPT,Professional,Both,,,,306,260.1,15.27,306,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,51.77536,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Insertion Of Temporary Indwelling Bladder Catheter; Simple (Eg, Foley) (Pro Cah)",,51702,CPT,Professional,Both,,,,306,260.1,15.27,306,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,17.6276,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Insertion Of Temporary Indwelling Bladder Catheter; Simple (Eg, Foley) (Pro Cah)",,51702,CPT,Professional,Both,,,,306,260.1,15.27,306,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),27.393,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Insertion Of Temporary Indwelling Bladder Catheter; Simple (Eg, Foley) (Pro Cah)",,51702,CPT,Professional,Both,,,,306,260.1,15.27,306,CorVel,Worker's Compensation,47.4925485,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Insertion Of Temporary Indwelling Bladder Catheter; Simple (Eg, Foley) (Pro Cah)",,51702,CPT,Professional,Both,,,,306,260.1,15.27,306,First Health Group Corporation,First Health Network,296.82,97,,percent of total billed charges,,
"Insertion Of Temporary Indwelling Bladder Catheter; Simple (Eg, Foley) (Pro Cah)",,51702,CPT,Professional,Both,,,,306,260.1,15.27,306,"Health Partners, Inc.",Commercial,50.79,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Insertion Of Temporary Indwelling Bladder Catheter; Simple (Eg, Foley) (Pro Cah)",,51702,CPT,Professional,Both,,,,306,260.1,15.27,306,"Health Partners, Inc.",Medicare Advantage,27.393,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Insertion Of Temporary Indwelling Bladder Catheter; Simple (Eg, Foley) (Pro Cah)",,51702,CPT,Professional,Both,,,,306,260.1,15.27,306,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),23.72,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Insertion Of Temporary Indwelling Bladder Catheter; Simple (Eg, Foley) (Pro Cah)",,51702,CPT,Professional,Both,,,,306,260.1,15.27,306,"Health Partners, Inc.",State of Minnesota Advantage Program,43.755585,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Insertion Of Temporary Indwelling Bladder Catheter; Simple (Eg, Foley) (Pro Cah)",,51702,CPT,Professional,Both,,,,306,260.1,15.27,306,"Health Partners, Inc.",State Public Programs,15.27,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Insertion Of Temporary Indwelling Bladder Catheter; Simple (Eg, Foley) (Pro Cah)",,51702,CPT,Professional,Both,,,,306,260.1,15.27,306,Humana Insurance Company,Commercial PPO,23.82,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Insertion Of Temporary Indwelling Bladder Catheter; Simple (Eg, Foley) (Pro Cah)",,51702,CPT,Professional,Both,,,,306,260.1,15.27,306,Humana Insurance Company,Medicare PPO,306,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Insertion Of Temporary Indwelling Bladder Catheter; Simple (Eg, Foley) (Pro Cah)",,51702,CPT,Professional,Both,,,,306,260.1,15.27,306,Medica,Individual & Family,259.488,84.8,,percent of total billed charges,,
"Insertion Of Temporary Indwelling Bladder Catheter; Simple (Eg, Foley) (Pro Cah)",,51702,CPT,Professional,Both,,,,306,260.1,15.27,306,Medica,Medica Advantage Solution,152.388,49.8,,percent of total billed charges,,
"Insertion Of Temporary Indwelling Bladder Catheter; Simple (Eg, Foley) (Pro Cah)",,51702,CPT,Professional,Both,,,,306,260.1,15.27,306,Medica,Medical Assistance,17.63,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Insertion Of Temporary Indwelling Bladder Catheter; Simple (Eg, Foley) (Pro Cah)",,51702,CPT,Professional,Both,,,,306,260.1,15.27,306,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,23.82,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Insertion Of Temporary Indwelling Bladder Catheter; Simple (Eg, Foley) (Pro Cah)",,51702,CPT,Professional,Both,,,,306,260.1,15.27,306,"Multiplan, Inc.","Multiplan, Inc.",287.64,94,,percent of total billed charges,,
"Insertion Of Temporary Indwelling Bladder Catheter; Simple (Eg, Foley) (Pro Cah)",,51702,CPT,Professional,Both,,,,306,260.1,15.27,306,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,275.706,90.1,,percent of total billed charges,,
"Insertion Of Temporary Indwelling Bladder Catheter; Simple (Eg, Foley) (Pro Cah)",,51702,CPT,Professional,Both,,,,306,260.1,15.27,306,"Preferred One Administrative Services, INC.",PPO,301.716,98.6,,percent of total billed charges,,
"Insertion Of Temporary Indwelling Bladder Catheter; Simple (Eg, Foley) (Pro Cah)",,51702,CPT,Professional,Both,,,,306,260.1,15.27,306,PrimeWest Health,Minnesota Senior Health Options (MSHO),27.393,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Insertion Of Temporary Indwelling Bladder Catheter; Simple (Eg, Foley) (Pro Cah)",,51702,CPT,Professional,Both,,,,306,260.1,15.27,306,PrimeWest Health,MinnesotaCare,18.861532,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Insertion Of Temporary Indwelling Bladder Catheter; Simple (Eg, Foley) (Pro Cah)",,51702,CPT,Professional,Both,,,,306,260.1,15.27,306,Sanford Health Plan,Sanford Health Plan,269.28,88,,percent of total billed charges,,
"Insertion Of Temporary Indwelling Bladder Catheter; Simple (Eg, Foley) (Pro Cah)",,51702,CPT,Professional,Both,,,,306,260.1,15.27,306,"UCare Health, Inc.",Individual & Family Plan,38.721792,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Insertion Of Temporary Indwelling Bladder Catheter; Simple (Eg, Foley) (Pro Cah)",,51702,CPT,Professional,Both,,,,306,260.1,15.27,306,"UCare Health, Inc.",Medical Assistance,19.39036,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Insertion Of Temporary Indwelling Bladder Catheter; Simple (Eg, Foley) (Pro Cah)",,51702,CPT,Professional,Both,,,,306,260.1,15.27,306,"UCare Health, Inc.",Medicare Advantage,27.393,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Insertion Of Temporary Indwelling Bladder Catheter; Simple (Eg, Foley) (Pro Cah)",,51702,CPT,Professional,Both,,,,306,260.1,15.27,306,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),21.9144,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Insertion Of Temporary Indwelling Bladder Catheter; Simple (Eg, Foley) (Pro Cah)",,51702,CPT,Professional,Both,,,,306,260.1,15.27,306,UnitedHealthcare,Individual & Family,306,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Insertion Of Temporary Indwelling Bladder Catheter; Simple (Eg, Foley) (Pro Cah)",,51702,CPT,Professional,Both,,,,306,260.1,15.27,306,UnitedHealthcare,Medicare Advantage,27.393,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Insertion Of Temporary Indwelling Bladder Catheter; Simple (Eg, Foley) (Pro Cah)",,51702,CPT,Professional,Both,,,,306,260.1,15.27,306,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,17.6276,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Bladder Catheter Complex,,51703,CPT,Facility,Both,,,,301,255.85,86.2666,301,Aetna,Commercial,276.92,92,,percent of total billed charges,,
Bladder Catheter Complex,,51703,CPT,Facility,Outpatient,,,,301,255.85,86.2666,301,Aetna,Medicare Advantage,147.49,49,,percent of total billed charges,,
Bladder Catheter Complex,,51703,CPT,Facility,Inpatient,,,,301,255.85,86.2666,301,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Bladder Catheter Complex,,51703,CPT,Facility,Both,,,,301,255.85,86.2666,301,Aetna,PPO,279.93,93,,percent of total billed charges,,
Bladder Catheter Complex,,51703,CPT,Facility,Both,,,,301,255.85,86.2666,301,America's PPO,America's PPO,289.0503,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Bladder Catheter Complex,,51703,CPT,Facility,Both,,,,301,255.85,86.2666,301,BlueCross BlueShield Minnesota, Federal Employee Program,296.184,98.4,,percent of total billed charges,,
Bladder Catheter Complex,,51703,CPT,Facility,Both,,,,301,255.85,86.2666,301,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,301,100,,percent of total billed charges,,
Bladder Catheter Complex,,51703,CPT,Facility,Both,,,,301,255.85,86.2666,301,BlueCross BlueShield Minnesota,High Value Network Plan,270.9,90,,percent of total billed charges,,
Bladder Catheter Complex,,51703,CPT,Facility,Outpatient,,,,301,255.85,86.2666,301,BlueCross BlueShield Minnesota,Medicare Advantage,147.49,49,,percent of total billed charges,,
Bladder Catheter Complex,,51703,CPT,Facility,Inpatient,,,,301,255.85,86.2666,301,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Bladder Catheter Complex,,51703,CPT,Facility,Both,,,,301,255.85,86.2666,301,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,266.5957,88.57,,percent of total billed charges,,
Bladder Catheter Complex,,51703,CPT,Facility,Both,,,,301,255.85,86.2666,301,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,86.2666,28.66,,percent of total billed charges,,
Bladder Catheter Complex,,51703,CPT,Facility,Outpatient,,,,301,255.85,86.2666,301,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),147.49,49,,percent of total billed charges,,
Bladder Catheter Complex,,51703,CPT,Facility,Inpatient,,,,301,255.85,86.2666,301,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Bladder Catheter Complex,,51703,CPT,Facility,Both,,,,301,255.85,86.2666,301,CorVel,Worker's Compensation,301,100,,percent of total billed charges,,
Bladder Catheter Complex,,51703,CPT,Facility,Both,,,,301,255.85,86.2666,301,First Health Group Corporation,First Health Network,291.97,97,,percent of total billed charges,,
Bladder Catheter Complex,,51703,CPT,Facility,Both,,,,301,255.85,86.2666,301,"Health Partners, Inc.",Commercial,284.746,94.6,,percent of total billed charges,,
Bladder Catheter Complex,,51703,CPT,Facility,Outpatient,,,,301,255.85,86.2666,301,"Health Partners, Inc.",Medicare Advantage,147.49,49,,percent of total billed charges,,
Bladder Catheter Complex,,51703,CPT,Facility,Inpatient,,,,301,255.85,86.2666,301,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Bladder Catheter Complex,,51703,CPT,Facility,Both,,,,301,255.85,86.2666,301,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),180.6,60,,percent of total billed charges,,
Bladder Catheter Complex,,51703,CPT,Facility,Both,,,,301,255.85,86.2666,301,"Health Partners, Inc.",State of Minnesota Advantage Program,245.315,81.5,,percent of total billed charges,,
Bladder Catheter Complex,,51703,CPT,Facility,Both,,,,301,255.85,86.2666,301,"Health Partners, Inc.",State Public Programs,150.5,50,,percent of total billed charges,,
Bladder Catheter Complex,,51703,CPT,Facility,Both,,,,301,255.85,86.2666,301,Humana Insurance Company,Commercial PPO,285.95,95,,percent of total billed charges,,
Bladder Catheter Complex,,51703,CPT,Facility,Outpatient,,,,301,255.85,86.2666,301,Humana Insurance Company,Medicare PPO,147.49,49,,percent of total billed charges,,
Bladder Catheter Complex,,51703,CPT,Facility,Inpatient,,,,301,255.85,86.2666,301,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Bladder Catheter Complex,,51703,CPT,Facility,Both,,,,301,255.85,86.2666,301,Medica,Individual & Family,298.291,99.1,,percent of total billed charges,,
Bladder Catheter Complex,,51703,CPT,Facility,Outpatient,,,,301,255.85,86.2666,301,Medica,Medica Advantage Solution,149.898,49.8,,percent of total billed charges,,
Bladder Catheter Complex,,51703,CPT,Facility,Inpatient,,,,301,255.85,86.2666,301,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Bladder Catheter Complex,,51703,CPT,Facility,Outpatient,,,,301,255.85,86.2666,301,Medica,Medical Assistance,134.246,44.6,,percent of total billed charges,,
Bladder Catheter Complex,,51703,CPT,Facility,Inpatient,,,,301,255.85,86.2666,301,Medica,Medical Assistance,,,,,Included in per diem rate,
Bladder Catheter Complex,,51703,CPT,Facility,Outpatient,,,,301,255.85,86.2666,301,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,149.898,49.8,,percent of total billed charges,,
Bladder Catheter Complex,,51703,CPT,Facility,Inpatient,,,,301,255.85,86.2666,301,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Bladder Catheter Complex,,51703,CPT,Facility,Both,,,,301,255.85,86.2666,301,"Multiplan, Inc.","Multiplan, Inc.",282.94,94,,percent of total billed charges,,
Bladder Catheter Complex,,51703,CPT,Facility,Outpatient,,,,301,255.85,86.2666,301,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,271.201,90.1,,percent of total billed charges,,
Bladder Catheter Complex,,51703,CPT,Facility,Inpatient,,,,301,255.85,86.2666,301,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Bladder Catheter Complex,,51703,CPT,Facility,Both,,,,301,255.85,86.2666,301,"Preferred One Administrative Services, INC.",PPO,296.786,98.6,,percent of total billed charges,,
Bladder Catheter Complex,,51703,CPT,Facility,Outpatient,,,,301,255.85,86.2666,301,PrimeWest Health,Minnesota Senior Health Options (MSHO),154.8645,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Bladder Catheter Complex,,51703,CPT,Facility,Inpatient,,,,301,255.85,86.2666,301,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Bladder Catheter Complex,,51703,CPT,Facility,Outpatient,,,,301,255.85,86.2666,301,PrimeWest Health,MinnesotaCare,154.5936,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Bladder Catheter Complex,,51703,CPT,Facility,Inpatient,,,,301,255.85,86.2666,301,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Bladder Catheter Complex,,51703,CPT,Facility,Both,,,,301,255.85,86.2666,301,Sanford Health Plan,Sanford Health Plan,276.92,92,,percent of total billed charges,,
Bladder Catheter Complex,,51703,CPT,Facility,Outpatient,,,,301,255.85,86.2666,301,"UCare Health, Inc.",Individual & Family Plan,169.6135,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Bladder Catheter Complex,,51703,CPT,Facility,Inpatient,,,,301,255.85,86.2666,301,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Bladder Catheter Complex,,51703,CPT,Facility,Outpatient,,,,301,255.85,86.2666,301,"UCare Health, Inc.",Medical Assistance,151.9147,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Bladder Catheter Complex,,51703,CPT,Facility,Inpatient,,,,301,255.85,86.2666,301,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Bladder Catheter Complex,,51703,CPT,Facility,Outpatient,,,,301,255.85,86.2666,301,"UCare Health, Inc.",Medicare Advantage,151.9147,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Bladder Catheter Complex,,51703,CPT,Facility,Inpatient,,,,301,255.85,86.2666,301,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Bladder Catheter Complex,,51703,CPT,Facility,Outpatient,,,,301,255.85,86.2666,301,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),151.9147,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Bladder Catheter Complex,,51703,CPT,Facility,Inpatient,,,,301,255.85,86.2666,301,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Bladder Catheter Complex,,51703,CPT,Facility,Both,,,,301,255.85,86.2666,301,UnitedHealthcare,Individual & Family,282.94,94,,percent of total billed charges,,
Bladder Catheter Complex,,51703,CPT,Facility,Outpatient,,,,301,255.85,86.2666,301,UnitedHealthcare,Medicare Advantage,147.49,49,,percent of total billed charges,,
Bladder Catheter Complex,,51703,CPT,Facility,Inpatient,,,,301,255.85,86.2666,301,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Bladder Catheter Complex,,51703,CPT,Facility,Outpatient,,,,301,255.85,86.2666,301,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,144.48,48,,percent of total billed charges,,100% of DHS outpatient percentage
Bladder Catheter Complex,,51703,CPT,Facility,Inpatient,,,,301,255.85,86.2666,301,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Insertion Of Temporary Indwelling Bladder Catheter; Complicated (Pro Cah),,51703,CPT,Professional,Both,,,,449,381.65,46.68,449,Aetna,Commercial,381.65,85,,percent of total billed charges,,
Insertion Of Temporary Indwelling Bladder Catheter; Complicated (Pro Cah),,51703,CPT,Professional,Both,,,,449,381.65,46.68,449,Aetna,Medicare Advantage,73.89,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Insertion Of Temporary Indwelling Bladder Catheter; Complicated (Pro Cah),,51703,CPT,Professional,Both,,,,449,381.65,46.68,449,Aetna,PPO,417.57,93,,percent of total billed charges,,
Insertion Of Temporary Indwelling Bladder Catheter; Complicated (Pro Cah),,51703,CPT,Professional,Both,,,,449,381.65,46.68,449,America's PPO,America's PPO,383.6256,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Insertion Of Temporary Indwelling Bladder Catheter; Complicated (Pro Cah),,51703,CPT,Professional,Both,,,,449,381.65,46.68,449,BlueCross BlueShield Minnesota, Federal Employee Program,154.94,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Insertion Of Temporary Indwelling Bladder Catheter; Complicated (Pro Cah),,51703,CPT,Professional,Both,,,,449,381.65,46.68,449,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,157.41904,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Insertion Of Temporary Indwelling Bladder Catheter; Complicated (Pro Cah),,51703,CPT,Professional,Both,,,,449,381.65,46.68,449,BlueCross BlueShield Minnesota,High Value Network Plan,157.41904,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Insertion Of Temporary Indwelling Bladder Catheter; Complicated (Pro Cah),,51703,CPT,Professional,Both,,,,449,381.65,46.68,449,BlueCross BlueShield Minnesota,Medicare Advantage,83.398,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Insertion Of Temporary Indwelling Bladder Catheter; Complicated (Pro Cah),,51703,CPT,Professional,Both,,,,449,381.65,46.68,449,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,157.41904,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Insertion Of Temporary Indwelling Bladder Catheter; Complicated (Pro Cah),,51703,CPT,Professional,Both,,,,449,381.65,46.68,449,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,53.8988,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Insertion Of Temporary Indwelling Bladder Catheter; Complicated (Pro Cah),,51703,CPT,Professional,Both,,,,449,381.65,46.68,449,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),83.398,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Insertion Of Temporary Indwelling Bladder Catheter; Complicated (Pro Cah),,51703,CPT,Professional,Both,,,,449,381.65,46.68,449,CorVel,Worker's Compensation,142.7100537,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Insertion Of Temporary Indwelling Bladder Catheter; Complicated (Pro Cah),,51703,CPT,Professional,Both,,,,449,381.65,46.68,449,First Health Group Corporation,First Health Network,435.53,97,,percent of total billed charges,,
Insertion Of Temporary Indwelling Bladder Catheter; Complicated (Pro Cah),,51703,CPT,Professional,Both,,,,449,381.65,46.68,449,"Health Partners, Inc.",Commercial,154.53,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Insertion Of Temporary Indwelling Bladder Catheter; Complicated (Pro Cah),,51703,CPT,Professional,Both,,,,449,381.65,46.68,449,"Health Partners, Inc.",Medicare Advantage,83.398,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Insertion Of Temporary Indwelling Bladder Catheter; Complicated (Pro Cah),,51703,CPT,Professional,Both,,,,449,381.65,46.68,449,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),72.52,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Insertion Of Temporary Indwelling Bladder Catheter; Complicated (Pro Cah),,51703,CPT,Professional,Both,,,,449,381.65,46.68,449,"Health Partners, Inc.",State of Minnesota Advantage Program,133.127595,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Insertion Of Temporary Indwelling Bladder Catheter; Complicated (Pro Cah),,51703,CPT,Professional,Both,,,,449,381.65,46.68,449,"Health Partners, Inc.",State Public Programs,46.68,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Insertion Of Temporary Indwelling Bladder Catheter; Complicated (Pro Cah),,51703,CPT,Professional,Both,,,,449,381.65,46.68,449,Humana Insurance Company,Commercial PPO,72.52,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Insertion Of Temporary Indwelling Bladder Catheter; Complicated (Pro Cah),,51703,CPT,Professional,Both,,,,449,381.65,46.68,449,Humana Insurance Company,Medicare PPO,449,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Insertion Of Temporary Indwelling Bladder Catheter; Complicated (Pro Cah),,51703,CPT,Professional,Both,,,,449,381.65,46.68,449,Medica,Individual & Family,380.752,84.8,,percent of total billed charges,,
Insertion Of Temporary Indwelling Bladder Catheter; Complicated (Pro Cah),,51703,CPT,Professional,Both,,,,449,381.65,46.68,449,Medica,Medica Advantage Solution,223.602,49.8,,percent of total billed charges,,
Insertion Of Temporary Indwelling Bladder Catheter; Complicated (Pro Cah),,51703,CPT,Professional,Both,,,,449,381.65,46.68,449,Medica,Medical Assistance,53.9,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Insertion Of Temporary Indwelling Bladder Catheter; Complicated (Pro Cah),,51703,CPT,Professional,Both,,,,449,381.65,46.68,449,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,72.52,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Insertion Of Temporary Indwelling Bladder Catheter; Complicated (Pro Cah),,51703,CPT,Professional,Both,,,,449,381.65,46.68,449,"Multiplan, Inc.","Multiplan, Inc.",422.06,94,,percent of total billed charges,,
Insertion Of Temporary Indwelling Bladder Catheter; Complicated (Pro Cah),,51703,CPT,Professional,Both,,,,449,381.65,46.68,449,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,404.549,90.1,,percent of total billed charges,,
Insertion Of Temporary Indwelling Bladder Catheter; Complicated (Pro Cah),,51703,CPT,Professional,Both,,,,449,381.65,46.68,449,"Preferred One Administrative Services, INC.",PPO,442.714,98.6,,percent of total billed charges,,
Insertion Of Temporary Indwelling Bladder Catheter; Complicated (Pro Cah),,51703,CPT,Professional,Both,,,,449,381.65,46.68,449,PrimeWest Health,Minnesota Senior Health Options (MSHO),83.398,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Insertion Of Temporary Indwelling Bladder Catheter; Complicated (Pro Cah),,51703,CPT,Professional,Both,,,,449,381.65,46.68,449,PrimeWest Health,MinnesotaCare,57.671716,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Insertion Of Temporary Indwelling Bladder Catheter; Complicated (Pro Cah),,51703,CPT,Professional,Both,,,,449,381.65,46.68,449,Sanford Health Plan,Sanford Health Plan,395.12,88,,percent of total billed charges,,
Insertion Of Temporary Indwelling Bladder Catheter; Complicated (Pro Cah),,51703,CPT,Professional,Both,,,,449,381.65,46.68,449,"UCare Health, Inc.",Individual & Family Plan,117.888512,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Insertion Of Temporary Indwelling Bladder Catheter; Complicated (Pro Cah),,51703,CPT,Professional,Both,,,,449,381.65,46.68,449,"UCare Health, Inc.",Medical Assistance,59.28868,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Insertion Of Temporary Indwelling Bladder Catheter; Complicated (Pro Cah),,51703,CPT,Professional,Both,,,,449,381.65,46.68,449,"UCare Health, Inc.",Medicare Advantage,83.398,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Insertion Of Temporary Indwelling Bladder Catheter; Complicated (Pro Cah),,51703,CPT,Professional,Both,,,,449,381.65,46.68,449,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),66.7184,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Insertion Of Temporary Indwelling Bladder Catheter; Complicated (Pro Cah),,51703,CPT,Professional,Both,,,,449,381.65,46.68,449,UnitedHealthcare,Individual & Family,449,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Insertion Of Temporary Indwelling Bladder Catheter; Complicated (Pro Cah),,51703,CPT,Professional,Both,,,,449,381.65,46.68,449,UnitedHealthcare,Medicare Advantage,83.398,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Insertion Of Temporary Indwelling Bladder Catheter; Complicated (Pro Cah),,51703,CPT,Professional,Both,,,,449,381.65,46.68,449,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,53.8988,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Change Of Cystostomy Tube,,51705,CPT,Facility,Both,,,,230,195.5,65.918,299,Aetna,Commercial,211.6,92,,percent of total billed charges,,
Change Of Cystostomy Tube,,51705,CPT,Facility,Outpatient,,,,230,195.5,65.918,299,Aetna,Medicare Advantage,112.7,49,,percent of total billed charges,,
Change Of Cystostomy Tube,,51705,CPT,Facility,Inpatient,,,,230,195.5,65.918,299,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Change Of Cystostomy Tube,,51705,CPT,Facility,Both,,,,230,195.5,65.918,299,Aetna,PPO,213.9,93,,percent of total billed charges,,
Change Of Cystostomy Tube,,51705,CPT,Facility,Both,,,,230,195.5,65.918,299,America's PPO,America's PPO,220.869,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Change Of Cystostomy Tube,,51705,CPT,Facility,Both,,,,230,195.5,65.918,299,BlueCross BlueShield Minnesota, Federal Employee Program,226.32,98.4,,percent of total billed charges,,
Change Of Cystostomy Tube,,51705,CPT,Facility,Both,,,,230,195.5,65.918,299,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,230,100,,percent of total billed charges,,
Change Of Cystostomy Tube,,51705,CPT,Facility,Both,,,,230,195.5,65.918,299,BlueCross BlueShield Minnesota,High Value Network Plan,207,90,,percent of total billed charges,,
Change Of Cystostomy Tube,,51705,CPT,Facility,Outpatient,,,,230,195.5,65.918,299,BlueCross BlueShield Minnesota,Medicare Advantage,112.7,49,,percent of total billed charges,,
Change Of Cystostomy Tube,,51705,CPT,Facility,Inpatient,,,,230,195.5,65.918,299,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Change Of Cystostomy Tube,,51705,CPT,Facility,Both,,,,230,195.5,65.918,299,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,203.711,88.57,,percent of total billed charges,,
Change Of Cystostomy Tube,,51705,CPT,Facility,Both,,,,230,195.5,65.918,299,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,65.918,28.66,,percent of total billed charges,,
Change Of Cystostomy Tube,,51705,CPT,Facility,Outpatient,,,,230,195.5,65.918,299,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),112.7,49,,percent of total billed charges,,
Change Of Cystostomy Tube,,51705,CPT,Facility,Inpatient,,,,230,195.5,65.918,299,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Change Of Cystostomy Tube,,51705,CPT,Facility,Both,,,,230,195.5,65.918,299,CorVel,Worker's Compensation,230,100,,percent of total billed charges,,
Change Of Cystostomy Tube,,51705,CPT,Facility,Both,,,,230,195.5,65.918,299,First Health Group Corporation,First Health Network,223.1,97,,percent of total billed charges,,
Change Of Cystostomy Tube,,51705,CPT,Facility,Both,,,,230,195.5,65.918,299,"Health Partners, Inc.",Commercial,217.58,94.6,,percent of total billed charges,,
Change Of Cystostomy Tube,,51705,CPT,Facility,Outpatient,,,,230,195.5,65.918,299,"Health Partners, Inc.",Medicare Advantage,112.7,49,,percent of total billed charges,,
Change Of Cystostomy Tube,,51705,CPT,Facility,Inpatient,,,,230,195.5,65.918,299,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Change Of Cystostomy Tube,,51705,CPT,Facility,Both,,,,230,195.5,65.918,299,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),138,60,,percent of total billed charges,,
Change Of Cystostomy Tube,,51705,CPT,Facility,Both,,,,230,195.5,65.918,299,"Health Partners, Inc.",State of Minnesota Advantage Program,187.45,81.5,,percent of total billed charges,,
Change Of Cystostomy Tube,,51705,CPT,Facility,Both,,,,230,195.5,65.918,299,"Health Partners, Inc.",State Public Programs,115,50,,percent of total billed charges,,
Change Of Cystostomy Tube,,51705,CPT,Facility,Both,,,,230,195.5,65.918,299,Humana Insurance Company,Commercial PPO,218.5,95,,percent of total billed charges,,
Change Of Cystostomy Tube,,51705,CPT,Facility,Outpatient,,,,230,195.5,65.918,299,Humana Insurance Company,Medicare PPO,112.7,49,,percent of total billed charges,,
Change Of Cystostomy Tube,,51705,CPT,Facility,Inpatient,,,,230,195.5,65.918,299,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Change Of Cystostomy Tube,,51705,CPT,Facility,Both,,,,230,195.5,65.918,299,Medica,Individual & Family,227.93,99.1,,percent of total billed charges,,
Change Of Cystostomy Tube,,51705,CPT,Facility,Outpatient,,,,230,195.5,65.918,299,Medica,Medica Advantage Solution,114.54,49.8,,percent of total billed charges,,
Change Of Cystostomy Tube,,51705,CPT,Facility,Inpatient,,,,230,195.5,65.918,299,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Change Of Cystostomy Tube,,51705,CPT,Facility,Outpatient,,,,230,195.5,65.918,299,Medica,Medical Assistance,299,,,Other,Grouper,All inclusive per visit
Change Of Cystostomy Tube,,51705,CPT,Facility,Inpatient,,,,230,195.5,65.918,299,Medica,Medical Assistance,,,,,Included in per diem rate,
Change Of Cystostomy Tube,,51705,CPT,Facility,Outpatient,,,,230,195.5,65.918,299,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,114.54,49.8,,percent of total billed charges,,
Change Of Cystostomy Tube,,51705,CPT,Facility,Inpatient,,,,230,195.5,65.918,299,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Change Of Cystostomy Tube,,51705,CPT,Facility,Both,,,,230,195.5,65.918,299,"Multiplan, Inc.","Multiplan, Inc.",216.2,94,,percent of total billed charges,,
Change Of Cystostomy Tube,,51705,CPT,Facility,Outpatient,,,,230,195.5,65.918,299,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,207.23,90.1,,percent of total billed charges,,
Change Of Cystostomy Tube,,51705,CPT,Facility,Inpatient,,,,230,195.5,65.918,299,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Change Of Cystostomy Tube,,51705,CPT,Facility,Both,,,,230,195.5,65.918,299,"Preferred One Administrative Services, INC.",PPO,226.78,98.6,,percent of total billed charges,,
Change Of Cystostomy Tube,,51705,CPT,Facility,Outpatient,,,,230,195.5,65.918,299,PrimeWest Health,Minnesota Senior Health Options (MSHO),118.335,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Change Of Cystostomy Tube,,51705,CPT,Facility,Inpatient,,,,230,195.5,65.918,299,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Change Of Cystostomy Tube,,51705,CPT,Facility,Outpatient,,,,230,195.5,65.918,299,PrimeWest Health,MinnesotaCare,118.128,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Change Of Cystostomy Tube,,51705,CPT,Facility,Inpatient,,,,230,195.5,65.918,299,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Change Of Cystostomy Tube,,51705,CPT,Facility,Both,,,,230,195.5,65.918,299,Sanford Health Plan,Sanford Health Plan,211.6,92,,percent of total billed charges,,
Change Of Cystostomy Tube,,51705,CPT,Facility,Outpatient,,,,230,195.5,65.918,299,"UCare Health, Inc.",Individual & Family Plan,129.605,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Change Of Cystostomy Tube,,51705,CPT,Facility,Inpatient,,,,230,195.5,65.918,299,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Change Of Cystostomy Tube,,51705,CPT,Facility,Outpatient,,,,230,195.5,65.918,299,"UCare Health, Inc.",Medical Assistance,116.081,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Change Of Cystostomy Tube,,51705,CPT,Facility,Inpatient,,,,230,195.5,65.918,299,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Change Of Cystostomy Tube,,51705,CPT,Facility,Outpatient,,,,230,195.5,65.918,299,"UCare Health, Inc.",Medicare Advantage,116.081,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Change Of Cystostomy Tube,,51705,CPT,Facility,Inpatient,,,,230,195.5,65.918,299,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Change Of Cystostomy Tube,,51705,CPT,Facility,Outpatient,,,,230,195.5,65.918,299,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),116.081,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Change Of Cystostomy Tube,,51705,CPT,Facility,Inpatient,,,,230,195.5,65.918,299,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Change Of Cystostomy Tube,,51705,CPT,Facility,Both,,,,230,195.5,65.918,299,UnitedHealthcare,Individual & Family,216.2,94,,percent of total billed charges,,
Change Of Cystostomy Tube,,51705,CPT,Facility,Outpatient,,,,230,195.5,65.918,299,UnitedHealthcare,Medicare Advantage,112.7,49,,percent of total billed charges,,
Change Of Cystostomy Tube,,51705,CPT,Facility,Inpatient,,,,230,195.5,65.918,299,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Change Of Cystostomy Tube,,51705,CPT,Facility,Outpatient,,,,230,195.5,65.918,299,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,110.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
Change Of Cystostomy Tube,,51705,CPT,Facility,Inpatient,,,,230,195.5,65.918,299,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Change Of Cystostomy Tube; Simple (Pro Cah),,51705,CPT,Professional,Both,,,,332,282.2,31.63,332,Aetna,Commercial,282.2,85,,percent of total billed charges,,
Change Of Cystostomy Tube; Simple (Pro Cah),,51705,CPT,Professional,Both,,,,332,282.2,31.63,332,Aetna,Medicare Advantage,50.08,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Change Of Cystostomy Tube; Simple (Pro Cah),,51705,CPT,Professional,Both,,,,332,282.2,31.63,332,Aetna,PPO,308.76,93,,percent of total billed charges,,
Change Of Cystostomy Tube; Simple (Pro Cah),,51705,CPT,Professional,Both,,,,332,282.2,31.63,332,America's PPO,America's PPO,283.6608,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Change Of Cystostomy Tube; Simple (Pro Cah),,51705,CPT,Professional,Both,,,,332,282.2,31.63,332,BlueCross BlueShield Minnesota, Federal Employee Program,104.67,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Change Of Cystostomy Tube; Simple (Pro Cah),,51705,CPT,Professional,Both,,,,332,282.2,31.63,332,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,106.34472,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Change Of Cystostomy Tube; Simple (Pro Cah),,51705,CPT,Professional,Both,,,,332,282.2,31.63,332,BlueCross BlueShield Minnesota,High Value Network Plan,106.34472,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Change Of Cystostomy Tube; Simple (Pro Cah),,51705,CPT,Professional,Both,,,,332,282.2,31.63,332,BlueCross BlueShield Minnesota,Medicare Advantage,56.718,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Change Of Cystostomy Tube; Simple (Pro Cah),,51705,CPT,Professional,Both,,,,332,282.2,31.63,332,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,106.34472,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Change Of Cystostomy Tube; Simple (Pro Cah),,51705,CPT,Professional,Both,,,,332,282.2,31.63,332,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,36.51504,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Change Of Cystostomy Tube; Simple (Pro Cah),,51705,CPT,Professional,Both,,,,332,282.2,31.63,332,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),56.718,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Change Of Cystostomy Tube; Simple (Pro Cah),,51705,CPT,Professional,Both,,,,332,282.2,31.63,332,CorVel,Worker's Compensation,96.402384,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Change Of Cystostomy Tube; Simple (Pro Cah),,51705,CPT,Professional,Both,,,,332,282.2,31.63,332,First Health Group Corporation,First Health Network,322.04,97,,percent of total billed charges,,
Change Of Cystostomy Tube; Simple (Pro Cah),,51705,CPT,Professional,Both,,,,332,282.2,31.63,332,"Health Partners, Inc.",Commercial,104.48,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Change Of Cystostomy Tube; Simple (Pro Cah),,51705,CPT,Professional,Both,,,,332,282.2,31.63,332,"Health Partners, Inc.",Medicare Advantage,56.718,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Change Of Cystostomy Tube; Simple (Pro Cah),,51705,CPT,Professional,Both,,,,332,282.2,31.63,332,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),49.48,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Change Of Cystostomy Tube; Simple (Pro Cah),,51705,CPT,Professional,Both,,,,332,282.2,31.63,332,"Health Partners, Inc.",State of Minnesota Advantage Program,90.00952,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Change Of Cystostomy Tube; Simple (Pro Cah),,51705,CPT,Professional,Both,,,,332,282.2,31.63,332,"Health Partners, Inc.",State Public Programs,31.63,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Change Of Cystostomy Tube; Simple (Pro Cah),,51705,CPT,Professional,Both,,,,332,282.2,31.63,332,Humana Insurance Company,Commercial PPO,49.32,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Change Of Cystostomy Tube; Simple (Pro Cah),,51705,CPT,Professional,Both,,,,332,282.2,31.63,332,Humana Insurance Company,Medicare PPO,332,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Change Of Cystostomy Tube; Simple (Pro Cah),,51705,CPT,Professional,Both,,,,332,282.2,31.63,332,Medica,Individual & Family,281.536,84.8,,percent of total billed charges,,
Change Of Cystostomy Tube; Simple (Pro Cah),,51705,CPT,Professional,Both,,,,332,282.2,31.63,332,Medica,Medica Advantage Solution,165.336,49.8,,percent of total billed charges,,
Change Of Cystostomy Tube; Simple (Pro Cah),,51705,CPT,Professional,Both,,,,332,282.2,31.63,332,Medica,Medical Assistance,36.52,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Change Of Cystostomy Tube; Simple (Pro Cah),,51705,CPT,Professional,Both,,,,332,282.2,31.63,332,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,49.32,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Change Of Cystostomy Tube; Simple (Pro Cah),,51705,CPT,Professional,Both,,,,332,282.2,31.63,332,"Multiplan, Inc.","Multiplan, Inc.",312.08,94,,percent of total billed charges,,
Change Of Cystostomy Tube; Simple (Pro Cah),,51705,CPT,Professional,Both,,,,332,282.2,31.63,332,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,299.132,90.1,,percent of total billed charges,,
Change Of Cystostomy Tube; Simple (Pro Cah),,51705,CPT,Professional,Both,,,,332,282.2,31.63,332,"Preferred One Administrative Services, INC.",PPO,327.352,98.6,,percent of total billed charges,,
Change Of Cystostomy Tube; Simple (Pro Cah),,51705,CPT,Professional,Both,,,,332,282.2,31.63,332,PrimeWest Health,Minnesota Senior Health Options (MSHO),56.718,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Change Of Cystostomy Tube; Simple (Pro Cah),,51705,CPT,Professional,Both,,,,332,282.2,31.63,332,PrimeWest Health,MinnesotaCare,39.0710928,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Change Of Cystostomy Tube; Simple (Pro Cah),,51705,CPT,Professional,Both,,,,332,282.2,31.63,332,Sanford Health Plan,Sanford Health Plan,292.16,88,,percent of total billed charges,,
Change Of Cystostomy Tube; Simple (Pro Cah),,51705,CPT,Professional,Both,,,,332,282.2,31.63,332,"UCare Health, Inc.",Individual & Family Plan,80.174592,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Change Of Cystostomy Tube; Simple (Pro Cah),,51705,CPT,Professional,Both,,,,332,282.2,31.63,332,"UCare Health, Inc.",Medical Assistance,40.166544,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Change Of Cystostomy Tube; Simple (Pro Cah),,51705,CPT,Professional,Both,,,,332,282.2,31.63,332,"UCare Health, Inc.",Medicare Advantage,56.718,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Change Of Cystostomy Tube; Simple (Pro Cah),,51705,CPT,Professional,Both,,,,332,282.2,31.63,332,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),45.3744,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Change Of Cystostomy Tube; Simple (Pro Cah),,51705,CPT,Professional,Both,,,,332,282.2,31.63,332,UnitedHealthcare,Individual & Family,332,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Change Of Cystostomy Tube; Simple (Pro Cah),,51705,CPT,Professional,Both,,,,332,282.2,31.63,332,UnitedHealthcare,Medicare Advantage,56.718,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Change Of Cystostomy Tube; Simple (Pro Cah),,51705,CPT,Professional,Both,,,,332,282.2,31.63,332,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,36.51504,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Change Of Cystostomy Tube; Complicated (Procah),,51710,CPT,Professional,Both,,,,560,476,49.08,560,Aetna,Commercial,476,85,,percent of total billed charges,,
Change Of Cystostomy Tube; Complicated (Procah),,51710,CPT,Professional,Both,,,,560,476,49.08,560,Aetna,Medicare Advantage,77.23,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Change Of Cystostomy Tube; Complicated (Procah),,51710,CPT,Professional,Both,,,,560,476,49.08,560,Aetna,PPO,520.8,93,,percent of total billed charges,,
Change Of Cystostomy Tube; Complicated (Procah),,51710,CPT,Professional,Both,,,,560,476,49.08,560,America's PPO,America's PPO,478.464,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Change Of Cystostomy Tube; Complicated (Procah),,51710,CPT,Professional,Both,,,,560,476,49.08,560,BlueCross BlueShield Minnesota, Federal Employee Program,162.51,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Change Of Cystostomy Tube; Complicated (Procah),,51710,CPT,Professional,Both,,,,560,476,49.08,560,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,165.11016,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Change Of Cystostomy Tube; Complicated (Procah),,51710,CPT,Professional,Both,,,,560,476,49.08,560,BlueCross BlueShield Minnesota,High Value Network Plan,165.11016,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Change Of Cystostomy Tube; Complicated (Procah),,51710,CPT,Professional,Both,,,,560,476,49.08,560,BlueCross BlueShield Minnesota,Medicare Advantage,87.86,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Change Of Cystostomy Tube; Complicated (Procah),,51710,CPT,Professional,Both,,,,560,476,49.08,560,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,165.11016,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Change Of Cystostomy Tube; Complicated (Procah),,51710,CPT,Professional,Both,,,,560,476,49.08,560,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,56.66232,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Change Of Cystostomy Tube; Complicated (Procah),,51710,CPT,Professional,Both,,,,560,476,49.08,560,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),87.86,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Change Of Cystostomy Tube; Complicated (Procah),,51710,CPT,Professional,Both,,,,560,476,49.08,560,CorVel,Worker's Compensation,149.1449397,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Change Of Cystostomy Tube; Complicated (Procah),,51710,CPT,Professional,Both,,,,560,476,49.08,560,First Health Group Corporation,First Health Network,543.2,97,,percent of total billed charges,,
Change Of Cystostomy Tube; Complicated (Procah),,51710,CPT,Professional,Both,,,,560,476,49.08,560,"Health Partners, Inc.",Commercial,161.07,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Change Of Cystostomy Tube; Complicated (Procah),,51710,CPT,Professional,Both,,,,560,476,49.08,560,"Health Partners, Inc.",Medicare Advantage,87.86,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Change Of Cystostomy Tube; Complicated (Procah),,51710,CPT,Professional,Both,,,,560,476,49.08,560,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),76.59,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Change Of Cystostomy Tube; Complicated (Procah),,51710,CPT,Professional,Both,,,,560,476,49.08,560,"Health Partners, Inc.",State of Minnesota Advantage Program,138.761805,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Change Of Cystostomy Tube; Complicated (Procah),,51710,CPT,Professional,Both,,,,560,476,49.08,560,"Health Partners, Inc.",State Public Programs,49.08,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Change Of Cystostomy Tube; Complicated (Procah),,51710,CPT,Professional,Both,,,,560,476,49.08,560,Humana Insurance Company,Commercial PPO,76.4,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Change Of Cystostomy Tube; Complicated (Procah),,51710,CPT,Professional,Both,,,,560,476,49.08,560,Humana Insurance Company,Medicare PPO,560,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Change Of Cystostomy Tube; Complicated (Procah),,51710,CPT,Professional,Both,,,,560,476,49.08,560,Medica,Individual & Family,474.88,84.8,,percent of total billed charges,,
Change Of Cystostomy Tube; Complicated (Procah),,51710,CPT,Professional,Both,,,,560,476,49.08,560,Medica,Medica Advantage Solution,278.88,49.8,,percent of total billed charges,,
Change Of Cystostomy Tube; Complicated (Procah),,51710,CPT,Professional,Both,,,,560,476,49.08,560,Medica,Medical Assistance,56.66,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Change Of Cystostomy Tube; Complicated (Procah),,51710,CPT,Professional,Both,,,,560,476,49.08,560,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,76.4,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Change Of Cystostomy Tube; Complicated (Procah),,51710,CPT,Professional,Both,,,,560,476,49.08,560,"Multiplan, Inc.","Multiplan, Inc.",526.4,94,,percent of total billed charges,,
Change Of Cystostomy Tube; Complicated (Procah),,51710,CPT,Professional,Both,,,,560,476,49.08,560,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,504.56,90.1,,percent of total billed charges,,
Change Of Cystostomy Tube; Complicated (Procah),,51710,CPT,Professional,Both,,,,560,476,49.08,560,"Preferred One Administrative Services, INC.",PPO,552.16,98.6,,percent of total billed charges,,
Change Of Cystostomy Tube; Complicated (Procah),,51710,CPT,Professional,Both,,,,560,476,49.08,560,PrimeWest Health,Minnesota Senior Health Options (MSHO),87.86,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Change Of Cystostomy Tube; Complicated (Procah),,51710,CPT,Professional,Both,,,,560,476,49.08,560,PrimeWest Health,MinnesotaCare,60.6286824,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Change Of Cystostomy Tube; Complicated (Procah),,51710,CPT,Professional,Both,,,,560,476,49.08,560,Sanford Health Plan,Sanford Health Plan,492.8,88,,percent of total billed charges,,
Change Of Cystostomy Tube; Complicated (Procah),,51710,CPT,Professional,Both,,,,560,476,49.08,560,"UCare Health, Inc.",Individual & Family Plan,124.19584,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Change Of Cystostomy Tube; Complicated (Procah),,51710,CPT,Professional,Both,,,,560,476,49.08,560,"UCare Health, Inc.",Medical Assistance,62.328552,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Change Of Cystostomy Tube; Complicated (Procah),,51710,CPT,Professional,Both,,,,560,476,49.08,560,"UCare Health, Inc.",Medicare Advantage,87.86,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Change Of Cystostomy Tube; Complicated (Procah),,51710,CPT,Professional,Both,,,,560,476,49.08,560,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),70.288,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Change Of Cystostomy Tube; Complicated (Procah),,51710,CPT,Professional,Both,,,,560,476,49.08,560,UnitedHealthcare,Individual & Family,560,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Change Of Cystostomy Tube; Complicated (Procah),,51710,CPT,Professional,Both,,,,560,476,49.08,560,UnitedHealthcare,Medicare Advantage,87.86,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Change Of Cystostomy Tube; Complicated (Procah),,51710,CPT,Professional,Both,,,,560,476,49.08,560,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,56.66232,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Bladder Instillation,,51720,CPT,Facility,Both,,,,485,412.25,139.001,485,Aetna,Commercial,446.2,92,,percent of total billed charges,,
Bladder Instillation,,51720,CPT,Facility,Outpatient,,,,485,412.25,139.001,485,Aetna,Medicare Advantage,237.65,49,,percent of total billed charges,,
Bladder Instillation,,51720,CPT,Facility,Inpatient,,,,485,412.25,139.001,485,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Bladder Instillation,,51720,CPT,Facility,Both,,,,485,412.25,139.001,485,Aetna,PPO,451.05,93,,percent of total billed charges,,
Bladder Instillation,,51720,CPT,Facility,Both,,,,485,412.25,139.001,485,America's PPO,America's PPO,465.7455,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Bladder Instillation,,51720,CPT,Facility,Both,,,,485,412.25,139.001,485,BlueCross BlueShield Minnesota, Federal Employee Program,477.24,98.4,,percent of total billed charges,,
Bladder Instillation,,51720,CPT,Facility,Both,,,,485,412.25,139.001,485,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,485,100,,percent of total billed charges,,
Bladder Instillation,,51720,CPT,Facility,Both,,,,485,412.25,139.001,485,BlueCross BlueShield Minnesota,High Value Network Plan,436.5,90,,percent of total billed charges,,
Bladder Instillation,,51720,CPT,Facility,Outpatient,,,,485,412.25,139.001,485,BlueCross BlueShield Minnesota,Medicare Advantage,237.65,49,,percent of total billed charges,,
Bladder Instillation,,51720,CPT,Facility,Inpatient,,,,485,412.25,139.001,485,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Bladder Instillation,,51720,CPT,Facility,Both,,,,485,412.25,139.001,485,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,429.5645,88.57,,percent of total billed charges,,
Bladder Instillation,,51720,CPT,Facility,Both,,,,485,412.25,139.001,485,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,139.001,28.66,,percent of total billed charges,,
Bladder Instillation,,51720,CPT,Facility,Outpatient,,,,485,412.25,139.001,485,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),237.65,49,,percent of total billed charges,,
Bladder Instillation,,51720,CPT,Facility,Inpatient,,,,485,412.25,139.001,485,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Bladder Instillation,,51720,CPT,Facility,Both,,,,485,412.25,139.001,485,CorVel,Worker's Compensation,485,100,,percent of total billed charges,,
Bladder Instillation,,51720,CPT,Facility,Both,,,,485,412.25,139.001,485,First Health Group Corporation,First Health Network,470.45,97,,percent of total billed charges,,
Bladder Instillation,,51720,CPT,Facility,Both,,,,485,412.25,139.001,485,"Health Partners, Inc.",Commercial,458.81,94.6,,percent of total billed charges,,
Bladder Instillation,,51720,CPT,Facility,Outpatient,,,,485,412.25,139.001,485,"Health Partners, Inc.",Medicare Advantage,237.65,49,,percent of total billed charges,,
Bladder Instillation,,51720,CPT,Facility,Inpatient,,,,485,412.25,139.001,485,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Bladder Instillation,,51720,CPT,Facility,Both,,,,485,412.25,139.001,485,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),291,60,,percent of total billed charges,,
Bladder Instillation,,51720,CPT,Facility,Both,,,,485,412.25,139.001,485,"Health Partners, Inc.",State of Minnesota Advantage Program,395.275,81.5,,percent of total billed charges,,
Bladder Instillation,,51720,CPT,Facility,Both,,,,485,412.25,139.001,485,"Health Partners, Inc.",State Public Programs,242.5,50,,percent of total billed charges,,
Bladder Instillation,,51720,CPT,Facility,Both,,,,485,412.25,139.001,485,Humana Insurance Company,Commercial PPO,460.75,95,,percent of total billed charges,,
Bladder Instillation,,51720,CPT,Facility,Outpatient,,,,485,412.25,139.001,485,Humana Insurance Company,Medicare PPO,237.65,49,,percent of total billed charges,,
Bladder Instillation,,51720,CPT,Facility,Inpatient,,,,485,412.25,139.001,485,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Bladder Instillation,,51720,CPT,Facility,Both,,,,485,412.25,139.001,485,Medica,Individual & Family,480.635,99.1,,percent of total billed charges,,
Bladder Instillation,,51720,CPT,Facility,Outpatient,,,,485,412.25,139.001,485,Medica,Medica Advantage Solution,241.53,49.8,,percent of total billed charges,,
Bladder Instillation,,51720,CPT,Facility,Inpatient,,,,485,412.25,139.001,485,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Bladder Instillation,,51720,CPT,Facility,Outpatient,,,,485,412.25,139.001,485,Medica,Medical Assistance,216.31,44.6,,percent of total billed charges,,
Bladder Instillation,,51720,CPT,Facility,Inpatient,,,,485,412.25,139.001,485,Medica,Medical Assistance,,,,,Included in per diem rate,
Bladder Instillation,,51720,CPT,Facility,Outpatient,,,,485,412.25,139.001,485,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,241.53,49.8,,percent of total billed charges,,
Bladder Instillation,,51720,CPT,Facility,Inpatient,,,,485,412.25,139.001,485,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Bladder Instillation,,51720,CPT,Facility,Both,,,,485,412.25,139.001,485,"Multiplan, Inc.","Multiplan, Inc.",455.9,94,,percent of total billed charges,,
Bladder Instillation,,51720,CPT,Facility,Outpatient,,,,485,412.25,139.001,485,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,436.985,90.1,,percent of total billed charges,,
Bladder Instillation,,51720,CPT,Facility,Inpatient,,,,485,412.25,139.001,485,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Bladder Instillation,,51720,CPT,Facility,Both,,,,485,412.25,139.001,485,"Preferred One Administrative Services, INC.",PPO,478.21,98.6,,percent of total billed charges,,
Bladder Instillation,,51720,CPT,Facility,Outpatient,,,,485,412.25,139.001,485,PrimeWest Health,Minnesota Senior Health Options (MSHO),249.5325,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Bladder Instillation,,51720,CPT,Facility,Inpatient,,,,485,412.25,139.001,485,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Bladder Instillation,,51720,CPT,Facility,Outpatient,,,,485,412.25,139.001,485,PrimeWest Health,MinnesotaCare,249.096,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Bladder Instillation,,51720,CPT,Facility,Inpatient,,,,485,412.25,139.001,485,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Bladder Instillation,,51720,CPT,Facility,Both,,,,485,412.25,139.001,485,Sanford Health Plan,Sanford Health Plan,446.2,92,,percent of total billed charges,,
Bladder Instillation,,51720,CPT,Facility,Outpatient,,,,485,412.25,139.001,485,"UCare Health, Inc.",Individual & Family Plan,273.2975,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Bladder Instillation,,51720,CPT,Facility,Inpatient,,,,485,412.25,139.001,485,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Bladder Instillation,,51720,CPT,Facility,Outpatient,,,,485,412.25,139.001,485,"UCare Health, Inc.",Medical Assistance,244.7795,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Bladder Instillation,,51720,CPT,Facility,Inpatient,,,,485,412.25,139.001,485,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Bladder Instillation,,51720,CPT,Facility,Outpatient,,,,485,412.25,139.001,485,"UCare Health, Inc.",Medicare Advantage,244.7795,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Bladder Instillation,,51720,CPT,Facility,Inpatient,,,,485,412.25,139.001,485,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Bladder Instillation,,51720,CPT,Facility,Outpatient,,,,485,412.25,139.001,485,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),244.7795,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Bladder Instillation,,51720,CPT,Facility,Inpatient,,,,485,412.25,139.001,485,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Bladder Instillation,,51720,CPT,Facility,Both,,,,485,412.25,139.001,485,UnitedHealthcare,Individual & Family,455.9,94,,percent of total billed charges,,
Bladder Instillation,,51720,CPT,Facility,Outpatient,,,,485,412.25,139.001,485,UnitedHealthcare,Medicare Advantage,237.65,49,,percent of total billed charges,,
Bladder Instillation,,51720,CPT,Facility,Inpatient,,,,485,412.25,139.001,485,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Bladder Instillation,,51720,CPT,Facility,Outpatient,,,,485,412.25,139.001,485,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,232.8,48,,percent of total billed charges,,100% of DHS outpatient percentage
Bladder Instillation,,51720,CPT,Facility,Inpatient,,,,485,412.25,139.001,485,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Bladder Instillation Of Anticarcinogenic Agent (Pro Cah),,51720,CPT,Professional,Both,,,,408,346.8,26.61,408,Aetna,Commercial,346.8,85,,percent of total billed charges,,
Bladder Instillation Of Anticarcinogenic Agent (Pro Cah),,51720,CPT,Professional,Both,,,,408,346.8,26.61,408,Aetna,Medicare Advantage,42.19,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Bladder Instillation Of Anticarcinogenic Agent (Pro Cah),,51720,CPT,Professional,Both,,,,408,346.8,26.61,408,Aetna,PPO,379.44,93,,percent of total billed charges,,
Bladder Instillation Of Anticarcinogenic Agent (Pro Cah),,51720,CPT,Professional,Both,,,,408,346.8,26.61,408,America's PPO,America's PPO,348.5952,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Bladder Instillation Of Anticarcinogenic Agent (Pro Cah),,51720,CPT,Professional,Both,,,,408,346.8,26.61,408,BlueCross BlueShield Minnesota, Federal Employee Program,88.83,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Bladder Instillation Of Anticarcinogenic Agent (Pro Cah),,51720,CPT,Professional,Both,,,,408,346.8,26.61,408,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,90.25128,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Bladder Instillation Of Anticarcinogenic Agent (Pro Cah),,51720,CPT,Professional,Both,,,,408,346.8,26.61,408,BlueCross BlueShield Minnesota,High Value Network Plan,90.25128,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Bladder Instillation Of Anticarcinogenic Agent (Pro Cah),,51720,CPT,Professional,Both,,,,408,346.8,26.61,408,BlueCross BlueShield Minnesota,Medicare Advantage,47.61,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Bladder Instillation Of Anticarcinogenic Agent (Pro Cah),,51720,CPT,Professional,Both,,,,408,346.8,26.61,408,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,90.25128,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Bladder Instillation Of Anticarcinogenic Agent (Pro Cah),,51720,CPT,Professional,Both,,,,408,346.8,26.61,408,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,30.72384,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Bladder Instillation Of Anticarcinogenic Agent (Pro Cah),,51720,CPT,Professional,Both,,,,408,346.8,26.61,408,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),47.61,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Bladder Instillation Of Anticarcinogenic Agent (Pro Cah),,51720,CPT,Professional,Both,,,,408,346.8,26.61,408,CorVel,Worker's Compensation,81.221964,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Bladder Instillation Of Anticarcinogenic Agent (Pro Cah),,51720,CPT,Professional,Both,,,,408,346.8,26.61,408,First Health Group Corporation,First Health Network,395.76,97,,percent of total billed charges,,
Bladder Instillation Of Anticarcinogenic Agent (Pro Cah),,51720,CPT,Professional,Both,,,,408,346.8,26.61,408,"Health Partners, Inc.",Commercial,87.79,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Bladder Instillation Of Anticarcinogenic Agent (Pro Cah),,51720,CPT,Professional,Both,,,,408,346.8,26.61,408,"Health Partners, Inc.",Medicare Advantage,47.61,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Bladder Instillation Of Anticarcinogenic Agent (Pro Cah),,51720,CPT,Professional,Both,,,,408,346.8,26.61,408,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),41.68,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Bladder Instillation Of Anticarcinogenic Agent (Pro Cah),,51720,CPT,Professional,Both,,,,408,346.8,26.61,408,"Health Partners, Inc.",State of Minnesota Advantage Program,75.631085,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Bladder Instillation Of Anticarcinogenic Agent (Pro Cah),,51720,CPT,Professional,Both,,,,408,346.8,26.61,408,"Health Partners, Inc.",State Public Programs,26.61,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Bladder Instillation Of Anticarcinogenic Agent (Pro Cah),,51720,CPT,Professional,Both,,,,408,346.8,26.61,408,Humana Insurance Company,Commercial PPO,41.4,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Bladder Instillation Of Anticarcinogenic Agent (Pro Cah),,51720,CPT,Professional,Both,,,,408,346.8,26.61,408,Humana Insurance Company,Medicare PPO,408,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Bladder Instillation Of Anticarcinogenic Agent (Pro Cah),,51720,CPT,Professional,Both,,,,408,346.8,26.61,408,Medica,Individual & Family,345.984,84.8,,percent of total billed charges,,
Bladder Instillation Of Anticarcinogenic Agent (Pro Cah),,51720,CPT,Professional,Both,,,,408,346.8,26.61,408,Medica,Medica Advantage Solution,203.184,49.8,,percent of total billed charges,,
Bladder Instillation Of Anticarcinogenic Agent (Pro Cah),,51720,CPT,Professional,Both,,,,408,346.8,26.61,408,Medica,Medical Assistance,30.72,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Bladder Instillation Of Anticarcinogenic Agent (Pro Cah),,51720,CPT,Professional,Both,,,,408,346.8,26.61,408,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,41.4,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Bladder Instillation Of Anticarcinogenic Agent (Pro Cah),,51720,CPT,Professional,Both,,,,408,346.8,26.61,408,"Multiplan, Inc.","Multiplan, Inc.",383.52,94,,percent of total billed charges,,
Bladder Instillation Of Anticarcinogenic Agent (Pro Cah),,51720,CPT,Professional,Both,,,,408,346.8,26.61,408,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,367.608,90.1,,percent of total billed charges,,
Bladder Instillation Of Anticarcinogenic Agent (Pro Cah),,51720,CPT,Professional,Both,,,,408,346.8,26.61,408,"Preferred One Administrative Services, INC.",PPO,402.288,98.6,,percent of total billed charges,,
Bladder Instillation Of Anticarcinogenic Agent (Pro Cah),,51720,CPT,Professional,Both,,,,408,346.8,26.61,408,PrimeWest Health,Minnesota Senior Health Options (MSHO),47.61,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Bladder Instillation Of Anticarcinogenic Agent (Pro Cah),,51720,CPT,Professional,Both,,,,408,346.8,26.61,408,PrimeWest Health,MinnesotaCare,32.8745088,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Bladder Instillation Of Anticarcinogenic Agent (Pro Cah),,51720,CPT,Professional,Both,,,,408,346.8,26.61,408,Sanford Health Plan,Sanford Health Plan,359.04,88,,percent of total billed charges,,
Bladder Instillation Of Anticarcinogenic Agent (Pro Cah),,51720,CPT,Professional,Both,,,,408,346.8,26.61,408,"UCare Health, Inc.",Individual & Family Plan,67.29984,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Bladder Instillation Of Anticarcinogenic Agent (Pro Cah),,51720,CPT,Professional,Both,,,,408,346.8,26.61,408,"UCare Health, Inc.",Medical Assistance,33.796224,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Bladder Instillation Of Anticarcinogenic Agent (Pro Cah),,51720,CPT,Professional,Both,,,,408,346.8,26.61,408,"UCare Health, Inc.",Medicare Advantage,47.61,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Bladder Instillation Of Anticarcinogenic Agent (Pro Cah),,51720,CPT,Professional,Both,,,,408,346.8,26.61,408,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),38.088,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Bladder Instillation Of Anticarcinogenic Agent (Pro Cah),,51720,CPT,Professional,Both,,,,408,346.8,26.61,408,UnitedHealthcare,Individual & Family,408,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Bladder Instillation Of Anticarcinogenic Agent (Pro Cah),,51720,CPT,Professional,Both,,,,408,346.8,26.61,408,UnitedHealthcare,Medicare Advantage,47.61,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Bladder Instillation Of Anticarcinogenic Agent (Pro Cah),,51720,CPT,Professional,Both,,,,408,346.8,26.61,408,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,30.72384,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Mitomycin Intravesical Instillation,,51720,CPT,Facility,Both,,,,265,225.25,75.949,299,Aetna,Commercial,243.8,92,,percent of total billed charges,,
Mitomycin Intravesical Instillation,,51720,CPT,Facility,Outpatient,,,,265,225.25,75.949,299,Aetna,Medicare Advantage,129.85,49,,percent of total billed charges,,
Mitomycin Intravesical Instillation,,51720,CPT,Facility,Inpatient,,,,265,225.25,75.949,299,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Mitomycin Intravesical Instillation,,51720,CPT,Facility,Both,,,,265,225.25,75.949,299,Aetna,PPO,246.45,93,,percent of total billed charges,,
Mitomycin Intravesical Instillation,,51720,CPT,Facility,Both,,,,265,225.25,75.949,299,America's PPO,America's PPO,254.4795,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Mitomycin Intravesical Instillation,,51720,CPT,Facility,Both,,,,265,225.25,75.949,299,BlueCross BlueShield Minnesota, Federal Employee Program,260.76,98.4,,percent of total billed charges,,
Mitomycin Intravesical Instillation,,51720,CPT,Facility,Both,,,,265,225.25,75.949,299,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,265,100,,percent of total billed charges,,
Mitomycin Intravesical Instillation,,51720,CPT,Facility,Both,,,,265,225.25,75.949,299,BlueCross BlueShield Minnesota,High Value Network Plan,238.5,90,,percent of total billed charges,,
Mitomycin Intravesical Instillation,,51720,CPT,Facility,Outpatient,,,,265,225.25,75.949,299,BlueCross BlueShield Minnesota,Medicare Advantage,129.85,49,,percent of total billed charges,,
Mitomycin Intravesical Instillation,,51720,CPT,Facility,Inpatient,,,,265,225.25,75.949,299,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Mitomycin Intravesical Instillation,,51720,CPT,Facility,Both,,,,265,225.25,75.949,299,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,234.7105,88.57,,percent of total billed charges,,
Mitomycin Intravesical Instillation,,51720,CPT,Facility,Both,,,,265,225.25,75.949,299,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,75.949,28.66,,percent of total billed charges,,
Mitomycin Intravesical Instillation,,51720,CPT,Facility,Outpatient,,,,265,225.25,75.949,299,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),129.85,49,,percent of total billed charges,,
Mitomycin Intravesical Instillation,,51720,CPT,Facility,Inpatient,,,,265,225.25,75.949,299,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Mitomycin Intravesical Instillation,,51720,CPT,Facility,Both,,,,265,225.25,75.949,299,CorVel,Worker's Compensation,265,100,,percent of total billed charges,,
Mitomycin Intravesical Instillation,,51720,CPT,Facility,Both,,,,265,225.25,75.949,299,First Health Group Corporation,First Health Network,257.05,97,,percent of total billed charges,,
Mitomycin Intravesical Instillation,,51720,CPT,Facility,Both,,,,265,225.25,75.949,299,"Health Partners, Inc.",Commercial,250.69,94.6,,percent of total billed charges,,
Mitomycin Intravesical Instillation,,51720,CPT,Facility,Outpatient,,,,265,225.25,75.949,299,"Health Partners, Inc.",Medicare Advantage,129.85,49,,percent of total billed charges,,
Mitomycin Intravesical Instillation,,51720,CPT,Facility,Inpatient,,,,265,225.25,75.949,299,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mitomycin Intravesical Instillation,,51720,CPT,Facility,Both,,,,265,225.25,75.949,299,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),159,60,,percent of total billed charges,,
Mitomycin Intravesical Instillation,,51720,CPT,Facility,Both,,,,265,225.25,75.949,299,"Health Partners, Inc.",State of Minnesota Advantage Program,215.975,81.5,,percent of total billed charges,,
Mitomycin Intravesical Instillation,,51720,CPT,Facility,Both,,,,265,225.25,75.949,299,"Health Partners, Inc.",State Public Programs,132.5,50,,percent of total billed charges,,
Mitomycin Intravesical Instillation,,51720,CPT,Facility,Both,,,,265,225.25,75.949,299,Humana Insurance Company,Commercial PPO,251.75,95,,percent of total billed charges,,
Mitomycin Intravesical Instillation,,51720,CPT,Facility,Outpatient,,,,265,225.25,75.949,299,Humana Insurance Company,Medicare PPO,129.85,49,,percent of total billed charges,,
Mitomycin Intravesical Instillation,,51720,CPT,Facility,Inpatient,,,,265,225.25,75.949,299,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Mitomycin Intravesical Instillation,,51720,CPT,Facility,Both,,,,265,225.25,75.949,299,Medica,Individual & Family,262.615,99.1,,percent of total billed charges,,
Mitomycin Intravesical Instillation,,51720,CPT,Facility,Outpatient,,,,265,225.25,75.949,299,Medica,Medica Advantage Solution,131.97,49.8,,percent of total billed charges,,
Mitomycin Intravesical Instillation,,51720,CPT,Facility,Inpatient,,,,265,225.25,75.949,299,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Mitomycin Intravesical Instillation,,51720,CPT,Facility,Outpatient,,,,265,225.25,75.949,299,Medica,Medical Assistance,299,,,Other,Grouper,All inclusive per visit
Mitomycin Intravesical Instillation,,51720,CPT,Facility,Inpatient,,,,265,225.25,75.949,299,Medica,Medical Assistance,,,,,Included in per diem rate,
Mitomycin Intravesical Instillation,,51720,CPT,Facility,Outpatient,,,,265,225.25,75.949,299,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,131.97,49.8,,percent of total billed charges,,
Mitomycin Intravesical Instillation,,51720,CPT,Facility,Inpatient,,,,265,225.25,75.949,299,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Mitomycin Intravesical Instillation,,51720,CPT,Facility,Both,,,,265,225.25,75.949,299,"Multiplan, Inc.","Multiplan, Inc.",249.1,94,,percent of total billed charges,,
Mitomycin Intravesical Instillation,,51720,CPT,Facility,Outpatient,,,,265,225.25,75.949,299,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,238.765,90.1,,percent of total billed charges,,
Mitomycin Intravesical Instillation,,51720,CPT,Facility,Inpatient,,,,265,225.25,75.949,299,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Mitomycin Intravesical Instillation,,51720,CPT,Facility,Both,,,,265,225.25,75.949,299,"Preferred One Administrative Services, INC.",PPO,261.29,98.6,,percent of total billed charges,,
Mitomycin Intravesical Instillation,,51720,CPT,Facility,Outpatient,,,,265,225.25,75.949,299,PrimeWest Health,Minnesota Senior Health Options (MSHO),136.3425,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Mitomycin Intravesical Instillation,,51720,CPT,Facility,Inpatient,,,,265,225.25,75.949,299,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mitomycin Intravesical Instillation,,51720,CPT,Facility,Outpatient,,,,265,225.25,75.949,299,PrimeWest Health,MinnesotaCare,136.104,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Mitomycin Intravesical Instillation,,51720,CPT,Facility,Inpatient,,,,265,225.25,75.949,299,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Mitomycin Intravesical Instillation,,51720,CPT,Facility,Both,,,,265,225.25,75.949,299,Sanford Health Plan,Sanford Health Plan,243.8,92,,percent of total billed charges,,
Mitomycin Intravesical Instillation,,51720,CPT,Facility,Outpatient,,,,265,225.25,75.949,299,"UCare Health, Inc.",Individual & Family Plan,149.3275,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Mitomycin Intravesical Instillation,,51720,CPT,Facility,Inpatient,,,,265,225.25,75.949,299,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Mitomycin Intravesical Instillation,,51720,CPT,Facility,Outpatient,,,,265,225.25,75.949,299,"UCare Health, Inc.",Medical Assistance,133.7455,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mitomycin Intravesical Instillation,,51720,CPT,Facility,Inpatient,,,,265,225.25,75.949,299,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Mitomycin Intravesical Instillation,,51720,CPT,Facility,Outpatient,,,,265,225.25,75.949,299,"UCare Health, Inc.",Medicare Advantage,133.7455,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mitomycin Intravesical Instillation,,51720,CPT,Facility,Inpatient,,,,265,225.25,75.949,299,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mitomycin Intravesical Instillation,,51720,CPT,Facility,Outpatient,,,,265,225.25,75.949,299,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),133.7455,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mitomycin Intravesical Instillation,,51720,CPT,Facility,Inpatient,,,,265,225.25,75.949,299,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mitomycin Intravesical Instillation,,51720,CPT,Facility,Both,,,,265,225.25,75.949,299,UnitedHealthcare,Individual & Family,249.1,94,,percent of total billed charges,,
Mitomycin Intravesical Instillation,,51720,CPT,Facility,Outpatient,,,,265,225.25,75.949,299,UnitedHealthcare,Medicare Advantage,129.85,49,,percent of total billed charges,,
Mitomycin Intravesical Instillation,,51720,CPT,Facility,Inpatient,,,,265,225.25,75.949,299,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Mitomycin Intravesical Instillation,,51720,CPT,Facility,Outpatient,,,,265,225.25,75.949,299,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,127.2,48,,percent of total billed charges,,100% of DHS outpatient percentage
Mitomycin Intravesical Instillation,,51720,CPT,Facility,Inpatient,,,,265,225.25,75.949,299,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Simple Cystometrogram (Cmg),,51725,CPT,Facility,Both,,,,993,844.05,284.5938,993,Aetna,Commercial,913.56,92,,percent of total billed charges,,
Simple Cystometrogram (Cmg),,51725,CPT,Facility,Outpatient,,,,993,844.05,284.5938,993,Aetna,Medicare Advantage,486.57,49,,percent of total billed charges,,
Simple Cystometrogram (Cmg),,51725,CPT,Facility,Inpatient,,,,993,844.05,284.5938,993,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Simple Cystometrogram (Cmg),,51725,CPT,Facility,Both,,,,993,844.05,284.5938,993,Aetna,PPO,923.49,93,,percent of total billed charges,,
Simple Cystometrogram (Cmg),,51725,CPT,Facility,Both,,,,993,844.05,284.5938,993,America's PPO,America's PPO,953.5779,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Simple Cystometrogram (Cmg),,51725,CPT,Facility,Both,,,,993,844.05,284.5938,993,BlueCross BlueShield Minnesota, Federal Employee Program,977.112,98.4,,percent of total billed charges,,
Simple Cystometrogram (Cmg),,51725,CPT,Facility,Both,,,,993,844.05,284.5938,993,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,993,100,,percent of total billed charges,,
Simple Cystometrogram (Cmg),,51725,CPT,Facility,Both,,,,993,844.05,284.5938,993,BlueCross BlueShield Minnesota,High Value Network Plan,893.7,90,,percent of total billed charges,,
Simple Cystometrogram (Cmg),,51725,CPT,Facility,Outpatient,,,,993,844.05,284.5938,993,BlueCross BlueShield Minnesota,Medicare Advantage,486.57,49,,percent of total billed charges,,
Simple Cystometrogram (Cmg),,51725,CPT,Facility,Inpatient,,,,993,844.05,284.5938,993,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Simple Cystometrogram (Cmg),,51725,CPT,Facility,Both,,,,993,844.05,284.5938,993,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,879.5001,88.57,,percent of total billed charges,,
Simple Cystometrogram (Cmg),,51725,CPT,Facility,Both,,,,993,844.05,284.5938,993,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,284.5938,28.66,,percent of total billed charges,,
Simple Cystometrogram (Cmg),,51725,CPT,Facility,Outpatient,,,,993,844.05,284.5938,993,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),486.57,49,,percent of total billed charges,,
Simple Cystometrogram (Cmg),,51725,CPT,Facility,Inpatient,,,,993,844.05,284.5938,993,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Simple Cystometrogram (Cmg),,51725,CPT,Facility,Both,,,,993,844.05,284.5938,993,CorVel,Worker's Compensation,993,100,,percent of total billed charges,,
Simple Cystometrogram (Cmg),,51725,CPT,Facility,Both,,,,993,844.05,284.5938,993,First Health Group Corporation,First Health Network,963.21,97,,percent of total billed charges,,
Simple Cystometrogram (Cmg),,51725,CPT,Facility,Both,,,,993,844.05,284.5938,993,"Health Partners, Inc.",Commercial,939.378,94.6,,percent of total billed charges,,
Simple Cystometrogram (Cmg),,51725,CPT,Facility,Outpatient,,,,993,844.05,284.5938,993,"Health Partners, Inc.",Medicare Advantage,486.57,49,,percent of total billed charges,,
Simple Cystometrogram (Cmg),,51725,CPT,Facility,Inpatient,,,,993,844.05,284.5938,993,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Simple Cystometrogram (Cmg),,51725,CPT,Facility,Both,,,,993,844.05,284.5938,993,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),595.8,60,,percent of total billed charges,,
Simple Cystometrogram (Cmg),,51725,CPT,Facility,Both,,,,993,844.05,284.5938,993,"Health Partners, Inc.",State of Minnesota Advantage Program,809.295,81.5,,percent of total billed charges,,
Simple Cystometrogram (Cmg),,51725,CPT,Facility,Both,,,,993,844.05,284.5938,993,"Health Partners, Inc.",State Public Programs,496.5,50,,percent of total billed charges,,
Simple Cystometrogram (Cmg),,51725,CPT,Facility,Both,,,,993,844.05,284.5938,993,Humana Insurance Company,Commercial PPO,943.35,95,,percent of total billed charges,,
Simple Cystometrogram (Cmg),,51725,CPT,Facility,Outpatient,,,,993,844.05,284.5938,993,Humana Insurance Company,Medicare PPO,486.57,49,,percent of total billed charges,,
Simple Cystometrogram (Cmg),,51725,CPT,Facility,Inpatient,,,,993,844.05,284.5938,993,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Simple Cystometrogram (Cmg),,51725,CPT,Facility,Both,,,,993,844.05,284.5938,993,Medica,Individual & Family,984.063,99.1,,percent of total billed charges,,
Simple Cystometrogram (Cmg),,51725,CPT,Facility,Outpatient,,,,993,844.05,284.5938,993,Medica,Medica Advantage Solution,494.514,49.8,,percent of total billed charges,,
Simple Cystometrogram (Cmg),,51725,CPT,Facility,Inpatient,,,,993,844.05,284.5938,993,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Simple Cystometrogram (Cmg),,51725,CPT,Facility,Outpatient,,,,993,844.05,284.5938,993,Medica,Medical Assistance,442.878,44.6,,percent of total billed charges,,
Simple Cystometrogram (Cmg),,51725,CPT,Facility,Inpatient,,,,993,844.05,284.5938,993,Medica,Medical Assistance,,,,,Included in per diem rate,
Simple Cystometrogram (Cmg),,51725,CPT,Facility,Outpatient,,,,993,844.05,284.5938,993,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,494.514,49.8,,percent of total billed charges,,
Simple Cystometrogram (Cmg),,51725,CPT,Facility,Inpatient,,,,993,844.05,284.5938,993,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Simple Cystometrogram (Cmg),,51725,CPT,Facility,Both,,,,993,844.05,284.5938,993,"Multiplan, Inc.","Multiplan, Inc.",933.42,94,,percent of total billed charges,,
Simple Cystometrogram (Cmg),,51725,CPT,Facility,Outpatient,,,,993,844.05,284.5938,993,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,894.693,90.1,,percent of total billed charges,,
Simple Cystometrogram (Cmg),,51725,CPT,Facility,Inpatient,,,,993,844.05,284.5938,993,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Simple Cystometrogram (Cmg),,51725,CPT,Facility,Both,,,,993,844.05,284.5938,993,"Preferred One Administrative Services, INC.",PPO,979.098,98.6,,percent of total billed charges,,
Simple Cystometrogram (Cmg),,51725,CPT,Facility,Outpatient,,,,993,844.05,284.5938,993,PrimeWest Health,Minnesota Senior Health Options (MSHO),510.8985,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Simple Cystometrogram (Cmg),,51725,CPT,Facility,Inpatient,,,,993,844.05,284.5938,993,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Simple Cystometrogram (Cmg),,51725,CPT,Facility,Outpatient,,,,993,844.05,284.5938,993,PrimeWest Health,MinnesotaCare,510.0048,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Simple Cystometrogram (Cmg),,51725,CPT,Facility,Inpatient,,,,993,844.05,284.5938,993,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Simple Cystometrogram (Cmg),,51725,CPT,Facility,Both,,,,993,844.05,284.5938,993,Sanford Health Plan,Sanford Health Plan,913.56,92,,percent of total billed charges,,
Simple Cystometrogram (Cmg),,51725,CPT,Facility,Outpatient,,,,993,844.05,284.5938,993,"UCare Health, Inc.",Individual & Family Plan,559.5555,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Simple Cystometrogram (Cmg),,51725,CPT,Facility,Inpatient,,,,993,844.05,284.5938,993,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Simple Cystometrogram (Cmg),,51725,CPT,Facility,Outpatient,,,,993,844.05,284.5938,993,"UCare Health, Inc.",Medical Assistance,501.1671,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Simple Cystometrogram (Cmg),,51725,CPT,Facility,Inpatient,,,,993,844.05,284.5938,993,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Simple Cystometrogram (Cmg),,51725,CPT,Facility,Outpatient,,,,993,844.05,284.5938,993,"UCare Health, Inc.",Medicare Advantage,501.1671,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Simple Cystometrogram (Cmg),,51725,CPT,Facility,Inpatient,,,,993,844.05,284.5938,993,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Simple Cystometrogram (Cmg),,51725,CPT,Facility,Outpatient,,,,993,844.05,284.5938,993,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),501.1671,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Simple Cystometrogram (Cmg),,51725,CPT,Facility,Inpatient,,,,993,844.05,284.5938,993,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Simple Cystometrogram (Cmg),,51725,CPT,Facility,Both,,,,993,844.05,284.5938,993,UnitedHealthcare,Individual & Family,933.42,94,,percent of total billed charges,,
Simple Cystometrogram (Cmg),,51725,CPT,Facility,Outpatient,,,,993,844.05,284.5938,993,UnitedHealthcare,Medicare Advantage,486.57,49,,percent of total billed charges,,
Simple Cystometrogram (Cmg),,51725,CPT,Facility,Inpatient,,,,993,844.05,284.5938,993,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Simple Cystometrogram (Cmg),,51725,CPT,Facility,Outpatient,,,,993,844.05,284.5938,993,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,476.64,48,,percent of total billed charges,,100% of DHS outpatient percentage
Simple Cystometrogram (Cmg),,51725,CPT,Facility,Inpatient,,,,993,844.05,284.5938,993,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Simple Cystometrogram (Cmg) (Eg, Spinal Manometer) (Procah)",,51725,CPT,Professional,Both,,,,791,672.35,53.6448,791,Aetna,Commercial,672.35,85,,percent of total billed charges,,
"Simple Cystometrogram (Cmg) (Eg, Spinal Manometer) (Procah)",,51725,CPT,Professional,Both,,,,791,672.35,53.6448,791,Aetna,Medicare Advantage,232.58,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Simple Cystometrogram (Cmg) (Eg, Spinal Manometer) (Procah)",,51725,CPT,Professional,Both,,,,791,672.35,53.6448,791,Aetna,PPO,735.63,93,,percent of total billed charges,,
"Simple Cystometrogram (Cmg) (Eg, Spinal Manometer) (Procah)",,51725,CPT,Professional,Both,,,,791,672.35,53.6448,791,America's PPO,America's PPO,675.8304,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Simple Cystometrogram (Cmg) (Eg, Spinal Manometer) (Procah)",,51725,CPT,Professional,Both,,,,791,672.35,53.6448,791,BlueCross BlueShield Minnesota, Federal Employee Program,472.38,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Simple Cystometrogram (Cmg) (Eg, Spinal Manometer) (Procah)",,51725,CPT,Professional,Both,,,,791,672.35,53.6448,791,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,479.93808,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Simple Cystometrogram (Cmg) (Eg, Spinal Manometer) (Procah)",,51725,CPT,Professional,Both,,,,791,672.35,53.6448,791,BlueCross BlueShield Minnesota,High Value Network Plan,479.93808,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Simple Cystometrogram (Cmg) (Eg, Spinal Manometer) (Procah)",,51725,CPT,Professional,Both,,,,791,672.35,53.6448,791,BlueCross BlueShield Minnesota,Medicare Advantage,266.1675,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Simple Cystometrogram (Cmg) (Eg, Spinal Manometer) (Procah)",,51725,CPT,Professional,Both,,,,791,672.35,53.6448,791,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,479.93808,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Simple Cystometrogram (Cmg) (Eg, Spinal Manometer) (Procah)",,51725,CPT,Professional,Both,,,,791,672.35,53.6448,791,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,53.6448,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Simple Cystometrogram (Cmg) (Eg, Spinal Manometer) (Procah)",,51725,CPT,Professional,Both,,,,791,672.35,53.6448,791,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),266.1675,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Simple Cystometrogram (Cmg) (Eg, Spinal Manometer) (Procah)",,51725,CPT,Professional,Both,,,,791,672.35,53.6448,791,CorVel,Worker's Compensation,460.4060178,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Simple Cystometrogram (Cmg) (Eg, Spinal Manometer) (Procah)",,51725,CPT,Professional,Both,,,,791,672.35,53.6448,791,First Health Group Corporation,First Health Network,767.27,97,,percent of total billed charges,,
"Simple Cystometrogram (Cmg) (Eg, Spinal Manometer) (Procah)",,51725,CPT,Professional,Both,,,,791,672.35,53.6448,791,"Health Partners, Inc.",Commercial,497.71,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Simple Cystometrogram (Cmg) (Eg, Spinal Manometer) (Procah)",,51725,CPT,Professional,Both,,,,791,672.35,53.6448,791,"Health Partners, Inc.",Medicare Advantage,266.1675,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Simple Cystometrogram (Cmg) (Eg, Spinal Manometer) (Procah)",,51725,CPT,Professional,Both,,,,791,672.35,53.6448,791,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),231.45,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Simple Cystometrogram (Cmg) (Eg, Spinal Manometer) (Procah)",,51725,CPT,Professional,Both,,,,791,672.35,53.6448,791,"Health Partners, Inc.",State of Minnesota Advantage Program,428.777165,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Simple Cystometrogram (Cmg) (Eg, Spinal Manometer) (Procah)",,51725,CPT,Professional,Both,,,,791,672.35,53.6448,791,"Health Partners, Inc.",State Public Programs,148.77,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Simple Cystometrogram (Cmg) (Eg, Spinal Manometer) (Procah)",,51725,CPT,Professional,Both,,,,791,672.35,53.6448,791,Humana Insurance Company,Commercial PPO,231.45,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Simple Cystometrogram (Cmg) (Eg, Spinal Manometer) (Procah)",,51725,CPT,Professional,Both,,,,791,672.35,53.6448,791,Humana Insurance Company,Medicare PPO,791,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Simple Cystometrogram (Cmg) (Eg, Spinal Manometer) (Procah)",,51725,CPT,Professional,Both,,,,791,672.35,53.6448,791,Medica,Individual & Family,670.768,84.8,,percent of total billed charges,,
"Simple Cystometrogram (Cmg) (Eg, Spinal Manometer) (Procah)",,51725,CPT,Professional,Both,,,,791,672.35,53.6448,791,Medica,Medica Advantage Solution,393.918,49.8,,percent of total billed charges,,
"Simple Cystometrogram (Cmg) (Eg, Spinal Manometer) (Procah)",,51725,CPT,Professional,Both,,,,791,672.35,53.6448,791,Medica,Medical Assistance,171.76,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Simple Cystometrogram (Cmg) (Eg, Spinal Manometer) (Procah)",,51725,CPT,Professional,Both,,,,791,672.35,53.6448,791,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,231.45,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Simple Cystometrogram (Cmg) (Eg, Spinal Manometer) (Procah)",,51725,CPT,Professional,Both,,,,791,672.35,53.6448,791,"Multiplan, Inc.","Multiplan, Inc.",743.54,94,,percent of total billed charges,,
"Simple Cystometrogram (Cmg) (Eg, Spinal Manometer) (Procah)",,51725,CPT,Professional,Both,,,,791,672.35,53.6448,791,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,712.691,90.1,,percent of total billed charges,,
"Simple Cystometrogram (Cmg) (Eg, Spinal Manometer) (Procah)",,51725,CPT,Professional,Both,,,,791,672.35,53.6448,791,"Preferred One Administrative Services, INC.",PPO,779.926,98.6,,percent of total billed charges,,
"Simple Cystometrogram (Cmg) (Eg, Spinal Manometer) (Procah)",,51725,CPT,Professional,Both,,,,791,672.35,53.6448,791,PrimeWest Health,Minnesota Senior Health Options (MSHO),266.1675,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Simple Cystometrogram (Cmg) (Eg, Spinal Manometer) (Procah)",,51725,CPT,Professional,Both,,,,791,672.35,53.6448,791,PrimeWest Health,MinnesotaCare,57.399936,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Simple Cystometrogram (Cmg) (Eg, Spinal Manometer) (Procah)",,51725,CPT,Professional,Both,,,,791,672.35,53.6448,791,Sanford Health Plan,Sanford Health Plan,696.08,88,,percent of total billed charges,,
"Simple Cystometrogram (Cmg) (Eg, Spinal Manometer) (Procah)",,51725,CPT,Professional,Both,,,,791,672.35,53.6448,791,"UCare Health, Inc.",Individual & Family Plan,376.24512,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Simple Cystometrogram (Cmg) (Eg, Spinal Manometer) (Procah)",,51725,CPT,Professional,Both,,,,791,672.35,53.6448,791,"UCare Health, Inc.",Medical Assistance,59.00928,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Simple Cystometrogram (Cmg) (Eg, Spinal Manometer) (Procah)",,51725,CPT,Professional,Both,,,,791,672.35,53.6448,791,"UCare Health, Inc.",Medicare Advantage,266.1675,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Simple Cystometrogram (Cmg) (Eg, Spinal Manometer) (Procah)",,51725,CPT,Professional,Both,,,,791,672.35,53.6448,791,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),212.934,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Simple Cystometrogram (Cmg) (Eg, Spinal Manometer) (Procah)",,51725,CPT,Professional,Both,,,,791,672.35,53.6448,791,UnitedHealthcare,Individual & Family,791,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Simple Cystometrogram (Cmg) (Eg, Spinal Manometer) (Procah)",,51725,CPT,Professional,Both,,,,791,672.35,53.6448,791,UnitedHealthcare,Medicare Advantage,266.1675,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Simple Cystometrogram (Cmg) (Eg, Spinal Manometer) (Procah)",,51725,CPT,Professional,Both,,,,791,672.35,53.6448,791,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,53.6448,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Bladder Scan,,51798,CPT,Facility,Both,,,,107,90.95,30.6662,107,Aetna,Commercial,98.44,92,,percent of total billed charges,,
Bladder Scan,,51798,CPT,Facility,Outpatient,,,,107,90.95,30.6662,107,Aetna,Medicare Advantage,52.43,49,,percent of total billed charges,,
Bladder Scan,,51798,CPT,Facility,Inpatient,,,,107,90.95,30.6662,107,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Bladder Scan,,51798,CPT,Facility,Both,,,,107,90.95,30.6662,107,Aetna,PPO,99.51,93,,percent of total billed charges,,
Bladder Scan,,51798,CPT,Facility,Both,,,,107,90.95,30.6662,107,America's PPO,America's PPO,102.7521,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Bladder Scan,,51798,CPT,Facility,Both,,,,107,90.95,30.6662,107,BlueCross BlueShield Minnesota, Federal Employee Program,105.288,98.4,,percent of total billed charges,,
Bladder Scan,,51798,CPT,Facility,Both,,,,107,90.95,30.6662,107,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,107,100,,percent of total billed charges,,
Bladder Scan,,51798,CPT,Facility,Both,,,,107,90.95,30.6662,107,BlueCross BlueShield Minnesota,High Value Network Plan,96.3,90,,percent of total billed charges,,
Bladder Scan,,51798,CPT,Facility,Outpatient,,,,107,90.95,30.6662,107,BlueCross BlueShield Minnesota,Medicare Advantage,52.43,49,,percent of total billed charges,,
Bladder Scan,,51798,CPT,Facility,Inpatient,,,,107,90.95,30.6662,107,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Bladder Scan,,51798,CPT,Facility,Both,,,,107,90.95,30.6662,107,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,94.7699,88.57,,percent of total billed charges,,
Bladder Scan,,51798,CPT,Facility,Both,,,,107,90.95,30.6662,107,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,30.6662,28.66,,percent of total billed charges,,
Bladder Scan,,51798,CPT,Facility,Outpatient,,,,107,90.95,30.6662,107,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),52.43,49,,percent of total billed charges,,
Bladder Scan,,51798,CPT,Facility,Inpatient,,,,107,90.95,30.6662,107,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Bladder Scan,,51798,CPT,Facility,Both,,,,107,90.95,30.6662,107,CorVel,Worker's Compensation,107,100,,percent of total billed charges,,
Bladder Scan,,51798,CPT,Facility,Both,,,,107,90.95,30.6662,107,First Health Group Corporation,First Health Network,103.79,97,,percent of total billed charges,,
Bladder Scan,,51798,CPT,Facility,Both,,,,107,90.95,30.6662,107,"Health Partners, Inc.",Commercial,101.222,94.6,,percent of total billed charges,,
Bladder Scan,,51798,CPT,Facility,Outpatient,,,,107,90.95,30.6662,107,"Health Partners, Inc.",Medicare Advantage,52.43,49,,percent of total billed charges,,
Bladder Scan,,51798,CPT,Facility,Inpatient,,,,107,90.95,30.6662,107,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Bladder Scan,,51798,CPT,Facility,Both,,,,107,90.95,30.6662,107,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),64.2,60,,percent of total billed charges,,
Bladder Scan,,51798,CPT,Facility,Both,,,,107,90.95,30.6662,107,"Health Partners, Inc.",State of Minnesota Advantage Program,87.205,81.5,,percent of total billed charges,,
Bladder Scan,,51798,CPT,Facility,Both,,,,107,90.95,30.6662,107,"Health Partners, Inc.",State Public Programs,53.5,50,,percent of total billed charges,,
Bladder Scan,,51798,CPT,Facility,Both,,,,107,90.95,30.6662,107,Humana Insurance Company,Commercial PPO,101.65,95,,percent of total billed charges,,
Bladder Scan,,51798,CPT,Facility,Outpatient,,,,107,90.95,30.6662,107,Humana Insurance Company,Medicare PPO,52.43,49,,percent of total billed charges,,
Bladder Scan,,51798,CPT,Facility,Inpatient,,,,107,90.95,30.6662,107,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Bladder Scan,,51798,CPT,Facility,Both,,,,107,90.95,30.6662,107,Medica,Individual & Family,106.037,99.1,,percent of total billed charges,,
Bladder Scan,,51798,CPT,Facility,Outpatient,,,,107,90.95,30.6662,107,Medica,Medica Advantage Solution,53.286,49.8,,percent of total billed charges,,
Bladder Scan,,51798,CPT,Facility,Inpatient,,,,107,90.95,30.6662,107,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Bladder Scan,,51798,CPT,Facility,Outpatient,,,,107,90.95,30.6662,107,Medica,Medical Assistance,47.722,44.6,,percent of total billed charges,,
Bladder Scan,,51798,CPT,Facility,Inpatient,,,,107,90.95,30.6662,107,Medica,Medical Assistance,,,,,Included in per diem rate,
Bladder Scan,,51798,CPT,Facility,Outpatient,,,,107,90.95,30.6662,107,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,53.286,49.8,,percent of total billed charges,,
Bladder Scan,,51798,CPT,Facility,Inpatient,,,,107,90.95,30.6662,107,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Bladder Scan,,51798,CPT,Facility,Both,,,,107,90.95,30.6662,107,"Multiplan, Inc.","Multiplan, Inc.",100.58,94,,percent of total billed charges,,
Bladder Scan,,51798,CPT,Facility,Outpatient,,,,107,90.95,30.6662,107,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,96.407,90.1,,percent of total billed charges,,
Bladder Scan,,51798,CPT,Facility,Inpatient,,,,107,90.95,30.6662,107,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Bladder Scan,,51798,CPT,Facility,Both,,,,107,90.95,30.6662,107,"Preferred One Administrative Services, INC.",PPO,105.502,98.6,,percent of total billed charges,,
Bladder Scan,,51798,CPT,Facility,Outpatient,,,,107,90.95,30.6662,107,PrimeWest Health,Minnesota Senior Health Options (MSHO),55.0515,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Bladder Scan,,51798,CPT,Facility,Inpatient,,,,107,90.95,30.6662,107,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Bladder Scan,,51798,CPT,Facility,Outpatient,,,,107,90.95,30.6662,107,PrimeWest Health,MinnesotaCare,54.9552,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Bladder Scan,,51798,CPT,Facility,Inpatient,,,,107,90.95,30.6662,107,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Bladder Scan,,51798,CPT,Facility,Both,,,,107,90.95,30.6662,107,Sanford Health Plan,Sanford Health Plan,98.44,92,,percent of total billed charges,,
Bladder Scan,,51798,CPT,Facility,Outpatient,,,,107,90.95,30.6662,107,"UCare Health, Inc.",Individual & Family Plan,60.2945,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Bladder Scan,,51798,CPT,Facility,Inpatient,,,,107,90.95,30.6662,107,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Bladder Scan,,51798,CPT,Facility,Outpatient,,,,107,90.95,30.6662,107,"UCare Health, Inc.",Medical Assistance,54.0029,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Bladder Scan,,51798,CPT,Facility,Inpatient,,,,107,90.95,30.6662,107,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Bladder Scan,,51798,CPT,Facility,Outpatient,,,,107,90.95,30.6662,107,"UCare Health, Inc.",Medicare Advantage,54.0029,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Bladder Scan,,51798,CPT,Facility,Inpatient,,,,107,90.95,30.6662,107,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Bladder Scan,,51798,CPT,Facility,Outpatient,,,,107,90.95,30.6662,107,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),54.0029,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Bladder Scan,,51798,CPT,Facility,Inpatient,,,,107,90.95,30.6662,107,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Bladder Scan,,51798,CPT,Facility,Both,,,,107,90.95,30.6662,107,UnitedHealthcare,Individual & Family,100.58,94,,percent of total billed charges,,
Bladder Scan,,51798,CPT,Facility,Outpatient,,,,107,90.95,30.6662,107,UnitedHealthcare,Medicare Advantage,52.43,49,,percent of total billed charges,,
Bladder Scan,,51798,CPT,Facility,Inpatient,,,,107,90.95,30.6662,107,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Bladder Scan,,51798,CPT,Facility,Outpatient,,,,107,90.95,30.6662,107,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,51.36,48,,percent of total billed charges,,100% of DHS outpatient percentage
Bladder Scan,,51798,CPT,Facility,Inpatient,,,,107,90.95,30.6662,107,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Cystourethroscopy,,52000,CPT,Facility,Both,,,,536,455.6,153.6176,536,Aetna,Commercial,493.12,92,,percent of total billed charges,,
Cystourethroscopy,,52000,CPT,Facility,Outpatient,,,,536,455.6,153.6176,536,Aetna,Medicare Advantage,262.64,49,,percent of total billed charges,,
Cystourethroscopy,,52000,CPT,Facility,Inpatient,,,,536,455.6,153.6176,536,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Cystourethroscopy,,52000,CPT,Facility,Both,,,,536,455.6,153.6176,536,Aetna,PPO,498.48,93,,percent of total billed charges,,
Cystourethroscopy,,52000,CPT,Facility,Both,,,,536,455.6,153.6176,536,America's PPO,America's PPO,514.7208,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Cystourethroscopy,,52000,CPT,Facility,Both,,,,536,455.6,153.6176,536,BlueCross BlueShield Minnesota, Federal Employee Program,527.424,98.4,,percent of total billed charges,,
Cystourethroscopy,,52000,CPT,Facility,Both,,,,536,455.6,153.6176,536,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,536,100,,percent of total billed charges,,
Cystourethroscopy,,52000,CPT,Facility,Both,,,,536,455.6,153.6176,536,BlueCross BlueShield Minnesota,High Value Network Plan,482.4,90,,percent of total billed charges,,
Cystourethroscopy,,52000,CPT,Facility,Outpatient,,,,536,455.6,153.6176,536,BlueCross BlueShield Minnesota,Medicare Advantage,262.64,49,,percent of total billed charges,,
Cystourethroscopy,,52000,CPT,Facility,Inpatient,,,,536,455.6,153.6176,536,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Cystourethroscopy,,52000,CPT,Facility,Both,,,,536,455.6,153.6176,536,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,474.7352,88.57,,percent of total billed charges,,
Cystourethroscopy,,52000,CPT,Facility,Both,,,,536,455.6,153.6176,536,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,153.6176,28.66,,percent of total billed charges,,
Cystourethroscopy,,52000,CPT,Facility,Outpatient,,,,536,455.6,153.6176,536,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),262.64,49,,percent of total billed charges,,
Cystourethroscopy,,52000,CPT,Facility,Inpatient,,,,536,455.6,153.6176,536,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Cystourethroscopy,,52000,CPT,Facility,Both,,,,536,455.6,153.6176,536,CorVel,Worker's Compensation,536,100,,percent of total billed charges,,
Cystourethroscopy,,52000,CPT,Facility,Both,,,,536,455.6,153.6176,536,First Health Group Corporation,First Health Network,519.92,97,,percent of total billed charges,,
Cystourethroscopy,,52000,CPT,Facility,Both,,,,536,455.6,153.6176,536,"Health Partners, Inc.",Commercial,507.056,94.6,,percent of total billed charges,,
Cystourethroscopy,,52000,CPT,Facility,Outpatient,,,,536,455.6,153.6176,536,"Health Partners, Inc.",Medicare Advantage,262.64,49,,percent of total billed charges,,
Cystourethroscopy,,52000,CPT,Facility,Inpatient,,,,536,455.6,153.6176,536,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Cystourethroscopy,,52000,CPT,Facility,Both,,,,536,455.6,153.6176,536,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),321.6,60,,percent of total billed charges,,
Cystourethroscopy,,52000,CPT,Facility,Both,,,,536,455.6,153.6176,536,"Health Partners, Inc.",State of Minnesota Advantage Program,436.84,81.5,,percent of total billed charges,,
Cystourethroscopy,,52000,CPT,Facility,Both,,,,536,455.6,153.6176,536,"Health Partners, Inc.",State Public Programs,268,50,,percent of total billed charges,,
Cystourethroscopy,,52000,CPT,Facility,Both,,,,536,455.6,153.6176,536,Humana Insurance Company,Commercial PPO,509.2,95,,percent of total billed charges,,
Cystourethroscopy,,52000,CPT,Facility,Outpatient,,,,536,455.6,153.6176,536,Humana Insurance Company,Medicare PPO,262.64,49,,percent of total billed charges,,
Cystourethroscopy,,52000,CPT,Facility,Inpatient,,,,536,455.6,153.6176,536,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Cystourethroscopy,,52000,CPT,Facility,Both,,,,536,455.6,153.6176,536,Medica,Individual & Family,531.176,99.1,,percent of total billed charges,,
Cystourethroscopy,,52000,CPT,Facility,Outpatient,,,,536,455.6,153.6176,536,Medica,Medica Advantage Solution,266.928,49.8,,percent of total billed charges,,
Cystourethroscopy,,52000,CPT,Facility,Inpatient,,,,536,455.6,153.6176,536,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Cystourethroscopy,,52000,CPT,Facility,Outpatient,,,,536,455.6,153.6176,536,Medica,Medical Assistance,449,,,Other,Grouper,All inclusive per visit
Cystourethroscopy,,52000,CPT,Facility,Inpatient,,,,536,455.6,153.6176,536,Medica,Medical Assistance,,,,,Included in per diem rate,
Cystourethroscopy,,52000,CPT,Facility,Outpatient,,,,536,455.6,153.6176,536,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,266.928,49.8,,percent of total billed charges,,
Cystourethroscopy,,52000,CPT,Facility,Inpatient,,,,536,455.6,153.6176,536,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Cystourethroscopy,,52000,CPT,Facility,Both,,,,536,455.6,153.6176,536,"Multiplan, Inc.","Multiplan, Inc.",503.84,94,,percent of total billed charges,,
Cystourethroscopy,,52000,CPT,Facility,Outpatient,,,,536,455.6,153.6176,536,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,482.936,90.1,,percent of total billed charges,,
Cystourethroscopy,,52000,CPT,Facility,Inpatient,,,,536,455.6,153.6176,536,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Cystourethroscopy,,52000,CPT,Facility,Both,,,,536,455.6,153.6176,536,"Preferred One Administrative Services, INC.",PPO,528.496,98.6,,percent of total billed charges,,
Cystourethroscopy,,52000,CPT,Facility,Outpatient,,,,536,455.6,153.6176,536,PrimeWest Health,Minnesota Senior Health Options (MSHO),275.772,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Cystourethroscopy,,52000,CPT,Facility,Inpatient,,,,536,455.6,153.6176,536,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Cystourethroscopy,,52000,CPT,Facility,Outpatient,,,,536,455.6,153.6176,536,PrimeWest Health,MinnesotaCare,275.2896,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Cystourethroscopy,,52000,CPT,Facility,Inpatient,,,,536,455.6,153.6176,536,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Cystourethroscopy,,52000,CPT,Facility,Both,,,,536,455.6,153.6176,536,Sanford Health Plan,Sanford Health Plan,493.12,92,,percent of total billed charges,,
Cystourethroscopy,,52000,CPT,Facility,Outpatient,,,,536,455.6,153.6176,536,"UCare Health, Inc.",Individual & Family Plan,302.036,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Cystourethroscopy,,52000,CPT,Facility,Inpatient,,,,536,455.6,153.6176,536,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Cystourethroscopy,,52000,CPT,Facility,Outpatient,,,,536,455.6,153.6176,536,"UCare Health, Inc.",Medical Assistance,270.5192,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Cystourethroscopy,,52000,CPT,Facility,Inpatient,,,,536,455.6,153.6176,536,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Cystourethroscopy,,52000,CPT,Facility,Outpatient,,,,536,455.6,153.6176,536,"UCare Health, Inc.",Medicare Advantage,270.5192,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Cystourethroscopy,,52000,CPT,Facility,Inpatient,,,,536,455.6,153.6176,536,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Cystourethroscopy,,52000,CPT,Facility,Outpatient,,,,536,455.6,153.6176,536,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),270.5192,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Cystourethroscopy,,52000,CPT,Facility,Inpatient,,,,536,455.6,153.6176,536,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Cystourethroscopy,,52000,CPT,Facility,Both,,,,536,455.6,153.6176,536,UnitedHealthcare,Individual & Family,503.84,94,,percent of total billed charges,,
Cystourethroscopy,,52000,CPT,Facility,Outpatient,,,,536,455.6,153.6176,536,UnitedHealthcare,Medicare Advantage,262.64,49,,percent of total billed charges,,
Cystourethroscopy,,52000,CPT,Facility,Inpatient,,,,536,455.6,153.6176,536,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Cystourethroscopy,,52000,CPT,Facility,Outpatient,,,,536,455.6,153.6176,536,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,257.28,48,,percent of total billed charges,,100% of DHS outpatient percentage
Cystourethroscopy,,52000,CPT,Facility,Inpatient,,,,536,455.6,153.6176,536,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Cystourethroscopy (Separate Procedure) (Pro Cah),,52000,CPT,Professional,Both,,,,816,693.6,48.86,816,Aetna,Commercial,693.6,85,,percent of total billed charges,,
Cystourethroscopy (Separate Procedure) (Pro Cah),,52000,CPT,Professional,Both,,,,816,693.6,48.86,816,Aetna,Medicare Advantage,77.75,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Cystourethroscopy (Separate Procedure) (Pro Cah),,52000,CPT,Professional,Both,,,,816,693.6,48.86,816,Aetna,PPO,758.88,93,,percent of total billed charges,,
Cystourethroscopy (Separate Procedure) (Pro Cah),,52000,CPT,Professional,Both,,,,816,693.6,48.86,816,America's PPO,America's PPO,697.1904,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Cystourethroscopy (Separate Procedure) (Pro Cah),,52000,CPT,Professional,Both,,,,816,693.6,48.86,816,BlueCross BlueShield Minnesota, Federal Employee Program,162.51,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Cystourethroscopy (Separate Procedure) (Pro Cah),,52000,CPT,Professional,Both,,,,816,693.6,48.86,816,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,165.11016,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Cystourethroscopy (Separate Procedure) (Pro Cah),,52000,CPT,Professional,Both,,,,816,693.6,48.86,816,BlueCross BlueShield Minnesota,High Value Network Plan,165.11016,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Cystourethroscopy (Separate Procedure) (Pro Cah),,52000,CPT,Professional,Both,,,,816,693.6,48.86,816,BlueCross BlueShield Minnesota,Medicare Advantage,87.4575,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Cystourethroscopy (Separate Procedure) (Pro Cah),,52000,CPT,Professional,Both,,,,816,693.6,48.86,816,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,165.11016,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Cystourethroscopy (Separate Procedure) (Pro Cah),,52000,CPT,Professional,Both,,,,816,693.6,48.86,816,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,56.40832,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Cystourethroscopy (Separate Procedure) (Pro Cah),,52000,CPT,Professional,Both,,,,816,693.6,48.86,816,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),87.4575,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Cystourethroscopy (Separate Procedure) (Pro Cah),,52000,CPT,Professional,Both,,,,816,693.6,48.86,816,CorVel,Worker's Compensation,150.1424142,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Cystourethroscopy (Separate Procedure) (Pro Cah),,52000,CPT,Professional,Both,,,,816,693.6,48.86,816,First Health Group Corporation,First Health Network,791.52,97,,percent of total billed charges,,
Cystourethroscopy (Separate Procedure) (Pro Cah),,52000,CPT,Professional,Both,,,,816,693.6,48.86,816,"Health Partners, Inc.",Commercial,162.52,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Cystourethroscopy (Separate Procedure) (Pro Cah),,52000,CPT,Professional,Both,,,,816,693.6,48.86,816,"Health Partners, Inc.",Medicare Advantage,87.4575,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Cystourethroscopy (Separate Procedure) (Pro Cah),,52000,CPT,Professional,Both,,,,816,693.6,48.86,816,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),75.91,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Cystourethroscopy (Separate Procedure) (Pro Cah),,52000,CPT,Professional,Both,,,,816,693.6,48.86,816,"Health Partners, Inc.",State of Minnesota Advantage Program,140.01098,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Cystourethroscopy (Separate Procedure) (Pro Cah),,52000,CPT,Professional,Both,,,,816,693.6,48.86,816,"Health Partners, Inc.",State Public Programs,48.86,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Cystourethroscopy (Separate Procedure) (Pro Cah),,52000,CPT,Professional,Both,,,,816,693.6,48.86,816,Humana Insurance Company,Commercial PPO,76.05,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Cystourethroscopy (Separate Procedure) (Pro Cah),,52000,CPT,Professional,Both,,,,816,693.6,48.86,816,Humana Insurance Company,Medicare PPO,816,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Cystourethroscopy (Separate Procedure) (Pro Cah),,52000,CPT,Professional,Both,,,,816,693.6,48.86,816,Medica,Individual & Family,691.968,84.8,,percent of total billed charges,,
Cystourethroscopy (Separate Procedure) (Pro Cah),,52000,CPT,Professional,Both,,,,816,693.6,48.86,816,Medica,Medica Advantage Solution,406.368,49.8,,percent of total billed charges,,
Cystourethroscopy (Separate Procedure) (Pro Cah),,52000,CPT,Professional,Both,,,,816,693.6,48.86,816,Medica,Medical Assistance,56.41,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Cystourethroscopy (Separate Procedure) (Pro Cah),,52000,CPT,Professional,Both,,,,816,693.6,48.86,816,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,76.05,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Cystourethroscopy (Separate Procedure) (Pro Cah),,52000,CPT,Professional,Both,,,,816,693.6,48.86,816,"Multiplan, Inc.","Multiplan, Inc.",767.04,94,,percent of total billed charges,,
Cystourethroscopy (Separate Procedure) (Pro Cah),,52000,CPT,Professional,Both,,,,816,693.6,48.86,816,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,735.216,90.1,,percent of total billed charges,,
Cystourethroscopy (Separate Procedure) (Pro Cah),,52000,CPT,Professional,Both,,,,816,693.6,48.86,816,"Preferred One Administrative Services, INC.",PPO,804.576,98.6,,percent of total billed charges,,
Cystourethroscopy (Separate Procedure) (Pro Cah),,52000,CPT,Professional,Both,,,,816,693.6,48.86,816,PrimeWest Health,Minnesota Senior Health Options (MSHO),87.4575,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Cystourethroscopy (Separate Procedure) (Pro Cah),,52000,CPT,Professional,Both,,,,816,693.6,48.86,816,PrimeWest Health,MinnesotaCare,60.3569024,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Cystourethroscopy (Separate Procedure) (Pro Cah),,52000,CPT,Professional,Both,,,,816,693.6,48.86,816,Sanford Health Plan,Sanford Health Plan,718.08,88,,percent of total billed charges,,
Cystourethroscopy (Separate Procedure) (Pro Cah),,52000,CPT,Professional,Both,,,,816,693.6,48.86,816,"UCare Health, Inc.",Individual & Family Plan,123.62688,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Cystourethroscopy (Separate Procedure) (Pro Cah),,52000,CPT,Professional,Both,,,,816,693.6,48.86,816,"UCare Health, Inc.",Medical Assistance,62.049152,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Cystourethroscopy (Separate Procedure) (Pro Cah),,52000,CPT,Professional,Both,,,,816,693.6,48.86,816,"UCare Health, Inc.",Medicare Advantage,87.4575,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Cystourethroscopy (Separate Procedure) (Pro Cah),,52000,CPT,Professional,Both,,,,816,693.6,48.86,816,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),69.966,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Cystourethroscopy (Separate Procedure) (Pro Cah),,52000,CPT,Professional,Both,,,,816,693.6,48.86,816,UnitedHealthcare,Individual & Family,816,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Cystourethroscopy (Separate Procedure) (Pro Cah),,52000,CPT,Professional,Both,,,,816,693.6,48.86,816,UnitedHealthcare,Medicare Advantage,87.4575,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Cystourethroscopy (Separate Procedure) (Pro Cah),,52000,CPT,Professional,Both,,,,816,693.6,48.86,816,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,56.40832,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Cystourethroscopy, W Fulguration Trigone/Bladder Neck/Prostatic Fossa/Urethra/Periurethral Glands (Pro Cah)",,52214,CPT,Professional,Both,,,,2601,2210.85,105.8,2601,Aetna,Commercial,2210.85,85,,percent of total billed charges,,
"Cystourethroscopy, W Fulguration Trigone/Bladder Neck/Prostatic Fossa/Urethra/Periurethral Glands (Pro Cah)",,52214,CPT,Professional,Both,,,,2601,2210.85,105.8,2601,Aetna,Medicare Advantage,169.72,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Cystourethroscopy, W Fulguration Trigone/Bladder Neck/Prostatic Fossa/Urethra/Periurethral Glands (Pro Cah)",,52214,CPT,Professional,Both,,,,2601,2210.85,105.8,2601,Aetna,PPO,2418.93,93,,percent of total billed charges,,
"Cystourethroscopy, W Fulguration Trigone/Bladder Neck/Prostatic Fossa/Urethra/Periurethral Glands (Pro Cah)",,52214,CPT,Professional,Both,,,,2601,2210.85,105.8,2601,America's PPO,America's PPO,2222.2944,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Cystourethroscopy, W Fulguration Trigone/Bladder Neck/Prostatic Fossa/Urethra/Periurethral Glands (Pro Cah)",,52214,CPT,Professional,Both,,,,2601,2210.85,105.8,2601,BlueCross BlueShield Minnesota, Federal Employee Program,352.56,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Cystourethroscopy, W Fulguration Trigone/Bladder Neck/Prostatic Fossa/Urethra/Periurethral Glands (Pro Cah)",,52214,CPT,Professional,Both,,,,2601,2210.85,105.8,2601,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,358.20096,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Cystourethroscopy, W Fulguration Trigone/Bladder Neck/Prostatic Fossa/Urethra/Periurethral Glands (Pro Cah)",,52214,CPT,Professional,Both,,,,2601,2210.85,105.8,2601,BlueCross BlueShield Minnesota,High Value Network Plan,358.20096,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Cystourethroscopy, W Fulguration Trigone/Bladder Neck/Prostatic Fossa/Urethra/Periurethral Glands (Pro Cah)",,52214,CPT,Professional,Both,,,,2601,2210.85,105.8,2601,BlueCross BlueShield Minnesota,Medicare Advantage,189.382,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Cystourethroscopy, W Fulguration Trigone/Bladder Neck/Prostatic Fossa/Urethra/Periurethral Glands (Pro Cah)",,52214,CPT,Professional,Both,,,,2601,2210.85,105.8,2601,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,358.20096,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Cystourethroscopy, W Fulguration Trigone/Bladder Neck/Prostatic Fossa/Urethra/Periurethral Glands (Pro Cah)",,52214,CPT,Professional,Both,,,,2601,2210.85,105.8,2601,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,122.15368,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Cystourethroscopy, W Fulguration Trigone/Bladder Neck/Prostatic Fossa/Urethra/Periurethral Glands (Pro Cah)",,52214,CPT,Professional,Both,,,,2601,2210.85,105.8,2601,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),189.382,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Cystourethroscopy, W Fulguration Trigone/Bladder Neck/Prostatic Fossa/Urethra/Periurethral Glands (Pro Cah)",,52214,CPT,Professional,Both,,,,2601,2210.85,105.8,2601,CorVel,Worker's Compensation,325.787934,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Cystourethroscopy, W Fulguration Trigone/Bladder Neck/Prostatic Fossa/Urethra/Periurethral Glands (Pro Cah)",,52214,CPT,Professional,Both,,,,2601,2210.85,105.8,2601,First Health Group Corporation,First Health Network,2522.97,97,,percent of total billed charges,,
"Cystourethroscopy, W Fulguration Trigone/Bladder Neck/Prostatic Fossa/Urethra/Periurethral Glands (Pro Cah)",,52214,CPT,Professional,Both,,,,2601,2210.85,105.8,2601,"Health Partners, Inc.",Commercial,351.88,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Cystourethroscopy, W Fulguration Trigone/Bladder Neck/Prostatic Fossa/Urethra/Periurethral Glands (Pro Cah)",,52214,CPT,Professional,Both,,,,2601,2210.85,105.8,2601,"Health Partners, Inc.",Medicare Advantage,189.382,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Cystourethroscopy, W Fulguration Trigone/Bladder Neck/Prostatic Fossa/Urethra/Periurethral Glands (Pro Cah)",,52214,CPT,Professional,Both,,,,2601,2210.85,105.8,2601,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),164.69,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Cystourethroscopy, W Fulguration Trigone/Bladder Neck/Prostatic Fossa/Urethra/Periurethral Glands (Pro Cah)",,52214,CPT,Professional,Both,,,,2601,2210.85,105.8,2601,"Health Partners, Inc.",State of Minnesota Advantage Program,303.14462,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Cystourethroscopy, W Fulguration Trigone/Bladder Neck/Prostatic Fossa/Urethra/Periurethral Glands (Pro Cah)",,52214,CPT,Professional,Both,,,,2601,2210.85,105.8,2601,"Health Partners, Inc.",State Public Programs,105.8,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Cystourethroscopy, W Fulguration Trigone/Bladder Neck/Prostatic Fossa/Urethra/Periurethral Glands (Pro Cah)",,52214,CPT,Professional,Both,,,,2601,2210.85,105.8,2601,Humana Insurance Company,Commercial PPO,164.68,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Cystourethroscopy, W Fulguration Trigone/Bladder Neck/Prostatic Fossa/Urethra/Periurethral Glands (Pro Cah)",,52214,CPT,Professional,Both,,,,2601,2210.85,105.8,2601,Humana Insurance Company,Medicare PPO,2601,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Cystourethroscopy, W Fulguration Trigone/Bladder Neck/Prostatic Fossa/Urethra/Periurethral Glands (Pro Cah)",,52214,CPT,Professional,Both,,,,2601,2210.85,105.8,2601,Medica,Individual & Family,2205.648,84.8,,percent of total billed charges,,
"Cystourethroscopy, W Fulguration Trigone/Bladder Neck/Prostatic Fossa/Urethra/Periurethral Glands (Pro Cah)",,52214,CPT,Professional,Both,,,,2601,2210.85,105.8,2601,Medica,Medica Advantage Solution,1295.298,49.8,,percent of total billed charges,,
"Cystourethroscopy, W Fulguration Trigone/Bladder Neck/Prostatic Fossa/Urethra/Periurethral Glands (Pro Cah)",,52214,CPT,Professional,Both,,,,2601,2210.85,105.8,2601,Medica,Medical Assistance,122.15,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Cystourethroscopy, W Fulguration Trigone/Bladder Neck/Prostatic Fossa/Urethra/Periurethral Glands (Pro Cah)",,52214,CPT,Professional,Both,,,,2601,2210.85,105.8,2601,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,164.68,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Cystourethroscopy, W Fulguration Trigone/Bladder Neck/Prostatic Fossa/Urethra/Periurethral Glands (Pro Cah)",,52214,CPT,Professional,Both,,,,2601,2210.85,105.8,2601,"Multiplan, Inc.","Multiplan, Inc.",2444.94,94,,percent of total billed charges,,
"Cystourethroscopy, W Fulguration Trigone/Bladder Neck/Prostatic Fossa/Urethra/Periurethral Glands (Pro Cah)",,52214,CPT,Professional,Both,,,,2601,2210.85,105.8,2601,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,2343.501,90.1,,percent of total billed charges,,
"Cystourethroscopy, W Fulguration Trigone/Bladder Neck/Prostatic Fossa/Urethra/Periurethral Glands (Pro Cah)",,52214,CPT,Professional,Both,,,,2601,2210.85,105.8,2601,"Preferred One Administrative Services, INC.",PPO,2564.586,98.6,,percent of total billed charges,,
"Cystourethroscopy, W Fulguration Trigone/Bladder Neck/Prostatic Fossa/Urethra/Periurethral Glands (Pro Cah)",,52214,CPT,Professional,Both,,,,2601,2210.85,105.8,2601,PrimeWest Health,Minnesota Senior Health Options (MSHO),189.382,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Cystourethroscopy, W Fulguration Trigone/Bladder Neck/Prostatic Fossa/Urethra/Periurethral Glands (Pro Cah)",,52214,CPT,Professional,Both,,,,2601,2210.85,105.8,2601,PrimeWest Health,MinnesotaCare,130.7044376,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Cystourethroscopy, W Fulguration Trigone/Bladder Neck/Prostatic Fossa/Urethra/Periurethral Glands (Pro Cah)",,52214,CPT,Professional,Both,,,,2601,2210.85,105.8,2601,Sanford Health Plan,Sanford Health Plan,2288.88,88,,percent of total billed charges,,
"Cystourethroscopy, W Fulguration Trigone/Bladder Neck/Prostatic Fossa/Urethra/Periurethral Glands (Pro Cah)",,52214,CPT,Professional,Both,,,,2601,2210.85,105.8,2601,"UCare Health, Inc.",Individual & Family Plan,267.703808,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Cystourethroscopy, W Fulguration Trigone/Bladder Neck/Prostatic Fossa/Urethra/Periurethral Glands (Pro Cah)",,52214,CPT,Professional,Both,,,,2601,2210.85,105.8,2601,"UCare Health, Inc.",Medical Assistance,134.369048,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Cystourethroscopy, W Fulguration Trigone/Bladder Neck/Prostatic Fossa/Urethra/Periurethral Glands (Pro Cah)",,52214,CPT,Professional,Both,,,,2601,2210.85,105.8,2601,"UCare Health, Inc.",Medicare Advantage,189.382,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Cystourethroscopy, W Fulguration Trigone/Bladder Neck/Prostatic Fossa/Urethra/Periurethral Glands (Pro Cah)",,52214,CPT,Professional,Both,,,,2601,2210.85,105.8,2601,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),151.5056,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Cystourethroscopy, W Fulguration Trigone/Bladder Neck/Prostatic Fossa/Urethra/Periurethral Glands (Pro Cah)",,52214,CPT,Professional,Both,,,,2601,2210.85,105.8,2601,UnitedHealthcare,Individual & Family,2601,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Cystourethroscopy, W Fulguration Trigone/Bladder Neck/Prostatic Fossa/Urethra/Periurethral Glands (Pro Cah)",,52214,CPT,Professional,Both,,,,2601,2210.85,105.8,2601,UnitedHealthcare,Medicare Advantage,189.382,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Cystourethroscopy, W Fulguration Trigone/Bladder Neck/Prostatic Fossa/Urethra/Periurethral Glands (Pro Cah)",,52214,CPT,Professional,Both,,,,2601,2210.85,105.8,2601,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,122.15368,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Cystourethroscopy, W/Fulguration Or Treatment Of Minor Lesions W W/O Biopsy (Pro Cah)",,52224,CPT,Professional,Both,,,,3765,3200.25,122.59,3765,Aetna,Commercial,3200.25,85,,percent of total billed charges,,
"Cystourethroscopy, W/Fulguration Or Treatment Of Minor Lesions W W/O Biopsy (Pro Cah)",,52224,CPT,Professional,Both,,,,3765,3200.25,122.59,3765,Aetna,Medicare Advantage,196.11,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Cystourethroscopy, W/Fulguration Or Treatment Of Minor Lesions W W/O Biopsy (Pro Cah)",,52224,CPT,Professional,Both,,,,3765,3200.25,122.59,3765,Aetna,PPO,3501.45,93,,percent of total billed charges,,
"Cystourethroscopy, W/Fulguration Or Treatment Of Minor Lesions W W/O Biopsy (Pro Cah)",,52224,CPT,Professional,Both,,,,3765,3200.25,122.59,3765,America's PPO,America's PPO,3216.816,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Cystourethroscopy, W/Fulguration Or Treatment Of Minor Lesions W W/O Biopsy (Pro Cah)",,52224,CPT,Professional,Both,,,,3765,3200.25,122.59,3765,BlueCross BlueShield Minnesota, Federal Employee Program,408.34,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Cystourethroscopy, W/Fulguration Or Treatment Of Minor Lesions W W/O Biopsy (Pro Cah)",,52224,CPT,Professional,Both,,,,3765,3200.25,122.59,3765,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,414.87344,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Cystourethroscopy, W/Fulguration Or Treatment Of Minor Lesions W W/O Biopsy (Pro Cah)",,52224,CPT,Professional,Both,,,,3765,3200.25,122.59,3765,BlueCross BlueShield Minnesota,High Value Network Plan,414.87344,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Cystourethroscopy, W/Fulguration Or Treatment Of Minor Lesions W W/O Biopsy (Pro Cah)",,52224,CPT,Professional,Both,,,,3765,3200.25,122.59,3765,BlueCross BlueShield Minnesota,Medicare Advantage,219.2475,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Cystourethroscopy, W/Fulguration Or Treatment Of Minor Lesions W W/O Biopsy (Pro Cah)",,52224,CPT,Professional,Both,,,,3765,3200.25,122.59,3765,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,414.87344,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Cystourethroscopy, W/Fulguration Or Treatment Of Minor Lesions W W/O Biopsy (Pro Cah)",,52224,CPT,Professional,Both,,,,3765,3200.25,122.59,3765,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,141.53896,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Cystourethroscopy, W/Fulguration Or Treatment Of Minor Lesions W W/O Biopsy (Pro Cah)",,52224,CPT,Professional,Both,,,,3765,3200.25,122.59,3765,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),219.2475,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Cystourethroscopy, W/Fulguration Or Treatment Of Minor Lesions W W/O Biopsy (Pro Cah)",,52224,CPT,Professional,Both,,,,3765,3200.25,122.59,3765,CorVel,Worker's Compensation,376.4327706,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Cystourethroscopy, W/Fulguration Or Treatment Of Minor Lesions W W/O Biopsy (Pro Cah)",,52224,CPT,Professional,Both,,,,3765,3200.25,122.59,3765,First Health Group Corporation,First Health Network,3652.05,97,,percent of total billed charges,,
"Cystourethroscopy, W/Fulguration Or Treatment Of Minor Lesions W W/O Biopsy (Pro Cah)",,52224,CPT,Professional,Both,,,,3765,3200.25,122.59,3765,"Health Partners, Inc.",Commercial,407.02,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Cystourethroscopy, W/Fulguration Or Treatment Of Minor Lesions W W/O Biopsy (Pro Cah)",,52224,CPT,Professional,Both,,,,3765,3200.25,122.59,3765,"Health Partners, Inc.",Medicare Advantage,219.2475,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Cystourethroscopy, W/Fulguration Or Treatment Of Minor Lesions W W/O Biopsy (Pro Cah)",,52224,CPT,Professional,Both,,,,3765,3200.25,122.59,3765,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),190.78,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Cystourethroscopy, W/Fulguration Or Treatment Of Minor Lesions W W/O Biopsy (Pro Cah)",,52224,CPT,Professional,Both,,,,3765,3200.25,122.59,3765,"Health Partners, Inc.",State of Minnesota Advantage Program,350.64773,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Cystourethroscopy, W/Fulguration Or Treatment Of Minor Lesions W W/O Biopsy (Pro Cah)",,52224,CPT,Professional,Both,,,,3765,3200.25,122.59,3765,"Health Partners, Inc.",State Public Programs,122.59,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Cystourethroscopy, W/Fulguration Or Treatment Of Minor Lesions W W/O Biopsy (Pro Cah)",,52224,CPT,Professional,Both,,,,3765,3200.25,122.59,3765,Humana Insurance Company,Commercial PPO,190.65,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Cystourethroscopy, W/Fulguration Or Treatment Of Minor Lesions W W/O Biopsy (Pro Cah)",,52224,CPT,Professional,Both,,,,3765,3200.25,122.59,3765,Humana Insurance Company,Medicare PPO,3765,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Cystourethroscopy, W/Fulguration Or Treatment Of Minor Lesions W W/O Biopsy (Pro Cah)",,52224,CPT,Professional,Both,,,,3765,3200.25,122.59,3765,Medica,Individual & Family,3192.72,84.8,,percent of total billed charges,,
"Cystourethroscopy, W/Fulguration Or Treatment Of Minor Lesions W W/O Biopsy (Pro Cah)",,52224,CPT,Professional,Both,,,,3765,3200.25,122.59,3765,Medica,Medica Advantage Solution,1874.97,49.8,,percent of total billed charges,,
"Cystourethroscopy, W/Fulguration Or Treatment Of Minor Lesions W W/O Biopsy (Pro Cah)",,52224,CPT,Professional,Both,,,,3765,3200.25,122.59,3765,Medica,Medical Assistance,141.54,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Cystourethroscopy, W/Fulguration Or Treatment Of Minor Lesions W W/O Biopsy (Pro Cah)",,52224,CPT,Professional,Both,,,,3765,3200.25,122.59,3765,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,190.65,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Cystourethroscopy, W/Fulguration Or Treatment Of Minor Lesions W W/O Biopsy (Pro Cah)",,52224,CPT,Professional,Both,,,,3765,3200.25,122.59,3765,"Multiplan, Inc.","Multiplan, Inc.",3539.1,94,,percent of total billed charges,,
"Cystourethroscopy, W/Fulguration Or Treatment Of Minor Lesions W W/O Biopsy (Pro Cah)",,52224,CPT,Professional,Both,,,,3765,3200.25,122.59,3765,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,3392.265,90.1,,percent of total billed charges,,
"Cystourethroscopy, W/Fulguration Or Treatment Of Minor Lesions W W/O Biopsy (Pro Cah)",,52224,CPT,Professional,Both,,,,3765,3200.25,122.59,3765,"Preferred One Administrative Services, INC.",PPO,3712.29,98.6,,percent of total billed charges,,
"Cystourethroscopy, W/Fulguration Or Treatment Of Minor Lesions W W/O Biopsy (Pro Cah)",,52224,CPT,Professional,Both,,,,3765,3200.25,122.59,3765,PrimeWest Health,Minnesota Senior Health Options (MSHO),219.2475,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Cystourethroscopy, W/Fulguration Or Treatment Of Minor Lesions W W/O Biopsy (Pro Cah)",,52224,CPT,Professional,Both,,,,3765,3200.25,122.59,3765,PrimeWest Health,MinnesotaCare,151.4466872,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Cystourethroscopy, W/Fulguration Or Treatment Of Minor Lesions W W/O Biopsy (Pro Cah)",,52224,CPT,Professional,Both,,,,3765,3200.25,122.59,3765,Sanford Health Plan,Sanford Health Plan,3313.2,88,,percent of total billed charges,,
"Cystourethroscopy, W/Fulguration Or Treatment Of Minor Lesions W W/O Biopsy (Pro Cah)",,52224,CPT,Professional,Both,,,,3765,3200.25,122.59,3765,"UCare Health, Inc.",Individual & Family Plan,309.92064,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Cystourethroscopy, W/Fulguration Or Treatment Of Minor Lesions W W/O Biopsy (Pro Cah)",,52224,CPT,Professional,Both,,,,3765,3200.25,122.59,3765,"UCare Health, Inc.",Medical Assistance,155.692856,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Cystourethroscopy, W/Fulguration Or Treatment Of Minor Lesions W W/O Biopsy (Pro Cah)",,52224,CPT,Professional,Both,,,,3765,3200.25,122.59,3765,"UCare Health, Inc.",Medicare Advantage,219.2475,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Cystourethroscopy, W/Fulguration Or Treatment Of Minor Lesions W W/O Biopsy (Pro Cah)",,52224,CPT,Professional,Both,,,,3765,3200.25,122.59,3765,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),175.398,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Cystourethroscopy, W/Fulguration Or Treatment Of Minor Lesions W W/O Biopsy (Pro Cah)",,52224,CPT,Professional,Both,,,,3765,3200.25,122.59,3765,UnitedHealthcare,Individual & Family,3765,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Cystourethroscopy, W/Fulguration Or Treatment Of Minor Lesions W W/O Biopsy (Pro Cah)",,52224,CPT,Professional,Both,,,,3765,3200.25,122.59,3765,UnitedHealthcare,Medicare Advantage,219.2475,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Cystourethroscopy, W/Fulguration Or Treatment Of Minor Lesions W W/O Biopsy (Pro Cah)",,52224,CPT,Professional,Both,,,,3765,3200.25,122.59,3765,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,141.53896,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Cystourethroscopy, W/Fulguration A/O Resection Of Small Bladder Tumor(S) (0.5 Up To 2.0 Cm) (Pro Cah)",,52234,CPT,Professional,Both,,,,1479,1257.15,149.21,1479,Aetna,Commercial,1257.15,85,,percent of total billed charges,,
"Cystourethroscopy, W/Fulguration A/O Resection Of Small Bladder Tumor(S) (0.5 Up To 2.0 Cm) (Pro Cah)",,52234,CPT,Professional,Both,,,,1479,1257.15,149.21,1479,Aetna,Medicare Advantage,237.01,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Cystourethroscopy, W/Fulguration A/O Resection Of Small Bladder Tumor(S) (0.5 Up To 2.0 Cm) (Pro Cah)",,52234,CPT,Professional,Both,,,,1479,1257.15,149.21,1479,Aetna,PPO,1375.47,93,,percent of total billed charges,,
"Cystourethroscopy, W/Fulguration A/O Resection Of Small Bladder Tumor(S) (0.5 Up To 2.0 Cm) (Pro Cah)",,52234,CPT,Professional,Both,,,,1479,1257.15,149.21,1479,America's PPO,America's PPO,1263.6576,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Cystourethroscopy, W/Fulguration A/O Resection Of Small Bladder Tumor(S) (0.5 Up To 2.0 Cm) (Pro Cah)",,52234,CPT,Professional,Both,,,,1479,1257.15,149.21,1479,BlueCross BlueShield Minnesota, Federal Employee Program,494.41,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Cystourethroscopy, W/Fulguration A/O Resection Of Small Bladder Tumor(S) (0.5 Up To 2.0 Cm) (Pro Cah)",,52234,CPT,Professional,Both,,,,1479,1257.15,149.21,1479,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,502.32056,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Cystourethroscopy, W/Fulguration A/O Resection Of Small Bladder Tumor(S) (0.5 Up To 2.0 Cm) (Pro Cah)",,52234,CPT,Professional,Both,,,,1479,1257.15,149.21,1479,BlueCross BlueShield Minnesota,High Value Network Plan,502.32056,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Cystourethroscopy, W/Fulguration A/O Resection Of Small Bladder Tumor(S) (0.5 Up To 2.0 Cm) (Pro Cah)",,52234,CPT,Professional,Both,,,,1479,1257.15,149.21,1479,BlueCross BlueShield Minnesota,Medicare Advantage,266.846,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Cystourethroscopy, W/Fulguration A/O Resection Of Small Bladder Tumor(S) (0.5 Up To 2.0 Cm) (Pro Cah)",,52234,CPT,Professional,Both,,,,1479,1257.15,149.21,1479,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,502.32056,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Cystourethroscopy, W/Fulguration A/O Resection Of Small Bladder Tumor(S) (0.5 Up To 2.0 Cm) (Pro Cah)",,52234,CPT,Professional,Both,,,,1479,1257.15,149.21,1479,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,172.27296,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Cystourethroscopy, W/Fulguration A/O Resection Of Small Bladder Tumor(S) (0.5 Up To 2.0 Cm) (Pro Cah)",,52234,CPT,Professional,Both,,,,1479,1257.15,149.21,1479,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),266.846,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Cystourethroscopy, W/Fulguration A/O Resection Of Small Bladder Tumor(S) (0.5 Up To 2.0 Cm) (Pro Cah)",,52234,CPT,Professional,Both,,,,1479,1257.15,149.21,1479,CorVel,Worker's Compensation,456.2878251,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Cystourethroscopy, W/Fulguration A/O Resection Of Small Bladder Tumor(S) (0.5 Up To 2.0 Cm) (Pro Cah)",,52234,CPT,Professional,Both,,,,1479,1257.15,149.21,1479,First Health Group Corporation,First Health Network,1434.63,97,,percent of total billed charges,,
"Cystourethroscopy, W/Fulguration A/O Resection Of Small Bladder Tumor(S) (0.5 Up To 2.0 Cm) (Pro Cah)",,52234,CPT,Professional,Both,,,,1479,1257.15,149.21,1479,"Health Partners, Inc.",Commercial,493.36,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Cystourethroscopy, W/Fulguration A/O Resection Of Small Bladder Tumor(S) (0.5 Up To 2.0 Cm) (Pro Cah)",,52234,CPT,Professional,Both,,,,1479,1257.15,149.21,1479,"Health Partners, Inc.",Medicare Advantage,266.846,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Cystourethroscopy, W/Fulguration A/O Resection Of Small Bladder Tumor(S) (0.5 Up To 2.0 Cm) (Pro Cah)",,52234,CPT,Professional,Both,,,,1479,1257.15,149.21,1479,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),232.13,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Cystourethroscopy, W/Fulguration A/O Resection Of Small Bladder Tumor(S) (0.5 Up To 2.0 Cm) (Pro Cah)",,52234,CPT,Professional,Both,,,,1479,1257.15,149.21,1479,"Health Partners, Inc.",State of Minnesota Advantage Program,425.02964,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Cystourethroscopy, W/Fulguration A/O Resection Of Small Bladder Tumor(S) (0.5 Up To 2.0 Cm) (Pro Cah)",,52234,CPT,Professional,Both,,,,1479,1257.15,149.21,1479,"Health Partners, Inc.",State Public Programs,149.21,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Cystourethroscopy, W/Fulguration A/O Resection Of Small Bladder Tumor(S) (0.5 Up To 2.0 Cm) (Pro Cah)",,52234,CPT,Professional,Both,,,,1479,1257.15,149.21,1479,Humana Insurance Company,Commercial PPO,232.04,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Cystourethroscopy, W/Fulguration A/O Resection Of Small Bladder Tumor(S) (0.5 Up To 2.0 Cm) (Pro Cah)",,52234,CPT,Professional,Both,,,,1479,1257.15,149.21,1479,Humana Insurance Company,Medicare PPO,1479,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Cystourethroscopy, W/Fulguration A/O Resection Of Small Bladder Tumor(S) (0.5 Up To 2.0 Cm) (Pro Cah)",,52234,CPT,Professional,Both,,,,1479,1257.15,149.21,1479,Medica,Individual & Family,1254.192,84.8,,percent of total billed charges,,
"Cystourethroscopy, W/Fulguration A/O Resection Of Small Bladder Tumor(S) (0.5 Up To 2.0 Cm) (Pro Cah)",,52234,CPT,Professional,Both,,,,1479,1257.15,149.21,1479,Medica,Medica Advantage Solution,736.542,49.8,,percent of total billed charges,,
"Cystourethroscopy, W/Fulguration A/O Resection Of Small Bladder Tumor(S) (0.5 Up To 2.0 Cm) (Pro Cah)",,52234,CPT,Professional,Both,,,,1479,1257.15,149.21,1479,Medica,Medical Assistance,172.27,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Cystourethroscopy, W/Fulguration A/O Resection Of Small Bladder Tumor(S) (0.5 Up To 2.0 Cm) (Pro Cah)",,52234,CPT,Professional,Both,,,,1479,1257.15,149.21,1479,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,232.04,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Cystourethroscopy, W/Fulguration A/O Resection Of Small Bladder Tumor(S) (0.5 Up To 2.0 Cm) (Pro Cah)",,52234,CPT,Professional,Both,,,,1479,1257.15,149.21,1479,"Multiplan, Inc.","Multiplan, Inc.",1390.26,94,,percent of total billed charges,,
"Cystourethroscopy, W/Fulguration A/O Resection Of Small Bladder Tumor(S) (0.5 Up To 2.0 Cm) (Pro Cah)",,52234,CPT,Professional,Both,,,,1479,1257.15,149.21,1479,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1332.579,90.1,,percent of total billed charges,,
"Cystourethroscopy, W/Fulguration A/O Resection Of Small Bladder Tumor(S) (0.5 Up To 2.0 Cm) (Pro Cah)",,52234,CPT,Professional,Both,,,,1479,1257.15,149.21,1479,"Preferred One Administrative Services, INC.",PPO,1458.294,98.6,,percent of total billed charges,,
"Cystourethroscopy, W/Fulguration A/O Resection Of Small Bladder Tumor(S) (0.5 Up To 2.0 Cm) (Pro Cah)",,52234,CPT,Professional,Both,,,,1479,1257.15,149.21,1479,PrimeWest Health,Minnesota Senior Health Options (MSHO),266.846,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Cystourethroscopy, W/Fulguration A/O Resection Of Small Bladder Tumor(S) (0.5 Up To 2.0 Cm) (Pro Cah)",,52234,CPT,Professional,Both,,,,1479,1257.15,149.21,1479,PrimeWest Health,MinnesotaCare,184.3320672,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Cystourethroscopy, W/Fulguration A/O Resection Of Small Bladder Tumor(S) (0.5 Up To 2.0 Cm) (Pro Cah)",,52234,CPT,Professional,Both,,,,1479,1257.15,149.21,1479,Sanford Health Plan,Sanford Health Plan,1301.52,88,,percent of total billed charges,,
"Cystourethroscopy, W/Fulguration A/O Resection Of Small Bladder Tumor(S) (0.5 Up To 2.0 Cm) (Pro Cah)",,52234,CPT,Professional,Both,,,,1479,1257.15,149.21,1479,"UCare Health, Inc.",Individual & Family Plan,377.204224,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Cystourethroscopy, W/Fulguration A/O Resection Of Small Bladder Tumor(S) (0.5 Up To 2.0 Cm) (Pro Cah)",,52234,CPT,Professional,Both,,,,1479,1257.15,149.21,1479,"UCare Health, Inc.",Medical Assistance,189.500256,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Cystourethroscopy, W/Fulguration A/O Resection Of Small Bladder Tumor(S) (0.5 Up To 2.0 Cm) (Pro Cah)",,52234,CPT,Professional,Both,,,,1479,1257.15,149.21,1479,"UCare Health, Inc.",Medicare Advantage,266.846,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Cystourethroscopy, W/Fulguration A/O Resection Of Small Bladder Tumor(S) (0.5 Up To 2.0 Cm) (Pro Cah)",,52234,CPT,Professional,Both,,,,1479,1257.15,149.21,1479,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),213.4768,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Cystourethroscopy, W/Fulguration A/O Resection Of Small Bladder Tumor(S) (0.5 Up To 2.0 Cm) (Pro Cah)",,52234,CPT,Professional,Both,,,,1479,1257.15,149.21,1479,UnitedHealthcare,Individual & Family,1479,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Cystourethroscopy, W/Fulguration A/O Resection Of Small Bladder Tumor(S) (0.5 Up To 2.0 Cm) (Pro Cah)",,52234,CPT,Professional,Both,,,,1479,1257.15,149.21,1479,UnitedHealthcare,Medicare Advantage,266.846,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Cystourethroscopy, W/Fulguration A/O Resection Of Small Bladder Tumor(S) (0.5 Up To 2.0 Cm) (Pro Cah)",,52234,CPT,Professional,Both,,,,1479,1257.15,149.21,1479,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,172.27296,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Cystourethroscopy, W/Fulguration And/Or Resection Of Bladder Tumor(S) (2.0 Cm To 5.0 Cm) (Pro Cah)",,52235,CPT,Professional,Both,,,,2055,1746.75,174.95,2055,Aetna,Commercial,1746.75,85,,percent of total billed charges,,
"Cystourethroscopy, W/Fulguration And/Or Resection Of Bladder Tumor(S) (2.0 Cm To 5.0 Cm) (Pro Cah)",,52235,CPT,Professional,Both,,,,2055,1746.75,174.95,2055,Aetna,Medicare Advantage,277.94,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Cystourethroscopy, W/Fulguration And/Or Resection Of Bladder Tumor(S) (2.0 Cm To 5.0 Cm) (Pro Cah)",,52235,CPT,Professional,Both,,,,2055,1746.75,174.95,2055,Aetna,PPO,1911.15,93,,percent of total billed charges,,
"Cystourethroscopy, W/Fulguration And/Or Resection Of Bladder Tumor(S) (2.0 Cm To 5.0 Cm) (Pro Cah)",,52235,CPT,Professional,Both,,,,2055,1746.75,174.95,2055,America's PPO,America's PPO,1755.792,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Cystourethroscopy, W/Fulguration And/Or Resection Of Bladder Tumor(S) (2.0 Cm To 5.0 Cm) (Pro Cah)",,52235,CPT,Professional,Both,,,,2055,1746.75,174.95,2055,BlueCross BlueShield Minnesota, Federal Employee Program,579.8,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Cystourethroscopy, W/Fulguration And/Or Resection Of Bladder Tumor(S) (2.0 Cm To 5.0 Cm) (Pro Cah)",,52235,CPT,Professional,Both,,,,2055,1746.75,174.95,2055,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,589.0768,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Cystourethroscopy, W/Fulguration And/Or Resection Of Bladder Tumor(S) (2.0 Cm To 5.0 Cm) (Pro Cah)",,52235,CPT,Professional,Both,,,,2055,1746.75,174.95,2055,BlueCross BlueShield Minnesota,High Value Network Plan,589.0768,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Cystourethroscopy, W/Fulguration And/Or Resection Of Bladder Tumor(S) (2.0 Cm To 5.0 Cm) (Pro Cah)",,52235,CPT,Professional,Both,,,,2055,1746.75,174.95,2055,BlueCross BlueShield Minnesota,Medicare Advantage,312.777,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Cystourethroscopy, W/Fulguration And/Or Resection Of Bladder Tumor(S) (2.0 Cm To 5.0 Cm) (Pro Cah)",,52235,CPT,Professional,Both,,,,2055,1746.75,174.95,2055,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,589.0768,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Cystourethroscopy, W/Fulguration And/Or Resection Of Bladder Tumor(S) (2.0 Cm To 5.0 Cm) (Pro Cah)",,52235,CPT,Professional,Both,,,,2055,1746.75,174.95,2055,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,201.99096,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Cystourethroscopy, W/Fulguration And/Or Resection Of Bladder Tumor(S) (2.0 Cm To 5.0 Cm) (Pro Cah)",,52235,CPT,Professional,Both,,,,2055,1746.75,174.95,2055,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),312.777,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Cystourethroscopy, W/Fulguration And/Or Resection Of Bladder Tumor(S) (2.0 Cm To 5.0 Cm) (Pro Cah)",,52235,CPT,Professional,Both,,,,2055,1746.75,174.95,2055,CorVel,Worker's Compensation,534.5946111,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Cystourethroscopy, W/Fulguration And/Or Resection Of Bladder Tumor(S) (2.0 Cm To 5.0 Cm) (Pro Cah)",,52235,CPT,Professional,Both,,,,2055,1746.75,174.95,2055,First Health Group Corporation,First Health Network,1993.35,97,,percent of total billed charges,,
"Cystourethroscopy, W/Fulguration And/Or Resection Of Bladder Tumor(S) (2.0 Cm To 5.0 Cm) (Pro Cah)",,52235,CPT,Professional,Both,,,,2055,1746.75,174.95,2055,"Health Partners, Inc.",Commercial,577.51,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Cystourethroscopy, W/Fulguration And/Or Resection Of Bladder Tumor(S) (2.0 Cm To 5.0 Cm) (Pro Cah)",,52235,CPT,Professional,Both,,,,2055,1746.75,174.95,2055,"Health Partners, Inc.",Medicare Advantage,312.777,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Cystourethroscopy, W/Fulguration And/Or Resection Of Bladder Tumor(S) (2.0 Cm To 5.0 Cm) (Pro Cah)",,52235,CPT,Professional,Both,,,,2055,1746.75,174.95,2055,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),271.78,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Cystourethroscopy, W/Fulguration And/Or Resection Of Bladder Tumor(S) (2.0 Cm To 5.0 Cm) (Pro Cah)",,52235,CPT,Professional,Both,,,,2055,1746.75,174.95,2055,"Health Partners, Inc.",State of Minnesota Advantage Program,497.524865,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Cystourethroscopy, W/Fulguration And/Or Resection Of Bladder Tumor(S) (2.0 Cm To 5.0 Cm) (Pro Cah)",,52235,CPT,Professional,Both,,,,2055,1746.75,174.95,2055,"Health Partners, Inc.",State Public Programs,174.95,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Cystourethroscopy, W/Fulguration And/Or Resection Of Bladder Tumor(S) (2.0 Cm To 5.0 Cm) (Pro Cah)",,52235,CPT,Professional,Both,,,,2055,1746.75,174.95,2055,Humana Insurance Company,Commercial PPO,271.98,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Cystourethroscopy, W/Fulguration And/Or Resection Of Bladder Tumor(S) (2.0 Cm To 5.0 Cm) (Pro Cah)",,52235,CPT,Professional,Both,,,,2055,1746.75,174.95,2055,Humana Insurance Company,Medicare PPO,2055,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Cystourethroscopy, W/Fulguration And/Or Resection Of Bladder Tumor(S) (2.0 Cm To 5.0 Cm) (Pro Cah)",,52235,CPT,Professional,Both,,,,2055,1746.75,174.95,2055,Medica,Individual & Family,1742.64,84.8,,percent of total billed charges,,
"Cystourethroscopy, W/Fulguration And/Or Resection Of Bladder Tumor(S) (2.0 Cm To 5.0 Cm) (Pro Cah)",,52235,CPT,Professional,Both,,,,2055,1746.75,174.95,2055,Medica,Medica Advantage Solution,1023.39,49.8,,percent of total billed charges,,
"Cystourethroscopy, W/Fulguration And/Or Resection Of Bladder Tumor(S) (2.0 Cm To 5.0 Cm) (Pro Cah)",,52235,CPT,Professional,Both,,,,2055,1746.75,174.95,2055,Medica,Medical Assistance,201.99,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Cystourethroscopy, W/Fulguration And/Or Resection Of Bladder Tumor(S) (2.0 Cm To 5.0 Cm) (Pro Cah)",,52235,CPT,Professional,Both,,,,2055,1746.75,174.95,2055,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,271.98,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Cystourethroscopy, W/Fulguration And/Or Resection Of Bladder Tumor(S) (2.0 Cm To 5.0 Cm) (Pro Cah)",,52235,CPT,Professional,Both,,,,2055,1746.75,174.95,2055,"Multiplan, Inc.","Multiplan, Inc.",1931.7,94,,percent of total billed charges,,
"Cystourethroscopy, W/Fulguration And/Or Resection Of Bladder Tumor(S) (2.0 Cm To 5.0 Cm) (Pro Cah)",,52235,CPT,Professional,Both,,,,2055,1746.75,174.95,2055,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1851.555,90.1,,percent of total billed charges,,
"Cystourethroscopy, W/Fulguration And/Or Resection Of Bladder Tumor(S) (2.0 Cm To 5.0 Cm) (Pro Cah)",,52235,CPT,Professional,Both,,,,2055,1746.75,174.95,2055,"Preferred One Administrative Services, INC.",PPO,2026.23,98.6,,percent of total billed charges,,
"Cystourethroscopy, W/Fulguration And/Or Resection Of Bladder Tumor(S) (2.0 Cm To 5.0 Cm) (Pro Cah)",,52235,CPT,Professional,Both,,,,2055,1746.75,174.95,2055,PrimeWest Health,Minnesota Senior Health Options (MSHO),312.777,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Cystourethroscopy, W/Fulguration And/Or Resection Of Bladder Tumor(S) (2.0 Cm To 5.0 Cm) (Pro Cah)",,52235,CPT,Professional,Both,,,,2055,1746.75,174.95,2055,PrimeWest Health,MinnesotaCare,216.1303272,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Cystourethroscopy, W/Fulguration And/Or Resection Of Bladder Tumor(S) (2.0 Cm To 5.0 Cm) (Pro Cah)",,52235,CPT,Professional,Both,,,,2055,1746.75,174.95,2055,Sanford Health Plan,Sanford Health Plan,1808.4,88,,percent of total billed charges,,
"Cystourethroscopy, W/Fulguration And/Or Resection Of Bladder Tumor(S) (2.0 Cm To 5.0 Cm) (Pro Cah)",,52235,CPT,Professional,Both,,,,2055,1746.75,174.95,2055,"UCare Health, Inc.",Individual & Family Plan,442.130688,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Cystourethroscopy, W/Fulguration And/Or Resection Of Bladder Tumor(S) (2.0 Cm To 5.0 Cm) (Pro Cah)",,52235,CPT,Professional,Both,,,,2055,1746.75,174.95,2055,"UCare Health, Inc.",Medical Assistance,222.190056,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Cystourethroscopy, W/Fulguration And/Or Resection Of Bladder Tumor(S) (2.0 Cm To 5.0 Cm) (Pro Cah)",,52235,CPT,Professional,Both,,,,2055,1746.75,174.95,2055,"UCare Health, Inc.",Medicare Advantage,312.777,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Cystourethroscopy, W/Fulguration And/Or Resection Of Bladder Tumor(S) (2.0 Cm To 5.0 Cm) (Pro Cah)",,52235,CPT,Professional,Both,,,,2055,1746.75,174.95,2055,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),250.2216,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Cystourethroscopy, W/Fulguration And/Or Resection Of Bladder Tumor(S) (2.0 Cm To 5.0 Cm) (Pro Cah)",,52235,CPT,Professional,Both,,,,2055,1746.75,174.95,2055,UnitedHealthcare,Individual & Family,2055,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Cystourethroscopy, W/Fulguration And/Or Resection Of Bladder Tumor(S) (2.0 Cm To 5.0 Cm) (Pro Cah)",,52235,CPT,Professional,Both,,,,2055,1746.75,174.95,2055,UnitedHealthcare,Medicare Advantage,312.777,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Cystourethroscopy, W/Fulguration And/Or Resection Of Bladder Tumor(S) (2.0 Cm To 5.0 Cm) (Pro Cah)",,52235,CPT,Professional,Both,,,,2055,1746.75,174.95,2055,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,201.99096,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Cystourethroscopy, With Dilation Of Bladder For Interstitial Cystitis; General Or Conduction (Spinal) Anesthesia (Procah)",,52260,CPT,Professional,Both,,,,1025,871.25,127.83,1025,Aetna,Commercial,871.25,85,,percent of total billed charges,,
"Cystourethroscopy, With Dilation Of Bladder For Interstitial Cystitis; General Or Conduction (Spinal) Anesthesia (Procah)",,52260,CPT,Professional,Both,,,,1025,871.25,127.83,1025,Aetna,Medicare Advantage,203.02,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Cystourethroscopy, With Dilation Of Bladder For Interstitial Cystitis; General Or Conduction (Spinal) Anesthesia (Procah)",,52260,CPT,Professional,Both,,,,1025,871.25,127.83,1025,Aetna,PPO,953.25,93,,percent of total billed charges,,
"Cystourethroscopy, With Dilation Of Bladder For Interstitial Cystitis; General Or Conduction (Spinal) Anesthesia (Procah)",,52260,CPT,Professional,Both,,,,1025,871.25,127.83,1025,America's PPO,America's PPO,875.76,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Cystourethroscopy, With Dilation Of Bladder For Interstitial Cystitis; General Or Conduction (Spinal) Anesthesia (Procah)",,52260,CPT,Professional,Both,,,,1025,871.25,127.83,1025,BlueCross BlueShield Minnesota, Federal Employee Program,424.87,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Cystourethroscopy, With Dilation Of Bladder For Interstitial Cystitis; General Or Conduction (Spinal) Anesthesia (Procah)",,52260,CPT,Professional,Both,,,,1025,871.25,127.83,1025,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,431.66792,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Cystourethroscopy, With Dilation Of Bladder For Interstitial Cystitis; General Or Conduction (Spinal) Anesthesia (Procah)",,52260,CPT,Professional,Both,,,,1025,871.25,127.83,1025,BlueCross BlueShield Minnesota,High Value Network Plan,431.66792,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Cystourethroscopy, With Dilation Of Bladder For Interstitial Cystitis; General Or Conduction (Spinal) Anesthesia (Procah)",,52260,CPT,Professional,Both,,,,1025,871.25,127.83,1025,BlueCross BlueShield Minnesota,Medicare Advantage,228.62,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Cystourethroscopy, With Dilation Of Bladder For Interstitial Cystitis; General Or Conduction (Spinal) Anesthesia (Procah)",,52260,CPT,Professional,Both,,,,1025,871.25,127.83,1025,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,431.66792,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Cystourethroscopy, With Dilation Of Bladder For Interstitial Cystitis; General Or Conduction (Spinal) Anesthesia (Procah)",,52260,CPT,Professional,Both,,,,1025,871.25,127.83,1025,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,147.58416,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Cystourethroscopy, With Dilation Of Bladder For Interstitial Cystitis; General Or Conduction (Spinal) Anesthesia (Procah)",,52260,CPT,Professional,Both,,,,1025,871.25,127.83,1025,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),228.62,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Cystourethroscopy, With Dilation Of Bladder For Interstitial Cystitis; General Or Conduction (Spinal) Anesthesia (Procah)",,52260,CPT,Professional,Both,,,,1025,871.25,127.83,1025,CorVel,Worker's Compensation,390.8440941,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Cystourethroscopy, With Dilation Of Bladder For Interstitial Cystitis; General Or Conduction (Spinal) Anesthesia (Procah)",,52260,CPT,Professional,Both,,,,1025,871.25,127.83,1025,First Health Group Corporation,First Health Network,994.25,97,,percent of total billed charges,,
"Cystourethroscopy, With Dilation Of Bladder For Interstitial Cystitis; General Or Conduction (Spinal) Anesthesia (Procah)",,52260,CPT,Professional,Both,,,,1025,871.25,127.83,1025,"Health Partners, Inc.",Commercial,422.26,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Cystourethroscopy, With Dilation Of Bladder For Interstitial Cystitis; General Or Conduction (Spinal) Anesthesia (Procah)",,52260,CPT,Professional,Both,,,,1025,871.25,127.83,1025,"Health Partners, Inc.",Medicare Advantage,228.62,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Cystourethroscopy, With Dilation Of Bladder For Interstitial Cystitis; General Or Conduction (Spinal) Anesthesia (Procah)",,52260,CPT,Professional,Both,,,,1025,871.25,127.83,1025,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),198.58,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Cystourethroscopy, With Dilation Of Bladder For Interstitial Cystitis; General Or Conduction (Spinal) Anesthesia (Procah)",,52260,CPT,Professional,Both,,,,1025,871.25,127.83,1025,"Health Partners, Inc.",State of Minnesota Advantage Program,363.77699,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Cystourethroscopy, With Dilation Of Bladder For Interstitial Cystitis; General Or Conduction (Spinal) Anesthesia (Procah)",,52260,CPT,Professional,Both,,,,1025,871.25,127.83,1025,"Health Partners, Inc.",State Public Programs,127.83,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Cystourethroscopy, With Dilation Of Bladder For Interstitial Cystitis; General Or Conduction (Spinal) Anesthesia (Procah)",,52260,CPT,Professional,Both,,,,1025,871.25,127.83,1025,Humana Insurance Company,Commercial PPO,198.8,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Cystourethroscopy, With Dilation Of Bladder For Interstitial Cystitis; General Or Conduction (Spinal) Anesthesia (Procah)",,52260,CPT,Professional,Both,,,,1025,871.25,127.83,1025,Humana Insurance Company,Medicare PPO,1025,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Cystourethroscopy, With Dilation Of Bladder For Interstitial Cystitis; General Or Conduction (Spinal) Anesthesia (Procah)",,52260,CPT,Professional,Both,,,,1025,871.25,127.83,1025,Medica,Individual & Family,869.2,84.8,,percent of total billed charges,,
"Cystourethroscopy, With Dilation Of Bladder For Interstitial Cystitis; General Or Conduction (Spinal) Anesthesia (Procah)",,52260,CPT,Professional,Both,,,,1025,871.25,127.83,1025,Medica,Medica Advantage Solution,510.45,49.8,,percent of total billed charges,,
"Cystourethroscopy, With Dilation Of Bladder For Interstitial Cystitis; General Or Conduction (Spinal) Anesthesia (Procah)",,52260,CPT,Professional,Both,,,,1025,871.25,127.83,1025,Medica,Medical Assistance,147.58,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Cystourethroscopy, With Dilation Of Bladder For Interstitial Cystitis; General Or Conduction (Spinal) Anesthesia (Procah)",,52260,CPT,Professional,Both,,,,1025,871.25,127.83,1025,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,198.8,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Cystourethroscopy, With Dilation Of Bladder For Interstitial Cystitis; General Or Conduction (Spinal) Anesthesia (Procah)",,52260,CPT,Professional,Both,,,,1025,871.25,127.83,1025,"Multiplan, Inc.","Multiplan, Inc.",963.5,94,,percent of total billed charges,,
"Cystourethroscopy, With Dilation Of Bladder For Interstitial Cystitis; General Or Conduction (Spinal) Anesthesia (Procah)",,52260,CPT,Professional,Both,,,,1025,871.25,127.83,1025,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,923.525,90.1,,percent of total billed charges,,
"Cystourethroscopy, With Dilation Of Bladder For Interstitial Cystitis; General Or Conduction (Spinal) Anesthesia (Procah)",,52260,CPT,Professional,Both,,,,1025,871.25,127.83,1025,"Preferred One Administrative Services, INC.",PPO,1010.65,98.6,,percent of total billed charges,,
"Cystourethroscopy, With Dilation Of Bladder For Interstitial Cystitis; General Or Conduction (Spinal) Anesthesia (Procah)",,52260,CPT,Professional,Both,,,,1025,871.25,127.83,1025,PrimeWest Health,Minnesota Senior Health Options (MSHO),228.62,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Cystourethroscopy, With Dilation Of Bladder For Interstitial Cystitis; General Or Conduction (Spinal) Anesthesia (Procah)",,52260,CPT,Professional,Both,,,,1025,871.25,127.83,1025,PrimeWest Health,MinnesotaCare,157.9150512,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Cystourethroscopy, With Dilation Of Bladder For Interstitial Cystitis; General Or Conduction (Spinal) Anesthesia (Procah)",,52260,CPT,Professional,Both,,,,1025,871.25,127.83,1025,Sanford Health Plan,Sanford Health Plan,902,88,,percent of total billed charges,,
"Cystourethroscopy, With Dilation Of Bladder For Interstitial Cystitis; General Or Conduction (Spinal) Anesthesia (Procah)",,52260,CPT,Professional,Both,,,,1025,871.25,127.83,1025,"UCare Health, Inc.",Individual & Family Plan,323.16928,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Cystourethroscopy, With Dilation Of Bladder For Interstitial Cystitis; General Or Conduction (Spinal) Anesthesia (Procah)",,52260,CPT,Professional,Both,,,,1025,871.25,127.83,1025,"UCare Health, Inc.",Medical Assistance,162.342576,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Cystourethroscopy, With Dilation Of Bladder For Interstitial Cystitis; General Or Conduction (Spinal) Anesthesia (Procah)",,52260,CPT,Professional,Both,,,,1025,871.25,127.83,1025,"UCare Health, Inc.",Medicare Advantage,228.62,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Cystourethroscopy, With Dilation Of Bladder For Interstitial Cystitis; General Or Conduction (Spinal) Anesthesia (Procah)",,52260,CPT,Professional,Both,,,,1025,871.25,127.83,1025,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),182.896,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Cystourethroscopy, With Dilation Of Bladder For Interstitial Cystitis; General Or Conduction (Spinal) Anesthesia (Procah)",,52260,CPT,Professional,Both,,,,1025,871.25,127.83,1025,UnitedHealthcare,Individual & Family,1025,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Cystourethroscopy, With Dilation Of Bladder For Interstitial Cystitis; General Or Conduction (Spinal) Anesthesia (Procah)",,52260,CPT,Professional,Both,,,,1025,871.25,127.83,1025,UnitedHealthcare,Medicare Advantage,228.62,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Cystourethroscopy, With Dilation Of Bladder For Interstitial Cystitis; General Or Conduction (Spinal) Anesthesia (Procah)",,52260,CPT,Professional,Both,,,,1025,871.25,127.83,1025,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,147.58416,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Cystourethroscopy With Chemodenervation Of Bladder,,52287,CPT,Facility,Both,,,,612,520.2,175.3992,724,Aetna,Commercial,563.04,92,,percent of total billed charges,,
Cystourethroscopy With Chemodenervation Of Bladder,,52287,CPT,Facility,Outpatient,,,,612,520.2,175.3992,724,Aetna,Medicare Advantage,299.88,49,,percent of total billed charges,,
Cystourethroscopy With Chemodenervation Of Bladder,,52287,CPT,Facility,Inpatient,,,,612,520.2,175.3992,724,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Cystourethroscopy With Chemodenervation Of Bladder,,52287,CPT,Facility,Both,,,,612,520.2,175.3992,724,Aetna,PPO,569.16,93,,percent of total billed charges,,
Cystourethroscopy With Chemodenervation Of Bladder,,52287,CPT,Facility,Both,,,,612,520.2,175.3992,724,America's PPO,America's PPO,587.7036,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Cystourethroscopy With Chemodenervation Of Bladder,,52287,CPT,Facility,Both,,,,612,520.2,175.3992,724,BlueCross BlueShield Minnesota, Federal Employee Program,602.208,98.4,,percent of total billed charges,,
Cystourethroscopy With Chemodenervation Of Bladder,,52287,CPT,Facility,Both,,,,612,520.2,175.3992,724,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,612,100,,percent of total billed charges,,
Cystourethroscopy With Chemodenervation Of Bladder,,52287,CPT,Facility,Both,,,,612,520.2,175.3992,724,BlueCross BlueShield Minnesota,High Value Network Plan,550.8,90,,percent of total billed charges,,
Cystourethroscopy With Chemodenervation Of Bladder,,52287,CPT,Facility,Outpatient,,,,612,520.2,175.3992,724,BlueCross BlueShield Minnesota,Medicare Advantage,299.88,49,,percent of total billed charges,,
Cystourethroscopy With Chemodenervation Of Bladder,,52287,CPT,Facility,Inpatient,,,,612,520.2,175.3992,724,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Cystourethroscopy With Chemodenervation Of Bladder,,52287,CPT,Facility,Both,,,,612,520.2,175.3992,724,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,542.0484,88.57,,percent of total billed charges,,
Cystourethroscopy With Chemodenervation Of Bladder,,52287,CPT,Facility,Both,,,,612,520.2,175.3992,724,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,175.3992,28.66,,percent of total billed charges,,
Cystourethroscopy With Chemodenervation Of Bladder,,52287,CPT,Facility,Outpatient,,,,612,520.2,175.3992,724,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),299.88,49,,percent of total billed charges,,
Cystourethroscopy With Chemodenervation Of Bladder,,52287,CPT,Facility,Inpatient,,,,612,520.2,175.3992,724,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Cystourethroscopy With Chemodenervation Of Bladder,,52287,CPT,Facility,Both,,,,612,520.2,175.3992,724,CorVel,Worker's Compensation,612,100,,percent of total billed charges,,
Cystourethroscopy With Chemodenervation Of Bladder,,52287,CPT,Facility,Both,,,,612,520.2,175.3992,724,First Health Group Corporation,First Health Network,593.64,97,,percent of total billed charges,,
Cystourethroscopy With Chemodenervation Of Bladder,,52287,CPT,Facility,Both,,,,612,520.2,175.3992,724,"Health Partners, Inc.",Commercial,578.952,94.6,,percent of total billed charges,,
Cystourethroscopy With Chemodenervation Of Bladder,,52287,CPT,Facility,Outpatient,,,,612,520.2,175.3992,724,"Health Partners, Inc.",Medicare Advantage,299.88,49,,percent of total billed charges,,
Cystourethroscopy With Chemodenervation Of Bladder,,52287,CPT,Facility,Inpatient,,,,612,520.2,175.3992,724,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Cystourethroscopy With Chemodenervation Of Bladder,,52287,CPT,Facility,Both,,,,612,520.2,175.3992,724,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),367.2,60,,percent of total billed charges,,
Cystourethroscopy With Chemodenervation Of Bladder,,52287,CPT,Facility,Both,,,,612,520.2,175.3992,724,"Health Partners, Inc.",State of Minnesota Advantage Program,498.78,81.5,,percent of total billed charges,,
Cystourethroscopy With Chemodenervation Of Bladder,,52287,CPT,Facility,Both,,,,612,520.2,175.3992,724,"Health Partners, Inc.",State Public Programs,306,50,,percent of total billed charges,,
Cystourethroscopy With Chemodenervation Of Bladder,,52287,CPT,Facility,Both,,,,612,520.2,175.3992,724,Humana Insurance Company,Commercial PPO,581.4,95,,percent of total billed charges,,
Cystourethroscopy With Chemodenervation Of Bladder,,52287,CPT,Facility,Outpatient,,,,612,520.2,175.3992,724,Humana Insurance Company,Medicare PPO,299.88,49,,percent of total billed charges,,
Cystourethroscopy With Chemodenervation Of Bladder,,52287,CPT,Facility,Inpatient,,,,612,520.2,175.3992,724,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Cystourethroscopy With Chemodenervation Of Bladder,,52287,CPT,Facility,Both,,,,612,520.2,175.3992,724,Medica,Individual & Family,606.492,99.1,,percent of total billed charges,,
Cystourethroscopy With Chemodenervation Of Bladder,,52287,CPT,Facility,Outpatient,,,,612,520.2,175.3992,724,Medica,Medica Advantage Solution,304.776,49.8,,percent of total billed charges,,
Cystourethroscopy With Chemodenervation Of Bladder,,52287,CPT,Facility,Inpatient,,,,612,520.2,175.3992,724,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Cystourethroscopy With Chemodenervation Of Bladder,,52287,CPT,Facility,Outpatient,,,,612,520.2,175.3992,724,Medica,Medical Assistance,724,,,Other,Grouper,All inclusive per visit
Cystourethroscopy With Chemodenervation Of Bladder,,52287,CPT,Facility,Inpatient,,,,612,520.2,175.3992,724,Medica,Medical Assistance,,,,,Included in per diem rate,
Cystourethroscopy With Chemodenervation Of Bladder,,52287,CPT,Facility,Outpatient,,,,612,520.2,175.3992,724,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,304.776,49.8,,percent of total billed charges,,
Cystourethroscopy With Chemodenervation Of Bladder,,52287,CPT,Facility,Inpatient,,,,612,520.2,175.3992,724,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Cystourethroscopy With Chemodenervation Of Bladder,,52287,CPT,Facility,Both,,,,612,520.2,175.3992,724,"Multiplan, Inc.","Multiplan, Inc.",575.28,94,,percent of total billed charges,,
Cystourethroscopy With Chemodenervation Of Bladder,,52287,CPT,Facility,Outpatient,,,,612,520.2,175.3992,724,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,551.412,90.1,,percent of total billed charges,,
Cystourethroscopy With Chemodenervation Of Bladder,,52287,CPT,Facility,Inpatient,,,,612,520.2,175.3992,724,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Cystourethroscopy With Chemodenervation Of Bladder,,52287,CPT,Facility,Both,,,,612,520.2,175.3992,724,"Preferred One Administrative Services, INC.",PPO,603.432,98.6,,percent of total billed charges,,
Cystourethroscopy With Chemodenervation Of Bladder,,52287,CPT,Facility,Outpatient,,,,612,520.2,175.3992,724,PrimeWest Health,Minnesota Senior Health Options (MSHO),314.874,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Cystourethroscopy With Chemodenervation Of Bladder,,52287,CPT,Facility,Inpatient,,,,612,520.2,175.3992,724,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Cystourethroscopy With Chemodenervation Of Bladder,,52287,CPT,Facility,Outpatient,,,,612,520.2,175.3992,724,PrimeWest Health,MinnesotaCare,314.3232,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Cystourethroscopy With Chemodenervation Of Bladder,,52287,CPT,Facility,Inpatient,,,,612,520.2,175.3992,724,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Cystourethroscopy With Chemodenervation Of Bladder,,52287,CPT,Facility,Both,,,,612,520.2,175.3992,724,Sanford Health Plan,Sanford Health Plan,563.04,92,,percent of total billed charges,,
Cystourethroscopy With Chemodenervation Of Bladder,,52287,CPT,Facility,Outpatient,,,,612,520.2,175.3992,724,"UCare Health, Inc.",Individual & Family Plan,344.862,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Cystourethroscopy With Chemodenervation Of Bladder,,52287,CPT,Facility,Inpatient,,,,612,520.2,175.3992,724,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Cystourethroscopy With Chemodenervation Of Bladder,,52287,CPT,Facility,Outpatient,,,,612,520.2,175.3992,724,"UCare Health, Inc.",Medical Assistance,308.8764,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Cystourethroscopy With Chemodenervation Of Bladder,,52287,CPT,Facility,Inpatient,,,,612,520.2,175.3992,724,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Cystourethroscopy With Chemodenervation Of Bladder,,52287,CPT,Facility,Outpatient,,,,612,520.2,175.3992,724,"UCare Health, Inc.",Medicare Advantage,308.8764,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Cystourethroscopy With Chemodenervation Of Bladder,,52287,CPT,Facility,Inpatient,,,,612,520.2,175.3992,724,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Cystourethroscopy With Chemodenervation Of Bladder,,52287,CPT,Facility,Outpatient,,,,612,520.2,175.3992,724,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),308.8764,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Cystourethroscopy With Chemodenervation Of Bladder,,52287,CPT,Facility,Inpatient,,,,612,520.2,175.3992,724,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Cystourethroscopy With Chemodenervation Of Bladder,,52287,CPT,Facility,Both,,,,612,520.2,175.3992,724,UnitedHealthcare,Individual & Family,575.28,94,,percent of total billed charges,,
Cystourethroscopy With Chemodenervation Of Bladder,,52287,CPT,Facility,Outpatient,,,,612,520.2,175.3992,724,UnitedHealthcare,Medicare Advantage,299.88,49,,percent of total billed charges,,
Cystourethroscopy With Chemodenervation Of Bladder,,52287,CPT,Facility,Inpatient,,,,612,520.2,175.3992,724,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Cystourethroscopy With Chemodenervation Of Bladder,,52287,CPT,Facility,Outpatient,,,,612,520.2,175.3992,724,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,293.76,48,,percent of total billed charges,,100% of DHS outpatient percentage
Cystourethroscopy With Chemodenervation Of Bladder,,52287,CPT,Facility,Inpatient,,,,612,520.2,175.3992,724,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Cystourethroscopy, W/Injection(S) For Chemodenervation Of The Bladder (Pro Cah)",,52287,CPT,Professional,Both,,,,918,780.3,102.53,918,Aetna,Commercial,780.3,85,,percent of total billed charges,,
"Cystourethroscopy, W/Injection(S) For Chemodenervation Of The Bladder (Pro Cah)",,52287,CPT,Professional,Both,,,,918,780.3,102.53,918,Aetna,Medicare Advantage,163.12,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Cystourethroscopy, W/Injection(S) For Chemodenervation Of The Bladder (Pro Cah)",,52287,CPT,Professional,Both,,,,918,780.3,102.53,918,Aetna,PPO,853.74,93,,percent of total billed charges,,
"Cystourethroscopy, W/Injection(S) For Chemodenervation Of The Bladder (Pro Cah)",,52287,CPT,Professional,Both,,,,918,780.3,102.53,918,America's PPO,America's PPO,784.3392,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Cystourethroscopy, W/Injection(S) For Chemodenervation Of The Bladder (Pro Cah)",,52287,CPT,Professional,Both,,,,918,780.3,102.53,918,BlueCross BlueShield Minnesota, Federal Employee Program,341.55,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Cystourethroscopy, W/Injection(S) For Chemodenervation Of The Bladder (Pro Cah)",,52287,CPT,Professional,Both,,,,918,780.3,102.53,918,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,347.0148,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Cystourethroscopy, W/Injection(S) For Chemodenervation Of The Bladder (Pro Cah)",,52287,CPT,Professional,Both,,,,918,780.3,102.53,918,BlueCross BlueShield Minnesota,High Value Network Plan,347.0148,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Cystourethroscopy, W/Injection(S) For Chemodenervation Of The Bladder (Pro Cah)",,52287,CPT,Professional,Both,,,,918,780.3,102.53,918,BlueCross BlueShield Minnesota,Medicare Advantage,183.5285,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Cystourethroscopy, W/Injection(S) For Chemodenervation Of The Bladder (Pro Cah)",,52287,CPT,Professional,Both,,,,918,780.3,102.53,918,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,347.0148,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Cystourethroscopy, W/Injection(S) For Chemodenervation Of The Bladder (Pro Cah)",,52287,CPT,Professional,Both,,,,918,780.3,102.53,918,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,118.37416,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Cystourethroscopy, W/Injection(S) For Chemodenervation Of The Bladder (Pro Cah)",,52287,CPT,Professional,Both,,,,918,780.3,102.53,918,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),183.5285,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Cystourethroscopy, W/Injection(S) For Chemodenervation Of The Bladder (Pro Cah)",,52287,CPT,Professional,Both,,,,918,780.3,102.53,918,CorVel,Worker's Compensation,314.2454412,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Cystourethroscopy, W/Injection(S) For Chemodenervation Of The Bladder (Pro Cah)",,52287,CPT,Professional,Both,,,,918,780.3,102.53,918,First Health Group Corporation,First Health Network,890.46,97,,percent of total billed charges,,
"Cystourethroscopy, W/Injection(S) For Chemodenervation Of The Bladder (Pro Cah)",,52287,CPT,Professional,Both,,,,918,780.3,102.53,918,"Health Partners, Inc.",Commercial,339.55,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Cystourethroscopy, W/Injection(S) For Chemodenervation Of The Bladder (Pro Cah)",,52287,CPT,Professional,Both,,,,918,780.3,102.53,918,"Health Partners, Inc.",Medicare Advantage,183.5285,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Cystourethroscopy, W/Injection(S) For Chemodenervation Of The Bladder (Pro Cah)",,52287,CPT,Professional,Both,,,,918,780.3,102.53,918,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),159.61,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Cystourethroscopy, W/Injection(S) For Chemodenervation Of The Bladder (Pro Cah)",,52287,CPT,Professional,Both,,,,918,780.3,102.53,918,"Health Partners, Inc.",State of Minnesota Advantage Program,292.522325,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Cystourethroscopy, W/Injection(S) For Chemodenervation Of The Bladder (Pro Cah)",,52287,CPT,Professional,Both,,,,918,780.3,102.53,918,"Health Partners, Inc.",State Public Programs,102.53,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Cystourethroscopy, W/Injection(S) For Chemodenervation Of The Bladder (Pro Cah)",,52287,CPT,Professional,Both,,,,918,780.3,102.53,918,Humana Insurance Company,Commercial PPO,159.59,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Cystourethroscopy, W/Injection(S) For Chemodenervation Of The Bladder (Pro Cah)",,52287,CPT,Professional,Both,,,,918,780.3,102.53,918,Humana Insurance Company,Medicare PPO,918,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Cystourethroscopy, W/Injection(S) For Chemodenervation Of The Bladder (Pro Cah)",,52287,CPT,Professional,Both,,,,918,780.3,102.53,918,Medica,Individual & Family,778.464,84.8,,percent of total billed charges,,
"Cystourethroscopy, W/Injection(S) For Chemodenervation Of The Bladder (Pro Cah)",,52287,CPT,Professional,Both,,,,918,780.3,102.53,918,Medica,Medica Advantage Solution,457.164,49.8,,percent of total billed charges,,
"Cystourethroscopy, W/Injection(S) For Chemodenervation Of The Bladder (Pro Cah)",,52287,CPT,Professional,Both,,,,918,780.3,102.53,918,Medica,Medical Assistance,118.37,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Cystourethroscopy, W/Injection(S) For Chemodenervation Of The Bladder (Pro Cah)",,52287,CPT,Professional,Both,,,,918,780.3,102.53,918,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,159.59,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Cystourethroscopy, W/Injection(S) For Chemodenervation Of The Bladder (Pro Cah)",,52287,CPT,Professional,Both,,,,918,780.3,102.53,918,"Multiplan, Inc.","Multiplan, Inc.",862.92,94,,percent of total billed charges,,
"Cystourethroscopy, W/Injection(S) For Chemodenervation Of The Bladder (Pro Cah)",,52287,CPT,Professional,Both,,,,918,780.3,102.53,918,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,827.118,90.1,,percent of total billed charges,,
"Cystourethroscopy, W/Injection(S) For Chemodenervation Of The Bladder (Pro Cah)",,52287,CPT,Professional,Both,,,,918,780.3,102.53,918,"Preferred One Administrative Services, INC.",PPO,905.148,98.6,,percent of total billed charges,,
"Cystourethroscopy, W/Injection(S) For Chemodenervation Of The Bladder (Pro Cah)",,52287,CPT,Professional,Both,,,,918,780.3,102.53,918,PrimeWest Health,Minnesota Senior Health Options (MSHO),183.5285,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Cystourethroscopy, W/Injection(S) For Chemodenervation Of The Bladder (Pro Cah)",,52287,CPT,Professional,Both,,,,918,780.3,102.53,918,PrimeWest Health,MinnesotaCare,126.6603512,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Cystourethroscopy, W/Injection(S) For Chemodenervation Of The Bladder (Pro Cah)",,52287,CPT,Professional,Both,,,,918,780.3,102.53,918,Sanford Health Plan,Sanford Health Plan,807.84,88,,percent of total billed charges,,
"Cystourethroscopy, W/Injection(S) For Chemodenervation Of The Bladder (Pro Cah)",,52287,CPT,Professional,Both,,,,918,780.3,102.53,918,"UCare Health, Inc.",Individual & Family Plan,259.429504,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Cystourethroscopy, W/Injection(S) For Chemodenervation Of The Bladder (Pro Cah)",,52287,CPT,Professional,Both,,,,918,780.3,102.53,918,"UCare Health, Inc.",Medical Assistance,130.211576,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Cystourethroscopy, W/Injection(S) For Chemodenervation Of The Bladder (Pro Cah)",,52287,CPT,Professional,Both,,,,918,780.3,102.53,918,"UCare Health, Inc.",Medicare Advantage,183.5285,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Cystourethroscopy, W/Injection(S) For Chemodenervation Of The Bladder (Pro Cah)",,52287,CPT,Professional,Both,,,,918,780.3,102.53,918,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),146.8228,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Cystourethroscopy, W/Injection(S) For Chemodenervation Of The Bladder (Pro Cah)",,52287,CPT,Professional,Both,,,,918,780.3,102.53,918,UnitedHealthcare,Individual & Family,918,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Cystourethroscopy, W/Injection(S) For Chemodenervation Of The Bladder (Pro Cah)",,52287,CPT,Professional,Both,,,,918,780.3,102.53,918,UnitedHealthcare,Medicare Advantage,183.5285,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Cystourethroscopy, W/Injection(S) For Chemodenervation Of The Bladder (Pro Cah)",,52287,CPT,Professional,Both,,,,918,780.3,102.53,918,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,118.37416,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Cystourethroscopy, W/Removal Foreign Body Or Stent From Urethera/Bladder; Simple (Pro Cah)",,52310,CPT,Professional,Both,,,,1020,867,91.84,1020,Aetna,Commercial,867,85,,percent of total billed charges,,
"Cystourethroscopy, W/Removal Foreign Body Or Stent From Urethera/Bladder; Simple (Pro Cah)",,52310,CPT,Professional,Both,,,,1020,867,91.84,1020,Aetna,Medicare Advantage,145.94,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Cystourethroscopy, W/Removal Foreign Body Or Stent From Urethera/Bladder; Simple (Pro Cah)",,52310,CPT,Professional,Both,,,,1020,867,91.84,1020,Aetna,PPO,948.6,93,,percent of total billed charges,,
"Cystourethroscopy, W/Removal Foreign Body Or Stent From Urethera/Bladder; Simple (Pro Cah)",,52310,CPT,Professional,Both,,,,1020,867,91.84,1020,America's PPO,America's PPO,871.488,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Cystourethroscopy, W/Removal Foreign Body Or Stent From Urethera/Bladder; Simple (Pro Cah)",,52310,CPT,Professional,Both,,,,1020,867,91.84,1020,BlueCross BlueShield Minnesota, Federal Employee Program,305.05,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Cystourethroscopy, W/Removal Foreign Body Or Stent From Urethera/Bladder; Simple (Pro Cah)",,52310,CPT,Professional,Both,,,,1020,867,91.84,1020,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,309.9308,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Cystourethroscopy, W/Removal Foreign Body Or Stent From Urethera/Bladder; Simple (Pro Cah)",,52310,CPT,Professional,Both,,,,1020,867,91.84,1020,BlueCross BlueShield Minnesota,High Value Network Plan,309.9308,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Cystourethroscopy, W/Removal Foreign Body Or Stent From Urethera/Bladder; Simple (Pro Cah)",,52310,CPT,Professional,Both,,,,1020,867,91.84,1020,BlueCross BlueShield Minnesota,Medicare Advantage,164.381,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Cystourethroscopy, W/Removal Foreign Body Or Stent From Urethera/Bladder; Simple (Pro Cah)",,52310,CPT,Professional,Both,,,,1020,867,91.84,1020,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,309.9308,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Cystourethroscopy, W/Removal Foreign Body Or Stent From Urethera/Bladder; Simple (Pro Cah)",,52310,CPT,Professional,Both,,,,1020,867,91.84,1020,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,106.02976,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Cystourethroscopy, W/Removal Foreign Body Or Stent From Urethera/Bladder; Simple (Pro Cah)",,52310,CPT,Professional,Both,,,,1020,867,91.84,1020,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),164.381,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Cystourethroscopy, W/Removal Foreign Body Or Stent From Urethera/Bladder; Simple (Pro Cah)",,52310,CPT,Professional,Both,,,,1020,867,91.84,1020,CorVel,Worker's Compensation,281.1830238,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Cystourethroscopy, W/Removal Foreign Body Or Stent From Urethera/Bladder; Simple (Pro Cah)",,52310,CPT,Professional,Both,,,,1020,867,91.84,1020,First Health Group Corporation,First Health Network,989.4,97,,percent of total billed charges,,
"Cystourethroscopy, W/Removal Foreign Body Or Stent From Urethera/Bladder; Simple (Pro Cah)",,52310,CPT,Professional,Both,,,,1020,867,91.84,1020,"Health Partners, Inc.",Commercial,304,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Cystourethroscopy, W/Removal Foreign Body Or Stent From Urethera/Bladder; Simple (Pro Cah)",,52310,CPT,Professional,Both,,,,1020,867,91.84,1020,"Health Partners, Inc.",Medicare Advantage,164.381,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Cystourethroscopy, W/Removal Foreign Body Or Stent From Urethera/Bladder; Simple (Pro Cah)",,52310,CPT,Professional,Both,,,,1020,867,91.84,1020,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),142.67,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Cystourethroscopy, W/Removal Foreign Body Or Stent From Urethera/Bladder; Simple (Pro Cah)",,52310,CPT,Professional,Both,,,,1020,867,91.84,1020,"Health Partners, Inc.",State of Minnesota Advantage Program,261.896,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Cystourethroscopy, W/Removal Foreign Body Or Stent From Urethera/Bladder; Simple (Pro Cah)",,52310,CPT,Professional,Both,,,,1020,867,91.84,1020,"Health Partners, Inc.",State Public Programs,91.84,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Cystourethroscopy, W/Removal Foreign Body Or Stent From Urethera/Bladder; Simple (Pro Cah)",,52310,CPT,Professional,Both,,,,1020,867,91.84,1020,Humana Insurance Company,Commercial PPO,142.94,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Cystourethroscopy, W/Removal Foreign Body Or Stent From Urethera/Bladder; Simple (Pro Cah)",,52310,CPT,Professional,Both,,,,1020,867,91.84,1020,Humana Insurance Company,Medicare PPO,1020,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Cystourethroscopy, W/Removal Foreign Body Or Stent From Urethera/Bladder; Simple (Pro Cah)",,52310,CPT,Professional,Both,,,,1020,867,91.84,1020,Medica,Individual & Family,864.96,84.8,,percent of total billed charges,,
"Cystourethroscopy, W/Removal Foreign Body Or Stent From Urethera/Bladder; Simple (Pro Cah)",,52310,CPT,Professional,Both,,,,1020,867,91.84,1020,Medica,Medica Advantage Solution,507.96,49.8,,percent of total billed charges,,
"Cystourethroscopy, W/Removal Foreign Body Or Stent From Urethera/Bladder; Simple (Pro Cah)",,52310,CPT,Professional,Both,,,,1020,867,91.84,1020,Medica,Medical Assistance,106.03,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Cystourethroscopy, W/Removal Foreign Body Or Stent From Urethera/Bladder; Simple (Pro Cah)",,52310,CPT,Professional,Both,,,,1020,867,91.84,1020,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,142.94,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Cystourethroscopy, W/Removal Foreign Body Or Stent From Urethera/Bladder; Simple (Pro Cah)",,52310,CPT,Professional,Both,,,,1020,867,91.84,1020,"Multiplan, Inc.","Multiplan, Inc.",958.8,94,,percent of total billed charges,,
"Cystourethroscopy, W/Removal Foreign Body Or Stent From Urethera/Bladder; Simple (Pro Cah)",,52310,CPT,Professional,Both,,,,1020,867,91.84,1020,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,919.02,90.1,,percent of total billed charges,,
"Cystourethroscopy, W/Removal Foreign Body Or Stent From Urethera/Bladder; Simple (Pro Cah)",,52310,CPT,Professional,Both,,,,1020,867,91.84,1020,"Preferred One Administrative Services, INC.",PPO,1005.72,98.6,,percent of total billed charges,,
"Cystourethroscopy, W/Removal Foreign Body Or Stent From Urethera/Bladder; Simple (Pro Cah)",,52310,CPT,Professional,Both,,,,1020,867,91.84,1020,PrimeWest Health,Minnesota Senior Health Options (MSHO),164.381,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Cystourethroscopy, W/Removal Foreign Body Or Stent From Urethera/Bladder; Simple (Pro Cah)",,52310,CPT,Professional,Both,,,,1020,867,91.84,1020,PrimeWest Health,MinnesotaCare,113.4518432,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Cystourethroscopy, W/Removal Foreign Body Or Stent From Urethera/Bladder; Simple (Pro Cah)",,52310,CPT,Professional,Both,,,,1020,867,91.84,1020,Sanford Health Plan,Sanford Health Plan,897.6,88,,percent of total billed charges,,
"Cystourethroscopy, W/Removal Foreign Body Or Stent From Urethera/Bladder; Simple (Pro Cah)",,52310,CPT,Professional,Both,,,,1020,867,91.84,1020,"UCare Health, Inc.",Individual & Family Plan,232.363264,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Cystourethroscopy, W/Removal Foreign Body Or Stent From Urethera/Bladder; Simple (Pro Cah)",,52310,CPT,Professional,Both,,,,1020,867,91.84,1020,"UCare Health, Inc.",Medical Assistance,116.632736,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Cystourethroscopy, W/Removal Foreign Body Or Stent From Urethera/Bladder; Simple (Pro Cah)",,52310,CPT,Professional,Both,,,,1020,867,91.84,1020,"UCare Health, Inc.",Medicare Advantage,164.381,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Cystourethroscopy, W/Removal Foreign Body Or Stent From Urethera/Bladder; Simple (Pro Cah)",,52310,CPT,Professional,Both,,,,1020,867,91.84,1020,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),131.5048,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Cystourethroscopy, W/Removal Foreign Body Or Stent From Urethera/Bladder; Simple (Pro Cah)",,52310,CPT,Professional,Both,,,,1020,867,91.84,1020,UnitedHealthcare,Individual & Family,1020,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Cystourethroscopy, W/Removal Foreign Body Or Stent From Urethera/Bladder; Simple (Pro Cah)",,52310,CPT,Professional,Both,,,,1020,867,91.84,1020,UnitedHealthcare,Medicare Advantage,164.381,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Cystourethroscopy, W/Removal Foreign Body Or Stent From Urethera/Bladder; Simple (Pro Cah)",,52310,CPT,Professional,Both,,,,1020,867,91.84,1020,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,106.02976,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Litholapaxy: Crushing Or Frag Of Calculus In Bladder And Removal Of Fragements; Simple (Pro Cah),,52317,CPT,Professional,Both,,,,2387,2028.95,209.85,2387,Aetna,Commercial,2028.95,85,,percent of total billed charges,,
Litholapaxy: Crushing Or Frag Of Calculus In Bladder And Removal Of Fragements; Simple (Pro Cah),,52317,CPT,Professional,Both,,,,2387,2028.95,209.85,2387,Aetna,Medicare Advantage,334.33,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Litholapaxy: Crushing Or Frag Of Calculus In Bladder And Removal Of Fragements; Simple (Pro Cah),,52317,CPT,Professional,Both,,,,2387,2028.95,209.85,2387,Aetna,PPO,2219.91,93,,percent of total billed charges,,
Litholapaxy: Crushing Or Frag Of Calculus In Bladder And Removal Of Fragements; Simple (Pro Cah),,52317,CPT,Professional,Both,,,,2387,2028.95,209.85,2387,America's PPO,America's PPO,2039.4528,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Litholapaxy: Crushing Or Frag Of Calculus In Bladder And Removal Of Fragements; Simple (Pro Cah),,52317,CPT,Professional,Both,,,,2387,2028.95,209.85,2387,BlueCross BlueShield Minnesota, Federal Employee Program,696.17,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Litholapaxy: Crushing Or Frag Of Calculus In Bladder And Removal Of Fragements; Simple (Pro Cah),,52317,CPT,Professional,Both,,,,2387,2028.95,209.85,2387,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,707.30872,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Litholapaxy: Crushing Or Frag Of Calculus In Bladder And Removal Of Fragements; Simple (Pro Cah),,52317,CPT,Professional,Both,,,,2387,2028.95,209.85,2387,BlueCross BlueShield Minnesota,High Value Network Plan,707.30872,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Litholapaxy: Crushing Or Frag Of Calculus In Bladder And Removal Of Fragements; Simple (Pro Cah),,52317,CPT,Professional,Both,,,,2387,2028.95,209.85,2387,BlueCross BlueShield Minnesota,Medicare Advantage,375.176,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Litholapaxy: Crushing Or Frag Of Calculus In Bladder And Removal Of Fragements; Simple (Pro Cah),,52317,CPT,Professional,Both,,,,2387,2028.95,209.85,2387,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,707.30872,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Litholapaxy: Crushing Or Frag Of Calculus In Bladder And Removal Of Fragements; Simple (Pro Cah),,52317,CPT,Professional,Both,,,,2387,2028.95,209.85,2387,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,242.28552,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Litholapaxy: Crushing Or Frag Of Calculus In Bladder And Removal Of Fragements; Simple (Pro Cah),,52317,CPT,Professional,Both,,,,2387,2028.95,209.85,2387,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),375.176,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Litholapaxy: Crushing Or Frag Of Calculus In Bladder And Removal Of Fragements; Simple (Pro Cah),,52317,CPT,Professional,Both,,,,2387,2028.95,209.85,2387,CorVel,Worker's Compensation,642.9525834,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Litholapaxy: Crushing Or Frag Of Calculus In Bladder And Removal Of Fragements; Simple (Pro Cah),,52317,CPT,Professional,Both,,,,2387,2028.95,209.85,2387,First Health Group Corporation,First Health Network,2315.39,97,,percent of total billed charges,,
Litholapaxy: Crushing Or Frag Of Calculus In Bladder And Removal Of Fragements; Simple (Pro Cah),,52317,CPT,Professional,Both,,,,2387,2028.95,209.85,2387,"Health Partners, Inc.",Commercial,694.32,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Litholapaxy: Crushing Or Frag Of Calculus In Bladder And Removal Of Fragements; Simple (Pro Cah),,52317,CPT,Professional,Both,,,,2387,2028.95,209.85,2387,"Health Partners, Inc.",Medicare Advantage,375.176,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Litholapaxy: Crushing Or Frag Of Calculus In Bladder And Removal Of Fragements; Simple (Pro Cah),,52317,CPT,Professional,Both,,,,2387,2028.95,209.85,2387,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),326.33,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Litholapaxy: Crushing Or Frag Of Calculus In Bladder And Removal Of Fragements; Simple (Pro Cah),,52317,CPT,Professional,Both,,,,2387,2028.95,209.85,2387,"Health Partners, Inc.",State of Minnesota Advantage Program,598.15668,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Litholapaxy: Crushing Or Frag Of Calculus In Bladder And Removal Of Fragements; Simple (Pro Cah),,52317,CPT,Professional,Both,,,,2387,2028.95,209.85,2387,"Health Partners, Inc.",State Public Programs,209.85,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Litholapaxy: Crushing Or Frag Of Calculus In Bladder And Removal Of Fragements; Simple (Pro Cah),,52317,CPT,Professional,Both,,,,2387,2028.95,209.85,2387,Humana Insurance Company,Commercial PPO,326.24,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Litholapaxy: Crushing Or Frag Of Calculus In Bladder And Removal Of Fragements; Simple (Pro Cah),,52317,CPT,Professional,Both,,,,2387,2028.95,209.85,2387,Humana Insurance Company,Medicare PPO,2387,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Litholapaxy: Crushing Or Frag Of Calculus In Bladder And Removal Of Fragements; Simple (Pro Cah),,52317,CPT,Professional,Both,,,,2387,2028.95,209.85,2387,Medica,Individual & Family,2024.176,84.8,,percent of total billed charges,,
Litholapaxy: Crushing Or Frag Of Calculus In Bladder And Removal Of Fragements; Simple (Pro Cah),,52317,CPT,Professional,Both,,,,2387,2028.95,209.85,2387,Medica,Medica Advantage Solution,1188.726,49.8,,percent of total billed charges,,
Litholapaxy: Crushing Or Frag Of Calculus In Bladder And Removal Of Fragements; Simple (Pro Cah),,52317,CPT,Professional,Both,,,,2387,2028.95,209.85,2387,Medica,Medical Assistance,242.29,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Litholapaxy: Crushing Or Frag Of Calculus In Bladder And Removal Of Fragements; Simple (Pro Cah),,52317,CPT,Professional,Both,,,,2387,2028.95,209.85,2387,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,326.24,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Litholapaxy: Crushing Or Frag Of Calculus In Bladder And Removal Of Fragements; Simple (Pro Cah),,52317,CPT,Professional,Both,,,,2387,2028.95,209.85,2387,"Multiplan, Inc.","Multiplan, Inc.",2243.78,94,,percent of total billed charges,,
Litholapaxy: Crushing Or Frag Of Calculus In Bladder And Removal Of Fragements; Simple (Pro Cah),,52317,CPT,Professional,Both,,,,2387,2028.95,209.85,2387,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,2150.687,90.1,,percent of total billed charges,,
Litholapaxy: Crushing Or Frag Of Calculus In Bladder And Removal Of Fragements; Simple (Pro Cah),,52317,CPT,Professional,Both,,,,2387,2028.95,209.85,2387,"Preferred One Administrative Services, INC.",PPO,2353.582,98.6,,percent of total billed charges,,
Litholapaxy: Crushing Or Frag Of Calculus In Bladder And Removal Of Fragements; Simple (Pro Cah),,52317,CPT,Professional,Both,,,,2387,2028.95,209.85,2387,PrimeWest Health,Minnesota Senior Health Options (MSHO),375.176,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Litholapaxy: Crushing Or Frag Of Calculus In Bladder And Removal Of Fragements; Simple (Pro Cah),,52317,CPT,Professional,Both,,,,2387,2028.95,209.85,2387,PrimeWest Health,MinnesotaCare,259.2455064,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Litholapaxy: Crushing Or Frag Of Calculus In Bladder And Removal Of Fragements; Simple (Pro Cah),,52317,CPT,Professional,Both,,,,2387,2028.95,209.85,2387,Sanford Health Plan,Sanford Health Plan,2100.56,88,,percent of total billed charges,,
Litholapaxy: Crushing Or Frag Of Calculus In Bladder And Removal Of Fragements; Simple (Pro Cah),,52317,CPT,Professional,Both,,,,2387,2028.95,209.85,2387,"UCare Health, Inc.",Individual & Family Plan,530.335744,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Litholapaxy: Crushing Or Frag Of Calculus In Bladder And Removal Of Fragements; Simple (Pro Cah),,52317,CPT,Professional,Both,,,,2387,2028.95,209.85,2387,"UCare Health, Inc.",Medical Assistance,266.514072,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Litholapaxy: Crushing Or Frag Of Calculus In Bladder And Removal Of Fragements; Simple (Pro Cah),,52317,CPT,Professional,Both,,,,2387,2028.95,209.85,2387,"UCare Health, Inc.",Medicare Advantage,375.176,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Litholapaxy: Crushing Or Frag Of Calculus In Bladder And Removal Of Fragements; Simple (Pro Cah),,52317,CPT,Professional,Both,,,,2387,2028.95,209.85,2387,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),300.1408,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Litholapaxy: Crushing Or Frag Of Calculus In Bladder And Removal Of Fragements; Simple (Pro Cah),,52317,CPT,Professional,Both,,,,2387,2028.95,209.85,2387,UnitedHealthcare,Individual & Family,2387,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Litholapaxy: Crushing Or Frag Of Calculus In Bladder And Removal Of Fragements; Simple (Pro Cah),,52317,CPT,Professional,Both,,,,2387,2028.95,209.85,2387,UnitedHealthcare,Medicare Advantage,375.176,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Litholapaxy: Crushing Or Frag Of Calculus In Bladder And Removal Of Fragements; Simple (Pro Cah),,52317,CPT,Professional,Both,,,,2387,2028.95,209.85,2387,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,242.28552,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Transurethral Electrosurgical Resection Prostate, Incl Control Postop Bleeding, Complete (Pro Cah)",,52601,CPT,Professional,Both,,,,3060,2601,447.86,3060,Aetna,Commercial,2601,85,,percent of total billed charges,,
"Transurethral Electrosurgical Resection Prostate, Incl Control Postop Bleeding, Complete (Pro Cah)",,52601,CPT,Professional,Both,,,,3060,2601,447.86,3060,Aetna,Medicare Advantage,709.67,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Transurethral Electrosurgical Resection Prostate, Incl Control Postop Bleeding, Complete (Pro Cah)",,52601,CPT,Professional,Both,,,,3060,2601,447.86,3060,Aetna,PPO,2845.8,93,,percent of total billed charges,,
"Transurethral Electrosurgical Resection Prostate, Incl Control Postop Bleeding, Complete (Pro Cah)",,52601,CPT,Professional,Both,,,,3060,2601,447.86,3060,America's PPO,America's PPO,2614.464,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Transurethral Electrosurgical Resection Prostate, Incl Control Postop Bleeding, Complete (Pro Cah)",,52601,CPT,Professional,Both,,,,3060,2601,447.86,3060,BlueCross BlueShield Minnesota, Federal Employee Program,1477.74,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Transurethral Electrosurgical Resection Prostate, Incl Control Postop Bleeding, Complete (Pro Cah)",,52601,CPT,Professional,Both,,,,3060,2601,447.86,3060,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1501.38384,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Transurethral Electrosurgical Resection Prostate, Incl Control Postop Bleeding, Complete (Pro Cah)",,52601,CPT,Professional,Both,,,,3060,2601,447.86,3060,BlueCross BlueShield Minnesota,High Value Network Plan,1501.38384,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Transurethral Electrosurgical Resection Prostate, Incl Control Postop Bleeding, Complete (Pro Cah)",,52601,CPT,Professional,Both,,,,3060,2601,447.86,3060,BlueCross BlueShield Minnesota,Medicare Advantage,800.3195,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Transurethral Electrosurgical Resection Prostate, Incl Control Postop Bleeding, Complete (Pro Cah)",,52601,CPT,Professional,Both,,,,3060,2601,447.86,3060,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1501.38384,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Transurethral Electrosurgical Resection Prostate, Incl Control Postop Bleeding, Complete (Pro Cah)",,52601,CPT,Professional,Both,,,,3060,2601,447.86,3060,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,517.07288,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Transurethral Electrosurgical Resection Prostate, Incl Control Postop Bleeding, Complete (Pro Cah)",,52601,CPT,Professional,Both,,,,3060,2601,447.86,3060,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),800.3195,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Transurethral Electrosurgical Resection Prostate, Incl Control Postop Bleeding, Complete (Pro Cah)",,52601,CPT,Professional,Both,,,,3060,2601,447.86,3060,CorVel,Worker's Compensation,1368.433587,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Transurethral Electrosurgical Resection Prostate, Incl Control Postop Bleeding, Complete (Pro Cah)",,52601,CPT,Professional,Both,,,,3060,2601,447.86,3060,First Health Group Corporation,First Health Network,2968.2,97,,percent of total billed charges,,
"Transurethral Electrosurgical Resection Prostate, Incl Control Postop Bleeding, Complete (Pro Cah)",,52601,CPT,Professional,Both,,,,3060,2601,447.86,3060,"Health Partners, Inc.",Commercial,1478.63,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Transurethral Electrosurgical Resection Prostate, Incl Control Postop Bleeding, Complete (Pro Cah)",,52601,CPT,Professional,Both,,,,3060,2601,447.86,3060,"Health Partners, Inc.",Medicare Advantage,800.3195,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Transurethral Electrosurgical Resection Prostate, Incl Control Postop Bleeding, Complete (Pro Cah)",,52601,CPT,Professional,Both,,,,3060,2601,447.86,3060,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),696.04,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Transurethral Electrosurgical Resection Prostate, Incl Control Postop Bleeding, Complete (Pro Cah)",,52601,CPT,Professional,Both,,,,3060,2601,447.86,3060,"Health Partners, Inc.",State of Minnesota Advantage Program,1273.839745,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Transurethral Electrosurgical Resection Prostate, Incl Control Postop Bleeding, Complete (Pro Cah)",,52601,CPT,Professional,Both,,,,3060,2601,447.86,3060,"Health Partners, Inc.",State Public Programs,447.86,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Transurethral Electrosurgical Resection Prostate, Incl Control Postop Bleeding, Complete (Pro Cah)",,52601,CPT,Professional,Both,,,,3060,2601,447.86,3060,Humana Insurance Company,Commercial PPO,695.93,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Transurethral Electrosurgical Resection Prostate, Incl Control Postop Bleeding, Complete (Pro Cah)",,52601,CPT,Professional,Both,,,,3060,2601,447.86,3060,Humana Insurance Company,Medicare PPO,3060,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Transurethral Electrosurgical Resection Prostate, Incl Control Postop Bleeding, Complete (Pro Cah)",,52601,CPT,Professional,Both,,,,3060,2601,447.86,3060,Medica,Individual & Family,2594.88,84.8,,percent of total billed charges,,
"Transurethral Electrosurgical Resection Prostate, Incl Control Postop Bleeding, Complete (Pro Cah)",,52601,CPT,Professional,Both,,,,3060,2601,447.86,3060,Medica,Medica Advantage Solution,1523.88,49.8,,percent of total billed charges,,
"Transurethral Electrosurgical Resection Prostate, Incl Control Postop Bleeding, Complete (Pro Cah)",,52601,CPT,Professional,Both,,,,3060,2601,447.86,3060,Medica,Medical Assistance,517.07,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Transurethral Electrosurgical Resection Prostate, Incl Control Postop Bleeding, Complete (Pro Cah)",,52601,CPT,Professional,Both,,,,3060,2601,447.86,3060,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,695.93,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Transurethral Electrosurgical Resection Prostate, Incl Control Postop Bleeding, Complete (Pro Cah)",,52601,CPT,Professional,Both,,,,3060,2601,447.86,3060,"Multiplan, Inc.","Multiplan, Inc.",2876.4,94,,percent of total billed charges,,
"Transurethral Electrosurgical Resection Prostate, Incl Control Postop Bleeding, Complete (Pro Cah)",,52601,CPT,Professional,Both,,,,3060,2601,447.86,3060,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,2757.06,90.1,,percent of total billed charges,,
"Transurethral Electrosurgical Resection Prostate, Incl Control Postop Bleeding, Complete (Pro Cah)",,52601,CPT,Professional,Both,,,,3060,2601,447.86,3060,"Preferred One Administrative Services, INC.",PPO,3017.16,98.6,,percent of total billed charges,,
"Transurethral Electrosurgical Resection Prostate, Incl Control Postop Bleeding, Complete (Pro Cah)",,52601,CPT,Professional,Both,,,,3060,2601,447.86,3060,PrimeWest Health,Minnesota Senior Health Options (MSHO),800.3195,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Transurethral Electrosurgical Resection Prostate, Incl Control Postop Bleeding, Complete (Pro Cah)",,52601,CPT,Professional,Both,,,,3060,2601,447.86,3060,PrimeWest Health,MinnesotaCare,553.2679816,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Transurethral Electrosurgical Resection Prostate, Incl Control Postop Bleeding, Complete (Pro Cah)",,52601,CPT,Professional,Both,,,,3060,2601,447.86,3060,Sanford Health Plan,Sanford Health Plan,2692.8,88,,percent of total billed charges,,
"Transurethral Electrosurgical Resection Prostate, Incl Control Postop Bleeding, Complete (Pro Cah)",,52601,CPT,Professional,Both,,,,3060,2601,447.86,3060,"UCare Health, Inc.",Individual & Family Plan,1131.303808,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Transurethral Electrosurgical Resection Prostate, Incl Control Postop Bleeding, Complete (Pro Cah)",,52601,CPT,Professional,Both,,,,3060,2601,447.86,3060,"UCare Health, Inc.",Medical Assistance,568.780168,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Transurethral Electrosurgical Resection Prostate, Incl Control Postop Bleeding, Complete (Pro Cah)",,52601,CPT,Professional,Both,,,,3060,2601,447.86,3060,"UCare Health, Inc.",Medicare Advantage,800.3195,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Transurethral Electrosurgical Resection Prostate, Incl Control Postop Bleeding, Complete (Pro Cah)",,52601,CPT,Professional,Both,,,,3060,2601,447.86,3060,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),640.2556,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Transurethral Electrosurgical Resection Prostate, Incl Control Postop Bleeding, Complete (Pro Cah)",,52601,CPT,Professional,Both,,,,3060,2601,447.86,3060,UnitedHealthcare,Individual & Family,3060,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Transurethral Electrosurgical Resection Prostate, Incl Control Postop Bleeding, Complete (Pro Cah)",,52601,CPT,Professional,Both,,,,3060,2601,447.86,3060,UnitedHealthcare,Medicare Advantage,800.3195,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Transurethral Electrosurgical Resection Prostate, Incl Control Postop Bleeding, Complete (Pro Cah)",,52601,CPT,Professional,Both,,,,3060,2601,447.86,3060,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,517.07288,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Circumcision, Using Clamp Or Other Device With Regional Dorsal Penile Or Ring Block (Pro Cah)",,54150,CPT,Professional,Both,,,,667,566.95,58.68,667,Aetna,Commercial,566.95,85,,percent of total billed charges,,
"Circumcision, Using Clamp Or Other Device With Regional Dorsal Penile Or Ring Block (Pro Cah)",,54150,CPT,Professional,Both,,,,667,566.95,58.68,667,Aetna,Medicare Advantage,93.77,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Circumcision, Using Clamp Or Other Device With Regional Dorsal Penile Or Ring Block (Pro Cah)",,54150,CPT,Professional,Both,,,,667,566.95,58.68,667,Aetna,PPO,620.31,93,,percent of total billed charges,,
"Circumcision, Using Clamp Or Other Device With Regional Dorsal Penile Or Ring Block (Pro Cah)",,54150,CPT,Professional,Both,,,,667,566.95,58.68,667,America's PPO,America's PPO,569.8848,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Circumcision, Using Clamp Or Other Device With Regional Dorsal Penile Or Ring Block (Pro Cah)",,54150,CPT,Professional,Both,,,,667,566.95,58.68,667,BlueCross BlueShield Minnesota, Federal Employee Program,196.25,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Circumcision, Using Clamp Or Other Device With Regional Dorsal Penile Or Ring Block (Pro Cah)",,54150,CPT,Professional,Both,,,,667,566.95,58.68,667,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,199.39,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Circumcision, Using Clamp Or Other Device With Regional Dorsal Penile Or Ring Block (Pro Cah)",,54150,CPT,Professional,Both,,,,667,566.95,58.68,667,BlueCross BlueShield Minnesota,High Value Network Plan,199.39,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Circumcision, Using Clamp Or Other Device With Regional Dorsal Penile Or Ring Block (Pro Cah)",,54150,CPT,Professional,Both,,,,667,566.95,58.68,667,BlueCross BlueShield Minnesota,Medicare Advantage,105.018,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Circumcision, Using Clamp Or Other Device With Regional Dorsal Penile Or Ring Block (Pro Cah)",,54150,CPT,Professional,Both,,,,667,566.95,58.68,667,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,199.39,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Circumcision, Using Clamp Or Other Device With Regional Dorsal Penile Or Ring Block (Pro Cah)",,54150,CPT,Professional,Both,,,,667,566.95,58.68,667,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,67.74688,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Circumcision, Using Clamp Or Other Device With Regional Dorsal Penile Or Ring Block (Pro Cah)",,54150,CPT,Professional,Both,,,,667,566.95,58.68,667,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),105.018,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Circumcision, Using Clamp Or Other Device With Regional Dorsal Penile Or Ring Block (Pro Cah)",,54150,CPT,Professional,Both,,,,667,566.95,58.68,667,CorVel,Worker's Compensation,180.5005674,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Circumcision, Using Clamp Or Other Device With Regional Dorsal Penile Or Ring Block (Pro Cah)",,54150,CPT,Professional,Both,,,,667,566.95,58.68,667,First Health Group Corporation,First Health Network,646.99,97,,percent of total billed charges,,
"Circumcision, Using Clamp Or Other Device With Regional Dorsal Penile Or Ring Block (Pro Cah)",,54150,CPT,Professional,Both,,,,667,566.95,58.68,667,"Health Partners, Inc.",Commercial,195.16,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Circumcision, Using Clamp Or Other Device With Regional Dorsal Penile Or Ring Block (Pro Cah)",,54150,CPT,Professional,Both,,,,667,566.95,58.68,667,"Health Partners, Inc.",Medicare Advantage,105.018,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Circumcision, Using Clamp Or Other Device With Regional Dorsal Penile Or Ring Block (Pro Cah)",,54150,CPT,Professional,Both,,,,667,566.95,58.68,667,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),91.16,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Circumcision, Using Clamp Or Other Device With Regional Dorsal Penile Or Ring Block (Pro Cah)",,54150,CPT,Professional,Both,,,,667,566.95,58.68,667,"Health Partners, Inc.",State of Minnesota Advantage Program,168.13034,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Circumcision, Using Clamp Or Other Device With Regional Dorsal Penile Or Ring Block (Pro Cah)",,54150,CPT,Professional,Both,,,,667,566.95,58.68,667,"Health Partners, Inc.",State Public Programs,58.68,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Circumcision, Using Clamp Or Other Device With Regional Dorsal Penile Or Ring Block (Pro Cah)",,54150,CPT,Professional,Both,,,,667,566.95,58.68,667,Humana Insurance Company,Commercial PPO,91.32,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Circumcision, Using Clamp Or Other Device With Regional Dorsal Penile Or Ring Block (Pro Cah)",,54150,CPT,Professional,Both,,,,667,566.95,58.68,667,Humana Insurance Company,Medicare PPO,667,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Circumcision, Using Clamp Or Other Device With Regional Dorsal Penile Or Ring Block (Pro Cah)",,54150,CPT,Professional,Both,,,,667,566.95,58.68,667,Medica,Individual & Family,565.616,84.8,,percent of total billed charges,,
"Circumcision, Using Clamp Or Other Device With Regional Dorsal Penile Or Ring Block (Pro Cah)",,54150,CPT,Professional,Both,,,,667,566.95,58.68,667,Medica,Medica Advantage Solution,332.166,49.8,,percent of total billed charges,,
"Circumcision, Using Clamp Or Other Device With Regional Dorsal Penile Or Ring Block (Pro Cah)",,54150,CPT,Professional,Both,,,,667,566.95,58.68,667,Medica,Medical Assistance,67.75,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Circumcision, Using Clamp Or Other Device With Regional Dorsal Penile Or Ring Block (Pro Cah)",,54150,CPT,Professional,Both,,,,667,566.95,58.68,667,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,91.32,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Circumcision, Using Clamp Or Other Device With Regional Dorsal Penile Or Ring Block (Pro Cah)",,54150,CPT,Professional,Both,,,,667,566.95,58.68,667,"Multiplan, Inc.","Multiplan, Inc.",626.98,94,,percent of total billed charges,,
"Circumcision, Using Clamp Or Other Device With Regional Dorsal Penile Or Ring Block (Pro Cah)",,54150,CPT,Professional,Both,,,,667,566.95,58.68,667,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,600.967,90.1,,percent of total billed charges,,
"Circumcision, Using Clamp Or Other Device With Regional Dorsal Penile Or Ring Block (Pro Cah)",,54150,CPT,Professional,Both,,,,667,566.95,58.68,667,"Preferred One Administrative Services, INC.",PPO,657.662,98.6,,percent of total billed charges,,
"Circumcision, Using Clamp Or Other Device With Regional Dorsal Penile Or Ring Block (Pro Cah)",,54150,CPT,Professional,Both,,,,667,566.95,58.68,667,PrimeWest Health,Minnesota Senior Health Options (MSHO),105.018,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Circumcision, Using Clamp Or Other Device With Regional Dorsal Penile Or Ring Block (Pro Cah)",,54150,CPT,Professional,Both,,,,667,566.95,58.68,667,PrimeWest Health,MinnesotaCare,72.4891616,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Circumcision, Using Clamp Or Other Device With Regional Dorsal Penile Or Ring Block (Pro Cah)",,54150,CPT,Professional,Both,,,,667,566.95,58.68,667,Sanford Health Plan,Sanford Health Plan,586.96,88,,percent of total billed charges,,
"Circumcision, Using Clamp Or Other Device With Regional Dorsal Penile Or Ring Block (Pro Cah)",,54150,CPT,Professional,Both,,,,667,566.95,58.68,667,"UCare Health, Inc.",Individual & Family Plan,148.449792,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Circumcision, Using Clamp Or Other Device With Regional Dorsal Penile Or Ring Block (Pro Cah)",,54150,CPT,Professional,Both,,,,667,566.95,58.68,667,"UCare Health, Inc.",Medical Assistance,74.521568,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Circumcision, Using Clamp Or Other Device With Regional Dorsal Penile Or Ring Block (Pro Cah)",,54150,CPT,Professional,Both,,,,667,566.95,58.68,667,"UCare Health, Inc.",Medicare Advantage,105.018,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Circumcision, Using Clamp Or Other Device With Regional Dorsal Penile Or Ring Block (Pro Cah)",,54150,CPT,Professional,Both,,,,667,566.95,58.68,667,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),84.0144,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Circumcision, Using Clamp Or Other Device With Regional Dorsal Penile Or Ring Block (Pro Cah)",,54150,CPT,Professional,Both,,,,667,566.95,58.68,667,UnitedHealthcare,Individual & Family,667,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Circumcision, Using Clamp Or Other Device With Regional Dorsal Penile Or Ring Block (Pro Cah)",,54150,CPT,Professional,Both,,,,667,566.95,58.68,667,UnitedHealthcare,Medicare Advantage,105.018,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Circumcision, Using Clamp Or Other Device With Regional Dorsal Penile Or Ring Block (Pro Cah)",,54150,CPT,Professional,Both,,,,667,566.95,58.68,667,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,67.74688,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Injection Procedure For Peyronie Disease (Procah),,54200,CPT,Professional,Both,,,,510,433.5,54.53,510,Aetna,Commercial,433.5,85,,percent of total billed charges,,
Injection Procedure For Peyronie Disease (Procah),,54200,CPT,Professional,Both,,,,510,433.5,54.53,510,Aetna,Medicare Advantage,84.52,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Injection Procedure For Peyronie Disease (Procah),,54200,CPT,Professional,Both,,,,510,433.5,54.53,510,Aetna,PPO,474.3,93,,percent of total billed charges,,
Injection Procedure For Peyronie Disease (Procah),,54200,CPT,Professional,Both,,,,510,433.5,54.53,510,America's PPO,America's PPO,435.744,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Injection Procedure For Peyronie Disease (Procah),,54200,CPT,Professional,Both,,,,510,433.5,54.53,510,BlueCross BlueShield Minnesota, Federal Employee Program,176.97,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Injection Procedure For Peyronie Disease (Procah),,54200,CPT,Professional,Both,,,,510,433.5,54.53,510,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,179.80152,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Injection Procedure For Peyronie Disease (Procah),,54200,CPT,Professional,Both,,,,510,433.5,54.53,510,BlueCross BlueShield Minnesota,High Value Network Plan,179.80152,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Injection Procedure For Peyronie Disease (Procah),,54200,CPT,Professional,Both,,,,510,433.5,54.53,510,BlueCross BlueShield Minnesota,Medicare Advantage,97.451,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Injection Procedure For Peyronie Disease (Procah),,54200,CPT,Professional,Both,,,,510,433.5,54.53,510,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,179.80152,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Injection Procedure For Peyronie Disease (Procah),,54200,CPT,Professional,Both,,,,510,433.5,54.53,510,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,62.96152,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Injection Procedure For Peyronie Disease (Procah),,54200,CPT,Professional,Both,,,,510,433.5,54.53,510,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),97.451,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Injection Procedure For Peyronie Disease (Procah),,54200,CPT,Professional,Both,,,,510,433.5,54.53,510,CorVel,Worker's Compensation,164.49933,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Injection Procedure For Peyronie Disease (Procah),,54200,CPT,Professional,Both,,,,510,433.5,54.53,510,First Health Group Corporation,First Health Network,494.7,97,,percent of total billed charges,,
Injection Procedure For Peyronie Disease (Procah),,54200,CPT,Professional,Both,,,,510,433.5,54.53,510,"Health Partners, Inc.",Commercial,177.75,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Injection Procedure For Peyronie Disease (Procah),,54200,CPT,Professional,Both,,,,510,433.5,54.53,510,"Health Partners, Inc.",Medicare Advantage,97.451,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Injection Procedure For Peyronie Disease (Procah),,54200,CPT,Professional,Both,,,,510,433.5,54.53,510,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),54.53,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Injection Procedure For Peyronie Disease (Procah),,54200,CPT,Professional,Both,,,,510,433.5,54.53,510,"Health Partners, Inc.",State of Minnesota Advantage Program,153.131625,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Injection Procedure For Peyronie Disease (Procah),,54200,CPT,Professional,Both,,,,510,433.5,54.53,510,"Health Partners, Inc.",State Public Programs,54.53,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Injection Procedure For Peyronie Disease (Procah),,54200,CPT,Professional,Both,,,,510,433.5,54.53,510,Humana Insurance Company,Commercial PPO,84.74,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Injection Procedure For Peyronie Disease (Procah),,54200,CPT,Professional,Both,,,,510,433.5,54.53,510,Humana Insurance Company,Medicare PPO,510,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Injection Procedure For Peyronie Disease (Procah),,54200,CPT,Professional,Both,,,,510,433.5,54.53,510,Medica,Individual & Family,432.48,84.8,,percent of total billed charges,,
Injection Procedure For Peyronie Disease (Procah),,54200,CPT,Professional,Both,,,,510,433.5,54.53,510,Medica,Medica Advantage Solution,253.98,49.8,,percent of total billed charges,,
Injection Procedure For Peyronie Disease (Procah),,54200,CPT,Professional,Both,,,,510,433.5,54.53,510,Medica,Medical Assistance,62.96,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Injection Procedure For Peyronie Disease (Procah),,54200,CPT,Professional,Both,,,,510,433.5,54.53,510,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,84.74,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Injection Procedure For Peyronie Disease (Procah),,54200,CPT,Professional,Both,,,,510,433.5,54.53,510,"Multiplan, Inc.","Multiplan, Inc.",479.4,94,,percent of total billed charges,,
Injection Procedure For Peyronie Disease (Procah),,54200,CPT,Professional,Both,,,,510,433.5,54.53,510,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,459.51,90.1,,percent of total billed charges,,
Injection Procedure For Peyronie Disease (Procah),,54200,CPT,Professional,Both,,,,510,433.5,54.53,510,"Preferred One Administrative Services, INC.",PPO,502.86,98.6,,percent of total billed charges,,
Injection Procedure For Peyronie Disease (Procah),,54200,CPT,Professional,Both,,,,510,433.5,54.53,510,PrimeWest Health,Minnesota Senior Health Options (MSHO),97.451,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Injection Procedure For Peyronie Disease (Procah),,54200,CPT,Professional,Both,,,,510,433.5,54.53,510,PrimeWest Health,MinnesotaCare,67.3688264,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Injection Procedure For Peyronie Disease (Procah),,54200,CPT,Professional,Both,,,,510,433.5,54.53,510,Sanford Health Plan,Sanford Health Plan,448.8,88,,percent of total billed charges,,
Injection Procedure For Peyronie Disease (Procah),,54200,CPT,Professional,Both,,,,510,433.5,54.53,510,"UCare Health, Inc.",Individual & Family Plan,137.753344,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Injection Procedure For Peyronie Disease (Procah),,54200,CPT,Professional,Both,,,,510,433.5,54.53,510,"UCare Health, Inc.",Medical Assistance,69.257672,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Injection Procedure For Peyronie Disease (Procah),,54200,CPT,Professional,Both,,,,510,433.5,54.53,510,"UCare Health, Inc.",Medicare Advantage,97.451,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Injection Procedure For Peyronie Disease (Procah),,54200,CPT,Professional,Both,,,,510,433.5,54.53,510,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),77.9608,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Injection Procedure For Peyronie Disease (Procah),,54200,CPT,Professional,Both,,,,510,433.5,54.53,510,UnitedHealthcare,Individual & Family,510,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Injection Procedure For Peyronie Disease (Procah),,54200,CPT,Professional,Both,,,,510,433.5,54.53,510,UnitedHealthcare,Medicare Advantage,97.451,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Injection Procedure For Peyronie Disease (Procah),,54200,CPT,Professional,Both,,,,510,433.5,54.53,510,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,62.96152,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Injection Procedure For Peyronie Disease; With Surgical Exposure Of Plaque,,54205,CPT,Facility,Both,,,,2550,2167.5,730.83,2550,Aetna,Commercial,2346,92,,percent of total billed charges,,
Injection Procedure For Peyronie Disease; With Surgical Exposure Of Plaque,,54205,CPT,Facility,Outpatient,,,,2550,2167.5,730.83,2550,Aetna,Medicare Advantage,1249.5,49,,percent of total billed charges,,
Injection Procedure For Peyronie Disease; With Surgical Exposure Of Plaque,,54205,CPT,Facility,Inpatient,,,,2550,2167.5,730.83,2550,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Injection Procedure For Peyronie Disease; With Surgical Exposure Of Plaque,,54205,CPT,Facility,Both,,,,2550,2167.5,730.83,2550,Aetna,PPO,2371.5,93,,percent of total billed charges,,
Injection Procedure For Peyronie Disease; With Surgical Exposure Of Plaque,,54205,CPT,Facility,Both,,,,2550,2167.5,730.83,2550,America's PPO,America's PPO,2448.765,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Injection Procedure For Peyronie Disease; With Surgical Exposure Of Plaque,,54205,CPT,Facility,Both,,,,2550,2167.5,730.83,2550,BlueCross BlueShield Minnesota, Federal Employee Program,2509.2,98.4,,percent of total billed charges,,
Injection Procedure For Peyronie Disease; With Surgical Exposure Of Plaque,,54205,CPT,Facility,Both,,,,2550,2167.5,730.83,2550,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,2550,100,,percent of total billed charges,,
Injection Procedure For Peyronie Disease; With Surgical Exposure Of Plaque,,54205,CPT,Facility,Both,,,,2550,2167.5,730.83,2550,BlueCross BlueShield Minnesota,High Value Network Plan,2295,90,,percent of total billed charges,,
Injection Procedure For Peyronie Disease; With Surgical Exposure Of Plaque,,54205,CPT,Facility,Outpatient,,,,2550,2167.5,730.83,2550,BlueCross BlueShield Minnesota,Medicare Advantage,1249.5,49,,percent of total billed charges,,
Injection Procedure For Peyronie Disease; With Surgical Exposure Of Plaque,,54205,CPT,Facility,Inpatient,,,,2550,2167.5,730.83,2550,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Injection Procedure For Peyronie Disease; With Surgical Exposure Of Plaque,,54205,CPT,Facility,Both,,,,2550,2167.5,730.83,2550,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,2258.535,88.57,,percent of total billed charges,,
Injection Procedure For Peyronie Disease; With Surgical Exposure Of Plaque,,54205,CPT,Facility,Both,,,,2550,2167.5,730.83,2550,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,730.83,28.66,,percent of total billed charges,,
Injection Procedure For Peyronie Disease; With Surgical Exposure Of Plaque,,54205,CPT,Facility,Outpatient,,,,2550,2167.5,730.83,2550,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1249.5,49,,percent of total billed charges,,
Injection Procedure For Peyronie Disease; With Surgical Exposure Of Plaque,,54205,CPT,Facility,Inpatient,,,,2550,2167.5,730.83,2550,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Injection Procedure For Peyronie Disease; With Surgical Exposure Of Plaque,,54205,CPT,Facility,Both,,,,2550,2167.5,730.83,2550,CorVel,Worker's Compensation,2550,100,,percent of total billed charges,,
Injection Procedure For Peyronie Disease; With Surgical Exposure Of Plaque,,54205,CPT,Facility,Both,,,,2550,2167.5,730.83,2550,First Health Group Corporation,First Health Network,2473.5,97,,percent of total billed charges,,
Injection Procedure For Peyronie Disease; With Surgical Exposure Of Plaque,,54205,CPT,Facility,Both,,,,2550,2167.5,730.83,2550,"Health Partners, Inc.",Commercial,2412.3,94.6,,percent of total billed charges,,
Injection Procedure For Peyronie Disease; With Surgical Exposure Of Plaque,,54205,CPT,Facility,Outpatient,,,,2550,2167.5,730.83,2550,"Health Partners, Inc.",Medicare Advantage,1249.5,49,,percent of total billed charges,,
Injection Procedure For Peyronie Disease; With Surgical Exposure Of Plaque,,54205,CPT,Facility,Inpatient,,,,2550,2167.5,730.83,2550,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Injection Procedure For Peyronie Disease; With Surgical Exposure Of Plaque,,54205,CPT,Facility,Both,,,,2550,2167.5,730.83,2550,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1530,60,,percent of total billed charges,,
Injection Procedure For Peyronie Disease; With Surgical Exposure Of Plaque,,54205,CPT,Facility,Both,,,,2550,2167.5,730.83,2550,"Health Partners, Inc.",State of Minnesota Advantage Program,2078.25,81.5,,percent of total billed charges,,
Injection Procedure For Peyronie Disease; With Surgical Exposure Of Plaque,,54205,CPT,Facility,Both,,,,2550,2167.5,730.83,2550,"Health Partners, Inc.",State Public Programs,1275,50,,percent of total billed charges,,
Injection Procedure For Peyronie Disease; With Surgical Exposure Of Plaque,,54205,CPT,Facility,Both,,,,2550,2167.5,730.83,2550,Humana Insurance Company,Commercial PPO,2422.5,95,,percent of total billed charges,,
Injection Procedure For Peyronie Disease; With Surgical Exposure Of Plaque,,54205,CPT,Facility,Outpatient,,,,2550,2167.5,730.83,2550,Humana Insurance Company,Medicare PPO,1249.5,49,,percent of total billed charges,,
Injection Procedure For Peyronie Disease; With Surgical Exposure Of Plaque,,54205,CPT,Facility,Inpatient,,,,2550,2167.5,730.83,2550,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Injection Procedure For Peyronie Disease; With Surgical Exposure Of Plaque,,54205,CPT,Facility,Both,,,,2550,2167.5,730.83,2550,Medica,Individual & Family,2527.05,99.1,,percent of total billed charges,,
Injection Procedure For Peyronie Disease; With Surgical Exposure Of Plaque,,54205,CPT,Facility,Outpatient,,,,2550,2167.5,730.83,2550,Medica,Medica Advantage Solution,1269.9,49.8,,percent of total billed charges,,
Injection Procedure For Peyronie Disease; With Surgical Exposure Of Plaque,,54205,CPT,Facility,Inpatient,,,,2550,2167.5,730.83,2550,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Injection Procedure For Peyronie Disease; With Surgical Exposure Of Plaque,,54205,CPT,Facility,Outpatient,,,,2550,2167.5,730.83,2550,Medica,Medical Assistance,1497,,,Other,Grouper,All inclusive per visit
Injection Procedure For Peyronie Disease; With Surgical Exposure Of Plaque,,54205,CPT,Facility,Inpatient,,,,2550,2167.5,730.83,2550,Medica,Medical Assistance,,,,,Included in per diem rate,
Injection Procedure For Peyronie Disease; With Surgical Exposure Of Plaque,,54205,CPT,Facility,Outpatient,,,,2550,2167.5,730.83,2550,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1269.9,49.8,,percent of total billed charges,,
Injection Procedure For Peyronie Disease; With Surgical Exposure Of Plaque,,54205,CPT,Facility,Inpatient,,,,2550,2167.5,730.83,2550,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Injection Procedure For Peyronie Disease; With Surgical Exposure Of Plaque,,54205,CPT,Facility,Both,,,,2550,2167.5,730.83,2550,"Multiplan, Inc.","Multiplan, Inc.",2397,94,,percent of total billed charges,,
Injection Procedure For Peyronie Disease; With Surgical Exposure Of Plaque,,54205,CPT,Facility,Outpatient,,,,2550,2167.5,730.83,2550,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,2297.55,90.1,,percent of total billed charges,,
Injection Procedure For Peyronie Disease; With Surgical Exposure Of Plaque,,54205,CPT,Facility,Inpatient,,,,2550,2167.5,730.83,2550,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Injection Procedure For Peyronie Disease; With Surgical Exposure Of Plaque,,54205,CPT,Facility,Both,,,,2550,2167.5,730.83,2550,"Preferred One Administrative Services, INC.",PPO,2514.3,98.6,,percent of total billed charges,,
Injection Procedure For Peyronie Disease; With Surgical Exposure Of Plaque,,54205,CPT,Facility,Outpatient,,,,2550,2167.5,730.83,2550,PrimeWest Health,Minnesota Senior Health Options (MSHO),1311.975,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Injection Procedure For Peyronie Disease; With Surgical Exposure Of Plaque,,54205,CPT,Facility,Inpatient,,,,2550,2167.5,730.83,2550,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Injection Procedure For Peyronie Disease; With Surgical Exposure Of Plaque,,54205,CPT,Facility,Outpatient,,,,2550,2167.5,730.83,2550,PrimeWest Health,MinnesotaCare,1309.68,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Injection Procedure For Peyronie Disease; With Surgical Exposure Of Plaque,,54205,CPT,Facility,Inpatient,,,,2550,2167.5,730.83,2550,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Injection Procedure For Peyronie Disease; With Surgical Exposure Of Plaque,,54205,CPT,Facility,Both,,,,2550,2167.5,730.83,2550,Sanford Health Plan,Sanford Health Plan,2346,92,,percent of total billed charges,,
Injection Procedure For Peyronie Disease; With Surgical Exposure Of Plaque,,54205,CPT,Facility,Outpatient,,,,2550,2167.5,730.83,2550,"UCare Health, Inc.",Individual & Family Plan,1436.925,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Injection Procedure For Peyronie Disease; With Surgical Exposure Of Plaque,,54205,CPT,Facility,Inpatient,,,,2550,2167.5,730.83,2550,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Injection Procedure For Peyronie Disease; With Surgical Exposure Of Plaque,,54205,CPT,Facility,Outpatient,,,,2550,2167.5,730.83,2550,"UCare Health, Inc.",Medical Assistance,1286.985,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Injection Procedure For Peyronie Disease; With Surgical Exposure Of Plaque,,54205,CPT,Facility,Inpatient,,,,2550,2167.5,730.83,2550,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Injection Procedure For Peyronie Disease; With Surgical Exposure Of Plaque,,54205,CPT,Facility,Outpatient,,,,2550,2167.5,730.83,2550,"UCare Health, Inc.",Medicare Advantage,1286.985,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Injection Procedure For Peyronie Disease; With Surgical Exposure Of Plaque,,54205,CPT,Facility,Inpatient,,,,2550,2167.5,730.83,2550,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Injection Procedure For Peyronie Disease; With Surgical Exposure Of Plaque,,54205,CPT,Facility,Outpatient,,,,2550,2167.5,730.83,2550,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1286.985,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Injection Procedure For Peyronie Disease; With Surgical Exposure Of Plaque,,54205,CPT,Facility,Inpatient,,,,2550,2167.5,730.83,2550,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Injection Procedure For Peyronie Disease; With Surgical Exposure Of Plaque,,54205,CPT,Facility,Both,,,,2550,2167.5,730.83,2550,UnitedHealthcare,Individual & Family,2397,94,,percent of total billed charges,,
Injection Procedure For Peyronie Disease; With Surgical Exposure Of Plaque,,54205,CPT,Facility,Outpatient,,,,2550,2167.5,730.83,2550,UnitedHealthcare,Medicare Advantage,1249.5,49,,percent of total billed charges,,
Injection Procedure For Peyronie Disease; With Surgical Exposure Of Plaque,,54205,CPT,Facility,Inpatient,,,,2550,2167.5,730.83,2550,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Injection Procedure For Peyronie Disease; With Surgical Exposure Of Plaque,,54205,CPT,Facility,Outpatient,,,,2550,2167.5,730.83,2550,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1224,48,,percent of total billed charges,,100% of DHS outpatient percentage
Injection Procedure For Peyronie Disease; With Surgical Exposure Of Plaque,,54205,CPT,Facility,Inpatient,,,,2550,2167.5,730.83,2550,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Injection Of Corpora Cavernosa With Pharmacologic Agent(S) (Procah),,54235,CPT,Professional,Both,,,,459,390.15,45.59,459,Aetna,Commercial,390.15,85,,percent of total billed charges,,
Injection Of Corpora Cavernosa With Pharmacologic Agent(S) (Procah),,54235,CPT,Professional,Both,,,,459,390.15,45.59,459,Aetna,Medicare Advantage,71.17,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Injection Of Corpora Cavernosa With Pharmacologic Agent(S) (Procah),,54235,CPT,Professional,Both,,,,459,390.15,45.59,459,Aetna,PPO,426.87,93,,percent of total billed charges,,
Injection Of Corpora Cavernosa With Pharmacologic Agent(S) (Procah),,54235,CPT,Professional,Both,,,,459,390.15,45.59,459,America's PPO,America's PPO,392.1696,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Injection Of Corpora Cavernosa With Pharmacologic Agent(S) (Procah),,54235,CPT,Professional,Both,,,,459,390.15,45.59,459,BlueCross BlueShield Minnesota, Federal Employee Program,150.8,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Injection Of Corpora Cavernosa With Pharmacologic Agent(S) (Procah),,54235,CPT,Professional,Both,,,,459,390.15,45.59,459,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,153.2128,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Injection Of Corpora Cavernosa With Pharmacologic Agent(S) (Procah),,54235,CPT,Professional,Both,,,,459,390.15,45.59,459,BlueCross BlueShield Minnesota,High Value Network Plan,153.2128,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Injection Of Corpora Cavernosa With Pharmacologic Agent(S) (Procah),,54235,CPT,Professional,Both,,,,459,390.15,45.59,459,BlueCross BlueShield Minnesota,Medicare Advantage,81.489,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Injection Of Corpora Cavernosa With Pharmacologic Agent(S) (Procah),,54235,CPT,Professional,Both,,,,459,390.15,45.59,459,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,153.2128,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Injection Of Corpora Cavernosa With Pharmacologic Agent(S) (Procah),,54235,CPT,Professional,Both,,,,459,390.15,45.59,459,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,52.63896,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Injection Of Corpora Cavernosa With Pharmacologic Agent(S) (Procah),,54235,CPT,Professional,Both,,,,459,390.15,45.59,459,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),81.489,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Injection Of Corpora Cavernosa With Pharmacologic Agent(S) (Procah),,54235,CPT,Professional,Both,,,,459,390.15,45.59,459,CorVel,Worker's Compensation,137.2121892,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Injection Of Corpora Cavernosa With Pharmacologic Agent(S) (Procah),,54235,CPT,Professional,Both,,,,459,390.15,45.59,459,First Health Group Corporation,First Health Network,445.23,97,,percent of total billed charges,,
Injection Of Corpora Cavernosa With Pharmacologic Agent(S) (Procah),,54235,CPT,Professional,Both,,,,459,390.15,45.59,459,"Health Partners, Inc.",Commercial,148.01,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Injection Of Corpora Cavernosa With Pharmacologic Agent(S) (Procah),,54235,CPT,Professional,Both,,,,459,390.15,45.59,459,"Health Partners, Inc.",Medicare Advantage,81.489,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Injection Of Corpora Cavernosa With Pharmacologic Agent(S) (Procah),,54235,CPT,Professional,Both,,,,459,390.15,45.59,459,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),71.16,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Injection Of Corpora Cavernosa With Pharmacologic Agent(S) (Procah),,54235,CPT,Professional,Both,,,,459,390.15,45.59,459,"Health Partners, Inc.",State of Minnesota Advantage Program,127.510615,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Injection Of Corpora Cavernosa With Pharmacologic Agent(S) (Procah),,54235,CPT,Professional,Both,,,,459,390.15,45.59,459,"Health Partners, Inc.",State Public Programs,45.59,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Injection Of Corpora Cavernosa With Pharmacologic Agent(S) (Procah),,54235,CPT,Professional,Both,,,,459,390.15,45.59,459,Humana Insurance Company,Commercial PPO,70.86,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Injection Of Corpora Cavernosa With Pharmacologic Agent(S) (Procah),,54235,CPT,Professional,Both,,,,459,390.15,45.59,459,Humana Insurance Company,Medicare PPO,459,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Injection Of Corpora Cavernosa With Pharmacologic Agent(S) (Procah),,54235,CPT,Professional,Both,,,,459,390.15,45.59,459,Medica,Individual & Family,389.232,84.8,,percent of total billed charges,,
Injection Of Corpora Cavernosa With Pharmacologic Agent(S) (Procah),,54235,CPT,Professional,Both,,,,459,390.15,45.59,459,Medica,Medica Advantage Solution,228.582,49.8,,percent of total billed charges,,
Injection Of Corpora Cavernosa With Pharmacologic Agent(S) (Procah),,54235,CPT,Professional,Both,,,,459,390.15,45.59,459,Medica,Medical Assistance,52.64,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Injection Of Corpora Cavernosa With Pharmacologic Agent(S) (Procah),,54235,CPT,Professional,Both,,,,459,390.15,45.59,459,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,70.86,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Injection Of Corpora Cavernosa With Pharmacologic Agent(S) (Procah),,54235,CPT,Professional,Both,,,,459,390.15,45.59,459,"Multiplan, Inc.","Multiplan, Inc.",431.46,94,,percent of total billed charges,,
Injection Of Corpora Cavernosa With Pharmacologic Agent(S) (Procah),,54235,CPT,Professional,Both,,,,459,390.15,45.59,459,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,413.559,90.1,,percent of total billed charges,,
Injection Of Corpora Cavernosa With Pharmacologic Agent(S) (Procah),,54235,CPT,Professional,Both,,,,459,390.15,45.59,459,"Preferred One Administrative Services, INC.",PPO,452.574,98.6,,percent of total billed charges,,
Injection Of Corpora Cavernosa With Pharmacologic Agent(S) (Procah),,54235,CPT,Professional,Both,,,,459,390.15,45.59,459,PrimeWest Health,Minnesota Senior Health Options (MSHO),81.489,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Injection Of Corpora Cavernosa With Pharmacologic Agent(S) (Procah),,54235,CPT,Professional,Both,,,,459,390.15,45.59,459,PrimeWest Health,MinnesotaCare,56.3236872,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Injection Of Corpora Cavernosa With Pharmacologic Agent(S) (Procah),,54235,CPT,Professional,Both,,,,459,390.15,45.59,459,Sanford Health Plan,Sanford Health Plan,403.92,88,,percent of total billed charges,,
Injection Of Corpora Cavernosa With Pharmacologic Agent(S) (Procah),,54235,CPT,Professional,Both,,,,459,390.15,45.59,459,"UCare Health, Inc.",Individual & Family Plan,115.190016,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Injection Of Corpora Cavernosa With Pharmacologic Agent(S) (Procah),,54235,CPT,Professional,Both,,,,459,390.15,45.59,459,"UCare Health, Inc.",Medical Assistance,57.902856,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Injection Of Corpora Cavernosa With Pharmacologic Agent(S) (Procah),,54235,CPT,Professional,Both,,,,459,390.15,45.59,459,"UCare Health, Inc.",Medicare Advantage,81.489,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Injection Of Corpora Cavernosa With Pharmacologic Agent(S) (Procah),,54235,CPT,Professional,Both,,,,459,390.15,45.59,459,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),65.1912,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Injection Of Corpora Cavernosa With Pharmacologic Agent(S) (Procah),,54235,CPT,Professional,Both,,,,459,390.15,45.59,459,UnitedHealthcare,Individual & Family,459,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Injection Of Corpora Cavernosa With Pharmacologic Agent(S) (Procah),,54235,CPT,Professional,Both,,,,459,390.15,45.59,459,UnitedHealthcare,Medicare Advantage,81.489,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Injection Of Corpora Cavernosa With Pharmacologic Agent(S) (Procah),,54235,CPT,Professional,Both,,,,459,390.15,45.59,459,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,52.63896,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision Of Spermatocele, With Or Without Epididymectomy (Pro Cah)",,54840,CPT,Professional,Both,,,,1864,1584.4,200.69,1864,Aetna,Commercial,1584.4,85,,percent of total billed charges,,
"Excision Of Spermatocele, With Or Without Epididymectomy (Pro Cah)",,54840,CPT,Professional,Both,,,,1864,1584.4,200.69,1864,Aetna,Medicare Advantage,316.65,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision Of Spermatocele, With Or Without Epididymectomy (Pro Cah)",,54840,CPT,Professional,Both,,,,1864,1584.4,200.69,1864,Aetna,PPO,1733.52,93,,percent of total billed charges,,
"Excision Of Spermatocele, With Or Without Epididymectomy (Pro Cah)",,54840,CPT,Professional,Both,,,,1864,1584.4,200.69,1864,America's PPO,America's PPO,1592.6016,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Excision Of Spermatocele, With Or Without Epididymectomy (Pro Cah)",,54840,CPT,Professional,Both,,,,1864,1584.4,200.69,1864,BlueCross BlueShield Minnesota, Federal Employee Program,658.99,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Excision Of Spermatocele, With Or Without Epididymectomy (Pro Cah)",,54840,CPT,Professional,Both,,,,1864,1584.4,200.69,1864,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,669.53384,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision Of Spermatocele, With Or Without Epididymectomy (Pro Cah)",,54840,CPT,Professional,Both,,,,1864,1584.4,200.69,1864,BlueCross BlueShield Minnesota,High Value Network Plan,669.53384,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision Of Spermatocele, With Or Without Epididymectomy (Pro Cah)",,54840,CPT,Professional,Both,,,,1864,1584.4,200.69,1864,BlueCross BlueShield Minnesota,Medicare Advantage,358.57,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision Of Spermatocele, With Or Without Epididymectomy (Pro Cah)",,54840,CPT,Professional,Both,,,,1864,1584.4,200.69,1864,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,669.53384,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision Of Spermatocele, With Or Without Epididymectomy (Pro Cah)",,54840,CPT,Professional,Both,,,,1864,1584.4,200.69,1864,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,231.70896,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision Of Spermatocele, With Or Without Epididymectomy (Pro Cah)",,54840,CPT,Professional,Both,,,,1864,1584.4,200.69,1864,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),358.57,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision Of Spermatocele, With Or Without Epididymectomy (Pro Cah)",,54840,CPT,Professional,Both,,,,1864,1584.4,200.69,1864,CorVel,Worker's Compensation,611.6009859,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Excision Of Spermatocele, With Or Without Epididymectomy (Pro Cah)",,54840,CPT,Professional,Both,,,,1864,1584.4,200.69,1864,First Health Group Corporation,First Health Network,1808.08,97,,percent of total billed charges,,
"Excision Of Spermatocele, With Or Without Epididymectomy (Pro Cah)",,54840,CPT,Professional,Both,,,,1864,1584.4,200.69,1864,"Health Partners, Inc.",Commercial,660.96,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision Of Spermatocele, With Or Without Epididymectomy (Pro Cah)",,54840,CPT,Professional,Both,,,,1864,1584.4,200.69,1864,"Health Partners, Inc.",Medicare Advantage,358.57,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision Of Spermatocele, With Or Without Epididymectomy (Pro Cah)",,54840,CPT,Professional,Both,,,,1864,1584.4,200.69,1864,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),311.76,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Excision Of Spermatocele, With Or Without Epididymectomy (Pro Cah)",,54840,CPT,Professional,Both,,,,1864,1584.4,200.69,1864,"Health Partners, Inc.",State of Minnesota Advantage Program,569.41704,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision Of Spermatocele, With Or Without Epididymectomy (Pro Cah)",,54840,CPT,Professional,Both,,,,1864,1584.4,200.69,1864,"Health Partners, Inc.",State Public Programs,200.69,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Excision Of Spermatocele, With Or Without Epididymectomy (Pro Cah)",,54840,CPT,Professional,Both,,,,1864,1584.4,200.69,1864,Humana Insurance Company,Commercial PPO,311.8,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Excision Of Spermatocele, With Or Without Epididymectomy (Pro Cah)",,54840,CPT,Professional,Both,,,,1864,1584.4,200.69,1864,Humana Insurance Company,Medicare PPO,1864,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Excision Of Spermatocele, With Or Without Epididymectomy (Pro Cah)",,54840,CPT,Professional,Both,,,,1864,1584.4,200.69,1864,Medica,Individual & Family,1580.672,84.8,,percent of total billed charges,,
"Excision Of Spermatocele, With Or Without Epididymectomy (Pro Cah)",,54840,CPT,Professional,Both,,,,1864,1584.4,200.69,1864,Medica,Medica Advantage Solution,928.272,49.8,,percent of total billed charges,,
"Excision Of Spermatocele, With Or Without Epididymectomy (Pro Cah)",,54840,CPT,Professional,Both,,,,1864,1584.4,200.69,1864,Medica,Medical Assistance,231.71,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Excision Of Spermatocele, With Or Without Epididymectomy (Pro Cah)",,54840,CPT,Professional,Both,,,,1864,1584.4,200.69,1864,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,311.8,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Excision Of Spermatocele, With Or Without Epididymectomy (Pro Cah)",,54840,CPT,Professional,Both,,,,1864,1584.4,200.69,1864,"Multiplan, Inc.","Multiplan, Inc.",1752.16,94,,percent of total billed charges,,
"Excision Of Spermatocele, With Or Without Epididymectomy (Pro Cah)",,54840,CPT,Professional,Both,,,,1864,1584.4,200.69,1864,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1679.464,90.1,,percent of total billed charges,,
"Excision Of Spermatocele, With Or Without Epididymectomy (Pro Cah)",,54840,CPT,Professional,Both,,,,1864,1584.4,200.69,1864,"Preferred One Administrative Services, INC.",PPO,1837.904,98.6,,percent of total billed charges,,
"Excision Of Spermatocele, With Or Without Epididymectomy (Pro Cah)",,54840,CPT,Professional,Both,,,,1864,1584.4,200.69,1864,PrimeWest Health,Minnesota Senior Health Options (MSHO),358.57,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision Of Spermatocele, With Or Without Epididymectomy (Pro Cah)",,54840,CPT,Professional,Both,,,,1864,1584.4,200.69,1864,PrimeWest Health,MinnesotaCare,247.9285872,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision Of Spermatocele, With Or Without Epididymectomy (Pro Cah)",,54840,CPT,Professional,Both,,,,1864,1584.4,200.69,1864,Sanford Health Plan,Sanford Health Plan,1640.32,88,,percent of total billed charges,,
"Excision Of Spermatocele, With Or Without Epididymectomy (Pro Cah)",,54840,CPT,Professional,Both,,,,1864,1584.4,200.69,1864,"UCare Health, Inc.",Individual & Family Plan,506.86208,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Excision Of Spermatocele, With Or Without Epididymectomy (Pro Cah)",,54840,CPT,Professional,Both,,,,1864,1584.4,200.69,1864,"UCare Health, Inc.",Medical Assistance,254.879856,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Excision Of Spermatocele, With Or Without Epididymectomy (Pro Cah)",,54840,CPT,Professional,Both,,,,1864,1584.4,200.69,1864,"UCare Health, Inc.",Medicare Advantage,358.57,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Excision Of Spermatocele, With Or Without Epididymectomy (Pro Cah)",,54840,CPT,Professional,Both,,,,1864,1584.4,200.69,1864,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),286.856,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Excision Of Spermatocele, With Or Without Epididymectomy (Pro Cah)",,54840,CPT,Professional,Both,,,,1864,1584.4,200.69,1864,UnitedHealthcare,Individual & Family,1864,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Excision Of Spermatocele, With Or Without Epididymectomy (Pro Cah)",,54840,CPT,Professional,Both,,,,1864,1584.4,200.69,1864,UnitedHealthcare,Medicare Advantage,358.57,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision Of Spermatocele, With Or Without Epididymectomy (Pro Cah)",,54840,CPT,Professional,Both,,,,1864,1584.4,200.69,1864,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,231.70896,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Puncture Aspiration Of A Hydrocele,,55000,CPT,Facility,Both,,,,204,173.4,58.4664,204,Aetna,Commercial,187.68,92,,percent of total billed charges,,
Puncture Aspiration Of A Hydrocele,,55000,CPT,Facility,Outpatient,,,,204,173.4,58.4664,204,Aetna,Medicare Advantage,99.96,49,,percent of total billed charges,,
Puncture Aspiration Of A Hydrocele,,55000,CPT,Facility,Inpatient,,,,204,173.4,58.4664,204,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Puncture Aspiration Of A Hydrocele,,55000,CPT,Facility,Both,,,,204,173.4,58.4664,204,Aetna,PPO,189.72,93,,percent of total billed charges,,
Puncture Aspiration Of A Hydrocele,,55000,CPT,Facility,Both,,,,204,173.4,58.4664,204,America's PPO,America's PPO,195.9012,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Puncture Aspiration Of A Hydrocele,,55000,CPT,Facility,Both,,,,204,173.4,58.4664,204,BlueCross BlueShield Minnesota, Federal Employee Program,200.736,98.4,,percent of total billed charges,,
Puncture Aspiration Of A Hydrocele,,55000,CPT,Facility,Both,,,,204,173.4,58.4664,204,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,204,100,,percent of total billed charges,,
Puncture Aspiration Of A Hydrocele,,55000,CPT,Facility,Both,,,,204,173.4,58.4664,204,BlueCross BlueShield Minnesota,High Value Network Plan,183.6,90,,percent of total billed charges,,
Puncture Aspiration Of A Hydrocele,,55000,CPT,Facility,Outpatient,,,,204,173.4,58.4664,204,BlueCross BlueShield Minnesota,Medicare Advantage,99.96,49,,percent of total billed charges,,
Puncture Aspiration Of A Hydrocele,,55000,CPT,Facility,Inpatient,,,,204,173.4,58.4664,204,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Puncture Aspiration Of A Hydrocele,,55000,CPT,Facility,Both,,,,204,173.4,58.4664,204,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,180.6828,88.57,,percent of total billed charges,,
Puncture Aspiration Of A Hydrocele,,55000,CPT,Facility,Both,,,,204,173.4,58.4664,204,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,58.4664,28.66,,percent of total billed charges,,
Puncture Aspiration Of A Hydrocele,,55000,CPT,Facility,Outpatient,,,,204,173.4,58.4664,204,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),99.96,49,,percent of total billed charges,,
Puncture Aspiration Of A Hydrocele,,55000,CPT,Facility,Inpatient,,,,204,173.4,58.4664,204,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Puncture Aspiration Of A Hydrocele,,55000,CPT,Facility,Both,,,,204,173.4,58.4664,204,CorVel,Worker's Compensation,204,100,,percent of total billed charges,,
Puncture Aspiration Of A Hydrocele,,55000,CPT,Facility,Both,,,,204,173.4,58.4664,204,First Health Group Corporation,First Health Network,197.88,97,,percent of total billed charges,,
Puncture Aspiration Of A Hydrocele,,55000,CPT,Facility,Both,,,,204,173.4,58.4664,204,"Health Partners, Inc.",Commercial,192.984,94.6,,percent of total billed charges,,
Puncture Aspiration Of A Hydrocele,,55000,CPT,Facility,Outpatient,,,,204,173.4,58.4664,204,"Health Partners, Inc.",Medicare Advantage,99.96,49,,percent of total billed charges,,
Puncture Aspiration Of A Hydrocele,,55000,CPT,Facility,Inpatient,,,,204,173.4,58.4664,204,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Puncture Aspiration Of A Hydrocele,,55000,CPT,Facility,Both,,,,204,173.4,58.4664,204,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),122.4,60,,percent of total billed charges,,
Puncture Aspiration Of A Hydrocele,,55000,CPT,Facility,Both,,,,204,173.4,58.4664,204,"Health Partners, Inc.",State of Minnesota Advantage Program,166.26,81.5,,percent of total billed charges,,
Puncture Aspiration Of A Hydrocele,,55000,CPT,Facility,Both,,,,204,173.4,58.4664,204,"Health Partners, Inc.",State Public Programs,102,50,,percent of total billed charges,,
Puncture Aspiration Of A Hydrocele,,55000,CPT,Facility,Both,,,,204,173.4,58.4664,204,Humana Insurance Company,Commercial PPO,193.8,95,,percent of total billed charges,,
Puncture Aspiration Of A Hydrocele,,55000,CPT,Facility,Outpatient,,,,204,173.4,58.4664,204,Humana Insurance Company,Medicare PPO,99.96,49,,percent of total billed charges,,
Puncture Aspiration Of A Hydrocele,,55000,CPT,Facility,Inpatient,,,,204,173.4,58.4664,204,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Puncture Aspiration Of A Hydrocele,,55000,CPT,Facility,Both,,,,204,173.4,58.4664,204,Medica,Individual & Family,202.164,99.1,,percent of total billed charges,,
Puncture Aspiration Of A Hydrocele,,55000,CPT,Facility,Outpatient,,,,204,173.4,58.4664,204,Medica,Medica Advantage Solution,101.592,49.8,,percent of total billed charges,,
Puncture Aspiration Of A Hydrocele,,55000,CPT,Facility,Inpatient,,,,204,173.4,58.4664,204,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Puncture Aspiration Of A Hydrocele,,55000,CPT,Facility,Outpatient,,,,204,173.4,58.4664,204,Medica,Medical Assistance,90.984,44.6,,percent of total billed charges,,
Puncture Aspiration Of A Hydrocele,,55000,CPT,Facility,Inpatient,,,,204,173.4,58.4664,204,Medica,Medical Assistance,,,,,Included in per diem rate,
Puncture Aspiration Of A Hydrocele,,55000,CPT,Facility,Outpatient,,,,204,173.4,58.4664,204,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,101.592,49.8,,percent of total billed charges,,
Puncture Aspiration Of A Hydrocele,,55000,CPT,Facility,Inpatient,,,,204,173.4,58.4664,204,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Puncture Aspiration Of A Hydrocele,,55000,CPT,Facility,Both,,,,204,173.4,58.4664,204,"Multiplan, Inc.","Multiplan, Inc.",191.76,94,,percent of total billed charges,,
Puncture Aspiration Of A Hydrocele,,55000,CPT,Facility,Outpatient,,,,204,173.4,58.4664,204,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,183.804,90.1,,percent of total billed charges,,
Puncture Aspiration Of A Hydrocele,,55000,CPT,Facility,Inpatient,,,,204,173.4,58.4664,204,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Puncture Aspiration Of A Hydrocele,,55000,CPT,Facility,Both,,,,204,173.4,58.4664,204,"Preferred One Administrative Services, INC.",PPO,201.144,98.6,,percent of total billed charges,,
Puncture Aspiration Of A Hydrocele,,55000,CPT,Facility,Outpatient,,,,204,173.4,58.4664,204,PrimeWest Health,Minnesota Senior Health Options (MSHO),104.958,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Puncture Aspiration Of A Hydrocele,,55000,CPT,Facility,Inpatient,,,,204,173.4,58.4664,204,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Puncture Aspiration Of A Hydrocele,,55000,CPT,Facility,Outpatient,,,,204,173.4,58.4664,204,PrimeWest Health,MinnesotaCare,104.7744,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Puncture Aspiration Of A Hydrocele,,55000,CPT,Facility,Inpatient,,,,204,173.4,58.4664,204,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Puncture Aspiration Of A Hydrocele,,55000,CPT,Facility,Both,,,,204,173.4,58.4664,204,Sanford Health Plan,Sanford Health Plan,187.68,92,,percent of total billed charges,,
Puncture Aspiration Of A Hydrocele,,55000,CPT,Facility,Outpatient,,,,204,173.4,58.4664,204,"UCare Health, Inc.",Individual & Family Plan,114.954,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Puncture Aspiration Of A Hydrocele,,55000,CPT,Facility,Inpatient,,,,204,173.4,58.4664,204,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Puncture Aspiration Of A Hydrocele,,55000,CPT,Facility,Outpatient,,,,204,173.4,58.4664,204,"UCare Health, Inc.",Medical Assistance,102.9588,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Puncture Aspiration Of A Hydrocele,,55000,CPT,Facility,Inpatient,,,,204,173.4,58.4664,204,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Puncture Aspiration Of A Hydrocele,,55000,CPT,Facility,Outpatient,,,,204,173.4,58.4664,204,"UCare Health, Inc.",Medicare Advantage,102.9588,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Puncture Aspiration Of A Hydrocele,,55000,CPT,Facility,Inpatient,,,,204,173.4,58.4664,204,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Puncture Aspiration Of A Hydrocele,,55000,CPT,Facility,Outpatient,,,,204,173.4,58.4664,204,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),102.9588,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Puncture Aspiration Of A Hydrocele,,55000,CPT,Facility,Inpatient,,,,204,173.4,58.4664,204,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Puncture Aspiration Of A Hydrocele,,55000,CPT,Facility,Both,,,,204,173.4,58.4664,204,UnitedHealthcare,Individual & Family,191.76,94,,percent of total billed charges,,
Puncture Aspiration Of A Hydrocele,,55000,CPT,Facility,Outpatient,,,,204,173.4,58.4664,204,UnitedHealthcare,Medicare Advantage,99.96,49,,percent of total billed charges,,
Puncture Aspiration Of A Hydrocele,,55000,CPT,Facility,Inpatient,,,,204,173.4,58.4664,204,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Puncture Aspiration Of A Hydrocele,,55000,CPT,Facility,Outpatient,,,,204,173.4,58.4664,204,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,97.92,48,,percent of total billed charges,,100% of DHS outpatient percentage
Puncture Aspiration Of A Hydrocele,,55000,CPT,Facility,Inpatient,,,,204,173.4,58.4664,204,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Puncture Aspiration Of Hydrocele, Tunica Vaginalis, With Or Without Injection Of Medication (Pro Cah)",,55000,CPT,Professional,Both,,,,332,282.2,51.92,332,Aetna,Commercial,282.2,85,,percent of total billed charges,,
"Puncture Aspiration Of Hydrocele, Tunica Vaginalis, With Or Without Injection Of Medication (Pro Cah)",,55000,CPT,Professional,Both,,,,332,282.2,51.92,332,Aetna,Medicare Advantage,82.04,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Puncture Aspiration Of Hydrocele, Tunica Vaginalis, With Or Without Injection Of Medication (Pro Cah)",,55000,CPT,Professional,Both,,,,332,282.2,51.92,332,Aetna,PPO,308.76,93,,percent of total billed charges,,
"Puncture Aspiration Of Hydrocele, Tunica Vaginalis, With Or Without Injection Of Medication (Pro Cah)",,55000,CPT,Professional,Both,,,,332,282.2,51.92,332,America's PPO,America's PPO,283.6608,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Puncture Aspiration Of Hydrocele, Tunica Vaginalis, With Or Without Injection Of Medication (Pro Cah)",,55000,CPT,Professional,Both,,,,332,282.2,51.92,332,BlueCross BlueShield Minnesota, Federal Employee Program,171.46,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Puncture Aspiration Of Hydrocele, Tunica Vaginalis, With Or Without Injection Of Medication (Pro Cah)",,55000,CPT,Professional,Both,,,,332,282.2,51.92,332,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,174.20336,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Puncture Aspiration Of Hydrocele, Tunica Vaginalis, With Or Without Injection Of Medication (Pro Cah)",,55000,CPT,Professional,Both,,,,332,282.2,51.92,332,BlueCross BlueShield Minnesota,High Value Network Plan,174.20336,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Puncture Aspiration Of Hydrocele, Tunica Vaginalis, With Or Without Injection Of Medication (Pro Cah)",,55000,CPT,Professional,Both,,,,332,282.2,51.92,332,BlueCross BlueShield Minnesota,Medicare Advantage,92.9545,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Puncture Aspiration Of Hydrocele, Tunica Vaginalis, With Or Without Injection Of Medication (Pro Cah)",,55000,CPT,Professional,Both,,,,332,282.2,51.92,332,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,174.20336,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Puncture Aspiration Of Hydrocele, Tunica Vaginalis, With Or Without Injection Of Medication (Pro Cah)",,55000,CPT,Professional,Both,,,,332,282.2,51.92,332,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,59.944,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Puncture Aspiration Of Hydrocele, Tunica Vaginalis, With Or Without Injection Of Medication (Pro Cah)",,55000,CPT,Professional,Both,,,,332,282.2,51.92,332,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),92.9545,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Puncture Aspiration Of Hydrocele, Tunica Vaginalis, With Or Without Injection Of Medication (Pro Cah)",,55000,CPT,Professional,Both,,,,332,282.2,51.92,332,CorVel,Worker's Compensation,158.3949204,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Puncture Aspiration Of Hydrocele, Tunica Vaginalis, With Or Without Injection Of Medication (Pro Cah)",,55000,CPT,Professional,Both,,,,332,282.2,51.92,332,First Health Group Corporation,First Health Network,322.04,97,,percent of total billed charges,,
"Puncture Aspiration Of Hydrocele, Tunica Vaginalis, With Or Without Injection Of Medication (Pro Cah)",,55000,CPT,Professional,Both,,,,332,282.2,51.92,332,"Health Partners, Inc.",Commercial,171.23,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Puncture Aspiration Of Hydrocele, Tunica Vaginalis, With Or Without Injection Of Medication (Pro Cah)",,55000,CPT,Professional,Both,,,,332,282.2,51.92,332,"Health Partners, Inc.",Medicare Advantage,92.9545,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Puncture Aspiration Of Hydrocele, Tunica Vaginalis, With Or Without Injection Of Medication (Pro Cah)",,55000,CPT,Professional,Both,,,,332,282.2,51.92,332,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),80.99,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Puncture Aspiration Of Hydrocele, Tunica Vaginalis, With Or Without Injection Of Medication (Pro Cah)",,55000,CPT,Professional,Both,,,,332,282.2,51.92,332,"Health Partners, Inc.",State of Minnesota Advantage Program,147.514645,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Puncture Aspiration Of Hydrocele, Tunica Vaginalis, With Or Without Injection Of Medication (Pro Cah)",,55000,CPT,Professional,Both,,,,332,282.2,51.92,332,"Health Partners, Inc.",State Public Programs,51.92,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Puncture Aspiration Of Hydrocele, Tunica Vaginalis, With Or Without Injection Of Medication (Pro Cah)",,55000,CPT,Professional,Both,,,,332,282.2,51.92,332,Humana Insurance Company,Commercial PPO,80.83,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Puncture Aspiration Of Hydrocele, Tunica Vaginalis, With Or Without Injection Of Medication (Pro Cah)",,55000,CPT,Professional,Both,,,,332,282.2,51.92,332,Humana Insurance Company,Medicare PPO,332,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Puncture Aspiration Of Hydrocele, Tunica Vaginalis, With Or Without Injection Of Medication (Pro Cah)",,55000,CPT,Professional,Both,,,,332,282.2,51.92,332,Medica,Individual & Family,281.536,84.8,,percent of total billed charges,,
"Puncture Aspiration Of Hydrocele, Tunica Vaginalis, With Or Without Injection Of Medication (Pro Cah)",,55000,CPT,Professional,Both,,,,332,282.2,51.92,332,Medica,Medica Advantage Solution,165.336,49.8,,percent of total billed charges,,
"Puncture Aspiration Of Hydrocele, Tunica Vaginalis, With Or Without Injection Of Medication (Pro Cah)",,55000,CPT,Professional,Both,,,,332,282.2,51.92,332,Medica,Medical Assistance,59.94,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Puncture Aspiration Of Hydrocele, Tunica Vaginalis, With Or Without Injection Of Medication (Pro Cah)",,55000,CPT,Professional,Both,,,,332,282.2,51.92,332,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,80.83,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Puncture Aspiration Of Hydrocele, Tunica Vaginalis, With Or Without Injection Of Medication (Pro Cah)",,55000,CPT,Professional,Both,,,,332,282.2,51.92,332,"Multiplan, Inc.","Multiplan, Inc.",312.08,94,,percent of total billed charges,,
"Puncture Aspiration Of Hydrocele, Tunica Vaginalis, With Or Without Injection Of Medication (Pro Cah)",,55000,CPT,Professional,Both,,,,332,282.2,51.92,332,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,299.132,90.1,,percent of total billed charges,,
"Puncture Aspiration Of Hydrocele, Tunica Vaginalis, With Or Without Injection Of Medication (Pro Cah)",,55000,CPT,Professional,Both,,,,332,282.2,51.92,332,"Preferred One Administrative Services, INC.",PPO,327.352,98.6,,percent of total billed charges,,
"Puncture Aspiration Of Hydrocele, Tunica Vaginalis, With Or Without Injection Of Medication (Pro Cah)",,55000,CPT,Professional,Both,,,,332,282.2,51.92,332,PrimeWest Health,Minnesota Senior Health Options (MSHO),92.9545,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Puncture Aspiration Of Hydrocele, Tunica Vaginalis, With Or Without Injection Of Medication (Pro Cah)",,55000,CPT,Professional,Both,,,,332,282.2,51.92,332,PrimeWest Health,MinnesotaCare,64.14008,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Puncture Aspiration Of Hydrocele, Tunica Vaginalis, With Or Without Injection Of Medication (Pro Cah)",,55000,CPT,Professional,Both,,,,332,282.2,51.92,332,Sanford Health Plan,Sanford Health Plan,292.16,88,,percent of total billed charges,,
"Puncture Aspiration Of Hydrocele, Tunica Vaginalis, With Or Without Injection Of Medication (Pro Cah)",,55000,CPT,Professional,Both,,,,332,282.2,51.92,332,"UCare Health, Inc.",Individual & Family Plan,131.397248,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Puncture Aspiration Of Hydrocele, Tunica Vaginalis, With Or Without Injection Of Medication (Pro Cah)",,55000,CPT,Professional,Both,,,,332,282.2,51.92,332,"UCare Health, Inc.",Medical Assistance,65.9384,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Puncture Aspiration Of Hydrocele, Tunica Vaginalis, With Or Without Injection Of Medication (Pro Cah)",,55000,CPT,Professional,Both,,,,332,282.2,51.92,332,"UCare Health, Inc.",Medicare Advantage,92.9545,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Puncture Aspiration Of Hydrocele, Tunica Vaginalis, With Or Without Injection Of Medication (Pro Cah)",,55000,CPT,Professional,Both,,,,332,282.2,51.92,332,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),74.3636,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Puncture Aspiration Of Hydrocele, Tunica Vaginalis, With Or Without Injection Of Medication (Pro Cah)",,55000,CPT,Professional,Both,,,,332,282.2,51.92,332,UnitedHealthcare,Individual & Family,332,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Puncture Aspiration Of Hydrocele, Tunica Vaginalis, With Or Without Injection Of Medication (Pro Cah)",,55000,CPT,Professional,Both,,,,332,282.2,51.92,332,UnitedHealthcare,Medicare Advantage,92.9545,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Puncture Aspiration Of Hydrocele, Tunica Vaginalis, With Or Without Injection Of Medication (Pro Cah)",,55000,CPT,Professional,Both,,,,332,282.2,51.92,332,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,59.944,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Excision Of Hydrocele; Unilateral (Pro Cah),,55040,CPT,Professional,Both,,,,1632,1387.2,210.51,1632,Aetna,Commercial,1387.2,85,,percent of total billed charges,,
Excision Of Hydrocele; Unilateral (Pro Cah),,55040,CPT,Professional,Both,,,,1632,1387.2,210.51,1632,Aetna,Medicare Advantage,332.26,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Excision Of Hydrocele; Unilateral (Pro Cah),,55040,CPT,Professional,Both,,,,1632,1387.2,210.51,1632,Aetna,PPO,1517.76,93,,percent of total billed charges,,
Excision Of Hydrocele; Unilateral (Pro Cah),,55040,CPT,Professional,Both,,,,1632,1387.2,210.51,1632,America's PPO,America's PPO,1394.3808,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Excision Of Hydrocele; Unilateral (Pro Cah),,55040,CPT,Professional,Both,,,,1632,1387.2,210.51,1632,BlueCross BlueShield Minnesota, Federal Employee Program,690.67,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Excision Of Hydrocele; Unilateral (Pro Cah),,55040,CPT,Professional,Both,,,,1632,1387.2,210.51,1632,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,701.72072,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Excision Of Hydrocele; Unilateral (Pro Cah),,55040,CPT,Professional,Both,,,,1632,1387.2,210.51,1632,BlueCross BlueShield Minnesota,High Value Network Plan,701.72072,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Excision Of Hydrocele; Unilateral (Pro Cah),,55040,CPT,Professional,Both,,,,1632,1387.2,210.51,1632,BlueCross BlueShield Minnesota,Medicare Advantage,376.165,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Excision Of Hydrocele; Unilateral (Pro Cah),,55040,CPT,Professional,Both,,,,1632,1387.2,210.51,1632,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,701.72072,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Excision Of Hydrocele; Unilateral (Pro Cah),,55040,CPT,Professional,Both,,,,1632,1387.2,210.51,1632,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,243.04752,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Excision Of Hydrocele; Unilateral (Pro Cah),,55040,CPT,Professional,Both,,,,1632,1387.2,210.51,1632,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),376.165,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Excision Of Hydrocele; Unilateral (Pro Cah),,55040,CPT,Professional,Both,,,,1632,1387.2,210.51,1632,CorVel,Worker's Compensation,642.125049,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Excision Of Hydrocele; Unilateral (Pro Cah),,55040,CPT,Professional,Both,,,,1632,1387.2,210.51,1632,First Health Group Corporation,First Health Network,1583.04,97,,percent of total billed charges,,
Excision Of Hydrocele; Unilateral (Pro Cah),,55040,CPT,Professional,Both,,,,1632,1387.2,210.51,1632,"Health Partners, Inc.",Commercial,693.6,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Excision Of Hydrocele; Unilateral (Pro Cah),,55040,CPT,Professional,Both,,,,1632,1387.2,210.51,1632,"Health Partners, Inc.",Medicare Advantage,376.165,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Excision Of Hydrocele; Unilateral (Pro Cah),,55040,CPT,Professional,Both,,,,1632,1387.2,210.51,1632,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),327.01,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Excision Of Hydrocele; Unilateral (Pro Cah),,55040,CPT,Professional,Both,,,,1632,1387.2,210.51,1632,"Health Partners, Inc.",State of Minnesota Advantage Program,597.5364,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Excision Of Hydrocele; Unilateral (Pro Cah),,55040,CPT,Professional,Both,,,,1632,1387.2,210.51,1632,"Health Partners, Inc.",State Public Programs,210.51,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Excision Of Hydrocele; Unilateral (Pro Cah),,55040,CPT,Professional,Both,,,,1632,1387.2,210.51,1632,Humana Insurance Company,Commercial PPO,327.1,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Excision Of Hydrocele; Unilateral (Pro Cah),,55040,CPT,Professional,Both,,,,1632,1387.2,210.51,1632,Humana Insurance Company,Medicare PPO,1632,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Excision Of Hydrocele; Unilateral (Pro Cah),,55040,CPT,Professional,Both,,,,1632,1387.2,210.51,1632,Medica,Individual & Family,1383.936,84.8,,percent of total billed charges,,
Excision Of Hydrocele; Unilateral (Pro Cah),,55040,CPT,Professional,Both,,,,1632,1387.2,210.51,1632,Medica,Medica Advantage Solution,812.736,49.8,,percent of total billed charges,,
Excision Of Hydrocele; Unilateral (Pro Cah),,55040,CPT,Professional,Both,,,,1632,1387.2,210.51,1632,Medica,Medical Assistance,243.05,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Excision Of Hydrocele; Unilateral (Pro Cah),,55040,CPT,Professional,Both,,,,1632,1387.2,210.51,1632,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,327.1,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Excision Of Hydrocele; Unilateral (Pro Cah),,55040,CPT,Professional,Both,,,,1632,1387.2,210.51,1632,"Multiplan, Inc.","Multiplan, Inc.",1534.08,94,,percent of total billed charges,,
Excision Of Hydrocele; Unilateral (Pro Cah),,55040,CPT,Professional,Both,,,,1632,1387.2,210.51,1632,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1470.432,90.1,,percent of total billed charges,,
Excision Of Hydrocele; Unilateral (Pro Cah),,55040,CPT,Professional,Both,,,,1632,1387.2,210.51,1632,"Preferred One Administrative Services, INC.",PPO,1609.152,98.6,,percent of total billed charges,,
Excision Of Hydrocele; Unilateral (Pro Cah),,55040,CPT,Professional,Both,,,,1632,1387.2,210.51,1632,PrimeWest Health,Minnesota Senior Health Options (MSHO),376.165,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Excision Of Hydrocele; Unilateral (Pro Cah),,55040,CPT,Professional,Both,,,,1632,1387.2,210.51,1632,PrimeWest Health,MinnesotaCare,260.0608464,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Excision Of Hydrocele; Unilateral (Pro Cah),,55040,CPT,Professional,Both,,,,1632,1387.2,210.51,1632,Sanford Health Plan,Sanford Health Plan,1436.16,88,,percent of total billed charges,,
Excision Of Hydrocele; Unilateral (Pro Cah),,55040,CPT,Professional,Both,,,,1632,1387.2,210.51,1632,"UCare Health, Inc.",Individual & Family Plan,531.73376,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Excision Of Hydrocele; Unilateral (Pro Cah),,55040,CPT,Professional,Both,,,,1632,1387.2,210.51,1632,"UCare Health, Inc.",Medical Assistance,267.352272,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Excision Of Hydrocele; Unilateral (Pro Cah),,55040,CPT,Professional,Both,,,,1632,1387.2,210.51,1632,"UCare Health, Inc.",Medicare Advantage,376.165,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Excision Of Hydrocele; Unilateral (Pro Cah),,55040,CPT,Professional,Both,,,,1632,1387.2,210.51,1632,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),300.932,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Excision Of Hydrocele; Unilateral (Pro Cah),,55040,CPT,Professional,Both,,,,1632,1387.2,210.51,1632,UnitedHealthcare,Individual & Family,1632,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Excision Of Hydrocele; Unilateral (Pro Cah),,55040,CPT,Professional,Both,,,,1632,1387.2,210.51,1632,UnitedHealthcare,Medicare Advantage,376.165,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Excision Of Hydrocele; Unilateral (Pro Cah),,55040,CPT,Professional,Both,,,,1632,1387.2,210.51,1632,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,243.04752,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Vasectomy,,55250,CPT,Facility,Both,,,,640,544,183.424,1372,Aetna,Commercial,588.8,92,,percent of total billed charges,,
Vasectomy,,55250,CPT,Facility,Outpatient,,,,640,544,183.424,1372,Aetna,Medicare Advantage,313.6,49,,percent of total billed charges,,
Vasectomy,,55250,CPT,Facility,Inpatient,,,,640,544,183.424,1372,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Vasectomy,,55250,CPT,Facility,Both,,,,640,544,183.424,1372,Aetna,PPO,595.2,93,,percent of total billed charges,,
Vasectomy,,55250,CPT,Facility,Both,,,,640,544,183.424,1372,America's PPO,America's PPO,614.592,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Vasectomy,,55250,CPT,Facility,Both,,,,640,544,183.424,1372,BlueCross BlueShield Minnesota, Federal Employee Program,629.76,98.4,,percent of total billed charges,,
Vasectomy,,55250,CPT,Facility,Both,,,,640,544,183.424,1372,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,640,100,,percent of total billed charges,,
Vasectomy,,55250,CPT,Facility,Both,,,,640,544,183.424,1372,BlueCross BlueShield Minnesota,High Value Network Plan,576,90,,percent of total billed charges,,
Vasectomy,,55250,CPT,Facility,Outpatient,,,,640,544,183.424,1372,BlueCross BlueShield Minnesota,Medicare Advantage,313.6,49,,percent of total billed charges,,
Vasectomy,,55250,CPT,Facility,Inpatient,,,,640,544,183.424,1372,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Vasectomy,,55250,CPT,Facility,Both,,,,640,544,183.424,1372,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,566.848,88.57,,percent of total billed charges,,
Vasectomy,,55250,CPT,Facility,Both,,,,640,544,183.424,1372,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,183.424,28.66,,percent of total billed charges,,
Vasectomy,,55250,CPT,Facility,Outpatient,,,,640,544,183.424,1372,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),313.6,49,,percent of total billed charges,,
Vasectomy,,55250,CPT,Facility,Inpatient,,,,640,544,183.424,1372,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Vasectomy,,55250,CPT,Facility,Both,,,,640,544,183.424,1372,CorVel,Worker's Compensation,640,100,,percent of total billed charges,,
Vasectomy,,55250,CPT,Facility,Both,,,,640,544,183.424,1372,First Health Group Corporation,First Health Network,620.8,97,,percent of total billed charges,,
Vasectomy,,55250,CPT,Facility,Both,,,,640,544,183.424,1372,"Health Partners, Inc.",Commercial,605.44,94.6,,percent of total billed charges,,
Vasectomy,,55250,CPT,Facility,Outpatient,,,,640,544,183.424,1372,"Health Partners, Inc.",Medicare Advantage,313.6,49,,percent of total billed charges,,
Vasectomy,,55250,CPT,Facility,Inpatient,,,,640,544,183.424,1372,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Vasectomy,,55250,CPT,Facility,Both,,,,640,544,183.424,1372,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),384,60,,percent of total billed charges,,
Vasectomy,,55250,CPT,Facility,Both,,,,640,544,183.424,1372,"Health Partners, Inc.",State of Minnesota Advantage Program,521.6,81.5,,percent of total billed charges,,
Vasectomy,,55250,CPT,Facility,Both,,,,640,544,183.424,1372,"Health Partners, Inc.",State Public Programs,320,50,,percent of total billed charges,,
Vasectomy,,55250,CPT,Facility,Both,,,,640,544,183.424,1372,Humana Insurance Company,Commercial PPO,608,95,,percent of total billed charges,,
Vasectomy,,55250,CPT,Facility,Outpatient,,,,640,544,183.424,1372,Humana Insurance Company,Medicare PPO,313.6,49,,percent of total billed charges,,
Vasectomy,,55250,CPT,Facility,Inpatient,,,,640,544,183.424,1372,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Vasectomy,,55250,CPT,Facility,Both,,,,640,544,183.424,1372,Medica,Individual & Family,634.24,99.1,,percent of total billed charges,,
Vasectomy,,55250,CPT,Facility,Outpatient,,,,640,544,183.424,1372,Medica,Medica Advantage Solution,318.72,49.8,,percent of total billed charges,,
Vasectomy,,55250,CPT,Facility,Inpatient,,,,640,544,183.424,1372,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Vasectomy,,55250,CPT,Facility,Outpatient,,,,640,544,183.424,1372,Medica,Medical Assistance,1372,,,Other,Grouper,All inclusive per visit
Vasectomy,,55250,CPT,Facility,Inpatient,,,,640,544,183.424,1372,Medica,Medical Assistance,,,,,Included in per diem rate,
Vasectomy,,55250,CPT,Facility,Outpatient,,,,640,544,183.424,1372,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,318.72,49.8,,percent of total billed charges,,
Vasectomy,,55250,CPT,Facility,Inpatient,,,,640,544,183.424,1372,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Vasectomy,,55250,CPT,Facility,Both,,,,640,544,183.424,1372,"Multiplan, Inc.","Multiplan, Inc.",601.6,94,,percent of total billed charges,,
Vasectomy,,55250,CPT,Facility,Outpatient,,,,640,544,183.424,1372,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,576.64,90.1,,percent of total billed charges,,
Vasectomy,,55250,CPT,Facility,Inpatient,,,,640,544,183.424,1372,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Vasectomy,,55250,CPT,Facility,Both,,,,640,544,183.424,1372,"Preferred One Administrative Services, INC.",PPO,631.04,98.6,,percent of total billed charges,,
Vasectomy,,55250,CPT,Facility,Outpatient,,,,640,544,183.424,1372,PrimeWest Health,Minnesota Senior Health Options (MSHO),329.28,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Vasectomy,,55250,CPT,Facility,Inpatient,,,,640,544,183.424,1372,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Vasectomy,,55250,CPT,Facility,Outpatient,,,,640,544,183.424,1372,PrimeWest Health,MinnesotaCare,328.704,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Vasectomy,,55250,CPT,Facility,Inpatient,,,,640,544,183.424,1372,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Vasectomy,,55250,CPT,Facility,Both,,,,640,544,183.424,1372,Sanford Health Plan,Sanford Health Plan,588.8,92,,percent of total billed charges,,
Vasectomy,,55250,CPT,Facility,Outpatient,,,,640,544,183.424,1372,"UCare Health, Inc.",Individual & Family Plan,360.64,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Vasectomy,,55250,CPT,Facility,Inpatient,,,,640,544,183.424,1372,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Vasectomy,,55250,CPT,Facility,Outpatient,,,,640,544,183.424,1372,"UCare Health, Inc.",Medical Assistance,323.008,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Vasectomy,,55250,CPT,Facility,Inpatient,,,,640,544,183.424,1372,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Vasectomy,,55250,CPT,Facility,Outpatient,,,,640,544,183.424,1372,"UCare Health, Inc.",Medicare Advantage,323.008,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Vasectomy,,55250,CPT,Facility,Inpatient,,,,640,544,183.424,1372,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Vasectomy,,55250,CPT,Facility,Outpatient,,,,640,544,183.424,1372,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),323.008,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Vasectomy,,55250,CPT,Facility,Inpatient,,,,640,544,183.424,1372,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Vasectomy,,55250,CPT,Facility,Both,,,,640,544,183.424,1372,UnitedHealthcare,Individual & Family,601.6,94,,percent of total billed charges,,
Vasectomy,,55250,CPT,Facility,Outpatient,,,,640,544,183.424,1372,UnitedHealthcare,Medicare Advantage,313.6,49,,percent of total billed charges,,
Vasectomy,,55250,CPT,Facility,Inpatient,,,,640,544,183.424,1372,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Vasectomy,,55250,CPT,Facility,Outpatient,,,,640,544,183.424,1372,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,307.2,48,,percent of total billed charges,,100% of DHS outpatient percentage
Vasectomy,,55250,CPT,Facility,Inpatient,,,,640,544,183.424,1372,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Vasectomy, Unilateral Or Bilateral, Including Postoperative Semen Examination(S) (Pbb)",,55250,CPT,Facility,Outpatient,,,,422,358.7,120.9452,422,Aetna,Commercial,388.24,92,,percent of total billed charges,,
"Vasectomy, Unilateral Or Bilateral, Including Postoperative Semen Examination(S) (Pbb)",,55250,CPT,Professional,Outpatient,,,,670,569.5,155.77,670,Aetna,Commercial,569.5,85,,percent of total billed charges,,
"Vasectomy, Unilateral Or Bilateral, Including Postoperative Semen Examination(S) (Pbb)",,55250,CPT,Facility,Outpatient,,,,422,358.7,120.9452,422,Aetna,Medicare Advantage,206.78,49,,percent of total billed charges,,
"Vasectomy, Unilateral Or Bilateral, Including Postoperative Semen Examination(S) (Pbb)",,55250,CPT,Professional,Outpatient,,,,670,569.5,155.77,670,Aetna,Medicare Advantage,224.9,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Vasectomy, Unilateral Or Bilateral, Including Postoperative Semen Examination(S) (Pbb)",,55250,CPT,Facility,Outpatient,,,,422,358.7,120.9452,422,Aetna,PPO,392.46,93,,percent of total billed charges,,
"Vasectomy, Unilateral Or Bilateral, Including Postoperative Semen Examination(S) (Pbb)",,55250,CPT,Professional,Outpatient,,,,670,569.5,155.77,670,Aetna,PPO,623.1,93,,percent of total billed charges,,
"Vasectomy, Unilateral Or Bilateral, Including Postoperative Semen Examination(S) (Pbb)",,55250,CPT,Facility,Outpatient,,,,422,358.7,120.9452,422,America's PPO,America's PPO,405.2466,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Vasectomy, Unilateral Or Bilateral, Including Postoperative Semen Examination(S) (Pbb)",,55250,CPT,Professional,Outpatient,,,,670,569.5,155.77,670,America's PPO,America's PPO,572.448,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Vasectomy, Unilateral Or Bilateral, Including Postoperative Semen Examination(S) (Pbb)",,55250,CPT,Facility,Outpatient,,,,422,358.7,120.9452,422,BlueCross BlueShield Minnesota, Federal Employee Program,415.248,98.4,,percent of total billed charges,,
"Vasectomy, Unilateral Or Bilateral, Including Postoperative Semen Examination(S) (Pbb)",,55250,CPT,Professional,Outpatient,,,,670,569.5,155.77,670,BlueCross BlueShield Minnesota, Federal Employee Program,468.25,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Vasectomy, Unilateral Or Bilateral, Including Postoperative Semen Examination(S) (Pbb)",,55250,CPT,Facility,Outpatient,,,,422,358.7,120.9452,422,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,422,100,,percent of total billed charges,,
"Vasectomy, Unilateral Or Bilateral, Including Postoperative Semen Examination(S) (Pbb)",,55250,CPT,Professional,Outpatient,,,,670,569.5,155.77,670,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,475.742,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Vasectomy, Unilateral Or Bilateral, Including Postoperative Semen Examination(S) (Pbb)",,55250,CPT,Facility,Outpatient,,,,422,358.7,120.9452,422,BlueCross BlueShield Minnesota,High Value Network Plan,379.8,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
"Vasectomy, Unilateral Or Bilateral, Including Postoperative Semen Examination(S) (Pbb)",,55250,CPT,Professional,Outpatient,,,,670,569.5,155.77,670,BlueCross BlueShield Minnesota,High Value Network Plan,475.742,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Vasectomy, Unilateral Or Bilateral, Including Postoperative Semen Examination(S) (Pbb)",,55250,CPT,Facility,Outpatient,,,,422,358.7,120.9452,422,BlueCross BlueShield Minnesota,Medicare Advantage,206.78,49,,percent of total billed charges,,
"Vasectomy, Unilateral Or Bilateral, Including Postoperative Semen Examination(S) (Pbb)",,55250,CPT,Professional,Outpatient,,,,670,569.5,155.77,670,BlueCross BlueShield Minnesota,Medicare Advantage,256.7375,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Vasectomy, Unilateral Or Bilateral, Including Postoperative Semen Examination(S) (Pbb)",,55250,CPT,Professional,Outpatient,,,,670,569.5,155.77,670,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,475.742,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Vasectomy, Unilateral Or Bilateral, Including Postoperative Semen Examination(S) (Pbb)",,55250,CPT,Facility,Outpatient,,,,422,358.7,120.9452,422,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,120.9452,28.66,,percent of total billed charges,,
"Vasectomy, Unilateral Or Bilateral, Including Postoperative Semen Examination(S) (Pbb)",,55250,CPT,Professional,Outpatient,,,,670,569.5,155.77,670,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,165.71976,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Vasectomy, Unilateral Or Bilateral, Including Postoperative Semen Examination(S) (Pbb)",,55250,CPT,Facility,Outpatient,,,,422,358.7,120.9452,422,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),206.78,49,,percent of total billed charges,,
"Vasectomy, Unilateral Or Bilateral, Including Postoperative Semen Examination(S) (Pbb)",,55250,CPT,Professional,Outpatient,,,,670,569.5,155.77,670,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),256.7375,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Vasectomy, Unilateral Or Bilateral, Including Postoperative Semen Examination(S) (Pbb)",,55250,CPT,Facility,Outpatient,,,,422,358.7,120.9452,422,CorVel,Worker's Compensation,422,100,,percent of total billed charges,,
"Vasectomy, Unilateral Or Bilateral, Including Postoperative Semen Examination(S) (Pbb)",,55250,CPT,Professional,Outpatient,,,,670,569.5,155.77,670,CorVel,Worker's Compensation,435.2139093,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Vasectomy, Unilateral Or Bilateral, Including Postoperative Semen Examination(S) (Pbb)",,55250,CPT,Facility,Outpatient,,,,422,358.7,120.9452,422,First Health Group Corporation,First Health Network,409.34,97,,percent of total billed charges,,
"Vasectomy, Unilateral Or Bilateral, Including Postoperative Semen Examination(S) (Pbb)",,55250,CPT,Professional,Outpatient,,,,670,569.5,155.77,670,First Health Group Corporation,First Health Network,649.9,97,,percent of total billed charges,,
"Vasectomy, Unilateral Or Bilateral, Including Postoperative Semen Examination(S) (Pbb)",,55250,CPT,Facility,Outpatient,,,,422,358.7,120.9452,422,"Health Partners, Inc.",Commercial,399.212,94.6,,percent of total billed charges,,
"Vasectomy, Unilateral Or Bilateral, Including Postoperative Semen Examination(S) (Pbb)",,55250,CPT,Professional,Outpatient,,,,670,569.5,155.77,670,"Health Partners, Inc.",Commercial,470.14,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Vasectomy, Unilateral Or Bilateral, Including Postoperative Semen Examination(S) (Pbb)",,55250,CPT,Facility,Outpatient,,,,422,358.7,120.9452,422,"Health Partners, Inc.",Medicare Advantage,206.78,49,,percent of total billed charges,,
"Vasectomy, Unilateral Or Bilateral, Including Postoperative Semen Examination(S) (Pbb)",,55250,CPT,Professional,Outpatient,,,,670,569.5,155.77,670,"Health Partners, Inc.",Medicare Advantage,256.7375,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Vasectomy, Unilateral Or Bilateral, Including Postoperative Semen Examination(S) (Pbb)",,55250,CPT,Facility,Outpatient,,,,422,358.7,120.9452,422,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),253.2,60,,percent of total billed charges,,
"Vasectomy, Unilateral Or Bilateral, Including Postoperative Semen Examination(S) (Pbb)",,55250,CPT,Professional,Outpatient,,,,670,569.5,155.77,670,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),223.32,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Vasectomy, Unilateral Or Bilateral, Including Postoperative Semen Examination(S) (Pbb)",,55250,CPT,Facility,Outpatient,,,,422,358.7,120.9452,422,"Health Partners, Inc.",State of Minnesota Advantage Program,343.93,81.5,,percent of total billed charges,,
"Vasectomy, Unilateral Or Bilateral, Including Postoperative Semen Examination(S) (Pbb)",,55250,CPT,Professional,Outpatient,,,,670,569.5,155.77,670,"Health Partners, Inc.",State of Minnesota Advantage Program,405.02561,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Vasectomy, Unilateral Or Bilateral, Including Postoperative Semen Examination(S) (Pbb)",,55250,CPT,Facility,Outpatient,,,,422,358.7,120.9452,422,"Health Partners, Inc.",State Public Programs,211,50,,percent of total billed charges,,
"Vasectomy, Unilateral Or Bilateral, Including Postoperative Semen Examination(S) (Pbb)",,55250,CPT,Professional,Outpatient,,,,670,569.5,155.77,670,"Health Partners, Inc.",State Public Programs,155.77,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Vasectomy, Unilateral Or Bilateral, Including Postoperative Semen Examination(S) (Pbb)",,55250,CPT,Facility,Outpatient,,,,422,358.7,120.9452,422,Humana Insurance Company,Commercial PPO,400.9,95,,percent of total billed charges,,
"Vasectomy, Unilateral Or Bilateral, Including Postoperative Semen Examination(S) (Pbb)",,55250,CPT,Professional,Outpatient,,,,670,569.5,155.77,670,Humana Insurance Company,Commercial PPO,223.25,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Vasectomy, Unilateral Or Bilateral, Including Postoperative Semen Examination(S) (Pbb)",,55250,CPT,Facility,Outpatient,,,,422,358.7,120.9452,422,Humana Insurance Company,Medicare PPO,206.78,49,,percent of total billed charges,,
"Vasectomy, Unilateral Or Bilateral, Including Postoperative Semen Examination(S) (Pbb)",,55250,CPT,Professional,Outpatient,,,,670,569.5,155.77,670,Humana Insurance Company,Medicare PPO,670,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Vasectomy, Unilateral Or Bilateral, Including Postoperative Semen Examination(S) (Pbb)",,55250,CPT,Facility,Outpatient,,,,422,358.7,120.9452,422,Medica,Individual & Family,418.202,99.1,,percent of total billed charges,,
"Vasectomy, Unilateral Or Bilateral, Including Postoperative Semen Examination(S) (Pbb)",,55250,CPT,Professional,Outpatient,,,,670,569.5,155.77,670,Medica,Individual & Family,568.16,84.8,,percent of total billed charges,,
"Vasectomy, Unilateral Or Bilateral, Including Postoperative Semen Examination(S) (Pbb)",,55250,CPT,Facility,Outpatient,,,,422,358.7,120.9452,422,Medica,Medica Advantage Solution,210.156,49.8,,percent of total billed charges,,
"Vasectomy, Unilateral Or Bilateral, Including Postoperative Semen Examination(S) (Pbb)",,55250,CPT,Professional,Outpatient,,,,670,569.5,155.77,670,Medica,Medica Advantage Solution,333.66,49.8,,percent of total billed charges,,
"Vasectomy, Unilateral Or Bilateral, Including Postoperative Semen Examination(S) (Pbb)",,55250,CPT,Facility,Outpatient,,,,422,358.7,120.9452,422,Medica,Medical Assistance,188.212,44.6,,percent of total billed charges,,
"Vasectomy, Unilateral Or Bilateral, Including Postoperative Semen Examination(S) (Pbb)",,55250,CPT,Professional,Outpatient,,,,670,569.5,155.77,670,Medica,Medical Assistance,165.72,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Vasectomy, Unilateral Or Bilateral, Including Postoperative Semen Examination(S) (Pbb)",,55250,CPT,Facility,Outpatient,,,,422,358.7,120.9452,422,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,210.156,49.8,,percent of total billed charges,,
"Vasectomy, Unilateral Or Bilateral, Including Postoperative Semen Examination(S) (Pbb)",,55250,CPT,Professional,Outpatient,,,,670,569.5,155.77,670,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,223.25,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Vasectomy, Unilateral Or Bilateral, Including Postoperative Semen Examination(S) (Pbb)",,55250,CPT,Facility,Outpatient,,,,422,358.7,120.9452,422,"Multiplan, Inc.","Multiplan, Inc.",396.68,94,,percent of total billed charges,,
"Vasectomy, Unilateral Or Bilateral, Including Postoperative Semen Examination(S) (Pbb)",,55250,CPT,Professional,Outpatient,,,,670,569.5,155.77,670,"Multiplan, Inc.","Multiplan, Inc.",629.8,94,,percent of total billed charges,,
"Vasectomy, Unilateral Or Bilateral, Including Postoperative Semen Examination(S) (Pbb)",,55250,CPT,Facility,Outpatient,,,,422,358.7,120.9452,422,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,380.222,90.1,,percent of total billed charges,,
"Vasectomy, Unilateral Or Bilateral, Including Postoperative Semen Examination(S) (Pbb)",,55250,CPT,Professional,Outpatient,,,,670,569.5,155.77,670,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,603.67,90.1,,percent of total billed charges,,
"Vasectomy, Unilateral Or Bilateral, Including Postoperative Semen Examination(S) (Pbb)",,55250,CPT,Facility,Outpatient,,,,422,358.7,120.9452,422,"Preferred One Administrative Services, INC.",PPO,416.092,98.6,,percent of total billed charges,,
"Vasectomy, Unilateral Or Bilateral, Including Postoperative Semen Examination(S) (Pbb)",,55250,CPT,Professional,Outpatient,,,,670,569.5,155.77,670,"Preferred One Administrative Services, INC.",PPO,660.62,98.6,,percent of total billed charges,,
"Vasectomy, Unilateral Or Bilateral, Including Postoperative Semen Examination(S) (Pbb)",,55250,CPT,Facility,Outpatient,,,,422,358.7,120.9452,422,PrimeWest Health,Minnesota Senior Health Options (MSHO),217.119,51.45,,percent of total billed charges,,
"Vasectomy, Unilateral Or Bilateral, Including Postoperative Semen Examination(S) (Pbb)",,55250,CPT,Professional,Outpatient,,,,670,569.5,155.77,670,PrimeWest Health,Minnesota Senior Health Options (MSHO),256.7375,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Vasectomy, Unilateral Or Bilateral, Including Postoperative Semen Examination(S) (Pbb)",,55250,CPT,Facility,Outpatient,,,,422,358.7,120.9452,422,PrimeWest Health,MinnesotaCare,216.7392,51.36,,percent of total billed charges,,
"Vasectomy, Unilateral Or Bilateral, Including Postoperative Semen Examination(S) (Pbb)",,55250,CPT,Professional,Outpatient,,,,670,569.5,155.77,670,PrimeWest Health,MinnesotaCare,177.3201432,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Vasectomy, Unilateral Or Bilateral, Including Postoperative Semen Examination(S) (Pbb)",,55250,CPT,Facility,Outpatient,,,,422,358.7,120.9452,422,Sanford Health Plan,Sanford Health Plan,388.24,92,,percent of total billed charges,,
"Vasectomy, Unilateral Or Bilateral, Including Postoperative Semen Examination(S) (Pbb)",,55250,CPT,Professional,Outpatient,,,,670,569.5,155.77,670,Sanford Health Plan,Sanford Health Plan,589.6,88,,percent of total billed charges,,
"Vasectomy, Unilateral Or Bilateral, Including Postoperative Semen Examination(S) (Pbb)",,55250,CPT,Facility,Outpatient,,,,422,358.7,120.9452,422,"UCare Health, Inc.",Individual & Family Plan,237.797,56.35,,percent of total billed charges,,
"Vasectomy, Unilateral Or Bilateral, Including Postoperative Semen Examination(S) (Pbb)",,55250,CPT,Professional,Outpatient,,,,670,569.5,155.77,670,"UCare Health, Inc.",Individual & Family Plan,362.9152,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Vasectomy, Unilateral Or Bilateral, Including Postoperative Semen Examination(S) (Pbb)",,55250,CPT,Facility,Outpatient,,,,422,358.7,120.9452,422,"UCare Health, Inc.",Medical Assistance,212.9834,50.47,,percent of total billed charges,,
"Vasectomy, Unilateral Or Bilateral, Including Postoperative Semen Examination(S) (Pbb)",,55250,CPT,Professional,Outpatient,,,,670,569.5,155.77,670,"UCare Health, Inc.",Medical Assistance,182.291736,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Vasectomy, Unilateral Or Bilateral, Including Postoperative Semen Examination(S) (Pbb)",,55250,CPT,Facility,Outpatient,,,,422,358.7,120.9452,422,"UCare Health, Inc.",Medicare Advantage,212.9834,50.47,,percent of total billed charges,,
"Vasectomy, Unilateral Or Bilateral, Including Postoperative Semen Examination(S) (Pbb)",,55250,CPT,Professional,Outpatient,,,,670,569.5,155.77,670,"UCare Health, Inc.",Medicare Advantage,256.7375,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Vasectomy, Unilateral Or Bilateral, Including Postoperative Semen Examination(S) (Pbb)",,55250,CPT,Facility,Outpatient,,,,422,358.7,120.9452,422,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),212.9834,50.47,,percent of total billed charges,,
"Vasectomy, Unilateral Or Bilateral, Including Postoperative Semen Examination(S) (Pbb)",,55250,CPT,Professional,Outpatient,,,,670,569.5,155.77,670,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),205.39,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Vasectomy, Unilateral Or Bilateral, Including Postoperative Semen Examination(S) (Pbb)",,55250,CPT,Facility,Outpatient,,,,422,358.7,120.9452,422,UnitedHealthcare,Individual & Family,396.68,94,,percent of total billed charges,,
"Vasectomy, Unilateral Or Bilateral, Including Postoperative Semen Examination(S) (Pbb)",,55250,CPT,Professional,Outpatient,,,,670,569.5,155.77,670,UnitedHealthcare,Individual & Family,670,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Vasectomy, Unilateral Or Bilateral, Including Postoperative Semen Examination(S) (Pbb)",,55250,CPT,Facility,Outpatient,,,,422,358.7,120.9452,422,UnitedHealthcare,Medicare Advantage,206.78,49,,percent of total billed charges,,
"Vasectomy, Unilateral Or Bilateral, Including Postoperative Semen Examination(S) (Pbb)",,55250,CPT,Professional,Outpatient,,,,670,569.5,155.77,670,UnitedHealthcare,Medicare Advantage,256.7375,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Vasectomy, Unilateral Or Bilateral, Including Postoperative Semen Examination(S) (Pbb)",,55250,CPT,Facility,Outpatient,,,,422,358.7,120.9452,422,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,202.56,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Vasectomy, Unilateral Or Bilateral, Including Postoperative Semen Examination(S) (Pbb)",,55250,CPT,Professional,Outpatient,,,,670,569.5,155.77,670,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,165.71976,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Vasectomy,Unilateral Or Bilateral, Including Postoperative Semen Exam (Pro Cah)",,55250,CPT,Professional,Both,,,,1092,928.2,155.77,1092,Aetna,Commercial,928.2,85,,percent of total billed charges,,
"Vasectomy,Unilateral Or Bilateral, Including Postoperative Semen Exam (Pro Cah)",,55250,CPT,Professional,Both,,,,1092,928.2,155.77,1092,Aetna,Medicare Advantage,224.9,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Vasectomy,Unilateral Or Bilateral, Including Postoperative Semen Exam (Pro Cah)",,55250,CPT,Professional,Both,,,,1092,928.2,155.77,1092,Aetna,PPO,1015.56,93,,percent of total billed charges,,
"Vasectomy,Unilateral Or Bilateral, Including Postoperative Semen Exam (Pro Cah)",,55250,CPT,Professional,Both,,,,1092,928.2,155.77,1092,America's PPO,America's PPO,933.0048,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Vasectomy,Unilateral Or Bilateral, Including Postoperative Semen Exam (Pro Cah)",,55250,CPT,Professional,Both,,,,1092,928.2,155.77,1092,BlueCross BlueShield Minnesota, Federal Employee Program,468.25,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Vasectomy,Unilateral Or Bilateral, Including Postoperative Semen Exam (Pro Cah)",,55250,CPT,Professional,Both,,,,1092,928.2,155.77,1092,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,475.742,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Vasectomy,Unilateral Or Bilateral, Including Postoperative Semen Exam (Pro Cah)",,55250,CPT,Professional,Both,,,,1092,928.2,155.77,1092,BlueCross BlueShield Minnesota,High Value Network Plan,475.742,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Vasectomy,Unilateral Or Bilateral, Including Postoperative Semen Exam (Pro Cah)",,55250,CPT,Professional,Both,,,,1092,928.2,155.77,1092,BlueCross BlueShield Minnesota,Medicare Advantage,256.7375,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Vasectomy,Unilateral Or Bilateral, Including Postoperative Semen Exam (Pro Cah)",,55250,CPT,Professional,Both,,,,1092,928.2,155.77,1092,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,475.742,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Vasectomy,Unilateral Or Bilateral, Including Postoperative Semen Exam (Pro Cah)",,55250,CPT,Professional,Both,,,,1092,928.2,155.77,1092,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,165.71976,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Vasectomy,Unilateral Or Bilateral, Including Postoperative Semen Exam (Pro Cah)",,55250,CPT,Professional,Both,,,,1092,928.2,155.77,1092,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),256.7375,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Vasectomy,Unilateral Or Bilateral, Including Postoperative Semen Exam (Pro Cah)",,55250,CPT,Professional,Both,,,,1092,928.2,155.77,1092,CorVel,Worker's Compensation,435.2139093,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Vasectomy,Unilateral Or Bilateral, Including Postoperative Semen Exam (Pro Cah)",,55250,CPT,Professional,Both,,,,1092,928.2,155.77,1092,First Health Group Corporation,First Health Network,1059.24,97,,percent of total billed charges,,
"Vasectomy,Unilateral Or Bilateral, Including Postoperative Semen Exam (Pro Cah)",,55250,CPT,Professional,Both,,,,1092,928.2,155.77,1092,"Health Partners, Inc.",Commercial,470.14,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Vasectomy,Unilateral Or Bilateral, Including Postoperative Semen Exam (Pro Cah)",,55250,CPT,Professional,Both,,,,1092,928.2,155.77,1092,"Health Partners, Inc.",Medicare Advantage,256.7375,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Vasectomy,Unilateral Or Bilateral, Including Postoperative Semen Exam (Pro Cah)",,55250,CPT,Professional,Both,,,,1092,928.2,155.77,1092,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),223.32,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Vasectomy,Unilateral Or Bilateral, Including Postoperative Semen Exam (Pro Cah)",,55250,CPT,Professional,Both,,,,1092,928.2,155.77,1092,"Health Partners, Inc.",State of Minnesota Advantage Program,405.02561,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Vasectomy,Unilateral Or Bilateral, Including Postoperative Semen Exam (Pro Cah)",,55250,CPT,Professional,Both,,,,1092,928.2,155.77,1092,"Health Partners, Inc.",State Public Programs,155.77,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Vasectomy,Unilateral Or Bilateral, Including Postoperative Semen Exam (Pro Cah)",,55250,CPT,Professional,Both,,,,1092,928.2,155.77,1092,Humana Insurance Company,Commercial PPO,223.25,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Vasectomy,Unilateral Or Bilateral, Including Postoperative Semen Exam (Pro Cah)",,55250,CPT,Professional,Both,,,,1092,928.2,155.77,1092,Humana Insurance Company,Medicare PPO,1092,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Vasectomy,Unilateral Or Bilateral, Including Postoperative Semen Exam (Pro Cah)",,55250,CPT,Professional,Both,,,,1092,928.2,155.77,1092,Medica,Individual & Family,926.016,84.8,,percent of total billed charges,,
"Vasectomy,Unilateral Or Bilateral, Including Postoperative Semen Exam (Pro Cah)",,55250,CPT,Professional,Both,,,,1092,928.2,155.77,1092,Medica,Medica Advantage Solution,543.816,49.8,,percent of total billed charges,,
"Vasectomy,Unilateral Or Bilateral, Including Postoperative Semen Exam (Pro Cah)",,55250,CPT,Professional,Both,,,,1092,928.2,155.77,1092,Medica,Medical Assistance,165.72,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Vasectomy,Unilateral Or Bilateral, Including Postoperative Semen Exam (Pro Cah)",,55250,CPT,Professional,Both,,,,1092,928.2,155.77,1092,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,223.25,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Vasectomy,Unilateral Or Bilateral, Including Postoperative Semen Exam (Pro Cah)",,55250,CPT,Professional,Both,,,,1092,928.2,155.77,1092,"Multiplan, Inc.","Multiplan, Inc.",1026.48,94,,percent of total billed charges,,
"Vasectomy,Unilateral Or Bilateral, Including Postoperative Semen Exam (Pro Cah)",,55250,CPT,Professional,Both,,,,1092,928.2,155.77,1092,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,983.892,90.1,,percent of total billed charges,,
"Vasectomy,Unilateral Or Bilateral, Including Postoperative Semen Exam (Pro Cah)",,55250,CPT,Professional,Both,,,,1092,928.2,155.77,1092,"Preferred One Administrative Services, INC.",PPO,1076.712,98.6,,percent of total billed charges,,
"Vasectomy,Unilateral Or Bilateral, Including Postoperative Semen Exam (Pro Cah)",,55250,CPT,Professional,Both,,,,1092,928.2,155.77,1092,PrimeWest Health,Minnesota Senior Health Options (MSHO),256.7375,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Vasectomy,Unilateral Or Bilateral, Including Postoperative Semen Exam (Pro Cah)",,55250,CPT,Professional,Both,,,,1092,928.2,155.77,1092,PrimeWest Health,MinnesotaCare,177.3201432,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Vasectomy,Unilateral Or Bilateral, Including Postoperative Semen Exam (Pro Cah)",,55250,CPT,Professional,Both,,,,1092,928.2,155.77,1092,Sanford Health Plan,Sanford Health Plan,960.96,88,,percent of total billed charges,,
"Vasectomy,Unilateral Or Bilateral, Including Postoperative Semen Exam (Pro Cah)",,55250,CPT,Professional,Both,,,,1092,928.2,155.77,1092,"UCare Health, Inc.",Individual & Family Plan,362.9152,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Vasectomy,Unilateral Or Bilateral, Including Postoperative Semen Exam (Pro Cah)",,55250,CPT,Professional,Both,,,,1092,928.2,155.77,1092,"UCare Health, Inc.",Medical Assistance,182.291736,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Vasectomy,Unilateral Or Bilateral, Including Postoperative Semen Exam (Pro Cah)",,55250,CPT,Professional,Both,,,,1092,928.2,155.77,1092,"UCare Health, Inc.",Medicare Advantage,256.7375,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Vasectomy,Unilateral Or Bilateral, Including Postoperative Semen Exam (Pro Cah)",,55250,CPT,Professional,Both,,,,1092,928.2,155.77,1092,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),205.39,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Vasectomy,Unilateral Or Bilateral, Including Postoperative Semen Exam (Pro Cah)",,55250,CPT,Professional,Both,,,,1092,928.2,155.77,1092,UnitedHealthcare,Individual & Family,1092,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Vasectomy,Unilateral Or Bilateral, Including Postoperative Semen Exam (Pro Cah)",,55250,CPT,Professional,Both,,,,1092,928.2,155.77,1092,UnitedHealthcare,Medicare Advantage,256.7375,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Vasectomy,Unilateral Or Bilateral, Including Postoperative Semen Exam (Pro Cah)",,55250,CPT,Professional,Both,,,,1092,928.2,155.77,1092,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,165.71976,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Excision Of Varicocele Or Ligation Of Spermatic Veins For Varicocele; With Hernia Repair (Pro Cah),,55540,CPT,Professional,Both,,,,1995,1695.75,363.87,1995,Aetna,Commercial,1695.75,85,,percent of total billed charges,,
Excision Of Varicocele Or Ligation Of Spermatic Veins For Varicocele; With Hernia Repair (Pro Cah),,55540,CPT,Professional,Both,,,,1995,1695.75,363.87,1995,Aetna,Medicare Advantage,530.23,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Excision Of Varicocele Or Ligation Of Spermatic Veins For Varicocele; With Hernia Repair (Pro Cah),,55540,CPT,Professional,Both,,,,1995,1695.75,363.87,1995,Aetna,PPO,1855.35,93,,percent of total billed charges,,
Excision Of Varicocele Or Ligation Of Spermatic Veins For Varicocele; With Hernia Repair (Pro Cah),,55540,CPT,Professional,Both,,,,1995,1695.75,363.87,1995,America's PPO,America's PPO,1704.528,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Excision Of Varicocele Or Ligation Of Spermatic Veins For Varicocele; With Hernia Repair (Pro Cah),,55540,CPT,Professional,Both,,,,1995,1695.75,363.87,1995,BlueCross BlueShield Minnesota, Federal Employee Program,1147.21,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Excision Of Varicocele Or Ligation Of Spermatic Veins For Varicocele; With Hernia Repair (Pro Cah),,55540,CPT,Professional,Both,,,,1995,1695.75,363.87,1995,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1165.56536,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Excision Of Varicocele Or Ligation Of Spermatic Veins For Varicocele; With Hernia Repair (Pro Cah),,55540,CPT,Professional,Both,,,,1995,1695.75,363.87,1995,BlueCross BlueShield Minnesota,High Value Network Plan,1165.56536,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Excision Of Varicocele Or Ligation Of Spermatic Veins For Varicocele; With Hernia Repair (Pro Cah),,55540,CPT,Professional,Both,,,,1995,1695.75,363.87,1995,BlueCross BlueShield Minnesota,Medicare Advantage,599.265,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Excision Of Varicocele Or Ligation Of Spermatic Veins For Varicocele; With Hernia Repair (Pro Cah),,55540,CPT,Professional,Both,,,,1995,1695.75,363.87,1995,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1165.56536,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Excision Of Varicocele Or Ligation Of Spermatic Veins For Varicocele; With Hernia Repair (Pro Cah),,55540,CPT,Professional,Both,,,,1995,1695.75,363.87,1995,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,387.11632,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Excision Of Varicocele Or Ligation Of Spermatic Veins For Varicocele; With Hernia Repair (Pro Cah),,55540,CPT,Professional,Both,,,,1995,1695.75,363.87,1995,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),599.265,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Excision Of Varicocele Or Ligation Of Spermatic Veins For Varicocele; With Hernia Repair (Pro Cah),,55540,CPT,Professional,Both,,,,1995,1695.75,363.87,1995,CorVel,Worker's Compensation,1030.295777,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Excision Of Varicocele Or Ligation Of Spermatic Veins For Varicocele; With Hernia Repair (Pro Cah),,55540,CPT,Professional,Both,,,,1995,1695.75,363.87,1995,First Health Group Corporation,First Health Network,1935.15,97,,percent of total billed charges,,
Excision Of Varicocele Or Ligation Of Spermatic Veins For Varicocele; With Hernia Repair (Pro Cah),,55540,CPT,Professional,Both,,,,1995,1695.75,363.87,1995,"Health Partners, Inc.",Commercial,1112.96,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Excision Of Varicocele Or Ligation Of Spermatic Veins For Varicocele; With Hernia Repair (Pro Cah),,55540,CPT,Professional,Both,,,,1995,1695.75,363.87,1995,"Health Partners, Inc.",Medicare Advantage,599.265,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Excision Of Varicocele Or Ligation Of Spermatic Veins For Varicocele; With Hernia Repair (Pro Cah),,55540,CPT,Professional,Both,,,,1995,1695.75,363.87,1995,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),521.19,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Excision Of Varicocele Or Ligation Of Spermatic Veins For Varicocele; With Hernia Repair (Pro Cah),,55540,CPT,Professional,Both,,,,1995,1695.75,363.87,1995,"Health Partners, Inc.",State of Minnesota Advantage Program,958.81504,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Excision Of Varicocele Or Ligation Of Spermatic Veins For Varicocele; With Hernia Repair (Pro Cah),,55540,CPT,Professional,Both,,,,1995,1695.75,363.87,1995,"Health Partners, Inc.",State Public Programs,363.87,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Excision Of Varicocele Or Ligation Of Spermatic Veins For Varicocele; With Hernia Repair (Pro Cah),,55540,CPT,Professional,Both,,,,1995,1695.75,363.87,1995,Humana Insurance Company,Commercial PPO,521.1,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Excision Of Varicocele Or Ligation Of Spermatic Veins For Varicocele; With Hernia Repair (Pro Cah),,55540,CPT,Professional,Both,,,,1995,1695.75,363.87,1995,Humana Insurance Company,Medicare PPO,1995,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Excision Of Varicocele Or Ligation Of Spermatic Veins For Varicocele; With Hernia Repair (Pro Cah),,55540,CPT,Professional,Both,,,,1995,1695.75,363.87,1995,Medica,Individual & Family,1691.76,84.8,,percent of total billed charges,,
Excision Of Varicocele Or Ligation Of Spermatic Veins For Varicocele; With Hernia Repair (Pro Cah),,55540,CPT,Professional,Both,,,,1995,1695.75,363.87,1995,Medica,Medica Advantage Solution,993.51,49.8,,percent of total billed charges,,
Excision Of Varicocele Or Ligation Of Spermatic Veins For Varicocele; With Hernia Repair (Pro Cah),,55540,CPT,Professional,Both,,,,1995,1695.75,363.87,1995,Medica,Medical Assistance,387.12,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Excision Of Varicocele Or Ligation Of Spermatic Veins For Varicocele; With Hernia Repair (Pro Cah),,55540,CPT,Professional,Both,,,,1995,1695.75,363.87,1995,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,521.1,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Excision Of Varicocele Or Ligation Of Spermatic Veins For Varicocele; With Hernia Repair (Pro Cah),,55540,CPT,Professional,Both,,,,1995,1695.75,363.87,1995,"Multiplan, Inc.","Multiplan, Inc.",1875.3,94,,percent of total billed charges,,
Excision Of Varicocele Or Ligation Of Spermatic Veins For Varicocele; With Hernia Repair (Pro Cah),,55540,CPT,Professional,Both,,,,1995,1695.75,363.87,1995,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1797.495,90.1,,percent of total billed charges,,
Excision Of Varicocele Or Ligation Of Spermatic Veins For Varicocele; With Hernia Repair (Pro Cah),,55540,CPT,Professional,Both,,,,1995,1695.75,363.87,1995,"Preferred One Administrative Services, INC.",PPO,1967.07,98.6,,percent of total billed charges,,
Excision Of Varicocele Or Ligation Of Spermatic Veins For Varicocele; With Hernia Repair (Pro Cah),,55540,CPT,Professional,Both,,,,1995,1695.75,363.87,1995,PrimeWest Health,Minnesota Senior Health Options (MSHO),599.265,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Excision Of Varicocele Or Ligation Of Spermatic Veins For Varicocele; With Hernia Repair (Pro Cah),,55540,CPT,Professional,Both,,,,1995,1695.75,363.87,1995,PrimeWest Health,MinnesotaCare,414.2144624,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Excision Of Varicocele Or Ligation Of Spermatic Veins For Varicocele; With Hernia Repair (Pro Cah),,55540,CPT,Professional,Both,,,,1995,1695.75,363.87,1995,Sanford Health Plan,Sanford Health Plan,1755.6,88,,percent of total billed charges,,
Excision Of Varicocele Or Ligation Of Spermatic Veins For Varicocele; With Hernia Repair (Pro Cah),,55540,CPT,Professional,Both,,,,1995,1695.75,363.87,1995,"UCare Health, Inc.",Individual & Family Plan,847.10016,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Excision Of Varicocele Or Ligation Of Spermatic Veins For Varicocele; With Hernia Repair (Pro Cah),,55540,CPT,Professional,Both,,,,1995,1695.75,363.87,1995,"UCare Health, Inc.",Medical Assistance,425.827952,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Excision Of Varicocele Or Ligation Of Spermatic Veins For Varicocele; With Hernia Repair (Pro Cah),,55540,CPT,Professional,Both,,,,1995,1695.75,363.87,1995,"UCare Health, Inc.",Medicare Advantage,599.265,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Excision Of Varicocele Or Ligation Of Spermatic Veins For Varicocele; With Hernia Repair (Pro Cah),,55540,CPT,Professional,Both,,,,1995,1695.75,363.87,1995,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),479.412,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Excision Of Varicocele Or Ligation Of Spermatic Veins For Varicocele; With Hernia Repair (Pro Cah),,55540,CPT,Professional,Both,,,,1995,1695.75,363.87,1995,UnitedHealthcare,Individual & Family,1995,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Excision Of Varicocele Or Ligation Of Spermatic Veins For Varicocele; With Hernia Repair (Pro Cah),,55540,CPT,Professional,Both,,,,1995,1695.75,363.87,1995,UnitedHealthcare,Medicare Advantage,599.265,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Excision Of Varicocele Or Ligation Of Spermatic Veins For Varicocele; With Hernia Repair (Pro Cah),,55540,CPT,Professional,Both,,,,1995,1695.75,363.87,1995,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,387.11632,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Biopsy, Prostate; Needle Or Punch, Single Or Multiple, Any Approach (Pro Cah)",,55700,CPT,Professional,Both,,,,694,589.9,78.96,694,Aetna,Commercial,589.9,85,,percent of total billed charges,,
"Biopsy, Prostate; Needle Or Punch, Single Or Multiple, Any Approach (Pro Cah)",,55700,CPT,Professional,Both,,,,694,589.9,78.96,694,Aetna,Medicare Advantage,126.03,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Biopsy, Prostate; Needle Or Punch, Single Or Multiple, Any Approach (Pro Cah)",,55700,CPT,Professional,Both,,,,694,589.9,78.96,694,Aetna,PPO,645.42,93,,percent of total billed charges,,
"Biopsy, Prostate; Needle Or Punch, Single Or Multiple, Any Approach (Pro Cah)",,55700,CPT,Professional,Both,,,,694,589.9,78.96,694,America's PPO,America's PPO,592.9536,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Biopsy, Prostate; Needle Or Punch, Single Or Multiple, Any Approach (Pro Cah)",,55700,CPT,Professional,Both,,,,694,589.9,78.96,694,BlueCross BlueShield Minnesota, Federal Employee Program,262.36,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Biopsy, Prostate; Needle Or Punch, Single Or Multiple, Any Approach (Pro Cah)",,55700,CPT,Professional,Both,,,,694,589.9,78.96,694,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,266.55776,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Biopsy, Prostate; Needle Or Punch, Single Or Multiple, Any Approach (Pro Cah)",,55700,CPT,Professional,Both,,,,694,589.9,78.96,694,BlueCross BlueShield Minnesota,High Value Network Plan,266.55776,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Biopsy, Prostate; Needle Or Punch, Single Or Multiple, Any Approach (Pro Cah)",,55700,CPT,Professional,Both,,,,694,589.9,78.96,694,BlueCross BlueShield Minnesota,Medicare Advantage,141.3465,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Biopsy, Prostate; Needle Or Punch, Single Or Multiple, Any Approach (Pro Cah)",,55700,CPT,Professional,Both,,,,694,589.9,78.96,694,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,266.55776,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Biopsy, Prostate; Needle Or Punch, Single Or Multiple, Any Approach (Pro Cah)",,55700,CPT,Professional,Both,,,,694,589.9,78.96,694,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,91.16568,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Biopsy, Prostate; Needle Or Punch, Single Or Multiple, Any Approach (Pro Cah)",,55700,CPT,Professional,Both,,,,694,589.9,78.96,694,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),141.3465,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Biopsy, Prostate; Needle Or Punch, Single Or Multiple, Any Approach (Pro Cah)",,55700,CPT,Professional,Both,,,,694,589.9,78.96,694,CorVel,Worker's Compensation,242.1639708,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Biopsy, Prostate; Needle Or Punch, Single Or Multiple, Any Approach (Pro Cah)",,55700,CPT,Professional,Both,,,,694,589.9,78.96,694,First Health Group Corporation,First Health Network,673.18,97,,percent of total billed charges,,
"Biopsy, Prostate; Needle Or Punch, Single Or Multiple, Any Approach (Pro Cah)",,55700,CPT,Professional,Both,,,,694,589.9,78.96,694,"Health Partners, Inc.",Commercial,261.19,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Biopsy, Prostate; Needle Or Punch, Single Or Multiple, Any Approach (Pro Cah)",,55700,CPT,Professional,Both,,,,694,589.9,78.96,694,"Health Partners, Inc.",Medicare Advantage,141.3465,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Biopsy, Prostate; Needle Or Punch, Single Or Multiple, Any Approach (Pro Cah)",,55700,CPT,Professional,Both,,,,694,589.9,78.96,694,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),123.01,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Biopsy, Prostate; Needle Or Punch, Single Or Multiple, Any Approach (Pro Cah)",,55700,CPT,Professional,Both,,,,694,589.9,78.96,694,"Health Partners, Inc.",State of Minnesota Advantage Program,225.015185,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Biopsy, Prostate; Needle Or Punch, Single Or Multiple, Any Approach (Pro Cah)",,55700,CPT,Professional,Both,,,,694,589.9,78.96,694,"Health Partners, Inc.",State Public Programs,78.96,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Biopsy, Prostate; Needle Or Punch, Single Or Multiple, Any Approach (Pro Cah)",,55700,CPT,Professional,Both,,,,694,589.9,78.96,694,Humana Insurance Company,Commercial PPO,122.91,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Biopsy, Prostate; Needle Or Punch, Single Or Multiple, Any Approach (Pro Cah)",,55700,CPT,Professional,Both,,,,694,589.9,78.96,694,Humana Insurance Company,Medicare PPO,694,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Biopsy, Prostate; Needle Or Punch, Single Or Multiple, Any Approach (Pro Cah)",,55700,CPT,Professional,Both,,,,694,589.9,78.96,694,Medica,Individual & Family,588.512,84.8,,percent of total billed charges,,
"Biopsy, Prostate; Needle Or Punch, Single Or Multiple, Any Approach (Pro Cah)",,55700,CPT,Professional,Both,,,,694,589.9,78.96,694,Medica,Medica Advantage Solution,345.612,49.8,,percent of total billed charges,,
"Biopsy, Prostate; Needle Or Punch, Single Or Multiple, Any Approach (Pro Cah)",,55700,CPT,Professional,Both,,,,694,589.9,78.96,694,Medica,Medical Assistance,91.17,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Biopsy, Prostate; Needle Or Punch, Single Or Multiple, Any Approach (Pro Cah)",,55700,CPT,Professional,Both,,,,694,589.9,78.96,694,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,122.91,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Biopsy, Prostate; Needle Or Punch, Single Or Multiple, Any Approach (Pro Cah)",,55700,CPT,Professional,Both,,,,694,589.9,78.96,694,"Multiplan, Inc.","Multiplan, Inc.",652.36,94,,percent of total billed charges,,
"Biopsy, Prostate; Needle Or Punch, Single Or Multiple, Any Approach (Pro Cah)",,55700,CPT,Professional,Both,,,,694,589.9,78.96,694,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,625.294,90.1,,percent of total billed charges,,
"Biopsy, Prostate; Needle Or Punch, Single Or Multiple, Any Approach (Pro Cah)",,55700,CPT,Professional,Both,,,,694,589.9,78.96,694,"Preferred One Administrative Services, INC.",PPO,684.284,98.6,,percent of total billed charges,,
"Biopsy, Prostate; Needle Or Punch, Single Or Multiple, Any Approach (Pro Cah)",,55700,CPT,Professional,Both,,,,694,589.9,78.96,694,PrimeWest Health,Minnesota Senior Health Options (MSHO),141.3465,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Biopsy, Prostate; Needle Or Punch, Single Or Multiple, Any Approach (Pro Cah)",,55700,CPT,Professional,Both,,,,694,589.9,78.96,694,PrimeWest Health,MinnesotaCare,97.5472776,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Biopsy, Prostate; Needle Or Punch, Single Or Multiple, Any Approach (Pro Cah)",,55700,CPT,Professional,Both,,,,694,589.9,78.96,694,Sanford Health Plan,Sanford Health Plan,610.72,88,,percent of total billed charges,,
"Biopsy, Prostate; Needle Or Punch, Single Or Multiple, Any Approach (Pro Cah)",,55700,CPT,Professional,Both,,,,694,589.9,78.96,694,"UCare Health, Inc.",Individual & Family Plan,199.802496,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Biopsy, Prostate; Needle Or Punch, Single Or Multiple, Any Approach (Pro Cah)",,55700,CPT,Professional,Both,,,,694,589.9,78.96,694,"UCare Health, Inc.",Medical Assistance,100.282248,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Biopsy, Prostate; Needle Or Punch, Single Or Multiple, Any Approach (Pro Cah)",,55700,CPT,Professional,Both,,,,694,589.9,78.96,694,"UCare Health, Inc.",Medicare Advantage,141.3465,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Biopsy, Prostate; Needle Or Punch, Single Or Multiple, Any Approach (Pro Cah)",,55700,CPT,Professional,Both,,,,694,589.9,78.96,694,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),113.0772,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Biopsy, Prostate; Needle Or Punch, Single Or Multiple, Any Approach (Pro Cah)",,55700,CPT,Professional,Both,,,,694,589.9,78.96,694,UnitedHealthcare,Individual & Family,694,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Biopsy, Prostate; Needle Or Punch, Single Or Multiple, Any Approach (Pro Cah)",,55700,CPT,Professional,Both,,,,694,589.9,78.96,694,UnitedHealthcare,Medicare Advantage,141.3465,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Biopsy, Prostate; Needle Or Punch, Single Or Multiple, Any Approach (Pro Cah)",,55700,CPT,Professional,Both,,,,694,589.9,78.96,694,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,91.16568,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Biopsies, Prostate, Needle, Transperineal, Stereotactic Template Guided Saturation Sampling, Including Imaging Guidance (Procah)",,55706,CPT,Professional,Both,,,,1760,1496,233.42,1760,Aetna,Commercial,1496,85,,percent of total billed charges,,
"Biopsies, Prostate, Needle, Transperineal, Stereotactic Template Guided Saturation Sampling, Including Imaging Guidance (Procah)",,55706,CPT,Professional,Both,,,,1760,1496,233.42,1760,Aetna,Medicare Advantage,367.37,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Biopsies, Prostate, Needle, Transperineal, Stereotactic Template Guided Saturation Sampling, Including Imaging Guidance (Procah)",,55706,CPT,Professional,Both,,,,1760,1496,233.42,1760,Aetna,PPO,1636.8,93,,percent of total billed charges,,
"Biopsies, Prostate, Needle, Transperineal, Stereotactic Template Guided Saturation Sampling, Including Imaging Guidance (Procah)",,55706,CPT,Professional,Both,,,,1760,1496,233.42,1760,America's PPO,America's PPO,1503.744,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Biopsies, Prostate, Needle, Transperineal, Stereotactic Template Guided Saturation Sampling, Including Imaging Guidance (Procah)",,55706,CPT,Professional,Both,,,,1760,1496,233.42,1760,BlueCross BlueShield Minnesota, Federal Employee Program,765.72,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Biopsies, Prostate, Needle, Transperineal, Stereotactic Template Guided Saturation Sampling, Including Imaging Guidance (Procah)",,55706,CPT,Professional,Both,,,,1760,1496,233.42,1760,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,777.97152,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Biopsies, Prostate, Needle, Transperineal, Stereotactic Template Guided Saturation Sampling, Including Imaging Guidance (Procah)",,55706,CPT,Professional,Both,,,,1760,1496,233.42,1760,BlueCross BlueShield Minnesota,High Value Network Plan,777.97152,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Biopsies, Prostate, Needle, Transperineal, Stereotactic Template Guided Saturation Sampling, Including Imaging Guidance (Procah)",,55706,CPT,Professional,Both,,,,1760,1496,233.42,1760,BlueCross BlueShield Minnesota,Medicare Advantage,417.22,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Biopsies, Prostate, Needle, Transperineal, Stereotactic Template Guided Saturation Sampling, Including Imaging Guidance (Procah)",,55706,CPT,Professional,Both,,,,1760,1496,233.42,1760,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,777.97152,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Biopsies, Prostate, Needle, Transperineal, Stereotactic Template Guided Saturation Sampling, Including Imaging Guidance (Procah)",,55706,CPT,Professional,Both,,,,1760,1496,233.42,1760,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,269.494,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Biopsies, Prostate, Needle, Transperineal, Stereotactic Template Guided Saturation Sampling, Including Imaging Guidance (Procah)",,55706,CPT,Professional,Both,,,,1760,1496,233.42,1760,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),417.22,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Biopsies, Prostate, Needle, Transperineal, Stereotactic Template Guided Saturation Sampling, Including Imaging Guidance (Procah)",,55706,CPT,Professional,Both,,,,1760,1496,233.42,1760,CorVel,Worker's Compensation,711.3094773,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Biopsies, Prostate, Needle, Transperineal, Stereotactic Template Guided Saturation Sampling, Including Imaging Guidance (Procah)",,55706,CPT,Professional,Both,,,,1760,1496,233.42,1760,First Health Group Corporation,First Health Network,1707.2,97,,percent of total billed charges,,
"Biopsies, Prostate, Needle, Transperineal, Stereotactic Template Guided Saturation Sampling, Including Imaging Guidance (Procah)",,55706,CPT,Professional,Both,,,,1760,1496,233.42,1760,"Health Partners, Inc.",Commercial,768.33,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Biopsies, Prostate, Needle, Transperineal, Stereotactic Template Guided Saturation Sampling, Including Imaging Guidance (Procah)",,55706,CPT,Professional,Both,,,,1760,1496,233.42,1760,"Health Partners, Inc.",Medicare Advantage,417.22,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Biopsies, Prostate, Needle, Transperineal, Stereotactic Template Guided Saturation Sampling, Including Imaging Guidance (Procah)",,55706,CPT,Professional,Both,,,,1760,1496,233.42,1760,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),362.93,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Biopsies, Prostate, Needle, Transperineal, Stereotactic Template Guided Saturation Sampling, Including Imaging Guidance (Procah)",,55706,CPT,Professional,Both,,,,1760,1496,233.42,1760,"Health Partners, Inc.",State of Minnesota Advantage Program,661.916295,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Biopsies, Prostate, Needle, Transperineal, Stereotactic Template Guided Saturation Sampling, Including Imaging Guidance (Procah)",,55706,CPT,Professional,Both,,,,1760,1496,233.42,1760,"Health Partners, Inc.",State Public Programs,233.42,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Biopsies, Prostate, Needle, Transperineal, Stereotactic Template Guided Saturation Sampling, Including Imaging Guidance (Procah)",,55706,CPT,Professional,Both,,,,1760,1496,233.42,1760,Humana Insurance Company,Commercial PPO,362.8,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Biopsies, Prostate, Needle, Transperineal, Stereotactic Template Guided Saturation Sampling, Including Imaging Guidance (Procah)",,55706,CPT,Professional,Both,,,,1760,1496,233.42,1760,Humana Insurance Company,Medicare PPO,1760,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Biopsies, Prostate, Needle, Transperineal, Stereotactic Template Guided Saturation Sampling, Including Imaging Guidance (Procah)",,55706,CPT,Professional,Both,,,,1760,1496,233.42,1760,Medica,Individual & Family,1492.48,84.8,,percent of total billed charges,,
"Biopsies, Prostate, Needle, Transperineal, Stereotactic Template Guided Saturation Sampling, Including Imaging Guidance (Procah)",,55706,CPT,Professional,Both,,,,1760,1496,233.42,1760,Medica,Medica Advantage Solution,876.48,49.8,,percent of total billed charges,,
"Biopsies, Prostate, Needle, Transperineal, Stereotactic Template Guided Saturation Sampling, Including Imaging Guidance (Procah)",,55706,CPT,Professional,Both,,,,1760,1496,233.42,1760,Medica,Medical Assistance,269.49,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Biopsies, Prostate, Needle, Transperineal, Stereotactic Template Guided Saturation Sampling, Including Imaging Guidance (Procah)",,55706,CPT,Professional,Both,,,,1760,1496,233.42,1760,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,362.8,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Biopsies, Prostate, Needle, Transperineal, Stereotactic Template Guided Saturation Sampling, Including Imaging Guidance (Procah)",,55706,CPT,Professional,Both,,,,1760,1496,233.42,1760,"Multiplan, Inc.","Multiplan, Inc.",1654.4,94,,percent of total billed charges,,
"Biopsies, Prostate, Needle, Transperineal, Stereotactic Template Guided Saturation Sampling, Including Imaging Guidance (Procah)",,55706,CPT,Professional,Both,,,,1760,1496,233.42,1760,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1585.76,90.1,,percent of total billed charges,,
"Biopsies, Prostate, Needle, Transperineal, Stereotactic Template Guided Saturation Sampling, Including Imaging Guidance (Procah)",,55706,CPT,Professional,Both,,,,1760,1496,233.42,1760,"Preferred One Administrative Services, INC.",PPO,1735.36,98.6,,percent of total billed charges,,
"Biopsies, Prostate, Needle, Transperineal, Stereotactic Template Guided Saturation Sampling, Including Imaging Guidance (Procah)",,55706,CPT,Professional,Both,,,,1760,1496,233.42,1760,PrimeWest Health,Minnesota Senior Health Options (MSHO),417.22,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Biopsies, Prostate, Needle, Transperineal, Stereotactic Template Guided Saturation Sampling, Including Imaging Guidance (Procah)",,55706,CPT,Professional,Both,,,,1760,1496,233.42,1760,PrimeWest Health,MinnesotaCare,288.35858,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Biopsies, Prostate, Needle, Transperineal, Stereotactic Template Guided Saturation Sampling, Including Imaging Guidance (Procah)",,55706,CPT,Professional,Both,,,,1760,1496,233.42,1760,Sanford Health Plan,Sanford Health Plan,1548.8,88,,percent of total billed charges,,
"Biopsies, Prostate, Needle, Transperineal, Stereotactic Template Guided Saturation Sampling, Including Imaging Guidance (Procah)",,55706,CPT,Professional,Both,,,,1760,1496,233.42,1760,"UCare Health, Inc.",Individual & Family Plan,589.76768,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Biopsies, Prostate, Needle, Transperineal, Stereotactic Template Guided Saturation Sampling, Including Imaging Guidance (Procah)",,55706,CPT,Professional,Both,,,,1760,1496,233.42,1760,"UCare Health, Inc.",Medical Assistance,296.4434,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Biopsies, Prostate, Needle, Transperineal, Stereotactic Template Guided Saturation Sampling, Including Imaging Guidance (Procah)",,55706,CPT,Professional,Both,,,,1760,1496,233.42,1760,"UCare Health, Inc.",Medicare Advantage,417.22,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Biopsies, Prostate, Needle, Transperineal, Stereotactic Template Guided Saturation Sampling, Including Imaging Guidance (Procah)",,55706,CPT,Professional,Both,,,,1760,1496,233.42,1760,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),333.776,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Biopsies, Prostate, Needle, Transperineal, Stereotactic Template Guided Saturation Sampling, Including Imaging Guidance (Procah)",,55706,CPT,Professional,Both,,,,1760,1496,233.42,1760,UnitedHealthcare,Individual & Family,1760,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Biopsies, Prostate, Needle, Transperineal, Stereotactic Template Guided Saturation Sampling, Including Imaging Guidance (Procah)",,55706,CPT,Professional,Both,,,,1760,1496,233.42,1760,UnitedHealthcare,Medicare Advantage,417.22,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Biopsies, Prostate, Needle, Transperineal, Stereotactic Template Guided Saturation Sampling, Including Imaging Guidance (Procah)",,55706,CPT,Professional,Both,,,,1760,1496,233.42,1760,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,269.494,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Prostate Biopsy With Ultrasound Guidance,,55706,CPT,Facility,Both,,,,1148,975.8,329.0168,1148,Aetna,Commercial,1056.16,92,,percent of total billed charges,,
Prostate Biopsy With Ultrasound Guidance,,55706,CPT,Facility,Outpatient,,,,1148,975.8,329.0168,1148,Aetna,Medicare Advantage,562.52,49,,percent of total billed charges,,
Prostate Biopsy With Ultrasound Guidance,,55706,CPT,Facility,Inpatient,,,,1148,975.8,329.0168,1148,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Prostate Biopsy With Ultrasound Guidance,,55706,CPT,Facility,Both,,,,1148,975.8,329.0168,1148,Aetna,PPO,1067.64,93,,percent of total billed charges,,
Prostate Biopsy With Ultrasound Guidance,,55706,CPT,Facility,Both,,,,1148,975.8,329.0168,1148,America's PPO,America's PPO,1102.4244,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Prostate Biopsy With Ultrasound Guidance,,55706,CPT,Facility,Both,,,,1148,975.8,329.0168,1148,BlueCross BlueShield Minnesota, Federal Employee Program,1129.632,98.4,,percent of total billed charges,,
Prostate Biopsy With Ultrasound Guidance,,55706,CPT,Facility,Both,,,,1148,975.8,329.0168,1148,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1148,100,,percent of total billed charges,,
Prostate Biopsy With Ultrasound Guidance,,55706,CPT,Facility,Both,,,,1148,975.8,329.0168,1148,BlueCross BlueShield Minnesota,High Value Network Plan,1033.2,90,,percent of total billed charges,,
Prostate Biopsy With Ultrasound Guidance,,55706,CPT,Facility,Outpatient,,,,1148,975.8,329.0168,1148,BlueCross BlueShield Minnesota,Medicare Advantage,562.52,49,,percent of total billed charges,,
Prostate Biopsy With Ultrasound Guidance,,55706,CPT,Facility,Inpatient,,,,1148,975.8,329.0168,1148,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Prostate Biopsy With Ultrasound Guidance,,55706,CPT,Facility,Both,,,,1148,975.8,329.0168,1148,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1016.7836,88.57,,percent of total billed charges,,
Prostate Biopsy With Ultrasound Guidance,,55706,CPT,Facility,Both,,,,1148,975.8,329.0168,1148,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,329.0168,28.66,,percent of total billed charges,,
Prostate Biopsy With Ultrasound Guidance,,55706,CPT,Facility,Outpatient,,,,1148,975.8,329.0168,1148,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),562.52,49,,percent of total billed charges,,
Prostate Biopsy With Ultrasound Guidance,,55706,CPT,Facility,Inpatient,,,,1148,975.8,329.0168,1148,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Prostate Biopsy With Ultrasound Guidance,,55706,CPT,Facility,Both,,,,1148,975.8,329.0168,1148,CorVel,Worker's Compensation,1148,100,,percent of total billed charges,,
Prostate Biopsy With Ultrasound Guidance,,55706,CPT,Facility,Both,,,,1148,975.8,329.0168,1148,First Health Group Corporation,First Health Network,1113.56,97,,percent of total billed charges,,
Prostate Biopsy With Ultrasound Guidance,,55706,CPT,Facility,Both,,,,1148,975.8,329.0168,1148,"Health Partners, Inc.",Commercial,1086.008,94.6,,percent of total billed charges,,
Prostate Biopsy With Ultrasound Guidance,,55706,CPT,Facility,Outpatient,,,,1148,975.8,329.0168,1148,"Health Partners, Inc.",Medicare Advantage,562.52,49,,percent of total billed charges,,
Prostate Biopsy With Ultrasound Guidance,,55706,CPT,Facility,Inpatient,,,,1148,975.8,329.0168,1148,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Prostate Biopsy With Ultrasound Guidance,,55706,CPT,Facility,Both,,,,1148,975.8,329.0168,1148,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),688.8,60,,percent of total billed charges,,
Prostate Biopsy With Ultrasound Guidance,,55706,CPT,Facility,Both,,,,1148,975.8,329.0168,1148,"Health Partners, Inc.",State of Minnesota Advantage Program,935.62,81.5,,percent of total billed charges,,
Prostate Biopsy With Ultrasound Guidance,,55706,CPT,Facility,Both,,,,1148,975.8,329.0168,1148,"Health Partners, Inc.",State Public Programs,574,50,,percent of total billed charges,,
Prostate Biopsy With Ultrasound Guidance,,55706,CPT,Facility,Both,,,,1148,975.8,329.0168,1148,Humana Insurance Company,Commercial PPO,1090.6,95,,percent of total billed charges,,
Prostate Biopsy With Ultrasound Guidance,,55706,CPT,Facility,Outpatient,,,,1148,975.8,329.0168,1148,Humana Insurance Company,Medicare PPO,562.52,49,,percent of total billed charges,,
Prostate Biopsy With Ultrasound Guidance,,55706,CPT,Facility,Inpatient,,,,1148,975.8,329.0168,1148,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Prostate Biopsy With Ultrasound Guidance,,55706,CPT,Facility,Both,,,,1148,975.8,329.0168,1148,Medica,Individual & Family,1137.668,99.1,,percent of total billed charges,,
Prostate Biopsy With Ultrasound Guidance,,55706,CPT,Facility,Outpatient,,,,1148,975.8,329.0168,1148,Medica,Medica Advantage Solution,571.704,49.8,,percent of total billed charges,,
Prostate Biopsy With Ultrasound Guidance,,55706,CPT,Facility,Inpatient,,,,1148,975.8,329.0168,1148,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Prostate Biopsy With Ultrasound Guidance,,55706,CPT,Facility,Outpatient,,,,1148,975.8,329.0168,1148,Medica,Medical Assistance,724,,,Other,Grouper,All inclusive per visit
Prostate Biopsy With Ultrasound Guidance,,55706,CPT,Facility,Inpatient,,,,1148,975.8,329.0168,1148,Medica,Medical Assistance,,,,,Included in per diem rate,
Prostate Biopsy With Ultrasound Guidance,,55706,CPT,Facility,Outpatient,,,,1148,975.8,329.0168,1148,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,571.704,49.8,,percent of total billed charges,,
Prostate Biopsy With Ultrasound Guidance,,55706,CPT,Facility,Inpatient,,,,1148,975.8,329.0168,1148,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Prostate Biopsy With Ultrasound Guidance,,55706,CPT,Facility,Both,,,,1148,975.8,329.0168,1148,"Multiplan, Inc.","Multiplan, Inc.",1079.12,94,,percent of total billed charges,,
Prostate Biopsy With Ultrasound Guidance,,55706,CPT,Facility,Outpatient,,,,1148,975.8,329.0168,1148,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1034.348,90.1,,percent of total billed charges,,
Prostate Biopsy With Ultrasound Guidance,,55706,CPT,Facility,Inpatient,,,,1148,975.8,329.0168,1148,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Prostate Biopsy With Ultrasound Guidance,,55706,CPT,Facility,Both,,,,1148,975.8,329.0168,1148,"Preferred One Administrative Services, INC.",PPO,1131.928,98.6,,percent of total billed charges,,
Prostate Biopsy With Ultrasound Guidance,,55706,CPT,Facility,Outpatient,,,,1148,975.8,329.0168,1148,PrimeWest Health,Minnesota Senior Health Options (MSHO),590.646,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Prostate Biopsy With Ultrasound Guidance,,55706,CPT,Facility,Inpatient,,,,1148,975.8,329.0168,1148,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Prostate Biopsy With Ultrasound Guidance,,55706,CPT,Facility,Outpatient,,,,1148,975.8,329.0168,1148,PrimeWest Health,MinnesotaCare,589.6128,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Prostate Biopsy With Ultrasound Guidance,,55706,CPT,Facility,Inpatient,,,,1148,975.8,329.0168,1148,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Prostate Biopsy With Ultrasound Guidance,,55706,CPT,Facility,Both,,,,1148,975.8,329.0168,1148,Sanford Health Plan,Sanford Health Plan,1056.16,92,,percent of total billed charges,,
Prostate Biopsy With Ultrasound Guidance,,55706,CPT,Facility,Outpatient,,,,1148,975.8,329.0168,1148,"UCare Health, Inc.",Individual & Family Plan,646.898,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Prostate Biopsy With Ultrasound Guidance,,55706,CPT,Facility,Inpatient,,,,1148,975.8,329.0168,1148,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Prostate Biopsy With Ultrasound Guidance,,55706,CPT,Facility,Outpatient,,,,1148,975.8,329.0168,1148,"UCare Health, Inc.",Medical Assistance,579.3956,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Prostate Biopsy With Ultrasound Guidance,,55706,CPT,Facility,Inpatient,,,,1148,975.8,329.0168,1148,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Prostate Biopsy With Ultrasound Guidance,,55706,CPT,Facility,Outpatient,,,,1148,975.8,329.0168,1148,"UCare Health, Inc.",Medicare Advantage,579.3956,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Prostate Biopsy With Ultrasound Guidance,,55706,CPT,Facility,Inpatient,,,,1148,975.8,329.0168,1148,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Prostate Biopsy With Ultrasound Guidance,,55706,CPT,Facility,Outpatient,,,,1148,975.8,329.0168,1148,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),579.3956,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Prostate Biopsy With Ultrasound Guidance,,55706,CPT,Facility,Inpatient,,,,1148,975.8,329.0168,1148,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Prostate Biopsy With Ultrasound Guidance,,55706,CPT,Facility,Both,,,,1148,975.8,329.0168,1148,UnitedHealthcare,Individual & Family,1079.12,94,,percent of total billed charges,,
Prostate Biopsy With Ultrasound Guidance,,55706,CPT,Facility,Outpatient,,,,1148,975.8,329.0168,1148,UnitedHealthcare,Medicare Advantage,562.52,49,,percent of total billed charges,,
Prostate Biopsy With Ultrasound Guidance,,55706,CPT,Facility,Inpatient,,,,1148,975.8,329.0168,1148,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Prostate Biopsy With Ultrasound Guidance,,55706,CPT,Facility,Outpatient,,,,1148,975.8,329.0168,1148,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,551.04,48,,percent of total billed charges,,100% of DHS outpatient percentage
Prostate Biopsy With Ultrasound Guidance,,55706,CPT,Facility,Inpatient,,,,1148,975.8,329.0168,1148,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Laparoscopy, Surgical Prostatectomy, Simple Subtotal, Includes Robotic Assistance, When Performed (Pro Cah)",,55867,CPT,Professional,Both,,,,2495,2120.75,643.32,2495,Aetna,Commercial,2120.75,85,,percent of total billed charges,,
"Laparoscopy, Surgical Prostatectomy, Simple Subtotal, Includes Robotic Assistance, When Performed (Pro Cah)",,55867,CPT,Professional,Both,,,,2495,2120.75,643.32,2495,Aetna,Medicare Advantage,2495,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Laparoscopy, Surgical Prostatectomy, Simple Subtotal, Includes Robotic Assistance, When Performed (Pro Cah)",,55867,CPT,Professional,Both,,,,2495,2120.75,643.32,2495,Aetna,PPO,2320.35,93,,percent of total billed charges,,
"Laparoscopy, Surgical Prostatectomy, Simple Subtotal, Includes Robotic Assistance, When Performed (Pro Cah)",,55867,CPT,Professional,Both,,,,2495,2120.75,643.32,2495,America's PPO,America's PPO,2131.728,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Laparoscopy, Surgical Prostatectomy, Simple Subtotal, Includes Robotic Assistance, When Performed (Pro Cah)",,55867,CPT,Professional,Both,,,,2495,2120.75,643.32,2495,BlueCross BlueShield Minnesota, Federal Employee Program,2127.09,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Laparoscopy, Surgical Prostatectomy, Simple Subtotal, Includes Robotic Assistance, When Performed (Pro Cah)",,55867,CPT,Professional,Both,,,,2495,2120.75,643.32,2495,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,2161.12344,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Laparoscopy, Surgical Prostatectomy, Simple Subtotal, Includes Robotic Assistance, When Performed (Pro Cah)",,55867,CPT,Professional,Both,,,,2495,2120.75,643.32,2495,BlueCross BlueShield Minnesota,High Value Network Plan,2161.12344,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Laparoscopy, Surgical Prostatectomy, Simple Subtotal, Includes Robotic Assistance, When Performed (Pro Cah)",,55867,CPT,Professional,Both,,,,2495,2120.75,643.32,2495,BlueCross BlueShield Minnesota,Medicare Advantage,1149.2755,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Laparoscopy, Surgical Prostatectomy, Simple Subtotal, Includes Robotic Assistance, When Performed (Pro Cah)",,55867,CPT,Professional,Both,,,,2495,2120.75,643.32,2495,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,2161.12344,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Laparoscopy, Surgical Prostatectomy, Simple Subtotal, Includes Robotic Assistance, When Performed (Pro Cah)",,55867,CPT,Professional,Both,,,,2495,2120.75,643.32,2495,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,742.7468,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Laparoscopy, Surgical Prostatectomy, Simple Subtotal, Includes Robotic Assistance, When Performed (Pro Cah)",,55867,CPT,Professional,Both,,,,2495,2120.75,643.32,2495,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1149.2755,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Laparoscopy, Surgical Prostatectomy, Simple Subtotal, Includes Robotic Assistance, When Performed (Pro Cah)",,55867,CPT,Professional,Both,,,,2495,2120.75,643.32,2495,CorVel,Worker's Compensation,,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Laparoscopy, Surgical Prostatectomy, Simple Subtotal, Includes Robotic Assistance, When Performed (Pro Cah)",,55867,CPT,Professional,Both,,,,2495,2120.75,643.32,2495,First Health Group Corporation,First Health Network,2420.15,97,,percent of total billed charges,,
"Laparoscopy, Surgical Prostatectomy, Simple Subtotal, Includes Robotic Assistance, When Performed (Pro Cah)",,55867,CPT,Professional,Both,,,,2495,2120.75,643.32,2495,"Health Partners, Inc.",Commercial,2139.57,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Laparoscopy, Surgical Prostatectomy, Simple Subtotal, Includes Robotic Assistance, When Performed (Pro Cah)",,55867,CPT,Professional,Both,,,,2495,2120.75,643.32,2495,"Health Partners, Inc.",Medicare Advantage,1149.2755,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Laparoscopy, Surgical Prostatectomy, Simple Subtotal, Includes Robotic Assistance, When Performed (Pro Cah)",,55867,CPT,Professional,Both,,,,2495,2120.75,643.32,2495,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),999.33,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Laparoscopy, Surgical Prostatectomy, Simple Subtotal, Includes Robotic Assistance, When Performed (Pro Cah)",,55867,CPT,Professional,Both,,,,2495,2120.75,643.32,2495,"Health Partners, Inc.",State of Minnesota Advantage Program,1843.239555,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Laparoscopy, Surgical Prostatectomy, Simple Subtotal, Includes Robotic Assistance, When Performed (Pro Cah)",,55867,CPT,Professional,Both,,,,2495,2120.75,643.32,2495,"Health Partners, Inc.",State Public Programs,643.32,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Laparoscopy, Surgical Prostatectomy, Simple Subtotal, Includes Robotic Assistance, When Performed (Pro Cah)",,55867,CPT,Professional,Both,,,,2495,2120.75,643.32,2495,Humana Insurance Company,Commercial PPO,999.37,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Laparoscopy, Surgical Prostatectomy, Simple Subtotal, Includes Robotic Assistance, When Performed (Pro Cah)",,55867,CPT,Professional,Both,,,,2495,2120.75,643.32,2495,Humana Insurance Company,Medicare PPO,2495,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Laparoscopy, Surgical Prostatectomy, Simple Subtotal, Includes Robotic Assistance, When Performed (Pro Cah)",,55867,CPT,Professional,Both,,,,2495,2120.75,643.32,2495,Medica,Individual & Family,2115.76,84.8,,percent of total billed charges,,
"Laparoscopy, Surgical Prostatectomy, Simple Subtotal, Includes Robotic Assistance, When Performed (Pro Cah)",,55867,CPT,Professional,Both,,,,2495,2120.75,643.32,2495,Medica,Medica Advantage Solution,1242.51,49.8,,percent of total billed charges,,
"Laparoscopy, Surgical Prostatectomy, Simple Subtotal, Includes Robotic Assistance, When Performed (Pro Cah)",,55867,CPT,Professional,Both,,,,2495,2120.75,643.32,2495,Medica,Medical Assistance,742.75,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Laparoscopy, Surgical Prostatectomy, Simple Subtotal, Includes Robotic Assistance, When Performed (Pro Cah)",,55867,CPT,Professional,Both,,,,2495,2120.75,643.32,2495,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,999.37,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Laparoscopy, Surgical Prostatectomy, Simple Subtotal, Includes Robotic Assistance, When Performed (Pro Cah)",,55867,CPT,Professional,Both,,,,2495,2120.75,643.32,2495,"Multiplan, Inc.","Multiplan, Inc.",2345.3,94,,percent of total billed charges,,
"Laparoscopy, Surgical Prostatectomy, Simple Subtotal, Includes Robotic Assistance, When Performed (Pro Cah)",,55867,CPT,Professional,Both,,,,2495,2120.75,643.32,2495,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,2247.995,90.1,,percent of total billed charges,,
"Laparoscopy, Surgical Prostatectomy, Simple Subtotal, Includes Robotic Assistance, When Performed (Pro Cah)",,55867,CPT,Professional,Both,,,,2495,2120.75,643.32,2495,"Preferred One Administrative Services, INC.",PPO,2460.07,98.6,,percent of total billed charges,,
"Laparoscopy, Surgical Prostatectomy, Simple Subtotal, Includes Robotic Assistance, When Performed (Pro Cah)",,55867,CPT,Professional,Both,,,,2495,2120.75,643.32,2495,PrimeWest Health,Minnesota Senior Health Options (MSHO),1149.2755,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Laparoscopy, Surgical Prostatectomy, Simple Subtotal, Includes Robotic Assistance, When Performed (Pro Cah)",,55867,CPT,Professional,Both,,,,2495,2120.75,643.32,2495,PrimeWest Health,MinnesotaCare,794.739076,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Laparoscopy, Surgical Prostatectomy, Simple Subtotal, Includes Robotic Assistance, When Performed (Pro Cah)",,55867,CPT,Professional,Both,,,,2495,2120.75,643.32,2495,Sanford Health Plan,Sanford Health Plan,2195.6,88,,percent of total billed charges,,
"Laparoscopy, Surgical Prostatectomy, Simple Subtotal, Includes Robotic Assistance, When Performed (Pro Cah)",,55867,CPT,Professional,Both,,,,2495,2120.75,643.32,2495,"UCare Health, Inc.",Individual & Family Plan,1624.575872,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Laparoscopy, Surgical Prostatectomy, Simple Subtotal, Includes Robotic Assistance, When Performed (Pro Cah)",,55867,CPT,Professional,Both,,,,2495,2120.75,643.32,2495,"UCare Health, Inc.",Medical Assistance,817.02148,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Laparoscopy, Surgical Prostatectomy, Simple Subtotal, Includes Robotic Assistance, When Performed (Pro Cah)",,55867,CPT,Professional,Both,,,,2495,2120.75,643.32,2495,"UCare Health, Inc.",Medicare Advantage,1149.2755,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Laparoscopy, Surgical Prostatectomy, Simple Subtotal, Includes Robotic Assistance, When Performed (Pro Cah)",,55867,CPT,Professional,Both,,,,2495,2120.75,643.32,2495,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),919.4204,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Laparoscopy, Surgical Prostatectomy, Simple Subtotal, Includes Robotic Assistance, When Performed (Pro Cah)",,55867,CPT,Professional,Both,,,,2495,2120.75,643.32,2495,UnitedHealthcare,Individual & Family,2495,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Laparoscopy, Surgical Prostatectomy, Simple Subtotal, Includes Robotic Assistance, When Performed (Pro Cah)",,55867,CPT,Professional,Both,,,,2495,2120.75,643.32,2495,UnitedHealthcare,Medicare Advantage,1149.2755,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Laparoscopy, Surgical Prostatectomy, Simple Subtotal, Includes Robotic Assistance, When Performed (Pro Cah)",,55867,CPT,Professional,Both,,,,2495,2120.75,643.32,2495,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,742.7468,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Excision Of Bartholin'S Gland Or Cyst (Pbb),,56740,CPT,Facility,Outpatient,,,,1204,1023.4,345.0664,1204,Aetna,Commercial,1107.68,92,,percent of total billed charges,,
Excision Of Bartholin'S Gland Or Cyst (Pbb),,56740,CPT,Professional,Outpatient,,,,1203,1022.55,196.12,1203,Aetna,Commercial,1022.55,85,,percent of total billed charges,,
Excision Of Bartholin'S Gland Or Cyst (Pbb),,56740,CPT,Facility,Outpatient,,,,1204,1023.4,345.0664,1204,Aetna,Medicare Advantage,589.96,49,,percent of total billed charges,,
Excision Of Bartholin'S Gland Or Cyst (Pbb),,56740,CPT,Professional,Outpatient,,,,1203,1022.55,196.12,1203,Aetna,Medicare Advantage,306.43,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Excision Of Bartholin'S Gland Or Cyst (Pbb),,56740,CPT,Facility,Outpatient,,,,1204,1023.4,345.0664,1204,Aetna,PPO,1119.72,93,,percent of total billed charges,,
Excision Of Bartholin'S Gland Or Cyst (Pbb),,56740,CPT,Professional,Outpatient,,,,1203,1022.55,196.12,1203,Aetna,PPO,1118.79,93,,percent of total billed charges,,
Excision Of Bartholin'S Gland Or Cyst (Pbb),,56740,CPT,Facility,Outpatient,,,,1204,1023.4,345.0664,1204,America's PPO,America's PPO,1156.2012,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Excision Of Bartholin'S Gland Or Cyst (Pbb),,56740,CPT,Professional,Outpatient,,,,1203,1022.55,196.12,1203,America's PPO,America's PPO,1027.8432,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Excision Of Bartholin'S Gland Or Cyst (Pbb),,56740,CPT,Facility,Outpatient,,,,1204,1023.4,345.0664,1204,BlueCross BlueShield Minnesota, Federal Employee Program,1184.736,98.4,,percent of total billed charges,,
Excision Of Bartholin'S Gland Or Cyst (Pbb),,56740,CPT,Professional,Outpatient,,,,1203,1022.55,196.12,1203,BlueCross BlueShield Minnesota, Federal Employee Program,652.79,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Excision Of Bartholin'S Gland Or Cyst (Pbb),,56740,CPT,Facility,Outpatient,,,,1204,1023.4,345.0664,1204,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1204,100,,percent of total billed charges,,
Excision Of Bartholin'S Gland Or Cyst (Pbb),,56740,CPT,Professional,Outpatient,,,,1203,1022.55,196.12,1203,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,663.23464,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Excision Of Bartholin'S Gland Or Cyst (Pbb),,56740,CPT,Facility,Outpatient,,,,1204,1023.4,345.0664,1204,BlueCross BlueShield Minnesota,High Value Network Plan,1083.6,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
Excision Of Bartholin'S Gland Or Cyst (Pbb),,56740,CPT,Professional,Outpatient,,,,1203,1022.55,196.12,1203,BlueCross BlueShield Minnesota,High Value Network Plan,663.23464,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Excision Of Bartholin'S Gland Or Cyst (Pbb),,56740,CPT,Facility,Outpatient,,,,1204,1023.4,345.0664,1204,BlueCross BlueShield Minnesota,Medicare Advantage,589.96,49,,percent of total billed charges,,
Excision Of Bartholin'S Gland Or Cyst (Pbb),,56740,CPT,Professional,Outpatient,,,,1203,1022.55,196.12,1203,BlueCross BlueShield Minnesota,Medicare Advantage,350.704,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Excision Of Bartholin'S Gland Or Cyst (Pbb),,56740,CPT,Professional,Outpatient,,,,1203,1022.55,196.12,1203,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,663.23464,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Excision Of Bartholin'S Gland Or Cyst (Pbb),,56740,CPT,Facility,Outpatient,,,,1204,1023.4,345.0664,1204,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,345.0664,28.66,,percent of total billed charges,,
Excision Of Bartholin'S Gland Or Cyst (Pbb),,56740,CPT,Professional,Outpatient,,,,1203,1022.55,196.12,1203,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,226.42576,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Excision Of Bartholin'S Gland Or Cyst (Pbb),,56740,CPT,Facility,Outpatient,,,,1204,1023.4,345.0664,1204,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),589.96,49,,percent of total billed charges,,
Excision Of Bartholin'S Gland Or Cyst (Pbb),,56740,CPT,Professional,Outpatient,,,,1203,1022.55,196.12,1203,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),350.704,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Excision Of Bartholin'S Gland Or Cyst (Pbb),,56740,CPT,Facility,Outpatient,,,,1204,1023.4,345.0664,1204,CorVel,Worker's Compensation,1204,100,,percent of total billed charges,,
Excision Of Bartholin'S Gland Or Cyst (Pbb),,56740,CPT,Professional,Outpatient,,,,1203,1022.55,196.12,1203,CorVel,Worker's Compensation,600.8275896,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Excision Of Bartholin'S Gland Or Cyst (Pbb),,56740,CPT,Facility,Outpatient,,,,1204,1023.4,345.0664,1204,First Health Group Corporation,First Health Network,1167.88,97,,percent of total billed charges,,
Excision Of Bartholin'S Gland Or Cyst (Pbb),,56740,CPT,Professional,Outpatient,,,,1203,1022.55,196.12,1203,First Health Group Corporation,First Health Network,1166.91,97,,percent of total billed charges,,
Excision Of Bartholin'S Gland Or Cyst (Pbb),,56740,CPT,Facility,Outpatient,,,,1204,1023.4,345.0664,1204,"Health Partners, Inc.",Commercial,1138.984,94.6,,percent of total billed charges,,
Excision Of Bartholin'S Gland Or Cyst (Pbb),,56740,CPT,Professional,Outpatient,,,,1203,1022.55,196.12,1203,"Health Partners, Inc.",Commercial,649.35,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Excision Of Bartholin'S Gland Or Cyst (Pbb),,56740,CPT,Facility,Outpatient,,,,1204,1023.4,345.0664,1204,"Health Partners, Inc.",Medicare Advantage,589.96,49,,percent of total billed charges,,
Excision Of Bartholin'S Gland Or Cyst (Pbb),,56740,CPT,Professional,Outpatient,,,,1203,1022.55,196.12,1203,"Health Partners, Inc.",Medicare Advantage,350.704,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Excision Of Bartholin'S Gland Or Cyst (Pbb),,56740,CPT,Facility,Outpatient,,,,1204,1023.4,345.0664,1204,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),722.4,60,,percent of total billed charges,,
Excision Of Bartholin'S Gland Or Cyst (Pbb),,56740,CPT,Professional,Outpatient,,,,1203,1022.55,196.12,1203,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),304.98,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Excision Of Bartholin'S Gland Or Cyst (Pbb),,56740,CPT,Facility,Outpatient,,,,1204,1023.4,345.0664,1204,"Health Partners, Inc.",State of Minnesota Advantage Program,981.26,81.5,,percent of total billed charges,,
Excision Of Bartholin'S Gland Or Cyst (Pbb),,56740,CPT,Professional,Outpatient,,,,1203,1022.55,196.12,1203,"Health Partners, Inc.",State of Minnesota Advantage Program,559.415025,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Excision Of Bartholin'S Gland Or Cyst (Pbb),,56740,CPT,Facility,Outpatient,,,,1204,1023.4,345.0664,1204,"Health Partners, Inc.",State Public Programs,602,50,,percent of total billed charges,,
Excision Of Bartholin'S Gland Or Cyst (Pbb),,56740,CPT,Professional,Outpatient,,,,1203,1022.55,196.12,1203,"Health Partners, Inc.",State Public Programs,196.12,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Excision Of Bartholin'S Gland Or Cyst (Pbb),,56740,CPT,Facility,Outpatient,,,,1204,1023.4,345.0664,1204,Humana Insurance Company,Commercial PPO,1143.8,95,,percent of total billed charges,,
Excision Of Bartholin'S Gland Or Cyst (Pbb),,56740,CPT,Professional,Outpatient,,,,1203,1022.55,196.12,1203,Humana Insurance Company,Commercial PPO,304.96,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Excision Of Bartholin'S Gland Or Cyst (Pbb),,56740,CPT,Facility,Outpatient,,,,1204,1023.4,345.0664,1204,Humana Insurance Company,Medicare PPO,589.96,49,,percent of total billed charges,,
Excision Of Bartholin'S Gland Or Cyst (Pbb),,56740,CPT,Professional,Outpatient,,,,1203,1022.55,196.12,1203,Humana Insurance Company,Medicare PPO,1203,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Excision Of Bartholin'S Gland Or Cyst (Pbb),,56740,CPT,Facility,Outpatient,,,,1204,1023.4,345.0664,1204,Medica,Individual & Family,1193.164,99.1,,percent of total billed charges,,
Excision Of Bartholin'S Gland Or Cyst (Pbb),,56740,CPT,Professional,Outpatient,,,,1203,1022.55,196.12,1203,Medica,Individual & Family,1020.144,84.8,,percent of total billed charges,,
Excision Of Bartholin'S Gland Or Cyst (Pbb),,56740,CPT,Facility,Outpatient,,,,1204,1023.4,345.0664,1204,Medica,Medica Advantage Solution,599.592,49.8,,percent of total billed charges,,
Excision Of Bartholin'S Gland Or Cyst (Pbb),,56740,CPT,Professional,Outpatient,,,,1203,1022.55,196.12,1203,Medica,Medica Advantage Solution,599.094,49.8,,percent of total billed charges,,
Excision Of Bartholin'S Gland Or Cyst (Pbb),,56740,CPT,Facility,Outpatient,,,,1204,1023.4,345.0664,1204,Medica,Medical Assistance,536.984,44.6,,percent of total billed charges,,
Excision Of Bartholin'S Gland Or Cyst (Pbb),,56740,CPT,Professional,Outpatient,,,,1203,1022.55,196.12,1203,Medica,Medical Assistance,226.43,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Excision Of Bartholin'S Gland Or Cyst (Pbb),,56740,CPT,Facility,Outpatient,,,,1204,1023.4,345.0664,1204,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,599.592,49.8,,percent of total billed charges,,
Excision Of Bartholin'S Gland Or Cyst (Pbb),,56740,CPT,Professional,Outpatient,,,,1203,1022.55,196.12,1203,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,304.96,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Excision Of Bartholin'S Gland Or Cyst (Pbb),,56740,CPT,Facility,Outpatient,,,,1204,1023.4,345.0664,1204,"Multiplan, Inc.","Multiplan, Inc.",1131.76,94,,percent of total billed charges,,
Excision Of Bartholin'S Gland Or Cyst (Pbb),,56740,CPT,Professional,Outpatient,,,,1203,1022.55,196.12,1203,"Multiplan, Inc.","Multiplan, Inc.",1130.82,94,,percent of total billed charges,,
Excision Of Bartholin'S Gland Or Cyst (Pbb),,56740,CPT,Facility,Outpatient,,,,1204,1023.4,345.0664,1204,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1084.804,90.1,,percent of total billed charges,,
Excision Of Bartholin'S Gland Or Cyst (Pbb),,56740,CPT,Professional,Outpatient,,,,1203,1022.55,196.12,1203,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1083.903,90.1,,percent of total billed charges,,
Excision Of Bartholin'S Gland Or Cyst (Pbb),,56740,CPT,Facility,Outpatient,,,,1204,1023.4,345.0664,1204,"Preferred One Administrative Services, INC.",PPO,1187.144,98.6,,percent of total billed charges,,
Excision Of Bartholin'S Gland Or Cyst (Pbb),,56740,CPT,Professional,Outpatient,,,,1203,1022.55,196.12,1203,"Preferred One Administrative Services, INC.",PPO,1186.158,98.6,,percent of total billed charges,,
Excision Of Bartholin'S Gland Or Cyst (Pbb),,56740,CPT,Facility,Outpatient,,,,1204,1023.4,345.0664,1204,PrimeWest Health,Minnesota Senior Health Options (MSHO),619.458,51.45,,percent of total billed charges,,
Excision Of Bartholin'S Gland Or Cyst (Pbb),,56740,CPT,Professional,Outpatient,,,,1203,1022.55,196.12,1203,PrimeWest Health,Minnesota Senior Health Options (MSHO),350.704,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Excision Of Bartholin'S Gland Or Cyst (Pbb),,56740,CPT,Facility,Outpatient,,,,1204,1023.4,345.0664,1204,PrimeWest Health,MinnesotaCare,618.3744,51.36,,percent of total billed charges,,
Excision Of Bartholin'S Gland Or Cyst (Pbb),,56740,CPT,Professional,Outpatient,,,,1203,1022.55,196.12,1203,PrimeWest Health,MinnesotaCare,242.2755632,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Excision Of Bartholin'S Gland Or Cyst (Pbb),,56740,CPT,Facility,Outpatient,,,,1204,1023.4,345.0664,1204,Sanford Health Plan,Sanford Health Plan,1107.68,92,,percent of total billed charges,,
Excision Of Bartholin'S Gland Or Cyst (Pbb),,56740,CPT,Professional,Outpatient,,,,1203,1022.55,196.12,1203,Sanford Health Plan,Sanford Health Plan,1058.64,88,,percent of total billed charges,,
Excision Of Bartholin'S Gland Or Cyst (Pbb),,56740,CPT,Facility,Outpatient,,,,1204,1023.4,345.0664,1204,"UCare Health, Inc.",Individual & Family Plan,678.454,56.35,,percent of total billed charges,,
Excision Of Bartholin'S Gland Or Cyst (Pbb),,56740,CPT,Professional,Outpatient,,,,1203,1022.55,196.12,1203,"UCare Health, Inc.",Individual & Family Plan,495.742976,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Excision Of Bartholin'S Gland Or Cyst (Pbb),,56740,CPT,Facility,Outpatient,,,,1204,1023.4,345.0664,1204,"UCare Health, Inc.",Medical Assistance,607.6588,50.47,,percent of total billed charges,,
Excision Of Bartholin'S Gland Or Cyst (Pbb),,56740,CPT,Professional,Outpatient,,,,1203,1022.55,196.12,1203,"UCare Health, Inc.",Medical Assistance,249.068336,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Excision Of Bartholin'S Gland Or Cyst (Pbb),,56740,CPT,Facility,Outpatient,,,,1204,1023.4,345.0664,1204,"UCare Health, Inc.",Medicare Advantage,607.6588,50.47,,percent of total billed charges,,
Excision Of Bartholin'S Gland Or Cyst (Pbb),,56740,CPT,Professional,Outpatient,,,,1203,1022.55,196.12,1203,"UCare Health, Inc.",Medicare Advantage,350.704,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Excision Of Bartholin'S Gland Or Cyst (Pbb),,56740,CPT,Facility,Outpatient,,,,1204,1023.4,345.0664,1204,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),607.6588,50.47,,percent of total billed charges,,
Excision Of Bartholin'S Gland Or Cyst (Pbb),,56740,CPT,Professional,Outpatient,,,,1203,1022.55,196.12,1203,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),280.5632,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Excision Of Bartholin'S Gland Or Cyst (Pbb),,56740,CPT,Facility,Outpatient,,,,1204,1023.4,345.0664,1204,UnitedHealthcare,Individual & Family,1131.76,94,,percent of total billed charges,,
Excision Of Bartholin'S Gland Or Cyst (Pbb),,56740,CPT,Professional,Outpatient,,,,1203,1022.55,196.12,1203,UnitedHealthcare,Individual & Family,1203,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Excision Of Bartholin'S Gland Or Cyst (Pbb),,56740,CPT,Facility,Outpatient,,,,1204,1023.4,345.0664,1204,UnitedHealthcare,Medicare Advantage,589.96,49,,percent of total billed charges,,
Excision Of Bartholin'S Gland Or Cyst (Pbb),,56740,CPT,Professional,Outpatient,,,,1203,1022.55,196.12,1203,UnitedHealthcare,Medicare Advantage,350.704,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Excision Of Bartholin'S Gland Or Cyst (Pbb),,56740,CPT,Facility,Outpatient,,,,1204,1023.4,345.0664,1204,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,577.92,48,,percent of total billed charges,,100% of DHS outpatient percentage
Excision Of Bartholin'S Gland Or Cyst (Pbb),,56740,CPT,Professional,Outpatient,,,,1203,1022.55,196.12,1203,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,226.42576,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Excision Of Bartholin'S Gland Or Cyst (Pro Cah),,56740,CPT,Professional,Both,,,,2407,2045.95,196.12,2407,Aetna,Commercial,2045.95,85,,percent of total billed charges,,
Excision Of Bartholin'S Gland Or Cyst (Pro Cah),,56740,CPT,Professional,Both,,,,2407,2045.95,196.12,2407,Aetna,Medicare Advantage,306.43,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Excision Of Bartholin'S Gland Or Cyst (Pro Cah),,56740,CPT,Professional,Both,,,,2407,2045.95,196.12,2407,Aetna,PPO,2238.51,93,,percent of total billed charges,,
Excision Of Bartholin'S Gland Or Cyst (Pro Cah),,56740,CPT,Professional,Both,,,,2407,2045.95,196.12,2407,America's PPO,America's PPO,2056.5408,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Excision Of Bartholin'S Gland Or Cyst (Pro Cah),,56740,CPT,Professional,Both,,,,2407,2045.95,196.12,2407,BlueCross BlueShield Minnesota, Federal Employee Program,652.79,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Excision Of Bartholin'S Gland Or Cyst (Pro Cah),,56740,CPT,Professional,Both,,,,2407,2045.95,196.12,2407,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,663.23464,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Excision Of Bartholin'S Gland Or Cyst (Pro Cah),,56740,CPT,Professional,Both,,,,2407,2045.95,196.12,2407,BlueCross BlueShield Minnesota,High Value Network Plan,663.23464,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Excision Of Bartholin'S Gland Or Cyst (Pro Cah),,56740,CPT,Professional,Both,,,,2407,2045.95,196.12,2407,BlueCross BlueShield Minnesota,Medicare Advantage,350.704,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Excision Of Bartholin'S Gland Or Cyst (Pro Cah),,56740,CPT,Professional,Both,,,,2407,2045.95,196.12,2407,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,663.23464,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Excision Of Bartholin'S Gland Or Cyst (Pro Cah),,56740,CPT,Professional,Both,,,,2407,2045.95,196.12,2407,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,226.42576,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Excision Of Bartholin'S Gland Or Cyst (Pro Cah),,56740,CPT,Professional,Both,,,,2407,2045.95,196.12,2407,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),350.704,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Excision Of Bartholin'S Gland Or Cyst (Pro Cah),,56740,CPT,Professional,Both,,,,2407,2045.95,196.12,2407,CorVel,Worker's Compensation,600.8275896,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Excision Of Bartholin'S Gland Or Cyst (Pro Cah),,56740,CPT,Professional,Both,,,,2407,2045.95,196.12,2407,First Health Group Corporation,First Health Network,2334.79,97,,percent of total billed charges,,
Excision Of Bartholin'S Gland Or Cyst (Pro Cah),,56740,CPT,Professional,Both,,,,2407,2045.95,196.12,2407,"Health Partners, Inc.",Commercial,649.35,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Excision Of Bartholin'S Gland Or Cyst (Pro Cah),,56740,CPT,Professional,Both,,,,2407,2045.95,196.12,2407,"Health Partners, Inc.",Medicare Advantage,350.704,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Excision Of Bartholin'S Gland Or Cyst (Pro Cah),,56740,CPT,Professional,Both,,,,2407,2045.95,196.12,2407,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),304.98,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Excision Of Bartholin'S Gland Or Cyst (Pro Cah),,56740,CPT,Professional,Both,,,,2407,2045.95,196.12,2407,"Health Partners, Inc.",State of Minnesota Advantage Program,559.415025,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Excision Of Bartholin'S Gland Or Cyst (Pro Cah),,56740,CPT,Professional,Both,,,,2407,2045.95,196.12,2407,"Health Partners, Inc.",State Public Programs,196.12,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Excision Of Bartholin'S Gland Or Cyst (Pro Cah),,56740,CPT,Professional,Both,,,,2407,2045.95,196.12,2407,Humana Insurance Company,Commercial PPO,304.96,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Excision Of Bartholin'S Gland Or Cyst (Pro Cah),,56740,CPT,Professional,Both,,,,2407,2045.95,196.12,2407,Humana Insurance Company,Medicare PPO,2407,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Excision Of Bartholin'S Gland Or Cyst (Pro Cah),,56740,CPT,Professional,Both,,,,2407,2045.95,196.12,2407,Medica,Individual & Family,2041.136,84.8,,percent of total billed charges,,
Excision Of Bartholin'S Gland Or Cyst (Pro Cah),,56740,CPT,Professional,Both,,,,2407,2045.95,196.12,2407,Medica,Medica Advantage Solution,1198.686,49.8,,percent of total billed charges,,
Excision Of Bartholin'S Gland Or Cyst (Pro Cah),,56740,CPT,Professional,Both,,,,2407,2045.95,196.12,2407,Medica,Medical Assistance,226.43,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Excision Of Bartholin'S Gland Or Cyst (Pro Cah),,56740,CPT,Professional,Both,,,,2407,2045.95,196.12,2407,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,304.96,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Excision Of Bartholin'S Gland Or Cyst (Pro Cah),,56740,CPT,Professional,Both,,,,2407,2045.95,196.12,2407,"Multiplan, Inc.","Multiplan, Inc.",2262.58,94,,percent of total billed charges,,
Excision Of Bartholin'S Gland Or Cyst (Pro Cah),,56740,CPT,Professional,Both,,,,2407,2045.95,196.12,2407,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,2168.707,90.1,,percent of total billed charges,,
Excision Of Bartholin'S Gland Or Cyst (Pro Cah),,56740,CPT,Professional,Both,,,,2407,2045.95,196.12,2407,"Preferred One Administrative Services, INC.",PPO,2373.302,98.6,,percent of total billed charges,,
Excision Of Bartholin'S Gland Or Cyst (Pro Cah),,56740,CPT,Professional,Both,,,,2407,2045.95,196.12,2407,PrimeWest Health,Minnesota Senior Health Options (MSHO),350.704,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Excision Of Bartholin'S Gland Or Cyst (Pro Cah),,56740,CPT,Professional,Both,,,,2407,2045.95,196.12,2407,PrimeWest Health,MinnesotaCare,242.2755632,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Excision Of Bartholin'S Gland Or Cyst (Pro Cah),,56740,CPT,Professional,Both,,,,2407,2045.95,196.12,2407,Sanford Health Plan,Sanford Health Plan,2118.16,88,,percent of total billed charges,,
Excision Of Bartholin'S Gland Or Cyst (Pro Cah),,56740,CPT,Professional,Both,,,,2407,2045.95,196.12,2407,"UCare Health, Inc.",Individual & Family Plan,495.742976,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Excision Of Bartholin'S Gland Or Cyst (Pro Cah),,56740,CPT,Professional,Both,,,,2407,2045.95,196.12,2407,"UCare Health, Inc.",Medical Assistance,249.068336,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Excision Of Bartholin'S Gland Or Cyst (Pro Cah),,56740,CPT,Professional,Both,,,,2407,2045.95,196.12,2407,"UCare Health, Inc.",Medicare Advantage,350.704,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Excision Of Bartholin'S Gland Or Cyst (Pro Cah),,56740,CPT,Professional,Both,,,,2407,2045.95,196.12,2407,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),280.5632,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Excision Of Bartholin'S Gland Or Cyst (Pro Cah),,56740,CPT,Professional,Both,,,,2407,2045.95,196.12,2407,UnitedHealthcare,Individual & Family,2407,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Excision Of Bartholin'S Gland Or Cyst (Pro Cah),,56740,CPT,Professional,Both,,,,2407,2045.95,196.12,2407,UnitedHealthcare,Medicare Advantage,350.704,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Excision Of Bartholin'S Gland Or Cyst (Pro Cah),,56740,CPT,Professional,Both,,,,2407,2045.95,196.12,2407,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,226.42576,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Anterior Colporrhaphy, Repair Cystocele W Or W/O Repair Urethrocele, W/Cysto, When Prfrmd (Pro Cah)",,57240,CPT,Professional,Both,,,,1836,1560.6,381.76,1836,Aetna,Commercial,1560.6,85,,percent of total billed charges,,
"Anterior Colporrhaphy, Repair Cystocele W Or W/O Repair Urethrocele, W/Cysto, When Prfrmd (Pro Cah)",,57240,CPT,Professional,Both,,,,1836,1560.6,381.76,1836,Aetna,Medicare Advantage,597.34,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Anterior Colporrhaphy, Repair Cystocele W Or W/O Repair Urethrocele, W/Cysto, When Prfrmd (Pro Cah)",,57240,CPT,Professional,Both,,,,1836,1560.6,381.76,1836,Aetna,PPO,1707.48,93,,percent of total billed charges,,
"Anterior Colporrhaphy, Repair Cystocele W Or W/O Repair Urethrocele, W/Cysto, When Prfrmd (Pro Cah)",,57240,CPT,Professional,Both,,,,1836,1560.6,381.76,1836,America's PPO,America's PPO,1568.6784,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Anterior Colporrhaphy, Repair Cystocele W Or W/O Repair Urethrocele, W/Cysto, When Prfrmd (Pro Cah)",,57240,CPT,Professional,Both,,,,1836,1560.6,381.76,1836,BlueCross BlueShield Minnesota, Federal Employee Program,1267.71,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Anterior Colporrhaphy, Repair Cystocele W Or W/O Repair Urethrocele, W/Cysto, When Prfrmd (Pro Cah)",,57240,CPT,Professional,Both,,,,1836,1560.6,381.76,1836,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1287.99336,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Anterior Colporrhaphy, Repair Cystocele W Or W/O Repair Urethrocele, W/Cysto, When Prfrmd (Pro Cah)",,57240,CPT,Professional,Both,,,,1836,1560.6,381.76,1836,BlueCross BlueShield Minnesota,High Value Network Plan,1287.99336,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Anterior Colporrhaphy, Repair Cystocele W Or W/O Repair Urethrocele, W/Cysto, When Prfrmd (Pro Cah)",,57240,CPT,Professional,Both,,,,1836,1560.6,381.76,1836,BlueCross BlueShield Minnesota,Medicare Advantage,682.019,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Anterior Colporrhaphy, Repair Cystocele W Or W/O Repair Urethrocele, W/Cysto, When Prfrmd (Pro Cah)",,57240,CPT,Professional,Both,,,,1836,1560.6,381.76,1836,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1287.99336,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Anterior Colporrhaphy, Repair Cystocele W Or W/O Repair Urethrocele, W/Cysto, When Prfrmd (Pro Cah)",,57240,CPT,Professional,Both,,,,1836,1560.6,381.76,1836,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,440.76112,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Anterior Colporrhaphy, Repair Cystocele W Or W/O Repair Urethrocele, W/Cysto, When Prfrmd (Pro Cah)",,57240,CPT,Professional,Both,,,,1836,1560.6,381.76,1836,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),682.019,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Anterior Colporrhaphy, Repair Cystocele W Or W/O Repair Urethrocele, W/Cysto, When Prfrmd (Pro Cah)",,57240,CPT,Professional,Both,,,,1836,1560.6,381.76,1836,CorVel,Worker's Compensation,1166.045004,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Anterior Colporrhaphy, Repair Cystocele W Or W/O Repair Urethrocele, W/Cysto, When Prfrmd (Pro Cah)",,57240,CPT,Professional,Both,,,,1836,1560.6,381.76,1836,First Health Group Corporation,First Health Network,1780.92,97,,percent of total billed charges,,
"Anterior Colporrhaphy, Repair Cystocele W Or W/O Repair Urethrocele, W/Cysto, When Prfrmd (Pro Cah)",,57240,CPT,Professional,Both,,,,1836,1560.6,381.76,1836,"Health Partners, Inc.",Commercial,1259.51,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Anterior Colporrhaphy, Repair Cystocele W Or W/O Repair Urethrocele, W/Cysto, When Prfrmd (Pro Cah)",,57240,CPT,Professional,Both,,,,1836,1560.6,381.76,1836,"Health Partners, Inc.",Medicare Advantage,682.019,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Anterior Colporrhaphy, Repair Cystocele W Or W/O Repair Urethrocele, W/Cysto, When Prfrmd (Pro Cah)",,57240,CPT,Professional,Both,,,,1836,1560.6,381.76,1836,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),593.03,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Anterior Colporrhaphy, Repair Cystocele W Or W/O Repair Urethrocele, W/Cysto, When Prfrmd (Pro Cah)",,57240,CPT,Professional,Both,,,,1836,1560.6,381.76,1836,"Health Partners, Inc.",State of Minnesota Advantage Program,1085.067865,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Anterior Colporrhaphy, Repair Cystocele W Or W/O Repair Urethrocele, W/Cysto, When Prfrmd (Pro Cah)",,57240,CPT,Professional,Both,,,,1836,1560.6,381.76,1836,"Health Partners, Inc.",State Public Programs,381.76,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Anterior Colporrhaphy, Repair Cystocele W Or W/O Repair Urethrocele, W/Cysto, When Prfrmd (Pro Cah)",,57240,CPT,Professional,Both,,,,1836,1560.6,381.76,1836,Humana Insurance Company,Commercial PPO,593.06,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Anterior Colporrhaphy, Repair Cystocele W Or W/O Repair Urethrocele, W/Cysto, When Prfrmd (Pro Cah)",,57240,CPT,Professional,Both,,,,1836,1560.6,381.76,1836,Humana Insurance Company,Medicare PPO,1836,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Anterior Colporrhaphy, Repair Cystocele W Or W/O Repair Urethrocele, W/Cysto, When Prfrmd (Pro Cah)",,57240,CPT,Professional,Both,,,,1836,1560.6,381.76,1836,Medica,Individual & Family,1556.928,84.8,,percent of total billed charges,,
"Anterior Colporrhaphy, Repair Cystocele W Or W/O Repair Urethrocele, W/Cysto, When Prfrmd (Pro Cah)",,57240,CPT,Professional,Both,,,,1836,1560.6,381.76,1836,Medica,Medica Advantage Solution,914.328,49.8,,percent of total billed charges,,
"Anterior Colporrhaphy, Repair Cystocele W Or W/O Repair Urethrocele, W/Cysto, When Prfrmd (Pro Cah)",,57240,CPT,Professional,Both,,,,1836,1560.6,381.76,1836,Medica,Medical Assistance,440.76,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Anterior Colporrhaphy, Repair Cystocele W Or W/O Repair Urethrocele, W/Cysto, When Prfrmd (Pro Cah)",,57240,CPT,Professional,Both,,,,1836,1560.6,381.76,1836,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,593.06,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Anterior Colporrhaphy, Repair Cystocele W Or W/O Repair Urethrocele, W/Cysto, When Prfrmd (Pro Cah)",,57240,CPT,Professional,Both,,,,1836,1560.6,381.76,1836,"Multiplan, Inc.","Multiplan, Inc.",1725.84,94,,percent of total billed charges,,
"Anterior Colporrhaphy, Repair Cystocele W Or W/O Repair Urethrocele, W/Cysto, When Prfrmd (Pro Cah)",,57240,CPT,Professional,Both,,,,1836,1560.6,381.76,1836,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1654.236,90.1,,percent of total billed charges,,
"Anterior Colporrhaphy, Repair Cystocele W Or W/O Repair Urethrocele, W/Cysto, When Prfrmd (Pro Cah)",,57240,CPT,Professional,Both,,,,1836,1560.6,381.76,1836,"Preferred One Administrative Services, INC.",PPO,1810.296,98.6,,percent of total billed charges,,
"Anterior Colporrhaphy, Repair Cystocele W Or W/O Repair Urethrocele, W/Cysto, When Prfrmd (Pro Cah)",,57240,CPT,Professional,Both,,,,1836,1560.6,381.76,1836,PrimeWest Health,Minnesota Senior Health Options (MSHO),682.019,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Anterior Colporrhaphy, Repair Cystocele W Or W/O Repair Urethrocele, W/Cysto, When Prfrmd (Pro Cah)",,57240,CPT,Professional,Both,,,,1836,1560.6,381.76,1836,PrimeWest Health,MinnesotaCare,471.6143984,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Anterior Colporrhaphy, Repair Cystocele W Or W/O Repair Urethrocele, W/Cysto, When Prfrmd (Pro Cah)",,57240,CPT,Professional,Both,,,,1836,1560.6,381.76,1836,Sanford Health Plan,Sanford Health Plan,1615.68,88,,percent of total billed charges,,
"Anterior Colporrhaphy, Repair Cystocele W Or W/O Repair Urethrocele, W/Cysto, When Prfrmd (Pro Cah)",,57240,CPT,Professional,Both,,,,1836,1560.6,381.76,1836,"UCare Health, Inc.",Individual & Family Plan,964.078336,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Anterior Colporrhaphy, Repair Cystocele W Or W/O Repair Urethrocele, W/Cysto, When Prfrmd (Pro Cah)",,57240,CPT,Professional,Both,,,,1836,1560.6,381.76,1836,"UCare Health, Inc.",Medical Assistance,484.837232,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Anterior Colporrhaphy, Repair Cystocele W Or W/O Repair Urethrocele, W/Cysto, When Prfrmd (Pro Cah)",,57240,CPT,Professional,Both,,,,1836,1560.6,381.76,1836,"UCare Health, Inc.",Medicare Advantage,682.019,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Anterior Colporrhaphy, Repair Cystocele W Or W/O Repair Urethrocele, W/Cysto, When Prfrmd (Pro Cah)",,57240,CPT,Professional,Both,,,,1836,1560.6,381.76,1836,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),545.6152,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Anterior Colporrhaphy, Repair Cystocele W Or W/O Repair Urethrocele, W/Cysto, When Prfrmd (Pro Cah)",,57240,CPT,Professional,Both,,,,1836,1560.6,381.76,1836,UnitedHealthcare,Individual & Family,1836,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Anterior Colporrhaphy, Repair Cystocele W Or W/O Repair Urethrocele, W/Cysto, When Prfrmd (Pro Cah)",,57240,CPT,Professional,Both,,,,1836,1560.6,381.76,1836,UnitedHealthcare,Medicare Advantage,682.019,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Anterior Colporrhaphy, Repair Cystocele W Or W/O Repair Urethrocele, W/Cysto, When Prfrmd (Pro Cah)",,57240,CPT,Professional,Both,,,,1836,1560.6,381.76,1836,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,440.76112,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Posterior Colporrhaphy, Repair Rectocele W/W/O Perineorrhaphy (Pro Cah)",,57250,CPT,Professional,Both,,,,1530,1300.5,382.85,1530,Aetna,Commercial,1300.5,85,,percent of total billed charges,,
"Posterior Colporrhaphy, Repair Rectocele W/W/O Perineorrhaphy (Pro Cah)",,57250,CPT,Professional,Both,,,,1530,1300.5,382.85,1530,Aetna,Medicare Advantage,599.49,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Posterior Colporrhaphy, Repair Rectocele W/W/O Perineorrhaphy (Pro Cah)",,57250,CPT,Professional,Both,,,,1530,1300.5,382.85,1530,Aetna,PPO,1422.9,93,,percent of total billed charges,,
"Posterior Colporrhaphy, Repair Rectocele W/W/O Perineorrhaphy (Pro Cah)",,57250,CPT,Professional,Both,,,,1530,1300.5,382.85,1530,America's PPO,America's PPO,1307.232,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Posterior Colporrhaphy, Repair Rectocele W/W/O Perineorrhaphy (Pro Cah)",,57250,CPT,Professional,Both,,,,1530,1300.5,382.85,1530,BlueCross BlueShield Minnesota, Federal Employee Program,1273.91,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Posterior Colporrhaphy, Repair Rectocele W/W/O Perineorrhaphy (Pro Cah)",,57250,CPT,Professional,Both,,,,1530,1300.5,382.85,1530,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1294.29256,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Posterior Colporrhaphy, Repair Rectocele W/W/O Perineorrhaphy (Pro Cah)",,57250,CPT,Professional,Both,,,,1530,1300.5,382.85,1530,BlueCross BlueShield Minnesota,High Value Network Plan,1294.29256,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Posterior Colporrhaphy, Repair Rectocele W/W/O Perineorrhaphy (Pro Cah)",,57250,CPT,Professional,Both,,,,1530,1300.5,382.85,1530,BlueCross BlueShield Minnesota,Medicare Advantage,683.974,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Posterior Colporrhaphy, Repair Rectocele W/W/O Perineorrhaphy (Pro Cah)",,57250,CPT,Professional,Both,,,,1530,1300.5,382.85,1530,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1294.29256,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Posterior Colporrhaphy, Repair Rectocele W/W/O Perineorrhaphy (Pro Cah)",,57250,CPT,Professional,Both,,,,1530,1300.5,382.85,1530,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,442.02096,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Posterior Colporrhaphy, Repair Rectocele W/W/O Perineorrhaphy (Pro Cah)",,57250,CPT,Professional,Both,,,,1530,1300.5,382.85,1530,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),683.974,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Posterior Colporrhaphy, Repair Rectocele W/W/O Perineorrhaphy (Pro Cah)",,57250,CPT,Professional,Both,,,,1530,1300.5,382.85,1530,CorVel,Worker's Compensation,1170.663613,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Posterior Colporrhaphy, Repair Rectocele W/W/O Perineorrhaphy (Pro Cah)",,57250,CPT,Professional,Both,,,,1530,1300.5,382.85,1530,First Health Group Corporation,First Health Network,1484.1,97,,percent of total billed charges,,
"Posterior Colporrhaphy, Repair Rectocele W/W/O Perineorrhaphy (Pro Cah)",,57250,CPT,Professional,Both,,,,1530,1300.5,382.85,1530,"Health Partners, Inc.",Commercial,1264.59,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Posterior Colporrhaphy, Repair Rectocele W/W/O Perineorrhaphy (Pro Cah)",,57250,CPT,Professional,Both,,,,1530,1300.5,382.85,1530,"Health Partners, Inc.",Medicare Advantage,683.974,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Posterior Colporrhaphy, Repair Rectocele W/W/O Perineorrhaphy (Pro Cah)",,57250,CPT,Professional,Both,,,,1530,1300.5,382.85,1530,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),594.72,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Posterior Colporrhaphy, Repair Rectocele W/W/O Perineorrhaphy (Pro Cah)",,57250,CPT,Professional,Both,,,,1530,1300.5,382.85,1530,"Health Partners, Inc.",State of Minnesota Advantage Program,1089.444285,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Posterior Colporrhaphy, Repair Rectocele W/W/O Perineorrhaphy (Pro Cah)",,57250,CPT,Professional,Both,,,,1530,1300.5,382.85,1530,"Health Partners, Inc.",State Public Programs,382.85,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Posterior Colporrhaphy, Repair Rectocele W/W/O Perineorrhaphy (Pro Cah)",,57250,CPT,Professional,Both,,,,1530,1300.5,382.85,1530,Humana Insurance Company,Commercial PPO,594.76,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Posterior Colporrhaphy, Repair Rectocele W/W/O Perineorrhaphy (Pro Cah)",,57250,CPT,Professional,Both,,,,1530,1300.5,382.85,1530,Humana Insurance Company,Medicare PPO,1530,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Posterior Colporrhaphy, Repair Rectocele W/W/O Perineorrhaphy (Pro Cah)",,57250,CPT,Professional,Both,,,,1530,1300.5,382.85,1530,Medica,Individual & Family,1297.44,84.8,,percent of total billed charges,,
"Posterior Colporrhaphy, Repair Rectocele W/W/O Perineorrhaphy (Pro Cah)",,57250,CPT,Professional,Both,,,,1530,1300.5,382.85,1530,Medica,Medica Advantage Solution,761.94,49.8,,percent of total billed charges,,
"Posterior Colporrhaphy, Repair Rectocele W/W/O Perineorrhaphy (Pro Cah)",,57250,CPT,Professional,Both,,,,1530,1300.5,382.85,1530,Medica,Medical Assistance,442.02,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Posterior Colporrhaphy, Repair Rectocele W/W/O Perineorrhaphy (Pro Cah)",,57250,CPT,Professional,Both,,,,1530,1300.5,382.85,1530,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,594.76,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Posterior Colporrhaphy, Repair Rectocele W/W/O Perineorrhaphy (Pro Cah)",,57250,CPT,Professional,Both,,,,1530,1300.5,382.85,1530,"Multiplan, Inc.","Multiplan, Inc.",1438.2,94,,percent of total billed charges,,
"Posterior Colporrhaphy, Repair Rectocele W/W/O Perineorrhaphy (Pro Cah)",,57250,CPT,Professional,Both,,,,1530,1300.5,382.85,1530,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1378.53,90.1,,percent of total billed charges,,
"Posterior Colporrhaphy, Repair Rectocele W/W/O Perineorrhaphy (Pro Cah)",,57250,CPT,Professional,Both,,,,1530,1300.5,382.85,1530,"Preferred One Administrative Services, INC.",PPO,1508.58,98.6,,percent of total billed charges,,
"Posterior Colporrhaphy, Repair Rectocele W/W/O Perineorrhaphy (Pro Cah)",,57250,CPT,Professional,Both,,,,1530,1300.5,382.85,1530,PrimeWest Health,Minnesota Senior Health Options (MSHO),683.974,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Posterior Colporrhaphy, Repair Rectocele W/W/O Perineorrhaphy (Pro Cah)",,57250,CPT,Professional,Both,,,,1530,1300.5,382.85,1530,PrimeWest Health,MinnesotaCare,472.9624272,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Posterior Colporrhaphy, Repair Rectocele W/W/O Perineorrhaphy (Pro Cah)",,57250,CPT,Professional,Both,,,,1530,1300.5,382.85,1530,Sanford Health Plan,Sanford Health Plan,1346.4,88,,percent of total billed charges,,
"Posterior Colporrhaphy, Repair Rectocele W/W/O Perineorrhaphy (Pro Cah)",,57250,CPT,Professional,Both,,,,1530,1300.5,382.85,1530,"UCare Health, Inc.",Individual & Family Plan,966.841856,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Posterior Colporrhaphy, Repair Rectocele W/W/O Perineorrhaphy (Pro Cah)",,57250,CPT,Professional,Both,,,,1530,1300.5,382.85,1530,"UCare Health, Inc.",Medical Assistance,486.223056,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Posterior Colporrhaphy, Repair Rectocele W/W/O Perineorrhaphy (Pro Cah)",,57250,CPT,Professional,Both,,,,1530,1300.5,382.85,1530,"UCare Health, Inc.",Medicare Advantage,683.974,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Posterior Colporrhaphy, Repair Rectocele W/W/O Perineorrhaphy (Pro Cah)",,57250,CPT,Professional,Both,,,,1530,1300.5,382.85,1530,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),547.1792,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Posterior Colporrhaphy, Repair Rectocele W/W/O Perineorrhaphy (Pro Cah)",,57250,CPT,Professional,Both,,,,1530,1300.5,382.85,1530,UnitedHealthcare,Individual & Family,1530,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Posterior Colporrhaphy, Repair Rectocele W/W/O Perineorrhaphy (Pro Cah)",,57250,CPT,Professional,Both,,,,1530,1300.5,382.85,1530,UnitedHealthcare,Medicare Advantage,683.974,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Posterior Colporrhaphy, Repair Rectocele W/W/O Perineorrhaphy (Pro Cah)",,57250,CPT,Professional,Both,,,,1530,1300.5,382.85,1530,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,442.02096,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Colposcopy Of The Cervix Including Upper/Adjacent Vagina; With Endocervical Curettage,,57456,CPT,Facility,Both,,,,300,255,85.98,300,Aetna,Commercial,276,92,,percent of total billed charges,,
Colposcopy Of The Cervix Including Upper/Adjacent Vagina; With Endocervical Curettage,,57456,CPT,Facility,Outpatient,,,,300,255,85.98,300,Aetna,Medicare Advantage,147,49,,percent of total billed charges,,
Colposcopy Of The Cervix Including Upper/Adjacent Vagina; With Endocervical Curettage,,57456,CPT,Facility,Inpatient,,,,300,255,85.98,300,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Colposcopy Of The Cervix Including Upper/Adjacent Vagina; With Endocervical Curettage,,57456,CPT,Facility,Both,,,,300,255,85.98,300,Aetna,PPO,279,93,,percent of total billed charges,,
Colposcopy Of The Cervix Including Upper/Adjacent Vagina; With Endocervical Curettage,,57456,CPT,Facility,Both,,,,300,255,85.98,300,America's PPO,America's PPO,288.09,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Colposcopy Of The Cervix Including Upper/Adjacent Vagina; With Endocervical Curettage,,57456,CPT,Facility,Both,,,,300,255,85.98,300,BlueCross BlueShield Minnesota, Federal Employee Program,295.2,98.4,,percent of total billed charges,,
Colposcopy Of The Cervix Including Upper/Adjacent Vagina; With Endocervical Curettage,,57456,CPT,Facility,Both,,,,300,255,85.98,300,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,300,100,,percent of total billed charges,,
Colposcopy Of The Cervix Including Upper/Adjacent Vagina; With Endocervical Curettage,,57456,CPT,Facility,Both,,,,300,255,85.98,300,BlueCross BlueShield Minnesota,High Value Network Plan,270,90,,percent of total billed charges,,
Colposcopy Of The Cervix Including Upper/Adjacent Vagina; With Endocervical Curettage,,57456,CPT,Facility,Outpatient,,,,300,255,85.98,300,BlueCross BlueShield Minnesota,Medicare Advantage,147,49,,percent of total billed charges,,
Colposcopy Of The Cervix Including Upper/Adjacent Vagina; With Endocervical Curettage,,57456,CPT,Facility,Inpatient,,,,300,255,85.98,300,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Colposcopy Of The Cervix Including Upper/Adjacent Vagina; With Endocervical Curettage,,57456,CPT,Facility,Both,,,,300,255,85.98,300,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,265.71,88.57,,percent of total billed charges,,
Colposcopy Of The Cervix Including Upper/Adjacent Vagina; With Endocervical Curettage,,57456,CPT,Facility,Both,,,,300,255,85.98,300,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,85.98,28.66,,percent of total billed charges,,
Colposcopy Of The Cervix Including Upper/Adjacent Vagina; With Endocervical Curettage,,57456,CPT,Facility,Outpatient,,,,300,255,85.98,300,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),147,49,,percent of total billed charges,,
Colposcopy Of The Cervix Including Upper/Adjacent Vagina; With Endocervical Curettage,,57456,CPT,Facility,Inpatient,,,,300,255,85.98,300,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Colposcopy Of The Cervix Including Upper/Adjacent Vagina; With Endocervical Curettage,,57456,CPT,Facility,Both,,,,300,255,85.98,300,CorVel,Worker's Compensation,300,100,,percent of total billed charges,,
Colposcopy Of The Cervix Including Upper/Adjacent Vagina; With Endocervical Curettage,,57456,CPT,Facility,Both,,,,300,255,85.98,300,First Health Group Corporation,First Health Network,291,97,,percent of total billed charges,,
Colposcopy Of The Cervix Including Upper/Adjacent Vagina; With Endocervical Curettage,,57456,CPT,Facility,Both,,,,300,255,85.98,300,"Health Partners, Inc.",Commercial,283.8,94.6,,percent of total billed charges,,
Colposcopy Of The Cervix Including Upper/Adjacent Vagina; With Endocervical Curettage,,57456,CPT,Facility,Outpatient,,,,300,255,85.98,300,"Health Partners, Inc.",Medicare Advantage,147,49,,percent of total billed charges,,
Colposcopy Of The Cervix Including Upper/Adjacent Vagina; With Endocervical Curettage,,57456,CPT,Facility,Inpatient,,,,300,255,85.98,300,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Colposcopy Of The Cervix Including Upper/Adjacent Vagina; With Endocervical Curettage,,57456,CPT,Facility,Both,,,,300,255,85.98,300,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),180,60,,percent of total billed charges,,
Colposcopy Of The Cervix Including Upper/Adjacent Vagina; With Endocervical Curettage,,57456,CPT,Facility,Both,,,,300,255,85.98,300,"Health Partners, Inc.",State of Minnesota Advantage Program,244.5,81.5,,percent of total billed charges,,
Colposcopy Of The Cervix Including Upper/Adjacent Vagina; With Endocervical Curettage,,57456,CPT,Facility,Both,,,,300,255,85.98,300,"Health Partners, Inc.",State Public Programs,150,50,,percent of total billed charges,,
Colposcopy Of The Cervix Including Upper/Adjacent Vagina; With Endocervical Curettage,,57456,CPT,Facility,Both,,,,300,255,85.98,300,Humana Insurance Company,Commercial PPO,285,95,,percent of total billed charges,,
Colposcopy Of The Cervix Including Upper/Adjacent Vagina; With Endocervical Curettage,,57456,CPT,Facility,Outpatient,,,,300,255,85.98,300,Humana Insurance Company,Medicare PPO,147,49,,percent of total billed charges,,
Colposcopy Of The Cervix Including Upper/Adjacent Vagina; With Endocervical Curettage,,57456,CPT,Facility,Inpatient,,,,300,255,85.98,300,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Colposcopy Of The Cervix Including Upper/Adjacent Vagina; With Endocervical Curettage,,57456,CPT,Facility,Both,,,,300,255,85.98,300,Medica,Individual & Family,297.3,99.1,,percent of total billed charges,,
Colposcopy Of The Cervix Including Upper/Adjacent Vagina; With Endocervical Curettage,,57456,CPT,Facility,Outpatient,,,,300,255,85.98,300,Medica,Medica Advantage Solution,149.4,49.8,,percent of total billed charges,,
Colposcopy Of The Cervix Including Upper/Adjacent Vagina; With Endocervical Curettage,,57456,CPT,Facility,Inpatient,,,,300,255,85.98,300,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Colposcopy Of The Cervix Including Upper/Adjacent Vagina; With Endocervical Curettage,,57456,CPT,Facility,Outpatient,,,,300,255,85.98,300,Medica,Medical Assistance,133.8,44.6,,percent of total billed charges,,
Colposcopy Of The Cervix Including Upper/Adjacent Vagina; With Endocervical Curettage,,57456,CPT,Facility,Inpatient,,,,300,255,85.98,300,Medica,Medical Assistance,,,,,Included in per diem rate,
Colposcopy Of The Cervix Including Upper/Adjacent Vagina; With Endocervical Curettage,,57456,CPT,Facility,Outpatient,,,,300,255,85.98,300,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,149.4,49.8,,percent of total billed charges,,
Colposcopy Of The Cervix Including Upper/Adjacent Vagina; With Endocervical Curettage,,57456,CPT,Facility,Inpatient,,,,300,255,85.98,300,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Colposcopy Of The Cervix Including Upper/Adjacent Vagina; With Endocervical Curettage,,57456,CPT,Facility,Both,,,,300,255,85.98,300,"Multiplan, Inc.","Multiplan, Inc.",282,94,,percent of total billed charges,,
Colposcopy Of The Cervix Including Upper/Adjacent Vagina; With Endocervical Curettage,,57456,CPT,Facility,Outpatient,,,,300,255,85.98,300,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,270.3,90.1,,percent of total billed charges,,
Colposcopy Of The Cervix Including Upper/Adjacent Vagina; With Endocervical Curettage,,57456,CPT,Facility,Inpatient,,,,300,255,85.98,300,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Colposcopy Of The Cervix Including Upper/Adjacent Vagina; With Endocervical Curettage,,57456,CPT,Facility,Both,,,,300,255,85.98,300,"Preferred One Administrative Services, INC.",PPO,295.8,98.6,,percent of total billed charges,,
Colposcopy Of The Cervix Including Upper/Adjacent Vagina; With Endocervical Curettage,,57456,CPT,Facility,Outpatient,,,,300,255,85.98,300,PrimeWest Health,Minnesota Senior Health Options (MSHO),154.35,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Colposcopy Of The Cervix Including Upper/Adjacent Vagina; With Endocervical Curettage,,57456,CPT,Facility,Inpatient,,,,300,255,85.98,300,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Colposcopy Of The Cervix Including Upper/Adjacent Vagina; With Endocervical Curettage,,57456,CPT,Facility,Outpatient,,,,300,255,85.98,300,PrimeWest Health,MinnesotaCare,154.08,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Colposcopy Of The Cervix Including Upper/Adjacent Vagina; With Endocervical Curettage,,57456,CPT,Facility,Inpatient,,,,300,255,85.98,300,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Colposcopy Of The Cervix Including Upper/Adjacent Vagina; With Endocervical Curettage,,57456,CPT,Facility,Both,,,,300,255,85.98,300,Sanford Health Plan,Sanford Health Plan,276,92,,percent of total billed charges,,
Colposcopy Of The Cervix Including Upper/Adjacent Vagina; With Endocervical Curettage,,57456,CPT,Facility,Outpatient,,,,300,255,85.98,300,"UCare Health, Inc.",Individual & Family Plan,169.05,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Colposcopy Of The Cervix Including Upper/Adjacent Vagina; With Endocervical Curettage,,57456,CPT,Facility,Inpatient,,,,300,255,85.98,300,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Colposcopy Of The Cervix Including Upper/Adjacent Vagina; With Endocervical Curettage,,57456,CPT,Facility,Outpatient,,,,300,255,85.98,300,"UCare Health, Inc.",Medical Assistance,151.41,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Colposcopy Of The Cervix Including Upper/Adjacent Vagina; With Endocervical Curettage,,57456,CPT,Facility,Inpatient,,,,300,255,85.98,300,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Colposcopy Of The Cervix Including Upper/Adjacent Vagina; With Endocervical Curettage,,57456,CPT,Facility,Outpatient,,,,300,255,85.98,300,"UCare Health, Inc.",Medicare Advantage,151.41,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Colposcopy Of The Cervix Including Upper/Adjacent Vagina; With Endocervical Curettage,,57456,CPT,Facility,Inpatient,,,,300,255,85.98,300,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Colposcopy Of The Cervix Including Upper/Adjacent Vagina; With Endocervical Curettage,,57456,CPT,Facility,Outpatient,,,,300,255,85.98,300,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),151.41,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Colposcopy Of The Cervix Including Upper/Adjacent Vagina; With Endocervical Curettage,,57456,CPT,Facility,Inpatient,,,,300,255,85.98,300,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Colposcopy Of The Cervix Including Upper/Adjacent Vagina; With Endocervical Curettage,,57456,CPT,Facility,Both,,,,300,255,85.98,300,UnitedHealthcare,Individual & Family,282,94,,percent of total billed charges,,
Colposcopy Of The Cervix Including Upper/Adjacent Vagina; With Endocervical Curettage,,57456,CPT,Facility,Outpatient,,,,300,255,85.98,300,UnitedHealthcare,Medicare Advantage,147,49,,percent of total billed charges,,
Colposcopy Of The Cervix Including Upper/Adjacent Vagina; With Endocervical Curettage,,57456,CPT,Facility,Inpatient,,,,300,255,85.98,300,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Colposcopy Of The Cervix Including Upper/Adjacent Vagina; With Endocervical Curettage,,57456,CPT,Facility,Outpatient,,,,300,255,85.98,300,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,144,48,,percent of total billed charges,,100% of DHS outpatient percentage
Colposcopy Of The Cervix Including Upper/Adjacent Vagina; With Endocervical Curettage,,57456,CPT,Facility,Inpatient,,,,300,255,85.98,300,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Biopsy Of Cervix, Or Excision Of Lesion (S) W/Wo Fulguration (Pro Cah)",,57500,CPT,Professional,Both,,,,493,419.05,46.02,493,Aetna,Commercial,419.05,85,,percent of total billed charges,,
"Biopsy Of Cervix, Or Excision Of Lesion (S) W/Wo Fulguration (Pro Cah)",,57500,CPT,Professional,Both,,,,493,419.05,46.02,493,Aetna,Medicare Advantage,72.61,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Biopsy Of Cervix, Or Excision Of Lesion (S) W/Wo Fulguration (Pro Cah)",,57500,CPT,Professional,Both,,,,493,419.05,46.02,493,Aetna,PPO,458.49,93,,percent of total billed charges,,
"Biopsy Of Cervix, Or Excision Of Lesion (S) W/Wo Fulguration (Pro Cah)",,57500,CPT,Professional,Both,,,,493,419.05,46.02,493,America's PPO,America's PPO,421.2192,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Biopsy Of Cervix, Or Excision Of Lesion (S) W/Wo Fulguration (Pro Cah)",,57500,CPT,Professional,Both,,,,493,419.05,46.02,493,BlueCross BlueShield Minnesota, Federal Employee Program,153.56,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Biopsy Of Cervix, Or Excision Of Lesion (S) W/Wo Fulguration (Pro Cah)",,57500,CPT,Professional,Both,,,,493,419.05,46.02,493,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,156.01696,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Biopsy Of Cervix, Or Excision Of Lesion (S) W/Wo Fulguration (Pro Cah)",,57500,CPT,Professional,Both,,,,493,419.05,46.02,493,BlueCross BlueShield Minnesota,High Value Network Plan,156.01696,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Biopsy Of Cervix, Or Excision Of Lesion (S) W/Wo Fulguration (Pro Cah)",,57500,CPT,Professional,Both,,,,493,419.05,46.02,493,BlueCross BlueShield Minnesota,Medicare Advantage,82.5355,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Biopsy Of Cervix, Or Excision Of Lesion (S) W/Wo Fulguration (Pro Cah)",,57500,CPT,Professional,Both,,,,493,419.05,46.02,493,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,156.01696,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Biopsy Of Cervix, Or Excision Of Lesion (S) W/Wo Fulguration (Pro Cah)",,57500,CPT,Professional,Both,,,,493,419.05,46.02,493,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,53.1368,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Biopsy Of Cervix, Or Excision Of Lesion (S) W/Wo Fulguration (Pro Cah)",,57500,CPT,Professional,Both,,,,493,419.05,46.02,493,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),82.5355,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Biopsy Of Cervix, Or Excision Of Lesion (S) W/Wo Fulguration (Pro Cah)",,57500,CPT,Professional,Both,,,,493,419.05,46.02,493,CorVel,Worker's Compensation,140.4612021,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Biopsy Of Cervix, Or Excision Of Lesion (S) W/Wo Fulguration (Pro Cah)",,57500,CPT,Professional,Both,,,,493,419.05,46.02,493,First Health Group Corporation,First Health Network,478.21,97,,percent of total billed charges,,
"Biopsy Of Cervix, Or Excision Of Lesion (S) W/Wo Fulguration (Pro Cah)",,57500,CPT,Professional,Both,,,,493,419.05,46.02,493,"Health Partners, Inc.",Commercial,151.64,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Biopsy Of Cervix, Or Excision Of Lesion (S) W/Wo Fulguration (Pro Cah)",,57500,CPT,Professional,Both,,,,493,419.05,46.02,493,"Health Partners, Inc.",Medicare Advantage,82.5355,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Biopsy Of Cervix, Or Excision Of Lesion (S) W/Wo Fulguration (Pro Cah)",,57500,CPT,Professional,Both,,,,493,419.05,46.02,493,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),71.84,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Biopsy Of Cervix, Or Excision Of Lesion (S) W/Wo Fulguration (Pro Cah)",,57500,CPT,Professional,Both,,,,493,419.05,46.02,493,"Health Partners, Inc.",State of Minnesota Advantage Program,130.63786,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Biopsy Of Cervix, Or Excision Of Lesion (S) W/Wo Fulguration (Pro Cah)",,57500,CPT,Professional,Both,,,,493,419.05,46.02,493,"Health Partners, Inc.",State Public Programs,46.02,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Biopsy Of Cervix, Or Excision Of Lesion (S) W/Wo Fulguration (Pro Cah)",,57500,CPT,Professional,Both,,,,493,419.05,46.02,493,Humana Insurance Company,Commercial PPO,71.77,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Biopsy Of Cervix, Or Excision Of Lesion (S) W/Wo Fulguration (Pro Cah)",,57500,CPT,Professional,Both,,,,493,419.05,46.02,493,Humana Insurance Company,Medicare PPO,493,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Biopsy Of Cervix, Or Excision Of Lesion (S) W/Wo Fulguration (Pro Cah)",,57500,CPT,Professional,Both,,,,493,419.05,46.02,493,Medica,Individual & Family,418.064,84.8,,percent of total billed charges,,
"Biopsy Of Cervix, Or Excision Of Lesion (S) W/Wo Fulguration (Pro Cah)",,57500,CPT,Professional,Both,,,,493,419.05,46.02,493,Medica,Medica Advantage Solution,245.514,49.8,,percent of total billed charges,,
"Biopsy Of Cervix, Or Excision Of Lesion (S) W/Wo Fulguration (Pro Cah)",,57500,CPT,Professional,Both,,,,493,419.05,46.02,493,Medica,Medical Assistance,53.14,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Biopsy Of Cervix, Or Excision Of Lesion (S) W/Wo Fulguration (Pro Cah)",,57500,CPT,Professional,Both,,,,493,419.05,46.02,493,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,71.77,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Biopsy Of Cervix, Or Excision Of Lesion (S) W/Wo Fulguration (Pro Cah)",,57500,CPT,Professional,Both,,,,493,419.05,46.02,493,"Multiplan, Inc.","Multiplan, Inc.",463.42,94,,percent of total billed charges,,
"Biopsy Of Cervix, Or Excision Of Lesion (S) W/Wo Fulguration (Pro Cah)",,57500,CPT,Professional,Both,,,,493,419.05,46.02,493,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,444.193,90.1,,percent of total billed charges,,
"Biopsy Of Cervix, Or Excision Of Lesion (S) W/Wo Fulguration (Pro Cah)",,57500,CPT,Professional,Both,,,,493,419.05,46.02,493,"Preferred One Administrative Services, INC.",PPO,486.098,98.6,,percent of total billed charges,,
"Biopsy Of Cervix, Or Excision Of Lesion (S) W/Wo Fulguration (Pro Cah)",,57500,CPT,Professional,Both,,,,493,419.05,46.02,493,PrimeWest Health,Minnesota Senior Health Options (MSHO),82.5355,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Biopsy Of Cervix, Or Excision Of Lesion (S) W/Wo Fulguration (Pro Cah)",,57500,CPT,Professional,Both,,,,493,419.05,46.02,493,PrimeWest Health,MinnesotaCare,56.856376,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Biopsy Of Cervix, Or Excision Of Lesion (S) W/Wo Fulguration (Pro Cah)",,57500,CPT,Professional,Both,,,,493,419.05,46.02,493,Sanford Health Plan,Sanford Health Plan,433.84,88,,percent of total billed charges,,
"Biopsy Of Cervix, Or Excision Of Lesion (S) W/Wo Fulguration (Pro Cah)",,57500,CPT,Professional,Both,,,,493,419.05,46.02,493,"UCare Health, Inc.",Individual & Family Plan,116.669312,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Biopsy Of Cervix, Or Excision Of Lesion (S) W/Wo Fulguration (Pro Cah)",,57500,CPT,Professional,Both,,,,493,419.05,46.02,493,"UCare Health, Inc.",Medical Assistance,58.45048,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Biopsy Of Cervix, Or Excision Of Lesion (S) W/Wo Fulguration (Pro Cah)",,57500,CPT,Professional,Both,,,,493,419.05,46.02,493,"UCare Health, Inc.",Medicare Advantage,82.5355,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Biopsy Of Cervix, Or Excision Of Lesion (S) W/Wo Fulguration (Pro Cah)",,57500,CPT,Professional,Both,,,,493,419.05,46.02,493,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),66.0284,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Biopsy Of Cervix, Or Excision Of Lesion (S) W/Wo Fulguration (Pro Cah)",,57500,CPT,Professional,Both,,,,493,419.05,46.02,493,UnitedHealthcare,Individual & Family,493,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Biopsy Of Cervix, Or Excision Of Lesion (S) W/Wo Fulguration (Pro Cah)",,57500,CPT,Professional,Both,,,,493,419.05,46.02,493,UnitedHealthcare,Medicare Advantage,82.5355,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Biopsy Of Cervix, Or Excision Of Lesion (S) W/Wo Fulguration (Pro Cah)",,57500,CPT,Professional,Both,,,,493,419.05,46.02,493,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,53.1368,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Excision Of Lesion On Cervix,,57500,CPT,Facility,Both,,,,260,221,74.516,449,Aetna,Commercial,239.2,92,,percent of total billed charges,,
Excision Of Lesion On Cervix,,57500,CPT,Facility,Outpatient,,,,260,221,74.516,449,Aetna,Medicare Advantage,127.4,49,,percent of total billed charges,,
Excision Of Lesion On Cervix,,57500,CPT,Facility,Inpatient,,,,260,221,74.516,449,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Excision Of Lesion On Cervix,,57500,CPT,Facility,Both,,,,260,221,74.516,449,Aetna,PPO,241.8,93,,percent of total billed charges,,
Excision Of Lesion On Cervix,,57500,CPT,Facility,Both,,,,260,221,74.516,449,America's PPO,America's PPO,249.678,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Excision Of Lesion On Cervix,,57500,CPT,Facility,Both,,,,260,221,74.516,449,BlueCross BlueShield Minnesota, Federal Employee Program,255.84,98.4,,percent of total billed charges,,
Excision Of Lesion On Cervix,,57500,CPT,Facility,Both,,,,260,221,74.516,449,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,260,100,,percent of total billed charges,,
Excision Of Lesion On Cervix,,57500,CPT,Facility,Both,,,,260,221,74.516,449,BlueCross BlueShield Minnesota,High Value Network Plan,234,90,,percent of total billed charges,,
Excision Of Lesion On Cervix,,57500,CPT,Facility,Outpatient,,,,260,221,74.516,449,BlueCross BlueShield Minnesota,Medicare Advantage,127.4,49,,percent of total billed charges,,
Excision Of Lesion On Cervix,,57500,CPT,Facility,Inpatient,,,,260,221,74.516,449,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Excision Of Lesion On Cervix,,57500,CPT,Facility,Both,,,,260,221,74.516,449,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,230.282,88.57,,percent of total billed charges,,
Excision Of Lesion On Cervix,,57500,CPT,Facility,Both,,,,260,221,74.516,449,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,74.516,28.66,,percent of total billed charges,,
Excision Of Lesion On Cervix,,57500,CPT,Facility,Outpatient,,,,260,221,74.516,449,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),127.4,49,,percent of total billed charges,,
Excision Of Lesion On Cervix,,57500,CPT,Facility,Inpatient,,,,260,221,74.516,449,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Excision Of Lesion On Cervix,,57500,CPT,Facility,Both,,,,260,221,74.516,449,CorVel,Worker's Compensation,260,100,,percent of total billed charges,,
Excision Of Lesion On Cervix,,57500,CPT,Facility,Both,,,,260,221,74.516,449,First Health Group Corporation,First Health Network,252.2,97,,percent of total billed charges,,
Excision Of Lesion On Cervix,,57500,CPT,Facility,Both,,,,260,221,74.516,449,"Health Partners, Inc.",Commercial,245.96,94.6,,percent of total billed charges,,
Excision Of Lesion On Cervix,,57500,CPT,Facility,Outpatient,,,,260,221,74.516,449,"Health Partners, Inc.",Medicare Advantage,127.4,49,,percent of total billed charges,,
Excision Of Lesion On Cervix,,57500,CPT,Facility,Inpatient,,,,260,221,74.516,449,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Excision Of Lesion On Cervix,,57500,CPT,Facility,Both,,,,260,221,74.516,449,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),156,60,,percent of total billed charges,,
Excision Of Lesion On Cervix,,57500,CPT,Facility,Both,,,,260,221,74.516,449,"Health Partners, Inc.",State of Minnesota Advantage Program,211.9,81.5,,percent of total billed charges,,
Excision Of Lesion On Cervix,,57500,CPT,Facility,Both,,,,260,221,74.516,449,"Health Partners, Inc.",State Public Programs,130,50,,percent of total billed charges,,
Excision Of Lesion On Cervix,,57500,CPT,Facility,Both,,,,260,221,74.516,449,Humana Insurance Company,Commercial PPO,247,95,,percent of total billed charges,,
Excision Of Lesion On Cervix,,57500,CPT,Facility,Outpatient,,,,260,221,74.516,449,Humana Insurance Company,Medicare PPO,127.4,49,,percent of total billed charges,,
Excision Of Lesion On Cervix,,57500,CPT,Facility,Inpatient,,,,260,221,74.516,449,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Excision Of Lesion On Cervix,,57500,CPT,Facility,Both,,,,260,221,74.516,449,Medica,Individual & Family,257.66,99.1,,percent of total billed charges,,
Excision Of Lesion On Cervix,,57500,CPT,Facility,Outpatient,,,,260,221,74.516,449,Medica,Medica Advantage Solution,129.48,49.8,,percent of total billed charges,,
Excision Of Lesion On Cervix,,57500,CPT,Facility,Inpatient,,,,260,221,74.516,449,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Excision Of Lesion On Cervix,,57500,CPT,Facility,Outpatient,,,,260,221,74.516,449,Medica,Medical Assistance,449,,,Other,Grouper,All inclusive per visit
Excision Of Lesion On Cervix,,57500,CPT,Facility,Inpatient,,,,260,221,74.516,449,Medica,Medical Assistance,,,,,Included in per diem rate,
Excision Of Lesion On Cervix,,57500,CPT,Facility,Outpatient,,,,260,221,74.516,449,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,129.48,49.8,,percent of total billed charges,,
Excision Of Lesion On Cervix,,57500,CPT,Facility,Inpatient,,,,260,221,74.516,449,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Excision Of Lesion On Cervix,,57500,CPT,Facility,Both,,,,260,221,74.516,449,"Multiplan, Inc.","Multiplan, Inc.",244.4,94,,percent of total billed charges,,
Excision Of Lesion On Cervix,,57500,CPT,Facility,Outpatient,,,,260,221,74.516,449,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,234.26,90.1,,percent of total billed charges,,
Excision Of Lesion On Cervix,,57500,CPT,Facility,Inpatient,,,,260,221,74.516,449,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Excision Of Lesion On Cervix,,57500,CPT,Facility,Both,,,,260,221,74.516,449,"Preferred One Administrative Services, INC.",PPO,256.36,98.6,,percent of total billed charges,,
Excision Of Lesion On Cervix,,57500,CPT,Facility,Outpatient,,,,260,221,74.516,449,PrimeWest Health,Minnesota Senior Health Options (MSHO),133.77,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Excision Of Lesion On Cervix,,57500,CPT,Facility,Inpatient,,,,260,221,74.516,449,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Excision Of Lesion On Cervix,,57500,CPT,Facility,Outpatient,,,,260,221,74.516,449,PrimeWest Health,MinnesotaCare,133.536,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Excision Of Lesion On Cervix,,57500,CPT,Facility,Inpatient,,,,260,221,74.516,449,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Excision Of Lesion On Cervix,,57500,CPT,Facility,Both,,,,260,221,74.516,449,Sanford Health Plan,Sanford Health Plan,239.2,92,,percent of total billed charges,,
Excision Of Lesion On Cervix,,57500,CPT,Facility,Outpatient,,,,260,221,74.516,449,"UCare Health, Inc.",Individual & Family Plan,146.51,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Excision Of Lesion On Cervix,,57500,CPT,Facility,Inpatient,,,,260,221,74.516,449,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Excision Of Lesion On Cervix,,57500,CPT,Facility,Outpatient,,,,260,221,74.516,449,"UCare Health, Inc.",Medical Assistance,131.222,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Excision Of Lesion On Cervix,,57500,CPT,Facility,Inpatient,,,,260,221,74.516,449,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Excision Of Lesion On Cervix,,57500,CPT,Facility,Outpatient,,,,260,221,74.516,449,"UCare Health, Inc.",Medicare Advantage,131.222,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Excision Of Lesion On Cervix,,57500,CPT,Facility,Inpatient,,,,260,221,74.516,449,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Excision Of Lesion On Cervix,,57500,CPT,Facility,Outpatient,,,,260,221,74.516,449,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),131.222,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Excision Of Lesion On Cervix,,57500,CPT,Facility,Inpatient,,,,260,221,74.516,449,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Excision Of Lesion On Cervix,,57500,CPT,Facility,Both,,,,260,221,74.516,449,UnitedHealthcare,Individual & Family,244.4,94,,percent of total billed charges,,
Excision Of Lesion On Cervix,,57500,CPT,Facility,Outpatient,,,,260,221,74.516,449,UnitedHealthcare,Medicare Advantage,127.4,49,,percent of total billed charges,,
Excision Of Lesion On Cervix,,57500,CPT,Facility,Inpatient,,,,260,221,74.516,449,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Excision Of Lesion On Cervix,,57500,CPT,Facility,Outpatient,,,,260,221,74.516,449,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,124.8,48,,percent of total billed charges,,100% of DHS outpatient percentage
Excision Of Lesion On Cervix,,57500,CPT,Facility,Inpatient,,,,260,221,74.516,449,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Biopsy Of Endometrial W/O Cervical Dilation,,58100,CPT,Facility,Both,,,,225,191.25,64.485,225,Aetna,Commercial,207,92,,percent of total billed charges,,
Biopsy Of Endometrial W/O Cervical Dilation,,58100,CPT,Facility,Outpatient,,,,225,191.25,64.485,225,Aetna,Medicare Advantage,110.25,49,,percent of total billed charges,,
Biopsy Of Endometrial W/O Cervical Dilation,,58100,CPT,Facility,Inpatient,,,,225,191.25,64.485,225,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Biopsy Of Endometrial W/O Cervical Dilation,,58100,CPT,Facility,Both,,,,225,191.25,64.485,225,Aetna,PPO,209.25,93,,percent of total billed charges,,
Biopsy Of Endometrial W/O Cervical Dilation,,58100,CPT,Facility,Both,,,,225,191.25,64.485,225,America's PPO,America's PPO,216.0675,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Biopsy Of Endometrial W/O Cervical Dilation,,58100,CPT,Facility,Both,,,,225,191.25,64.485,225,BlueCross BlueShield Minnesota, Federal Employee Program,221.4,98.4,,percent of total billed charges,,
Biopsy Of Endometrial W/O Cervical Dilation,,58100,CPT,Facility,Both,,,,225,191.25,64.485,225,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,225,100,,percent of total billed charges,,
Biopsy Of Endometrial W/O Cervical Dilation,,58100,CPT,Facility,Both,,,,225,191.25,64.485,225,BlueCross BlueShield Minnesota,High Value Network Plan,202.5,90,,percent of total billed charges,,
Biopsy Of Endometrial W/O Cervical Dilation,,58100,CPT,Facility,Outpatient,,,,225,191.25,64.485,225,BlueCross BlueShield Minnesota,Medicare Advantage,110.25,49,,percent of total billed charges,,
Biopsy Of Endometrial W/O Cervical Dilation,,58100,CPT,Facility,Inpatient,,,,225,191.25,64.485,225,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Biopsy Of Endometrial W/O Cervical Dilation,,58100,CPT,Facility,Both,,,,225,191.25,64.485,225,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,199.2825,88.57,,percent of total billed charges,,
Biopsy Of Endometrial W/O Cervical Dilation,,58100,CPT,Facility,Both,,,,225,191.25,64.485,225,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,64.485,28.66,,percent of total billed charges,,
Biopsy Of Endometrial W/O Cervical Dilation,,58100,CPT,Facility,Outpatient,,,,225,191.25,64.485,225,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),110.25,49,,percent of total billed charges,,
Biopsy Of Endometrial W/O Cervical Dilation,,58100,CPT,Facility,Inpatient,,,,225,191.25,64.485,225,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Biopsy Of Endometrial W/O Cervical Dilation,,58100,CPT,Facility,Both,,,,225,191.25,64.485,225,CorVel,Worker's Compensation,225,100,,percent of total billed charges,,
Biopsy Of Endometrial W/O Cervical Dilation,,58100,CPT,Facility,Both,,,,225,191.25,64.485,225,First Health Group Corporation,First Health Network,218.25,97,,percent of total billed charges,,
Biopsy Of Endometrial W/O Cervical Dilation,,58100,CPT,Facility,Both,,,,225,191.25,64.485,225,"Health Partners, Inc.",Commercial,212.85,94.6,,percent of total billed charges,,
Biopsy Of Endometrial W/O Cervical Dilation,,58100,CPT,Facility,Outpatient,,,,225,191.25,64.485,225,"Health Partners, Inc.",Medicare Advantage,110.25,49,,percent of total billed charges,,
Biopsy Of Endometrial W/O Cervical Dilation,,58100,CPT,Facility,Inpatient,,,,225,191.25,64.485,225,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Biopsy Of Endometrial W/O Cervical Dilation,,58100,CPT,Facility,Both,,,,225,191.25,64.485,225,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),135,60,,percent of total billed charges,,
Biopsy Of Endometrial W/O Cervical Dilation,,58100,CPT,Facility,Both,,,,225,191.25,64.485,225,"Health Partners, Inc.",State of Minnesota Advantage Program,183.375,81.5,,percent of total billed charges,,
Biopsy Of Endometrial W/O Cervical Dilation,,58100,CPT,Facility,Both,,,,225,191.25,64.485,225,"Health Partners, Inc.",State Public Programs,112.5,50,,percent of total billed charges,,
Biopsy Of Endometrial W/O Cervical Dilation,,58100,CPT,Facility,Both,,,,225,191.25,64.485,225,Humana Insurance Company,Commercial PPO,213.75,95,,percent of total billed charges,,
Biopsy Of Endometrial W/O Cervical Dilation,,58100,CPT,Facility,Outpatient,,,,225,191.25,64.485,225,Humana Insurance Company,Medicare PPO,110.25,49,,percent of total billed charges,,
Biopsy Of Endometrial W/O Cervical Dilation,,58100,CPT,Facility,Inpatient,,,,225,191.25,64.485,225,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Biopsy Of Endometrial W/O Cervical Dilation,,58100,CPT,Facility,Both,,,,225,191.25,64.485,225,Medica,Individual & Family,222.975,99.1,,percent of total billed charges,,
Biopsy Of Endometrial W/O Cervical Dilation,,58100,CPT,Facility,Outpatient,,,,225,191.25,64.485,225,Medica,Medica Advantage Solution,112.05,49.8,,percent of total billed charges,,
Biopsy Of Endometrial W/O Cervical Dilation,,58100,CPT,Facility,Inpatient,,,,225,191.25,64.485,225,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Biopsy Of Endometrial W/O Cervical Dilation,,58100,CPT,Facility,Outpatient,,,,225,191.25,64.485,225,Medica,Medical Assistance,100.35,44.6,,percent of total billed charges,,
Biopsy Of Endometrial W/O Cervical Dilation,,58100,CPT,Facility,Inpatient,,,,225,191.25,64.485,225,Medica,Medical Assistance,,,,,Included in per diem rate,
Biopsy Of Endometrial W/O Cervical Dilation,,58100,CPT,Facility,Outpatient,,,,225,191.25,64.485,225,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,112.05,49.8,,percent of total billed charges,,
Biopsy Of Endometrial W/O Cervical Dilation,,58100,CPT,Facility,Inpatient,,,,225,191.25,64.485,225,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Biopsy Of Endometrial W/O Cervical Dilation,,58100,CPT,Facility,Both,,,,225,191.25,64.485,225,"Multiplan, Inc.","Multiplan, Inc.",211.5,94,,percent of total billed charges,,
Biopsy Of Endometrial W/O Cervical Dilation,,58100,CPT,Facility,Outpatient,,,,225,191.25,64.485,225,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,202.725,90.1,,percent of total billed charges,,
Biopsy Of Endometrial W/O Cervical Dilation,,58100,CPT,Facility,Inpatient,,,,225,191.25,64.485,225,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Biopsy Of Endometrial W/O Cervical Dilation,,58100,CPT,Facility,Both,,,,225,191.25,64.485,225,"Preferred One Administrative Services, INC.",PPO,221.85,98.6,,percent of total billed charges,,
Biopsy Of Endometrial W/O Cervical Dilation,,58100,CPT,Facility,Outpatient,,,,225,191.25,64.485,225,PrimeWest Health,Minnesota Senior Health Options (MSHO),115.7625,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Biopsy Of Endometrial W/O Cervical Dilation,,58100,CPT,Facility,Inpatient,,,,225,191.25,64.485,225,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Biopsy Of Endometrial W/O Cervical Dilation,,58100,CPT,Facility,Outpatient,,,,225,191.25,64.485,225,PrimeWest Health,MinnesotaCare,115.56,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Biopsy Of Endometrial W/O Cervical Dilation,,58100,CPT,Facility,Inpatient,,,,225,191.25,64.485,225,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Biopsy Of Endometrial W/O Cervical Dilation,,58100,CPT,Facility,Both,,,,225,191.25,64.485,225,Sanford Health Plan,Sanford Health Plan,207,92,,percent of total billed charges,,
Biopsy Of Endometrial W/O Cervical Dilation,,58100,CPT,Facility,Outpatient,,,,225,191.25,64.485,225,"UCare Health, Inc.",Individual & Family Plan,126.7875,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Biopsy Of Endometrial W/O Cervical Dilation,,58100,CPT,Facility,Inpatient,,,,225,191.25,64.485,225,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Biopsy Of Endometrial W/O Cervical Dilation,,58100,CPT,Facility,Outpatient,,,,225,191.25,64.485,225,"UCare Health, Inc.",Medical Assistance,113.5575,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Biopsy Of Endometrial W/O Cervical Dilation,,58100,CPT,Facility,Inpatient,,,,225,191.25,64.485,225,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Biopsy Of Endometrial W/O Cervical Dilation,,58100,CPT,Facility,Outpatient,,,,225,191.25,64.485,225,"UCare Health, Inc.",Medicare Advantage,113.5575,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Biopsy Of Endometrial W/O Cervical Dilation,,58100,CPT,Facility,Inpatient,,,,225,191.25,64.485,225,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Biopsy Of Endometrial W/O Cervical Dilation,,58100,CPT,Facility,Outpatient,,,,225,191.25,64.485,225,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),113.5575,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Biopsy Of Endometrial W/O Cervical Dilation,,58100,CPT,Facility,Inpatient,,,,225,191.25,64.485,225,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Biopsy Of Endometrial W/O Cervical Dilation,,58100,CPT,Facility,Both,,,,225,191.25,64.485,225,UnitedHealthcare,Individual & Family,211.5,94,,percent of total billed charges,,
Biopsy Of Endometrial W/O Cervical Dilation,,58100,CPT,Facility,Outpatient,,,,225,191.25,64.485,225,UnitedHealthcare,Medicare Advantage,110.25,49,,percent of total billed charges,,
Biopsy Of Endometrial W/O Cervical Dilation,,58100,CPT,Facility,Inpatient,,,,225,191.25,64.485,225,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Biopsy Of Endometrial W/O Cervical Dilation,,58100,CPT,Facility,Outpatient,,,,225,191.25,64.485,225,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,108,48,,percent of total billed charges,,100% of DHS outpatient percentage
Biopsy Of Endometrial W/O Cervical Dilation,,58100,CPT,Facility,Inpatient,,,,225,191.25,64.485,225,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Endometrial Biopsy; W/Wo Endocervical Biopsy, W/O Cervical Dilation, Any Method (Pro Cah)",,58100,CPT,Professional,Both,,,,448,380.8,41.67,448,Aetna,Commercial,380.8,85,,percent of total billed charges,,
"Endometrial Biopsy; W/Wo Endocervical Biopsy, W/O Cervical Dilation, Any Method (Pro Cah)",,58100,CPT,Professional,Both,,,,448,380.8,41.67,448,Aetna,Medicare Advantage,61.3,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Endometrial Biopsy; W/Wo Endocervical Biopsy, W/O Cervical Dilation, Any Method (Pro Cah)",,58100,CPT,Professional,Both,,,,448,380.8,41.67,448,Aetna,PPO,416.64,93,,percent of total billed charges,,
"Endometrial Biopsy; W/Wo Endocervical Biopsy, W/O Cervical Dilation, Any Method (Pro Cah)",,58100,CPT,Professional,Both,,,,448,380.8,41.67,448,America's PPO,America's PPO,382.7712,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Endometrial Biopsy; W/Wo Endocervical Biopsy, W/O Cervical Dilation, Any Method (Pro Cah)",,58100,CPT,Professional,Both,,,,448,380.8,41.67,448,BlueCross BlueShield Minnesota, Federal Employee Program,129.46,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Endometrial Biopsy; W/Wo Endocervical Biopsy, W/O Cervical Dilation, Any Method (Pro Cah)",,58100,CPT,Professional,Both,,,,448,380.8,41.67,448,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,131.53136,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Endometrial Biopsy; W/Wo Endocervical Biopsy, W/O Cervical Dilation, Any Method (Pro Cah)",,58100,CPT,Professional,Both,,,,448,380.8,41.67,448,BlueCross BlueShield Minnesota,High Value Network Plan,131.53136,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Endometrial Biopsy; W/Wo Endocervical Biopsy, W/O Cervical Dilation, Any Method (Pro Cah)",,58100,CPT,Professional,Both,,,,448,380.8,41.67,448,BlueCross BlueShield Minnesota,Medicare Advantage,68.632,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Endometrial Biopsy; W/Wo Endocervical Biopsy, W/O Cervical Dilation, Any Method (Pro Cah)",,58100,CPT,Professional,Both,,,,448,380.8,41.67,448,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,131.53136,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Endometrial Biopsy; W/Wo Endocervical Biopsy, W/O Cervical Dilation, Any Method (Pro Cah)",,58100,CPT,Professional,Both,,,,448,380.8,41.67,448,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,44.32808,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Endometrial Biopsy; W/Wo Endocervical Biopsy, W/O Cervical Dilation, Any Method (Pro Cah)",,58100,CPT,Professional,Both,,,,448,380.8,41.67,448,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),68.632,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Endometrial Biopsy; W/Wo Endocervical Biopsy, W/O Cervical Dilation, Any Method (Pro Cah)",,58100,CPT,Professional,Both,,,,448,380.8,41.67,448,CorVel,Worker's Compensation,117.9982107,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Endometrial Biopsy; W/Wo Endocervical Biopsy, W/O Cervical Dilation, Any Method (Pro Cah)",,58100,CPT,Professional,Both,,,,448,380.8,41.67,448,First Health Group Corporation,First Health Network,434.56,97,,percent of total billed charges,,
"Endometrial Biopsy; W/Wo Endocervical Biopsy, W/O Cervical Dilation, Any Method (Pro Cah)",,58100,CPT,Professional,Both,,,,448,380.8,41.67,448,"Health Partners, Inc.",Commercial,127.69,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Endometrial Biopsy; W/Wo Endocervical Biopsy, W/O Cervical Dilation, Any Method (Pro Cah)",,58100,CPT,Professional,Both,,,,448,380.8,41.67,448,"Health Partners, Inc.",Medicare Advantage,68.632,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Endometrial Biopsy; W/Wo Endocervical Biopsy, W/O Cervical Dilation, Any Method (Pro Cah)",,58100,CPT,Professional,Both,,,,448,380.8,41.67,448,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),59.64,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Endometrial Biopsy; W/Wo Endocervical Biopsy, W/O Cervical Dilation, Any Method (Pro Cah)",,58100,CPT,Professional,Both,,,,448,380.8,41.67,448,"Health Partners, Inc.",State of Minnesota Advantage Program,110.004935,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Endometrial Biopsy; W/Wo Endocervical Biopsy, W/O Cervical Dilation, Any Method (Pro Cah)",,58100,CPT,Professional,Both,,,,448,380.8,41.67,448,"Health Partners, Inc.",State Public Programs,41.67,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Endometrial Biopsy; W/Wo Endocervical Biopsy, W/O Cervical Dilation, Any Method (Pro Cah)",,58100,CPT,Professional,Both,,,,448,380.8,41.67,448,Humana Insurance Company,Commercial PPO,59.68,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Endometrial Biopsy; W/Wo Endocervical Biopsy, W/O Cervical Dilation, Any Method (Pro Cah)",,58100,CPT,Professional,Both,,,,448,380.8,41.67,448,Humana Insurance Company,Medicare PPO,448,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Endometrial Biopsy; W/Wo Endocervical Biopsy, W/O Cervical Dilation, Any Method (Pro Cah)",,58100,CPT,Professional,Both,,,,448,380.8,41.67,448,Medica,Individual & Family,379.904,84.8,,percent of total billed charges,,
"Endometrial Biopsy; W/Wo Endocervical Biopsy, W/O Cervical Dilation, Any Method (Pro Cah)",,58100,CPT,Professional,Both,,,,448,380.8,41.67,448,Medica,Medica Advantage Solution,223.104,49.8,,percent of total billed charges,,
"Endometrial Biopsy; W/Wo Endocervical Biopsy, W/O Cervical Dilation, Any Method (Pro Cah)",,58100,CPT,Professional,Both,,,,448,380.8,41.67,448,Medica,Medical Assistance,44.33,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Endometrial Biopsy; W/Wo Endocervical Biopsy, W/O Cervical Dilation, Any Method (Pro Cah)",,58100,CPT,Professional,Both,,,,448,380.8,41.67,448,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,59.68,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Endometrial Biopsy; W/Wo Endocervical Biopsy, W/O Cervical Dilation, Any Method (Pro Cah)",,58100,CPT,Professional,Both,,,,448,380.8,41.67,448,"Multiplan, Inc.","Multiplan, Inc.",421.12,94,,percent of total billed charges,,
"Endometrial Biopsy; W/Wo Endocervical Biopsy, W/O Cervical Dilation, Any Method (Pro Cah)",,58100,CPT,Professional,Both,,,,448,380.8,41.67,448,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,403.648,90.1,,percent of total billed charges,,
"Endometrial Biopsy; W/Wo Endocervical Biopsy, W/O Cervical Dilation, Any Method (Pro Cah)",,58100,CPT,Professional,Both,,,,448,380.8,41.67,448,"Preferred One Administrative Services, INC.",PPO,441.728,98.6,,percent of total billed charges,,
"Endometrial Biopsy; W/Wo Endocervical Biopsy, W/O Cervical Dilation, Any Method (Pro Cah)",,58100,CPT,Professional,Both,,,,448,380.8,41.67,448,PrimeWest Health,Minnesota Senior Health Options (MSHO),68.632,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Endometrial Biopsy; W/Wo Endocervical Biopsy, W/O Cervical Dilation, Any Method (Pro Cah)",,58100,CPT,Professional,Both,,,,448,380.8,41.67,448,PrimeWest Health,MinnesotaCare,47.4310456,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Endometrial Biopsy; W/Wo Endocervical Biopsy, W/O Cervical Dilation, Any Method (Pro Cah)",,58100,CPT,Professional,Both,,,,448,380.8,41.67,448,Sanford Health Plan,Sanford Health Plan,394.24,88,,percent of total billed charges,,
"Endometrial Biopsy; W/Wo Endocervical Biopsy, W/O Cervical Dilation, Any Method (Pro Cah)",,58100,CPT,Professional,Both,,,,448,380.8,41.67,448,"UCare Health, Inc.",Individual & Family Plan,97.015808,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Endometrial Biopsy; W/Wo Endocervical Biopsy, W/O Cervical Dilation, Any Method (Pro Cah)",,58100,CPT,Professional,Both,,,,448,380.8,41.67,448,"UCare Health, Inc.",Medical Assistance,48.760888,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Endometrial Biopsy; W/Wo Endocervical Biopsy, W/O Cervical Dilation, Any Method (Pro Cah)",,58100,CPT,Professional,Both,,,,448,380.8,41.67,448,"UCare Health, Inc.",Medicare Advantage,68.632,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Endometrial Biopsy; W/Wo Endocervical Biopsy, W/O Cervical Dilation, Any Method (Pro Cah)",,58100,CPT,Professional,Both,,,,448,380.8,41.67,448,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),54.9056,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Endometrial Biopsy; W/Wo Endocervical Biopsy, W/O Cervical Dilation, Any Method (Pro Cah)",,58100,CPT,Professional,Both,,,,448,380.8,41.67,448,UnitedHealthcare,Individual & Family,448,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Endometrial Biopsy; W/Wo Endocervical Biopsy, W/O Cervical Dilation, Any Method (Pro Cah)",,58100,CPT,Professional,Both,,,,448,380.8,41.67,448,UnitedHealthcare,Medicare Advantage,68.632,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Endometrial Biopsy; W/Wo Endocervical Biopsy, W/O Cervical Dilation, Any Method (Pro Cah)",,58100,CPT,Professional,Both,,,,448,380.8,41.67,448,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,44.32808,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Dilation And Curettage, Diagnostic And/Or Therapeutic (Nonobstetrical) (Pro Cah)",,58120,CPT,Professional,Both,,,,1303,1107.55,157.67,1303,Aetna,Commercial,1107.55,85,,percent of total billed charges,,
"Dilation And Curettage, Diagnostic And/Or Therapeutic (Nonobstetrical) (Pro Cah)",,58120,CPT,Professional,Both,,,,1303,1107.55,157.67,1303,Aetna,Medicare Advantage,226.08,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Dilation And Curettage, Diagnostic And/Or Therapeutic (Nonobstetrical) (Pro Cah)",,58120,CPT,Professional,Both,,,,1303,1107.55,157.67,1303,Aetna,PPO,1211.79,93,,percent of total billed charges,,
"Dilation And Curettage, Diagnostic And/Or Therapeutic (Nonobstetrical) (Pro Cah)",,58120,CPT,Professional,Both,,,,1303,1107.55,157.67,1303,America's PPO,America's PPO,1113.2832,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Dilation And Curettage, Diagnostic And/Or Therapeutic (Nonobstetrical) (Pro Cah)",,58120,CPT,Professional,Both,,,,1303,1107.55,157.67,1303,BlueCross BlueShield Minnesota, Federal Employee Program,482.71,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Dilation And Curettage, Diagnostic And/Or Therapeutic (Nonobstetrical) (Pro Cah)",,58120,CPT,Professional,Both,,,,1303,1107.55,157.67,1303,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,490.43336,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Dilation And Curettage, Diagnostic And/Or Therapeutic (Nonobstetrical) (Pro Cah)",,58120,CPT,Professional,Both,,,,1303,1107.55,157.67,1303,BlueCross BlueShield Minnesota,High Value Network Plan,490.43336,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Dilation And Curettage, Diagnostic And/Or Therapeutic (Nonobstetrical) (Pro Cah)",,58120,CPT,Professional,Both,,,,1303,1107.55,157.67,1303,BlueCross BlueShield Minnesota,Medicare Advantage,259.785,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Dilation And Curettage, Diagnostic And/Or Therapeutic (Nonobstetrical) (Pro Cah)",,58120,CPT,Professional,Both,,,,1303,1107.55,157.67,1303,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,490.43336,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Dilation And Curettage, Diagnostic And/Or Therapeutic (Nonobstetrical) (Pro Cah)",,58120,CPT,Professional,Both,,,,1303,1107.55,157.67,1303,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,167.7416,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Dilation And Curettage, Diagnostic And/Or Therapeutic (Nonobstetrical) (Pro Cah)",,58120,CPT,Professional,Both,,,,1303,1107.55,157.67,1303,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),259.785,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Dilation And Curettage, Diagnostic And/Or Therapeutic (Nonobstetrical) (Pro Cah)",,58120,CPT,Professional,Both,,,,1303,1107.55,157.67,1303,CorVel,Worker's Compensation,444.5270298,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Dilation And Curettage, Diagnostic And/Or Therapeutic (Nonobstetrical) (Pro Cah)",,58120,CPT,Professional,Both,,,,1303,1107.55,157.67,1303,First Health Group Corporation,First Health Network,1263.91,97,,percent of total billed charges,,
"Dilation And Curettage, Diagnostic And/Or Therapeutic (Nonobstetrical) (Pro Cah)",,58120,CPT,Professional,Both,,,,1303,1107.55,157.67,1303,"Health Partners, Inc.",Commercial,480.29,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Dilation And Curettage, Diagnostic And/Or Therapeutic (Nonobstetrical) (Pro Cah)",,58120,CPT,Professional,Both,,,,1303,1107.55,157.67,1303,"Health Partners, Inc.",Medicare Advantage,259.785,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Dilation And Curettage, Diagnostic And/Or Therapeutic (Nonobstetrical) (Pro Cah)",,58120,CPT,Professional,Both,,,,1303,1107.55,157.67,1303,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),225.69,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Dilation And Curettage, Diagnostic And/Or Therapeutic (Nonobstetrical) (Pro Cah)",,58120,CPT,Professional,Both,,,,1303,1107.55,157.67,1303,"Health Partners, Inc.",State of Minnesota Advantage Program,413.769835,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Dilation And Curettage, Diagnostic And/Or Therapeutic (Nonobstetrical) (Pro Cah)",,58120,CPT,Professional,Both,,,,1303,1107.55,157.67,1303,"Health Partners, Inc.",State Public Programs,157.67,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Dilation And Curettage, Diagnostic And/Or Therapeutic (Nonobstetrical) (Pro Cah)",,58120,CPT,Professional,Both,,,,1303,1107.55,157.67,1303,Humana Insurance Company,Commercial PPO,225.9,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Dilation And Curettage, Diagnostic And/Or Therapeutic (Nonobstetrical) (Pro Cah)",,58120,CPT,Professional,Both,,,,1303,1107.55,157.67,1303,Humana Insurance Company,Medicare PPO,1303,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Dilation And Curettage, Diagnostic And/Or Therapeutic (Nonobstetrical) (Pro Cah)",,58120,CPT,Professional,Both,,,,1303,1107.55,157.67,1303,Medica,Individual & Family,1104.944,84.8,,percent of total billed charges,,
"Dilation And Curettage, Diagnostic And/Or Therapeutic (Nonobstetrical) (Pro Cah)",,58120,CPT,Professional,Both,,,,1303,1107.55,157.67,1303,Medica,Medica Advantage Solution,648.894,49.8,,percent of total billed charges,,
"Dilation And Curettage, Diagnostic And/Or Therapeutic (Nonobstetrical) (Pro Cah)",,58120,CPT,Professional,Both,,,,1303,1107.55,157.67,1303,Medica,Medical Assistance,167.74,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Dilation And Curettage, Diagnostic And/Or Therapeutic (Nonobstetrical) (Pro Cah)",,58120,CPT,Professional,Both,,,,1303,1107.55,157.67,1303,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,225.9,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Dilation And Curettage, Diagnostic And/Or Therapeutic (Nonobstetrical) (Pro Cah)",,58120,CPT,Professional,Both,,,,1303,1107.55,157.67,1303,"Multiplan, Inc.","Multiplan, Inc.",1224.82,94,,percent of total billed charges,,
"Dilation And Curettage, Diagnostic And/Or Therapeutic (Nonobstetrical) (Pro Cah)",,58120,CPT,Professional,Both,,,,1303,1107.55,157.67,1303,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1174.003,90.1,,percent of total billed charges,,
"Dilation And Curettage, Diagnostic And/Or Therapeutic (Nonobstetrical) (Pro Cah)",,58120,CPT,Professional,Both,,,,1303,1107.55,157.67,1303,"Preferred One Administrative Services, INC.",PPO,1284.758,98.6,,percent of total billed charges,,
"Dilation And Curettage, Diagnostic And/Or Therapeutic (Nonobstetrical) (Pro Cah)",,58120,CPT,Professional,Both,,,,1303,1107.55,157.67,1303,PrimeWest Health,Minnesota Senior Health Options (MSHO),259.785,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Dilation And Curettage, Diagnostic And/Or Therapeutic (Nonobstetrical) (Pro Cah)",,58120,CPT,Professional,Both,,,,1303,1107.55,157.67,1303,PrimeWest Health,MinnesotaCare,179.483512,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Dilation And Curettage, Diagnostic And/Or Therapeutic (Nonobstetrical) (Pro Cah)",,58120,CPT,Professional,Both,,,,1303,1107.55,157.67,1303,Sanford Health Plan,Sanford Health Plan,1146.64,88,,percent of total billed charges,,
"Dilation And Curettage, Diagnostic And/Or Therapeutic (Nonobstetrical) (Pro Cah)",,58120,CPT,Professional,Both,,,,1303,1107.55,157.67,1303,"UCare Health, Inc.",Individual & Family Plan,367.22304,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Dilation And Curettage, Diagnostic And/Or Therapeutic (Nonobstetrical) (Pro Cah)",,58120,CPT,Professional,Both,,,,1303,1107.55,157.67,1303,"UCare Health, Inc.",Medical Assistance,184.51576,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Dilation And Curettage, Diagnostic And/Or Therapeutic (Nonobstetrical) (Pro Cah)",,58120,CPT,Professional,Both,,,,1303,1107.55,157.67,1303,"UCare Health, Inc.",Medicare Advantage,259.785,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Dilation And Curettage, Diagnostic And/Or Therapeutic (Nonobstetrical) (Pro Cah)",,58120,CPT,Professional,Both,,,,1303,1107.55,157.67,1303,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),207.828,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Dilation And Curettage, Diagnostic And/Or Therapeutic (Nonobstetrical) (Pro Cah)",,58120,CPT,Professional,Both,,,,1303,1107.55,157.67,1303,UnitedHealthcare,Individual & Family,1303,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Dilation And Curettage, Diagnostic And/Or Therapeutic (Nonobstetrical) (Pro Cah)",,58120,CPT,Professional,Both,,,,1303,1107.55,157.67,1303,UnitedHealthcare,Medicare Advantage,259.785,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Dilation And Curettage, Diagnostic And/Or Therapeutic (Nonobstetrical) (Pro Cah)",,58120,CPT,Professional,Both,,,,1303,1107.55,157.67,1303,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,167.7416,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Supracervical Abd Hysterectomy, W/Wo Removal Of Tubes, W/Wo Removal Of Ovaries (Procah)",,58180,CPT,Professional,Both,,,,3733,3173.05,590.09,3733,Aetna,Commercial,3173.05,85,,percent of total billed charges,,
"Supracervical Abd Hysterectomy, W/Wo Removal Of Tubes, W/Wo Removal Of Ovaries (Procah)",,58180,CPT,Professional,Both,,,,3733,3173.05,590.09,3733,Aetna,Medicare Advantage,931.03,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Supracervical Abd Hysterectomy, W/Wo Removal Of Tubes, W/Wo Removal Of Ovaries (Procah)",,58180,CPT,Professional,Both,,,,3733,3173.05,590.09,3733,Aetna,PPO,3471.69,93,,percent of total billed charges,,
"Supracervical Abd Hysterectomy, W/Wo Removal Of Tubes, W/Wo Removal Of Ovaries (Procah)",,58180,CPT,Professional,Both,,,,3733,3173.05,590.09,3733,America's PPO,America's PPO,3189.4752,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Supracervical Abd Hysterectomy, W/Wo Removal Of Tubes, W/Wo Removal Of Ovaries (Procah)",,58180,CPT,Professional,Both,,,,3733,3173.05,590.09,3733,BlueCross BlueShield Minnesota, Federal Employee Program,1978.35,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Supracervical Abd Hysterectomy, W/Wo Removal Of Tubes, W/Wo Removal Of Ovaries (Procah)",,58180,CPT,Professional,Both,,,,3733,3173.05,590.09,3733,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,2010.0036,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Supracervical Abd Hysterectomy, W/Wo Removal Of Tubes, W/Wo Removal Of Ovaries (Procah)",,58180,CPT,Professional,Both,,,,3733,3173.05,590.09,3733,BlueCross BlueShield Minnesota,High Value Network Plan,2010.0036,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Supracervical Abd Hysterectomy, W/Wo Removal Of Tubes, W/Wo Removal Of Ovaries (Procah)",,58180,CPT,Professional,Both,,,,3733,3173.05,590.09,3733,BlueCross BlueShield Minnesota,Medicare Advantage,1054.3315,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Supracervical Abd Hysterectomy, W/Wo Removal Of Tubes, W/Wo Removal Of Ovaries (Procah)",,58180,CPT,Professional,Both,,,,3733,3173.05,590.09,3733,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,2010.0036,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Supracervical Abd Hysterectomy, W/Wo Removal Of Tubes, W/Wo Removal Of Ovaries (Procah)",,58180,CPT,Professional,Both,,,,3733,3173.05,590.09,3733,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,681.28896,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Supracervical Abd Hysterectomy, W/Wo Removal Of Tubes, W/Wo Removal Of Ovaries (Procah)",,58180,CPT,Professional,Both,,,,3733,3173.05,590.09,3733,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1054.3315,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Supracervical Abd Hysterectomy, W/Wo Removal Of Tubes, W/Wo Removal Of Ovaries (Procah)",,58180,CPT,Professional,Both,,,,3733,3173.05,590.09,3733,CorVel,Worker's Compensation,1804.833047,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Supracervical Abd Hysterectomy, W/Wo Removal Of Tubes, W/Wo Removal Of Ovaries (Procah)",,58180,CPT,Professional,Both,,,,3733,3173.05,590.09,3733,First Health Group Corporation,First Health Network,3621.01,97,,percent of total billed charges,,
"Supracervical Abd Hysterectomy, W/Wo Removal Of Tubes, W/Wo Removal Of Ovaries (Procah)",,58180,CPT,Professional,Both,,,,3733,3173.05,590.09,3733,"Health Partners, Inc.",Commercial,1949.49,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Supracervical Abd Hysterectomy, W/Wo Removal Of Tubes, W/Wo Removal Of Ovaries (Procah)",,58180,CPT,Professional,Both,,,,3733,3173.05,590.09,3733,"Health Partners, Inc.",Medicare Advantage,1054.3315,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Supracervical Abd Hysterectomy, W/Wo Removal Of Tubes, W/Wo Removal Of Ovaries (Procah)",,58180,CPT,Professional,Both,,,,3733,3173.05,590.09,3733,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),916.99,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Supracervical Abd Hysterectomy, W/Wo Removal Of Tubes, W/Wo Removal Of Ovaries (Procah)",,58180,CPT,Professional,Both,,,,3733,3173.05,590.09,3733,"Health Partners, Inc.",State of Minnesota Advantage Program,1679.485635,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Supracervical Abd Hysterectomy, W/Wo Removal Of Tubes, W/Wo Removal Of Ovaries (Procah)",,58180,CPT,Professional,Both,,,,3733,3173.05,590.09,3733,"Health Partners, Inc.",State Public Programs,590.09,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Supracervical Abd Hysterectomy, W/Wo Removal Of Tubes, W/Wo Removal Of Ovaries (Procah)",,58180,CPT,Professional,Both,,,,3733,3173.05,590.09,3733,Humana Insurance Company,Commercial PPO,916.81,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Supracervical Abd Hysterectomy, W/Wo Removal Of Tubes, W/Wo Removal Of Ovaries (Procah)",,58180,CPT,Professional,Both,,,,3733,3173.05,590.09,3733,Humana Insurance Company,Medicare PPO,3733,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Supracervical Abd Hysterectomy, W/Wo Removal Of Tubes, W/Wo Removal Of Ovaries (Procah)",,58180,CPT,Professional,Both,,,,3733,3173.05,590.09,3733,Medica,Individual & Family,3165.584,84.8,,percent of total billed charges,,
"Supracervical Abd Hysterectomy, W/Wo Removal Of Tubes, W/Wo Removal Of Ovaries (Procah)",,58180,CPT,Professional,Both,,,,3733,3173.05,590.09,3733,Medica,Medica Advantage Solution,1859.034,49.8,,percent of total billed charges,,
"Supracervical Abd Hysterectomy, W/Wo Removal Of Tubes, W/Wo Removal Of Ovaries (Procah)",,58180,CPT,Professional,Both,,,,3733,3173.05,590.09,3733,Medica,Medical Assistance,681.29,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Supracervical Abd Hysterectomy, W/Wo Removal Of Tubes, W/Wo Removal Of Ovaries (Procah)",,58180,CPT,Professional,Both,,,,3733,3173.05,590.09,3733,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,916.81,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Supracervical Abd Hysterectomy, W/Wo Removal Of Tubes, W/Wo Removal Of Ovaries (Procah)",,58180,CPT,Professional,Both,,,,3733,3173.05,590.09,3733,"Multiplan, Inc.","Multiplan, Inc.",3509.02,94,,percent of total billed charges,,
"Supracervical Abd Hysterectomy, W/Wo Removal Of Tubes, W/Wo Removal Of Ovaries (Procah)",,58180,CPT,Professional,Both,,,,3733,3173.05,590.09,3733,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,3363.433,90.1,,percent of total billed charges,,
"Supracervical Abd Hysterectomy, W/Wo Removal Of Tubes, W/Wo Removal Of Ovaries (Procah)",,58180,CPT,Professional,Both,,,,3733,3173.05,590.09,3733,"Preferred One Administrative Services, INC.",PPO,3680.738,98.6,,percent of total billed charges,,
"Supracervical Abd Hysterectomy, W/Wo Removal Of Tubes, W/Wo Removal Of Ovaries (Procah)",,58180,CPT,Professional,Both,,,,3733,3173.05,590.09,3733,PrimeWest Health,Minnesota Senior Health Options (MSHO),1054.3315,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Supracervical Abd Hysterectomy, W/Wo Removal Of Tubes, W/Wo Removal Of Ovaries (Procah)",,58180,CPT,Professional,Both,,,,3733,3173.05,590.09,3733,PrimeWest Health,MinnesotaCare,728.9791872,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Supracervical Abd Hysterectomy, W/Wo Removal Of Tubes, W/Wo Removal Of Ovaries (Procah)",,58180,CPT,Professional,Both,,,,3733,3173.05,590.09,3733,Sanford Health Plan,Sanford Health Plan,3285.04,88,,percent of total billed charges,,
"Supracervical Abd Hysterectomy, W/Wo Removal Of Tubes, W/Wo Removal Of Ovaries (Procah)",,58180,CPT,Professional,Both,,,,3733,3173.05,590.09,3733,"UCare Health, Inc.",Individual & Family Plan,1490.366336,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Supracervical Abd Hysterectomy, W/Wo Removal Of Tubes, W/Wo Removal Of Ovaries (Procah)",,58180,CPT,Professional,Both,,,,3733,3173.05,590.09,3733,"UCare Health, Inc.",Medical Assistance,749.417856,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Supracervical Abd Hysterectomy, W/Wo Removal Of Tubes, W/Wo Removal Of Ovaries (Procah)",,58180,CPT,Professional,Both,,,,3733,3173.05,590.09,3733,"UCare Health, Inc.",Medicare Advantage,1054.3315,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Supracervical Abd Hysterectomy, W/Wo Removal Of Tubes, W/Wo Removal Of Ovaries (Procah)",,58180,CPT,Professional,Both,,,,3733,3173.05,590.09,3733,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),843.4652,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Supracervical Abd Hysterectomy, W/Wo Removal Of Tubes, W/Wo Removal Of Ovaries (Procah)",,58180,CPT,Professional,Both,,,,3733,3173.05,590.09,3733,UnitedHealthcare,Individual & Family,3733,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Supracervical Abd Hysterectomy, W/Wo Removal Of Tubes, W/Wo Removal Of Ovaries (Procah)",,58180,CPT,Professional,Both,,,,3733,3173.05,590.09,3733,UnitedHealthcare,Medicare Advantage,1054.3315,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Supracervical Abd Hysterectomy, W/Wo Removal Of Tubes, W/Wo Removal Of Ovaries (Procah)",,58180,CPT,Professional,Both,,,,3733,3173.05,590.09,3733,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,681.28896,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Ligation Or Transection Of Fallopian Tube, Abd Or Vag Approach, Unilateral Or Bilateral (Pro Cah)",,58600,CPT,Professional,Both,,,,1530,1300.5,250.47,1530,Aetna,Commercial,1300.5,85,,percent of total billed charges,,
"Ligation Or Transection Of Fallopian Tube, Abd Or Vag Approach, Unilateral Or Bilateral (Pro Cah)",,58600,CPT,Professional,Both,,,,1530,1300.5,250.47,1530,Aetna,Medicare Advantage,362.36,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Ligation Or Transection Of Fallopian Tube, Abd Or Vag Approach, Unilateral Or Bilateral (Pro Cah)",,58600,CPT,Professional,Both,,,,1530,1300.5,250.47,1530,Aetna,PPO,1422.9,93,,percent of total billed charges,,
"Ligation Or Transection Of Fallopian Tube, Abd Or Vag Approach, Unilateral Or Bilateral (Pro Cah)",,58600,CPT,Professional,Both,,,,1530,1300.5,250.47,1530,America's PPO,America's PPO,1307.232,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Ligation Or Transection Of Fallopian Tube, Abd Or Vag Approach, Unilateral Or Bilateral (Pro Cah)",,58600,CPT,Professional,Both,,,,1530,1300.5,250.47,1530,BlueCross BlueShield Minnesota, Federal Employee Program,768.48,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Ligation Or Transection Of Fallopian Tube, Abd Or Vag Approach, Unilateral Or Bilateral (Pro Cah)",,58600,CPT,Professional,Both,,,,1530,1300.5,250.47,1530,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,780.77568,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Ligation Or Transection Of Fallopian Tube, Abd Or Vag Approach, Unilateral Or Bilateral (Pro Cah)",,58600,CPT,Professional,Both,,,,1530,1300.5,250.47,1530,BlueCross BlueShield Minnesota,High Value Network Plan,780.77568,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Ligation Or Transection Of Fallopian Tube, Abd Or Vag Approach, Unilateral Or Bilateral (Pro Cah)",,58600,CPT,Professional,Both,,,,1530,1300.5,250.47,1530,BlueCross BlueShield Minnesota,Medicare Advantage,412.597,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Ligation Or Transection Of Fallopian Tube, Abd Or Vag Approach, Unilateral Or Bilateral (Pro Cah)",,58600,CPT,Professional,Both,,,,1530,1300.5,250.47,1530,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,780.77568,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Ligation Or Transection Of Fallopian Tube, Abd Or Vag Approach, Unilateral Or Bilateral (Pro Cah)",,58600,CPT,Professional,Both,,,,1530,1300.5,250.47,1530,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,266.46632,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Ligation Or Transection Of Fallopian Tube, Abd Or Vag Approach, Unilateral Or Bilateral (Pro Cah)",,58600,CPT,Professional,Both,,,,1530,1300.5,250.47,1530,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),412.597,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Ligation Or Transection Of Fallopian Tube, Abd Or Vag Approach, Unilateral Or Bilateral (Pro Cah)",,58600,CPT,Professional,Both,,,,1530,1300.5,250.47,1530,CorVel,Worker's Compensation,704.1578874,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Ligation Or Transection Of Fallopian Tube, Abd Or Vag Approach, Unilateral Or Bilateral (Pro Cah)",,58600,CPT,Professional,Both,,,,1530,1300.5,250.47,1530,First Health Group Corporation,First Health Network,1484.1,97,,percent of total billed charges,,
"Ligation Or Transection Of Fallopian Tube, Abd Or Vag Approach, Unilateral Or Bilateral (Pro Cah)",,58600,CPT,Professional,Both,,,,1530,1300.5,250.47,1530,"Health Partners, Inc.",Commercial,760.35,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Ligation Or Transection Of Fallopian Tube, Abd Or Vag Approach, Unilateral Or Bilateral (Pro Cah)",,58600,CPT,Professional,Both,,,,1530,1300.5,250.47,1530,"Health Partners, Inc.",Medicare Advantage,412.597,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Ligation Or Transection Of Fallopian Tube, Abd Or Vag Approach, Unilateral Or Bilateral (Pro Cah)",,58600,CPT,Professional,Both,,,,1530,1300.5,250.47,1530,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),358.87,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Ligation Or Transection Of Fallopian Tube, Abd Or Vag Approach, Unilateral Or Bilateral (Pro Cah)",,58600,CPT,Professional,Both,,,,1530,1300.5,250.47,1530,"Health Partners, Inc.",State of Minnesota Advantage Program,655.041525,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Ligation Or Transection Of Fallopian Tube, Abd Or Vag Approach, Unilateral Or Bilateral (Pro Cah)",,58600,CPT,Professional,Both,,,,1530,1300.5,250.47,1530,"Health Partners, Inc.",State Public Programs,250.47,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Ligation Or Transection Of Fallopian Tube, Abd Or Vag Approach, Unilateral Or Bilateral (Pro Cah)",,58600,CPT,Professional,Both,,,,1530,1300.5,250.47,1530,Humana Insurance Company,Commercial PPO,358.78,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Ligation Or Transection Of Fallopian Tube, Abd Or Vag Approach, Unilateral Or Bilateral (Pro Cah)",,58600,CPT,Professional,Both,,,,1530,1300.5,250.47,1530,Humana Insurance Company,Medicare PPO,1530,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Ligation Or Transection Of Fallopian Tube, Abd Or Vag Approach, Unilateral Or Bilateral (Pro Cah)",,58600,CPT,Professional,Both,,,,1530,1300.5,250.47,1530,Medica,Individual & Family,1297.44,84.8,,percent of total billed charges,,
"Ligation Or Transection Of Fallopian Tube, Abd Or Vag Approach, Unilateral Or Bilateral (Pro Cah)",,58600,CPT,Professional,Both,,,,1530,1300.5,250.47,1530,Medica,Medica Advantage Solution,761.94,49.8,,percent of total billed charges,,
"Ligation Or Transection Of Fallopian Tube, Abd Or Vag Approach, Unilateral Or Bilateral (Pro Cah)",,58600,CPT,Professional,Both,,,,1530,1300.5,250.47,1530,Medica,Medical Assistance,266.47,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Ligation Or Transection Of Fallopian Tube, Abd Or Vag Approach, Unilateral Or Bilateral (Pro Cah)",,58600,CPT,Professional,Both,,,,1530,1300.5,250.47,1530,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,358.78,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Ligation Or Transection Of Fallopian Tube, Abd Or Vag Approach, Unilateral Or Bilateral (Pro Cah)",,58600,CPT,Professional,Both,,,,1530,1300.5,250.47,1530,"Multiplan, Inc.","Multiplan, Inc.",1438.2,94,,percent of total billed charges,,
"Ligation Or Transection Of Fallopian Tube, Abd Or Vag Approach, Unilateral Or Bilateral (Pro Cah)",,58600,CPT,Professional,Both,,,,1530,1300.5,250.47,1530,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1378.53,90.1,,percent of total billed charges,,
"Ligation Or Transection Of Fallopian Tube, Abd Or Vag Approach, Unilateral Or Bilateral (Pro Cah)",,58600,CPT,Professional,Both,,,,1530,1300.5,250.47,1530,"Preferred One Administrative Services, INC.",PPO,1508.58,98.6,,percent of total billed charges,,
"Ligation Or Transection Of Fallopian Tube, Abd Or Vag Approach, Unilateral Or Bilateral (Pro Cah)",,58600,CPT,Professional,Both,,,,1530,1300.5,250.47,1530,PrimeWest Health,Minnesota Senior Health Options (MSHO),412.597,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Ligation Or Transection Of Fallopian Tube, Abd Or Vag Approach, Unilateral Or Bilateral (Pro Cah)",,58600,CPT,Professional,Both,,,,1530,1300.5,250.47,1530,PrimeWest Health,MinnesotaCare,285.1189624,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Ligation Or Transection Of Fallopian Tube, Abd Or Vag Approach, Unilateral Or Bilateral (Pro Cah)",,58600,CPT,Professional,Both,,,,1530,1300.5,250.47,1530,Sanford Health Plan,Sanford Health Plan,1346.4,88,,percent of total billed charges,,
"Ligation Or Transection Of Fallopian Tube, Abd Or Vag Approach, Unilateral Or Bilateral (Pro Cah)",,58600,CPT,Professional,Both,,,,1530,1300.5,250.47,1530,"UCare Health, Inc.",Individual & Family Plan,583.232768,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Ligation Or Transection Of Fallopian Tube, Abd Or Vag Approach, Unilateral Or Bilateral (Pro Cah)",,58600,CPT,Professional,Both,,,,1530,1300.5,250.47,1530,"UCare Health, Inc.",Medical Assistance,293.112952,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Ligation Or Transection Of Fallopian Tube, Abd Or Vag Approach, Unilateral Or Bilateral (Pro Cah)",,58600,CPT,Professional,Both,,,,1530,1300.5,250.47,1530,"UCare Health, Inc.",Medicare Advantage,412.597,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Ligation Or Transection Of Fallopian Tube, Abd Or Vag Approach, Unilateral Or Bilateral (Pro Cah)",,58600,CPT,Professional,Both,,,,1530,1300.5,250.47,1530,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),330.0776,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Ligation Or Transection Of Fallopian Tube, Abd Or Vag Approach, Unilateral Or Bilateral (Pro Cah)",,58600,CPT,Professional,Both,,,,1530,1300.5,250.47,1530,UnitedHealthcare,Individual & Family,1530,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Ligation Or Transection Of Fallopian Tube, Abd Or Vag Approach, Unilateral Or Bilateral (Pro Cah)",,58600,CPT,Professional,Both,,,,1530,1300.5,250.47,1530,UnitedHealthcare,Medicare Advantage,412.597,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Ligation Or Transection Of Fallopian Tube, Abd Or Vag Approach, Unilateral Or Bilateral (Pro Cah)",,58600,CPT,Professional,Both,,,,1530,1300.5,250.47,1530,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,266.46632,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Laparoscopy, Lysis (Pro Cah)",,58660,CPT,Professional,Both,,,,2958,2514.3,452.89,2958,Aetna,Commercial,2514.3,85,,percent of total billed charges,,
"Laparoscopy, Lysis (Pro Cah)",,58660,CPT,Professional,Both,,,,2958,2514.3,452.89,2958,Aetna,Medicare Advantage,656.69,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Laparoscopy, Lysis (Pro Cah)",,58660,CPT,Professional,Both,,,,2958,2514.3,452.89,2958,Aetna,PPO,2750.94,93,,percent of total billed charges,,
"Laparoscopy, Lysis (Pro Cah)",,58660,CPT,Professional,Both,,,,2958,2514.3,452.89,2958,America's PPO,America's PPO,2527.3152,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Laparoscopy, Lysis (Pro Cah)",,58660,CPT,Professional,Both,,,,2958,2514.3,452.89,2958,BlueCross BlueShield Minnesota, Federal Employee Program,1408.88,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Laparoscopy, Lysis (Pro Cah)",,58660,CPT,Professional,Both,,,,2958,2514.3,452.89,2958,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1431.42208,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Laparoscopy, Lysis (Pro Cah)",,58660,CPT,Professional,Both,,,,2958,2514.3,452.89,2958,BlueCross BlueShield Minnesota,High Value Network Plan,1431.42208,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Laparoscopy, Lysis (Pro Cah)",,58660,CPT,Professional,Both,,,,2958,2514.3,452.89,2958,BlueCross BlueShield Minnesota,Medicare Advantage,745.1655,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Laparoscopy, Lysis (Pro Cah)",,58660,CPT,Professional,Both,,,,2958,2514.3,452.89,2958,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1431.42208,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Laparoscopy, Lysis (Pro Cah)",,58660,CPT,Professional,Both,,,,2958,2514.3,452.89,2958,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,481.81768,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Laparoscopy, Lysis (Pro Cah)",,58660,CPT,Professional,Both,,,,2958,2514.3,452.89,2958,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),745.1655,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Laparoscopy, Lysis (Pro Cah)",,58660,CPT,Professional,Both,,,,2958,2514.3,452.89,2958,CorVel,Worker's Compensation,1276.285751,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Laparoscopy, Lysis (Pro Cah)",,58660,CPT,Professional,Both,,,,2958,2514.3,452.89,2958,First Health Group Corporation,First Health Network,2869.26,97,,percent of total billed charges,,
"Laparoscopy, Lysis (Pro Cah)",,58660,CPT,Professional,Both,,,,2958,2514.3,452.89,2958,"Health Partners, Inc.",Commercial,1379.22,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Laparoscopy, Lysis (Pro Cah)",,58660,CPT,Professional,Both,,,,2958,2514.3,452.89,2958,"Health Partners, Inc.",Medicare Advantage,745.1655,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Laparoscopy, Lysis (Pro Cah)",,58660,CPT,Professional,Both,,,,2958,2514.3,452.89,2958,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),647.92,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Laparoscopy, Lysis (Pro Cah)",,58660,CPT,Professional,Both,,,,2958,2514.3,452.89,2958,"Health Partners, Inc.",State of Minnesota Advantage Program,1188.19803,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Laparoscopy, Lysis (Pro Cah)",,58660,CPT,Professional,Both,,,,2958,2514.3,452.89,2958,"Health Partners, Inc.",State Public Programs,452.89,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Laparoscopy, Lysis (Pro Cah)",,58660,CPT,Professional,Both,,,,2958,2514.3,452.89,2958,Humana Insurance Company,Commercial PPO,647.97,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Laparoscopy, Lysis (Pro Cah)",,58660,CPT,Professional,Both,,,,2958,2514.3,452.89,2958,Humana Insurance Company,Medicare PPO,2958,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Laparoscopy, Lysis (Pro Cah)",,58660,CPT,Professional,Both,,,,2958,2514.3,452.89,2958,Medica,Individual & Family,2508.384,84.8,,percent of total billed charges,,
"Laparoscopy, Lysis (Pro Cah)",,58660,CPT,Professional,Both,,,,2958,2514.3,452.89,2958,Medica,Medica Advantage Solution,1473.084,49.8,,percent of total billed charges,,
"Laparoscopy, Lysis (Pro Cah)",,58660,CPT,Professional,Both,,,,2958,2514.3,452.89,2958,Medica,Medical Assistance,481.82,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Laparoscopy, Lysis (Pro Cah)",,58660,CPT,Professional,Both,,,,2958,2514.3,452.89,2958,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,647.97,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Laparoscopy, Lysis (Pro Cah)",,58660,CPT,Professional,Both,,,,2958,2514.3,452.89,2958,"Multiplan, Inc.","Multiplan, Inc.",2780.52,94,,percent of total billed charges,,
"Laparoscopy, Lysis (Pro Cah)",,58660,CPT,Professional,Both,,,,2958,2514.3,452.89,2958,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,2665.158,90.1,,percent of total billed charges,,
"Laparoscopy, Lysis (Pro Cah)",,58660,CPT,Professional,Both,,,,2958,2514.3,452.89,2958,"Preferred One Administrative Services, INC.",PPO,2916.588,98.6,,percent of total billed charges,,
"Laparoscopy, Lysis (Pro Cah)",,58660,CPT,Professional,Both,,,,2958,2514.3,452.89,2958,PrimeWest Health,Minnesota Senior Health Options (MSHO),745.1655,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Laparoscopy, Lysis (Pro Cah)",,58660,CPT,Professional,Both,,,,2958,2514.3,452.89,2958,PrimeWest Health,MinnesotaCare,515.5449176,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Laparoscopy, Lysis (Pro Cah)",,58660,CPT,Professional,Both,,,,2958,2514.3,452.89,2958,Sanford Health Plan,Sanford Health Plan,2603.04,88,,percent of total billed charges,,
"Laparoscopy, Lysis (Pro Cah)",,58660,CPT,Professional,Both,,,,2958,2514.3,452.89,2958,"UCare Health, Inc.",Individual & Family Plan,1053.340032,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Laparoscopy, Lysis (Pro Cah)",,58660,CPT,Professional,Both,,,,2958,2514.3,452.89,2958,"UCare Health, Inc.",Medical Assistance,529.999448,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Laparoscopy, Lysis (Pro Cah)",,58660,CPT,Professional,Both,,,,2958,2514.3,452.89,2958,"UCare Health, Inc.",Medicare Advantage,745.1655,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Laparoscopy, Lysis (Pro Cah)",,58660,CPT,Professional,Both,,,,2958,2514.3,452.89,2958,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),596.1324,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Laparoscopy, Lysis (Pro Cah)",,58660,CPT,Professional,Both,,,,2958,2514.3,452.89,2958,UnitedHealthcare,Individual & Family,2958,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Laparoscopy, Lysis (Pro Cah)",,58660,CPT,Professional,Both,,,,2958,2514.3,452.89,2958,UnitedHealthcare,Medicare Advantage,745.1655,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Laparoscopy, Lysis (Pro Cah)",,58660,CPT,Professional,Both,,,,2958,2514.3,452.89,2958,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,481.81768,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Removal Of Ovary(S) Partial Or Total (Pro Cah),,58940,CPT,Professional,Both,,,,2388,2029.8,345.11,2388,Aetna,Commercial,2029.8,85,,percent of total billed charges,,
Removal Of Ovary(S) Partial Or Total (Pro Cah),,58940,CPT,Professional,Both,,,,2388,2029.8,345.11,2388,Aetna,Medicare Advantage,537.86,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Removal Of Ovary(S) Partial Or Total (Pro Cah),,58940,CPT,Professional,Both,,,,2388,2029.8,345.11,2388,Aetna,PPO,2220.84,93,,percent of total billed charges,,
Removal Of Ovary(S) Partial Or Total (Pro Cah),,58940,CPT,Professional,Both,,,,2388,2029.8,345.11,2388,America's PPO,America's PPO,2040.3072,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Removal Of Ovary(S) Partial Or Total (Pro Cah),,58940,CPT,Professional,Both,,,,2388,2029.8,345.11,2388,BlueCross BlueShield Minnesota, Federal Employee Program,1152.72,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Removal Of Ovary(S) Partial Or Total (Pro Cah),,58940,CPT,Professional,Both,,,,2388,2029.8,345.11,2388,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1171.16352,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Removal Of Ovary(S) Partial Or Total (Pro Cah),,58940,CPT,Professional,Both,,,,2388,2029.8,345.11,2388,BlueCross BlueShield Minnesota,High Value Network Plan,1171.16352,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Removal Of Ovary(S) Partial Or Total (Pro Cah),,58940,CPT,Professional,Both,,,,2388,2029.8,345.11,2388,BlueCross BlueShield Minnesota,Medicare Advantage,616.814,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Removal Of Ovary(S) Partial Or Total (Pro Cah),,58940,CPT,Professional,Both,,,,2388,2029.8,345.11,2388,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1171.16352,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Removal Of Ovary(S) Partial Or Total (Pro Cah),,58940,CPT,Professional,Both,,,,2388,2029.8,345.11,2388,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,398.44472,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Removal Of Ovary(S) Partial Or Total (Pro Cah),,58940,CPT,Professional,Both,,,,2388,2029.8,345.11,2388,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),616.814,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Removal Of Ovary(S) Partial Or Total (Pro Cah),,58940,CPT,Professional,Both,,,,2388,2029.8,345.11,2388,CorVel,Worker's Compensation,1055.191666,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Removal Of Ovary(S) Partial Or Total (Pro Cah),,58940,CPT,Professional,Both,,,,2388,2029.8,345.11,2388,First Health Group Corporation,First Health Network,2316.36,97,,percent of total billed charges,,
Removal Of Ovary(S) Partial Or Total (Pro Cah),,58940,CPT,Professional,Both,,,,2388,2029.8,345.11,2388,"Health Partners, Inc.",Commercial,1139.8,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Removal Of Ovary(S) Partial Or Total (Pro Cah),,58940,CPT,Professional,Both,,,,2388,2029.8,345.11,2388,"Health Partners, Inc.",Medicare Advantage,616.814,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Removal Of Ovary(S) Partial Or Total (Pro Cah),,58940,CPT,Professional,Both,,,,2388,2029.8,345.11,2388,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),536.43,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Removal Of Ovary(S) Partial Or Total (Pro Cah),,58940,CPT,Professional,Both,,,,2388,2029.8,345.11,2388,"Health Partners, Inc.",State of Minnesota Advantage Program,981.9377,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Removal Of Ovary(S) Partial Or Total (Pro Cah),,58940,CPT,Professional,Both,,,,2388,2029.8,345.11,2388,"Health Partners, Inc.",State Public Programs,345.11,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Removal Of Ovary(S) Partial Or Total (Pro Cah),,58940,CPT,Professional,Both,,,,2388,2029.8,345.11,2388,Humana Insurance Company,Commercial PPO,536.36,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Removal Of Ovary(S) Partial Or Total (Pro Cah),,58940,CPT,Professional,Both,,,,2388,2029.8,345.11,2388,Humana Insurance Company,Medicare PPO,2388,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Removal Of Ovary(S) Partial Or Total (Pro Cah),,58940,CPT,Professional,Both,,,,2388,2029.8,345.11,2388,Medica,Individual & Family,2025.024,84.8,,percent of total billed charges,,
Removal Of Ovary(S) Partial Or Total (Pro Cah),,58940,CPT,Professional,Both,,,,2388,2029.8,345.11,2388,Medica,Medica Advantage Solution,1189.224,49.8,,percent of total billed charges,,
Removal Of Ovary(S) Partial Or Total (Pro Cah),,58940,CPT,Professional,Both,,,,2388,2029.8,345.11,2388,Medica,Medical Assistance,398.44,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Removal Of Ovary(S) Partial Or Total (Pro Cah),,58940,CPT,Professional,Both,,,,2388,2029.8,345.11,2388,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,536.36,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Removal Of Ovary(S) Partial Or Total (Pro Cah),,58940,CPT,Professional,Both,,,,2388,2029.8,345.11,2388,"Multiplan, Inc.","Multiplan, Inc.",2244.72,94,,percent of total billed charges,,
Removal Of Ovary(S) Partial Or Total (Pro Cah),,58940,CPT,Professional,Both,,,,2388,2029.8,345.11,2388,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,2151.588,90.1,,percent of total billed charges,,
Removal Of Ovary(S) Partial Or Total (Pro Cah),,58940,CPT,Professional,Both,,,,2388,2029.8,345.11,2388,"Preferred One Administrative Services, INC.",PPO,2354.568,98.6,,percent of total billed charges,,
Removal Of Ovary(S) Partial Or Total (Pro Cah),,58940,CPT,Professional,Both,,,,2388,2029.8,345.11,2388,PrimeWest Health,Minnesota Senior Health Options (MSHO),616.814,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Removal Of Ovary(S) Partial Or Total (Pro Cah),,58940,CPT,Professional,Both,,,,2388,2029.8,345.11,2388,PrimeWest Health,MinnesotaCare,426.3358504,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Removal Of Ovary(S) Partial Or Total (Pro Cah),,58940,CPT,Professional,Both,,,,2388,2029.8,345.11,2388,Sanford Health Plan,Sanford Health Plan,2101.44,88,,percent of total billed charges,,
Removal Of Ovary(S) Partial Or Total (Pro Cah),,58940,CPT,Professional,Both,,,,2388,2029.8,345.11,2388,"UCare Health, Inc.",Individual & Family Plan,871.906816,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Removal Of Ovary(S) Partial Or Total (Pro Cah),,58940,CPT,Professional,Both,,,,2388,2029.8,345.11,2388,"UCare Health, Inc.",Medical Assistance,438.289192,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Removal Of Ovary(S) Partial Or Total (Pro Cah),,58940,CPT,Professional,Both,,,,2388,2029.8,345.11,2388,"UCare Health, Inc.",Medicare Advantage,616.814,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Removal Of Ovary(S) Partial Or Total (Pro Cah),,58940,CPT,Professional,Both,,,,2388,2029.8,345.11,2388,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),493.4512,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Removal Of Ovary(S) Partial Or Total (Pro Cah),,58940,CPT,Professional,Both,,,,2388,2029.8,345.11,2388,UnitedHealthcare,Individual & Family,2388,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Removal Of Ovary(S) Partial Or Total (Pro Cah),,58940,CPT,Professional,Both,,,,2388,2029.8,345.11,2388,UnitedHealthcare,Medicare Advantage,616.814,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Removal Of Ovary(S) Partial Or Total (Pro Cah),,58940,CPT,Professional,Both,,,,2388,2029.8,345.11,2388,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,398.44472,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Fetal Non Stress Test,,59025,CPT,Facility,Both,,,,510,433.5,146.166,510,Aetna,Commercial,469.2,92,,percent of total billed charges,,
Fetal Non Stress Test,,59025,CPT,Facility,Outpatient,,,,510,433.5,146.166,510,Aetna,Medicare Advantage,249.9,49,,percent of total billed charges,,
Fetal Non Stress Test,,59025,CPT,Facility,Inpatient,,,,510,433.5,146.166,510,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Fetal Non Stress Test,,59025,CPT,Facility,Both,,,,510,433.5,146.166,510,Aetna,PPO,474.3,93,,percent of total billed charges,,
Fetal Non Stress Test,,59025,CPT,Facility,Both,,,,510,433.5,146.166,510,America's PPO,America's PPO,489.753,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Fetal Non Stress Test,,59025,CPT,Facility,Both,,,,510,433.5,146.166,510,BlueCross BlueShield Minnesota, Federal Employee Program,501.84,98.4,,percent of total billed charges,,
Fetal Non Stress Test,,59025,CPT,Facility,Both,,,,510,433.5,146.166,510,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,510,100,,percent of total billed charges,,
Fetal Non Stress Test,,59025,CPT,Facility,Both,,,,510,433.5,146.166,510,BlueCross BlueShield Minnesota,High Value Network Plan,459,90,,percent of total billed charges,,
Fetal Non Stress Test,,59025,CPT,Facility,Outpatient,,,,510,433.5,146.166,510,BlueCross BlueShield Minnesota,Medicare Advantage,249.9,49,,percent of total billed charges,,
Fetal Non Stress Test,,59025,CPT,Facility,Inpatient,,,,510,433.5,146.166,510,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Fetal Non Stress Test,,59025,CPT,Facility,Both,,,,510,433.5,146.166,510,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,451.707,88.57,,percent of total billed charges,,
Fetal Non Stress Test,,59025,CPT,Facility,Both,,,,510,433.5,146.166,510,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,146.166,28.66,,percent of total billed charges,,
Fetal Non Stress Test,,59025,CPT,Facility,Outpatient,,,,510,433.5,146.166,510,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),249.9,49,,percent of total billed charges,,
Fetal Non Stress Test,,59025,CPT,Facility,Inpatient,,,,510,433.5,146.166,510,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Fetal Non Stress Test,,59025,CPT,Facility,Both,,,,510,433.5,146.166,510,CorVel,Worker's Compensation,510,100,,percent of total billed charges,,
Fetal Non Stress Test,,59025,CPT,Facility,Both,,,,510,433.5,146.166,510,First Health Group Corporation,First Health Network,494.7,97,,percent of total billed charges,,
Fetal Non Stress Test,,59025,CPT,Facility,Both,,,,510,433.5,146.166,510,"Health Partners, Inc.",Commercial,482.46,94.6,,percent of total billed charges,,
Fetal Non Stress Test,,59025,CPT,Facility,Outpatient,,,,510,433.5,146.166,510,"Health Partners, Inc.",Medicare Advantage,249.9,49,,percent of total billed charges,,
Fetal Non Stress Test,,59025,CPT,Facility,Inpatient,,,,510,433.5,146.166,510,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Fetal Non Stress Test,,59025,CPT,Facility,Both,,,,510,433.5,146.166,510,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),306,60,,percent of total billed charges,,
Fetal Non Stress Test,,59025,CPT,Facility,Both,,,,510,433.5,146.166,510,"Health Partners, Inc.",State of Minnesota Advantage Program,415.65,81.5,,percent of total billed charges,,
Fetal Non Stress Test,,59025,CPT,Facility,Both,,,,510,433.5,146.166,510,"Health Partners, Inc.",State Public Programs,255,50,,percent of total billed charges,,
Fetal Non Stress Test,,59025,CPT,Facility,Both,,,,510,433.5,146.166,510,Humana Insurance Company,Commercial PPO,484.5,95,,percent of total billed charges,,
Fetal Non Stress Test,,59025,CPT,Facility,Outpatient,,,,510,433.5,146.166,510,Humana Insurance Company,Medicare PPO,249.9,49,,percent of total billed charges,,
Fetal Non Stress Test,,59025,CPT,Facility,Inpatient,,,,510,433.5,146.166,510,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Fetal Non Stress Test,,59025,CPT,Facility,Both,,,,510,433.5,146.166,510,Medica,Individual & Family,505.41,99.1,,percent of total billed charges,,
Fetal Non Stress Test,,59025,CPT,Facility,Outpatient,,,,510,433.5,146.166,510,Medica,Medica Advantage Solution,253.98,49.8,,percent of total billed charges,,
Fetal Non Stress Test,,59025,CPT,Facility,Inpatient,,,,510,433.5,146.166,510,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Fetal Non Stress Test,,59025,CPT,Facility,Outpatient,,,,510,433.5,146.166,510,Medica,Medical Assistance,227.46,44.6,,percent of total billed charges,,
Fetal Non Stress Test,,59025,CPT,Facility,Inpatient,,,,510,433.5,146.166,510,Medica,Medical Assistance,,,,,Included in per diem rate,
Fetal Non Stress Test,,59025,CPT,Facility,Outpatient,,,,510,433.5,146.166,510,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,253.98,49.8,,percent of total billed charges,,
Fetal Non Stress Test,,59025,CPT,Facility,Inpatient,,,,510,433.5,146.166,510,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Fetal Non Stress Test,,59025,CPT,Facility,Both,,,,510,433.5,146.166,510,"Multiplan, Inc.","Multiplan, Inc.",479.4,94,,percent of total billed charges,,
Fetal Non Stress Test,,59025,CPT,Facility,Outpatient,,,,510,433.5,146.166,510,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,459.51,90.1,,percent of total billed charges,,
Fetal Non Stress Test,,59025,CPT,Facility,Inpatient,,,,510,433.5,146.166,510,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Fetal Non Stress Test,,59025,CPT,Facility,Both,,,,510,433.5,146.166,510,"Preferred One Administrative Services, INC.",PPO,502.86,98.6,,percent of total billed charges,,
Fetal Non Stress Test,,59025,CPT,Facility,Outpatient,,,,510,433.5,146.166,510,PrimeWest Health,Minnesota Senior Health Options (MSHO),262.395,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Fetal Non Stress Test,,59025,CPT,Facility,Inpatient,,,,510,433.5,146.166,510,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Fetal Non Stress Test,,59025,CPT,Facility,Outpatient,,,,510,433.5,146.166,510,PrimeWest Health,MinnesotaCare,261.936,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Fetal Non Stress Test,,59025,CPT,Facility,Inpatient,,,,510,433.5,146.166,510,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Fetal Non Stress Test,,59025,CPT,Facility,Both,,,,510,433.5,146.166,510,Sanford Health Plan,Sanford Health Plan,469.2,92,,percent of total billed charges,,
Fetal Non Stress Test,,59025,CPT,Facility,Outpatient,,,,510,433.5,146.166,510,"UCare Health, Inc.",Individual & Family Plan,287.385,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Fetal Non Stress Test,,59025,CPT,Facility,Inpatient,,,,510,433.5,146.166,510,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Fetal Non Stress Test,,59025,CPT,Facility,Outpatient,,,,510,433.5,146.166,510,"UCare Health, Inc.",Medical Assistance,257.397,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Fetal Non Stress Test,,59025,CPT,Facility,Inpatient,,,,510,433.5,146.166,510,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Fetal Non Stress Test,,59025,CPT,Facility,Outpatient,,,,510,433.5,146.166,510,"UCare Health, Inc.",Medicare Advantage,257.397,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Fetal Non Stress Test,,59025,CPT,Facility,Inpatient,,,,510,433.5,146.166,510,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Fetal Non Stress Test,,59025,CPT,Facility,Outpatient,,,,510,433.5,146.166,510,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),257.397,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Fetal Non Stress Test,,59025,CPT,Facility,Inpatient,,,,510,433.5,146.166,510,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Fetal Non Stress Test,,59025,CPT,Facility,Both,,,,510,433.5,146.166,510,UnitedHealthcare,Individual & Family,479.4,94,,percent of total billed charges,,
Fetal Non Stress Test,,59025,CPT,Facility,Outpatient,,,,510,433.5,146.166,510,UnitedHealthcare,Medicare Advantage,249.9,49,,percent of total billed charges,,
Fetal Non Stress Test,,59025,CPT,Facility,Inpatient,,,,510,433.5,146.166,510,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Fetal Non Stress Test,,59025,CPT,Facility,Outpatient,,,,510,433.5,146.166,510,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,244.8,48,,percent of total billed charges,,100% of DHS outpatient percentage
Fetal Non Stress Test,,59025,CPT,Facility,Inpatient,,,,510,433.5,146.166,510,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Cesarean Delivery Only (Pro Cah),,59514,CPT,Professional,Both,,,,2142,1820.7,475.2,2142,Aetna,Commercial,1820.7,85,,percent of total billed charges,,
Cesarean Delivery Only (Pro Cah),,59514,CPT,Professional,Both,,,,2142,1820.7,475.2,2142,Aetna,Medicare Advantage,837.57,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Cesarean Delivery Only (Pro Cah),,59514,CPT,Professional,Both,,,,2142,1820.7,475.2,2142,Aetna,PPO,1992.06,93,,percent of total billed charges,,
Cesarean Delivery Only (Pro Cah),,59514,CPT,Professional,Both,,,,2142,1820.7,475.2,2142,America's PPO,America's PPO,1830.1248,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Cesarean Delivery Only (Pro Cah),,59514,CPT,Professional,Both,,,,2142,1820.7,475.2,2142,BlueCross BlueShield Minnesota, Federal Employee Program,1868.17,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Cesarean Delivery Only (Pro Cah),,59514,CPT,Professional,Both,,,,2142,1820.7,475.2,2142,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1898.06072,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Cesarean Delivery Only (Pro Cah),,59514,CPT,Professional,Both,,,,2142,1820.7,475.2,2142,BlueCross BlueShield Minnesota,High Value Network Plan,1898.06072,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Cesarean Delivery Only (Pro Cah),,59514,CPT,Professional,Both,,,,2142,1820.7,475.2,2142,BlueCross BlueShield Minnesota,Medicare Advantage,939.2855,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Cesarean Delivery Only (Pro Cah),,59514,CPT,Professional,Both,,,,2142,1820.7,475.2,2142,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1898.06072,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Cesarean Delivery Only (Pro Cah),,59514,CPT,Professional,Both,,,,2142,1820.7,475.2,2142,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,548.64,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Cesarean Delivery Only (Pro Cah),,59514,CPT,Professional,Both,,,,2142,1820.7,475.2,2142,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),939.2855,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Cesarean Delivery Only (Pro Cah),,59514,CPT,Professional,Both,,,,2142,1820.7,475.2,2142,CorVel,Worker's Compensation,1611.576225,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Cesarean Delivery Only (Pro Cah),,59514,CPT,Professional,Both,,,,2142,1820.7,475.2,2142,First Health Group Corporation,First Health Network,2077.74,97,,percent of total billed charges,,
Cesarean Delivery Only (Pro Cah),,59514,CPT,Professional,Both,,,,2142,1820.7,475.2,2142,"Health Partners, Inc.",Commercial,1740.54,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Cesarean Delivery Only (Pro Cah),,59514,CPT,Professional,Both,,,,2142,1820.7,475.2,2142,"Health Partners, Inc.",Medicare Advantage,939.2855,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Cesarean Delivery Only (Pro Cah),,59514,CPT,Professional,Both,,,,2142,1820.7,475.2,2142,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),816.68,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Cesarean Delivery Only (Pro Cah),,59514,CPT,Professional,Both,,,,2142,1820.7,475.2,2142,"Health Partners, Inc.",State of Minnesota Advantage Program,1499.47521,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Cesarean Delivery Only (Pro Cah),,59514,CPT,Professional,Both,,,,2142,1820.7,475.2,2142,"Health Partners, Inc.",State Public Programs,475.2,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Cesarean Delivery Only (Pro Cah),,59514,CPT,Professional,Both,,,,2142,1820.7,475.2,2142,Humana Insurance Company,Commercial PPO,816.77,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Cesarean Delivery Only (Pro Cah),,59514,CPT,Professional,Both,,,,2142,1820.7,475.2,2142,Humana Insurance Company,Medicare PPO,2142,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Cesarean Delivery Only (Pro Cah),,59514,CPT,Professional,Both,,,,2142,1820.7,475.2,2142,Medica,Individual & Family,1816.416,84.8,,percent of total billed charges,,
Cesarean Delivery Only (Pro Cah),,59514,CPT,Professional,Both,,,,2142,1820.7,475.2,2142,Medica,Medica Advantage Solution,1066.716,49.8,,percent of total billed charges,,
Cesarean Delivery Only (Pro Cah),,59514,CPT,Professional,Both,,,,2142,1820.7,475.2,2142,Medica,Medical Assistance,548.64,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Cesarean Delivery Only (Pro Cah),,59514,CPT,Professional,Both,,,,2142,1820.7,475.2,2142,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,816.77,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Cesarean Delivery Only (Pro Cah),,59514,CPT,Professional,Both,,,,2142,1820.7,475.2,2142,"Multiplan, Inc.","Multiplan, Inc.",2013.48,94,,percent of total billed charges,,
Cesarean Delivery Only (Pro Cah),,59514,CPT,Professional,Both,,,,2142,1820.7,475.2,2142,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1929.942,90.1,,percent of total billed charges,,
Cesarean Delivery Only (Pro Cah),,59514,CPT,Professional,Both,,,,2142,1820.7,475.2,2142,"Preferred One Administrative Services, INC.",PPO,2112.012,98.6,,percent of total billed charges,,
Cesarean Delivery Only (Pro Cah),,59514,CPT,Professional,Both,,,,2142,1820.7,475.2,2142,PrimeWest Health,Minnesota Senior Health Options (MSHO),939.2855,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Cesarean Delivery Only (Pro Cah),,59514,CPT,Professional,Both,,,,2142,1820.7,475.2,2142,PrimeWest Health,MinnesotaCare,587.0448,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Cesarean Delivery Only (Pro Cah),,59514,CPT,Professional,Both,,,,2142,1820.7,475.2,2142,Sanford Health Plan,Sanford Health Plan,1884.96,88,,percent of total billed charges,,
Cesarean Delivery Only (Pro Cah),,59514,CPT,Professional,Both,,,,2142,1820.7,475.2,2142,"UCare Health, Inc.",Individual & Family Plan,1327.741312,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Cesarean Delivery Only (Pro Cah),,59514,CPT,Professional,Both,,,,2142,1820.7,475.2,2142,"UCare Health, Inc.",Medical Assistance,603.504,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Cesarean Delivery Only (Pro Cah),,59514,CPT,Professional,Both,,,,2142,1820.7,475.2,2142,"UCare Health, Inc.",Medicare Advantage,939.2855,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Cesarean Delivery Only (Pro Cah),,59514,CPT,Professional,Both,,,,2142,1820.7,475.2,2142,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),751.4284,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Cesarean Delivery Only (Pro Cah),,59514,CPT,Professional,Both,,,,2142,1820.7,475.2,2142,UnitedHealthcare,Individual & Family,2142,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Cesarean Delivery Only (Pro Cah),,59514,CPT,Professional,Both,,,,2142,1820.7,475.2,2142,UnitedHealthcare,Medicare Advantage,939.2855,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Cesarean Delivery Only (Pro Cah),,59514,CPT,Professional,Both,,,,2142,1820.7,475.2,2142,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,548.64,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Biopsy Thyroid Percutaneous Core Needle (Pro Cah),,60100,CPT,Professional,Both,,,,893,759.05,47.12,893,Aetna,Commercial,759.05,85,,percent of total billed charges,,
Biopsy Thyroid Percutaneous Core Needle (Pro Cah),,60100,CPT,Professional,Both,,,,893,759.05,47.12,893,Aetna,Medicare Advantage,75.37,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Biopsy Thyroid Percutaneous Core Needle (Pro Cah),,60100,CPT,Professional,Both,,,,893,759.05,47.12,893,Aetna,PPO,830.49,93,,percent of total billed charges,,
Biopsy Thyroid Percutaneous Core Needle (Pro Cah),,60100,CPT,Professional,Both,,,,893,759.05,47.12,893,America's PPO,America's PPO,762.9792,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Biopsy Thyroid Percutaneous Core Needle (Pro Cah),,60100,CPT,Professional,Both,,,,893,759.05,47.12,893,BlueCross BlueShield Minnesota, Federal Employee Program,157,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Biopsy Thyroid Percutaneous Core Needle (Pro Cah),,60100,CPT,Professional,Both,,,,893,759.05,47.12,893,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,159.512,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Biopsy Thyroid Percutaneous Core Needle (Pro Cah),,60100,CPT,Professional,Both,,,,893,759.05,47.12,893,BlueCross BlueShield Minnesota,High Value Network Plan,159.512,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Biopsy Thyroid Percutaneous Core Needle (Pro Cah),,60100,CPT,Professional,Both,,,,893,759.05,47.12,893,BlueCross BlueShield Minnesota,Medicare Advantage,84.525,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Biopsy Thyroid Percutaneous Core Needle (Pro Cah),,60100,CPT,Professional,Both,,,,893,759.05,47.12,893,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,159.512,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Biopsy Thyroid Percutaneous Core Needle (Pro Cah),,60100,CPT,Professional,Both,,,,893,759.05,47.12,893,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,54.39664,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Biopsy Thyroid Percutaneous Core Needle (Pro Cah),,60100,CPT,Professional,Both,,,,893,759.05,47.12,893,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),84.525,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Biopsy Thyroid Percutaneous Core Needle (Pro Cah),,60100,CPT,Professional,Both,,,,893,759.05,47.12,893,CorVel,Worker's Compensation,144.8480748,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Biopsy Thyroid Percutaneous Core Needle (Pro Cah),,60100,CPT,Professional,Both,,,,893,759.05,47.12,893,First Health Group Corporation,First Health Network,866.21,97,,percent of total billed charges,,
Biopsy Thyroid Percutaneous Core Needle (Pro Cah),,60100,CPT,Professional,Both,,,,893,759.05,47.12,893,"Health Partners, Inc.",Commercial,156.72,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Biopsy Thyroid Percutaneous Core Needle (Pro Cah),,60100,CPT,Professional,Both,,,,893,759.05,47.12,893,"Health Partners, Inc.",Medicare Advantage,84.525,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Biopsy Thyroid Percutaneous Core Needle (Pro Cah),,60100,CPT,Professional,Both,,,,893,759.05,47.12,893,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),73.54,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Biopsy Thyroid Percutaneous Core Needle (Pro Cah),,60100,CPT,Professional,Both,,,,893,759.05,47.12,893,"Health Partners, Inc.",State of Minnesota Advantage Program,135.01428,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Biopsy Thyroid Percutaneous Core Needle (Pro Cah),,60100,CPT,Professional,Both,,,,893,759.05,47.12,893,"Health Partners, Inc.",State Public Programs,47.12,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Biopsy Thyroid Percutaneous Core Needle (Pro Cah),,60100,CPT,Professional,Both,,,,893,759.05,47.12,893,Humana Insurance Company,Commercial PPO,73.5,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Biopsy Thyroid Percutaneous Core Needle (Pro Cah),,60100,CPT,Professional,Both,,,,893,759.05,47.12,893,Humana Insurance Company,Medicare PPO,893,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Biopsy Thyroid Percutaneous Core Needle (Pro Cah),,60100,CPT,Professional,Both,,,,893,759.05,47.12,893,Medica,Individual & Family,757.264,84.8,,percent of total billed charges,,
Biopsy Thyroid Percutaneous Core Needle (Pro Cah),,60100,CPT,Professional,Both,,,,893,759.05,47.12,893,Medica,Medica Advantage Solution,444.714,49.8,,percent of total billed charges,,
Biopsy Thyroid Percutaneous Core Needle (Pro Cah),,60100,CPT,Professional,Both,,,,893,759.05,47.12,893,Medica,Medical Assistance,54.4,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Biopsy Thyroid Percutaneous Core Needle (Pro Cah),,60100,CPT,Professional,Both,,,,893,759.05,47.12,893,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,73.5,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Biopsy Thyroid Percutaneous Core Needle (Pro Cah),,60100,CPT,Professional,Both,,,,893,759.05,47.12,893,"Multiplan, Inc.","Multiplan, Inc.",839.42,94,,percent of total billed charges,,
Biopsy Thyroid Percutaneous Core Needle (Pro Cah),,60100,CPT,Professional,Both,,,,893,759.05,47.12,893,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,804.593,90.1,,percent of total billed charges,,
Biopsy Thyroid Percutaneous Core Needle (Pro Cah),,60100,CPT,Professional,Both,,,,893,759.05,47.12,893,"Preferred One Administrative Services, INC.",PPO,880.498,98.6,,percent of total billed charges,,
Biopsy Thyroid Percutaneous Core Needle (Pro Cah),,60100,CPT,Professional,Both,,,,893,759.05,47.12,893,PrimeWest Health,Minnesota Senior Health Options (MSHO),84.525,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Biopsy Thyroid Percutaneous Core Needle (Pro Cah),,60100,CPT,Professional,Both,,,,893,759.05,47.12,893,PrimeWest Health,MinnesotaCare,58.2044048,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Biopsy Thyroid Percutaneous Core Needle (Pro Cah),,60100,CPT,Professional,Both,,,,893,759.05,47.12,893,Sanford Health Plan,Sanford Health Plan,785.84,88,,percent of total billed charges,,
Biopsy Thyroid Percutaneous Core Needle (Pro Cah),,60100,CPT,Professional,Both,,,,893,759.05,47.12,893,"UCare Health, Inc.",Individual & Family Plan,119.4816,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Biopsy Thyroid Percutaneous Core Needle (Pro Cah),,60100,CPT,Professional,Both,,,,893,759.05,47.12,893,"UCare Health, Inc.",Medical Assistance,59.836304,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Biopsy Thyroid Percutaneous Core Needle (Pro Cah),,60100,CPT,Professional,Both,,,,893,759.05,47.12,893,"UCare Health, Inc.",Medicare Advantage,84.525,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Biopsy Thyroid Percutaneous Core Needle (Pro Cah),,60100,CPT,Professional,Both,,,,893,759.05,47.12,893,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),67.62,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Biopsy Thyroid Percutaneous Core Needle (Pro Cah),,60100,CPT,Professional,Both,,,,893,759.05,47.12,893,UnitedHealthcare,Individual & Family,893,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Biopsy Thyroid Percutaneous Core Needle (Pro Cah),,60100,CPT,Professional,Both,,,,893,759.05,47.12,893,UnitedHealthcare,Medicare Advantage,84.525,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Biopsy Thyroid Percutaneous Core Needle (Pro Cah),,60100,CPT,Professional,Both,,,,893,759.05,47.12,893,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,54.39664,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Biopsy Thyroid, Percutaneous Core Needle (Pbb)",,60100,CPT,Facility,Outpatient,,,,434,368.9,124.3844,434,Aetna,Commercial,399.28,92,,percent of total billed charges,,
"Biopsy Thyroid, Percutaneous Core Needle (Pbb)",,60100,CPT,Professional,Outpatient,,,,459,390.15,47.12,459,Aetna,Commercial,390.15,85,,percent of total billed charges,,
"Biopsy Thyroid, Percutaneous Core Needle (Pbb)",,60100,CPT,Facility,Outpatient,,,,434,368.9,124.3844,434,Aetna,Medicare Advantage,212.66,49,,percent of total billed charges,,
"Biopsy Thyroid, Percutaneous Core Needle (Pbb)",,60100,CPT,Professional,Outpatient,,,,459,390.15,47.12,459,Aetna,Medicare Advantage,75.37,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Biopsy Thyroid, Percutaneous Core Needle (Pbb)",,60100,CPT,Facility,Outpatient,,,,434,368.9,124.3844,434,Aetna,PPO,403.62,93,,percent of total billed charges,,
"Biopsy Thyroid, Percutaneous Core Needle (Pbb)",,60100,CPT,Professional,Outpatient,,,,459,390.15,47.12,459,Aetna,PPO,426.87,93,,percent of total billed charges,,
"Biopsy Thyroid, Percutaneous Core Needle (Pbb)",,60100,CPT,Facility,Outpatient,,,,434,368.9,124.3844,434,America's PPO,America's PPO,416.7702,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Biopsy Thyroid, Percutaneous Core Needle (Pbb)",,60100,CPT,Professional,Outpatient,,,,459,390.15,47.12,459,America's PPO,America's PPO,392.1696,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Biopsy Thyroid, Percutaneous Core Needle (Pbb)",,60100,CPT,Facility,Outpatient,,,,434,368.9,124.3844,434,BlueCross BlueShield Minnesota, Federal Employee Program,427.056,98.4,,percent of total billed charges,,
"Biopsy Thyroid, Percutaneous Core Needle (Pbb)",,60100,CPT,Professional,Outpatient,,,,459,390.15,47.12,459,BlueCross BlueShield Minnesota, Federal Employee Program,157,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Biopsy Thyroid, Percutaneous Core Needle (Pbb)",,60100,CPT,Facility,Outpatient,,,,434,368.9,124.3844,434,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,434,100,,percent of total billed charges,,
"Biopsy Thyroid, Percutaneous Core Needle (Pbb)",,60100,CPT,Professional,Outpatient,,,,459,390.15,47.12,459,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,159.512,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Biopsy Thyroid, Percutaneous Core Needle (Pbb)",,60100,CPT,Facility,Outpatient,,,,434,368.9,124.3844,434,BlueCross BlueShield Minnesota,High Value Network Plan,390.6,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
"Biopsy Thyroid, Percutaneous Core Needle (Pbb)",,60100,CPT,Professional,Outpatient,,,,459,390.15,47.12,459,BlueCross BlueShield Minnesota,High Value Network Plan,159.512,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Biopsy Thyroid, Percutaneous Core Needle (Pbb)",,60100,CPT,Facility,Outpatient,,,,434,368.9,124.3844,434,BlueCross BlueShield Minnesota,Medicare Advantage,212.66,49,,percent of total billed charges,,
"Biopsy Thyroid, Percutaneous Core Needle (Pbb)",,60100,CPT,Professional,Outpatient,,,,459,390.15,47.12,459,BlueCross BlueShield Minnesota,Medicare Advantage,84.525,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Biopsy Thyroid, Percutaneous Core Needle (Pbb)",,60100,CPT,Professional,Outpatient,,,,459,390.15,47.12,459,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,159.512,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Biopsy Thyroid, Percutaneous Core Needle (Pbb)",,60100,CPT,Facility,Outpatient,,,,434,368.9,124.3844,434,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,124.3844,28.66,,percent of total billed charges,,
"Biopsy Thyroid, Percutaneous Core Needle (Pbb)",,60100,CPT,Professional,Outpatient,,,,459,390.15,47.12,459,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,54.39664,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Biopsy Thyroid, Percutaneous Core Needle (Pbb)",,60100,CPT,Facility,Outpatient,,,,434,368.9,124.3844,434,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),212.66,49,,percent of total billed charges,,
"Biopsy Thyroid, Percutaneous Core Needle (Pbb)",,60100,CPT,Professional,Outpatient,,,,459,390.15,47.12,459,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),84.525,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Biopsy Thyroid, Percutaneous Core Needle (Pbb)",,60100,CPT,Facility,Outpatient,,,,434,368.9,124.3844,434,CorVel,Worker's Compensation,434,100,,percent of total billed charges,,
"Biopsy Thyroid, Percutaneous Core Needle (Pbb)",,60100,CPT,Professional,Outpatient,,,,459,390.15,47.12,459,CorVel,Worker's Compensation,144.8480748,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Biopsy Thyroid, Percutaneous Core Needle (Pbb)",,60100,CPT,Facility,Outpatient,,,,434,368.9,124.3844,434,First Health Group Corporation,First Health Network,420.98,97,,percent of total billed charges,,
"Biopsy Thyroid, Percutaneous Core Needle (Pbb)",,60100,CPT,Professional,Outpatient,,,,459,390.15,47.12,459,First Health Group Corporation,First Health Network,445.23,97,,percent of total billed charges,,
"Biopsy Thyroid, Percutaneous Core Needle (Pbb)",,60100,CPT,Facility,Outpatient,,,,434,368.9,124.3844,434,"Health Partners, Inc.",Commercial,410.564,94.6,,percent of total billed charges,,
"Biopsy Thyroid, Percutaneous Core Needle (Pbb)",,60100,CPT,Professional,Outpatient,,,,459,390.15,47.12,459,"Health Partners, Inc.",Commercial,156.72,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Biopsy Thyroid, Percutaneous Core Needle (Pbb)",,60100,CPT,Facility,Outpatient,,,,434,368.9,124.3844,434,"Health Partners, Inc.",Medicare Advantage,212.66,49,,percent of total billed charges,,
"Biopsy Thyroid, Percutaneous Core Needle (Pbb)",,60100,CPT,Professional,Outpatient,,,,459,390.15,47.12,459,"Health Partners, Inc.",Medicare Advantage,84.525,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Biopsy Thyroid, Percutaneous Core Needle (Pbb)",,60100,CPT,Facility,Outpatient,,,,434,368.9,124.3844,434,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),260.4,60,,percent of total billed charges,,
"Biopsy Thyroid, Percutaneous Core Needle (Pbb)",,60100,CPT,Professional,Outpatient,,,,459,390.15,47.12,459,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),73.54,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Biopsy Thyroid, Percutaneous Core Needle (Pbb)",,60100,CPT,Facility,Outpatient,,,,434,368.9,124.3844,434,"Health Partners, Inc.",State of Minnesota Advantage Program,353.71,81.5,,percent of total billed charges,,
"Biopsy Thyroid, Percutaneous Core Needle (Pbb)",,60100,CPT,Professional,Outpatient,,,,459,390.15,47.12,459,"Health Partners, Inc.",State of Minnesota Advantage Program,135.01428,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Biopsy Thyroid, Percutaneous Core Needle (Pbb)",,60100,CPT,Facility,Outpatient,,,,434,368.9,124.3844,434,"Health Partners, Inc.",State Public Programs,217,50,,percent of total billed charges,,
"Biopsy Thyroid, Percutaneous Core Needle (Pbb)",,60100,CPT,Professional,Outpatient,,,,459,390.15,47.12,459,"Health Partners, Inc.",State Public Programs,47.12,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Biopsy Thyroid, Percutaneous Core Needle (Pbb)",,60100,CPT,Facility,Outpatient,,,,434,368.9,124.3844,434,Humana Insurance Company,Commercial PPO,412.3,95,,percent of total billed charges,,
"Biopsy Thyroid, Percutaneous Core Needle (Pbb)",,60100,CPT,Professional,Outpatient,,,,459,390.15,47.12,459,Humana Insurance Company,Commercial PPO,73.5,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Biopsy Thyroid, Percutaneous Core Needle (Pbb)",,60100,CPT,Facility,Outpatient,,,,434,368.9,124.3844,434,Humana Insurance Company,Medicare PPO,212.66,49,,percent of total billed charges,,
"Biopsy Thyroid, Percutaneous Core Needle (Pbb)",,60100,CPT,Professional,Outpatient,,,,459,390.15,47.12,459,Humana Insurance Company,Medicare PPO,459,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Biopsy Thyroid, Percutaneous Core Needle (Pbb)",,60100,CPT,Facility,Outpatient,,,,434,368.9,124.3844,434,Medica,Individual & Family,430.094,99.1,,percent of total billed charges,,
"Biopsy Thyroid, Percutaneous Core Needle (Pbb)",,60100,CPT,Professional,Outpatient,,,,459,390.15,47.12,459,Medica,Individual & Family,389.232,84.8,,percent of total billed charges,,
"Biopsy Thyroid, Percutaneous Core Needle (Pbb)",,60100,CPT,Facility,Outpatient,,,,434,368.9,124.3844,434,Medica,Medica Advantage Solution,216.132,49.8,,percent of total billed charges,,
"Biopsy Thyroid, Percutaneous Core Needle (Pbb)",,60100,CPT,Professional,Outpatient,,,,459,390.15,47.12,459,Medica,Medica Advantage Solution,228.582,49.8,,percent of total billed charges,,
"Biopsy Thyroid, Percutaneous Core Needle (Pbb)",,60100,CPT,Facility,Outpatient,,,,434,368.9,124.3844,434,Medica,Medical Assistance,193.564,44.6,,percent of total billed charges,,
"Biopsy Thyroid, Percutaneous Core Needle (Pbb)",,60100,CPT,Professional,Outpatient,,,,459,390.15,47.12,459,Medica,Medical Assistance,54.4,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Biopsy Thyroid, Percutaneous Core Needle (Pbb)",,60100,CPT,Facility,Outpatient,,,,434,368.9,124.3844,434,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,216.132,49.8,,percent of total billed charges,,
"Biopsy Thyroid, Percutaneous Core Needle (Pbb)",,60100,CPT,Professional,Outpatient,,,,459,390.15,47.12,459,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,73.5,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Biopsy Thyroid, Percutaneous Core Needle (Pbb)",,60100,CPT,Facility,Outpatient,,,,434,368.9,124.3844,434,"Multiplan, Inc.","Multiplan, Inc.",407.96,94,,percent of total billed charges,,
"Biopsy Thyroid, Percutaneous Core Needle (Pbb)",,60100,CPT,Professional,Outpatient,,,,459,390.15,47.12,459,"Multiplan, Inc.","Multiplan, Inc.",431.46,94,,percent of total billed charges,,
"Biopsy Thyroid, Percutaneous Core Needle (Pbb)",,60100,CPT,Facility,Outpatient,,,,434,368.9,124.3844,434,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,391.034,90.1,,percent of total billed charges,,
"Biopsy Thyroid, Percutaneous Core Needle (Pbb)",,60100,CPT,Professional,Outpatient,,,,459,390.15,47.12,459,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,413.559,90.1,,percent of total billed charges,,
"Biopsy Thyroid, Percutaneous Core Needle (Pbb)",,60100,CPT,Facility,Outpatient,,,,434,368.9,124.3844,434,"Preferred One Administrative Services, INC.",PPO,427.924,98.6,,percent of total billed charges,,
"Biopsy Thyroid, Percutaneous Core Needle (Pbb)",,60100,CPT,Professional,Outpatient,,,,459,390.15,47.12,459,"Preferred One Administrative Services, INC.",PPO,452.574,98.6,,percent of total billed charges,,
"Biopsy Thyroid, Percutaneous Core Needle (Pbb)",,60100,CPT,Facility,Outpatient,,,,434,368.9,124.3844,434,PrimeWest Health,Minnesota Senior Health Options (MSHO),223.293,51.45,,percent of total billed charges,,
"Biopsy Thyroid, Percutaneous Core Needle (Pbb)",,60100,CPT,Professional,Outpatient,,,,459,390.15,47.12,459,PrimeWest Health,Minnesota Senior Health Options (MSHO),84.525,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Biopsy Thyroid, Percutaneous Core Needle (Pbb)",,60100,CPT,Facility,Outpatient,,,,434,368.9,124.3844,434,PrimeWest Health,MinnesotaCare,222.9024,51.36,,percent of total billed charges,,
"Biopsy Thyroid, Percutaneous Core Needle (Pbb)",,60100,CPT,Professional,Outpatient,,,,459,390.15,47.12,459,PrimeWest Health,MinnesotaCare,58.2044048,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Biopsy Thyroid, Percutaneous Core Needle (Pbb)",,60100,CPT,Facility,Outpatient,,,,434,368.9,124.3844,434,Sanford Health Plan,Sanford Health Plan,399.28,92,,percent of total billed charges,,
"Biopsy Thyroid, Percutaneous Core Needle (Pbb)",,60100,CPT,Professional,Outpatient,,,,459,390.15,47.12,459,Sanford Health Plan,Sanford Health Plan,403.92,88,,percent of total billed charges,,
"Biopsy Thyroid, Percutaneous Core Needle (Pbb)",,60100,CPT,Facility,Outpatient,,,,434,368.9,124.3844,434,"UCare Health, Inc.",Individual & Family Plan,244.559,56.35,,percent of total billed charges,,
"Biopsy Thyroid, Percutaneous Core Needle (Pbb)",,60100,CPT,Professional,Outpatient,,,,459,390.15,47.12,459,"UCare Health, Inc.",Individual & Family Plan,119.4816,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Biopsy Thyroid, Percutaneous Core Needle (Pbb)",,60100,CPT,Facility,Outpatient,,,,434,368.9,124.3844,434,"UCare Health, Inc.",Medical Assistance,219.0398,50.47,,percent of total billed charges,,
"Biopsy Thyroid, Percutaneous Core Needle (Pbb)",,60100,CPT,Professional,Outpatient,,,,459,390.15,47.12,459,"UCare Health, Inc.",Medical Assistance,59.836304,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Biopsy Thyroid, Percutaneous Core Needle (Pbb)",,60100,CPT,Facility,Outpatient,,,,434,368.9,124.3844,434,"UCare Health, Inc.",Medicare Advantage,219.0398,50.47,,percent of total billed charges,,
"Biopsy Thyroid, Percutaneous Core Needle (Pbb)",,60100,CPT,Professional,Outpatient,,,,459,390.15,47.12,459,"UCare Health, Inc.",Medicare Advantage,84.525,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Biopsy Thyroid, Percutaneous Core Needle (Pbb)",,60100,CPT,Facility,Outpatient,,,,434,368.9,124.3844,434,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),219.0398,50.47,,percent of total billed charges,,
"Biopsy Thyroid, Percutaneous Core Needle (Pbb)",,60100,CPT,Professional,Outpatient,,,,459,390.15,47.12,459,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),67.62,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Biopsy Thyroid, Percutaneous Core Needle (Pbb)",,60100,CPT,Facility,Outpatient,,,,434,368.9,124.3844,434,UnitedHealthcare,Individual & Family,407.96,94,,percent of total billed charges,,
"Biopsy Thyroid, Percutaneous Core Needle (Pbb)",,60100,CPT,Professional,Outpatient,,,,459,390.15,47.12,459,UnitedHealthcare,Individual & Family,459,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Biopsy Thyroid, Percutaneous Core Needle (Pbb)",,60100,CPT,Facility,Outpatient,,,,434,368.9,124.3844,434,UnitedHealthcare,Medicare Advantage,212.66,49,,percent of total billed charges,,
"Biopsy Thyroid, Percutaneous Core Needle (Pbb)",,60100,CPT,Professional,Outpatient,,,,459,390.15,47.12,459,UnitedHealthcare,Medicare Advantage,84.525,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Biopsy Thyroid, Percutaneous Core Needle (Pbb)",,60100,CPT,Facility,Outpatient,,,,434,368.9,124.3844,434,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,208.32,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Biopsy Thyroid, Percutaneous Core Needle (Pbb)",,60100,CPT,Professional,Outpatient,,,,459,390.15,47.12,459,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,54.39664,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Thyroidectomy Total Or Complete (Pro Cah),,60240,CPT,Professional,Both,,,,3835,3259.75,559.12,3835,Aetna,Commercial,3259.75,85,,percent of total billed charges,,
Thyroidectomy Total Or Complete (Pro Cah),,60240,CPT,Professional,Both,,,,3835,3259.75,559.12,3835,Aetna,Medicare Advantage,877.57,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Thyroidectomy Total Or Complete (Pro Cah),,60240,CPT,Professional,Both,,,,3835,3259.75,559.12,3835,Aetna,PPO,3566.55,93,,percent of total billed charges,,
Thyroidectomy Total Or Complete (Pro Cah),,60240,CPT,Professional,Both,,,,3835,3259.75,559.12,3835,America's PPO,America's PPO,3276.624,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Thyroidectomy Total Or Complete (Pro Cah),,60240,CPT,Professional,Both,,,,3835,3259.75,559.12,3835,BlueCross BlueShield Minnesota, Federal Employee Program,1890.9,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Thyroidectomy Total Or Complete (Pro Cah),,60240,CPT,Professional,Both,,,,3835,3259.75,559.12,3835,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1921.1544,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Thyroidectomy Total Or Complete (Pro Cah),,60240,CPT,Professional,Both,,,,3835,3259.75,559.12,3835,BlueCross BlueShield Minnesota,High Value Network Plan,1921.1544,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Thyroidectomy Total Or Complete (Pro Cah),,60240,CPT,Professional,Both,,,,3835,3259.75,559.12,3835,BlueCross BlueShield Minnesota,Medicare Advantage,998.844,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Thyroidectomy Total Or Complete (Pro Cah),,60240,CPT,Professional,Both,,,,3835,3259.75,559.12,3835,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1921.1544,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Thyroidectomy Total Or Complete (Pro Cah),,60240,CPT,Professional,Both,,,,3835,3259.75,559.12,3835,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,645.52576,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Thyroidectomy Total Or Complete (Pro Cah),,60240,CPT,Professional,Both,,,,3835,3259.75,559.12,3835,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),998.844,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Thyroidectomy Total Or Complete (Pro Cah),,60240,CPT,Professional,Both,,,,3835,3259.75,559.12,3835,CorVel,Worker's Compensation,1709.408658,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Thyroidectomy Total Or Complete (Pro Cah),,60240,CPT,Professional,Both,,,,3835,3259.75,559.12,3835,First Health Group Corporation,First Health Network,3719.95,97,,percent of total billed charges,,
Thyroidectomy Total Or Complete (Pro Cah),,60240,CPT,Professional,Both,,,,3835,3259.75,559.12,3835,"Health Partners, Inc.",Commercial,1846.46,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Thyroidectomy Total Or Complete (Pro Cah),,60240,CPT,Professional,Both,,,,3835,3259.75,559.12,3835,"Health Partners, Inc.",Medicare Advantage,998.844,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Thyroidectomy Total Or Complete (Pro Cah),,60240,CPT,Professional,Both,,,,3835,3259.75,559.12,3835,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),868.53,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Thyroidectomy Total Or Complete (Pro Cah),,60240,CPT,Professional,Both,,,,3835,3259.75,559.12,3835,"Health Partners, Inc.",State of Minnesota Advantage Program,1590.72529,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Thyroidectomy Total Or Complete (Pro Cah),,60240,CPT,Professional,Both,,,,3835,3259.75,559.12,3835,"Health Partners, Inc.",State Public Programs,559.12,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Thyroidectomy Total Or Complete (Pro Cah),,60240,CPT,Professional,Both,,,,3835,3259.75,559.12,3835,Humana Insurance Company,Commercial PPO,868.56,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Thyroidectomy Total Or Complete (Pro Cah),,60240,CPT,Professional,Both,,,,3835,3259.75,559.12,3835,Humana Insurance Company,Medicare PPO,3835,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Thyroidectomy Total Or Complete (Pro Cah),,60240,CPT,Professional,Both,,,,3835,3259.75,559.12,3835,Medica,Individual & Family,3252.08,84.8,,percent of total billed charges,,
Thyroidectomy Total Or Complete (Pro Cah),,60240,CPT,Professional,Both,,,,3835,3259.75,559.12,3835,Medica,Medica Advantage Solution,1909.83,49.8,,percent of total billed charges,,
Thyroidectomy Total Or Complete (Pro Cah),,60240,CPT,Professional,Both,,,,3835,3259.75,559.12,3835,Medica,Medical Assistance,645.53,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Thyroidectomy Total Or Complete (Pro Cah),,60240,CPT,Professional,Both,,,,3835,3259.75,559.12,3835,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,868.56,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Thyroidectomy Total Or Complete (Pro Cah),,60240,CPT,Professional,Both,,,,3835,3259.75,559.12,3835,"Multiplan, Inc.","Multiplan, Inc.",3604.9,94,,percent of total billed charges,,
Thyroidectomy Total Or Complete (Pro Cah),,60240,CPT,Professional,Both,,,,3835,3259.75,559.12,3835,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,3455.335,90.1,,percent of total billed charges,,
Thyroidectomy Total Or Complete (Pro Cah),,60240,CPT,Professional,Both,,,,3835,3259.75,559.12,3835,"Preferred One Administrative Services, INC.",PPO,3781.31,98.6,,percent of total billed charges,,
Thyroidectomy Total Or Complete (Pro Cah),,60240,CPT,Professional,Both,,,,3835,3259.75,559.12,3835,PrimeWest Health,Minnesota Senior Health Options (MSHO),998.844,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Thyroidectomy Total Or Complete (Pro Cah),,60240,CPT,Professional,Both,,,,3835,3259.75,559.12,3835,PrimeWest Health,MinnesotaCare,690.7125632,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Thyroidectomy Total Or Complete (Pro Cah),,60240,CPT,Professional,Both,,,,3835,3259.75,559.12,3835,Sanford Health Plan,Sanford Health Plan,3374.8,88,,percent of total billed charges,,
Thyroidectomy Total Or Complete (Pro Cah),,60240,CPT,Professional,Both,,,,3835,3259.75,559.12,3835,"UCare Health, Inc.",Individual & Family Plan,1411.931136,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Thyroidectomy Total Or Complete (Pro Cah),,60240,CPT,Professional,Both,,,,3835,3259.75,559.12,3835,"UCare Health, Inc.",Medical Assistance,710.078336,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Thyroidectomy Total Or Complete (Pro Cah),,60240,CPT,Professional,Both,,,,3835,3259.75,559.12,3835,"UCare Health, Inc.",Medicare Advantage,998.844,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Thyroidectomy Total Or Complete (Pro Cah),,60240,CPT,Professional,Both,,,,3835,3259.75,559.12,3835,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),799.0752,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Thyroidectomy Total Or Complete (Pro Cah),,60240,CPT,Professional,Both,,,,3835,3259.75,559.12,3835,UnitedHealthcare,Individual & Family,3835,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Thyroidectomy Total Or Complete (Pro Cah),,60240,CPT,Professional,Both,,,,3835,3259.75,559.12,3835,UnitedHealthcare,Medicare Advantage,998.844,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Thyroidectomy Total Or Complete (Pro Cah),,60240,CPT,Professional,Both,,,,3835,3259.75,559.12,3835,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,645.52576,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Lumbar Puncture,,62270,CPT,Facility,Both,,,,918,780.3,263.0988,918,Aetna,Commercial,844.56,92,,percent of total billed charges,,
Lumbar Puncture,,62270,CPT,Facility,Outpatient,,,,918,780.3,263.0988,918,Aetna,Medicare Advantage,449.82,49,,percent of total billed charges,,
Lumbar Puncture,,62270,CPT,Facility,Inpatient,,,,918,780.3,263.0988,918,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Lumbar Puncture,,62270,CPT,Facility,Both,,,,918,780.3,263.0988,918,Aetna,PPO,853.74,93,,percent of total billed charges,,
Lumbar Puncture,,62270,CPT,Facility,Both,,,,918,780.3,263.0988,918,America's PPO,America's PPO,881.5554,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Lumbar Puncture,,62270,CPT,Facility,Both,,,,918,780.3,263.0988,918,BlueCross BlueShield Minnesota, Federal Employee Program,903.312,98.4,,percent of total billed charges,,
Lumbar Puncture,,62270,CPT,Facility,Both,,,,918,780.3,263.0988,918,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,918,100,,percent of total billed charges,,
Lumbar Puncture,,62270,CPT,Facility,Both,,,,918,780.3,263.0988,918,BlueCross BlueShield Minnesota,High Value Network Plan,826.2,90,,percent of total billed charges,,
Lumbar Puncture,,62270,CPT,Facility,Outpatient,,,,918,780.3,263.0988,918,BlueCross BlueShield Minnesota,Medicare Advantage,449.82,49,,percent of total billed charges,,
Lumbar Puncture,,62270,CPT,Facility,Inpatient,,,,918,780.3,263.0988,918,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Lumbar Puncture,,62270,CPT,Facility,Both,,,,918,780.3,263.0988,918,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,813.0726,88.57,,percent of total billed charges,,
Lumbar Puncture,,62270,CPT,Facility,Both,,,,918,780.3,263.0988,918,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,263.0988,28.66,,percent of total billed charges,,
Lumbar Puncture,,62270,CPT,Facility,Outpatient,,,,918,780.3,263.0988,918,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),449.82,49,,percent of total billed charges,,
Lumbar Puncture,,62270,CPT,Facility,Inpatient,,,,918,780.3,263.0988,918,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Lumbar Puncture,,62270,CPT,Facility,Both,,,,918,780.3,263.0988,918,CorVel,Worker's Compensation,918,100,,percent of total billed charges,,
Lumbar Puncture,,62270,CPT,Facility,Both,,,,918,780.3,263.0988,918,First Health Group Corporation,First Health Network,890.46,97,,percent of total billed charges,,
Lumbar Puncture,,62270,CPT,Facility,Both,,,,918,780.3,263.0988,918,"Health Partners, Inc.",Commercial,868.428,94.6,,percent of total billed charges,,
Lumbar Puncture,,62270,CPT,Facility,Outpatient,,,,918,780.3,263.0988,918,"Health Partners, Inc.",Medicare Advantage,449.82,49,,percent of total billed charges,,
Lumbar Puncture,,62270,CPT,Facility,Inpatient,,,,918,780.3,263.0988,918,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Lumbar Puncture,,62270,CPT,Facility,Both,,,,918,780.3,263.0988,918,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),550.8,60,,percent of total billed charges,,
Lumbar Puncture,,62270,CPT,Facility,Both,,,,918,780.3,263.0988,918,"Health Partners, Inc.",State of Minnesota Advantage Program,748.17,81.5,,percent of total billed charges,,
Lumbar Puncture,,62270,CPT,Facility,Both,,,,918,780.3,263.0988,918,"Health Partners, Inc.",State Public Programs,459,50,,percent of total billed charges,,
Lumbar Puncture,,62270,CPT,Facility,Both,,,,918,780.3,263.0988,918,Humana Insurance Company,Commercial PPO,872.1,95,,percent of total billed charges,,
Lumbar Puncture,,62270,CPT,Facility,Outpatient,,,,918,780.3,263.0988,918,Humana Insurance Company,Medicare PPO,449.82,49,,percent of total billed charges,,
Lumbar Puncture,,62270,CPT,Facility,Inpatient,,,,918,780.3,263.0988,918,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Lumbar Puncture,,62270,CPT,Facility,Both,,,,918,780.3,263.0988,918,Medica,Individual & Family,909.738,99.1,,percent of total billed charges,,
Lumbar Puncture,,62270,CPT,Facility,Outpatient,,,,918,780.3,263.0988,918,Medica,Medica Advantage Solution,457.164,49.8,,percent of total billed charges,,
Lumbar Puncture,,62270,CPT,Facility,Inpatient,,,,918,780.3,263.0988,918,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Lumbar Puncture,,62270,CPT,Facility,Outpatient,,,,918,780.3,263.0988,918,Medica,Medical Assistance,449,,,Other,Grouper,All inclusive per visit
Lumbar Puncture,,62270,CPT,Facility,Inpatient,,,,918,780.3,263.0988,918,Medica,Medical Assistance,,,,,Included in per diem rate,
Lumbar Puncture,,62270,CPT,Facility,Outpatient,,,,918,780.3,263.0988,918,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,457.164,49.8,,percent of total billed charges,,
Lumbar Puncture,,62270,CPT,Facility,Inpatient,,,,918,780.3,263.0988,918,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Lumbar Puncture,,62270,CPT,Facility,Both,,,,918,780.3,263.0988,918,"Multiplan, Inc.","Multiplan, Inc.",862.92,94,,percent of total billed charges,,
Lumbar Puncture,,62270,CPT,Facility,Outpatient,,,,918,780.3,263.0988,918,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,827.118,90.1,,percent of total billed charges,,
Lumbar Puncture,,62270,CPT,Facility,Inpatient,,,,918,780.3,263.0988,918,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Lumbar Puncture,,62270,CPT,Facility,Both,,,,918,780.3,263.0988,918,"Preferred One Administrative Services, INC.",PPO,905.148,98.6,,percent of total billed charges,,
Lumbar Puncture,,62270,CPT,Facility,Outpatient,,,,918,780.3,263.0988,918,PrimeWest Health,Minnesota Senior Health Options (MSHO),472.311,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Lumbar Puncture,,62270,CPT,Facility,Inpatient,,,,918,780.3,263.0988,918,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Lumbar Puncture,,62270,CPT,Facility,Outpatient,,,,918,780.3,263.0988,918,PrimeWest Health,MinnesotaCare,471.4848,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Lumbar Puncture,,62270,CPT,Facility,Inpatient,,,,918,780.3,263.0988,918,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Lumbar Puncture,,62270,CPT,Facility,Both,,,,918,780.3,263.0988,918,Sanford Health Plan,Sanford Health Plan,844.56,92,,percent of total billed charges,,
Lumbar Puncture,,62270,CPT,Facility,Outpatient,,,,918,780.3,263.0988,918,"UCare Health, Inc.",Individual & Family Plan,517.293,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Lumbar Puncture,,62270,CPT,Facility,Inpatient,,,,918,780.3,263.0988,918,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Lumbar Puncture,,62270,CPT,Facility,Outpatient,,,,918,780.3,263.0988,918,"UCare Health, Inc.",Medical Assistance,463.3146,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Lumbar Puncture,,62270,CPT,Facility,Inpatient,,,,918,780.3,263.0988,918,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Lumbar Puncture,,62270,CPT,Facility,Outpatient,,,,918,780.3,263.0988,918,"UCare Health, Inc.",Medicare Advantage,463.3146,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Lumbar Puncture,,62270,CPT,Facility,Inpatient,,,,918,780.3,263.0988,918,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Lumbar Puncture,,62270,CPT,Facility,Outpatient,,,,918,780.3,263.0988,918,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),463.3146,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Lumbar Puncture,,62270,CPT,Facility,Inpatient,,,,918,780.3,263.0988,918,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Lumbar Puncture,,62270,CPT,Facility,Both,,,,918,780.3,263.0988,918,UnitedHealthcare,Individual & Family,862.92,94,,percent of total billed charges,,
Lumbar Puncture,,62270,CPT,Facility,Outpatient,,,,918,780.3,263.0988,918,UnitedHealthcare,Medicare Advantage,449.82,49,,percent of total billed charges,,
Lumbar Puncture,,62270,CPT,Facility,Inpatient,,,,918,780.3,263.0988,918,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Lumbar Puncture,,62270,CPT,Facility,Outpatient,,,,918,780.3,263.0988,918,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,440.64,48,,percent of total billed charges,,100% of DHS outpatient percentage
Lumbar Puncture,,62270,CPT,Facility,Inpatient,,,,918,780.3,263.0988,918,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Xr Epidural Cervical Thoracic Inj,,62321,CPT,Facility,Both,,,,2400,2040,449,2400,Aetna,Commercial,2208,92,,percent of total billed charges,,
Xr Epidural Cervical Thoracic Inj,,62321,CPT,Facility,Outpatient,,,,2400,2040,449,2400,Aetna,Medicare Advantage,1176,49,,percent of total billed charges,,
Xr Epidural Cervical Thoracic Inj,,62321,CPT,Facility,Inpatient,,,,2400,2040,449,2400,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Xr Epidural Cervical Thoracic Inj,,62321,CPT,Facility,Both,,,,2400,2040,449,2400,Aetna,PPO,2232,93,,percent of total billed charges,,
Xr Epidural Cervical Thoracic Inj,,62321,CPT,Facility,Both,,,,2400,2040,449,2400,America's PPO,America's PPO,2304.72,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Xr Epidural Cervical Thoracic Inj,,62321,CPT,Facility,Both,,,,2400,2040,449,2400,BlueCross BlueShield Minnesota, Federal Employee Program,2361.6,98.4,,percent of total billed charges,,
Xr Epidural Cervical Thoracic Inj,,62321,CPT,Facility,Both,,,,2400,2040,449,2400,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,2400,100,,percent of total billed charges,,
Xr Epidural Cervical Thoracic Inj,,62321,CPT,Facility,Both,,,,2400,2040,449,2400,BlueCross BlueShield Minnesota,High Value Network Plan,2160,90,,percent of total billed charges,,
Xr Epidural Cervical Thoracic Inj,,62321,CPT,Facility,Outpatient,,,,2400,2040,449,2400,BlueCross BlueShield Minnesota,Medicare Advantage,1176,49,,percent of total billed charges,,
Xr Epidural Cervical Thoracic Inj,,62321,CPT,Facility,Inpatient,,,,2400,2040,449,2400,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Xr Epidural Cervical Thoracic Inj,,62321,CPT,Facility,Both,,,,2400,2040,449,2400,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,2125.68,88.57,,percent of total billed charges,,
Xr Epidural Cervical Thoracic Inj,,62321,CPT,Facility,Both,,,,2400,2040,449,2400,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,687.84,28.66,,percent of total billed charges,,
Xr Epidural Cervical Thoracic Inj,,62321,CPT,Facility,Outpatient,,,,2400,2040,449,2400,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1176,49,,percent of total billed charges,,
Xr Epidural Cervical Thoracic Inj,,62321,CPT,Facility,Inpatient,,,,2400,2040,449,2400,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Xr Epidural Cervical Thoracic Inj,,62321,CPT,Facility,Both,,,,2400,2040,449,2400,CorVel,Worker's Compensation,2400,100,,percent of total billed charges,,
Xr Epidural Cervical Thoracic Inj,,62321,CPT,Facility,Both,,,,2400,2040,449,2400,First Health Group Corporation,First Health Network,2328,97,,percent of total billed charges,,
Xr Epidural Cervical Thoracic Inj,,62321,CPT,Facility,Both,,,,2400,2040,449,2400,"Health Partners, Inc.",Commercial,2270.4,94.6,,percent of total billed charges,,
Xr Epidural Cervical Thoracic Inj,,62321,CPT,Facility,Outpatient,,,,2400,2040,449,2400,"Health Partners, Inc.",Medicare Advantage,1176,49,,percent of total billed charges,,
Xr Epidural Cervical Thoracic Inj,,62321,CPT,Facility,Inpatient,,,,2400,2040,449,2400,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Epidural Cervical Thoracic Inj,,62321,CPT,Facility,Both,,,,2400,2040,449,2400,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1440,60,,percent of total billed charges,,
Xr Epidural Cervical Thoracic Inj,,62321,CPT,Facility,Both,,,,2400,2040,449,2400,"Health Partners, Inc.",State of Minnesota Advantage Program,1956,81.5,,percent of total billed charges,,
Xr Epidural Cervical Thoracic Inj,,62321,CPT,Facility,Both,,,,2400,2040,449,2400,"Health Partners, Inc.",State Public Programs,1200,50,,percent of total billed charges,,
Xr Epidural Cervical Thoracic Inj,,62321,CPT,Facility,Both,,,,2400,2040,449,2400,Humana Insurance Company,Commercial PPO,2280,95,,percent of total billed charges,,
Xr Epidural Cervical Thoracic Inj,,62321,CPT,Facility,Outpatient,,,,2400,2040,449,2400,Humana Insurance Company,Medicare PPO,1176,49,,percent of total billed charges,,
Xr Epidural Cervical Thoracic Inj,,62321,CPT,Facility,Inpatient,,,,2400,2040,449,2400,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Xr Epidural Cervical Thoracic Inj,,62321,CPT,Facility,Both,,,,2400,2040,449,2400,Medica,Individual & Family,2378.4,99.1,,percent of total billed charges,,
Xr Epidural Cervical Thoracic Inj,,62321,CPT,Facility,Outpatient,,,,2400,2040,449,2400,Medica,Medica Advantage Solution,1195.2,49.8,,percent of total billed charges,,
Xr Epidural Cervical Thoracic Inj,,62321,CPT,Facility,Inpatient,,,,2400,2040,449,2400,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Xr Epidural Cervical Thoracic Inj,,62321,CPT,Facility,Outpatient,,,,2400,2040,449,2400,Medica,Medical Assistance,449,,,Other,Grouper,All inclusive per visit
Xr Epidural Cervical Thoracic Inj,,62321,CPT,Facility,Inpatient,,,,2400,2040,449,2400,Medica,Medical Assistance,,,,,Included in per diem rate,
Xr Epidural Cervical Thoracic Inj,,62321,CPT,Facility,Outpatient,,,,2400,2040,449,2400,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1195.2,49.8,,percent of total billed charges,,
Xr Epidural Cervical Thoracic Inj,,62321,CPT,Facility,Inpatient,,,,2400,2040,449,2400,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Xr Epidural Cervical Thoracic Inj,,62321,CPT,Facility,Both,,,,2400,2040,449,2400,"Multiplan, Inc.","Multiplan, Inc.",2256,94,,percent of total billed charges,,
Xr Epidural Cervical Thoracic Inj,,62321,CPT,Facility,Outpatient,,,,2400,2040,449,2400,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,2162.4,90.1,,percent of total billed charges,,
Xr Epidural Cervical Thoracic Inj,,62321,CPT,Facility,Inpatient,,,,2400,2040,449,2400,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Xr Epidural Cervical Thoracic Inj,,62321,CPT,Facility,Both,,,,2400,2040,449,2400,"Preferred One Administrative Services, INC.",PPO,2366.4,98.6,,percent of total billed charges,,
Xr Epidural Cervical Thoracic Inj,,62321,CPT,Facility,Outpatient,,,,2400,2040,449,2400,PrimeWest Health,Minnesota Senior Health Options (MSHO),1234.8,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Xr Epidural Cervical Thoracic Inj,,62321,CPT,Facility,Inpatient,,,,2400,2040,449,2400,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Epidural Cervical Thoracic Inj,,62321,CPT,Facility,Outpatient,,,,2400,2040,449,2400,PrimeWest Health,MinnesotaCare,1232.64,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Xr Epidural Cervical Thoracic Inj,,62321,CPT,Facility,Inpatient,,,,2400,2040,449,2400,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Xr Epidural Cervical Thoracic Inj,,62321,CPT,Facility,Both,,,,2400,2040,449,2400,Sanford Health Plan,Sanford Health Plan,2208,92,,percent of total billed charges,,
Xr Epidural Cervical Thoracic Inj,,62321,CPT,Facility,Outpatient,,,,2400,2040,449,2400,"UCare Health, Inc.",Individual & Family Plan,1352.4,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Xr Epidural Cervical Thoracic Inj,,62321,CPT,Facility,Inpatient,,,,2400,2040,449,2400,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Xr Epidural Cervical Thoracic Inj,,62321,CPT,Facility,Outpatient,,,,2400,2040,449,2400,"UCare Health, Inc.",Medical Assistance,1211.28,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Epidural Cervical Thoracic Inj,,62321,CPT,Facility,Inpatient,,,,2400,2040,449,2400,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Xr Epidural Cervical Thoracic Inj,,62321,CPT,Facility,Outpatient,,,,2400,2040,449,2400,"UCare Health, Inc.",Medicare Advantage,1211.28,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Epidural Cervical Thoracic Inj,,62321,CPT,Facility,Inpatient,,,,2400,2040,449,2400,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Epidural Cervical Thoracic Inj,,62321,CPT,Facility,Outpatient,,,,2400,2040,449,2400,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1211.28,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Epidural Cervical Thoracic Inj,,62321,CPT,Facility,Inpatient,,,,2400,2040,449,2400,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Epidural Cervical Thoracic Inj,,62321,CPT,Facility,Both,,,,2400,2040,449,2400,UnitedHealthcare,Individual & Family,2256,94,,percent of total billed charges,,
Xr Epidural Cervical Thoracic Inj,,62321,CPT,Facility,Outpatient,,,,2400,2040,449,2400,UnitedHealthcare,Medicare Advantage,1176,49,,percent of total billed charges,,
Xr Epidural Cervical Thoracic Inj,,62321,CPT,Facility,Inpatient,,,,2400,2040,449,2400,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Xr Epidural Cervical Thoracic Inj,,62321,CPT,Facility,Outpatient,,,,2400,2040,449,2400,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1152,48,,percent of total billed charges,,100% of DHS outpatient percentage
Xr Epidural Cervical Thoracic Inj,,62321,CPT,Facility,Inpatient,,,,2400,2040,449,2400,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Xr Epidural Lumbar Or Sacral Inj,,62323,CPT,Facility,Both,,,,2400,2040,449,2400,Aetna,Commercial,2208,92,,percent of total billed charges,,
Xr Epidural Lumbar Or Sacral Inj,,62323,CPT,Facility,Outpatient,,,,2400,2040,449,2400,Aetna,Medicare Advantage,1176,49,,percent of total billed charges,,
Xr Epidural Lumbar Or Sacral Inj,,62323,CPT,Facility,Inpatient,,,,2400,2040,449,2400,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Xr Epidural Lumbar Or Sacral Inj,,62323,CPT,Facility,Both,,,,2400,2040,449,2400,Aetna,PPO,2232,93,,percent of total billed charges,,
Xr Epidural Lumbar Or Sacral Inj,,62323,CPT,Facility,Both,,,,2400,2040,449,2400,America's PPO,America's PPO,2304.72,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Xr Epidural Lumbar Or Sacral Inj,,62323,CPT,Facility,Both,,,,2400,2040,449,2400,BlueCross BlueShield Minnesota, Federal Employee Program,2361.6,98.4,,percent of total billed charges,,
Xr Epidural Lumbar Or Sacral Inj,,62323,CPT,Facility,Both,,,,2400,2040,449,2400,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,2400,100,,percent of total billed charges,,
Xr Epidural Lumbar Or Sacral Inj,,62323,CPT,Facility,Both,,,,2400,2040,449,2400,BlueCross BlueShield Minnesota,High Value Network Plan,2160,90,,percent of total billed charges,,
Xr Epidural Lumbar Or Sacral Inj,,62323,CPT,Facility,Outpatient,,,,2400,2040,449,2400,BlueCross BlueShield Minnesota,Medicare Advantage,1176,49,,percent of total billed charges,,
Xr Epidural Lumbar Or Sacral Inj,,62323,CPT,Facility,Inpatient,,,,2400,2040,449,2400,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Xr Epidural Lumbar Or Sacral Inj,,62323,CPT,Facility,Both,,,,2400,2040,449,2400,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,2125.68,88.57,,percent of total billed charges,,
Xr Epidural Lumbar Or Sacral Inj,,62323,CPT,Facility,Both,,,,2400,2040,449,2400,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,687.84,28.66,,percent of total billed charges,,
Xr Epidural Lumbar Or Sacral Inj,,62323,CPT,Facility,Outpatient,,,,2400,2040,449,2400,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1176,49,,percent of total billed charges,,
Xr Epidural Lumbar Or Sacral Inj,,62323,CPT,Facility,Inpatient,,,,2400,2040,449,2400,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Xr Epidural Lumbar Or Sacral Inj,,62323,CPT,Facility,Both,,,,2400,2040,449,2400,CorVel,Worker's Compensation,2400,100,,percent of total billed charges,,
Xr Epidural Lumbar Or Sacral Inj,,62323,CPT,Facility,Both,,,,2400,2040,449,2400,First Health Group Corporation,First Health Network,2328,97,,percent of total billed charges,,
Xr Epidural Lumbar Or Sacral Inj,,62323,CPT,Facility,Both,,,,2400,2040,449,2400,"Health Partners, Inc.",Commercial,2270.4,94.6,,percent of total billed charges,,
Xr Epidural Lumbar Or Sacral Inj,,62323,CPT,Facility,Outpatient,,,,2400,2040,449,2400,"Health Partners, Inc.",Medicare Advantage,1176,49,,percent of total billed charges,,
Xr Epidural Lumbar Or Sacral Inj,,62323,CPT,Facility,Inpatient,,,,2400,2040,449,2400,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Epidural Lumbar Or Sacral Inj,,62323,CPT,Facility,Both,,,,2400,2040,449,2400,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1440,60,,percent of total billed charges,,
Xr Epidural Lumbar Or Sacral Inj,,62323,CPT,Facility,Both,,,,2400,2040,449,2400,"Health Partners, Inc.",State of Minnesota Advantage Program,1956,81.5,,percent of total billed charges,,
Xr Epidural Lumbar Or Sacral Inj,,62323,CPT,Facility,Both,,,,2400,2040,449,2400,"Health Partners, Inc.",State Public Programs,1200,50,,percent of total billed charges,,
Xr Epidural Lumbar Or Sacral Inj,,62323,CPT,Facility,Both,,,,2400,2040,449,2400,Humana Insurance Company,Commercial PPO,2280,95,,percent of total billed charges,,
Xr Epidural Lumbar Or Sacral Inj,,62323,CPT,Facility,Outpatient,,,,2400,2040,449,2400,Humana Insurance Company,Medicare PPO,1176,49,,percent of total billed charges,,
Xr Epidural Lumbar Or Sacral Inj,,62323,CPT,Facility,Inpatient,,,,2400,2040,449,2400,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Xr Epidural Lumbar Or Sacral Inj,,62323,CPT,Facility,Both,,,,2400,2040,449,2400,Medica,Individual & Family,2378.4,99.1,,percent of total billed charges,,
Xr Epidural Lumbar Or Sacral Inj,,62323,CPT,Facility,Outpatient,,,,2400,2040,449,2400,Medica,Medica Advantage Solution,1195.2,49.8,,percent of total billed charges,,
Xr Epidural Lumbar Or Sacral Inj,,62323,CPT,Facility,Inpatient,,,,2400,2040,449,2400,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Xr Epidural Lumbar Or Sacral Inj,,62323,CPT,Facility,Outpatient,,,,2400,2040,449,2400,Medica,Medical Assistance,449,,,Other,Grouper,All inclusive per visit
Xr Epidural Lumbar Or Sacral Inj,,62323,CPT,Facility,Inpatient,,,,2400,2040,449,2400,Medica,Medical Assistance,,,,,Included in per diem rate,
Xr Epidural Lumbar Or Sacral Inj,,62323,CPT,Facility,Outpatient,,,,2400,2040,449,2400,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1195.2,49.8,,percent of total billed charges,,
Xr Epidural Lumbar Or Sacral Inj,,62323,CPT,Facility,Inpatient,,,,2400,2040,449,2400,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Xr Epidural Lumbar Or Sacral Inj,,62323,CPT,Facility,Both,,,,2400,2040,449,2400,"Multiplan, Inc.","Multiplan, Inc.",2256,94,,percent of total billed charges,,
Xr Epidural Lumbar Or Sacral Inj,,62323,CPT,Facility,Outpatient,,,,2400,2040,449,2400,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,2162.4,90.1,,percent of total billed charges,,
Xr Epidural Lumbar Or Sacral Inj,,62323,CPT,Facility,Inpatient,,,,2400,2040,449,2400,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Xr Epidural Lumbar Or Sacral Inj,,62323,CPT,Facility,Both,,,,2400,2040,449,2400,"Preferred One Administrative Services, INC.",PPO,2366.4,98.6,,percent of total billed charges,,
Xr Epidural Lumbar Or Sacral Inj,,62323,CPT,Facility,Outpatient,,,,2400,2040,449,2400,PrimeWest Health,Minnesota Senior Health Options (MSHO),1234.8,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Xr Epidural Lumbar Or Sacral Inj,,62323,CPT,Facility,Inpatient,,,,2400,2040,449,2400,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Epidural Lumbar Or Sacral Inj,,62323,CPT,Facility,Outpatient,,,,2400,2040,449,2400,PrimeWest Health,MinnesotaCare,1232.64,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Xr Epidural Lumbar Or Sacral Inj,,62323,CPT,Facility,Inpatient,,,,2400,2040,449,2400,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Xr Epidural Lumbar Or Sacral Inj,,62323,CPT,Facility,Both,,,,2400,2040,449,2400,Sanford Health Plan,Sanford Health Plan,2208,92,,percent of total billed charges,,
Xr Epidural Lumbar Or Sacral Inj,,62323,CPT,Facility,Outpatient,,,,2400,2040,449,2400,"UCare Health, Inc.",Individual & Family Plan,1352.4,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Xr Epidural Lumbar Or Sacral Inj,,62323,CPT,Facility,Inpatient,,,,2400,2040,449,2400,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Xr Epidural Lumbar Or Sacral Inj,,62323,CPT,Facility,Outpatient,,,,2400,2040,449,2400,"UCare Health, Inc.",Medical Assistance,1211.28,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Epidural Lumbar Or Sacral Inj,,62323,CPT,Facility,Inpatient,,,,2400,2040,449,2400,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Xr Epidural Lumbar Or Sacral Inj,,62323,CPT,Facility,Outpatient,,,,2400,2040,449,2400,"UCare Health, Inc.",Medicare Advantage,1211.28,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Epidural Lumbar Or Sacral Inj,,62323,CPT,Facility,Inpatient,,,,2400,2040,449,2400,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Epidural Lumbar Or Sacral Inj,,62323,CPT,Facility,Outpatient,,,,2400,2040,449,2400,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1211.28,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Epidural Lumbar Or Sacral Inj,,62323,CPT,Facility,Inpatient,,,,2400,2040,449,2400,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Epidural Lumbar Or Sacral Inj,,62323,CPT,Facility,Both,,,,2400,2040,449,2400,UnitedHealthcare,Individual & Family,2256,94,,percent of total billed charges,,
Xr Epidural Lumbar Or Sacral Inj,,62323,CPT,Facility,Outpatient,,,,2400,2040,449,2400,UnitedHealthcare,Medicare Advantage,1176,49,,percent of total billed charges,,
Xr Epidural Lumbar Or Sacral Inj,,62323,CPT,Facility,Inpatient,,,,2400,2040,449,2400,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Xr Epidural Lumbar Or Sacral Inj,,62323,CPT,Facility,Outpatient,,,,2400,2040,449,2400,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1152,48,,percent of total billed charges,,100% of DHS outpatient percentage
Xr Epidural Lumbar Or Sacral Inj,,62323,CPT,Facility,Inpatient,,,,2400,2040,449,2400,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Sc Inj Intercostal Nerve Single Lvl,,64420,CPT,Facility,Both,,,,663,563.55,190.0158,663,Aetna,Commercial,609.96,92,,percent of total billed charges,,
Sc Inj Intercostal Nerve Single Lvl,,64420,CPT,Facility,Outpatient,,,,663,563.55,190.0158,663,Aetna,Medicare Advantage,324.87,49,,percent of total billed charges,,
Sc Inj Intercostal Nerve Single Lvl,,64420,CPT,Facility,Inpatient,,,,663,563.55,190.0158,663,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Sc Inj Intercostal Nerve Single Lvl,,64420,CPT,Facility,Both,,,,663,563.55,190.0158,663,Aetna,PPO,616.59,93,,percent of total billed charges,,
Sc Inj Intercostal Nerve Single Lvl,,64420,CPT,Facility,Both,,,,663,563.55,190.0158,663,America's PPO,America's PPO,636.6789,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Sc Inj Intercostal Nerve Single Lvl,,64420,CPT,Facility,Both,,,,663,563.55,190.0158,663,BlueCross BlueShield Minnesota, Federal Employee Program,652.392,98.4,,percent of total billed charges,,
Sc Inj Intercostal Nerve Single Lvl,,64420,CPT,Facility,Both,,,,663,563.55,190.0158,663,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,663,100,,percent of total billed charges,,
Sc Inj Intercostal Nerve Single Lvl,,64420,CPT,Facility,Both,,,,663,563.55,190.0158,663,BlueCross BlueShield Minnesota,High Value Network Plan,596.7,90,,percent of total billed charges,,
Sc Inj Intercostal Nerve Single Lvl,,64420,CPT,Facility,Outpatient,,,,663,563.55,190.0158,663,BlueCross BlueShield Minnesota,Medicare Advantage,324.87,49,,percent of total billed charges,,
Sc Inj Intercostal Nerve Single Lvl,,64420,CPT,Facility,Inpatient,,,,663,563.55,190.0158,663,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Sc Inj Intercostal Nerve Single Lvl,,64420,CPT,Facility,Both,,,,663,563.55,190.0158,663,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,587.2191,88.57,,percent of total billed charges,,
Sc Inj Intercostal Nerve Single Lvl,,64420,CPT,Facility,Both,,,,663,563.55,190.0158,663,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,190.0158,28.66,,percent of total billed charges,,
Sc Inj Intercostal Nerve Single Lvl,,64420,CPT,Facility,Outpatient,,,,663,563.55,190.0158,663,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),324.87,49,,percent of total billed charges,,
Sc Inj Intercostal Nerve Single Lvl,,64420,CPT,Facility,Inpatient,,,,663,563.55,190.0158,663,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Sc Inj Intercostal Nerve Single Lvl,,64420,CPT,Facility,Both,,,,663,563.55,190.0158,663,CorVel,Worker's Compensation,663,100,,percent of total billed charges,,
Sc Inj Intercostal Nerve Single Lvl,,64420,CPT,Facility,Both,,,,663,563.55,190.0158,663,First Health Group Corporation,First Health Network,643.11,97,,percent of total billed charges,,
Sc Inj Intercostal Nerve Single Lvl,,64420,CPT,Facility,Both,,,,663,563.55,190.0158,663,"Health Partners, Inc.",Commercial,627.198,94.6,,percent of total billed charges,,
Sc Inj Intercostal Nerve Single Lvl,,64420,CPT,Facility,Outpatient,,,,663,563.55,190.0158,663,"Health Partners, Inc.",Medicare Advantage,324.87,49,,percent of total billed charges,,
Sc Inj Intercostal Nerve Single Lvl,,64420,CPT,Facility,Inpatient,,,,663,563.55,190.0158,663,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sc Inj Intercostal Nerve Single Lvl,,64420,CPT,Facility,Both,,,,663,563.55,190.0158,663,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),397.8,60,,percent of total billed charges,,
Sc Inj Intercostal Nerve Single Lvl,,64420,CPT,Facility,Both,,,,663,563.55,190.0158,663,"Health Partners, Inc.",State of Minnesota Advantage Program,540.345,81.5,,percent of total billed charges,,
Sc Inj Intercostal Nerve Single Lvl,,64420,CPT,Facility,Both,,,,663,563.55,190.0158,663,"Health Partners, Inc.",State Public Programs,331.5,50,,percent of total billed charges,,
Sc Inj Intercostal Nerve Single Lvl,,64420,CPT,Facility,Both,,,,663,563.55,190.0158,663,Humana Insurance Company,Commercial PPO,629.85,95,,percent of total billed charges,,
Sc Inj Intercostal Nerve Single Lvl,,64420,CPT,Facility,Outpatient,,,,663,563.55,190.0158,663,Humana Insurance Company,Medicare PPO,324.87,49,,percent of total billed charges,,
Sc Inj Intercostal Nerve Single Lvl,,64420,CPT,Facility,Inpatient,,,,663,563.55,190.0158,663,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Sc Inj Intercostal Nerve Single Lvl,,64420,CPT,Facility,Both,,,,663,563.55,190.0158,663,Medica,Individual & Family,657.033,99.1,,percent of total billed charges,,
Sc Inj Intercostal Nerve Single Lvl,,64420,CPT,Facility,Outpatient,,,,663,563.55,190.0158,663,Medica,Medica Advantage Solution,330.174,49.8,,percent of total billed charges,,
Sc Inj Intercostal Nerve Single Lvl,,64420,CPT,Facility,Inpatient,,,,663,563.55,190.0158,663,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Sc Inj Intercostal Nerve Single Lvl,,64420,CPT,Facility,Outpatient,,,,663,563.55,190.0158,663,Medica,Medical Assistance,449,,,Other,Grouper,All inclusive per visit
Sc Inj Intercostal Nerve Single Lvl,,64420,CPT,Facility,Inpatient,,,,663,563.55,190.0158,663,Medica,Medical Assistance,,,,,Included in per diem rate,
Sc Inj Intercostal Nerve Single Lvl,,64420,CPT,Facility,Outpatient,,,,663,563.55,190.0158,663,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,330.174,49.8,,percent of total billed charges,,
Sc Inj Intercostal Nerve Single Lvl,,64420,CPT,Facility,Inpatient,,,,663,563.55,190.0158,663,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Sc Inj Intercostal Nerve Single Lvl,,64420,CPT,Facility,Both,,,,663,563.55,190.0158,663,"Multiplan, Inc.","Multiplan, Inc.",623.22,94,,percent of total billed charges,,
Sc Inj Intercostal Nerve Single Lvl,,64420,CPT,Facility,Outpatient,,,,663,563.55,190.0158,663,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,597.363,90.1,,percent of total billed charges,,
Sc Inj Intercostal Nerve Single Lvl,,64420,CPT,Facility,Inpatient,,,,663,563.55,190.0158,663,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Sc Inj Intercostal Nerve Single Lvl,,64420,CPT,Facility,Both,,,,663,563.55,190.0158,663,"Preferred One Administrative Services, INC.",PPO,653.718,98.6,,percent of total billed charges,,
Sc Inj Intercostal Nerve Single Lvl,,64420,CPT,Facility,Outpatient,,,,663,563.55,190.0158,663,PrimeWest Health,Minnesota Senior Health Options (MSHO),341.1135,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Sc Inj Intercostal Nerve Single Lvl,,64420,CPT,Facility,Inpatient,,,,663,563.55,190.0158,663,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sc Inj Intercostal Nerve Single Lvl,,64420,CPT,Facility,Outpatient,,,,663,563.55,190.0158,663,PrimeWest Health,MinnesotaCare,340.5168,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Sc Inj Intercostal Nerve Single Lvl,,64420,CPT,Facility,Inpatient,,,,663,563.55,190.0158,663,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Sc Inj Intercostal Nerve Single Lvl,,64420,CPT,Facility,Both,,,,663,563.55,190.0158,663,Sanford Health Plan,Sanford Health Plan,609.96,92,,percent of total billed charges,,
Sc Inj Intercostal Nerve Single Lvl,,64420,CPT,Facility,Outpatient,,,,663,563.55,190.0158,663,"UCare Health, Inc.",Individual & Family Plan,373.6005,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Sc Inj Intercostal Nerve Single Lvl,,64420,CPT,Facility,Inpatient,,,,663,563.55,190.0158,663,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Sc Inj Intercostal Nerve Single Lvl,,64420,CPT,Facility,Outpatient,,,,663,563.55,190.0158,663,"UCare Health, Inc.",Medical Assistance,334.6161,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sc Inj Intercostal Nerve Single Lvl,,64420,CPT,Facility,Inpatient,,,,663,563.55,190.0158,663,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Sc Inj Intercostal Nerve Single Lvl,,64420,CPT,Facility,Outpatient,,,,663,563.55,190.0158,663,"UCare Health, Inc.",Medicare Advantage,334.6161,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sc Inj Intercostal Nerve Single Lvl,,64420,CPT,Facility,Inpatient,,,,663,563.55,190.0158,663,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sc Inj Intercostal Nerve Single Lvl,,64420,CPT,Facility,Outpatient,,,,663,563.55,190.0158,663,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),334.6161,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sc Inj Intercostal Nerve Single Lvl,,64420,CPT,Facility,Inpatient,,,,663,563.55,190.0158,663,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sc Inj Intercostal Nerve Single Lvl,,64420,CPT,Facility,Both,,,,663,563.55,190.0158,663,UnitedHealthcare,Individual & Family,623.22,94,,percent of total billed charges,,
Sc Inj Intercostal Nerve Single Lvl,,64420,CPT,Facility,Outpatient,,,,663,563.55,190.0158,663,UnitedHealthcare,Medicare Advantage,324.87,49,,percent of total billed charges,,
Sc Inj Intercostal Nerve Single Lvl,,64420,CPT,Facility,Inpatient,,,,663,563.55,190.0158,663,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Sc Inj Intercostal Nerve Single Lvl,,64420,CPT,Facility,Outpatient,,,,663,563.55,190.0158,663,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,318.24,48,,percent of total billed charges,,100% of DHS outpatient percentage
Sc Inj Intercostal Nerve Single Lvl,,64420,CPT,Facility,Inpatient,,,,663,563.55,190.0158,663,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Sc Inj Intercostal Nerves Ea Addl Lvl,,64421,CPT,Facility,Both,,,,867,736.95,248.4822,867,Aetna,Commercial,797.64,92,,percent of total billed charges,,
Sc Inj Intercostal Nerves Ea Addl Lvl,,64421,CPT,Facility,Outpatient,,,,867,736.95,248.4822,867,Aetna,Medicare Advantage,424.83,49,,percent of total billed charges,,
Sc Inj Intercostal Nerves Ea Addl Lvl,,64421,CPT,Facility,Inpatient,,,,867,736.95,248.4822,867,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Sc Inj Intercostal Nerves Ea Addl Lvl,,64421,CPT,Facility,Both,,,,867,736.95,248.4822,867,Aetna,PPO,806.31,93,,percent of total billed charges,,
Sc Inj Intercostal Nerves Ea Addl Lvl,,64421,CPT,Facility,Both,,,,867,736.95,248.4822,867,America's PPO,America's PPO,832.5801,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Sc Inj Intercostal Nerves Ea Addl Lvl,,64421,CPT,Facility,Both,,,,867,736.95,248.4822,867,BlueCross BlueShield Minnesota, Federal Employee Program,853.128,98.4,,percent of total billed charges,,
Sc Inj Intercostal Nerves Ea Addl Lvl,,64421,CPT,Facility,Both,,,,867,736.95,248.4822,867,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,867,100,,percent of total billed charges,,
Sc Inj Intercostal Nerves Ea Addl Lvl,,64421,CPT,Facility,Both,,,,867,736.95,248.4822,867,BlueCross BlueShield Minnesota,High Value Network Plan,780.3,90,,percent of total billed charges,,
Sc Inj Intercostal Nerves Ea Addl Lvl,,64421,CPT,Facility,Outpatient,,,,867,736.95,248.4822,867,BlueCross BlueShield Minnesota,Medicare Advantage,424.83,49,,percent of total billed charges,,
Sc Inj Intercostal Nerves Ea Addl Lvl,,64421,CPT,Facility,Inpatient,,,,867,736.95,248.4822,867,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Sc Inj Intercostal Nerves Ea Addl Lvl,,64421,CPT,Facility,Both,,,,867,736.95,248.4822,867,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,767.9019,88.57,,percent of total billed charges,,
Sc Inj Intercostal Nerves Ea Addl Lvl,,64421,CPT,Facility,Both,,,,867,736.95,248.4822,867,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,248.4822,28.66,,percent of total billed charges,,
Sc Inj Intercostal Nerves Ea Addl Lvl,,64421,CPT,Facility,Outpatient,,,,867,736.95,248.4822,867,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),424.83,49,,percent of total billed charges,,
Sc Inj Intercostal Nerves Ea Addl Lvl,,64421,CPT,Facility,Inpatient,,,,867,736.95,248.4822,867,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Sc Inj Intercostal Nerves Ea Addl Lvl,,64421,CPT,Facility,Both,,,,867,736.95,248.4822,867,CorVel,Worker's Compensation,867,100,,percent of total billed charges,,
Sc Inj Intercostal Nerves Ea Addl Lvl,,64421,CPT,Facility,Both,,,,867,736.95,248.4822,867,First Health Group Corporation,First Health Network,840.99,97,,percent of total billed charges,,
Sc Inj Intercostal Nerves Ea Addl Lvl,,64421,CPT,Facility,Both,,,,867,736.95,248.4822,867,"Health Partners, Inc.",Commercial,820.182,94.6,,percent of total billed charges,,
Sc Inj Intercostal Nerves Ea Addl Lvl,,64421,CPT,Facility,Outpatient,,,,867,736.95,248.4822,867,"Health Partners, Inc.",Medicare Advantage,424.83,49,,percent of total billed charges,,
Sc Inj Intercostal Nerves Ea Addl Lvl,,64421,CPT,Facility,Inpatient,,,,867,736.95,248.4822,867,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sc Inj Intercostal Nerves Ea Addl Lvl,,64421,CPT,Facility,Both,,,,867,736.95,248.4822,867,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),520.2,60,,percent of total billed charges,,
Sc Inj Intercostal Nerves Ea Addl Lvl,,64421,CPT,Facility,Both,,,,867,736.95,248.4822,867,"Health Partners, Inc.",State of Minnesota Advantage Program,706.605,81.5,,percent of total billed charges,,
Sc Inj Intercostal Nerves Ea Addl Lvl,,64421,CPT,Facility,Both,,,,867,736.95,248.4822,867,"Health Partners, Inc.",State Public Programs,433.5,50,,percent of total billed charges,,
Sc Inj Intercostal Nerves Ea Addl Lvl,,64421,CPT,Facility,Both,,,,867,736.95,248.4822,867,Humana Insurance Company,Commercial PPO,823.65,95,,percent of total billed charges,,
Sc Inj Intercostal Nerves Ea Addl Lvl,,64421,CPT,Facility,Outpatient,,,,867,736.95,248.4822,867,Humana Insurance Company,Medicare PPO,424.83,49,,percent of total billed charges,,
Sc Inj Intercostal Nerves Ea Addl Lvl,,64421,CPT,Facility,Inpatient,,,,867,736.95,248.4822,867,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Sc Inj Intercostal Nerves Ea Addl Lvl,,64421,CPT,Facility,Both,,,,867,736.95,248.4822,867,Medica,Individual & Family,859.197,99.1,,percent of total billed charges,,
Sc Inj Intercostal Nerves Ea Addl Lvl,,64421,CPT,Facility,Outpatient,,,,867,736.95,248.4822,867,Medica,Medica Advantage Solution,431.766,49.8,,percent of total billed charges,,
Sc Inj Intercostal Nerves Ea Addl Lvl,,64421,CPT,Facility,Inpatient,,,,867,736.95,248.4822,867,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Sc Inj Intercostal Nerves Ea Addl Lvl,,64421,CPT,Facility,Outpatient,,,,867,736.95,248.4822,867,Medica,Medical Assistance,449,,,Other,Grouper,All inclusive per visit
Sc Inj Intercostal Nerves Ea Addl Lvl,,64421,CPT,Facility,Inpatient,,,,867,736.95,248.4822,867,Medica,Medical Assistance,,,,,Included in per diem rate,
Sc Inj Intercostal Nerves Ea Addl Lvl,,64421,CPT,Facility,Outpatient,,,,867,736.95,248.4822,867,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,431.766,49.8,,percent of total billed charges,,
Sc Inj Intercostal Nerves Ea Addl Lvl,,64421,CPT,Facility,Inpatient,,,,867,736.95,248.4822,867,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Sc Inj Intercostal Nerves Ea Addl Lvl,,64421,CPT,Facility,Both,,,,867,736.95,248.4822,867,"Multiplan, Inc.","Multiplan, Inc.",814.98,94,,percent of total billed charges,,
Sc Inj Intercostal Nerves Ea Addl Lvl,,64421,CPT,Facility,Outpatient,,,,867,736.95,248.4822,867,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,781.167,90.1,,percent of total billed charges,,
Sc Inj Intercostal Nerves Ea Addl Lvl,,64421,CPT,Facility,Inpatient,,,,867,736.95,248.4822,867,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Sc Inj Intercostal Nerves Ea Addl Lvl,,64421,CPT,Facility,Both,,,,867,736.95,248.4822,867,"Preferred One Administrative Services, INC.",PPO,854.862,98.6,,percent of total billed charges,,
Sc Inj Intercostal Nerves Ea Addl Lvl,,64421,CPT,Facility,Outpatient,,,,867,736.95,248.4822,867,PrimeWest Health,Minnesota Senior Health Options (MSHO),446.0715,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Sc Inj Intercostal Nerves Ea Addl Lvl,,64421,CPT,Facility,Inpatient,,,,867,736.95,248.4822,867,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sc Inj Intercostal Nerves Ea Addl Lvl,,64421,CPT,Facility,Outpatient,,,,867,736.95,248.4822,867,PrimeWest Health,MinnesotaCare,445.2912,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Sc Inj Intercostal Nerves Ea Addl Lvl,,64421,CPT,Facility,Inpatient,,,,867,736.95,248.4822,867,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Sc Inj Intercostal Nerves Ea Addl Lvl,,64421,CPT,Facility,Both,,,,867,736.95,248.4822,867,Sanford Health Plan,Sanford Health Plan,797.64,92,,percent of total billed charges,,
Sc Inj Intercostal Nerves Ea Addl Lvl,,64421,CPT,Facility,Outpatient,,,,867,736.95,248.4822,867,"UCare Health, Inc.",Individual & Family Plan,488.5545,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Sc Inj Intercostal Nerves Ea Addl Lvl,,64421,CPT,Facility,Inpatient,,,,867,736.95,248.4822,867,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Sc Inj Intercostal Nerves Ea Addl Lvl,,64421,CPT,Facility,Outpatient,,,,867,736.95,248.4822,867,"UCare Health, Inc.",Medical Assistance,437.5749,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sc Inj Intercostal Nerves Ea Addl Lvl,,64421,CPT,Facility,Inpatient,,,,867,736.95,248.4822,867,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Sc Inj Intercostal Nerves Ea Addl Lvl,,64421,CPT,Facility,Outpatient,,,,867,736.95,248.4822,867,"UCare Health, Inc.",Medicare Advantage,437.5749,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sc Inj Intercostal Nerves Ea Addl Lvl,,64421,CPT,Facility,Inpatient,,,,867,736.95,248.4822,867,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sc Inj Intercostal Nerves Ea Addl Lvl,,64421,CPT,Facility,Outpatient,,,,867,736.95,248.4822,867,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),437.5749,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sc Inj Intercostal Nerves Ea Addl Lvl,,64421,CPT,Facility,Inpatient,,,,867,736.95,248.4822,867,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sc Inj Intercostal Nerves Ea Addl Lvl,,64421,CPT,Facility,Both,,,,867,736.95,248.4822,867,UnitedHealthcare,Individual & Family,814.98,94,,percent of total billed charges,,
Sc Inj Intercostal Nerves Ea Addl Lvl,,64421,CPT,Facility,Outpatient,,,,867,736.95,248.4822,867,UnitedHealthcare,Medicare Advantage,424.83,49,,percent of total billed charges,,
Sc Inj Intercostal Nerves Ea Addl Lvl,,64421,CPT,Facility,Inpatient,,,,867,736.95,248.4822,867,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Sc Inj Intercostal Nerves Ea Addl Lvl,,64421,CPT,Facility,Outpatient,,,,867,736.95,248.4822,867,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,416.16,48,,percent of total billed charges,,100% of DHS outpatient percentage
Sc Inj Intercostal Nerves Ea Addl Lvl,,64421,CPT,Facility,Inpatient,,,,867,736.95,248.4822,867,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Xr Ct Foramin Inj Cerv Thor Sngl Lvl W Guid,,64479,CPT,Facility,Both,,,,2550,2167.5,449,2550,Aetna,Commercial,2346,92,,percent of total billed charges,,
Xr Ct Foramin Inj Cerv Thor Sngl Lvl W Guid,,64479,CPT,Facility,Outpatient,,,,2550,2167.5,449,2550,Aetna,Medicare Advantage,1249.5,49,,percent of total billed charges,,
Xr Ct Foramin Inj Cerv Thor Sngl Lvl W Guid,,64479,CPT,Facility,Inpatient,,,,2550,2167.5,449,2550,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Xr Ct Foramin Inj Cerv Thor Sngl Lvl W Guid,,64479,CPT,Facility,Both,,,,2550,2167.5,449,2550,Aetna,PPO,2371.5,93,,percent of total billed charges,,
Xr Ct Foramin Inj Cerv Thor Sngl Lvl W Guid,,64479,CPT,Facility,Both,,,,2550,2167.5,449,2550,America's PPO,America's PPO,2448.765,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Xr Ct Foramin Inj Cerv Thor Sngl Lvl W Guid,,64479,CPT,Facility,Both,,,,2550,2167.5,449,2550,BlueCross BlueShield Minnesota, Federal Employee Program,2509.2,98.4,,percent of total billed charges,,
Xr Ct Foramin Inj Cerv Thor Sngl Lvl W Guid,,64479,CPT,Facility,Both,,,,2550,2167.5,449,2550,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,2550,100,,percent of total billed charges,,
Xr Ct Foramin Inj Cerv Thor Sngl Lvl W Guid,,64479,CPT,Facility,Both,,,,2550,2167.5,449,2550,BlueCross BlueShield Minnesota,High Value Network Plan,2295,90,,percent of total billed charges,,
Xr Ct Foramin Inj Cerv Thor Sngl Lvl W Guid,,64479,CPT,Facility,Outpatient,,,,2550,2167.5,449,2550,BlueCross BlueShield Minnesota,Medicare Advantage,1249.5,49,,percent of total billed charges,,
Xr Ct Foramin Inj Cerv Thor Sngl Lvl W Guid,,64479,CPT,Facility,Inpatient,,,,2550,2167.5,449,2550,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Xr Ct Foramin Inj Cerv Thor Sngl Lvl W Guid,,64479,CPT,Facility,Both,,,,2550,2167.5,449,2550,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,2258.535,88.57,,percent of total billed charges,,
Xr Ct Foramin Inj Cerv Thor Sngl Lvl W Guid,,64479,CPT,Facility,Both,,,,2550,2167.5,449,2550,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,730.83,28.66,,percent of total billed charges,,
Xr Ct Foramin Inj Cerv Thor Sngl Lvl W Guid,,64479,CPT,Facility,Outpatient,,,,2550,2167.5,449,2550,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1249.5,49,,percent of total billed charges,,
Xr Ct Foramin Inj Cerv Thor Sngl Lvl W Guid,,64479,CPT,Facility,Inpatient,,,,2550,2167.5,449,2550,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Xr Ct Foramin Inj Cerv Thor Sngl Lvl W Guid,,64479,CPT,Facility,Both,,,,2550,2167.5,449,2550,CorVel,Worker's Compensation,2550,100,,percent of total billed charges,,
Xr Ct Foramin Inj Cerv Thor Sngl Lvl W Guid,,64479,CPT,Facility,Both,,,,2550,2167.5,449,2550,First Health Group Corporation,First Health Network,2473.5,97,,percent of total billed charges,,
Xr Ct Foramin Inj Cerv Thor Sngl Lvl W Guid,,64479,CPT,Facility,Both,,,,2550,2167.5,449,2550,"Health Partners, Inc.",Commercial,2412.3,94.6,,percent of total billed charges,,
Xr Ct Foramin Inj Cerv Thor Sngl Lvl W Guid,,64479,CPT,Facility,Outpatient,,,,2550,2167.5,449,2550,"Health Partners, Inc.",Medicare Advantage,1249.5,49,,percent of total billed charges,,
Xr Ct Foramin Inj Cerv Thor Sngl Lvl W Guid,,64479,CPT,Facility,Inpatient,,,,2550,2167.5,449,2550,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Ct Foramin Inj Cerv Thor Sngl Lvl W Guid,,64479,CPT,Facility,Both,,,,2550,2167.5,449,2550,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1530,60,,percent of total billed charges,,
Xr Ct Foramin Inj Cerv Thor Sngl Lvl W Guid,,64479,CPT,Facility,Both,,,,2550,2167.5,449,2550,"Health Partners, Inc.",State of Minnesota Advantage Program,2078.25,81.5,,percent of total billed charges,,
Xr Ct Foramin Inj Cerv Thor Sngl Lvl W Guid,,64479,CPT,Facility,Both,,,,2550,2167.5,449,2550,"Health Partners, Inc.",State Public Programs,1275,50,,percent of total billed charges,,
Xr Ct Foramin Inj Cerv Thor Sngl Lvl W Guid,,64479,CPT,Facility,Both,,,,2550,2167.5,449,2550,Humana Insurance Company,Commercial PPO,2422.5,95,,percent of total billed charges,,
Xr Ct Foramin Inj Cerv Thor Sngl Lvl W Guid,,64479,CPT,Facility,Outpatient,,,,2550,2167.5,449,2550,Humana Insurance Company,Medicare PPO,1249.5,49,,percent of total billed charges,,
Xr Ct Foramin Inj Cerv Thor Sngl Lvl W Guid,,64479,CPT,Facility,Inpatient,,,,2550,2167.5,449,2550,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Xr Ct Foramin Inj Cerv Thor Sngl Lvl W Guid,,64479,CPT,Facility,Both,,,,2550,2167.5,449,2550,Medica,Individual & Family,2527.05,99.1,,percent of total billed charges,,
Xr Ct Foramin Inj Cerv Thor Sngl Lvl W Guid,,64479,CPT,Facility,Outpatient,,,,2550,2167.5,449,2550,Medica,Medica Advantage Solution,1269.9,49.8,,percent of total billed charges,,
Xr Ct Foramin Inj Cerv Thor Sngl Lvl W Guid,,64479,CPT,Facility,Inpatient,,,,2550,2167.5,449,2550,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Xr Ct Foramin Inj Cerv Thor Sngl Lvl W Guid,,64479,CPT,Facility,Outpatient,,,,2550,2167.5,449,2550,Medica,Medical Assistance,449,,,Other,Grouper,All inclusive per visit
Xr Ct Foramin Inj Cerv Thor Sngl Lvl W Guid,,64479,CPT,Facility,Inpatient,,,,2550,2167.5,449,2550,Medica,Medical Assistance,,,,,Included in per diem rate,
Xr Ct Foramin Inj Cerv Thor Sngl Lvl W Guid,,64479,CPT,Facility,Outpatient,,,,2550,2167.5,449,2550,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1269.9,49.8,,percent of total billed charges,,
Xr Ct Foramin Inj Cerv Thor Sngl Lvl W Guid,,64479,CPT,Facility,Inpatient,,,,2550,2167.5,449,2550,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Xr Ct Foramin Inj Cerv Thor Sngl Lvl W Guid,,64479,CPT,Facility,Both,,,,2550,2167.5,449,2550,"Multiplan, Inc.","Multiplan, Inc.",2397,94,,percent of total billed charges,,
Xr Ct Foramin Inj Cerv Thor Sngl Lvl W Guid,,64479,CPT,Facility,Outpatient,,,,2550,2167.5,449,2550,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,2297.55,90.1,,percent of total billed charges,,
Xr Ct Foramin Inj Cerv Thor Sngl Lvl W Guid,,64479,CPT,Facility,Inpatient,,,,2550,2167.5,449,2550,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Xr Ct Foramin Inj Cerv Thor Sngl Lvl W Guid,,64479,CPT,Facility,Both,,,,2550,2167.5,449,2550,"Preferred One Administrative Services, INC.",PPO,2514.3,98.6,,percent of total billed charges,,
Xr Ct Foramin Inj Cerv Thor Sngl Lvl W Guid,,64479,CPT,Facility,Outpatient,,,,2550,2167.5,449,2550,PrimeWest Health,Minnesota Senior Health Options (MSHO),1311.975,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Xr Ct Foramin Inj Cerv Thor Sngl Lvl W Guid,,64479,CPT,Facility,Inpatient,,,,2550,2167.5,449,2550,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Ct Foramin Inj Cerv Thor Sngl Lvl W Guid,,64479,CPT,Facility,Outpatient,,,,2550,2167.5,449,2550,PrimeWest Health,MinnesotaCare,1309.68,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Xr Ct Foramin Inj Cerv Thor Sngl Lvl W Guid,,64479,CPT,Facility,Inpatient,,,,2550,2167.5,449,2550,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Xr Ct Foramin Inj Cerv Thor Sngl Lvl W Guid,,64479,CPT,Facility,Both,,,,2550,2167.5,449,2550,Sanford Health Plan,Sanford Health Plan,2346,92,,percent of total billed charges,,
Xr Ct Foramin Inj Cerv Thor Sngl Lvl W Guid,,64479,CPT,Facility,Outpatient,,,,2550,2167.5,449,2550,"UCare Health, Inc.",Individual & Family Plan,1436.925,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Xr Ct Foramin Inj Cerv Thor Sngl Lvl W Guid,,64479,CPT,Facility,Inpatient,,,,2550,2167.5,449,2550,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Xr Ct Foramin Inj Cerv Thor Sngl Lvl W Guid,,64479,CPT,Facility,Outpatient,,,,2550,2167.5,449,2550,"UCare Health, Inc.",Medical Assistance,1286.985,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Ct Foramin Inj Cerv Thor Sngl Lvl W Guid,,64479,CPT,Facility,Inpatient,,,,2550,2167.5,449,2550,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Xr Ct Foramin Inj Cerv Thor Sngl Lvl W Guid,,64479,CPT,Facility,Outpatient,,,,2550,2167.5,449,2550,"UCare Health, Inc.",Medicare Advantage,1286.985,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Ct Foramin Inj Cerv Thor Sngl Lvl W Guid,,64479,CPT,Facility,Inpatient,,,,2550,2167.5,449,2550,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Ct Foramin Inj Cerv Thor Sngl Lvl W Guid,,64479,CPT,Facility,Outpatient,,,,2550,2167.5,449,2550,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1286.985,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Ct Foramin Inj Cerv Thor Sngl Lvl W Guid,,64479,CPT,Facility,Inpatient,,,,2550,2167.5,449,2550,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Ct Foramin Inj Cerv Thor Sngl Lvl W Guid,,64479,CPT,Facility,Both,,,,2550,2167.5,449,2550,UnitedHealthcare,Individual & Family,2397,94,,percent of total billed charges,,
Xr Ct Foramin Inj Cerv Thor Sngl Lvl W Guid,,64479,CPT,Facility,Outpatient,,,,2550,2167.5,449,2550,UnitedHealthcare,Medicare Advantage,1249.5,49,,percent of total billed charges,,
Xr Ct Foramin Inj Cerv Thor Sngl Lvl W Guid,,64479,CPT,Facility,Inpatient,,,,2550,2167.5,449,2550,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Xr Ct Foramin Inj Cerv Thor Sngl Lvl W Guid,,64479,CPT,Facility,Outpatient,,,,2550,2167.5,449,2550,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1224,48,,percent of total billed charges,,100% of DHS outpatient percentage
Xr Ct Foramin Inj Cerv Thor Sngl Lvl W Guid,,64479,CPT,Facility,Inpatient,,,,2550,2167.5,449,2550,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Sc Foramin Inj Cerv Thor Added Level,,64480,CPT,Facility,Both,,,,1224,1040.4,299,1224,Aetna,Commercial,1126.08,92,,percent of total billed charges,,
Sc Foramin Inj Cerv Thor Added Level,,64480,CPT,Facility,Outpatient,,,,1224,1040.4,299,1224,Aetna,Medicare Advantage,599.76,49,,percent of total billed charges,,
Sc Foramin Inj Cerv Thor Added Level,,64480,CPT,Facility,Inpatient,,,,1224,1040.4,299,1224,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Sc Foramin Inj Cerv Thor Added Level,,64480,CPT,Facility,Both,,,,1224,1040.4,299,1224,Aetna,PPO,1138.32,93,,percent of total billed charges,,
Sc Foramin Inj Cerv Thor Added Level,,64480,CPT,Facility,Both,,,,1224,1040.4,299,1224,America's PPO,America's PPO,1175.4072,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Sc Foramin Inj Cerv Thor Added Level,,64480,CPT,Facility,Both,,,,1224,1040.4,299,1224,BlueCross BlueShield Minnesota, Federal Employee Program,1204.416,98.4,,percent of total billed charges,,
Sc Foramin Inj Cerv Thor Added Level,,64480,CPT,Facility,Both,,,,1224,1040.4,299,1224,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1224,100,,percent of total billed charges,,
Sc Foramin Inj Cerv Thor Added Level,,64480,CPT,Facility,Both,,,,1224,1040.4,299,1224,BlueCross BlueShield Minnesota,High Value Network Plan,1101.6,90,,percent of total billed charges,,
Sc Foramin Inj Cerv Thor Added Level,,64480,CPT,Facility,Outpatient,,,,1224,1040.4,299,1224,BlueCross BlueShield Minnesota,Medicare Advantage,599.76,49,,percent of total billed charges,,
Sc Foramin Inj Cerv Thor Added Level,,64480,CPT,Facility,Inpatient,,,,1224,1040.4,299,1224,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Sc Foramin Inj Cerv Thor Added Level,,64480,CPT,Facility,Both,,,,1224,1040.4,299,1224,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1084.0968,88.57,,percent of total billed charges,,
Sc Foramin Inj Cerv Thor Added Level,,64480,CPT,Facility,Both,,,,1224,1040.4,299,1224,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,350.7984,28.66,,percent of total billed charges,,
Sc Foramin Inj Cerv Thor Added Level,,64480,CPT,Facility,Outpatient,,,,1224,1040.4,299,1224,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),599.76,49,,percent of total billed charges,,
Sc Foramin Inj Cerv Thor Added Level,,64480,CPT,Facility,Inpatient,,,,1224,1040.4,299,1224,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Sc Foramin Inj Cerv Thor Added Level,,64480,CPT,Facility,Both,,,,1224,1040.4,299,1224,CorVel,Worker's Compensation,1224,100,,percent of total billed charges,,
Sc Foramin Inj Cerv Thor Added Level,,64480,CPT,Facility,Both,,,,1224,1040.4,299,1224,First Health Group Corporation,First Health Network,1187.28,97,,percent of total billed charges,,
Sc Foramin Inj Cerv Thor Added Level,,64480,CPT,Facility,Both,,,,1224,1040.4,299,1224,"Health Partners, Inc.",Commercial,1157.904,94.6,,percent of total billed charges,,
Sc Foramin Inj Cerv Thor Added Level,,64480,CPT,Facility,Outpatient,,,,1224,1040.4,299,1224,"Health Partners, Inc.",Medicare Advantage,599.76,49,,percent of total billed charges,,
Sc Foramin Inj Cerv Thor Added Level,,64480,CPT,Facility,Inpatient,,,,1224,1040.4,299,1224,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sc Foramin Inj Cerv Thor Added Level,,64480,CPT,Facility,Both,,,,1224,1040.4,299,1224,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),734.4,60,,percent of total billed charges,,
Sc Foramin Inj Cerv Thor Added Level,,64480,CPT,Facility,Both,,,,1224,1040.4,299,1224,"Health Partners, Inc.",State of Minnesota Advantage Program,997.56,81.5,,percent of total billed charges,,
Sc Foramin Inj Cerv Thor Added Level,,64480,CPT,Facility,Both,,,,1224,1040.4,299,1224,"Health Partners, Inc.",State Public Programs,612,50,,percent of total billed charges,,
Sc Foramin Inj Cerv Thor Added Level,,64480,CPT,Facility,Both,,,,1224,1040.4,299,1224,Humana Insurance Company,Commercial PPO,1162.8,95,,percent of total billed charges,,
Sc Foramin Inj Cerv Thor Added Level,,64480,CPT,Facility,Outpatient,,,,1224,1040.4,299,1224,Humana Insurance Company,Medicare PPO,599.76,49,,percent of total billed charges,,
Sc Foramin Inj Cerv Thor Added Level,,64480,CPT,Facility,Inpatient,,,,1224,1040.4,299,1224,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Sc Foramin Inj Cerv Thor Added Level,,64480,CPT,Facility,Both,,,,1224,1040.4,299,1224,Medica,Individual & Family,1212.984,99.1,,percent of total billed charges,,
Sc Foramin Inj Cerv Thor Added Level,,64480,CPT,Facility,Outpatient,,,,1224,1040.4,299,1224,Medica,Medica Advantage Solution,609.552,49.8,,percent of total billed charges,,
Sc Foramin Inj Cerv Thor Added Level,,64480,CPT,Facility,Inpatient,,,,1224,1040.4,299,1224,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Sc Foramin Inj Cerv Thor Added Level,,64480,CPT,Facility,Outpatient,,,,1224,1040.4,299,1224,Medica,Medical Assistance,299,,,Other,Grouper,All inclusive per visit
Sc Foramin Inj Cerv Thor Added Level,,64480,CPT,Facility,Inpatient,,,,1224,1040.4,299,1224,Medica,Medical Assistance,,,,,Included in per diem rate,
Sc Foramin Inj Cerv Thor Added Level,,64480,CPT,Facility,Outpatient,,,,1224,1040.4,299,1224,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,609.552,49.8,,percent of total billed charges,,
Sc Foramin Inj Cerv Thor Added Level,,64480,CPT,Facility,Inpatient,,,,1224,1040.4,299,1224,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Sc Foramin Inj Cerv Thor Added Level,,64480,CPT,Facility,Both,,,,1224,1040.4,299,1224,"Multiplan, Inc.","Multiplan, Inc.",1150.56,94,,percent of total billed charges,,
Sc Foramin Inj Cerv Thor Added Level,,64480,CPT,Facility,Outpatient,,,,1224,1040.4,299,1224,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1102.824,90.1,,percent of total billed charges,,
Sc Foramin Inj Cerv Thor Added Level,,64480,CPT,Facility,Inpatient,,,,1224,1040.4,299,1224,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Sc Foramin Inj Cerv Thor Added Level,,64480,CPT,Facility,Both,,,,1224,1040.4,299,1224,"Preferred One Administrative Services, INC.",PPO,1206.864,98.6,,percent of total billed charges,,
Sc Foramin Inj Cerv Thor Added Level,,64480,CPT,Facility,Outpatient,,,,1224,1040.4,299,1224,PrimeWest Health,Minnesota Senior Health Options (MSHO),629.748,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Sc Foramin Inj Cerv Thor Added Level,,64480,CPT,Facility,Inpatient,,,,1224,1040.4,299,1224,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sc Foramin Inj Cerv Thor Added Level,,64480,CPT,Facility,Outpatient,,,,1224,1040.4,299,1224,PrimeWest Health,MinnesotaCare,628.6464,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Sc Foramin Inj Cerv Thor Added Level,,64480,CPT,Facility,Inpatient,,,,1224,1040.4,299,1224,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Sc Foramin Inj Cerv Thor Added Level,,64480,CPT,Facility,Both,,,,1224,1040.4,299,1224,Sanford Health Plan,Sanford Health Plan,1126.08,92,,percent of total billed charges,,
Sc Foramin Inj Cerv Thor Added Level,,64480,CPT,Facility,Outpatient,,,,1224,1040.4,299,1224,"UCare Health, Inc.",Individual & Family Plan,689.724,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Sc Foramin Inj Cerv Thor Added Level,,64480,CPT,Facility,Inpatient,,,,1224,1040.4,299,1224,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Sc Foramin Inj Cerv Thor Added Level,,64480,CPT,Facility,Outpatient,,,,1224,1040.4,299,1224,"UCare Health, Inc.",Medical Assistance,617.7528,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sc Foramin Inj Cerv Thor Added Level,,64480,CPT,Facility,Inpatient,,,,1224,1040.4,299,1224,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Sc Foramin Inj Cerv Thor Added Level,,64480,CPT,Facility,Outpatient,,,,1224,1040.4,299,1224,"UCare Health, Inc.",Medicare Advantage,617.7528,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sc Foramin Inj Cerv Thor Added Level,,64480,CPT,Facility,Inpatient,,,,1224,1040.4,299,1224,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sc Foramin Inj Cerv Thor Added Level,,64480,CPT,Facility,Outpatient,,,,1224,1040.4,299,1224,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),617.7528,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sc Foramin Inj Cerv Thor Added Level,,64480,CPT,Facility,Inpatient,,,,1224,1040.4,299,1224,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sc Foramin Inj Cerv Thor Added Level,,64480,CPT,Facility,Both,,,,1224,1040.4,299,1224,UnitedHealthcare,Individual & Family,1150.56,94,,percent of total billed charges,,
Sc Foramin Inj Cerv Thor Added Level,,64480,CPT,Facility,Outpatient,,,,1224,1040.4,299,1224,UnitedHealthcare,Medicare Advantage,599.76,49,,percent of total billed charges,,
Sc Foramin Inj Cerv Thor Added Level,,64480,CPT,Facility,Inpatient,,,,1224,1040.4,299,1224,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Sc Foramin Inj Cerv Thor Added Level,,64480,CPT,Facility,Outpatient,,,,1224,1040.4,299,1224,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,587.52,48,,percent of total billed charges,,100% of DHS outpatient percentage
Sc Foramin Inj Cerv Thor Added Level,,64480,CPT,Facility,Inpatient,,,,1224,1040.4,299,1224,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Xr Ct Foramin Inj Lumb Sacr Sngl Lvl W Guid,,64483,CPT,Facility,Both,,,,2448,2080.8,449,2448,Aetna,Commercial,2252.16,92,,percent of total billed charges,,
Xr Ct Foramin Inj Lumb Sacr Sngl Lvl W Guid,,64483,CPT,Facility,Outpatient,,,,2448,2080.8,449,2448,Aetna,Medicare Advantage,1199.52,49,,percent of total billed charges,,
Xr Ct Foramin Inj Lumb Sacr Sngl Lvl W Guid,,64483,CPT,Facility,Inpatient,,,,2448,2080.8,449,2448,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Xr Ct Foramin Inj Lumb Sacr Sngl Lvl W Guid,,64483,CPT,Facility,Both,,,,2448,2080.8,449,2448,Aetna,PPO,2276.64,93,,percent of total billed charges,,
Xr Ct Foramin Inj Lumb Sacr Sngl Lvl W Guid,,64483,CPT,Facility,Both,,,,2448,2080.8,449,2448,America's PPO,America's PPO,2350.8144,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Xr Ct Foramin Inj Lumb Sacr Sngl Lvl W Guid,,64483,CPT,Facility,Both,,,,2448,2080.8,449,2448,BlueCross BlueShield Minnesota, Federal Employee Program,2408.832,98.4,,percent of total billed charges,,
Xr Ct Foramin Inj Lumb Sacr Sngl Lvl W Guid,,64483,CPT,Facility,Both,,,,2448,2080.8,449,2448,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,2448,100,,percent of total billed charges,,
Xr Ct Foramin Inj Lumb Sacr Sngl Lvl W Guid,,64483,CPT,Facility,Both,,,,2448,2080.8,449,2448,BlueCross BlueShield Minnesota,High Value Network Plan,2203.2,90,,percent of total billed charges,,
Xr Ct Foramin Inj Lumb Sacr Sngl Lvl W Guid,,64483,CPT,Facility,Outpatient,,,,2448,2080.8,449,2448,BlueCross BlueShield Minnesota,Medicare Advantage,1199.52,49,,percent of total billed charges,,
Xr Ct Foramin Inj Lumb Sacr Sngl Lvl W Guid,,64483,CPT,Facility,Inpatient,,,,2448,2080.8,449,2448,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Xr Ct Foramin Inj Lumb Sacr Sngl Lvl W Guid,,64483,CPT,Facility,Both,,,,2448,2080.8,449,2448,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,2168.1936,88.57,,percent of total billed charges,,
Xr Ct Foramin Inj Lumb Sacr Sngl Lvl W Guid,,64483,CPT,Facility,Both,,,,2448,2080.8,449,2448,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,701.5968,28.66,,percent of total billed charges,,
Xr Ct Foramin Inj Lumb Sacr Sngl Lvl W Guid,,64483,CPT,Facility,Outpatient,,,,2448,2080.8,449,2448,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1199.52,49,,percent of total billed charges,,
Xr Ct Foramin Inj Lumb Sacr Sngl Lvl W Guid,,64483,CPT,Facility,Inpatient,,,,2448,2080.8,449,2448,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Xr Ct Foramin Inj Lumb Sacr Sngl Lvl W Guid,,64483,CPT,Facility,Both,,,,2448,2080.8,449,2448,CorVel,Worker's Compensation,2448,100,,percent of total billed charges,,
Xr Ct Foramin Inj Lumb Sacr Sngl Lvl W Guid,,64483,CPT,Facility,Both,,,,2448,2080.8,449,2448,First Health Group Corporation,First Health Network,2374.56,97,,percent of total billed charges,,
Xr Ct Foramin Inj Lumb Sacr Sngl Lvl W Guid,,64483,CPT,Facility,Both,,,,2448,2080.8,449,2448,"Health Partners, Inc.",Commercial,2315.808,94.6,,percent of total billed charges,,
Xr Ct Foramin Inj Lumb Sacr Sngl Lvl W Guid,,64483,CPT,Facility,Outpatient,,,,2448,2080.8,449,2448,"Health Partners, Inc.",Medicare Advantage,1199.52,49,,percent of total billed charges,,
Xr Ct Foramin Inj Lumb Sacr Sngl Lvl W Guid,,64483,CPT,Facility,Inpatient,,,,2448,2080.8,449,2448,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Ct Foramin Inj Lumb Sacr Sngl Lvl W Guid,,64483,CPT,Facility,Both,,,,2448,2080.8,449,2448,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1468.8,60,,percent of total billed charges,,
Xr Ct Foramin Inj Lumb Sacr Sngl Lvl W Guid,,64483,CPT,Facility,Both,,,,2448,2080.8,449,2448,"Health Partners, Inc.",State of Minnesota Advantage Program,1995.12,81.5,,percent of total billed charges,,
Xr Ct Foramin Inj Lumb Sacr Sngl Lvl W Guid,,64483,CPT,Facility,Both,,,,2448,2080.8,449,2448,"Health Partners, Inc.",State Public Programs,1224,50,,percent of total billed charges,,
Xr Ct Foramin Inj Lumb Sacr Sngl Lvl W Guid,,64483,CPT,Facility,Both,,,,2448,2080.8,449,2448,Humana Insurance Company,Commercial PPO,2325.6,95,,percent of total billed charges,,
Xr Ct Foramin Inj Lumb Sacr Sngl Lvl W Guid,,64483,CPT,Facility,Outpatient,,,,2448,2080.8,449,2448,Humana Insurance Company,Medicare PPO,1199.52,49,,percent of total billed charges,,
Xr Ct Foramin Inj Lumb Sacr Sngl Lvl W Guid,,64483,CPT,Facility,Inpatient,,,,2448,2080.8,449,2448,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Xr Ct Foramin Inj Lumb Sacr Sngl Lvl W Guid,,64483,CPT,Facility,Both,,,,2448,2080.8,449,2448,Medica,Individual & Family,2425.968,99.1,,percent of total billed charges,,
Xr Ct Foramin Inj Lumb Sacr Sngl Lvl W Guid,,64483,CPT,Facility,Outpatient,,,,2448,2080.8,449,2448,Medica,Medica Advantage Solution,1219.104,49.8,,percent of total billed charges,,
Xr Ct Foramin Inj Lumb Sacr Sngl Lvl W Guid,,64483,CPT,Facility,Inpatient,,,,2448,2080.8,449,2448,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Xr Ct Foramin Inj Lumb Sacr Sngl Lvl W Guid,,64483,CPT,Facility,Outpatient,,,,2448,2080.8,449,2448,Medica,Medical Assistance,449,,,Other,Grouper,All inclusive per visit
Xr Ct Foramin Inj Lumb Sacr Sngl Lvl W Guid,,64483,CPT,Facility,Inpatient,,,,2448,2080.8,449,2448,Medica,Medical Assistance,,,,,Included in per diem rate,
Xr Ct Foramin Inj Lumb Sacr Sngl Lvl W Guid,,64483,CPT,Facility,Outpatient,,,,2448,2080.8,449,2448,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1219.104,49.8,,percent of total billed charges,,
Xr Ct Foramin Inj Lumb Sacr Sngl Lvl W Guid,,64483,CPT,Facility,Inpatient,,,,2448,2080.8,449,2448,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Xr Ct Foramin Inj Lumb Sacr Sngl Lvl W Guid,,64483,CPT,Facility,Both,,,,2448,2080.8,449,2448,"Multiplan, Inc.","Multiplan, Inc.",2301.12,94,,percent of total billed charges,,
Xr Ct Foramin Inj Lumb Sacr Sngl Lvl W Guid,,64483,CPT,Facility,Outpatient,,,,2448,2080.8,449,2448,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,2205.648,90.1,,percent of total billed charges,,
Xr Ct Foramin Inj Lumb Sacr Sngl Lvl W Guid,,64483,CPT,Facility,Inpatient,,,,2448,2080.8,449,2448,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Xr Ct Foramin Inj Lumb Sacr Sngl Lvl W Guid,,64483,CPT,Facility,Both,,,,2448,2080.8,449,2448,"Preferred One Administrative Services, INC.",PPO,2413.728,98.6,,percent of total billed charges,,
Xr Ct Foramin Inj Lumb Sacr Sngl Lvl W Guid,,64483,CPT,Facility,Outpatient,,,,2448,2080.8,449,2448,PrimeWest Health,Minnesota Senior Health Options (MSHO),1259.496,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Xr Ct Foramin Inj Lumb Sacr Sngl Lvl W Guid,,64483,CPT,Facility,Inpatient,,,,2448,2080.8,449,2448,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Ct Foramin Inj Lumb Sacr Sngl Lvl W Guid,,64483,CPT,Facility,Outpatient,,,,2448,2080.8,449,2448,PrimeWest Health,MinnesotaCare,1257.2928,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Xr Ct Foramin Inj Lumb Sacr Sngl Lvl W Guid,,64483,CPT,Facility,Inpatient,,,,2448,2080.8,449,2448,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Xr Ct Foramin Inj Lumb Sacr Sngl Lvl W Guid,,64483,CPT,Facility,Both,,,,2448,2080.8,449,2448,Sanford Health Plan,Sanford Health Plan,2252.16,92,,percent of total billed charges,,
Xr Ct Foramin Inj Lumb Sacr Sngl Lvl W Guid,,64483,CPT,Facility,Outpatient,,,,2448,2080.8,449,2448,"UCare Health, Inc.",Individual & Family Plan,1379.448,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Xr Ct Foramin Inj Lumb Sacr Sngl Lvl W Guid,,64483,CPT,Facility,Inpatient,,,,2448,2080.8,449,2448,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Xr Ct Foramin Inj Lumb Sacr Sngl Lvl W Guid,,64483,CPT,Facility,Outpatient,,,,2448,2080.8,449,2448,"UCare Health, Inc.",Medical Assistance,1235.5056,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Ct Foramin Inj Lumb Sacr Sngl Lvl W Guid,,64483,CPT,Facility,Inpatient,,,,2448,2080.8,449,2448,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Xr Ct Foramin Inj Lumb Sacr Sngl Lvl W Guid,,64483,CPT,Facility,Outpatient,,,,2448,2080.8,449,2448,"UCare Health, Inc.",Medicare Advantage,1235.5056,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Ct Foramin Inj Lumb Sacr Sngl Lvl W Guid,,64483,CPT,Facility,Inpatient,,,,2448,2080.8,449,2448,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Ct Foramin Inj Lumb Sacr Sngl Lvl W Guid,,64483,CPT,Facility,Outpatient,,,,2448,2080.8,449,2448,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1235.5056,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Ct Foramin Inj Lumb Sacr Sngl Lvl W Guid,,64483,CPT,Facility,Inpatient,,,,2448,2080.8,449,2448,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Ct Foramin Inj Lumb Sacr Sngl Lvl W Guid,,64483,CPT,Facility,Both,,,,2448,2080.8,449,2448,UnitedHealthcare,Individual & Family,2301.12,94,,percent of total billed charges,,
Xr Ct Foramin Inj Lumb Sacr Sngl Lvl W Guid,,64483,CPT,Facility,Outpatient,,,,2448,2080.8,449,2448,UnitedHealthcare,Medicare Advantage,1199.52,49,,percent of total billed charges,,
Xr Ct Foramin Inj Lumb Sacr Sngl Lvl W Guid,,64483,CPT,Facility,Inpatient,,,,2448,2080.8,449,2448,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Xr Ct Foramin Inj Lumb Sacr Sngl Lvl W Guid,,64483,CPT,Facility,Outpatient,,,,2448,2080.8,449,2448,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1175.04,48,,percent of total billed charges,,100% of DHS outpatient percentage
Xr Ct Foramin Inj Lumb Sacr Sngl Lvl W Guid,,64483,CPT,Facility,Inpatient,,,,2448,2080.8,449,2448,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Sc Foramin Inj Lumb Sacr Additional Level,,64484,CPT,Facility,Both,,,,1224,1040.4,299,1224,Aetna,Commercial,1126.08,92,,percent of total billed charges,,
Sc Foramin Inj Lumb Sacr Additional Level,,64484,CPT,Facility,Outpatient,,,,1224,1040.4,299,1224,Aetna,Medicare Advantage,599.76,49,,percent of total billed charges,,
Sc Foramin Inj Lumb Sacr Additional Level,,64484,CPT,Facility,Inpatient,,,,1224,1040.4,299,1224,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Sc Foramin Inj Lumb Sacr Additional Level,,64484,CPT,Facility,Both,,,,1224,1040.4,299,1224,Aetna,PPO,1138.32,93,,percent of total billed charges,,
Sc Foramin Inj Lumb Sacr Additional Level,,64484,CPT,Facility,Both,,,,1224,1040.4,299,1224,America's PPO,America's PPO,1175.4072,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Sc Foramin Inj Lumb Sacr Additional Level,,64484,CPT,Facility,Both,,,,1224,1040.4,299,1224,BlueCross BlueShield Minnesota, Federal Employee Program,1204.416,98.4,,percent of total billed charges,,
Sc Foramin Inj Lumb Sacr Additional Level,,64484,CPT,Facility,Both,,,,1224,1040.4,299,1224,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1224,100,,percent of total billed charges,,
Sc Foramin Inj Lumb Sacr Additional Level,,64484,CPT,Facility,Both,,,,1224,1040.4,299,1224,BlueCross BlueShield Minnesota,High Value Network Plan,1101.6,90,,percent of total billed charges,,
Sc Foramin Inj Lumb Sacr Additional Level,,64484,CPT,Facility,Outpatient,,,,1224,1040.4,299,1224,BlueCross BlueShield Minnesota,Medicare Advantage,599.76,49,,percent of total billed charges,,
Sc Foramin Inj Lumb Sacr Additional Level,,64484,CPT,Facility,Inpatient,,,,1224,1040.4,299,1224,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Sc Foramin Inj Lumb Sacr Additional Level,,64484,CPT,Facility,Both,,,,1224,1040.4,299,1224,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1084.0968,88.57,,percent of total billed charges,,
Sc Foramin Inj Lumb Sacr Additional Level,,64484,CPT,Facility,Both,,,,1224,1040.4,299,1224,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,350.7984,28.66,,percent of total billed charges,,
Sc Foramin Inj Lumb Sacr Additional Level,,64484,CPT,Facility,Outpatient,,,,1224,1040.4,299,1224,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),599.76,49,,percent of total billed charges,,
Sc Foramin Inj Lumb Sacr Additional Level,,64484,CPT,Facility,Inpatient,,,,1224,1040.4,299,1224,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Sc Foramin Inj Lumb Sacr Additional Level,,64484,CPT,Facility,Both,,,,1224,1040.4,299,1224,CorVel,Worker's Compensation,1224,100,,percent of total billed charges,,
Sc Foramin Inj Lumb Sacr Additional Level,,64484,CPT,Facility,Both,,,,1224,1040.4,299,1224,First Health Group Corporation,First Health Network,1187.28,97,,percent of total billed charges,,
Sc Foramin Inj Lumb Sacr Additional Level,,64484,CPT,Facility,Both,,,,1224,1040.4,299,1224,"Health Partners, Inc.",Commercial,1157.904,94.6,,percent of total billed charges,,
Sc Foramin Inj Lumb Sacr Additional Level,,64484,CPT,Facility,Outpatient,,,,1224,1040.4,299,1224,"Health Partners, Inc.",Medicare Advantage,599.76,49,,percent of total billed charges,,
Sc Foramin Inj Lumb Sacr Additional Level,,64484,CPT,Facility,Inpatient,,,,1224,1040.4,299,1224,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sc Foramin Inj Lumb Sacr Additional Level,,64484,CPT,Facility,Both,,,,1224,1040.4,299,1224,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),734.4,60,,percent of total billed charges,,
Sc Foramin Inj Lumb Sacr Additional Level,,64484,CPT,Facility,Both,,,,1224,1040.4,299,1224,"Health Partners, Inc.",State of Minnesota Advantage Program,997.56,81.5,,percent of total billed charges,,
Sc Foramin Inj Lumb Sacr Additional Level,,64484,CPT,Facility,Both,,,,1224,1040.4,299,1224,"Health Partners, Inc.",State Public Programs,612,50,,percent of total billed charges,,
Sc Foramin Inj Lumb Sacr Additional Level,,64484,CPT,Facility,Both,,,,1224,1040.4,299,1224,Humana Insurance Company,Commercial PPO,1162.8,95,,percent of total billed charges,,
Sc Foramin Inj Lumb Sacr Additional Level,,64484,CPT,Facility,Outpatient,,,,1224,1040.4,299,1224,Humana Insurance Company,Medicare PPO,599.76,49,,percent of total billed charges,,
Sc Foramin Inj Lumb Sacr Additional Level,,64484,CPT,Facility,Inpatient,,,,1224,1040.4,299,1224,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Sc Foramin Inj Lumb Sacr Additional Level,,64484,CPT,Facility,Both,,,,1224,1040.4,299,1224,Medica,Individual & Family,1212.984,99.1,,percent of total billed charges,,
Sc Foramin Inj Lumb Sacr Additional Level,,64484,CPT,Facility,Outpatient,,,,1224,1040.4,299,1224,Medica,Medica Advantage Solution,609.552,49.8,,percent of total billed charges,,
Sc Foramin Inj Lumb Sacr Additional Level,,64484,CPT,Facility,Inpatient,,,,1224,1040.4,299,1224,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Sc Foramin Inj Lumb Sacr Additional Level,,64484,CPT,Facility,Outpatient,,,,1224,1040.4,299,1224,Medica,Medical Assistance,299,,,Other,Grouper,All inclusive per visit
Sc Foramin Inj Lumb Sacr Additional Level,,64484,CPT,Facility,Inpatient,,,,1224,1040.4,299,1224,Medica,Medical Assistance,,,,,Included in per diem rate,
Sc Foramin Inj Lumb Sacr Additional Level,,64484,CPT,Facility,Outpatient,,,,1224,1040.4,299,1224,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,609.552,49.8,,percent of total billed charges,,
Sc Foramin Inj Lumb Sacr Additional Level,,64484,CPT,Facility,Inpatient,,,,1224,1040.4,299,1224,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Sc Foramin Inj Lumb Sacr Additional Level,,64484,CPT,Facility,Both,,,,1224,1040.4,299,1224,"Multiplan, Inc.","Multiplan, Inc.",1150.56,94,,percent of total billed charges,,
Sc Foramin Inj Lumb Sacr Additional Level,,64484,CPT,Facility,Outpatient,,,,1224,1040.4,299,1224,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1102.824,90.1,,percent of total billed charges,,
Sc Foramin Inj Lumb Sacr Additional Level,,64484,CPT,Facility,Inpatient,,,,1224,1040.4,299,1224,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Sc Foramin Inj Lumb Sacr Additional Level,,64484,CPT,Facility,Both,,,,1224,1040.4,299,1224,"Preferred One Administrative Services, INC.",PPO,1206.864,98.6,,percent of total billed charges,,
Sc Foramin Inj Lumb Sacr Additional Level,,64484,CPT,Facility,Outpatient,,,,1224,1040.4,299,1224,PrimeWest Health,Minnesota Senior Health Options (MSHO),629.748,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Sc Foramin Inj Lumb Sacr Additional Level,,64484,CPT,Facility,Inpatient,,,,1224,1040.4,299,1224,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sc Foramin Inj Lumb Sacr Additional Level,,64484,CPT,Facility,Outpatient,,,,1224,1040.4,299,1224,PrimeWest Health,MinnesotaCare,628.6464,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Sc Foramin Inj Lumb Sacr Additional Level,,64484,CPT,Facility,Inpatient,,,,1224,1040.4,299,1224,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Sc Foramin Inj Lumb Sacr Additional Level,,64484,CPT,Facility,Both,,,,1224,1040.4,299,1224,Sanford Health Plan,Sanford Health Plan,1126.08,92,,percent of total billed charges,,
Sc Foramin Inj Lumb Sacr Additional Level,,64484,CPT,Facility,Outpatient,,,,1224,1040.4,299,1224,"UCare Health, Inc.",Individual & Family Plan,689.724,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Sc Foramin Inj Lumb Sacr Additional Level,,64484,CPT,Facility,Inpatient,,,,1224,1040.4,299,1224,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Sc Foramin Inj Lumb Sacr Additional Level,,64484,CPT,Facility,Outpatient,,,,1224,1040.4,299,1224,"UCare Health, Inc.",Medical Assistance,617.7528,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sc Foramin Inj Lumb Sacr Additional Level,,64484,CPT,Facility,Inpatient,,,,1224,1040.4,299,1224,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Sc Foramin Inj Lumb Sacr Additional Level,,64484,CPT,Facility,Outpatient,,,,1224,1040.4,299,1224,"UCare Health, Inc.",Medicare Advantage,617.7528,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sc Foramin Inj Lumb Sacr Additional Level,,64484,CPT,Facility,Inpatient,,,,1224,1040.4,299,1224,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sc Foramin Inj Lumb Sacr Additional Level,,64484,CPT,Facility,Outpatient,,,,1224,1040.4,299,1224,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),617.7528,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sc Foramin Inj Lumb Sacr Additional Level,,64484,CPT,Facility,Inpatient,,,,1224,1040.4,299,1224,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sc Foramin Inj Lumb Sacr Additional Level,,64484,CPT,Facility,Both,,,,1224,1040.4,299,1224,UnitedHealthcare,Individual & Family,1150.56,94,,percent of total billed charges,,
Sc Foramin Inj Lumb Sacr Additional Level,,64484,CPT,Facility,Outpatient,,,,1224,1040.4,299,1224,UnitedHealthcare,Medicare Advantage,599.76,49,,percent of total billed charges,,
Sc Foramin Inj Lumb Sacr Additional Level,,64484,CPT,Facility,Inpatient,,,,1224,1040.4,299,1224,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Sc Foramin Inj Lumb Sacr Additional Level,,64484,CPT,Facility,Outpatient,,,,1224,1040.4,299,1224,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,587.52,48,,percent of total billed charges,,100% of DHS outpatient percentage
Sc Foramin Inj Lumb Sacr Additional Level,,64484,CPT,Facility,Inpatient,,,,1224,1040.4,299,1224,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
INSULIN GLARGINE U-300 CONC 300 UNIT/ML (1.5 ML) SUBQ INPN,,116289,LOCAL,Facility,Both,1.5,mL,,637,541.45,182.5642,637,Aetna,Commercial,586.04,92,,percent of total billed charges,,
INSULIN GLARGINE U-300 CONC 300 UNIT/ML (1.5 ML) SUBQ INPN,,116289,LOCAL,Facility,Outpatient,1.5,mL,,637,541.45,182.5642,637,Aetna,Medicare Advantage,312.13,49,,percent of total billed charges,,
INSULIN GLARGINE U-300 CONC 300 UNIT/ML (1.5 ML) SUBQ INPN,,116289,LOCAL,Facility,Inpatient,1.5,mL,,637,541.45,182.5642,637,Aetna,Medicare Advantage,,,,,Included in per diem rate,
INSULIN GLARGINE U-300 CONC 300 UNIT/ML (1.5 ML) SUBQ INPN,,116289,LOCAL,Facility,Both,1.5,mL,,637,541.45,182.5642,637,Aetna,PPO,592.41,93,,percent of total billed charges,,
INSULIN GLARGINE U-300 CONC 300 UNIT/ML (1.5 ML) SUBQ INPN,,116289,LOCAL,Facility,Both,1.5,mL,,637,541.45,182.5642,637,America's PPO,America's PPO,611.7111,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
INSULIN GLARGINE U-300 CONC 300 UNIT/ML (1.5 ML) SUBQ INPN,,116289,LOCAL,Facility,Both,1.5,mL,,637,541.45,182.5642,637,BlueCross BlueShield Minnesota, Federal Employee Program,626.808,98.4,,percent of total billed charges,,
INSULIN GLARGINE U-300 CONC 300 UNIT/ML (1.5 ML) SUBQ INPN,,116289,LOCAL,Facility,Both,1.5,mL,,637,541.45,182.5642,637,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,637,100,,percent of total billed charges,,
INSULIN GLARGINE U-300 CONC 300 UNIT/ML (1.5 ML) SUBQ INPN,,116289,LOCAL,Facility,Both,1.5,mL,,637,541.45,182.5642,637,BlueCross BlueShield Minnesota,High Value Network Plan,573.3,90,,percent of total billed charges,,
INSULIN GLARGINE U-300 CONC 300 UNIT/ML (1.5 ML) SUBQ INPN,,116289,LOCAL,Facility,Outpatient,1.5,mL,,637,541.45,182.5642,637,BlueCross BlueShield Minnesota,Medicare Advantage,312.13,49,,percent of total billed charges,,
INSULIN GLARGINE U-300 CONC 300 UNIT/ML (1.5 ML) SUBQ INPN,,116289,LOCAL,Facility,Inpatient,1.5,mL,,637,541.45,182.5642,637,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
INSULIN GLARGINE U-300 CONC 300 UNIT/ML (1.5 ML) SUBQ INPN,,116289,LOCAL,Facility,Both,1.5,mL,,637,541.45,182.5642,637,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,564.1909,88.57,,percent of total billed charges,,
INSULIN GLARGINE U-300 CONC 300 UNIT/ML (1.5 ML) SUBQ INPN,,116289,LOCAL,Facility,Both,1.5,mL,,637,541.45,182.5642,637,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,182.5642,28.66,,percent of total billed charges,,
INSULIN GLARGINE U-300 CONC 300 UNIT/ML (1.5 ML) SUBQ INPN,,116289,LOCAL,Facility,Outpatient,1.5,mL,,637,541.45,182.5642,637,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),312.13,49,,percent of total billed charges,,
INSULIN GLARGINE U-300 CONC 300 UNIT/ML (1.5 ML) SUBQ INPN,,116289,LOCAL,Facility,Inpatient,1.5,mL,,637,541.45,182.5642,637,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
INSULIN GLARGINE U-300 CONC 300 UNIT/ML (1.5 ML) SUBQ INPN,,116289,LOCAL,Facility,Both,1.5,mL,,637,541.45,182.5642,637,CorVel,Worker's Compensation,637,100,,percent of total billed charges,,
INSULIN GLARGINE U-300 CONC 300 UNIT/ML (1.5 ML) SUBQ INPN,,116289,LOCAL,Facility,Both,1.5,mL,,637,541.45,182.5642,637,First Health Group Corporation,First Health Network,617.89,97,,percent of total billed charges,,
INSULIN GLARGINE U-300 CONC 300 UNIT/ML (1.5 ML) SUBQ INPN,,116289,LOCAL,Facility,Both,1.5,mL,,637,541.45,182.5642,637,"Health Partners, Inc.",Commercial,602.602,94.6,,percent of total billed charges,,
INSULIN GLARGINE U-300 CONC 300 UNIT/ML (1.5 ML) SUBQ INPN,,116289,LOCAL,Facility,Outpatient,1.5,mL,,637,541.45,182.5642,637,"Health Partners, Inc.",Medicare Advantage,312.13,49,,percent of total billed charges,,
INSULIN GLARGINE U-300 CONC 300 UNIT/ML (1.5 ML) SUBQ INPN,,116289,LOCAL,Facility,Inpatient,1.5,mL,,637,541.45,182.5642,637,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
INSULIN GLARGINE U-300 CONC 300 UNIT/ML (1.5 ML) SUBQ INPN,,116289,LOCAL,Facility,Both,1.5,mL,,637,541.45,182.5642,637,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),382.2,60,,percent of total billed charges,,
INSULIN GLARGINE U-300 CONC 300 UNIT/ML (1.5 ML) SUBQ INPN,,116289,LOCAL,Facility,Both,1.5,mL,,637,541.45,182.5642,637,"Health Partners, Inc.",State of Minnesota Advantage Program,519.155,81.5,,percent of total billed charges,,
INSULIN GLARGINE U-300 CONC 300 UNIT/ML (1.5 ML) SUBQ INPN,,116289,LOCAL,Facility,Both,1.5,mL,,637,541.45,182.5642,637,"Health Partners, Inc.",State Public Programs,318.5,50,,percent of total billed charges,,
INSULIN GLARGINE U-300 CONC 300 UNIT/ML (1.5 ML) SUBQ INPN,,116289,LOCAL,Facility,Both,1.5,mL,,637,541.45,182.5642,637,Humana Insurance Company,Commercial PPO,605.15,95,,percent of total billed charges,,
INSULIN GLARGINE U-300 CONC 300 UNIT/ML (1.5 ML) SUBQ INPN,,116289,LOCAL,Facility,Outpatient,1.5,mL,,637,541.45,182.5642,637,Humana Insurance Company,Medicare PPO,312.13,49,,percent of total billed charges,,
INSULIN GLARGINE U-300 CONC 300 UNIT/ML (1.5 ML) SUBQ INPN,,116289,LOCAL,Facility,Inpatient,1.5,mL,,637,541.45,182.5642,637,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
INSULIN GLARGINE U-300 CONC 300 UNIT/ML (1.5 ML) SUBQ INPN,,116289,LOCAL,Facility,Both,1.5,mL,,637,541.45,182.5642,637,Medica,Individual & Family,631.267,99.1,,percent of total billed charges,,
INSULIN GLARGINE U-300 CONC 300 UNIT/ML (1.5 ML) SUBQ INPN,,116289,LOCAL,Facility,Outpatient,1.5,mL,,637,541.45,182.5642,637,Medica,Medica Advantage Solution,317.226,49.8,,percent of total billed charges,,
INSULIN GLARGINE U-300 CONC 300 UNIT/ML (1.5 ML) SUBQ INPN,,116289,LOCAL,Facility,Inpatient,1.5,mL,,637,541.45,182.5642,637,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
INSULIN GLARGINE U-300 CONC 300 UNIT/ML (1.5 ML) SUBQ INPN,,116289,LOCAL,Facility,Outpatient,1.5,mL,,637,541.45,182.5642,637,Medica,Medical Assistance,284.102,44.6,,percent of total billed charges,,
INSULIN GLARGINE U-300 CONC 300 UNIT/ML (1.5 ML) SUBQ INPN,,116289,LOCAL,Facility,Inpatient,1.5,mL,,637,541.45,182.5642,637,Medica,Medical Assistance,,,,,Included in per diem rate,
INSULIN GLARGINE U-300 CONC 300 UNIT/ML (1.5 ML) SUBQ INPN,,116289,LOCAL,Facility,Outpatient,1.5,mL,,637,541.45,182.5642,637,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,317.226,49.8,,percent of total billed charges,,
INSULIN GLARGINE U-300 CONC 300 UNIT/ML (1.5 ML) SUBQ INPN,,116289,LOCAL,Facility,Inpatient,1.5,mL,,637,541.45,182.5642,637,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
INSULIN GLARGINE U-300 CONC 300 UNIT/ML (1.5 ML) SUBQ INPN,,116289,LOCAL,Facility,Both,1.5,mL,,637,541.45,182.5642,637,"Multiplan, Inc.","Multiplan, Inc.",598.78,94,,percent of total billed charges,,
INSULIN GLARGINE U-300 CONC 300 UNIT/ML (1.5 ML) SUBQ INPN,,116289,LOCAL,Facility,Outpatient,1.5,mL,,637,541.45,182.5642,637,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,573.937,90.1,,percent of total billed charges,,
INSULIN GLARGINE U-300 CONC 300 UNIT/ML (1.5 ML) SUBQ INPN,,116289,LOCAL,Facility,Inpatient,1.5,mL,,637,541.45,182.5642,637,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
INSULIN GLARGINE U-300 CONC 300 UNIT/ML (1.5 ML) SUBQ INPN,,116289,LOCAL,Facility,Both,1.5,mL,,637,541.45,182.5642,637,"Preferred One Administrative Services, INC.",PPO,628.082,98.6,,percent of total billed charges,,
INSULIN GLARGINE U-300 CONC 300 UNIT/ML (1.5 ML) SUBQ INPN,,116289,LOCAL,Facility,Outpatient,1.5,mL,,637,541.45,182.5642,637,PrimeWest Health,Minnesota Senior Health Options (MSHO),327.7365,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
INSULIN GLARGINE U-300 CONC 300 UNIT/ML (1.5 ML) SUBQ INPN,,116289,LOCAL,Facility,Inpatient,1.5,mL,,637,541.45,182.5642,637,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
INSULIN GLARGINE U-300 CONC 300 UNIT/ML (1.5 ML) SUBQ INPN,,116289,LOCAL,Facility,Outpatient,1.5,mL,,637,541.45,182.5642,637,PrimeWest Health,MinnesotaCare,327.1632,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
INSULIN GLARGINE U-300 CONC 300 UNIT/ML (1.5 ML) SUBQ INPN,,116289,LOCAL,Facility,Inpatient,1.5,mL,,637,541.45,182.5642,637,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
INSULIN GLARGINE U-300 CONC 300 UNIT/ML (1.5 ML) SUBQ INPN,,116289,LOCAL,Facility,Both,1.5,mL,,637,541.45,182.5642,637,Sanford Health Plan,Sanford Health Plan,586.04,92,,percent of total billed charges,,
INSULIN GLARGINE U-300 CONC 300 UNIT/ML (1.5 ML) SUBQ INPN,,116289,LOCAL,Facility,Outpatient,1.5,mL,,637,541.45,182.5642,637,"UCare Health, Inc.",Individual & Family Plan,358.9495,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
INSULIN GLARGINE U-300 CONC 300 UNIT/ML (1.5 ML) SUBQ INPN,,116289,LOCAL,Facility,Inpatient,1.5,mL,,637,541.45,182.5642,637,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
INSULIN GLARGINE U-300 CONC 300 UNIT/ML (1.5 ML) SUBQ INPN,,116289,LOCAL,Facility,Outpatient,1.5,mL,,637,541.45,182.5642,637,"UCare Health, Inc.",Medical Assistance,321.4939,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
INSULIN GLARGINE U-300 CONC 300 UNIT/ML (1.5 ML) SUBQ INPN,,116289,LOCAL,Facility,Inpatient,1.5,mL,,637,541.45,182.5642,637,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
INSULIN GLARGINE U-300 CONC 300 UNIT/ML (1.5 ML) SUBQ INPN,,116289,LOCAL,Facility,Outpatient,1.5,mL,,637,541.45,182.5642,637,"UCare Health, Inc.",Medicare Advantage,321.4939,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
INSULIN GLARGINE U-300 CONC 300 UNIT/ML (1.5 ML) SUBQ INPN,,116289,LOCAL,Facility,Inpatient,1.5,mL,,637,541.45,182.5642,637,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
INSULIN GLARGINE U-300 CONC 300 UNIT/ML (1.5 ML) SUBQ INPN,,116289,LOCAL,Facility,Outpatient,1.5,mL,,637,541.45,182.5642,637,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),321.4939,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
INSULIN GLARGINE U-300 CONC 300 UNIT/ML (1.5 ML) SUBQ INPN,,116289,LOCAL,Facility,Inpatient,1.5,mL,,637,541.45,182.5642,637,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
INSULIN GLARGINE U-300 CONC 300 UNIT/ML (1.5 ML) SUBQ INPN,,116289,LOCAL,Facility,Both,1.5,mL,,637,541.45,182.5642,637,UnitedHealthcare,Individual & Family,598.78,94,,percent of total billed charges,,
INSULIN GLARGINE U-300 CONC 300 UNIT/ML (1.5 ML) SUBQ INPN,,116289,LOCAL,Facility,Outpatient,1.5,mL,,637,541.45,182.5642,637,UnitedHealthcare,Medicare Advantage,312.13,49,,percent of total billed charges,,
INSULIN GLARGINE U-300 CONC 300 UNIT/ML (1.5 ML) SUBQ INPN,,116289,LOCAL,Facility,Inpatient,1.5,mL,,637,541.45,182.5642,637,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
INSULIN GLARGINE U-300 CONC 300 UNIT/ML (1.5 ML) SUBQ INPN,,116289,LOCAL,Facility,Outpatient,1.5,mL,,637,541.45,182.5642,637,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,305.76,48,,percent of total billed charges,,100% of DHS outpatient percentage
INSULIN GLARGINE U-300 CONC 300 UNIT/ML (1.5 ML) SUBQ INPN,,116289,LOCAL,Facility,Inpatient,1.5,mL,,637,541.45,182.5642,637,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Posterior Tibial Neurostimulation, Percutaneous Needle Electrode, Single Treatment, Including Progr (Pro Cah)",,64566,CPT,Professional,Both,,,,408,346.8,18.32,408,Aetna,Commercial,346.8,85,,percent of total billed charges,,
"Posterior Tibial Neurostimulation, Percutaneous Needle Electrode, Single Treatment, Including Progr (Pro Cah)",,64566,CPT,Professional,Both,,,,408,346.8,18.32,408,Aetna,Medicare Advantage,29.47,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Posterior Tibial Neurostimulation, Percutaneous Needle Electrode, Single Treatment, Including Progr (Pro Cah)",,64566,CPT,Professional,Both,,,,408,346.8,18.32,408,Aetna,PPO,379.44,93,,percent of total billed charges,,
"Posterior Tibial Neurostimulation, Percutaneous Needle Electrode, Single Treatment, Including Progr (Pro Cah)",,64566,CPT,Professional,Both,,,,408,346.8,18.32,408,America's PPO,America's PPO,348.5952,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Posterior Tibial Neurostimulation, Percutaneous Needle Electrode, Single Treatment, Including Progr (Pro Cah)",,64566,CPT,Professional,Both,,,,408,346.8,18.32,408,BlueCross BlueShield Minnesota, Federal Employee Program,61.29,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Posterior Tibial Neurostimulation, Percutaneous Needle Electrode, Single Treatment, Including Progr (Pro Cah)",,64566,CPT,Professional,Both,,,,408,346.8,18.32,408,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,62.27064,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Posterior Tibial Neurostimulation, Percutaneous Needle Electrode, Single Treatment, Including Progr (Pro Cah)",,64566,CPT,Professional,Both,,,,408,346.8,18.32,408,BlueCross BlueShield Minnesota,High Value Network Plan,62.27064,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Posterior Tibial Neurostimulation, Percutaneous Needle Electrode, Single Treatment, Including Progr (Pro Cah)",,64566,CPT,Professional,Both,,,,408,346.8,18.32,408,BlueCross BlueShield Minnesota,Medicare Advantage,32.7405,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Posterior Tibial Neurostimulation, Percutaneous Needle Electrode, Single Treatment, Including Progr (Pro Cah)",,64566,CPT,Professional,Both,,,,408,346.8,18.32,408,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,62.27064,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Posterior Tibial Neurostimulation, Percutaneous Needle Electrode, Single Treatment, Including Progr (Pro Cah)",,64566,CPT,Professional,Both,,,,408,346.8,18.32,408,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,21.15312,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Posterior Tibial Neurostimulation, Percutaneous Needle Electrode, Single Treatment, Including Progr (Pro Cah)",,64566,CPT,Professional,Both,,,,408,346.8,18.32,408,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),32.7405,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Posterior Tibial Neurostimulation, Percutaneous Needle Electrode, Single Treatment, Including Progr (Pro Cah)",,64566,CPT,Professional,Both,,,,408,346.8,18.32,408,CorVel,Worker's Compensation,56.725065,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Posterior Tibial Neurostimulation, Percutaneous Needle Electrode, Single Treatment, Including Progr (Pro Cah)",,64566,CPT,Professional,Both,,,,408,346.8,18.32,408,First Health Group Corporation,First Health Network,395.76,97,,percent of total billed charges,,
"Posterior Tibial Neurostimulation, Percutaneous Needle Electrode, Single Treatment, Including Progr (Pro Cah)",,64566,CPT,Professional,Both,,,,408,346.8,18.32,408,"Health Partners, Inc.",Commercial,60.94,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Posterior Tibial Neurostimulation, Percutaneous Needle Electrode, Single Treatment, Including Progr (Pro Cah)",,64566,CPT,Professional,Both,,,,408,346.8,18.32,408,"Health Partners, Inc.",Medicare Advantage,32.7405,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Posterior Tibial Neurostimulation, Percutaneous Needle Electrode, Single Treatment, Including Progr (Pro Cah)",,64566,CPT,Professional,Both,,,,408,346.8,18.32,408,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),28.47,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Posterior Tibial Neurostimulation, Percutaneous Needle Electrode, Single Treatment, Including Progr (Pro Cah)",,64566,CPT,Professional,Both,,,,408,346.8,18.32,408,"Health Partners, Inc.",State of Minnesota Advantage Program,52.49981,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Posterior Tibial Neurostimulation, Percutaneous Needle Electrode, Single Treatment, Including Progr (Pro Cah)",,64566,CPT,Professional,Both,,,,408,346.8,18.32,408,"Health Partners, Inc.",State Public Programs,18.32,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Posterior Tibial Neurostimulation, Percutaneous Needle Electrode, Single Treatment, Including Progr (Pro Cah)",,64566,CPT,Professional,Both,,,,408,346.8,18.32,408,Humana Insurance Company,Commercial PPO,28.47,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Posterior Tibial Neurostimulation, Percutaneous Needle Electrode, Single Treatment, Including Progr (Pro Cah)",,64566,CPT,Professional,Both,,,,408,346.8,18.32,408,Humana Insurance Company,Medicare PPO,408,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Posterior Tibial Neurostimulation, Percutaneous Needle Electrode, Single Treatment, Including Progr (Pro Cah)",,64566,CPT,Professional,Both,,,,408,346.8,18.32,408,Medica,Individual & Family,345.984,84.8,,percent of total billed charges,,
"Posterior Tibial Neurostimulation, Percutaneous Needle Electrode, Single Treatment, Including Progr (Pro Cah)",,64566,CPT,Professional,Both,,,,408,346.8,18.32,408,Medica,Medica Advantage Solution,203.184,49.8,,percent of total billed charges,,
"Posterior Tibial Neurostimulation, Percutaneous Needle Electrode, Single Treatment, Including Progr (Pro Cah)",,64566,CPT,Professional,Both,,,,408,346.8,18.32,408,Medica,Medical Assistance,21.15,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Posterior Tibial Neurostimulation, Percutaneous Needle Electrode, Single Treatment, Including Progr (Pro Cah)",,64566,CPT,Professional,Both,,,,408,346.8,18.32,408,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,28.47,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Posterior Tibial Neurostimulation, Percutaneous Needle Electrode, Single Treatment, Including Progr (Pro Cah)",,64566,CPT,Professional,Both,,,,408,346.8,18.32,408,"Multiplan, Inc.","Multiplan, Inc.",383.52,94,,percent of total billed charges,,
"Posterior Tibial Neurostimulation, Percutaneous Needle Electrode, Single Treatment, Including Progr (Pro Cah)",,64566,CPT,Professional,Both,,,,408,346.8,18.32,408,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,367.608,90.1,,percent of total billed charges,,
"Posterior Tibial Neurostimulation, Percutaneous Needle Electrode, Single Treatment, Including Progr (Pro Cah)",,64566,CPT,Professional,Both,,,,408,346.8,18.32,408,"Preferred One Administrative Services, INC.",PPO,402.288,98.6,,percent of total billed charges,,
"Posterior Tibial Neurostimulation, Percutaneous Needle Electrode, Single Treatment, Including Progr (Pro Cah)",,64566,CPT,Professional,Both,,,,408,346.8,18.32,408,PrimeWest Health,Minnesota Senior Health Options (MSHO),32.7405,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Posterior Tibial Neurostimulation, Percutaneous Needle Electrode, Single Treatment, Including Progr (Pro Cah)",,64566,CPT,Professional,Both,,,,408,346.8,18.32,408,PrimeWest Health,MinnesotaCare,22.6338384,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Posterior Tibial Neurostimulation, Percutaneous Needle Electrode, Single Treatment, Including Progr (Pro Cah)",,64566,CPT,Professional,Both,,,,408,346.8,18.32,408,Sanford Health Plan,Sanford Health Plan,359.04,88,,percent of total billed charges,,
"Posterior Tibial Neurostimulation, Percutaneous Needle Electrode, Single Treatment, Including Progr (Pro Cah)",,64566,CPT,Professional,Both,,,,408,346.8,18.32,408,"UCare Health, Inc.",Individual & Family Plan,46.280832,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Posterior Tibial Neurostimulation, Percutaneous Needle Electrode, Single Treatment, Including Progr (Pro Cah)",,64566,CPT,Professional,Both,,,,408,346.8,18.32,408,"UCare Health, Inc.",Medical Assistance,23.268432,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Posterior Tibial Neurostimulation, Percutaneous Needle Electrode, Single Treatment, Including Progr (Pro Cah)",,64566,CPT,Professional,Both,,,,408,346.8,18.32,408,"UCare Health, Inc.",Medicare Advantage,32.7405,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Posterior Tibial Neurostimulation, Percutaneous Needle Electrode, Single Treatment, Including Progr (Pro Cah)",,64566,CPT,Professional,Both,,,,408,346.8,18.32,408,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),26.1924,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Posterior Tibial Neurostimulation, Percutaneous Needle Electrode, Single Treatment, Including Progr (Pro Cah)",,64566,CPT,Professional,Both,,,,408,346.8,18.32,408,UnitedHealthcare,Individual & Family,408,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Posterior Tibial Neurostimulation, Percutaneous Needle Electrode, Single Treatment, Including Progr (Pro Cah)",,64566,CPT,Professional,Both,,,,408,346.8,18.32,408,UnitedHealthcare,Medicare Advantage,32.7405,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Posterior Tibial Neurostimulation, Percutaneous Needle Electrode, Single Treatment, Including Progr (Pro Cah)",,64566,CPT,Professional,Both,,,,408,346.8,18.32,408,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,21.15312,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Chemodeneration Of Muscle(S)-Facial Nerve Unilaterally,,64612,CPT,Facility,Both,,,,280,238,80.248,280,Aetna,Commercial,257.6,92,,percent of total billed charges,,
Chemodeneration Of Muscle(S)-Facial Nerve Unilaterally,,64612,CPT,Facility,Outpatient,,,,280,238,80.248,280,Aetna,Medicare Advantage,137.2,49,,percent of total billed charges,,
Chemodeneration Of Muscle(S)-Facial Nerve Unilaterally,,64612,CPT,Facility,Inpatient,,,,280,238,80.248,280,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Chemodeneration Of Muscle(S)-Facial Nerve Unilaterally,,64612,CPT,Facility,Both,,,,280,238,80.248,280,Aetna,PPO,260.4,93,,percent of total billed charges,,
Chemodeneration Of Muscle(S)-Facial Nerve Unilaterally,,64612,CPT,Facility,Both,,,,280,238,80.248,280,America's PPO,America's PPO,268.884,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Chemodeneration Of Muscle(S)-Facial Nerve Unilaterally,,64612,CPT,Facility,Both,,,,280,238,80.248,280,BlueCross BlueShield Minnesota, Federal Employee Program,275.52,98.4,,percent of total billed charges,,
Chemodeneration Of Muscle(S)-Facial Nerve Unilaterally,,64612,CPT,Facility,Both,,,,280,238,80.248,280,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,280,100,,percent of total billed charges,,
Chemodeneration Of Muscle(S)-Facial Nerve Unilaterally,,64612,CPT,Facility,Both,,,,280,238,80.248,280,BlueCross BlueShield Minnesota,High Value Network Plan,252,90,,percent of total billed charges,,
Chemodeneration Of Muscle(S)-Facial Nerve Unilaterally,,64612,CPT,Facility,Outpatient,,,,280,238,80.248,280,BlueCross BlueShield Minnesota,Medicare Advantage,137.2,49,,percent of total billed charges,,
Chemodeneration Of Muscle(S)-Facial Nerve Unilaterally,,64612,CPT,Facility,Inpatient,,,,280,238,80.248,280,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Chemodeneration Of Muscle(S)-Facial Nerve Unilaterally,,64612,CPT,Facility,Both,,,,280,238,80.248,280,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,247.996,88.57,,percent of total billed charges,,
Chemodeneration Of Muscle(S)-Facial Nerve Unilaterally,,64612,CPT,Facility,Both,,,,280,238,80.248,280,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,80.248,28.66,,percent of total billed charges,,
Chemodeneration Of Muscle(S)-Facial Nerve Unilaterally,,64612,CPT,Facility,Outpatient,,,,280,238,80.248,280,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),137.2,49,,percent of total billed charges,,
Chemodeneration Of Muscle(S)-Facial Nerve Unilaterally,,64612,CPT,Facility,Inpatient,,,,280,238,80.248,280,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Chemodeneration Of Muscle(S)-Facial Nerve Unilaterally,,64612,CPT,Facility,Both,,,,280,238,80.248,280,CorVel,Worker's Compensation,280,100,,percent of total billed charges,,
Chemodeneration Of Muscle(S)-Facial Nerve Unilaterally,,64612,CPT,Facility,Both,,,,280,238,80.248,280,First Health Group Corporation,First Health Network,271.6,97,,percent of total billed charges,,
Chemodeneration Of Muscle(S)-Facial Nerve Unilaterally,,64612,CPT,Facility,Both,,,,280,238,80.248,280,"Health Partners, Inc.",Commercial,264.88,94.6,,percent of total billed charges,,
Chemodeneration Of Muscle(S)-Facial Nerve Unilaterally,,64612,CPT,Facility,Outpatient,,,,280,238,80.248,280,"Health Partners, Inc.",Medicare Advantage,137.2,49,,percent of total billed charges,,
Chemodeneration Of Muscle(S)-Facial Nerve Unilaterally,,64612,CPT,Facility,Inpatient,,,,280,238,80.248,280,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Chemodeneration Of Muscle(S)-Facial Nerve Unilaterally,,64612,CPT,Facility,Both,,,,280,238,80.248,280,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),168,60,,percent of total billed charges,,
Chemodeneration Of Muscle(S)-Facial Nerve Unilaterally,,64612,CPT,Facility,Both,,,,280,238,80.248,280,"Health Partners, Inc.",State of Minnesota Advantage Program,228.2,81.5,,percent of total billed charges,,
Chemodeneration Of Muscle(S)-Facial Nerve Unilaterally,,64612,CPT,Facility,Both,,,,280,238,80.248,280,"Health Partners, Inc.",State Public Programs,140,50,,percent of total billed charges,,
Chemodeneration Of Muscle(S)-Facial Nerve Unilaterally,,64612,CPT,Facility,Both,,,,280,238,80.248,280,Humana Insurance Company,Commercial PPO,266,95,,percent of total billed charges,,
Chemodeneration Of Muscle(S)-Facial Nerve Unilaterally,,64612,CPT,Facility,Outpatient,,,,280,238,80.248,280,Humana Insurance Company,Medicare PPO,137.2,49,,percent of total billed charges,,
Chemodeneration Of Muscle(S)-Facial Nerve Unilaterally,,64612,CPT,Facility,Inpatient,,,,280,238,80.248,280,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Chemodeneration Of Muscle(S)-Facial Nerve Unilaterally,,64612,CPT,Facility,Both,,,,280,238,80.248,280,Medica,Individual & Family,277.48,99.1,,percent of total billed charges,,
Chemodeneration Of Muscle(S)-Facial Nerve Unilaterally,,64612,CPT,Facility,Outpatient,,,,280,238,80.248,280,Medica,Medica Advantage Solution,139.44,49.8,,percent of total billed charges,,
Chemodeneration Of Muscle(S)-Facial Nerve Unilaterally,,64612,CPT,Facility,Inpatient,,,,280,238,80.248,280,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Chemodeneration Of Muscle(S)-Facial Nerve Unilaterally,,64612,CPT,Facility,Outpatient,,,,280,238,80.248,280,Medica,Medical Assistance,124.88,44.6,,percent of total billed charges,,
Chemodeneration Of Muscle(S)-Facial Nerve Unilaterally,,64612,CPT,Facility,Inpatient,,,,280,238,80.248,280,Medica,Medical Assistance,,,,,Included in per diem rate,
Chemodeneration Of Muscle(S)-Facial Nerve Unilaterally,,64612,CPT,Facility,Outpatient,,,,280,238,80.248,280,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,139.44,49.8,,percent of total billed charges,,
Chemodeneration Of Muscle(S)-Facial Nerve Unilaterally,,64612,CPT,Facility,Inpatient,,,,280,238,80.248,280,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Chemodeneration Of Muscle(S)-Facial Nerve Unilaterally,,64612,CPT,Facility,Both,,,,280,238,80.248,280,"Multiplan, Inc.","Multiplan, Inc.",263.2,94,,percent of total billed charges,,
Chemodeneration Of Muscle(S)-Facial Nerve Unilaterally,,64612,CPT,Facility,Outpatient,,,,280,238,80.248,280,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,252.28,90.1,,percent of total billed charges,,
Chemodeneration Of Muscle(S)-Facial Nerve Unilaterally,,64612,CPT,Facility,Inpatient,,,,280,238,80.248,280,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Chemodeneration Of Muscle(S)-Facial Nerve Unilaterally,,64612,CPT,Facility,Both,,,,280,238,80.248,280,"Preferred One Administrative Services, INC.",PPO,276.08,98.6,,percent of total billed charges,,
Chemodeneration Of Muscle(S)-Facial Nerve Unilaterally,,64612,CPT,Facility,Outpatient,,,,280,238,80.248,280,PrimeWest Health,Minnesota Senior Health Options (MSHO),144.06,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Chemodeneration Of Muscle(S)-Facial Nerve Unilaterally,,64612,CPT,Facility,Inpatient,,,,280,238,80.248,280,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Chemodeneration Of Muscle(S)-Facial Nerve Unilaterally,,64612,CPT,Facility,Outpatient,,,,280,238,80.248,280,PrimeWest Health,MinnesotaCare,143.808,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Chemodeneration Of Muscle(S)-Facial Nerve Unilaterally,,64612,CPT,Facility,Inpatient,,,,280,238,80.248,280,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Chemodeneration Of Muscle(S)-Facial Nerve Unilaterally,,64612,CPT,Facility,Both,,,,280,238,80.248,280,Sanford Health Plan,Sanford Health Plan,257.6,92,,percent of total billed charges,,
Chemodeneration Of Muscle(S)-Facial Nerve Unilaterally,,64612,CPT,Facility,Outpatient,,,,280,238,80.248,280,"UCare Health, Inc.",Individual & Family Plan,157.78,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Chemodeneration Of Muscle(S)-Facial Nerve Unilaterally,,64612,CPT,Facility,Inpatient,,,,280,238,80.248,280,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Chemodeneration Of Muscle(S)-Facial Nerve Unilaterally,,64612,CPT,Facility,Outpatient,,,,280,238,80.248,280,"UCare Health, Inc.",Medical Assistance,141.316,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Chemodeneration Of Muscle(S)-Facial Nerve Unilaterally,,64612,CPT,Facility,Inpatient,,,,280,238,80.248,280,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Chemodeneration Of Muscle(S)-Facial Nerve Unilaterally,,64612,CPT,Facility,Outpatient,,,,280,238,80.248,280,"UCare Health, Inc.",Medicare Advantage,141.316,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Chemodeneration Of Muscle(S)-Facial Nerve Unilaterally,,64612,CPT,Facility,Inpatient,,,,280,238,80.248,280,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Chemodeneration Of Muscle(S)-Facial Nerve Unilaterally,,64612,CPT,Facility,Outpatient,,,,280,238,80.248,280,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),141.316,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Chemodeneration Of Muscle(S)-Facial Nerve Unilaterally,,64612,CPT,Facility,Inpatient,,,,280,238,80.248,280,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Chemodeneration Of Muscle(S)-Facial Nerve Unilaterally,,64612,CPT,Facility,Both,,,,280,238,80.248,280,UnitedHealthcare,Individual & Family,263.2,94,,percent of total billed charges,,
Chemodeneration Of Muscle(S)-Facial Nerve Unilaterally,,64612,CPT,Facility,Outpatient,,,,280,238,80.248,280,UnitedHealthcare,Medicare Advantage,137.2,49,,percent of total billed charges,,
Chemodeneration Of Muscle(S)-Facial Nerve Unilaterally,,64612,CPT,Facility,Inpatient,,,,280,238,80.248,280,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Chemodeneration Of Muscle(S)-Facial Nerve Unilaterally,,64612,CPT,Facility,Outpatient,,,,280,238,80.248,280,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,134.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
Chemodeneration Of Muscle(S)-Facial Nerve Unilaterally,,64612,CPT,Facility,Inpatient,,,,280,238,80.248,280,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Chemodenervation Of Muscle(S); Muscle(S) Innervated By Facial Nerve, Unilateral (Pro Cah)",,64612,CPT,Professional,Both,,,,306,260.1,73.52,306,Aetna,Commercial,260.1,85,,percent of total billed charges,,
"Chemodenervation Of Muscle(S); Muscle(S) Innervated By Facial Nerve, Unilateral (Pro Cah)",,64612,CPT,Professional,Both,,,,645,548.25,73.52,645,Aetna,Commercial,548.25,85,,percent of total billed charges,,
"Chemodenervation Of Muscle(S); Muscle(S) Innervated By Facial Nerve, Unilateral (Pro Cah)",,64612,CPT,Professional,Both,,,,306,260.1,73.52,306,Aetna,Medicare Advantage,114.74,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Chemodenervation Of Muscle(S); Muscle(S) Innervated By Facial Nerve, Unilateral (Pro Cah)",,64612,CPT,Professional,Both,,,,645,548.25,73.52,645,Aetna,Medicare Advantage,114.74,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Chemodenervation Of Muscle(S); Muscle(S) Innervated By Facial Nerve, Unilateral (Pro Cah)",,64612,CPT,Professional,Both,,,,306,260.1,73.52,306,Aetna,PPO,284.58,93,,percent of total billed charges,,
"Chemodenervation Of Muscle(S); Muscle(S) Innervated By Facial Nerve, Unilateral (Pro Cah)",,64612,CPT,Professional,Both,,,,645,548.25,73.52,645,Aetna,PPO,599.85,93,,percent of total billed charges,,
"Chemodenervation Of Muscle(S); Muscle(S) Innervated By Facial Nerve, Unilateral (Pro Cah)",,64612,CPT,Professional,Both,,,,306,260.1,73.52,306,America's PPO,America's PPO,261.4464,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Chemodenervation Of Muscle(S); Muscle(S) Innervated By Facial Nerve, Unilateral (Pro Cah)",,64612,CPT,Professional,Both,,,,645,548.25,73.52,645,America's PPO,America's PPO,551.088,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Chemodenervation Of Muscle(S); Muscle(S) Innervated By Facial Nerve, Unilateral (Pro Cah)",,64612,CPT,Professional,Both,,,,306,260.1,73.52,306,BlueCross BlueShield Minnesota, Federal Employee Program,243.76,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Chemodenervation Of Muscle(S); Muscle(S) Innervated By Facial Nerve, Unilateral (Pro Cah)",,64612,CPT,Professional,Both,,,,645,548.25,73.52,645,BlueCross BlueShield Minnesota, Federal Employee Program,243.76,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Chemodenervation Of Muscle(S); Muscle(S) Innervated By Facial Nerve, Unilateral (Pro Cah)",,64612,CPT,Professional,Both,,,,306,260.1,73.52,306,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,247.66016,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Chemodenervation Of Muscle(S); Muscle(S) Innervated By Facial Nerve, Unilateral (Pro Cah)",,64612,CPT,Professional,Both,,,,645,548.25,73.52,645,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,247.66016,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Chemodenervation Of Muscle(S); Muscle(S) Innervated By Facial Nerve, Unilateral (Pro Cah)",,64612,CPT,Professional,Both,,,,306,260.1,73.52,306,BlueCross BlueShield Minnesota,High Value Network Plan,247.66016,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Chemodenervation Of Muscle(S); Muscle(S) Innervated By Facial Nerve, Unilateral (Pro Cah)",,64612,CPT,Professional,Both,,,,645,548.25,73.52,645,BlueCross BlueShield Minnesota,High Value Network Plan,247.66016,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Chemodenervation Of Muscle(S); Muscle(S) Innervated By Facial Nerve, Unilateral (Pro Cah)",,64612,CPT,Professional,Both,,,,306,260.1,73.52,306,BlueCross BlueShield Minnesota,Medicare Advantage,131.698,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Chemodenervation Of Muscle(S); Muscle(S) Innervated By Facial Nerve, Unilateral (Pro Cah)",,64612,CPT,Professional,Both,,,,645,548.25,73.52,645,BlueCross BlueShield Minnesota,Medicare Advantage,131.698,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Chemodenervation Of Muscle(S); Muscle(S) Innervated By Facial Nerve, Unilateral (Pro Cah)",,64612,CPT,Professional,Both,,,,306,260.1,73.52,306,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,247.66016,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Chemodenervation Of Muscle(S); Muscle(S) Innervated By Facial Nerve, Unilateral (Pro Cah)",,64612,CPT,Professional,Both,,,,645,548.25,73.52,645,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,247.66016,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Chemodenervation Of Muscle(S); Muscle(S) Innervated By Facial Nerve, Unilateral (Pro Cah)",,64612,CPT,Professional,Both,,,,306,260.1,73.52,306,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,84.87664,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Chemodenervation Of Muscle(S); Muscle(S) Innervated By Facial Nerve, Unilateral (Pro Cah)",,64612,CPT,Professional,Both,,,,645,548.25,73.52,645,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,84.87664,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Chemodenervation Of Muscle(S); Muscle(S) Innervated By Facial Nerve, Unilateral (Pro Cah)",,64612,CPT,Professional,Both,,,,306,260.1,73.52,306,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),131.698,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Chemodenervation Of Muscle(S); Muscle(S) Innervated By Facial Nerve, Unilateral (Pro Cah)",,64612,CPT,Professional,Both,,,,645,548.25,73.52,645,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),131.698,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Chemodenervation Of Muscle(S); Muscle(S) Innervated By Facial Nerve, Unilateral (Pro Cah)",,64612,CPT,Professional,Both,,,,306,260.1,73.52,306,CorVel,Worker's Compensation,223.1461287,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Chemodenervation Of Muscle(S); Muscle(S) Innervated By Facial Nerve, Unilateral (Pro Cah)",,64612,CPT,Professional,Both,,,,645,548.25,73.52,645,CorVel,Worker's Compensation,223.1461287,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Chemodenervation Of Muscle(S); Muscle(S) Innervated By Facial Nerve, Unilateral (Pro Cah)",,64612,CPT,Professional,Both,,,,306,260.1,73.52,306,First Health Group Corporation,First Health Network,296.82,97,,percent of total billed charges,,
"Chemodenervation Of Muscle(S); Muscle(S) Innervated By Facial Nerve, Unilateral (Pro Cah)",,64612,CPT,Professional,Both,,,,645,548.25,73.52,645,First Health Group Corporation,First Health Network,625.65,97,,percent of total billed charges,,
"Chemodenervation Of Muscle(S); Muscle(S) Innervated By Facial Nerve, Unilateral (Pro Cah)",,64612,CPT,Professional,Both,,,,306,260.1,73.52,306,"Health Partners, Inc.",Commercial,240.87,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Chemodenervation Of Muscle(S); Muscle(S) Innervated By Facial Nerve, Unilateral (Pro Cah)",,64612,CPT,Professional,Both,,,,645,548.25,73.52,645,"Health Partners, Inc.",Commercial,240.87,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Chemodenervation Of Muscle(S); Muscle(S) Innervated By Facial Nerve, Unilateral (Pro Cah)",,64612,CPT,Professional,Both,,,,306,260.1,73.52,306,"Health Partners, Inc.",Medicare Advantage,131.698,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Chemodenervation Of Muscle(S); Muscle(S) Innervated By Facial Nerve, Unilateral (Pro Cah)",,64612,CPT,Professional,Both,,,,645,548.25,73.52,645,"Health Partners, Inc.",Medicare Advantage,131.698,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Chemodenervation Of Muscle(S); Muscle(S) Innervated By Facial Nerve, Unilateral (Pro Cah)",,64612,CPT,Professional,Both,,,,306,260.1,73.52,306,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),114.2,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Chemodenervation Of Muscle(S); Muscle(S) Innervated By Facial Nerve, Unilateral (Pro Cah)",,64612,CPT,Professional,Both,,,,645,548.25,73.52,645,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),114.2,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Chemodenervation Of Muscle(S); Muscle(S) Innervated By Facial Nerve, Unilateral (Pro Cah)",,64612,CPT,Professional,Both,,,,306,260.1,73.52,306,"Health Partners, Inc.",State of Minnesota Advantage Program,207.509505,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Chemodenervation Of Muscle(S); Muscle(S) Innervated By Facial Nerve, Unilateral (Pro Cah)",,64612,CPT,Professional,Both,,,,645,548.25,73.52,645,"Health Partners, Inc.",State of Minnesota Advantage Program,207.509505,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Chemodenervation Of Muscle(S); Muscle(S) Innervated By Facial Nerve, Unilateral (Pro Cah)",,64612,CPT,Professional,Both,,,,306,260.1,73.52,306,"Health Partners, Inc.",State Public Programs,73.52,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Chemodenervation Of Muscle(S); Muscle(S) Innervated By Facial Nerve, Unilateral (Pro Cah)",,64612,CPT,Professional,Both,,,,645,548.25,73.52,645,"Health Partners, Inc.",State Public Programs,73.52,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Chemodenervation Of Muscle(S); Muscle(S) Innervated By Facial Nerve, Unilateral (Pro Cah)",,64612,CPT,Professional,Both,,,,306,260.1,73.52,306,Humana Insurance Company,Commercial PPO,114.52,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Chemodenervation Of Muscle(S); Muscle(S) Innervated By Facial Nerve, Unilateral (Pro Cah)",,64612,CPT,Professional,Both,,,,645,548.25,73.52,645,Humana Insurance Company,Commercial PPO,114.52,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Chemodenervation Of Muscle(S); Muscle(S) Innervated By Facial Nerve, Unilateral (Pro Cah)",,64612,CPT,Professional,Both,,,,306,260.1,73.52,306,Humana Insurance Company,Medicare PPO,306,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Chemodenervation Of Muscle(S); Muscle(S) Innervated By Facial Nerve, Unilateral (Pro Cah)",,64612,CPT,Professional,Both,,,,645,548.25,73.52,645,Humana Insurance Company,Medicare PPO,645,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Chemodenervation Of Muscle(S); Muscle(S) Innervated By Facial Nerve, Unilateral (Pro Cah)",,64612,CPT,Professional,Both,,,,306,260.1,73.52,306,Medica,Individual & Family,259.488,84.8,,percent of total billed charges,,
"Chemodenervation Of Muscle(S); Muscle(S) Innervated By Facial Nerve, Unilateral (Pro Cah)",,64612,CPT,Professional,Both,,,,645,548.25,73.52,645,Medica,Individual & Family,546.96,84.8,,percent of total billed charges,,
"Chemodenervation Of Muscle(S); Muscle(S) Innervated By Facial Nerve, Unilateral (Pro Cah)",,64612,CPT,Professional,Both,,,,306,260.1,73.52,306,Medica,Medica Advantage Solution,152.388,49.8,,percent of total billed charges,,
"Chemodenervation Of Muscle(S); Muscle(S) Innervated By Facial Nerve, Unilateral (Pro Cah)",,64612,CPT,Professional,Both,,,,645,548.25,73.52,645,Medica,Medica Advantage Solution,321.21,49.8,,percent of total billed charges,,
"Chemodenervation Of Muscle(S); Muscle(S) Innervated By Facial Nerve, Unilateral (Pro Cah)",,64612,CPT,Professional,Both,,,,306,260.1,73.52,306,Medica,Medical Assistance,84.88,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Chemodenervation Of Muscle(S); Muscle(S) Innervated By Facial Nerve, Unilateral (Pro Cah)",,64612,CPT,Professional,Both,,,,645,548.25,73.52,645,Medica,Medical Assistance,84.88,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Chemodenervation Of Muscle(S); Muscle(S) Innervated By Facial Nerve, Unilateral (Pro Cah)",,64612,CPT,Professional,Both,,,,306,260.1,73.52,306,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,114.52,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Chemodenervation Of Muscle(S); Muscle(S) Innervated By Facial Nerve, Unilateral (Pro Cah)",,64612,CPT,Professional,Both,,,,645,548.25,73.52,645,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,114.52,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Chemodenervation Of Muscle(S); Muscle(S) Innervated By Facial Nerve, Unilateral (Pro Cah)",,64612,CPT,Professional,Both,,,,306,260.1,73.52,306,"Multiplan, Inc.","Multiplan, Inc.",287.64,94,,percent of total billed charges,,
"Chemodenervation Of Muscle(S); Muscle(S) Innervated By Facial Nerve, Unilateral (Pro Cah)",,64612,CPT,Professional,Both,,,,645,548.25,73.52,645,"Multiplan, Inc.","Multiplan, Inc.",606.3,94,,percent of total billed charges,,
"Chemodenervation Of Muscle(S); Muscle(S) Innervated By Facial Nerve, Unilateral (Pro Cah)",,64612,CPT,Professional,Both,,,,306,260.1,73.52,306,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,275.706,90.1,,percent of total billed charges,,
"Chemodenervation Of Muscle(S); Muscle(S) Innervated By Facial Nerve, Unilateral (Pro Cah)",,64612,CPT,Professional,Both,,,,645,548.25,73.52,645,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,581.145,90.1,,percent of total billed charges,,
"Chemodenervation Of Muscle(S); Muscle(S) Innervated By Facial Nerve, Unilateral (Pro Cah)",,64612,CPT,Professional,Both,,,,306,260.1,73.52,306,"Preferred One Administrative Services, INC.",PPO,301.716,98.6,,percent of total billed charges,,
"Chemodenervation Of Muscle(S); Muscle(S) Innervated By Facial Nerve, Unilateral (Pro Cah)",,64612,CPT,Professional,Both,,,,645,548.25,73.52,645,"Preferred One Administrative Services, INC.",PPO,635.97,98.6,,percent of total billed charges,,
"Chemodenervation Of Muscle(S); Muscle(S) Innervated By Facial Nerve, Unilateral (Pro Cah)",,64612,CPT,Professional,Both,,,,306,260.1,73.52,306,PrimeWest Health,Minnesota Senior Health Options (MSHO),131.698,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Chemodenervation Of Muscle(S); Muscle(S) Innervated By Facial Nerve, Unilateral (Pro Cah)",,64612,CPT,Professional,Both,,,,645,548.25,73.52,645,PrimeWest Health,Minnesota Senior Health Options (MSHO),131.698,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Chemodenervation Of Muscle(S); Muscle(S) Innervated By Facial Nerve, Unilateral (Pro Cah)",,64612,CPT,Professional,Both,,,,306,260.1,73.52,306,PrimeWest Health,MinnesotaCare,90.8180048,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Chemodenervation Of Muscle(S); Muscle(S) Innervated By Facial Nerve, Unilateral (Pro Cah)",,64612,CPT,Professional,Both,,,,645,548.25,73.52,645,PrimeWest Health,MinnesotaCare,90.8180048,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Chemodenervation Of Muscle(S); Muscle(S) Innervated By Facial Nerve, Unilateral (Pro Cah)",,64612,CPT,Professional,Both,,,,306,260.1,73.52,306,Sanford Health Plan,Sanford Health Plan,269.28,88,,percent of total billed charges,,
"Chemodenervation Of Muscle(S); Muscle(S) Innervated By Facial Nerve, Unilateral (Pro Cah)",,64612,CPT,Professional,Both,,,,645,548.25,73.52,645,Sanford Health Plan,Sanford Health Plan,567.6,88,,percent of total billed charges,,
"Chemodenervation Of Muscle(S); Muscle(S) Innervated By Facial Nerve, Unilateral (Pro Cah)",,64612,CPT,Professional,Both,,,,306,260.1,73.52,306,"UCare Health, Inc.",Individual & Family Plan,186.163712,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Chemodenervation Of Muscle(S); Muscle(S) Innervated By Facial Nerve, Unilateral (Pro Cah)",,64612,CPT,Professional,Both,,,,645,548.25,73.52,645,"UCare Health, Inc.",Individual & Family Plan,186.163712,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Chemodenervation Of Muscle(S); Muscle(S) Innervated By Facial Nerve, Unilateral (Pro Cah)",,64612,CPT,Professional,Both,,,,306,260.1,73.52,306,"UCare Health, Inc.",Medical Assistance,93.364304,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Chemodenervation Of Muscle(S); Muscle(S) Innervated By Facial Nerve, Unilateral (Pro Cah)",,64612,CPT,Professional,Both,,,,645,548.25,73.52,645,"UCare Health, Inc.",Medical Assistance,93.364304,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Chemodenervation Of Muscle(S); Muscle(S) Innervated By Facial Nerve, Unilateral (Pro Cah)",,64612,CPT,Professional,Both,,,,306,260.1,73.52,306,"UCare Health, Inc.",Medicare Advantage,131.698,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Chemodenervation Of Muscle(S); Muscle(S) Innervated By Facial Nerve, Unilateral (Pro Cah)",,64612,CPT,Professional,Both,,,,645,548.25,73.52,645,"UCare Health, Inc.",Medicare Advantage,131.698,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Chemodenervation Of Muscle(S); Muscle(S) Innervated By Facial Nerve, Unilateral (Pro Cah)",,64612,CPT,Professional,Both,,,,306,260.1,73.52,306,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),105.3584,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Chemodenervation Of Muscle(S); Muscle(S) Innervated By Facial Nerve, Unilateral (Pro Cah)",,64612,CPT,Professional,Both,,,,645,548.25,73.52,645,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),105.3584,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Chemodenervation Of Muscle(S); Muscle(S) Innervated By Facial Nerve, Unilateral (Pro Cah)",,64612,CPT,Professional,Both,,,,306,260.1,73.52,306,UnitedHealthcare,Individual & Family,306,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Chemodenervation Of Muscle(S); Muscle(S) Innervated By Facial Nerve, Unilateral (Pro Cah)",,64612,CPT,Professional,Both,,,,645,548.25,73.52,645,UnitedHealthcare,Individual & Family,645,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Chemodenervation Of Muscle(S); Muscle(S) Innervated By Facial Nerve, Unilateral (Pro Cah)",,64612,CPT,Professional,Both,,,,306,260.1,73.52,306,UnitedHealthcare,Medicare Advantage,131.698,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Chemodenervation Of Muscle(S); Muscle(S) Innervated By Facial Nerve, Unilateral (Pro Cah)",,64612,CPT,Professional,Both,,,,645,548.25,73.52,645,UnitedHealthcare,Medicare Advantage,131.698,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Chemodenervation Of Muscle(S); Muscle(S) Innervated By Facial Nerve, Unilateral (Pro Cah)",,64612,CPT,Professional,Both,,,,306,260.1,73.52,306,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,84.87664,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Chemodenervation Of Muscle(S); Muscle(S) Innervated By Facial Nerve, Unilateral (Pro Cah)",,64612,CPT,Professional,Both,,,,645,548.25,73.52,645,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,84.87664,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Botox Injection; Chronic Migraine,,64615,CPT,Facility,Both,,,,255,216.75,73.083,299,Aetna,Commercial,234.6,92,,percent of total billed charges,,
Botox Injection; Chronic Migraine,,64615,CPT,Facility,Outpatient,,,,255,216.75,73.083,299,Aetna,Medicare Advantage,124.95,49,,percent of total billed charges,,
Botox Injection; Chronic Migraine,,64615,CPT,Facility,Inpatient,,,,255,216.75,73.083,299,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Botox Injection; Chronic Migraine,,64615,CPT,Facility,Both,,,,255,216.75,73.083,299,Aetna,PPO,237.15,93,,percent of total billed charges,,
Botox Injection; Chronic Migraine,,64615,CPT,Facility,Both,,,,255,216.75,73.083,299,America's PPO,America's PPO,244.8765,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Botox Injection; Chronic Migraine,,64615,CPT,Facility,Both,,,,255,216.75,73.083,299,BlueCross BlueShield Minnesota, Federal Employee Program,250.92,98.4,,percent of total billed charges,,
Botox Injection; Chronic Migraine,,64615,CPT,Facility,Both,,,,255,216.75,73.083,299,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,255,100,,percent of total billed charges,,
Botox Injection; Chronic Migraine,,64615,CPT,Facility,Both,,,,255,216.75,73.083,299,BlueCross BlueShield Minnesota,High Value Network Plan,229.5,90,,percent of total billed charges,,
Botox Injection; Chronic Migraine,,64615,CPT,Facility,Outpatient,,,,255,216.75,73.083,299,BlueCross BlueShield Minnesota,Medicare Advantage,124.95,49,,percent of total billed charges,,
Botox Injection; Chronic Migraine,,64615,CPT,Facility,Inpatient,,,,255,216.75,73.083,299,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Botox Injection; Chronic Migraine,,64615,CPT,Facility,Both,,,,255,216.75,73.083,299,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,225.8535,88.57,,percent of total billed charges,,
Botox Injection; Chronic Migraine,,64615,CPT,Facility,Both,,,,255,216.75,73.083,299,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,73.083,28.66,,percent of total billed charges,,
Botox Injection; Chronic Migraine,,64615,CPT,Facility,Outpatient,,,,255,216.75,73.083,299,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),124.95,49,,percent of total billed charges,,
Botox Injection; Chronic Migraine,,64615,CPT,Facility,Inpatient,,,,255,216.75,73.083,299,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Botox Injection; Chronic Migraine,,64615,CPT,Facility,Both,,,,255,216.75,73.083,299,CorVel,Worker's Compensation,255,100,,percent of total billed charges,,
Botox Injection; Chronic Migraine,,64615,CPT,Facility,Both,,,,255,216.75,73.083,299,First Health Group Corporation,First Health Network,247.35,97,,percent of total billed charges,,
Botox Injection; Chronic Migraine,,64615,CPT,Facility,Both,,,,255,216.75,73.083,299,"Health Partners, Inc.",Commercial,241.23,94.6,,percent of total billed charges,,
Botox Injection; Chronic Migraine,,64615,CPT,Facility,Outpatient,,,,255,216.75,73.083,299,"Health Partners, Inc.",Medicare Advantage,124.95,49,,percent of total billed charges,,
Botox Injection; Chronic Migraine,,64615,CPT,Facility,Inpatient,,,,255,216.75,73.083,299,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Botox Injection; Chronic Migraine,,64615,CPT,Facility,Both,,,,255,216.75,73.083,299,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),153,60,,percent of total billed charges,,
Botox Injection; Chronic Migraine,,64615,CPT,Facility,Both,,,,255,216.75,73.083,299,"Health Partners, Inc.",State of Minnesota Advantage Program,207.825,81.5,,percent of total billed charges,,
Botox Injection; Chronic Migraine,,64615,CPT,Facility,Both,,,,255,216.75,73.083,299,"Health Partners, Inc.",State Public Programs,127.5,50,,percent of total billed charges,,
Botox Injection; Chronic Migraine,,64615,CPT,Facility,Both,,,,255,216.75,73.083,299,Humana Insurance Company,Commercial PPO,242.25,95,,percent of total billed charges,,
Botox Injection; Chronic Migraine,,64615,CPT,Facility,Outpatient,,,,255,216.75,73.083,299,Humana Insurance Company,Medicare PPO,124.95,49,,percent of total billed charges,,
Botox Injection; Chronic Migraine,,64615,CPT,Facility,Inpatient,,,,255,216.75,73.083,299,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Botox Injection; Chronic Migraine,,64615,CPT,Facility,Both,,,,255,216.75,73.083,299,Medica,Individual & Family,252.705,99.1,,percent of total billed charges,,
Botox Injection; Chronic Migraine,,64615,CPT,Facility,Outpatient,,,,255,216.75,73.083,299,Medica,Medica Advantage Solution,126.99,49.8,,percent of total billed charges,,
Botox Injection; Chronic Migraine,,64615,CPT,Facility,Inpatient,,,,255,216.75,73.083,299,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Botox Injection; Chronic Migraine,,64615,CPT,Facility,Outpatient,,,,255,216.75,73.083,299,Medica,Medical Assistance,299,,,Other,Grouper,All inclusive per visit
Botox Injection; Chronic Migraine,,64615,CPT,Facility,Inpatient,,,,255,216.75,73.083,299,Medica,Medical Assistance,,,,,Included in per diem rate,
Botox Injection; Chronic Migraine,,64615,CPT,Facility,Outpatient,,,,255,216.75,73.083,299,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,126.99,49.8,,percent of total billed charges,,
Botox Injection; Chronic Migraine,,64615,CPT,Facility,Inpatient,,,,255,216.75,73.083,299,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Botox Injection; Chronic Migraine,,64615,CPT,Facility,Both,,,,255,216.75,73.083,299,"Multiplan, Inc.","Multiplan, Inc.",239.7,94,,percent of total billed charges,,
Botox Injection; Chronic Migraine,,64615,CPT,Facility,Outpatient,,,,255,216.75,73.083,299,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,229.755,90.1,,percent of total billed charges,,
Botox Injection; Chronic Migraine,,64615,CPT,Facility,Inpatient,,,,255,216.75,73.083,299,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Botox Injection; Chronic Migraine,,64615,CPT,Facility,Both,,,,255,216.75,73.083,299,"Preferred One Administrative Services, INC.",PPO,251.43,98.6,,percent of total billed charges,,
Botox Injection; Chronic Migraine,,64615,CPT,Facility,Outpatient,,,,255,216.75,73.083,299,PrimeWest Health,Minnesota Senior Health Options (MSHO),131.1975,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Botox Injection; Chronic Migraine,,64615,CPT,Facility,Inpatient,,,,255,216.75,73.083,299,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Botox Injection; Chronic Migraine,,64615,CPT,Facility,Outpatient,,,,255,216.75,73.083,299,PrimeWest Health,MinnesotaCare,130.968,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Botox Injection; Chronic Migraine,,64615,CPT,Facility,Inpatient,,,,255,216.75,73.083,299,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Botox Injection; Chronic Migraine,,64615,CPT,Facility,Both,,,,255,216.75,73.083,299,Sanford Health Plan,Sanford Health Plan,234.6,92,,percent of total billed charges,,
Botox Injection; Chronic Migraine,,64615,CPT,Facility,Outpatient,,,,255,216.75,73.083,299,"UCare Health, Inc.",Individual & Family Plan,143.6925,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Botox Injection; Chronic Migraine,,64615,CPT,Facility,Inpatient,,,,255,216.75,73.083,299,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Botox Injection; Chronic Migraine,,64615,CPT,Facility,Outpatient,,,,255,216.75,73.083,299,"UCare Health, Inc.",Medical Assistance,128.6985,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Botox Injection; Chronic Migraine,,64615,CPT,Facility,Inpatient,,,,255,216.75,73.083,299,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Botox Injection; Chronic Migraine,,64615,CPT,Facility,Outpatient,,,,255,216.75,73.083,299,"UCare Health, Inc.",Medicare Advantage,128.6985,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Botox Injection; Chronic Migraine,,64615,CPT,Facility,Inpatient,,,,255,216.75,73.083,299,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Botox Injection; Chronic Migraine,,64615,CPT,Facility,Outpatient,,,,255,216.75,73.083,299,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),128.6985,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Botox Injection; Chronic Migraine,,64615,CPT,Facility,Inpatient,,,,255,216.75,73.083,299,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Botox Injection; Chronic Migraine,,64615,CPT,Facility,Both,,,,255,216.75,73.083,299,UnitedHealthcare,Individual & Family,239.7,94,,percent of total billed charges,,
Botox Injection; Chronic Migraine,,64615,CPT,Facility,Outpatient,,,,255,216.75,73.083,299,UnitedHealthcare,Medicare Advantage,124.95,49,,percent of total billed charges,,
Botox Injection; Chronic Migraine,,64615,CPT,Facility,Inpatient,,,,255,216.75,73.083,299,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Botox Injection; Chronic Migraine,,64615,CPT,Facility,Outpatient,,,,255,216.75,73.083,299,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,122.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
Botox Injection; Chronic Migraine,,64615,CPT,Facility,Inpatient,,,,255,216.75,73.083,299,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Chemodenervation Of Muscle(S) Innervated By Facial,Trigeminal,Cervical Spinal And Assessory Nerves (Pro Cah)",,64615,CPT,Professional,Both,,,,590,501.5,71.11,590,Aetna,Commercial,501.5,85,,percent of total billed charges,,
"Chemodenervation Of Muscle(S) Innervated By Facial,Trigeminal,Cervical Spinal And Assessory Nerves (Pro Cah)",,64615,CPT,Professional,Both,,,,590,501.5,71.11,590,Aetna,Medicare Advantage,113.53,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Chemodenervation Of Muscle(S) Innervated By Facial,Trigeminal,Cervical Spinal And Assessory Nerves (Pro Cah)",,64615,CPT,Professional,Both,,,,590,501.5,71.11,590,Aetna,PPO,548.7,93,,percent of total billed charges,,
"Chemodenervation Of Muscle(S) Innervated By Facial,Trigeminal,Cervical Spinal And Assessory Nerves (Pro Cah)",,64615,CPT,Professional,Both,,,,590,501.5,71.11,590,America's PPO,America's PPO,504.096,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Chemodenervation Of Muscle(S) Innervated By Facial,Trigeminal,Cervical Spinal And Assessory Nerves (Pro Cah)",,64615,CPT,Professional,Both,,,,590,501.5,71.11,590,BlueCross BlueShield Minnesota, Federal Employee Program,253.4,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Chemodenervation Of Muscle(S) Innervated By Facial,Trigeminal,Cervical Spinal And Assessory Nerves (Pro Cah)",,64615,CPT,Professional,Both,,,,590,501.5,71.11,590,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,257.4544,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Chemodenervation Of Muscle(S) Innervated By Facial,Trigeminal,Cervical Spinal And Assessory Nerves (Pro Cah)",,64615,CPT,Professional,Both,,,,590,501.5,71.11,590,BlueCross BlueShield Minnesota,High Value Network Plan,257.4544,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Chemodenervation Of Muscle(S) Innervated By Facial,Trigeminal,Cervical Spinal And Assessory Nerves (Pro Cah)",,64615,CPT,Professional,Both,,,,590,501.5,71.11,590,BlueCross BlueShield Minnesota,Medicare Advantage,127.213,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Chemodenervation Of Muscle(S) Innervated By Facial,Trigeminal,Cervical Spinal And Assessory Nerves (Pro Cah)",,64615,CPT,Professional,Both,,,,590,501.5,71.11,590,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,257.4544,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Chemodenervation Of Muscle(S) Innervated By Facial,Trigeminal,Cervical Spinal And Assessory Nerves (Pro Cah)",,64615,CPT,Professional,Both,,,,590,501.5,71.11,590,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,82.10296,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Chemodenervation Of Muscle(S) Innervated By Facial,Trigeminal,Cervical Spinal And Assessory Nerves (Pro Cah)",,64615,CPT,Professional,Both,,,,590,501.5,71.11,590,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),127.213,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Chemodenervation Of Muscle(S) Innervated By Facial,Trigeminal,Cervical Spinal And Assessory Nerves (Pro Cah)",,64615,CPT,Professional,Both,,,,590,501.5,71.11,590,CorVel,Worker's Compensation,219.4625259,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Chemodenervation Of Muscle(S) Innervated By Facial,Trigeminal,Cervical Spinal And Assessory Nerves (Pro Cah)",,64615,CPT,Professional,Both,,,,590,501.5,71.11,590,First Health Group Corporation,First Health Network,572.3,97,,percent of total billed charges,,
"Chemodenervation Of Muscle(S) Innervated By Facial,Trigeminal,Cervical Spinal And Assessory Nerves (Pro Cah)",,64615,CPT,Professional,Both,,,,590,501.5,71.11,590,"Health Partners, Inc.",Commercial,237.25,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Chemodenervation Of Muscle(S) Innervated By Facial,Trigeminal,Cervical Spinal And Assessory Nerves (Pro Cah)",,64615,CPT,Professional,Both,,,,590,501.5,71.11,590,"Health Partners, Inc.",Medicare Advantage,127.213,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Chemodenervation Of Muscle(S) Innervated By Facial,Trigeminal,Cervical Spinal And Assessory Nerves (Pro Cah)",,64615,CPT,Professional,Both,,,,590,501.5,71.11,590,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),110.47,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Chemodenervation Of Muscle(S) Innervated By Facial,Trigeminal,Cervical Spinal And Assessory Nerves (Pro Cah)",,64615,CPT,Professional,Both,,,,590,501.5,71.11,590,"Health Partners, Inc.",State of Minnesota Advantage Program,204.390875,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Chemodenervation Of Muscle(S) Innervated By Facial,Trigeminal,Cervical Spinal And Assessory Nerves (Pro Cah)",,64615,CPT,Professional,Both,,,,590,501.5,71.11,590,"Health Partners, Inc.",State Public Programs,71.11,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Chemodenervation Of Muscle(S) Innervated By Facial,Trigeminal,Cervical Spinal And Assessory Nerves (Pro Cah)",,64615,CPT,Professional,Both,,,,590,501.5,71.11,590,Humana Insurance Company,Commercial PPO,110.62,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Chemodenervation Of Muscle(S) Innervated By Facial,Trigeminal,Cervical Spinal And Assessory Nerves (Pro Cah)",,64615,CPT,Professional,Both,,,,590,501.5,71.11,590,Humana Insurance Company,Medicare PPO,590,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Chemodenervation Of Muscle(S) Innervated By Facial,Trigeminal,Cervical Spinal And Assessory Nerves (Pro Cah)",,64615,CPT,Professional,Both,,,,590,501.5,71.11,590,Medica,Individual & Family,500.32,84.8,,percent of total billed charges,,
"Chemodenervation Of Muscle(S) Innervated By Facial,Trigeminal,Cervical Spinal And Assessory Nerves (Pro Cah)",,64615,CPT,Professional,Both,,,,590,501.5,71.11,590,Medica,Medica Advantage Solution,293.82,49.8,,percent of total billed charges,,
"Chemodenervation Of Muscle(S) Innervated By Facial,Trigeminal,Cervical Spinal And Assessory Nerves (Pro Cah)",,64615,CPT,Professional,Both,,,,590,501.5,71.11,590,Medica,Medical Assistance,82.1,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Chemodenervation Of Muscle(S) Innervated By Facial,Trigeminal,Cervical Spinal And Assessory Nerves (Pro Cah)",,64615,CPT,Professional,Both,,,,590,501.5,71.11,590,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,110.62,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Chemodenervation Of Muscle(S) Innervated By Facial,Trigeminal,Cervical Spinal And Assessory Nerves (Pro Cah)",,64615,CPT,Professional,Both,,,,590,501.5,71.11,590,"Multiplan, Inc.","Multiplan, Inc.",554.6,94,,percent of total billed charges,,
"Chemodenervation Of Muscle(S) Innervated By Facial,Trigeminal,Cervical Spinal And Assessory Nerves (Pro Cah)",,64615,CPT,Professional,Both,,,,590,501.5,71.11,590,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,531.59,90.1,,percent of total billed charges,,
"Chemodenervation Of Muscle(S) Innervated By Facial,Trigeminal,Cervical Spinal And Assessory Nerves (Pro Cah)",,64615,CPT,Professional,Both,,,,590,501.5,71.11,590,"Preferred One Administrative Services, INC.",PPO,581.74,98.6,,percent of total billed charges,,
"Chemodenervation Of Muscle(S) Innervated By Facial,Trigeminal,Cervical Spinal And Assessory Nerves (Pro Cah)",,64615,CPT,Professional,Both,,,,590,501.5,71.11,590,PrimeWest Health,Minnesota Senior Health Options (MSHO),127.213,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Chemodenervation Of Muscle(S) Innervated By Facial,Trigeminal,Cervical Spinal And Assessory Nerves (Pro Cah)",,64615,CPT,Professional,Both,,,,590,501.5,71.11,590,PrimeWest Health,MinnesotaCare,87.8501672,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Chemodenervation Of Muscle(S) Innervated By Facial,Trigeminal,Cervical Spinal And Assessory Nerves (Pro Cah)",,64615,CPT,Professional,Both,,,,590,501.5,71.11,590,Sanford Health Plan,Sanford Health Plan,519.2,88,,percent of total billed charges,,
"Chemodenervation Of Muscle(S) Innervated By Facial,Trigeminal,Cervical Spinal And Assessory Nerves (Pro Cah)",,64615,CPT,Professional,Both,,,,590,501.5,71.11,590,"UCare Health, Inc.",Individual & Family Plan,179.823872,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Chemodenervation Of Muscle(S) Innervated By Facial,Trigeminal,Cervical Spinal And Assessory Nerves (Pro Cah)",,64615,CPT,Professional,Both,,,,590,501.5,71.11,590,"UCare Health, Inc.",Medical Assistance,90.313256,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Chemodenervation Of Muscle(S) Innervated By Facial,Trigeminal,Cervical Spinal And Assessory Nerves (Pro Cah)",,64615,CPT,Professional,Both,,,,590,501.5,71.11,590,"UCare Health, Inc.",Medicare Advantage,127.213,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Chemodenervation Of Muscle(S) Innervated By Facial,Trigeminal,Cervical Spinal And Assessory Nerves (Pro Cah)",,64615,CPT,Professional,Both,,,,590,501.5,71.11,590,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),101.7704,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Chemodenervation Of Muscle(S) Innervated By Facial,Trigeminal,Cervical Spinal And Assessory Nerves (Pro Cah)",,64615,CPT,Professional,Both,,,,590,501.5,71.11,590,UnitedHealthcare,Individual & Family,590,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Chemodenervation Of Muscle(S) Innervated By Facial,Trigeminal,Cervical Spinal And Assessory Nerves (Pro Cah)",,64615,CPT,Professional,Both,,,,590,501.5,71.11,590,UnitedHealthcare,Medicare Advantage,127.213,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Chemodenervation Of Muscle(S) Innervated By Facial,Trigeminal,Cervical Spinal And Assessory Nerves (Pro Cah)",,64615,CPT,Professional,Both,,,,590,501.5,71.11,590,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,82.10296,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Neuroplasty And/Or Transposition; Ulnar Nerve At Elbow (Pro Cah),,64718,CPT,Professional,Both,,,,2769,2353.65,379.58,2769,Aetna,Commercial,2353.65,85,,percent of total billed charges,,
Neuroplasty And/Or Transposition; Ulnar Nerve At Elbow (Pro Cah),,64718,CPT,Professional,Both,,,,2769,2353.65,379.58,2769,Aetna,Medicare Advantage,589.41,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Neuroplasty And/Or Transposition; Ulnar Nerve At Elbow (Pro Cah),,64718,CPT,Professional,Both,,,,2769,2353.65,379.58,2769,Aetna,PPO,2575.17,93,,percent of total billed charges,,
Neuroplasty And/Or Transposition; Ulnar Nerve At Elbow (Pro Cah),,64718,CPT,Professional,Both,,,,2769,2353.65,379.58,2769,America's PPO,America's PPO,2365.8336,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Neuroplasty And/Or Transposition; Ulnar Nerve At Elbow (Pro Cah),,64718,CPT,Professional,Both,,,,2769,2353.65,379.58,2769,BlueCross BlueShield Minnesota, Federal Employee Program,1253.25,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Neuroplasty And/Or Transposition; Ulnar Nerve At Elbow (Pro Cah),,64718,CPT,Professional,Both,,,,2769,2353.65,379.58,2769,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1273.302,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Neuroplasty And/Or Transposition; Ulnar Nerve At Elbow (Pro Cah),,64718,CPT,Professional,Both,,,,2769,2353.65,379.58,2769,BlueCross BlueShield Minnesota,High Value Network Plan,1273.302,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Neuroplasty And/Or Transposition; Ulnar Nerve At Elbow (Pro Cah),,64718,CPT,Professional,Both,,,,2769,2353.65,379.58,2769,BlueCross BlueShield Minnesota,Medicare Advantage,678.201,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Neuroplasty And/Or Transposition; Ulnar Nerve At Elbow (Pro Cah),,64718,CPT,Professional,Both,,,,2769,2353.65,379.58,2769,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1273.302,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Neuroplasty And/Or Transposition; Ulnar Nerve At Elbow (Pro Cah),,64718,CPT,Professional,Both,,,,2769,2353.65,379.58,2769,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,438.24144,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Neuroplasty And/Or Transposition; Ulnar Nerve At Elbow (Pro Cah),,64718,CPT,Professional,Both,,,,2769,2353.65,379.58,2769,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),678.201,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Neuroplasty And/Or Transposition; Ulnar Nerve At Elbow (Pro Cah),,64718,CPT,Professional,Both,,,,2769,2353.65,379.58,2769,CorVel,Worker's Compensation,1145.073858,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Neuroplasty And/Or Transposition; Ulnar Nerve At Elbow (Pro Cah),,64718,CPT,Professional,Both,,,,2769,2353.65,379.58,2769,First Health Group Corporation,First Health Network,2685.93,97,,percent of total billed charges,,
Neuroplasty And/Or Transposition; Ulnar Nerve At Elbow (Pro Cah),,64718,CPT,Professional,Both,,,,2769,2353.65,379.58,2769,"Health Partners, Inc.",Commercial,1237.02,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Neuroplasty And/Or Transposition; Ulnar Nerve At Elbow (Pro Cah),,64718,CPT,Professional,Both,,,,2769,2353.65,379.58,2769,"Health Partners, Inc.",Medicare Advantage,678.201,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Neuroplasty And/Or Transposition; Ulnar Nerve At Elbow (Pro Cah),,64718,CPT,Professional,Both,,,,2769,2353.65,379.58,2769,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),589.64,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Neuroplasty And/Or Transposition; Ulnar Nerve At Elbow (Pro Cah),,64718,CPT,Professional,Both,,,,2769,2353.65,379.58,2769,"Health Partners, Inc.",State of Minnesota Advantage Program,1065.69273,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Neuroplasty And/Or Transposition; Ulnar Nerve At Elbow (Pro Cah),,64718,CPT,Professional,Both,,,,2769,2353.65,379.58,2769,"Health Partners, Inc.",State Public Programs,379.58,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Neuroplasty And/Or Transposition; Ulnar Nerve At Elbow (Pro Cah),,64718,CPT,Professional,Both,,,,2769,2353.65,379.58,2769,Humana Insurance Company,Commercial PPO,589.74,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Neuroplasty And/Or Transposition; Ulnar Nerve At Elbow (Pro Cah),,64718,CPT,Professional,Both,,,,2769,2353.65,379.58,2769,Humana Insurance Company,Medicare PPO,2769,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Neuroplasty And/Or Transposition; Ulnar Nerve At Elbow (Pro Cah),,64718,CPT,Professional,Both,,,,2769,2353.65,379.58,2769,Medica,Individual & Family,2348.112,84.8,,percent of total billed charges,,
Neuroplasty And/Or Transposition; Ulnar Nerve At Elbow (Pro Cah),,64718,CPT,Professional,Both,,,,2769,2353.65,379.58,2769,Medica,Medica Advantage Solution,1378.962,49.8,,percent of total billed charges,,
Neuroplasty And/Or Transposition; Ulnar Nerve At Elbow (Pro Cah),,64718,CPT,Professional,Both,,,,2769,2353.65,379.58,2769,Medica,Medical Assistance,438.24,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Neuroplasty And/Or Transposition; Ulnar Nerve At Elbow (Pro Cah),,64718,CPT,Professional,Both,,,,2769,2353.65,379.58,2769,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,589.74,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Neuroplasty And/Or Transposition; Ulnar Nerve At Elbow (Pro Cah),,64718,CPT,Professional,Both,,,,2769,2353.65,379.58,2769,"Multiplan, Inc.","Multiplan, Inc.",2602.86,94,,percent of total billed charges,,
Neuroplasty And/Or Transposition; Ulnar Nerve At Elbow (Pro Cah),,64718,CPT,Professional,Both,,,,2769,2353.65,379.58,2769,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,2494.869,90.1,,percent of total billed charges,,
Neuroplasty And/Or Transposition; Ulnar Nerve At Elbow (Pro Cah),,64718,CPT,Professional,Both,,,,2769,2353.65,379.58,2769,"Preferred One Administrative Services, INC.",PPO,2730.234,98.6,,percent of total billed charges,,
Neuroplasty And/Or Transposition; Ulnar Nerve At Elbow (Pro Cah),,64718,CPT,Professional,Both,,,,2769,2353.65,379.58,2769,PrimeWest Health,Minnesota Senior Health Options (MSHO),678.201,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Neuroplasty And/Or Transposition; Ulnar Nerve At Elbow (Pro Cah),,64718,CPT,Professional,Both,,,,2769,2353.65,379.58,2769,PrimeWest Health,MinnesotaCare,468.9183408,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Neuroplasty And/Or Transposition; Ulnar Nerve At Elbow (Pro Cah),,64718,CPT,Professional,Both,,,,2769,2353.65,379.58,2769,Sanford Health Plan,Sanford Health Plan,2436.72,88,,percent of total billed charges,,
Neuroplasty And/Or Transposition; Ulnar Nerve At Elbow (Pro Cah),,64718,CPT,Professional,Both,,,,2769,2353.65,379.58,2769,"UCare Health, Inc.",Individual & Family Plan,958.681344,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Neuroplasty And/Or Transposition; Ulnar Nerve At Elbow (Pro Cah),,64718,CPT,Professional,Both,,,,2769,2353.65,379.58,2769,"UCare Health, Inc.",Medical Assistance,482.065584,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Neuroplasty And/Or Transposition; Ulnar Nerve At Elbow (Pro Cah),,64718,CPT,Professional,Both,,,,2769,2353.65,379.58,2769,"UCare Health, Inc.",Medicare Advantage,678.201,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Neuroplasty And/Or Transposition; Ulnar Nerve At Elbow (Pro Cah),,64718,CPT,Professional,Both,,,,2769,2353.65,379.58,2769,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),542.5608,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Neuroplasty And/Or Transposition; Ulnar Nerve At Elbow (Pro Cah),,64718,CPT,Professional,Both,,,,2769,2353.65,379.58,2769,UnitedHealthcare,Individual & Family,2769,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Neuroplasty And/Or Transposition; Ulnar Nerve At Elbow (Pro Cah),,64718,CPT,Professional,Both,,,,2769,2353.65,379.58,2769,UnitedHealthcare,Medicare Advantage,678.201,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Neuroplasty And/Or Transposition; Ulnar Nerve At Elbow (Pro Cah),,64718,CPT,Professional,Both,,,,2769,2353.65,379.58,2769,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,438.24144,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Neuroplasty And/Or Transposition Median Nerve At Carpal Tunnel (Pro Cah),,64721,CPT,Professional,Both,,,,2234,1898.9,276.61,2234,Aetna,Commercial,1898.9,85,,percent of total billed charges,,
Neuroplasty And/Or Transposition Median Nerve At Carpal Tunnel (Pro Cah),,64721,CPT,Professional,Both,,,,2234,1898.9,276.61,2234,Aetna,Medicare Advantage,429.14,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Neuroplasty And/Or Transposition Median Nerve At Carpal Tunnel (Pro Cah),,64721,CPT,Professional,Both,,,,2234,1898.9,276.61,2234,Aetna,PPO,2077.62,93,,percent of total billed charges,,
Neuroplasty And/Or Transposition Median Nerve At Carpal Tunnel (Pro Cah),,64721,CPT,Professional,Both,,,,2234,1898.9,276.61,2234,America's PPO,America's PPO,1908.7296,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Neuroplasty And/Or Transposition Median Nerve At Carpal Tunnel (Pro Cah),,64721,CPT,Professional,Both,,,,2234,1898.9,276.61,2234,BlueCross BlueShield Minnesota, Federal Employee Program,908.95,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Neuroplasty And/Or Transposition Median Nerve At Carpal Tunnel (Pro Cah),,64721,CPT,Professional,Both,,,,2234,1898.9,276.61,2234,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,923.4932,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Neuroplasty And/Or Transposition Median Nerve At Carpal Tunnel (Pro Cah),,64721,CPT,Professional,Both,,,,2234,1898.9,276.61,2234,BlueCross BlueShield Minnesota,High Value Network Plan,923.4932,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Neuroplasty And/Or Transposition Median Nerve At Carpal Tunnel (Pro Cah),,64721,CPT,Professional,Both,,,,2234,1898.9,276.61,2234,BlueCross BlueShield Minnesota,Medicare Advantage,494.3045,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Neuroplasty And/Or Transposition Median Nerve At Carpal Tunnel (Pro Cah),,64721,CPT,Professional,Both,,,,2234,1898.9,276.61,2234,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,923.4932,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Neuroplasty And/Or Transposition Median Nerve At Carpal Tunnel (Pro Cah),,64721,CPT,Professional,Both,,,,2234,1898.9,276.61,2234,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,319.35928,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Neuroplasty And/Or Transposition Median Nerve At Carpal Tunnel (Pro Cah),,64721,CPT,Professional,Both,,,,2234,1898.9,276.61,2234,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),494.3045,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Neuroplasty And/Or Transposition Median Nerve At Carpal Tunnel (Pro Cah),,64721,CPT,Professional,Both,,,,2234,1898.9,276.61,2234,CorVel,Worker's Compensation,834.291702,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Neuroplasty And/Or Transposition Median Nerve At Carpal Tunnel (Pro Cah),,64721,CPT,Professional,Both,,,,2234,1898.9,276.61,2234,First Health Group Corporation,First Health Network,2166.98,97,,percent of total billed charges,,
Neuroplasty And/Or Transposition Median Nerve At Carpal Tunnel (Pro Cah),,64721,CPT,Professional,Both,,,,2234,1898.9,276.61,2234,"Health Partners, Inc.",Commercial,901.1,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Neuroplasty And/Or Transposition Median Nerve At Carpal Tunnel (Pro Cah),,64721,CPT,Professional,Both,,,,2234,1898.9,276.61,2234,"Health Partners, Inc.",Medicare Advantage,494.3045,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Neuroplasty And/Or Transposition Median Nerve At Carpal Tunnel (Pro Cah),,64721,CPT,Professional,Both,,,,2234,1898.9,276.61,2234,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),430.03,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Neuroplasty And/Or Transposition Median Nerve At Carpal Tunnel (Pro Cah),,64721,CPT,Professional,Both,,,,2234,1898.9,276.61,2234,"Health Partners, Inc.",State of Minnesota Advantage Program,776.29765,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Neuroplasty And/Or Transposition Median Nerve At Carpal Tunnel (Pro Cah),,64721,CPT,Professional,Both,,,,2234,1898.9,276.61,2234,"Health Partners, Inc.",State Public Programs,276.61,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Neuroplasty And/Or Transposition Median Nerve At Carpal Tunnel (Pro Cah),,64721,CPT,Professional,Both,,,,2234,1898.9,276.61,2234,Humana Insurance Company,Commercial PPO,429.83,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Neuroplasty And/Or Transposition Median Nerve At Carpal Tunnel (Pro Cah),,64721,CPT,Professional,Both,,,,2234,1898.9,276.61,2234,Humana Insurance Company,Medicare PPO,2234,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Neuroplasty And/Or Transposition Median Nerve At Carpal Tunnel (Pro Cah),,64721,CPT,Professional,Both,,,,2234,1898.9,276.61,2234,Medica,Individual & Family,1894.432,84.8,,percent of total billed charges,,
Neuroplasty And/Or Transposition Median Nerve At Carpal Tunnel (Pro Cah),,64721,CPT,Professional,Both,,,,2234,1898.9,276.61,2234,Medica,Medica Advantage Solution,1112.532,49.8,,percent of total billed charges,,
Neuroplasty And/Or Transposition Median Nerve At Carpal Tunnel (Pro Cah),,64721,CPT,Professional,Both,,,,2234,1898.9,276.61,2234,Medica,Medical Assistance,319.36,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Neuroplasty And/Or Transposition Median Nerve At Carpal Tunnel (Pro Cah),,64721,CPT,Professional,Both,,,,2234,1898.9,276.61,2234,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,429.83,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Neuroplasty And/Or Transposition Median Nerve At Carpal Tunnel (Pro Cah),,64721,CPT,Professional,Both,,,,2234,1898.9,276.61,2234,"Multiplan, Inc.","Multiplan, Inc.",2099.96,94,,percent of total billed charges,,
Neuroplasty And/Or Transposition Median Nerve At Carpal Tunnel (Pro Cah),,64721,CPT,Professional,Both,,,,2234,1898.9,276.61,2234,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,2012.834,90.1,,percent of total billed charges,,
Neuroplasty And/Or Transposition Median Nerve At Carpal Tunnel (Pro Cah),,64721,CPT,Professional,Both,,,,2234,1898.9,276.61,2234,"Preferred One Administrative Services, INC.",PPO,2202.724,98.6,,percent of total billed charges,,
Neuroplasty And/Or Transposition Median Nerve At Carpal Tunnel (Pro Cah),,64721,CPT,Professional,Both,,,,2234,1898.9,276.61,2234,PrimeWest Health,Minnesota Senior Health Options (MSHO),494.3045,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Neuroplasty And/Or Transposition Median Nerve At Carpal Tunnel (Pro Cah),,64721,CPT,Professional,Both,,,,2234,1898.9,276.61,2234,PrimeWest Health,MinnesotaCare,341.7144296,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Neuroplasty And/Or Transposition Median Nerve At Carpal Tunnel (Pro Cah),,64721,CPT,Professional,Both,,,,2234,1898.9,276.61,2234,Sanford Health Plan,Sanford Health Plan,1965.92,88,,percent of total billed charges,,
Neuroplasty And/Or Transposition Median Nerve At Carpal Tunnel (Pro Cah),,64721,CPT,Professional,Both,,,,2234,1898.9,276.61,2234,"UCare Health, Inc.",Individual & Family Plan,698.731648,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Neuroplasty And/Or Transposition Median Nerve At Carpal Tunnel (Pro Cah),,64721,CPT,Professional,Both,,,,2234,1898.9,276.61,2234,"UCare Health, Inc.",Medical Assistance,351.295208,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Neuroplasty And/Or Transposition Median Nerve At Carpal Tunnel (Pro Cah),,64721,CPT,Professional,Both,,,,2234,1898.9,276.61,2234,"UCare Health, Inc.",Medicare Advantage,494.3045,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Neuroplasty And/Or Transposition Median Nerve At Carpal Tunnel (Pro Cah),,64721,CPT,Professional,Both,,,,2234,1898.9,276.61,2234,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),395.4436,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Neuroplasty And/Or Transposition Median Nerve At Carpal Tunnel (Pro Cah),,64721,CPT,Professional,Both,,,,2234,1898.9,276.61,2234,UnitedHealthcare,Individual & Family,2234,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Neuroplasty And/Or Transposition Median Nerve At Carpal Tunnel (Pro Cah),,64721,CPT,Professional,Both,,,,2234,1898.9,276.61,2234,UnitedHealthcare,Medicare Advantage,494.3045,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Neuroplasty And/Or Transposition Median Nerve At Carpal Tunnel (Pro Cah),,64721,CPT,Professional,Both,,,,2234,1898.9,276.61,2234,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,319.35928,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Remove Fb Eye Superficial (Pro Cah),,65205,CPT,Professional,Both,,,,252,214.2,18.1,252,Aetna,Commercial,214.2,85,,percent of total billed charges,,
Remove Fb Eye Superficial (Pro Cah),,65205,CPT,Professional,Both,,,,252,214.2,18.1,252,Aetna,Medicare Advantage,28.9,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Remove Fb Eye Superficial (Pro Cah),,65205,CPT,Professional,Both,,,,252,214.2,18.1,252,Aetna,PPO,234.36,93,,percent of total billed charges,,
Remove Fb Eye Superficial (Pro Cah),,65205,CPT,Professional,Both,,,,252,214.2,18.1,252,America's PPO,America's PPO,215.3088,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Remove Fb Eye Superficial (Pro Cah),,65205,CPT,Professional,Both,,,,252,214.2,18.1,252,BlueCross BlueShield Minnesota, Federal Employee Program,59.22,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Remove Fb Eye Superficial (Pro Cah),,65205,CPT,Professional,Both,,,,252,214.2,18.1,252,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,60.16752,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Remove Fb Eye Superficial (Pro Cah),,65205,CPT,Professional,Both,,,,252,214.2,18.1,252,BlueCross BlueShield Minnesota,High Value Network Plan,60.16752,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Remove Fb Eye Superficial (Pro Cah),,65205,CPT,Professional,Both,,,,252,214.2,18.1,252,BlueCross BlueShield Minnesota,Medicare Advantage,32.706,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Remove Fb Eye Superficial (Pro Cah),,65205,CPT,Professional,Both,,,,252,214.2,18.1,252,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,60.16752,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Remove Fb Eye Superficial (Pro Cah),,65205,CPT,Professional,Both,,,,252,214.2,18.1,252,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,20.89912,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Remove Fb Eye Superficial (Pro Cah),,65205,CPT,Professional,Both,,,,252,214.2,18.1,252,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),32.706,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Remove Fb Eye Superficial (Pro Cah),,65205,CPT,Professional,Both,,,,252,214.2,18.1,252,CorVel,Worker's Compensation,55.6355676,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Remove Fb Eye Superficial (Pro Cah),,65205,CPT,Professional,Both,,,,252,214.2,18.1,252,First Health Group Corporation,First Health Network,244.44,97,,percent of total billed charges,,
Remove Fb Eye Superficial (Pro Cah),,65205,CPT,Professional,Both,,,,252,214.2,18.1,252,"Health Partners, Inc.",Commercial,59.5,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Remove Fb Eye Superficial (Pro Cah),,65205,CPT,Professional,Both,,,,252,214.2,18.1,252,"Health Partners, Inc.",Medicare Advantage,32.706,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Remove Fb Eye Superficial (Pro Cah),,65205,CPT,Professional,Both,,,,252,214.2,18.1,252,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),28.47,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Remove Fb Eye Superficial (Pro Cah),,65205,CPT,Professional,Both,,,,252,214.2,18.1,252,"Health Partners, Inc.",State of Minnesota Advantage Program,51.25925,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Remove Fb Eye Superficial (Pro Cah),,65205,CPT,Professional,Both,,,,252,214.2,18.1,252,"Health Partners, Inc.",State Public Programs,18.1,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Remove Fb Eye Superficial (Pro Cah),,65205,CPT,Professional,Both,,,,252,214.2,18.1,252,Humana Insurance Company,Commercial PPO,28.44,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Remove Fb Eye Superficial (Pro Cah),,65205,CPT,Professional,Both,,,,252,214.2,18.1,252,Humana Insurance Company,Medicare PPO,252,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Remove Fb Eye Superficial (Pro Cah),,65205,CPT,Professional,Both,,,,252,214.2,18.1,252,Medica,Individual & Family,213.696,84.8,,percent of total billed charges,,
Remove Fb Eye Superficial (Pro Cah),,65205,CPT,Professional,Both,,,,252,214.2,18.1,252,Medica,Medica Advantage Solution,125.496,49.8,,percent of total billed charges,,
Remove Fb Eye Superficial (Pro Cah),,65205,CPT,Professional,Both,,,,252,214.2,18.1,252,Medica,Medical Assistance,20.9,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Remove Fb Eye Superficial (Pro Cah),,65205,CPT,Professional,Both,,,,252,214.2,18.1,252,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,28.44,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Remove Fb Eye Superficial (Pro Cah),,65205,CPT,Professional,Both,,,,252,214.2,18.1,252,"Multiplan, Inc.","Multiplan, Inc.",236.88,94,,percent of total billed charges,,
Remove Fb Eye Superficial (Pro Cah),,65205,CPT,Professional,Both,,,,252,214.2,18.1,252,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,227.052,90.1,,percent of total billed charges,,
Remove Fb Eye Superficial (Pro Cah),,65205,CPT,Professional,Both,,,,252,214.2,18.1,252,"Preferred One Administrative Services, INC.",PPO,248.472,98.6,,percent of total billed charges,,
Remove Fb Eye Superficial (Pro Cah),,65205,CPT,Professional,Both,,,,252,214.2,18.1,252,PrimeWest Health,Minnesota Senior Health Options (MSHO),32.706,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Remove Fb Eye Superficial (Pro Cah),,65205,CPT,Professional,Both,,,,252,214.2,18.1,252,PrimeWest Health,MinnesotaCare,22.3620584,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Remove Fb Eye Superficial (Pro Cah),,65205,CPT,Professional,Both,,,,252,214.2,18.1,252,Sanford Health Plan,Sanford Health Plan,221.76,88,,percent of total billed charges,,
Remove Fb Eye Superficial (Pro Cah),,65205,CPT,Professional,Both,,,,252,214.2,18.1,252,"UCare Health, Inc.",Individual & Family Plan,46.232064,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Remove Fb Eye Superficial (Pro Cah),,65205,CPT,Professional,Both,,,,252,214.2,18.1,252,"UCare Health, Inc.",Medical Assistance,22.989032,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Remove Fb Eye Superficial (Pro Cah),,65205,CPT,Professional,Both,,,,252,214.2,18.1,252,"UCare Health, Inc.",Medicare Advantage,32.706,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Remove Fb Eye Superficial (Pro Cah),,65205,CPT,Professional,Both,,,,252,214.2,18.1,252,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),26.1648,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Remove Fb Eye Superficial (Pro Cah),,65205,CPT,Professional,Both,,,,252,214.2,18.1,252,UnitedHealthcare,Individual & Family,252,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Remove Fb Eye Superficial (Pro Cah),,65205,CPT,Professional,Both,,,,252,214.2,18.1,252,UnitedHealthcare,Medicare Advantage,32.706,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Remove Fb Eye Superficial (Pro Cah),,65205,CPT,Professional,Both,,,,252,214.2,18.1,252,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,20.89912,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Remove Fb Eye Conjunctival,,65210,CPT,Facility,Both,,,,138,117.3,39.5508,299,Aetna,Commercial,126.96,92,,percent of total billed charges,,
Remove Fb Eye Conjunctival,,65210,CPT,Facility,Outpatient,,,,138,117.3,39.5508,299,Aetna,Medicare Advantage,67.62,49,,percent of total billed charges,,
Remove Fb Eye Conjunctival,,65210,CPT,Facility,Inpatient,,,,138,117.3,39.5508,299,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Remove Fb Eye Conjunctival,,65210,CPT,Facility,Both,,,,138,117.3,39.5508,299,Aetna,PPO,128.34,93,,percent of total billed charges,,
Remove Fb Eye Conjunctival,,65210,CPT,Facility,Both,,,,138,117.3,39.5508,299,America's PPO,America's PPO,132.5214,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Remove Fb Eye Conjunctival,,65210,CPT,Facility,Both,,,,138,117.3,39.5508,299,BlueCross BlueShield Minnesota, Federal Employee Program,135.792,98.4,,percent of total billed charges,,
Remove Fb Eye Conjunctival,,65210,CPT,Facility,Both,,,,138,117.3,39.5508,299,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,138,100,,percent of total billed charges,,
Remove Fb Eye Conjunctival,,65210,CPT,Facility,Both,,,,138,117.3,39.5508,299,BlueCross BlueShield Minnesota,High Value Network Plan,124.2,90,,percent of total billed charges,,
Remove Fb Eye Conjunctival,,65210,CPT,Facility,Outpatient,,,,138,117.3,39.5508,299,BlueCross BlueShield Minnesota,Medicare Advantage,67.62,49,,percent of total billed charges,,
Remove Fb Eye Conjunctival,,65210,CPT,Facility,Inpatient,,,,138,117.3,39.5508,299,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Remove Fb Eye Conjunctival,,65210,CPT,Facility,Both,,,,138,117.3,39.5508,299,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,122.2266,88.57,,percent of total billed charges,,
Remove Fb Eye Conjunctival,,65210,CPT,Facility,Both,,,,138,117.3,39.5508,299,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,39.5508,28.66,,percent of total billed charges,,
Remove Fb Eye Conjunctival,,65210,CPT,Facility,Outpatient,,,,138,117.3,39.5508,299,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),67.62,49,,percent of total billed charges,,
Remove Fb Eye Conjunctival,,65210,CPT,Facility,Inpatient,,,,138,117.3,39.5508,299,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Remove Fb Eye Conjunctival,,65210,CPT,Facility,Both,,,,138,117.3,39.5508,299,CorVel,Worker's Compensation,138,100,,percent of total billed charges,,
Remove Fb Eye Conjunctival,,65210,CPT,Facility,Both,,,,138,117.3,39.5508,299,First Health Group Corporation,First Health Network,133.86,97,,percent of total billed charges,,
Remove Fb Eye Conjunctival,,65210,CPT,Facility,Both,,,,138,117.3,39.5508,299,"Health Partners, Inc.",Commercial,130.548,94.6,,percent of total billed charges,,
Remove Fb Eye Conjunctival,,65210,CPT,Facility,Outpatient,,,,138,117.3,39.5508,299,"Health Partners, Inc.",Medicare Advantage,67.62,49,,percent of total billed charges,,
Remove Fb Eye Conjunctival,,65210,CPT,Facility,Inpatient,,,,138,117.3,39.5508,299,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Remove Fb Eye Conjunctival,,65210,CPT,Facility,Both,,,,138,117.3,39.5508,299,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),82.8,60,,percent of total billed charges,,
Remove Fb Eye Conjunctival,,65210,CPT,Facility,Both,,,,138,117.3,39.5508,299,"Health Partners, Inc.",State of Minnesota Advantage Program,112.47,81.5,,percent of total billed charges,,
Remove Fb Eye Conjunctival,,65210,CPT,Facility,Both,,,,138,117.3,39.5508,299,"Health Partners, Inc.",State Public Programs,69,50,,percent of total billed charges,,
Remove Fb Eye Conjunctival,,65210,CPT,Facility,Both,,,,138,117.3,39.5508,299,Humana Insurance Company,Commercial PPO,131.1,95,,percent of total billed charges,,
Remove Fb Eye Conjunctival,,65210,CPT,Facility,Outpatient,,,,138,117.3,39.5508,299,Humana Insurance Company,Medicare PPO,67.62,49,,percent of total billed charges,,
Remove Fb Eye Conjunctival,,65210,CPT,Facility,Inpatient,,,,138,117.3,39.5508,299,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Remove Fb Eye Conjunctival,,65210,CPT,Facility,Both,,,,138,117.3,39.5508,299,Medica,Individual & Family,136.758,99.1,,percent of total billed charges,,
Remove Fb Eye Conjunctival,,65210,CPT,Facility,Outpatient,,,,138,117.3,39.5508,299,Medica,Medica Advantage Solution,68.724,49.8,,percent of total billed charges,,
Remove Fb Eye Conjunctival,,65210,CPT,Facility,Inpatient,,,,138,117.3,39.5508,299,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Remove Fb Eye Conjunctival,,65210,CPT,Facility,Outpatient,,,,138,117.3,39.5508,299,Medica,Medical Assistance,299,,,Other,Grouper,All inclusive per visit
Remove Fb Eye Conjunctival,,65210,CPT,Facility,Inpatient,,,,138,117.3,39.5508,299,Medica,Medical Assistance,,,,,Included in per diem rate,
Remove Fb Eye Conjunctival,,65210,CPT,Facility,Outpatient,,,,138,117.3,39.5508,299,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,68.724,49.8,,percent of total billed charges,,
Remove Fb Eye Conjunctival,,65210,CPT,Facility,Inpatient,,,,138,117.3,39.5508,299,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Remove Fb Eye Conjunctival,,65210,CPT,Facility,Both,,,,138,117.3,39.5508,299,"Multiplan, Inc.","Multiplan, Inc.",129.72,94,,percent of total billed charges,,
Remove Fb Eye Conjunctival,,65210,CPT,Facility,Outpatient,,,,138,117.3,39.5508,299,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,124.338,90.1,,percent of total billed charges,,
Remove Fb Eye Conjunctival,,65210,CPT,Facility,Inpatient,,,,138,117.3,39.5508,299,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Remove Fb Eye Conjunctival,,65210,CPT,Facility,Both,,,,138,117.3,39.5508,299,"Preferred One Administrative Services, INC.",PPO,136.068,98.6,,percent of total billed charges,,
Remove Fb Eye Conjunctival,,65210,CPT,Facility,Outpatient,,,,138,117.3,39.5508,299,PrimeWest Health,Minnesota Senior Health Options (MSHO),71.001,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Remove Fb Eye Conjunctival,,65210,CPT,Facility,Inpatient,,,,138,117.3,39.5508,299,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Remove Fb Eye Conjunctival,,65210,CPT,Facility,Outpatient,,,,138,117.3,39.5508,299,PrimeWest Health,MinnesotaCare,70.8768,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Remove Fb Eye Conjunctival,,65210,CPT,Facility,Inpatient,,,,138,117.3,39.5508,299,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Remove Fb Eye Conjunctival,,65210,CPT,Facility,Both,,,,138,117.3,39.5508,299,Sanford Health Plan,Sanford Health Plan,126.96,92,,percent of total billed charges,,
Remove Fb Eye Conjunctival,,65210,CPT,Facility,Outpatient,,,,138,117.3,39.5508,299,"UCare Health, Inc.",Individual & Family Plan,77.763,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Remove Fb Eye Conjunctival,,65210,CPT,Facility,Inpatient,,,,138,117.3,39.5508,299,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Remove Fb Eye Conjunctival,,65210,CPT,Facility,Outpatient,,,,138,117.3,39.5508,299,"UCare Health, Inc.",Medical Assistance,69.6486,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Remove Fb Eye Conjunctival,,65210,CPT,Facility,Inpatient,,,,138,117.3,39.5508,299,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Remove Fb Eye Conjunctival,,65210,CPT,Facility,Outpatient,,,,138,117.3,39.5508,299,"UCare Health, Inc.",Medicare Advantage,69.6486,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Remove Fb Eye Conjunctival,,65210,CPT,Facility,Inpatient,,,,138,117.3,39.5508,299,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Remove Fb Eye Conjunctival,,65210,CPT,Facility,Outpatient,,,,138,117.3,39.5508,299,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),69.6486,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Remove Fb Eye Conjunctival,,65210,CPT,Facility,Inpatient,,,,138,117.3,39.5508,299,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Remove Fb Eye Conjunctival,,65210,CPT,Facility,Both,,,,138,117.3,39.5508,299,UnitedHealthcare,Individual & Family,129.72,94,,percent of total billed charges,,
Remove Fb Eye Conjunctival,,65210,CPT,Facility,Outpatient,,,,138,117.3,39.5508,299,UnitedHealthcare,Medicare Advantage,67.62,49,,percent of total billed charges,,
Remove Fb Eye Conjunctival,,65210,CPT,Facility,Inpatient,,,,138,117.3,39.5508,299,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Remove Fb Eye Conjunctival,,65210,CPT,Facility,Outpatient,,,,138,117.3,39.5508,299,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,66.24,48,,percent of total billed charges,,100% of DHS outpatient percentage
Remove Fb Eye Conjunctival,,65210,CPT,Facility,Inpatient,,,,138,117.3,39.5508,299,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Remove Fb Eye Conjunctival (Pro Cah),,65210,CPT,Professional,Both,,,,209,177.65,22.69,209,Aetna,Commercial,177.65,85,,percent of total billed charges,,
Remove Fb Eye Conjunctival (Pro Cah),,65210,CPT,Professional,Both,,,,209,177.65,22.69,209,Aetna,Medicare Advantage,36.27,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Remove Fb Eye Conjunctival (Pro Cah),,65210,CPT,Professional,Both,,,,209,177.65,22.69,209,Aetna,PPO,194.37,93,,percent of total billed charges,,
Remove Fb Eye Conjunctival (Pro Cah),,65210,CPT,Professional,Both,,,,209,177.65,22.69,209,America's PPO,America's PPO,178.5696,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Remove Fb Eye Conjunctival (Pro Cah),,65210,CPT,Professional,Both,,,,209,177.65,22.69,209,BlueCross BlueShield Minnesota, Federal Employee Program,72.99,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Remove Fb Eye Conjunctival (Pro Cah),,65210,CPT,Professional,Both,,,,209,177.65,22.69,209,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,74.15784,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Remove Fb Eye Conjunctival (Pro Cah),,65210,CPT,Professional,Both,,,,209,177.65,22.69,209,BlueCross BlueShield Minnesota,High Value Network Plan,74.15784,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Remove Fb Eye Conjunctival (Pro Cah),,65210,CPT,Professional,Both,,,,209,177.65,22.69,209,BlueCross BlueShield Minnesota,Medicare Advantage,40.5605,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Remove Fb Eye Conjunctival (Pro Cah),,65210,CPT,Professional,Both,,,,209,177.65,22.69,209,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,74.15784,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Remove Fb Eye Conjunctival (Pro Cah),,65210,CPT,Professional,Both,,,,209,177.65,22.69,209,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,26.19248,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Remove Fb Eye Conjunctival (Pro Cah),,65210,CPT,Professional,Both,,,,209,177.65,22.69,209,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),40.5605,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Remove Fb Eye Conjunctival (Pro Cah),,65210,CPT,Professional,Both,,,,209,177.65,22.69,209,CorVel,Worker's Compensation,69.1394244,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Remove Fb Eye Conjunctival (Pro Cah),,65210,CPT,Professional,Both,,,,209,177.65,22.69,209,First Health Group Corporation,First Health Network,202.73,97,,percent of total billed charges,,
Remove Fb Eye Conjunctival (Pro Cah),,65210,CPT,Professional,Both,,,,209,177.65,22.69,209,"Health Partners, Inc.",Commercial,74.73,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Remove Fb Eye Conjunctival (Pro Cah),,65210,CPT,Professional,Both,,,,209,177.65,22.69,209,"Health Partners, Inc.",Medicare Advantage,40.5605,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Remove Fb Eye Conjunctival (Pro Cah),,65210,CPT,Professional,Both,,,,209,177.65,22.69,209,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),35.24,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Remove Fb Eye Conjunctival (Pro Cah),,65210,CPT,Professional,Both,,,,209,177.65,22.69,209,"Health Partners, Inc.",State of Minnesota Advantage Program,64.379895,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Remove Fb Eye Conjunctival (Pro Cah),,65210,CPT,Professional,Both,,,,209,177.65,22.69,209,"Health Partners, Inc.",State Public Programs,22.69,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Remove Fb Eye Conjunctival (Pro Cah),,65210,CPT,Professional,Both,,,,209,177.65,22.69,209,Humana Insurance Company,Commercial PPO,35.27,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Remove Fb Eye Conjunctival (Pro Cah),,65210,CPT,Professional,Both,,,,209,177.65,22.69,209,Humana Insurance Company,Medicare PPO,209,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Remove Fb Eye Conjunctival (Pro Cah),,65210,CPT,Professional,Both,,,,209,177.65,22.69,209,Medica,Individual & Family,177.232,84.8,,percent of total billed charges,,
Remove Fb Eye Conjunctival (Pro Cah),,65210,CPT,Professional,Both,,,,209,177.65,22.69,209,Medica,Medica Advantage Solution,104.082,49.8,,percent of total billed charges,,
Remove Fb Eye Conjunctival (Pro Cah),,65210,CPT,Professional,Both,,,,209,177.65,22.69,209,Medica,Medical Assistance,26.19,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Remove Fb Eye Conjunctival (Pro Cah),,65210,CPT,Professional,Both,,,,209,177.65,22.69,209,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,35.27,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Remove Fb Eye Conjunctival (Pro Cah),,65210,CPT,Professional,Both,,,,209,177.65,22.69,209,"Multiplan, Inc.","Multiplan, Inc.",196.46,94,,percent of total billed charges,,
Remove Fb Eye Conjunctival (Pro Cah),,65210,CPT,Professional,Both,,,,209,177.65,22.69,209,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,188.309,90.1,,percent of total billed charges,,
Remove Fb Eye Conjunctival (Pro Cah),,65210,CPT,Professional,Both,,,,209,177.65,22.69,209,"Preferred One Administrative Services, INC.",PPO,206.074,98.6,,percent of total billed charges,,
Remove Fb Eye Conjunctival (Pro Cah),,65210,CPT,Professional,Both,,,,209,177.65,22.69,209,PrimeWest Health,Minnesota Senior Health Options (MSHO),40.5605,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Remove Fb Eye Conjunctival (Pro Cah),,65210,CPT,Professional,Both,,,,209,177.65,22.69,209,PrimeWest Health,MinnesotaCare,28.0259536,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Remove Fb Eye Conjunctival (Pro Cah),,65210,CPT,Professional,Both,,,,209,177.65,22.69,209,Sanford Health Plan,Sanford Health Plan,183.92,88,,percent of total billed charges,,
Remove Fb Eye Conjunctival (Pro Cah),,65210,CPT,Professional,Both,,,,209,177.65,22.69,209,"UCare Health, Inc.",Individual & Family Plan,57.334912,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Remove Fb Eye Conjunctival (Pro Cah),,65210,CPT,Professional,Both,,,,209,177.65,22.69,209,"UCare Health, Inc.",Medical Assistance,28.811728,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Remove Fb Eye Conjunctival (Pro Cah),,65210,CPT,Professional,Both,,,,209,177.65,22.69,209,"UCare Health, Inc.",Medicare Advantage,40.5605,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Remove Fb Eye Conjunctival (Pro Cah),,65210,CPT,Professional,Both,,,,209,177.65,22.69,209,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),32.4484,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Remove Fb Eye Conjunctival (Pro Cah),,65210,CPT,Professional,Both,,,,209,177.65,22.69,209,UnitedHealthcare,Individual & Family,209,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Remove Fb Eye Conjunctival (Pro Cah),,65210,CPT,Professional,Both,,,,209,177.65,22.69,209,UnitedHealthcare,Medicare Advantage,40.5605,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Remove Fb Eye Conjunctival (Pro Cah),,65210,CPT,Professional,Both,,,,209,177.65,22.69,209,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,26.19248,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Remove Fb Eye Corneal W Slit Lamp,,65222,CPT,Facility,Both,,,,194,164.9,55.6004,299,Aetna,Commercial,178.48,92,,percent of total billed charges,,
Remove Fb Eye Corneal W Slit Lamp,,65222,CPT,Facility,Outpatient,,,,194,164.9,55.6004,299,Aetna,Medicare Advantage,95.06,49,,percent of total billed charges,,
Remove Fb Eye Corneal W Slit Lamp,,65222,CPT,Facility,Inpatient,,,,194,164.9,55.6004,299,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Remove Fb Eye Corneal W Slit Lamp,,65222,CPT,Facility,Both,,,,194,164.9,55.6004,299,Aetna,PPO,180.42,93,,percent of total billed charges,,
Remove Fb Eye Corneal W Slit Lamp,,65222,CPT,Facility,Both,,,,194,164.9,55.6004,299,America's PPO,America's PPO,186.2982,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Remove Fb Eye Corneal W Slit Lamp,,65222,CPT,Facility,Both,,,,194,164.9,55.6004,299,BlueCross BlueShield Minnesota, Federal Employee Program,190.896,98.4,,percent of total billed charges,,
Remove Fb Eye Corneal W Slit Lamp,,65222,CPT,Facility,Both,,,,194,164.9,55.6004,299,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,194,100,,percent of total billed charges,,
Remove Fb Eye Corneal W Slit Lamp,,65222,CPT,Facility,Both,,,,194,164.9,55.6004,299,BlueCross BlueShield Minnesota,High Value Network Plan,174.6,90,,percent of total billed charges,,
Remove Fb Eye Corneal W Slit Lamp,,65222,CPT,Facility,Outpatient,,,,194,164.9,55.6004,299,BlueCross BlueShield Minnesota,Medicare Advantage,95.06,49,,percent of total billed charges,,
Remove Fb Eye Corneal W Slit Lamp,,65222,CPT,Facility,Inpatient,,,,194,164.9,55.6004,299,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Remove Fb Eye Corneal W Slit Lamp,,65222,CPT,Facility,Both,,,,194,164.9,55.6004,299,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,171.8258,88.57,,percent of total billed charges,,
Remove Fb Eye Corneal W Slit Lamp,,65222,CPT,Facility,Both,,,,194,164.9,55.6004,299,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,55.6004,28.66,,percent of total billed charges,,
Remove Fb Eye Corneal W Slit Lamp,,65222,CPT,Facility,Outpatient,,,,194,164.9,55.6004,299,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),95.06,49,,percent of total billed charges,,
Remove Fb Eye Corneal W Slit Lamp,,65222,CPT,Facility,Inpatient,,,,194,164.9,55.6004,299,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Remove Fb Eye Corneal W Slit Lamp,,65222,CPT,Facility,Both,,,,194,164.9,55.6004,299,CorVel,Worker's Compensation,194,100,,percent of total billed charges,,
Remove Fb Eye Corneal W Slit Lamp,,65222,CPT,Facility,Both,,,,194,164.9,55.6004,299,First Health Group Corporation,First Health Network,188.18,97,,percent of total billed charges,,
Remove Fb Eye Corneal W Slit Lamp,,65222,CPT,Facility,Both,,,,194,164.9,55.6004,299,"Health Partners, Inc.",Commercial,183.524,94.6,,percent of total billed charges,,
Remove Fb Eye Corneal W Slit Lamp,,65222,CPT,Facility,Outpatient,,,,194,164.9,55.6004,299,"Health Partners, Inc.",Medicare Advantage,95.06,49,,percent of total billed charges,,
Remove Fb Eye Corneal W Slit Lamp,,65222,CPT,Facility,Inpatient,,,,194,164.9,55.6004,299,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Remove Fb Eye Corneal W Slit Lamp,,65222,CPT,Facility,Both,,,,194,164.9,55.6004,299,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),116.4,60,,percent of total billed charges,,
Remove Fb Eye Corneal W Slit Lamp,,65222,CPT,Facility,Both,,,,194,164.9,55.6004,299,"Health Partners, Inc.",State of Minnesota Advantage Program,158.11,81.5,,percent of total billed charges,,
Remove Fb Eye Corneal W Slit Lamp,,65222,CPT,Facility,Both,,,,194,164.9,55.6004,299,"Health Partners, Inc.",State Public Programs,97,50,,percent of total billed charges,,
Remove Fb Eye Corneal W Slit Lamp,,65222,CPT,Facility,Both,,,,194,164.9,55.6004,299,Humana Insurance Company,Commercial PPO,184.3,95,,percent of total billed charges,,
Remove Fb Eye Corneal W Slit Lamp,,65222,CPT,Facility,Outpatient,,,,194,164.9,55.6004,299,Humana Insurance Company,Medicare PPO,95.06,49,,percent of total billed charges,,
Remove Fb Eye Corneal W Slit Lamp,,65222,CPT,Facility,Inpatient,,,,194,164.9,55.6004,299,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Remove Fb Eye Corneal W Slit Lamp,,65222,CPT,Facility,Both,,,,194,164.9,55.6004,299,Medica,Individual & Family,192.254,99.1,,percent of total billed charges,,
Remove Fb Eye Corneal W Slit Lamp,,65222,CPT,Facility,Outpatient,,,,194,164.9,55.6004,299,Medica,Medica Advantage Solution,96.612,49.8,,percent of total billed charges,,
Remove Fb Eye Corneal W Slit Lamp,,65222,CPT,Facility,Inpatient,,,,194,164.9,55.6004,299,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Remove Fb Eye Corneal W Slit Lamp,,65222,CPT,Facility,Outpatient,,,,194,164.9,55.6004,299,Medica,Medical Assistance,299,,,Other,Grouper,All inclusive per visit
Remove Fb Eye Corneal W Slit Lamp,,65222,CPT,Facility,Inpatient,,,,194,164.9,55.6004,299,Medica,Medical Assistance,,,,,Included in per diem rate,
Remove Fb Eye Corneal W Slit Lamp,,65222,CPT,Facility,Outpatient,,,,194,164.9,55.6004,299,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,96.612,49.8,,percent of total billed charges,,
Remove Fb Eye Corneal W Slit Lamp,,65222,CPT,Facility,Inpatient,,,,194,164.9,55.6004,299,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Remove Fb Eye Corneal W Slit Lamp,,65222,CPT,Facility,Both,,,,194,164.9,55.6004,299,"Multiplan, Inc.","Multiplan, Inc.",182.36,94,,percent of total billed charges,,
Remove Fb Eye Corneal W Slit Lamp,,65222,CPT,Facility,Outpatient,,,,194,164.9,55.6004,299,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,174.794,90.1,,percent of total billed charges,,
Remove Fb Eye Corneal W Slit Lamp,,65222,CPT,Facility,Inpatient,,,,194,164.9,55.6004,299,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Remove Fb Eye Corneal W Slit Lamp,,65222,CPT,Facility,Both,,,,194,164.9,55.6004,299,"Preferred One Administrative Services, INC.",PPO,191.284,98.6,,percent of total billed charges,,
Remove Fb Eye Corneal W Slit Lamp,,65222,CPT,Facility,Outpatient,,,,194,164.9,55.6004,299,PrimeWest Health,Minnesota Senior Health Options (MSHO),99.813,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Remove Fb Eye Corneal W Slit Lamp,,65222,CPT,Facility,Inpatient,,,,194,164.9,55.6004,299,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Remove Fb Eye Corneal W Slit Lamp,,65222,CPT,Facility,Outpatient,,,,194,164.9,55.6004,299,PrimeWest Health,MinnesotaCare,99.6384,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Remove Fb Eye Corneal W Slit Lamp,,65222,CPT,Facility,Inpatient,,,,194,164.9,55.6004,299,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Remove Fb Eye Corneal W Slit Lamp,,65222,CPT,Facility,Both,,,,194,164.9,55.6004,299,Sanford Health Plan,Sanford Health Plan,178.48,92,,percent of total billed charges,,
Remove Fb Eye Corneal W Slit Lamp,,65222,CPT,Facility,Outpatient,,,,194,164.9,55.6004,299,"UCare Health, Inc.",Individual & Family Plan,109.319,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Remove Fb Eye Corneal W Slit Lamp,,65222,CPT,Facility,Inpatient,,,,194,164.9,55.6004,299,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Remove Fb Eye Corneal W Slit Lamp,,65222,CPT,Facility,Outpatient,,,,194,164.9,55.6004,299,"UCare Health, Inc.",Medical Assistance,97.9118,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Remove Fb Eye Corneal W Slit Lamp,,65222,CPT,Facility,Inpatient,,,,194,164.9,55.6004,299,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Remove Fb Eye Corneal W Slit Lamp,,65222,CPT,Facility,Outpatient,,,,194,164.9,55.6004,299,"UCare Health, Inc.",Medicare Advantage,97.9118,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Remove Fb Eye Corneal W Slit Lamp,,65222,CPT,Facility,Inpatient,,,,194,164.9,55.6004,299,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Remove Fb Eye Corneal W Slit Lamp,,65222,CPT,Facility,Outpatient,,,,194,164.9,55.6004,299,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),97.9118,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Remove Fb Eye Corneal W Slit Lamp,,65222,CPT,Facility,Inpatient,,,,194,164.9,55.6004,299,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Remove Fb Eye Corneal W Slit Lamp,,65222,CPT,Facility,Both,,,,194,164.9,55.6004,299,UnitedHealthcare,Individual & Family,182.36,94,,percent of total billed charges,,
Remove Fb Eye Corneal W Slit Lamp,,65222,CPT,Facility,Outpatient,,,,194,164.9,55.6004,299,UnitedHealthcare,Medicare Advantage,95.06,49,,percent of total billed charges,,
Remove Fb Eye Corneal W Slit Lamp,,65222,CPT,Facility,Inpatient,,,,194,164.9,55.6004,299,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Remove Fb Eye Corneal W Slit Lamp,,65222,CPT,Facility,Outpatient,,,,194,164.9,55.6004,299,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,93.12,48,,percent of total billed charges,,100% of DHS outpatient percentage
Remove Fb Eye Corneal W Slit Lamp,,65222,CPT,Facility,Inpatient,,,,194,164.9,55.6004,299,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Remove Fb Eye Corneal W Slit Lamp (Pro Cah),,65222,CPT,Professional,Both,,,,296,251.6,31.63,296,Aetna,Commercial,251.6,85,,percent of total billed charges,,
Remove Fb Eye Corneal W Slit Lamp (Pro Cah),,65222,CPT,Professional,Both,,,,296,251.6,31.63,296,Aetna,Medicare Advantage,50.43,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Remove Fb Eye Corneal W Slit Lamp (Pro Cah),,65222,CPT,Professional,Both,,,,296,251.6,31.63,296,Aetna,PPO,275.28,93,,percent of total billed charges,,
Remove Fb Eye Corneal W Slit Lamp (Pro Cah),,65222,CPT,Professional,Both,,,,296,251.6,31.63,296,America's PPO,America's PPO,252.9024,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Remove Fb Eye Corneal W Slit Lamp (Pro Cah),,65222,CPT,Professional,Both,,,,296,251.6,31.63,296,BlueCross BlueShield Minnesota, Federal Employee Program,101.22,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Remove Fb Eye Corneal W Slit Lamp (Pro Cah),,65222,CPT,Professional,Both,,,,296,251.6,31.63,296,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,102.83952,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Remove Fb Eye Corneal W Slit Lamp (Pro Cah),,65222,CPT,Professional,Both,,,,296,251.6,31.63,296,BlueCross BlueShield Minnesota,High Value Network Plan,102.83952,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Remove Fb Eye Corneal W Slit Lamp (Pro Cah),,65222,CPT,Professional,Both,,,,296,251.6,31.63,296,BlueCross BlueShield Minnesota,Medicare Advantage,56.672,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Remove Fb Eye Corneal W Slit Lamp (Pro Cah),,65222,CPT,Professional,Both,,,,296,251.6,31.63,296,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,102.83952,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Remove Fb Eye Corneal W Slit Lamp (Pro Cah),,65222,CPT,Professional,Both,,,,296,251.6,31.63,296,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,36.51504,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Remove Fb Eye Corneal W Slit Lamp (Pro Cah),,65222,CPT,Professional,Both,,,,296,251.6,31.63,296,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),56.672,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Remove Fb Eye Corneal W Slit Lamp (Pro Cah),,65222,CPT,Professional,Both,,,,296,251.6,31.63,296,CorVel,Worker's Compensation,96.3929802,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Remove Fb Eye Corneal W Slit Lamp (Pro Cah),,65222,CPT,Professional,Both,,,,296,251.6,31.63,296,First Health Group Corporation,First Health Network,287.12,97,,percent of total billed charges,,
Remove Fb Eye Corneal W Slit Lamp (Pro Cah),,65222,CPT,Professional,Both,,,,296,251.6,31.63,296,"Health Partners, Inc.",Commercial,104.48,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Remove Fb Eye Corneal W Slit Lamp (Pro Cah),,65222,CPT,Professional,Both,,,,296,251.6,31.63,296,"Health Partners, Inc.",Medicare Advantage,56.672,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Remove Fb Eye Corneal W Slit Lamp (Pro Cah),,65222,CPT,Professional,Both,,,,296,251.6,31.63,296,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),49.14,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Remove Fb Eye Corneal W Slit Lamp (Pro Cah),,65222,CPT,Professional,Both,,,,296,251.6,31.63,296,"Health Partners, Inc.",State of Minnesota Advantage Program,90.00952,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Remove Fb Eye Corneal W Slit Lamp (Pro Cah),,65222,CPT,Professional,Both,,,,296,251.6,31.63,296,"Health Partners, Inc.",State Public Programs,31.63,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Remove Fb Eye Corneal W Slit Lamp (Pro Cah),,65222,CPT,Professional,Both,,,,296,251.6,31.63,296,Humana Insurance Company,Commercial PPO,49.28,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Remove Fb Eye Corneal W Slit Lamp (Pro Cah),,65222,CPT,Professional,Both,,,,296,251.6,31.63,296,Humana Insurance Company,Medicare PPO,296,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Remove Fb Eye Corneal W Slit Lamp (Pro Cah),,65222,CPT,Professional,Both,,,,296,251.6,31.63,296,Medica,Individual & Family,251.008,84.8,,percent of total billed charges,,
Remove Fb Eye Corneal W Slit Lamp (Pro Cah),,65222,CPT,Professional,Both,,,,296,251.6,31.63,296,Medica,Medica Advantage Solution,147.408,49.8,,percent of total billed charges,,
Remove Fb Eye Corneal W Slit Lamp (Pro Cah),,65222,CPT,Professional,Both,,,,296,251.6,31.63,296,Medica,Medical Assistance,36.52,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Remove Fb Eye Corneal W Slit Lamp (Pro Cah),,65222,CPT,Professional,Both,,,,296,251.6,31.63,296,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,49.28,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Remove Fb Eye Corneal W Slit Lamp (Pro Cah),,65222,CPT,Professional,Both,,,,296,251.6,31.63,296,"Multiplan, Inc.","Multiplan, Inc.",278.24,94,,percent of total billed charges,,
Remove Fb Eye Corneal W Slit Lamp (Pro Cah),,65222,CPT,Professional,Both,,,,296,251.6,31.63,296,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,266.696,90.1,,percent of total billed charges,,
Remove Fb Eye Corneal W Slit Lamp (Pro Cah),,65222,CPT,Professional,Both,,,,296,251.6,31.63,296,"Preferred One Administrative Services, INC.",PPO,291.856,98.6,,percent of total billed charges,,
Remove Fb Eye Corneal W Slit Lamp (Pro Cah),,65222,CPT,Professional,Both,,,,296,251.6,31.63,296,PrimeWest Health,Minnesota Senior Health Options (MSHO),56.672,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Remove Fb Eye Corneal W Slit Lamp (Pro Cah),,65222,CPT,Professional,Both,,,,296,251.6,31.63,296,PrimeWest Health,MinnesotaCare,39.0710928,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Remove Fb Eye Corneal W Slit Lamp (Pro Cah),,65222,CPT,Professional,Both,,,,296,251.6,31.63,296,Sanford Health Plan,Sanford Health Plan,260.48,88,,percent of total billed charges,,
Remove Fb Eye Corneal W Slit Lamp (Pro Cah),,65222,CPT,Professional,Both,,,,296,251.6,31.63,296,"UCare Health, Inc.",Individual & Family Plan,80.109568,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Remove Fb Eye Corneal W Slit Lamp (Pro Cah),,65222,CPT,Professional,Both,,,,296,251.6,31.63,296,"UCare Health, Inc.",Medical Assistance,40.166544,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Remove Fb Eye Corneal W Slit Lamp (Pro Cah),,65222,CPT,Professional,Both,,,,296,251.6,31.63,296,"UCare Health, Inc.",Medicare Advantage,56.672,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Remove Fb Eye Corneal W Slit Lamp (Pro Cah),,65222,CPT,Professional,Both,,,,296,251.6,31.63,296,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),45.3376,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Remove Fb Eye Corneal W Slit Lamp (Pro Cah),,65222,CPT,Professional,Both,,,,296,251.6,31.63,296,UnitedHealthcare,Individual & Family,296,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Remove Fb Eye Corneal W Slit Lamp (Pro Cah),,65222,CPT,Professional,Both,,,,296,251.6,31.63,296,UnitedHealthcare,Medicare Advantage,56.672,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Remove Fb Eye Corneal W Slit Lamp (Pro Cah),,65222,CPT,Professional,Both,,,,296,251.6,31.63,296,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,36.51504,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Placement Of Amniotic Membrane On The Ocular Surface; Without Sutures (Procah),,65778,CPT,Professional,Both,,,,306,260.1,33.37,306,Aetna,Commercial,260.1,85,,percent of total billed charges,,
Placement Of Amniotic Membrane On The Ocular Surface; Without Sutures (Procah),,65778,CPT,Professional,Both,,,,306,260.1,33.37,306,Aetna,Medicare Advantage,53.18,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Placement Of Amniotic Membrane On The Ocular Surface; Without Sutures (Procah),,65778,CPT,Professional,Both,,,,306,260.1,33.37,306,Aetna,PPO,284.58,93,,percent of total billed charges,,
Placement Of Amniotic Membrane On The Ocular Surface; Without Sutures (Procah),,65778,CPT,Professional,Both,,,,306,260.1,33.37,306,America's PPO,America's PPO,261.4464,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Placement Of Amniotic Membrane On The Ocular Surface; Without Sutures (Procah),,65778,CPT,Professional,Both,,,,306,260.1,33.37,306,BlueCross BlueShield Minnesota, Federal Employee Program,106.73,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Placement Of Amniotic Membrane On The Ocular Surface; Without Sutures (Procah),,65778,CPT,Professional,Both,,,,306,260.1,33.37,306,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,108.43768,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Placement Of Amniotic Membrane On The Ocular Surface; Without Sutures (Procah),,65778,CPT,Professional,Both,,,,306,260.1,33.37,306,BlueCross BlueShield Minnesota,High Value Network Plan,108.43768,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Placement Of Amniotic Membrane On The Ocular Surface; Without Sutures (Procah),,65778,CPT,Professional,Both,,,,306,260.1,33.37,306,BlueCross BlueShield Minnesota,Medicare Advantage,59.731,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Placement Of Amniotic Membrane On The Ocular Surface; Without Sutures (Procah),,65778,CPT,Professional,Both,,,,306,260.1,33.37,306,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,108.43768,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Placement Of Amniotic Membrane On The Ocular Surface; Without Sutures (Procah),,65778,CPT,Professional,Both,,,,306,260.1,33.37,306,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,38.52672,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Placement Of Amniotic Membrane On The Ocular Surface; Without Sutures (Procah),,65778,CPT,Professional,Both,,,,306,260.1,33.37,306,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),59.731,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Placement Of Amniotic Membrane On The Ocular Surface; Without Sutures (Procah),,65778,CPT,Professional,Both,,,,306,260.1,33.37,306,CorVel,Worker's Compensation,102.3771555,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Placement Of Amniotic Membrane On The Ocular Surface; Without Sutures (Procah),,65778,CPT,Professional,Both,,,,306,260.1,33.37,306,First Health Group Corporation,First Health Network,296.82,97,,percent of total billed charges,,
Placement Of Amniotic Membrane On The Ocular Surface; Without Sutures (Procah),,65778,CPT,Professional,Both,,,,306,260.1,33.37,306,"Health Partners, Inc.",Commercial,111.01,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Placement Of Amniotic Membrane On The Ocular Surface; Without Sutures (Procah),,65778,CPT,Professional,Both,,,,306,260.1,33.37,306,"Health Partners, Inc.",Medicare Advantage,59.731,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Placement Of Amniotic Membrane On The Ocular Surface; Without Sutures (Procah),,65778,CPT,Professional,Both,,,,306,260.1,33.37,306,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),51.85,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Placement Of Amniotic Membrane On The Ocular Surface; Without Sutures (Procah),,65778,CPT,Professional,Both,,,,306,260.1,33.37,306,"Health Partners, Inc.",State of Minnesota Advantage Program,95.635115,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Placement Of Amniotic Membrane On The Ocular Surface; Without Sutures (Procah),,65778,CPT,Professional,Both,,,,306,260.1,33.37,306,"Health Partners, Inc.",State Public Programs,33.37,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Placement Of Amniotic Membrane On The Ocular Surface; Without Sutures (Procah),,65778,CPT,Professional,Both,,,,306,260.1,33.37,306,Humana Insurance Company,Commercial PPO,51.94,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Placement Of Amniotic Membrane On The Ocular Surface; Without Sutures (Procah),,65778,CPT,Professional,Both,,,,306,260.1,33.37,306,Humana Insurance Company,Medicare PPO,306,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Placement Of Amniotic Membrane On The Ocular Surface; Without Sutures (Procah),,65778,CPT,Professional,Both,,,,306,260.1,33.37,306,Medica,Individual & Family,259.488,84.8,,percent of total billed charges,,
Placement Of Amniotic Membrane On The Ocular Surface; Without Sutures (Procah),,65778,CPT,Professional,Both,,,,306,260.1,33.37,306,Medica,Medica Advantage Solution,152.388,49.8,,percent of total billed charges,,
Placement Of Amniotic Membrane On The Ocular Surface; Without Sutures (Procah),,65778,CPT,Professional,Both,,,,306,260.1,33.37,306,Medica,Medical Assistance,38.53,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Placement Of Amniotic Membrane On The Ocular Surface; Without Sutures (Procah),,65778,CPT,Professional,Both,,,,306,260.1,33.37,306,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,51.94,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Placement Of Amniotic Membrane On The Ocular Surface; Without Sutures (Procah),,65778,CPT,Professional,Both,,,,306,260.1,33.37,306,"Multiplan, Inc.","Multiplan, Inc.",287.64,94,,percent of total billed charges,,
Placement Of Amniotic Membrane On The Ocular Surface; Without Sutures (Procah),,65778,CPT,Professional,Both,,,,306,260.1,33.37,306,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,275.706,90.1,,percent of total billed charges,,
Placement Of Amniotic Membrane On The Ocular Surface; Without Sutures (Procah),,65778,CPT,Professional,Both,,,,306,260.1,33.37,306,"Preferred One Administrative Services, INC.",PPO,301.716,98.6,,percent of total billed charges,,
Placement Of Amniotic Membrane On The Ocular Surface; Without Sutures (Procah),,65778,CPT,Professional,Both,,,,306,260.1,33.37,306,PrimeWest Health,Minnesota Senior Health Options (MSHO),59.731,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Placement Of Amniotic Membrane On The Ocular Surface; Without Sutures (Procah),,65778,CPT,Professional,Both,,,,306,260.1,33.37,306,PrimeWest Health,MinnesotaCare,41.2235904,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Placement Of Amniotic Membrane On The Ocular Surface; Without Sutures (Procah),,65778,CPT,Professional,Both,,,,306,260.1,33.37,306,Sanford Health Plan,Sanford Health Plan,269.28,88,,percent of total billed charges,,
Placement Of Amniotic Membrane On The Ocular Surface; Without Sutures (Procah),,65778,CPT,Professional,Both,,,,306,260.1,33.37,306,"UCare Health, Inc.",Individual & Family Plan,84.433664,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Placement Of Amniotic Membrane On The Ocular Surface; Without Sutures (Procah),,65778,CPT,Professional,Both,,,,306,260.1,33.37,306,"UCare Health, Inc.",Medical Assistance,42.379392,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Placement Of Amniotic Membrane On The Ocular Surface; Without Sutures (Procah),,65778,CPT,Professional,Both,,,,306,260.1,33.37,306,"UCare Health, Inc.",Medicare Advantage,59.731,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Placement Of Amniotic Membrane On The Ocular Surface; Without Sutures (Procah),,65778,CPT,Professional,Both,,,,306,260.1,33.37,306,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),47.7848,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Placement Of Amniotic Membrane On The Ocular Surface; Without Sutures (Procah),,65778,CPT,Professional,Both,,,,306,260.1,33.37,306,UnitedHealthcare,Individual & Family,306,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Placement Of Amniotic Membrane On The Ocular Surface; Without Sutures (Procah),,65778,CPT,Professional,Both,,,,306,260.1,33.37,306,UnitedHealthcare,Medicare Advantage,59.731,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Placement Of Amniotic Membrane On The Ocular Surface; Without Sutures (Procah),,65778,CPT,Professional,Both,,,,306,260.1,33.37,306,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,38.52672,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
PALIPERIDONE PALMITATE 234 MG/1.5 ML IM SYRG,,J2426,HCPCS,Facility,Both,1.5,mL,,12054,10245.9,3454.6764,12054,Aetna,Commercial,11089.68,92,,percent of total billed charges,,
PALIPERIDONE PALMITATE 234 MG/1.5 ML IM SYRG,,J2426,HCPCS,Facility,Outpatient,1.5,mL,,12054,10245.9,3454.6764,12054,Aetna,Medicare Advantage,5906.46,49,,percent of total billed charges,,
PALIPERIDONE PALMITATE 234 MG/1.5 ML IM SYRG,,J2426,HCPCS,Facility,Inpatient,1.5,mL,,12054,10245.9,3454.6764,12054,Aetna,Medicare Advantage,,,,,Included in per diem rate,
PALIPERIDONE PALMITATE 234 MG/1.5 ML IM SYRG,,J2426,HCPCS,Facility,Both,1.5,mL,,12054,10245.9,3454.6764,12054,Aetna,PPO,11210.22,93,,percent of total billed charges,,
PALIPERIDONE PALMITATE 234 MG/1.5 ML IM SYRG,,J2426,HCPCS,Facility,Both,1.5,mL,,12054,10245.9,3454.6764,12054,America's PPO,America's PPO,11575.4562,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
PALIPERIDONE PALMITATE 234 MG/1.5 ML IM SYRG,,J2426,HCPCS,Facility,Both,1.5,mL,,12054,10245.9,3454.6764,12054,BlueCross BlueShield Minnesota, Federal Employee Program,11861.136,98.4,,percent of total billed charges,,
PALIPERIDONE PALMITATE 234 MG/1.5 ML IM SYRG,,J2426,HCPCS,Facility,Both,1.5,mL,,12054,10245.9,3454.6764,12054,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,12054,100,,percent of total billed charges,,
PALIPERIDONE PALMITATE 234 MG/1.5 ML IM SYRG,,J2426,HCPCS,Facility,Both,1.5,mL,,12054,10245.9,3454.6764,12054,BlueCross BlueShield Minnesota,High Value Network Plan,10848.6,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
PALIPERIDONE PALMITATE 234 MG/1.5 ML IM SYRG,,J2426,HCPCS,Facility,Outpatient,1.5,mL,,12054,10245.9,3454.6764,12054,BlueCross BlueShield Minnesota,Medicare Advantage,5906.46,49,,percent of total billed charges,,
PALIPERIDONE PALMITATE 234 MG/1.5 ML IM SYRG,,J2426,HCPCS,Facility,Inpatient,1.5,mL,,12054,10245.9,3454.6764,12054,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
PALIPERIDONE PALMITATE 234 MG/1.5 ML IM SYRG,,J2426,HCPCS,Facility,Both,1.5,mL,,12054,10245.9,3454.6764,12054,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,10676.2278,88.57,,percent of total billed charges,,
PALIPERIDONE PALMITATE 234 MG/1.5 ML IM SYRG,,J2426,HCPCS,Facility,Both,1.5,mL,,12054,10245.9,3454.6764,12054,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,3454.6764,28.66,,percent of total billed charges,,
PALIPERIDONE PALMITATE 234 MG/1.5 ML IM SYRG,,J2426,HCPCS,Facility,Outpatient,1.5,mL,,12054,10245.9,3454.6764,12054,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),5906.46,49,,percent of total billed charges,,
PALIPERIDONE PALMITATE 234 MG/1.5 ML IM SYRG,,J2426,HCPCS,Facility,Inpatient,1.5,mL,,12054,10245.9,3454.6764,12054,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
PALIPERIDONE PALMITATE 234 MG/1.5 ML IM SYRG,,J2426,HCPCS,Facility,Both,1.5,mL,,12054,10245.9,3454.6764,12054,CorVel,Worker's Compensation,12054,100,,percent of total billed charges,,
PALIPERIDONE PALMITATE 234 MG/1.5 ML IM SYRG,,J2426,HCPCS,Facility,Both,1.5,mL,,12054,10245.9,3454.6764,12054,First Health Group Corporation,First Health Network,11692.38,97,,percent of total billed charges,,
PALIPERIDONE PALMITATE 234 MG/1.5 ML IM SYRG,,J2426,HCPCS,Facility,Both,1.5,mL,,12054,10245.9,3454.6764,12054,"Health Partners, Inc.",Commercial,11403.084,94.6,,percent of total billed charges,,
PALIPERIDONE PALMITATE 234 MG/1.5 ML IM SYRG,,J2426,HCPCS,Facility,Outpatient,1.5,mL,,12054,10245.9,3454.6764,12054,"Health Partners, Inc.",Medicare Advantage,5906.46,49,,percent of total billed charges,,
PALIPERIDONE PALMITATE 234 MG/1.5 ML IM SYRG,,J2426,HCPCS,Facility,Inpatient,1.5,mL,,12054,10245.9,3454.6764,12054,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PALIPERIDONE PALMITATE 234 MG/1.5 ML IM SYRG,,J2426,HCPCS,Facility,Both,1.5,mL,,12054,10245.9,3454.6764,12054,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),7232.4,60,,percent of total billed charges,,
PALIPERIDONE PALMITATE 234 MG/1.5 ML IM SYRG,,J2426,HCPCS,Facility,Both,1.5,mL,,12054,10245.9,3454.6764,12054,"Health Partners, Inc.",State of Minnesota Advantage Program,9824.01,81.5,,percent of total billed charges,,
PALIPERIDONE PALMITATE 234 MG/1.5 ML IM SYRG,,J2426,HCPCS,Facility,Both,1.5,mL,,12054,10245.9,3454.6764,12054,"Health Partners, Inc.",State Public Programs,6027,50,,percent of total billed charges,,
PALIPERIDONE PALMITATE 234 MG/1.5 ML IM SYRG,,J2426,HCPCS,Facility,Both,1.5,mL,,12054,10245.9,3454.6764,12054,Humana Insurance Company,Commercial PPO,11451.3,95,,percent of total billed charges,,
PALIPERIDONE PALMITATE 234 MG/1.5 ML IM SYRG,,J2426,HCPCS,Facility,Outpatient,1.5,mL,,12054,10245.9,3454.6764,12054,Humana Insurance Company,Medicare PPO,5906.46,49,,percent of total billed charges,,
PALIPERIDONE PALMITATE 234 MG/1.5 ML IM SYRG,,J2426,HCPCS,Facility,Inpatient,1.5,mL,,12054,10245.9,3454.6764,12054,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
PALIPERIDONE PALMITATE 234 MG/1.5 ML IM SYRG,,J2426,HCPCS,Facility,Both,1.5,mL,,12054,10245.9,3454.6764,12054,Medica,Individual & Family,11945.514,99.1,,percent of total billed charges,,
PALIPERIDONE PALMITATE 234 MG/1.5 ML IM SYRG,,J2426,HCPCS,Facility,Outpatient,1.5,mL,,12054,10245.9,3454.6764,12054,Medica,Medica Advantage Solution,6002.892,49.8,,percent of total billed charges,,
PALIPERIDONE PALMITATE 234 MG/1.5 ML IM SYRG,,J2426,HCPCS,Facility,Inpatient,1.5,mL,,12054,10245.9,3454.6764,12054,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
PALIPERIDONE PALMITATE 234 MG/1.5 ML IM SYRG,,J2426,HCPCS,Facility,Outpatient,1.5,mL,,12054,10245.9,3454.6764,12054,Medica,Medical Assistance,5376.084,44.6,,percent of total billed charges,,
PALIPERIDONE PALMITATE 234 MG/1.5 ML IM SYRG,,J2426,HCPCS,Facility,Inpatient,1.5,mL,,12054,10245.9,3454.6764,12054,Medica,Medical Assistance,,,,,Included in per diem rate,
PALIPERIDONE PALMITATE 234 MG/1.5 ML IM SYRG,,J2426,HCPCS,Facility,Outpatient,1.5,mL,,12054,10245.9,3454.6764,12054,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,6002.892,49.8,,percent of total billed charges,,
PALIPERIDONE PALMITATE 234 MG/1.5 ML IM SYRG,,J2426,HCPCS,Facility,Inpatient,1.5,mL,,12054,10245.9,3454.6764,12054,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
PALIPERIDONE PALMITATE 234 MG/1.5 ML IM SYRG,,J2426,HCPCS,Facility,Both,1.5,mL,,12054,10245.9,3454.6764,12054,"Multiplan, Inc.","Multiplan, Inc.",11330.76,94,,percent of total billed charges,,
PALIPERIDONE PALMITATE 234 MG/1.5 ML IM SYRG,,J2426,HCPCS,Facility,Outpatient,1.5,mL,,12054,10245.9,3454.6764,12054,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,10860.654,90.1,,percent of total billed charges,,
PALIPERIDONE PALMITATE 234 MG/1.5 ML IM SYRG,,J2426,HCPCS,Facility,Inpatient,1.5,mL,,12054,10245.9,3454.6764,12054,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
PALIPERIDONE PALMITATE 234 MG/1.5 ML IM SYRG,,J2426,HCPCS,Facility,Both,1.5,mL,,12054,10245.9,3454.6764,12054,"Preferred One Administrative Services, INC.",PPO,11885.244,98.6,,percent of total billed charges,,
PALIPERIDONE PALMITATE 234 MG/1.5 ML IM SYRG,,J2426,HCPCS,Facility,Outpatient,1.5,mL,,12054,10245.9,3454.6764,12054,PrimeWest Health,Minnesota Senior Health Options (MSHO),6201.783,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
PALIPERIDONE PALMITATE 234 MG/1.5 ML IM SYRG,,J2426,HCPCS,Facility,Inpatient,1.5,mL,,12054,10245.9,3454.6764,12054,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PALIPERIDONE PALMITATE 234 MG/1.5 ML IM SYRG,,J2426,HCPCS,Facility,Outpatient,1.5,mL,,12054,10245.9,3454.6764,12054,PrimeWest Health,MinnesotaCare,6190.9344,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
PALIPERIDONE PALMITATE 234 MG/1.5 ML IM SYRG,,J2426,HCPCS,Facility,Inpatient,1.5,mL,,12054,10245.9,3454.6764,12054,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
PALIPERIDONE PALMITATE 234 MG/1.5 ML IM SYRG,,J2426,HCPCS,Facility,Both,1.5,mL,,12054,10245.9,3454.6764,12054,Sanford Health Plan,Sanford Health Plan,11089.68,92,,percent of total billed charges,,
PALIPERIDONE PALMITATE 234 MG/1.5 ML IM SYRG,,J2426,HCPCS,Facility,Outpatient,1.5,mL,,12054,10245.9,3454.6764,12054,"UCare Health, Inc.",Individual & Family Plan,6792.429,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
PALIPERIDONE PALMITATE 234 MG/1.5 ML IM SYRG,,J2426,HCPCS,Facility,Inpatient,1.5,mL,,12054,10245.9,3454.6764,12054,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
PALIPERIDONE PALMITATE 234 MG/1.5 ML IM SYRG,,J2426,HCPCS,Facility,Outpatient,1.5,mL,,12054,10245.9,3454.6764,12054,"UCare Health, Inc.",Medical Assistance,6083.6538,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PALIPERIDONE PALMITATE 234 MG/1.5 ML IM SYRG,,J2426,HCPCS,Facility,Inpatient,1.5,mL,,12054,10245.9,3454.6764,12054,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
PALIPERIDONE PALMITATE 234 MG/1.5 ML IM SYRG,,J2426,HCPCS,Facility,Outpatient,1.5,mL,,12054,10245.9,3454.6764,12054,"UCare Health, Inc.",Medicare Advantage,6083.6538,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PALIPERIDONE PALMITATE 234 MG/1.5 ML IM SYRG,,J2426,HCPCS,Facility,Inpatient,1.5,mL,,12054,10245.9,3454.6764,12054,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PALIPERIDONE PALMITATE 234 MG/1.5 ML IM SYRG,,J2426,HCPCS,Facility,Outpatient,1.5,mL,,12054,10245.9,3454.6764,12054,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),6083.6538,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PALIPERIDONE PALMITATE 234 MG/1.5 ML IM SYRG,,J2426,HCPCS,Facility,Inpatient,1.5,mL,,12054,10245.9,3454.6764,12054,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PALIPERIDONE PALMITATE 234 MG/1.5 ML IM SYRG,,J2426,HCPCS,Facility,Both,1.5,mL,,12054,10245.9,3454.6764,12054,UnitedHealthcare,Individual & Family,11330.76,94,,percent of total billed charges,,
PALIPERIDONE PALMITATE 234 MG/1.5 ML IM SYRG,,J2426,HCPCS,Facility,Outpatient,1.5,mL,,12054,10245.9,3454.6764,12054,UnitedHealthcare,Medicare Advantage,5906.46,49,,percent of total billed charges,,
PALIPERIDONE PALMITATE 234 MG/1.5 ML IM SYRG,,J2426,HCPCS,Facility,Inpatient,1.5,mL,,12054,10245.9,3454.6764,12054,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
PALIPERIDONE PALMITATE 234 MG/1.5 ML IM SYRG,,J2426,HCPCS,Facility,Outpatient,1.5,mL,,12054,10245.9,3454.6764,12054,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,5785.92,48,,percent of total billed charges,,100% of DHS outpatient percentage
PALIPERIDONE PALMITATE 234 MG/1.5 ML IM SYRG,,J2426,HCPCS,Facility,Inpatient,1.5,mL,,12054,10245.9,3454.6764,12054,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Trabeculoplasty By Laser Surgery (Procah),,65855,CPT,Professional,Both,,,,1607,1365.95,129.36,1607,Aetna,Commercial,1365.95,85,,percent of total billed charges,,
Trabeculoplasty By Laser Surgery (Procah),,65855,CPT,Professional,Both,,,,1607,1365.95,129.36,1607,Aetna,Medicare Advantage,203.18,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Trabeculoplasty By Laser Surgery (Procah),,65855,CPT,Professional,Both,,,,1607,1365.95,129.36,1607,Aetna,PPO,1494.51,93,,percent of total billed charges,,
Trabeculoplasty By Laser Surgery (Procah),,65855,CPT,Professional,Both,,,,1607,1365.95,129.36,1607,America's PPO,America's PPO,1373.0208,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Trabeculoplasty By Laser Surgery (Procah),,65855,CPT,Professional,Both,,,,1607,1365.95,129.36,1607,BlueCross BlueShield Minnesota, Federal Employee Program,415.91,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Trabeculoplasty By Laser Surgery (Procah),,65855,CPT,Professional,Both,,,,1607,1365.95,129.36,1607,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,422.56456,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Trabeculoplasty By Laser Surgery (Procah),,65855,CPT,Professional,Both,,,,1607,1365.95,129.36,1607,BlueCross BlueShield Minnesota,High Value Network Plan,422.56456,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Trabeculoplasty By Laser Surgery (Procah),,65855,CPT,Professional,Both,,,,1607,1365.95,129.36,1607,BlueCross BlueShield Minnesota,Medicare Advantage,231.4145,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Trabeculoplasty By Laser Surgery (Procah),,65855,CPT,Professional,Both,,,,1607,1365.95,129.36,1607,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,422.56456,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Trabeculoplasty By Laser Surgery (Procah),,65855,CPT,Professional,Both,,,,1607,1365.95,129.36,1607,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,149.352,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Trabeculoplasty By Laser Surgery (Procah),,65855,CPT,Professional,Both,,,,1607,1365.95,129.36,1607,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),231.4145,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Trabeculoplasty By Laser Surgery (Procah),,65855,CPT,Professional,Both,,,,1607,1365.95,129.36,1607,CorVel,Worker's Compensation,391.3606314,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Trabeculoplasty By Laser Surgery (Procah),,65855,CPT,Professional,Both,,,,1607,1365.95,129.36,1607,First Health Group Corporation,First Health Network,1558.79,97,,percent of total billed charges,,
Trabeculoplasty By Laser Surgery (Procah),,65855,CPT,Professional,Both,,,,1607,1365.95,129.36,1607,"Health Partners, Inc.",Commercial,422.98,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Trabeculoplasty By Laser Surgery (Procah),,65855,CPT,Professional,Both,,,,1607,1365.95,129.36,1607,"Health Partners, Inc.",Medicare Advantage,231.4145,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Trabeculoplasty By Laser Surgery (Procah),,65855,CPT,Professional,Both,,,,1607,1365.95,129.36,1607,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),200.95,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Trabeculoplasty By Laser Surgery (Procah),,65855,CPT,Professional,Both,,,,1607,1365.95,129.36,1607,"Health Partners, Inc.",State of Minnesota Advantage Program,364.39727,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Trabeculoplasty By Laser Surgery (Procah),,65855,CPT,Professional,Both,,,,1607,1365.95,129.36,1607,"Health Partners, Inc.",State Public Programs,129.36,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Trabeculoplasty By Laser Surgery (Procah),,65855,CPT,Professional,Both,,,,1607,1365.95,129.36,1607,Humana Insurance Company,Commercial PPO,201.23,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Trabeculoplasty By Laser Surgery (Procah),,65855,CPT,Professional,Both,,,,1607,1365.95,129.36,1607,Humana Insurance Company,Medicare PPO,1607,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Trabeculoplasty By Laser Surgery (Procah),,65855,CPT,Professional,Both,,,,1607,1365.95,129.36,1607,Medica,Individual & Family,1362.736,84.8,,percent of total billed charges,,
Trabeculoplasty By Laser Surgery (Procah),,65855,CPT,Professional,Both,,,,1607,1365.95,129.36,1607,Medica,Medica Advantage Solution,800.286,49.8,,percent of total billed charges,,
Trabeculoplasty By Laser Surgery (Procah),,65855,CPT,Professional,Both,,,,1607,1365.95,129.36,1607,Medica,Medical Assistance,149.35,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Trabeculoplasty By Laser Surgery (Procah),,65855,CPT,Professional,Both,,,,1607,1365.95,129.36,1607,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,201.23,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Trabeculoplasty By Laser Surgery (Procah),,65855,CPT,Professional,Both,,,,1607,1365.95,129.36,1607,"Multiplan, Inc.","Multiplan, Inc.",1510.58,94,,percent of total billed charges,,
Trabeculoplasty By Laser Surgery (Procah),,65855,CPT,Professional,Both,,,,1607,1365.95,129.36,1607,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1447.907,90.1,,percent of total billed charges,,
Trabeculoplasty By Laser Surgery (Procah),,65855,CPT,Professional,Both,,,,1607,1365.95,129.36,1607,"Preferred One Administrative Services, INC.",PPO,1584.502,98.6,,percent of total billed charges,,
Trabeculoplasty By Laser Surgery (Procah),,65855,CPT,Professional,Both,,,,1607,1365.95,129.36,1607,PrimeWest Health,Minnesota Senior Health Options (MSHO),231.4145,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Trabeculoplasty By Laser Surgery (Procah),,65855,CPT,Professional,Both,,,,1607,1365.95,129.36,1607,PrimeWest Health,MinnesotaCare,159.80664,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Trabeculoplasty By Laser Surgery (Procah),,65855,CPT,Professional,Both,,,,1607,1365.95,129.36,1607,Sanford Health Plan,Sanford Health Plan,1414.16,88,,percent of total billed charges,,
Trabeculoplasty By Laser Surgery (Procah),,65855,CPT,Professional,Both,,,,1607,1365.95,129.36,1607,"UCare Health, Inc.",Individual & Family Plan,327.119488,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Trabeculoplasty By Laser Surgery (Procah),,65855,CPT,Professional,Both,,,,1607,1365.95,129.36,1607,"UCare Health, Inc.",Medical Assistance,164.2872,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Trabeculoplasty By Laser Surgery (Procah),,65855,CPT,Professional,Both,,,,1607,1365.95,129.36,1607,"UCare Health, Inc.",Medicare Advantage,231.4145,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Trabeculoplasty By Laser Surgery (Procah),,65855,CPT,Professional,Both,,,,1607,1365.95,129.36,1607,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),185.1316,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Trabeculoplasty By Laser Surgery (Procah),,65855,CPT,Professional,Both,,,,1607,1365.95,129.36,1607,UnitedHealthcare,Individual & Family,1607,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Trabeculoplasty By Laser Surgery (Procah),,65855,CPT,Professional,Both,,,,1607,1365.95,129.36,1607,UnitedHealthcare,Medicare Advantage,231.4145,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Trabeculoplasty By Laser Surgery (Procah),,65855,CPT,Professional,Both,,,,1607,1365.95,129.36,1607,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,149.352,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
NEPAFENAC 0.3 % OPHT DRPS,,105426,LOCAL,Facility,Both,1.7,mL,,1254,1065.9,359.3964,1254,Aetna,Commercial,1153.68,92,,percent of total billed charges,,
NEPAFENAC 0.3 % OPHT DRPS,,105426,LOCAL,Facility,Outpatient,1.7,mL,,1254,1065.9,359.3964,1254,Aetna,Medicare Advantage,614.46,49,,percent of total billed charges,,
NEPAFENAC 0.3 % OPHT DRPS,,105426,LOCAL,Facility,Inpatient,1.7,mL,,1254,1065.9,359.3964,1254,Aetna,Medicare Advantage,,,,,Included in per diem rate,
NEPAFENAC 0.3 % OPHT DRPS,,105426,LOCAL,Facility,Both,1.7,mL,,1254,1065.9,359.3964,1254,Aetna,PPO,1166.22,93,,percent of total billed charges,,
NEPAFENAC 0.3 % OPHT DRPS,,105426,LOCAL,Facility,Both,1.7,mL,,1254,1065.9,359.3964,1254,America's PPO,America's PPO,1204.2162,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
NEPAFENAC 0.3 % OPHT DRPS,,105426,LOCAL,Facility,Both,1.7,mL,,1254,1065.9,359.3964,1254,BlueCross BlueShield Minnesota, Federal Employee Program,1233.936,98.4,,percent of total billed charges,,
NEPAFENAC 0.3 % OPHT DRPS,,105426,LOCAL,Facility,Both,1.7,mL,,1254,1065.9,359.3964,1254,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1254,100,,percent of total billed charges,,
NEPAFENAC 0.3 % OPHT DRPS,,105426,LOCAL,Facility,Both,1.7,mL,,1254,1065.9,359.3964,1254,BlueCross BlueShield Minnesota,High Value Network Plan,1128.6,90,,percent of total billed charges,,
NEPAFENAC 0.3 % OPHT DRPS,,105426,LOCAL,Facility,Outpatient,1.7,mL,,1254,1065.9,359.3964,1254,BlueCross BlueShield Minnesota,Medicare Advantage,614.46,49,,percent of total billed charges,,
NEPAFENAC 0.3 % OPHT DRPS,,105426,LOCAL,Facility,Inpatient,1.7,mL,,1254,1065.9,359.3964,1254,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
NEPAFENAC 0.3 % OPHT DRPS,,105426,LOCAL,Facility,Both,1.7,mL,,1254,1065.9,359.3964,1254,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1110.6678,88.57,,percent of total billed charges,,
NEPAFENAC 0.3 % OPHT DRPS,,105426,LOCAL,Facility,Both,1.7,mL,,1254,1065.9,359.3964,1254,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,359.3964,28.66,,percent of total billed charges,,
NEPAFENAC 0.3 % OPHT DRPS,,105426,LOCAL,Facility,Outpatient,1.7,mL,,1254,1065.9,359.3964,1254,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),614.46,49,,percent of total billed charges,,
NEPAFENAC 0.3 % OPHT DRPS,,105426,LOCAL,Facility,Inpatient,1.7,mL,,1254,1065.9,359.3964,1254,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
NEPAFENAC 0.3 % OPHT DRPS,,105426,LOCAL,Facility,Both,1.7,mL,,1254,1065.9,359.3964,1254,CorVel,Worker's Compensation,1254,100,,percent of total billed charges,,
NEPAFENAC 0.3 % OPHT DRPS,,105426,LOCAL,Facility,Both,1.7,mL,,1254,1065.9,359.3964,1254,First Health Group Corporation,First Health Network,1216.38,97,,percent of total billed charges,,
NEPAFENAC 0.3 % OPHT DRPS,,105426,LOCAL,Facility,Both,1.7,mL,,1254,1065.9,359.3964,1254,"Health Partners, Inc.",Commercial,1186.284,94.6,,percent of total billed charges,,
NEPAFENAC 0.3 % OPHT DRPS,,105426,LOCAL,Facility,Outpatient,1.7,mL,,1254,1065.9,359.3964,1254,"Health Partners, Inc.",Medicare Advantage,614.46,49,,percent of total billed charges,,
NEPAFENAC 0.3 % OPHT DRPS,,105426,LOCAL,Facility,Inpatient,1.7,mL,,1254,1065.9,359.3964,1254,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
NEPAFENAC 0.3 % OPHT DRPS,,105426,LOCAL,Facility,Both,1.7,mL,,1254,1065.9,359.3964,1254,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),752.4,60,,percent of total billed charges,,
NEPAFENAC 0.3 % OPHT DRPS,,105426,LOCAL,Facility,Both,1.7,mL,,1254,1065.9,359.3964,1254,"Health Partners, Inc.",State of Minnesota Advantage Program,1022.01,81.5,,percent of total billed charges,,
NEPAFENAC 0.3 % OPHT DRPS,,105426,LOCAL,Facility,Both,1.7,mL,,1254,1065.9,359.3964,1254,"Health Partners, Inc.",State Public Programs,627,50,,percent of total billed charges,,
NEPAFENAC 0.3 % OPHT DRPS,,105426,LOCAL,Facility,Both,1.7,mL,,1254,1065.9,359.3964,1254,Humana Insurance Company,Commercial PPO,1191.3,95,,percent of total billed charges,,
NEPAFENAC 0.3 % OPHT DRPS,,105426,LOCAL,Facility,Outpatient,1.7,mL,,1254,1065.9,359.3964,1254,Humana Insurance Company,Medicare PPO,614.46,49,,percent of total billed charges,,
NEPAFENAC 0.3 % OPHT DRPS,,105426,LOCAL,Facility,Inpatient,1.7,mL,,1254,1065.9,359.3964,1254,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
NEPAFENAC 0.3 % OPHT DRPS,,105426,LOCAL,Facility,Both,1.7,mL,,1254,1065.9,359.3964,1254,Medica,Individual & Family,1242.714,99.1,,percent of total billed charges,,
NEPAFENAC 0.3 % OPHT DRPS,,105426,LOCAL,Facility,Outpatient,1.7,mL,,1254,1065.9,359.3964,1254,Medica,Medica Advantage Solution,624.492,49.8,,percent of total billed charges,,
NEPAFENAC 0.3 % OPHT DRPS,,105426,LOCAL,Facility,Inpatient,1.7,mL,,1254,1065.9,359.3964,1254,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
NEPAFENAC 0.3 % OPHT DRPS,,105426,LOCAL,Facility,Outpatient,1.7,mL,,1254,1065.9,359.3964,1254,Medica,Medical Assistance,559.284,44.6,,percent of total billed charges,,
NEPAFENAC 0.3 % OPHT DRPS,,105426,LOCAL,Facility,Inpatient,1.7,mL,,1254,1065.9,359.3964,1254,Medica,Medical Assistance,,,,,Included in per diem rate,
NEPAFENAC 0.3 % OPHT DRPS,,105426,LOCAL,Facility,Outpatient,1.7,mL,,1254,1065.9,359.3964,1254,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,624.492,49.8,,percent of total billed charges,,
NEPAFENAC 0.3 % OPHT DRPS,,105426,LOCAL,Facility,Inpatient,1.7,mL,,1254,1065.9,359.3964,1254,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
NEPAFENAC 0.3 % OPHT DRPS,,105426,LOCAL,Facility,Both,1.7,mL,,1254,1065.9,359.3964,1254,"Multiplan, Inc.","Multiplan, Inc.",1178.76,94,,percent of total billed charges,,
NEPAFENAC 0.3 % OPHT DRPS,,105426,LOCAL,Facility,Outpatient,1.7,mL,,1254,1065.9,359.3964,1254,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1129.854,90.1,,percent of total billed charges,,
NEPAFENAC 0.3 % OPHT DRPS,,105426,LOCAL,Facility,Inpatient,1.7,mL,,1254,1065.9,359.3964,1254,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
NEPAFENAC 0.3 % OPHT DRPS,,105426,LOCAL,Facility,Both,1.7,mL,,1254,1065.9,359.3964,1254,"Preferred One Administrative Services, INC.",PPO,1236.444,98.6,,percent of total billed charges,,
NEPAFENAC 0.3 % OPHT DRPS,,105426,LOCAL,Facility,Outpatient,1.7,mL,,1254,1065.9,359.3964,1254,PrimeWest Health,Minnesota Senior Health Options (MSHO),645.183,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
NEPAFENAC 0.3 % OPHT DRPS,,105426,LOCAL,Facility,Inpatient,1.7,mL,,1254,1065.9,359.3964,1254,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
NEPAFENAC 0.3 % OPHT DRPS,,105426,LOCAL,Facility,Outpatient,1.7,mL,,1254,1065.9,359.3964,1254,PrimeWest Health,MinnesotaCare,644.0544,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
NEPAFENAC 0.3 % OPHT DRPS,,105426,LOCAL,Facility,Inpatient,1.7,mL,,1254,1065.9,359.3964,1254,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
NEPAFENAC 0.3 % OPHT DRPS,,105426,LOCAL,Facility,Both,1.7,mL,,1254,1065.9,359.3964,1254,Sanford Health Plan,Sanford Health Plan,1153.68,92,,percent of total billed charges,,
NEPAFENAC 0.3 % OPHT DRPS,,105426,LOCAL,Facility,Outpatient,1.7,mL,,1254,1065.9,359.3964,1254,"UCare Health, Inc.",Individual & Family Plan,706.629,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
NEPAFENAC 0.3 % OPHT DRPS,,105426,LOCAL,Facility,Inpatient,1.7,mL,,1254,1065.9,359.3964,1254,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
NEPAFENAC 0.3 % OPHT DRPS,,105426,LOCAL,Facility,Outpatient,1.7,mL,,1254,1065.9,359.3964,1254,"UCare Health, Inc.",Medical Assistance,632.8938,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
NEPAFENAC 0.3 % OPHT DRPS,,105426,LOCAL,Facility,Inpatient,1.7,mL,,1254,1065.9,359.3964,1254,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
NEPAFENAC 0.3 % OPHT DRPS,,105426,LOCAL,Facility,Outpatient,1.7,mL,,1254,1065.9,359.3964,1254,"UCare Health, Inc.",Medicare Advantage,632.8938,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
NEPAFENAC 0.3 % OPHT DRPS,,105426,LOCAL,Facility,Inpatient,1.7,mL,,1254,1065.9,359.3964,1254,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
NEPAFENAC 0.3 % OPHT DRPS,,105426,LOCAL,Facility,Outpatient,1.7,mL,,1254,1065.9,359.3964,1254,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),632.8938,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
NEPAFENAC 0.3 % OPHT DRPS,,105426,LOCAL,Facility,Inpatient,1.7,mL,,1254,1065.9,359.3964,1254,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
NEPAFENAC 0.3 % OPHT DRPS,,105426,LOCAL,Facility,Both,1.7,mL,,1254,1065.9,359.3964,1254,UnitedHealthcare,Individual & Family,1178.76,94,,percent of total billed charges,,
NEPAFENAC 0.3 % OPHT DRPS,,105426,LOCAL,Facility,Outpatient,1.7,mL,,1254,1065.9,359.3964,1254,UnitedHealthcare,Medicare Advantage,614.46,49,,percent of total billed charges,,
NEPAFENAC 0.3 % OPHT DRPS,,105426,LOCAL,Facility,Inpatient,1.7,mL,,1254,1065.9,359.3964,1254,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
NEPAFENAC 0.3 % OPHT DRPS,,105426,LOCAL,Facility,Outpatient,1.7,mL,,1254,1065.9,359.3964,1254,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,601.92,48,,percent of total billed charges,,100% of DHS outpatient percentage
NEPAFENAC 0.3 % OPHT DRPS,,105426,LOCAL,Facility,Inpatient,1.7,mL,,1254,1065.9,359.3964,1254,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBQ SOLN,,J0897,HCPCS,Facility,Both,1.7,mL,,10758,9144.3,3083.2428,10758,Aetna,Commercial,9897.36,92,,percent of total billed charges,,
DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBQ SOLN,,J0897,HCPCS,Facility,Outpatient,1.7,mL,,10758,9144.3,3083.2428,10758,Aetna,Medicare Advantage,5271.42,49,,percent of total billed charges,,
DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBQ SOLN,,J0897,HCPCS,Facility,Inpatient,1.7,mL,,10758,9144.3,3083.2428,10758,Aetna,Medicare Advantage,,,,,Included in per diem rate,
DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBQ SOLN,,J0897,HCPCS,Facility,Both,1.7,mL,,10758,9144.3,3083.2428,10758,Aetna,PPO,10004.94,93,,percent of total billed charges,,
DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBQ SOLN,,J0897,HCPCS,Facility,Both,1.7,mL,,10758,9144.3,3083.2428,10758,America's PPO,America's PPO,10330.9074,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBQ SOLN,,J0897,HCPCS,Facility,Both,1.7,mL,,10758,9144.3,3083.2428,10758,BlueCross BlueShield Minnesota, Federal Employee Program,10585.872,98.4,,percent of total billed charges,,
DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBQ SOLN,,J0897,HCPCS,Facility,Both,1.7,mL,,10758,9144.3,3083.2428,10758,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,10758,100,,percent of total billed charges,,
DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBQ SOLN,,J0897,HCPCS,Facility,Both,1.7,mL,,10758,9144.3,3083.2428,10758,BlueCross BlueShield Minnesota,High Value Network Plan,9682.2,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBQ SOLN,,J0897,HCPCS,Facility,Outpatient,1.7,mL,,10758,9144.3,3083.2428,10758,BlueCross BlueShield Minnesota,Medicare Advantage,5271.42,49,,percent of total billed charges,,
DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBQ SOLN,,J0897,HCPCS,Facility,Inpatient,1.7,mL,,10758,9144.3,3083.2428,10758,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBQ SOLN,,J0897,HCPCS,Facility,Both,1.7,mL,,10758,9144.3,3083.2428,10758,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,9528.3606,88.57,,percent of total billed charges,,
DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBQ SOLN,,J0897,HCPCS,Facility,Both,1.7,mL,,10758,9144.3,3083.2428,10758,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,3083.2428,28.66,,percent of total billed charges,,
DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBQ SOLN,,J0897,HCPCS,Facility,Outpatient,1.7,mL,,10758,9144.3,3083.2428,10758,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),5271.42,49,,percent of total billed charges,,
DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBQ SOLN,,J0897,HCPCS,Facility,Inpatient,1.7,mL,,10758,9144.3,3083.2428,10758,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBQ SOLN,,J0897,HCPCS,Facility,Both,1.7,mL,,10758,9144.3,3083.2428,10758,CorVel,Worker's Compensation,10758,100,,percent of total billed charges,,
DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBQ SOLN,,J0897,HCPCS,Facility,Both,1.7,mL,,10758,9144.3,3083.2428,10758,First Health Group Corporation,First Health Network,10435.26,97,,percent of total billed charges,,
DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBQ SOLN,,J0897,HCPCS,Facility,Both,1.7,mL,,10758,9144.3,3083.2428,10758,"Health Partners, Inc.",Commercial,10177.068,94.6,,percent of total billed charges,,
DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBQ SOLN,,J0897,HCPCS,Facility,Outpatient,1.7,mL,,10758,9144.3,3083.2428,10758,"Health Partners, Inc.",Medicare Advantage,5271.42,49,,percent of total billed charges,,
DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBQ SOLN,,J0897,HCPCS,Facility,Inpatient,1.7,mL,,10758,9144.3,3083.2428,10758,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBQ SOLN,,J0897,HCPCS,Facility,Both,1.7,mL,,10758,9144.3,3083.2428,10758,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),6454.8,60,,percent of total billed charges,,
DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBQ SOLN,,J0897,HCPCS,Facility,Both,1.7,mL,,10758,9144.3,3083.2428,10758,"Health Partners, Inc.",State of Minnesota Advantage Program,8767.77,81.5,,percent of total billed charges,,
DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBQ SOLN,,J0897,HCPCS,Facility,Both,1.7,mL,,10758,9144.3,3083.2428,10758,"Health Partners, Inc.",State Public Programs,5379,50,,percent of total billed charges,,
DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBQ SOLN,,J0897,HCPCS,Facility,Both,1.7,mL,,10758,9144.3,3083.2428,10758,Humana Insurance Company,Commercial PPO,10220.1,95,,percent of total billed charges,,
DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBQ SOLN,,J0897,HCPCS,Facility,Outpatient,1.7,mL,,10758,9144.3,3083.2428,10758,Humana Insurance Company,Medicare PPO,5271.42,49,,percent of total billed charges,,
DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBQ SOLN,,J0897,HCPCS,Facility,Inpatient,1.7,mL,,10758,9144.3,3083.2428,10758,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBQ SOLN,,J0897,HCPCS,Facility,Both,1.7,mL,,10758,9144.3,3083.2428,10758,Medica,Individual & Family,10661.178,99.1,,percent of total billed charges,,
DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBQ SOLN,,J0897,HCPCS,Facility,Outpatient,1.7,mL,,10758,9144.3,3083.2428,10758,Medica,Medica Advantage Solution,5357.484,49.8,,percent of total billed charges,,
DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBQ SOLN,,J0897,HCPCS,Facility,Inpatient,1.7,mL,,10758,9144.3,3083.2428,10758,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBQ SOLN,,J0897,HCPCS,Facility,Outpatient,1.7,mL,,10758,9144.3,3083.2428,10758,Medica,Medical Assistance,4798.068,44.6,,percent of total billed charges,,
DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBQ SOLN,,J0897,HCPCS,Facility,Inpatient,1.7,mL,,10758,9144.3,3083.2428,10758,Medica,Medical Assistance,,,,,Included in per diem rate,
DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBQ SOLN,,J0897,HCPCS,Facility,Outpatient,1.7,mL,,10758,9144.3,3083.2428,10758,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,5357.484,49.8,,percent of total billed charges,,
DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBQ SOLN,,J0897,HCPCS,Facility,Inpatient,1.7,mL,,10758,9144.3,3083.2428,10758,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBQ SOLN,,J0897,HCPCS,Facility,Both,1.7,mL,,10758,9144.3,3083.2428,10758,"Multiplan, Inc.","Multiplan, Inc.",10112.52,94,,percent of total billed charges,,
DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBQ SOLN,,J0897,HCPCS,Facility,Outpatient,1.7,mL,,10758,9144.3,3083.2428,10758,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,9692.958,90.1,,percent of total billed charges,,
DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBQ SOLN,,J0897,HCPCS,Facility,Inpatient,1.7,mL,,10758,9144.3,3083.2428,10758,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBQ SOLN,,J0897,HCPCS,Facility,Both,1.7,mL,,10758,9144.3,3083.2428,10758,"Preferred One Administrative Services, INC.",PPO,10607.388,98.6,,percent of total billed charges,,
DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBQ SOLN,,J0897,HCPCS,Facility,Outpatient,1.7,mL,,10758,9144.3,3083.2428,10758,PrimeWest Health,Minnesota Senior Health Options (MSHO),5534.991,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBQ SOLN,,J0897,HCPCS,Facility,Inpatient,1.7,mL,,10758,9144.3,3083.2428,10758,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBQ SOLN,,J0897,HCPCS,Facility,Outpatient,1.7,mL,,10758,9144.3,3083.2428,10758,PrimeWest Health,MinnesotaCare,5525.3088,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBQ SOLN,,J0897,HCPCS,Facility,Inpatient,1.7,mL,,10758,9144.3,3083.2428,10758,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBQ SOLN,,J0897,HCPCS,Facility,Both,1.7,mL,,10758,9144.3,3083.2428,10758,Sanford Health Plan,Sanford Health Plan,9897.36,92,,percent of total billed charges,,
DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBQ SOLN,,J0897,HCPCS,Facility,Outpatient,1.7,mL,,10758,9144.3,3083.2428,10758,"UCare Health, Inc.",Individual & Family Plan,6062.133,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBQ SOLN,,J0897,HCPCS,Facility,Inpatient,1.7,mL,,10758,9144.3,3083.2428,10758,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBQ SOLN,,J0897,HCPCS,Facility,Outpatient,1.7,mL,,10758,9144.3,3083.2428,10758,"UCare Health, Inc.",Medical Assistance,5429.5626,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBQ SOLN,,J0897,HCPCS,Facility,Inpatient,1.7,mL,,10758,9144.3,3083.2428,10758,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBQ SOLN,,J0897,HCPCS,Facility,Outpatient,1.7,mL,,10758,9144.3,3083.2428,10758,"UCare Health, Inc.",Medicare Advantage,5429.5626,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBQ SOLN,,J0897,HCPCS,Facility,Inpatient,1.7,mL,,10758,9144.3,3083.2428,10758,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBQ SOLN,,J0897,HCPCS,Facility,Outpatient,1.7,mL,,10758,9144.3,3083.2428,10758,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),5429.5626,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBQ SOLN,,J0897,HCPCS,Facility,Inpatient,1.7,mL,,10758,9144.3,3083.2428,10758,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBQ SOLN,,J0897,HCPCS,Facility,Both,1.7,mL,,10758,9144.3,3083.2428,10758,UnitedHealthcare,Individual & Family,10112.52,94,,percent of total billed charges,,
DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBQ SOLN,,J0897,HCPCS,Facility,Outpatient,1.7,mL,,10758,9144.3,3083.2428,10758,UnitedHealthcare,Medicare Advantage,5271.42,49,,percent of total billed charges,,
DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBQ SOLN,,J0897,HCPCS,Facility,Inpatient,1.7,mL,,10758,9144.3,3083.2428,10758,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBQ SOLN,,J0897,HCPCS,Facility,Outpatient,1.7,mL,,10758,9144.3,3083.2428,10758,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,5163.84,48,,percent of total billed charges,,100% of DHS outpatient percentage
DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBQ SOLN,,J0897,HCPCS,Facility,Inpatient,1.7,mL,,10758,9144.3,3083.2428,10758,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
LATANOPROST 0.005 % OPHT DROP,,501,LOCAL,Facility,Both,2.5,mL,,399,339.15,114.3534,399,Aetna,Commercial,367.08,92,,percent of total billed charges,,
LATANOPROST 0.005 % OPHT DROP,,501,LOCAL,Facility,Both,2.5,mL,,399,339.15,114.3534,399,Aetna,Commercial,367.08,92,,percent of total billed charges,,
LATANOPROST 0.005 % OPHT DROP,,501,LOCAL,Facility,Outpatient,2.5,mL,,399,339.15,114.3534,399,Aetna,Medicare Advantage,195.51,49,,percent of total billed charges,,
LATANOPROST 0.005 % OPHT DROP,,501,LOCAL,Facility,Outpatient,2.5,mL,,399,339.15,114.3534,399,Aetna,Medicare Advantage,195.51,49,,percent of total billed charges,,
LATANOPROST 0.005 % OPHT DROP,,501,LOCAL,Facility,Inpatient,2.5,mL,,399,339.15,114.3534,399,Aetna,Medicare Advantage,,,,,Included in per diem rate,
LATANOPROST 0.005 % OPHT DROP,,501,LOCAL,Facility,Inpatient,2.5,mL,,399,339.15,114.3534,399,Aetna,Medicare Advantage,,,,,Included in per diem rate,
LATANOPROST 0.005 % OPHT DROP,,501,LOCAL,Facility,Both,2.5,mL,,399,339.15,114.3534,399,Aetna,PPO,371.07,93,,percent of total billed charges,,
LATANOPROST 0.005 % OPHT DROP,,501,LOCAL,Facility,Both,2.5,mL,,399,339.15,114.3534,399,Aetna,PPO,371.07,93,,percent of total billed charges,,
LATANOPROST 0.005 % OPHT DROP,,501,LOCAL,Facility,Both,2.5,mL,,399,339.15,114.3534,399,America's PPO,America's PPO,383.1597,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
LATANOPROST 0.005 % OPHT DROP,,501,LOCAL,Facility,Both,2.5,mL,,399,339.15,114.3534,399,America's PPO,America's PPO,383.1597,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
LATANOPROST 0.005 % OPHT DROP,,501,LOCAL,Facility,Both,2.5,mL,,399,339.15,114.3534,399,BlueCross BlueShield Minnesota, Federal Employee Program,392.616,98.4,,percent of total billed charges,,
LATANOPROST 0.005 % OPHT DROP,,501,LOCAL,Facility,Both,2.5,mL,,399,339.15,114.3534,399,BlueCross BlueShield Minnesota, Federal Employee Program,392.616,98.4,,percent of total billed charges,,
LATANOPROST 0.005 % OPHT DROP,,501,LOCAL,Facility,Both,2.5,mL,,399,339.15,114.3534,399,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,399,100,,percent of total billed charges,,
LATANOPROST 0.005 % OPHT DROP,,501,LOCAL,Facility,Both,2.5,mL,,399,339.15,114.3534,399,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,399,100,,percent of total billed charges,,
LATANOPROST 0.005 % OPHT DROP,,501,LOCAL,Facility,Both,2.5,mL,,399,339.15,114.3534,399,BlueCross BlueShield Minnesota,High Value Network Plan,359.1,90,,percent of total billed charges,,
LATANOPROST 0.005 % OPHT DROP,,501,LOCAL,Facility,Both,2.5,mL,,399,339.15,114.3534,399,BlueCross BlueShield Minnesota,High Value Network Plan,359.1,90,,percent of total billed charges,,
LATANOPROST 0.005 % OPHT DROP,,501,LOCAL,Facility,Outpatient,2.5,mL,,399,339.15,114.3534,399,BlueCross BlueShield Minnesota,Medicare Advantage,195.51,49,,percent of total billed charges,,
LATANOPROST 0.005 % OPHT DROP,,501,LOCAL,Facility,Outpatient,2.5,mL,,399,339.15,114.3534,399,BlueCross BlueShield Minnesota,Medicare Advantage,195.51,49,,percent of total billed charges,,
LATANOPROST 0.005 % OPHT DROP,,501,LOCAL,Facility,Inpatient,2.5,mL,,399,339.15,114.3534,399,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
LATANOPROST 0.005 % OPHT DROP,,501,LOCAL,Facility,Inpatient,2.5,mL,,399,339.15,114.3534,399,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
LATANOPROST 0.005 % OPHT DROP,,501,LOCAL,Facility,Both,2.5,mL,,399,339.15,114.3534,399,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,353.3943,88.57,,percent of total billed charges,,
LATANOPROST 0.005 % OPHT DROP,,501,LOCAL,Facility,Both,2.5,mL,,399,339.15,114.3534,399,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,353.3943,88.57,,percent of total billed charges,,
LATANOPROST 0.005 % OPHT DROP,,501,LOCAL,Facility,Both,2.5,mL,,399,339.15,114.3534,399,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,114.3534,28.66,,percent of total billed charges,,
LATANOPROST 0.005 % OPHT DROP,,501,LOCAL,Facility,Both,2.5,mL,,399,339.15,114.3534,399,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,114.3534,28.66,,percent of total billed charges,,
LATANOPROST 0.005 % OPHT DROP,,501,LOCAL,Facility,Outpatient,2.5,mL,,399,339.15,114.3534,399,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),195.51,49,,percent of total billed charges,,
LATANOPROST 0.005 % OPHT DROP,,501,LOCAL,Facility,Outpatient,2.5,mL,,399,339.15,114.3534,399,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),195.51,49,,percent of total billed charges,,
LATANOPROST 0.005 % OPHT DROP,,501,LOCAL,Facility,Inpatient,2.5,mL,,399,339.15,114.3534,399,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
LATANOPROST 0.005 % OPHT DROP,,501,LOCAL,Facility,Inpatient,2.5,mL,,399,339.15,114.3534,399,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
LATANOPROST 0.005 % OPHT DROP,,501,LOCAL,Facility,Both,2.5,mL,,399,339.15,114.3534,399,CorVel,Worker's Compensation,399,100,,percent of total billed charges,,
LATANOPROST 0.005 % OPHT DROP,,501,LOCAL,Facility,Both,2.5,mL,,399,339.15,114.3534,399,CorVel,Worker's Compensation,399,100,,percent of total billed charges,,
LATANOPROST 0.005 % OPHT DROP,,501,LOCAL,Facility,Both,2.5,mL,,399,339.15,114.3534,399,First Health Group Corporation,First Health Network,387.03,97,,percent of total billed charges,,
LATANOPROST 0.005 % OPHT DROP,,501,LOCAL,Facility,Both,2.5,mL,,399,339.15,114.3534,399,First Health Group Corporation,First Health Network,387.03,97,,percent of total billed charges,,
LATANOPROST 0.005 % OPHT DROP,,501,LOCAL,Facility,Both,2.5,mL,,399,339.15,114.3534,399,"Health Partners, Inc.",Commercial,377.454,94.6,,percent of total billed charges,,
LATANOPROST 0.005 % OPHT DROP,,501,LOCAL,Facility,Both,2.5,mL,,399,339.15,114.3534,399,"Health Partners, Inc.",Commercial,377.454,94.6,,percent of total billed charges,,
LATANOPROST 0.005 % OPHT DROP,,501,LOCAL,Facility,Outpatient,2.5,mL,,399,339.15,114.3534,399,"Health Partners, Inc.",Medicare Advantage,195.51,49,,percent of total billed charges,,
LATANOPROST 0.005 % OPHT DROP,,501,LOCAL,Facility,Outpatient,2.5,mL,,399,339.15,114.3534,399,"Health Partners, Inc.",Medicare Advantage,195.51,49,,percent of total billed charges,,
LATANOPROST 0.005 % OPHT DROP,,501,LOCAL,Facility,Inpatient,2.5,mL,,399,339.15,114.3534,399,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LATANOPROST 0.005 % OPHT DROP,,501,LOCAL,Facility,Inpatient,2.5,mL,,399,339.15,114.3534,399,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LATANOPROST 0.005 % OPHT DROP,,501,LOCAL,Facility,Both,2.5,mL,,399,339.15,114.3534,399,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),239.4,60,,percent of total billed charges,,
LATANOPROST 0.005 % OPHT DROP,,501,LOCAL,Facility,Both,2.5,mL,,399,339.15,114.3534,399,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),239.4,60,,percent of total billed charges,,
LATANOPROST 0.005 % OPHT DROP,,501,LOCAL,Facility,Both,2.5,mL,,399,339.15,114.3534,399,"Health Partners, Inc.",State of Minnesota Advantage Program,325.185,81.5,,percent of total billed charges,,
LATANOPROST 0.005 % OPHT DROP,,501,LOCAL,Facility,Both,2.5,mL,,399,339.15,114.3534,399,"Health Partners, Inc.",State of Minnesota Advantage Program,325.185,81.5,,percent of total billed charges,,
LATANOPROST 0.005 % OPHT DROP,,501,LOCAL,Facility,Both,2.5,mL,,399,339.15,114.3534,399,"Health Partners, Inc.",State Public Programs,199.5,50,,percent of total billed charges,,
LATANOPROST 0.005 % OPHT DROP,,501,LOCAL,Facility,Both,2.5,mL,,399,339.15,114.3534,399,"Health Partners, Inc.",State Public Programs,199.5,50,,percent of total billed charges,,
LATANOPROST 0.005 % OPHT DROP,,501,LOCAL,Facility,Both,2.5,mL,,399,339.15,114.3534,399,Humana Insurance Company,Commercial PPO,379.05,95,,percent of total billed charges,,
LATANOPROST 0.005 % OPHT DROP,,501,LOCAL,Facility,Both,2.5,mL,,399,339.15,114.3534,399,Humana Insurance Company,Commercial PPO,379.05,95,,percent of total billed charges,,
LATANOPROST 0.005 % OPHT DROP,,501,LOCAL,Facility,Outpatient,2.5,mL,,399,339.15,114.3534,399,Humana Insurance Company,Medicare PPO,195.51,49,,percent of total billed charges,,
LATANOPROST 0.005 % OPHT DROP,,501,LOCAL,Facility,Outpatient,2.5,mL,,399,339.15,114.3534,399,Humana Insurance Company,Medicare PPO,195.51,49,,percent of total billed charges,,
LATANOPROST 0.005 % OPHT DROP,,501,LOCAL,Facility,Inpatient,2.5,mL,,399,339.15,114.3534,399,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
LATANOPROST 0.005 % OPHT DROP,,501,LOCAL,Facility,Inpatient,2.5,mL,,399,339.15,114.3534,399,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
LATANOPROST 0.005 % OPHT DROP,,501,LOCAL,Facility,Both,2.5,mL,,399,339.15,114.3534,399,Medica,Individual & Family,395.409,99.1,,percent of total billed charges,,
LATANOPROST 0.005 % OPHT DROP,,501,LOCAL,Facility,Both,2.5,mL,,399,339.15,114.3534,399,Medica,Individual & Family,395.409,99.1,,percent of total billed charges,,
LATANOPROST 0.005 % OPHT DROP,,501,LOCAL,Facility,Outpatient,2.5,mL,,399,339.15,114.3534,399,Medica,Medica Advantage Solution,198.702,49.8,,percent of total billed charges,,
LATANOPROST 0.005 % OPHT DROP,,501,LOCAL,Facility,Outpatient,2.5,mL,,399,339.15,114.3534,399,Medica,Medica Advantage Solution,198.702,49.8,,percent of total billed charges,,
LATANOPROST 0.005 % OPHT DROP,,501,LOCAL,Facility,Inpatient,2.5,mL,,399,339.15,114.3534,399,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
LATANOPROST 0.005 % OPHT DROP,,501,LOCAL,Facility,Inpatient,2.5,mL,,399,339.15,114.3534,399,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
LATANOPROST 0.005 % OPHT DROP,,501,LOCAL,Facility,Outpatient,2.5,mL,,399,339.15,114.3534,399,Medica,Medical Assistance,177.954,44.6,,percent of total billed charges,,
LATANOPROST 0.005 % OPHT DROP,,501,LOCAL,Facility,Outpatient,2.5,mL,,399,339.15,114.3534,399,Medica,Medical Assistance,177.954,44.6,,percent of total billed charges,,
LATANOPROST 0.005 % OPHT DROP,,501,LOCAL,Facility,Inpatient,2.5,mL,,399,339.15,114.3534,399,Medica,Medical Assistance,,,,,Included in per diem rate,
LATANOPROST 0.005 % OPHT DROP,,501,LOCAL,Facility,Inpatient,2.5,mL,,399,339.15,114.3534,399,Medica,Medical Assistance,,,,,Included in per diem rate,
LATANOPROST 0.005 % OPHT DROP,,501,LOCAL,Facility,Outpatient,2.5,mL,,399,339.15,114.3534,399,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,198.702,49.8,,percent of total billed charges,,
LATANOPROST 0.005 % OPHT DROP,,501,LOCAL,Facility,Outpatient,2.5,mL,,399,339.15,114.3534,399,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,198.702,49.8,,percent of total billed charges,,
LATANOPROST 0.005 % OPHT DROP,,501,LOCAL,Facility,Inpatient,2.5,mL,,399,339.15,114.3534,399,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
LATANOPROST 0.005 % OPHT DROP,,501,LOCAL,Facility,Inpatient,2.5,mL,,399,339.15,114.3534,399,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
LATANOPROST 0.005 % OPHT DROP,,501,LOCAL,Facility,Both,2.5,mL,,399,339.15,114.3534,399,"Multiplan, Inc.","Multiplan, Inc.",375.06,94,,percent of total billed charges,,
LATANOPROST 0.005 % OPHT DROP,,501,LOCAL,Facility,Both,2.5,mL,,399,339.15,114.3534,399,"Multiplan, Inc.","Multiplan, Inc.",375.06,94,,percent of total billed charges,,
LATANOPROST 0.005 % OPHT DROP,,501,LOCAL,Facility,Outpatient,2.5,mL,,399,339.15,114.3534,399,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,359.499,90.1,,percent of total billed charges,,
LATANOPROST 0.005 % OPHT DROP,,501,LOCAL,Facility,Outpatient,2.5,mL,,399,339.15,114.3534,399,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,359.499,90.1,,percent of total billed charges,,
LATANOPROST 0.005 % OPHT DROP,,501,LOCAL,Facility,Inpatient,2.5,mL,,399,339.15,114.3534,399,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
LATANOPROST 0.005 % OPHT DROP,,501,LOCAL,Facility,Inpatient,2.5,mL,,399,339.15,114.3534,399,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
LATANOPROST 0.005 % OPHT DROP,,501,LOCAL,Facility,Both,2.5,mL,,399,339.15,114.3534,399,"Preferred One Administrative Services, INC.",PPO,393.414,98.6,,percent of total billed charges,,
LATANOPROST 0.005 % OPHT DROP,,501,LOCAL,Facility,Both,2.5,mL,,399,339.15,114.3534,399,"Preferred One Administrative Services, INC.",PPO,393.414,98.6,,percent of total billed charges,,
LATANOPROST 0.005 % OPHT DROP,,501,LOCAL,Facility,Outpatient,2.5,mL,,399,339.15,114.3534,399,PrimeWest Health,Minnesota Senior Health Options (MSHO),205.2855,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
LATANOPROST 0.005 % OPHT DROP,,501,LOCAL,Facility,Outpatient,2.5,mL,,399,339.15,114.3534,399,PrimeWest Health,Minnesota Senior Health Options (MSHO),205.2855,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
LATANOPROST 0.005 % OPHT DROP,,501,LOCAL,Facility,Inpatient,2.5,mL,,399,339.15,114.3534,399,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LATANOPROST 0.005 % OPHT DROP,,501,LOCAL,Facility,Inpatient,2.5,mL,,399,339.15,114.3534,399,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LATANOPROST 0.005 % OPHT DROP,,501,LOCAL,Facility,Outpatient,2.5,mL,,399,339.15,114.3534,399,PrimeWest Health,MinnesotaCare,204.9264,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
LATANOPROST 0.005 % OPHT DROP,,501,LOCAL,Facility,Outpatient,2.5,mL,,399,339.15,114.3534,399,PrimeWest Health,MinnesotaCare,204.9264,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
LATANOPROST 0.005 % OPHT DROP,,501,LOCAL,Facility,Inpatient,2.5,mL,,399,339.15,114.3534,399,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
LATANOPROST 0.005 % OPHT DROP,,501,LOCAL,Facility,Inpatient,2.5,mL,,399,339.15,114.3534,399,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
LATANOPROST 0.005 % OPHT DROP,,501,LOCAL,Facility,Both,2.5,mL,,399,339.15,114.3534,399,Sanford Health Plan,Sanford Health Plan,367.08,92,,percent of total billed charges,,
LATANOPROST 0.005 % OPHT DROP,,501,LOCAL,Facility,Both,2.5,mL,,399,339.15,114.3534,399,Sanford Health Plan,Sanford Health Plan,367.08,92,,percent of total billed charges,,
LATANOPROST 0.005 % OPHT DROP,,501,LOCAL,Facility,Outpatient,2.5,mL,,399,339.15,114.3534,399,"UCare Health, Inc.",Individual & Family Plan,224.8365,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
LATANOPROST 0.005 % OPHT DROP,,501,LOCAL,Facility,Outpatient,2.5,mL,,399,339.15,114.3534,399,"UCare Health, Inc.",Individual & Family Plan,224.8365,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
LATANOPROST 0.005 % OPHT DROP,,501,LOCAL,Facility,Inpatient,2.5,mL,,399,339.15,114.3534,399,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
LATANOPROST 0.005 % OPHT DROP,,501,LOCAL,Facility,Inpatient,2.5,mL,,399,339.15,114.3534,399,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
LATANOPROST 0.005 % OPHT DROP,,501,LOCAL,Facility,Outpatient,2.5,mL,,399,339.15,114.3534,399,"UCare Health, Inc.",Medical Assistance,201.3753,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LATANOPROST 0.005 % OPHT DROP,,501,LOCAL,Facility,Outpatient,2.5,mL,,399,339.15,114.3534,399,"UCare Health, Inc.",Medical Assistance,201.3753,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LATANOPROST 0.005 % OPHT DROP,,501,LOCAL,Facility,Inpatient,2.5,mL,,399,339.15,114.3534,399,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
LATANOPROST 0.005 % OPHT DROP,,501,LOCAL,Facility,Inpatient,2.5,mL,,399,339.15,114.3534,399,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
LATANOPROST 0.005 % OPHT DROP,,501,LOCAL,Facility,Outpatient,2.5,mL,,399,339.15,114.3534,399,"UCare Health, Inc.",Medicare Advantage,201.3753,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LATANOPROST 0.005 % OPHT DROP,,501,LOCAL,Facility,Outpatient,2.5,mL,,399,339.15,114.3534,399,"UCare Health, Inc.",Medicare Advantage,201.3753,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LATANOPROST 0.005 % OPHT DROP,,501,LOCAL,Facility,Inpatient,2.5,mL,,399,339.15,114.3534,399,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LATANOPROST 0.005 % OPHT DROP,,501,LOCAL,Facility,Inpatient,2.5,mL,,399,339.15,114.3534,399,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LATANOPROST 0.005 % OPHT DROP,,501,LOCAL,Facility,Outpatient,2.5,mL,,399,339.15,114.3534,399,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),201.3753,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LATANOPROST 0.005 % OPHT DROP,,501,LOCAL,Facility,Outpatient,2.5,mL,,399,339.15,114.3534,399,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),201.3753,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LATANOPROST 0.005 % OPHT DROP,,501,LOCAL,Facility,Inpatient,2.5,mL,,399,339.15,114.3534,399,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LATANOPROST 0.005 % OPHT DROP,,501,LOCAL,Facility,Inpatient,2.5,mL,,399,339.15,114.3534,399,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LATANOPROST 0.005 % OPHT DROP,,501,LOCAL,Facility,Both,2.5,mL,,399,339.15,114.3534,399,UnitedHealthcare,Individual & Family,375.06,94,,percent of total billed charges,,
LATANOPROST 0.005 % OPHT DROP,,501,LOCAL,Facility,Both,2.5,mL,,399,339.15,114.3534,399,UnitedHealthcare,Individual & Family,375.06,94,,percent of total billed charges,,
LATANOPROST 0.005 % OPHT DROP,,501,LOCAL,Facility,Outpatient,2.5,mL,,399,339.15,114.3534,399,UnitedHealthcare,Medicare Advantage,195.51,49,,percent of total billed charges,,
LATANOPROST 0.005 % OPHT DROP,,501,LOCAL,Facility,Outpatient,2.5,mL,,399,339.15,114.3534,399,UnitedHealthcare,Medicare Advantage,195.51,49,,percent of total billed charges,,
LATANOPROST 0.005 % OPHT DROP,,501,LOCAL,Facility,Inpatient,2.5,mL,,399,339.15,114.3534,399,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
LATANOPROST 0.005 % OPHT DROP,,501,LOCAL,Facility,Inpatient,2.5,mL,,399,339.15,114.3534,399,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
LATANOPROST 0.005 % OPHT DROP,,501,LOCAL,Facility,Outpatient,2.5,mL,,399,339.15,114.3534,399,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,191.52,48,,percent of total billed charges,,100% of DHS outpatient percentage
LATANOPROST 0.005 % OPHT DROP,,501,LOCAL,Facility,Outpatient,2.5,mL,,399,339.15,114.3534,399,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,191.52,48,,percent of total billed charges,,100% of DHS outpatient percentage
LATANOPROST 0.005 % OPHT DROP,,501,LOCAL,Facility,Inpatient,2.5,mL,,399,339.15,114.3534,399,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
LATANOPROST 0.005 % OPHT DROP,,501,LOCAL,Facility,Inpatient,2.5,mL,,399,339.15,114.3534,399,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
PHENYLEPHRINE HCL 10 % OPHT DROP,,16,LOCAL,Facility,Both,5,mL,,225,191.25,64.485,225,Aetna,Commercial,207,92,,percent of total billed charges,,
PHENYLEPHRINE HCL 10 % OPHT DROP,,16,LOCAL,Facility,Outpatient,5,mL,,225,191.25,64.485,225,Aetna,Medicare Advantage,110.25,49,,percent of total billed charges,,
PHENYLEPHRINE HCL 10 % OPHT DROP,,16,LOCAL,Facility,Inpatient,5,mL,,225,191.25,64.485,225,Aetna,Medicare Advantage,,,,,Included in per diem rate,
PHENYLEPHRINE HCL 10 % OPHT DROP,,16,LOCAL,Facility,Both,5,mL,,225,191.25,64.485,225,Aetna,PPO,209.25,93,,percent of total billed charges,,
PHENYLEPHRINE HCL 10 % OPHT DROP,,16,LOCAL,Facility,Both,5,mL,,225,191.25,64.485,225,America's PPO,America's PPO,216.0675,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
PHENYLEPHRINE HCL 10 % OPHT DROP,,16,LOCAL,Facility,Both,5,mL,,225,191.25,64.485,225,BlueCross BlueShield Minnesota, Federal Employee Program,221.4,98.4,,percent of total billed charges,,
PHENYLEPHRINE HCL 10 % OPHT DROP,,16,LOCAL,Facility,Both,5,mL,,225,191.25,64.485,225,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,225,100,,percent of total billed charges,,
PHENYLEPHRINE HCL 10 % OPHT DROP,,16,LOCAL,Facility,Both,5,mL,,225,191.25,64.485,225,BlueCross BlueShield Minnesota,High Value Network Plan,202.5,90,,percent of total billed charges,,
PHENYLEPHRINE HCL 10 % OPHT DROP,,16,LOCAL,Facility,Outpatient,5,mL,,225,191.25,64.485,225,BlueCross BlueShield Minnesota,Medicare Advantage,110.25,49,,percent of total billed charges,,
PHENYLEPHRINE HCL 10 % OPHT DROP,,16,LOCAL,Facility,Inpatient,5,mL,,225,191.25,64.485,225,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
PHENYLEPHRINE HCL 10 % OPHT DROP,,16,LOCAL,Facility,Both,5,mL,,225,191.25,64.485,225,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,199.2825,88.57,,percent of total billed charges,,
PHENYLEPHRINE HCL 10 % OPHT DROP,,16,LOCAL,Facility,Both,5,mL,,225,191.25,64.485,225,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,64.485,28.66,,percent of total billed charges,,
PHENYLEPHRINE HCL 10 % OPHT DROP,,16,LOCAL,Facility,Outpatient,5,mL,,225,191.25,64.485,225,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),110.25,49,,percent of total billed charges,,
PHENYLEPHRINE HCL 10 % OPHT DROP,,16,LOCAL,Facility,Inpatient,5,mL,,225,191.25,64.485,225,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
PHENYLEPHRINE HCL 10 % OPHT DROP,,16,LOCAL,Facility,Both,5,mL,,225,191.25,64.485,225,CorVel,Worker's Compensation,225,100,,percent of total billed charges,,
PHENYLEPHRINE HCL 10 % OPHT DROP,,16,LOCAL,Facility,Both,5,mL,,225,191.25,64.485,225,First Health Group Corporation,First Health Network,218.25,97,,percent of total billed charges,,
PHENYLEPHRINE HCL 10 % OPHT DROP,,16,LOCAL,Facility,Both,5,mL,,225,191.25,64.485,225,"Health Partners, Inc.",Commercial,212.85,94.6,,percent of total billed charges,,
PHENYLEPHRINE HCL 10 % OPHT DROP,,16,LOCAL,Facility,Outpatient,5,mL,,225,191.25,64.485,225,"Health Partners, Inc.",Medicare Advantage,110.25,49,,percent of total billed charges,,
PHENYLEPHRINE HCL 10 % OPHT DROP,,16,LOCAL,Facility,Inpatient,5,mL,,225,191.25,64.485,225,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PHENYLEPHRINE HCL 10 % OPHT DROP,,16,LOCAL,Facility,Both,5,mL,,225,191.25,64.485,225,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),135,60,,percent of total billed charges,,
PHENYLEPHRINE HCL 10 % OPHT DROP,,16,LOCAL,Facility,Both,5,mL,,225,191.25,64.485,225,"Health Partners, Inc.",State of Minnesota Advantage Program,183.375,81.5,,percent of total billed charges,,
PHENYLEPHRINE HCL 10 % OPHT DROP,,16,LOCAL,Facility,Both,5,mL,,225,191.25,64.485,225,"Health Partners, Inc.",State Public Programs,112.5,50,,percent of total billed charges,,
PHENYLEPHRINE HCL 10 % OPHT DROP,,16,LOCAL,Facility,Both,5,mL,,225,191.25,64.485,225,Humana Insurance Company,Commercial PPO,213.75,95,,percent of total billed charges,,
PHENYLEPHRINE HCL 10 % OPHT DROP,,16,LOCAL,Facility,Outpatient,5,mL,,225,191.25,64.485,225,Humana Insurance Company,Medicare PPO,110.25,49,,percent of total billed charges,,
PHENYLEPHRINE HCL 10 % OPHT DROP,,16,LOCAL,Facility,Inpatient,5,mL,,225,191.25,64.485,225,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
PHENYLEPHRINE HCL 10 % OPHT DROP,,16,LOCAL,Facility,Both,5,mL,,225,191.25,64.485,225,Medica,Individual & Family,222.975,99.1,,percent of total billed charges,,
PHENYLEPHRINE HCL 10 % OPHT DROP,,16,LOCAL,Facility,Outpatient,5,mL,,225,191.25,64.485,225,Medica,Medica Advantage Solution,112.05,49.8,,percent of total billed charges,,
PHENYLEPHRINE HCL 10 % OPHT DROP,,16,LOCAL,Facility,Inpatient,5,mL,,225,191.25,64.485,225,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
PHENYLEPHRINE HCL 10 % OPHT DROP,,16,LOCAL,Facility,Outpatient,5,mL,,225,191.25,64.485,225,Medica,Medical Assistance,100.35,44.6,,percent of total billed charges,,
PHENYLEPHRINE HCL 10 % OPHT DROP,,16,LOCAL,Facility,Inpatient,5,mL,,225,191.25,64.485,225,Medica,Medical Assistance,,,,,Included in per diem rate,
PHENYLEPHRINE HCL 10 % OPHT DROP,,16,LOCAL,Facility,Outpatient,5,mL,,225,191.25,64.485,225,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,112.05,49.8,,percent of total billed charges,,
PHENYLEPHRINE HCL 10 % OPHT DROP,,16,LOCAL,Facility,Inpatient,5,mL,,225,191.25,64.485,225,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
PHENYLEPHRINE HCL 10 % OPHT DROP,,16,LOCAL,Facility,Both,5,mL,,225,191.25,64.485,225,"Multiplan, Inc.","Multiplan, Inc.",211.5,94,,percent of total billed charges,,
PHENYLEPHRINE HCL 10 % OPHT DROP,,16,LOCAL,Facility,Outpatient,5,mL,,225,191.25,64.485,225,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,202.725,90.1,,percent of total billed charges,,
PHENYLEPHRINE HCL 10 % OPHT DROP,,16,LOCAL,Facility,Inpatient,5,mL,,225,191.25,64.485,225,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
PHENYLEPHRINE HCL 10 % OPHT DROP,,16,LOCAL,Facility,Both,5,mL,,225,191.25,64.485,225,"Preferred One Administrative Services, INC.",PPO,221.85,98.6,,percent of total billed charges,,
PHENYLEPHRINE HCL 10 % OPHT DROP,,16,LOCAL,Facility,Outpatient,5,mL,,225,191.25,64.485,225,PrimeWest Health,Minnesota Senior Health Options (MSHO),115.7625,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
PHENYLEPHRINE HCL 10 % OPHT DROP,,16,LOCAL,Facility,Inpatient,5,mL,,225,191.25,64.485,225,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PHENYLEPHRINE HCL 10 % OPHT DROP,,16,LOCAL,Facility,Outpatient,5,mL,,225,191.25,64.485,225,PrimeWest Health,MinnesotaCare,115.56,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
PHENYLEPHRINE HCL 10 % OPHT DROP,,16,LOCAL,Facility,Inpatient,5,mL,,225,191.25,64.485,225,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
PHENYLEPHRINE HCL 10 % OPHT DROP,,16,LOCAL,Facility,Both,5,mL,,225,191.25,64.485,225,Sanford Health Plan,Sanford Health Plan,207,92,,percent of total billed charges,,
PHENYLEPHRINE HCL 10 % OPHT DROP,,16,LOCAL,Facility,Outpatient,5,mL,,225,191.25,64.485,225,"UCare Health, Inc.",Individual & Family Plan,126.7875,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
PHENYLEPHRINE HCL 10 % OPHT DROP,,16,LOCAL,Facility,Inpatient,5,mL,,225,191.25,64.485,225,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
PHENYLEPHRINE HCL 10 % OPHT DROP,,16,LOCAL,Facility,Outpatient,5,mL,,225,191.25,64.485,225,"UCare Health, Inc.",Medical Assistance,113.5575,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PHENYLEPHRINE HCL 10 % OPHT DROP,,16,LOCAL,Facility,Inpatient,5,mL,,225,191.25,64.485,225,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
PHENYLEPHRINE HCL 10 % OPHT DROP,,16,LOCAL,Facility,Outpatient,5,mL,,225,191.25,64.485,225,"UCare Health, Inc.",Medicare Advantage,113.5575,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PHENYLEPHRINE HCL 10 % OPHT DROP,,16,LOCAL,Facility,Inpatient,5,mL,,225,191.25,64.485,225,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PHENYLEPHRINE HCL 10 % OPHT DROP,,16,LOCAL,Facility,Outpatient,5,mL,,225,191.25,64.485,225,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),113.5575,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PHENYLEPHRINE HCL 10 % OPHT DROP,,16,LOCAL,Facility,Inpatient,5,mL,,225,191.25,64.485,225,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PHENYLEPHRINE HCL 10 % OPHT DROP,,16,LOCAL,Facility,Both,5,mL,,225,191.25,64.485,225,UnitedHealthcare,Individual & Family,211.5,94,,percent of total billed charges,,
PHENYLEPHRINE HCL 10 % OPHT DROP,,16,LOCAL,Facility,Outpatient,5,mL,,225,191.25,64.485,225,UnitedHealthcare,Medicare Advantage,110.25,49,,percent of total billed charges,,
PHENYLEPHRINE HCL 10 % OPHT DROP,,16,LOCAL,Facility,Inpatient,5,mL,,225,191.25,64.485,225,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
PHENYLEPHRINE HCL 10 % OPHT DROP,,16,LOCAL,Facility,Outpatient,5,mL,,225,191.25,64.485,225,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,108,48,,percent of total billed charges,,100% of DHS outpatient percentage
PHENYLEPHRINE HCL 10 % OPHT DROP,,16,LOCAL,Facility,Inpatient,5,mL,,225,191.25,64.485,225,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
ACETYLCYSTEINE 200 MG/ML (20 %) MISC SOLN,,1042,LOCAL,Facility,Both,10,mL,,77,65.45,22.0682,77,Aetna,Commercial,70.84,92,,percent of total billed charges,,
ACETYLCYSTEINE 200 MG/ML (20 %) MISC SOLN,,1042,LOCAL,Facility,Outpatient,10,mL,,77,65.45,22.0682,77,Aetna,Medicare Advantage,37.73,49,,percent of total billed charges,,
ACETYLCYSTEINE 200 MG/ML (20 %) MISC SOLN,,1042,LOCAL,Facility,Inpatient,10,mL,,77,65.45,22.0682,77,Aetna,Medicare Advantage,,,,,Included in per diem rate,
ACETYLCYSTEINE 200 MG/ML (20 %) MISC SOLN,,1042,LOCAL,Facility,Both,10,mL,,77,65.45,22.0682,77,Aetna,PPO,71.61,93,,percent of total billed charges,,
ACETYLCYSTEINE 200 MG/ML (20 %) MISC SOLN,,1042,LOCAL,Facility,Both,10,mL,,77,65.45,22.0682,77,America's PPO,America's PPO,73.9431,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
ACETYLCYSTEINE 200 MG/ML (20 %) MISC SOLN,,1042,LOCAL,Facility,Both,10,mL,,77,65.45,22.0682,77,BlueCross BlueShield Minnesota, Federal Employee Program,75.768,98.4,,percent of total billed charges,,
ACETYLCYSTEINE 200 MG/ML (20 %) MISC SOLN,,1042,LOCAL,Facility,Both,10,mL,,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,77,100,,percent of total billed charges,,
ACETYLCYSTEINE 200 MG/ML (20 %) MISC SOLN,,1042,LOCAL,Facility,Both,10,mL,,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,High Value Network Plan,69.3,90,,percent of total billed charges,,
ACETYLCYSTEINE 200 MG/ML (20 %) MISC SOLN,,1042,LOCAL,Facility,Outpatient,10,mL,,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,Medicare Advantage,37.73,49,,percent of total billed charges,,
ACETYLCYSTEINE 200 MG/ML (20 %) MISC SOLN,,1042,LOCAL,Facility,Inpatient,10,mL,,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
ACETYLCYSTEINE 200 MG/ML (20 %) MISC SOLN,,1042,LOCAL,Facility,Both,10,mL,,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,68.1989,88.57,,percent of total billed charges,,
ACETYLCYSTEINE 200 MG/ML (20 %) MISC SOLN,,1042,LOCAL,Facility,Both,10,mL,,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,22.0682,28.66,,percent of total billed charges,,
ACETYLCYSTEINE 200 MG/ML (20 %) MISC SOLN,,1042,LOCAL,Facility,Outpatient,10,mL,,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),37.73,49,,percent of total billed charges,,
ACETYLCYSTEINE 200 MG/ML (20 %) MISC SOLN,,1042,LOCAL,Facility,Inpatient,10,mL,,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
ACETYLCYSTEINE 200 MG/ML (20 %) MISC SOLN,,1042,LOCAL,Facility,Both,10,mL,,77,65.45,22.0682,77,CorVel,Worker's Compensation,77,100,,percent of total billed charges,,
ACETYLCYSTEINE 200 MG/ML (20 %) MISC SOLN,,1042,LOCAL,Facility,Both,10,mL,,77,65.45,22.0682,77,First Health Group Corporation,First Health Network,74.69,97,,percent of total billed charges,,
ACETYLCYSTEINE 200 MG/ML (20 %) MISC SOLN,,1042,LOCAL,Facility,Both,10,mL,,77,65.45,22.0682,77,"Health Partners, Inc.",Commercial,72.842,94.6,,percent of total billed charges,,
ACETYLCYSTEINE 200 MG/ML (20 %) MISC SOLN,,1042,LOCAL,Facility,Outpatient,10,mL,,77,65.45,22.0682,77,"Health Partners, Inc.",Medicare Advantage,37.73,49,,percent of total billed charges,,
ACETYLCYSTEINE 200 MG/ML (20 %) MISC SOLN,,1042,LOCAL,Facility,Inpatient,10,mL,,77,65.45,22.0682,77,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ACETYLCYSTEINE 200 MG/ML (20 %) MISC SOLN,,1042,LOCAL,Facility,Both,10,mL,,77,65.45,22.0682,77,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),46.2,60,,percent of total billed charges,,
ACETYLCYSTEINE 200 MG/ML (20 %) MISC SOLN,,1042,LOCAL,Facility,Both,10,mL,,77,65.45,22.0682,77,"Health Partners, Inc.",State of Minnesota Advantage Program,62.755,81.5,,percent of total billed charges,,
ACETYLCYSTEINE 200 MG/ML (20 %) MISC SOLN,,1042,LOCAL,Facility,Both,10,mL,,77,65.45,22.0682,77,"Health Partners, Inc.",State Public Programs,38.5,50,,percent of total billed charges,,
ACETYLCYSTEINE 200 MG/ML (20 %) MISC SOLN,,1042,LOCAL,Facility,Both,10,mL,,77,65.45,22.0682,77,Humana Insurance Company,Commercial PPO,73.15,95,,percent of total billed charges,,
ACETYLCYSTEINE 200 MG/ML (20 %) MISC SOLN,,1042,LOCAL,Facility,Outpatient,10,mL,,77,65.45,22.0682,77,Humana Insurance Company,Medicare PPO,37.73,49,,percent of total billed charges,,
ACETYLCYSTEINE 200 MG/ML (20 %) MISC SOLN,,1042,LOCAL,Facility,Inpatient,10,mL,,77,65.45,22.0682,77,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
ACETYLCYSTEINE 200 MG/ML (20 %) MISC SOLN,,1042,LOCAL,Facility,Both,10,mL,,77,65.45,22.0682,77,Medica,Individual & Family,76.307,99.1,,percent of total billed charges,,
ACETYLCYSTEINE 200 MG/ML (20 %) MISC SOLN,,1042,LOCAL,Facility,Outpatient,10,mL,,77,65.45,22.0682,77,Medica,Medica Advantage Solution,38.346,49.8,,percent of total billed charges,,
ACETYLCYSTEINE 200 MG/ML (20 %) MISC SOLN,,1042,LOCAL,Facility,Inpatient,10,mL,,77,65.45,22.0682,77,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
ACETYLCYSTEINE 200 MG/ML (20 %) MISC SOLN,,1042,LOCAL,Facility,Outpatient,10,mL,,77,65.45,22.0682,77,Medica,Medical Assistance,34.342,44.6,,percent of total billed charges,,
ACETYLCYSTEINE 200 MG/ML (20 %) MISC SOLN,,1042,LOCAL,Facility,Inpatient,10,mL,,77,65.45,22.0682,77,Medica,Medical Assistance,,,,,Included in per diem rate,
ACETYLCYSTEINE 200 MG/ML (20 %) MISC SOLN,,1042,LOCAL,Facility,Outpatient,10,mL,,77,65.45,22.0682,77,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,38.346,49.8,,percent of total billed charges,,
ACETYLCYSTEINE 200 MG/ML (20 %) MISC SOLN,,1042,LOCAL,Facility,Inpatient,10,mL,,77,65.45,22.0682,77,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
ACETYLCYSTEINE 200 MG/ML (20 %) MISC SOLN,,1042,LOCAL,Facility,Both,10,mL,,77,65.45,22.0682,77,"Multiplan, Inc.","Multiplan, Inc.",72.38,94,,percent of total billed charges,,
ACETYLCYSTEINE 200 MG/ML (20 %) MISC SOLN,,1042,LOCAL,Facility,Outpatient,10,mL,,77,65.45,22.0682,77,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,69.377,90.1,,percent of total billed charges,,
ACETYLCYSTEINE 200 MG/ML (20 %) MISC SOLN,,1042,LOCAL,Facility,Inpatient,10,mL,,77,65.45,22.0682,77,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
ACETYLCYSTEINE 200 MG/ML (20 %) MISC SOLN,,1042,LOCAL,Facility,Both,10,mL,,77,65.45,22.0682,77,"Preferred One Administrative Services, INC.",PPO,75.922,98.6,,percent of total billed charges,,
ACETYLCYSTEINE 200 MG/ML (20 %) MISC SOLN,,1042,LOCAL,Facility,Outpatient,10,mL,,77,65.45,22.0682,77,PrimeWest Health,Minnesota Senior Health Options (MSHO),39.6165,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
ACETYLCYSTEINE 200 MG/ML (20 %) MISC SOLN,,1042,LOCAL,Facility,Inpatient,10,mL,,77,65.45,22.0682,77,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ACETYLCYSTEINE 200 MG/ML (20 %) MISC SOLN,,1042,LOCAL,Facility,Outpatient,10,mL,,77,65.45,22.0682,77,PrimeWest Health,MinnesotaCare,39.5472,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
ACETYLCYSTEINE 200 MG/ML (20 %) MISC SOLN,,1042,LOCAL,Facility,Inpatient,10,mL,,77,65.45,22.0682,77,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
ACETYLCYSTEINE 200 MG/ML (20 %) MISC SOLN,,1042,LOCAL,Facility,Both,10,mL,,77,65.45,22.0682,77,Sanford Health Plan,Sanford Health Plan,70.84,92,,percent of total billed charges,,
ACETYLCYSTEINE 200 MG/ML (20 %) MISC SOLN,,1042,LOCAL,Facility,Outpatient,10,mL,,77,65.45,22.0682,77,"UCare Health, Inc.",Individual & Family Plan,43.3895,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
ACETYLCYSTEINE 200 MG/ML (20 %) MISC SOLN,,1042,LOCAL,Facility,Inpatient,10,mL,,77,65.45,22.0682,77,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
ACETYLCYSTEINE 200 MG/ML (20 %) MISC SOLN,,1042,LOCAL,Facility,Outpatient,10,mL,,77,65.45,22.0682,77,"UCare Health, Inc.",Medical Assistance,38.8619,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ACETYLCYSTEINE 200 MG/ML (20 %) MISC SOLN,,1042,LOCAL,Facility,Inpatient,10,mL,,77,65.45,22.0682,77,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
ACETYLCYSTEINE 200 MG/ML (20 %) MISC SOLN,,1042,LOCAL,Facility,Outpatient,10,mL,,77,65.45,22.0682,77,"UCare Health, Inc.",Medicare Advantage,38.8619,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ACETYLCYSTEINE 200 MG/ML (20 %) MISC SOLN,,1042,LOCAL,Facility,Inpatient,10,mL,,77,65.45,22.0682,77,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ACETYLCYSTEINE 200 MG/ML (20 %) MISC SOLN,,1042,LOCAL,Facility,Outpatient,10,mL,,77,65.45,22.0682,77,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),38.8619,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ACETYLCYSTEINE 200 MG/ML (20 %) MISC SOLN,,1042,LOCAL,Facility,Inpatient,10,mL,,77,65.45,22.0682,77,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ACETYLCYSTEINE 200 MG/ML (20 %) MISC SOLN,,1042,LOCAL,Facility,Both,10,mL,,77,65.45,22.0682,77,UnitedHealthcare,Individual & Family,72.38,94,,percent of total billed charges,,
ACETYLCYSTEINE 200 MG/ML (20 %) MISC SOLN,,1042,LOCAL,Facility,Outpatient,10,mL,,77,65.45,22.0682,77,UnitedHealthcare,Medicare Advantage,37.73,49,,percent of total billed charges,,
ACETYLCYSTEINE 200 MG/ML (20 %) MISC SOLN,,1042,LOCAL,Facility,Inpatient,10,mL,,77,65.45,22.0682,77,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
ACETYLCYSTEINE 200 MG/ML (20 %) MISC SOLN,,1042,LOCAL,Facility,Outpatient,10,mL,,77,65.45,22.0682,77,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,36.96,48,,percent of total billed charges,,100% of DHS outpatient percentage
ACETYLCYSTEINE 200 MG/ML (20 %) MISC SOLN,,1042,LOCAL,Facility,Inpatient,10,mL,,77,65.45,22.0682,77,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Both,10,mL,,15,12.75,4.299,15,Aetna,Commercial,13.8,92,,percent of total billed charges,,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Outpatient,10,mL,,15,12.75,4.299,15,Aetna,Medicare Advantage,7.35,49,,percent of total billed charges,,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Inpatient,10,mL,,15,12.75,4.299,15,Aetna,Medicare Advantage,,,,,Included in per diem rate,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Both,10,mL,,15,12.75,4.299,15,Aetna,PPO,13.95,93,,percent of total billed charges,,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Both,10,mL,,15,12.75,4.299,15,America's PPO,America's PPO,14.4045,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Both,10,mL,,15,12.75,4.299,15,BlueCross BlueShield Minnesota, Federal Employee Program,14.76,98.4,,percent of total billed charges,,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Both,10,mL,,15,12.75,4.299,15,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,15,100,,percent of total billed charges,,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Both,10,mL,,15,12.75,4.299,15,BlueCross BlueShield Minnesota,High Value Network Plan,13.5,90,,percent of total billed charges,,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Outpatient,10,mL,,15,12.75,4.299,15,BlueCross BlueShield Minnesota,Medicare Advantage,7.35,49,,percent of total billed charges,,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Inpatient,10,mL,,15,12.75,4.299,15,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Both,10,mL,,15,12.75,4.299,15,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,13.2855,88.57,,percent of total billed charges,,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Both,10,mL,,15,12.75,4.299,15,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,4.299,28.66,,percent of total billed charges,,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Outpatient,10,mL,,15,12.75,4.299,15,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),7.35,49,,percent of total billed charges,,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Inpatient,10,mL,,15,12.75,4.299,15,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Both,10,mL,,15,12.75,4.299,15,CorVel,Worker's Compensation,15,100,,percent of total billed charges,,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Both,10,mL,,15,12.75,4.299,15,First Health Group Corporation,First Health Network,14.55,97,,percent of total billed charges,,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Both,10,mL,,15,12.75,4.299,15,"Health Partners, Inc.",Commercial,14.19,94.6,,percent of total billed charges,,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Outpatient,10,mL,,15,12.75,4.299,15,"Health Partners, Inc.",Medicare Advantage,7.35,49,,percent of total billed charges,,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Inpatient,10,mL,,15,12.75,4.299,15,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Both,10,mL,,15,12.75,4.299,15,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),9,60,,percent of total billed charges,,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Both,10,mL,,15,12.75,4.299,15,"Health Partners, Inc.",State of Minnesota Advantage Program,12.225,81.5,,percent of total billed charges,,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Both,10,mL,,15,12.75,4.299,15,"Health Partners, Inc.",State Public Programs,7.5,50,,percent of total billed charges,,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Both,10,mL,,15,12.75,4.299,15,Humana Insurance Company,Commercial PPO,14.25,95,,percent of total billed charges,,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Outpatient,10,mL,,15,12.75,4.299,15,Humana Insurance Company,Medicare PPO,7.35,49,,percent of total billed charges,,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Inpatient,10,mL,,15,12.75,4.299,15,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Both,10,mL,,15,12.75,4.299,15,Medica,Individual & Family,14.865,99.1,,percent of total billed charges,,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Outpatient,10,mL,,15,12.75,4.299,15,Medica,Medica Advantage Solution,7.47,49.8,,percent of total billed charges,,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Inpatient,10,mL,,15,12.75,4.299,15,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Outpatient,10,mL,,15,12.75,4.299,15,Medica,Medical Assistance,6.69,44.6,,percent of total billed charges,,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Inpatient,10,mL,,15,12.75,4.299,15,Medica,Medical Assistance,,,,,Included in per diem rate,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Outpatient,10,mL,,15,12.75,4.299,15,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,7.47,49.8,,percent of total billed charges,,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Inpatient,10,mL,,15,12.75,4.299,15,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Both,10,mL,,15,12.75,4.299,15,"Multiplan, Inc.","Multiplan, Inc.",14.1,94,,percent of total billed charges,,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Outpatient,10,mL,,15,12.75,4.299,15,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,13.515,90.1,,percent of total billed charges,,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Inpatient,10,mL,,15,12.75,4.299,15,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Both,10,mL,,15,12.75,4.299,15,"Preferred One Administrative Services, INC.",PPO,14.79,98.6,,percent of total billed charges,,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Outpatient,10,mL,,15,12.75,4.299,15,PrimeWest Health,Minnesota Senior Health Options (MSHO),7.7175,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Inpatient,10,mL,,15,12.75,4.299,15,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Outpatient,10,mL,,15,12.75,4.299,15,PrimeWest Health,MinnesotaCare,7.704,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Inpatient,10,mL,,15,12.75,4.299,15,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Both,10,mL,,15,12.75,4.299,15,Sanford Health Plan,Sanford Health Plan,13.8,92,,percent of total billed charges,,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Outpatient,10,mL,,15,12.75,4.299,15,"UCare Health, Inc.",Individual & Family Plan,8.4525,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Inpatient,10,mL,,15,12.75,4.299,15,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Outpatient,10,mL,,15,12.75,4.299,15,"UCare Health, Inc.",Medical Assistance,7.5705,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Inpatient,10,mL,,15,12.75,4.299,15,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Outpatient,10,mL,,15,12.75,4.299,15,"UCare Health, Inc.",Medicare Advantage,7.5705,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Inpatient,10,mL,,15,12.75,4.299,15,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Outpatient,10,mL,,15,12.75,4.299,15,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),7.5705,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Inpatient,10,mL,,15,12.75,4.299,15,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Both,10,mL,,15,12.75,4.299,15,UnitedHealthcare,Individual & Family,14.1,94,,percent of total billed charges,,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Outpatient,10,mL,,15,12.75,4.299,15,UnitedHealthcare,Medicare Advantage,7.35,49,,percent of total billed charges,,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Inpatient,10,mL,,15,12.75,4.299,15,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Outpatient,10,mL,,15,12.75,4.299,15,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,7.2,48,,percent of total billed charges,,100% of DHS outpatient percentage
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Inpatient,10,mL,,15,12.75,4.299,15,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
SUCRALFATE 100 MG/ML ORAL SUSP,,4184,LOCAL,Facility,Both,10,mL,,59,50.15,16.9094,59,Aetna,Commercial,54.28,92,,percent of total billed charges,,
SUCRALFATE 100 MG/ML ORAL SUSP,,4184,LOCAL,Facility,Outpatient,10,mL,,59,50.15,16.9094,59,Aetna,Medicare Advantage,28.91,49,,percent of total billed charges,,
SUCRALFATE 100 MG/ML ORAL SUSP,,4184,LOCAL,Facility,Inpatient,10,mL,,59,50.15,16.9094,59,Aetna,Medicare Advantage,,,,,Included in per diem rate,
SUCRALFATE 100 MG/ML ORAL SUSP,,4184,LOCAL,Facility,Both,10,mL,,59,50.15,16.9094,59,Aetna,PPO,54.87,93,,percent of total billed charges,,
SUCRALFATE 100 MG/ML ORAL SUSP,,4184,LOCAL,Facility,Both,10,mL,,59,50.15,16.9094,59,America's PPO,America's PPO,56.6577,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SUCRALFATE 100 MG/ML ORAL SUSP,,4184,LOCAL,Facility,Both,10,mL,,59,50.15,16.9094,59,BlueCross BlueShield Minnesota, Federal Employee Program,58.056,98.4,,percent of total billed charges,,
SUCRALFATE 100 MG/ML ORAL SUSP,,4184,LOCAL,Facility,Both,10,mL,,59,50.15,16.9094,59,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,59,100,,percent of total billed charges,,
SUCRALFATE 100 MG/ML ORAL SUSP,,4184,LOCAL,Facility,Both,10,mL,,59,50.15,16.9094,59,BlueCross BlueShield Minnesota,High Value Network Plan,53.1,90,,percent of total billed charges,,
SUCRALFATE 100 MG/ML ORAL SUSP,,4184,LOCAL,Facility,Outpatient,10,mL,,59,50.15,16.9094,59,BlueCross BlueShield Minnesota,Medicare Advantage,28.91,49,,percent of total billed charges,,
SUCRALFATE 100 MG/ML ORAL SUSP,,4184,LOCAL,Facility,Inpatient,10,mL,,59,50.15,16.9094,59,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
SUCRALFATE 100 MG/ML ORAL SUSP,,4184,LOCAL,Facility,Both,10,mL,,59,50.15,16.9094,59,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,52.2563,88.57,,percent of total billed charges,,
SUCRALFATE 100 MG/ML ORAL SUSP,,4184,LOCAL,Facility,Both,10,mL,,59,50.15,16.9094,59,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,16.9094,28.66,,percent of total billed charges,,
SUCRALFATE 100 MG/ML ORAL SUSP,,4184,LOCAL,Facility,Outpatient,10,mL,,59,50.15,16.9094,59,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),28.91,49,,percent of total billed charges,,
SUCRALFATE 100 MG/ML ORAL SUSP,,4184,LOCAL,Facility,Inpatient,10,mL,,59,50.15,16.9094,59,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
SUCRALFATE 100 MG/ML ORAL SUSP,,4184,LOCAL,Facility,Both,10,mL,,59,50.15,16.9094,59,CorVel,Worker's Compensation,59,100,,percent of total billed charges,,
SUCRALFATE 100 MG/ML ORAL SUSP,,4184,LOCAL,Facility,Both,10,mL,,59,50.15,16.9094,59,First Health Group Corporation,First Health Network,57.23,97,,percent of total billed charges,,
SUCRALFATE 100 MG/ML ORAL SUSP,,4184,LOCAL,Facility,Both,10,mL,,59,50.15,16.9094,59,"Health Partners, Inc.",Commercial,55.814,94.6,,percent of total billed charges,,
SUCRALFATE 100 MG/ML ORAL SUSP,,4184,LOCAL,Facility,Outpatient,10,mL,,59,50.15,16.9094,59,"Health Partners, Inc.",Medicare Advantage,28.91,49,,percent of total billed charges,,
SUCRALFATE 100 MG/ML ORAL SUSP,,4184,LOCAL,Facility,Inpatient,10,mL,,59,50.15,16.9094,59,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUCRALFATE 100 MG/ML ORAL SUSP,,4184,LOCAL,Facility,Both,10,mL,,59,50.15,16.9094,59,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),35.4,60,,percent of total billed charges,,
SUCRALFATE 100 MG/ML ORAL SUSP,,4184,LOCAL,Facility,Both,10,mL,,59,50.15,16.9094,59,"Health Partners, Inc.",State of Minnesota Advantage Program,48.085,81.5,,percent of total billed charges,,
SUCRALFATE 100 MG/ML ORAL SUSP,,4184,LOCAL,Facility,Both,10,mL,,59,50.15,16.9094,59,"Health Partners, Inc.",State Public Programs,29.5,50,,percent of total billed charges,,
SUCRALFATE 100 MG/ML ORAL SUSP,,4184,LOCAL,Facility,Both,10,mL,,59,50.15,16.9094,59,Humana Insurance Company,Commercial PPO,56.05,95,,percent of total billed charges,,
SUCRALFATE 100 MG/ML ORAL SUSP,,4184,LOCAL,Facility,Outpatient,10,mL,,59,50.15,16.9094,59,Humana Insurance Company,Medicare PPO,28.91,49,,percent of total billed charges,,
SUCRALFATE 100 MG/ML ORAL SUSP,,4184,LOCAL,Facility,Inpatient,10,mL,,59,50.15,16.9094,59,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
SUCRALFATE 100 MG/ML ORAL SUSP,,4184,LOCAL,Facility,Both,10,mL,,59,50.15,16.9094,59,Medica,Individual & Family,58.469,99.1,,percent of total billed charges,,
SUCRALFATE 100 MG/ML ORAL SUSP,,4184,LOCAL,Facility,Outpatient,10,mL,,59,50.15,16.9094,59,Medica,Medica Advantage Solution,29.382,49.8,,percent of total billed charges,,
SUCRALFATE 100 MG/ML ORAL SUSP,,4184,LOCAL,Facility,Inpatient,10,mL,,59,50.15,16.9094,59,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
SUCRALFATE 100 MG/ML ORAL SUSP,,4184,LOCAL,Facility,Outpatient,10,mL,,59,50.15,16.9094,59,Medica,Medical Assistance,26.314,44.6,,percent of total billed charges,,
SUCRALFATE 100 MG/ML ORAL SUSP,,4184,LOCAL,Facility,Inpatient,10,mL,,59,50.15,16.9094,59,Medica,Medical Assistance,,,,,Included in per diem rate,
SUCRALFATE 100 MG/ML ORAL SUSP,,4184,LOCAL,Facility,Outpatient,10,mL,,59,50.15,16.9094,59,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,29.382,49.8,,percent of total billed charges,,
SUCRALFATE 100 MG/ML ORAL SUSP,,4184,LOCAL,Facility,Inpatient,10,mL,,59,50.15,16.9094,59,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
SUCRALFATE 100 MG/ML ORAL SUSP,,4184,LOCAL,Facility,Both,10,mL,,59,50.15,16.9094,59,"Multiplan, Inc.","Multiplan, Inc.",55.46,94,,percent of total billed charges,,
SUCRALFATE 100 MG/ML ORAL SUSP,,4184,LOCAL,Facility,Outpatient,10,mL,,59,50.15,16.9094,59,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,53.159,90.1,,percent of total billed charges,,
SUCRALFATE 100 MG/ML ORAL SUSP,,4184,LOCAL,Facility,Inpatient,10,mL,,59,50.15,16.9094,59,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
SUCRALFATE 100 MG/ML ORAL SUSP,,4184,LOCAL,Facility,Both,10,mL,,59,50.15,16.9094,59,"Preferred One Administrative Services, INC.",PPO,58.174,98.6,,percent of total billed charges,,
SUCRALFATE 100 MG/ML ORAL SUSP,,4184,LOCAL,Facility,Outpatient,10,mL,,59,50.15,16.9094,59,PrimeWest Health,Minnesota Senior Health Options (MSHO),30.3555,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
SUCRALFATE 100 MG/ML ORAL SUSP,,4184,LOCAL,Facility,Inpatient,10,mL,,59,50.15,16.9094,59,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUCRALFATE 100 MG/ML ORAL SUSP,,4184,LOCAL,Facility,Outpatient,10,mL,,59,50.15,16.9094,59,PrimeWest Health,MinnesotaCare,30.3024,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
SUCRALFATE 100 MG/ML ORAL SUSP,,4184,LOCAL,Facility,Inpatient,10,mL,,59,50.15,16.9094,59,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
SUCRALFATE 100 MG/ML ORAL SUSP,,4184,LOCAL,Facility,Both,10,mL,,59,50.15,16.9094,59,Sanford Health Plan,Sanford Health Plan,54.28,92,,percent of total billed charges,,
SUCRALFATE 100 MG/ML ORAL SUSP,,4184,LOCAL,Facility,Outpatient,10,mL,,59,50.15,16.9094,59,"UCare Health, Inc.",Individual & Family Plan,33.2465,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
SUCRALFATE 100 MG/ML ORAL SUSP,,4184,LOCAL,Facility,Inpatient,10,mL,,59,50.15,16.9094,59,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
SUCRALFATE 100 MG/ML ORAL SUSP,,4184,LOCAL,Facility,Outpatient,10,mL,,59,50.15,16.9094,59,"UCare Health, Inc.",Medical Assistance,29.7773,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUCRALFATE 100 MG/ML ORAL SUSP,,4184,LOCAL,Facility,Inpatient,10,mL,,59,50.15,16.9094,59,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
SUCRALFATE 100 MG/ML ORAL SUSP,,4184,LOCAL,Facility,Outpatient,10,mL,,59,50.15,16.9094,59,"UCare Health, Inc.",Medicare Advantage,29.7773,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUCRALFATE 100 MG/ML ORAL SUSP,,4184,LOCAL,Facility,Inpatient,10,mL,,59,50.15,16.9094,59,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUCRALFATE 100 MG/ML ORAL SUSP,,4184,LOCAL,Facility,Outpatient,10,mL,,59,50.15,16.9094,59,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),29.7773,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUCRALFATE 100 MG/ML ORAL SUSP,,4184,LOCAL,Facility,Inpatient,10,mL,,59,50.15,16.9094,59,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUCRALFATE 100 MG/ML ORAL SUSP,,4184,LOCAL,Facility,Both,10,mL,,59,50.15,16.9094,59,UnitedHealthcare,Individual & Family,55.46,94,,percent of total billed charges,,
SUCRALFATE 100 MG/ML ORAL SUSP,,4184,LOCAL,Facility,Outpatient,10,mL,,59,50.15,16.9094,59,UnitedHealthcare,Medicare Advantage,28.91,49,,percent of total billed charges,,
SUCRALFATE 100 MG/ML ORAL SUSP,,4184,LOCAL,Facility,Inpatient,10,mL,,59,50.15,16.9094,59,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
SUCRALFATE 100 MG/ML ORAL SUSP,,4184,LOCAL,Facility,Outpatient,10,mL,,59,50.15,16.9094,59,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,28.32,48,,percent of total billed charges,,100% of DHS outpatient percentage
SUCRALFATE 100 MG/ML ORAL SUSP,,4184,LOCAL,Facility,Inpatient,10,mL,,59,50.15,16.9094,59,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
BRINZOLAMIDE 1 % OPHT DRPS,,4364,LOCAL,Facility,Both,10,mL,,1483,1260.55,425.0278,1483,Aetna,Commercial,1364.36,92,,percent of total billed charges,,
BRINZOLAMIDE 1 % OPHT DRPS,,4364,LOCAL,Facility,Outpatient,10,mL,,1483,1260.55,425.0278,1483,Aetna,Medicare Advantage,726.67,49,,percent of total billed charges,,
BRINZOLAMIDE 1 % OPHT DRPS,,4364,LOCAL,Facility,Inpatient,10,mL,,1483,1260.55,425.0278,1483,Aetna,Medicare Advantage,,,,,Included in per diem rate,
BRINZOLAMIDE 1 % OPHT DRPS,,4364,LOCAL,Facility,Both,10,mL,,1483,1260.55,425.0278,1483,Aetna,PPO,1379.19,93,,percent of total billed charges,,
BRINZOLAMIDE 1 % OPHT DRPS,,4364,LOCAL,Facility,Both,10,mL,,1483,1260.55,425.0278,1483,America's PPO,America's PPO,1424.1249,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
BRINZOLAMIDE 1 % OPHT DRPS,,4364,LOCAL,Facility,Both,10,mL,,1483,1260.55,425.0278,1483,BlueCross BlueShield Minnesota, Federal Employee Program,1459.272,98.4,,percent of total billed charges,,
BRINZOLAMIDE 1 % OPHT DRPS,,4364,LOCAL,Facility,Both,10,mL,,1483,1260.55,425.0278,1483,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1483,100,,percent of total billed charges,,
BRINZOLAMIDE 1 % OPHT DRPS,,4364,LOCAL,Facility,Both,10,mL,,1483,1260.55,425.0278,1483,BlueCross BlueShield Minnesota,High Value Network Plan,1334.7,90,,percent of total billed charges,,
BRINZOLAMIDE 1 % OPHT DRPS,,4364,LOCAL,Facility,Outpatient,10,mL,,1483,1260.55,425.0278,1483,BlueCross BlueShield Minnesota,Medicare Advantage,726.67,49,,percent of total billed charges,,
BRINZOLAMIDE 1 % OPHT DRPS,,4364,LOCAL,Facility,Inpatient,10,mL,,1483,1260.55,425.0278,1483,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
BRINZOLAMIDE 1 % OPHT DRPS,,4364,LOCAL,Facility,Both,10,mL,,1483,1260.55,425.0278,1483,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1313.4931,88.57,,percent of total billed charges,,
BRINZOLAMIDE 1 % OPHT DRPS,,4364,LOCAL,Facility,Both,10,mL,,1483,1260.55,425.0278,1483,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,425.0278,28.66,,percent of total billed charges,,
BRINZOLAMIDE 1 % OPHT DRPS,,4364,LOCAL,Facility,Outpatient,10,mL,,1483,1260.55,425.0278,1483,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),726.67,49,,percent of total billed charges,,
BRINZOLAMIDE 1 % OPHT DRPS,,4364,LOCAL,Facility,Inpatient,10,mL,,1483,1260.55,425.0278,1483,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
BRINZOLAMIDE 1 % OPHT DRPS,,4364,LOCAL,Facility,Both,10,mL,,1483,1260.55,425.0278,1483,CorVel,Worker's Compensation,1483,100,,percent of total billed charges,,
BRINZOLAMIDE 1 % OPHT DRPS,,4364,LOCAL,Facility,Both,10,mL,,1483,1260.55,425.0278,1483,First Health Group Corporation,First Health Network,1438.51,97,,percent of total billed charges,,
BRINZOLAMIDE 1 % OPHT DRPS,,4364,LOCAL,Facility,Both,10,mL,,1483,1260.55,425.0278,1483,"Health Partners, Inc.",Commercial,1402.918,94.6,,percent of total billed charges,,
BRINZOLAMIDE 1 % OPHT DRPS,,4364,LOCAL,Facility,Outpatient,10,mL,,1483,1260.55,425.0278,1483,"Health Partners, Inc.",Medicare Advantage,726.67,49,,percent of total billed charges,,
BRINZOLAMIDE 1 % OPHT DRPS,,4364,LOCAL,Facility,Inpatient,10,mL,,1483,1260.55,425.0278,1483,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
BRINZOLAMIDE 1 % OPHT DRPS,,4364,LOCAL,Facility,Both,10,mL,,1483,1260.55,425.0278,1483,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),889.8,60,,percent of total billed charges,,
BRINZOLAMIDE 1 % OPHT DRPS,,4364,LOCAL,Facility,Both,10,mL,,1483,1260.55,425.0278,1483,"Health Partners, Inc.",State of Minnesota Advantage Program,1208.645,81.5,,percent of total billed charges,,
BRINZOLAMIDE 1 % OPHT DRPS,,4364,LOCAL,Facility,Both,10,mL,,1483,1260.55,425.0278,1483,"Health Partners, Inc.",State Public Programs,741.5,50,,percent of total billed charges,,
BRINZOLAMIDE 1 % OPHT DRPS,,4364,LOCAL,Facility,Both,10,mL,,1483,1260.55,425.0278,1483,Humana Insurance Company,Commercial PPO,1408.85,95,,percent of total billed charges,,
BRINZOLAMIDE 1 % OPHT DRPS,,4364,LOCAL,Facility,Outpatient,10,mL,,1483,1260.55,425.0278,1483,Humana Insurance Company,Medicare PPO,726.67,49,,percent of total billed charges,,
BRINZOLAMIDE 1 % OPHT DRPS,,4364,LOCAL,Facility,Inpatient,10,mL,,1483,1260.55,425.0278,1483,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
BRINZOLAMIDE 1 % OPHT DRPS,,4364,LOCAL,Facility,Both,10,mL,,1483,1260.55,425.0278,1483,Medica,Individual & Family,1469.653,99.1,,percent of total billed charges,,
BRINZOLAMIDE 1 % OPHT DRPS,,4364,LOCAL,Facility,Outpatient,10,mL,,1483,1260.55,425.0278,1483,Medica,Medica Advantage Solution,738.534,49.8,,percent of total billed charges,,
BRINZOLAMIDE 1 % OPHT DRPS,,4364,LOCAL,Facility,Inpatient,10,mL,,1483,1260.55,425.0278,1483,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
BRINZOLAMIDE 1 % OPHT DRPS,,4364,LOCAL,Facility,Outpatient,10,mL,,1483,1260.55,425.0278,1483,Medica,Medical Assistance,661.418,44.6,,percent of total billed charges,,
BRINZOLAMIDE 1 % OPHT DRPS,,4364,LOCAL,Facility,Inpatient,10,mL,,1483,1260.55,425.0278,1483,Medica,Medical Assistance,,,,,Included in per diem rate,
BRINZOLAMIDE 1 % OPHT DRPS,,4364,LOCAL,Facility,Outpatient,10,mL,,1483,1260.55,425.0278,1483,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,738.534,49.8,,percent of total billed charges,,
BRINZOLAMIDE 1 % OPHT DRPS,,4364,LOCAL,Facility,Inpatient,10,mL,,1483,1260.55,425.0278,1483,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
BRINZOLAMIDE 1 % OPHT DRPS,,4364,LOCAL,Facility,Both,10,mL,,1483,1260.55,425.0278,1483,"Multiplan, Inc.","Multiplan, Inc.",1394.02,94,,percent of total billed charges,,
BRINZOLAMIDE 1 % OPHT DRPS,,4364,LOCAL,Facility,Outpatient,10,mL,,1483,1260.55,425.0278,1483,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1336.183,90.1,,percent of total billed charges,,
BRINZOLAMIDE 1 % OPHT DRPS,,4364,LOCAL,Facility,Inpatient,10,mL,,1483,1260.55,425.0278,1483,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
BRINZOLAMIDE 1 % OPHT DRPS,,4364,LOCAL,Facility,Both,10,mL,,1483,1260.55,425.0278,1483,"Preferred One Administrative Services, INC.",PPO,1462.238,98.6,,percent of total billed charges,,
BRINZOLAMIDE 1 % OPHT DRPS,,4364,LOCAL,Facility,Outpatient,10,mL,,1483,1260.55,425.0278,1483,PrimeWest Health,Minnesota Senior Health Options (MSHO),763.0035,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
BRINZOLAMIDE 1 % OPHT DRPS,,4364,LOCAL,Facility,Inpatient,10,mL,,1483,1260.55,425.0278,1483,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
BRINZOLAMIDE 1 % OPHT DRPS,,4364,LOCAL,Facility,Outpatient,10,mL,,1483,1260.55,425.0278,1483,PrimeWest Health,MinnesotaCare,761.6688,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
BRINZOLAMIDE 1 % OPHT DRPS,,4364,LOCAL,Facility,Inpatient,10,mL,,1483,1260.55,425.0278,1483,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
BRINZOLAMIDE 1 % OPHT DRPS,,4364,LOCAL,Facility,Both,10,mL,,1483,1260.55,425.0278,1483,Sanford Health Plan,Sanford Health Plan,1364.36,92,,percent of total billed charges,,
BRINZOLAMIDE 1 % OPHT DRPS,,4364,LOCAL,Facility,Outpatient,10,mL,,1483,1260.55,425.0278,1483,"UCare Health, Inc.",Individual & Family Plan,835.6705,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
BRINZOLAMIDE 1 % OPHT DRPS,,4364,LOCAL,Facility,Inpatient,10,mL,,1483,1260.55,425.0278,1483,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
BRINZOLAMIDE 1 % OPHT DRPS,,4364,LOCAL,Facility,Outpatient,10,mL,,1483,1260.55,425.0278,1483,"UCare Health, Inc.",Medical Assistance,748.4701,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BRINZOLAMIDE 1 % OPHT DRPS,,4364,LOCAL,Facility,Inpatient,10,mL,,1483,1260.55,425.0278,1483,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
BRINZOLAMIDE 1 % OPHT DRPS,,4364,LOCAL,Facility,Outpatient,10,mL,,1483,1260.55,425.0278,1483,"UCare Health, Inc.",Medicare Advantage,748.4701,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BRINZOLAMIDE 1 % OPHT DRPS,,4364,LOCAL,Facility,Inpatient,10,mL,,1483,1260.55,425.0278,1483,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
BRINZOLAMIDE 1 % OPHT DRPS,,4364,LOCAL,Facility,Outpatient,10,mL,,1483,1260.55,425.0278,1483,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),748.4701,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BRINZOLAMIDE 1 % OPHT DRPS,,4364,LOCAL,Facility,Inpatient,10,mL,,1483,1260.55,425.0278,1483,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
BRINZOLAMIDE 1 % OPHT DRPS,,4364,LOCAL,Facility,Both,10,mL,,1483,1260.55,425.0278,1483,UnitedHealthcare,Individual & Family,1394.02,94,,percent of total billed charges,,
BRINZOLAMIDE 1 % OPHT DRPS,,4364,LOCAL,Facility,Outpatient,10,mL,,1483,1260.55,425.0278,1483,UnitedHealthcare,Medicare Advantage,726.67,49,,percent of total billed charges,,
BRINZOLAMIDE 1 % OPHT DRPS,,4364,LOCAL,Facility,Inpatient,10,mL,,1483,1260.55,425.0278,1483,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
BRINZOLAMIDE 1 % OPHT DRPS,,4364,LOCAL,Facility,Outpatient,10,mL,,1483,1260.55,425.0278,1483,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,711.84,48,,percent of total billed charges,,100% of DHS outpatient percentage
BRINZOLAMIDE 1 % OPHT DRPS,,4364,LOCAL,Facility,Inpatient,10,mL,,1483,1260.55,425.0278,1483,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
ROCURONIUM 10 MG/ML IV SOLN,,6620,LOCAL,Facility,Both,10,mL,,42,35.7,12.0372,42,Aetna,Commercial,38.64,92,,percent of total billed charges,,
ROCURONIUM 10 MG/ML IV SOLN,,6620,LOCAL,Facility,Outpatient,10,mL,,42,35.7,12.0372,42,Aetna,Medicare Advantage,20.58,49,,percent of total billed charges,,
ROCURONIUM 10 MG/ML IV SOLN,,6620,LOCAL,Facility,Inpatient,10,mL,,42,35.7,12.0372,42,Aetna,Medicare Advantage,,,,,Included in per diem rate,
ROCURONIUM 10 MG/ML IV SOLN,,6620,LOCAL,Facility,Both,10,mL,,42,35.7,12.0372,42,Aetna,PPO,39.06,93,,percent of total billed charges,,
ROCURONIUM 10 MG/ML IV SOLN,,6620,LOCAL,Facility,Both,10,mL,,42,35.7,12.0372,42,America's PPO,America's PPO,40.3326,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
ROCURONIUM 10 MG/ML IV SOLN,,6620,LOCAL,Facility,Both,10,mL,,42,35.7,12.0372,42,BlueCross BlueShield Minnesota, Federal Employee Program,41.328,98.4,,percent of total billed charges,,
ROCURONIUM 10 MG/ML IV SOLN,,6620,LOCAL,Facility,Both,10,mL,,42,35.7,12.0372,42,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,42,100,,percent of total billed charges,,
ROCURONIUM 10 MG/ML IV SOLN,,6620,LOCAL,Facility,Both,10,mL,,42,35.7,12.0372,42,BlueCross BlueShield Minnesota,High Value Network Plan,37.8,90,,percent of total billed charges,,
ROCURONIUM 10 MG/ML IV SOLN,,6620,LOCAL,Facility,Outpatient,10,mL,,42,35.7,12.0372,42,BlueCross BlueShield Minnesota,Medicare Advantage,20.58,49,,percent of total billed charges,,
ROCURONIUM 10 MG/ML IV SOLN,,6620,LOCAL,Facility,Inpatient,10,mL,,42,35.7,12.0372,42,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
ROCURONIUM 10 MG/ML IV SOLN,,6620,LOCAL,Facility,Both,10,mL,,42,35.7,12.0372,42,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,37.1994,88.57,,percent of total billed charges,,
ROCURONIUM 10 MG/ML IV SOLN,,6620,LOCAL,Facility,Both,10,mL,,42,35.7,12.0372,42,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,12.0372,28.66,,percent of total billed charges,,
ROCURONIUM 10 MG/ML IV SOLN,,6620,LOCAL,Facility,Outpatient,10,mL,,42,35.7,12.0372,42,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),20.58,49,,percent of total billed charges,,
ROCURONIUM 10 MG/ML IV SOLN,,6620,LOCAL,Facility,Inpatient,10,mL,,42,35.7,12.0372,42,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
ROCURONIUM 10 MG/ML IV SOLN,,6620,LOCAL,Facility,Both,10,mL,,42,35.7,12.0372,42,CorVel,Worker's Compensation,42,100,,percent of total billed charges,,
ROCURONIUM 10 MG/ML IV SOLN,,6620,LOCAL,Facility,Both,10,mL,,42,35.7,12.0372,42,First Health Group Corporation,First Health Network,40.74,97,,percent of total billed charges,,
ROCURONIUM 10 MG/ML IV SOLN,,6620,LOCAL,Facility,Both,10,mL,,42,35.7,12.0372,42,"Health Partners, Inc.",Commercial,39.732,94.6,,percent of total billed charges,,
ROCURONIUM 10 MG/ML IV SOLN,,6620,LOCAL,Facility,Outpatient,10,mL,,42,35.7,12.0372,42,"Health Partners, Inc.",Medicare Advantage,20.58,49,,percent of total billed charges,,
ROCURONIUM 10 MG/ML IV SOLN,,6620,LOCAL,Facility,Inpatient,10,mL,,42,35.7,12.0372,42,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ROCURONIUM 10 MG/ML IV SOLN,,6620,LOCAL,Facility,Both,10,mL,,42,35.7,12.0372,42,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),25.2,60,,percent of total billed charges,,
ROCURONIUM 10 MG/ML IV SOLN,,6620,LOCAL,Facility,Both,10,mL,,42,35.7,12.0372,42,"Health Partners, Inc.",State of Minnesota Advantage Program,34.23,81.5,,percent of total billed charges,,
ROCURONIUM 10 MG/ML IV SOLN,,6620,LOCAL,Facility,Both,10,mL,,42,35.7,12.0372,42,"Health Partners, Inc.",State Public Programs,21,50,,percent of total billed charges,,
ROCURONIUM 10 MG/ML IV SOLN,,6620,LOCAL,Facility,Both,10,mL,,42,35.7,12.0372,42,Humana Insurance Company,Commercial PPO,39.9,95,,percent of total billed charges,,
ROCURONIUM 10 MG/ML IV SOLN,,6620,LOCAL,Facility,Outpatient,10,mL,,42,35.7,12.0372,42,Humana Insurance Company,Medicare PPO,20.58,49,,percent of total billed charges,,
ROCURONIUM 10 MG/ML IV SOLN,,6620,LOCAL,Facility,Inpatient,10,mL,,42,35.7,12.0372,42,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
ROCURONIUM 10 MG/ML IV SOLN,,6620,LOCAL,Facility,Both,10,mL,,42,35.7,12.0372,42,Medica,Individual & Family,41.622,99.1,,percent of total billed charges,,
ROCURONIUM 10 MG/ML IV SOLN,,6620,LOCAL,Facility,Outpatient,10,mL,,42,35.7,12.0372,42,Medica,Medica Advantage Solution,20.916,49.8,,percent of total billed charges,,
ROCURONIUM 10 MG/ML IV SOLN,,6620,LOCAL,Facility,Inpatient,10,mL,,42,35.7,12.0372,42,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
ROCURONIUM 10 MG/ML IV SOLN,,6620,LOCAL,Facility,Outpatient,10,mL,,42,35.7,12.0372,42,Medica,Medical Assistance,18.732,44.6,,percent of total billed charges,,
ROCURONIUM 10 MG/ML IV SOLN,,6620,LOCAL,Facility,Inpatient,10,mL,,42,35.7,12.0372,42,Medica,Medical Assistance,,,,,Included in per diem rate,
ROCURONIUM 10 MG/ML IV SOLN,,6620,LOCAL,Facility,Outpatient,10,mL,,42,35.7,12.0372,42,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,20.916,49.8,,percent of total billed charges,,
ROCURONIUM 10 MG/ML IV SOLN,,6620,LOCAL,Facility,Inpatient,10,mL,,42,35.7,12.0372,42,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
ROCURONIUM 10 MG/ML IV SOLN,,6620,LOCAL,Facility,Both,10,mL,,42,35.7,12.0372,42,"Multiplan, Inc.","Multiplan, Inc.",39.48,94,,percent of total billed charges,,
ROCURONIUM 10 MG/ML IV SOLN,,6620,LOCAL,Facility,Outpatient,10,mL,,42,35.7,12.0372,42,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,37.842,90.1,,percent of total billed charges,,
ROCURONIUM 10 MG/ML IV SOLN,,6620,LOCAL,Facility,Inpatient,10,mL,,42,35.7,12.0372,42,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
ROCURONIUM 10 MG/ML IV SOLN,,6620,LOCAL,Facility,Both,10,mL,,42,35.7,12.0372,42,"Preferred One Administrative Services, INC.",PPO,41.412,98.6,,percent of total billed charges,,
ROCURONIUM 10 MG/ML IV SOLN,,6620,LOCAL,Facility,Outpatient,10,mL,,42,35.7,12.0372,42,PrimeWest Health,Minnesota Senior Health Options (MSHO),21.609,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
ROCURONIUM 10 MG/ML IV SOLN,,6620,LOCAL,Facility,Inpatient,10,mL,,42,35.7,12.0372,42,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ROCURONIUM 10 MG/ML IV SOLN,,6620,LOCAL,Facility,Outpatient,10,mL,,42,35.7,12.0372,42,PrimeWest Health,MinnesotaCare,21.5712,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
ROCURONIUM 10 MG/ML IV SOLN,,6620,LOCAL,Facility,Inpatient,10,mL,,42,35.7,12.0372,42,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
ROCURONIUM 10 MG/ML IV SOLN,,6620,LOCAL,Facility,Both,10,mL,,42,35.7,12.0372,42,Sanford Health Plan,Sanford Health Plan,38.64,92,,percent of total billed charges,,
ROCURONIUM 10 MG/ML IV SOLN,,6620,LOCAL,Facility,Outpatient,10,mL,,42,35.7,12.0372,42,"UCare Health, Inc.",Individual & Family Plan,23.667,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
ROCURONIUM 10 MG/ML IV SOLN,,6620,LOCAL,Facility,Inpatient,10,mL,,42,35.7,12.0372,42,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
ROCURONIUM 10 MG/ML IV SOLN,,6620,LOCAL,Facility,Outpatient,10,mL,,42,35.7,12.0372,42,"UCare Health, Inc.",Medical Assistance,21.1974,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ROCURONIUM 10 MG/ML IV SOLN,,6620,LOCAL,Facility,Inpatient,10,mL,,42,35.7,12.0372,42,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
ROCURONIUM 10 MG/ML IV SOLN,,6620,LOCAL,Facility,Outpatient,10,mL,,42,35.7,12.0372,42,"UCare Health, Inc.",Medicare Advantage,21.1974,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ROCURONIUM 10 MG/ML IV SOLN,,6620,LOCAL,Facility,Inpatient,10,mL,,42,35.7,12.0372,42,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ROCURONIUM 10 MG/ML IV SOLN,,6620,LOCAL,Facility,Outpatient,10,mL,,42,35.7,12.0372,42,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),21.1974,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ROCURONIUM 10 MG/ML IV SOLN,,6620,LOCAL,Facility,Inpatient,10,mL,,42,35.7,12.0372,42,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ROCURONIUM 10 MG/ML IV SOLN,,6620,LOCAL,Facility,Both,10,mL,,42,35.7,12.0372,42,UnitedHealthcare,Individual & Family,39.48,94,,percent of total billed charges,,
ROCURONIUM 10 MG/ML IV SOLN,,6620,LOCAL,Facility,Outpatient,10,mL,,42,35.7,12.0372,42,UnitedHealthcare,Medicare Advantage,20.58,49,,percent of total billed charges,,
ROCURONIUM 10 MG/ML IV SOLN,,6620,LOCAL,Facility,Inpatient,10,mL,,42,35.7,12.0372,42,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
ROCURONIUM 10 MG/ML IV SOLN,,6620,LOCAL,Facility,Outpatient,10,mL,,42,35.7,12.0372,42,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,20.16,48,,percent of total billed charges,,100% of DHS outpatient percentage
ROCURONIUM 10 MG/ML IV SOLN,,6620,LOCAL,Facility,Inpatient,10,mL,,42,35.7,12.0372,42,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"POLYMYXIN B SULF-TRIMETHOPRIM 10,000 UNIT- 1 MG/ML OPHT DROP",,13293,LOCAL,Facility,Both,10,mL,,84,71.4,24.0744,84,Aetna,Commercial,77.28,92,,percent of total billed charges,,
"POLYMYXIN B SULF-TRIMETHOPRIM 10,000 UNIT- 1 MG/ML OPHT DROP",,13293,LOCAL,Facility,Outpatient,10,mL,,84,71.4,24.0744,84,Aetna,Medicare Advantage,41.16,49,,percent of total billed charges,,
"POLYMYXIN B SULF-TRIMETHOPRIM 10,000 UNIT- 1 MG/ML OPHT DROP",,13293,LOCAL,Facility,Inpatient,10,mL,,84,71.4,24.0744,84,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"POLYMYXIN B SULF-TRIMETHOPRIM 10,000 UNIT- 1 MG/ML OPHT DROP",,13293,LOCAL,Facility,Both,10,mL,,84,71.4,24.0744,84,Aetna,PPO,78.12,93,,percent of total billed charges,,
"POLYMYXIN B SULF-TRIMETHOPRIM 10,000 UNIT- 1 MG/ML OPHT DROP",,13293,LOCAL,Facility,Both,10,mL,,84,71.4,24.0744,84,America's PPO,America's PPO,80.6652,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"POLYMYXIN B SULF-TRIMETHOPRIM 10,000 UNIT- 1 MG/ML OPHT DROP",,13293,LOCAL,Facility,Both,10,mL,,84,71.4,24.0744,84,BlueCross BlueShield Minnesota, Federal Employee Program,82.656,98.4,,percent of total billed charges,,
"POLYMYXIN B SULF-TRIMETHOPRIM 10,000 UNIT- 1 MG/ML OPHT DROP",,13293,LOCAL,Facility,Both,10,mL,,84,71.4,24.0744,84,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,84,100,,percent of total billed charges,,
"POLYMYXIN B SULF-TRIMETHOPRIM 10,000 UNIT- 1 MG/ML OPHT DROP",,13293,LOCAL,Facility,Both,10,mL,,84,71.4,24.0744,84,BlueCross BlueShield Minnesota,High Value Network Plan,75.6,90,,percent of total billed charges,,
"POLYMYXIN B SULF-TRIMETHOPRIM 10,000 UNIT- 1 MG/ML OPHT DROP",,13293,LOCAL,Facility,Outpatient,10,mL,,84,71.4,24.0744,84,BlueCross BlueShield Minnesota,Medicare Advantage,41.16,49,,percent of total billed charges,,
"POLYMYXIN B SULF-TRIMETHOPRIM 10,000 UNIT- 1 MG/ML OPHT DROP",,13293,LOCAL,Facility,Inpatient,10,mL,,84,71.4,24.0744,84,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"POLYMYXIN B SULF-TRIMETHOPRIM 10,000 UNIT- 1 MG/ML OPHT DROP",,13293,LOCAL,Facility,Both,10,mL,,84,71.4,24.0744,84,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,74.3988,88.57,,percent of total billed charges,,
"POLYMYXIN B SULF-TRIMETHOPRIM 10,000 UNIT- 1 MG/ML OPHT DROP",,13293,LOCAL,Facility,Both,10,mL,,84,71.4,24.0744,84,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,24.0744,28.66,,percent of total billed charges,,
"POLYMYXIN B SULF-TRIMETHOPRIM 10,000 UNIT- 1 MG/ML OPHT DROP",,13293,LOCAL,Facility,Outpatient,10,mL,,84,71.4,24.0744,84,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),41.16,49,,percent of total billed charges,,
"POLYMYXIN B SULF-TRIMETHOPRIM 10,000 UNIT- 1 MG/ML OPHT DROP",,13293,LOCAL,Facility,Inpatient,10,mL,,84,71.4,24.0744,84,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"POLYMYXIN B SULF-TRIMETHOPRIM 10,000 UNIT- 1 MG/ML OPHT DROP",,13293,LOCAL,Facility,Both,10,mL,,84,71.4,24.0744,84,CorVel,Worker's Compensation,84,100,,percent of total billed charges,,
"POLYMYXIN B SULF-TRIMETHOPRIM 10,000 UNIT- 1 MG/ML OPHT DROP",,13293,LOCAL,Facility,Both,10,mL,,84,71.4,24.0744,84,First Health Group Corporation,First Health Network,81.48,97,,percent of total billed charges,,
"POLYMYXIN B SULF-TRIMETHOPRIM 10,000 UNIT- 1 MG/ML OPHT DROP",,13293,LOCAL,Facility,Both,10,mL,,84,71.4,24.0744,84,"Health Partners, Inc.",Commercial,79.464,94.6,,percent of total billed charges,,
"POLYMYXIN B SULF-TRIMETHOPRIM 10,000 UNIT- 1 MG/ML OPHT DROP",,13293,LOCAL,Facility,Outpatient,10,mL,,84,71.4,24.0744,84,"Health Partners, Inc.",Medicare Advantage,41.16,49,,percent of total billed charges,,
"POLYMYXIN B SULF-TRIMETHOPRIM 10,000 UNIT- 1 MG/ML OPHT DROP",,13293,LOCAL,Facility,Inpatient,10,mL,,84,71.4,24.0744,84,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"POLYMYXIN B SULF-TRIMETHOPRIM 10,000 UNIT- 1 MG/ML OPHT DROP",,13293,LOCAL,Facility,Both,10,mL,,84,71.4,24.0744,84,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),50.4,60,,percent of total billed charges,,
"POLYMYXIN B SULF-TRIMETHOPRIM 10,000 UNIT- 1 MG/ML OPHT DROP",,13293,LOCAL,Facility,Both,10,mL,,84,71.4,24.0744,84,"Health Partners, Inc.",State of Minnesota Advantage Program,68.46,81.5,,percent of total billed charges,,
"POLYMYXIN B SULF-TRIMETHOPRIM 10,000 UNIT- 1 MG/ML OPHT DROP",,13293,LOCAL,Facility,Both,10,mL,,84,71.4,24.0744,84,"Health Partners, Inc.",State Public Programs,42,50,,percent of total billed charges,,
"POLYMYXIN B SULF-TRIMETHOPRIM 10,000 UNIT- 1 MG/ML OPHT DROP",,13293,LOCAL,Facility,Both,10,mL,,84,71.4,24.0744,84,Humana Insurance Company,Commercial PPO,79.8,95,,percent of total billed charges,,
"POLYMYXIN B SULF-TRIMETHOPRIM 10,000 UNIT- 1 MG/ML OPHT DROP",,13293,LOCAL,Facility,Outpatient,10,mL,,84,71.4,24.0744,84,Humana Insurance Company,Medicare PPO,41.16,49,,percent of total billed charges,,
"POLYMYXIN B SULF-TRIMETHOPRIM 10,000 UNIT- 1 MG/ML OPHT DROP",,13293,LOCAL,Facility,Inpatient,10,mL,,84,71.4,24.0744,84,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"POLYMYXIN B SULF-TRIMETHOPRIM 10,000 UNIT- 1 MG/ML OPHT DROP",,13293,LOCAL,Facility,Both,10,mL,,84,71.4,24.0744,84,Medica,Individual & Family,83.244,99.1,,percent of total billed charges,,
"POLYMYXIN B SULF-TRIMETHOPRIM 10,000 UNIT- 1 MG/ML OPHT DROP",,13293,LOCAL,Facility,Outpatient,10,mL,,84,71.4,24.0744,84,Medica,Medica Advantage Solution,41.832,49.8,,percent of total billed charges,,
"POLYMYXIN B SULF-TRIMETHOPRIM 10,000 UNIT- 1 MG/ML OPHT DROP",,13293,LOCAL,Facility,Inpatient,10,mL,,84,71.4,24.0744,84,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"POLYMYXIN B SULF-TRIMETHOPRIM 10,000 UNIT- 1 MG/ML OPHT DROP",,13293,LOCAL,Facility,Outpatient,10,mL,,84,71.4,24.0744,84,Medica,Medical Assistance,37.464,44.6,,percent of total billed charges,,
"POLYMYXIN B SULF-TRIMETHOPRIM 10,000 UNIT- 1 MG/ML OPHT DROP",,13293,LOCAL,Facility,Inpatient,10,mL,,84,71.4,24.0744,84,Medica,Medical Assistance,,,,,Included in per diem rate,
"POLYMYXIN B SULF-TRIMETHOPRIM 10,000 UNIT- 1 MG/ML OPHT DROP",,13293,LOCAL,Facility,Outpatient,10,mL,,84,71.4,24.0744,84,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,41.832,49.8,,percent of total billed charges,,
"POLYMYXIN B SULF-TRIMETHOPRIM 10,000 UNIT- 1 MG/ML OPHT DROP",,13293,LOCAL,Facility,Inpatient,10,mL,,84,71.4,24.0744,84,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"POLYMYXIN B SULF-TRIMETHOPRIM 10,000 UNIT- 1 MG/ML OPHT DROP",,13293,LOCAL,Facility,Both,10,mL,,84,71.4,24.0744,84,"Multiplan, Inc.","Multiplan, Inc.",78.96,94,,percent of total billed charges,,
"POLYMYXIN B SULF-TRIMETHOPRIM 10,000 UNIT- 1 MG/ML OPHT DROP",,13293,LOCAL,Facility,Outpatient,10,mL,,84,71.4,24.0744,84,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,75.684,90.1,,percent of total billed charges,,
"POLYMYXIN B SULF-TRIMETHOPRIM 10,000 UNIT- 1 MG/ML OPHT DROP",,13293,LOCAL,Facility,Inpatient,10,mL,,84,71.4,24.0744,84,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"POLYMYXIN B SULF-TRIMETHOPRIM 10,000 UNIT- 1 MG/ML OPHT DROP",,13293,LOCAL,Facility,Both,10,mL,,84,71.4,24.0744,84,"Preferred One Administrative Services, INC.",PPO,82.824,98.6,,percent of total billed charges,,
"POLYMYXIN B SULF-TRIMETHOPRIM 10,000 UNIT- 1 MG/ML OPHT DROP",,13293,LOCAL,Facility,Outpatient,10,mL,,84,71.4,24.0744,84,PrimeWest Health,Minnesota Senior Health Options (MSHO),43.218,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"POLYMYXIN B SULF-TRIMETHOPRIM 10,000 UNIT- 1 MG/ML OPHT DROP",,13293,LOCAL,Facility,Inpatient,10,mL,,84,71.4,24.0744,84,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"POLYMYXIN B SULF-TRIMETHOPRIM 10,000 UNIT- 1 MG/ML OPHT DROP",,13293,LOCAL,Facility,Outpatient,10,mL,,84,71.4,24.0744,84,PrimeWest Health,MinnesotaCare,43.1424,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"POLYMYXIN B SULF-TRIMETHOPRIM 10,000 UNIT- 1 MG/ML OPHT DROP",,13293,LOCAL,Facility,Inpatient,10,mL,,84,71.4,24.0744,84,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"POLYMYXIN B SULF-TRIMETHOPRIM 10,000 UNIT- 1 MG/ML OPHT DROP",,13293,LOCAL,Facility,Both,10,mL,,84,71.4,24.0744,84,Sanford Health Plan,Sanford Health Plan,77.28,92,,percent of total billed charges,,
"POLYMYXIN B SULF-TRIMETHOPRIM 10,000 UNIT- 1 MG/ML OPHT DROP",,13293,LOCAL,Facility,Outpatient,10,mL,,84,71.4,24.0744,84,"UCare Health, Inc.",Individual & Family Plan,47.334,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"POLYMYXIN B SULF-TRIMETHOPRIM 10,000 UNIT- 1 MG/ML OPHT DROP",,13293,LOCAL,Facility,Inpatient,10,mL,,84,71.4,24.0744,84,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"POLYMYXIN B SULF-TRIMETHOPRIM 10,000 UNIT- 1 MG/ML OPHT DROP",,13293,LOCAL,Facility,Outpatient,10,mL,,84,71.4,24.0744,84,"UCare Health, Inc.",Medical Assistance,42.3948,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"POLYMYXIN B SULF-TRIMETHOPRIM 10,000 UNIT- 1 MG/ML OPHT DROP",,13293,LOCAL,Facility,Inpatient,10,mL,,84,71.4,24.0744,84,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"POLYMYXIN B SULF-TRIMETHOPRIM 10,000 UNIT- 1 MG/ML OPHT DROP",,13293,LOCAL,Facility,Outpatient,10,mL,,84,71.4,24.0744,84,"UCare Health, Inc.",Medicare Advantage,42.3948,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"POLYMYXIN B SULF-TRIMETHOPRIM 10,000 UNIT- 1 MG/ML OPHT DROP",,13293,LOCAL,Facility,Inpatient,10,mL,,84,71.4,24.0744,84,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"POLYMYXIN B SULF-TRIMETHOPRIM 10,000 UNIT- 1 MG/ML OPHT DROP",,13293,LOCAL,Facility,Outpatient,10,mL,,84,71.4,24.0744,84,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),42.3948,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"POLYMYXIN B SULF-TRIMETHOPRIM 10,000 UNIT- 1 MG/ML OPHT DROP",,13293,LOCAL,Facility,Inpatient,10,mL,,84,71.4,24.0744,84,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"POLYMYXIN B SULF-TRIMETHOPRIM 10,000 UNIT- 1 MG/ML OPHT DROP",,13293,LOCAL,Facility,Both,10,mL,,84,71.4,24.0744,84,UnitedHealthcare,Individual & Family,78.96,94,,percent of total billed charges,,
"POLYMYXIN B SULF-TRIMETHOPRIM 10,000 UNIT- 1 MG/ML OPHT DROP",,13293,LOCAL,Facility,Outpatient,10,mL,,84,71.4,24.0744,84,UnitedHealthcare,Medicare Advantage,41.16,49,,percent of total billed charges,,
"POLYMYXIN B SULF-TRIMETHOPRIM 10,000 UNIT- 1 MG/ML OPHT DROP",,13293,LOCAL,Facility,Inpatient,10,mL,,84,71.4,24.0744,84,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"POLYMYXIN B SULF-TRIMETHOPRIM 10,000 UNIT- 1 MG/ML OPHT DROP",,13293,LOCAL,Facility,Outpatient,10,mL,,84,71.4,24.0744,84,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,40.32,48,,percent of total billed charges,,100% of DHS outpatient percentage
"POLYMYXIN B SULF-TRIMETHOPRIM 10,000 UNIT- 1 MG/ML OPHT DROP",,13293,LOCAL,Facility,Inpatient,10,mL,,84,71.4,24.0744,84,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
DORZOLAMIDE-TIMOLOL 22.3-6.8 MG/ML OPHT DROP,,15779,LOCAL,Facility,Both,10,DROP BTL,,93,79.05,26.6538,93,Aetna,Commercial,85.56,92,,percent of total billed charges,,
DORZOLAMIDE-TIMOLOL 22.3-6.8 MG/ML OPHT DROP,,15779,LOCAL,Facility,Outpatient,10,DROP BTL,,93,79.05,26.6538,93,Aetna,Medicare Advantage,45.57,49,,percent of total billed charges,,
DORZOLAMIDE-TIMOLOL 22.3-6.8 MG/ML OPHT DROP,,15779,LOCAL,Facility,Inpatient,10,DROP BTL,,93,79.05,26.6538,93,Aetna,Medicare Advantage,,,,,Included in per diem rate,
DORZOLAMIDE-TIMOLOL 22.3-6.8 MG/ML OPHT DROP,,15779,LOCAL,Facility,Both,10,DROP BTL,,93,79.05,26.6538,93,Aetna,PPO,86.49,93,,percent of total billed charges,,
DORZOLAMIDE-TIMOLOL 22.3-6.8 MG/ML OPHT DROP,,15779,LOCAL,Facility,Both,10,DROP BTL,,93,79.05,26.6538,93,America's PPO,America's PPO,89.3079,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
DORZOLAMIDE-TIMOLOL 22.3-6.8 MG/ML OPHT DROP,,15779,LOCAL,Facility,Both,10,DROP BTL,,93,79.05,26.6538,93,BlueCross BlueShield Minnesota, Federal Employee Program,91.512,98.4,,percent of total billed charges,,
DORZOLAMIDE-TIMOLOL 22.3-6.8 MG/ML OPHT DROP,,15779,LOCAL,Facility,Both,10,DROP BTL,,93,79.05,26.6538,93,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,93,100,,percent of total billed charges,,
DORZOLAMIDE-TIMOLOL 22.3-6.8 MG/ML OPHT DROP,,15779,LOCAL,Facility,Both,10,DROP BTL,,93,79.05,26.6538,93,BlueCross BlueShield Minnesota,High Value Network Plan,83.7,90,,percent of total billed charges,,
DORZOLAMIDE-TIMOLOL 22.3-6.8 MG/ML OPHT DROP,,15779,LOCAL,Facility,Outpatient,10,DROP BTL,,93,79.05,26.6538,93,BlueCross BlueShield Minnesota,Medicare Advantage,45.57,49,,percent of total billed charges,,
DORZOLAMIDE-TIMOLOL 22.3-6.8 MG/ML OPHT DROP,,15779,LOCAL,Facility,Inpatient,10,DROP BTL,,93,79.05,26.6538,93,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
DORZOLAMIDE-TIMOLOL 22.3-6.8 MG/ML OPHT DROP,,15779,LOCAL,Facility,Both,10,DROP BTL,,93,79.05,26.6538,93,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,82.3701,88.57,,percent of total billed charges,,
DORZOLAMIDE-TIMOLOL 22.3-6.8 MG/ML OPHT DROP,,15779,LOCAL,Facility,Both,10,DROP BTL,,93,79.05,26.6538,93,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,26.6538,28.66,,percent of total billed charges,,
DORZOLAMIDE-TIMOLOL 22.3-6.8 MG/ML OPHT DROP,,15779,LOCAL,Facility,Outpatient,10,DROP BTL,,93,79.05,26.6538,93,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),45.57,49,,percent of total billed charges,,
DORZOLAMIDE-TIMOLOL 22.3-6.8 MG/ML OPHT DROP,,15779,LOCAL,Facility,Inpatient,10,DROP BTL,,93,79.05,26.6538,93,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
DORZOLAMIDE-TIMOLOL 22.3-6.8 MG/ML OPHT DROP,,15779,LOCAL,Facility,Both,10,DROP BTL,,93,79.05,26.6538,93,CorVel,Worker's Compensation,93,100,,percent of total billed charges,,
DORZOLAMIDE-TIMOLOL 22.3-6.8 MG/ML OPHT DROP,,15779,LOCAL,Facility,Both,10,DROP BTL,,93,79.05,26.6538,93,First Health Group Corporation,First Health Network,90.21,97,,percent of total billed charges,,
DORZOLAMIDE-TIMOLOL 22.3-6.8 MG/ML OPHT DROP,,15779,LOCAL,Facility,Both,10,DROP BTL,,93,79.05,26.6538,93,"Health Partners, Inc.",Commercial,87.978,94.6,,percent of total billed charges,,
DORZOLAMIDE-TIMOLOL 22.3-6.8 MG/ML OPHT DROP,,15779,LOCAL,Facility,Outpatient,10,DROP BTL,,93,79.05,26.6538,93,"Health Partners, Inc.",Medicare Advantage,45.57,49,,percent of total billed charges,,
DORZOLAMIDE-TIMOLOL 22.3-6.8 MG/ML OPHT DROP,,15779,LOCAL,Facility,Inpatient,10,DROP BTL,,93,79.05,26.6538,93,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DORZOLAMIDE-TIMOLOL 22.3-6.8 MG/ML OPHT DROP,,15779,LOCAL,Facility,Both,10,DROP BTL,,93,79.05,26.6538,93,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),55.8,60,,percent of total billed charges,,
DORZOLAMIDE-TIMOLOL 22.3-6.8 MG/ML OPHT DROP,,15779,LOCAL,Facility,Both,10,DROP BTL,,93,79.05,26.6538,93,"Health Partners, Inc.",State of Minnesota Advantage Program,75.795,81.5,,percent of total billed charges,,
DORZOLAMIDE-TIMOLOL 22.3-6.8 MG/ML OPHT DROP,,15779,LOCAL,Facility,Both,10,DROP BTL,,93,79.05,26.6538,93,"Health Partners, Inc.",State Public Programs,46.5,50,,percent of total billed charges,,
DORZOLAMIDE-TIMOLOL 22.3-6.8 MG/ML OPHT DROP,,15779,LOCAL,Facility,Both,10,DROP BTL,,93,79.05,26.6538,93,Humana Insurance Company,Commercial PPO,88.35,95,,percent of total billed charges,,
DORZOLAMIDE-TIMOLOL 22.3-6.8 MG/ML OPHT DROP,,15779,LOCAL,Facility,Outpatient,10,DROP BTL,,93,79.05,26.6538,93,Humana Insurance Company,Medicare PPO,45.57,49,,percent of total billed charges,,
DORZOLAMIDE-TIMOLOL 22.3-6.8 MG/ML OPHT DROP,,15779,LOCAL,Facility,Inpatient,10,DROP BTL,,93,79.05,26.6538,93,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
DORZOLAMIDE-TIMOLOL 22.3-6.8 MG/ML OPHT DROP,,15779,LOCAL,Facility,Both,10,DROP BTL,,93,79.05,26.6538,93,Medica,Individual & Family,92.163,99.1,,percent of total billed charges,,
DORZOLAMIDE-TIMOLOL 22.3-6.8 MG/ML OPHT DROP,,15779,LOCAL,Facility,Outpatient,10,DROP BTL,,93,79.05,26.6538,93,Medica,Medica Advantage Solution,46.314,49.8,,percent of total billed charges,,
DORZOLAMIDE-TIMOLOL 22.3-6.8 MG/ML OPHT DROP,,15779,LOCAL,Facility,Inpatient,10,DROP BTL,,93,79.05,26.6538,93,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
DORZOLAMIDE-TIMOLOL 22.3-6.8 MG/ML OPHT DROP,,15779,LOCAL,Facility,Outpatient,10,DROP BTL,,93,79.05,26.6538,93,Medica,Medical Assistance,41.478,44.6,,percent of total billed charges,,
DORZOLAMIDE-TIMOLOL 22.3-6.8 MG/ML OPHT DROP,,15779,LOCAL,Facility,Inpatient,10,DROP BTL,,93,79.05,26.6538,93,Medica,Medical Assistance,,,,,Included in per diem rate,
DORZOLAMIDE-TIMOLOL 22.3-6.8 MG/ML OPHT DROP,,15779,LOCAL,Facility,Outpatient,10,DROP BTL,,93,79.05,26.6538,93,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,46.314,49.8,,percent of total billed charges,,
DORZOLAMIDE-TIMOLOL 22.3-6.8 MG/ML OPHT DROP,,15779,LOCAL,Facility,Inpatient,10,DROP BTL,,93,79.05,26.6538,93,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
DORZOLAMIDE-TIMOLOL 22.3-6.8 MG/ML OPHT DROP,,15779,LOCAL,Facility,Both,10,DROP BTL,,93,79.05,26.6538,93,"Multiplan, Inc.","Multiplan, Inc.",87.42,94,,percent of total billed charges,,
DORZOLAMIDE-TIMOLOL 22.3-6.8 MG/ML OPHT DROP,,15779,LOCAL,Facility,Outpatient,10,DROP BTL,,93,79.05,26.6538,93,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,83.793,90.1,,percent of total billed charges,,
DORZOLAMIDE-TIMOLOL 22.3-6.8 MG/ML OPHT DROP,,15779,LOCAL,Facility,Inpatient,10,DROP BTL,,93,79.05,26.6538,93,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
DORZOLAMIDE-TIMOLOL 22.3-6.8 MG/ML OPHT DROP,,15779,LOCAL,Facility,Both,10,DROP BTL,,93,79.05,26.6538,93,"Preferred One Administrative Services, INC.",PPO,91.698,98.6,,percent of total billed charges,,
DORZOLAMIDE-TIMOLOL 22.3-6.8 MG/ML OPHT DROP,,15779,LOCAL,Facility,Outpatient,10,DROP BTL,,93,79.05,26.6538,93,PrimeWest Health,Minnesota Senior Health Options (MSHO),47.8485,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
DORZOLAMIDE-TIMOLOL 22.3-6.8 MG/ML OPHT DROP,,15779,LOCAL,Facility,Inpatient,10,DROP BTL,,93,79.05,26.6538,93,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DORZOLAMIDE-TIMOLOL 22.3-6.8 MG/ML OPHT DROP,,15779,LOCAL,Facility,Outpatient,10,DROP BTL,,93,79.05,26.6538,93,PrimeWest Health,MinnesotaCare,47.7648,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
DORZOLAMIDE-TIMOLOL 22.3-6.8 MG/ML OPHT DROP,,15779,LOCAL,Facility,Inpatient,10,DROP BTL,,93,79.05,26.6538,93,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
DORZOLAMIDE-TIMOLOL 22.3-6.8 MG/ML OPHT DROP,,15779,LOCAL,Facility,Both,10,DROP BTL,,93,79.05,26.6538,93,Sanford Health Plan,Sanford Health Plan,85.56,92,,percent of total billed charges,,
DORZOLAMIDE-TIMOLOL 22.3-6.8 MG/ML OPHT DROP,,15779,LOCAL,Facility,Outpatient,10,DROP BTL,,93,79.05,26.6538,93,"UCare Health, Inc.",Individual & Family Plan,52.4055,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
DORZOLAMIDE-TIMOLOL 22.3-6.8 MG/ML OPHT DROP,,15779,LOCAL,Facility,Inpatient,10,DROP BTL,,93,79.05,26.6538,93,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
DORZOLAMIDE-TIMOLOL 22.3-6.8 MG/ML OPHT DROP,,15779,LOCAL,Facility,Outpatient,10,DROP BTL,,93,79.05,26.6538,93,"UCare Health, Inc.",Medical Assistance,46.9371,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DORZOLAMIDE-TIMOLOL 22.3-6.8 MG/ML OPHT DROP,,15779,LOCAL,Facility,Inpatient,10,DROP BTL,,93,79.05,26.6538,93,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
DORZOLAMIDE-TIMOLOL 22.3-6.8 MG/ML OPHT DROP,,15779,LOCAL,Facility,Outpatient,10,DROP BTL,,93,79.05,26.6538,93,"UCare Health, Inc.",Medicare Advantage,46.9371,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DORZOLAMIDE-TIMOLOL 22.3-6.8 MG/ML OPHT DROP,,15779,LOCAL,Facility,Inpatient,10,DROP BTL,,93,79.05,26.6538,93,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DORZOLAMIDE-TIMOLOL 22.3-6.8 MG/ML OPHT DROP,,15779,LOCAL,Facility,Outpatient,10,DROP BTL,,93,79.05,26.6538,93,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),46.9371,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DORZOLAMIDE-TIMOLOL 22.3-6.8 MG/ML OPHT DROP,,15779,LOCAL,Facility,Inpatient,10,DROP BTL,,93,79.05,26.6538,93,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DORZOLAMIDE-TIMOLOL 22.3-6.8 MG/ML OPHT DROP,,15779,LOCAL,Facility,Both,10,DROP BTL,,93,79.05,26.6538,93,UnitedHealthcare,Individual & Family,87.42,94,,percent of total billed charges,,
DORZOLAMIDE-TIMOLOL 22.3-6.8 MG/ML OPHT DROP,,15779,LOCAL,Facility,Outpatient,10,DROP BTL,,93,79.05,26.6538,93,UnitedHealthcare,Medicare Advantage,45.57,49,,percent of total billed charges,,
DORZOLAMIDE-TIMOLOL 22.3-6.8 MG/ML OPHT DROP,,15779,LOCAL,Facility,Inpatient,10,DROP BTL,,93,79.05,26.6538,93,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
DORZOLAMIDE-TIMOLOL 22.3-6.8 MG/ML OPHT DROP,,15779,LOCAL,Facility,Outpatient,10,DROP BTL,,93,79.05,26.6538,93,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,44.64,48,,percent of total billed charges,,100% of DHS outpatient percentage
DORZOLAMIDE-TIMOLOL 22.3-6.8 MG/ML OPHT DROP,,15779,LOCAL,Facility,Inpatient,10,DROP BTL,,93,79.05,26.6538,93,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Iridotomy/Iridectomy By Laser Surgery (Eg, For Glaucoma) (Per Session) (Pro Cah)",,66761,CPT,Professional,Both,,,,1530,1300.5,149.64,1530,Aetna,Commercial,1300.5,85,,percent of total billed charges,,
"Iridotomy/Iridectomy By Laser Surgery (Eg, For Glaucoma) (Per Session) (Pro Cah)",,66761,CPT,Professional,Both,,,,1530,1300.5,149.64,1530,Aetna,Medicare Advantage,234.64,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Iridotomy/Iridectomy By Laser Surgery (Eg, For Glaucoma) (Per Session) (Pro Cah)",,66761,CPT,Professional,Both,,,,1530,1300.5,149.64,1530,Aetna,PPO,1422.9,93,,percent of total billed charges,,
"Iridotomy/Iridectomy By Laser Surgery (Eg, For Glaucoma) (Per Session) (Pro Cah)",,66761,CPT,Professional,Both,,,,1530,1300.5,149.64,1530,America's PPO,America's PPO,1307.232,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Iridotomy/Iridectomy By Laser Surgery (Eg, For Glaucoma) (Per Session) (Pro Cah)",,66761,CPT,Professional,Both,,,,1530,1300.5,149.64,1530,BlueCross BlueShield Minnesota, Federal Employee Program,478.58,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Iridotomy/Iridectomy By Laser Surgery (Eg, For Glaucoma) (Per Session) (Pro Cah)",,66761,CPT,Professional,Both,,,,1530,1300.5,149.64,1530,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,486.23728,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Iridotomy/Iridectomy By Laser Surgery (Eg, For Glaucoma) (Per Session) (Pro Cah)",,66761,CPT,Professional,Both,,,,1530,1300.5,149.64,1530,BlueCross BlueShield Minnesota,High Value Network Plan,486.23728,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Iridotomy/Iridectomy By Laser Surgery (Eg, For Glaucoma) (Per Session) (Pro Cah)",,66761,CPT,Professional,Both,,,,1530,1300.5,149.64,1530,BlueCross BlueShield Minnesota,Medicare Advantage,267.559,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Iridotomy/Iridectomy By Laser Surgery (Eg, For Glaucoma) (Per Session) (Pro Cah)",,66761,CPT,Professional,Both,,,,1530,1300.5,149.64,1530,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,486.23728,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Iridotomy/Iridectomy By Laser Surgery (Eg, For Glaucoma) (Per Session) (Pro Cah)",,66761,CPT,Professional,Both,,,,1530,1300.5,149.64,1530,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,172.7708,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Iridotomy/Iridectomy By Laser Surgery (Eg, For Glaucoma) (Per Session) (Pro Cah)",,66761,CPT,Professional,Both,,,,1530,1300.5,149.64,1530,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),267.559,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Iridotomy/Iridectomy By Laser Surgery (Eg, For Glaucoma) (Per Session) (Pro Cah)",,66761,CPT,Professional,Both,,,,1530,1300.5,149.64,1530,CorVel,Worker's Compensation,453.2799525,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Iridotomy/Iridectomy By Laser Surgery (Eg, For Glaucoma) (Per Session) (Pro Cah)",,66761,CPT,Professional,Both,,,,1530,1300.5,149.64,1530,First Health Group Corporation,First Health Network,1484.1,97,,percent of total billed charges,,
"Iridotomy/Iridectomy By Laser Surgery (Eg, For Glaucoma) (Per Session) (Pro Cah)",,66761,CPT,Professional,Both,,,,1530,1300.5,149.64,1530,"Health Partners, Inc.",Commercial,489.73,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Iridotomy/Iridectomy By Laser Surgery (Eg, For Glaucoma) (Per Session) (Pro Cah)",,66761,CPT,Professional,Both,,,,1530,1300.5,149.64,1530,"Health Partners, Inc.",Medicare Advantage,267.559,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Iridotomy/Iridectomy By Laser Surgery (Eg, For Glaucoma) (Per Session) (Pro Cah)",,66761,CPT,Professional,Both,,,,1530,1300.5,149.64,1530,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),232.47,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Iridotomy/Iridectomy By Laser Surgery (Eg, For Glaucoma) (Per Session) (Pro Cah)",,66761,CPT,Professional,Both,,,,1530,1300.5,149.64,1530,"Health Partners, Inc.",State of Minnesota Advantage Program,421.902395,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Iridotomy/Iridectomy By Laser Surgery (Eg, For Glaucoma) (Per Session) (Pro Cah)",,66761,CPT,Professional,Both,,,,1530,1300.5,149.64,1530,"Health Partners, Inc.",State Public Programs,149.64,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Iridotomy/Iridectomy By Laser Surgery (Eg, For Glaucoma) (Per Session) (Pro Cah)",,66761,CPT,Professional,Both,,,,1530,1300.5,149.64,1530,Humana Insurance Company,Commercial PPO,232.66,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Iridotomy/Iridectomy By Laser Surgery (Eg, For Glaucoma) (Per Session) (Pro Cah)",,66761,CPT,Professional,Both,,,,1530,1300.5,149.64,1530,Humana Insurance Company,Medicare PPO,1530,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Iridotomy/Iridectomy By Laser Surgery (Eg, For Glaucoma) (Per Session) (Pro Cah)",,66761,CPT,Professional,Both,,,,1530,1300.5,149.64,1530,Medica,Individual & Family,1297.44,84.8,,percent of total billed charges,,
"Iridotomy/Iridectomy By Laser Surgery (Eg, For Glaucoma) (Per Session) (Pro Cah)",,66761,CPT,Professional,Both,,,,1530,1300.5,149.64,1530,Medica,Medica Advantage Solution,761.94,49.8,,percent of total billed charges,,
"Iridotomy/Iridectomy By Laser Surgery (Eg, For Glaucoma) (Per Session) (Pro Cah)",,66761,CPT,Professional,Both,,,,1530,1300.5,149.64,1530,Medica,Medical Assistance,172.77,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Iridotomy/Iridectomy By Laser Surgery (Eg, For Glaucoma) (Per Session) (Pro Cah)",,66761,CPT,Professional,Both,,,,1530,1300.5,149.64,1530,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,232.66,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Iridotomy/Iridectomy By Laser Surgery (Eg, For Glaucoma) (Per Session) (Pro Cah)",,66761,CPT,Professional,Both,,,,1530,1300.5,149.64,1530,"Multiplan, Inc.","Multiplan, Inc.",1438.2,94,,percent of total billed charges,,
"Iridotomy/Iridectomy By Laser Surgery (Eg, For Glaucoma) (Per Session) (Pro Cah)",,66761,CPT,Professional,Both,,,,1530,1300.5,149.64,1530,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1378.53,90.1,,percent of total billed charges,,
"Iridotomy/Iridectomy By Laser Surgery (Eg, For Glaucoma) (Per Session) (Pro Cah)",,66761,CPT,Professional,Both,,,,1530,1300.5,149.64,1530,"Preferred One Administrative Services, INC.",PPO,1508.58,98.6,,percent of total billed charges,,
"Iridotomy/Iridectomy By Laser Surgery (Eg, For Glaucoma) (Per Session) (Pro Cah)",,66761,CPT,Professional,Both,,,,1530,1300.5,149.64,1530,PrimeWest Health,Minnesota Senior Health Options (MSHO),267.559,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Iridotomy/Iridectomy By Laser Surgery (Eg, For Glaucoma) (Per Session) (Pro Cah)",,66761,CPT,Professional,Both,,,,1530,1300.5,149.64,1530,PrimeWest Health,MinnesotaCare,184.864756,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Iridotomy/Iridectomy By Laser Surgery (Eg, For Glaucoma) (Per Session) (Pro Cah)",,66761,CPT,Professional,Both,,,,1530,1300.5,149.64,1530,Sanford Health Plan,Sanford Health Plan,1346.4,88,,percent of total billed charges,,
"Iridotomy/Iridectomy By Laser Surgery (Eg, For Glaucoma) (Per Session) (Pro Cah)",,66761,CPT,Professional,Both,,,,1530,1300.5,149.64,1530,"UCare Health, Inc.",Individual & Family Plan,378.212096,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Iridotomy/Iridectomy By Laser Surgery (Eg, For Glaucoma) (Per Session) (Pro Cah)",,66761,CPT,Professional,Both,,,,1530,1300.5,149.64,1530,"UCare Health, Inc.",Medical Assistance,190.04788,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Iridotomy/Iridectomy By Laser Surgery (Eg, For Glaucoma) (Per Session) (Pro Cah)",,66761,CPT,Professional,Both,,,,1530,1300.5,149.64,1530,"UCare Health, Inc.",Medicare Advantage,267.559,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Iridotomy/Iridectomy By Laser Surgery (Eg, For Glaucoma) (Per Session) (Pro Cah)",,66761,CPT,Professional,Both,,,,1530,1300.5,149.64,1530,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),214.0472,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Iridotomy/Iridectomy By Laser Surgery (Eg, For Glaucoma) (Per Session) (Pro Cah)",,66761,CPT,Professional,Both,,,,1530,1300.5,149.64,1530,UnitedHealthcare,Individual & Family,1530,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Iridotomy/Iridectomy By Laser Surgery (Eg, For Glaucoma) (Per Session) (Pro Cah)",,66761,CPT,Professional,Both,,,,1530,1300.5,149.64,1530,UnitedHealthcare,Medicare Advantage,267.559,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Iridotomy/Iridectomy By Laser Surgery (Eg, For Glaucoma) (Per Session) (Pro Cah)",,66761,CPT,Professional,Both,,,,1530,1300.5,149.64,1530,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,172.7708,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Discission Of Secondary Membranous Cataract (Procah),,66821,CPT,Professional,Both,,,,1224,1040.4,198.95,1224,Aetna,Commercial,1040.4,85,,percent of total billed charges,,
Discission Of Secondary Membranous Cataract (Procah),,66821,CPT,Professional,Both,,,,1224,1040.4,198.95,1224,Aetna,Medicare Advantage,311.87,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Discission Of Secondary Membranous Cataract (Procah),,66821,CPT,Professional,Both,,,,1224,1040.4,198.95,1224,Aetna,PPO,1138.32,93,,percent of total billed charges,,
Discission Of Secondary Membranous Cataract (Procah),,66821,CPT,Professional,Both,,,,1224,1040.4,198.95,1224,America's PPO,America's PPO,1045.7856,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Discission Of Secondary Membranous Cataract (Procah),,66821,CPT,Professional,Both,,,,1224,1040.4,198.95,1224,BlueCross BlueShield Minnesota, Federal Employee Program,632.82,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Discission Of Secondary Membranous Cataract (Procah),,66821,CPT,Professional,Both,,,,1224,1040.4,198.95,1224,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,642.94512,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Discission Of Secondary Membranous Cataract (Procah),,66821,CPT,Professional,Both,,,,1224,1040.4,198.95,1224,BlueCross BlueShield Minnesota,High Value Network Plan,642.94512,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Discission Of Secondary Membranous Cataract (Procah),,66821,CPT,Professional,Both,,,,1224,1040.4,198.95,1224,BlueCross BlueShield Minnesota,Medicare Advantage,355.6605,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Discission Of Secondary Membranous Cataract (Procah),,66821,CPT,Professional,Both,,,,1224,1040.4,198.95,1224,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,642.94512,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Discission Of Secondary Membranous Cataract (Procah),,66821,CPT,Professional,Both,,,,1224,1040.4,198.95,1224,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,229.69728,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Discission Of Secondary Membranous Cataract (Procah),,66821,CPT,Professional,Both,,,,1224,1040.4,198.95,1224,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),355.6605,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Discission Of Secondary Membranous Cataract (Procah),,66821,CPT,Professional,Both,,,,1224,1040.4,198.95,1224,CorVel,Worker's Compensation,601.0411902,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Discission Of Secondary Membranous Cataract (Procah),,66821,CPT,Professional,Both,,,,1224,1040.4,198.95,1224,First Health Group Corporation,First Health Network,1187.28,97,,percent of total billed charges,,
Discission Of Secondary Membranous Cataract (Procah),,66821,CPT,Professional,Both,,,,1224,1040.4,198.95,1224,"Health Partners, Inc.",Commercial,649.35,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Discission Of Secondary Membranous Cataract (Procah),,66821,CPT,Professional,Both,,,,1224,1040.4,198.95,1224,"Health Partners, Inc.",Medicare Advantage,355.6605,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Discission Of Secondary Membranous Cataract (Procah),,66821,CPT,Professional,Both,,,,1224,1040.4,198.95,1224,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),309.05,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Discission Of Secondary Membranous Cataract (Procah),,66821,CPT,Professional,Both,,,,1224,1040.4,198.95,1224,"Health Partners, Inc.",State of Minnesota Advantage Program,559.415025,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Discission Of Secondary Membranous Cataract (Procah),,66821,CPT,Professional,Both,,,,1224,1040.4,198.95,1224,"Health Partners, Inc.",State Public Programs,198.95,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Discission Of Secondary Membranous Cataract (Procah),,66821,CPT,Professional,Both,,,,1224,1040.4,198.95,1224,Humana Insurance Company,Commercial PPO,309.27,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Discission Of Secondary Membranous Cataract (Procah),,66821,CPT,Professional,Both,,,,1224,1040.4,198.95,1224,Humana Insurance Company,Medicare PPO,1224,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Discission Of Secondary Membranous Cataract (Procah),,66821,CPT,Professional,Both,,,,1224,1040.4,198.95,1224,Medica,Individual & Family,1037.952,84.8,,percent of total billed charges,,
Discission Of Secondary Membranous Cataract (Procah),,66821,CPT,Professional,Both,,,,1224,1040.4,198.95,1224,Medica,Medica Advantage Solution,609.552,49.8,,percent of total billed charges,,
Discission Of Secondary Membranous Cataract (Procah),,66821,CPT,Professional,Both,,,,1224,1040.4,198.95,1224,Medica,Medical Assistance,229.7,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Discission Of Secondary Membranous Cataract (Procah),,66821,CPT,Professional,Both,,,,1224,1040.4,198.95,1224,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,309.27,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Discission Of Secondary Membranous Cataract (Procah),,66821,CPT,Professional,Both,,,,1224,1040.4,198.95,1224,"Multiplan, Inc.","Multiplan, Inc.",1150.56,94,,percent of total billed charges,,
Discission Of Secondary Membranous Cataract (Procah),,66821,CPT,Professional,Both,,,,1224,1040.4,198.95,1224,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1102.824,90.1,,percent of total billed charges,,
Discission Of Secondary Membranous Cataract (Procah),,66821,CPT,Professional,Both,,,,1224,1040.4,198.95,1224,"Preferred One Administrative Services, INC.",PPO,1206.864,98.6,,percent of total billed charges,,
Discission Of Secondary Membranous Cataract (Procah),,66821,CPT,Professional,Both,,,,1224,1040.4,198.95,1224,PrimeWest Health,Minnesota Senior Health Options (MSHO),355.6605,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Discission Of Secondary Membranous Cataract (Procah),,66821,CPT,Professional,Both,,,,1224,1040.4,198.95,1224,PrimeWest Health,MinnesotaCare,245.7760896,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Discission Of Secondary Membranous Cataract (Procah),,66821,CPT,Professional,Both,,,,1224,1040.4,198.95,1224,Sanford Health Plan,Sanford Health Plan,1077.12,88,,percent of total billed charges,,
Discission Of Secondary Membranous Cataract (Procah),,66821,CPT,Professional,Both,,,,1224,1040.4,198.95,1224,"UCare Health, Inc.",Individual & Family Plan,502.749312,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Discission Of Secondary Membranous Cataract (Procah),,66821,CPT,Professional,Both,,,,1224,1040.4,198.95,1224,"UCare Health, Inc.",Medical Assistance,252.667008,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Discission Of Secondary Membranous Cataract (Procah),,66821,CPT,Professional,Both,,,,1224,1040.4,198.95,1224,"UCare Health, Inc.",Medicare Advantage,355.6605,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Discission Of Secondary Membranous Cataract (Procah),,66821,CPT,Professional,Both,,,,1224,1040.4,198.95,1224,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),284.5284,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Discission Of Secondary Membranous Cataract (Procah),,66821,CPT,Professional,Both,,,,1224,1040.4,198.95,1224,UnitedHealthcare,Individual & Family,1224,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Discission Of Secondary Membranous Cataract (Procah),,66821,CPT,Professional,Both,,,,1224,1040.4,198.95,1224,UnitedHealthcare,Medicare Advantage,355.6605,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Discission Of Secondary Membranous Cataract (Procah),,66821,CPT,Professional,Both,,,,1224,1040.4,198.95,1224,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,229.69728,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
KETAMINE 50 MG/ML INJ SOLN,,16109,LOCAL,Facility,Both,10,mL,,43,36.55,12.3238,43,Aetna,Commercial,39.56,92,,percent of total billed charges,,
KETAMINE 50 MG/ML INJ SOLN,,16109,LOCAL,Facility,Outpatient,10,mL,,43,36.55,12.3238,43,Aetna,Medicare Advantage,21.07,49,,percent of total billed charges,,
KETAMINE 50 MG/ML INJ SOLN,,16109,LOCAL,Facility,Inpatient,10,mL,,43,36.55,12.3238,43,Aetna,Medicare Advantage,,,,,Included in per diem rate,
KETAMINE 50 MG/ML INJ SOLN,,16109,LOCAL,Facility,Both,10,mL,,43,36.55,12.3238,43,Aetna,PPO,39.99,93,,percent of total billed charges,,
KETAMINE 50 MG/ML INJ SOLN,,16109,LOCAL,Facility,Both,10,mL,,43,36.55,12.3238,43,America's PPO,America's PPO,41.2929,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
KETAMINE 50 MG/ML INJ SOLN,,16109,LOCAL,Facility,Both,10,mL,,43,36.55,12.3238,43,BlueCross BlueShield Minnesota, Federal Employee Program,42.312,98.4,,percent of total billed charges,,
KETAMINE 50 MG/ML INJ SOLN,,16109,LOCAL,Facility,Both,10,mL,,43,36.55,12.3238,43,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,43,100,,percent of total billed charges,,
KETAMINE 50 MG/ML INJ SOLN,,16109,LOCAL,Facility,Both,10,mL,,43,36.55,12.3238,43,BlueCross BlueShield Minnesota,High Value Network Plan,38.7,90,,percent of total billed charges,,
KETAMINE 50 MG/ML INJ SOLN,,16109,LOCAL,Facility,Outpatient,10,mL,,43,36.55,12.3238,43,BlueCross BlueShield Minnesota,Medicare Advantage,21.07,49,,percent of total billed charges,,
KETAMINE 50 MG/ML INJ SOLN,,16109,LOCAL,Facility,Inpatient,10,mL,,43,36.55,12.3238,43,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
KETAMINE 50 MG/ML INJ SOLN,,16109,LOCAL,Facility,Both,10,mL,,43,36.55,12.3238,43,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,38.0851,88.57,,percent of total billed charges,,
KETAMINE 50 MG/ML INJ SOLN,,16109,LOCAL,Facility,Both,10,mL,,43,36.55,12.3238,43,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,12.3238,28.66,,percent of total billed charges,,
KETAMINE 50 MG/ML INJ SOLN,,16109,LOCAL,Facility,Outpatient,10,mL,,43,36.55,12.3238,43,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),21.07,49,,percent of total billed charges,,
KETAMINE 50 MG/ML INJ SOLN,,16109,LOCAL,Facility,Inpatient,10,mL,,43,36.55,12.3238,43,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
KETAMINE 50 MG/ML INJ SOLN,,16109,LOCAL,Facility,Both,10,mL,,43,36.55,12.3238,43,CorVel,Worker's Compensation,43,100,,percent of total billed charges,,
KETAMINE 50 MG/ML INJ SOLN,,16109,LOCAL,Facility,Both,10,mL,,43,36.55,12.3238,43,First Health Group Corporation,First Health Network,41.71,97,,percent of total billed charges,,
KETAMINE 50 MG/ML INJ SOLN,,16109,LOCAL,Facility,Both,10,mL,,43,36.55,12.3238,43,"Health Partners, Inc.",Commercial,40.678,94.6,,percent of total billed charges,,
KETAMINE 50 MG/ML INJ SOLN,,16109,LOCAL,Facility,Outpatient,10,mL,,43,36.55,12.3238,43,"Health Partners, Inc.",Medicare Advantage,21.07,49,,percent of total billed charges,,
KETAMINE 50 MG/ML INJ SOLN,,16109,LOCAL,Facility,Inpatient,10,mL,,43,36.55,12.3238,43,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
KETAMINE 50 MG/ML INJ SOLN,,16109,LOCAL,Facility,Both,10,mL,,43,36.55,12.3238,43,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),25.8,60,,percent of total billed charges,,
KETAMINE 50 MG/ML INJ SOLN,,16109,LOCAL,Facility,Both,10,mL,,43,36.55,12.3238,43,"Health Partners, Inc.",State of Minnesota Advantage Program,35.045,81.5,,percent of total billed charges,,
KETAMINE 50 MG/ML INJ SOLN,,16109,LOCAL,Facility,Both,10,mL,,43,36.55,12.3238,43,"Health Partners, Inc.",State Public Programs,21.5,50,,percent of total billed charges,,
KETAMINE 50 MG/ML INJ SOLN,,16109,LOCAL,Facility,Both,10,mL,,43,36.55,12.3238,43,Humana Insurance Company,Commercial PPO,40.85,95,,percent of total billed charges,,
KETAMINE 50 MG/ML INJ SOLN,,16109,LOCAL,Facility,Outpatient,10,mL,,43,36.55,12.3238,43,Humana Insurance Company,Medicare PPO,21.07,49,,percent of total billed charges,,
KETAMINE 50 MG/ML INJ SOLN,,16109,LOCAL,Facility,Inpatient,10,mL,,43,36.55,12.3238,43,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
KETAMINE 50 MG/ML INJ SOLN,,16109,LOCAL,Facility,Both,10,mL,,43,36.55,12.3238,43,Medica,Individual & Family,42.613,99.1,,percent of total billed charges,,
KETAMINE 50 MG/ML INJ SOLN,,16109,LOCAL,Facility,Outpatient,10,mL,,43,36.55,12.3238,43,Medica,Medica Advantage Solution,21.414,49.8,,percent of total billed charges,,
KETAMINE 50 MG/ML INJ SOLN,,16109,LOCAL,Facility,Inpatient,10,mL,,43,36.55,12.3238,43,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
KETAMINE 50 MG/ML INJ SOLN,,16109,LOCAL,Facility,Outpatient,10,mL,,43,36.55,12.3238,43,Medica,Medical Assistance,19.178,44.6,,percent of total billed charges,,
KETAMINE 50 MG/ML INJ SOLN,,16109,LOCAL,Facility,Inpatient,10,mL,,43,36.55,12.3238,43,Medica,Medical Assistance,,,,,Included in per diem rate,
KETAMINE 50 MG/ML INJ SOLN,,16109,LOCAL,Facility,Outpatient,10,mL,,43,36.55,12.3238,43,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,21.414,49.8,,percent of total billed charges,,
KETAMINE 50 MG/ML INJ SOLN,,16109,LOCAL,Facility,Inpatient,10,mL,,43,36.55,12.3238,43,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
KETAMINE 50 MG/ML INJ SOLN,,16109,LOCAL,Facility,Both,10,mL,,43,36.55,12.3238,43,"Multiplan, Inc.","Multiplan, Inc.",40.42,94,,percent of total billed charges,,
KETAMINE 50 MG/ML INJ SOLN,,16109,LOCAL,Facility,Outpatient,10,mL,,43,36.55,12.3238,43,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,38.743,90.1,,percent of total billed charges,,
KETAMINE 50 MG/ML INJ SOLN,,16109,LOCAL,Facility,Inpatient,10,mL,,43,36.55,12.3238,43,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
KETAMINE 50 MG/ML INJ SOLN,,16109,LOCAL,Facility,Both,10,mL,,43,36.55,12.3238,43,"Preferred One Administrative Services, INC.",PPO,42.398,98.6,,percent of total billed charges,,
KETAMINE 50 MG/ML INJ SOLN,,16109,LOCAL,Facility,Outpatient,10,mL,,43,36.55,12.3238,43,PrimeWest Health,Minnesota Senior Health Options (MSHO),22.1235,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
KETAMINE 50 MG/ML INJ SOLN,,16109,LOCAL,Facility,Inpatient,10,mL,,43,36.55,12.3238,43,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
KETAMINE 50 MG/ML INJ SOLN,,16109,LOCAL,Facility,Outpatient,10,mL,,43,36.55,12.3238,43,PrimeWest Health,MinnesotaCare,22.0848,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
KETAMINE 50 MG/ML INJ SOLN,,16109,LOCAL,Facility,Inpatient,10,mL,,43,36.55,12.3238,43,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
KETAMINE 50 MG/ML INJ SOLN,,16109,LOCAL,Facility,Both,10,mL,,43,36.55,12.3238,43,Sanford Health Plan,Sanford Health Plan,39.56,92,,percent of total billed charges,,
KETAMINE 50 MG/ML INJ SOLN,,16109,LOCAL,Facility,Outpatient,10,mL,,43,36.55,12.3238,43,"UCare Health, Inc.",Individual & Family Plan,24.2305,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
KETAMINE 50 MG/ML INJ SOLN,,16109,LOCAL,Facility,Inpatient,10,mL,,43,36.55,12.3238,43,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
KETAMINE 50 MG/ML INJ SOLN,,16109,LOCAL,Facility,Outpatient,10,mL,,43,36.55,12.3238,43,"UCare Health, Inc.",Medical Assistance,21.7021,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
KETAMINE 50 MG/ML INJ SOLN,,16109,LOCAL,Facility,Inpatient,10,mL,,43,36.55,12.3238,43,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
KETAMINE 50 MG/ML INJ SOLN,,16109,LOCAL,Facility,Outpatient,10,mL,,43,36.55,12.3238,43,"UCare Health, Inc.",Medicare Advantage,21.7021,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
KETAMINE 50 MG/ML INJ SOLN,,16109,LOCAL,Facility,Inpatient,10,mL,,43,36.55,12.3238,43,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
KETAMINE 50 MG/ML INJ SOLN,,16109,LOCAL,Facility,Outpatient,10,mL,,43,36.55,12.3238,43,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),21.7021,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
KETAMINE 50 MG/ML INJ SOLN,,16109,LOCAL,Facility,Inpatient,10,mL,,43,36.55,12.3238,43,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
KETAMINE 50 MG/ML INJ SOLN,,16109,LOCAL,Facility,Both,10,mL,,43,36.55,12.3238,43,UnitedHealthcare,Individual & Family,40.42,94,,percent of total billed charges,,
KETAMINE 50 MG/ML INJ SOLN,,16109,LOCAL,Facility,Outpatient,10,mL,,43,36.55,12.3238,43,UnitedHealthcare,Medicare Advantage,21.07,49,,percent of total billed charges,,
KETAMINE 50 MG/ML INJ SOLN,,16109,LOCAL,Facility,Inpatient,10,mL,,43,36.55,12.3238,43,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
KETAMINE 50 MG/ML INJ SOLN,,16109,LOCAL,Facility,Outpatient,10,mL,,43,36.55,12.3238,43,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,20.64,48,,percent of total billed charges,,100% of DHS outpatient percentage
KETAMINE 50 MG/ML INJ SOLN,,16109,LOCAL,Facility,Inpatient,10,mL,,43,36.55,12.3238,43,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Extracapsular Cmplx Cataract Reml W Insert Of Intraoc Lens Prosthesis(1-Stage Proc)Wo Cyclophotocoag (Procah),,66982,CPT,Professional,Both,,,,3876,3294.6,470.55,3876,Aetna,Commercial,3294.6,85,,percent of total billed charges,,
Extracapsular Cmplx Cataract Reml W Insert Of Intraoc Lens Prosthesis(1-Stage Proc)Wo Cyclophotocoag (Procah),,66982,CPT,Professional,Both,,,,3876,3294.6,470.55,3876,Aetna,Medicare Advantage,738.97,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Extracapsular Cmplx Cataract Reml W Insert Of Intraoc Lens Prosthesis(1-Stage Proc)Wo Cyclophotocoag (Procah),,66982,CPT,Professional,Both,,,,3876,3294.6,470.55,3876,Aetna,PPO,3604.68,93,,percent of total billed charges,,
Extracapsular Cmplx Cataract Reml W Insert Of Intraoc Lens Prosthesis(1-Stage Proc)Wo Cyclophotocoag (Procah),,66982,CPT,Professional,Both,,,,3876,3294.6,470.55,3876,America's PPO,America's PPO,3311.6544,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Extracapsular Cmplx Cataract Reml W Insert Of Intraoc Lens Prosthesis(1-Stage Proc)Wo Cyclophotocoag (Procah),,66982,CPT,Professional,Both,,,,3876,3294.6,470.55,3876,BlueCross BlueShield Minnesota, Federal Employee Program,1507.35,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Extracapsular Cmplx Cataract Reml W Insert Of Intraoc Lens Prosthesis(1-Stage Proc)Wo Cyclophotocoag (Procah),,66982,CPT,Professional,Both,,,,3876,3294.6,470.55,3876,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1531.4676,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Extracapsular Cmplx Cataract Reml W Insert Of Intraoc Lens Prosthesis(1-Stage Proc)Wo Cyclophotocoag (Procah),,66982,CPT,Professional,Both,,,,3876,3294.6,470.55,3876,BlueCross BlueShield Minnesota,High Value Network Plan,1531.4676,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Extracapsular Cmplx Cataract Reml W Insert Of Intraoc Lens Prosthesis(1-Stage Proc)Wo Cyclophotocoag (Procah),,66982,CPT,Professional,Both,,,,3876,3294.6,470.55,3876,BlueCross BlueShield Minnesota,Medicare Advantage,840.88,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Extracapsular Cmplx Cataract Reml W Insert Of Intraoc Lens Prosthesis(1-Stage Proc)Wo Cyclophotocoag (Procah),,66982,CPT,Professional,Both,,,,3876,3294.6,470.55,3876,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1531.4676,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Extracapsular Cmplx Cataract Reml W Insert Of Intraoc Lens Prosthesis(1-Stage Proc)Wo Cyclophotocoag (Procah),,66982,CPT,Professional,Both,,,,3876,3294.6,470.55,3876,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,543.27552,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Extracapsular Cmplx Cataract Reml W Insert Of Intraoc Lens Prosthesis(1-Stage Proc)Wo Cyclophotocoag (Procah),,66982,CPT,Professional,Both,,,,3876,3294.6,470.55,3876,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),840.88,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Extracapsular Cmplx Cataract Reml W Insert Of Intraoc Lens Prosthesis(1-Stage Proc)Wo Cyclophotocoag (Procah),,66982,CPT,Professional,Both,,,,3876,3294.6,470.55,3876,CorVel,Worker's Compensation,1423.925411,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Extracapsular Cmplx Cataract Reml W Insert Of Intraoc Lens Prosthesis(1-Stage Proc)Wo Cyclophotocoag (Procah),,66982,CPT,Professional,Both,,,,3876,3294.6,470.55,3876,First Health Group Corporation,First Health Network,3759.72,97,,percent of total billed charges,,
Extracapsular Cmplx Cataract Reml W Insert Of Intraoc Lens Prosthesis(1-Stage Proc)Wo Cyclophotocoag (Procah),,66982,CPT,Professional,Both,,,,3876,3294.6,470.55,3876,"Health Partners, Inc.",Commercial,1538.11,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Extracapsular Cmplx Cataract Reml W Insert Of Intraoc Lens Prosthesis(1-Stage Proc)Wo Cyclophotocoag (Procah),,66982,CPT,Professional,Both,,,,3876,3294.6,470.55,3876,"Health Partners, Inc.",Medicare Advantage,840.88,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Extracapsular Cmplx Cataract Reml W Insert Of Intraoc Lens Prosthesis(1-Stage Proc)Wo Cyclophotocoag (Procah),,66982,CPT,Professional,Both,,,,3876,3294.6,470.55,3876,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),731.29,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Extracapsular Cmplx Cataract Reml W Insert Of Intraoc Lens Prosthesis(1-Stage Proc)Wo Cyclophotocoag (Procah),,66982,CPT,Professional,Both,,,,3876,3294.6,470.55,3876,"Health Partners, Inc.",State of Minnesota Advantage Program,1325.081765,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Extracapsular Cmplx Cataract Reml W Insert Of Intraoc Lens Prosthesis(1-Stage Proc)Wo Cyclophotocoag (Procah),,66982,CPT,Professional,Both,,,,3876,3294.6,470.55,3876,"Health Partners, Inc.",State Public Programs,470.55,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Extracapsular Cmplx Cataract Reml W Insert Of Intraoc Lens Prosthesis(1-Stage Proc)Wo Cyclophotocoag (Procah),,66982,CPT,Professional,Both,,,,3876,3294.6,470.55,3876,Humana Insurance Company,Commercial PPO,731.2,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Extracapsular Cmplx Cataract Reml W Insert Of Intraoc Lens Prosthesis(1-Stage Proc)Wo Cyclophotocoag (Procah),,66982,CPT,Professional,Both,,,,3876,3294.6,470.55,3876,Humana Insurance Company,Medicare PPO,3876,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Extracapsular Cmplx Cataract Reml W Insert Of Intraoc Lens Prosthesis(1-Stage Proc)Wo Cyclophotocoag (Procah),,66982,CPT,Professional,Both,,,,3876,3294.6,470.55,3876,Medica,Individual & Family,3286.848,84.8,,percent of total billed charges,,
Extracapsular Cmplx Cataract Reml W Insert Of Intraoc Lens Prosthesis(1-Stage Proc)Wo Cyclophotocoag (Procah),,66982,CPT,Professional,Both,,,,3876,3294.6,470.55,3876,Medica,Medica Advantage Solution,1930.248,49.8,,percent of total billed charges,,
Extracapsular Cmplx Cataract Reml W Insert Of Intraoc Lens Prosthesis(1-Stage Proc)Wo Cyclophotocoag (Procah),,66982,CPT,Professional,Both,,,,3876,3294.6,470.55,3876,Medica,Medical Assistance,543.28,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Extracapsular Cmplx Cataract Reml W Insert Of Intraoc Lens Prosthesis(1-Stage Proc)Wo Cyclophotocoag (Procah),,66982,CPT,Professional,Both,,,,3876,3294.6,470.55,3876,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,731.2,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Extracapsular Cmplx Cataract Reml W Insert Of Intraoc Lens Prosthesis(1-Stage Proc)Wo Cyclophotocoag (Procah),,66982,CPT,Professional,Both,,,,3876,3294.6,470.55,3876,"Multiplan, Inc.","Multiplan, Inc.",3643.44,94,,percent of total billed charges,,
Extracapsular Cmplx Cataract Reml W Insert Of Intraoc Lens Prosthesis(1-Stage Proc)Wo Cyclophotocoag (Procah),,66982,CPT,Professional,Both,,,,3876,3294.6,470.55,3876,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,3492.276,90.1,,percent of total billed charges,,
Extracapsular Cmplx Cataract Reml W Insert Of Intraoc Lens Prosthesis(1-Stage Proc)Wo Cyclophotocoag (Procah),,66982,CPT,Professional,Both,,,,3876,3294.6,470.55,3876,"Preferred One Administrative Services, INC.",PPO,3821.736,98.6,,percent of total billed charges,,
Extracapsular Cmplx Cataract Reml W Insert Of Intraoc Lens Prosthesis(1-Stage Proc)Wo Cyclophotocoag (Procah),,66982,CPT,Professional,Both,,,,3876,3294.6,470.55,3876,PrimeWest Health,Minnesota Senior Health Options (MSHO),840.88,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Extracapsular Cmplx Cataract Reml W Insert Of Intraoc Lens Prosthesis(1-Stage Proc)Wo Cyclophotocoag (Procah),,66982,CPT,Professional,Both,,,,3876,3294.6,470.55,3876,PrimeWest Health,MinnesotaCare,581.3048064,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Extracapsular Cmplx Cataract Reml W Insert Of Intraoc Lens Prosthesis(1-Stage Proc)Wo Cyclophotocoag (Procah),,66982,CPT,Professional,Both,,,,3876,3294.6,470.55,3876,Sanford Health Plan,Sanford Health Plan,3410.88,88,,percent of total billed charges,,
Extracapsular Cmplx Cataract Reml W Insert Of Intraoc Lens Prosthesis(1-Stage Proc)Wo Cyclophotocoag (Procah),,66982,CPT,Professional,Both,,,,3876,3294.6,470.55,3876,"UCare Health, Inc.",Individual & Family Plan,1188.63872,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Extracapsular Cmplx Cataract Reml W Insert Of Intraoc Lens Prosthesis(1-Stage Proc)Wo Cyclophotocoag (Procah),,66982,CPT,Professional,Both,,,,3876,3294.6,470.55,3876,"UCare Health, Inc.",Medical Assistance,597.603072,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Extracapsular Cmplx Cataract Reml W Insert Of Intraoc Lens Prosthesis(1-Stage Proc)Wo Cyclophotocoag (Procah),,66982,CPT,Professional,Both,,,,3876,3294.6,470.55,3876,"UCare Health, Inc.",Medicare Advantage,840.88,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Extracapsular Cmplx Cataract Reml W Insert Of Intraoc Lens Prosthesis(1-Stage Proc)Wo Cyclophotocoag (Procah),,66982,CPT,Professional,Both,,,,3876,3294.6,470.55,3876,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),672.704,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Extracapsular Cmplx Cataract Reml W Insert Of Intraoc Lens Prosthesis(1-Stage Proc)Wo Cyclophotocoag (Procah),,66982,CPT,Professional,Both,,,,3876,3294.6,470.55,3876,UnitedHealthcare,Individual & Family,3876,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Extracapsular Cmplx Cataract Reml W Insert Of Intraoc Lens Prosthesis(1-Stage Proc)Wo Cyclophotocoag (Procah),,66982,CPT,Professional,Both,,,,3876,3294.6,470.55,3876,UnitedHealthcare,Medicare Advantage,840.88,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Extracapsular Cmplx Cataract Reml W Insert Of Intraoc Lens Prosthesis(1-Stage Proc)Wo Cyclophotocoag (Procah),,66982,CPT,Professional,Both,,,,3876,3294.6,470.55,3876,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,543.27552,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Extracapsular Cataract Reml W Insert Of Intrao Lens Prosthesis (1 Stage) Man/Mech Wo Cyclophotocoag (Procah),,66984,CPT,Professional,Both,,,,3190,2711.5,344.02,3190,Aetna,Commercial,2711.5,85,,percent of total billed charges,,
Extracapsular Cataract Reml W Insert Of Intrao Lens Prosthesis (1 Stage) Man/Mech Wo Cyclophotocoag (Procah),,66984,CPT,Professional,Both,,,,3190,2711.5,344.02,3190,Aetna,Medicare Advantage,539.76,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Extracapsular Cataract Reml W Insert Of Intrao Lens Prosthesis (1 Stage) Man/Mech Wo Cyclophotocoag (Procah),,66984,CPT,Professional,Both,,,,3190,2711.5,344.02,3190,Aetna,PPO,2966.7,93,,percent of total billed charges,,
Extracapsular Cataract Reml W Insert Of Intrao Lens Prosthesis (1 Stage) Man/Mech Wo Cyclophotocoag (Procah),,66984,CPT,Professional,Both,,,,3190,2711.5,344.02,3190,America's PPO,America's PPO,2725.536,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Extracapsular Cataract Reml W Insert Of Intrao Lens Prosthesis (1 Stage) Man/Mech Wo Cyclophotocoag (Procah),,66984,CPT,Professional,Both,,,,3190,2711.5,344.02,3190,BlueCross BlueShield Minnesota, Federal Employee Program,1101.07,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Extracapsular Cataract Reml W Insert Of Intrao Lens Prosthesis (1 Stage) Man/Mech Wo Cyclophotocoag (Procah),,66984,CPT,Professional,Both,,,,3190,2711.5,344.02,3190,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1118.68712,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Extracapsular Cataract Reml W Insert Of Intrao Lens Prosthesis (1 Stage) Man/Mech Wo Cyclophotocoag (Procah),,66984,CPT,Professional,Both,,,,3190,2711.5,344.02,3190,BlueCross BlueShield Minnesota,High Value Network Plan,1118.68712,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Extracapsular Cataract Reml W Insert Of Intrao Lens Prosthesis (1 Stage) Man/Mech Wo Cyclophotocoag (Procah),,66984,CPT,Professional,Both,,,,3190,2711.5,344.02,3190,BlueCross BlueShield Minnesota,Medicare Advantage,614.675,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Extracapsular Cataract Reml W Insert Of Intrao Lens Prosthesis (1 Stage) Man/Mech Wo Cyclophotocoag (Procah),,66984,CPT,Professional,Both,,,,3190,2711.5,344.02,3190,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1118.68712,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Extracapsular Cataract Reml W Insert Of Intrao Lens Prosthesis (1 Stage) Man/Mech Wo Cyclophotocoag (Procah),,66984,CPT,Professional,Both,,,,3190,2711.5,344.02,3190,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,397.18488,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Extracapsular Cataract Reml W Insert Of Intrao Lens Prosthesis (1 Stage) Man/Mech Wo Cyclophotocoag (Procah),,66984,CPT,Professional,Both,,,,3190,2711.5,344.02,3190,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),614.675,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Extracapsular Cataract Reml W Insert Of Intrao Lens Prosthesis (1 Stage) Man/Mech Wo Cyclophotocoag (Procah),,66984,CPT,Professional,Both,,,,3190,2711.5,344.02,3190,CorVel,Worker's Compensation,1039.756,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Extracapsular Cataract Reml W Insert Of Intrao Lens Prosthesis (1 Stage) Man/Mech Wo Cyclophotocoag (Procah),,66984,CPT,Professional,Both,,,,3190,2711.5,344.02,3190,First Health Group Corporation,First Health Network,3094.3,97,,percent of total billed charges,,
Extracapsular Cataract Reml W Insert Of Intrao Lens Prosthesis (1 Stage) Man/Mech Wo Cyclophotocoag (Procah),,66984,CPT,Professional,Both,,,,3190,2711.5,344.02,3190,"Health Partners, Inc.",Commercial,1123.12,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Extracapsular Cataract Reml W Insert Of Intrao Lens Prosthesis (1 Stage) Man/Mech Wo Cyclophotocoag (Procah),,66984,CPT,Professional,Both,,,,3190,2711.5,344.02,3190,"Health Partners, Inc.",Medicare Advantage,614.675,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Extracapsular Cataract Reml W Insert Of Intrao Lens Prosthesis (1 Stage) Man/Mech Wo Cyclophotocoag (Procah),,66984,CPT,Professional,Both,,,,3190,2711.5,344.02,3190,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),534.4,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Extracapsular Cataract Reml W Insert Of Intrao Lens Prosthesis (1 Stage) Man/Mech Wo Cyclophotocoag (Procah),,66984,CPT,Professional,Both,,,,3190,2711.5,344.02,3190,"Health Partners, Inc.",State of Minnesota Advantage Program,967.56788,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Extracapsular Cataract Reml W Insert Of Intrao Lens Prosthesis (1 Stage) Man/Mech Wo Cyclophotocoag (Procah),,66984,CPT,Professional,Both,,,,3190,2711.5,344.02,3190,"Health Partners, Inc.",State Public Programs,344.02,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Extracapsular Cataract Reml W Insert Of Intrao Lens Prosthesis (1 Stage) Man/Mech Wo Cyclophotocoag (Procah),,66984,CPT,Professional,Both,,,,3190,2711.5,344.02,3190,Humana Insurance Company,Commercial PPO,534.5,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Extracapsular Cataract Reml W Insert Of Intrao Lens Prosthesis (1 Stage) Man/Mech Wo Cyclophotocoag (Procah),,66984,CPT,Professional,Both,,,,3190,2711.5,344.02,3190,Humana Insurance Company,Medicare PPO,3190,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Extracapsular Cataract Reml W Insert Of Intrao Lens Prosthesis (1 Stage) Man/Mech Wo Cyclophotocoag (Procah),,66984,CPT,Professional,Both,,,,3190,2711.5,344.02,3190,Medica,Individual & Family,2705.12,84.8,,percent of total billed charges,,
Extracapsular Cataract Reml W Insert Of Intrao Lens Prosthesis (1 Stage) Man/Mech Wo Cyclophotocoag (Procah),,66984,CPT,Professional,Both,,,,3190,2711.5,344.02,3190,Medica,Medica Advantage Solution,1588.62,49.8,,percent of total billed charges,,
Extracapsular Cataract Reml W Insert Of Intrao Lens Prosthesis (1 Stage) Man/Mech Wo Cyclophotocoag (Procah),,66984,CPT,Professional,Both,,,,3190,2711.5,344.02,3190,Medica,Medical Assistance,397.18,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Extracapsular Cataract Reml W Insert Of Intrao Lens Prosthesis (1 Stage) Man/Mech Wo Cyclophotocoag (Procah),,66984,CPT,Professional,Both,,,,3190,2711.5,344.02,3190,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,534.5,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Extracapsular Cataract Reml W Insert Of Intrao Lens Prosthesis (1 Stage) Man/Mech Wo Cyclophotocoag (Procah),,66984,CPT,Professional,Both,,,,3190,2711.5,344.02,3190,"Multiplan, Inc.","Multiplan, Inc.",2998.6,94,,percent of total billed charges,,
Extracapsular Cataract Reml W Insert Of Intrao Lens Prosthesis (1 Stage) Man/Mech Wo Cyclophotocoag (Procah),,66984,CPT,Professional,Both,,,,3190,2711.5,344.02,3190,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,2874.19,90.1,,percent of total billed charges,,
Extracapsular Cataract Reml W Insert Of Intrao Lens Prosthesis (1 Stage) Man/Mech Wo Cyclophotocoag (Procah),,66984,CPT,Professional,Both,,,,3190,2711.5,344.02,3190,"Preferred One Administrative Services, INC.",PPO,3145.34,98.6,,percent of total billed charges,,
Extracapsular Cataract Reml W Insert Of Intrao Lens Prosthesis (1 Stage) Man/Mech Wo Cyclophotocoag (Procah),,66984,CPT,Professional,Both,,,,3190,2711.5,344.02,3190,PrimeWest Health,Minnesota Senior Health Options (MSHO),614.675,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Extracapsular Cataract Reml W Insert Of Intrao Lens Prosthesis (1 Stage) Man/Mech Wo Cyclophotocoag (Procah),,66984,CPT,Professional,Both,,,,3190,2711.5,344.02,3190,PrimeWest Health,MinnesotaCare,424.9878216,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Extracapsular Cataract Reml W Insert Of Intrao Lens Prosthesis (1 Stage) Man/Mech Wo Cyclophotocoag (Procah),,66984,CPT,Professional,Both,,,,3190,2711.5,344.02,3190,Sanford Health Plan,Sanford Health Plan,2807.2,88,,percent of total billed charges,,
Extracapsular Cataract Reml W Insert Of Intrao Lens Prosthesis (1 Stage) Man/Mech Wo Cyclophotocoag (Procah),,66984,CPT,Professional,Both,,,,3190,2711.5,344.02,3190,"UCare Health, Inc.",Individual & Family Plan,868.8832,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Extracapsular Cataract Reml W Insert Of Intrao Lens Prosthesis (1 Stage) Man/Mech Wo Cyclophotocoag (Procah),,66984,CPT,Professional,Both,,,,3190,2711.5,344.02,3190,"UCare Health, Inc.",Medical Assistance,436.903368,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Extracapsular Cataract Reml W Insert Of Intrao Lens Prosthesis (1 Stage) Man/Mech Wo Cyclophotocoag (Procah),,66984,CPT,Professional,Both,,,,3190,2711.5,344.02,3190,"UCare Health, Inc.",Medicare Advantage,614.675,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Extracapsular Cataract Reml W Insert Of Intrao Lens Prosthesis (1 Stage) Man/Mech Wo Cyclophotocoag (Procah),,66984,CPT,Professional,Both,,,,3190,2711.5,344.02,3190,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),491.74,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Extracapsular Cataract Reml W Insert Of Intrao Lens Prosthesis (1 Stage) Man/Mech Wo Cyclophotocoag (Procah),,66984,CPT,Professional,Both,,,,3190,2711.5,344.02,3190,UnitedHealthcare,Individual & Family,3190,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Extracapsular Cataract Reml W Insert Of Intrao Lens Prosthesis (1 Stage) Man/Mech Wo Cyclophotocoag (Procah),,66984,CPT,Professional,Both,,,,3190,2711.5,344.02,3190,UnitedHealthcare,Medicare Advantage,614.675,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Extracapsular Cataract Reml W Insert Of Intrao Lens Prosthesis (1 Stage) Man/Mech Wo Cyclophotocoag (Procah),,66984,CPT,Professional,Both,,,,3190,2711.5,344.02,3190,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,397.18488,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Intravitreal Injection Of Pharmacologic Agent,,67028,CPT,Facility,Both,,,,658,559.3,188.5828,658,Aetna,Commercial,605.36,92,,percent of total billed charges,,
Intravitreal Injection Of Pharmacologic Agent,,67028,CPT,Facility,Outpatient,,,,658,559.3,188.5828,658,Aetna,Medicare Advantage,322.42,49,,percent of total billed charges,,
Intravitreal Injection Of Pharmacologic Agent,,67028,CPT,Facility,Inpatient,,,,658,559.3,188.5828,658,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Intravitreal Injection Of Pharmacologic Agent,,67028,CPT,Facility,Both,,,,658,559.3,188.5828,658,Aetna,PPO,611.94,93,,percent of total billed charges,,
Intravitreal Injection Of Pharmacologic Agent,,67028,CPT,Facility,Both,,,,658,559.3,188.5828,658,America's PPO,America's PPO,631.8774,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Intravitreal Injection Of Pharmacologic Agent,,67028,CPT,Facility,Both,,,,658,559.3,188.5828,658,BlueCross BlueShield Minnesota, Federal Employee Program,647.472,98.4,,percent of total billed charges,,
Intravitreal Injection Of Pharmacologic Agent,,67028,CPT,Facility,Both,,,,658,559.3,188.5828,658,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,658,100,,percent of total billed charges,,
Intravitreal Injection Of Pharmacologic Agent,,67028,CPT,Facility,Both,,,,658,559.3,188.5828,658,BlueCross BlueShield Minnesota,High Value Network Plan,592.2,90,,percent of total billed charges,,
Intravitreal Injection Of Pharmacologic Agent,,67028,CPT,Facility,Outpatient,,,,658,559.3,188.5828,658,BlueCross BlueShield Minnesota,Medicare Advantage,322.42,49,,percent of total billed charges,,
Intravitreal Injection Of Pharmacologic Agent,,67028,CPT,Facility,Inpatient,,,,658,559.3,188.5828,658,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Intravitreal Injection Of Pharmacologic Agent,,67028,CPT,Facility,Both,,,,658,559.3,188.5828,658,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,582.7906,88.57,,percent of total billed charges,,
Intravitreal Injection Of Pharmacologic Agent,,67028,CPT,Facility,Both,,,,658,559.3,188.5828,658,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,188.5828,28.66,,percent of total billed charges,,
Intravitreal Injection Of Pharmacologic Agent,,67028,CPT,Facility,Outpatient,,,,658,559.3,188.5828,658,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),322.42,49,,percent of total billed charges,,
Intravitreal Injection Of Pharmacologic Agent,,67028,CPT,Facility,Inpatient,,,,658,559.3,188.5828,658,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Intravitreal Injection Of Pharmacologic Agent,,67028,CPT,Facility,Both,,,,658,559.3,188.5828,658,CorVel,Worker's Compensation,658,100,,percent of total billed charges,,
Intravitreal Injection Of Pharmacologic Agent,,67028,CPT,Facility,Both,,,,658,559.3,188.5828,658,First Health Group Corporation,First Health Network,638.26,97,,percent of total billed charges,,
Intravitreal Injection Of Pharmacologic Agent,,67028,CPT,Facility,Both,,,,658,559.3,188.5828,658,"Health Partners, Inc.",Commercial,622.468,94.6,,percent of total billed charges,,
Intravitreal Injection Of Pharmacologic Agent,,67028,CPT,Facility,Outpatient,,,,658,559.3,188.5828,658,"Health Partners, Inc.",Medicare Advantage,322.42,49,,percent of total billed charges,,
Intravitreal Injection Of Pharmacologic Agent,,67028,CPT,Facility,Inpatient,,,,658,559.3,188.5828,658,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Intravitreal Injection Of Pharmacologic Agent,,67028,CPT,Facility,Both,,,,658,559.3,188.5828,658,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),394.8,60,,percent of total billed charges,,
Intravitreal Injection Of Pharmacologic Agent,,67028,CPT,Facility,Both,,,,658,559.3,188.5828,658,"Health Partners, Inc.",State of Minnesota Advantage Program,536.27,81.5,,percent of total billed charges,,
Intravitreal Injection Of Pharmacologic Agent,,67028,CPT,Facility,Both,,,,658,559.3,188.5828,658,"Health Partners, Inc.",State Public Programs,329,50,,percent of total billed charges,,
Intravitreal Injection Of Pharmacologic Agent,,67028,CPT,Facility,Both,,,,658,559.3,188.5828,658,Humana Insurance Company,Commercial PPO,625.1,95,,percent of total billed charges,,
Intravitreal Injection Of Pharmacologic Agent,,67028,CPT,Facility,Outpatient,,,,658,559.3,188.5828,658,Humana Insurance Company,Medicare PPO,322.42,49,,percent of total billed charges,,
Intravitreal Injection Of Pharmacologic Agent,,67028,CPT,Facility,Inpatient,,,,658,559.3,188.5828,658,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Intravitreal Injection Of Pharmacologic Agent,,67028,CPT,Facility,Both,,,,658,559.3,188.5828,658,Medica,Individual & Family,652.078,99.1,,percent of total billed charges,,
Intravitreal Injection Of Pharmacologic Agent,,67028,CPT,Facility,Outpatient,,,,658,559.3,188.5828,658,Medica,Medica Advantage Solution,327.684,49.8,,percent of total billed charges,,
Intravitreal Injection Of Pharmacologic Agent,,67028,CPT,Facility,Inpatient,,,,658,559.3,188.5828,658,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Intravitreal Injection Of Pharmacologic Agent,,67028,CPT,Facility,Outpatient,,,,658,559.3,188.5828,658,Medica,Medical Assistance,299,,,Other,Grouper,All inclusive per visit
Intravitreal Injection Of Pharmacologic Agent,,67028,CPT,Facility,Inpatient,,,,658,559.3,188.5828,658,Medica,Medical Assistance,,,,,Included in per diem rate,
Intravitreal Injection Of Pharmacologic Agent,,67028,CPT,Facility,Outpatient,,,,658,559.3,188.5828,658,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,327.684,49.8,,percent of total billed charges,,
Intravitreal Injection Of Pharmacologic Agent,,67028,CPT,Facility,Inpatient,,,,658,559.3,188.5828,658,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Intravitreal Injection Of Pharmacologic Agent,,67028,CPT,Facility,Both,,,,658,559.3,188.5828,658,"Multiplan, Inc.","Multiplan, Inc.",618.52,94,,percent of total billed charges,,
Intravitreal Injection Of Pharmacologic Agent,,67028,CPT,Facility,Outpatient,,,,658,559.3,188.5828,658,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,592.858,90.1,,percent of total billed charges,,
Intravitreal Injection Of Pharmacologic Agent,,67028,CPT,Facility,Inpatient,,,,658,559.3,188.5828,658,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Intravitreal Injection Of Pharmacologic Agent,,67028,CPT,Facility,Both,,,,658,559.3,188.5828,658,"Preferred One Administrative Services, INC.",PPO,648.788,98.6,,percent of total billed charges,,
Intravitreal Injection Of Pharmacologic Agent,,67028,CPT,Facility,Outpatient,,,,658,559.3,188.5828,658,PrimeWest Health,Minnesota Senior Health Options (MSHO),338.541,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Intravitreal Injection Of Pharmacologic Agent,,67028,CPT,Facility,Inpatient,,,,658,559.3,188.5828,658,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Intravitreal Injection Of Pharmacologic Agent,,67028,CPT,Facility,Outpatient,,,,658,559.3,188.5828,658,PrimeWest Health,MinnesotaCare,337.9488,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Intravitreal Injection Of Pharmacologic Agent,,67028,CPT,Facility,Inpatient,,,,658,559.3,188.5828,658,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Intravitreal Injection Of Pharmacologic Agent,,67028,CPT,Facility,Both,,,,658,559.3,188.5828,658,Sanford Health Plan,Sanford Health Plan,605.36,92,,percent of total billed charges,,
Intravitreal Injection Of Pharmacologic Agent,,67028,CPT,Facility,Outpatient,,,,658,559.3,188.5828,658,"UCare Health, Inc.",Individual & Family Plan,370.783,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Intravitreal Injection Of Pharmacologic Agent,,67028,CPT,Facility,Inpatient,,,,658,559.3,188.5828,658,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Intravitreal Injection Of Pharmacologic Agent,,67028,CPT,Facility,Outpatient,,,,658,559.3,188.5828,658,"UCare Health, Inc.",Medical Assistance,332.0926,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Intravitreal Injection Of Pharmacologic Agent,,67028,CPT,Facility,Inpatient,,,,658,559.3,188.5828,658,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Intravitreal Injection Of Pharmacologic Agent,,67028,CPT,Facility,Outpatient,,,,658,559.3,188.5828,658,"UCare Health, Inc.",Medicare Advantage,332.0926,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Intravitreal Injection Of Pharmacologic Agent,,67028,CPT,Facility,Inpatient,,,,658,559.3,188.5828,658,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Intravitreal Injection Of Pharmacologic Agent,,67028,CPT,Facility,Outpatient,,,,658,559.3,188.5828,658,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),332.0926,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Intravitreal Injection Of Pharmacologic Agent,,67028,CPT,Facility,Inpatient,,,,658,559.3,188.5828,658,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Intravitreal Injection Of Pharmacologic Agent,,67028,CPT,Facility,Both,,,,658,559.3,188.5828,658,UnitedHealthcare,Individual & Family,618.52,94,,percent of total billed charges,,
Intravitreal Injection Of Pharmacologic Agent,,67028,CPT,Facility,Outpatient,,,,658,559.3,188.5828,658,UnitedHealthcare,Medicare Advantage,322.42,49,,percent of total billed charges,,
Intravitreal Injection Of Pharmacologic Agent,,67028,CPT,Facility,Inpatient,,,,658,559.3,188.5828,658,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Intravitreal Injection Of Pharmacologic Agent,,67028,CPT,Facility,Outpatient,,,,658,559.3,188.5828,658,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,315.84,48,,percent of total billed charges,,100% of DHS outpatient percentage
Intravitreal Injection Of Pharmacologic Agent,,67028,CPT,Facility,Inpatient,,,,658,559.3,188.5828,658,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Intravitreal Injection Of Pharmacologic Agent (Pro Cah),,67028,CPT,Professional,Both,,,,984,836.4,57.37,984,Aetna,Commercial,836.4,85,,percent of total billed charges,,
Intravitreal Injection Of Pharmacologic Agent (Pro Cah),,67028,CPT,Professional,Both,,,,984,836.4,57.37,984,Aetna,Medicare Advantage,90.84,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Intravitreal Injection Of Pharmacologic Agent (Pro Cah),,67028,CPT,Professional,Both,,,,984,836.4,57.37,984,Aetna,PPO,915.12,93,,percent of total billed charges,,
Intravitreal Injection Of Pharmacologic Agent (Pro Cah),,67028,CPT,Professional,Both,,,,984,836.4,57.37,984,America's PPO,America's PPO,840.7296,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Intravitreal Injection Of Pharmacologic Agent (Pro Cah),,67028,CPT,Professional,Both,,,,984,836.4,57.37,984,BlueCross BlueShield Minnesota, Federal Employee Program,185.23,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Intravitreal Injection Of Pharmacologic Agent (Pro Cah),,67028,CPT,Professional,Both,,,,984,836.4,57.37,984,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,188.19368,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Intravitreal Injection Of Pharmacologic Agent (Pro Cah),,67028,CPT,Professional,Both,,,,984,836.4,57.37,984,BlueCross BlueShield Minnesota,High Value Network Plan,188.19368,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Intravitreal Injection Of Pharmacologic Agent (Pro Cah),,67028,CPT,Professional,Both,,,,984,836.4,57.37,984,BlueCross BlueShield Minnesota,Medicare Advantage,102.787,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Intravitreal Injection Of Pharmacologic Agent (Pro Cah),,67028,CPT,Professional,Both,,,,984,836.4,57.37,984,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,188.19368,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Intravitreal Injection Of Pharmacologic Agent (Pro Cah),,67028,CPT,Professional,Both,,,,984,836.4,57.37,984,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,66.23304,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Intravitreal Injection Of Pharmacologic Agent (Pro Cah),,67028,CPT,Professional,Both,,,,984,836.4,57.37,984,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),102.787,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Intravitreal Injection Of Pharmacologic Agent (Pro Cah),,67028,CPT,Professional,Both,,,,984,836.4,57.37,984,CorVel,Worker's Compensation,174.1805421,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Intravitreal Injection Of Pharmacologic Agent (Pro Cah),,67028,CPT,Professional,Both,,,,984,836.4,57.37,984,First Health Group Corporation,First Health Network,954.48,97,,percent of total billed charges,,
Intravitreal Injection Of Pharmacologic Agent (Pro Cah),,67028,CPT,Professional,Both,,,,984,836.4,57.37,984,"Health Partners, Inc.",Commercial,187.91,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Intravitreal Injection Of Pharmacologic Agent (Pro Cah),,67028,CPT,Professional,Both,,,,984,836.4,57.37,984,"Health Partners, Inc.",Medicare Advantage,102.787,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Intravitreal Injection Of Pharmacologic Agent (Pro Cah),,67028,CPT,Professional,Both,,,,984,836.4,57.37,984,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),89.46,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Intravitreal Injection Of Pharmacologic Agent (Pro Cah),,67028,CPT,Professional,Both,,,,984,836.4,57.37,984,"Health Partners, Inc.",State of Minnesota Advantage Program,161.884465,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Intravitreal Injection Of Pharmacologic Agent (Pro Cah),,67028,CPT,Professional,Both,,,,984,836.4,57.37,984,"Health Partners, Inc.",State Public Programs,57.37,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Intravitreal Injection Of Pharmacologic Agent (Pro Cah),,67028,CPT,Professional,Both,,,,984,836.4,57.37,984,Humana Insurance Company,Commercial PPO,89.38,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Intravitreal Injection Of Pharmacologic Agent (Pro Cah),,67028,CPT,Professional,Both,,,,984,836.4,57.37,984,Humana Insurance Company,Medicare PPO,984,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Intravitreal Injection Of Pharmacologic Agent (Pro Cah),,67028,CPT,Professional,Both,,,,984,836.4,57.37,984,Medica,Individual & Family,834.432,84.8,,percent of total billed charges,,
Intravitreal Injection Of Pharmacologic Agent (Pro Cah),,67028,CPT,Professional,Both,,,,984,836.4,57.37,984,Medica,Medica Advantage Solution,490.032,49.8,,percent of total billed charges,,
Intravitreal Injection Of Pharmacologic Agent (Pro Cah),,67028,CPT,Professional,Both,,,,984,836.4,57.37,984,Medica,Medical Assistance,66.23,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Intravitreal Injection Of Pharmacologic Agent (Pro Cah),,67028,CPT,Professional,Both,,,,984,836.4,57.37,984,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,89.38,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Intravitreal Injection Of Pharmacologic Agent (Pro Cah),,67028,CPT,Professional,Both,,,,984,836.4,57.37,984,"Multiplan, Inc.","Multiplan, Inc.",924.96,94,,percent of total billed charges,,
Intravitreal Injection Of Pharmacologic Agent (Pro Cah),,67028,CPT,Professional,Both,,,,984,836.4,57.37,984,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,886.584,90.1,,percent of total billed charges,,
Intravitreal Injection Of Pharmacologic Agent (Pro Cah),,67028,CPT,Professional,Both,,,,984,836.4,57.37,984,"Preferred One Administrative Services, INC.",PPO,970.224,98.6,,percent of total billed charges,,
Intravitreal Injection Of Pharmacologic Agent (Pro Cah),,67028,CPT,Professional,Both,,,,984,836.4,57.37,984,PrimeWest Health,Minnesota Senior Health Options (MSHO),102.787,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Intravitreal Injection Of Pharmacologic Agent (Pro Cah),,67028,CPT,Professional,Both,,,,984,836.4,57.37,984,PrimeWest Health,MinnesotaCare,70.8693528,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Intravitreal Injection Of Pharmacologic Agent (Pro Cah),,67028,CPT,Professional,Both,,,,984,836.4,57.37,984,Sanford Health Plan,Sanford Health Plan,865.92,88,,percent of total billed charges,,
Intravitreal Injection Of Pharmacologic Agent (Pro Cah),,67028,CPT,Professional,Both,,,,984,836.4,57.37,984,"UCare Health, Inc.",Individual & Family Plan,145.296128,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Intravitreal Injection Of Pharmacologic Agent (Pro Cah),,67028,CPT,Professional,Both,,,,984,836.4,57.37,984,"UCare Health, Inc.",Medical Assistance,72.856344,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Intravitreal Injection Of Pharmacologic Agent (Pro Cah),,67028,CPT,Professional,Both,,,,984,836.4,57.37,984,"UCare Health, Inc.",Medicare Advantage,102.787,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Intravitreal Injection Of Pharmacologic Agent (Pro Cah),,67028,CPT,Professional,Both,,,,984,836.4,57.37,984,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),82.2296,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Intravitreal Injection Of Pharmacologic Agent (Pro Cah),,67028,CPT,Professional,Both,,,,984,836.4,57.37,984,UnitedHealthcare,Individual & Family,984,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Intravitreal Injection Of Pharmacologic Agent (Pro Cah),,67028,CPT,Professional,Both,,,,984,836.4,57.37,984,UnitedHealthcare,Medicare Advantage,102.787,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Intravitreal Injection Of Pharmacologic Agent (Pro Cah),,67028,CPT,Professional,Both,,,,984,836.4,57.37,984,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,66.23304,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Remove Eyelid Lesion,,67800,CPT,Facility,Both,,,,245,208.25,70.217,299,Aetna,Commercial,225.4,92,,percent of total billed charges,,
Remove Eyelid Lesion,,67800,CPT,Facility,Outpatient,,,,245,208.25,70.217,299,Aetna,Medicare Advantage,120.05,49,,percent of total billed charges,,
Remove Eyelid Lesion,,67800,CPT,Facility,Inpatient,,,,245,208.25,70.217,299,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Remove Eyelid Lesion,,67800,CPT,Facility,Both,,,,245,208.25,70.217,299,Aetna,PPO,227.85,93,,percent of total billed charges,,
Remove Eyelid Lesion,,67800,CPT,Facility,Both,,,,245,208.25,70.217,299,America's PPO,America's PPO,235.2735,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Remove Eyelid Lesion,,67800,CPT,Facility,Both,,,,245,208.25,70.217,299,BlueCross BlueShield Minnesota, Federal Employee Program,241.08,98.4,,percent of total billed charges,,
Remove Eyelid Lesion,,67800,CPT,Facility,Both,,,,245,208.25,70.217,299,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,245,100,,percent of total billed charges,,
Remove Eyelid Lesion,,67800,CPT,Facility,Both,,,,245,208.25,70.217,299,BlueCross BlueShield Minnesota,High Value Network Plan,220.5,90,,percent of total billed charges,,
Remove Eyelid Lesion,,67800,CPT,Facility,Outpatient,,,,245,208.25,70.217,299,BlueCross BlueShield Minnesota,Medicare Advantage,120.05,49,,percent of total billed charges,,
Remove Eyelid Lesion,,67800,CPT,Facility,Inpatient,,,,245,208.25,70.217,299,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Remove Eyelid Lesion,,67800,CPT,Facility,Both,,,,245,208.25,70.217,299,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,216.9965,88.57,,percent of total billed charges,,
Remove Eyelid Lesion,,67800,CPT,Facility,Both,,,,245,208.25,70.217,299,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,70.217,28.66,,percent of total billed charges,,
Remove Eyelid Lesion,,67800,CPT,Facility,Outpatient,,,,245,208.25,70.217,299,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),120.05,49,,percent of total billed charges,,
Remove Eyelid Lesion,,67800,CPT,Facility,Inpatient,,,,245,208.25,70.217,299,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Remove Eyelid Lesion,,67800,CPT,Facility,Both,,,,245,208.25,70.217,299,CorVel,Worker's Compensation,245,100,,percent of total billed charges,,
Remove Eyelid Lesion,,67800,CPT,Facility,Both,,,,245,208.25,70.217,299,First Health Group Corporation,First Health Network,237.65,97,,percent of total billed charges,,
Remove Eyelid Lesion,,67800,CPT,Facility,Both,,,,245,208.25,70.217,299,"Health Partners, Inc.",Commercial,231.77,94.6,,percent of total billed charges,,
Remove Eyelid Lesion,,67800,CPT,Facility,Outpatient,,,,245,208.25,70.217,299,"Health Partners, Inc.",Medicare Advantage,120.05,49,,percent of total billed charges,,
Remove Eyelid Lesion,,67800,CPT,Facility,Inpatient,,,,245,208.25,70.217,299,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Remove Eyelid Lesion,,67800,CPT,Facility,Both,,,,245,208.25,70.217,299,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),147,60,,percent of total billed charges,,
Remove Eyelid Lesion,,67800,CPT,Facility,Both,,,,245,208.25,70.217,299,"Health Partners, Inc.",State of Minnesota Advantage Program,199.675,81.5,,percent of total billed charges,,
Remove Eyelid Lesion,,67800,CPT,Facility,Both,,,,245,208.25,70.217,299,"Health Partners, Inc.",State Public Programs,122.5,50,,percent of total billed charges,,
Remove Eyelid Lesion,,67800,CPT,Facility,Both,,,,245,208.25,70.217,299,Humana Insurance Company,Commercial PPO,232.75,95,,percent of total billed charges,,
Remove Eyelid Lesion,,67800,CPT,Facility,Outpatient,,,,245,208.25,70.217,299,Humana Insurance Company,Medicare PPO,120.05,49,,percent of total billed charges,,
Remove Eyelid Lesion,,67800,CPT,Facility,Inpatient,,,,245,208.25,70.217,299,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Remove Eyelid Lesion,,67800,CPT,Facility,Both,,,,245,208.25,70.217,299,Medica,Individual & Family,242.795,99.1,,percent of total billed charges,,
Remove Eyelid Lesion,,67800,CPT,Facility,Outpatient,,,,245,208.25,70.217,299,Medica,Medica Advantage Solution,122.01,49.8,,percent of total billed charges,,
Remove Eyelid Lesion,,67800,CPT,Facility,Inpatient,,,,245,208.25,70.217,299,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Remove Eyelid Lesion,,67800,CPT,Facility,Outpatient,,,,245,208.25,70.217,299,Medica,Medical Assistance,299,,,Other,Grouper,All inclusive per visit
Remove Eyelid Lesion,,67800,CPT,Facility,Inpatient,,,,245,208.25,70.217,299,Medica,Medical Assistance,,,,,Included in per diem rate,
Remove Eyelid Lesion,,67800,CPT,Facility,Outpatient,,,,245,208.25,70.217,299,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,122.01,49.8,,percent of total billed charges,,
Remove Eyelid Lesion,,67800,CPT,Facility,Inpatient,,,,245,208.25,70.217,299,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Remove Eyelid Lesion,,67800,CPT,Facility,Both,,,,245,208.25,70.217,299,"Multiplan, Inc.","Multiplan, Inc.",230.3,94,,percent of total billed charges,,
Remove Eyelid Lesion,,67800,CPT,Facility,Outpatient,,,,245,208.25,70.217,299,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,220.745,90.1,,percent of total billed charges,,
Remove Eyelid Lesion,,67800,CPT,Facility,Inpatient,,,,245,208.25,70.217,299,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Remove Eyelid Lesion,,67800,CPT,Facility,Both,,,,245,208.25,70.217,299,"Preferred One Administrative Services, INC.",PPO,241.57,98.6,,percent of total billed charges,,
Remove Eyelid Lesion,,67800,CPT,Facility,Outpatient,,,,245,208.25,70.217,299,PrimeWest Health,Minnesota Senior Health Options (MSHO),126.0525,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Remove Eyelid Lesion,,67800,CPT,Facility,Inpatient,,,,245,208.25,70.217,299,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Remove Eyelid Lesion,,67800,CPT,Facility,Outpatient,,,,245,208.25,70.217,299,PrimeWest Health,MinnesotaCare,125.832,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Remove Eyelid Lesion,,67800,CPT,Facility,Inpatient,,,,245,208.25,70.217,299,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Remove Eyelid Lesion,,67800,CPT,Facility,Both,,,,245,208.25,70.217,299,Sanford Health Plan,Sanford Health Plan,225.4,92,,percent of total billed charges,,
Remove Eyelid Lesion,,67800,CPT,Facility,Outpatient,,,,245,208.25,70.217,299,"UCare Health, Inc.",Individual & Family Plan,138.0575,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Remove Eyelid Lesion,,67800,CPT,Facility,Inpatient,,,,245,208.25,70.217,299,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Remove Eyelid Lesion,,67800,CPT,Facility,Outpatient,,,,245,208.25,70.217,299,"UCare Health, Inc.",Medical Assistance,123.6515,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Remove Eyelid Lesion,,67800,CPT,Facility,Inpatient,,,,245,208.25,70.217,299,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Remove Eyelid Lesion,,67800,CPT,Facility,Outpatient,,,,245,208.25,70.217,299,"UCare Health, Inc.",Medicare Advantage,123.6515,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Remove Eyelid Lesion,,67800,CPT,Facility,Inpatient,,,,245,208.25,70.217,299,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Remove Eyelid Lesion,,67800,CPT,Facility,Outpatient,,,,245,208.25,70.217,299,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),123.6515,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Remove Eyelid Lesion,,67800,CPT,Facility,Inpatient,,,,245,208.25,70.217,299,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Remove Eyelid Lesion,,67800,CPT,Facility,Both,,,,245,208.25,70.217,299,UnitedHealthcare,Individual & Family,230.3,94,,percent of total billed charges,,
Remove Eyelid Lesion,,67800,CPT,Facility,Outpatient,,,,245,208.25,70.217,299,UnitedHealthcare,Medicare Advantage,120.05,49,,percent of total billed charges,,
Remove Eyelid Lesion,,67800,CPT,Facility,Inpatient,,,,245,208.25,70.217,299,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Remove Eyelid Lesion,,67800,CPT,Facility,Outpatient,,,,245,208.25,70.217,299,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,117.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
Remove Eyelid Lesion,,67800,CPT,Facility,Inpatient,,,,245,208.25,70.217,299,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Remove Eyelid Lesion (Pro Cah),,67800,CPT,Professional,Both,,,,362,307.7,64.57,362,Aetna,Commercial,307.7,85,,percent of total billed charges,,
Remove Eyelid Lesion (Pro Cah),,67800,CPT,Professional,Both,,,,362,307.7,64.57,362,Aetna,Medicare Advantage,101.81,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Remove Eyelid Lesion (Pro Cah),,67800,CPT,Professional,Both,,,,362,307.7,64.57,362,Aetna,PPO,336.66,93,,percent of total billed charges,,
Remove Eyelid Lesion (Pro Cah),,67800,CPT,Professional,Both,,,,362,307.7,64.57,362,America's PPO,America's PPO,309.2928,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Remove Eyelid Lesion (Pro Cah),,67800,CPT,Professional,Both,,,,362,307.7,64.57,362,BlueCross BlueShield Minnesota, Federal Employee Program,207.27,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Remove Eyelid Lesion (Pro Cah),,67800,CPT,Professional,Both,,,,362,307.7,64.57,362,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,210.58632,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Remove Eyelid Lesion (Pro Cah),,67800,CPT,Professional,Both,,,,362,307.7,64.57,362,BlueCross BlueShield Minnesota,High Value Network Plan,210.58632,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Remove Eyelid Lesion (Pro Cah),,67800,CPT,Professional,Both,,,,362,307.7,64.57,362,BlueCross BlueShield Minnesota,Medicare Advantage,115.5175,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Remove Eyelid Lesion (Pro Cah),,67800,CPT,Professional,Both,,,,362,307.7,64.57,362,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,210.58632,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Remove Eyelid Lesion (Pro Cah),,67800,CPT,Professional,Both,,,,362,307.7,64.57,362,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,74.54392,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Remove Eyelid Lesion (Pro Cah),,67800,CPT,Professional,Both,,,,362,307.7,64.57,362,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),115.5175,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Remove Eyelid Lesion (Pro Cah),,67800,CPT,Professional,Both,,,,362,307.7,64.57,362,CorVel,Worker's Compensation,195.3001335,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Remove Eyelid Lesion (Pro Cah),,67800,CPT,Professional,Both,,,,362,307.7,64.57,362,First Health Group Corporation,First Health Network,351.14,97,,percent of total billed charges,,
Remove Eyelid Lesion (Pro Cah),,67800,CPT,Professional,Both,,,,362,307.7,64.57,362,"Health Partners, Inc.",Commercial,211.12,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Remove Eyelid Lesion (Pro Cah),,67800,CPT,Professional,Both,,,,362,307.7,64.57,362,"Health Partners, Inc.",Medicare Advantage,115.5175,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Remove Eyelid Lesion (Pro Cah),,67800,CPT,Professional,Both,,,,362,307.7,64.57,362,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),100.64,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Remove Eyelid Lesion (Pro Cah),,67800,CPT,Professional,Both,,,,362,307.7,64.57,362,"Health Partners, Inc.",State of Minnesota Advantage Program,181.87988,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Remove Eyelid Lesion (Pro Cah),,67800,CPT,Professional,Both,,,,362,307.7,64.57,362,"Health Partners, Inc.",State Public Programs,64.57,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Remove Eyelid Lesion (Pro Cah),,67800,CPT,Professional,Both,,,,362,307.7,64.57,362,Humana Insurance Company,Commercial PPO,100.45,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Remove Eyelid Lesion (Pro Cah),,67800,CPT,Professional,Both,,,,362,307.7,64.57,362,Humana Insurance Company,Medicare PPO,362,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Remove Eyelid Lesion (Pro Cah),,67800,CPT,Professional,Both,,,,362,307.7,64.57,362,Medica,Individual & Family,306.976,84.8,,percent of total billed charges,,
Remove Eyelid Lesion (Pro Cah),,67800,CPT,Professional,Both,,,,362,307.7,64.57,362,Medica,Medica Advantage Solution,180.276,49.8,,percent of total billed charges,,
Remove Eyelid Lesion (Pro Cah),,67800,CPT,Professional,Both,,,,362,307.7,64.57,362,Medica,Medical Assistance,74.54,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Remove Eyelid Lesion (Pro Cah),,67800,CPT,Professional,Both,,,,362,307.7,64.57,362,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,100.45,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Remove Eyelid Lesion (Pro Cah),,67800,CPT,Professional,Both,,,,362,307.7,64.57,362,"Multiplan, Inc.","Multiplan, Inc.",340.28,94,,percent of total billed charges,,
Remove Eyelid Lesion (Pro Cah),,67800,CPT,Professional,Both,,,,362,307.7,64.57,362,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,326.162,90.1,,percent of total billed charges,,
Remove Eyelid Lesion (Pro Cah),,67800,CPT,Professional,Both,,,,362,307.7,64.57,362,"Preferred One Administrative Services, INC.",PPO,356.932,98.6,,percent of total billed charges,,
Remove Eyelid Lesion (Pro Cah),,67800,CPT,Professional,Both,,,,362,307.7,64.57,362,PrimeWest Health,Minnesota Senior Health Options (MSHO),115.5175,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Remove Eyelid Lesion (Pro Cah),,67800,CPT,Professional,Both,,,,362,307.7,64.57,362,PrimeWest Health,MinnesotaCare,79.7619944,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Remove Eyelid Lesion (Pro Cah),,67800,CPT,Professional,Both,,,,362,307.7,64.57,362,Sanford Health Plan,Sanford Health Plan,318.56,88,,percent of total billed charges,,
Remove Eyelid Lesion (Pro Cah),,67800,CPT,Professional,Both,,,,362,307.7,64.57,362,"UCare Health, Inc.",Individual & Family Plan,163.29152,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Remove Eyelid Lesion (Pro Cah),,67800,CPT,Professional,Both,,,,362,307.7,64.57,362,"UCare Health, Inc.",Medical Assistance,81.998312,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Remove Eyelid Lesion (Pro Cah),,67800,CPT,Professional,Both,,,,362,307.7,64.57,362,"UCare Health, Inc.",Medicare Advantage,115.5175,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Remove Eyelid Lesion (Pro Cah),,67800,CPT,Professional,Both,,,,362,307.7,64.57,362,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),92.414,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Remove Eyelid Lesion (Pro Cah),,67800,CPT,Professional,Both,,,,362,307.7,64.57,362,UnitedHealthcare,Individual & Family,362,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Remove Eyelid Lesion (Pro Cah),,67800,CPT,Professional,Both,,,,362,307.7,64.57,362,UnitedHealthcare,Medicare Advantage,115.5175,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Remove Eyelid Lesion (Pro Cah),,67800,CPT,Professional,Both,,,,362,307.7,64.57,362,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,74.54392,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Excision Of Lesion Of Eyelid,,67840,CPT,Facility,Both,,,,459,390.15,131.5494,724,Aetna,Commercial,422.28,92,,percent of total billed charges,,
Excision Of Lesion Of Eyelid,,67840,CPT,Facility,Outpatient,,,,459,390.15,131.5494,724,Aetna,Medicare Advantage,224.91,49,,percent of total billed charges,,
Excision Of Lesion Of Eyelid,,67840,CPT,Facility,Inpatient,,,,459,390.15,131.5494,724,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Excision Of Lesion Of Eyelid,,67840,CPT,Facility,Both,,,,459,390.15,131.5494,724,Aetna,PPO,426.87,93,,percent of total billed charges,,
Excision Of Lesion Of Eyelid,,67840,CPT,Facility,Both,,,,459,390.15,131.5494,724,America's PPO,America's PPO,440.7777,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Excision Of Lesion Of Eyelid,,67840,CPT,Facility,Both,,,,459,390.15,131.5494,724,BlueCross BlueShield Minnesota, Federal Employee Program,451.656,98.4,,percent of total billed charges,,
Excision Of Lesion Of Eyelid,,67840,CPT,Facility,Both,,,,459,390.15,131.5494,724,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,459,100,,percent of total billed charges,,
Excision Of Lesion Of Eyelid,,67840,CPT,Facility,Both,,,,459,390.15,131.5494,724,BlueCross BlueShield Minnesota,High Value Network Plan,413.1,90,,percent of total billed charges,,
Excision Of Lesion Of Eyelid,,67840,CPT,Facility,Outpatient,,,,459,390.15,131.5494,724,BlueCross BlueShield Minnesota,Medicare Advantage,224.91,49,,percent of total billed charges,,
Excision Of Lesion Of Eyelid,,67840,CPT,Facility,Inpatient,,,,459,390.15,131.5494,724,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Excision Of Lesion Of Eyelid,,67840,CPT,Facility,Both,,,,459,390.15,131.5494,724,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,406.5363,88.57,,percent of total billed charges,,
Excision Of Lesion Of Eyelid,,67840,CPT,Facility,Both,,,,459,390.15,131.5494,724,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,131.5494,28.66,,percent of total billed charges,,
Excision Of Lesion Of Eyelid,,67840,CPT,Facility,Outpatient,,,,459,390.15,131.5494,724,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),224.91,49,,percent of total billed charges,,
Excision Of Lesion Of Eyelid,,67840,CPT,Facility,Inpatient,,,,459,390.15,131.5494,724,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Excision Of Lesion Of Eyelid,,67840,CPT,Facility,Both,,,,459,390.15,131.5494,724,CorVel,Worker's Compensation,459,100,,percent of total billed charges,,
Excision Of Lesion Of Eyelid,,67840,CPT,Facility,Both,,,,459,390.15,131.5494,724,First Health Group Corporation,First Health Network,445.23,97,,percent of total billed charges,,
Excision Of Lesion Of Eyelid,,67840,CPT,Facility,Both,,,,459,390.15,131.5494,724,"Health Partners, Inc.",Commercial,434.214,94.6,,percent of total billed charges,,
Excision Of Lesion Of Eyelid,,67840,CPT,Facility,Outpatient,,,,459,390.15,131.5494,724,"Health Partners, Inc.",Medicare Advantage,224.91,49,,percent of total billed charges,,
Excision Of Lesion Of Eyelid,,67840,CPT,Facility,Inpatient,,,,459,390.15,131.5494,724,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Excision Of Lesion Of Eyelid,,67840,CPT,Facility,Both,,,,459,390.15,131.5494,724,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),275.4,60,,percent of total billed charges,,
Excision Of Lesion Of Eyelid,,67840,CPT,Facility,Both,,,,459,390.15,131.5494,724,"Health Partners, Inc.",State of Minnesota Advantage Program,374.085,81.5,,percent of total billed charges,,
Excision Of Lesion Of Eyelid,,67840,CPT,Facility,Both,,,,459,390.15,131.5494,724,"Health Partners, Inc.",State Public Programs,229.5,50,,percent of total billed charges,,
Excision Of Lesion Of Eyelid,,67840,CPT,Facility,Both,,,,459,390.15,131.5494,724,Humana Insurance Company,Commercial PPO,436.05,95,,percent of total billed charges,,
Excision Of Lesion Of Eyelid,,67840,CPT,Facility,Outpatient,,,,459,390.15,131.5494,724,Humana Insurance Company,Medicare PPO,224.91,49,,percent of total billed charges,,
Excision Of Lesion Of Eyelid,,67840,CPT,Facility,Inpatient,,,,459,390.15,131.5494,724,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Excision Of Lesion Of Eyelid,,67840,CPT,Facility,Both,,,,459,390.15,131.5494,724,Medica,Individual & Family,454.869,99.1,,percent of total billed charges,,
Excision Of Lesion Of Eyelid,,67840,CPT,Facility,Outpatient,,,,459,390.15,131.5494,724,Medica,Medica Advantage Solution,228.582,49.8,,percent of total billed charges,,
Excision Of Lesion Of Eyelid,,67840,CPT,Facility,Inpatient,,,,459,390.15,131.5494,724,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Excision Of Lesion Of Eyelid,,67840,CPT,Facility,Outpatient,,,,459,390.15,131.5494,724,Medica,Medical Assistance,724,,,Other,Grouper,All inclusive per visit
Excision Of Lesion Of Eyelid,,67840,CPT,Facility,Inpatient,,,,459,390.15,131.5494,724,Medica,Medical Assistance,,,,,Included in per diem rate,
Excision Of Lesion Of Eyelid,,67840,CPT,Facility,Outpatient,,,,459,390.15,131.5494,724,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,228.582,49.8,,percent of total billed charges,,
Excision Of Lesion Of Eyelid,,67840,CPT,Facility,Inpatient,,,,459,390.15,131.5494,724,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Excision Of Lesion Of Eyelid,,67840,CPT,Facility,Both,,,,459,390.15,131.5494,724,"Multiplan, Inc.","Multiplan, Inc.",431.46,94,,percent of total billed charges,,
Excision Of Lesion Of Eyelid,,67840,CPT,Facility,Outpatient,,,,459,390.15,131.5494,724,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,413.559,90.1,,percent of total billed charges,,
Excision Of Lesion Of Eyelid,,67840,CPT,Facility,Inpatient,,,,459,390.15,131.5494,724,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Excision Of Lesion Of Eyelid,,67840,CPT,Facility,Both,,,,459,390.15,131.5494,724,"Preferred One Administrative Services, INC.",PPO,452.574,98.6,,percent of total billed charges,,
Excision Of Lesion Of Eyelid,,67840,CPT,Facility,Outpatient,,,,459,390.15,131.5494,724,PrimeWest Health,Minnesota Senior Health Options (MSHO),236.1555,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Excision Of Lesion Of Eyelid,,67840,CPT,Facility,Inpatient,,,,459,390.15,131.5494,724,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Excision Of Lesion Of Eyelid,,67840,CPT,Facility,Outpatient,,,,459,390.15,131.5494,724,PrimeWest Health,MinnesotaCare,235.7424,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Excision Of Lesion Of Eyelid,,67840,CPT,Facility,Inpatient,,,,459,390.15,131.5494,724,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Excision Of Lesion Of Eyelid,,67840,CPT,Facility,Both,,,,459,390.15,131.5494,724,Sanford Health Plan,Sanford Health Plan,422.28,92,,percent of total billed charges,,
Excision Of Lesion Of Eyelid,,67840,CPT,Facility,Outpatient,,,,459,390.15,131.5494,724,"UCare Health, Inc.",Individual & Family Plan,258.6465,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Excision Of Lesion Of Eyelid,,67840,CPT,Facility,Inpatient,,,,459,390.15,131.5494,724,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Excision Of Lesion Of Eyelid,,67840,CPT,Facility,Outpatient,,,,459,390.15,131.5494,724,"UCare Health, Inc.",Medical Assistance,231.6573,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Excision Of Lesion Of Eyelid,,67840,CPT,Facility,Inpatient,,,,459,390.15,131.5494,724,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Excision Of Lesion Of Eyelid,,67840,CPT,Facility,Outpatient,,,,459,390.15,131.5494,724,"UCare Health, Inc.",Medicare Advantage,231.6573,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Excision Of Lesion Of Eyelid,,67840,CPT,Facility,Inpatient,,,,459,390.15,131.5494,724,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Excision Of Lesion Of Eyelid,,67840,CPT,Facility,Outpatient,,,,459,390.15,131.5494,724,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),231.6573,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Excision Of Lesion Of Eyelid,,67840,CPT,Facility,Inpatient,,,,459,390.15,131.5494,724,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Excision Of Lesion Of Eyelid,,67840,CPT,Facility,Both,,,,459,390.15,131.5494,724,UnitedHealthcare,Individual & Family,431.46,94,,percent of total billed charges,,
Excision Of Lesion Of Eyelid,,67840,CPT,Facility,Outpatient,,,,459,390.15,131.5494,724,UnitedHealthcare,Medicare Advantage,224.91,49,,percent of total billed charges,,
Excision Of Lesion Of Eyelid,,67840,CPT,Facility,Inpatient,,,,459,390.15,131.5494,724,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Excision Of Lesion Of Eyelid,,67840,CPT,Facility,Outpatient,,,,459,390.15,131.5494,724,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,220.32,48,,percent of total billed charges,,100% of DHS outpatient percentage
Excision Of Lesion Of Eyelid,,67840,CPT,Facility,Inpatient,,,,459,390.15,131.5494,724,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Excision Of Lesion Of Eyelid (Pro Cah),,67840,CPT,Professional,Both,,,,689,585.65,99.48,689,Aetna,Commercial,585.65,85,,percent of total billed charges,,
Excision Of Lesion Of Eyelid (Pro Cah),,67840,CPT,Professional,Both,,,,689,585.65,99.48,689,Aetna,Medicare Advantage,155.49,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Excision Of Lesion Of Eyelid (Pro Cah),,67840,CPT,Professional,Both,,,,689,585.65,99.48,689,Aetna,PPO,640.77,93,,percent of total billed charges,,
Excision Of Lesion Of Eyelid (Pro Cah),,67840,CPT,Professional,Both,,,,689,585.65,99.48,689,America's PPO,America's PPO,588.6816,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Excision Of Lesion Of Eyelid (Pro Cah),,67840,CPT,Professional,Both,,,,689,585.65,99.48,689,BlueCross BlueShield Minnesota, Federal Employee Program,319.51,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Excision Of Lesion Of Eyelid (Pro Cah),,67840,CPT,Professional,Both,,,,689,585.65,99.48,689,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,324.62216,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Excision Of Lesion Of Eyelid (Pro Cah),,67840,CPT,Professional,Both,,,,689,585.65,99.48,689,BlueCross BlueShield Minnesota,High Value Network Plan,324.62216,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Excision Of Lesion Of Eyelid (Pro Cah),,67840,CPT,Professional,Both,,,,689,585.65,99.48,689,BlueCross BlueShield Minnesota,Medicare Advantage,177.8475,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Excision Of Lesion Of Eyelid (Pro Cah),,67840,CPT,Professional,Both,,,,689,585.65,99.48,689,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,324.62216,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Excision Of Lesion Of Eyelid (Pro Cah),,67840,CPT,Professional,Both,,,,689,585.65,99.48,689,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,114.84864,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Excision Of Lesion Of Eyelid (Pro Cah),,67840,CPT,Professional,Both,,,,689,585.65,99.48,689,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),177.8475,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Excision Of Lesion Of Eyelid (Pro Cah),,67840,CPT,Professional,Both,,,,689,585.65,99.48,689,CorVel,Worker's Compensation,300.4722327,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Excision Of Lesion Of Eyelid (Pro Cah),,67840,CPT,Professional,Both,,,,689,585.65,99.48,689,First Health Group Corporation,First Health Network,668.33,97,,percent of total billed charges,,
Excision Of Lesion Of Eyelid (Pro Cah),,67840,CPT,Professional,Both,,,,689,585.65,99.48,689,"Health Partners, Inc.",Commercial,324.31,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Excision Of Lesion Of Eyelid (Pro Cah),,67840,CPT,Professional,Both,,,,689,585.65,99.48,689,"Health Partners, Inc.",Medicare Advantage,177.8475,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Excision Of Lesion Of Eyelid (Pro Cah),,67840,CPT,Professional,Both,,,,689,585.65,99.48,689,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),154.86,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Excision Of Lesion Of Eyelid (Pro Cah),,67840,CPT,Professional,Both,,,,689,585.65,99.48,689,"Health Partners, Inc.",State of Minnesota Advantage Program,279.393065,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Excision Of Lesion Of Eyelid (Pro Cah),,67840,CPT,Professional,Both,,,,689,585.65,99.48,689,"Health Partners, Inc.",State Public Programs,99.48,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Excision Of Lesion Of Eyelid (Pro Cah),,67840,CPT,Professional,Both,,,,689,585.65,99.48,689,Humana Insurance Company,Commercial PPO,154.65,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Excision Of Lesion Of Eyelid (Pro Cah),,67840,CPT,Professional,Both,,,,689,585.65,99.48,689,Humana Insurance Company,Medicare PPO,689,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Excision Of Lesion Of Eyelid (Pro Cah),,67840,CPT,Professional,Both,,,,689,585.65,99.48,689,Medica,Individual & Family,584.272,84.8,,percent of total billed charges,,
Excision Of Lesion Of Eyelid (Pro Cah),,67840,CPT,Professional,Both,,,,689,585.65,99.48,689,Medica,Medica Advantage Solution,343.122,49.8,,percent of total billed charges,,
Excision Of Lesion Of Eyelid (Pro Cah),,67840,CPT,Professional,Both,,,,689,585.65,99.48,689,Medica,Medical Assistance,114.85,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Excision Of Lesion Of Eyelid (Pro Cah),,67840,CPT,Professional,Both,,,,689,585.65,99.48,689,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,154.65,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Excision Of Lesion Of Eyelid (Pro Cah),,67840,CPT,Professional,Both,,,,689,585.65,99.48,689,"Multiplan, Inc.","Multiplan, Inc.",647.66,94,,percent of total billed charges,,
Excision Of Lesion Of Eyelid (Pro Cah),,67840,CPT,Professional,Both,,,,689,585.65,99.48,689,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,620.789,90.1,,percent of total billed charges,,
Excision Of Lesion Of Eyelid (Pro Cah),,67840,CPT,Professional,Both,,,,689,585.65,99.48,689,"Preferred One Administrative Services, INC.",PPO,679.354,98.6,,percent of total billed charges,,
Excision Of Lesion Of Eyelid (Pro Cah),,67840,CPT,Professional,Both,,,,689,585.65,99.48,689,PrimeWest Health,Minnesota Senior Health Options (MSHO),177.8475,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Excision Of Lesion Of Eyelid (Pro Cah),,67840,CPT,Professional,Both,,,,689,585.65,99.48,689,PrimeWest Health,MinnesotaCare,122.8880448,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Excision Of Lesion Of Eyelid (Pro Cah),,67840,CPT,Professional,Both,,,,689,585.65,99.48,689,Sanford Health Plan,Sanford Health Plan,606.32,88,,percent of total billed charges,,
Excision Of Lesion Of Eyelid (Pro Cah),,67840,CPT,Professional,Both,,,,689,585.65,99.48,689,"UCare Health, Inc.",Individual & Family Plan,251.39904,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Excision Of Lesion Of Eyelid (Pro Cah),,67840,CPT,Professional,Both,,,,689,585.65,99.48,689,"UCare Health, Inc.",Medical Assistance,126.333504,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Excision Of Lesion Of Eyelid (Pro Cah),,67840,CPT,Professional,Both,,,,689,585.65,99.48,689,"UCare Health, Inc.",Medicare Advantage,177.8475,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Excision Of Lesion Of Eyelid (Pro Cah),,67840,CPT,Professional,Both,,,,689,585.65,99.48,689,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),142.278,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Excision Of Lesion Of Eyelid (Pro Cah),,67840,CPT,Professional,Both,,,,689,585.65,99.48,689,UnitedHealthcare,Individual & Family,689,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Excision Of Lesion Of Eyelid (Pro Cah),,67840,CPT,Professional,Both,,,,689,585.65,99.48,689,UnitedHealthcare,Medicare Advantage,177.8475,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Excision Of Lesion Of Eyelid (Pro Cah),,67840,CPT,Professional,Both,,,,689,585.65,99.48,689,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,114.84864,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Repair Of Ectropion; Suture (Pro Cah),,67914,CPT,Professional,Both,,,,1479,1257.15,208.55,1479,Aetna,Commercial,1257.15,85,,percent of total billed charges,,
Repair Of Ectropion; Suture (Pro Cah),,67914,CPT,Professional,Both,,,,1479,1257.15,208.55,1479,Aetna,Medicare Advantage,325.42,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Repair Of Ectropion; Suture (Pro Cah),,67914,CPT,Professional,Both,,,,1479,1257.15,208.55,1479,Aetna,PPO,1375.47,93,,percent of total billed charges,,
Repair Of Ectropion; Suture (Pro Cah),,67914,CPT,Professional,Both,,,,1479,1257.15,208.55,1479,America's PPO,America's PPO,1263.6576,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Repair Of Ectropion; Suture (Pro Cah),,67914,CPT,Professional,Both,,,,1479,1257.15,208.55,1479,BlueCross BlueShield Minnesota, Federal Employee Program,665.88,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Repair Of Ectropion; Suture (Pro Cah),,67914,CPT,Professional,Both,,,,1479,1257.15,208.55,1479,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,676.53408,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Repair Of Ectropion; Suture (Pro Cah),,67914,CPT,Professional,Both,,,,1479,1257.15,208.55,1479,BlueCross BlueShield Minnesota,High Value Network Plan,676.53408,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Repair Of Ectropion; Suture (Pro Cah),,67914,CPT,Professional,Both,,,,1479,1257.15,208.55,1479,BlueCross BlueShield Minnesota,Medicare Advantage,372.853,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Repair Of Ectropion; Suture (Pro Cah),,67914,CPT,Professional,Both,,,,1479,1257.15,208.55,1479,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,676.53408,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Repair Of Ectropion; Suture (Pro Cah),,67914,CPT,Professional,Both,,,,1479,1257.15,208.55,1479,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,240.78184,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Repair Of Ectropion; Suture (Pro Cah),,67914,CPT,Professional,Both,,,,1479,1257.15,208.55,1479,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),372.853,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Repair Of Ectropion; Suture (Pro Cah),,67914,CPT,Professional,Both,,,,1479,1257.15,208.55,1479,CorVel,Worker's Compensation,628.2692214,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Repair Of Ectropion; Suture (Pro Cah),,67914,CPT,Professional,Both,,,,1479,1257.15,208.55,1479,First Health Group Corporation,First Health Network,1434.63,97,,percent of total billed charges,,
Repair Of Ectropion; Suture (Pro Cah),,67914,CPT,Professional,Both,,,,1479,1257.15,208.55,1479,"Health Partners, Inc.",Commercial,678.36,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Repair Of Ectropion; Suture (Pro Cah),,67914,CPT,Professional,Both,,,,1479,1257.15,208.55,1479,"Health Partners, Inc.",Medicare Advantage,372.853,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Repair Of Ectropion; Suture (Pro Cah),,67914,CPT,Professional,Both,,,,1479,1257.15,208.55,1479,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),324.3,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Repair Of Ectropion; Suture (Pro Cah),,67914,CPT,Professional,Both,,,,1479,1257.15,208.55,1479,"Health Partners, Inc.",State of Minnesota Advantage Program,584.40714,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Repair Of Ectropion; Suture (Pro Cah),,67914,CPT,Professional,Both,,,,1479,1257.15,208.55,1479,"Health Partners, Inc.",State Public Programs,208.55,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Repair Of Ectropion; Suture (Pro Cah),,67914,CPT,Professional,Both,,,,1479,1257.15,208.55,1479,Humana Insurance Company,Commercial PPO,324.22,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Repair Of Ectropion; Suture (Pro Cah),,67914,CPT,Professional,Both,,,,1479,1257.15,208.55,1479,Humana Insurance Company,Medicare PPO,1479,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Repair Of Ectropion; Suture (Pro Cah),,67914,CPT,Professional,Both,,,,1479,1257.15,208.55,1479,Medica,Individual & Family,1254.192,84.8,,percent of total billed charges,,
Repair Of Ectropion; Suture (Pro Cah),,67914,CPT,Professional,Both,,,,1479,1257.15,208.55,1479,Medica,Medica Advantage Solution,736.542,49.8,,percent of total billed charges,,
Repair Of Ectropion; Suture (Pro Cah),,67914,CPT,Professional,Both,,,,1479,1257.15,208.55,1479,Medica,Medical Assistance,240.78,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Repair Of Ectropion; Suture (Pro Cah),,67914,CPT,Professional,Both,,,,1479,1257.15,208.55,1479,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,324.22,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Repair Of Ectropion; Suture (Pro Cah),,67914,CPT,Professional,Both,,,,1479,1257.15,208.55,1479,"Multiplan, Inc.","Multiplan, Inc.",1390.26,94,,percent of total billed charges,,
Repair Of Ectropion; Suture (Pro Cah),,67914,CPT,Professional,Both,,,,1479,1257.15,208.55,1479,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1332.579,90.1,,percent of total billed charges,,
Repair Of Ectropion; Suture (Pro Cah),,67914,CPT,Professional,Both,,,,1479,1257.15,208.55,1479,"Preferred One Administrative Services, INC.",PPO,1458.294,98.6,,percent of total billed charges,,
Repair Of Ectropion; Suture (Pro Cah),,67914,CPT,Professional,Both,,,,1479,1257.15,208.55,1479,PrimeWest Health,Minnesota Senior Health Options (MSHO),372.853,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Repair Of Ectropion; Suture (Pro Cah),,67914,CPT,Professional,Both,,,,1479,1257.15,208.55,1479,PrimeWest Health,MinnesotaCare,257.6365688,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Repair Of Ectropion; Suture (Pro Cah),,67914,CPT,Professional,Both,,,,1479,1257.15,208.55,1479,Sanford Health Plan,Sanford Health Plan,1301.52,88,,percent of total billed charges,,
Repair Of Ectropion; Suture (Pro Cah),,67914,CPT,Professional,Both,,,,1479,1257.15,208.55,1479,"UCare Health, Inc.",Individual & Family Plan,527.052032,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Repair Of Ectropion; Suture (Pro Cah),,67914,CPT,Professional,Both,,,,1479,1257.15,208.55,1479,"UCare Health, Inc.",Medical Assistance,264.860024,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Repair Of Ectropion; Suture (Pro Cah),,67914,CPT,Professional,Both,,,,1479,1257.15,208.55,1479,"UCare Health, Inc.",Medicare Advantage,372.853,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Repair Of Ectropion; Suture (Pro Cah),,67914,CPT,Professional,Both,,,,1479,1257.15,208.55,1479,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),298.2824,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Repair Of Ectropion; Suture (Pro Cah),,67914,CPT,Professional,Both,,,,1479,1257.15,208.55,1479,UnitedHealthcare,Individual & Family,1479,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Repair Of Ectropion; Suture (Pro Cah),,67914,CPT,Professional,Both,,,,1479,1257.15,208.55,1479,UnitedHealthcare,Medicare Advantage,372.853,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Repair Of Ectropion; Suture (Pro Cah),,67914,CPT,Professional,Both,,,,1479,1257.15,208.55,1479,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,240.78184,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Repair Of Ectropion; Extensive (Pro Cah),,67917,CPT,Professional,Both,,,,2142,1820.7,288.39,2142,Aetna,Commercial,1820.7,85,,percent of total billed charges,,
Repair Of Ectropion; Extensive (Pro Cah),,67917,CPT,Professional,Both,,,,2142,1820.7,288.39,2142,Aetna,Medicare Advantage,451.3,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Repair Of Ectropion; Extensive (Pro Cah),,67917,CPT,Professional,Both,,,,2142,1820.7,288.39,2142,Aetna,PPO,1992.06,93,,percent of total billed charges,,
Repair Of Ectropion; Extensive (Pro Cah),,67917,CPT,Professional,Both,,,,2142,1820.7,288.39,2142,America's PPO,America's PPO,1830.1248,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Repair Of Ectropion; Extensive (Pro Cah),,67917,CPT,Professional,Both,,,,2142,1820.7,288.39,2142,BlueCross BlueShield Minnesota, Federal Employee Program,924.1,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Repair Of Ectropion; Extensive (Pro Cah),,67917,CPT,Professional,Both,,,,2142,1820.7,288.39,2142,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,938.8856,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Repair Of Ectropion; Extensive (Pro Cah),,67917,CPT,Professional,Both,,,,2142,1820.7,288.39,2142,BlueCross BlueShield Minnesota,High Value Network Plan,938.8856,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Repair Of Ectropion; Extensive (Pro Cah),,67917,CPT,Professional,Both,,,,2142,1820.7,288.39,2142,BlueCross BlueShield Minnesota,Medicare Advantage,515.292,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Repair Of Ectropion; Extensive (Pro Cah),,67917,CPT,Professional,Both,,,,2142,1820.7,288.39,2142,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,938.8856,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Repair Of Ectropion; Extensive (Pro Cah),,67917,CPT,Professional,Both,,,,2142,1820.7,288.39,2142,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,332.96352,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Repair Of Ectropion; Extensive (Pro Cah),,67917,CPT,Professional,Both,,,,2142,1820.7,288.39,2142,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),515.292,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Repair Of Ectropion; Extensive (Pro Cah),,67917,CPT,Professional,Both,,,,2142,1820.7,288.39,2142,CorVel,Worker's Compensation,870.8261367,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Repair Of Ectropion; Extensive (Pro Cah),,67917,CPT,Professional,Both,,,,2142,1820.7,288.39,2142,First Health Group Corporation,First Health Network,2077.74,97,,percent of total billed charges,,
Repair Of Ectropion; Extensive (Pro Cah),,67917,CPT,Professional,Both,,,,2142,1820.7,288.39,2142,"Health Partners, Inc.",Commercial,941.01,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Repair Of Ectropion; Extensive (Pro Cah),,67917,CPT,Professional,Both,,,,2142,1820.7,288.39,2142,"Health Partners, Inc.",Medicare Advantage,515.292,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Repair Of Ectropion; Extensive (Pro Cah),,67917,CPT,Professional,Both,,,,2142,1820.7,288.39,2142,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),447.99,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Repair Of Ectropion; Extensive (Pro Cah),,67917,CPT,Professional,Both,,,,2142,1820.7,288.39,2142,"Health Partners, Inc.",State of Minnesota Advantage Program,810.680115,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Repair Of Ectropion; Extensive (Pro Cah),,67917,CPT,Professional,Both,,,,2142,1820.7,288.39,2142,"Health Partners, Inc.",State Public Programs,288.39,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Repair Of Ectropion; Extensive (Pro Cah),,67917,CPT,Professional,Both,,,,2142,1820.7,288.39,2142,Humana Insurance Company,Commercial PPO,448.08,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Repair Of Ectropion; Extensive (Pro Cah),,67917,CPT,Professional,Both,,,,2142,1820.7,288.39,2142,Humana Insurance Company,Medicare PPO,2142,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Repair Of Ectropion; Extensive (Pro Cah),,67917,CPT,Professional,Both,,,,2142,1820.7,288.39,2142,Medica,Individual & Family,1816.416,84.8,,percent of total billed charges,,
Repair Of Ectropion; Extensive (Pro Cah),,67917,CPT,Professional,Both,,,,2142,1820.7,288.39,2142,Medica,Medica Advantage Solution,1066.716,49.8,,percent of total billed charges,,
Repair Of Ectropion; Extensive (Pro Cah),,67917,CPT,Professional,Both,,,,2142,1820.7,288.39,2142,Medica,Medical Assistance,332.96,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Repair Of Ectropion; Extensive (Pro Cah),,67917,CPT,Professional,Both,,,,2142,1820.7,288.39,2142,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,448.08,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Repair Of Ectropion; Extensive (Pro Cah),,67917,CPT,Professional,Both,,,,2142,1820.7,288.39,2142,"Multiplan, Inc.","Multiplan, Inc.",2013.48,94,,percent of total billed charges,,
Repair Of Ectropion; Extensive (Pro Cah),,67917,CPT,Professional,Both,,,,2142,1820.7,288.39,2142,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1929.942,90.1,,percent of total billed charges,,
Repair Of Ectropion; Extensive (Pro Cah),,67917,CPT,Professional,Both,,,,2142,1820.7,288.39,2142,"Preferred One Administrative Services, INC.",PPO,2112.012,98.6,,percent of total billed charges,,
Repair Of Ectropion; Extensive (Pro Cah),,67917,CPT,Professional,Both,,,,2142,1820.7,288.39,2142,PrimeWest Health,Minnesota Senior Health Options (MSHO),515.292,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Repair Of Ectropion; Extensive (Pro Cah),,67917,CPT,Professional,Both,,,,2142,1820.7,288.39,2142,PrimeWest Health,MinnesotaCare,356.2709664,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Repair Of Ectropion; Extensive (Pro Cah),,67917,CPT,Professional,Both,,,,2142,1820.7,288.39,2142,Sanford Health Plan,Sanford Health Plan,1884.96,88,,percent of total billed charges,,
Repair Of Ectropion; Extensive (Pro Cah),,67917,CPT,Professional,Both,,,,2142,1820.7,288.39,2142,"UCare Health, Inc.",Individual & Family Plan,728.398848,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Repair Of Ectropion; Extensive (Pro Cah),,67917,CPT,Professional,Both,,,,2142,1820.7,288.39,2142,"UCare Health, Inc.",Medical Assistance,366.259872,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Repair Of Ectropion; Extensive (Pro Cah),,67917,CPT,Professional,Both,,,,2142,1820.7,288.39,2142,"UCare Health, Inc.",Medicare Advantage,515.292,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Repair Of Ectropion; Extensive (Pro Cah),,67917,CPT,Professional,Both,,,,2142,1820.7,288.39,2142,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),412.2336,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Repair Of Ectropion; Extensive (Pro Cah),,67917,CPT,Professional,Both,,,,2142,1820.7,288.39,2142,UnitedHealthcare,Individual & Family,2142,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Repair Of Ectropion; Extensive (Pro Cah),,67917,CPT,Professional,Both,,,,2142,1820.7,288.39,2142,UnitedHealthcare,Medicare Advantage,515.292,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Repair Of Ectropion; Extensive (Pro Cah),,67917,CPT,Professional,Both,,,,2142,1820.7,288.39,2142,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,332.96352,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
DORZOLAMIDE 2 % OPHT DROP,,20174,LOCAL,Facility,Both,10,mL,,383,325.55,109.7678,383,Aetna,Commercial,352.36,92,,percent of total billed charges,,
DORZOLAMIDE 2 % OPHT DROP,,20174,LOCAL,Facility,Both,10,mL,,281,238.85,80.5346,281,Aetna,Commercial,258.52,92,,percent of total billed charges,,
DORZOLAMIDE 2 % OPHT DROP,,20174,LOCAL,Facility,Outpatient,10,mL,,383,325.55,109.7678,383,Aetna,Medicare Advantage,187.67,49,,percent of total billed charges,,
DORZOLAMIDE 2 % OPHT DROP,,20174,LOCAL,Facility,Outpatient,10,mL,,281,238.85,80.5346,281,Aetna,Medicare Advantage,137.69,49,,percent of total billed charges,,
DORZOLAMIDE 2 % OPHT DROP,,20174,LOCAL,Facility,Inpatient,10,mL,,383,325.55,109.7678,383,Aetna,Medicare Advantage,,,,,Included in per diem rate,
DORZOLAMIDE 2 % OPHT DROP,,20174,LOCAL,Facility,Inpatient,10,mL,,281,238.85,80.5346,281,Aetna,Medicare Advantage,,,,,Included in per diem rate,
DORZOLAMIDE 2 % OPHT DROP,,20174,LOCAL,Facility,Both,10,mL,,383,325.55,109.7678,383,Aetna,PPO,356.19,93,,percent of total billed charges,,
DORZOLAMIDE 2 % OPHT DROP,,20174,LOCAL,Facility,Both,10,mL,,281,238.85,80.5346,281,Aetna,PPO,261.33,93,,percent of total billed charges,,
DORZOLAMIDE 2 % OPHT DROP,,20174,LOCAL,Facility,Both,10,mL,,383,325.55,109.7678,383,America's PPO,America's PPO,367.7949,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
DORZOLAMIDE 2 % OPHT DROP,,20174,LOCAL,Facility,Both,10,mL,,281,238.85,80.5346,281,America's PPO,America's PPO,269.8443,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
DORZOLAMIDE 2 % OPHT DROP,,20174,LOCAL,Facility,Both,10,mL,,383,325.55,109.7678,383,BlueCross BlueShield Minnesota, Federal Employee Program,376.872,98.4,,percent of total billed charges,,
DORZOLAMIDE 2 % OPHT DROP,,20174,LOCAL,Facility,Both,10,mL,,281,238.85,80.5346,281,BlueCross BlueShield Minnesota, Federal Employee Program,276.504,98.4,,percent of total billed charges,,
DORZOLAMIDE 2 % OPHT DROP,,20174,LOCAL,Facility,Both,10,mL,,383,325.55,109.7678,383,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,383,100,,percent of total billed charges,,
DORZOLAMIDE 2 % OPHT DROP,,20174,LOCAL,Facility,Both,10,mL,,281,238.85,80.5346,281,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,281,100,,percent of total billed charges,,
DORZOLAMIDE 2 % OPHT DROP,,20174,LOCAL,Facility,Both,10,mL,,383,325.55,109.7678,383,BlueCross BlueShield Minnesota,High Value Network Plan,344.7,90,,percent of total billed charges,,
DORZOLAMIDE 2 % OPHT DROP,,20174,LOCAL,Facility,Both,10,mL,,281,238.85,80.5346,281,BlueCross BlueShield Minnesota,High Value Network Plan,252.9,90,,percent of total billed charges,,
DORZOLAMIDE 2 % OPHT DROP,,20174,LOCAL,Facility,Outpatient,10,mL,,383,325.55,109.7678,383,BlueCross BlueShield Minnesota,Medicare Advantage,187.67,49,,percent of total billed charges,,
DORZOLAMIDE 2 % OPHT DROP,,20174,LOCAL,Facility,Outpatient,10,mL,,281,238.85,80.5346,281,BlueCross BlueShield Minnesota,Medicare Advantage,137.69,49,,percent of total billed charges,,
DORZOLAMIDE 2 % OPHT DROP,,20174,LOCAL,Facility,Inpatient,10,mL,,383,325.55,109.7678,383,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
DORZOLAMIDE 2 % OPHT DROP,,20174,LOCAL,Facility,Inpatient,10,mL,,281,238.85,80.5346,281,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
DORZOLAMIDE 2 % OPHT DROP,,20174,LOCAL,Facility,Both,10,mL,,383,325.55,109.7678,383,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,339.2231,88.57,,percent of total billed charges,,
DORZOLAMIDE 2 % OPHT DROP,,20174,LOCAL,Facility,Both,10,mL,,281,238.85,80.5346,281,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,248.8817,88.57,,percent of total billed charges,,
DORZOLAMIDE 2 % OPHT DROP,,20174,LOCAL,Facility,Both,10,mL,,383,325.55,109.7678,383,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,109.7678,28.66,,percent of total billed charges,,
DORZOLAMIDE 2 % OPHT DROP,,20174,LOCAL,Facility,Both,10,mL,,281,238.85,80.5346,281,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,80.5346,28.66,,percent of total billed charges,,
DORZOLAMIDE 2 % OPHT DROP,,20174,LOCAL,Facility,Outpatient,10,mL,,383,325.55,109.7678,383,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),187.67,49,,percent of total billed charges,,
DORZOLAMIDE 2 % OPHT DROP,,20174,LOCAL,Facility,Outpatient,10,mL,,281,238.85,80.5346,281,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),137.69,49,,percent of total billed charges,,
DORZOLAMIDE 2 % OPHT DROP,,20174,LOCAL,Facility,Inpatient,10,mL,,383,325.55,109.7678,383,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
DORZOLAMIDE 2 % OPHT DROP,,20174,LOCAL,Facility,Inpatient,10,mL,,281,238.85,80.5346,281,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
DORZOLAMIDE 2 % OPHT DROP,,20174,LOCAL,Facility,Both,10,mL,,383,325.55,109.7678,383,CorVel,Worker's Compensation,383,100,,percent of total billed charges,,
DORZOLAMIDE 2 % OPHT DROP,,20174,LOCAL,Facility,Both,10,mL,,281,238.85,80.5346,281,CorVel,Worker's Compensation,281,100,,percent of total billed charges,,
DORZOLAMIDE 2 % OPHT DROP,,20174,LOCAL,Facility,Both,10,mL,,383,325.55,109.7678,383,First Health Group Corporation,First Health Network,371.51,97,,percent of total billed charges,,
DORZOLAMIDE 2 % OPHT DROP,,20174,LOCAL,Facility,Both,10,mL,,281,238.85,80.5346,281,First Health Group Corporation,First Health Network,272.57,97,,percent of total billed charges,,
DORZOLAMIDE 2 % OPHT DROP,,20174,LOCAL,Facility,Both,10,mL,,383,325.55,109.7678,383,"Health Partners, Inc.",Commercial,362.318,94.6,,percent of total billed charges,,
DORZOLAMIDE 2 % OPHT DROP,,20174,LOCAL,Facility,Both,10,mL,,281,238.85,80.5346,281,"Health Partners, Inc.",Commercial,265.826,94.6,,percent of total billed charges,,
DORZOLAMIDE 2 % OPHT DROP,,20174,LOCAL,Facility,Outpatient,10,mL,,383,325.55,109.7678,383,"Health Partners, Inc.",Medicare Advantage,187.67,49,,percent of total billed charges,,
DORZOLAMIDE 2 % OPHT DROP,,20174,LOCAL,Facility,Outpatient,10,mL,,281,238.85,80.5346,281,"Health Partners, Inc.",Medicare Advantage,137.69,49,,percent of total billed charges,,
DORZOLAMIDE 2 % OPHT DROP,,20174,LOCAL,Facility,Inpatient,10,mL,,383,325.55,109.7678,383,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DORZOLAMIDE 2 % OPHT DROP,,20174,LOCAL,Facility,Inpatient,10,mL,,281,238.85,80.5346,281,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DORZOLAMIDE 2 % OPHT DROP,,20174,LOCAL,Facility,Both,10,mL,,383,325.55,109.7678,383,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),229.8,60,,percent of total billed charges,,
DORZOLAMIDE 2 % OPHT DROP,,20174,LOCAL,Facility,Both,10,mL,,281,238.85,80.5346,281,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),168.6,60,,percent of total billed charges,,
DORZOLAMIDE 2 % OPHT DROP,,20174,LOCAL,Facility,Both,10,mL,,383,325.55,109.7678,383,"Health Partners, Inc.",State of Minnesota Advantage Program,312.145,81.5,,percent of total billed charges,,
DORZOLAMIDE 2 % OPHT DROP,,20174,LOCAL,Facility,Both,10,mL,,281,238.85,80.5346,281,"Health Partners, Inc.",State of Minnesota Advantage Program,229.015,81.5,,percent of total billed charges,,
DORZOLAMIDE 2 % OPHT DROP,,20174,LOCAL,Facility,Both,10,mL,,383,325.55,109.7678,383,"Health Partners, Inc.",State Public Programs,191.5,50,,percent of total billed charges,,
DORZOLAMIDE 2 % OPHT DROP,,20174,LOCAL,Facility,Both,10,mL,,281,238.85,80.5346,281,"Health Partners, Inc.",State Public Programs,140.5,50,,percent of total billed charges,,
DORZOLAMIDE 2 % OPHT DROP,,20174,LOCAL,Facility,Both,10,mL,,383,325.55,109.7678,383,Humana Insurance Company,Commercial PPO,363.85,95,,percent of total billed charges,,
DORZOLAMIDE 2 % OPHT DROP,,20174,LOCAL,Facility,Both,10,mL,,281,238.85,80.5346,281,Humana Insurance Company,Commercial PPO,266.95,95,,percent of total billed charges,,
DORZOLAMIDE 2 % OPHT DROP,,20174,LOCAL,Facility,Outpatient,10,mL,,383,325.55,109.7678,383,Humana Insurance Company,Medicare PPO,187.67,49,,percent of total billed charges,,
DORZOLAMIDE 2 % OPHT DROP,,20174,LOCAL,Facility,Outpatient,10,mL,,281,238.85,80.5346,281,Humana Insurance Company,Medicare PPO,137.69,49,,percent of total billed charges,,
DORZOLAMIDE 2 % OPHT DROP,,20174,LOCAL,Facility,Inpatient,10,mL,,383,325.55,109.7678,383,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
DORZOLAMIDE 2 % OPHT DROP,,20174,LOCAL,Facility,Inpatient,10,mL,,281,238.85,80.5346,281,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
DORZOLAMIDE 2 % OPHT DROP,,20174,LOCAL,Facility,Both,10,mL,,383,325.55,109.7678,383,Medica,Individual & Family,379.553,99.1,,percent of total billed charges,,
DORZOLAMIDE 2 % OPHT DROP,,20174,LOCAL,Facility,Both,10,mL,,281,238.85,80.5346,281,Medica,Individual & Family,278.471,99.1,,percent of total billed charges,,
DORZOLAMIDE 2 % OPHT DROP,,20174,LOCAL,Facility,Outpatient,10,mL,,383,325.55,109.7678,383,Medica,Medica Advantage Solution,190.734,49.8,,percent of total billed charges,,
DORZOLAMIDE 2 % OPHT DROP,,20174,LOCAL,Facility,Outpatient,10,mL,,281,238.85,80.5346,281,Medica,Medica Advantage Solution,139.938,49.8,,percent of total billed charges,,
DORZOLAMIDE 2 % OPHT DROP,,20174,LOCAL,Facility,Inpatient,10,mL,,383,325.55,109.7678,383,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
DORZOLAMIDE 2 % OPHT DROP,,20174,LOCAL,Facility,Inpatient,10,mL,,281,238.85,80.5346,281,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
DORZOLAMIDE 2 % OPHT DROP,,20174,LOCAL,Facility,Outpatient,10,mL,,383,325.55,109.7678,383,Medica,Medical Assistance,170.818,44.6,,percent of total billed charges,,
DORZOLAMIDE 2 % OPHT DROP,,20174,LOCAL,Facility,Outpatient,10,mL,,281,238.85,80.5346,281,Medica,Medical Assistance,125.326,44.6,,percent of total billed charges,,
DORZOLAMIDE 2 % OPHT DROP,,20174,LOCAL,Facility,Inpatient,10,mL,,383,325.55,109.7678,383,Medica,Medical Assistance,,,,,Included in per diem rate,
DORZOLAMIDE 2 % OPHT DROP,,20174,LOCAL,Facility,Inpatient,10,mL,,281,238.85,80.5346,281,Medica,Medical Assistance,,,,,Included in per diem rate,
DORZOLAMIDE 2 % OPHT DROP,,20174,LOCAL,Facility,Outpatient,10,mL,,383,325.55,109.7678,383,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,190.734,49.8,,percent of total billed charges,,
DORZOLAMIDE 2 % OPHT DROP,,20174,LOCAL,Facility,Outpatient,10,mL,,281,238.85,80.5346,281,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,139.938,49.8,,percent of total billed charges,,
DORZOLAMIDE 2 % OPHT DROP,,20174,LOCAL,Facility,Inpatient,10,mL,,383,325.55,109.7678,383,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
DORZOLAMIDE 2 % OPHT DROP,,20174,LOCAL,Facility,Inpatient,10,mL,,281,238.85,80.5346,281,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
DORZOLAMIDE 2 % OPHT DROP,,20174,LOCAL,Facility,Both,10,mL,,383,325.55,109.7678,383,"Multiplan, Inc.","Multiplan, Inc.",360.02,94,,percent of total billed charges,,
DORZOLAMIDE 2 % OPHT DROP,,20174,LOCAL,Facility,Both,10,mL,,281,238.85,80.5346,281,"Multiplan, Inc.","Multiplan, Inc.",264.14,94,,percent of total billed charges,,
DORZOLAMIDE 2 % OPHT DROP,,20174,LOCAL,Facility,Outpatient,10,mL,,383,325.55,109.7678,383,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,345.083,90.1,,percent of total billed charges,,
DORZOLAMIDE 2 % OPHT DROP,,20174,LOCAL,Facility,Outpatient,10,mL,,281,238.85,80.5346,281,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,253.181,90.1,,percent of total billed charges,,
DORZOLAMIDE 2 % OPHT DROP,,20174,LOCAL,Facility,Inpatient,10,mL,,383,325.55,109.7678,383,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
DORZOLAMIDE 2 % OPHT DROP,,20174,LOCAL,Facility,Inpatient,10,mL,,281,238.85,80.5346,281,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
DORZOLAMIDE 2 % OPHT DROP,,20174,LOCAL,Facility,Both,10,mL,,383,325.55,109.7678,383,"Preferred One Administrative Services, INC.",PPO,377.638,98.6,,percent of total billed charges,,
DORZOLAMIDE 2 % OPHT DROP,,20174,LOCAL,Facility,Both,10,mL,,281,238.85,80.5346,281,"Preferred One Administrative Services, INC.",PPO,277.066,98.6,,percent of total billed charges,,
DORZOLAMIDE 2 % OPHT DROP,,20174,LOCAL,Facility,Outpatient,10,mL,,383,325.55,109.7678,383,PrimeWest Health,Minnesota Senior Health Options (MSHO),197.0535,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
DORZOLAMIDE 2 % OPHT DROP,,20174,LOCAL,Facility,Outpatient,10,mL,,281,238.85,80.5346,281,PrimeWest Health,Minnesota Senior Health Options (MSHO),144.5745,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
DORZOLAMIDE 2 % OPHT DROP,,20174,LOCAL,Facility,Inpatient,10,mL,,383,325.55,109.7678,383,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DORZOLAMIDE 2 % OPHT DROP,,20174,LOCAL,Facility,Inpatient,10,mL,,281,238.85,80.5346,281,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DORZOLAMIDE 2 % OPHT DROP,,20174,LOCAL,Facility,Outpatient,10,mL,,383,325.55,109.7678,383,PrimeWest Health,MinnesotaCare,196.7088,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
DORZOLAMIDE 2 % OPHT DROP,,20174,LOCAL,Facility,Outpatient,10,mL,,281,238.85,80.5346,281,PrimeWest Health,MinnesotaCare,144.3216,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
DORZOLAMIDE 2 % OPHT DROP,,20174,LOCAL,Facility,Inpatient,10,mL,,383,325.55,109.7678,383,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
DORZOLAMIDE 2 % OPHT DROP,,20174,LOCAL,Facility,Inpatient,10,mL,,281,238.85,80.5346,281,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
DORZOLAMIDE 2 % OPHT DROP,,20174,LOCAL,Facility,Both,10,mL,,383,325.55,109.7678,383,Sanford Health Plan,Sanford Health Plan,352.36,92,,percent of total billed charges,,
DORZOLAMIDE 2 % OPHT DROP,,20174,LOCAL,Facility,Both,10,mL,,281,238.85,80.5346,281,Sanford Health Plan,Sanford Health Plan,258.52,92,,percent of total billed charges,,
DORZOLAMIDE 2 % OPHT DROP,,20174,LOCAL,Facility,Outpatient,10,mL,,383,325.55,109.7678,383,"UCare Health, Inc.",Individual & Family Plan,215.8205,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
DORZOLAMIDE 2 % OPHT DROP,,20174,LOCAL,Facility,Outpatient,10,mL,,281,238.85,80.5346,281,"UCare Health, Inc.",Individual & Family Plan,158.3435,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
DORZOLAMIDE 2 % OPHT DROP,,20174,LOCAL,Facility,Inpatient,10,mL,,383,325.55,109.7678,383,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
DORZOLAMIDE 2 % OPHT DROP,,20174,LOCAL,Facility,Inpatient,10,mL,,281,238.85,80.5346,281,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
DORZOLAMIDE 2 % OPHT DROP,,20174,LOCAL,Facility,Outpatient,10,mL,,383,325.55,109.7678,383,"UCare Health, Inc.",Medical Assistance,193.3001,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DORZOLAMIDE 2 % OPHT DROP,,20174,LOCAL,Facility,Outpatient,10,mL,,281,238.85,80.5346,281,"UCare Health, Inc.",Medical Assistance,141.8207,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DORZOLAMIDE 2 % OPHT DROP,,20174,LOCAL,Facility,Inpatient,10,mL,,383,325.55,109.7678,383,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
DORZOLAMIDE 2 % OPHT DROP,,20174,LOCAL,Facility,Inpatient,10,mL,,281,238.85,80.5346,281,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
DORZOLAMIDE 2 % OPHT DROP,,20174,LOCAL,Facility,Outpatient,10,mL,,383,325.55,109.7678,383,"UCare Health, Inc.",Medicare Advantage,193.3001,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DORZOLAMIDE 2 % OPHT DROP,,20174,LOCAL,Facility,Outpatient,10,mL,,281,238.85,80.5346,281,"UCare Health, Inc.",Medicare Advantage,141.8207,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DORZOLAMIDE 2 % OPHT DROP,,20174,LOCAL,Facility,Inpatient,10,mL,,383,325.55,109.7678,383,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DORZOLAMIDE 2 % OPHT DROP,,20174,LOCAL,Facility,Inpatient,10,mL,,281,238.85,80.5346,281,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DORZOLAMIDE 2 % OPHT DROP,,20174,LOCAL,Facility,Outpatient,10,mL,,383,325.55,109.7678,383,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),193.3001,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DORZOLAMIDE 2 % OPHT DROP,,20174,LOCAL,Facility,Outpatient,10,mL,,281,238.85,80.5346,281,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),141.8207,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DORZOLAMIDE 2 % OPHT DROP,,20174,LOCAL,Facility,Inpatient,10,mL,,383,325.55,109.7678,383,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DORZOLAMIDE 2 % OPHT DROP,,20174,LOCAL,Facility,Inpatient,10,mL,,281,238.85,80.5346,281,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DORZOLAMIDE 2 % OPHT DROP,,20174,LOCAL,Facility,Both,10,mL,,383,325.55,109.7678,383,UnitedHealthcare,Individual & Family,360.02,94,,percent of total billed charges,,
DORZOLAMIDE 2 % OPHT DROP,,20174,LOCAL,Facility,Both,10,mL,,281,238.85,80.5346,281,UnitedHealthcare,Individual & Family,264.14,94,,percent of total billed charges,,
DORZOLAMIDE 2 % OPHT DROP,,20174,LOCAL,Facility,Outpatient,10,mL,,383,325.55,109.7678,383,UnitedHealthcare,Medicare Advantage,187.67,49,,percent of total billed charges,,
DORZOLAMIDE 2 % OPHT DROP,,20174,LOCAL,Facility,Outpatient,10,mL,,281,238.85,80.5346,281,UnitedHealthcare,Medicare Advantage,137.69,49,,percent of total billed charges,,
DORZOLAMIDE 2 % OPHT DROP,,20174,LOCAL,Facility,Inpatient,10,mL,,383,325.55,109.7678,383,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
DORZOLAMIDE 2 % OPHT DROP,,20174,LOCAL,Facility,Inpatient,10,mL,,281,238.85,80.5346,281,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
DORZOLAMIDE 2 % OPHT DROP,,20174,LOCAL,Facility,Outpatient,10,mL,,383,325.55,109.7678,383,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,183.84,48,,percent of total billed charges,,100% of DHS outpatient percentage
DORZOLAMIDE 2 % OPHT DROP,,20174,LOCAL,Facility,Outpatient,10,mL,,281,238.85,80.5346,281,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,134.88,48,,percent of total billed charges,,100% of DHS outpatient percentage
DORZOLAMIDE 2 % OPHT DROP,,20174,LOCAL,Facility,Inpatient,10,mL,,383,325.55,109.7678,383,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
DORZOLAMIDE 2 % OPHT DROP,,20174,LOCAL,Facility,Inpatient,10,mL,,281,238.85,80.5346,281,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"NEOMYCIN-POLYMYXIN-HC 3.5-10,000-1 MG/ML-UNIT/ML-% OTIC DRPS",,20577,LOCAL,Facility,Both,10,mL,,393,334.05,112.6338,393,Aetna,Commercial,361.56,92,,percent of total billed charges,,
"NEOMYCIN-POLYMYXIN-HC 3.5-10,000-1 MG/ML-UNIT/ML-% OTIC DRPS",,20577,LOCAL,Facility,Outpatient,10,mL,,393,334.05,112.6338,393,Aetna,Medicare Advantage,192.57,49,,percent of total billed charges,,
"NEOMYCIN-POLYMYXIN-HC 3.5-10,000-1 MG/ML-UNIT/ML-% OTIC DRPS",,20577,LOCAL,Facility,Inpatient,10,mL,,393,334.05,112.6338,393,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"NEOMYCIN-POLYMYXIN-HC 3.5-10,000-1 MG/ML-UNIT/ML-% OTIC DRPS",,20577,LOCAL,Facility,Both,10,mL,,393,334.05,112.6338,393,Aetna,PPO,365.49,93,,percent of total billed charges,,
"NEOMYCIN-POLYMYXIN-HC 3.5-10,000-1 MG/ML-UNIT/ML-% OTIC DRPS",,20577,LOCAL,Facility,Both,10,mL,,393,334.05,112.6338,393,America's PPO,America's PPO,377.3979,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"NEOMYCIN-POLYMYXIN-HC 3.5-10,000-1 MG/ML-UNIT/ML-% OTIC DRPS",,20577,LOCAL,Facility,Both,10,mL,,393,334.05,112.6338,393,BlueCross BlueShield Minnesota, Federal Employee Program,386.712,98.4,,percent of total billed charges,,
"NEOMYCIN-POLYMYXIN-HC 3.5-10,000-1 MG/ML-UNIT/ML-% OTIC DRPS",,20577,LOCAL,Facility,Both,10,mL,,393,334.05,112.6338,393,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,393,100,,percent of total billed charges,,
"NEOMYCIN-POLYMYXIN-HC 3.5-10,000-1 MG/ML-UNIT/ML-% OTIC DRPS",,20577,LOCAL,Facility,Both,10,mL,,393,334.05,112.6338,393,BlueCross BlueShield Minnesota,High Value Network Plan,353.7,90,,percent of total billed charges,,
"NEOMYCIN-POLYMYXIN-HC 3.5-10,000-1 MG/ML-UNIT/ML-% OTIC DRPS",,20577,LOCAL,Facility,Outpatient,10,mL,,393,334.05,112.6338,393,BlueCross BlueShield Minnesota,Medicare Advantage,192.57,49,,percent of total billed charges,,
"NEOMYCIN-POLYMYXIN-HC 3.5-10,000-1 MG/ML-UNIT/ML-% OTIC DRPS",,20577,LOCAL,Facility,Inpatient,10,mL,,393,334.05,112.6338,393,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"NEOMYCIN-POLYMYXIN-HC 3.5-10,000-1 MG/ML-UNIT/ML-% OTIC DRPS",,20577,LOCAL,Facility,Both,10,mL,,393,334.05,112.6338,393,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,348.0801,88.57,,percent of total billed charges,,
"NEOMYCIN-POLYMYXIN-HC 3.5-10,000-1 MG/ML-UNIT/ML-% OTIC DRPS",,20577,LOCAL,Facility,Both,10,mL,,393,334.05,112.6338,393,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,112.6338,28.66,,percent of total billed charges,,
"NEOMYCIN-POLYMYXIN-HC 3.5-10,000-1 MG/ML-UNIT/ML-% OTIC DRPS",,20577,LOCAL,Facility,Outpatient,10,mL,,393,334.05,112.6338,393,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),192.57,49,,percent of total billed charges,,
"NEOMYCIN-POLYMYXIN-HC 3.5-10,000-1 MG/ML-UNIT/ML-% OTIC DRPS",,20577,LOCAL,Facility,Inpatient,10,mL,,393,334.05,112.6338,393,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"NEOMYCIN-POLYMYXIN-HC 3.5-10,000-1 MG/ML-UNIT/ML-% OTIC DRPS",,20577,LOCAL,Facility,Both,10,mL,,393,334.05,112.6338,393,CorVel,Worker's Compensation,393,100,,percent of total billed charges,,
"NEOMYCIN-POLYMYXIN-HC 3.5-10,000-1 MG/ML-UNIT/ML-% OTIC DRPS",,20577,LOCAL,Facility,Both,10,mL,,393,334.05,112.6338,393,First Health Group Corporation,First Health Network,381.21,97,,percent of total billed charges,,
"NEOMYCIN-POLYMYXIN-HC 3.5-10,000-1 MG/ML-UNIT/ML-% OTIC DRPS",,20577,LOCAL,Facility,Both,10,mL,,393,334.05,112.6338,393,"Health Partners, Inc.",Commercial,371.778,94.6,,percent of total billed charges,,
"NEOMYCIN-POLYMYXIN-HC 3.5-10,000-1 MG/ML-UNIT/ML-% OTIC DRPS",,20577,LOCAL,Facility,Outpatient,10,mL,,393,334.05,112.6338,393,"Health Partners, Inc.",Medicare Advantage,192.57,49,,percent of total billed charges,,
"NEOMYCIN-POLYMYXIN-HC 3.5-10,000-1 MG/ML-UNIT/ML-% OTIC DRPS",,20577,LOCAL,Facility,Inpatient,10,mL,,393,334.05,112.6338,393,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"NEOMYCIN-POLYMYXIN-HC 3.5-10,000-1 MG/ML-UNIT/ML-% OTIC DRPS",,20577,LOCAL,Facility,Both,10,mL,,393,334.05,112.6338,393,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),235.8,60,,percent of total billed charges,,
"NEOMYCIN-POLYMYXIN-HC 3.5-10,000-1 MG/ML-UNIT/ML-% OTIC DRPS",,20577,LOCAL,Facility,Both,10,mL,,393,334.05,112.6338,393,"Health Partners, Inc.",State of Minnesota Advantage Program,320.295,81.5,,percent of total billed charges,,
"NEOMYCIN-POLYMYXIN-HC 3.5-10,000-1 MG/ML-UNIT/ML-% OTIC DRPS",,20577,LOCAL,Facility,Both,10,mL,,393,334.05,112.6338,393,"Health Partners, Inc.",State Public Programs,196.5,50,,percent of total billed charges,,
"NEOMYCIN-POLYMYXIN-HC 3.5-10,000-1 MG/ML-UNIT/ML-% OTIC DRPS",,20577,LOCAL,Facility,Both,10,mL,,393,334.05,112.6338,393,Humana Insurance Company,Commercial PPO,373.35,95,,percent of total billed charges,,
"NEOMYCIN-POLYMYXIN-HC 3.5-10,000-1 MG/ML-UNIT/ML-% OTIC DRPS",,20577,LOCAL,Facility,Outpatient,10,mL,,393,334.05,112.6338,393,Humana Insurance Company,Medicare PPO,192.57,49,,percent of total billed charges,,
"NEOMYCIN-POLYMYXIN-HC 3.5-10,000-1 MG/ML-UNIT/ML-% OTIC DRPS",,20577,LOCAL,Facility,Inpatient,10,mL,,393,334.05,112.6338,393,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"NEOMYCIN-POLYMYXIN-HC 3.5-10,000-1 MG/ML-UNIT/ML-% OTIC DRPS",,20577,LOCAL,Facility,Both,10,mL,,393,334.05,112.6338,393,Medica,Individual & Family,389.463,99.1,,percent of total billed charges,,
"NEOMYCIN-POLYMYXIN-HC 3.5-10,000-1 MG/ML-UNIT/ML-% OTIC DRPS",,20577,LOCAL,Facility,Outpatient,10,mL,,393,334.05,112.6338,393,Medica,Medica Advantage Solution,195.714,49.8,,percent of total billed charges,,
"NEOMYCIN-POLYMYXIN-HC 3.5-10,000-1 MG/ML-UNIT/ML-% OTIC DRPS",,20577,LOCAL,Facility,Inpatient,10,mL,,393,334.05,112.6338,393,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"NEOMYCIN-POLYMYXIN-HC 3.5-10,000-1 MG/ML-UNIT/ML-% OTIC DRPS",,20577,LOCAL,Facility,Outpatient,10,mL,,393,334.05,112.6338,393,Medica,Medical Assistance,175.278,44.6,,percent of total billed charges,,
"NEOMYCIN-POLYMYXIN-HC 3.5-10,000-1 MG/ML-UNIT/ML-% OTIC DRPS",,20577,LOCAL,Facility,Inpatient,10,mL,,393,334.05,112.6338,393,Medica,Medical Assistance,,,,,Included in per diem rate,
"NEOMYCIN-POLYMYXIN-HC 3.5-10,000-1 MG/ML-UNIT/ML-% OTIC DRPS",,20577,LOCAL,Facility,Outpatient,10,mL,,393,334.05,112.6338,393,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,195.714,49.8,,percent of total billed charges,,
"NEOMYCIN-POLYMYXIN-HC 3.5-10,000-1 MG/ML-UNIT/ML-% OTIC DRPS",,20577,LOCAL,Facility,Inpatient,10,mL,,393,334.05,112.6338,393,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"NEOMYCIN-POLYMYXIN-HC 3.5-10,000-1 MG/ML-UNIT/ML-% OTIC DRPS",,20577,LOCAL,Facility,Both,10,mL,,393,334.05,112.6338,393,"Multiplan, Inc.","Multiplan, Inc.",369.42,94,,percent of total billed charges,,
"NEOMYCIN-POLYMYXIN-HC 3.5-10,000-1 MG/ML-UNIT/ML-% OTIC DRPS",,20577,LOCAL,Facility,Outpatient,10,mL,,393,334.05,112.6338,393,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,354.093,90.1,,percent of total billed charges,,
"NEOMYCIN-POLYMYXIN-HC 3.5-10,000-1 MG/ML-UNIT/ML-% OTIC DRPS",,20577,LOCAL,Facility,Inpatient,10,mL,,393,334.05,112.6338,393,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"NEOMYCIN-POLYMYXIN-HC 3.5-10,000-1 MG/ML-UNIT/ML-% OTIC DRPS",,20577,LOCAL,Facility,Both,10,mL,,393,334.05,112.6338,393,"Preferred One Administrative Services, INC.",PPO,387.498,98.6,,percent of total billed charges,,
"NEOMYCIN-POLYMYXIN-HC 3.5-10,000-1 MG/ML-UNIT/ML-% OTIC DRPS",,20577,LOCAL,Facility,Outpatient,10,mL,,393,334.05,112.6338,393,PrimeWest Health,Minnesota Senior Health Options (MSHO),202.1985,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"NEOMYCIN-POLYMYXIN-HC 3.5-10,000-1 MG/ML-UNIT/ML-% OTIC DRPS",,20577,LOCAL,Facility,Inpatient,10,mL,,393,334.05,112.6338,393,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"NEOMYCIN-POLYMYXIN-HC 3.5-10,000-1 MG/ML-UNIT/ML-% OTIC DRPS",,20577,LOCAL,Facility,Outpatient,10,mL,,393,334.05,112.6338,393,PrimeWest Health,MinnesotaCare,201.8448,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"NEOMYCIN-POLYMYXIN-HC 3.5-10,000-1 MG/ML-UNIT/ML-% OTIC DRPS",,20577,LOCAL,Facility,Inpatient,10,mL,,393,334.05,112.6338,393,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"NEOMYCIN-POLYMYXIN-HC 3.5-10,000-1 MG/ML-UNIT/ML-% OTIC DRPS",,20577,LOCAL,Facility,Both,10,mL,,393,334.05,112.6338,393,Sanford Health Plan,Sanford Health Plan,361.56,92,,percent of total billed charges,,
"NEOMYCIN-POLYMYXIN-HC 3.5-10,000-1 MG/ML-UNIT/ML-% OTIC DRPS",,20577,LOCAL,Facility,Outpatient,10,mL,,393,334.05,112.6338,393,"UCare Health, Inc.",Individual & Family Plan,221.4555,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"NEOMYCIN-POLYMYXIN-HC 3.5-10,000-1 MG/ML-UNIT/ML-% OTIC DRPS",,20577,LOCAL,Facility,Inpatient,10,mL,,393,334.05,112.6338,393,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"NEOMYCIN-POLYMYXIN-HC 3.5-10,000-1 MG/ML-UNIT/ML-% OTIC DRPS",,20577,LOCAL,Facility,Outpatient,10,mL,,393,334.05,112.6338,393,"UCare Health, Inc.",Medical Assistance,198.3471,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"NEOMYCIN-POLYMYXIN-HC 3.5-10,000-1 MG/ML-UNIT/ML-% OTIC DRPS",,20577,LOCAL,Facility,Inpatient,10,mL,,393,334.05,112.6338,393,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"NEOMYCIN-POLYMYXIN-HC 3.5-10,000-1 MG/ML-UNIT/ML-% OTIC DRPS",,20577,LOCAL,Facility,Outpatient,10,mL,,393,334.05,112.6338,393,"UCare Health, Inc.",Medicare Advantage,198.3471,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"NEOMYCIN-POLYMYXIN-HC 3.5-10,000-1 MG/ML-UNIT/ML-% OTIC DRPS",,20577,LOCAL,Facility,Inpatient,10,mL,,393,334.05,112.6338,393,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"NEOMYCIN-POLYMYXIN-HC 3.5-10,000-1 MG/ML-UNIT/ML-% OTIC DRPS",,20577,LOCAL,Facility,Outpatient,10,mL,,393,334.05,112.6338,393,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),198.3471,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"NEOMYCIN-POLYMYXIN-HC 3.5-10,000-1 MG/ML-UNIT/ML-% OTIC DRPS",,20577,LOCAL,Facility,Inpatient,10,mL,,393,334.05,112.6338,393,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"NEOMYCIN-POLYMYXIN-HC 3.5-10,000-1 MG/ML-UNIT/ML-% OTIC DRPS",,20577,LOCAL,Facility,Both,10,mL,,393,334.05,112.6338,393,UnitedHealthcare,Individual & Family,369.42,94,,percent of total billed charges,,
"NEOMYCIN-POLYMYXIN-HC 3.5-10,000-1 MG/ML-UNIT/ML-% OTIC DRPS",,20577,LOCAL,Facility,Outpatient,10,mL,,393,334.05,112.6338,393,UnitedHealthcare,Medicare Advantage,192.57,49,,percent of total billed charges,,
"NEOMYCIN-POLYMYXIN-HC 3.5-10,000-1 MG/ML-UNIT/ML-% OTIC DRPS",,20577,LOCAL,Facility,Inpatient,10,mL,,393,334.05,112.6338,393,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"NEOMYCIN-POLYMYXIN-HC 3.5-10,000-1 MG/ML-UNIT/ML-% OTIC DRPS",,20577,LOCAL,Facility,Outpatient,10,mL,,393,334.05,112.6338,393,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,188.64,48,,percent of total billed charges,,100% of DHS outpatient percentage
"NEOMYCIN-POLYMYXIN-HC 3.5-10,000-1 MG/ML-UNIT/ML-% OTIC DRPS",,20577,LOCAL,Facility,Inpatient,10,mL,,393,334.05,112.6338,393,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
CALCIUM CHLORIDE 100 MG/ML (10 %) IV SYRG,,24538,LOCAL,Facility,Both,10,mL,,58,49.3,16.6228,58,Aetna,Commercial,53.36,92,,percent of total billed charges,,
CALCIUM CHLORIDE 100 MG/ML (10 %) IV SYRG,,24538,LOCAL,Facility,Outpatient,10,mL,,58,49.3,16.6228,58,Aetna,Medicare Advantage,28.42,49,,percent of total billed charges,,
CALCIUM CHLORIDE 100 MG/ML (10 %) IV SYRG,,24538,LOCAL,Facility,Inpatient,10,mL,,58,49.3,16.6228,58,Aetna,Medicare Advantage,,,,,Included in per diem rate,
CALCIUM CHLORIDE 100 MG/ML (10 %) IV SYRG,,24538,LOCAL,Facility,Both,10,mL,,58,49.3,16.6228,58,Aetna,PPO,53.94,93,,percent of total billed charges,,
CALCIUM CHLORIDE 100 MG/ML (10 %) IV SYRG,,24538,LOCAL,Facility,Both,10,mL,,58,49.3,16.6228,58,America's PPO,America's PPO,55.6974,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
CALCIUM CHLORIDE 100 MG/ML (10 %) IV SYRG,,24538,LOCAL,Facility,Both,10,mL,,58,49.3,16.6228,58,BlueCross BlueShield Minnesota, Federal Employee Program,57.072,98.4,,percent of total billed charges,,
CALCIUM CHLORIDE 100 MG/ML (10 %) IV SYRG,,24538,LOCAL,Facility,Both,10,mL,,58,49.3,16.6228,58,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,58,100,,percent of total billed charges,,
CALCIUM CHLORIDE 100 MG/ML (10 %) IV SYRG,,24538,LOCAL,Facility,Both,10,mL,,58,49.3,16.6228,58,BlueCross BlueShield Minnesota,High Value Network Plan,52.2,90,,percent of total billed charges,,
CALCIUM CHLORIDE 100 MG/ML (10 %) IV SYRG,,24538,LOCAL,Facility,Outpatient,10,mL,,58,49.3,16.6228,58,BlueCross BlueShield Minnesota,Medicare Advantage,28.42,49,,percent of total billed charges,,
CALCIUM CHLORIDE 100 MG/ML (10 %) IV SYRG,,24538,LOCAL,Facility,Inpatient,10,mL,,58,49.3,16.6228,58,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
CALCIUM CHLORIDE 100 MG/ML (10 %) IV SYRG,,24538,LOCAL,Facility,Both,10,mL,,58,49.3,16.6228,58,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,51.3706,88.57,,percent of total billed charges,,
CALCIUM CHLORIDE 100 MG/ML (10 %) IV SYRG,,24538,LOCAL,Facility,Both,10,mL,,58,49.3,16.6228,58,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,16.6228,28.66,,percent of total billed charges,,
CALCIUM CHLORIDE 100 MG/ML (10 %) IV SYRG,,24538,LOCAL,Facility,Outpatient,10,mL,,58,49.3,16.6228,58,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),28.42,49,,percent of total billed charges,,
CALCIUM CHLORIDE 100 MG/ML (10 %) IV SYRG,,24538,LOCAL,Facility,Inpatient,10,mL,,58,49.3,16.6228,58,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
CALCIUM CHLORIDE 100 MG/ML (10 %) IV SYRG,,24538,LOCAL,Facility,Both,10,mL,,58,49.3,16.6228,58,CorVel,Worker's Compensation,58,100,,percent of total billed charges,,
CALCIUM CHLORIDE 100 MG/ML (10 %) IV SYRG,,24538,LOCAL,Facility,Both,10,mL,,58,49.3,16.6228,58,First Health Group Corporation,First Health Network,56.26,97,,percent of total billed charges,,
CALCIUM CHLORIDE 100 MG/ML (10 %) IV SYRG,,24538,LOCAL,Facility,Both,10,mL,,58,49.3,16.6228,58,"Health Partners, Inc.",Commercial,54.868,94.6,,percent of total billed charges,,
CALCIUM CHLORIDE 100 MG/ML (10 %) IV SYRG,,24538,LOCAL,Facility,Outpatient,10,mL,,58,49.3,16.6228,58,"Health Partners, Inc.",Medicare Advantage,28.42,49,,percent of total billed charges,,
CALCIUM CHLORIDE 100 MG/ML (10 %) IV SYRG,,24538,LOCAL,Facility,Inpatient,10,mL,,58,49.3,16.6228,58,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CALCIUM CHLORIDE 100 MG/ML (10 %) IV SYRG,,24538,LOCAL,Facility,Both,10,mL,,58,49.3,16.6228,58,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),34.8,60,,percent of total billed charges,,
CALCIUM CHLORIDE 100 MG/ML (10 %) IV SYRG,,24538,LOCAL,Facility,Both,10,mL,,58,49.3,16.6228,58,"Health Partners, Inc.",State of Minnesota Advantage Program,47.27,81.5,,percent of total billed charges,,
CALCIUM CHLORIDE 100 MG/ML (10 %) IV SYRG,,24538,LOCAL,Facility,Both,10,mL,,58,49.3,16.6228,58,"Health Partners, Inc.",State Public Programs,29,50,,percent of total billed charges,,
CALCIUM CHLORIDE 100 MG/ML (10 %) IV SYRG,,24538,LOCAL,Facility,Both,10,mL,,58,49.3,16.6228,58,Humana Insurance Company,Commercial PPO,55.1,95,,percent of total billed charges,,
CALCIUM CHLORIDE 100 MG/ML (10 %) IV SYRG,,24538,LOCAL,Facility,Outpatient,10,mL,,58,49.3,16.6228,58,Humana Insurance Company,Medicare PPO,28.42,49,,percent of total billed charges,,
CALCIUM CHLORIDE 100 MG/ML (10 %) IV SYRG,,24538,LOCAL,Facility,Inpatient,10,mL,,58,49.3,16.6228,58,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
CALCIUM CHLORIDE 100 MG/ML (10 %) IV SYRG,,24538,LOCAL,Facility,Both,10,mL,,58,49.3,16.6228,58,Medica,Individual & Family,57.478,99.1,,percent of total billed charges,,
CALCIUM CHLORIDE 100 MG/ML (10 %) IV SYRG,,24538,LOCAL,Facility,Outpatient,10,mL,,58,49.3,16.6228,58,Medica,Medica Advantage Solution,28.884,49.8,,percent of total billed charges,,
CALCIUM CHLORIDE 100 MG/ML (10 %) IV SYRG,,24538,LOCAL,Facility,Inpatient,10,mL,,58,49.3,16.6228,58,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
CALCIUM CHLORIDE 100 MG/ML (10 %) IV SYRG,,24538,LOCAL,Facility,Outpatient,10,mL,,58,49.3,16.6228,58,Medica,Medical Assistance,25.868,44.6,,percent of total billed charges,,
CALCIUM CHLORIDE 100 MG/ML (10 %) IV SYRG,,24538,LOCAL,Facility,Inpatient,10,mL,,58,49.3,16.6228,58,Medica,Medical Assistance,,,,,Included in per diem rate,
CALCIUM CHLORIDE 100 MG/ML (10 %) IV SYRG,,24538,LOCAL,Facility,Outpatient,10,mL,,58,49.3,16.6228,58,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,28.884,49.8,,percent of total billed charges,,
CALCIUM CHLORIDE 100 MG/ML (10 %) IV SYRG,,24538,LOCAL,Facility,Inpatient,10,mL,,58,49.3,16.6228,58,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
CALCIUM CHLORIDE 100 MG/ML (10 %) IV SYRG,,24538,LOCAL,Facility,Both,10,mL,,58,49.3,16.6228,58,"Multiplan, Inc.","Multiplan, Inc.",54.52,94,,percent of total billed charges,,
CALCIUM CHLORIDE 100 MG/ML (10 %) IV SYRG,,24538,LOCAL,Facility,Outpatient,10,mL,,58,49.3,16.6228,58,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,52.258,90.1,,percent of total billed charges,,
CALCIUM CHLORIDE 100 MG/ML (10 %) IV SYRG,,24538,LOCAL,Facility,Inpatient,10,mL,,58,49.3,16.6228,58,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
CALCIUM CHLORIDE 100 MG/ML (10 %) IV SYRG,,24538,LOCAL,Facility,Both,10,mL,,58,49.3,16.6228,58,"Preferred One Administrative Services, INC.",PPO,57.188,98.6,,percent of total billed charges,,
CALCIUM CHLORIDE 100 MG/ML (10 %) IV SYRG,,24538,LOCAL,Facility,Outpatient,10,mL,,58,49.3,16.6228,58,PrimeWest Health,Minnesota Senior Health Options (MSHO),29.841,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
CALCIUM CHLORIDE 100 MG/ML (10 %) IV SYRG,,24538,LOCAL,Facility,Inpatient,10,mL,,58,49.3,16.6228,58,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CALCIUM CHLORIDE 100 MG/ML (10 %) IV SYRG,,24538,LOCAL,Facility,Outpatient,10,mL,,58,49.3,16.6228,58,PrimeWest Health,MinnesotaCare,29.7888,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
CALCIUM CHLORIDE 100 MG/ML (10 %) IV SYRG,,24538,LOCAL,Facility,Inpatient,10,mL,,58,49.3,16.6228,58,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
CALCIUM CHLORIDE 100 MG/ML (10 %) IV SYRG,,24538,LOCAL,Facility,Both,10,mL,,58,49.3,16.6228,58,Sanford Health Plan,Sanford Health Plan,53.36,92,,percent of total billed charges,,
CALCIUM CHLORIDE 100 MG/ML (10 %) IV SYRG,,24538,LOCAL,Facility,Outpatient,10,mL,,58,49.3,16.6228,58,"UCare Health, Inc.",Individual & Family Plan,32.683,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
CALCIUM CHLORIDE 100 MG/ML (10 %) IV SYRG,,24538,LOCAL,Facility,Inpatient,10,mL,,58,49.3,16.6228,58,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
CALCIUM CHLORIDE 100 MG/ML (10 %) IV SYRG,,24538,LOCAL,Facility,Outpatient,10,mL,,58,49.3,16.6228,58,"UCare Health, Inc.",Medical Assistance,29.2726,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CALCIUM CHLORIDE 100 MG/ML (10 %) IV SYRG,,24538,LOCAL,Facility,Inpatient,10,mL,,58,49.3,16.6228,58,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
CALCIUM CHLORIDE 100 MG/ML (10 %) IV SYRG,,24538,LOCAL,Facility,Outpatient,10,mL,,58,49.3,16.6228,58,"UCare Health, Inc.",Medicare Advantage,29.2726,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CALCIUM CHLORIDE 100 MG/ML (10 %) IV SYRG,,24538,LOCAL,Facility,Inpatient,10,mL,,58,49.3,16.6228,58,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CALCIUM CHLORIDE 100 MG/ML (10 %) IV SYRG,,24538,LOCAL,Facility,Outpatient,10,mL,,58,49.3,16.6228,58,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),29.2726,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CALCIUM CHLORIDE 100 MG/ML (10 %) IV SYRG,,24538,LOCAL,Facility,Inpatient,10,mL,,58,49.3,16.6228,58,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CALCIUM CHLORIDE 100 MG/ML (10 %) IV SYRG,,24538,LOCAL,Facility,Both,10,mL,,58,49.3,16.6228,58,UnitedHealthcare,Individual & Family,54.52,94,,percent of total billed charges,,
CALCIUM CHLORIDE 100 MG/ML (10 %) IV SYRG,,24538,LOCAL,Facility,Outpatient,10,mL,,58,49.3,16.6228,58,UnitedHealthcare,Medicare Advantage,28.42,49,,percent of total billed charges,,
CALCIUM CHLORIDE 100 MG/ML (10 %) IV SYRG,,24538,LOCAL,Facility,Inpatient,10,mL,,58,49.3,16.6228,58,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
CALCIUM CHLORIDE 100 MG/ML (10 %) IV SYRG,,24538,LOCAL,Facility,Outpatient,10,mL,,58,49.3,16.6228,58,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,27.84,48,,percent of total billed charges,,100% of DHS outpatient percentage
CALCIUM CHLORIDE 100 MG/ML (10 %) IV SYRG,,24538,LOCAL,Facility,Inpatient,10,mL,,58,49.3,16.6228,58,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
SODIUM BICARBONATE 4.2 % (0.5 MEQ/ML) IV SYRG,,25451,LOCAL,Facility,Both,10,mL,,63,53.55,18.0558,63,Aetna,Commercial,57.96,92,,percent of total billed charges,,
SODIUM BICARBONATE 4.2 % (0.5 MEQ/ML) IV SYRG,,25451,LOCAL,Facility,Outpatient,10,mL,,63,53.55,18.0558,63,Aetna,Medicare Advantage,30.87,49,,percent of total billed charges,,
SODIUM BICARBONATE 4.2 % (0.5 MEQ/ML) IV SYRG,,25451,LOCAL,Facility,Inpatient,10,mL,,63,53.55,18.0558,63,Aetna,Medicare Advantage,,,,,Included in per diem rate,
SODIUM BICARBONATE 4.2 % (0.5 MEQ/ML) IV SYRG,,25451,LOCAL,Facility,Both,10,mL,,63,53.55,18.0558,63,Aetna,PPO,58.59,93,,percent of total billed charges,,
SODIUM BICARBONATE 4.2 % (0.5 MEQ/ML) IV SYRG,,25451,LOCAL,Facility,Both,10,mL,,63,53.55,18.0558,63,America's PPO,America's PPO,60.4989,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SODIUM BICARBONATE 4.2 % (0.5 MEQ/ML) IV SYRG,,25451,LOCAL,Facility,Both,10,mL,,63,53.55,18.0558,63,BlueCross BlueShield Minnesota, Federal Employee Program,61.992,98.4,,percent of total billed charges,,
SODIUM BICARBONATE 4.2 % (0.5 MEQ/ML) IV SYRG,,25451,LOCAL,Facility,Both,10,mL,,63,53.55,18.0558,63,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,63,100,,percent of total billed charges,,
SODIUM BICARBONATE 4.2 % (0.5 MEQ/ML) IV SYRG,,25451,LOCAL,Facility,Both,10,mL,,63,53.55,18.0558,63,BlueCross BlueShield Minnesota,High Value Network Plan,56.7,90,,percent of total billed charges,,
SODIUM BICARBONATE 4.2 % (0.5 MEQ/ML) IV SYRG,,25451,LOCAL,Facility,Outpatient,10,mL,,63,53.55,18.0558,63,BlueCross BlueShield Minnesota,Medicare Advantage,30.87,49,,percent of total billed charges,,
SODIUM BICARBONATE 4.2 % (0.5 MEQ/ML) IV SYRG,,25451,LOCAL,Facility,Inpatient,10,mL,,63,53.55,18.0558,63,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
SODIUM BICARBONATE 4.2 % (0.5 MEQ/ML) IV SYRG,,25451,LOCAL,Facility,Both,10,mL,,63,53.55,18.0558,63,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,55.7991,88.57,,percent of total billed charges,,
SODIUM BICARBONATE 4.2 % (0.5 MEQ/ML) IV SYRG,,25451,LOCAL,Facility,Both,10,mL,,63,53.55,18.0558,63,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,18.0558,28.66,,percent of total billed charges,,
SODIUM BICARBONATE 4.2 % (0.5 MEQ/ML) IV SYRG,,25451,LOCAL,Facility,Outpatient,10,mL,,63,53.55,18.0558,63,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),30.87,49,,percent of total billed charges,,
SODIUM BICARBONATE 4.2 % (0.5 MEQ/ML) IV SYRG,,25451,LOCAL,Facility,Inpatient,10,mL,,63,53.55,18.0558,63,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
SODIUM BICARBONATE 4.2 % (0.5 MEQ/ML) IV SYRG,,25451,LOCAL,Facility,Both,10,mL,,63,53.55,18.0558,63,CorVel,Worker's Compensation,63,100,,percent of total billed charges,,
SODIUM BICARBONATE 4.2 % (0.5 MEQ/ML) IV SYRG,,25451,LOCAL,Facility,Both,10,mL,,63,53.55,18.0558,63,First Health Group Corporation,First Health Network,61.11,97,,percent of total billed charges,,
SODIUM BICARBONATE 4.2 % (0.5 MEQ/ML) IV SYRG,,25451,LOCAL,Facility,Both,10,mL,,63,53.55,18.0558,63,"Health Partners, Inc.",Commercial,59.598,94.6,,percent of total billed charges,,
SODIUM BICARBONATE 4.2 % (0.5 MEQ/ML) IV SYRG,,25451,LOCAL,Facility,Outpatient,10,mL,,63,53.55,18.0558,63,"Health Partners, Inc.",Medicare Advantage,30.87,49,,percent of total billed charges,,
SODIUM BICARBONATE 4.2 % (0.5 MEQ/ML) IV SYRG,,25451,LOCAL,Facility,Inpatient,10,mL,,63,53.55,18.0558,63,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SODIUM BICARBONATE 4.2 % (0.5 MEQ/ML) IV SYRG,,25451,LOCAL,Facility,Both,10,mL,,63,53.55,18.0558,63,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),37.8,60,,percent of total billed charges,,
SODIUM BICARBONATE 4.2 % (0.5 MEQ/ML) IV SYRG,,25451,LOCAL,Facility,Both,10,mL,,63,53.55,18.0558,63,"Health Partners, Inc.",State of Minnesota Advantage Program,51.345,81.5,,percent of total billed charges,,
SODIUM BICARBONATE 4.2 % (0.5 MEQ/ML) IV SYRG,,25451,LOCAL,Facility,Both,10,mL,,63,53.55,18.0558,63,"Health Partners, Inc.",State Public Programs,31.5,50,,percent of total billed charges,,
SODIUM BICARBONATE 4.2 % (0.5 MEQ/ML) IV SYRG,,25451,LOCAL,Facility,Both,10,mL,,63,53.55,18.0558,63,Humana Insurance Company,Commercial PPO,59.85,95,,percent of total billed charges,,
SODIUM BICARBONATE 4.2 % (0.5 MEQ/ML) IV SYRG,,25451,LOCAL,Facility,Outpatient,10,mL,,63,53.55,18.0558,63,Humana Insurance Company,Medicare PPO,30.87,49,,percent of total billed charges,,
SODIUM BICARBONATE 4.2 % (0.5 MEQ/ML) IV SYRG,,25451,LOCAL,Facility,Inpatient,10,mL,,63,53.55,18.0558,63,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
SODIUM BICARBONATE 4.2 % (0.5 MEQ/ML) IV SYRG,,25451,LOCAL,Facility,Both,10,mL,,63,53.55,18.0558,63,Medica,Individual & Family,62.433,99.1,,percent of total billed charges,,
SODIUM BICARBONATE 4.2 % (0.5 MEQ/ML) IV SYRG,,25451,LOCAL,Facility,Outpatient,10,mL,,63,53.55,18.0558,63,Medica,Medica Advantage Solution,31.374,49.8,,percent of total billed charges,,
SODIUM BICARBONATE 4.2 % (0.5 MEQ/ML) IV SYRG,,25451,LOCAL,Facility,Inpatient,10,mL,,63,53.55,18.0558,63,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
SODIUM BICARBONATE 4.2 % (0.5 MEQ/ML) IV SYRG,,25451,LOCAL,Facility,Outpatient,10,mL,,63,53.55,18.0558,63,Medica,Medical Assistance,28.098,44.6,,percent of total billed charges,,
SODIUM BICARBONATE 4.2 % (0.5 MEQ/ML) IV SYRG,,25451,LOCAL,Facility,Inpatient,10,mL,,63,53.55,18.0558,63,Medica,Medical Assistance,,,,,Included in per diem rate,
SODIUM BICARBONATE 4.2 % (0.5 MEQ/ML) IV SYRG,,25451,LOCAL,Facility,Outpatient,10,mL,,63,53.55,18.0558,63,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,31.374,49.8,,percent of total billed charges,,
SODIUM BICARBONATE 4.2 % (0.5 MEQ/ML) IV SYRG,,25451,LOCAL,Facility,Inpatient,10,mL,,63,53.55,18.0558,63,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
SODIUM BICARBONATE 4.2 % (0.5 MEQ/ML) IV SYRG,,25451,LOCAL,Facility,Both,10,mL,,63,53.55,18.0558,63,"Multiplan, Inc.","Multiplan, Inc.",59.22,94,,percent of total billed charges,,
SODIUM BICARBONATE 4.2 % (0.5 MEQ/ML) IV SYRG,,25451,LOCAL,Facility,Outpatient,10,mL,,63,53.55,18.0558,63,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,56.763,90.1,,percent of total billed charges,,
SODIUM BICARBONATE 4.2 % (0.5 MEQ/ML) IV SYRG,,25451,LOCAL,Facility,Inpatient,10,mL,,63,53.55,18.0558,63,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
SODIUM BICARBONATE 4.2 % (0.5 MEQ/ML) IV SYRG,,25451,LOCAL,Facility,Both,10,mL,,63,53.55,18.0558,63,"Preferred One Administrative Services, INC.",PPO,62.118,98.6,,percent of total billed charges,,
SODIUM BICARBONATE 4.2 % (0.5 MEQ/ML) IV SYRG,,25451,LOCAL,Facility,Outpatient,10,mL,,63,53.55,18.0558,63,PrimeWest Health,Minnesota Senior Health Options (MSHO),32.4135,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
SODIUM BICARBONATE 4.2 % (0.5 MEQ/ML) IV SYRG,,25451,LOCAL,Facility,Inpatient,10,mL,,63,53.55,18.0558,63,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SODIUM BICARBONATE 4.2 % (0.5 MEQ/ML) IV SYRG,,25451,LOCAL,Facility,Outpatient,10,mL,,63,53.55,18.0558,63,PrimeWest Health,MinnesotaCare,32.3568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
SODIUM BICARBONATE 4.2 % (0.5 MEQ/ML) IV SYRG,,25451,LOCAL,Facility,Inpatient,10,mL,,63,53.55,18.0558,63,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
SODIUM BICARBONATE 4.2 % (0.5 MEQ/ML) IV SYRG,,25451,LOCAL,Facility,Both,10,mL,,63,53.55,18.0558,63,Sanford Health Plan,Sanford Health Plan,57.96,92,,percent of total billed charges,,
SODIUM BICARBONATE 4.2 % (0.5 MEQ/ML) IV SYRG,,25451,LOCAL,Facility,Outpatient,10,mL,,63,53.55,18.0558,63,"UCare Health, Inc.",Individual & Family Plan,35.5005,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
SODIUM BICARBONATE 4.2 % (0.5 MEQ/ML) IV SYRG,,25451,LOCAL,Facility,Inpatient,10,mL,,63,53.55,18.0558,63,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
SODIUM BICARBONATE 4.2 % (0.5 MEQ/ML) IV SYRG,,25451,LOCAL,Facility,Outpatient,10,mL,,63,53.55,18.0558,63,"UCare Health, Inc.",Medical Assistance,31.7961,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SODIUM BICARBONATE 4.2 % (0.5 MEQ/ML) IV SYRG,,25451,LOCAL,Facility,Inpatient,10,mL,,63,53.55,18.0558,63,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
SODIUM BICARBONATE 4.2 % (0.5 MEQ/ML) IV SYRG,,25451,LOCAL,Facility,Outpatient,10,mL,,63,53.55,18.0558,63,"UCare Health, Inc.",Medicare Advantage,31.7961,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SODIUM BICARBONATE 4.2 % (0.5 MEQ/ML) IV SYRG,,25451,LOCAL,Facility,Inpatient,10,mL,,63,53.55,18.0558,63,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SODIUM BICARBONATE 4.2 % (0.5 MEQ/ML) IV SYRG,,25451,LOCAL,Facility,Outpatient,10,mL,,63,53.55,18.0558,63,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),31.7961,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SODIUM BICARBONATE 4.2 % (0.5 MEQ/ML) IV SYRG,,25451,LOCAL,Facility,Inpatient,10,mL,,63,53.55,18.0558,63,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SODIUM BICARBONATE 4.2 % (0.5 MEQ/ML) IV SYRG,,25451,LOCAL,Facility,Both,10,mL,,63,53.55,18.0558,63,UnitedHealthcare,Individual & Family,59.22,94,,percent of total billed charges,,
SODIUM BICARBONATE 4.2 % (0.5 MEQ/ML) IV SYRG,,25451,LOCAL,Facility,Outpatient,10,mL,,63,53.55,18.0558,63,UnitedHealthcare,Medicare Advantage,30.87,49,,percent of total billed charges,,
SODIUM BICARBONATE 4.2 % (0.5 MEQ/ML) IV SYRG,,25451,LOCAL,Facility,Inpatient,10,mL,,63,53.55,18.0558,63,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
SODIUM BICARBONATE 4.2 % (0.5 MEQ/ML) IV SYRG,,25451,LOCAL,Facility,Outpatient,10,mL,,63,53.55,18.0558,63,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,30.24,48,,percent of total billed charges,,100% of DHS outpatient percentage
SODIUM BICARBONATE 4.2 % (0.5 MEQ/ML) IV SYRG,,25451,LOCAL,Facility,Inpatient,10,mL,,63,53.55,18.0558,63,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"BUPIVACAINE-EPINEPHRINE (PF) 0.25 %-1:200,000 INJ SOLN",,28219,LOCAL,Facility,Both,10,mL,,26,22.1,7.4516,26,Aetna,Commercial,23.92,92,,percent of total billed charges,,
"BUPIVACAINE-EPINEPHRINE (PF) 0.25 %-1:200,000 INJ SOLN",,28219,LOCAL,Facility,Outpatient,10,mL,,26,22.1,7.4516,26,Aetna,Medicare Advantage,12.74,49,,percent of total billed charges,,
"BUPIVACAINE-EPINEPHRINE (PF) 0.25 %-1:200,000 INJ SOLN",,28219,LOCAL,Facility,Inpatient,10,mL,,26,22.1,7.4516,26,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"BUPIVACAINE-EPINEPHRINE (PF) 0.25 %-1:200,000 INJ SOLN",,28219,LOCAL,Facility,Both,10,mL,,26,22.1,7.4516,26,Aetna,PPO,24.18,93,,percent of total billed charges,,
"BUPIVACAINE-EPINEPHRINE (PF) 0.25 %-1:200,000 INJ SOLN",,28219,LOCAL,Facility,Both,10,mL,,26,22.1,7.4516,26,America's PPO,America's PPO,24.9678,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"BUPIVACAINE-EPINEPHRINE (PF) 0.25 %-1:200,000 INJ SOLN",,28219,LOCAL,Facility,Both,10,mL,,26,22.1,7.4516,26,BlueCross BlueShield Minnesota, Federal Employee Program,25.584,98.4,,percent of total billed charges,,
"BUPIVACAINE-EPINEPHRINE (PF) 0.25 %-1:200,000 INJ SOLN",,28219,LOCAL,Facility,Both,10,mL,,26,22.1,7.4516,26,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,26,100,,percent of total billed charges,,
"BUPIVACAINE-EPINEPHRINE (PF) 0.25 %-1:200,000 INJ SOLN",,28219,LOCAL,Facility,Both,10,mL,,26,22.1,7.4516,26,BlueCross BlueShield Minnesota,High Value Network Plan,23.4,90,,percent of total billed charges,,
"BUPIVACAINE-EPINEPHRINE (PF) 0.25 %-1:200,000 INJ SOLN",,28219,LOCAL,Facility,Outpatient,10,mL,,26,22.1,7.4516,26,BlueCross BlueShield Minnesota,Medicare Advantage,12.74,49,,percent of total billed charges,,
"BUPIVACAINE-EPINEPHRINE (PF) 0.25 %-1:200,000 INJ SOLN",,28219,LOCAL,Facility,Inpatient,10,mL,,26,22.1,7.4516,26,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"BUPIVACAINE-EPINEPHRINE (PF) 0.25 %-1:200,000 INJ SOLN",,28219,LOCAL,Facility,Both,10,mL,,26,22.1,7.4516,26,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,23.0282,88.57,,percent of total billed charges,,
"BUPIVACAINE-EPINEPHRINE (PF) 0.25 %-1:200,000 INJ SOLN",,28219,LOCAL,Facility,Both,10,mL,,26,22.1,7.4516,26,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,7.4516,28.66,,percent of total billed charges,,
"BUPIVACAINE-EPINEPHRINE (PF) 0.25 %-1:200,000 INJ SOLN",,28219,LOCAL,Facility,Outpatient,10,mL,,26,22.1,7.4516,26,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),12.74,49,,percent of total billed charges,,
"BUPIVACAINE-EPINEPHRINE (PF) 0.25 %-1:200,000 INJ SOLN",,28219,LOCAL,Facility,Inpatient,10,mL,,26,22.1,7.4516,26,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"BUPIVACAINE-EPINEPHRINE (PF) 0.25 %-1:200,000 INJ SOLN",,28219,LOCAL,Facility,Both,10,mL,,26,22.1,7.4516,26,CorVel,Worker's Compensation,26,100,,percent of total billed charges,,
"BUPIVACAINE-EPINEPHRINE (PF) 0.25 %-1:200,000 INJ SOLN",,28219,LOCAL,Facility,Both,10,mL,,26,22.1,7.4516,26,First Health Group Corporation,First Health Network,25.22,97,,percent of total billed charges,,
"BUPIVACAINE-EPINEPHRINE (PF) 0.25 %-1:200,000 INJ SOLN",,28219,LOCAL,Facility,Both,10,mL,,26,22.1,7.4516,26,"Health Partners, Inc.",Commercial,24.596,94.6,,percent of total billed charges,,
"BUPIVACAINE-EPINEPHRINE (PF) 0.25 %-1:200,000 INJ SOLN",,28219,LOCAL,Facility,Outpatient,10,mL,,26,22.1,7.4516,26,"Health Partners, Inc.",Medicare Advantage,12.74,49,,percent of total billed charges,,
"BUPIVACAINE-EPINEPHRINE (PF) 0.25 %-1:200,000 INJ SOLN",,28219,LOCAL,Facility,Inpatient,10,mL,,26,22.1,7.4516,26,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"BUPIVACAINE-EPINEPHRINE (PF) 0.25 %-1:200,000 INJ SOLN",,28219,LOCAL,Facility,Both,10,mL,,26,22.1,7.4516,26,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),15.6,60,,percent of total billed charges,,
"BUPIVACAINE-EPINEPHRINE (PF) 0.25 %-1:200,000 INJ SOLN",,28219,LOCAL,Facility,Both,10,mL,,26,22.1,7.4516,26,"Health Partners, Inc.",State of Minnesota Advantage Program,21.19,81.5,,percent of total billed charges,,
"BUPIVACAINE-EPINEPHRINE (PF) 0.25 %-1:200,000 INJ SOLN",,28219,LOCAL,Facility,Both,10,mL,,26,22.1,7.4516,26,"Health Partners, Inc.",State Public Programs,13,50,,percent of total billed charges,,
"BUPIVACAINE-EPINEPHRINE (PF) 0.25 %-1:200,000 INJ SOLN",,28219,LOCAL,Facility,Both,10,mL,,26,22.1,7.4516,26,Humana Insurance Company,Commercial PPO,24.7,95,,percent of total billed charges,,
"BUPIVACAINE-EPINEPHRINE (PF) 0.25 %-1:200,000 INJ SOLN",,28219,LOCAL,Facility,Outpatient,10,mL,,26,22.1,7.4516,26,Humana Insurance Company,Medicare PPO,12.74,49,,percent of total billed charges,,
"BUPIVACAINE-EPINEPHRINE (PF) 0.25 %-1:200,000 INJ SOLN",,28219,LOCAL,Facility,Inpatient,10,mL,,26,22.1,7.4516,26,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"BUPIVACAINE-EPINEPHRINE (PF) 0.25 %-1:200,000 INJ SOLN",,28219,LOCAL,Facility,Both,10,mL,,26,22.1,7.4516,26,Medica,Individual & Family,25.766,99.1,,percent of total billed charges,,
"BUPIVACAINE-EPINEPHRINE (PF) 0.25 %-1:200,000 INJ SOLN",,28219,LOCAL,Facility,Outpatient,10,mL,,26,22.1,7.4516,26,Medica,Medica Advantage Solution,12.948,49.8,,percent of total billed charges,,
"BUPIVACAINE-EPINEPHRINE (PF) 0.25 %-1:200,000 INJ SOLN",,28219,LOCAL,Facility,Inpatient,10,mL,,26,22.1,7.4516,26,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"BUPIVACAINE-EPINEPHRINE (PF) 0.25 %-1:200,000 INJ SOLN",,28219,LOCAL,Facility,Outpatient,10,mL,,26,22.1,7.4516,26,Medica,Medical Assistance,11.596,44.6,,percent of total billed charges,,
"BUPIVACAINE-EPINEPHRINE (PF) 0.25 %-1:200,000 INJ SOLN",,28219,LOCAL,Facility,Inpatient,10,mL,,26,22.1,7.4516,26,Medica,Medical Assistance,,,,,Included in per diem rate,
"BUPIVACAINE-EPINEPHRINE (PF) 0.25 %-1:200,000 INJ SOLN",,28219,LOCAL,Facility,Outpatient,10,mL,,26,22.1,7.4516,26,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,12.948,49.8,,percent of total billed charges,,
"BUPIVACAINE-EPINEPHRINE (PF) 0.25 %-1:200,000 INJ SOLN",,28219,LOCAL,Facility,Inpatient,10,mL,,26,22.1,7.4516,26,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"BUPIVACAINE-EPINEPHRINE (PF) 0.25 %-1:200,000 INJ SOLN",,28219,LOCAL,Facility,Both,10,mL,,26,22.1,7.4516,26,"Multiplan, Inc.","Multiplan, Inc.",24.44,94,,percent of total billed charges,,
"BUPIVACAINE-EPINEPHRINE (PF) 0.25 %-1:200,000 INJ SOLN",,28219,LOCAL,Facility,Outpatient,10,mL,,26,22.1,7.4516,26,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,23.426,90.1,,percent of total billed charges,,
"BUPIVACAINE-EPINEPHRINE (PF) 0.25 %-1:200,000 INJ SOLN",,28219,LOCAL,Facility,Inpatient,10,mL,,26,22.1,7.4516,26,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"BUPIVACAINE-EPINEPHRINE (PF) 0.25 %-1:200,000 INJ SOLN",,28219,LOCAL,Facility,Both,10,mL,,26,22.1,7.4516,26,"Preferred One Administrative Services, INC.",PPO,25.636,98.6,,percent of total billed charges,,
"BUPIVACAINE-EPINEPHRINE (PF) 0.25 %-1:200,000 INJ SOLN",,28219,LOCAL,Facility,Outpatient,10,mL,,26,22.1,7.4516,26,PrimeWest Health,Minnesota Senior Health Options (MSHO),13.377,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"BUPIVACAINE-EPINEPHRINE (PF) 0.25 %-1:200,000 INJ SOLN",,28219,LOCAL,Facility,Inpatient,10,mL,,26,22.1,7.4516,26,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"BUPIVACAINE-EPINEPHRINE (PF) 0.25 %-1:200,000 INJ SOLN",,28219,LOCAL,Facility,Outpatient,10,mL,,26,22.1,7.4516,26,PrimeWest Health,MinnesotaCare,13.3536,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"BUPIVACAINE-EPINEPHRINE (PF) 0.25 %-1:200,000 INJ SOLN",,28219,LOCAL,Facility,Inpatient,10,mL,,26,22.1,7.4516,26,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"BUPIVACAINE-EPINEPHRINE (PF) 0.25 %-1:200,000 INJ SOLN",,28219,LOCAL,Facility,Both,10,mL,,26,22.1,7.4516,26,Sanford Health Plan,Sanford Health Plan,23.92,92,,percent of total billed charges,,
"BUPIVACAINE-EPINEPHRINE (PF) 0.25 %-1:200,000 INJ SOLN",,28219,LOCAL,Facility,Outpatient,10,mL,,26,22.1,7.4516,26,"UCare Health, Inc.",Individual & Family Plan,14.651,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"BUPIVACAINE-EPINEPHRINE (PF) 0.25 %-1:200,000 INJ SOLN",,28219,LOCAL,Facility,Inpatient,10,mL,,26,22.1,7.4516,26,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"BUPIVACAINE-EPINEPHRINE (PF) 0.25 %-1:200,000 INJ SOLN",,28219,LOCAL,Facility,Outpatient,10,mL,,26,22.1,7.4516,26,"UCare Health, Inc.",Medical Assistance,13.1222,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"BUPIVACAINE-EPINEPHRINE (PF) 0.25 %-1:200,000 INJ SOLN",,28219,LOCAL,Facility,Inpatient,10,mL,,26,22.1,7.4516,26,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"BUPIVACAINE-EPINEPHRINE (PF) 0.25 %-1:200,000 INJ SOLN",,28219,LOCAL,Facility,Outpatient,10,mL,,26,22.1,7.4516,26,"UCare Health, Inc.",Medicare Advantage,13.1222,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"BUPIVACAINE-EPINEPHRINE (PF) 0.25 %-1:200,000 INJ SOLN",,28219,LOCAL,Facility,Inpatient,10,mL,,26,22.1,7.4516,26,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"BUPIVACAINE-EPINEPHRINE (PF) 0.25 %-1:200,000 INJ SOLN",,28219,LOCAL,Facility,Outpatient,10,mL,,26,22.1,7.4516,26,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),13.1222,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"BUPIVACAINE-EPINEPHRINE (PF) 0.25 %-1:200,000 INJ SOLN",,28219,LOCAL,Facility,Inpatient,10,mL,,26,22.1,7.4516,26,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"BUPIVACAINE-EPINEPHRINE (PF) 0.25 %-1:200,000 INJ SOLN",,28219,LOCAL,Facility,Both,10,mL,,26,22.1,7.4516,26,UnitedHealthcare,Individual & Family,24.44,94,,percent of total billed charges,,
"BUPIVACAINE-EPINEPHRINE (PF) 0.25 %-1:200,000 INJ SOLN",,28219,LOCAL,Facility,Outpatient,10,mL,,26,22.1,7.4516,26,UnitedHealthcare,Medicare Advantage,12.74,49,,percent of total billed charges,,
"BUPIVACAINE-EPINEPHRINE (PF) 0.25 %-1:200,000 INJ SOLN",,28219,LOCAL,Facility,Inpatient,10,mL,,26,22.1,7.4516,26,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"BUPIVACAINE-EPINEPHRINE (PF) 0.25 %-1:200,000 INJ SOLN",,28219,LOCAL,Facility,Outpatient,10,mL,,26,22.1,7.4516,26,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,12.48,48,,percent of total billed charges,,100% of DHS outpatient percentage
"BUPIVACAINE-EPINEPHRINE (PF) 0.25 %-1:200,000 INJ SOLN",,28219,LOCAL,Facility,Inpatient,10,mL,,26,22.1,7.4516,26,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
LIDOCAINE HCL 2 % MM JELP,,84187,LOCAL,Facility,Both,10,mL,,39,33.15,11.1774,39,Aetna,Commercial,35.88,92,,percent of total billed charges,,
LIDOCAINE HCL 2 % MM JELP,,84187,LOCAL,Facility,Outpatient,10,mL,,39,33.15,11.1774,39,Aetna,Medicare Advantage,19.11,49,,percent of total billed charges,,
LIDOCAINE HCL 2 % MM JELP,,84187,LOCAL,Facility,Inpatient,10,mL,,39,33.15,11.1774,39,Aetna,Medicare Advantage,,,,,Included in per diem rate,
LIDOCAINE HCL 2 % MM JELP,,84187,LOCAL,Facility,Both,10,mL,,39,33.15,11.1774,39,Aetna,PPO,36.27,93,,percent of total billed charges,,
LIDOCAINE HCL 2 % MM JELP,,84187,LOCAL,Facility,Both,10,mL,,39,33.15,11.1774,39,America's PPO,America's PPO,37.4517,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
LIDOCAINE HCL 2 % MM JELP,,84187,LOCAL,Facility,Both,10,mL,,39,33.15,11.1774,39,BlueCross BlueShield Minnesota, Federal Employee Program,38.376,98.4,,percent of total billed charges,,
LIDOCAINE HCL 2 % MM JELP,,84187,LOCAL,Facility,Both,10,mL,,39,33.15,11.1774,39,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,39,100,,percent of total billed charges,,
LIDOCAINE HCL 2 % MM JELP,,84187,LOCAL,Facility,Both,10,mL,,39,33.15,11.1774,39,BlueCross BlueShield Minnesota,High Value Network Plan,35.1,90,,percent of total billed charges,,
LIDOCAINE HCL 2 % MM JELP,,84187,LOCAL,Facility,Outpatient,10,mL,,39,33.15,11.1774,39,BlueCross BlueShield Minnesota,Medicare Advantage,19.11,49,,percent of total billed charges,,
LIDOCAINE HCL 2 % MM JELP,,84187,LOCAL,Facility,Inpatient,10,mL,,39,33.15,11.1774,39,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
LIDOCAINE HCL 2 % MM JELP,,84187,LOCAL,Facility,Both,10,mL,,39,33.15,11.1774,39,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,34.5423,88.57,,percent of total billed charges,,
LIDOCAINE HCL 2 % MM JELP,,84187,LOCAL,Facility,Both,10,mL,,39,33.15,11.1774,39,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,11.1774,28.66,,percent of total billed charges,,
LIDOCAINE HCL 2 % MM JELP,,84187,LOCAL,Facility,Outpatient,10,mL,,39,33.15,11.1774,39,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),19.11,49,,percent of total billed charges,,
LIDOCAINE HCL 2 % MM JELP,,84187,LOCAL,Facility,Inpatient,10,mL,,39,33.15,11.1774,39,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
LIDOCAINE HCL 2 % MM JELP,,84187,LOCAL,Facility,Both,10,mL,,39,33.15,11.1774,39,CorVel,Worker's Compensation,39,100,,percent of total billed charges,,
LIDOCAINE HCL 2 % MM JELP,,84187,LOCAL,Facility,Both,10,mL,,39,33.15,11.1774,39,First Health Group Corporation,First Health Network,37.83,97,,percent of total billed charges,,
LIDOCAINE HCL 2 % MM JELP,,84187,LOCAL,Facility,Both,10,mL,,39,33.15,11.1774,39,"Health Partners, Inc.",Commercial,36.894,94.6,,percent of total billed charges,,
LIDOCAINE HCL 2 % MM JELP,,84187,LOCAL,Facility,Outpatient,10,mL,,39,33.15,11.1774,39,"Health Partners, Inc.",Medicare Advantage,19.11,49,,percent of total billed charges,,
LIDOCAINE HCL 2 % MM JELP,,84187,LOCAL,Facility,Inpatient,10,mL,,39,33.15,11.1774,39,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LIDOCAINE HCL 2 % MM JELP,,84187,LOCAL,Facility,Both,10,mL,,39,33.15,11.1774,39,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),23.4,60,,percent of total billed charges,,
LIDOCAINE HCL 2 % MM JELP,,84187,LOCAL,Facility,Both,10,mL,,39,33.15,11.1774,39,"Health Partners, Inc.",State of Minnesota Advantage Program,31.785,81.5,,percent of total billed charges,,
LIDOCAINE HCL 2 % MM JELP,,84187,LOCAL,Facility,Both,10,mL,,39,33.15,11.1774,39,"Health Partners, Inc.",State Public Programs,19.5,50,,percent of total billed charges,,
LIDOCAINE HCL 2 % MM JELP,,84187,LOCAL,Facility,Both,10,mL,,39,33.15,11.1774,39,Humana Insurance Company,Commercial PPO,37.05,95,,percent of total billed charges,,
LIDOCAINE HCL 2 % MM JELP,,84187,LOCAL,Facility,Outpatient,10,mL,,39,33.15,11.1774,39,Humana Insurance Company,Medicare PPO,19.11,49,,percent of total billed charges,,
LIDOCAINE HCL 2 % MM JELP,,84187,LOCAL,Facility,Inpatient,10,mL,,39,33.15,11.1774,39,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
LIDOCAINE HCL 2 % MM JELP,,84187,LOCAL,Facility,Both,10,mL,,39,33.15,11.1774,39,Medica,Individual & Family,38.649,99.1,,percent of total billed charges,,
LIDOCAINE HCL 2 % MM JELP,,84187,LOCAL,Facility,Outpatient,10,mL,,39,33.15,11.1774,39,Medica,Medica Advantage Solution,19.422,49.8,,percent of total billed charges,,
LIDOCAINE HCL 2 % MM JELP,,84187,LOCAL,Facility,Inpatient,10,mL,,39,33.15,11.1774,39,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
LIDOCAINE HCL 2 % MM JELP,,84187,LOCAL,Facility,Outpatient,10,mL,,39,33.15,11.1774,39,Medica,Medical Assistance,17.394,44.6,,percent of total billed charges,,
LIDOCAINE HCL 2 % MM JELP,,84187,LOCAL,Facility,Inpatient,10,mL,,39,33.15,11.1774,39,Medica,Medical Assistance,,,,,Included in per diem rate,
LIDOCAINE HCL 2 % MM JELP,,84187,LOCAL,Facility,Outpatient,10,mL,,39,33.15,11.1774,39,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,19.422,49.8,,percent of total billed charges,,
LIDOCAINE HCL 2 % MM JELP,,84187,LOCAL,Facility,Inpatient,10,mL,,39,33.15,11.1774,39,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
LIDOCAINE HCL 2 % MM JELP,,84187,LOCAL,Facility,Both,10,mL,,39,33.15,11.1774,39,"Multiplan, Inc.","Multiplan, Inc.",36.66,94,,percent of total billed charges,,
LIDOCAINE HCL 2 % MM JELP,,84187,LOCAL,Facility,Outpatient,10,mL,,39,33.15,11.1774,39,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,35.139,90.1,,percent of total billed charges,,
LIDOCAINE HCL 2 % MM JELP,,84187,LOCAL,Facility,Inpatient,10,mL,,39,33.15,11.1774,39,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
LIDOCAINE HCL 2 % MM JELP,,84187,LOCAL,Facility,Both,10,mL,,39,33.15,11.1774,39,"Preferred One Administrative Services, INC.",PPO,38.454,98.6,,percent of total billed charges,,
LIDOCAINE HCL 2 % MM JELP,,84187,LOCAL,Facility,Outpatient,10,mL,,39,33.15,11.1774,39,PrimeWest Health,Minnesota Senior Health Options (MSHO),20.0655,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
LIDOCAINE HCL 2 % MM JELP,,84187,LOCAL,Facility,Inpatient,10,mL,,39,33.15,11.1774,39,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LIDOCAINE HCL 2 % MM JELP,,84187,LOCAL,Facility,Outpatient,10,mL,,39,33.15,11.1774,39,PrimeWest Health,MinnesotaCare,20.0304,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
LIDOCAINE HCL 2 % MM JELP,,84187,LOCAL,Facility,Inpatient,10,mL,,39,33.15,11.1774,39,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
LIDOCAINE HCL 2 % MM JELP,,84187,LOCAL,Facility,Both,10,mL,,39,33.15,11.1774,39,Sanford Health Plan,Sanford Health Plan,35.88,92,,percent of total billed charges,,
LIDOCAINE HCL 2 % MM JELP,,84187,LOCAL,Facility,Outpatient,10,mL,,39,33.15,11.1774,39,"UCare Health, Inc.",Individual & Family Plan,21.9765,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
LIDOCAINE HCL 2 % MM JELP,,84187,LOCAL,Facility,Inpatient,10,mL,,39,33.15,11.1774,39,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
LIDOCAINE HCL 2 % MM JELP,,84187,LOCAL,Facility,Outpatient,10,mL,,39,33.15,11.1774,39,"UCare Health, Inc.",Medical Assistance,19.6833,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LIDOCAINE HCL 2 % MM JELP,,84187,LOCAL,Facility,Inpatient,10,mL,,39,33.15,11.1774,39,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
LIDOCAINE HCL 2 % MM JELP,,84187,LOCAL,Facility,Outpatient,10,mL,,39,33.15,11.1774,39,"UCare Health, Inc.",Medicare Advantage,19.6833,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LIDOCAINE HCL 2 % MM JELP,,84187,LOCAL,Facility,Inpatient,10,mL,,39,33.15,11.1774,39,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LIDOCAINE HCL 2 % MM JELP,,84187,LOCAL,Facility,Outpatient,10,mL,,39,33.15,11.1774,39,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),19.6833,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LIDOCAINE HCL 2 % MM JELP,,84187,LOCAL,Facility,Inpatient,10,mL,,39,33.15,11.1774,39,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LIDOCAINE HCL 2 % MM JELP,,84187,LOCAL,Facility,Both,10,mL,,39,33.15,11.1774,39,UnitedHealthcare,Individual & Family,36.66,94,,percent of total billed charges,,
LIDOCAINE HCL 2 % MM JELP,,84187,LOCAL,Facility,Outpatient,10,mL,,39,33.15,11.1774,39,UnitedHealthcare,Medicare Advantage,19.11,49,,percent of total billed charges,,
LIDOCAINE HCL 2 % MM JELP,,84187,LOCAL,Facility,Inpatient,10,mL,,39,33.15,11.1774,39,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
LIDOCAINE HCL 2 % MM JELP,,84187,LOCAL,Facility,Outpatient,10,mL,,39,33.15,11.1774,39,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,18.72,48,,percent of total billed charges,,100% of DHS outpatient percentage
LIDOCAINE HCL 2 % MM JELP,,84187,LOCAL,Facility,Inpatient,10,mL,,39,33.15,11.1774,39,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Snip Incision Of Lacrimal Punctum (Pro Cah),,68440,CPT,Professional,Both,,,,536,455.6,63.91,536,Aetna,Commercial,455.6,85,,percent of total billed charges,,
Snip Incision Of Lacrimal Punctum (Pro Cah),,68440,CPT,Professional,Both,,,,536,455.6,63.91,536,Aetna,Medicare Advantage,99.28,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Snip Incision Of Lacrimal Punctum (Pro Cah),,68440,CPT,Professional,Both,,,,536,455.6,63.91,536,Aetna,PPO,498.48,93,,percent of total billed charges,,
Snip Incision Of Lacrimal Punctum (Pro Cah),,68440,CPT,Professional,Both,,,,536,455.6,63.91,536,America's PPO,America's PPO,457.9584,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Snip Incision Of Lacrimal Punctum (Pro Cah),,68440,CPT,Professional,Both,,,,536,455.6,63.91,536,BlueCross BlueShield Minnesota, Federal Employee Program,203.14,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Snip Incision Of Lacrimal Punctum (Pro Cah),,68440,CPT,Professional,Both,,,,536,455.6,63.91,536,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,206.39024,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Snip Incision Of Lacrimal Punctum (Pro Cah),,68440,CPT,Professional,Both,,,,536,455.6,63.91,536,BlueCross BlueShield Minnesota,High Value Network Plan,206.39024,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Snip Incision Of Lacrimal Punctum (Pro Cah),,68440,CPT,Professional,Both,,,,536,455.6,63.91,536,BlueCross BlueShield Minnesota,Medicare Advantage,114.2525,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Snip Incision Of Lacrimal Punctum (Pro Cah),,68440,CPT,Professional,Both,,,,536,455.6,63.91,536,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,206.39024,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Snip Incision Of Lacrimal Punctum (Pro Cah),,68440,CPT,Professional,Both,,,,536,455.6,63.91,536,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,73.79208,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Snip Incision Of Lacrimal Punctum (Pro Cah),,68440,CPT,Professional,Both,,,,536,455.6,63.91,536,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),114.2525,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Snip Incision Of Lacrimal Punctum (Pro Cah),,68440,CPT,Professional,Both,,,,536,455.6,63.91,536,CorVel,Worker's Compensation,191.790501,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Snip Incision Of Lacrimal Punctum (Pro Cah),,68440,CPT,Professional,Both,,,,536,455.6,63.91,536,First Health Group Corporation,First Health Network,519.92,97,,percent of total billed charges,,
Snip Incision Of Lacrimal Punctum (Pro Cah),,68440,CPT,Professional,Both,,,,536,455.6,63.91,536,"Health Partners, Inc.",Commercial,206.78,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Snip Incision Of Lacrimal Punctum (Pro Cah),,68440,CPT,Professional,Both,,,,536,455.6,63.91,536,"Health Partners, Inc.",Medicare Advantage,114.2525,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Snip Incision Of Lacrimal Punctum (Pro Cah),,68440,CPT,Professional,Both,,,,536,455.6,63.91,536,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),99.63,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Snip Incision Of Lacrimal Punctum (Pro Cah),,68440,CPT,Professional,Both,,,,536,455.6,63.91,536,"Health Partners, Inc.",State of Minnesota Advantage Program,178.14097,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Snip Incision Of Lacrimal Punctum (Pro Cah),,68440,CPT,Professional,Both,,,,536,455.6,63.91,536,"Health Partners, Inc.",State Public Programs,63.91,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Snip Incision Of Lacrimal Punctum (Pro Cah),,68440,CPT,Professional,Both,,,,536,455.6,63.91,536,Humana Insurance Company,Commercial PPO,99.35,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Snip Incision Of Lacrimal Punctum (Pro Cah),,68440,CPT,Professional,Both,,,,536,455.6,63.91,536,Humana Insurance Company,Medicare PPO,536,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Snip Incision Of Lacrimal Punctum (Pro Cah),,68440,CPT,Professional,Both,,,,536,455.6,63.91,536,Medica,Individual & Family,454.528,84.8,,percent of total billed charges,,
Snip Incision Of Lacrimal Punctum (Pro Cah),,68440,CPT,Professional,Both,,,,536,455.6,63.91,536,Medica,Medica Advantage Solution,266.928,49.8,,percent of total billed charges,,
Snip Incision Of Lacrimal Punctum (Pro Cah),,68440,CPT,Professional,Both,,,,536,455.6,63.91,536,Medica,Medical Assistance,73.79,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Snip Incision Of Lacrimal Punctum (Pro Cah),,68440,CPT,Professional,Both,,,,536,455.6,63.91,536,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,99.35,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Snip Incision Of Lacrimal Punctum (Pro Cah),,68440,CPT,Professional,Both,,,,536,455.6,63.91,536,"Multiplan, Inc.","Multiplan, Inc.",503.84,94,,percent of total billed charges,,
Snip Incision Of Lacrimal Punctum (Pro Cah),,68440,CPT,Professional,Both,,,,536,455.6,63.91,536,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,482.936,90.1,,percent of total billed charges,,
Snip Incision Of Lacrimal Punctum (Pro Cah),,68440,CPT,Professional,Both,,,,536,455.6,63.91,536,"Preferred One Administrative Services, INC.",PPO,528.496,98.6,,percent of total billed charges,,
Snip Incision Of Lacrimal Punctum (Pro Cah),,68440,CPT,Professional,Both,,,,536,455.6,63.91,536,PrimeWest Health,Minnesota Senior Health Options (MSHO),114.2525,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Snip Incision Of Lacrimal Punctum (Pro Cah),,68440,CPT,Professional,Both,,,,536,455.6,63.91,536,PrimeWest Health,MinnesotaCare,78.9575256,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Snip Incision Of Lacrimal Punctum (Pro Cah),,68440,CPT,Professional,Both,,,,536,455.6,63.91,536,Sanford Health Plan,Sanford Health Plan,471.68,88,,percent of total billed charges,,
Snip Incision Of Lacrimal Punctum (Pro Cah),,68440,CPT,Professional,Both,,,,536,455.6,63.91,536,"UCare Health, Inc.",Individual & Family Plan,161.50336,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Snip Incision Of Lacrimal Punctum (Pro Cah),,68440,CPT,Professional,Both,,,,536,455.6,63.91,536,"UCare Health, Inc.",Medical Assistance,81.171288,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Snip Incision Of Lacrimal Punctum (Pro Cah),,68440,CPT,Professional,Both,,,,536,455.6,63.91,536,"UCare Health, Inc.",Medicare Advantage,114.2525,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Snip Incision Of Lacrimal Punctum (Pro Cah),,68440,CPT,Professional,Both,,,,536,455.6,63.91,536,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),91.402,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Snip Incision Of Lacrimal Punctum (Pro Cah),,68440,CPT,Professional,Both,,,,536,455.6,63.91,536,UnitedHealthcare,Individual & Family,536,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Snip Incision Of Lacrimal Punctum (Pro Cah),,68440,CPT,Professional,Both,,,,536,455.6,63.91,536,UnitedHealthcare,Medicare Advantage,114.2525,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Snip Incision Of Lacrimal Punctum (Pro Cah),,68440,CPT,Professional,Both,,,,536,455.6,63.91,536,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,73.79208,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Close Tear Duct Opening By Plug,Ea",,68761,CPT,Facility,Both,,,,301,255.85,86.2666,301,Aetna,Commercial,276.92,92,,percent of total billed charges,,
"Close Tear Duct Opening By Plug,Ea",,68761,CPT,Facility,Outpatient,,,,301,255.85,86.2666,301,Aetna,Medicare Advantage,147.49,49,,percent of total billed charges,,
"Close Tear Duct Opening By Plug,Ea",,68761,CPT,Facility,Inpatient,,,,301,255.85,86.2666,301,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Close Tear Duct Opening By Plug,Ea",,68761,CPT,Facility,Both,,,,301,255.85,86.2666,301,Aetna,PPO,279.93,93,,percent of total billed charges,,
"Close Tear Duct Opening By Plug,Ea",,68761,CPT,Facility,Both,,,,301,255.85,86.2666,301,America's PPO,America's PPO,289.0503,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Close Tear Duct Opening By Plug,Ea",,68761,CPT,Facility,Both,,,,301,255.85,86.2666,301,BlueCross BlueShield Minnesota, Federal Employee Program,296.184,98.4,,percent of total billed charges,,
"Close Tear Duct Opening By Plug,Ea",,68761,CPT,Facility,Both,,,,301,255.85,86.2666,301,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,301,100,,percent of total billed charges,,
"Close Tear Duct Opening By Plug,Ea",,68761,CPT,Facility,Both,,,,301,255.85,86.2666,301,BlueCross BlueShield Minnesota,High Value Network Plan,270.9,90,,percent of total billed charges,,
"Close Tear Duct Opening By Plug,Ea",,68761,CPT,Facility,Outpatient,,,,301,255.85,86.2666,301,BlueCross BlueShield Minnesota,Medicare Advantage,147.49,49,,percent of total billed charges,,
"Close Tear Duct Opening By Plug,Ea",,68761,CPT,Facility,Inpatient,,,,301,255.85,86.2666,301,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Close Tear Duct Opening By Plug,Ea",,68761,CPT,Facility,Both,,,,301,255.85,86.2666,301,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,266.5957,88.57,,percent of total billed charges,,
"Close Tear Duct Opening By Plug,Ea",,68761,CPT,Facility,Both,,,,301,255.85,86.2666,301,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,86.2666,28.66,,percent of total billed charges,,
"Close Tear Duct Opening By Plug,Ea",,68761,CPT,Facility,Outpatient,,,,301,255.85,86.2666,301,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),147.49,49,,percent of total billed charges,,
"Close Tear Duct Opening By Plug,Ea",,68761,CPT,Facility,Inpatient,,,,301,255.85,86.2666,301,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Close Tear Duct Opening By Plug,Ea",,68761,CPT,Facility,Both,,,,301,255.85,86.2666,301,CorVel,Worker's Compensation,301,100,,percent of total billed charges,,
"Close Tear Duct Opening By Plug,Ea",,68761,CPT,Facility,Both,,,,301,255.85,86.2666,301,First Health Group Corporation,First Health Network,291.97,97,,percent of total billed charges,,
"Close Tear Duct Opening By Plug,Ea",,68761,CPT,Facility,Both,,,,301,255.85,86.2666,301,"Health Partners, Inc.",Commercial,284.746,94.6,,percent of total billed charges,,
"Close Tear Duct Opening By Plug,Ea",,68761,CPT,Facility,Outpatient,,,,301,255.85,86.2666,301,"Health Partners, Inc.",Medicare Advantage,147.49,49,,percent of total billed charges,,
"Close Tear Duct Opening By Plug,Ea",,68761,CPT,Facility,Inpatient,,,,301,255.85,86.2666,301,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Close Tear Duct Opening By Plug,Ea",,68761,CPT,Facility,Both,,,,301,255.85,86.2666,301,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),180.6,60,,percent of total billed charges,,
"Close Tear Duct Opening By Plug,Ea",,68761,CPT,Facility,Both,,,,301,255.85,86.2666,301,"Health Partners, Inc.",State of Minnesota Advantage Program,245.315,81.5,,percent of total billed charges,,
"Close Tear Duct Opening By Plug,Ea",,68761,CPT,Facility,Both,,,,301,255.85,86.2666,301,"Health Partners, Inc.",State Public Programs,150.5,50,,percent of total billed charges,,
"Close Tear Duct Opening By Plug,Ea",,68761,CPT,Facility,Both,,,,301,255.85,86.2666,301,Humana Insurance Company,Commercial PPO,285.95,95,,percent of total billed charges,,
"Close Tear Duct Opening By Plug,Ea",,68761,CPT,Facility,Outpatient,,,,301,255.85,86.2666,301,Humana Insurance Company,Medicare PPO,147.49,49,,percent of total billed charges,,
"Close Tear Duct Opening By Plug,Ea",,68761,CPT,Facility,Inpatient,,,,301,255.85,86.2666,301,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Close Tear Duct Opening By Plug,Ea",,68761,CPT,Facility,Both,,,,301,255.85,86.2666,301,Medica,Individual & Family,298.291,99.1,,percent of total billed charges,,
"Close Tear Duct Opening By Plug,Ea",,68761,CPT,Facility,Outpatient,,,,301,255.85,86.2666,301,Medica,Medica Advantage Solution,149.898,49.8,,percent of total billed charges,,
"Close Tear Duct Opening By Plug,Ea",,68761,CPT,Facility,Inpatient,,,,301,255.85,86.2666,301,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Close Tear Duct Opening By Plug,Ea",,68761,CPT,Facility,Outpatient,,,,301,255.85,86.2666,301,Medica,Medical Assistance,299,,,Other,Grouper,All inclusive per visit
"Close Tear Duct Opening By Plug,Ea",,68761,CPT,Facility,Inpatient,,,,301,255.85,86.2666,301,Medica,Medical Assistance,,,,,Included in per diem rate,
"Close Tear Duct Opening By Plug,Ea",,68761,CPT,Facility,Outpatient,,,,301,255.85,86.2666,301,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,149.898,49.8,,percent of total billed charges,,
"Close Tear Duct Opening By Plug,Ea",,68761,CPT,Facility,Inpatient,,,,301,255.85,86.2666,301,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Close Tear Duct Opening By Plug,Ea",,68761,CPT,Facility,Both,,,,301,255.85,86.2666,301,"Multiplan, Inc.","Multiplan, Inc.",282.94,94,,percent of total billed charges,,
"Close Tear Duct Opening By Plug,Ea",,68761,CPT,Facility,Outpatient,,,,301,255.85,86.2666,301,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,271.201,90.1,,percent of total billed charges,,
"Close Tear Duct Opening By Plug,Ea",,68761,CPT,Facility,Inpatient,,,,301,255.85,86.2666,301,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Close Tear Duct Opening By Plug,Ea",,68761,CPT,Facility,Both,,,,301,255.85,86.2666,301,"Preferred One Administrative Services, INC.",PPO,296.786,98.6,,percent of total billed charges,,
"Close Tear Duct Opening By Plug,Ea",,68761,CPT,Facility,Outpatient,,,,301,255.85,86.2666,301,PrimeWest Health,Minnesota Senior Health Options (MSHO),154.8645,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Close Tear Duct Opening By Plug,Ea",,68761,CPT,Facility,Inpatient,,,,301,255.85,86.2666,301,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Close Tear Duct Opening By Plug,Ea",,68761,CPT,Facility,Outpatient,,,,301,255.85,86.2666,301,PrimeWest Health,MinnesotaCare,154.5936,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Close Tear Duct Opening By Plug,Ea",,68761,CPT,Facility,Inpatient,,,,301,255.85,86.2666,301,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Close Tear Duct Opening By Plug,Ea",,68761,CPT,Facility,Both,,,,301,255.85,86.2666,301,Sanford Health Plan,Sanford Health Plan,276.92,92,,percent of total billed charges,,
"Close Tear Duct Opening By Plug,Ea",,68761,CPT,Facility,Outpatient,,,,301,255.85,86.2666,301,"UCare Health, Inc.",Individual & Family Plan,169.6135,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Close Tear Duct Opening By Plug,Ea",,68761,CPT,Facility,Inpatient,,,,301,255.85,86.2666,301,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Close Tear Duct Opening By Plug,Ea",,68761,CPT,Facility,Outpatient,,,,301,255.85,86.2666,301,"UCare Health, Inc.",Medical Assistance,151.9147,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Close Tear Duct Opening By Plug,Ea",,68761,CPT,Facility,Inpatient,,,,301,255.85,86.2666,301,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Close Tear Duct Opening By Plug,Ea",,68761,CPT,Facility,Outpatient,,,,301,255.85,86.2666,301,"UCare Health, Inc.",Medicare Advantage,151.9147,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Close Tear Duct Opening By Plug,Ea",,68761,CPT,Facility,Inpatient,,,,301,255.85,86.2666,301,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Close Tear Duct Opening By Plug,Ea",,68761,CPT,Facility,Outpatient,,,,301,255.85,86.2666,301,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),151.9147,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Close Tear Duct Opening By Plug,Ea",,68761,CPT,Facility,Inpatient,,,,301,255.85,86.2666,301,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Close Tear Duct Opening By Plug,Ea",,68761,CPT,Facility,Both,,,,301,255.85,86.2666,301,UnitedHealthcare,Individual & Family,282.94,94,,percent of total billed charges,,
"Close Tear Duct Opening By Plug,Ea",,68761,CPT,Facility,Outpatient,,,,301,255.85,86.2666,301,UnitedHealthcare,Medicare Advantage,147.49,49,,percent of total billed charges,,
"Close Tear Duct Opening By Plug,Ea",,68761,CPT,Facility,Inpatient,,,,301,255.85,86.2666,301,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Close Tear Duct Opening By Plug,Ea",,68761,CPT,Facility,Outpatient,,,,301,255.85,86.2666,301,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,144.48,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Close Tear Duct Opening By Plug,Ea",,68761,CPT,Facility,Inpatient,,,,301,255.85,86.2666,301,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Close Tear Duct Opening By Plug,Ea (Pro Cah)",,68761,CPT,Professional,Both,,,,449,381.65,75.04,449,Aetna,Commercial,381.65,85,,percent of total billed charges,,
"Close Tear Duct Opening By Plug,Ea (Pro Cah)",,68761,CPT,Professional,Both,,,,449,381.65,75.04,449,Aetna,Medicare Advantage,117.47,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Close Tear Duct Opening By Plug,Ea (Pro Cah)",,68761,CPT,Professional,Both,,,,449,381.65,75.04,449,Aetna,PPO,417.57,93,,percent of total billed charges,,
"Close Tear Duct Opening By Plug,Ea (Pro Cah)",,68761,CPT,Professional,Both,,,,449,381.65,75.04,449,America's PPO,America's PPO,383.6256,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Close Tear Duct Opening By Plug,Ea (Pro Cah)",,68761,CPT,Professional,Both,,,,449,381.65,75.04,449,BlueCross BlueShield Minnesota, Federal Employee Program,238.26,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Close Tear Duct Opening By Plug,Ea (Pro Cah)",,68761,CPT,Professional,Both,,,,449,381.65,75.04,449,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,242.07216,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Close Tear Duct Opening By Plug,Ea (Pro Cah)",,68761,CPT,Professional,Both,,,,449,381.65,75.04,449,BlueCross BlueShield Minnesota,High Value Network Plan,242.07216,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Close Tear Duct Opening By Plug,Ea (Pro Cah)",,68761,CPT,Professional,Both,,,,449,381.65,75.04,449,BlueCross BlueShield Minnesota,Medicare Advantage,134.1935,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Close Tear Duct Opening By Plug,Ea (Pro Cah)",,68761,CPT,Professional,Both,,,,449,381.65,75.04,449,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,242.07216,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Close Tear Duct Opening By Plug,Ea (Pro Cah)",,68761,CPT,Professional,Both,,,,449,381.65,75.04,449,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,86.63432,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Close Tear Duct Opening By Plug,Ea (Pro Cah)",,68761,CPT,Professional,Both,,,,449,381.65,75.04,449,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),134.1935,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Close Tear Duct Opening By Plug,Ea (Pro Cah)",,68761,CPT,Professional,Both,,,,449,381.65,75.04,449,CorVel,Worker's Compensation,226.806222,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Close Tear Duct Opening By Plug,Ea (Pro Cah)",,68761,CPT,Professional,Both,,,,449,381.65,75.04,449,First Health Group Corporation,First Health Network,435.53,97,,percent of total billed charges,,
"Close Tear Duct Opening By Plug,Ea (Pro Cah)",,68761,CPT,Professional,Both,,,,449,381.65,75.04,449,"Health Partners, Inc.",Commercial,244.5,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Close Tear Duct Opening By Plug,Ea (Pro Cah)",,68761,CPT,Professional,Both,,,,449,381.65,75.04,449,"Health Partners, Inc.",Medicare Advantage,134.1935,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Close Tear Duct Opening By Plug,Ea (Pro Cah)",,68761,CPT,Professional,Both,,,,449,381.65,75.04,449,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),116.91,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Close Tear Duct Opening By Plug,Ea (Pro Cah)",,68761,CPT,Professional,Both,,,,449,381.65,75.04,449,"Health Partners, Inc.",State of Minnesota Advantage Program,210.63675,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Close Tear Duct Opening By Plug,Ea (Pro Cah)",,68761,CPT,Professional,Both,,,,449,381.65,75.04,449,"Health Partners, Inc.",State Public Programs,75.04,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Close Tear Duct Opening By Plug,Ea (Pro Cah)",,68761,CPT,Professional,Both,,,,449,381.65,75.04,449,Humana Insurance Company,Commercial PPO,116.69,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Close Tear Duct Opening By Plug,Ea (Pro Cah)",,68761,CPT,Professional,Both,,,,449,381.65,75.04,449,Humana Insurance Company,Medicare PPO,449,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Close Tear Duct Opening By Plug,Ea (Pro Cah)",,68761,CPT,Professional,Both,,,,449,381.65,75.04,449,Medica,Individual & Family,380.752,84.8,,percent of total billed charges,,
"Close Tear Duct Opening By Plug,Ea (Pro Cah)",,68761,CPT,Professional,Both,,,,449,381.65,75.04,449,Medica,Medica Advantage Solution,223.602,49.8,,percent of total billed charges,,
"Close Tear Duct Opening By Plug,Ea (Pro Cah)",,68761,CPT,Professional,Both,,,,449,381.65,75.04,449,Medica,Medical Assistance,86.63,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Close Tear Duct Opening By Plug,Ea (Pro Cah)",,68761,CPT,Professional,Both,,,,449,381.65,75.04,449,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,116.69,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Close Tear Duct Opening By Plug,Ea (Pro Cah)",,68761,CPT,Professional,Both,,,,449,381.65,75.04,449,"Multiplan, Inc.","Multiplan, Inc.",422.06,94,,percent of total billed charges,,
"Close Tear Duct Opening By Plug,Ea (Pro Cah)",,68761,CPT,Professional,Both,,,,449,381.65,75.04,449,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,404.549,90.1,,percent of total billed charges,,
"Close Tear Duct Opening By Plug,Ea (Pro Cah)",,68761,CPT,Professional,Both,,,,449,381.65,75.04,449,"Preferred One Administrative Services, INC.",PPO,442.714,98.6,,percent of total billed charges,,
"Close Tear Duct Opening By Plug,Ea (Pro Cah)",,68761,CPT,Professional,Both,,,,449,381.65,75.04,449,PrimeWest Health,Minnesota Senior Health Options (MSHO),134.1935,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Close Tear Duct Opening By Plug,Ea (Pro Cah)",,68761,CPT,Professional,Both,,,,449,381.65,75.04,449,PrimeWest Health,MinnesotaCare,92.6987224,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Close Tear Duct Opening By Plug,Ea (Pro Cah)",,68761,CPT,Professional,Both,,,,449,381.65,75.04,449,Sanford Health Plan,Sanford Health Plan,395.12,88,,percent of total billed charges,,
"Close Tear Duct Opening By Plug,Ea (Pro Cah)",,68761,CPT,Professional,Both,,,,449,381.65,75.04,449,"UCare Health, Inc.",Individual & Family Plan,189.691264,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Close Tear Duct Opening By Plug,Ea (Pro Cah)",,68761,CPT,Professional,Both,,,,449,381.65,75.04,449,"UCare Health, Inc.",Medical Assistance,95.297752,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Close Tear Duct Opening By Plug,Ea (Pro Cah)",,68761,CPT,Professional,Both,,,,449,381.65,75.04,449,"UCare Health, Inc.",Medicare Advantage,134.1935,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Close Tear Duct Opening By Plug,Ea (Pro Cah)",,68761,CPT,Professional,Both,,,,449,381.65,75.04,449,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),107.3548,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Close Tear Duct Opening By Plug,Ea (Pro Cah)",,68761,CPT,Professional,Both,,,,449,381.65,75.04,449,UnitedHealthcare,Individual & Family,449,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Close Tear Duct Opening By Plug,Ea (Pro Cah)",,68761,CPT,Professional,Both,,,,449,381.65,75.04,449,UnitedHealthcare,Medicare Advantage,134.1935,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Close Tear Duct Opening By Plug,Ea (Pro Cah)",,68761,CPT,Professional,Both,,,,449,381.65,75.04,449,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,86.63432,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Dilation Of Lacrimal Punctum, With Or Without Irrigation (Pro Cah)",,68801,CPT,Professional,Both,,,,306,260.1,50.83,306,Aetna,Commercial,260.1,85,,percent of total billed charges,,
"Dilation Of Lacrimal Punctum, With Or Without Irrigation (Pro Cah)",,68801,CPT,Professional,Both,,,,306,260.1,50.83,306,Aetna,Medicare Advantage,78.36,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Dilation Of Lacrimal Punctum, With Or Without Irrigation (Pro Cah)",,68801,CPT,Professional,Both,,,,306,260.1,50.83,306,Aetna,PPO,284.58,93,,percent of total billed charges,,
"Dilation Of Lacrimal Punctum, With Or Without Irrigation (Pro Cah)",,68801,CPT,Professional,Both,,,,306,260.1,50.83,306,America's PPO,America's PPO,261.4464,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Dilation Of Lacrimal Punctum, With Or Without Irrigation (Pro Cah)",,68801,CPT,Professional,Both,,,,306,260.1,50.83,306,BlueCross BlueShield Minnesota, Federal Employee Program,160.44,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Dilation Of Lacrimal Punctum, With Or Without Irrigation (Pro Cah)",,68801,CPT,Professional,Both,,,,306,260.1,50.83,306,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,163.00704,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Dilation Of Lacrimal Punctum, With Or Without Irrigation (Pro Cah)",,68801,CPT,Professional,Both,,,,306,260.1,50.83,306,BlueCross BlueShield Minnesota,High Value Network Plan,163.00704,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Dilation Of Lacrimal Punctum, With Or Without Irrigation (Pro Cah)",,68801,CPT,Professional,Both,,,,306,260.1,50.83,306,BlueCross BlueShield Minnesota,Medicare Advantage,90.8385,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Dilation Of Lacrimal Punctum, With Or Without Irrigation (Pro Cah)",,68801,CPT,Professional,Both,,,,306,260.1,50.83,306,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,163.00704,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Dilation Of Lacrimal Punctum, With Or Without Irrigation (Pro Cah)",,68801,CPT,Professional,Both,,,,306,260.1,50.83,306,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,58.68416,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Dilation Of Lacrimal Punctum, With Or Without Irrigation (Pro Cah)",,68801,CPT,Professional,Both,,,,306,260.1,50.83,306,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),90.8385,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Dilation Of Lacrimal Punctum, With Or Without Irrigation (Pro Cah)",,68801,CPT,Professional,Both,,,,306,260.1,50.83,306,CorVel,Worker's Compensation,151.5254445,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Dilation Of Lacrimal Punctum, With Or Without Irrigation (Pro Cah)",,68801,CPT,Professional,Both,,,,306,260.1,50.83,306,First Health Group Corporation,First Health Network,296.82,97,,percent of total billed charges,,
"Dilation Of Lacrimal Punctum, With Or Without Irrigation (Pro Cah)",,68801,CPT,Professional,Both,,,,306,260.1,50.83,306,"Health Partners, Inc.",Commercial,163.97,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Dilation Of Lacrimal Punctum, With Or Without Irrigation (Pro Cah)",,68801,CPT,Professional,Both,,,,306,260.1,50.83,306,"Health Partners, Inc.",Medicare Advantage,90.8385,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Dilation Of Lacrimal Punctum, With Or Without Irrigation (Pro Cah)",,68801,CPT,Professional,Both,,,,306,260.1,50.83,306,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),78.96,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Dilation Of Lacrimal Punctum, With Or Without Irrigation (Pro Cah)",,68801,CPT,Professional,Both,,,,306,260.1,50.83,306,"Health Partners, Inc.",State of Minnesota Advantage Program,141.260155,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Dilation Of Lacrimal Punctum, With Or Without Irrigation (Pro Cah)",,68801,CPT,Professional,Both,,,,306,260.1,50.83,306,"Health Partners, Inc.",State Public Programs,50.83,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Dilation Of Lacrimal Punctum, With Or Without Irrigation (Pro Cah)",,68801,CPT,Professional,Both,,,,306,260.1,50.83,306,Humana Insurance Company,Commercial PPO,78.99,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Dilation Of Lacrimal Punctum, With Or Without Irrigation (Pro Cah)",,68801,CPT,Professional,Both,,,,306,260.1,50.83,306,Humana Insurance Company,Medicare PPO,306,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Dilation Of Lacrimal Punctum, With Or Without Irrigation (Pro Cah)",,68801,CPT,Professional,Both,,,,306,260.1,50.83,306,Medica,Individual & Family,259.488,84.8,,percent of total billed charges,,
"Dilation Of Lacrimal Punctum, With Or Without Irrigation (Pro Cah)",,68801,CPT,Professional,Both,,,,306,260.1,50.83,306,Medica,Medica Advantage Solution,152.388,49.8,,percent of total billed charges,,
"Dilation Of Lacrimal Punctum, With Or Without Irrigation (Pro Cah)",,68801,CPT,Professional,Both,,,,306,260.1,50.83,306,Medica,Medical Assistance,58.68,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Dilation Of Lacrimal Punctum, With Or Without Irrigation (Pro Cah)",,68801,CPT,Professional,Both,,,,306,260.1,50.83,306,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,78.99,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Dilation Of Lacrimal Punctum, With Or Without Irrigation (Pro Cah)",,68801,CPT,Professional,Both,,,,306,260.1,50.83,306,"Multiplan, Inc.","Multiplan, Inc.",287.64,94,,percent of total billed charges,,
"Dilation Of Lacrimal Punctum, With Or Without Irrigation (Pro Cah)",,68801,CPT,Professional,Both,,,,306,260.1,50.83,306,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,275.706,90.1,,percent of total billed charges,,
"Dilation Of Lacrimal Punctum, With Or Without Irrigation (Pro Cah)",,68801,CPT,Professional,Both,,,,306,260.1,50.83,306,"Preferred One Administrative Services, INC.",PPO,301.716,98.6,,percent of total billed charges,,
"Dilation Of Lacrimal Punctum, With Or Without Irrigation (Pro Cah)",,68801,CPT,Professional,Both,,,,306,260.1,50.83,306,PrimeWest Health,Minnesota Senior Health Options (MSHO),90.8385,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Dilation Of Lacrimal Punctum, With Or Without Irrigation (Pro Cah)",,68801,CPT,Professional,Both,,,,306,260.1,50.83,306,PrimeWest Health,MinnesotaCare,62.7920512,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Dilation Of Lacrimal Punctum, With Or Without Irrigation (Pro Cah)",,68801,CPT,Professional,Both,,,,306,260.1,50.83,306,Sanford Health Plan,Sanford Health Plan,269.28,88,,percent of total billed charges,,
"Dilation Of Lacrimal Punctum, With Or Without Irrigation (Pro Cah)",,68801,CPT,Professional,Both,,,,306,260.1,50.83,306,"UCare Health, Inc.",Individual & Family Plan,128.406144,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Dilation Of Lacrimal Punctum, With Or Without Irrigation (Pro Cah)",,68801,CPT,Professional,Both,,,,306,260.1,50.83,306,"UCare Health, Inc.",Medical Assistance,64.552576,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Dilation Of Lacrimal Punctum, With Or Without Irrigation (Pro Cah)",,68801,CPT,Professional,Both,,,,306,260.1,50.83,306,"UCare Health, Inc.",Medicare Advantage,90.8385,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Dilation Of Lacrimal Punctum, With Or Without Irrigation (Pro Cah)",,68801,CPT,Professional,Both,,,,306,260.1,50.83,306,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),72.6708,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Dilation Of Lacrimal Punctum, With Or Without Irrigation (Pro Cah)",,68801,CPT,Professional,Both,,,,306,260.1,50.83,306,UnitedHealthcare,Individual & Family,306,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Dilation Of Lacrimal Punctum, With Or Without Irrigation (Pro Cah)",,68801,CPT,Professional,Both,,,,306,260.1,50.83,306,UnitedHealthcare,Medicare Advantage,90.8385,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Dilation Of Lacrimal Punctum, With Or Without Irrigation (Pro Cah)",,68801,CPT,Professional,Both,,,,306,260.1,50.83,306,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,58.68416,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) IV SOLN",,99049,LOCAL,Facility,Both,10,mL,,108,91.8,30.9528,108,Aetna,Commercial,99.36,92,,percent of total billed charges,,
"TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) IV SOLN",,99049,LOCAL,Facility,Outpatient,10,mL,,108,91.8,30.9528,108,Aetna,Medicare Advantage,52.92,49,,percent of total billed charges,,
"TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) IV SOLN",,99049,LOCAL,Facility,Inpatient,10,mL,,108,91.8,30.9528,108,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) IV SOLN",,99049,LOCAL,Facility,Both,10,mL,,108,91.8,30.9528,108,Aetna,PPO,100.44,93,,percent of total billed charges,,
"TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) IV SOLN",,99049,LOCAL,Facility,Both,10,mL,,108,91.8,30.9528,108,America's PPO,America's PPO,103.7124,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) IV SOLN",,99049,LOCAL,Facility,Both,10,mL,,108,91.8,30.9528,108,BlueCross BlueShield Minnesota, Federal Employee Program,106.272,98.4,,percent of total billed charges,,
"TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) IV SOLN",,99049,LOCAL,Facility,Both,10,mL,,108,91.8,30.9528,108,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,108,100,,percent of total billed charges,,
"TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) IV SOLN",,99049,LOCAL,Facility,Both,10,mL,,108,91.8,30.9528,108,BlueCross BlueShield Minnesota,High Value Network Plan,97.2,90,,percent of total billed charges,,
"TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) IV SOLN",,99049,LOCAL,Facility,Outpatient,10,mL,,108,91.8,30.9528,108,BlueCross BlueShield Minnesota,Medicare Advantage,52.92,49,,percent of total billed charges,,
"TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) IV SOLN",,99049,LOCAL,Facility,Inpatient,10,mL,,108,91.8,30.9528,108,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) IV SOLN",,99049,LOCAL,Facility,Both,10,mL,,108,91.8,30.9528,108,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,95.6556,88.57,,percent of total billed charges,,
"TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) IV SOLN",,99049,LOCAL,Facility,Both,10,mL,,108,91.8,30.9528,108,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,30.9528,28.66,,percent of total billed charges,,
"TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) IV SOLN",,99049,LOCAL,Facility,Outpatient,10,mL,,108,91.8,30.9528,108,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),52.92,49,,percent of total billed charges,,
"TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) IV SOLN",,99049,LOCAL,Facility,Inpatient,10,mL,,108,91.8,30.9528,108,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) IV SOLN",,99049,LOCAL,Facility,Both,10,mL,,108,91.8,30.9528,108,CorVel,Worker's Compensation,108,100,,percent of total billed charges,,
"TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) IV SOLN",,99049,LOCAL,Facility,Both,10,mL,,108,91.8,30.9528,108,First Health Group Corporation,First Health Network,104.76,97,,percent of total billed charges,,
"TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) IV SOLN",,99049,LOCAL,Facility,Both,10,mL,,108,91.8,30.9528,108,"Health Partners, Inc.",Commercial,102.168,94.6,,percent of total billed charges,,
"TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) IV SOLN",,99049,LOCAL,Facility,Outpatient,10,mL,,108,91.8,30.9528,108,"Health Partners, Inc.",Medicare Advantage,52.92,49,,percent of total billed charges,,
"TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) IV SOLN",,99049,LOCAL,Facility,Inpatient,10,mL,,108,91.8,30.9528,108,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) IV SOLN",,99049,LOCAL,Facility,Both,10,mL,,108,91.8,30.9528,108,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),64.8,60,,percent of total billed charges,,
"TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) IV SOLN",,99049,LOCAL,Facility,Both,10,mL,,108,91.8,30.9528,108,"Health Partners, Inc.",State of Minnesota Advantage Program,88.02,81.5,,percent of total billed charges,,
"TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) IV SOLN",,99049,LOCAL,Facility,Both,10,mL,,108,91.8,30.9528,108,"Health Partners, Inc.",State Public Programs,54,50,,percent of total billed charges,,
"TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) IV SOLN",,99049,LOCAL,Facility,Both,10,mL,,108,91.8,30.9528,108,Humana Insurance Company,Commercial PPO,102.6,95,,percent of total billed charges,,
"TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) IV SOLN",,99049,LOCAL,Facility,Outpatient,10,mL,,108,91.8,30.9528,108,Humana Insurance Company,Medicare PPO,52.92,49,,percent of total billed charges,,
"TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) IV SOLN",,99049,LOCAL,Facility,Inpatient,10,mL,,108,91.8,30.9528,108,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) IV SOLN",,99049,LOCAL,Facility,Both,10,mL,,108,91.8,30.9528,108,Medica,Individual & Family,107.028,99.1,,percent of total billed charges,,
"TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) IV SOLN",,99049,LOCAL,Facility,Outpatient,10,mL,,108,91.8,30.9528,108,Medica,Medica Advantage Solution,53.784,49.8,,percent of total billed charges,,
"TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) IV SOLN",,99049,LOCAL,Facility,Inpatient,10,mL,,108,91.8,30.9528,108,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) IV SOLN",,99049,LOCAL,Facility,Outpatient,10,mL,,108,91.8,30.9528,108,Medica,Medical Assistance,48.168,44.6,,percent of total billed charges,,
"TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) IV SOLN",,99049,LOCAL,Facility,Inpatient,10,mL,,108,91.8,30.9528,108,Medica,Medical Assistance,,,,,Included in per diem rate,
"TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) IV SOLN",,99049,LOCAL,Facility,Outpatient,10,mL,,108,91.8,30.9528,108,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,53.784,49.8,,percent of total billed charges,,
"TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) IV SOLN",,99049,LOCAL,Facility,Inpatient,10,mL,,108,91.8,30.9528,108,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) IV SOLN",,99049,LOCAL,Facility,Both,10,mL,,108,91.8,30.9528,108,"Multiplan, Inc.","Multiplan, Inc.",101.52,94,,percent of total billed charges,,
"TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) IV SOLN",,99049,LOCAL,Facility,Outpatient,10,mL,,108,91.8,30.9528,108,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,97.308,90.1,,percent of total billed charges,,
"TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) IV SOLN",,99049,LOCAL,Facility,Inpatient,10,mL,,108,91.8,30.9528,108,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) IV SOLN",,99049,LOCAL,Facility,Both,10,mL,,108,91.8,30.9528,108,"Preferred One Administrative Services, INC.",PPO,106.488,98.6,,percent of total billed charges,,
"TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) IV SOLN",,99049,LOCAL,Facility,Outpatient,10,mL,,108,91.8,30.9528,108,PrimeWest Health,Minnesota Senior Health Options (MSHO),55.566,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) IV SOLN",,99049,LOCAL,Facility,Inpatient,10,mL,,108,91.8,30.9528,108,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) IV SOLN",,99049,LOCAL,Facility,Outpatient,10,mL,,108,91.8,30.9528,108,PrimeWest Health,MinnesotaCare,55.4688,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) IV SOLN",,99049,LOCAL,Facility,Inpatient,10,mL,,108,91.8,30.9528,108,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) IV SOLN",,99049,LOCAL,Facility,Both,10,mL,,108,91.8,30.9528,108,Sanford Health Plan,Sanford Health Plan,99.36,92,,percent of total billed charges,,
"TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) IV SOLN",,99049,LOCAL,Facility,Outpatient,10,mL,,108,91.8,30.9528,108,"UCare Health, Inc.",Individual & Family Plan,60.858,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) IV SOLN",,99049,LOCAL,Facility,Inpatient,10,mL,,108,91.8,30.9528,108,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) IV SOLN",,99049,LOCAL,Facility,Outpatient,10,mL,,108,91.8,30.9528,108,"UCare Health, Inc.",Medical Assistance,54.5076,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) IV SOLN",,99049,LOCAL,Facility,Inpatient,10,mL,,108,91.8,30.9528,108,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) IV SOLN",,99049,LOCAL,Facility,Outpatient,10,mL,,108,91.8,30.9528,108,"UCare Health, Inc.",Medicare Advantage,54.5076,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) IV SOLN",,99049,LOCAL,Facility,Inpatient,10,mL,,108,91.8,30.9528,108,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) IV SOLN",,99049,LOCAL,Facility,Outpatient,10,mL,,108,91.8,30.9528,108,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),54.5076,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) IV SOLN",,99049,LOCAL,Facility,Inpatient,10,mL,,108,91.8,30.9528,108,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) IV SOLN",,99049,LOCAL,Facility,Both,10,mL,,108,91.8,30.9528,108,UnitedHealthcare,Individual & Family,101.52,94,,percent of total billed charges,,
"TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) IV SOLN",,99049,LOCAL,Facility,Outpatient,10,mL,,108,91.8,30.9528,108,UnitedHealthcare,Medicare Advantage,52.92,49,,percent of total billed charges,,
"TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) IV SOLN",,99049,LOCAL,Facility,Inpatient,10,mL,,108,91.8,30.9528,108,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) IV SOLN",,99049,LOCAL,Facility,Outpatient,10,mL,,108,91.8,30.9528,108,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,51.84,48,,percent of total billed charges,,100% of DHS outpatient percentage
"TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) IV SOLN",,99049,LOCAL,Facility,Inpatient,10,mL,,108,91.8,30.9528,108,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSP,,104491,LOCAL,Facility,Both,10,mL,,22,18.7,6.3052,22,Aetna,Commercial,20.24,92,,percent of total billed charges,,
MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSP,,104491,LOCAL,Facility,Both,10,mL,,22,18.7,6.3052,22,Aetna,Commercial,20.24,92,,percent of total billed charges,,
MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSP,,104491,LOCAL,Facility,Outpatient,10,mL,,22,18.7,6.3052,22,Aetna,Medicare Advantage,10.78,49,,percent of total billed charges,,
MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSP,,104491,LOCAL,Facility,Outpatient,10,mL,,22,18.7,6.3052,22,Aetna,Medicare Advantage,10.78,49,,percent of total billed charges,,
MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSP,,104491,LOCAL,Facility,Inpatient,10,mL,,22,18.7,6.3052,22,Aetna,Medicare Advantage,,,,,Included in per diem rate,
MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSP,,104491,LOCAL,Facility,Inpatient,10,mL,,22,18.7,6.3052,22,Aetna,Medicare Advantage,,,,,Included in per diem rate,
MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSP,,104491,LOCAL,Facility,Both,10,mL,,22,18.7,6.3052,22,Aetna,PPO,20.46,93,,percent of total billed charges,,
MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSP,,104491,LOCAL,Facility,Both,10,mL,,22,18.7,6.3052,22,Aetna,PPO,20.46,93,,percent of total billed charges,,
MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSP,,104491,LOCAL,Facility,Both,10,mL,,22,18.7,6.3052,22,America's PPO,America's PPO,21.1266,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSP,,104491,LOCAL,Facility,Both,10,mL,,22,18.7,6.3052,22,America's PPO,America's PPO,21.1266,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSP,,104491,LOCAL,Facility,Both,10,mL,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota, Federal Employee Program,21.648,98.4,,percent of total billed charges,,
MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSP,,104491,LOCAL,Facility,Both,10,mL,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota, Federal Employee Program,21.648,98.4,,percent of total billed charges,,
MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSP,,104491,LOCAL,Facility,Both,10,mL,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,22,100,,percent of total billed charges,,
MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSP,,104491,LOCAL,Facility,Both,10,mL,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,22,100,,percent of total billed charges,,
MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSP,,104491,LOCAL,Facility,Both,10,mL,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota,High Value Network Plan,19.8,90,,percent of total billed charges,,
MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSP,,104491,LOCAL,Facility,Both,10,mL,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota,High Value Network Plan,19.8,90,,percent of total billed charges,,
MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSP,,104491,LOCAL,Facility,Outpatient,10,mL,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota,Medicare Advantage,10.78,49,,percent of total billed charges,,
MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSP,,104491,LOCAL,Facility,Outpatient,10,mL,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota,Medicare Advantage,10.78,49,,percent of total billed charges,,
MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSP,,104491,LOCAL,Facility,Inpatient,10,mL,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSP,,104491,LOCAL,Facility,Inpatient,10,mL,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSP,,104491,LOCAL,Facility,Both,10,mL,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,19.4854,88.57,,percent of total billed charges,,
MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSP,,104491,LOCAL,Facility,Both,10,mL,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,19.4854,88.57,,percent of total billed charges,,
MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSP,,104491,LOCAL,Facility,Both,10,mL,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,6.3052,28.66,,percent of total billed charges,,
MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSP,,104491,LOCAL,Facility,Both,10,mL,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,6.3052,28.66,,percent of total billed charges,,
MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSP,,104491,LOCAL,Facility,Outpatient,10,mL,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),10.78,49,,percent of total billed charges,,
MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSP,,104491,LOCAL,Facility,Outpatient,10,mL,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),10.78,49,,percent of total billed charges,,
MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSP,,104491,LOCAL,Facility,Inpatient,10,mL,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSP,,104491,LOCAL,Facility,Inpatient,10,mL,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSP,,104491,LOCAL,Facility,Both,10,mL,,22,18.7,6.3052,22,CorVel,Worker's Compensation,22,100,,percent of total billed charges,,
MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSP,,104491,LOCAL,Facility,Both,10,mL,,22,18.7,6.3052,22,CorVel,Worker's Compensation,22,100,,percent of total billed charges,,
MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSP,,104491,LOCAL,Facility,Both,10,mL,,22,18.7,6.3052,22,First Health Group Corporation,First Health Network,21.34,97,,percent of total billed charges,,
MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSP,,104491,LOCAL,Facility,Both,10,mL,,22,18.7,6.3052,22,First Health Group Corporation,First Health Network,21.34,97,,percent of total billed charges,,
MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSP,,104491,LOCAL,Facility,Both,10,mL,,22,18.7,6.3052,22,"Health Partners, Inc.",Commercial,20.812,94.6,,percent of total billed charges,,
MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSP,,104491,LOCAL,Facility,Both,10,mL,,22,18.7,6.3052,22,"Health Partners, Inc.",Commercial,20.812,94.6,,percent of total billed charges,,
MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSP,,104491,LOCAL,Facility,Outpatient,10,mL,,22,18.7,6.3052,22,"Health Partners, Inc.",Medicare Advantage,10.78,49,,percent of total billed charges,,
MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSP,,104491,LOCAL,Facility,Outpatient,10,mL,,22,18.7,6.3052,22,"Health Partners, Inc.",Medicare Advantage,10.78,49,,percent of total billed charges,,
MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSP,,104491,LOCAL,Facility,Inpatient,10,mL,,22,18.7,6.3052,22,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSP,,104491,LOCAL,Facility,Inpatient,10,mL,,22,18.7,6.3052,22,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSP,,104491,LOCAL,Facility,Both,10,mL,,22,18.7,6.3052,22,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),13.2,60,,percent of total billed charges,,
MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSP,,104491,LOCAL,Facility,Both,10,mL,,22,18.7,6.3052,22,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),13.2,60,,percent of total billed charges,,
MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSP,,104491,LOCAL,Facility,Both,10,mL,,22,18.7,6.3052,22,"Health Partners, Inc.",State of Minnesota Advantage Program,17.93,81.5,,percent of total billed charges,,
MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSP,,104491,LOCAL,Facility,Both,10,mL,,22,18.7,6.3052,22,"Health Partners, Inc.",State of Minnesota Advantage Program,17.93,81.5,,percent of total billed charges,,
MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSP,,104491,LOCAL,Facility,Both,10,mL,,22,18.7,6.3052,22,"Health Partners, Inc.",State Public Programs,11,50,,percent of total billed charges,,
MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSP,,104491,LOCAL,Facility,Both,10,mL,,22,18.7,6.3052,22,"Health Partners, Inc.",State Public Programs,11,50,,percent of total billed charges,,
MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSP,,104491,LOCAL,Facility,Both,10,mL,,22,18.7,6.3052,22,Humana Insurance Company,Commercial PPO,20.9,95,,percent of total billed charges,,
MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSP,,104491,LOCAL,Facility,Both,10,mL,,22,18.7,6.3052,22,Humana Insurance Company,Commercial PPO,20.9,95,,percent of total billed charges,,
MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSP,,104491,LOCAL,Facility,Outpatient,10,mL,,22,18.7,6.3052,22,Humana Insurance Company,Medicare PPO,10.78,49,,percent of total billed charges,,
MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSP,,104491,LOCAL,Facility,Outpatient,10,mL,,22,18.7,6.3052,22,Humana Insurance Company,Medicare PPO,10.78,49,,percent of total billed charges,,
MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSP,,104491,LOCAL,Facility,Inpatient,10,mL,,22,18.7,6.3052,22,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSP,,104491,LOCAL,Facility,Inpatient,10,mL,,22,18.7,6.3052,22,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSP,,104491,LOCAL,Facility,Both,10,mL,,22,18.7,6.3052,22,Medica,Individual & Family,21.802,99.1,,percent of total billed charges,,
MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSP,,104491,LOCAL,Facility,Both,10,mL,,22,18.7,6.3052,22,Medica,Individual & Family,21.802,99.1,,percent of total billed charges,,
MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSP,,104491,LOCAL,Facility,Outpatient,10,mL,,22,18.7,6.3052,22,Medica,Medica Advantage Solution,10.956,49.8,,percent of total billed charges,,
MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSP,,104491,LOCAL,Facility,Outpatient,10,mL,,22,18.7,6.3052,22,Medica,Medica Advantage Solution,10.956,49.8,,percent of total billed charges,,
"Excision Soft Tissue Lesion, External Auditory Canal (Procah)",,69145,CPT,Professional,Both,,,,885,752.25,166.01,885,Aetna,Commercial,752.25,85,,percent of total billed charges,,
"Excision Soft Tissue Lesion, External Auditory Canal (Procah)",,69145,CPT,Professional,Both,,,,885,752.25,166.01,885,Aetna,Medicare Advantage,254.77,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision Soft Tissue Lesion, External Auditory Canal (Procah)",,69145,CPT,Professional,Both,,,,885,752.25,166.01,885,Aetna,PPO,823.05,93,,percent of total billed charges,,
"Excision Soft Tissue Lesion, External Auditory Canal (Procah)",,69145,CPT,Professional,Both,,,,885,752.25,166.01,885,America's PPO,America's PPO,756.144,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Excision Soft Tissue Lesion, External Auditory Canal (Procah)",,69145,CPT,Professional,Both,,,,885,752.25,166.01,885,BlueCross BlueShield Minnesota, Federal Employee Program,535.73,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Excision Soft Tissue Lesion, External Auditory Canal (Procah)",,69145,CPT,Professional,Both,,,,885,752.25,166.01,885,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,544.30168,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision Soft Tissue Lesion, External Auditory Canal (Procah)",,69145,CPT,Professional,Both,,,,885,752.25,166.01,885,BlueCross BlueShield Minnesota,High Value Network Plan,544.30168,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision Soft Tissue Lesion, External Auditory Canal (Procah)",,69145,CPT,Professional,Both,,,,885,752.25,166.01,885,BlueCross BlueShield Minnesota,Medicare Advantage,296.6885,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision Soft Tissue Lesion, External Auditory Canal (Procah)",,69145,CPT,Professional,Both,,,,885,752.25,166.01,885,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,544.30168,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Excision Soft Tissue Lesion, External Auditory Canal (Procah)",,69145,CPT,Professional,Both,,,,885,752.25,166.01,885,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,191.6684,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision Soft Tissue Lesion, External Auditory Canal (Procah)",,69145,CPT,Professional,Both,,,,885,752.25,166.01,885,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),296.6885,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision Soft Tissue Lesion, External Auditory Canal (Procah)",,69145,CPT,Professional,Both,,,,885,752.25,166.01,885,CorVel,Worker's Compensation,502.2441957,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Excision Soft Tissue Lesion, External Auditory Canal (Procah)",,69145,CPT,Professional,Both,,,,885,752.25,166.01,885,First Health Group Corporation,First Health Network,858.45,97,,percent of total billed charges,,
"Excision Soft Tissue Lesion, External Auditory Canal (Procah)",,69145,CPT,Professional,Both,,,,885,752.25,166.01,885,"Health Partners, Inc.",Commercial,542.7,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision Soft Tissue Lesion, External Auditory Canal (Procah)",,69145,CPT,Professional,Both,,,,885,752.25,166.01,885,"Health Partners, Inc.",Medicare Advantage,296.6885,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision Soft Tissue Lesion, External Auditory Canal (Procah)",,69145,CPT,Professional,Both,,,,885,752.25,166.01,885,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),257.88,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Excision Soft Tissue Lesion, External Auditory Canal (Procah)",,69145,CPT,Professional,Both,,,,885,752.25,166.01,885,"Health Partners, Inc.",State of Minnesota Advantage Program,467.53605,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Excision Soft Tissue Lesion, External Auditory Canal (Procah)",,69145,CPT,Professional,Both,,,,885,752.25,166.01,885,"Health Partners, Inc.",State Public Programs,166.01,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Excision Soft Tissue Lesion, External Auditory Canal (Procah)",,69145,CPT,Professional,Both,,,,885,752.25,166.01,885,Humana Insurance Company,Commercial PPO,257.99,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Excision Soft Tissue Lesion, External Auditory Canal (Procah)",,69145,CPT,Professional,Both,,,,885,752.25,166.01,885,Humana Insurance Company,Medicare PPO,885,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Excision Soft Tissue Lesion, External Auditory Canal (Procah)",,69145,CPT,Professional,Both,,,,885,752.25,166.01,885,Medica,Individual & Family,750.48,84.8,,percent of total billed charges,,
"Excision Soft Tissue Lesion, External Auditory Canal (Procah)",,69145,CPT,Professional,Both,,,,885,752.25,166.01,885,Medica,Medica Advantage Solution,440.73,49.8,,percent of total billed charges,,
"Excision Soft Tissue Lesion, External Auditory Canal (Procah)",,69145,CPT,Professional,Both,,,,885,752.25,166.01,885,Medica,Medical Assistance,191.67,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Excision Soft Tissue Lesion, External Auditory Canal (Procah)",,69145,CPT,Professional,Both,,,,885,752.25,166.01,885,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,257.99,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Excision Soft Tissue Lesion, External Auditory Canal (Procah)",,69145,CPT,Professional,Both,,,,885,752.25,166.01,885,"Multiplan, Inc.","Multiplan, Inc.",831.9,94,,percent of total billed charges,,
"Excision Soft Tissue Lesion, External Auditory Canal (Procah)",,69145,CPT,Professional,Both,,,,885,752.25,166.01,885,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,797.385,90.1,,percent of total billed charges,,
"Excision Soft Tissue Lesion, External Auditory Canal (Procah)",,69145,CPT,Professional,Both,,,,885,752.25,166.01,885,"Preferred One Administrative Services, INC.",PPO,872.61,98.6,,percent of total billed charges,,
"Excision Soft Tissue Lesion, External Auditory Canal (Procah)",,69145,CPT,Professional,Both,,,,885,752.25,166.01,885,PrimeWest Health,Minnesota Senior Health Options (MSHO),296.6885,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision Soft Tissue Lesion, External Auditory Canal (Procah)",,69145,CPT,Professional,Both,,,,885,752.25,166.01,885,PrimeWest Health,MinnesotaCare,205.085188,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Excision Soft Tissue Lesion, External Auditory Canal (Procah)",,69145,CPT,Professional,Both,,,,885,752.25,166.01,885,Sanford Health Plan,Sanford Health Plan,778.8,88,,percent of total billed charges,,
"Excision Soft Tissue Lesion, External Auditory Canal (Procah)",,69145,CPT,Professional,Both,,,,885,752.25,166.01,885,"UCare Health, Inc.",Individual & Family Plan,419.388544,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Excision Soft Tissue Lesion, External Auditory Canal (Procah)",,69145,CPT,Professional,Both,,,,885,752.25,166.01,885,"UCare Health, Inc.",Medical Assistance,210.83524,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Excision Soft Tissue Lesion, External Auditory Canal (Procah)",,69145,CPT,Professional,Both,,,,885,752.25,166.01,885,"UCare Health, Inc.",Medicare Advantage,296.6885,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Excision Soft Tissue Lesion, External Auditory Canal (Procah)",,69145,CPT,Professional,Both,,,,885,752.25,166.01,885,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),237.3508,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Excision Soft Tissue Lesion, External Auditory Canal (Procah)",,69145,CPT,Professional,Both,,,,885,752.25,166.01,885,UnitedHealthcare,Individual & Family,885,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Excision Soft Tissue Lesion, External Auditory Canal (Procah)",,69145,CPT,Professional,Both,,,,885,752.25,166.01,885,UnitedHealthcare,Medicare Advantage,296.6885,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Excision Soft Tissue Lesion, External Auditory Canal (Procah)",,69145,CPT,Professional,Both,,,,885,752.25,166.01,885,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,191.6684,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Removal Of Foreign Body From Ear Canal Without General Anesthesia,,69200,CPT,Facility,Both,,,,170,144.5,48.722,170,Aetna,Commercial,156.4,92,,percent of total billed charges,,
Removal Of Foreign Body From Ear Canal Without General Anesthesia,,69200,CPT,Facility,Outpatient,,,,170,144.5,48.722,170,Aetna,Medicare Advantage,83.3,49,,percent of total billed charges,,
Removal Of Foreign Body From Ear Canal Without General Anesthesia,,69200,CPT,Facility,Inpatient,,,,170,144.5,48.722,170,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Removal Of Foreign Body From Ear Canal Without General Anesthesia,,69200,CPT,Facility,Both,,,,170,144.5,48.722,170,Aetna,PPO,158.1,93,,percent of total billed charges,,
Removal Of Foreign Body From Ear Canal Without General Anesthesia,,69200,CPT,Facility,Both,,,,170,144.5,48.722,170,America's PPO,America's PPO,163.251,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Removal Of Foreign Body From Ear Canal Without General Anesthesia,,69200,CPT,Facility,Both,,,,170,144.5,48.722,170,BlueCross BlueShield Minnesota, Federal Employee Program,167.28,98.4,,percent of total billed charges,,
Removal Of Foreign Body From Ear Canal Without General Anesthesia,,69200,CPT,Facility,Both,,,,170,144.5,48.722,170,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,170,100,,percent of total billed charges,,
Removal Of Foreign Body From Ear Canal Without General Anesthesia,,69200,CPT,Facility,Both,,,,170,144.5,48.722,170,BlueCross BlueShield Minnesota,High Value Network Plan,153,90,,percent of total billed charges,,
Removal Of Foreign Body From Ear Canal Without General Anesthesia,,69200,CPT,Facility,Outpatient,,,,170,144.5,48.722,170,BlueCross BlueShield Minnesota,Medicare Advantage,83.3,49,,percent of total billed charges,,
Removal Of Foreign Body From Ear Canal Without General Anesthesia,,69200,CPT,Facility,Inpatient,,,,170,144.5,48.722,170,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Removal Of Foreign Body From Ear Canal Without General Anesthesia,,69200,CPT,Facility,Both,,,,170,144.5,48.722,170,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,150.569,88.57,,percent of total billed charges,,
Removal Of Foreign Body From Ear Canal Without General Anesthesia,,69200,CPT,Facility,Both,,,,170,144.5,48.722,170,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,48.722,28.66,,percent of total billed charges,,
Removal Of Foreign Body From Ear Canal Without General Anesthesia,,69200,CPT,Facility,Outpatient,,,,170,144.5,48.722,170,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),83.3,49,,percent of total billed charges,,
Removal Of Foreign Body From Ear Canal Without General Anesthesia,,69200,CPT,Facility,Inpatient,,,,170,144.5,48.722,170,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Removal Of Foreign Body From Ear Canal Without General Anesthesia,,69200,CPT,Facility,Both,,,,170,144.5,48.722,170,CorVel,Worker's Compensation,170,100,,percent of total billed charges,,
Removal Of Foreign Body From Ear Canal Without General Anesthesia,,69200,CPT,Facility,Both,,,,170,144.5,48.722,170,First Health Group Corporation,First Health Network,164.9,97,,percent of total billed charges,,
Removal Of Foreign Body From Ear Canal Without General Anesthesia,,69200,CPT,Facility,Both,,,,170,144.5,48.722,170,"Health Partners, Inc.",Commercial,160.82,94.6,,percent of total billed charges,,
Removal Of Foreign Body From Ear Canal Without General Anesthesia,,69200,CPT,Facility,Outpatient,,,,170,144.5,48.722,170,"Health Partners, Inc.",Medicare Advantage,83.3,49,,percent of total billed charges,,
Removal Of Foreign Body From Ear Canal Without General Anesthesia,,69200,CPT,Facility,Inpatient,,,,170,144.5,48.722,170,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Removal Of Foreign Body From Ear Canal Without General Anesthesia,,69200,CPT,Facility,Both,,,,170,144.5,48.722,170,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),102,60,,percent of total billed charges,,
Removal Of Foreign Body From Ear Canal Without General Anesthesia,,69200,CPT,Facility,Both,,,,170,144.5,48.722,170,"Health Partners, Inc.",State of Minnesota Advantage Program,138.55,81.5,,percent of total billed charges,,
Removal Of Foreign Body From Ear Canal Without General Anesthesia,,69200,CPT,Facility,Both,,,,170,144.5,48.722,170,"Health Partners, Inc.",State Public Programs,85,50,,percent of total billed charges,,
Removal Of Foreign Body From Ear Canal Without General Anesthesia,,69200,CPT,Facility,Both,,,,170,144.5,48.722,170,Humana Insurance Company,Commercial PPO,161.5,95,,percent of total billed charges,,
Removal Of Foreign Body From Ear Canal Without General Anesthesia,,69200,CPT,Facility,Outpatient,,,,170,144.5,48.722,170,Humana Insurance Company,Medicare PPO,83.3,49,,percent of total billed charges,,
Removal Of Foreign Body From Ear Canal Without General Anesthesia,,69200,CPT,Facility,Inpatient,,,,170,144.5,48.722,170,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Removal Of Foreign Body From Ear Canal Without General Anesthesia,,69200,CPT,Facility,Both,,,,170,144.5,48.722,170,Medica,Individual & Family,168.47,99.1,,percent of total billed charges,,
Removal Of Foreign Body From Ear Canal Without General Anesthesia,,69200,CPT,Facility,Outpatient,,,,170,144.5,48.722,170,Medica,Medica Advantage Solution,84.66,49.8,,percent of total billed charges,,
Removal Of Foreign Body From Ear Canal Without General Anesthesia,,69200,CPT,Facility,Inpatient,,,,170,144.5,48.722,170,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Removal Of Foreign Body From Ear Canal Without General Anesthesia,,69200,CPT,Facility,Outpatient,,,,170,144.5,48.722,170,Medica,Medical Assistance,75.82,44.6,,percent of total billed charges,,
Removal Of Foreign Body From Ear Canal Without General Anesthesia,,69200,CPT,Facility,Inpatient,,,,170,144.5,48.722,170,Medica,Medical Assistance,,,,,Included in per diem rate,
Removal Of Foreign Body From Ear Canal Without General Anesthesia,,69200,CPT,Facility,Outpatient,,,,170,144.5,48.722,170,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,84.66,49.8,,percent of total billed charges,,
Removal Of Foreign Body From Ear Canal Without General Anesthesia,,69200,CPT,Facility,Inpatient,,,,170,144.5,48.722,170,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Removal Of Foreign Body From Ear Canal Without General Anesthesia,,69200,CPT,Facility,Both,,,,170,144.5,48.722,170,"Multiplan, Inc.","Multiplan, Inc.",159.8,94,,percent of total billed charges,,
Removal Of Foreign Body From Ear Canal Without General Anesthesia,,69200,CPT,Facility,Outpatient,,,,170,144.5,48.722,170,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,153.17,90.1,,percent of total billed charges,,
Removal Of Foreign Body From Ear Canal Without General Anesthesia,,69200,CPT,Facility,Inpatient,,,,170,144.5,48.722,170,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Removal Of Foreign Body From Ear Canal Without General Anesthesia,,69200,CPT,Facility,Both,,,,170,144.5,48.722,170,"Preferred One Administrative Services, INC.",PPO,167.62,98.6,,percent of total billed charges,,
Removal Of Foreign Body From Ear Canal Without General Anesthesia,,69200,CPT,Facility,Outpatient,,,,170,144.5,48.722,170,PrimeWest Health,Minnesota Senior Health Options (MSHO),87.465,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Removal Of Foreign Body From Ear Canal Without General Anesthesia,,69200,CPT,Facility,Inpatient,,,,170,144.5,48.722,170,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Removal Of Foreign Body From Ear Canal Without General Anesthesia,,69200,CPT,Facility,Outpatient,,,,170,144.5,48.722,170,PrimeWest Health,MinnesotaCare,87.312,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Removal Of Foreign Body From Ear Canal Without General Anesthesia,,69200,CPT,Facility,Inpatient,,,,170,144.5,48.722,170,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Removal Of Foreign Body From Ear Canal Without General Anesthesia,,69200,CPT,Facility,Both,,,,170,144.5,48.722,170,Sanford Health Plan,Sanford Health Plan,156.4,92,,percent of total billed charges,,
Removal Of Foreign Body From Ear Canal Without General Anesthesia,,69200,CPT,Facility,Outpatient,,,,170,144.5,48.722,170,"UCare Health, Inc.",Individual & Family Plan,95.795,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Removal Of Foreign Body From Ear Canal Without General Anesthesia,,69200,CPT,Facility,Inpatient,,,,170,144.5,48.722,170,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Removal Of Foreign Body From Ear Canal Without General Anesthesia,,69200,CPT,Facility,Outpatient,,,,170,144.5,48.722,170,"UCare Health, Inc.",Medical Assistance,85.799,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Removal Of Foreign Body From Ear Canal Without General Anesthesia,,69200,CPT,Facility,Inpatient,,,,170,144.5,48.722,170,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Removal Of Foreign Body From Ear Canal Without General Anesthesia,,69200,CPT,Facility,Outpatient,,,,170,144.5,48.722,170,"UCare Health, Inc.",Medicare Advantage,85.799,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Removal Of Foreign Body From Ear Canal Without General Anesthesia,,69200,CPT,Facility,Inpatient,,,,170,144.5,48.722,170,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Removal Of Foreign Body From Ear Canal Without General Anesthesia,,69200,CPT,Facility,Outpatient,,,,170,144.5,48.722,170,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),85.799,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Removal Of Foreign Body From Ear Canal Without General Anesthesia,,69200,CPT,Facility,Inpatient,,,,170,144.5,48.722,170,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Removal Of Foreign Body From Ear Canal Without General Anesthesia,,69200,CPT,Facility,Both,,,,170,144.5,48.722,170,UnitedHealthcare,Individual & Family,159.8,94,,percent of total billed charges,,
Removal Of Foreign Body From Ear Canal Without General Anesthesia,,69200,CPT,Facility,Outpatient,,,,170,144.5,48.722,170,UnitedHealthcare,Medicare Advantage,83.3,49,,percent of total billed charges,,
Removal Of Foreign Body From Ear Canal Without General Anesthesia,,69200,CPT,Facility,Inpatient,,,,170,144.5,48.722,170,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Removal Of Foreign Body From Ear Canal Without General Anesthesia,,69200,CPT,Facility,Outpatient,,,,170,144.5,48.722,170,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,81.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
Removal Of Foreign Body From Ear Canal Without General Anesthesia,,69200,CPT,Facility,Inpatient,,,,170,144.5,48.722,170,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Remove Fb External Auditory Canal (Pro Cah),,69200,CPT,Professional,Both,,,,290,246.5,29.22,290,Aetna,Commercial,246.5,85,,percent of total billed charges,,
Remove Fb External Auditory Canal (Pro Cah),,69200,CPT,Professional,Both,,,,290,246.5,29.22,290,Aetna,Medicare Advantage,45.54,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Remove Fb External Auditory Canal (Pro Cah),,69200,CPT,Professional,Both,,,,290,246.5,29.22,290,Aetna,PPO,269.7,93,,percent of total billed charges,,
Remove Fb External Auditory Canal (Pro Cah),,69200,CPT,Professional,Both,,,,290,246.5,29.22,290,America's PPO,America's PPO,247.776,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Remove Fb External Auditory Canal (Pro Cah),,69200,CPT,Professional,Both,,,,290,246.5,29.22,290,BlueCross BlueShield Minnesota, Federal Employee Program,97.09,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Remove Fb External Auditory Canal (Pro Cah),,69200,CPT,Professional,Both,,,,290,246.5,29.22,290,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,98.64344,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Remove Fb External Auditory Canal (Pro Cah),,69200,CPT,Professional,Both,,,,290,246.5,29.22,290,BlueCross BlueShield Minnesota,High Value Network Plan,98.64344,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Remove Fb External Auditory Canal (Pro Cah),,69200,CPT,Professional,Both,,,,290,246.5,29.22,290,BlueCross BlueShield Minnesota,Medicare Advantage,52.4515,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Remove Fb External Auditory Canal (Pro Cah),,69200,CPT,Professional,Both,,,,290,246.5,29.22,290,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,98.64344,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Remove Fb External Auditory Canal (Pro Cah),,69200,CPT,Professional,Both,,,,290,246.5,29.22,290,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,33.74136,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Remove Fb External Auditory Canal (Pro Cah),,69200,CPT,Professional,Both,,,,290,246.5,29.22,290,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),52.4515,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Remove Fb External Auditory Canal (Pro Cah),,69200,CPT,Professional,Both,,,,290,246.5,29.22,290,CorVel,Worker's Compensation,89.0311482,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Remove Fb External Auditory Canal (Pro Cah),,69200,CPT,Professional,Both,,,,290,246.5,29.22,290,First Health Group Corporation,First Health Network,281.3,97,,percent of total billed charges,,
Remove Fb External Auditory Canal (Pro Cah),,69200,CPT,Professional,Both,,,,290,246.5,29.22,290,"Health Partners, Inc.",Commercial,96.5,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Remove Fb External Auditory Canal (Pro Cah),,69200,CPT,Professional,Both,,,,290,246.5,29.22,290,"Health Partners, Inc.",Medicare Advantage,52.4515,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Remove Fb External Auditory Canal (Pro Cah),,69200,CPT,Professional,Both,,,,290,246.5,29.22,290,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),45.75,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Remove Fb External Auditory Canal (Pro Cah),,69200,CPT,Professional,Both,,,,290,246.5,29.22,290,"Health Partners, Inc.",State of Minnesota Advantage Program,83.13475,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Remove Fb External Auditory Canal (Pro Cah),,69200,CPT,Professional,Both,,,,290,246.5,29.22,290,"Health Partners, Inc.",State Public Programs,29.22,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Remove Fb External Auditory Canal (Pro Cah),,69200,CPT,Professional,Both,,,,290,246.5,29.22,290,Humana Insurance Company,Commercial PPO,45.61,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Remove Fb External Auditory Canal (Pro Cah),,69200,CPT,Professional,Both,,,,290,246.5,29.22,290,Humana Insurance Company,Medicare PPO,290,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Remove Fb External Auditory Canal (Pro Cah),,69200,CPT,Professional,Both,,,,290,246.5,29.22,290,Medica,Individual & Family,245.92,84.8,,percent of total billed charges,,
Remove Fb External Auditory Canal (Pro Cah),,69200,CPT,Professional,Both,,,,290,246.5,29.22,290,Medica,Medica Advantage Solution,144.42,49.8,,percent of total billed charges,,
Remove Fb External Auditory Canal (Pro Cah),,69200,CPT,Professional,Both,,,,290,246.5,29.22,290,Medica,Medical Assistance,33.74,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Remove Fb External Auditory Canal (Pro Cah),,69200,CPT,Professional,Both,,,,290,246.5,29.22,290,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,45.61,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Remove Fb External Auditory Canal (Pro Cah),,69200,CPT,Professional,Both,,,,290,246.5,29.22,290,"Multiplan, Inc.","Multiplan, Inc.",272.6,94,,percent of total billed charges,,
Remove Fb External Auditory Canal (Pro Cah),,69200,CPT,Professional,Both,,,,290,246.5,29.22,290,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,261.29,90.1,,percent of total billed charges,,
Remove Fb External Auditory Canal (Pro Cah),,69200,CPT,Professional,Both,,,,290,246.5,29.22,290,"Preferred One Administrative Services, INC.",PPO,285.94,98.6,,percent of total billed charges,,
Remove Fb External Auditory Canal (Pro Cah),,69200,CPT,Professional,Both,,,,290,246.5,29.22,290,PrimeWest Health,Minnesota Senior Health Options (MSHO),52.4515,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Remove Fb External Auditory Canal (Pro Cah),,69200,CPT,Professional,Both,,,,290,246.5,29.22,290,PrimeWest Health,MinnesotaCare,36.1032552,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Remove Fb External Auditory Canal (Pro Cah),,69200,CPT,Professional,Both,,,,290,246.5,29.22,290,Sanford Health Plan,Sanford Health Plan,255.2,88,,percent of total billed charges,,
Remove Fb External Auditory Canal (Pro Cah),,69200,CPT,Professional,Both,,,,290,246.5,29.22,290,"UCare Health, Inc.",Individual & Family Plan,74.143616,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Remove Fb External Auditory Canal (Pro Cah),,69200,CPT,Professional,Both,,,,290,246.5,29.22,290,"UCare Health, Inc.",Medical Assistance,37.115496,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Remove Fb External Auditory Canal (Pro Cah),,69200,CPT,Professional,Both,,,,290,246.5,29.22,290,"UCare Health, Inc.",Medicare Advantage,52.4515,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Remove Fb External Auditory Canal (Pro Cah),,69200,CPT,Professional,Both,,,,290,246.5,29.22,290,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),41.9612,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Remove Fb External Auditory Canal (Pro Cah),,69200,CPT,Professional,Both,,,,290,246.5,29.22,290,UnitedHealthcare,Individual & Family,290,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Remove Fb External Auditory Canal (Pro Cah),,69200,CPT,Professional,Both,,,,290,246.5,29.22,290,UnitedHealthcare,Medicare Advantage,52.4515,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Remove Fb External Auditory Canal (Pro Cah),,69200,CPT,Professional,Both,,,,290,246.5,29.22,290,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,33.74136,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Removal Impacted Cerumen By Irrigation/Lavage, Unilateral",,69209,CPT,Facility,Both,,,,40,34,11.464,40,Aetna,Commercial,36.8,92,,percent of total billed charges,,
"Removal Impacted Cerumen By Irrigation/Lavage, Unilateral",,69209,CPT,Facility,Outpatient,,,,40,34,11.464,40,Aetna,Medicare Advantage,19.6,49,,percent of total billed charges,,
"Removal Impacted Cerumen By Irrigation/Lavage, Unilateral",,69209,CPT,Facility,Inpatient,,,,40,34,11.464,40,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Removal Impacted Cerumen By Irrigation/Lavage, Unilateral",,69209,CPT,Facility,Both,,,,40,34,11.464,40,Aetna,PPO,37.2,93,,percent of total billed charges,,
"Removal Impacted Cerumen By Irrigation/Lavage, Unilateral",,69209,CPT,Facility,Both,,,,40,34,11.464,40,America's PPO,America's PPO,38.412,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Removal Impacted Cerumen By Irrigation/Lavage, Unilateral",,69209,CPT,Facility,Both,,,,40,34,11.464,40,BlueCross BlueShield Minnesota, Federal Employee Program,39.36,98.4,,percent of total billed charges,,
"Removal Impacted Cerumen By Irrigation/Lavage, Unilateral",,69209,CPT,Facility,Both,,,,40,34,11.464,40,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,40,100,,percent of total billed charges,,
"Removal Impacted Cerumen By Irrigation/Lavage, Unilateral",,69209,CPT,Facility,Both,,,,40,34,11.464,40,BlueCross BlueShield Minnesota,High Value Network Plan,36,90,,percent of total billed charges,,
"Removal Impacted Cerumen By Irrigation/Lavage, Unilateral",,69209,CPT,Facility,Outpatient,,,,40,34,11.464,40,BlueCross BlueShield Minnesota,Medicare Advantage,19.6,49,,percent of total billed charges,,
"Removal Impacted Cerumen By Irrigation/Lavage, Unilateral",,69209,CPT,Facility,Inpatient,,,,40,34,11.464,40,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Removal Impacted Cerumen By Irrigation/Lavage, Unilateral",,69209,CPT,Facility,Both,,,,40,34,11.464,40,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,35.428,88.57,,percent of total billed charges,,
"Removal Impacted Cerumen By Irrigation/Lavage, Unilateral",,69209,CPT,Facility,Both,,,,40,34,11.464,40,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,11.464,28.66,,percent of total billed charges,,
"Removal Impacted Cerumen By Irrigation/Lavage, Unilateral",,69209,CPT,Facility,Outpatient,,,,40,34,11.464,40,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),19.6,49,,percent of total billed charges,,
"Removal Impacted Cerumen By Irrigation/Lavage, Unilateral",,69209,CPT,Facility,Inpatient,,,,40,34,11.464,40,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Removal Impacted Cerumen By Irrigation/Lavage, Unilateral",,69209,CPT,Facility,Both,,,,40,34,11.464,40,CorVel,Worker's Compensation,40,100,,percent of total billed charges,,
"Removal Impacted Cerumen By Irrigation/Lavage, Unilateral",,69209,CPT,Facility,Both,,,,40,34,11.464,40,First Health Group Corporation,First Health Network,38.8,97,,percent of total billed charges,,
"Removal Impacted Cerumen By Irrigation/Lavage, Unilateral",,69209,CPT,Facility,Both,,,,40,34,11.464,40,"Health Partners, Inc.",Commercial,37.84,94.6,,percent of total billed charges,,
"Removal Impacted Cerumen By Irrigation/Lavage, Unilateral",,69209,CPT,Facility,Outpatient,,,,40,34,11.464,40,"Health Partners, Inc.",Medicare Advantage,19.6,49,,percent of total billed charges,,
"Removal Impacted Cerumen By Irrigation/Lavage, Unilateral",,69209,CPT,Facility,Inpatient,,,,40,34,11.464,40,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Removal Impacted Cerumen By Irrigation/Lavage, Unilateral",,69209,CPT,Facility,Both,,,,40,34,11.464,40,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),24,60,,percent of total billed charges,,
"Removal Impacted Cerumen By Irrigation/Lavage, Unilateral",,69209,CPT,Facility,Both,,,,40,34,11.464,40,"Health Partners, Inc.",State of Minnesota Advantage Program,32.6,81.5,,percent of total billed charges,,
"Removal Impacted Cerumen By Irrigation/Lavage, Unilateral",,69209,CPT,Facility,Both,,,,40,34,11.464,40,"Health Partners, Inc.",State Public Programs,20,50,,percent of total billed charges,,
"Removal Impacted Cerumen By Irrigation/Lavage, Unilateral",,69209,CPT,Facility,Both,,,,40,34,11.464,40,Humana Insurance Company,Commercial PPO,38,95,,percent of total billed charges,,
"Removal Impacted Cerumen By Irrigation/Lavage, Unilateral",,69209,CPT,Facility,Outpatient,,,,40,34,11.464,40,Humana Insurance Company,Medicare PPO,19.6,49,,percent of total billed charges,,
"Removal Impacted Cerumen By Irrigation/Lavage, Unilateral",,69209,CPT,Facility,Inpatient,,,,40,34,11.464,40,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Removal Impacted Cerumen By Irrigation/Lavage, Unilateral",,69209,CPT,Facility,Both,,,,40,34,11.464,40,Medica,Individual & Family,39.64,99.1,,percent of total billed charges,,
"Removal Impacted Cerumen By Irrigation/Lavage, Unilateral",,69209,CPT,Facility,Outpatient,,,,40,34,11.464,40,Medica,Medica Advantage Solution,19.92,49.8,,percent of total billed charges,,
"Removal Impacted Cerumen By Irrigation/Lavage, Unilateral",,69209,CPT,Facility,Inpatient,,,,40,34,11.464,40,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Removal Impacted Cerumen By Irrigation/Lavage, Unilateral",,69209,CPT,Facility,Outpatient,,,,40,34,11.464,40,Medica,Medical Assistance,17.84,44.6,,percent of total billed charges,,
"Removal Impacted Cerumen By Irrigation/Lavage, Unilateral",,69209,CPT,Facility,Inpatient,,,,40,34,11.464,40,Medica,Medical Assistance,,,,,Included in per diem rate,
"Removal Impacted Cerumen By Irrigation/Lavage, Unilateral",,69209,CPT,Facility,Outpatient,,,,40,34,11.464,40,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,19.92,49.8,,percent of total billed charges,,
"Removal Impacted Cerumen By Irrigation/Lavage, Unilateral",,69209,CPT,Facility,Inpatient,,,,40,34,11.464,40,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Removal Impacted Cerumen By Irrigation/Lavage, Unilateral",,69209,CPT,Facility,Both,,,,40,34,11.464,40,"Multiplan, Inc.","Multiplan, Inc.",37.6,94,,percent of total billed charges,,
"Removal Impacted Cerumen By Irrigation/Lavage, Unilateral",,69209,CPT,Facility,Outpatient,,,,40,34,11.464,40,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,36.04,90.1,,percent of total billed charges,,
"Removal Impacted Cerumen By Irrigation/Lavage, Unilateral",,69209,CPT,Facility,Inpatient,,,,40,34,11.464,40,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Removal Impacted Cerumen By Irrigation/Lavage, Unilateral",,69209,CPT,Facility,Both,,,,40,34,11.464,40,"Preferred One Administrative Services, INC.",PPO,39.44,98.6,,percent of total billed charges,,
"Removal Impacted Cerumen By Irrigation/Lavage, Unilateral",,69209,CPT,Facility,Outpatient,,,,40,34,11.464,40,PrimeWest Health,Minnesota Senior Health Options (MSHO),20.58,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Removal Impacted Cerumen By Irrigation/Lavage, Unilateral",,69209,CPT,Facility,Inpatient,,,,40,34,11.464,40,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Removal Impacted Cerumen By Irrigation/Lavage, Unilateral",,69209,CPT,Facility,Outpatient,,,,40,34,11.464,40,PrimeWest Health,MinnesotaCare,20.544,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Removal Impacted Cerumen By Irrigation/Lavage, Unilateral",,69209,CPT,Facility,Inpatient,,,,40,34,11.464,40,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Removal Impacted Cerumen By Irrigation/Lavage, Unilateral",,69209,CPT,Facility,Both,,,,40,34,11.464,40,Sanford Health Plan,Sanford Health Plan,36.8,92,,percent of total billed charges,,
"Removal Impacted Cerumen By Irrigation/Lavage, Unilateral",,69209,CPT,Facility,Outpatient,,,,40,34,11.464,40,"UCare Health, Inc.",Individual & Family Plan,22.54,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Removal Impacted Cerumen By Irrigation/Lavage, Unilateral",,69209,CPT,Facility,Inpatient,,,,40,34,11.464,40,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Removal Impacted Cerumen By Irrigation/Lavage, Unilateral",,69209,CPT,Facility,Outpatient,,,,40,34,11.464,40,"UCare Health, Inc.",Medical Assistance,20.188,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Removal Impacted Cerumen By Irrigation/Lavage, Unilateral",,69209,CPT,Facility,Inpatient,,,,40,34,11.464,40,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Removal Impacted Cerumen By Irrigation/Lavage, Unilateral",,69209,CPT,Facility,Outpatient,,,,40,34,11.464,40,"UCare Health, Inc.",Medicare Advantage,20.188,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Removal Impacted Cerumen By Irrigation/Lavage, Unilateral",,69209,CPT,Facility,Inpatient,,,,40,34,11.464,40,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Removal Impacted Cerumen By Irrigation/Lavage, Unilateral",,69209,CPT,Facility,Outpatient,,,,40,34,11.464,40,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),20.188,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Removal Impacted Cerumen By Irrigation/Lavage, Unilateral",,69209,CPT,Facility,Inpatient,,,,40,34,11.464,40,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Removal Impacted Cerumen By Irrigation/Lavage, Unilateral",,69209,CPT,Facility,Both,,,,40,34,11.464,40,UnitedHealthcare,Individual & Family,37.6,94,,percent of total billed charges,,
"Removal Impacted Cerumen By Irrigation/Lavage, Unilateral",,69209,CPT,Facility,Outpatient,,,,40,34,11.464,40,UnitedHealthcare,Medicare Advantage,19.6,49,,percent of total billed charges,,
"Removal Impacted Cerumen By Irrigation/Lavage, Unilateral",,69209,CPT,Facility,Inpatient,,,,40,34,11.464,40,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Removal Impacted Cerumen By Irrigation/Lavage, Unilateral",,69209,CPT,Facility,Outpatient,,,,40,34,11.464,40,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,19.2,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Removal Impacted Cerumen By Irrigation/Lavage, Unilateral",,69209,CPT,Facility,Inpatient,,,,40,34,11.464,40,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Removal Impacted Cerumen Using Irrigation/Lavage, Unilateral (Pro Cah)",,69209,CPT,Professional,Both,,,,133,113.05,10.03,133,Aetna,Commercial,113.05,85,,percent of total billed charges,,
"Removal Impacted Cerumen Using Irrigation/Lavage, Unilateral (Pro Cah)",,69209,CPT,Professional,Both,,,,133,113.05,10.03,133,Aetna,Medicare Advantage,15.32,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Removal Impacted Cerumen Using Irrigation/Lavage, Unilateral (Pro Cah)",,69209,CPT,Professional,Both,,,,133,113.05,10.03,133,Aetna,PPO,123.69,93,,percent of total billed charges,,
"Removal Impacted Cerumen Using Irrigation/Lavage, Unilateral (Pro Cah)",,69209,CPT,Professional,Both,,,,133,113.05,10.03,133,America's PPO,America's PPO,113.6352,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Removal Impacted Cerumen Using Irrigation/Lavage, Unilateral (Pro Cah)",,69209,CPT,Professional,Both,,,,133,113.05,10.03,133,BlueCross BlueShield Minnesota, Federal Employee Program,31.68,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Removal Impacted Cerumen Using Irrigation/Lavage, Unilateral (Pro Cah)",,69209,CPT,Professional,Both,,,,133,113.05,10.03,133,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,32.18688,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Removal Impacted Cerumen Using Irrigation/Lavage, Unilateral (Pro Cah)",,69209,CPT,Professional,Both,,,,133,113.05,10.03,133,BlueCross BlueShield Minnesota,High Value Network Plan,32.18688,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Removal Impacted Cerumen Using Irrigation/Lavage, Unilateral (Pro Cah)",,69209,CPT,Professional,Both,,,,133,113.05,10.03,133,BlueCross BlueShield Minnesota,Medicare Advantage,17.9975,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Removal Impacted Cerumen Using Irrigation/Lavage, Unilateral (Pro Cah)",,69209,CPT,Professional,Both,,,,133,113.05,10.03,133,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,32.18688,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Removal Impacted Cerumen Using Irrigation/Lavage, Unilateral (Pro Cah)",,69209,CPT,Professional,Both,,,,133,113.05,10.03,133,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,11.5824,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Removal Impacted Cerumen Using Irrigation/Lavage, Unilateral (Pro Cah)",,69209,CPT,Professional,Both,,,,133,113.05,10.03,133,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),17.9975,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Removal Impacted Cerumen Using Irrigation/Lavage, Unilateral (Pro Cah)",,69209,CPT,Professional,Both,,,,133,113.05,10.03,133,CorVel,Worker's Compensation,30.1761225,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Removal Impacted Cerumen Using Irrigation/Lavage, Unilateral (Pro Cah)",,69209,CPT,Professional,Both,,,,133,113.05,10.03,133,First Health Group Corporation,First Health Network,129.01,97,,percent of total billed charges,,
"Removal Impacted Cerumen Using Irrigation/Lavage, Unilateral (Pro Cah)",,69209,CPT,Professional,Both,,,,133,113.05,10.03,133,"Health Partners, Inc.",Commercial,32.64,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Removal Impacted Cerumen Using Irrigation/Lavage, Unilateral (Pro Cah)",,69209,CPT,Professional,Both,,,,133,113.05,10.03,133,"Health Partners, Inc.",Medicare Advantage,17.9975,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Removal Impacted Cerumen Using Irrigation/Lavage, Unilateral (Pro Cah)",,69209,CPT,Professional,Both,,,,133,113.05,10.03,133,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),15.59,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Removal Impacted Cerumen Using Irrigation/Lavage, Unilateral (Pro Cah)",,69209,CPT,Professional,Both,,,,133,113.05,10.03,133,"Health Partners, Inc.",State of Minnesota Advantage Program,28.11936,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Removal Impacted Cerumen Using Irrigation/Lavage, Unilateral (Pro Cah)",,69209,CPT,Professional,Both,,,,133,113.05,10.03,133,"Health Partners, Inc.",State Public Programs,10.03,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Removal Impacted Cerumen Using Irrigation/Lavage, Unilateral (Pro Cah)",,69209,CPT,Professional,Both,,,,133,113.05,10.03,133,Humana Insurance Company,Commercial PPO,15.65,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Removal Impacted Cerumen Using Irrigation/Lavage, Unilateral (Pro Cah)",,69209,CPT,Professional,Both,,,,133,113.05,10.03,133,Humana Insurance Company,Medicare PPO,133,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Removal Impacted Cerumen Using Irrigation/Lavage, Unilateral (Pro Cah)",,69209,CPT,Professional,Both,,,,133,113.05,10.03,133,Medica,Individual & Family,112.784,84.8,,percent of total billed charges,,
"Removal Impacted Cerumen Using Irrigation/Lavage, Unilateral (Pro Cah)",,69209,CPT,Professional,Both,,,,133,113.05,10.03,133,Medica,Medica Advantage Solution,66.234,49.8,,percent of total billed charges,,
"Removal Impacted Cerumen Using Irrigation/Lavage, Unilateral (Pro Cah)",,69209,CPT,Professional,Both,,,,133,113.05,10.03,133,Medica,Medical Assistance,11.58,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Removal Impacted Cerumen Using Irrigation/Lavage, Unilateral (Pro Cah)",,69209,CPT,Professional,Both,,,,133,113.05,10.03,133,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,15.65,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Removal Impacted Cerumen Using Irrigation/Lavage, Unilateral (Pro Cah)",,69209,CPT,Professional,Both,,,,133,113.05,10.03,133,"Multiplan, Inc.","Multiplan, Inc.",125.02,94,,percent of total billed charges,,
"Removal Impacted Cerumen Using Irrigation/Lavage, Unilateral (Pro Cah)",,69209,CPT,Professional,Both,,,,133,113.05,10.03,133,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,119.833,90.1,,percent of total billed charges,,
"Removal Impacted Cerumen Using Irrigation/Lavage, Unilateral (Pro Cah)",,69209,CPT,Professional,Both,,,,133,113.05,10.03,133,"Preferred One Administrative Services, INC.",PPO,131.138,98.6,,percent of total billed charges,,
"Removal Impacted Cerumen Using Irrigation/Lavage, Unilateral (Pro Cah)",,69209,CPT,Professional,Both,,,,133,113.05,10.03,133,PrimeWest Health,Minnesota Senior Health Options (MSHO),17.9975,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Removal Impacted Cerumen Using Irrigation/Lavage, Unilateral (Pro Cah)",,69209,CPT,Professional,Both,,,,133,113.05,10.03,133,PrimeWest Health,MinnesotaCare,12.393168,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Removal Impacted Cerumen Using Irrigation/Lavage, Unilateral (Pro Cah)",,69209,CPT,Professional,Both,,,,133,113.05,10.03,133,Sanford Health Plan,Sanford Health Plan,117.04,88,,percent of total billed charges,,
"Removal Impacted Cerumen Using Irrigation/Lavage, Unilateral (Pro Cah)",,69209,CPT,Professional,Both,,,,133,113.05,10.03,133,"UCare Health, Inc.",Individual & Family Plan,25.44064,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Removal Impacted Cerumen Using Irrigation/Lavage, Unilateral (Pro Cah)",,69209,CPT,Professional,Both,,,,133,113.05,10.03,133,"UCare Health, Inc.",Medical Assistance,12.74064,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Removal Impacted Cerumen Using Irrigation/Lavage, Unilateral (Pro Cah)",,69209,CPT,Professional,Both,,,,133,113.05,10.03,133,"UCare Health, Inc.",Medicare Advantage,17.9975,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Removal Impacted Cerumen Using Irrigation/Lavage, Unilateral (Pro Cah)",,69209,CPT,Professional,Both,,,,133,113.05,10.03,133,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),14.398,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Removal Impacted Cerumen Using Irrigation/Lavage, Unilateral (Pro Cah)",,69209,CPT,Professional,Both,,,,133,113.05,10.03,133,UnitedHealthcare,Individual & Family,133,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Removal Impacted Cerumen Using Irrigation/Lavage, Unilateral (Pro Cah)",,69209,CPT,Professional,Both,,,,133,113.05,10.03,133,UnitedHealthcare,Medicare Advantage,17.9975,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Removal Impacted Cerumen Using Irrigation/Lavage, Unilateral (Pro Cah)",,69209,CPT,Professional,Both,,,,133,113.05,10.03,133,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,11.5824,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Removal Impacted Cerumen,,69210,CPT,Facility,Both,,,,82,69.7,23.5012,299,Aetna,Commercial,75.44,92,,percent of total billed charges,,
Removal Impacted Cerumen,,69210,CPT,Facility,Outpatient,,,,82,69.7,23.5012,299,Aetna,Medicare Advantage,40.18,49,,percent of total billed charges,,
Removal Impacted Cerumen,,69210,CPT,Facility,Inpatient,,,,82,69.7,23.5012,299,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Removal Impacted Cerumen,,69210,CPT,Facility,Both,,,,82,69.7,23.5012,299,Aetna,PPO,76.26,93,,percent of total billed charges,,
Removal Impacted Cerumen,,69210,CPT,Facility,Both,,,,82,69.7,23.5012,299,America's PPO,America's PPO,78.7446,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Removal Impacted Cerumen,,69210,CPT,Facility,Both,,,,82,69.7,23.5012,299,BlueCross BlueShield Minnesota, Federal Employee Program,80.688,98.4,,percent of total billed charges,,
Removal Impacted Cerumen,,69210,CPT,Facility,Both,,,,82,69.7,23.5012,299,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,82,100,,percent of total billed charges,,
Removal Impacted Cerumen,,69210,CPT,Facility,Both,,,,82,69.7,23.5012,299,BlueCross BlueShield Minnesota,High Value Network Plan,73.8,90,,percent of total billed charges,,
Removal Impacted Cerumen,,69210,CPT,Facility,Outpatient,,,,82,69.7,23.5012,299,BlueCross BlueShield Minnesota,Medicare Advantage,40.18,49,,percent of total billed charges,,
Removal Impacted Cerumen,,69210,CPT,Facility,Inpatient,,,,82,69.7,23.5012,299,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Removal Impacted Cerumen,,69210,CPT,Facility,Both,,,,82,69.7,23.5012,299,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,72.6274,88.57,,percent of total billed charges,,
Removal Impacted Cerumen,,69210,CPT,Facility,Both,,,,82,69.7,23.5012,299,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,23.5012,28.66,,percent of total billed charges,,
Removal Impacted Cerumen,,69210,CPT,Facility,Outpatient,,,,82,69.7,23.5012,299,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),40.18,49,,percent of total billed charges,,
Removal Impacted Cerumen,,69210,CPT,Facility,Inpatient,,,,82,69.7,23.5012,299,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Removal Impacted Cerumen,,69210,CPT,Facility,Both,,,,82,69.7,23.5012,299,CorVel,Worker's Compensation,82,100,,percent of total billed charges,,
Removal Impacted Cerumen,,69210,CPT,Facility,Both,,,,82,69.7,23.5012,299,First Health Group Corporation,First Health Network,79.54,97,,percent of total billed charges,,
Removal Impacted Cerumen,,69210,CPT,Facility,Both,,,,82,69.7,23.5012,299,"Health Partners, Inc.",Commercial,77.572,94.6,,percent of total billed charges,,
Removal Impacted Cerumen,,69210,CPT,Facility,Outpatient,,,,82,69.7,23.5012,299,"Health Partners, Inc.",Medicare Advantage,40.18,49,,percent of total billed charges,,
Removal Impacted Cerumen,,69210,CPT,Facility,Inpatient,,,,82,69.7,23.5012,299,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Removal Impacted Cerumen,,69210,CPT,Facility,Both,,,,82,69.7,23.5012,299,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),49.2,60,,percent of total billed charges,,
Removal Impacted Cerumen,,69210,CPT,Facility,Both,,,,82,69.7,23.5012,299,"Health Partners, Inc.",State of Minnesota Advantage Program,66.83,81.5,,percent of total billed charges,,
Removal Impacted Cerumen,,69210,CPT,Facility,Both,,,,82,69.7,23.5012,299,"Health Partners, Inc.",State Public Programs,41,50,,percent of total billed charges,,
Removal Impacted Cerumen,,69210,CPT,Facility,Both,,,,82,69.7,23.5012,299,Humana Insurance Company,Commercial PPO,77.9,95,,percent of total billed charges,,
Removal Impacted Cerumen,,69210,CPT,Facility,Outpatient,,,,82,69.7,23.5012,299,Humana Insurance Company,Medicare PPO,40.18,49,,percent of total billed charges,,
Removal Impacted Cerumen,,69210,CPT,Facility,Inpatient,,,,82,69.7,23.5012,299,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Removal Impacted Cerumen,,69210,CPT,Facility,Both,,,,82,69.7,23.5012,299,Medica,Individual & Family,81.262,99.1,,percent of total billed charges,,
Removal Impacted Cerumen,,69210,CPT,Facility,Outpatient,,,,82,69.7,23.5012,299,Medica,Medica Advantage Solution,40.836,49.8,,percent of total billed charges,,
Removal Impacted Cerumen,,69210,CPT,Facility,Inpatient,,,,82,69.7,23.5012,299,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Removal Impacted Cerumen,,69210,CPT,Facility,Outpatient,,,,82,69.7,23.5012,299,Medica,Medical Assistance,299,,,Other,Grouper,All inclusive per visit
Removal Impacted Cerumen,,69210,CPT,Facility,Inpatient,,,,82,69.7,23.5012,299,Medica,Medical Assistance,,,,,Included in per diem rate,
Removal Impacted Cerumen,,69210,CPT,Facility,Outpatient,,,,82,69.7,23.5012,299,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,40.836,49.8,,percent of total billed charges,,
Removal Impacted Cerumen,,69210,CPT,Facility,Inpatient,,,,82,69.7,23.5012,299,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Removal Impacted Cerumen,,69210,CPT,Facility,Both,,,,82,69.7,23.5012,299,"Multiplan, Inc.","Multiplan, Inc.",77.08,94,,percent of total billed charges,,
Removal Impacted Cerumen,,69210,CPT,Facility,Outpatient,,,,82,69.7,23.5012,299,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,73.882,90.1,,percent of total billed charges,,
Removal Impacted Cerumen,,69210,CPT,Facility,Inpatient,,,,82,69.7,23.5012,299,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Removal Impacted Cerumen,,69210,CPT,Facility,Both,,,,82,69.7,23.5012,299,"Preferred One Administrative Services, INC.",PPO,80.852,98.6,,percent of total billed charges,,
Removal Impacted Cerumen,,69210,CPT,Facility,Outpatient,,,,82,69.7,23.5012,299,PrimeWest Health,Minnesota Senior Health Options (MSHO),42.189,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Removal Impacted Cerumen,,69210,CPT,Facility,Inpatient,,,,82,69.7,23.5012,299,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Removal Impacted Cerumen,,69210,CPT,Facility,Outpatient,,,,82,69.7,23.5012,299,PrimeWest Health,MinnesotaCare,42.1152,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Removal Impacted Cerumen,,69210,CPT,Facility,Inpatient,,,,82,69.7,23.5012,299,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Removal Impacted Cerumen,,69210,CPT,Facility,Both,,,,82,69.7,23.5012,299,Sanford Health Plan,Sanford Health Plan,75.44,92,,percent of total billed charges,,
Removal Impacted Cerumen,,69210,CPT,Facility,Outpatient,,,,82,69.7,23.5012,299,"UCare Health, Inc.",Individual & Family Plan,46.207,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Removal Impacted Cerumen,,69210,CPT,Facility,Inpatient,,,,82,69.7,23.5012,299,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Removal Impacted Cerumen,,69210,CPT,Facility,Outpatient,,,,82,69.7,23.5012,299,"UCare Health, Inc.",Medical Assistance,41.3854,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Removal Impacted Cerumen,,69210,CPT,Facility,Inpatient,,,,82,69.7,23.5012,299,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Removal Impacted Cerumen,,69210,CPT,Facility,Outpatient,,,,82,69.7,23.5012,299,"UCare Health, Inc.",Medicare Advantage,41.3854,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Removal Impacted Cerumen,,69210,CPT,Facility,Inpatient,,,,82,69.7,23.5012,299,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Removal Impacted Cerumen,,69210,CPT,Facility,Outpatient,,,,82,69.7,23.5012,299,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),41.3854,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Removal Impacted Cerumen,,69210,CPT,Facility,Inpatient,,,,82,69.7,23.5012,299,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Removal Impacted Cerumen,,69210,CPT,Facility,Both,,,,82,69.7,23.5012,299,UnitedHealthcare,Individual & Family,77.08,94,,percent of total billed charges,,
Removal Impacted Cerumen,,69210,CPT,Facility,Outpatient,,,,82,69.7,23.5012,299,UnitedHealthcare,Medicare Advantage,40.18,49,,percent of total billed charges,,
Removal Impacted Cerumen,,69210,CPT,Facility,Inpatient,,,,82,69.7,23.5012,299,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Removal Impacted Cerumen,,69210,CPT,Facility,Outpatient,,,,82,69.7,23.5012,299,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,39.36,48,,percent of total billed charges,,100% of DHS outpatient percentage
Removal Impacted Cerumen,,69210,CPT,Facility,Inpatient,,,,82,69.7,23.5012,299,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Removal Impacted Cerumen Requiring Instrumentation, Unilateral (Pro Cah)",,69210,CPT,Professional,Both,,,,117,99.45,20.06,117,Aetna,Commercial,99.45,85,,percent of total billed charges,,
"Removal Impacted Cerumen Requiring Instrumentation, Unilateral (Pro Cah)",,69210,CPT,Professional,Both,,,,117,99.45,20.06,117,Aetna,Medicare Advantage,31.94,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Removal Impacted Cerumen Requiring Instrumentation, Unilateral (Pro Cah)",,69210,CPT,Professional,Both,,,,117,99.45,20.06,117,Aetna,PPO,108.81,93,,percent of total billed charges,,
"Removal Impacted Cerumen Requiring Instrumentation, Unilateral (Pro Cah)",,69210,CPT,Professional,Both,,,,117,99.45,20.06,117,America's PPO,America's PPO,99.9648,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Removal Impacted Cerumen Requiring Instrumentation, Unilateral (Pro Cah)",,69210,CPT,Professional,Both,,,,117,99.45,20.06,117,BlueCross BlueShield Minnesota, Federal Employee Program,66.79,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Removal Impacted Cerumen Requiring Instrumentation, Unilateral (Pro Cah)",,69210,CPT,Professional,Both,,,,117,99.45,20.06,117,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,67.85864,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Removal Impacted Cerumen Requiring Instrumentation, Unilateral (Pro Cah)",,69210,CPT,Professional,Both,,,,117,99.45,20.06,117,BlueCross BlueShield Minnesota,High Value Network Plan,67.85864,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Removal Impacted Cerumen Requiring Instrumentation, Unilateral (Pro Cah)",,69210,CPT,Professional,Both,,,,117,99.45,20.06,117,BlueCross BlueShield Minnesota,Medicare Advantage,35.903,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Removal Impacted Cerumen Requiring Instrumentation, Unilateral (Pro Cah)",,69210,CPT,Professional,Both,,,,117,99.45,20.06,117,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,67.85864,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Removal Impacted Cerumen Requiring Instrumentation, Unilateral (Pro Cah)",,69210,CPT,Professional,Both,,,,117,99.45,20.06,117,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,23.1648,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Removal Impacted Cerumen Requiring Instrumentation, Unilateral (Pro Cah)",,69210,CPT,Professional,Both,,,,117,99.45,20.06,117,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),35.903,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Removal Impacted Cerumen Requiring Instrumentation, Unilateral (Pro Cah)",,69210,CPT,Professional,Both,,,,117,99.45,20.06,117,CorVel,Worker's Compensation,61.4793576,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Removal Impacted Cerumen Requiring Instrumentation, Unilateral (Pro Cah)",,69210,CPT,Professional,Both,,,,117,99.45,20.06,117,First Health Group Corporation,First Health Network,113.49,97,,percent of total billed charges,,
"Removal Impacted Cerumen Requiring Instrumentation, Unilateral (Pro Cah)",,69210,CPT,Professional,Both,,,,117,99.45,20.06,117,"Health Partners, Inc.",Commercial,66.02,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Removal Impacted Cerumen Requiring Instrumentation, Unilateral (Pro Cah)",,69210,CPT,Professional,Both,,,,117,99.45,20.06,117,"Health Partners, Inc.",Medicare Advantage,35.903,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Removal Impacted Cerumen Requiring Instrumentation, Unilateral (Pro Cah)",,69210,CPT,Professional,Both,,,,117,99.45,20.06,117,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),31.52,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Removal Impacted Cerumen Requiring Instrumentation, Unilateral (Pro Cah)",,69210,CPT,Professional,Both,,,,117,99.45,20.06,117,"Health Partners, Inc.",State of Minnesota Advantage Program,56.87623,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Removal Impacted Cerumen Requiring Instrumentation, Unilateral (Pro Cah)",,69210,CPT,Professional,Both,,,,117,99.45,20.06,117,"Health Partners, Inc.",State Public Programs,20.06,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Removal Impacted Cerumen Requiring Instrumentation, Unilateral (Pro Cah)",,69210,CPT,Professional,Both,,,,117,99.45,20.06,117,Humana Insurance Company,Commercial PPO,31.22,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Removal Impacted Cerumen Requiring Instrumentation, Unilateral (Pro Cah)",,69210,CPT,Professional,Both,,,,117,99.45,20.06,117,Humana Insurance Company,Medicare PPO,117,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Removal Impacted Cerumen Requiring Instrumentation, Unilateral (Pro Cah)",,69210,CPT,Professional,Both,,,,117,99.45,20.06,117,Medica,Individual & Family,99.216,84.8,,percent of total billed charges,,
"Removal Impacted Cerumen Requiring Instrumentation, Unilateral (Pro Cah)",,69210,CPT,Professional,Both,,,,117,99.45,20.06,117,Medica,Medica Advantage Solution,58.266,49.8,,percent of total billed charges,,
"Removal Impacted Cerumen Requiring Instrumentation, Unilateral (Pro Cah)",,69210,CPT,Professional,Both,,,,117,99.45,20.06,117,Medica,Medical Assistance,23.16,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Removal Impacted Cerumen Requiring Instrumentation, Unilateral (Pro Cah)",,69210,CPT,Professional,Both,,,,117,99.45,20.06,117,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,31.22,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Removal Impacted Cerumen Requiring Instrumentation, Unilateral (Pro Cah)",,69210,CPT,Professional,Both,,,,117,99.45,20.06,117,"Multiplan, Inc.","Multiplan, Inc.",109.98,94,,percent of total billed charges,,
"Removal Impacted Cerumen Requiring Instrumentation, Unilateral (Pro Cah)",,69210,CPT,Professional,Both,,,,117,99.45,20.06,117,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,105.417,90.1,,percent of total billed charges,,
"Removal Impacted Cerumen Requiring Instrumentation, Unilateral (Pro Cah)",,69210,CPT,Professional,Both,,,,117,99.45,20.06,117,"Preferred One Administrative Services, INC.",PPO,115.362,98.6,,percent of total billed charges,,
"Removal Impacted Cerumen Requiring Instrumentation, Unilateral (Pro Cah)",,69210,CPT,Professional,Both,,,,117,99.45,20.06,117,PrimeWest Health,Minnesota Senior Health Options (MSHO),35.903,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Removal Impacted Cerumen Requiring Instrumentation, Unilateral (Pro Cah)",,69210,CPT,Professional,Both,,,,117,99.45,20.06,117,PrimeWest Health,MinnesotaCare,24.786336,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Removal Impacted Cerumen Requiring Instrumentation, Unilateral (Pro Cah)",,69210,CPT,Professional,Both,,,,117,99.45,20.06,117,Sanford Health Plan,Sanford Health Plan,102.96,88,,percent of total billed charges,,
"Removal Impacted Cerumen Requiring Instrumentation, Unilateral (Pro Cah)",,69210,CPT,Professional,Both,,,,117,99.45,20.06,117,"UCare Health, Inc.",Individual & Family Plan,50.751232,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Removal Impacted Cerumen Requiring Instrumentation, Unilateral (Pro Cah)",,69210,CPT,Professional,Both,,,,117,99.45,20.06,117,"UCare Health, Inc.",Medical Assistance,25.48128,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Removal Impacted Cerumen Requiring Instrumentation, Unilateral (Pro Cah)",,69210,CPT,Professional,Both,,,,117,99.45,20.06,117,"UCare Health, Inc.",Medicare Advantage,35.903,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Removal Impacted Cerumen Requiring Instrumentation, Unilateral (Pro Cah)",,69210,CPT,Professional,Both,,,,117,99.45,20.06,117,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),28.7224,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Removal Impacted Cerumen Requiring Instrumentation, Unilateral (Pro Cah)",,69210,CPT,Professional,Both,,,,117,99.45,20.06,117,UnitedHealthcare,Individual & Family,117,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Removal Impacted Cerumen Requiring Instrumentation, Unilateral (Pro Cah)",,69210,CPT,Professional,Both,,,,117,99.45,20.06,117,UnitedHealthcare,Medicare Advantage,35.903,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Removal Impacted Cerumen Requiring Instrumentation, Unilateral (Pro Cah)",,69210,CPT,Professional,Both,,,,117,99.45,20.06,117,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,23.1648,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Myringotomy Including Aspiration And/Or Eustachian Tube Inflation (Pro Cah),,69420,CPT,Professional,Both,,,,485,412.25,77,485,Aetna,Commercial,412.25,85,,percent of total billed charges,,
Myringotomy Including Aspiration And/Or Eustachian Tube Inflation (Pro Cah),,69420,CPT,Professional,Both,,,,485,412.25,77,485,Aetna,Medicare Advantage,118.13,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Myringotomy Including Aspiration And/Or Eustachian Tube Inflation (Pro Cah),,69420,CPT,Professional,Both,,,,485,412.25,77,485,Aetna,PPO,451.05,93,,percent of total billed charges,,
Myringotomy Including Aspiration And/Or Eustachian Tube Inflation (Pro Cah),,69420,CPT,Professional,Both,,,,485,412.25,77,485,America's PPO,America's PPO,414.384,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Myringotomy Including Aspiration And/Or Eustachian Tube Inflation (Pro Cah),,69420,CPT,Professional,Both,,,,485,412.25,77,485,BlueCross BlueShield Minnesota, Federal Employee Program,249.27,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Myringotomy Including Aspiration And/Or Eustachian Tube Inflation (Pro Cah),,69420,CPT,Professional,Both,,,,485,412.25,77,485,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,253.25832,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Myringotomy Including Aspiration And/Or Eustachian Tube Inflation (Pro Cah),,69420,CPT,Professional,Both,,,,485,412.25,77,485,BlueCross BlueShield Minnesota,High Value Network Plan,253.25832,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Myringotomy Including Aspiration And/Or Eustachian Tube Inflation (Pro Cah),,69420,CPT,Professional,Both,,,,485,412.25,77,485,BlueCross BlueShield Minnesota,Medicare Advantage,137.5975,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Myringotomy Including Aspiration And/Or Eustachian Tube Inflation (Pro Cah),,69420,CPT,Professional,Both,,,,485,412.25,77,485,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,253.25832,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Myringotomy Including Aspiration And/Or Eustachian Tube Inflation (Pro Cah),,69420,CPT,Professional,Both,,,,485,412.25,77,485,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,88.9,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Myringotomy Including Aspiration And/Or Eustachian Tube Inflation (Pro Cah),,69420,CPT,Professional,Both,,,,485,412.25,77,485,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),137.5975,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Myringotomy Including Aspiration And/Or Eustachian Tube Inflation (Pro Cah),,69420,CPT,Professional,Both,,,,485,412.25,77,485,CorVel,Worker's Compensation,231.4819257,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Myringotomy Including Aspiration And/Or Eustachian Tube Inflation (Pro Cah),,69420,CPT,Professional,Both,,,,485,412.25,77,485,First Health Group Corporation,First Health Network,470.45,97,,percent of total billed charges,,
Myringotomy Including Aspiration And/Or Eustachian Tube Inflation (Pro Cah),,69420,CPT,Professional,Both,,,,485,412.25,77,485,"Health Partners, Inc.",Commercial,250.3,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Myringotomy Including Aspiration And/Or Eustachian Tube Inflation (Pro Cah),,69420,CPT,Professional,Both,,,,485,412.25,77,485,"Health Partners, Inc.",Medicare Advantage,137.5975,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Myringotomy Including Aspiration And/Or Eustachian Tube Inflation (Pro Cah),,69420,CPT,Professional,Both,,,,485,412.25,77,485,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),119.62,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Myringotomy Including Aspiration And/Or Eustachian Tube Inflation (Pro Cah),,69420,CPT,Professional,Both,,,,485,412.25,77,485,"Health Partners, Inc.",State of Minnesota Advantage Program,215.63345,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Myringotomy Including Aspiration And/Or Eustachian Tube Inflation (Pro Cah),,69420,CPT,Professional,Both,,,,485,412.25,77,485,"Health Partners, Inc.",State Public Programs,77,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Myringotomy Including Aspiration And/Or Eustachian Tube Inflation (Pro Cah),,69420,CPT,Professional,Both,,,,485,412.25,77,485,Humana Insurance Company,Commercial PPO,119.65,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Myringotomy Including Aspiration And/Or Eustachian Tube Inflation (Pro Cah),,69420,CPT,Professional,Both,,,,485,412.25,77,485,Humana Insurance Company,Medicare PPO,485,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Myringotomy Including Aspiration And/Or Eustachian Tube Inflation (Pro Cah),,69420,CPT,Professional,Both,,,,485,412.25,77,485,Medica,Individual & Family,411.28,84.8,,percent of total billed charges,,
Myringotomy Including Aspiration And/Or Eustachian Tube Inflation (Pro Cah),,69420,CPT,Professional,Both,,,,485,412.25,77,485,Medica,Medica Advantage Solution,241.53,49.8,,percent of total billed charges,,
Myringotomy Including Aspiration And/Or Eustachian Tube Inflation (Pro Cah),,69420,CPT,Professional,Both,,,,485,412.25,77,485,Medica,Medical Assistance,88.9,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Myringotomy Including Aspiration And/Or Eustachian Tube Inflation (Pro Cah),,69420,CPT,Professional,Both,,,,485,412.25,77,485,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,119.65,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Myringotomy Including Aspiration And/Or Eustachian Tube Inflation (Pro Cah),,69420,CPT,Professional,Both,,,,485,412.25,77,485,"Multiplan, Inc.","Multiplan, Inc.",455.9,94,,percent of total billed charges,,
Myringotomy Including Aspiration And/Or Eustachian Tube Inflation (Pro Cah),,69420,CPT,Professional,Both,,,,485,412.25,77,485,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,436.985,90.1,,percent of total billed charges,,
Myringotomy Including Aspiration And/Or Eustachian Tube Inflation (Pro Cah),,69420,CPT,Professional,Both,,,,485,412.25,77,485,"Preferred One Administrative Services, INC.",PPO,478.21,98.6,,percent of total billed charges,,
Myringotomy Including Aspiration And/Or Eustachian Tube Inflation (Pro Cah),,69420,CPT,Professional,Both,,,,485,412.25,77,485,PrimeWest Health,Minnesota Senior Health Options (MSHO),137.5975,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Myringotomy Including Aspiration And/Or Eustachian Tube Inflation (Pro Cah),,69420,CPT,Professional,Both,,,,485,412.25,77,485,PrimeWest Health,MinnesotaCare,95.123,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Myringotomy Including Aspiration And/Or Eustachian Tube Inflation (Pro Cah),,69420,CPT,Professional,Both,,,,485,412.25,77,485,Sanford Health Plan,Sanford Health Plan,426.8,88,,percent of total billed charges,,
Myringotomy Including Aspiration And/Or Eustachian Tube Inflation (Pro Cah),,69420,CPT,Professional,Both,,,,485,412.25,77,485,"UCare Health, Inc.",Individual & Family Plan,194.50304,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Myringotomy Including Aspiration And/Or Eustachian Tube Inflation (Pro Cah),,69420,CPT,Professional,Both,,,,485,412.25,77,485,"UCare Health, Inc.",Medical Assistance,97.79,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Myringotomy Including Aspiration And/Or Eustachian Tube Inflation (Pro Cah),,69420,CPT,Professional,Both,,,,485,412.25,77,485,"UCare Health, Inc.",Medicare Advantage,137.5975,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Myringotomy Including Aspiration And/Or Eustachian Tube Inflation (Pro Cah),,69420,CPT,Professional,Both,,,,485,412.25,77,485,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),110.078,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Myringotomy Including Aspiration And/Or Eustachian Tube Inflation (Pro Cah),,69420,CPT,Professional,Both,,,,485,412.25,77,485,UnitedHealthcare,Individual & Family,485,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Myringotomy Including Aspiration And/Or Eustachian Tube Inflation (Pro Cah),,69420,CPT,Professional,Both,,,,485,412.25,77,485,UnitedHealthcare,Medicare Advantage,137.5975,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Myringotomy Including Aspiration And/Or Eustachian Tube Inflation (Pro Cah),,69420,CPT,Professional,Both,,,,485,412.25,77,485,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,88.9,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Myringotomy W/ Aspiration,,69420,CPT,Facility,Both,,,,295,250.75,84.547,299,Aetna,Commercial,271.4,92,,percent of total billed charges,,
Myringotomy W/ Aspiration,,69420,CPT,Facility,Outpatient,,,,295,250.75,84.547,299,Aetna,Medicare Advantage,144.55,49,,percent of total billed charges,,
Myringotomy W/ Aspiration,,69420,CPT,Facility,Inpatient,,,,295,250.75,84.547,299,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Myringotomy W/ Aspiration,,69420,CPT,Facility,Both,,,,295,250.75,84.547,299,Aetna,PPO,274.35,93,,percent of total billed charges,,
Myringotomy W/ Aspiration,,69420,CPT,Facility,Both,,,,295,250.75,84.547,299,America's PPO,America's PPO,283.2885,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Myringotomy W/ Aspiration,,69420,CPT,Facility,Both,,,,295,250.75,84.547,299,BlueCross BlueShield Minnesota, Federal Employee Program,290.28,98.4,,percent of total billed charges,,
Myringotomy W/ Aspiration,,69420,CPT,Facility,Both,,,,295,250.75,84.547,299,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,295,100,,percent of total billed charges,,
Myringotomy W/ Aspiration,,69420,CPT,Facility,Both,,,,295,250.75,84.547,299,BlueCross BlueShield Minnesota,High Value Network Plan,265.5,90,,percent of total billed charges,,
Myringotomy W/ Aspiration,,69420,CPT,Facility,Outpatient,,,,295,250.75,84.547,299,BlueCross BlueShield Minnesota,Medicare Advantage,144.55,49,,percent of total billed charges,,
Myringotomy W/ Aspiration,,69420,CPT,Facility,Inpatient,,,,295,250.75,84.547,299,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Myringotomy W/ Aspiration,,69420,CPT,Facility,Both,,,,295,250.75,84.547,299,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,261.2815,88.57,,percent of total billed charges,,
Myringotomy W/ Aspiration,,69420,CPT,Facility,Both,,,,295,250.75,84.547,299,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,84.547,28.66,,percent of total billed charges,,
Myringotomy W/ Aspiration,,69420,CPT,Facility,Outpatient,,,,295,250.75,84.547,299,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),144.55,49,,percent of total billed charges,,
Myringotomy W/ Aspiration,,69420,CPT,Facility,Inpatient,,,,295,250.75,84.547,299,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Myringotomy W/ Aspiration,,69420,CPT,Facility,Both,,,,295,250.75,84.547,299,CorVel,Worker's Compensation,295,100,,percent of total billed charges,,
Myringotomy W/ Aspiration,,69420,CPT,Facility,Both,,,,295,250.75,84.547,299,First Health Group Corporation,First Health Network,286.15,97,,percent of total billed charges,,
Myringotomy W/ Aspiration,,69420,CPT,Facility,Both,,,,295,250.75,84.547,299,"Health Partners, Inc.",Commercial,279.07,94.6,,percent of total billed charges,,
Myringotomy W/ Aspiration,,69420,CPT,Facility,Outpatient,,,,295,250.75,84.547,299,"Health Partners, Inc.",Medicare Advantage,144.55,49,,percent of total billed charges,,
Myringotomy W/ Aspiration,,69420,CPT,Facility,Inpatient,,,,295,250.75,84.547,299,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Myringotomy W/ Aspiration,,69420,CPT,Facility,Both,,,,295,250.75,84.547,299,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),177,60,,percent of total billed charges,,
Myringotomy W/ Aspiration,,69420,CPT,Facility,Both,,,,295,250.75,84.547,299,"Health Partners, Inc.",State of Minnesota Advantage Program,240.425,81.5,,percent of total billed charges,,
Myringotomy W/ Aspiration,,69420,CPT,Facility,Both,,,,295,250.75,84.547,299,"Health Partners, Inc.",State Public Programs,147.5,50,,percent of total billed charges,,
Myringotomy W/ Aspiration,,69420,CPT,Facility,Both,,,,295,250.75,84.547,299,Humana Insurance Company,Commercial PPO,280.25,95,,percent of total billed charges,,
Myringotomy W/ Aspiration,,69420,CPT,Facility,Outpatient,,,,295,250.75,84.547,299,Humana Insurance Company,Medicare PPO,144.55,49,,percent of total billed charges,,
Myringotomy W/ Aspiration,,69420,CPT,Facility,Inpatient,,,,295,250.75,84.547,299,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Myringotomy W/ Aspiration,,69420,CPT,Facility,Both,,,,295,250.75,84.547,299,Medica,Individual & Family,292.345,99.1,,percent of total billed charges,,
Myringotomy W/ Aspiration,,69420,CPT,Facility,Outpatient,,,,295,250.75,84.547,299,Medica,Medica Advantage Solution,146.91,49.8,,percent of total billed charges,,
Myringotomy W/ Aspiration,,69420,CPT,Facility,Inpatient,,,,295,250.75,84.547,299,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Myringotomy W/ Aspiration,,69420,CPT,Facility,Outpatient,,,,295,250.75,84.547,299,Medica,Medical Assistance,299,,,Other,Grouper,All inclusive per visit
Myringotomy W/ Aspiration,,69420,CPT,Facility,Inpatient,,,,295,250.75,84.547,299,Medica,Medical Assistance,,,,,Included in per diem rate,
Myringotomy W/ Aspiration,,69420,CPT,Facility,Outpatient,,,,295,250.75,84.547,299,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,146.91,49.8,,percent of total billed charges,,
Myringotomy W/ Aspiration,,69420,CPT,Facility,Inpatient,,,,295,250.75,84.547,299,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Myringotomy W/ Aspiration,,69420,CPT,Facility,Both,,,,295,250.75,84.547,299,"Multiplan, Inc.","Multiplan, Inc.",277.3,94,,percent of total billed charges,,
Myringotomy W/ Aspiration,,69420,CPT,Facility,Outpatient,,,,295,250.75,84.547,299,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,265.795,90.1,,percent of total billed charges,,
Myringotomy W/ Aspiration,,69420,CPT,Facility,Inpatient,,,,295,250.75,84.547,299,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Myringotomy W/ Aspiration,,69420,CPT,Facility,Both,,,,295,250.75,84.547,299,"Preferred One Administrative Services, INC.",PPO,290.87,98.6,,percent of total billed charges,,
Myringotomy W/ Aspiration,,69420,CPT,Facility,Outpatient,,,,295,250.75,84.547,299,PrimeWest Health,Minnesota Senior Health Options (MSHO),151.7775,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Myringotomy W/ Aspiration,,69420,CPT,Facility,Inpatient,,,,295,250.75,84.547,299,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Myringotomy W/ Aspiration,,69420,CPT,Facility,Outpatient,,,,295,250.75,84.547,299,PrimeWest Health,MinnesotaCare,151.512,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Myringotomy W/ Aspiration,,69420,CPT,Facility,Inpatient,,,,295,250.75,84.547,299,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Myringotomy W/ Aspiration,,69420,CPT,Facility,Both,,,,295,250.75,84.547,299,Sanford Health Plan,Sanford Health Plan,271.4,92,,percent of total billed charges,,
Myringotomy W/ Aspiration,,69420,CPT,Facility,Outpatient,,,,295,250.75,84.547,299,"UCare Health, Inc.",Individual & Family Plan,166.2325,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Myringotomy W/ Aspiration,,69420,CPT,Facility,Inpatient,,,,295,250.75,84.547,299,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Myringotomy W/ Aspiration,,69420,CPT,Facility,Outpatient,,,,295,250.75,84.547,299,"UCare Health, Inc.",Medical Assistance,148.8865,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Myringotomy W/ Aspiration,,69420,CPT,Facility,Inpatient,,,,295,250.75,84.547,299,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Myringotomy W/ Aspiration,,69420,CPT,Facility,Outpatient,,,,295,250.75,84.547,299,"UCare Health, Inc.",Medicare Advantage,148.8865,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Myringotomy W/ Aspiration,,69420,CPT,Facility,Inpatient,,,,295,250.75,84.547,299,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Myringotomy W/ Aspiration,,69420,CPT,Facility,Outpatient,,,,295,250.75,84.547,299,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),148.8865,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Myringotomy W/ Aspiration,,69420,CPT,Facility,Inpatient,,,,295,250.75,84.547,299,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Myringotomy W/ Aspiration,,69420,CPT,Facility,Both,,,,295,250.75,84.547,299,UnitedHealthcare,Individual & Family,277.3,94,,percent of total billed charges,,
Myringotomy W/ Aspiration,,69420,CPT,Facility,Outpatient,,,,295,250.75,84.547,299,UnitedHealthcare,Medicare Advantage,144.55,49,,percent of total billed charges,,
Myringotomy W/ Aspiration,,69420,CPT,Facility,Inpatient,,,,295,250.75,84.547,299,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Myringotomy W/ Aspiration,,69420,CPT,Facility,Outpatient,,,,295,250.75,84.547,299,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,141.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
Myringotomy W/ Aspiration,,69420,CPT,Facility,Inpatient,,,,295,250.75,84.547,299,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Incision Of Eardrum (Pro Cah),,69421,CPT,Professional,Both,,,,561,476.85,97.07,561,Aetna,Commercial,476.85,85,,percent of total billed charges,,
Incision Of Eardrum (Pro Cah),,69421,CPT,Professional,Both,,,,561,476.85,97.07,561,Aetna,Medicare Advantage,148.25,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Incision Of Eardrum (Pro Cah),,69421,CPT,Professional,Both,,,,561,476.85,97.07,561,Aetna,PPO,521.73,93,,percent of total billed charges,,
Incision Of Eardrum (Pro Cah),,69421,CPT,Professional,Both,,,,561,476.85,97.07,561,America's PPO,America's PPO,479.3184,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Incision Of Eardrum (Pro Cah),,69421,CPT,Professional,Both,,,,561,476.85,97.07,561,BlueCross BlueShield Minnesota, Federal Employee Program,315.38,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Incision Of Eardrum (Pro Cah),,69421,CPT,Professional,Both,,,,561,476.85,97.07,561,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,320.42608,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Incision Of Eardrum (Pro Cah),,69421,CPT,Professional,Both,,,,561,476.85,97.07,561,BlueCross BlueShield Minnesota,High Value Network Plan,320.42608,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Incision Of Eardrum (Pro Cah),,69421,CPT,Professional,Both,,,,561,476.85,97.07,561,BlueCross BlueShield Minnesota,Medicare Advantage,173.811,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Incision Of Eardrum (Pro Cah),,69421,CPT,Professional,Both,,,,561,476.85,97.07,561,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,320.42608,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Incision Of Eardrum (Pro Cah),,69421,CPT,Professional,Both,,,,561,476.85,97.07,561,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,112.07496,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Incision Of Eardrum (Pro Cah),,69421,CPT,Professional,Both,,,,561,476.85,97.07,561,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),173.811,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Incision Of Eardrum (Pro Cah),,69421,CPT,Professional,Both,,,,561,476.85,97.07,561,CorVel,Worker's Compensation,293.5570812,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Incision Of Eardrum (Pro Cah),,69421,CPT,Professional,Both,,,,561,476.85,97.07,561,First Health Group Corporation,First Health Network,544.17,97,,percent of total billed charges,,
Incision Of Eardrum (Pro Cah),,69421,CPT,Professional,Both,,,,561,476.85,97.07,561,"Health Partners, Inc.",Commercial,317.05,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Incision Of Eardrum (Pro Cah),,69421,CPT,Professional,Both,,,,561,476.85,97.07,561,"Health Partners, Inc.",Medicare Advantage,173.811,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Incision Of Eardrum (Pro Cah),,69421,CPT,Professional,Both,,,,561,476.85,97.07,561,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),151.14,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Incision Of Eardrum (Pro Cah),,69421,CPT,Professional,Both,,,,561,476.85,97.07,561,"Health Partners, Inc.",State of Minnesota Advantage Program,273.138575,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Incision Of Eardrum (Pro Cah),,69421,CPT,Professional,Both,,,,561,476.85,97.07,561,"Health Partners, Inc.",State Public Programs,97.07,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Incision Of Eardrum (Pro Cah),,69421,CPT,Professional,Both,,,,561,476.85,97.07,561,Humana Insurance Company,Commercial PPO,151.14,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Incision Of Eardrum (Pro Cah),,69421,CPT,Professional,Both,,,,561,476.85,97.07,561,Humana Insurance Company,Medicare PPO,561,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Incision Of Eardrum (Pro Cah),,69421,CPT,Professional,Both,,,,561,476.85,97.07,561,Medica,Individual & Family,475.728,84.8,,percent of total billed charges,,
Incision Of Eardrum (Pro Cah),,69421,CPT,Professional,Both,,,,561,476.85,97.07,561,Medica,Medica Advantage Solution,279.378,49.8,,percent of total billed charges,,
Incision Of Eardrum (Pro Cah),,69421,CPT,Professional,Both,,,,561,476.85,97.07,561,Medica,Medical Assistance,112.07,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Incision Of Eardrum (Pro Cah),,69421,CPT,Professional,Both,,,,561,476.85,97.07,561,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,151.14,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Incision Of Eardrum (Pro Cah),,69421,CPT,Professional,Both,,,,561,476.85,97.07,561,"Multiplan, Inc.","Multiplan, Inc.",527.34,94,,percent of total billed charges,,
Incision Of Eardrum (Pro Cah),,69421,CPT,Professional,Both,,,,561,476.85,97.07,561,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,505.461,90.1,,percent of total billed charges,,
Incision Of Eardrum (Pro Cah),,69421,CPT,Professional,Both,,,,561,476.85,97.07,561,"Preferred One Administrative Services, INC.",PPO,553.146,98.6,,percent of total billed charges,,
Incision Of Eardrum (Pro Cah),,69421,CPT,Professional,Both,,,,561,476.85,97.07,561,PrimeWest Health,Minnesota Senior Health Options (MSHO),173.811,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Incision Of Eardrum (Pro Cah),,69421,CPT,Professional,Both,,,,561,476.85,97.07,561,PrimeWest Health,MinnesotaCare,119.9202072,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Incision Of Eardrum (Pro Cah),,69421,CPT,Professional,Both,,,,561,476.85,97.07,561,Sanford Health Plan,Sanford Health Plan,493.68,88,,percent of total billed charges,,
Incision Of Eardrum (Pro Cah),,69421,CPT,Professional,Both,,,,561,476.85,97.07,561,"UCare Health, Inc.",Individual & Family Plan,245.693184,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Incision Of Eardrum (Pro Cah),,69421,CPT,Professional,Both,,,,561,476.85,97.07,561,"UCare Health, Inc.",Medical Assistance,123.282456,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Incision Of Eardrum (Pro Cah),,69421,CPT,Professional,Both,,,,561,476.85,97.07,561,"UCare Health, Inc.",Medicare Advantage,173.811,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Incision Of Eardrum (Pro Cah),,69421,CPT,Professional,Both,,,,561,476.85,97.07,561,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),139.0488,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Incision Of Eardrum (Pro Cah),,69421,CPT,Professional,Both,,,,561,476.85,97.07,561,UnitedHealthcare,Individual & Family,561,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Incision Of Eardrum (Pro Cah),,69421,CPT,Professional,Both,,,,561,476.85,97.07,561,UnitedHealthcare,Medicare Advantage,173.811,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Incision Of Eardrum (Pro Cah),,69421,CPT,Professional,Both,,,,561,476.85,97.07,561,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,112.07496,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Removal Of Ear Tube(S),,69424,CPT,Facility,Both,,,,310,263.5,88.846,310,Aetna,Commercial,285.2,92,,percent of total billed charges,,
Removal Of Ear Tube(S),,69424,CPT,Facility,Outpatient,,,,310,263.5,88.846,310,Aetna,Medicare Advantage,151.9,49,,percent of total billed charges,,
Removal Of Ear Tube(S),,69424,CPT,Facility,Inpatient,,,,310,263.5,88.846,310,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Removal Of Ear Tube(S),,69424,CPT,Facility,Both,,,,310,263.5,88.846,310,Aetna,PPO,288.3,93,,percent of total billed charges,,
Removal Of Ear Tube(S),,69424,CPT,Facility,Both,,,,310,263.5,88.846,310,America's PPO,America's PPO,297.693,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Removal Of Ear Tube(S),,69424,CPT,Facility,Both,,,,310,263.5,88.846,310,BlueCross BlueShield Minnesota, Federal Employee Program,305.04,98.4,,percent of total billed charges,,
Removal Of Ear Tube(S),,69424,CPT,Facility,Both,,,,310,263.5,88.846,310,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,310,100,,percent of total billed charges,,
Removal Of Ear Tube(S),,69424,CPT,Facility,Both,,,,310,263.5,88.846,310,BlueCross BlueShield Minnesota,High Value Network Plan,279,90,,percent of total billed charges,,
Removal Of Ear Tube(S),,69424,CPT,Facility,Outpatient,,,,310,263.5,88.846,310,BlueCross BlueShield Minnesota,Medicare Advantage,151.9,49,,percent of total billed charges,,
Removal Of Ear Tube(S),,69424,CPT,Facility,Inpatient,,,,310,263.5,88.846,310,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Removal Of Ear Tube(S),,69424,CPT,Facility,Both,,,,310,263.5,88.846,310,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,274.567,88.57,,percent of total billed charges,,
Removal Of Ear Tube(S),,69424,CPT,Facility,Both,,,,310,263.5,88.846,310,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,88.846,28.66,,percent of total billed charges,,
Removal Of Ear Tube(S),,69424,CPT,Facility,Outpatient,,,,310,263.5,88.846,310,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),151.9,49,,percent of total billed charges,,
Removal Of Ear Tube(S),,69424,CPT,Facility,Inpatient,,,,310,263.5,88.846,310,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Removal Of Ear Tube(S),,69424,CPT,Facility,Both,,,,310,263.5,88.846,310,CorVel,Worker's Compensation,310,100,,percent of total billed charges,,
Removal Of Ear Tube(S),,69424,CPT,Facility,Both,,,,310,263.5,88.846,310,First Health Group Corporation,First Health Network,300.7,97,,percent of total billed charges,,
Removal Of Ear Tube(S),,69424,CPT,Facility,Both,,,,310,263.5,88.846,310,"Health Partners, Inc.",Commercial,293.26,94.6,,percent of total billed charges,,
Removal Of Ear Tube(S),,69424,CPT,Facility,Outpatient,,,,310,263.5,88.846,310,"Health Partners, Inc.",Medicare Advantage,151.9,49,,percent of total billed charges,,
Removal Of Ear Tube(S),,69424,CPT,Facility,Inpatient,,,,310,263.5,88.846,310,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Removal Of Ear Tube(S),,69424,CPT,Facility,Both,,,,310,263.5,88.846,310,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),186,60,,percent of total billed charges,,
Removal Of Ear Tube(S),,69424,CPT,Facility,Both,,,,310,263.5,88.846,310,"Health Partners, Inc.",State of Minnesota Advantage Program,252.65,81.5,,percent of total billed charges,,
Removal Of Ear Tube(S),,69424,CPT,Facility,Both,,,,310,263.5,88.846,310,"Health Partners, Inc.",State Public Programs,155,50,,percent of total billed charges,,
Removal Of Ear Tube(S),,69424,CPT,Facility,Both,,,,310,263.5,88.846,310,Humana Insurance Company,Commercial PPO,294.5,95,,percent of total billed charges,,
Removal Of Ear Tube(S),,69424,CPT,Facility,Outpatient,,,,310,263.5,88.846,310,Humana Insurance Company,Medicare PPO,151.9,49,,percent of total billed charges,,
Removal Of Ear Tube(S),,69424,CPT,Facility,Inpatient,,,,310,263.5,88.846,310,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Removal Of Ear Tube(S),,69424,CPT,Facility,Both,,,,310,263.5,88.846,310,Medica,Individual & Family,307.21,99.1,,percent of total billed charges,,
Removal Of Ear Tube(S),,69424,CPT,Facility,Outpatient,,,,310,263.5,88.846,310,Medica,Medica Advantage Solution,154.38,49.8,,percent of total billed charges,,
Removal Of Ear Tube(S),,69424,CPT,Facility,Inpatient,,,,310,263.5,88.846,310,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Removal Of Ear Tube(S),,69424,CPT,Facility,Outpatient,,,,310,263.5,88.846,310,Medica,Medical Assistance,138.26,44.6,,percent of total billed charges,,
Removal Of Ear Tube(S),,69424,CPT,Facility,Inpatient,,,,310,263.5,88.846,310,Medica,Medical Assistance,,,,,Included in per diem rate,
Removal Of Ear Tube(S),,69424,CPT,Facility,Outpatient,,,,310,263.5,88.846,310,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,154.38,49.8,,percent of total billed charges,,
Removal Of Ear Tube(S),,69424,CPT,Facility,Inpatient,,,,310,263.5,88.846,310,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Removal Of Ear Tube(S),,69424,CPT,Facility,Both,,,,310,263.5,88.846,310,"Multiplan, Inc.","Multiplan, Inc.",291.4,94,,percent of total billed charges,,
Removal Of Ear Tube(S),,69424,CPT,Facility,Outpatient,,,,310,263.5,88.846,310,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,279.31,90.1,,percent of total billed charges,,
Removal Of Ear Tube(S),,69424,CPT,Facility,Inpatient,,,,310,263.5,88.846,310,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Removal Of Ear Tube(S),,69424,CPT,Facility,Both,,,,310,263.5,88.846,310,"Preferred One Administrative Services, INC.",PPO,305.66,98.6,,percent of total billed charges,,
Removal Of Ear Tube(S),,69424,CPT,Facility,Outpatient,,,,310,263.5,88.846,310,PrimeWest Health,Minnesota Senior Health Options (MSHO),159.495,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Removal Of Ear Tube(S),,69424,CPT,Facility,Inpatient,,,,310,263.5,88.846,310,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Removal Of Ear Tube(S),,69424,CPT,Facility,Outpatient,,,,310,263.5,88.846,310,PrimeWest Health,MinnesotaCare,159.216,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Removal Of Ear Tube(S),,69424,CPT,Facility,Inpatient,,,,310,263.5,88.846,310,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Removal Of Ear Tube(S),,69424,CPT,Facility,Both,,,,310,263.5,88.846,310,Sanford Health Plan,Sanford Health Plan,285.2,92,,percent of total billed charges,,
Removal Of Ear Tube(S),,69424,CPT,Facility,Outpatient,,,,310,263.5,88.846,310,"UCare Health, Inc.",Individual & Family Plan,174.685,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Removal Of Ear Tube(S),,69424,CPT,Facility,Inpatient,,,,310,263.5,88.846,310,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Removal Of Ear Tube(S),,69424,CPT,Facility,Outpatient,,,,310,263.5,88.846,310,"UCare Health, Inc.",Medical Assistance,156.457,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Removal Of Ear Tube(S),,69424,CPT,Facility,Inpatient,,,,310,263.5,88.846,310,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Removal Of Ear Tube(S),,69424,CPT,Facility,Outpatient,,,,310,263.5,88.846,310,"UCare Health, Inc.",Medicare Advantage,156.457,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Removal Of Ear Tube(S),,69424,CPT,Facility,Inpatient,,,,310,263.5,88.846,310,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Removal Of Ear Tube(S),,69424,CPT,Facility,Outpatient,,,,310,263.5,88.846,310,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),156.457,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Removal Of Ear Tube(S),,69424,CPT,Facility,Inpatient,,,,310,263.5,88.846,310,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Removal Of Ear Tube(S),,69424,CPT,Facility,Both,,,,310,263.5,88.846,310,UnitedHealthcare,Individual & Family,291.4,94,,percent of total billed charges,,
Removal Of Ear Tube(S),,69424,CPT,Facility,Outpatient,,,,310,263.5,88.846,310,UnitedHealthcare,Medicare Advantage,151.9,49,,percent of total billed charges,,
Removal Of Ear Tube(S),,69424,CPT,Facility,Inpatient,,,,310,263.5,88.846,310,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Removal Of Ear Tube(S),,69424,CPT,Facility,Outpatient,,,,310,263.5,88.846,310,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,148.8,48,,percent of total billed charges,,100% of DHS outpatient percentage
Removal Of Ear Tube(S),,69424,CPT,Facility,Inpatient,,,,310,263.5,88.846,310,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Remove Ventilating Tube (Pro Cah),,69424,CPT,Professional,Both,,,,510,433.5,37.95,510,Aetna,Commercial,433.5,85,,percent of total billed charges,,
Remove Ventilating Tube (Pro Cah),,69424,CPT,Professional,Both,,,,510,433.5,37.95,510,Aetna,Medicare Advantage,59.29,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Remove Ventilating Tube (Pro Cah),,69424,CPT,Professional,Both,,,,510,433.5,37.95,510,Aetna,PPO,474.3,93,,percent of total billed charges,,
Remove Ventilating Tube (Pro Cah),,69424,CPT,Professional,Both,,,,510,433.5,37.95,510,America's PPO,America's PPO,435.744,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Remove Ventilating Tube (Pro Cah),,69424,CPT,Professional,Both,,,,510,433.5,37.95,510,BlueCross BlueShield Minnesota, Federal Employee Program,123.95,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Remove Ventilating Tube (Pro Cah),,69424,CPT,Professional,Both,,,,510,433.5,37.95,510,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,125.9332,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Remove Ventilating Tube (Pro Cah),,69424,CPT,Professional,Both,,,,510,433.5,37.95,510,BlueCross BlueShield Minnesota,High Value Network Plan,125.9332,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Remove Ventilating Tube (Pro Cah),,69424,CPT,Professional,Both,,,,510,433.5,37.95,510,BlueCross BlueShield Minnesota,Medicare Advantage,68.149,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Remove Ventilating Tube (Pro Cah),,69424,CPT,Professional,Both,,,,510,433.5,37.95,510,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,125.9332,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Remove Ventilating Tube (Pro Cah),,69424,CPT,Professional,Both,,,,510,433.5,37.95,510,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,43.82008,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Remove Ventilating Tube (Pro Cah),,69424,CPT,Professional,Both,,,,510,433.5,37.95,510,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),68.149,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Remove Ventilating Tube (Pro Cah),,69424,CPT,Professional,Both,,,,510,433.5,37.95,510,CorVel,Worker's Compensation,115.2610332,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Remove Ventilating Tube (Pro Cah),,69424,CPT,Professional,Both,,,,510,433.5,37.95,510,First Health Group Corporation,First Health Network,494.7,97,,percent of total billed charges,,
Remove Ventilating Tube (Pro Cah),,69424,CPT,Professional,Both,,,,510,433.5,37.95,510,"Health Partners, Inc.",Commercial,124.8,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Remove Ventilating Tube (Pro Cah),,69424,CPT,Professional,Both,,,,510,433.5,37.95,510,"Health Partners, Inc.",Medicare Advantage,68.149,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Remove Ventilating Tube (Pro Cah),,69424,CPT,Professional,Both,,,,510,433.5,37.95,510,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),59.3,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Remove Ventilating Tube (Pro Cah),,69424,CPT,Professional,Both,,,,510,433.5,37.95,510,"Health Partners, Inc.",State of Minnesota Advantage Program,107.5152,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Remove Ventilating Tube (Pro Cah),,69424,CPT,Professional,Both,,,,510,433.5,37.95,510,"Health Partners, Inc.",State Public Programs,37.95,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Remove Ventilating Tube (Pro Cah),,69424,CPT,Professional,Both,,,,510,433.5,37.95,510,Humana Insurance Company,Commercial PPO,59.26,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Remove Ventilating Tube (Pro Cah),,69424,CPT,Professional,Both,,,,510,433.5,37.95,510,Humana Insurance Company,Medicare PPO,510,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Remove Ventilating Tube (Pro Cah),,69424,CPT,Professional,Both,,,,510,433.5,37.95,510,Medica,Individual & Family,432.48,84.8,,percent of total billed charges,,
Remove Ventilating Tube (Pro Cah),,69424,CPT,Professional,Both,,,,510,433.5,37.95,510,Medica,Medica Advantage Solution,253.98,49.8,,percent of total billed charges,,
Remove Ventilating Tube (Pro Cah),,69424,CPT,Professional,Both,,,,510,433.5,37.95,510,Medica,Medical Assistance,43.82,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Remove Ventilating Tube (Pro Cah),,69424,CPT,Professional,Both,,,,510,433.5,37.95,510,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,59.26,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Remove Ventilating Tube (Pro Cah),,69424,CPT,Professional,Both,,,,510,433.5,37.95,510,"Multiplan, Inc.","Multiplan, Inc.",479.4,94,,percent of total billed charges,,
Remove Ventilating Tube (Pro Cah),,69424,CPT,Professional,Both,,,,510,433.5,37.95,510,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,459.51,90.1,,percent of total billed charges,,
Remove Ventilating Tube (Pro Cah),,69424,CPT,Professional,Both,,,,510,433.5,37.95,510,"Preferred One Administrative Services, INC.",PPO,502.86,98.6,,percent of total billed charges,,
Remove Ventilating Tube (Pro Cah),,69424,CPT,Professional,Both,,,,510,433.5,37.95,510,PrimeWest Health,Minnesota Senior Health Options (MSHO),68.149,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Remove Ventilating Tube (Pro Cah),,69424,CPT,Professional,Both,,,,510,433.5,37.95,510,PrimeWest Health,MinnesotaCare,46.8874856,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Remove Ventilating Tube (Pro Cah),,69424,CPT,Professional,Both,,,,510,433.5,37.95,510,Sanford Health Plan,Sanford Health Plan,448.8,88,,percent of total billed charges,,
Remove Ventilating Tube (Pro Cah),,69424,CPT,Professional,Both,,,,510,433.5,37.95,510,"UCare Health, Inc.",Individual & Family Plan,96.333056,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Remove Ventilating Tube (Pro Cah),,69424,CPT,Professional,Both,,,,510,433.5,37.95,510,"UCare Health, Inc.",Medical Assistance,48.202088,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Remove Ventilating Tube (Pro Cah),,69424,CPT,Professional,Both,,,,510,433.5,37.95,510,"UCare Health, Inc.",Medicare Advantage,68.149,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Remove Ventilating Tube (Pro Cah),,69424,CPT,Professional,Both,,,,510,433.5,37.95,510,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),54.5192,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Remove Ventilating Tube (Pro Cah),,69424,CPT,Professional,Both,,,,510,433.5,37.95,510,UnitedHealthcare,Individual & Family,510,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Remove Ventilating Tube (Pro Cah),,69424,CPT,Professional,Both,,,,510,433.5,37.95,510,UnitedHealthcare,Medicare Advantage,68.149,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Remove Ventilating Tube (Pro Cah),,69424,CPT,Professional,Both,,,,510,433.5,37.95,510,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,43.82008,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Tympanostomy, Local Or Topical Anesthesia (Pro Cah)",,69433,CPT,Professional,Both,,,,612,520.2,84.42,612,Aetna,Commercial,520.2,85,,percent of total billed charges,,
"Tympanostomy, Local Or Topical Anesthesia (Pro Cah)",,69433,CPT,Professional,Both,,,,612,520.2,84.42,612,Aetna,Medicare Advantage,129.12,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Tympanostomy, Local Or Topical Anesthesia (Pro Cah)",,69433,CPT,Professional,Both,,,,612,520.2,84.42,612,Aetna,PPO,569.16,93,,percent of total billed charges,,
"Tympanostomy, Local Or Topical Anesthesia (Pro Cah)",,69433,CPT,Professional,Both,,,,612,520.2,84.42,612,America's PPO,America's PPO,522.8928,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Tympanostomy, Local Or Topical Anesthesia (Pro Cah)",,69433,CPT,Professional,Both,,,,612,520.2,84.42,612,BlueCross BlueShield Minnesota, Federal Employee Program,274.06,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Tympanostomy, Local Or Topical Anesthesia (Pro Cah)",,69433,CPT,Professional,Both,,,,612,520.2,84.42,612,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,278.44496,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Tympanostomy, Local Or Topical Anesthesia (Pro Cah)",,69433,CPT,Professional,Both,,,,612,520.2,84.42,612,BlueCross BlueShield Minnesota,High Value Network Plan,278.44496,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Tympanostomy, Local Or Topical Anesthesia (Pro Cah)",,69433,CPT,Professional,Both,,,,612,520.2,84.42,612,BlueCross BlueShield Minnesota,Medicare Advantage,150.949,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Tympanostomy, Local Or Topical Anesthesia (Pro Cah)",,69433,CPT,Professional,Both,,,,612,520.2,84.42,612,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,278.44496,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Tympanostomy, Local Or Topical Anesthesia (Pro Cah)",,69433,CPT,Professional,Both,,,,612,520.2,84.42,612,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,97.46488,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Tympanostomy, Local Or Topical Anesthesia (Pro Cah)",,69433,CPT,Professional,Both,,,,612,520.2,84.42,612,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),150.949,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Tympanostomy, Local Or Topical Anesthesia (Pro Cah)",,69433,CPT,Professional,Both,,,,612,520.2,84.42,612,CorVel,Worker's Compensation,253.5640632,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Tympanostomy, Local Or Topical Anesthesia (Pro Cah)",,69433,CPT,Professional,Both,,,,612,520.2,84.42,612,First Health Group Corporation,First Health Network,593.64,97,,percent of total billed charges,,
"Tympanostomy, Local Or Topical Anesthesia (Pro Cah)",,69433,CPT,Professional,Both,,,,612,520.2,84.42,612,"Health Partners, Inc.",Commercial,274.25,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Tympanostomy, Local Or Topical Anesthesia (Pro Cah)",,69433,CPT,Professional,Both,,,,612,520.2,84.42,612,"Health Partners, Inc.",Medicare Advantage,150.949,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Tympanostomy, Local Or Topical Anesthesia (Pro Cah)",,69433,CPT,Professional,Both,,,,612,520.2,84.42,612,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),131.14,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Tympanostomy, Local Or Topical Anesthesia (Pro Cah)",,69433,CPT,Professional,Both,,,,612,520.2,84.42,612,"Health Partners, Inc.",State of Minnesota Advantage Program,236.266375,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Tympanostomy, Local Or Topical Anesthesia (Pro Cah)",,69433,CPT,Professional,Both,,,,612,520.2,84.42,612,"Health Partners, Inc.",State Public Programs,84.42,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Tympanostomy, Local Or Topical Anesthesia (Pro Cah)",,69433,CPT,Professional,Both,,,,612,520.2,84.42,612,Humana Insurance Company,Commercial PPO,131.26,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Tympanostomy, Local Or Topical Anesthesia (Pro Cah)",,69433,CPT,Professional,Both,,,,612,520.2,84.42,612,Humana Insurance Company,Medicare PPO,612,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Tympanostomy, Local Or Topical Anesthesia (Pro Cah)",,69433,CPT,Professional,Both,,,,612,520.2,84.42,612,Medica,Individual & Family,518.976,84.8,,percent of total billed charges,,
"Tympanostomy, Local Or Topical Anesthesia (Pro Cah)",,69433,CPT,Professional,Both,,,,612,520.2,84.42,612,Medica,Medica Advantage Solution,304.776,49.8,,percent of total billed charges,,
"Tympanostomy, Local Or Topical Anesthesia (Pro Cah)",,69433,CPT,Professional,Both,,,,612,520.2,84.42,612,Medica,Medical Assistance,97.46,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Tympanostomy, Local Or Topical Anesthesia (Pro Cah)",,69433,CPT,Professional,Both,,,,612,520.2,84.42,612,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,131.26,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Tympanostomy, Local Or Topical Anesthesia (Pro Cah)",,69433,CPT,Professional,Both,,,,612,520.2,84.42,612,"Multiplan, Inc.","Multiplan, Inc.",575.28,94,,percent of total billed charges,,
"Tympanostomy, Local Or Topical Anesthesia (Pro Cah)",,69433,CPT,Professional,Both,,,,612,520.2,84.42,612,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,551.412,90.1,,percent of total billed charges,,
"Tympanostomy, Local Or Topical Anesthesia (Pro Cah)",,69433,CPT,Professional,Both,,,,612,520.2,84.42,612,"Preferred One Administrative Services, INC.",PPO,603.432,98.6,,percent of total billed charges,,
"Tympanostomy, Local Or Topical Anesthesia (Pro Cah)",,69433,CPT,Professional,Both,,,,612,520.2,84.42,612,PrimeWest Health,Minnesota Senior Health Options (MSHO),150.949,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Tympanostomy, Local Or Topical Anesthesia (Pro Cah)",,69433,CPT,Professional,Both,,,,612,520.2,84.42,612,PrimeWest Health,MinnesotaCare,104.2874216,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Tympanostomy, Local Or Topical Anesthesia (Pro Cah)",,69433,CPT,Professional,Both,,,,612,520.2,84.42,612,Sanford Health Plan,Sanford Health Plan,538.56,88,,percent of total billed charges,,
"Tympanostomy, Local Or Topical Anesthesia (Pro Cah)",,69433,CPT,Professional,Both,,,,612,520.2,84.42,612,"UCare Health, Inc.",Individual & Family Plan,213.376256,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Tympanostomy, Local Or Topical Anesthesia (Pro Cah)",,69433,CPT,Professional,Both,,,,612,520.2,84.42,612,"UCare Health, Inc.",Medical Assistance,107.211368,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Tympanostomy, Local Or Topical Anesthesia (Pro Cah)",,69433,CPT,Professional,Both,,,,612,520.2,84.42,612,"UCare Health, Inc.",Medicare Advantage,150.949,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Tympanostomy, Local Or Topical Anesthesia (Pro Cah)",,69433,CPT,Professional,Both,,,,612,520.2,84.42,612,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),120.7592,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Tympanostomy, Local Or Topical Anesthesia (Pro Cah)",,69433,CPT,Professional,Both,,,,612,520.2,84.42,612,UnitedHealthcare,Individual & Family,612,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Tympanostomy, Local Or Topical Anesthesia (Pro Cah)",,69433,CPT,Professional,Both,,,,612,520.2,84.42,612,UnitedHealthcare,Medicare Advantage,150.949,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Tympanostomy, Local Or Topical Anesthesia (Pro Cah)",,69433,CPT,Professional,Both,,,,612,520.2,84.42,612,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,97.46488,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Tympanostomy Unilateral (Pro Cah),,69436,CPT,Professional,Both,,,,816,693.6,101.66,816,Aetna,Commercial,693.6,85,,percent of total billed charges,,
Tympanostomy Unilateral (Pro Cah),,69436,CPT,Professional,Both,,,,816,693.6,101.66,816,Aetna,Medicare Advantage,155.82,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Tympanostomy Unilateral (Pro Cah),,69436,CPT,Professional,Both,,,,816,693.6,101.66,816,Aetna,PPO,758.88,93,,percent of total billed charges,,
Tympanostomy Unilateral (Pro Cah),,69436,CPT,Professional,Both,,,,816,693.6,101.66,816,America's PPO,America's PPO,697.1904,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Tympanostomy Unilateral (Pro Cah),,69436,CPT,Professional,Both,,,,816,693.6,101.66,816,BlueCross BlueShield Minnesota, Federal Employee Program,330.53,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Tympanostomy Unilateral (Pro Cah),,69436,CPT,Professional,Both,,,,816,693.6,101.66,816,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,335.81848,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Tympanostomy Unilateral (Pro Cah),,69436,CPT,Professional,Both,,,,816,693.6,101.66,816,BlueCross BlueShield Minnesota,High Value Network Plan,335.81848,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Tympanostomy Unilateral (Pro Cah),,69436,CPT,Professional,Both,,,,816,693.6,101.66,816,BlueCross BlueShield Minnesota,Medicare Advantage,181.8265,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Tympanostomy Unilateral (Pro Cah),,69436,CPT,Professional,Both,,,,816,693.6,101.66,816,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,335.81848,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Tympanostomy Unilateral (Pro Cah),,69436,CPT,Professional,Both,,,,816,693.6,101.66,816,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,117.36832,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Tympanostomy Unilateral (Pro Cah),,69436,CPT,Professional,Both,,,,816,693.6,101.66,816,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),181.8265,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Tympanostomy Unilateral (Pro Cah),,69436,CPT,Professional,Both,,,,816,693.6,101.66,816,CorVel,Worker's Compensation,306.9957831,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Tympanostomy Unilateral (Pro Cah),,69436,CPT,Professional,Both,,,,816,693.6,101.66,816,First Health Group Corporation,First Health Network,791.52,97,,percent of total billed charges,,
Tympanostomy Unilateral (Pro Cah),,69436,CPT,Professional,Both,,,,816,693.6,101.66,816,"Health Partners, Inc.",Commercial,331.56,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Tympanostomy Unilateral (Pro Cah),,69436,CPT,Professional,Both,,,,816,693.6,101.66,816,"Health Partners, Inc.",Medicare Advantage,181.8265,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Tympanostomy Unilateral (Pro Cah),,69436,CPT,Professional,Both,,,,816,693.6,101.66,816,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),158.25,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Tympanostomy Unilateral (Pro Cah),,69436,CPT,Professional,Both,,,,816,693.6,101.66,816,"Health Partners, Inc.",State of Minnesota Advantage Program,285.63894,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Tympanostomy Unilateral (Pro Cah),,69436,CPT,Professional,Both,,,,816,693.6,101.66,816,"Health Partners, Inc.",State Public Programs,101.66,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Tympanostomy Unilateral (Pro Cah),,69436,CPT,Professional,Both,,,,816,693.6,101.66,816,Humana Insurance Company,Commercial PPO,158.11,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Tympanostomy Unilateral (Pro Cah),,69436,CPT,Professional,Both,,,,816,693.6,101.66,816,Humana Insurance Company,Medicare PPO,816,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Tympanostomy Unilateral (Pro Cah),,69436,CPT,Professional,Both,,,,816,693.6,101.66,816,Medica,Individual & Family,691.968,84.8,,percent of total billed charges,,
Tympanostomy Unilateral (Pro Cah),,69436,CPT,Professional,Both,,,,816,693.6,101.66,816,Medica,Medica Advantage Solution,406.368,49.8,,percent of total billed charges,,
Tympanostomy Unilateral (Pro Cah),,69436,CPT,Professional,Both,,,,816,693.6,101.66,816,Medica,Medical Assistance,117.37,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Tympanostomy Unilateral (Pro Cah),,69436,CPT,Professional,Both,,,,816,693.6,101.66,816,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,158.11,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Tympanostomy Unilateral (Pro Cah),,69436,CPT,Professional,Both,,,,816,693.6,101.66,816,"Multiplan, Inc.","Multiplan, Inc.",767.04,94,,percent of total billed charges,,
Tympanostomy Unilateral (Pro Cah),,69436,CPT,Professional,Both,,,,816,693.6,101.66,816,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,735.216,90.1,,percent of total billed charges,,
Tympanostomy Unilateral (Pro Cah),,69436,CPT,Professional,Both,,,,816,693.6,101.66,816,"Preferred One Administrative Services, INC.",PPO,804.576,98.6,,percent of total billed charges,,
Tympanostomy Unilateral (Pro Cah),,69436,CPT,Professional,Both,,,,816,693.6,101.66,816,PrimeWest Health,Minnesota Senior Health Options (MSHO),181.8265,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Tympanostomy Unilateral (Pro Cah),,69436,CPT,Professional,Both,,,,816,693.6,101.66,816,PrimeWest Health,MinnesotaCare,125.5841024,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Tympanostomy Unilateral (Pro Cah),,69436,CPT,Professional,Both,,,,816,693.6,101.66,816,Sanford Health Plan,Sanford Health Plan,718.08,88,,percent of total billed charges,,
Tympanostomy Unilateral (Pro Cah),,69436,CPT,Professional,Both,,,,816,693.6,101.66,816,"UCare Health, Inc.",Individual & Family Plan,257.023616,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Tympanostomy Unilateral (Pro Cah),,69436,CPT,Professional,Both,,,,816,693.6,101.66,816,"UCare Health, Inc.",Medical Assistance,129.105152,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Tympanostomy Unilateral (Pro Cah),,69436,CPT,Professional,Both,,,,816,693.6,101.66,816,"UCare Health, Inc.",Medicare Advantage,181.8265,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Tympanostomy Unilateral (Pro Cah),,69436,CPT,Professional,Both,,,,816,693.6,101.66,816,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),145.4612,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Tympanostomy Unilateral (Pro Cah),,69436,CPT,Professional,Both,,,,816,693.6,101.66,816,UnitedHealthcare,Individual & Family,816,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Tympanostomy Unilateral (Pro Cah),,69436,CPT,Professional,Both,,,,816,693.6,101.66,816,UnitedHealthcare,Medicare Advantage,181.8265,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Tympanostomy Unilateral (Pro Cah),,69436,CPT,Professional,Both,,,,816,693.6,101.66,816,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,117.36832,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Tympanic Membrane Repair,,69610,CPT,Facility,Both,,,,310,263.5,88.846,310,Aetna,Commercial,285.2,92,,percent of total billed charges,,
Tympanic Membrane Repair,,69610,CPT,Facility,Outpatient,,,,310,263.5,88.846,310,Aetna,Medicare Advantage,151.9,49,,percent of total billed charges,,
Tympanic Membrane Repair,,69610,CPT,Facility,Inpatient,,,,310,263.5,88.846,310,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Tympanic Membrane Repair,,69610,CPT,Facility,Both,,,,310,263.5,88.846,310,Aetna,PPO,288.3,93,,percent of total billed charges,,
Tympanic Membrane Repair,,69610,CPT,Facility,Both,,,,310,263.5,88.846,310,America's PPO,America's PPO,297.693,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Tympanic Membrane Repair,,69610,CPT,Facility,Both,,,,310,263.5,88.846,310,BlueCross BlueShield Minnesota, Federal Employee Program,305.04,98.4,,percent of total billed charges,,
Tympanic Membrane Repair,,69610,CPT,Facility,Both,,,,310,263.5,88.846,310,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,310,100,,percent of total billed charges,,
Tympanic Membrane Repair,,69610,CPT,Facility,Both,,,,310,263.5,88.846,310,BlueCross BlueShield Minnesota,High Value Network Plan,279,90,,percent of total billed charges,,
Tympanic Membrane Repair,,69610,CPT,Facility,Outpatient,,,,310,263.5,88.846,310,BlueCross BlueShield Minnesota,Medicare Advantage,151.9,49,,percent of total billed charges,,
Tympanic Membrane Repair,,69610,CPT,Facility,Inpatient,,,,310,263.5,88.846,310,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Tympanic Membrane Repair,,69610,CPT,Facility,Both,,,,310,263.5,88.846,310,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,274.567,88.57,,percent of total billed charges,,
Tympanic Membrane Repair,,69610,CPT,Facility,Both,,,,310,263.5,88.846,310,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,88.846,28.66,,percent of total billed charges,,
Tympanic Membrane Repair,,69610,CPT,Facility,Outpatient,,,,310,263.5,88.846,310,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),151.9,49,,percent of total billed charges,,
Tympanic Membrane Repair,,69610,CPT,Facility,Inpatient,,,,310,263.5,88.846,310,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Tympanic Membrane Repair,,69610,CPT,Facility,Both,,,,310,263.5,88.846,310,CorVel,Worker's Compensation,310,100,,percent of total billed charges,,
Tympanic Membrane Repair,,69610,CPT,Facility,Both,,,,310,263.5,88.846,310,First Health Group Corporation,First Health Network,300.7,97,,percent of total billed charges,,
Tympanic Membrane Repair,,69610,CPT,Facility,Both,,,,310,263.5,88.846,310,"Health Partners, Inc.",Commercial,293.26,94.6,,percent of total billed charges,,
Tympanic Membrane Repair,,69610,CPT,Facility,Outpatient,,,,310,263.5,88.846,310,"Health Partners, Inc.",Medicare Advantage,151.9,49,,percent of total billed charges,,
Tympanic Membrane Repair,,69610,CPT,Facility,Inpatient,,,,310,263.5,88.846,310,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Tympanic Membrane Repair,,69610,CPT,Facility,Both,,,,310,263.5,88.846,310,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),186,60,,percent of total billed charges,,
Tympanic Membrane Repair,,69610,CPT,Facility,Both,,,,310,263.5,88.846,310,"Health Partners, Inc.",State of Minnesota Advantage Program,252.65,81.5,,percent of total billed charges,,
Tympanic Membrane Repair,,69610,CPT,Facility,Both,,,,310,263.5,88.846,310,"Health Partners, Inc.",State Public Programs,155,50,,percent of total billed charges,,
Tympanic Membrane Repair,,69610,CPT,Facility,Both,,,,310,263.5,88.846,310,Humana Insurance Company,Commercial PPO,294.5,95,,percent of total billed charges,,
Tympanic Membrane Repair,,69610,CPT,Facility,Outpatient,,,,310,263.5,88.846,310,Humana Insurance Company,Medicare PPO,151.9,49,,percent of total billed charges,,
Tympanic Membrane Repair,,69610,CPT,Facility,Inpatient,,,,310,263.5,88.846,310,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Tympanic Membrane Repair,,69610,CPT,Facility,Both,,,,310,263.5,88.846,310,Medica,Individual & Family,307.21,99.1,,percent of total billed charges,,
Tympanic Membrane Repair,,69610,CPT,Facility,Outpatient,,,,310,263.5,88.846,310,Medica,Medica Advantage Solution,154.38,49.8,,percent of total billed charges,,
Tympanic Membrane Repair,,69610,CPT,Facility,Inpatient,,,,310,263.5,88.846,310,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Tympanic Membrane Repair,,69610,CPT,Facility,Outpatient,,,,310,263.5,88.846,310,Medica,Medical Assistance,138.26,44.6,,percent of total billed charges,,
Tympanic Membrane Repair,,69610,CPT,Facility,Inpatient,,,,310,263.5,88.846,310,Medica,Medical Assistance,,,,,Included in per diem rate,
Tympanic Membrane Repair,,69610,CPT,Facility,Outpatient,,,,310,263.5,88.846,310,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,154.38,49.8,,percent of total billed charges,,
Tympanic Membrane Repair,,69610,CPT,Facility,Inpatient,,,,310,263.5,88.846,310,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Tympanic Membrane Repair,,69610,CPT,Facility,Both,,,,310,263.5,88.846,310,"Multiplan, Inc.","Multiplan, Inc.",291.4,94,,percent of total billed charges,,
Tympanic Membrane Repair,,69610,CPT,Facility,Outpatient,,,,310,263.5,88.846,310,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,279.31,90.1,,percent of total billed charges,,
Tympanic Membrane Repair,,69610,CPT,Facility,Inpatient,,,,310,263.5,88.846,310,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Tympanic Membrane Repair,,69610,CPT,Facility,Both,,,,310,263.5,88.846,310,"Preferred One Administrative Services, INC.",PPO,305.66,98.6,,percent of total billed charges,,
Tympanic Membrane Repair,,69610,CPT,Facility,Outpatient,,,,310,263.5,88.846,310,PrimeWest Health,Minnesota Senior Health Options (MSHO),159.495,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Tympanic Membrane Repair,,69610,CPT,Facility,Inpatient,,,,310,263.5,88.846,310,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Tympanic Membrane Repair,,69610,CPT,Facility,Outpatient,,,,310,263.5,88.846,310,PrimeWest Health,MinnesotaCare,159.216,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Tympanic Membrane Repair,,69610,CPT,Facility,Inpatient,,,,310,263.5,88.846,310,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Tympanic Membrane Repair,,69610,CPT,Facility,Both,,,,310,263.5,88.846,310,Sanford Health Plan,Sanford Health Plan,285.2,92,,percent of total billed charges,,
Tympanic Membrane Repair,,69610,CPT,Facility,Outpatient,,,,310,263.5,88.846,310,"UCare Health, Inc.",Individual & Family Plan,174.685,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Tympanic Membrane Repair,,69610,CPT,Facility,Inpatient,,,,310,263.5,88.846,310,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Tympanic Membrane Repair,,69610,CPT,Facility,Outpatient,,,,310,263.5,88.846,310,"UCare Health, Inc.",Medical Assistance,156.457,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Tympanic Membrane Repair,,69610,CPT,Facility,Inpatient,,,,310,263.5,88.846,310,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Tympanic Membrane Repair,,69610,CPT,Facility,Outpatient,,,,310,263.5,88.846,310,"UCare Health, Inc.",Medicare Advantage,156.457,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Tympanic Membrane Repair,,69610,CPT,Facility,Inpatient,,,,310,263.5,88.846,310,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Tympanic Membrane Repair,,69610,CPT,Facility,Outpatient,,,,310,263.5,88.846,310,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),156.457,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Tympanic Membrane Repair,,69610,CPT,Facility,Inpatient,,,,310,263.5,88.846,310,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Tympanic Membrane Repair,,69610,CPT,Facility,Both,,,,310,263.5,88.846,310,UnitedHealthcare,Individual & Family,291.4,94,,percent of total billed charges,,
Tympanic Membrane Repair,,69610,CPT,Facility,Outpatient,,,,310,263.5,88.846,310,UnitedHealthcare,Medicare Advantage,151.9,49,,percent of total billed charges,,
Tympanic Membrane Repair,,69610,CPT,Facility,Inpatient,,,,310,263.5,88.846,310,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Tympanic Membrane Repair,,69610,CPT,Facility,Outpatient,,,,310,263.5,88.846,310,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,148.8,48,,percent of total billed charges,,100% of DHS outpatient percentage
Tympanic Membrane Repair,,69610,CPT,Facility,Inpatient,,,,310,263.5,88.846,310,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Tympanic Membrane Repair, W Wo Site Preparation Of Perforation For Closure, W Wo Patch (Pro Cah)",,69610,CPT,Professional,Both,,,,510,433.5,179.97,510,Aetna,Commercial,433.5,85,,percent of total billed charges,,
"Tympanic Membrane Repair, W Wo Site Preparation Of Perforation For Closure, W Wo Patch (Pro Cah)",,69610,CPT,Professional,Both,,,,510,433.5,179.97,510,Aetna,Medicare Advantage,279.32,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Tympanic Membrane Repair, W Wo Site Preparation Of Perforation For Closure, W Wo Patch (Pro Cah)",,69610,CPT,Professional,Both,,,,510,433.5,179.97,510,Aetna,PPO,474.3,93,,percent of total billed charges,,
"Tympanic Membrane Repair, W Wo Site Preparation Of Perforation For Closure, W Wo Patch (Pro Cah)",,69610,CPT,Professional,Both,,,,510,433.5,179.97,510,America's PPO,America's PPO,435.744,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Tympanic Membrane Repair, W Wo Site Preparation Of Perforation For Closure, W Wo Patch (Pro Cah)",,69610,CPT,Professional,Both,,,,510,433.5,179.97,510,BlueCross BlueShield Minnesota, Federal Employee Program,510,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Tympanic Membrane Repair, W Wo Site Preparation Of Perforation For Closure, W Wo Patch (Pro Cah)",,69610,CPT,Professional,Both,,,,510,433.5,179.97,510,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,510,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Tympanic Membrane Repair, W Wo Site Preparation Of Perforation For Closure, W Wo Patch (Pro Cah)",,69610,CPT,Professional,Both,,,,510,433.5,179.97,510,BlueCross BlueShield Minnesota,High Value Network Plan,510,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Tympanic Membrane Repair, W Wo Site Preparation Of Perforation For Closure, W Wo Patch (Pro Cah)",,69610,CPT,Professional,Both,,,,510,433.5,179.97,510,BlueCross BlueShield Minnesota,Medicare Advantage,321.839,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Tympanic Membrane Repair, W Wo Site Preparation Of Perforation For Closure, W Wo Patch (Pro Cah)",,69610,CPT,Professional,Both,,,,510,433.5,179.97,510,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,510,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Tympanic Membrane Repair, W Wo Site Preparation Of Perforation For Closure, W Wo Patch (Pro Cah)",,69610,CPT,Professional,Both,,,,510,433.5,179.97,510,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,207.78216,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Tympanic Membrane Repair, W Wo Site Preparation Of Perforation For Closure, W Wo Patch (Pro Cah)",,69610,CPT,Professional,Both,,,,510,433.5,179.97,510,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),321.839,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Tympanic Membrane Repair, W Wo Site Preparation Of Perforation For Closure, W Wo Patch (Pro Cah)",,69610,CPT,Professional,Both,,,,510,433.5,179.97,510,CorVel,Worker's Compensation,510,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Tympanic Membrane Repair, W Wo Site Preparation Of Perforation For Closure, W Wo Patch (Pro Cah)",,69610,CPT,Professional,Both,,,,510,433.5,179.97,510,First Health Group Corporation,First Health Network,494.7,97,,percent of total billed charges,,
"Tympanic Membrane Repair, W Wo Site Preparation Of Perforation For Closure, W Wo Patch (Pro Cah)",,69610,CPT,Professional,Both,,,,510,433.5,179.97,510,"Health Partners, Inc.",Commercial,510,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Tympanic Membrane Repair, W Wo Site Preparation Of Perforation For Closure, W Wo Patch (Pro Cah)",,69610,CPT,Professional,Both,,,,510,433.5,179.97,510,"Health Partners, Inc.",Medicare Advantage,321.839,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Tympanic Membrane Repair, W Wo Site Preparation Of Perforation For Closure, W Wo Patch (Pro Cah)",,69610,CPT,Professional,Both,,,,510,433.5,179.97,510,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),279.91,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Tympanic Membrane Repair, W Wo Site Preparation Of Perforation For Closure, W Wo Patch (Pro Cah)",,69610,CPT,Professional,Both,,,,510,433.5,179.97,510,"Health Partners, Inc.",State of Minnesota Advantage Program,507.535495,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Tympanic Membrane Repair, W Wo Site Preparation Of Perforation For Closure, W Wo Patch (Pro Cah)",,69610,CPT,Professional,Both,,,,510,433.5,179.97,510,"Health Partners, Inc.",State Public Programs,179.97,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Tympanic Membrane Repair, W Wo Site Preparation Of Perforation For Closure, W Wo Patch (Pro Cah)",,69610,CPT,Professional,Both,,,,510,433.5,179.97,510,Humana Insurance Company,Commercial PPO,279.86,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Tympanic Membrane Repair, W Wo Site Preparation Of Perforation For Closure, W Wo Patch (Pro Cah)",,69610,CPT,Professional,Both,,,,510,433.5,179.97,510,Humana Insurance Company,Medicare PPO,510,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Tympanic Membrane Repair, W Wo Site Preparation Of Perforation For Closure, W Wo Patch (Pro Cah)",,69610,CPT,Professional,Both,,,,510,433.5,179.97,510,Medica,Individual & Family,432.48,84.8,,percent of total billed charges,,
"Tympanic Membrane Repair, W Wo Site Preparation Of Perforation For Closure, W Wo Patch (Pro Cah)",,69610,CPT,Professional,Both,,,,510,433.5,179.97,510,Medica,Medica Advantage Solution,253.98,49.8,,percent of total billed charges,,
"Tympanic Membrane Repair, W Wo Site Preparation Of Perforation For Closure, W Wo Patch (Pro Cah)",,69610,CPT,Professional,Both,,,,510,433.5,179.97,510,Medica,Medical Assistance,207.78,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Tympanic Membrane Repair, W Wo Site Preparation Of Perforation For Closure, W Wo Patch (Pro Cah)",,69610,CPT,Professional,Both,,,,510,433.5,179.97,510,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,279.86,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Tympanic Membrane Repair, W Wo Site Preparation Of Perforation For Closure, W Wo Patch (Pro Cah)",,69610,CPT,Professional,Both,,,,510,433.5,179.97,510,"Multiplan, Inc.","Multiplan, Inc.",479.4,94,,percent of total billed charges,,
"Tympanic Membrane Repair, W Wo Site Preparation Of Perforation For Closure, W Wo Patch (Pro Cah)",,69610,CPT,Professional,Both,,,,510,433.5,179.97,510,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,459.51,90.1,,percent of total billed charges,,
"Tympanic Membrane Repair, W Wo Site Preparation Of Perforation For Closure, W Wo Patch (Pro Cah)",,69610,CPT,Professional,Both,,,,510,433.5,179.97,510,"Preferred One Administrative Services, INC.",PPO,502.86,98.6,,percent of total billed charges,,
"Tympanic Membrane Repair, W Wo Site Preparation Of Perforation For Closure, W Wo Patch (Pro Cah)",,69610,CPT,Professional,Both,,,,510,433.5,179.97,510,PrimeWest Health,Minnesota Senior Health Options (MSHO),321.839,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Tympanic Membrane Repair, W Wo Site Preparation Of Perforation For Closure, W Wo Patch (Pro Cah)",,69610,CPT,Professional,Both,,,,510,433.5,179.97,510,PrimeWest Health,MinnesotaCare,222.3269112,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Tympanic Membrane Repair, W Wo Site Preparation Of Perforation For Closure, W Wo Patch (Pro Cah)",,69610,CPT,Professional,Both,,,,510,433.5,179.97,510,Sanford Health Plan,Sanford Health Plan,448.8,88,,percent of total billed charges,,
"Tympanic Membrane Repair, W Wo Site Preparation Of Perforation For Closure, W Wo Patch (Pro Cah)",,69610,CPT,Professional,Both,,,,510,433.5,179.97,510,"UCare Health, Inc.",Individual & Family Plan,454.940416,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Tympanic Membrane Repair, W Wo Site Preparation Of Perforation For Closure, W Wo Patch (Pro Cah)",,69610,CPT,Professional,Both,,,,510,433.5,179.97,510,"UCare Health, Inc.",Medical Assistance,228.560376,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Tympanic Membrane Repair, W Wo Site Preparation Of Perforation For Closure, W Wo Patch (Pro Cah)",,69610,CPT,Professional,Both,,,,510,433.5,179.97,510,"UCare Health, Inc.",Medicare Advantage,321.839,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Tympanic Membrane Repair, W Wo Site Preparation Of Perforation For Closure, W Wo Patch (Pro Cah)",,69610,CPT,Professional,Both,,,,510,433.5,179.97,510,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),257.4712,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Tympanic Membrane Repair, W Wo Site Preparation Of Perforation For Closure, W Wo Patch (Pro Cah)",,69610,CPT,Professional,Both,,,,510,433.5,179.97,510,UnitedHealthcare,Individual & Family,510,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Tympanic Membrane Repair, W Wo Site Preparation Of Perforation For Closure, W Wo Patch (Pro Cah)",,69610,CPT,Professional,Both,,,,510,433.5,179.97,510,UnitedHealthcare,Medicare Advantage,321.839,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Tympanic Membrane Repair, W Wo Site Preparation Of Perforation For Closure, W Wo Patch (Pro Cah)",,69610,CPT,Professional,Both,,,,510,433.5,179.97,510,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,207.78216,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Xr Eye Foreign Body Detection,,70030,CPT,Facility,Both,,,,255,216.75,73.083,255,Aetna,Commercial,234.6,92,,percent of total billed charges,,
Xr Eye Foreign Body Detection,,70030,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,Aetna,Medicare Advantage,124.95,49,,percent of total billed charges,,
Xr Eye Foreign Body Detection,,70030,CPT,Facility,Inpatient,,,,255,216.75,73.083,255,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Xr Eye Foreign Body Detection,,70030,CPT,Facility,Both,,,,255,216.75,73.083,255,Aetna,PPO,237.15,93,,percent of total billed charges,,
Xr Eye Foreign Body Detection,,70030,CPT,Facility,Both,,,,255,216.75,73.083,255,America's PPO,America's PPO,244.8765,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Xr Eye Foreign Body Detection,,70030,CPT,Facility,Both,,,,255,216.75,73.083,255,BlueCross BlueShield Minnesota, Federal Employee Program,250.92,98.4,,percent of total billed charges,,
Xr Eye Foreign Body Detection,,70030,CPT,Facility,Both,,,,255,216.75,73.083,255,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,255,100,,percent of total billed charges,,
Xr Eye Foreign Body Detection,,70030,CPT,Facility,Both,,,,255,216.75,73.083,255,BlueCross BlueShield Minnesota,High Value Network Plan,229.5,90,,percent of total billed charges,,
Xr Eye Foreign Body Detection,,70030,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,BlueCross BlueShield Minnesota,Medicare Advantage,124.95,49,,percent of total billed charges,,
Xr Eye Foreign Body Detection,,70030,CPT,Facility,Inpatient,,,,255,216.75,73.083,255,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Xr Eye Foreign Body Detection,,70030,CPT,Facility,Both,,,,255,216.75,73.083,255,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,225.8535,88.57,,percent of total billed charges,,
Xr Eye Foreign Body Detection,,70030,CPT,Facility,Both,,,,255,216.75,73.083,255,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,73.083,28.66,,percent of total billed charges,,
Xr Eye Foreign Body Detection,,70030,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),124.95,49,,percent of total billed charges,,
Xr Eye Foreign Body Detection,,70030,CPT,Facility,Inpatient,,,,255,216.75,73.083,255,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Xr Eye Foreign Body Detection,,70030,CPT,Facility,Both,,,,255,216.75,73.083,255,CorVel,Worker's Compensation,255,100,,percent of total billed charges,,
Xr Eye Foreign Body Detection,,70030,CPT,Facility,Both,,,,255,216.75,73.083,255,First Health Group Corporation,First Health Network,247.35,97,,percent of total billed charges,,
Xr Eye Foreign Body Detection,,70030,CPT,Facility,Both,,,,255,216.75,73.083,255,"Health Partners, Inc.",Commercial,241.23,94.6,,percent of total billed charges,,
Xr Eye Foreign Body Detection,,70030,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,"Health Partners, Inc.",Medicare Advantage,124.95,49,,percent of total billed charges,,
Xr Eye Foreign Body Detection,,70030,CPT,Facility,Inpatient,,,,255,216.75,73.083,255,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Eye Foreign Body Detection,,70030,CPT,Facility,Both,,,,255,216.75,73.083,255,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),153,60,,percent of total billed charges,,
Xr Eye Foreign Body Detection,,70030,CPT,Facility,Both,,,,255,216.75,73.083,255,"Health Partners, Inc.",State of Minnesota Advantage Program,207.825,81.5,,percent of total billed charges,,
Xr Eye Foreign Body Detection,,70030,CPT,Facility,Both,,,,255,216.75,73.083,255,"Health Partners, Inc.",State Public Programs,127.5,50,,percent of total billed charges,,
Xr Eye Foreign Body Detection,,70030,CPT,Facility,Both,,,,255,216.75,73.083,255,Humana Insurance Company,Commercial PPO,242.25,95,,percent of total billed charges,,
Xr Eye Foreign Body Detection,,70030,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,Humana Insurance Company,Medicare PPO,124.95,49,,percent of total billed charges,,
Xr Eye Foreign Body Detection,,70030,CPT,Facility,Inpatient,,,,255,216.75,73.083,255,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Xr Eye Foreign Body Detection,,70030,CPT,Facility,Both,,,,255,216.75,73.083,255,Medica,Individual & Family,252.705,99.1,,percent of total billed charges,,
Xr Eye Foreign Body Detection,,70030,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,Medica,Medica Advantage Solution,126.99,49.8,,percent of total billed charges,,
Xr Eye Foreign Body Detection,,70030,CPT,Facility,Inpatient,,,,255,216.75,73.083,255,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Xr Eye Foreign Body Detection,,70030,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,Medica,Medical Assistance,113.73,44.6,,percent of total billed charges,,
Xr Eye Foreign Body Detection,,70030,CPT,Facility,Inpatient,,,,255,216.75,73.083,255,Medica,Medical Assistance,,,,,Included in per diem rate,
Xr Eye Foreign Body Detection,,70030,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,126.99,49.8,,percent of total billed charges,,
Xr Eye Foreign Body Detection,,70030,CPT,Facility,Inpatient,,,,255,216.75,73.083,255,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Xr Eye Foreign Body Detection,,70030,CPT,Facility,Both,,,,255,216.75,73.083,255,"Multiplan, Inc.","Multiplan, Inc.",239.7,94,,percent of total billed charges,,
Xr Eye Foreign Body Detection,,70030,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,229.755,90.1,,percent of total billed charges,,
Xr Eye Foreign Body Detection,,70030,CPT,Facility,Inpatient,,,,255,216.75,73.083,255,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Xr Eye Foreign Body Detection,,70030,CPT,Facility,Both,,,,255,216.75,73.083,255,"Preferred One Administrative Services, INC.",PPO,251.43,98.6,,percent of total billed charges,,
Xr Eye Foreign Body Detection,,70030,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,PrimeWest Health,Minnesota Senior Health Options (MSHO),131.1975,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Xr Eye Foreign Body Detection,,70030,CPT,Facility,Inpatient,,,,255,216.75,73.083,255,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Eye Foreign Body Detection,,70030,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,PrimeWest Health,MinnesotaCare,130.968,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Xr Eye Foreign Body Detection,,70030,CPT,Facility,Inpatient,,,,255,216.75,73.083,255,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Xr Eye Foreign Body Detection,,70030,CPT,Facility,Both,,,,255,216.75,73.083,255,Sanford Health Plan,Sanford Health Plan,234.6,92,,percent of total billed charges,,
Xr Eye Foreign Body Detection,,70030,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,"UCare Health, Inc.",Individual & Family Plan,143.6925,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Xr Eye Foreign Body Detection,,70030,CPT,Facility,Inpatient,,,,255,216.75,73.083,255,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Xr Eye Foreign Body Detection,,70030,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,"UCare Health, Inc.",Medical Assistance,128.6985,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Eye Foreign Body Detection,,70030,CPT,Facility,Inpatient,,,,255,216.75,73.083,255,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Xr Eye Foreign Body Detection,,70030,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,"UCare Health, Inc.",Medicare Advantage,128.6985,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Eye Foreign Body Detection,,70030,CPT,Facility,Inpatient,,,,255,216.75,73.083,255,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Eye Foreign Body Detection,,70030,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),128.6985,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Eye Foreign Body Detection,,70030,CPT,Facility,Inpatient,,,,255,216.75,73.083,255,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Eye Foreign Body Detection,,70030,CPT,Facility,Both,,,,255,216.75,73.083,255,UnitedHealthcare,Individual & Family,239.7,94,,percent of total billed charges,,
Xr Eye Foreign Body Detection,,70030,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,UnitedHealthcare,Medicare Advantage,124.95,49,,percent of total billed charges,,
Xr Eye Foreign Body Detection,,70030,CPT,Facility,Inpatient,,,,255,216.75,73.083,255,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Xr Eye Foreign Body Detection,,70030,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,122.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
Xr Eye Foreign Body Detection,,70030,CPT,Facility,Inpatient,,,,255,216.75,73.083,255,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Xr Mandible Less Than 4 Views,,70100,CPT,Facility,Both,,,,255,216.75,73.083,255,Aetna,Commercial,234.6,92,,percent of total billed charges,,
Xr Mandible Less Than 4 Views,,70100,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,Aetna,Medicare Advantage,124.95,49,,percent of total billed charges,,
Xr Mandible Less Than 4 Views,,70100,CPT,Facility,Inpatient,,,,255,216.75,73.083,255,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Xr Mandible Less Than 4 Views,,70100,CPT,Facility,Both,,,,255,216.75,73.083,255,Aetna,PPO,237.15,93,,percent of total billed charges,,
Xr Mandible Less Than 4 Views,,70100,CPT,Facility,Both,,,,255,216.75,73.083,255,America's PPO,America's PPO,244.8765,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Xr Mandible Less Than 4 Views,,70100,CPT,Facility,Both,,,,255,216.75,73.083,255,BlueCross BlueShield Minnesota, Federal Employee Program,250.92,98.4,,percent of total billed charges,,
Xr Mandible Less Than 4 Views,,70100,CPT,Facility,Both,,,,255,216.75,73.083,255,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,255,100,,percent of total billed charges,,
Xr Mandible Less Than 4 Views,,70100,CPT,Facility,Both,,,,255,216.75,73.083,255,BlueCross BlueShield Minnesota,High Value Network Plan,229.5,90,,percent of total billed charges,,
Xr Mandible Less Than 4 Views,,70100,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,BlueCross BlueShield Minnesota,Medicare Advantage,124.95,49,,percent of total billed charges,,
Xr Mandible Less Than 4 Views,,70100,CPT,Facility,Inpatient,,,,255,216.75,73.083,255,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Xr Mandible Less Than 4 Views,,70100,CPT,Facility,Both,,,,255,216.75,73.083,255,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,225.8535,88.57,,percent of total billed charges,,
Xr Mandible Less Than 4 Views,,70100,CPT,Facility,Both,,,,255,216.75,73.083,255,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,73.083,28.66,,percent of total billed charges,,
Xr Mandible Less Than 4 Views,,70100,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),124.95,49,,percent of total billed charges,,
Xr Mandible Less Than 4 Views,,70100,CPT,Facility,Inpatient,,,,255,216.75,73.083,255,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Xr Mandible Less Than 4 Views,,70100,CPT,Facility,Both,,,,255,216.75,73.083,255,CorVel,Worker's Compensation,255,100,,percent of total billed charges,,
Xr Mandible Less Than 4 Views,,70100,CPT,Facility,Both,,,,255,216.75,73.083,255,First Health Group Corporation,First Health Network,247.35,97,,percent of total billed charges,,
Xr Mandible Less Than 4 Views,,70100,CPT,Facility,Both,,,,255,216.75,73.083,255,"Health Partners, Inc.",Commercial,241.23,94.6,,percent of total billed charges,,
Xr Mandible Less Than 4 Views,,70100,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,"Health Partners, Inc.",Medicare Advantage,124.95,49,,percent of total billed charges,,
Xr Mandible Less Than 4 Views,,70100,CPT,Facility,Inpatient,,,,255,216.75,73.083,255,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Mandible Less Than 4 Views,,70100,CPT,Facility,Both,,,,255,216.75,73.083,255,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),153,60,,percent of total billed charges,,
Xr Mandible Less Than 4 Views,,70100,CPT,Facility,Both,,,,255,216.75,73.083,255,"Health Partners, Inc.",State of Minnesota Advantage Program,207.825,81.5,,percent of total billed charges,,
Xr Mandible Less Than 4 Views,,70100,CPT,Facility,Both,,,,255,216.75,73.083,255,"Health Partners, Inc.",State Public Programs,127.5,50,,percent of total billed charges,,
Xr Mandible Less Than 4 Views,,70100,CPT,Facility,Both,,,,255,216.75,73.083,255,Humana Insurance Company,Commercial PPO,242.25,95,,percent of total billed charges,,
Xr Mandible Less Than 4 Views,,70100,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,Humana Insurance Company,Medicare PPO,124.95,49,,percent of total billed charges,,
Xr Mandible Less Than 4 Views,,70100,CPT,Facility,Inpatient,,,,255,216.75,73.083,255,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Xr Mandible Less Than 4 Views,,70100,CPT,Facility,Both,,,,255,216.75,73.083,255,Medica,Individual & Family,252.705,99.1,,percent of total billed charges,,
Xr Mandible Less Than 4 Views,,70100,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,Medica,Medica Advantage Solution,126.99,49.8,,percent of total billed charges,,
Xr Mandible Less Than 4 Views,,70100,CPT,Facility,Inpatient,,,,255,216.75,73.083,255,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Xr Mandible Less Than 4 Views,,70100,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,Medica,Medical Assistance,113.73,44.6,,percent of total billed charges,,
Xr Mandible Less Than 4 Views,,70100,CPT,Facility,Inpatient,,,,255,216.75,73.083,255,Medica,Medical Assistance,,,,,Included in per diem rate,
Xr Mandible Less Than 4 Views,,70100,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,126.99,49.8,,percent of total billed charges,,
Xr Mandible Less Than 4 Views,,70100,CPT,Facility,Inpatient,,,,255,216.75,73.083,255,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Xr Mandible Less Than 4 Views,,70100,CPT,Facility,Both,,,,255,216.75,73.083,255,"Multiplan, Inc.","Multiplan, Inc.",239.7,94,,percent of total billed charges,,
Xr Mandible Less Than 4 Views,,70100,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,229.755,90.1,,percent of total billed charges,,
Xr Mandible Less Than 4 Views,,70100,CPT,Facility,Inpatient,,,,255,216.75,73.083,255,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Xr Mandible Less Than 4 Views,,70100,CPT,Facility,Both,,,,255,216.75,73.083,255,"Preferred One Administrative Services, INC.",PPO,251.43,98.6,,percent of total billed charges,,
Xr Mandible Less Than 4 Views,,70100,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,PrimeWest Health,Minnesota Senior Health Options (MSHO),131.1975,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Xr Mandible Less Than 4 Views,,70100,CPT,Facility,Inpatient,,,,255,216.75,73.083,255,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Mandible Less Than 4 Views,,70100,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,PrimeWest Health,MinnesotaCare,130.968,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Xr Mandible Less Than 4 Views,,70100,CPT,Facility,Inpatient,,,,255,216.75,73.083,255,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Xr Mandible Less Than 4 Views,,70100,CPT,Facility,Both,,,,255,216.75,73.083,255,Sanford Health Plan,Sanford Health Plan,234.6,92,,percent of total billed charges,,
Xr Mandible Less Than 4 Views,,70100,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,"UCare Health, Inc.",Individual & Family Plan,143.6925,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Xr Mandible Less Than 4 Views,,70100,CPT,Facility,Inpatient,,,,255,216.75,73.083,255,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Xr Mandible Less Than 4 Views,,70100,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,"UCare Health, Inc.",Medical Assistance,128.6985,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Mandible Less Than 4 Views,,70100,CPT,Facility,Inpatient,,,,255,216.75,73.083,255,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Xr Mandible Less Than 4 Views,,70100,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,"UCare Health, Inc.",Medicare Advantage,128.6985,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Mandible Less Than 4 Views,,70100,CPT,Facility,Inpatient,,,,255,216.75,73.083,255,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Mandible Less Than 4 Views,,70100,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),128.6985,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Mandible Less Than 4 Views,,70100,CPT,Facility,Inpatient,,,,255,216.75,73.083,255,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Mandible Less Than 4 Views,,70100,CPT,Facility,Both,,,,255,216.75,73.083,255,UnitedHealthcare,Individual & Family,239.7,94,,percent of total billed charges,,
Xr Mandible Less Than 4 Views,,70100,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,UnitedHealthcare,Medicare Advantage,124.95,49,,percent of total billed charges,,
Xr Mandible Less Than 4 Views,,70100,CPT,Facility,Inpatient,,,,255,216.75,73.083,255,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Xr Mandible Less Than 4 Views,,70100,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,122.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
Xr Mandible Less Than 4 Views,,70100,CPT,Facility,Inpatient,,,,255,216.75,73.083,255,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Xr Mandible Routine Complete,,70110,CPT,Facility,Both,,,,306,260.1,87.6996,306,Aetna,Commercial,281.52,92,,percent of total billed charges,,
Xr Mandible Routine Complete,,70110,CPT,Facility,Outpatient,,,,306,260.1,87.6996,306,Aetna,Medicare Advantage,149.94,49,,percent of total billed charges,,
Xr Mandible Routine Complete,,70110,CPT,Facility,Inpatient,,,,306,260.1,87.6996,306,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Xr Mandible Routine Complete,,70110,CPT,Facility,Both,,,,306,260.1,87.6996,306,Aetna,PPO,284.58,93,,percent of total billed charges,,
Xr Mandible Routine Complete,,70110,CPT,Facility,Both,,,,306,260.1,87.6996,306,America's PPO,America's PPO,293.8518,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Xr Mandible Routine Complete,,70110,CPT,Facility,Both,,,,306,260.1,87.6996,306,BlueCross BlueShield Minnesota, Federal Employee Program,301.104,98.4,,percent of total billed charges,,
Xr Mandible Routine Complete,,70110,CPT,Facility,Both,,,,306,260.1,87.6996,306,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,306,100,,percent of total billed charges,,
Xr Mandible Routine Complete,,70110,CPT,Facility,Both,,,,306,260.1,87.6996,306,BlueCross BlueShield Minnesota,High Value Network Plan,275.4,90,,percent of total billed charges,,
Xr Mandible Routine Complete,,70110,CPT,Facility,Outpatient,,,,306,260.1,87.6996,306,BlueCross BlueShield Minnesota,Medicare Advantage,149.94,49,,percent of total billed charges,,
Xr Mandible Routine Complete,,70110,CPT,Facility,Inpatient,,,,306,260.1,87.6996,306,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Xr Mandible Routine Complete,,70110,CPT,Facility,Both,,,,306,260.1,87.6996,306,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,271.0242,88.57,,percent of total billed charges,,
Xr Mandible Routine Complete,,70110,CPT,Facility,Both,,,,306,260.1,87.6996,306,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,87.6996,28.66,,percent of total billed charges,,
Xr Mandible Routine Complete,,70110,CPT,Facility,Outpatient,,,,306,260.1,87.6996,306,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),149.94,49,,percent of total billed charges,,
Xr Mandible Routine Complete,,70110,CPT,Facility,Inpatient,,,,306,260.1,87.6996,306,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Xr Mandible Routine Complete,,70110,CPT,Facility,Both,,,,306,260.1,87.6996,306,CorVel,Worker's Compensation,306,100,,percent of total billed charges,,
Xr Mandible Routine Complete,,70110,CPT,Facility,Both,,,,306,260.1,87.6996,306,First Health Group Corporation,First Health Network,296.82,97,,percent of total billed charges,,
Xr Mandible Routine Complete,,70110,CPT,Facility,Both,,,,306,260.1,87.6996,306,"Health Partners, Inc.",Commercial,289.476,94.6,,percent of total billed charges,,
Xr Mandible Routine Complete,,70110,CPT,Facility,Outpatient,,,,306,260.1,87.6996,306,"Health Partners, Inc.",Medicare Advantage,149.94,49,,percent of total billed charges,,
Xr Mandible Routine Complete,,70110,CPT,Facility,Inpatient,,,,306,260.1,87.6996,306,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Mandible Routine Complete,,70110,CPT,Facility,Both,,,,306,260.1,87.6996,306,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),183.6,60,,percent of total billed charges,,
Xr Mandible Routine Complete,,70110,CPT,Facility,Both,,,,306,260.1,87.6996,306,"Health Partners, Inc.",State of Minnesota Advantage Program,249.39,81.5,,percent of total billed charges,,
Xr Mandible Routine Complete,,70110,CPT,Facility,Both,,,,306,260.1,87.6996,306,"Health Partners, Inc.",State Public Programs,153,50,,percent of total billed charges,,
Xr Mandible Routine Complete,,70110,CPT,Facility,Both,,,,306,260.1,87.6996,306,Humana Insurance Company,Commercial PPO,290.7,95,,percent of total billed charges,,
Xr Mandible Routine Complete,,70110,CPT,Facility,Outpatient,,,,306,260.1,87.6996,306,Humana Insurance Company,Medicare PPO,149.94,49,,percent of total billed charges,,
Xr Mandible Routine Complete,,70110,CPT,Facility,Inpatient,,,,306,260.1,87.6996,306,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Xr Mandible Routine Complete,,70110,CPT,Facility,Both,,,,306,260.1,87.6996,306,Medica,Individual & Family,303.246,99.1,,percent of total billed charges,,
Xr Mandible Routine Complete,,70110,CPT,Facility,Outpatient,,,,306,260.1,87.6996,306,Medica,Medica Advantage Solution,152.388,49.8,,percent of total billed charges,,
Xr Mandible Routine Complete,,70110,CPT,Facility,Inpatient,,,,306,260.1,87.6996,306,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Xr Mandible Routine Complete,,70110,CPT,Facility,Outpatient,,,,306,260.1,87.6996,306,Medica,Medical Assistance,136.476,44.6,,percent of total billed charges,,
Xr Mandible Routine Complete,,70110,CPT,Facility,Inpatient,,,,306,260.1,87.6996,306,Medica,Medical Assistance,,,,,Included in per diem rate,
Xr Mandible Routine Complete,,70110,CPT,Facility,Outpatient,,,,306,260.1,87.6996,306,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,152.388,49.8,,percent of total billed charges,,
Xr Mandible Routine Complete,,70110,CPT,Facility,Inpatient,,,,306,260.1,87.6996,306,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Xr Mandible Routine Complete,,70110,CPT,Facility,Both,,,,306,260.1,87.6996,306,"Multiplan, Inc.","Multiplan, Inc.",287.64,94,,percent of total billed charges,,
Xr Mandible Routine Complete,,70110,CPT,Facility,Outpatient,,,,306,260.1,87.6996,306,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,275.706,90.1,,percent of total billed charges,,
Xr Mandible Routine Complete,,70110,CPT,Facility,Inpatient,,,,306,260.1,87.6996,306,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Xr Mandible Routine Complete,,70110,CPT,Facility,Both,,,,306,260.1,87.6996,306,"Preferred One Administrative Services, INC.",PPO,301.716,98.6,,percent of total billed charges,,
Xr Mandible Routine Complete,,70110,CPT,Facility,Outpatient,,,,306,260.1,87.6996,306,PrimeWest Health,Minnesota Senior Health Options (MSHO),157.437,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Xr Mandible Routine Complete,,70110,CPT,Facility,Inpatient,,,,306,260.1,87.6996,306,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Mandible Routine Complete,,70110,CPT,Facility,Outpatient,,,,306,260.1,87.6996,306,PrimeWest Health,MinnesotaCare,157.1616,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Xr Mandible Routine Complete,,70110,CPT,Facility,Inpatient,,,,306,260.1,87.6996,306,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Xr Mandible Routine Complete,,70110,CPT,Facility,Both,,,,306,260.1,87.6996,306,Sanford Health Plan,Sanford Health Plan,281.52,92,,percent of total billed charges,,
Xr Mandible Routine Complete,,70110,CPT,Facility,Outpatient,,,,306,260.1,87.6996,306,"UCare Health, Inc.",Individual & Family Plan,172.431,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Xr Mandible Routine Complete,,70110,CPT,Facility,Inpatient,,,,306,260.1,87.6996,306,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Xr Mandible Routine Complete,,70110,CPT,Facility,Outpatient,,,,306,260.1,87.6996,306,"UCare Health, Inc.",Medical Assistance,154.4382,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Mandible Routine Complete,,70110,CPT,Facility,Inpatient,,,,306,260.1,87.6996,306,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Xr Mandible Routine Complete,,70110,CPT,Facility,Outpatient,,,,306,260.1,87.6996,306,"UCare Health, Inc.",Medicare Advantage,154.4382,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Mandible Routine Complete,,70110,CPT,Facility,Inpatient,,,,306,260.1,87.6996,306,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Mandible Routine Complete,,70110,CPT,Facility,Outpatient,,,,306,260.1,87.6996,306,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),154.4382,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Mandible Routine Complete,,70110,CPT,Facility,Inpatient,,,,306,260.1,87.6996,306,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Mandible Routine Complete,,70110,CPT,Facility,Both,,,,306,260.1,87.6996,306,UnitedHealthcare,Individual & Family,287.64,94,,percent of total billed charges,,
Xr Mandible Routine Complete,,70110,CPT,Facility,Outpatient,,,,306,260.1,87.6996,306,UnitedHealthcare,Medicare Advantage,149.94,49,,percent of total billed charges,,
Xr Mandible Routine Complete,,70110,CPT,Facility,Inpatient,,,,306,260.1,87.6996,306,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Xr Mandible Routine Complete,,70110,CPT,Facility,Outpatient,,,,306,260.1,87.6996,306,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,146.88,48,,percent of total billed charges,,100% of DHS outpatient percentage
Xr Mandible Routine Complete,,70110,CPT,Facility,Inpatient,,,,306,260.1,87.6996,306,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Xr Mastoids Less Than 3 Views,,70120,CPT,Facility,Both,,,,255,216.75,73.083,255,Aetna,Commercial,234.6,92,,percent of total billed charges,,
Xr Mastoids Less Than 3 Views,,70120,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,Aetna,Medicare Advantage,124.95,49,,percent of total billed charges,,
Xr Mastoids Less Than 3 Views,,70120,CPT,Facility,Inpatient,,,,255,216.75,73.083,255,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Xr Mastoids Less Than 3 Views,,70120,CPT,Facility,Both,,,,255,216.75,73.083,255,Aetna,PPO,237.15,93,,percent of total billed charges,,
Xr Mastoids Less Than 3 Views,,70120,CPT,Facility,Both,,,,255,216.75,73.083,255,America's PPO,America's PPO,244.8765,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Xr Mastoids Less Than 3 Views,,70120,CPT,Facility,Both,,,,255,216.75,73.083,255,BlueCross BlueShield Minnesota, Federal Employee Program,250.92,98.4,,percent of total billed charges,,
Xr Mastoids Less Than 3 Views,,70120,CPT,Facility,Both,,,,255,216.75,73.083,255,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,255,100,,percent of total billed charges,,
Xr Mastoids Less Than 3 Views,,70120,CPT,Facility,Both,,,,255,216.75,73.083,255,BlueCross BlueShield Minnesota,High Value Network Plan,229.5,90,,percent of total billed charges,,
Xr Mastoids Less Than 3 Views,,70120,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,BlueCross BlueShield Minnesota,Medicare Advantage,124.95,49,,percent of total billed charges,,
Xr Mastoids Less Than 3 Views,,70120,CPT,Facility,Inpatient,,,,255,216.75,73.083,255,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Xr Mastoids Less Than 3 Views,,70120,CPT,Facility,Both,,,,255,216.75,73.083,255,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,225.8535,88.57,,percent of total billed charges,,
Xr Mastoids Less Than 3 Views,,70120,CPT,Facility,Both,,,,255,216.75,73.083,255,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,73.083,28.66,,percent of total billed charges,,
Xr Mastoids Less Than 3 Views,,70120,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),124.95,49,,percent of total billed charges,,
Xr Mastoids Less Than 3 Views,,70120,CPT,Facility,Inpatient,,,,255,216.75,73.083,255,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Xr Mastoids Less Than 3 Views,,70120,CPT,Facility,Both,,,,255,216.75,73.083,255,CorVel,Worker's Compensation,255,100,,percent of total billed charges,,
Xr Mastoids Less Than 3 Views,,70120,CPT,Facility,Both,,,,255,216.75,73.083,255,First Health Group Corporation,First Health Network,247.35,97,,percent of total billed charges,,
Xr Mastoids Less Than 3 Views,,70120,CPT,Facility,Both,,,,255,216.75,73.083,255,"Health Partners, Inc.",Commercial,241.23,94.6,,percent of total billed charges,,
Xr Mastoids Less Than 3 Views,,70120,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,"Health Partners, Inc.",Medicare Advantage,124.95,49,,percent of total billed charges,,
Xr Mastoids Less Than 3 Views,,70120,CPT,Facility,Inpatient,,,,255,216.75,73.083,255,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Mastoids Less Than 3 Views,,70120,CPT,Facility,Both,,,,255,216.75,73.083,255,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),153,60,,percent of total billed charges,,
Xr Mastoids Less Than 3 Views,,70120,CPT,Facility,Both,,,,255,216.75,73.083,255,"Health Partners, Inc.",State of Minnesota Advantage Program,207.825,81.5,,percent of total billed charges,,
Xr Mastoids Less Than 3 Views,,70120,CPT,Facility,Both,,,,255,216.75,73.083,255,"Health Partners, Inc.",State Public Programs,127.5,50,,percent of total billed charges,,
Xr Mastoids Less Than 3 Views,,70120,CPT,Facility,Both,,,,255,216.75,73.083,255,Humana Insurance Company,Commercial PPO,242.25,95,,percent of total billed charges,,
Xr Mastoids Less Than 3 Views,,70120,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,Humana Insurance Company,Medicare PPO,124.95,49,,percent of total billed charges,,
Xr Mastoids Less Than 3 Views,,70120,CPT,Facility,Inpatient,,,,255,216.75,73.083,255,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Xr Mastoids Less Than 3 Views,,70120,CPT,Facility,Both,,,,255,216.75,73.083,255,Medica,Individual & Family,252.705,99.1,,percent of total billed charges,,
Xr Mastoids Less Than 3 Views,,70120,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,Medica,Medica Advantage Solution,126.99,49.8,,percent of total billed charges,,
Xr Mastoids Less Than 3 Views,,70120,CPT,Facility,Inpatient,,,,255,216.75,73.083,255,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Xr Mastoids Less Than 3 Views,,70120,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,Medica,Medical Assistance,113.73,44.6,,percent of total billed charges,,
Xr Mastoids Less Than 3 Views,,70120,CPT,Facility,Inpatient,,,,255,216.75,73.083,255,Medica,Medical Assistance,,,,,Included in per diem rate,
Xr Mastoids Less Than 3 Views,,70120,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,126.99,49.8,,percent of total billed charges,,
Xr Mastoids Less Than 3 Views,,70120,CPT,Facility,Inpatient,,,,255,216.75,73.083,255,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Xr Mastoids Less Than 3 Views,,70120,CPT,Facility,Both,,,,255,216.75,73.083,255,"Multiplan, Inc.","Multiplan, Inc.",239.7,94,,percent of total billed charges,,
Xr Mastoids Less Than 3 Views,,70120,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,229.755,90.1,,percent of total billed charges,,
Xr Mastoids Less Than 3 Views,,70120,CPT,Facility,Inpatient,,,,255,216.75,73.083,255,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Xr Mastoids Less Than 3 Views,,70120,CPT,Facility,Both,,,,255,216.75,73.083,255,"Preferred One Administrative Services, INC.",PPO,251.43,98.6,,percent of total billed charges,,
Xr Mastoids Less Than 3 Views,,70120,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,PrimeWest Health,Minnesota Senior Health Options (MSHO),131.1975,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Xr Mastoids Less Than 3 Views,,70120,CPT,Facility,Inpatient,,,,255,216.75,73.083,255,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Mastoids Less Than 3 Views,,70120,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,PrimeWest Health,MinnesotaCare,130.968,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Xr Mastoids Less Than 3 Views,,70120,CPT,Facility,Inpatient,,,,255,216.75,73.083,255,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Xr Mastoids Less Than 3 Views,,70120,CPT,Facility,Both,,,,255,216.75,73.083,255,Sanford Health Plan,Sanford Health Plan,234.6,92,,percent of total billed charges,,
Xr Mastoids Less Than 3 Views,,70120,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,"UCare Health, Inc.",Individual & Family Plan,143.6925,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Xr Mastoids Less Than 3 Views,,70120,CPT,Facility,Inpatient,,,,255,216.75,73.083,255,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Xr Mastoids Less Than 3 Views,,70120,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,"UCare Health, Inc.",Medical Assistance,128.6985,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Mastoids Less Than 3 Views,,70120,CPT,Facility,Inpatient,,,,255,216.75,73.083,255,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Xr Mastoids Less Than 3 Views,,70120,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,"UCare Health, Inc.",Medicare Advantage,128.6985,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Mastoids Less Than 3 Views,,70120,CPT,Facility,Inpatient,,,,255,216.75,73.083,255,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Mastoids Less Than 3 Views,,70120,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),128.6985,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Mastoids Less Than 3 Views,,70120,CPT,Facility,Inpatient,,,,255,216.75,73.083,255,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Mastoids Less Than 3 Views,,70120,CPT,Facility,Both,,,,255,216.75,73.083,255,UnitedHealthcare,Individual & Family,239.7,94,,percent of total billed charges,,
Xr Mastoids Less Than 3 Views,,70120,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,UnitedHealthcare,Medicare Advantage,124.95,49,,percent of total billed charges,,
Xr Mastoids Less Than 3 Views,,70120,CPT,Facility,Inpatient,,,,255,216.75,73.083,255,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Xr Mastoids Less Than 3 Views,,70120,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,122.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
Xr Mastoids Less Than 3 Views,,70120,CPT,Facility,Inpatient,,,,255,216.75,73.083,255,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Xr Mastoids Complete Minimum 3 Views Per Side,,70130,CPT,Facility,Both,,,,306,260.1,87.6996,306,Aetna,Commercial,281.52,92,,percent of total billed charges,,
Xr Mastoids Complete Minimum 3 Views Per Side,,70130,CPT,Facility,Outpatient,,,,306,260.1,87.6996,306,Aetna,Medicare Advantage,149.94,49,,percent of total billed charges,,
Xr Mastoids Complete Minimum 3 Views Per Side,,70130,CPT,Facility,Inpatient,,,,306,260.1,87.6996,306,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Xr Mastoids Complete Minimum 3 Views Per Side,,70130,CPT,Facility,Both,,,,306,260.1,87.6996,306,Aetna,PPO,284.58,93,,percent of total billed charges,,
Xr Mastoids Complete Minimum 3 Views Per Side,,70130,CPT,Facility,Both,,,,306,260.1,87.6996,306,America's PPO,America's PPO,293.8518,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Xr Mastoids Complete Minimum 3 Views Per Side,,70130,CPT,Facility,Both,,,,306,260.1,87.6996,306,BlueCross BlueShield Minnesota, Federal Employee Program,301.104,98.4,,percent of total billed charges,,
Xr Mastoids Complete Minimum 3 Views Per Side,,70130,CPT,Facility,Both,,,,306,260.1,87.6996,306,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,306,100,,percent of total billed charges,,
Xr Mastoids Complete Minimum 3 Views Per Side,,70130,CPT,Facility,Both,,,,306,260.1,87.6996,306,BlueCross BlueShield Minnesota,High Value Network Plan,275.4,90,,percent of total billed charges,,
Xr Mastoids Complete Minimum 3 Views Per Side,,70130,CPT,Facility,Outpatient,,,,306,260.1,87.6996,306,BlueCross BlueShield Minnesota,Medicare Advantage,149.94,49,,percent of total billed charges,,
Xr Mastoids Complete Minimum 3 Views Per Side,,70130,CPT,Facility,Inpatient,,,,306,260.1,87.6996,306,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Xr Mastoids Complete Minimum 3 Views Per Side,,70130,CPT,Facility,Both,,,,306,260.1,87.6996,306,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,271.0242,88.57,,percent of total billed charges,,
Xr Mastoids Complete Minimum 3 Views Per Side,,70130,CPT,Facility,Both,,,,306,260.1,87.6996,306,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,87.6996,28.66,,percent of total billed charges,,
Xr Mastoids Complete Minimum 3 Views Per Side,,70130,CPT,Facility,Outpatient,,,,306,260.1,87.6996,306,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),149.94,49,,percent of total billed charges,,
Xr Mastoids Complete Minimum 3 Views Per Side,,70130,CPT,Facility,Inpatient,,,,306,260.1,87.6996,306,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Xr Mastoids Complete Minimum 3 Views Per Side,,70130,CPT,Facility,Both,,,,306,260.1,87.6996,306,CorVel,Worker's Compensation,306,100,,percent of total billed charges,,
Xr Mastoids Complete Minimum 3 Views Per Side,,70130,CPT,Facility,Both,,,,306,260.1,87.6996,306,First Health Group Corporation,First Health Network,296.82,97,,percent of total billed charges,,
Xr Mastoids Complete Minimum 3 Views Per Side,,70130,CPT,Facility,Both,,,,306,260.1,87.6996,306,"Health Partners, Inc.",Commercial,289.476,94.6,,percent of total billed charges,,
Xr Mastoids Complete Minimum 3 Views Per Side,,70130,CPT,Facility,Outpatient,,,,306,260.1,87.6996,306,"Health Partners, Inc.",Medicare Advantage,149.94,49,,percent of total billed charges,,
Xr Mastoids Complete Minimum 3 Views Per Side,,70130,CPT,Facility,Inpatient,,,,306,260.1,87.6996,306,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Mastoids Complete Minimum 3 Views Per Side,,70130,CPT,Facility,Both,,,,306,260.1,87.6996,306,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),183.6,60,,percent of total billed charges,,
Xr Mastoids Complete Minimum 3 Views Per Side,,70130,CPT,Facility,Both,,,,306,260.1,87.6996,306,"Health Partners, Inc.",State of Minnesota Advantage Program,249.39,81.5,,percent of total billed charges,,
Xr Mastoids Complete Minimum 3 Views Per Side,,70130,CPT,Facility,Both,,,,306,260.1,87.6996,306,"Health Partners, Inc.",State Public Programs,153,50,,percent of total billed charges,,
Xr Mastoids Complete Minimum 3 Views Per Side,,70130,CPT,Facility,Both,,,,306,260.1,87.6996,306,Humana Insurance Company,Commercial PPO,290.7,95,,percent of total billed charges,,
Xr Mastoids Complete Minimum 3 Views Per Side,,70130,CPT,Facility,Outpatient,,,,306,260.1,87.6996,306,Humana Insurance Company,Medicare PPO,149.94,49,,percent of total billed charges,,
Xr Mastoids Complete Minimum 3 Views Per Side,,70130,CPT,Facility,Inpatient,,,,306,260.1,87.6996,306,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Xr Mastoids Complete Minimum 3 Views Per Side,,70130,CPT,Facility,Both,,,,306,260.1,87.6996,306,Medica,Individual & Family,303.246,99.1,,percent of total billed charges,,
Xr Mastoids Complete Minimum 3 Views Per Side,,70130,CPT,Facility,Outpatient,,,,306,260.1,87.6996,306,Medica,Medica Advantage Solution,152.388,49.8,,percent of total billed charges,,
Xr Mastoids Complete Minimum 3 Views Per Side,,70130,CPT,Facility,Inpatient,,,,306,260.1,87.6996,306,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Xr Mastoids Complete Minimum 3 Views Per Side,,70130,CPT,Facility,Outpatient,,,,306,260.1,87.6996,306,Medica,Medical Assistance,136.476,44.6,,percent of total billed charges,,
Xr Mastoids Complete Minimum 3 Views Per Side,,70130,CPT,Facility,Inpatient,,,,306,260.1,87.6996,306,Medica,Medical Assistance,,,,,Included in per diem rate,
Xr Mastoids Complete Minimum 3 Views Per Side,,70130,CPT,Facility,Outpatient,,,,306,260.1,87.6996,306,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,152.388,49.8,,percent of total billed charges,,
Xr Mastoids Complete Minimum 3 Views Per Side,,70130,CPT,Facility,Inpatient,,,,306,260.1,87.6996,306,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Xr Mastoids Complete Minimum 3 Views Per Side,,70130,CPT,Facility,Both,,,,306,260.1,87.6996,306,"Multiplan, Inc.","Multiplan, Inc.",287.64,94,,percent of total billed charges,,
Xr Mastoids Complete Minimum 3 Views Per Side,,70130,CPT,Facility,Outpatient,,,,306,260.1,87.6996,306,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,275.706,90.1,,percent of total billed charges,,
Xr Mastoids Complete Minimum 3 Views Per Side,,70130,CPT,Facility,Inpatient,,,,306,260.1,87.6996,306,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Xr Mastoids Complete Minimum 3 Views Per Side,,70130,CPT,Facility,Both,,,,306,260.1,87.6996,306,"Preferred One Administrative Services, INC.",PPO,301.716,98.6,,percent of total billed charges,,
Xr Mastoids Complete Minimum 3 Views Per Side,,70130,CPT,Facility,Outpatient,,,,306,260.1,87.6996,306,PrimeWest Health,Minnesota Senior Health Options (MSHO),157.437,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Xr Mastoids Complete Minimum 3 Views Per Side,,70130,CPT,Facility,Inpatient,,,,306,260.1,87.6996,306,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Mastoids Complete Minimum 3 Views Per Side,,70130,CPT,Facility,Outpatient,,,,306,260.1,87.6996,306,PrimeWest Health,MinnesotaCare,157.1616,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Xr Mastoids Complete Minimum 3 Views Per Side,,70130,CPT,Facility,Inpatient,,,,306,260.1,87.6996,306,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Xr Mastoids Complete Minimum 3 Views Per Side,,70130,CPT,Facility,Both,,,,306,260.1,87.6996,306,Sanford Health Plan,Sanford Health Plan,281.52,92,,percent of total billed charges,,
Xr Mastoids Complete Minimum 3 Views Per Side,,70130,CPT,Facility,Outpatient,,,,306,260.1,87.6996,306,"UCare Health, Inc.",Individual & Family Plan,172.431,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Xr Mastoids Complete Minimum 3 Views Per Side,,70130,CPT,Facility,Inpatient,,,,306,260.1,87.6996,306,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Xr Mastoids Complete Minimum 3 Views Per Side,,70130,CPT,Facility,Outpatient,,,,306,260.1,87.6996,306,"UCare Health, Inc.",Medical Assistance,154.4382,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Mastoids Complete Minimum 3 Views Per Side,,70130,CPT,Facility,Inpatient,,,,306,260.1,87.6996,306,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Xr Mastoids Complete Minimum 3 Views Per Side,,70130,CPT,Facility,Outpatient,,,,306,260.1,87.6996,306,"UCare Health, Inc.",Medicare Advantage,154.4382,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Mastoids Complete Minimum 3 Views Per Side,,70130,CPT,Facility,Inpatient,,,,306,260.1,87.6996,306,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Mastoids Complete Minimum 3 Views Per Side,,70130,CPT,Facility,Outpatient,,,,306,260.1,87.6996,306,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),154.4382,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Mastoids Complete Minimum 3 Views Per Side,,70130,CPT,Facility,Inpatient,,,,306,260.1,87.6996,306,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Mastoids Complete Minimum 3 Views Per Side,,70130,CPT,Facility,Both,,,,306,260.1,87.6996,306,UnitedHealthcare,Individual & Family,287.64,94,,percent of total billed charges,,
Xr Mastoids Complete Minimum 3 Views Per Side,,70130,CPT,Facility,Outpatient,,,,306,260.1,87.6996,306,UnitedHealthcare,Medicare Advantage,149.94,49,,percent of total billed charges,,
Xr Mastoids Complete Minimum 3 Views Per Side,,70130,CPT,Facility,Inpatient,,,,306,260.1,87.6996,306,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Xr Mastoids Complete Minimum 3 Views Per Side,,70130,CPT,Facility,Outpatient,,,,306,260.1,87.6996,306,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,146.88,48,,percent of total billed charges,,100% of DHS outpatient percentage
Xr Mastoids Complete Minimum 3 Views Per Side,,70130,CPT,Facility,Inpatient,,,,306,260.1,87.6996,306,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Xr Facial Bones Less Than 3 Views,,70140,CPT,Facility,Both,,,,275,233.75,78.815,275,Aetna,Commercial,253,92,,percent of total billed charges,,
Xr Facial Bones Less Than 3 Views,,70140,CPT,Facility,Outpatient,,,,275,233.75,78.815,275,Aetna,Medicare Advantage,134.75,49,,percent of total billed charges,,
Xr Facial Bones Less Than 3 Views,,70140,CPT,Facility,Inpatient,,,,275,233.75,78.815,275,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Xr Facial Bones Less Than 3 Views,,70140,CPT,Facility,Both,,,,275,233.75,78.815,275,Aetna,PPO,255.75,93,,percent of total billed charges,,
Xr Facial Bones Less Than 3 Views,,70140,CPT,Facility,Both,,,,275,233.75,78.815,275,America's PPO,America's PPO,264.0825,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Xr Facial Bones Less Than 3 Views,,70140,CPT,Facility,Both,,,,275,233.75,78.815,275,BlueCross BlueShield Minnesota, Federal Employee Program,270.6,98.4,,percent of total billed charges,,
Xr Facial Bones Less Than 3 Views,,70140,CPT,Facility,Both,,,,275,233.75,78.815,275,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,275,100,,percent of total billed charges,,
Xr Facial Bones Less Than 3 Views,,70140,CPT,Facility,Both,,,,275,233.75,78.815,275,BlueCross BlueShield Minnesota,High Value Network Plan,247.5,90,,percent of total billed charges,,
Xr Facial Bones Less Than 3 Views,,70140,CPT,Facility,Outpatient,,,,275,233.75,78.815,275,BlueCross BlueShield Minnesota,Medicare Advantage,134.75,49,,percent of total billed charges,,
Xr Facial Bones Less Than 3 Views,,70140,CPT,Facility,Inpatient,,,,275,233.75,78.815,275,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Xr Facial Bones Less Than 3 Views,,70140,CPT,Facility,Both,,,,275,233.75,78.815,275,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,243.5675,88.57,,percent of total billed charges,,
Xr Facial Bones Less Than 3 Views,,70140,CPT,Facility,Both,,,,275,233.75,78.815,275,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,78.815,28.66,,percent of total billed charges,,
Xr Facial Bones Less Than 3 Views,,70140,CPT,Facility,Outpatient,,,,275,233.75,78.815,275,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),134.75,49,,percent of total billed charges,,
Xr Facial Bones Less Than 3 Views,,70140,CPT,Facility,Inpatient,,,,275,233.75,78.815,275,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Xr Facial Bones Less Than 3 Views,,70140,CPT,Facility,Both,,,,275,233.75,78.815,275,CorVel,Worker's Compensation,275,100,,percent of total billed charges,,
Xr Facial Bones Less Than 3 Views,,70140,CPT,Facility,Both,,,,275,233.75,78.815,275,First Health Group Corporation,First Health Network,266.75,97,,percent of total billed charges,,
Xr Facial Bones Less Than 3 Views,,70140,CPT,Facility,Both,,,,275,233.75,78.815,275,"Health Partners, Inc.",Commercial,260.15,94.6,,percent of total billed charges,,
Xr Facial Bones Less Than 3 Views,,70140,CPT,Facility,Outpatient,,,,275,233.75,78.815,275,"Health Partners, Inc.",Medicare Advantage,134.75,49,,percent of total billed charges,,
Xr Facial Bones Less Than 3 Views,,70140,CPT,Facility,Inpatient,,,,275,233.75,78.815,275,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Facial Bones Less Than 3 Views,,70140,CPT,Facility,Both,,,,275,233.75,78.815,275,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),165,60,,percent of total billed charges,,
Xr Facial Bones Less Than 3 Views,,70140,CPT,Facility,Both,,,,275,233.75,78.815,275,"Health Partners, Inc.",State of Minnesota Advantage Program,224.125,81.5,,percent of total billed charges,,
Xr Facial Bones Less Than 3 Views,,70140,CPT,Facility,Both,,,,275,233.75,78.815,275,"Health Partners, Inc.",State Public Programs,137.5,50,,percent of total billed charges,,
Xr Facial Bones Less Than 3 Views,,70140,CPT,Facility,Both,,,,275,233.75,78.815,275,Humana Insurance Company,Commercial PPO,261.25,95,,percent of total billed charges,,
Xr Facial Bones Less Than 3 Views,,70140,CPT,Facility,Outpatient,,,,275,233.75,78.815,275,Humana Insurance Company,Medicare PPO,134.75,49,,percent of total billed charges,,
Xr Facial Bones Less Than 3 Views,,70140,CPT,Facility,Inpatient,,,,275,233.75,78.815,275,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Xr Facial Bones Less Than 3 Views,,70140,CPT,Facility,Both,,,,275,233.75,78.815,275,Medica,Individual & Family,272.525,99.1,,percent of total billed charges,,
Xr Facial Bones Less Than 3 Views,,70140,CPT,Facility,Outpatient,,,,275,233.75,78.815,275,Medica,Medica Advantage Solution,136.95,49.8,,percent of total billed charges,,
Xr Facial Bones Less Than 3 Views,,70140,CPT,Facility,Inpatient,,,,275,233.75,78.815,275,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Xr Facial Bones Less Than 3 Views,,70140,CPT,Facility,Outpatient,,,,275,233.75,78.815,275,Medica,Medical Assistance,122.65,44.6,,percent of total billed charges,,
Xr Facial Bones Less Than 3 Views,,70140,CPT,Facility,Inpatient,,,,275,233.75,78.815,275,Medica,Medical Assistance,,,,,Included in per diem rate,
Xr Facial Bones Less Than 3 Views,,70140,CPT,Facility,Outpatient,,,,275,233.75,78.815,275,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,136.95,49.8,,percent of total billed charges,,
Xr Facial Bones Less Than 3 Views,,70140,CPT,Facility,Inpatient,,,,275,233.75,78.815,275,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Xr Facial Bones Less Than 3 Views,,70140,CPT,Facility,Both,,,,275,233.75,78.815,275,"Multiplan, Inc.","Multiplan, Inc.",258.5,94,,percent of total billed charges,,
Xr Facial Bones Less Than 3 Views,,70140,CPT,Facility,Outpatient,,,,275,233.75,78.815,275,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,247.775,90.1,,percent of total billed charges,,
Xr Facial Bones Less Than 3 Views,,70140,CPT,Facility,Inpatient,,,,275,233.75,78.815,275,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Xr Facial Bones Less Than 3 Views,,70140,CPT,Facility,Both,,,,275,233.75,78.815,275,"Preferred One Administrative Services, INC.",PPO,271.15,98.6,,percent of total billed charges,,
Xr Facial Bones Less Than 3 Views,,70140,CPT,Facility,Outpatient,,,,275,233.75,78.815,275,PrimeWest Health,Minnesota Senior Health Options (MSHO),141.4875,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Xr Facial Bones Less Than 3 Views,,70140,CPT,Facility,Inpatient,,,,275,233.75,78.815,275,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Facial Bones Less Than 3 Views,,70140,CPT,Facility,Outpatient,,,,275,233.75,78.815,275,PrimeWest Health,MinnesotaCare,141.24,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Xr Facial Bones Less Than 3 Views,,70140,CPT,Facility,Inpatient,,,,275,233.75,78.815,275,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Xr Facial Bones Less Than 3 Views,,70140,CPT,Facility,Both,,,,275,233.75,78.815,275,Sanford Health Plan,Sanford Health Plan,253,92,,percent of total billed charges,,
Xr Facial Bones Less Than 3 Views,,70140,CPT,Facility,Outpatient,,,,275,233.75,78.815,275,"UCare Health, Inc.",Individual & Family Plan,154.9625,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Xr Facial Bones Less Than 3 Views,,70140,CPT,Facility,Inpatient,,,,275,233.75,78.815,275,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Xr Facial Bones Less Than 3 Views,,70140,CPT,Facility,Outpatient,,,,275,233.75,78.815,275,"UCare Health, Inc.",Medical Assistance,138.7925,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Facial Bones Less Than 3 Views,,70140,CPT,Facility,Inpatient,,,,275,233.75,78.815,275,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Xr Facial Bones Less Than 3 Views,,70140,CPT,Facility,Outpatient,,,,275,233.75,78.815,275,"UCare Health, Inc.",Medicare Advantage,138.7925,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Facial Bones Less Than 3 Views,,70140,CPT,Facility,Inpatient,,,,275,233.75,78.815,275,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Facial Bones Less Than 3 Views,,70140,CPT,Facility,Outpatient,,,,275,233.75,78.815,275,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),138.7925,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Facial Bones Less Than 3 Views,,70140,CPT,Facility,Inpatient,,,,275,233.75,78.815,275,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Facial Bones Less Than 3 Views,,70140,CPT,Facility,Both,,,,275,233.75,78.815,275,UnitedHealthcare,Individual & Family,258.5,94,,percent of total billed charges,,
Xr Facial Bones Less Than 3 Views,,70140,CPT,Facility,Outpatient,,,,275,233.75,78.815,275,UnitedHealthcare,Medicare Advantage,134.75,49,,percent of total billed charges,,
Xr Facial Bones Less Than 3 Views,,70140,CPT,Facility,Inpatient,,,,275,233.75,78.815,275,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Xr Facial Bones Less Than 3 Views,,70140,CPT,Facility,Outpatient,,,,275,233.75,78.815,275,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,132,48,,percent of total billed charges,,100% of DHS outpatient percentage
Xr Facial Bones Less Than 3 Views,,70140,CPT,Facility,Inpatient,,,,275,233.75,78.815,275,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Xr Facial Bones Routine Complete,,70150,CPT,Facility,Both,,,,404,343.4,115.7864,404,Aetna,Commercial,371.68,92,,percent of total billed charges,,
Xr Facial Bones Routine Complete,,70150,CPT,Facility,Outpatient,,,,404,343.4,115.7864,404,Aetna,Medicare Advantage,197.96,49,,percent of total billed charges,,
Xr Facial Bones Routine Complete,,70150,CPT,Facility,Inpatient,,,,404,343.4,115.7864,404,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Xr Facial Bones Routine Complete,,70150,CPT,Facility,Both,,,,404,343.4,115.7864,404,Aetna,PPO,375.72,93,,percent of total billed charges,,
Xr Facial Bones Routine Complete,,70150,CPT,Facility,Both,,,,404,343.4,115.7864,404,America's PPO,America's PPO,387.9612,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Xr Facial Bones Routine Complete,,70150,CPT,Facility,Both,,,,404,343.4,115.7864,404,BlueCross BlueShield Minnesota, Federal Employee Program,397.536,98.4,,percent of total billed charges,,
Xr Facial Bones Routine Complete,,70150,CPT,Facility,Both,,,,404,343.4,115.7864,404,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,404,100,,percent of total billed charges,,
Xr Facial Bones Routine Complete,,70150,CPT,Facility,Both,,,,404,343.4,115.7864,404,BlueCross BlueShield Minnesota,High Value Network Plan,363.6,90,,percent of total billed charges,,
Xr Facial Bones Routine Complete,,70150,CPT,Facility,Outpatient,,,,404,343.4,115.7864,404,BlueCross BlueShield Minnesota,Medicare Advantage,197.96,49,,percent of total billed charges,,
Xr Facial Bones Routine Complete,,70150,CPT,Facility,Inpatient,,,,404,343.4,115.7864,404,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Xr Facial Bones Routine Complete,,70150,CPT,Facility,Both,,,,404,343.4,115.7864,404,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,357.8228,88.57,,percent of total billed charges,,
Xr Facial Bones Routine Complete,,70150,CPT,Facility,Both,,,,404,343.4,115.7864,404,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,115.7864,28.66,,percent of total billed charges,,
Xr Facial Bones Routine Complete,,70150,CPT,Facility,Outpatient,,,,404,343.4,115.7864,404,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),197.96,49,,percent of total billed charges,,
Xr Facial Bones Routine Complete,,70150,CPT,Facility,Inpatient,,,,404,343.4,115.7864,404,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Xr Facial Bones Routine Complete,,70150,CPT,Facility,Both,,,,404,343.4,115.7864,404,CorVel,Worker's Compensation,404,100,,percent of total billed charges,,
Xr Facial Bones Routine Complete,,70150,CPT,Facility,Both,,,,404,343.4,115.7864,404,First Health Group Corporation,First Health Network,391.88,97,,percent of total billed charges,,
Xr Facial Bones Routine Complete,,70150,CPT,Facility,Both,,,,404,343.4,115.7864,404,"Health Partners, Inc.",Commercial,382.184,94.6,,percent of total billed charges,,
Xr Facial Bones Routine Complete,,70150,CPT,Facility,Outpatient,,,,404,343.4,115.7864,404,"Health Partners, Inc.",Medicare Advantage,197.96,49,,percent of total billed charges,,
Xr Facial Bones Routine Complete,,70150,CPT,Facility,Inpatient,,,,404,343.4,115.7864,404,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Facial Bones Routine Complete,,70150,CPT,Facility,Both,,,,404,343.4,115.7864,404,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),242.4,60,,percent of total billed charges,,
Xr Facial Bones Routine Complete,,70150,CPT,Facility,Both,,,,404,343.4,115.7864,404,"Health Partners, Inc.",State of Minnesota Advantage Program,329.26,81.5,,percent of total billed charges,,
Xr Facial Bones Routine Complete,,70150,CPT,Facility,Both,,,,404,343.4,115.7864,404,"Health Partners, Inc.",State Public Programs,202,50,,percent of total billed charges,,
Xr Facial Bones Routine Complete,,70150,CPT,Facility,Both,,,,404,343.4,115.7864,404,Humana Insurance Company,Commercial PPO,383.8,95,,percent of total billed charges,,
Xr Facial Bones Routine Complete,,70150,CPT,Facility,Outpatient,,,,404,343.4,115.7864,404,Humana Insurance Company,Medicare PPO,197.96,49,,percent of total billed charges,,
Xr Facial Bones Routine Complete,,70150,CPT,Facility,Inpatient,,,,404,343.4,115.7864,404,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Xr Facial Bones Routine Complete,,70150,CPT,Facility,Both,,,,404,343.4,115.7864,404,Medica,Individual & Family,400.364,99.1,,percent of total billed charges,,
Xr Facial Bones Routine Complete,,70150,CPT,Facility,Outpatient,,,,404,343.4,115.7864,404,Medica,Medica Advantage Solution,201.192,49.8,,percent of total billed charges,,
Xr Facial Bones Routine Complete,,70150,CPT,Facility,Inpatient,,,,404,343.4,115.7864,404,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Xr Facial Bones Routine Complete,,70150,CPT,Facility,Outpatient,,,,404,343.4,115.7864,404,Medica,Medical Assistance,180.184,44.6,,percent of total billed charges,,
Xr Facial Bones Routine Complete,,70150,CPT,Facility,Inpatient,,,,404,343.4,115.7864,404,Medica,Medical Assistance,,,,,Included in per diem rate,
Xr Facial Bones Routine Complete,,70150,CPT,Facility,Outpatient,,,,404,343.4,115.7864,404,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,201.192,49.8,,percent of total billed charges,,
Xr Facial Bones Routine Complete,,70150,CPT,Facility,Inpatient,,,,404,343.4,115.7864,404,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Xr Facial Bones Routine Complete,,70150,CPT,Facility,Both,,,,404,343.4,115.7864,404,"Multiplan, Inc.","Multiplan, Inc.",379.76,94,,percent of total billed charges,,
Xr Facial Bones Routine Complete,,70150,CPT,Facility,Outpatient,,,,404,343.4,115.7864,404,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,364.004,90.1,,percent of total billed charges,,
Xr Facial Bones Routine Complete,,70150,CPT,Facility,Inpatient,,,,404,343.4,115.7864,404,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Xr Facial Bones Routine Complete,,70150,CPT,Facility,Both,,,,404,343.4,115.7864,404,"Preferred One Administrative Services, INC.",PPO,398.344,98.6,,percent of total billed charges,,
Xr Facial Bones Routine Complete,,70150,CPT,Facility,Outpatient,,,,404,343.4,115.7864,404,PrimeWest Health,Minnesota Senior Health Options (MSHO),207.858,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Xr Facial Bones Routine Complete,,70150,CPT,Facility,Inpatient,,,,404,343.4,115.7864,404,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Facial Bones Routine Complete,,70150,CPT,Facility,Outpatient,,,,404,343.4,115.7864,404,PrimeWest Health,MinnesotaCare,207.4944,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Xr Facial Bones Routine Complete,,70150,CPT,Facility,Inpatient,,,,404,343.4,115.7864,404,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Xr Facial Bones Routine Complete,,70150,CPT,Facility,Both,,,,404,343.4,115.7864,404,Sanford Health Plan,Sanford Health Plan,371.68,92,,percent of total billed charges,,
Xr Facial Bones Routine Complete,,70150,CPT,Facility,Outpatient,,,,404,343.4,115.7864,404,"UCare Health, Inc.",Individual & Family Plan,227.654,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Xr Facial Bones Routine Complete,,70150,CPT,Facility,Inpatient,,,,404,343.4,115.7864,404,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Xr Facial Bones Routine Complete,,70150,CPT,Facility,Outpatient,,,,404,343.4,115.7864,404,"UCare Health, Inc.",Medical Assistance,203.8988,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Facial Bones Routine Complete,,70150,CPT,Facility,Inpatient,,,,404,343.4,115.7864,404,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Xr Facial Bones Routine Complete,,70150,CPT,Facility,Outpatient,,,,404,343.4,115.7864,404,"UCare Health, Inc.",Medicare Advantage,203.8988,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Facial Bones Routine Complete,,70150,CPT,Facility,Inpatient,,,,404,343.4,115.7864,404,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Facial Bones Routine Complete,,70150,CPT,Facility,Outpatient,,,,404,343.4,115.7864,404,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),203.8988,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Facial Bones Routine Complete,,70150,CPT,Facility,Inpatient,,,,404,343.4,115.7864,404,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Facial Bones Routine Complete,,70150,CPT,Facility,Both,,,,404,343.4,115.7864,404,UnitedHealthcare,Individual & Family,379.76,94,,percent of total billed charges,,
Xr Facial Bones Routine Complete,,70150,CPT,Facility,Outpatient,,,,404,343.4,115.7864,404,UnitedHealthcare,Medicare Advantage,197.96,49,,percent of total billed charges,,
Xr Facial Bones Routine Complete,,70150,CPT,Facility,Inpatient,,,,404,343.4,115.7864,404,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Xr Facial Bones Routine Complete,,70150,CPT,Facility,Outpatient,,,,404,343.4,115.7864,404,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,193.92,48,,percent of total billed charges,,100% of DHS outpatient percentage
Xr Facial Bones Routine Complete,,70150,CPT,Facility,Inpatient,,,,404,343.4,115.7864,404,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Xr Nasal Bones,,70160,CPT,Facility,Both,,,,404,343.4,115.7864,404,Aetna,Commercial,371.68,92,,percent of total billed charges,,
Xr Nasal Bones,,70160,CPT,Facility,Outpatient,,,,404,343.4,115.7864,404,Aetna,Medicare Advantage,197.96,49,,percent of total billed charges,,
Xr Nasal Bones,,70160,CPT,Facility,Inpatient,,,,404,343.4,115.7864,404,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Xr Nasal Bones,,70160,CPT,Facility,Both,,,,404,343.4,115.7864,404,Aetna,PPO,375.72,93,,percent of total billed charges,,
Xr Nasal Bones,,70160,CPT,Facility,Both,,,,404,343.4,115.7864,404,America's PPO,America's PPO,387.9612,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Xr Nasal Bones,,70160,CPT,Facility,Both,,,,404,343.4,115.7864,404,BlueCross BlueShield Minnesota, Federal Employee Program,397.536,98.4,,percent of total billed charges,,
Xr Nasal Bones,,70160,CPT,Facility,Both,,,,404,343.4,115.7864,404,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,404,100,,percent of total billed charges,,
Xr Nasal Bones,,70160,CPT,Facility,Both,,,,404,343.4,115.7864,404,BlueCross BlueShield Minnesota,High Value Network Plan,363.6,90,,percent of total billed charges,,
Xr Nasal Bones,,70160,CPT,Facility,Outpatient,,,,404,343.4,115.7864,404,BlueCross BlueShield Minnesota,Medicare Advantage,197.96,49,,percent of total billed charges,,
Xr Nasal Bones,,70160,CPT,Facility,Inpatient,,,,404,343.4,115.7864,404,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Xr Nasal Bones,,70160,CPT,Facility,Both,,,,404,343.4,115.7864,404,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,357.8228,88.57,,percent of total billed charges,,
Xr Nasal Bones,,70160,CPT,Facility,Both,,,,404,343.4,115.7864,404,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,115.7864,28.66,,percent of total billed charges,,
Xr Nasal Bones,,70160,CPT,Facility,Outpatient,,,,404,343.4,115.7864,404,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),197.96,49,,percent of total billed charges,,
Xr Nasal Bones,,70160,CPT,Facility,Inpatient,,,,404,343.4,115.7864,404,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Xr Nasal Bones,,70160,CPT,Facility,Both,,,,404,343.4,115.7864,404,CorVel,Worker's Compensation,404,100,,percent of total billed charges,,
Xr Nasal Bones,,70160,CPT,Facility,Both,,,,404,343.4,115.7864,404,First Health Group Corporation,First Health Network,391.88,97,,percent of total billed charges,,
Xr Nasal Bones,,70160,CPT,Facility,Both,,,,404,343.4,115.7864,404,"Health Partners, Inc.",Commercial,382.184,94.6,,percent of total billed charges,,
Xr Nasal Bones,,70160,CPT,Facility,Outpatient,,,,404,343.4,115.7864,404,"Health Partners, Inc.",Medicare Advantage,197.96,49,,percent of total billed charges,,
Xr Nasal Bones,,70160,CPT,Facility,Inpatient,,,,404,343.4,115.7864,404,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Nasal Bones,,70160,CPT,Facility,Both,,,,404,343.4,115.7864,404,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),242.4,60,,percent of total billed charges,,
Xr Nasal Bones,,70160,CPT,Facility,Both,,,,404,343.4,115.7864,404,"Health Partners, Inc.",State of Minnesota Advantage Program,329.26,81.5,,percent of total billed charges,,
Xr Nasal Bones,,70160,CPT,Facility,Both,,,,404,343.4,115.7864,404,"Health Partners, Inc.",State Public Programs,202,50,,percent of total billed charges,,
Xr Nasal Bones,,70160,CPT,Facility,Both,,,,404,343.4,115.7864,404,Humana Insurance Company,Commercial PPO,383.8,95,,percent of total billed charges,,
Xr Nasal Bones,,70160,CPT,Facility,Outpatient,,,,404,343.4,115.7864,404,Humana Insurance Company,Medicare PPO,197.96,49,,percent of total billed charges,,
Xr Nasal Bones,,70160,CPT,Facility,Inpatient,,,,404,343.4,115.7864,404,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Xr Nasal Bones,,70160,CPT,Facility,Both,,,,404,343.4,115.7864,404,Medica,Individual & Family,400.364,99.1,,percent of total billed charges,,
Xr Nasal Bones,,70160,CPT,Facility,Outpatient,,,,404,343.4,115.7864,404,Medica,Medica Advantage Solution,201.192,49.8,,percent of total billed charges,,
Xr Nasal Bones,,70160,CPT,Facility,Inpatient,,,,404,343.4,115.7864,404,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Xr Nasal Bones,,70160,CPT,Facility,Outpatient,,,,404,343.4,115.7864,404,Medica,Medical Assistance,180.184,44.6,,percent of total billed charges,,
Xr Nasal Bones,,70160,CPT,Facility,Inpatient,,,,404,343.4,115.7864,404,Medica,Medical Assistance,,,,,Included in per diem rate,
Xr Nasal Bones,,70160,CPT,Facility,Outpatient,,,,404,343.4,115.7864,404,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,201.192,49.8,,percent of total billed charges,,
Xr Nasal Bones,,70160,CPT,Facility,Inpatient,,,,404,343.4,115.7864,404,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Xr Nasal Bones,,70160,CPT,Facility,Both,,,,404,343.4,115.7864,404,"Multiplan, Inc.","Multiplan, Inc.",379.76,94,,percent of total billed charges,,
Xr Nasal Bones,,70160,CPT,Facility,Outpatient,,,,404,343.4,115.7864,404,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,364.004,90.1,,percent of total billed charges,,
Xr Nasal Bones,,70160,CPT,Facility,Inpatient,,,,404,343.4,115.7864,404,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Xr Nasal Bones,,70160,CPT,Facility,Both,,,,404,343.4,115.7864,404,"Preferred One Administrative Services, INC.",PPO,398.344,98.6,,percent of total billed charges,,
Xr Nasal Bones,,70160,CPT,Facility,Outpatient,,,,404,343.4,115.7864,404,PrimeWest Health,Minnesota Senior Health Options (MSHO),207.858,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Xr Nasal Bones,,70160,CPT,Facility,Inpatient,,,,404,343.4,115.7864,404,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Nasal Bones,,70160,CPT,Facility,Outpatient,,,,404,343.4,115.7864,404,PrimeWest Health,MinnesotaCare,207.4944,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Xr Nasal Bones,,70160,CPT,Facility,Inpatient,,,,404,343.4,115.7864,404,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Xr Nasal Bones,,70160,CPT,Facility,Both,,,,404,343.4,115.7864,404,Sanford Health Plan,Sanford Health Plan,371.68,92,,percent of total billed charges,,
Xr Nasal Bones,,70160,CPT,Facility,Outpatient,,,,404,343.4,115.7864,404,"UCare Health, Inc.",Individual & Family Plan,227.654,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Xr Nasal Bones,,70160,CPT,Facility,Inpatient,,,,404,343.4,115.7864,404,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Xr Nasal Bones,,70160,CPT,Facility,Outpatient,,,,404,343.4,115.7864,404,"UCare Health, Inc.",Medical Assistance,203.8988,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Nasal Bones,,70160,CPT,Facility,Inpatient,,,,404,343.4,115.7864,404,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Xr Nasal Bones,,70160,CPT,Facility,Outpatient,,,,404,343.4,115.7864,404,"UCare Health, Inc.",Medicare Advantage,203.8988,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Nasal Bones,,70160,CPT,Facility,Inpatient,,,,404,343.4,115.7864,404,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Nasal Bones,,70160,CPT,Facility,Outpatient,,,,404,343.4,115.7864,404,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),203.8988,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Nasal Bones,,70160,CPT,Facility,Inpatient,,,,404,343.4,115.7864,404,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Nasal Bones,,70160,CPT,Facility,Both,,,,404,343.4,115.7864,404,UnitedHealthcare,Individual & Family,379.76,94,,percent of total billed charges,,
Xr Nasal Bones,,70160,CPT,Facility,Outpatient,,,,404,343.4,115.7864,404,UnitedHealthcare,Medicare Advantage,197.96,49,,percent of total billed charges,,
Xr Nasal Bones,,70160,CPT,Facility,Inpatient,,,,404,343.4,115.7864,404,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Xr Nasal Bones,,70160,CPT,Facility,Outpatient,,,,404,343.4,115.7864,404,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,193.92,48,,percent of total billed charges,,100% of DHS outpatient percentage
Xr Nasal Bones,,70160,CPT,Facility,Inpatient,,,,404,343.4,115.7864,404,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Xr Orbits Greater Than 3 Views,,70200,CPT,Facility,Both,,,,326,277.1,93.4316,326,Aetna,Commercial,299.92,92,,percent of total billed charges,,
Xr Orbits Greater Than 3 Views,,70200,CPT,Facility,Outpatient,,,,326,277.1,93.4316,326,Aetna,Medicare Advantage,159.74,49,,percent of total billed charges,,
Xr Orbits Greater Than 3 Views,,70200,CPT,Facility,Inpatient,,,,326,277.1,93.4316,326,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Xr Orbits Greater Than 3 Views,,70200,CPT,Facility,Both,,,,326,277.1,93.4316,326,Aetna,PPO,303.18,93,,percent of total billed charges,,
Xr Orbits Greater Than 3 Views,,70200,CPT,Facility,Both,,,,326,277.1,93.4316,326,America's PPO,America's PPO,313.0578,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Xr Orbits Greater Than 3 Views,,70200,CPT,Facility,Both,,,,326,277.1,93.4316,326,BlueCross BlueShield Minnesota, Federal Employee Program,320.784,98.4,,percent of total billed charges,,
Xr Orbits Greater Than 3 Views,,70200,CPT,Facility,Both,,,,326,277.1,93.4316,326,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,326,100,,percent of total billed charges,,
Xr Orbits Greater Than 3 Views,,70200,CPT,Facility,Both,,,,326,277.1,93.4316,326,BlueCross BlueShield Minnesota,High Value Network Plan,293.4,90,,percent of total billed charges,,
Xr Orbits Greater Than 3 Views,,70200,CPT,Facility,Outpatient,,,,326,277.1,93.4316,326,BlueCross BlueShield Minnesota,Medicare Advantage,159.74,49,,percent of total billed charges,,
Xr Orbits Greater Than 3 Views,,70200,CPT,Facility,Inpatient,,,,326,277.1,93.4316,326,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Xr Orbits Greater Than 3 Views,,70200,CPT,Facility,Both,,,,326,277.1,93.4316,326,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,288.7382,88.57,,percent of total billed charges,,
Xr Orbits Greater Than 3 Views,,70200,CPT,Facility,Both,,,,326,277.1,93.4316,326,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,93.4316,28.66,,percent of total billed charges,,
Xr Orbits Greater Than 3 Views,,70200,CPT,Facility,Outpatient,,,,326,277.1,93.4316,326,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),159.74,49,,percent of total billed charges,,
Xr Orbits Greater Than 3 Views,,70200,CPT,Facility,Inpatient,,,,326,277.1,93.4316,326,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Xr Orbits Greater Than 3 Views,,70200,CPT,Facility,Both,,,,326,277.1,93.4316,326,CorVel,Worker's Compensation,326,100,,percent of total billed charges,,
Xr Orbits Greater Than 3 Views,,70200,CPT,Facility,Both,,,,326,277.1,93.4316,326,First Health Group Corporation,First Health Network,316.22,97,,percent of total billed charges,,
Xr Orbits Greater Than 3 Views,,70200,CPT,Facility,Both,,,,326,277.1,93.4316,326,"Health Partners, Inc.",Commercial,308.396,94.6,,percent of total billed charges,,
Xr Orbits Greater Than 3 Views,,70200,CPT,Facility,Outpatient,,,,326,277.1,93.4316,326,"Health Partners, Inc.",Medicare Advantage,159.74,49,,percent of total billed charges,,
Xr Orbits Greater Than 3 Views,,70200,CPT,Facility,Inpatient,,,,326,277.1,93.4316,326,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Orbits Greater Than 3 Views,,70200,CPT,Facility,Both,,,,326,277.1,93.4316,326,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),195.6,60,,percent of total billed charges,,
Xr Orbits Greater Than 3 Views,,70200,CPT,Facility,Both,,,,326,277.1,93.4316,326,"Health Partners, Inc.",State of Minnesota Advantage Program,265.69,81.5,,percent of total billed charges,,
Xr Orbits Greater Than 3 Views,,70200,CPT,Facility,Both,,,,326,277.1,93.4316,326,"Health Partners, Inc.",State Public Programs,163,50,,percent of total billed charges,,
Xr Orbits Greater Than 3 Views,,70200,CPT,Facility,Both,,,,326,277.1,93.4316,326,Humana Insurance Company,Commercial PPO,309.7,95,,percent of total billed charges,,
Xr Orbits Greater Than 3 Views,,70200,CPT,Facility,Outpatient,,,,326,277.1,93.4316,326,Humana Insurance Company,Medicare PPO,159.74,49,,percent of total billed charges,,
Xr Orbits Greater Than 3 Views,,70200,CPT,Facility,Inpatient,,,,326,277.1,93.4316,326,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Xr Orbits Greater Than 3 Views,,70200,CPT,Facility,Both,,,,326,277.1,93.4316,326,Medica,Individual & Family,323.066,99.1,,percent of total billed charges,,
Xr Orbits Greater Than 3 Views,,70200,CPT,Facility,Outpatient,,,,326,277.1,93.4316,326,Medica,Medica Advantage Solution,162.348,49.8,,percent of total billed charges,,
Xr Orbits Greater Than 3 Views,,70200,CPT,Facility,Inpatient,,,,326,277.1,93.4316,326,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Xr Orbits Greater Than 3 Views,,70200,CPT,Facility,Outpatient,,,,326,277.1,93.4316,326,Medica,Medical Assistance,145.396,44.6,,percent of total billed charges,,
Xr Orbits Greater Than 3 Views,,70200,CPT,Facility,Inpatient,,,,326,277.1,93.4316,326,Medica,Medical Assistance,,,,,Included in per diem rate,
Xr Orbits Greater Than 3 Views,,70200,CPT,Facility,Outpatient,,,,326,277.1,93.4316,326,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,162.348,49.8,,percent of total billed charges,,
Xr Orbits Greater Than 3 Views,,70200,CPT,Facility,Inpatient,,,,326,277.1,93.4316,326,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Xr Orbits Greater Than 3 Views,,70200,CPT,Facility,Both,,,,326,277.1,93.4316,326,"Multiplan, Inc.","Multiplan, Inc.",306.44,94,,percent of total billed charges,,
Xr Orbits Greater Than 3 Views,,70200,CPT,Facility,Outpatient,,,,326,277.1,93.4316,326,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,293.726,90.1,,percent of total billed charges,,
Xr Orbits Greater Than 3 Views,,70200,CPT,Facility,Inpatient,,,,326,277.1,93.4316,326,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Xr Orbits Greater Than 3 Views,,70200,CPT,Facility,Both,,,,326,277.1,93.4316,326,"Preferred One Administrative Services, INC.",PPO,321.436,98.6,,percent of total billed charges,,
Xr Orbits Greater Than 3 Views,,70200,CPT,Facility,Outpatient,,,,326,277.1,93.4316,326,PrimeWest Health,Minnesota Senior Health Options (MSHO),167.727,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Xr Orbits Greater Than 3 Views,,70200,CPT,Facility,Inpatient,,,,326,277.1,93.4316,326,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Orbits Greater Than 3 Views,,70200,CPT,Facility,Outpatient,,,,326,277.1,93.4316,326,PrimeWest Health,MinnesotaCare,167.4336,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Xr Orbits Greater Than 3 Views,,70200,CPT,Facility,Inpatient,,,,326,277.1,93.4316,326,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Xr Orbits Greater Than 3 Views,,70200,CPT,Facility,Both,,,,326,277.1,93.4316,326,Sanford Health Plan,Sanford Health Plan,299.92,92,,percent of total billed charges,,
Xr Orbits Greater Than 3 Views,,70200,CPT,Facility,Outpatient,,,,326,277.1,93.4316,326,"UCare Health, Inc.",Individual & Family Plan,183.701,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Xr Orbits Greater Than 3 Views,,70200,CPT,Facility,Inpatient,,,,326,277.1,93.4316,326,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Xr Orbits Greater Than 3 Views,,70200,CPT,Facility,Outpatient,,,,326,277.1,93.4316,326,"UCare Health, Inc.",Medical Assistance,164.5322,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Orbits Greater Than 3 Views,,70200,CPT,Facility,Inpatient,,,,326,277.1,93.4316,326,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Xr Orbits Greater Than 3 Views,,70200,CPT,Facility,Outpatient,,,,326,277.1,93.4316,326,"UCare Health, Inc.",Medicare Advantage,164.5322,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Orbits Greater Than 3 Views,,70200,CPT,Facility,Inpatient,,,,326,277.1,93.4316,326,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Orbits Greater Than 3 Views,,70200,CPT,Facility,Outpatient,,,,326,277.1,93.4316,326,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),164.5322,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Orbits Greater Than 3 Views,,70200,CPT,Facility,Inpatient,,,,326,277.1,93.4316,326,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Orbits Greater Than 3 Views,,70200,CPT,Facility,Both,,,,326,277.1,93.4316,326,UnitedHealthcare,Individual & Family,306.44,94,,percent of total billed charges,,
Xr Orbits Greater Than 3 Views,,70200,CPT,Facility,Outpatient,,,,326,277.1,93.4316,326,UnitedHealthcare,Medicare Advantage,159.74,49,,percent of total billed charges,,
Xr Orbits Greater Than 3 Views,,70200,CPT,Facility,Inpatient,,,,326,277.1,93.4316,326,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Xr Orbits Greater Than 3 Views,,70200,CPT,Facility,Outpatient,,,,326,277.1,93.4316,326,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,156.48,48,,percent of total billed charges,,100% of DHS outpatient percentage
Xr Orbits Greater Than 3 Views,,70200,CPT,Facility,Inpatient,,,,326,277.1,93.4316,326,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Xr Sinus Waters View,,70210,CPT,Facility,Both,,,,270,229.5,77.382,270,Aetna,Commercial,248.4,92,,percent of total billed charges,,
Xr Sinus Waters View,,70210,CPT,Facility,Outpatient,,,,270,229.5,77.382,270,Aetna,Medicare Advantage,132.3,49,,percent of total billed charges,,
Xr Sinus Waters View,,70210,CPT,Facility,Inpatient,,,,270,229.5,77.382,270,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Xr Sinus Waters View,,70210,CPT,Facility,Both,,,,270,229.5,77.382,270,Aetna,PPO,251.1,93,,percent of total billed charges,,
Xr Sinus Waters View,,70210,CPT,Facility,Both,,,,270,229.5,77.382,270,America's PPO,America's PPO,259.281,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Xr Sinus Waters View,,70210,CPT,Facility,Both,,,,270,229.5,77.382,270,BlueCross BlueShield Minnesota, Federal Employee Program,265.68,98.4,,percent of total billed charges,,
Xr Sinus Waters View,,70210,CPT,Facility,Both,,,,270,229.5,77.382,270,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,270,100,,percent of total billed charges,,
Xr Sinus Waters View,,70210,CPT,Facility,Both,,,,270,229.5,77.382,270,BlueCross BlueShield Minnesota,High Value Network Plan,243,90,,percent of total billed charges,,
Xr Sinus Waters View,,70210,CPT,Facility,Outpatient,,,,270,229.5,77.382,270,BlueCross BlueShield Minnesota,Medicare Advantage,132.3,49,,percent of total billed charges,,
Xr Sinus Waters View,,70210,CPT,Facility,Inpatient,,,,270,229.5,77.382,270,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Xr Sinus Waters View,,70210,CPT,Facility,Both,,,,270,229.5,77.382,270,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,239.139,88.57,,percent of total billed charges,,
Xr Sinus Waters View,,70210,CPT,Facility,Both,,,,270,229.5,77.382,270,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,77.382,28.66,,percent of total billed charges,,
Xr Sinus Waters View,,70210,CPT,Facility,Outpatient,,,,270,229.5,77.382,270,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),132.3,49,,percent of total billed charges,,
Xr Sinus Waters View,,70210,CPT,Facility,Inpatient,,,,270,229.5,77.382,270,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Xr Sinus Waters View,,70210,CPT,Facility,Both,,,,270,229.5,77.382,270,CorVel,Worker's Compensation,270,100,,percent of total billed charges,,
Xr Sinus Waters View,,70210,CPT,Facility,Both,,,,270,229.5,77.382,270,First Health Group Corporation,First Health Network,261.9,97,,percent of total billed charges,,
Xr Sinus Waters View,,70210,CPT,Facility,Both,,,,270,229.5,77.382,270,"Health Partners, Inc.",Commercial,255.42,94.6,,percent of total billed charges,,
Xr Sinus Waters View,,70210,CPT,Facility,Outpatient,,,,270,229.5,77.382,270,"Health Partners, Inc.",Medicare Advantage,132.3,49,,percent of total billed charges,,
Xr Sinus Waters View,,70210,CPT,Facility,Inpatient,,,,270,229.5,77.382,270,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Sinus Waters View,,70210,CPT,Facility,Both,,,,270,229.5,77.382,270,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),162,60,,percent of total billed charges,,
Xr Sinus Waters View,,70210,CPT,Facility,Both,,,,270,229.5,77.382,270,"Health Partners, Inc.",State of Minnesota Advantage Program,220.05,81.5,,percent of total billed charges,,
Xr Sinus Waters View,,70210,CPT,Facility,Both,,,,270,229.5,77.382,270,"Health Partners, Inc.",State Public Programs,135,50,,percent of total billed charges,,
Xr Sinus Waters View,,70210,CPT,Facility,Both,,,,270,229.5,77.382,270,Humana Insurance Company,Commercial PPO,256.5,95,,percent of total billed charges,,
Xr Sinus Waters View,,70210,CPT,Facility,Outpatient,,,,270,229.5,77.382,270,Humana Insurance Company,Medicare PPO,132.3,49,,percent of total billed charges,,
Xr Sinus Waters View,,70210,CPT,Facility,Inpatient,,,,270,229.5,77.382,270,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Xr Sinus Waters View,,70210,CPT,Facility,Both,,,,270,229.5,77.382,270,Medica,Individual & Family,267.57,99.1,,percent of total billed charges,,
Xr Sinus Waters View,,70210,CPT,Facility,Outpatient,,,,270,229.5,77.382,270,Medica,Medica Advantage Solution,134.46,49.8,,percent of total billed charges,,
Xr Sinus Waters View,,70210,CPT,Facility,Inpatient,,,,270,229.5,77.382,270,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Xr Sinus Waters View,,70210,CPT,Facility,Outpatient,,,,270,229.5,77.382,270,Medica,Medical Assistance,120.42,44.6,,percent of total billed charges,,
Xr Sinus Waters View,,70210,CPT,Facility,Inpatient,,,,270,229.5,77.382,270,Medica,Medical Assistance,,,,,Included in per diem rate,
Xr Sinus Waters View,,70210,CPT,Facility,Outpatient,,,,270,229.5,77.382,270,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,134.46,49.8,,percent of total billed charges,,
Xr Sinus Waters View,,70210,CPT,Facility,Inpatient,,,,270,229.5,77.382,270,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Xr Sinus Waters View,,70210,CPT,Facility,Both,,,,270,229.5,77.382,270,"Multiplan, Inc.","Multiplan, Inc.",253.8,94,,percent of total billed charges,,
Xr Sinus Waters View,,70210,CPT,Facility,Outpatient,,,,270,229.5,77.382,270,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,243.27,90.1,,percent of total billed charges,,
Xr Sinus Waters View,,70210,CPT,Facility,Inpatient,,,,270,229.5,77.382,270,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Xr Sinus Waters View,,70210,CPT,Facility,Both,,,,270,229.5,77.382,270,"Preferred One Administrative Services, INC.",PPO,266.22,98.6,,percent of total billed charges,,
Xr Sinus Waters View,,70210,CPT,Facility,Outpatient,,,,270,229.5,77.382,270,PrimeWest Health,Minnesota Senior Health Options (MSHO),138.915,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Xr Sinus Waters View,,70210,CPT,Facility,Inpatient,,,,270,229.5,77.382,270,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Sinus Waters View,,70210,CPT,Facility,Outpatient,,,,270,229.5,77.382,270,PrimeWest Health,MinnesotaCare,138.672,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Xr Sinus Waters View,,70210,CPT,Facility,Inpatient,,,,270,229.5,77.382,270,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Xr Sinus Waters View,,70210,CPT,Facility,Both,,,,270,229.5,77.382,270,Sanford Health Plan,Sanford Health Plan,248.4,92,,percent of total billed charges,,
Xr Sinus Waters View,,70210,CPT,Facility,Outpatient,,,,270,229.5,77.382,270,"UCare Health, Inc.",Individual & Family Plan,152.145,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Xr Sinus Waters View,,70210,CPT,Facility,Inpatient,,,,270,229.5,77.382,270,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Xr Sinus Waters View,,70210,CPT,Facility,Outpatient,,,,270,229.5,77.382,270,"UCare Health, Inc.",Medical Assistance,136.269,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Sinus Waters View,,70210,CPT,Facility,Inpatient,,,,270,229.5,77.382,270,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Xr Sinus Waters View,,70210,CPT,Facility,Outpatient,,,,270,229.5,77.382,270,"UCare Health, Inc.",Medicare Advantage,136.269,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Sinus Waters View,,70210,CPT,Facility,Inpatient,,,,270,229.5,77.382,270,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Sinus Waters View,,70210,CPT,Facility,Outpatient,,,,270,229.5,77.382,270,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),136.269,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Sinus Waters View,,70210,CPT,Facility,Inpatient,,,,270,229.5,77.382,270,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Sinus Waters View,,70210,CPT,Facility,Both,,,,270,229.5,77.382,270,UnitedHealthcare,Individual & Family,253.8,94,,percent of total billed charges,,
Xr Sinus Waters View,,70210,CPT,Facility,Outpatient,,,,270,229.5,77.382,270,UnitedHealthcare,Medicare Advantage,132.3,49,,percent of total billed charges,,
Xr Sinus Waters View,,70210,CPT,Facility,Inpatient,,,,270,229.5,77.382,270,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Xr Sinus Waters View,,70210,CPT,Facility,Outpatient,,,,270,229.5,77.382,270,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,129.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
Xr Sinus Waters View,,70210,CPT,Facility,Inpatient,,,,270,229.5,77.382,270,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Xr Sinus Routine Complete,,70220,CPT,Facility,Both,,,,357,303.45,102.3162,357,Aetna,Commercial,328.44,92,,percent of total billed charges,,
Xr Sinus Routine Complete,,70220,CPT,Facility,Outpatient,,,,357,303.45,102.3162,357,Aetna,Medicare Advantage,174.93,49,,percent of total billed charges,,
Xr Sinus Routine Complete,,70220,CPT,Facility,Inpatient,,,,357,303.45,102.3162,357,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Xr Sinus Routine Complete,,70220,CPT,Facility,Both,,,,357,303.45,102.3162,357,Aetna,PPO,332.01,93,,percent of total billed charges,,
Xr Sinus Routine Complete,,70220,CPT,Facility,Both,,,,357,303.45,102.3162,357,America's PPO,America's PPO,342.8271,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Xr Sinus Routine Complete,,70220,CPT,Facility,Both,,,,357,303.45,102.3162,357,BlueCross BlueShield Minnesota, Federal Employee Program,351.288,98.4,,percent of total billed charges,,
Xr Sinus Routine Complete,,70220,CPT,Facility,Both,,,,357,303.45,102.3162,357,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,357,100,,percent of total billed charges,,
Xr Sinus Routine Complete,,70220,CPT,Facility,Both,,,,357,303.45,102.3162,357,BlueCross BlueShield Minnesota,High Value Network Plan,321.3,90,,percent of total billed charges,,
Xr Sinus Routine Complete,,70220,CPT,Facility,Outpatient,,,,357,303.45,102.3162,357,BlueCross BlueShield Minnesota,Medicare Advantage,174.93,49,,percent of total billed charges,,
Xr Sinus Routine Complete,,70220,CPT,Facility,Inpatient,,,,357,303.45,102.3162,357,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Xr Sinus Routine Complete,,70220,CPT,Facility,Both,,,,357,303.45,102.3162,357,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,316.1949,88.57,,percent of total billed charges,,
Xr Sinus Routine Complete,,70220,CPT,Facility,Both,,,,357,303.45,102.3162,357,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,102.3162,28.66,,percent of total billed charges,,
Xr Sinus Routine Complete,,70220,CPT,Facility,Outpatient,,,,357,303.45,102.3162,357,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),174.93,49,,percent of total billed charges,,
Xr Sinus Routine Complete,,70220,CPT,Facility,Inpatient,,,,357,303.45,102.3162,357,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Xr Sinus Routine Complete,,70220,CPT,Facility,Both,,,,357,303.45,102.3162,357,CorVel,Worker's Compensation,357,100,,percent of total billed charges,,
Xr Sinus Routine Complete,,70220,CPT,Facility,Both,,,,357,303.45,102.3162,357,First Health Group Corporation,First Health Network,346.29,97,,percent of total billed charges,,
Xr Sinus Routine Complete,,70220,CPT,Facility,Both,,,,357,303.45,102.3162,357,"Health Partners, Inc.",Commercial,337.722,94.6,,percent of total billed charges,,
Xr Sinus Routine Complete,,70220,CPT,Facility,Outpatient,,,,357,303.45,102.3162,357,"Health Partners, Inc.",Medicare Advantage,174.93,49,,percent of total billed charges,,
Xr Sinus Routine Complete,,70220,CPT,Facility,Inpatient,,,,357,303.45,102.3162,357,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Sinus Routine Complete,,70220,CPT,Facility,Both,,,,357,303.45,102.3162,357,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),214.2,60,,percent of total billed charges,,
Xr Sinus Routine Complete,,70220,CPT,Facility,Both,,,,357,303.45,102.3162,357,"Health Partners, Inc.",State of Minnesota Advantage Program,290.955,81.5,,percent of total billed charges,,
Xr Sinus Routine Complete,,70220,CPT,Facility,Both,,,,357,303.45,102.3162,357,"Health Partners, Inc.",State Public Programs,178.5,50,,percent of total billed charges,,
Xr Sinus Routine Complete,,70220,CPT,Facility,Both,,,,357,303.45,102.3162,357,Humana Insurance Company,Commercial PPO,339.15,95,,percent of total billed charges,,
Xr Sinus Routine Complete,,70220,CPT,Facility,Outpatient,,,,357,303.45,102.3162,357,Humana Insurance Company,Medicare PPO,174.93,49,,percent of total billed charges,,
Xr Sinus Routine Complete,,70220,CPT,Facility,Inpatient,,,,357,303.45,102.3162,357,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Xr Sinus Routine Complete,,70220,CPT,Facility,Both,,,,357,303.45,102.3162,357,Medica,Individual & Family,353.787,99.1,,percent of total billed charges,,
Xr Sinus Routine Complete,,70220,CPT,Facility,Outpatient,,,,357,303.45,102.3162,357,Medica,Medica Advantage Solution,177.786,49.8,,percent of total billed charges,,
Xr Sinus Routine Complete,,70220,CPT,Facility,Inpatient,,,,357,303.45,102.3162,357,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Xr Sinus Routine Complete,,70220,CPT,Facility,Outpatient,,,,357,303.45,102.3162,357,Medica,Medical Assistance,159.222,44.6,,percent of total billed charges,,
Xr Sinus Routine Complete,,70220,CPT,Facility,Inpatient,,,,357,303.45,102.3162,357,Medica,Medical Assistance,,,,,Included in per diem rate,
Xr Sinus Routine Complete,,70220,CPT,Facility,Outpatient,,,,357,303.45,102.3162,357,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,177.786,49.8,,percent of total billed charges,,
Xr Sinus Routine Complete,,70220,CPT,Facility,Inpatient,,,,357,303.45,102.3162,357,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Xr Sinus Routine Complete,,70220,CPT,Facility,Both,,,,357,303.45,102.3162,357,"Multiplan, Inc.","Multiplan, Inc.",335.58,94,,percent of total billed charges,,
Xr Sinus Routine Complete,,70220,CPT,Facility,Outpatient,,,,357,303.45,102.3162,357,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,321.657,90.1,,percent of total billed charges,,
Xr Sinus Routine Complete,,70220,CPT,Facility,Inpatient,,,,357,303.45,102.3162,357,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Xr Sinus Routine Complete,,70220,CPT,Facility,Both,,,,357,303.45,102.3162,357,"Preferred One Administrative Services, INC.",PPO,352.002,98.6,,percent of total billed charges,,
Xr Sinus Routine Complete,,70220,CPT,Facility,Outpatient,,,,357,303.45,102.3162,357,PrimeWest Health,Minnesota Senior Health Options (MSHO),183.6765,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Xr Sinus Routine Complete,,70220,CPT,Facility,Inpatient,,,,357,303.45,102.3162,357,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Sinus Routine Complete,,70220,CPT,Facility,Outpatient,,,,357,303.45,102.3162,357,PrimeWest Health,MinnesotaCare,183.3552,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Xr Sinus Routine Complete,,70220,CPT,Facility,Inpatient,,,,357,303.45,102.3162,357,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Xr Sinus Routine Complete,,70220,CPT,Facility,Both,,,,357,303.45,102.3162,357,Sanford Health Plan,Sanford Health Plan,328.44,92,,percent of total billed charges,,
Xr Sinus Routine Complete,,70220,CPT,Facility,Outpatient,,,,357,303.45,102.3162,357,"UCare Health, Inc.",Individual & Family Plan,201.1695,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Xr Sinus Routine Complete,,70220,CPT,Facility,Inpatient,,,,357,303.45,102.3162,357,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Xr Sinus Routine Complete,,70220,CPT,Facility,Outpatient,,,,357,303.45,102.3162,357,"UCare Health, Inc.",Medical Assistance,180.1779,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Sinus Routine Complete,,70220,CPT,Facility,Inpatient,,,,357,303.45,102.3162,357,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Xr Sinus Routine Complete,,70220,CPT,Facility,Outpatient,,,,357,303.45,102.3162,357,"UCare Health, Inc.",Medicare Advantage,180.1779,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Sinus Routine Complete,,70220,CPT,Facility,Inpatient,,,,357,303.45,102.3162,357,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Sinus Routine Complete,,70220,CPT,Facility,Outpatient,,,,357,303.45,102.3162,357,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),180.1779,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Sinus Routine Complete,,70220,CPT,Facility,Inpatient,,,,357,303.45,102.3162,357,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Sinus Routine Complete,,70220,CPT,Facility,Both,,,,357,303.45,102.3162,357,UnitedHealthcare,Individual & Family,335.58,94,,percent of total billed charges,,
Xr Sinus Routine Complete,,70220,CPT,Facility,Outpatient,,,,357,303.45,102.3162,357,UnitedHealthcare,Medicare Advantage,174.93,49,,percent of total billed charges,,
Xr Sinus Routine Complete,,70220,CPT,Facility,Inpatient,,,,357,303.45,102.3162,357,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Xr Sinus Routine Complete,,70220,CPT,Facility,Outpatient,,,,357,303.45,102.3162,357,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,171.36,48,,percent of total billed charges,,100% of DHS outpatient percentage
Xr Sinus Routine Complete,,70220,CPT,Facility,Inpatient,,,,357,303.45,102.3162,357,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Xr Skull Under 4 Views,,70250,CPT,Facility,Both,,,,314,266.9,89.9924,314,Aetna,Commercial,288.88,92,,percent of total billed charges,,
Xr Skull Under 4 Views,,70250,CPT,Facility,Outpatient,,,,314,266.9,89.9924,314,Aetna,Medicare Advantage,153.86,49,,percent of total billed charges,,
Xr Skull Under 4 Views,,70250,CPT,Facility,Inpatient,,,,314,266.9,89.9924,314,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Xr Skull Under 4 Views,,70250,CPT,Facility,Both,,,,314,266.9,89.9924,314,Aetna,PPO,292.02,93,,percent of total billed charges,,
Xr Skull Under 4 Views,,70250,CPT,Facility,Both,,,,314,266.9,89.9924,314,America's PPO,America's PPO,301.5342,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Xr Skull Under 4 Views,,70250,CPT,Facility,Both,,,,314,266.9,89.9924,314,BlueCross BlueShield Minnesota, Federal Employee Program,308.976,98.4,,percent of total billed charges,,
Xr Skull Under 4 Views,,70250,CPT,Facility,Both,,,,314,266.9,89.9924,314,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,314,100,,percent of total billed charges,,
Xr Skull Under 4 Views,,70250,CPT,Facility,Both,,,,314,266.9,89.9924,314,BlueCross BlueShield Minnesota,High Value Network Plan,282.6,90,,percent of total billed charges,,
Xr Skull Under 4 Views,,70250,CPT,Facility,Outpatient,,,,314,266.9,89.9924,314,BlueCross BlueShield Minnesota,Medicare Advantage,153.86,49,,percent of total billed charges,,
Xr Skull Under 4 Views,,70250,CPT,Facility,Inpatient,,,,314,266.9,89.9924,314,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Xr Skull Under 4 Views,,70250,CPT,Facility,Both,,,,314,266.9,89.9924,314,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,278.1098,88.57,,percent of total billed charges,,
Xr Skull Under 4 Views,,70250,CPT,Facility,Both,,,,314,266.9,89.9924,314,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,89.9924,28.66,,percent of total billed charges,,
Xr Skull Under 4 Views,,70250,CPT,Facility,Outpatient,,,,314,266.9,89.9924,314,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),153.86,49,,percent of total billed charges,,
Xr Skull Under 4 Views,,70250,CPT,Facility,Inpatient,,,,314,266.9,89.9924,314,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Xr Skull Under 4 Views,,70250,CPT,Facility,Both,,,,314,266.9,89.9924,314,CorVel,Worker's Compensation,314,100,,percent of total billed charges,,
Xr Skull Under 4 Views,,70250,CPT,Facility,Both,,,,314,266.9,89.9924,314,First Health Group Corporation,First Health Network,304.58,97,,percent of total billed charges,,
Xr Skull Under 4 Views,,70250,CPT,Facility,Both,,,,314,266.9,89.9924,314,"Health Partners, Inc.",Commercial,297.044,94.6,,percent of total billed charges,,
Xr Skull Under 4 Views,,70250,CPT,Facility,Outpatient,,,,314,266.9,89.9924,314,"Health Partners, Inc.",Medicare Advantage,153.86,49,,percent of total billed charges,,
Xr Skull Under 4 Views,,70250,CPT,Facility,Inpatient,,,,314,266.9,89.9924,314,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Skull Under 4 Views,,70250,CPT,Facility,Both,,,,314,266.9,89.9924,314,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),188.4,60,,percent of total billed charges,,
Xr Skull Under 4 Views,,70250,CPT,Facility,Both,,,,314,266.9,89.9924,314,"Health Partners, Inc.",State of Minnesota Advantage Program,255.91,81.5,,percent of total billed charges,,
Xr Skull Under 4 Views,,70250,CPT,Facility,Both,,,,314,266.9,89.9924,314,"Health Partners, Inc.",State Public Programs,157,50,,percent of total billed charges,,
Xr Skull Under 4 Views,,70250,CPT,Facility,Both,,,,314,266.9,89.9924,314,Humana Insurance Company,Commercial PPO,298.3,95,,percent of total billed charges,,
Xr Skull Under 4 Views,,70250,CPT,Facility,Outpatient,,,,314,266.9,89.9924,314,Humana Insurance Company,Medicare PPO,153.86,49,,percent of total billed charges,,
Xr Skull Under 4 Views,,70250,CPT,Facility,Inpatient,,,,314,266.9,89.9924,314,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Xr Skull Under 4 Views,,70250,CPT,Facility,Both,,,,314,266.9,89.9924,314,Medica,Individual & Family,311.174,99.1,,percent of total billed charges,,
Xr Skull Under 4 Views,,70250,CPT,Facility,Outpatient,,,,314,266.9,89.9924,314,Medica,Medica Advantage Solution,156.372,49.8,,percent of total billed charges,,
Xr Skull Under 4 Views,,70250,CPT,Facility,Inpatient,,,,314,266.9,89.9924,314,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Xr Skull Under 4 Views,,70250,CPT,Facility,Outpatient,,,,314,266.9,89.9924,314,Medica,Medical Assistance,140.044,44.6,,percent of total billed charges,,
Xr Skull Under 4 Views,,70250,CPT,Facility,Inpatient,,,,314,266.9,89.9924,314,Medica,Medical Assistance,,,,,Included in per diem rate,
Xr Skull Under 4 Views,,70250,CPT,Facility,Outpatient,,,,314,266.9,89.9924,314,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,156.372,49.8,,percent of total billed charges,,
Xr Skull Under 4 Views,,70250,CPT,Facility,Inpatient,,,,314,266.9,89.9924,314,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Xr Skull Under 4 Views,,70250,CPT,Facility,Both,,,,314,266.9,89.9924,314,"Multiplan, Inc.","Multiplan, Inc.",295.16,94,,percent of total billed charges,,
Xr Skull Under 4 Views,,70250,CPT,Facility,Outpatient,,,,314,266.9,89.9924,314,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,282.914,90.1,,percent of total billed charges,,
Xr Skull Under 4 Views,,70250,CPT,Facility,Inpatient,,,,314,266.9,89.9924,314,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Xr Skull Under 4 Views,,70250,CPT,Facility,Both,,,,314,266.9,89.9924,314,"Preferred One Administrative Services, INC.",PPO,309.604,98.6,,percent of total billed charges,,
Xr Skull Under 4 Views,,70250,CPT,Facility,Outpatient,,,,314,266.9,89.9924,314,PrimeWest Health,Minnesota Senior Health Options (MSHO),161.553,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Xr Skull Under 4 Views,,70250,CPT,Facility,Inpatient,,,,314,266.9,89.9924,314,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Skull Under 4 Views,,70250,CPT,Facility,Outpatient,,,,314,266.9,89.9924,314,PrimeWest Health,MinnesotaCare,161.2704,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Xr Skull Under 4 Views,,70250,CPT,Facility,Inpatient,,,,314,266.9,89.9924,314,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Xr Skull Under 4 Views,,70250,CPT,Facility,Both,,,,314,266.9,89.9924,314,Sanford Health Plan,Sanford Health Plan,288.88,92,,percent of total billed charges,,
Xr Skull Under 4 Views,,70250,CPT,Facility,Outpatient,,,,314,266.9,89.9924,314,"UCare Health, Inc.",Individual & Family Plan,176.939,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Xr Skull Under 4 Views,,70250,CPT,Facility,Inpatient,,,,314,266.9,89.9924,314,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Xr Skull Under 4 Views,,70250,CPT,Facility,Outpatient,,,,314,266.9,89.9924,314,"UCare Health, Inc.",Medical Assistance,158.4758,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Skull Under 4 Views,,70250,CPT,Facility,Inpatient,,,,314,266.9,89.9924,314,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Xr Skull Under 4 Views,,70250,CPT,Facility,Outpatient,,,,314,266.9,89.9924,314,"UCare Health, Inc.",Medicare Advantage,158.4758,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Skull Under 4 Views,,70250,CPT,Facility,Inpatient,,,,314,266.9,89.9924,314,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Skull Under 4 Views,,70250,CPT,Facility,Outpatient,,,,314,266.9,89.9924,314,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),158.4758,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Skull Under 4 Views,,70250,CPT,Facility,Inpatient,,,,314,266.9,89.9924,314,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Skull Under 4 Views,,70250,CPT,Facility,Both,,,,314,266.9,89.9924,314,UnitedHealthcare,Individual & Family,295.16,94,,percent of total billed charges,,
Xr Skull Under 4 Views,,70250,CPT,Facility,Outpatient,,,,314,266.9,89.9924,314,UnitedHealthcare,Medicare Advantage,153.86,49,,percent of total billed charges,,
Xr Skull Under 4 Views,,70250,CPT,Facility,Inpatient,,,,314,266.9,89.9924,314,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Xr Skull Under 4 Views,,70250,CPT,Facility,Outpatient,,,,314,266.9,89.9924,314,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,150.72,48,,percent of total billed charges,,100% of DHS outpatient percentage
Xr Skull Under 4 Views,,70250,CPT,Facility,Inpatient,,,,314,266.9,89.9924,314,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Xr Skull Routine Over 3 Views,,70260,CPT,Facility,Both,,,,383,325.55,109.7678,383,Aetna,Commercial,352.36,92,,percent of total billed charges,,
Xr Skull Routine Over 3 Views,,70260,CPT,Facility,Outpatient,,,,383,325.55,109.7678,383,Aetna,Medicare Advantage,187.67,49,,percent of total billed charges,,
Xr Skull Routine Over 3 Views,,70260,CPT,Facility,Inpatient,,,,383,325.55,109.7678,383,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Xr Skull Routine Over 3 Views,,70260,CPT,Facility,Both,,,,383,325.55,109.7678,383,Aetna,PPO,356.19,93,,percent of total billed charges,,
Xr Skull Routine Over 3 Views,,70260,CPT,Facility,Both,,,,383,325.55,109.7678,383,America's PPO,America's PPO,367.7949,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Xr Skull Routine Over 3 Views,,70260,CPT,Facility,Both,,,,383,325.55,109.7678,383,BlueCross BlueShield Minnesota, Federal Employee Program,376.872,98.4,,percent of total billed charges,,
Xr Skull Routine Over 3 Views,,70260,CPT,Facility,Both,,,,383,325.55,109.7678,383,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,383,100,,percent of total billed charges,,
Xr Skull Routine Over 3 Views,,70260,CPT,Facility,Both,,,,383,325.55,109.7678,383,BlueCross BlueShield Minnesota,High Value Network Plan,344.7,90,,percent of total billed charges,,
Xr Skull Routine Over 3 Views,,70260,CPT,Facility,Outpatient,,,,383,325.55,109.7678,383,BlueCross BlueShield Minnesota,Medicare Advantage,187.67,49,,percent of total billed charges,,
Xr Skull Routine Over 3 Views,,70260,CPT,Facility,Inpatient,,,,383,325.55,109.7678,383,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Xr Skull Routine Over 3 Views,,70260,CPT,Facility,Both,,,,383,325.55,109.7678,383,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,339.2231,88.57,,percent of total billed charges,,
Xr Skull Routine Over 3 Views,,70260,CPT,Facility,Both,,,,383,325.55,109.7678,383,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,109.7678,28.66,,percent of total billed charges,,
Xr Skull Routine Over 3 Views,,70260,CPT,Facility,Outpatient,,,,383,325.55,109.7678,383,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),187.67,49,,percent of total billed charges,,
Xr Skull Routine Over 3 Views,,70260,CPT,Facility,Inpatient,,,,383,325.55,109.7678,383,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Xr Skull Routine Over 3 Views,,70260,CPT,Facility,Both,,,,383,325.55,109.7678,383,CorVel,Worker's Compensation,383,100,,percent of total billed charges,,
Xr Skull Routine Over 3 Views,,70260,CPT,Facility,Both,,,,383,325.55,109.7678,383,First Health Group Corporation,First Health Network,371.51,97,,percent of total billed charges,,
Xr Skull Routine Over 3 Views,,70260,CPT,Facility,Both,,,,383,325.55,109.7678,383,"Health Partners, Inc.",Commercial,362.318,94.6,,percent of total billed charges,,
Xr Skull Routine Over 3 Views,,70260,CPT,Facility,Outpatient,,,,383,325.55,109.7678,383,"Health Partners, Inc.",Medicare Advantage,187.67,49,,percent of total billed charges,,
Xr Skull Routine Over 3 Views,,70260,CPT,Facility,Inpatient,,,,383,325.55,109.7678,383,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Skull Routine Over 3 Views,,70260,CPT,Facility,Both,,,,383,325.55,109.7678,383,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),229.8,60,,percent of total billed charges,,
Xr Skull Routine Over 3 Views,,70260,CPT,Facility,Both,,,,383,325.55,109.7678,383,"Health Partners, Inc.",State of Minnesota Advantage Program,312.145,81.5,,percent of total billed charges,,
Xr Skull Routine Over 3 Views,,70260,CPT,Facility,Both,,,,383,325.55,109.7678,383,"Health Partners, Inc.",State Public Programs,191.5,50,,percent of total billed charges,,
Xr Skull Routine Over 3 Views,,70260,CPT,Facility,Both,,,,383,325.55,109.7678,383,Humana Insurance Company,Commercial PPO,363.85,95,,percent of total billed charges,,
Xr Skull Routine Over 3 Views,,70260,CPT,Facility,Outpatient,,,,383,325.55,109.7678,383,Humana Insurance Company,Medicare PPO,187.67,49,,percent of total billed charges,,
Xr Skull Routine Over 3 Views,,70260,CPT,Facility,Inpatient,,,,383,325.55,109.7678,383,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Xr Skull Routine Over 3 Views,,70260,CPT,Facility,Both,,,,383,325.55,109.7678,383,Medica,Individual & Family,379.553,99.1,,percent of total billed charges,,
Xr Skull Routine Over 3 Views,,70260,CPT,Facility,Outpatient,,,,383,325.55,109.7678,383,Medica,Medica Advantage Solution,190.734,49.8,,percent of total billed charges,,
Xr Skull Routine Over 3 Views,,70260,CPT,Facility,Inpatient,,,,383,325.55,109.7678,383,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Xr Skull Routine Over 3 Views,,70260,CPT,Facility,Outpatient,,,,383,325.55,109.7678,383,Medica,Medical Assistance,170.818,44.6,,percent of total billed charges,,
Xr Skull Routine Over 3 Views,,70260,CPT,Facility,Inpatient,,,,383,325.55,109.7678,383,Medica,Medical Assistance,,,,,Included in per diem rate,
Xr Skull Routine Over 3 Views,,70260,CPT,Facility,Outpatient,,,,383,325.55,109.7678,383,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,190.734,49.8,,percent of total billed charges,,
Xr Skull Routine Over 3 Views,,70260,CPT,Facility,Inpatient,,,,383,325.55,109.7678,383,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Xr Skull Routine Over 3 Views,,70260,CPT,Facility,Both,,,,383,325.55,109.7678,383,"Multiplan, Inc.","Multiplan, Inc.",360.02,94,,percent of total billed charges,,
Xr Skull Routine Over 3 Views,,70260,CPT,Facility,Outpatient,,,,383,325.55,109.7678,383,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,345.083,90.1,,percent of total billed charges,,
Xr Skull Routine Over 3 Views,,70260,CPT,Facility,Inpatient,,,,383,325.55,109.7678,383,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Xr Skull Routine Over 3 Views,,70260,CPT,Facility,Both,,,,383,325.55,109.7678,383,"Preferred One Administrative Services, INC.",PPO,377.638,98.6,,percent of total billed charges,,
Xr Skull Routine Over 3 Views,,70260,CPT,Facility,Outpatient,,,,383,325.55,109.7678,383,PrimeWest Health,Minnesota Senior Health Options (MSHO),197.0535,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Xr Skull Routine Over 3 Views,,70260,CPT,Facility,Inpatient,,,,383,325.55,109.7678,383,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Skull Routine Over 3 Views,,70260,CPT,Facility,Outpatient,,,,383,325.55,109.7678,383,PrimeWest Health,MinnesotaCare,196.7088,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Xr Skull Routine Over 3 Views,,70260,CPT,Facility,Inpatient,,,,383,325.55,109.7678,383,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Xr Skull Routine Over 3 Views,,70260,CPT,Facility,Both,,,,383,325.55,109.7678,383,Sanford Health Plan,Sanford Health Plan,352.36,92,,percent of total billed charges,,
Xr Skull Routine Over 3 Views,,70260,CPT,Facility,Outpatient,,,,383,325.55,109.7678,383,"UCare Health, Inc.",Individual & Family Plan,215.8205,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Xr Skull Routine Over 3 Views,,70260,CPT,Facility,Inpatient,,,,383,325.55,109.7678,383,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Xr Skull Routine Over 3 Views,,70260,CPT,Facility,Outpatient,,,,383,325.55,109.7678,383,"UCare Health, Inc.",Medical Assistance,193.3001,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Skull Routine Over 3 Views,,70260,CPT,Facility,Inpatient,,,,383,325.55,109.7678,383,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Xr Skull Routine Over 3 Views,,70260,CPT,Facility,Outpatient,,,,383,325.55,109.7678,383,"UCare Health, Inc.",Medicare Advantage,193.3001,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Skull Routine Over 3 Views,,70260,CPT,Facility,Inpatient,,,,383,325.55,109.7678,383,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Skull Routine Over 3 Views,,70260,CPT,Facility,Outpatient,,,,383,325.55,109.7678,383,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),193.3001,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Skull Routine Over 3 Views,,70260,CPT,Facility,Inpatient,,,,383,325.55,109.7678,383,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Skull Routine Over 3 Views,,70260,CPT,Facility,Both,,,,383,325.55,109.7678,383,UnitedHealthcare,Individual & Family,360.02,94,,percent of total billed charges,,
Xr Skull Routine Over 3 Views,,70260,CPT,Facility,Outpatient,,,,383,325.55,109.7678,383,UnitedHealthcare,Medicare Advantage,187.67,49,,percent of total billed charges,,
Xr Skull Routine Over 3 Views,,70260,CPT,Facility,Inpatient,,,,383,325.55,109.7678,383,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Xr Skull Routine Over 3 Views,,70260,CPT,Facility,Outpatient,,,,383,325.55,109.7678,383,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,183.84,48,,percent of total billed charges,,100% of DHS outpatient percentage
Xr Skull Routine Over 3 Views,,70260,CPT,Facility,Inpatient,,,,383,325.55,109.7678,383,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Xr Temporomandibular Joint Unilateral,,70328,CPT,Facility,Both,,,,270,229.5,77.382,270,Aetna,Commercial,248.4,92,,percent of total billed charges,,
Xr Temporomandibular Joint Unilateral,,70328,CPT,Facility,Outpatient,,,,270,229.5,77.382,270,Aetna,Medicare Advantage,132.3,49,,percent of total billed charges,,
Xr Temporomandibular Joint Unilateral,,70328,CPT,Facility,Inpatient,,,,270,229.5,77.382,270,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Xr Temporomandibular Joint Unilateral,,70328,CPT,Facility,Both,,,,270,229.5,77.382,270,Aetna,PPO,251.1,93,,percent of total billed charges,,
Xr Temporomandibular Joint Unilateral,,70328,CPT,Facility,Both,,,,270,229.5,77.382,270,America's PPO,America's PPO,259.281,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Xr Temporomandibular Joint Unilateral,,70328,CPT,Facility,Both,,,,270,229.5,77.382,270,BlueCross BlueShield Minnesota, Federal Employee Program,265.68,98.4,,percent of total billed charges,,
Xr Temporomandibular Joint Unilateral,,70328,CPT,Facility,Both,,,,270,229.5,77.382,270,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,270,100,,percent of total billed charges,,
Xr Temporomandibular Joint Unilateral,,70328,CPT,Facility,Both,,,,270,229.5,77.382,270,BlueCross BlueShield Minnesota,High Value Network Plan,243,90,,percent of total billed charges,,
Xr Temporomandibular Joint Unilateral,,70328,CPT,Facility,Outpatient,,,,270,229.5,77.382,270,BlueCross BlueShield Minnesota,Medicare Advantage,132.3,49,,percent of total billed charges,,
Xr Temporomandibular Joint Unilateral,,70328,CPT,Facility,Inpatient,,,,270,229.5,77.382,270,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Xr Temporomandibular Joint Unilateral,,70328,CPT,Facility,Both,,,,270,229.5,77.382,270,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,239.139,88.57,,percent of total billed charges,,
Xr Temporomandibular Joint Unilateral,,70328,CPT,Facility,Both,,,,270,229.5,77.382,270,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,77.382,28.66,,percent of total billed charges,,
Xr Temporomandibular Joint Unilateral,,70328,CPT,Facility,Outpatient,,,,270,229.5,77.382,270,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),132.3,49,,percent of total billed charges,,
Xr Temporomandibular Joint Unilateral,,70328,CPT,Facility,Inpatient,,,,270,229.5,77.382,270,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Xr Temporomandibular Joint Unilateral,,70328,CPT,Facility,Both,,,,270,229.5,77.382,270,CorVel,Worker's Compensation,270,100,,percent of total billed charges,,
Xr Temporomandibular Joint Unilateral,,70328,CPT,Facility,Both,,,,270,229.5,77.382,270,First Health Group Corporation,First Health Network,261.9,97,,percent of total billed charges,,
Xr Temporomandibular Joint Unilateral,,70328,CPT,Facility,Both,,,,270,229.5,77.382,270,"Health Partners, Inc.",Commercial,255.42,94.6,,percent of total billed charges,,
Xr Temporomandibular Joint Unilateral,,70328,CPT,Facility,Outpatient,,,,270,229.5,77.382,270,"Health Partners, Inc.",Medicare Advantage,132.3,49,,percent of total billed charges,,
Xr Temporomandibular Joint Unilateral,,70328,CPT,Facility,Inpatient,,,,270,229.5,77.382,270,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Temporomandibular Joint Unilateral,,70328,CPT,Facility,Both,,,,270,229.5,77.382,270,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),162,60,,percent of total billed charges,,
Xr Temporomandibular Joint Unilateral,,70328,CPT,Facility,Both,,,,270,229.5,77.382,270,"Health Partners, Inc.",State of Minnesota Advantage Program,220.05,81.5,,percent of total billed charges,,
Xr Temporomandibular Joint Unilateral,,70328,CPT,Facility,Both,,,,270,229.5,77.382,270,"Health Partners, Inc.",State Public Programs,135,50,,percent of total billed charges,,
Xr Temporomandibular Joint Unilateral,,70328,CPT,Facility,Both,,,,270,229.5,77.382,270,Humana Insurance Company,Commercial PPO,256.5,95,,percent of total billed charges,,
Xr Temporomandibular Joint Unilateral,,70328,CPT,Facility,Outpatient,,,,270,229.5,77.382,270,Humana Insurance Company,Medicare PPO,132.3,49,,percent of total billed charges,,
Xr Temporomandibular Joint Unilateral,,70328,CPT,Facility,Inpatient,,,,270,229.5,77.382,270,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Xr Temporomandibular Joint Unilateral,,70328,CPT,Facility,Both,,,,270,229.5,77.382,270,Medica,Individual & Family,267.57,99.1,,percent of total billed charges,,
Xr Temporomandibular Joint Unilateral,,70328,CPT,Facility,Outpatient,,,,270,229.5,77.382,270,Medica,Medica Advantage Solution,134.46,49.8,,percent of total billed charges,,
Xr Temporomandibular Joint Unilateral,,70328,CPT,Facility,Inpatient,,,,270,229.5,77.382,270,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Xr Temporomandibular Joint Unilateral,,70328,CPT,Facility,Outpatient,,,,270,229.5,77.382,270,Medica,Medical Assistance,120.42,44.6,,percent of total billed charges,,
Xr Temporomandibular Joint Unilateral,,70328,CPT,Facility,Inpatient,,,,270,229.5,77.382,270,Medica,Medical Assistance,,,,,Included in per diem rate,
Xr Temporomandibular Joint Unilateral,,70328,CPT,Facility,Outpatient,,,,270,229.5,77.382,270,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,134.46,49.8,,percent of total billed charges,,
Xr Temporomandibular Joint Unilateral,,70328,CPT,Facility,Inpatient,,,,270,229.5,77.382,270,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Xr Temporomandibular Joint Unilateral,,70328,CPT,Facility,Both,,,,270,229.5,77.382,270,"Multiplan, Inc.","Multiplan, Inc.",253.8,94,,percent of total billed charges,,
Xr Temporomandibular Joint Unilateral,,70328,CPT,Facility,Outpatient,,,,270,229.5,77.382,270,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,243.27,90.1,,percent of total billed charges,,
Xr Temporomandibular Joint Unilateral,,70328,CPT,Facility,Inpatient,,,,270,229.5,77.382,270,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Xr Temporomandibular Joint Unilateral,,70328,CPT,Facility,Both,,,,270,229.5,77.382,270,"Preferred One Administrative Services, INC.",PPO,266.22,98.6,,percent of total billed charges,,
Xr Temporomandibular Joint Unilateral,,70328,CPT,Facility,Outpatient,,,,270,229.5,77.382,270,PrimeWest Health,Minnesota Senior Health Options (MSHO),138.915,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Xr Temporomandibular Joint Unilateral,,70328,CPT,Facility,Inpatient,,,,270,229.5,77.382,270,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Temporomandibular Joint Unilateral,,70328,CPT,Facility,Outpatient,,,,270,229.5,77.382,270,PrimeWest Health,MinnesotaCare,138.672,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Xr Temporomandibular Joint Unilateral,,70328,CPT,Facility,Inpatient,,,,270,229.5,77.382,270,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Xr Temporomandibular Joint Unilateral,,70328,CPT,Facility,Both,,,,270,229.5,77.382,270,Sanford Health Plan,Sanford Health Plan,248.4,92,,percent of total billed charges,,
Xr Temporomandibular Joint Unilateral,,70328,CPT,Facility,Outpatient,,,,270,229.5,77.382,270,"UCare Health, Inc.",Individual & Family Plan,152.145,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Xr Temporomandibular Joint Unilateral,,70328,CPT,Facility,Inpatient,,,,270,229.5,77.382,270,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Xr Temporomandibular Joint Unilateral,,70328,CPT,Facility,Outpatient,,,,270,229.5,77.382,270,"UCare Health, Inc.",Medical Assistance,136.269,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Temporomandibular Joint Unilateral,,70328,CPT,Facility,Inpatient,,,,270,229.5,77.382,270,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Xr Temporomandibular Joint Unilateral,,70328,CPT,Facility,Outpatient,,,,270,229.5,77.382,270,"UCare Health, Inc.",Medicare Advantage,136.269,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Temporomandibular Joint Unilateral,,70328,CPT,Facility,Inpatient,,,,270,229.5,77.382,270,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Temporomandibular Joint Unilateral,,70328,CPT,Facility,Outpatient,,,,270,229.5,77.382,270,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),136.269,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Temporomandibular Joint Unilateral,,70328,CPT,Facility,Inpatient,,,,270,229.5,77.382,270,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Temporomandibular Joint Unilateral,,70328,CPT,Facility,Both,,,,270,229.5,77.382,270,UnitedHealthcare,Individual & Family,253.8,94,,percent of total billed charges,,
Xr Temporomandibular Joint Unilateral,,70328,CPT,Facility,Outpatient,,,,270,229.5,77.382,270,UnitedHealthcare,Medicare Advantage,132.3,49,,percent of total billed charges,,
Xr Temporomandibular Joint Unilateral,,70328,CPT,Facility,Inpatient,,,,270,229.5,77.382,270,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Xr Temporomandibular Joint Unilateral,,70328,CPT,Facility,Outpatient,,,,270,229.5,77.382,270,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,129.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
Xr Temporomandibular Joint Unilateral,,70328,CPT,Facility,Inpatient,,,,270,229.5,77.382,270,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Mri Temporomandibular Joint Bil,,70336,CPT,Facility,Both,,,,2142,1820.7,533.908,2142,Aetna,Commercial,1970.64,92,,percent of total billed charges,,
Mri Temporomandibular Joint Bil,,70336,CPT,Facility,Outpatient,,,,2142,1820.7,533.908,2142,Aetna,Medicare Advantage,1049.58,49,,percent of total billed charges,,
Mri Temporomandibular Joint Bil,,70336,CPT,Facility,Inpatient,,,,2142,1820.7,533.908,2142,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Mri Temporomandibular Joint Bil,,70336,CPT,Facility,Both,,,,2142,1820.7,533.908,2142,Aetna,PPO,1992.06,93,,percent of total billed charges,,
Mri Temporomandibular Joint Bil,,70336,CPT,Facility,Both,,,,2142,1820.7,533.908,2142,America's PPO,America's PPO,2056.9626,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Mri Temporomandibular Joint Bil,,70336,CPT,Facility,Both,,,,2142,1820.7,533.908,2142,BlueCross BlueShield Minnesota, Federal Employee Program,1051,,,Fee schedule,,100% of BCBS commercial commodity fee schedule
Mri Temporomandibular Joint Bil,,70336,CPT,Facility,Both,,,,2142,1820.7,533.908,2142,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1067.816,,,Fee schedule,,"100% of BCBS commercial commodity fee schedule, plus MN Care tax"
Mri Temporomandibular Joint Bil,,70336,CPT,Facility,Both,,,,2142,1820.7,533.908,2142,BlueCross BlueShield Minnesota,High Value Network Plan,961.0344,,,Fee schedule,,"90% of BCBS commercial commodity fee schedule, plus MN Care tax; see disclaimer for more information"
Mri Temporomandibular Joint Bil,,70336,CPT,Facility,Outpatient,,,,2142,1820.7,533.908,2142,BlueCross BlueShield Minnesota,Medicare Advantage,1049.58,49,,percent of total billed charges,,
Mri Temporomandibular Joint Bil,,70336,CPT,Facility,Inpatient,,,,2142,1820.7,533.908,2142,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Mri Temporomandibular Joint Bil,,70336,CPT,Facility,Both,,,,2142,1820.7,533.908,2142,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,945.7646312,,,Fee schedule,,"88.57% of BCBS commercial commodity fee schedule, plus MN Care tax"
Mri Temporomandibular Joint Bil,,70336,CPT,Facility,Both,,,,2142,1820.7,533.908,2142,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,533.908,,,Fee schedule,,"100% of BCBS Medicaid commodity fee schedule, plus MN Care tax"
Mri Temporomandibular Joint Bil,,70336,CPT,Facility,Outpatient,,,,2142,1820.7,533.908,2142,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1049.58,49,,percent of total billed charges,,
Mri Temporomandibular Joint Bil,,70336,CPT,Facility,Inpatient,,,,2142,1820.7,533.908,2142,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Mri Temporomandibular Joint Bil,,70336,CPT,Facility,Both,,,,2142,1820.7,533.908,2142,CorVel,Worker's Compensation,2142,100,,percent of total billed charges,,
Mri Temporomandibular Joint Bil,,70336,CPT,Facility,Both,,,,2142,1820.7,533.908,2142,First Health Group Corporation,First Health Network,2077.74,97,,percent of total billed charges,,
Mri Temporomandibular Joint Bil,,70336,CPT,Facility,Both,,,,2142,1820.7,533.908,2142,"Health Partners, Inc.",Commercial,2026.332,94.6,,percent of total billed charges,,
Mri Temporomandibular Joint Bil,,70336,CPT,Facility,Outpatient,,,,2142,1820.7,533.908,2142,"Health Partners, Inc.",Medicare Advantage,1049.58,49,,percent of total billed charges,,
Mri Temporomandibular Joint Bil,,70336,CPT,Facility,Inpatient,,,,2142,1820.7,533.908,2142,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mri Temporomandibular Joint Bil,,70336,CPT,Facility,Both,,,,2142,1820.7,533.908,2142,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1285.2,60,,percent of total billed charges,,
Mri Temporomandibular Joint Bil,,70336,CPT,Facility,Both,,,,2142,1820.7,533.908,2142,"Health Partners, Inc.",State of Minnesota Advantage Program,1745.73,81.5,,percent of total billed charges,,
Mri Temporomandibular Joint Bil,,70336,CPT,Facility,Both,,,,2142,1820.7,533.908,2142,"Health Partners, Inc.",State Public Programs,1071,50,,percent of total billed charges,,
Mri Temporomandibular Joint Bil,,70336,CPT,Facility,Both,,,,2142,1820.7,533.908,2142,Humana Insurance Company,Commercial PPO,2034.9,95,,percent of total billed charges,,
Mri Temporomandibular Joint Bil,,70336,CPT,Facility,Outpatient,,,,2142,1820.7,533.908,2142,Humana Insurance Company,Medicare PPO,1049.58,49,,percent of total billed charges,,
Mri Temporomandibular Joint Bil,,70336,CPT,Facility,Inpatient,,,,2142,1820.7,533.908,2142,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Mri Temporomandibular Joint Bil,,70336,CPT,Facility,Both,,,,2142,1820.7,533.908,2142,Medica,Individual & Family,2122.722,99.1,,percent of total billed charges,,
Mri Temporomandibular Joint Bil,,70336,CPT,Facility,Outpatient,,,,2142,1820.7,533.908,2142,Medica,Medica Advantage Solution,1066.716,49.8,,percent of total billed charges,,
Mri Temporomandibular Joint Bil,,70336,CPT,Facility,Inpatient,,,,2142,1820.7,533.908,2142,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Mri Temporomandibular Joint Bil,,70336,CPT,Facility,Outpatient,,,,2142,1820.7,533.908,2142,Medica,Medical Assistance,747,,,Other ,per vist,Pays in addition to all Outpatient Service Categories
Mri Temporomandibular Joint Bil,,70336,CPT,Facility,Inpatient,,,,2142,1820.7,533.908,2142,Medica,Medical Assistance,,,,,Included in per diem rate,
Mri Temporomandibular Joint Bil,,70336,CPT,Facility,Outpatient,,,,2142,1820.7,533.908,2142,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1066.716,49.8,,percent of total billed charges,,
Mri Temporomandibular Joint Bil,,70336,CPT,Facility,Inpatient,,,,2142,1820.7,533.908,2142,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Mri Temporomandibular Joint Bil,,70336,CPT,Facility,Both,,,,2142,1820.7,533.908,2142,"Multiplan, Inc.","Multiplan, Inc.",2013.48,94,,percent of total billed charges,,
Mri Temporomandibular Joint Bil,,70336,CPT,Facility,Outpatient,,,,2142,1820.7,533.908,2142,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1535,,,Other ,per scan,
Mri Temporomandibular Joint Bil,,70336,CPT,Facility,Inpatient,,,,2142,1820.7,533.908,2142,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Mri Temporomandibular Joint Bil,,70336,CPT,Facility,Both,,,,2142,1820.7,533.908,2142,"Preferred One Administrative Services, INC.",PPO,2112.012,98.6,,percent of total billed charges,,
Mri Temporomandibular Joint Bil,,70336,CPT,Facility,Outpatient,,,,2142,1820.7,533.908,2142,PrimeWest Health,Minnesota Senior Health Options (MSHO),1102.059,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Mri Temporomandibular Joint Bil,,70336,CPT,Facility,Inpatient,,,,2142,1820.7,533.908,2142,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mri Temporomandibular Joint Bil,,70336,CPT,Facility,Outpatient,,,,2142,1820.7,533.908,2142,PrimeWest Health,MinnesotaCare,1100.1312,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Mri Temporomandibular Joint Bil,,70336,CPT,Facility,Inpatient,,,,2142,1820.7,533.908,2142,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Mri Temporomandibular Joint Bil,,70336,CPT,Facility,Both,,,,2142,1820.7,533.908,2142,Sanford Health Plan,Sanford Health Plan,1970.64,92,,percent of total billed charges,,
Mri Temporomandibular Joint Bil,,70336,CPT,Facility,Outpatient,,,,2142,1820.7,533.908,2142,"UCare Health, Inc.",Individual & Family Plan,1207.017,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Mri Temporomandibular Joint Bil,,70336,CPT,Facility,Inpatient,,,,2142,1820.7,533.908,2142,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Mri Temporomandibular Joint Bil,,70336,CPT,Facility,Outpatient,,,,2142,1820.7,533.908,2142,"UCare Health, Inc.",Medical Assistance,1081.0674,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mri Temporomandibular Joint Bil,,70336,CPT,Facility,Inpatient,,,,2142,1820.7,533.908,2142,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Mri Temporomandibular Joint Bil,,70336,CPT,Facility,Outpatient,,,,2142,1820.7,533.908,2142,"UCare Health, Inc.",Medicare Advantage,1081.0674,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mri Temporomandibular Joint Bil,,70336,CPT,Facility,Inpatient,,,,2142,1820.7,533.908,2142,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mri Temporomandibular Joint Bil,,70336,CPT,Facility,Outpatient,,,,2142,1820.7,533.908,2142,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1081.0674,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mri Temporomandibular Joint Bil,,70336,CPT,Facility,Inpatient,,,,2142,1820.7,533.908,2142,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mri Temporomandibular Joint Bil,,70336,CPT,Facility,Both,,,,2142,1820.7,533.908,2142,UnitedHealthcare,Individual & Family,2013.48,94,,percent of total billed charges,,
Mri Temporomandibular Joint Bil,,70336,CPT,Facility,Outpatient,,,,2142,1820.7,533.908,2142,UnitedHealthcare,Medicare Advantage,1049.58,49,,percent of total billed charges,,
Mri Temporomandibular Joint Bil,,70336,CPT,Facility,Inpatient,,,,2142,1820.7,533.908,2142,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Mri Temporomandibular Joint Bil,,70336,CPT,Facility,Outpatient,,,,2142,1820.7,533.908,2142,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1028.16,48,,percent of total billed charges,,100% of DHS outpatient percentage
Mri Temporomandibular Joint Bil,,70336,CPT,Facility,Inpatient,,,,2142,1820.7,533.908,2142,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Xr Neck Soft Tissue,,70360,CPT,Facility,Both,,,,255,216.75,73.083,255,Aetna,Commercial,234.6,92,,percent of total billed charges,,
Xr Neck Soft Tissue,,70360,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,Aetna,Medicare Advantage,124.95,49,,percent of total billed charges,,
Xr Neck Soft Tissue,,70360,CPT,Facility,Inpatient,,,,255,216.75,73.083,255,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Xr Neck Soft Tissue,,70360,CPT,Facility,Both,,,,255,216.75,73.083,255,Aetna,PPO,237.15,93,,percent of total billed charges,,
Xr Neck Soft Tissue,,70360,CPT,Facility,Both,,,,255,216.75,73.083,255,America's PPO,America's PPO,244.8765,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Xr Neck Soft Tissue,,70360,CPT,Facility,Both,,,,255,216.75,73.083,255,BlueCross BlueShield Minnesota, Federal Employee Program,250.92,98.4,,percent of total billed charges,,
Xr Neck Soft Tissue,,70360,CPT,Facility,Both,,,,255,216.75,73.083,255,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,255,100,,percent of total billed charges,,
Xr Neck Soft Tissue,,70360,CPT,Facility,Both,,,,255,216.75,73.083,255,BlueCross BlueShield Minnesota,High Value Network Plan,229.5,90,,percent of total billed charges,,
Xr Neck Soft Tissue,,70360,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,BlueCross BlueShield Minnesota,Medicare Advantage,124.95,49,,percent of total billed charges,,
Xr Neck Soft Tissue,,70360,CPT,Facility,Inpatient,,,,255,216.75,73.083,255,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Xr Neck Soft Tissue,,70360,CPT,Facility,Both,,,,255,216.75,73.083,255,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,225.8535,88.57,,percent of total billed charges,,
Xr Neck Soft Tissue,,70360,CPT,Facility,Both,,,,255,216.75,73.083,255,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,73.083,28.66,,percent of total billed charges,,
Xr Neck Soft Tissue,,70360,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),124.95,49,,percent of total billed charges,,
Xr Neck Soft Tissue,,70360,CPT,Facility,Inpatient,,,,255,216.75,73.083,255,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Xr Neck Soft Tissue,,70360,CPT,Facility,Both,,,,255,216.75,73.083,255,CorVel,Worker's Compensation,255,100,,percent of total billed charges,,
Xr Neck Soft Tissue,,70360,CPT,Facility,Both,,,,255,216.75,73.083,255,First Health Group Corporation,First Health Network,247.35,97,,percent of total billed charges,,
Xr Neck Soft Tissue,,70360,CPT,Facility,Both,,,,255,216.75,73.083,255,"Health Partners, Inc.",Commercial,241.23,94.6,,percent of total billed charges,,
Xr Neck Soft Tissue,,70360,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,"Health Partners, Inc.",Medicare Advantage,124.95,49,,percent of total billed charges,,
Xr Neck Soft Tissue,,70360,CPT,Facility,Inpatient,,,,255,216.75,73.083,255,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Neck Soft Tissue,,70360,CPT,Facility,Both,,,,255,216.75,73.083,255,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),153,60,,percent of total billed charges,,
Xr Neck Soft Tissue,,70360,CPT,Facility,Both,,,,255,216.75,73.083,255,"Health Partners, Inc.",State of Minnesota Advantage Program,207.825,81.5,,percent of total billed charges,,
Xr Neck Soft Tissue,,70360,CPT,Facility,Both,,,,255,216.75,73.083,255,"Health Partners, Inc.",State Public Programs,127.5,50,,percent of total billed charges,,
Xr Neck Soft Tissue,,70360,CPT,Facility,Both,,,,255,216.75,73.083,255,Humana Insurance Company,Commercial PPO,242.25,95,,percent of total billed charges,,
Xr Neck Soft Tissue,,70360,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,Humana Insurance Company,Medicare PPO,124.95,49,,percent of total billed charges,,
Xr Neck Soft Tissue,,70360,CPT,Facility,Inpatient,,,,255,216.75,73.083,255,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Xr Neck Soft Tissue,,70360,CPT,Facility,Both,,,,255,216.75,73.083,255,Medica,Individual & Family,252.705,99.1,,percent of total billed charges,,
Xr Neck Soft Tissue,,70360,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,Medica,Medica Advantage Solution,126.99,49.8,,percent of total billed charges,,
Xr Neck Soft Tissue,,70360,CPT,Facility,Inpatient,,,,255,216.75,73.083,255,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Xr Neck Soft Tissue,,70360,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,Medica,Medical Assistance,113.73,44.6,,percent of total billed charges,,
Xr Neck Soft Tissue,,70360,CPT,Facility,Inpatient,,,,255,216.75,73.083,255,Medica,Medical Assistance,,,,,Included in per diem rate,
Xr Neck Soft Tissue,,70360,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,126.99,49.8,,percent of total billed charges,,
Xr Neck Soft Tissue,,70360,CPT,Facility,Inpatient,,,,255,216.75,73.083,255,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Xr Neck Soft Tissue,,70360,CPT,Facility,Both,,,,255,216.75,73.083,255,"Multiplan, Inc.","Multiplan, Inc.",239.7,94,,percent of total billed charges,,
Xr Neck Soft Tissue,,70360,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,229.755,90.1,,percent of total billed charges,,
Xr Neck Soft Tissue,,70360,CPT,Facility,Inpatient,,,,255,216.75,73.083,255,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Xr Neck Soft Tissue,,70360,CPT,Facility,Both,,,,255,216.75,73.083,255,"Preferred One Administrative Services, INC.",PPO,251.43,98.6,,percent of total billed charges,,
Xr Neck Soft Tissue,,70360,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,PrimeWest Health,Minnesota Senior Health Options (MSHO),131.1975,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Xr Neck Soft Tissue,,70360,CPT,Facility,Inpatient,,,,255,216.75,73.083,255,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Neck Soft Tissue,,70360,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,PrimeWest Health,MinnesotaCare,130.968,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Xr Neck Soft Tissue,,70360,CPT,Facility,Inpatient,,,,255,216.75,73.083,255,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Xr Neck Soft Tissue,,70360,CPT,Facility,Both,,,,255,216.75,73.083,255,Sanford Health Plan,Sanford Health Plan,234.6,92,,percent of total billed charges,,
Xr Neck Soft Tissue,,70360,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,"UCare Health, Inc.",Individual & Family Plan,143.6925,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Xr Neck Soft Tissue,,70360,CPT,Facility,Inpatient,,,,255,216.75,73.083,255,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Xr Neck Soft Tissue,,70360,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,"UCare Health, Inc.",Medical Assistance,128.6985,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Neck Soft Tissue,,70360,CPT,Facility,Inpatient,,,,255,216.75,73.083,255,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Xr Neck Soft Tissue,,70360,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,"UCare Health, Inc.",Medicare Advantage,128.6985,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Neck Soft Tissue,,70360,CPT,Facility,Inpatient,,,,255,216.75,73.083,255,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Neck Soft Tissue,,70360,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),128.6985,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Neck Soft Tissue,,70360,CPT,Facility,Inpatient,,,,255,216.75,73.083,255,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Neck Soft Tissue,,70360,CPT,Facility,Both,,,,255,216.75,73.083,255,UnitedHealthcare,Individual & Family,239.7,94,,percent of total billed charges,,
Xr Neck Soft Tissue,,70360,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,UnitedHealthcare,Medicare Advantage,124.95,49,,percent of total billed charges,,
Xr Neck Soft Tissue,,70360,CPT,Facility,Inpatient,,,,255,216.75,73.083,255,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Xr Neck Soft Tissue,,70360,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,122.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
Xr Neck Soft Tissue,,70360,CPT,Facility,Inpatient,,,,255,216.75,73.083,255,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Ct Head Routine Wo Iv Contrast,,70450,CPT,Facility,Both,,,,1479,1257.15,434.34,1479,Aetna,Commercial,1360.68,92,,percent of total billed charges,,
Ct Head Routine Wo Iv Contrast,,70450,CPT,Facility,Outpatient,,,,1479,1257.15,434.34,1479,Aetna,Medicare Advantage,724.71,49,,percent of total billed charges,,
Ct Head Routine Wo Iv Contrast,,70450,CPT,Facility,Inpatient,,,,1479,1257.15,434.34,1479,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Ct Head Routine Wo Iv Contrast,,70450,CPT,Facility,Both,,,,1479,1257.15,434.34,1479,Aetna,PPO,1375.47,93,,percent of total billed charges,,
Ct Head Routine Wo Iv Contrast,,70450,CPT,Facility,Both,,,,1479,1257.15,434.34,1479,America's PPO,America's PPO,1420.2837,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Ct Head Routine Wo Iv Contrast,,70450,CPT,Facility,Both,,,,1479,1257.15,434.34,1479,BlueCross BlueShield Minnesota, Federal Employee Program,855,,,Fee schedule,,100% of BCBS commercial commodity fee schedule
Ct Head Routine Wo Iv Contrast,,70450,CPT,Facility,Both,,,,1479,1257.15,434.34,1479,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,868.68,,,Fee schedule,,"100% of BCBS commercial commodity fee schedule, plus MN Care tax"
Ct Head Routine Wo Iv Contrast,,70450,CPT,Facility,Both,,,,1479,1257.15,434.34,1479,BlueCross BlueShield Minnesota,High Value Network Plan,781.812,,,Fee schedule,,"90% of BCBS commercial commodity fee schedule, plus MN Care tax; see disclaimer for more information"
Ct Head Routine Wo Iv Contrast,,70450,CPT,Facility,Outpatient,,,,1479,1257.15,434.34,1479,BlueCross BlueShield Minnesota,Medicare Advantage,724.71,49,,percent of total billed charges,,
Ct Head Routine Wo Iv Contrast,,70450,CPT,Facility,Inpatient,,,,1479,1257.15,434.34,1479,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Ct Head Routine Wo Iv Contrast,,70450,CPT,Facility,Both,,,,1479,1257.15,434.34,1479,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,769.389876,,,Fee schedule,,"88.57% of BCBS commercial commodity fee schedule, plus MN Care tax"
Ct Head Routine Wo Iv Contrast,,70450,CPT,Facility,Both,,,,1479,1257.15,434.34,1479,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,434.34,,,Fee schedule,,"100% of BCBS Medicaid commodity fee schedule, plus MN Care tax"
Ct Head Routine Wo Iv Contrast,,70450,CPT,Facility,Outpatient,,,,1479,1257.15,434.34,1479,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),724.71,49,,percent of total billed charges,,
Ct Head Routine Wo Iv Contrast,,70450,CPT,Facility,Inpatient,,,,1479,1257.15,434.34,1479,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Ct Head Routine Wo Iv Contrast,,70450,CPT,Facility,Both,,,,1479,1257.15,434.34,1479,CorVel,Worker's Compensation,1479,100,,percent of total billed charges,,
Ct Head Routine Wo Iv Contrast,,70450,CPT,Facility,Both,,,,1479,1257.15,434.34,1479,First Health Group Corporation,First Health Network,1434.63,97,,percent of total billed charges,,
Ct Head Routine Wo Iv Contrast,,70450,CPT,Facility,Both,,,,1479,1257.15,434.34,1479,"Health Partners, Inc.",Commercial,1399.134,94.6,,percent of total billed charges,,
Ct Head Routine Wo Iv Contrast,,70450,CPT,Facility,Outpatient,,,,1479,1257.15,434.34,1479,"Health Partners, Inc.",Medicare Advantage,724.71,49,,percent of total billed charges,,
Ct Head Routine Wo Iv Contrast,,70450,CPT,Facility,Inpatient,,,,1479,1257.15,434.34,1479,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ct Head Routine Wo Iv Contrast,,70450,CPT,Facility,Both,,,,1479,1257.15,434.34,1479,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),887.4,60,,percent of total billed charges,,
Ct Head Routine Wo Iv Contrast,,70450,CPT,Facility,Both,,,,1479,1257.15,434.34,1479,"Health Partners, Inc.",State of Minnesota Advantage Program,1205.385,81.5,,percent of total billed charges,,
Ct Head Routine Wo Iv Contrast,,70450,CPT,Facility,Both,,,,1479,1257.15,434.34,1479,"Health Partners, Inc.",State Public Programs,739.5,50,,percent of total billed charges,,
Ct Head Routine Wo Iv Contrast,,70450,CPT,Facility,Both,,,,1479,1257.15,434.34,1479,Humana Insurance Company,Commercial PPO,1405.05,95,,percent of total billed charges,,
Ct Head Routine Wo Iv Contrast,,70450,CPT,Facility,Outpatient,,,,1479,1257.15,434.34,1479,Humana Insurance Company,Medicare PPO,724.71,49,,percent of total billed charges,,
Ct Head Routine Wo Iv Contrast,,70450,CPT,Facility,Inpatient,,,,1479,1257.15,434.34,1479,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Ct Head Routine Wo Iv Contrast,,70450,CPT,Facility,Both,,,,1479,1257.15,434.34,1479,Medica,Individual & Family,1465.689,99.1,,percent of total billed charges,,
Ct Head Routine Wo Iv Contrast,,70450,CPT,Facility,Outpatient,,,,1479,1257.15,434.34,1479,Medica,Medica Advantage Solution,736.542,49.8,,percent of total billed charges,,
Ct Head Routine Wo Iv Contrast,,70450,CPT,Facility,Inpatient,,,,1479,1257.15,434.34,1479,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Ct Head Routine Wo Iv Contrast,,70450,CPT,Facility,Outpatient,,,,1479,1257.15,434.34,1479,Medica,Medical Assistance,659.634,44.6,,percent of total billed charges,,
Ct Head Routine Wo Iv Contrast,,70450,CPT,Facility,Inpatient,,,,1479,1257.15,434.34,1479,Medica,Medical Assistance,,,,,Included in per diem rate,
Ct Head Routine Wo Iv Contrast,,70450,CPT,Facility,Outpatient,,,,1479,1257.15,434.34,1479,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,736.542,49.8,,percent of total billed charges,,
Ct Head Routine Wo Iv Contrast,,70450,CPT,Facility,Inpatient,,,,1479,1257.15,434.34,1479,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Ct Head Routine Wo Iv Contrast,,70450,CPT,Facility,Both,,,,1479,1257.15,434.34,1479,"Multiplan, Inc.","Multiplan, Inc.",1390.26,94,,percent of total billed charges,,
Ct Head Routine Wo Iv Contrast,,70450,CPT,Facility,Outpatient,,,,1479,1257.15,434.34,1479,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1283,,,Other,Per scan,
Ct Head Routine Wo Iv Contrast,,70450,CPT,Facility,Inpatient,,,,1479,1257.15,434.34,1479,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Ct Head Routine Wo Iv Contrast,,70450,CPT,Facility,Both,,,,1479,1257.15,434.34,1479,"Preferred One Administrative Services, INC.",PPO,1458.294,98.6,,percent of total billed charges,,
Ct Head Routine Wo Iv Contrast,,70450,CPT,Facility,Outpatient,,,,1479,1257.15,434.34,1479,PrimeWest Health,Minnesota Senior Health Options (MSHO),760.9455,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Ct Head Routine Wo Iv Contrast,,70450,CPT,Facility,Inpatient,,,,1479,1257.15,434.34,1479,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ct Head Routine Wo Iv Contrast,,70450,CPT,Facility,Outpatient,,,,1479,1257.15,434.34,1479,PrimeWest Health,MinnesotaCare,759.6144,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Ct Head Routine Wo Iv Contrast,,70450,CPT,Facility,Inpatient,,,,1479,1257.15,434.34,1479,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Ct Head Routine Wo Iv Contrast,,70450,CPT,Facility,Both,,,,1479,1257.15,434.34,1479,Sanford Health Plan,Sanford Health Plan,1360.68,92,,percent of total billed charges,,
Ct Head Routine Wo Iv Contrast,,70450,CPT,Facility,Outpatient,,,,1479,1257.15,434.34,1479,"UCare Health, Inc.",Individual & Family Plan,833.4165,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Ct Head Routine Wo Iv Contrast,,70450,CPT,Facility,Inpatient,,,,1479,1257.15,434.34,1479,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Ct Head Routine Wo Iv Contrast,,70450,CPT,Facility,Outpatient,,,,1479,1257.15,434.34,1479,"UCare Health, Inc.",Medical Assistance,746.4513,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ct Head Routine Wo Iv Contrast,,70450,CPT,Facility,Inpatient,,,,1479,1257.15,434.34,1479,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Ct Head Routine Wo Iv Contrast,,70450,CPT,Facility,Outpatient,,,,1479,1257.15,434.34,1479,"UCare Health, Inc.",Medicare Advantage,746.4513,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ct Head Routine Wo Iv Contrast,,70450,CPT,Facility,Inpatient,,,,1479,1257.15,434.34,1479,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ct Head Routine Wo Iv Contrast,,70450,CPT,Facility,Outpatient,,,,1479,1257.15,434.34,1479,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),746.4513,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ct Head Routine Wo Iv Contrast,,70450,CPT,Facility,Inpatient,,,,1479,1257.15,434.34,1479,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ct Head Routine Wo Iv Contrast,,70450,CPT,Facility,Both,,,,1479,1257.15,434.34,1479,UnitedHealthcare,Individual & Family,1390.26,94,,percent of total billed charges,,
Ct Head Routine Wo Iv Contrast,,70450,CPT,Facility,Outpatient,,,,1479,1257.15,434.34,1479,UnitedHealthcare,Medicare Advantage,724.71,49,,percent of total billed charges,,
Ct Head Routine Wo Iv Contrast,,70450,CPT,Facility,Inpatient,,,,1479,1257.15,434.34,1479,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Ct Head Routine Wo Iv Contrast,,70450,CPT,Facility,Outpatient,,,,1479,1257.15,434.34,1479,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,709.92,48,,percent of total billed charges,,100% of DHS outpatient percentage
Ct Head Routine Wo Iv Contrast,,70450,CPT,Facility,Inpatient,,,,1479,1257.15,434.34,1479,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Ct Head W Iv Contrast,,70460,CPT,Facility,Both,,,,1632,1387.2,412.496,1632,Aetna,Commercial,1501.44,92,,percent of total billed charges,,
Ct Head W Iv Contrast,,70460,CPT,Facility,Outpatient,,,,1632,1387.2,412.496,1632,Aetna,Medicare Advantage,799.68,49,,percent of total billed charges,,
Ct Head W Iv Contrast,,70460,CPT,Facility,Inpatient,,,,1632,1387.2,412.496,1632,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Ct Head W Iv Contrast,,70460,CPT,Facility,Both,,,,1632,1387.2,412.496,1632,Aetna,PPO,1517.76,93,,percent of total billed charges,,
Ct Head W Iv Contrast,,70460,CPT,Facility,Both,,,,1632,1387.2,412.496,1632,America's PPO,America's PPO,1567.2096,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Ct Head W Iv Contrast,,70460,CPT,Facility,Both,,,,1632,1387.2,412.496,1632,BlueCross BlueShield Minnesota, Federal Employee Program,812,,,Fee schedule,,100% of BCBS commercial commodity fee schedule
Ct Head W Iv Contrast,,70460,CPT,Facility,Both,,,,1632,1387.2,412.496,1632,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,824.992,,,Fee schedule,,"100% of BCBS commercial commodity fee schedule, plus MN Care tax"
Ct Head W Iv Contrast,,70460,CPT,Facility,Both,,,,1632,1387.2,412.496,1632,BlueCross BlueShield Minnesota,High Value Network Plan,742.4928,,,Fee schedule,,"90% of BCBS commercial commodity fee schedule, plus MN Care tax; see disclaimer for more information"
Ct Head W Iv Contrast,,70460,CPT,Facility,Outpatient,,,,1632,1387.2,412.496,1632,BlueCross BlueShield Minnesota,Medicare Advantage,799.68,49,,percent of total billed charges,,
Ct Head W Iv Contrast,,70460,CPT,Facility,Inpatient,,,,1632,1387.2,412.496,1632,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Ct Head W Iv Contrast,,70460,CPT,Facility,Both,,,,1632,1387.2,412.496,1632,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,730.6954144,,,Fee schedule,,"88.57% of BCBS commercial commodity fee schedule, plus MN Care tax"
Ct Head W Iv Contrast,,70460,CPT,Facility,Both,,,,1632,1387.2,412.496,1632,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,412.496,,,Fee schedule,,"100% of BCBS Medicaid commodity fee schedule, plus MN Care tax"
Ct Head W Iv Contrast,,70460,CPT,Facility,Outpatient,,,,1632,1387.2,412.496,1632,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),799.68,49,,percent of total billed charges,,
Ct Head W Iv Contrast,,70460,CPT,Facility,Inpatient,,,,1632,1387.2,412.496,1632,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Ct Head W Iv Contrast,,70460,CPT,Facility,Both,,,,1632,1387.2,412.496,1632,CorVel,Worker's Compensation,1632,100,,percent of total billed charges,,
Ct Head W Iv Contrast,,70460,CPT,Facility,Both,,,,1632,1387.2,412.496,1632,First Health Group Corporation,First Health Network,1583.04,97,,percent of total billed charges,,
Ct Head W Iv Contrast,,70460,CPT,Facility,Both,,,,1632,1387.2,412.496,1632,"Health Partners, Inc.",Commercial,1543.872,94.6,,percent of total billed charges,,
Ct Head W Iv Contrast,,70460,CPT,Facility,Outpatient,,,,1632,1387.2,412.496,1632,"Health Partners, Inc.",Medicare Advantage,799.68,49,,percent of total billed charges,,
Ct Head W Iv Contrast,,70460,CPT,Facility,Inpatient,,,,1632,1387.2,412.496,1632,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ct Head W Iv Contrast,,70460,CPT,Facility,Both,,,,1632,1387.2,412.496,1632,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),979.2,60,,percent of total billed charges,,
Ct Head W Iv Contrast,,70460,CPT,Facility,Both,,,,1632,1387.2,412.496,1632,"Health Partners, Inc.",State of Minnesota Advantage Program,1330.08,81.5,,percent of total billed charges,,
Ct Head W Iv Contrast,,70460,CPT,Facility,Both,,,,1632,1387.2,412.496,1632,"Health Partners, Inc.",State Public Programs,816,50,,percent of total billed charges,,
Ct Head W Iv Contrast,,70460,CPT,Facility,Both,,,,1632,1387.2,412.496,1632,Humana Insurance Company,Commercial PPO,1550.4,95,,percent of total billed charges,,
Ct Head W Iv Contrast,,70460,CPT,Facility,Outpatient,,,,1632,1387.2,412.496,1632,Humana Insurance Company,Medicare PPO,799.68,49,,percent of total billed charges,,
Ct Head W Iv Contrast,,70460,CPT,Facility,Inpatient,,,,1632,1387.2,412.496,1632,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Ct Head W Iv Contrast,,70460,CPT,Facility,Both,,,,1632,1387.2,412.496,1632,Medica,Individual & Family,1617.312,99.1,,percent of total billed charges,,
Ct Head W Iv Contrast,,70460,CPT,Facility,Outpatient,,,,1632,1387.2,412.496,1632,Medica,Medica Advantage Solution,812.736,49.8,,percent of total billed charges,,
Ct Head W Iv Contrast,,70460,CPT,Facility,Inpatient,,,,1632,1387.2,412.496,1632,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Ct Head W Iv Contrast,,70460,CPT,Facility,Outpatient,,,,1632,1387.2,412.496,1632,Medica,Medical Assistance,727.872,44.6,,percent of total billed charges,,
Ct Head W Iv Contrast,,70460,CPT,Facility,Inpatient,,,,1632,1387.2,412.496,1632,Medica,Medical Assistance,,,,,Included in per diem rate,
Ct Head W Iv Contrast,,70460,CPT,Facility,Outpatient,,,,1632,1387.2,412.496,1632,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,812.736,49.8,,percent of total billed charges,,
Ct Head W Iv Contrast,,70460,CPT,Facility,Inpatient,,,,1632,1387.2,412.496,1632,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Ct Head W Iv Contrast,,70460,CPT,Facility,Both,,,,1632,1387.2,412.496,1632,"Multiplan, Inc.","Multiplan, Inc.",1534.08,94,,percent of total billed charges,,
Ct Head W Iv Contrast,,70460,CPT,Facility,Outpatient,,,,1632,1387.2,412.496,1632,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1283,,,Other,Per scan,
Ct Head W Iv Contrast,,70460,CPT,Facility,Inpatient,,,,1632,1387.2,412.496,1632,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Ct Head W Iv Contrast,,70460,CPT,Facility,Both,,,,1632,1387.2,412.496,1632,"Preferred One Administrative Services, INC.",PPO,1609.152,98.6,,percent of total billed charges,,
Ct Head W Iv Contrast,,70460,CPT,Facility,Outpatient,,,,1632,1387.2,412.496,1632,PrimeWest Health,Minnesota Senior Health Options (MSHO),839.664,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Ct Head W Iv Contrast,,70460,CPT,Facility,Inpatient,,,,1632,1387.2,412.496,1632,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ct Head W Iv Contrast,,70460,CPT,Facility,Outpatient,,,,1632,1387.2,412.496,1632,PrimeWest Health,MinnesotaCare,838.1952,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Ct Head W Iv Contrast,,70460,CPT,Facility,Inpatient,,,,1632,1387.2,412.496,1632,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Ct Head W Iv Contrast,,70460,CPT,Facility,Both,,,,1632,1387.2,412.496,1632,Sanford Health Plan,Sanford Health Plan,1501.44,92,,percent of total billed charges,,
Ct Head W Iv Contrast,,70460,CPT,Facility,Outpatient,,,,1632,1387.2,412.496,1632,"UCare Health, Inc.",Individual & Family Plan,919.632,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Ct Head W Iv Contrast,,70460,CPT,Facility,Inpatient,,,,1632,1387.2,412.496,1632,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Ct Head W Iv Contrast,,70460,CPT,Facility,Outpatient,,,,1632,1387.2,412.496,1632,"UCare Health, Inc.",Medical Assistance,823.6704,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ct Head W Iv Contrast,,70460,CPT,Facility,Inpatient,,,,1632,1387.2,412.496,1632,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Ct Head W Iv Contrast,,70460,CPT,Facility,Outpatient,,,,1632,1387.2,412.496,1632,"UCare Health, Inc.",Medicare Advantage,823.6704,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ct Head W Iv Contrast,,70460,CPT,Facility,Inpatient,,,,1632,1387.2,412.496,1632,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ct Head W Iv Contrast,,70460,CPT,Facility,Outpatient,,,,1632,1387.2,412.496,1632,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),823.6704,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ct Head W Iv Contrast,,70460,CPT,Facility,Inpatient,,,,1632,1387.2,412.496,1632,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ct Head W Iv Contrast,,70460,CPT,Facility,Both,,,,1632,1387.2,412.496,1632,UnitedHealthcare,Individual & Family,1534.08,94,,percent of total billed charges,,
Ct Head W Iv Contrast,,70460,CPT,Facility,Outpatient,,,,1632,1387.2,412.496,1632,UnitedHealthcare,Medicare Advantage,799.68,49,,percent of total billed charges,,
Ct Head W Iv Contrast,,70460,CPT,Facility,Inpatient,,,,1632,1387.2,412.496,1632,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Ct Head W Iv Contrast,,70460,CPT,Facility,Outpatient,,,,1632,1387.2,412.496,1632,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,783.36,48,,percent of total billed charges,,100% of DHS outpatient percentage
Ct Head W Iv Contrast,,70460,CPT,Facility,Inpatient,,,,1632,1387.2,412.496,1632,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Ct Head Wo W Iv Contrast,,70470,CPT,Facility,Both,,,,1836,1560.6,412.496,1836,Aetna,Commercial,1689.12,92,,percent of total billed charges,,
Ct Head Wo W Iv Contrast,,70470,CPT,Facility,Outpatient,,,,1836,1560.6,412.496,1836,Aetna,Medicare Advantage,899.64,49,,percent of total billed charges,,
Ct Head Wo W Iv Contrast,,70470,CPT,Facility,Inpatient,,,,1836,1560.6,412.496,1836,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Ct Head Wo W Iv Contrast,,70470,CPT,Facility,Both,,,,1836,1560.6,412.496,1836,Aetna,PPO,1707.48,93,,percent of total billed charges,,
Ct Head Wo W Iv Contrast,,70470,CPT,Facility,Both,,,,1836,1560.6,412.496,1836,America's PPO,America's PPO,1763.1108,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Ct Head Wo W Iv Contrast,,70470,CPT,Facility,Both,,,,1836,1560.6,412.496,1836,BlueCross BlueShield Minnesota, Federal Employee Program,812,,,Fee schedule,,100% of BCBS commercial commodity fee schedule
Ct Head Wo W Iv Contrast,,70470,CPT,Facility,Both,,,,1836,1560.6,412.496,1836,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,824.992,,,Fee schedule,,"100% of BCBS commercial commodity fee schedule, plus MN Care tax"
Ct Head Wo W Iv Contrast,,70470,CPT,Facility,Both,,,,1836,1560.6,412.496,1836,BlueCross BlueShield Minnesota,High Value Network Plan,742.4928,,,Fee schedule,,"90% of BCBS commercial commodity fee schedule, plus MN Care tax; see disclaimer for more information"
Ct Head Wo W Iv Contrast,,70470,CPT,Facility,Outpatient,,,,1836,1560.6,412.496,1836,BlueCross BlueShield Minnesota,Medicare Advantage,899.64,49,,percent of total billed charges,,
Ct Head Wo W Iv Contrast,,70470,CPT,Facility,Inpatient,,,,1836,1560.6,412.496,1836,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Ct Head Wo W Iv Contrast,,70470,CPT,Facility,Both,,,,1836,1560.6,412.496,1836,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,730.6954144,,,Fee schedule,,"88.57% of BCBS commercial commodity fee schedule, plus MN Care tax"
Ct Head Wo W Iv Contrast,,70470,CPT,Facility,Both,,,,1836,1560.6,412.496,1836,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,412.496,,,Fee schedule,,"100% of BCBS Medicaid commodity fee schedule, plus MN Care tax"
Ct Head Wo W Iv Contrast,,70470,CPT,Facility,Outpatient,,,,1836,1560.6,412.496,1836,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),899.64,49,,percent of total billed charges,,
Ct Head Wo W Iv Contrast,,70470,CPT,Facility,Inpatient,,,,1836,1560.6,412.496,1836,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Ct Head Wo W Iv Contrast,,70470,CPT,Facility,Both,,,,1836,1560.6,412.496,1836,CorVel,Worker's Compensation,1836,100,,percent of total billed charges,,
Ct Head Wo W Iv Contrast,,70470,CPT,Facility,Both,,,,1836,1560.6,412.496,1836,First Health Group Corporation,First Health Network,1780.92,97,,percent of total billed charges,,
Ct Head Wo W Iv Contrast,,70470,CPT,Facility,Both,,,,1836,1560.6,412.496,1836,"Health Partners, Inc.",Commercial,1736.856,94.6,,percent of total billed charges,,
Ct Head Wo W Iv Contrast,,70470,CPT,Facility,Outpatient,,,,1836,1560.6,412.496,1836,"Health Partners, Inc.",Medicare Advantage,899.64,49,,percent of total billed charges,,
Ct Head Wo W Iv Contrast,,70470,CPT,Facility,Inpatient,,,,1836,1560.6,412.496,1836,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ct Head Wo W Iv Contrast,,70470,CPT,Facility,Both,,,,1836,1560.6,412.496,1836,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1101.6,60,,percent of total billed charges,,
Ct Head Wo W Iv Contrast,,70470,CPT,Facility,Both,,,,1836,1560.6,412.496,1836,"Health Partners, Inc.",State of Minnesota Advantage Program,1496.34,81.5,,percent of total billed charges,,
Ct Head Wo W Iv Contrast,,70470,CPT,Facility,Both,,,,1836,1560.6,412.496,1836,"Health Partners, Inc.",State Public Programs,918,50,,percent of total billed charges,,
Ct Head Wo W Iv Contrast,,70470,CPT,Facility,Both,,,,1836,1560.6,412.496,1836,Humana Insurance Company,Commercial PPO,1744.2,95,,percent of total billed charges,,
Ct Head Wo W Iv Contrast,,70470,CPT,Facility,Outpatient,,,,1836,1560.6,412.496,1836,Humana Insurance Company,Medicare PPO,899.64,49,,percent of total billed charges,,
Ct Head Wo W Iv Contrast,,70470,CPT,Facility,Inpatient,,,,1836,1560.6,412.496,1836,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Ct Head Wo W Iv Contrast,,70470,CPT,Facility,Both,,,,1836,1560.6,412.496,1836,Medica,Individual & Family,1819.476,99.1,,percent of total billed charges,,
Ct Head Wo W Iv Contrast,,70470,CPT,Facility,Outpatient,,,,1836,1560.6,412.496,1836,Medica,Medica Advantage Solution,914.328,49.8,,percent of total billed charges,,
Ct Head Wo W Iv Contrast,,70470,CPT,Facility,Inpatient,,,,1836,1560.6,412.496,1836,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Ct Head Wo W Iv Contrast,,70470,CPT,Facility,Outpatient,,,,1836,1560.6,412.496,1836,Medica,Medical Assistance,818.856,44.6,,percent of total billed charges,,
Ct Head Wo W Iv Contrast,,70470,CPT,Facility,Inpatient,,,,1836,1560.6,412.496,1836,Medica,Medical Assistance,,,,,Included in per diem rate,
Ct Head Wo W Iv Contrast,,70470,CPT,Facility,Outpatient,,,,1836,1560.6,412.496,1836,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,914.328,49.8,,percent of total billed charges,,
Ct Head Wo W Iv Contrast,,70470,CPT,Facility,Inpatient,,,,1836,1560.6,412.496,1836,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Ct Head Wo W Iv Contrast,,70470,CPT,Facility,Both,,,,1836,1560.6,412.496,1836,"Multiplan, Inc.","Multiplan, Inc.",1725.84,94,,percent of total billed charges,,
Ct Head Wo W Iv Contrast,,70470,CPT,Facility,Outpatient,,,,1836,1560.6,412.496,1836,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1283,,,Other,Per scan,
Ct Head Wo W Iv Contrast,,70470,CPT,Facility,Inpatient,,,,1836,1560.6,412.496,1836,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Ct Head Wo W Iv Contrast,,70470,CPT,Facility,Both,,,,1836,1560.6,412.496,1836,"Preferred One Administrative Services, INC.",PPO,1810.296,98.6,,percent of total billed charges,,
Ct Head Wo W Iv Contrast,,70470,CPT,Facility,Outpatient,,,,1836,1560.6,412.496,1836,PrimeWest Health,Minnesota Senior Health Options (MSHO),944.622,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Ct Head Wo W Iv Contrast,,70470,CPT,Facility,Inpatient,,,,1836,1560.6,412.496,1836,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ct Head Wo W Iv Contrast,,70470,CPT,Facility,Outpatient,,,,1836,1560.6,412.496,1836,PrimeWest Health,MinnesotaCare,942.9696,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Ct Head Wo W Iv Contrast,,70470,CPT,Facility,Inpatient,,,,1836,1560.6,412.496,1836,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Ct Head Wo W Iv Contrast,,70470,CPT,Facility,Both,,,,1836,1560.6,412.496,1836,Sanford Health Plan,Sanford Health Plan,1689.12,92,,percent of total billed charges,,
Ct Head Wo W Iv Contrast,,70470,CPT,Facility,Outpatient,,,,1836,1560.6,412.496,1836,"UCare Health, Inc.",Individual & Family Plan,1034.586,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Ct Head Wo W Iv Contrast,,70470,CPT,Facility,Inpatient,,,,1836,1560.6,412.496,1836,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Ct Head Wo W Iv Contrast,,70470,CPT,Facility,Outpatient,,,,1836,1560.6,412.496,1836,"UCare Health, Inc.",Medical Assistance,926.6292,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ct Head Wo W Iv Contrast,,70470,CPT,Facility,Inpatient,,,,1836,1560.6,412.496,1836,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Ct Head Wo W Iv Contrast,,70470,CPT,Facility,Outpatient,,,,1836,1560.6,412.496,1836,"UCare Health, Inc.",Medicare Advantage,926.6292,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ct Head Wo W Iv Contrast,,70470,CPT,Facility,Inpatient,,,,1836,1560.6,412.496,1836,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ct Head Wo W Iv Contrast,,70470,CPT,Facility,Outpatient,,,,1836,1560.6,412.496,1836,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),926.6292,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ct Head Wo W Iv Contrast,,70470,CPT,Facility,Inpatient,,,,1836,1560.6,412.496,1836,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ct Head Wo W Iv Contrast,,70470,CPT,Facility,Both,,,,1836,1560.6,412.496,1836,UnitedHealthcare,Individual & Family,1725.84,94,,percent of total billed charges,,
Ct Head Wo W Iv Contrast,,70470,CPT,Facility,Outpatient,,,,1836,1560.6,412.496,1836,UnitedHealthcare,Medicare Advantage,899.64,49,,percent of total billed charges,,
Ct Head Wo W Iv Contrast,,70470,CPT,Facility,Inpatient,,,,1836,1560.6,412.496,1836,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Ct Head Wo W Iv Contrast,,70470,CPT,Facility,Outpatient,,,,1836,1560.6,412.496,1836,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,881.28,48,,percent of total billed charges,,100% of DHS outpatient percentage
Ct Head Wo W Iv Contrast,,70470,CPT,Facility,Inpatient,,,,1836,1560.6,412.496,1836,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Ct Orbits Sella Iac Without Iv Contrast,,70480,CPT,Facility,Both,,,,1281,1088.85,325.628,1283,Aetna,Commercial,1178.52,92,,percent of total billed charges,,
Ct Orbits Sella Iac Without Iv Contrast,,70480,CPT,Facility,Outpatient,,,,1281,1088.85,325.628,1283,Aetna,Medicare Advantage,627.69,49,,percent of total billed charges,,
Ct Orbits Sella Iac Without Iv Contrast,,70480,CPT,Facility,Inpatient,,,,1281,1088.85,325.628,1283,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Ct Orbits Sella Iac Without Iv Contrast,,70480,CPT,Facility,Both,,,,1281,1088.85,325.628,1283,Aetna,PPO,1191.33,93,,percent of total billed charges,,
Ct Orbits Sella Iac Without Iv Contrast,,70480,CPT,Facility,Both,,,,1281,1088.85,325.628,1283,America's PPO,America's PPO,1230.1443,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Ct Orbits Sella Iac Without Iv Contrast,,70480,CPT,Facility,Both,,,,1281,1088.85,325.628,1283,BlueCross BlueShield Minnesota, Federal Employee Program,641,,,Fee schedule,,100% of BCBS commercial commodity fee schedule
Ct Orbits Sella Iac Without Iv Contrast,,70480,CPT,Facility,Both,,,,1281,1088.85,325.628,1283,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,651.256,,,Fee schedule,,"100% of BCBS commercial commodity fee schedule, plus MN Care tax"
Ct Orbits Sella Iac Without Iv Contrast,,70480,CPT,Facility,Both,,,,1281,1088.85,325.628,1283,BlueCross BlueShield Minnesota,High Value Network Plan,586.1304,,,Fee schedule,,"90% of BCBS commercial commodity fee schedule, plus MN Care tax; see disclaimer for more information"
Ct Orbits Sella Iac Without Iv Contrast,,70480,CPT,Facility,Outpatient,,,,1281,1088.85,325.628,1283,BlueCross BlueShield Minnesota,Medicare Advantage,627.69,49,,percent of total billed charges,,
Ct Orbits Sella Iac Without Iv Contrast,,70480,CPT,Facility,Inpatient,,,,1281,1088.85,325.628,1283,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Ct Orbits Sella Iac Without Iv Contrast,,70480,CPT,Facility,Both,,,,1281,1088.85,325.628,1283,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,576.8174392,,,Fee schedule,,"88.57% of BCBS commercial commodity fee schedule, plus MN Care tax"
Ct Orbits Sella Iac Without Iv Contrast,,70480,CPT,Facility,Both,,,,1281,1088.85,325.628,1283,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,325.628,,,Fee schedule,,"100% of BCBS Medicaid commodity fee schedule, plus MN Care tax"
Ct Orbits Sella Iac Without Iv Contrast,,70480,CPT,Facility,Outpatient,,,,1281,1088.85,325.628,1283,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),627.69,49,,percent of total billed charges,,
Ct Orbits Sella Iac Without Iv Contrast,,70480,CPT,Facility,Inpatient,,,,1281,1088.85,325.628,1283,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Ct Orbits Sella Iac Without Iv Contrast,,70480,CPT,Facility,Both,,,,1281,1088.85,325.628,1283,CorVel,Worker's Compensation,1281,100,,percent of total billed charges,,
Ct Orbits Sella Iac Without Iv Contrast,,70480,CPT,Facility,Both,,,,1281,1088.85,325.628,1283,First Health Group Corporation,First Health Network,1242.57,97,,percent of total billed charges,,
Ct Orbits Sella Iac Without Iv Contrast,,70480,CPT,Facility,Both,,,,1281,1088.85,325.628,1283,"Health Partners, Inc.",Commercial,1211.826,94.6,,percent of total billed charges,,
Ct Orbits Sella Iac Without Iv Contrast,,70480,CPT,Facility,Outpatient,,,,1281,1088.85,325.628,1283,"Health Partners, Inc.",Medicare Advantage,627.69,49,,percent of total billed charges,,
Ct Orbits Sella Iac Without Iv Contrast,,70480,CPT,Facility,Inpatient,,,,1281,1088.85,325.628,1283,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ct Orbits Sella Iac Without Iv Contrast,,70480,CPT,Facility,Both,,,,1281,1088.85,325.628,1283,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),768.6,60,,percent of total billed charges,,
Ct Orbits Sella Iac Without Iv Contrast,,70480,CPT,Facility,Both,,,,1281,1088.85,325.628,1283,"Health Partners, Inc.",State of Minnesota Advantage Program,1044.015,81.5,,percent of total billed charges,,
Ct Orbits Sella Iac Without Iv Contrast,,70480,CPT,Facility,Both,,,,1281,1088.85,325.628,1283,"Health Partners, Inc.",State Public Programs,640.5,50,,percent of total billed charges,,
Ct Orbits Sella Iac Without Iv Contrast,,70480,CPT,Facility,Both,,,,1281,1088.85,325.628,1283,Humana Insurance Company,Commercial PPO,1216.95,95,,percent of total billed charges,,
Ct Orbits Sella Iac Without Iv Contrast,,70480,CPT,Facility,Outpatient,,,,1281,1088.85,325.628,1283,Humana Insurance Company,Medicare PPO,627.69,49,,percent of total billed charges,,
Ct Orbits Sella Iac Without Iv Contrast,,70480,CPT,Facility,Inpatient,,,,1281,1088.85,325.628,1283,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Ct Orbits Sella Iac Without Iv Contrast,,70480,CPT,Facility,Both,,,,1281,1088.85,325.628,1283,Medica,Individual & Family,1269.471,99.1,,percent of total billed charges,,
Ct Orbits Sella Iac Without Iv Contrast,,70480,CPT,Facility,Outpatient,,,,1281,1088.85,325.628,1283,Medica,Medica Advantage Solution,637.938,49.8,,percent of total billed charges,,
Ct Orbits Sella Iac Without Iv Contrast,,70480,CPT,Facility,Inpatient,,,,1281,1088.85,325.628,1283,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Ct Orbits Sella Iac Without Iv Contrast,,70480,CPT,Facility,Outpatient,,,,1281,1088.85,325.628,1283,Medica,Medical Assistance,571.326,44.6,,percent of total billed charges,,
Ct Orbits Sella Iac Without Iv Contrast,,70480,CPT,Facility,Inpatient,,,,1281,1088.85,325.628,1283,Medica,Medical Assistance,,,,,Included in per diem rate,
Ct Orbits Sella Iac Without Iv Contrast,,70480,CPT,Facility,Outpatient,,,,1281,1088.85,325.628,1283,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,637.938,49.8,,percent of total billed charges,,
Ct Orbits Sella Iac Without Iv Contrast,,70480,CPT,Facility,Inpatient,,,,1281,1088.85,325.628,1283,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Ct Orbits Sella Iac Without Iv Contrast,,70480,CPT,Facility,Both,,,,1281,1088.85,325.628,1283,"Multiplan, Inc.","Multiplan, Inc.",1204.14,94,,percent of total billed charges,,
Ct Orbits Sella Iac Without Iv Contrast,,70480,CPT,Facility,Outpatient,,,,1281,1088.85,325.628,1283,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1283,,,Other,Per scan,
Ct Orbits Sella Iac Without Iv Contrast,,70480,CPT,Facility,Inpatient,,,,1281,1088.85,325.628,1283,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Ct Orbits Sella Iac Without Iv Contrast,,70480,CPT,Facility,Both,,,,1281,1088.85,325.628,1283,"Preferred One Administrative Services, INC.",PPO,1263.066,98.6,,percent of total billed charges,,
Ct Orbits Sella Iac Without Iv Contrast,,70480,CPT,Facility,Outpatient,,,,1281,1088.85,325.628,1283,PrimeWest Health,Minnesota Senior Health Options (MSHO),659.0745,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Ct Orbits Sella Iac Without Iv Contrast,,70480,CPT,Facility,Inpatient,,,,1281,1088.85,325.628,1283,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ct Orbits Sella Iac Without Iv Contrast,,70480,CPT,Facility,Outpatient,,,,1281,1088.85,325.628,1283,PrimeWest Health,MinnesotaCare,657.9216,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Ct Orbits Sella Iac Without Iv Contrast,,70480,CPT,Facility,Inpatient,,,,1281,1088.85,325.628,1283,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Ct Orbits Sella Iac Without Iv Contrast,,70480,CPT,Facility,Both,,,,1281,1088.85,325.628,1283,Sanford Health Plan,Sanford Health Plan,1178.52,92,,percent of total billed charges,,
Ct Orbits Sella Iac Without Iv Contrast,,70480,CPT,Facility,Outpatient,,,,1281,1088.85,325.628,1283,"UCare Health, Inc.",Individual & Family Plan,721.8435,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Ct Orbits Sella Iac Without Iv Contrast,,70480,CPT,Facility,Inpatient,,,,1281,1088.85,325.628,1283,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Ct Orbits Sella Iac Without Iv Contrast,,70480,CPT,Facility,Outpatient,,,,1281,1088.85,325.628,1283,"UCare Health, Inc.",Medical Assistance,646.5207,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ct Orbits Sella Iac Without Iv Contrast,,70480,CPT,Facility,Inpatient,,,,1281,1088.85,325.628,1283,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Ct Orbits Sella Iac Without Iv Contrast,,70480,CPT,Facility,Outpatient,,,,1281,1088.85,325.628,1283,"UCare Health, Inc.",Medicare Advantage,646.5207,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ct Orbits Sella Iac Without Iv Contrast,,70480,CPT,Facility,Inpatient,,,,1281,1088.85,325.628,1283,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ct Orbits Sella Iac Without Iv Contrast,,70480,CPT,Facility,Outpatient,,,,1281,1088.85,325.628,1283,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),646.5207,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ct Orbits Sella Iac Without Iv Contrast,,70480,CPT,Facility,Inpatient,,,,1281,1088.85,325.628,1283,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ct Orbits Sella Iac Without Iv Contrast,,70480,CPT,Facility,Both,,,,1281,1088.85,325.628,1283,UnitedHealthcare,Individual & Family,1204.14,94,,percent of total billed charges,,
Ct Orbits Sella Iac Without Iv Contrast,,70480,CPT,Facility,Outpatient,,,,1281,1088.85,325.628,1283,UnitedHealthcare,Medicare Advantage,627.69,49,,percent of total billed charges,,
Ct Orbits Sella Iac Without Iv Contrast,,70480,CPT,Facility,Inpatient,,,,1281,1088.85,325.628,1283,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Ct Orbits Sella Iac Without Iv Contrast,,70480,CPT,Facility,Outpatient,,,,1281,1088.85,325.628,1283,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,614.88,48,,percent of total billed charges,,100% of DHS outpatient percentage
Ct Orbits Sella Iac Without Iv Contrast,,70480,CPT,Facility,Inpatient,,,,1281,1088.85,325.628,1283,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Ct Orbits Wo Iv Contrast,,70480,CPT,Facility,Both,,,,1281,1088.85,325.628,1283,Aetna,Commercial,1178.52,92,,percent of total billed charges,,
Ct Orbits Wo Iv Contrast,,70480,CPT,Facility,Outpatient,,,,1281,1088.85,325.628,1283,Aetna,Medicare Advantage,627.69,49,,percent of total billed charges,,
Ct Orbits Wo Iv Contrast,,70480,CPT,Facility,Inpatient,,,,1281,1088.85,325.628,1283,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Ct Orbits Wo Iv Contrast,,70480,CPT,Facility,Both,,,,1281,1088.85,325.628,1283,Aetna,PPO,1191.33,93,,percent of total billed charges,,
Ct Orbits Wo Iv Contrast,,70480,CPT,Facility,Both,,,,1281,1088.85,325.628,1283,America's PPO,America's PPO,1230.1443,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Ct Orbits Wo Iv Contrast,,70480,CPT,Facility,Both,,,,1281,1088.85,325.628,1283,BlueCross BlueShield Minnesota, Federal Employee Program,641,,,Fee schedule,,100% of BCBS commercial commodity fee schedule
Ct Orbits Wo Iv Contrast,,70480,CPT,Facility,Both,,,,1281,1088.85,325.628,1283,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,651.256,,,Fee schedule,,"100% of BCBS commercial commodity fee schedule, plus MN Care tax"
Ct Orbits Wo Iv Contrast,,70480,CPT,Facility,Both,,,,1281,1088.85,325.628,1283,BlueCross BlueShield Minnesota,High Value Network Plan,586.1304,,,Fee schedule,,"90% of BCBS commercial commodity fee schedule, plus MN Care tax; see disclaimer for more information"
Ct Orbits Wo Iv Contrast,,70480,CPT,Facility,Outpatient,,,,1281,1088.85,325.628,1283,BlueCross BlueShield Minnesota,Medicare Advantage,627.69,49,,percent of total billed charges,,
Ct Orbits Wo Iv Contrast,,70480,CPT,Facility,Inpatient,,,,1281,1088.85,325.628,1283,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Ct Orbits Wo Iv Contrast,,70480,CPT,Facility,Both,,,,1281,1088.85,325.628,1283,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,576.8174392,,,Fee schedule,,"88.57% of BCBS commercial commodity fee schedule, plus MN Care tax"
Ct Orbits Wo Iv Contrast,,70480,CPT,Facility,Both,,,,1281,1088.85,325.628,1283,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,325.628,,,Fee schedule,,"100% of BCBS Medicaid commodity fee schedule, plus MN Care tax"
Ct Orbits Wo Iv Contrast,,70480,CPT,Facility,Outpatient,,,,1281,1088.85,325.628,1283,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),627.69,49,,percent of total billed charges,,
Ct Orbits Wo Iv Contrast,,70480,CPT,Facility,Inpatient,,,,1281,1088.85,325.628,1283,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Ct Orbits Wo Iv Contrast,,70480,CPT,Facility,Both,,,,1281,1088.85,325.628,1283,CorVel,Worker's Compensation,1281,100,,percent of total billed charges,,
Ct Orbits Wo Iv Contrast,,70480,CPT,Facility,Both,,,,1281,1088.85,325.628,1283,First Health Group Corporation,First Health Network,1242.57,97,,percent of total billed charges,,
Ct Orbits Wo Iv Contrast,,70480,CPT,Facility,Both,,,,1281,1088.85,325.628,1283,"Health Partners, Inc.",Commercial,1211.826,94.6,,percent of total billed charges,,
Ct Orbits Wo Iv Contrast,,70480,CPT,Facility,Outpatient,,,,1281,1088.85,325.628,1283,"Health Partners, Inc.",Medicare Advantage,627.69,49,,percent of total billed charges,,
Ct Orbits Wo Iv Contrast,,70480,CPT,Facility,Inpatient,,,,1281,1088.85,325.628,1283,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ct Orbits Wo Iv Contrast,,70480,CPT,Facility,Both,,,,1281,1088.85,325.628,1283,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),768.6,60,,percent of total billed charges,,
Ct Orbits Wo Iv Contrast,,70480,CPT,Facility,Both,,,,1281,1088.85,325.628,1283,"Health Partners, Inc.",State of Minnesota Advantage Program,1044.015,81.5,,percent of total billed charges,,
Ct Orbits Wo Iv Contrast,,70480,CPT,Facility,Both,,,,1281,1088.85,325.628,1283,"Health Partners, Inc.",State Public Programs,640.5,50,,percent of total billed charges,,
Ct Orbits Wo Iv Contrast,,70480,CPT,Facility,Both,,,,1281,1088.85,325.628,1283,Humana Insurance Company,Commercial PPO,1216.95,95,,percent of total billed charges,,
Ct Orbits Wo Iv Contrast,,70480,CPT,Facility,Outpatient,,,,1281,1088.85,325.628,1283,Humana Insurance Company,Medicare PPO,627.69,49,,percent of total billed charges,,
Ct Orbits Wo Iv Contrast,,70480,CPT,Facility,Inpatient,,,,1281,1088.85,325.628,1283,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Ct Orbits Wo Iv Contrast,,70480,CPT,Facility,Both,,,,1281,1088.85,325.628,1283,Medica,Individual & Family,1269.471,99.1,,percent of total billed charges,,
Ct Orbits Wo Iv Contrast,,70480,CPT,Facility,Outpatient,,,,1281,1088.85,325.628,1283,Medica,Medica Advantage Solution,637.938,49.8,,percent of total billed charges,,
Ct Orbits Wo Iv Contrast,,70480,CPT,Facility,Inpatient,,,,1281,1088.85,325.628,1283,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Ct Orbits Wo Iv Contrast,,70480,CPT,Facility,Outpatient,,,,1281,1088.85,325.628,1283,Medica,Medical Assistance,571.326,44.6,,percent of total billed charges,,
Ct Orbits Wo Iv Contrast,,70480,CPT,Facility,Inpatient,,,,1281,1088.85,325.628,1283,Medica,Medical Assistance,,,,,Included in per diem rate,
Ct Orbits Wo Iv Contrast,,70480,CPT,Facility,Outpatient,,,,1281,1088.85,325.628,1283,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,637.938,49.8,,percent of total billed charges,,
Ct Orbits Wo Iv Contrast,,70480,CPT,Facility,Inpatient,,,,1281,1088.85,325.628,1283,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Ct Orbits Wo Iv Contrast,,70480,CPT,Facility,Both,,,,1281,1088.85,325.628,1283,"Multiplan, Inc.","Multiplan, Inc.",1204.14,94,,percent of total billed charges,,
Ct Orbits Wo Iv Contrast,,70480,CPT,Facility,Outpatient,,,,1281,1088.85,325.628,1283,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1283,,,Other,Per scan,
Ct Orbits Wo Iv Contrast,,70480,CPT,Facility,Inpatient,,,,1281,1088.85,325.628,1283,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Ct Orbits Wo Iv Contrast,,70480,CPT,Facility,Both,,,,1281,1088.85,325.628,1283,"Preferred One Administrative Services, INC.",PPO,1263.066,98.6,,percent of total billed charges,,
Ct Orbits Wo Iv Contrast,,70480,CPT,Facility,Outpatient,,,,1281,1088.85,325.628,1283,PrimeWest Health,Minnesota Senior Health Options (MSHO),659.0745,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Ct Orbits Wo Iv Contrast,,70480,CPT,Facility,Inpatient,,,,1281,1088.85,325.628,1283,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ct Orbits Wo Iv Contrast,,70480,CPT,Facility,Outpatient,,,,1281,1088.85,325.628,1283,PrimeWest Health,MinnesotaCare,657.9216,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Ct Orbits Wo Iv Contrast,,70480,CPT,Facility,Inpatient,,,,1281,1088.85,325.628,1283,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Ct Orbits Wo Iv Contrast,,70480,CPT,Facility,Both,,,,1281,1088.85,325.628,1283,Sanford Health Plan,Sanford Health Plan,1178.52,92,,percent of total billed charges,,
Ct Orbits Wo Iv Contrast,,70480,CPT,Facility,Outpatient,,,,1281,1088.85,325.628,1283,"UCare Health, Inc.",Individual & Family Plan,721.8435,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Ct Orbits Wo Iv Contrast,,70480,CPT,Facility,Inpatient,,,,1281,1088.85,325.628,1283,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Ct Orbits Wo Iv Contrast,,70480,CPT,Facility,Outpatient,,,,1281,1088.85,325.628,1283,"UCare Health, Inc.",Medical Assistance,646.5207,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ct Orbits Wo Iv Contrast,,70480,CPT,Facility,Inpatient,,,,1281,1088.85,325.628,1283,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Ct Orbits Wo Iv Contrast,,70480,CPT,Facility,Outpatient,,,,1281,1088.85,325.628,1283,"UCare Health, Inc.",Medicare Advantage,646.5207,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ct Orbits Wo Iv Contrast,,70480,CPT,Facility,Inpatient,,,,1281,1088.85,325.628,1283,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ct Orbits Wo Iv Contrast,,70480,CPT,Facility,Outpatient,,,,1281,1088.85,325.628,1283,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),646.5207,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ct Orbits Wo Iv Contrast,,70480,CPT,Facility,Inpatient,,,,1281,1088.85,325.628,1283,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ct Orbits Wo Iv Contrast,,70480,CPT,Facility,Both,,,,1281,1088.85,325.628,1283,UnitedHealthcare,Individual & Family,1204.14,94,,percent of total billed charges,,
Ct Orbits Wo Iv Contrast,,70480,CPT,Facility,Outpatient,,,,1281,1088.85,325.628,1283,UnitedHealthcare,Medicare Advantage,627.69,49,,percent of total billed charges,,
Ct Orbits Wo Iv Contrast,,70480,CPT,Facility,Inpatient,,,,1281,1088.85,325.628,1283,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Ct Orbits Wo Iv Contrast,,70480,CPT,Facility,Outpatient,,,,1281,1088.85,325.628,1283,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,614.88,48,,percent of total billed charges,,100% of DHS outpatient percentage
Ct Orbits Wo Iv Contrast,,70480,CPT,Facility,Inpatient,,,,1281,1088.85,325.628,1283,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Ct Posterior Fossa Ear Wo Iv Contrast,,70480,CPT,Facility,Both,,,,1281,1088.85,325.628,1283,Aetna,Commercial,1178.52,92,,percent of total billed charges,,
Ct Posterior Fossa Ear Wo Iv Contrast,,70480,CPT,Facility,Outpatient,,,,1281,1088.85,325.628,1283,Aetna,Medicare Advantage,627.69,49,,percent of total billed charges,,
Ct Posterior Fossa Ear Wo Iv Contrast,,70480,CPT,Facility,Inpatient,,,,1281,1088.85,325.628,1283,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Ct Posterior Fossa Ear Wo Iv Contrast,,70480,CPT,Facility,Both,,,,1281,1088.85,325.628,1283,Aetna,PPO,1191.33,93,,percent of total billed charges,,
Ct Posterior Fossa Ear Wo Iv Contrast,,70480,CPT,Facility,Both,,,,1281,1088.85,325.628,1283,America's PPO,America's PPO,1230.1443,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Ct Posterior Fossa Ear Wo Iv Contrast,,70480,CPT,Facility,Both,,,,1281,1088.85,325.628,1283,BlueCross BlueShield Minnesota, Federal Employee Program,641,,,Fee schedule,,100% of BCBS commercial commodity fee schedule
Ct Posterior Fossa Ear Wo Iv Contrast,,70480,CPT,Facility,Both,,,,1281,1088.85,325.628,1283,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,651.256,,,Fee schedule,,"100% of BCBS commercial commodity fee schedule, plus MN Care tax"
Ct Posterior Fossa Ear Wo Iv Contrast,,70480,CPT,Facility,Both,,,,1281,1088.85,325.628,1283,BlueCross BlueShield Minnesota,High Value Network Plan,586.1304,,,Fee schedule,,"90% of BCBS commercial commodity fee schedule, plus MN Care tax; see disclaimer for more information"
Ct Posterior Fossa Ear Wo Iv Contrast,,70480,CPT,Facility,Outpatient,,,,1281,1088.85,325.628,1283,BlueCross BlueShield Minnesota,Medicare Advantage,627.69,49,,percent of total billed charges,,
Ct Posterior Fossa Ear Wo Iv Contrast,,70480,CPT,Facility,Inpatient,,,,1281,1088.85,325.628,1283,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Ct Posterior Fossa Ear Wo Iv Contrast,,70480,CPT,Facility,Both,,,,1281,1088.85,325.628,1283,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,576.8174392,,,Fee schedule,,"88.57% of BCBS commercial commodity fee schedule, plus MN Care tax"
Ct Posterior Fossa Ear Wo Iv Contrast,,70480,CPT,Facility,Both,,,,1281,1088.85,325.628,1283,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,325.628,,,Fee schedule,,"100% of BCBS Medicaid commodity fee schedule, plus MN Care tax"
Ct Posterior Fossa Ear Wo Iv Contrast,,70480,CPT,Facility,Outpatient,,,,1281,1088.85,325.628,1283,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),627.69,49,,percent of total billed charges,,
Ct Posterior Fossa Ear Wo Iv Contrast,,70480,CPT,Facility,Inpatient,,,,1281,1088.85,325.628,1283,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Ct Posterior Fossa Ear Wo Iv Contrast,,70480,CPT,Facility,Both,,,,1281,1088.85,325.628,1283,CorVel,Worker's Compensation,1281,100,,percent of total billed charges,,
Ct Posterior Fossa Ear Wo Iv Contrast,,70480,CPT,Facility,Both,,,,1281,1088.85,325.628,1283,First Health Group Corporation,First Health Network,1242.57,97,,percent of total billed charges,,
Ct Posterior Fossa Ear Wo Iv Contrast,,70480,CPT,Facility,Both,,,,1281,1088.85,325.628,1283,"Health Partners, Inc.",Commercial,1211.826,94.6,,percent of total billed charges,,
Ct Posterior Fossa Ear Wo Iv Contrast,,70480,CPT,Facility,Outpatient,,,,1281,1088.85,325.628,1283,"Health Partners, Inc.",Medicare Advantage,627.69,49,,percent of total billed charges,,
Ct Posterior Fossa Ear Wo Iv Contrast,,70480,CPT,Facility,Inpatient,,,,1281,1088.85,325.628,1283,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ct Posterior Fossa Ear Wo Iv Contrast,,70480,CPT,Facility,Both,,,,1281,1088.85,325.628,1283,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),768.6,60,,percent of total billed charges,,
Ct Posterior Fossa Ear Wo Iv Contrast,,70480,CPT,Facility,Both,,,,1281,1088.85,325.628,1283,"Health Partners, Inc.",State of Minnesota Advantage Program,1044.015,81.5,,percent of total billed charges,,
Ct Posterior Fossa Ear Wo Iv Contrast,,70480,CPT,Facility,Both,,,,1281,1088.85,325.628,1283,"Health Partners, Inc.",State Public Programs,640.5,50,,percent of total billed charges,,
Ct Posterior Fossa Ear Wo Iv Contrast,,70480,CPT,Facility,Both,,,,1281,1088.85,325.628,1283,Humana Insurance Company,Commercial PPO,1216.95,95,,percent of total billed charges,,
Ct Posterior Fossa Ear Wo Iv Contrast,,70480,CPT,Facility,Outpatient,,,,1281,1088.85,325.628,1283,Humana Insurance Company,Medicare PPO,627.69,49,,percent of total billed charges,,
Ct Posterior Fossa Ear Wo Iv Contrast,,70480,CPT,Facility,Inpatient,,,,1281,1088.85,325.628,1283,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Ct Posterior Fossa Ear Wo Iv Contrast,,70480,CPT,Facility,Both,,,,1281,1088.85,325.628,1283,Medica,Individual & Family,1269.471,99.1,,percent of total billed charges,,
Ct Posterior Fossa Ear Wo Iv Contrast,,70480,CPT,Facility,Outpatient,,,,1281,1088.85,325.628,1283,Medica,Medica Advantage Solution,637.938,49.8,,percent of total billed charges,,
Ct Posterior Fossa Ear Wo Iv Contrast,,70480,CPT,Facility,Inpatient,,,,1281,1088.85,325.628,1283,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Ct Posterior Fossa Ear Wo Iv Contrast,,70480,CPT,Facility,Outpatient,,,,1281,1088.85,325.628,1283,Medica,Medical Assistance,499,,,Other,Per visit,Pays in addition to all Outpatient Service Categories
Ct Posterior Fossa Ear Wo Iv Contrast,,70480,CPT,Facility,Inpatient,,,,1281,1088.85,325.628,1283,Medica,Medical Assistance,,,,,Included in per diem rate,
Ct Posterior Fossa Ear Wo Iv Contrast,,70480,CPT,Facility,Outpatient,,,,1281,1088.85,325.628,1283,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,637.938,49.8,,percent of total billed charges,,
Ct Posterior Fossa Ear Wo Iv Contrast,,70480,CPT,Facility,Inpatient,,,,1281,1088.85,325.628,1283,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Ct Posterior Fossa Ear Wo Iv Contrast,,70480,CPT,Facility,Both,,,,1281,1088.85,325.628,1283,"Multiplan, Inc.","Multiplan, Inc.",1204.14,94,,percent of total billed charges,,
Ct Posterior Fossa Ear Wo Iv Contrast,,70480,CPT,Facility,Outpatient,,,,1281,1088.85,325.628,1283,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1283,,,Other,Per scan,
Ct Posterior Fossa Ear Wo Iv Contrast,,70480,CPT,Facility,Inpatient,,,,1281,1088.85,325.628,1283,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Ct Posterior Fossa Ear Wo Iv Contrast,,70480,CPT,Facility,Both,,,,1281,1088.85,325.628,1283,"Preferred One Administrative Services, INC.",PPO,1263.066,98.6,,percent of total billed charges,,
Ct Posterior Fossa Ear Wo Iv Contrast,,70480,CPT,Facility,Outpatient,,,,1281,1088.85,325.628,1283,PrimeWest Health,Minnesota Senior Health Options (MSHO),659.0745,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Ct Posterior Fossa Ear Wo Iv Contrast,,70480,CPT,Facility,Inpatient,,,,1281,1088.85,325.628,1283,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ct Posterior Fossa Ear Wo Iv Contrast,,70480,CPT,Facility,Outpatient,,,,1281,1088.85,325.628,1283,PrimeWest Health,MinnesotaCare,657.9216,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Ct Posterior Fossa Ear Wo Iv Contrast,,70480,CPT,Facility,Inpatient,,,,1281,1088.85,325.628,1283,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Ct Posterior Fossa Ear Wo Iv Contrast,,70480,CPT,Facility,Both,,,,1281,1088.85,325.628,1283,Sanford Health Plan,Sanford Health Plan,1178.52,92,,percent of total billed charges,,
Ct Posterior Fossa Ear Wo Iv Contrast,,70480,CPT,Facility,Outpatient,,,,1281,1088.85,325.628,1283,"UCare Health, Inc.",Individual & Family Plan,721.8435,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Ct Posterior Fossa Ear Wo Iv Contrast,,70480,CPT,Facility,Inpatient,,,,1281,1088.85,325.628,1283,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Ct Posterior Fossa Ear Wo Iv Contrast,,70480,CPT,Facility,Outpatient,,,,1281,1088.85,325.628,1283,"UCare Health, Inc.",Medical Assistance,646.5207,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ct Posterior Fossa Ear Wo Iv Contrast,,70480,CPT,Facility,Inpatient,,,,1281,1088.85,325.628,1283,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Ct Posterior Fossa Ear Wo Iv Contrast,,70480,CPT,Facility,Outpatient,,,,1281,1088.85,325.628,1283,"UCare Health, Inc.",Medicare Advantage,646.5207,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ct Posterior Fossa Ear Wo Iv Contrast,,70480,CPT,Facility,Inpatient,,,,1281,1088.85,325.628,1283,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ct Posterior Fossa Ear Wo Iv Contrast,,70480,CPT,Facility,Outpatient,,,,1281,1088.85,325.628,1283,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),646.5207,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ct Posterior Fossa Ear Wo Iv Contrast,,70480,CPT,Facility,Inpatient,,,,1281,1088.85,325.628,1283,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ct Posterior Fossa Ear Wo Iv Contrast,,70480,CPT,Facility,Both,,,,1281,1088.85,325.628,1283,UnitedHealthcare,Individual & Family,1204.14,94,,percent of total billed charges,,
Ct Posterior Fossa Ear Wo Iv Contrast,,70480,CPT,Facility,Outpatient,,,,1281,1088.85,325.628,1283,UnitedHealthcare,Medicare Advantage,627.69,49,,percent of total billed charges,,
Ct Posterior Fossa Ear Wo Iv Contrast,,70480,CPT,Facility,Inpatient,,,,1281,1088.85,325.628,1283,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Ct Posterior Fossa Ear Wo Iv Contrast,,70480,CPT,Facility,Outpatient,,,,1281,1088.85,325.628,1283,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,614.88,48,,percent of total billed charges,,100% of DHS outpatient percentage
Ct Posterior Fossa Ear Wo Iv Contrast,,70480,CPT,Facility,Inpatient,,,,1281,1088.85,325.628,1283,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Ct Orbits Sella Iac W Iv Contrast,,70481,CPT,Facility,Both,,,,1479,1257.15,412.496,1479,Aetna,Commercial,1360.68,92,,percent of total billed charges,,
Ct Orbits Sella Iac W Iv Contrast,,70481,CPT,Facility,Outpatient,,,,1479,1257.15,412.496,1479,Aetna,Medicare Advantage,724.71,49,,percent of total billed charges,,
Ct Orbits Sella Iac W Iv Contrast,,70481,CPT,Facility,Inpatient,,,,1479,1257.15,412.496,1479,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Ct Orbits Sella Iac W Iv Contrast,,70481,CPT,Facility,Both,,,,1479,1257.15,412.496,1479,Aetna,PPO,1375.47,93,,percent of total billed charges,,
Ct Orbits Sella Iac W Iv Contrast,,70481,CPT,Facility,Both,,,,1479,1257.15,412.496,1479,America's PPO,America's PPO,1420.2837,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Ct Orbits Sella Iac W Iv Contrast,,70481,CPT,Facility,Both,,,,1479,1257.15,412.496,1479,BlueCross BlueShield Minnesota, Federal Employee Program,812,,,Fee schedule,,100% of BCBS commercial commodity fee schedule
Ct Orbits Sella Iac W Iv Contrast,,70481,CPT,Facility,Both,,,,1479,1257.15,412.496,1479,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,824.992,,,Fee schedule,,"100% of BCBS commercial commodity fee schedule, plus MN Care tax"
Ct Orbits Sella Iac W Iv Contrast,,70481,CPT,Facility,Both,,,,1479,1257.15,412.496,1479,BlueCross BlueShield Minnesota,High Value Network Plan,742.4928,,,Fee schedule,,"90% of BCBS commercial commodity fee schedule, plus MN Care tax; see disclaimer for more information"
Ct Orbits Sella Iac W Iv Contrast,,70481,CPT,Facility,Outpatient,,,,1479,1257.15,412.496,1479,BlueCross BlueShield Minnesota,Medicare Advantage,724.71,49,,percent of total billed charges,,
Ct Orbits Sella Iac W Iv Contrast,,70481,CPT,Facility,Inpatient,,,,1479,1257.15,412.496,1479,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Ct Orbits Sella Iac W Iv Contrast,,70481,CPT,Facility,Both,,,,1479,1257.15,412.496,1479,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,730.6954144,,,Fee schedule,,"88.57% of BCBS commercial commodity fee schedule, plus MN Care tax"
Ct Orbits Sella Iac W Iv Contrast,,70481,CPT,Facility,Both,,,,1479,1257.15,412.496,1479,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,412.496,,,Fee schedule,,"100% of BCBS Medicaid commodity fee schedule, plus MN Care tax"
Ct Orbits Sella Iac W Iv Contrast,,70481,CPT,Facility,Outpatient,,,,1479,1257.15,412.496,1479,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),724.71,49,,percent of total billed charges,,
Ct Orbits Sella Iac W Iv Contrast,,70481,CPT,Facility,Inpatient,,,,1479,1257.15,412.496,1479,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Ct Orbits Sella Iac W Iv Contrast,,70481,CPT,Facility,Both,,,,1479,1257.15,412.496,1479,CorVel,Worker's Compensation,1479,100,,percent of total billed charges,,
Ct Orbits Sella Iac W Iv Contrast,,70481,CPT,Facility,Both,,,,1479,1257.15,412.496,1479,First Health Group Corporation,First Health Network,1434.63,97,,percent of total billed charges,,
Ct Orbits Sella Iac W Iv Contrast,,70481,CPT,Facility,Both,,,,1479,1257.15,412.496,1479,"Health Partners, Inc.",Commercial,1399.134,94.6,,percent of total billed charges,,
Ct Orbits Sella Iac W Iv Contrast,,70481,CPT,Facility,Outpatient,,,,1479,1257.15,412.496,1479,"Health Partners, Inc.",Medicare Advantage,724.71,49,,percent of total billed charges,,
Ct Orbits Sella Iac W Iv Contrast,,70481,CPT,Facility,Inpatient,,,,1479,1257.15,412.496,1479,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ct Orbits Sella Iac W Iv Contrast,,70481,CPT,Facility,Both,,,,1479,1257.15,412.496,1479,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),887.4,60,,percent of total billed charges,,
Ct Orbits Sella Iac W Iv Contrast,,70481,CPT,Facility,Both,,,,1479,1257.15,412.496,1479,"Health Partners, Inc.",State of Minnesota Advantage Program,1205.385,81.5,,percent of total billed charges,,
Ct Orbits Sella Iac W Iv Contrast,,70481,CPT,Facility,Both,,,,1479,1257.15,412.496,1479,"Health Partners, Inc.",State Public Programs,739.5,50,,percent of total billed charges,,
Ct Orbits Sella Iac W Iv Contrast,,70481,CPT,Facility,Both,,,,1479,1257.15,412.496,1479,Humana Insurance Company,Commercial PPO,1405.05,95,,percent of total billed charges,,
Ct Orbits Sella Iac W Iv Contrast,,70481,CPT,Facility,Outpatient,,,,1479,1257.15,412.496,1479,Humana Insurance Company,Medicare PPO,724.71,49,,percent of total billed charges,,
Ct Orbits Sella Iac W Iv Contrast,,70481,CPT,Facility,Inpatient,,,,1479,1257.15,412.496,1479,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Ct Orbits Sella Iac W Iv Contrast,,70481,CPT,Facility,Both,,,,1479,1257.15,412.496,1479,Medica,Individual & Family,1465.689,99.1,,percent of total billed charges,,
Ct Orbits Sella Iac W Iv Contrast,,70481,CPT,Facility,Outpatient,,,,1479,1257.15,412.496,1479,Medica,Medica Advantage Solution,736.542,49.8,,percent of total billed charges,,
Ct Orbits Sella Iac W Iv Contrast,,70481,CPT,Facility,Inpatient,,,,1479,1257.15,412.496,1479,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Ct Orbits Sella Iac W Iv Contrast,,70481,CPT,Facility,Outpatient,,,,1479,1257.15,412.496,1479,Medica,Medical Assistance,499,,,Other,Per visit,Pays in addition to all Outpatient Service Categories
Ct Orbits Sella Iac W Iv Contrast,,70481,CPT,Facility,Inpatient,,,,1479,1257.15,412.496,1479,Medica,Medical Assistance,,,,,Included in per diem rate,
Ct Orbits Sella Iac W Iv Contrast,,70481,CPT,Facility,Outpatient,,,,1479,1257.15,412.496,1479,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,736.542,49.8,,percent of total billed charges,,
Ct Orbits Sella Iac W Iv Contrast,,70481,CPT,Facility,Inpatient,,,,1479,1257.15,412.496,1479,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Ct Orbits Sella Iac W Iv Contrast,,70481,CPT,Facility,Both,,,,1479,1257.15,412.496,1479,"Multiplan, Inc.","Multiplan, Inc.",1390.26,94,,percent of total billed charges,,
Ct Orbits Sella Iac W Iv Contrast,,70481,CPT,Facility,Outpatient,,,,1479,1257.15,412.496,1479,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1283,,,Other,Per scan,
Ct Orbits Sella Iac W Iv Contrast,,70481,CPT,Facility,Inpatient,,,,1479,1257.15,412.496,1479,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Ct Orbits Sella Iac W Iv Contrast,,70481,CPT,Facility,Both,,,,1479,1257.15,412.496,1479,"Preferred One Administrative Services, INC.",PPO,1458.294,98.6,,percent of total billed charges,,
Ct Orbits Sella Iac W Iv Contrast,,70481,CPT,Facility,Outpatient,,,,1479,1257.15,412.496,1479,PrimeWest Health,Minnesota Senior Health Options (MSHO),760.9455,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Ct Orbits Sella Iac W Iv Contrast,,70481,CPT,Facility,Inpatient,,,,1479,1257.15,412.496,1479,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ct Orbits Sella Iac W Iv Contrast,,70481,CPT,Facility,Outpatient,,,,1479,1257.15,412.496,1479,PrimeWest Health,MinnesotaCare,759.6144,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Ct Orbits Sella Iac W Iv Contrast,,70481,CPT,Facility,Inpatient,,,,1479,1257.15,412.496,1479,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Ct Orbits Sella Iac W Iv Contrast,,70481,CPT,Facility,Both,,,,1479,1257.15,412.496,1479,Sanford Health Plan,Sanford Health Plan,1360.68,92,,percent of total billed charges,,
Ct Orbits Sella Iac W Iv Contrast,,70481,CPT,Facility,Outpatient,,,,1479,1257.15,412.496,1479,"UCare Health, Inc.",Individual & Family Plan,833.4165,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Ct Orbits Sella Iac W Iv Contrast,,70481,CPT,Facility,Inpatient,,,,1479,1257.15,412.496,1479,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Ct Orbits Sella Iac W Iv Contrast,,70481,CPT,Facility,Outpatient,,,,1479,1257.15,412.496,1479,"UCare Health, Inc.",Medical Assistance,746.4513,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ct Orbits Sella Iac W Iv Contrast,,70481,CPT,Facility,Inpatient,,,,1479,1257.15,412.496,1479,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Ct Orbits Sella Iac W Iv Contrast,,70481,CPT,Facility,Outpatient,,,,1479,1257.15,412.496,1479,"UCare Health, Inc.",Medicare Advantage,746.4513,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ct Orbits Sella Iac W Iv Contrast,,70481,CPT,Facility,Inpatient,,,,1479,1257.15,412.496,1479,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ct Orbits Sella Iac W Iv Contrast,,70481,CPT,Facility,Outpatient,,,,1479,1257.15,412.496,1479,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),746.4513,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ct Orbits Sella Iac W Iv Contrast,,70481,CPT,Facility,Inpatient,,,,1479,1257.15,412.496,1479,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ct Orbits Sella Iac W Iv Contrast,,70481,CPT,Facility,Both,,,,1479,1257.15,412.496,1479,UnitedHealthcare,Individual & Family,1390.26,94,,percent of total billed charges,,
Ct Orbits Sella Iac W Iv Contrast,,70481,CPT,Facility,Outpatient,,,,1479,1257.15,412.496,1479,UnitedHealthcare,Medicare Advantage,724.71,49,,percent of total billed charges,,
Ct Orbits Sella Iac W Iv Contrast,,70481,CPT,Facility,Inpatient,,,,1479,1257.15,412.496,1479,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Ct Orbits Sella Iac W Iv Contrast,,70481,CPT,Facility,Outpatient,,,,1479,1257.15,412.496,1479,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,709.92,48,,percent of total billed charges,,100% of DHS outpatient percentage
Ct Orbits Sella Iac W Iv Contrast,,70481,CPT,Facility,Inpatient,,,,1479,1257.15,412.496,1479,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Ct Posterior Fossa Inner Ear W Iv Contrast,,70481,CPT,Facility,Both,,,,1479,1257.15,412.496,1479,Aetna,Commercial,1360.68,92,,percent of total billed charges,,
Ct Posterior Fossa Inner Ear W Iv Contrast,,70481,CPT,Facility,Outpatient,,,,1479,1257.15,412.496,1479,Aetna,Medicare Advantage,724.71,49,,percent of total billed charges,,
Ct Posterior Fossa Inner Ear W Iv Contrast,,70481,CPT,Facility,Inpatient,,,,1479,1257.15,412.496,1479,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Ct Posterior Fossa Inner Ear W Iv Contrast,,70481,CPT,Facility,Both,,,,1479,1257.15,412.496,1479,Aetna,PPO,1375.47,93,,percent of total billed charges,,
Ct Posterior Fossa Inner Ear W Iv Contrast,,70481,CPT,Facility,Both,,,,1479,1257.15,412.496,1479,America's PPO,America's PPO,1420.2837,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Ct Posterior Fossa Inner Ear W Iv Contrast,,70481,CPT,Facility,Both,,,,1479,1257.15,412.496,1479,BlueCross BlueShield Minnesota, Federal Employee Program,812,,,Fee schedule,,100% of BCBS commercial commodity fee schedule
Ct Posterior Fossa Inner Ear W Iv Contrast,,70481,CPT,Facility,Both,,,,1479,1257.15,412.496,1479,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,824.992,,,Fee schedule,,"100% of BCBS commercial commodity fee schedule, plus MN Care tax"
Ct Posterior Fossa Inner Ear W Iv Contrast,,70481,CPT,Facility,Both,,,,1479,1257.15,412.496,1479,BlueCross BlueShield Minnesota,High Value Network Plan,742.4928,,,Fee schedule,,"90% of BCBS commercial commodity fee schedule, plus MN Care tax; see disclaimer for more information"
Ct Posterior Fossa Inner Ear W Iv Contrast,,70481,CPT,Facility,Outpatient,,,,1479,1257.15,412.496,1479,BlueCross BlueShield Minnesota,Medicare Advantage,724.71,49,,percent of total billed charges,,
Ct Posterior Fossa Inner Ear W Iv Contrast,,70481,CPT,Facility,Inpatient,,,,1479,1257.15,412.496,1479,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Ct Posterior Fossa Inner Ear W Iv Contrast,,70481,CPT,Facility,Both,,,,1479,1257.15,412.496,1479,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,730.6954144,,,Fee schedule,,"88.57% of BCBS commercial commodity fee schedule, plus MN Care tax"
Ct Posterior Fossa Inner Ear W Iv Contrast,,70481,CPT,Facility,Both,,,,1479,1257.15,412.496,1479,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,412.496,,,Fee schedule,,"100% of BCBS Medicaid commodity fee schedule, plus MN Care tax"
Ct Posterior Fossa Inner Ear W Iv Contrast,,70481,CPT,Facility,Outpatient,,,,1479,1257.15,412.496,1479,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),724.71,49,,percent of total billed charges,,
Ct Posterior Fossa Inner Ear W Iv Contrast,,70481,CPT,Facility,Inpatient,,,,1479,1257.15,412.496,1479,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Ct Posterior Fossa Inner Ear W Iv Contrast,,70481,CPT,Facility,Both,,,,1479,1257.15,412.496,1479,CorVel,Worker's Compensation,1479,100,,percent of total billed charges,,
Ct Posterior Fossa Inner Ear W Iv Contrast,,70481,CPT,Facility,Both,,,,1479,1257.15,412.496,1479,First Health Group Corporation,First Health Network,1434.63,97,,percent of total billed charges,,
Ct Posterior Fossa Inner Ear W Iv Contrast,,70481,CPT,Facility,Both,,,,1479,1257.15,412.496,1479,"Health Partners, Inc.",Commercial,1399.134,94.6,,percent of total billed charges,,
Ct Posterior Fossa Inner Ear W Iv Contrast,,70481,CPT,Facility,Outpatient,,,,1479,1257.15,412.496,1479,"Health Partners, Inc.",Medicare Advantage,724.71,49,,percent of total billed charges,,
Ct Posterior Fossa Inner Ear W Iv Contrast,,70481,CPT,Facility,Inpatient,,,,1479,1257.15,412.496,1479,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ct Posterior Fossa Inner Ear W Iv Contrast,,70481,CPT,Facility,Both,,,,1479,1257.15,412.496,1479,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),887.4,60,,percent of total billed charges,,
Ct Posterior Fossa Inner Ear W Iv Contrast,,70481,CPT,Facility,Both,,,,1479,1257.15,412.496,1479,"Health Partners, Inc.",State of Minnesota Advantage Program,1205.385,81.5,,percent of total billed charges,,
Ct Posterior Fossa Inner Ear W Iv Contrast,,70481,CPT,Facility,Both,,,,1479,1257.15,412.496,1479,"Health Partners, Inc.",State Public Programs,739.5,50,,percent of total billed charges,,
Ct Posterior Fossa Inner Ear W Iv Contrast,,70481,CPT,Facility,Both,,,,1479,1257.15,412.496,1479,Humana Insurance Company,Commercial PPO,1405.05,95,,percent of total billed charges,,
Ct Posterior Fossa Inner Ear W Iv Contrast,,70481,CPT,Facility,Outpatient,,,,1479,1257.15,412.496,1479,Humana Insurance Company,Medicare PPO,724.71,49,,percent of total billed charges,,
Ct Posterior Fossa Inner Ear W Iv Contrast,,70481,CPT,Facility,Inpatient,,,,1479,1257.15,412.496,1479,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Ct Posterior Fossa Inner Ear W Iv Contrast,,70481,CPT,Facility,Both,,,,1479,1257.15,412.496,1479,Medica,Individual & Family,1465.689,99.1,,percent of total billed charges,,
Ct Posterior Fossa Inner Ear W Iv Contrast,,70481,CPT,Facility,Outpatient,,,,1479,1257.15,412.496,1479,Medica,Medica Advantage Solution,736.542,49.8,,percent of total billed charges,,
Ct Posterior Fossa Inner Ear W Iv Contrast,,70481,CPT,Facility,Inpatient,,,,1479,1257.15,412.496,1479,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Ct Posterior Fossa Inner Ear W Iv Contrast,,70481,CPT,Facility,Outpatient,,,,1479,1257.15,412.496,1479,Medica,Medical Assistance,659.634,44.6,,percent of total billed charges,,
Ct Posterior Fossa Inner Ear W Iv Contrast,,70481,CPT,Facility,Inpatient,,,,1479,1257.15,412.496,1479,Medica,Medical Assistance,,,,,Included in per diem rate,
Ct Posterior Fossa Inner Ear W Iv Contrast,,70481,CPT,Facility,Outpatient,,,,1479,1257.15,412.496,1479,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,736.542,49.8,,percent of total billed charges,,
Ct Posterior Fossa Inner Ear W Iv Contrast,,70481,CPT,Facility,Inpatient,,,,1479,1257.15,412.496,1479,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Ct Posterior Fossa Inner Ear W Iv Contrast,,70481,CPT,Facility,Both,,,,1479,1257.15,412.496,1479,"Multiplan, Inc.","Multiplan, Inc.",1390.26,94,,percent of total billed charges,,
Ct Posterior Fossa Inner Ear W Iv Contrast,,70481,CPT,Facility,Outpatient,,,,1479,1257.15,412.496,1479,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1283,,,Other,Per scan,
Ct Posterior Fossa Inner Ear W Iv Contrast,,70481,CPT,Facility,Inpatient,,,,1479,1257.15,412.496,1479,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Ct Posterior Fossa Inner Ear W Iv Contrast,,70481,CPT,Facility,Both,,,,1479,1257.15,412.496,1479,"Preferred One Administrative Services, INC.",PPO,1458.294,98.6,,percent of total billed charges,,
Ct Posterior Fossa Inner Ear W Iv Contrast,,70481,CPT,Facility,Outpatient,,,,1479,1257.15,412.496,1479,PrimeWest Health,Minnesota Senior Health Options (MSHO),760.9455,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Ct Posterior Fossa Inner Ear W Iv Contrast,,70481,CPT,Facility,Inpatient,,,,1479,1257.15,412.496,1479,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ct Posterior Fossa Inner Ear W Iv Contrast,,70481,CPT,Facility,Outpatient,,,,1479,1257.15,412.496,1479,PrimeWest Health,MinnesotaCare,759.6144,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Ct Posterior Fossa Inner Ear W Iv Contrast,,70481,CPT,Facility,Inpatient,,,,1479,1257.15,412.496,1479,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Ct Posterior Fossa Inner Ear W Iv Contrast,,70481,CPT,Facility,Both,,,,1479,1257.15,412.496,1479,Sanford Health Plan,Sanford Health Plan,1360.68,92,,percent of total billed charges,,
Ct Posterior Fossa Inner Ear W Iv Contrast,,70481,CPT,Facility,Outpatient,,,,1479,1257.15,412.496,1479,"UCare Health, Inc.",Individual & Family Plan,833.4165,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Ct Posterior Fossa Inner Ear W Iv Contrast,,70481,CPT,Facility,Inpatient,,,,1479,1257.15,412.496,1479,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Ct Posterior Fossa Inner Ear W Iv Contrast,,70481,CPT,Facility,Outpatient,,,,1479,1257.15,412.496,1479,"UCare Health, Inc.",Medical Assistance,746.4513,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ct Posterior Fossa Inner Ear W Iv Contrast,,70481,CPT,Facility,Inpatient,,,,1479,1257.15,412.496,1479,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Ct Posterior Fossa Inner Ear W Iv Contrast,,70481,CPT,Facility,Outpatient,,,,1479,1257.15,412.496,1479,"UCare Health, Inc.",Medicare Advantage,746.4513,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ct Posterior Fossa Inner Ear W Iv Contrast,,70481,CPT,Facility,Inpatient,,,,1479,1257.15,412.496,1479,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ct Posterior Fossa Inner Ear W Iv Contrast,,70481,CPT,Facility,Outpatient,,,,1479,1257.15,412.496,1479,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),746.4513,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ct Posterior Fossa Inner Ear W Iv Contrast,,70481,CPT,Facility,Inpatient,,,,1479,1257.15,412.496,1479,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ct Posterior Fossa Inner Ear W Iv Contrast,,70481,CPT,Facility,Both,,,,1479,1257.15,412.496,1479,UnitedHealthcare,Individual & Family,1390.26,94,,percent of total billed charges,,
Ct Posterior Fossa Inner Ear W Iv Contrast,,70481,CPT,Facility,Outpatient,,,,1479,1257.15,412.496,1479,UnitedHealthcare,Medicare Advantage,724.71,49,,percent of total billed charges,,
Ct Posterior Fossa Inner Ear W Iv Contrast,,70481,CPT,Facility,Inpatient,,,,1479,1257.15,412.496,1479,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Ct Posterior Fossa Inner Ear W Iv Contrast,,70481,CPT,Facility,Outpatient,,,,1479,1257.15,412.496,1479,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,709.92,48,,percent of total billed charges,,100% of DHS outpatient percentage
Ct Posterior Fossa Inner Ear W Iv Contrast,,70481,CPT,Facility,Inpatient,,,,1479,1257.15,412.496,1479,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Ct Orbits Sella Iac Wo W Iv Contrast,,70482,CPT,Facility,Both,,,,1683,1430.55,412.496,1683,Aetna,Commercial,1548.36,92,,percent of total billed charges,,
Ct Orbits Sella Iac Wo W Iv Contrast,,70482,CPT,Facility,Outpatient,,,,1683,1430.55,412.496,1683,Aetna,Medicare Advantage,824.67,49,,percent of total billed charges,,
Ct Orbits Sella Iac Wo W Iv Contrast,,70482,CPT,Facility,Inpatient,,,,1683,1430.55,412.496,1683,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Ct Orbits Sella Iac Wo W Iv Contrast,,70482,CPT,Facility,Both,,,,1683,1430.55,412.496,1683,Aetna,PPO,1565.19,93,,percent of total billed charges,,
Ct Orbits Sella Iac Wo W Iv Contrast,,70482,CPT,Facility,Both,,,,1683,1430.55,412.496,1683,America's PPO,America's PPO,1616.1849,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Ct Orbits Sella Iac Wo W Iv Contrast,,70482,CPT,Facility,Both,,,,1683,1430.55,412.496,1683,BlueCross BlueShield Minnesota, Federal Employee Program,812,,,Fee schedule,,100% of BCBS commercial commodity fee schedule
Ct Orbits Sella Iac Wo W Iv Contrast,,70482,CPT,Facility,Both,,,,1683,1430.55,412.496,1683,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,824.992,,,Fee schedule,,"100% of BCBS commercial commodity fee schedule, plus MN Care tax"
Ct Orbits Sella Iac Wo W Iv Contrast,,70482,CPT,Facility,Both,,,,1683,1430.55,412.496,1683,BlueCross BlueShield Minnesota,High Value Network Plan,742.4928,,,Fee schedule,,"90% of BCBS commercial commodity fee schedule, plus MN Care tax; see disclaimer for more information"
Ct Orbits Sella Iac Wo W Iv Contrast,,70482,CPT,Facility,Outpatient,,,,1683,1430.55,412.496,1683,BlueCross BlueShield Minnesota,Medicare Advantage,824.67,49,,percent of total billed charges,,
Ct Orbits Sella Iac Wo W Iv Contrast,,70482,CPT,Facility,Inpatient,,,,1683,1430.55,412.496,1683,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Ct Orbits Sella Iac Wo W Iv Contrast,,70482,CPT,Facility,Both,,,,1683,1430.55,412.496,1683,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,730.6954144,,,Fee schedule,,"88.57% of BCBS commercial commodity fee schedule, plus MN Care tax"
Ct Orbits Sella Iac Wo W Iv Contrast,,70482,CPT,Facility,Both,,,,1683,1430.55,412.496,1683,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,412.496,,,Fee schedule,,"100% of BCBS Medicaid commodity fee schedule, plus MN Care tax"
Ct Orbits Sella Iac Wo W Iv Contrast,,70482,CPT,Facility,Outpatient,,,,1683,1430.55,412.496,1683,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),824.67,49,,percent of total billed charges,,
Ct Orbits Sella Iac Wo W Iv Contrast,,70482,CPT,Facility,Inpatient,,,,1683,1430.55,412.496,1683,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Ct Orbits Sella Iac Wo W Iv Contrast,,70482,CPT,Facility,Both,,,,1683,1430.55,412.496,1683,CorVel,Worker's Compensation,1683,100,,percent of total billed charges,,
Ct Orbits Sella Iac Wo W Iv Contrast,,70482,CPT,Facility,Both,,,,1683,1430.55,412.496,1683,First Health Group Corporation,First Health Network,1632.51,97,,percent of total billed charges,,
Ct Orbits Sella Iac Wo W Iv Contrast,,70482,CPT,Facility,Both,,,,1683,1430.55,412.496,1683,"Health Partners, Inc.",Commercial,1592.118,94.6,,percent of total billed charges,,
Ct Orbits Sella Iac Wo W Iv Contrast,,70482,CPT,Facility,Outpatient,,,,1683,1430.55,412.496,1683,"Health Partners, Inc.",Medicare Advantage,824.67,49,,percent of total billed charges,,
Ct Orbits Sella Iac Wo W Iv Contrast,,70482,CPT,Facility,Inpatient,,,,1683,1430.55,412.496,1683,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ct Orbits Sella Iac Wo W Iv Contrast,,70482,CPT,Facility,Both,,,,1683,1430.55,412.496,1683,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1009.8,60,,percent of total billed charges,,
Ct Orbits Sella Iac Wo W Iv Contrast,,70482,CPT,Facility,Both,,,,1683,1430.55,412.496,1683,"Health Partners, Inc.",State of Minnesota Advantage Program,1371.645,81.5,,percent of total billed charges,,
Ct Orbits Sella Iac Wo W Iv Contrast,,70482,CPT,Facility,Both,,,,1683,1430.55,412.496,1683,"Health Partners, Inc.",State Public Programs,841.5,50,,percent of total billed charges,,
Ct Orbits Sella Iac Wo W Iv Contrast,,70482,CPT,Facility,Both,,,,1683,1430.55,412.496,1683,Humana Insurance Company,Commercial PPO,1598.85,95,,percent of total billed charges,,
Ct Orbits Sella Iac Wo W Iv Contrast,,70482,CPT,Facility,Outpatient,,,,1683,1430.55,412.496,1683,Humana Insurance Company,Medicare PPO,824.67,49,,percent of total billed charges,,
Ct Orbits Sella Iac Wo W Iv Contrast,,70482,CPT,Facility,Inpatient,,,,1683,1430.55,412.496,1683,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Ct Orbits Sella Iac Wo W Iv Contrast,,70482,CPT,Facility,Both,,,,1683,1430.55,412.496,1683,Medica,Individual & Family,1667.853,99.1,,percent of total billed charges,,
Ct Orbits Sella Iac Wo W Iv Contrast,,70482,CPT,Facility,Outpatient,,,,1683,1430.55,412.496,1683,Medica,Medica Advantage Solution,838.134,49.8,,percent of total billed charges,,
Ct Orbits Sella Iac Wo W Iv Contrast,,70482,CPT,Facility,Inpatient,,,,1683,1430.55,412.496,1683,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Ct Orbits Sella Iac Wo W Iv Contrast,,70482,CPT,Facility,Outpatient,,,,1683,1430.55,412.496,1683,Medica,Medical Assistance,499,,,Other,Per visit,Pays in addition to all Outpatient Service Categories
Ct Orbits Sella Iac Wo W Iv Contrast,,70482,CPT,Facility,Inpatient,,,,1683,1430.55,412.496,1683,Medica,Medical Assistance,,,,,Included in per diem rate,
Ct Orbits Sella Iac Wo W Iv Contrast,,70482,CPT,Facility,Outpatient,,,,1683,1430.55,412.496,1683,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,838.134,49.8,,percent of total billed charges,,
Ct Orbits Sella Iac Wo W Iv Contrast,,70482,CPT,Facility,Inpatient,,,,1683,1430.55,412.496,1683,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Ct Orbits Sella Iac Wo W Iv Contrast,,70482,CPT,Facility,Both,,,,1683,1430.55,412.496,1683,"Multiplan, Inc.","Multiplan, Inc.",1582.02,94,,percent of total billed charges,,
Ct Orbits Sella Iac Wo W Iv Contrast,,70482,CPT,Facility,Outpatient,,,,1683,1430.55,412.496,1683,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1283,,,Other,Per scan,
Ct Orbits Sella Iac Wo W Iv Contrast,,70482,CPT,Facility,Inpatient,,,,1683,1430.55,412.496,1683,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Ct Orbits Sella Iac Wo W Iv Contrast,,70482,CPT,Facility,Both,,,,1683,1430.55,412.496,1683,"Preferred One Administrative Services, INC.",PPO,1659.438,98.6,,percent of total billed charges,,
Ct Orbits Sella Iac Wo W Iv Contrast,,70482,CPT,Facility,Outpatient,,,,1683,1430.55,412.496,1683,PrimeWest Health,Minnesota Senior Health Options (MSHO),865.9035,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Ct Orbits Sella Iac Wo W Iv Contrast,,70482,CPT,Facility,Inpatient,,,,1683,1430.55,412.496,1683,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ct Orbits Sella Iac Wo W Iv Contrast,,70482,CPT,Facility,Outpatient,,,,1683,1430.55,412.496,1683,PrimeWest Health,MinnesotaCare,864.3888,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Ct Orbits Sella Iac Wo W Iv Contrast,,70482,CPT,Facility,Inpatient,,,,1683,1430.55,412.496,1683,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Ct Orbits Sella Iac Wo W Iv Contrast,,70482,CPT,Facility,Both,,,,1683,1430.55,412.496,1683,Sanford Health Plan,Sanford Health Plan,1548.36,92,,percent of total billed charges,,
Ct Orbits Sella Iac Wo W Iv Contrast,,70482,CPT,Facility,Outpatient,,,,1683,1430.55,412.496,1683,"UCare Health, Inc.",Individual & Family Plan,948.3705,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Ct Orbits Sella Iac Wo W Iv Contrast,,70482,CPT,Facility,Inpatient,,,,1683,1430.55,412.496,1683,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Ct Orbits Sella Iac Wo W Iv Contrast,,70482,CPT,Facility,Outpatient,,,,1683,1430.55,412.496,1683,"UCare Health, Inc.",Medical Assistance,849.4101,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ct Orbits Sella Iac Wo W Iv Contrast,,70482,CPT,Facility,Inpatient,,,,1683,1430.55,412.496,1683,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Ct Orbits Sella Iac Wo W Iv Contrast,,70482,CPT,Facility,Outpatient,,,,1683,1430.55,412.496,1683,"UCare Health, Inc.",Medicare Advantage,849.4101,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ct Orbits Sella Iac Wo W Iv Contrast,,70482,CPT,Facility,Inpatient,,,,1683,1430.55,412.496,1683,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ct Orbits Sella Iac Wo W Iv Contrast,,70482,CPT,Facility,Outpatient,,,,1683,1430.55,412.496,1683,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),849.4101,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ct Orbits Sella Iac Wo W Iv Contrast,,70482,CPT,Facility,Inpatient,,,,1683,1430.55,412.496,1683,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ct Orbits Sella Iac Wo W Iv Contrast,,70482,CPT,Facility,Both,,,,1683,1430.55,412.496,1683,UnitedHealthcare,Individual & Family,1582.02,94,,percent of total billed charges,,
Ct Orbits Sella Iac Wo W Iv Contrast,,70482,CPT,Facility,Outpatient,,,,1683,1430.55,412.496,1683,UnitedHealthcare,Medicare Advantage,824.67,49,,percent of total billed charges,,
Ct Orbits Sella Iac Wo W Iv Contrast,,70482,CPT,Facility,Inpatient,,,,1683,1430.55,412.496,1683,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Ct Orbits Sella Iac Wo W Iv Contrast,,70482,CPT,Facility,Outpatient,,,,1683,1430.55,412.496,1683,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,807.84,48,,percent of total billed charges,,100% of DHS outpatient percentage
Ct Orbits Sella Iac Wo W Iv Contrast,,70482,CPT,Facility,Inpatient,,,,1683,1430.55,412.496,1683,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Ct Posterior Fossa Ear Wo W Iv Contrast,,70482,CPT,Facility,Both,,,,1683,1430.55,412.496,1683,Aetna,Commercial,1548.36,92,,percent of total billed charges,,
Ct Posterior Fossa Ear Wo W Iv Contrast,,70482,CPT,Facility,Outpatient,,,,1683,1430.55,412.496,1683,Aetna,Medicare Advantage,824.67,49,,percent of total billed charges,,
Ct Posterior Fossa Ear Wo W Iv Contrast,,70482,CPT,Facility,Inpatient,,,,1683,1430.55,412.496,1683,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Ct Posterior Fossa Ear Wo W Iv Contrast,,70482,CPT,Facility,Both,,,,1683,1430.55,412.496,1683,Aetna,PPO,1565.19,93,,percent of total billed charges,,
Ct Posterior Fossa Ear Wo W Iv Contrast,,70482,CPT,Facility,Both,,,,1683,1430.55,412.496,1683,America's PPO,America's PPO,1616.1849,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Ct Posterior Fossa Ear Wo W Iv Contrast,,70482,CPT,Facility,Both,,,,1683,1430.55,412.496,1683,BlueCross BlueShield Minnesota, Federal Employee Program,812,,,Fee schedule,,100% of BCBS commercial commodity fee schedule
Ct Posterior Fossa Ear Wo W Iv Contrast,,70482,CPT,Facility,Both,,,,1683,1430.55,412.496,1683,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,824.992,,,Fee schedule,,"100% of BCBS commercial commodity fee schedule, plus MN Care tax"
Ct Posterior Fossa Ear Wo W Iv Contrast,,70482,CPT,Facility,Both,,,,1683,1430.55,412.496,1683,BlueCross BlueShield Minnesota,High Value Network Plan,742.4928,,,Fee schedule,,"90% of BCBS commercial commodity fee schedule, plus MN Care tax; see disclaimer for more information"
Ct Posterior Fossa Ear Wo W Iv Contrast,,70482,CPT,Facility,Outpatient,,,,1683,1430.55,412.496,1683,BlueCross BlueShield Minnesota,Medicare Advantage,824.67,49,,percent of total billed charges,,
Ct Posterior Fossa Ear Wo W Iv Contrast,,70482,CPT,Facility,Inpatient,,,,1683,1430.55,412.496,1683,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Ct Posterior Fossa Ear Wo W Iv Contrast,,70482,CPT,Facility,Both,,,,1683,1430.55,412.496,1683,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,730.6954144,,,Fee schedule,,"88.57% of BCBS commercial commodity fee schedule, plus MN Care tax"
Ct Posterior Fossa Ear Wo W Iv Contrast,,70482,CPT,Facility,Both,,,,1683,1430.55,412.496,1683,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,412.496,,,Fee schedule,,"100% of BCBS Medicaid commodity fee schedule, plus MN Care tax"
Ct Posterior Fossa Ear Wo W Iv Contrast,,70482,CPT,Facility,Outpatient,,,,1683,1430.55,412.496,1683,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),824.67,49,,percent of total billed charges,,
Ct Posterior Fossa Ear Wo W Iv Contrast,,70482,CPT,Facility,Inpatient,,,,1683,1430.55,412.496,1683,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Ct Posterior Fossa Ear Wo W Iv Contrast,,70482,CPT,Facility,Both,,,,1683,1430.55,412.496,1683,CorVel,Worker's Compensation,1683,100,,percent of total billed charges,,
Ct Posterior Fossa Ear Wo W Iv Contrast,,70482,CPT,Facility,Both,,,,1683,1430.55,412.496,1683,First Health Group Corporation,First Health Network,1632.51,97,,percent of total billed charges,,
Ct Posterior Fossa Ear Wo W Iv Contrast,,70482,CPT,Facility,Both,,,,1683,1430.55,412.496,1683,"Health Partners, Inc.",Commercial,1592.118,94.6,,percent of total billed charges,,
Ct Posterior Fossa Ear Wo W Iv Contrast,,70482,CPT,Facility,Outpatient,,,,1683,1430.55,412.496,1683,"Health Partners, Inc.",Medicare Advantage,824.67,49,,percent of total billed charges,,
Ct Posterior Fossa Ear Wo W Iv Contrast,,70482,CPT,Facility,Inpatient,,,,1683,1430.55,412.496,1683,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ct Posterior Fossa Ear Wo W Iv Contrast,,70482,CPT,Facility,Both,,,,1683,1430.55,412.496,1683,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1009.8,60,,percent of total billed charges,,
Ct Posterior Fossa Ear Wo W Iv Contrast,,70482,CPT,Facility,Both,,,,1683,1430.55,412.496,1683,"Health Partners, Inc.",State of Minnesota Advantage Program,1371.645,81.5,,percent of total billed charges,,
Ct Posterior Fossa Ear Wo W Iv Contrast,,70482,CPT,Facility,Both,,,,1683,1430.55,412.496,1683,"Health Partners, Inc.",State Public Programs,841.5,50,,percent of total billed charges,,
Ct Posterior Fossa Ear Wo W Iv Contrast,,70482,CPT,Facility,Both,,,,1683,1430.55,412.496,1683,Humana Insurance Company,Commercial PPO,1598.85,95,,percent of total billed charges,,
Ct Posterior Fossa Ear Wo W Iv Contrast,,70482,CPT,Facility,Outpatient,,,,1683,1430.55,412.496,1683,Humana Insurance Company,Medicare PPO,824.67,49,,percent of total billed charges,,
Ct Posterior Fossa Ear Wo W Iv Contrast,,70482,CPT,Facility,Inpatient,,,,1683,1430.55,412.496,1683,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Ct Posterior Fossa Ear Wo W Iv Contrast,,70482,CPT,Facility,Both,,,,1683,1430.55,412.496,1683,Medica,Individual & Family,1667.853,99.1,,percent of total billed charges,,
Ct Posterior Fossa Ear Wo W Iv Contrast,,70482,CPT,Facility,Outpatient,,,,1683,1430.55,412.496,1683,Medica,Medica Advantage Solution,838.134,49.8,,percent of total billed charges,,
Ct Posterior Fossa Ear Wo W Iv Contrast,,70482,CPT,Facility,Inpatient,,,,1683,1430.55,412.496,1683,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Ct Posterior Fossa Ear Wo W Iv Contrast,,70482,CPT,Facility,Outpatient,,,,1683,1430.55,412.496,1683,Medica,Medical Assistance,750.618,44.6,,percent of total billed charges,,
Ct Posterior Fossa Ear Wo W Iv Contrast,,70482,CPT,Facility,Inpatient,,,,1683,1430.55,412.496,1683,Medica,Medical Assistance,,,,,Included in per diem rate,
Ct Posterior Fossa Ear Wo W Iv Contrast,,70482,CPT,Facility,Outpatient,,,,1683,1430.55,412.496,1683,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,838.134,49.8,,percent of total billed charges,,
Ct Posterior Fossa Ear Wo W Iv Contrast,,70482,CPT,Facility,Inpatient,,,,1683,1430.55,412.496,1683,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Ct Posterior Fossa Ear Wo W Iv Contrast,,70482,CPT,Facility,Both,,,,1683,1430.55,412.496,1683,"Multiplan, Inc.","Multiplan, Inc.",1582.02,94,,percent of total billed charges,,
Ct Posterior Fossa Ear Wo W Iv Contrast,,70482,CPT,Facility,Outpatient,,,,1683,1430.55,412.496,1683,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1283,,,Other,Per scan,
Ct Posterior Fossa Ear Wo W Iv Contrast,,70482,CPT,Facility,Inpatient,,,,1683,1430.55,412.496,1683,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Ct Posterior Fossa Ear Wo W Iv Contrast,,70482,CPT,Facility,Both,,,,1683,1430.55,412.496,1683,"Preferred One Administrative Services, INC.",PPO,1659.438,98.6,,percent of total billed charges,,
Ct Posterior Fossa Ear Wo W Iv Contrast,,70482,CPT,Facility,Outpatient,,,,1683,1430.55,412.496,1683,PrimeWest Health,Minnesota Senior Health Options (MSHO),865.9035,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Ct Posterior Fossa Ear Wo W Iv Contrast,,70482,CPT,Facility,Inpatient,,,,1683,1430.55,412.496,1683,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ct Posterior Fossa Ear Wo W Iv Contrast,,70482,CPT,Facility,Outpatient,,,,1683,1430.55,412.496,1683,PrimeWest Health,MinnesotaCare,864.3888,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Ct Posterior Fossa Ear Wo W Iv Contrast,,70482,CPT,Facility,Inpatient,,,,1683,1430.55,412.496,1683,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Ct Posterior Fossa Ear Wo W Iv Contrast,,70482,CPT,Facility,Both,,,,1683,1430.55,412.496,1683,Sanford Health Plan,Sanford Health Plan,1548.36,92,,percent of total billed charges,,
Ct Posterior Fossa Ear Wo W Iv Contrast,,70482,CPT,Facility,Outpatient,,,,1683,1430.55,412.496,1683,"UCare Health, Inc.",Individual & Family Plan,948.3705,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Ct Posterior Fossa Ear Wo W Iv Contrast,,70482,CPT,Facility,Inpatient,,,,1683,1430.55,412.496,1683,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Ct Posterior Fossa Ear Wo W Iv Contrast,,70482,CPT,Facility,Outpatient,,,,1683,1430.55,412.496,1683,"UCare Health, Inc.",Medical Assistance,849.4101,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ct Posterior Fossa Ear Wo W Iv Contrast,,70482,CPT,Facility,Inpatient,,,,1683,1430.55,412.496,1683,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Ct Posterior Fossa Ear Wo W Iv Contrast,,70482,CPT,Facility,Outpatient,,,,1683,1430.55,412.496,1683,"UCare Health, Inc.",Medicare Advantage,849.4101,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ct Posterior Fossa Ear Wo W Iv Contrast,,70482,CPT,Facility,Inpatient,,,,1683,1430.55,412.496,1683,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ct Posterior Fossa Ear Wo W Iv Contrast,,70482,CPT,Facility,Outpatient,,,,1683,1430.55,412.496,1683,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),849.4101,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ct Posterior Fossa Ear Wo W Iv Contrast,,70482,CPT,Facility,Inpatient,,,,1683,1430.55,412.496,1683,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ct Posterior Fossa Ear Wo W Iv Contrast,,70482,CPT,Facility,Both,,,,1683,1430.55,412.496,1683,UnitedHealthcare,Individual & Family,1582.02,94,,percent of total billed charges,,
Ct Posterior Fossa Ear Wo W Iv Contrast,,70482,CPT,Facility,Outpatient,,,,1683,1430.55,412.496,1683,UnitedHealthcare,Medicare Advantage,824.67,49,,percent of total billed charges,,
Ct Posterior Fossa Ear Wo W Iv Contrast,,70482,CPT,Facility,Inpatient,,,,1683,1430.55,412.496,1683,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Ct Posterior Fossa Ear Wo W Iv Contrast,,70482,CPT,Facility,Outpatient,,,,1683,1430.55,412.496,1683,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,807.84,48,,percent of total billed charges,,100% of DHS outpatient percentage
Ct Posterior Fossa Ear Wo W Iv Contrast,,70482,CPT,Facility,Inpatient,,,,1683,1430.55,412.496,1683,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Ct Facial Bones Wo Iv Contrast,,70486,CPT,Facility,Both,,,,1391,1182.35,325.628,1391,Aetna,Commercial,1279.72,92,,percent of total billed charges,,
Ct Facial Bones Wo Iv Contrast,,70486,CPT,Facility,Outpatient,,,,1391,1182.35,325.628,1391,Aetna,Medicare Advantage,681.59,49,,percent of total billed charges,,
Ct Facial Bones Wo Iv Contrast,,70486,CPT,Facility,Inpatient,,,,1391,1182.35,325.628,1391,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Ct Facial Bones Wo Iv Contrast,,70486,CPT,Facility,Both,,,,1391,1182.35,325.628,1391,Aetna,PPO,1293.63,93,,percent of total billed charges,,
Ct Facial Bones Wo Iv Contrast,,70486,CPT,Facility,Both,,,,1391,1182.35,325.628,1391,America's PPO,America's PPO,1335.7773,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Ct Facial Bones Wo Iv Contrast,,70486,CPT,Facility,Both,,,,1391,1182.35,325.628,1391,BlueCross BlueShield Minnesota, Federal Employee Program,641,,,Fee schedule,,100% of BCBS commercial commodity fee schedule
Ct Facial Bones Wo Iv Contrast,,70486,CPT,Facility,Both,,,,1391,1182.35,325.628,1391,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,651.256,,,Fee schedule,,"100% of BCBS commercial commodity fee schedule, plus MN Care tax"
Ct Facial Bones Wo Iv Contrast,,70486,CPT,Facility,Both,,,,1391,1182.35,325.628,1391,BlueCross BlueShield Minnesota,High Value Network Plan,586.1304,,,Fee schedule,,"90% of BCBS commercial commodity fee schedule, plus MN Care tax; see disclaimer for more information"
Ct Facial Bones Wo Iv Contrast,,70486,CPT,Facility,Outpatient,,,,1391,1182.35,325.628,1391,BlueCross BlueShield Minnesota,Medicare Advantage,681.59,49,,percent of total billed charges,,
Ct Facial Bones Wo Iv Contrast,,70486,CPT,Facility,Inpatient,,,,1391,1182.35,325.628,1391,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Ct Facial Bones Wo Iv Contrast,,70486,CPT,Facility,Both,,,,1391,1182.35,325.628,1391,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,576.8174392,,,Fee schedule,,"88.57% of BCBS commercial commodity fee schedule, plus MN Care tax"
Ct Facial Bones Wo Iv Contrast,,70486,CPT,Facility,Both,,,,1391,1182.35,325.628,1391,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,325.628,,,Fee schedule,,"100% of BCBS Medicaid commodity fee schedule, plus MN Care tax"
Ct Facial Bones Wo Iv Contrast,,70486,CPT,Facility,Outpatient,,,,1391,1182.35,325.628,1391,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),681.59,49,,percent of total billed charges,,
Ct Facial Bones Wo Iv Contrast,,70486,CPT,Facility,Inpatient,,,,1391,1182.35,325.628,1391,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Ct Facial Bones Wo Iv Contrast,,70486,CPT,Facility,Both,,,,1391,1182.35,325.628,1391,CorVel,Worker's Compensation,1391,100,,percent of total billed charges,,
Ct Facial Bones Wo Iv Contrast,,70486,CPT,Facility,Both,,,,1391,1182.35,325.628,1391,First Health Group Corporation,First Health Network,1349.27,97,,percent of total billed charges,,
Ct Facial Bones Wo Iv Contrast,,70486,CPT,Facility,Both,,,,1391,1182.35,325.628,1391,"Health Partners, Inc.",Commercial,1315.886,94.6,,percent of total billed charges,,
Ct Facial Bones Wo Iv Contrast,,70486,CPT,Facility,Outpatient,,,,1391,1182.35,325.628,1391,"Health Partners, Inc.",Medicare Advantage,681.59,49,,percent of total billed charges,,
Ct Facial Bones Wo Iv Contrast,,70486,CPT,Facility,Inpatient,,,,1391,1182.35,325.628,1391,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ct Facial Bones Wo Iv Contrast,,70486,CPT,Facility,Both,,,,1391,1182.35,325.628,1391,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),834.6,60,,percent of total billed charges,,
Ct Facial Bones Wo Iv Contrast,,70486,CPT,Facility,Both,,,,1391,1182.35,325.628,1391,"Health Partners, Inc.",State of Minnesota Advantage Program,1133.665,81.5,,percent of total billed charges,,
Ct Facial Bones Wo Iv Contrast,,70486,CPT,Facility,Both,,,,1391,1182.35,325.628,1391,"Health Partners, Inc.",State Public Programs,695.5,50,,percent of total billed charges,,
Ct Facial Bones Wo Iv Contrast,,70486,CPT,Facility,Both,,,,1391,1182.35,325.628,1391,Humana Insurance Company,Commercial PPO,1321.45,95,,percent of total billed charges,,
Ct Facial Bones Wo Iv Contrast,,70486,CPT,Facility,Outpatient,,,,1391,1182.35,325.628,1391,Humana Insurance Company,Medicare PPO,681.59,49,,percent of total billed charges,,
Ct Facial Bones Wo Iv Contrast,,70486,CPT,Facility,Inpatient,,,,1391,1182.35,325.628,1391,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Ct Facial Bones Wo Iv Contrast,,70486,CPT,Facility,Both,,,,1391,1182.35,325.628,1391,Medica,Individual & Family,1378.481,99.1,,percent of total billed charges,,
Ct Facial Bones Wo Iv Contrast,,70486,CPT,Facility,Outpatient,,,,1391,1182.35,325.628,1391,Medica,Medica Advantage Solution,692.718,49.8,,percent of total billed charges,,
Ct Facial Bones Wo Iv Contrast,,70486,CPT,Facility,Inpatient,,,,1391,1182.35,325.628,1391,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Ct Facial Bones Wo Iv Contrast,,70486,CPT,Facility,Outpatient,,,,1391,1182.35,325.628,1391,Medica,Medical Assistance,499,,,Other,Per visit,Pays in addition to all Outpatient Service Categories
Ct Facial Bones Wo Iv Contrast,,70486,CPT,Facility,Inpatient,,,,1391,1182.35,325.628,1391,Medica,Medical Assistance,,,,,Included in per diem rate,
Ct Facial Bones Wo Iv Contrast,,70486,CPT,Facility,Outpatient,,,,1391,1182.35,325.628,1391,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,692.718,49.8,,percent of total billed charges,,
Ct Facial Bones Wo Iv Contrast,,70486,CPT,Facility,Inpatient,,,,1391,1182.35,325.628,1391,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Ct Facial Bones Wo Iv Contrast,,70486,CPT,Facility,Both,,,,1391,1182.35,325.628,1391,"Multiplan, Inc.","Multiplan, Inc.",1307.54,94,,percent of total billed charges,,
Ct Facial Bones Wo Iv Contrast,,70486,CPT,Facility,Outpatient,,,,1391,1182.35,325.628,1391,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1283,,,Other,Per scan,
Ct Facial Bones Wo Iv Contrast,,70486,CPT,Facility,Inpatient,,,,1391,1182.35,325.628,1391,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Ct Facial Bones Wo Iv Contrast,,70486,CPT,Facility,Both,,,,1391,1182.35,325.628,1391,"Preferred One Administrative Services, INC.",PPO,1371.526,98.6,,percent of total billed charges,,
Ct Facial Bones Wo Iv Contrast,,70486,CPT,Facility,Outpatient,,,,1391,1182.35,325.628,1391,PrimeWest Health,Minnesota Senior Health Options (MSHO),715.6695,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Ct Facial Bones Wo Iv Contrast,,70486,CPT,Facility,Inpatient,,,,1391,1182.35,325.628,1391,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ct Facial Bones Wo Iv Contrast,,70486,CPT,Facility,Outpatient,,,,1391,1182.35,325.628,1391,PrimeWest Health,MinnesotaCare,714.4176,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Ct Facial Bones Wo Iv Contrast,,70486,CPT,Facility,Inpatient,,,,1391,1182.35,325.628,1391,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Ct Facial Bones Wo Iv Contrast,,70486,CPT,Facility,Both,,,,1391,1182.35,325.628,1391,Sanford Health Plan,Sanford Health Plan,1279.72,92,,percent of total billed charges,,
Ct Facial Bones Wo Iv Contrast,,70486,CPT,Facility,Outpatient,,,,1391,1182.35,325.628,1391,"UCare Health, Inc.",Individual & Family Plan,783.8285,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Ct Facial Bones Wo Iv Contrast,,70486,CPT,Facility,Inpatient,,,,1391,1182.35,325.628,1391,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Ct Facial Bones Wo Iv Contrast,,70486,CPT,Facility,Outpatient,,,,1391,1182.35,325.628,1391,"UCare Health, Inc.",Medical Assistance,702.0377,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ct Facial Bones Wo Iv Contrast,,70486,CPT,Facility,Inpatient,,,,1391,1182.35,325.628,1391,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Ct Facial Bones Wo Iv Contrast,,70486,CPT,Facility,Outpatient,,,,1391,1182.35,325.628,1391,"UCare Health, Inc.",Medicare Advantage,702.0377,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ct Facial Bones Wo Iv Contrast,,70486,CPT,Facility,Inpatient,,,,1391,1182.35,325.628,1391,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ct Facial Bones Wo Iv Contrast,,70486,CPT,Facility,Outpatient,,,,1391,1182.35,325.628,1391,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),702.0377,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ct Facial Bones Wo Iv Contrast,,70486,CPT,Facility,Inpatient,,,,1391,1182.35,325.628,1391,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ct Facial Bones Wo Iv Contrast,,70486,CPT,Facility,Both,,,,1391,1182.35,325.628,1391,UnitedHealthcare,Individual & Family,1307.54,94,,percent of total billed charges,,
Ct Facial Bones Wo Iv Contrast,,70486,CPT,Facility,Outpatient,,,,1391,1182.35,325.628,1391,UnitedHealthcare,Medicare Advantage,681.59,49,,percent of total billed charges,,
Ct Facial Bones Wo Iv Contrast,,70486,CPT,Facility,Inpatient,,,,1391,1182.35,325.628,1391,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Ct Facial Bones Wo Iv Contrast,,70486,CPT,Facility,Outpatient,,,,1391,1182.35,325.628,1391,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,667.68,48,,percent of total billed charges,,100% of DHS outpatient percentage
Ct Facial Bones Wo Iv Contrast,,70486,CPT,Facility,Inpatient,,,,1391,1182.35,325.628,1391,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Ct Sinus Wo Iv Contrast,,70486,CPT,Facility,Both,,,,1391,1182.35,325.628,1391,Aetna,Commercial,1279.72,92,,percent of total billed charges,,
Ct Sinus Wo Iv Contrast,,70486,CPT,Facility,Outpatient,,,,1391,1182.35,325.628,1391,Aetna,Medicare Advantage,681.59,49,,percent of total billed charges,,
Ct Sinus Wo Iv Contrast,,70486,CPT,Facility,Inpatient,,,,1391,1182.35,325.628,1391,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Ct Sinus Wo Iv Contrast,,70486,CPT,Facility,Both,,,,1391,1182.35,325.628,1391,Aetna,PPO,1293.63,93,,percent of total billed charges,,
Ct Sinus Wo Iv Contrast,,70486,CPT,Facility,Both,,,,1391,1182.35,325.628,1391,America's PPO,America's PPO,1335.7773,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Ct Sinus Wo Iv Contrast,,70486,CPT,Facility,Both,,,,1391,1182.35,325.628,1391,BlueCross BlueShield Minnesota, Federal Employee Program,641,,,Fee schedule,,100% of BCBS commercial commodity fee schedule
Ct Sinus Wo Iv Contrast,,70486,CPT,Facility,Both,,,,1391,1182.35,325.628,1391,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,651.256,,,Fee schedule,,"100% of BCBS commercial commodity fee schedule, plus MN Care tax"
Ct Sinus Wo Iv Contrast,,70486,CPT,Facility,Both,,,,1391,1182.35,325.628,1391,BlueCross BlueShield Minnesota,High Value Network Plan,586.1304,,,Fee schedule,,"90% of BCBS commercial commodity fee schedule, plus MN Care tax; see disclaimer for more information"
Ct Sinus Wo Iv Contrast,,70486,CPT,Facility,Outpatient,,,,1391,1182.35,325.628,1391,BlueCross BlueShield Minnesota,Medicare Advantage,681.59,49,,percent of total billed charges,,
Ct Sinus Wo Iv Contrast,,70486,CPT,Facility,Inpatient,,,,1391,1182.35,325.628,1391,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Ct Sinus Wo Iv Contrast,,70486,CPT,Facility,Both,,,,1391,1182.35,325.628,1391,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,576.8174392,,,Fee schedule,,"88.57% of BCBS commercial commodity fee schedule, plus MN Care tax"
Ct Sinus Wo Iv Contrast,,70486,CPT,Facility,Both,,,,1391,1182.35,325.628,1391,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,325.628,,,Fee schedule,,"100% of BCBS Medicaid commodity fee schedule, plus MN Care tax"
Ct Sinus Wo Iv Contrast,,70486,CPT,Facility,Outpatient,,,,1391,1182.35,325.628,1391,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),681.59,49,,percent of total billed charges,,
Ct Sinus Wo Iv Contrast,,70486,CPT,Facility,Inpatient,,,,1391,1182.35,325.628,1391,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Ct Sinus Wo Iv Contrast,,70486,CPT,Facility,Both,,,,1391,1182.35,325.628,1391,CorVel,Worker's Compensation,1391,100,,percent of total billed charges,,
Ct Sinus Wo Iv Contrast,,70486,CPT,Facility,Both,,,,1391,1182.35,325.628,1391,First Health Group Corporation,First Health Network,1349.27,97,,percent of total billed charges,,
Ct Sinus Wo Iv Contrast,,70486,CPT,Facility,Both,,,,1391,1182.35,325.628,1391,"Health Partners, Inc.",Commercial,1315.886,94.6,,percent of total billed charges,,
Ct Sinus Wo Iv Contrast,,70486,CPT,Facility,Outpatient,,,,1391,1182.35,325.628,1391,"Health Partners, Inc.",Medicare Advantage,681.59,49,,percent of total billed charges,,
Ct Sinus Wo Iv Contrast,,70486,CPT,Facility,Inpatient,,,,1391,1182.35,325.628,1391,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ct Sinus Wo Iv Contrast,,70486,CPT,Facility,Both,,,,1391,1182.35,325.628,1391,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),834.6,60,,percent of total billed charges,,
Ct Sinus Wo Iv Contrast,,70486,CPT,Facility,Both,,,,1391,1182.35,325.628,1391,"Health Partners, Inc.",State of Minnesota Advantage Program,1133.665,81.5,,percent of total billed charges,,
Ct Sinus Wo Iv Contrast,,70486,CPT,Facility,Both,,,,1391,1182.35,325.628,1391,"Health Partners, Inc.",State Public Programs,695.5,50,,percent of total billed charges,,
Ct Sinus Wo Iv Contrast,,70486,CPT,Facility,Both,,,,1391,1182.35,325.628,1391,Humana Insurance Company,Commercial PPO,1321.45,95,,percent of total billed charges,,
Ct Sinus Wo Iv Contrast,,70486,CPT,Facility,Outpatient,,,,1391,1182.35,325.628,1391,Humana Insurance Company,Medicare PPO,681.59,49,,percent of total billed charges,,
Ct Sinus Wo Iv Contrast,,70486,CPT,Facility,Inpatient,,,,1391,1182.35,325.628,1391,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Ct Sinus Wo Iv Contrast,,70486,CPT,Facility,Both,,,,1391,1182.35,325.628,1391,Medica,Individual & Family,1378.481,99.1,,percent of total billed charges,,
Ct Sinus Wo Iv Contrast,,70486,CPT,Facility,Outpatient,,,,1391,1182.35,325.628,1391,Medica,Medica Advantage Solution,692.718,49.8,,percent of total billed charges,,
Ct Sinus Wo Iv Contrast,,70486,CPT,Facility,Inpatient,,,,1391,1182.35,325.628,1391,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Ct Sinus Wo Iv Contrast,,70486,CPT,Facility,Outpatient,,,,1391,1182.35,325.628,1391,Medica,Medical Assistance,620.386,44.6,,percent of total billed charges,,
Ct Sinus Wo Iv Contrast,,70486,CPT,Facility,Inpatient,,,,1391,1182.35,325.628,1391,Medica,Medical Assistance,,,,,Included in per diem rate,
Ct Sinus Wo Iv Contrast,,70486,CPT,Facility,Outpatient,,,,1391,1182.35,325.628,1391,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,692.718,49.8,,percent of total billed charges,,
Ct Sinus Wo Iv Contrast,,70486,CPT,Facility,Inpatient,,,,1391,1182.35,325.628,1391,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Ct Sinus Wo Iv Contrast,,70486,CPT,Facility,Both,,,,1391,1182.35,325.628,1391,"Multiplan, Inc.","Multiplan, Inc.",1307.54,94,,percent of total billed charges,,
Ct Sinus Wo Iv Contrast,,70486,CPT,Facility,Outpatient,,,,1391,1182.35,325.628,1391,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1283,,,Other,Per scan,
Ct Sinus Wo Iv Contrast,,70486,CPT,Facility,Inpatient,,,,1391,1182.35,325.628,1391,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Ct Sinus Wo Iv Contrast,,70486,CPT,Facility,Both,,,,1391,1182.35,325.628,1391,"Preferred One Administrative Services, INC.",PPO,1371.526,98.6,,percent of total billed charges,,
Ct Sinus Wo Iv Contrast,,70486,CPT,Facility,Outpatient,,,,1391,1182.35,325.628,1391,PrimeWest Health,Minnesota Senior Health Options (MSHO),715.6695,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Ct Sinus Wo Iv Contrast,,70486,CPT,Facility,Inpatient,,,,1391,1182.35,325.628,1391,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ct Sinus Wo Iv Contrast,,70486,CPT,Facility,Outpatient,,,,1391,1182.35,325.628,1391,PrimeWest Health,MinnesotaCare,714.4176,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Ct Sinus Wo Iv Contrast,,70486,CPT,Facility,Inpatient,,,,1391,1182.35,325.628,1391,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Ct Sinus Wo Iv Contrast,,70486,CPT,Facility,Both,,,,1391,1182.35,325.628,1391,Sanford Health Plan,Sanford Health Plan,1279.72,92,,percent of total billed charges,,
Ct Sinus Wo Iv Contrast,,70486,CPT,Facility,Outpatient,,,,1391,1182.35,325.628,1391,"UCare Health, Inc.",Individual & Family Plan,783.8285,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Ct Sinus Wo Iv Contrast,,70486,CPT,Facility,Inpatient,,,,1391,1182.35,325.628,1391,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Ct Sinus Wo Iv Contrast,,70486,CPT,Facility,Outpatient,,,,1391,1182.35,325.628,1391,"UCare Health, Inc.",Medical Assistance,702.0377,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ct Sinus Wo Iv Contrast,,70486,CPT,Facility,Inpatient,,,,1391,1182.35,325.628,1391,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Ct Sinus Wo Iv Contrast,,70486,CPT,Facility,Outpatient,,,,1391,1182.35,325.628,1391,"UCare Health, Inc.",Medicare Advantage,702.0377,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ct Sinus Wo Iv Contrast,,70486,CPT,Facility,Inpatient,,,,1391,1182.35,325.628,1391,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ct Sinus Wo Iv Contrast,,70486,CPT,Facility,Outpatient,,,,1391,1182.35,325.628,1391,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),702.0377,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ct Sinus Wo Iv Contrast,,70486,CPT,Facility,Inpatient,,,,1391,1182.35,325.628,1391,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ct Sinus Wo Iv Contrast,,70486,CPT,Facility,Both,,,,1391,1182.35,325.628,1391,UnitedHealthcare,Individual & Family,1307.54,94,,percent of total billed charges,,
Ct Sinus Wo Iv Contrast,,70486,CPT,Facility,Outpatient,,,,1391,1182.35,325.628,1391,UnitedHealthcare,Medicare Advantage,681.59,49,,percent of total billed charges,,
Ct Sinus Wo Iv Contrast,,70486,CPT,Facility,Inpatient,,,,1391,1182.35,325.628,1391,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Ct Sinus Wo Iv Contrast,,70486,CPT,Facility,Outpatient,,,,1391,1182.35,325.628,1391,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,667.68,48,,percent of total billed charges,,100% of DHS outpatient percentage
Ct Sinus Wo Iv Contrast,,70486,CPT,Facility,Inpatient,,,,1391,1182.35,325.628,1391,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Ct Facial Bones W Iv Contrast,,70487,CPT,Facility,Both,,,,1567,1331.95,412.496,1567,Aetna,Commercial,1441.64,92,,percent of total billed charges,,
Ct Facial Bones W Iv Contrast,,70487,CPT,Facility,Outpatient,,,,1567,1331.95,412.496,1567,Aetna,Medicare Advantage,767.83,49,,percent of total billed charges,,
Ct Facial Bones W Iv Contrast,,70487,CPT,Facility,Inpatient,,,,1567,1331.95,412.496,1567,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Ct Facial Bones W Iv Contrast,,70487,CPT,Facility,Both,,,,1567,1331.95,412.496,1567,Aetna,PPO,1457.31,93,,percent of total billed charges,,
Ct Facial Bones W Iv Contrast,,70487,CPT,Facility,Both,,,,1567,1331.95,412.496,1567,America's PPO,America's PPO,1504.7901,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Ct Facial Bones W Iv Contrast,,70487,CPT,Facility,Both,,,,1567,1331.95,412.496,1567,BlueCross BlueShield Minnesota, Federal Employee Program,812,,,Fee schedule,,100% of BCBS commercial commodity fee schedule
Ct Facial Bones W Iv Contrast,,70487,CPT,Facility,Both,,,,1567,1331.95,412.496,1567,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,824.992,,,Fee schedule,,"100% of BCBS commercial commodity fee schedule, plus MN Care tax"
Ct Facial Bones W Iv Contrast,,70487,CPT,Facility,Both,,,,1567,1331.95,412.496,1567,BlueCross BlueShield Minnesota,High Value Network Plan,742.4928,,,Fee schedule,,"90% of BCBS commercial commodity fee schedule, plus MN Care tax; see disclaimer for more information"
Ct Facial Bones W Iv Contrast,,70487,CPT,Facility,Outpatient,,,,1567,1331.95,412.496,1567,BlueCross BlueShield Minnesota,Medicare Advantage,767.83,49,,percent of total billed charges,,
Ct Facial Bones W Iv Contrast,,70487,CPT,Facility,Inpatient,,,,1567,1331.95,412.496,1567,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Ct Facial Bones W Iv Contrast,,70487,CPT,Facility,Both,,,,1567,1331.95,412.496,1567,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,730.6954144,,,Fee schedule,,"88.57% of BCBS commercial commodity fee schedule, plus MN Care tax"
Ct Facial Bones W Iv Contrast,,70487,CPT,Facility,Both,,,,1567,1331.95,412.496,1567,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,412.496,,,Fee schedule,,"100% of BCBS Medicaid commodity fee schedule, plus MN Care tax"
Ct Facial Bones W Iv Contrast,,70487,CPT,Facility,Outpatient,,,,1567,1331.95,412.496,1567,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),767.83,49,,percent of total billed charges,,
Ct Facial Bones W Iv Contrast,,70487,CPT,Facility,Inpatient,,,,1567,1331.95,412.496,1567,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Ct Facial Bones W Iv Contrast,,70487,CPT,Facility,Both,,,,1567,1331.95,412.496,1567,CorVel,Worker's Compensation,1567,100,,percent of total billed charges,,
Ct Facial Bones W Iv Contrast,,70487,CPT,Facility,Both,,,,1567,1331.95,412.496,1567,First Health Group Corporation,First Health Network,1519.99,97,,percent of total billed charges,,
Ct Facial Bones W Iv Contrast,,70487,CPT,Facility,Both,,,,1567,1331.95,412.496,1567,"Health Partners, Inc.",Commercial,1482.382,94.6,,percent of total billed charges,,
Ct Facial Bones W Iv Contrast,,70487,CPT,Facility,Outpatient,,,,1567,1331.95,412.496,1567,"Health Partners, Inc.",Medicare Advantage,767.83,49,,percent of total billed charges,,
Ct Facial Bones W Iv Contrast,,70487,CPT,Facility,Inpatient,,,,1567,1331.95,412.496,1567,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ct Facial Bones W Iv Contrast,,70487,CPT,Facility,Both,,,,1567,1331.95,412.496,1567,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),940.2,60,,percent of total billed charges,,
Ct Facial Bones W Iv Contrast,,70487,CPT,Facility,Both,,,,1567,1331.95,412.496,1567,"Health Partners, Inc.",State of Minnesota Advantage Program,1277.105,81.5,,percent of total billed charges,,
Ct Facial Bones W Iv Contrast,,70487,CPT,Facility,Both,,,,1567,1331.95,412.496,1567,"Health Partners, Inc.",State Public Programs,783.5,50,,percent of total billed charges,,
Ct Facial Bones W Iv Contrast,,70487,CPT,Facility,Both,,,,1567,1331.95,412.496,1567,Humana Insurance Company,Commercial PPO,1488.65,95,,percent of total billed charges,,
Ct Facial Bones W Iv Contrast,,70487,CPT,Facility,Outpatient,,,,1567,1331.95,412.496,1567,Humana Insurance Company,Medicare PPO,767.83,49,,percent of total billed charges,,
Ct Facial Bones W Iv Contrast,,70487,CPT,Facility,Inpatient,,,,1567,1331.95,412.496,1567,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Ct Facial Bones W Iv Contrast,,70487,CPT,Facility,Both,,,,1567,1331.95,412.496,1567,Medica,Individual & Family,1552.897,99.1,,percent of total billed charges,,
Ct Facial Bones W Iv Contrast,,70487,CPT,Facility,Outpatient,,,,1567,1331.95,412.496,1567,Medica,Medica Advantage Solution,780.366,49.8,,percent of total billed charges,,
Ct Facial Bones W Iv Contrast,,70487,CPT,Facility,Inpatient,,,,1567,1331.95,412.496,1567,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Ct Facial Bones W Iv Contrast,,70487,CPT,Facility,Outpatient,,,,1567,1331.95,412.496,1567,Medica,Medical Assistance,499,,,Other,Per visit,Pays in addition to all Outpatient Service Categories
Ct Facial Bones W Iv Contrast,,70487,CPT,Facility,Inpatient,,,,1567,1331.95,412.496,1567,Medica,Medical Assistance,,,,,Included in per diem rate,
Ct Facial Bones W Iv Contrast,,70487,CPT,Facility,Outpatient,,,,1567,1331.95,412.496,1567,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,780.366,49.8,,percent of total billed charges,,
Ct Facial Bones W Iv Contrast,,70487,CPT,Facility,Inpatient,,,,1567,1331.95,412.496,1567,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Ct Facial Bones W Iv Contrast,,70487,CPT,Facility,Both,,,,1567,1331.95,412.496,1567,"Multiplan, Inc.","Multiplan, Inc.",1472.98,94,,percent of total billed charges,,
Ct Facial Bones W Iv Contrast,,70487,CPT,Facility,Outpatient,,,,1567,1331.95,412.496,1567,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1283,,,Other ,Per scan,
Ct Facial Bones W Iv Contrast,,70487,CPT,Facility,Inpatient,,,,1567,1331.95,412.496,1567,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Ct Facial Bones W Iv Contrast,,70487,CPT,Facility,Both,,,,1567,1331.95,412.496,1567,"Preferred One Administrative Services, INC.",PPO,1545.062,98.6,,percent of total billed charges,,
Ct Facial Bones W Iv Contrast,,70487,CPT,Facility,Outpatient,,,,1567,1331.95,412.496,1567,PrimeWest Health,Minnesota Senior Health Options (MSHO),806.2215,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Ct Facial Bones W Iv Contrast,,70487,CPT,Facility,Inpatient,,,,1567,1331.95,412.496,1567,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ct Facial Bones W Iv Contrast,,70487,CPT,Facility,Outpatient,,,,1567,1331.95,412.496,1567,PrimeWest Health,MinnesotaCare,804.8112,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Ct Facial Bones W Iv Contrast,,70487,CPT,Facility,Inpatient,,,,1567,1331.95,412.496,1567,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Ct Facial Bones W Iv Contrast,,70487,CPT,Facility,Both,,,,1567,1331.95,412.496,1567,Sanford Health Plan,Sanford Health Plan,1441.64,92,,percent of total billed charges,,
Ct Facial Bones W Iv Contrast,,70487,CPT,Facility,Outpatient,,,,1567,1331.95,412.496,1567,"UCare Health, Inc.",Individual & Family Plan,883.0045,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Ct Facial Bones W Iv Contrast,,70487,CPT,Facility,Inpatient,,,,1567,1331.95,412.496,1567,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Ct Facial Bones W Iv Contrast,,70487,CPT,Facility,Outpatient,,,,1567,1331.95,412.496,1567,"UCare Health, Inc.",Medical Assistance,790.8649,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ct Facial Bones W Iv Contrast,,70487,CPT,Facility,Inpatient,,,,1567,1331.95,412.496,1567,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Ct Facial Bones W Iv Contrast,,70487,CPT,Facility,Outpatient,,,,1567,1331.95,412.496,1567,"UCare Health, Inc.",Medicare Advantage,790.8649,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ct Facial Bones W Iv Contrast,,70487,CPT,Facility,Inpatient,,,,1567,1331.95,412.496,1567,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ct Facial Bones W Iv Contrast,,70487,CPT,Facility,Outpatient,,,,1567,1331.95,412.496,1567,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),790.8649,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ct Facial Bones W Iv Contrast,,70487,CPT,Facility,Inpatient,,,,1567,1331.95,412.496,1567,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ct Facial Bones W Iv Contrast,,70487,CPT,Facility,Both,,,,1567,1331.95,412.496,1567,UnitedHealthcare,Individual & Family,1472.98,94,,percent of total billed charges,,
Ct Facial Bones W Iv Contrast,,70487,CPT,Facility,Outpatient,,,,1567,1331.95,412.496,1567,UnitedHealthcare,Medicare Advantage,767.83,49,,percent of total billed charges,,
Ct Facial Bones W Iv Contrast,,70487,CPT,Facility,Inpatient,,,,1567,1331.95,412.496,1567,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Ct Facial Bones W Iv Contrast,,70487,CPT,Facility,Outpatient,,,,1567,1331.95,412.496,1567,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,752.16,48,,percent of total billed charges,,100% of DHS outpatient percentage
Ct Facial Bones W Iv Contrast,,70487,CPT,Facility,Inpatient,,,,1567,1331.95,412.496,1567,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Ct Facial Bones W Wo Iv Contrast,,70488,CPT,Facility,Both,,,,1770,1504.5,412.496,1770,Aetna,Commercial,1628.4,92,,percent of total billed charges,,
Ct Facial Bones W Wo Iv Contrast,,70488,CPT,Facility,Outpatient,,,,1770,1504.5,412.496,1770,Aetna,Medicare Advantage,867.3,49,,percent of total billed charges,,
Ct Facial Bones W Wo Iv Contrast,,70488,CPT,Facility,Inpatient,,,,1770,1504.5,412.496,1770,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Ct Facial Bones W Wo Iv Contrast,,70488,CPT,Facility,Both,,,,1770,1504.5,412.496,1770,Aetna,PPO,1646.1,93,,percent of total billed charges,,
Ct Facial Bones W Wo Iv Contrast,,70488,CPT,Facility,Both,,,,1770,1504.5,412.496,1770,America's PPO,America's PPO,1699.731,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Ct Facial Bones W Wo Iv Contrast,,70488,CPT,Facility,Both,,,,1770,1504.5,412.496,1770,BlueCross BlueShield Minnesota, Federal Employee Program,812,,,Fee schedule,,100% of BCBS commercial commodity fee schedule
Ct Facial Bones W Wo Iv Contrast,,70488,CPT,Facility,Both,,,,1770,1504.5,412.496,1770,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,824.992,,,Fee schedule,,"100% of BCBS commercial commodity fee schedule, plus MN Care tax"
Ct Facial Bones W Wo Iv Contrast,,70488,CPT,Facility,Both,,,,1770,1504.5,412.496,1770,BlueCross BlueShield Minnesota,High Value Network Plan,742.4928,,,Fee schedule,,"90% of BCBS commercial commodity fee schedule, plus MN Care tax; see disclaimer for more information"
Ct Facial Bones W Wo Iv Contrast,,70488,CPT,Facility,Outpatient,,,,1770,1504.5,412.496,1770,BlueCross BlueShield Minnesota,Medicare Advantage,867.3,49,,percent of total billed charges,,
Ct Facial Bones W Wo Iv Contrast,,70488,CPT,Facility,Inpatient,,,,1770,1504.5,412.496,1770,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Ct Facial Bones W Wo Iv Contrast,,70488,CPT,Facility,Both,,,,1770,1504.5,412.496,1770,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,730.6954144,,,Fee schedule,,"88.57% of BCBS commercial commodity fee schedule, plus MN Care tax"
Ct Facial Bones W Wo Iv Contrast,,70488,CPT,Facility,Both,,,,1770,1504.5,412.496,1770,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,412.496,,,Fee schedule,,"100% of BCBS Medicaid commodity fee schedule, plus MN Care tax"
Ct Facial Bones W Wo Iv Contrast,,70488,CPT,Facility,Outpatient,,,,1770,1504.5,412.496,1770,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),867.3,49,,percent of total billed charges,,
Ct Facial Bones W Wo Iv Contrast,,70488,CPT,Facility,Inpatient,,,,1770,1504.5,412.496,1770,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Ct Facial Bones W Wo Iv Contrast,,70488,CPT,Facility,Both,,,,1770,1504.5,412.496,1770,CorVel,Worker's Compensation,1770,100,,percent of total billed charges,,
Ct Facial Bones W Wo Iv Contrast,,70488,CPT,Facility,Both,,,,1770,1504.5,412.496,1770,First Health Group Corporation,First Health Network,1716.9,97,,percent of total billed charges,,
Ct Facial Bones W Wo Iv Contrast,,70488,CPT,Facility,Both,,,,1770,1504.5,412.496,1770,"Health Partners, Inc.",Commercial,1674.42,94.6,,percent of total billed charges,,
Ct Facial Bones W Wo Iv Contrast,,70488,CPT,Facility,Outpatient,,,,1770,1504.5,412.496,1770,"Health Partners, Inc.",Medicare Advantage,867.3,49,,percent of total billed charges,,
Ct Facial Bones W Wo Iv Contrast,,70488,CPT,Facility,Inpatient,,,,1770,1504.5,412.496,1770,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ct Facial Bones W Wo Iv Contrast,,70488,CPT,Facility,Both,,,,1770,1504.5,412.496,1770,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1062,60,,percent of total billed charges,,
Ct Facial Bones W Wo Iv Contrast,,70488,CPT,Facility,Both,,,,1770,1504.5,412.496,1770,"Health Partners, Inc.",State of Minnesota Advantage Program,1442.55,81.5,,percent of total billed charges,,
Ct Facial Bones W Wo Iv Contrast,,70488,CPT,Facility,Both,,,,1770,1504.5,412.496,1770,"Health Partners, Inc.",State Public Programs,885,50,,percent of total billed charges,,
Ct Facial Bones W Wo Iv Contrast,,70488,CPT,Facility,Both,,,,1770,1504.5,412.496,1770,Humana Insurance Company,Commercial PPO,1681.5,95,,percent of total billed charges,,
Ct Facial Bones W Wo Iv Contrast,,70488,CPT,Facility,Outpatient,,,,1770,1504.5,412.496,1770,Humana Insurance Company,Medicare PPO,867.3,49,,percent of total billed charges,,
Ct Facial Bones W Wo Iv Contrast,,70488,CPT,Facility,Inpatient,,,,1770,1504.5,412.496,1770,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Ct Facial Bones W Wo Iv Contrast,,70488,CPT,Facility,Both,,,,1770,1504.5,412.496,1770,Medica,Individual & Family,1754.07,99.1,,percent of total billed charges,,
Ct Facial Bones W Wo Iv Contrast,,70488,CPT,Facility,Outpatient,,,,1770,1504.5,412.496,1770,Medica,Medica Advantage Solution,881.46,49.8,,percent of total billed charges,,
Ct Facial Bones W Wo Iv Contrast,,70488,CPT,Facility,Inpatient,,,,1770,1504.5,412.496,1770,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Ct Facial Bones W Wo Iv Contrast,,70488,CPT,Facility,Outpatient,,,,1770,1504.5,412.496,1770,Medica,Medical Assistance,499,,,Other,Per visit,Pays in addition to all Outpatient Service Categories
Ct Facial Bones W Wo Iv Contrast,,70488,CPT,Facility,Inpatient,,,,1770,1504.5,412.496,1770,Medica,Medical Assistance,,,,,Included in per diem rate,
Ct Facial Bones W Wo Iv Contrast,,70488,CPT,Facility,Outpatient,,,,1770,1504.5,412.496,1770,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,881.46,49.8,,percent of total billed charges,,
Ct Facial Bones W Wo Iv Contrast,,70488,CPT,Facility,Inpatient,,,,1770,1504.5,412.496,1770,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Ct Facial Bones W Wo Iv Contrast,,70488,CPT,Facility,Both,,,,1770,1504.5,412.496,1770,"Multiplan, Inc.","Multiplan, Inc.",1663.8,94,,percent of total billed charges,,
Ct Facial Bones W Wo Iv Contrast,,70488,CPT,Facility,Outpatient,,,,1770,1504.5,412.496,1770,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1283,,,Other,Per scan,
Ct Facial Bones W Wo Iv Contrast,,70488,CPT,Facility,Inpatient,,,,1770,1504.5,412.496,1770,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Ct Facial Bones W Wo Iv Contrast,,70488,CPT,Facility,Both,,,,1770,1504.5,412.496,1770,"Preferred One Administrative Services, INC.",PPO,1745.22,98.6,,percent of total billed charges,,
Ct Facial Bones W Wo Iv Contrast,,70488,CPT,Facility,Outpatient,,,,1770,1504.5,412.496,1770,PrimeWest Health,Minnesota Senior Health Options (MSHO),910.665,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Ct Facial Bones W Wo Iv Contrast,,70488,CPT,Facility,Inpatient,,,,1770,1504.5,412.496,1770,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ct Facial Bones W Wo Iv Contrast,,70488,CPT,Facility,Outpatient,,,,1770,1504.5,412.496,1770,PrimeWest Health,MinnesotaCare,909.072,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Ct Facial Bones W Wo Iv Contrast,,70488,CPT,Facility,Inpatient,,,,1770,1504.5,412.496,1770,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Ct Facial Bones W Wo Iv Contrast,,70488,CPT,Facility,Both,,,,1770,1504.5,412.496,1770,Sanford Health Plan,Sanford Health Plan,1628.4,92,,percent of total billed charges,,
Ct Facial Bones W Wo Iv Contrast,,70488,CPT,Facility,Outpatient,,,,1770,1504.5,412.496,1770,"UCare Health, Inc.",Individual & Family Plan,997.395,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Ct Facial Bones W Wo Iv Contrast,,70488,CPT,Facility,Inpatient,,,,1770,1504.5,412.496,1770,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Ct Facial Bones W Wo Iv Contrast,,70488,CPT,Facility,Outpatient,,,,1770,1504.5,412.496,1770,"UCare Health, Inc.",Medical Assistance,893.319,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ct Facial Bones W Wo Iv Contrast,,70488,CPT,Facility,Inpatient,,,,1770,1504.5,412.496,1770,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Ct Facial Bones W Wo Iv Contrast,,70488,CPT,Facility,Outpatient,,,,1770,1504.5,412.496,1770,"UCare Health, Inc.",Medicare Advantage,893.319,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ct Facial Bones W Wo Iv Contrast,,70488,CPT,Facility,Inpatient,,,,1770,1504.5,412.496,1770,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ct Facial Bones W Wo Iv Contrast,,70488,CPT,Facility,Outpatient,,,,1770,1504.5,412.496,1770,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),893.319,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ct Facial Bones W Wo Iv Contrast,,70488,CPT,Facility,Inpatient,,,,1770,1504.5,412.496,1770,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ct Facial Bones W Wo Iv Contrast,,70488,CPT,Facility,Both,,,,1770,1504.5,412.496,1770,UnitedHealthcare,Individual & Family,1663.8,94,,percent of total billed charges,,
Ct Facial Bones W Wo Iv Contrast,,70488,CPT,Facility,Outpatient,,,,1770,1504.5,412.496,1770,UnitedHealthcare,Medicare Advantage,867.3,49,,percent of total billed charges,,
Ct Facial Bones W Wo Iv Contrast,,70488,CPT,Facility,Inpatient,,,,1770,1504.5,412.496,1770,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Ct Facial Bones W Wo Iv Contrast,,70488,CPT,Facility,Outpatient,,,,1770,1504.5,412.496,1770,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,849.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
Ct Facial Bones W Wo Iv Contrast,,70488,CPT,Facility,Inpatient,,,,1770,1504.5,412.496,1770,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Ct Neck Nasophar Wo Iv Contrast,,70490,CPT,Facility,Both,,,,1403,1192.55,325.628,1403,Aetna,Commercial,1290.76,92,,percent of total billed charges,,
Ct Neck Nasophar Wo Iv Contrast,,70490,CPT,Facility,Outpatient,,,,1403,1192.55,325.628,1403,Aetna,Medicare Advantage,687.47,49,,percent of total billed charges,,
Ct Neck Nasophar Wo Iv Contrast,,70490,CPT,Facility,Inpatient,,,,1403,1192.55,325.628,1403,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Ct Neck Nasophar Wo Iv Contrast,,70490,CPT,Facility,Both,,,,1403,1192.55,325.628,1403,Aetna,PPO,1304.79,93,,percent of total billed charges,,
Ct Neck Nasophar Wo Iv Contrast,,70490,CPT,Facility,Both,,,,1403,1192.55,325.628,1403,America's PPO,America's PPO,1347.3009,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Ct Neck Nasophar Wo Iv Contrast,,70490,CPT,Facility,Both,,,,1403,1192.55,325.628,1403,BlueCross BlueShield Minnesota, Federal Employee Program,641,,,Fee schedule,,100% of BCBS commercial commodity fee schedule
Ct Neck Nasophar Wo Iv Contrast,,70490,CPT,Facility,Both,,,,1403,1192.55,325.628,1403,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,651.256,,,Fee schedule,,"100% of BCBS commercial commodity fee schedule, plus MN Care tax"
Ct Neck Nasophar Wo Iv Contrast,,70490,CPT,Facility,Both,,,,1403,1192.55,325.628,1403,BlueCross BlueShield Minnesota,High Value Network Plan,586.1304,,,Fee schedule,,"90% of BCBS commercial commodity fee schedule, plus MN Care tax; see disclaimer for more information"
Ct Neck Nasophar Wo Iv Contrast,,70490,CPT,Facility,Outpatient,,,,1403,1192.55,325.628,1403,BlueCross BlueShield Minnesota,Medicare Advantage,687.47,49,,percent of total billed charges,,
Ct Neck Nasophar Wo Iv Contrast,,70490,CPT,Facility,Inpatient,,,,1403,1192.55,325.628,1403,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Ct Neck Nasophar Wo Iv Contrast,,70490,CPT,Facility,Both,,,,1403,1192.55,325.628,1403,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,576.8174392,,,Fee schedule,,"88.57% of BCBS commercial commodity fee schedule, plus MN Care tax"
Ct Neck Nasophar Wo Iv Contrast,,70490,CPT,Facility,Both,,,,1403,1192.55,325.628,1403,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,325.628,,,Fee schedule,,"100% of BCBS Medicaid commodity fee schedule, plus MN Care tax"
Ct Neck Nasophar Wo Iv Contrast,,70490,CPT,Facility,Outpatient,,,,1403,1192.55,325.628,1403,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),687.47,49,,percent of total billed charges,,
Ct Neck Nasophar Wo Iv Contrast,,70490,CPT,Facility,Inpatient,,,,1403,1192.55,325.628,1403,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Ct Neck Nasophar Wo Iv Contrast,,70490,CPT,Facility,Both,,,,1403,1192.55,325.628,1403,CorVel,Worker's Compensation,1403,100,,percent of total billed charges,,
Ct Neck Nasophar Wo Iv Contrast,,70490,CPT,Facility,Both,,,,1403,1192.55,325.628,1403,First Health Group Corporation,First Health Network,1360.91,97,,percent of total billed charges,,
Ct Neck Nasophar Wo Iv Contrast,,70490,CPT,Facility,Both,,,,1403,1192.55,325.628,1403,"Health Partners, Inc.",Commercial,1327.238,94.6,,percent of total billed charges,,
Ct Neck Nasophar Wo Iv Contrast,,70490,CPT,Facility,Outpatient,,,,1403,1192.55,325.628,1403,"Health Partners, Inc.",Medicare Advantage,687.47,49,,percent of total billed charges,,
Ct Neck Nasophar Wo Iv Contrast,,70490,CPT,Facility,Inpatient,,,,1403,1192.55,325.628,1403,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ct Neck Nasophar Wo Iv Contrast,,70490,CPT,Facility,Both,,,,1403,1192.55,325.628,1403,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),841.8,60,,percent of total billed charges,,
Ct Neck Nasophar Wo Iv Contrast,,70490,CPT,Facility,Both,,,,1403,1192.55,325.628,1403,"Health Partners, Inc.",State of Minnesota Advantage Program,1143.445,81.5,,percent of total billed charges,,
Ct Neck Nasophar Wo Iv Contrast,,70490,CPT,Facility,Both,,,,1403,1192.55,325.628,1403,"Health Partners, Inc.",State Public Programs,701.5,50,,percent of total billed charges,,
Ct Neck Nasophar Wo Iv Contrast,,70490,CPT,Facility,Both,,,,1403,1192.55,325.628,1403,Humana Insurance Company,Commercial PPO,1332.85,95,,percent of total billed charges,,
Ct Neck Nasophar Wo Iv Contrast,,70490,CPT,Facility,Outpatient,,,,1403,1192.55,325.628,1403,Humana Insurance Company,Medicare PPO,687.47,49,,percent of total billed charges,,
Ct Neck Nasophar Wo Iv Contrast,,70490,CPT,Facility,Inpatient,,,,1403,1192.55,325.628,1403,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Ct Neck Nasophar Wo Iv Contrast,,70490,CPT,Facility,Both,,,,1403,1192.55,325.628,1403,Medica,Individual & Family,1390.373,99.1,,percent of total billed charges,,
Ct Neck Nasophar Wo Iv Contrast,,70490,CPT,Facility,Outpatient,,,,1403,1192.55,325.628,1403,Medica,Medica Advantage Solution,698.694,49.8,,percent of total billed charges,,
Ct Neck Nasophar Wo Iv Contrast,,70490,CPT,Facility,Inpatient,,,,1403,1192.55,325.628,1403,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Ct Neck Nasophar Wo Iv Contrast,,70490,CPT,Facility,Outpatient,,,,1403,1192.55,325.628,1403,Medica,Medical Assistance,499,,,Other,Per visit,Pays in addition to all Outpatient Service Categories
Ct Neck Nasophar Wo Iv Contrast,,70490,CPT,Facility,Inpatient,,,,1403,1192.55,325.628,1403,Medica,Medical Assistance,,,,,Included in per diem rate,
Ct Neck Nasophar Wo Iv Contrast,,70490,CPT,Facility,Outpatient,,,,1403,1192.55,325.628,1403,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,698.694,49.8,,percent of total billed charges,,
Ct Neck Nasophar Wo Iv Contrast,,70490,CPT,Facility,Inpatient,,,,1403,1192.55,325.628,1403,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Ct Neck Nasophar Wo Iv Contrast,,70490,CPT,Facility,Both,,,,1403,1192.55,325.628,1403,"Multiplan, Inc.","Multiplan, Inc.",1318.82,94,,percent of total billed charges,,
Ct Neck Nasophar Wo Iv Contrast,,70490,CPT,Facility,Outpatient,,,,1403,1192.55,325.628,1403,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1283,,,Other,Per scan,
Ct Neck Nasophar Wo Iv Contrast,,70490,CPT,Facility,Inpatient,,,,1403,1192.55,325.628,1403,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Ct Neck Nasophar Wo Iv Contrast,,70490,CPT,Facility,Both,,,,1403,1192.55,325.628,1403,"Preferred One Administrative Services, INC.",PPO,1383.358,98.6,,percent of total billed charges,,
Ct Neck Nasophar Wo Iv Contrast,,70490,CPT,Facility,Outpatient,,,,1403,1192.55,325.628,1403,PrimeWest Health,Minnesota Senior Health Options (MSHO),721.8435,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Ct Neck Nasophar Wo Iv Contrast,,70490,CPT,Facility,Inpatient,,,,1403,1192.55,325.628,1403,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ct Neck Nasophar Wo Iv Contrast,,70490,CPT,Facility,Outpatient,,,,1403,1192.55,325.628,1403,PrimeWest Health,MinnesotaCare,720.5808,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Ct Neck Nasophar Wo Iv Contrast,,70490,CPT,Facility,Inpatient,,,,1403,1192.55,325.628,1403,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Ct Neck Nasophar Wo Iv Contrast,,70490,CPT,Facility,Both,,,,1403,1192.55,325.628,1403,Sanford Health Plan,Sanford Health Plan,1290.76,92,,percent of total billed charges,,
Ct Neck Nasophar Wo Iv Contrast,,70490,CPT,Facility,Outpatient,,,,1403,1192.55,325.628,1403,"UCare Health, Inc.",Individual & Family Plan,790.5905,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Ct Neck Nasophar Wo Iv Contrast,,70490,CPT,Facility,Inpatient,,,,1403,1192.55,325.628,1403,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Ct Neck Nasophar Wo Iv Contrast,,70490,CPT,Facility,Outpatient,,,,1403,1192.55,325.628,1403,"UCare Health, Inc.",Medical Assistance,708.0941,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ct Neck Nasophar Wo Iv Contrast,,70490,CPT,Facility,Inpatient,,,,1403,1192.55,325.628,1403,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Ct Neck Nasophar Wo Iv Contrast,,70490,CPT,Facility,Outpatient,,,,1403,1192.55,325.628,1403,"UCare Health, Inc.",Medicare Advantage,708.0941,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ct Neck Nasophar Wo Iv Contrast,,70490,CPT,Facility,Inpatient,,,,1403,1192.55,325.628,1403,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ct Neck Nasophar Wo Iv Contrast,,70490,CPT,Facility,Outpatient,,,,1403,1192.55,325.628,1403,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),708.0941,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ct Neck Nasophar Wo Iv Contrast,,70490,CPT,Facility,Inpatient,,,,1403,1192.55,325.628,1403,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ct Neck Nasophar Wo Iv Contrast,,70490,CPT,Facility,Both,,,,1403,1192.55,325.628,1403,UnitedHealthcare,Individual & Family,1318.82,94,,percent of total billed charges,,
Ct Neck Nasophar Wo Iv Contrast,,70490,CPT,Facility,Outpatient,,,,1403,1192.55,325.628,1403,UnitedHealthcare,Medicare Advantage,687.47,49,,percent of total billed charges,,
Ct Neck Nasophar Wo Iv Contrast,,70490,CPT,Facility,Inpatient,,,,1403,1192.55,325.628,1403,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Ct Neck Nasophar Wo Iv Contrast,,70490,CPT,Facility,Outpatient,,,,1403,1192.55,325.628,1403,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,673.44,48,,percent of total billed charges,,100% of DHS outpatient percentage
Ct Neck Nasophar Wo Iv Contrast,,70490,CPT,Facility,Inpatient,,,,1403,1192.55,325.628,1403,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Ct Neck Nasophar W Iv Contrast,,70491,CPT,Facility,Both,,,,1530,1300.5,412.496,1530,Aetna,Commercial,1407.6,92,,percent of total billed charges,,
Ct Neck Nasophar W Iv Contrast,,70491,CPT,Facility,Outpatient,,,,1530,1300.5,412.496,1530,Aetna,Medicare Advantage,749.7,49,,percent of total billed charges,,
Ct Neck Nasophar W Iv Contrast,,70491,CPT,Facility,Inpatient,,,,1530,1300.5,412.496,1530,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Ct Neck Nasophar W Iv Contrast,,70491,CPT,Facility,Both,,,,1530,1300.5,412.496,1530,Aetna,PPO,1422.9,93,,percent of total billed charges,,
Ct Neck Nasophar W Iv Contrast,,70491,CPT,Facility,Both,,,,1530,1300.5,412.496,1530,America's PPO,America's PPO,1469.259,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Ct Neck Nasophar W Iv Contrast,,70491,CPT,Facility,Both,,,,1530,1300.5,412.496,1530,BlueCross BlueShield Minnesota, Federal Employee Program,812,,,Fee schedule,,100% of BCBS commercial commodity fee schedule
Ct Neck Nasophar W Iv Contrast,,70491,CPT,Facility,Both,,,,1530,1300.5,412.496,1530,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,824.992,,,Fee schedule,,"100% of BCBS commercial commodity fee schedule, plus MN Care tax"
Ct Neck Nasophar W Iv Contrast,,70491,CPT,Facility,Both,,,,1530,1300.5,412.496,1530,BlueCross BlueShield Minnesota,High Value Network Plan,742.4928,,,Fee schedule,,"90% of BCBS commercial commodity fee schedule, plus MN Care tax; see disclaimer for more information"
Ct Neck Nasophar W Iv Contrast,,70491,CPT,Facility,Outpatient,,,,1530,1300.5,412.496,1530,BlueCross BlueShield Minnesota,Medicare Advantage,749.7,49,,percent of total billed charges,,
Ct Neck Nasophar W Iv Contrast,,70491,CPT,Facility,Inpatient,,,,1530,1300.5,412.496,1530,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Ct Neck Nasophar W Iv Contrast,,70491,CPT,Facility,Both,,,,1530,1300.5,412.496,1530,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,730.6954144,,,Fee schedule,,"88.57% of BCBS commercial commodity fee schedule, plus MN Care tax"
Ct Neck Nasophar W Iv Contrast,,70491,CPT,Facility,Both,,,,1530,1300.5,412.496,1530,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,412.496,,,Fee schedule,,"100% of BCBS Medicaid commodity fee schedule, plus MN Care tax"
Ct Neck Nasophar W Iv Contrast,,70491,CPT,Facility,Outpatient,,,,1530,1300.5,412.496,1530,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),749.7,49,,percent of total billed charges,,
Ct Neck Nasophar W Iv Contrast,,70491,CPT,Facility,Inpatient,,,,1530,1300.5,412.496,1530,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Ct Neck Nasophar W Iv Contrast,,70491,CPT,Facility,Both,,,,1530,1300.5,412.496,1530,CorVel,Worker's Compensation,1530,100,,percent of total billed charges,,
Ct Neck Nasophar W Iv Contrast,,70491,CPT,Facility,Both,,,,1530,1300.5,412.496,1530,First Health Group Corporation,First Health Network,1484.1,97,,percent of total billed charges,,
Ct Neck Nasophar W Iv Contrast,,70491,CPT,Facility,Both,,,,1530,1300.5,412.496,1530,"Health Partners, Inc.",Commercial,1447.38,94.6,,percent of total billed charges,,
Ct Neck Nasophar W Iv Contrast,,70491,CPT,Facility,Outpatient,,,,1530,1300.5,412.496,1530,"Health Partners, Inc.",Medicare Advantage,749.7,49,,percent of total billed charges,,
Ct Neck Nasophar W Iv Contrast,,70491,CPT,Facility,Inpatient,,,,1530,1300.5,412.496,1530,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ct Neck Nasophar W Iv Contrast,,70491,CPT,Facility,Both,,,,1530,1300.5,412.496,1530,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),918,60,,percent of total billed charges,,
Ct Neck Nasophar W Iv Contrast,,70491,CPT,Facility,Both,,,,1530,1300.5,412.496,1530,"Health Partners, Inc.",State of Minnesota Advantage Program,1246.95,81.5,,percent of total billed charges,,
Ct Neck Nasophar W Iv Contrast,,70491,CPT,Facility,Both,,,,1530,1300.5,412.496,1530,"Health Partners, Inc.",State Public Programs,765,50,,percent of total billed charges,,
Ct Neck Nasophar W Iv Contrast,,70491,CPT,Facility,Both,,,,1530,1300.5,412.496,1530,Humana Insurance Company,Commercial PPO,1453.5,95,,percent of total billed charges,,
Ct Neck Nasophar W Iv Contrast,,70491,CPT,Facility,Outpatient,,,,1530,1300.5,412.496,1530,Humana Insurance Company,Medicare PPO,749.7,49,,percent of total billed charges,,
Ct Neck Nasophar W Iv Contrast,,70491,CPT,Facility,Inpatient,,,,1530,1300.5,412.496,1530,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Ct Neck Nasophar W Iv Contrast,,70491,CPT,Facility,Both,,,,1530,1300.5,412.496,1530,Medica,Individual & Family,1516.23,99.1,,percent of total billed charges,,
Ct Neck Nasophar W Iv Contrast,,70491,CPT,Facility,Outpatient,,,,1530,1300.5,412.496,1530,Medica,Medica Advantage Solution,761.94,49.8,,percent of total billed charges,,
Ct Neck Nasophar W Iv Contrast,,70491,CPT,Facility,Inpatient,,,,1530,1300.5,412.496,1530,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Ct Neck Nasophar W Iv Contrast,,70491,CPT,Facility,Outpatient,,,,1530,1300.5,412.496,1530,Medica,Medical Assistance,499,,,Other,Per visit,Pays in addition to all Outpatient Service Categories
Ct Neck Nasophar W Iv Contrast,,70491,CPT,Facility,Inpatient,,,,1530,1300.5,412.496,1530,Medica,Medical Assistance,,,,,Included in per diem rate,
Ct Neck Nasophar W Iv Contrast,,70491,CPT,Facility,Outpatient,,,,1530,1300.5,412.496,1530,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,761.94,49.8,,percent of total billed charges,,
Ct Neck Nasophar W Iv Contrast,,70491,CPT,Facility,Inpatient,,,,1530,1300.5,412.496,1530,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Ct Neck Nasophar W Iv Contrast,,70491,CPT,Facility,Both,,,,1530,1300.5,412.496,1530,"Multiplan, Inc.","Multiplan, Inc.",1438.2,94,,percent of total billed charges,,
Ct Neck Nasophar W Iv Contrast,,70491,CPT,Facility,Outpatient,,,,1530,1300.5,412.496,1530,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1283,,,Other,Per scan,
Ct Neck Nasophar W Iv Contrast,,70491,CPT,Facility,Inpatient,,,,1530,1300.5,412.496,1530,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Ct Neck Nasophar W Iv Contrast,,70491,CPT,Facility,Both,,,,1530,1300.5,412.496,1530,"Preferred One Administrative Services, INC.",PPO,1508.58,98.6,,percent of total billed charges,,
Ct Neck Nasophar W Iv Contrast,,70491,CPT,Facility,Outpatient,,,,1530,1300.5,412.496,1530,PrimeWest Health,Minnesota Senior Health Options (MSHO),787.185,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Ct Neck Nasophar W Iv Contrast,,70491,CPT,Facility,Inpatient,,,,1530,1300.5,412.496,1530,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ct Neck Nasophar W Iv Contrast,,70491,CPT,Facility,Outpatient,,,,1530,1300.5,412.496,1530,PrimeWest Health,MinnesotaCare,785.808,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Ct Neck Nasophar W Iv Contrast,,70491,CPT,Facility,Inpatient,,,,1530,1300.5,412.496,1530,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Ct Neck Nasophar W Iv Contrast,,70491,CPT,Facility,Both,,,,1530,1300.5,412.496,1530,Sanford Health Plan,Sanford Health Plan,1407.6,92,,percent of total billed charges,,
Ct Neck Nasophar W Iv Contrast,,70491,CPT,Facility,Outpatient,,,,1530,1300.5,412.496,1530,"UCare Health, Inc.",Individual & Family Plan,862.155,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Ct Neck Nasophar W Iv Contrast,,70491,CPT,Facility,Inpatient,,,,1530,1300.5,412.496,1530,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Ct Neck Nasophar W Iv Contrast,,70491,CPT,Facility,Outpatient,,,,1530,1300.5,412.496,1530,"UCare Health, Inc.",Medical Assistance,772.191,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ct Neck Nasophar W Iv Contrast,,70491,CPT,Facility,Inpatient,,,,1530,1300.5,412.496,1530,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Ct Neck Nasophar W Iv Contrast,,70491,CPT,Facility,Outpatient,,,,1530,1300.5,412.496,1530,"UCare Health, Inc.",Medicare Advantage,772.191,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ct Neck Nasophar W Iv Contrast,,70491,CPT,Facility,Inpatient,,,,1530,1300.5,412.496,1530,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ct Neck Nasophar W Iv Contrast,,70491,CPT,Facility,Outpatient,,,,1530,1300.5,412.496,1530,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),772.191,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ct Neck Nasophar W Iv Contrast,,70491,CPT,Facility,Inpatient,,,,1530,1300.5,412.496,1530,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ct Neck Nasophar W Iv Contrast,,70491,CPT,Facility,Both,,,,1530,1300.5,412.496,1530,UnitedHealthcare,Individual & Family,1438.2,94,,percent of total billed charges,,
Ct Neck Nasophar W Iv Contrast,,70491,CPT,Facility,Outpatient,,,,1530,1300.5,412.496,1530,UnitedHealthcare,Medicare Advantage,749.7,49,,percent of total billed charges,,
Ct Neck Nasophar W Iv Contrast,,70491,CPT,Facility,Inpatient,,,,1530,1300.5,412.496,1530,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Ct Neck Nasophar W Iv Contrast,,70491,CPT,Facility,Outpatient,,,,1530,1300.5,412.496,1530,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,734.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
Ct Neck Nasophar W Iv Contrast,,70491,CPT,Facility,Inpatient,,,,1530,1300.5,412.496,1530,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Ct Neck Nasopharynx Wo W Iv Contrast,,70492,CPT,Facility,Both,,,,1683,1430.55,412.496,1683,Aetna,Commercial,1548.36,92,,percent of total billed charges,,
Ct Neck Nasopharynx Wo W Iv Contrast,,70492,CPT,Facility,Outpatient,,,,1683,1430.55,412.496,1683,Aetna,Medicare Advantage,824.67,49,,percent of total billed charges,,
Ct Neck Nasopharynx Wo W Iv Contrast,,70492,CPT,Facility,Inpatient,,,,1683,1430.55,412.496,1683,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Ct Neck Nasopharynx Wo W Iv Contrast,,70492,CPT,Facility,Both,,,,1683,1430.55,412.496,1683,Aetna,PPO,1565.19,93,,percent of total billed charges,,
Ct Neck Nasopharynx Wo W Iv Contrast,,70492,CPT,Facility,Both,,,,1683,1430.55,412.496,1683,America's PPO,America's PPO,1616.1849,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Ct Neck Nasopharynx Wo W Iv Contrast,,70492,CPT,Facility,Both,,,,1683,1430.55,412.496,1683,BlueCross BlueShield Minnesota, Federal Employee Program,812,,,Fee schedule,,100% of BCBS commercial commodity fee schedule
Ct Neck Nasopharynx Wo W Iv Contrast,,70492,CPT,Facility,Both,,,,1683,1430.55,412.496,1683,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,824.992,,,Fee schedule,,"100% of BCBS commercial commodity fee schedule, plus MN Care tax"
Ct Neck Nasopharynx Wo W Iv Contrast,,70492,CPT,Facility,Both,,,,1683,1430.55,412.496,1683,BlueCross BlueShield Minnesota,High Value Network Plan,742.4928,,,Fee schedule,,"90% of BCBS commercial commodity fee schedule, plus MN Care tax; see disclaimer for more information"
Ct Neck Nasopharynx Wo W Iv Contrast,,70492,CPT,Facility,Outpatient,,,,1683,1430.55,412.496,1683,BlueCross BlueShield Minnesota,Medicare Advantage,824.67,49,,percent of total billed charges,,
Ct Neck Nasopharynx Wo W Iv Contrast,,70492,CPT,Facility,Inpatient,,,,1683,1430.55,412.496,1683,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Ct Neck Nasopharynx Wo W Iv Contrast,,70492,CPT,Facility,Both,,,,1683,1430.55,412.496,1683,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,730.6954144,,,Fee schedule,,"88.57% of BCBS commercial commodity fee schedule, plus MN Care tax"
Ct Neck Nasopharynx Wo W Iv Contrast,,70492,CPT,Facility,Both,,,,1683,1430.55,412.496,1683,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,412.496,,,Fee schedule,,"100% of BCBS Medicaid commodity fee schedule, plus MN Care tax"
Ct Neck Nasopharynx Wo W Iv Contrast,,70492,CPT,Facility,Outpatient,,,,1683,1430.55,412.496,1683,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),824.67,49,,percent of total billed charges,,
Ct Neck Nasopharynx Wo W Iv Contrast,,70492,CPT,Facility,Inpatient,,,,1683,1430.55,412.496,1683,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Ct Neck Nasopharynx Wo W Iv Contrast,,70492,CPT,Facility,Both,,,,1683,1430.55,412.496,1683,CorVel,Worker's Compensation,1683,100,,percent of total billed charges,,
Ct Neck Nasopharynx Wo W Iv Contrast,,70492,CPT,Facility,Both,,,,1683,1430.55,412.496,1683,First Health Group Corporation,First Health Network,1632.51,97,,percent of total billed charges,,
Ct Neck Nasopharynx Wo W Iv Contrast,,70492,CPT,Facility,Both,,,,1683,1430.55,412.496,1683,"Health Partners, Inc.",Commercial,1592.118,94.6,,percent of total billed charges,,
Ct Neck Nasopharynx Wo W Iv Contrast,,70492,CPT,Facility,Outpatient,,,,1683,1430.55,412.496,1683,"Health Partners, Inc.",Medicare Advantage,824.67,49,,percent of total billed charges,,
Ct Neck Nasopharynx Wo W Iv Contrast,,70492,CPT,Facility,Inpatient,,,,1683,1430.55,412.496,1683,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ct Neck Nasopharynx Wo W Iv Contrast,,70492,CPT,Facility,Both,,,,1683,1430.55,412.496,1683,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1009.8,60,,percent of total billed charges,,
Ct Neck Nasopharynx Wo W Iv Contrast,,70492,CPT,Facility,Both,,,,1683,1430.55,412.496,1683,"Health Partners, Inc.",State of Minnesota Advantage Program,1371.645,81.5,,percent of total billed charges,,
Ct Neck Nasopharynx Wo W Iv Contrast,,70492,CPT,Facility,Both,,,,1683,1430.55,412.496,1683,"Health Partners, Inc.",State Public Programs,841.5,50,,percent of total billed charges,,
Ct Neck Nasopharynx Wo W Iv Contrast,,70492,CPT,Facility,Both,,,,1683,1430.55,412.496,1683,Humana Insurance Company,Commercial PPO,1598.85,95,,percent of total billed charges,,
Ct Neck Nasopharynx Wo W Iv Contrast,,70492,CPT,Facility,Outpatient,,,,1683,1430.55,412.496,1683,Humana Insurance Company,Medicare PPO,824.67,49,,percent of total billed charges,,
Ct Neck Nasopharynx Wo W Iv Contrast,,70492,CPT,Facility,Inpatient,,,,1683,1430.55,412.496,1683,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Ct Neck Nasopharynx Wo W Iv Contrast,,70492,CPT,Facility,Both,,,,1683,1430.55,412.496,1683,Medica,Individual & Family,1667.853,99.1,,percent of total billed charges,,
Ct Neck Nasopharynx Wo W Iv Contrast,,70492,CPT,Facility,Outpatient,,,,1683,1430.55,412.496,1683,Medica,Medica Advantage Solution,838.134,49.8,,percent of total billed charges,,
Ct Neck Nasopharynx Wo W Iv Contrast,,70492,CPT,Facility,Inpatient,,,,1683,1430.55,412.496,1683,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Ct Neck Nasopharynx Wo W Iv Contrast,,70492,CPT,Facility,Outpatient,,,,1683,1430.55,412.496,1683,Medica,Medical Assistance,499,,,Other,Per visit,Pays in addition to all Outpatient Service Categories
Ct Neck Nasopharynx Wo W Iv Contrast,,70492,CPT,Facility,Inpatient,,,,1683,1430.55,412.496,1683,Medica,Medical Assistance,,,,,Included in per diem rate,
Ct Neck Nasopharynx Wo W Iv Contrast,,70492,CPT,Facility,Outpatient,,,,1683,1430.55,412.496,1683,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,838.134,49.8,,percent of total billed charges,,
Ct Neck Nasopharynx Wo W Iv Contrast,,70492,CPT,Facility,Inpatient,,,,1683,1430.55,412.496,1683,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Ct Neck Nasopharynx Wo W Iv Contrast,,70492,CPT,Facility,Both,,,,1683,1430.55,412.496,1683,"Multiplan, Inc.","Multiplan, Inc.",1582.02,94,,percent of total billed charges,,
Ct Neck Nasopharynx Wo W Iv Contrast,,70492,CPT,Facility,Outpatient,,,,1683,1430.55,412.496,1683,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1283,,,Other,Per scan,
Ct Neck Nasopharynx Wo W Iv Contrast,,70492,CPT,Facility,Inpatient,,,,1683,1430.55,412.496,1683,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Ct Neck Nasopharynx Wo W Iv Contrast,,70492,CPT,Facility,Both,,,,1683,1430.55,412.496,1683,"Preferred One Administrative Services, INC.",PPO,1659.438,98.6,,percent of total billed charges,,
Ct Neck Nasopharynx Wo W Iv Contrast,,70492,CPT,Facility,Outpatient,,,,1683,1430.55,412.496,1683,PrimeWest Health,Minnesota Senior Health Options (MSHO),865.9035,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Ct Neck Nasopharynx Wo W Iv Contrast,,70492,CPT,Facility,Inpatient,,,,1683,1430.55,412.496,1683,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ct Neck Nasopharynx Wo W Iv Contrast,,70492,CPT,Facility,Outpatient,,,,1683,1430.55,412.496,1683,PrimeWest Health,MinnesotaCare,864.3888,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Ct Neck Nasopharynx Wo W Iv Contrast,,70492,CPT,Facility,Inpatient,,,,1683,1430.55,412.496,1683,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Ct Neck Nasopharynx Wo W Iv Contrast,,70492,CPT,Facility,Both,,,,1683,1430.55,412.496,1683,Sanford Health Plan,Sanford Health Plan,1548.36,92,,percent of total billed charges,,
Ct Neck Nasopharynx Wo W Iv Contrast,,70492,CPT,Facility,Outpatient,,,,1683,1430.55,412.496,1683,"UCare Health, Inc.",Individual & Family Plan,948.3705,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Ct Neck Nasopharynx Wo W Iv Contrast,,70492,CPT,Facility,Inpatient,,,,1683,1430.55,412.496,1683,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Ct Neck Nasopharynx Wo W Iv Contrast,,70492,CPT,Facility,Outpatient,,,,1683,1430.55,412.496,1683,"UCare Health, Inc.",Medical Assistance,849.4101,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ct Neck Nasopharynx Wo W Iv Contrast,,70492,CPT,Facility,Inpatient,,,,1683,1430.55,412.496,1683,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Ct Neck Nasopharynx Wo W Iv Contrast,,70492,CPT,Facility,Outpatient,,,,1683,1430.55,412.496,1683,"UCare Health, Inc.",Medicare Advantage,849.4101,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ct Neck Nasopharynx Wo W Iv Contrast,,70492,CPT,Facility,Inpatient,,,,1683,1430.55,412.496,1683,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ct Neck Nasopharynx Wo W Iv Contrast,,70492,CPT,Facility,Outpatient,,,,1683,1430.55,412.496,1683,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),849.4101,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ct Neck Nasopharynx Wo W Iv Contrast,,70492,CPT,Facility,Inpatient,,,,1683,1430.55,412.496,1683,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ct Neck Nasopharynx Wo W Iv Contrast,,70492,CPT,Facility,Both,,,,1683,1430.55,412.496,1683,UnitedHealthcare,Individual & Family,1582.02,94,,percent of total billed charges,,
Ct Neck Nasopharynx Wo W Iv Contrast,,70492,CPT,Facility,Outpatient,,,,1683,1430.55,412.496,1683,UnitedHealthcare,Medicare Advantage,824.67,49,,percent of total billed charges,,
Ct Neck Nasopharynx Wo W Iv Contrast,,70492,CPT,Facility,Inpatient,,,,1683,1430.55,412.496,1683,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Ct Neck Nasopharynx Wo W Iv Contrast,,70492,CPT,Facility,Outpatient,,,,1683,1430.55,412.496,1683,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,807.84,48,,percent of total billed charges,,100% of DHS outpatient percentage
Ct Neck Nasopharynx Wo W Iv Contrast,,70492,CPT,Facility,Inpatient,,,,1683,1430.55,412.496,1683,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Cta Head,,70496,CPT,Facility,Both,,,,2020,1717,412.496,2020,Aetna,Commercial,1858.4,92,,percent of total billed charges,,
Cta Head,,70496,CPT,Facility,Outpatient,,,,2020,1717,412.496,2020,Aetna,Medicare Advantage,989.8,49,,percent of total billed charges,,
Cta Head,,70496,CPT,Facility,Inpatient,,,,2020,1717,412.496,2020,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Cta Head,,70496,CPT,Facility,Both,,,,2020,1717,412.496,2020,Aetna,PPO,1878.6,93,,percent of total billed charges,,
Cta Head,,70496,CPT,Facility,Both,,,,2020,1717,412.496,2020,America's PPO,America's PPO,1939.806,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Cta Head,,70496,CPT,Facility,Both,,,,2020,1717,412.496,2020,BlueCross BlueShield Minnesota, Federal Employee Program,812,,,Fee schedule,,100% of BCBS commercial commodity fee schedule
Cta Head,,70496,CPT,Facility,Both,,,,2020,1717,412.496,2020,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,824.992,,,Fee schedule,,"100% of BCBS commercial commodity fee schedule, plus MN Care tax"
Cta Head,,70496,CPT,Facility,Both,,,,2020,1717,412.496,2020,BlueCross BlueShield Minnesota,High Value Network Plan,742.4928,,,Fee schedule,,"90% of BCBS commercial commodity fee schedule, plus MN Care tax; see disclaimer for more information"
Cta Head,,70496,CPT,Facility,Outpatient,,,,2020,1717,412.496,2020,BlueCross BlueShield Minnesota,Medicare Advantage,989.8,49,,percent of total billed charges,,
Cta Head,,70496,CPT,Facility,Inpatient,,,,2020,1717,412.496,2020,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Cta Head,,70496,CPT,Facility,Both,,,,2020,1717,412.496,2020,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,730.6954144,,,Fee schedule,,"88.57% of BCBS commercial commodity fee schedule, plus MN Care tax"
Cta Head,,70496,CPT,Facility,Both,,,,2020,1717,412.496,2020,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,412.496,,,Fee schedule,,"100% of BCBS Medicaid commodity fee schedule, plus MN Care tax"
Cta Head,,70496,CPT,Facility,Outpatient,,,,2020,1717,412.496,2020,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),989.8,49,,percent of total billed charges,,
Cta Head,,70496,CPT,Facility,Inpatient,,,,2020,1717,412.496,2020,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Cta Head,,70496,CPT,Facility,Both,,,,2020,1717,412.496,2020,CorVel,Worker's Compensation,2020,100,,percent of total billed charges,,
Cta Head,,70496,CPT,Facility,Both,,,,2020,1717,412.496,2020,First Health Group Corporation,First Health Network,1959.4,97,,percent of total billed charges,,
Cta Head,,70496,CPT,Facility,Both,,,,2020,1717,412.496,2020,"Health Partners, Inc.",Commercial,1910.92,94.6,,percent of total billed charges,,
Cta Head,,70496,CPT,Facility,Outpatient,,,,2020,1717,412.496,2020,"Health Partners, Inc.",Medicare Advantage,989.8,49,,percent of total billed charges,,
Cta Head,,70496,CPT,Facility,Inpatient,,,,2020,1717,412.496,2020,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Cta Head,,70496,CPT,Facility,Both,,,,2020,1717,412.496,2020,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1212,60,,percent of total billed charges,,
Cta Head,,70496,CPT,Facility,Both,,,,2020,1717,412.496,2020,"Health Partners, Inc.",State of Minnesota Advantage Program,1646.3,81.5,,percent of total billed charges,,
Cta Head,,70496,CPT,Facility,Both,,,,2020,1717,412.496,2020,"Health Partners, Inc.",State Public Programs,1010,50,,percent of total billed charges,,
Cta Head,,70496,CPT,Facility,Both,,,,2020,1717,412.496,2020,Humana Insurance Company,Commercial PPO,1919,95,,percent of total billed charges,,
Cta Head,,70496,CPT,Facility,Outpatient,,,,2020,1717,412.496,2020,Humana Insurance Company,Medicare PPO,989.8,49,,percent of total billed charges,,
Cta Head,,70496,CPT,Facility,Inpatient,,,,2020,1717,412.496,2020,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Cta Head,,70496,CPT,Facility,Both,,,,2020,1717,412.496,2020,Medica,Individual & Family,2001.82,99.1,,percent of total billed charges,,
Cta Head,,70496,CPT,Facility,Outpatient,,,,2020,1717,412.496,2020,Medica,Medica Advantage Solution,1005.96,49.8,,percent of total billed charges,,
Cta Head,,70496,CPT,Facility,Inpatient,,,,2020,1717,412.496,2020,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Cta Head,,70496,CPT,Facility,Outpatient,,,,2020,1717,412.496,2020,Medica,Medical Assistance,499,,,Other,Per visit,Pays in addition to all Outpatient Service Categories
Cta Head,,70496,CPT,Facility,Inpatient,,,,2020,1717,412.496,2020,Medica,Medical Assistance,,,,,Included in per diem rate,
Cta Head,,70496,CPT,Facility,Outpatient,,,,2020,1717,412.496,2020,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1005.96,49.8,,percent of total billed charges,,
Cta Head,,70496,CPT,Facility,Inpatient,,,,2020,1717,412.496,2020,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Cta Head,,70496,CPT,Facility,Both,,,,2020,1717,412.496,2020,"Multiplan, Inc.","Multiplan, Inc.",1898.8,94,,percent of total billed charges,,
Cta Head,,70496,CPT,Facility,Outpatient,,,,2020,1717,412.496,2020,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1283,,,Other,Per scan,
Cta Head,,70496,CPT,Facility,Inpatient,,,,2020,1717,412.496,2020,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Cta Head,,70496,CPT,Facility,Both,,,,2020,1717,412.496,2020,"Preferred One Administrative Services, INC.",PPO,1991.72,98.6,,percent of total billed charges,,
Cta Head,,70496,CPT,Facility,Outpatient,,,,2020,1717,412.496,2020,PrimeWest Health,Minnesota Senior Health Options (MSHO),1039.29,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Cta Head,,70496,CPT,Facility,Inpatient,,,,2020,1717,412.496,2020,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Cta Head,,70496,CPT,Facility,Outpatient,,,,2020,1717,412.496,2020,PrimeWest Health,MinnesotaCare,1037.472,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Cta Head,,70496,CPT,Facility,Inpatient,,,,2020,1717,412.496,2020,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Cta Head,,70496,CPT,Facility,Both,,,,2020,1717,412.496,2020,Sanford Health Plan,Sanford Health Plan,1858.4,92,,percent of total billed charges,,
Cta Head,,70496,CPT,Facility,Outpatient,,,,2020,1717,412.496,2020,"UCare Health, Inc.",Individual & Family Plan,1138.27,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Cta Head,,70496,CPT,Facility,Inpatient,,,,2020,1717,412.496,2020,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Cta Head,,70496,CPT,Facility,Outpatient,,,,2020,1717,412.496,2020,"UCare Health, Inc.",Medical Assistance,1019.494,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Cta Head,,70496,CPT,Facility,Inpatient,,,,2020,1717,412.496,2020,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Cta Head,,70496,CPT,Facility,Outpatient,,,,2020,1717,412.496,2020,"UCare Health, Inc.",Medicare Advantage,1019.494,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Cta Head,,70496,CPT,Facility,Inpatient,,,,2020,1717,412.496,2020,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Cta Head,,70496,CPT,Facility,Outpatient,,,,2020,1717,412.496,2020,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1019.494,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Cta Head,,70496,CPT,Facility,Inpatient,,,,2020,1717,412.496,2020,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Cta Head,,70496,CPT,Facility,Both,,,,2020,1717,412.496,2020,UnitedHealthcare,Individual & Family,1898.8,94,,percent of total billed charges,,
Cta Head,,70496,CPT,Facility,Outpatient,,,,2020,1717,412.496,2020,UnitedHealthcare,Medicare Advantage,989.8,49,,percent of total billed charges,,
Cta Head,,70496,CPT,Facility,Inpatient,,,,2020,1717,412.496,2020,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Cta Head,,70496,CPT,Facility,Outpatient,,,,2020,1717,412.496,2020,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,969.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
Cta Head,,70496,CPT,Facility,Inpatient,,,,2020,1717,412.496,2020,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Cta Carotids,,70498,CPT,Facility,Both,,,,2020,1717,412.496,2020,Aetna,Commercial,1858.4,92,,percent of total billed charges,,
Cta Carotids,,70498,CPT,Facility,Outpatient,,,,2020,1717,412.496,2020,Aetna,Medicare Advantage,989.8,49,,percent of total billed charges,,
Cta Carotids,,70498,CPT,Facility,Inpatient,,,,2020,1717,412.496,2020,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Cta Carotids,,70498,CPT,Facility,Both,,,,2020,1717,412.496,2020,Aetna,PPO,1878.6,93,,percent of total billed charges,,
Cta Carotids,,70498,CPT,Facility,Both,,,,2020,1717,412.496,2020,America's PPO,America's PPO,1939.806,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Cta Carotids,,70498,CPT,Facility,Both,,,,2020,1717,412.496,2020,BlueCross BlueShield Minnesota, Federal Employee Program,812,,,Fee schedule,,100% of BCBS commercial commodity fee schedule
Cta Carotids,,70498,CPT,Facility,Both,,,,2020,1717,412.496,2020,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,824.992,,,Fee schedule,,"100% of BCBS commercial commodity fee schedule, plus MN Care tax"
Cta Carotids,,70498,CPT,Facility,Both,,,,2020,1717,412.496,2020,BlueCross BlueShield Minnesota,High Value Network Plan,742.4928,,,Fee schedule,,"90% of BCBS commercial commodity fee schedule, plus MN Care tax; see disclaimer for more information"
Cta Carotids,,70498,CPT,Facility,Outpatient,,,,2020,1717,412.496,2020,BlueCross BlueShield Minnesota,Medicare Advantage,989.8,49,,percent of total billed charges,,
Cta Carotids,,70498,CPT,Facility,Inpatient,,,,2020,1717,412.496,2020,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Cta Carotids,,70498,CPT,Facility,Both,,,,2020,1717,412.496,2020,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,730.6954144,,,Fee schedule,,"88.57% of BCBS commercial commodity fee schedule, plus MN Care tax"
Cta Carotids,,70498,CPT,Facility,Both,,,,2020,1717,412.496,2020,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,412.496,,,Fee schedule,,"100% of BCBS Medicaid commodity fee schedule, plus MN Care tax"
Cta Carotids,,70498,CPT,Facility,Outpatient,,,,2020,1717,412.496,2020,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),989.8,49,,percent of total billed charges,,
Cta Carotids,,70498,CPT,Facility,Inpatient,,,,2020,1717,412.496,2020,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Cta Carotids,,70498,CPT,Facility,Both,,,,2020,1717,412.496,2020,CorVel,Worker's Compensation,2020,100,,percent of total billed charges,,
Cta Carotids,,70498,CPT,Facility,Both,,,,2020,1717,412.496,2020,First Health Group Corporation,First Health Network,1959.4,97,,percent of total billed charges,,
Cta Carotids,,70498,CPT,Facility,Both,,,,2020,1717,412.496,2020,"Health Partners, Inc.",Commercial,1910.92,94.6,,percent of total billed charges,,
Cta Carotids,,70498,CPT,Facility,Outpatient,,,,2020,1717,412.496,2020,"Health Partners, Inc.",Medicare Advantage,989.8,49,,percent of total billed charges,,
Cta Carotids,,70498,CPT,Facility,Inpatient,,,,2020,1717,412.496,2020,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Cta Carotids,,70498,CPT,Facility,Both,,,,2020,1717,412.496,2020,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1212,60,,percent of total billed charges,,
Cta Carotids,,70498,CPT,Facility,Both,,,,2020,1717,412.496,2020,"Health Partners, Inc.",State of Minnesota Advantage Program,1646.3,81.5,,percent of total billed charges,,
Cta Carotids,,70498,CPT,Facility,Both,,,,2020,1717,412.496,2020,"Health Partners, Inc.",State Public Programs,1010,50,,percent of total billed charges,,
Cta Carotids,,70498,CPT,Facility,Both,,,,2020,1717,412.496,2020,Humana Insurance Company,Commercial PPO,1919,95,,percent of total billed charges,,
Cta Carotids,,70498,CPT,Facility,Outpatient,,,,2020,1717,412.496,2020,Humana Insurance Company,Medicare PPO,989.8,49,,percent of total billed charges,,
Cta Carotids,,70498,CPT,Facility,Inpatient,,,,2020,1717,412.496,2020,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Cta Carotids,,70498,CPT,Facility,Both,,,,2020,1717,412.496,2020,Medica,Individual & Family,2001.82,99.1,,percent of total billed charges,,
Cta Carotids,,70498,CPT,Facility,Outpatient,,,,2020,1717,412.496,2020,Medica,Medica Advantage Solution,1005.96,49.8,,percent of total billed charges,,
Cta Carotids,,70498,CPT,Facility,Inpatient,,,,2020,1717,412.496,2020,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Cta Carotids,,70498,CPT,Facility,Outpatient,,,,2020,1717,412.496,2020,Medica,Medical Assistance,499,,,Other,Per visit,Pays in addition to all Outpatient Service Categories
Cta Carotids,,70498,CPT,Facility,Inpatient,,,,2020,1717,412.496,2020,Medica,Medical Assistance,,,,,Included in per diem rate,
Cta Carotids,,70498,CPT,Facility,Outpatient,,,,2020,1717,412.496,2020,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1005.96,49.8,,percent of total billed charges,,
Cta Carotids,,70498,CPT,Facility,Inpatient,,,,2020,1717,412.496,2020,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Cta Carotids,,70498,CPT,Facility,Both,,,,2020,1717,412.496,2020,"Multiplan, Inc.","Multiplan, Inc.",1898.8,94,,percent of total billed charges,,
Cta Carotids,,70498,CPT,Facility,Outpatient,,,,2020,1717,412.496,2020,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1283,,,Other,Per scan,
Cta Carotids,,70498,CPT,Facility,Inpatient,,,,2020,1717,412.496,2020,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Cta Carotids,,70498,CPT,Facility,Both,,,,2020,1717,412.496,2020,"Preferred One Administrative Services, INC.",PPO,1991.72,98.6,,percent of total billed charges,,
Cta Carotids,,70498,CPT,Facility,Outpatient,,,,2020,1717,412.496,2020,PrimeWest Health,Minnesota Senior Health Options (MSHO),1039.29,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Cta Carotids,,70498,CPT,Facility,Inpatient,,,,2020,1717,412.496,2020,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Cta Carotids,,70498,CPT,Facility,Outpatient,,,,2020,1717,412.496,2020,PrimeWest Health,MinnesotaCare,1037.472,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Cta Carotids,,70498,CPT,Facility,Inpatient,,,,2020,1717,412.496,2020,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Cta Carotids,,70498,CPT,Facility,Both,,,,2020,1717,412.496,2020,Sanford Health Plan,Sanford Health Plan,1858.4,92,,percent of total billed charges,,
Cta Carotids,,70498,CPT,Facility,Outpatient,,,,2020,1717,412.496,2020,"UCare Health, Inc.",Individual & Family Plan,1138.27,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Cta Carotids,,70498,CPT,Facility,Inpatient,,,,2020,1717,412.496,2020,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Cta Carotids,,70498,CPT,Facility,Outpatient,,,,2020,1717,412.496,2020,"UCare Health, Inc.",Medical Assistance,1019.494,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Cta Carotids,,70498,CPT,Facility,Inpatient,,,,2020,1717,412.496,2020,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Cta Carotids,,70498,CPT,Facility,Outpatient,,,,2020,1717,412.496,2020,"UCare Health, Inc.",Medicare Advantage,1019.494,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Cta Carotids,,70498,CPT,Facility,Inpatient,,,,2020,1717,412.496,2020,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Cta Carotids,,70498,CPT,Facility,Outpatient,,,,2020,1717,412.496,2020,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1019.494,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Cta Carotids,,70498,CPT,Facility,Inpatient,,,,2020,1717,412.496,2020,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Cta Carotids,,70498,CPT,Facility,Both,,,,2020,1717,412.496,2020,UnitedHealthcare,Individual & Family,1898.8,94,,percent of total billed charges,,
Cta Carotids,,70498,CPT,Facility,Outpatient,,,,2020,1717,412.496,2020,UnitedHealthcare,Medicare Advantage,989.8,49,,percent of total billed charges,,
Cta Carotids,,70498,CPT,Facility,Inpatient,,,,2020,1717,412.496,2020,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Cta Carotids,,70498,CPT,Facility,Outpatient,,,,2020,1717,412.496,2020,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,969.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
Cta Carotids,,70498,CPT,Facility,Inpatient,,,,2020,1717,412.496,2020,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Mri Neck Orbits Face Routine Wo Contrast,,70540,CPT,Facility,Both,,,,2142,1820.7,533.908,2142,Aetna,Commercial,1970.64,92,,percent of total billed charges,,
Mri Neck Orbits Face Routine Wo Contrast,,70540,CPT,Facility,Outpatient,,,,2142,1820.7,533.908,2142,Aetna,Medicare Advantage,1049.58,49,,percent of total billed charges,,
Mri Neck Orbits Face Routine Wo Contrast,,70540,CPT,Facility,Inpatient,,,,2142,1820.7,533.908,2142,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Mri Neck Orbits Face Routine Wo Contrast,,70540,CPT,Facility,Both,,,,2142,1820.7,533.908,2142,Aetna,PPO,1992.06,93,,percent of total billed charges,,
Mri Neck Orbits Face Routine Wo Contrast,,70540,CPT,Facility,Both,,,,2142,1820.7,533.908,2142,America's PPO,America's PPO,2056.9626,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Mri Neck Orbits Face Routine Wo Contrast,,70540,CPT,Facility,Both,,,,2142,1820.7,533.908,2142,BlueCross BlueShield Minnesota, Federal Employee Program,1051,,,Fee schedule,,100% of BCBS commercial commodity fee schedule
Mri Neck Orbits Face Routine Wo Contrast,,70540,CPT,Facility,Both,,,,2142,1820.7,533.908,2142,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1067.816,,,Fee schedule,,"100% of BCBS commercial commodity fee schedule, plus MN Care tax"
Mri Neck Orbits Face Routine Wo Contrast,,70540,CPT,Facility,Both,,,,2142,1820.7,533.908,2142,BlueCross BlueShield Minnesota,High Value Network Plan,961.0344,,,Fee schedule,,"90% of BCBS commercial commodity fee schedule, plus MN Care tax; see disclaimer for more information"
Mri Neck Orbits Face Routine Wo Contrast,,70540,CPT,Facility,Outpatient,,,,2142,1820.7,533.908,2142,BlueCross BlueShield Minnesota,Medicare Advantage,1049.58,49,,percent of total billed charges,,
Mri Neck Orbits Face Routine Wo Contrast,,70540,CPT,Facility,Inpatient,,,,2142,1820.7,533.908,2142,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Mri Neck Orbits Face Routine Wo Contrast,,70540,CPT,Facility,Both,,,,2142,1820.7,533.908,2142,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,945.7646312,,,Fee schedule,,"88.57% of BCBS commercial commodity fee schedule, plus MN Care tax"
Mri Neck Orbits Face Routine Wo Contrast,,70540,CPT,Facility,Both,,,,2142,1820.7,533.908,2142,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,533.908,,,Fee schedule,,"100% of BCBS Medicaid commodity fee schedule, plus MN Care tax"
Mri Neck Orbits Face Routine Wo Contrast,,70540,CPT,Facility,Outpatient,,,,2142,1820.7,533.908,2142,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1049.58,49,,percent of total billed charges,,
Mri Neck Orbits Face Routine Wo Contrast,,70540,CPT,Facility,Inpatient,,,,2142,1820.7,533.908,2142,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Mri Neck Orbits Face Routine Wo Contrast,,70540,CPT,Facility,Both,,,,2142,1820.7,533.908,2142,CorVel,Worker's Compensation,2142,100,,percent of total billed charges,,
Mri Neck Orbits Face Routine Wo Contrast,,70540,CPT,Facility,Both,,,,2142,1820.7,533.908,2142,First Health Group Corporation,First Health Network,2077.74,97,,percent of total billed charges,,
Mri Neck Orbits Face Routine Wo Contrast,,70540,CPT,Facility,Both,,,,2142,1820.7,533.908,2142,"Health Partners, Inc.",Commercial,2026.332,94.6,,percent of total billed charges,,
Mri Neck Orbits Face Routine Wo Contrast,,70540,CPT,Facility,Outpatient,,,,2142,1820.7,533.908,2142,"Health Partners, Inc.",Medicare Advantage,1049.58,49,,percent of total billed charges,,
Mri Neck Orbits Face Routine Wo Contrast,,70540,CPT,Facility,Inpatient,,,,2142,1820.7,533.908,2142,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mri Neck Orbits Face Routine Wo Contrast,,70540,CPT,Facility,Both,,,,2142,1820.7,533.908,2142,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1285.2,60,,percent of total billed charges,,
Mri Neck Orbits Face Routine Wo Contrast,,70540,CPT,Facility,Both,,,,2142,1820.7,533.908,2142,"Health Partners, Inc.",State of Minnesota Advantage Program,1745.73,81.5,,percent of total billed charges,,
Mri Neck Orbits Face Routine Wo Contrast,,70540,CPT,Facility,Both,,,,2142,1820.7,533.908,2142,"Health Partners, Inc.",State Public Programs,1071,50,,percent of total billed charges,,
Mri Neck Orbits Face Routine Wo Contrast,,70540,CPT,Facility,Both,,,,2142,1820.7,533.908,2142,Humana Insurance Company,Commercial PPO,2034.9,95,,percent of total billed charges,,
Mri Neck Orbits Face Routine Wo Contrast,,70540,CPT,Facility,Outpatient,,,,2142,1820.7,533.908,2142,Humana Insurance Company,Medicare PPO,1049.58,49,,percent of total billed charges,,
Mri Neck Orbits Face Routine Wo Contrast,,70540,CPT,Facility,Inpatient,,,,2142,1820.7,533.908,2142,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Mri Neck Orbits Face Routine Wo Contrast,,70540,CPT,Facility,Both,,,,2142,1820.7,533.908,2142,Medica,Individual & Family,2122.722,99.1,,percent of total billed charges,,
Mri Neck Orbits Face Routine Wo Contrast,,70540,CPT,Facility,Outpatient,,,,2142,1820.7,533.908,2142,Medica,Medica Advantage Solution,1066.716,49.8,,percent of total billed charges,,
Mri Neck Orbits Face Routine Wo Contrast,,70540,CPT,Facility,Inpatient,,,,2142,1820.7,533.908,2142,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Mri Neck Orbits Face Routine Wo Contrast,,70540,CPT,Facility,Outpatient,,,,2142,1820.7,533.908,2142,Medica,Medical Assistance,747,,,Other  ,per vist,Pays in addition to all Outpatient Service Categories
Mri Neck Orbits Face Routine Wo Contrast,,70540,CPT,Facility,Inpatient,,,,2142,1820.7,533.908,2142,Medica,Medical Assistance,,,,,Included in per diem rate,
Mri Neck Orbits Face Routine Wo Contrast,,70540,CPT,Facility,Outpatient,,,,2142,1820.7,533.908,2142,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1066.716,49.8,,percent of total billed charges,,
Mri Neck Orbits Face Routine Wo Contrast,,70540,CPT,Facility,Inpatient,,,,2142,1820.7,533.908,2142,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Mri Neck Orbits Face Routine Wo Contrast,,70540,CPT,Facility,Both,,,,2142,1820.7,533.908,2142,"Multiplan, Inc.","Multiplan, Inc.",2013.48,94,,percent of total billed charges,,
Mri Neck Orbits Face Routine Wo Contrast,,70540,CPT,Facility,Outpatient,,,,2142,1820.7,533.908,2142,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1535,,,Other ,per scan,
Mri Neck Orbits Face Routine Wo Contrast,,70540,CPT,Facility,Inpatient,,,,2142,1820.7,533.908,2142,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Mri Neck Orbits Face Routine Wo Contrast,,70540,CPT,Facility,Both,,,,2142,1820.7,533.908,2142,"Preferred One Administrative Services, INC.",PPO,2112.012,98.6,,percent of total billed charges,,
Mri Neck Orbits Face Routine Wo Contrast,,70540,CPT,Facility,Outpatient,,,,2142,1820.7,533.908,2142,PrimeWest Health,Minnesota Senior Health Options (MSHO),1102.059,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Mri Neck Orbits Face Routine Wo Contrast,,70540,CPT,Facility,Inpatient,,,,2142,1820.7,533.908,2142,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mri Neck Orbits Face Routine Wo Contrast,,70540,CPT,Facility,Outpatient,,,,2142,1820.7,533.908,2142,PrimeWest Health,MinnesotaCare,1100.1312,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Mri Neck Orbits Face Routine Wo Contrast,,70540,CPT,Facility,Inpatient,,,,2142,1820.7,533.908,2142,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Mri Neck Orbits Face Routine Wo Contrast,,70540,CPT,Facility,Both,,,,2142,1820.7,533.908,2142,Sanford Health Plan,Sanford Health Plan,1970.64,92,,percent of total billed charges,,
Mri Neck Orbits Face Routine Wo Contrast,,70540,CPT,Facility,Outpatient,,,,2142,1820.7,533.908,2142,"UCare Health, Inc.",Individual & Family Plan,1207.017,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Mri Neck Orbits Face Routine Wo Contrast,,70540,CPT,Facility,Inpatient,,,,2142,1820.7,533.908,2142,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Mri Neck Orbits Face Routine Wo Contrast,,70540,CPT,Facility,Outpatient,,,,2142,1820.7,533.908,2142,"UCare Health, Inc.",Medical Assistance,1081.0674,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mri Neck Orbits Face Routine Wo Contrast,,70540,CPT,Facility,Inpatient,,,,2142,1820.7,533.908,2142,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Mri Neck Orbits Face Routine Wo Contrast,,70540,CPT,Facility,Outpatient,,,,2142,1820.7,533.908,2142,"UCare Health, Inc.",Medicare Advantage,1081.0674,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mri Neck Orbits Face Routine Wo Contrast,,70540,CPT,Facility,Inpatient,,,,2142,1820.7,533.908,2142,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mri Neck Orbits Face Routine Wo Contrast,,70540,CPT,Facility,Outpatient,,,,2142,1820.7,533.908,2142,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1081.0674,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mri Neck Orbits Face Routine Wo Contrast,,70540,CPT,Facility,Inpatient,,,,2142,1820.7,533.908,2142,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mri Neck Orbits Face Routine Wo Contrast,,70540,CPT,Facility,Both,,,,2142,1820.7,533.908,2142,UnitedHealthcare,Individual & Family,2013.48,94,,percent of total billed charges,,
Mri Neck Orbits Face Routine Wo Contrast,,70540,CPT,Facility,Outpatient,,,,2142,1820.7,533.908,2142,UnitedHealthcare,Medicare Advantage,1049.58,49,,percent of total billed charges,,
Mri Neck Orbits Face Routine Wo Contrast,,70540,CPT,Facility,Inpatient,,,,2142,1820.7,533.908,2142,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Mri Neck Orbits Face Routine Wo Contrast,,70540,CPT,Facility,Outpatient,,,,2142,1820.7,533.908,2142,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1028.16,48,,percent of total billed charges,,100% of DHS outpatient percentage
Mri Neck Orbits Face Routine Wo Contrast,,70540,CPT,Facility,Inpatient,,,,2142,1820.7,533.908,2142,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Mri Neck Orbits Face W Contrast,,70542,CPT,Facility,Both,,,,2244,1907.4,561.34,2244,Aetna,Commercial,2064.48,92,,percent of total billed charges,,
Mri Neck Orbits Face W Contrast,,70542,CPT,Facility,Outpatient,,,,2244,1907.4,561.34,2244,Aetna,Medicare Advantage,1099.56,49,,percent of total billed charges,,
Mri Neck Orbits Face W Contrast,,70542,CPT,Facility,Inpatient,,,,2244,1907.4,561.34,2244,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Mri Neck Orbits Face W Contrast,,70542,CPT,Facility,Both,,,,2244,1907.4,561.34,2244,Aetna,PPO,2086.92,93,,percent of total billed charges,,
Mri Neck Orbits Face W Contrast,,70542,CPT,Facility,Both,,,,2244,1907.4,561.34,2244,America's PPO,America's PPO,2154.9132,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Mri Neck Orbits Face W Contrast,,70542,CPT,Facility,Both,,,,2244,1907.4,561.34,2244,BlueCross BlueShield Minnesota, Federal Employee Program,1105,,,Fee schedule,,100% of BCBS commercial commodity fee schedule
Mri Neck Orbits Face W Contrast,,70542,CPT,Facility,Both,,,,2244,1907.4,561.34,2244,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1122.68,,,Fee schedule,,"100% of BCBS commercial commodity fee schedule, plus MN Care tax"
Mri Neck Orbits Face W Contrast,,70542,CPT,Facility,Both,,,,2244,1907.4,561.34,2244,BlueCross BlueShield Minnesota,High Value Network Plan,1010.412,,,Fee schedule,,"90% of BCBS commercial commodity fee schedule, plus MN Care tax; see disclaimer for more information"
Mri Neck Orbits Face W Contrast,,70542,CPT,Facility,Outpatient,,,,2244,1907.4,561.34,2244,BlueCross BlueShield Minnesota,Medicare Advantage,1099.56,49,,percent of total billed charges,,
Mri Neck Orbits Face W Contrast,,70542,CPT,Facility,Inpatient,,,,2244,1907.4,561.34,2244,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Mri Neck Orbits Face W Contrast,,70542,CPT,Facility,Both,,,,2244,1907.4,561.34,2244,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,994.357676,,,Fee schedule,,"88.57% of BCBS commercial commodity fee schedule, plus MN Care tax"
Mri Neck Orbits Face W Contrast,,70542,CPT,Facility,Both,,,,2244,1907.4,561.34,2244,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,561.34,,,Fee schedule,,"100% of BCBS Medicaid commodity fee schedule, plus MN Care tax"
Mri Neck Orbits Face W Contrast,,70542,CPT,Facility,Outpatient,,,,2244,1907.4,561.34,2244,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1099.56,49,,percent of total billed charges,,
Mri Neck Orbits Face W Contrast,,70542,CPT,Facility,Inpatient,,,,2244,1907.4,561.34,2244,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Mri Neck Orbits Face W Contrast,,70542,CPT,Facility,Both,,,,2244,1907.4,561.34,2244,CorVel,Worker's Compensation,2244,100,,percent of total billed charges,,
Mri Neck Orbits Face W Contrast,,70542,CPT,Facility,Both,,,,2244,1907.4,561.34,2244,First Health Group Corporation,First Health Network,2176.68,97,,percent of total billed charges,,
Mri Neck Orbits Face W Contrast,,70542,CPT,Facility,Both,,,,2244,1907.4,561.34,2244,"Health Partners, Inc.",Commercial,2122.824,94.6,,percent of total billed charges,,
Mri Neck Orbits Face W Contrast,,70542,CPT,Facility,Outpatient,,,,2244,1907.4,561.34,2244,"Health Partners, Inc.",Medicare Advantage,1099.56,49,,percent of total billed charges,,
Mri Neck Orbits Face W Contrast,,70542,CPT,Facility,Inpatient,,,,2244,1907.4,561.34,2244,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mri Neck Orbits Face W Contrast,,70542,CPT,Facility,Both,,,,2244,1907.4,561.34,2244,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1346.4,60,,percent of total billed charges,,
Mri Neck Orbits Face W Contrast,,70542,CPT,Facility,Both,,,,2244,1907.4,561.34,2244,"Health Partners, Inc.",State of Minnesota Advantage Program,1828.86,81.5,,percent of total billed charges,,
Mri Neck Orbits Face W Contrast,,70542,CPT,Facility,Both,,,,2244,1907.4,561.34,2244,"Health Partners, Inc.",State Public Programs,1122,50,,percent of total billed charges,,
Mri Neck Orbits Face W Contrast,,70542,CPT,Facility,Both,,,,2244,1907.4,561.34,2244,Humana Insurance Company,Commercial PPO,2131.8,95,,percent of total billed charges,,
Mri Neck Orbits Face W Contrast,,70542,CPT,Facility,Outpatient,,,,2244,1907.4,561.34,2244,Humana Insurance Company,Medicare PPO,1099.56,49,,percent of total billed charges,,
Mri Neck Orbits Face W Contrast,,70542,CPT,Facility,Inpatient,,,,2244,1907.4,561.34,2244,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Mri Neck Orbits Face W Contrast,,70542,CPT,Facility,Both,,,,2244,1907.4,561.34,2244,Medica,Individual & Family,2223.804,99.1,,percent of total billed charges,,
Mri Neck Orbits Face W Contrast,,70542,CPT,Facility,Outpatient,,,,2244,1907.4,561.34,2244,Medica,Medica Advantage Solution,1117.512,49.8,,percent of total billed charges,,
Mri Neck Orbits Face W Contrast,,70542,CPT,Facility,Inpatient,,,,2244,1907.4,561.34,2244,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Mri Neck Orbits Face W Contrast,,70542,CPT,Facility,Outpatient,,,,2244,1907.4,561.34,2244,Medica,Medical Assistance,747,,,Other ,per vist,Pays in addition to all Outpatient Service Categories
Mri Neck Orbits Face W Contrast,,70542,CPT,Facility,Inpatient,,,,2244,1907.4,561.34,2244,Medica,Medical Assistance,,,,,Included in per diem rate,
Mri Neck Orbits Face W Contrast,,70542,CPT,Facility,Outpatient,,,,2244,1907.4,561.34,2244,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1117.512,49.8,,percent of total billed charges,,
Mri Neck Orbits Face W Contrast,,70542,CPT,Facility,Inpatient,,,,2244,1907.4,561.34,2244,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Mri Neck Orbits Face W Contrast,,70542,CPT,Facility,Both,,,,2244,1907.4,561.34,2244,"Multiplan, Inc.","Multiplan, Inc.",2109.36,94,,percent of total billed charges,,
Mri Neck Orbits Face W Contrast,,70542,CPT,Facility,Outpatient,,,,2244,1907.4,561.34,2244,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1535,,,Other ,per scan,
Mri Neck Orbits Face W Contrast,,70542,CPT,Facility,Inpatient,,,,2244,1907.4,561.34,2244,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Mri Neck Orbits Face W Contrast,,70542,CPT,Facility,Both,,,,2244,1907.4,561.34,2244,"Preferred One Administrative Services, INC.",PPO,2212.584,98.6,,percent of total billed charges,,
Mri Neck Orbits Face W Contrast,,70542,CPT,Facility,Outpatient,,,,2244,1907.4,561.34,2244,PrimeWest Health,Minnesota Senior Health Options (MSHO),1154.538,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Mri Neck Orbits Face W Contrast,,70542,CPT,Facility,Inpatient,,,,2244,1907.4,561.34,2244,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mri Neck Orbits Face W Contrast,,70542,CPT,Facility,Outpatient,,,,2244,1907.4,561.34,2244,PrimeWest Health,MinnesotaCare,1152.5184,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Mri Neck Orbits Face W Contrast,,70542,CPT,Facility,Inpatient,,,,2244,1907.4,561.34,2244,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Mri Neck Orbits Face W Contrast,,70542,CPT,Facility,Both,,,,2244,1907.4,561.34,2244,Sanford Health Plan,Sanford Health Plan,2064.48,92,,percent of total billed charges,,
Mri Neck Orbits Face W Contrast,,70542,CPT,Facility,Outpatient,,,,2244,1907.4,561.34,2244,"UCare Health, Inc.",Individual & Family Plan,1264.494,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Mri Neck Orbits Face W Contrast,,70542,CPT,Facility,Inpatient,,,,2244,1907.4,561.34,2244,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Mri Neck Orbits Face W Contrast,,70542,CPT,Facility,Outpatient,,,,2244,1907.4,561.34,2244,"UCare Health, Inc.",Medical Assistance,1132.5468,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mri Neck Orbits Face W Contrast,,70542,CPT,Facility,Inpatient,,,,2244,1907.4,561.34,2244,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Mri Neck Orbits Face W Contrast,,70542,CPT,Facility,Outpatient,,,,2244,1907.4,561.34,2244,"UCare Health, Inc.",Medicare Advantage,1132.5468,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mri Neck Orbits Face W Contrast,,70542,CPT,Facility,Inpatient,,,,2244,1907.4,561.34,2244,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mri Neck Orbits Face W Contrast,,70542,CPT,Facility,Outpatient,,,,2244,1907.4,561.34,2244,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1132.5468,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mri Neck Orbits Face W Contrast,,70542,CPT,Facility,Inpatient,,,,2244,1907.4,561.34,2244,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mri Neck Orbits Face W Contrast,,70542,CPT,Facility,Both,,,,2244,1907.4,561.34,2244,UnitedHealthcare,Individual & Family,2109.36,94,,percent of total billed charges,,
Mri Neck Orbits Face W Contrast,,70542,CPT,Facility,Outpatient,,,,2244,1907.4,561.34,2244,UnitedHealthcare,Medicare Advantage,1099.56,49,,percent of total billed charges,,
Mri Neck Orbits Face W Contrast,,70542,CPT,Facility,Inpatient,,,,2244,1907.4,561.34,2244,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Mri Neck Orbits Face W Contrast,,70542,CPT,Facility,Outpatient,,,,2244,1907.4,561.34,2244,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1077.12,48,,percent of total billed charges,,100% of DHS outpatient percentage
Mri Neck Orbits Face W Contrast,,70542,CPT,Facility,Inpatient,,,,2244,1907.4,561.34,2244,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Mri Neck Orbits Face Wo W Contrast,,70543,CPT,Facility,Both,,,,2410,2048.5,561.34,2410,Aetna,Commercial,2217.2,92,,percent of total billed charges,,
Mri Neck Orbits Face Wo W Contrast,,70543,CPT,Facility,Outpatient,,,,2410,2048.5,561.34,2410,Aetna,Medicare Advantage,1180.9,49,,percent of total billed charges,,
Mri Neck Orbits Face Wo W Contrast,,70543,CPT,Facility,Inpatient,,,,2410,2048.5,561.34,2410,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Mri Neck Orbits Face Wo W Contrast,,70543,CPT,Facility,Both,,,,2410,2048.5,561.34,2410,Aetna,PPO,2241.3,93,,percent of total billed charges,,
Mri Neck Orbits Face Wo W Contrast,,70543,CPT,Facility,Both,,,,2410,2048.5,561.34,2410,America's PPO,America's PPO,2314.323,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Mri Neck Orbits Face Wo W Contrast,,70543,CPT,Facility,Both,,,,2410,2048.5,561.34,2410,BlueCross BlueShield Minnesota, Federal Employee Program,1105,,,Fee schedule,,100% of BCBS commercial commodity fee schedule
Mri Neck Orbits Face Wo W Contrast,,70543,CPT,Facility,Both,,,,2410,2048.5,561.34,2410,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1122.68,,,Fee schedule,,"100% of BCBS commercial commodity fee schedule, plus MN Care tax"
Mri Neck Orbits Face Wo W Contrast,,70543,CPT,Facility,Both,,,,2410,2048.5,561.34,2410,BlueCross BlueShield Minnesota,High Value Network Plan,1010.412,,,Fee schedule,,"90% of BCBS commercial commodity fee schedule, plus MN Care tax; see disclaimer for more information"
Mri Neck Orbits Face Wo W Contrast,,70543,CPT,Facility,Outpatient,,,,2410,2048.5,561.34,2410,BlueCross BlueShield Minnesota,Medicare Advantage,1180.9,49,,percent of total billed charges,,
Mri Neck Orbits Face Wo W Contrast,,70543,CPT,Facility,Inpatient,,,,2410,2048.5,561.34,2410,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Mri Neck Orbits Face Wo W Contrast,,70543,CPT,Facility,Both,,,,2410,2048.5,561.34,2410,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,994.357676,,,Fee schedule,,"88.57% of BCBS commercial commodity fee schedule, plus MN Care tax"
Mri Neck Orbits Face Wo W Contrast,,70543,CPT,Facility,Both,,,,2410,2048.5,561.34,2410,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,561.34,,,Fee schedule,,"100% of BCBS Medicaid commodity fee schedule, plus MN Care tax"
Mri Neck Orbits Face Wo W Contrast,,70543,CPT,Facility,Outpatient,,,,2410,2048.5,561.34,2410,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1180.9,49,,percent of total billed charges,,
Mri Neck Orbits Face Wo W Contrast,,70543,CPT,Facility,Inpatient,,,,2410,2048.5,561.34,2410,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Mri Neck Orbits Face Wo W Contrast,,70543,CPT,Facility,Both,,,,2410,2048.5,561.34,2410,CorVel,Worker's Compensation,2410,100,,percent of total billed charges,,
Mri Neck Orbits Face Wo W Contrast,,70543,CPT,Facility,Both,,,,2410,2048.5,561.34,2410,First Health Group Corporation,First Health Network,2337.7,97,,percent of total billed charges,,
Mri Neck Orbits Face Wo W Contrast,,70543,CPT,Facility,Both,,,,2410,2048.5,561.34,2410,"Health Partners, Inc.",Commercial,2279.86,94.6,,percent of total billed charges,,
Mri Neck Orbits Face Wo W Contrast,,70543,CPT,Facility,Outpatient,,,,2410,2048.5,561.34,2410,"Health Partners, Inc.",Medicare Advantage,1180.9,49,,percent of total billed charges,,
Mri Neck Orbits Face Wo W Contrast,,70543,CPT,Facility,Inpatient,,,,2410,2048.5,561.34,2410,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mri Neck Orbits Face Wo W Contrast,,70543,CPT,Facility,Both,,,,2410,2048.5,561.34,2410,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1446,60,,percent of total billed charges,,
Mri Neck Orbits Face Wo W Contrast,,70543,CPT,Facility,Both,,,,2410,2048.5,561.34,2410,"Health Partners, Inc.",State of Minnesota Advantage Program,1964.15,81.5,,percent of total billed charges,,
Mri Neck Orbits Face Wo W Contrast,,70543,CPT,Facility,Both,,,,2410,2048.5,561.34,2410,"Health Partners, Inc.",State Public Programs,1205,50,,percent of total billed charges,,
Mri Neck Orbits Face Wo W Contrast,,70543,CPT,Facility,Both,,,,2410,2048.5,561.34,2410,Humana Insurance Company,Commercial PPO,2289.5,95,,percent of total billed charges,,
Mri Neck Orbits Face Wo W Contrast,,70543,CPT,Facility,Outpatient,,,,2410,2048.5,561.34,2410,Humana Insurance Company,Medicare PPO,1180.9,49,,percent of total billed charges,,
Mri Neck Orbits Face Wo W Contrast,,70543,CPT,Facility,Inpatient,,,,2410,2048.5,561.34,2410,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Mri Neck Orbits Face Wo W Contrast,,70543,CPT,Facility,Both,,,,2410,2048.5,561.34,2410,Medica,Individual & Family,2388.31,99.1,,percent of total billed charges,,
Mri Neck Orbits Face Wo W Contrast,,70543,CPT,Facility,Outpatient,,,,2410,2048.5,561.34,2410,Medica,Medica Advantage Solution,1200.18,49.8,,percent of total billed charges,,
Mri Neck Orbits Face Wo W Contrast,,70543,CPT,Facility,Inpatient,,,,2410,2048.5,561.34,2410,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Mri Neck Orbits Face Wo W Contrast,,70543,CPT,Facility,Outpatient,,,,2410,2048.5,561.34,2410,Medica,Medical Assistance,747,,,Other ,per vist,Pays in addition to all Outpatient Service Categories
Mri Neck Orbits Face Wo W Contrast,,70543,CPT,Facility,Inpatient,,,,2410,2048.5,561.34,2410,Medica,Medical Assistance,,,,,Included in per diem rate,
Mri Neck Orbits Face Wo W Contrast,,70543,CPT,Facility,Outpatient,,,,2410,2048.5,561.34,2410,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1200.18,49.8,,percent of total billed charges,,
Mri Neck Orbits Face Wo W Contrast,,70543,CPT,Facility,Inpatient,,,,2410,2048.5,561.34,2410,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Mri Neck Orbits Face Wo W Contrast,,70543,CPT,Facility,Both,,,,2410,2048.5,561.34,2410,"Multiplan, Inc.","Multiplan, Inc.",2265.4,94,,percent of total billed charges,,
Mri Neck Orbits Face Wo W Contrast,,70543,CPT,Facility,Outpatient,,,,2410,2048.5,561.34,2410,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1535,,,Other ,per scan,
Mri Neck Orbits Face Wo W Contrast,,70543,CPT,Facility,Inpatient,,,,2410,2048.5,561.34,2410,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Mri Neck Orbits Face Wo W Contrast,,70543,CPT,Facility,Both,,,,2410,2048.5,561.34,2410,"Preferred One Administrative Services, INC.",PPO,2376.26,98.6,,percent of total billed charges,,
Mri Neck Orbits Face Wo W Contrast,,70543,CPT,Facility,Outpatient,,,,2410,2048.5,561.34,2410,PrimeWest Health,Minnesota Senior Health Options (MSHO),1239.945,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Mri Neck Orbits Face Wo W Contrast,,70543,CPT,Facility,Inpatient,,,,2410,2048.5,561.34,2410,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mri Neck Orbits Face Wo W Contrast,,70543,CPT,Facility,Outpatient,,,,2410,2048.5,561.34,2410,PrimeWest Health,MinnesotaCare,1237.776,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Mri Neck Orbits Face Wo W Contrast,,70543,CPT,Facility,Inpatient,,,,2410,2048.5,561.34,2410,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Mri Neck Orbits Face Wo W Contrast,,70543,CPT,Facility,Both,,,,2410,2048.5,561.34,2410,Sanford Health Plan,Sanford Health Plan,2217.2,92,,percent of total billed charges,,
Mri Neck Orbits Face Wo W Contrast,,70543,CPT,Facility,Outpatient,,,,2410,2048.5,561.34,2410,"UCare Health, Inc.",Individual & Family Plan,1358.035,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Mri Neck Orbits Face Wo W Contrast,,70543,CPT,Facility,Inpatient,,,,2410,2048.5,561.34,2410,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Mri Neck Orbits Face Wo W Contrast,,70543,CPT,Facility,Outpatient,,,,2410,2048.5,561.34,2410,"UCare Health, Inc.",Medical Assistance,1216.327,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mri Neck Orbits Face Wo W Contrast,,70543,CPT,Facility,Inpatient,,,,2410,2048.5,561.34,2410,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Mri Neck Orbits Face Wo W Contrast,,70543,CPT,Facility,Outpatient,,,,2410,2048.5,561.34,2410,"UCare Health, Inc.",Medicare Advantage,1216.327,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mri Neck Orbits Face Wo W Contrast,,70543,CPT,Facility,Inpatient,,,,2410,2048.5,561.34,2410,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mri Neck Orbits Face Wo W Contrast,,70543,CPT,Facility,Outpatient,,,,2410,2048.5,561.34,2410,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1216.327,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mri Neck Orbits Face Wo W Contrast,,70543,CPT,Facility,Inpatient,,,,2410,2048.5,561.34,2410,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mri Neck Orbits Face Wo W Contrast,,70543,CPT,Facility,Both,,,,2410,2048.5,561.34,2410,UnitedHealthcare,Individual & Family,2265.4,94,,percent of total billed charges,,
Mri Neck Orbits Face Wo W Contrast,,70543,CPT,Facility,Outpatient,,,,2410,2048.5,561.34,2410,UnitedHealthcare,Medicare Advantage,1180.9,49,,percent of total billed charges,,
Mri Neck Orbits Face Wo W Contrast,,70543,CPT,Facility,Inpatient,,,,2410,2048.5,561.34,2410,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Mri Neck Orbits Face Wo W Contrast,,70543,CPT,Facility,Outpatient,,,,2410,2048.5,561.34,2410,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1156.8,48,,percent of total billed charges,,100% of DHS outpatient percentage
Mri Neck Orbits Face Wo W Contrast,,70543,CPT,Facility,Inpatient,,,,2410,2048.5,561.34,2410,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Mra Head Routine Wo Contrast,,70544,CPT,Facility,Both,,,,2142,1820.7,533.908,2142,Aetna,Commercial,1970.64,92,,percent of total billed charges,,
Mra Head Routine Wo Contrast,,70544,CPT,Facility,Outpatient,,,,2142,1820.7,533.908,2142,Aetna,Medicare Advantage,1049.58,49,,percent of total billed charges,,
Mra Head Routine Wo Contrast,,70544,CPT,Facility,Inpatient,,,,2142,1820.7,533.908,2142,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Mra Head Routine Wo Contrast,,70544,CPT,Facility,Both,,,,2142,1820.7,533.908,2142,Aetna,PPO,1992.06,93,,percent of total billed charges,,
Mra Head Routine Wo Contrast,,70544,CPT,Facility,Both,,,,2142,1820.7,533.908,2142,America's PPO,America's PPO,2056.9626,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Mra Head Routine Wo Contrast,,70544,CPT,Facility,Both,,,,2142,1820.7,533.908,2142,BlueCross BlueShield Minnesota, Federal Employee Program,1051,,,Fee schedule,,100% of BCBS commercial commodity fee schedule
Mra Head Routine Wo Contrast,,70544,CPT,Facility,Both,,,,2142,1820.7,533.908,2142,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1067.816,,,Fee schedule,,"100% of BCBS commercial commodity fee schedule, plus MN Care tax"
Mra Head Routine Wo Contrast,,70544,CPT,Facility,Both,,,,2142,1820.7,533.908,2142,BlueCross BlueShield Minnesota,High Value Network Plan,961.0344,,,Fee schedule,,"90% of BCBS commercial commodity fee schedule, plus MN Care tax; see disclaimer for more information"
Mra Head Routine Wo Contrast,,70544,CPT,Facility,Outpatient,,,,2142,1820.7,533.908,2142,BlueCross BlueShield Minnesota,Medicare Advantage,1049.58,49,,percent of total billed charges,,
Mra Head Routine Wo Contrast,,70544,CPT,Facility,Inpatient,,,,2142,1820.7,533.908,2142,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Mra Head Routine Wo Contrast,,70544,CPT,Facility,Both,,,,2142,1820.7,533.908,2142,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,945.7646312,,,Fee schedule,,"88.57% of BCBS commercial commodity fee schedule, plus MN Care tax"
Mra Head Routine Wo Contrast,,70544,CPT,Facility,Both,,,,2142,1820.7,533.908,2142,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,533.908,,,Fee schedule,,"100% of BCBS Medicaid commodity fee schedule, plus MN Care tax"
Mra Head Routine Wo Contrast,,70544,CPT,Facility,Outpatient,,,,2142,1820.7,533.908,2142,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1049.58,49,,percent of total billed charges,,
Mra Head Routine Wo Contrast,,70544,CPT,Facility,Inpatient,,,,2142,1820.7,533.908,2142,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Mra Head Routine Wo Contrast,,70544,CPT,Facility,Both,,,,2142,1820.7,533.908,2142,CorVel,Worker's Compensation,2142,100,,percent of total billed charges,,
Mra Head Routine Wo Contrast,,70544,CPT,Facility,Both,,,,2142,1820.7,533.908,2142,First Health Group Corporation,First Health Network,2077.74,97,,percent of total billed charges,,
Mra Head Routine Wo Contrast,,70544,CPT,Facility,Both,,,,2142,1820.7,533.908,2142,"Health Partners, Inc.",Commercial,2026.332,94.6,,percent of total billed charges,,
Mra Head Routine Wo Contrast,,70544,CPT,Facility,Outpatient,,,,2142,1820.7,533.908,2142,"Health Partners, Inc.",Medicare Advantage,1049.58,49,,percent of total billed charges,,
Mra Head Routine Wo Contrast,,70544,CPT,Facility,Inpatient,,,,2142,1820.7,533.908,2142,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mra Head Routine Wo Contrast,,70544,CPT,Facility,Both,,,,2142,1820.7,533.908,2142,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1285.2,60,,percent of total billed charges,,
Mra Head Routine Wo Contrast,,70544,CPT,Facility,Both,,,,2142,1820.7,533.908,2142,"Health Partners, Inc.",State of Minnesota Advantage Program,1745.73,81.5,,percent of total billed charges,,
Mra Head Routine Wo Contrast,,70544,CPT,Facility,Both,,,,2142,1820.7,533.908,2142,"Health Partners, Inc.",State Public Programs,1071,50,,percent of total billed charges,,
Mra Head Routine Wo Contrast,,70544,CPT,Facility,Both,,,,2142,1820.7,533.908,2142,Humana Insurance Company,Commercial PPO,2034.9,95,,percent of total billed charges,,
Mra Head Routine Wo Contrast,,70544,CPT,Facility,Outpatient,,,,2142,1820.7,533.908,2142,Humana Insurance Company,Medicare PPO,1049.58,49,,percent of total billed charges,,
Mra Head Routine Wo Contrast,,70544,CPT,Facility,Inpatient,,,,2142,1820.7,533.908,2142,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Mra Head Routine Wo Contrast,,70544,CPT,Facility,Both,,,,2142,1820.7,533.908,2142,Medica,Individual & Family,2122.722,99.1,,percent of total billed charges,,
Mra Head Routine Wo Contrast,,70544,CPT,Facility,Outpatient,,,,2142,1820.7,533.908,2142,Medica,Medica Advantage Solution,1066.716,49.8,,percent of total billed charges,,
Mra Head Routine Wo Contrast,,70544,CPT,Facility,Inpatient,,,,2142,1820.7,533.908,2142,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Mra Head Routine Wo Contrast,,70544,CPT,Facility,Outpatient,,,,2142,1820.7,533.908,2142,Medica,Medical Assistance,747,,,Other,Per vist,Pays in addition to all Outpatient Service Categories
Mra Head Routine Wo Contrast,,70544,CPT,Facility,Inpatient,,,,2142,1820.7,533.908,2142,Medica,Medical Assistance,,,,,Included in per diem rate,
Mra Head Routine Wo Contrast,,70544,CPT,Facility,Outpatient,,,,2142,1820.7,533.908,2142,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1066.716,49.8,,percent of total billed charges,,
Mra Head Routine Wo Contrast,,70544,CPT,Facility,Inpatient,,,,2142,1820.7,533.908,2142,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Mra Head Routine Wo Contrast,,70544,CPT,Facility,Both,,,,2142,1820.7,533.908,2142,"Multiplan, Inc.","Multiplan, Inc.",2013.48,94,,percent of total billed charges,,
Mra Head Routine Wo Contrast,,70544,CPT,Facility,Outpatient,,,,2142,1820.7,533.908,2142,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1535,,,Other,Per scan,
Mra Head Routine Wo Contrast,,70544,CPT,Facility,Inpatient,,,,2142,1820.7,533.908,2142,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Mra Head Routine Wo Contrast,,70544,CPT,Facility,Both,,,,2142,1820.7,533.908,2142,"Preferred One Administrative Services, INC.",PPO,2112.012,98.6,,percent of total billed charges,,
Mra Head Routine Wo Contrast,,70544,CPT,Facility,Outpatient,,,,2142,1820.7,533.908,2142,PrimeWest Health,Minnesota Senior Health Options (MSHO),1102.059,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Mra Head Routine Wo Contrast,,70544,CPT,Facility,Inpatient,,,,2142,1820.7,533.908,2142,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mra Head Routine Wo Contrast,,70544,CPT,Facility,Outpatient,,,,2142,1820.7,533.908,2142,PrimeWest Health,MinnesotaCare,1100.1312,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Mra Head Routine Wo Contrast,,70544,CPT,Facility,Inpatient,,,,2142,1820.7,533.908,2142,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Mra Head Routine Wo Contrast,,70544,CPT,Facility,Both,,,,2142,1820.7,533.908,2142,Sanford Health Plan,Sanford Health Plan,1970.64,92,,percent of total billed charges,,
Mra Head Routine Wo Contrast,,70544,CPT,Facility,Outpatient,,,,2142,1820.7,533.908,2142,"UCare Health, Inc.",Individual & Family Plan,1207.017,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Mra Head Routine Wo Contrast,,70544,CPT,Facility,Inpatient,,,,2142,1820.7,533.908,2142,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Mra Head Routine Wo Contrast,,70544,CPT,Facility,Outpatient,,,,2142,1820.7,533.908,2142,"UCare Health, Inc.",Medical Assistance,1081.0674,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mra Head Routine Wo Contrast,,70544,CPT,Facility,Inpatient,,,,2142,1820.7,533.908,2142,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Mra Head Routine Wo Contrast,,70544,CPT,Facility,Outpatient,,,,2142,1820.7,533.908,2142,"UCare Health, Inc.",Medicare Advantage,1081.0674,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mra Head Routine Wo Contrast,,70544,CPT,Facility,Inpatient,,,,2142,1820.7,533.908,2142,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mra Head Routine Wo Contrast,,70544,CPT,Facility,Outpatient,,,,2142,1820.7,533.908,2142,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1081.0674,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mra Head Routine Wo Contrast,,70544,CPT,Facility,Inpatient,,,,2142,1820.7,533.908,2142,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mra Head Routine Wo Contrast,,70544,CPT,Facility,Both,,,,2142,1820.7,533.908,2142,UnitedHealthcare,Individual & Family,2013.48,94,,percent of total billed charges,,
Mra Head Routine Wo Contrast,,70544,CPT,Facility,Outpatient,,,,2142,1820.7,533.908,2142,UnitedHealthcare,Medicare Advantage,1049.58,49,,percent of total billed charges,,
Mra Head Routine Wo Contrast,,70544,CPT,Facility,Inpatient,,,,2142,1820.7,533.908,2142,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Mra Head Routine Wo Contrast,,70544,CPT,Facility,Outpatient,,,,2142,1820.7,533.908,2142,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1028.16,48,,percent of total billed charges,,100% of DHS outpatient percentage
Mra Head Routine Wo Contrast,,70544,CPT,Facility,Inpatient,,,,2142,1820.7,533.908,2142,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Mra Head W Contrast,,70545,CPT,Facility,Both,,,,2244,1907.4,561.34,2244,Aetna,Commercial,2064.48,92,,percent of total billed charges,,
Mra Head W Contrast,,70545,CPT,Facility,Outpatient,,,,2244,1907.4,561.34,2244,Aetna,Medicare Advantage,1099.56,49,,percent of total billed charges,,
Mra Head W Contrast,,70545,CPT,Facility,Inpatient,,,,2244,1907.4,561.34,2244,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Mra Head W Contrast,,70545,CPT,Facility,Both,,,,2244,1907.4,561.34,2244,Aetna,PPO,2086.92,93,,percent of total billed charges,,
Mra Head W Contrast,,70545,CPT,Facility,Both,,,,2244,1907.4,561.34,2244,America's PPO,America's PPO,2154.9132,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Mra Head W Contrast,,70545,CPT,Facility,Both,,,,2244,1907.4,561.34,2244,BlueCross BlueShield Minnesota, Federal Employee Program,1105,,,Fee schedule,,100% of BCBS commercial commodity fee schedule
Mra Head W Contrast,,70545,CPT,Facility,Both,,,,2244,1907.4,561.34,2244,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1122.68,,,Fee schedule,,"100% of BCBS commercial commodity fee schedule, plus MN Care tax"
Mra Head W Contrast,,70545,CPT,Facility,Both,,,,2244,1907.4,561.34,2244,BlueCross BlueShield Minnesota,High Value Network Plan,1010.412,,,Fee schedule,,"90% of BCBS commercial commodity fee schedule, plus MN Care tax; see disclaimer for more information"
Mra Head W Contrast,,70545,CPT,Facility,Outpatient,,,,2244,1907.4,561.34,2244,BlueCross BlueShield Minnesota,Medicare Advantage,1099.56,49,,percent of total billed charges,,
Mra Head W Contrast,,70545,CPT,Facility,Inpatient,,,,2244,1907.4,561.34,2244,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Mra Head W Contrast,,70545,CPT,Facility,Both,,,,2244,1907.4,561.34,2244,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,994.357676,,,Fee schedule,,"88.57% of BCBS commercial commodity fee schedule, plus MN Care tax"
Mra Head W Contrast,,70545,CPT,Facility,Both,,,,2244,1907.4,561.34,2244,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,561.34,,,Fee schedule,,"100% of BCBS Medicaid commodity fee schedule, plus MN Care tax"
Mra Head W Contrast,,70545,CPT,Facility,Outpatient,,,,2244,1907.4,561.34,2244,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1099.56,49,,percent of total billed charges,,
Mra Head W Contrast,,70545,CPT,Facility,Inpatient,,,,2244,1907.4,561.34,2244,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Mra Head W Contrast,,70545,CPT,Facility,Both,,,,2244,1907.4,561.34,2244,CorVel,Worker's Compensation,2244,100,,percent of total billed charges,,
Mra Head W Contrast,,70545,CPT,Facility,Both,,,,2244,1907.4,561.34,2244,First Health Group Corporation,First Health Network,2176.68,97,,percent of total billed charges,,
Mra Head W Contrast,,70545,CPT,Facility,Both,,,,2244,1907.4,561.34,2244,"Health Partners, Inc.",Commercial,2122.824,94.6,,percent of total billed charges,,
Mra Head W Contrast,,70545,CPT,Facility,Outpatient,,,,2244,1907.4,561.34,2244,"Health Partners, Inc.",Medicare Advantage,1099.56,49,,percent of total billed charges,,
Mra Head W Contrast,,70545,CPT,Facility,Inpatient,,,,2244,1907.4,561.34,2244,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mra Head W Contrast,,70545,CPT,Facility,Both,,,,2244,1907.4,561.34,2244,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1346.4,60,,percent of total billed charges,,
Mra Head W Contrast,,70545,CPT,Facility,Both,,,,2244,1907.4,561.34,2244,"Health Partners, Inc.",State of Minnesota Advantage Program,1828.86,81.5,,percent of total billed charges,,
Mra Head W Contrast,,70545,CPT,Facility,Both,,,,2244,1907.4,561.34,2244,"Health Partners, Inc.",State Public Programs,1122,50,,percent of total billed charges,,
Mra Head W Contrast,,70545,CPT,Facility,Both,,,,2244,1907.4,561.34,2244,Humana Insurance Company,Commercial PPO,2131.8,95,,percent of total billed charges,,
Mra Head W Contrast,,70545,CPT,Facility,Outpatient,,,,2244,1907.4,561.34,2244,Humana Insurance Company,Medicare PPO,1099.56,49,,percent of total billed charges,,
Mra Head W Contrast,,70545,CPT,Facility,Inpatient,,,,2244,1907.4,561.34,2244,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Mra Head W Contrast,,70545,CPT,Facility,Both,,,,2244,1907.4,561.34,2244,Medica,Individual & Family,2223.804,99.1,,percent of total billed charges,,
Mra Head W Contrast,,70545,CPT,Facility,Outpatient,,,,2244,1907.4,561.34,2244,Medica,Medica Advantage Solution,1117.512,49.8,,percent of total billed charges,,
Mra Head W Contrast,,70545,CPT,Facility,Inpatient,,,,2244,1907.4,561.34,2244,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Mra Head W Contrast,,70545,CPT,Facility,Outpatient,,,,2244,1907.4,561.34,2244,Medica,Medical Assistance,747,,,Other ,per vist,Pays in addition to all Outpatient Service Categories
Mra Head W Contrast,,70545,CPT,Facility,Inpatient,,,,2244,1907.4,561.34,2244,Medica,Medical Assistance,,,,,Included in per diem rate,
Mra Head W Contrast,,70545,CPT,Facility,Outpatient,,,,2244,1907.4,561.34,2244,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1117.512,49.8,,percent of total billed charges,,
Mra Head W Contrast,,70545,CPT,Facility,Inpatient,,,,2244,1907.4,561.34,2244,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Mra Head W Contrast,,70545,CPT,Facility,Both,,,,2244,1907.4,561.34,2244,"Multiplan, Inc.","Multiplan, Inc.",2109.36,94,,percent of total billed charges,,
Mra Head W Contrast,,70545,CPT,Facility,Outpatient,,,,2244,1907.4,561.34,2244,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1535,,,Other,Per scan,
Mra Head W Contrast,,70545,CPT,Facility,Inpatient,,,,2244,1907.4,561.34,2244,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Mra Head W Contrast,,70545,CPT,Facility,Both,,,,2244,1907.4,561.34,2244,"Preferred One Administrative Services, INC.",PPO,2212.584,98.6,,percent of total billed charges,,
Mra Head W Contrast,,70545,CPT,Facility,Outpatient,,,,2244,1907.4,561.34,2244,PrimeWest Health,Minnesota Senior Health Options (MSHO),1154.538,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Mra Head W Contrast,,70545,CPT,Facility,Inpatient,,,,2244,1907.4,561.34,2244,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mra Head W Contrast,,70545,CPT,Facility,Outpatient,,,,2244,1907.4,561.34,2244,PrimeWest Health,MinnesotaCare,1152.5184,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Mra Head W Contrast,,70545,CPT,Facility,Inpatient,,,,2244,1907.4,561.34,2244,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Mra Head W Contrast,,70545,CPT,Facility,Both,,,,2244,1907.4,561.34,2244,Sanford Health Plan,Sanford Health Plan,2064.48,92,,percent of total billed charges,,
Mra Head W Contrast,,70545,CPT,Facility,Outpatient,,,,2244,1907.4,561.34,2244,"UCare Health, Inc.",Individual & Family Plan,1264.494,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Mra Head W Contrast,,70545,CPT,Facility,Inpatient,,,,2244,1907.4,561.34,2244,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Mra Head W Contrast,,70545,CPT,Facility,Outpatient,,,,2244,1907.4,561.34,2244,"UCare Health, Inc.",Medical Assistance,1132.5468,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mra Head W Contrast,,70545,CPT,Facility,Inpatient,,,,2244,1907.4,561.34,2244,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Mra Head W Contrast,,70545,CPT,Facility,Outpatient,,,,2244,1907.4,561.34,2244,"UCare Health, Inc.",Medicare Advantage,1132.5468,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mra Head W Contrast,,70545,CPT,Facility,Inpatient,,,,2244,1907.4,561.34,2244,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mra Head W Contrast,,70545,CPT,Facility,Outpatient,,,,2244,1907.4,561.34,2244,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1132.5468,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mra Head W Contrast,,70545,CPT,Facility,Inpatient,,,,2244,1907.4,561.34,2244,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mra Head W Contrast,,70545,CPT,Facility,Both,,,,2244,1907.4,561.34,2244,UnitedHealthcare,Individual & Family,2109.36,94,,percent of total billed charges,,
Mra Head W Contrast,,70545,CPT,Facility,Outpatient,,,,2244,1907.4,561.34,2244,UnitedHealthcare,Medicare Advantage,1099.56,49,,percent of total billed charges,,
Mra Head W Contrast,,70545,CPT,Facility,Inpatient,,,,2244,1907.4,561.34,2244,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Mra Head W Contrast,,70545,CPT,Facility,Outpatient,,,,2244,1907.4,561.34,2244,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1077.12,48,,percent of total billed charges,,100% of DHS outpatient percentage
Mra Head W Contrast,,70545,CPT,Facility,Inpatient,,,,2244,1907.4,561.34,2244,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Mra Head Wo W Contrast,,70546,CPT,Facility,Both,,,,2550,2167.5,561.34,2550,Aetna,Commercial,2346,92,,percent of total billed charges,,
Mra Head Wo W Contrast,,70546,CPT,Facility,Outpatient,,,,2550,2167.5,561.34,2550,Aetna,Medicare Advantage,1249.5,49,,percent of total billed charges,,
Mra Head Wo W Contrast,,70546,CPT,Facility,Inpatient,,,,2550,2167.5,561.34,2550,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Mra Head Wo W Contrast,,70546,CPT,Facility,Both,,,,2550,2167.5,561.34,2550,Aetna,PPO,2371.5,93,,percent of total billed charges,,
Mra Head Wo W Contrast,,70546,CPT,Facility,Both,,,,2550,2167.5,561.34,2550,America's PPO,America's PPO,2448.765,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Mra Head Wo W Contrast,,70546,CPT,Facility,Both,,,,2550,2167.5,561.34,2550,BlueCross BlueShield Minnesota, Federal Employee Program,1105,,,Fee schedule,,100% of BCBS commercial commodity fee schedule
Mra Head Wo W Contrast,,70546,CPT,Facility,Both,,,,2550,2167.5,561.34,2550,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1122.68,,,Fee schedule,,"100% of BCBS commercial commodity fee schedule, plus MN Care tax"
Mra Head Wo W Contrast,,70546,CPT,Facility,Both,,,,2550,2167.5,561.34,2550,BlueCross BlueShield Minnesota,High Value Network Plan,1010.412,,,Fee schedule,,"90% of BCBS commercial commodity fee schedule, plus MN Care tax; see disclaimer for more information"
Mra Head Wo W Contrast,,70546,CPT,Facility,Outpatient,,,,2550,2167.5,561.34,2550,BlueCross BlueShield Minnesota,Medicare Advantage,1249.5,49,,percent of total billed charges,,
Mra Head Wo W Contrast,,70546,CPT,Facility,Inpatient,,,,2550,2167.5,561.34,2550,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Mra Head Wo W Contrast,,70546,CPT,Facility,Both,,,,2550,2167.5,561.34,2550,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,994.357676,,,Fee schedule,,"88.57% of BCBS commercial commodity fee schedule, plus MN Care tax"
Mra Head Wo W Contrast,,70546,CPT,Facility,Both,,,,2550,2167.5,561.34,2550,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,561.34,,,Fee schedule,,"100% of BCBS Medicaid commodity fee schedule, plus MN Care tax"
Mra Head Wo W Contrast,,70546,CPT,Facility,Outpatient,,,,2550,2167.5,561.34,2550,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1249.5,49,,percent of total billed charges,,
Mra Head Wo W Contrast,,70546,CPT,Facility,Inpatient,,,,2550,2167.5,561.34,2550,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Mra Head Wo W Contrast,,70546,CPT,Facility,Both,,,,2550,2167.5,561.34,2550,CorVel,Worker's Compensation,2550,100,,percent of total billed charges,,
Mra Head Wo W Contrast,,70546,CPT,Facility,Both,,,,2550,2167.5,561.34,2550,First Health Group Corporation,First Health Network,2473.5,97,,percent of total billed charges,,
Mra Head Wo W Contrast,,70546,CPT,Facility,Both,,,,2550,2167.5,561.34,2550,"Health Partners, Inc.",Commercial,2412.3,94.6,,percent of total billed charges,,
Mra Head Wo W Contrast,,70546,CPT,Facility,Outpatient,,,,2550,2167.5,561.34,2550,"Health Partners, Inc.",Medicare Advantage,1249.5,49,,percent of total billed charges,,
Mra Head Wo W Contrast,,70546,CPT,Facility,Inpatient,,,,2550,2167.5,561.34,2550,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mra Head Wo W Contrast,,70546,CPT,Facility,Both,,,,2550,2167.5,561.34,2550,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1530,60,,percent of total billed charges,,
Mra Head Wo W Contrast,,70546,CPT,Facility,Both,,,,2550,2167.5,561.34,2550,"Health Partners, Inc.",State of Minnesota Advantage Program,2078.25,81.5,,percent of total billed charges,,
Mra Head Wo W Contrast,,70546,CPT,Facility,Both,,,,2550,2167.5,561.34,2550,"Health Partners, Inc.",State Public Programs,1275,50,,percent of total billed charges,,
Mra Head Wo W Contrast,,70546,CPT,Facility,Both,,,,2550,2167.5,561.34,2550,Humana Insurance Company,Commercial PPO,2422.5,95,,percent of total billed charges,,
Mra Head Wo W Contrast,,70546,CPT,Facility,Outpatient,,,,2550,2167.5,561.34,2550,Humana Insurance Company,Medicare PPO,1249.5,49,,percent of total billed charges,,
Mra Head Wo W Contrast,,70546,CPT,Facility,Inpatient,,,,2550,2167.5,561.34,2550,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Mra Head Wo W Contrast,,70546,CPT,Facility,Both,,,,2550,2167.5,561.34,2550,Medica,Individual & Family,2527.05,99.1,,percent of total billed charges,,
Mra Head Wo W Contrast,,70546,CPT,Facility,Outpatient,,,,2550,2167.5,561.34,2550,Medica,Medica Advantage Solution,1269.9,49.8,,percent of total billed charges,,
Mra Head Wo W Contrast,,70546,CPT,Facility,Inpatient,,,,2550,2167.5,561.34,2550,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Mra Head Wo W Contrast,,70546,CPT,Facility,Outpatient,,,,2550,2167.5,561.34,2550,Medica,Medical Assistance,747,,,Other ,per vist,Pays in addition to all Outpatient Service Categories
Mra Head Wo W Contrast,,70546,CPT,Facility,Inpatient,,,,2550,2167.5,561.34,2550,Medica,Medical Assistance,,,,,Included in per diem rate,
Mra Head Wo W Contrast,,70546,CPT,Facility,Outpatient,,,,2550,2167.5,561.34,2550,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1269.9,49.8,,percent of total billed charges,,
Mra Head Wo W Contrast,,70546,CPT,Facility,Inpatient,,,,2550,2167.5,561.34,2550,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Mra Head Wo W Contrast,,70546,CPT,Facility,Both,,,,2550,2167.5,561.34,2550,"Multiplan, Inc.","Multiplan, Inc.",2397,94,,percent of total billed charges,,
Mra Head Wo W Contrast,,70546,CPT,Facility,Outpatient,,,,2550,2167.5,561.34,2550,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1535,,,Other ,per scan,
Mra Head Wo W Contrast,,70546,CPT,Facility,Inpatient,,,,2550,2167.5,561.34,2550,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Mra Head Wo W Contrast,,70546,CPT,Facility,Both,,,,2550,2167.5,561.34,2550,"Preferred One Administrative Services, INC.",PPO,2514.3,98.6,,percent of total billed charges,,
Mra Head Wo W Contrast,,70546,CPT,Facility,Outpatient,,,,2550,2167.5,561.34,2550,PrimeWest Health,Minnesota Senior Health Options (MSHO),1311.975,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Mra Head Wo W Contrast,,70546,CPT,Facility,Inpatient,,,,2550,2167.5,561.34,2550,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mra Head Wo W Contrast,,70546,CPT,Facility,Outpatient,,,,2550,2167.5,561.34,2550,PrimeWest Health,MinnesotaCare,1309.68,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Mra Head Wo W Contrast,,70546,CPT,Facility,Inpatient,,,,2550,2167.5,561.34,2550,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Mra Head Wo W Contrast,,70546,CPT,Facility,Both,,,,2550,2167.5,561.34,2550,Sanford Health Plan,Sanford Health Plan,2346,92,,percent of total billed charges,,
Mra Head Wo W Contrast,,70546,CPT,Facility,Outpatient,,,,2550,2167.5,561.34,2550,"UCare Health, Inc.",Individual & Family Plan,1436.925,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Mra Head Wo W Contrast,,70546,CPT,Facility,Inpatient,,,,2550,2167.5,561.34,2550,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Mra Head Wo W Contrast,,70546,CPT,Facility,Outpatient,,,,2550,2167.5,561.34,2550,"UCare Health, Inc.",Medical Assistance,1286.985,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mra Head Wo W Contrast,,70546,CPT,Facility,Inpatient,,,,2550,2167.5,561.34,2550,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Mra Head Wo W Contrast,,70546,CPT,Facility,Outpatient,,,,2550,2167.5,561.34,2550,"UCare Health, Inc.",Medicare Advantage,1286.985,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mra Head Wo W Contrast,,70546,CPT,Facility,Inpatient,,,,2550,2167.5,561.34,2550,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mra Head Wo W Contrast,,70546,CPT,Facility,Outpatient,,,,2550,2167.5,561.34,2550,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1286.985,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mra Head Wo W Contrast,,70546,CPT,Facility,Inpatient,,,,2550,2167.5,561.34,2550,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mra Head Wo W Contrast,,70546,CPT,Facility,Both,,,,2550,2167.5,561.34,2550,UnitedHealthcare,Individual & Family,2397,94,,percent of total billed charges,,
Mra Head Wo W Contrast,,70546,CPT,Facility,Outpatient,,,,2550,2167.5,561.34,2550,UnitedHealthcare,Medicare Advantage,1249.5,49,,percent of total billed charges,,
Mra Head Wo W Contrast,,70546,CPT,Facility,Inpatient,,,,2550,2167.5,561.34,2550,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Mra Head Wo W Contrast,,70546,CPT,Facility,Outpatient,,,,2550,2167.5,561.34,2550,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1224,48,,percent of total billed charges,,100% of DHS outpatient percentage
Mra Head Wo W Contrast,,70546,CPT,Facility,Inpatient,,,,2550,2167.5,561.34,2550,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Mra Carotids Neck Wo Contrast,,70547,CPT,Facility,Both,,,,2142,1820.7,533.908,2142,Aetna,Commercial,1970.64,92,,percent of total billed charges,,
Mra Carotids Neck Wo Contrast,,70547,CPT,Facility,Outpatient,,,,2142,1820.7,533.908,2142,Aetna,Medicare Advantage,1049.58,49,,percent of total billed charges,,
Mra Carotids Neck Wo Contrast,,70547,CPT,Facility,Inpatient,,,,2142,1820.7,533.908,2142,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Mra Carotids Neck Wo Contrast,,70547,CPT,Facility,Both,,,,2142,1820.7,533.908,2142,Aetna,PPO,1992.06,93,,percent of total billed charges,,
Mra Carotids Neck Wo Contrast,,70547,CPT,Facility,Both,,,,2142,1820.7,533.908,2142,America's PPO,America's PPO,2056.9626,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Mra Carotids Neck Wo Contrast,,70547,CPT,Facility,Both,,,,2142,1820.7,533.908,2142,BlueCross BlueShield Minnesota, Federal Employee Program,1051,,,Fee schedule,,100% of BCBS commercial commodity fee schedule
Mra Carotids Neck Wo Contrast,,70547,CPT,Facility,Both,,,,2142,1820.7,533.908,2142,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1067.816,,,Fee schedule,,"100% of BCBS commercial commodity fee schedule, plus MN Care tax"
Mra Carotids Neck Wo Contrast,,70547,CPT,Facility,Both,,,,2142,1820.7,533.908,2142,BlueCross BlueShield Minnesota,High Value Network Plan,961.0344,,,Fee schedule,,"90% of BCBS commercial commodity fee schedule, plus MN Care tax; see disclaimer for more information"
Mra Carotids Neck Wo Contrast,,70547,CPT,Facility,Outpatient,,,,2142,1820.7,533.908,2142,BlueCross BlueShield Minnesota,Medicare Advantage,1049.58,49,,percent of total billed charges,,
Mra Carotids Neck Wo Contrast,,70547,CPT,Facility,Inpatient,,,,2142,1820.7,533.908,2142,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Mra Carotids Neck Wo Contrast,,70547,CPT,Facility,Both,,,,2142,1820.7,533.908,2142,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,945.7646312,,,Fee schedule,,"88.57% of BCBS commercial commodity fee schedule, plus MN Care tax"
Mra Carotids Neck Wo Contrast,,70547,CPT,Facility,Both,,,,2142,1820.7,533.908,2142,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,533.908,,,Fee schedule,,"100% of BCBS Medicaid commodity fee schedule, plus MN Care tax"
Mra Carotids Neck Wo Contrast,,70547,CPT,Facility,Outpatient,,,,2142,1820.7,533.908,2142,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1049.58,49,,percent of total billed charges,,
Mra Carotids Neck Wo Contrast,,70547,CPT,Facility,Inpatient,,,,2142,1820.7,533.908,2142,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Mra Carotids Neck Wo Contrast,,70547,CPT,Facility,Both,,,,2142,1820.7,533.908,2142,CorVel,Worker's Compensation,2142,100,,percent of total billed charges,,
Mra Carotids Neck Wo Contrast,,70547,CPT,Facility,Both,,,,2142,1820.7,533.908,2142,First Health Group Corporation,First Health Network,2077.74,97,,percent of total billed charges,,
Mra Carotids Neck Wo Contrast,,70547,CPT,Facility,Both,,,,2142,1820.7,533.908,2142,"Health Partners, Inc.",Commercial,2026.332,94.6,,percent of total billed charges,,
Mra Carotids Neck Wo Contrast,,70547,CPT,Facility,Outpatient,,,,2142,1820.7,533.908,2142,"Health Partners, Inc.",Medicare Advantage,1049.58,49,,percent of total billed charges,,
Mra Carotids Neck Wo Contrast,,70547,CPT,Facility,Inpatient,,,,2142,1820.7,533.908,2142,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mra Carotids Neck Wo Contrast,,70547,CPT,Facility,Both,,,,2142,1820.7,533.908,2142,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1285.2,60,,percent of total billed charges,,
Mra Carotids Neck Wo Contrast,,70547,CPT,Facility,Both,,,,2142,1820.7,533.908,2142,"Health Partners, Inc.",State of Minnesota Advantage Program,1745.73,81.5,,percent of total billed charges,,
Mra Carotids Neck Wo Contrast,,70547,CPT,Facility,Both,,,,2142,1820.7,533.908,2142,"Health Partners, Inc.",State Public Programs,1071,50,,percent of total billed charges,,
Mra Carotids Neck Wo Contrast,,70547,CPT,Facility,Both,,,,2142,1820.7,533.908,2142,Humana Insurance Company,Commercial PPO,2034.9,95,,percent of total billed charges,,
Mra Carotids Neck Wo Contrast,,70547,CPT,Facility,Outpatient,,,,2142,1820.7,533.908,2142,Humana Insurance Company,Medicare PPO,1049.58,49,,percent of total billed charges,,
Mra Carotids Neck Wo Contrast,,70547,CPT,Facility,Inpatient,,,,2142,1820.7,533.908,2142,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Mra Carotids Neck Wo Contrast,,70547,CPT,Facility,Both,,,,2142,1820.7,533.908,2142,Medica,Individual & Family,2122.722,99.1,,percent of total billed charges,,
Mra Carotids Neck Wo Contrast,,70547,CPT,Facility,Outpatient,,,,2142,1820.7,533.908,2142,Medica,Medica Advantage Solution,1066.716,49.8,,percent of total billed charges,,
Mra Carotids Neck Wo Contrast,,70547,CPT,Facility,Inpatient,,,,2142,1820.7,533.908,2142,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Mra Carotids Neck Wo Contrast,,70547,CPT,Facility,Outpatient,,,,2142,1820.7,533.908,2142,Medica,Medical Assistance,747,,,Other,Per vist,Pays in addition to all Outpatient Service Categories
Mra Carotids Neck Wo Contrast,,70547,CPT,Facility,Inpatient,,,,2142,1820.7,533.908,2142,Medica,Medical Assistance,,,,,Included in per diem rate,
Mra Carotids Neck Wo Contrast,,70547,CPT,Facility,Outpatient,,,,2142,1820.7,533.908,2142,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1066.716,49.8,,percent of total billed charges,,
Mra Carotids Neck Wo Contrast,,70547,CPT,Facility,Inpatient,,,,2142,1820.7,533.908,2142,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Mra Carotids Neck Wo Contrast,,70547,CPT,Facility,Both,,,,2142,1820.7,533.908,2142,"Multiplan, Inc.","Multiplan, Inc.",2013.48,94,,percent of total billed charges,,
Mra Carotids Neck Wo Contrast,,70547,CPT,Facility,Outpatient,,,,2142,1820.7,533.908,2142,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1535,,,Other,Per scan,
Mra Carotids Neck Wo Contrast,,70547,CPT,Facility,Inpatient,,,,2142,1820.7,533.908,2142,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Mra Carotids Neck Wo Contrast,,70547,CPT,Facility,Both,,,,2142,1820.7,533.908,2142,"Preferred One Administrative Services, INC.",PPO,2112.012,98.6,,percent of total billed charges,,
Mra Carotids Neck Wo Contrast,,70547,CPT,Facility,Outpatient,,,,2142,1820.7,533.908,2142,PrimeWest Health,Minnesota Senior Health Options (MSHO),1102.059,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Mra Carotids Neck Wo Contrast,,70547,CPT,Facility,Inpatient,,,,2142,1820.7,533.908,2142,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mra Carotids Neck Wo Contrast,,70547,CPT,Facility,Outpatient,,,,2142,1820.7,533.908,2142,PrimeWest Health,MinnesotaCare,1100.1312,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Mra Carotids Neck Wo Contrast,,70547,CPT,Facility,Inpatient,,,,2142,1820.7,533.908,2142,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Mra Carotids Neck Wo Contrast,,70547,CPT,Facility,Both,,,,2142,1820.7,533.908,2142,Sanford Health Plan,Sanford Health Plan,1970.64,92,,percent of total billed charges,,
Mra Carotids Neck Wo Contrast,,70547,CPT,Facility,Outpatient,,,,2142,1820.7,533.908,2142,"UCare Health, Inc.",Individual & Family Plan,1207.017,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Mra Carotids Neck Wo Contrast,,70547,CPT,Facility,Inpatient,,,,2142,1820.7,533.908,2142,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Mra Carotids Neck Wo Contrast,,70547,CPT,Facility,Outpatient,,,,2142,1820.7,533.908,2142,"UCare Health, Inc.",Medical Assistance,1081.0674,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mra Carotids Neck Wo Contrast,,70547,CPT,Facility,Inpatient,,,,2142,1820.7,533.908,2142,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Mra Carotids Neck Wo Contrast,,70547,CPT,Facility,Outpatient,,,,2142,1820.7,533.908,2142,"UCare Health, Inc.",Medicare Advantage,1081.0674,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mra Carotids Neck Wo Contrast,,70547,CPT,Facility,Inpatient,,,,2142,1820.7,533.908,2142,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mra Carotids Neck Wo Contrast,,70547,CPT,Facility,Outpatient,,,,2142,1820.7,533.908,2142,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1081.0674,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mra Carotids Neck Wo Contrast,,70547,CPT,Facility,Inpatient,,,,2142,1820.7,533.908,2142,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mra Carotids Neck Wo Contrast,,70547,CPT,Facility,Both,,,,2142,1820.7,533.908,2142,UnitedHealthcare,Individual & Family,2013.48,94,,percent of total billed charges,,
Mra Carotids Neck Wo Contrast,,70547,CPT,Facility,Outpatient,,,,2142,1820.7,533.908,2142,UnitedHealthcare,Medicare Advantage,1049.58,49,,percent of total billed charges,,
Mra Carotids Neck Wo Contrast,,70547,CPT,Facility,Inpatient,,,,2142,1820.7,533.908,2142,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Mra Carotids Neck Wo Contrast,,70547,CPT,Facility,Outpatient,,,,2142,1820.7,533.908,2142,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1028.16,48,,percent of total billed charges,,100% of DHS outpatient percentage
Mra Carotids Neck Wo Contrast,,70547,CPT,Facility,Inpatient,,,,2142,1820.7,533.908,2142,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Mra Carotids Neck W Contrast,,70548,CPT,Facility,Both,,,,2346,1994.1,561.34,2346,Aetna,Commercial,2158.32,92,,percent of total billed charges,,
Mra Carotids Neck W Contrast,,70548,CPT,Facility,Outpatient,,,,2346,1994.1,561.34,2346,Aetna,Medicare Advantage,1149.54,49,,percent of total billed charges,,
Mra Carotids Neck W Contrast,,70548,CPT,Facility,Inpatient,,,,2346,1994.1,561.34,2346,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Mra Carotids Neck W Contrast,,70548,CPT,Facility,Both,,,,2346,1994.1,561.34,2346,Aetna,PPO,2181.78,93,,percent of total billed charges,,
Mra Carotids Neck W Contrast,,70548,CPT,Facility,Both,,,,2346,1994.1,561.34,2346,America's PPO,America's PPO,2252.8638,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Mra Carotids Neck W Contrast,,70548,CPT,Facility,Both,,,,2346,1994.1,561.34,2346,BlueCross BlueShield Minnesota, Federal Employee Program,1105,,,Fee schedule,,100% of BCBS commercial commodity fee schedule
Mra Carotids Neck W Contrast,,70548,CPT,Facility,Both,,,,2346,1994.1,561.34,2346,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1122.68,,,Fee schedule,,"100% of BCBS commercial commodity fee schedule, plus MN Care tax"
Mra Carotids Neck W Contrast,,70548,CPT,Facility,Both,,,,2346,1994.1,561.34,2346,BlueCross BlueShield Minnesota,High Value Network Plan,1010.412,,,Fee schedule,,"90% of BCBS commercial commodity fee schedule, plus MN Care tax; see disclaimer for more information"
Mra Carotids Neck W Contrast,,70548,CPT,Facility,Outpatient,,,,2346,1994.1,561.34,2346,BlueCross BlueShield Minnesota,Medicare Advantage,1149.54,49,,percent of total billed charges,,
Mra Carotids Neck W Contrast,,70548,CPT,Facility,Inpatient,,,,2346,1994.1,561.34,2346,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Mra Carotids Neck W Contrast,,70548,CPT,Facility,Both,,,,2346,1994.1,561.34,2346,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,994.357676,,,Fee schedule,,"88.57% of BCBS commercial commodity fee schedule, plus MN Care tax"
Mra Carotids Neck W Contrast,,70548,CPT,Facility,Both,,,,2346,1994.1,561.34,2346,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,561.34,,,Fee schedule,,"100% of BCBS Medicaid commodity fee schedule, plus MN Care tax"
Mra Carotids Neck W Contrast,,70548,CPT,Facility,Outpatient,,,,2346,1994.1,561.34,2346,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1149.54,49,,percent of total billed charges,,
Mra Carotids Neck W Contrast,,70548,CPT,Facility,Inpatient,,,,2346,1994.1,561.34,2346,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Mra Carotids Neck W Contrast,,70548,CPT,Facility,Both,,,,2346,1994.1,561.34,2346,CorVel,Worker's Compensation,2346,100,,percent of total billed charges,,
Mra Carotids Neck W Contrast,,70548,CPT,Facility,Both,,,,2346,1994.1,561.34,2346,First Health Group Corporation,First Health Network,2275.62,97,,percent of total billed charges,,
Mra Carotids Neck W Contrast,,70548,CPT,Facility,Both,,,,2346,1994.1,561.34,2346,"Health Partners, Inc.",Commercial,2219.316,94.6,,percent of total billed charges,,
Mra Carotids Neck W Contrast,,70548,CPT,Facility,Outpatient,,,,2346,1994.1,561.34,2346,"Health Partners, Inc.",Medicare Advantage,1149.54,49,,percent of total billed charges,,
Mra Carotids Neck W Contrast,,70548,CPT,Facility,Inpatient,,,,2346,1994.1,561.34,2346,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mra Carotids Neck W Contrast,,70548,CPT,Facility,Both,,,,2346,1994.1,561.34,2346,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1407.6,60,,percent of total billed charges,,
Mra Carotids Neck W Contrast,,70548,CPT,Facility,Both,,,,2346,1994.1,561.34,2346,"Health Partners, Inc.",State of Minnesota Advantage Program,1911.99,81.5,,percent of total billed charges,,
Mra Carotids Neck W Contrast,,70548,CPT,Facility,Both,,,,2346,1994.1,561.34,2346,"Health Partners, Inc.",State Public Programs,1173,50,,percent of total billed charges,,
Mra Carotids Neck W Contrast,,70548,CPT,Facility,Both,,,,2346,1994.1,561.34,2346,Humana Insurance Company,Commercial PPO,2228.7,95,,percent of total billed charges,,
Mra Carotids Neck W Contrast,,70548,CPT,Facility,Outpatient,,,,2346,1994.1,561.34,2346,Humana Insurance Company,Medicare PPO,1149.54,49,,percent of total billed charges,,
Mra Carotids Neck W Contrast,,70548,CPT,Facility,Inpatient,,,,2346,1994.1,561.34,2346,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Mra Carotids Neck W Contrast,,70548,CPT,Facility,Both,,,,2346,1994.1,561.34,2346,Medica,Individual & Family,2324.886,99.1,,percent of total billed charges,,
Mra Carotids Neck W Contrast,,70548,CPT,Facility,Outpatient,,,,2346,1994.1,561.34,2346,Medica,Medica Advantage Solution,1168.308,49.8,,percent of total billed charges,,
Mra Carotids Neck W Contrast,,70548,CPT,Facility,Inpatient,,,,2346,1994.1,561.34,2346,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Mra Carotids Neck W Contrast,,70548,CPT,Facility,Outpatient,,,,2346,1994.1,561.34,2346,Medica,Medical Assistance,747,,,Other,Per vist,Pays in addition to all Outpatient Service Categories
Mra Carotids Neck W Contrast,,70548,CPT,Facility,Inpatient,,,,2346,1994.1,561.34,2346,Medica,Medical Assistance,,,,,Included in per diem rate,
Mra Carotids Neck W Contrast,,70548,CPT,Facility,Outpatient,,,,2346,1994.1,561.34,2346,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1168.308,49.8,,percent of total billed charges,,
Mra Carotids Neck W Contrast,,70548,CPT,Facility,Inpatient,,,,2346,1994.1,561.34,2346,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Mra Carotids Neck W Contrast,,70548,CPT,Facility,Both,,,,2346,1994.1,561.34,2346,"Multiplan, Inc.","Multiplan, Inc.",2205.24,94,,percent of total billed charges,,
Mra Carotids Neck W Contrast,,70548,CPT,Facility,Outpatient,,,,2346,1994.1,561.34,2346,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1535,,,Other,Per scan,
Mra Carotids Neck W Contrast,,70548,CPT,Facility,Inpatient,,,,2346,1994.1,561.34,2346,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Mra Carotids Neck W Contrast,,70548,CPT,Facility,Both,,,,2346,1994.1,561.34,2346,"Preferred One Administrative Services, INC.",PPO,2313.156,98.6,,percent of total billed charges,,
Mra Carotids Neck W Contrast,,70548,CPT,Facility,Outpatient,,,,2346,1994.1,561.34,2346,PrimeWest Health,Minnesota Senior Health Options (MSHO),1207.017,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Mra Carotids Neck W Contrast,,70548,CPT,Facility,Inpatient,,,,2346,1994.1,561.34,2346,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mra Carotids Neck W Contrast,,70548,CPT,Facility,Outpatient,,,,2346,1994.1,561.34,2346,PrimeWest Health,MinnesotaCare,1204.9056,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Mra Carotids Neck W Contrast,,70548,CPT,Facility,Inpatient,,,,2346,1994.1,561.34,2346,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Mra Carotids Neck W Contrast,,70548,CPT,Facility,Both,,,,2346,1994.1,561.34,2346,Sanford Health Plan,Sanford Health Plan,2158.32,92,,percent of total billed charges,,
Mra Carotids Neck W Contrast,,70548,CPT,Facility,Outpatient,,,,2346,1994.1,561.34,2346,"UCare Health, Inc.",Individual & Family Plan,1321.971,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Mra Carotids Neck W Contrast,,70548,CPT,Facility,Inpatient,,,,2346,1994.1,561.34,2346,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Mra Carotids Neck W Contrast,,70548,CPT,Facility,Outpatient,,,,2346,1994.1,561.34,2346,"UCare Health, Inc.",Medical Assistance,1184.0262,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mra Carotids Neck W Contrast,,70548,CPT,Facility,Inpatient,,,,2346,1994.1,561.34,2346,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Mra Carotids Neck W Contrast,,70548,CPT,Facility,Outpatient,,,,2346,1994.1,561.34,2346,"UCare Health, Inc.",Medicare Advantage,1184.0262,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mra Carotids Neck W Contrast,,70548,CPT,Facility,Inpatient,,,,2346,1994.1,561.34,2346,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mra Carotids Neck W Contrast,,70548,CPT,Facility,Outpatient,,,,2346,1994.1,561.34,2346,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1184.0262,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mra Carotids Neck W Contrast,,70548,CPT,Facility,Inpatient,,,,2346,1994.1,561.34,2346,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mra Carotids Neck W Contrast,,70548,CPT,Facility,Both,,,,2346,1994.1,561.34,2346,UnitedHealthcare,Individual & Family,2205.24,94,,percent of total billed charges,,
Mra Carotids Neck W Contrast,,70548,CPT,Facility,Outpatient,,,,2346,1994.1,561.34,2346,UnitedHealthcare,Medicare Advantage,1149.54,49,,percent of total billed charges,,
Mra Carotids Neck W Contrast,,70548,CPT,Facility,Inpatient,,,,2346,1994.1,561.34,2346,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Mra Carotids Neck W Contrast,,70548,CPT,Facility,Outpatient,,,,2346,1994.1,561.34,2346,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1126.08,48,,percent of total billed charges,,100% of DHS outpatient percentage
Mra Carotids Neck W Contrast,,70548,CPT,Facility,Inpatient,,,,2346,1994.1,561.34,2346,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Mra Carotids Neck Wo W Contrast,,70549,CPT,Facility,Both,,,,2550,2167.5,561.34,2550,Aetna,Commercial,2346,92,,percent of total billed charges,,
Mra Carotids Neck Wo W Contrast,,70549,CPT,Facility,Outpatient,,,,2550,2167.5,561.34,2550,Aetna,Medicare Advantage,1249.5,49,,percent of total billed charges,,
Mra Carotids Neck Wo W Contrast,,70549,CPT,Facility,Inpatient,,,,2550,2167.5,561.34,2550,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Mra Carotids Neck Wo W Contrast,,70549,CPT,Facility,Both,,,,2550,2167.5,561.34,2550,Aetna,PPO,2371.5,93,,percent of total billed charges,,
Mra Carotids Neck Wo W Contrast,,70549,CPT,Facility,Both,,,,2550,2167.5,561.34,2550,America's PPO,America's PPO,2448.765,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Mra Carotids Neck Wo W Contrast,,70549,CPT,Facility,Both,,,,2550,2167.5,561.34,2550,BlueCross BlueShield Minnesota, Federal Employee Program,1105,,,Fee schedule,,100% of BCBS commercial commodity fee schedule
Mra Carotids Neck Wo W Contrast,,70549,CPT,Facility,Both,,,,2550,2167.5,561.34,2550,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1122.68,,,Fee schedule,,"100% of BCBS commercial commodity fee schedule, plus MN Care tax"
Mra Carotids Neck Wo W Contrast,,70549,CPT,Facility,Both,,,,2550,2167.5,561.34,2550,BlueCross BlueShield Minnesota,High Value Network Plan,1010.412,,,Fee schedule,,"90% of BCBS commercial commodity fee schedule, plus MN Care tax; see disclaimer for more information"
Mra Carotids Neck Wo W Contrast,,70549,CPT,Facility,Outpatient,,,,2550,2167.5,561.34,2550,BlueCross BlueShield Minnesota,Medicare Advantage,1249.5,49,,percent of total billed charges,,
Mra Carotids Neck Wo W Contrast,,70549,CPT,Facility,Inpatient,,,,2550,2167.5,561.34,2550,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Mra Carotids Neck Wo W Contrast,,70549,CPT,Facility,Both,,,,2550,2167.5,561.34,2550,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,994.357676,,,Fee schedule,,"88.57% of BCBS commercial commodity fee schedule, plus MN Care tax"
Mra Carotids Neck Wo W Contrast,,70549,CPT,Facility,Both,,,,2550,2167.5,561.34,2550,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,561.34,,,Fee schedule,,"100% of BCBS Medicaid commodity fee schedule, plus MN Care tax"
Mra Carotids Neck Wo W Contrast,,70549,CPT,Facility,Outpatient,,,,2550,2167.5,561.34,2550,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1249.5,49,,percent of total billed charges,,
Mra Carotids Neck Wo W Contrast,,70549,CPT,Facility,Inpatient,,,,2550,2167.5,561.34,2550,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Mra Carotids Neck Wo W Contrast,,70549,CPT,Facility,Both,,,,2550,2167.5,561.34,2550,CorVel,Worker's Compensation,2550,100,,percent of total billed charges,,
Mra Carotids Neck Wo W Contrast,,70549,CPT,Facility,Both,,,,2550,2167.5,561.34,2550,First Health Group Corporation,First Health Network,2473.5,97,,percent of total billed charges,,
Mra Carotids Neck Wo W Contrast,,70549,CPT,Facility,Both,,,,2550,2167.5,561.34,2550,"Health Partners, Inc.",Commercial,2412.3,94.6,,percent of total billed charges,,
Mra Carotids Neck Wo W Contrast,,70549,CPT,Facility,Outpatient,,,,2550,2167.5,561.34,2550,"Health Partners, Inc.",Medicare Advantage,1249.5,49,,percent of total billed charges,,
Mra Carotids Neck Wo W Contrast,,70549,CPT,Facility,Inpatient,,,,2550,2167.5,561.34,2550,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mra Carotids Neck Wo W Contrast,,70549,CPT,Facility,Both,,,,2550,2167.5,561.34,2550,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1530,60,,percent of total billed charges,,
Mra Carotids Neck Wo W Contrast,,70549,CPT,Facility,Both,,,,2550,2167.5,561.34,2550,"Health Partners, Inc.",State of Minnesota Advantage Program,2078.25,81.5,,percent of total billed charges,,
Mra Carotids Neck Wo W Contrast,,70549,CPT,Facility,Both,,,,2550,2167.5,561.34,2550,"Health Partners, Inc.",State Public Programs,1275,50,,percent of total billed charges,,
Mra Carotids Neck Wo W Contrast,,70549,CPT,Facility,Both,,,,2550,2167.5,561.34,2550,Humana Insurance Company,Commercial PPO,2422.5,95,,percent of total billed charges,,
Mra Carotids Neck Wo W Contrast,,70549,CPT,Facility,Outpatient,,,,2550,2167.5,561.34,2550,Humana Insurance Company,Medicare PPO,1249.5,49,,percent of total billed charges,,
Mra Carotids Neck Wo W Contrast,,70549,CPT,Facility,Inpatient,,,,2550,2167.5,561.34,2550,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Mra Carotids Neck Wo W Contrast,,70549,CPT,Facility,Both,,,,2550,2167.5,561.34,2550,Medica,Individual & Family,2527.05,99.1,,percent of total billed charges,,
Mra Carotids Neck Wo W Contrast,,70549,CPT,Facility,Outpatient,,,,2550,2167.5,561.34,2550,Medica,Medica Advantage Solution,1269.9,49.8,,percent of total billed charges,,
Mra Carotids Neck Wo W Contrast,,70549,CPT,Facility,Inpatient,,,,2550,2167.5,561.34,2550,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Mra Carotids Neck Wo W Contrast,,70549,CPT,Facility,Outpatient,,,,2550,2167.5,561.34,2550,Medica,Medical Assistance,747,,,Other,Per vist,Pays in addition to all Outpatient Service Categories
Mra Carotids Neck Wo W Contrast,,70549,CPT,Facility,Inpatient,,,,2550,2167.5,561.34,2550,Medica,Medical Assistance,,,,,Included in per diem rate,
Mra Carotids Neck Wo W Contrast,,70549,CPT,Facility,Outpatient,,,,2550,2167.5,561.34,2550,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1269.9,49.8,,percent of total billed charges,,
Mra Carotids Neck Wo W Contrast,,70549,CPT,Facility,Inpatient,,,,2550,2167.5,561.34,2550,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Mra Carotids Neck Wo W Contrast,,70549,CPT,Facility,Both,,,,2550,2167.5,561.34,2550,"Multiplan, Inc.","Multiplan, Inc.",2397,94,,percent of total billed charges,,
Mra Carotids Neck Wo W Contrast,,70549,CPT,Facility,Outpatient,,,,2550,2167.5,561.34,2550,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1535,,,Other,Per scan,
Mra Carotids Neck Wo W Contrast,,70549,CPT,Facility,Inpatient,,,,2550,2167.5,561.34,2550,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Mra Carotids Neck Wo W Contrast,,70549,CPT,Facility,Both,,,,2550,2167.5,561.34,2550,"Preferred One Administrative Services, INC.",PPO,2514.3,98.6,,percent of total billed charges,,
Mra Carotids Neck Wo W Contrast,,70549,CPT,Facility,Outpatient,,,,2550,2167.5,561.34,2550,PrimeWest Health,Minnesota Senior Health Options (MSHO),1311.975,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Mra Carotids Neck Wo W Contrast,,70549,CPT,Facility,Inpatient,,,,2550,2167.5,561.34,2550,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mra Carotids Neck Wo W Contrast,,70549,CPT,Facility,Outpatient,,,,2550,2167.5,561.34,2550,PrimeWest Health,MinnesotaCare,1309.68,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Mra Carotids Neck Wo W Contrast,,70549,CPT,Facility,Inpatient,,,,2550,2167.5,561.34,2550,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Mra Carotids Neck Wo W Contrast,,70549,CPT,Facility,Both,,,,2550,2167.5,561.34,2550,Sanford Health Plan,Sanford Health Plan,2346,92,,percent of total billed charges,,
Mra Carotids Neck Wo W Contrast,,70549,CPT,Facility,Outpatient,,,,2550,2167.5,561.34,2550,"UCare Health, Inc.",Individual & Family Plan,1436.925,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Mra Carotids Neck Wo W Contrast,,70549,CPT,Facility,Inpatient,,,,2550,2167.5,561.34,2550,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Mra Carotids Neck Wo W Contrast,,70549,CPT,Facility,Outpatient,,,,2550,2167.5,561.34,2550,"UCare Health, Inc.",Medical Assistance,1286.985,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mra Carotids Neck Wo W Contrast,,70549,CPT,Facility,Inpatient,,,,2550,2167.5,561.34,2550,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Mra Carotids Neck Wo W Contrast,,70549,CPT,Facility,Outpatient,,,,2550,2167.5,561.34,2550,"UCare Health, Inc.",Medicare Advantage,1286.985,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mra Carotids Neck Wo W Contrast,,70549,CPT,Facility,Inpatient,,,,2550,2167.5,561.34,2550,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mra Carotids Neck Wo W Contrast,,70549,CPT,Facility,Outpatient,,,,2550,2167.5,561.34,2550,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1286.985,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mra Carotids Neck Wo W Contrast,,70549,CPT,Facility,Inpatient,,,,2550,2167.5,561.34,2550,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mra Carotids Neck Wo W Contrast,,70549,CPT,Facility,Both,,,,2550,2167.5,561.34,2550,UnitedHealthcare,Individual & Family,2397,94,,percent of total billed charges,,
Mra Carotids Neck Wo W Contrast,,70549,CPT,Facility,Outpatient,,,,2550,2167.5,561.34,2550,UnitedHealthcare,Medicare Advantage,1249.5,49,,percent of total billed charges,,
Mra Carotids Neck Wo W Contrast,,70549,CPT,Facility,Inpatient,,,,2550,2167.5,561.34,2550,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Mra Carotids Neck Wo W Contrast,,70549,CPT,Facility,Outpatient,,,,2550,2167.5,561.34,2550,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1224,48,,percent of total billed charges,,100% of DHS outpatient percentage
Mra Carotids Neck Wo W Contrast,,70549,CPT,Facility,Inpatient,,,,2550,2167.5,561.34,2550,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Mri Head Routine Wo Contrast,,70551,CPT,Facility,Both,,,,2142,1820.7,533.908,2142,Aetna,Commercial,1970.64,92,,percent of total billed charges,,
Mri Head Routine Wo Contrast,,70551,CPT,Facility,Outpatient,,,,2142,1820.7,533.908,2142,Aetna,Medicare Advantage,1049.58,49,,percent of total billed charges,,
Mri Head Routine Wo Contrast,,70551,CPT,Facility,Inpatient,,,,2142,1820.7,533.908,2142,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Mri Head Routine Wo Contrast,,70551,CPT,Facility,Both,,,,2142,1820.7,533.908,2142,Aetna,PPO,1992.06,93,,percent of total billed charges,,
Mri Head Routine Wo Contrast,,70551,CPT,Facility,Both,,,,2142,1820.7,533.908,2142,America's PPO,America's PPO,2056.9626,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Mri Head Routine Wo Contrast,,70551,CPT,Facility,Both,,,,2142,1820.7,533.908,2142,BlueCross BlueShield Minnesota, Federal Employee Program,1051,,,Fee schedule,,100% of BCBS commercial commodity fee schedule
Mri Head Routine Wo Contrast,,70551,CPT,Facility,Both,,,,2142,1820.7,533.908,2142,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1067.816,,,Fee schedule,,"100% of BCBS commercial commodity fee schedule, plus MN Care tax"
Mri Head Routine Wo Contrast,,70551,CPT,Facility,Both,,,,2142,1820.7,533.908,2142,BlueCross BlueShield Minnesota,High Value Network Plan,961.0344,,,Fee schedule,,"90% of BCBS commercial commodity fee schedule, plus MN Care tax; see disclaimer for more information"
Mri Head Routine Wo Contrast,,70551,CPT,Facility,Outpatient,,,,2142,1820.7,533.908,2142,BlueCross BlueShield Minnesota,Medicare Advantage,1049.58,49,,percent of total billed charges,,
Mri Head Routine Wo Contrast,,70551,CPT,Facility,Inpatient,,,,2142,1820.7,533.908,2142,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Mri Head Routine Wo Contrast,,70551,CPT,Facility,Both,,,,2142,1820.7,533.908,2142,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,945.7646312,,,Fee schedule,,"88.57% of BCBS commercial commodity fee schedule, plus MN Care tax"
Mri Head Routine Wo Contrast,,70551,CPT,Facility,Both,,,,2142,1820.7,533.908,2142,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,533.908,,,Fee schedule,,"100% of BCBS Medicaid commodity fee schedule, plus MN Care tax"
Mri Head Routine Wo Contrast,,70551,CPT,Facility,Outpatient,,,,2142,1820.7,533.908,2142,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1049.58,49,,percent of total billed charges,,
Mri Head Routine Wo Contrast,,70551,CPT,Facility,Inpatient,,,,2142,1820.7,533.908,2142,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Mri Head Routine Wo Contrast,,70551,CPT,Facility,Both,,,,2142,1820.7,533.908,2142,CorVel,Worker's Compensation,2142,100,,percent of total billed charges,,
Mri Head Routine Wo Contrast,,70551,CPT,Facility,Both,,,,2142,1820.7,533.908,2142,First Health Group Corporation,First Health Network,2077.74,97,,percent of total billed charges,,
Mri Head Routine Wo Contrast,,70551,CPT,Facility,Both,,,,2142,1820.7,533.908,2142,"Health Partners, Inc.",Commercial,2026.332,94.6,,percent of total billed charges,,
Mri Head Routine Wo Contrast,,70551,CPT,Facility,Outpatient,,,,2142,1820.7,533.908,2142,"Health Partners, Inc.",Medicare Advantage,1049.58,49,,percent of total billed charges,,
Mri Head Routine Wo Contrast,,70551,CPT,Facility,Inpatient,,,,2142,1820.7,533.908,2142,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mri Head Routine Wo Contrast,,70551,CPT,Facility,Both,,,,2142,1820.7,533.908,2142,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1285.2,60,,percent of total billed charges,,
Mri Head Routine Wo Contrast,,70551,CPT,Facility,Both,,,,2142,1820.7,533.908,2142,"Health Partners, Inc.",State of Minnesota Advantage Program,1745.73,81.5,,percent of total billed charges,,
Mri Head Routine Wo Contrast,,70551,CPT,Facility,Both,,,,2142,1820.7,533.908,2142,"Health Partners, Inc.",State Public Programs,1071,50,,percent of total billed charges,,
Mri Head Routine Wo Contrast,,70551,CPT,Facility,Both,,,,2142,1820.7,533.908,2142,Humana Insurance Company,Commercial PPO,2034.9,95,,percent of total billed charges,,
Mri Head Routine Wo Contrast,,70551,CPT,Facility,Outpatient,,,,2142,1820.7,533.908,2142,Humana Insurance Company,Medicare PPO,1049.58,49,,percent of total billed charges,,
Mri Head Routine Wo Contrast,,70551,CPT,Facility,Inpatient,,,,2142,1820.7,533.908,2142,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Mri Head Routine Wo Contrast,,70551,CPT,Facility,Both,,,,2142,1820.7,533.908,2142,Medica,Individual & Family,2122.722,99.1,,percent of total billed charges,,
Mri Head Routine Wo Contrast,,70551,CPT,Facility,Outpatient,,,,2142,1820.7,533.908,2142,Medica,Medica Advantage Solution,1066.716,49.8,,percent of total billed charges,,
Mri Head Routine Wo Contrast,,70551,CPT,Facility,Inpatient,,,,2142,1820.7,533.908,2142,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Mri Head Routine Wo Contrast,,70551,CPT,Facility,Outpatient,,,,2142,1820.7,533.908,2142,Medica,Medical Assistance,747,,,Other ,per vist,Pays in addition to all Outpatient Service Categories
Mri Head Routine Wo Contrast,,70551,CPT,Facility,Inpatient,,,,2142,1820.7,533.908,2142,Medica,Medical Assistance,,,,,Included in per diem rate,
Mri Head Routine Wo Contrast,,70551,CPT,Facility,Outpatient,,,,2142,1820.7,533.908,2142,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1066.716,49.8,,percent of total billed charges,,
Mri Head Routine Wo Contrast,,70551,CPT,Facility,Inpatient,,,,2142,1820.7,533.908,2142,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Mri Head Routine Wo Contrast,,70551,CPT,Facility,Both,,,,2142,1820.7,533.908,2142,"Multiplan, Inc.","Multiplan, Inc.",2013.48,94,,percent of total billed charges,,
Mri Head Routine Wo Contrast,,70551,CPT,Facility,Outpatient,,,,2142,1820.7,533.908,2142,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1535,,,Other ,per scan,
Mri Head Routine Wo Contrast,,70551,CPT,Facility,Inpatient,,,,2142,1820.7,533.908,2142,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Mri Head Routine Wo Contrast,,70551,CPT,Facility,Both,,,,2142,1820.7,533.908,2142,"Preferred One Administrative Services, INC.",PPO,2112.012,98.6,,percent of total billed charges,,
Mri Head Routine Wo Contrast,,70551,CPT,Facility,Outpatient,,,,2142,1820.7,533.908,2142,PrimeWest Health,Minnesota Senior Health Options (MSHO),1102.059,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Mri Head Routine Wo Contrast,,70551,CPT,Facility,Inpatient,,,,2142,1820.7,533.908,2142,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mri Head Routine Wo Contrast,,70551,CPT,Facility,Outpatient,,,,2142,1820.7,533.908,2142,PrimeWest Health,MinnesotaCare,1100.1312,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Mri Head Routine Wo Contrast,,70551,CPT,Facility,Inpatient,,,,2142,1820.7,533.908,2142,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Mri Head Routine Wo Contrast,,70551,CPT,Facility,Both,,,,2142,1820.7,533.908,2142,Sanford Health Plan,Sanford Health Plan,1970.64,92,,percent of total billed charges,,
Mri Head Routine Wo Contrast,,70551,CPT,Facility,Outpatient,,,,2142,1820.7,533.908,2142,"UCare Health, Inc.",Individual & Family Plan,1207.017,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Mri Head Routine Wo Contrast,,70551,CPT,Facility,Inpatient,,,,2142,1820.7,533.908,2142,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Mri Head Routine Wo Contrast,,70551,CPT,Facility,Outpatient,,,,2142,1820.7,533.908,2142,"UCare Health, Inc.",Medical Assistance,1081.0674,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mri Head Routine Wo Contrast,,70551,CPT,Facility,Inpatient,,,,2142,1820.7,533.908,2142,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Mri Head Routine Wo Contrast,,70551,CPT,Facility,Outpatient,,,,2142,1820.7,533.908,2142,"UCare Health, Inc.",Medicare Advantage,1081.0674,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mri Head Routine Wo Contrast,,70551,CPT,Facility,Inpatient,,,,2142,1820.7,533.908,2142,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mri Head Routine Wo Contrast,,70551,CPT,Facility,Outpatient,,,,2142,1820.7,533.908,2142,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1081.0674,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mri Head Routine Wo Contrast,,70551,CPT,Facility,Inpatient,,,,2142,1820.7,533.908,2142,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mri Head Routine Wo Contrast,,70551,CPT,Facility,Both,,,,2142,1820.7,533.908,2142,UnitedHealthcare,Individual & Family,2013.48,94,,percent of total billed charges,,
Mri Head Routine Wo Contrast,,70551,CPT,Facility,Outpatient,,,,2142,1820.7,533.908,2142,UnitedHealthcare,Medicare Advantage,1049.58,49,,percent of total billed charges,,
Mri Head Routine Wo Contrast,,70551,CPT,Facility,Inpatient,,,,2142,1820.7,533.908,2142,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Mri Head Routine Wo Contrast,,70551,CPT,Facility,Outpatient,,,,2142,1820.7,533.908,2142,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1028.16,48,,percent of total billed charges,,100% of DHS outpatient percentage
Mri Head Routine Wo Contrast,,70551,CPT,Facility,Inpatient,,,,2142,1820.7,533.908,2142,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Mri Head W Contrast,,70552,CPT,Facility,Both,,,,2244,1907.4,561.34,2244,Aetna,Commercial,2064.48,92,,percent of total billed charges,,
Mri Head W Contrast,,70552,CPT,Facility,Outpatient,,,,2244,1907.4,561.34,2244,Aetna,Medicare Advantage,1099.56,49,,percent of total billed charges,,
Mri Head W Contrast,,70552,CPT,Facility,Inpatient,,,,2244,1907.4,561.34,2244,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Mri Head W Contrast,,70552,CPT,Facility,Both,,,,2244,1907.4,561.34,2244,Aetna,PPO,2086.92,93,,percent of total billed charges,,
Mri Head W Contrast,,70552,CPT,Facility,Both,,,,2244,1907.4,561.34,2244,America's PPO,America's PPO,2154.9132,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Mri Head W Contrast,,70552,CPT,Facility,Both,,,,2244,1907.4,561.34,2244,BlueCross BlueShield Minnesota, Federal Employee Program,1105,,,Fee schedule,,100% of BCBS commercial commodity fee schedule
Mri Head W Contrast,,70552,CPT,Facility,Both,,,,2244,1907.4,561.34,2244,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1122.68,,,Fee schedule,,"100% of BCBS commercial commodity fee schedule, plus MN Care tax"
Mri Head W Contrast,,70552,CPT,Facility,Both,,,,2244,1907.4,561.34,2244,BlueCross BlueShield Minnesota,High Value Network Plan,1010.412,,,Fee schedule,,"90% of BCBS commercial commodity fee schedule, plus MN Care tax; see disclaimer for more information"
Mri Head W Contrast,,70552,CPT,Facility,Outpatient,,,,2244,1907.4,561.34,2244,BlueCross BlueShield Minnesota,Medicare Advantage,1099.56,49,,percent of total billed charges,,
Mri Head W Contrast,,70552,CPT,Facility,Inpatient,,,,2244,1907.4,561.34,2244,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Mri Head W Contrast,,70552,CPT,Facility,Both,,,,2244,1907.4,561.34,2244,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,994.357676,,,Fee schedule,,"88.57% of BCBS commercial commodity fee schedule, plus MN Care tax"
Mri Head W Contrast,,70552,CPT,Facility,Both,,,,2244,1907.4,561.34,2244,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,561.34,,,Fee schedule,,"100% of BCBS Medicaid commodity fee schedule, plus MN Care tax"
Mri Head W Contrast,,70552,CPT,Facility,Outpatient,,,,2244,1907.4,561.34,2244,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1099.56,49,,percent of total billed charges,,
Mri Head W Contrast,,70552,CPT,Facility,Inpatient,,,,2244,1907.4,561.34,2244,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Mri Head W Contrast,,70552,CPT,Facility,Both,,,,2244,1907.4,561.34,2244,CorVel,Worker's Compensation,2244,100,,percent of total billed charges,,
Mri Head W Contrast,,70552,CPT,Facility,Both,,,,2244,1907.4,561.34,2244,First Health Group Corporation,First Health Network,2176.68,97,,percent of total billed charges,,
Mri Head W Contrast,,70552,CPT,Facility,Both,,,,2244,1907.4,561.34,2244,"Health Partners, Inc.",Commercial,2122.824,94.6,,percent of total billed charges,,
Mri Head W Contrast,,70552,CPT,Facility,Outpatient,,,,2244,1907.4,561.34,2244,"Health Partners, Inc.",Medicare Advantage,1099.56,49,,percent of total billed charges,,
Mri Head W Contrast,,70552,CPT,Facility,Inpatient,,,,2244,1907.4,561.34,2244,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mri Head W Contrast,,70552,CPT,Facility,Both,,,,2244,1907.4,561.34,2244,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1346.4,60,,percent of total billed charges,,
Mri Head W Contrast,,70552,CPT,Facility,Both,,,,2244,1907.4,561.34,2244,"Health Partners, Inc.",State of Minnesota Advantage Program,1828.86,81.5,,percent of total billed charges,,
Mri Head W Contrast,,70552,CPT,Facility,Both,,,,2244,1907.4,561.34,2244,"Health Partners, Inc.",State Public Programs,1122,50,,percent of total billed charges,,
Mri Head W Contrast,,70552,CPT,Facility,Both,,,,2244,1907.4,561.34,2244,Humana Insurance Company,Commercial PPO,2131.8,95,,percent of total billed charges,,
Mri Head W Contrast,,70552,CPT,Facility,Outpatient,,,,2244,1907.4,561.34,2244,Humana Insurance Company,Medicare PPO,1099.56,49,,percent of total billed charges,,
Mri Head W Contrast,,70552,CPT,Facility,Inpatient,,,,2244,1907.4,561.34,2244,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Mri Head W Contrast,,70552,CPT,Facility,Both,,,,2244,1907.4,561.34,2244,Medica,Individual & Family,2223.804,99.1,,percent of total billed charges,,
Mri Head W Contrast,,70552,CPT,Facility,Outpatient,,,,2244,1907.4,561.34,2244,Medica,Medica Advantage Solution,1117.512,49.8,,percent of total billed charges,,
Mri Head W Contrast,,70552,CPT,Facility,Inpatient,,,,2244,1907.4,561.34,2244,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Mri Head W Contrast,,70552,CPT,Facility,Outpatient,,,,2244,1907.4,561.34,2244,Medica,Medical Assistance,747,,,Other ,per vist,Pays in addition to all Outpatient Service Categories
Mri Head W Contrast,,70552,CPT,Facility,Inpatient,,,,2244,1907.4,561.34,2244,Medica,Medical Assistance,,,,,Included in per diem rate,
Mri Head W Contrast,,70552,CPT,Facility,Outpatient,,,,2244,1907.4,561.34,2244,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1117.512,49.8,,percent of total billed charges,,
Mri Head W Contrast,,70552,CPT,Facility,Inpatient,,,,2244,1907.4,561.34,2244,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Mri Head W Contrast,,70552,CPT,Facility,Both,,,,2244,1907.4,561.34,2244,"Multiplan, Inc.","Multiplan, Inc.",2109.36,94,,percent of total billed charges,,
Mri Head W Contrast,,70552,CPT,Facility,Outpatient,,,,2244,1907.4,561.34,2244,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1535,,,Other ,per scan,
Mri Head W Contrast,,70552,CPT,Facility,Inpatient,,,,2244,1907.4,561.34,2244,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Mri Head W Contrast,,70552,CPT,Facility,Both,,,,2244,1907.4,561.34,2244,"Preferred One Administrative Services, INC.",PPO,2212.584,98.6,,percent of total billed charges,,
Mri Head W Contrast,,70552,CPT,Facility,Outpatient,,,,2244,1907.4,561.34,2244,PrimeWest Health,Minnesota Senior Health Options (MSHO),1154.538,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Mri Head W Contrast,,70552,CPT,Facility,Inpatient,,,,2244,1907.4,561.34,2244,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mri Head W Contrast,,70552,CPT,Facility,Outpatient,,,,2244,1907.4,561.34,2244,PrimeWest Health,MinnesotaCare,1152.5184,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Mri Head W Contrast,,70552,CPT,Facility,Inpatient,,,,2244,1907.4,561.34,2244,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Mri Head W Contrast,,70552,CPT,Facility,Both,,,,2244,1907.4,561.34,2244,Sanford Health Plan,Sanford Health Plan,2064.48,92,,percent of total billed charges,,
Mri Head W Contrast,,70552,CPT,Facility,Outpatient,,,,2244,1907.4,561.34,2244,"UCare Health, Inc.",Individual & Family Plan,1264.494,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Mri Head W Contrast,,70552,CPT,Facility,Inpatient,,,,2244,1907.4,561.34,2244,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Mri Head W Contrast,,70552,CPT,Facility,Outpatient,,,,2244,1907.4,561.34,2244,"UCare Health, Inc.",Medical Assistance,1132.5468,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mri Head W Contrast,,70552,CPT,Facility,Inpatient,,,,2244,1907.4,561.34,2244,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Mri Head W Contrast,,70552,CPT,Facility,Outpatient,,,,2244,1907.4,561.34,2244,"UCare Health, Inc.",Medicare Advantage,1132.5468,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mri Head W Contrast,,70552,CPT,Facility,Inpatient,,,,2244,1907.4,561.34,2244,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mri Head W Contrast,,70552,CPT,Facility,Outpatient,,,,2244,1907.4,561.34,2244,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1132.5468,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mri Head W Contrast,,70552,CPT,Facility,Inpatient,,,,2244,1907.4,561.34,2244,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mri Head W Contrast,,70552,CPT,Facility,Both,,,,2244,1907.4,561.34,2244,UnitedHealthcare,Individual & Family,2109.36,94,,percent of total billed charges,,
Mri Head W Contrast,,70552,CPT,Facility,Outpatient,,,,2244,1907.4,561.34,2244,UnitedHealthcare,Medicare Advantage,1099.56,49,,percent of total billed charges,,
Mri Head W Contrast,,70552,CPT,Facility,Inpatient,,,,2244,1907.4,561.34,2244,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Mri Head W Contrast,,70552,CPT,Facility,Outpatient,,,,2244,1907.4,561.34,2244,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1077.12,48,,percent of total billed charges,,100% of DHS outpatient percentage
Mri Head W Contrast,,70552,CPT,Facility,Inpatient,,,,2244,1907.4,561.34,2244,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Mri Head Wo W Contrast,,70553,CPT,Facility,Both,,,,2518,2140.3,561.34,2518,Aetna,Commercial,2316.56,92,,percent of total billed charges,,
Mri Head Wo W Contrast,,70553,CPT,Facility,Outpatient,,,,2518,2140.3,561.34,2518,Aetna,Medicare Advantage,1233.82,49,,percent of total billed charges,,
Mri Head Wo W Contrast,,70553,CPT,Facility,Inpatient,,,,2518,2140.3,561.34,2518,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Mri Head Wo W Contrast,,70553,CPT,Facility,Both,,,,2518,2140.3,561.34,2518,Aetna,PPO,2341.74,93,,percent of total billed charges,,
Mri Head Wo W Contrast,,70553,CPT,Facility,Both,,,,2518,2140.3,561.34,2518,America's PPO,America's PPO,2418.0354,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Mri Head Wo W Contrast,,70553,CPT,Facility,Both,,,,2518,2140.3,561.34,2518,BlueCross BlueShield Minnesota, Federal Employee Program,1105,,,Fee schedule,,100% of BCBS commercial commodity fee schedule
Mri Head Wo W Contrast,,70553,CPT,Facility,Both,,,,2518,2140.3,561.34,2518,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1122.68,,,Fee schedule,,"100% of BCBS commercial commodity fee schedule, plus MN Care tax"
Mri Head Wo W Contrast,,70553,CPT,Facility,Both,,,,2518,2140.3,561.34,2518,BlueCross BlueShield Minnesota,High Value Network Plan,1010.412,,,Fee schedule,,"90% of BCBS commercial commodity fee schedule, plus MN Care tax; see disclaimer for more information"
Mri Head Wo W Contrast,,70553,CPT,Facility,Outpatient,,,,2518,2140.3,561.34,2518,BlueCross BlueShield Minnesota,Medicare Advantage,1233.82,49,,percent of total billed charges,,
Mri Head Wo W Contrast,,70553,CPT,Facility,Inpatient,,,,2518,2140.3,561.34,2518,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Mri Head Wo W Contrast,,70553,CPT,Facility,Both,,,,2518,2140.3,561.34,2518,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,994.357676,,,Fee schedule,,"88.57% of BCBS commercial commodity fee schedule, plus MN Care tax"
Mri Head Wo W Contrast,,70553,CPT,Facility,Both,,,,2518,2140.3,561.34,2518,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,561.34,,,Fee schedule,,"100% of BCBS Medicaid commodity fee schedule, plus MN Care tax"
Mri Head Wo W Contrast,,70553,CPT,Facility,Outpatient,,,,2518,2140.3,561.34,2518,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1233.82,49,,percent of total billed charges,,
Mri Head Wo W Contrast,,70553,CPT,Facility,Inpatient,,,,2518,2140.3,561.34,2518,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Mri Head Wo W Contrast,,70553,CPT,Facility,Both,,,,2518,2140.3,561.34,2518,CorVel,Worker's Compensation,2518,100,,percent of total billed charges,,
Mri Head Wo W Contrast,,70553,CPT,Facility,Both,,,,2518,2140.3,561.34,2518,First Health Group Corporation,First Health Network,2442.46,97,,percent of total billed charges,,
Mri Head Wo W Contrast,,70553,CPT,Facility,Both,,,,2518,2140.3,561.34,2518,"Health Partners, Inc.",Commercial,2382.028,94.6,,percent of total billed charges,,
Mri Head Wo W Contrast,,70553,CPT,Facility,Outpatient,,,,2518,2140.3,561.34,2518,"Health Partners, Inc.",Medicare Advantage,1233.82,49,,percent of total billed charges,,
Mri Head Wo W Contrast,,70553,CPT,Facility,Inpatient,,,,2518,2140.3,561.34,2518,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mri Head Wo W Contrast,,70553,CPT,Facility,Both,,,,2518,2140.3,561.34,2518,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1510.8,60,,percent of total billed charges,,
Mri Head Wo W Contrast,,70553,CPT,Facility,Both,,,,2518,2140.3,561.34,2518,"Health Partners, Inc.",State of Minnesota Advantage Program,2052.17,81.5,,percent of total billed charges,,
Mri Head Wo W Contrast,,70553,CPT,Facility,Both,,,,2518,2140.3,561.34,2518,"Health Partners, Inc.",State Public Programs,1259,50,,percent of total billed charges,,
Mri Head Wo W Contrast,,70553,CPT,Facility,Both,,,,2518,2140.3,561.34,2518,Humana Insurance Company,Commercial PPO,2392.1,95,,percent of total billed charges,,
Mri Head Wo W Contrast,,70553,CPT,Facility,Outpatient,,,,2518,2140.3,561.34,2518,Humana Insurance Company,Medicare PPO,1233.82,49,,percent of total billed charges,,
Mri Head Wo W Contrast,,70553,CPT,Facility,Inpatient,,,,2518,2140.3,561.34,2518,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Mri Head Wo W Contrast,,70553,CPT,Facility,Both,,,,2518,2140.3,561.34,2518,Medica,Individual & Family,2495.338,99.1,,percent of total billed charges,,
Mri Head Wo W Contrast,,70553,CPT,Facility,Outpatient,,,,2518,2140.3,561.34,2518,Medica,Medica Advantage Solution,1253.964,49.8,,percent of total billed charges,,
Mri Head Wo W Contrast,,70553,CPT,Facility,Inpatient,,,,2518,2140.3,561.34,2518,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Mri Head Wo W Contrast,,70553,CPT,Facility,Outpatient,,,,2518,2140.3,561.34,2518,Medica,Medical Assistance,747,,,Other ,per vist,Pays in addition to all Outpatient Service Categories
Mri Head Wo W Contrast,,70553,CPT,Facility,Inpatient,,,,2518,2140.3,561.34,2518,Medica,Medical Assistance,,,,,Included in per diem rate,
Mri Head Wo W Contrast,,70553,CPT,Facility,Outpatient,,,,2518,2140.3,561.34,2518,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1253.964,49.8,,percent of total billed charges,,
Mri Head Wo W Contrast,,70553,CPT,Facility,Inpatient,,,,2518,2140.3,561.34,2518,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Mri Head Wo W Contrast,,70553,CPT,Facility,Both,,,,2518,2140.3,561.34,2518,"Multiplan, Inc.","Multiplan, Inc.",2366.92,94,,percent of total billed charges,,
Mri Head Wo W Contrast,,70553,CPT,Facility,Outpatient,,,,2518,2140.3,561.34,2518,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1535,,,Other ,per scan,
Mri Head Wo W Contrast,,70553,CPT,Facility,Inpatient,,,,2518,2140.3,561.34,2518,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Mri Head Wo W Contrast,,70553,CPT,Facility,Both,,,,2518,2140.3,561.34,2518,"Preferred One Administrative Services, INC.",PPO,2482.748,98.6,,percent of total billed charges,,
Mri Head Wo W Contrast,,70553,CPT,Facility,Outpatient,,,,2518,2140.3,561.34,2518,PrimeWest Health,Minnesota Senior Health Options (MSHO),1295.511,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Mri Head Wo W Contrast,,70553,CPT,Facility,Inpatient,,,,2518,2140.3,561.34,2518,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mri Head Wo W Contrast,,70553,CPT,Facility,Outpatient,,,,2518,2140.3,561.34,2518,PrimeWest Health,MinnesotaCare,1293.2448,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Mri Head Wo W Contrast,,70553,CPT,Facility,Inpatient,,,,2518,2140.3,561.34,2518,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Mri Head Wo W Contrast,,70553,CPT,Facility,Both,,,,2518,2140.3,561.34,2518,Sanford Health Plan,Sanford Health Plan,2316.56,92,,percent of total billed charges,,
Mri Head Wo W Contrast,,70553,CPT,Facility,Outpatient,,,,2518,2140.3,561.34,2518,"UCare Health, Inc.",Individual & Family Plan,1418.893,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Mri Head Wo W Contrast,,70553,CPT,Facility,Inpatient,,,,2518,2140.3,561.34,2518,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Mri Head Wo W Contrast,,70553,CPT,Facility,Outpatient,,,,2518,2140.3,561.34,2518,"UCare Health, Inc.",Medical Assistance,1270.8346,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mri Head Wo W Contrast,,70553,CPT,Facility,Inpatient,,,,2518,2140.3,561.34,2518,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Mri Head Wo W Contrast,,70553,CPT,Facility,Outpatient,,,,2518,2140.3,561.34,2518,"UCare Health, Inc.",Medicare Advantage,1270.8346,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mri Head Wo W Contrast,,70553,CPT,Facility,Inpatient,,,,2518,2140.3,561.34,2518,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mri Head Wo W Contrast,,70553,CPT,Facility,Outpatient,,,,2518,2140.3,561.34,2518,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1270.8346,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mri Head Wo W Contrast,,70553,CPT,Facility,Inpatient,,,,2518,2140.3,561.34,2518,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mri Head Wo W Contrast,,70553,CPT,Facility,Both,,,,2518,2140.3,561.34,2518,UnitedHealthcare,Individual & Family,2366.92,94,,percent of total billed charges,,
Mri Head Wo W Contrast,,70553,CPT,Facility,Outpatient,,,,2518,2140.3,561.34,2518,UnitedHealthcare,Medicare Advantage,1233.82,49,,percent of total billed charges,,
Mri Head Wo W Contrast,,70553,CPT,Facility,Inpatient,,,,2518,2140.3,561.34,2518,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Mri Head Wo W Contrast,,70553,CPT,Facility,Outpatient,,,,2518,2140.3,561.34,2518,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1208.64,48,,percent of total billed charges,,100% of DHS outpatient percentage
Mri Head Wo W Contrast,,70553,CPT,Facility,Inpatient,,,,2518,2140.3,561.34,2518,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Xr Chest Decubitus,,71045,CPT,Facility,Both,,,,204,173.4,58.4664,204,Aetna,Commercial,187.68,92,,percent of total billed charges,,
Xr Chest Decubitus,,71045,CPT,Facility,Outpatient,,,,204,173.4,58.4664,204,Aetna,Medicare Advantage,99.96,49,,percent of total billed charges,,
Xr Chest Decubitus,,71045,CPT,Facility,Inpatient,,,,204,173.4,58.4664,204,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Xr Chest Decubitus,,71045,CPT,Facility,Both,,,,204,173.4,58.4664,204,Aetna,PPO,189.72,93,,percent of total billed charges,,
Xr Chest Decubitus,,71045,CPT,Facility,Both,,,,204,173.4,58.4664,204,America's PPO,America's PPO,195.9012,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Xr Chest Decubitus,,71045,CPT,Facility,Both,,,,204,173.4,58.4664,204,BlueCross BlueShield Minnesota, Federal Employee Program,200.736,98.4,,percent of total billed charges,,
Xr Chest Decubitus,,71045,CPT,Facility,Both,,,,204,173.4,58.4664,204,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,204,100,,percent of total billed charges,,
Xr Chest Decubitus,,71045,CPT,Facility,Both,,,,204,173.4,58.4664,204,BlueCross BlueShield Minnesota,High Value Network Plan,183.6,90,,percent of total billed charges,,
Xr Chest Decubitus,,71045,CPT,Facility,Outpatient,,,,204,173.4,58.4664,204,BlueCross BlueShield Minnesota,Medicare Advantage,99.96,49,,percent of total billed charges,,
Xr Chest Decubitus,,71045,CPT,Facility,Inpatient,,,,204,173.4,58.4664,204,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Xr Chest Decubitus,,71045,CPT,Facility,Both,,,,204,173.4,58.4664,204,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,180.6828,88.57,,percent of total billed charges,,
Xr Chest Decubitus,,71045,CPT,Facility,Both,,,,204,173.4,58.4664,204,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,58.4664,28.66,,percent of total billed charges,,
Xr Chest Decubitus,,71045,CPT,Facility,Outpatient,,,,204,173.4,58.4664,204,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),99.96,49,,percent of total billed charges,,
Xr Chest Decubitus,,71045,CPT,Facility,Inpatient,,,,204,173.4,58.4664,204,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Xr Chest Decubitus,,71045,CPT,Facility,Both,,,,204,173.4,58.4664,204,CorVel,Worker's Compensation,204,100,,percent of total billed charges,,
Xr Chest Decubitus,,71045,CPT,Facility,Both,,,,204,173.4,58.4664,204,First Health Group Corporation,First Health Network,197.88,97,,percent of total billed charges,,
Xr Chest Decubitus,,71045,CPT,Facility,Both,,,,204,173.4,58.4664,204,"Health Partners, Inc.",Commercial,192.984,94.6,,percent of total billed charges,,
Xr Chest Decubitus,,71045,CPT,Facility,Outpatient,,,,204,173.4,58.4664,204,"Health Partners, Inc.",Medicare Advantage,99.96,49,,percent of total billed charges,,
Xr Chest Decubitus,,71045,CPT,Facility,Inpatient,,,,204,173.4,58.4664,204,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Chest Decubitus,,71045,CPT,Facility,Both,,,,204,173.4,58.4664,204,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),122.4,60,,percent of total billed charges,,
Xr Chest Decubitus,,71045,CPT,Facility,Both,,,,204,173.4,58.4664,204,"Health Partners, Inc.",State of Minnesota Advantage Program,166.26,81.5,,percent of total billed charges,,
Xr Chest Decubitus,,71045,CPT,Facility,Both,,,,204,173.4,58.4664,204,"Health Partners, Inc.",State Public Programs,102,50,,percent of total billed charges,,
Xr Chest Decubitus,,71045,CPT,Facility,Both,,,,204,173.4,58.4664,204,Humana Insurance Company,Commercial PPO,193.8,95,,percent of total billed charges,,
Xr Chest Decubitus,,71045,CPT,Facility,Outpatient,,,,204,173.4,58.4664,204,Humana Insurance Company,Medicare PPO,99.96,49,,percent of total billed charges,,
Xr Chest Decubitus,,71045,CPT,Facility,Inpatient,,,,204,173.4,58.4664,204,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Xr Chest Decubitus,,71045,CPT,Facility,Both,,,,204,173.4,58.4664,204,Medica,Individual & Family,202.164,99.1,,percent of total billed charges,,
Xr Chest Decubitus,,71045,CPT,Facility,Outpatient,,,,204,173.4,58.4664,204,Medica,Medica Advantage Solution,101.592,49.8,,percent of total billed charges,,
Xr Chest Decubitus,,71045,CPT,Facility,Inpatient,,,,204,173.4,58.4664,204,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Xr Chest Decubitus,,71045,CPT,Facility,Outpatient,,,,204,173.4,58.4664,204,Medica,Medical Assistance,90.984,44.6,,percent of total billed charges,,
Xr Chest Decubitus,,71045,CPT,Facility,Inpatient,,,,204,173.4,58.4664,204,Medica,Medical Assistance,,,,,Included in per diem rate,
Xr Chest Decubitus,,71045,CPT,Facility,Outpatient,,,,204,173.4,58.4664,204,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,101.592,49.8,,percent of total billed charges,,
Xr Chest Decubitus,,71045,CPT,Facility,Inpatient,,,,204,173.4,58.4664,204,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Xr Chest Decubitus,,71045,CPT,Facility,Both,,,,204,173.4,58.4664,204,"Multiplan, Inc.","Multiplan, Inc.",191.76,94,,percent of total billed charges,,
Xr Chest Decubitus,,71045,CPT,Facility,Outpatient,,,,204,173.4,58.4664,204,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,183.804,90.1,,percent of total billed charges,,
Xr Chest Decubitus,,71045,CPT,Facility,Inpatient,,,,204,173.4,58.4664,204,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Xr Chest Decubitus,,71045,CPT,Facility,Both,,,,204,173.4,58.4664,204,"Preferred One Administrative Services, INC.",PPO,201.144,98.6,,percent of total billed charges,,
Xr Chest Decubitus,,71045,CPT,Facility,Outpatient,,,,204,173.4,58.4664,204,PrimeWest Health,Minnesota Senior Health Options (MSHO),104.958,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Xr Chest Decubitus,,71045,CPT,Facility,Inpatient,,,,204,173.4,58.4664,204,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Chest Decubitus,,71045,CPT,Facility,Outpatient,,,,204,173.4,58.4664,204,PrimeWest Health,MinnesotaCare,104.7744,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Xr Chest Decubitus,,71045,CPT,Facility,Inpatient,,,,204,173.4,58.4664,204,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Xr Chest Decubitus,,71045,CPT,Facility,Both,,,,204,173.4,58.4664,204,Sanford Health Plan,Sanford Health Plan,187.68,92,,percent of total billed charges,,
Xr Chest Decubitus,,71045,CPT,Facility,Outpatient,,,,204,173.4,58.4664,204,"UCare Health, Inc.",Individual & Family Plan,114.954,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Xr Chest Decubitus,,71045,CPT,Facility,Inpatient,,,,204,173.4,58.4664,204,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Xr Chest Decubitus,,71045,CPT,Facility,Outpatient,,,,204,173.4,58.4664,204,"UCare Health, Inc.",Medical Assistance,102.9588,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Chest Decubitus,,71045,CPT,Facility,Inpatient,,,,204,173.4,58.4664,204,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Xr Chest Decubitus,,71045,CPT,Facility,Outpatient,,,,204,173.4,58.4664,204,"UCare Health, Inc.",Medicare Advantage,102.9588,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Chest Decubitus,,71045,CPT,Facility,Inpatient,,,,204,173.4,58.4664,204,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Chest Decubitus,,71045,CPT,Facility,Outpatient,,,,204,173.4,58.4664,204,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),102.9588,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Chest Decubitus,,71045,CPT,Facility,Inpatient,,,,204,173.4,58.4664,204,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Chest Decubitus,,71045,CPT,Facility,Both,,,,204,173.4,58.4664,204,UnitedHealthcare,Individual & Family,191.76,94,,percent of total billed charges,,
Xr Chest Decubitus,,71045,CPT,Facility,Outpatient,,,,204,173.4,58.4664,204,UnitedHealthcare,Medicare Advantage,99.96,49,,percent of total billed charges,,
Xr Chest Decubitus,,71045,CPT,Facility,Inpatient,,,,204,173.4,58.4664,204,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Xr Chest Decubitus,,71045,CPT,Facility,Outpatient,,,,204,173.4,58.4664,204,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,97.92,48,,percent of total billed charges,,100% of DHS outpatient percentage
Xr Chest Decubitus,,71045,CPT,Facility,Inpatient,,,,204,173.4,58.4664,204,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Xr Chest One View,,71045,CPT,Facility,Both,,,,204,173.4,58.4664,204,Aetna,Commercial,187.68,92,,percent of total billed charges,,
Xr Chest One View,,71045,CPT,Facility,Outpatient,,,,204,173.4,58.4664,204,Aetna,Medicare Advantage,99.96,49,,percent of total billed charges,,
Xr Chest One View,,71045,CPT,Facility,Inpatient,,,,204,173.4,58.4664,204,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Xr Chest One View,,71045,CPT,Facility,Both,,,,204,173.4,58.4664,204,Aetna,PPO,189.72,93,,percent of total billed charges,,
Xr Chest One View,,71045,CPT,Facility,Both,,,,204,173.4,58.4664,204,America's PPO,America's PPO,195.9012,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Xr Chest One View,,71045,CPT,Facility,Both,,,,204,173.4,58.4664,204,BlueCross BlueShield Minnesota, Federal Employee Program,200.736,98.4,,percent of total billed charges,,
Xr Chest One View,,71045,CPT,Facility,Both,,,,204,173.4,58.4664,204,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,204,100,,percent of total billed charges,,
Xr Chest One View,,71045,CPT,Facility,Both,,,,204,173.4,58.4664,204,BlueCross BlueShield Minnesota,High Value Network Plan,183.6,90,,percent of total billed charges,,
Xr Chest One View,,71045,CPT,Facility,Outpatient,,,,204,173.4,58.4664,204,BlueCross BlueShield Minnesota,Medicare Advantage,99.96,49,,percent of total billed charges,,
Xr Chest One View,,71045,CPT,Facility,Inpatient,,,,204,173.4,58.4664,204,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Xr Chest One View,,71045,CPT,Facility,Both,,,,204,173.4,58.4664,204,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,180.6828,88.57,,percent of total billed charges,,
Xr Chest One View,,71045,CPT,Facility,Both,,,,204,173.4,58.4664,204,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,58.4664,28.66,,percent of total billed charges,,
Xr Chest One View,,71045,CPT,Facility,Outpatient,,,,204,173.4,58.4664,204,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),99.96,49,,percent of total billed charges,,
Xr Chest One View,,71045,CPT,Facility,Inpatient,,,,204,173.4,58.4664,204,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Xr Chest One View,,71045,CPT,Facility,Both,,,,204,173.4,58.4664,204,CorVel,Worker's Compensation,204,100,,percent of total billed charges,,
Xr Chest One View,,71045,CPT,Facility,Both,,,,204,173.4,58.4664,204,First Health Group Corporation,First Health Network,197.88,97,,percent of total billed charges,,
Xr Chest One View,,71045,CPT,Facility,Both,,,,204,173.4,58.4664,204,"Health Partners, Inc.",Commercial,192.984,94.6,,percent of total billed charges,,
Xr Chest One View,,71045,CPT,Facility,Outpatient,,,,204,173.4,58.4664,204,"Health Partners, Inc.",Medicare Advantage,99.96,49,,percent of total billed charges,,
Xr Chest One View,,71045,CPT,Facility,Inpatient,,,,204,173.4,58.4664,204,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Chest One View,,71045,CPT,Facility,Both,,,,204,173.4,58.4664,204,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),122.4,60,,percent of total billed charges,,
Xr Chest One View,,71045,CPT,Facility,Both,,,,204,173.4,58.4664,204,"Health Partners, Inc.",State of Minnesota Advantage Program,166.26,81.5,,percent of total billed charges,,
Xr Chest One View,,71045,CPT,Facility,Both,,,,204,173.4,58.4664,204,"Health Partners, Inc.",State Public Programs,102,50,,percent of total billed charges,,
Xr Chest One View,,71045,CPT,Facility,Both,,,,204,173.4,58.4664,204,Humana Insurance Company,Commercial PPO,193.8,95,,percent of total billed charges,,
Xr Chest One View,,71045,CPT,Facility,Outpatient,,,,204,173.4,58.4664,204,Humana Insurance Company,Medicare PPO,99.96,49,,percent of total billed charges,,
Xr Chest One View,,71045,CPT,Facility,Inpatient,,,,204,173.4,58.4664,204,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Xr Chest One View,,71045,CPT,Facility,Both,,,,204,173.4,58.4664,204,Medica,Individual & Family,202.164,99.1,,percent of total billed charges,,
Xr Chest One View,,71045,CPT,Facility,Outpatient,,,,204,173.4,58.4664,204,Medica,Medica Advantage Solution,101.592,49.8,,percent of total billed charges,,
Xr Chest One View,,71045,CPT,Facility,Inpatient,,,,204,173.4,58.4664,204,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Xr Chest One View,,71045,CPT,Facility,Outpatient,,,,204,173.4,58.4664,204,Medica,Medical Assistance,90.984,44.6,,percent of total billed charges,,
Xr Chest One View,,71045,CPT,Facility,Inpatient,,,,204,173.4,58.4664,204,Medica,Medical Assistance,,,,,Included in per diem rate,
Xr Chest One View,,71045,CPT,Facility,Outpatient,,,,204,173.4,58.4664,204,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,101.592,49.8,,percent of total billed charges,,
Xr Chest One View,,71045,CPT,Facility,Inpatient,,,,204,173.4,58.4664,204,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Xr Chest One View,,71045,CPT,Facility,Both,,,,204,173.4,58.4664,204,"Multiplan, Inc.","Multiplan, Inc.",191.76,94,,percent of total billed charges,,
Xr Chest One View,,71045,CPT,Facility,Outpatient,,,,204,173.4,58.4664,204,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,183.804,90.1,,percent of total billed charges,,
Xr Chest One View,,71045,CPT,Facility,Inpatient,,,,204,173.4,58.4664,204,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Xr Chest One View,,71045,CPT,Facility,Both,,,,204,173.4,58.4664,204,"Preferred One Administrative Services, INC.",PPO,201.144,98.6,,percent of total billed charges,,
Xr Chest One View,,71045,CPT,Facility,Outpatient,,,,204,173.4,58.4664,204,PrimeWest Health,Minnesota Senior Health Options (MSHO),104.958,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Xr Chest One View,,71045,CPT,Facility,Inpatient,,,,204,173.4,58.4664,204,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Chest One View,,71045,CPT,Facility,Outpatient,,,,204,173.4,58.4664,204,PrimeWest Health,MinnesotaCare,104.7744,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Xr Chest One View,,71045,CPT,Facility,Inpatient,,,,204,173.4,58.4664,204,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Xr Chest One View,,71045,CPT,Facility,Both,,,,204,173.4,58.4664,204,Sanford Health Plan,Sanford Health Plan,187.68,92,,percent of total billed charges,,
Xr Chest One View,,71045,CPT,Facility,Outpatient,,,,204,173.4,58.4664,204,"UCare Health, Inc.",Individual & Family Plan,114.954,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Xr Chest One View,,71045,CPT,Facility,Inpatient,,,,204,173.4,58.4664,204,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Xr Chest One View,,71045,CPT,Facility,Outpatient,,,,204,173.4,58.4664,204,"UCare Health, Inc.",Medical Assistance,102.9588,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Chest One View,,71045,CPT,Facility,Inpatient,,,,204,173.4,58.4664,204,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Xr Chest One View,,71045,CPT,Facility,Outpatient,,,,204,173.4,58.4664,204,"UCare Health, Inc.",Medicare Advantage,102.9588,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Chest One View,,71045,CPT,Facility,Inpatient,,,,204,173.4,58.4664,204,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Chest One View,,71045,CPT,Facility,Outpatient,,,,204,173.4,58.4664,204,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),102.9588,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Chest One View,,71045,CPT,Facility,Inpatient,,,,204,173.4,58.4664,204,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Chest One View,,71045,CPT,Facility,Both,,,,204,173.4,58.4664,204,UnitedHealthcare,Individual & Family,191.76,94,,percent of total billed charges,,
Xr Chest One View,,71045,CPT,Facility,Outpatient,,,,204,173.4,58.4664,204,UnitedHealthcare,Medicare Advantage,99.96,49,,percent of total billed charges,,
Xr Chest One View,,71045,CPT,Facility,Inpatient,,,,204,173.4,58.4664,204,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Xr Chest One View,,71045,CPT,Facility,Outpatient,,,,204,173.4,58.4664,204,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,97.92,48,,percent of total billed charges,,100% of DHS outpatient percentage
Xr Chest One View,,71045,CPT,Facility,Inpatient,,,,204,173.4,58.4664,204,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Xr Chest Pa And Lat,,71046,CPT,Facility,Both,,,,263.16,223.686,109.22,263.16,Aetna,Commercial,242.1072,92,,percent of total billed charges,,
Xr Chest Pa And Lat,,71046,CPT,Facility,Outpatient,,,,263.16,223.686,109.22,263.16,Aetna,Medicare Advantage,128.9484,49,,percent of total billed charges,,
Xr Chest Pa And Lat,,71046,CPT,Facility,Inpatient,,,,263.16,223.686,109.22,263.16,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Xr Chest Pa And Lat,,71046,CPT,Facility,Both,,,,263.16,223.686,109.22,263.16,Aetna,PPO,244.7388,93,,percent of total billed charges,,
Xr Chest Pa And Lat,,71046,CPT,Facility,Both,,,,263.16,223.686,109.22,263.16,America's PPO,America's PPO,252.712548,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Xr Chest Pa And Lat,,71046,CPT,Facility,Both,,,,263.16,223.686,109.22,263.16,BlueCross BlueShield Minnesota, Federal Employee Program,215,,,Fee schedule,,100% of BCBS commercial commodity fee schedule
Xr Chest Pa And Lat,,71046,CPT,Facility,Both,,,,263.16,223.686,109.22,263.16,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,218.44,,,Fee schedule,,"100% of BCBS commercial commodity fee schedule, plus MN Care tax"
Xr Chest Pa And Lat,,71046,CPT,Facility,Both,,,,263.16,223.686,109.22,263.16,BlueCross BlueShield Minnesota,High Value Network Plan,196.596,,,Fee schedule,,"90% of BCBS commercial commodity fee schedule, plus MN Care tax; see disclaimer for more information"
Xr Chest Pa And Lat,,71046,CPT,Facility,Outpatient,,,,263.16,223.686,109.22,263.16,BlueCross BlueShield Minnesota,Medicare Advantage,128.9484,49,,percent of total billed charges,,
Xr Chest Pa And Lat,,71046,CPT,Facility,Inpatient,,,,263.16,223.686,109.22,263.16,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Xr Chest Pa And Lat,,71046,CPT,Facility,Both,,,,263.16,223.686,109.22,263.16,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,193.472308,,,Fee schedule,,"88.57% of BCBS commercial commodity fee schedule, plus MN Care tax"
Xr Chest Pa And Lat,,71046,CPT,Facility,Both,,,,263.16,223.686,109.22,263.16,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,109.22,,,Fee schedule,,"100% of BCBS Medicaid commodity fee schedule, plus MN Care tax"
Xr Chest Pa And Lat,,71046,CPT,Facility,Outpatient,,,,263.16,223.686,109.22,263.16,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),128.9484,49,,percent of total billed charges,,
Xr Chest Pa And Lat,,71046,CPT,Facility,Inpatient,,,,263.16,223.686,109.22,263.16,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Xr Chest Pa And Lat,,71046,CPT,Facility,Both,,,,263.16,223.686,109.22,263.16,CorVel,Worker's Compensation,263.16,100,,percent of total billed charges,,
Xr Chest Pa And Lat,,71046,CPT,Facility,Both,,,,263.16,223.686,109.22,263.16,First Health Group Corporation,First Health Network,255.2652,97,,percent of total billed charges,,
Xr Chest Pa And Lat,,71046,CPT,Facility,Both,,,,263.16,223.686,109.22,263.16,"Health Partners, Inc.",Commercial,248.94936,94.6,,percent of total billed charges,,
Xr Chest Pa And Lat,,71046,CPT,Facility,Outpatient,,,,263.16,223.686,109.22,263.16,"Health Partners, Inc.",Medicare Advantage,128.9484,49,,percent of total billed charges,,
Xr Chest Pa And Lat,,71046,CPT,Facility,Inpatient,,,,263.16,223.686,109.22,263.16,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Chest Pa And Lat,,71046,CPT,Facility,Both,,,,263.16,223.686,109.22,263.16,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),157.896,60,,percent of total billed charges,,
Xr Chest Pa And Lat,,71046,CPT,Facility,Both,,,,263.16,223.686,109.22,263.16,"Health Partners, Inc.",State of Minnesota Advantage Program,214.4754,81.5,,percent of total billed charges,,
Xr Chest Pa And Lat,,71046,CPT,Facility,Both,,,,263.16,223.686,109.22,263.16,"Health Partners, Inc.",State Public Programs,131.58,50,,percent of total billed charges,,
Xr Chest Pa And Lat,,71046,CPT,Facility,Both,,,,263.16,223.686,109.22,263.16,Humana Insurance Company,Commercial PPO,250.002,95,,percent of total billed charges,,
Xr Chest Pa And Lat,,71046,CPT,Facility,Outpatient,,,,263.16,223.686,109.22,263.16,Humana Insurance Company,Medicare PPO,128.9484,49,,percent of total billed charges,,
Xr Chest Pa And Lat,,71046,CPT,Facility,Inpatient,,,,263.16,223.686,109.22,263.16,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Xr Chest Pa And Lat,,71046,CPT,Facility,Both,,,,263.16,223.686,109.22,263.16,Medica,Individual & Family,260.79156,99.1,,percent of total billed charges,,
Xr Chest Pa And Lat,,71046,CPT,Facility,Outpatient,,,,263.16,223.686,109.22,263.16,Medica,Medica Advantage Solution,131.05368,49.8,,percent of total billed charges,,
Xr Chest Pa And Lat,,71046,CPT,Facility,Inpatient,,,,263.16,223.686,109.22,263.16,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Xr Chest Pa And Lat,,71046,CPT,Facility,Outpatient,,,,263.16,223.686,109.22,263.16,Medica,Medical Assistance,117.36936,44.6,,percent of total billed charges,,
Xr Chest Pa And Lat,,71046,CPT,Facility,Inpatient,,,,263.16,223.686,109.22,263.16,Medica,Medical Assistance,,,,,Included in per diem rate,
Xr Chest Pa And Lat,,71046,CPT,Facility,Outpatient,,,,263.16,223.686,109.22,263.16,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,131.05368,49.8,,percent of total billed charges,,
Xr Chest Pa And Lat,,71046,CPT,Facility,Inpatient,,,,263.16,223.686,109.22,263.16,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Xr Chest Pa And Lat,,71046,CPT,Facility,Both,,,,263.16,223.686,109.22,263.16,"Multiplan, Inc.","Multiplan, Inc.",247.3704,94,,percent of total billed charges,,
Xr Chest Pa And Lat,,71046,CPT,Facility,Outpatient,,,,263.16,223.686,109.22,263.16,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,237.10716,90.1,,percent of total billed charges,,
Xr Chest Pa And Lat,,71046,CPT,Facility,Inpatient,,,,263.16,223.686,109.22,263.16,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Xr Chest Pa And Lat,,71046,CPT,Facility,Both,,,,263.16,223.686,109.22,263.16,"Preferred One Administrative Services, INC.",PPO,259.47576,98.6,,percent of total billed charges,,
Xr Chest Pa And Lat,,71046,CPT,Facility,Outpatient,,,,263.16,223.686,109.22,263.16,PrimeWest Health,Minnesota Senior Health Options (MSHO),135.39582,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Xr Chest Pa And Lat,,71046,CPT,Facility,Inpatient,,,,263.16,223.686,109.22,263.16,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Chest Pa And Lat,,71046,CPT,Facility,Outpatient,,,,263.16,223.686,109.22,263.16,PrimeWest Health,MinnesotaCare,135.158976,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Xr Chest Pa And Lat,,71046,CPT,Facility,Inpatient,,,,263.16,223.686,109.22,263.16,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Xr Chest Pa And Lat,,71046,CPT,Facility,Both,,,,263.16,223.686,109.22,263.16,Sanford Health Plan,Sanford Health Plan,242.1072,92,,percent of total billed charges,,
Xr Chest Pa And Lat,,71046,CPT,Facility,Outpatient,,,,263.16,223.686,109.22,263.16,"UCare Health, Inc.",Individual & Family Plan,148.29066,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Xr Chest Pa And Lat,,71046,CPT,Facility,Inpatient,,,,263.16,223.686,109.22,263.16,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Xr Chest Pa And Lat,,71046,CPT,Facility,Outpatient,,,,263.16,223.686,109.22,263.16,"UCare Health, Inc.",Medical Assistance,132.816852,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Chest Pa And Lat,,71046,CPT,Facility,Inpatient,,,,263.16,223.686,109.22,263.16,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Xr Chest Pa And Lat,,71046,CPT,Facility,Outpatient,,,,263.16,223.686,109.22,263.16,"UCare Health, Inc.",Medicare Advantage,132.816852,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Chest Pa And Lat,,71046,CPT,Facility,Inpatient,,,,263.16,223.686,109.22,263.16,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Chest Pa And Lat,,71046,CPT,Facility,Outpatient,,,,263.16,223.686,109.22,263.16,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),132.816852,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Chest Pa And Lat,,71046,CPT,Facility,Inpatient,,,,263.16,223.686,109.22,263.16,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Chest Pa And Lat,,71046,CPT,Facility,Both,,,,263.16,223.686,109.22,263.16,UnitedHealthcare,Individual & Family,247.3704,94,,percent of total billed charges,,
Xr Chest Pa And Lat,,71046,CPT,Facility,Outpatient,,,,263.16,223.686,109.22,263.16,UnitedHealthcare,Medicare Advantage,128.9484,49,,percent of total billed charges,,
Xr Chest Pa And Lat,,71046,CPT,Facility,Inpatient,,,,263.16,223.686,109.22,263.16,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Xr Chest Pa And Lat,,71046,CPT,Facility,Outpatient,,,,263.16,223.686,109.22,263.16,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,126.3168,48,,percent of total billed charges,,100% of DHS outpatient percentage
Xr Chest Pa And Lat,,71046,CPT,Facility,Inpatient,,,,263.16,223.686,109.22,263.16,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Xr Chest Pa Lat W Lordotic,,71047,CPT,Facility,Both,,,,270,229.5,77.382,270,Aetna,Commercial,248.4,92,,percent of total billed charges,,
Xr Chest Pa Lat W Lordotic,,71047,CPT,Facility,Outpatient,,,,270,229.5,77.382,270,Aetna,Medicare Advantage,132.3,49,,percent of total billed charges,,
Xr Chest Pa Lat W Lordotic,,71047,CPT,Facility,Inpatient,,,,270,229.5,77.382,270,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Xr Chest Pa Lat W Lordotic,,71047,CPT,Facility,Both,,,,270,229.5,77.382,270,Aetna,PPO,251.1,93,,percent of total billed charges,,
Xr Chest Pa Lat W Lordotic,,71047,CPT,Facility,Both,,,,270,229.5,77.382,270,America's PPO,America's PPO,259.281,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Xr Chest Pa Lat W Lordotic,,71047,CPT,Facility,Both,,,,270,229.5,77.382,270,BlueCross BlueShield Minnesota, Federal Employee Program,265.68,98.4,,percent of total billed charges,,
Xr Chest Pa Lat W Lordotic,,71047,CPT,Facility,Both,,,,270,229.5,77.382,270,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,270,100,,percent of total billed charges,,
Xr Chest Pa Lat W Lordotic,,71047,CPT,Facility,Both,,,,270,229.5,77.382,270,BlueCross BlueShield Minnesota,High Value Network Plan,243,90,,percent of total billed charges,,
Xr Chest Pa Lat W Lordotic,,71047,CPT,Facility,Outpatient,,,,270,229.5,77.382,270,BlueCross BlueShield Minnesota,Medicare Advantage,132.3,49,,percent of total billed charges,,
Xr Chest Pa Lat W Lordotic,,71047,CPT,Facility,Inpatient,,,,270,229.5,77.382,270,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Xr Chest Pa Lat W Lordotic,,71047,CPT,Facility,Both,,,,270,229.5,77.382,270,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,239.139,88.57,,percent of total billed charges,,
Xr Chest Pa Lat W Lordotic,,71047,CPT,Facility,Both,,,,270,229.5,77.382,270,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,77.382,28.66,,percent of total billed charges,,
Xr Chest Pa Lat W Lordotic,,71047,CPT,Facility,Outpatient,,,,270,229.5,77.382,270,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),132.3,49,,percent of total billed charges,,
Xr Chest Pa Lat W Lordotic,,71047,CPT,Facility,Inpatient,,,,270,229.5,77.382,270,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Xr Chest Pa Lat W Lordotic,,71047,CPT,Facility,Both,,,,270,229.5,77.382,270,CorVel,Worker's Compensation,270,100,,percent of total billed charges,,
Xr Chest Pa Lat W Lordotic,,71047,CPT,Facility,Both,,,,270,229.5,77.382,270,First Health Group Corporation,First Health Network,261.9,97,,percent of total billed charges,,
Xr Chest Pa Lat W Lordotic,,71047,CPT,Facility,Both,,,,270,229.5,77.382,270,"Health Partners, Inc.",Commercial,255.42,94.6,,percent of total billed charges,,
Xr Chest Pa Lat W Lordotic,,71047,CPT,Facility,Outpatient,,,,270,229.5,77.382,270,"Health Partners, Inc.",Medicare Advantage,132.3,49,,percent of total billed charges,,
Xr Chest Pa Lat W Lordotic,,71047,CPT,Facility,Inpatient,,,,270,229.5,77.382,270,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Chest Pa Lat W Lordotic,,71047,CPT,Facility,Both,,,,270,229.5,77.382,270,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),162,60,,percent of total billed charges,,
Xr Chest Pa Lat W Lordotic,,71047,CPT,Facility,Both,,,,270,229.5,77.382,270,"Health Partners, Inc.",State of Minnesota Advantage Program,220.05,81.5,,percent of total billed charges,,
Xr Chest Pa Lat W Lordotic,,71047,CPT,Facility,Both,,,,270,229.5,77.382,270,"Health Partners, Inc.",State Public Programs,135,50,,percent of total billed charges,,
Xr Chest Pa Lat W Lordotic,,71047,CPT,Facility,Both,,,,270,229.5,77.382,270,Humana Insurance Company,Commercial PPO,256.5,95,,percent of total billed charges,,
Xr Chest Pa Lat W Lordotic,,71047,CPT,Facility,Outpatient,,,,270,229.5,77.382,270,Humana Insurance Company,Medicare PPO,132.3,49,,percent of total billed charges,,
Xr Chest Pa Lat W Lordotic,,71047,CPT,Facility,Inpatient,,,,270,229.5,77.382,270,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Xr Chest Pa Lat W Lordotic,,71047,CPT,Facility,Both,,,,270,229.5,77.382,270,Medica,Individual & Family,267.57,99.1,,percent of total billed charges,,
Xr Chest Pa Lat W Lordotic,,71047,CPT,Facility,Outpatient,,,,270,229.5,77.382,270,Medica,Medica Advantage Solution,134.46,49.8,,percent of total billed charges,,
Xr Chest Pa Lat W Lordotic,,71047,CPT,Facility,Inpatient,,,,270,229.5,77.382,270,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Xr Chest Pa Lat W Lordotic,,71047,CPT,Facility,Outpatient,,,,270,229.5,77.382,270,Medica,Medical Assistance,120.42,44.6,,percent of total billed charges,,
Xr Chest Pa Lat W Lordotic,,71047,CPT,Facility,Inpatient,,,,270,229.5,77.382,270,Medica,Medical Assistance,,,,,Included in per diem rate,
Xr Chest Pa Lat W Lordotic,,71047,CPT,Facility,Outpatient,,,,270,229.5,77.382,270,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,134.46,49.8,,percent of total billed charges,,
Xr Chest Pa Lat W Lordotic,,71047,CPT,Facility,Inpatient,,,,270,229.5,77.382,270,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Xr Chest Pa Lat W Lordotic,,71047,CPT,Facility,Both,,,,270,229.5,77.382,270,"Multiplan, Inc.","Multiplan, Inc.",253.8,94,,percent of total billed charges,,
Xr Chest Pa Lat W Lordotic,,71047,CPT,Facility,Outpatient,,,,270,229.5,77.382,270,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,243.27,90.1,,percent of total billed charges,,
Xr Chest Pa Lat W Lordotic,,71047,CPT,Facility,Inpatient,,,,270,229.5,77.382,270,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Xr Chest Pa Lat W Lordotic,,71047,CPT,Facility,Both,,,,270,229.5,77.382,270,"Preferred One Administrative Services, INC.",PPO,266.22,98.6,,percent of total billed charges,,
Xr Chest Pa Lat W Lordotic,,71047,CPT,Facility,Outpatient,,,,270,229.5,77.382,270,PrimeWest Health,Minnesota Senior Health Options (MSHO),138.915,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Xr Chest Pa Lat W Lordotic,,71047,CPT,Facility,Inpatient,,,,270,229.5,77.382,270,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Chest Pa Lat W Lordotic,,71047,CPT,Facility,Outpatient,,,,270,229.5,77.382,270,PrimeWest Health,MinnesotaCare,138.672,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Xr Chest Pa Lat W Lordotic,,71047,CPT,Facility,Inpatient,,,,270,229.5,77.382,270,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Xr Chest Pa Lat W Lordotic,,71047,CPT,Facility,Both,,,,270,229.5,77.382,270,Sanford Health Plan,Sanford Health Plan,248.4,92,,percent of total billed charges,,
Xr Chest Pa Lat W Lordotic,,71047,CPT,Facility,Outpatient,,,,270,229.5,77.382,270,"UCare Health, Inc.",Individual & Family Plan,152.145,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Xr Chest Pa Lat W Lordotic,,71047,CPT,Facility,Inpatient,,,,270,229.5,77.382,270,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Xr Chest Pa Lat W Lordotic,,71047,CPT,Facility,Outpatient,,,,270,229.5,77.382,270,"UCare Health, Inc.",Medical Assistance,136.269,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Chest Pa Lat W Lordotic,,71047,CPT,Facility,Inpatient,,,,270,229.5,77.382,270,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Xr Chest Pa Lat W Lordotic,,71047,CPT,Facility,Outpatient,,,,270,229.5,77.382,270,"UCare Health, Inc.",Medicare Advantage,136.269,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Chest Pa Lat W Lordotic,,71047,CPT,Facility,Inpatient,,,,270,229.5,77.382,270,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Chest Pa Lat W Lordotic,,71047,CPT,Facility,Outpatient,,,,270,229.5,77.382,270,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),136.269,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Chest Pa Lat W Lordotic,,71047,CPT,Facility,Inpatient,,,,270,229.5,77.382,270,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Chest Pa Lat W Lordotic,,71047,CPT,Facility,Both,,,,270,229.5,77.382,270,UnitedHealthcare,Individual & Family,253.8,94,,percent of total billed charges,,
Xr Chest Pa Lat W Lordotic,,71047,CPT,Facility,Outpatient,,,,270,229.5,77.382,270,UnitedHealthcare,Medicare Advantage,132.3,49,,percent of total billed charges,,
Xr Chest Pa Lat W Lordotic,,71047,CPT,Facility,Inpatient,,,,270,229.5,77.382,270,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Xr Chest Pa Lat W Lordotic,,71047,CPT,Facility,Outpatient,,,,270,229.5,77.382,270,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,129.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
Xr Chest Pa Lat W Lordotic,,71047,CPT,Facility,Inpatient,,,,270,229.5,77.382,270,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Xr Chest Pa Lat And Obliques,,71048,CPT,Facility,Both,,,,281,238.85,80.5346,281,Aetna,Commercial,258.52,92,,percent of total billed charges,,
Xr Chest Pa Lat And Obliques,,71048,CPT,Facility,Outpatient,,,,281,238.85,80.5346,281,Aetna,Medicare Advantage,137.69,49,,percent of total billed charges,,
Xr Chest Pa Lat And Obliques,,71048,CPT,Facility,Inpatient,,,,281,238.85,80.5346,281,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Xr Chest Pa Lat And Obliques,,71048,CPT,Facility,Both,,,,281,238.85,80.5346,281,Aetna,PPO,261.33,93,,percent of total billed charges,,
Xr Chest Pa Lat And Obliques,,71048,CPT,Facility,Both,,,,281,238.85,80.5346,281,America's PPO,America's PPO,269.8443,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Xr Chest Pa Lat And Obliques,,71048,CPT,Facility,Both,,,,281,238.85,80.5346,281,BlueCross BlueShield Minnesota, Federal Employee Program,276.504,98.4,,percent of total billed charges,,
Xr Chest Pa Lat And Obliques,,71048,CPT,Facility,Both,,,,281,238.85,80.5346,281,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,281,100,,percent of total billed charges,,
Xr Chest Pa Lat And Obliques,,71048,CPT,Facility,Both,,,,281,238.85,80.5346,281,BlueCross BlueShield Minnesota,High Value Network Plan,252.9,90,,percent of total billed charges,,
Xr Chest Pa Lat And Obliques,,71048,CPT,Facility,Outpatient,,,,281,238.85,80.5346,281,BlueCross BlueShield Minnesota,Medicare Advantage,137.69,49,,percent of total billed charges,,
Xr Chest Pa Lat And Obliques,,71048,CPT,Facility,Inpatient,,,,281,238.85,80.5346,281,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Xr Chest Pa Lat And Obliques,,71048,CPT,Facility,Both,,,,281,238.85,80.5346,281,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,248.8817,88.57,,percent of total billed charges,,
Xr Chest Pa Lat And Obliques,,71048,CPT,Facility,Both,,,,281,238.85,80.5346,281,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,80.5346,28.66,,percent of total billed charges,,
Xr Chest Pa Lat And Obliques,,71048,CPT,Facility,Outpatient,,,,281,238.85,80.5346,281,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),137.69,49,,percent of total billed charges,,
Xr Chest Pa Lat And Obliques,,71048,CPT,Facility,Inpatient,,,,281,238.85,80.5346,281,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Xr Chest Pa Lat And Obliques,,71048,CPT,Facility,Both,,,,281,238.85,80.5346,281,CorVel,Worker's Compensation,281,100,,percent of total billed charges,,
Xr Chest Pa Lat And Obliques,,71048,CPT,Facility,Both,,,,281,238.85,80.5346,281,First Health Group Corporation,First Health Network,272.57,97,,percent of total billed charges,,
Xr Chest Pa Lat And Obliques,,71048,CPT,Facility,Both,,,,281,238.85,80.5346,281,"Health Partners, Inc.",Commercial,265.826,94.6,,percent of total billed charges,,
Xr Chest Pa Lat And Obliques,,71048,CPT,Facility,Outpatient,,,,281,238.85,80.5346,281,"Health Partners, Inc.",Medicare Advantage,137.69,49,,percent of total billed charges,,
Xr Chest Pa Lat And Obliques,,71048,CPT,Facility,Inpatient,,,,281,238.85,80.5346,281,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Chest Pa Lat And Obliques,,71048,CPT,Facility,Both,,,,281,238.85,80.5346,281,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),168.6,60,,percent of total billed charges,,
Xr Chest Pa Lat And Obliques,,71048,CPT,Facility,Both,,,,281,238.85,80.5346,281,"Health Partners, Inc.",State of Minnesota Advantage Program,229.015,81.5,,percent of total billed charges,,
Xr Chest Pa Lat And Obliques,,71048,CPT,Facility,Both,,,,281,238.85,80.5346,281,"Health Partners, Inc.",State Public Programs,140.5,50,,percent of total billed charges,,
Xr Chest Pa Lat And Obliques,,71048,CPT,Facility,Both,,,,281,238.85,80.5346,281,Humana Insurance Company,Commercial PPO,266.95,95,,percent of total billed charges,,
Xr Chest Pa Lat And Obliques,,71048,CPT,Facility,Outpatient,,,,281,238.85,80.5346,281,Humana Insurance Company,Medicare PPO,137.69,49,,percent of total billed charges,,
Xr Chest Pa Lat And Obliques,,71048,CPT,Facility,Inpatient,,,,281,238.85,80.5346,281,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Xr Chest Pa Lat And Obliques,,71048,CPT,Facility,Both,,,,281,238.85,80.5346,281,Medica,Individual & Family,278.471,99.1,,percent of total billed charges,,
Xr Chest Pa Lat And Obliques,,71048,CPT,Facility,Outpatient,,,,281,238.85,80.5346,281,Medica,Medica Advantage Solution,139.938,49.8,,percent of total billed charges,,
Xr Chest Pa Lat And Obliques,,71048,CPT,Facility,Inpatient,,,,281,238.85,80.5346,281,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Xr Chest Pa Lat And Obliques,,71048,CPT,Facility,Outpatient,,,,281,238.85,80.5346,281,Medica,Medical Assistance,125.326,44.6,,percent of total billed charges,,
Xr Chest Pa Lat And Obliques,,71048,CPT,Facility,Inpatient,,,,281,238.85,80.5346,281,Medica,Medical Assistance,,,,,Included in per diem rate,
Xr Chest Pa Lat And Obliques,,71048,CPT,Facility,Outpatient,,,,281,238.85,80.5346,281,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,139.938,49.8,,percent of total billed charges,,
Xr Chest Pa Lat And Obliques,,71048,CPT,Facility,Inpatient,,,,281,238.85,80.5346,281,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Xr Chest Pa Lat And Obliques,,71048,CPT,Facility,Both,,,,281,238.85,80.5346,281,"Multiplan, Inc.","Multiplan, Inc.",264.14,94,,percent of total billed charges,,
Xr Chest Pa Lat And Obliques,,71048,CPT,Facility,Outpatient,,,,281,238.85,80.5346,281,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,253.181,90.1,,percent of total billed charges,,
Xr Chest Pa Lat And Obliques,,71048,CPT,Facility,Inpatient,,,,281,238.85,80.5346,281,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Xr Chest Pa Lat And Obliques,,71048,CPT,Facility,Both,,,,281,238.85,80.5346,281,"Preferred One Administrative Services, INC.",PPO,277.066,98.6,,percent of total billed charges,,
Xr Chest Pa Lat And Obliques,,71048,CPT,Facility,Outpatient,,,,281,238.85,80.5346,281,PrimeWest Health,Minnesota Senior Health Options (MSHO),144.5745,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Xr Chest Pa Lat And Obliques,,71048,CPT,Facility,Inpatient,,,,281,238.85,80.5346,281,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Chest Pa Lat And Obliques,,71048,CPT,Facility,Outpatient,,,,281,238.85,80.5346,281,PrimeWest Health,MinnesotaCare,144.3216,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Xr Chest Pa Lat And Obliques,,71048,CPT,Facility,Inpatient,,,,281,238.85,80.5346,281,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Xr Chest Pa Lat And Obliques,,71048,CPT,Facility,Both,,,,281,238.85,80.5346,281,Sanford Health Plan,Sanford Health Plan,258.52,92,,percent of total billed charges,,
Xr Chest Pa Lat And Obliques,,71048,CPT,Facility,Outpatient,,,,281,238.85,80.5346,281,"UCare Health, Inc.",Individual & Family Plan,158.3435,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Xr Chest Pa Lat And Obliques,,71048,CPT,Facility,Inpatient,,,,281,238.85,80.5346,281,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Xr Chest Pa Lat And Obliques,,71048,CPT,Facility,Outpatient,,,,281,238.85,80.5346,281,"UCare Health, Inc.",Medical Assistance,141.8207,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Chest Pa Lat And Obliques,,71048,CPT,Facility,Inpatient,,,,281,238.85,80.5346,281,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Xr Chest Pa Lat And Obliques,,71048,CPT,Facility,Outpatient,,,,281,238.85,80.5346,281,"UCare Health, Inc.",Medicare Advantage,141.8207,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Chest Pa Lat And Obliques,,71048,CPT,Facility,Inpatient,,,,281,238.85,80.5346,281,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Chest Pa Lat And Obliques,,71048,CPT,Facility,Outpatient,,,,281,238.85,80.5346,281,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),141.8207,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Chest Pa Lat And Obliques,,71048,CPT,Facility,Inpatient,,,,281,238.85,80.5346,281,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Chest Pa Lat And Obliques,,71048,CPT,Facility,Both,,,,281,238.85,80.5346,281,UnitedHealthcare,Individual & Family,264.14,94,,percent of total billed charges,,
Xr Chest Pa Lat And Obliques,,71048,CPT,Facility,Outpatient,,,,281,238.85,80.5346,281,UnitedHealthcare,Medicare Advantage,137.69,49,,percent of total billed charges,,
Xr Chest Pa Lat And Obliques,,71048,CPT,Facility,Inpatient,,,,281,238.85,80.5346,281,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Xr Chest Pa Lat And Obliques,,71048,CPT,Facility,Outpatient,,,,281,238.85,80.5346,281,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,134.88,48,,percent of total billed charges,,100% of DHS outpatient percentage
Xr Chest Pa Lat And Obliques,,71048,CPT,Facility,Inpatient,,,,281,238.85,80.5346,281,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Xr Ribs Bil,,71110,CPT,Facility,Both,,,,300,255,85.98,300,Aetna,Commercial,276,92,,percent of total billed charges,,
Xr Ribs Bil,,71110,CPT,Facility,Outpatient,,,,300,255,85.98,300,Aetna,Medicare Advantage,147,49,,percent of total billed charges,,
Xr Ribs Bil,,71110,CPT,Facility,Inpatient,,,,300,255,85.98,300,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Xr Ribs Bil,,71110,CPT,Facility,Both,,,,300,255,85.98,300,Aetna,PPO,279,93,,percent of total billed charges,,
Xr Ribs Bil,,71110,CPT,Facility,Both,,,,300,255,85.98,300,America's PPO,America's PPO,288.09,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Xr Ribs Bil,,71110,CPT,Facility,Both,,,,300,255,85.98,300,BlueCross BlueShield Minnesota, Federal Employee Program,295.2,98.4,,percent of total billed charges,,
Xr Ribs Bil,,71110,CPT,Facility,Both,,,,300,255,85.98,300,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,300,100,,percent of total billed charges,,
Xr Ribs Bil,,71110,CPT,Facility,Both,,,,300,255,85.98,300,BlueCross BlueShield Minnesota,High Value Network Plan,270,90,,percent of total billed charges,,
Xr Ribs Bil,,71110,CPT,Facility,Outpatient,,,,300,255,85.98,300,BlueCross BlueShield Minnesota,Medicare Advantage,147,49,,percent of total billed charges,,
Xr Ribs Bil,,71110,CPT,Facility,Inpatient,,,,300,255,85.98,300,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Xr Ribs Bil,,71110,CPT,Facility,Both,,,,300,255,85.98,300,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,265.71,88.57,,percent of total billed charges,,
Xr Ribs Bil,,71110,CPT,Facility,Both,,,,300,255,85.98,300,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,85.98,28.66,,percent of total billed charges,,
Xr Ribs Bil,,71110,CPT,Facility,Outpatient,,,,300,255,85.98,300,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),147,49,,percent of total billed charges,,
Xr Ribs Bil,,71110,CPT,Facility,Inpatient,,,,300,255,85.98,300,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Xr Ribs Bil,,71110,CPT,Facility,Both,,,,300,255,85.98,300,CorVel,Worker's Compensation,300,100,,percent of total billed charges,,
Xr Ribs Bil,,71110,CPT,Facility,Both,,,,300,255,85.98,300,First Health Group Corporation,First Health Network,291,97,,percent of total billed charges,,
Xr Ribs Bil,,71110,CPT,Facility,Both,,,,300,255,85.98,300,"Health Partners, Inc.",Commercial,283.8,94.6,,percent of total billed charges,,
Xr Ribs Bil,,71110,CPT,Facility,Outpatient,,,,300,255,85.98,300,"Health Partners, Inc.",Medicare Advantage,147,49,,percent of total billed charges,,
Xr Ribs Bil,,71110,CPT,Facility,Inpatient,,,,300,255,85.98,300,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Ribs Bil,,71110,CPT,Facility,Both,,,,300,255,85.98,300,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),180,60,,percent of total billed charges,,
Xr Ribs Bil,,71110,CPT,Facility,Both,,,,300,255,85.98,300,"Health Partners, Inc.",State of Minnesota Advantage Program,244.5,81.5,,percent of total billed charges,,
Xr Ribs Bil,,71110,CPT,Facility,Both,,,,300,255,85.98,300,"Health Partners, Inc.",State Public Programs,150,50,,percent of total billed charges,,
Xr Ribs Bil,,71110,CPT,Facility,Both,,,,300,255,85.98,300,Humana Insurance Company,Commercial PPO,285,95,,percent of total billed charges,,
Xr Ribs Bil,,71110,CPT,Facility,Outpatient,,,,300,255,85.98,300,Humana Insurance Company,Medicare PPO,147,49,,percent of total billed charges,,
Xr Ribs Bil,,71110,CPT,Facility,Inpatient,,,,300,255,85.98,300,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Xr Ribs Bil,,71110,CPT,Facility,Both,,,,300,255,85.98,300,Medica,Individual & Family,297.3,99.1,,percent of total billed charges,,
Xr Ribs Bil,,71110,CPT,Facility,Outpatient,,,,300,255,85.98,300,Medica,Medica Advantage Solution,149.4,49.8,,percent of total billed charges,,
Xr Ribs Bil,,71110,CPT,Facility,Inpatient,,,,300,255,85.98,300,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Xr Ribs Bil,,71110,CPT,Facility,Outpatient,,,,300,255,85.98,300,Medica,Medical Assistance,133.8,44.6,,percent of total billed charges,,
Xr Ribs Bil,,71110,CPT,Facility,Inpatient,,,,300,255,85.98,300,Medica,Medical Assistance,,,,,Included in per diem rate,
Xr Ribs Bil,,71110,CPT,Facility,Outpatient,,,,300,255,85.98,300,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,149.4,49.8,,percent of total billed charges,,
Xr Ribs Bil,,71110,CPT,Facility,Inpatient,,,,300,255,85.98,300,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Xr Ribs Bil,,71110,CPT,Facility,Both,,,,300,255,85.98,300,"Multiplan, Inc.","Multiplan, Inc.",282,94,,percent of total billed charges,,
Xr Ribs Bil,,71110,CPT,Facility,Outpatient,,,,300,255,85.98,300,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,270.3,90.1,,percent of total billed charges,,
Xr Ribs Bil,,71110,CPT,Facility,Inpatient,,,,300,255,85.98,300,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Xr Ribs Bil,,71110,CPT,Facility,Both,,,,300,255,85.98,300,"Preferred One Administrative Services, INC.",PPO,295.8,98.6,,percent of total billed charges,,
Xr Ribs Bil,,71110,CPT,Facility,Outpatient,,,,300,255,85.98,300,PrimeWest Health,Minnesota Senior Health Options (MSHO),154.35,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Xr Ribs Bil,,71110,CPT,Facility,Inpatient,,,,300,255,85.98,300,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Ribs Bil,,71110,CPT,Facility,Outpatient,,,,300,255,85.98,300,PrimeWest Health,MinnesotaCare,154.08,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Xr Ribs Bil,,71110,CPT,Facility,Inpatient,,,,300,255,85.98,300,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Xr Ribs Bil,,71110,CPT,Facility,Both,,,,300,255,85.98,300,Sanford Health Plan,Sanford Health Plan,276,92,,percent of total billed charges,,
Xr Ribs Bil,,71110,CPT,Facility,Outpatient,,,,300,255,85.98,300,"UCare Health, Inc.",Individual & Family Plan,169.05,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Xr Ribs Bil,,71110,CPT,Facility,Inpatient,,,,300,255,85.98,300,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Xr Ribs Bil,,71110,CPT,Facility,Outpatient,,,,300,255,85.98,300,"UCare Health, Inc.",Medical Assistance,151.41,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Ribs Bil,,71110,CPT,Facility,Inpatient,,,,300,255,85.98,300,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Xr Ribs Bil,,71110,CPT,Facility,Outpatient,,,,300,255,85.98,300,"UCare Health, Inc.",Medicare Advantage,151.41,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Ribs Bil,,71110,CPT,Facility,Inpatient,,,,300,255,85.98,300,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Ribs Bil,,71110,CPT,Facility,Outpatient,,,,300,255,85.98,300,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),151.41,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Ribs Bil,,71110,CPT,Facility,Inpatient,,,,300,255,85.98,300,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Ribs Bil,,71110,CPT,Facility,Both,,,,300,255,85.98,300,UnitedHealthcare,Individual & Family,282,94,,percent of total billed charges,,
Xr Ribs Bil,,71110,CPT,Facility,Outpatient,,,,300,255,85.98,300,UnitedHealthcare,Medicare Advantage,147,49,,percent of total billed charges,,
Xr Ribs Bil,,71110,CPT,Facility,Inpatient,,,,300,255,85.98,300,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Xr Ribs Bil,,71110,CPT,Facility,Outpatient,,,,300,255,85.98,300,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,144,48,,percent of total billed charges,,100% of DHS outpatient percentage
Xr Ribs Bil,,71110,CPT,Facility,Inpatient,,,,300,255,85.98,300,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Xr Ribs Bil W Chest,,71111,CPT,Facility,Both,,,,461,391.85,132.1226,461,Aetna,Commercial,424.12,92,,percent of total billed charges,,
Xr Ribs Bil W Chest,,71111,CPT,Facility,Outpatient,,,,461,391.85,132.1226,461,Aetna,Medicare Advantage,225.89,49,,percent of total billed charges,,
Xr Ribs Bil W Chest,,71111,CPT,Facility,Inpatient,,,,461,391.85,132.1226,461,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Xr Ribs Bil W Chest,,71111,CPT,Facility,Both,,,,461,391.85,132.1226,461,Aetna,PPO,428.73,93,,percent of total billed charges,,
Xr Ribs Bil W Chest,,71111,CPT,Facility,Both,,,,461,391.85,132.1226,461,America's PPO,America's PPO,442.6983,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Xr Ribs Bil W Chest,,71111,CPT,Facility,Both,,,,461,391.85,132.1226,461,BlueCross BlueShield Minnesota, Federal Employee Program,453.624,98.4,,percent of total billed charges,,
Xr Ribs Bil W Chest,,71111,CPT,Facility,Both,,,,461,391.85,132.1226,461,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,461,100,,percent of total billed charges,,
Xr Ribs Bil W Chest,,71111,CPT,Facility,Both,,,,461,391.85,132.1226,461,BlueCross BlueShield Minnesota,High Value Network Plan,414.9,90,,percent of total billed charges,,
Xr Ribs Bil W Chest,,71111,CPT,Facility,Outpatient,,,,461,391.85,132.1226,461,BlueCross BlueShield Minnesota,Medicare Advantage,225.89,49,,percent of total billed charges,,
Xr Ribs Bil W Chest,,71111,CPT,Facility,Inpatient,,,,461,391.85,132.1226,461,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Xr Ribs Bil W Chest,,71111,CPT,Facility,Both,,,,461,391.85,132.1226,461,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,408.3077,88.57,,percent of total billed charges,,
Xr Ribs Bil W Chest,,71111,CPT,Facility,Both,,,,461,391.85,132.1226,461,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,132.1226,28.66,,percent of total billed charges,,
Xr Ribs Bil W Chest,,71111,CPT,Facility,Outpatient,,,,461,391.85,132.1226,461,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),225.89,49,,percent of total billed charges,,
Xr Ribs Bil W Chest,,71111,CPT,Facility,Inpatient,,,,461,391.85,132.1226,461,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Xr Ribs Bil W Chest,,71111,CPT,Facility,Both,,,,461,391.85,132.1226,461,CorVel,Worker's Compensation,461,100,,percent of total billed charges,,
Xr Ribs Bil W Chest,,71111,CPT,Facility,Both,,,,461,391.85,132.1226,461,First Health Group Corporation,First Health Network,447.17,97,,percent of total billed charges,,
Xr Ribs Bil W Chest,,71111,CPT,Facility,Both,,,,461,391.85,132.1226,461,"Health Partners, Inc.",Commercial,436.106,94.6,,percent of total billed charges,,
Xr Ribs Bil W Chest,,71111,CPT,Facility,Outpatient,,,,461,391.85,132.1226,461,"Health Partners, Inc.",Medicare Advantage,225.89,49,,percent of total billed charges,,
Xr Ribs Bil W Chest,,71111,CPT,Facility,Inpatient,,,,461,391.85,132.1226,461,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Ribs Bil W Chest,,71111,CPT,Facility,Both,,,,461,391.85,132.1226,461,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),276.6,60,,percent of total billed charges,,
Xr Ribs Bil W Chest,,71111,CPT,Facility,Both,,,,461,391.85,132.1226,461,"Health Partners, Inc.",State of Minnesota Advantage Program,375.715,81.5,,percent of total billed charges,,
Xr Ribs Bil W Chest,,71111,CPT,Facility,Both,,,,461,391.85,132.1226,461,"Health Partners, Inc.",State Public Programs,230.5,50,,percent of total billed charges,,
Xr Ribs Bil W Chest,,71111,CPT,Facility,Both,,,,461,391.85,132.1226,461,Humana Insurance Company,Commercial PPO,437.95,95,,percent of total billed charges,,
Xr Ribs Bil W Chest,,71111,CPT,Facility,Outpatient,,,,461,391.85,132.1226,461,Humana Insurance Company,Medicare PPO,225.89,49,,percent of total billed charges,,
Xr Ribs Bil W Chest,,71111,CPT,Facility,Inpatient,,,,461,391.85,132.1226,461,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Xr Ribs Bil W Chest,,71111,CPT,Facility,Both,,,,461,391.85,132.1226,461,Medica,Individual & Family,456.851,99.1,,percent of total billed charges,,
Xr Ribs Bil W Chest,,71111,CPT,Facility,Outpatient,,,,461,391.85,132.1226,461,Medica,Medica Advantage Solution,229.578,49.8,,percent of total billed charges,,
Xr Ribs Bil W Chest,,71111,CPT,Facility,Inpatient,,,,461,391.85,132.1226,461,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Xr Ribs Bil W Chest,,71111,CPT,Facility,Outpatient,,,,461,391.85,132.1226,461,Medica,Medical Assistance,205.606,44.6,,percent of total billed charges,,
Xr Ribs Bil W Chest,,71111,CPT,Facility,Inpatient,,,,461,391.85,132.1226,461,Medica,Medical Assistance,,,,,Included in per diem rate,
Xr Ribs Bil W Chest,,71111,CPT,Facility,Outpatient,,,,461,391.85,132.1226,461,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,229.578,49.8,,percent of total billed charges,,
Xr Ribs Bil W Chest,,71111,CPT,Facility,Inpatient,,,,461,391.85,132.1226,461,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Xr Ribs Bil W Chest,,71111,CPT,Facility,Both,,,,461,391.85,132.1226,461,"Multiplan, Inc.","Multiplan, Inc.",433.34,94,,percent of total billed charges,,
Xr Ribs Bil W Chest,,71111,CPT,Facility,Outpatient,,,,461,391.85,132.1226,461,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,415.361,90.1,,percent of total billed charges,,
Xr Ribs Bil W Chest,,71111,CPT,Facility,Inpatient,,,,461,391.85,132.1226,461,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Xr Ribs Bil W Chest,,71111,CPT,Facility,Both,,,,461,391.85,132.1226,461,"Preferred One Administrative Services, INC.",PPO,454.546,98.6,,percent of total billed charges,,
Xr Ribs Bil W Chest,,71111,CPT,Facility,Outpatient,,,,461,391.85,132.1226,461,PrimeWest Health,Minnesota Senior Health Options (MSHO),237.1845,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Xr Ribs Bil W Chest,,71111,CPT,Facility,Inpatient,,,,461,391.85,132.1226,461,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Ribs Bil W Chest,,71111,CPT,Facility,Outpatient,,,,461,391.85,132.1226,461,PrimeWest Health,MinnesotaCare,236.7696,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Xr Ribs Bil W Chest,,71111,CPT,Facility,Inpatient,,,,461,391.85,132.1226,461,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Xr Ribs Bil W Chest,,71111,CPT,Facility,Both,,,,461,391.85,132.1226,461,Sanford Health Plan,Sanford Health Plan,424.12,92,,percent of total billed charges,,
Xr Ribs Bil W Chest,,71111,CPT,Facility,Outpatient,,,,461,391.85,132.1226,461,"UCare Health, Inc.",Individual & Family Plan,259.7735,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Xr Ribs Bil W Chest,,71111,CPT,Facility,Inpatient,,,,461,391.85,132.1226,461,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Xr Ribs Bil W Chest,,71111,CPT,Facility,Outpatient,,,,461,391.85,132.1226,461,"UCare Health, Inc.",Medical Assistance,232.6667,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Ribs Bil W Chest,,71111,CPT,Facility,Inpatient,,,,461,391.85,132.1226,461,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Xr Ribs Bil W Chest,,71111,CPT,Facility,Outpatient,,,,461,391.85,132.1226,461,"UCare Health, Inc.",Medicare Advantage,232.6667,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Ribs Bil W Chest,,71111,CPT,Facility,Inpatient,,,,461,391.85,132.1226,461,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Ribs Bil W Chest,,71111,CPT,Facility,Outpatient,,,,461,391.85,132.1226,461,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),232.6667,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Ribs Bil W Chest,,71111,CPT,Facility,Inpatient,,,,461,391.85,132.1226,461,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Ribs Bil W Chest,,71111,CPT,Facility,Both,,,,461,391.85,132.1226,461,UnitedHealthcare,Individual & Family,433.34,94,,percent of total billed charges,,
Xr Ribs Bil W Chest,,71111,CPT,Facility,Outpatient,,,,461,391.85,132.1226,461,UnitedHealthcare,Medicare Advantage,225.89,49,,percent of total billed charges,,
Xr Ribs Bil W Chest,,71111,CPT,Facility,Inpatient,,,,461,391.85,132.1226,461,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Xr Ribs Bil W Chest,,71111,CPT,Facility,Outpatient,,,,461,391.85,132.1226,461,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,221.28,48,,percent of total billed charges,,100% of DHS outpatient percentage
Xr Ribs Bil W Chest,,71111,CPT,Facility,Inpatient,,,,461,391.85,132.1226,461,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Xr Sternum,,71120,CPT,Facility,Both,,,,265,225.25,75.949,265,Aetna,Commercial,243.8,92,,percent of total billed charges,,
Xr Sternum,,71120,CPT,Facility,Outpatient,,,,265,225.25,75.949,265,Aetna,Medicare Advantage,129.85,49,,percent of total billed charges,,
Xr Sternum,,71120,CPT,Facility,Inpatient,,,,265,225.25,75.949,265,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Xr Sternum,,71120,CPT,Facility,Both,,,,265,225.25,75.949,265,Aetna,PPO,246.45,93,,percent of total billed charges,,
Xr Sternum,,71120,CPT,Facility,Both,,,,265,225.25,75.949,265,America's PPO,America's PPO,254.4795,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Xr Sternum,,71120,CPT,Facility,Both,,,,265,225.25,75.949,265,BlueCross BlueShield Minnesota, Federal Employee Program,260.76,98.4,,percent of total billed charges,,
Xr Sternum,,71120,CPT,Facility,Both,,,,265,225.25,75.949,265,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,265,100,,percent of total billed charges,,
Xr Sternum,,71120,CPT,Facility,Both,,,,265,225.25,75.949,265,BlueCross BlueShield Minnesota,High Value Network Plan,238.5,90,,percent of total billed charges,,
Xr Sternum,,71120,CPT,Facility,Outpatient,,,,265,225.25,75.949,265,BlueCross BlueShield Minnesota,Medicare Advantage,129.85,49,,percent of total billed charges,,
Xr Sternum,,71120,CPT,Facility,Inpatient,,,,265,225.25,75.949,265,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Xr Sternum,,71120,CPT,Facility,Both,,,,265,225.25,75.949,265,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,234.7105,88.57,,percent of total billed charges,,
Xr Sternum,,71120,CPT,Facility,Both,,,,265,225.25,75.949,265,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,75.949,28.66,,percent of total billed charges,,
Xr Sternum,,71120,CPT,Facility,Outpatient,,,,265,225.25,75.949,265,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),129.85,49,,percent of total billed charges,,
Xr Sternum,,71120,CPT,Facility,Inpatient,,,,265,225.25,75.949,265,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Xr Sternum,,71120,CPT,Facility,Both,,,,265,225.25,75.949,265,CorVel,Worker's Compensation,265,100,,percent of total billed charges,,
Xr Sternum,,71120,CPT,Facility,Both,,,,265,225.25,75.949,265,First Health Group Corporation,First Health Network,257.05,97,,percent of total billed charges,,
Xr Sternum,,71120,CPT,Facility,Both,,,,265,225.25,75.949,265,"Health Partners, Inc.",Commercial,250.69,94.6,,percent of total billed charges,,
Xr Sternum,,71120,CPT,Facility,Outpatient,,,,265,225.25,75.949,265,"Health Partners, Inc.",Medicare Advantage,129.85,49,,percent of total billed charges,,
Xr Sternum,,71120,CPT,Facility,Inpatient,,,,265,225.25,75.949,265,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Sternum,,71120,CPT,Facility,Both,,,,265,225.25,75.949,265,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),159,60,,percent of total billed charges,,
Xr Sternum,,71120,CPT,Facility,Both,,,,265,225.25,75.949,265,"Health Partners, Inc.",State of Minnesota Advantage Program,215.975,81.5,,percent of total billed charges,,
Xr Sternum,,71120,CPT,Facility,Both,,,,265,225.25,75.949,265,"Health Partners, Inc.",State Public Programs,132.5,50,,percent of total billed charges,,
Xr Sternum,,71120,CPT,Facility,Both,,,,265,225.25,75.949,265,Humana Insurance Company,Commercial PPO,251.75,95,,percent of total billed charges,,
Xr Sternum,,71120,CPT,Facility,Outpatient,,,,265,225.25,75.949,265,Humana Insurance Company,Medicare PPO,129.85,49,,percent of total billed charges,,
Xr Sternum,,71120,CPT,Facility,Inpatient,,,,265,225.25,75.949,265,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Xr Sternum,,71120,CPT,Facility,Both,,,,265,225.25,75.949,265,Medica,Individual & Family,262.615,99.1,,percent of total billed charges,,
Xr Sternum,,71120,CPT,Facility,Outpatient,,,,265,225.25,75.949,265,Medica,Medica Advantage Solution,131.97,49.8,,percent of total billed charges,,
Xr Sternum,,71120,CPT,Facility,Inpatient,,,,265,225.25,75.949,265,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Xr Sternum,,71120,CPT,Facility,Outpatient,,,,265,225.25,75.949,265,Medica,Medical Assistance,118.19,44.6,,percent of total billed charges,,
Xr Sternum,,71120,CPT,Facility,Inpatient,,,,265,225.25,75.949,265,Medica,Medical Assistance,,,,,Included in per diem rate,
Xr Sternum,,71120,CPT,Facility,Outpatient,,,,265,225.25,75.949,265,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,131.97,49.8,,percent of total billed charges,,
Xr Sternum,,71120,CPT,Facility,Inpatient,,,,265,225.25,75.949,265,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Xr Sternum,,71120,CPT,Facility,Both,,,,265,225.25,75.949,265,"Multiplan, Inc.","Multiplan, Inc.",249.1,94,,percent of total billed charges,,
Xr Sternum,,71120,CPT,Facility,Outpatient,,,,265,225.25,75.949,265,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,238.765,90.1,,percent of total billed charges,,
Xr Sternum,,71120,CPT,Facility,Inpatient,,,,265,225.25,75.949,265,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Xr Sternum,,71120,CPT,Facility,Both,,,,265,225.25,75.949,265,"Preferred One Administrative Services, INC.",PPO,261.29,98.6,,percent of total billed charges,,
Xr Sternum,,71120,CPT,Facility,Outpatient,,,,265,225.25,75.949,265,PrimeWest Health,Minnesota Senior Health Options (MSHO),136.3425,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Xr Sternum,,71120,CPT,Facility,Inpatient,,,,265,225.25,75.949,265,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Sternum,,71120,CPT,Facility,Outpatient,,,,265,225.25,75.949,265,PrimeWest Health,MinnesotaCare,136.104,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Xr Sternum,,71120,CPT,Facility,Inpatient,,,,265,225.25,75.949,265,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Xr Sternum,,71120,CPT,Facility,Both,,,,265,225.25,75.949,265,Sanford Health Plan,Sanford Health Plan,243.8,92,,percent of total billed charges,,
Xr Sternum,,71120,CPT,Facility,Outpatient,,,,265,225.25,75.949,265,"UCare Health, Inc.",Individual & Family Plan,149.3275,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Xr Sternum,,71120,CPT,Facility,Inpatient,,,,265,225.25,75.949,265,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Xr Sternum,,71120,CPT,Facility,Outpatient,,,,265,225.25,75.949,265,"UCare Health, Inc.",Medical Assistance,133.7455,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Sternum,,71120,CPT,Facility,Inpatient,,,,265,225.25,75.949,265,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Xr Sternum,,71120,CPT,Facility,Outpatient,,,,265,225.25,75.949,265,"UCare Health, Inc.",Medicare Advantage,133.7455,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Sternum,,71120,CPT,Facility,Inpatient,,,,265,225.25,75.949,265,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Sternum,,71120,CPT,Facility,Outpatient,,,,265,225.25,75.949,265,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),133.7455,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Sternum,,71120,CPT,Facility,Inpatient,,,,265,225.25,75.949,265,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Sternum,,71120,CPT,Facility,Both,,,,265,225.25,75.949,265,UnitedHealthcare,Individual & Family,249.1,94,,percent of total billed charges,,
Xr Sternum,,71120,CPT,Facility,Outpatient,,,,265,225.25,75.949,265,UnitedHealthcare,Medicare Advantage,129.85,49,,percent of total billed charges,,
Xr Sternum,,71120,CPT,Facility,Inpatient,,,,265,225.25,75.949,265,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Xr Sternum,,71120,CPT,Facility,Outpatient,,,,265,225.25,75.949,265,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,127.2,48,,percent of total billed charges,,100% of DHS outpatient percentage
Xr Sternum,,71120,CPT,Facility,Inpatient,,,,265,225.25,75.949,265,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Xr Sternoclavicular Joints,,71130,CPT,Facility,Both,,,,295,250.75,84.547,295,Aetna,Commercial,271.4,92,,percent of total billed charges,,
Xr Sternoclavicular Joints,,71130,CPT,Facility,Outpatient,,,,295,250.75,84.547,295,Aetna,Medicare Advantage,144.55,49,,percent of total billed charges,,
Xr Sternoclavicular Joints,,71130,CPT,Facility,Inpatient,,,,295,250.75,84.547,295,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Xr Sternoclavicular Joints,,71130,CPT,Facility,Both,,,,295,250.75,84.547,295,Aetna,PPO,274.35,93,,percent of total billed charges,,
Xr Sternoclavicular Joints,,71130,CPT,Facility,Both,,,,295,250.75,84.547,295,America's PPO,America's PPO,283.2885,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Xr Sternoclavicular Joints,,71130,CPT,Facility,Both,,,,295,250.75,84.547,295,BlueCross BlueShield Minnesota, Federal Employee Program,290.28,98.4,,percent of total billed charges,,
Xr Sternoclavicular Joints,,71130,CPT,Facility,Both,,,,295,250.75,84.547,295,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,295,100,,percent of total billed charges,,
Xr Sternoclavicular Joints,,71130,CPT,Facility,Both,,,,295,250.75,84.547,295,BlueCross BlueShield Minnesota,High Value Network Plan,265.5,90,,percent of total billed charges,,
Xr Sternoclavicular Joints,,71130,CPT,Facility,Outpatient,,,,295,250.75,84.547,295,BlueCross BlueShield Minnesota,Medicare Advantage,144.55,49,,percent of total billed charges,,
Xr Sternoclavicular Joints,,71130,CPT,Facility,Inpatient,,,,295,250.75,84.547,295,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Xr Sternoclavicular Joints,,71130,CPT,Facility,Both,,,,295,250.75,84.547,295,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,261.2815,88.57,,percent of total billed charges,,
Xr Sternoclavicular Joints,,71130,CPT,Facility,Both,,,,295,250.75,84.547,295,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,84.547,28.66,,percent of total billed charges,,
Xr Sternoclavicular Joints,,71130,CPT,Facility,Outpatient,,,,295,250.75,84.547,295,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),144.55,49,,percent of total billed charges,,
Xr Sternoclavicular Joints,,71130,CPT,Facility,Inpatient,,,,295,250.75,84.547,295,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Xr Sternoclavicular Joints,,71130,CPT,Facility,Both,,,,295,250.75,84.547,295,CorVel,Worker's Compensation,295,100,,percent of total billed charges,,
Xr Sternoclavicular Joints,,71130,CPT,Facility,Both,,,,295,250.75,84.547,295,First Health Group Corporation,First Health Network,286.15,97,,percent of total billed charges,,
Xr Sternoclavicular Joints,,71130,CPT,Facility,Both,,,,295,250.75,84.547,295,"Health Partners, Inc.",Commercial,279.07,94.6,,percent of total billed charges,,
Xr Sternoclavicular Joints,,71130,CPT,Facility,Outpatient,,,,295,250.75,84.547,295,"Health Partners, Inc.",Medicare Advantage,144.55,49,,percent of total billed charges,,
Xr Sternoclavicular Joints,,71130,CPT,Facility,Inpatient,,,,295,250.75,84.547,295,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Sternoclavicular Joints,,71130,CPT,Facility,Both,,,,295,250.75,84.547,295,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),177,60,,percent of total billed charges,,
Xr Sternoclavicular Joints,,71130,CPT,Facility,Both,,,,295,250.75,84.547,295,"Health Partners, Inc.",State of Minnesota Advantage Program,240.425,81.5,,percent of total billed charges,,
Xr Sternoclavicular Joints,,71130,CPT,Facility,Both,,,,295,250.75,84.547,295,"Health Partners, Inc.",State Public Programs,147.5,50,,percent of total billed charges,,
Xr Sternoclavicular Joints,,71130,CPT,Facility,Both,,,,295,250.75,84.547,295,Humana Insurance Company,Commercial PPO,280.25,95,,percent of total billed charges,,
Xr Sternoclavicular Joints,,71130,CPT,Facility,Outpatient,,,,295,250.75,84.547,295,Humana Insurance Company,Medicare PPO,144.55,49,,percent of total billed charges,,
Xr Sternoclavicular Joints,,71130,CPT,Facility,Inpatient,,,,295,250.75,84.547,295,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Xr Sternoclavicular Joints,,71130,CPT,Facility,Both,,,,295,250.75,84.547,295,Medica,Individual & Family,292.345,99.1,,percent of total billed charges,,
Xr Sternoclavicular Joints,,71130,CPT,Facility,Outpatient,,,,295,250.75,84.547,295,Medica,Medica Advantage Solution,146.91,49.8,,percent of total billed charges,,
Xr Sternoclavicular Joints,,71130,CPT,Facility,Inpatient,,,,295,250.75,84.547,295,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Xr Sternoclavicular Joints,,71130,CPT,Facility,Outpatient,,,,295,250.75,84.547,295,Medica,Medical Assistance,131.57,44.6,,percent of total billed charges,,
Xr Sternoclavicular Joints,,71130,CPT,Facility,Inpatient,,,,295,250.75,84.547,295,Medica,Medical Assistance,,,,,Included in per diem rate,
Xr Sternoclavicular Joints,,71130,CPT,Facility,Outpatient,,,,295,250.75,84.547,295,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,146.91,49.8,,percent of total billed charges,,
Xr Sternoclavicular Joints,,71130,CPT,Facility,Inpatient,,,,295,250.75,84.547,295,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Xr Sternoclavicular Joints,,71130,CPT,Facility,Both,,,,295,250.75,84.547,295,"Multiplan, Inc.","Multiplan, Inc.",277.3,94,,percent of total billed charges,,
Xr Sternoclavicular Joints,,71130,CPT,Facility,Outpatient,,,,295,250.75,84.547,295,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,265.795,90.1,,percent of total billed charges,,
Xr Sternoclavicular Joints,,71130,CPT,Facility,Inpatient,,,,295,250.75,84.547,295,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Xr Sternoclavicular Joints,,71130,CPT,Facility,Both,,,,295,250.75,84.547,295,"Preferred One Administrative Services, INC.",PPO,290.87,98.6,,percent of total billed charges,,
Xr Sternoclavicular Joints,,71130,CPT,Facility,Outpatient,,,,295,250.75,84.547,295,PrimeWest Health,Minnesota Senior Health Options (MSHO),151.7775,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Xr Sternoclavicular Joints,,71130,CPT,Facility,Inpatient,,,,295,250.75,84.547,295,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Sternoclavicular Joints,,71130,CPT,Facility,Outpatient,,,,295,250.75,84.547,295,PrimeWest Health,MinnesotaCare,151.512,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Xr Sternoclavicular Joints,,71130,CPT,Facility,Inpatient,,,,295,250.75,84.547,295,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Xr Sternoclavicular Joints,,71130,CPT,Facility,Both,,,,295,250.75,84.547,295,Sanford Health Plan,Sanford Health Plan,271.4,92,,percent of total billed charges,,
Xr Sternoclavicular Joints,,71130,CPT,Facility,Outpatient,,,,295,250.75,84.547,295,"UCare Health, Inc.",Individual & Family Plan,166.2325,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Xr Sternoclavicular Joints,,71130,CPT,Facility,Inpatient,,,,295,250.75,84.547,295,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Xr Sternoclavicular Joints,,71130,CPT,Facility,Outpatient,,,,295,250.75,84.547,295,"UCare Health, Inc.",Medical Assistance,148.8865,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Sternoclavicular Joints,,71130,CPT,Facility,Inpatient,,,,295,250.75,84.547,295,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Xr Sternoclavicular Joints,,71130,CPT,Facility,Outpatient,,,,295,250.75,84.547,295,"UCare Health, Inc.",Medicare Advantage,148.8865,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Sternoclavicular Joints,,71130,CPT,Facility,Inpatient,,,,295,250.75,84.547,295,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Sternoclavicular Joints,,71130,CPT,Facility,Outpatient,,,,295,250.75,84.547,295,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),148.8865,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Sternoclavicular Joints,,71130,CPT,Facility,Inpatient,,,,295,250.75,84.547,295,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Sternoclavicular Joints,,71130,CPT,Facility,Both,,,,295,250.75,84.547,295,UnitedHealthcare,Individual & Family,277.3,94,,percent of total billed charges,,
Xr Sternoclavicular Joints,,71130,CPT,Facility,Outpatient,,,,295,250.75,84.547,295,UnitedHealthcare,Medicare Advantage,144.55,49,,percent of total billed charges,,
Xr Sternoclavicular Joints,,71130,CPT,Facility,Inpatient,,,,295,250.75,84.547,295,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Xr Sternoclavicular Joints,,71130,CPT,Facility,Outpatient,,,,295,250.75,84.547,295,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,141.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
Xr Sternoclavicular Joints,,71130,CPT,Facility,Inpatient,,,,295,250.75,84.547,295,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Ct Chest High Resol Wo Iv Contrast,,71250,CPT,Facility,Both,,,,1584,1346.4,325.628,1584,Aetna,Commercial,1457.28,92,,percent of total billed charges,,
Ct Chest High Resol Wo Iv Contrast,,71250,CPT,Facility,Outpatient,,,,1584,1346.4,325.628,1584,Aetna,Medicare Advantage,776.16,49,,percent of total billed charges,,
Ct Chest High Resol Wo Iv Contrast,,71250,CPT,Facility,Inpatient,,,,1584,1346.4,325.628,1584,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Ct Chest High Resol Wo Iv Contrast,,71250,CPT,Facility,Both,,,,1584,1346.4,325.628,1584,Aetna,PPO,1473.12,93,,percent of total billed charges,,
Ct Chest High Resol Wo Iv Contrast,,71250,CPT,Facility,Both,,,,1584,1346.4,325.628,1584,America's PPO,America's PPO,1521.1152,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Ct Chest High Resol Wo Iv Contrast,,71250,CPT,Facility,Both,,,,1584,1346.4,325.628,1584,BlueCross BlueShield Minnesota, Federal Employee Program,641,,,Fee schedule,,100% of BCBS commercial commodity fee schedule
Ct Chest High Resol Wo Iv Contrast,,71250,CPT,Facility,Both,,,,1584,1346.4,325.628,1584,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,651.256,,,Fee schedule,,"100% of BCBS commercial commodity fee schedule, plus MN Care tax"
Ct Chest High Resol Wo Iv Contrast,,71250,CPT,Facility,Both,,,,1584,1346.4,325.628,1584,BlueCross BlueShield Minnesota,High Value Network Plan,586.1304,,,Fee schedule,,"90% of BCBS commercial commodity fee schedule, plus MN Care tax; see disclaimer for more information"
Ct Chest High Resol Wo Iv Contrast,,71250,CPT,Facility,Outpatient,,,,1584,1346.4,325.628,1584,BlueCross BlueShield Minnesota,Medicare Advantage,776.16,49,,percent of total billed charges,,
Ct Chest High Resol Wo Iv Contrast,,71250,CPT,Facility,Inpatient,,,,1584,1346.4,325.628,1584,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Ct Chest High Resol Wo Iv Contrast,,71250,CPT,Facility,Both,,,,1584,1346.4,325.628,1584,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,576.8174392,,,Fee schedule,,"88.57% of BCBS commercial commodity fee schedule, plus MN Care tax"
Ct Chest High Resol Wo Iv Contrast,,71250,CPT,Facility,Both,,,,1584,1346.4,325.628,1584,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,325.628,,,Fee schedule,,"100% of BCBS Medicaid commodity fee schedule, plus MN Care tax"
Ct Chest High Resol Wo Iv Contrast,,71250,CPT,Facility,Outpatient,,,,1584,1346.4,325.628,1584,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),776.16,49,,percent of total billed charges,,
Ct Chest High Resol Wo Iv Contrast,,71250,CPT,Facility,Inpatient,,,,1584,1346.4,325.628,1584,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Ct Chest High Resol Wo Iv Contrast,,71250,CPT,Facility,Both,,,,1584,1346.4,325.628,1584,CorVel,Worker's Compensation,1584,100,,percent of total billed charges,,
Ct Chest High Resol Wo Iv Contrast,,71250,CPT,Facility,Both,,,,1584,1346.4,325.628,1584,First Health Group Corporation,First Health Network,1536.48,97,,percent of total billed charges,,
Ct Chest High Resol Wo Iv Contrast,,71250,CPT,Facility,Both,,,,1584,1346.4,325.628,1584,"Health Partners, Inc.",Commercial,1498.464,94.6,,percent of total billed charges,,
Ct Chest High Resol Wo Iv Contrast,,71250,CPT,Facility,Outpatient,,,,1584,1346.4,325.628,1584,"Health Partners, Inc.",Medicare Advantage,776.16,49,,percent of total billed charges,,
Ct Chest High Resol Wo Iv Contrast,,71250,CPT,Facility,Inpatient,,,,1584,1346.4,325.628,1584,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ct Chest High Resol Wo Iv Contrast,,71250,CPT,Facility,Both,,,,1584,1346.4,325.628,1584,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),950.4,60,,percent of total billed charges,,
Ct Chest High Resol Wo Iv Contrast,,71250,CPT,Facility,Both,,,,1584,1346.4,325.628,1584,"Health Partners, Inc.",State of Minnesota Advantage Program,1290.96,81.5,,percent of total billed charges,,
Ct Chest High Resol Wo Iv Contrast,,71250,CPT,Facility,Both,,,,1584,1346.4,325.628,1584,"Health Partners, Inc.",State Public Programs,792,50,,percent of total billed charges,,
Ct Chest High Resol Wo Iv Contrast,,71250,CPT,Facility,Both,,,,1584,1346.4,325.628,1584,Humana Insurance Company,Commercial PPO,1504.8,95,,percent of total billed charges,,
Ct Chest High Resol Wo Iv Contrast,,71250,CPT,Facility,Outpatient,,,,1584,1346.4,325.628,1584,Humana Insurance Company,Medicare PPO,776.16,49,,percent of total billed charges,,
Ct Chest High Resol Wo Iv Contrast,,71250,CPT,Facility,Inpatient,,,,1584,1346.4,325.628,1584,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Ct Chest High Resol Wo Iv Contrast,,71250,CPT,Facility,Both,,,,1584,1346.4,325.628,1584,Medica,Individual & Family,1569.744,99.1,,percent of total billed charges,,
Ct Chest High Resol Wo Iv Contrast,,71250,CPT,Facility,Outpatient,,,,1584,1346.4,325.628,1584,Medica,Medica Advantage Solution,788.832,49.8,,percent of total billed charges,,
Ct Chest High Resol Wo Iv Contrast,,71250,CPT,Facility,Inpatient,,,,1584,1346.4,325.628,1584,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Ct Chest High Resol Wo Iv Contrast,,71250,CPT,Facility,Outpatient,,,,1584,1346.4,325.628,1584,Medica,Medical Assistance,706.464,44.6,,percent of total billed charges,,
Ct Chest High Resol Wo Iv Contrast,,71250,CPT,Facility,Inpatient,,,,1584,1346.4,325.628,1584,Medica,Medical Assistance,,,,,Included in per diem rate,
Ct Chest High Resol Wo Iv Contrast,,71250,CPT,Facility,Outpatient,,,,1584,1346.4,325.628,1584,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,788.832,49.8,,percent of total billed charges,,
Ct Chest High Resol Wo Iv Contrast,,71250,CPT,Facility,Inpatient,,,,1584,1346.4,325.628,1584,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Ct Chest High Resol Wo Iv Contrast,,71250,CPT,Facility,Both,,,,1584,1346.4,325.628,1584,"Multiplan, Inc.","Multiplan, Inc.",1488.96,94,,percent of total billed charges,,
Ct Chest High Resol Wo Iv Contrast,,71250,CPT,Facility,Outpatient,,,,1584,1346.4,325.628,1584,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1283,,,Other,Per scan,
Ct Chest High Resol Wo Iv Contrast,,71250,CPT,Facility,Inpatient,,,,1584,1346.4,325.628,1584,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Ct Chest High Resol Wo Iv Contrast,,71250,CPT,Facility,Both,,,,1584,1346.4,325.628,1584,"Preferred One Administrative Services, INC.",PPO,1561.824,98.6,,percent of total billed charges,,
Ct Chest High Resol Wo Iv Contrast,,71250,CPT,Facility,Outpatient,,,,1584,1346.4,325.628,1584,PrimeWest Health,Minnesota Senior Health Options (MSHO),814.968,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Ct Chest High Resol Wo Iv Contrast,,71250,CPT,Facility,Inpatient,,,,1584,1346.4,325.628,1584,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ct Chest High Resol Wo Iv Contrast,,71250,CPT,Facility,Outpatient,,,,1584,1346.4,325.628,1584,PrimeWest Health,MinnesotaCare,813.5424,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Ct Chest High Resol Wo Iv Contrast,,71250,CPT,Facility,Inpatient,,,,1584,1346.4,325.628,1584,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Ct Chest High Resol Wo Iv Contrast,,71250,CPT,Facility,Both,,,,1584,1346.4,325.628,1584,Sanford Health Plan,Sanford Health Plan,1457.28,92,,percent of total billed charges,,
Ct Chest High Resol Wo Iv Contrast,,71250,CPT,Facility,Outpatient,,,,1584,1346.4,325.628,1584,"UCare Health, Inc.",Individual & Family Plan,892.584,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Ct Chest High Resol Wo Iv Contrast,,71250,CPT,Facility,Inpatient,,,,1584,1346.4,325.628,1584,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Ct Chest High Resol Wo Iv Contrast,,71250,CPT,Facility,Outpatient,,,,1584,1346.4,325.628,1584,"UCare Health, Inc.",Medical Assistance,799.4448,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ct Chest High Resol Wo Iv Contrast,,71250,CPT,Facility,Inpatient,,,,1584,1346.4,325.628,1584,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Ct Chest High Resol Wo Iv Contrast,,71250,CPT,Facility,Outpatient,,,,1584,1346.4,325.628,1584,"UCare Health, Inc.",Medicare Advantage,799.4448,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ct Chest High Resol Wo Iv Contrast,,71250,CPT,Facility,Inpatient,,,,1584,1346.4,325.628,1584,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ct Chest High Resol Wo Iv Contrast,,71250,CPT,Facility,Outpatient,,,,1584,1346.4,325.628,1584,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),799.4448,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ct Chest High Resol Wo Iv Contrast,,71250,CPT,Facility,Inpatient,,,,1584,1346.4,325.628,1584,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ct Chest High Resol Wo Iv Contrast,,71250,CPT,Facility,Both,,,,1584,1346.4,325.628,1584,UnitedHealthcare,Individual & Family,1488.96,94,,percent of total billed charges,,
Ct Chest High Resol Wo Iv Contrast,,71250,CPT,Facility,Outpatient,,,,1584,1346.4,325.628,1584,UnitedHealthcare,Medicare Advantage,776.16,49,,percent of total billed charges,,
Ct Chest High Resol Wo Iv Contrast,,71250,CPT,Facility,Inpatient,,,,1584,1346.4,325.628,1584,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Ct Chest High Resol Wo Iv Contrast,,71250,CPT,Facility,Outpatient,,,,1584,1346.4,325.628,1584,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,760.32,48,,percent of total billed charges,,100% of DHS outpatient percentage
Ct Chest High Resol Wo Iv Contrast,,71250,CPT,Facility,Inpatient,,,,1584,1346.4,325.628,1584,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Ct Chest Pulmonary Nodule Followup Wo Contr,,71250,CPT,Facility,Both,,,,1584,1346.4,325.628,1584,Aetna,Commercial,1457.28,92,,percent of total billed charges,,
Ct Chest Pulmonary Nodule Followup Wo Contr,,71250,CPT,Facility,Outpatient,,,,1584,1346.4,325.628,1584,Aetna,Medicare Advantage,776.16,49,,percent of total billed charges,,
Ct Chest Pulmonary Nodule Followup Wo Contr,,71250,CPT,Facility,Inpatient,,,,1584,1346.4,325.628,1584,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Ct Chest Pulmonary Nodule Followup Wo Contr,,71250,CPT,Facility,Both,,,,1584,1346.4,325.628,1584,Aetna,PPO,1473.12,93,,percent of total billed charges,,
Ct Chest Pulmonary Nodule Followup Wo Contr,,71250,CPT,Facility,Both,,,,1584,1346.4,325.628,1584,America's PPO,America's PPO,1521.1152,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Ct Chest Pulmonary Nodule Followup Wo Contr,,71250,CPT,Facility,Both,,,,1584,1346.4,325.628,1584,BlueCross BlueShield Minnesota, Federal Employee Program,641,,,Fee schedule,,100% of BCBS commercial commodity fee schedule
Ct Chest Pulmonary Nodule Followup Wo Contr,,71250,CPT,Facility,Both,,,,1584,1346.4,325.628,1584,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,651.256,,,Fee schedule,,"100% of BCBS commercial commodity fee schedule, plus MN Care tax"
Ct Chest Pulmonary Nodule Followup Wo Contr,,71250,CPT,Facility,Both,,,,1584,1346.4,325.628,1584,BlueCross BlueShield Minnesota,High Value Network Plan,586.1304,,,Fee schedule,,"90% of BCBS commercial commodity fee schedule, plus MN Care tax; see disclaimer for more information"
Ct Chest Pulmonary Nodule Followup Wo Contr,,71250,CPT,Facility,Outpatient,,,,1584,1346.4,325.628,1584,BlueCross BlueShield Minnesota,Medicare Advantage,776.16,49,,percent of total billed charges,,
Ct Chest Pulmonary Nodule Followup Wo Contr,,71250,CPT,Facility,Inpatient,,,,1584,1346.4,325.628,1584,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Ct Chest Pulmonary Nodule Followup Wo Contr,,71250,CPT,Facility,Both,,,,1584,1346.4,325.628,1584,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,576.8174392,,,Fee schedule,,"88.57% of BCBS commercial commodity fee schedule, plus MN Care tax"
Ct Chest Pulmonary Nodule Followup Wo Contr,,71250,CPT,Facility,Both,,,,1584,1346.4,325.628,1584,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,325.628,,,Fee schedule,,"100% of BCBS Medicaid commodity fee schedule, plus MN Care tax"
Ct Chest Pulmonary Nodule Followup Wo Contr,,71250,CPT,Facility,Outpatient,,,,1584,1346.4,325.628,1584,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),776.16,49,,percent of total billed charges,,
Ct Chest Pulmonary Nodule Followup Wo Contr,,71250,CPT,Facility,Inpatient,,,,1584,1346.4,325.628,1584,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Ct Chest Pulmonary Nodule Followup Wo Contr,,71250,CPT,Facility,Both,,,,1584,1346.4,325.628,1584,CorVel,Worker's Compensation,1584,100,,percent of total billed charges,,
Ct Chest Pulmonary Nodule Followup Wo Contr,,71250,CPT,Facility,Both,,,,1584,1346.4,325.628,1584,First Health Group Corporation,First Health Network,1536.48,97,,percent of total billed charges,,
Ct Chest Pulmonary Nodule Followup Wo Contr,,71250,CPT,Facility,Both,,,,1584,1346.4,325.628,1584,"Health Partners, Inc.",Commercial,1498.464,94.6,,percent of total billed charges,,
Ct Chest Pulmonary Nodule Followup Wo Contr,,71250,CPT,Facility,Outpatient,,,,1584,1346.4,325.628,1584,"Health Partners, Inc.",Medicare Advantage,776.16,49,,percent of total billed charges,,
Ct Chest Pulmonary Nodule Followup Wo Contr,,71250,CPT,Facility,Inpatient,,,,1584,1346.4,325.628,1584,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ct Chest Pulmonary Nodule Followup Wo Contr,,71250,CPT,Facility,Both,,,,1584,1346.4,325.628,1584,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),950.4,60,,percent of total billed charges,,
Ct Chest Pulmonary Nodule Followup Wo Contr,,71250,CPT,Facility,Both,,,,1584,1346.4,325.628,1584,"Health Partners, Inc.",State of Minnesota Advantage Program,1290.96,81.5,,percent of total billed charges,,
Ct Chest Pulmonary Nodule Followup Wo Contr,,71250,CPT,Facility,Both,,,,1584,1346.4,325.628,1584,"Health Partners, Inc.",State Public Programs,792,50,,percent of total billed charges,,
Ct Chest Pulmonary Nodule Followup Wo Contr,,71250,CPT,Facility,Both,,,,1584,1346.4,325.628,1584,Humana Insurance Company,Commercial PPO,1504.8,95,,percent of total billed charges,,
Ct Chest Pulmonary Nodule Followup Wo Contr,,71250,CPT,Facility,Outpatient,,,,1584,1346.4,325.628,1584,Humana Insurance Company,Medicare PPO,776.16,49,,percent of total billed charges,,
Ct Chest Pulmonary Nodule Followup Wo Contr,,71250,CPT,Facility,Inpatient,,,,1584,1346.4,325.628,1584,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Ct Chest Pulmonary Nodule Followup Wo Contr,,71250,CPT,Facility,Both,,,,1584,1346.4,325.628,1584,Medica,Individual & Family,1569.744,99.1,,percent of total billed charges,,
Ct Chest Pulmonary Nodule Followup Wo Contr,,71250,CPT,Facility,Outpatient,,,,1584,1346.4,325.628,1584,Medica,Medica Advantage Solution,788.832,49.8,,percent of total billed charges,,
Ct Chest Pulmonary Nodule Followup Wo Contr,,71250,CPT,Facility,Inpatient,,,,1584,1346.4,325.628,1584,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Ct Chest Pulmonary Nodule Followup Wo Contr,,71250,CPT,Facility,Outpatient,,,,1584,1346.4,325.628,1584,Medica,Medical Assistance,706.464,44.6,,percent of total billed charges,,
Ct Chest Pulmonary Nodule Followup Wo Contr,,71250,CPT,Facility,Inpatient,,,,1584,1346.4,325.628,1584,Medica,Medical Assistance,,,,,Included in per diem rate,
Ct Chest Pulmonary Nodule Followup Wo Contr,,71250,CPT,Facility,Outpatient,,,,1584,1346.4,325.628,1584,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,788.832,49.8,,percent of total billed charges,,
Ct Chest Pulmonary Nodule Followup Wo Contr,,71250,CPT,Facility,Inpatient,,,,1584,1346.4,325.628,1584,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Ct Chest Pulmonary Nodule Followup Wo Contr,,71250,CPT,Facility,Both,,,,1584,1346.4,325.628,1584,"Multiplan, Inc.","Multiplan, Inc.",1488.96,94,,percent of total billed charges,,
Ct Chest Pulmonary Nodule Followup Wo Contr,,71250,CPT,Facility,Outpatient,,,,1584,1346.4,325.628,1584,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1283,,,Other,Per scan,
Ct Chest Pulmonary Nodule Followup Wo Contr,,71250,CPT,Facility,Inpatient,,,,1584,1346.4,325.628,1584,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Ct Chest Pulmonary Nodule Followup Wo Contr,,71250,CPT,Facility,Both,,,,1584,1346.4,325.628,1584,"Preferred One Administrative Services, INC.",PPO,1561.824,98.6,,percent of total billed charges,,
Ct Chest Pulmonary Nodule Followup Wo Contr,,71250,CPT,Facility,Outpatient,,,,1584,1346.4,325.628,1584,PrimeWest Health,Minnesota Senior Health Options (MSHO),814.968,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Ct Chest Pulmonary Nodule Followup Wo Contr,,71250,CPT,Facility,Inpatient,,,,1584,1346.4,325.628,1584,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ct Chest Pulmonary Nodule Followup Wo Contr,,71250,CPT,Facility,Outpatient,,,,1584,1346.4,325.628,1584,PrimeWest Health,MinnesotaCare,813.5424,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Ct Chest Pulmonary Nodule Followup Wo Contr,,71250,CPT,Facility,Inpatient,,,,1584,1346.4,325.628,1584,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Ct Chest Pulmonary Nodule Followup Wo Contr,,71250,CPT,Facility,Both,,,,1584,1346.4,325.628,1584,Sanford Health Plan,Sanford Health Plan,1457.28,92,,percent of total billed charges,,
Ct Chest Pulmonary Nodule Followup Wo Contr,,71250,CPT,Facility,Outpatient,,,,1584,1346.4,325.628,1584,"UCare Health, Inc.",Individual & Family Plan,892.584,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Ct Chest Pulmonary Nodule Followup Wo Contr,,71250,CPT,Facility,Inpatient,,,,1584,1346.4,325.628,1584,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Ct Chest Pulmonary Nodule Followup Wo Contr,,71250,CPT,Facility,Outpatient,,,,1584,1346.4,325.628,1584,"UCare Health, Inc.",Medical Assistance,799.4448,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ct Chest Pulmonary Nodule Followup Wo Contr,,71250,CPT,Facility,Inpatient,,,,1584,1346.4,325.628,1584,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Ct Chest Pulmonary Nodule Followup Wo Contr,,71250,CPT,Facility,Outpatient,,,,1584,1346.4,325.628,1584,"UCare Health, Inc.",Medicare Advantage,799.4448,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ct Chest Pulmonary Nodule Followup Wo Contr,,71250,CPT,Facility,Inpatient,,,,1584,1346.4,325.628,1584,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ct Chest Pulmonary Nodule Followup Wo Contr,,71250,CPT,Facility,Outpatient,,,,1584,1346.4,325.628,1584,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),799.4448,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ct Chest Pulmonary Nodule Followup Wo Contr,,71250,CPT,Facility,Inpatient,,,,1584,1346.4,325.628,1584,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ct Chest Pulmonary Nodule Followup Wo Contr,,71250,CPT,Facility,Both,,,,1584,1346.4,325.628,1584,UnitedHealthcare,Individual & Family,1488.96,94,,percent of total billed charges,,
Ct Chest Pulmonary Nodule Followup Wo Contr,,71250,CPT,Facility,Outpatient,,,,1584,1346.4,325.628,1584,UnitedHealthcare,Medicare Advantage,776.16,49,,percent of total billed charges,,
Ct Chest Pulmonary Nodule Followup Wo Contr,,71250,CPT,Facility,Inpatient,,,,1584,1346.4,325.628,1584,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Ct Chest Pulmonary Nodule Followup Wo Contr,,71250,CPT,Facility,Outpatient,,,,1584,1346.4,325.628,1584,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,760.32,48,,percent of total billed charges,,100% of DHS outpatient percentage
Ct Chest Pulmonary Nodule Followup Wo Contr,,71250,CPT,Facility,Inpatient,,,,1584,1346.4,325.628,1584,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Ct Chest Wo Iv Contrast,,71250,CPT,Facility,Both,,,,1584,1346.4,325.628,1584,Aetna,Commercial,1457.28,92,,percent of total billed charges,,
Ct Chest Wo Iv Contrast,,71250,CPT,Facility,Outpatient,,,,1584,1346.4,325.628,1584,Aetna,Medicare Advantage,776.16,49,,percent of total billed charges,,
Ct Chest Wo Iv Contrast,,71250,CPT,Facility,Inpatient,,,,1584,1346.4,325.628,1584,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Ct Chest Wo Iv Contrast,,71250,CPT,Facility,Both,,,,1584,1346.4,325.628,1584,Aetna,PPO,1473.12,93,,percent of total billed charges,,
Ct Chest Wo Iv Contrast,,71250,CPT,Facility,Both,,,,1584,1346.4,325.628,1584,America's PPO,America's PPO,1521.1152,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Ct Chest Wo Iv Contrast,,71250,CPT,Facility,Both,,,,1584,1346.4,325.628,1584,BlueCross BlueShield Minnesota, Federal Employee Program,641,,,Fee schedule,,100% of BCBS commercial commodity fee schedule
Ct Chest Wo Iv Contrast,,71250,CPT,Facility,Both,,,,1584,1346.4,325.628,1584,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,651.256,,,Fee schedule,,"100% of BCBS commercial commodity fee schedule, plus MN Care tax"
Ct Chest Wo Iv Contrast,,71250,CPT,Facility,Both,,,,1584,1346.4,325.628,1584,BlueCross BlueShield Minnesota,High Value Network Plan,586.1304,,,Fee schedule,,"90% of BCBS commercial commodity fee schedule, plus MN Care tax; see disclaimer for more information"
Ct Chest Wo Iv Contrast,,71250,CPT,Facility,Outpatient,,,,1584,1346.4,325.628,1584,BlueCross BlueShield Minnesota,Medicare Advantage,776.16,49,,percent of total billed charges,,
Ct Chest Wo Iv Contrast,,71250,CPT,Facility,Inpatient,,,,1584,1346.4,325.628,1584,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Ct Chest Wo Iv Contrast,,71250,CPT,Facility,Both,,,,1584,1346.4,325.628,1584,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,576.8174392,,,Fee schedule,,"88.57% of BCBS commercial commodity fee schedule, plus MN Care tax"
Ct Chest Wo Iv Contrast,,71250,CPT,Facility,Both,,,,1584,1346.4,325.628,1584,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,325.628,,,Fee schedule,,"100% of BCBS Medicaid commodity fee schedule, plus MN Care tax"
Ct Chest Wo Iv Contrast,,71250,CPT,Facility,Outpatient,,,,1584,1346.4,325.628,1584,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),776.16,49,,percent of total billed charges,,
Ct Chest Wo Iv Contrast,,71250,CPT,Facility,Inpatient,,,,1584,1346.4,325.628,1584,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Ct Chest Wo Iv Contrast,,71250,CPT,Facility,Both,,,,1584,1346.4,325.628,1584,CorVel,Worker's Compensation,1584,100,,percent of total billed charges,,
Ct Chest Wo Iv Contrast,,71250,CPT,Facility,Both,,,,1584,1346.4,325.628,1584,First Health Group Corporation,First Health Network,1536.48,97,,percent of total billed charges,,
Ct Chest Wo Iv Contrast,,71250,CPT,Facility,Both,,,,1584,1346.4,325.628,1584,"Health Partners, Inc.",Commercial,1498.464,94.6,,percent of total billed charges,,
Ct Chest Wo Iv Contrast,,71250,CPT,Facility,Outpatient,,,,1584,1346.4,325.628,1584,"Health Partners, Inc.",Medicare Advantage,776.16,49,,percent of total billed charges,,
Ct Chest Wo Iv Contrast,,71250,CPT,Facility,Inpatient,,,,1584,1346.4,325.628,1584,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ct Chest Wo Iv Contrast,,71250,CPT,Facility,Both,,,,1584,1346.4,325.628,1584,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),950.4,60,,percent of total billed charges,,
Ct Chest Wo Iv Contrast,,71250,CPT,Facility,Both,,,,1584,1346.4,325.628,1584,"Health Partners, Inc.",State of Minnesota Advantage Program,1290.96,81.5,,percent of total billed charges,,
Ct Chest Wo Iv Contrast,,71250,CPT,Facility,Both,,,,1584,1346.4,325.628,1584,"Health Partners, Inc.",State Public Programs,792,50,,percent of total billed charges,,
Ct Chest Wo Iv Contrast,,71250,CPT,Facility,Both,,,,1584,1346.4,325.628,1584,Humana Insurance Company,Commercial PPO,1504.8,95,,percent of total billed charges,,
Ct Chest Wo Iv Contrast,,71250,CPT,Facility,Outpatient,,,,1584,1346.4,325.628,1584,Humana Insurance Company,Medicare PPO,776.16,49,,percent of total billed charges,,
Ct Chest Wo Iv Contrast,,71250,CPT,Facility,Inpatient,,,,1584,1346.4,325.628,1584,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Ct Chest Wo Iv Contrast,,71250,CPT,Facility,Both,,,,1584,1346.4,325.628,1584,Medica,Individual & Family,1569.744,99.1,,percent of total billed charges,,
Ct Chest Wo Iv Contrast,,71250,CPT,Facility,Outpatient,,,,1584,1346.4,325.628,1584,Medica,Medica Advantage Solution,788.832,49.8,,percent of total billed charges,,
Ct Chest Wo Iv Contrast,,71250,CPT,Facility,Inpatient,,,,1584,1346.4,325.628,1584,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Ct Chest Wo Iv Contrast,,71250,CPT,Facility,Outpatient,,,,1584,1346.4,325.628,1584,Medica,Medical Assistance,706.464,44.6,,percent of total billed charges,,
Ct Chest Wo Iv Contrast,,71250,CPT,Facility,Inpatient,,,,1584,1346.4,325.628,1584,Medica,Medical Assistance,,,,,Included in per diem rate,
Ct Chest Wo Iv Contrast,,71250,CPT,Facility,Outpatient,,,,1584,1346.4,325.628,1584,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,788.832,49.8,,percent of total billed charges,,
Ct Chest Wo Iv Contrast,,71250,CPT,Facility,Inpatient,,,,1584,1346.4,325.628,1584,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Ct Chest Wo Iv Contrast,,71250,CPT,Facility,Both,,,,1584,1346.4,325.628,1584,"Multiplan, Inc.","Multiplan, Inc.",1488.96,94,,percent of total billed charges,,
Ct Chest Wo Iv Contrast,,71250,CPT,Facility,Outpatient,,,,1584,1346.4,325.628,1584,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1283,,,Other,Per scan,
Ct Chest Wo Iv Contrast,,71250,CPT,Facility,Inpatient,,,,1584,1346.4,325.628,1584,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Ct Chest Wo Iv Contrast,,71250,CPT,Facility,Both,,,,1584,1346.4,325.628,1584,"Preferred One Administrative Services, INC.",PPO,1561.824,98.6,,percent of total billed charges,,
Ct Chest Wo Iv Contrast,,71250,CPT,Facility,Outpatient,,,,1584,1346.4,325.628,1584,PrimeWest Health,Minnesota Senior Health Options (MSHO),814.968,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Ct Chest Wo Iv Contrast,,71250,CPT,Facility,Inpatient,,,,1584,1346.4,325.628,1584,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ct Chest Wo Iv Contrast,,71250,CPT,Facility,Outpatient,,,,1584,1346.4,325.628,1584,PrimeWest Health,MinnesotaCare,813.5424,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Ct Chest Wo Iv Contrast,,71250,CPT,Facility,Inpatient,,,,1584,1346.4,325.628,1584,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Ct Chest Wo Iv Contrast,,71250,CPT,Facility,Both,,,,1584,1346.4,325.628,1584,Sanford Health Plan,Sanford Health Plan,1457.28,92,,percent of total billed charges,,
Ct Chest Wo Iv Contrast,,71250,CPT,Facility,Outpatient,,,,1584,1346.4,325.628,1584,"UCare Health, Inc.",Individual & Family Plan,892.584,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Ct Chest Wo Iv Contrast,,71250,CPT,Facility,Inpatient,,,,1584,1346.4,325.628,1584,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Ct Chest Wo Iv Contrast,,71250,CPT,Facility,Outpatient,,,,1584,1346.4,325.628,1584,"UCare Health, Inc.",Medical Assistance,799.4448,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ct Chest Wo Iv Contrast,,71250,CPT,Facility,Inpatient,,,,1584,1346.4,325.628,1584,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Ct Chest Wo Iv Contrast,,71250,CPT,Facility,Outpatient,,,,1584,1346.4,325.628,1584,"UCare Health, Inc.",Medicare Advantage,799.4448,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ct Chest Wo Iv Contrast,,71250,CPT,Facility,Inpatient,,,,1584,1346.4,325.628,1584,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ct Chest Wo Iv Contrast,,71250,CPT,Facility,Outpatient,,,,1584,1346.4,325.628,1584,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),799.4448,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ct Chest Wo Iv Contrast,,71250,CPT,Facility,Inpatient,,,,1584,1346.4,325.628,1584,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ct Chest Wo Iv Contrast,,71250,CPT,Facility,Both,,,,1584,1346.4,325.628,1584,UnitedHealthcare,Individual & Family,1488.96,94,,percent of total billed charges,,
Ct Chest Wo Iv Contrast,,71250,CPT,Facility,Outpatient,,,,1584,1346.4,325.628,1584,UnitedHealthcare,Medicare Advantage,776.16,49,,percent of total billed charges,,
Ct Chest Wo Iv Contrast,,71250,CPT,Facility,Inpatient,,,,1584,1346.4,325.628,1584,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Ct Chest Wo Iv Contrast,,71250,CPT,Facility,Outpatient,,,,1584,1346.4,325.628,1584,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,760.32,48,,percent of total billed charges,,100% of DHS outpatient percentage
Ct Chest Wo Iv Contrast,,71250,CPT,Facility,Inpatient,,,,1584,1346.4,325.628,1584,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Ct Chest W Iv Contrast,,71260,CPT,Facility,Both,,,,1742,1480.7,412.496,1742,Aetna,Commercial,1602.64,92,,percent of total billed charges,,
Ct Chest W Iv Contrast,,71260,CPT,Facility,Outpatient,,,,1742,1480.7,412.496,1742,Aetna,Medicare Advantage,853.58,49,,percent of total billed charges,,
Ct Chest W Iv Contrast,,71260,CPT,Facility,Inpatient,,,,1742,1480.7,412.496,1742,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Ct Chest W Iv Contrast,,71260,CPT,Facility,Both,,,,1742,1480.7,412.496,1742,Aetna,PPO,1620.06,93,,percent of total billed charges,,
Ct Chest W Iv Contrast,,71260,CPT,Facility,Both,,,,1742,1480.7,412.496,1742,America's PPO,America's PPO,1672.8426,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Ct Chest W Iv Contrast,,71260,CPT,Facility,Both,,,,1742,1480.7,412.496,1742,BlueCross BlueShield Minnesota, Federal Employee Program,812,,,Fee schedule,,100% of BCBS commercial commodity fee schedule
Ct Chest W Iv Contrast,,71260,CPT,Facility,Both,,,,1742,1480.7,412.496,1742,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,824.992,,,Fee schedule,,"100% of BCBS commercial commodity fee schedule, plus MN Care tax"
Ct Chest W Iv Contrast,,71260,CPT,Facility,Both,,,,1742,1480.7,412.496,1742,BlueCross BlueShield Minnesota,High Value Network Plan,742.4928,,,Fee schedule,,"90% of BCBS commercial commodity fee schedule, plus MN Care tax; see disclaimer for more information"
Ct Chest W Iv Contrast,,71260,CPT,Facility,Outpatient,,,,1742,1480.7,412.496,1742,BlueCross BlueShield Minnesota,Medicare Advantage,853.58,49,,percent of total billed charges,,
Ct Chest W Iv Contrast,,71260,CPT,Facility,Inpatient,,,,1742,1480.7,412.496,1742,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Ct Chest W Iv Contrast,,71260,CPT,Facility,Both,,,,1742,1480.7,412.496,1742,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,730.6954144,,,Fee schedule,,"88.57% of BCBS commercial commodity fee schedule, plus MN Care tax"
Ct Chest W Iv Contrast,,71260,CPT,Facility,Both,,,,1742,1480.7,412.496,1742,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,412.496,,,Fee schedule,,"100% of BCBS Medicaid commodity fee schedule, plus MN Care tax"
Ct Chest W Iv Contrast,,71260,CPT,Facility,Outpatient,,,,1742,1480.7,412.496,1742,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),853.58,49,,percent of total billed charges,,
Ct Chest W Iv Contrast,,71260,CPT,Facility,Inpatient,,,,1742,1480.7,412.496,1742,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Ct Chest W Iv Contrast,,71260,CPT,Facility,Both,,,,1742,1480.7,412.496,1742,CorVel,Worker's Compensation,1742,100,,percent of total billed charges,,
Ct Chest W Iv Contrast,,71260,CPT,Facility,Both,,,,1742,1480.7,412.496,1742,First Health Group Corporation,First Health Network,1689.74,97,,percent of total billed charges,,
Ct Chest W Iv Contrast,,71260,CPT,Facility,Both,,,,1742,1480.7,412.496,1742,"Health Partners, Inc.",Commercial,1647.932,94.6,,percent of total billed charges,,
Ct Chest W Iv Contrast,,71260,CPT,Facility,Outpatient,,,,1742,1480.7,412.496,1742,"Health Partners, Inc.",Medicare Advantage,853.58,49,,percent of total billed charges,,
Ct Chest W Iv Contrast,,71260,CPT,Facility,Inpatient,,,,1742,1480.7,412.496,1742,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ct Chest W Iv Contrast,,71260,CPT,Facility,Both,,,,1742,1480.7,412.496,1742,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1045.2,60,,percent of total billed charges,,
Ct Chest W Iv Contrast,,71260,CPT,Facility,Both,,,,1742,1480.7,412.496,1742,"Health Partners, Inc.",State of Minnesota Advantage Program,1419.73,81.5,,percent of total billed charges,,
Ct Chest W Iv Contrast,,71260,CPT,Facility,Both,,,,1742,1480.7,412.496,1742,"Health Partners, Inc.",State Public Programs,871,50,,percent of total billed charges,,
Ct Chest W Iv Contrast,,71260,CPT,Facility,Both,,,,1742,1480.7,412.496,1742,Humana Insurance Company,Commercial PPO,1654.9,95,,percent of total billed charges,,
Ct Chest W Iv Contrast,,71260,CPT,Facility,Outpatient,,,,1742,1480.7,412.496,1742,Humana Insurance Company,Medicare PPO,853.58,49,,percent of total billed charges,,
Ct Chest W Iv Contrast,,71260,CPT,Facility,Inpatient,,,,1742,1480.7,412.496,1742,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Ct Chest W Iv Contrast,,71260,CPT,Facility,Both,,,,1742,1480.7,412.496,1742,Medica,Individual & Family,1726.322,99.1,,percent of total billed charges,,
Ct Chest W Iv Contrast,,71260,CPT,Facility,Outpatient,,,,1742,1480.7,412.496,1742,Medica,Medica Advantage Solution,867.516,49.8,,percent of total billed charges,,
Ct Chest W Iv Contrast,,71260,CPT,Facility,Inpatient,,,,1742,1480.7,412.496,1742,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Ct Chest W Iv Contrast,,71260,CPT,Facility,Outpatient,,,,1742,1480.7,412.496,1742,Medica,Medical Assistance,776.932,44.6,,percent of total billed charges,,
Ct Chest W Iv Contrast,,71260,CPT,Facility,Inpatient,,,,1742,1480.7,412.496,1742,Medica,Medical Assistance,,,,,Included in per diem rate,
Ct Chest W Iv Contrast,,71260,CPT,Facility,Outpatient,,,,1742,1480.7,412.496,1742,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,867.516,49.8,,percent of total billed charges,,
Ct Chest W Iv Contrast,,71260,CPT,Facility,Inpatient,,,,1742,1480.7,412.496,1742,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Ct Chest W Iv Contrast,,71260,CPT,Facility,Both,,,,1742,1480.7,412.496,1742,"Multiplan, Inc.","Multiplan, Inc.",1637.48,94,,percent of total billed charges,,
Ct Chest W Iv Contrast,,71260,CPT,Facility,Outpatient,,,,1742,1480.7,412.496,1742,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1283,,,Other,Per scan,
Ct Chest W Iv Contrast,,71260,CPT,Facility,Inpatient,,,,1742,1480.7,412.496,1742,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Ct Chest W Iv Contrast,,71260,CPT,Facility,Both,,,,1742,1480.7,412.496,1742,"Preferred One Administrative Services, INC.",PPO,1717.612,98.6,,percent of total billed charges,,
Ct Chest W Iv Contrast,,71260,CPT,Facility,Outpatient,,,,1742,1480.7,412.496,1742,PrimeWest Health,Minnesota Senior Health Options (MSHO),896.259,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Ct Chest W Iv Contrast,,71260,CPT,Facility,Inpatient,,,,1742,1480.7,412.496,1742,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ct Chest W Iv Contrast,,71260,CPT,Facility,Outpatient,,,,1742,1480.7,412.496,1742,PrimeWest Health,MinnesotaCare,894.6912,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Ct Chest W Iv Contrast,,71260,CPT,Facility,Inpatient,,,,1742,1480.7,412.496,1742,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Ct Chest W Iv Contrast,,71260,CPT,Facility,Both,,,,1742,1480.7,412.496,1742,Sanford Health Plan,Sanford Health Plan,1602.64,92,,percent of total billed charges,,
Ct Chest W Iv Contrast,,71260,CPT,Facility,Outpatient,,,,1742,1480.7,412.496,1742,"UCare Health, Inc.",Individual & Family Plan,981.617,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Ct Chest W Iv Contrast,,71260,CPT,Facility,Inpatient,,,,1742,1480.7,412.496,1742,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Ct Chest W Iv Contrast,,71260,CPT,Facility,Outpatient,,,,1742,1480.7,412.496,1742,"UCare Health, Inc.",Medical Assistance,879.1874,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ct Chest W Iv Contrast,,71260,CPT,Facility,Inpatient,,,,1742,1480.7,412.496,1742,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Ct Chest W Iv Contrast,,71260,CPT,Facility,Outpatient,,,,1742,1480.7,412.496,1742,"UCare Health, Inc.",Medicare Advantage,879.1874,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ct Chest W Iv Contrast,,71260,CPT,Facility,Inpatient,,,,1742,1480.7,412.496,1742,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ct Chest W Iv Contrast,,71260,CPT,Facility,Outpatient,,,,1742,1480.7,412.496,1742,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),879.1874,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ct Chest W Iv Contrast,,71260,CPT,Facility,Inpatient,,,,1742,1480.7,412.496,1742,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ct Chest W Iv Contrast,,71260,CPT,Facility,Both,,,,1742,1480.7,412.496,1742,UnitedHealthcare,Individual & Family,1637.48,94,,percent of total billed charges,,
Ct Chest W Iv Contrast,,71260,CPT,Facility,Outpatient,,,,1742,1480.7,412.496,1742,UnitedHealthcare,Medicare Advantage,853.58,49,,percent of total billed charges,,
Ct Chest W Iv Contrast,,71260,CPT,Facility,Inpatient,,,,1742,1480.7,412.496,1742,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Ct Chest W Iv Contrast,,71260,CPT,Facility,Outpatient,,,,1742,1480.7,412.496,1742,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,836.16,48,,percent of total billed charges,,100% of DHS outpatient percentage
Ct Chest W Iv Contrast,,71260,CPT,Facility,Inpatient,,,,1742,1480.7,412.496,1742,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Ct Chest Wo W Iv Contrast,,71270,CPT,Facility,Both,,,,2129,1809.65,412.496,2129,Aetna,Commercial,1958.68,92,,percent of total billed charges,,
Ct Chest Wo W Iv Contrast,,71270,CPT,Facility,Outpatient,,,,2129,1809.65,412.496,2129,Aetna,Medicare Advantage,1043.21,49,,percent of total billed charges,,
Ct Chest Wo W Iv Contrast,,71270,CPT,Facility,Inpatient,,,,2129,1809.65,412.496,2129,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Ct Chest Wo W Iv Contrast,,71270,CPT,Facility,Both,,,,2129,1809.65,412.496,2129,Aetna,PPO,1979.97,93,,percent of total billed charges,,
Ct Chest Wo W Iv Contrast,,71270,CPT,Facility,Both,,,,2129,1809.65,412.496,2129,America's PPO,America's PPO,2044.4787,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Ct Chest Wo W Iv Contrast,,71270,CPT,Facility,Both,,,,2129,1809.65,412.496,2129,BlueCross BlueShield Minnesota, Federal Employee Program,812,,,Fee schedule,,100% of BCBS commercial commodity fee schedule
Ct Chest Wo W Iv Contrast,,71270,CPT,Facility,Both,,,,2129,1809.65,412.496,2129,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,824.992,,,Fee schedule,,"100% of BCBS commercial commodity fee schedule, plus MN Care tax"
Ct Chest Wo W Iv Contrast,,71270,CPT,Facility,Both,,,,2129,1809.65,412.496,2129,BlueCross BlueShield Minnesota,High Value Network Plan,742.4928,,,Fee schedule,,"90% of BCBS commercial commodity fee schedule, plus MN Care tax; see disclaimer for more information"
Ct Chest Wo W Iv Contrast,,71270,CPT,Facility,Outpatient,,,,2129,1809.65,412.496,2129,BlueCross BlueShield Minnesota,Medicare Advantage,1043.21,49,,percent of total billed charges,,
Ct Chest Wo W Iv Contrast,,71270,CPT,Facility,Inpatient,,,,2129,1809.65,412.496,2129,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Ct Chest Wo W Iv Contrast,,71270,CPT,Facility,Both,,,,2129,1809.65,412.496,2129,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,730.6954144,,,Fee schedule,,"88.57% of BCBS commercial commodity fee schedule, plus MN Care tax"
Ct Chest Wo W Iv Contrast,,71270,CPT,Facility,Both,,,,2129,1809.65,412.496,2129,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,412.496,,,Fee schedule,,"100% of BCBS Medicaid commodity fee schedule, plus MN Care tax"
Ct Chest Wo W Iv Contrast,,71270,CPT,Facility,Outpatient,,,,2129,1809.65,412.496,2129,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1043.21,49,,percent of total billed charges,,
Ct Chest Wo W Iv Contrast,,71270,CPT,Facility,Inpatient,,,,2129,1809.65,412.496,2129,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Ct Chest Wo W Iv Contrast,,71270,CPT,Facility,Both,,,,2129,1809.65,412.496,2129,CorVel,Worker's Compensation,2129,100,,percent of total billed charges,,
Ct Chest Wo W Iv Contrast,,71270,CPT,Facility,Both,,,,2129,1809.65,412.496,2129,First Health Group Corporation,First Health Network,2065.13,97,,percent of total billed charges,,
Ct Chest Wo W Iv Contrast,,71270,CPT,Facility,Both,,,,2129,1809.65,412.496,2129,"Health Partners, Inc.",Commercial,2014.034,94.6,,percent of total billed charges,,
Ct Chest Wo W Iv Contrast,,71270,CPT,Facility,Outpatient,,,,2129,1809.65,412.496,2129,"Health Partners, Inc.",Medicare Advantage,1043.21,49,,percent of total billed charges,,
Ct Chest Wo W Iv Contrast,,71270,CPT,Facility,Inpatient,,,,2129,1809.65,412.496,2129,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ct Chest Wo W Iv Contrast,,71270,CPT,Facility,Both,,,,2129,1809.65,412.496,2129,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1277.4,60,,percent of total billed charges,,
Ct Chest Wo W Iv Contrast,,71270,CPT,Facility,Both,,,,2129,1809.65,412.496,2129,"Health Partners, Inc.",State of Minnesota Advantage Program,1735.135,81.5,,percent of total billed charges,,
Ct Chest Wo W Iv Contrast,,71270,CPT,Facility,Both,,,,2129,1809.65,412.496,2129,"Health Partners, Inc.",State Public Programs,1064.5,50,,percent of total billed charges,,
Ct Chest Wo W Iv Contrast,,71270,CPT,Facility,Both,,,,2129,1809.65,412.496,2129,Humana Insurance Company,Commercial PPO,2022.55,95,,percent of total billed charges,,
Ct Chest Wo W Iv Contrast,,71270,CPT,Facility,Outpatient,,,,2129,1809.65,412.496,2129,Humana Insurance Company,Medicare PPO,1043.21,49,,percent of total billed charges,,
Ct Chest Wo W Iv Contrast,,71270,CPT,Facility,Inpatient,,,,2129,1809.65,412.496,2129,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Ct Chest Wo W Iv Contrast,,71270,CPT,Facility,Both,,,,2129,1809.65,412.496,2129,Medica,Individual & Family,2109.839,99.1,,percent of total billed charges,,
Ct Chest Wo W Iv Contrast,,71270,CPT,Facility,Outpatient,,,,2129,1809.65,412.496,2129,Medica,Medica Advantage Solution,1060.242,49.8,,percent of total billed charges,,
Ct Chest Wo W Iv Contrast,,71270,CPT,Facility,Inpatient,,,,2129,1809.65,412.496,2129,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Ct Chest Wo W Iv Contrast,,71270,CPT,Facility,Outpatient,,,,2129,1809.65,412.496,2129,Medica,Medical Assistance,949.534,44.6,,percent of total billed charges,,
Ct Chest Wo W Iv Contrast,,71270,CPT,Facility,Inpatient,,,,2129,1809.65,412.496,2129,Medica,Medical Assistance,,,,,Included in per diem rate,
Ct Chest Wo W Iv Contrast,,71270,CPT,Facility,Outpatient,,,,2129,1809.65,412.496,2129,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1060.242,49.8,,percent of total billed charges,,
Ct Chest Wo W Iv Contrast,,71270,CPT,Facility,Inpatient,,,,2129,1809.65,412.496,2129,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Ct Chest Wo W Iv Contrast,,71270,CPT,Facility,Both,,,,2129,1809.65,412.496,2129,"Multiplan, Inc.","Multiplan, Inc.",2001.26,94,,percent of total billed charges,,
Ct Chest Wo W Iv Contrast,,71270,CPT,Facility,Outpatient,,,,2129,1809.65,412.496,2129,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1283,,,Other,Per scan,
Ct Chest Wo W Iv Contrast,,71270,CPT,Facility,Inpatient,,,,2129,1809.65,412.496,2129,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Ct Chest Wo W Iv Contrast,,71270,CPT,Facility,Both,,,,2129,1809.65,412.496,2129,"Preferred One Administrative Services, INC.",PPO,2099.194,98.6,,percent of total billed charges,,
Ct Chest Wo W Iv Contrast,,71270,CPT,Facility,Outpatient,,,,2129,1809.65,412.496,2129,PrimeWest Health,Minnesota Senior Health Options (MSHO),1095.3705,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Ct Chest Wo W Iv Contrast,,71270,CPT,Facility,Inpatient,,,,2129,1809.65,412.496,2129,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ct Chest Wo W Iv Contrast,,71270,CPT,Facility,Outpatient,,,,2129,1809.65,412.496,2129,PrimeWest Health,MinnesotaCare,1093.4544,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Ct Chest Wo W Iv Contrast,,71270,CPT,Facility,Inpatient,,,,2129,1809.65,412.496,2129,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Ct Chest Wo W Iv Contrast,,71270,CPT,Facility,Both,,,,2129,1809.65,412.496,2129,Sanford Health Plan,Sanford Health Plan,1958.68,92,,percent of total billed charges,,
Ct Chest Wo W Iv Contrast,,71270,CPT,Facility,Outpatient,,,,2129,1809.65,412.496,2129,"UCare Health, Inc.",Individual & Family Plan,1199.6915,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Ct Chest Wo W Iv Contrast,,71270,CPT,Facility,Inpatient,,,,2129,1809.65,412.496,2129,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Ct Chest Wo W Iv Contrast,,71270,CPT,Facility,Outpatient,,,,2129,1809.65,412.496,2129,"UCare Health, Inc.",Medical Assistance,1074.5063,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ct Chest Wo W Iv Contrast,,71270,CPT,Facility,Inpatient,,,,2129,1809.65,412.496,2129,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Ct Chest Wo W Iv Contrast,,71270,CPT,Facility,Outpatient,,,,2129,1809.65,412.496,2129,"UCare Health, Inc.",Medicare Advantage,1074.5063,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ct Chest Wo W Iv Contrast,,71270,CPT,Facility,Inpatient,,,,2129,1809.65,412.496,2129,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ct Chest Wo W Iv Contrast,,71270,CPT,Facility,Outpatient,,,,2129,1809.65,412.496,2129,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1074.5063,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ct Chest Wo W Iv Contrast,,71270,CPT,Facility,Inpatient,,,,2129,1809.65,412.496,2129,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ct Chest Wo W Iv Contrast,,71270,CPT,Facility,Both,,,,2129,1809.65,412.496,2129,UnitedHealthcare,Individual & Family,2001.26,94,,percent of total billed charges,,
Ct Chest Wo W Iv Contrast,,71270,CPT,Facility,Outpatient,,,,2129,1809.65,412.496,2129,UnitedHealthcare,Medicare Advantage,1043.21,49,,percent of total billed charges,,
Ct Chest Wo W Iv Contrast,,71270,CPT,Facility,Inpatient,,,,2129,1809.65,412.496,2129,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Ct Chest Wo W Iv Contrast,,71270,CPT,Facility,Outpatient,,,,2129,1809.65,412.496,2129,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1021.92,48,,percent of total billed charges,,100% of DHS outpatient percentage
Ct Chest Wo W Iv Contrast,,71270,CPT,Facility,Inpatient,,,,2129,1809.65,412.496,2129,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Ct Lung Cancer Screening,,71271,CPT,Facility,Both,,,,1584,1346.4,453.9744,1584,Aetna,Commercial,1457.28,92,,percent of total billed charges,,
Ct Lung Cancer Screening,,71271,CPT,Facility,Outpatient,,,,1584,1346.4,453.9744,1584,Aetna,Medicare Advantage,776.16,49,,percent of total billed charges,,
Ct Lung Cancer Screening,,71271,CPT,Facility,Inpatient,,,,1584,1346.4,453.9744,1584,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Ct Lung Cancer Screening,,71271,CPT,Facility,Both,,,,1584,1346.4,453.9744,1584,Aetna,PPO,1473.12,93,,percent of total billed charges,,
Ct Lung Cancer Screening,,71271,CPT,Facility,Both,,,,1584,1346.4,453.9744,1584,America's PPO,America's PPO,1521.1152,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Ct Lung Cancer Screening,,71271,CPT,Facility,Both,,,,1584,1346.4,453.9744,1584,BlueCross BlueShield Minnesota, Federal Employee Program,1558.656,98.4,,percent of total billed charges,,
Ct Lung Cancer Screening,,71271,CPT,Facility,Both,,,,1584,1346.4,453.9744,1584,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1584,100,,percent of total billed charges,,
Ct Lung Cancer Screening,,71271,CPT,Facility,Both,,,,1584,1346.4,453.9744,1584,BlueCross BlueShield Minnesota,High Value Network Plan,1425.6,90,,percent of total billed charges,,
Ct Lung Cancer Screening,,71271,CPT,Facility,Outpatient,,,,1584,1346.4,453.9744,1584,BlueCross BlueShield Minnesota,Medicare Advantage,776.16,49,,percent of total billed charges,,
Ct Lung Cancer Screening,,71271,CPT,Facility,Inpatient,,,,1584,1346.4,453.9744,1584,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Ct Lung Cancer Screening,,71271,CPT,Facility,Both,,,,1584,1346.4,453.9744,1584,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1402.9488,88.57,,percent of total billed charges,,
Ct Lung Cancer Screening,,71271,CPT,Facility,Both,,,,1584,1346.4,453.9744,1584,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,453.9744,28.66,,percent of total billed charges,,
Ct Lung Cancer Screening,,71271,CPT,Facility,Outpatient,,,,1584,1346.4,453.9744,1584,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),776.16,49,,percent of total billed charges,,
Ct Lung Cancer Screening,,71271,CPT,Facility,Inpatient,,,,1584,1346.4,453.9744,1584,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Ct Lung Cancer Screening,,71271,CPT,Facility,Both,,,,1584,1346.4,453.9744,1584,CorVel,Worker's Compensation,1584,100,,percent of total billed charges,,
Ct Lung Cancer Screening,,71271,CPT,Facility,Both,,,,1584,1346.4,453.9744,1584,First Health Group Corporation,First Health Network,1536.48,97,,percent of total billed charges,,
Ct Lung Cancer Screening,,71271,CPT,Facility,Both,,,,1584,1346.4,453.9744,1584,"Health Partners, Inc.",Commercial,1498.464,94.6,,percent of total billed charges,,
Ct Lung Cancer Screening,,71271,CPT,Facility,Outpatient,,,,1584,1346.4,453.9744,1584,"Health Partners, Inc.",Medicare Advantage,776.16,49,,percent of total billed charges,,
Ct Lung Cancer Screening,,71271,CPT,Facility,Inpatient,,,,1584,1346.4,453.9744,1584,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ct Lung Cancer Screening,,71271,CPT,Facility,Both,,,,1584,1346.4,453.9744,1584,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),950.4,60,,percent of total billed charges,,
Ct Lung Cancer Screening,,71271,CPT,Facility,Both,,,,1584,1346.4,453.9744,1584,"Health Partners, Inc.",State of Minnesota Advantage Program,1290.96,81.5,,percent of total billed charges,,
Ct Lung Cancer Screening,,71271,CPT,Facility,Both,,,,1584,1346.4,453.9744,1584,"Health Partners, Inc.",State Public Programs,792,50,,percent of total billed charges,,
Ct Lung Cancer Screening,,71271,CPT,Facility,Both,,,,1584,1346.4,453.9744,1584,Humana Insurance Company,Commercial PPO,1504.8,95,,percent of total billed charges,,
Ct Lung Cancer Screening,,71271,CPT,Facility,Outpatient,,,,1584,1346.4,453.9744,1584,Humana Insurance Company,Medicare PPO,776.16,49,,percent of total billed charges,,
Ct Lung Cancer Screening,,71271,CPT,Facility,Inpatient,,,,1584,1346.4,453.9744,1584,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Ct Lung Cancer Screening,,71271,CPT,Facility,Both,,,,1584,1346.4,453.9744,1584,Medica,Individual & Family,1569.744,99.1,,percent of total billed charges,,
Ct Lung Cancer Screening,,71271,CPT,Facility,Outpatient,,,,1584,1346.4,453.9744,1584,Medica,Medica Advantage Solution,788.832,49.8,,percent of total billed charges,,
Ct Lung Cancer Screening,,71271,CPT,Facility,Inpatient,,,,1584,1346.4,453.9744,1584,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Ct Lung Cancer Screening,,71271,CPT,Facility,Outpatient,,,,1584,1346.4,453.9744,1584,Medica,Medical Assistance,706.464,44.6,,percent of total billed charges,,
Ct Lung Cancer Screening,,71271,CPT,Facility,Inpatient,,,,1584,1346.4,453.9744,1584,Medica,Medical Assistance,,,,,Included in per diem rate,
Ct Lung Cancer Screening,,71271,CPT,Facility,Outpatient,,,,1584,1346.4,453.9744,1584,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,788.832,49.8,,percent of total billed charges,,
Ct Lung Cancer Screening,,71271,CPT,Facility,Inpatient,,,,1584,1346.4,453.9744,1584,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Ct Lung Cancer Screening,,71271,CPT,Facility,Both,,,,1584,1346.4,453.9744,1584,"Multiplan, Inc.","Multiplan, Inc.",1488.96,94,,percent of total billed charges,,
Ct Lung Cancer Screening,,71271,CPT,Facility,Outpatient,,,,1584,1346.4,453.9744,1584,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1283,,,Other,Per scan,
Ct Lung Cancer Screening,,71271,CPT,Facility,Inpatient,,,,1584,1346.4,453.9744,1584,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Ct Lung Cancer Screening,,71271,CPT,Facility,Both,,,,1584,1346.4,453.9744,1584,"Preferred One Administrative Services, INC.",PPO,1561.824,98.6,,percent of total billed charges,,
Ct Lung Cancer Screening,,71271,CPT,Facility,Outpatient,,,,1584,1346.4,453.9744,1584,PrimeWest Health,Minnesota Senior Health Options (MSHO),814.968,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Ct Lung Cancer Screening,,71271,CPT,Facility,Inpatient,,,,1584,1346.4,453.9744,1584,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ct Lung Cancer Screening,,71271,CPT,Facility,Outpatient,,,,1584,1346.4,453.9744,1584,PrimeWest Health,MinnesotaCare,813.5424,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Ct Lung Cancer Screening,,71271,CPT,Facility,Inpatient,,,,1584,1346.4,453.9744,1584,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Ct Lung Cancer Screening,,71271,CPT,Facility,Both,,,,1584,1346.4,453.9744,1584,Sanford Health Plan,Sanford Health Plan,1457.28,92,,percent of total billed charges,,
Ct Lung Cancer Screening,,71271,CPT,Facility,Outpatient,,,,1584,1346.4,453.9744,1584,"UCare Health, Inc.",Individual & Family Plan,892.584,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Ct Lung Cancer Screening,,71271,CPT,Facility,Inpatient,,,,1584,1346.4,453.9744,1584,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Ct Lung Cancer Screening,,71271,CPT,Facility,Outpatient,,,,1584,1346.4,453.9744,1584,"UCare Health, Inc.",Medical Assistance,799.4448,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ct Lung Cancer Screening,,71271,CPT,Facility,Inpatient,,,,1584,1346.4,453.9744,1584,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Ct Lung Cancer Screening,,71271,CPT,Facility,Outpatient,,,,1584,1346.4,453.9744,1584,"UCare Health, Inc.",Medicare Advantage,799.4448,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ct Lung Cancer Screening,,71271,CPT,Facility,Inpatient,,,,1584,1346.4,453.9744,1584,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ct Lung Cancer Screening,,71271,CPT,Facility,Outpatient,,,,1584,1346.4,453.9744,1584,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),799.4448,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ct Lung Cancer Screening,,71271,CPT,Facility,Inpatient,,,,1584,1346.4,453.9744,1584,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ct Lung Cancer Screening,,71271,CPT,Facility,Both,,,,1584,1346.4,453.9744,1584,UnitedHealthcare,Individual & Family,1488.96,94,,percent of total billed charges,,
Ct Lung Cancer Screening,,71271,CPT,Facility,Outpatient,,,,1584,1346.4,453.9744,1584,UnitedHealthcare,Medicare Advantage,776.16,49,,percent of total billed charges,,
Ct Lung Cancer Screening,,71271,CPT,Facility,Inpatient,,,,1584,1346.4,453.9744,1584,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Ct Lung Cancer Screening,,71271,CPT,Facility,Outpatient,,,,1584,1346.4,453.9744,1584,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,760.32,48,,percent of total billed charges,,100% of DHS outpatient percentage
Ct Lung Cancer Screening,,71271,CPT,Facility,Inpatient,,,,1584,1346.4,453.9744,1584,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Cta Chest,,71275,CPT,Facility,Both,,,,2346,1994.1,412.496,2346,Aetna,Commercial,2158.32,92,,percent of total billed charges,,
Cta Chest,,71275,CPT,Facility,Outpatient,,,,2346,1994.1,412.496,2346,Aetna,Medicare Advantage,1149.54,49,,percent of total billed charges,,
Cta Chest,,71275,CPT,Facility,Inpatient,,,,2346,1994.1,412.496,2346,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Cta Chest,,71275,CPT,Facility,Both,,,,2346,1994.1,412.496,2346,Aetna,PPO,2181.78,93,,percent of total billed charges,,
Cta Chest,,71275,CPT,Facility,Both,,,,2346,1994.1,412.496,2346,America's PPO,America's PPO,2252.8638,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Cta Chest,,71275,CPT,Facility,Both,,,,2346,1994.1,412.496,2346,BlueCross BlueShield Minnesota, Federal Employee Program,812,,,Fee schedule,,100% of BCBS commercial commodity fee schedule
Cta Chest,,71275,CPT,Facility,Both,,,,2346,1994.1,412.496,2346,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,824.992,,,Fee schedule,,"100% of BCBS commercial commodity fee schedule, plus MN Care tax"
Cta Chest,,71275,CPT,Facility,Both,,,,2346,1994.1,412.496,2346,BlueCross BlueShield Minnesota,High Value Network Plan,742.4928,,,Fee schedule,,"90% of BCBS commercial commodity fee schedule, plus MN Care tax; see disclaimer for more information"
Cta Chest,,71275,CPT,Facility,Outpatient,,,,2346,1994.1,412.496,2346,BlueCross BlueShield Minnesota,Medicare Advantage,1149.54,49,,percent of total billed charges,,
Cta Chest,,71275,CPT,Facility,Inpatient,,,,2346,1994.1,412.496,2346,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Cta Chest,,71275,CPT,Facility,Both,,,,2346,1994.1,412.496,2346,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,730.6954144,,,Fee schedule,,"88.57% of BCBS commercial commodity fee schedule, plus MN Care tax"
Cta Chest,,71275,CPT,Facility,Both,,,,2346,1994.1,412.496,2346,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,412.496,,,Fee schedule,,"100% of BCBS Medicaid commodity fee schedule, plus MN Care tax"
Cta Chest,,71275,CPT,Facility,Outpatient,,,,2346,1994.1,412.496,2346,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1149.54,49,,percent of total billed charges,,
Cta Chest,,71275,CPT,Facility,Inpatient,,,,2346,1994.1,412.496,2346,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Cta Chest,,71275,CPT,Facility,Both,,,,2346,1994.1,412.496,2346,CorVel,Worker's Compensation,2346,100,,percent of total billed charges,,
Cta Chest,,71275,CPT,Facility,Both,,,,2346,1994.1,412.496,2346,First Health Group Corporation,First Health Network,2275.62,97,,percent of total billed charges,,
Cta Chest,,71275,CPT,Facility,Both,,,,2346,1994.1,412.496,2346,"Health Partners, Inc.",Commercial,2219.316,94.6,,percent of total billed charges,,
Cta Chest,,71275,CPT,Facility,Outpatient,,,,2346,1994.1,412.496,2346,"Health Partners, Inc.",Medicare Advantage,1149.54,49,,percent of total billed charges,,
Cta Chest,,71275,CPT,Facility,Inpatient,,,,2346,1994.1,412.496,2346,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Cta Chest,,71275,CPT,Facility,Both,,,,2346,1994.1,412.496,2346,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1407.6,60,,percent of total billed charges,,
Cta Chest,,71275,CPT,Facility,Both,,,,2346,1994.1,412.496,2346,"Health Partners, Inc.",State of Minnesota Advantage Program,1911.99,81.5,,percent of total billed charges,,
Cta Chest,,71275,CPT,Facility,Both,,,,2346,1994.1,412.496,2346,"Health Partners, Inc.",State Public Programs,1173,50,,percent of total billed charges,,
Cta Chest,,71275,CPT,Facility,Both,,,,2346,1994.1,412.496,2346,Humana Insurance Company,Commercial PPO,2228.7,95,,percent of total billed charges,,
Cta Chest,,71275,CPT,Facility,Outpatient,,,,2346,1994.1,412.496,2346,Humana Insurance Company,Medicare PPO,1149.54,49,,percent of total billed charges,,
Cta Chest,,71275,CPT,Facility,Inpatient,,,,2346,1994.1,412.496,2346,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Cta Chest,,71275,CPT,Facility,Both,,,,2346,1994.1,412.496,2346,Medica,Individual & Family,2324.886,99.1,,percent of total billed charges,,
Cta Chest,,71275,CPT,Facility,Outpatient,,,,2346,1994.1,412.496,2346,Medica,Medica Advantage Solution,1168.308,49.8,,percent of total billed charges,,
Cta Chest,,71275,CPT,Facility,Inpatient,,,,2346,1994.1,412.496,2346,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Cta Chest,,71275,CPT,Facility,Outpatient,,,,2346,1994.1,412.496,2346,Medica,Medical Assistance,499,,,Other,Per visit,Pays in addition to all Outpatient Service Categories
Cta Chest,,71275,CPT,Facility,Inpatient,,,,2346,1994.1,412.496,2346,Medica,Medical Assistance,,,,,Included in per diem rate,
Cta Chest,,71275,CPT,Facility,Outpatient,,,,2346,1994.1,412.496,2346,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1168.308,49.8,,percent of total billed charges,,
Cta Chest,,71275,CPT,Facility,Inpatient,,,,2346,1994.1,412.496,2346,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Cta Chest,,71275,CPT,Facility,Both,,,,2346,1994.1,412.496,2346,"Multiplan, Inc.","Multiplan, Inc.",2205.24,94,,percent of total billed charges,,
Cta Chest,,71275,CPT,Facility,Outpatient,,,,2346,1994.1,412.496,2346,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1283,,,Other,Per scan,
Cta Chest,,71275,CPT,Facility,Inpatient,,,,2346,1994.1,412.496,2346,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Cta Chest,,71275,CPT,Facility,Both,,,,2346,1994.1,412.496,2346,"Preferred One Administrative Services, INC.",PPO,2313.156,98.6,,percent of total billed charges,,
Cta Chest,,71275,CPT,Facility,Outpatient,,,,2346,1994.1,412.496,2346,PrimeWest Health,Minnesota Senior Health Options (MSHO),1207.017,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Cta Chest,,71275,CPT,Facility,Inpatient,,,,2346,1994.1,412.496,2346,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Cta Chest,,71275,CPT,Facility,Outpatient,,,,2346,1994.1,412.496,2346,PrimeWest Health,MinnesotaCare,1204.9056,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Cta Chest,,71275,CPT,Facility,Inpatient,,,,2346,1994.1,412.496,2346,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Cta Chest,,71275,CPT,Facility,Both,,,,2346,1994.1,412.496,2346,Sanford Health Plan,Sanford Health Plan,2158.32,92,,percent of total billed charges,,
Cta Chest,,71275,CPT,Facility,Outpatient,,,,2346,1994.1,412.496,2346,"UCare Health, Inc.",Individual & Family Plan,1321.971,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Cta Chest,,71275,CPT,Facility,Inpatient,,,,2346,1994.1,412.496,2346,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Cta Chest,,71275,CPT,Facility,Outpatient,,,,2346,1994.1,412.496,2346,"UCare Health, Inc.",Medical Assistance,1184.0262,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Cta Chest,,71275,CPT,Facility,Inpatient,,,,2346,1994.1,412.496,2346,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Cta Chest,,71275,CPT,Facility,Outpatient,,,,2346,1994.1,412.496,2346,"UCare Health, Inc.",Medicare Advantage,1184.0262,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Cta Chest,,71275,CPT,Facility,Inpatient,,,,2346,1994.1,412.496,2346,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Cta Chest,,71275,CPT,Facility,Outpatient,,,,2346,1994.1,412.496,2346,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1184.0262,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Cta Chest,,71275,CPT,Facility,Inpatient,,,,2346,1994.1,412.496,2346,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Cta Chest,,71275,CPT,Facility,Both,,,,2346,1994.1,412.496,2346,UnitedHealthcare,Individual & Family,2205.24,94,,percent of total billed charges,,
Cta Chest,,71275,CPT,Facility,Outpatient,,,,2346,1994.1,412.496,2346,UnitedHealthcare,Medicare Advantage,1149.54,49,,percent of total billed charges,,
Cta Chest,,71275,CPT,Facility,Inpatient,,,,2346,1994.1,412.496,2346,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Cta Chest,,71275,CPT,Facility,Outpatient,,,,2346,1994.1,412.496,2346,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1126.08,48,,percent of total billed charges,,100% of DHS outpatient percentage
Cta Chest,,71275,CPT,Facility,Inpatient,,,,2346,1994.1,412.496,2346,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Cta Pulmonary Embolism Study,,71275,CPT,Facility,Both,,,,2346,1994.1,412.496,2346,Aetna,Commercial,2158.32,92,,percent of total billed charges,,
Cta Pulmonary Embolism Study,,71275,CPT,Facility,Outpatient,,,,2346,1994.1,412.496,2346,Aetna,Medicare Advantage,1149.54,49,,percent of total billed charges,,
Cta Pulmonary Embolism Study,,71275,CPT,Facility,Inpatient,,,,2346,1994.1,412.496,2346,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Cta Pulmonary Embolism Study,,71275,CPT,Facility,Both,,,,2346,1994.1,412.496,2346,Aetna,PPO,2181.78,93,,percent of total billed charges,,
Cta Pulmonary Embolism Study,,71275,CPT,Facility,Both,,,,2346,1994.1,412.496,2346,America's PPO,America's PPO,2252.8638,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Cta Pulmonary Embolism Study,,71275,CPT,Facility,Both,,,,2346,1994.1,412.496,2346,BlueCross BlueShield Minnesota, Federal Employee Program,812,,,Fee schedule,,100% of BCBS commercial commodity fee schedule
Cta Pulmonary Embolism Study,,71275,CPT,Facility,Both,,,,2346,1994.1,412.496,2346,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,824.992,,,Fee schedule,,"100% of BCBS commercial commodity fee schedule, plus MN Care tax"
Cta Pulmonary Embolism Study,,71275,CPT,Facility,Both,,,,2346,1994.1,412.496,2346,BlueCross BlueShield Minnesota,High Value Network Plan,742.4928,,,Fee schedule,,"90% of BCBS commercial commodity fee schedule, plus MN Care tax; see disclaimer for more information"
Cta Pulmonary Embolism Study,,71275,CPT,Facility,Outpatient,,,,2346,1994.1,412.496,2346,BlueCross BlueShield Minnesota,Medicare Advantage,1149.54,49,,percent of total billed charges,,
Cta Pulmonary Embolism Study,,71275,CPT,Facility,Inpatient,,,,2346,1994.1,412.496,2346,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Cta Pulmonary Embolism Study,,71275,CPT,Facility,Both,,,,2346,1994.1,412.496,2346,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,730.6954144,,,Fee schedule,,"88.57% of BCBS commercial commodity fee schedule, plus MN Care tax"
Cta Pulmonary Embolism Study,,71275,CPT,Facility,Both,,,,2346,1994.1,412.496,2346,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,412.496,,,Fee schedule,,"100% of BCBS Medicaid commodity fee schedule, plus MN Care tax"
Cta Pulmonary Embolism Study,,71275,CPT,Facility,Outpatient,,,,2346,1994.1,412.496,2346,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1149.54,49,,percent of total billed charges,,
Cta Pulmonary Embolism Study,,71275,CPT,Facility,Inpatient,,,,2346,1994.1,412.496,2346,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Cta Pulmonary Embolism Study,,71275,CPT,Facility,Both,,,,2346,1994.1,412.496,2346,CorVel,Worker's Compensation,2346,100,,percent of total billed charges,,
Cta Pulmonary Embolism Study,,71275,CPT,Facility,Both,,,,2346,1994.1,412.496,2346,First Health Group Corporation,First Health Network,2275.62,97,,percent of total billed charges,,
Cta Pulmonary Embolism Study,,71275,CPT,Facility,Both,,,,2346,1994.1,412.496,2346,"Health Partners, Inc.",Commercial,2219.316,94.6,,percent of total billed charges,,
Cta Pulmonary Embolism Study,,71275,CPT,Facility,Outpatient,,,,2346,1994.1,412.496,2346,"Health Partners, Inc.",Medicare Advantage,1149.54,49,,percent of total billed charges,,
Cta Pulmonary Embolism Study,,71275,CPT,Facility,Inpatient,,,,2346,1994.1,412.496,2346,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Cta Pulmonary Embolism Study,,71275,CPT,Facility,Both,,,,2346,1994.1,412.496,2346,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1407.6,60,,percent of total billed charges,,
Cta Pulmonary Embolism Study,,71275,CPT,Facility,Both,,,,2346,1994.1,412.496,2346,"Health Partners, Inc.",State of Minnesota Advantage Program,1911.99,81.5,,percent of total billed charges,,
Cta Pulmonary Embolism Study,,71275,CPT,Facility,Both,,,,2346,1994.1,412.496,2346,"Health Partners, Inc.",State Public Programs,1173,50,,percent of total billed charges,,
Cta Pulmonary Embolism Study,,71275,CPT,Facility,Both,,,,2346,1994.1,412.496,2346,Humana Insurance Company,Commercial PPO,2228.7,95,,percent of total billed charges,,
Cta Pulmonary Embolism Study,,71275,CPT,Facility,Outpatient,,,,2346,1994.1,412.496,2346,Humana Insurance Company,Medicare PPO,1149.54,49,,percent of total billed charges,,
Cta Pulmonary Embolism Study,,71275,CPT,Facility,Inpatient,,,,2346,1994.1,412.496,2346,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Cta Pulmonary Embolism Study,,71275,CPT,Facility,Both,,,,2346,1994.1,412.496,2346,Medica,Individual & Family,2324.886,99.1,,percent of total billed charges,,
Cta Pulmonary Embolism Study,,71275,CPT,Facility,Outpatient,,,,2346,1994.1,412.496,2346,Medica,Medica Advantage Solution,1168.308,49.8,,percent of total billed charges,,
Cta Pulmonary Embolism Study,,71275,CPT,Facility,Inpatient,,,,2346,1994.1,412.496,2346,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Cta Pulmonary Embolism Study,,71275,CPT,Facility,Outpatient,,,,2346,1994.1,412.496,2346,Medica,Medical Assistance,499,,,Other,Per visit,Pays in addition to all Outpatient Service Categories
Cta Pulmonary Embolism Study,,71275,CPT,Facility,Inpatient,,,,2346,1994.1,412.496,2346,Medica,Medical Assistance,,,,,Included in per diem rate,
Cta Pulmonary Embolism Study,,71275,CPT,Facility,Outpatient,,,,2346,1994.1,412.496,2346,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1168.308,49.8,,percent of total billed charges,,
Cta Pulmonary Embolism Study,,71275,CPT,Facility,Inpatient,,,,2346,1994.1,412.496,2346,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Cta Pulmonary Embolism Study,,71275,CPT,Facility,Both,,,,2346,1994.1,412.496,2346,"Multiplan, Inc.","Multiplan, Inc.",2205.24,94,,percent of total billed charges,,
Cta Pulmonary Embolism Study,,71275,CPT,Facility,Outpatient,,,,2346,1994.1,412.496,2346,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1283,,,Other,Per scan,
Cta Pulmonary Embolism Study,,71275,CPT,Facility,Inpatient,,,,2346,1994.1,412.496,2346,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Cta Pulmonary Embolism Study,,71275,CPT,Facility,Both,,,,2346,1994.1,412.496,2346,"Preferred One Administrative Services, INC.",PPO,2313.156,98.6,,percent of total billed charges,,
Cta Pulmonary Embolism Study,,71275,CPT,Facility,Outpatient,,,,2346,1994.1,412.496,2346,PrimeWest Health,Minnesota Senior Health Options (MSHO),1207.017,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Cta Pulmonary Embolism Study,,71275,CPT,Facility,Inpatient,,,,2346,1994.1,412.496,2346,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Cta Pulmonary Embolism Study,,71275,CPT,Facility,Outpatient,,,,2346,1994.1,412.496,2346,PrimeWest Health,MinnesotaCare,1204.9056,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Cta Pulmonary Embolism Study,,71275,CPT,Facility,Inpatient,,,,2346,1994.1,412.496,2346,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Cta Pulmonary Embolism Study,,71275,CPT,Facility,Both,,,,2346,1994.1,412.496,2346,Sanford Health Plan,Sanford Health Plan,2158.32,92,,percent of total billed charges,,
Cta Pulmonary Embolism Study,,71275,CPT,Facility,Outpatient,,,,2346,1994.1,412.496,2346,"UCare Health, Inc.",Individual & Family Plan,1321.971,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Cta Pulmonary Embolism Study,,71275,CPT,Facility,Inpatient,,,,2346,1994.1,412.496,2346,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Cta Pulmonary Embolism Study,,71275,CPT,Facility,Outpatient,,,,2346,1994.1,412.496,2346,"UCare Health, Inc.",Medical Assistance,1184.0262,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Cta Pulmonary Embolism Study,,71275,CPT,Facility,Inpatient,,,,2346,1994.1,412.496,2346,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Cta Pulmonary Embolism Study,,71275,CPT,Facility,Outpatient,,,,2346,1994.1,412.496,2346,"UCare Health, Inc.",Medicare Advantage,1184.0262,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Cta Pulmonary Embolism Study,,71275,CPT,Facility,Inpatient,,,,2346,1994.1,412.496,2346,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Cta Pulmonary Embolism Study,,71275,CPT,Facility,Outpatient,,,,2346,1994.1,412.496,2346,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1184.0262,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Cta Pulmonary Embolism Study,,71275,CPT,Facility,Inpatient,,,,2346,1994.1,412.496,2346,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Cta Pulmonary Embolism Study,,71275,CPT,Facility,Both,,,,2346,1994.1,412.496,2346,UnitedHealthcare,Individual & Family,2205.24,94,,percent of total billed charges,,
Cta Pulmonary Embolism Study,,71275,CPT,Facility,Outpatient,,,,2346,1994.1,412.496,2346,UnitedHealthcare,Medicare Advantage,1149.54,49,,percent of total billed charges,,
Cta Pulmonary Embolism Study,,71275,CPT,Facility,Inpatient,,,,2346,1994.1,412.496,2346,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Cta Pulmonary Embolism Study,,71275,CPT,Facility,Outpatient,,,,2346,1994.1,412.496,2346,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1126.08,48,,percent of total billed charges,,100% of DHS outpatient percentage
Cta Pulmonary Embolism Study,,71275,CPT,Facility,Inpatient,,,,2346,1994.1,412.496,2346,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Mri Chest Routine Wo Contrast,,71550,CPT,Facility,Both,,,,2142,1820.7,533.908,2142,Aetna,Commercial,1970.64,92,,percent of total billed charges,,
Mri Chest Routine Wo Contrast,,71550,CPT,Facility,Outpatient,,,,2142,1820.7,533.908,2142,Aetna,Medicare Advantage,1049.58,49,,percent of total billed charges,,
Mri Chest Routine Wo Contrast,,71550,CPT,Facility,Inpatient,,,,2142,1820.7,533.908,2142,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Mri Chest Routine Wo Contrast,,71550,CPT,Facility,Both,,,,2142,1820.7,533.908,2142,Aetna,PPO,1992.06,93,,percent of total billed charges,,
Mri Chest Routine Wo Contrast,,71550,CPT,Facility,Both,,,,2142,1820.7,533.908,2142,America's PPO,America's PPO,2056.9626,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Mri Chest Routine Wo Contrast,,71550,CPT,Facility,Both,,,,2142,1820.7,533.908,2142,BlueCross BlueShield Minnesota, Federal Employee Program,1051,,,Fee schedule,,100% of BCBS commercial commodity fee schedule
Mri Chest Routine Wo Contrast,,71550,CPT,Facility,Both,,,,2142,1820.7,533.908,2142,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1067.816,,,Fee schedule,,"100% of BCBS commercial commodity fee schedule, plus MN Care tax"
Mri Chest Routine Wo Contrast,,71550,CPT,Facility,Both,,,,2142,1820.7,533.908,2142,BlueCross BlueShield Minnesota,High Value Network Plan,961.0344,,,Fee schedule,,"90% of BCBS commercial commodity fee schedule, plus MN Care tax; see disclaimer for more information"
Mri Chest Routine Wo Contrast,,71550,CPT,Facility,Outpatient,,,,2142,1820.7,533.908,2142,BlueCross BlueShield Minnesota,Medicare Advantage,1049.58,49,,percent of total billed charges,,
Mri Chest Routine Wo Contrast,,71550,CPT,Facility,Inpatient,,,,2142,1820.7,533.908,2142,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Mri Chest Routine Wo Contrast,,71550,CPT,Facility,Both,,,,2142,1820.7,533.908,2142,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,945.7646312,,,Fee schedule,,"88.57% of BCBS commercial commodity fee schedule, plus MN Care tax"
Mri Chest Routine Wo Contrast,,71550,CPT,Facility,Both,,,,2142,1820.7,533.908,2142,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,533.908,,,Fee schedule,,"100% of BCBS Medicaid commodity fee schedule, plus MN Care tax"
Mri Chest Routine Wo Contrast,,71550,CPT,Facility,Outpatient,,,,2142,1820.7,533.908,2142,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1049.58,49,,percent of total billed charges,,
Mri Chest Routine Wo Contrast,,71550,CPT,Facility,Inpatient,,,,2142,1820.7,533.908,2142,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Mri Chest Routine Wo Contrast,,71550,CPT,Facility,Both,,,,2142,1820.7,533.908,2142,CorVel,Worker's Compensation,2142,100,,percent of total billed charges,,
Mri Chest Routine Wo Contrast,,71550,CPT,Facility,Both,,,,2142,1820.7,533.908,2142,First Health Group Corporation,First Health Network,2077.74,97,,percent of total billed charges,,
Mri Chest Routine Wo Contrast,,71550,CPT,Facility,Both,,,,2142,1820.7,533.908,2142,"Health Partners, Inc.",Commercial,2026.332,94.6,,percent of total billed charges,,
Mri Chest Routine Wo Contrast,,71550,CPT,Facility,Outpatient,,,,2142,1820.7,533.908,2142,"Health Partners, Inc.",Medicare Advantage,1049.58,49,,percent of total billed charges,,
Mri Chest Routine Wo Contrast,,71550,CPT,Facility,Inpatient,,,,2142,1820.7,533.908,2142,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mri Chest Routine Wo Contrast,,71550,CPT,Facility,Both,,,,2142,1820.7,533.908,2142,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1285.2,60,,percent of total billed charges,,
Mri Chest Routine Wo Contrast,,71550,CPT,Facility,Both,,,,2142,1820.7,533.908,2142,"Health Partners, Inc.",State of Minnesota Advantage Program,1745.73,81.5,,percent of total billed charges,,
Mri Chest Routine Wo Contrast,,71550,CPT,Facility,Both,,,,2142,1820.7,533.908,2142,"Health Partners, Inc.",State Public Programs,1071,50,,percent of total billed charges,,
Mri Chest Routine Wo Contrast,,71550,CPT,Facility,Both,,,,2142,1820.7,533.908,2142,Humana Insurance Company,Commercial PPO,2034.9,95,,percent of total billed charges,,
Mri Chest Routine Wo Contrast,,71550,CPT,Facility,Outpatient,,,,2142,1820.7,533.908,2142,Humana Insurance Company,Medicare PPO,1049.58,49,,percent of total billed charges,,
Mri Chest Routine Wo Contrast,,71550,CPT,Facility,Inpatient,,,,2142,1820.7,533.908,2142,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Mri Chest Routine Wo Contrast,,71550,CPT,Facility,Both,,,,2142,1820.7,533.908,2142,Medica,Individual & Family,2122.722,99.1,,percent of total billed charges,,
Mri Chest Routine Wo Contrast,,71550,CPT,Facility,Outpatient,,,,2142,1820.7,533.908,2142,Medica,Medica Advantage Solution,1066.716,49.8,,percent of total billed charges,,
Mri Chest Routine Wo Contrast,,71550,CPT,Facility,Inpatient,,,,2142,1820.7,533.908,2142,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Mri Chest Routine Wo Contrast,,71550,CPT,Facility,Outpatient,,,,2142,1820.7,533.908,2142,Medica,Medical Assistance,747,,,Other ,per vist,Pays in addition to all Outpatient Service Categories
Mri Chest Routine Wo Contrast,,71550,CPT,Facility,Inpatient,,,,2142,1820.7,533.908,2142,Medica,Medical Assistance,,,,,Included in per diem rate,
Mri Chest Routine Wo Contrast,,71550,CPT,Facility,Outpatient,,,,2142,1820.7,533.908,2142,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1066.716,49.8,,percent of total billed charges,,
Mri Chest Routine Wo Contrast,,71550,CPT,Facility,Inpatient,,,,2142,1820.7,533.908,2142,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Mri Chest Routine Wo Contrast,,71550,CPT,Facility,Both,,,,2142,1820.7,533.908,2142,"Multiplan, Inc.","Multiplan, Inc.",2013.48,94,,percent of total billed charges,,
Mri Chest Routine Wo Contrast,,71550,CPT,Facility,Outpatient,,,,2142,1820.7,533.908,2142,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1535,,,Other  ,per scan,
Mri Chest Routine Wo Contrast,,71550,CPT,Facility,Inpatient,,,,2142,1820.7,533.908,2142,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Mri Chest Routine Wo Contrast,,71550,CPT,Facility,Both,,,,2142,1820.7,533.908,2142,"Preferred One Administrative Services, INC.",PPO,2112.012,98.6,,percent of total billed charges,,
Mri Chest Routine Wo Contrast,,71550,CPT,Facility,Outpatient,,,,2142,1820.7,533.908,2142,PrimeWest Health,Minnesota Senior Health Options (MSHO),1102.059,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Mri Chest Routine Wo Contrast,,71550,CPT,Facility,Inpatient,,,,2142,1820.7,533.908,2142,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mri Chest Routine Wo Contrast,,71550,CPT,Facility,Outpatient,,,,2142,1820.7,533.908,2142,PrimeWest Health,MinnesotaCare,1100.1312,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Mri Chest Routine Wo Contrast,,71550,CPT,Facility,Inpatient,,,,2142,1820.7,533.908,2142,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Mri Chest Routine Wo Contrast,,71550,CPT,Facility,Both,,,,2142,1820.7,533.908,2142,Sanford Health Plan,Sanford Health Plan,1970.64,92,,percent of total billed charges,,
Mri Chest Routine Wo Contrast,,71550,CPT,Facility,Outpatient,,,,2142,1820.7,533.908,2142,"UCare Health, Inc.",Individual & Family Plan,1207.017,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Mri Chest Routine Wo Contrast,,71550,CPT,Facility,Inpatient,,,,2142,1820.7,533.908,2142,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Mri Chest Routine Wo Contrast,,71550,CPT,Facility,Outpatient,,,,2142,1820.7,533.908,2142,"UCare Health, Inc.",Medical Assistance,1081.0674,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mri Chest Routine Wo Contrast,,71550,CPT,Facility,Inpatient,,,,2142,1820.7,533.908,2142,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Mri Chest Routine Wo Contrast,,71550,CPT,Facility,Outpatient,,,,2142,1820.7,533.908,2142,"UCare Health, Inc.",Medicare Advantage,1081.0674,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mri Chest Routine Wo Contrast,,71550,CPT,Facility,Inpatient,,,,2142,1820.7,533.908,2142,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mri Chest Routine Wo Contrast,,71550,CPT,Facility,Outpatient,,,,2142,1820.7,533.908,2142,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1081.0674,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mri Chest Routine Wo Contrast,,71550,CPT,Facility,Inpatient,,,,2142,1820.7,533.908,2142,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mri Chest Routine Wo Contrast,,71550,CPT,Facility,Both,,,,2142,1820.7,533.908,2142,UnitedHealthcare,Individual & Family,2013.48,94,,percent of total billed charges,,
Mri Chest Routine Wo Contrast,,71550,CPT,Facility,Outpatient,,,,2142,1820.7,533.908,2142,UnitedHealthcare,Medicare Advantage,1049.58,49,,percent of total billed charges,,
Mri Chest Routine Wo Contrast,,71550,CPT,Facility,Inpatient,,,,2142,1820.7,533.908,2142,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Mri Chest Routine Wo Contrast,,71550,CPT,Facility,Outpatient,,,,2142,1820.7,533.908,2142,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1028.16,48,,percent of total billed charges,,100% of DHS outpatient percentage
Mri Chest Routine Wo Contrast,,71550,CPT,Facility,Inpatient,,,,2142,1820.7,533.908,2142,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Mri Chest W Contrast,,71551,CPT,Facility,Both,,,,2550,2167.5,564.388,2550,Aetna,Commercial,2346,92,,percent of total billed charges,,
Mri Chest W Contrast,,71551,CPT,Facility,Outpatient,,,,2550,2167.5,564.388,2550,Aetna,Medicare Advantage,1249.5,49,,percent of total billed charges,,
Mri Chest W Contrast,,71551,CPT,Facility,Inpatient,,,,2550,2167.5,564.388,2550,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Mri Chest W Contrast,,71551,CPT,Facility,Both,,,,2550,2167.5,564.388,2550,Aetna,PPO,2371.5,93,,percent of total billed charges,,
Mri Chest W Contrast,,71551,CPT,Facility,Both,,,,2550,2167.5,564.388,2550,America's PPO,America's PPO,2448.765,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Mri Chest W Contrast,,71551,CPT,Facility,Both,,,,2550,2167.5,564.388,2550,BlueCross BlueShield Minnesota, Federal Employee Program,1111,,,Fee schedule,,100% of BCBS commercial commodity fee schedule
Mri Chest W Contrast,,71551,CPT,Facility,Both,,,,2550,2167.5,564.388,2550,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1128.776,,,Fee schedule,,"100% of BCBS commercial commodity fee schedule, plus MN Care tax"
Mri Chest W Contrast,,71551,CPT,Facility,Both,,,,2550,2167.5,564.388,2550,BlueCross BlueShield Minnesota,High Value Network Plan,1015.8984,,,Fee schedule,,"90% of BCBS commercial commodity fee schedule, plus MN Care tax; see disclaimer for more information"
Mri Chest W Contrast,,71551,CPT,Facility,Outpatient,,,,2550,2167.5,564.388,2550,BlueCross BlueShield Minnesota,Medicare Advantage,1249.5,49,,percent of total billed charges,,
Mri Chest W Contrast,,71551,CPT,Facility,Inpatient,,,,2550,2167.5,564.388,2550,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Mri Chest W Contrast,,71551,CPT,Facility,Both,,,,2550,2167.5,564.388,2550,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,999.7569032,,,Fee schedule,,"88.57% of BCBS commercial commodity fee schedule, plus MN Care tax"
Mri Chest W Contrast,,71551,CPT,Facility,Both,,,,2550,2167.5,564.388,2550,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,564.388,,,Fee schedule,,"100% of BCBS Medicaid commodity fee schedule, plus MN Care tax"
Mri Chest W Contrast,,71551,CPT,Facility,Outpatient,,,,2550,2167.5,564.388,2550,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1249.5,49,,percent of total billed charges,,
Mri Chest W Contrast,,71551,CPT,Facility,Inpatient,,,,2550,2167.5,564.388,2550,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Mri Chest W Contrast,,71551,CPT,Facility,Both,,,,2550,2167.5,564.388,2550,CorVel,Worker's Compensation,2550,100,,percent of total billed charges,,
Mri Chest W Contrast,,71551,CPT,Facility,Both,,,,2550,2167.5,564.388,2550,First Health Group Corporation,First Health Network,2473.5,97,,percent of total billed charges,,
Mri Chest W Contrast,,71551,CPT,Facility,Both,,,,2550,2167.5,564.388,2550,"Health Partners, Inc.",Commercial,2412.3,94.6,,percent of total billed charges,,
Mri Chest W Contrast,,71551,CPT,Facility,Outpatient,,,,2550,2167.5,564.388,2550,"Health Partners, Inc.",Medicare Advantage,1249.5,49,,percent of total billed charges,,
Mri Chest W Contrast,,71551,CPT,Facility,Inpatient,,,,2550,2167.5,564.388,2550,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mri Chest W Contrast,,71551,CPT,Facility,Both,,,,2550,2167.5,564.388,2550,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1530,60,,percent of total billed charges,,
Mri Chest W Contrast,,71551,CPT,Facility,Both,,,,2550,2167.5,564.388,2550,"Health Partners, Inc.",State of Minnesota Advantage Program,2078.25,81.5,,percent of total billed charges,,
Mri Chest W Contrast,,71551,CPT,Facility,Both,,,,2550,2167.5,564.388,2550,"Health Partners, Inc.",State Public Programs,1275,50,,percent of total billed charges,,
Mri Chest W Contrast,,71551,CPT,Facility,Both,,,,2550,2167.5,564.388,2550,Humana Insurance Company,Commercial PPO,2422.5,95,,percent of total billed charges,,
Mri Chest W Contrast,,71551,CPT,Facility,Outpatient,,,,2550,2167.5,564.388,2550,Humana Insurance Company,Medicare PPO,1249.5,49,,percent of total billed charges,,
Mri Chest W Contrast,,71551,CPT,Facility,Inpatient,,,,2550,2167.5,564.388,2550,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Mri Chest W Contrast,,71551,CPT,Facility,Both,,,,2550,2167.5,564.388,2550,Medica,Individual & Family,2527.05,99.1,,percent of total billed charges,,
Mri Chest W Contrast,,71551,CPT,Facility,Outpatient,,,,2550,2167.5,564.388,2550,Medica,Medica Advantage Solution,1269.9,49.8,,percent of total billed charges,,
Mri Chest W Contrast,,71551,CPT,Facility,Inpatient,,,,2550,2167.5,564.388,2550,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Mri Chest W Contrast,,71551,CPT,Facility,Outpatient,,,,2550,2167.5,564.388,2550,Medica,Medical Assistance,747,,,Other , per vist,Pays in addition to all Outpatient Service Categories
Mri Chest W Contrast,,71551,CPT,Facility,Inpatient,,,,2550,2167.5,564.388,2550,Medica,Medical Assistance,,,,,Included in per diem rate,
Mri Chest W Contrast,,71551,CPT,Facility,Outpatient,,,,2550,2167.5,564.388,2550,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1269.9,49.8,,percent of total billed charges,,
Mri Chest W Contrast,,71551,CPT,Facility,Inpatient,,,,2550,2167.5,564.388,2550,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Mri Chest W Contrast,,71551,CPT,Facility,Both,,,,2550,2167.5,564.388,2550,"Multiplan, Inc.","Multiplan, Inc.",2397,94,,percent of total billed charges,,
Mri Chest W Contrast,,71551,CPT,Facility,Outpatient,,,,2550,2167.5,564.388,2550,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1535,,,Other ,per scan,
Mri Chest W Contrast,,71551,CPT,Facility,Inpatient,,,,2550,2167.5,564.388,2550,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Mri Chest W Contrast,,71551,CPT,Facility,Both,,,,2550,2167.5,564.388,2550,"Preferred One Administrative Services, INC.",PPO,2514.3,98.6,,percent of total billed charges,,
Mri Chest W Contrast,,71551,CPT,Facility,Outpatient,,,,2550,2167.5,564.388,2550,PrimeWest Health,Minnesota Senior Health Options (MSHO),1311.975,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Mri Chest W Contrast,,71551,CPT,Facility,Inpatient,,,,2550,2167.5,564.388,2550,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mri Chest W Contrast,,71551,CPT,Facility,Outpatient,,,,2550,2167.5,564.388,2550,PrimeWest Health,MinnesotaCare,1309.68,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Mri Chest W Contrast,,71551,CPT,Facility,Inpatient,,,,2550,2167.5,564.388,2550,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Mri Chest W Contrast,,71551,CPT,Facility,Both,,,,2550,2167.5,564.388,2550,Sanford Health Plan,Sanford Health Plan,2346,92,,percent of total billed charges,,
Mri Chest W Contrast,,71551,CPT,Facility,Outpatient,,,,2550,2167.5,564.388,2550,"UCare Health, Inc.",Individual & Family Plan,1436.925,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Mri Chest W Contrast,,71551,CPT,Facility,Inpatient,,,,2550,2167.5,564.388,2550,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Mri Chest W Contrast,,71551,CPT,Facility,Outpatient,,,,2550,2167.5,564.388,2550,"UCare Health, Inc.",Medical Assistance,1286.985,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mri Chest W Contrast,,71551,CPT,Facility,Inpatient,,,,2550,2167.5,564.388,2550,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Mri Chest W Contrast,,71551,CPT,Facility,Outpatient,,,,2550,2167.5,564.388,2550,"UCare Health, Inc.",Medicare Advantage,1286.985,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mri Chest W Contrast,,71551,CPT,Facility,Inpatient,,,,2550,2167.5,564.388,2550,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mri Chest W Contrast,,71551,CPT,Facility,Outpatient,,,,2550,2167.5,564.388,2550,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1286.985,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mri Chest W Contrast,,71551,CPT,Facility,Inpatient,,,,2550,2167.5,564.388,2550,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mri Chest W Contrast,,71551,CPT,Facility,Both,,,,2550,2167.5,564.388,2550,UnitedHealthcare,Individual & Family,2397,94,,percent of total billed charges,,
Mri Chest W Contrast,,71551,CPT,Facility,Outpatient,,,,2550,2167.5,564.388,2550,UnitedHealthcare,Medicare Advantage,1249.5,49,,percent of total billed charges,,
Mri Chest W Contrast,,71551,CPT,Facility,Inpatient,,,,2550,2167.5,564.388,2550,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Mri Chest W Contrast,,71551,CPT,Facility,Outpatient,,,,2550,2167.5,564.388,2550,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1224,48,,percent of total billed charges,,100% of DHS outpatient percentage
Mri Chest W Contrast,,71551,CPT,Facility,Inpatient,,,,2550,2167.5,564.388,2550,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Mri Chest Wo W Contrast,,71552,CPT,Facility,Both,,,,2952,2509.2,561.34,2952,Aetna,Commercial,2715.84,92,,percent of total billed charges,,
Mri Chest Wo W Contrast,,71552,CPT,Facility,Outpatient,,,,2952,2509.2,561.34,2952,Aetna,Medicare Advantage,1446.48,49,,percent of total billed charges,,
Mri Chest Wo W Contrast,,71552,CPT,Facility,Inpatient,,,,2952,2509.2,561.34,2952,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Mri Chest Wo W Contrast,,71552,CPT,Facility,Both,,,,2952,2509.2,561.34,2952,Aetna,PPO,2745.36,93,,percent of total billed charges,,
Mri Chest Wo W Contrast,,71552,CPT,Facility,Both,,,,2952,2509.2,561.34,2952,America's PPO,America's PPO,2834.8056,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Mri Chest Wo W Contrast,,71552,CPT,Facility,Both,,,,2952,2509.2,561.34,2952,BlueCross BlueShield Minnesota, Federal Employee Program,1105,,,Fee schedule,,100% of BCBS commercial commodity fee schedule
Mri Chest Wo W Contrast,,71552,CPT,Facility,Both,,,,2952,2509.2,561.34,2952,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1122.68,,,Fee schedule,,"100% of BCBS commercial commodity fee schedule, plus MN Care tax"
Mri Chest Wo W Contrast,,71552,CPT,Facility,Both,,,,2952,2509.2,561.34,2952,BlueCross BlueShield Minnesota,High Value Network Plan,1010.412,,,Fee schedule,,"90% of BCBS commercial commodity fee schedule, plus MN Care tax; see disclaimer for more information"
Mri Chest Wo W Contrast,,71552,CPT,Facility,Outpatient,,,,2952,2509.2,561.34,2952,BlueCross BlueShield Minnesota,Medicare Advantage,1446.48,49,,percent of total billed charges,,
Mri Chest Wo W Contrast,,71552,CPT,Facility,Inpatient,,,,2952,2509.2,561.34,2952,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Mri Chest Wo W Contrast,,71552,CPT,Facility,Both,,,,2952,2509.2,561.34,2952,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,994.357676,,,Fee schedule,,"88.57% of BCBS commercial commodity fee schedule, plus MN Care tax"
Mri Chest Wo W Contrast,,71552,CPT,Facility,Both,,,,2952,2509.2,561.34,2952,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,561.34,,,Fee schedule,,"100% of BCBS Medicaid commodity fee schedule, plus MN Care tax"
Mri Chest Wo W Contrast,,71552,CPT,Facility,Outpatient,,,,2952,2509.2,561.34,2952,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1446.48,49,,percent of total billed charges,,
Mri Chest Wo W Contrast,,71552,CPT,Facility,Inpatient,,,,2952,2509.2,561.34,2952,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Mri Chest Wo W Contrast,,71552,CPT,Facility,Both,,,,2952,2509.2,561.34,2952,CorVel,Worker's Compensation,2952,100,,percent of total billed charges,,
Mri Chest Wo W Contrast,,71552,CPT,Facility,Both,,,,2952,2509.2,561.34,2952,First Health Group Corporation,First Health Network,2863.44,97,,percent of total billed charges,,
Mri Chest Wo W Contrast,,71552,CPT,Facility,Both,,,,2952,2509.2,561.34,2952,"Health Partners, Inc.",Commercial,2792.592,94.6,,percent of total billed charges,,
Mri Chest Wo W Contrast,,71552,CPT,Facility,Outpatient,,,,2952,2509.2,561.34,2952,"Health Partners, Inc.",Medicare Advantage,1446.48,49,,percent of total billed charges,,
Mri Chest Wo W Contrast,,71552,CPT,Facility,Inpatient,,,,2952,2509.2,561.34,2952,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mri Chest Wo W Contrast,,71552,CPT,Facility,Both,,,,2952,2509.2,561.34,2952,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1771.2,60,,percent of total billed charges,,
Mri Chest Wo W Contrast,,71552,CPT,Facility,Both,,,,2952,2509.2,561.34,2952,"Health Partners, Inc.",State of Minnesota Advantage Program,2405.88,81.5,,percent of total billed charges,,
Mri Chest Wo W Contrast,,71552,CPT,Facility,Both,,,,2952,2509.2,561.34,2952,"Health Partners, Inc.",State Public Programs,1476,50,,percent of total billed charges,,
Mri Chest Wo W Contrast,,71552,CPT,Facility,Both,,,,2952,2509.2,561.34,2952,Humana Insurance Company,Commercial PPO,2804.4,95,,percent of total billed charges,,
Mri Chest Wo W Contrast,,71552,CPT,Facility,Outpatient,,,,2952,2509.2,561.34,2952,Humana Insurance Company,Medicare PPO,1446.48,49,,percent of total billed charges,,
Mri Chest Wo W Contrast,,71552,CPT,Facility,Inpatient,,,,2952,2509.2,561.34,2952,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Mri Chest Wo W Contrast,,71552,CPT,Facility,Both,,,,2952,2509.2,561.34,2952,Medica,Individual & Family,2925.432,99.1,,percent of total billed charges,,
Mri Chest Wo W Contrast,,71552,CPT,Facility,Outpatient,,,,2952,2509.2,561.34,2952,Medica,Medica Advantage Solution,1470.096,49.8,,percent of total billed charges,,
Mri Chest Wo W Contrast,,71552,CPT,Facility,Inpatient,,,,2952,2509.2,561.34,2952,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Mri Chest Wo W Contrast,,71552,CPT,Facility,Outpatient,,,,2952,2509.2,561.34,2952,Medica,Medical Assistance,747,,,Other ,per vist,Pays in addition to all Outpatient Service Categories
Mri Chest Wo W Contrast,,71552,CPT,Facility,Inpatient,,,,2952,2509.2,561.34,2952,Medica,Medical Assistance,,,,,Included in per diem rate,
Mri Chest Wo W Contrast,,71552,CPT,Facility,Outpatient,,,,2952,2509.2,561.34,2952,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1470.096,49.8,,percent of total billed charges,,
Mri Chest Wo W Contrast,,71552,CPT,Facility,Inpatient,,,,2952,2509.2,561.34,2952,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Mri Chest Wo W Contrast,,71552,CPT,Facility,Both,,,,2952,2509.2,561.34,2952,"Multiplan, Inc.","Multiplan, Inc.",2774.88,94,,percent of total billed charges,,
Mri Chest Wo W Contrast,,71552,CPT,Facility,Outpatient,,,,2952,2509.2,561.34,2952,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1535,,,Other ,per scan,
Mri Chest Wo W Contrast,,71552,CPT,Facility,Inpatient,,,,2952,2509.2,561.34,2952,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Mri Chest Wo W Contrast,,71552,CPT,Facility,Both,,,,2952,2509.2,561.34,2952,"Preferred One Administrative Services, INC.",PPO,2910.672,98.6,,percent of total billed charges,,
Mri Chest Wo W Contrast,,71552,CPT,Facility,Outpatient,,,,2952,2509.2,561.34,2952,PrimeWest Health,Minnesota Senior Health Options (MSHO),1518.804,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Mri Chest Wo W Contrast,,71552,CPT,Facility,Inpatient,,,,2952,2509.2,561.34,2952,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mri Chest Wo W Contrast,,71552,CPT,Facility,Outpatient,,,,2952,2509.2,561.34,2952,PrimeWest Health,MinnesotaCare,1516.1472,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Mri Chest Wo W Contrast,,71552,CPT,Facility,Inpatient,,,,2952,2509.2,561.34,2952,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Mri Chest Wo W Contrast,,71552,CPT,Facility,Both,,,,2952,2509.2,561.34,2952,Sanford Health Plan,Sanford Health Plan,2715.84,92,,percent of total billed charges,,
Mri Chest Wo W Contrast,,71552,CPT,Facility,Outpatient,,,,2952,2509.2,561.34,2952,"UCare Health, Inc.",Individual & Family Plan,1663.452,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Mri Chest Wo W Contrast,,71552,CPT,Facility,Inpatient,,,,2952,2509.2,561.34,2952,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Mri Chest Wo W Contrast,,71552,CPT,Facility,Outpatient,,,,2952,2509.2,561.34,2952,"UCare Health, Inc.",Medical Assistance,1489.8744,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mri Chest Wo W Contrast,,71552,CPT,Facility,Inpatient,,,,2952,2509.2,561.34,2952,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Mri Chest Wo W Contrast,,71552,CPT,Facility,Outpatient,,,,2952,2509.2,561.34,2952,"UCare Health, Inc.",Medicare Advantage,1489.8744,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mri Chest Wo W Contrast,,71552,CPT,Facility,Inpatient,,,,2952,2509.2,561.34,2952,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mri Chest Wo W Contrast,,71552,CPT,Facility,Outpatient,,,,2952,2509.2,561.34,2952,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1489.8744,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mri Chest Wo W Contrast,,71552,CPT,Facility,Inpatient,,,,2952,2509.2,561.34,2952,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mri Chest Wo W Contrast,,71552,CPT,Facility,Both,,,,2952,2509.2,561.34,2952,UnitedHealthcare,Individual & Family,2774.88,94,,percent of total billed charges,,
Mri Chest Wo W Contrast,,71552,CPT,Facility,Outpatient,,,,2952,2509.2,561.34,2952,UnitedHealthcare,Medicare Advantage,1446.48,49,,percent of total billed charges,,
Mri Chest Wo W Contrast,,71552,CPT,Facility,Inpatient,,,,2952,2509.2,561.34,2952,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Mri Chest Wo W Contrast,,71552,CPT,Facility,Outpatient,,,,2952,2509.2,561.34,2952,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1416.96,48,,percent of total billed charges,,100% of DHS outpatient percentage
Mri Chest Wo W Contrast,,71552,CPT,Facility,Inpatient,,,,2952,2509.2,561.34,2952,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Mra Chest Wo W Contrast,,71555,CPT,Facility,Both,,,,2856,2427.6,533.908,2856,Aetna,Commercial,2627.52,92,,percent of total billed charges,,
Mra Chest Wo W Contrast,,71555,CPT,Facility,Outpatient,,,,2856,2427.6,533.908,2856,Aetna,Medicare Advantage,1399.44,49,,percent of total billed charges,,
Mra Chest Wo W Contrast,,71555,CPT,Facility,Inpatient,,,,2856,2427.6,533.908,2856,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Mra Chest Wo W Contrast,,71555,CPT,Facility,Both,,,,2856,2427.6,533.908,2856,Aetna,PPO,2656.08,93,,percent of total billed charges,,
Mra Chest Wo W Contrast,,71555,CPT,Facility,Both,,,,2856,2427.6,533.908,2856,America's PPO,America's PPO,2742.6168,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Mra Chest Wo W Contrast,,71555,CPT,Facility,Both,,,,2856,2427.6,533.908,2856,BlueCross BlueShield Minnesota, Federal Employee Program,1051,,,Fee schedule,,100% of BCBS commercial commodity fee schedule
Mra Chest Wo W Contrast,,71555,CPT,Facility,Both,,,,2856,2427.6,533.908,2856,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1067.816,,,Fee schedule,,"100% of BCBS commercial commodity fee schedule, plus MN Care tax"
Mra Chest Wo W Contrast,,71555,CPT,Facility,Both,,,,2856,2427.6,533.908,2856,BlueCross BlueShield Minnesota,High Value Network Plan,961.0344,,,Fee schedule,,"90% of BCBS commercial commodity fee schedule, plus MN Care tax; see disclaimer for more information"
Mra Chest Wo W Contrast,,71555,CPT,Facility,Outpatient,,,,2856,2427.6,533.908,2856,BlueCross BlueShield Minnesota,Medicare Advantage,1399.44,49,,percent of total billed charges,,
Mra Chest Wo W Contrast,,71555,CPT,Facility,Inpatient,,,,2856,2427.6,533.908,2856,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Mra Chest Wo W Contrast,,71555,CPT,Facility,Both,,,,2856,2427.6,533.908,2856,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,945.7646312,,,Fee schedule,,"88.57% of BCBS commercial commodity fee schedule, plus MN Care tax"
Mra Chest Wo W Contrast,,71555,CPT,Facility,Both,,,,2856,2427.6,533.908,2856,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,533.908,,,Fee schedule,,"100% of BCBS Medicaid commodity fee schedule, plus MN Care tax"
Mra Chest Wo W Contrast,,71555,CPT,Facility,Outpatient,,,,2856,2427.6,533.908,2856,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1399.44,49,,percent of total billed charges,,
Mra Chest Wo W Contrast,,71555,CPT,Facility,Inpatient,,,,2856,2427.6,533.908,2856,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Mra Chest Wo W Contrast,,71555,CPT,Facility,Both,,,,2856,2427.6,533.908,2856,CorVel,Worker's Compensation,2856,100,,percent of total billed charges,,
Mra Chest Wo W Contrast,,71555,CPT,Facility,Both,,,,2856,2427.6,533.908,2856,First Health Group Corporation,First Health Network,2770.32,97,,percent of total billed charges,,
Mra Chest Wo W Contrast,,71555,CPT,Facility,Both,,,,2856,2427.6,533.908,2856,"Health Partners, Inc.",Commercial,2701.776,94.6,,percent of total billed charges,,
Mra Chest Wo W Contrast,,71555,CPT,Facility,Outpatient,,,,2856,2427.6,533.908,2856,"Health Partners, Inc.",Medicare Advantage,1399.44,49,,percent of total billed charges,,
Mra Chest Wo W Contrast,,71555,CPT,Facility,Inpatient,,,,2856,2427.6,533.908,2856,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mra Chest Wo W Contrast,,71555,CPT,Facility,Both,,,,2856,2427.6,533.908,2856,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1713.6,60,,percent of total billed charges,,
Mra Chest Wo W Contrast,,71555,CPT,Facility,Both,,,,2856,2427.6,533.908,2856,"Health Partners, Inc.",State of Minnesota Advantage Program,2327.64,81.5,,percent of total billed charges,,
Mra Chest Wo W Contrast,,71555,CPT,Facility,Both,,,,2856,2427.6,533.908,2856,"Health Partners, Inc.",State Public Programs,1428,50,,percent of total billed charges,,
Mra Chest Wo W Contrast,,71555,CPT,Facility,Both,,,,2856,2427.6,533.908,2856,Humana Insurance Company,Commercial PPO,2713.2,95,,percent of total billed charges,,
Mra Chest Wo W Contrast,,71555,CPT,Facility,Outpatient,,,,2856,2427.6,533.908,2856,Humana Insurance Company,Medicare PPO,1399.44,49,,percent of total billed charges,,
Mra Chest Wo W Contrast,,71555,CPT,Facility,Inpatient,,,,2856,2427.6,533.908,2856,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Mra Chest Wo W Contrast,,71555,CPT,Facility,Both,,,,2856,2427.6,533.908,2856,Medica,Individual & Family,2830.296,99.1,,percent of total billed charges,,
Mra Chest Wo W Contrast,,71555,CPT,Facility,Outpatient,,,,2856,2427.6,533.908,2856,Medica,Medica Advantage Solution,1422.288,49.8,,percent of total billed charges,,
Mra Chest Wo W Contrast,,71555,CPT,Facility,Inpatient,,,,2856,2427.6,533.908,2856,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Mra Chest Wo W Contrast,,71555,CPT,Facility,Outpatient,,,,2856,2427.6,533.908,2856,Medica,Medical Assistance,747,,,Other,Per vist,Pays in addition to all Outpatient Service Categories
Mra Chest Wo W Contrast,,71555,CPT,Facility,Inpatient,,,,2856,2427.6,533.908,2856,Medica,Medical Assistance,,,,,Included in per diem rate,
Mra Chest Wo W Contrast,,71555,CPT,Facility,Outpatient,,,,2856,2427.6,533.908,2856,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1422.288,49.8,,percent of total billed charges,,
Mra Chest Wo W Contrast,,71555,CPT,Facility,Inpatient,,,,2856,2427.6,533.908,2856,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Mra Chest Wo W Contrast,,71555,CPT,Facility,Both,,,,2856,2427.6,533.908,2856,"Multiplan, Inc.","Multiplan, Inc.",2684.64,94,,percent of total billed charges,,
Mra Chest Wo W Contrast,,71555,CPT,Facility,Outpatient,,,,2856,2427.6,533.908,2856,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1535,,,Other,Per scan,
Mra Chest Wo W Contrast,,71555,CPT,Facility,Inpatient,,,,2856,2427.6,533.908,2856,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Mra Chest Wo W Contrast,,71555,CPT,Facility,Both,,,,2856,2427.6,533.908,2856,"Preferred One Administrative Services, INC.",PPO,2816.016,98.6,,percent of total billed charges,,
Mra Chest Wo W Contrast,,71555,CPT,Facility,Outpatient,,,,2856,2427.6,533.908,2856,PrimeWest Health,Minnesota Senior Health Options (MSHO),1469.412,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Mra Chest Wo W Contrast,,71555,CPT,Facility,Inpatient,,,,2856,2427.6,533.908,2856,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mra Chest Wo W Contrast,,71555,CPT,Facility,Outpatient,,,,2856,2427.6,533.908,2856,PrimeWest Health,MinnesotaCare,1466.8416,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Mra Chest Wo W Contrast,,71555,CPT,Facility,Inpatient,,,,2856,2427.6,533.908,2856,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Mra Chest Wo W Contrast,,71555,CPT,Facility,Both,,,,2856,2427.6,533.908,2856,Sanford Health Plan,Sanford Health Plan,2627.52,92,,percent of total billed charges,,
Mra Chest Wo W Contrast,,71555,CPT,Facility,Outpatient,,,,2856,2427.6,533.908,2856,"UCare Health, Inc.",Individual & Family Plan,1609.356,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Mra Chest Wo W Contrast,,71555,CPT,Facility,Inpatient,,,,2856,2427.6,533.908,2856,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Mra Chest Wo W Contrast,,71555,CPT,Facility,Outpatient,,,,2856,2427.6,533.908,2856,"UCare Health, Inc.",Medical Assistance,1441.4232,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mra Chest Wo W Contrast,,71555,CPT,Facility,Inpatient,,,,2856,2427.6,533.908,2856,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Mra Chest Wo W Contrast,,71555,CPT,Facility,Outpatient,,,,2856,2427.6,533.908,2856,"UCare Health, Inc.",Medicare Advantage,1441.4232,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mra Chest Wo W Contrast,,71555,CPT,Facility,Inpatient,,,,2856,2427.6,533.908,2856,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mra Chest Wo W Contrast,,71555,CPT,Facility,Outpatient,,,,2856,2427.6,533.908,2856,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1441.4232,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mra Chest Wo W Contrast,,71555,CPT,Facility,Inpatient,,,,2856,2427.6,533.908,2856,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mra Chest Wo W Contrast,,71555,CPT,Facility,Both,,,,2856,2427.6,533.908,2856,UnitedHealthcare,Individual & Family,2684.64,94,,percent of total billed charges,,
Mra Chest Wo W Contrast,,71555,CPT,Facility,Outpatient,,,,2856,2427.6,533.908,2856,UnitedHealthcare,Medicare Advantage,1399.44,49,,percent of total billed charges,,
Mra Chest Wo W Contrast,,71555,CPT,Facility,Inpatient,,,,2856,2427.6,533.908,2856,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Mra Chest Wo W Contrast,,71555,CPT,Facility,Outpatient,,,,2856,2427.6,533.908,2856,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1370.88,48,,percent of total billed charges,,100% of DHS outpatient percentage
Mra Chest Wo W Contrast,,71555,CPT,Facility,Inpatient,,,,2856,2427.6,533.908,2856,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Xr Cervical Spine One View,,72020,CPT,Facility,Both,,,,204,173.4,58.4664,204,Aetna,Commercial,187.68,92,,percent of total billed charges,,
Xr Cervical Spine One View,,72020,CPT,Facility,Outpatient,,,,204,173.4,58.4664,204,Aetna,Medicare Advantage,99.96,49,,percent of total billed charges,,
Xr Cervical Spine One View,,72020,CPT,Facility,Inpatient,,,,204,173.4,58.4664,204,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Xr Cervical Spine One View,,72020,CPT,Facility,Both,,,,204,173.4,58.4664,204,Aetna,PPO,189.72,93,,percent of total billed charges,,
Xr Cervical Spine One View,,72020,CPT,Facility,Both,,,,204,173.4,58.4664,204,America's PPO,America's PPO,195.9012,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Xr Cervical Spine One View,,72020,CPT,Facility,Both,,,,204,173.4,58.4664,204,BlueCross BlueShield Minnesota, Federal Employee Program,200.736,98.4,,percent of total billed charges,,
Xr Cervical Spine One View,,72020,CPT,Facility,Both,,,,204,173.4,58.4664,204,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,204,100,,percent of total billed charges,,
Xr Cervical Spine One View,,72020,CPT,Facility,Both,,,,204,173.4,58.4664,204,BlueCross BlueShield Minnesota,High Value Network Plan,183.6,90,,percent of total billed charges,,
Xr Cervical Spine One View,,72020,CPT,Facility,Outpatient,,,,204,173.4,58.4664,204,BlueCross BlueShield Minnesota,Medicare Advantage,99.96,49,,percent of total billed charges,,
Xr Cervical Spine One View,,72020,CPT,Facility,Inpatient,,,,204,173.4,58.4664,204,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Xr Cervical Spine One View,,72020,CPT,Facility,Both,,,,204,173.4,58.4664,204,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,180.6828,88.57,,percent of total billed charges,,
Xr Cervical Spine One View,,72020,CPT,Facility,Both,,,,204,173.4,58.4664,204,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,58.4664,28.66,,percent of total billed charges,,
Xr Cervical Spine One View,,72020,CPT,Facility,Outpatient,,,,204,173.4,58.4664,204,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),99.96,49,,percent of total billed charges,,
Xr Cervical Spine One View,,72020,CPT,Facility,Inpatient,,,,204,173.4,58.4664,204,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Xr Cervical Spine One View,,72020,CPT,Facility,Both,,,,204,173.4,58.4664,204,CorVel,Worker's Compensation,204,100,,percent of total billed charges,,
Xr Cervical Spine One View,,72020,CPT,Facility,Both,,,,204,173.4,58.4664,204,First Health Group Corporation,First Health Network,197.88,97,,percent of total billed charges,,
Xr Cervical Spine One View,,72020,CPT,Facility,Both,,,,204,173.4,58.4664,204,"Health Partners, Inc.",Commercial,192.984,94.6,,percent of total billed charges,,
Xr Cervical Spine One View,,72020,CPT,Facility,Outpatient,,,,204,173.4,58.4664,204,"Health Partners, Inc.",Medicare Advantage,99.96,49,,percent of total billed charges,,
Xr Cervical Spine One View,,72020,CPT,Facility,Inpatient,,,,204,173.4,58.4664,204,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Cervical Spine One View,,72020,CPT,Facility,Both,,,,204,173.4,58.4664,204,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),122.4,60,,percent of total billed charges,,
Xr Cervical Spine One View,,72020,CPT,Facility,Both,,,,204,173.4,58.4664,204,"Health Partners, Inc.",State of Minnesota Advantage Program,166.26,81.5,,percent of total billed charges,,
Xr Cervical Spine One View,,72020,CPT,Facility,Both,,,,204,173.4,58.4664,204,"Health Partners, Inc.",State Public Programs,102,50,,percent of total billed charges,,
Xr Cervical Spine One View,,72020,CPT,Facility,Both,,,,204,173.4,58.4664,204,Humana Insurance Company,Commercial PPO,193.8,95,,percent of total billed charges,,
Xr Cervical Spine One View,,72020,CPT,Facility,Outpatient,,,,204,173.4,58.4664,204,Humana Insurance Company,Medicare PPO,99.96,49,,percent of total billed charges,,
Xr Cervical Spine One View,,72020,CPT,Facility,Inpatient,,,,204,173.4,58.4664,204,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Xr Cervical Spine One View,,72020,CPT,Facility,Both,,,,204,173.4,58.4664,204,Medica,Individual & Family,202.164,99.1,,percent of total billed charges,,
Xr Cervical Spine One View,,72020,CPT,Facility,Outpatient,,,,204,173.4,58.4664,204,Medica,Medica Advantage Solution,101.592,49.8,,percent of total billed charges,,
Xr Cervical Spine One View,,72020,CPT,Facility,Inpatient,,,,204,173.4,58.4664,204,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Xr Cervical Spine One View,,72020,CPT,Facility,Outpatient,,,,204,173.4,58.4664,204,Medica,Medical Assistance,90.984,44.6,,percent of total billed charges,,
Xr Cervical Spine One View,,72020,CPT,Facility,Inpatient,,,,204,173.4,58.4664,204,Medica,Medical Assistance,,,,,Included in per diem rate,
Xr Cervical Spine One View,,72020,CPT,Facility,Outpatient,,,,204,173.4,58.4664,204,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,101.592,49.8,,percent of total billed charges,,
Xr Cervical Spine One View,,72020,CPT,Facility,Inpatient,,,,204,173.4,58.4664,204,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Xr Cervical Spine One View,,72020,CPT,Facility,Both,,,,204,173.4,58.4664,204,"Multiplan, Inc.","Multiplan, Inc.",191.76,94,,percent of total billed charges,,
Xr Cervical Spine One View,,72020,CPT,Facility,Outpatient,,,,204,173.4,58.4664,204,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,183.804,90.1,,percent of total billed charges,,
Xr Cervical Spine One View,,72020,CPT,Facility,Inpatient,,,,204,173.4,58.4664,204,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Xr Cervical Spine One View,,72020,CPT,Facility,Both,,,,204,173.4,58.4664,204,"Preferred One Administrative Services, INC.",PPO,201.144,98.6,,percent of total billed charges,,
Xr Cervical Spine One View,,72020,CPT,Facility,Outpatient,,,,204,173.4,58.4664,204,PrimeWest Health,Minnesota Senior Health Options (MSHO),104.958,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Xr Cervical Spine One View,,72020,CPT,Facility,Inpatient,,,,204,173.4,58.4664,204,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Cervical Spine One View,,72020,CPT,Facility,Outpatient,,,,204,173.4,58.4664,204,PrimeWest Health,MinnesotaCare,104.7744,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Xr Cervical Spine One View,,72020,CPT,Facility,Inpatient,,,,204,173.4,58.4664,204,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Xr Cervical Spine One View,,72020,CPT,Facility,Both,,,,204,173.4,58.4664,204,Sanford Health Plan,Sanford Health Plan,187.68,92,,percent of total billed charges,,
Xr Cervical Spine One View,,72020,CPT,Facility,Outpatient,,,,204,173.4,58.4664,204,"UCare Health, Inc.",Individual & Family Plan,114.954,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Xr Cervical Spine One View,,72020,CPT,Facility,Inpatient,,,,204,173.4,58.4664,204,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Xr Cervical Spine One View,,72020,CPT,Facility,Outpatient,,,,204,173.4,58.4664,204,"UCare Health, Inc.",Medical Assistance,102.9588,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Cervical Spine One View,,72020,CPT,Facility,Inpatient,,,,204,173.4,58.4664,204,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Xr Cervical Spine One View,,72020,CPT,Facility,Outpatient,,,,204,173.4,58.4664,204,"UCare Health, Inc.",Medicare Advantage,102.9588,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Cervical Spine One View,,72020,CPT,Facility,Inpatient,,,,204,173.4,58.4664,204,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Cervical Spine One View,,72020,CPT,Facility,Outpatient,,,,204,173.4,58.4664,204,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),102.9588,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Cervical Spine One View,,72020,CPT,Facility,Inpatient,,,,204,173.4,58.4664,204,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Cervical Spine One View,,72020,CPT,Facility,Both,,,,204,173.4,58.4664,204,UnitedHealthcare,Individual & Family,191.76,94,,percent of total billed charges,,
Xr Cervical Spine One View,,72020,CPT,Facility,Outpatient,,,,204,173.4,58.4664,204,UnitedHealthcare,Medicare Advantage,99.96,49,,percent of total billed charges,,
Xr Cervical Spine One View,,72020,CPT,Facility,Inpatient,,,,204,173.4,58.4664,204,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Xr Cervical Spine One View,,72020,CPT,Facility,Outpatient,,,,204,173.4,58.4664,204,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,97.92,48,,percent of total billed charges,,100% of DHS outpatient percentage
Xr Cervical Spine One View,,72020,CPT,Facility,Inpatient,,,,204,173.4,58.4664,204,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Xr Lumbar Spine One View,,72020,CPT,Facility,Both,,,,308,261.8,88.2728,308,Aetna,Commercial,283.36,92,,percent of total billed charges,,
Xr Lumbar Spine One View,,72020,CPT,Facility,Outpatient,,,,308,261.8,88.2728,308,Aetna,Medicare Advantage,150.92,49,,percent of total billed charges,,
Xr Lumbar Spine One View,,72020,CPT,Facility,Inpatient,,,,308,261.8,88.2728,308,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Xr Lumbar Spine One View,,72020,CPT,Facility,Both,,,,308,261.8,88.2728,308,Aetna,PPO,286.44,93,,percent of total billed charges,,
Xr Lumbar Spine One View,,72020,CPT,Facility,Both,,,,308,261.8,88.2728,308,America's PPO,America's PPO,295.7724,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Xr Lumbar Spine One View,,72020,CPT,Facility,Both,,,,308,261.8,88.2728,308,BlueCross BlueShield Minnesota, Federal Employee Program,303.072,98.4,,percent of total billed charges,,
Xr Lumbar Spine One View,,72020,CPT,Facility,Both,,,,308,261.8,88.2728,308,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,308,100,,percent of total billed charges,,
Xr Lumbar Spine One View,,72020,CPT,Facility,Both,,,,308,261.8,88.2728,308,BlueCross BlueShield Minnesota,High Value Network Plan,277.2,90,,percent of total billed charges,,
Xr Lumbar Spine One View,,72020,CPT,Facility,Outpatient,,,,308,261.8,88.2728,308,BlueCross BlueShield Minnesota,Medicare Advantage,150.92,49,,percent of total billed charges,,
Xr Lumbar Spine One View,,72020,CPT,Facility,Inpatient,,,,308,261.8,88.2728,308,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Xr Lumbar Spine One View,,72020,CPT,Facility,Both,,,,308,261.8,88.2728,308,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,272.7956,88.57,,percent of total billed charges,,
Xr Lumbar Spine One View,,72020,CPT,Facility,Both,,,,308,261.8,88.2728,308,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,88.2728,28.66,,percent of total billed charges,,
Xr Lumbar Spine One View,,72020,CPT,Facility,Outpatient,,,,308,261.8,88.2728,308,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),150.92,49,,percent of total billed charges,,
Xr Lumbar Spine One View,,72020,CPT,Facility,Inpatient,,,,308,261.8,88.2728,308,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Xr Lumbar Spine One View,,72020,CPT,Facility,Both,,,,308,261.8,88.2728,308,CorVel,Worker's Compensation,308,100,,percent of total billed charges,,
Xr Lumbar Spine One View,,72020,CPT,Facility,Both,,,,308,261.8,88.2728,308,First Health Group Corporation,First Health Network,298.76,97,,percent of total billed charges,,
Xr Lumbar Spine One View,,72020,CPT,Facility,Both,,,,308,261.8,88.2728,308,"Health Partners, Inc.",Commercial,291.368,94.6,,percent of total billed charges,,
Xr Lumbar Spine One View,,72020,CPT,Facility,Outpatient,,,,308,261.8,88.2728,308,"Health Partners, Inc.",Medicare Advantage,150.92,49,,percent of total billed charges,,
Xr Lumbar Spine One View,,72020,CPT,Facility,Inpatient,,,,308,261.8,88.2728,308,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Lumbar Spine One View,,72020,CPT,Facility,Both,,,,308,261.8,88.2728,308,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),184.8,60,,percent of total billed charges,,
Xr Lumbar Spine One View,,72020,CPT,Facility,Both,,,,308,261.8,88.2728,308,"Health Partners, Inc.",State of Minnesota Advantage Program,251.02,81.5,,percent of total billed charges,,
Xr Lumbar Spine One View,,72020,CPT,Facility,Both,,,,308,261.8,88.2728,308,"Health Partners, Inc.",State Public Programs,154,50,,percent of total billed charges,,
Xr Lumbar Spine One View,,72020,CPT,Facility,Both,,,,308,261.8,88.2728,308,Humana Insurance Company,Commercial PPO,292.6,95,,percent of total billed charges,,
Xr Lumbar Spine One View,,72020,CPT,Facility,Outpatient,,,,308,261.8,88.2728,308,Humana Insurance Company,Medicare PPO,150.92,49,,percent of total billed charges,,
Xr Lumbar Spine One View,,72020,CPT,Facility,Inpatient,,,,308,261.8,88.2728,308,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Xr Lumbar Spine One View,,72020,CPT,Facility,Both,,,,308,261.8,88.2728,308,Medica,Individual & Family,305.228,99.1,,percent of total billed charges,,
Xr Lumbar Spine One View,,72020,CPT,Facility,Outpatient,,,,308,261.8,88.2728,308,Medica,Medica Advantage Solution,153.384,49.8,,percent of total billed charges,,
Xr Lumbar Spine One View,,72020,CPT,Facility,Inpatient,,,,308,261.8,88.2728,308,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Xr Lumbar Spine One View,,72020,CPT,Facility,Outpatient,,,,308,261.8,88.2728,308,Medica,Medical Assistance,137.368,44.6,,percent of total billed charges,,
Xr Lumbar Spine One View,,72020,CPT,Facility,Inpatient,,,,308,261.8,88.2728,308,Medica,Medical Assistance,,,,,Included in per diem rate,
Xr Lumbar Spine One View,,72020,CPT,Facility,Outpatient,,,,308,261.8,88.2728,308,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,153.384,49.8,,percent of total billed charges,,
Xr Lumbar Spine One View,,72020,CPT,Facility,Inpatient,,,,308,261.8,88.2728,308,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Xr Lumbar Spine One View,,72020,CPT,Facility,Both,,,,308,261.8,88.2728,308,"Multiplan, Inc.","Multiplan, Inc.",289.52,94,,percent of total billed charges,,
Xr Lumbar Spine One View,,72020,CPT,Facility,Outpatient,,,,308,261.8,88.2728,308,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,277.508,90.1,,percent of total billed charges,,
Xr Lumbar Spine One View,,72020,CPT,Facility,Inpatient,,,,308,261.8,88.2728,308,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Xr Lumbar Spine One View,,72020,CPT,Facility,Both,,,,308,261.8,88.2728,308,"Preferred One Administrative Services, INC.",PPO,303.688,98.6,,percent of total billed charges,,
Xr Lumbar Spine One View,,72020,CPT,Facility,Outpatient,,,,308,261.8,88.2728,308,PrimeWest Health,Minnesota Senior Health Options (MSHO),158.466,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Xr Lumbar Spine One View,,72020,CPT,Facility,Inpatient,,,,308,261.8,88.2728,308,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Lumbar Spine One View,,72020,CPT,Facility,Outpatient,,,,308,261.8,88.2728,308,PrimeWest Health,MinnesotaCare,158.1888,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Xr Lumbar Spine One View,,72020,CPT,Facility,Inpatient,,,,308,261.8,88.2728,308,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Xr Lumbar Spine One View,,72020,CPT,Facility,Both,,,,308,261.8,88.2728,308,Sanford Health Plan,Sanford Health Plan,283.36,92,,percent of total billed charges,,
Xr Lumbar Spine One View,,72020,CPT,Facility,Outpatient,,,,308,261.8,88.2728,308,"UCare Health, Inc.",Individual & Family Plan,173.558,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Xr Lumbar Spine One View,,72020,CPT,Facility,Inpatient,,,,308,261.8,88.2728,308,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Xr Lumbar Spine One View,,72020,CPT,Facility,Outpatient,,,,308,261.8,88.2728,308,"UCare Health, Inc.",Medical Assistance,155.4476,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Lumbar Spine One View,,72020,CPT,Facility,Inpatient,,,,308,261.8,88.2728,308,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Xr Lumbar Spine One View,,72020,CPT,Facility,Outpatient,,,,308,261.8,88.2728,308,"UCare Health, Inc.",Medicare Advantage,155.4476,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Lumbar Spine One View,,72020,CPT,Facility,Inpatient,,,,308,261.8,88.2728,308,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Lumbar Spine One View,,72020,CPT,Facility,Outpatient,,,,308,261.8,88.2728,308,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),155.4476,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Lumbar Spine One View,,72020,CPT,Facility,Inpatient,,,,308,261.8,88.2728,308,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Lumbar Spine One View,,72020,CPT,Facility,Both,,,,308,261.8,88.2728,308,UnitedHealthcare,Individual & Family,289.52,94,,percent of total billed charges,,
Xr Lumbar Spine One View,,72020,CPT,Facility,Outpatient,,,,308,261.8,88.2728,308,UnitedHealthcare,Medicare Advantage,150.92,49,,percent of total billed charges,,
Xr Lumbar Spine One View,,72020,CPT,Facility,Inpatient,,,,308,261.8,88.2728,308,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Xr Lumbar Spine One View,,72020,CPT,Facility,Outpatient,,,,308,261.8,88.2728,308,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,147.84,48,,percent of total billed charges,,100% of DHS outpatient percentage
Xr Lumbar Spine One View,,72020,CPT,Facility,Inpatient,,,,308,261.8,88.2728,308,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Xr Thoracic Spine One View,,72020,CPT,Facility,Both,,,,281,238.85,80.5346,281,Aetna,Commercial,258.52,92,,percent of total billed charges,,
Xr Thoracic Spine One View,,72020,CPT,Facility,Outpatient,,,,281,238.85,80.5346,281,Aetna,Medicare Advantage,137.69,49,,percent of total billed charges,,
Xr Thoracic Spine One View,,72020,CPT,Facility,Inpatient,,,,281,238.85,80.5346,281,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Xr Thoracic Spine One View,,72020,CPT,Facility,Both,,,,281,238.85,80.5346,281,Aetna,PPO,261.33,93,,percent of total billed charges,,
Xr Thoracic Spine One View,,72020,CPT,Facility,Both,,,,281,238.85,80.5346,281,America's PPO,America's PPO,269.8443,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Xr Thoracic Spine One View,,72020,CPT,Facility,Both,,,,281,238.85,80.5346,281,BlueCross BlueShield Minnesota, Federal Employee Program,276.504,98.4,,percent of total billed charges,,
Xr Thoracic Spine One View,,72020,CPT,Facility,Both,,,,281,238.85,80.5346,281,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,281,100,,percent of total billed charges,,
Xr Thoracic Spine One View,,72020,CPT,Facility,Both,,,,281,238.85,80.5346,281,BlueCross BlueShield Minnesota,High Value Network Plan,252.9,90,,percent of total billed charges,,
Xr Thoracic Spine One View,,72020,CPT,Facility,Outpatient,,,,281,238.85,80.5346,281,BlueCross BlueShield Minnesota,Medicare Advantage,137.69,49,,percent of total billed charges,,
Xr Thoracic Spine One View,,72020,CPT,Facility,Inpatient,,,,281,238.85,80.5346,281,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Xr Thoracic Spine One View,,72020,CPT,Facility,Both,,,,281,238.85,80.5346,281,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,248.8817,88.57,,percent of total billed charges,,
Xr Thoracic Spine One View,,72020,CPT,Facility,Both,,,,281,238.85,80.5346,281,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,80.5346,28.66,,percent of total billed charges,,
Xr Thoracic Spine One View,,72020,CPT,Facility,Outpatient,,,,281,238.85,80.5346,281,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),137.69,49,,percent of total billed charges,,
Xr Thoracic Spine One View,,72020,CPT,Facility,Inpatient,,,,281,238.85,80.5346,281,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Xr Thoracic Spine One View,,72020,CPT,Facility,Both,,,,281,238.85,80.5346,281,CorVel,Worker's Compensation,281,100,,percent of total billed charges,,
Xr Thoracic Spine One View,,72020,CPT,Facility,Both,,,,281,238.85,80.5346,281,First Health Group Corporation,First Health Network,272.57,97,,percent of total billed charges,,
Xr Thoracic Spine One View,,72020,CPT,Facility,Both,,,,281,238.85,80.5346,281,"Health Partners, Inc.",Commercial,265.826,94.6,,percent of total billed charges,,
Xr Thoracic Spine One View,,72020,CPT,Facility,Outpatient,,,,281,238.85,80.5346,281,"Health Partners, Inc.",Medicare Advantage,137.69,49,,percent of total billed charges,,
Xr Thoracic Spine One View,,72020,CPT,Facility,Inpatient,,,,281,238.85,80.5346,281,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Thoracic Spine One View,,72020,CPT,Facility,Both,,,,281,238.85,80.5346,281,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),168.6,60,,percent of total billed charges,,
Xr Thoracic Spine One View,,72020,CPT,Facility,Both,,,,281,238.85,80.5346,281,"Health Partners, Inc.",State of Minnesota Advantage Program,229.015,81.5,,percent of total billed charges,,
Xr Thoracic Spine One View,,72020,CPT,Facility,Both,,,,281,238.85,80.5346,281,"Health Partners, Inc.",State Public Programs,140.5,50,,percent of total billed charges,,
Xr Thoracic Spine One View,,72020,CPT,Facility,Both,,,,281,238.85,80.5346,281,Humana Insurance Company,Commercial PPO,266.95,95,,percent of total billed charges,,
Xr Thoracic Spine One View,,72020,CPT,Facility,Outpatient,,,,281,238.85,80.5346,281,Humana Insurance Company,Medicare PPO,137.69,49,,percent of total billed charges,,
Xr Thoracic Spine One View,,72020,CPT,Facility,Inpatient,,,,281,238.85,80.5346,281,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Xr Thoracic Spine One View,,72020,CPT,Facility,Both,,,,281,238.85,80.5346,281,Medica,Individual & Family,278.471,99.1,,percent of total billed charges,,
Xr Thoracic Spine One View,,72020,CPT,Facility,Outpatient,,,,281,238.85,80.5346,281,Medica,Medica Advantage Solution,139.938,49.8,,percent of total billed charges,,
Xr Thoracic Spine One View,,72020,CPT,Facility,Inpatient,,,,281,238.85,80.5346,281,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Xr Thoracic Spine One View,,72020,CPT,Facility,Outpatient,,,,281,238.85,80.5346,281,Medica,Medical Assistance,125.326,44.6,,percent of total billed charges,,
Xr Thoracic Spine One View,,72020,CPT,Facility,Inpatient,,,,281,238.85,80.5346,281,Medica,Medical Assistance,,,,,Included in per diem rate,
Xr Thoracic Spine One View,,72020,CPT,Facility,Outpatient,,,,281,238.85,80.5346,281,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,139.938,49.8,,percent of total billed charges,,
Xr Thoracic Spine One View,,72020,CPT,Facility,Inpatient,,,,281,238.85,80.5346,281,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Xr Thoracic Spine One View,,72020,CPT,Facility,Both,,,,281,238.85,80.5346,281,"Multiplan, Inc.","Multiplan, Inc.",264.14,94,,percent of total billed charges,,
Xr Thoracic Spine One View,,72020,CPT,Facility,Outpatient,,,,281,238.85,80.5346,281,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,253.181,90.1,,percent of total billed charges,,
Xr Thoracic Spine One View,,72020,CPT,Facility,Inpatient,,,,281,238.85,80.5346,281,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Xr Thoracic Spine One View,,72020,CPT,Facility,Both,,,,281,238.85,80.5346,281,"Preferred One Administrative Services, INC.",PPO,277.066,98.6,,percent of total billed charges,,
Xr Thoracic Spine One View,,72020,CPT,Facility,Outpatient,,,,281,238.85,80.5346,281,PrimeWest Health,Minnesota Senior Health Options (MSHO),144.5745,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Xr Thoracic Spine One View,,72020,CPT,Facility,Inpatient,,,,281,238.85,80.5346,281,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Thoracic Spine One View,,72020,CPT,Facility,Outpatient,,,,281,238.85,80.5346,281,PrimeWest Health,MinnesotaCare,144.3216,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Xr Thoracic Spine One View,,72020,CPT,Facility,Inpatient,,,,281,238.85,80.5346,281,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Xr Thoracic Spine One View,,72020,CPT,Facility,Both,,,,281,238.85,80.5346,281,Sanford Health Plan,Sanford Health Plan,258.52,92,,percent of total billed charges,,
Xr Thoracic Spine One View,,72020,CPT,Facility,Outpatient,,,,281,238.85,80.5346,281,"UCare Health, Inc.",Individual & Family Plan,158.3435,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Xr Thoracic Spine One View,,72020,CPT,Facility,Inpatient,,,,281,238.85,80.5346,281,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Xr Thoracic Spine One View,,72020,CPT,Facility,Outpatient,,,,281,238.85,80.5346,281,"UCare Health, Inc.",Medical Assistance,141.8207,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Thoracic Spine One View,,72020,CPT,Facility,Inpatient,,,,281,238.85,80.5346,281,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Xr Thoracic Spine One View,,72020,CPT,Facility,Outpatient,,,,281,238.85,80.5346,281,"UCare Health, Inc.",Medicare Advantage,141.8207,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Thoracic Spine One View,,72020,CPT,Facility,Inpatient,,,,281,238.85,80.5346,281,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Thoracic Spine One View,,72020,CPT,Facility,Outpatient,,,,281,238.85,80.5346,281,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),141.8207,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Thoracic Spine One View,,72020,CPT,Facility,Inpatient,,,,281,238.85,80.5346,281,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Thoracic Spine One View,,72020,CPT,Facility,Both,,,,281,238.85,80.5346,281,UnitedHealthcare,Individual & Family,264.14,94,,percent of total billed charges,,
Xr Thoracic Spine One View,,72020,CPT,Facility,Outpatient,,,,281,238.85,80.5346,281,UnitedHealthcare,Medicare Advantage,137.69,49,,percent of total billed charges,,
Xr Thoracic Spine One View,,72020,CPT,Facility,Inpatient,,,,281,238.85,80.5346,281,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Xr Thoracic Spine One View,,72020,CPT,Facility,Outpatient,,,,281,238.85,80.5346,281,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,134.88,48,,percent of total billed charges,,100% of DHS outpatient percentage
Xr Thoracic Spine One View,,72020,CPT,Facility,Inpatient,,,,281,238.85,80.5346,281,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Xr Cervical Spine 2 Or 3 Views,,72040,CPT,Facility,Both,,,,308,261.8,88.2728,308,Aetna,Commercial,283.36,92,,percent of total billed charges,,
Xr Cervical Spine 2 Or 3 Views,,72040,CPT,Facility,Outpatient,,,,308,261.8,88.2728,308,Aetna,Medicare Advantage,150.92,49,,percent of total billed charges,,
Xr Cervical Spine 2 Or 3 Views,,72040,CPT,Facility,Inpatient,,,,308,261.8,88.2728,308,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Xr Cervical Spine 2 Or 3 Views,,72040,CPT,Facility,Both,,,,308,261.8,88.2728,308,Aetna,PPO,286.44,93,,percent of total billed charges,,
Xr Cervical Spine 2 Or 3 Views,,72040,CPT,Facility,Both,,,,308,261.8,88.2728,308,America's PPO,America's PPO,295.7724,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Xr Cervical Spine 2 Or 3 Views,,72040,CPT,Facility,Both,,,,308,261.8,88.2728,308,BlueCross BlueShield Minnesota, Federal Employee Program,303.072,98.4,,percent of total billed charges,,
Xr Cervical Spine 2 Or 3 Views,,72040,CPT,Facility,Both,,,,308,261.8,88.2728,308,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,308,100,,percent of total billed charges,,
Xr Cervical Spine 2 Or 3 Views,,72040,CPT,Facility,Both,,,,308,261.8,88.2728,308,BlueCross BlueShield Minnesota,High Value Network Plan,277.2,90,,percent of total billed charges,,
Xr Cervical Spine 2 Or 3 Views,,72040,CPT,Facility,Outpatient,,,,308,261.8,88.2728,308,BlueCross BlueShield Minnesota,Medicare Advantage,150.92,49,,percent of total billed charges,,
Xr Cervical Spine 2 Or 3 Views,,72040,CPT,Facility,Inpatient,,,,308,261.8,88.2728,308,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Xr Cervical Spine 2 Or 3 Views,,72040,CPT,Facility,Both,,,,308,261.8,88.2728,308,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,272.7956,88.57,,percent of total billed charges,,
Xr Cervical Spine 2 Or 3 Views,,72040,CPT,Facility,Both,,,,308,261.8,88.2728,308,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,88.2728,28.66,,percent of total billed charges,,
Xr Cervical Spine 2 Or 3 Views,,72040,CPT,Facility,Outpatient,,,,308,261.8,88.2728,308,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),150.92,49,,percent of total billed charges,,
Xr Cervical Spine 2 Or 3 Views,,72040,CPT,Facility,Inpatient,,,,308,261.8,88.2728,308,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Xr Cervical Spine 2 Or 3 Views,,72040,CPT,Facility,Both,,,,308,261.8,88.2728,308,CorVel,Worker's Compensation,308,100,,percent of total billed charges,,
Xr Cervical Spine 2 Or 3 Views,,72040,CPT,Facility,Both,,,,308,261.8,88.2728,308,First Health Group Corporation,First Health Network,298.76,97,,percent of total billed charges,,
Xr Cervical Spine 2 Or 3 Views,,72040,CPT,Facility,Both,,,,308,261.8,88.2728,308,"Health Partners, Inc.",Commercial,291.368,94.6,,percent of total billed charges,,
Xr Cervical Spine 2 Or 3 Views,,72040,CPT,Facility,Outpatient,,,,308,261.8,88.2728,308,"Health Partners, Inc.",Medicare Advantage,150.92,49,,percent of total billed charges,,
Xr Cervical Spine 2 Or 3 Views,,72040,CPT,Facility,Inpatient,,,,308,261.8,88.2728,308,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Cervical Spine 2 Or 3 Views,,72040,CPT,Facility,Both,,,,308,261.8,88.2728,308,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),184.8,60,,percent of total billed charges,,
Xr Cervical Spine 2 Or 3 Views,,72040,CPT,Facility,Both,,,,308,261.8,88.2728,308,"Health Partners, Inc.",State of Minnesota Advantage Program,251.02,81.5,,percent of total billed charges,,
Xr Cervical Spine 2 Or 3 Views,,72040,CPT,Facility,Both,,,,308,261.8,88.2728,308,"Health Partners, Inc.",State Public Programs,154,50,,percent of total billed charges,,
Xr Cervical Spine 2 Or 3 Views,,72040,CPT,Facility,Both,,,,308,261.8,88.2728,308,Humana Insurance Company,Commercial PPO,292.6,95,,percent of total billed charges,,
Xr Cervical Spine 2 Or 3 Views,,72040,CPT,Facility,Outpatient,,,,308,261.8,88.2728,308,Humana Insurance Company,Medicare PPO,150.92,49,,percent of total billed charges,,
Xr Cervical Spine 2 Or 3 Views,,72040,CPT,Facility,Inpatient,,,,308,261.8,88.2728,308,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Xr Cervical Spine 2 Or 3 Views,,72040,CPT,Facility,Both,,,,308,261.8,88.2728,308,Medica,Individual & Family,305.228,99.1,,percent of total billed charges,,
Xr Cervical Spine 2 Or 3 Views,,72040,CPT,Facility,Outpatient,,,,308,261.8,88.2728,308,Medica,Medica Advantage Solution,153.384,49.8,,percent of total billed charges,,
Xr Cervical Spine 2 Or 3 Views,,72040,CPT,Facility,Inpatient,,,,308,261.8,88.2728,308,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Xr Cervical Spine 2 Or 3 Views,,72040,CPT,Facility,Outpatient,,,,308,261.8,88.2728,308,Medica,Medical Assistance,137.368,44.6,,percent of total billed charges,,
Xr Cervical Spine 2 Or 3 Views,,72040,CPT,Facility,Inpatient,,,,308,261.8,88.2728,308,Medica,Medical Assistance,,,,,Included in per diem rate,
Xr Cervical Spine 2 Or 3 Views,,72040,CPT,Facility,Outpatient,,,,308,261.8,88.2728,308,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,153.384,49.8,,percent of total billed charges,,
Xr Cervical Spine 2 Or 3 Views,,72040,CPT,Facility,Inpatient,,,,308,261.8,88.2728,308,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Xr Cervical Spine 2 Or 3 Views,,72040,CPT,Facility,Both,,,,308,261.8,88.2728,308,"Multiplan, Inc.","Multiplan, Inc.",289.52,94,,percent of total billed charges,,
Xr Cervical Spine 2 Or 3 Views,,72040,CPT,Facility,Outpatient,,,,308,261.8,88.2728,308,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,277.508,90.1,,percent of total billed charges,,
Xr Cervical Spine 2 Or 3 Views,,72040,CPT,Facility,Inpatient,,,,308,261.8,88.2728,308,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Xr Cervical Spine 2 Or 3 Views,,72040,CPT,Facility,Both,,,,308,261.8,88.2728,308,"Preferred One Administrative Services, INC.",PPO,303.688,98.6,,percent of total billed charges,,
Xr Cervical Spine 2 Or 3 Views,,72040,CPT,Facility,Outpatient,,,,308,261.8,88.2728,308,PrimeWest Health,Minnesota Senior Health Options (MSHO),158.466,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Xr Cervical Spine 2 Or 3 Views,,72040,CPT,Facility,Inpatient,,,,308,261.8,88.2728,308,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Cervical Spine 2 Or 3 Views,,72040,CPT,Facility,Outpatient,,,,308,261.8,88.2728,308,PrimeWest Health,MinnesotaCare,158.1888,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Xr Cervical Spine 2 Or 3 Views,,72040,CPT,Facility,Inpatient,,,,308,261.8,88.2728,308,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Xr Cervical Spine 2 Or 3 Views,,72040,CPT,Facility,Both,,,,308,261.8,88.2728,308,Sanford Health Plan,Sanford Health Plan,283.36,92,,percent of total billed charges,,
Xr Cervical Spine 2 Or 3 Views,,72040,CPT,Facility,Outpatient,,,,308,261.8,88.2728,308,"UCare Health, Inc.",Individual & Family Plan,173.558,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Xr Cervical Spine 2 Or 3 Views,,72040,CPT,Facility,Inpatient,,,,308,261.8,88.2728,308,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Xr Cervical Spine 2 Or 3 Views,,72040,CPT,Facility,Outpatient,,,,308,261.8,88.2728,308,"UCare Health, Inc.",Medical Assistance,155.4476,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Cervical Spine 2 Or 3 Views,,72040,CPT,Facility,Inpatient,,,,308,261.8,88.2728,308,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Xr Cervical Spine 2 Or 3 Views,,72040,CPT,Facility,Outpatient,,,,308,261.8,88.2728,308,"UCare Health, Inc.",Medicare Advantage,155.4476,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Cervical Spine 2 Or 3 Views,,72040,CPT,Facility,Inpatient,,,,308,261.8,88.2728,308,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Cervical Spine 2 Or 3 Views,,72040,CPT,Facility,Outpatient,,,,308,261.8,88.2728,308,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),155.4476,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Cervical Spine 2 Or 3 Views,,72040,CPT,Facility,Inpatient,,,,308,261.8,88.2728,308,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Cervical Spine 2 Or 3 Views,,72040,CPT,Facility,Both,,,,308,261.8,88.2728,308,UnitedHealthcare,Individual & Family,289.52,94,,percent of total billed charges,,
Xr Cervical Spine 2 Or 3 Views,,72040,CPT,Facility,Outpatient,,,,308,261.8,88.2728,308,UnitedHealthcare,Medicare Advantage,150.92,49,,percent of total billed charges,,
Xr Cervical Spine 2 Or 3 Views,,72040,CPT,Facility,Inpatient,,,,308,261.8,88.2728,308,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Xr Cervical Spine 2 Or 3 Views,,72040,CPT,Facility,Outpatient,,,,308,261.8,88.2728,308,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,147.84,48,,percent of total billed charges,,100% of DHS outpatient percentage
Xr Cervical Spine 2 Or 3 Views,,72040,CPT,Facility,Inpatient,,,,308,261.8,88.2728,308,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Xr Cervical Spine 4 To 6 Views,,72050,CPT,Facility,Both,,,,393,334.05,112.6338,393,Aetna,Commercial,361.56,92,,percent of total billed charges,,
Xr Cervical Spine 4 To 6 Views,,72050,CPT,Facility,Outpatient,,,,393,334.05,112.6338,393,Aetna,Medicare Advantage,192.57,49,,percent of total billed charges,,
Xr Cervical Spine 4 To 6 Views,,72050,CPT,Facility,Inpatient,,,,393,334.05,112.6338,393,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Xr Cervical Spine 4 To 6 Views,,72050,CPT,Facility,Both,,,,393,334.05,112.6338,393,Aetna,PPO,365.49,93,,percent of total billed charges,,
Xr Cervical Spine 4 To 6 Views,,72050,CPT,Facility,Both,,,,393,334.05,112.6338,393,America's PPO,America's PPO,377.3979,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Xr Cervical Spine 4 To 6 Views,,72050,CPT,Facility,Both,,,,393,334.05,112.6338,393,BlueCross BlueShield Minnesota, Federal Employee Program,386.712,98.4,,percent of total billed charges,,
Xr Cervical Spine 4 To 6 Views,,72050,CPT,Facility,Both,,,,393,334.05,112.6338,393,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,393,100,,percent of total billed charges,,
Xr Cervical Spine 4 To 6 Views,,72050,CPT,Facility,Both,,,,393,334.05,112.6338,393,BlueCross BlueShield Minnesota,High Value Network Plan,353.7,90,,percent of total billed charges,,
Xr Cervical Spine 4 To 6 Views,,72050,CPT,Facility,Outpatient,,,,393,334.05,112.6338,393,BlueCross BlueShield Minnesota,Medicare Advantage,192.57,49,,percent of total billed charges,,
Xr Cervical Spine 4 To 6 Views,,72050,CPT,Facility,Inpatient,,,,393,334.05,112.6338,393,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Xr Cervical Spine 4 To 6 Views,,72050,CPT,Facility,Both,,,,393,334.05,112.6338,393,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,348.0801,88.57,,percent of total billed charges,,
Xr Cervical Spine 4 To 6 Views,,72050,CPT,Facility,Both,,,,393,334.05,112.6338,393,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,112.6338,28.66,,percent of total billed charges,,
Xr Cervical Spine 4 To 6 Views,,72050,CPT,Facility,Outpatient,,,,393,334.05,112.6338,393,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),192.57,49,,percent of total billed charges,,
Xr Cervical Spine 4 To 6 Views,,72050,CPT,Facility,Inpatient,,,,393,334.05,112.6338,393,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Xr Cervical Spine 4 To 6 Views,,72050,CPT,Facility,Both,,,,393,334.05,112.6338,393,CorVel,Worker's Compensation,393,100,,percent of total billed charges,,
Xr Cervical Spine 4 To 6 Views,,72050,CPT,Facility,Both,,,,393,334.05,112.6338,393,First Health Group Corporation,First Health Network,381.21,97,,percent of total billed charges,,
Xr Cervical Spine 4 To 6 Views,,72050,CPT,Facility,Both,,,,393,334.05,112.6338,393,"Health Partners, Inc.",Commercial,371.778,94.6,,percent of total billed charges,,
Xr Cervical Spine 4 To 6 Views,,72050,CPT,Facility,Outpatient,,,,393,334.05,112.6338,393,"Health Partners, Inc.",Medicare Advantage,192.57,49,,percent of total billed charges,,
Xr Cervical Spine 4 To 6 Views,,72050,CPT,Facility,Inpatient,,,,393,334.05,112.6338,393,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Cervical Spine 4 To 6 Views,,72050,CPT,Facility,Both,,,,393,334.05,112.6338,393,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),235.8,60,,percent of total billed charges,,
Xr Cervical Spine 4 To 6 Views,,72050,CPT,Facility,Both,,,,393,334.05,112.6338,393,"Health Partners, Inc.",State of Minnesota Advantage Program,320.295,81.5,,percent of total billed charges,,
Xr Cervical Spine 4 To 6 Views,,72050,CPT,Facility,Both,,,,393,334.05,112.6338,393,"Health Partners, Inc.",State Public Programs,196.5,50,,percent of total billed charges,,
Xr Cervical Spine 4 To 6 Views,,72050,CPT,Facility,Both,,,,393,334.05,112.6338,393,Humana Insurance Company,Commercial PPO,373.35,95,,percent of total billed charges,,
Xr Cervical Spine 4 To 6 Views,,72050,CPT,Facility,Outpatient,,,,393,334.05,112.6338,393,Humana Insurance Company,Medicare PPO,192.57,49,,percent of total billed charges,,
Xr Cervical Spine 4 To 6 Views,,72050,CPT,Facility,Inpatient,,,,393,334.05,112.6338,393,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Xr Cervical Spine 4 To 6 Views,,72050,CPT,Facility,Both,,,,393,334.05,112.6338,393,Medica,Individual & Family,389.463,99.1,,percent of total billed charges,,
Xr Cervical Spine 4 To 6 Views,,72050,CPT,Facility,Outpatient,,,,393,334.05,112.6338,393,Medica,Medica Advantage Solution,195.714,49.8,,percent of total billed charges,,
Xr Cervical Spine 4 To 6 Views,,72050,CPT,Facility,Inpatient,,,,393,334.05,112.6338,393,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Xr Cervical Spine 4 To 6 Views,,72050,CPT,Facility,Outpatient,,,,393,334.05,112.6338,393,Medica,Medical Assistance,175.278,44.6,,percent of total billed charges,,
Xr Cervical Spine 4 To 6 Views,,72050,CPT,Facility,Inpatient,,,,393,334.05,112.6338,393,Medica,Medical Assistance,,,,,Included in per diem rate,
Xr Cervical Spine 4 To 6 Views,,72050,CPT,Facility,Outpatient,,,,393,334.05,112.6338,393,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,195.714,49.8,,percent of total billed charges,,
Xr Cervical Spine 4 To 6 Views,,72050,CPT,Facility,Inpatient,,,,393,334.05,112.6338,393,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Xr Cervical Spine 4 To 6 Views,,72050,CPT,Facility,Both,,,,393,334.05,112.6338,393,"Multiplan, Inc.","Multiplan, Inc.",369.42,94,,percent of total billed charges,,
Xr Cervical Spine 4 To 6 Views,,72050,CPT,Facility,Outpatient,,,,393,334.05,112.6338,393,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,354.093,90.1,,percent of total billed charges,,
Xr Cervical Spine 4 To 6 Views,,72050,CPT,Facility,Inpatient,,,,393,334.05,112.6338,393,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Xr Cervical Spine 4 To 6 Views,,72050,CPT,Facility,Both,,,,393,334.05,112.6338,393,"Preferred One Administrative Services, INC.",PPO,387.498,98.6,,percent of total billed charges,,
Xr Cervical Spine 4 To 6 Views,,72050,CPT,Facility,Outpatient,,,,393,334.05,112.6338,393,PrimeWest Health,Minnesota Senior Health Options (MSHO),202.1985,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Xr Cervical Spine 4 To 6 Views,,72050,CPT,Facility,Inpatient,,,,393,334.05,112.6338,393,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Cervical Spine 4 To 6 Views,,72050,CPT,Facility,Outpatient,,,,393,334.05,112.6338,393,PrimeWest Health,MinnesotaCare,201.8448,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Xr Cervical Spine 4 To 6 Views,,72050,CPT,Facility,Inpatient,,,,393,334.05,112.6338,393,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Xr Cervical Spine 4 To 6 Views,,72050,CPT,Facility,Both,,,,393,334.05,112.6338,393,Sanford Health Plan,Sanford Health Plan,361.56,92,,percent of total billed charges,,
Xr Cervical Spine 4 To 6 Views,,72050,CPT,Facility,Outpatient,,,,393,334.05,112.6338,393,"UCare Health, Inc.",Individual & Family Plan,221.4555,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Xr Cervical Spine 4 To 6 Views,,72050,CPT,Facility,Inpatient,,,,393,334.05,112.6338,393,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Xr Cervical Spine 4 To 6 Views,,72050,CPT,Facility,Outpatient,,,,393,334.05,112.6338,393,"UCare Health, Inc.",Medical Assistance,198.3471,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Cervical Spine 4 To 6 Views,,72050,CPT,Facility,Inpatient,,,,393,334.05,112.6338,393,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Xr Cervical Spine 4 To 6 Views,,72050,CPT,Facility,Outpatient,,,,393,334.05,112.6338,393,"UCare Health, Inc.",Medicare Advantage,198.3471,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Cervical Spine 4 To 6 Views,,72050,CPT,Facility,Inpatient,,,,393,334.05,112.6338,393,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Cervical Spine 4 To 6 Views,,72050,CPT,Facility,Outpatient,,,,393,334.05,112.6338,393,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),198.3471,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Cervical Spine 4 To 6 Views,,72050,CPT,Facility,Inpatient,,,,393,334.05,112.6338,393,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Cervical Spine 4 To 6 Views,,72050,CPT,Facility,Both,,,,393,334.05,112.6338,393,UnitedHealthcare,Individual & Family,369.42,94,,percent of total billed charges,,
Xr Cervical Spine 4 To 6 Views,,72050,CPT,Facility,Outpatient,,,,393,334.05,112.6338,393,UnitedHealthcare,Medicare Advantage,192.57,49,,percent of total billed charges,,
Xr Cervical Spine 4 To 6 Views,,72050,CPT,Facility,Inpatient,,,,393,334.05,112.6338,393,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Xr Cervical Spine 4 To 6 Views,,72050,CPT,Facility,Outpatient,,,,393,334.05,112.6338,393,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,188.64,48,,percent of total billed charges,,100% of DHS outpatient percentage
Xr Cervical Spine 4 To 6 Views,,72050,CPT,Facility,Inpatient,,,,393,334.05,112.6338,393,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Xr Cervical Spine W Flex Ext Obl Ap,,72052,CPT,Facility,Both,,,,420,357,120.372,420,Aetna,Commercial,386.4,92,,percent of total billed charges,,
Xr Cervical Spine W Flex Ext Obl Ap,,72052,CPT,Facility,Outpatient,,,,420,357,120.372,420,Aetna,Medicare Advantage,205.8,49,,percent of total billed charges,,
Xr Cervical Spine W Flex Ext Obl Ap,,72052,CPT,Facility,Inpatient,,,,420,357,120.372,420,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Xr Cervical Spine W Flex Ext Obl Ap,,72052,CPT,Facility,Both,,,,420,357,120.372,420,Aetna,PPO,390.6,93,,percent of total billed charges,,
Xr Cervical Spine W Flex Ext Obl Ap,,72052,CPT,Facility,Both,,,,420,357,120.372,420,America's PPO,America's PPO,403.326,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Xr Cervical Spine W Flex Ext Obl Ap,,72052,CPT,Facility,Both,,,,420,357,120.372,420,BlueCross BlueShield Minnesota, Federal Employee Program,413.28,98.4,,percent of total billed charges,,
Xr Cervical Spine W Flex Ext Obl Ap,,72052,CPT,Facility,Both,,,,420,357,120.372,420,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,420,100,,percent of total billed charges,,
Xr Cervical Spine W Flex Ext Obl Ap,,72052,CPT,Facility,Both,,,,420,357,120.372,420,BlueCross BlueShield Minnesota,High Value Network Plan,378,90,,percent of total billed charges,,
Xr Cervical Spine W Flex Ext Obl Ap,,72052,CPT,Facility,Outpatient,,,,420,357,120.372,420,BlueCross BlueShield Minnesota,Medicare Advantage,205.8,49,,percent of total billed charges,,
Xr Cervical Spine W Flex Ext Obl Ap,,72052,CPT,Facility,Inpatient,,,,420,357,120.372,420,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Xr Cervical Spine W Flex Ext Obl Ap,,72052,CPT,Facility,Both,,,,420,357,120.372,420,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,371.994,88.57,,percent of total billed charges,,
Xr Cervical Spine W Flex Ext Obl Ap,,72052,CPT,Facility,Both,,,,420,357,120.372,420,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,120.372,28.66,,percent of total billed charges,,
Xr Cervical Spine W Flex Ext Obl Ap,,72052,CPT,Facility,Outpatient,,,,420,357,120.372,420,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),205.8,49,,percent of total billed charges,,
Xr Cervical Spine W Flex Ext Obl Ap,,72052,CPT,Facility,Inpatient,,,,420,357,120.372,420,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Xr Cervical Spine W Flex Ext Obl Ap,,72052,CPT,Facility,Both,,,,420,357,120.372,420,CorVel,Worker's Compensation,420,100,,percent of total billed charges,,
Xr Cervical Spine W Flex Ext Obl Ap,,72052,CPT,Facility,Both,,,,420,357,120.372,420,First Health Group Corporation,First Health Network,407.4,97,,percent of total billed charges,,
Xr Cervical Spine W Flex Ext Obl Ap,,72052,CPT,Facility,Both,,,,420,357,120.372,420,"Health Partners, Inc.",Commercial,397.32,94.6,,percent of total billed charges,,
Xr Cervical Spine W Flex Ext Obl Ap,,72052,CPT,Facility,Outpatient,,,,420,357,120.372,420,"Health Partners, Inc.",Medicare Advantage,205.8,49,,percent of total billed charges,,
Xr Cervical Spine W Flex Ext Obl Ap,,72052,CPT,Facility,Inpatient,,,,420,357,120.372,420,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Cervical Spine W Flex Ext Obl Ap,,72052,CPT,Facility,Both,,,,420,357,120.372,420,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),252,60,,percent of total billed charges,,
Xr Cervical Spine W Flex Ext Obl Ap,,72052,CPT,Facility,Both,,,,420,357,120.372,420,"Health Partners, Inc.",State of Minnesota Advantage Program,342.3,81.5,,percent of total billed charges,,
Xr Cervical Spine W Flex Ext Obl Ap,,72052,CPT,Facility,Both,,,,420,357,120.372,420,"Health Partners, Inc.",State Public Programs,210,50,,percent of total billed charges,,
Xr Cervical Spine W Flex Ext Obl Ap,,72052,CPT,Facility,Both,,,,420,357,120.372,420,Humana Insurance Company,Commercial PPO,399,95,,percent of total billed charges,,
Xr Cervical Spine W Flex Ext Obl Ap,,72052,CPT,Facility,Outpatient,,,,420,357,120.372,420,Humana Insurance Company,Medicare PPO,205.8,49,,percent of total billed charges,,
Xr Cervical Spine W Flex Ext Obl Ap,,72052,CPT,Facility,Inpatient,,,,420,357,120.372,420,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Xr Cervical Spine W Flex Ext Obl Ap,,72052,CPT,Facility,Both,,,,420,357,120.372,420,Medica,Individual & Family,416.22,99.1,,percent of total billed charges,,
Xr Cervical Spine W Flex Ext Obl Ap,,72052,CPT,Facility,Outpatient,,,,420,357,120.372,420,Medica,Medica Advantage Solution,209.16,49.8,,percent of total billed charges,,
Xr Cervical Spine W Flex Ext Obl Ap,,72052,CPT,Facility,Inpatient,,,,420,357,120.372,420,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Xr Cervical Spine W Flex Ext Obl Ap,,72052,CPT,Facility,Outpatient,,,,420,357,120.372,420,Medica,Medical Assistance,187.32,44.6,,percent of total billed charges,,
Xr Cervical Spine W Flex Ext Obl Ap,,72052,CPT,Facility,Inpatient,,,,420,357,120.372,420,Medica,Medical Assistance,,,,,Included in per diem rate,
Xr Cervical Spine W Flex Ext Obl Ap,,72052,CPT,Facility,Outpatient,,,,420,357,120.372,420,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,209.16,49.8,,percent of total billed charges,,
Xr Cervical Spine W Flex Ext Obl Ap,,72052,CPT,Facility,Inpatient,,,,420,357,120.372,420,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Xr Cervical Spine W Flex Ext Obl Ap,,72052,CPT,Facility,Both,,,,420,357,120.372,420,"Multiplan, Inc.","Multiplan, Inc.",394.8,94,,percent of total billed charges,,
Xr Cervical Spine W Flex Ext Obl Ap,,72052,CPT,Facility,Outpatient,,,,420,357,120.372,420,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,378.42,90.1,,percent of total billed charges,,
Xr Cervical Spine W Flex Ext Obl Ap,,72052,CPT,Facility,Inpatient,,,,420,357,120.372,420,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Xr Cervical Spine W Flex Ext Obl Ap,,72052,CPT,Facility,Both,,,,420,357,120.372,420,"Preferred One Administrative Services, INC.",PPO,414.12,98.6,,percent of total billed charges,,
Xr Cervical Spine W Flex Ext Obl Ap,,72052,CPT,Facility,Outpatient,,,,420,357,120.372,420,PrimeWest Health,Minnesota Senior Health Options (MSHO),216.09,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Xr Cervical Spine W Flex Ext Obl Ap,,72052,CPT,Facility,Inpatient,,,,420,357,120.372,420,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Cervical Spine W Flex Ext Obl Ap,,72052,CPT,Facility,Outpatient,,,,420,357,120.372,420,PrimeWest Health,MinnesotaCare,215.712,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Xr Cervical Spine W Flex Ext Obl Ap,,72052,CPT,Facility,Inpatient,,,,420,357,120.372,420,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Xr Cervical Spine W Flex Ext Obl Ap,,72052,CPT,Facility,Both,,,,420,357,120.372,420,Sanford Health Plan,Sanford Health Plan,386.4,92,,percent of total billed charges,,
Xr Cervical Spine W Flex Ext Obl Ap,,72052,CPT,Facility,Outpatient,,,,420,357,120.372,420,"UCare Health, Inc.",Individual & Family Plan,236.67,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Xr Cervical Spine W Flex Ext Obl Ap,,72052,CPT,Facility,Inpatient,,,,420,357,120.372,420,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Xr Cervical Spine W Flex Ext Obl Ap,,72052,CPT,Facility,Outpatient,,,,420,357,120.372,420,"UCare Health, Inc.",Medical Assistance,211.974,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Cervical Spine W Flex Ext Obl Ap,,72052,CPT,Facility,Inpatient,,,,420,357,120.372,420,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Xr Cervical Spine W Flex Ext Obl Ap,,72052,CPT,Facility,Outpatient,,,,420,357,120.372,420,"UCare Health, Inc.",Medicare Advantage,211.974,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Cervical Spine W Flex Ext Obl Ap,,72052,CPT,Facility,Inpatient,,,,420,357,120.372,420,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Cervical Spine W Flex Ext Obl Ap,,72052,CPT,Facility,Outpatient,,,,420,357,120.372,420,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),211.974,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Cervical Spine W Flex Ext Obl Ap,,72052,CPT,Facility,Inpatient,,,,420,357,120.372,420,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Cervical Spine W Flex Ext Obl Ap,,72052,CPT,Facility,Both,,,,420,357,120.372,420,UnitedHealthcare,Individual & Family,394.8,94,,percent of total billed charges,,
Xr Cervical Spine W Flex Ext Obl Ap,,72052,CPT,Facility,Outpatient,,,,420,357,120.372,420,UnitedHealthcare,Medicare Advantage,205.8,49,,percent of total billed charges,,
Xr Cervical Spine W Flex Ext Obl Ap,,72052,CPT,Facility,Inpatient,,,,420,357,120.372,420,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Xr Cervical Spine W Flex Ext Obl Ap,,72052,CPT,Facility,Outpatient,,,,420,357,120.372,420,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,201.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
Xr Cervical Spine W Flex Ext Obl Ap,,72052,CPT,Facility,Inpatient,,,,420,357,120.372,420,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Xr Thoracic Spine Ap And Lat,,72070,CPT,Facility,Both,,,,305,259.25,87.413,305,Aetna,Commercial,280.6,92,,percent of total billed charges,,
Xr Thoracic Spine Ap And Lat,,72070,CPT,Facility,Outpatient,,,,305,259.25,87.413,305,Aetna,Medicare Advantage,149.45,49,,percent of total billed charges,,
Xr Thoracic Spine Ap And Lat,,72070,CPT,Facility,Inpatient,,,,305,259.25,87.413,305,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Xr Thoracic Spine Ap And Lat,,72070,CPT,Facility,Both,,,,305,259.25,87.413,305,Aetna,PPO,283.65,93,,percent of total billed charges,,
Xr Thoracic Spine Ap And Lat,,72070,CPT,Facility,Both,,,,305,259.25,87.413,305,America's PPO,America's PPO,292.8915,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Xr Thoracic Spine Ap And Lat,,72070,CPT,Facility,Both,,,,305,259.25,87.413,305,BlueCross BlueShield Minnesota, Federal Employee Program,300.12,98.4,,percent of total billed charges,,
Xr Thoracic Spine Ap And Lat,,72070,CPT,Facility,Both,,,,305,259.25,87.413,305,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,305,100,,percent of total billed charges,,
Xr Thoracic Spine Ap And Lat,,72070,CPT,Facility,Both,,,,305,259.25,87.413,305,BlueCross BlueShield Minnesota,High Value Network Plan,274.5,90,,percent of total billed charges,,
Xr Thoracic Spine Ap And Lat,,72070,CPT,Facility,Outpatient,,,,305,259.25,87.413,305,BlueCross BlueShield Minnesota,Medicare Advantage,149.45,49,,percent of total billed charges,,
Xr Thoracic Spine Ap And Lat,,72070,CPT,Facility,Inpatient,,,,305,259.25,87.413,305,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Xr Thoracic Spine Ap And Lat,,72070,CPT,Facility,Both,,,,305,259.25,87.413,305,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,270.1385,88.57,,percent of total billed charges,,
Xr Thoracic Spine Ap And Lat,,72070,CPT,Facility,Both,,,,305,259.25,87.413,305,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,87.413,28.66,,percent of total billed charges,,
Xr Thoracic Spine Ap And Lat,,72070,CPT,Facility,Outpatient,,,,305,259.25,87.413,305,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),149.45,49,,percent of total billed charges,,
Xr Thoracic Spine Ap And Lat,,72070,CPT,Facility,Inpatient,,,,305,259.25,87.413,305,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Xr Thoracic Spine Ap And Lat,,72070,CPT,Facility,Both,,,,305,259.25,87.413,305,CorVel,Worker's Compensation,305,100,,percent of total billed charges,,
Xr Thoracic Spine Ap And Lat,,72070,CPT,Facility,Both,,,,305,259.25,87.413,305,First Health Group Corporation,First Health Network,295.85,97,,percent of total billed charges,,
Xr Thoracic Spine Ap And Lat,,72070,CPT,Facility,Both,,,,305,259.25,87.413,305,"Health Partners, Inc.",Commercial,288.53,94.6,,percent of total billed charges,,
Xr Thoracic Spine Ap And Lat,,72070,CPT,Facility,Outpatient,,,,305,259.25,87.413,305,"Health Partners, Inc.",Medicare Advantage,149.45,49,,percent of total billed charges,,
Xr Thoracic Spine Ap And Lat,,72070,CPT,Facility,Inpatient,,,,305,259.25,87.413,305,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Thoracic Spine Ap And Lat,,72070,CPT,Facility,Both,,,,305,259.25,87.413,305,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),183,60,,percent of total billed charges,,
Xr Thoracic Spine Ap And Lat,,72070,CPT,Facility,Both,,,,305,259.25,87.413,305,"Health Partners, Inc.",State of Minnesota Advantage Program,248.575,81.5,,percent of total billed charges,,
Xr Thoracic Spine Ap And Lat,,72070,CPT,Facility,Both,,,,305,259.25,87.413,305,"Health Partners, Inc.",State Public Programs,152.5,50,,percent of total billed charges,,
Xr Thoracic Spine Ap And Lat,,72070,CPT,Facility,Both,,,,305,259.25,87.413,305,Humana Insurance Company,Commercial PPO,289.75,95,,percent of total billed charges,,
Xr Thoracic Spine Ap And Lat,,72070,CPT,Facility,Outpatient,,,,305,259.25,87.413,305,Humana Insurance Company,Medicare PPO,149.45,49,,percent of total billed charges,,
Xr Thoracic Spine Ap And Lat,,72070,CPT,Facility,Inpatient,,,,305,259.25,87.413,305,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Xr Thoracic Spine Ap And Lat,,72070,CPT,Facility,Both,,,,305,259.25,87.413,305,Medica,Individual & Family,302.255,99.1,,percent of total billed charges,,
Xr Thoracic Spine Ap And Lat,,72070,CPT,Facility,Outpatient,,,,305,259.25,87.413,305,Medica,Medica Advantage Solution,151.89,49.8,,percent of total billed charges,,
Xr Thoracic Spine Ap And Lat,,72070,CPT,Facility,Inpatient,,,,305,259.25,87.413,305,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Xr Thoracic Spine Ap And Lat,,72070,CPT,Facility,Outpatient,,,,305,259.25,87.413,305,Medica,Medical Assistance,136.03,44.6,,percent of total billed charges,,
Xr Thoracic Spine Ap And Lat,,72070,CPT,Facility,Inpatient,,,,305,259.25,87.413,305,Medica,Medical Assistance,,,,,Included in per diem rate,
Xr Thoracic Spine Ap And Lat,,72070,CPT,Facility,Outpatient,,,,305,259.25,87.413,305,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,151.89,49.8,,percent of total billed charges,,
Xr Thoracic Spine Ap And Lat,,72070,CPT,Facility,Inpatient,,,,305,259.25,87.413,305,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Xr Thoracic Spine Ap And Lat,,72070,CPT,Facility,Both,,,,305,259.25,87.413,305,"Multiplan, Inc.","Multiplan, Inc.",286.7,94,,percent of total billed charges,,
Xr Thoracic Spine Ap And Lat,,72070,CPT,Facility,Outpatient,,,,305,259.25,87.413,305,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,274.805,90.1,,percent of total billed charges,,
Xr Thoracic Spine Ap And Lat,,72070,CPT,Facility,Inpatient,,,,305,259.25,87.413,305,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Xr Thoracic Spine Ap And Lat,,72070,CPT,Facility,Both,,,,305,259.25,87.413,305,"Preferred One Administrative Services, INC.",PPO,300.73,98.6,,percent of total billed charges,,
Xr Thoracic Spine Ap And Lat,,72070,CPT,Facility,Outpatient,,,,305,259.25,87.413,305,PrimeWest Health,Minnesota Senior Health Options (MSHO),156.9225,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Xr Thoracic Spine Ap And Lat,,72070,CPT,Facility,Inpatient,,,,305,259.25,87.413,305,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Thoracic Spine Ap And Lat,,72070,CPT,Facility,Outpatient,,,,305,259.25,87.413,305,PrimeWest Health,MinnesotaCare,156.648,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Xr Thoracic Spine Ap And Lat,,72070,CPT,Facility,Inpatient,,,,305,259.25,87.413,305,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Xr Thoracic Spine Ap And Lat,,72070,CPT,Facility,Both,,,,305,259.25,87.413,305,Sanford Health Plan,Sanford Health Plan,280.6,92,,percent of total billed charges,,
Xr Thoracic Spine Ap And Lat,,72070,CPT,Facility,Outpatient,,,,305,259.25,87.413,305,"UCare Health, Inc.",Individual & Family Plan,171.8675,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Xr Thoracic Spine Ap And Lat,,72070,CPT,Facility,Inpatient,,,,305,259.25,87.413,305,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Xr Thoracic Spine Ap And Lat,,72070,CPT,Facility,Outpatient,,,,305,259.25,87.413,305,"UCare Health, Inc.",Medical Assistance,153.9335,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Thoracic Spine Ap And Lat,,72070,CPT,Facility,Inpatient,,,,305,259.25,87.413,305,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Xr Thoracic Spine Ap And Lat,,72070,CPT,Facility,Outpatient,,,,305,259.25,87.413,305,"UCare Health, Inc.",Medicare Advantage,153.9335,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Thoracic Spine Ap And Lat,,72070,CPT,Facility,Inpatient,,,,305,259.25,87.413,305,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Thoracic Spine Ap And Lat,,72070,CPT,Facility,Outpatient,,,,305,259.25,87.413,305,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),153.9335,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Thoracic Spine Ap And Lat,,72070,CPT,Facility,Inpatient,,,,305,259.25,87.413,305,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Thoracic Spine Ap And Lat,,72070,CPT,Facility,Both,,,,305,259.25,87.413,305,UnitedHealthcare,Individual & Family,286.7,94,,percent of total billed charges,,
Xr Thoracic Spine Ap And Lat,,72070,CPT,Facility,Outpatient,,,,305,259.25,87.413,305,UnitedHealthcare,Medicare Advantage,149.45,49,,percent of total billed charges,,
Xr Thoracic Spine Ap And Lat,,72070,CPT,Facility,Inpatient,,,,305,259.25,87.413,305,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Xr Thoracic Spine Ap And Lat,,72070,CPT,Facility,Outpatient,,,,305,259.25,87.413,305,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,146.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
Xr Thoracic Spine Ap And Lat,,72070,CPT,Facility,Inpatient,,,,305,259.25,87.413,305,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Xr Thoracic Spine Routine 3 Views,,72072,CPT,Facility,Both,,,,328,278.8,94.0048,328,Aetna,Commercial,301.76,92,,percent of total billed charges,,
Xr Thoracic Spine Routine 3 Views,,72072,CPT,Facility,Outpatient,,,,328,278.8,94.0048,328,Aetna,Medicare Advantage,160.72,49,,percent of total billed charges,,
Xr Thoracic Spine Routine 3 Views,,72072,CPT,Facility,Inpatient,,,,328,278.8,94.0048,328,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Xr Thoracic Spine Routine 3 Views,,72072,CPT,Facility,Both,,,,328,278.8,94.0048,328,Aetna,PPO,305.04,93,,percent of total billed charges,,
Xr Thoracic Spine Routine 3 Views,,72072,CPT,Facility,Both,,,,328,278.8,94.0048,328,America's PPO,America's PPO,314.9784,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Xr Thoracic Spine Routine 3 Views,,72072,CPT,Facility,Both,,,,328,278.8,94.0048,328,BlueCross BlueShield Minnesota, Federal Employee Program,322.752,98.4,,percent of total billed charges,,
Xr Thoracic Spine Routine 3 Views,,72072,CPT,Facility,Both,,,,328,278.8,94.0048,328,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,328,100,,percent of total billed charges,,
Xr Thoracic Spine Routine 3 Views,,72072,CPT,Facility,Both,,,,328,278.8,94.0048,328,BlueCross BlueShield Minnesota,High Value Network Plan,295.2,90,,percent of total billed charges,,
Xr Thoracic Spine Routine 3 Views,,72072,CPT,Facility,Outpatient,,,,328,278.8,94.0048,328,BlueCross BlueShield Minnesota,Medicare Advantage,160.72,49,,percent of total billed charges,,
Xr Thoracic Spine Routine 3 Views,,72072,CPT,Facility,Inpatient,,,,328,278.8,94.0048,328,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Xr Thoracic Spine Routine 3 Views,,72072,CPT,Facility,Both,,,,328,278.8,94.0048,328,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,290.5096,88.57,,percent of total billed charges,,
Xr Thoracic Spine Routine 3 Views,,72072,CPT,Facility,Both,,,,328,278.8,94.0048,328,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,94.0048,28.66,,percent of total billed charges,,
Xr Thoracic Spine Routine 3 Views,,72072,CPT,Facility,Outpatient,,,,328,278.8,94.0048,328,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),160.72,49,,percent of total billed charges,,
Xr Thoracic Spine Routine 3 Views,,72072,CPT,Facility,Inpatient,,,,328,278.8,94.0048,328,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Xr Thoracic Spine Routine 3 Views,,72072,CPT,Facility,Both,,,,328,278.8,94.0048,328,CorVel,Worker's Compensation,328,100,,percent of total billed charges,,
Xr Thoracic Spine Routine 3 Views,,72072,CPT,Facility,Both,,,,328,278.8,94.0048,328,First Health Group Corporation,First Health Network,318.16,97,,percent of total billed charges,,
Xr Thoracic Spine Routine 3 Views,,72072,CPT,Facility,Both,,,,328,278.8,94.0048,328,"Health Partners, Inc.",Commercial,310.288,94.6,,percent of total billed charges,,
Xr Thoracic Spine Routine 3 Views,,72072,CPT,Facility,Outpatient,,,,328,278.8,94.0048,328,"Health Partners, Inc.",Medicare Advantage,160.72,49,,percent of total billed charges,,
Xr Thoracic Spine Routine 3 Views,,72072,CPT,Facility,Inpatient,,,,328,278.8,94.0048,328,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Thoracic Spine Routine 3 Views,,72072,CPT,Facility,Both,,,,328,278.8,94.0048,328,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),196.8,60,,percent of total billed charges,,
Xr Thoracic Spine Routine 3 Views,,72072,CPT,Facility,Both,,,,328,278.8,94.0048,328,"Health Partners, Inc.",State of Minnesota Advantage Program,267.32,81.5,,percent of total billed charges,,
Xr Thoracic Spine Routine 3 Views,,72072,CPT,Facility,Both,,,,328,278.8,94.0048,328,"Health Partners, Inc.",State Public Programs,164,50,,percent of total billed charges,,
Xr Thoracic Spine Routine 3 Views,,72072,CPT,Facility,Both,,,,328,278.8,94.0048,328,Humana Insurance Company,Commercial PPO,311.6,95,,percent of total billed charges,,
Xr Thoracic Spine Routine 3 Views,,72072,CPT,Facility,Outpatient,,,,328,278.8,94.0048,328,Humana Insurance Company,Medicare PPO,160.72,49,,percent of total billed charges,,
Xr Thoracic Spine Routine 3 Views,,72072,CPT,Facility,Inpatient,,,,328,278.8,94.0048,328,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Xr Thoracic Spine Routine 3 Views,,72072,CPT,Facility,Both,,,,328,278.8,94.0048,328,Medica,Individual & Family,325.048,99.1,,percent of total billed charges,,
Xr Thoracic Spine Routine 3 Views,,72072,CPT,Facility,Outpatient,,,,328,278.8,94.0048,328,Medica,Medica Advantage Solution,163.344,49.8,,percent of total billed charges,,
Xr Thoracic Spine Routine 3 Views,,72072,CPT,Facility,Inpatient,,,,328,278.8,94.0048,328,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Xr Thoracic Spine Routine 3 Views,,72072,CPT,Facility,Outpatient,,,,328,278.8,94.0048,328,Medica,Medical Assistance,146.288,44.6,,percent of total billed charges,,
Xr Thoracic Spine Routine 3 Views,,72072,CPT,Facility,Inpatient,,,,328,278.8,94.0048,328,Medica,Medical Assistance,,,,,Included in per diem rate,
Xr Thoracic Spine Routine 3 Views,,72072,CPT,Facility,Outpatient,,,,328,278.8,94.0048,328,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,163.344,49.8,,percent of total billed charges,,
Xr Thoracic Spine Routine 3 Views,,72072,CPT,Facility,Inpatient,,,,328,278.8,94.0048,328,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Xr Thoracic Spine Routine 3 Views,,72072,CPT,Facility,Both,,,,328,278.8,94.0048,328,"Multiplan, Inc.","Multiplan, Inc.",308.32,94,,percent of total billed charges,,
Xr Thoracic Spine Routine 3 Views,,72072,CPT,Facility,Outpatient,,,,328,278.8,94.0048,328,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,295.528,90.1,,percent of total billed charges,,
Xr Thoracic Spine Routine 3 Views,,72072,CPT,Facility,Inpatient,,,,328,278.8,94.0048,328,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Xr Thoracic Spine Routine 3 Views,,72072,CPT,Facility,Both,,,,328,278.8,94.0048,328,"Preferred One Administrative Services, INC.",PPO,323.408,98.6,,percent of total billed charges,,
Xr Thoracic Spine Routine 3 Views,,72072,CPT,Facility,Outpatient,,,,328,278.8,94.0048,328,PrimeWest Health,Minnesota Senior Health Options (MSHO),168.756,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Xr Thoracic Spine Routine 3 Views,,72072,CPT,Facility,Inpatient,,,,328,278.8,94.0048,328,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Thoracic Spine Routine 3 Views,,72072,CPT,Facility,Outpatient,,,,328,278.8,94.0048,328,PrimeWest Health,MinnesotaCare,168.4608,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Xr Thoracic Spine Routine 3 Views,,72072,CPT,Facility,Inpatient,,,,328,278.8,94.0048,328,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Xr Thoracic Spine Routine 3 Views,,72072,CPT,Facility,Both,,,,328,278.8,94.0048,328,Sanford Health Plan,Sanford Health Plan,301.76,92,,percent of total billed charges,,
Xr Thoracic Spine Routine 3 Views,,72072,CPT,Facility,Outpatient,,,,328,278.8,94.0048,328,"UCare Health, Inc.",Individual & Family Plan,184.828,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Xr Thoracic Spine Routine 3 Views,,72072,CPT,Facility,Inpatient,,,,328,278.8,94.0048,328,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Xr Thoracic Spine Routine 3 Views,,72072,CPT,Facility,Outpatient,,,,328,278.8,94.0048,328,"UCare Health, Inc.",Medical Assistance,165.5416,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Thoracic Spine Routine 3 Views,,72072,CPT,Facility,Inpatient,,,,328,278.8,94.0048,328,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Xr Thoracic Spine Routine 3 Views,,72072,CPT,Facility,Outpatient,,,,328,278.8,94.0048,328,"UCare Health, Inc.",Medicare Advantage,165.5416,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Thoracic Spine Routine 3 Views,,72072,CPT,Facility,Inpatient,,,,328,278.8,94.0048,328,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Thoracic Spine Routine 3 Views,,72072,CPT,Facility,Outpatient,,,,328,278.8,94.0048,328,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),165.5416,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Thoracic Spine Routine 3 Views,,72072,CPT,Facility,Inpatient,,,,328,278.8,94.0048,328,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Thoracic Spine Routine 3 Views,,72072,CPT,Facility,Both,,,,328,278.8,94.0048,328,UnitedHealthcare,Individual & Family,308.32,94,,percent of total billed charges,,
Xr Thoracic Spine Routine 3 Views,,72072,CPT,Facility,Outpatient,,,,328,278.8,94.0048,328,UnitedHealthcare,Medicare Advantage,160.72,49,,percent of total billed charges,,
Xr Thoracic Spine Routine 3 Views,,72072,CPT,Facility,Inpatient,,,,328,278.8,94.0048,328,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Xr Thoracic Spine Routine 3 Views,,72072,CPT,Facility,Outpatient,,,,328,278.8,94.0048,328,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,157.44,48,,percent of total billed charges,,100% of DHS outpatient percentage
Xr Thoracic Spine Routine 3 Views,,72072,CPT,Facility,Inpatient,,,,328,278.8,94.0048,328,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Xr Spine Thoracic Min 4 Views,,72074,CPT,Facility,Both,,,,359,305.15,102.8894,359,Aetna,Commercial,330.28,92,,percent of total billed charges,,
Xr Spine Thoracic Min 4 Views,,72074,CPT,Facility,Outpatient,,,,359,305.15,102.8894,359,Aetna,Medicare Advantage,175.91,49,,percent of total billed charges,,
Xr Spine Thoracic Min 4 Views,,72074,CPT,Facility,Inpatient,,,,359,305.15,102.8894,359,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Xr Spine Thoracic Min 4 Views,,72074,CPT,Facility,Both,,,,359,305.15,102.8894,359,Aetna,PPO,333.87,93,,percent of total billed charges,,
Xr Spine Thoracic Min 4 Views,,72074,CPT,Facility,Both,,,,359,305.15,102.8894,359,America's PPO,America's PPO,344.7477,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Xr Spine Thoracic Min 4 Views,,72074,CPT,Facility,Both,,,,359,305.15,102.8894,359,BlueCross BlueShield Minnesota, Federal Employee Program,353.256,98.4,,percent of total billed charges,,
Xr Spine Thoracic Min 4 Views,,72074,CPT,Facility,Both,,,,359,305.15,102.8894,359,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,359,100,,percent of total billed charges,,
Xr Spine Thoracic Min 4 Views,,72074,CPT,Facility,Both,,,,359,305.15,102.8894,359,BlueCross BlueShield Minnesota,High Value Network Plan,323.1,90,,percent of total billed charges,,
Xr Spine Thoracic Min 4 Views,,72074,CPT,Facility,Outpatient,,,,359,305.15,102.8894,359,BlueCross BlueShield Minnesota,Medicare Advantage,175.91,49,,percent of total billed charges,,
Xr Spine Thoracic Min 4 Views,,72074,CPT,Facility,Inpatient,,,,359,305.15,102.8894,359,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Xr Spine Thoracic Min 4 Views,,72074,CPT,Facility,Both,,,,359,305.15,102.8894,359,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,317.9663,88.57,,percent of total billed charges,,
Xr Spine Thoracic Min 4 Views,,72074,CPT,Facility,Both,,,,359,305.15,102.8894,359,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,102.8894,28.66,,percent of total billed charges,,
Xr Spine Thoracic Min 4 Views,,72074,CPT,Facility,Outpatient,,,,359,305.15,102.8894,359,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),175.91,49,,percent of total billed charges,,
Xr Spine Thoracic Min 4 Views,,72074,CPT,Facility,Inpatient,,,,359,305.15,102.8894,359,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Xr Spine Thoracic Min 4 Views,,72074,CPT,Facility,Both,,,,359,305.15,102.8894,359,CorVel,Worker's Compensation,359,100,,percent of total billed charges,,
Xr Spine Thoracic Min 4 Views,,72074,CPT,Facility,Both,,,,359,305.15,102.8894,359,First Health Group Corporation,First Health Network,348.23,97,,percent of total billed charges,,
Xr Spine Thoracic Min 4 Views,,72074,CPT,Facility,Both,,,,359,305.15,102.8894,359,"Health Partners, Inc.",Commercial,339.614,94.6,,percent of total billed charges,,
Xr Spine Thoracic Min 4 Views,,72074,CPT,Facility,Outpatient,,,,359,305.15,102.8894,359,"Health Partners, Inc.",Medicare Advantage,175.91,49,,percent of total billed charges,,
Xr Spine Thoracic Min 4 Views,,72074,CPT,Facility,Inpatient,,,,359,305.15,102.8894,359,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Spine Thoracic Min 4 Views,,72074,CPT,Facility,Both,,,,359,305.15,102.8894,359,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),215.4,60,,percent of total billed charges,,
Xr Spine Thoracic Min 4 Views,,72074,CPT,Facility,Both,,,,359,305.15,102.8894,359,"Health Partners, Inc.",State of Minnesota Advantage Program,292.585,81.5,,percent of total billed charges,,
Xr Spine Thoracic Min 4 Views,,72074,CPT,Facility,Both,,,,359,305.15,102.8894,359,"Health Partners, Inc.",State Public Programs,179.5,50,,percent of total billed charges,,
Xr Spine Thoracic Min 4 Views,,72074,CPT,Facility,Both,,,,359,305.15,102.8894,359,Humana Insurance Company,Commercial PPO,341.05,95,,percent of total billed charges,,
Xr Spine Thoracic Min 4 Views,,72074,CPT,Facility,Outpatient,,,,359,305.15,102.8894,359,Humana Insurance Company,Medicare PPO,175.91,49,,percent of total billed charges,,
Xr Spine Thoracic Min 4 Views,,72074,CPT,Facility,Inpatient,,,,359,305.15,102.8894,359,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Xr Spine Thoracic Min 4 Views,,72074,CPT,Facility,Both,,,,359,305.15,102.8894,359,Medica,Individual & Family,355.769,99.1,,percent of total billed charges,,
Xr Spine Thoracic Min 4 Views,,72074,CPT,Facility,Outpatient,,,,359,305.15,102.8894,359,Medica,Medica Advantage Solution,178.782,49.8,,percent of total billed charges,,
Xr Spine Thoracic Min 4 Views,,72074,CPT,Facility,Inpatient,,,,359,305.15,102.8894,359,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Xr Spine Thoracic Min 4 Views,,72074,CPT,Facility,Outpatient,,,,359,305.15,102.8894,359,Medica,Medical Assistance,160.114,44.6,,percent of total billed charges,,
Xr Spine Thoracic Min 4 Views,,72074,CPT,Facility,Inpatient,,,,359,305.15,102.8894,359,Medica,Medical Assistance,,,,,Included in per diem rate,
Xr Spine Thoracic Min 4 Views,,72074,CPT,Facility,Outpatient,,,,359,305.15,102.8894,359,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,178.782,49.8,,percent of total billed charges,,
Xr Spine Thoracic Min 4 Views,,72074,CPT,Facility,Inpatient,,,,359,305.15,102.8894,359,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Xr Spine Thoracic Min 4 Views,,72074,CPT,Facility,Both,,,,359,305.15,102.8894,359,"Multiplan, Inc.","Multiplan, Inc.",337.46,94,,percent of total billed charges,,
Xr Spine Thoracic Min 4 Views,,72074,CPT,Facility,Outpatient,,,,359,305.15,102.8894,359,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,323.459,90.1,,percent of total billed charges,,
Xr Spine Thoracic Min 4 Views,,72074,CPT,Facility,Inpatient,,,,359,305.15,102.8894,359,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Xr Spine Thoracic Min 4 Views,,72074,CPT,Facility,Both,,,,359,305.15,102.8894,359,"Preferred One Administrative Services, INC.",PPO,353.974,98.6,,percent of total billed charges,,
Xr Spine Thoracic Min 4 Views,,72074,CPT,Facility,Outpatient,,,,359,305.15,102.8894,359,PrimeWest Health,Minnesota Senior Health Options (MSHO),184.7055,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Xr Spine Thoracic Min 4 Views,,72074,CPT,Facility,Inpatient,,,,359,305.15,102.8894,359,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Spine Thoracic Min 4 Views,,72074,CPT,Facility,Outpatient,,,,359,305.15,102.8894,359,PrimeWest Health,MinnesotaCare,184.3824,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Xr Spine Thoracic Min 4 Views,,72074,CPT,Facility,Inpatient,,,,359,305.15,102.8894,359,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Xr Spine Thoracic Min 4 Views,,72074,CPT,Facility,Both,,,,359,305.15,102.8894,359,Sanford Health Plan,Sanford Health Plan,330.28,92,,percent of total billed charges,,
Xr Spine Thoracic Min 4 Views,,72074,CPT,Facility,Outpatient,,,,359,305.15,102.8894,359,"UCare Health, Inc.",Individual & Family Plan,202.2965,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Xr Spine Thoracic Min 4 Views,,72074,CPT,Facility,Inpatient,,,,359,305.15,102.8894,359,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Xr Spine Thoracic Min 4 Views,,72074,CPT,Facility,Outpatient,,,,359,305.15,102.8894,359,"UCare Health, Inc.",Medical Assistance,181.1873,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Spine Thoracic Min 4 Views,,72074,CPT,Facility,Inpatient,,,,359,305.15,102.8894,359,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Xr Spine Thoracic Min 4 Views,,72074,CPT,Facility,Outpatient,,,,359,305.15,102.8894,359,"UCare Health, Inc.",Medicare Advantage,181.1873,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Spine Thoracic Min 4 Views,,72074,CPT,Facility,Inpatient,,,,359,305.15,102.8894,359,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Spine Thoracic Min 4 Views,,72074,CPT,Facility,Outpatient,,,,359,305.15,102.8894,359,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),181.1873,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Spine Thoracic Min 4 Views,,72074,CPT,Facility,Inpatient,,,,359,305.15,102.8894,359,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Spine Thoracic Min 4 Views,,72074,CPT,Facility,Both,,,,359,305.15,102.8894,359,UnitedHealthcare,Individual & Family,337.46,94,,percent of total billed charges,,
Xr Spine Thoracic Min 4 Views,,72074,CPT,Facility,Outpatient,,,,359,305.15,102.8894,359,UnitedHealthcare,Medicare Advantage,175.91,49,,percent of total billed charges,,
Xr Spine Thoracic Min 4 Views,,72074,CPT,Facility,Inpatient,,,,359,305.15,102.8894,359,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Xr Spine Thoracic Min 4 Views,,72074,CPT,Facility,Outpatient,,,,359,305.15,102.8894,359,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,172.32,48,,percent of total billed charges,,100% of DHS outpatient percentage
Xr Spine Thoracic Min 4 Views,,72074,CPT,Facility,Inpatient,,,,359,305.15,102.8894,359,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Xr Thoracolumbar Spine Ap And Lat,,72080,CPT,Facility,Both,,,,277,235.45,79.3882,277,Aetna,Commercial,254.84,92,,percent of total billed charges,,
Xr Thoracolumbar Spine Ap And Lat,,72080,CPT,Facility,Outpatient,,,,277,235.45,79.3882,277,Aetna,Medicare Advantage,135.73,49,,percent of total billed charges,,
Xr Thoracolumbar Spine Ap And Lat,,72080,CPT,Facility,Inpatient,,,,277,235.45,79.3882,277,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Xr Thoracolumbar Spine Ap And Lat,,72080,CPT,Facility,Both,,,,277,235.45,79.3882,277,Aetna,PPO,257.61,93,,percent of total billed charges,,
Xr Thoracolumbar Spine Ap And Lat,,72080,CPT,Facility,Both,,,,277,235.45,79.3882,277,America's PPO,America's PPO,266.0031,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Xr Thoracolumbar Spine Ap And Lat,,72080,CPT,Facility,Both,,,,277,235.45,79.3882,277,BlueCross BlueShield Minnesota, Federal Employee Program,272.568,98.4,,percent of total billed charges,,
Xr Thoracolumbar Spine Ap And Lat,,72080,CPT,Facility,Both,,,,277,235.45,79.3882,277,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,277,100,,percent of total billed charges,,
Xr Thoracolumbar Spine Ap And Lat,,72080,CPT,Facility,Both,,,,277,235.45,79.3882,277,BlueCross BlueShield Minnesota,High Value Network Plan,249.3,90,,percent of total billed charges,,
Xr Thoracolumbar Spine Ap And Lat,,72080,CPT,Facility,Outpatient,,,,277,235.45,79.3882,277,BlueCross BlueShield Minnesota,Medicare Advantage,135.73,49,,percent of total billed charges,,
Xr Thoracolumbar Spine Ap And Lat,,72080,CPT,Facility,Inpatient,,,,277,235.45,79.3882,277,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Xr Thoracolumbar Spine Ap And Lat,,72080,CPT,Facility,Both,,,,277,235.45,79.3882,277,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,245.3389,88.57,,percent of total billed charges,,
Xr Thoracolumbar Spine Ap And Lat,,72080,CPT,Facility,Both,,,,277,235.45,79.3882,277,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,79.3882,28.66,,percent of total billed charges,,
Xr Thoracolumbar Spine Ap And Lat,,72080,CPT,Facility,Outpatient,,,,277,235.45,79.3882,277,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),135.73,49,,percent of total billed charges,,
Xr Thoracolumbar Spine Ap And Lat,,72080,CPT,Facility,Inpatient,,,,277,235.45,79.3882,277,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Xr Thoracolumbar Spine Ap And Lat,,72080,CPT,Facility,Both,,,,277,235.45,79.3882,277,CorVel,Worker's Compensation,277,100,,percent of total billed charges,,
Xr Thoracolumbar Spine Ap And Lat,,72080,CPT,Facility,Both,,,,277,235.45,79.3882,277,First Health Group Corporation,First Health Network,268.69,97,,percent of total billed charges,,
Xr Thoracolumbar Spine Ap And Lat,,72080,CPT,Facility,Both,,,,277,235.45,79.3882,277,"Health Partners, Inc.",Commercial,262.042,94.6,,percent of total billed charges,,
Xr Thoracolumbar Spine Ap And Lat,,72080,CPT,Facility,Outpatient,,,,277,235.45,79.3882,277,"Health Partners, Inc.",Medicare Advantage,135.73,49,,percent of total billed charges,,
Xr Thoracolumbar Spine Ap And Lat,,72080,CPT,Facility,Inpatient,,,,277,235.45,79.3882,277,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Thoracolumbar Spine Ap And Lat,,72080,CPT,Facility,Both,,,,277,235.45,79.3882,277,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),166.2,60,,percent of total billed charges,,
Xr Thoracolumbar Spine Ap And Lat,,72080,CPT,Facility,Both,,,,277,235.45,79.3882,277,"Health Partners, Inc.",State of Minnesota Advantage Program,225.755,81.5,,percent of total billed charges,,
Xr Thoracolumbar Spine Ap And Lat,,72080,CPT,Facility,Both,,,,277,235.45,79.3882,277,"Health Partners, Inc.",State Public Programs,138.5,50,,percent of total billed charges,,
Xr Thoracolumbar Spine Ap And Lat,,72080,CPT,Facility,Both,,,,277,235.45,79.3882,277,Humana Insurance Company,Commercial PPO,263.15,95,,percent of total billed charges,,
Xr Thoracolumbar Spine Ap And Lat,,72080,CPT,Facility,Outpatient,,,,277,235.45,79.3882,277,Humana Insurance Company,Medicare PPO,135.73,49,,percent of total billed charges,,
Xr Thoracolumbar Spine Ap And Lat,,72080,CPT,Facility,Inpatient,,,,277,235.45,79.3882,277,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Xr Thoracolumbar Spine Ap And Lat,,72080,CPT,Facility,Both,,,,277,235.45,79.3882,277,Medica,Individual & Family,274.507,99.1,,percent of total billed charges,,
Xr Thoracolumbar Spine Ap And Lat,,72080,CPT,Facility,Outpatient,,,,277,235.45,79.3882,277,Medica,Medica Advantage Solution,137.946,49.8,,percent of total billed charges,,
Xr Thoracolumbar Spine Ap And Lat,,72080,CPT,Facility,Inpatient,,,,277,235.45,79.3882,277,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Xr Thoracolumbar Spine Ap And Lat,,72080,CPT,Facility,Outpatient,,,,277,235.45,79.3882,277,Medica,Medical Assistance,123.542,44.6,,percent of total billed charges,,
Xr Thoracolumbar Spine Ap And Lat,,72080,CPT,Facility,Inpatient,,,,277,235.45,79.3882,277,Medica,Medical Assistance,,,,,Included in per diem rate,
Xr Thoracolumbar Spine Ap And Lat,,72080,CPT,Facility,Outpatient,,,,277,235.45,79.3882,277,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,137.946,49.8,,percent of total billed charges,,
Xr Thoracolumbar Spine Ap And Lat,,72080,CPT,Facility,Inpatient,,,,277,235.45,79.3882,277,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Xr Thoracolumbar Spine Ap And Lat,,72080,CPT,Facility,Both,,,,277,235.45,79.3882,277,"Multiplan, Inc.","Multiplan, Inc.",260.38,94,,percent of total billed charges,,
Xr Thoracolumbar Spine Ap And Lat,,72080,CPT,Facility,Outpatient,,,,277,235.45,79.3882,277,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,249.577,90.1,,percent of total billed charges,,
Xr Thoracolumbar Spine Ap And Lat,,72080,CPT,Facility,Inpatient,,,,277,235.45,79.3882,277,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Xr Thoracolumbar Spine Ap And Lat,,72080,CPT,Facility,Both,,,,277,235.45,79.3882,277,"Preferred One Administrative Services, INC.",PPO,273.122,98.6,,percent of total billed charges,,
Xr Thoracolumbar Spine Ap And Lat,,72080,CPT,Facility,Outpatient,,,,277,235.45,79.3882,277,PrimeWest Health,Minnesota Senior Health Options (MSHO),142.5165,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Xr Thoracolumbar Spine Ap And Lat,,72080,CPT,Facility,Inpatient,,,,277,235.45,79.3882,277,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Thoracolumbar Spine Ap And Lat,,72080,CPT,Facility,Outpatient,,,,277,235.45,79.3882,277,PrimeWest Health,MinnesotaCare,142.2672,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Xr Thoracolumbar Spine Ap And Lat,,72080,CPT,Facility,Inpatient,,,,277,235.45,79.3882,277,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Xr Thoracolumbar Spine Ap And Lat,,72080,CPT,Facility,Both,,,,277,235.45,79.3882,277,Sanford Health Plan,Sanford Health Plan,254.84,92,,percent of total billed charges,,
Xr Thoracolumbar Spine Ap And Lat,,72080,CPT,Facility,Outpatient,,,,277,235.45,79.3882,277,"UCare Health, Inc.",Individual & Family Plan,156.0895,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Xr Thoracolumbar Spine Ap And Lat,,72080,CPT,Facility,Inpatient,,,,277,235.45,79.3882,277,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Xr Thoracolumbar Spine Ap And Lat,,72080,CPT,Facility,Outpatient,,,,277,235.45,79.3882,277,"UCare Health, Inc.",Medical Assistance,139.8019,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Thoracolumbar Spine Ap And Lat,,72080,CPT,Facility,Inpatient,,,,277,235.45,79.3882,277,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Xr Thoracolumbar Spine Ap And Lat,,72080,CPT,Facility,Outpatient,,,,277,235.45,79.3882,277,"UCare Health, Inc.",Medicare Advantage,139.8019,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Thoracolumbar Spine Ap And Lat,,72080,CPT,Facility,Inpatient,,,,277,235.45,79.3882,277,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Thoracolumbar Spine Ap And Lat,,72080,CPT,Facility,Outpatient,,,,277,235.45,79.3882,277,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),139.8019,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Thoracolumbar Spine Ap And Lat,,72080,CPT,Facility,Inpatient,,,,277,235.45,79.3882,277,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Thoracolumbar Spine Ap And Lat,,72080,CPT,Facility,Both,,,,277,235.45,79.3882,277,UnitedHealthcare,Individual & Family,260.38,94,,percent of total billed charges,,
Xr Thoracolumbar Spine Ap And Lat,,72080,CPT,Facility,Outpatient,,,,277,235.45,79.3882,277,UnitedHealthcare,Medicare Advantage,135.73,49,,percent of total billed charges,,
Xr Thoracolumbar Spine Ap And Lat,,72080,CPT,Facility,Inpatient,,,,277,235.45,79.3882,277,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Xr Thoracolumbar Spine Ap And Lat,,72080,CPT,Facility,Outpatient,,,,277,235.45,79.3882,277,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,132.96,48,,percent of total billed charges,,100% of DHS outpatient percentage
Xr Thoracolumbar Spine Ap And Lat,,72080,CPT,Facility,Inpatient,,,,277,235.45,79.3882,277,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Xr Scoliosis Routine Standing One View,,72081,CPT,Facility,Both,,,,281,238.85,80.5346,281,Aetna,Commercial,258.52,92,,percent of total billed charges,,
Xr Scoliosis Routine Standing One View,,72081,CPT,Facility,Outpatient,,,,281,238.85,80.5346,281,Aetna,Medicare Advantage,137.69,49,,percent of total billed charges,,
Xr Scoliosis Routine Standing One View,,72081,CPT,Facility,Inpatient,,,,281,238.85,80.5346,281,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Xr Scoliosis Routine Standing One View,,72081,CPT,Facility,Both,,,,281,238.85,80.5346,281,Aetna,PPO,261.33,93,,percent of total billed charges,,
Xr Scoliosis Routine Standing One View,,72081,CPT,Facility,Both,,,,281,238.85,80.5346,281,America's PPO,America's PPO,269.8443,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Xr Scoliosis Routine Standing One View,,72081,CPT,Facility,Both,,,,281,238.85,80.5346,281,BlueCross BlueShield Minnesota, Federal Employee Program,276.504,98.4,,percent of total billed charges,,
Xr Scoliosis Routine Standing One View,,72081,CPT,Facility,Both,,,,281,238.85,80.5346,281,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,281,100,,percent of total billed charges,,
Xr Scoliosis Routine Standing One View,,72081,CPT,Facility,Both,,,,281,238.85,80.5346,281,BlueCross BlueShield Minnesota,High Value Network Plan,252.9,90,,percent of total billed charges,,
Xr Scoliosis Routine Standing One View,,72081,CPT,Facility,Outpatient,,,,281,238.85,80.5346,281,BlueCross BlueShield Minnesota,Medicare Advantage,137.69,49,,percent of total billed charges,,
Xr Scoliosis Routine Standing One View,,72081,CPT,Facility,Inpatient,,,,281,238.85,80.5346,281,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Xr Scoliosis Routine Standing One View,,72081,CPT,Facility,Both,,,,281,238.85,80.5346,281,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,248.8817,88.57,,percent of total billed charges,,
Xr Scoliosis Routine Standing One View,,72081,CPT,Facility,Both,,,,281,238.85,80.5346,281,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,80.5346,28.66,,percent of total billed charges,,
Xr Scoliosis Routine Standing One View,,72081,CPT,Facility,Outpatient,,,,281,238.85,80.5346,281,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),137.69,49,,percent of total billed charges,,
Xr Scoliosis Routine Standing One View,,72081,CPT,Facility,Inpatient,,,,281,238.85,80.5346,281,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Xr Scoliosis Routine Standing One View,,72081,CPT,Facility,Both,,,,281,238.85,80.5346,281,CorVel,Worker's Compensation,281,100,,percent of total billed charges,,
Xr Scoliosis Routine Standing One View,,72081,CPT,Facility,Both,,,,281,238.85,80.5346,281,First Health Group Corporation,First Health Network,272.57,97,,percent of total billed charges,,
Xr Scoliosis Routine Standing One View,,72081,CPT,Facility,Both,,,,281,238.85,80.5346,281,"Health Partners, Inc.",Commercial,265.826,94.6,,percent of total billed charges,,
Xr Scoliosis Routine Standing One View,,72081,CPT,Facility,Outpatient,,,,281,238.85,80.5346,281,"Health Partners, Inc.",Medicare Advantage,137.69,49,,percent of total billed charges,,
Xr Scoliosis Routine Standing One View,,72081,CPT,Facility,Inpatient,,,,281,238.85,80.5346,281,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Scoliosis Routine Standing One View,,72081,CPT,Facility,Both,,,,281,238.85,80.5346,281,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),168.6,60,,percent of total billed charges,,
Xr Scoliosis Routine Standing One View,,72081,CPT,Facility,Both,,,,281,238.85,80.5346,281,"Health Partners, Inc.",State of Minnesota Advantage Program,229.015,81.5,,percent of total billed charges,,
Xr Scoliosis Routine Standing One View,,72081,CPT,Facility,Both,,,,281,238.85,80.5346,281,"Health Partners, Inc.",State Public Programs,140.5,50,,percent of total billed charges,,
Xr Scoliosis Routine Standing One View,,72081,CPT,Facility,Both,,,,281,238.85,80.5346,281,Humana Insurance Company,Commercial PPO,266.95,95,,percent of total billed charges,,
Xr Scoliosis Routine Standing One View,,72081,CPT,Facility,Outpatient,,,,281,238.85,80.5346,281,Humana Insurance Company,Medicare PPO,137.69,49,,percent of total billed charges,,
Xr Scoliosis Routine Standing One View,,72081,CPT,Facility,Inpatient,,,,281,238.85,80.5346,281,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Xr Scoliosis Routine Standing One View,,72081,CPT,Facility,Both,,,,281,238.85,80.5346,281,Medica,Individual & Family,278.471,99.1,,percent of total billed charges,,
Xr Scoliosis Routine Standing One View,,72081,CPT,Facility,Outpatient,,,,281,238.85,80.5346,281,Medica,Medica Advantage Solution,139.938,49.8,,percent of total billed charges,,
Xr Scoliosis Routine Standing One View,,72081,CPT,Facility,Inpatient,,,,281,238.85,80.5346,281,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Xr Scoliosis Routine Standing One View,,72081,CPT,Facility,Outpatient,,,,281,238.85,80.5346,281,Medica,Medical Assistance,125.326,44.6,,percent of total billed charges,,
Xr Scoliosis Routine Standing One View,,72081,CPT,Facility,Inpatient,,,,281,238.85,80.5346,281,Medica,Medical Assistance,,,,,Included in per diem rate,
Xr Scoliosis Routine Standing One View,,72081,CPT,Facility,Outpatient,,,,281,238.85,80.5346,281,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,139.938,49.8,,percent of total billed charges,,
Xr Scoliosis Routine Standing One View,,72081,CPT,Facility,Inpatient,,,,281,238.85,80.5346,281,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Xr Scoliosis Routine Standing One View,,72081,CPT,Facility,Both,,,,281,238.85,80.5346,281,"Multiplan, Inc.","Multiplan, Inc.",264.14,94,,percent of total billed charges,,
Xr Scoliosis Routine Standing One View,,72081,CPT,Facility,Outpatient,,,,281,238.85,80.5346,281,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,253.181,90.1,,percent of total billed charges,,
Xr Scoliosis Routine Standing One View,,72081,CPT,Facility,Inpatient,,,,281,238.85,80.5346,281,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Xr Scoliosis Routine Standing One View,,72081,CPT,Facility,Both,,,,281,238.85,80.5346,281,"Preferred One Administrative Services, INC.",PPO,277.066,98.6,,percent of total billed charges,,
Xr Scoliosis Routine Standing One View,,72081,CPT,Facility,Outpatient,,,,281,238.85,80.5346,281,PrimeWest Health,Minnesota Senior Health Options (MSHO),144.5745,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Xr Scoliosis Routine Standing One View,,72081,CPT,Facility,Inpatient,,,,281,238.85,80.5346,281,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Scoliosis Routine Standing One View,,72081,CPT,Facility,Outpatient,,,,281,238.85,80.5346,281,PrimeWest Health,MinnesotaCare,144.3216,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Xr Scoliosis Routine Standing One View,,72081,CPT,Facility,Inpatient,,,,281,238.85,80.5346,281,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Xr Scoliosis Routine Standing One View,,72081,CPT,Facility,Both,,,,281,238.85,80.5346,281,Sanford Health Plan,Sanford Health Plan,258.52,92,,percent of total billed charges,,
Xr Scoliosis Routine Standing One View,,72081,CPT,Facility,Outpatient,,,,281,238.85,80.5346,281,"UCare Health, Inc.",Individual & Family Plan,158.3435,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Xr Scoliosis Routine Standing One View,,72081,CPT,Facility,Inpatient,,,,281,238.85,80.5346,281,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Xr Scoliosis Routine Standing One View,,72081,CPT,Facility,Outpatient,,,,281,238.85,80.5346,281,"UCare Health, Inc.",Medical Assistance,141.8207,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Scoliosis Routine Standing One View,,72081,CPT,Facility,Inpatient,,,,281,238.85,80.5346,281,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Xr Scoliosis Routine Standing One View,,72081,CPT,Facility,Outpatient,,,,281,238.85,80.5346,281,"UCare Health, Inc.",Medicare Advantage,141.8207,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Scoliosis Routine Standing One View,,72081,CPT,Facility,Inpatient,,,,281,238.85,80.5346,281,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Scoliosis Routine Standing One View,,72081,CPT,Facility,Outpatient,,,,281,238.85,80.5346,281,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),141.8207,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Scoliosis Routine Standing One View,,72081,CPT,Facility,Inpatient,,,,281,238.85,80.5346,281,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Scoliosis Routine Standing One View,,72081,CPT,Facility,Both,,,,281,238.85,80.5346,281,UnitedHealthcare,Individual & Family,264.14,94,,percent of total billed charges,,
Xr Scoliosis Routine Standing One View,,72081,CPT,Facility,Outpatient,,,,281,238.85,80.5346,281,UnitedHealthcare,Medicare Advantage,137.69,49,,percent of total billed charges,,
Xr Scoliosis Routine Standing One View,,72081,CPT,Facility,Inpatient,,,,281,238.85,80.5346,281,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Xr Scoliosis Routine Standing One View,,72081,CPT,Facility,Outpatient,,,,281,238.85,80.5346,281,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,134.88,48,,percent of total billed charges,,100% of DHS outpatient percentage
Xr Scoliosis Routine Standing One View,,72081,CPT,Facility,Inpatient,,,,281,238.85,80.5346,281,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Xr Entire Spine Survey Study 2 Or 3 Views,,72082,CPT,Facility,Both,,,,332,282.2,95.1512,332,Aetna,Commercial,305.44,92,,percent of total billed charges,,
Xr Entire Spine Survey Study 2 Or 3 Views,,72082,CPT,Facility,Outpatient,,,,332,282.2,95.1512,332,Aetna,Medicare Advantage,162.68,49,,percent of total billed charges,,
Xr Entire Spine Survey Study 2 Or 3 Views,,72082,CPT,Facility,Inpatient,,,,332,282.2,95.1512,332,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Xr Entire Spine Survey Study 2 Or 3 Views,,72082,CPT,Facility,Both,,,,332,282.2,95.1512,332,Aetna,PPO,308.76,93,,percent of total billed charges,,
Xr Entire Spine Survey Study 2 Or 3 Views,,72082,CPT,Facility,Both,,,,332,282.2,95.1512,332,America's PPO,America's PPO,318.8196,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Xr Entire Spine Survey Study 2 Or 3 Views,,72082,CPT,Facility,Both,,,,332,282.2,95.1512,332,BlueCross BlueShield Minnesota, Federal Employee Program,326.688,98.4,,percent of total billed charges,,
Xr Entire Spine Survey Study 2 Or 3 Views,,72082,CPT,Facility,Both,,,,332,282.2,95.1512,332,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,332,100,,percent of total billed charges,,
Xr Entire Spine Survey Study 2 Or 3 Views,,72082,CPT,Facility,Both,,,,332,282.2,95.1512,332,BlueCross BlueShield Minnesota,High Value Network Plan,298.8,90,,percent of total billed charges,,
Xr Entire Spine Survey Study 2 Or 3 Views,,72082,CPT,Facility,Outpatient,,,,332,282.2,95.1512,332,BlueCross BlueShield Minnesota,Medicare Advantage,162.68,49,,percent of total billed charges,,
Xr Entire Spine Survey Study 2 Or 3 Views,,72082,CPT,Facility,Inpatient,,,,332,282.2,95.1512,332,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Xr Entire Spine Survey Study 2 Or 3 Views,,72082,CPT,Facility,Both,,,,332,282.2,95.1512,332,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,294.0524,88.57,,percent of total billed charges,,
Xr Entire Spine Survey Study 2 Or 3 Views,,72082,CPT,Facility,Both,,,,332,282.2,95.1512,332,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,95.1512,28.66,,percent of total billed charges,,
Xr Entire Spine Survey Study 2 Or 3 Views,,72082,CPT,Facility,Outpatient,,,,332,282.2,95.1512,332,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),162.68,49,,percent of total billed charges,,
Xr Entire Spine Survey Study 2 Or 3 Views,,72082,CPT,Facility,Inpatient,,,,332,282.2,95.1512,332,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Xr Entire Spine Survey Study 2 Or 3 Views,,72082,CPT,Facility,Both,,,,332,282.2,95.1512,332,CorVel,Worker's Compensation,332,100,,percent of total billed charges,,
Xr Entire Spine Survey Study 2 Or 3 Views,,72082,CPT,Facility,Both,,,,332,282.2,95.1512,332,First Health Group Corporation,First Health Network,322.04,97,,percent of total billed charges,,
Xr Entire Spine Survey Study 2 Or 3 Views,,72082,CPT,Facility,Both,,,,332,282.2,95.1512,332,"Health Partners, Inc.",Commercial,314.072,94.6,,percent of total billed charges,,
Xr Entire Spine Survey Study 2 Or 3 Views,,72082,CPT,Facility,Outpatient,,,,332,282.2,95.1512,332,"Health Partners, Inc.",Medicare Advantage,162.68,49,,percent of total billed charges,,
Xr Entire Spine Survey Study 2 Or 3 Views,,72082,CPT,Facility,Inpatient,,,,332,282.2,95.1512,332,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Entire Spine Survey Study 2 Or 3 Views,,72082,CPT,Facility,Both,,,,332,282.2,95.1512,332,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),199.2,60,,percent of total billed charges,,
Xr Entire Spine Survey Study 2 Or 3 Views,,72082,CPT,Facility,Both,,,,332,282.2,95.1512,332,"Health Partners, Inc.",State of Minnesota Advantage Program,270.58,81.5,,percent of total billed charges,,
Xr Entire Spine Survey Study 2 Or 3 Views,,72082,CPT,Facility,Both,,,,332,282.2,95.1512,332,"Health Partners, Inc.",State Public Programs,166,50,,percent of total billed charges,,
Xr Entire Spine Survey Study 2 Or 3 Views,,72082,CPT,Facility,Both,,,,332,282.2,95.1512,332,Humana Insurance Company,Commercial PPO,315.4,95,,percent of total billed charges,,
Xr Entire Spine Survey Study 2 Or 3 Views,,72082,CPT,Facility,Outpatient,,,,332,282.2,95.1512,332,Humana Insurance Company,Medicare PPO,162.68,49,,percent of total billed charges,,
Xr Entire Spine Survey Study 2 Or 3 Views,,72082,CPT,Facility,Inpatient,,,,332,282.2,95.1512,332,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Xr Entire Spine Survey Study 2 Or 3 Views,,72082,CPT,Facility,Both,,,,332,282.2,95.1512,332,Medica,Individual & Family,329.012,99.1,,percent of total billed charges,,
Xr Entire Spine Survey Study 2 Or 3 Views,,72082,CPT,Facility,Outpatient,,,,332,282.2,95.1512,332,Medica,Medica Advantage Solution,165.336,49.8,,percent of total billed charges,,
Xr Entire Spine Survey Study 2 Or 3 Views,,72082,CPT,Facility,Inpatient,,,,332,282.2,95.1512,332,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Xr Entire Spine Survey Study 2 Or 3 Views,,72082,CPT,Facility,Outpatient,,,,332,282.2,95.1512,332,Medica,Medical Assistance,148.072,44.6,,percent of total billed charges,,
Xr Entire Spine Survey Study 2 Or 3 Views,,72082,CPT,Facility,Inpatient,,,,332,282.2,95.1512,332,Medica,Medical Assistance,,,,,Included in per diem rate,
Xr Entire Spine Survey Study 2 Or 3 Views,,72082,CPT,Facility,Outpatient,,,,332,282.2,95.1512,332,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,165.336,49.8,,percent of total billed charges,,
Xr Entire Spine Survey Study 2 Or 3 Views,,72082,CPT,Facility,Inpatient,,,,332,282.2,95.1512,332,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Xr Entire Spine Survey Study 2 Or 3 Views,,72082,CPT,Facility,Both,,,,332,282.2,95.1512,332,"Multiplan, Inc.","Multiplan, Inc.",312.08,94,,percent of total billed charges,,
Xr Entire Spine Survey Study 2 Or 3 Views,,72082,CPT,Facility,Outpatient,,,,332,282.2,95.1512,332,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,299.132,90.1,,percent of total billed charges,,
Xr Entire Spine Survey Study 2 Or 3 Views,,72082,CPT,Facility,Inpatient,,,,332,282.2,95.1512,332,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Xr Entire Spine Survey Study 2 Or 3 Views,,72082,CPT,Facility,Both,,,,332,282.2,95.1512,332,"Preferred One Administrative Services, INC.",PPO,327.352,98.6,,percent of total billed charges,,
Xr Entire Spine Survey Study 2 Or 3 Views,,72082,CPT,Facility,Outpatient,,,,332,282.2,95.1512,332,PrimeWest Health,Minnesota Senior Health Options (MSHO),170.814,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Xr Entire Spine Survey Study 2 Or 3 Views,,72082,CPT,Facility,Inpatient,,,,332,282.2,95.1512,332,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Entire Spine Survey Study 2 Or 3 Views,,72082,CPT,Facility,Outpatient,,,,332,282.2,95.1512,332,PrimeWest Health,MinnesotaCare,170.5152,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Xr Entire Spine Survey Study 2 Or 3 Views,,72082,CPT,Facility,Inpatient,,,,332,282.2,95.1512,332,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Xr Entire Spine Survey Study 2 Or 3 Views,,72082,CPT,Facility,Both,,,,332,282.2,95.1512,332,Sanford Health Plan,Sanford Health Plan,305.44,92,,percent of total billed charges,,
Xr Entire Spine Survey Study 2 Or 3 Views,,72082,CPT,Facility,Outpatient,,,,332,282.2,95.1512,332,"UCare Health, Inc.",Individual & Family Plan,187.082,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Xr Entire Spine Survey Study 2 Or 3 Views,,72082,CPT,Facility,Inpatient,,,,332,282.2,95.1512,332,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Xr Entire Spine Survey Study 2 Or 3 Views,,72082,CPT,Facility,Outpatient,,,,332,282.2,95.1512,332,"UCare Health, Inc.",Medical Assistance,167.5604,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Entire Spine Survey Study 2 Or 3 Views,,72082,CPT,Facility,Inpatient,,,,332,282.2,95.1512,332,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Xr Entire Spine Survey Study 2 Or 3 Views,,72082,CPT,Facility,Outpatient,,,,332,282.2,95.1512,332,"UCare Health, Inc.",Medicare Advantage,167.5604,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Entire Spine Survey Study 2 Or 3 Views,,72082,CPT,Facility,Inpatient,,,,332,282.2,95.1512,332,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Entire Spine Survey Study 2 Or 3 Views,,72082,CPT,Facility,Outpatient,,,,332,282.2,95.1512,332,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),167.5604,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Entire Spine Survey Study 2 Or 3 Views,,72082,CPT,Facility,Inpatient,,,,332,282.2,95.1512,332,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Entire Spine Survey Study 2 Or 3 Views,,72082,CPT,Facility,Both,,,,332,282.2,95.1512,332,UnitedHealthcare,Individual & Family,312.08,94,,percent of total billed charges,,
Xr Entire Spine Survey Study 2 Or 3 Views,,72082,CPT,Facility,Outpatient,,,,332,282.2,95.1512,332,UnitedHealthcare,Medicare Advantage,162.68,49,,percent of total billed charges,,
Xr Entire Spine Survey Study 2 Or 3 Views,,72082,CPT,Facility,Inpatient,,,,332,282.2,95.1512,332,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Xr Entire Spine Survey Study 2 Or 3 Views,,72082,CPT,Facility,Outpatient,,,,332,282.2,95.1512,332,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,159.36,48,,percent of total billed charges,,100% of DHS outpatient percentage
Xr Entire Spine Survey Study 2 Or 3 Views,,72082,CPT,Facility,Inpatient,,,,332,282.2,95.1512,332,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Xr Lumbar Spine 2 Or 3 Views,,72100,CPT,Facility,Both,,,,353,300.05,101.1698,353,Aetna,Commercial,324.76,92,,percent of total billed charges,,
Xr Lumbar Spine 2 Or 3 Views,,72100,CPT,Facility,Outpatient,,,,353,300.05,101.1698,353,Aetna,Medicare Advantage,172.97,49,,percent of total billed charges,,
Xr Lumbar Spine 2 Or 3 Views,,72100,CPT,Facility,Inpatient,,,,353,300.05,101.1698,353,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Xr Lumbar Spine 2 Or 3 Views,,72100,CPT,Facility,Both,,,,353,300.05,101.1698,353,Aetna,PPO,328.29,93,,percent of total billed charges,,
Xr Lumbar Spine 2 Or 3 Views,,72100,CPT,Facility,Both,,,,353,300.05,101.1698,353,America's PPO,America's PPO,338.9859,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Xr Lumbar Spine 2 Or 3 Views,,72100,CPT,Facility,Both,,,,353,300.05,101.1698,353,BlueCross BlueShield Minnesota, Federal Employee Program,347.352,98.4,,percent of total billed charges,,
Xr Lumbar Spine 2 Or 3 Views,,72100,CPT,Facility,Both,,,,353,300.05,101.1698,353,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,353,100,,percent of total billed charges,,
Xr Lumbar Spine 2 Or 3 Views,,72100,CPT,Facility,Both,,,,353,300.05,101.1698,353,BlueCross BlueShield Minnesota,High Value Network Plan,317.7,90,,percent of total billed charges,,
Xr Lumbar Spine 2 Or 3 Views,,72100,CPT,Facility,Outpatient,,,,353,300.05,101.1698,353,BlueCross BlueShield Minnesota,Medicare Advantage,172.97,49,,percent of total billed charges,,
Xr Lumbar Spine 2 Or 3 Views,,72100,CPT,Facility,Inpatient,,,,353,300.05,101.1698,353,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Xr Lumbar Spine 2 Or 3 Views,,72100,CPT,Facility,Both,,,,353,300.05,101.1698,353,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,312.6521,88.57,,percent of total billed charges,,
Xr Lumbar Spine 2 Or 3 Views,,72100,CPT,Facility,Both,,,,353,300.05,101.1698,353,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,101.1698,28.66,,percent of total billed charges,,
Xr Lumbar Spine 2 Or 3 Views,,72100,CPT,Facility,Outpatient,,,,353,300.05,101.1698,353,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),172.97,49,,percent of total billed charges,,
Xr Lumbar Spine 2 Or 3 Views,,72100,CPT,Facility,Inpatient,,,,353,300.05,101.1698,353,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Xr Lumbar Spine 2 Or 3 Views,,72100,CPT,Facility,Both,,,,353,300.05,101.1698,353,CorVel,Worker's Compensation,353,100,,percent of total billed charges,,
Xr Lumbar Spine 2 Or 3 Views,,72100,CPT,Facility,Both,,,,353,300.05,101.1698,353,First Health Group Corporation,First Health Network,342.41,97,,percent of total billed charges,,
Xr Lumbar Spine 2 Or 3 Views,,72100,CPT,Facility,Both,,,,353,300.05,101.1698,353,"Health Partners, Inc.",Commercial,333.938,94.6,,percent of total billed charges,,
Xr Lumbar Spine 2 Or 3 Views,,72100,CPT,Facility,Outpatient,,,,353,300.05,101.1698,353,"Health Partners, Inc.",Medicare Advantage,172.97,49,,percent of total billed charges,,
Xr Lumbar Spine 2 Or 3 Views,,72100,CPT,Facility,Inpatient,,,,353,300.05,101.1698,353,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Lumbar Spine 2 Or 3 Views,,72100,CPT,Facility,Both,,,,353,300.05,101.1698,353,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),211.8,60,,percent of total billed charges,,
Xr Lumbar Spine 2 Or 3 Views,,72100,CPT,Facility,Both,,,,353,300.05,101.1698,353,"Health Partners, Inc.",State of Minnesota Advantage Program,287.695,81.5,,percent of total billed charges,,
Xr Lumbar Spine 2 Or 3 Views,,72100,CPT,Facility,Both,,,,353,300.05,101.1698,353,"Health Partners, Inc.",State Public Programs,176.5,50,,percent of total billed charges,,
Xr Lumbar Spine 2 Or 3 Views,,72100,CPT,Facility,Both,,,,353,300.05,101.1698,353,Humana Insurance Company,Commercial PPO,335.35,95,,percent of total billed charges,,
Xr Lumbar Spine 2 Or 3 Views,,72100,CPT,Facility,Outpatient,,,,353,300.05,101.1698,353,Humana Insurance Company,Medicare PPO,172.97,49,,percent of total billed charges,,
Xr Lumbar Spine 2 Or 3 Views,,72100,CPT,Facility,Inpatient,,,,353,300.05,101.1698,353,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Xr Lumbar Spine 2 Or 3 Views,,72100,CPT,Facility,Both,,,,353,300.05,101.1698,353,Medica,Individual & Family,349.823,99.1,,percent of total billed charges,,
Xr Lumbar Spine 2 Or 3 Views,,72100,CPT,Facility,Outpatient,,,,353,300.05,101.1698,353,Medica,Medica Advantage Solution,175.794,49.8,,percent of total billed charges,,
Xr Lumbar Spine 2 Or 3 Views,,72100,CPT,Facility,Inpatient,,,,353,300.05,101.1698,353,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Xr Lumbar Spine 2 Or 3 Views,,72100,CPT,Facility,Outpatient,,,,353,300.05,101.1698,353,Medica,Medical Assistance,157.438,44.6,,percent of total billed charges,,
Xr Lumbar Spine 2 Or 3 Views,,72100,CPT,Facility,Inpatient,,,,353,300.05,101.1698,353,Medica,Medical Assistance,,,,,Included in per diem rate,
Xr Lumbar Spine 2 Or 3 Views,,72100,CPT,Facility,Outpatient,,,,353,300.05,101.1698,353,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,175.794,49.8,,percent of total billed charges,,
Xr Lumbar Spine 2 Or 3 Views,,72100,CPT,Facility,Inpatient,,,,353,300.05,101.1698,353,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Xr Lumbar Spine 2 Or 3 Views,,72100,CPT,Facility,Both,,,,353,300.05,101.1698,353,"Multiplan, Inc.","Multiplan, Inc.",331.82,94,,percent of total billed charges,,
Xr Lumbar Spine 2 Or 3 Views,,72100,CPT,Facility,Outpatient,,,,353,300.05,101.1698,353,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,318.053,90.1,,percent of total billed charges,,
Xr Lumbar Spine 2 Or 3 Views,,72100,CPT,Facility,Inpatient,,,,353,300.05,101.1698,353,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Xr Lumbar Spine 2 Or 3 Views,,72100,CPT,Facility,Both,,,,353,300.05,101.1698,353,"Preferred One Administrative Services, INC.",PPO,348.058,98.6,,percent of total billed charges,,
Xr Lumbar Spine 2 Or 3 Views,,72100,CPT,Facility,Outpatient,,,,353,300.05,101.1698,353,PrimeWest Health,Minnesota Senior Health Options (MSHO),181.6185,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Xr Lumbar Spine 2 Or 3 Views,,72100,CPT,Facility,Inpatient,,,,353,300.05,101.1698,353,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Lumbar Spine 2 Or 3 Views,,72100,CPT,Facility,Outpatient,,,,353,300.05,101.1698,353,PrimeWest Health,MinnesotaCare,181.3008,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Xr Lumbar Spine 2 Or 3 Views,,72100,CPT,Facility,Inpatient,,,,353,300.05,101.1698,353,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Xr Lumbar Spine 2 Or 3 Views,,72100,CPT,Facility,Both,,,,353,300.05,101.1698,353,Sanford Health Plan,Sanford Health Plan,324.76,92,,percent of total billed charges,,
Xr Lumbar Spine 2 Or 3 Views,,72100,CPT,Facility,Outpatient,,,,353,300.05,101.1698,353,"UCare Health, Inc.",Individual & Family Plan,198.9155,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Xr Lumbar Spine 2 Or 3 Views,,72100,CPT,Facility,Inpatient,,,,353,300.05,101.1698,353,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Xr Lumbar Spine 2 Or 3 Views,,72100,CPT,Facility,Outpatient,,,,353,300.05,101.1698,353,"UCare Health, Inc.",Medical Assistance,178.1591,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Lumbar Spine 2 Or 3 Views,,72100,CPT,Facility,Inpatient,,,,353,300.05,101.1698,353,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Xr Lumbar Spine 2 Or 3 Views,,72100,CPT,Facility,Outpatient,,,,353,300.05,101.1698,353,"UCare Health, Inc.",Medicare Advantage,178.1591,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Lumbar Spine 2 Or 3 Views,,72100,CPT,Facility,Inpatient,,,,353,300.05,101.1698,353,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Lumbar Spine 2 Or 3 Views,,72100,CPT,Facility,Outpatient,,,,353,300.05,101.1698,353,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),178.1591,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Lumbar Spine 2 Or 3 Views,,72100,CPT,Facility,Inpatient,,,,353,300.05,101.1698,353,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Lumbar Spine 2 Or 3 Views,,72100,CPT,Facility,Both,,,,353,300.05,101.1698,353,UnitedHealthcare,Individual & Family,331.82,94,,percent of total billed charges,,
Xr Lumbar Spine 2 Or 3 Views,,72100,CPT,Facility,Outpatient,,,,353,300.05,101.1698,353,UnitedHealthcare,Medicare Advantage,172.97,49,,percent of total billed charges,,
Xr Lumbar Spine 2 Or 3 Views,,72100,CPT,Facility,Inpatient,,,,353,300.05,101.1698,353,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Xr Lumbar Spine 2 Or 3 Views,,72100,CPT,Facility,Outpatient,,,,353,300.05,101.1698,353,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,169.44,48,,percent of total billed charges,,100% of DHS outpatient percentage
Xr Lumbar Spine 2 Or 3 Views,,72100,CPT,Facility,Inpatient,,,,353,300.05,101.1698,353,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Xr Lumbar Spine 4 Views,,72110,CPT,Facility,Both,,,,386,328.1,110.6276,386,Aetna,Commercial,355.12,92,,percent of total billed charges,,
Xr Lumbar Spine 4 Views,,72110,CPT,Facility,Outpatient,,,,386,328.1,110.6276,386,Aetna,Medicare Advantage,189.14,49,,percent of total billed charges,,
Xr Lumbar Spine 4 Views,,72110,CPT,Facility,Inpatient,,,,386,328.1,110.6276,386,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Xr Lumbar Spine 4 Views,,72110,CPT,Facility,Both,,,,386,328.1,110.6276,386,Aetna,PPO,358.98,93,,percent of total billed charges,,
Xr Lumbar Spine 4 Views,,72110,CPT,Facility,Both,,,,386,328.1,110.6276,386,America's PPO,America's PPO,370.6758,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Xr Lumbar Spine 4 Views,,72110,CPT,Facility,Both,,,,386,328.1,110.6276,386,BlueCross BlueShield Minnesota, Federal Employee Program,379.824,98.4,,percent of total billed charges,,
Xr Lumbar Spine 4 Views,,72110,CPT,Facility,Both,,,,386,328.1,110.6276,386,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,386,100,,percent of total billed charges,,
Xr Lumbar Spine 4 Views,,72110,CPT,Facility,Both,,,,386,328.1,110.6276,386,BlueCross BlueShield Minnesota,High Value Network Plan,347.4,90,,percent of total billed charges,,
Xr Lumbar Spine 4 Views,,72110,CPT,Facility,Outpatient,,,,386,328.1,110.6276,386,BlueCross BlueShield Minnesota,Medicare Advantage,189.14,49,,percent of total billed charges,,
Xr Lumbar Spine 4 Views,,72110,CPT,Facility,Inpatient,,,,386,328.1,110.6276,386,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Xr Lumbar Spine 4 Views,,72110,CPT,Facility,Both,,,,386,328.1,110.6276,386,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,341.8802,88.57,,percent of total billed charges,,
Xr Lumbar Spine 4 Views,,72110,CPT,Facility,Both,,,,386,328.1,110.6276,386,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,110.6276,28.66,,percent of total billed charges,,
Xr Lumbar Spine 4 Views,,72110,CPT,Facility,Outpatient,,,,386,328.1,110.6276,386,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),189.14,49,,percent of total billed charges,,
Xr Lumbar Spine 4 Views,,72110,CPT,Facility,Inpatient,,,,386,328.1,110.6276,386,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Xr Lumbar Spine 4 Views,,72110,CPT,Facility,Both,,,,386,328.1,110.6276,386,CorVel,Worker's Compensation,386,100,,percent of total billed charges,,
Xr Lumbar Spine 4 Views,,72110,CPT,Facility,Both,,,,386,328.1,110.6276,386,First Health Group Corporation,First Health Network,374.42,97,,percent of total billed charges,,
Xr Lumbar Spine 4 Views,,72110,CPT,Facility,Both,,,,386,328.1,110.6276,386,"Health Partners, Inc.",Commercial,365.156,94.6,,percent of total billed charges,,
Xr Lumbar Spine 4 Views,,72110,CPT,Facility,Outpatient,,,,386,328.1,110.6276,386,"Health Partners, Inc.",Medicare Advantage,189.14,49,,percent of total billed charges,,
Xr Lumbar Spine 4 Views,,72110,CPT,Facility,Inpatient,,,,386,328.1,110.6276,386,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Lumbar Spine 4 Views,,72110,CPT,Facility,Both,,,,386,328.1,110.6276,386,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),231.6,60,,percent of total billed charges,,
Xr Lumbar Spine 4 Views,,72110,CPT,Facility,Both,,,,386,328.1,110.6276,386,"Health Partners, Inc.",State of Minnesota Advantage Program,314.59,81.5,,percent of total billed charges,,
Xr Lumbar Spine 4 Views,,72110,CPT,Facility,Both,,,,386,328.1,110.6276,386,"Health Partners, Inc.",State Public Programs,193,50,,percent of total billed charges,,
Xr Lumbar Spine 4 Views,,72110,CPT,Facility,Both,,,,386,328.1,110.6276,386,Humana Insurance Company,Commercial PPO,366.7,95,,percent of total billed charges,,
Xr Lumbar Spine 4 Views,,72110,CPT,Facility,Outpatient,,,,386,328.1,110.6276,386,Humana Insurance Company,Medicare PPO,189.14,49,,percent of total billed charges,,
Xr Lumbar Spine 4 Views,,72110,CPT,Facility,Inpatient,,,,386,328.1,110.6276,386,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Xr Lumbar Spine 4 Views,,72110,CPT,Facility,Both,,,,386,328.1,110.6276,386,Medica,Individual & Family,382.526,99.1,,percent of total billed charges,,
Xr Lumbar Spine 4 Views,,72110,CPT,Facility,Outpatient,,,,386,328.1,110.6276,386,Medica,Medica Advantage Solution,192.228,49.8,,percent of total billed charges,,
Xr Lumbar Spine 4 Views,,72110,CPT,Facility,Inpatient,,,,386,328.1,110.6276,386,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Xr Lumbar Spine 4 Views,,72110,CPT,Facility,Outpatient,,,,386,328.1,110.6276,386,Medica,Medical Assistance,172.156,44.6,,percent of total billed charges,,
Xr Lumbar Spine 4 Views,,72110,CPT,Facility,Inpatient,,,,386,328.1,110.6276,386,Medica,Medical Assistance,,,,,Included in per diem rate,
Xr Lumbar Spine 4 Views,,72110,CPT,Facility,Outpatient,,,,386,328.1,110.6276,386,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,192.228,49.8,,percent of total billed charges,,
Xr Lumbar Spine 4 Views,,72110,CPT,Facility,Inpatient,,,,386,328.1,110.6276,386,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Xr Lumbar Spine 4 Views,,72110,CPT,Facility,Both,,,,386,328.1,110.6276,386,"Multiplan, Inc.","Multiplan, Inc.",362.84,94,,percent of total billed charges,,
Xr Lumbar Spine 4 Views,,72110,CPT,Facility,Outpatient,,,,386,328.1,110.6276,386,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,347.786,90.1,,percent of total billed charges,,
Xr Lumbar Spine 4 Views,,72110,CPT,Facility,Inpatient,,,,386,328.1,110.6276,386,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Xr Lumbar Spine 4 Views,,72110,CPT,Facility,Both,,,,386,328.1,110.6276,386,"Preferred One Administrative Services, INC.",PPO,380.596,98.6,,percent of total billed charges,,
Xr Lumbar Spine 4 Views,,72110,CPT,Facility,Outpatient,,,,386,328.1,110.6276,386,PrimeWest Health,Minnesota Senior Health Options (MSHO),198.597,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Xr Lumbar Spine 4 Views,,72110,CPT,Facility,Inpatient,,,,386,328.1,110.6276,386,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Lumbar Spine 4 Views,,72110,CPT,Facility,Outpatient,,,,386,328.1,110.6276,386,PrimeWest Health,MinnesotaCare,198.2496,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Xr Lumbar Spine 4 Views,,72110,CPT,Facility,Inpatient,,,,386,328.1,110.6276,386,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Xr Lumbar Spine 4 Views,,72110,CPT,Facility,Both,,,,386,328.1,110.6276,386,Sanford Health Plan,Sanford Health Plan,355.12,92,,percent of total billed charges,,
Xr Lumbar Spine 4 Views,,72110,CPT,Facility,Outpatient,,,,386,328.1,110.6276,386,"UCare Health, Inc.",Individual & Family Plan,217.511,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Xr Lumbar Spine 4 Views,,72110,CPT,Facility,Inpatient,,,,386,328.1,110.6276,386,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Xr Lumbar Spine 4 Views,,72110,CPT,Facility,Outpatient,,,,386,328.1,110.6276,386,"UCare Health, Inc.",Medical Assistance,194.8142,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Lumbar Spine 4 Views,,72110,CPT,Facility,Inpatient,,,,386,328.1,110.6276,386,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Xr Lumbar Spine 4 Views,,72110,CPT,Facility,Outpatient,,,,386,328.1,110.6276,386,"UCare Health, Inc.",Medicare Advantage,194.8142,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Lumbar Spine 4 Views,,72110,CPT,Facility,Inpatient,,,,386,328.1,110.6276,386,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Lumbar Spine 4 Views,,72110,CPT,Facility,Outpatient,,,,386,328.1,110.6276,386,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),194.8142,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Lumbar Spine 4 Views,,72110,CPT,Facility,Inpatient,,,,386,328.1,110.6276,386,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Lumbar Spine 4 Views,,72110,CPT,Facility,Both,,,,386,328.1,110.6276,386,UnitedHealthcare,Individual & Family,362.84,94,,percent of total billed charges,,
Xr Lumbar Spine 4 Views,,72110,CPT,Facility,Outpatient,,,,386,328.1,110.6276,386,UnitedHealthcare,Medicare Advantage,189.14,49,,percent of total billed charges,,
Xr Lumbar Spine 4 Views,,72110,CPT,Facility,Inpatient,,,,386,328.1,110.6276,386,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Xr Lumbar Spine 4 Views,,72110,CPT,Facility,Outpatient,,,,386,328.1,110.6276,386,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,185.28,48,,percent of total billed charges,,100% of DHS outpatient percentage
Xr Lumbar Spine 4 Views,,72110,CPT,Facility,Inpatient,,,,386,328.1,110.6276,386,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Xr Lumbar Spine W Obliq 4 Or More Views,,72110,CPT,Facility,Both,,,,386,328.1,110.6276,386,Aetna,Commercial,355.12,92,,percent of total billed charges,,
Xr Lumbar Spine W Obliq 4 Or More Views,,72110,CPT,Facility,Outpatient,,,,386,328.1,110.6276,386,Aetna,Medicare Advantage,189.14,49,,percent of total billed charges,,
Xr Lumbar Spine W Obliq 4 Or More Views,,72110,CPT,Facility,Inpatient,,,,386,328.1,110.6276,386,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Xr Lumbar Spine W Obliq 4 Or More Views,,72110,CPT,Facility,Both,,,,386,328.1,110.6276,386,Aetna,PPO,358.98,93,,percent of total billed charges,,
Xr Lumbar Spine W Obliq 4 Or More Views,,72110,CPT,Facility,Both,,,,386,328.1,110.6276,386,America's PPO,America's PPO,370.6758,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Xr Lumbar Spine W Obliq 4 Or More Views,,72110,CPT,Facility,Both,,,,386,328.1,110.6276,386,BlueCross BlueShield Minnesota, Federal Employee Program,379.824,98.4,,percent of total billed charges,,
Xr Lumbar Spine W Obliq 4 Or More Views,,72110,CPT,Facility,Both,,,,386,328.1,110.6276,386,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,386,100,,percent of total billed charges,,
Xr Lumbar Spine W Obliq 4 Or More Views,,72110,CPT,Facility,Both,,,,386,328.1,110.6276,386,BlueCross BlueShield Minnesota,High Value Network Plan,347.4,90,,percent of total billed charges,,
Xr Lumbar Spine W Obliq 4 Or More Views,,72110,CPT,Facility,Outpatient,,,,386,328.1,110.6276,386,BlueCross BlueShield Minnesota,Medicare Advantage,189.14,49,,percent of total billed charges,,
Xr Lumbar Spine W Obliq 4 Or More Views,,72110,CPT,Facility,Inpatient,,,,386,328.1,110.6276,386,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Xr Lumbar Spine W Obliq 4 Or More Views,,72110,CPT,Facility,Both,,,,386,328.1,110.6276,386,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,341.8802,88.57,,percent of total billed charges,,
Xr Lumbar Spine W Obliq 4 Or More Views,,72110,CPT,Facility,Both,,,,386,328.1,110.6276,386,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,110.6276,28.66,,percent of total billed charges,,
Xr Lumbar Spine W Obliq 4 Or More Views,,72110,CPT,Facility,Outpatient,,,,386,328.1,110.6276,386,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),189.14,49,,percent of total billed charges,,
Xr Lumbar Spine W Obliq 4 Or More Views,,72110,CPT,Facility,Inpatient,,,,386,328.1,110.6276,386,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Xr Lumbar Spine W Obliq 4 Or More Views,,72110,CPT,Facility,Both,,,,386,328.1,110.6276,386,CorVel,Worker's Compensation,386,100,,percent of total billed charges,,
Xr Lumbar Spine W Obliq 4 Or More Views,,72110,CPT,Facility,Both,,,,386,328.1,110.6276,386,First Health Group Corporation,First Health Network,374.42,97,,percent of total billed charges,,
Xr Lumbar Spine W Obliq 4 Or More Views,,72110,CPT,Facility,Both,,,,386,328.1,110.6276,386,"Health Partners, Inc.",Commercial,365.156,94.6,,percent of total billed charges,,
Xr Lumbar Spine W Obliq 4 Or More Views,,72110,CPT,Facility,Outpatient,,,,386,328.1,110.6276,386,"Health Partners, Inc.",Medicare Advantage,189.14,49,,percent of total billed charges,,
Xr Lumbar Spine W Obliq 4 Or More Views,,72110,CPT,Facility,Inpatient,,,,386,328.1,110.6276,386,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Lumbar Spine W Obliq 4 Or More Views,,72110,CPT,Facility,Both,,,,386,328.1,110.6276,386,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),231.6,60,,percent of total billed charges,,
Xr Lumbar Spine W Obliq 4 Or More Views,,72110,CPT,Facility,Both,,,,386,328.1,110.6276,386,"Health Partners, Inc.",State of Minnesota Advantage Program,314.59,81.5,,percent of total billed charges,,
Xr Lumbar Spine W Obliq 4 Or More Views,,72110,CPT,Facility,Both,,,,386,328.1,110.6276,386,"Health Partners, Inc.",State Public Programs,193,50,,percent of total billed charges,,
Xr Lumbar Spine W Obliq 4 Or More Views,,72110,CPT,Facility,Both,,,,386,328.1,110.6276,386,Humana Insurance Company,Commercial PPO,366.7,95,,percent of total billed charges,,
Xr Lumbar Spine W Obliq 4 Or More Views,,72110,CPT,Facility,Outpatient,,,,386,328.1,110.6276,386,Humana Insurance Company,Medicare PPO,189.14,49,,percent of total billed charges,,
Xr Lumbar Spine W Obliq 4 Or More Views,,72110,CPT,Facility,Inpatient,,,,386,328.1,110.6276,386,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Xr Lumbar Spine W Obliq 4 Or More Views,,72110,CPT,Facility,Both,,,,386,328.1,110.6276,386,Medica,Individual & Family,382.526,99.1,,percent of total billed charges,,
Xr Lumbar Spine W Obliq 4 Or More Views,,72110,CPT,Facility,Outpatient,,,,386,328.1,110.6276,386,Medica,Medica Advantage Solution,192.228,49.8,,percent of total billed charges,,
Xr Lumbar Spine W Obliq 4 Or More Views,,72110,CPT,Facility,Inpatient,,,,386,328.1,110.6276,386,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Xr Lumbar Spine W Obliq 4 Or More Views,,72110,CPT,Facility,Outpatient,,,,386,328.1,110.6276,386,Medica,Medical Assistance,172.156,44.6,,percent of total billed charges,,
Xr Lumbar Spine W Obliq 4 Or More Views,,72110,CPT,Facility,Inpatient,,,,386,328.1,110.6276,386,Medica,Medical Assistance,,,,,Included in per diem rate,
Xr Lumbar Spine W Obliq 4 Or More Views,,72110,CPT,Facility,Outpatient,,,,386,328.1,110.6276,386,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,192.228,49.8,,percent of total billed charges,,
Xr Lumbar Spine W Obliq 4 Or More Views,,72110,CPT,Facility,Inpatient,,,,386,328.1,110.6276,386,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Xr Lumbar Spine W Obliq 4 Or More Views,,72110,CPT,Facility,Both,,,,386,328.1,110.6276,386,"Multiplan, Inc.","Multiplan, Inc.",362.84,94,,percent of total billed charges,,
Xr Lumbar Spine W Obliq 4 Or More Views,,72110,CPT,Facility,Outpatient,,,,386,328.1,110.6276,386,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,347.786,90.1,,percent of total billed charges,,
Xr Lumbar Spine W Obliq 4 Or More Views,,72110,CPT,Facility,Inpatient,,,,386,328.1,110.6276,386,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Xr Lumbar Spine W Obliq 4 Or More Views,,72110,CPT,Facility,Both,,,,386,328.1,110.6276,386,"Preferred One Administrative Services, INC.",PPO,380.596,98.6,,percent of total billed charges,,
Xr Lumbar Spine W Obliq 4 Or More Views,,72110,CPT,Facility,Outpatient,,,,386,328.1,110.6276,386,PrimeWest Health,Minnesota Senior Health Options (MSHO),198.597,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Xr Lumbar Spine W Obliq 4 Or More Views,,72110,CPT,Facility,Inpatient,,,,386,328.1,110.6276,386,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Lumbar Spine W Obliq 4 Or More Views,,72110,CPT,Facility,Outpatient,,,,386,328.1,110.6276,386,PrimeWest Health,MinnesotaCare,198.2496,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Xr Lumbar Spine W Obliq 4 Or More Views,,72110,CPT,Facility,Inpatient,,,,386,328.1,110.6276,386,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Xr Lumbar Spine W Obliq 4 Or More Views,,72110,CPT,Facility,Both,,,,386,328.1,110.6276,386,Sanford Health Plan,Sanford Health Plan,355.12,92,,percent of total billed charges,,
Xr Lumbar Spine W Obliq 4 Or More Views,,72110,CPT,Facility,Outpatient,,,,386,328.1,110.6276,386,"UCare Health, Inc.",Individual & Family Plan,217.511,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Xr Lumbar Spine W Obliq 4 Or More Views,,72110,CPT,Facility,Inpatient,,,,386,328.1,110.6276,386,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Xr Lumbar Spine W Obliq 4 Or More Views,,72110,CPT,Facility,Outpatient,,,,386,328.1,110.6276,386,"UCare Health, Inc.",Medical Assistance,194.8142,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Lumbar Spine W Obliq 4 Or More Views,,72110,CPT,Facility,Inpatient,,,,386,328.1,110.6276,386,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Xr Lumbar Spine W Obliq 4 Or More Views,,72110,CPT,Facility,Outpatient,,,,386,328.1,110.6276,386,"UCare Health, Inc.",Medicare Advantage,194.8142,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Lumbar Spine W Obliq 4 Or More Views,,72110,CPT,Facility,Inpatient,,,,386,328.1,110.6276,386,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Lumbar Spine W Obliq 4 Or More Views,,72110,CPT,Facility,Outpatient,,,,386,328.1,110.6276,386,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),194.8142,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Lumbar Spine W Obliq 4 Or More Views,,72110,CPT,Facility,Inpatient,,,,386,328.1,110.6276,386,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Lumbar Spine W Obliq 4 Or More Views,,72110,CPT,Facility,Both,,,,386,328.1,110.6276,386,UnitedHealthcare,Individual & Family,362.84,94,,percent of total billed charges,,
Xr Lumbar Spine W Obliq 4 Or More Views,,72110,CPT,Facility,Outpatient,,,,386,328.1,110.6276,386,UnitedHealthcare,Medicare Advantage,189.14,49,,percent of total billed charges,,
Xr Lumbar Spine W Obliq 4 Or More Views,,72110,CPT,Facility,Inpatient,,,,386,328.1,110.6276,386,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Xr Lumbar Spine W Obliq 4 Or More Views,,72110,CPT,Facility,Outpatient,,,,386,328.1,110.6276,386,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,185.28,48,,percent of total billed charges,,100% of DHS outpatient percentage
Xr Lumbar Spine W Obliq 4 Or More Views,,72110,CPT,Facility,Inpatient,,,,386,328.1,110.6276,386,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Ct Cervical Spine Routine Without Contrast,,72125,CPT,Facility,Both,,,,1702,1446.7,325.628,1702,Aetna,Commercial,1565.84,92,,percent of total billed charges,,
Ct Cervical Spine Routine Without Contrast,,72125,CPT,Facility,Outpatient,,,,1702,1446.7,325.628,1702,Aetna,Medicare Advantage,833.98,49,,percent of total billed charges,,
Ct Cervical Spine Routine Without Contrast,,72125,CPT,Facility,Inpatient,,,,1702,1446.7,325.628,1702,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Ct Cervical Spine Routine Without Contrast,,72125,CPT,Facility,Both,,,,1702,1446.7,325.628,1702,Aetna,PPO,1582.86,93,,percent of total billed charges,,
Ct Cervical Spine Routine Without Contrast,,72125,CPT,Facility,Both,,,,1702,1446.7,325.628,1702,America's PPO,America's PPO,1634.4306,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Ct Cervical Spine Routine Without Contrast,,72125,CPT,Facility,Both,,,,1702,1446.7,325.628,1702,BlueCross BlueShield Minnesota, Federal Employee Program,641,,,Fee schedule,,100% of BCBS commercial commodity fee schedule
Ct Cervical Spine Routine Without Contrast,,72125,CPT,Facility,Both,,,,1702,1446.7,325.628,1702,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,651.256,,,Fee schedule,,"100% of BCBS commercial commodity fee schedule, plus MN Care tax"
Ct Cervical Spine Routine Without Contrast,,72125,CPT,Facility,Both,,,,1702,1446.7,325.628,1702,BlueCross BlueShield Minnesota,High Value Network Plan,586.1304,,,Fee schedule,,"90% of BCBS commercial commodity fee schedule, plus MN Care tax; see disclaimer for more information"
Ct Cervical Spine Routine Without Contrast,,72125,CPT,Facility,Outpatient,,,,1702,1446.7,325.628,1702,BlueCross BlueShield Minnesota,Medicare Advantage,833.98,49,,percent of total billed charges,,
Ct Cervical Spine Routine Without Contrast,,72125,CPT,Facility,Inpatient,,,,1702,1446.7,325.628,1702,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Ct Cervical Spine Routine Without Contrast,,72125,CPT,Facility,Both,,,,1702,1446.7,325.628,1702,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,576.8174392,,,Fee schedule,,"88.57% of BCBS commercial commodity fee schedule, plus MN Care tax"
Ct Cervical Spine Routine Without Contrast,,72125,CPT,Facility,Both,,,,1702,1446.7,325.628,1702,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,325.628,,,Fee schedule,,"100% of BCBS Medicaid commodity fee schedule, plus MN Care tax"
Ct Cervical Spine Routine Without Contrast,,72125,CPT,Facility,Outpatient,,,,1702,1446.7,325.628,1702,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),833.98,49,,percent of total billed charges,,
Ct Cervical Spine Routine Without Contrast,,72125,CPT,Facility,Inpatient,,,,1702,1446.7,325.628,1702,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Ct Cervical Spine Routine Without Contrast,,72125,CPT,Facility,Both,,,,1702,1446.7,325.628,1702,CorVel,Worker's Compensation,1702,100,,percent of total billed charges,,
Ct Cervical Spine Routine Without Contrast,,72125,CPT,Facility,Both,,,,1702,1446.7,325.628,1702,First Health Group Corporation,First Health Network,1650.94,97,,percent of total billed charges,,
Ct Cervical Spine Routine Without Contrast,,72125,CPT,Facility,Both,,,,1702,1446.7,325.628,1702,"Health Partners, Inc.",Commercial,1610.092,94.6,,percent of total billed charges,,
Ct Cervical Spine Routine Without Contrast,,72125,CPT,Facility,Outpatient,,,,1702,1446.7,325.628,1702,"Health Partners, Inc.",Medicare Advantage,833.98,49,,percent of total billed charges,,
Ct Cervical Spine Routine Without Contrast,,72125,CPT,Facility,Inpatient,,,,1702,1446.7,325.628,1702,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ct Cervical Spine Routine Without Contrast,,72125,CPT,Facility,Both,,,,1702,1446.7,325.628,1702,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1021.2,60,,percent of total billed charges,,
Ct Cervical Spine Routine Without Contrast,,72125,CPT,Facility,Both,,,,1702,1446.7,325.628,1702,"Health Partners, Inc.",State of Minnesota Advantage Program,1387.13,81.5,,percent of total billed charges,,
Ct Cervical Spine Routine Without Contrast,,72125,CPT,Facility,Both,,,,1702,1446.7,325.628,1702,"Health Partners, Inc.",State Public Programs,851,50,,percent of total billed charges,,
Ct Cervical Spine Routine Without Contrast,,72125,CPT,Facility,Both,,,,1702,1446.7,325.628,1702,Humana Insurance Company,Commercial PPO,1616.9,95,,percent of total billed charges,,
Ct Cervical Spine Routine Without Contrast,,72125,CPT,Facility,Outpatient,,,,1702,1446.7,325.628,1702,Humana Insurance Company,Medicare PPO,833.98,49,,percent of total billed charges,,
Ct Cervical Spine Routine Without Contrast,,72125,CPT,Facility,Inpatient,,,,1702,1446.7,325.628,1702,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Ct Cervical Spine Routine Without Contrast,,72125,CPT,Facility,Both,,,,1702,1446.7,325.628,1702,Medica,Individual & Family,1686.682,99.1,,percent of total billed charges,,
Ct Cervical Spine Routine Without Contrast,,72125,CPT,Facility,Outpatient,,,,1702,1446.7,325.628,1702,Medica,Medica Advantage Solution,847.596,49.8,,percent of total billed charges,,
Ct Cervical Spine Routine Without Contrast,,72125,CPT,Facility,Inpatient,,,,1702,1446.7,325.628,1702,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Ct Cervical Spine Routine Without Contrast,,72125,CPT,Facility,Outpatient,,,,1702,1446.7,325.628,1702,Medica,Medical Assistance,759.092,44.6,,percent of total billed charges,,
Ct Cervical Spine Routine Without Contrast,,72125,CPT,Facility,Inpatient,,,,1702,1446.7,325.628,1702,Medica,Medical Assistance,,,,,Included in per diem rate,
Ct Cervical Spine Routine Without Contrast,,72125,CPT,Facility,Outpatient,,,,1702,1446.7,325.628,1702,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,847.596,49.8,,percent of total billed charges,,
Ct Cervical Spine Routine Without Contrast,,72125,CPT,Facility,Inpatient,,,,1702,1446.7,325.628,1702,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Ct Cervical Spine Routine Without Contrast,,72125,CPT,Facility,Both,,,,1702,1446.7,325.628,1702,"Multiplan, Inc.","Multiplan, Inc.",1599.88,94,,percent of total billed charges,,
Ct Cervical Spine Routine Without Contrast,,72125,CPT,Facility,Outpatient,,,,1702,1446.7,325.628,1702,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1283,,,Other,Per scan,
Ct Cervical Spine Routine Without Contrast,,72125,CPT,Facility,Inpatient,,,,1702,1446.7,325.628,1702,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Ct Cervical Spine Routine Without Contrast,,72125,CPT,Facility,Both,,,,1702,1446.7,325.628,1702,"Preferred One Administrative Services, INC.",PPO,1678.172,98.6,,percent of total billed charges,,
Ct Cervical Spine Routine Without Contrast,,72125,CPT,Facility,Outpatient,,,,1702,1446.7,325.628,1702,PrimeWest Health,Minnesota Senior Health Options (MSHO),875.679,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Ct Cervical Spine Routine Without Contrast,,72125,CPT,Facility,Inpatient,,,,1702,1446.7,325.628,1702,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ct Cervical Spine Routine Without Contrast,,72125,CPT,Facility,Outpatient,,,,1702,1446.7,325.628,1702,PrimeWest Health,MinnesotaCare,874.1472,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Ct Cervical Spine Routine Without Contrast,,72125,CPT,Facility,Inpatient,,,,1702,1446.7,325.628,1702,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Ct Cervical Spine Routine Without Contrast,,72125,CPT,Facility,Both,,,,1702,1446.7,325.628,1702,Sanford Health Plan,Sanford Health Plan,1565.84,92,,percent of total billed charges,,
Ct Cervical Spine Routine Without Contrast,,72125,CPT,Facility,Outpatient,,,,1702,1446.7,325.628,1702,"UCare Health, Inc.",Individual & Family Plan,959.077,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Ct Cervical Spine Routine Without Contrast,,72125,CPT,Facility,Inpatient,,,,1702,1446.7,325.628,1702,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Ct Cervical Spine Routine Without Contrast,,72125,CPT,Facility,Outpatient,,,,1702,1446.7,325.628,1702,"UCare Health, Inc.",Medical Assistance,858.9994,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ct Cervical Spine Routine Without Contrast,,72125,CPT,Facility,Inpatient,,,,1702,1446.7,325.628,1702,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Ct Cervical Spine Routine Without Contrast,,72125,CPT,Facility,Outpatient,,,,1702,1446.7,325.628,1702,"UCare Health, Inc.",Medicare Advantage,858.9994,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ct Cervical Spine Routine Without Contrast,,72125,CPT,Facility,Inpatient,,,,1702,1446.7,325.628,1702,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ct Cervical Spine Routine Without Contrast,,72125,CPT,Facility,Outpatient,,,,1702,1446.7,325.628,1702,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),858.9994,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ct Cervical Spine Routine Without Contrast,,72125,CPT,Facility,Inpatient,,,,1702,1446.7,325.628,1702,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ct Cervical Spine Routine Without Contrast,,72125,CPT,Facility,Both,,,,1702,1446.7,325.628,1702,UnitedHealthcare,Individual & Family,1599.88,94,,percent of total billed charges,,
Ct Cervical Spine Routine Without Contrast,,72125,CPT,Facility,Outpatient,,,,1702,1446.7,325.628,1702,UnitedHealthcare,Medicare Advantage,833.98,49,,percent of total billed charges,,
Ct Cervical Spine Routine Without Contrast,,72125,CPT,Facility,Inpatient,,,,1702,1446.7,325.628,1702,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Ct Cervical Spine Routine Without Contrast,,72125,CPT,Facility,Outpatient,,,,1702,1446.7,325.628,1702,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,816.96,48,,percent of total billed charges,,100% of DHS outpatient percentage
Ct Cervical Spine Routine Without Contrast,,72125,CPT,Facility,Inpatient,,,,1702,1446.7,325.628,1702,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Ct Cervical Spine W Contrast,,72126,CPT,Facility,Both,,,,1930,1640.5,561.34,1930,Aetna,Commercial,1775.6,92,,percent of total billed charges,,
Ct Cervical Spine W Contrast,,72126,CPT,Facility,Outpatient,,,,1930,1640.5,561.34,1930,Aetna,Medicare Advantage,945.7,49,,percent of total billed charges,,
Ct Cervical Spine W Contrast,,72126,CPT,Facility,Inpatient,,,,1930,1640.5,561.34,1930,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Ct Cervical Spine W Contrast,,72126,CPT,Facility,Both,,,,1930,1640.5,561.34,1930,Aetna,PPO,1794.9,93,,percent of total billed charges,,
Ct Cervical Spine W Contrast,,72126,CPT,Facility,Both,,,,1930,1640.5,561.34,1930,America's PPO,America's PPO,1853.379,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Ct Cervical Spine W Contrast,,72126,CPT,Facility,Both,,,,1930,1640.5,561.34,1930,BlueCross BlueShield Minnesota, Federal Employee Program,1105,,,Fee schedule,,100% of BCBS commercial commodity fee schedule
Ct Cervical Spine W Contrast,,72126,CPT,Facility,Both,,,,1930,1640.5,561.34,1930,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1122.68,,,Fee schedule,,"100% of BCBS commercial commodity fee schedule, plus MN Care tax"
Ct Cervical Spine W Contrast,,72126,CPT,Facility,Both,,,,1930,1640.5,561.34,1930,BlueCross BlueShield Minnesota,High Value Network Plan,1010.412,,,Fee schedule,,"90% of BCBS commercial commodity fee schedule, plus MN Care tax; see disclaimer for more information"
Ct Cervical Spine W Contrast,,72126,CPT,Facility,Outpatient,,,,1930,1640.5,561.34,1930,BlueCross BlueShield Minnesota,Medicare Advantage,945.7,49,,percent of total billed charges,,
Ct Cervical Spine W Contrast,,72126,CPT,Facility,Inpatient,,,,1930,1640.5,561.34,1930,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Ct Cervical Spine W Contrast,,72126,CPT,Facility,Both,,,,1930,1640.5,561.34,1930,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,994.357676,,,Fee schedule,,"88.57% of BCBS commercial commodity fee schedule, plus MN Care tax"
Ct Cervical Spine W Contrast,,72126,CPT,Facility,Both,,,,1930,1640.5,561.34,1930,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,561.34,,,Fee schedule,,"100% of BCBS Medicaid commodity fee schedule, plus MN Care tax"
Ct Cervical Spine W Contrast,,72126,CPT,Facility,Outpatient,,,,1930,1640.5,561.34,1930,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),945.7,49,,percent of total billed charges,,
Ct Cervical Spine W Contrast,,72126,CPT,Facility,Inpatient,,,,1930,1640.5,561.34,1930,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Ct Cervical Spine W Contrast,,72126,CPT,Facility,Both,,,,1930,1640.5,561.34,1930,CorVel,Worker's Compensation,1930,100,,percent of total billed charges,,
Ct Cervical Spine W Contrast,,72126,CPT,Facility,Both,,,,1930,1640.5,561.34,1930,First Health Group Corporation,First Health Network,1872.1,97,,percent of total billed charges,,
Ct Cervical Spine W Contrast,,72126,CPT,Facility,Both,,,,1930,1640.5,561.34,1930,"Health Partners, Inc.",Commercial,1825.78,94.6,,percent of total billed charges,,
Ct Cervical Spine W Contrast,,72126,CPT,Facility,Outpatient,,,,1930,1640.5,561.34,1930,"Health Partners, Inc.",Medicare Advantage,945.7,49,,percent of total billed charges,,
Ct Cervical Spine W Contrast,,72126,CPT,Facility,Inpatient,,,,1930,1640.5,561.34,1930,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ct Cervical Spine W Contrast,,72126,CPT,Facility,Both,,,,1930,1640.5,561.34,1930,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1158,60,,percent of total billed charges,,
Ct Cervical Spine W Contrast,,72126,CPT,Facility,Both,,,,1930,1640.5,561.34,1930,"Health Partners, Inc.",State of Minnesota Advantage Program,1572.95,81.5,,percent of total billed charges,,
Ct Cervical Spine W Contrast,,72126,CPT,Facility,Both,,,,1930,1640.5,561.34,1930,"Health Partners, Inc.",State Public Programs,965,50,,percent of total billed charges,,
Ct Cervical Spine W Contrast,,72126,CPT,Facility,Both,,,,1930,1640.5,561.34,1930,Humana Insurance Company,Commercial PPO,1833.5,95,,percent of total billed charges,,
Ct Cervical Spine W Contrast,,72126,CPT,Facility,Outpatient,,,,1930,1640.5,561.34,1930,Humana Insurance Company,Medicare PPO,945.7,49,,percent of total billed charges,,
Ct Cervical Spine W Contrast,,72126,CPT,Facility,Inpatient,,,,1930,1640.5,561.34,1930,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Ct Cervical Spine W Contrast,,72126,CPT,Facility,Both,,,,1930,1640.5,561.34,1930,Medica,Individual & Family,1912.63,99.1,,percent of total billed charges,,
Ct Cervical Spine W Contrast,,72126,CPT,Facility,Outpatient,,,,1930,1640.5,561.34,1930,Medica,Medica Advantage Solution,961.14,49.8,,percent of total billed charges,,
Ct Cervical Spine W Contrast,,72126,CPT,Facility,Inpatient,,,,1930,1640.5,561.34,1930,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Ct Cervical Spine W Contrast,,72126,CPT,Facility,Outpatient,,,,1930,1640.5,561.34,1930,Medica,Medical Assistance,860.78,44.6,,percent of total billed charges,,
Ct Cervical Spine W Contrast,,72126,CPT,Facility,Inpatient,,,,1930,1640.5,561.34,1930,Medica,Medical Assistance,,,,,Included in per diem rate,
Ct Cervical Spine W Contrast,,72126,CPT,Facility,Outpatient,,,,1930,1640.5,561.34,1930,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,961.14,49.8,,percent of total billed charges,,
Ct Cervical Spine W Contrast,,72126,CPT,Facility,Inpatient,,,,1930,1640.5,561.34,1930,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Ct Cervical Spine W Contrast,,72126,CPT,Facility,Both,,,,1930,1640.5,561.34,1930,"Multiplan, Inc.","Multiplan, Inc.",1814.2,94,,percent of total billed charges,,
Ct Cervical Spine W Contrast,,72126,CPT,Facility,Outpatient,,,,1930,1640.5,561.34,1930,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1283,,,Other,Per scan,
Ct Cervical Spine W Contrast,,72126,CPT,Facility,Inpatient,,,,1930,1640.5,561.34,1930,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Ct Cervical Spine W Contrast,,72126,CPT,Facility,Both,,,,1930,1640.5,561.34,1930,"Preferred One Administrative Services, INC.",PPO,1902.98,98.6,,percent of total billed charges,,
Ct Cervical Spine W Contrast,,72126,CPT,Facility,Outpatient,,,,1930,1640.5,561.34,1930,PrimeWest Health,Minnesota Senior Health Options (MSHO),992.985,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Ct Cervical Spine W Contrast,,72126,CPT,Facility,Inpatient,,,,1930,1640.5,561.34,1930,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ct Cervical Spine W Contrast,,72126,CPT,Facility,Outpatient,,,,1930,1640.5,561.34,1930,PrimeWest Health,MinnesotaCare,991.248,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Ct Cervical Spine W Contrast,,72126,CPT,Facility,Inpatient,,,,1930,1640.5,561.34,1930,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Ct Cervical Spine W Contrast,,72126,CPT,Facility,Both,,,,1930,1640.5,561.34,1930,Sanford Health Plan,Sanford Health Plan,1775.6,92,,percent of total billed charges,,
Ct Cervical Spine W Contrast,,72126,CPT,Facility,Outpatient,,,,1930,1640.5,561.34,1930,"UCare Health, Inc.",Individual & Family Plan,1087.555,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Ct Cervical Spine W Contrast,,72126,CPT,Facility,Inpatient,,,,1930,1640.5,561.34,1930,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Ct Cervical Spine W Contrast,,72126,CPT,Facility,Outpatient,,,,1930,1640.5,561.34,1930,"UCare Health, Inc.",Medical Assistance,974.071,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ct Cervical Spine W Contrast,,72126,CPT,Facility,Inpatient,,,,1930,1640.5,561.34,1930,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Ct Cervical Spine W Contrast,,72126,CPT,Facility,Outpatient,,,,1930,1640.5,561.34,1930,"UCare Health, Inc.",Medicare Advantage,974.071,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ct Cervical Spine W Contrast,,72126,CPT,Facility,Inpatient,,,,1930,1640.5,561.34,1930,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ct Cervical Spine W Contrast,,72126,CPT,Facility,Outpatient,,,,1930,1640.5,561.34,1930,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),974.071,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ct Cervical Spine W Contrast,,72126,CPT,Facility,Inpatient,,,,1930,1640.5,561.34,1930,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ct Cervical Spine W Contrast,,72126,CPT,Facility,Both,,,,1930,1640.5,561.34,1930,UnitedHealthcare,Individual & Family,1814.2,94,,percent of total billed charges,,
Ct Cervical Spine W Contrast,,72126,CPT,Facility,Outpatient,,,,1930,1640.5,561.34,1930,UnitedHealthcare,Medicare Advantage,945.7,49,,percent of total billed charges,,
Ct Cervical Spine W Contrast,,72126,CPT,Facility,Inpatient,,,,1930,1640.5,561.34,1930,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Ct Cervical Spine W Contrast,,72126,CPT,Facility,Outpatient,,,,1930,1640.5,561.34,1930,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,926.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
Ct Cervical Spine W Contrast,,72126,CPT,Facility,Inpatient,,,,1930,1640.5,561.34,1930,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Ct Cervical Spine Wo W Contrast,,72127,CPT,Facility,Both,,,,2076,1764.6,412.496,2076,Aetna,Commercial,1909.92,92,,percent of total billed charges,,
Ct Cervical Spine Wo W Contrast,,72127,CPT,Facility,Outpatient,,,,2076,1764.6,412.496,2076,Aetna,Medicare Advantage,1017.24,49,,percent of total billed charges,,
Ct Cervical Spine Wo W Contrast,,72127,CPT,Facility,Inpatient,,,,2076,1764.6,412.496,2076,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Ct Cervical Spine Wo W Contrast,,72127,CPT,Facility,Both,,,,2076,1764.6,412.496,2076,Aetna,PPO,1930.68,93,,percent of total billed charges,,
Ct Cervical Spine Wo W Contrast,,72127,CPT,Facility,Both,,,,2076,1764.6,412.496,2076,America's PPO,America's PPO,1993.5828,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Ct Cervical Spine Wo W Contrast,,72127,CPT,Facility,Both,,,,2076,1764.6,412.496,2076,BlueCross BlueShield Minnesota, Federal Employee Program,812,,,Fee schedule,,100% of BCBS commercial commodity fee schedule
Ct Cervical Spine Wo W Contrast,,72127,CPT,Facility,Both,,,,2076,1764.6,412.496,2076,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,824.992,,,Fee schedule,,"100% of BCBS commercial commodity fee schedule, plus MN Care tax"
Ct Cervical Spine Wo W Contrast,,72127,CPT,Facility,Both,,,,2076,1764.6,412.496,2076,BlueCross BlueShield Minnesota,High Value Network Plan,742.4928,,,Fee schedule,,"90% of BCBS commercial commodity fee schedule, plus MN Care tax; see disclaimer for more information"
Ct Cervical Spine Wo W Contrast,,72127,CPT,Facility,Outpatient,,,,2076,1764.6,412.496,2076,BlueCross BlueShield Minnesota,Medicare Advantage,1017.24,49,,percent of total billed charges,,
Ct Cervical Spine Wo W Contrast,,72127,CPT,Facility,Inpatient,,,,2076,1764.6,412.496,2076,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Ct Cervical Spine Wo W Contrast,,72127,CPT,Facility,Both,,,,2076,1764.6,412.496,2076,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,730.6954144,,,Fee schedule,,"88.57% of BCBS commercial commodity fee schedule, plus MN Care tax"
Ct Cervical Spine Wo W Contrast,,72127,CPT,Facility,Both,,,,2076,1764.6,412.496,2076,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,412.496,,,Fee schedule,,"100% of BCBS Medicaid commodity fee schedule, plus MN Care tax"
Ct Cervical Spine Wo W Contrast,,72127,CPT,Facility,Outpatient,,,,2076,1764.6,412.496,2076,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1017.24,49,,percent of total billed charges,,
Ct Cervical Spine Wo W Contrast,,72127,CPT,Facility,Inpatient,,,,2076,1764.6,412.496,2076,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Ct Cervical Spine Wo W Contrast,,72127,CPT,Facility,Both,,,,2076,1764.6,412.496,2076,CorVel,Worker's Compensation,2076,100,,percent of total billed charges,,
Ct Cervical Spine Wo W Contrast,,72127,CPT,Facility,Both,,,,2076,1764.6,412.496,2076,First Health Group Corporation,First Health Network,2013.72,97,,percent of total billed charges,,
Ct Cervical Spine Wo W Contrast,,72127,CPT,Facility,Both,,,,2076,1764.6,412.496,2076,"Health Partners, Inc.",Commercial,1963.896,94.6,,percent of total billed charges,,
Ct Cervical Spine Wo W Contrast,,72127,CPT,Facility,Outpatient,,,,2076,1764.6,412.496,2076,"Health Partners, Inc.",Medicare Advantage,1017.24,49,,percent of total billed charges,,
Ct Cervical Spine Wo W Contrast,,72127,CPT,Facility,Inpatient,,,,2076,1764.6,412.496,2076,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ct Cervical Spine Wo W Contrast,,72127,CPT,Facility,Both,,,,2076,1764.6,412.496,2076,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1245.6,60,,percent of total billed charges,,
Ct Cervical Spine Wo W Contrast,,72127,CPT,Facility,Both,,,,2076,1764.6,412.496,2076,"Health Partners, Inc.",State of Minnesota Advantage Program,1691.94,81.5,,percent of total billed charges,,
Ct Cervical Spine Wo W Contrast,,72127,CPT,Facility,Both,,,,2076,1764.6,412.496,2076,"Health Partners, Inc.",State Public Programs,1038,50,,percent of total billed charges,,
Ct Cervical Spine Wo W Contrast,,72127,CPT,Facility,Both,,,,2076,1764.6,412.496,2076,Humana Insurance Company,Commercial PPO,1972.2,95,,percent of total billed charges,,
Ct Cervical Spine Wo W Contrast,,72127,CPT,Facility,Outpatient,,,,2076,1764.6,412.496,2076,Humana Insurance Company,Medicare PPO,1017.24,49,,percent of total billed charges,,
Ct Cervical Spine Wo W Contrast,,72127,CPT,Facility,Inpatient,,,,2076,1764.6,412.496,2076,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Ct Cervical Spine Wo W Contrast,,72127,CPT,Facility,Both,,,,2076,1764.6,412.496,2076,Medica,Individual & Family,2057.316,99.1,,percent of total billed charges,,
Ct Cervical Spine Wo W Contrast,,72127,CPT,Facility,Outpatient,,,,2076,1764.6,412.496,2076,Medica,Medica Advantage Solution,1033.848,49.8,,percent of total billed charges,,
Ct Cervical Spine Wo W Contrast,,72127,CPT,Facility,Inpatient,,,,2076,1764.6,412.496,2076,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Ct Cervical Spine Wo W Contrast,,72127,CPT,Facility,Outpatient,,,,2076,1764.6,412.496,2076,Medica,Medical Assistance,925.896,44.6,,percent of total billed charges,,
Ct Cervical Spine Wo W Contrast,,72127,CPT,Facility,Inpatient,,,,2076,1764.6,412.496,2076,Medica,Medical Assistance,,,,,Included in per diem rate,
Ct Cervical Spine Wo W Contrast,,72127,CPT,Facility,Outpatient,,,,2076,1764.6,412.496,2076,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1033.848,49.8,,percent of total billed charges,,
Ct Cervical Spine Wo W Contrast,,72127,CPT,Facility,Inpatient,,,,2076,1764.6,412.496,2076,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Ct Cervical Spine Wo W Contrast,,72127,CPT,Facility,Both,,,,2076,1764.6,412.496,2076,"Multiplan, Inc.","Multiplan, Inc.",1951.44,94,,percent of total billed charges,,
Ct Cervical Spine Wo W Contrast,,72127,CPT,Facility,Outpatient,,,,2076,1764.6,412.496,2076,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1283,,,Other,Per scan,
Ct Cervical Spine Wo W Contrast,,72127,CPT,Facility,Inpatient,,,,2076,1764.6,412.496,2076,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Ct Cervical Spine Wo W Contrast,,72127,CPT,Facility,Both,,,,2076,1764.6,412.496,2076,"Preferred One Administrative Services, INC.",PPO,2046.936,98.6,,percent of total billed charges,,
Ct Cervical Spine Wo W Contrast,,72127,CPT,Facility,Outpatient,,,,2076,1764.6,412.496,2076,PrimeWest Health,Minnesota Senior Health Options (MSHO),1068.102,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Ct Cervical Spine Wo W Contrast,,72127,CPT,Facility,Inpatient,,,,2076,1764.6,412.496,2076,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ct Cervical Spine Wo W Contrast,,72127,CPT,Facility,Outpatient,,,,2076,1764.6,412.496,2076,PrimeWest Health,MinnesotaCare,1066.2336,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Ct Cervical Spine Wo W Contrast,,72127,CPT,Facility,Inpatient,,,,2076,1764.6,412.496,2076,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Ct Cervical Spine Wo W Contrast,,72127,CPT,Facility,Both,,,,2076,1764.6,412.496,2076,Sanford Health Plan,Sanford Health Plan,1909.92,92,,percent of total billed charges,,
Ct Cervical Spine Wo W Contrast,,72127,CPT,Facility,Outpatient,,,,2076,1764.6,412.496,2076,"UCare Health, Inc.",Individual & Family Plan,1169.826,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Ct Cervical Spine Wo W Contrast,,72127,CPT,Facility,Inpatient,,,,2076,1764.6,412.496,2076,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Ct Cervical Spine Wo W Contrast,,72127,CPT,Facility,Outpatient,,,,2076,1764.6,412.496,2076,"UCare Health, Inc.",Medical Assistance,1047.7572,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ct Cervical Spine Wo W Contrast,,72127,CPT,Facility,Inpatient,,,,2076,1764.6,412.496,2076,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Ct Cervical Spine Wo W Contrast,,72127,CPT,Facility,Outpatient,,,,2076,1764.6,412.496,2076,"UCare Health, Inc.",Medicare Advantage,1047.7572,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ct Cervical Spine Wo W Contrast,,72127,CPT,Facility,Inpatient,,,,2076,1764.6,412.496,2076,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ct Cervical Spine Wo W Contrast,,72127,CPT,Facility,Outpatient,,,,2076,1764.6,412.496,2076,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1047.7572,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ct Cervical Spine Wo W Contrast,,72127,CPT,Facility,Inpatient,,,,2076,1764.6,412.496,2076,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ct Cervical Spine Wo W Contrast,,72127,CPT,Facility,Both,,,,2076,1764.6,412.496,2076,UnitedHealthcare,Individual & Family,1951.44,94,,percent of total billed charges,,
Ct Cervical Spine Wo W Contrast,,72127,CPT,Facility,Outpatient,,,,2076,1764.6,412.496,2076,UnitedHealthcare,Medicare Advantage,1017.24,49,,percent of total billed charges,,
Ct Cervical Spine Wo W Contrast,,72127,CPT,Facility,Inpatient,,,,2076,1764.6,412.496,2076,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Ct Cervical Spine Wo W Contrast,,72127,CPT,Facility,Outpatient,,,,2076,1764.6,412.496,2076,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,996.48,48,,percent of total billed charges,,100% of DHS outpatient percentage
Ct Cervical Spine Wo W Contrast,,72127,CPT,Facility,Inpatient,,,,2076,1764.6,412.496,2076,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Ct Thoracic Spine Routine Without Contrast,,72128,CPT,Facility,Both,,,,1702,1446.7,325.628,1702,Aetna,Commercial,1565.84,92,,percent of total billed charges,,
Ct Thoracic Spine Routine Without Contrast,,72128,CPT,Facility,Outpatient,,,,1702,1446.7,325.628,1702,Aetna,Medicare Advantage,833.98,49,,percent of total billed charges,,
Ct Thoracic Spine Routine Without Contrast,,72128,CPT,Facility,Inpatient,,,,1702,1446.7,325.628,1702,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Ct Thoracic Spine Routine Without Contrast,,72128,CPT,Facility,Both,,,,1702,1446.7,325.628,1702,Aetna,PPO,1582.86,93,,percent of total billed charges,,
Ct Thoracic Spine Routine Without Contrast,,72128,CPT,Facility,Both,,,,1702,1446.7,325.628,1702,America's PPO,America's PPO,1634.4306,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Ct Thoracic Spine Routine Without Contrast,,72128,CPT,Facility,Both,,,,1702,1446.7,325.628,1702,BlueCross BlueShield Minnesota, Federal Employee Program,641,,,Fee schedule,,100% of BCBS commercial commodity fee schedule
Ct Thoracic Spine Routine Without Contrast,,72128,CPT,Facility,Both,,,,1702,1446.7,325.628,1702,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,651.256,,,Fee schedule,,"100% of BCBS commercial commodity fee schedule, plus MN Care tax"
Ct Thoracic Spine Routine Without Contrast,,72128,CPT,Facility,Both,,,,1702,1446.7,325.628,1702,BlueCross BlueShield Minnesota,High Value Network Plan,586.1304,,,Fee schedule,,"90% of BCBS commercial commodity fee schedule, plus MN Care tax; see disclaimer for more information"
Ct Thoracic Spine Routine Without Contrast,,72128,CPT,Facility,Outpatient,,,,1702,1446.7,325.628,1702,BlueCross BlueShield Minnesota,Medicare Advantage,833.98,49,,percent of total billed charges,,
Ct Thoracic Spine Routine Without Contrast,,72128,CPT,Facility,Inpatient,,,,1702,1446.7,325.628,1702,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Ct Thoracic Spine Routine Without Contrast,,72128,CPT,Facility,Both,,,,1702,1446.7,325.628,1702,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,576.8174392,,,Fee schedule,,"88.57% of BCBS commercial commodity fee schedule, plus MN Care tax"
Ct Thoracic Spine Routine Without Contrast,,72128,CPT,Facility,Both,,,,1702,1446.7,325.628,1702,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,325.628,,,Fee schedule,,"100% of BCBS Medicaid commodity fee schedule, plus MN Care tax"
Ct Thoracic Spine Routine Without Contrast,,72128,CPT,Facility,Outpatient,,,,1702,1446.7,325.628,1702,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),833.98,49,,percent of total billed charges,,
Ct Thoracic Spine Routine Without Contrast,,72128,CPT,Facility,Inpatient,,,,1702,1446.7,325.628,1702,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Ct Thoracic Spine Routine Without Contrast,,72128,CPT,Facility,Both,,,,1702,1446.7,325.628,1702,CorVel,Worker's Compensation,1702,100,,percent of total billed charges,,
Ct Thoracic Spine Routine Without Contrast,,72128,CPT,Facility,Both,,,,1702,1446.7,325.628,1702,First Health Group Corporation,First Health Network,1650.94,97,,percent of total billed charges,,
Ct Thoracic Spine Routine Without Contrast,,72128,CPT,Facility,Both,,,,1702,1446.7,325.628,1702,"Health Partners, Inc.",Commercial,1610.092,94.6,,percent of total billed charges,,
Ct Thoracic Spine Routine Without Contrast,,72128,CPT,Facility,Outpatient,,,,1702,1446.7,325.628,1702,"Health Partners, Inc.",Medicare Advantage,833.98,49,,percent of total billed charges,,
Ct Thoracic Spine Routine Without Contrast,,72128,CPT,Facility,Inpatient,,,,1702,1446.7,325.628,1702,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ct Thoracic Spine Routine Without Contrast,,72128,CPT,Facility,Both,,,,1702,1446.7,325.628,1702,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1021.2,60,,percent of total billed charges,,
Ct Thoracic Spine Routine Without Contrast,,72128,CPT,Facility,Both,,,,1702,1446.7,325.628,1702,"Health Partners, Inc.",State of Minnesota Advantage Program,1387.13,81.5,,percent of total billed charges,,
Ct Thoracic Spine Routine Without Contrast,,72128,CPT,Facility,Both,,,,1702,1446.7,325.628,1702,"Health Partners, Inc.",State Public Programs,851,50,,percent of total billed charges,,
Ct Thoracic Spine Routine Without Contrast,,72128,CPT,Facility,Both,,,,1702,1446.7,325.628,1702,Humana Insurance Company,Commercial PPO,1616.9,95,,percent of total billed charges,,
Ct Thoracic Spine Routine Without Contrast,,72128,CPT,Facility,Outpatient,,,,1702,1446.7,325.628,1702,Humana Insurance Company,Medicare PPO,833.98,49,,percent of total billed charges,,
Ct Thoracic Spine Routine Without Contrast,,72128,CPT,Facility,Inpatient,,,,1702,1446.7,325.628,1702,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Ct Thoracic Spine Routine Without Contrast,,72128,CPT,Facility,Both,,,,1702,1446.7,325.628,1702,Medica,Individual & Family,1686.682,99.1,,percent of total billed charges,,
Ct Thoracic Spine Routine Without Contrast,,72128,CPT,Facility,Outpatient,,,,1702,1446.7,325.628,1702,Medica,Medica Advantage Solution,847.596,49.8,,percent of total billed charges,,
Ct Thoracic Spine Routine Without Contrast,,72128,CPT,Facility,Inpatient,,,,1702,1446.7,325.628,1702,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Ct Thoracic Spine Routine Without Contrast,,72128,CPT,Facility,Outpatient,,,,1702,1446.7,325.628,1702,Medica,Medical Assistance,759.092,44.6,,percent of total billed charges,,
Ct Thoracic Spine Routine Without Contrast,,72128,CPT,Facility,Inpatient,,,,1702,1446.7,325.628,1702,Medica,Medical Assistance,,,,,Included in per diem rate,
Ct Thoracic Spine Routine Without Contrast,,72128,CPT,Facility,Outpatient,,,,1702,1446.7,325.628,1702,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,847.596,49.8,,percent of total billed charges,,
Ct Thoracic Spine Routine Without Contrast,,72128,CPT,Facility,Inpatient,,,,1702,1446.7,325.628,1702,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Ct Thoracic Spine Routine Without Contrast,,72128,CPT,Facility,Both,,,,1702,1446.7,325.628,1702,"Multiplan, Inc.","Multiplan, Inc.",1599.88,94,,percent of total billed charges,,
Ct Thoracic Spine Routine Without Contrast,,72128,CPT,Facility,Outpatient,,,,1702,1446.7,325.628,1702,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1283,,,Other,Per scan,
Ct Thoracic Spine Routine Without Contrast,,72128,CPT,Facility,Inpatient,,,,1702,1446.7,325.628,1702,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Ct Thoracic Spine Routine Without Contrast,,72128,CPT,Facility,Both,,,,1702,1446.7,325.628,1702,"Preferred One Administrative Services, INC.",PPO,1678.172,98.6,,percent of total billed charges,,
Ct Thoracic Spine Routine Without Contrast,,72128,CPT,Facility,Outpatient,,,,1702,1446.7,325.628,1702,PrimeWest Health,Minnesota Senior Health Options (MSHO),875.679,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Ct Thoracic Spine Routine Without Contrast,,72128,CPT,Facility,Inpatient,,,,1702,1446.7,325.628,1702,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ct Thoracic Spine Routine Without Contrast,,72128,CPT,Facility,Outpatient,,,,1702,1446.7,325.628,1702,PrimeWest Health,MinnesotaCare,874.1472,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Ct Thoracic Spine Routine Without Contrast,,72128,CPT,Facility,Inpatient,,,,1702,1446.7,325.628,1702,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Ct Thoracic Spine Routine Without Contrast,,72128,CPT,Facility,Both,,,,1702,1446.7,325.628,1702,Sanford Health Plan,Sanford Health Plan,1565.84,92,,percent of total billed charges,,
Ct Thoracic Spine Routine Without Contrast,,72128,CPT,Facility,Outpatient,,,,1702,1446.7,325.628,1702,"UCare Health, Inc.",Individual & Family Plan,959.077,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Ct Thoracic Spine Routine Without Contrast,,72128,CPT,Facility,Inpatient,,,,1702,1446.7,325.628,1702,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Ct Thoracic Spine Routine Without Contrast,,72128,CPT,Facility,Outpatient,,,,1702,1446.7,325.628,1702,"UCare Health, Inc.",Medical Assistance,858.9994,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ct Thoracic Spine Routine Without Contrast,,72128,CPT,Facility,Inpatient,,,,1702,1446.7,325.628,1702,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Ct Thoracic Spine Routine Without Contrast,,72128,CPT,Facility,Outpatient,,,,1702,1446.7,325.628,1702,"UCare Health, Inc.",Medicare Advantage,858.9994,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ct Thoracic Spine Routine Without Contrast,,72128,CPT,Facility,Inpatient,,,,1702,1446.7,325.628,1702,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ct Thoracic Spine Routine Without Contrast,,72128,CPT,Facility,Outpatient,,,,1702,1446.7,325.628,1702,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),858.9994,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ct Thoracic Spine Routine Without Contrast,,72128,CPT,Facility,Inpatient,,,,1702,1446.7,325.628,1702,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ct Thoracic Spine Routine Without Contrast,,72128,CPT,Facility,Both,,,,1702,1446.7,325.628,1702,UnitedHealthcare,Individual & Family,1599.88,94,,percent of total billed charges,,
Ct Thoracic Spine Routine Without Contrast,,72128,CPT,Facility,Outpatient,,,,1702,1446.7,325.628,1702,UnitedHealthcare,Medicare Advantage,833.98,49,,percent of total billed charges,,
Ct Thoracic Spine Routine Without Contrast,,72128,CPT,Facility,Inpatient,,,,1702,1446.7,325.628,1702,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Ct Thoracic Spine Routine Without Contrast,,72128,CPT,Facility,Outpatient,,,,1702,1446.7,325.628,1702,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,816.96,48,,percent of total billed charges,,100% of DHS outpatient percentage
Ct Thoracic Spine Routine Without Contrast,,72128,CPT,Facility,Inpatient,,,,1702,1446.7,325.628,1702,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Ct Thoracic Spine W Contrast,,72129,CPT,Facility,Both,,,,1930,1640.5,412.496,1930,Aetna,Commercial,1775.6,92,,percent of total billed charges,,
Ct Thoracic Spine W Contrast,,72129,CPT,Facility,Outpatient,,,,1930,1640.5,412.496,1930,Aetna,Medicare Advantage,945.7,49,,percent of total billed charges,,
Ct Thoracic Spine W Contrast,,72129,CPT,Facility,Inpatient,,,,1930,1640.5,412.496,1930,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Ct Thoracic Spine W Contrast,,72129,CPT,Facility,Both,,,,1930,1640.5,412.496,1930,Aetna,PPO,1794.9,93,,percent of total billed charges,,
Ct Thoracic Spine W Contrast,,72129,CPT,Facility,Both,,,,1930,1640.5,412.496,1930,America's PPO,America's PPO,1853.379,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Ct Thoracic Spine W Contrast,,72129,CPT,Facility,Both,,,,1930,1640.5,412.496,1930,BlueCross BlueShield Minnesota, Federal Employee Program,812,,,Fee schedule,,100% of BCBS commercial commodity fee schedule
Ct Thoracic Spine W Contrast,,72129,CPT,Facility,Both,,,,1930,1640.5,412.496,1930,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,824.992,,,Fee schedule,,"100% of BCBS commercial commodity fee schedule, plus MN Care tax"
Ct Thoracic Spine W Contrast,,72129,CPT,Facility,Both,,,,1930,1640.5,412.496,1930,BlueCross BlueShield Minnesota,High Value Network Plan,742.4928,,,Fee schedule,,"90% of BCBS commercial commodity fee schedule, plus MN Care tax; see disclaimer for more information"
Ct Thoracic Spine W Contrast,,72129,CPT,Facility,Outpatient,,,,1930,1640.5,412.496,1930,BlueCross BlueShield Minnesota,Medicare Advantage,945.7,49,,percent of total billed charges,,
Ct Thoracic Spine W Contrast,,72129,CPT,Facility,Inpatient,,,,1930,1640.5,412.496,1930,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Ct Thoracic Spine W Contrast,,72129,CPT,Facility,Both,,,,1930,1640.5,412.496,1930,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,730.6954144,,,Fee schedule,,"88.57% of BCBS commercial commodity fee schedule, plus MN Care tax"
Ct Thoracic Spine W Contrast,,72129,CPT,Facility,Both,,,,1930,1640.5,412.496,1930,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,412.496,,,Fee schedule,,"100% of BCBS Medicaid commodity fee schedule, plus MN Care tax"
Ct Thoracic Spine W Contrast,,72129,CPT,Facility,Outpatient,,,,1930,1640.5,412.496,1930,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),945.7,49,,percent of total billed charges,,
Ct Thoracic Spine W Contrast,,72129,CPT,Facility,Inpatient,,,,1930,1640.5,412.496,1930,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Ct Thoracic Spine W Contrast,,72129,CPT,Facility,Both,,,,1930,1640.5,412.496,1930,CorVel,Worker's Compensation,1930,100,,percent of total billed charges,,
Ct Thoracic Spine W Contrast,,72129,CPT,Facility,Both,,,,1930,1640.5,412.496,1930,First Health Group Corporation,First Health Network,1872.1,97,,percent of total billed charges,,
Ct Thoracic Spine W Contrast,,72129,CPT,Facility,Both,,,,1930,1640.5,412.496,1930,"Health Partners, Inc.",Commercial,1825.78,94.6,,percent of total billed charges,,
Ct Thoracic Spine W Contrast,,72129,CPT,Facility,Outpatient,,,,1930,1640.5,412.496,1930,"Health Partners, Inc.",Medicare Advantage,945.7,49,,percent of total billed charges,,
Ct Thoracic Spine W Contrast,,72129,CPT,Facility,Inpatient,,,,1930,1640.5,412.496,1930,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ct Thoracic Spine W Contrast,,72129,CPT,Facility,Both,,,,1930,1640.5,412.496,1930,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1158,60,,percent of total billed charges,,
Ct Thoracic Spine W Contrast,,72129,CPT,Facility,Both,,,,1930,1640.5,412.496,1930,"Health Partners, Inc.",State of Minnesota Advantage Program,1572.95,81.5,,percent of total billed charges,,
Ct Thoracic Spine W Contrast,,72129,CPT,Facility,Both,,,,1930,1640.5,412.496,1930,"Health Partners, Inc.",State Public Programs,965,50,,percent of total billed charges,,
Ct Thoracic Spine W Contrast,,72129,CPT,Facility,Both,,,,1930,1640.5,412.496,1930,Humana Insurance Company,Commercial PPO,1833.5,95,,percent of total billed charges,,
Ct Thoracic Spine W Contrast,,72129,CPT,Facility,Outpatient,,,,1930,1640.5,412.496,1930,Humana Insurance Company,Medicare PPO,945.7,49,,percent of total billed charges,,
Ct Thoracic Spine W Contrast,,72129,CPT,Facility,Inpatient,,,,1930,1640.5,412.496,1930,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Ct Thoracic Spine W Contrast,,72129,CPT,Facility,Both,,,,1930,1640.5,412.496,1930,Medica,Individual & Family,1912.63,99.1,,percent of total billed charges,,
Ct Thoracic Spine W Contrast,,72129,CPT,Facility,Outpatient,,,,1930,1640.5,412.496,1930,Medica,Medica Advantage Solution,961.14,49.8,,percent of total billed charges,,
Ct Thoracic Spine W Contrast,,72129,CPT,Facility,Inpatient,,,,1930,1640.5,412.496,1930,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Ct Thoracic Spine W Contrast,,72129,CPT,Facility,Outpatient,,,,1930,1640.5,412.496,1930,Medica,Medical Assistance,860.78,44.6,,percent of total billed charges,,
Ct Thoracic Spine W Contrast,,72129,CPT,Facility,Inpatient,,,,1930,1640.5,412.496,1930,Medica,Medical Assistance,,,,,Included in per diem rate,
Ct Thoracic Spine W Contrast,,72129,CPT,Facility,Outpatient,,,,1930,1640.5,412.496,1930,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,961.14,49.8,,percent of total billed charges,,
Ct Thoracic Spine W Contrast,,72129,CPT,Facility,Inpatient,,,,1930,1640.5,412.496,1930,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Ct Thoracic Spine W Contrast,,72129,CPT,Facility,Both,,,,1930,1640.5,412.496,1930,"Multiplan, Inc.","Multiplan, Inc.",1814.2,94,,percent of total billed charges,,
Ct Thoracic Spine W Contrast,,72129,CPT,Facility,Outpatient,,,,1930,1640.5,412.496,1930,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1283,,,Other,Per scan,
Ct Thoracic Spine W Contrast,,72129,CPT,Facility,Inpatient,,,,1930,1640.5,412.496,1930,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Ct Thoracic Spine W Contrast,,72129,CPT,Facility,Both,,,,1930,1640.5,412.496,1930,"Preferred One Administrative Services, INC.",PPO,1902.98,98.6,,percent of total billed charges,,
Ct Thoracic Spine W Contrast,,72129,CPT,Facility,Outpatient,,,,1930,1640.5,412.496,1930,PrimeWest Health,Minnesota Senior Health Options (MSHO),992.985,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Ct Thoracic Spine W Contrast,,72129,CPT,Facility,Inpatient,,,,1930,1640.5,412.496,1930,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ct Thoracic Spine W Contrast,,72129,CPT,Facility,Outpatient,,,,1930,1640.5,412.496,1930,PrimeWest Health,MinnesotaCare,991.248,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Ct Thoracic Spine W Contrast,,72129,CPT,Facility,Inpatient,,,,1930,1640.5,412.496,1930,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Ct Thoracic Spine W Contrast,,72129,CPT,Facility,Both,,,,1930,1640.5,412.496,1930,Sanford Health Plan,Sanford Health Plan,1775.6,92,,percent of total billed charges,,
Ct Thoracic Spine W Contrast,,72129,CPT,Facility,Outpatient,,,,1930,1640.5,412.496,1930,"UCare Health, Inc.",Individual & Family Plan,1087.555,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Ct Thoracic Spine W Contrast,,72129,CPT,Facility,Inpatient,,,,1930,1640.5,412.496,1930,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Ct Thoracic Spine W Contrast,,72129,CPT,Facility,Outpatient,,,,1930,1640.5,412.496,1930,"UCare Health, Inc.",Medical Assistance,974.071,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ct Thoracic Spine W Contrast,,72129,CPT,Facility,Inpatient,,,,1930,1640.5,412.496,1930,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Ct Thoracic Spine W Contrast,,72129,CPT,Facility,Outpatient,,,,1930,1640.5,412.496,1930,"UCare Health, Inc.",Medicare Advantage,974.071,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ct Thoracic Spine W Contrast,,72129,CPT,Facility,Inpatient,,,,1930,1640.5,412.496,1930,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ct Thoracic Spine W Contrast,,72129,CPT,Facility,Outpatient,,,,1930,1640.5,412.496,1930,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),974.071,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ct Thoracic Spine W Contrast,,72129,CPT,Facility,Inpatient,,,,1930,1640.5,412.496,1930,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ct Thoracic Spine W Contrast,,72129,CPT,Facility,Both,,,,1930,1640.5,412.496,1930,UnitedHealthcare,Individual & Family,1814.2,94,,percent of total billed charges,,
Ct Thoracic Spine W Contrast,,72129,CPT,Facility,Outpatient,,,,1930,1640.5,412.496,1930,UnitedHealthcare,Medicare Advantage,945.7,49,,percent of total billed charges,,
Ct Thoracic Spine W Contrast,,72129,CPT,Facility,Inpatient,,,,1930,1640.5,412.496,1930,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Ct Thoracic Spine W Contrast,,72129,CPT,Facility,Outpatient,,,,1930,1640.5,412.496,1930,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,926.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
Ct Thoracic Spine W Contrast,,72129,CPT,Facility,Inpatient,,,,1930,1640.5,412.496,1930,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Ct Thoracic Spine Wo W Contrast,,72130,CPT,Facility,Both,,,,2076,1764.6,412.496,2076,Aetna,Commercial,1909.92,92,,percent of total billed charges,,
Ct Thoracic Spine Wo W Contrast,,72130,CPT,Facility,Outpatient,,,,2076,1764.6,412.496,2076,Aetna,Medicare Advantage,1017.24,49,,percent of total billed charges,,
Ct Thoracic Spine Wo W Contrast,,72130,CPT,Facility,Inpatient,,,,2076,1764.6,412.496,2076,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Ct Thoracic Spine Wo W Contrast,,72130,CPT,Facility,Both,,,,2076,1764.6,412.496,2076,Aetna,PPO,1930.68,93,,percent of total billed charges,,
Ct Thoracic Spine Wo W Contrast,,72130,CPT,Facility,Both,,,,2076,1764.6,412.496,2076,America's PPO,America's PPO,1993.5828,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Ct Thoracic Spine Wo W Contrast,,72130,CPT,Facility,Both,,,,2076,1764.6,412.496,2076,BlueCross BlueShield Minnesota, Federal Employee Program,812,,,Fee schedule,,100% of BCBS commercial commodity fee schedule
Ct Thoracic Spine Wo W Contrast,,72130,CPT,Facility,Both,,,,2076,1764.6,412.496,2076,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,824.992,,,Fee schedule,,"100% of BCBS commercial commodity fee schedule, plus MN Care tax"
Ct Thoracic Spine Wo W Contrast,,72130,CPT,Facility,Both,,,,2076,1764.6,412.496,2076,BlueCross BlueShield Minnesota,High Value Network Plan,742.4928,,,Fee schedule,,"90% of BCBS commercial commodity fee schedule, plus MN Care tax; see disclaimer for more information"
Ct Thoracic Spine Wo W Contrast,,72130,CPT,Facility,Outpatient,,,,2076,1764.6,412.496,2076,BlueCross BlueShield Minnesota,Medicare Advantage,1017.24,49,,percent of total billed charges,,
Ct Thoracic Spine Wo W Contrast,,72130,CPT,Facility,Inpatient,,,,2076,1764.6,412.496,2076,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Ct Thoracic Spine Wo W Contrast,,72130,CPT,Facility,Both,,,,2076,1764.6,412.496,2076,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,730.6954144,,,Fee schedule,,"88.57% of BCBS commercial commodity fee schedule, plus MN Care tax"
Ct Thoracic Spine Wo W Contrast,,72130,CPT,Facility,Both,,,,2076,1764.6,412.496,2076,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,412.496,,,Fee schedule,,"100% of BCBS Medicaid commodity fee schedule, plus MN Care tax"
Ct Thoracic Spine Wo W Contrast,,72130,CPT,Facility,Outpatient,,,,2076,1764.6,412.496,2076,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1017.24,49,,percent of total billed charges,,
Ct Thoracic Spine Wo W Contrast,,72130,CPT,Facility,Inpatient,,,,2076,1764.6,412.496,2076,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Ct Thoracic Spine Wo W Contrast,,72130,CPT,Facility,Both,,,,2076,1764.6,412.496,2076,CorVel,Worker's Compensation,2076,100,,percent of total billed charges,,
Ct Thoracic Spine Wo W Contrast,,72130,CPT,Facility,Both,,,,2076,1764.6,412.496,2076,First Health Group Corporation,First Health Network,2013.72,97,,percent of total billed charges,,
Ct Thoracic Spine Wo W Contrast,,72130,CPT,Facility,Both,,,,2076,1764.6,412.496,2076,"Health Partners, Inc.",Commercial,1963.896,94.6,,percent of total billed charges,,
Ct Thoracic Spine Wo W Contrast,,72130,CPT,Facility,Outpatient,,,,2076,1764.6,412.496,2076,"Health Partners, Inc.",Medicare Advantage,1017.24,49,,percent of total billed charges,,
Ct Thoracic Spine Wo W Contrast,,72130,CPT,Facility,Inpatient,,,,2076,1764.6,412.496,2076,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ct Thoracic Spine Wo W Contrast,,72130,CPT,Facility,Both,,,,2076,1764.6,412.496,2076,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1245.6,60,,percent of total billed charges,,
Ct Thoracic Spine Wo W Contrast,,72130,CPT,Facility,Both,,,,2076,1764.6,412.496,2076,"Health Partners, Inc.",State of Minnesota Advantage Program,1691.94,81.5,,percent of total billed charges,,
Ct Thoracic Spine Wo W Contrast,,72130,CPT,Facility,Both,,,,2076,1764.6,412.496,2076,"Health Partners, Inc.",State Public Programs,1038,50,,percent of total billed charges,,
Ct Thoracic Spine Wo W Contrast,,72130,CPT,Facility,Both,,,,2076,1764.6,412.496,2076,Humana Insurance Company,Commercial PPO,1972.2,95,,percent of total billed charges,,
Ct Thoracic Spine Wo W Contrast,,72130,CPT,Facility,Outpatient,,,,2076,1764.6,412.496,2076,Humana Insurance Company,Medicare PPO,1017.24,49,,percent of total billed charges,,
Ct Thoracic Spine Wo W Contrast,,72130,CPT,Facility,Inpatient,,,,2076,1764.6,412.496,2076,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Ct Thoracic Spine Wo W Contrast,,72130,CPT,Facility,Both,,,,2076,1764.6,412.496,2076,Medica,Individual & Family,2057.316,99.1,,percent of total billed charges,,
Ct Thoracic Spine Wo W Contrast,,72130,CPT,Facility,Outpatient,,,,2076,1764.6,412.496,2076,Medica,Medica Advantage Solution,1033.848,49.8,,percent of total billed charges,,
Ct Thoracic Spine Wo W Contrast,,72130,CPT,Facility,Inpatient,,,,2076,1764.6,412.496,2076,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Ct Thoracic Spine Wo W Contrast,,72130,CPT,Facility,Outpatient,,,,2076,1764.6,412.496,2076,Medica,Medical Assistance,925.896,44.6,,percent of total billed charges,,
Ct Thoracic Spine Wo W Contrast,,72130,CPT,Facility,Inpatient,,,,2076,1764.6,412.496,2076,Medica,Medical Assistance,,,,,Included in per diem rate,
Ct Thoracic Spine Wo W Contrast,,72130,CPT,Facility,Outpatient,,,,2076,1764.6,412.496,2076,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1033.848,49.8,,percent of total billed charges,,
Ct Thoracic Spine Wo W Contrast,,72130,CPT,Facility,Inpatient,,,,2076,1764.6,412.496,2076,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Ct Thoracic Spine Wo W Contrast,,72130,CPT,Facility,Both,,,,2076,1764.6,412.496,2076,"Multiplan, Inc.","Multiplan, Inc.",1951.44,94,,percent of total billed charges,,
Ct Thoracic Spine Wo W Contrast,,72130,CPT,Facility,Outpatient,,,,2076,1764.6,412.496,2076,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1283,,,Other,Per scan,
Ct Thoracic Spine Wo W Contrast,,72130,CPT,Facility,Inpatient,,,,2076,1764.6,412.496,2076,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Ct Thoracic Spine Wo W Contrast,,72130,CPT,Facility,Both,,,,2076,1764.6,412.496,2076,"Preferred One Administrative Services, INC.",PPO,2046.936,98.6,,percent of total billed charges,,
Ct Thoracic Spine Wo W Contrast,,72130,CPT,Facility,Outpatient,,,,2076,1764.6,412.496,2076,PrimeWest Health,Minnesota Senior Health Options (MSHO),1068.102,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Ct Thoracic Spine Wo W Contrast,,72130,CPT,Facility,Inpatient,,,,2076,1764.6,412.496,2076,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ct Thoracic Spine Wo W Contrast,,72130,CPT,Facility,Outpatient,,,,2076,1764.6,412.496,2076,PrimeWest Health,MinnesotaCare,1066.2336,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Ct Thoracic Spine Wo W Contrast,,72130,CPT,Facility,Inpatient,,,,2076,1764.6,412.496,2076,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Ct Thoracic Spine Wo W Contrast,,72130,CPT,Facility,Both,,,,2076,1764.6,412.496,2076,Sanford Health Plan,Sanford Health Plan,1909.92,92,,percent of total billed charges,,
Ct Thoracic Spine Wo W Contrast,,72130,CPT,Facility,Outpatient,,,,2076,1764.6,412.496,2076,"UCare Health, Inc.",Individual & Family Plan,1169.826,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Ct Thoracic Spine Wo W Contrast,,72130,CPT,Facility,Inpatient,,,,2076,1764.6,412.496,2076,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Ct Thoracic Spine Wo W Contrast,,72130,CPT,Facility,Outpatient,,,,2076,1764.6,412.496,2076,"UCare Health, Inc.",Medical Assistance,1047.7572,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ct Thoracic Spine Wo W Contrast,,72130,CPT,Facility,Inpatient,,,,2076,1764.6,412.496,2076,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Ct Thoracic Spine Wo W Contrast,,72130,CPT,Facility,Outpatient,,,,2076,1764.6,412.496,2076,"UCare Health, Inc.",Medicare Advantage,1047.7572,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ct Thoracic Spine Wo W Contrast,,72130,CPT,Facility,Inpatient,,,,2076,1764.6,412.496,2076,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ct Thoracic Spine Wo W Contrast,,72130,CPT,Facility,Outpatient,,,,2076,1764.6,412.496,2076,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1047.7572,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ct Thoracic Spine Wo W Contrast,,72130,CPT,Facility,Inpatient,,,,2076,1764.6,412.496,2076,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ct Thoracic Spine Wo W Contrast,,72130,CPT,Facility,Both,,,,2076,1764.6,412.496,2076,UnitedHealthcare,Individual & Family,1951.44,94,,percent of total billed charges,,
Ct Thoracic Spine Wo W Contrast,,72130,CPT,Facility,Outpatient,,,,2076,1764.6,412.496,2076,UnitedHealthcare,Medicare Advantage,1017.24,49,,percent of total billed charges,,
Ct Thoracic Spine Wo W Contrast,,72130,CPT,Facility,Inpatient,,,,2076,1764.6,412.496,2076,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Ct Thoracic Spine Wo W Contrast,,72130,CPT,Facility,Outpatient,,,,2076,1764.6,412.496,2076,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,996.48,48,,percent of total billed charges,,100% of DHS outpatient percentage
Ct Thoracic Spine Wo W Contrast,,72130,CPT,Facility,Inpatient,,,,2076,1764.6,412.496,2076,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Ct Lumbar Spine Routine Without Contrast,,72131,CPT,Facility,Both,,,,1702,1446.7,325.628,1702,Aetna,Commercial,1565.84,92,,percent of total billed charges,,
Ct Lumbar Spine Routine Without Contrast,,72131,CPT,Facility,Outpatient,,,,1702,1446.7,325.628,1702,Aetna,Medicare Advantage,833.98,49,,percent of total billed charges,,
Ct Lumbar Spine Routine Without Contrast,,72131,CPT,Facility,Inpatient,,,,1702,1446.7,325.628,1702,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Ct Lumbar Spine Routine Without Contrast,,72131,CPT,Facility,Both,,,,1702,1446.7,325.628,1702,Aetna,PPO,1582.86,93,,percent of total billed charges,,
Ct Lumbar Spine Routine Without Contrast,,72131,CPT,Facility,Both,,,,1702,1446.7,325.628,1702,America's PPO,America's PPO,1634.4306,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Ct Lumbar Spine Routine Without Contrast,,72131,CPT,Facility,Both,,,,1702,1446.7,325.628,1702,BlueCross BlueShield Minnesota, Federal Employee Program,641,,,Fee schedule,,100% of BCBS commercial commodity fee schedule
Ct Lumbar Spine Routine Without Contrast,,72131,CPT,Facility,Both,,,,1702,1446.7,325.628,1702,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,651.256,,,Fee schedule,,"100% of BCBS commercial commodity fee schedule, plus MN Care tax"
Ct Lumbar Spine Routine Without Contrast,,72131,CPT,Facility,Both,,,,1702,1446.7,325.628,1702,BlueCross BlueShield Minnesota,High Value Network Plan,586.1304,,,Fee schedule,,"90% of BCBS commercial commodity fee schedule, plus MN Care tax; see disclaimer for more information"
Ct Lumbar Spine Routine Without Contrast,,72131,CPT,Facility,Outpatient,,,,1702,1446.7,325.628,1702,BlueCross BlueShield Minnesota,Medicare Advantage,833.98,49,,percent of total billed charges,,
Ct Lumbar Spine Routine Without Contrast,,72131,CPT,Facility,Inpatient,,,,1702,1446.7,325.628,1702,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Ct Lumbar Spine Routine Without Contrast,,72131,CPT,Facility,Both,,,,1702,1446.7,325.628,1702,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,576.8174392,,,Fee schedule,,"88.57% of BCBS commercial commodity fee schedule, plus MN Care tax"
Ct Lumbar Spine Routine Without Contrast,,72131,CPT,Facility,Both,,,,1702,1446.7,325.628,1702,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,325.628,,,Fee schedule,,"100% of BCBS Medicaid commodity fee schedule, plus MN Care tax"
Ct Lumbar Spine Routine Without Contrast,,72131,CPT,Facility,Outpatient,,,,1702,1446.7,325.628,1702,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),833.98,49,,percent of total billed charges,,
Ct Lumbar Spine Routine Without Contrast,,72131,CPT,Facility,Inpatient,,,,1702,1446.7,325.628,1702,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Ct Lumbar Spine Routine Without Contrast,,72131,CPT,Facility,Both,,,,1702,1446.7,325.628,1702,CorVel,Worker's Compensation,1702,100,,percent of total billed charges,,
Ct Lumbar Spine Routine Without Contrast,,72131,CPT,Facility,Both,,,,1702,1446.7,325.628,1702,First Health Group Corporation,First Health Network,1650.94,97,,percent of total billed charges,,
Ct Lumbar Spine Routine Without Contrast,,72131,CPT,Facility,Both,,,,1702,1446.7,325.628,1702,"Health Partners, Inc.",Commercial,1610.092,94.6,,percent of total billed charges,,
Ct Lumbar Spine Routine Without Contrast,,72131,CPT,Facility,Outpatient,,,,1702,1446.7,325.628,1702,"Health Partners, Inc.",Medicare Advantage,833.98,49,,percent of total billed charges,,
Ct Lumbar Spine Routine Without Contrast,,72131,CPT,Facility,Inpatient,,,,1702,1446.7,325.628,1702,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ct Lumbar Spine Routine Without Contrast,,72131,CPT,Facility,Both,,,,1702,1446.7,325.628,1702,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1021.2,60,,percent of total billed charges,,
Ct Lumbar Spine Routine Without Contrast,,72131,CPT,Facility,Both,,,,1702,1446.7,325.628,1702,"Health Partners, Inc.",State of Minnesota Advantage Program,1387.13,81.5,,percent of total billed charges,,
Ct Lumbar Spine Routine Without Contrast,,72131,CPT,Facility,Both,,,,1702,1446.7,325.628,1702,"Health Partners, Inc.",State Public Programs,851,50,,percent of total billed charges,,
Ct Lumbar Spine Routine Without Contrast,,72131,CPT,Facility,Both,,,,1702,1446.7,325.628,1702,Humana Insurance Company,Commercial PPO,1616.9,95,,percent of total billed charges,,
Ct Lumbar Spine Routine Without Contrast,,72131,CPT,Facility,Outpatient,,,,1702,1446.7,325.628,1702,Humana Insurance Company,Medicare PPO,833.98,49,,percent of total billed charges,,
Ct Lumbar Spine Routine Without Contrast,,72131,CPT,Facility,Inpatient,,,,1702,1446.7,325.628,1702,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Ct Lumbar Spine Routine Without Contrast,,72131,CPT,Facility,Both,,,,1702,1446.7,325.628,1702,Medica,Individual & Family,1686.682,99.1,,percent of total billed charges,,
Ct Lumbar Spine Routine Without Contrast,,72131,CPT,Facility,Outpatient,,,,1702,1446.7,325.628,1702,Medica,Medica Advantage Solution,847.596,49.8,,percent of total billed charges,,
Ct Lumbar Spine Routine Without Contrast,,72131,CPT,Facility,Inpatient,,,,1702,1446.7,325.628,1702,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Ct Lumbar Spine Routine Without Contrast,,72131,CPT,Facility,Outpatient,,,,1702,1446.7,325.628,1702,Medica,Medical Assistance,759.092,44.6,,percent of total billed charges,,
Ct Lumbar Spine Routine Without Contrast,,72131,CPT,Facility,Inpatient,,,,1702,1446.7,325.628,1702,Medica,Medical Assistance,,,,,Included in per diem rate,
Ct Lumbar Spine Routine Without Contrast,,72131,CPT,Facility,Outpatient,,,,1702,1446.7,325.628,1702,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,847.596,49.8,,percent of total billed charges,,
Ct Lumbar Spine Routine Without Contrast,,72131,CPT,Facility,Inpatient,,,,1702,1446.7,325.628,1702,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Ct Lumbar Spine Routine Without Contrast,,72131,CPT,Facility,Both,,,,1702,1446.7,325.628,1702,"Multiplan, Inc.","Multiplan, Inc.",1599.88,94,,percent of total billed charges,,
Ct Lumbar Spine Routine Without Contrast,,72131,CPT,Facility,Outpatient,,,,1702,1446.7,325.628,1702,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1283,,,Other,Per scan,
Ct Lumbar Spine Routine Without Contrast,,72131,CPT,Facility,Inpatient,,,,1702,1446.7,325.628,1702,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Ct Lumbar Spine Routine Without Contrast,,72131,CPT,Facility,Both,,,,1702,1446.7,325.628,1702,"Preferred One Administrative Services, INC.",PPO,1678.172,98.6,,percent of total billed charges,,
Ct Lumbar Spine Routine Without Contrast,,72131,CPT,Facility,Outpatient,,,,1702,1446.7,325.628,1702,PrimeWest Health,Minnesota Senior Health Options (MSHO),875.679,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Ct Lumbar Spine Routine Without Contrast,,72131,CPT,Facility,Inpatient,,,,1702,1446.7,325.628,1702,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ct Lumbar Spine Routine Without Contrast,,72131,CPT,Facility,Outpatient,,,,1702,1446.7,325.628,1702,PrimeWest Health,MinnesotaCare,874.1472,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Ct Lumbar Spine Routine Without Contrast,,72131,CPT,Facility,Inpatient,,,,1702,1446.7,325.628,1702,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Ct Lumbar Spine Routine Without Contrast,,72131,CPT,Facility,Both,,,,1702,1446.7,325.628,1702,Sanford Health Plan,Sanford Health Plan,1565.84,92,,percent of total billed charges,,
Ct Lumbar Spine Routine Without Contrast,,72131,CPT,Facility,Outpatient,,,,1702,1446.7,325.628,1702,"UCare Health, Inc.",Individual & Family Plan,959.077,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Ct Lumbar Spine Routine Without Contrast,,72131,CPT,Facility,Inpatient,,,,1702,1446.7,325.628,1702,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Ct Lumbar Spine Routine Without Contrast,,72131,CPT,Facility,Outpatient,,,,1702,1446.7,325.628,1702,"UCare Health, Inc.",Medical Assistance,858.9994,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ct Lumbar Spine Routine Without Contrast,,72131,CPT,Facility,Inpatient,,,,1702,1446.7,325.628,1702,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Ct Lumbar Spine Routine Without Contrast,,72131,CPT,Facility,Outpatient,,,,1702,1446.7,325.628,1702,"UCare Health, Inc.",Medicare Advantage,858.9994,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ct Lumbar Spine Routine Without Contrast,,72131,CPT,Facility,Inpatient,,,,1702,1446.7,325.628,1702,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ct Lumbar Spine Routine Without Contrast,,72131,CPT,Facility,Outpatient,,,,1702,1446.7,325.628,1702,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),858.9994,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ct Lumbar Spine Routine Without Contrast,,72131,CPT,Facility,Inpatient,,,,1702,1446.7,325.628,1702,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ct Lumbar Spine Routine Without Contrast,,72131,CPT,Facility,Both,,,,1702,1446.7,325.628,1702,UnitedHealthcare,Individual & Family,1599.88,94,,percent of total billed charges,,
Ct Lumbar Spine Routine Without Contrast,,72131,CPT,Facility,Outpatient,,,,1702,1446.7,325.628,1702,UnitedHealthcare,Medicare Advantage,833.98,49,,percent of total billed charges,,
Ct Lumbar Spine Routine Without Contrast,,72131,CPT,Facility,Inpatient,,,,1702,1446.7,325.628,1702,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Ct Lumbar Spine Routine Without Contrast,,72131,CPT,Facility,Outpatient,,,,1702,1446.7,325.628,1702,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,816.96,48,,percent of total billed charges,,100% of DHS outpatient percentage
Ct Lumbar Spine Routine Without Contrast,,72131,CPT,Facility,Inpatient,,,,1702,1446.7,325.628,1702,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Ct Lumbar Spine W Contrast,,72132,CPT,Facility,Both,,,,1930,1640.5,561.34,1930,Aetna,Commercial,1775.6,92,,percent of total billed charges,,
Ct Lumbar Spine W Contrast,,72132,CPT,Facility,Outpatient,,,,1930,1640.5,561.34,1930,Aetna,Medicare Advantage,945.7,49,,percent of total billed charges,,
Ct Lumbar Spine W Contrast,,72132,CPT,Facility,Inpatient,,,,1930,1640.5,561.34,1930,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Ct Lumbar Spine W Contrast,,72132,CPT,Facility,Both,,,,1930,1640.5,561.34,1930,Aetna,PPO,1794.9,93,,percent of total billed charges,,
Ct Lumbar Spine W Contrast,,72132,CPT,Facility,Both,,,,1930,1640.5,561.34,1930,America's PPO,America's PPO,1853.379,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Ct Lumbar Spine W Contrast,,72132,CPT,Facility,Both,,,,1930,1640.5,561.34,1930,BlueCross BlueShield Minnesota, Federal Employee Program,1105,,,Fee schedule,,100% of BCBS commercial commodity fee schedule
Ct Lumbar Spine W Contrast,,72132,CPT,Facility,Both,,,,1930,1640.5,561.34,1930,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1122.68,,,Fee schedule,,"100% of BCBS commercial commodity fee schedule, plus MN Care tax"
Ct Lumbar Spine W Contrast,,72132,CPT,Facility,Both,,,,1930,1640.5,561.34,1930,BlueCross BlueShield Minnesota,High Value Network Plan,1010.412,,,Fee schedule,,"90% of BCBS commercial commodity fee schedule, plus MN Care tax; see disclaimer for more information"
Ct Lumbar Spine W Contrast,,72132,CPT,Facility,Outpatient,,,,1930,1640.5,561.34,1930,BlueCross BlueShield Minnesota,Medicare Advantage,945.7,49,,percent of total billed charges,,
Ct Lumbar Spine W Contrast,,72132,CPT,Facility,Inpatient,,,,1930,1640.5,561.34,1930,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Ct Lumbar Spine W Contrast,,72132,CPT,Facility,Both,,,,1930,1640.5,561.34,1930,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,994.357676,,,Fee schedule,,"88.57% of BCBS commercial commodity fee schedule, plus MN Care tax"
Ct Lumbar Spine W Contrast,,72132,CPT,Facility,Both,,,,1930,1640.5,561.34,1930,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,561.34,,,Fee schedule,,"100% of BCBS Medicaid commodity fee schedule, plus MN Care tax"
Ct Lumbar Spine W Contrast,,72132,CPT,Facility,Outpatient,,,,1930,1640.5,561.34,1930,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),945.7,49,,percent of total billed charges,,
Ct Lumbar Spine W Contrast,,72132,CPT,Facility,Inpatient,,,,1930,1640.5,561.34,1930,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Ct Lumbar Spine W Contrast,,72132,CPT,Facility,Both,,,,1930,1640.5,561.34,1930,CorVel,Worker's Compensation,1930,100,,percent of total billed charges,,
Ct Lumbar Spine W Contrast,,72132,CPT,Facility,Both,,,,1930,1640.5,561.34,1930,First Health Group Corporation,First Health Network,1872.1,97,,percent of total billed charges,,
Ct Lumbar Spine W Contrast,,72132,CPT,Facility,Both,,,,1930,1640.5,561.34,1930,"Health Partners, Inc.",Commercial,1825.78,94.6,,percent of total billed charges,,
Ct Lumbar Spine W Contrast,,72132,CPT,Facility,Outpatient,,,,1930,1640.5,561.34,1930,"Health Partners, Inc.",Medicare Advantage,945.7,49,,percent of total billed charges,,
Ct Lumbar Spine W Contrast,,72132,CPT,Facility,Inpatient,,,,1930,1640.5,561.34,1930,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ct Lumbar Spine W Contrast,,72132,CPT,Facility,Both,,,,1930,1640.5,561.34,1930,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1158,60,,percent of total billed charges,,
Ct Lumbar Spine W Contrast,,72132,CPT,Facility,Both,,,,1930,1640.5,561.34,1930,"Health Partners, Inc.",State of Minnesota Advantage Program,1572.95,81.5,,percent of total billed charges,,
Ct Lumbar Spine W Contrast,,72132,CPT,Facility,Both,,,,1930,1640.5,561.34,1930,"Health Partners, Inc.",State Public Programs,965,50,,percent of total billed charges,,
Ct Lumbar Spine W Contrast,,72132,CPT,Facility,Both,,,,1930,1640.5,561.34,1930,Humana Insurance Company,Commercial PPO,1833.5,95,,percent of total billed charges,,
Ct Lumbar Spine W Contrast,,72132,CPT,Facility,Outpatient,,,,1930,1640.5,561.34,1930,Humana Insurance Company,Medicare PPO,945.7,49,,percent of total billed charges,,
Ct Lumbar Spine W Contrast,,72132,CPT,Facility,Inpatient,,,,1930,1640.5,561.34,1930,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Ct Lumbar Spine W Contrast,,72132,CPT,Facility,Both,,,,1930,1640.5,561.34,1930,Medica,Individual & Family,1912.63,99.1,,percent of total billed charges,,
Ct Lumbar Spine W Contrast,,72132,CPT,Facility,Outpatient,,,,1930,1640.5,561.34,1930,Medica,Medica Advantage Solution,961.14,49.8,,percent of total billed charges,,
Ct Lumbar Spine W Contrast,,72132,CPT,Facility,Inpatient,,,,1930,1640.5,561.34,1930,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Ct Lumbar Spine W Contrast,,72132,CPT,Facility,Outpatient,,,,1930,1640.5,561.34,1930,Medica,Medical Assistance,860.78,44.6,,percent of total billed charges,,
Ct Lumbar Spine W Contrast,,72132,CPT,Facility,Inpatient,,,,1930,1640.5,561.34,1930,Medica,Medical Assistance,,,,,Included in per diem rate,
Ct Lumbar Spine W Contrast,,72132,CPT,Facility,Outpatient,,,,1930,1640.5,561.34,1930,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,961.14,49.8,,percent of total billed charges,,
Ct Lumbar Spine W Contrast,,72132,CPT,Facility,Inpatient,,,,1930,1640.5,561.34,1930,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Ct Lumbar Spine W Contrast,,72132,CPT,Facility,Both,,,,1930,1640.5,561.34,1930,"Multiplan, Inc.","Multiplan, Inc.",1814.2,94,,percent of total billed charges,,
Ct Lumbar Spine W Contrast,,72132,CPT,Facility,Outpatient,,,,1930,1640.5,561.34,1930,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1283,,,Other,Per scan,
Ct Lumbar Spine W Contrast,,72132,CPT,Facility,Inpatient,,,,1930,1640.5,561.34,1930,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Ct Lumbar Spine W Contrast,,72132,CPT,Facility,Both,,,,1930,1640.5,561.34,1930,"Preferred One Administrative Services, INC.",PPO,1902.98,98.6,,percent of total billed charges,,
Ct Lumbar Spine W Contrast,,72132,CPT,Facility,Outpatient,,,,1930,1640.5,561.34,1930,PrimeWest Health,Minnesota Senior Health Options (MSHO),992.985,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Ct Lumbar Spine W Contrast,,72132,CPT,Facility,Inpatient,,,,1930,1640.5,561.34,1930,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ct Lumbar Spine W Contrast,,72132,CPT,Facility,Outpatient,,,,1930,1640.5,561.34,1930,PrimeWest Health,MinnesotaCare,991.248,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Ct Lumbar Spine W Contrast,,72132,CPT,Facility,Inpatient,,,,1930,1640.5,561.34,1930,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Ct Lumbar Spine W Contrast,,72132,CPT,Facility,Both,,,,1930,1640.5,561.34,1930,Sanford Health Plan,Sanford Health Plan,1775.6,92,,percent of total billed charges,,
Ct Lumbar Spine W Contrast,,72132,CPT,Facility,Outpatient,,,,1930,1640.5,561.34,1930,"UCare Health, Inc.",Individual & Family Plan,1087.555,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Ct Lumbar Spine W Contrast,,72132,CPT,Facility,Inpatient,,,,1930,1640.5,561.34,1930,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Ct Lumbar Spine W Contrast,,72132,CPT,Facility,Outpatient,,,,1930,1640.5,561.34,1930,"UCare Health, Inc.",Medical Assistance,974.071,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ct Lumbar Spine W Contrast,,72132,CPT,Facility,Inpatient,,,,1930,1640.5,561.34,1930,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Ct Lumbar Spine W Contrast,,72132,CPT,Facility,Outpatient,,,,1930,1640.5,561.34,1930,"UCare Health, Inc.",Medicare Advantage,974.071,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ct Lumbar Spine W Contrast,,72132,CPT,Facility,Inpatient,,,,1930,1640.5,561.34,1930,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ct Lumbar Spine W Contrast,,72132,CPT,Facility,Outpatient,,,,1930,1640.5,561.34,1930,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),974.071,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ct Lumbar Spine W Contrast,,72132,CPT,Facility,Inpatient,,,,1930,1640.5,561.34,1930,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ct Lumbar Spine W Contrast,,72132,CPT,Facility,Both,,,,1930,1640.5,561.34,1930,UnitedHealthcare,Individual & Family,1814.2,94,,percent of total billed charges,,
Ct Lumbar Spine W Contrast,,72132,CPT,Facility,Outpatient,,,,1930,1640.5,561.34,1930,UnitedHealthcare,Medicare Advantage,945.7,49,,percent of total billed charges,,
Ct Lumbar Spine W Contrast,,72132,CPT,Facility,Inpatient,,,,1930,1640.5,561.34,1930,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Ct Lumbar Spine W Contrast,,72132,CPT,Facility,Outpatient,,,,1930,1640.5,561.34,1930,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,926.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
Ct Lumbar Spine W Contrast,,72132,CPT,Facility,Inpatient,,,,1930,1640.5,561.34,1930,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Ct Lumbar Spine Wo W Contrast,,72133,CPT,Facility,Both,,,,2076,1764.6,412.496,2076,Aetna,Commercial,1909.92,92,,percent of total billed charges,,
Ct Lumbar Spine Wo W Contrast,,72133,CPT,Facility,Outpatient,,,,2076,1764.6,412.496,2076,Aetna,Medicare Advantage,1017.24,49,,percent of total billed charges,,
Ct Lumbar Spine Wo W Contrast,,72133,CPT,Facility,Inpatient,,,,2076,1764.6,412.496,2076,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Ct Lumbar Spine Wo W Contrast,,72133,CPT,Facility,Both,,,,2076,1764.6,412.496,2076,Aetna,PPO,1930.68,93,,percent of total billed charges,,
Ct Lumbar Spine Wo W Contrast,,72133,CPT,Facility,Both,,,,2076,1764.6,412.496,2076,America's PPO,America's PPO,1993.5828,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Ct Lumbar Spine Wo W Contrast,,72133,CPT,Facility,Both,,,,2076,1764.6,412.496,2076,BlueCross BlueShield Minnesota, Federal Employee Program,812,,,Fee schedule,,100% of BCBS commercial commodity fee schedule
Ct Lumbar Spine Wo W Contrast,,72133,CPT,Facility,Both,,,,2076,1764.6,412.496,2076,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,824.992,,,Fee schedule,,"100% of BCBS commercial commodity fee schedule, plus MN Care tax"
Ct Lumbar Spine Wo W Contrast,,72133,CPT,Facility,Both,,,,2076,1764.6,412.496,2076,BlueCross BlueShield Minnesota,High Value Network Plan,742.4928,,,Fee schedule,,"90% of BCBS commercial commodity fee schedule, plus MN Care tax; see disclaimer for more information"
Ct Lumbar Spine Wo W Contrast,,72133,CPT,Facility,Outpatient,,,,2076,1764.6,412.496,2076,BlueCross BlueShield Minnesota,Medicare Advantage,1017.24,49,,percent of total billed charges,,
Ct Lumbar Spine Wo W Contrast,,72133,CPT,Facility,Inpatient,,,,2076,1764.6,412.496,2076,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Ct Lumbar Spine Wo W Contrast,,72133,CPT,Facility,Both,,,,2076,1764.6,412.496,2076,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,730.6954144,,,Fee schedule,,"88.57% of BCBS commercial commodity fee schedule, plus MN Care tax"
Ct Lumbar Spine Wo W Contrast,,72133,CPT,Facility,Both,,,,2076,1764.6,412.496,2076,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,412.496,,,Fee schedule,,"100% of BCBS Medicaid commodity fee schedule, plus MN Care tax"
Ct Lumbar Spine Wo W Contrast,,72133,CPT,Facility,Outpatient,,,,2076,1764.6,412.496,2076,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1017.24,49,,percent of total billed charges,,
Ct Lumbar Spine Wo W Contrast,,72133,CPT,Facility,Inpatient,,,,2076,1764.6,412.496,2076,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Ct Lumbar Spine Wo W Contrast,,72133,CPT,Facility,Both,,,,2076,1764.6,412.496,2076,CorVel,Worker's Compensation,2076,100,,percent of total billed charges,,
Ct Lumbar Spine Wo W Contrast,,72133,CPT,Facility,Both,,,,2076,1764.6,412.496,2076,First Health Group Corporation,First Health Network,2013.72,97,,percent of total billed charges,,
Ct Lumbar Spine Wo W Contrast,,72133,CPT,Facility,Both,,,,2076,1764.6,412.496,2076,"Health Partners, Inc.",Commercial,1963.896,94.6,,percent of total billed charges,,
Ct Lumbar Spine Wo W Contrast,,72133,CPT,Facility,Outpatient,,,,2076,1764.6,412.496,2076,"Health Partners, Inc.",Medicare Advantage,1017.24,49,,percent of total billed charges,,
Ct Lumbar Spine Wo W Contrast,,72133,CPT,Facility,Inpatient,,,,2076,1764.6,412.496,2076,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ct Lumbar Spine Wo W Contrast,,72133,CPT,Facility,Both,,,,2076,1764.6,412.496,2076,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1245.6,60,,percent of total billed charges,,
Ct Lumbar Spine Wo W Contrast,,72133,CPT,Facility,Both,,,,2076,1764.6,412.496,2076,"Health Partners, Inc.",State of Minnesota Advantage Program,1691.94,81.5,,percent of total billed charges,,
Ct Lumbar Spine Wo W Contrast,,72133,CPT,Facility,Both,,,,2076,1764.6,412.496,2076,"Health Partners, Inc.",State Public Programs,1038,50,,percent of total billed charges,,
Ct Lumbar Spine Wo W Contrast,,72133,CPT,Facility,Both,,,,2076,1764.6,412.496,2076,Humana Insurance Company,Commercial PPO,1972.2,95,,percent of total billed charges,,
Ct Lumbar Spine Wo W Contrast,,72133,CPT,Facility,Outpatient,,,,2076,1764.6,412.496,2076,Humana Insurance Company,Medicare PPO,1017.24,49,,percent of total billed charges,,
Ct Lumbar Spine Wo W Contrast,,72133,CPT,Facility,Inpatient,,,,2076,1764.6,412.496,2076,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Ct Lumbar Spine Wo W Contrast,,72133,CPT,Facility,Both,,,,2076,1764.6,412.496,2076,Medica,Individual & Family,2057.316,99.1,,percent of total billed charges,,
Ct Lumbar Spine Wo W Contrast,,72133,CPT,Facility,Outpatient,,,,2076,1764.6,412.496,2076,Medica,Medica Advantage Solution,1033.848,49.8,,percent of total billed charges,,
Ct Lumbar Spine Wo W Contrast,,72133,CPT,Facility,Inpatient,,,,2076,1764.6,412.496,2076,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Ct Lumbar Spine Wo W Contrast,,72133,CPT,Facility,Outpatient,,,,2076,1764.6,412.496,2076,Medica,Medical Assistance,925.896,44.6,,percent of total billed charges,,
Ct Lumbar Spine Wo W Contrast,,72133,CPT,Facility,Inpatient,,,,2076,1764.6,412.496,2076,Medica,Medical Assistance,,,,,Included in per diem rate,
Ct Lumbar Spine Wo W Contrast,,72133,CPT,Facility,Outpatient,,,,2076,1764.6,412.496,2076,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1033.848,49.8,,percent of total billed charges,,
Ct Lumbar Spine Wo W Contrast,,72133,CPT,Facility,Inpatient,,,,2076,1764.6,412.496,2076,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Ct Lumbar Spine Wo W Contrast,,72133,CPT,Facility,Both,,,,2076,1764.6,412.496,2076,"Multiplan, Inc.","Multiplan, Inc.",1951.44,94,,percent of total billed charges,,
Ct Lumbar Spine Wo W Contrast,,72133,CPT,Facility,Outpatient,,,,2076,1764.6,412.496,2076,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1283,,,Other,Per scan,
Ct Lumbar Spine Wo W Contrast,,72133,CPT,Facility,Inpatient,,,,2076,1764.6,412.496,2076,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Ct Lumbar Spine Wo W Contrast,,72133,CPT,Facility,Both,,,,2076,1764.6,412.496,2076,"Preferred One Administrative Services, INC.",PPO,2046.936,98.6,,percent of total billed charges,,
Ct Lumbar Spine Wo W Contrast,,72133,CPT,Facility,Outpatient,,,,2076,1764.6,412.496,2076,PrimeWest Health,Minnesota Senior Health Options (MSHO),1068.102,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Ct Lumbar Spine Wo W Contrast,,72133,CPT,Facility,Inpatient,,,,2076,1764.6,412.496,2076,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ct Lumbar Spine Wo W Contrast,,72133,CPT,Facility,Outpatient,,,,2076,1764.6,412.496,2076,PrimeWest Health,MinnesotaCare,1066.2336,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Ct Lumbar Spine Wo W Contrast,,72133,CPT,Facility,Inpatient,,,,2076,1764.6,412.496,2076,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Ct Lumbar Spine Wo W Contrast,,72133,CPT,Facility,Both,,,,2076,1764.6,412.496,2076,Sanford Health Plan,Sanford Health Plan,1909.92,92,,percent of total billed charges,,
Ct Lumbar Spine Wo W Contrast,,72133,CPT,Facility,Outpatient,,,,2076,1764.6,412.496,2076,"UCare Health, Inc.",Individual & Family Plan,1169.826,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Ct Lumbar Spine Wo W Contrast,,72133,CPT,Facility,Inpatient,,,,2076,1764.6,412.496,2076,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Ct Lumbar Spine Wo W Contrast,,72133,CPT,Facility,Outpatient,,,,2076,1764.6,412.496,2076,"UCare Health, Inc.",Medical Assistance,1047.7572,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ct Lumbar Spine Wo W Contrast,,72133,CPT,Facility,Inpatient,,,,2076,1764.6,412.496,2076,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Ct Lumbar Spine Wo W Contrast,,72133,CPT,Facility,Outpatient,,,,2076,1764.6,412.496,2076,"UCare Health, Inc.",Medicare Advantage,1047.7572,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ct Lumbar Spine Wo W Contrast,,72133,CPT,Facility,Inpatient,,,,2076,1764.6,412.496,2076,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ct Lumbar Spine Wo W Contrast,,72133,CPT,Facility,Outpatient,,,,2076,1764.6,412.496,2076,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1047.7572,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ct Lumbar Spine Wo W Contrast,,72133,CPT,Facility,Inpatient,,,,2076,1764.6,412.496,2076,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ct Lumbar Spine Wo W Contrast,,72133,CPT,Facility,Both,,,,2076,1764.6,412.496,2076,UnitedHealthcare,Individual & Family,1951.44,94,,percent of total billed charges,,
Ct Lumbar Spine Wo W Contrast,,72133,CPT,Facility,Outpatient,,,,2076,1764.6,412.496,2076,UnitedHealthcare,Medicare Advantage,1017.24,49,,percent of total billed charges,,
Ct Lumbar Spine Wo W Contrast,,72133,CPT,Facility,Inpatient,,,,2076,1764.6,412.496,2076,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Ct Lumbar Spine Wo W Contrast,,72133,CPT,Facility,Outpatient,,,,2076,1764.6,412.496,2076,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,996.48,48,,percent of total billed charges,,100% of DHS outpatient percentage
Ct Lumbar Spine Wo W Contrast,,72133,CPT,Facility,Inpatient,,,,2076,1764.6,412.496,2076,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Mri Cervical Spine Routine Wo Contrast,,72141,CPT,Facility,Both,,,,2468,2097.8,533.908,2468,Aetna,Commercial,2270.56,92,,percent of total billed charges,,
Mri Cervical Spine Routine Wo Contrast,,72141,CPT,Facility,Outpatient,,,,2468,2097.8,533.908,2468,Aetna,Medicare Advantage,1209.32,49,,percent of total billed charges,,
Mri Cervical Spine Routine Wo Contrast,,72141,CPT,Facility,Inpatient,,,,2468,2097.8,533.908,2468,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Mri Cervical Spine Routine Wo Contrast,,72141,CPT,Facility,Both,,,,2468,2097.8,533.908,2468,Aetna,PPO,2295.24,93,,percent of total billed charges,,
Mri Cervical Spine Routine Wo Contrast,,72141,CPT,Facility,Both,,,,2468,2097.8,533.908,2468,America's PPO,America's PPO,2370.0204,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Mri Cervical Spine Routine Wo Contrast,,72141,CPT,Facility,Both,,,,2468,2097.8,533.908,2468,BlueCross BlueShield Minnesota, Federal Employee Program,1051,,,Fee schedule,,100% of BCBS commercial commodity fee schedule
Mri Cervical Spine Routine Wo Contrast,,72141,CPT,Facility,Both,,,,2468,2097.8,533.908,2468,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1067.816,,,Fee schedule,,"100% of BCBS commercial commodity fee schedule, plus MN Care tax"
Mri Cervical Spine Routine Wo Contrast,,72141,CPT,Facility,Both,,,,2468,2097.8,533.908,2468,BlueCross BlueShield Minnesota,High Value Network Plan,961.0344,,,Fee schedule,,"90% of BCBS commercial commodity fee schedule, plus MN Care tax; see disclaimer for more information"
Mri Cervical Spine Routine Wo Contrast,,72141,CPT,Facility,Outpatient,,,,2468,2097.8,533.908,2468,BlueCross BlueShield Minnesota,Medicare Advantage,1209.32,49,,percent of total billed charges,,
Mri Cervical Spine Routine Wo Contrast,,72141,CPT,Facility,Inpatient,,,,2468,2097.8,533.908,2468,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Mri Cervical Spine Routine Wo Contrast,,72141,CPT,Facility,Both,,,,2468,2097.8,533.908,2468,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,945.7646312,,,Fee schedule,,"88.57% of BCBS commercial commodity fee schedule, plus MN Care tax"
Mri Cervical Spine Routine Wo Contrast,,72141,CPT,Facility,Both,,,,2468,2097.8,533.908,2468,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,533.908,,,Fee schedule,,"100% of BCBS Medicaid commodity fee schedule, plus MN Care tax"
Mri Cervical Spine Routine Wo Contrast,,72141,CPT,Facility,Outpatient,,,,2468,2097.8,533.908,2468,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1209.32,49,,percent of total billed charges,,
Mri Cervical Spine Routine Wo Contrast,,72141,CPT,Facility,Inpatient,,,,2468,2097.8,533.908,2468,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Mri Cervical Spine Routine Wo Contrast,,72141,CPT,Facility,Both,,,,2468,2097.8,533.908,2468,CorVel,Worker's Compensation,2468,100,,percent of total billed charges,,
Mri Cervical Spine Routine Wo Contrast,,72141,CPT,Facility,Both,,,,2468,2097.8,533.908,2468,First Health Group Corporation,First Health Network,2393.96,97,,percent of total billed charges,,
Mri Cervical Spine Routine Wo Contrast,,72141,CPT,Facility,Both,,,,2468,2097.8,533.908,2468,"Health Partners, Inc.",Commercial,2334.728,94.6,,percent of total billed charges,,
Mri Cervical Spine Routine Wo Contrast,,72141,CPT,Facility,Outpatient,,,,2468,2097.8,533.908,2468,"Health Partners, Inc.",Medicare Advantage,1209.32,49,,percent of total billed charges,,
Mri Cervical Spine Routine Wo Contrast,,72141,CPT,Facility,Inpatient,,,,2468,2097.8,533.908,2468,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mri Cervical Spine Routine Wo Contrast,,72141,CPT,Facility,Both,,,,2468,2097.8,533.908,2468,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1480.8,60,,percent of total billed charges,,
Mri Cervical Spine Routine Wo Contrast,,72141,CPT,Facility,Both,,,,2468,2097.8,533.908,2468,"Health Partners, Inc.",State of Minnesota Advantage Program,2011.42,81.5,,percent of total billed charges,,
Mri Cervical Spine Routine Wo Contrast,,72141,CPT,Facility,Both,,,,2468,2097.8,533.908,2468,"Health Partners, Inc.",State Public Programs,1234,50,,percent of total billed charges,,
Mri Cervical Spine Routine Wo Contrast,,72141,CPT,Facility,Both,,,,2468,2097.8,533.908,2468,Humana Insurance Company,Commercial PPO,2344.6,95,,percent of total billed charges,,
Mri Cervical Spine Routine Wo Contrast,,72141,CPT,Facility,Outpatient,,,,2468,2097.8,533.908,2468,Humana Insurance Company,Medicare PPO,1209.32,49,,percent of total billed charges,,
Mri Cervical Spine Routine Wo Contrast,,72141,CPT,Facility,Inpatient,,,,2468,2097.8,533.908,2468,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Mri Cervical Spine Routine Wo Contrast,,72141,CPT,Facility,Both,,,,2468,2097.8,533.908,2468,Medica,Individual & Family,2445.788,99.1,,percent of total billed charges,,
Mri Cervical Spine Routine Wo Contrast,,72141,CPT,Facility,Outpatient,,,,2468,2097.8,533.908,2468,Medica,Medica Advantage Solution,1229.064,49.8,,percent of total billed charges,,
Mri Cervical Spine Routine Wo Contrast,,72141,CPT,Facility,Inpatient,,,,2468,2097.8,533.908,2468,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Mri Cervical Spine Routine Wo Contrast,,72141,CPT,Facility,Outpatient,,,,2468,2097.8,533.908,2468,Medica,Medical Assistance,747,,,Other ,per vist,Pays in addition to all Outpatient Service Categories
Mri Cervical Spine Routine Wo Contrast,,72141,CPT,Facility,Inpatient,,,,2468,2097.8,533.908,2468,Medica,Medical Assistance,,,,,Included in per diem rate,
Mri Cervical Spine Routine Wo Contrast,,72141,CPT,Facility,Outpatient,,,,2468,2097.8,533.908,2468,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1229.064,49.8,,percent of total billed charges,,
Mri Cervical Spine Routine Wo Contrast,,72141,CPT,Facility,Inpatient,,,,2468,2097.8,533.908,2468,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Mri Cervical Spine Routine Wo Contrast,,72141,CPT,Facility,Both,,,,2468,2097.8,533.908,2468,"Multiplan, Inc.","Multiplan, Inc.",2319.92,94,,percent of total billed charges,,
Mri Cervical Spine Routine Wo Contrast,,72141,CPT,Facility,Outpatient,,,,2468,2097.8,533.908,2468,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1535,,,Other ,per scan,
Mri Cervical Spine Routine Wo Contrast,,72141,CPT,Facility,Inpatient,,,,2468,2097.8,533.908,2468,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Mri Cervical Spine Routine Wo Contrast,,72141,CPT,Facility,Both,,,,2468,2097.8,533.908,2468,"Preferred One Administrative Services, INC.",PPO,2433.448,98.6,,percent of total billed charges,,
Mri Cervical Spine Routine Wo Contrast,,72141,CPT,Facility,Outpatient,,,,2468,2097.8,533.908,2468,PrimeWest Health,Minnesota Senior Health Options (MSHO),1269.786,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Mri Cervical Spine Routine Wo Contrast,,72141,CPT,Facility,Inpatient,,,,2468,2097.8,533.908,2468,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mri Cervical Spine Routine Wo Contrast,,72141,CPT,Facility,Outpatient,,,,2468,2097.8,533.908,2468,PrimeWest Health,MinnesotaCare,1267.5648,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Mri Cervical Spine Routine Wo Contrast,,72141,CPT,Facility,Inpatient,,,,2468,2097.8,533.908,2468,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Mri Cervical Spine Routine Wo Contrast,,72141,CPT,Facility,Both,,,,2468,2097.8,533.908,2468,Sanford Health Plan,Sanford Health Plan,2270.56,92,,percent of total billed charges,,
Mri Cervical Spine Routine Wo Contrast,,72141,CPT,Facility,Outpatient,,,,2468,2097.8,533.908,2468,"UCare Health, Inc.",Individual & Family Plan,1390.718,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Mri Cervical Spine Routine Wo Contrast,,72141,CPT,Facility,Inpatient,,,,2468,2097.8,533.908,2468,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Mri Cervical Spine Routine Wo Contrast,,72141,CPT,Facility,Outpatient,,,,2468,2097.8,533.908,2468,"UCare Health, Inc.",Medical Assistance,1245.5996,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mri Cervical Spine Routine Wo Contrast,,72141,CPT,Facility,Inpatient,,,,2468,2097.8,533.908,2468,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Mri Cervical Spine Routine Wo Contrast,,72141,CPT,Facility,Outpatient,,,,2468,2097.8,533.908,2468,"UCare Health, Inc.",Medicare Advantage,1245.5996,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mri Cervical Spine Routine Wo Contrast,,72141,CPT,Facility,Inpatient,,,,2468,2097.8,533.908,2468,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mri Cervical Spine Routine Wo Contrast,,72141,CPT,Facility,Outpatient,,,,2468,2097.8,533.908,2468,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1245.5996,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mri Cervical Spine Routine Wo Contrast,,72141,CPT,Facility,Inpatient,,,,2468,2097.8,533.908,2468,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mri Cervical Spine Routine Wo Contrast,,72141,CPT,Facility,Both,,,,2468,2097.8,533.908,2468,UnitedHealthcare,Individual & Family,2319.92,94,,percent of total billed charges,,
Mri Cervical Spine Routine Wo Contrast,,72141,CPT,Facility,Outpatient,,,,2468,2097.8,533.908,2468,UnitedHealthcare,Medicare Advantage,1209.32,49,,percent of total billed charges,,
Mri Cervical Spine Routine Wo Contrast,,72141,CPT,Facility,Inpatient,,,,2468,2097.8,533.908,2468,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Mri Cervical Spine Routine Wo Contrast,,72141,CPT,Facility,Outpatient,,,,2468,2097.8,533.908,2468,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1184.64,48,,percent of total billed charges,,100% of DHS outpatient percentage
Mri Cervical Spine Routine Wo Contrast,,72141,CPT,Facility,Inpatient,,,,2468,2097.8,533.908,2468,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Mri Cervical Spine W Contrast,,72142,CPT,Facility,Both,,,,2653,2255.05,561.34,2653,Aetna,Commercial,2440.76,92,,percent of total billed charges,,
Mri Cervical Spine W Contrast,,72142,CPT,Facility,Outpatient,,,,2653,2255.05,561.34,2653,Aetna,Medicare Advantage,1299.97,49,,percent of total billed charges,,
Mri Cervical Spine W Contrast,,72142,CPT,Facility,Inpatient,,,,2653,2255.05,561.34,2653,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Mri Cervical Spine W Contrast,,72142,CPT,Facility,Both,,,,2653,2255.05,561.34,2653,Aetna,PPO,2467.29,93,,percent of total billed charges,,
Mri Cervical Spine W Contrast,,72142,CPT,Facility,Both,,,,2653,2255.05,561.34,2653,America's PPO,America's PPO,2547.6759,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Mri Cervical Spine W Contrast,,72142,CPT,Facility,Both,,,,2653,2255.05,561.34,2653,BlueCross BlueShield Minnesota, Federal Employee Program,1105,,,Fee schedule,,100% of BCBS commercial commodity fee schedule
Mri Cervical Spine W Contrast,,72142,CPT,Facility,Both,,,,2653,2255.05,561.34,2653,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1122.68,,,Fee schedule,,"100% of BCBS commercial commodity fee schedule, plus MN Care tax"
Mri Cervical Spine W Contrast,,72142,CPT,Facility,Both,,,,2653,2255.05,561.34,2653,BlueCross BlueShield Minnesota,High Value Network Plan,1010.412,,,Fee schedule,,"90% of BCBS commercial commodity fee schedule, plus MN Care tax; see disclaimer for more information"
Mri Cervical Spine W Contrast,,72142,CPT,Facility,Outpatient,,,,2653,2255.05,561.34,2653,BlueCross BlueShield Minnesota,Medicare Advantage,1299.97,49,,percent of total billed charges,,
Mri Cervical Spine W Contrast,,72142,CPT,Facility,Inpatient,,,,2653,2255.05,561.34,2653,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Mri Cervical Spine W Contrast,,72142,CPT,Facility,Both,,,,2653,2255.05,561.34,2653,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,994.357676,,,Fee schedule,,"88.57% of BCBS commercial commodity fee schedule, plus MN Care tax"
Mri Cervical Spine W Contrast,,72142,CPT,Facility,Both,,,,2653,2255.05,561.34,2653,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,561.34,,,Fee schedule,,"100% of BCBS Medicaid commodity fee schedule, plus MN Care tax"
Mri Cervical Spine W Contrast,,72142,CPT,Facility,Outpatient,,,,2653,2255.05,561.34,2653,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1299.97,49,,percent of total billed charges,,
Mri Cervical Spine W Contrast,,72142,CPT,Facility,Inpatient,,,,2653,2255.05,561.34,2653,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Mri Cervical Spine W Contrast,,72142,CPT,Facility,Both,,,,2653,2255.05,561.34,2653,CorVel,Worker's Compensation,2653,100,,percent of total billed charges,,
Mri Cervical Spine W Contrast,,72142,CPT,Facility,Both,,,,2653,2255.05,561.34,2653,First Health Group Corporation,First Health Network,2573.41,97,,percent of total billed charges,,
Mri Cervical Spine W Contrast,,72142,CPT,Facility,Both,,,,2653,2255.05,561.34,2653,"Health Partners, Inc.",Commercial,2509.738,94.6,,percent of total billed charges,,
Mri Cervical Spine W Contrast,,72142,CPT,Facility,Outpatient,,,,2653,2255.05,561.34,2653,"Health Partners, Inc.",Medicare Advantage,1299.97,49,,percent of total billed charges,,
Mri Cervical Spine W Contrast,,72142,CPT,Facility,Inpatient,,,,2653,2255.05,561.34,2653,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mri Cervical Spine W Contrast,,72142,CPT,Facility,Both,,,,2653,2255.05,561.34,2653,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1591.8,60,,percent of total billed charges,,
Mri Cervical Spine W Contrast,,72142,CPT,Facility,Both,,,,2653,2255.05,561.34,2653,"Health Partners, Inc.",State of Minnesota Advantage Program,2162.195,81.5,,percent of total billed charges,,
Mri Cervical Spine W Contrast,,72142,CPT,Facility,Both,,,,2653,2255.05,561.34,2653,"Health Partners, Inc.",State Public Programs,1326.5,50,,percent of total billed charges,,
Mri Cervical Spine W Contrast,,72142,CPT,Facility,Both,,,,2653,2255.05,561.34,2653,Humana Insurance Company,Commercial PPO,2520.35,95,,percent of total billed charges,,
Mri Cervical Spine W Contrast,,72142,CPT,Facility,Outpatient,,,,2653,2255.05,561.34,2653,Humana Insurance Company,Medicare PPO,1299.97,49,,percent of total billed charges,,
Mri Cervical Spine W Contrast,,72142,CPT,Facility,Inpatient,,,,2653,2255.05,561.34,2653,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Mri Cervical Spine W Contrast,,72142,CPT,Facility,Both,,,,2653,2255.05,561.34,2653,Medica,Individual & Family,2629.123,99.1,,percent of total billed charges,,
Mri Cervical Spine W Contrast,,72142,CPT,Facility,Outpatient,,,,2653,2255.05,561.34,2653,Medica,Medica Advantage Solution,1321.194,49.8,,percent of total billed charges,,
Mri Cervical Spine W Contrast,,72142,CPT,Facility,Inpatient,,,,2653,2255.05,561.34,2653,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Mri Cervical Spine W Contrast,,72142,CPT,Facility,Outpatient,,,,2653,2255.05,561.34,2653,Medica,Medical Assistance,747,,,Other ,per vist,Pays in addition to all Outpatient Service Categories
Mri Cervical Spine W Contrast,,72142,CPT,Facility,Inpatient,,,,2653,2255.05,561.34,2653,Medica,Medical Assistance,,,,,Included in per diem rate,
Mri Cervical Spine W Contrast,,72142,CPT,Facility,Outpatient,,,,2653,2255.05,561.34,2653,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1321.194,49.8,,percent of total billed charges,,
Mri Cervical Spine W Contrast,,72142,CPT,Facility,Inpatient,,,,2653,2255.05,561.34,2653,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Mri Cervical Spine W Contrast,,72142,CPT,Facility,Both,,,,2653,2255.05,561.34,2653,"Multiplan, Inc.","Multiplan, Inc.",2493.82,94,,percent of total billed charges,,
Mri Cervical Spine W Contrast,,72142,CPT,Facility,Outpatient,,,,2653,2255.05,561.34,2653,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1535,,,Other ,per scan,
Mri Cervical Spine W Contrast,,72142,CPT,Facility,Inpatient,,,,2653,2255.05,561.34,2653,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Mri Cervical Spine W Contrast,,72142,CPT,Facility,Both,,,,2653,2255.05,561.34,2653,"Preferred One Administrative Services, INC.",PPO,2615.858,98.6,,percent of total billed charges,,
Mri Cervical Spine W Contrast,,72142,CPT,Facility,Outpatient,,,,2653,2255.05,561.34,2653,PrimeWest Health,Minnesota Senior Health Options (MSHO),1364.9685,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Mri Cervical Spine W Contrast,,72142,CPT,Facility,Inpatient,,,,2653,2255.05,561.34,2653,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mri Cervical Spine W Contrast,,72142,CPT,Facility,Outpatient,,,,2653,2255.05,561.34,2653,PrimeWest Health,MinnesotaCare,1362.5808,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Mri Cervical Spine W Contrast,,72142,CPT,Facility,Inpatient,,,,2653,2255.05,561.34,2653,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Mri Cervical Spine W Contrast,,72142,CPT,Facility,Both,,,,2653,2255.05,561.34,2653,Sanford Health Plan,Sanford Health Plan,2440.76,92,,percent of total billed charges,,
Mri Cervical Spine W Contrast,,72142,CPT,Facility,Outpatient,,,,2653,2255.05,561.34,2653,"UCare Health, Inc.",Individual & Family Plan,1494.9655,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Mri Cervical Spine W Contrast,,72142,CPT,Facility,Inpatient,,,,2653,2255.05,561.34,2653,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Mri Cervical Spine W Contrast,,72142,CPT,Facility,Outpatient,,,,2653,2255.05,561.34,2653,"UCare Health, Inc.",Medical Assistance,1338.9691,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mri Cervical Spine W Contrast,,72142,CPT,Facility,Inpatient,,,,2653,2255.05,561.34,2653,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Mri Cervical Spine W Contrast,,72142,CPT,Facility,Outpatient,,,,2653,2255.05,561.34,2653,"UCare Health, Inc.",Medicare Advantage,1338.9691,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mri Cervical Spine W Contrast,,72142,CPT,Facility,Inpatient,,,,2653,2255.05,561.34,2653,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mri Cervical Spine W Contrast,,72142,CPT,Facility,Outpatient,,,,2653,2255.05,561.34,2653,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1338.9691,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mri Cervical Spine W Contrast,,72142,CPT,Facility,Inpatient,,,,2653,2255.05,561.34,2653,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mri Cervical Spine W Contrast,,72142,CPT,Facility,Both,,,,2653,2255.05,561.34,2653,UnitedHealthcare,Individual & Family,2493.82,94,,percent of total billed charges,,
Mri Cervical Spine W Contrast,,72142,CPT,Facility,Outpatient,,,,2653,2255.05,561.34,2653,UnitedHealthcare,Medicare Advantage,1299.97,49,,percent of total billed charges,,
Mri Cervical Spine W Contrast,,72142,CPT,Facility,Inpatient,,,,2653,2255.05,561.34,2653,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Mri Cervical Spine W Contrast,,72142,CPT,Facility,Outpatient,,,,2653,2255.05,561.34,2653,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1273.44,48,,percent of total billed charges,,100% of DHS outpatient percentage
Mri Cervical Spine W Contrast,,72142,CPT,Facility,Inpatient,,,,2653,2255.05,561.34,2653,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Mri Thoracic Spine Routine Wo Contrast,,72146,CPT,Facility,Both,,,,2468,2097.8,533.908,2468,Aetna,Commercial,2270.56,92,,percent of total billed charges,,
Mri Thoracic Spine Routine Wo Contrast,,72146,CPT,Facility,Outpatient,,,,2468,2097.8,533.908,2468,Aetna,Medicare Advantage,1209.32,49,,percent of total billed charges,,
Mri Thoracic Spine Routine Wo Contrast,,72146,CPT,Facility,Inpatient,,,,2468,2097.8,533.908,2468,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Mri Thoracic Spine Routine Wo Contrast,,72146,CPT,Facility,Both,,,,2468,2097.8,533.908,2468,Aetna,PPO,2295.24,93,,percent of total billed charges,,
Mri Thoracic Spine Routine Wo Contrast,,72146,CPT,Facility,Both,,,,2468,2097.8,533.908,2468,America's PPO,America's PPO,2370.0204,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Mri Thoracic Spine Routine Wo Contrast,,72146,CPT,Facility,Both,,,,2468,2097.8,533.908,2468,BlueCross BlueShield Minnesota, Federal Employee Program,1051,,,Fee schedule,,100% of BCBS commercial commodity fee schedule
Mri Thoracic Spine Routine Wo Contrast,,72146,CPT,Facility,Both,,,,2468,2097.8,533.908,2468,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1067.816,,,Fee schedule,,"100% of BCBS commercial commodity fee schedule, plus MN Care tax"
Mri Thoracic Spine Routine Wo Contrast,,72146,CPT,Facility,Both,,,,2468,2097.8,533.908,2468,BlueCross BlueShield Minnesota,High Value Network Plan,961.0344,,,Fee schedule,,"90% of BCBS commercial commodity fee schedule, plus MN Care tax; see disclaimer for more information"
Mri Thoracic Spine Routine Wo Contrast,,72146,CPT,Facility,Outpatient,,,,2468,2097.8,533.908,2468,BlueCross BlueShield Minnesota,Medicare Advantage,1209.32,49,,percent of total billed charges,,
Mri Thoracic Spine Routine Wo Contrast,,72146,CPT,Facility,Inpatient,,,,2468,2097.8,533.908,2468,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Mri Thoracic Spine Routine Wo Contrast,,72146,CPT,Facility,Both,,,,2468,2097.8,533.908,2468,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,945.7646312,,,Fee schedule,,"88.57% of BCBS commercial commodity fee schedule, plus MN Care tax"
Mri Thoracic Spine Routine Wo Contrast,,72146,CPT,Facility,Both,,,,2468,2097.8,533.908,2468,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,533.908,,,Fee schedule,,"100% of BCBS Medicaid commodity fee schedule, plus MN Care tax"
Mri Thoracic Spine Routine Wo Contrast,,72146,CPT,Facility,Outpatient,,,,2468,2097.8,533.908,2468,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1209.32,49,,percent of total billed charges,,
Mri Thoracic Spine Routine Wo Contrast,,72146,CPT,Facility,Inpatient,,,,2468,2097.8,533.908,2468,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Mri Thoracic Spine Routine Wo Contrast,,72146,CPT,Facility,Both,,,,2468,2097.8,533.908,2468,CorVel,Worker's Compensation,2468,100,,percent of total billed charges,,
Mri Thoracic Spine Routine Wo Contrast,,72146,CPT,Facility,Both,,,,2468,2097.8,533.908,2468,First Health Group Corporation,First Health Network,2393.96,97,,percent of total billed charges,,
Mri Thoracic Spine Routine Wo Contrast,,72146,CPT,Facility,Both,,,,2468,2097.8,533.908,2468,"Health Partners, Inc.",Commercial,2334.728,94.6,,percent of total billed charges,,
Mri Thoracic Spine Routine Wo Contrast,,72146,CPT,Facility,Outpatient,,,,2468,2097.8,533.908,2468,"Health Partners, Inc.",Medicare Advantage,1209.32,49,,percent of total billed charges,,
Mri Thoracic Spine Routine Wo Contrast,,72146,CPT,Facility,Inpatient,,,,2468,2097.8,533.908,2468,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mri Thoracic Spine Routine Wo Contrast,,72146,CPT,Facility,Both,,,,2468,2097.8,533.908,2468,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1480.8,60,,percent of total billed charges,,
Mri Thoracic Spine Routine Wo Contrast,,72146,CPT,Facility,Both,,,,2468,2097.8,533.908,2468,"Health Partners, Inc.",State of Minnesota Advantage Program,2011.42,81.5,,percent of total billed charges,,
Mri Thoracic Spine Routine Wo Contrast,,72146,CPT,Facility,Both,,,,2468,2097.8,533.908,2468,"Health Partners, Inc.",State Public Programs,1234,50,,percent of total billed charges,,
Mri Thoracic Spine Routine Wo Contrast,,72146,CPT,Facility,Both,,,,2468,2097.8,533.908,2468,Humana Insurance Company,Commercial PPO,2344.6,95,,percent of total billed charges,,
Mri Thoracic Spine Routine Wo Contrast,,72146,CPT,Facility,Outpatient,,,,2468,2097.8,533.908,2468,Humana Insurance Company,Medicare PPO,1209.32,49,,percent of total billed charges,,
Mri Thoracic Spine Routine Wo Contrast,,72146,CPT,Facility,Inpatient,,,,2468,2097.8,533.908,2468,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Mri Thoracic Spine Routine Wo Contrast,,72146,CPT,Facility,Both,,,,2468,2097.8,533.908,2468,Medica,Individual & Family,2445.788,99.1,,percent of total billed charges,,
Mri Thoracic Spine Routine Wo Contrast,,72146,CPT,Facility,Outpatient,,,,2468,2097.8,533.908,2468,Medica,Medica Advantage Solution,1229.064,49.8,,percent of total billed charges,,
Mri Thoracic Spine Routine Wo Contrast,,72146,CPT,Facility,Inpatient,,,,2468,2097.8,533.908,2468,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Mri Thoracic Spine Routine Wo Contrast,,72146,CPT,Facility,Outpatient,,,,2468,2097.8,533.908,2468,Medica,Medical Assistance,747,,,Other  ,per vist,Pays in addition to all Outpatient Service Categories
Mri Thoracic Spine Routine Wo Contrast,,72146,CPT,Facility,Inpatient,,,,2468,2097.8,533.908,2468,Medica,Medical Assistance,,,,,Included in per diem rate,
Mri Thoracic Spine Routine Wo Contrast,,72146,CPT,Facility,Outpatient,,,,2468,2097.8,533.908,2468,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1229.064,49.8,,percent of total billed charges,,
Mri Thoracic Spine Routine Wo Contrast,,72146,CPT,Facility,Inpatient,,,,2468,2097.8,533.908,2468,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Mri Thoracic Spine Routine Wo Contrast,,72146,CPT,Facility,Both,,,,2468,2097.8,533.908,2468,"Multiplan, Inc.","Multiplan, Inc.",2319.92,94,,percent of total billed charges,,
Mri Thoracic Spine Routine Wo Contrast,,72146,CPT,Facility,Outpatient,,,,2468,2097.8,533.908,2468,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1535,,,Other ,per scan,
Mri Thoracic Spine Routine Wo Contrast,,72146,CPT,Facility,Inpatient,,,,2468,2097.8,533.908,2468,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Mri Thoracic Spine Routine Wo Contrast,,72146,CPT,Facility,Both,,,,2468,2097.8,533.908,2468,"Preferred One Administrative Services, INC.",PPO,2433.448,98.6,,percent of total billed charges,,
Mri Thoracic Spine Routine Wo Contrast,,72146,CPT,Facility,Outpatient,,,,2468,2097.8,533.908,2468,PrimeWest Health,Minnesota Senior Health Options (MSHO),1269.786,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Mri Thoracic Spine Routine Wo Contrast,,72146,CPT,Facility,Inpatient,,,,2468,2097.8,533.908,2468,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mri Thoracic Spine Routine Wo Contrast,,72146,CPT,Facility,Outpatient,,,,2468,2097.8,533.908,2468,PrimeWest Health,MinnesotaCare,1267.5648,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Mri Thoracic Spine Routine Wo Contrast,,72146,CPT,Facility,Inpatient,,,,2468,2097.8,533.908,2468,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Mri Thoracic Spine Routine Wo Contrast,,72146,CPT,Facility,Both,,,,2468,2097.8,533.908,2468,Sanford Health Plan,Sanford Health Plan,2270.56,92,,percent of total billed charges,,
Mri Thoracic Spine Routine Wo Contrast,,72146,CPT,Facility,Outpatient,,,,2468,2097.8,533.908,2468,"UCare Health, Inc.",Individual & Family Plan,1390.718,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Mri Thoracic Spine Routine Wo Contrast,,72146,CPT,Facility,Inpatient,,,,2468,2097.8,533.908,2468,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Mri Thoracic Spine Routine Wo Contrast,,72146,CPT,Facility,Outpatient,,,,2468,2097.8,533.908,2468,"UCare Health, Inc.",Medical Assistance,1245.5996,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mri Thoracic Spine Routine Wo Contrast,,72146,CPT,Facility,Inpatient,,,,2468,2097.8,533.908,2468,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Mri Thoracic Spine Routine Wo Contrast,,72146,CPT,Facility,Outpatient,,,,2468,2097.8,533.908,2468,"UCare Health, Inc.",Medicare Advantage,1245.5996,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mri Thoracic Spine Routine Wo Contrast,,72146,CPT,Facility,Inpatient,,,,2468,2097.8,533.908,2468,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mri Thoracic Spine Routine Wo Contrast,,72146,CPT,Facility,Outpatient,,,,2468,2097.8,533.908,2468,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1245.5996,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mri Thoracic Spine Routine Wo Contrast,,72146,CPT,Facility,Inpatient,,,,2468,2097.8,533.908,2468,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mri Thoracic Spine Routine Wo Contrast,,72146,CPT,Facility,Both,,,,2468,2097.8,533.908,2468,UnitedHealthcare,Individual & Family,2319.92,94,,percent of total billed charges,,
Mri Thoracic Spine Routine Wo Contrast,,72146,CPT,Facility,Outpatient,,,,2468,2097.8,533.908,2468,UnitedHealthcare,Medicare Advantage,1209.32,49,,percent of total billed charges,,
Mri Thoracic Spine Routine Wo Contrast,,72146,CPT,Facility,Inpatient,,,,2468,2097.8,533.908,2468,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Mri Thoracic Spine Routine Wo Contrast,,72146,CPT,Facility,Outpatient,,,,2468,2097.8,533.908,2468,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1184.64,48,,percent of total billed charges,,100% of DHS outpatient percentage
Mri Thoracic Spine Routine Wo Contrast,,72146,CPT,Facility,Inpatient,,,,2468,2097.8,533.908,2468,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Mri Thoracic Spine W Contrast,,72147,CPT,Facility,Both,,,,2653,2255.05,561.34,2653,Aetna,Commercial,2440.76,92,,percent of total billed charges,,
Mri Thoracic Spine W Contrast,,72147,CPT,Facility,Outpatient,,,,2653,2255.05,561.34,2653,Aetna,Medicare Advantage,1299.97,49,,percent of total billed charges,,
Mri Thoracic Spine W Contrast,,72147,CPT,Facility,Inpatient,,,,2653,2255.05,561.34,2653,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Mri Thoracic Spine W Contrast,,72147,CPT,Facility,Both,,,,2653,2255.05,561.34,2653,Aetna,PPO,2467.29,93,,percent of total billed charges,,
Mri Thoracic Spine W Contrast,,72147,CPT,Facility,Both,,,,2653,2255.05,561.34,2653,America's PPO,America's PPO,2547.6759,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Mri Thoracic Spine W Contrast,,72147,CPT,Facility,Both,,,,2653,2255.05,561.34,2653,BlueCross BlueShield Minnesota, Federal Employee Program,1105,,,Fee schedule,,100% of BCBS commercial commodity fee schedule
Mri Thoracic Spine W Contrast,,72147,CPT,Facility,Both,,,,2653,2255.05,561.34,2653,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1122.68,,,Fee schedule,,"100% of BCBS commercial commodity fee schedule, plus MN Care tax"
Mri Thoracic Spine W Contrast,,72147,CPT,Facility,Both,,,,2653,2255.05,561.34,2653,BlueCross BlueShield Minnesota,High Value Network Plan,1010.412,,,Fee schedule,,"90% of BCBS commercial commodity fee schedule, plus MN Care tax; see disclaimer for more information"
Mri Thoracic Spine W Contrast,,72147,CPT,Facility,Outpatient,,,,2653,2255.05,561.34,2653,BlueCross BlueShield Minnesota,Medicare Advantage,1299.97,49,,percent of total billed charges,,
Mri Thoracic Spine W Contrast,,72147,CPT,Facility,Inpatient,,,,2653,2255.05,561.34,2653,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Mri Thoracic Spine W Contrast,,72147,CPT,Facility,Both,,,,2653,2255.05,561.34,2653,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,994.357676,,,Fee schedule,,"88.57% of BCBS commercial commodity fee schedule, plus MN Care tax"
Mri Thoracic Spine W Contrast,,72147,CPT,Facility,Both,,,,2653,2255.05,561.34,2653,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,561.34,,,Fee schedule,,"100% of BCBS Medicaid commodity fee schedule, plus MN Care tax"
Mri Thoracic Spine W Contrast,,72147,CPT,Facility,Outpatient,,,,2653,2255.05,561.34,2653,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1299.97,49,,percent of total billed charges,,
Mri Thoracic Spine W Contrast,,72147,CPT,Facility,Inpatient,,,,2653,2255.05,561.34,2653,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Mri Thoracic Spine W Contrast,,72147,CPT,Facility,Both,,,,2653,2255.05,561.34,2653,CorVel,Worker's Compensation,2653,100,,percent of total billed charges,,
Mri Thoracic Spine W Contrast,,72147,CPT,Facility,Both,,,,2653,2255.05,561.34,2653,First Health Group Corporation,First Health Network,2573.41,97,,percent of total billed charges,,
Mri Thoracic Spine W Contrast,,72147,CPT,Facility,Both,,,,2653,2255.05,561.34,2653,"Health Partners, Inc.",Commercial,2509.738,94.6,,percent of total billed charges,,
Mri Thoracic Spine W Contrast,,72147,CPT,Facility,Outpatient,,,,2653,2255.05,561.34,2653,"Health Partners, Inc.",Medicare Advantage,1299.97,49,,percent of total billed charges,,
Mri Thoracic Spine W Contrast,,72147,CPT,Facility,Inpatient,,,,2653,2255.05,561.34,2653,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mri Thoracic Spine W Contrast,,72147,CPT,Facility,Both,,,,2653,2255.05,561.34,2653,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1591.8,60,,percent of total billed charges,,
Mri Thoracic Spine W Contrast,,72147,CPT,Facility,Both,,,,2653,2255.05,561.34,2653,"Health Partners, Inc.",State of Minnesota Advantage Program,2162.195,81.5,,percent of total billed charges,,
Mri Thoracic Spine W Contrast,,72147,CPT,Facility,Both,,,,2653,2255.05,561.34,2653,"Health Partners, Inc.",State Public Programs,1326.5,50,,percent of total billed charges,,
Mri Thoracic Spine W Contrast,,72147,CPT,Facility,Both,,,,2653,2255.05,561.34,2653,Humana Insurance Company,Commercial PPO,2520.35,95,,percent of total billed charges,,
Mri Thoracic Spine W Contrast,,72147,CPT,Facility,Outpatient,,,,2653,2255.05,561.34,2653,Humana Insurance Company,Medicare PPO,1299.97,49,,percent of total billed charges,,
Mri Thoracic Spine W Contrast,,72147,CPT,Facility,Inpatient,,,,2653,2255.05,561.34,2653,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Mri Thoracic Spine W Contrast,,72147,CPT,Facility,Both,,,,2653,2255.05,561.34,2653,Medica,Individual & Family,2629.123,99.1,,percent of total billed charges,,
Mri Thoracic Spine W Contrast,,72147,CPT,Facility,Outpatient,,,,2653,2255.05,561.34,2653,Medica,Medica Advantage Solution,1321.194,49.8,,percent of total billed charges,,
Mri Thoracic Spine W Contrast,,72147,CPT,Facility,Inpatient,,,,2653,2255.05,561.34,2653,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Mri Thoracic Spine W Contrast,,72147,CPT,Facility,Outpatient,,,,2653,2255.05,561.34,2653,Medica,Medical Assistance,747,,,Other ,per vist,Pays in addition to all Outpatient Service Categories
Mri Thoracic Spine W Contrast,,72147,CPT,Facility,Inpatient,,,,2653,2255.05,561.34,2653,Medica,Medical Assistance,,,,,Included in per diem rate,
Mri Thoracic Spine W Contrast,,72147,CPT,Facility,Outpatient,,,,2653,2255.05,561.34,2653,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1321.194,49.8,,percent of total billed charges,,
Mri Thoracic Spine W Contrast,,72147,CPT,Facility,Inpatient,,,,2653,2255.05,561.34,2653,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Mri Thoracic Spine W Contrast,,72147,CPT,Facility,Both,,,,2653,2255.05,561.34,2653,"Multiplan, Inc.","Multiplan, Inc.",2493.82,94,,percent of total billed charges,,
Mri Thoracic Spine W Contrast,,72147,CPT,Facility,Outpatient,,,,2653,2255.05,561.34,2653,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1535,,,Other ,per scan,
Mri Thoracic Spine W Contrast,,72147,CPT,Facility,Inpatient,,,,2653,2255.05,561.34,2653,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Mri Thoracic Spine W Contrast,,72147,CPT,Facility,Both,,,,2653,2255.05,561.34,2653,"Preferred One Administrative Services, INC.",PPO,2615.858,98.6,,percent of total billed charges,,
Mri Thoracic Spine W Contrast,,72147,CPT,Facility,Outpatient,,,,2653,2255.05,561.34,2653,PrimeWest Health,Minnesota Senior Health Options (MSHO),1364.9685,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Mri Thoracic Spine W Contrast,,72147,CPT,Facility,Inpatient,,,,2653,2255.05,561.34,2653,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mri Thoracic Spine W Contrast,,72147,CPT,Facility,Outpatient,,,,2653,2255.05,561.34,2653,PrimeWest Health,MinnesotaCare,1362.5808,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Mri Thoracic Spine W Contrast,,72147,CPT,Facility,Inpatient,,,,2653,2255.05,561.34,2653,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Mri Thoracic Spine W Contrast,,72147,CPT,Facility,Both,,,,2653,2255.05,561.34,2653,Sanford Health Plan,Sanford Health Plan,2440.76,92,,percent of total billed charges,,
Mri Thoracic Spine W Contrast,,72147,CPT,Facility,Outpatient,,,,2653,2255.05,561.34,2653,"UCare Health, Inc.",Individual & Family Plan,1494.9655,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Mri Thoracic Spine W Contrast,,72147,CPT,Facility,Inpatient,,,,2653,2255.05,561.34,2653,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Mri Thoracic Spine W Contrast,,72147,CPT,Facility,Outpatient,,,,2653,2255.05,561.34,2653,"UCare Health, Inc.",Medical Assistance,1338.9691,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mri Thoracic Spine W Contrast,,72147,CPT,Facility,Inpatient,,,,2653,2255.05,561.34,2653,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Mri Thoracic Spine W Contrast,,72147,CPT,Facility,Outpatient,,,,2653,2255.05,561.34,2653,"UCare Health, Inc.",Medicare Advantage,1338.9691,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mri Thoracic Spine W Contrast,,72147,CPT,Facility,Inpatient,,,,2653,2255.05,561.34,2653,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mri Thoracic Spine W Contrast,,72147,CPT,Facility,Outpatient,,,,2653,2255.05,561.34,2653,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1338.9691,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mri Thoracic Spine W Contrast,,72147,CPT,Facility,Inpatient,,,,2653,2255.05,561.34,2653,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mri Thoracic Spine W Contrast,,72147,CPT,Facility,Both,,,,2653,2255.05,561.34,2653,UnitedHealthcare,Individual & Family,2493.82,94,,percent of total billed charges,,
Mri Thoracic Spine W Contrast,,72147,CPT,Facility,Outpatient,,,,2653,2255.05,561.34,2653,UnitedHealthcare,Medicare Advantage,1299.97,49,,percent of total billed charges,,
Mri Thoracic Spine W Contrast,,72147,CPT,Facility,Inpatient,,,,2653,2255.05,561.34,2653,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Mri Thoracic Spine W Contrast,,72147,CPT,Facility,Outpatient,,,,2653,2255.05,561.34,2653,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1273.44,48,,percent of total billed charges,,100% of DHS outpatient percentage
Mri Thoracic Spine W Contrast,,72147,CPT,Facility,Inpatient,,,,2653,2255.05,561.34,2653,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Mri Lumbar Spine Routine Wo Contrast,,72148,CPT,Facility,Both,,,,2468,2097.8,533.908,2468,Aetna,Commercial,2270.56,92,,percent of total billed charges,,
Mri Lumbar Spine Routine Wo Contrast,,72148,CPT,Facility,Outpatient,,,,2468,2097.8,533.908,2468,Aetna,Medicare Advantage,1209.32,49,,percent of total billed charges,,
Mri Lumbar Spine Routine Wo Contrast,,72148,CPT,Facility,Inpatient,,,,2468,2097.8,533.908,2468,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Mri Lumbar Spine Routine Wo Contrast,,72148,CPT,Facility,Both,,,,2468,2097.8,533.908,2468,Aetna,PPO,2295.24,93,,percent of total billed charges,,
Mri Lumbar Spine Routine Wo Contrast,,72148,CPT,Facility,Both,,,,2468,2097.8,533.908,2468,America's PPO,America's PPO,2370.0204,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Mri Lumbar Spine Routine Wo Contrast,,72148,CPT,Facility,Both,,,,2468,2097.8,533.908,2468,BlueCross BlueShield Minnesota, Federal Employee Program,1051,,,Fee schedule,,100% of BCBS commercial commodity fee schedule
Mri Lumbar Spine Routine Wo Contrast,,72148,CPT,Facility,Both,,,,2468,2097.8,533.908,2468,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1067.816,,,Fee schedule,,"100% of BCBS commercial commodity fee schedule, plus MN Care tax"
Mri Lumbar Spine Routine Wo Contrast,,72148,CPT,Facility,Both,,,,2468,2097.8,533.908,2468,BlueCross BlueShield Minnesota,High Value Network Plan,961.0344,,,Fee schedule,,"90% of BCBS commercial commodity fee schedule, plus MN Care tax; see disclaimer for more information"
Mri Lumbar Spine Routine Wo Contrast,,72148,CPT,Facility,Outpatient,,,,2468,2097.8,533.908,2468,BlueCross BlueShield Minnesota,Medicare Advantage,1209.32,49,,percent of total billed charges,,
Mri Lumbar Spine Routine Wo Contrast,,72148,CPT,Facility,Inpatient,,,,2468,2097.8,533.908,2468,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Mri Lumbar Spine Routine Wo Contrast,,72148,CPT,Facility,Both,,,,2468,2097.8,533.908,2468,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,945.7646312,,,Fee schedule,,"88.57% of BCBS commercial commodity fee schedule, plus MN Care tax"
Mri Lumbar Spine Routine Wo Contrast,,72148,CPT,Facility,Both,,,,2468,2097.8,533.908,2468,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,533.908,,,Fee schedule,,"100% of BCBS Medicaid commodity fee schedule, plus MN Care tax"
Mri Lumbar Spine Routine Wo Contrast,,72148,CPT,Facility,Outpatient,,,,2468,2097.8,533.908,2468,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1209.32,49,,percent of total billed charges,,
Mri Lumbar Spine Routine Wo Contrast,,72148,CPT,Facility,Inpatient,,,,2468,2097.8,533.908,2468,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Mri Lumbar Spine Routine Wo Contrast,,72148,CPT,Facility,Both,,,,2468,2097.8,533.908,2468,CorVel,Worker's Compensation,2468,100,,percent of total billed charges,,
Mri Lumbar Spine Routine Wo Contrast,,72148,CPT,Facility,Both,,,,2468,2097.8,533.908,2468,First Health Group Corporation,First Health Network,2393.96,97,,percent of total billed charges,,
Mri Lumbar Spine Routine Wo Contrast,,72148,CPT,Facility,Both,,,,2468,2097.8,533.908,2468,"Health Partners, Inc.",Commercial,2334.728,94.6,,percent of total billed charges,,
Mri Lumbar Spine Routine Wo Contrast,,72148,CPT,Facility,Outpatient,,,,2468,2097.8,533.908,2468,"Health Partners, Inc.",Medicare Advantage,1209.32,49,,percent of total billed charges,,
Mri Lumbar Spine Routine Wo Contrast,,72148,CPT,Facility,Inpatient,,,,2468,2097.8,533.908,2468,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mri Lumbar Spine Routine Wo Contrast,,72148,CPT,Facility,Both,,,,2468,2097.8,533.908,2468,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1480.8,60,,percent of total billed charges,,
Mri Lumbar Spine Routine Wo Contrast,,72148,CPT,Facility,Both,,,,2468,2097.8,533.908,2468,"Health Partners, Inc.",State of Minnesota Advantage Program,2011.42,81.5,,percent of total billed charges,,
Mri Lumbar Spine Routine Wo Contrast,,72148,CPT,Facility,Both,,,,2468,2097.8,533.908,2468,"Health Partners, Inc.",State Public Programs,1234,50,,percent of total billed charges,,
Mri Lumbar Spine Routine Wo Contrast,,72148,CPT,Facility,Both,,,,2468,2097.8,533.908,2468,Humana Insurance Company,Commercial PPO,2344.6,95,,percent of total billed charges,,
Mri Lumbar Spine Routine Wo Contrast,,72148,CPT,Facility,Outpatient,,,,2468,2097.8,533.908,2468,Humana Insurance Company,Medicare PPO,1209.32,49,,percent of total billed charges,,
Mri Lumbar Spine Routine Wo Contrast,,72148,CPT,Facility,Inpatient,,,,2468,2097.8,533.908,2468,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Mri Lumbar Spine Routine Wo Contrast,,72148,CPT,Facility,Both,,,,2468,2097.8,533.908,2468,Medica,Individual & Family,2445.788,99.1,,percent of total billed charges,,
Mri Lumbar Spine Routine Wo Contrast,,72148,CPT,Facility,Outpatient,,,,2468,2097.8,533.908,2468,Medica,Medica Advantage Solution,1229.064,49.8,,percent of total billed charges,,
Mri Lumbar Spine Routine Wo Contrast,,72148,CPT,Facility,Inpatient,,,,2468,2097.8,533.908,2468,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Mri Lumbar Spine Routine Wo Contrast,,72148,CPT,Facility,Outpatient,,,,2468,2097.8,533.908,2468,Medica,Medical Assistance,747,,,Other ,per vist,Pays in addition to all Outpatient Service Categories
Mri Lumbar Spine Routine Wo Contrast,,72148,CPT,Facility,Inpatient,,,,2468,2097.8,533.908,2468,Medica,Medical Assistance,,,,,Included in per diem rate,
Mri Lumbar Spine Routine Wo Contrast,,72148,CPT,Facility,Outpatient,,,,2468,2097.8,533.908,2468,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1229.064,49.8,,percent of total billed charges,,
Mri Lumbar Spine Routine Wo Contrast,,72148,CPT,Facility,Inpatient,,,,2468,2097.8,533.908,2468,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Mri Lumbar Spine Routine Wo Contrast,,72148,CPT,Facility,Both,,,,2468,2097.8,533.908,2468,"Multiplan, Inc.","Multiplan, Inc.",2319.92,94,,percent of total billed charges,,
Mri Lumbar Spine Routine Wo Contrast,,72148,CPT,Facility,Outpatient,,,,2468,2097.8,533.908,2468,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1535,,,Other ,per scan,
Mri Lumbar Spine Routine Wo Contrast,,72148,CPT,Facility,Inpatient,,,,2468,2097.8,533.908,2468,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Mri Lumbar Spine Routine Wo Contrast,,72148,CPT,Facility,Both,,,,2468,2097.8,533.908,2468,"Preferred One Administrative Services, INC.",PPO,2433.448,98.6,,percent of total billed charges,,
Mri Lumbar Spine Routine Wo Contrast,,72148,CPT,Facility,Outpatient,,,,2468,2097.8,533.908,2468,PrimeWest Health,Minnesota Senior Health Options (MSHO),1269.786,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Mri Lumbar Spine Routine Wo Contrast,,72148,CPT,Facility,Inpatient,,,,2468,2097.8,533.908,2468,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mri Lumbar Spine Routine Wo Contrast,,72148,CPT,Facility,Outpatient,,,,2468,2097.8,533.908,2468,PrimeWest Health,MinnesotaCare,1267.5648,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Mri Lumbar Spine Routine Wo Contrast,,72148,CPT,Facility,Inpatient,,,,2468,2097.8,533.908,2468,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Mri Lumbar Spine Routine Wo Contrast,,72148,CPT,Facility,Both,,,,2468,2097.8,533.908,2468,Sanford Health Plan,Sanford Health Plan,2270.56,92,,percent of total billed charges,,
Mri Lumbar Spine Routine Wo Contrast,,72148,CPT,Facility,Outpatient,,,,2468,2097.8,533.908,2468,"UCare Health, Inc.",Individual & Family Plan,1390.718,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Mri Lumbar Spine Routine Wo Contrast,,72148,CPT,Facility,Inpatient,,,,2468,2097.8,533.908,2468,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Mri Lumbar Spine Routine Wo Contrast,,72148,CPT,Facility,Outpatient,,,,2468,2097.8,533.908,2468,"UCare Health, Inc.",Medical Assistance,1245.5996,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mri Lumbar Spine Routine Wo Contrast,,72148,CPT,Facility,Inpatient,,,,2468,2097.8,533.908,2468,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Mri Lumbar Spine Routine Wo Contrast,,72148,CPT,Facility,Outpatient,,,,2468,2097.8,533.908,2468,"UCare Health, Inc.",Medicare Advantage,1245.5996,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mri Lumbar Spine Routine Wo Contrast,,72148,CPT,Facility,Inpatient,,,,2468,2097.8,533.908,2468,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mri Lumbar Spine Routine Wo Contrast,,72148,CPT,Facility,Outpatient,,,,2468,2097.8,533.908,2468,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1245.5996,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mri Lumbar Spine Routine Wo Contrast,,72148,CPT,Facility,Inpatient,,,,2468,2097.8,533.908,2468,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mri Lumbar Spine Routine Wo Contrast,,72148,CPT,Facility,Both,,,,2468,2097.8,533.908,2468,UnitedHealthcare,Individual & Family,2319.92,94,,percent of total billed charges,,
Mri Lumbar Spine Routine Wo Contrast,,72148,CPT,Facility,Outpatient,,,,2468,2097.8,533.908,2468,UnitedHealthcare,Medicare Advantage,1209.32,49,,percent of total billed charges,,
Mri Lumbar Spine Routine Wo Contrast,,72148,CPT,Facility,Inpatient,,,,2468,2097.8,533.908,2468,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Mri Lumbar Spine Routine Wo Contrast,,72148,CPT,Facility,Outpatient,,,,2468,2097.8,533.908,2468,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1184.64,48,,percent of total billed charges,,100% of DHS outpatient percentage
Mri Lumbar Spine Routine Wo Contrast,,72148,CPT,Facility,Inpatient,,,,2468,2097.8,533.908,2468,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Mri Lumbar Spine W Contrast,,72149,CPT,Facility,Both,,,,2653,2255.05,561.34,2653,Aetna,Commercial,2440.76,92,,percent of total billed charges,,
Mri Lumbar Spine W Contrast,,72149,CPT,Facility,Outpatient,,,,2653,2255.05,561.34,2653,Aetna,Medicare Advantage,1299.97,49,,percent of total billed charges,,
Mri Lumbar Spine W Contrast,,72149,CPT,Facility,Inpatient,,,,2653,2255.05,561.34,2653,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Mri Lumbar Spine W Contrast,,72149,CPT,Facility,Both,,,,2653,2255.05,561.34,2653,Aetna,PPO,2467.29,93,,percent of total billed charges,,
Mri Lumbar Spine W Contrast,,72149,CPT,Facility,Both,,,,2653,2255.05,561.34,2653,America's PPO,America's PPO,2547.6759,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Mri Lumbar Spine W Contrast,,72149,CPT,Facility,Both,,,,2653,2255.05,561.34,2653,BlueCross BlueShield Minnesota, Federal Employee Program,1105,,,Fee schedule,,100% of BCBS commercial commodity fee schedule
Mri Lumbar Spine W Contrast,,72149,CPT,Facility,Both,,,,2653,2255.05,561.34,2653,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1122.68,,,Fee schedule,,"100% of BCBS commercial commodity fee schedule, plus MN Care tax"
Mri Lumbar Spine W Contrast,,72149,CPT,Facility,Both,,,,2653,2255.05,561.34,2653,BlueCross BlueShield Minnesota,High Value Network Plan,1010.412,,,Fee schedule,,"90% of BCBS commercial commodity fee schedule, plus MN Care tax; see disclaimer for more information"
Mri Lumbar Spine W Contrast,,72149,CPT,Facility,Outpatient,,,,2653,2255.05,561.34,2653,BlueCross BlueShield Minnesota,Medicare Advantage,1299.97,49,,percent of total billed charges,,
Mri Lumbar Spine W Contrast,,72149,CPT,Facility,Inpatient,,,,2653,2255.05,561.34,2653,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Mri Lumbar Spine W Contrast,,72149,CPT,Facility,Both,,,,2653,2255.05,561.34,2653,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,994.357676,,,Fee schedule,,"88.57% of BCBS commercial commodity fee schedule, plus MN Care tax"
Mri Lumbar Spine W Contrast,,72149,CPT,Facility,Both,,,,2653,2255.05,561.34,2653,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,561.34,,,Fee schedule,,"100% of BCBS Medicaid commodity fee schedule, plus MN Care tax"
Mri Lumbar Spine W Contrast,,72149,CPT,Facility,Outpatient,,,,2653,2255.05,561.34,2653,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1299.97,49,,percent of total billed charges,,
Mri Lumbar Spine W Contrast,,72149,CPT,Facility,Inpatient,,,,2653,2255.05,561.34,2653,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Mri Lumbar Spine W Contrast,,72149,CPT,Facility,Both,,,,2653,2255.05,561.34,2653,CorVel,Worker's Compensation,2653,100,,percent of total billed charges,,
Mri Lumbar Spine W Contrast,,72149,CPT,Facility,Both,,,,2653,2255.05,561.34,2653,First Health Group Corporation,First Health Network,2573.41,97,,percent of total billed charges,,
Mri Lumbar Spine W Contrast,,72149,CPT,Facility,Both,,,,2653,2255.05,561.34,2653,"Health Partners, Inc.",Commercial,2509.738,94.6,,percent of total billed charges,,
Mri Lumbar Spine W Contrast,,72149,CPT,Facility,Outpatient,,,,2653,2255.05,561.34,2653,"Health Partners, Inc.",Medicare Advantage,1299.97,49,,percent of total billed charges,,
Mri Lumbar Spine W Contrast,,72149,CPT,Facility,Inpatient,,,,2653,2255.05,561.34,2653,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mri Lumbar Spine W Contrast,,72149,CPT,Facility,Both,,,,2653,2255.05,561.34,2653,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1591.8,60,,percent of total billed charges,,
Mri Lumbar Spine W Contrast,,72149,CPT,Facility,Both,,,,2653,2255.05,561.34,2653,"Health Partners, Inc.",State of Minnesota Advantage Program,2162.195,81.5,,percent of total billed charges,,
Mri Lumbar Spine W Contrast,,72149,CPT,Facility,Both,,,,2653,2255.05,561.34,2653,"Health Partners, Inc.",State Public Programs,1326.5,50,,percent of total billed charges,,
Mri Lumbar Spine W Contrast,,72149,CPT,Facility,Both,,,,2653,2255.05,561.34,2653,Humana Insurance Company,Commercial PPO,2520.35,95,,percent of total billed charges,,
Mri Lumbar Spine W Contrast,,72149,CPT,Facility,Outpatient,,,,2653,2255.05,561.34,2653,Humana Insurance Company,Medicare PPO,1299.97,49,,percent of total billed charges,,
Mri Lumbar Spine W Contrast,,72149,CPT,Facility,Inpatient,,,,2653,2255.05,561.34,2653,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Mri Lumbar Spine W Contrast,,72149,CPT,Facility,Both,,,,2653,2255.05,561.34,2653,Medica,Individual & Family,2629.123,99.1,,percent of total billed charges,,
Mri Lumbar Spine W Contrast,,72149,CPT,Facility,Outpatient,,,,2653,2255.05,561.34,2653,Medica,Medica Advantage Solution,1321.194,49.8,,percent of total billed charges,,
Mri Lumbar Spine W Contrast,,72149,CPT,Facility,Inpatient,,,,2653,2255.05,561.34,2653,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Mri Lumbar Spine W Contrast,,72149,CPT,Facility,Outpatient,,,,2653,2255.05,561.34,2653,Medica,Medical Assistance,747,,,Other  ,per vist,Pays in addition to all Outpatient Service Categories
Mri Lumbar Spine W Contrast,,72149,CPT,Facility,Inpatient,,,,2653,2255.05,561.34,2653,Medica,Medical Assistance,,,,,Included in per diem rate,
Mri Lumbar Spine W Contrast,,72149,CPT,Facility,Outpatient,,,,2653,2255.05,561.34,2653,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1321.194,49.8,,percent of total billed charges,,
Mri Lumbar Spine W Contrast,,72149,CPT,Facility,Inpatient,,,,2653,2255.05,561.34,2653,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Mri Lumbar Spine W Contrast,,72149,CPT,Facility,Both,,,,2653,2255.05,561.34,2653,"Multiplan, Inc.","Multiplan, Inc.",2493.82,94,,percent of total billed charges,,
Mri Lumbar Spine W Contrast,,72149,CPT,Facility,Outpatient,,,,2653,2255.05,561.34,2653,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1535,,,Other ,per scan,
Mri Lumbar Spine W Contrast,,72149,CPT,Facility,Inpatient,,,,2653,2255.05,561.34,2653,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Mri Lumbar Spine W Contrast,,72149,CPT,Facility,Both,,,,2653,2255.05,561.34,2653,"Preferred One Administrative Services, INC.",PPO,2615.858,98.6,,percent of total billed charges,,
Mri Lumbar Spine W Contrast,,72149,CPT,Facility,Outpatient,,,,2653,2255.05,561.34,2653,PrimeWest Health,Minnesota Senior Health Options (MSHO),1364.9685,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Mri Lumbar Spine W Contrast,,72149,CPT,Facility,Inpatient,,,,2653,2255.05,561.34,2653,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mri Lumbar Spine W Contrast,,72149,CPT,Facility,Outpatient,,,,2653,2255.05,561.34,2653,PrimeWest Health,MinnesotaCare,1362.5808,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Mri Lumbar Spine W Contrast,,72149,CPT,Facility,Inpatient,,,,2653,2255.05,561.34,2653,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Mri Lumbar Spine W Contrast,,72149,CPT,Facility,Both,,,,2653,2255.05,561.34,2653,Sanford Health Plan,Sanford Health Plan,2440.76,92,,percent of total billed charges,,
Mri Lumbar Spine W Contrast,,72149,CPT,Facility,Outpatient,,,,2653,2255.05,561.34,2653,"UCare Health, Inc.",Individual & Family Plan,1494.9655,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Mri Lumbar Spine W Contrast,,72149,CPT,Facility,Inpatient,,,,2653,2255.05,561.34,2653,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Mri Lumbar Spine W Contrast,,72149,CPT,Facility,Outpatient,,,,2653,2255.05,561.34,2653,"UCare Health, Inc.",Medical Assistance,1338.9691,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mri Lumbar Spine W Contrast,,72149,CPT,Facility,Inpatient,,,,2653,2255.05,561.34,2653,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Mri Lumbar Spine W Contrast,,72149,CPT,Facility,Outpatient,,,,2653,2255.05,561.34,2653,"UCare Health, Inc.",Medicare Advantage,1338.9691,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mri Lumbar Spine W Contrast,,72149,CPT,Facility,Inpatient,,,,2653,2255.05,561.34,2653,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mri Lumbar Spine W Contrast,,72149,CPT,Facility,Outpatient,,,,2653,2255.05,561.34,2653,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1338.9691,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mri Lumbar Spine W Contrast,,72149,CPT,Facility,Inpatient,,,,2653,2255.05,561.34,2653,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mri Lumbar Spine W Contrast,,72149,CPT,Facility,Both,,,,2653,2255.05,561.34,2653,UnitedHealthcare,Individual & Family,2493.82,94,,percent of total billed charges,,
Mri Lumbar Spine W Contrast,,72149,CPT,Facility,Outpatient,,,,2653,2255.05,561.34,2653,UnitedHealthcare,Medicare Advantage,1299.97,49,,percent of total billed charges,,
Mri Lumbar Spine W Contrast,,72149,CPT,Facility,Inpatient,,,,2653,2255.05,561.34,2653,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Mri Lumbar Spine W Contrast,,72149,CPT,Facility,Outpatient,,,,2653,2255.05,561.34,2653,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1273.44,48,,percent of total billed charges,,100% of DHS outpatient percentage
Mri Lumbar Spine W Contrast,,72149,CPT,Facility,Inpatient,,,,2653,2255.05,561.34,2653,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Mri Cervical Spine Wo W Contrast,,72156,CPT,Facility,Both,,,,3120,2652,561.34,3120,Aetna,Commercial,2870.4,92,,percent of total billed charges,,
Mri Cervical Spine Wo W Contrast,,72156,CPT,Facility,Outpatient,,,,3120,2652,561.34,3120,Aetna,Medicare Advantage,1528.8,49,,percent of total billed charges,,
Mri Cervical Spine Wo W Contrast,,72156,CPT,Facility,Inpatient,,,,3120,2652,561.34,3120,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Mri Cervical Spine Wo W Contrast,,72156,CPT,Facility,Both,,,,3120,2652,561.34,3120,Aetna,PPO,2901.6,93,,percent of total billed charges,,
Mri Cervical Spine Wo W Contrast,,72156,CPT,Facility,Both,,,,3120,2652,561.34,3120,America's PPO,America's PPO,2996.136,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Mri Cervical Spine Wo W Contrast,,72156,CPT,Facility,Both,,,,3120,2652,561.34,3120,BlueCross BlueShield Minnesota, Federal Employee Program,1105,,,Fee schedule,,100% of BCBS commercial commodity fee schedule
Mri Cervical Spine Wo W Contrast,,72156,CPT,Facility,Both,,,,3120,2652,561.34,3120,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1122.68,,,Fee schedule,,"100% of BCBS commercial commodity fee schedule, plus MN Care tax"
Mri Cervical Spine Wo W Contrast,,72156,CPT,Facility,Both,,,,3120,2652,561.34,3120,BlueCross BlueShield Minnesota,High Value Network Plan,1010.412,,,Fee schedule,,"90% of BCBS commercial commodity fee schedule, plus MN Care tax; see disclaimer for more information"
Mri Cervical Spine Wo W Contrast,,72156,CPT,Facility,Outpatient,,,,3120,2652,561.34,3120,BlueCross BlueShield Minnesota,Medicare Advantage,1528.8,49,,percent of total billed charges,,
Mri Cervical Spine Wo W Contrast,,72156,CPT,Facility,Inpatient,,,,3120,2652,561.34,3120,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Mri Cervical Spine Wo W Contrast,,72156,CPT,Facility,Both,,,,3120,2652,561.34,3120,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,994.357676,,,Fee schedule,,"88.57% of BCBS commercial commodity fee schedule, plus MN Care tax"
Mri Cervical Spine Wo W Contrast,,72156,CPT,Facility,Both,,,,3120,2652,561.34,3120,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,561.34,,,Fee schedule,,"100% of BCBS Medicaid commodity fee schedule, plus MN Care tax"
Mri Cervical Spine Wo W Contrast,,72156,CPT,Facility,Outpatient,,,,3120,2652,561.34,3120,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1528.8,49,,percent of total billed charges,,
Mri Cervical Spine Wo W Contrast,,72156,CPT,Facility,Inpatient,,,,3120,2652,561.34,3120,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Mri Cervical Spine Wo W Contrast,,72156,CPT,Facility,Both,,,,3120,2652,561.34,3120,CorVel,Worker's Compensation,3120,100,,percent of total billed charges,,
Mri Cervical Spine Wo W Contrast,,72156,CPT,Facility,Both,,,,3120,2652,561.34,3120,First Health Group Corporation,First Health Network,3026.4,97,,percent of total billed charges,,
Mri Cervical Spine Wo W Contrast,,72156,CPT,Facility,Both,,,,3120,2652,561.34,3120,"Health Partners, Inc.",Commercial,2951.52,94.6,,percent of total billed charges,,
Mri Cervical Spine Wo W Contrast,,72156,CPT,Facility,Outpatient,,,,3120,2652,561.34,3120,"Health Partners, Inc.",Medicare Advantage,1528.8,49,,percent of total billed charges,,
Mri Cervical Spine Wo W Contrast,,72156,CPT,Facility,Inpatient,,,,3120,2652,561.34,3120,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mri Cervical Spine Wo W Contrast,,72156,CPT,Facility,Both,,,,3120,2652,561.34,3120,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1872,60,,percent of total billed charges,,
Mri Cervical Spine Wo W Contrast,,72156,CPT,Facility,Both,,,,3120,2652,561.34,3120,"Health Partners, Inc.",State of Minnesota Advantage Program,2542.8,81.5,,percent of total billed charges,,
Mri Cervical Spine Wo W Contrast,,72156,CPT,Facility,Both,,,,3120,2652,561.34,3120,"Health Partners, Inc.",State Public Programs,1560,50,,percent of total billed charges,,
Mri Cervical Spine Wo W Contrast,,72156,CPT,Facility,Both,,,,3120,2652,561.34,3120,Humana Insurance Company,Commercial PPO,2964,95,,percent of total billed charges,,
Mri Cervical Spine Wo W Contrast,,72156,CPT,Facility,Outpatient,,,,3120,2652,561.34,3120,Humana Insurance Company,Medicare PPO,1528.8,49,,percent of total billed charges,,
Mri Cervical Spine Wo W Contrast,,72156,CPT,Facility,Inpatient,,,,3120,2652,561.34,3120,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Mri Cervical Spine Wo W Contrast,,72156,CPT,Facility,Both,,,,3120,2652,561.34,3120,Medica,Individual & Family,3091.92,99.1,,percent of total billed charges,,
Mri Cervical Spine Wo W Contrast,,72156,CPT,Facility,Outpatient,,,,3120,2652,561.34,3120,Medica,Medica Advantage Solution,1553.76,49.8,,percent of total billed charges,,
Mri Cervical Spine Wo W Contrast,,72156,CPT,Facility,Inpatient,,,,3120,2652,561.34,3120,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Mri Cervical Spine Wo W Contrast,,72156,CPT,Facility,Outpatient,,,,3120,2652,561.34,3120,Medica,Medical Assistance,747,,,Other ,per vist,Pays in addition to all Outpatient Service Categories
Mri Cervical Spine Wo W Contrast,,72156,CPT,Facility,Inpatient,,,,3120,2652,561.34,3120,Medica,Medical Assistance,,,,,Included in per diem rate,
Mri Cervical Spine Wo W Contrast,,72156,CPT,Facility,Outpatient,,,,3120,2652,561.34,3120,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1553.76,49.8,,percent of total billed charges,,
Mri Cervical Spine Wo W Contrast,,72156,CPT,Facility,Inpatient,,,,3120,2652,561.34,3120,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Mri Cervical Spine Wo W Contrast,,72156,CPT,Facility,Both,,,,3120,2652,561.34,3120,"Multiplan, Inc.","Multiplan, Inc.",2932.8,94,,percent of total billed charges,,
Mri Cervical Spine Wo W Contrast,,72156,CPT,Facility,Outpatient,,,,3120,2652,561.34,3120,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1535,,,Other ,per scan,
Mri Cervical Spine Wo W Contrast,,72156,CPT,Facility,Inpatient,,,,3120,2652,561.34,3120,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Mri Cervical Spine Wo W Contrast,,72156,CPT,Facility,Both,,,,3120,2652,561.34,3120,"Preferred One Administrative Services, INC.",PPO,3076.32,98.6,,percent of total billed charges,,
Mri Cervical Spine Wo W Contrast,,72156,CPT,Facility,Outpatient,,,,3120,2652,561.34,3120,PrimeWest Health,Minnesota Senior Health Options (MSHO),1605.24,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Mri Cervical Spine Wo W Contrast,,72156,CPT,Facility,Inpatient,,,,3120,2652,561.34,3120,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mri Cervical Spine Wo W Contrast,,72156,CPT,Facility,Outpatient,,,,3120,2652,561.34,3120,PrimeWest Health,MinnesotaCare,1602.432,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Mri Cervical Spine Wo W Contrast,,72156,CPT,Facility,Inpatient,,,,3120,2652,561.34,3120,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Mri Cervical Spine Wo W Contrast,,72156,CPT,Facility,Both,,,,3120,2652,561.34,3120,Sanford Health Plan,Sanford Health Plan,2870.4,92,,percent of total billed charges,,
Mri Cervical Spine Wo W Contrast,,72156,CPT,Facility,Outpatient,,,,3120,2652,561.34,3120,"UCare Health, Inc.",Individual & Family Plan,1758.12,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Mri Cervical Spine Wo W Contrast,,72156,CPT,Facility,Inpatient,,,,3120,2652,561.34,3120,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Mri Cervical Spine Wo W Contrast,,72156,CPT,Facility,Outpatient,,,,3120,2652,561.34,3120,"UCare Health, Inc.",Medical Assistance,1574.664,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mri Cervical Spine Wo W Contrast,,72156,CPT,Facility,Inpatient,,,,3120,2652,561.34,3120,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Mri Cervical Spine Wo W Contrast,,72156,CPT,Facility,Outpatient,,,,3120,2652,561.34,3120,"UCare Health, Inc.",Medicare Advantage,1574.664,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mri Cervical Spine Wo W Contrast,,72156,CPT,Facility,Inpatient,,,,3120,2652,561.34,3120,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mri Cervical Spine Wo W Contrast,,72156,CPT,Facility,Outpatient,,,,3120,2652,561.34,3120,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1574.664,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mri Cervical Spine Wo W Contrast,,72156,CPT,Facility,Inpatient,,,,3120,2652,561.34,3120,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mri Cervical Spine Wo W Contrast,,72156,CPT,Facility,Both,,,,3120,2652,561.34,3120,UnitedHealthcare,Individual & Family,2932.8,94,,percent of total billed charges,,
Mri Cervical Spine Wo W Contrast,,72156,CPT,Facility,Outpatient,,,,3120,2652,561.34,3120,UnitedHealthcare,Medicare Advantage,1528.8,49,,percent of total billed charges,,
Mri Cervical Spine Wo W Contrast,,72156,CPT,Facility,Inpatient,,,,3120,2652,561.34,3120,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Mri Cervical Spine Wo W Contrast,,72156,CPT,Facility,Outpatient,,,,3120,2652,561.34,3120,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1497.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
Mri Cervical Spine Wo W Contrast,,72156,CPT,Facility,Inpatient,,,,3120,2652,561.34,3120,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Mri Thoracic Spine Wo W Contrast,,72157,CPT,Facility,Both,,,,3120,2652,561.34,3120,Aetna,Commercial,2870.4,92,,percent of total billed charges,,
Mri Thoracic Spine Wo W Contrast,,72157,CPT,Facility,Outpatient,,,,3120,2652,561.34,3120,Aetna,Medicare Advantage,1528.8,49,,percent of total billed charges,,
Mri Thoracic Spine Wo W Contrast,,72157,CPT,Facility,Inpatient,,,,3120,2652,561.34,3120,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Mri Thoracic Spine Wo W Contrast,,72157,CPT,Facility,Both,,,,3120,2652,561.34,3120,Aetna,PPO,2901.6,93,,percent of total billed charges,,
Mri Thoracic Spine Wo W Contrast,,72157,CPT,Facility,Both,,,,3120,2652,561.34,3120,America's PPO,America's PPO,2996.136,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Mri Thoracic Spine Wo W Contrast,,72157,CPT,Facility,Both,,,,3120,2652,561.34,3120,BlueCross BlueShield Minnesota, Federal Employee Program,1105,,,Fee schedule,,100% of BCBS commercial commodity fee schedule
Mri Thoracic Spine Wo W Contrast,,72157,CPT,Facility,Both,,,,3120,2652,561.34,3120,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1122.68,,,Fee schedule,,"100% of BCBS commercial commodity fee schedule, plus MN Care tax"
Mri Thoracic Spine Wo W Contrast,,72157,CPT,Facility,Both,,,,3120,2652,561.34,3120,BlueCross BlueShield Minnesota,High Value Network Plan,1010.412,,,Fee schedule,,"90% of BCBS commercial commodity fee schedule, plus MN Care tax; see disclaimer for more information"
Mri Thoracic Spine Wo W Contrast,,72157,CPT,Facility,Outpatient,,,,3120,2652,561.34,3120,BlueCross BlueShield Minnesota,Medicare Advantage,1528.8,49,,percent of total billed charges,,
Mri Thoracic Spine Wo W Contrast,,72157,CPT,Facility,Inpatient,,,,3120,2652,561.34,3120,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Mri Thoracic Spine Wo W Contrast,,72157,CPT,Facility,Both,,,,3120,2652,561.34,3120,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,994.357676,,,Fee schedule,,"88.57% of BCBS commercial commodity fee schedule, plus MN Care tax"
Mri Thoracic Spine Wo W Contrast,,72157,CPT,Facility,Both,,,,3120,2652,561.34,3120,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,561.34,,,Fee schedule,,"100% of BCBS Medicaid commodity fee schedule, plus MN Care tax"
Mri Thoracic Spine Wo W Contrast,,72157,CPT,Facility,Outpatient,,,,3120,2652,561.34,3120,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1528.8,49,,percent of total billed charges,,
Mri Thoracic Spine Wo W Contrast,,72157,CPT,Facility,Inpatient,,,,3120,2652,561.34,3120,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Mri Thoracic Spine Wo W Contrast,,72157,CPT,Facility,Both,,,,3120,2652,561.34,3120,CorVel,Worker's Compensation,3120,100,,percent of total billed charges,,
Mri Thoracic Spine Wo W Contrast,,72157,CPT,Facility,Both,,,,3120,2652,561.34,3120,First Health Group Corporation,First Health Network,3026.4,97,,percent of total billed charges,,
Mri Thoracic Spine Wo W Contrast,,72157,CPT,Facility,Both,,,,3120,2652,561.34,3120,"Health Partners, Inc.",Commercial,2951.52,94.6,,percent of total billed charges,,
Mri Thoracic Spine Wo W Contrast,,72157,CPT,Facility,Outpatient,,,,3120,2652,561.34,3120,"Health Partners, Inc.",Medicare Advantage,1528.8,49,,percent of total billed charges,,
Mri Thoracic Spine Wo W Contrast,,72157,CPT,Facility,Inpatient,,,,3120,2652,561.34,3120,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mri Thoracic Spine Wo W Contrast,,72157,CPT,Facility,Both,,,,3120,2652,561.34,3120,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1872,60,,percent of total billed charges,,
Mri Thoracic Spine Wo W Contrast,,72157,CPT,Facility,Both,,,,3120,2652,561.34,3120,"Health Partners, Inc.",State of Minnesota Advantage Program,2542.8,81.5,,percent of total billed charges,,
Mri Thoracic Spine Wo W Contrast,,72157,CPT,Facility,Both,,,,3120,2652,561.34,3120,"Health Partners, Inc.",State Public Programs,1560,50,,percent of total billed charges,,
Mri Thoracic Spine Wo W Contrast,,72157,CPT,Facility,Both,,,,3120,2652,561.34,3120,Humana Insurance Company,Commercial PPO,2964,95,,percent of total billed charges,,
Mri Thoracic Spine Wo W Contrast,,72157,CPT,Facility,Outpatient,,,,3120,2652,561.34,3120,Humana Insurance Company,Medicare PPO,1528.8,49,,percent of total billed charges,,
Mri Thoracic Spine Wo W Contrast,,72157,CPT,Facility,Inpatient,,,,3120,2652,561.34,3120,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Mri Thoracic Spine Wo W Contrast,,72157,CPT,Facility,Both,,,,3120,2652,561.34,3120,Medica,Individual & Family,3091.92,99.1,,percent of total billed charges,,
Mri Thoracic Spine Wo W Contrast,,72157,CPT,Facility,Outpatient,,,,3120,2652,561.34,3120,Medica,Medica Advantage Solution,1553.76,49.8,,percent of total billed charges,,
Mri Thoracic Spine Wo W Contrast,,72157,CPT,Facility,Inpatient,,,,3120,2652,561.34,3120,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Mri Thoracic Spine Wo W Contrast,,72157,CPT,Facility,Outpatient,,,,3120,2652,561.34,3120,Medica,Medical Assistance,747,,,Other ,per vist,Pays in addition to all Outpatient Service Categories
Mri Thoracic Spine Wo W Contrast,,72157,CPT,Facility,Inpatient,,,,3120,2652,561.34,3120,Medica,Medical Assistance,,,,,Included in per diem rate,
Mri Thoracic Spine Wo W Contrast,,72157,CPT,Facility,Outpatient,,,,3120,2652,561.34,3120,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1553.76,49.8,,percent of total billed charges,,
Mri Thoracic Spine Wo W Contrast,,72157,CPT,Facility,Inpatient,,,,3120,2652,561.34,3120,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Mri Thoracic Spine Wo W Contrast,,72157,CPT,Facility,Both,,,,3120,2652,561.34,3120,"Multiplan, Inc.","Multiplan, Inc.",2932.8,94,,percent of total billed charges,,
Mri Thoracic Spine Wo W Contrast,,72157,CPT,Facility,Outpatient,,,,3120,2652,561.34,3120,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1535,,,Other ,per scan,
Mri Thoracic Spine Wo W Contrast,,72157,CPT,Facility,Inpatient,,,,3120,2652,561.34,3120,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Mri Thoracic Spine Wo W Contrast,,72157,CPT,Facility,Both,,,,3120,2652,561.34,3120,"Preferred One Administrative Services, INC.",PPO,3076.32,98.6,,percent of total billed charges,,
Mri Thoracic Spine Wo W Contrast,,72157,CPT,Facility,Outpatient,,,,3120,2652,561.34,3120,PrimeWest Health,Minnesota Senior Health Options (MSHO),1605.24,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Mri Thoracic Spine Wo W Contrast,,72157,CPT,Facility,Inpatient,,,,3120,2652,561.34,3120,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mri Thoracic Spine Wo W Contrast,,72157,CPT,Facility,Outpatient,,,,3120,2652,561.34,3120,PrimeWest Health,MinnesotaCare,1602.432,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Mri Thoracic Spine Wo W Contrast,,72157,CPT,Facility,Inpatient,,,,3120,2652,561.34,3120,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Mri Thoracic Spine Wo W Contrast,,72157,CPT,Facility,Both,,,,3120,2652,561.34,3120,Sanford Health Plan,Sanford Health Plan,2870.4,92,,percent of total billed charges,,
Mri Thoracic Spine Wo W Contrast,,72157,CPT,Facility,Outpatient,,,,3120,2652,561.34,3120,"UCare Health, Inc.",Individual & Family Plan,1758.12,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Mri Thoracic Spine Wo W Contrast,,72157,CPT,Facility,Inpatient,,,,3120,2652,561.34,3120,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Mri Thoracic Spine Wo W Contrast,,72157,CPT,Facility,Outpatient,,,,3120,2652,561.34,3120,"UCare Health, Inc.",Medical Assistance,1574.664,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mri Thoracic Spine Wo W Contrast,,72157,CPT,Facility,Inpatient,,,,3120,2652,561.34,3120,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Mri Thoracic Spine Wo W Contrast,,72157,CPT,Facility,Outpatient,,,,3120,2652,561.34,3120,"UCare Health, Inc.",Medicare Advantage,1574.664,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mri Thoracic Spine Wo W Contrast,,72157,CPT,Facility,Inpatient,,,,3120,2652,561.34,3120,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mri Thoracic Spine Wo W Contrast,,72157,CPT,Facility,Outpatient,,,,3120,2652,561.34,3120,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1574.664,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mri Thoracic Spine Wo W Contrast,,72157,CPT,Facility,Inpatient,,,,3120,2652,561.34,3120,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mri Thoracic Spine Wo W Contrast,,72157,CPT,Facility,Both,,,,3120,2652,561.34,3120,UnitedHealthcare,Individual & Family,2932.8,94,,percent of total billed charges,,
Mri Thoracic Spine Wo W Contrast,,72157,CPT,Facility,Outpatient,,,,3120,2652,561.34,3120,UnitedHealthcare,Medicare Advantage,1528.8,49,,percent of total billed charges,,
Mri Thoracic Spine Wo W Contrast,,72157,CPT,Facility,Inpatient,,,,3120,2652,561.34,3120,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Mri Thoracic Spine Wo W Contrast,,72157,CPT,Facility,Outpatient,,,,3120,2652,561.34,3120,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1497.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
Mri Thoracic Spine Wo W Contrast,,72157,CPT,Facility,Inpatient,,,,3120,2652,561.34,3120,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Mri Lumbar Spine Wo W Contrast,,72158,CPT,Facility,Both,,,,3120,2652,561.34,3120,Aetna,Commercial,2870.4,92,,percent of total billed charges,,
Mri Lumbar Spine Wo W Contrast,,72158,CPT,Facility,Outpatient,,,,3120,2652,561.34,3120,Aetna,Medicare Advantage,1528.8,49,,percent of total billed charges,,
Mri Lumbar Spine Wo W Contrast,,72158,CPT,Facility,Inpatient,,,,3120,2652,561.34,3120,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Mri Lumbar Spine Wo W Contrast,,72158,CPT,Facility,Both,,,,3120,2652,561.34,3120,Aetna,PPO,2901.6,93,,percent of total billed charges,,
Mri Lumbar Spine Wo W Contrast,,72158,CPT,Facility,Both,,,,3120,2652,561.34,3120,America's PPO,America's PPO,2996.136,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Mri Lumbar Spine Wo W Contrast,,72158,CPT,Facility,Both,,,,3120,2652,561.34,3120,BlueCross BlueShield Minnesota, Federal Employee Program,1105,,,Fee schedule,,100% of BCBS commercial commodity fee schedule
Mri Lumbar Spine Wo W Contrast,,72158,CPT,Facility,Both,,,,3120,2652,561.34,3120,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1122.68,,,Fee schedule,,"100% of BCBS commercial commodity fee schedule, plus MN Care tax"
Mri Lumbar Spine Wo W Contrast,,72158,CPT,Facility,Both,,,,3120,2652,561.34,3120,BlueCross BlueShield Minnesota,High Value Network Plan,1010.412,,,Fee schedule,,"90% of BCBS commercial commodity fee schedule, plus MN Care tax; see disclaimer for more information"
Mri Lumbar Spine Wo W Contrast,,72158,CPT,Facility,Outpatient,,,,3120,2652,561.34,3120,BlueCross BlueShield Minnesota,Medicare Advantage,1528.8,49,,percent of total billed charges,,
Mri Lumbar Spine Wo W Contrast,,72158,CPT,Facility,Inpatient,,,,3120,2652,561.34,3120,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Mri Lumbar Spine Wo W Contrast,,72158,CPT,Facility,Both,,,,3120,2652,561.34,3120,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,994.357676,,,Fee schedule,,"88.57% of BCBS commercial commodity fee schedule, plus MN Care tax"
Mri Lumbar Spine Wo W Contrast,,72158,CPT,Facility,Both,,,,3120,2652,561.34,3120,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,561.34,,,Fee schedule,,"100% of BCBS Medicaid commodity fee schedule, plus MN Care tax"
Mri Lumbar Spine Wo W Contrast,,72158,CPT,Facility,Outpatient,,,,3120,2652,561.34,3120,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1528.8,49,,percent of total billed charges,,
Mri Lumbar Spine Wo W Contrast,,72158,CPT,Facility,Inpatient,,,,3120,2652,561.34,3120,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Mri Lumbar Spine Wo W Contrast,,72158,CPT,Facility,Both,,,,3120,2652,561.34,3120,CorVel,Worker's Compensation,3120,100,,percent of total billed charges,,
Mri Lumbar Spine Wo W Contrast,,72158,CPT,Facility,Both,,,,3120,2652,561.34,3120,First Health Group Corporation,First Health Network,3026.4,97,,percent of total billed charges,,
Mri Lumbar Spine Wo W Contrast,,72158,CPT,Facility,Both,,,,3120,2652,561.34,3120,"Health Partners, Inc.",Commercial,2951.52,94.6,,percent of total billed charges,,
Mri Lumbar Spine Wo W Contrast,,72158,CPT,Facility,Outpatient,,,,3120,2652,561.34,3120,"Health Partners, Inc.",Medicare Advantage,1528.8,49,,percent of total billed charges,,
Mri Lumbar Spine Wo W Contrast,,72158,CPT,Facility,Inpatient,,,,3120,2652,561.34,3120,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mri Lumbar Spine Wo W Contrast,,72158,CPT,Facility,Both,,,,3120,2652,561.34,3120,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1872,60,,percent of total billed charges,,
Mri Lumbar Spine Wo W Contrast,,72158,CPT,Facility,Both,,,,3120,2652,561.34,3120,"Health Partners, Inc.",State of Minnesota Advantage Program,2542.8,81.5,,percent of total billed charges,,
Mri Lumbar Spine Wo W Contrast,,72158,CPT,Facility,Both,,,,3120,2652,561.34,3120,"Health Partners, Inc.",State Public Programs,1560,50,,percent of total billed charges,,
Mri Lumbar Spine Wo W Contrast,,72158,CPT,Facility,Both,,,,3120,2652,561.34,3120,Humana Insurance Company,Commercial PPO,2964,95,,percent of total billed charges,,
Mri Lumbar Spine Wo W Contrast,,72158,CPT,Facility,Outpatient,,,,3120,2652,561.34,3120,Humana Insurance Company,Medicare PPO,1528.8,49,,percent of total billed charges,,
Mri Lumbar Spine Wo W Contrast,,72158,CPT,Facility,Inpatient,,,,3120,2652,561.34,3120,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Mri Lumbar Spine Wo W Contrast,,72158,CPT,Facility,Both,,,,3120,2652,561.34,3120,Medica,Individual & Family,3091.92,99.1,,percent of total billed charges,,
Mri Lumbar Spine Wo W Contrast,,72158,CPT,Facility,Outpatient,,,,3120,2652,561.34,3120,Medica,Medica Advantage Solution,1553.76,49.8,,percent of total billed charges,,
Mri Lumbar Spine Wo W Contrast,,72158,CPT,Facility,Inpatient,,,,3120,2652,561.34,3120,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Mri Lumbar Spine Wo W Contrast,,72158,CPT,Facility,Outpatient,,,,3120,2652,561.34,3120,Medica,Medical Assistance,747,,,Other ,per vist,Pays in addition to all Outpatient Service Categories
Mri Lumbar Spine Wo W Contrast,,72158,CPT,Facility,Inpatient,,,,3120,2652,561.34,3120,Medica,Medical Assistance,,,,,Included in per diem rate,
Mri Lumbar Spine Wo W Contrast,,72158,CPT,Facility,Outpatient,,,,3120,2652,561.34,3120,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1553.76,49.8,,percent of total billed charges,,
Mri Lumbar Spine Wo W Contrast,,72158,CPT,Facility,Inpatient,,,,3120,2652,561.34,3120,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Mri Lumbar Spine Wo W Contrast,,72158,CPT,Facility,Both,,,,3120,2652,561.34,3120,"Multiplan, Inc.","Multiplan, Inc.",2932.8,94,,percent of total billed charges,,
Mri Lumbar Spine Wo W Contrast,,72158,CPT,Facility,Outpatient,,,,3120,2652,561.34,3120,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1535,,,Other ,per scan,
Mri Lumbar Spine Wo W Contrast,,72158,CPT,Facility,Inpatient,,,,3120,2652,561.34,3120,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Mri Lumbar Spine Wo W Contrast,,72158,CPT,Facility,Both,,,,3120,2652,561.34,3120,"Preferred One Administrative Services, INC.",PPO,3076.32,98.6,,percent of total billed charges,,
Mri Lumbar Spine Wo W Contrast,,72158,CPT,Facility,Outpatient,,,,3120,2652,561.34,3120,PrimeWest Health,Minnesota Senior Health Options (MSHO),1605.24,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Mri Lumbar Spine Wo W Contrast,,72158,CPT,Facility,Inpatient,,,,3120,2652,561.34,3120,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mri Lumbar Spine Wo W Contrast,,72158,CPT,Facility,Outpatient,,,,3120,2652,561.34,3120,PrimeWest Health,MinnesotaCare,1602.432,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Mri Lumbar Spine Wo W Contrast,,72158,CPT,Facility,Inpatient,,,,3120,2652,561.34,3120,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Mri Lumbar Spine Wo W Contrast,,72158,CPT,Facility,Both,,,,3120,2652,561.34,3120,Sanford Health Plan,Sanford Health Plan,2870.4,92,,percent of total billed charges,,
Mri Lumbar Spine Wo W Contrast,,72158,CPT,Facility,Outpatient,,,,3120,2652,561.34,3120,"UCare Health, Inc.",Individual & Family Plan,1758.12,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Mri Lumbar Spine Wo W Contrast,,72158,CPT,Facility,Inpatient,,,,3120,2652,561.34,3120,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Mri Lumbar Spine Wo W Contrast,,72158,CPT,Facility,Outpatient,,,,3120,2652,561.34,3120,"UCare Health, Inc.",Medical Assistance,1574.664,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mri Lumbar Spine Wo W Contrast,,72158,CPT,Facility,Inpatient,,,,3120,2652,561.34,3120,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Mri Lumbar Spine Wo W Contrast,,72158,CPT,Facility,Outpatient,,,,3120,2652,561.34,3120,"UCare Health, Inc.",Medicare Advantage,1574.664,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mri Lumbar Spine Wo W Contrast,,72158,CPT,Facility,Inpatient,,,,3120,2652,561.34,3120,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mri Lumbar Spine Wo W Contrast,,72158,CPT,Facility,Outpatient,,,,3120,2652,561.34,3120,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1574.664,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mri Lumbar Spine Wo W Contrast,,72158,CPT,Facility,Inpatient,,,,3120,2652,561.34,3120,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mri Lumbar Spine Wo W Contrast,,72158,CPT,Facility,Both,,,,3120,2652,561.34,3120,UnitedHealthcare,Individual & Family,2932.8,94,,percent of total billed charges,,
Mri Lumbar Spine Wo W Contrast,,72158,CPT,Facility,Outpatient,,,,3120,2652,561.34,3120,UnitedHealthcare,Medicare Advantage,1528.8,49,,percent of total billed charges,,
Mri Lumbar Spine Wo W Contrast,,72158,CPT,Facility,Inpatient,,,,3120,2652,561.34,3120,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Mri Lumbar Spine Wo W Contrast,,72158,CPT,Facility,Outpatient,,,,3120,2652,561.34,3120,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1497.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
Mri Lumbar Spine Wo W Contrast,,72158,CPT,Facility,Inpatient,,,,3120,2652,561.34,3120,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Xr Pelvis Routine 1 Or 2 Views,,72170,CPT,Facility,Both,,,,255,216.75,73.083,255,Aetna,Commercial,234.6,92,,percent of total billed charges,,
Xr Pelvis Routine 1 Or 2 Views,,72170,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,Aetna,Medicare Advantage,124.95,49,,percent of total billed charges,,
Xr Pelvis Routine 1 Or 2 Views,,72170,CPT,Facility,Inpatient,,,,255,216.75,73.083,255,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Xr Pelvis Routine 1 Or 2 Views,,72170,CPT,Facility,Both,,,,255,216.75,73.083,255,Aetna,PPO,237.15,93,,percent of total billed charges,,
Xr Pelvis Routine 1 Or 2 Views,,72170,CPT,Facility,Both,,,,255,216.75,73.083,255,America's PPO,America's PPO,244.8765,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Xr Pelvis Routine 1 Or 2 Views,,72170,CPT,Facility,Both,,,,255,216.75,73.083,255,BlueCross BlueShield Minnesota, Federal Employee Program,250.92,98.4,,percent of total billed charges,,
Xr Pelvis Routine 1 Or 2 Views,,72170,CPT,Facility,Both,,,,255,216.75,73.083,255,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,255,100,,percent of total billed charges,,
Xr Pelvis Routine 1 Or 2 Views,,72170,CPT,Facility,Both,,,,255,216.75,73.083,255,BlueCross BlueShield Minnesota,High Value Network Plan,229.5,90,,percent of total billed charges,,
Xr Pelvis Routine 1 Or 2 Views,,72170,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,BlueCross BlueShield Minnesota,Medicare Advantage,124.95,49,,percent of total billed charges,,
Xr Pelvis Routine 1 Or 2 Views,,72170,CPT,Facility,Inpatient,,,,255,216.75,73.083,255,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Xr Pelvis Routine 1 Or 2 Views,,72170,CPT,Facility,Both,,,,255,216.75,73.083,255,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,225.8535,88.57,,percent of total billed charges,,
Xr Pelvis Routine 1 Or 2 Views,,72170,CPT,Facility,Both,,,,255,216.75,73.083,255,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,73.083,28.66,,percent of total billed charges,,
Xr Pelvis Routine 1 Or 2 Views,,72170,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),124.95,49,,percent of total billed charges,,
Xr Pelvis Routine 1 Or 2 Views,,72170,CPT,Facility,Inpatient,,,,255,216.75,73.083,255,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Xr Pelvis Routine 1 Or 2 Views,,72170,CPT,Facility,Both,,,,255,216.75,73.083,255,CorVel,Worker's Compensation,255,100,,percent of total billed charges,,
Xr Pelvis Routine 1 Or 2 Views,,72170,CPT,Facility,Both,,,,255,216.75,73.083,255,First Health Group Corporation,First Health Network,247.35,97,,percent of total billed charges,,
Xr Pelvis Routine 1 Or 2 Views,,72170,CPT,Facility,Both,,,,255,216.75,73.083,255,"Health Partners, Inc.",Commercial,241.23,94.6,,percent of total billed charges,,
Xr Pelvis Routine 1 Or 2 Views,,72170,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,"Health Partners, Inc.",Medicare Advantage,124.95,49,,percent of total billed charges,,
Xr Pelvis Routine 1 Or 2 Views,,72170,CPT,Facility,Inpatient,,,,255,216.75,73.083,255,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Pelvis Routine 1 Or 2 Views,,72170,CPT,Facility,Both,,,,255,216.75,73.083,255,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),153,60,,percent of total billed charges,,
Xr Pelvis Routine 1 Or 2 Views,,72170,CPT,Facility,Both,,,,255,216.75,73.083,255,"Health Partners, Inc.",State of Minnesota Advantage Program,207.825,81.5,,percent of total billed charges,,
Xr Pelvis Routine 1 Or 2 Views,,72170,CPT,Facility,Both,,,,255,216.75,73.083,255,"Health Partners, Inc.",State Public Programs,127.5,50,,percent of total billed charges,,
Xr Pelvis Routine 1 Or 2 Views,,72170,CPT,Facility,Both,,,,255,216.75,73.083,255,Humana Insurance Company,Commercial PPO,242.25,95,,percent of total billed charges,,
Xr Pelvis Routine 1 Or 2 Views,,72170,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,Humana Insurance Company,Medicare PPO,124.95,49,,percent of total billed charges,,
Xr Pelvis Routine 1 Or 2 Views,,72170,CPT,Facility,Inpatient,,,,255,216.75,73.083,255,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Xr Pelvis Routine 1 Or 2 Views,,72170,CPT,Facility,Both,,,,255,216.75,73.083,255,Medica,Individual & Family,252.705,99.1,,percent of total billed charges,,
Xr Pelvis Routine 1 Or 2 Views,,72170,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,Medica,Medica Advantage Solution,126.99,49.8,,percent of total billed charges,,
Xr Pelvis Routine 1 Or 2 Views,,72170,CPT,Facility,Inpatient,,,,255,216.75,73.083,255,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Xr Pelvis Routine 1 Or 2 Views,,72170,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,Medica,Medical Assistance,113.73,44.6,,percent of total billed charges,,
Xr Pelvis Routine 1 Or 2 Views,,72170,CPT,Facility,Inpatient,,,,255,216.75,73.083,255,Medica,Medical Assistance,,,,,Included in per diem rate,
Xr Pelvis Routine 1 Or 2 Views,,72170,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,126.99,49.8,,percent of total billed charges,,
Xr Pelvis Routine 1 Or 2 Views,,72170,CPT,Facility,Inpatient,,,,255,216.75,73.083,255,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Xr Pelvis Routine 1 Or 2 Views,,72170,CPT,Facility,Both,,,,255,216.75,73.083,255,"Multiplan, Inc.","Multiplan, Inc.",239.7,94,,percent of total billed charges,,
Xr Pelvis Routine 1 Or 2 Views,,72170,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,229.755,90.1,,percent of total billed charges,,
Xr Pelvis Routine 1 Or 2 Views,,72170,CPT,Facility,Inpatient,,,,255,216.75,73.083,255,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Xr Pelvis Routine 1 Or 2 Views,,72170,CPT,Facility,Both,,,,255,216.75,73.083,255,"Preferred One Administrative Services, INC.",PPO,251.43,98.6,,percent of total billed charges,,
Xr Pelvis Routine 1 Or 2 Views,,72170,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,PrimeWest Health,Minnesota Senior Health Options (MSHO),131.1975,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Xr Pelvis Routine 1 Or 2 Views,,72170,CPT,Facility,Inpatient,,,,255,216.75,73.083,255,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Pelvis Routine 1 Or 2 Views,,72170,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,PrimeWest Health,MinnesotaCare,130.968,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Xr Pelvis Routine 1 Or 2 Views,,72170,CPT,Facility,Inpatient,,,,255,216.75,73.083,255,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Xr Pelvis Routine 1 Or 2 Views,,72170,CPT,Facility,Both,,,,255,216.75,73.083,255,Sanford Health Plan,Sanford Health Plan,234.6,92,,percent of total billed charges,,
Xr Pelvis Routine 1 Or 2 Views,,72170,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,"UCare Health, Inc.",Individual & Family Plan,143.6925,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Xr Pelvis Routine 1 Or 2 Views,,72170,CPT,Facility,Inpatient,,,,255,216.75,73.083,255,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Xr Pelvis Routine 1 Or 2 Views,,72170,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,"UCare Health, Inc.",Medical Assistance,128.6985,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Pelvis Routine 1 Or 2 Views,,72170,CPT,Facility,Inpatient,,,,255,216.75,73.083,255,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Xr Pelvis Routine 1 Or 2 Views,,72170,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,"UCare Health, Inc.",Medicare Advantage,128.6985,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Pelvis Routine 1 Or 2 Views,,72170,CPT,Facility,Inpatient,,,,255,216.75,73.083,255,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Pelvis Routine 1 Or 2 Views,,72170,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),128.6985,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Pelvis Routine 1 Or 2 Views,,72170,CPT,Facility,Inpatient,,,,255,216.75,73.083,255,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Pelvis Routine 1 Or 2 Views,,72170,CPT,Facility,Both,,,,255,216.75,73.083,255,UnitedHealthcare,Individual & Family,239.7,94,,percent of total billed charges,,
Xr Pelvis Routine 1 Or 2 Views,,72170,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,UnitedHealthcare,Medicare Advantage,124.95,49,,percent of total billed charges,,
Xr Pelvis Routine 1 Or 2 Views,,72170,CPT,Facility,Inpatient,,,,255,216.75,73.083,255,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Xr Pelvis Routine 1 Or 2 Views,,72170,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,122.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
Xr Pelvis Routine 1 Or 2 Views,,72170,CPT,Facility,Inpatient,,,,255,216.75,73.083,255,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Ct Pelvis Wo Iv Contrast,,72192,CPT,Facility,Both,,,,1426,1212.1,325.628,1426,Aetna,Commercial,1311.92,92,,percent of total billed charges,,
Ct Pelvis Wo Iv Contrast,,72192,CPT,Facility,Outpatient,,,,1426,1212.1,325.628,1426,Aetna,Medicare Advantage,698.74,49,,percent of total billed charges,,
Ct Pelvis Wo Iv Contrast,,72192,CPT,Facility,Inpatient,,,,1426,1212.1,325.628,1426,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Ct Pelvis Wo Iv Contrast,,72192,CPT,Facility,Both,,,,1426,1212.1,325.628,1426,Aetna,PPO,1326.18,93,,percent of total billed charges,,
Ct Pelvis Wo Iv Contrast,,72192,CPT,Facility,Both,,,,1426,1212.1,325.628,1426,America's PPO,America's PPO,1369.3878,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Ct Pelvis Wo Iv Contrast,,72192,CPT,Facility,Both,,,,1426,1212.1,325.628,1426,BlueCross BlueShield Minnesota, Federal Employee Program,641,,,Fee schedule,,100% of BCBS commercial commodity fee schedule
Ct Pelvis Wo Iv Contrast,,72192,CPT,Facility,Both,,,,1426,1212.1,325.628,1426,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,651.256,,,Fee schedule,,"100% of BCBS commercial commodity fee schedule, plus MN Care tax"
Ct Pelvis Wo Iv Contrast,,72192,CPT,Facility,Both,,,,1426,1212.1,325.628,1426,BlueCross BlueShield Minnesota,High Value Network Plan,586.1304,,,Fee schedule,,"90% of BCBS commercial commodity fee schedule, plus MN Care tax; see disclaimer for more information"
Ct Pelvis Wo Iv Contrast,,72192,CPT,Facility,Outpatient,,,,1426,1212.1,325.628,1426,BlueCross BlueShield Minnesota,Medicare Advantage,698.74,49,,percent of total billed charges,,
Ct Pelvis Wo Iv Contrast,,72192,CPT,Facility,Inpatient,,,,1426,1212.1,325.628,1426,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Ct Pelvis Wo Iv Contrast,,72192,CPT,Facility,Both,,,,1426,1212.1,325.628,1426,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,576.8174392,,,Fee schedule,,"88.57% of BCBS commercial commodity fee schedule, plus MN Care tax"
Ct Pelvis Wo Iv Contrast,,72192,CPT,Facility,Both,,,,1426,1212.1,325.628,1426,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,325.628,,,Fee schedule,,"100% of BCBS Medicaid commodity fee schedule, plus MN Care tax"
Ct Pelvis Wo Iv Contrast,,72192,CPT,Facility,Outpatient,,,,1426,1212.1,325.628,1426,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),698.74,49,,percent of total billed charges,,
Ct Pelvis Wo Iv Contrast,,72192,CPT,Facility,Inpatient,,,,1426,1212.1,325.628,1426,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Ct Pelvis Wo Iv Contrast,,72192,CPT,Facility,Both,,,,1426,1212.1,325.628,1426,CorVel,Worker's Compensation,1426,100,,percent of total billed charges,,
Ct Pelvis Wo Iv Contrast,,72192,CPT,Facility,Both,,,,1426,1212.1,325.628,1426,First Health Group Corporation,First Health Network,1383.22,97,,percent of total billed charges,,
Ct Pelvis Wo Iv Contrast,,72192,CPT,Facility,Both,,,,1426,1212.1,325.628,1426,"Health Partners, Inc.",Commercial,1348.996,94.6,,percent of total billed charges,,
Ct Pelvis Wo Iv Contrast,,72192,CPT,Facility,Outpatient,,,,1426,1212.1,325.628,1426,"Health Partners, Inc.",Medicare Advantage,698.74,49,,percent of total billed charges,,
Ct Pelvis Wo Iv Contrast,,72192,CPT,Facility,Inpatient,,,,1426,1212.1,325.628,1426,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ct Pelvis Wo Iv Contrast,,72192,CPT,Facility,Both,,,,1426,1212.1,325.628,1426,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),855.6,60,,percent of total billed charges,,
Ct Pelvis Wo Iv Contrast,,72192,CPT,Facility,Both,,,,1426,1212.1,325.628,1426,"Health Partners, Inc.",State of Minnesota Advantage Program,1162.19,81.5,,percent of total billed charges,,
Ct Pelvis Wo Iv Contrast,,72192,CPT,Facility,Both,,,,1426,1212.1,325.628,1426,"Health Partners, Inc.",State Public Programs,713,50,,percent of total billed charges,,
Ct Pelvis Wo Iv Contrast,,72192,CPT,Facility,Both,,,,1426,1212.1,325.628,1426,Humana Insurance Company,Commercial PPO,1354.7,95,,percent of total billed charges,,
Ct Pelvis Wo Iv Contrast,,72192,CPT,Facility,Outpatient,,,,1426,1212.1,325.628,1426,Humana Insurance Company,Medicare PPO,698.74,49,,percent of total billed charges,,
Ct Pelvis Wo Iv Contrast,,72192,CPT,Facility,Inpatient,,,,1426,1212.1,325.628,1426,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Ct Pelvis Wo Iv Contrast,,72192,CPT,Facility,Both,,,,1426,1212.1,325.628,1426,Medica,Individual & Family,1413.166,99.1,,percent of total billed charges,,
Ct Pelvis Wo Iv Contrast,,72192,CPT,Facility,Outpatient,,,,1426,1212.1,325.628,1426,Medica,Medica Advantage Solution,710.148,49.8,,percent of total billed charges,,
Ct Pelvis Wo Iv Contrast,,72192,CPT,Facility,Inpatient,,,,1426,1212.1,325.628,1426,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Ct Pelvis Wo Iv Contrast,,72192,CPT,Facility,Outpatient,,,,1426,1212.1,325.628,1426,Medica,Medical Assistance,635.996,44.6,,percent of total billed charges,,
Ct Pelvis Wo Iv Contrast,,72192,CPT,Facility,Inpatient,,,,1426,1212.1,325.628,1426,Medica,Medical Assistance,,,,,Included in per diem rate,
Ct Pelvis Wo Iv Contrast,,72192,CPT,Facility,Outpatient,,,,1426,1212.1,325.628,1426,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,710.148,49.8,,percent of total billed charges,,
Ct Pelvis Wo Iv Contrast,,72192,CPT,Facility,Inpatient,,,,1426,1212.1,325.628,1426,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Ct Pelvis Wo Iv Contrast,,72192,CPT,Facility,Both,,,,1426,1212.1,325.628,1426,"Multiplan, Inc.","Multiplan, Inc.",1340.44,94,,percent of total billed charges,,
Ct Pelvis Wo Iv Contrast,,72192,CPT,Facility,Outpatient,,,,1426,1212.1,325.628,1426,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1283,,,Other,Per scan,
Ct Pelvis Wo Iv Contrast,,72192,CPT,Facility,Inpatient,,,,1426,1212.1,325.628,1426,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Ct Pelvis Wo Iv Contrast,,72192,CPT,Facility,Both,,,,1426,1212.1,325.628,1426,"Preferred One Administrative Services, INC.",PPO,1406.036,98.6,,percent of total billed charges,,
Ct Pelvis Wo Iv Contrast,,72192,CPT,Facility,Outpatient,,,,1426,1212.1,325.628,1426,PrimeWest Health,Minnesota Senior Health Options (MSHO),733.677,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Ct Pelvis Wo Iv Contrast,,72192,CPT,Facility,Inpatient,,,,1426,1212.1,325.628,1426,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ct Pelvis Wo Iv Contrast,,72192,CPT,Facility,Outpatient,,,,1426,1212.1,325.628,1426,PrimeWest Health,MinnesotaCare,732.3936,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Ct Pelvis Wo Iv Contrast,,72192,CPT,Facility,Inpatient,,,,1426,1212.1,325.628,1426,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Ct Pelvis Wo Iv Contrast,,72192,CPT,Facility,Both,,,,1426,1212.1,325.628,1426,Sanford Health Plan,Sanford Health Plan,1311.92,92,,percent of total billed charges,,
Ct Pelvis Wo Iv Contrast,,72192,CPT,Facility,Outpatient,,,,1426,1212.1,325.628,1426,"UCare Health, Inc.",Individual & Family Plan,803.551,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Ct Pelvis Wo Iv Contrast,,72192,CPT,Facility,Inpatient,,,,1426,1212.1,325.628,1426,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Ct Pelvis Wo Iv Contrast,,72192,CPT,Facility,Outpatient,,,,1426,1212.1,325.628,1426,"UCare Health, Inc.",Medical Assistance,719.7022,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ct Pelvis Wo Iv Contrast,,72192,CPT,Facility,Inpatient,,,,1426,1212.1,325.628,1426,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Ct Pelvis Wo Iv Contrast,,72192,CPT,Facility,Outpatient,,,,1426,1212.1,325.628,1426,"UCare Health, Inc.",Medicare Advantage,719.7022,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ct Pelvis Wo Iv Contrast,,72192,CPT,Facility,Inpatient,,,,1426,1212.1,325.628,1426,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ct Pelvis Wo Iv Contrast,,72192,CPT,Facility,Outpatient,,,,1426,1212.1,325.628,1426,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),719.7022,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ct Pelvis Wo Iv Contrast,,72192,CPT,Facility,Inpatient,,,,1426,1212.1,325.628,1426,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ct Pelvis Wo Iv Contrast,,72192,CPT,Facility,Both,,,,1426,1212.1,325.628,1426,UnitedHealthcare,Individual & Family,1340.44,94,,percent of total billed charges,,
Ct Pelvis Wo Iv Contrast,,72192,CPT,Facility,Outpatient,,,,1426,1212.1,325.628,1426,UnitedHealthcare,Medicare Advantage,698.74,49,,percent of total billed charges,,
Ct Pelvis Wo Iv Contrast,,72192,CPT,Facility,Inpatient,,,,1426,1212.1,325.628,1426,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Ct Pelvis Wo Iv Contrast,,72192,CPT,Facility,Outpatient,,,,1426,1212.1,325.628,1426,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,684.48,48,,percent of total billed charges,,100% of DHS outpatient percentage
Ct Pelvis Wo Iv Contrast,,72192,CPT,Facility,Inpatient,,,,1426,1212.1,325.628,1426,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Ct Pelvis W Iv Contrast,,72193,CPT,Facility,Both,,,,1567,1331.95,412.496,1567,Aetna,Commercial,1441.64,92,,percent of total billed charges,,
Ct Pelvis W Iv Contrast,,72193,CPT,Facility,Outpatient,,,,1567,1331.95,412.496,1567,Aetna,Medicare Advantage,767.83,49,,percent of total billed charges,,
Ct Pelvis W Iv Contrast,,72193,CPT,Facility,Inpatient,,,,1567,1331.95,412.496,1567,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Ct Pelvis W Iv Contrast,,72193,CPT,Facility,Both,,,,1567,1331.95,412.496,1567,Aetna,PPO,1457.31,93,,percent of total billed charges,,
Ct Pelvis W Iv Contrast,,72193,CPT,Facility,Both,,,,1567,1331.95,412.496,1567,America's PPO,America's PPO,1504.7901,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Ct Pelvis W Iv Contrast,,72193,CPT,Facility,Both,,,,1567,1331.95,412.496,1567,BlueCross BlueShield Minnesota, Federal Employee Program,812,,,Fee schedule,,100% of BCBS commercial commodity fee schedule
Ct Pelvis W Iv Contrast,,72193,CPT,Facility,Both,,,,1567,1331.95,412.496,1567,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,824.992,,,Fee schedule,,"100% of BCBS commercial commodity fee schedule, plus MN Care tax"
Ct Pelvis W Iv Contrast,,72193,CPT,Facility,Both,,,,1567,1331.95,412.496,1567,BlueCross BlueShield Minnesota,High Value Network Plan,742.4928,,,Fee schedule,,"90% of BCBS commercial commodity fee schedule, plus MN Care tax; see disclaimer for more information"
Ct Pelvis W Iv Contrast,,72193,CPT,Facility,Outpatient,,,,1567,1331.95,412.496,1567,BlueCross BlueShield Minnesota,Medicare Advantage,767.83,49,,percent of total billed charges,,
Ct Pelvis W Iv Contrast,,72193,CPT,Facility,Inpatient,,,,1567,1331.95,412.496,1567,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Ct Pelvis W Iv Contrast,,72193,CPT,Facility,Both,,,,1567,1331.95,412.496,1567,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,730.6954144,,,Fee schedule,,"88.57% of BCBS commercial commodity fee schedule, plus MN Care tax"
Ct Pelvis W Iv Contrast,,72193,CPT,Facility,Both,,,,1567,1331.95,412.496,1567,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,412.496,,,Fee schedule,,"100% of BCBS Medicaid commodity fee schedule, plus MN Care tax"
Ct Pelvis W Iv Contrast,,72193,CPT,Facility,Outpatient,,,,1567,1331.95,412.496,1567,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),767.83,49,,percent of total billed charges,,
Ct Pelvis W Iv Contrast,,72193,CPT,Facility,Inpatient,,,,1567,1331.95,412.496,1567,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Ct Pelvis W Iv Contrast,,72193,CPT,Facility,Both,,,,1567,1331.95,412.496,1567,CorVel,Worker's Compensation,1567,100,,percent of total billed charges,,
Ct Pelvis W Iv Contrast,,72193,CPT,Facility,Both,,,,1567,1331.95,412.496,1567,First Health Group Corporation,First Health Network,1519.99,97,,percent of total billed charges,,
Ct Pelvis W Iv Contrast,,72193,CPT,Facility,Both,,,,1567,1331.95,412.496,1567,"Health Partners, Inc.",Commercial,1482.382,94.6,,percent of total billed charges,,
Ct Pelvis W Iv Contrast,,72193,CPT,Facility,Outpatient,,,,1567,1331.95,412.496,1567,"Health Partners, Inc.",Medicare Advantage,767.83,49,,percent of total billed charges,,
Ct Pelvis W Iv Contrast,,72193,CPT,Facility,Inpatient,,,,1567,1331.95,412.496,1567,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ct Pelvis W Iv Contrast,,72193,CPT,Facility,Both,,,,1567,1331.95,412.496,1567,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),940.2,60,,percent of total billed charges,,
Ct Pelvis W Iv Contrast,,72193,CPT,Facility,Both,,,,1567,1331.95,412.496,1567,"Health Partners, Inc.",State of Minnesota Advantage Program,1277.105,81.5,,percent of total billed charges,,
Ct Pelvis W Iv Contrast,,72193,CPT,Facility,Both,,,,1567,1331.95,412.496,1567,"Health Partners, Inc.",State Public Programs,783.5,50,,percent of total billed charges,,
Ct Pelvis W Iv Contrast,,72193,CPT,Facility,Both,,,,1567,1331.95,412.496,1567,Humana Insurance Company,Commercial PPO,1488.65,95,,percent of total billed charges,,
Ct Pelvis W Iv Contrast,,72193,CPT,Facility,Outpatient,,,,1567,1331.95,412.496,1567,Humana Insurance Company,Medicare PPO,767.83,49,,percent of total billed charges,,
Ct Pelvis W Iv Contrast,,72193,CPT,Facility,Inpatient,,,,1567,1331.95,412.496,1567,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Ct Pelvis W Iv Contrast,,72193,CPT,Facility,Both,,,,1567,1331.95,412.496,1567,Medica,Individual & Family,1552.897,99.1,,percent of total billed charges,,
Ct Pelvis W Iv Contrast,,72193,CPT,Facility,Outpatient,,,,1567,1331.95,412.496,1567,Medica,Medica Advantage Solution,780.366,49.8,,percent of total billed charges,,
Ct Pelvis W Iv Contrast,,72193,CPT,Facility,Inpatient,,,,1567,1331.95,412.496,1567,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Ct Pelvis W Iv Contrast,,72193,CPT,Facility,Outpatient,,,,1567,1331.95,412.496,1567,Medica,Medical Assistance,698.882,44.6,,percent of total billed charges,,
Ct Pelvis W Iv Contrast,,72193,CPT,Facility,Inpatient,,,,1567,1331.95,412.496,1567,Medica,Medical Assistance,,,,,Included in per diem rate,
Ct Pelvis W Iv Contrast,,72193,CPT,Facility,Outpatient,,,,1567,1331.95,412.496,1567,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,780.366,49.8,,percent of total billed charges,,
Ct Pelvis W Iv Contrast,,72193,CPT,Facility,Inpatient,,,,1567,1331.95,412.496,1567,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Ct Pelvis W Iv Contrast,,72193,CPT,Facility,Both,,,,1567,1331.95,412.496,1567,"Multiplan, Inc.","Multiplan, Inc.",1472.98,94,,percent of total billed charges,,
Ct Pelvis W Iv Contrast,,72193,CPT,Facility,Outpatient,,,,1567,1331.95,412.496,1567,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1283,,,Other,Per scan,
Ct Pelvis W Iv Contrast,,72193,CPT,Facility,Inpatient,,,,1567,1331.95,412.496,1567,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Ct Pelvis W Iv Contrast,,72193,CPT,Facility,Both,,,,1567,1331.95,412.496,1567,"Preferred One Administrative Services, INC.",PPO,1545.062,98.6,,percent of total billed charges,,
Ct Pelvis W Iv Contrast,,72193,CPT,Facility,Outpatient,,,,1567,1331.95,412.496,1567,PrimeWest Health,Minnesota Senior Health Options (MSHO),806.2215,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Ct Pelvis W Iv Contrast,,72193,CPT,Facility,Inpatient,,,,1567,1331.95,412.496,1567,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ct Pelvis W Iv Contrast,,72193,CPT,Facility,Outpatient,,,,1567,1331.95,412.496,1567,PrimeWest Health,MinnesotaCare,804.8112,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Ct Pelvis W Iv Contrast,,72193,CPT,Facility,Inpatient,,,,1567,1331.95,412.496,1567,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Ct Pelvis W Iv Contrast,,72193,CPT,Facility,Both,,,,1567,1331.95,412.496,1567,Sanford Health Plan,Sanford Health Plan,1441.64,92,,percent of total billed charges,,
Ct Pelvis W Iv Contrast,,72193,CPT,Facility,Outpatient,,,,1567,1331.95,412.496,1567,"UCare Health, Inc.",Individual & Family Plan,883.0045,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Ct Pelvis W Iv Contrast,,72193,CPT,Facility,Inpatient,,,,1567,1331.95,412.496,1567,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Ct Pelvis W Iv Contrast,,72193,CPT,Facility,Outpatient,,,,1567,1331.95,412.496,1567,"UCare Health, Inc.",Medical Assistance,790.8649,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ct Pelvis W Iv Contrast,,72193,CPT,Facility,Inpatient,,,,1567,1331.95,412.496,1567,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Ct Pelvis W Iv Contrast,,72193,CPT,Facility,Outpatient,,,,1567,1331.95,412.496,1567,"UCare Health, Inc.",Medicare Advantage,790.8649,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ct Pelvis W Iv Contrast,,72193,CPT,Facility,Inpatient,,,,1567,1331.95,412.496,1567,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ct Pelvis W Iv Contrast,,72193,CPT,Facility,Outpatient,,,,1567,1331.95,412.496,1567,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),790.8649,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ct Pelvis W Iv Contrast,,72193,CPT,Facility,Inpatient,,,,1567,1331.95,412.496,1567,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ct Pelvis W Iv Contrast,,72193,CPT,Facility,Both,,,,1567,1331.95,412.496,1567,UnitedHealthcare,Individual & Family,1472.98,94,,percent of total billed charges,,
Ct Pelvis W Iv Contrast,,72193,CPT,Facility,Outpatient,,,,1567,1331.95,412.496,1567,UnitedHealthcare,Medicare Advantage,767.83,49,,percent of total billed charges,,
Ct Pelvis W Iv Contrast,,72193,CPT,Facility,Inpatient,,,,1567,1331.95,412.496,1567,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Ct Pelvis W Iv Contrast,,72193,CPT,Facility,Outpatient,,,,1567,1331.95,412.496,1567,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,752.16,48,,percent of total billed charges,,100% of DHS outpatient percentage
Ct Pelvis W Iv Contrast,,72193,CPT,Facility,Inpatient,,,,1567,1331.95,412.496,1567,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Ct Pelvis Wo W Iv Contrast,,72194,CPT,Facility,Both,,,,1770,1504.5,412.496,1770,Aetna,Commercial,1628.4,92,,percent of total billed charges,,
Ct Pelvis Wo W Iv Contrast,,72194,CPT,Facility,Outpatient,,,,1770,1504.5,412.496,1770,Aetna,Medicare Advantage,867.3,49,,percent of total billed charges,,
Ct Pelvis Wo W Iv Contrast,,72194,CPT,Facility,Inpatient,,,,1770,1504.5,412.496,1770,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Ct Pelvis Wo W Iv Contrast,,72194,CPT,Facility,Both,,,,1770,1504.5,412.496,1770,Aetna,PPO,1646.1,93,,percent of total billed charges,,
Ct Pelvis Wo W Iv Contrast,,72194,CPT,Facility,Both,,,,1770,1504.5,412.496,1770,America's PPO,America's PPO,1699.731,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Ct Pelvis Wo W Iv Contrast,,72194,CPT,Facility,Both,,,,1770,1504.5,412.496,1770,BlueCross BlueShield Minnesota, Federal Employee Program,812,,,Fee schedule,,100% of BCBS commercial commodity fee schedule
Ct Pelvis Wo W Iv Contrast,,72194,CPT,Facility,Both,,,,1770,1504.5,412.496,1770,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,824.992,,,Fee schedule,,"100% of BCBS commercial commodity fee schedule, plus MN Care tax"
Ct Pelvis Wo W Iv Contrast,,72194,CPT,Facility,Both,,,,1770,1504.5,412.496,1770,BlueCross BlueShield Minnesota,High Value Network Plan,742.4928,,,Fee schedule,,"90% of BCBS commercial commodity fee schedule, plus MN Care tax; see disclaimer for more information"
Ct Pelvis Wo W Iv Contrast,,72194,CPT,Facility,Outpatient,,,,1770,1504.5,412.496,1770,BlueCross BlueShield Minnesota,Medicare Advantage,867.3,49,,percent of total billed charges,,
Ct Pelvis Wo W Iv Contrast,,72194,CPT,Facility,Inpatient,,,,1770,1504.5,412.496,1770,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Ct Pelvis Wo W Iv Contrast,,72194,CPT,Facility,Both,,,,1770,1504.5,412.496,1770,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,730.6954144,,,Fee schedule,,"88.57% of BCBS commercial commodity fee schedule, plus MN Care tax"
Ct Pelvis Wo W Iv Contrast,,72194,CPT,Facility,Both,,,,1770,1504.5,412.496,1770,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,412.496,,,Fee schedule,,"100% of BCBS Medicaid commodity fee schedule, plus MN Care tax"
Ct Pelvis Wo W Iv Contrast,,72194,CPT,Facility,Outpatient,,,,1770,1504.5,412.496,1770,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),867.3,49,,percent of total billed charges,,
Ct Pelvis Wo W Iv Contrast,,72194,CPT,Facility,Inpatient,,,,1770,1504.5,412.496,1770,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Ct Pelvis Wo W Iv Contrast,,72194,CPT,Facility,Both,,,,1770,1504.5,412.496,1770,CorVel,Worker's Compensation,1770,100,,percent of total billed charges,,
Ct Pelvis Wo W Iv Contrast,,72194,CPT,Facility,Both,,,,1770,1504.5,412.496,1770,First Health Group Corporation,First Health Network,1716.9,97,,percent of total billed charges,,
Ct Pelvis Wo W Iv Contrast,,72194,CPT,Facility,Both,,,,1770,1504.5,412.496,1770,"Health Partners, Inc.",Commercial,1674.42,94.6,,percent of total billed charges,,
Ct Pelvis Wo W Iv Contrast,,72194,CPT,Facility,Outpatient,,,,1770,1504.5,412.496,1770,"Health Partners, Inc.",Medicare Advantage,867.3,49,,percent of total billed charges,,
Ct Pelvis Wo W Iv Contrast,,72194,CPT,Facility,Inpatient,,,,1770,1504.5,412.496,1770,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ct Pelvis Wo W Iv Contrast,,72194,CPT,Facility,Both,,,,1770,1504.5,412.496,1770,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1062,60,,percent of total billed charges,,
Ct Pelvis Wo W Iv Contrast,,72194,CPT,Facility,Both,,,,1770,1504.5,412.496,1770,"Health Partners, Inc.",State of Minnesota Advantage Program,1442.55,81.5,,percent of total billed charges,,
Ct Pelvis Wo W Iv Contrast,,72194,CPT,Facility,Both,,,,1770,1504.5,412.496,1770,"Health Partners, Inc.",State Public Programs,885,50,,percent of total billed charges,,
Ct Pelvis Wo W Iv Contrast,,72194,CPT,Facility,Both,,,,1770,1504.5,412.496,1770,Humana Insurance Company,Commercial PPO,1681.5,95,,percent of total billed charges,,
Ct Pelvis Wo W Iv Contrast,,72194,CPT,Facility,Outpatient,,,,1770,1504.5,412.496,1770,Humana Insurance Company,Medicare PPO,867.3,49,,percent of total billed charges,,
Ct Pelvis Wo W Iv Contrast,,72194,CPT,Facility,Inpatient,,,,1770,1504.5,412.496,1770,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Ct Pelvis Wo W Iv Contrast,,72194,CPT,Facility,Both,,,,1770,1504.5,412.496,1770,Medica,Individual & Family,1754.07,99.1,,percent of total billed charges,,
Ct Pelvis Wo W Iv Contrast,,72194,CPT,Facility,Outpatient,,,,1770,1504.5,412.496,1770,Medica,Medica Advantage Solution,881.46,49.8,,percent of total billed charges,,
Ct Pelvis Wo W Iv Contrast,,72194,CPT,Facility,Inpatient,,,,1770,1504.5,412.496,1770,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Ct Pelvis Wo W Iv Contrast,,72194,CPT,Facility,Outpatient,,,,1770,1504.5,412.496,1770,Medica,Medical Assistance,789.42,44.6,,percent of total billed charges,,
Ct Pelvis Wo W Iv Contrast,,72194,CPT,Facility,Inpatient,,,,1770,1504.5,412.496,1770,Medica,Medical Assistance,,,,,Included in per diem rate,
Ct Pelvis Wo W Iv Contrast,,72194,CPT,Facility,Outpatient,,,,1770,1504.5,412.496,1770,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,881.46,49.8,,percent of total billed charges,,
Ct Pelvis Wo W Iv Contrast,,72194,CPT,Facility,Inpatient,,,,1770,1504.5,412.496,1770,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Ct Pelvis Wo W Iv Contrast,,72194,CPT,Facility,Both,,,,1770,1504.5,412.496,1770,"Multiplan, Inc.","Multiplan, Inc.",1663.8,94,,percent of total billed charges,,
Ct Pelvis Wo W Iv Contrast,,72194,CPT,Facility,Outpatient,,,,1770,1504.5,412.496,1770,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1283,,,Other,Per scan,
Ct Pelvis Wo W Iv Contrast,,72194,CPT,Facility,Inpatient,,,,1770,1504.5,412.496,1770,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Ct Pelvis Wo W Iv Contrast,,72194,CPT,Facility,Both,,,,1770,1504.5,412.496,1770,"Preferred One Administrative Services, INC.",PPO,1745.22,98.6,,percent of total billed charges,,
Ct Pelvis Wo W Iv Contrast,,72194,CPT,Facility,Outpatient,,,,1770,1504.5,412.496,1770,PrimeWest Health,Minnesota Senior Health Options (MSHO),910.665,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Ct Pelvis Wo W Iv Contrast,,72194,CPT,Facility,Inpatient,,,,1770,1504.5,412.496,1770,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ct Pelvis Wo W Iv Contrast,,72194,CPT,Facility,Outpatient,,,,1770,1504.5,412.496,1770,PrimeWest Health,MinnesotaCare,909.072,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Ct Pelvis Wo W Iv Contrast,,72194,CPT,Facility,Inpatient,,,,1770,1504.5,412.496,1770,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Ct Pelvis Wo W Iv Contrast,,72194,CPT,Facility,Both,,,,1770,1504.5,412.496,1770,Sanford Health Plan,Sanford Health Plan,1628.4,92,,percent of total billed charges,,
Ct Pelvis Wo W Iv Contrast,,72194,CPT,Facility,Outpatient,,,,1770,1504.5,412.496,1770,"UCare Health, Inc.",Individual & Family Plan,997.395,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Ct Pelvis Wo W Iv Contrast,,72194,CPT,Facility,Inpatient,,,,1770,1504.5,412.496,1770,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Ct Pelvis Wo W Iv Contrast,,72194,CPT,Facility,Outpatient,,,,1770,1504.5,412.496,1770,"UCare Health, Inc.",Medical Assistance,893.319,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ct Pelvis Wo W Iv Contrast,,72194,CPT,Facility,Inpatient,,,,1770,1504.5,412.496,1770,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Ct Pelvis Wo W Iv Contrast,,72194,CPT,Facility,Outpatient,,,,1770,1504.5,412.496,1770,"UCare Health, Inc.",Medicare Advantage,893.319,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ct Pelvis Wo W Iv Contrast,,72194,CPT,Facility,Inpatient,,,,1770,1504.5,412.496,1770,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ct Pelvis Wo W Iv Contrast,,72194,CPT,Facility,Outpatient,,,,1770,1504.5,412.496,1770,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),893.319,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ct Pelvis Wo W Iv Contrast,,72194,CPT,Facility,Inpatient,,,,1770,1504.5,412.496,1770,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ct Pelvis Wo W Iv Contrast,,72194,CPT,Facility,Both,,,,1770,1504.5,412.496,1770,UnitedHealthcare,Individual & Family,1663.8,94,,percent of total billed charges,,
Ct Pelvis Wo W Iv Contrast,,72194,CPT,Facility,Outpatient,,,,1770,1504.5,412.496,1770,UnitedHealthcare,Medicare Advantage,867.3,49,,percent of total billed charges,,
Ct Pelvis Wo W Iv Contrast,,72194,CPT,Facility,Inpatient,,,,1770,1504.5,412.496,1770,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Ct Pelvis Wo W Iv Contrast,,72194,CPT,Facility,Outpatient,,,,1770,1504.5,412.496,1770,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,849.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
Ct Pelvis Wo W Iv Contrast,,72194,CPT,Facility,Inpatient,,,,1770,1504.5,412.496,1770,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Mri Pelvis Routine Wo Contrast,,72195,CPT,Facility,Both,,,,2334,1983.9,533.908,2334,Aetna,Commercial,2147.28,92,,percent of total billed charges,,
Mri Pelvis Routine Wo Contrast,,72195,CPT,Facility,Outpatient,,,,2334,1983.9,533.908,2334,Aetna,Medicare Advantage,1143.66,49,,percent of total billed charges,,
Mri Pelvis Routine Wo Contrast,,72195,CPT,Facility,Inpatient,,,,2334,1983.9,533.908,2334,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Mri Pelvis Routine Wo Contrast,,72195,CPT,Facility,Both,,,,2334,1983.9,533.908,2334,Aetna,PPO,2170.62,93,,percent of total billed charges,,
Mri Pelvis Routine Wo Contrast,,72195,CPT,Facility,Both,,,,2334,1983.9,533.908,2334,America's PPO,America's PPO,2241.3402,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Mri Pelvis Routine Wo Contrast,,72195,CPT,Facility,Both,,,,2334,1983.9,533.908,2334,BlueCross BlueShield Minnesota, Federal Employee Program,1051,,,Fee schedule,,100% of BCBS commercial commodity fee schedule
Mri Pelvis Routine Wo Contrast,,72195,CPT,Facility,Both,,,,2334,1983.9,533.908,2334,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1067.816,,,Fee schedule,,"100% of BCBS commercial commodity fee schedule, plus MN Care tax"
Mri Pelvis Routine Wo Contrast,,72195,CPT,Facility,Both,,,,2334,1983.9,533.908,2334,BlueCross BlueShield Minnesota,High Value Network Plan,961.0344,,,Fee schedule,,"90% of BCBS commercial commodity fee schedule, plus MN Care tax; see disclaimer for more information"
Mri Pelvis Routine Wo Contrast,,72195,CPT,Facility,Outpatient,,,,2334,1983.9,533.908,2334,BlueCross BlueShield Minnesota,Medicare Advantage,1143.66,49,,percent of total billed charges,,
Mri Pelvis Routine Wo Contrast,,72195,CPT,Facility,Inpatient,,,,2334,1983.9,533.908,2334,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Mri Pelvis Routine Wo Contrast,,72195,CPT,Facility,Both,,,,2334,1983.9,533.908,2334,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,945.7646312,,,Fee schedule,,"88.57% of BCBS commercial commodity fee schedule, plus MN Care tax"
Mri Pelvis Routine Wo Contrast,,72195,CPT,Facility,Both,,,,2334,1983.9,533.908,2334,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,533.908,,,Fee schedule,,"100% of BCBS Medicaid commodity fee schedule, plus MN Care tax"
Mri Pelvis Routine Wo Contrast,,72195,CPT,Facility,Outpatient,,,,2334,1983.9,533.908,2334,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1143.66,49,,percent of total billed charges,,
Mri Pelvis Routine Wo Contrast,,72195,CPT,Facility,Inpatient,,,,2334,1983.9,533.908,2334,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Mri Pelvis Routine Wo Contrast,,72195,CPT,Facility,Both,,,,2334,1983.9,533.908,2334,CorVel,Worker's Compensation,2334,100,,percent of total billed charges,,
Mri Pelvis Routine Wo Contrast,,72195,CPT,Facility,Both,,,,2334,1983.9,533.908,2334,First Health Group Corporation,First Health Network,2263.98,97,,percent of total billed charges,,
Mri Pelvis Routine Wo Contrast,,72195,CPT,Facility,Both,,,,2334,1983.9,533.908,2334,"Health Partners, Inc.",Commercial,2207.964,94.6,,percent of total billed charges,,
Mri Pelvis Routine Wo Contrast,,72195,CPT,Facility,Outpatient,,,,2334,1983.9,533.908,2334,"Health Partners, Inc.",Medicare Advantage,1143.66,49,,percent of total billed charges,,
Mri Pelvis Routine Wo Contrast,,72195,CPT,Facility,Inpatient,,,,2334,1983.9,533.908,2334,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mri Pelvis Routine Wo Contrast,,72195,CPT,Facility,Both,,,,2334,1983.9,533.908,2334,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1400.4,60,,percent of total billed charges,,
Mri Pelvis Routine Wo Contrast,,72195,CPT,Facility,Both,,,,2334,1983.9,533.908,2334,"Health Partners, Inc.",State of Minnesota Advantage Program,1902.21,81.5,,percent of total billed charges,,
Mri Pelvis Routine Wo Contrast,,72195,CPT,Facility,Both,,,,2334,1983.9,533.908,2334,"Health Partners, Inc.",State Public Programs,1167,50,,percent of total billed charges,,
Mri Pelvis Routine Wo Contrast,,72195,CPT,Facility,Both,,,,2334,1983.9,533.908,2334,Humana Insurance Company,Commercial PPO,2217.3,95,,percent of total billed charges,,
Mri Pelvis Routine Wo Contrast,,72195,CPT,Facility,Outpatient,,,,2334,1983.9,533.908,2334,Humana Insurance Company,Medicare PPO,1143.66,49,,percent of total billed charges,,
Mri Pelvis Routine Wo Contrast,,72195,CPT,Facility,Inpatient,,,,2334,1983.9,533.908,2334,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Mri Pelvis Routine Wo Contrast,,72195,CPT,Facility,Both,,,,2334,1983.9,533.908,2334,Medica,Individual & Family,2312.994,99.1,,percent of total billed charges,,
Mri Pelvis Routine Wo Contrast,,72195,CPT,Facility,Outpatient,,,,2334,1983.9,533.908,2334,Medica,Medica Advantage Solution,1162.332,49.8,,percent of total billed charges,,
Mri Pelvis Routine Wo Contrast,,72195,CPT,Facility,Inpatient,,,,2334,1983.9,533.908,2334,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Mri Pelvis Routine Wo Contrast,,72195,CPT,Facility,Outpatient,,,,2334,1983.9,533.908,2334,Medica,Medical Assistance,747,,,Other ,per vist,Pays in addition to all Outpatient Service Categories
Mri Pelvis Routine Wo Contrast,,72195,CPT,Facility,Inpatient,,,,2334,1983.9,533.908,2334,Medica,Medical Assistance,,,,,Included in per diem rate,
Mri Pelvis Routine Wo Contrast,,72195,CPT,Facility,Outpatient,,,,2334,1983.9,533.908,2334,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1162.332,49.8,,percent of total billed charges,,
Mri Pelvis Routine Wo Contrast,,72195,CPT,Facility,Inpatient,,,,2334,1983.9,533.908,2334,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Mri Pelvis Routine Wo Contrast,,72195,CPT,Facility,Both,,,,2334,1983.9,533.908,2334,"Multiplan, Inc.","Multiplan, Inc.",2193.96,94,,percent of total billed charges,,
Mri Pelvis Routine Wo Contrast,,72195,CPT,Facility,Outpatient,,,,2334,1983.9,533.908,2334,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1535,,,Other ,per scan,
Mri Pelvis Routine Wo Contrast,,72195,CPT,Facility,Inpatient,,,,2334,1983.9,533.908,2334,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Mri Pelvis Routine Wo Contrast,,72195,CPT,Facility,Both,,,,2334,1983.9,533.908,2334,"Preferred One Administrative Services, INC.",PPO,2301.324,98.6,,percent of total billed charges,,
Mri Pelvis Routine Wo Contrast,,72195,CPT,Facility,Outpatient,,,,2334,1983.9,533.908,2334,PrimeWest Health,Minnesota Senior Health Options (MSHO),1200.843,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Mri Pelvis Routine Wo Contrast,,72195,CPT,Facility,Inpatient,,,,2334,1983.9,533.908,2334,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mri Pelvis Routine Wo Contrast,,72195,CPT,Facility,Outpatient,,,,2334,1983.9,533.908,2334,PrimeWest Health,MinnesotaCare,1198.7424,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Mri Pelvis Routine Wo Contrast,,72195,CPT,Facility,Inpatient,,,,2334,1983.9,533.908,2334,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Mri Pelvis Routine Wo Contrast,,72195,CPT,Facility,Both,,,,2334,1983.9,533.908,2334,Sanford Health Plan,Sanford Health Plan,2147.28,92,,percent of total billed charges,,
Mri Pelvis Routine Wo Contrast,,72195,CPT,Facility,Outpatient,,,,2334,1983.9,533.908,2334,"UCare Health, Inc.",Individual & Family Plan,1315.209,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Mri Pelvis Routine Wo Contrast,,72195,CPT,Facility,Inpatient,,,,2334,1983.9,533.908,2334,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Mri Pelvis Routine Wo Contrast,,72195,CPT,Facility,Outpatient,,,,2334,1983.9,533.908,2334,"UCare Health, Inc.",Medical Assistance,1177.9698,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mri Pelvis Routine Wo Contrast,,72195,CPT,Facility,Inpatient,,,,2334,1983.9,533.908,2334,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Mri Pelvis Routine Wo Contrast,,72195,CPT,Facility,Outpatient,,,,2334,1983.9,533.908,2334,"UCare Health, Inc.",Medicare Advantage,1177.9698,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mri Pelvis Routine Wo Contrast,,72195,CPT,Facility,Inpatient,,,,2334,1983.9,533.908,2334,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mri Pelvis Routine Wo Contrast,,72195,CPT,Facility,Outpatient,,,,2334,1983.9,533.908,2334,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1177.9698,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mri Pelvis Routine Wo Contrast,,72195,CPT,Facility,Inpatient,,,,2334,1983.9,533.908,2334,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mri Pelvis Routine Wo Contrast,,72195,CPT,Facility,Both,,,,2334,1983.9,533.908,2334,UnitedHealthcare,Individual & Family,2193.96,94,,percent of total billed charges,,
Mri Pelvis Routine Wo Contrast,,72195,CPT,Facility,Outpatient,,,,2334,1983.9,533.908,2334,UnitedHealthcare,Medicare Advantage,1143.66,49,,percent of total billed charges,,
Mri Pelvis Routine Wo Contrast,,72195,CPT,Facility,Inpatient,,,,2334,1983.9,533.908,2334,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Mri Pelvis Routine Wo Contrast,,72195,CPT,Facility,Outpatient,,,,2334,1983.9,533.908,2334,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1120.32,48,,percent of total billed charges,,100% of DHS outpatient percentage
Mri Pelvis Routine Wo Contrast,,72195,CPT,Facility,Inpatient,,,,2334,1983.9,533.908,2334,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Mri Pelvis W Contrast,,72196,CPT,Facility,Both,,,,2468,2097.8,561.34,2468,Aetna,Commercial,2270.56,92,,percent of total billed charges,,
Mri Pelvis W Contrast,,72196,CPT,Facility,Outpatient,,,,2468,2097.8,561.34,2468,Aetna,Medicare Advantage,1209.32,49,,percent of total billed charges,,
Mri Pelvis W Contrast,,72196,CPT,Facility,Inpatient,,,,2468,2097.8,561.34,2468,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Mri Pelvis W Contrast,,72196,CPT,Facility,Both,,,,2468,2097.8,561.34,2468,Aetna,PPO,2295.24,93,,percent of total billed charges,,
Mri Pelvis W Contrast,,72196,CPT,Facility,Both,,,,2468,2097.8,561.34,2468,America's PPO,America's PPO,2370.0204,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Mri Pelvis W Contrast,,72196,CPT,Facility,Both,,,,2468,2097.8,561.34,2468,BlueCross BlueShield Minnesota, Federal Employee Program,1105,,,Fee schedule,,100% of BCBS commercial commodity fee schedule
Mri Pelvis W Contrast,,72196,CPT,Facility,Both,,,,2468,2097.8,561.34,2468,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1122.68,,,Fee schedule,,"100% of BCBS commercial commodity fee schedule, plus MN Care tax"
Mri Pelvis W Contrast,,72196,CPT,Facility,Both,,,,2468,2097.8,561.34,2468,BlueCross BlueShield Minnesota,High Value Network Plan,1010.412,,,Fee schedule,,"90% of BCBS commercial commodity fee schedule, plus MN Care tax; see disclaimer for more information"
Mri Pelvis W Contrast,,72196,CPT,Facility,Outpatient,,,,2468,2097.8,561.34,2468,BlueCross BlueShield Minnesota,Medicare Advantage,1209.32,49,,percent of total billed charges,,
Mri Pelvis W Contrast,,72196,CPT,Facility,Inpatient,,,,2468,2097.8,561.34,2468,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Mri Pelvis W Contrast,,72196,CPT,Facility,Both,,,,2468,2097.8,561.34,2468,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,994.357676,,,Fee schedule,,"88.57% of BCBS commercial commodity fee schedule, plus MN Care tax"
Mri Pelvis W Contrast,,72196,CPT,Facility,Both,,,,2468,2097.8,561.34,2468,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,561.34,,,Fee schedule,,"100% of BCBS Medicaid commodity fee schedule, plus MN Care tax"
Mri Pelvis W Contrast,,72196,CPT,Facility,Outpatient,,,,2468,2097.8,561.34,2468,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1209.32,49,,percent of total billed charges,,
Mri Pelvis W Contrast,,72196,CPT,Facility,Inpatient,,,,2468,2097.8,561.34,2468,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Mri Pelvis W Contrast,,72196,CPT,Facility,Both,,,,2468,2097.8,561.34,2468,CorVel,Worker's Compensation,2468,100,,percent of total billed charges,,
Mri Pelvis W Contrast,,72196,CPT,Facility,Both,,,,2468,2097.8,561.34,2468,First Health Group Corporation,First Health Network,2393.96,97,,percent of total billed charges,,
Mri Pelvis W Contrast,,72196,CPT,Facility,Both,,,,2468,2097.8,561.34,2468,"Health Partners, Inc.",Commercial,2334.728,94.6,,percent of total billed charges,,
Mri Pelvis W Contrast,,72196,CPT,Facility,Outpatient,,,,2468,2097.8,561.34,2468,"Health Partners, Inc.",Medicare Advantage,1209.32,49,,percent of total billed charges,,
Mri Pelvis W Contrast,,72196,CPT,Facility,Inpatient,,,,2468,2097.8,561.34,2468,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mri Pelvis W Contrast,,72196,CPT,Facility,Both,,,,2468,2097.8,561.34,2468,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1480.8,60,,percent of total billed charges,,
Mri Pelvis W Contrast,,72196,CPT,Facility,Both,,,,2468,2097.8,561.34,2468,"Health Partners, Inc.",State of Minnesota Advantage Program,2011.42,81.5,,percent of total billed charges,,
Mri Pelvis W Contrast,,72196,CPT,Facility,Both,,,,2468,2097.8,561.34,2468,"Health Partners, Inc.",State Public Programs,1234,50,,percent of total billed charges,,
Mri Pelvis W Contrast,,72196,CPT,Facility,Both,,,,2468,2097.8,561.34,2468,Humana Insurance Company,Commercial PPO,2344.6,95,,percent of total billed charges,,
Mri Pelvis W Contrast,,72196,CPT,Facility,Outpatient,,,,2468,2097.8,561.34,2468,Humana Insurance Company,Medicare PPO,1209.32,49,,percent of total billed charges,,
Mri Pelvis W Contrast,,72196,CPT,Facility,Inpatient,,,,2468,2097.8,561.34,2468,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Mri Pelvis W Contrast,,72196,CPT,Facility,Both,,,,2468,2097.8,561.34,2468,Medica,Individual & Family,2445.788,99.1,,percent of total billed charges,,
Mri Pelvis W Contrast,,72196,CPT,Facility,Outpatient,,,,2468,2097.8,561.34,2468,Medica,Medica Advantage Solution,1229.064,49.8,,percent of total billed charges,,
Mri Pelvis W Contrast,,72196,CPT,Facility,Inpatient,,,,2468,2097.8,561.34,2468,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Mri Pelvis W Contrast,,72196,CPT,Facility,Outpatient,,,,2468,2097.8,561.34,2468,Medica,Medical Assistance,747,,,Other ,per vist,Pays in addition to all Outpatient Service Categories
Mri Pelvis W Contrast,,72196,CPT,Facility,Inpatient,,,,2468,2097.8,561.34,2468,Medica,Medical Assistance,,,,,Included in per diem rate,
Mri Pelvis W Contrast,,72196,CPT,Facility,Outpatient,,,,2468,2097.8,561.34,2468,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1229.064,49.8,,percent of total billed charges,,
Mri Pelvis W Contrast,,72196,CPT,Facility,Inpatient,,,,2468,2097.8,561.34,2468,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Mri Pelvis W Contrast,,72196,CPT,Facility,Both,,,,2468,2097.8,561.34,2468,"Multiplan, Inc.","Multiplan, Inc.",2319.92,94,,percent of total billed charges,,
Mri Pelvis W Contrast,,72196,CPT,Facility,Outpatient,,,,2468,2097.8,561.34,2468,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1535,,,Other ,per scan,
Mri Pelvis W Contrast,,72196,CPT,Facility,Inpatient,,,,2468,2097.8,561.34,2468,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Mri Pelvis W Contrast,,72196,CPT,Facility,Both,,,,2468,2097.8,561.34,2468,"Preferred One Administrative Services, INC.",PPO,2433.448,98.6,,percent of total billed charges,,
Mri Pelvis W Contrast,,72196,CPT,Facility,Outpatient,,,,2468,2097.8,561.34,2468,PrimeWest Health,Minnesota Senior Health Options (MSHO),1269.786,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Mri Pelvis W Contrast,,72196,CPT,Facility,Inpatient,,,,2468,2097.8,561.34,2468,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mri Pelvis W Contrast,,72196,CPT,Facility,Outpatient,,,,2468,2097.8,561.34,2468,PrimeWest Health,MinnesotaCare,1267.5648,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Mri Pelvis W Contrast,,72196,CPT,Facility,Inpatient,,,,2468,2097.8,561.34,2468,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Mri Pelvis W Contrast,,72196,CPT,Facility,Both,,,,2468,2097.8,561.34,2468,Sanford Health Plan,Sanford Health Plan,2270.56,92,,percent of total billed charges,,
Mri Pelvis W Contrast,,72196,CPT,Facility,Outpatient,,,,2468,2097.8,561.34,2468,"UCare Health, Inc.",Individual & Family Plan,1390.718,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Mri Pelvis W Contrast,,72196,CPT,Facility,Inpatient,,,,2468,2097.8,561.34,2468,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Mri Pelvis W Contrast,,72196,CPT,Facility,Outpatient,,,,2468,2097.8,561.34,2468,"UCare Health, Inc.",Medical Assistance,1245.5996,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mri Pelvis W Contrast,,72196,CPT,Facility,Inpatient,,,,2468,2097.8,561.34,2468,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Mri Pelvis W Contrast,,72196,CPT,Facility,Outpatient,,,,2468,2097.8,561.34,2468,"UCare Health, Inc.",Medicare Advantage,1245.5996,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mri Pelvis W Contrast,,72196,CPT,Facility,Inpatient,,,,2468,2097.8,561.34,2468,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mri Pelvis W Contrast,,72196,CPT,Facility,Outpatient,,,,2468,2097.8,561.34,2468,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1245.5996,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mri Pelvis W Contrast,,72196,CPT,Facility,Inpatient,,,,2468,2097.8,561.34,2468,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mri Pelvis W Contrast,,72196,CPT,Facility,Both,,,,2468,2097.8,561.34,2468,UnitedHealthcare,Individual & Family,2319.92,94,,percent of total billed charges,,
Mri Pelvis W Contrast,,72196,CPT,Facility,Outpatient,,,,2468,2097.8,561.34,2468,UnitedHealthcare,Medicare Advantage,1209.32,49,,percent of total billed charges,,
Mri Pelvis W Contrast,,72196,CPT,Facility,Inpatient,,,,2468,2097.8,561.34,2468,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Mri Pelvis W Contrast,,72196,CPT,Facility,Outpatient,,,,2468,2097.8,561.34,2468,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1184.64,48,,percent of total billed charges,,100% of DHS outpatient percentage
Mri Pelvis W Contrast,,72196,CPT,Facility,Inpatient,,,,2468,2097.8,561.34,2468,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Mri Pelvis Wo W Contrast,,72197,CPT,Facility,Both,,,,2651,2253.35,561.34,2651,Aetna,Commercial,2438.92,92,,percent of total billed charges,,
Mri Pelvis Wo W Contrast,,72197,CPT,Facility,Outpatient,,,,2651,2253.35,561.34,2651,Aetna,Medicare Advantage,1298.99,49,,percent of total billed charges,,
Mri Pelvis Wo W Contrast,,72197,CPT,Facility,Inpatient,,,,2651,2253.35,561.34,2651,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Mri Pelvis Wo W Contrast,,72197,CPT,Facility,Both,,,,2651,2253.35,561.34,2651,Aetna,PPO,2465.43,93,,percent of total billed charges,,
Mri Pelvis Wo W Contrast,,72197,CPT,Facility,Both,,,,2651,2253.35,561.34,2651,America's PPO,America's PPO,2545.7553,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Mri Pelvis Wo W Contrast,,72197,CPT,Facility,Both,,,,2651,2253.35,561.34,2651,BlueCross BlueShield Minnesota, Federal Employee Program,1105,,,Fee schedule,,100% of BCBS commercial commodity fee schedule
Mri Pelvis Wo W Contrast,,72197,CPT,Facility,Both,,,,2651,2253.35,561.34,2651,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1122.68,,,Fee schedule,,"100% of BCBS commercial commodity fee schedule, plus MN Care tax"
Mri Pelvis Wo W Contrast,,72197,CPT,Facility,Both,,,,2651,2253.35,561.34,2651,BlueCross BlueShield Minnesota,High Value Network Plan,1010.412,,,Fee schedule,,"90% of BCBS commercial commodity fee schedule, plus MN Care tax; see disclaimer for more information"
Mri Pelvis Wo W Contrast,,72197,CPT,Facility,Outpatient,,,,2651,2253.35,561.34,2651,BlueCross BlueShield Minnesota,Medicare Advantage,1298.99,49,,percent of total billed charges,,
Mri Pelvis Wo W Contrast,,72197,CPT,Facility,Inpatient,,,,2651,2253.35,561.34,2651,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Mri Pelvis Wo W Contrast,,72197,CPT,Facility,Both,,,,2651,2253.35,561.34,2651,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,994.357676,,,Fee schedule,,"88.57% of BCBS commercial commodity fee schedule, plus MN Care tax"
Mri Pelvis Wo W Contrast,,72197,CPT,Facility,Both,,,,2651,2253.35,561.34,2651,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,561.34,,,Fee schedule,,"100% of BCBS Medicaid commodity fee schedule, plus MN Care tax"
Mri Pelvis Wo W Contrast,,72197,CPT,Facility,Outpatient,,,,2651,2253.35,561.34,2651,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1298.99,49,,percent of total billed charges,,
Mri Pelvis Wo W Contrast,,72197,CPT,Facility,Inpatient,,,,2651,2253.35,561.34,2651,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Mri Pelvis Wo W Contrast,,72197,CPT,Facility,Both,,,,2651,2253.35,561.34,2651,CorVel,Worker's Compensation,2651,100,,percent of total billed charges,,
Mri Pelvis Wo W Contrast,,72197,CPT,Facility,Both,,,,2651,2253.35,561.34,2651,First Health Group Corporation,First Health Network,2571.47,97,,percent of total billed charges,,
Mri Pelvis Wo W Contrast,,72197,CPT,Facility,Both,,,,2651,2253.35,561.34,2651,"Health Partners, Inc.",Commercial,2507.846,94.6,,percent of total billed charges,,
Mri Pelvis Wo W Contrast,,72197,CPT,Facility,Outpatient,,,,2651,2253.35,561.34,2651,"Health Partners, Inc.",Medicare Advantage,1298.99,49,,percent of total billed charges,,
Mri Pelvis Wo W Contrast,,72197,CPT,Facility,Inpatient,,,,2651,2253.35,561.34,2651,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mri Pelvis Wo W Contrast,,72197,CPT,Facility,Both,,,,2651,2253.35,561.34,2651,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1590.6,60,,percent of total billed charges,,
Mri Pelvis Wo W Contrast,,72197,CPT,Facility,Both,,,,2651,2253.35,561.34,2651,"Health Partners, Inc.",State of Minnesota Advantage Program,2160.565,81.5,,percent of total billed charges,,
Mri Pelvis Wo W Contrast,,72197,CPT,Facility,Both,,,,2651,2253.35,561.34,2651,"Health Partners, Inc.",State Public Programs,1325.5,50,,percent of total billed charges,,
Mri Pelvis Wo W Contrast,,72197,CPT,Facility,Both,,,,2651,2253.35,561.34,2651,Humana Insurance Company,Commercial PPO,2518.45,95,,percent of total billed charges,,
Mri Pelvis Wo W Contrast,,72197,CPT,Facility,Outpatient,,,,2651,2253.35,561.34,2651,Humana Insurance Company,Medicare PPO,1298.99,49,,percent of total billed charges,,
Mri Pelvis Wo W Contrast,,72197,CPT,Facility,Inpatient,,,,2651,2253.35,561.34,2651,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Mri Pelvis Wo W Contrast,,72197,CPT,Facility,Both,,,,2651,2253.35,561.34,2651,Medica,Individual & Family,2627.141,99.1,,percent of total billed charges,,
Mri Pelvis Wo W Contrast,,72197,CPT,Facility,Outpatient,,,,2651,2253.35,561.34,2651,Medica,Medica Advantage Solution,1320.198,49.8,,percent of total billed charges,,
Mri Pelvis Wo W Contrast,,72197,CPT,Facility,Inpatient,,,,2651,2253.35,561.34,2651,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Mri Pelvis Wo W Contrast,,72197,CPT,Facility,Outpatient,,,,2651,2253.35,561.34,2651,Medica,Medical Assistance,747,,,Other ,per vist,Pays in addition to all Outpatient Service Categories
Mri Pelvis Wo W Contrast,,72197,CPT,Facility,Inpatient,,,,2651,2253.35,561.34,2651,Medica,Medical Assistance,,,,,Included in per diem rate,
Mri Pelvis Wo W Contrast,,72197,CPT,Facility,Outpatient,,,,2651,2253.35,561.34,2651,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1320.198,49.8,,percent of total billed charges,,
Mri Pelvis Wo W Contrast,,72197,CPT,Facility,Inpatient,,,,2651,2253.35,561.34,2651,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Mri Pelvis Wo W Contrast,,72197,CPT,Facility,Both,,,,2651,2253.35,561.34,2651,"Multiplan, Inc.","Multiplan, Inc.",2491.94,94,,percent of total billed charges,,
Mri Pelvis Wo W Contrast,,72197,CPT,Facility,Outpatient,,,,2651,2253.35,561.34,2651,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1535,,,Other ,per scan,
Mri Pelvis Wo W Contrast,,72197,CPT,Facility,Inpatient,,,,2651,2253.35,561.34,2651,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Mri Pelvis Wo W Contrast,,72197,CPT,Facility,Both,,,,2651,2253.35,561.34,2651,"Preferred One Administrative Services, INC.",PPO,2613.886,98.6,,percent of total billed charges,,
Mri Pelvis Wo W Contrast,,72197,CPT,Facility,Outpatient,,,,2651,2253.35,561.34,2651,PrimeWest Health,Minnesota Senior Health Options (MSHO),1363.9395,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Mri Pelvis Wo W Contrast,,72197,CPT,Facility,Inpatient,,,,2651,2253.35,561.34,2651,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mri Pelvis Wo W Contrast,,72197,CPT,Facility,Outpatient,,,,2651,2253.35,561.34,2651,PrimeWest Health,MinnesotaCare,1361.5536,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Mri Pelvis Wo W Contrast,,72197,CPT,Facility,Inpatient,,,,2651,2253.35,561.34,2651,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Mri Pelvis Wo W Contrast,,72197,CPT,Facility,Both,,,,2651,2253.35,561.34,2651,Sanford Health Plan,Sanford Health Plan,2438.92,92,,percent of total billed charges,,
Mri Pelvis Wo W Contrast,,72197,CPT,Facility,Outpatient,,,,2651,2253.35,561.34,2651,"UCare Health, Inc.",Individual & Family Plan,1493.8385,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Mri Pelvis Wo W Contrast,,72197,CPT,Facility,Inpatient,,,,2651,2253.35,561.34,2651,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Mri Pelvis Wo W Contrast,,72197,CPT,Facility,Outpatient,,,,2651,2253.35,561.34,2651,"UCare Health, Inc.",Medical Assistance,1337.9597,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mri Pelvis Wo W Contrast,,72197,CPT,Facility,Inpatient,,,,2651,2253.35,561.34,2651,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Mri Pelvis Wo W Contrast,,72197,CPT,Facility,Outpatient,,,,2651,2253.35,561.34,2651,"UCare Health, Inc.",Medicare Advantage,1337.9597,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mri Pelvis Wo W Contrast,,72197,CPT,Facility,Inpatient,,,,2651,2253.35,561.34,2651,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mri Pelvis Wo W Contrast,,72197,CPT,Facility,Outpatient,,,,2651,2253.35,561.34,2651,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1337.9597,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mri Pelvis Wo W Contrast,,72197,CPT,Facility,Inpatient,,,,2651,2253.35,561.34,2651,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mri Pelvis Wo W Contrast,,72197,CPT,Facility,Both,,,,2651,2253.35,561.34,2651,UnitedHealthcare,Individual & Family,2491.94,94,,percent of total billed charges,,
Mri Pelvis Wo W Contrast,,72197,CPT,Facility,Outpatient,,,,2651,2253.35,561.34,2651,UnitedHealthcare,Medicare Advantage,1298.99,49,,percent of total billed charges,,
Mri Pelvis Wo W Contrast,,72197,CPT,Facility,Inpatient,,,,2651,2253.35,561.34,2651,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Mri Pelvis Wo W Contrast,,72197,CPT,Facility,Outpatient,,,,2651,2253.35,561.34,2651,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1272.48,48,,percent of total billed charges,,100% of DHS outpatient percentage
Mri Pelvis Wo W Contrast,,72197,CPT,Facility,Inpatient,,,,2651,2253.35,561.34,2651,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Xr Si Joints Less Than 3 Views,,72200,CPT,Facility,Both,,,,235,199.75,67.351,235,Aetna,Commercial,216.2,92,,percent of total billed charges,,
Xr Si Joints Less Than 3 Views,,72200,CPT,Facility,Outpatient,,,,235,199.75,67.351,235,Aetna,Medicare Advantage,115.15,49,,percent of total billed charges,,
Xr Si Joints Less Than 3 Views,,72200,CPT,Facility,Inpatient,,,,235,199.75,67.351,235,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Xr Si Joints Less Than 3 Views,,72200,CPT,Facility,Both,,,,235,199.75,67.351,235,Aetna,PPO,218.55,93,,percent of total billed charges,,
Xr Si Joints Less Than 3 Views,,72200,CPT,Facility,Both,,,,235,199.75,67.351,235,America's PPO,America's PPO,225.6705,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Xr Si Joints Less Than 3 Views,,72200,CPT,Facility,Both,,,,235,199.75,67.351,235,BlueCross BlueShield Minnesota, Federal Employee Program,231.24,98.4,,percent of total billed charges,,
Xr Si Joints Less Than 3 Views,,72200,CPT,Facility,Both,,,,235,199.75,67.351,235,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,235,100,,percent of total billed charges,,
Xr Si Joints Less Than 3 Views,,72200,CPT,Facility,Both,,,,235,199.75,67.351,235,BlueCross BlueShield Minnesota,High Value Network Plan,211.5,90,,percent of total billed charges,,
Xr Si Joints Less Than 3 Views,,72200,CPT,Facility,Outpatient,,,,235,199.75,67.351,235,BlueCross BlueShield Minnesota,Medicare Advantage,115.15,49,,percent of total billed charges,,
Xr Si Joints Less Than 3 Views,,72200,CPT,Facility,Inpatient,,,,235,199.75,67.351,235,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Xr Si Joints Less Than 3 Views,,72200,CPT,Facility,Both,,,,235,199.75,67.351,235,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,208.1395,88.57,,percent of total billed charges,,
Xr Si Joints Less Than 3 Views,,72200,CPT,Facility,Both,,,,235,199.75,67.351,235,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,67.351,28.66,,percent of total billed charges,,
Xr Si Joints Less Than 3 Views,,72200,CPT,Facility,Outpatient,,,,235,199.75,67.351,235,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),115.15,49,,percent of total billed charges,,
Xr Si Joints Less Than 3 Views,,72200,CPT,Facility,Inpatient,,,,235,199.75,67.351,235,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Xr Si Joints Less Than 3 Views,,72200,CPT,Facility,Both,,,,235,199.75,67.351,235,CorVel,Worker's Compensation,235,100,,percent of total billed charges,,
Xr Si Joints Less Than 3 Views,,72200,CPT,Facility,Both,,,,235,199.75,67.351,235,First Health Group Corporation,First Health Network,227.95,97,,percent of total billed charges,,
Xr Si Joints Less Than 3 Views,,72200,CPT,Facility,Both,,,,235,199.75,67.351,235,"Health Partners, Inc.",Commercial,222.31,94.6,,percent of total billed charges,,
Xr Si Joints Less Than 3 Views,,72200,CPT,Facility,Outpatient,,,,235,199.75,67.351,235,"Health Partners, Inc.",Medicare Advantage,115.15,49,,percent of total billed charges,,
Xr Si Joints Less Than 3 Views,,72200,CPT,Facility,Inpatient,,,,235,199.75,67.351,235,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Si Joints Less Than 3 Views,,72200,CPT,Facility,Both,,,,235,199.75,67.351,235,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),141,60,,percent of total billed charges,,
Xr Si Joints Less Than 3 Views,,72200,CPT,Facility,Both,,,,235,199.75,67.351,235,"Health Partners, Inc.",State of Minnesota Advantage Program,191.525,81.5,,percent of total billed charges,,
Xr Si Joints Less Than 3 Views,,72200,CPT,Facility,Both,,,,235,199.75,67.351,235,"Health Partners, Inc.",State Public Programs,117.5,50,,percent of total billed charges,,
Xr Si Joints Less Than 3 Views,,72200,CPT,Facility,Both,,,,235,199.75,67.351,235,Humana Insurance Company,Commercial PPO,223.25,95,,percent of total billed charges,,
Xr Si Joints Less Than 3 Views,,72200,CPT,Facility,Outpatient,,,,235,199.75,67.351,235,Humana Insurance Company,Medicare PPO,115.15,49,,percent of total billed charges,,
Xr Si Joints Less Than 3 Views,,72200,CPT,Facility,Inpatient,,,,235,199.75,67.351,235,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Xr Si Joints Less Than 3 Views,,72200,CPT,Facility,Both,,,,235,199.75,67.351,235,Medica,Individual & Family,232.885,99.1,,percent of total billed charges,,
Xr Si Joints Less Than 3 Views,,72200,CPT,Facility,Outpatient,,,,235,199.75,67.351,235,Medica,Medica Advantage Solution,117.03,49.8,,percent of total billed charges,,
Xr Si Joints Less Than 3 Views,,72200,CPT,Facility,Inpatient,,,,235,199.75,67.351,235,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Xr Si Joints Less Than 3 Views,,72200,CPT,Facility,Outpatient,,,,235,199.75,67.351,235,Medica,Medical Assistance,104.81,44.6,,percent of total billed charges,,
Xr Si Joints Less Than 3 Views,,72200,CPT,Facility,Inpatient,,,,235,199.75,67.351,235,Medica,Medical Assistance,,,,,Included in per diem rate,
Xr Si Joints Less Than 3 Views,,72200,CPT,Facility,Outpatient,,,,235,199.75,67.351,235,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,117.03,49.8,,percent of total billed charges,,
Xr Si Joints Less Than 3 Views,,72200,CPT,Facility,Inpatient,,,,235,199.75,67.351,235,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Xr Si Joints Less Than 3 Views,,72200,CPT,Facility,Both,,,,235,199.75,67.351,235,"Multiplan, Inc.","Multiplan, Inc.",220.9,94,,percent of total billed charges,,
Xr Si Joints Less Than 3 Views,,72200,CPT,Facility,Outpatient,,,,235,199.75,67.351,235,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,211.735,90.1,,percent of total billed charges,,
Xr Si Joints Less Than 3 Views,,72200,CPT,Facility,Inpatient,,,,235,199.75,67.351,235,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Xr Si Joints Less Than 3 Views,,72200,CPT,Facility,Both,,,,235,199.75,67.351,235,"Preferred One Administrative Services, INC.",PPO,231.71,98.6,,percent of total billed charges,,
Xr Si Joints Less Than 3 Views,,72200,CPT,Facility,Outpatient,,,,235,199.75,67.351,235,PrimeWest Health,Minnesota Senior Health Options (MSHO),120.9075,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Xr Si Joints Less Than 3 Views,,72200,CPT,Facility,Inpatient,,,,235,199.75,67.351,235,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Si Joints Less Than 3 Views,,72200,CPT,Facility,Outpatient,,,,235,199.75,67.351,235,PrimeWest Health,MinnesotaCare,120.696,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Xr Si Joints Less Than 3 Views,,72200,CPT,Facility,Inpatient,,,,235,199.75,67.351,235,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Xr Si Joints Less Than 3 Views,,72200,CPT,Facility,Both,,,,235,199.75,67.351,235,Sanford Health Plan,Sanford Health Plan,216.2,92,,percent of total billed charges,,
Xr Si Joints Less Than 3 Views,,72200,CPT,Facility,Outpatient,,,,235,199.75,67.351,235,"UCare Health, Inc.",Individual & Family Plan,132.4225,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Xr Si Joints Less Than 3 Views,,72200,CPT,Facility,Inpatient,,,,235,199.75,67.351,235,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Xr Si Joints Less Than 3 Views,,72200,CPT,Facility,Outpatient,,,,235,199.75,67.351,235,"UCare Health, Inc.",Medical Assistance,118.6045,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Si Joints Less Than 3 Views,,72200,CPT,Facility,Inpatient,,,,235,199.75,67.351,235,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Xr Si Joints Less Than 3 Views,,72200,CPT,Facility,Outpatient,,,,235,199.75,67.351,235,"UCare Health, Inc.",Medicare Advantage,118.6045,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Si Joints Less Than 3 Views,,72200,CPT,Facility,Inpatient,,,,235,199.75,67.351,235,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Si Joints Less Than 3 Views,,72200,CPT,Facility,Outpatient,,,,235,199.75,67.351,235,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),118.6045,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Si Joints Less Than 3 Views,,72200,CPT,Facility,Inpatient,,,,235,199.75,67.351,235,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Si Joints Less Than 3 Views,,72200,CPT,Facility,Both,,,,235,199.75,67.351,235,UnitedHealthcare,Individual & Family,220.9,94,,percent of total billed charges,,
Xr Si Joints Less Than 3 Views,,72200,CPT,Facility,Outpatient,,,,235,199.75,67.351,235,UnitedHealthcare,Medicare Advantage,115.15,49,,percent of total billed charges,,
Xr Si Joints Less Than 3 Views,,72200,CPT,Facility,Inpatient,,,,235,199.75,67.351,235,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Xr Si Joints Less Than 3 Views,,72200,CPT,Facility,Outpatient,,,,235,199.75,67.351,235,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,112.8,48,,percent of total billed charges,,100% of DHS outpatient percentage
Xr Si Joints Less Than 3 Views,,72200,CPT,Facility,Inpatient,,,,235,199.75,67.351,235,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Xr Sacroiliac Joints,,72202,CPT,Facility,Both,,,,270,229.5,77.382,270,Aetna,Commercial,248.4,92,,percent of total billed charges,,
Xr Sacroiliac Joints,,72202,CPT,Facility,Outpatient,,,,270,229.5,77.382,270,Aetna,Medicare Advantage,132.3,49,,percent of total billed charges,,
Xr Sacroiliac Joints,,72202,CPT,Facility,Inpatient,,,,270,229.5,77.382,270,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Xr Sacroiliac Joints,,72202,CPT,Facility,Both,,,,270,229.5,77.382,270,Aetna,PPO,251.1,93,,percent of total billed charges,,
Xr Sacroiliac Joints,,72202,CPT,Facility,Both,,,,270,229.5,77.382,270,America's PPO,America's PPO,259.281,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Xr Sacroiliac Joints,,72202,CPT,Facility,Both,,,,270,229.5,77.382,270,BlueCross BlueShield Minnesota, Federal Employee Program,265.68,98.4,,percent of total billed charges,,
Xr Sacroiliac Joints,,72202,CPT,Facility,Both,,,,270,229.5,77.382,270,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,270,100,,percent of total billed charges,,
Xr Sacroiliac Joints,,72202,CPT,Facility,Both,,,,270,229.5,77.382,270,BlueCross BlueShield Minnesota,High Value Network Plan,243,90,,percent of total billed charges,,
Xr Sacroiliac Joints,,72202,CPT,Facility,Outpatient,,,,270,229.5,77.382,270,BlueCross BlueShield Minnesota,Medicare Advantage,132.3,49,,percent of total billed charges,,
Xr Sacroiliac Joints,,72202,CPT,Facility,Inpatient,,,,270,229.5,77.382,270,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Xr Sacroiliac Joints,,72202,CPT,Facility,Both,,,,270,229.5,77.382,270,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,239.139,88.57,,percent of total billed charges,,
Xr Sacroiliac Joints,,72202,CPT,Facility,Both,,,,270,229.5,77.382,270,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,77.382,28.66,,percent of total billed charges,,
Xr Sacroiliac Joints,,72202,CPT,Facility,Outpatient,,,,270,229.5,77.382,270,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),132.3,49,,percent of total billed charges,,
Xr Sacroiliac Joints,,72202,CPT,Facility,Inpatient,,,,270,229.5,77.382,270,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Xr Sacroiliac Joints,,72202,CPT,Facility,Both,,,,270,229.5,77.382,270,CorVel,Worker's Compensation,270,100,,percent of total billed charges,,
Xr Sacroiliac Joints,,72202,CPT,Facility,Both,,,,270,229.5,77.382,270,First Health Group Corporation,First Health Network,261.9,97,,percent of total billed charges,,
Xr Sacroiliac Joints,,72202,CPT,Facility,Both,,,,270,229.5,77.382,270,"Health Partners, Inc.",Commercial,255.42,94.6,,percent of total billed charges,,
Xr Sacroiliac Joints,,72202,CPT,Facility,Outpatient,,,,270,229.5,77.382,270,"Health Partners, Inc.",Medicare Advantage,132.3,49,,percent of total billed charges,,
Xr Sacroiliac Joints,,72202,CPT,Facility,Inpatient,,,,270,229.5,77.382,270,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Sacroiliac Joints,,72202,CPT,Facility,Both,,,,270,229.5,77.382,270,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),162,60,,percent of total billed charges,,
Xr Sacroiliac Joints,,72202,CPT,Facility,Both,,,,270,229.5,77.382,270,"Health Partners, Inc.",State of Minnesota Advantage Program,220.05,81.5,,percent of total billed charges,,
Xr Sacroiliac Joints,,72202,CPT,Facility,Both,,,,270,229.5,77.382,270,"Health Partners, Inc.",State Public Programs,135,50,,percent of total billed charges,,
Xr Sacroiliac Joints,,72202,CPT,Facility,Both,,,,270,229.5,77.382,270,Humana Insurance Company,Commercial PPO,256.5,95,,percent of total billed charges,,
Xr Sacroiliac Joints,,72202,CPT,Facility,Outpatient,,,,270,229.5,77.382,270,Humana Insurance Company,Medicare PPO,132.3,49,,percent of total billed charges,,
Xr Sacroiliac Joints,,72202,CPT,Facility,Inpatient,,,,270,229.5,77.382,270,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Xr Sacroiliac Joints,,72202,CPT,Facility,Both,,,,270,229.5,77.382,270,Medica,Individual & Family,267.57,99.1,,percent of total billed charges,,
Xr Sacroiliac Joints,,72202,CPT,Facility,Outpatient,,,,270,229.5,77.382,270,Medica,Medica Advantage Solution,134.46,49.8,,percent of total billed charges,,
Xr Sacroiliac Joints,,72202,CPT,Facility,Inpatient,,,,270,229.5,77.382,270,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Xr Sacroiliac Joints,,72202,CPT,Facility,Outpatient,,,,270,229.5,77.382,270,Medica,Medical Assistance,120.42,44.6,,percent of total billed charges,,
Xr Sacroiliac Joints,,72202,CPT,Facility,Inpatient,,,,270,229.5,77.382,270,Medica,Medical Assistance,,,,,Included in per diem rate,
Xr Sacroiliac Joints,,72202,CPT,Facility,Outpatient,,,,270,229.5,77.382,270,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,134.46,49.8,,percent of total billed charges,,
Xr Sacroiliac Joints,,72202,CPT,Facility,Inpatient,,,,270,229.5,77.382,270,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Xr Sacroiliac Joints,,72202,CPT,Facility,Both,,,,270,229.5,77.382,270,"Multiplan, Inc.","Multiplan, Inc.",253.8,94,,percent of total billed charges,,
Xr Sacroiliac Joints,,72202,CPT,Facility,Outpatient,,,,270,229.5,77.382,270,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,243.27,90.1,,percent of total billed charges,,
Xr Sacroiliac Joints,,72202,CPT,Facility,Inpatient,,,,270,229.5,77.382,270,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Xr Sacroiliac Joints,,72202,CPT,Facility,Both,,,,270,229.5,77.382,270,"Preferred One Administrative Services, INC.",PPO,266.22,98.6,,percent of total billed charges,,
Xr Sacroiliac Joints,,72202,CPT,Facility,Outpatient,,,,270,229.5,77.382,270,PrimeWest Health,Minnesota Senior Health Options (MSHO),138.915,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Xr Sacroiliac Joints,,72202,CPT,Facility,Inpatient,,,,270,229.5,77.382,270,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Sacroiliac Joints,,72202,CPT,Facility,Outpatient,,,,270,229.5,77.382,270,PrimeWest Health,MinnesotaCare,138.672,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Xr Sacroiliac Joints,,72202,CPT,Facility,Inpatient,,,,270,229.5,77.382,270,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Xr Sacroiliac Joints,,72202,CPT,Facility,Both,,,,270,229.5,77.382,270,Sanford Health Plan,Sanford Health Plan,248.4,92,,percent of total billed charges,,
Xr Sacroiliac Joints,,72202,CPT,Facility,Outpatient,,,,270,229.5,77.382,270,"UCare Health, Inc.",Individual & Family Plan,152.145,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Xr Sacroiliac Joints,,72202,CPT,Facility,Inpatient,,,,270,229.5,77.382,270,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Xr Sacroiliac Joints,,72202,CPT,Facility,Outpatient,,,,270,229.5,77.382,270,"UCare Health, Inc.",Medical Assistance,136.269,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Sacroiliac Joints,,72202,CPT,Facility,Inpatient,,,,270,229.5,77.382,270,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Xr Sacroiliac Joints,,72202,CPT,Facility,Outpatient,,,,270,229.5,77.382,270,"UCare Health, Inc.",Medicare Advantage,136.269,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Sacroiliac Joints,,72202,CPT,Facility,Inpatient,,,,270,229.5,77.382,270,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Sacroiliac Joints,,72202,CPT,Facility,Outpatient,,,,270,229.5,77.382,270,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),136.269,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Sacroiliac Joints,,72202,CPT,Facility,Inpatient,,,,270,229.5,77.382,270,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Sacroiliac Joints,,72202,CPT,Facility,Both,,,,270,229.5,77.382,270,UnitedHealthcare,Individual & Family,253.8,94,,percent of total billed charges,,
Xr Sacroiliac Joints,,72202,CPT,Facility,Outpatient,,,,270,229.5,77.382,270,UnitedHealthcare,Medicare Advantage,132.3,49,,percent of total billed charges,,
Xr Sacroiliac Joints,,72202,CPT,Facility,Inpatient,,,,270,229.5,77.382,270,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Xr Sacroiliac Joints,,72202,CPT,Facility,Outpatient,,,,270,229.5,77.382,270,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,129.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
Xr Sacroiliac Joints,,72202,CPT,Facility,Inpatient,,,,270,229.5,77.382,270,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Xr Sacrum And Or Coccyx,,72220,CPT,Facility,Both,,,,256,217.6,73.3696,256,Aetna,Commercial,235.52,92,,percent of total billed charges,,
Xr Sacrum And Or Coccyx,,72220,CPT,Facility,Outpatient,,,,256,217.6,73.3696,256,Aetna,Medicare Advantage,125.44,49,,percent of total billed charges,,
Xr Sacrum And Or Coccyx,,72220,CPT,Facility,Inpatient,,,,256,217.6,73.3696,256,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Xr Sacrum And Or Coccyx,,72220,CPT,Facility,Both,,,,256,217.6,73.3696,256,Aetna,PPO,238.08,93,,percent of total billed charges,,
Xr Sacrum And Or Coccyx,,72220,CPT,Facility,Both,,,,256,217.6,73.3696,256,America's PPO,America's PPO,245.8368,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Xr Sacrum And Or Coccyx,,72220,CPT,Facility,Both,,,,256,217.6,73.3696,256,BlueCross BlueShield Minnesota, Federal Employee Program,251.904,98.4,,percent of total billed charges,,
Xr Sacrum And Or Coccyx,,72220,CPT,Facility,Both,,,,256,217.6,73.3696,256,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,256,100,,percent of total billed charges,,
Xr Sacrum And Or Coccyx,,72220,CPT,Facility,Both,,,,256,217.6,73.3696,256,BlueCross BlueShield Minnesota,High Value Network Plan,230.4,90,,percent of total billed charges,,
Xr Sacrum And Or Coccyx,,72220,CPT,Facility,Outpatient,,,,256,217.6,73.3696,256,BlueCross BlueShield Minnesota,Medicare Advantage,125.44,49,,percent of total billed charges,,
Xr Sacrum And Or Coccyx,,72220,CPT,Facility,Inpatient,,,,256,217.6,73.3696,256,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Xr Sacrum And Or Coccyx,,72220,CPT,Facility,Both,,,,256,217.6,73.3696,256,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,226.7392,88.57,,percent of total billed charges,,
Xr Sacrum And Or Coccyx,,72220,CPT,Facility,Both,,,,256,217.6,73.3696,256,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,73.3696,28.66,,percent of total billed charges,,
Xr Sacrum And Or Coccyx,,72220,CPT,Facility,Outpatient,,,,256,217.6,73.3696,256,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),125.44,49,,percent of total billed charges,,
Xr Sacrum And Or Coccyx,,72220,CPT,Facility,Inpatient,,,,256,217.6,73.3696,256,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Xr Sacrum And Or Coccyx,,72220,CPT,Facility,Both,,,,256,217.6,73.3696,256,CorVel,Worker's Compensation,256,100,,percent of total billed charges,,
Xr Sacrum And Or Coccyx,,72220,CPT,Facility,Both,,,,256,217.6,73.3696,256,First Health Group Corporation,First Health Network,248.32,97,,percent of total billed charges,,
Xr Sacrum And Or Coccyx,,72220,CPT,Facility,Both,,,,256,217.6,73.3696,256,"Health Partners, Inc.",Commercial,242.176,94.6,,percent of total billed charges,,
Xr Sacrum And Or Coccyx,,72220,CPT,Facility,Outpatient,,,,256,217.6,73.3696,256,"Health Partners, Inc.",Medicare Advantage,125.44,49,,percent of total billed charges,,
Xr Sacrum And Or Coccyx,,72220,CPT,Facility,Inpatient,,,,256,217.6,73.3696,256,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Sacrum And Or Coccyx,,72220,CPT,Facility,Both,,,,256,217.6,73.3696,256,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),153.6,60,,percent of total billed charges,,
Xr Sacrum And Or Coccyx,,72220,CPT,Facility,Both,,,,256,217.6,73.3696,256,"Health Partners, Inc.",State of Minnesota Advantage Program,208.64,81.5,,percent of total billed charges,,
Xr Sacrum And Or Coccyx,,72220,CPT,Facility,Both,,,,256,217.6,73.3696,256,"Health Partners, Inc.",State Public Programs,128,50,,percent of total billed charges,,
Xr Sacrum And Or Coccyx,,72220,CPT,Facility,Both,,,,256,217.6,73.3696,256,Humana Insurance Company,Commercial PPO,243.2,95,,percent of total billed charges,,
Xr Sacrum And Or Coccyx,,72220,CPT,Facility,Outpatient,,,,256,217.6,73.3696,256,Humana Insurance Company,Medicare PPO,125.44,49,,percent of total billed charges,,
Xr Sacrum And Or Coccyx,,72220,CPT,Facility,Inpatient,,,,256,217.6,73.3696,256,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Xr Sacrum And Or Coccyx,,72220,CPT,Facility,Both,,,,256,217.6,73.3696,256,Medica,Individual & Family,253.696,99.1,,percent of total billed charges,,
Xr Sacrum And Or Coccyx,,72220,CPT,Facility,Outpatient,,,,256,217.6,73.3696,256,Medica,Medica Advantage Solution,127.488,49.8,,percent of total billed charges,,
Xr Sacrum And Or Coccyx,,72220,CPT,Facility,Inpatient,,,,256,217.6,73.3696,256,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Xr Sacrum And Or Coccyx,,72220,CPT,Facility,Outpatient,,,,256,217.6,73.3696,256,Medica,Medical Assistance,114.176,44.6,,percent of total billed charges,,
Xr Sacrum And Or Coccyx,,72220,CPT,Facility,Inpatient,,,,256,217.6,73.3696,256,Medica,Medical Assistance,,,,,Included in per diem rate,
Xr Sacrum And Or Coccyx,,72220,CPT,Facility,Outpatient,,,,256,217.6,73.3696,256,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,127.488,49.8,,percent of total billed charges,,
Xr Sacrum And Or Coccyx,,72220,CPT,Facility,Inpatient,,,,256,217.6,73.3696,256,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Xr Sacrum And Or Coccyx,,72220,CPT,Facility,Both,,,,256,217.6,73.3696,256,"Multiplan, Inc.","Multiplan, Inc.",240.64,94,,percent of total billed charges,,
Xr Sacrum And Or Coccyx,,72220,CPT,Facility,Outpatient,,,,256,217.6,73.3696,256,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,230.656,90.1,,percent of total billed charges,,
Xr Sacrum And Or Coccyx,,72220,CPT,Facility,Inpatient,,,,256,217.6,73.3696,256,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Xr Sacrum And Or Coccyx,,72220,CPT,Facility,Both,,,,256,217.6,73.3696,256,"Preferred One Administrative Services, INC.",PPO,252.416,98.6,,percent of total billed charges,,
Xr Sacrum And Or Coccyx,,72220,CPT,Facility,Outpatient,,,,256,217.6,73.3696,256,PrimeWest Health,Minnesota Senior Health Options (MSHO),131.712,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Xr Sacrum And Or Coccyx,,72220,CPT,Facility,Inpatient,,,,256,217.6,73.3696,256,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Sacrum And Or Coccyx,,72220,CPT,Facility,Outpatient,,,,256,217.6,73.3696,256,PrimeWest Health,MinnesotaCare,131.4816,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Xr Sacrum And Or Coccyx,,72220,CPT,Facility,Inpatient,,,,256,217.6,73.3696,256,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Xr Sacrum And Or Coccyx,,72220,CPT,Facility,Both,,,,256,217.6,73.3696,256,Sanford Health Plan,Sanford Health Plan,235.52,92,,percent of total billed charges,,
Xr Sacrum And Or Coccyx,,72220,CPT,Facility,Outpatient,,,,256,217.6,73.3696,256,"UCare Health, Inc.",Individual & Family Plan,144.256,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Xr Sacrum And Or Coccyx,,72220,CPT,Facility,Inpatient,,,,256,217.6,73.3696,256,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Xr Sacrum And Or Coccyx,,72220,CPT,Facility,Outpatient,,,,256,217.6,73.3696,256,"UCare Health, Inc.",Medical Assistance,129.2032,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Sacrum And Or Coccyx,,72220,CPT,Facility,Inpatient,,,,256,217.6,73.3696,256,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Xr Sacrum And Or Coccyx,,72220,CPT,Facility,Outpatient,,,,256,217.6,73.3696,256,"UCare Health, Inc.",Medicare Advantage,129.2032,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Sacrum And Or Coccyx,,72220,CPT,Facility,Inpatient,,,,256,217.6,73.3696,256,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Sacrum And Or Coccyx,,72220,CPT,Facility,Outpatient,,,,256,217.6,73.3696,256,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),129.2032,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Sacrum And Or Coccyx,,72220,CPT,Facility,Inpatient,,,,256,217.6,73.3696,256,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Sacrum And Or Coccyx,,72220,CPT,Facility,Both,,,,256,217.6,73.3696,256,UnitedHealthcare,Individual & Family,240.64,94,,percent of total billed charges,,
Xr Sacrum And Or Coccyx,,72220,CPT,Facility,Outpatient,,,,256,217.6,73.3696,256,UnitedHealthcare,Medicare Advantage,125.44,49,,percent of total billed charges,,
Xr Sacrum And Or Coccyx,,72220,CPT,Facility,Inpatient,,,,256,217.6,73.3696,256,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Xr Sacrum And Or Coccyx,,72220,CPT,Facility,Outpatient,,,,256,217.6,73.3696,256,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,122.88,48,,percent of total billed charges,,100% of DHS outpatient percentage
Xr Sacrum And Or Coccyx,,72220,CPT,Facility,Inpatient,,,,256,217.6,73.3696,256,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Xr Acromioclavicular Joints,,73050,CPT,Facility,Both,,,,204,173.4,58.4664,204,Aetna,Commercial,187.68,92,,percent of total billed charges,,
Xr Acromioclavicular Joints,,73050,CPT,Facility,Outpatient,,,,204,173.4,58.4664,204,Aetna,Medicare Advantage,99.96,49,,percent of total billed charges,,
Xr Acromioclavicular Joints,,73050,CPT,Facility,Inpatient,,,,204,173.4,58.4664,204,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Xr Acromioclavicular Joints,,73050,CPT,Facility,Both,,,,204,173.4,58.4664,204,Aetna,PPO,189.72,93,,percent of total billed charges,,
Xr Acromioclavicular Joints,,73050,CPT,Facility,Both,,,,204,173.4,58.4664,204,America's PPO,America's PPO,195.9012,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Xr Acromioclavicular Joints,,73050,CPT,Facility,Both,,,,204,173.4,58.4664,204,BlueCross BlueShield Minnesota, Federal Employee Program,200.736,98.4,,percent of total billed charges,,
Xr Acromioclavicular Joints,,73050,CPT,Facility,Both,,,,204,173.4,58.4664,204,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,204,100,,percent of total billed charges,,
Xr Acromioclavicular Joints,,73050,CPT,Facility,Both,,,,204,173.4,58.4664,204,BlueCross BlueShield Minnesota,High Value Network Plan,183.6,90,,percent of total billed charges,,
Xr Acromioclavicular Joints,,73050,CPT,Facility,Outpatient,,,,204,173.4,58.4664,204,BlueCross BlueShield Minnesota,Medicare Advantage,99.96,49,,percent of total billed charges,,
Xr Acromioclavicular Joints,,73050,CPT,Facility,Inpatient,,,,204,173.4,58.4664,204,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Xr Acromioclavicular Joints,,73050,CPT,Facility,Both,,,,204,173.4,58.4664,204,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,180.6828,88.57,,percent of total billed charges,,
Xr Acromioclavicular Joints,,73050,CPT,Facility,Both,,,,204,173.4,58.4664,204,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,58.4664,28.66,,percent of total billed charges,,
Xr Acromioclavicular Joints,,73050,CPT,Facility,Outpatient,,,,204,173.4,58.4664,204,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),99.96,49,,percent of total billed charges,,
Xr Acromioclavicular Joints,,73050,CPT,Facility,Inpatient,,,,204,173.4,58.4664,204,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Xr Acromioclavicular Joints,,73050,CPT,Facility,Both,,,,204,173.4,58.4664,204,CorVel,Worker's Compensation,204,100,,percent of total billed charges,,
Xr Acromioclavicular Joints,,73050,CPT,Facility,Both,,,,204,173.4,58.4664,204,First Health Group Corporation,First Health Network,197.88,97,,percent of total billed charges,,
Xr Acromioclavicular Joints,,73050,CPT,Facility,Both,,,,204,173.4,58.4664,204,"Health Partners, Inc.",Commercial,192.984,94.6,,percent of total billed charges,,
Xr Acromioclavicular Joints,,73050,CPT,Facility,Outpatient,,,,204,173.4,58.4664,204,"Health Partners, Inc.",Medicare Advantage,99.96,49,,percent of total billed charges,,
Xr Acromioclavicular Joints,,73050,CPT,Facility,Inpatient,,,,204,173.4,58.4664,204,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Acromioclavicular Joints,,73050,CPT,Facility,Both,,,,204,173.4,58.4664,204,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),122.4,60,,percent of total billed charges,,
Xr Acromioclavicular Joints,,73050,CPT,Facility,Both,,,,204,173.4,58.4664,204,"Health Partners, Inc.",State of Minnesota Advantage Program,166.26,81.5,,percent of total billed charges,,
Xr Acromioclavicular Joints,,73050,CPT,Facility,Both,,,,204,173.4,58.4664,204,"Health Partners, Inc.",State Public Programs,102,50,,percent of total billed charges,,
Xr Acromioclavicular Joints,,73050,CPT,Facility,Both,,,,204,173.4,58.4664,204,Humana Insurance Company,Commercial PPO,193.8,95,,percent of total billed charges,,
Xr Acromioclavicular Joints,,73050,CPT,Facility,Outpatient,,,,204,173.4,58.4664,204,Humana Insurance Company,Medicare PPO,99.96,49,,percent of total billed charges,,
Xr Acromioclavicular Joints,,73050,CPT,Facility,Inpatient,,,,204,173.4,58.4664,204,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Xr Acromioclavicular Joints,,73050,CPT,Facility,Both,,,,204,173.4,58.4664,204,Medica,Individual & Family,202.164,99.1,,percent of total billed charges,,
Xr Acromioclavicular Joints,,73050,CPT,Facility,Outpatient,,,,204,173.4,58.4664,204,Medica,Medica Advantage Solution,101.592,49.8,,percent of total billed charges,,
Xr Acromioclavicular Joints,,73050,CPT,Facility,Inpatient,,,,204,173.4,58.4664,204,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Xr Acromioclavicular Joints,,73050,CPT,Facility,Outpatient,,,,204,173.4,58.4664,204,Medica,Medical Assistance,90.984,44.6,,percent of total billed charges,,
Xr Acromioclavicular Joints,,73050,CPT,Facility,Inpatient,,,,204,173.4,58.4664,204,Medica,Medical Assistance,,,,,Included in per diem rate,
Xr Acromioclavicular Joints,,73050,CPT,Facility,Outpatient,,,,204,173.4,58.4664,204,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,101.592,49.8,,percent of total billed charges,,
Xr Acromioclavicular Joints,,73050,CPT,Facility,Inpatient,,,,204,173.4,58.4664,204,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Xr Acromioclavicular Joints,,73050,CPT,Facility,Both,,,,204,173.4,58.4664,204,"Multiplan, Inc.","Multiplan, Inc.",191.76,94,,percent of total billed charges,,
Xr Acromioclavicular Joints,,73050,CPT,Facility,Outpatient,,,,204,173.4,58.4664,204,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,183.804,90.1,,percent of total billed charges,,
Xr Acromioclavicular Joints,,73050,CPT,Facility,Inpatient,,,,204,173.4,58.4664,204,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Xr Acromioclavicular Joints,,73050,CPT,Facility,Both,,,,204,173.4,58.4664,204,"Preferred One Administrative Services, INC.",PPO,201.144,98.6,,percent of total billed charges,,
Xr Acromioclavicular Joints,,73050,CPT,Facility,Outpatient,,,,204,173.4,58.4664,204,PrimeWest Health,Minnesota Senior Health Options (MSHO),104.958,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Xr Acromioclavicular Joints,,73050,CPT,Facility,Inpatient,,,,204,173.4,58.4664,204,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Acromioclavicular Joints,,73050,CPT,Facility,Outpatient,,,,204,173.4,58.4664,204,PrimeWest Health,MinnesotaCare,104.7744,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Xr Acromioclavicular Joints,,73050,CPT,Facility,Inpatient,,,,204,173.4,58.4664,204,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Xr Acromioclavicular Joints,,73050,CPT,Facility,Both,,,,204,173.4,58.4664,204,Sanford Health Plan,Sanford Health Plan,187.68,92,,percent of total billed charges,,
Xr Acromioclavicular Joints,,73050,CPT,Facility,Outpatient,,,,204,173.4,58.4664,204,"UCare Health, Inc.",Individual & Family Plan,114.954,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Xr Acromioclavicular Joints,,73050,CPT,Facility,Inpatient,,,,204,173.4,58.4664,204,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Xr Acromioclavicular Joints,,73050,CPT,Facility,Outpatient,,,,204,173.4,58.4664,204,"UCare Health, Inc.",Medical Assistance,102.9588,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Acromioclavicular Joints,,73050,CPT,Facility,Inpatient,,,,204,173.4,58.4664,204,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Xr Acromioclavicular Joints,,73050,CPT,Facility,Outpatient,,,,204,173.4,58.4664,204,"UCare Health, Inc.",Medicare Advantage,102.9588,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Acromioclavicular Joints,,73050,CPT,Facility,Inpatient,,,,204,173.4,58.4664,204,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Acromioclavicular Joints,,73050,CPT,Facility,Outpatient,,,,204,173.4,58.4664,204,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),102.9588,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Acromioclavicular Joints,,73050,CPT,Facility,Inpatient,,,,204,173.4,58.4664,204,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Acromioclavicular Joints,,73050,CPT,Facility,Both,,,,204,173.4,58.4664,204,UnitedHealthcare,Individual & Family,191.76,94,,percent of total billed charges,,
Xr Acromioclavicular Joints,,73050,CPT,Facility,Outpatient,,,,204,173.4,58.4664,204,UnitedHealthcare,Medicare Advantage,99.96,49,,percent of total billed charges,,
Xr Acromioclavicular Joints,,73050,CPT,Facility,Inpatient,,,,204,173.4,58.4664,204,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Xr Acromioclavicular Joints,,73050,CPT,Facility,Outpatient,,,,204,173.4,58.4664,204,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,97.92,48,,percent of total billed charges,,100% of DHS outpatient percentage
Xr Acromioclavicular Joints,,73050,CPT,Facility,Inpatient,,,,204,173.4,58.4664,204,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Ct Upper Extremity Without Contrast,,73200,CPT,Facility,Both,,,,1428,1213.8,325.628,1428,Aetna,Commercial,1313.76,92,,percent of total billed charges,,
Ct Upper Extremity Without Contrast,,73200,CPT,Facility,Outpatient,,,,1428,1213.8,325.628,1428,Aetna,Medicare Advantage,699.72,49,,percent of total billed charges,,
Ct Upper Extremity Without Contrast,,73200,CPT,Facility,Inpatient,,,,1428,1213.8,325.628,1428,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Ct Upper Extremity Without Contrast,,73200,CPT,Facility,Both,,,,1428,1213.8,325.628,1428,Aetna,PPO,1328.04,93,,percent of total billed charges,,
Ct Upper Extremity Without Contrast,,73200,CPT,Facility,Both,,,,1428,1213.8,325.628,1428,America's PPO,America's PPO,1371.3084,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Ct Upper Extremity Without Contrast,,73200,CPT,Facility,Both,,,,1428,1213.8,325.628,1428,BlueCross BlueShield Minnesota, Federal Employee Program,641,,,Fee schedule,,100% of BCBS commercial commodity fee schedule
Ct Upper Extremity Without Contrast,,73200,CPT,Facility,Both,,,,1428,1213.8,325.628,1428,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,651.256,,,Fee schedule,,"100% of BCBS commercial commodity fee schedule, plus MN Care tax"
Ct Upper Extremity Without Contrast,,73200,CPT,Facility,Both,,,,1428,1213.8,325.628,1428,BlueCross BlueShield Minnesota,High Value Network Plan,586.1304,,,Fee schedule,,"90% of BCBS commercial commodity fee schedule, plus MN Care tax; see disclaimer for more information"
Ct Upper Extremity Without Contrast,,73200,CPT,Facility,Outpatient,,,,1428,1213.8,325.628,1428,BlueCross BlueShield Minnesota,Medicare Advantage,699.72,49,,percent of total billed charges,,
Ct Upper Extremity Without Contrast,,73200,CPT,Facility,Inpatient,,,,1428,1213.8,325.628,1428,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Ct Upper Extremity Without Contrast,,73200,CPT,Facility,Both,,,,1428,1213.8,325.628,1428,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,576.8174392,,,Fee schedule,,"88.57% of BCBS commercial commodity fee schedule, plus MN Care tax"
Ct Upper Extremity Without Contrast,,73200,CPT,Facility,Both,,,,1428,1213.8,325.628,1428,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,325.628,,,Fee schedule,,"100% of BCBS Medicaid commodity fee schedule, plus MN Care tax"
Ct Upper Extremity Without Contrast,,73200,CPT,Facility,Outpatient,,,,1428,1213.8,325.628,1428,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),699.72,49,,percent of total billed charges,,
Ct Upper Extremity Without Contrast,,73200,CPT,Facility,Inpatient,,,,1428,1213.8,325.628,1428,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Ct Upper Extremity Without Contrast,,73200,CPT,Facility,Both,,,,1428,1213.8,325.628,1428,CorVel,Worker's Compensation,1428,100,,percent of total billed charges,,
Ct Upper Extremity Without Contrast,,73200,CPT,Facility,Both,,,,1428,1213.8,325.628,1428,First Health Group Corporation,First Health Network,1385.16,97,,percent of total billed charges,,
Ct Upper Extremity Without Contrast,,73200,CPT,Facility,Both,,,,1428,1213.8,325.628,1428,"Health Partners, Inc.",Commercial,1350.888,94.6,,percent of total billed charges,,
Ct Upper Extremity Without Contrast,,73200,CPT,Facility,Outpatient,,,,1428,1213.8,325.628,1428,"Health Partners, Inc.",Medicare Advantage,699.72,49,,percent of total billed charges,,
Ct Upper Extremity Without Contrast,,73200,CPT,Facility,Inpatient,,,,1428,1213.8,325.628,1428,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ct Upper Extremity Without Contrast,,73200,CPT,Facility,Both,,,,1428,1213.8,325.628,1428,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),856.8,60,,percent of total billed charges,,
Ct Upper Extremity Without Contrast,,73200,CPT,Facility,Both,,,,1428,1213.8,325.628,1428,"Health Partners, Inc.",State of Minnesota Advantage Program,1163.82,81.5,,percent of total billed charges,,
Ct Upper Extremity Without Contrast,,73200,CPT,Facility,Both,,,,1428,1213.8,325.628,1428,"Health Partners, Inc.",State Public Programs,714,50,,percent of total billed charges,,
Ct Upper Extremity Without Contrast,,73200,CPT,Facility,Both,,,,1428,1213.8,325.628,1428,Humana Insurance Company,Commercial PPO,1356.6,95,,percent of total billed charges,,
Ct Upper Extremity Without Contrast,,73200,CPT,Facility,Outpatient,,,,1428,1213.8,325.628,1428,Humana Insurance Company,Medicare PPO,699.72,49,,percent of total billed charges,,
Ct Upper Extremity Without Contrast,,73200,CPT,Facility,Inpatient,,,,1428,1213.8,325.628,1428,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Ct Upper Extremity Without Contrast,,73200,CPT,Facility,Both,,,,1428,1213.8,325.628,1428,Medica,Individual & Family,1415.148,99.1,,percent of total billed charges,,
Ct Upper Extremity Without Contrast,,73200,CPT,Facility,Outpatient,,,,1428,1213.8,325.628,1428,Medica,Medica Advantage Solution,711.144,49.8,,percent of total billed charges,,
Ct Upper Extremity Without Contrast,,73200,CPT,Facility,Inpatient,,,,1428,1213.8,325.628,1428,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Ct Upper Extremity Without Contrast,,73200,CPT,Facility,Outpatient,,,,1428,1213.8,325.628,1428,Medica,Medical Assistance,636.888,44.6,,percent of total billed charges,,
Ct Upper Extremity Without Contrast,,73200,CPT,Facility,Inpatient,,,,1428,1213.8,325.628,1428,Medica,Medical Assistance,,,,,Included in per diem rate,
Ct Upper Extremity Without Contrast,,73200,CPT,Facility,Outpatient,,,,1428,1213.8,325.628,1428,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,711.144,49.8,,percent of total billed charges,,
Ct Upper Extremity Without Contrast,,73200,CPT,Facility,Inpatient,,,,1428,1213.8,325.628,1428,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Ct Upper Extremity Without Contrast,,73200,CPT,Facility,Both,,,,1428,1213.8,325.628,1428,"Multiplan, Inc.","Multiplan, Inc.",1342.32,94,,percent of total billed charges,,
Ct Upper Extremity Without Contrast,,73200,CPT,Facility,Outpatient,,,,1428,1213.8,325.628,1428,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1283,,,Other,Per scan,
Ct Upper Extremity Without Contrast,,73200,CPT,Facility,Inpatient,,,,1428,1213.8,325.628,1428,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Ct Upper Extremity Without Contrast,,73200,CPT,Facility,Both,,,,1428,1213.8,325.628,1428,"Preferred One Administrative Services, INC.",PPO,1408.008,98.6,,percent of total billed charges,,
Ct Upper Extremity Without Contrast,,73200,CPT,Facility,Outpatient,,,,1428,1213.8,325.628,1428,PrimeWest Health,Minnesota Senior Health Options (MSHO),734.706,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Ct Upper Extremity Without Contrast,,73200,CPT,Facility,Inpatient,,,,1428,1213.8,325.628,1428,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ct Upper Extremity Without Contrast,,73200,CPT,Facility,Outpatient,,,,1428,1213.8,325.628,1428,PrimeWest Health,MinnesotaCare,733.4208,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Ct Upper Extremity Without Contrast,,73200,CPT,Facility,Inpatient,,,,1428,1213.8,325.628,1428,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Ct Upper Extremity Without Contrast,,73200,CPT,Facility,Both,,,,1428,1213.8,325.628,1428,Sanford Health Plan,Sanford Health Plan,1313.76,92,,percent of total billed charges,,
Ct Upper Extremity Without Contrast,,73200,CPT,Facility,Outpatient,,,,1428,1213.8,325.628,1428,"UCare Health, Inc.",Individual & Family Plan,804.678,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Ct Upper Extremity Without Contrast,,73200,CPT,Facility,Inpatient,,,,1428,1213.8,325.628,1428,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Ct Upper Extremity Without Contrast,,73200,CPT,Facility,Outpatient,,,,1428,1213.8,325.628,1428,"UCare Health, Inc.",Medical Assistance,720.7116,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ct Upper Extremity Without Contrast,,73200,CPT,Facility,Inpatient,,,,1428,1213.8,325.628,1428,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Ct Upper Extremity Without Contrast,,73200,CPT,Facility,Outpatient,,,,1428,1213.8,325.628,1428,"UCare Health, Inc.",Medicare Advantage,720.7116,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ct Upper Extremity Without Contrast,,73200,CPT,Facility,Inpatient,,,,1428,1213.8,325.628,1428,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ct Upper Extremity Without Contrast,,73200,CPT,Facility,Outpatient,,,,1428,1213.8,325.628,1428,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),720.7116,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ct Upper Extremity Without Contrast,,73200,CPT,Facility,Inpatient,,,,1428,1213.8,325.628,1428,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ct Upper Extremity Without Contrast,,73200,CPT,Facility,Both,,,,1428,1213.8,325.628,1428,UnitedHealthcare,Individual & Family,1342.32,94,,percent of total billed charges,,
Ct Upper Extremity Without Contrast,,73200,CPT,Facility,Outpatient,,,,1428,1213.8,325.628,1428,UnitedHealthcare,Medicare Advantage,699.72,49,,percent of total billed charges,,
Ct Upper Extremity Without Contrast,,73200,CPT,Facility,Inpatient,,,,1428,1213.8,325.628,1428,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Ct Upper Extremity Without Contrast,,73200,CPT,Facility,Outpatient,,,,1428,1213.8,325.628,1428,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,685.44,48,,percent of total billed charges,,100% of DHS outpatient percentage
Ct Upper Extremity Without Contrast,,73200,CPT,Facility,Inpatient,,,,1428,1213.8,325.628,1428,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Ct Upper Extremity With Contrast,,73201,CPT,Facility,Both,,,,1581,1343.85,561.34,1581,Aetna,Commercial,1454.52,92,,percent of total billed charges,,
Ct Upper Extremity With Contrast,,73201,CPT,Facility,Outpatient,,,,1581,1343.85,561.34,1581,Aetna,Medicare Advantage,774.69,49,,percent of total billed charges,,
Ct Upper Extremity With Contrast,,73201,CPT,Facility,Inpatient,,,,1581,1343.85,561.34,1581,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Ct Upper Extremity With Contrast,,73201,CPT,Facility,Both,,,,1581,1343.85,561.34,1581,Aetna,PPO,1470.33,93,,percent of total billed charges,,
Ct Upper Extremity With Contrast,,73201,CPT,Facility,Both,,,,1581,1343.85,561.34,1581,America's PPO,America's PPO,1518.2343,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Ct Upper Extremity With Contrast,,73201,CPT,Facility,Both,,,,1581,1343.85,561.34,1581,BlueCross BlueShield Minnesota, Federal Employee Program,1105,,,Fee schedule,,100% of BCBS commercial commodity fee schedule
Ct Upper Extremity With Contrast,,73201,CPT,Facility,Both,,,,1581,1343.85,561.34,1581,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1122.68,,,Fee schedule,,"100% of BCBS commercial commodity fee schedule, plus MN Care tax"
Ct Upper Extremity With Contrast,,73201,CPT,Facility,Both,,,,1581,1343.85,561.34,1581,BlueCross BlueShield Minnesota,High Value Network Plan,1010.412,,,Fee schedule,,"90% of BCBS commercial commodity fee schedule, plus MN Care tax; see disclaimer for more information"
Ct Upper Extremity With Contrast,,73201,CPT,Facility,Outpatient,,,,1581,1343.85,561.34,1581,BlueCross BlueShield Minnesota,Medicare Advantage,774.69,49,,percent of total billed charges,,
Ct Upper Extremity With Contrast,,73201,CPT,Facility,Inpatient,,,,1581,1343.85,561.34,1581,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Ct Upper Extremity With Contrast,,73201,CPT,Facility,Both,,,,1581,1343.85,561.34,1581,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,994.357676,,,Fee schedule,,"88.57% of BCBS commercial commodity fee schedule, plus MN Care tax"
Ct Upper Extremity With Contrast,,73201,CPT,Facility,Both,,,,1581,1343.85,561.34,1581,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,561.34,,,Fee schedule,,"100% of BCBS Medicaid commodity fee schedule, plus MN Care tax"
Ct Upper Extremity With Contrast,,73201,CPT,Facility,Outpatient,,,,1581,1343.85,561.34,1581,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),774.69,49,,percent of total billed charges,,
Ct Upper Extremity With Contrast,,73201,CPT,Facility,Inpatient,,,,1581,1343.85,561.34,1581,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Ct Upper Extremity With Contrast,,73201,CPT,Facility,Both,,,,1581,1343.85,561.34,1581,CorVel,Worker's Compensation,1581,100,,percent of total billed charges,,
Ct Upper Extremity With Contrast,,73201,CPT,Facility,Both,,,,1581,1343.85,561.34,1581,First Health Group Corporation,First Health Network,1533.57,97,,percent of total billed charges,,
Ct Upper Extremity With Contrast,,73201,CPT,Facility,Both,,,,1581,1343.85,561.34,1581,"Health Partners, Inc.",Commercial,1495.626,94.6,,percent of total billed charges,,
Ct Upper Extremity With Contrast,,73201,CPT,Facility,Outpatient,,,,1581,1343.85,561.34,1581,"Health Partners, Inc.",Medicare Advantage,774.69,49,,percent of total billed charges,,
Ct Upper Extremity With Contrast,,73201,CPT,Facility,Inpatient,,,,1581,1343.85,561.34,1581,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ct Upper Extremity With Contrast,,73201,CPT,Facility,Both,,,,1581,1343.85,561.34,1581,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),948.6,60,,percent of total billed charges,,
Ct Upper Extremity With Contrast,,73201,CPT,Facility,Both,,,,1581,1343.85,561.34,1581,"Health Partners, Inc.",State of Minnesota Advantage Program,1288.515,81.5,,percent of total billed charges,,
Ct Upper Extremity With Contrast,,73201,CPT,Facility,Both,,,,1581,1343.85,561.34,1581,"Health Partners, Inc.",State Public Programs,790.5,50,,percent of total billed charges,,
Ct Upper Extremity With Contrast,,73201,CPT,Facility,Both,,,,1581,1343.85,561.34,1581,Humana Insurance Company,Commercial PPO,1501.95,95,,percent of total billed charges,,
Ct Upper Extremity With Contrast,,73201,CPT,Facility,Outpatient,,,,1581,1343.85,561.34,1581,Humana Insurance Company,Medicare PPO,774.69,49,,percent of total billed charges,,
Ct Upper Extremity With Contrast,,73201,CPT,Facility,Inpatient,,,,1581,1343.85,561.34,1581,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Ct Upper Extremity With Contrast,,73201,CPT,Facility,Both,,,,1581,1343.85,561.34,1581,Medica,Individual & Family,1566.771,99.1,,percent of total billed charges,,
Ct Upper Extremity With Contrast,,73201,CPT,Facility,Outpatient,,,,1581,1343.85,561.34,1581,Medica,Medica Advantage Solution,787.338,49.8,,percent of total billed charges,,
Ct Upper Extremity With Contrast,,73201,CPT,Facility,Inpatient,,,,1581,1343.85,561.34,1581,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Ct Upper Extremity With Contrast,,73201,CPT,Facility,Outpatient,,,,1581,1343.85,561.34,1581,Medica,Medical Assistance,705.126,44.6,,percent of total billed charges,,
Ct Upper Extremity With Contrast,,73201,CPT,Facility,Inpatient,,,,1581,1343.85,561.34,1581,Medica,Medical Assistance,,,,,Included in per diem rate,
Ct Upper Extremity With Contrast,,73201,CPT,Facility,Outpatient,,,,1581,1343.85,561.34,1581,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,787.338,49.8,,percent of total billed charges,,
Ct Upper Extremity With Contrast,,73201,CPT,Facility,Inpatient,,,,1581,1343.85,561.34,1581,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Ct Upper Extremity With Contrast,,73201,CPT,Facility,Both,,,,1581,1343.85,561.34,1581,"Multiplan, Inc.","Multiplan, Inc.",1486.14,94,,percent of total billed charges,,
Ct Upper Extremity With Contrast,,73201,CPT,Facility,Outpatient,,,,1581,1343.85,561.34,1581,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1283,,,Other,Per scan,
Ct Upper Extremity With Contrast,,73201,CPT,Facility,Inpatient,,,,1581,1343.85,561.34,1581,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Ct Upper Extremity With Contrast,,73201,CPT,Facility,Both,,,,1581,1343.85,561.34,1581,"Preferred One Administrative Services, INC.",PPO,1558.866,98.6,,percent of total billed charges,,
Ct Upper Extremity With Contrast,,73201,CPT,Facility,Outpatient,,,,1581,1343.85,561.34,1581,PrimeWest Health,Minnesota Senior Health Options (MSHO),813.4245,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Ct Upper Extremity With Contrast,,73201,CPT,Facility,Inpatient,,,,1581,1343.85,561.34,1581,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ct Upper Extremity With Contrast,,73201,CPT,Facility,Outpatient,,,,1581,1343.85,561.34,1581,PrimeWest Health,MinnesotaCare,812.0016,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Ct Upper Extremity With Contrast,,73201,CPT,Facility,Inpatient,,,,1581,1343.85,561.34,1581,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Ct Upper Extremity With Contrast,,73201,CPT,Facility,Both,,,,1581,1343.85,561.34,1581,Sanford Health Plan,Sanford Health Plan,1454.52,92,,percent of total billed charges,,
Ct Upper Extremity With Contrast,,73201,CPT,Facility,Outpatient,,,,1581,1343.85,561.34,1581,"UCare Health, Inc.",Individual & Family Plan,890.8935,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Ct Upper Extremity With Contrast,,73201,CPT,Facility,Inpatient,,,,1581,1343.85,561.34,1581,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Ct Upper Extremity With Contrast,,73201,CPT,Facility,Outpatient,,,,1581,1343.85,561.34,1581,"UCare Health, Inc.",Medical Assistance,797.9307,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ct Upper Extremity With Contrast,,73201,CPT,Facility,Inpatient,,,,1581,1343.85,561.34,1581,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Ct Upper Extremity With Contrast,,73201,CPT,Facility,Outpatient,,,,1581,1343.85,561.34,1581,"UCare Health, Inc.",Medicare Advantage,797.9307,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ct Upper Extremity With Contrast,,73201,CPT,Facility,Inpatient,,,,1581,1343.85,561.34,1581,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ct Upper Extremity With Contrast,,73201,CPT,Facility,Outpatient,,,,1581,1343.85,561.34,1581,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),797.9307,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ct Upper Extremity With Contrast,,73201,CPT,Facility,Inpatient,,,,1581,1343.85,561.34,1581,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ct Upper Extremity With Contrast,,73201,CPT,Facility,Both,,,,1581,1343.85,561.34,1581,UnitedHealthcare,Individual & Family,1486.14,94,,percent of total billed charges,,
Ct Upper Extremity With Contrast,,73201,CPT,Facility,Outpatient,,,,1581,1343.85,561.34,1581,UnitedHealthcare,Medicare Advantage,774.69,49,,percent of total billed charges,,
Ct Upper Extremity With Contrast,,73201,CPT,Facility,Inpatient,,,,1581,1343.85,561.34,1581,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Ct Upper Extremity With Contrast,,73201,CPT,Facility,Outpatient,,,,1581,1343.85,561.34,1581,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,758.88,48,,percent of total billed charges,,100% of DHS outpatient percentage
Ct Upper Extremity With Contrast,,73201,CPT,Facility,Inpatient,,,,1581,1343.85,561.34,1581,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Ct Upper Extremity Without And With Contrast,,73202,CPT,Facility,Both,,,,1836,1560.6,412.496,1836,Aetna,Commercial,1689.12,92,,percent of total billed charges,,
Ct Upper Extremity Without And With Contrast,,73202,CPT,Facility,Outpatient,,,,1836,1560.6,412.496,1836,Aetna,Medicare Advantage,899.64,49,,percent of total billed charges,,
Ct Upper Extremity Without And With Contrast,,73202,CPT,Facility,Inpatient,,,,1836,1560.6,412.496,1836,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Ct Upper Extremity Without And With Contrast,,73202,CPT,Facility,Both,,,,1836,1560.6,412.496,1836,Aetna,PPO,1707.48,93,,percent of total billed charges,,
Ct Upper Extremity Without And With Contrast,,73202,CPT,Facility,Both,,,,1836,1560.6,412.496,1836,America's PPO,America's PPO,1763.1108,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Ct Upper Extremity Without And With Contrast,,73202,CPT,Facility,Both,,,,1836,1560.6,412.496,1836,BlueCross BlueShield Minnesota, Federal Employee Program,812,,,Fee schedule,,100% of BCBS commercial commodity fee schedule
Ct Upper Extremity Without And With Contrast,,73202,CPT,Facility,Both,,,,1836,1560.6,412.496,1836,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,824.992,,,Fee schedule,,"100% of BCBS commercial commodity fee schedule, plus MN Care tax"
Ct Upper Extremity Without And With Contrast,,73202,CPT,Facility,Both,,,,1836,1560.6,412.496,1836,BlueCross BlueShield Minnesota,High Value Network Plan,742.4928,,,Fee schedule,,"90% of BCBS commercial commodity fee schedule, plus MN Care tax; see disclaimer for more information"
Ct Upper Extremity Without And With Contrast,,73202,CPT,Facility,Outpatient,,,,1836,1560.6,412.496,1836,BlueCross BlueShield Minnesota,Medicare Advantage,899.64,49,,percent of total billed charges,,
Ct Upper Extremity Without And With Contrast,,73202,CPT,Facility,Inpatient,,,,1836,1560.6,412.496,1836,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Ct Upper Extremity Without And With Contrast,,73202,CPT,Facility,Both,,,,1836,1560.6,412.496,1836,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,730.6954144,,,Fee schedule,,"88.57% of BCBS commercial commodity fee schedule, plus MN Care tax"
Ct Upper Extremity Without And With Contrast,,73202,CPT,Facility,Both,,,,1836,1560.6,412.496,1836,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,412.496,,,Fee schedule,,"100% of BCBS Medicaid commodity fee schedule, plus MN Care tax"
Ct Upper Extremity Without And With Contrast,,73202,CPT,Facility,Outpatient,,,,1836,1560.6,412.496,1836,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),899.64,49,,percent of total billed charges,,
Ct Upper Extremity Without And With Contrast,,73202,CPT,Facility,Inpatient,,,,1836,1560.6,412.496,1836,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Ct Upper Extremity Without And With Contrast,,73202,CPT,Facility,Both,,,,1836,1560.6,412.496,1836,CorVel,Worker's Compensation,1836,100,,percent of total billed charges,,
Ct Upper Extremity Without And With Contrast,,73202,CPT,Facility,Both,,,,1836,1560.6,412.496,1836,First Health Group Corporation,First Health Network,1780.92,97,,percent of total billed charges,,
Ct Upper Extremity Without And With Contrast,,73202,CPT,Facility,Both,,,,1836,1560.6,412.496,1836,"Health Partners, Inc.",Commercial,1736.856,94.6,,percent of total billed charges,,
Ct Upper Extremity Without And With Contrast,,73202,CPT,Facility,Outpatient,,,,1836,1560.6,412.496,1836,"Health Partners, Inc.",Medicare Advantage,899.64,49,,percent of total billed charges,,
Ct Upper Extremity Without And With Contrast,,73202,CPT,Facility,Inpatient,,,,1836,1560.6,412.496,1836,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ct Upper Extremity Without And With Contrast,,73202,CPT,Facility,Both,,,,1836,1560.6,412.496,1836,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1101.6,60,,percent of total billed charges,,
Ct Upper Extremity Without And With Contrast,,73202,CPT,Facility,Both,,,,1836,1560.6,412.496,1836,"Health Partners, Inc.",State of Minnesota Advantage Program,1496.34,81.5,,percent of total billed charges,,
Ct Upper Extremity Without And With Contrast,,73202,CPT,Facility,Both,,,,1836,1560.6,412.496,1836,"Health Partners, Inc.",State Public Programs,918,50,,percent of total billed charges,,
Ct Upper Extremity Without And With Contrast,,73202,CPT,Facility,Both,,,,1836,1560.6,412.496,1836,Humana Insurance Company,Commercial PPO,1744.2,95,,percent of total billed charges,,
Ct Upper Extremity Without And With Contrast,,73202,CPT,Facility,Outpatient,,,,1836,1560.6,412.496,1836,Humana Insurance Company,Medicare PPO,899.64,49,,percent of total billed charges,,
Ct Upper Extremity Without And With Contrast,,73202,CPT,Facility,Inpatient,,,,1836,1560.6,412.496,1836,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Ct Upper Extremity Without And With Contrast,,73202,CPT,Facility,Both,,,,1836,1560.6,412.496,1836,Medica,Individual & Family,1819.476,99.1,,percent of total billed charges,,
Ct Upper Extremity Without And With Contrast,,73202,CPT,Facility,Outpatient,,,,1836,1560.6,412.496,1836,Medica,Medica Advantage Solution,914.328,49.8,,percent of total billed charges,,
Ct Upper Extremity Without And With Contrast,,73202,CPT,Facility,Inpatient,,,,1836,1560.6,412.496,1836,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Ct Upper Extremity Without And With Contrast,,73202,CPT,Facility,Outpatient,,,,1836,1560.6,412.496,1836,Medica,Medical Assistance,818.856,44.6,,percent of total billed charges,,
Ct Upper Extremity Without And With Contrast,,73202,CPT,Facility,Inpatient,,,,1836,1560.6,412.496,1836,Medica,Medical Assistance,,,,,Included in per diem rate,
Ct Upper Extremity Without And With Contrast,,73202,CPT,Facility,Outpatient,,,,1836,1560.6,412.496,1836,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,914.328,49.8,,percent of total billed charges,,
Ct Upper Extremity Without And With Contrast,,73202,CPT,Facility,Inpatient,,,,1836,1560.6,412.496,1836,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Ct Upper Extremity Without And With Contrast,,73202,CPT,Facility,Both,,,,1836,1560.6,412.496,1836,"Multiplan, Inc.","Multiplan, Inc.",1725.84,94,,percent of total billed charges,,
Ct Upper Extremity Without And With Contrast,,73202,CPT,Facility,Outpatient,,,,1836,1560.6,412.496,1836,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1283,,,Other,Per scan,
Ct Upper Extremity Without And With Contrast,,73202,CPT,Facility,Inpatient,,,,1836,1560.6,412.496,1836,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Ct Upper Extremity Without And With Contrast,,73202,CPT,Facility,Both,,,,1836,1560.6,412.496,1836,"Preferred One Administrative Services, INC.",PPO,1810.296,98.6,,percent of total billed charges,,
Ct Upper Extremity Without And With Contrast,,73202,CPT,Facility,Outpatient,,,,1836,1560.6,412.496,1836,PrimeWest Health,Minnesota Senior Health Options (MSHO),944.622,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Ct Upper Extremity Without And With Contrast,,73202,CPT,Facility,Inpatient,,,,1836,1560.6,412.496,1836,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ct Upper Extremity Without And With Contrast,,73202,CPT,Facility,Outpatient,,,,1836,1560.6,412.496,1836,PrimeWest Health,MinnesotaCare,942.9696,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Ct Upper Extremity Without And With Contrast,,73202,CPT,Facility,Inpatient,,,,1836,1560.6,412.496,1836,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Ct Upper Extremity Without And With Contrast,,73202,CPT,Facility,Both,,,,1836,1560.6,412.496,1836,Sanford Health Plan,Sanford Health Plan,1689.12,92,,percent of total billed charges,,
Ct Upper Extremity Without And With Contrast,,73202,CPT,Facility,Outpatient,,,,1836,1560.6,412.496,1836,"UCare Health, Inc.",Individual & Family Plan,1034.586,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Ct Upper Extremity Without And With Contrast,,73202,CPT,Facility,Inpatient,,,,1836,1560.6,412.496,1836,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Ct Upper Extremity Without And With Contrast,,73202,CPT,Facility,Outpatient,,,,1836,1560.6,412.496,1836,"UCare Health, Inc.",Medical Assistance,926.6292,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ct Upper Extremity Without And With Contrast,,73202,CPT,Facility,Inpatient,,,,1836,1560.6,412.496,1836,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Ct Upper Extremity Without And With Contrast,,73202,CPT,Facility,Outpatient,,,,1836,1560.6,412.496,1836,"UCare Health, Inc.",Medicare Advantage,926.6292,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ct Upper Extremity Without And With Contrast,,73202,CPT,Facility,Inpatient,,,,1836,1560.6,412.496,1836,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ct Upper Extremity Without And With Contrast,,73202,CPT,Facility,Outpatient,,,,1836,1560.6,412.496,1836,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),926.6292,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ct Upper Extremity Without And With Contrast,,73202,CPT,Facility,Inpatient,,,,1836,1560.6,412.496,1836,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ct Upper Extremity Without And With Contrast,,73202,CPT,Facility,Both,,,,1836,1560.6,412.496,1836,UnitedHealthcare,Individual & Family,1725.84,94,,percent of total billed charges,,
Ct Upper Extremity Without And With Contrast,,73202,CPT,Facility,Outpatient,,,,1836,1560.6,412.496,1836,UnitedHealthcare,Medicare Advantage,899.64,49,,percent of total billed charges,,
Ct Upper Extremity Without And With Contrast,,73202,CPT,Facility,Inpatient,,,,1836,1560.6,412.496,1836,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Ct Upper Extremity Without And With Contrast,,73202,CPT,Facility,Outpatient,,,,1836,1560.6,412.496,1836,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,881.28,48,,percent of total billed charges,,100% of DHS outpatient percentage
Ct Upper Extremity Without And With Contrast,,73202,CPT,Facility,Inpatient,,,,1836,1560.6,412.496,1836,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Xr Hips, Bilateral W/Pelvis When Performed; 2 Views",,73521,CPT,Facility,Both,,,,408,346.8,116.9328,408,Aetna,Commercial,375.36,92,,percent of total billed charges,,
"Xr Hips, Bilateral W/Pelvis When Performed; 2 Views",,73521,CPT,Facility,Outpatient,,,,408,346.8,116.9328,408,Aetna,Medicare Advantage,199.92,49,,percent of total billed charges,,
"Xr Hips, Bilateral W/Pelvis When Performed; 2 Views",,73521,CPT,Facility,Inpatient,,,,408,346.8,116.9328,408,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Xr Hips, Bilateral W/Pelvis When Performed; 2 Views",,73521,CPT,Facility,Both,,,,408,346.8,116.9328,408,Aetna,PPO,379.44,93,,percent of total billed charges,,
"Xr Hips, Bilateral W/Pelvis When Performed; 2 Views",,73521,CPT,Facility,Both,,,,408,346.8,116.9328,408,America's PPO,America's PPO,391.8024,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Xr Hips, Bilateral W/Pelvis When Performed; 2 Views",,73521,CPT,Facility,Both,,,,408,346.8,116.9328,408,BlueCross BlueShield Minnesota, Federal Employee Program,401.472,98.4,,percent of total billed charges,,
"Xr Hips, Bilateral W/Pelvis When Performed; 2 Views",,73521,CPT,Facility,Both,,,,408,346.8,116.9328,408,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,408,100,,percent of total billed charges,,
"Xr Hips, Bilateral W/Pelvis When Performed; 2 Views",,73521,CPT,Facility,Both,,,,408,346.8,116.9328,408,BlueCross BlueShield Minnesota,High Value Network Plan,367.2,90,,percent of total billed charges,,
"Xr Hips, Bilateral W/Pelvis When Performed; 2 Views",,73521,CPT,Facility,Outpatient,,,,408,346.8,116.9328,408,BlueCross BlueShield Minnesota,Medicare Advantage,199.92,49,,percent of total billed charges,,
"Xr Hips, Bilateral W/Pelvis When Performed; 2 Views",,73521,CPT,Facility,Inpatient,,,,408,346.8,116.9328,408,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Xr Hips, Bilateral W/Pelvis When Performed; 2 Views",,73521,CPT,Facility,Both,,,,408,346.8,116.9328,408,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,361.3656,88.57,,percent of total billed charges,,
"Xr Hips, Bilateral W/Pelvis When Performed; 2 Views",,73521,CPT,Facility,Both,,,,408,346.8,116.9328,408,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,116.9328,28.66,,percent of total billed charges,,
"Xr Hips, Bilateral W/Pelvis When Performed; 2 Views",,73521,CPT,Facility,Outpatient,,,,408,346.8,116.9328,408,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),199.92,49,,percent of total billed charges,,
"Xr Hips, Bilateral W/Pelvis When Performed; 2 Views",,73521,CPT,Facility,Inpatient,,,,408,346.8,116.9328,408,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Xr Hips, Bilateral W/Pelvis When Performed; 2 Views",,73521,CPT,Facility,Both,,,,408,346.8,116.9328,408,CorVel,Worker's Compensation,408,100,,percent of total billed charges,,
"Xr Hips, Bilateral W/Pelvis When Performed; 2 Views",,73521,CPT,Facility,Both,,,,408,346.8,116.9328,408,First Health Group Corporation,First Health Network,395.76,97,,percent of total billed charges,,
"Xr Hips, Bilateral W/Pelvis When Performed; 2 Views",,73521,CPT,Facility,Both,,,,408,346.8,116.9328,408,"Health Partners, Inc.",Commercial,385.968,94.6,,percent of total billed charges,,
"Xr Hips, Bilateral W/Pelvis When Performed; 2 Views",,73521,CPT,Facility,Outpatient,,,,408,346.8,116.9328,408,"Health Partners, Inc.",Medicare Advantage,199.92,49,,percent of total billed charges,,
"Xr Hips, Bilateral W/Pelvis When Performed; 2 Views",,73521,CPT,Facility,Inpatient,,,,408,346.8,116.9328,408,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Xr Hips, Bilateral W/Pelvis When Performed; 2 Views",,73521,CPT,Facility,Both,,,,408,346.8,116.9328,408,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),244.8,60,,percent of total billed charges,,
"Xr Hips, Bilateral W/Pelvis When Performed; 2 Views",,73521,CPT,Facility,Both,,,,408,346.8,116.9328,408,"Health Partners, Inc.",State of Minnesota Advantage Program,332.52,81.5,,percent of total billed charges,,
"Xr Hips, Bilateral W/Pelvis When Performed; 2 Views",,73521,CPT,Facility,Both,,,,408,346.8,116.9328,408,"Health Partners, Inc.",State Public Programs,204,50,,percent of total billed charges,,
"Xr Hips, Bilateral W/Pelvis When Performed; 2 Views",,73521,CPT,Facility,Both,,,,408,346.8,116.9328,408,Humana Insurance Company,Commercial PPO,387.6,95,,percent of total billed charges,,
"Xr Hips, Bilateral W/Pelvis When Performed; 2 Views",,73521,CPT,Facility,Outpatient,,,,408,346.8,116.9328,408,Humana Insurance Company,Medicare PPO,199.92,49,,percent of total billed charges,,
"Xr Hips, Bilateral W/Pelvis When Performed; 2 Views",,73521,CPT,Facility,Inpatient,,,,408,346.8,116.9328,408,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Xr Hips, Bilateral W/Pelvis When Performed; 2 Views",,73521,CPT,Facility,Both,,,,408,346.8,116.9328,408,Medica,Individual & Family,404.328,99.1,,percent of total billed charges,,
"Xr Hips, Bilateral W/Pelvis When Performed; 2 Views",,73521,CPT,Facility,Outpatient,,,,408,346.8,116.9328,408,Medica,Medica Advantage Solution,203.184,49.8,,percent of total billed charges,,
"Xr Hips, Bilateral W/Pelvis When Performed; 2 Views",,73521,CPT,Facility,Inpatient,,,,408,346.8,116.9328,408,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Xr Hips, Bilateral W/Pelvis When Performed; 2 Views",,73521,CPT,Facility,Outpatient,,,,408,346.8,116.9328,408,Medica,Medical Assistance,181.968,44.6,,percent of total billed charges,,
"Xr Hips, Bilateral W/Pelvis When Performed; 2 Views",,73521,CPT,Facility,Inpatient,,,,408,346.8,116.9328,408,Medica,Medical Assistance,,,,,Included in per diem rate,
"Xr Hips, Bilateral W/Pelvis When Performed; 2 Views",,73521,CPT,Facility,Outpatient,,,,408,346.8,116.9328,408,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,203.184,49.8,,percent of total billed charges,,
"Xr Hips, Bilateral W/Pelvis When Performed; 2 Views",,73521,CPT,Facility,Inpatient,,,,408,346.8,116.9328,408,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Xr Hips, Bilateral W/Pelvis When Performed; 2 Views",,73521,CPT,Facility,Both,,,,408,346.8,116.9328,408,"Multiplan, Inc.","Multiplan, Inc.",383.52,94,,percent of total billed charges,,
"Xr Hips, Bilateral W/Pelvis When Performed; 2 Views",,73521,CPT,Facility,Outpatient,,,,408,346.8,116.9328,408,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,367.608,90.1,,percent of total billed charges,,
"Xr Hips, Bilateral W/Pelvis When Performed; 2 Views",,73521,CPT,Facility,Inpatient,,,,408,346.8,116.9328,408,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Xr Hips, Bilateral W/Pelvis When Performed; 2 Views",,73521,CPT,Facility,Both,,,,408,346.8,116.9328,408,"Preferred One Administrative Services, INC.",PPO,402.288,98.6,,percent of total billed charges,,
"Xr Hips, Bilateral W/Pelvis When Performed; 2 Views",,73521,CPT,Facility,Outpatient,,,,408,346.8,116.9328,408,PrimeWest Health,Minnesota Senior Health Options (MSHO),209.916,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Xr Hips, Bilateral W/Pelvis When Performed; 2 Views",,73521,CPT,Facility,Inpatient,,,,408,346.8,116.9328,408,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Xr Hips, Bilateral W/Pelvis When Performed; 2 Views",,73521,CPT,Facility,Outpatient,,,,408,346.8,116.9328,408,PrimeWest Health,MinnesotaCare,209.5488,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Xr Hips, Bilateral W/Pelvis When Performed; 2 Views",,73521,CPT,Facility,Inpatient,,,,408,346.8,116.9328,408,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Xr Hips, Bilateral W/Pelvis When Performed; 2 Views",,73521,CPT,Facility,Both,,,,408,346.8,116.9328,408,Sanford Health Plan,Sanford Health Plan,375.36,92,,percent of total billed charges,,
"Xr Hips, Bilateral W/Pelvis When Performed; 2 Views",,73521,CPT,Facility,Outpatient,,,,408,346.8,116.9328,408,"UCare Health, Inc.",Individual & Family Plan,229.908,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Xr Hips, Bilateral W/Pelvis When Performed; 2 Views",,73521,CPT,Facility,Inpatient,,,,408,346.8,116.9328,408,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Xr Hips, Bilateral W/Pelvis When Performed; 2 Views",,73521,CPT,Facility,Outpatient,,,,408,346.8,116.9328,408,"UCare Health, Inc.",Medical Assistance,205.9176,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Xr Hips, Bilateral W/Pelvis When Performed; 2 Views",,73521,CPT,Facility,Inpatient,,,,408,346.8,116.9328,408,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Xr Hips, Bilateral W/Pelvis When Performed; 2 Views",,73521,CPT,Facility,Outpatient,,,,408,346.8,116.9328,408,"UCare Health, Inc.",Medicare Advantage,205.9176,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Xr Hips, Bilateral W/Pelvis When Performed; 2 Views",,73521,CPT,Facility,Inpatient,,,,408,346.8,116.9328,408,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Xr Hips, Bilateral W/Pelvis When Performed; 2 Views",,73521,CPT,Facility,Outpatient,,,,408,346.8,116.9328,408,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),205.9176,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Xr Hips, Bilateral W/Pelvis When Performed; 2 Views",,73521,CPT,Facility,Inpatient,,,,408,346.8,116.9328,408,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Xr Hips, Bilateral W/Pelvis When Performed; 2 Views",,73521,CPT,Facility,Both,,,,408,346.8,116.9328,408,UnitedHealthcare,Individual & Family,383.52,94,,percent of total billed charges,,
"Xr Hips, Bilateral W/Pelvis When Performed; 2 Views",,73521,CPT,Facility,Outpatient,,,,408,346.8,116.9328,408,UnitedHealthcare,Medicare Advantage,199.92,49,,percent of total billed charges,,
"Xr Hips, Bilateral W/Pelvis When Performed; 2 Views",,73521,CPT,Facility,Inpatient,,,,408,346.8,116.9328,408,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Xr Hips, Bilateral W/Pelvis When Performed; 2 Views",,73521,CPT,Facility,Outpatient,,,,408,346.8,116.9328,408,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,195.84,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Xr Hips, Bilateral W/Pelvis When Performed; 2 Views",,73521,CPT,Facility,Inpatient,,,,408,346.8,116.9328,408,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Xr Pelvis Bilateral Hips (3-4 Views),,73522,CPT,Facility,Both,,,,434,368.9,124.3844,434,Aetna,Commercial,399.28,92,,percent of total billed charges,,
Xr Pelvis Bilateral Hips (3-4 Views),,73522,CPT,Facility,Outpatient,,,,434,368.9,124.3844,434,Aetna,Medicare Advantage,212.66,49,,percent of total billed charges,,
Xr Pelvis Bilateral Hips (3-4 Views),,73522,CPT,Facility,Inpatient,,,,434,368.9,124.3844,434,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Xr Pelvis Bilateral Hips (3-4 Views),,73522,CPT,Facility,Both,,,,434,368.9,124.3844,434,Aetna,PPO,403.62,93,,percent of total billed charges,,
Xr Pelvis Bilateral Hips (3-4 Views),,73522,CPT,Facility,Both,,,,434,368.9,124.3844,434,America's PPO,America's PPO,416.7702,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Xr Pelvis Bilateral Hips (3-4 Views),,73522,CPT,Facility,Both,,,,434,368.9,124.3844,434,BlueCross BlueShield Minnesota, Federal Employee Program,427.056,98.4,,percent of total billed charges,,
Xr Pelvis Bilateral Hips (3-4 Views),,73522,CPT,Facility,Both,,,,434,368.9,124.3844,434,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,434,100,,percent of total billed charges,,
Xr Pelvis Bilateral Hips (3-4 Views),,73522,CPT,Facility,Both,,,,434,368.9,124.3844,434,BlueCross BlueShield Minnesota,High Value Network Plan,390.6,90,,percent of total billed charges,,
Xr Pelvis Bilateral Hips (3-4 Views),,73522,CPT,Facility,Outpatient,,,,434,368.9,124.3844,434,BlueCross BlueShield Minnesota,Medicare Advantage,212.66,49,,percent of total billed charges,,
Xr Pelvis Bilateral Hips (3-4 Views),,73522,CPT,Facility,Inpatient,,,,434,368.9,124.3844,434,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Xr Pelvis Bilateral Hips (3-4 Views),,73522,CPT,Facility,Both,,,,434,368.9,124.3844,434,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,384.3938,88.57,,percent of total billed charges,,
Xr Pelvis Bilateral Hips (3-4 Views),,73522,CPT,Facility,Both,,,,434,368.9,124.3844,434,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,124.3844,28.66,,percent of total billed charges,,
Xr Pelvis Bilateral Hips (3-4 Views),,73522,CPT,Facility,Outpatient,,,,434,368.9,124.3844,434,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),212.66,49,,percent of total billed charges,,
Xr Pelvis Bilateral Hips (3-4 Views),,73522,CPT,Facility,Inpatient,,,,434,368.9,124.3844,434,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Xr Pelvis Bilateral Hips (3-4 Views),,73522,CPT,Facility,Both,,,,434,368.9,124.3844,434,CorVel,Worker's Compensation,434,100,,percent of total billed charges,,
Xr Pelvis Bilateral Hips (3-4 Views),,73522,CPT,Facility,Both,,,,434,368.9,124.3844,434,First Health Group Corporation,First Health Network,420.98,97,,percent of total billed charges,,
Xr Pelvis Bilateral Hips (3-4 Views),,73522,CPT,Facility,Both,,,,434,368.9,124.3844,434,"Health Partners, Inc.",Commercial,410.564,94.6,,percent of total billed charges,,
Xr Pelvis Bilateral Hips (3-4 Views),,73522,CPT,Facility,Outpatient,,,,434,368.9,124.3844,434,"Health Partners, Inc.",Medicare Advantage,212.66,49,,percent of total billed charges,,
Xr Pelvis Bilateral Hips (3-4 Views),,73522,CPT,Facility,Inpatient,,,,434,368.9,124.3844,434,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Pelvis Bilateral Hips (3-4 Views),,73522,CPT,Facility,Both,,,,434,368.9,124.3844,434,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),260.4,60,,percent of total billed charges,,
Xr Pelvis Bilateral Hips (3-4 Views),,73522,CPT,Facility,Both,,,,434,368.9,124.3844,434,"Health Partners, Inc.",State of Minnesota Advantage Program,353.71,81.5,,percent of total billed charges,,
Xr Pelvis Bilateral Hips (3-4 Views),,73522,CPT,Facility,Both,,,,434,368.9,124.3844,434,"Health Partners, Inc.",State Public Programs,217,50,,percent of total billed charges,,
Xr Pelvis Bilateral Hips (3-4 Views),,73522,CPT,Facility,Both,,,,434,368.9,124.3844,434,Humana Insurance Company,Commercial PPO,412.3,95,,percent of total billed charges,,
Xr Pelvis Bilateral Hips (3-4 Views),,73522,CPT,Facility,Outpatient,,,,434,368.9,124.3844,434,Humana Insurance Company,Medicare PPO,212.66,49,,percent of total billed charges,,
Xr Pelvis Bilateral Hips (3-4 Views),,73522,CPT,Facility,Inpatient,,,,434,368.9,124.3844,434,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Xr Pelvis Bilateral Hips (3-4 Views),,73522,CPT,Facility,Both,,,,434,368.9,124.3844,434,Medica,Individual & Family,430.094,99.1,,percent of total billed charges,,
Xr Pelvis Bilateral Hips (3-4 Views),,73522,CPT,Facility,Outpatient,,,,434,368.9,124.3844,434,Medica,Medica Advantage Solution,216.132,49.8,,percent of total billed charges,,
Xr Pelvis Bilateral Hips (3-4 Views),,73522,CPT,Facility,Inpatient,,,,434,368.9,124.3844,434,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Xr Pelvis Bilateral Hips (3-4 Views),,73522,CPT,Facility,Outpatient,,,,434,368.9,124.3844,434,Medica,Medical Assistance,193.564,44.6,,percent of total billed charges,,
Xr Pelvis Bilateral Hips (3-4 Views),,73522,CPT,Facility,Inpatient,,,,434,368.9,124.3844,434,Medica,Medical Assistance,,,,,Included in per diem rate,
Xr Pelvis Bilateral Hips (3-4 Views),,73522,CPT,Facility,Outpatient,,,,434,368.9,124.3844,434,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,216.132,49.8,,percent of total billed charges,,
Xr Pelvis Bilateral Hips (3-4 Views),,73522,CPT,Facility,Inpatient,,,,434,368.9,124.3844,434,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Xr Pelvis Bilateral Hips (3-4 Views),,73522,CPT,Facility,Both,,,,434,368.9,124.3844,434,"Multiplan, Inc.","Multiplan, Inc.",407.96,94,,percent of total billed charges,,
Xr Pelvis Bilateral Hips (3-4 Views),,73522,CPT,Facility,Outpatient,,,,434,368.9,124.3844,434,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,391.034,90.1,,percent of total billed charges,,
Xr Pelvis Bilateral Hips (3-4 Views),,73522,CPT,Facility,Inpatient,,,,434,368.9,124.3844,434,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Xr Pelvis Bilateral Hips (3-4 Views),,73522,CPT,Facility,Both,,,,434,368.9,124.3844,434,"Preferred One Administrative Services, INC.",PPO,427.924,98.6,,percent of total billed charges,,
Xr Pelvis Bilateral Hips (3-4 Views),,73522,CPT,Facility,Outpatient,,,,434,368.9,124.3844,434,PrimeWest Health,Minnesota Senior Health Options (MSHO),223.293,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Xr Pelvis Bilateral Hips (3-4 Views),,73522,CPT,Facility,Inpatient,,,,434,368.9,124.3844,434,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Pelvis Bilateral Hips (3-4 Views),,73522,CPT,Facility,Outpatient,,,,434,368.9,124.3844,434,PrimeWest Health,MinnesotaCare,222.9024,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Xr Pelvis Bilateral Hips (3-4 Views),,73522,CPT,Facility,Inpatient,,,,434,368.9,124.3844,434,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Xr Pelvis Bilateral Hips (3-4 Views),,73522,CPT,Facility,Both,,,,434,368.9,124.3844,434,Sanford Health Plan,Sanford Health Plan,399.28,92,,percent of total billed charges,,
Xr Pelvis Bilateral Hips (3-4 Views),,73522,CPT,Facility,Outpatient,,,,434,368.9,124.3844,434,"UCare Health, Inc.",Individual & Family Plan,244.559,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Xr Pelvis Bilateral Hips (3-4 Views),,73522,CPT,Facility,Inpatient,,,,434,368.9,124.3844,434,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Xr Pelvis Bilateral Hips (3-4 Views),,73522,CPT,Facility,Outpatient,,,,434,368.9,124.3844,434,"UCare Health, Inc.",Medical Assistance,219.0398,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Pelvis Bilateral Hips (3-4 Views),,73522,CPT,Facility,Inpatient,,,,434,368.9,124.3844,434,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Xr Pelvis Bilateral Hips (3-4 Views),,73522,CPT,Facility,Outpatient,,,,434,368.9,124.3844,434,"UCare Health, Inc.",Medicare Advantage,219.0398,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Pelvis Bilateral Hips (3-4 Views),,73522,CPT,Facility,Inpatient,,,,434,368.9,124.3844,434,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Pelvis Bilateral Hips (3-4 Views),,73522,CPT,Facility,Outpatient,,,,434,368.9,124.3844,434,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),219.0398,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Pelvis Bilateral Hips (3-4 Views),,73522,CPT,Facility,Inpatient,,,,434,368.9,124.3844,434,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Pelvis Bilateral Hips (3-4 Views),,73522,CPT,Facility,Both,,,,434,368.9,124.3844,434,UnitedHealthcare,Individual & Family,407.96,94,,percent of total billed charges,,
Xr Pelvis Bilateral Hips (3-4 Views),,73522,CPT,Facility,Outpatient,,,,434,368.9,124.3844,434,UnitedHealthcare,Medicare Advantage,212.66,49,,percent of total billed charges,,
Xr Pelvis Bilateral Hips (3-4 Views),,73522,CPT,Facility,Inpatient,,,,434,368.9,124.3844,434,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Xr Pelvis Bilateral Hips (3-4 Views),,73522,CPT,Facility,Outpatient,,,,434,368.9,124.3844,434,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,208.32,48,,percent of total billed charges,,100% of DHS outpatient percentage
Xr Pelvis Bilateral Hips (3-4 Views),,73522,CPT,Facility,Inpatient,,,,434,368.9,124.3844,434,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Xr Hips, Bilateral W/Pelvis When Performed; Min 5 Views",,73523,CPT,Facility,Both,,,,459,390.15,131.5494,459,Aetna,Commercial,422.28,92,,percent of total billed charges,,
"Xr Hips, Bilateral W/Pelvis When Performed; Min 5 Views",,73523,CPT,Facility,Outpatient,,,,459,390.15,131.5494,459,Aetna,Medicare Advantage,224.91,49,,percent of total billed charges,,
"Xr Hips, Bilateral W/Pelvis When Performed; Min 5 Views",,73523,CPT,Facility,Inpatient,,,,459,390.15,131.5494,459,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Xr Hips, Bilateral W/Pelvis When Performed; Min 5 Views",,73523,CPT,Facility,Both,,,,459,390.15,131.5494,459,Aetna,PPO,426.87,93,,percent of total billed charges,,
"Xr Hips, Bilateral W/Pelvis When Performed; Min 5 Views",,73523,CPT,Facility,Both,,,,459,390.15,131.5494,459,America's PPO,America's PPO,440.7777,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Xr Hips, Bilateral W/Pelvis When Performed; Min 5 Views",,73523,CPT,Facility,Both,,,,459,390.15,131.5494,459,BlueCross BlueShield Minnesota, Federal Employee Program,451.656,98.4,,percent of total billed charges,,
"Xr Hips, Bilateral W/Pelvis When Performed; Min 5 Views",,73523,CPT,Facility,Both,,,,459,390.15,131.5494,459,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,459,100,,percent of total billed charges,,
"Xr Hips, Bilateral W/Pelvis When Performed; Min 5 Views",,73523,CPT,Facility,Both,,,,459,390.15,131.5494,459,BlueCross BlueShield Minnesota,High Value Network Plan,413.1,90,,percent of total billed charges,,
"Xr Hips, Bilateral W/Pelvis When Performed; Min 5 Views",,73523,CPT,Facility,Outpatient,,,,459,390.15,131.5494,459,BlueCross BlueShield Minnesota,Medicare Advantage,224.91,49,,percent of total billed charges,,
"Xr Hips, Bilateral W/Pelvis When Performed; Min 5 Views",,73523,CPT,Facility,Inpatient,,,,459,390.15,131.5494,459,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Xr Hips, Bilateral W/Pelvis When Performed; Min 5 Views",,73523,CPT,Facility,Both,,,,459,390.15,131.5494,459,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,406.5363,88.57,,percent of total billed charges,,
"Xr Hips, Bilateral W/Pelvis When Performed; Min 5 Views",,73523,CPT,Facility,Both,,,,459,390.15,131.5494,459,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,131.5494,28.66,,percent of total billed charges,,
"Xr Hips, Bilateral W/Pelvis When Performed; Min 5 Views",,73523,CPT,Facility,Outpatient,,,,459,390.15,131.5494,459,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),224.91,49,,percent of total billed charges,,
"Xr Hips, Bilateral W/Pelvis When Performed; Min 5 Views",,73523,CPT,Facility,Inpatient,,,,459,390.15,131.5494,459,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Xr Hips, Bilateral W/Pelvis When Performed; Min 5 Views",,73523,CPT,Facility,Both,,,,459,390.15,131.5494,459,CorVel,Worker's Compensation,459,100,,percent of total billed charges,,
"Xr Hips, Bilateral W/Pelvis When Performed; Min 5 Views",,73523,CPT,Facility,Both,,,,459,390.15,131.5494,459,First Health Group Corporation,First Health Network,445.23,97,,percent of total billed charges,,
"Xr Hips, Bilateral W/Pelvis When Performed; Min 5 Views",,73523,CPT,Facility,Both,,,,459,390.15,131.5494,459,"Health Partners, Inc.",Commercial,434.214,94.6,,percent of total billed charges,,
"Xr Hips, Bilateral W/Pelvis When Performed; Min 5 Views",,73523,CPT,Facility,Outpatient,,,,459,390.15,131.5494,459,"Health Partners, Inc.",Medicare Advantage,224.91,49,,percent of total billed charges,,
"Xr Hips, Bilateral W/Pelvis When Performed; Min 5 Views",,73523,CPT,Facility,Inpatient,,,,459,390.15,131.5494,459,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Xr Hips, Bilateral W/Pelvis When Performed; Min 5 Views",,73523,CPT,Facility,Both,,,,459,390.15,131.5494,459,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),275.4,60,,percent of total billed charges,,
"Xr Hips, Bilateral W/Pelvis When Performed; Min 5 Views",,73523,CPT,Facility,Both,,,,459,390.15,131.5494,459,"Health Partners, Inc.",State of Minnesota Advantage Program,374.085,81.5,,percent of total billed charges,,
"Xr Hips, Bilateral W/Pelvis When Performed; Min 5 Views",,73523,CPT,Facility,Both,,,,459,390.15,131.5494,459,"Health Partners, Inc.",State Public Programs,229.5,50,,percent of total billed charges,,
"Xr Hips, Bilateral W/Pelvis When Performed; Min 5 Views",,73523,CPT,Facility,Both,,,,459,390.15,131.5494,459,Humana Insurance Company,Commercial PPO,436.05,95,,percent of total billed charges,,
"Xr Hips, Bilateral W/Pelvis When Performed; Min 5 Views",,73523,CPT,Facility,Outpatient,,,,459,390.15,131.5494,459,Humana Insurance Company,Medicare PPO,224.91,49,,percent of total billed charges,,
"Xr Hips, Bilateral W/Pelvis When Performed; Min 5 Views",,73523,CPT,Facility,Inpatient,,,,459,390.15,131.5494,459,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Xr Hips, Bilateral W/Pelvis When Performed; Min 5 Views",,73523,CPT,Facility,Both,,,,459,390.15,131.5494,459,Medica,Individual & Family,454.869,99.1,,percent of total billed charges,,
"Xr Hips, Bilateral W/Pelvis When Performed; Min 5 Views",,73523,CPT,Facility,Outpatient,,,,459,390.15,131.5494,459,Medica,Medica Advantage Solution,228.582,49.8,,percent of total billed charges,,
"Xr Hips, Bilateral W/Pelvis When Performed; Min 5 Views",,73523,CPT,Facility,Inpatient,,,,459,390.15,131.5494,459,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Xr Hips, Bilateral W/Pelvis When Performed; Min 5 Views",,73523,CPT,Facility,Outpatient,,,,459,390.15,131.5494,459,Medica,Medical Assistance,204.714,44.6,,percent of total billed charges,,
"Xr Hips, Bilateral W/Pelvis When Performed; Min 5 Views",,73523,CPT,Facility,Inpatient,,,,459,390.15,131.5494,459,Medica,Medical Assistance,,,,,Included in per diem rate,
"Xr Hips, Bilateral W/Pelvis When Performed; Min 5 Views",,73523,CPT,Facility,Outpatient,,,,459,390.15,131.5494,459,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,228.582,49.8,,percent of total billed charges,,
"Xr Hips, Bilateral W/Pelvis When Performed; Min 5 Views",,73523,CPT,Facility,Inpatient,,,,459,390.15,131.5494,459,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Xr Hips, Bilateral W/Pelvis When Performed; Min 5 Views",,73523,CPT,Facility,Both,,,,459,390.15,131.5494,459,"Multiplan, Inc.","Multiplan, Inc.",431.46,94,,percent of total billed charges,,
"Xr Hips, Bilateral W/Pelvis When Performed; Min 5 Views",,73523,CPT,Facility,Outpatient,,,,459,390.15,131.5494,459,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,413.559,90.1,,percent of total billed charges,,
"Xr Hips, Bilateral W/Pelvis When Performed; Min 5 Views",,73523,CPT,Facility,Inpatient,,,,459,390.15,131.5494,459,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Xr Hips, Bilateral W/Pelvis When Performed; Min 5 Views",,73523,CPT,Facility,Both,,,,459,390.15,131.5494,459,"Preferred One Administrative Services, INC.",PPO,452.574,98.6,,percent of total billed charges,,
"Xr Hips, Bilateral W/Pelvis When Performed; Min 5 Views",,73523,CPT,Facility,Outpatient,,,,459,390.15,131.5494,459,PrimeWest Health,Minnesota Senior Health Options (MSHO),236.1555,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Xr Hips, Bilateral W/Pelvis When Performed; Min 5 Views",,73523,CPT,Facility,Inpatient,,,,459,390.15,131.5494,459,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Xr Hips, Bilateral W/Pelvis When Performed; Min 5 Views",,73523,CPT,Facility,Outpatient,,,,459,390.15,131.5494,459,PrimeWest Health,MinnesotaCare,235.7424,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Xr Hips, Bilateral W/Pelvis When Performed; Min 5 Views",,73523,CPT,Facility,Inpatient,,,,459,390.15,131.5494,459,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Xr Hips, Bilateral W/Pelvis When Performed; Min 5 Views",,73523,CPT,Facility,Both,,,,459,390.15,131.5494,459,Sanford Health Plan,Sanford Health Plan,422.28,92,,percent of total billed charges,,
"Xr Hips, Bilateral W/Pelvis When Performed; Min 5 Views",,73523,CPT,Facility,Outpatient,,,,459,390.15,131.5494,459,"UCare Health, Inc.",Individual & Family Plan,258.6465,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Xr Hips, Bilateral W/Pelvis When Performed; Min 5 Views",,73523,CPT,Facility,Inpatient,,,,459,390.15,131.5494,459,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Xr Hips, Bilateral W/Pelvis When Performed; Min 5 Views",,73523,CPT,Facility,Outpatient,,,,459,390.15,131.5494,459,"UCare Health, Inc.",Medical Assistance,231.6573,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Xr Hips, Bilateral W/Pelvis When Performed; Min 5 Views",,73523,CPT,Facility,Inpatient,,,,459,390.15,131.5494,459,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Xr Hips, Bilateral W/Pelvis When Performed; Min 5 Views",,73523,CPT,Facility,Outpatient,,,,459,390.15,131.5494,459,"UCare Health, Inc.",Medicare Advantage,231.6573,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Xr Hips, Bilateral W/Pelvis When Performed; Min 5 Views",,73523,CPT,Facility,Inpatient,,,,459,390.15,131.5494,459,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Xr Hips, Bilateral W/Pelvis When Performed; Min 5 Views",,73523,CPT,Facility,Outpatient,,,,459,390.15,131.5494,459,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),231.6573,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Xr Hips, Bilateral W/Pelvis When Performed; Min 5 Views",,73523,CPT,Facility,Inpatient,,,,459,390.15,131.5494,459,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Xr Hips, Bilateral W/Pelvis When Performed; Min 5 Views",,73523,CPT,Facility,Both,,,,459,390.15,131.5494,459,UnitedHealthcare,Individual & Family,431.46,94,,percent of total billed charges,,
"Xr Hips, Bilateral W/Pelvis When Performed; Min 5 Views",,73523,CPT,Facility,Outpatient,,,,459,390.15,131.5494,459,UnitedHealthcare,Medicare Advantage,224.91,49,,percent of total billed charges,,
"Xr Hips, Bilateral W/Pelvis When Performed; Min 5 Views",,73523,CPT,Facility,Inpatient,,,,459,390.15,131.5494,459,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Xr Hips, Bilateral W/Pelvis When Performed; Min 5 Views",,73523,CPT,Facility,Outpatient,,,,459,390.15,131.5494,459,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,220.32,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Xr Hips, Bilateral W/Pelvis When Performed; Min 5 Views",,73523,CPT,Facility,Inpatient,,,,459,390.15,131.5494,459,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Xr Knees Bil Ap Standing,,73565,CPT,Facility,Both,,,,258,219.3,73.9428,258,Aetna,Commercial,237.36,92,,percent of total billed charges,,
Xr Knees Bil Ap Standing,,73565,CPT,Facility,Outpatient,,,,258,219.3,73.9428,258,Aetna,Medicare Advantage,126.42,49,,percent of total billed charges,,
Xr Knees Bil Ap Standing,,73565,CPT,Facility,Inpatient,,,,258,219.3,73.9428,258,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Xr Knees Bil Ap Standing,,73565,CPT,Facility,Both,,,,258,219.3,73.9428,258,Aetna,PPO,239.94,93,,percent of total billed charges,,
Xr Knees Bil Ap Standing,,73565,CPT,Facility,Both,,,,258,219.3,73.9428,258,America's PPO,America's PPO,247.7574,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Xr Knees Bil Ap Standing,,73565,CPT,Facility,Both,,,,258,219.3,73.9428,258,BlueCross BlueShield Minnesota, Federal Employee Program,253.872,98.4,,percent of total billed charges,,
Xr Knees Bil Ap Standing,,73565,CPT,Facility,Both,,,,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,258,100,,percent of total billed charges,,
Xr Knees Bil Ap Standing,,73565,CPT,Facility,Both,,,,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,High Value Network Plan,232.2,90,,percent of total billed charges,,
Xr Knees Bil Ap Standing,,73565,CPT,Facility,Outpatient,,,,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,Medicare Advantage,126.42,49,,percent of total billed charges,,
Xr Knees Bil Ap Standing,,73565,CPT,Facility,Inpatient,,,,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Xr Knees Bil Ap Standing,,73565,CPT,Facility,Both,,,,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,228.5106,88.57,,percent of total billed charges,,
Xr Knees Bil Ap Standing,,73565,CPT,Facility,Both,,,,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,73.9428,28.66,,percent of total billed charges,,
Xr Knees Bil Ap Standing,,73565,CPT,Facility,Outpatient,,,,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),126.42,49,,percent of total billed charges,,
Xr Knees Bil Ap Standing,,73565,CPT,Facility,Inpatient,,,,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Xr Knees Bil Ap Standing,,73565,CPT,Facility,Both,,,,258,219.3,73.9428,258,CorVel,Worker's Compensation,258,100,,percent of total billed charges,,
Xr Knees Bil Ap Standing,,73565,CPT,Facility,Both,,,,258,219.3,73.9428,258,First Health Group Corporation,First Health Network,250.26,97,,percent of total billed charges,,
Xr Knees Bil Ap Standing,,73565,CPT,Facility,Both,,,,258,219.3,73.9428,258,"Health Partners, Inc.",Commercial,244.068,94.6,,percent of total billed charges,,
Xr Knees Bil Ap Standing,,73565,CPT,Facility,Outpatient,,,,258,219.3,73.9428,258,"Health Partners, Inc.",Medicare Advantage,126.42,49,,percent of total billed charges,,
Xr Knees Bil Ap Standing,,73565,CPT,Facility,Inpatient,,,,258,219.3,73.9428,258,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Knees Bil Ap Standing,,73565,CPT,Facility,Both,,,,258,219.3,73.9428,258,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),154.8,60,,percent of total billed charges,,
Xr Knees Bil Ap Standing,,73565,CPT,Facility,Both,,,,258,219.3,73.9428,258,"Health Partners, Inc.",State of Minnesota Advantage Program,210.27,81.5,,percent of total billed charges,,
Xr Knees Bil Ap Standing,,73565,CPT,Facility,Both,,,,258,219.3,73.9428,258,"Health Partners, Inc.",State Public Programs,129,50,,percent of total billed charges,,
Xr Knees Bil Ap Standing,,73565,CPT,Facility,Both,,,,258,219.3,73.9428,258,Humana Insurance Company,Commercial PPO,245.1,95,,percent of total billed charges,,
Xr Knees Bil Ap Standing,,73565,CPT,Facility,Outpatient,,,,258,219.3,73.9428,258,Humana Insurance Company,Medicare PPO,126.42,49,,percent of total billed charges,,
Xr Knees Bil Ap Standing,,73565,CPT,Facility,Inpatient,,,,258,219.3,73.9428,258,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Xr Knees Bil Ap Standing,,73565,CPT,Facility,Both,,,,258,219.3,73.9428,258,Medica,Individual & Family,255.678,99.1,,percent of total billed charges,,
Xr Knees Bil Ap Standing,,73565,CPT,Facility,Outpatient,,,,258,219.3,73.9428,258,Medica,Medica Advantage Solution,128.484,49.8,,percent of total billed charges,,
Xr Knees Bil Ap Standing,,73565,CPT,Facility,Inpatient,,,,258,219.3,73.9428,258,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Xr Knees Bil Ap Standing,,73565,CPT,Facility,Outpatient,,,,258,219.3,73.9428,258,Medica,Medical Assistance,115.068,44.6,,percent of total billed charges,,
Xr Knees Bil Ap Standing,,73565,CPT,Facility,Inpatient,,,,258,219.3,73.9428,258,Medica,Medical Assistance,,,,,Included in per diem rate,
Xr Knees Bil Ap Standing,,73565,CPT,Facility,Outpatient,,,,258,219.3,73.9428,258,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,128.484,49.8,,percent of total billed charges,,
Xr Knees Bil Ap Standing,,73565,CPT,Facility,Inpatient,,,,258,219.3,73.9428,258,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Xr Knees Bil Ap Standing,,73565,CPT,Facility,Both,,,,258,219.3,73.9428,258,"Multiplan, Inc.","Multiplan, Inc.",242.52,94,,percent of total billed charges,,
Xr Knees Bil Ap Standing,,73565,CPT,Facility,Outpatient,,,,258,219.3,73.9428,258,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,232.458,90.1,,percent of total billed charges,,
Xr Knees Bil Ap Standing,,73565,CPT,Facility,Inpatient,,,,258,219.3,73.9428,258,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Xr Knees Bil Ap Standing,,73565,CPT,Facility,Both,,,,258,219.3,73.9428,258,"Preferred One Administrative Services, INC.",PPO,254.388,98.6,,percent of total billed charges,,
Xr Knees Bil Ap Standing,,73565,CPT,Facility,Outpatient,,,,258,219.3,73.9428,258,PrimeWest Health,Minnesota Senior Health Options (MSHO),132.741,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Xr Knees Bil Ap Standing,,73565,CPT,Facility,Inpatient,,,,258,219.3,73.9428,258,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Knees Bil Ap Standing,,73565,CPT,Facility,Outpatient,,,,258,219.3,73.9428,258,PrimeWest Health,MinnesotaCare,132.5088,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Xr Knees Bil Ap Standing,,73565,CPT,Facility,Inpatient,,,,258,219.3,73.9428,258,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Xr Knees Bil Ap Standing,,73565,CPT,Facility,Both,,,,258,219.3,73.9428,258,Sanford Health Plan,Sanford Health Plan,237.36,92,,percent of total billed charges,,
Xr Knees Bil Ap Standing,,73565,CPT,Facility,Outpatient,,,,258,219.3,73.9428,258,"UCare Health, Inc.",Individual & Family Plan,145.383,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Xr Knees Bil Ap Standing,,73565,CPT,Facility,Inpatient,,,,258,219.3,73.9428,258,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Xr Knees Bil Ap Standing,,73565,CPT,Facility,Outpatient,,,,258,219.3,73.9428,258,"UCare Health, Inc.",Medical Assistance,130.2126,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Knees Bil Ap Standing,,73565,CPT,Facility,Inpatient,,,,258,219.3,73.9428,258,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Xr Knees Bil Ap Standing,,73565,CPT,Facility,Outpatient,,,,258,219.3,73.9428,258,"UCare Health, Inc.",Medicare Advantage,130.2126,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Knees Bil Ap Standing,,73565,CPT,Facility,Inpatient,,,,258,219.3,73.9428,258,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Knees Bil Ap Standing,,73565,CPT,Facility,Outpatient,,,,258,219.3,73.9428,258,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),130.2126,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Knees Bil Ap Standing,,73565,CPT,Facility,Inpatient,,,,258,219.3,73.9428,258,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Knees Bil Ap Standing,,73565,CPT,Facility,Both,,,,258,219.3,73.9428,258,UnitedHealthcare,Individual & Family,242.52,94,,percent of total billed charges,,
Xr Knees Bil Ap Standing,,73565,CPT,Facility,Outpatient,,,,258,219.3,73.9428,258,UnitedHealthcare,Medicare Advantage,126.42,49,,percent of total billed charges,,
Xr Knees Bil Ap Standing,,73565,CPT,Facility,Inpatient,,,,258,219.3,73.9428,258,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Xr Knees Bil Ap Standing,,73565,CPT,Facility,Outpatient,,,,258,219.3,73.9428,258,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,123.84,48,,percent of total billed charges,,100% of DHS outpatient percentage
Xr Knees Bil Ap Standing,,73565,CPT,Facility,Inpatient,,,,258,219.3,73.9428,258,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Xr Knees Bil Ap Standing And Flex,,73565,CPT,Facility,Both,,,,258,219.3,73.9428,258,Aetna,Commercial,237.36,92,,percent of total billed charges,,
Xr Knees Bil Ap Standing And Flex,,73565,CPT,Facility,Outpatient,,,,258,219.3,73.9428,258,Aetna,Medicare Advantage,126.42,49,,percent of total billed charges,,
Xr Knees Bil Ap Standing And Flex,,73565,CPT,Facility,Inpatient,,,,258,219.3,73.9428,258,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Xr Knees Bil Ap Standing And Flex,,73565,CPT,Facility,Both,,,,258,219.3,73.9428,258,Aetna,PPO,239.94,93,,percent of total billed charges,,
Xr Knees Bil Ap Standing And Flex,,73565,CPT,Facility,Both,,,,258,219.3,73.9428,258,America's PPO,America's PPO,247.7574,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Xr Knees Bil Ap Standing And Flex,,73565,CPT,Facility,Both,,,,258,219.3,73.9428,258,BlueCross BlueShield Minnesota, Federal Employee Program,253.872,98.4,,percent of total billed charges,,
Xr Knees Bil Ap Standing And Flex,,73565,CPT,Facility,Both,,,,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,258,100,,percent of total billed charges,,
Xr Knees Bil Ap Standing And Flex,,73565,CPT,Facility,Both,,,,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,High Value Network Plan,232.2,90,,percent of total billed charges,,
Xr Knees Bil Ap Standing And Flex,,73565,CPT,Facility,Outpatient,,,,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,Medicare Advantage,126.42,49,,percent of total billed charges,,
Xr Knees Bil Ap Standing And Flex,,73565,CPT,Facility,Inpatient,,,,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Xr Knees Bil Ap Standing And Flex,,73565,CPT,Facility,Both,,,,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,228.5106,88.57,,percent of total billed charges,,
Xr Knees Bil Ap Standing And Flex,,73565,CPT,Facility,Both,,,,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,73.9428,28.66,,percent of total billed charges,,
Xr Knees Bil Ap Standing And Flex,,73565,CPT,Facility,Outpatient,,,,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),126.42,49,,percent of total billed charges,,
Xr Knees Bil Ap Standing And Flex,,73565,CPT,Facility,Inpatient,,,,258,219.3,73.9428,258,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Xr Knees Bil Ap Standing And Flex,,73565,CPT,Facility,Both,,,,258,219.3,73.9428,258,CorVel,Worker's Compensation,258,100,,percent of total billed charges,,
Xr Knees Bil Ap Standing And Flex,,73565,CPT,Facility,Both,,,,258,219.3,73.9428,258,First Health Group Corporation,First Health Network,250.26,97,,percent of total billed charges,,
Xr Knees Bil Ap Standing And Flex,,73565,CPT,Facility,Both,,,,258,219.3,73.9428,258,"Health Partners, Inc.",Commercial,244.068,94.6,,percent of total billed charges,,
Xr Knees Bil Ap Standing And Flex,,73565,CPT,Facility,Outpatient,,,,258,219.3,73.9428,258,"Health Partners, Inc.",Medicare Advantage,126.42,49,,percent of total billed charges,,
Xr Knees Bil Ap Standing And Flex,,73565,CPT,Facility,Inpatient,,,,258,219.3,73.9428,258,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Knees Bil Ap Standing And Flex,,73565,CPT,Facility,Both,,,,258,219.3,73.9428,258,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),154.8,60,,percent of total billed charges,,
Xr Knees Bil Ap Standing And Flex,,73565,CPT,Facility,Both,,,,258,219.3,73.9428,258,"Health Partners, Inc.",State of Minnesota Advantage Program,210.27,81.5,,percent of total billed charges,,
Xr Knees Bil Ap Standing And Flex,,73565,CPT,Facility,Both,,,,258,219.3,73.9428,258,"Health Partners, Inc.",State Public Programs,129,50,,percent of total billed charges,,
Xr Knees Bil Ap Standing And Flex,,73565,CPT,Facility,Both,,,,258,219.3,73.9428,258,Humana Insurance Company,Commercial PPO,245.1,95,,percent of total billed charges,,
Xr Knees Bil Ap Standing And Flex,,73565,CPT,Facility,Outpatient,,,,258,219.3,73.9428,258,Humana Insurance Company,Medicare PPO,126.42,49,,percent of total billed charges,,
Xr Knees Bil Ap Standing And Flex,,73565,CPT,Facility,Inpatient,,,,258,219.3,73.9428,258,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Xr Knees Bil Ap Standing And Flex,,73565,CPT,Facility,Both,,,,258,219.3,73.9428,258,Medica,Individual & Family,255.678,99.1,,percent of total billed charges,,
Xr Knees Bil Ap Standing And Flex,,73565,CPT,Facility,Outpatient,,,,258,219.3,73.9428,258,Medica,Medica Advantage Solution,128.484,49.8,,percent of total billed charges,,
Xr Knees Bil Ap Standing And Flex,,73565,CPT,Facility,Inpatient,,,,258,219.3,73.9428,258,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Xr Knees Bil Ap Standing And Flex,,73565,CPT,Facility,Outpatient,,,,258,219.3,73.9428,258,Medica,Medical Assistance,115.068,44.6,,percent of total billed charges,,
Xr Knees Bil Ap Standing And Flex,,73565,CPT,Facility,Inpatient,,,,258,219.3,73.9428,258,Medica,Medical Assistance,,,,,Included in per diem rate,
Xr Knees Bil Ap Standing And Flex,,73565,CPT,Facility,Outpatient,,,,258,219.3,73.9428,258,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,128.484,49.8,,percent of total billed charges,,
Xr Knees Bil Ap Standing And Flex,,73565,CPT,Facility,Inpatient,,,,258,219.3,73.9428,258,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Xr Knees Bil Ap Standing And Flex,,73565,CPT,Facility,Both,,,,258,219.3,73.9428,258,"Multiplan, Inc.","Multiplan, Inc.",242.52,94,,percent of total billed charges,,
Xr Knees Bil Ap Standing And Flex,,73565,CPT,Facility,Outpatient,,,,258,219.3,73.9428,258,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,232.458,90.1,,percent of total billed charges,,
Xr Knees Bil Ap Standing And Flex,,73565,CPT,Facility,Inpatient,,,,258,219.3,73.9428,258,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Xr Knees Bil Ap Standing And Flex,,73565,CPT,Facility,Both,,,,258,219.3,73.9428,258,"Preferred One Administrative Services, INC.",PPO,254.388,98.6,,percent of total billed charges,,
Xr Knees Bil Ap Standing And Flex,,73565,CPT,Facility,Outpatient,,,,258,219.3,73.9428,258,PrimeWest Health,Minnesota Senior Health Options (MSHO),132.741,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Xr Knees Bil Ap Standing And Flex,,73565,CPT,Facility,Inpatient,,,,258,219.3,73.9428,258,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Knees Bil Ap Standing And Flex,,73565,CPT,Facility,Outpatient,,,,258,219.3,73.9428,258,PrimeWest Health,MinnesotaCare,132.5088,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Xr Knees Bil Ap Standing And Flex,,73565,CPT,Facility,Inpatient,,,,258,219.3,73.9428,258,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Xr Knees Bil Ap Standing And Flex,,73565,CPT,Facility,Both,,,,258,219.3,73.9428,258,Sanford Health Plan,Sanford Health Plan,237.36,92,,percent of total billed charges,,
Xr Knees Bil Ap Standing And Flex,,73565,CPT,Facility,Outpatient,,,,258,219.3,73.9428,258,"UCare Health, Inc.",Individual & Family Plan,145.383,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Xr Knees Bil Ap Standing And Flex,,73565,CPT,Facility,Inpatient,,,,258,219.3,73.9428,258,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Xr Knees Bil Ap Standing And Flex,,73565,CPT,Facility,Outpatient,,,,258,219.3,73.9428,258,"UCare Health, Inc.",Medical Assistance,130.2126,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Knees Bil Ap Standing And Flex,,73565,CPT,Facility,Inpatient,,,,258,219.3,73.9428,258,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Xr Knees Bil Ap Standing And Flex,,73565,CPT,Facility,Outpatient,,,,258,219.3,73.9428,258,"UCare Health, Inc.",Medicare Advantage,130.2126,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Knees Bil Ap Standing And Flex,,73565,CPT,Facility,Inpatient,,,,258,219.3,73.9428,258,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Knees Bil Ap Standing And Flex,,73565,CPT,Facility,Outpatient,,,,258,219.3,73.9428,258,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),130.2126,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Knees Bil Ap Standing And Flex,,73565,CPT,Facility,Inpatient,,,,258,219.3,73.9428,258,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Knees Bil Ap Standing And Flex,,73565,CPT,Facility,Both,,,,258,219.3,73.9428,258,UnitedHealthcare,Individual & Family,242.52,94,,percent of total billed charges,,
Xr Knees Bil Ap Standing And Flex,,73565,CPT,Facility,Outpatient,,,,258,219.3,73.9428,258,UnitedHealthcare,Medicare Advantage,126.42,49,,percent of total billed charges,,
Xr Knees Bil Ap Standing And Flex,,73565,CPT,Facility,Inpatient,,,,258,219.3,73.9428,258,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Xr Knees Bil Ap Standing And Flex,,73565,CPT,Facility,Outpatient,,,,258,219.3,73.9428,258,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,123.84,48,,percent of total billed charges,,100% of DHS outpatient percentage
Xr Knees Bil Ap Standing And Flex,,73565,CPT,Facility,Inpatient,,,,258,219.3,73.9428,258,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Ct Lower Extremity Without Contrast,,73700,CPT,Facility,Both,,,,1428,1213.8,325.628,1428,Aetna,Commercial,1313.76,92,,percent of total billed charges,,
Ct Lower Extremity Without Contrast,,73700,CPT,Facility,Outpatient,,,,1428,1213.8,325.628,1428,Aetna,Medicare Advantage,699.72,49,,percent of total billed charges,,
Ct Lower Extremity Without Contrast,,73700,CPT,Facility,Inpatient,,,,1428,1213.8,325.628,1428,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Ct Lower Extremity Without Contrast,,73700,CPT,Facility,Both,,,,1428,1213.8,325.628,1428,Aetna,PPO,1328.04,93,,percent of total billed charges,,
Ct Lower Extremity Without Contrast,,73700,CPT,Facility,Both,,,,1428,1213.8,325.628,1428,America's PPO,America's PPO,1371.3084,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Ct Lower Extremity Without Contrast,,73700,CPT,Facility,Both,,,,1428,1213.8,325.628,1428,BlueCross BlueShield Minnesota, Federal Employee Program,641,,,Fee schedule,,100% of BCBS commercial commodity fee schedule
Ct Lower Extremity Without Contrast,,73700,CPT,Facility,Both,,,,1428,1213.8,325.628,1428,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,651.256,,,Fee schedule,,"100% of BCBS commercial commodity fee schedule, plus MN Care tax"
Ct Lower Extremity Without Contrast,,73700,CPT,Facility,Both,,,,1428,1213.8,325.628,1428,BlueCross BlueShield Minnesota,High Value Network Plan,586.1304,,,Fee schedule,,"90% of BCBS commercial commodity fee schedule, plus MN Care tax; see disclaimer for more information"
Ct Lower Extremity Without Contrast,,73700,CPT,Facility,Outpatient,,,,1428,1213.8,325.628,1428,BlueCross BlueShield Minnesota,Medicare Advantage,699.72,49,,percent of total billed charges,,
Ct Lower Extremity Without Contrast,,73700,CPT,Facility,Inpatient,,,,1428,1213.8,325.628,1428,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Ct Lower Extremity Without Contrast,,73700,CPT,Facility,Both,,,,1428,1213.8,325.628,1428,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,576.8174392,,,Fee schedule,,"88.57% of BCBS commercial commodity fee schedule, plus MN Care tax"
Ct Lower Extremity Without Contrast,,73700,CPT,Facility,Both,,,,1428,1213.8,325.628,1428,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,325.628,,,Fee schedule,,"100% of BCBS Medicaid commodity fee schedule, plus MN Care tax"
Ct Lower Extremity Without Contrast,,73700,CPT,Facility,Outpatient,,,,1428,1213.8,325.628,1428,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),699.72,49,,percent of total billed charges,,
Ct Lower Extremity Without Contrast,,73700,CPT,Facility,Inpatient,,,,1428,1213.8,325.628,1428,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Ct Lower Extremity Without Contrast,,73700,CPT,Facility,Both,,,,1428,1213.8,325.628,1428,CorVel,Worker's Compensation,1428,100,,percent of total billed charges,,
Ct Lower Extremity Without Contrast,,73700,CPT,Facility,Both,,,,1428,1213.8,325.628,1428,First Health Group Corporation,First Health Network,1385.16,97,,percent of total billed charges,,
Ct Lower Extremity Without Contrast,,73700,CPT,Facility,Both,,,,1428,1213.8,325.628,1428,"Health Partners, Inc.",Commercial,1350.888,94.6,,percent of total billed charges,,
Ct Lower Extremity Without Contrast,,73700,CPT,Facility,Outpatient,,,,1428,1213.8,325.628,1428,"Health Partners, Inc.",Medicare Advantage,699.72,49,,percent of total billed charges,,
Ct Lower Extremity Without Contrast,,73700,CPT,Facility,Inpatient,,,,1428,1213.8,325.628,1428,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ct Lower Extremity Without Contrast,,73700,CPT,Facility,Both,,,,1428,1213.8,325.628,1428,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),856.8,60,,percent of total billed charges,,
Ct Lower Extremity Without Contrast,,73700,CPT,Facility,Both,,,,1428,1213.8,325.628,1428,"Health Partners, Inc.",State of Minnesota Advantage Program,1163.82,81.5,,percent of total billed charges,,
Ct Lower Extremity Without Contrast,,73700,CPT,Facility,Both,,,,1428,1213.8,325.628,1428,"Health Partners, Inc.",State Public Programs,714,50,,percent of total billed charges,,
Ct Lower Extremity Without Contrast,,73700,CPT,Facility,Both,,,,1428,1213.8,325.628,1428,Humana Insurance Company,Commercial PPO,1356.6,95,,percent of total billed charges,,
Ct Lower Extremity Without Contrast,,73700,CPT,Facility,Outpatient,,,,1428,1213.8,325.628,1428,Humana Insurance Company,Medicare PPO,699.72,49,,percent of total billed charges,,
Ct Lower Extremity Without Contrast,,73700,CPT,Facility,Inpatient,,,,1428,1213.8,325.628,1428,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Ct Lower Extremity Without Contrast,,73700,CPT,Facility,Both,,,,1428,1213.8,325.628,1428,Medica,Individual & Family,1415.148,99.1,,percent of total billed charges,,
Ct Lower Extremity Without Contrast,,73700,CPT,Facility,Outpatient,,,,1428,1213.8,325.628,1428,Medica,Medica Advantage Solution,711.144,49.8,,percent of total billed charges,,
Ct Lower Extremity Without Contrast,,73700,CPT,Facility,Inpatient,,,,1428,1213.8,325.628,1428,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Ct Lower Extremity Without Contrast,,73700,CPT,Facility,Outpatient,,,,1428,1213.8,325.628,1428,Medica,Medical Assistance,636.888,44.6,,percent of total billed charges,,
Ct Lower Extremity Without Contrast,,73700,CPT,Facility,Inpatient,,,,1428,1213.8,325.628,1428,Medica,Medical Assistance,,,,,Included in per diem rate,
Ct Lower Extremity Without Contrast,,73700,CPT,Facility,Outpatient,,,,1428,1213.8,325.628,1428,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,711.144,49.8,,percent of total billed charges,,
Ct Lower Extremity Without Contrast,,73700,CPT,Facility,Inpatient,,,,1428,1213.8,325.628,1428,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Ct Lower Extremity Without Contrast,,73700,CPT,Facility,Both,,,,1428,1213.8,325.628,1428,"Multiplan, Inc.","Multiplan, Inc.",1342.32,94,,percent of total billed charges,,
Ct Lower Extremity Without Contrast,,73700,CPT,Facility,Outpatient,,,,1428,1213.8,325.628,1428,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1283,,,Other,Per scan,
Ct Lower Extremity Without Contrast,,73700,CPT,Facility,Inpatient,,,,1428,1213.8,325.628,1428,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Ct Lower Extremity Without Contrast,,73700,CPT,Facility,Both,,,,1428,1213.8,325.628,1428,"Preferred One Administrative Services, INC.",PPO,1408.008,98.6,,percent of total billed charges,,
Ct Lower Extremity Without Contrast,,73700,CPT,Facility,Outpatient,,,,1428,1213.8,325.628,1428,PrimeWest Health,Minnesota Senior Health Options (MSHO),734.706,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Ct Lower Extremity Without Contrast,,73700,CPT,Facility,Inpatient,,,,1428,1213.8,325.628,1428,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ct Lower Extremity Without Contrast,,73700,CPT,Facility,Outpatient,,,,1428,1213.8,325.628,1428,PrimeWest Health,MinnesotaCare,733.4208,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Ct Lower Extremity Without Contrast,,73700,CPT,Facility,Inpatient,,,,1428,1213.8,325.628,1428,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Ct Lower Extremity Without Contrast,,73700,CPT,Facility,Both,,,,1428,1213.8,325.628,1428,Sanford Health Plan,Sanford Health Plan,1313.76,92,,percent of total billed charges,,
Ct Lower Extremity Without Contrast,,73700,CPT,Facility,Outpatient,,,,1428,1213.8,325.628,1428,"UCare Health, Inc.",Individual & Family Plan,804.678,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Ct Lower Extremity Without Contrast,,73700,CPT,Facility,Inpatient,,,,1428,1213.8,325.628,1428,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Ct Lower Extremity Without Contrast,,73700,CPT,Facility,Outpatient,,,,1428,1213.8,325.628,1428,"UCare Health, Inc.",Medical Assistance,720.7116,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ct Lower Extremity Without Contrast,,73700,CPT,Facility,Inpatient,,,,1428,1213.8,325.628,1428,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Ct Lower Extremity Without Contrast,,73700,CPT,Facility,Outpatient,,,,1428,1213.8,325.628,1428,"UCare Health, Inc.",Medicare Advantage,720.7116,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ct Lower Extremity Without Contrast,,73700,CPT,Facility,Inpatient,,,,1428,1213.8,325.628,1428,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ct Lower Extremity Without Contrast,,73700,CPT,Facility,Outpatient,,,,1428,1213.8,325.628,1428,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),720.7116,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ct Lower Extremity Without Contrast,,73700,CPT,Facility,Inpatient,,,,1428,1213.8,325.628,1428,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ct Lower Extremity Without Contrast,,73700,CPT,Facility,Both,,,,1428,1213.8,325.628,1428,UnitedHealthcare,Individual & Family,1342.32,94,,percent of total billed charges,,
Ct Lower Extremity Without Contrast,,73700,CPT,Facility,Outpatient,,,,1428,1213.8,325.628,1428,UnitedHealthcare,Medicare Advantage,699.72,49,,percent of total billed charges,,
Ct Lower Extremity Without Contrast,,73700,CPT,Facility,Inpatient,,,,1428,1213.8,325.628,1428,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Ct Lower Extremity Without Contrast,,73700,CPT,Facility,Outpatient,,,,1428,1213.8,325.628,1428,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,685.44,48,,percent of total billed charges,,100% of DHS outpatient percentage
Ct Lower Extremity Without Contrast,,73700,CPT,Facility,Inpatient,,,,1428,1213.8,325.628,1428,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Ct Lower Extremity With Contrast,,73701,CPT,Facility,Both,,,,1581,1343.85,412.496,1581,Aetna,Commercial,1454.52,92,,percent of total billed charges,,
Ct Lower Extremity With Contrast,,73701,CPT,Facility,Outpatient,,,,1581,1343.85,412.496,1581,Aetna,Medicare Advantage,774.69,49,,percent of total billed charges,,
Ct Lower Extremity With Contrast,,73701,CPT,Facility,Inpatient,,,,1581,1343.85,412.496,1581,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Ct Lower Extremity With Contrast,,73701,CPT,Facility,Both,,,,1581,1343.85,412.496,1581,Aetna,PPO,1470.33,93,,percent of total billed charges,,
Ct Lower Extremity With Contrast,,73701,CPT,Facility,Both,,,,1581,1343.85,412.496,1581,America's PPO,America's PPO,1518.2343,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Ct Lower Extremity With Contrast,,73701,CPT,Facility,Both,,,,1581,1343.85,412.496,1581,BlueCross BlueShield Minnesota, Federal Employee Program,812,,,Fee schedule,,100% of BCBS commercial commodity fee schedule
Ct Lower Extremity With Contrast,,73701,CPT,Facility,Both,,,,1581,1343.85,412.496,1581,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,824.992,,,Fee schedule,,"100% of BCBS commercial commodity fee schedule, plus MN Care tax"
Ct Lower Extremity With Contrast,,73701,CPT,Facility,Both,,,,1581,1343.85,412.496,1581,BlueCross BlueShield Minnesota,High Value Network Plan,742.4928,,,Fee schedule,,"90% of BCBS commercial commodity fee schedule, plus MN Care tax; see disclaimer for more information"
Ct Lower Extremity With Contrast,,73701,CPT,Facility,Outpatient,,,,1581,1343.85,412.496,1581,BlueCross BlueShield Minnesota,Medicare Advantage,774.69,49,,percent of total billed charges,,
Ct Lower Extremity With Contrast,,73701,CPT,Facility,Inpatient,,,,1581,1343.85,412.496,1581,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Ct Lower Extremity With Contrast,,73701,CPT,Facility,Both,,,,1581,1343.85,412.496,1581,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,730.6954144,,,Fee schedule,,"88.57% of BCBS commercial commodity fee schedule, plus MN Care tax"
Ct Lower Extremity With Contrast,,73701,CPT,Facility,Both,,,,1581,1343.85,412.496,1581,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,412.496,,,Fee schedule,,"100% of BCBS Medicaid commodity fee schedule, plus MN Care tax"
Ct Lower Extremity With Contrast,,73701,CPT,Facility,Outpatient,,,,1581,1343.85,412.496,1581,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),774.69,49,,percent of total billed charges,,
Ct Lower Extremity With Contrast,,73701,CPT,Facility,Inpatient,,,,1581,1343.85,412.496,1581,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Ct Lower Extremity With Contrast,,73701,CPT,Facility,Both,,,,1581,1343.85,412.496,1581,CorVel,Worker's Compensation,1581,100,,percent of total billed charges,,
Ct Lower Extremity With Contrast,,73701,CPT,Facility,Both,,,,1581,1343.85,412.496,1581,First Health Group Corporation,First Health Network,1533.57,97,,percent of total billed charges,,
Ct Lower Extremity With Contrast,,73701,CPT,Facility,Both,,,,1581,1343.85,412.496,1581,"Health Partners, Inc.",Commercial,1495.626,94.6,,percent of total billed charges,,
Ct Lower Extremity With Contrast,,73701,CPT,Facility,Outpatient,,,,1581,1343.85,412.496,1581,"Health Partners, Inc.",Medicare Advantage,774.69,49,,percent of total billed charges,,
Ct Lower Extremity With Contrast,,73701,CPT,Facility,Inpatient,,,,1581,1343.85,412.496,1581,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ct Lower Extremity With Contrast,,73701,CPT,Facility,Both,,,,1581,1343.85,412.496,1581,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),948.6,60,,percent of total billed charges,,
Ct Lower Extremity With Contrast,,73701,CPT,Facility,Both,,,,1581,1343.85,412.496,1581,"Health Partners, Inc.",State of Minnesota Advantage Program,1288.515,81.5,,percent of total billed charges,,
Ct Lower Extremity With Contrast,,73701,CPT,Facility,Both,,,,1581,1343.85,412.496,1581,"Health Partners, Inc.",State Public Programs,790.5,50,,percent of total billed charges,,
Ct Lower Extremity With Contrast,,73701,CPT,Facility,Both,,,,1581,1343.85,412.496,1581,Humana Insurance Company,Commercial PPO,1501.95,95,,percent of total billed charges,,
Ct Lower Extremity With Contrast,,73701,CPT,Facility,Outpatient,,,,1581,1343.85,412.496,1581,Humana Insurance Company,Medicare PPO,774.69,49,,percent of total billed charges,,
Ct Lower Extremity With Contrast,,73701,CPT,Facility,Inpatient,,,,1581,1343.85,412.496,1581,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Ct Lower Extremity With Contrast,,73701,CPT,Facility,Both,,,,1581,1343.85,412.496,1581,Medica,Individual & Family,1566.771,99.1,,percent of total billed charges,,
Ct Lower Extremity With Contrast,,73701,CPT,Facility,Outpatient,,,,1581,1343.85,412.496,1581,Medica,Medica Advantage Solution,787.338,49.8,,percent of total billed charges,,
Ct Lower Extremity With Contrast,,73701,CPT,Facility,Inpatient,,,,1581,1343.85,412.496,1581,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Ct Lower Extremity With Contrast,,73701,CPT,Facility,Outpatient,,,,1581,1343.85,412.496,1581,Medica,Medical Assistance,705.126,44.6,,percent of total billed charges,,
Ct Lower Extremity With Contrast,,73701,CPT,Facility,Inpatient,,,,1581,1343.85,412.496,1581,Medica,Medical Assistance,,,,,Included in per diem rate,
Ct Lower Extremity With Contrast,,73701,CPT,Facility,Outpatient,,,,1581,1343.85,412.496,1581,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,787.338,49.8,,percent of total billed charges,,
Ct Lower Extremity With Contrast,,73701,CPT,Facility,Inpatient,,,,1581,1343.85,412.496,1581,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Ct Lower Extremity With Contrast,,73701,CPT,Facility,Both,,,,1581,1343.85,412.496,1581,"Multiplan, Inc.","Multiplan, Inc.",1486.14,94,,percent of total billed charges,,
Ct Lower Extremity With Contrast,,73701,CPT,Facility,Outpatient,,,,1581,1343.85,412.496,1581,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1283,,,Other,Per scan,
Ct Lower Extremity With Contrast,,73701,CPT,Facility,Inpatient,,,,1581,1343.85,412.496,1581,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Ct Lower Extremity With Contrast,,73701,CPT,Facility,Both,,,,1581,1343.85,412.496,1581,"Preferred One Administrative Services, INC.",PPO,1558.866,98.6,,percent of total billed charges,,
Ct Lower Extremity With Contrast,,73701,CPT,Facility,Outpatient,,,,1581,1343.85,412.496,1581,PrimeWest Health,Minnesota Senior Health Options (MSHO),813.4245,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Ct Lower Extremity With Contrast,,73701,CPT,Facility,Inpatient,,,,1581,1343.85,412.496,1581,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ct Lower Extremity With Contrast,,73701,CPT,Facility,Outpatient,,,,1581,1343.85,412.496,1581,PrimeWest Health,MinnesotaCare,812.0016,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Ct Lower Extremity With Contrast,,73701,CPT,Facility,Inpatient,,,,1581,1343.85,412.496,1581,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Ct Lower Extremity With Contrast,,73701,CPT,Facility,Both,,,,1581,1343.85,412.496,1581,Sanford Health Plan,Sanford Health Plan,1454.52,92,,percent of total billed charges,,
Ct Lower Extremity With Contrast,,73701,CPT,Facility,Outpatient,,,,1581,1343.85,412.496,1581,"UCare Health, Inc.",Individual & Family Plan,890.8935,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Ct Lower Extremity With Contrast,,73701,CPT,Facility,Inpatient,,,,1581,1343.85,412.496,1581,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Ct Lower Extremity With Contrast,,73701,CPT,Facility,Outpatient,,,,1581,1343.85,412.496,1581,"UCare Health, Inc.",Medical Assistance,797.9307,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ct Lower Extremity With Contrast,,73701,CPT,Facility,Inpatient,,,,1581,1343.85,412.496,1581,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Ct Lower Extremity With Contrast,,73701,CPT,Facility,Outpatient,,,,1581,1343.85,412.496,1581,"UCare Health, Inc.",Medicare Advantage,797.9307,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ct Lower Extremity With Contrast,,73701,CPT,Facility,Inpatient,,,,1581,1343.85,412.496,1581,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ct Lower Extremity With Contrast,,73701,CPT,Facility,Outpatient,,,,1581,1343.85,412.496,1581,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),797.9307,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ct Lower Extremity With Contrast,,73701,CPT,Facility,Inpatient,,,,1581,1343.85,412.496,1581,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ct Lower Extremity With Contrast,,73701,CPT,Facility,Both,,,,1581,1343.85,412.496,1581,UnitedHealthcare,Individual & Family,1486.14,94,,percent of total billed charges,,
Ct Lower Extremity With Contrast,,73701,CPT,Facility,Outpatient,,,,1581,1343.85,412.496,1581,UnitedHealthcare,Medicare Advantage,774.69,49,,percent of total billed charges,,
Ct Lower Extremity With Contrast,,73701,CPT,Facility,Inpatient,,,,1581,1343.85,412.496,1581,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Ct Lower Extremity With Contrast,,73701,CPT,Facility,Outpatient,,,,1581,1343.85,412.496,1581,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,758.88,48,,percent of total billed charges,,100% of DHS outpatient percentage
Ct Lower Extremity With Contrast,,73701,CPT,Facility,Inpatient,,,,1581,1343.85,412.496,1581,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Ct Lower Extremity With And Without Contrast,,73702,CPT,Facility,Both,,,,1836,1560.6,412.496,1836,Aetna,Commercial,1689.12,92,,percent of total billed charges,,
Ct Lower Extremity With And Without Contrast,,73702,CPT,Facility,Outpatient,,,,1836,1560.6,412.496,1836,Aetna,Medicare Advantage,899.64,49,,percent of total billed charges,,
Ct Lower Extremity With And Without Contrast,,73702,CPT,Facility,Inpatient,,,,1836,1560.6,412.496,1836,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Ct Lower Extremity With And Without Contrast,,73702,CPT,Facility,Both,,,,1836,1560.6,412.496,1836,Aetna,PPO,1707.48,93,,percent of total billed charges,,
Ct Lower Extremity With And Without Contrast,,73702,CPT,Facility,Both,,,,1836,1560.6,412.496,1836,America's PPO,America's PPO,1763.1108,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Ct Lower Extremity With And Without Contrast,,73702,CPT,Facility,Both,,,,1836,1560.6,412.496,1836,BlueCross BlueShield Minnesota, Federal Employee Program,812,,,Fee schedule,,100% of BCBS commercial commodity fee schedule
Ct Lower Extremity With And Without Contrast,,73702,CPT,Facility,Both,,,,1836,1560.6,412.496,1836,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,824.992,,,Fee schedule,,"100% of BCBS commercial commodity fee schedule, plus MN Care tax"
Ct Lower Extremity With And Without Contrast,,73702,CPT,Facility,Both,,,,1836,1560.6,412.496,1836,BlueCross BlueShield Minnesota,High Value Network Plan,742.4928,,,Fee schedule,,"90% of BCBS commercial commodity fee schedule, plus MN Care tax; see disclaimer for more information"
Ct Lower Extremity With And Without Contrast,,73702,CPT,Facility,Outpatient,,,,1836,1560.6,412.496,1836,BlueCross BlueShield Minnesota,Medicare Advantage,899.64,49,,percent of total billed charges,,
Ct Lower Extremity With And Without Contrast,,73702,CPT,Facility,Inpatient,,,,1836,1560.6,412.496,1836,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Ct Lower Extremity With And Without Contrast,,73702,CPT,Facility,Both,,,,1836,1560.6,412.496,1836,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,730.6954144,,,Fee schedule,,"88.57% of BCBS commercial commodity fee schedule, plus MN Care tax"
Ct Lower Extremity With And Without Contrast,,73702,CPT,Facility,Both,,,,1836,1560.6,412.496,1836,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,412.496,,,Fee schedule,,"100% of BCBS Medicaid commodity fee schedule, plus MN Care tax"
Ct Lower Extremity With And Without Contrast,,73702,CPT,Facility,Outpatient,,,,1836,1560.6,412.496,1836,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),899.64,49,,percent of total billed charges,,
Ct Lower Extremity With And Without Contrast,,73702,CPT,Facility,Inpatient,,,,1836,1560.6,412.496,1836,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Ct Lower Extremity With And Without Contrast,,73702,CPT,Facility,Both,,,,1836,1560.6,412.496,1836,CorVel,Worker's Compensation,1836,100,,percent of total billed charges,,
Ct Lower Extremity With And Without Contrast,,73702,CPT,Facility,Both,,,,1836,1560.6,412.496,1836,First Health Group Corporation,First Health Network,1780.92,97,,percent of total billed charges,,
Ct Lower Extremity With And Without Contrast,,73702,CPT,Facility,Both,,,,1836,1560.6,412.496,1836,"Health Partners, Inc.",Commercial,1736.856,94.6,,percent of total billed charges,,
Ct Lower Extremity With And Without Contrast,,73702,CPT,Facility,Outpatient,,,,1836,1560.6,412.496,1836,"Health Partners, Inc.",Medicare Advantage,899.64,49,,percent of total billed charges,,
Ct Lower Extremity With And Without Contrast,,73702,CPT,Facility,Inpatient,,,,1836,1560.6,412.496,1836,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ct Lower Extremity With And Without Contrast,,73702,CPT,Facility,Both,,,,1836,1560.6,412.496,1836,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1101.6,60,,percent of total billed charges,,
Ct Lower Extremity With And Without Contrast,,73702,CPT,Facility,Both,,,,1836,1560.6,412.496,1836,"Health Partners, Inc.",State of Minnesota Advantage Program,1496.34,81.5,,percent of total billed charges,,
Ct Lower Extremity With And Without Contrast,,73702,CPT,Facility,Both,,,,1836,1560.6,412.496,1836,"Health Partners, Inc.",State Public Programs,918,50,,percent of total billed charges,,
Ct Lower Extremity With And Without Contrast,,73702,CPT,Facility,Both,,,,1836,1560.6,412.496,1836,Humana Insurance Company,Commercial PPO,1744.2,95,,percent of total billed charges,,
Ct Lower Extremity With And Without Contrast,,73702,CPT,Facility,Outpatient,,,,1836,1560.6,412.496,1836,Humana Insurance Company,Medicare PPO,899.64,49,,percent of total billed charges,,
Ct Lower Extremity With And Without Contrast,,73702,CPT,Facility,Inpatient,,,,1836,1560.6,412.496,1836,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Ct Lower Extremity With And Without Contrast,,73702,CPT,Facility,Both,,,,1836,1560.6,412.496,1836,Medica,Individual & Family,1819.476,99.1,,percent of total billed charges,,
Ct Lower Extremity With And Without Contrast,,73702,CPT,Facility,Outpatient,,,,1836,1560.6,412.496,1836,Medica,Medica Advantage Solution,914.328,49.8,,percent of total billed charges,,
Ct Lower Extremity With And Without Contrast,,73702,CPT,Facility,Inpatient,,,,1836,1560.6,412.496,1836,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Ct Lower Extremity With And Without Contrast,,73702,CPT,Facility,Outpatient,,,,1836,1560.6,412.496,1836,Medica,Medical Assistance,818.856,44.6,,percent of total billed charges,,
Ct Lower Extremity With And Without Contrast,,73702,CPT,Facility,Inpatient,,,,1836,1560.6,412.496,1836,Medica,Medical Assistance,,,,,Included in per diem rate,
Ct Lower Extremity With And Without Contrast,,73702,CPT,Facility,Outpatient,,,,1836,1560.6,412.496,1836,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,914.328,49.8,,percent of total billed charges,,
Ct Lower Extremity With And Without Contrast,,73702,CPT,Facility,Inpatient,,,,1836,1560.6,412.496,1836,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Ct Lower Extremity With And Without Contrast,,73702,CPT,Facility,Both,,,,1836,1560.6,412.496,1836,"Multiplan, Inc.","Multiplan, Inc.",1725.84,94,,percent of total billed charges,,
Ct Lower Extremity With And Without Contrast,,73702,CPT,Facility,Outpatient,,,,1836,1560.6,412.496,1836,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1283,,,Other,Per scan,
Ct Lower Extremity With And Without Contrast,,73702,CPT,Facility,Inpatient,,,,1836,1560.6,412.496,1836,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Ct Lower Extremity With And Without Contrast,,73702,CPT,Facility,Both,,,,1836,1560.6,412.496,1836,"Preferred One Administrative Services, INC.",PPO,1810.296,98.6,,percent of total billed charges,,
Ct Lower Extremity With And Without Contrast,,73702,CPT,Facility,Outpatient,,,,1836,1560.6,412.496,1836,PrimeWest Health,Minnesota Senior Health Options (MSHO),944.622,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Ct Lower Extremity With And Without Contrast,,73702,CPT,Facility,Inpatient,,,,1836,1560.6,412.496,1836,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ct Lower Extremity With And Without Contrast,,73702,CPT,Facility,Outpatient,,,,1836,1560.6,412.496,1836,PrimeWest Health,MinnesotaCare,942.9696,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Ct Lower Extremity With And Without Contrast,,73702,CPT,Facility,Inpatient,,,,1836,1560.6,412.496,1836,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Ct Lower Extremity With And Without Contrast,,73702,CPT,Facility,Both,,,,1836,1560.6,412.496,1836,Sanford Health Plan,Sanford Health Plan,1689.12,92,,percent of total billed charges,,
Ct Lower Extremity With And Without Contrast,,73702,CPT,Facility,Outpatient,,,,1836,1560.6,412.496,1836,"UCare Health, Inc.",Individual & Family Plan,1034.586,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Ct Lower Extremity With And Without Contrast,,73702,CPT,Facility,Inpatient,,,,1836,1560.6,412.496,1836,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Ct Lower Extremity With And Without Contrast,,73702,CPT,Facility,Outpatient,,,,1836,1560.6,412.496,1836,"UCare Health, Inc.",Medical Assistance,926.6292,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ct Lower Extremity With And Without Contrast,,73702,CPT,Facility,Inpatient,,,,1836,1560.6,412.496,1836,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Ct Lower Extremity With And Without Contrast,,73702,CPT,Facility,Outpatient,,,,1836,1560.6,412.496,1836,"UCare Health, Inc.",Medicare Advantage,926.6292,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ct Lower Extremity With And Without Contrast,,73702,CPT,Facility,Inpatient,,,,1836,1560.6,412.496,1836,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ct Lower Extremity With And Without Contrast,,73702,CPT,Facility,Outpatient,,,,1836,1560.6,412.496,1836,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),926.6292,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ct Lower Extremity With And Without Contrast,,73702,CPT,Facility,Inpatient,,,,1836,1560.6,412.496,1836,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ct Lower Extremity With And Without Contrast,,73702,CPT,Facility,Both,,,,1836,1560.6,412.496,1836,UnitedHealthcare,Individual & Family,1725.84,94,,percent of total billed charges,,
Ct Lower Extremity With And Without Contrast,,73702,CPT,Facility,Outpatient,,,,1836,1560.6,412.496,1836,UnitedHealthcare,Medicare Advantage,899.64,49,,percent of total billed charges,,
Ct Lower Extremity With And Without Contrast,,73702,CPT,Facility,Inpatient,,,,1836,1560.6,412.496,1836,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Ct Lower Extremity With And Without Contrast,,73702,CPT,Facility,Outpatient,,,,1836,1560.6,412.496,1836,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,881.28,48,,percent of total billed charges,,100% of DHS outpatient percentage
Ct Lower Extremity With And Without Contrast,,73702,CPT,Facility,Inpatient,,,,1836,1560.6,412.496,1836,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Mra Lower Extremity Wo/W Contrast,,73725,CPT,Facility,Both,,,,2346,1994.1,533.908,2346,Aetna,Commercial,2158.32,92,,percent of total billed charges,,
Mra Lower Extremity Wo/W Contrast,,73725,CPT,Facility,Outpatient,,,,2346,1994.1,533.908,2346,Aetna,Medicare Advantage,1149.54,49,,percent of total billed charges,,
Mra Lower Extremity Wo/W Contrast,,73725,CPT,Facility,Inpatient,,,,2346,1994.1,533.908,2346,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Mra Lower Extremity Wo/W Contrast,,73725,CPT,Facility,Both,,,,2346,1994.1,533.908,2346,Aetna,PPO,2181.78,93,,percent of total billed charges,,
Mra Lower Extremity Wo/W Contrast,,73725,CPT,Facility,Both,,,,2346,1994.1,533.908,2346,America's PPO,America's PPO,2252.8638,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Mra Lower Extremity Wo/W Contrast,,73725,CPT,Facility,Both,,,,2346,1994.1,533.908,2346,BlueCross BlueShield Minnesota, Federal Employee Program,1051,,,Fee schedule,,100% of BCBS commercial commodity fee schedule
Mra Lower Extremity Wo/W Contrast,,73725,CPT,Facility,Both,,,,2346,1994.1,533.908,2346,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1067.816,,,Fee schedule,,"100% of BCBS commercial commodity fee schedule, plus MN Care tax"
Mra Lower Extremity Wo/W Contrast,,73725,CPT,Facility,Both,,,,2346,1994.1,533.908,2346,BlueCross BlueShield Minnesota,High Value Network Plan,961.0344,,,Fee schedule,,"90% of BCBS commercial commodity fee schedule, plus MN Care tax; see disclaimer for more information"
Mra Lower Extremity Wo/W Contrast,,73725,CPT,Facility,Outpatient,,,,2346,1994.1,533.908,2346,BlueCross BlueShield Minnesota,Medicare Advantage,1149.54,49,,percent of total billed charges,,
Mra Lower Extremity Wo/W Contrast,,73725,CPT,Facility,Inpatient,,,,2346,1994.1,533.908,2346,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Mra Lower Extremity Wo/W Contrast,,73725,CPT,Facility,Both,,,,2346,1994.1,533.908,2346,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,945.7646312,,,Fee schedule,,"88.57% of BCBS commercial commodity fee schedule, plus MN Care tax"
Mra Lower Extremity Wo/W Contrast,,73725,CPT,Facility,Both,,,,2346,1994.1,533.908,2346,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,533.908,,,Fee schedule,,"100% of BCBS Medicaid commodity fee schedule, plus MN Care tax"
Mra Lower Extremity Wo/W Contrast,,73725,CPT,Facility,Outpatient,,,,2346,1994.1,533.908,2346,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1149.54,49,,percent of total billed charges,,
Mra Lower Extremity Wo/W Contrast,,73725,CPT,Facility,Inpatient,,,,2346,1994.1,533.908,2346,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Mra Lower Extremity Wo/W Contrast,,73725,CPT,Facility,Both,,,,2346,1994.1,533.908,2346,CorVel,Worker's Compensation,2346,100,,percent of total billed charges,,
Mra Lower Extremity Wo/W Contrast,,73725,CPT,Facility,Both,,,,2346,1994.1,533.908,2346,First Health Group Corporation,First Health Network,2275.62,97,,percent of total billed charges,,
Mra Lower Extremity Wo/W Contrast,,73725,CPT,Facility,Both,,,,2346,1994.1,533.908,2346,"Health Partners, Inc.",Commercial,2219.316,94.6,,percent of total billed charges,,
Mra Lower Extremity Wo/W Contrast,,73725,CPT,Facility,Outpatient,,,,2346,1994.1,533.908,2346,"Health Partners, Inc.",Medicare Advantage,1149.54,49,,percent of total billed charges,,
Mra Lower Extremity Wo/W Contrast,,73725,CPT,Facility,Inpatient,,,,2346,1994.1,533.908,2346,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mra Lower Extremity Wo/W Contrast,,73725,CPT,Facility,Both,,,,2346,1994.1,533.908,2346,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1407.6,60,,percent of total billed charges,,
Mra Lower Extremity Wo/W Contrast,,73725,CPT,Facility,Both,,,,2346,1994.1,533.908,2346,"Health Partners, Inc.",State of Minnesota Advantage Program,1911.99,81.5,,percent of total billed charges,,
Mra Lower Extremity Wo/W Contrast,,73725,CPT,Facility,Both,,,,2346,1994.1,533.908,2346,"Health Partners, Inc.",State Public Programs,1173,50,,percent of total billed charges,,
Mra Lower Extremity Wo/W Contrast,,73725,CPT,Facility,Both,,,,2346,1994.1,533.908,2346,Humana Insurance Company,Commercial PPO,2228.7,95,,percent of total billed charges,,
Mra Lower Extremity Wo/W Contrast,,73725,CPT,Facility,Outpatient,,,,2346,1994.1,533.908,2346,Humana Insurance Company,Medicare PPO,1149.54,49,,percent of total billed charges,,
Mra Lower Extremity Wo/W Contrast,,73725,CPT,Facility,Inpatient,,,,2346,1994.1,533.908,2346,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Mra Lower Extremity Wo/W Contrast,,73725,CPT,Facility,Both,,,,2346,1994.1,533.908,2346,Medica,Individual & Family,2324.886,99.1,,percent of total billed charges,,
Mra Lower Extremity Wo/W Contrast,,73725,CPT,Facility,Outpatient,,,,2346,1994.1,533.908,2346,Medica,Medica Advantage Solution,1168.308,49.8,,percent of total billed charges,,
Mra Lower Extremity Wo/W Contrast,,73725,CPT,Facility,Inpatient,,,,2346,1994.1,533.908,2346,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Mra Lower Extremity Wo/W Contrast,,73725,CPT,Facility,Outpatient,,,,2346,1994.1,533.908,2346,Medica,Medical Assistance,747,,,Other ,per vist,Pays in addition to all Outpatient Service Categories
Mra Lower Extremity Wo/W Contrast,,73725,CPT,Facility,Inpatient,,,,2346,1994.1,533.908,2346,Medica,Medical Assistance,,,,,Included in per diem rate,
Mra Lower Extremity Wo/W Contrast,,73725,CPT,Facility,Outpatient,,,,2346,1994.1,533.908,2346,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1168.308,49.8,,percent of total billed charges,,
Mra Lower Extremity Wo/W Contrast,,73725,CPT,Facility,Inpatient,,,,2346,1994.1,533.908,2346,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Mra Lower Extremity Wo/W Contrast,,73725,CPT,Facility,Both,,,,2346,1994.1,533.908,2346,"Multiplan, Inc.","Multiplan, Inc.",2205.24,94,,percent of total billed charges,,
Mra Lower Extremity Wo/W Contrast,,73725,CPT,Facility,Outpatient,,,,2346,1994.1,533.908,2346,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1535,,,Other  ,per scan,
Mra Lower Extremity Wo/W Contrast,,73725,CPT,Facility,Inpatient,,,,2346,1994.1,533.908,2346,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Mra Lower Extremity Wo/W Contrast,,73725,CPT,Facility,Both,,,,2346,1994.1,533.908,2346,"Preferred One Administrative Services, INC.",PPO,2313.156,98.6,,percent of total billed charges,,
Mra Lower Extremity Wo/W Contrast,,73725,CPT,Facility,Outpatient,,,,2346,1994.1,533.908,2346,PrimeWest Health,Minnesota Senior Health Options (MSHO),1207.017,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Mra Lower Extremity Wo/W Contrast,,73725,CPT,Facility,Inpatient,,,,2346,1994.1,533.908,2346,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mra Lower Extremity Wo/W Contrast,,73725,CPT,Facility,Outpatient,,,,2346,1994.1,533.908,2346,PrimeWest Health,MinnesotaCare,1204.9056,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Mra Lower Extremity Wo/W Contrast,,73725,CPT,Facility,Inpatient,,,,2346,1994.1,533.908,2346,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Mra Lower Extremity Wo/W Contrast,,73725,CPT,Facility,Both,,,,2346,1994.1,533.908,2346,Sanford Health Plan,Sanford Health Plan,2158.32,92,,percent of total billed charges,,
Mra Lower Extremity Wo/W Contrast,,73725,CPT,Facility,Outpatient,,,,2346,1994.1,533.908,2346,"UCare Health, Inc.",Individual & Family Plan,1321.971,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Mra Lower Extremity Wo/W Contrast,,73725,CPT,Facility,Inpatient,,,,2346,1994.1,533.908,2346,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Mra Lower Extremity Wo/W Contrast,,73725,CPT,Facility,Outpatient,,,,2346,1994.1,533.908,2346,"UCare Health, Inc.",Medical Assistance,1184.0262,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mra Lower Extremity Wo/W Contrast,,73725,CPT,Facility,Inpatient,,,,2346,1994.1,533.908,2346,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Mra Lower Extremity Wo/W Contrast,,73725,CPT,Facility,Outpatient,,,,2346,1994.1,533.908,2346,"UCare Health, Inc.",Medicare Advantage,1184.0262,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mra Lower Extremity Wo/W Contrast,,73725,CPT,Facility,Inpatient,,,,2346,1994.1,533.908,2346,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mra Lower Extremity Wo/W Contrast,,73725,CPT,Facility,Outpatient,,,,2346,1994.1,533.908,2346,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1184.0262,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mra Lower Extremity Wo/W Contrast,,73725,CPT,Facility,Inpatient,,,,2346,1994.1,533.908,2346,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mra Lower Extremity Wo/W Contrast,,73725,CPT,Facility,Both,,,,2346,1994.1,533.908,2346,UnitedHealthcare,Individual & Family,2205.24,94,,percent of total billed charges,,
Mra Lower Extremity Wo/W Contrast,,73725,CPT,Facility,Outpatient,,,,2346,1994.1,533.908,2346,UnitedHealthcare,Medicare Advantage,1149.54,49,,percent of total billed charges,,
Mra Lower Extremity Wo/W Contrast,,73725,CPT,Facility,Inpatient,,,,2346,1994.1,533.908,2346,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Mra Lower Extremity Wo/W Contrast,,73725,CPT,Facility,Outpatient,,,,2346,1994.1,533.908,2346,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1126.08,48,,percent of total billed charges,,100% of DHS outpatient percentage
Mra Lower Extremity Wo/W Contrast,,73725,CPT,Facility,Inpatient,,,,2346,1994.1,533.908,2346,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Xr Abdomen One View,,74018,CPT,Facility,Both,,,,241,204.85,69.0706,241,Aetna,Commercial,221.72,92,,percent of total billed charges,,
Xr Abdomen One View,,74018,CPT,Facility,Outpatient,,,,241,204.85,69.0706,241,Aetna,Medicare Advantage,118.09,49,,percent of total billed charges,,
Xr Abdomen One View,,74018,CPT,Facility,Inpatient,,,,241,204.85,69.0706,241,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Xr Abdomen One View,,74018,CPT,Facility,Both,,,,241,204.85,69.0706,241,Aetna,PPO,224.13,93,,percent of total billed charges,,
Xr Abdomen One View,,74018,CPT,Facility,Both,,,,241,204.85,69.0706,241,America's PPO,America's PPO,231.4323,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Xr Abdomen One View,,74018,CPT,Facility,Both,,,,241,204.85,69.0706,241,BlueCross BlueShield Minnesota, Federal Employee Program,237.144,98.4,,percent of total billed charges,,
Xr Abdomen One View,,74018,CPT,Facility,Both,,,,241,204.85,69.0706,241,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,241,100,,percent of total billed charges,,
Xr Abdomen One View,,74018,CPT,Facility,Both,,,,241,204.85,69.0706,241,BlueCross BlueShield Minnesota,High Value Network Plan,216.9,90,,percent of total billed charges,,
Xr Abdomen One View,,74018,CPT,Facility,Outpatient,,,,241,204.85,69.0706,241,BlueCross BlueShield Minnesota,Medicare Advantage,118.09,49,,percent of total billed charges,,
Xr Abdomen One View,,74018,CPT,Facility,Inpatient,,,,241,204.85,69.0706,241,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Xr Abdomen One View,,74018,CPT,Facility,Both,,,,241,204.85,69.0706,241,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,213.4537,88.57,,percent of total billed charges,,
Xr Abdomen One View,,74018,CPT,Facility,Both,,,,241,204.85,69.0706,241,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,69.0706,28.66,,percent of total billed charges,,
Xr Abdomen One View,,74018,CPT,Facility,Outpatient,,,,241,204.85,69.0706,241,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),118.09,49,,percent of total billed charges,,
Xr Abdomen One View,,74018,CPT,Facility,Inpatient,,,,241,204.85,69.0706,241,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Xr Abdomen One View,,74018,CPT,Facility,Both,,,,241,204.85,69.0706,241,CorVel,Worker's Compensation,241,100,,percent of total billed charges,,
Xr Abdomen One View,,74018,CPT,Facility,Both,,,,241,204.85,69.0706,241,First Health Group Corporation,First Health Network,233.77,97,,percent of total billed charges,,
Xr Abdomen One View,,74018,CPT,Facility,Both,,,,241,204.85,69.0706,241,"Health Partners, Inc.",Commercial,227.986,94.6,,percent of total billed charges,,
Xr Abdomen One View,,74018,CPT,Facility,Outpatient,,,,241,204.85,69.0706,241,"Health Partners, Inc.",Medicare Advantage,118.09,49,,percent of total billed charges,,
Xr Abdomen One View,,74018,CPT,Facility,Inpatient,,,,241,204.85,69.0706,241,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Abdomen One View,,74018,CPT,Facility,Both,,,,241,204.85,69.0706,241,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),144.6,60,,percent of total billed charges,,
Xr Abdomen One View,,74018,CPT,Facility,Both,,,,241,204.85,69.0706,241,"Health Partners, Inc.",State of Minnesota Advantage Program,196.415,81.5,,percent of total billed charges,,
Xr Abdomen One View,,74018,CPT,Facility,Both,,,,241,204.85,69.0706,241,"Health Partners, Inc.",State Public Programs,120.5,50,,percent of total billed charges,,
Xr Abdomen One View,,74018,CPT,Facility,Both,,,,241,204.85,69.0706,241,Humana Insurance Company,Commercial PPO,228.95,95,,percent of total billed charges,,
Xr Abdomen One View,,74018,CPT,Facility,Outpatient,,,,241,204.85,69.0706,241,Humana Insurance Company,Medicare PPO,118.09,49,,percent of total billed charges,,
Xr Abdomen One View,,74018,CPT,Facility,Inpatient,,,,241,204.85,69.0706,241,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Xr Abdomen One View,,74018,CPT,Facility,Both,,,,241,204.85,69.0706,241,Medica,Individual & Family,238.831,99.1,,percent of total billed charges,,
Xr Abdomen One View,,74018,CPT,Facility,Outpatient,,,,241,204.85,69.0706,241,Medica,Medica Advantage Solution,120.018,49.8,,percent of total billed charges,,
Xr Abdomen One View,,74018,CPT,Facility,Inpatient,,,,241,204.85,69.0706,241,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Xr Abdomen One View,,74018,CPT,Facility,Outpatient,,,,241,204.85,69.0706,241,Medica,Medical Assistance,107.486,44.6,,percent of total billed charges,,
Xr Abdomen One View,,74018,CPT,Facility,Inpatient,,,,241,204.85,69.0706,241,Medica,Medical Assistance,,,,,Included in per diem rate,
Xr Abdomen One View,,74018,CPT,Facility,Outpatient,,,,241,204.85,69.0706,241,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,120.018,49.8,,percent of total billed charges,,
Xr Abdomen One View,,74018,CPT,Facility,Inpatient,,,,241,204.85,69.0706,241,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Xr Abdomen One View,,74018,CPT,Facility,Both,,,,241,204.85,69.0706,241,"Multiplan, Inc.","Multiplan, Inc.",226.54,94,,percent of total billed charges,,
Xr Abdomen One View,,74018,CPT,Facility,Outpatient,,,,241,204.85,69.0706,241,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,217.141,90.1,,percent of total billed charges,,
Xr Abdomen One View,,74018,CPT,Facility,Inpatient,,,,241,204.85,69.0706,241,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Xr Abdomen One View,,74018,CPT,Facility,Both,,,,241,204.85,69.0706,241,"Preferred One Administrative Services, INC.",PPO,237.626,98.6,,percent of total billed charges,,
Xr Abdomen One View,,74018,CPT,Facility,Outpatient,,,,241,204.85,69.0706,241,PrimeWest Health,Minnesota Senior Health Options (MSHO),123.9945,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Xr Abdomen One View,,74018,CPT,Facility,Inpatient,,,,241,204.85,69.0706,241,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Abdomen One View,,74018,CPT,Facility,Outpatient,,,,241,204.85,69.0706,241,PrimeWest Health,MinnesotaCare,123.7776,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Xr Abdomen One View,,74018,CPT,Facility,Inpatient,,,,241,204.85,69.0706,241,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Xr Abdomen One View,,74018,CPT,Facility,Both,,,,241,204.85,69.0706,241,Sanford Health Plan,Sanford Health Plan,221.72,92,,percent of total billed charges,,
Xr Abdomen One View,,74018,CPT,Facility,Outpatient,,,,241,204.85,69.0706,241,"UCare Health, Inc.",Individual & Family Plan,135.8035,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Xr Abdomen One View,,74018,CPT,Facility,Inpatient,,,,241,204.85,69.0706,241,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Xr Abdomen One View,,74018,CPT,Facility,Outpatient,,,,241,204.85,69.0706,241,"UCare Health, Inc.",Medical Assistance,121.6327,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Abdomen One View,,74018,CPT,Facility,Inpatient,,,,241,204.85,69.0706,241,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Xr Abdomen One View,,74018,CPT,Facility,Outpatient,,,,241,204.85,69.0706,241,"UCare Health, Inc.",Medicare Advantage,121.6327,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Abdomen One View,,74018,CPT,Facility,Inpatient,,,,241,204.85,69.0706,241,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Abdomen One View,,74018,CPT,Facility,Outpatient,,,,241,204.85,69.0706,241,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),121.6327,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Abdomen One View,,74018,CPT,Facility,Inpatient,,,,241,204.85,69.0706,241,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Abdomen One View,,74018,CPT,Facility,Both,,,,241,204.85,69.0706,241,UnitedHealthcare,Individual & Family,226.54,94,,percent of total billed charges,,
Xr Abdomen One View,,74018,CPT,Facility,Outpatient,,,,241,204.85,69.0706,241,UnitedHealthcare,Medicare Advantage,118.09,49,,percent of total billed charges,,
Xr Abdomen One View,,74018,CPT,Facility,Inpatient,,,,241,204.85,69.0706,241,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Xr Abdomen One View,,74018,CPT,Facility,Outpatient,,,,241,204.85,69.0706,241,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,115.68,48,,percent of total billed charges,,100% of DHS outpatient percentage
Xr Abdomen One View,,74018,CPT,Facility,Inpatient,,,,241,204.85,69.0706,241,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Xr Kidneys Ureters And Bladder,,74018,CPT,Facility,Both,,,,241,204.85,69.0706,241,Aetna,Commercial,221.72,92,,percent of total billed charges,,
Xr Kidneys Ureters And Bladder,,74018,CPT,Facility,Outpatient,,,,241,204.85,69.0706,241,Aetna,Medicare Advantage,118.09,49,,percent of total billed charges,,
Xr Kidneys Ureters And Bladder,,74018,CPT,Facility,Inpatient,,,,241,204.85,69.0706,241,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Xr Kidneys Ureters And Bladder,,74018,CPT,Facility,Both,,,,241,204.85,69.0706,241,Aetna,PPO,224.13,93,,percent of total billed charges,,
Xr Kidneys Ureters And Bladder,,74018,CPT,Facility,Both,,,,241,204.85,69.0706,241,America's PPO,America's PPO,231.4323,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Xr Kidneys Ureters And Bladder,,74018,CPT,Facility,Both,,,,241,204.85,69.0706,241,BlueCross BlueShield Minnesota, Federal Employee Program,237.144,98.4,,percent of total billed charges,,
Xr Kidneys Ureters And Bladder,,74018,CPT,Facility,Both,,,,241,204.85,69.0706,241,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,241,100,,percent of total billed charges,,
Xr Kidneys Ureters And Bladder,,74018,CPT,Facility,Both,,,,241,204.85,69.0706,241,BlueCross BlueShield Minnesota,High Value Network Plan,216.9,90,,percent of total billed charges,,
Xr Kidneys Ureters And Bladder,,74018,CPT,Facility,Outpatient,,,,241,204.85,69.0706,241,BlueCross BlueShield Minnesota,Medicare Advantage,118.09,49,,percent of total billed charges,,
Xr Kidneys Ureters And Bladder,,74018,CPT,Facility,Inpatient,,,,241,204.85,69.0706,241,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Xr Kidneys Ureters And Bladder,,74018,CPT,Facility,Both,,,,241,204.85,69.0706,241,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,213.4537,88.57,,percent of total billed charges,,
Xr Kidneys Ureters And Bladder,,74018,CPT,Facility,Both,,,,241,204.85,69.0706,241,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,69.0706,28.66,,percent of total billed charges,,
Xr Kidneys Ureters And Bladder,,74018,CPT,Facility,Outpatient,,,,241,204.85,69.0706,241,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),118.09,49,,percent of total billed charges,,
Xr Kidneys Ureters And Bladder,,74018,CPT,Facility,Inpatient,,,,241,204.85,69.0706,241,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Xr Kidneys Ureters And Bladder,,74018,CPT,Facility,Both,,,,241,204.85,69.0706,241,CorVel,Worker's Compensation,241,100,,percent of total billed charges,,
Xr Kidneys Ureters And Bladder,,74018,CPT,Facility,Both,,,,241,204.85,69.0706,241,First Health Group Corporation,First Health Network,233.77,97,,percent of total billed charges,,
Xr Kidneys Ureters And Bladder,,74018,CPT,Facility,Both,,,,241,204.85,69.0706,241,"Health Partners, Inc.",Commercial,227.986,94.6,,percent of total billed charges,,
Xr Kidneys Ureters And Bladder,,74018,CPT,Facility,Outpatient,,,,241,204.85,69.0706,241,"Health Partners, Inc.",Medicare Advantage,118.09,49,,percent of total billed charges,,
Xr Kidneys Ureters And Bladder,,74018,CPT,Facility,Inpatient,,,,241,204.85,69.0706,241,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Kidneys Ureters And Bladder,,74018,CPT,Facility,Both,,,,241,204.85,69.0706,241,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),144.6,60,,percent of total billed charges,,
Xr Kidneys Ureters And Bladder,,74018,CPT,Facility,Both,,,,241,204.85,69.0706,241,"Health Partners, Inc.",State of Minnesota Advantage Program,196.415,81.5,,percent of total billed charges,,
Xr Kidneys Ureters And Bladder,,74018,CPT,Facility,Both,,,,241,204.85,69.0706,241,"Health Partners, Inc.",State Public Programs,120.5,50,,percent of total billed charges,,
Xr Kidneys Ureters And Bladder,,74018,CPT,Facility,Both,,,,241,204.85,69.0706,241,Humana Insurance Company,Commercial PPO,228.95,95,,percent of total billed charges,,
Xr Kidneys Ureters And Bladder,,74018,CPT,Facility,Outpatient,,,,241,204.85,69.0706,241,Humana Insurance Company,Medicare PPO,118.09,49,,percent of total billed charges,,
Xr Kidneys Ureters And Bladder,,74018,CPT,Facility,Inpatient,,,,241,204.85,69.0706,241,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Xr Kidneys Ureters And Bladder,,74018,CPT,Facility,Both,,,,241,204.85,69.0706,241,Medica,Individual & Family,238.831,99.1,,percent of total billed charges,,
Xr Kidneys Ureters And Bladder,,74018,CPT,Facility,Outpatient,,,,241,204.85,69.0706,241,Medica,Medica Advantage Solution,120.018,49.8,,percent of total billed charges,,
Xr Kidneys Ureters And Bladder,,74018,CPT,Facility,Inpatient,,,,241,204.85,69.0706,241,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Xr Kidneys Ureters And Bladder,,74018,CPT,Facility,Outpatient,,,,241,204.85,69.0706,241,Medica,Medical Assistance,107.486,44.6,,percent of total billed charges,,
Xr Kidneys Ureters And Bladder,,74018,CPT,Facility,Inpatient,,,,241,204.85,69.0706,241,Medica,Medical Assistance,,,,,Included in per diem rate,
Xr Kidneys Ureters And Bladder,,74018,CPT,Facility,Outpatient,,,,241,204.85,69.0706,241,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,120.018,49.8,,percent of total billed charges,,
Xr Kidneys Ureters And Bladder,,74018,CPT,Facility,Inpatient,,,,241,204.85,69.0706,241,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Xr Kidneys Ureters And Bladder,,74018,CPT,Facility,Both,,,,241,204.85,69.0706,241,"Multiplan, Inc.","Multiplan, Inc.",226.54,94,,percent of total billed charges,,
Xr Kidneys Ureters And Bladder,,74018,CPT,Facility,Outpatient,,,,241,204.85,69.0706,241,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,217.141,90.1,,percent of total billed charges,,
Xr Kidneys Ureters And Bladder,,74018,CPT,Facility,Inpatient,,,,241,204.85,69.0706,241,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Xr Kidneys Ureters And Bladder,,74018,CPT,Facility,Both,,,,241,204.85,69.0706,241,"Preferred One Administrative Services, INC.",PPO,237.626,98.6,,percent of total billed charges,,
Xr Kidneys Ureters And Bladder,,74018,CPT,Facility,Outpatient,,,,241,204.85,69.0706,241,PrimeWest Health,Minnesota Senior Health Options (MSHO),123.9945,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Xr Kidneys Ureters And Bladder,,74018,CPT,Facility,Inpatient,,,,241,204.85,69.0706,241,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Kidneys Ureters And Bladder,,74018,CPT,Facility,Outpatient,,,,241,204.85,69.0706,241,PrimeWest Health,MinnesotaCare,123.7776,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Xr Kidneys Ureters And Bladder,,74018,CPT,Facility,Inpatient,,,,241,204.85,69.0706,241,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Xr Kidneys Ureters And Bladder,,74018,CPT,Facility,Both,,,,241,204.85,69.0706,241,Sanford Health Plan,Sanford Health Plan,221.72,92,,percent of total billed charges,,
Xr Kidneys Ureters And Bladder,,74018,CPT,Facility,Outpatient,,,,241,204.85,69.0706,241,"UCare Health, Inc.",Individual & Family Plan,135.8035,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Xr Kidneys Ureters And Bladder,,74018,CPT,Facility,Inpatient,,,,241,204.85,69.0706,241,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Xr Kidneys Ureters And Bladder,,74018,CPT,Facility,Outpatient,,,,241,204.85,69.0706,241,"UCare Health, Inc.",Medical Assistance,121.6327,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Kidneys Ureters And Bladder,,74018,CPT,Facility,Inpatient,,,,241,204.85,69.0706,241,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Xr Kidneys Ureters And Bladder,,74018,CPT,Facility,Outpatient,,,,241,204.85,69.0706,241,"UCare Health, Inc.",Medicare Advantage,121.6327,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Kidneys Ureters And Bladder,,74018,CPT,Facility,Inpatient,,,,241,204.85,69.0706,241,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Kidneys Ureters And Bladder,,74018,CPT,Facility,Outpatient,,,,241,204.85,69.0706,241,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),121.6327,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Kidneys Ureters And Bladder,,74018,CPT,Facility,Inpatient,,,,241,204.85,69.0706,241,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Kidneys Ureters And Bladder,,74018,CPT,Facility,Both,,,,241,204.85,69.0706,241,UnitedHealthcare,Individual & Family,226.54,94,,percent of total billed charges,,
Xr Kidneys Ureters And Bladder,,74018,CPT,Facility,Outpatient,,,,241,204.85,69.0706,241,UnitedHealthcare,Medicare Advantage,118.09,49,,percent of total billed charges,,
Xr Kidneys Ureters And Bladder,,74018,CPT,Facility,Inpatient,,,,241,204.85,69.0706,241,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Xr Kidneys Ureters And Bladder,,74018,CPT,Facility,Outpatient,,,,241,204.85,69.0706,241,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,115.68,48,,percent of total billed charges,,100% of DHS outpatient percentage
Xr Kidneys Ureters And Bladder,,74018,CPT,Facility,Inpatient,,,,241,204.85,69.0706,241,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Xr Abdomen 2 Views,,74019,CPT,Facility,Both,,,,319,271.15,91.4254,319,Aetna,Commercial,293.48,92,,percent of total billed charges,,
Xr Abdomen 2 Views,,74019,CPT,Facility,Outpatient,,,,319,271.15,91.4254,319,Aetna,Medicare Advantage,156.31,49,,percent of total billed charges,,
Xr Abdomen 2 Views,,74019,CPT,Facility,Inpatient,,,,319,271.15,91.4254,319,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Xr Abdomen 2 Views,,74019,CPT,Facility,Both,,,,319,271.15,91.4254,319,Aetna,PPO,296.67,93,,percent of total billed charges,,
Xr Abdomen 2 Views,,74019,CPT,Facility,Both,,,,319,271.15,91.4254,319,America's PPO,America's PPO,306.3357,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Xr Abdomen 2 Views,,74019,CPT,Facility,Both,,,,319,271.15,91.4254,319,BlueCross BlueShield Minnesota, Federal Employee Program,313.896,98.4,,percent of total billed charges,,
Xr Abdomen 2 Views,,74019,CPT,Facility,Both,,,,319,271.15,91.4254,319,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,319,100,,percent of total billed charges,,
Xr Abdomen 2 Views,,74019,CPT,Facility,Both,,,,319,271.15,91.4254,319,BlueCross BlueShield Minnesota,High Value Network Plan,287.1,90,,percent of total billed charges,,
Xr Abdomen 2 Views,,74019,CPT,Facility,Outpatient,,,,319,271.15,91.4254,319,BlueCross BlueShield Minnesota,Medicare Advantage,156.31,49,,percent of total billed charges,,
Xr Abdomen 2 Views,,74019,CPT,Facility,Inpatient,,,,319,271.15,91.4254,319,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Xr Abdomen 2 Views,,74019,CPT,Facility,Both,,,,319,271.15,91.4254,319,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,282.5383,88.57,,percent of total billed charges,,
Xr Abdomen 2 Views,,74019,CPT,Facility,Both,,,,319,271.15,91.4254,319,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,91.4254,28.66,,percent of total billed charges,,
Xr Abdomen 2 Views,,74019,CPT,Facility,Outpatient,,,,319,271.15,91.4254,319,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),156.31,49,,percent of total billed charges,,
Xr Abdomen 2 Views,,74019,CPT,Facility,Inpatient,,,,319,271.15,91.4254,319,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Xr Abdomen 2 Views,,74019,CPT,Facility,Both,,,,319,271.15,91.4254,319,CorVel,Worker's Compensation,319,100,,percent of total billed charges,,
Xr Abdomen 2 Views,,74019,CPT,Facility,Both,,,,319,271.15,91.4254,319,First Health Group Corporation,First Health Network,309.43,97,,percent of total billed charges,,
Xr Abdomen 2 Views,,74019,CPT,Facility,Both,,,,319,271.15,91.4254,319,"Health Partners, Inc.",Commercial,301.774,94.6,,percent of total billed charges,,
Xr Abdomen 2 Views,,74019,CPT,Facility,Outpatient,,,,319,271.15,91.4254,319,"Health Partners, Inc.",Medicare Advantage,156.31,49,,percent of total billed charges,,
Xr Abdomen 2 Views,,74019,CPT,Facility,Inpatient,,,,319,271.15,91.4254,319,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Abdomen 2 Views,,74019,CPT,Facility,Both,,,,319,271.15,91.4254,319,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),191.4,60,,percent of total billed charges,,
Xr Abdomen 2 Views,,74019,CPT,Facility,Both,,,,319,271.15,91.4254,319,"Health Partners, Inc.",State of Minnesota Advantage Program,259.985,81.5,,percent of total billed charges,,
Xr Abdomen 2 Views,,74019,CPT,Facility,Both,,,,319,271.15,91.4254,319,"Health Partners, Inc.",State Public Programs,159.5,50,,percent of total billed charges,,
Xr Abdomen 2 Views,,74019,CPT,Facility,Both,,,,319,271.15,91.4254,319,Humana Insurance Company,Commercial PPO,303.05,95,,percent of total billed charges,,
Xr Abdomen 2 Views,,74019,CPT,Facility,Outpatient,,,,319,271.15,91.4254,319,Humana Insurance Company,Medicare PPO,156.31,49,,percent of total billed charges,,
Xr Abdomen 2 Views,,74019,CPT,Facility,Inpatient,,,,319,271.15,91.4254,319,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Xr Abdomen 2 Views,,74019,CPT,Facility,Both,,,,319,271.15,91.4254,319,Medica,Individual & Family,316.129,99.1,,percent of total billed charges,,
Xr Abdomen 2 Views,,74019,CPT,Facility,Outpatient,,,,319,271.15,91.4254,319,Medica,Medica Advantage Solution,158.862,49.8,,percent of total billed charges,,
Xr Abdomen 2 Views,,74019,CPT,Facility,Inpatient,,,,319,271.15,91.4254,319,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Xr Abdomen 2 Views,,74019,CPT,Facility,Outpatient,,,,319,271.15,91.4254,319,Medica,Medical Assistance,142.274,44.6,,percent of total billed charges,,
Xr Abdomen 2 Views,,74019,CPT,Facility,Inpatient,,,,319,271.15,91.4254,319,Medica,Medical Assistance,,,,,Included in per diem rate,
Xr Abdomen 2 Views,,74019,CPT,Facility,Outpatient,,,,319,271.15,91.4254,319,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,158.862,49.8,,percent of total billed charges,,
Xr Abdomen 2 Views,,74019,CPT,Facility,Inpatient,,,,319,271.15,91.4254,319,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Xr Abdomen 2 Views,,74019,CPT,Facility,Both,,,,319,271.15,91.4254,319,"Multiplan, Inc.","Multiplan, Inc.",299.86,94,,percent of total billed charges,,
Xr Abdomen 2 Views,,74019,CPT,Facility,Outpatient,,,,319,271.15,91.4254,319,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,287.419,90.1,,percent of total billed charges,,
Xr Abdomen 2 Views,,74019,CPT,Facility,Inpatient,,,,319,271.15,91.4254,319,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Xr Abdomen 2 Views,,74019,CPT,Facility,Both,,,,319,271.15,91.4254,319,"Preferred One Administrative Services, INC.",PPO,314.534,98.6,,percent of total billed charges,,
Xr Abdomen 2 Views,,74019,CPT,Facility,Outpatient,,,,319,271.15,91.4254,319,PrimeWest Health,Minnesota Senior Health Options (MSHO),164.1255,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Xr Abdomen 2 Views,,74019,CPT,Facility,Inpatient,,,,319,271.15,91.4254,319,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Abdomen 2 Views,,74019,CPT,Facility,Outpatient,,,,319,271.15,91.4254,319,PrimeWest Health,MinnesotaCare,163.8384,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Xr Abdomen 2 Views,,74019,CPT,Facility,Inpatient,,,,319,271.15,91.4254,319,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Xr Abdomen 2 Views,,74019,CPT,Facility,Both,,,,319,271.15,91.4254,319,Sanford Health Plan,Sanford Health Plan,293.48,92,,percent of total billed charges,,
Xr Abdomen 2 Views,,74019,CPT,Facility,Outpatient,,,,319,271.15,91.4254,319,"UCare Health, Inc.",Individual & Family Plan,179.7565,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Xr Abdomen 2 Views,,74019,CPT,Facility,Inpatient,,,,319,271.15,91.4254,319,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Xr Abdomen 2 Views,,74019,CPT,Facility,Outpatient,,,,319,271.15,91.4254,319,"UCare Health, Inc.",Medical Assistance,160.9993,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Abdomen 2 Views,,74019,CPT,Facility,Inpatient,,,,319,271.15,91.4254,319,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Xr Abdomen 2 Views,,74019,CPT,Facility,Outpatient,,,,319,271.15,91.4254,319,"UCare Health, Inc.",Medicare Advantage,160.9993,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Abdomen 2 Views,,74019,CPT,Facility,Inpatient,,,,319,271.15,91.4254,319,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Abdomen 2 Views,,74019,CPT,Facility,Outpatient,,,,319,271.15,91.4254,319,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),160.9993,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Abdomen 2 Views,,74019,CPT,Facility,Inpatient,,,,319,271.15,91.4254,319,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Abdomen 2 Views,,74019,CPT,Facility,Both,,,,319,271.15,91.4254,319,UnitedHealthcare,Individual & Family,299.86,94,,percent of total billed charges,,
Xr Abdomen 2 Views,,74019,CPT,Facility,Outpatient,,,,319,271.15,91.4254,319,UnitedHealthcare,Medicare Advantage,156.31,49,,percent of total billed charges,,
Xr Abdomen 2 Views,,74019,CPT,Facility,Inpatient,,,,319,271.15,91.4254,319,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Xr Abdomen 2 Views,,74019,CPT,Facility,Outpatient,,,,319,271.15,91.4254,319,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,153.12,48,,percent of total billed charges,,100% of DHS outpatient percentage
Xr Abdomen 2 Views,,74019,CPT,Facility,Inpatient,,,,319,271.15,91.4254,319,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Xr Abdomen; 3 Or More Views,,74021,CPT,Facility,Both,,,,255,216.75,73.083,255,Aetna,Commercial,234.6,92,,percent of total billed charges,,
Xr Abdomen; 3 Or More Views,,74021,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,Aetna,Medicare Advantage,124.95,49,,percent of total billed charges,,
Xr Abdomen; 3 Or More Views,,74021,CPT,Facility,Inpatient,,,,255,216.75,73.083,255,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Xr Abdomen; 3 Or More Views,,74021,CPT,Facility,Both,,,,255,216.75,73.083,255,Aetna,PPO,237.15,93,,percent of total billed charges,,
Xr Abdomen; 3 Or More Views,,74021,CPT,Facility,Both,,,,255,216.75,73.083,255,America's PPO,America's PPO,244.8765,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Xr Abdomen; 3 Or More Views,,74021,CPT,Facility,Both,,,,255,216.75,73.083,255,BlueCross BlueShield Minnesota, Federal Employee Program,250.92,98.4,,percent of total billed charges,,
Xr Abdomen; 3 Or More Views,,74021,CPT,Facility,Both,,,,255,216.75,73.083,255,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,255,100,,percent of total billed charges,,
Xr Abdomen; 3 Or More Views,,74021,CPT,Facility,Both,,,,255,216.75,73.083,255,BlueCross BlueShield Minnesota,High Value Network Plan,229.5,90,,percent of total billed charges,,
Xr Abdomen; 3 Or More Views,,74021,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,BlueCross BlueShield Minnesota,Medicare Advantage,124.95,49,,percent of total billed charges,,
Xr Abdomen; 3 Or More Views,,74021,CPT,Facility,Inpatient,,,,255,216.75,73.083,255,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Xr Abdomen; 3 Or More Views,,74021,CPT,Facility,Both,,,,255,216.75,73.083,255,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,225.8535,88.57,,percent of total billed charges,,
Xr Abdomen; 3 Or More Views,,74021,CPT,Facility,Both,,,,255,216.75,73.083,255,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,73.083,28.66,,percent of total billed charges,,
Xr Abdomen; 3 Or More Views,,74021,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),124.95,49,,percent of total billed charges,,
Xr Abdomen; 3 Or More Views,,74021,CPT,Facility,Inpatient,,,,255,216.75,73.083,255,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Xr Abdomen; 3 Or More Views,,74021,CPT,Facility,Both,,,,255,216.75,73.083,255,CorVel,Worker's Compensation,255,100,,percent of total billed charges,,
Xr Abdomen; 3 Or More Views,,74021,CPT,Facility,Both,,,,255,216.75,73.083,255,First Health Group Corporation,First Health Network,247.35,97,,percent of total billed charges,,
Xr Abdomen; 3 Or More Views,,74021,CPT,Facility,Both,,,,255,216.75,73.083,255,"Health Partners, Inc.",Commercial,241.23,94.6,,percent of total billed charges,,
Xr Abdomen; 3 Or More Views,,74021,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,"Health Partners, Inc.",Medicare Advantage,124.95,49,,percent of total billed charges,,
Xr Abdomen; 3 Or More Views,,74021,CPT,Facility,Inpatient,,,,255,216.75,73.083,255,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Abdomen; 3 Or More Views,,74021,CPT,Facility,Both,,,,255,216.75,73.083,255,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),153,60,,percent of total billed charges,,
Xr Abdomen; 3 Or More Views,,74021,CPT,Facility,Both,,,,255,216.75,73.083,255,"Health Partners, Inc.",State of Minnesota Advantage Program,207.825,81.5,,percent of total billed charges,,
Xr Abdomen; 3 Or More Views,,74021,CPT,Facility,Both,,,,255,216.75,73.083,255,"Health Partners, Inc.",State Public Programs,127.5,50,,percent of total billed charges,,
Xr Abdomen; 3 Or More Views,,74021,CPT,Facility,Both,,,,255,216.75,73.083,255,Humana Insurance Company,Commercial PPO,242.25,95,,percent of total billed charges,,
Xr Abdomen; 3 Or More Views,,74021,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,Humana Insurance Company,Medicare PPO,124.95,49,,percent of total billed charges,,
Xr Abdomen; 3 Or More Views,,74021,CPT,Facility,Inpatient,,,,255,216.75,73.083,255,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Xr Abdomen; 3 Or More Views,,74021,CPT,Facility,Both,,,,255,216.75,73.083,255,Medica,Individual & Family,252.705,99.1,,percent of total billed charges,,
Xr Abdomen; 3 Or More Views,,74021,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,Medica,Medica Advantage Solution,126.99,49.8,,percent of total billed charges,,
Xr Abdomen; 3 Or More Views,,74021,CPT,Facility,Inpatient,,,,255,216.75,73.083,255,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Xr Abdomen; 3 Or More Views,,74021,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,Medica,Medical Assistance,113.73,44.6,,percent of total billed charges,,
Xr Abdomen; 3 Or More Views,,74021,CPT,Facility,Inpatient,,,,255,216.75,73.083,255,Medica,Medical Assistance,,,,,Included in per diem rate,
Xr Abdomen; 3 Or More Views,,74021,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,126.99,49.8,,percent of total billed charges,,
Xr Abdomen; 3 Or More Views,,74021,CPT,Facility,Inpatient,,,,255,216.75,73.083,255,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Xr Abdomen; 3 Or More Views,,74021,CPT,Facility,Both,,,,255,216.75,73.083,255,"Multiplan, Inc.","Multiplan, Inc.",239.7,94,,percent of total billed charges,,
Xr Abdomen; 3 Or More Views,,74021,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,229.755,90.1,,percent of total billed charges,,
Xr Abdomen; 3 Or More Views,,74021,CPT,Facility,Inpatient,,,,255,216.75,73.083,255,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Xr Abdomen; 3 Or More Views,,74021,CPT,Facility,Both,,,,255,216.75,73.083,255,"Preferred One Administrative Services, INC.",PPO,251.43,98.6,,percent of total billed charges,,
Xr Abdomen; 3 Or More Views,,74021,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,PrimeWest Health,Minnesota Senior Health Options (MSHO),131.1975,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Xr Abdomen; 3 Or More Views,,74021,CPT,Facility,Inpatient,,,,255,216.75,73.083,255,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Abdomen; 3 Or More Views,,74021,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,PrimeWest Health,MinnesotaCare,130.968,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Xr Abdomen; 3 Or More Views,,74021,CPT,Facility,Inpatient,,,,255,216.75,73.083,255,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Xr Abdomen; 3 Or More Views,,74021,CPT,Facility,Both,,,,255,216.75,73.083,255,Sanford Health Plan,Sanford Health Plan,234.6,92,,percent of total billed charges,,
Xr Abdomen; 3 Or More Views,,74021,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,"UCare Health, Inc.",Individual & Family Plan,143.6925,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Xr Abdomen; 3 Or More Views,,74021,CPT,Facility,Inpatient,,,,255,216.75,73.083,255,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Xr Abdomen; 3 Or More Views,,74021,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,"UCare Health, Inc.",Medical Assistance,128.6985,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Abdomen; 3 Or More Views,,74021,CPT,Facility,Inpatient,,,,255,216.75,73.083,255,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Xr Abdomen; 3 Or More Views,,74021,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,"UCare Health, Inc.",Medicare Advantage,128.6985,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Abdomen; 3 Or More Views,,74021,CPT,Facility,Inpatient,,,,255,216.75,73.083,255,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Abdomen; 3 Or More Views,,74021,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),128.6985,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Abdomen; 3 Or More Views,,74021,CPT,Facility,Inpatient,,,,255,216.75,73.083,255,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Abdomen; 3 Or More Views,,74021,CPT,Facility,Both,,,,255,216.75,73.083,255,UnitedHealthcare,Individual & Family,239.7,94,,percent of total billed charges,,
Xr Abdomen; 3 Or More Views,,74021,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,UnitedHealthcare,Medicare Advantage,124.95,49,,percent of total billed charges,,
Xr Abdomen; 3 Or More Views,,74021,CPT,Facility,Inpatient,,,,255,216.75,73.083,255,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Xr Abdomen; 3 Or More Views,,74021,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,122.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
Xr Abdomen; 3 Or More Views,,74021,CPT,Facility,Inpatient,,,,255,216.75,73.083,255,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Xr Abdomen Flat And Upright Or Decub And Chest,,74022,CPT,Facility,Both,,,,306,260.1,87.6996,306,Aetna,Commercial,281.52,92,,percent of total billed charges,,
Xr Abdomen Flat And Upright Or Decub And Chest,,74022,CPT,Facility,Outpatient,,,,306,260.1,87.6996,306,Aetna,Medicare Advantage,149.94,49,,percent of total billed charges,,
Xr Abdomen Flat And Upright Or Decub And Chest,,74022,CPT,Facility,Inpatient,,,,306,260.1,87.6996,306,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Xr Abdomen Flat And Upright Or Decub And Chest,,74022,CPT,Facility,Both,,,,306,260.1,87.6996,306,Aetna,PPO,284.58,93,,percent of total billed charges,,
Xr Abdomen Flat And Upright Or Decub And Chest,,74022,CPT,Facility,Both,,,,306,260.1,87.6996,306,America's PPO,America's PPO,293.8518,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Xr Abdomen Flat And Upright Or Decub And Chest,,74022,CPT,Facility,Both,,,,306,260.1,87.6996,306,BlueCross BlueShield Minnesota, Federal Employee Program,301.104,98.4,,percent of total billed charges,,
Xr Abdomen Flat And Upright Or Decub And Chest,,74022,CPT,Facility,Both,,,,306,260.1,87.6996,306,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,306,100,,percent of total billed charges,,
Xr Abdomen Flat And Upright Or Decub And Chest,,74022,CPT,Facility,Both,,,,306,260.1,87.6996,306,BlueCross BlueShield Minnesota,High Value Network Plan,275.4,90,,percent of total billed charges,,
Xr Abdomen Flat And Upright Or Decub And Chest,,74022,CPT,Facility,Outpatient,,,,306,260.1,87.6996,306,BlueCross BlueShield Minnesota,Medicare Advantage,149.94,49,,percent of total billed charges,,
Xr Abdomen Flat And Upright Or Decub And Chest,,74022,CPT,Facility,Inpatient,,,,306,260.1,87.6996,306,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Xr Abdomen Flat And Upright Or Decub And Chest,,74022,CPT,Facility,Both,,,,306,260.1,87.6996,306,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,271.0242,88.57,,percent of total billed charges,,
Xr Abdomen Flat And Upright Or Decub And Chest,,74022,CPT,Facility,Both,,,,306,260.1,87.6996,306,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,87.6996,28.66,,percent of total billed charges,,
Xr Abdomen Flat And Upright Or Decub And Chest,,74022,CPT,Facility,Outpatient,,,,306,260.1,87.6996,306,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),149.94,49,,percent of total billed charges,,
Xr Abdomen Flat And Upright Or Decub And Chest,,74022,CPT,Facility,Inpatient,,,,306,260.1,87.6996,306,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Xr Abdomen Flat And Upright Or Decub And Chest,,74022,CPT,Facility,Both,,,,306,260.1,87.6996,306,CorVel,Worker's Compensation,306,100,,percent of total billed charges,,
Xr Abdomen Flat And Upright Or Decub And Chest,,74022,CPT,Facility,Both,,,,306,260.1,87.6996,306,First Health Group Corporation,First Health Network,296.82,97,,percent of total billed charges,,
Xr Abdomen Flat And Upright Or Decub And Chest,,74022,CPT,Facility,Both,,,,306,260.1,87.6996,306,"Health Partners, Inc.",Commercial,289.476,94.6,,percent of total billed charges,,
Xr Abdomen Flat And Upright Or Decub And Chest,,74022,CPT,Facility,Outpatient,,,,306,260.1,87.6996,306,"Health Partners, Inc.",Medicare Advantage,149.94,49,,percent of total billed charges,,
Xr Abdomen Flat And Upright Or Decub And Chest,,74022,CPT,Facility,Inpatient,,,,306,260.1,87.6996,306,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Abdomen Flat And Upright Or Decub And Chest,,74022,CPT,Facility,Both,,,,306,260.1,87.6996,306,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),183.6,60,,percent of total billed charges,,
Xr Abdomen Flat And Upright Or Decub And Chest,,74022,CPT,Facility,Both,,,,306,260.1,87.6996,306,"Health Partners, Inc.",State of Minnesota Advantage Program,249.39,81.5,,percent of total billed charges,,
Xr Abdomen Flat And Upright Or Decub And Chest,,74022,CPT,Facility,Both,,,,306,260.1,87.6996,306,"Health Partners, Inc.",State Public Programs,153,50,,percent of total billed charges,,
Xr Abdomen Flat And Upright Or Decub And Chest,,74022,CPT,Facility,Both,,,,306,260.1,87.6996,306,Humana Insurance Company,Commercial PPO,290.7,95,,percent of total billed charges,,
Xr Abdomen Flat And Upright Or Decub And Chest,,74022,CPT,Facility,Outpatient,,,,306,260.1,87.6996,306,Humana Insurance Company,Medicare PPO,149.94,49,,percent of total billed charges,,
Xr Abdomen Flat And Upright Or Decub And Chest,,74022,CPT,Facility,Inpatient,,,,306,260.1,87.6996,306,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Xr Abdomen Flat And Upright Or Decub And Chest,,74022,CPT,Facility,Both,,,,306,260.1,87.6996,306,Medica,Individual & Family,303.246,99.1,,percent of total billed charges,,
Xr Abdomen Flat And Upright Or Decub And Chest,,74022,CPT,Facility,Outpatient,,,,306,260.1,87.6996,306,Medica,Medica Advantage Solution,152.388,49.8,,percent of total billed charges,,
Xr Abdomen Flat And Upright Or Decub And Chest,,74022,CPT,Facility,Inpatient,,,,306,260.1,87.6996,306,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Xr Abdomen Flat And Upright Or Decub And Chest,,74022,CPT,Facility,Outpatient,,,,306,260.1,87.6996,306,Medica,Medical Assistance,136.476,44.6,,percent of total billed charges,,
Xr Abdomen Flat And Upright Or Decub And Chest,,74022,CPT,Facility,Inpatient,,,,306,260.1,87.6996,306,Medica,Medical Assistance,,,,,Included in per diem rate,
Xr Abdomen Flat And Upright Or Decub And Chest,,74022,CPT,Facility,Outpatient,,,,306,260.1,87.6996,306,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,152.388,49.8,,percent of total billed charges,,
Xr Abdomen Flat And Upright Or Decub And Chest,,74022,CPT,Facility,Inpatient,,,,306,260.1,87.6996,306,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Xr Abdomen Flat And Upright Or Decub And Chest,,74022,CPT,Facility,Both,,,,306,260.1,87.6996,306,"Multiplan, Inc.","Multiplan, Inc.",287.64,94,,percent of total billed charges,,
Xr Abdomen Flat And Upright Or Decub And Chest,,74022,CPT,Facility,Outpatient,,,,306,260.1,87.6996,306,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,275.706,90.1,,percent of total billed charges,,
Xr Abdomen Flat And Upright Or Decub And Chest,,74022,CPT,Facility,Inpatient,,,,306,260.1,87.6996,306,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Xr Abdomen Flat And Upright Or Decub And Chest,,74022,CPT,Facility,Both,,,,306,260.1,87.6996,306,"Preferred One Administrative Services, INC.",PPO,301.716,98.6,,percent of total billed charges,,
Xr Abdomen Flat And Upright Or Decub And Chest,,74022,CPT,Facility,Outpatient,,,,306,260.1,87.6996,306,PrimeWest Health,Minnesota Senior Health Options (MSHO),157.437,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Xr Abdomen Flat And Upright Or Decub And Chest,,74022,CPT,Facility,Inpatient,,,,306,260.1,87.6996,306,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Abdomen Flat And Upright Or Decub And Chest,,74022,CPT,Facility,Outpatient,,,,306,260.1,87.6996,306,PrimeWest Health,MinnesotaCare,157.1616,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Xr Abdomen Flat And Upright Or Decub And Chest,,74022,CPT,Facility,Inpatient,,,,306,260.1,87.6996,306,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Xr Abdomen Flat And Upright Or Decub And Chest,,74022,CPT,Facility,Both,,,,306,260.1,87.6996,306,Sanford Health Plan,Sanford Health Plan,281.52,92,,percent of total billed charges,,
Xr Abdomen Flat And Upright Or Decub And Chest,,74022,CPT,Facility,Outpatient,,,,306,260.1,87.6996,306,"UCare Health, Inc.",Individual & Family Plan,172.431,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Xr Abdomen Flat And Upright Or Decub And Chest,,74022,CPT,Facility,Inpatient,,,,306,260.1,87.6996,306,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Xr Abdomen Flat And Upright Or Decub And Chest,,74022,CPT,Facility,Outpatient,,,,306,260.1,87.6996,306,"UCare Health, Inc.",Medical Assistance,154.4382,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Abdomen Flat And Upright Or Decub And Chest,,74022,CPT,Facility,Inpatient,,,,306,260.1,87.6996,306,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Xr Abdomen Flat And Upright Or Decub And Chest,,74022,CPT,Facility,Outpatient,,,,306,260.1,87.6996,306,"UCare Health, Inc.",Medicare Advantage,154.4382,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Abdomen Flat And Upright Or Decub And Chest,,74022,CPT,Facility,Inpatient,,,,306,260.1,87.6996,306,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Abdomen Flat And Upright Or Decub And Chest,,74022,CPT,Facility,Outpatient,,,,306,260.1,87.6996,306,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),154.4382,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Abdomen Flat And Upright Or Decub And Chest,,74022,CPT,Facility,Inpatient,,,,306,260.1,87.6996,306,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Abdomen Flat And Upright Or Decub And Chest,,74022,CPT,Facility,Both,,,,306,260.1,87.6996,306,UnitedHealthcare,Individual & Family,287.64,94,,percent of total billed charges,,
Xr Abdomen Flat And Upright Or Decub And Chest,,74022,CPT,Facility,Outpatient,,,,306,260.1,87.6996,306,UnitedHealthcare,Medicare Advantage,149.94,49,,percent of total billed charges,,
Xr Abdomen Flat And Upright Or Decub And Chest,,74022,CPT,Facility,Inpatient,,,,306,260.1,87.6996,306,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Xr Abdomen Flat And Upright Or Decub And Chest,,74022,CPT,Facility,Outpatient,,,,306,260.1,87.6996,306,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,146.88,48,,percent of total billed charges,,100% of DHS outpatient percentage
Xr Abdomen Flat And Upright Or Decub And Chest,,74022,CPT,Facility,Inpatient,,,,306,260.1,87.6996,306,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Ct Abdomen Routine Wo Iv Contrast,,74150,CPT,Facility,Both,,,,1419,1206.15,325.628,1419,Aetna,Commercial,1305.48,92,,percent of total billed charges,,
Ct Abdomen Routine Wo Iv Contrast,,74150,CPT,Facility,Outpatient,,,,1419,1206.15,325.628,1419,Aetna,Medicare Advantage,695.31,49,,percent of total billed charges,,
Ct Abdomen Routine Wo Iv Contrast,,74150,CPT,Facility,Inpatient,,,,1419,1206.15,325.628,1419,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Ct Abdomen Routine Wo Iv Contrast,,74150,CPT,Facility,Both,,,,1419,1206.15,325.628,1419,Aetna,PPO,1319.67,93,,percent of total billed charges,,
Ct Abdomen Routine Wo Iv Contrast,,74150,CPT,Facility,Both,,,,1419,1206.15,325.628,1419,America's PPO,America's PPO,1362.6657,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Ct Abdomen Routine Wo Iv Contrast,,74150,CPT,Facility,Both,,,,1419,1206.15,325.628,1419,BlueCross BlueShield Minnesota, Federal Employee Program,641,,,Fee schedule,,100% of BCBS commercial commodity fee schedule
Ct Abdomen Routine Wo Iv Contrast,,74150,CPT,Facility,Both,,,,1419,1206.15,325.628,1419,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,651.256,,,Fee schedule,,"100% of BCBS commercial commodity fee schedule, plus MN Care tax"
Ct Abdomen Routine Wo Iv Contrast,,74150,CPT,Facility,Both,,,,1419,1206.15,325.628,1419,BlueCross BlueShield Minnesota,High Value Network Plan,586.1304,,,Fee schedule,,"90% of BCBS commercial commodity fee schedule, plus MN Care tax; see disclaimer for more information"
Ct Abdomen Routine Wo Iv Contrast,,74150,CPT,Facility,Outpatient,,,,1419,1206.15,325.628,1419,BlueCross BlueShield Minnesota,Medicare Advantage,695.31,49,,percent of total billed charges,,
Ct Abdomen Routine Wo Iv Contrast,,74150,CPT,Facility,Inpatient,,,,1419,1206.15,325.628,1419,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Ct Abdomen Routine Wo Iv Contrast,,74150,CPT,Facility,Both,,,,1419,1206.15,325.628,1419,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,576.8174392,,,Fee schedule,,"88.57% of BCBS commercial commodity fee schedule, plus MN Care tax"
Ct Abdomen Routine Wo Iv Contrast,,74150,CPT,Facility,Both,,,,1419,1206.15,325.628,1419,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,325.628,,,Fee schedule,,"100% of BCBS Medicaid commodity fee schedule, plus MN Care tax"
Ct Abdomen Routine Wo Iv Contrast,,74150,CPT,Facility,Outpatient,,,,1419,1206.15,325.628,1419,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),695.31,49,,percent of total billed charges,,
Ct Abdomen Routine Wo Iv Contrast,,74150,CPT,Facility,Inpatient,,,,1419,1206.15,325.628,1419,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Ct Abdomen Routine Wo Iv Contrast,,74150,CPT,Facility,Both,,,,1419,1206.15,325.628,1419,CorVel,Worker's Compensation,1419,100,,percent of total billed charges,,
Ct Abdomen Routine Wo Iv Contrast,,74150,CPT,Facility,Both,,,,1419,1206.15,325.628,1419,First Health Group Corporation,First Health Network,1376.43,97,,percent of total billed charges,,
Ct Abdomen Routine Wo Iv Contrast,,74150,CPT,Facility,Both,,,,1419,1206.15,325.628,1419,"Health Partners, Inc.",Commercial,1342.374,94.6,,percent of total billed charges,,
Ct Abdomen Routine Wo Iv Contrast,,74150,CPT,Facility,Outpatient,,,,1419,1206.15,325.628,1419,"Health Partners, Inc.",Medicare Advantage,695.31,49,,percent of total billed charges,,
Ct Abdomen Routine Wo Iv Contrast,,74150,CPT,Facility,Inpatient,,,,1419,1206.15,325.628,1419,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ct Abdomen Routine Wo Iv Contrast,,74150,CPT,Facility,Both,,,,1419,1206.15,325.628,1419,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),851.4,60,,percent of total billed charges,,
Ct Abdomen Routine Wo Iv Contrast,,74150,CPT,Facility,Both,,,,1419,1206.15,325.628,1419,"Health Partners, Inc.",State of Minnesota Advantage Program,1156.485,81.5,,percent of total billed charges,,
Ct Abdomen Routine Wo Iv Contrast,,74150,CPT,Facility,Both,,,,1419,1206.15,325.628,1419,"Health Partners, Inc.",State Public Programs,709.5,50,,percent of total billed charges,,
Ct Abdomen Routine Wo Iv Contrast,,74150,CPT,Facility,Both,,,,1419,1206.15,325.628,1419,Humana Insurance Company,Commercial PPO,1348.05,95,,percent of total billed charges,,
Ct Abdomen Routine Wo Iv Contrast,,74150,CPT,Facility,Outpatient,,,,1419,1206.15,325.628,1419,Humana Insurance Company,Medicare PPO,695.31,49,,percent of total billed charges,,
Ct Abdomen Routine Wo Iv Contrast,,74150,CPT,Facility,Inpatient,,,,1419,1206.15,325.628,1419,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Ct Abdomen Routine Wo Iv Contrast,,74150,CPT,Facility,Both,,,,1419,1206.15,325.628,1419,Medica,Individual & Family,1406.229,99.1,,percent of total billed charges,,
Ct Abdomen Routine Wo Iv Contrast,,74150,CPT,Facility,Outpatient,,,,1419,1206.15,325.628,1419,Medica,Medica Advantage Solution,706.662,49.8,,percent of total billed charges,,
Ct Abdomen Routine Wo Iv Contrast,,74150,CPT,Facility,Inpatient,,,,1419,1206.15,325.628,1419,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Ct Abdomen Routine Wo Iv Contrast,,74150,CPT,Facility,Outpatient,,,,1419,1206.15,325.628,1419,Medica,Medical Assistance,499,,,Other,Per visit,Pays in addition to all Outpatient Service Categories
Ct Abdomen Routine Wo Iv Contrast,,74150,CPT,Facility,Inpatient,,,,1419,1206.15,325.628,1419,Medica,Medical Assistance,,,,,Included in per diem rate,
Ct Abdomen Routine Wo Iv Contrast,,74150,CPT,Facility,Outpatient,,,,1419,1206.15,325.628,1419,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,706.662,49.8,,percent of total billed charges,,
Ct Abdomen Routine Wo Iv Contrast,,74150,CPT,Facility,Inpatient,,,,1419,1206.15,325.628,1419,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Ct Abdomen Routine Wo Iv Contrast,,74150,CPT,Facility,Both,,,,1419,1206.15,325.628,1419,"Multiplan, Inc.","Multiplan, Inc.",1333.86,94,,percent of total billed charges,,
Ct Abdomen Routine Wo Iv Contrast,,74150,CPT,Facility,Outpatient,,,,1419,1206.15,325.628,1419,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1283,,,Other,Per scan,
Ct Abdomen Routine Wo Iv Contrast,,74150,CPT,Facility,Inpatient,,,,1419,1206.15,325.628,1419,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Ct Abdomen Routine Wo Iv Contrast,,74150,CPT,Facility,Both,,,,1419,1206.15,325.628,1419,"Preferred One Administrative Services, INC.",PPO,1399.134,98.6,,percent of total billed charges,,
Ct Abdomen Routine Wo Iv Contrast,,74150,CPT,Facility,Outpatient,,,,1419,1206.15,325.628,1419,PrimeWest Health,Minnesota Senior Health Options (MSHO),730.0755,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Ct Abdomen Routine Wo Iv Contrast,,74150,CPT,Facility,Inpatient,,,,1419,1206.15,325.628,1419,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ct Abdomen Routine Wo Iv Contrast,,74150,CPT,Facility,Outpatient,,,,1419,1206.15,325.628,1419,PrimeWest Health,MinnesotaCare,728.7984,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Ct Abdomen Routine Wo Iv Contrast,,74150,CPT,Facility,Inpatient,,,,1419,1206.15,325.628,1419,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Ct Abdomen Routine Wo Iv Contrast,,74150,CPT,Facility,Both,,,,1419,1206.15,325.628,1419,Sanford Health Plan,Sanford Health Plan,1305.48,92,,percent of total billed charges,,
Ct Abdomen Routine Wo Iv Contrast,,74150,CPT,Facility,Outpatient,,,,1419,1206.15,325.628,1419,"UCare Health, Inc.",Individual & Family Plan,799.6065,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Ct Abdomen Routine Wo Iv Contrast,,74150,CPT,Facility,Inpatient,,,,1419,1206.15,325.628,1419,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Ct Abdomen Routine Wo Iv Contrast,,74150,CPT,Facility,Outpatient,,,,1419,1206.15,325.628,1419,"UCare Health, Inc.",Medical Assistance,716.1693,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ct Abdomen Routine Wo Iv Contrast,,74150,CPT,Facility,Inpatient,,,,1419,1206.15,325.628,1419,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Ct Abdomen Routine Wo Iv Contrast,,74150,CPT,Facility,Outpatient,,,,1419,1206.15,325.628,1419,"UCare Health, Inc.",Medicare Advantage,716.1693,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ct Abdomen Routine Wo Iv Contrast,,74150,CPT,Facility,Inpatient,,,,1419,1206.15,325.628,1419,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ct Abdomen Routine Wo Iv Contrast,,74150,CPT,Facility,Outpatient,,,,1419,1206.15,325.628,1419,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),716.1693,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ct Abdomen Routine Wo Iv Contrast,,74150,CPT,Facility,Inpatient,,,,1419,1206.15,325.628,1419,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ct Abdomen Routine Wo Iv Contrast,,74150,CPT,Facility,Both,,,,1419,1206.15,325.628,1419,UnitedHealthcare,Individual & Family,1333.86,94,,percent of total billed charges,,
Ct Abdomen Routine Wo Iv Contrast,,74150,CPT,Facility,Outpatient,,,,1419,1206.15,325.628,1419,UnitedHealthcare,Medicare Advantage,695.31,49,,percent of total billed charges,,
Ct Abdomen Routine Wo Iv Contrast,,74150,CPT,Facility,Inpatient,,,,1419,1206.15,325.628,1419,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Ct Abdomen Routine Wo Iv Contrast,,74150,CPT,Facility,Outpatient,,,,1419,1206.15,325.628,1419,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,681.12,48,,percent of total billed charges,,100% of DHS outpatient percentage
Ct Abdomen Routine Wo Iv Contrast,,74150,CPT,Facility,Inpatient,,,,1419,1206.15,325.628,1419,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Ct Abdomen W Iv Contrast,,74160,CPT,Facility,Both,,,,1621,1377.85,412.496,1621,Aetna,Commercial,1491.32,92,,percent of total billed charges,,
Ct Abdomen W Iv Contrast,,74160,CPT,Facility,Outpatient,,,,1621,1377.85,412.496,1621,Aetna,Medicare Advantage,794.29,49,,percent of total billed charges,,
Ct Abdomen W Iv Contrast,,74160,CPT,Facility,Inpatient,,,,1621,1377.85,412.496,1621,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Ct Abdomen W Iv Contrast,,74160,CPT,Facility,Both,,,,1621,1377.85,412.496,1621,Aetna,PPO,1507.53,93,,percent of total billed charges,,
Ct Abdomen W Iv Contrast,,74160,CPT,Facility,Both,,,,1621,1377.85,412.496,1621,America's PPO,America's PPO,1556.6463,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Ct Abdomen W Iv Contrast,,74160,CPT,Facility,Both,,,,1621,1377.85,412.496,1621,BlueCross BlueShield Minnesota, Federal Employee Program,812,,,Fee schedule,,100% of BCBS commercial commodity fee schedule
Ct Abdomen W Iv Contrast,,74160,CPT,Facility,Both,,,,1621,1377.85,412.496,1621,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,824.992,,,Fee schedule,,"100% of BCBS commercial commodity fee schedule, plus MN Care tax"
Ct Abdomen W Iv Contrast,,74160,CPT,Facility,Both,,,,1621,1377.85,412.496,1621,BlueCross BlueShield Minnesota,High Value Network Plan,742.4928,,,Fee schedule,,"90% of BCBS commercial commodity fee schedule, plus MN Care tax; see disclaimer for more information"
Ct Abdomen W Iv Contrast,,74160,CPT,Facility,Outpatient,,,,1621,1377.85,412.496,1621,BlueCross BlueShield Minnesota,Medicare Advantage,794.29,49,,percent of total billed charges,,
Ct Abdomen W Iv Contrast,,74160,CPT,Facility,Inpatient,,,,1621,1377.85,412.496,1621,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Ct Abdomen W Iv Contrast,,74160,CPT,Facility,Both,,,,1621,1377.85,412.496,1621,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,730.6954144,,,Fee schedule,,"88.57% of BCBS commercial commodity fee schedule, plus MN Care tax"
Ct Abdomen W Iv Contrast,,74160,CPT,Facility,Both,,,,1621,1377.85,412.496,1621,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,412.496,,,Fee schedule,,"100% of BCBS Medicaid commodity fee schedule, plus MN Care tax"
Ct Abdomen W Iv Contrast,,74160,CPT,Facility,Outpatient,,,,1621,1377.85,412.496,1621,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),794.29,49,,percent of total billed charges,,
Ct Abdomen W Iv Contrast,,74160,CPT,Facility,Inpatient,,,,1621,1377.85,412.496,1621,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Ct Abdomen W Iv Contrast,,74160,CPT,Facility,Both,,,,1621,1377.85,412.496,1621,CorVel,Worker's Compensation,1621,100,,percent of total billed charges,,
Ct Abdomen W Iv Contrast,,74160,CPT,Facility,Both,,,,1621,1377.85,412.496,1621,First Health Group Corporation,First Health Network,1572.37,97,,percent of total billed charges,,
Ct Abdomen W Iv Contrast,,74160,CPT,Facility,Both,,,,1621,1377.85,412.496,1621,"Health Partners, Inc.",Commercial,1533.466,94.6,,percent of total billed charges,,
Ct Abdomen W Iv Contrast,,74160,CPT,Facility,Outpatient,,,,1621,1377.85,412.496,1621,"Health Partners, Inc.",Medicare Advantage,794.29,49,,percent of total billed charges,,
Ct Abdomen W Iv Contrast,,74160,CPT,Facility,Inpatient,,,,1621,1377.85,412.496,1621,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ct Abdomen W Iv Contrast,,74160,CPT,Facility,Both,,,,1621,1377.85,412.496,1621,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),972.6,60,,percent of total billed charges,,
Ct Abdomen W Iv Contrast,,74160,CPT,Facility,Both,,,,1621,1377.85,412.496,1621,"Health Partners, Inc.",State of Minnesota Advantage Program,1321.115,81.5,,percent of total billed charges,,
Ct Abdomen W Iv Contrast,,74160,CPT,Facility,Both,,,,1621,1377.85,412.496,1621,"Health Partners, Inc.",State Public Programs,810.5,50,,percent of total billed charges,,
Ct Abdomen W Iv Contrast,,74160,CPT,Facility,Both,,,,1621,1377.85,412.496,1621,Humana Insurance Company,Commercial PPO,1539.95,95,,percent of total billed charges,,
Ct Abdomen W Iv Contrast,,74160,CPT,Facility,Outpatient,,,,1621,1377.85,412.496,1621,Humana Insurance Company,Medicare PPO,794.29,49,,percent of total billed charges,,
Ct Abdomen W Iv Contrast,,74160,CPT,Facility,Inpatient,,,,1621,1377.85,412.496,1621,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Ct Abdomen W Iv Contrast,,74160,CPT,Facility,Both,,,,1621,1377.85,412.496,1621,Medica,Individual & Family,1606.411,99.1,,percent of total billed charges,,
Ct Abdomen W Iv Contrast,,74160,CPT,Facility,Outpatient,,,,1621,1377.85,412.496,1621,Medica,Medica Advantage Solution,807.258,49.8,,percent of total billed charges,,
Ct Abdomen W Iv Contrast,,74160,CPT,Facility,Inpatient,,,,1621,1377.85,412.496,1621,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Ct Abdomen W Iv Contrast,,74160,CPT,Facility,Outpatient,,,,1621,1377.85,412.496,1621,Medica,Medical Assistance,499,,,Other,Per visit,Pays in addition to all Outpatient Service Categories
Ct Abdomen W Iv Contrast,,74160,CPT,Facility,Inpatient,,,,1621,1377.85,412.496,1621,Medica,Medical Assistance,,,,,Included in per diem rate,
Ct Abdomen W Iv Contrast,,74160,CPT,Facility,Outpatient,,,,1621,1377.85,412.496,1621,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,807.258,49.8,,percent of total billed charges,,
Ct Abdomen W Iv Contrast,,74160,CPT,Facility,Inpatient,,,,1621,1377.85,412.496,1621,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Ct Abdomen W Iv Contrast,,74160,CPT,Facility,Both,,,,1621,1377.85,412.496,1621,"Multiplan, Inc.","Multiplan, Inc.",1523.74,94,,percent of total billed charges,,
Ct Abdomen W Iv Contrast,,74160,CPT,Facility,Outpatient,,,,1621,1377.85,412.496,1621,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1283,,,Other,Per scan,
Ct Abdomen W Iv Contrast,,74160,CPT,Facility,Inpatient,,,,1621,1377.85,412.496,1621,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Ct Abdomen W Iv Contrast,,74160,CPT,Facility,Both,,,,1621,1377.85,412.496,1621,"Preferred One Administrative Services, INC.",PPO,1598.306,98.6,,percent of total billed charges,,
Ct Abdomen W Iv Contrast,,74160,CPT,Facility,Outpatient,,,,1621,1377.85,412.496,1621,PrimeWest Health,Minnesota Senior Health Options (MSHO),834.0045,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Ct Abdomen W Iv Contrast,,74160,CPT,Facility,Inpatient,,,,1621,1377.85,412.496,1621,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ct Abdomen W Iv Contrast,,74160,CPT,Facility,Outpatient,,,,1621,1377.85,412.496,1621,PrimeWest Health,MinnesotaCare,832.5456,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Ct Abdomen W Iv Contrast,,74160,CPT,Facility,Inpatient,,,,1621,1377.85,412.496,1621,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Ct Abdomen W Iv Contrast,,74160,CPT,Facility,Both,,,,1621,1377.85,412.496,1621,Sanford Health Plan,Sanford Health Plan,1491.32,92,,percent of total billed charges,,
Ct Abdomen W Iv Contrast,,74160,CPT,Facility,Outpatient,,,,1621,1377.85,412.496,1621,"UCare Health, Inc.",Individual & Family Plan,913.4335,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Ct Abdomen W Iv Contrast,,74160,CPT,Facility,Inpatient,,,,1621,1377.85,412.496,1621,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Ct Abdomen W Iv Contrast,,74160,CPT,Facility,Outpatient,,,,1621,1377.85,412.496,1621,"UCare Health, Inc.",Medical Assistance,818.1187,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ct Abdomen W Iv Contrast,,74160,CPT,Facility,Inpatient,,,,1621,1377.85,412.496,1621,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Ct Abdomen W Iv Contrast,,74160,CPT,Facility,Outpatient,,,,1621,1377.85,412.496,1621,"UCare Health, Inc.",Medicare Advantage,818.1187,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ct Abdomen W Iv Contrast,,74160,CPT,Facility,Inpatient,,,,1621,1377.85,412.496,1621,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ct Abdomen W Iv Contrast,,74160,CPT,Facility,Outpatient,,,,1621,1377.85,412.496,1621,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),818.1187,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ct Abdomen W Iv Contrast,,74160,CPT,Facility,Inpatient,,,,1621,1377.85,412.496,1621,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ct Abdomen W Iv Contrast,,74160,CPT,Facility,Both,,,,1621,1377.85,412.496,1621,UnitedHealthcare,Individual & Family,1523.74,94,,percent of total billed charges,,
Ct Abdomen W Iv Contrast,,74160,CPT,Facility,Outpatient,,,,1621,1377.85,412.496,1621,UnitedHealthcare,Medicare Advantage,794.29,49,,percent of total billed charges,,
Ct Abdomen W Iv Contrast,,74160,CPT,Facility,Inpatient,,,,1621,1377.85,412.496,1621,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Ct Abdomen W Iv Contrast,,74160,CPT,Facility,Outpatient,,,,1621,1377.85,412.496,1621,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,778.08,48,,percent of total billed charges,,100% of DHS outpatient percentage
Ct Abdomen W Iv Contrast,,74160,CPT,Facility,Inpatient,,,,1621,1377.85,412.496,1621,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Ct Abd Wo W Iv Contrast,,74170,CPT,Facility,Both,,,,2076,1764.6,412.496,2076,Aetna,Commercial,1909.92,92,,percent of total billed charges,,
Ct Abd Wo W Iv Contrast,,74170,CPT,Facility,Outpatient,,,,2076,1764.6,412.496,2076,Aetna,Medicare Advantage,1017.24,49,,percent of total billed charges,,
Ct Abd Wo W Iv Contrast,,74170,CPT,Facility,Inpatient,,,,2076,1764.6,412.496,2076,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Ct Abd Wo W Iv Contrast,,74170,CPT,Facility,Both,,,,2076,1764.6,412.496,2076,Aetna,PPO,1930.68,93,,percent of total billed charges,,
Ct Abd Wo W Iv Contrast,,74170,CPT,Facility,Both,,,,2076,1764.6,412.496,2076,America's PPO,America's PPO,1993.5828,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Ct Abd Wo W Iv Contrast,,74170,CPT,Facility,Both,,,,2076,1764.6,412.496,2076,BlueCross BlueShield Minnesota, Federal Employee Program,812,,,Fee schedule,,100% of BCBS commercial commodity fee schedule
Ct Abd Wo W Iv Contrast,,74170,CPT,Facility,Both,,,,2076,1764.6,412.496,2076,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,824.992,,,Fee schedule,,"100% of BCBS commercial commodity fee schedule, plus MN Care tax"
Ct Abd Wo W Iv Contrast,,74170,CPT,Facility,Both,,,,2076,1764.6,412.496,2076,BlueCross BlueShield Minnesota,High Value Network Plan,742.4928,,,Fee schedule,,"90% of BCBS commercial commodity fee schedule, plus MN Care tax; see disclaimer for more information"
Ct Abd Wo W Iv Contrast,,74170,CPT,Facility,Outpatient,,,,2076,1764.6,412.496,2076,BlueCross BlueShield Minnesota,Medicare Advantage,1017.24,49,,percent of total billed charges,,
Ct Abd Wo W Iv Contrast,,74170,CPT,Facility,Inpatient,,,,2076,1764.6,412.496,2076,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Ct Abd Wo W Iv Contrast,,74170,CPT,Facility,Both,,,,2076,1764.6,412.496,2076,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,730.6954144,,,Fee schedule,,"88.57% of BCBS commercial commodity fee schedule, plus MN Care tax"
Ct Abd Wo W Iv Contrast,,74170,CPT,Facility,Both,,,,2076,1764.6,412.496,2076,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,412.496,,,Fee schedule,,"100% of BCBS Medicaid commodity fee schedule, plus MN Care tax"
Ct Abd Wo W Iv Contrast,,74170,CPT,Facility,Outpatient,,,,2076,1764.6,412.496,2076,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1017.24,49,,percent of total billed charges,,
Ct Abd Wo W Iv Contrast,,74170,CPT,Facility,Inpatient,,,,2076,1764.6,412.496,2076,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Ct Abd Wo W Iv Contrast,,74170,CPT,Facility,Both,,,,2076,1764.6,412.496,2076,CorVel,Worker's Compensation,2076,100,,percent of total billed charges,,
Ct Abd Wo W Iv Contrast,,74170,CPT,Facility,Both,,,,2076,1764.6,412.496,2076,First Health Group Corporation,First Health Network,2013.72,97,,percent of total billed charges,,
Ct Abd Wo W Iv Contrast,,74170,CPT,Facility,Both,,,,2076,1764.6,412.496,2076,"Health Partners, Inc.",Commercial,1963.896,94.6,,percent of total billed charges,,
Ct Abd Wo W Iv Contrast,,74170,CPT,Facility,Outpatient,,,,2076,1764.6,412.496,2076,"Health Partners, Inc.",Medicare Advantage,1017.24,49,,percent of total billed charges,,
Ct Abd Wo W Iv Contrast,,74170,CPT,Facility,Inpatient,,,,2076,1764.6,412.496,2076,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ct Abd Wo W Iv Contrast,,74170,CPT,Facility,Both,,,,2076,1764.6,412.496,2076,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1245.6,60,,percent of total billed charges,,
Ct Abd Wo W Iv Contrast,,74170,CPT,Facility,Both,,,,2076,1764.6,412.496,2076,"Health Partners, Inc.",State of Minnesota Advantage Program,1691.94,81.5,,percent of total billed charges,,
Ct Abd Wo W Iv Contrast,,74170,CPT,Facility,Both,,,,2076,1764.6,412.496,2076,"Health Partners, Inc.",State Public Programs,1038,50,,percent of total billed charges,,
Ct Abd Wo W Iv Contrast,,74170,CPT,Facility,Both,,,,2076,1764.6,412.496,2076,Humana Insurance Company,Commercial PPO,1972.2,95,,percent of total billed charges,,
Ct Abd Wo W Iv Contrast,,74170,CPT,Facility,Outpatient,,,,2076,1764.6,412.496,2076,Humana Insurance Company,Medicare PPO,1017.24,49,,percent of total billed charges,,
Ct Abd Wo W Iv Contrast,,74170,CPT,Facility,Inpatient,,,,2076,1764.6,412.496,2076,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Ct Abd Wo W Iv Contrast,,74170,CPT,Facility,Both,,,,2076,1764.6,412.496,2076,Medica,Individual & Family,2057.316,99.1,,percent of total billed charges,,
Ct Abd Wo W Iv Contrast,,74170,CPT,Facility,Outpatient,,,,2076,1764.6,412.496,2076,Medica,Medica Advantage Solution,1033.848,49.8,,percent of total billed charges,,
Ct Abd Wo W Iv Contrast,,74170,CPT,Facility,Inpatient,,,,2076,1764.6,412.496,2076,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Ct Abd Wo W Iv Contrast,,74170,CPT,Facility,Outpatient,,,,2076,1764.6,412.496,2076,Medica,Medical Assistance,499,,,Other,Per visit,Pays in addition to all Outpatient Service Categories
Ct Abd Wo W Iv Contrast,,74170,CPT,Facility,Inpatient,,,,2076,1764.6,412.496,2076,Medica,Medical Assistance,,,,,Included in per diem rate,
Ct Abd Wo W Iv Contrast,,74170,CPT,Facility,Outpatient,,,,2076,1764.6,412.496,2076,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1033.848,49.8,,percent of total billed charges,,
Ct Abd Wo W Iv Contrast,,74170,CPT,Facility,Inpatient,,,,2076,1764.6,412.496,2076,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Ct Abd Wo W Iv Contrast,,74170,CPT,Facility,Both,,,,2076,1764.6,412.496,2076,"Multiplan, Inc.","Multiplan, Inc.",1951.44,94,,percent of total billed charges,,
Ct Abd Wo W Iv Contrast,,74170,CPT,Facility,Outpatient,,,,2076,1764.6,412.496,2076,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1283,,,Other,Per scan,
Ct Abd Wo W Iv Contrast,,74170,CPT,Facility,Inpatient,,,,2076,1764.6,412.496,2076,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Ct Abd Wo W Iv Contrast,,74170,CPT,Facility,Both,,,,2076,1764.6,412.496,2076,"Preferred One Administrative Services, INC.",PPO,2046.936,98.6,,percent of total billed charges,,
Ct Abd Wo W Iv Contrast,,74170,CPT,Facility,Outpatient,,,,2076,1764.6,412.496,2076,PrimeWest Health,Minnesota Senior Health Options (MSHO),1068.102,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Ct Abd Wo W Iv Contrast,,74170,CPT,Facility,Inpatient,,,,2076,1764.6,412.496,2076,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ct Abd Wo W Iv Contrast,,74170,CPT,Facility,Outpatient,,,,2076,1764.6,412.496,2076,PrimeWest Health,MinnesotaCare,1066.2336,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Ct Abd Wo W Iv Contrast,,74170,CPT,Facility,Inpatient,,,,2076,1764.6,412.496,2076,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Ct Abd Wo W Iv Contrast,,74170,CPT,Facility,Both,,,,2076,1764.6,412.496,2076,Sanford Health Plan,Sanford Health Plan,1909.92,92,,percent of total billed charges,,
Ct Abd Wo W Iv Contrast,,74170,CPT,Facility,Outpatient,,,,2076,1764.6,412.496,2076,"UCare Health, Inc.",Individual & Family Plan,1169.826,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Ct Abd Wo W Iv Contrast,,74170,CPT,Facility,Inpatient,,,,2076,1764.6,412.496,2076,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Ct Abd Wo W Iv Contrast,,74170,CPT,Facility,Outpatient,,,,2076,1764.6,412.496,2076,"UCare Health, Inc.",Medical Assistance,1047.7572,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ct Abd Wo W Iv Contrast,,74170,CPT,Facility,Inpatient,,,,2076,1764.6,412.496,2076,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Ct Abd Wo W Iv Contrast,,74170,CPT,Facility,Outpatient,,,,2076,1764.6,412.496,2076,"UCare Health, Inc.",Medicare Advantage,1047.7572,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ct Abd Wo W Iv Contrast,,74170,CPT,Facility,Inpatient,,,,2076,1764.6,412.496,2076,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ct Abd Wo W Iv Contrast,,74170,CPT,Facility,Outpatient,,,,2076,1764.6,412.496,2076,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1047.7572,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ct Abd Wo W Iv Contrast,,74170,CPT,Facility,Inpatient,,,,2076,1764.6,412.496,2076,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ct Abd Wo W Iv Contrast,,74170,CPT,Facility,Both,,,,2076,1764.6,412.496,2076,UnitedHealthcare,Individual & Family,1951.44,94,,percent of total billed charges,,
Ct Abd Wo W Iv Contrast,,74170,CPT,Facility,Outpatient,,,,2076,1764.6,412.496,2076,UnitedHealthcare,Medicare Advantage,1017.24,49,,percent of total billed charges,,
Ct Abd Wo W Iv Contrast,,74170,CPT,Facility,Inpatient,,,,2076,1764.6,412.496,2076,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Ct Abd Wo W Iv Contrast,,74170,CPT,Facility,Outpatient,,,,2076,1764.6,412.496,2076,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,996.48,48,,percent of total billed charges,,100% of DHS outpatient percentage
Ct Abd Wo W Iv Contrast,,74170,CPT,Facility,Inpatient,,,,2076,1764.6,412.496,2076,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Cta Abdomen And Pelvis,,74174,CPT,Facility,Both,,,,2346,1994.1,499,2346,Aetna,Commercial,2158.32,92,,percent of total billed charges,,
Cta Abdomen And Pelvis,,74174,CPT,Facility,Outpatient,,,,2346,1994.1,499,2346,Aetna,Medicare Advantage,1149.54,49,,percent of total billed charges,,
Cta Abdomen And Pelvis,,74174,CPT,Facility,Inpatient,,,,2346,1994.1,499,2346,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Cta Abdomen And Pelvis,,74174,CPT,Facility,Both,,,,2346,1994.1,499,2346,Aetna,PPO,2181.78,93,,percent of total billed charges,,
Cta Abdomen And Pelvis,,74174,CPT,Facility,Both,,,,2346,1994.1,499,2346,America's PPO,America's PPO,2252.8638,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Cta Abdomen And Pelvis,,74174,CPT,Facility,Both,,,,2346,1994.1,499,2346,BlueCross BlueShield Minnesota, Federal Employee Program,1105,,,Fee schedule,,100% of BCBS commercial commodity fee schedule
Cta Abdomen And Pelvis,,74174,CPT,Facility,Both,,,,2346,1994.1,499,2346,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1122.68,,,Fee schedule,,"100% of BCBS commercial commodity fee schedule, plus MN Care tax"
Cta Abdomen And Pelvis,,74174,CPT,Facility,Both,,,,2346,1994.1,499,2346,BlueCross BlueShield Minnesota,High Value Network Plan,1010.412,,,Fee schedule,,"90% of BCBS commercial commodity fee schedule, plus MN Care tax; see disclaimer for more information"
Cta Abdomen And Pelvis,,74174,CPT,Facility,Outpatient,,,,2346,1994.1,499,2346,BlueCross BlueShield Minnesota,Medicare Advantage,1149.54,49,,percent of total billed charges,,
Cta Abdomen And Pelvis,,74174,CPT,Facility,Inpatient,,,,2346,1994.1,499,2346,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Cta Abdomen And Pelvis,,74174,CPT,Facility,Both,,,,2346,1994.1,499,2346,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,994.357676,,,Fee schedule,,"88.57% of BCBS commercial commodity fee schedule, plus MN Care tax"
Cta Abdomen And Pelvis,,74174,CPT,Facility,Both,,,,2346,1994.1,499,2346,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,561.34,,,Fee schedule,,"100% of BCBS Medicaid commodity fee schedule, plus MN Care tax"
Cta Abdomen And Pelvis,,74174,CPT,Facility,Outpatient,,,,2346,1994.1,499,2346,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1149.54,49,,percent of total billed charges,,
Cta Abdomen And Pelvis,,74174,CPT,Facility,Inpatient,,,,2346,1994.1,499,2346,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Cta Abdomen And Pelvis,,74174,CPT,Facility,Both,,,,2346,1994.1,499,2346,CorVel,Worker's Compensation,2346,100,,percent of total billed charges,,
Cta Abdomen And Pelvis,,74174,CPT,Facility,Both,,,,2346,1994.1,499,2346,First Health Group Corporation,First Health Network,2275.62,97,,percent of total billed charges,,
Cta Abdomen And Pelvis,,74174,CPT,Facility,Both,,,,2346,1994.1,499,2346,"Health Partners, Inc.",Commercial,2219.316,94.6,,percent of total billed charges,,
Cta Abdomen And Pelvis,,74174,CPT,Facility,Outpatient,,,,2346,1994.1,499,2346,"Health Partners, Inc.",Medicare Advantage,1149.54,49,,percent of total billed charges,,
Cta Abdomen And Pelvis,,74174,CPT,Facility,Inpatient,,,,2346,1994.1,499,2346,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Cta Abdomen And Pelvis,,74174,CPT,Facility,Both,,,,2346,1994.1,499,2346,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1407.6,60,,percent of total billed charges,,
Cta Abdomen And Pelvis,,74174,CPT,Facility,Both,,,,2346,1994.1,499,2346,"Health Partners, Inc.",State of Minnesota Advantage Program,1911.99,81.5,,percent of total billed charges,,
Cta Abdomen And Pelvis,,74174,CPT,Facility,Both,,,,2346,1994.1,499,2346,"Health Partners, Inc.",State Public Programs,1173,50,,percent of total billed charges,,
Cta Abdomen And Pelvis,,74174,CPT,Facility,Both,,,,2346,1994.1,499,2346,Humana Insurance Company,Commercial PPO,2228.7,95,,percent of total billed charges,,
Cta Abdomen And Pelvis,,74174,CPT,Facility,Outpatient,,,,2346,1994.1,499,2346,Humana Insurance Company,Medicare PPO,1149.54,49,,percent of total billed charges,,
Cta Abdomen And Pelvis,,74174,CPT,Facility,Inpatient,,,,2346,1994.1,499,2346,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Cta Abdomen And Pelvis,,74174,CPT,Facility,Both,,,,2346,1994.1,499,2346,Medica,Individual & Family,2324.886,99.1,,percent of total billed charges,,
Cta Abdomen And Pelvis,,74174,CPT,Facility,Outpatient,,,,2346,1994.1,499,2346,Medica,Medica Advantage Solution,1168.308,49.8,,percent of total billed charges,,
Cta Abdomen And Pelvis,,74174,CPT,Facility,Inpatient,,,,2346,1994.1,499,2346,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Cta Abdomen And Pelvis,,74174,CPT,Facility,Outpatient,,,,2346,1994.1,499,2346,Medica,Medical Assistance,499,,,Other,Per visit,Pays in addition to all Outpatient Service Categories
Cta Abdomen And Pelvis,,74174,CPT,Facility,Inpatient,,,,2346,1994.1,499,2346,Medica,Medical Assistance,,,,,Included in per diem rate,
Cta Abdomen And Pelvis,,74174,CPT,Facility,Outpatient,,,,2346,1994.1,499,2346,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1168.308,49.8,,percent of total billed charges,,
Cta Abdomen And Pelvis,,74174,CPT,Facility,Inpatient,,,,2346,1994.1,499,2346,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Cta Abdomen And Pelvis,,74174,CPT,Facility,Both,,,,2346,1994.1,499,2346,"Multiplan, Inc.","Multiplan, Inc.",2205.24,94,,percent of total billed charges,,
Cta Abdomen And Pelvis,,74174,CPT,Facility,Outpatient,,,,2346,1994.1,499,2346,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1283,,,Other,Per scan,
Cta Abdomen And Pelvis,,74174,CPT,Facility,Inpatient,,,,2346,1994.1,499,2346,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Cta Abdomen And Pelvis,,74174,CPT,Facility,Both,,,,2346,1994.1,499,2346,"Preferred One Administrative Services, INC.",PPO,2313.156,98.6,,percent of total billed charges,,
Cta Abdomen And Pelvis,,74174,CPT,Facility,Outpatient,,,,2346,1994.1,499,2346,PrimeWest Health,Minnesota Senior Health Options (MSHO),1207.017,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Cta Abdomen And Pelvis,,74174,CPT,Facility,Inpatient,,,,2346,1994.1,499,2346,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Cta Abdomen And Pelvis,,74174,CPT,Facility,Outpatient,,,,2346,1994.1,499,2346,PrimeWest Health,MinnesotaCare,1204.9056,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Cta Abdomen And Pelvis,,74174,CPT,Facility,Inpatient,,,,2346,1994.1,499,2346,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Cta Abdomen And Pelvis,,74174,CPT,Facility,Both,,,,2346,1994.1,499,2346,Sanford Health Plan,Sanford Health Plan,2158.32,92,,percent of total billed charges,,
Cta Abdomen And Pelvis,,74174,CPT,Facility,Outpatient,,,,2346,1994.1,499,2346,"UCare Health, Inc.",Individual & Family Plan,1321.971,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Cta Abdomen And Pelvis,,74174,CPT,Facility,Inpatient,,,,2346,1994.1,499,2346,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Cta Abdomen And Pelvis,,74174,CPT,Facility,Outpatient,,,,2346,1994.1,499,2346,"UCare Health, Inc.",Medical Assistance,1184.0262,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Cta Abdomen And Pelvis,,74174,CPT,Facility,Inpatient,,,,2346,1994.1,499,2346,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Cta Abdomen And Pelvis,,74174,CPT,Facility,Outpatient,,,,2346,1994.1,499,2346,"UCare Health, Inc.",Medicare Advantage,1184.0262,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Cta Abdomen And Pelvis,,74174,CPT,Facility,Inpatient,,,,2346,1994.1,499,2346,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Cta Abdomen And Pelvis,,74174,CPT,Facility,Outpatient,,,,2346,1994.1,499,2346,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1184.0262,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Cta Abdomen And Pelvis,,74174,CPT,Facility,Inpatient,,,,2346,1994.1,499,2346,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Cta Abdomen And Pelvis,,74174,CPT,Facility,Both,,,,2346,1994.1,499,2346,UnitedHealthcare,Individual & Family,2205.24,94,,percent of total billed charges,,
Cta Abdomen And Pelvis,,74174,CPT,Facility,Outpatient,,,,2346,1994.1,499,2346,UnitedHealthcare,Medicare Advantage,1149.54,49,,percent of total billed charges,,
Cta Abdomen And Pelvis,,74174,CPT,Facility,Inpatient,,,,2346,1994.1,499,2346,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Cta Abdomen And Pelvis,,74174,CPT,Facility,Outpatient,,,,2346,1994.1,499,2346,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1126.08,48,,percent of total billed charges,,100% of DHS outpatient percentage
Cta Abdomen And Pelvis,,74174,CPT,Facility,Inpatient,,,,2346,1994.1,499,2346,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Cta Abdomen,,74175,CPT,Facility,Both,,,,2091,1777.35,412.496,2091,Aetna,Commercial,1923.72,92,,percent of total billed charges,,
Cta Abdomen,,74175,CPT,Facility,Outpatient,,,,2091,1777.35,412.496,2091,Aetna,Medicare Advantage,1024.59,49,,percent of total billed charges,,
Cta Abdomen,,74175,CPT,Facility,Inpatient,,,,2091,1777.35,412.496,2091,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Cta Abdomen,,74175,CPT,Facility,Both,,,,2091,1777.35,412.496,2091,Aetna,PPO,1944.63,93,,percent of total billed charges,,
Cta Abdomen,,74175,CPT,Facility,Both,,,,2091,1777.35,412.496,2091,America's PPO,America's PPO,2007.9873,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Cta Abdomen,,74175,CPT,Facility,Both,,,,2091,1777.35,412.496,2091,BlueCross BlueShield Minnesota, Federal Employee Program,812,,,Fee schedule,,100% of BCBS commercial commodity fee schedule
Cta Abdomen,,74175,CPT,Facility,Both,,,,2091,1777.35,412.496,2091,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,824.992,,,Fee schedule,,"100% of BCBS commercial commodity fee schedule, plus MN Care tax"
Cta Abdomen,,74175,CPT,Facility,Both,,,,2091,1777.35,412.496,2091,BlueCross BlueShield Minnesota,High Value Network Plan,742.4928,,,Fee schedule,,"90% of BCBS commercial commodity fee schedule, plus MN Care tax; see disclaimer for more information"
Cta Abdomen,,74175,CPT,Facility,Outpatient,,,,2091,1777.35,412.496,2091,BlueCross BlueShield Minnesota,Medicare Advantage,1024.59,49,,percent of total billed charges,,
Cta Abdomen,,74175,CPT,Facility,Inpatient,,,,2091,1777.35,412.496,2091,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Cta Abdomen,,74175,CPT,Facility,Both,,,,2091,1777.35,412.496,2091,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,730.6954144,,,Fee schedule,,"88.57% of BCBS commercial commodity fee schedule, plus MN Care tax"
Cta Abdomen,,74175,CPT,Facility,Both,,,,2091,1777.35,412.496,2091,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,412.496,,,Fee schedule,,"100% of BCBS Medicaid commodity fee schedule, plus MN Care tax"
Cta Abdomen,,74175,CPT,Facility,Outpatient,,,,2091,1777.35,412.496,2091,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1024.59,49,,percent of total billed charges,,
Cta Abdomen,,74175,CPT,Facility,Inpatient,,,,2091,1777.35,412.496,2091,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Cta Abdomen,,74175,CPT,Facility,Both,,,,2091,1777.35,412.496,2091,CorVel,Worker's Compensation,2091,100,,percent of total billed charges,,
Cta Abdomen,,74175,CPT,Facility,Both,,,,2091,1777.35,412.496,2091,First Health Group Corporation,First Health Network,2028.27,97,,percent of total billed charges,,
Cta Abdomen,,74175,CPT,Facility,Both,,,,2091,1777.35,412.496,2091,"Health Partners, Inc.",Commercial,1978.086,94.6,,percent of total billed charges,,
Cta Abdomen,,74175,CPT,Facility,Outpatient,,,,2091,1777.35,412.496,2091,"Health Partners, Inc.",Medicare Advantage,1024.59,49,,percent of total billed charges,,
Cta Abdomen,,74175,CPT,Facility,Inpatient,,,,2091,1777.35,412.496,2091,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Cta Abdomen,,74175,CPT,Facility,Both,,,,2091,1777.35,412.496,2091,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1254.6,60,,percent of total billed charges,,
Cta Abdomen,,74175,CPT,Facility,Both,,,,2091,1777.35,412.496,2091,"Health Partners, Inc.",State of Minnesota Advantage Program,1704.165,81.5,,percent of total billed charges,,
Cta Abdomen,,74175,CPT,Facility,Both,,,,2091,1777.35,412.496,2091,"Health Partners, Inc.",State Public Programs,1045.5,50,,percent of total billed charges,,
Cta Abdomen,,74175,CPT,Facility,Both,,,,2091,1777.35,412.496,2091,Humana Insurance Company,Commercial PPO,1986.45,95,,percent of total billed charges,,
Cta Abdomen,,74175,CPT,Facility,Outpatient,,,,2091,1777.35,412.496,2091,Humana Insurance Company,Medicare PPO,1024.59,49,,percent of total billed charges,,
Cta Abdomen,,74175,CPT,Facility,Inpatient,,,,2091,1777.35,412.496,2091,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Cta Abdomen,,74175,CPT,Facility,Both,,,,2091,1777.35,412.496,2091,Medica,Individual & Family,2072.181,99.1,,percent of total billed charges,,
Cta Abdomen,,74175,CPT,Facility,Outpatient,,,,2091,1777.35,412.496,2091,Medica,Medica Advantage Solution,1041.318,49.8,,percent of total billed charges,,
Cta Abdomen,,74175,CPT,Facility,Inpatient,,,,2091,1777.35,412.496,2091,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Cta Abdomen,,74175,CPT,Facility,Outpatient,,,,2091,1777.35,412.496,2091,Medica,Medical Assistance,499,,,Other,Per visit,Pays in addition to all Outpatient Service Categories
Cta Abdomen,,74175,CPT,Facility,Inpatient,,,,2091,1777.35,412.496,2091,Medica,Medical Assistance,,,,,Included in per diem rate,
Cta Abdomen,,74175,CPT,Facility,Outpatient,,,,2091,1777.35,412.496,2091,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1041.318,49.8,,percent of total billed charges,,
Cta Abdomen,,74175,CPT,Facility,Inpatient,,,,2091,1777.35,412.496,2091,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Cta Abdomen,,74175,CPT,Facility,Both,,,,2091,1777.35,412.496,2091,"Multiplan, Inc.","Multiplan, Inc.",1965.54,94,,percent of total billed charges,,
Cta Abdomen,,74175,CPT,Facility,Outpatient,,,,2091,1777.35,412.496,2091,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1283,,,Other,Per scan,
Cta Abdomen,,74175,CPT,Facility,Inpatient,,,,2091,1777.35,412.496,2091,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Cta Abdomen,,74175,CPT,Facility,Both,,,,2091,1777.35,412.496,2091,"Preferred One Administrative Services, INC.",PPO,2061.726,98.6,,percent of total billed charges,,
Cta Abdomen,,74175,CPT,Facility,Outpatient,,,,2091,1777.35,412.496,2091,PrimeWest Health,Minnesota Senior Health Options (MSHO),1075.8195,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Cta Abdomen,,74175,CPT,Facility,Inpatient,,,,2091,1777.35,412.496,2091,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Cta Abdomen,,74175,CPT,Facility,Outpatient,,,,2091,1777.35,412.496,2091,PrimeWest Health,MinnesotaCare,1073.9376,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Cta Abdomen,,74175,CPT,Facility,Inpatient,,,,2091,1777.35,412.496,2091,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Cta Abdomen,,74175,CPT,Facility,Both,,,,2091,1777.35,412.496,2091,Sanford Health Plan,Sanford Health Plan,1923.72,92,,percent of total billed charges,,
Cta Abdomen,,74175,CPT,Facility,Outpatient,,,,2091,1777.35,412.496,2091,"UCare Health, Inc.",Individual & Family Plan,1178.2785,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Cta Abdomen,,74175,CPT,Facility,Inpatient,,,,2091,1777.35,412.496,2091,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Cta Abdomen,,74175,CPT,Facility,Outpatient,,,,2091,1777.35,412.496,2091,"UCare Health, Inc.",Medical Assistance,1055.3277,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Cta Abdomen,,74175,CPT,Facility,Inpatient,,,,2091,1777.35,412.496,2091,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Cta Abdomen,,74175,CPT,Facility,Outpatient,,,,2091,1777.35,412.496,2091,"UCare Health, Inc.",Medicare Advantage,1055.3277,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Cta Abdomen,,74175,CPT,Facility,Inpatient,,,,2091,1777.35,412.496,2091,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Cta Abdomen,,74175,CPT,Facility,Outpatient,,,,2091,1777.35,412.496,2091,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1055.3277,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Cta Abdomen,,74175,CPT,Facility,Inpatient,,,,2091,1777.35,412.496,2091,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Cta Abdomen,,74175,CPT,Facility,Both,,,,2091,1777.35,412.496,2091,UnitedHealthcare,Individual & Family,1965.54,94,,percent of total billed charges,,
Cta Abdomen,,74175,CPT,Facility,Outpatient,,,,2091,1777.35,412.496,2091,UnitedHealthcare,Medicare Advantage,1024.59,49,,percent of total billed charges,,
Cta Abdomen,,74175,CPT,Facility,Inpatient,,,,2091,1777.35,412.496,2091,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Cta Abdomen,,74175,CPT,Facility,Outpatient,,,,2091,1777.35,412.496,2091,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1003.68,48,,percent of total billed charges,,100% of DHS outpatient percentage
Cta Abdomen,,74175,CPT,Facility,Inpatient,,,,2091,1777.35,412.496,2091,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Ct Abd And Pelvis Without Iv Contrast,,74176,CPT,Facility,Both,,,,2856,2427.6,533.908,2856,Aetna,Commercial,2627.52,92,,percent of total billed charges,,
Ct Abd And Pelvis Without Iv Contrast,,74176,CPT,Facility,Outpatient,,,,2856,2427.6,533.908,2856,Aetna,Medicare Advantage,1399.44,49,,percent of total billed charges,,
Ct Abd And Pelvis Without Iv Contrast,,74176,CPT,Facility,Inpatient,,,,2856,2427.6,533.908,2856,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Ct Abd And Pelvis Without Iv Contrast,,74176,CPT,Facility,Both,,,,2856,2427.6,533.908,2856,Aetna,PPO,2656.08,93,,percent of total billed charges,,
Ct Abd And Pelvis Without Iv Contrast,,74176,CPT,Facility,Both,,,,2856,2427.6,533.908,2856,America's PPO,America's PPO,2742.6168,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Ct Abd And Pelvis Without Iv Contrast,,74176,CPT,Facility,Both,,,,2856,2427.6,533.908,2856,BlueCross BlueShield Minnesota, Federal Employee Program,1051,,,Fee schedule,,100% of BCBS commercial commodity fee schedule
Ct Abd And Pelvis Without Iv Contrast,,74176,CPT,Facility,Both,,,,2856,2427.6,533.908,2856,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1067.816,,,Fee schedule,,"100% of BCBS commercial commodity fee schedule, plus MN Care tax"
Ct Abd And Pelvis Without Iv Contrast,,74176,CPT,Facility,Both,,,,2856,2427.6,533.908,2856,BlueCross BlueShield Minnesota,High Value Network Plan,961.0344,,,Fee schedule,,"90% of BCBS commercial commodity fee schedule, plus MN Care tax; see disclaimer for more information"
Ct Abd And Pelvis Without Iv Contrast,,74176,CPT,Facility,Outpatient,,,,2856,2427.6,533.908,2856,BlueCross BlueShield Minnesota,Medicare Advantage,1399.44,49,,percent of total billed charges,,
Ct Abd And Pelvis Without Iv Contrast,,74176,CPT,Facility,Inpatient,,,,2856,2427.6,533.908,2856,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Ct Abd And Pelvis Without Iv Contrast,,74176,CPT,Facility,Both,,,,2856,2427.6,533.908,2856,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,945.7646312,,,Fee schedule,,"88.57% of BCBS commercial commodity fee schedule, plus MN Care tax"
Ct Abd And Pelvis Without Iv Contrast,,74176,CPT,Facility,Both,,,,2856,2427.6,533.908,2856,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,533.908,,,Fee schedule,,"100% of BCBS Medicaid commodity fee schedule, plus MN Care tax"
Ct Abd And Pelvis Without Iv Contrast,,74176,CPT,Facility,Outpatient,,,,2856,2427.6,533.908,2856,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1399.44,49,,percent of total billed charges,,
Ct Abd And Pelvis Without Iv Contrast,,74176,CPT,Facility,Inpatient,,,,2856,2427.6,533.908,2856,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Ct Abd And Pelvis Without Iv Contrast,,74176,CPT,Facility,Both,,,,2856,2427.6,533.908,2856,CorVel,Worker's Compensation,2856,100,,percent of total billed charges,,
Ct Abd And Pelvis Without Iv Contrast,,74176,CPT,Facility,Both,,,,2856,2427.6,533.908,2856,First Health Group Corporation,First Health Network,2770.32,97,,percent of total billed charges,,
Ct Abd And Pelvis Without Iv Contrast,,74176,CPT,Facility,Both,,,,2856,2427.6,533.908,2856,"Health Partners, Inc.",Commercial,2701.776,94.6,,percent of total billed charges,,
Ct Abd And Pelvis Without Iv Contrast,,74176,CPT,Facility,Outpatient,,,,2856,2427.6,533.908,2856,"Health Partners, Inc.",Medicare Advantage,1399.44,49,,percent of total billed charges,,
Ct Abd And Pelvis Without Iv Contrast,,74176,CPT,Facility,Inpatient,,,,2856,2427.6,533.908,2856,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ct Abd And Pelvis Without Iv Contrast,,74176,CPT,Facility,Both,,,,2856,2427.6,533.908,2856,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1713.6,60,,percent of total billed charges,,
Ct Abd And Pelvis Without Iv Contrast,,74176,CPT,Facility,Both,,,,2856,2427.6,533.908,2856,"Health Partners, Inc.",State of Minnesota Advantage Program,2327.64,81.5,,percent of total billed charges,,
Ct Abd And Pelvis Without Iv Contrast,,74176,CPT,Facility,Both,,,,2856,2427.6,533.908,2856,"Health Partners, Inc.",State Public Programs,1428,50,,percent of total billed charges,,
Ct Abd And Pelvis Without Iv Contrast,,74176,CPT,Facility,Both,,,,2856,2427.6,533.908,2856,Humana Insurance Company,Commercial PPO,2713.2,95,,percent of total billed charges,,
Ct Abd And Pelvis Without Iv Contrast,,74176,CPT,Facility,Outpatient,,,,2856,2427.6,533.908,2856,Humana Insurance Company,Medicare PPO,1399.44,49,,percent of total billed charges,,
Ct Abd And Pelvis Without Iv Contrast,,74176,CPT,Facility,Inpatient,,,,2856,2427.6,533.908,2856,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Ct Abd And Pelvis Without Iv Contrast,,74176,CPT,Facility,Both,,,,2856,2427.6,533.908,2856,Medica,Individual & Family,2830.296,99.1,,percent of total billed charges,,
Ct Abd And Pelvis Without Iv Contrast,,74176,CPT,Facility,Outpatient,,,,2856,2427.6,533.908,2856,Medica,Medica Advantage Solution,1422.288,49.8,,percent of total billed charges,,
Ct Abd And Pelvis Without Iv Contrast,,74176,CPT,Facility,Inpatient,,,,2856,2427.6,533.908,2856,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Ct Abd And Pelvis Without Iv Contrast,,74176,CPT,Facility,Outpatient,,,,2856,2427.6,533.908,2856,Medica,Medical Assistance,1273.776,44.6,,percent of total billed charges,,
Ct Abd And Pelvis Without Iv Contrast,,74176,CPT,Facility,Inpatient,,,,2856,2427.6,533.908,2856,Medica,Medical Assistance,,,,,Included in per diem rate,
Ct Abd And Pelvis Without Iv Contrast,,74176,CPT,Facility,Outpatient,,,,2856,2427.6,533.908,2856,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1422.288,49.8,,percent of total billed charges,,
Ct Abd And Pelvis Without Iv Contrast,,74176,CPT,Facility,Inpatient,,,,2856,2427.6,533.908,2856,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Ct Abd And Pelvis Without Iv Contrast,,74176,CPT,Facility,Both,,,,2856,2427.6,533.908,2856,"Multiplan, Inc.","Multiplan, Inc.",2684.64,94,,percent of total billed charges,,
Ct Abd And Pelvis Without Iv Contrast,,74176,CPT,Facility,Outpatient,,,,2856,2427.6,533.908,2856,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1283,,,Other,Per scan,
Ct Abd And Pelvis Without Iv Contrast,,74176,CPT,Facility,Inpatient,,,,2856,2427.6,533.908,2856,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Ct Abd And Pelvis Without Iv Contrast,,74176,CPT,Facility,Both,,,,2856,2427.6,533.908,2856,"Preferred One Administrative Services, INC.",PPO,2816.016,98.6,,percent of total billed charges,,
Ct Abd And Pelvis Without Iv Contrast,,74176,CPT,Facility,Outpatient,,,,2856,2427.6,533.908,2856,PrimeWest Health,Minnesota Senior Health Options (MSHO),1469.412,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Ct Abd And Pelvis Without Iv Contrast,,74176,CPT,Facility,Inpatient,,,,2856,2427.6,533.908,2856,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ct Abd And Pelvis Without Iv Contrast,,74176,CPT,Facility,Outpatient,,,,2856,2427.6,533.908,2856,PrimeWest Health,MinnesotaCare,1466.8416,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Ct Abd And Pelvis Without Iv Contrast,,74176,CPT,Facility,Inpatient,,,,2856,2427.6,533.908,2856,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Ct Abd And Pelvis Without Iv Contrast,,74176,CPT,Facility,Both,,,,2856,2427.6,533.908,2856,Sanford Health Plan,Sanford Health Plan,2627.52,92,,percent of total billed charges,,
Ct Abd And Pelvis Without Iv Contrast,,74176,CPT,Facility,Outpatient,,,,2856,2427.6,533.908,2856,"UCare Health, Inc.",Individual & Family Plan,1609.356,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Ct Abd And Pelvis Without Iv Contrast,,74176,CPT,Facility,Inpatient,,,,2856,2427.6,533.908,2856,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Ct Abd And Pelvis Without Iv Contrast,,74176,CPT,Facility,Outpatient,,,,2856,2427.6,533.908,2856,"UCare Health, Inc.",Medical Assistance,1441.4232,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ct Abd And Pelvis Without Iv Contrast,,74176,CPT,Facility,Inpatient,,,,2856,2427.6,533.908,2856,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Ct Abd And Pelvis Without Iv Contrast,,74176,CPT,Facility,Outpatient,,,,2856,2427.6,533.908,2856,"UCare Health, Inc.",Medicare Advantage,1441.4232,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ct Abd And Pelvis Without Iv Contrast,,74176,CPT,Facility,Inpatient,,,,2856,2427.6,533.908,2856,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ct Abd And Pelvis Without Iv Contrast,,74176,CPT,Facility,Outpatient,,,,2856,2427.6,533.908,2856,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1441.4232,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ct Abd And Pelvis Without Iv Contrast,,74176,CPT,Facility,Inpatient,,,,2856,2427.6,533.908,2856,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ct Abd And Pelvis Without Iv Contrast,,74176,CPT,Facility,Both,,,,2856,2427.6,533.908,2856,UnitedHealthcare,Individual & Family,2684.64,94,,percent of total billed charges,,
Ct Abd And Pelvis Without Iv Contrast,,74176,CPT,Facility,Outpatient,,,,2856,2427.6,533.908,2856,UnitedHealthcare,Medicare Advantage,1399.44,49,,percent of total billed charges,,
Ct Abd And Pelvis Without Iv Contrast,,74176,CPT,Facility,Inpatient,,,,2856,2427.6,533.908,2856,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Ct Abd And Pelvis Without Iv Contrast,,74176,CPT,Facility,Outpatient,,,,2856,2427.6,533.908,2856,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1370.88,48,,percent of total billed charges,,100% of DHS outpatient percentage
Ct Abd And Pelvis Without Iv Contrast,,74176,CPT,Facility,Inpatient,,,,2856,2427.6,533.908,2856,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Ct Abd And Pelvis With Iv Contrast,,74177,CPT,Facility,Both,,,,3366,2861.1,561.34,3366,Aetna,Commercial,3096.72,92,,percent of total billed charges,,
Ct Abd And Pelvis With Iv Contrast,,74177,CPT,Facility,Outpatient,,,,3366,2861.1,561.34,3366,Aetna,Medicare Advantage,1649.34,49,,percent of total billed charges,,
Ct Abd And Pelvis With Iv Contrast,,74177,CPT,Facility,Inpatient,,,,3366,2861.1,561.34,3366,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Ct Abd And Pelvis With Iv Contrast,,74177,CPT,Facility,Both,,,,3366,2861.1,561.34,3366,Aetna,PPO,3130.38,93,,percent of total billed charges,,
Ct Abd And Pelvis With Iv Contrast,,74177,CPT,Facility,Both,,,,3366,2861.1,561.34,3366,America's PPO,America's PPO,3232.3698,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Ct Abd And Pelvis With Iv Contrast,,74177,CPT,Facility,Both,,,,3366,2861.1,561.34,3366,BlueCross BlueShield Minnesota, Federal Employee Program,1105,,,Fee schedule,,100% of BCBS commercial commodity fee schedule
Ct Abd And Pelvis With Iv Contrast,,74177,CPT,Facility,Both,,,,3366,2861.1,561.34,3366,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1122.68,,,Fee schedule,,"100% of BCBS commercial commodity fee schedule, plus MN Care tax"
Ct Abd And Pelvis With Iv Contrast,,74177,CPT,Facility,Both,,,,3366,2861.1,561.34,3366,BlueCross BlueShield Minnesota,High Value Network Plan,1010.412,,,Fee schedule,,"90% of BCBS commercial commodity fee schedule, plus MN Care tax; see disclaimer for more information"
Ct Abd And Pelvis With Iv Contrast,,74177,CPT,Facility,Outpatient,,,,3366,2861.1,561.34,3366,BlueCross BlueShield Minnesota,Medicare Advantage,1649.34,49,,percent of total billed charges,,
Ct Abd And Pelvis With Iv Contrast,,74177,CPT,Facility,Inpatient,,,,3366,2861.1,561.34,3366,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Ct Abd And Pelvis With Iv Contrast,,74177,CPT,Facility,Both,,,,3366,2861.1,561.34,3366,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,994.357676,,,Fee schedule,,"88.57% of BCBS commercial commodity fee schedule, plus MN Care tax"
Ct Abd And Pelvis With Iv Contrast,,74177,CPT,Facility,Both,,,,3366,2861.1,561.34,3366,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,561.34,,,Fee schedule,,"100% of BCBS Medicaid commodity fee schedule, plus MN Care tax"
Ct Abd And Pelvis With Iv Contrast,,74177,CPT,Facility,Outpatient,,,,3366,2861.1,561.34,3366,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1649.34,49,,percent of total billed charges,,
Ct Abd And Pelvis With Iv Contrast,,74177,CPT,Facility,Inpatient,,,,3366,2861.1,561.34,3366,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Ct Abd And Pelvis With Iv Contrast,,74177,CPT,Facility,Both,,,,3366,2861.1,561.34,3366,CorVel,Worker's Compensation,3366,100,,percent of total billed charges,,
Ct Abd And Pelvis With Iv Contrast,,74177,CPT,Facility,Both,,,,3366,2861.1,561.34,3366,First Health Group Corporation,First Health Network,3265.02,97,,percent of total billed charges,,
Ct Abd And Pelvis With Iv Contrast,,74177,CPT,Facility,Both,,,,3366,2861.1,561.34,3366,"Health Partners, Inc.",Commercial,3184.236,94.6,,percent of total billed charges,,
Ct Abd And Pelvis With Iv Contrast,,74177,CPT,Facility,Outpatient,,,,3366,2861.1,561.34,3366,"Health Partners, Inc.",Medicare Advantage,1649.34,49,,percent of total billed charges,,
Ct Abd And Pelvis With Iv Contrast,,74177,CPT,Facility,Inpatient,,,,3366,2861.1,561.34,3366,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ct Abd And Pelvis With Iv Contrast,,74177,CPT,Facility,Both,,,,3366,2861.1,561.34,3366,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),2019.6,60,,percent of total billed charges,,
Ct Abd And Pelvis With Iv Contrast,,74177,CPT,Facility,Both,,,,3366,2861.1,561.34,3366,"Health Partners, Inc.",State of Minnesota Advantage Program,2743.29,81.5,,percent of total billed charges,,
Ct Abd And Pelvis With Iv Contrast,,74177,CPT,Facility,Both,,,,3366,2861.1,561.34,3366,"Health Partners, Inc.",State Public Programs,1683,50,,percent of total billed charges,,
Ct Abd And Pelvis With Iv Contrast,,74177,CPT,Facility,Both,,,,3366,2861.1,561.34,3366,Humana Insurance Company,Commercial PPO,3197.7,95,,percent of total billed charges,,
Ct Abd And Pelvis With Iv Contrast,,74177,CPT,Facility,Outpatient,,,,3366,2861.1,561.34,3366,Humana Insurance Company,Medicare PPO,1649.34,49,,percent of total billed charges,,
Ct Abd And Pelvis With Iv Contrast,,74177,CPT,Facility,Inpatient,,,,3366,2861.1,561.34,3366,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Ct Abd And Pelvis With Iv Contrast,,74177,CPT,Facility,Both,,,,3366,2861.1,561.34,3366,Medica,Individual & Family,3335.706,99.1,,percent of total billed charges,,
Ct Abd And Pelvis With Iv Contrast,,74177,CPT,Facility,Outpatient,,,,3366,2861.1,561.34,3366,Medica,Medica Advantage Solution,1676.268,49.8,,percent of total billed charges,,
Ct Abd And Pelvis With Iv Contrast,,74177,CPT,Facility,Inpatient,,,,3366,2861.1,561.34,3366,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Ct Abd And Pelvis With Iv Contrast,,74177,CPT,Facility,Outpatient,,,,3366,2861.1,561.34,3366,Medica,Medical Assistance,1501.236,44.6,,percent of total billed charges,,
Ct Abd And Pelvis With Iv Contrast,,74177,CPT,Facility,Inpatient,,,,3366,2861.1,561.34,3366,Medica,Medical Assistance,,,,,Included in per diem rate,
Ct Abd And Pelvis With Iv Contrast,,74177,CPT,Facility,Outpatient,,,,3366,2861.1,561.34,3366,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1676.268,49.8,,percent of total billed charges,,
Ct Abd And Pelvis With Iv Contrast,,74177,CPT,Facility,Inpatient,,,,3366,2861.1,561.34,3366,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Ct Abd And Pelvis With Iv Contrast,,74177,CPT,Facility,Both,,,,3366,2861.1,561.34,3366,"Multiplan, Inc.","Multiplan, Inc.",3164.04,94,,percent of total billed charges,,
Ct Abd And Pelvis With Iv Contrast,,74177,CPT,Facility,Outpatient,,,,3366,2861.1,561.34,3366,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1283,,,Other,Per scan,
Ct Abd And Pelvis With Iv Contrast,,74177,CPT,Facility,Inpatient,,,,3366,2861.1,561.34,3366,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Ct Abd And Pelvis With Iv Contrast,,74177,CPT,Facility,Both,,,,3366,2861.1,561.34,3366,"Preferred One Administrative Services, INC.",PPO,3318.876,98.6,,percent of total billed charges,,
Ct Abd And Pelvis With Iv Contrast,,74177,CPT,Facility,Outpatient,,,,3366,2861.1,561.34,3366,PrimeWest Health,Minnesota Senior Health Options (MSHO),1731.807,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Ct Abd And Pelvis With Iv Contrast,,74177,CPT,Facility,Inpatient,,,,3366,2861.1,561.34,3366,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ct Abd And Pelvis With Iv Contrast,,74177,CPT,Facility,Outpatient,,,,3366,2861.1,561.34,3366,PrimeWest Health,MinnesotaCare,1728.7776,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Ct Abd And Pelvis With Iv Contrast,,74177,CPT,Facility,Inpatient,,,,3366,2861.1,561.34,3366,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Ct Abd And Pelvis With Iv Contrast,,74177,CPT,Facility,Both,,,,3366,2861.1,561.34,3366,Sanford Health Plan,Sanford Health Plan,3096.72,92,,percent of total billed charges,,
Ct Abd And Pelvis With Iv Contrast,,74177,CPT,Facility,Outpatient,,,,3366,2861.1,561.34,3366,"UCare Health, Inc.",Individual & Family Plan,1896.741,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Ct Abd And Pelvis With Iv Contrast,,74177,CPT,Facility,Inpatient,,,,3366,2861.1,561.34,3366,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Ct Abd And Pelvis With Iv Contrast,,74177,CPT,Facility,Outpatient,,,,3366,2861.1,561.34,3366,"UCare Health, Inc.",Medical Assistance,1698.8202,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ct Abd And Pelvis With Iv Contrast,,74177,CPT,Facility,Inpatient,,,,3366,2861.1,561.34,3366,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Ct Abd And Pelvis With Iv Contrast,,74177,CPT,Facility,Outpatient,,,,3366,2861.1,561.34,3366,"UCare Health, Inc.",Medicare Advantage,1698.8202,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ct Abd And Pelvis With Iv Contrast,,74177,CPT,Facility,Inpatient,,,,3366,2861.1,561.34,3366,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ct Abd And Pelvis With Iv Contrast,,74177,CPT,Facility,Outpatient,,,,3366,2861.1,561.34,3366,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1698.8202,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ct Abd And Pelvis With Iv Contrast,,74177,CPT,Facility,Inpatient,,,,3366,2861.1,561.34,3366,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ct Abd And Pelvis With Iv Contrast,,74177,CPT,Facility,Both,,,,3366,2861.1,561.34,3366,UnitedHealthcare,Individual & Family,3164.04,94,,percent of total billed charges,,
Ct Abd And Pelvis With Iv Contrast,,74177,CPT,Facility,Outpatient,,,,3366,2861.1,561.34,3366,UnitedHealthcare,Medicare Advantage,1649.34,49,,percent of total billed charges,,
Ct Abd And Pelvis With Iv Contrast,,74177,CPT,Facility,Inpatient,,,,3366,2861.1,561.34,3366,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Ct Abd And Pelvis With Iv Contrast,,74177,CPT,Facility,Outpatient,,,,3366,2861.1,561.34,3366,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1615.68,48,,percent of total billed charges,,100% of DHS outpatient percentage
Ct Abd And Pelvis With Iv Contrast,,74177,CPT,Facility,Inpatient,,,,3366,2861.1,561.34,3366,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Ct Abd And Pelvis Wo W Iv Contrast,,74178,CPT,Facility,Both,,,,3774,3207.9,561.34,3774,Aetna,Commercial,3472.08,92,,percent of total billed charges,,
Ct Abd And Pelvis Wo W Iv Contrast,,74178,CPT,Facility,Outpatient,,,,3774,3207.9,561.34,3774,Aetna,Medicare Advantage,1849.26,49,,percent of total billed charges,,
Ct Abd And Pelvis Wo W Iv Contrast,,74178,CPT,Facility,Inpatient,,,,3774,3207.9,561.34,3774,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Ct Abd And Pelvis Wo W Iv Contrast,,74178,CPT,Facility,Both,,,,3774,3207.9,561.34,3774,Aetna,PPO,3509.82,93,,percent of total billed charges,,
Ct Abd And Pelvis Wo W Iv Contrast,,74178,CPT,Facility,Both,,,,3774,3207.9,561.34,3774,America's PPO,America's PPO,3624.1722,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Ct Abd And Pelvis Wo W Iv Contrast,,74178,CPT,Facility,Both,,,,3774,3207.9,561.34,3774,BlueCross BlueShield Minnesota, Federal Employee Program,1105,,,Fee schedule,,100% of BCBS commercial commodity fee schedule
Ct Abd And Pelvis Wo W Iv Contrast,,74178,CPT,Facility,Both,,,,3774,3207.9,561.34,3774,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1122.68,,,Fee schedule,,"100% of BCBS commercial commodity fee schedule, plus MN Care tax"
Ct Abd And Pelvis Wo W Iv Contrast,,74178,CPT,Facility,Both,,,,3774,3207.9,561.34,3774,BlueCross BlueShield Minnesota,High Value Network Plan,1010.412,,,Fee schedule,,"90% of BCBS commercial commodity fee schedule, plus MN Care tax; see disclaimer for more information"
Ct Abd And Pelvis Wo W Iv Contrast,,74178,CPT,Facility,Outpatient,,,,3774,3207.9,561.34,3774,BlueCross BlueShield Minnesota,Medicare Advantage,1849.26,49,,percent of total billed charges,,
Ct Abd And Pelvis Wo W Iv Contrast,,74178,CPT,Facility,Inpatient,,,,3774,3207.9,561.34,3774,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Ct Abd And Pelvis Wo W Iv Contrast,,74178,CPT,Facility,Both,,,,3774,3207.9,561.34,3774,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,994.357676,,,Fee schedule,,"88.57% of BCBS commercial commodity fee schedule, plus MN Care tax"
Ct Abd And Pelvis Wo W Iv Contrast,,74178,CPT,Facility,Both,,,,3774,3207.9,561.34,3774,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,561.34,,,Fee schedule,,"100% of BCBS Medicaid commodity fee schedule, plus MN Care tax"
Ct Abd And Pelvis Wo W Iv Contrast,,74178,CPT,Facility,Outpatient,,,,3774,3207.9,561.34,3774,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1849.26,49,,percent of total billed charges,,
Ct Abd And Pelvis Wo W Iv Contrast,,74178,CPT,Facility,Inpatient,,,,3774,3207.9,561.34,3774,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Ct Abd And Pelvis Wo W Iv Contrast,,74178,CPT,Facility,Both,,,,3774,3207.9,561.34,3774,CorVel,Worker's Compensation,3774,100,,percent of total billed charges,,
Ct Abd And Pelvis Wo W Iv Contrast,,74178,CPT,Facility,Both,,,,3774,3207.9,561.34,3774,First Health Group Corporation,First Health Network,3660.78,97,,percent of total billed charges,,
Ct Abd And Pelvis Wo W Iv Contrast,,74178,CPT,Facility,Both,,,,3774,3207.9,561.34,3774,"Health Partners, Inc.",Commercial,3570.204,94.6,,percent of total billed charges,,
Ct Abd And Pelvis Wo W Iv Contrast,,74178,CPT,Facility,Outpatient,,,,3774,3207.9,561.34,3774,"Health Partners, Inc.",Medicare Advantage,1849.26,49,,percent of total billed charges,,
Ct Abd And Pelvis Wo W Iv Contrast,,74178,CPT,Facility,Inpatient,,,,3774,3207.9,561.34,3774,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ct Abd And Pelvis Wo W Iv Contrast,,74178,CPT,Facility,Both,,,,3774,3207.9,561.34,3774,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),2264.4,60,,percent of total billed charges,,
Ct Abd And Pelvis Wo W Iv Contrast,,74178,CPT,Facility,Both,,,,3774,3207.9,561.34,3774,"Health Partners, Inc.",State of Minnesota Advantage Program,3075.81,81.5,,percent of total billed charges,,
Ct Abd And Pelvis Wo W Iv Contrast,,74178,CPT,Facility,Both,,,,3774,3207.9,561.34,3774,"Health Partners, Inc.",State Public Programs,1887,50,,percent of total billed charges,,
Ct Abd And Pelvis Wo W Iv Contrast,,74178,CPT,Facility,Both,,,,3774,3207.9,561.34,3774,Humana Insurance Company,Commercial PPO,3585.3,95,,percent of total billed charges,,
Ct Abd And Pelvis Wo W Iv Contrast,,74178,CPT,Facility,Outpatient,,,,3774,3207.9,561.34,3774,Humana Insurance Company,Medicare PPO,1849.26,49,,percent of total billed charges,,
Ct Abd And Pelvis Wo W Iv Contrast,,74178,CPT,Facility,Inpatient,,,,3774,3207.9,561.34,3774,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Ct Abd And Pelvis Wo W Iv Contrast,,74178,CPT,Facility,Both,,,,3774,3207.9,561.34,3774,Medica,Individual & Family,3740.034,99.1,,percent of total billed charges,,
Ct Abd And Pelvis Wo W Iv Contrast,,74178,CPT,Facility,Outpatient,,,,3774,3207.9,561.34,3774,Medica,Medica Advantage Solution,1879.452,49.8,,percent of total billed charges,,
Ct Abd And Pelvis Wo W Iv Contrast,,74178,CPT,Facility,Inpatient,,,,3774,3207.9,561.34,3774,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Ct Abd And Pelvis Wo W Iv Contrast,,74178,CPT,Facility,Outpatient,,,,3774,3207.9,561.34,3774,Medica,Medical Assistance,1683.204,44.6,,percent of total billed charges,,
Ct Abd And Pelvis Wo W Iv Contrast,,74178,CPT,Facility,Inpatient,,,,3774,3207.9,561.34,3774,Medica,Medical Assistance,,,,,Included in per diem rate,
Ct Abd And Pelvis Wo W Iv Contrast,,74178,CPT,Facility,Outpatient,,,,3774,3207.9,561.34,3774,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1879.452,49.8,,percent of total billed charges,,
Ct Abd And Pelvis Wo W Iv Contrast,,74178,CPT,Facility,Inpatient,,,,3774,3207.9,561.34,3774,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Ct Abd And Pelvis Wo W Iv Contrast,,74178,CPT,Facility,Both,,,,3774,3207.9,561.34,3774,"Multiplan, Inc.","Multiplan, Inc.",3547.56,94,,percent of total billed charges,,
Ct Abd And Pelvis Wo W Iv Contrast,,74178,CPT,Facility,Outpatient,,,,3774,3207.9,561.34,3774,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1283,,,Other,Per scan,
Ct Abd And Pelvis Wo W Iv Contrast,,74178,CPT,Facility,Inpatient,,,,3774,3207.9,561.34,3774,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Ct Abd And Pelvis Wo W Iv Contrast,,74178,CPT,Facility,Both,,,,3774,3207.9,561.34,3774,"Preferred One Administrative Services, INC.",PPO,3721.164,98.6,,percent of total billed charges,,
Ct Abd And Pelvis Wo W Iv Contrast,,74178,CPT,Facility,Outpatient,,,,3774,3207.9,561.34,3774,PrimeWest Health,Minnesota Senior Health Options (MSHO),1941.723,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Ct Abd And Pelvis Wo W Iv Contrast,,74178,CPT,Facility,Inpatient,,,,3774,3207.9,561.34,3774,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ct Abd And Pelvis Wo W Iv Contrast,,74178,CPT,Facility,Outpatient,,,,3774,3207.9,561.34,3774,PrimeWest Health,MinnesotaCare,1938.3264,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Ct Abd And Pelvis Wo W Iv Contrast,,74178,CPT,Facility,Inpatient,,,,3774,3207.9,561.34,3774,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Ct Abd And Pelvis Wo W Iv Contrast,,74178,CPT,Facility,Both,,,,3774,3207.9,561.34,3774,Sanford Health Plan,Sanford Health Plan,3472.08,92,,percent of total billed charges,,
Ct Abd And Pelvis Wo W Iv Contrast,,74178,CPT,Facility,Outpatient,,,,3774,3207.9,561.34,3774,"UCare Health, Inc.",Individual & Family Plan,2126.649,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Ct Abd And Pelvis Wo W Iv Contrast,,74178,CPT,Facility,Inpatient,,,,3774,3207.9,561.34,3774,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Ct Abd And Pelvis Wo W Iv Contrast,,74178,CPT,Facility,Outpatient,,,,3774,3207.9,561.34,3774,"UCare Health, Inc.",Medical Assistance,1904.7378,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ct Abd And Pelvis Wo W Iv Contrast,,74178,CPT,Facility,Inpatient,,,,3774,3207.9,561.34,3774,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Ct Abd And Pelvis Wo W Iv Contrast,,74178,CPT,Facility,Outpatient,,,,3774,3207.9,561.34,3774,"UCare Health, Inc.",Medicare Advantage,1904.7378,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ct Abd And Pelvis Wo W Iv Contrast,,74178,CPT,Facility,Inpatient,,,,3774,3207.9,561.34,3774,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ct Abd And Pelvis Wo W Iv Contrast,,74178,CPT,Facility,Outpatient,,,,3774,3207.9,561.34,3774,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1904.7378,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ct Abd And Pelvis Wo W Iv Contrast,,74178,CPT,Facility,Inpatient,,,,3774,3207.9,561.34,3774,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ct Abd And Pelvis Wo W Iv Contrast,,74178,CPT,Facility,Both,,,,3774,3207.9,561.34,3774,UnitedHealthcare,Individual & Family,3547.56,94,,percent of total billed charges,,
Ct Abd And Pelvis Wo W Iv Contrast,,74178,CPT,Facility,Outpatient,,,,3774,3207.9,561.34,3774,UnitedHealthcare,Medicare Advantage,1849.26,49,,percent of total billed charges,,
Ct Abd And Pelvis Wo W Iv Contrast,,74178,CPT,Facility,Inpatient,,,,3774,3207.9,561.34,3774,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Ct Abd And Pelvis Wo W Iv Contrast,,74178,CPT,Facility,Outpatient,,,,3774,3207.9,561.34,3774,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1811.52,48,,percent of total billed charges,,100% of DHS outpatient percentage
Ct Abd And Pelvis Wo W Iv Contrast,,74178,CPT,Facility,Inpatient,,,,3774,3207.9,561.34,3774,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Mri Abdomen Routine Wo Contrast,,74181,CPT,Facility,Both,,,,2142,1820.7,533.908,2142,Aetna,Commercial,1970.64,92,,percent of total billed charges,,
Mri Abdomen Routine Wo Contrast,,74181,CPT,Facility,Outpatient,,,,2142,1820.7,533.908,2142,Aetna,Medicare Advantage,1049.58,49,,percent of total billed charges,,
Mri Abdomen Routine Wo Contrast,,74181,CPT,Facility,Inpatient,,,,2142,1820.7,533.908,2142,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Mri Abdomen Routine Wo Contrast,,74181,CPT,Facility,Both,,,,2142,1820.7,533.908,2142,Aetna,PPO,1992.06,93,,percent of total billed charges,,
Mri Abdomen Routine Wo Contrast,,74181,CPT,Facility,Both,,,,2142,1820.7,533.908,2142,America's PPO,America's PPO,2056.9626,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Mri Abdomen Routine Wo Contrast,,74181,CPT,Facility,Both,,,,2142,1820.7,533.908,2142,BlueCross BlueShield Minnesota, Federal Employee Program,1051,,,Fee schedule,,100% of BCBS commercial commodity fee schedule
Mri Abdomen Routine Wo Contrast,,74181,CPT,Facility,Both,,,,2142,1820.7,533.908,2142,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1067.816,,,Fee schedule,,"100% of BCBS commercial commodity fee schedule, plus MN Care tax"
Mri Abdomen Routine Wo Contrast,,74181,CPT,Facility,Both,,,,2142,1820.7,533.908,2142,BlueCross BlueShield Minnesota,High Value Network Plan,961.0344,,,Fee schedule,,"90% of BCBS commercial commodity fee schedule, plus MN Care tax; see disclaimer for more information"
Mri Abdomen Routine Wo Contrast,,74181,CPT,Facility,Outpatient,,,,2142,1820.7,533.908,2142,BlueCross BlueShield Minnesota,Medicare Advantage,1049.58,49,,percent of total billed charges,,
Mri Abdomen Routine Wo Contrast,,74181,CPT,Facility,Inpatient,,,,2142,1820.7,533.908,2142,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Mri Abdomen Routine Wo Contrast,,74181,CPT,Facility,Both,,,,2142,1820.7,533.908,2142,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,945.7646312,,,Fee schedule,,"88.57% of BCBS commercial commodity fee schedule, plus MN Care tax"
Mri Abdomen Routine Wo Contrast,,74181,CPT,Facility,Both,,,,2142,1820.7,533.908,2142,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,533.908,,,Fee schedule,,"100% of BCBS Medicaid commodity fee schedule, plus MN Care tax"
Mri Abdomen Routine Wo Contrast,,74181,CPT,Facility,Outpatient,,,,2142,1820.7,533.908,2142,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1049.58,49,,percent of total billed charges,,
Mri Abdomen Routine Wo Contrast,,74181,CPT,Facility,Inpatient,,,,2142,1820.7,533.908,2142,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Mri Abdomen Routine Wo Contrast,,74181,CPT,Facility,Both,,,,2142,1820.7,533.908,2142,CorVel,Worker's Compensation,2142,100,,percent of total billed charges,,
Mri Abdomen Routine Wo Contrast,,74181,CPT,Facility,Both,,,,2142,1820.7,533.908,2142,First Health Group Corporation,First Health Network,2077.74,97,,percent of total billed charges,,
Mri Abdomen Routine Wo Contrast,,74181,CPT,Facility,Both,,,,2142,1820.7,533.908,2142,"Health Partners, Inc.",Commercial,2026.332,94.6,,percent of total billed charges,,
Mri Abdomen Routine Wo Contrast,,74181,CPT,Facility,Outpatient,,,,2142,1820.7,533.908,2142,"Health Partners, Inc.",Medicare Advantage,1049.58,49,,percent of total billed charges,,
Mri Abdomen Routine Wo Contrast,,74181,CPT,Facility,Inpatient,,,,2142,1820.7,533.908,2142,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mri Abdomen Routine Wo Contrast,,74181,CPT,Facility,Both,,,,2142,1820.7,533.908,2142,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1285.2,60,,percent of total billed charges,,
Mri Abdomen Routine Wo Contrast,,74181,CPT,Facility,Both,,,,2142,1820.7,533.908,2142,"Health Partners, Inc.",State of Minnesota Advantage Program,1745.73,81.5,,percent of total billed charges,,
Mri Abdomen Routine Wo Contrast,,74181,CPT,Facility,Both,,,,2142,1820.7,533.908,2142,"Health Partners, Inc.",State Public Programs,1071,50,,percent of total billed charges,,
Mri Abdomen Routine Wo Contrast,,74181,CPT,Facility,Both,,,,2142,1820.7,533.908,2142,Humana Insurance Company,Commercial PPO,2034.9,95,,percent of total billed charges,,
Mri Abdomen Routine Wo Contrast,,74181,CPT,Facility,Outpatient,,,,2142,1820.7,533.908,2142,Humana Insurance Company,Medicare PPO,1049.58,49,,percent of total billed charges,,
Mri Abdomen Routine Wo Contrast,,74181,CPT,Facility,Inpatient,,,,2142,1820.7,533.908,2142,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Mri Abdomen Routine Wo Contrast,,74181,CPT,Facility,Both,,,,2142,1820.7,533.908,2142,Medica,Individual & Family,2122.722,99.1,,percent of total billed charges,,
Mri Abdomen Routine Wo Contrast,,74181,CPT,Facility,Outpatient,,,,2142,1820.7,533.908,2142,Medica,Medica Advantage Solution,1066.716,49.8,,percent of total billed charges,,
Mri Abdomen Routine Wo Contrast,,74181,CPT,Facility,Inpatient,,,,2142,1820.7,533.908,2142,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Mri Abdomen Routine Wo Contrast,,74181,CPT,Facility,Outpatient,,,,2142,1820.7,533.908,2142,Medica,Medical Assistance,747,,,Other ,per vist,Pays in addition to all Outpatient Service Categories
Mri Abdomen Routine Wo Contrast,,74181,CPT,Facility,Inpatient,,,,2142,1820.7,533.908,2142,Medica,Medical Assistance,,,,,Included in per diem rate,
Mri Abdomen Routine Wo Contrast,,74181,CPT,Facility,Outpatient,,,,2142,1820.7,533.908,2142,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1066.716,49.8,,percent of total billed charges,,
Mri Abdomen Routine Wo Contrast,,74181,CPT,Facility,Inpatient,,,,2142,1820.7,533.908,2142,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Mri Abdomen Routine Wo Contrast,,74181,CPT,Facility,Both,,,,2142,1820.7,533.908,2142,"Multiplan, Inc.","Multiplan, Inc.",2013.48,94,,percent of total billed charges,,
Mri Abdomen Routine Wo Contrast,,74181,CPT,Facility,Outpatient,,,,2142,1820.7,533.908,2142,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1535,,,Other ,per scan,
Mri Abdomen Routine Wo Contrast,,74181,CPT,Facility,Inpatient,,,,2142,1820.7,533.908,2142,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Mri Abdomen Routine Wo Contrast,,74181,CPT,Facility,Both,,,,2142,1820.7,533.908,2142,"Preferred One Administrative Services, INC.",PPO,2112.012,98.6,,percent of total billed charges,,
Mri Abdomen Routine Wo Contrast,,74181,CPT,Facility,Outpatient,,,,2142,1820.7,533.908,2142,PrimeWest Health,Minnesota Senior Health Options (MSHO),1102.059,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Mri Abdomen Routine Wo Contrast,,74181,CPT,Facility,Inpatient,,,,2142,1820.7,533.908,2142,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mri Abdomen Routine Wo Contrast,,74181,CPT,Facility,Outpatient,,,,2142,1820.7,533.908,2142,PrimeWest Health,MinnesotaCare,1100.1312,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Mri Abdomen Routine Wo Contrast,,74181,CPT,Facility,Inpatient,,,,2142,1820.7,533.908,2142,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Mri Abdomen Routine Wo Contrast,,74181,CPT,Facility,Both,,,,2142,1820.7,533.908,2142,Sanford Health Plan,Sanford Health Plan,1970.64,92,,percent of total billed charges,,
Mri Abdomen Routine Wo Contrast,,74181,CPT,Facility,Outpatient,,,,2142,1820.7,533.908,2142,"UCare Health, Inc.",Individual & Family Plan,1207.017,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Mri Abdomen Routine Wo Contrast,,74181,CPT,Facility,Inpatient,,,,2142,1820.7,533.908,2142,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Mri Abdomen Routine Wo Contrast,,74181,CPT,Facility,Outpatient,,,,2142,1820.7,533.908,2142,"UCare Health, Inc.",Medical Assistance,1081.0674,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mri Abdomen Routine Wo Contrast,,74181,CPT,Facility,Inpatient,,,,2142,1820.7,533.908,2142,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Mri Abdomen Routine Wo Contrast,,74181,CPT,Facility,Outpatient,,,,2142,1820.7,533.908,2142,"UCare Health, Inc.",Medicare Advantage,1081.0674,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mri Abdomen Routine Wo Contrast,,74181,CPT,Facility,Inpatient,,,,2142,1820.7,533.908,2142,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mri Abdomen Routine Wo Contrast,,74181,CPT,Facility,Outpatient,,,,2142,1820.7,533.908,2142,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1081.0674,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mri Abdomen Routine Wo Contrast,,74181,CPT,Facility,Inpatient,,,,2142,1820.7,533.908,2142,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mri Abdomen Routine Wo Contrast,,74181,CPT,Facility,Both,,,,2142,1820.7,533.908,2142,UnitedHealthcare,Individual & Family,2013.48,94,,percent of total billed charges,,
Mri Abdomen Routine Wo Contrast,,74181,CPT,Facility,Outpatient,,,,2142,1820.7,533.908,2142,UnitedHealthcare,Medicare Advantage,1049.58,49,,percent of total billed charges,,
Mri Abdomen Routine Wo Contrast,,74181,CPT,Facility,Inpatient,,,,2142,1820.7,533.908,2142,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Mri Abdomen Routine Wo Contrast,,74181,CPT,Facility,Outpatient,,,,2142,1820.7,533.908,2142,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1028.16,48,,percent of total billed charges,,100% of DHS outpatient percentage
Mri Abdomen Routine Wo Contrast,,74181,CPT,Facility,Inpatient,,,,2142,1820.7,533.908,2142,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Mri Abdomen W Contrast,,74182,CPT,Facility,Both,,,,2387,2028.95,561.34,2387,Aetna,Commercial,2196.04,92,,percent of total billed charges,,
Mri Abdomen W Contrast,,74182,CPT,Facility,Outpatient,,,,2387,2028.95,561.34,2387,Aetna,Medicare Advantage,1169.63,49,,percent of total billed charges,,
Mri Abdomen W Contrast,,74182,CPT,Facility,Inpatient,,,,2387,2028.95,561.34,2387,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Mri Abdomen W Contrast,,74182,CPT,Facility,Both,,,,2387,2028.95,561.34,2387,Aetna,PPO,2219.91,93,,percent of total billed charges,,
Mri Abdomen W Contrast,,74182,CPT,Facility,Both,,,,2387,2028.95,561.34,2387,America's PPO,America's PPO,2292.2361,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Mri Abdomen W Contrast,,74182,CPT,Facility,Both,,,,2387,2028.95,561.34,2387,BlueCross BlueShield Minnesota, Federal Employee Program,1105,,,Fee schedule,,100% of BCBS commercial commodity fee schedule
Mri Abdomen W Contrast,,74182,CPT,Facility,Both,,,,2387,2028.95,561.34,2387,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1122.68,,,Fee schedule,,"100% of BCBS commercial commodity fee schedule, plus MN Care tax"
Mri Abdomen W Contrast,,74182,CPT,Facility,Both,,,,2387,2028.95,561.34,2387,BlueCross BlueShield Minnesota,High Value Network Plan,1010.412,,,Fee schedule,,"90% of BCBS commercial commodity fee schedule, plus MN Care tax; see disclaimer for more information"
Mri Abdomen W Contrast,,74182,CPT,Facility,Outpatient,,,,2387,2028.95,561.34,2387,BlueCross BlueShield Minnesota,Medicare Advantage,1169.63,49,,percent of total billed charges,,
Mri Abdomen W Contrast,,74182,CPT,Facility,Inpatient,,,,2387,2028.95,561.34,2387,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Mri Abdomen W Contrast,,74182,CPT,Facility,Both,,,,2387,2028.95,561.34,2387,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,994.357676,,,Fee schedule,,"88.57% of BCBS commercial commodity fee schedule, plus MN Care tax"
Mri Abdomen W Contrast,,74182,CPT,Facility,Both,,,,2387,2028.95,561.34,2387,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,561.34,,,Fee schedule,,"100% of BCBS Medicaid commodity fee schedule, plus MN Care tax"
Mri Abdomen W Contrast,,74182,CPT,Facility,Outpatient,,,,2387,2028.95,561.34,2387,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1169.63,49,,percent of total billed charges,,
Mri Abdomen W Contrast,,74182,CPT,Facility,Inpatient,,,,2387,2028.95,561.34,2387,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Mri Abdomen W Contrast,,74182,CPT,Facility,Both,,,,2387,2028.95,561.34,2387,CorVel,Worker's Compensation,2387,100,,percent of total billed charges,,
Mri Abdomen W Contrast,,74182,CPT,Facility,Both,,,,2387,2028.95,561.34,2387,First Health Group Corporation,First Health Network,2315.39,97,,percent of total billed charges,,
Mri Abdomen W Contrast,,74182,CPT,Facility,Both,,,,2387,2028.95,561.34,2387,"Health Partners, Inc.",Commercial,2258.102,94.6,,percent of total billed charges,,
Mri Abdomen W Contrast,,74182,CPT,Facility,Outpatient,,,,2387,2028.95,561.34,2387,"Health Partners, Inc.",Medicare Advantage,1169.63,49,,percent of total billed charges,,
Mri Abdomen W Contrast,,74182,CPT,Facility,Inpatient,,,,2387,2028.95,561.34,2387,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mri Abdomen W Contrast,,74182,CPT,Facility,Both,,,,2387,2028.95,561.34,2387,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1432.2,60,,percent of total billed charges,,
Mri Abdomen W Contrast,,74182,CPT,Facility,Both,,,,2387,2028.95,561.34,2387,"Health Partners, Inc.",State of Minnesota Advantage Program,1945.405,81.5,,percent of total billed charges,,
Mri Abdomen W Contrast,,74182,CPT,Facility,Both,,,,2387,2028.95,561.34,2387,"Health Partners, Inc.",State Public Programs,1193.5,50,,percent of total billed charges,,
Mri Abdomen W Contrast,,74182,CPT,Facility,Both,,,,2387,2028.95,561.34,2387,Humana Insurance Company,Commercial PPO,2267.65,95,,percent of total billed charges,,
Mri Abdomen W Contrast,,74182,CPT,Facility,Outpatient,,,,2387,2028.95,561.34,2387,Humana Insurance Company,Medicare PPO,1169.63,49,,percent of total billed charges,,
Mri Abdomen W Contrast,,74182,CPT,Facility,Inpatient,,,,2387,2028.95,561.34,2387,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Mri Abdomen W Contrast,,74182,CPT,Facility,Both,,,,2387,2028.95,561.34,2387,Medica,Individual & Family,2365.517,99.1,,percent of total billed charges,,
Mri Abdomen W Contrast,,74182,CPT,Facility,Outpatient,,,,2387,2028.95,561.34,2387,Medica,Medica Advantage Solution,1188.726,49.8,,percent of total billed charges,,
Mri Abdomen W Contrast,,74182,CPT,Facility,Inpatient,,,,2387,2028.95,561.34,2387,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Mri Abdomen W Contrast,,74182,CPT,Facility,Outpatient,,,,2387,2028.95,561.34,2387,Medica,Medical Assistance,747,,,Other ,per vist,Pays in addition to all Outpatient Service Categories
Mri Abdomen W Contrast,,74182,CPT,Facility,Inpatient,,,,2387,2028.95,561.34,2387,Medica,Medical Assistance,,,,,Included in per diem rate,
Mri Abdomen W Contrast,,74182,CPT,Facility,Outpatient,,,,2387,2028.95,561.34,2387,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1188.726,49.8,,percent of total billed charges,,
Mri Abdomen W Contrast,,74182,CPT,Facility,Inpatient,,,,2387,2028.95,561.34,2387,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Mri Abdomen W Contrast,,74182,CPT,Facility,Both,,,,2387,2028.95,561.34,2387,"Multiplan, Inc.","Multiplan, Inc.",2243.78,94,,percent of total billed charges,,
Mri Abdomen W Contrast,,74182,CPT,Facility,Outpatient,,,,2387,2028.95,561.34,2387,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1535,,,Other ,per scan,
Mri Abdomen W Contrast,,74182,CPT,Facility,Inpatient,,,,2387,2028.95,561.34,2387,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Mri Abdomen W Contrast,,74182,CPT,Facility,Both,,,,2387,2028.95,561.34,2387,"Preferred One Administrative Services, INC.",PPO,2353.582,98.6,,percent of total billed charges,,
Mri Abdomen W Contrast,,74182,CPT,Facility,Outpatient,,,,2387,2028.95,561.34,2387,PrimeWest Health,Minnesota Senior Health Options (MSHO),1228.1115,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Mri Abdomen W Contrast,,74182,CPT,Facility,Inpatient,,,,2387,2028.95,561.34,2387,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mri Abdomen W Contrast,,74182,CPT,Facility,Outpatient,,,,2387,2028.95,561.34,2387,PrimeWest Health,MinnesotaCare,1225.9632,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Mri Abdomen W Contrast,,74182,CPT,Facility,Inpatient,,,,2387,2028.95,561.34,2387,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Mri Abdomen W Contrast,,74182,CPT,Facility,Both,,,,2387,2028.95,561.34,2387,Sanford Health Plan,Sanford Health Plan,2196.04,92,,percent of total billed charges,,
Mri Abdomen W Contrast,,74182,CPT,Facility,Outpatient,,,,2387,2028.95,561.34,2387,"UCare Health, Inc.",Individual & Family Plan,1345.0745,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Mri Abdomen W Contrast,,74182,CPT,Facility,Inpatient,,,,2387,2028.95,561.34,2387,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Mri Abdomen W Contrast,,74182,CPT,Facility,Outpatient,,,,2387,2028.95,561.34,2387,"UCare Health, Inc.",Medical Assistance,1204.7189,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mri Abdomen W Contrast,,74182,CPT,Facility,Inpatient,,,,2387,2028.95,561.34,2387,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Mri Abdomen W Contrast,,74182,CPT,Facility,Outpatient,,,,2387,2028.95,561.34,2387,"UCare Health, Inc.",Medicare Advantage,1204.7189,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mri Abdomen W Contrast,,74182,CPT,Facility,Inpatient,,,,2387,2028.95,561.34,2387,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mri Abdomen W Contrast,,74182,CPT,Facility,Outpatient,,,,2387,2028.95,561.34,2387,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1204.7189,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mri Abdomen W Contrast,,74182,CPT,Facility,Inpatient,,,,2387,2028.95,561.34,2387,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mri Abdomen W Contrast,,74182,CPT,Facility,Both,,,,2387,2028.95,561.34,2387,UnitedHealthcare,Individual & Family,2243.78,94,,percent of total billed charges,,
Mri Abdomen W Contrast,,74182,CPT,Facility,Outpatient,,,,2387,2028.95,561.34,2387,UnitedHealthcare,Medicare Advantage,1169.63,49,,percent of total billed charges,,
Mri Abdomen W Contrast,,74182,CPT,Facility,Inpatient,,,,2387,2028.95,561.34,2387,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Mri Abdomen W Contrast,,74182,CPT,Facility,Outpatient,,,,2387,2028.95,561.34,2387,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1145.76,48,,percent of total billed charges,,100% of DHS outpatient percentage
Mri Abdomen W Contrast,,74182,CPT,Facility,Inpatient,,,,2387,2028.95,561.34,2387,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Mri Liver W Contrast,,74182,CPT,Facility,Both,,,,2754,2340.9,561.34,2754,Aetna,Commercial,2533.68,92,,percent of total billed charges,,
Mri Liver W Contrast,,74182,CPT,Facility,Outpatient,,,,2754,2340.9,561.34,2754,Aetna,Medicare Advantage,1349.46,49,,percent of total billed charges,,
Mri Liver W Contrast,,74182,CPT,Facility,Inpatient,,,,2754,2340.9,561.34,2754,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Mri Liver W Contrast,,74182,CPT,Facility,Both,,,,2754,2340.9,561.34,2754,Aetna,PPO,2561.22,93,,percent of total billed charges,,
Mri Liver W Contrast,,74182,CPT,Facility,Both,,,,2754,2340.9,561.34,2754,America's PPO,America's PPO,2644.6662,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Mri Liver W Contrast,,74182,CPT,Facility,Both,,,,2754,2340.9,561.34,2754,BlueCross BlueShield Minnesota, Federal Employee Program,1105,,,Fee schedule,,100% of BCBS commercial commodity fee schedule
Mri Liver W Contrast,,74182,CPT,Facility,Both,,,,2754,2340.9,561.34,2754,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1122.68,,,Fee schedule,,"100% of BCBS commercial commodity fee schedule, plus MN Care tax"
Mri Liver W Contrast,,74182,CPT,Facility,Both,,,,2754,2340.9,561.34,2754,BlueCross BlueShield Minnesota,High Value Network Plan,1010.412,,,Fee schedule,,"90% of BCBS commercial commodity fee schedule, plus MN Care tax; see disclaimer for more information"
Mri Liver W Contrast,,74182,CPT,Facility,Outpatient,,,,2754,2340.9,561.34,2754,BlueCross BlueShield Minnesota,Medicare Advantage,1349.46,49,,percent of total billed charges,,
Mri Liver W Contrast,,74182,CPT,Facility,Inpatient,,,,2754,2340.9,561.34,2754,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Mri Liver W Contrast,,74182,CPT,Facility,Both,,,,2754,2340.9,561.34,2754,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,994.357676,,,Fee schedule,,"88.57% of BCBS commercial commodity fee schedule, plus MN Care tax"
Mri Liver W Contrast,,74182,CPT,Facility,Both,,,,2754,2340.9,561.34,2754,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,561.34,,,Fee schedule,,"100% of BCBS Medicaid commodity fee schedule, plus MN Care tax"
Mri Liver W Contrast,,74182,CPT,Facility,Outpatient,,,,2754,2340.9,561.34,2754,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1349.46,49,,percent of total billed charges,,
Mri Liver W Contrast,,74182,CPT,Facility,Inpatient,,,,2754,2340.9,561.34,2754,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Mri Liver W Contrast,,74182,CPT,Facility,Both,,,,2754,2340.9,561.34,2754,CorVel,Worker's Compensation,2754,100,,percent of total billed charges,,
Mri Liver W Contrast,,74182,CPT,Facility,Both,,,,2754,2340.9,561.34,2754,First Health Group Corporation,First Health Network,2671.38,97,,percent of total billed charges,,
Mri Liver W Contrast,,74182,CPT,Facility,Both,,,,2754,2340.9,561.34,2754,"Health Partners, Inc.",Commercial,2605.284,94.6,,percent of total billed charges,,
Mri Liver W Contrast,,74182,CPT,Facility,Outpatient,,,,2754,2340.9,561.34,2754,"Health Partners, Inc.",Medicare Advantage,1349.46,49,,percent of total billed charges,,
Mri Liver W Contrast,,74182,CPT,Facility,Inpatient,,,,2754,2340.9,561.34,2754,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mri Liver W Contrast,,74182,CPT,Facility,Both,,,,2754,2340.9,561.34,2754,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1652.4,60,,percent of total billed charges,,
Mri Liver W Contrast,,74182,CPT,Facility,Both,,,,2754,2340.9,561.34,2754,"Health Partners, Inc.",State of Minnesota Advantage Program,2244.51,81.5,,percent of total billed charges,,
Mri Liver W Contrast,,74182,CPT,Facility,Both,,,,2754,2340.9,561.34,2754,"Health Partners, Inc.",State Public Programs,1377,50,,percent of total billed charges,,
Mri Liver W Contrast,,74182,CPT,Facility,Both,,,,2754,2340.9,561.34,2754,Humana Insurance Company,Commercial PPO,2616.3,95,,percent of total billed charges,,
Mri Liver W Contrast,,74182,CPT,Facility,Outpatient,,,,2754,2340.9,561.34,2754,Humana Insurance Company,Medicare PPO,1349.46,49,,percent of total billed charges,,
Mri Liver W Contrast,,74182,CPT,Facility,Inpatient,,,,2754,2340.9,561.34,2754,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Mri Liver W Contrast,,74182,CPT,Facility,Both,,,,2754,2340.9,561.34,2754,Medica,Individual & Family,2729.214,99.1,,percent of total billed charges,,
Mri Liver W Contrast,,74182,CPT,Facility,Outpatient,,,,2754,2340.9,561.34,2754,Medica,Medica Advantage Solution,1371.492,49.8,,percent of total billed charges,,
Mri Liver W Contrast,,74182,CPT,Facility,Inpatient,,,,2754,2340.9,561.34,2754,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Mri Liver W Contrast,,74182,CPT,Facility,Outpatient,,,,2754,2340.9,561.34,2754,Medica,Medical Assistance,747,,,Other ,per vist,Pays in addition to all Outpatient Service Categories
Mri Liver W Contrast,,74182,CPT,Facility,Inpatient,,,,2754,2340.9,561.34,2754,Medica,Medical Assistance,,,,,Included in per diem rate,
Mri Liver W Contrast,,74182,CPT,Facility,Outpatient,,,,2754,2340.9,561.34,2754,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1371.492,49.8,,percent of total billed charges,,
Mri Liver W Contrast,,74182,CPT,Facility,Inpatient,,,,2754,2340.9,561.34,2754,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Mri Liver W Contrast,,74182,CPT,Facility,Both,,,,2754,2340.9,561.34,2754,"Multiplan, Inc.","Multiplan, Inc.",2588.76,94,,percent of total billed charges,,
Mri Liver W Contrast,,74182,CPT,Facility,Outpatient,,,,2754,2340.9,561.34,2754,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1535,,,Other  ,per scan,
Mri Liver W Contrast,,74182,CPT,Facility,Inpatient,,,,2754,2340.9,561.34,2754,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Mri Liver W Contrast,,74182,CPT,Facility,Both,,,,2754,2340.9,561.34,2754,"Preferred One Administrative Services, INC.",PPO,2715.444,98.6,,percent of total billed charges,,
Mri Liver W Contrast,,74182,CPT,Facility,Outpatient,,,,2754,2340.9,561.34,2754,PrimeWest Health,Minnesota Senior Health Options (MSHO),1416.933,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Mri Liver W Contrast,,74182,CPT,Facility,Inpatient,,,,2754,2340.9,561.34,2754,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mri Liver W Contrast,,74182,CPT,Facility,Outpatient,,,,2754,2340.9,561.34,2754,PrimeWest Health,MinnesotaCare,1414.4544,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Mri Liver W Contrast,,74182,CPT,Facility,Inpatient,,,,2754,2340.9,561.34,2754,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Mri Liver W Contrast,,74182,CPT,Facility,Both,,,,2754,2340.9,561.34,2754,Sanford Health Plan,Sanford Health Plan,2533.68,92,,percent of total billed charges,,
Mri Liver W Contrast,,74182,CPT,Facility,Outpatient,,,,2754,2340.9,561.34,2754,"UCare Health, Inc.",Individual & Family Plan,1551.879,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Mri Liver W Contrast,,74182,CPT,Facility,Inpatient,,,,2754,2340.9,561.34,2754,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Mri Liver W Contrast,,74182,CPT,Facility,Outpatient,,,,2754,2340.9,561.34,2754,"UCare Health, Inc.",Medical Assistance,1389.9438,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mri Liver W Contrast,,74182,CPT,Facility,Inpatient,,,,2754,2340.9,561.34,2754,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Mri Liver W Contrast,,74182,CPT,Facility,Outpatient,,,,2754,2340.9,561.34,2754,"UCare Health, Inc.",Medicare Advantage,1389.9438,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mri Liver W Contrast,,74182,CPT,Facility,Inpatient,,,,2754,2340.9,561.34,2754,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mri Liver W Contrast,,74182,CPT,Facility,Outpatient,,,,2754,2340.9,561.34,2754,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1389.9438,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mri Liver W Contrast,,74182,CPT,Facility,Inpatient,,,,2754,2340.9,561.34,2754,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mri Liver W Contrast,,74182,CPT,Facility,Both,,,,2754,2340.9,561.34,2754,UnitedHealthcare,Individual & Family,2588.76,94,,percent of total billed charges,,
Mri Liver W Contrast,,74182,CPT,Facility,Outpatient,,,,2754,2340.9,561.34,2754,UnitedHealthcare,Medicare Advantage,1349.46,49,,percent of total billed charges,,
Mri Liver W Contrast,,74182,CPT,Facility,Inpatient,,,,2754,2340.9,561.34,2754,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Mri Liver W Contrast,,74182,CPT,Facility,Outpatient,,,,2754,2340.9,561.34,2754,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1321.92,48,,percent of total billed charges,,100% of DHS outpatient percentage
Mri Liver W Contrast,,74182,CPT,Facility,Inpatient,,,,2754,2340.9,561.34,2754,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Mri Abdomen Wo W Contrast,,74183,CPT,Facility,Both,,,,2652,2254.2,561.34,2652,Aetna,Commercial,2439.84,92,,percent of total billed charges,,
Mri Abdomen Wo W Contrast,,74183,CPT,Facility,Outpatient,,,,2652,2254.2,561.34,2652,Aetna,Medicare Advantage,1299.48,49,,percent of total billed charges,,
Mri Abdomen Wo W Contrast,,74183,CPT,Facility,Inpatient,,,,2652,2254.2,561.34,2652,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Mri Abdomen Wo W Contrast,,74183,CPT,Facility,Both,,,,2652,2254.2,561.34,2652,Aetna,PPO,2466.36,93,,percent of total billed charges,,
Mri Abdomen Wo W Contrast,,74183,CPT,Facility,Both,,,,2652,2254.2,561.34,2652,America's PPO,America's PPO,2546.7156,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Mri Abdomen Wo W Contrast,,74183,CPT,Facility,Both,,,,2652,2254.2,561.34,2652,BlueCross BlueShield Minnesota, Federal Employee Program,1105,,,Fee schedule,,100% of BCBS commercial commodity fee schedule
Mri Abdomen Wo W Contrast,,74183,CPT,Facility,Both,,,,2652,2254.2,561.34,2652,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1122.68,,,Fee schedule,,"100% of BCBS commercial commodity fee schedule, plus MN Care tax"
Mri Abdomen Wo W Contrast,,74183,CPT,Facility,Both,,,,2652,2254.2,561.34,2652,BlueCross BlueShield Minnesota,High Value Network Plan,1010.412,,,Fee schedule,,"90% of BCBS commercial commodity fee schedule, plus MN Care tax; see disclaimer for more information"
Mri Abdomen Wo W Contrast,,74183,CPT,Facility,Outpatient,,,,2652,2254.2,561.34,2652,BlueCross BlueShield Minnesota,Medicare Advantage,1299.48,49,,percent of total billed charges,,
Mri Abdomen Wo W Contrast,,74183,CPT,Facility,Inpatient,,,,2652,2254.2,561.34,2652,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Mri Abdomen Wo W Contrast,,74183,CPT,Facility,Both,,,,2652,2254.2,561.34,2652,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,994.357676,,,Fee schedule,,"88.57% of BCBS commercial commodity fee schedule, plus MN Care tax"
Mri Abdomen Wo W Contrast,,74183,CPT,Facility,Both,,,,2652,2254.2,561.34,2652,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,561.34,,,Fee schedule,,"100% of BCBS Medicaid commodity fee schedule, plus MN Care tax"
Mri Abdomen Wo W Contrast,,74183,CPT,Facility,Outpatient,,,,2652,2254.2,561.34,2652,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1299.48,49,,percent of total billed charges,,
Mri Abdomen Wo W Contrast,,74183,CPT,Facility,Inpatient,,,,2652,2254.2,561.34,2652,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Mri Abdomen Wo W Contrast,,74183,CPT,Facility,Both,,,,2652,2254.2,561.34,2652,CorVel,Worker's Compensation,2652,100,,percent of total billed charges,,
Mri Abdomen Wo W Contrast,,74183,CPT,Facility,Both,,,,2652,2254.2,561.34,2652,First Health Group Corporation,First Health Network,2572.44,97,,percent of total billed charges,,
Mri Abdomen Wo W Contrast,,74183,CPT,Facility,Both,,,,2652,2254.2,561.34,2652,"Health Partners, Inc.",Commercial,2508.792,94.6,,percent of total billed charges,,
Mri Abdomen Wo W Contrast,,74183,CPT,Facility,Outpatient,,,,2652,2254.2,561.34,2652,"Health Partners, Inc.",Medicare Advantage,1299.48,49,,percent of total billed charges,,
Mri Abdomen Wo W Contrast,,74183,CPT,Facility,Inpatient,,,,2652,2254.2,561.34,2652,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mri Abdomen Wo W Contrast,,74183,CPT,Facility,Both,,,,2652,2254.2,561.34,2652,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1591.2,60,,percent of total billed charges,,
Mri Abdomen Wo W Contrast,,74183,CPT,Facility,Both,,,,2652,2254.2,561.34,2652,"Health Partners, Inc.",State of Minnesota Advantage Program,2161.38,81.5,,percent of total billed charges,,
Mri Abdomen Wo W Contrast,,74183,CPT,Facility,Both,,,,2652,2254.2,561.34,2652,"Health Partners, Inc.",State Public Programs,1326,50,,percent of total billed charges,,
Mri Abdomen Wo W Contrast,,74183,CPT,Facility,Both,,,,2652,2254.2,561.34,2652,Humana Insurance Company,Commercial PPO,2519.4,95,,percent of total billed charges,,
Mri Abdomen Wo W Contrast,,74183,CPT,Facility,Outpatient,,,,2652,2254.2,561.34,2652,Humana Insurance Company,Medicare PPO,1299.48,49,,percent of total billed charges,,
Mri Abdomen Wo W Contrast,,74183,CPT,Facility,Inpatient,,,,2652,2254.2,561.34,2652,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Mri Abdomen Wo W Contrast,,74183,CPT,Facility,Both,,,,2652,2254.2,561.34,2652,Medica,Individual & Family,2628.132,99.1,,percent of total billed charges,,
Mri Abdomen Wo W Contrast,,74183,CPT,Facility,Outpatient,,,,2652,2254.2,561.34,2652,Medica,Medica Advantage Solution,1320.696,49.8,,percent of total billed charges,,
Mri Abdomen Wo W Contrast,,74183,CPT,Facility,Inpatient,,,,2652,2254.2,561.34,2652,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Mri Abdomen Wo W Contrast,,74183,CPT,Facility,Outpatient,,,,2652,2254.2,561.34,2652,Medica,Medical Assistance,747,,,Other ,per vist,Pays in addition to all Outpatient Service Categories
Mri Abdomen Wo W Contrast,,74183,CPT,Facility,Inpatient,,,,2652,2254.2,561.34,2652,Medica,Medical Assistance,,,,,Included in per diem rate,
Mri Abdomen Wo W Contrast,,74183,CPT,Facility,Outpatient,,,,2652,2254.2,561.34,2652,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1320.696,49.8,,percent of total billed charges,,
Mri Abdomen Wo W Contrast,,74183,CPT,Facility,Inpatient,,,,2652,2254.2,561.34,2652,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Mri Abdomen Wo W Contrast,,74183,CPT,Facility,Both,,,,2652,2254.2,561.34,2652,"Multiplan, Inc.","Multiplan, Inc.",2492.88,94,,percent of total billed charges,,
Mri Abdomen Wo W Contrast,,74183,CPT,Facility,Outpatient,,,,2652,2254.2,561.34,2652,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1535,,,Other ,per scan,
Mri Abdomen Wo W Contrast,,74183,CPT,Facility,Inpatient,,,,2652,2254.2,561.34,2652,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Mri Abdomen Wo W Contrast,,74183,CPT,Facility,Both,,,,2652,2254.2,561.34,2652,"Preferred One Administrative Services, INC.",PPO,2614.872,98.6,,percent of total billed charges,,
Mri Abdomen Wo W Contrast,,74183,CPT,Facility,Outpatient,,,,2652,2254.2,561.34,2652,PrimeWest Health,Minnesota Senior Health Options (MSHO),1364.454,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Mri Abdomen Wo W Contrast,,74183,CPT,Facility,Inpatient,,,,2652,2254.2,561.34,2652,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mri Abdomen Wo W Contrast,,74183,CPT,Facility,Outpatient,,,,2652,2254.2,561.34,2652,PrimeWest Health,MinnesotaCare,1362.0672,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Mri Abdomen Wo W Contrast,,74183,CPT,Facility,Inpatient,,,,2652,2254.2,561.34,2652,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Mri Abdomen Wo W Contrast,,74183,CPT,Facility,Both,,,,2652,2254.2,561.34,2652,Sanford Health Plan,Sanford Health Plan,2439.84,92,,percent of total billed charges,,
Mri Abdomen Wo W Contrast,,74183,CPT,Facility,Outpatient,,,,2652,2254.2,561.34,2652,"UCare Health, Inc.",Individual & Family Plan,1494.402,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Mri Abdomen Wo W Contrast,,74183,CPT,Facility,Inpatient,,,,2652,2254.2,561.34,2652,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Mri Abdomen Wo W Contrast,,74183,CPT,Facility,Outpatient,,,,2652,2254.2,561.34,2652,"UCare Health, Inc.",Medical Assistance,1338.4644,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mri Abdomen Wo W Contrast,,74183,CPT,Facility,Inpatient,,,,2652,2254.2,561.34,2652,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Mri Abdomen Wo W Contrast,,74183,CPT,Facility,Outpatient,,,,2652,2254.2,561.34,2652,"UCare Health, Inc.",Medicare Advantage,1338.4644,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mri Abdomen Wo W Contrast,,74183,CPT,Facility,Inpatient,,,,2652,2254.2,561.34,2652,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mri Abdomen Wo W Contrast,,74183,CPT,Facility,Outpatient,,,,2652,2254.2,561.34,2652,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1338.4644,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mri Abdomen Wo W Contrast,,74183,CPT,Facility,Inpatient,,,,2652,2254.2,561.34,2652,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mri Abdomen Wo W Contrast,,74183,CPT,Facility,Both,,,,2652,2254.2,561.34,2652,UnitedHealthcare,Individual & Family,2492.88,94,,percent of total billed charges,,
Mri Abdomen Wo W Contrast,,74183,CPT,Facility,Outpatient,,,,2652,2254.2,561.34,2652,UnitedHealthcare,Medicare Advantage,1299.48,49,,percent of total billed charges,,
Mri Abdomen Wo W Contrast,,74183,CPT,Facility,Inpatient,,,,2652,2254.2,561.34,2652,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Mri Abdomen Wo W Contrast,,74183,CPT,Facility,Outpatient,,,,2652,2254.2,561.34,2652,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1272.96,48,,percent of total billed charges,,100% of DHS outpatient percentage
Mri Abdomen Wo W Contrast,,74183,CPT,Facility,Inpatient,,,,2652,2254.2,561.34,2652,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Mri Liver Without And With Contrast,,74183,CPT,Facility,Both,,,,2652,2254.2,561.34,2652,Aetna,Commercial,2439.84,92,,percent of total billed charges,,
Mri Liver Without And With Contrast,,74183,CPT,Facility,Outpatient,,,,2652,2254.2,561.34,2652,Aetna,Medicare Advantage,1299.48,49,,percent of total billed charges,,
Mri Liver Without And With Contrast,,74183,CPT,Facility,Inpatient,,,,2652,2254.2,561.34,2652,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Mri Liver Without And With Contrast,,74183,CPT,Facility,Both,,,,2652,2254.2,561.34,2652,Aetna,PPO,2466.36,93,,percent of total billed charges,,
Mri Liver Without And With Contrast,,74183,CPT,Facility,Both,,,,2652,2254.2,561.34,2652,America's PPO,America's PPO,2546.7156,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Mri Liver Without And With Contrast,,74183,CPT,Facility,Both,,,,2652,2254.2,561.34,2652,BlueCross BlueShield Minnesota, Federal Employee Program,1105,,,Fee schedule,,100% of BCBS commercial commodity fee schedule
Mri Liver Without And With Contrast,,74183,CPT,Facility,Both,,,,2652,2254.2,561.34,2652,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1122.68,,,Fee schedule,,"100% of BCBS commercial commodity fee schedule, plus MN Care tax"
Mri Liver Without And With Contrast,,74183,CPT,Facility,Both,,,,2652,2254.2,561.34,2652,BlueCross BlueShield Minnesota,High Value Network Plan,1010.412,,,Fee schedule,,"90% of BCBS commercial commodity fee schedule, plus MN Care tax; see disclaimer for more information"
Mri Liver Without And With Contrast,,74183,CPT,Facility,Outpatient,,,,2652,2254.2,561.34,2652,BlueCross BlueShield Minnesota,Medicare Advantage,1299.48,49,,percent of total billed charges,,
Mri Liver Without And With Contrast,,74183,CPT,Facility,Inpatient,,,,2652,2254.2,561.34,2652,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Mri Liver Without And With Contrast,,74183,CPT,Facility,Both,,,,2652,2254.2,561.34,2652,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,994.357676,,,Fee schedule,,"88.57% of BCBS commercial commodity fee schedule, plus MN Care tax"
Mri Liver Without And With Contrast,,74183,CPT,Facility,Both,,,,2652,2254.2,561.34,2652,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,561.34,,,Fee schedule,,"100% of BCBS Medicaid commodity fee schedule, plus MN Care tax"
Mri Liver Without And With Contrast,,74183,CPT,Facility,Outpatient,,,,2652,2254.2,561.34,2652,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1299.48,49,,percent of total billed charges,,
Mri Liver Without And With Contrast,,74183,CPT,Facility,Inpatient,,,,2652,2254.2,561.34,2652,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Mri Liver Without And With Contrast,,74183,CPT,Facility,Both,,,,2652,2254.2,561.34,2652,CorVel,Worker's Compensation,2652,100,,percent of total billed charges,,
Mri Liver Without And With Contrast,,74183,CPT,Facility,Both,,,,2652,2254.2,561.34,2652,First Health Group Corporation,First Health Network,2572.44,97,,percent of total billed charges,,
Mri Liver Without And With Contrast,,74183,CPT,Facility,Both,,,,2652,2254.2,561.34,2652,"Health Partners, Inc.",Commercial,2508.792,94.6,,percent of total billed charges,,
Mri Liver Without And With Contrast,,74183,CPT,Facility,Outpatient,,,,2652,2254.2,561.34,2652,"Health Partners, Inc.",Medicare Advantage,1299.48,49,,percent of total billed charges,,
Mri Liver Without And With Contrast,,74183,CPT,Facility,Inpatient,,,,2652,2254.2,561.34,2652,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mri Liver Without And With Contrast,,74183,CPT,Facility,Both,,,,2652,2254.2,561.34,2652,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1591.2,60,,percent of total billed charges,,
Mri Liver Without And With Contrast,,74183,CPT,Facility,Both,,,,2652,2254.2,561.34,2652,"Health Partners, Inc.",State of Minnesota Advantage Program,2161.38,81.5,,percent of total billed charges,,
Mri Liver Without And With Contrast,,74183,CPT,Facility,Both,,,,2652,2254.2,561.34,2652,"Health Partners, Inc.",State Public Programs,1326,50,,percent of total billed charges,,
Mri Liver Without And With Contrast,,74183,CPT,Facility,Both,,,,2652,2254.2,561.34,2652,Humana Insurance Company,Commercial PPO,2519.4,95,,percent of total billed charges,,
Mri Liver Without And With Contrast,,74183,CPT,Facility,Outpatient,,,,2652,2254.2,561.34,2652,Humana Insurance Company,Medicare PPO,1299.48,49,,percent of total billed charges,,
Mri Liver Without And With Contrast,,74183,CPT,Facility,Inpatient,,,,2652,2254.2,561.34,2652,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Mri Liver Without And With Contrast,,74183,CPT,Facility,Both,,,,2652,2254.2,561.34,2652,Medica,Individual & Family,2628.132,99.1,,percent of total billed charges,,
Mri Liver Without And With Contrast,,74183,CPT,Facility,Outpatient,,,,2652,2254.2,561.34,2652,Medica,Medica Advantage Solution,1320.696,49.8,,percent of total billed charges,,
Mri Liver Without And With Contrast,,74183,CPT,Facility,Inpatient,,,,2652,2254.2,561.34,2652,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Mri Liver Without And With Contrast,,74183,CPT,Facility,Outpatient,,,,2652,2254.2,561.34,2652,Medica,Medical Assistance,747,,,Other ,per vist,Pays in addition to all Outpatient Service Categories
Mri Liver Without And With Contrast,,74183,CPT,Facility,Inpatient,,,,2652,2254.2,561.34,2652,Medica,Medical Assistance,,,,,Included in per diem rate,
Mri Liver Without And With Contrast,,74183,CPT,Facility,Outpatient,,,,2652,2254.2,561.34,2652,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1320.696,49.8,,percent of total billed charges,,
Mri Liver Without And With Contrast,,74183,CPT,Facility,Inpatient,,,,2652,2254.2,561.34,2652,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Mri Liver Without And With Contrast,,74183,CPT,Facility,Both,,,,2652,2254.2,561.34,2652,"Multiplan, Inc.","Multiplan, Inc.",2492.88,94,,percent of total billed charges,,
Mri Liver Without And With Contrast,,74183,CPT,Facility,Outpatient,,,,2652,2254.2,561.34,2652,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1535,,,Other,per scan,
Mri Liver Without And With Contrast,,74183,CPT,Facility,Inpatient,,,,2652,2254.2,561.34,2652,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Mri Liver Without And With Contrast,,74183,CPT,Facility,Both,,,,2652,2254.2,561.34,2652,"Preferred One Administrative Services, INC.",PPO,2614.872,98.6,,percent of total billed charges,,
Mri Liver Without And With Contrast,,74183,CPT,Facility,Outpatient,,,,2652,2254.2,561.34,2652,PrimeWest Health,Minnesota Senior Health Options (MSHO),1364.454,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Mri Liver Without And With Contrast,,74183,CPT,Facility,Inpatient,,,,2652,2254.2,561.34,2652,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mri Liver Without And With Contrast,,74183,CPT,Facility,Outpatient,,,,2652,2254.2,561.34,2652,PrimeWest Health,MinnesotaCare,1362.0672,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Mri Liver Without And With Contrast,,74183,CPT,Facility,Inpatient,,,,2652,2254.2,561.34,2652,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Mri Liver Without And With Contrast,,74183,CPT,Facility,Both,,,,2652,2254.2,561.34,2652,Sanford Health Plan,Sanford Health Plan,2439.84,92,,percent of total billed charges,,
Mri Liver Without And With Contrast,,74183,CPT,Facility,Outpatient,,,,2652,2254.2,561.34,2652,"UCare Health, Inc.",Individual & Family Plan,1494.402,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Mri Liver Without And With Contrast,,74183,CPT,Facility,Inpatient,,,,2652,2254.2,561.34,2652,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Mri Liver Without And With Contrast,,74183,CPT,Facility,Outpatient,,,,2652,2254.2,561.34,2652,"UCare Health, Inc.",Medical Assistance,1338.4644,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mri Liver Without And With Contrast,,74183,CPT,Facility,Inpatient,,,,2652,2254.2,561.34,2652,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Mri Liver Without And With Contrast,,74183,CPT,Facility,Outpatient,,,,2652,2254.2,561.34,2652,"UCare Health, Inc.",Medicare Advantage,1338.4644,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mri Liver Without And With Contrast,,74183,CPT,Facility,Inpatient,,,,2652,2254.2,561.34,2652,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mri Liver Without And With Contrast,,74183,CPT,Facility,Outpatient,,,,2652,2254.2,561.34,2652,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1338.4644,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mri Liver Without And With Contrast,,74183,CPT,Facility,Inpatient,,,,2652,2254.2,561.34,2652,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mri Liver Without And With Contrast,,74183,CPT,Facility,Both,,,,2652,2254.2,561.34,2652,UnitedHealthcare,Individual & Family,2492.88,94,,percent of total billed charges,,
Mri Liver Without And With Contrast,,74183,CPT,Facility,Outpatient,,,,2652,2254.2,561.34,2652,UnitedHealthcare,Medicare Advantage,1299.48,49,,percent of total billed charges,,
Mri Liver Without And With Contrast,,74183,CPT,Facility,Inpatient,,,,2652,2254.2,561.34,2652,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Mri Liver Without And With Contrast,,74183,CPT,Facility,Outpatient,,,,2652,2254.2,561.34,2652,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1272.96,48,,percent of total billed charges,,100% of DHS outpatient percentage
Mri Liver Without And With Contrast,,74183,CPT,Facility,Inpatient,,,,2652,2254.2,561.34,2652,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Mra Abdomen Wo W Contrast,,74185,CPT,Facility,Both,,,,3254,2765.9,533.908,3254,Aetna,Commercial,2993.68,92,,percent of total billed charges,,
Mra Abdomen Wo W Contrast,,74185,CPT,Facility,Outpatient,,,,3254,2765.9,533.908,3254,Aetna,Medicare Advantage,1594.46,49,,percent of total billed charges,,
Mra Abdomen Wo W Contrast,,74185,CPT,Facility,Inpatient,,,,3254,2765.9,533.908,3254,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Mra Abdomen Wo W Contrast,,74185,CPT,Facility,Both,,,,3254,2765.9,533.908,3254,Aetna,PPO,3026.22,93,,percent of total billed charges,,
Mra Abdomen Wo W Contrast,,74185,CPT,Facility,Both,,,,3254,2765.9,533.908,3254,America's PPO,America's PPO,3124.8162,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Mra Abdomen Wo W Contrast,,74185,CPT,Facility,Both,,,,3254,2765.9,533.908,3254,BlueCross BlueShield Minnesota, Federal Employee Program,1051,,,Fee schedule,,100% of BCBS commercial commodity fee schedule
Mra Abdomen Wo W Contrast,,74185,CPT,Facility,Both,,,,3254,2765.9,533.908,3254,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1067.816,,,Fee schedule,,"100% of BCBS commercial commodity fee schedule, plus MN Care tax"
Mra Abdomen Wo W Contrast,,74185,CPT,Facility,Both,,,,3254,2765.9,533.908,3254,BlueCross BlueShield Minnesota,High Value Network Plan,961.0344,,,Fee schedule,,"90% of BCBS commercial commodity fee schedule, plus MN Care tax; see disclaimer for more information"
Mra Abdomen Wo W Contrast,,74185,CPT,Facility,Outpatient,,,,3254,2765.9,533.908,3254,BlueCross BlueShield Minnesota,Medicare Advantage,1594.46,49,,percent of total billed charges,,
Mra Abdomen Wo W Contrast,,74185,CPT,Facility,Inpatient,,,,3254,2765.9,533.908,3254,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Mra Abdomen Wo W Contrast,,74185,CPT,Facility,Both,,,,3254,2765.9,533.908,3254,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,945.7646312,,,Fee schedule,,"88.57% of BCBS commercial commodity fee schedule, plus MN Care tax"
Mra Abdomen Wo W Contrast,,74185,CPT,Facility,Both,,,,3254,2765.9,533.908,3254,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,533.908,,,Fee schedule,,"100% of BCBS Medicaid commodity fee schedule, plus MN Care tax"
Mra Abdomen Wo W Contrast,,74185,CPT,Facility,Outpatient,,,,3254,2765.9,533.908,3254,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1594.46,49,,percent of total billed charges,,
Mra Abdomen Wo W Contrast,,74185,CPT,Facility,Inpatient,,,,3254,2765.9,533.908,3254,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Mra Abdomen Wo W Contrast,,74185,CPT,Facility,Both,,,,3254,2765.9,533.908,3254,CorVel,Worker's Compensation,3254,100,,percent of total billed charges,,
Mra Abdomen Wo W Contrast,,74185,CPT,Facility,Both,,,,3254,2765.9,533.908,3254,First Health Group Corporation,First Health Network,3156.38,97,,percent of total billed charges,,
Mra Abdomen Wo W Contrast,,74185,CPT,Facility,Both,,,,3254,2765.9,533.908,3254,"Health Partners, Inc.",Commercial,3078.284,94.6,,percent of total billed charges,,
Mra Abdomen Wo W Contrast,,74185,CPT,Facility,Outpatient,,,,3254,2765.9,533.908,3254,"Health Partners, Inc.",Medicare Advantage,1594.46,49,,percent of total billed charges,,
Mra Abdomen Wo W Contrast,,74185,CPT,Facility,Inpatient,,,,3254,2765.9,533.908,3254,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mra Abdomen Wo W Contrast,,74185,CPT,Facility,Both,,,,3254,2765.9,533.908,3254,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1952.4,60,,percent of total billed charges,,
Mra Abdomen Wo W Contrast,,74185,CPT,Facility,Both,,,,3254,2765.9,533.908,3254,"Health Partners, Inc.",State of Minnesota Advantage Program,2652.01,81.5,,percent of total billed charges,,
Mra Abdomen Wo W Contrast,,74185,CPT,Facility,Both,,,,3254,2765.9,533.908,3254,"Health Partners, Inc.",State Public Programs,1627,50,,percent of total billed charges,,
Mra Abdomen Wo W Contrast,,74185,CPT,Facility,Both,,,,3254,2765.9,533.908,3254,Humana Insurance Company,Commercial PPO,3091.3,95,,percent of total billed charges,,
Mra Abdomen Wo W Contrast,,74185,CPT,Facility,Outpatient,,,,3254,2765.9,533.908,3254,Humana Insurance Company,Medicare PPO,1594.46,49,,percent of total billed charges,,
Mra Abdomen Wo W Contrast,,74185,CPT,Facility,Inpatient,,,,3254,2765.9,533.908,3254,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Mra Abdomen Wo W Contrast,,74185,CPT,Facility,Both,,,,3254,2765.9,533.908,3254,Medica,Individual & Family,3224.714,99.1,,percent of total billed charges,,
Mra Abdomen Wo W Contrast,,74185,CPT,Facility,Outpatient,,,,3254,2765.9,533.908,3254,Medica,Medica Advantage Solution,1620.492,49.8,,percent of total billed charges,,
Mra Abdomen Wo W Contrast,,74185,CPT,Facility,Inpatient,,,,3254,2765.9,533.908,3254,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Mra Abdomen Wo W Contrast,,74185,CPT,Facility,Outpatient,,,,3254,2765.9,533.908,3254,Medica,Medical Assistance,747,,,Other,Per vist,Pays in addition to all Outpatient Service Categories
Mra Abdomen Wo W Contrast,,74185,CPT,Facility,Inpatient,,,,3254,2765.9,533.908,3254,Medica,Medical Assistance,,,,,Included in per diem rate,
Mra Abdomen Wo W Contrast,,74185,CPT,Facility,Outpatient,,,,3254,2765.9,533.908,3254,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1620.492,49.8,,percent of total billed charges,,
Mra Abdomen Wo W Contrast,,74185,CPT,Facility,Inpatient,,,,3254,2765.9,533.908,3254,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Mra Abdomen Wo W Contrast,,74185,CPT,Facility,Both,,,,3254,2765.9,533.908,3254,"Multiplan, Inc.","Multiplan, Inc.",3058.76,94,,percent of total billed charges,,
Mra Abdomen Wo W Contrast,,74185,CPT,Facility,Outpatient,,,,3254,2765.9,533.908,3254,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1535,,,Other,Per scan,
Mra Abdomen Wo W Contrast,,74185,CPT,Facility,Inpatient,,,,3254,2765.9,533.908,3254,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Mra Abdomen Wo W Contrast,,74185,CPT,Facility,Both,,,,3254,2765.9,533.908,3254,"Preferred One Administrative Services, INC.",PPO,3208.444,98.6,,percent of total billed charges,,
Mra Abdomen Wo W Contrast,,74185,CPT,Facility,Outpatient,,,,3254,2765.9,533.908,3254,PrimeWest Health,Minnesota Senior Health Options (MSHO),1674.183,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Mra Abdomen Wo W Contrast,,74185,CPT,Facility,Inpatient,,,,3254,2765.9,533.908,3254,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mra Abdomen Wo W Contrast,,74185,CPT,Facility,Outpatient,,,,3254,2765.9,533.908,3254,PrimeWest Health,MinnesotaCare,1671.2544,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Mra Abdomen Wo W Contrast,,74185,CPT,Facility,Inpatient,,,,3254,2765.9,533.908,3254,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Mra Abdomen Wo W Contrast,,74185,CPT,Facility,Both,,,,3254,2765.9,533.908,3254,Sanford Health Plan,Sanford Health Plan,2993.68,92,,percent of total billed charges,,
Mra Abdomen Wo W Contrast,,74185,CPT,Facility,Outpatient,,,,3254,2765.9,533.908,3254,"UCare Health, Inc.",Individual & Family Plan,1833.629,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Mra Abdomen Wo W Contrast,,74185,CPT,Facility,Inpatient,,,,3254,2765.9,533.908,3254,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Mra Abdomen Wo W Contrast,,74185,CPT,Facility,Outpatient,,,,3254,2765.9,533.908,3254,"UCare Health, Inc.",Medical Assistance,1642.2938,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mra Abdomen Wo W Contrast,,74185,CPT,Facility,Inpatient,,,,3254,2765.9,533.908,3254,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Mra Abdomen Wo W Contrast,,74185,CPT,Facility,Outpatient,,,,3254,2765.9,533.908,3254,"UCare Health, Inc.",Medicare Advantage,1642.2938,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mra Abdomen Wo W Contrast,,74185,CPT,Facility,Inpatient,,,,3254,2765.9,533.908,3254,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mra Abdomen Wo W Contrast,,74185,CPT,Facility,Outpatient,,,,3254,2765.9,533.908,3254,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1642.2938,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mra Abdomen Wo W Contrast,,74185,CPT,Facility,Inpatient,,,,3254,2765.9,533.908,3254,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mra Abdomen Wo W Contrast,,74185,CPT,Facility,Both,,,,3254,2765.9,533.908,3254,UnitedHealthcare,Individual & Family,3058.76,94,,percent of total billed charges,,
Mra Abdomen Wo W Contrast,,74185,CPT,Facility,Outpatient,,,,3254,2765.9,533.908,3254,UnitedHealthcare,Medicare Advantage,1594.46,49,,percent of total billed charges,,
Mra Abdomen Wo W Contrast,,74185,CPT,Facility,Inpatient,,,,3254,2765.9,533.908,3254,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Mra Abdomen Wo W Contrast,,74185,CPT,Facility,Outpatient,,,,3254,2765.9,533.908,3254,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1561.92,48,,percent of total billed charges,,100% of DHS outpatient percentage
Mra Abdomen Wo W Contrast,,74185,CPT,Facility,Inpatient,,,,3254,2765.9,533.908,3254,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Xr Esophagram Barium,,74220,CPT,Facility,Both,,,,470,399.5,134.702,470,Aetna,Commercial,432.4,92,,percent of total billed charges,,
Xr Esophagram Barium,,74220,CPT,Facility,Outpatient,,,,470,399.5,134.702,470,Aetna,Medicare Advantage,230.3,49,,percent of total billed charges,,
Xr Esophagram Barium,,74220,CPT,Facility,Inpatient,,,,470,399.5,134.702,470,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Xr Esophagram Barium,,74220,CPT,Facility,Both,,,,470,399.5,134.702,470,Aetna,PPO,437.1,93,,percent of total billed charges,,
Xr Esophagram Barium,,74220,CPT,Facility,Both,,,,470,399.5,134.702,470,America's PPO,America's PPO,451.341,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Xr Esophagram Barium,,74220,CPT,Facility,Both,,,,470,399.5,134.702,470,BlueCross BlueShield Minnesota, Federal Employee Program,462.48,98.4,,percent of total billed charges,,
Xr Esophagram Barium,,74220,CPT,Facility,Both,,,,470,399.5,134.702,470,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,470,100,,percent of total billed charges,,
Xr Esophagram Barium,,74220,CPT,Facility,Both,,,,470,399.5,134.702,470,BlueCross BlueShield Minnesota,High Value Network Plan,423,90,,percent of total billed charges,,
Xr Esophagram Barium,,74220,CPT,Facility,Outpatient,,,,470,399.5,134.702,470,BlueCross BlueShield Minnesota,Medicare Advantage,230.3,49,,percent of total billed charges,,
Xr Esophagram Barium,,74220,CPT,Facility,Inpatient,,,,470,399.5,134.702,470,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Xr Esophagram Barium,,74220,CPT,Facility,Both,,,,470,399.5,134.702,470,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,416.279,88.57,,percent of total billed charges,,
Xr Esophagram Barium,,74220,CPT,Facility,Both,,,,470,399.5,134.702,470,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,134.702,28.66,,percent of total billed charges,,
Xr Esophagram Barium,,74220,CPT,Facility,Outpatient,,,,470,399.5,134.702,470,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),230.3,49,,percent of total billed charges,,
Xr Esophagram Barium,,74220,CPT,Facility,Inpatient,,,,470,399.5,134.702,470,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Xr Esophagram Barium,,74220,CPT,Facility,Both,,,,470,399.5,134.702,470,CorVel,Worker's Compensation,470,100,,percent of total billed charges,,
Xr Esophagram Barium,,74220,CPT,Facility,Both,,,,470,399.5,134.702,470,First Health Group Corporation,First Health Network,455.9,97,,percent of total billed charges,,
Xr Esophagram Barium,,74220,CPT,Facility,Both,,,,470,399.5,134.702,470,"Health Partners, Inc.",Commercial,444.62,94.6,,percent of total billed charges,,
Xr Esophagram Barium,,74220,CPT,Facility,Outpatient,,,,470,399.5,134.702,470,"Health Partners, Inc.",Medicare Advantage,230.3,49,,percent of total billed charges,,
Xr Esophagram Barium,,74220,CPT,Facility,Inpatient,,,,470,399.5,134.702,470,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Esophagram Barium,,74220,CPT,Facility,Both,,,,470,399.5,134.702,470,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),282,60,,percent of total billed charges,,
Xr Esophagram Barium,,74220,CPT,Facility,Both,,,,470,399.5,134.702,470,"Health Partners, Inc.",State of Minnesota Advantage Program,383.05,81.5,,percent of total billed charges,,
Xr Esophagram Barium,,74220,CPT,Facility,Both,,,,470,399.5,134.702,470,"Health Partners, Inc.",State Public Programs,235,50,,percent of total billed charges,,
Xr Esophagram Barium,,74220,CPT,Facility,Both,,,,470,399.5,134.702,470,Humana Insurance Company,Commercial PPO,446.5,95,,percent of total billed charges,,
Xr Esophagram Barium,,74220,CPT,Facility,Outpatient,,,,470,399.5,134.702,470,Humana Insurance Company,Medicare PPO,230.3,49,,percent of total billed charges,,
Xr Esophagram Barium,,74220,CPT,Facility,Inpatient,,,,470,399.5,134.702,470,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Xr Esophagram Barium,,74220,CPT,Facility,Both,,,,470,399.5,134.702,470,Medica,Individual & Family,465.77,99.1,,percent of total billed charges,,
Xr Esophagram Barium,,74220,CPT,Facility,Outpatient,,,,470,399.5,134.702,470,Medica,Medica Advantage Solution,234.06,49.8,,percent of total billed charges,,
Xr Esophagram Barium,,74220,CPT,Facility,Inpatient,,,,470,399.5,134.702,470,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Xr Esophagram Barium,,74220,CPT,Facility,Outpatient,,,,470,399.5,134.702,470,Medica,Medical Assistance,209.62,44.6,,percent of total billed charges,,
Xr Esophagram Barium,,74220,CPT,Facility,Inpatient,,,,470,399.5,134.702,470,Medica,Medical Assistance,,,,,Included in per diem rate,
Xr Esophagram Barium,,74220,CPT,Facility,Outpatient,,,,470,399.5,134.702,470,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,234.06,49.8,,percent of total billed charges,,
Xr Esophagram Barium,,74220,CPT,Facility,Inpatient,,,,470,399.5,134.702,470,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Xr Esophagram Barium,,74220,CPT,Facility,Both,,,,470,399.5,134.702,470,"Multiplan, Inc.","Multiplan, Inc.",441.8,94,,percent of total billed charges,,
Xr Esophagram Barium,,74220,CPT,Facility,Outpatient,,,,470,399.5,134.702,470,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,423.47,90.1,,percent of total billed charges,,
Xr Esophagram Barium,,74220,CPT,Facility,Inpatient,,,,470,399.5,134.702,470,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Xr Esophagram Barium,,74220,CPT,Facility,Both,,,,470,399.5,134.702,470,"Preferred One Administrative Services, INC.",PPO,463.42,98.6,,percent of total billed charges,,
Xr Esophagram Barium,,74220,CPT,Facility,Outpatient,,,,470,399.5,134.702,470,PrimeWest Health,Minnesota Senior Health Options (MSHO),241.815,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Xr Esophagram Barium,,74220,CPT,Facility,Inpatient,,,,470,399.5,134.702,470,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Esophagram Barium,,74220,CPT,Facility,Outpatient,,,,470,399.5,134.702,470,PrimeWest Health,MinnesotaCare,241.392,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Xr Esophagram Barium,,74220,CPT,Facility,Inpatient,,,,470,399.5,134.702,470,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Xr Esophagram Barium,,74220,CPT,Facility,Both,,,,470,399.5,134.702,470,Sanford Health Plan,Sanford Health Plan,432.4,92,,percent of total billed charges,,
Xr Esophagram Barium,,74220,CPT,Facility,Outpatient,,,,470,399.5,134.702,470,"UCare Health, Inc.",Individual & Family Plan,264.845,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Xr Esophagram Barium,,74220,CPT,Facility,Inpatient,,,,470,399.5,134.702,470,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Xr Esophagram Barium,,74220,CPT,Facility,Outpatient,,,,470,399.5,134.702,470,"UCare Health, Inc.",Medical Assistance,237.209,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Esophagram Barium,,74220,CPT,Facility,Inpatient,,,,470,399.5,134.702,470,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Xr Esophagram Barium,,74220,CPT,Facility,Outpatient,,,,470,399.5,134.702,470,"UCare Health, Inc.",Medicare Advantage,237.209,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Esophagram Barium,,74220,CPT,Facility,Inpatient,,,,470,399.5,134.702,470,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Esophagram Barium,,74220,CPT,Facility,Outpatient,,,,470,399.5,134.702,470,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),237.209,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Esophagram Barium,,74220,CPT,Facility,Inpatient,,,,470,399.5,134.702,470,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Esophagram Barium,,74220,CPT,Facility,Both,,,,470,399.5,134.702,470,UnitedHealthcare,Individual & Family,441.8,94,,percent of total billed charges,,
Xr Esophagram Barium,,74220,CPT,Facility,Outpatient,,,,470,399.5,134.702,470,UnitedHealthcare,Medicare Advantage,230.3,49,,percent of total billed charges,,
Xr Esophagram Barium,,74220,CPT,Facility,Inpatient,,,,470,399.5,134.702,470,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Xr Esophagram Barium,,74220,CPT,Facility,Outpatient,,,,470,399.5,134.702,470,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,225.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
Xr Esophagram Barium,,74220,CPT,Facility,Inpatient,,,,470,399.5,134.702,470,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Xr Video Swallow Eval,,74230,CPT,Facility,Both,,,,428,363.8,122.6648,428,Aetna,Commercial,393.76,92,,percent of total billed charges,,
Xr Video Swallow Eval,,74230,CPT,Facility,Outpatient,,,,428,363.8,122.6648,428,Aetna,Medicare Advantage,209.72,49,,percent of total billed charges,,
Xr Video Swallow Eval,,74230,CPT,Facility,Inpatient,,,,428,363.8,122.6648,428,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Xr Video Swallow Eval,,74230,CPT,Facility,Both,,,,428,363.8,122.6648,428,Aetna,PPO,398.04,93,,percent of total billed charges,,
Xr Video Swallow Eval,,74230,CPT,Facility,Both,,,,428,363.8,122.6648,428,America's PPO,America's PPO,411.0084,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Xr Video Swallow Eval,,74230,CPT,Facility,Both,,,,428,363.8,122.6648,428,BlueCross BlueShield Minnesota, Federal Employee Program,421.152,98.4,,percent of total billed charges,,
Xr Video Swallow Eval,,74230,CPT,Facility,Both,,,,428,363.8,122.6648,428,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,428,100,,percent of total billed charges,,
Xr Video Swallow Eval,,74230,CPT,Facility,Both,,,,428,363.8,122.6648,428,BlueCross BlueShield Minnesota,High Value Network Plan,385.2,90,,percent of total billed charges,,
Xr Video Swallow Eval,,74230,CPT,Facility,Outpatient,,,,428,363.8,122.6648,428,BlueCross BlueShield Minnesota,Medicare Advantage,209.72,49,,percent of total billed charges,,
Xr Video Swallow Eval,,74230,CPT,Facility,Inpatient,,,,428,363.8,122.6648,428,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Xr Video Swallow Eval,,74230,CPT,Facility,Both,,,,428,363.8,122.6648,428,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,379.0796,88.57,,percent of total billed charges,,
Xr Video Swallow Eval,,74230,CPT,Facility,Both,,,,428,363.8,122.6648,428,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,122.6648,28.66,,percent of total billed charges,,
Xr Video Swallow Eval,,74230,CPT,Facility,Outpatient,,,,428,363.8,122.6648,428,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),209.72,49,,percent of total billed charges,,
Xr Video Swallow Eval,,74230,CPT,Facility,Inpatient,,,,428,363.8,122.6648,428,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Xr Video Swallow Eval,,74230,CPT,Facility,Both,,,,428,363.8,122.6648,428,CorVel,Worker's Compensation,428,100,,percent of total billed charges,,
Xr Video Swallow Eval,,74230,CPT,Facility,Both,,,,428,363.8,122.6648,428,First Health Group Corporation,First Health Network,415.16,97,,percent of total billed charges,,
Xr Video Swallow Eval,,74230,CPT,Facility,Both,,,,428,363.8,122.6648,428,"Health Partners, Inc.",Commercial,404.888,94.6,,percent of total billed charges,,
Xr Video Swallow Eval,,74230,CPT,Facility,Outpatient,,,,428,363.8,122.6648,428,"Health Partners, Inc.",Medicare Advantage,209.72,49,,percent of total billed charges,,
Xr Video Swallow Eval,,74230,CPT,Facility,Inpatient,,,,428,363.8,122.6648,428,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Video Swallow Eval,,74230,CPT,Facility,Both,,,,428,363.8,122.6648,428,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),256.8,60,,percent of total billed charges,,
Xr Video Swallow Eval,,74230,CPT,Facility,Both,,,,428,363.8,122.6648,428,"Health Partners, Inc.",State of Minnesota Advantage Program,348.82,81.5,,percent of total billed charges,,
Xr Video Swallow Eval,,74230,CPT,Facility,Both,,,,428,363.8,122.6648,428,"Health Partners, Inc.",State Public Programs,214,50,,percent of total billed charges,,
Xr Video Swallow Eval,,74230,CPT,Facility,Both,,,,428,363.8,122.6648,428,Humana Insurance Company,Commercial PPO,406.6,95,,percent of total billed charges,,
Xr Video Swallow Eval,,74230,CPT,Facility,Outpatient,,,,428,363.8,122.6648,428,Humana Insurance Company,Medicare PPO,209.72,49,,percent of total billed charges,,
Xr Video Swallow Eval,,74230,CPT,Facility,Inpatient,,,,428,363.8,122.6648,428,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Xr Video Swallow Eval,,74230,CPT,Facility,Both,,,,428,363.8,122.6648,428,Medica,Individual & Family,424.148,99.1,,percent of total billed charges,,
Xr Video Swallow Eval,,74230,CPT,Facility,Outpatient,,,,428,363.8,122.6648,428,Medica,Medica Advantage Solution,213.144,49.8,,percent of total billed charges,,
Xr Video Swallow Eval,,74230,CPT,Facility,Inpatient,,,,428,363.8,122.6648,428,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Xr Video Swallow Eval,,74230,CPT,Facility,Outpatient,,,,428,363.8,122.6648,428,Medica,Medical Assistance,190.888,44.6,,percent of total billed charges,,
Xr Video Swallow Eval,,74230,CPT,Facility,Inpatient,,,,428,363.8,122.6648,428,Medica,Medical Assistance,,,,,Included in per diem rate,
Xr Video Swallow Eval,,74230,CPT,Facility,Outpatient,,,,428,363.8,122.6648,428,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,213.144,49.8,,percent of total billed charges,,
Xr Video Swallow Eval,,74230,CPT,Facility,Inpatient,,,,428,363.8,122.6648,428,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Xr Video Swallow Eval,,74230,CPT,Facility,Both,,,,428,363.8,122.6648,428,"Multiplan, Inc.","Multiplan, Inc.",402.32,94,,percent of total billed charges,,
Xr Video Swallow Eval,,74230,CPT,Facility,Outpatient,,,,428,363.8,122.6648,428,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,385.628,90.1,,percent of total billed charges,,
Xr Video Swallow Eval,,74230,CPT,Facility,Inpatient,,,,428,363.8,122.6648,428,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Xr Video Swallow Eval,,74230,CPT,Facility,Both,,,,428,363.8,122.6648,428,"Preferred One Administrative Services, INC.",PPO,422.008,98.6,,percent of total billed charges,,
Xr Video Swallow Eval,,74230,CPT,Facility,Outpatient,,,,428,363.8,122.6648,428,PrimeWest Health,Minnesota Senior Health Options (MSHO),220.206,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Xr Video Swallow Eval,,74230,CPT,Facility,Inpatient,,,,428,363.8,122.6648,428,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Video Swallow Eval,,74230,CPT,Facility,Outpatient,,,,428,363.8,122.6648,428,PrimeWest Health,MinnesotaCare,219.8208,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Xr Video Swallow Eval,,74230,CPT,Facility,Inpatient,,,,428,363.8,122.6648,428,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Xr Video Swallow Eval,,74230,CPT,Facility,Both,,,,428,363.8,122.6648,428,Sanford Health Plan,Sanford Health Plan,393.76,92,,percent of total billed charges,,
Xr Video Swallow Eval,,74230,CPT,Facility,Outpatient,,,,428,363.8,122.6648,428,"UCare Health, Inc.",Individual & Family Plan,241.178,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Xr Video Swallow Eval,,74230,CPT,Facility,Inpatient,,,,428,363.8,122.6648,428,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Xr Video Swallow Eval,,74230,CPT,Facility,Outpatient,,,,428,363.8,122.6648,428,"UCare Health, Inc.",Medical Assistance,216.0116,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Video Swallow Eval,,74230,CPT,Facility,Inpatient,,,,428,363.8,122.6648,428,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Xr Video Swallow Eval,,74230,CPT,Facility,Outpatient,,,,428,363.8,122.6648,428,"UCare Health, Inc.",Medicare Advantage,216.0116,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Video Swallow Eval,,74230,CPT,Facility,Inpatient,,,,428,363.8,122.6648,428,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Video Swallow Eval,,74230,CPT,Facility,Outpatient,,,,428,363.8,122.6648,428,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),216.0116,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Video Swallow Eval,,74230,CPT,Facility,Inpatient,,,,428,363.8,122.6648,428,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Video Swallow Eval,,74230,CPT,Facility,Both,,,,428,363.8,122.6648,428,UnitedHealthcare,Individual & Family,402.32,94,,percent of total billed charges,,
Xr Video Swallow Eval,,74230,CPT,Facility,Outpatient,,,,428,363.8,122.6648,428,UnitedHealthcare,Medicare Advantage,209.72,49,,percent of total billed charges,,
Xr Video Swallow Eval,,74230,CPT,Facility,Inpatient,,,,428,363.8,122.6648,428,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Xr Video Swallow Eval,,74230,CPT,Facility,Outpatient,,,,428,363.8,122.6648,428,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,205.44,48,,percent of total billed charges,,100% of DHS outpatient percentage
Xr Video Swallow Eval,,74230,CPT,Facility,Inpatient,,,,428,363.8,122.6648,428,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Xr Small Bowel Study,,74250,CPT,Facility,Both,,,,561,476.85,160.7826,561,Aetna,Commercial,516.12,92,,percent of total billed charges,,
Xr Small Bowel Study,,74250,CPT,Facility,Outpatient,,,,561,476.85,160.7826,561,Aetna,Medicare Advantage,274.89,49,,percent of total billed charges,,
Xr Small Bowel Study,,74250,CPT,Facility,Inpatient,,,,561,476.85,160.7826,561,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Xr Small Bowel Study,,74250,CPT,Facility,Both,,,,561,476.85,160.7826,561,Aetna,PPO,521.73,93,,percent of total billed charges,,
Xr Small Bowel Study,,74250,CPT,Facility,Both,,,,561,476.85,160.7826,561,America's PPO,America's PPO,538.7283,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Xr Small Bowel Study,,74250,CPT,Facility,Both,,,,561,476.85,160.7826,561,BlueCross BlueShield Minnesota, Federal Employee Program,552.024,98.4,,percent of total billed charges,,
Xr Small Bowel Study,,74250,CPT,Facility,Both,,,,561,476.85,160.7826,561,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,561,100,,percent of total billed charges,,
Xr Small Bowel Study,,74250,CPT,Facility,Both,,,,561,476.85,160.7826,561,BlueCross BlueShield Minnesota,High Value Network Plan,504.9,90,,percent of total billed charges,,
Xr Small Bowel Study,,74250,CPT,Facility,Outpatient,,,,561,476.85,160.7826,561,BlueCross BlueShield Minnesota,Medicare Advantage,274.89,49,,percent of total billed charges,,
Xr Small Bowel Study,,74250,CPT,Facility,Inpatient,,,,561,476.85,160.7826,561,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Xr Small Bowel Study,,74250,CPT,Facility,Both,,,,561,476.85,160.7826,561,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,496.8777,88.57,,percent of total billed charges,,
Xr Small Bowel Study,,74250,CPT,Facility,Both,,,,561,476.85,160.7826,561,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,160.7826,28.66,,percent of total billed charges,,
Xr Small Bowel Study,,74250,CPT,Facility,Outpatient,,,,561,476.85,160.7826,561,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),274.89,49,,percent of total billed charges,,
Xr Small Bowel Study,,74250,CPT,Facility,Inpatient,,,,561,476.85,160.7826,561,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Xr Small Bowel Study,,74250,CPT,Facility,Both,,,,561,476.85,160.7826,561,CorVel,Worker's Compensation,561,100,,percent of total billed charges,,
Xr Small Bowel Study,,74250,CPT,Facility,Both,,,,561,476.85,160.7826,561,First Health Group Corporation,First Health Network,544.17,97,,percent of total billed charges,,
Xr Small Bowel Study,,74250,CPT,Facility,Both,,,,561,476.85,160.7826,561,"Health Partners, Inc.",Commercial,530.706,94.6,,percent of total billed charges,,
Xr Small Bowel Study,,74250,CPT,Facility,Outpatient,,,,561,476.85,160.7826,561,"Health Partners, Inc.",Medicare Advantage,274.89,49,,percent of total billed charges,,
Xr Small Bowel Study,,74250,CPT,Facility,Inpatient,,,,561,476.85,160.7826,561,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Small Bowel Study,,74250,CPT,Facility,Both,,,,561,476.85,160.7826,561,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),336.6,60,,percent of total billed charges,,
Xr Small Bowel Study,,74250,CPT,Facility,Both,,,,561,476.85,160.7826,561,"Health Partners, Inc.",State of Minnesota Advantage Program,457.215,81.5,,percent of total billed charges,,
Xr Small Bowel Study,,74250,CPT,Facility,Both,,,,561,476.85,160.7826,561,"Health Partners, Inc.",State Public Programs,280.5,50,,percent of total billed charges,,
Xr Small Bowel Study,,74250,CPT,Facility,Both,,,,561,476.85,160.7826,561,Humana Insurance Company,Commercial PPO,532.95,95,,percent of total billed charges,,
Xr Small Bowel Study,,74250,CPT,Facility,Outpatient,,,,561,476.85,160.7826,561,Humana Insurance Company,Medicare PPO,274.89,49,,percent of total billed charges,,
Xr Small Bowel Study,,74250,CPT,Facility,Inpatient,,,,561,476.85,160.7826,561,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Xr Small Bowel Study,,74250,CPT,Facility,Both,,,,561,476.85,160.7826,561,Medica,Individual & Family,555.951,99.1,,percent of total billed charges,,
Xr Small Bowel Study,,74250,CPT,Facility,Outpatient,,,,561,476.85,160.7826,561,Medica,Medica Advantage Solution,279.378,49.8,,percent of total billed charges,,
Xr Small Bowel Study,,74250,CPT,Facility,Inpatient,,,,561,476.85,160.7826,561,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Xr Small Bowel Study,,74250,CPT,Facility,Outpatient,,,,561,476.85,160.7826,561,Medica,Medical Assistance,250.206,44.6,,percent of total billed charges,,
Xr Small Bowel Study,,74250,CPT,Facility,Inpatient,,,,561,476.85,160.7826,561,Medica,Medical Assistance,,,,,Included in per diem rate,
Xr Small Bowel Study,,74250,CPT,Facility,Outpatient,,,,561,476.85,160.7826,561,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,279.378,49.8,,percent of total billed charges,,
Xr Small Bowel Study,,74250,CPT,Facility,Inpatient,,,,561,476.85,160.7826,561,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Xr Small Bowel Study,,74250,CPT,Facility,Both,,,,561,476.85,160.7826,561,"Multiplan, Inc.","Multiplan, Inc.",527.34,94,,percent of total billed charges,,
Xr Small Bowel Study,,74250,CPT,Facility,Outpatient,,,,561,476.85,160.7826,561,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,505.461,90.1,,percent of total billed charges,,
Xr Small Bowel Study,,74250,CPT,Facility,Inpatient,,,,561,476.85,160.7826,561,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Xr Small Bowel Study,,74250,CPT,Facility,Both,,,,561,476.85,160.7826,561,"Preferred One Administrative Services, INC.",PPO,553.146,98.6,,percent of total billed charges,,
Xr Small Bowel Study,,74250,CPT,Facility,Outpatient,,,,561,476.85,160.7826,561,PrimeWest Health,Minnesota Senior Health Options (MSHO),288.6345,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Xr Small Bowel Study,,74250,CPT,Facility,Inpatient,,,,561,476.85,160.7826,561,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Small Bowel Study,,74250,CPT,Facility,Outpatient,,,,561,476.85,160.7826,561,PrimeWest Health,MinnesotaCare,288.1296,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Xr Small Bowel Study,,74250,CPT,Facility,Inpatient,,,,561,476.85,160.7826,561,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Xr Small Bowel Study,,74250,CPT,Facility,Both,,,,561,476.85,160.7826,561,Sanford Health Plan,Sanford Health Plan,516.12,92,,percent of total billed charges,,
Xr Small Bowel Study,,74250,CPT,Facility,Outpatient,,,,561,476.85,160.7826,561,"UCare Health, Inc.",Individual & Family Plan,316.1235,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Xr Small Bowel Study,,74250,CPT,Facility,Inpatient,,,,561,476.85,160.7826,561,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Xr Small Bowel Study,,74250,CPT,Facility,Outpatient,,,,561,476.85,160.7826,561,"UCare Health, Inc.",Medical Assistance,283.1367,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Small Bowel Study,,74250,CPT,Facility,Inpatient,,,,561,476.85,160.7826,561,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Xr Small Bowel Study,,74250,CPT,Facility,Outpatient,,,,561,476.85,160.7826,561,"UCare Health, Inc.",Medicare Advantage,283.1367,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Small Bowel Study,,74250,CPT,Facility,Inpatient,,,,561,476.85,160.7826,561,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Small Bowel Study,,74250,CPT,Facility,Outpatient,,,,561,476.85,160.7826,561,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),283.1367,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Small Bowel Study,,74250,CPT,Facility,Inpatient,,,,561,476.85,160.7826,561,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Small Bowel Study,,74250,CPT,Facility,Both,,,,561,476.85,160.7826,561,UnitedHealthcare,Individual & Family,527.34,94,,percent of total billed charges,,
Xr Small Bowel Study,,74250,CPT,Facility,Outpatient,,,,561,476.85,160.7826,561,UnitedHealthcare,Medicare Advantage,274.89,49,,percent of total billed charges,,
Xr Small Bowel Study,,74250,CPT,Facility,Inpatient,,,,561,476.85,160.7826,561,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Xr Small Bowel Study,,74250,CPT,Facility,Outpatient,,,,561,476.85,160.7826,561,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,269.28,48,,percent of total billed charges,,100% of DHS outpatient percentage
Xr Small Bowel Study,,74250,CPT,Facility,Inpatient,,,,561,476.85,160.7826,561,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Xr Operative Cholangiogram 1St Set,,74300,CPT,Facility,Both,,,,286,243.1,81.9676,286,Aetna,Commercial,263.12,92,,percent of total billed charges,,
Xr Operative Cholangiogram 1St Set,,74300,CPT,Facility,Outpatient,,,,286,243.1,81.9676,286,Aetna,Medicare Advantage,140.14,49,,percent of total billed charges,,
Xr Operative Cholangiogram 1St Set,,74300,CPT,Facility,Inpatient,,,,286,243.1,81.9676,286,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Xr Operative Cholangiogram 1St Set,,74300,CPT,Facility,Both,,,,286,243.1,81.9676,286,Aetna,PPO,265.98,93,,percent of total billed charges,,
Xr Operative Cholangiogram 1St Set,,74300,CPT,Facility,Both,,,,286,243.1,81.9676,286,America's PPO,America's PPO,274.6458,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Xr Operative Cholangiogram 1St Set,,74300,CPT,Facility,Both,,,,286,243.1,81.9676,286,BlueCross BlueShield Minnesota, Federal Employee Program,281.424,98.4,,percent of total billed charges,,
Xr Operative Cholangiogram 1St Set,,74300,CPT,Facility,Both,,,,286,243.1,81.9676,286,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,286,100,,percent of total billed charges,,
Xr Operative Cholangiogram 1St Set,,74300,CPT,Facility,Both,,,,286,243.1,81.9676,286,BlueCross BlueShield Minnesota,High Value Network Plan,257.4,90,,percent of total billed charges,,
Xr Operative Cholangiogram 1St Set,,74300,CPT,Facility,Outpatient,,,,286,243.1,81.9676,286,BlueCross BlueShield Minnesota,Medicare Advantage,140.14,49,,percent of total billed charges,,
Xr Operative Cholangiogram 1St Set,,74300,CPT,Facility,Inpatient,,,,286,243.1,81.9676,286,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Xr Operative Cholangiogram 1St Set,,74300,CPT,Facility,Both,,,,286,243.1,81.9676,286,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,253.3102,88.57,,percent of total billed charges,,
Xr Operative Cholangiogram 1St Set,,74300,CPT,Facility,Both,,,,286,243.1,81.9676,286,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,81.9676,28.66,,percent of total billed charges,,
Xr Operative Cholangiogram 1St Set,,74300,CPT,Facility,Outpatient,,,,286,243.1,81.9676,286,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),140.14,49,,percent of total billed charges,,
Xr Operative Cholangiogram 1St Set,,74300,CPT,Facility,Inpatient,,,,286,243.1,81.9676,286,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Xr Operative Cholangiogram 1St Set,,74300,CPT,Facility,Both,,,,286,243.1,81.9676,286,CorVel,Worker's Compensation,286,100,,percent of total billed charges,,
Xr Operative Cholangiogram 1St Set,,74300,CPT,Facility,Both,,,,286,243.1,81.9676,286,First Health Group Corporation,First Health Network,277.42,97,,percent of total billed charges,,
Xr Operative Cholangiogram 1St Set,,74300,CPT,Facility,Both,,,,286,243.1,81.9676,286,"Health Partners, Inc.",Commercial,270.556,94.6,,percent of total billed charges,,
Xr Operative Cholangiogram 1St Set,,74300,CPT,Facility,Outpatient,,,,286,243.1,81.9676,286,"Health Partners, Inc.",Medicare Advantage,140.14,49,,percent of total billed charges,,
Xr Operative Cholangiogram 1St Set,,74300,CPT,Facility,Inpatient,,,,286,243.1,81.9676,286,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Operative Cholangiogram 1St Set,,74300,CPT,Facility,Both,,,,286,243.1,81.9676,286,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),171.6,60,,percent of total billed charges,,
Xr Operative Cholangiogram 1St Set,,74300,CPT,Facility,Both,,,,286,243.1,81.9676,286,"Health Partners, Inc.",State of Minnesota Advantage Program,233.09,81.5,,percent of total billed charges,,
Xr Operative Cholangiogram 1St Set,,74300,CPT,Facility,Both,,,,286,243.1,81.9676,286,"Health Partners, Inc.",State Public Programs,143,50,,percent of total billed charges,,
Xr Operative Cholangiogram 1St Set,,74300,CPT,Facility,Both,,,,286,243.1,81.9676,286,Humana Insurance Company,Commercial PPO,271.7,95,,percent of total billed charges,,
Xr Operative Cholangiogram 1St Set,,74300,CPT,Facility,Outpatient,,,,286,243.1,81.9676,286,Humana Insurance Company,Medicare PPO,140.14,49,,percent of total billed charges,,
Xr Operative Cholangiogram 1St Set,,74300,CPT,Facility,Inpatient,,,,286,243.1,81.9676,286,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Xr Operative Cholangiogram 1St Set,,74300,CPT,Facility,Both,,,,286,243.1,81.9676,286,Medica,Individual & Family,283.426,99.1,,percent of total billed charges,,
Xr Operative Cholangiogram 1St Set,,74300,CPT,Facility,Outpatient,,,,286,243.1,81.9676,286,Medica,Medica Advantage Solution,142.428,49.8,,percent of total billed charges,,
Xr Operative Cholangiogram 1St Set,,74300,CPT,Facility,Inpatient,,,,286,243.1,81.9676,286,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Xr Operative Cholangiogram 1St Set,,74300,CPT,Facility,Outpatient,,,,286,243.1,81.9676,286,Medica,Medical Assistance,127.556,44.6,,percent of total billed charges,,
Xr Operative Cholangiogram 1St Set,,74300,CPT,Facility,Inpatient,,,,286,243.1,81.9676,286,Medica,Medical Assistance,,,,,Included in per diem rate,
Xr Operative Cholangiogram 1St Set,,74300,CPT,Facility,Outpatient,,,,286,243.1,81.9676,286,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,142.428,49.8,,percent of total billed charges,,
Xr Operative Cholangiogram 1St Set,,74300,CPT,Facility,Inpatient,,,,286,243.1,81.9676,286,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Xr Operative Cholangiogram 1St Set,,74300,CPT,Facility,Both,,,,286,243.1,81.9676,286,"Multiplan, Inc.","Multiplan, Inc.",268.84,94,,percent of total billed charges,,
Xr Operative Cholangiogram 1St Set,,74300,CPT,Facility,Outpatient,,,,286,243.1,81.9676,286,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,257.686,90.1,,percent of total billed charges,,
Xr Operative Cholangiogram 1St Set,,74300,CPT,Facility,Inpatient,,,,286,243.1,81.9676,286,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Xr Operative Cholangiogram 1St Set,,74300,CPT,Facility,Both,,,,286,243.1,81.9676,286,"Preferred One Administrative Services, INC.",PPO,281.996,98.6,,percent of total billed charges,,
Xr Operative Cholangiogram 1St Set,,74300,CPT,Facility,Outpatient,,,,286,243.1,81.9676,286,PrimeWest Health,Minnesota Senior Health Options (MSHO),147.147,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Xr Operative Cholangiogram 1St Set,,74300,CPT,Facility,Inpatient,,,,286,243.1,81.9676,286,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Operative Cholangiogram 1St Set,,74300,CPT,Facility,Outpatient,,,,286,243.1,81.9676,286,PrimeWest Health,MinnesotaCare,146.8896,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Xr Operative Cholangiogram 1St Set,,74300,CPT,Facility,Inpatient,,,,286,243.1,81.9676,286,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Xr Operative Cholangiogram 1St Set,,74300,CPT,Facility,Both,,,,286,243.1,81.9676,286,Sanford Health Plan,Sanford Health Plan,263.12,92,,percent of total billed charges,,
Xr Operative Cholangiogram 1St Set,,74300,CPT,Facility,Outpatient,,,,286,243.1,81.9676,286,"UCare Health, Inc.",Individual & Family Plan,161.161,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Xr Operative Cholangiogram 1St Set,,74300,CPT,Facility,Inpatient,,,,286,243.1,81.9676,286,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Xr Operative Cholangiogram 1St Set,,74300,CPT,Facility,Outpatient,,,,286,243.1,81.9676,286,"UCare Health, Inc.",Medical Assistance,144.3442,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Operative Cholangiogram 1St Set,,74300,CPT,Facility,Inpatient,,,,286,243.1,81.9676,286,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Xr Operative Cholangiogram 1St Set,,74300,CPT,Facility,Outpatient,,,,286,243.1,81.9676,286,"UCare Health, Inc.",Medicare Advantage,144.3442,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Operative Cholangiogram 1St Set,,74300,CPT,Facility,Inpatient,,,,286,243.1,81.9676,286,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Operative Cholangiogram 1St Set,,74300,CPT,Facility,Outpatient,,,,286,243.1,81.9676,286,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),144.3442,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Operative Cholangiogram 1St Set,,74300,CPT,Facility,Inpatient,,,,286,243.1,81.9676,286,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Operative Cholangiogram 1St Set,,74300,CPT,Facility,Both,,,,286,243.1,81.9676,286,UnitedHealthcare,Individual & Family,268.84,94,,percent of total billed charges,,
Xr Operative Cholangiogram 1St Set,,74300,CPT,Facility,Outpatient,,,,286,243.1,81.9676,286,UnitedHealthcare,Medicare Advantage,140.14,49,,percent of total billed charges,,
Xr Operative Cholangiogram 1St Set,,74300,CPT,Facility,Inpatient,,,,286,243.1,81.9676,286,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Xr Operative Cholangiogram 1St Set,,74300,CPT,Facility,Outpatient,,,,286,243.1,81.9676,286,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,137.28,48,,percent of total billed charges,,100% of DHS outpatient percentage
Xr Operative Cholangiogram 1St Set,,74300,CPT,Facility,Inpatient,,,,286,243.1,81.9676,286,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Xr Operative Cholangiogram Each Addl,,74301,CPT,Facility,Both,,,,204,173.4,58.4664,204,Aetna,Commercial,187.68,92,,percent of total billed charges,,
Xr Operative Cholangiogram Each Addl,,74301,CPT,Facility,Outpatient,,,,204,173.4,58.4664,204,Aetna,Medicare Advantage,99.96,49,,percent of total billed charges,,
Xr Operative Cholangiogram Each Addl,,74301,CPT,Facility,Inpatient,,,,204,173.4,58.4664,204,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Xr Operative Cholangiogram Each Addl,,74301,CPT,Facility,Both,,,,204,173.4,58.4664,204,Aetna,PPO,189.72,93,,percent of total billed charges,,
Xr Operative Cholangiogram Each Addl,,74301,CPT,Facility,Both,,,,204,173.4,58.4664,204,America's PPO,America's PPO,195.9012,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Xr Operative Cholangiogram Each Addl,,74301,CPT,Facility,Both,,,,204,173.4,58.4664,204,BlueCross BlueShield Minnesota, Federal Employee Program,200.736,98.4,,percent of total billed charges,,
Xr Operative Cholangiogram Each Addl,,74301,CPT,Facility,Both,,,,204,173.4,58.4664,204,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,204,100,,percent of total billed charges,,
Xr Operative Cholangiogram Each Addl,,74301,CPT,Facility,Both,,,,204,173.4,58.4664,204,BlueCross BlueShield Minnesota,High Value Network Plan,183.6,90,,percent of total billed charges,,
Xr Operative Cholangiogram Each Addl,,74301,CPT,Facility,Outpatient,,,,204,173.4,58.4664,204,BlueCross BlueShield Minnesota,Medicare Advantage,99.96,49,,percent of total billed charges,,
Xr Operative Cholangiogram Each Addl,,74301,CPT,Facility,Inpatient,,,,204,173.4,58.4664,204,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Xr Operative Cholangiogram Each Addl,,74301,CPT,Facility,Both,,,,204,173.4,58.4664,204,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,180.6828,88.57,,percent of total billed charges,,
Xr Operative Cholangiogram Each Addl,,74301,CPT,Facility,Both,,,,204,173.4,58.4664,204,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,58.4664,28.66,,percent of total billed charges,,
Xr Operative Cholangiogram Each Addl,,74301,CPT,Facility,Outpatient,,,,204,173.4,58.4664,204,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),99.96,49,,percent of total billed charges,,
Xr Operative Cholangiogram Each Addl,,74301,CPT,Facility,Inpatient,,,,204,173.4,58.4664,204,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Xr Operative Cholangiogram Each Addl,,74301,CPT,Facility,Both,,,,204,173.4,58.4664,204,CorVel,Worker's Compensation,204,100,,percent of total billed charges,,
Xr Operative Cholangiogram Each Addl,,74301,CPT,Facility,Both,,,,204,173.4,58.4664,204,First Health Group Corporation,First Health Network,197.88,97,,percent of total billed charges,,
Xr Operative Cholangiogram Each Addl,,74301,CPT,Facility,Both,,,,204,173.4,58.4664,204,"Health Partners, Inc.",Commercial,192.984,94.6,,percent of total billed charges,,
Xr Operative Cholangiogram Each Addl,,74301,CPT,Facility,Outpatient,,,,204,173.4,58.4664,204,"Health Partners, Inc.",Medicare Advantage,99.96,49,,percent of total billed charges,,
Xr Operative Cholangiogram Each Addl,,74301,CPT,Facility,Inpatient,,,,204,173.4,58.4664,204,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Operative Cholangiogram Each Addl,,74301,CPT,Facility,Both,,,,204,173.4,58.4664,204,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),122.4,60,,percent of total billed charges,,
Xr Operative Cholangiogram Each Addl,,74301,CPT,Facility,Both,,,,204,173.4,58.4664,204,"Health Partners, Inc.",State of Minnesota Advantage Program,166.26,81.5,,percent of total billed charges,,
Xr Operative Cholangiogram Each Addl,,74301,CPT,Facility,Both,,,,204,173.4,58.4664,204,"Health Partners, Inc.",State Public Programs,102,50,,percent of total billed charges,,
Xr Operative Cholangiogram Each Addl,,74301,CPT,Facility,Both,,,,204,173.4,58.4664,204,Humana Insurance Company,Commercial PPO,193.8,95,,percent of total billed charges,,
Xr Operative Cholangiogram Each Addl,,74301,CPT,Facility,Outpatient,,,,204,173.4,58.4664,204,Humana Insurance Company,Medicare PPO,99.96,49,,percent of total billed charges,,
Xr Operative Cholangiogram Each Addl,,74301,CPT,Facility,Inpatient,,,,204,173.4,58.4664,204,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Xr Operative Cholangiogram Each Addl,,74301,CPT,Facility,Both,,,,204,173.4,58.4664,204,Medica,Individual & Family,202.164,99.1,,percent of total billed charges,,
Xr Operative Cholangiogram Each Addl,,74301,CPT,Facility,Outpatient,,,,204,173.4,58.4664,204,Medica,Medica Advantage Solution,101.592,49.8,,percent of total billed charges,,
Xr Operative Cholangiogram Each Addl,,74301,CPT,Facility,Inpatient,,,,204,173.4,58.4664,204,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Xr Operative Cholangiogram Each Addl,,74301,CPT,Facility,Outpatient,,,,204,173.4,58.4664,204,Medica,Medical Assistance,90.984,44.6,,percent of total billed charges,,
Xr Operative Cholangiogram Each Addl,,74301,CPT,Facility,Inpatient,,,,204,173.4,58.4664,204,Medica,Medical Assistance,,,,,Included in per diem rate,
Xr Operative Cholangiogram Each Addl,,74301,CPT,Facility,Outpatient,,,,204,173.4,58.4664,204,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,101.592,49.8,,percent of total billed charges,,
Xr Operative Cholangiogram Each Addl,,74301,CPT,Facility,Inpatient,,,,204,173.4,58.4664,204,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Xr Operative Cholangiogram Each Addl,,74301,CPT,Facility,Both,,,,204,173.4,58.4664,204,"Multiplan, Inc.","Multiplan, Inc.",191.76,94,,percent of total billed charges,,
Xr Operative Cholangiogram Each Addl,,74301,CPT,Facility,Outpatient,,,,204,173.4,58.4664,204,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,183.804,90.1,,percent of total billed charges,,
Xr Operative Cholangiogram Each Addl,,74301,CPT,Facility,Inpatient,,,,204,173.4,58.4664,204,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Xr Operative Cholangiogram Each Addl,,74301,CPT,Facility,Both,,,,204,173.4,58.4664,204,"Preferred One Administrative Services, INC.",PPO,201.144,98.6,,percent of total billed charges,,
Xr Operative Cholangiogram Each Addl,,74301,CPT,Facility,Outpatient,,,,204,173.4,58.4664,204,PrimeWest Health,Minnesota Senior Health Options (MSHO),104.958,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Xr Operative Cholangiogram Each Addl,,74301,CPT,Facility,Inpatient,,,,204,173.4,58.4664,204,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Operative Cholangiogram Each Addl,,74301,CPT,Facility,Outpatient,,,,204,173.4,58.4664,204,PrimeWest Health,MinnesotaCare,104.7744,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Xr Operative Cholangiogram Each Addl,,74301,CPT,Facility,Inpatient,,,,204,173.4,58.4664,204,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Xr Operative Cholangiogram Each Addl,,74301,CPT,Facility,Both,,,,204,173.4,58.4664,204,Sanford Health Plan,Sanford Health Plan,187.68,92,,percent of total billed charges,,
Xr Operative Cholangiogram Each Addl,,74301,CPT,Facility,Outpatient,,,,204,173.4,58.4664,204,"UCare Health, Inc.",Individual & Family Plan,114.954,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Xr Operative Cholangiogram Each Addl,,74301,CPT,Facility,Inpatient,,,,204,173.4,58.4664,204,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Xr Operative Cholangiogram Each Addl,,74301,CPT,Facility,Outpatient,,,,204,173.4,58.4664,204,"UCare Health, Inc.",Medical Assistance,102.9588,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Operative Cholangiogram Each Addl,,74301,CPT,Facility,Inpatient,,,,204,173.4,58.4664,204,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Xr Operative Cholangiogram Each Addl,,74301,CPT,Facility,Outpatient,,,,204,173.4,58.4664,204,"UCare Health, Inc.",Medicare Advantage,102.9588,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Operative Cholangiogram Each Addl,,74301,CPT,Facility,Inpatient,,,,204,173.4,58.4664,204,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Operative Cholangiogram Each Addl,,74301,CPT,Facility,Outpatient,,,,204,173.4,58.4664,204,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),102.9588,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Operative Cholangiogram Each Addl,,74301,CPT,Facility,Inpatient,,,,204,173.4,58.4664,204,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Operative Cholangiogram Each Addl,,74301,CPT,Facility,Both,,,,204,173.4,58.4664,204,UnitedHealthcare,Individual & Family,191.76,94,,percent of total billed charges,,
Xr Operative Cholangiogram Each Addl,,74301,CPT,Facility,Outpatient,,,,204,173.4,58.4664,204,UnitedHealthcare,Medicare Advantage,99.96,49,,percent of total billed charges,,
Xr Operative Cholangiogram Each Addl,,74301,CPT,Facility,Inpatient,,,,204,173.4,58.4664,204,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Xr Operative Cholangiogram Each Addl,,74301,CPT,Facility,Outpatient,,,,204,173.4,58.4664,204,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,97.92,48,,percent of total billed charges,,100% of DHS outpatient percentage
Xr Operative Cholangiogram Each Addl,,74301,CPT,Facility,Inpatient,,,,204,173.4,58.4664,204,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Xr Or Retrograde Pyelogram,,74420,CPT,Facility,Both,,,,631,536.35,180.8446,631,Aetna,Commercial,580.52,92,,percent of total billed charges,,
Xr Or Retrograde Pyelogram,,74420,CPT,Facility,Outpatient,,,,631,536.35,180.8446,631,Aetna,Medicare Advantage,309.19,49,,percent of total billed charges,,
Xr Or Retrograde Pyelogram,,74420,CPT,Facility,Inpatient,,,,631,536.35,180.8446,631,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Xr Or Retrograde Pyelogram,,74420,CPT,Facility,Both,,,,631,536.35,180.8446,631,Aetna,PPO,586.83,93,,percent of total billed charges,,
Xr Or Retrograde Pyelogram,,74420,CPT,Facility,Both,,,,631,536.35,180.8446,631,America's PPO,America's PPO,605.9493,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Xr Or Retrograde Pyelogram,,74420,CPT,Facility,Both,,,,631,536.35,180.8446,631,BlueCross BlueShield Minnesota, Federal Employee Program,620.904,98.4,,percent of total billed charges,,
Xr Or Retrograde Pyelogram,,74420,CPT,Facility,Both,,,,631,536.35,180.8446,631,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,631,100,,percent of total billed charges,,
Xr Or Retrograde Pyelogram,,74420,CPT,Facility,Both,,,,631,536.35,180.8446,631,BlueCross BlueShield Minnesota,High Value Network Plan,567.9,90,,percent of total billed charges,,
Xr Or Retrograde Pyelogram,,74420,CPT,Facility,Outpatient,,,,631,536.35,180.8446,631,BlueCross BlueShield Minnesota,Medicare Advantage,309.19,49,,percent of total billed charges,,
Xr Or Retrograde Pyelogram,,74420,CPT,Facility,Inpatient,,,,631,536.35,180.8446,631,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Xr Or Retrograde Pyelogram,,74420,CPT,Facility,Both,,,,631,536.35,180.8446,631,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,558.8767,88.57,,percent of total billed charges,,
Xr Or Retrograde Pyelogram,,74420,CPT,Facility,Both,,,,631,536.35,180.8446,631,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,180.8446,28.66,,percent of total billed charges,,
Xr Or Retrograde Pyelogram,,74420,CPT,Facility,Outpatient,,,,631,536.35,180.8446,631,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),309.19,49,,percent of total billed charges,,
Xr Or Retrograde Pyelogram,,74420,CPT,Facility,Inpatient,,,,631,536.35,180.8446,631,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Xr Or Retrograde Pyelogram,,74420,CPT,Facility,Both,,,,631,536.35,180.8446,631,CorVel,Worker's Compensation,631,100,,percent of total billed charges,,
Xr Or Retrograde Pyelogram,,74420,CPT,Facility,Both,,,,631,536.35,180.8446,631,First Health Group Corporation,First Health Network,612.07,97,,percent of total billed charges,,
Xr Or Retrograde Pyelogram,,74420,CPT,Facility,Both,,,,631,536.35,180.8446,631,"Health Partners, Inc.",Commercial,596.926,94.6,,percent of total billed charges,,
Xr Or Retrograde Pyelogram,,74420,CPT,Facility,Outpatient,,,,631,536.35,180.8446,631,"Health Partners, Inc.",Medicare Advantage,309.19,49,,percent of total billed charges,,
Xr Or Retrograde Pyelogram,,74420,CPT,Facility,Inpatient,,,,631,536.35,180.8446,631,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Or Retrograde Pyelogram,,74420,CPT,Facility,Both,,,,631,536.35,180.8446,631,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),378.6,60,,percent of total billed charges,,
Xr Or Retrograde Pyelogram,,74420,CPT,Facility,Both,,,,631,536.35,180.8446,631,"Health Partners, Inc.",State of Minnesota Advantage Program,514.265,81.5,,percent of total billed charges,,
Xr Or Retrograde Pyelogram,,74420,CPT,Facility,Both,,,,631,536.35,180.8446,631,"Health Partners, Inc.",State Public Programs,315.5,50,,percent of total billed charges,,
Xr Or Retrograde Pyelogram,,74420,CPT,Facility,Both,,,,631,536.35,180.8446,631,Humana Insurance Company,Commercial PPO,599.45,95,,percent of total billed charges,,
Xr Or Retrograde Pyelogram,,74420,CPT,Facility,Outpatient,,,,631,536.35,180.8446,631,Humana Insurance Company,Medicare PPO,309.19,49,,percent of total billed charges,,
Xr Or Retrograde Pyelogram,,74420,CPT,Facility,Inpatient,,,,631,536.35,180.8446,631,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Xr Or Retrograde Pyelogram,,74420,CPT,Facility,Both,,,,631,536.35,180.8446,631,Medica,Individual & Family,625.321,99.1,,percent of total billed charges,,
Xr Or Retrograde Pyelogram,,74420,CPT,Facility,Outpatient,,,,631,536.35,180.8446,631,Medica,Medica Advantage Solution,314.238,49.8,,percent of total billed charges,,
Xr Or Retrograde Pyelogram,,74420,CPT,Facility,Inpatient,,,,631,536.35,180.8446,631,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Xr Or Retrograde Pyelogram,,74420,CPT,Facility,Outpatient,,,,631,536.35,180.8446,631,Medica,Medical Assistance,281.426,44.6,,percent of total billed charges,,
Xr Or Retrograde Pyelogram,,74420,CPT,Facility,Inpatient,,,,631,536.35,180.8446,631,Medica,Medical Assistance,,,,,Included in per diem rate,
Xr Or Retrograde Pyelogram,,74420,CPT,Facility,Outpatient,,,,631,536.35,180.8446,631,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,314.238,49.8,,percent of total billed charges,,
Xr Or Retrograde Pyelogram,,74420,CPT,Facility,Inpatient,,,,631,536.35,180.8446,631,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Xr Or Retrograde Pyelogram,,74420,CPT,Facility,Both,,,,631,536.35,180.8446,631,"Multiplan, Inc.","Multiplan, Inc.",593.14,94,,percent of total billed charges,,
Xr Or Retrograde Pyelogram,,74420,CPT,Facility,Outpatient,,,,631,536.35,180.8446,631,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,568.531,90.1,,percent of total billed charges,,
Xr Or Retrograde Pyelogram,,74420,CPT,Facility,Inpatient,,,,631,536.35,180.8446,631,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Xr Or Retrograde Pyelogram,,74420,CPT,Facility,Both,,,,631,536.35,180.8446,631,"Preferred One Administrative Services, INC.",PPO,622.166,98.6,,percent of total billed charges,,
Xr Or Retrograde Pyelogram,,74420,CPT,Facility,Outpatient,,,,631,536.35,180.8446,631,PrimeWest Health,Minnesota Senior Health Options (MSHO),324.6495,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Xr Or Retrograde Pyelogram,,74420,CPT,Facility,Inpatient,,,,631,536.35,180.8446,631,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Or Retrograde Pyelogram,,74420,CPT,Facility,Outpatient,,,,631,536.35,180.8446,631,PrimeWest Health,MinnesotaCare,324.0816,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Xr Or Retrograde Pyelogram,,74420,CPT,Facility,Inpatient,,,,631,536.35,180.8446,631,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Xr Or Retrograde Pyelogram,,74420,CPT,Facility,Both,,,,631,536.35,180.8446,631,Sanford Health Plan,Sanford Health Plan,580.52,92,,percent of total billed charges,,
Xr Or Retrograde Pyelogram,,74420,CPT,Facility,Outpatient,,,,631,536.35,180.8446,631,"UCare Health, Inc.",Individual & Family Plan,355.5685,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Xr Or Retrograde Pyelogram,,74420,CPT,Facility,Inpatient,,,,631,536.35,180.8446,631,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Xr Or Retrograde Pyelogram,,74420,CPT,Facility,Outpatient,,,,631,536.35,180.8446,631,"UCare Health, Inc.",Medical Assistance,318.4657,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Or Retrograde Pyelogram,,74420,CPT,Facility,Inpatient,,,,631,536.35,180.8446,631,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Xr Or Retrograde Pyelogram,,74420,CPT,Facility,Outpatient,,,,631,536.35,180.8446,631,"UCare Health, Inc.",Medicare Advantage,318.4657,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Or Retrograde Pyelogram,,74420,CPT,Facility,Inpatient,,,,631,536.35,180.8446,631,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Or Retrograde Pyelogram,,74420,CPT,Facility,Outpatient,,,,631,536.35,180.8446,631,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),318.4657,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Or Retrograde Pyelogram,,74420,CPT,Facility,Inpatient,,,,631,536.35,180.8446,631,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Or Retrograde Pyelogram,,74420,CPT,Facility,Both,,,,631,536.35,180.8446,631,UnitedHealthcare,Individual & Family,593.14,94,,percent of total billed charges,,
Xr Or Retrograde Pyelogram,,74420,CPT,Facility,Outpatient,,,,631,536.35,180.8446,631,UnitedHealthcare,Medicare Advantage,309.19,49,,percent of total billed charges,,
Xr Or Retrograde Pyelogram,,74420,CPT,Facility,Inpatient,,,,631,536.35,180.8446,631,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Xr Or Retrograde Pyelogram,,74420,CPT,Facility,Outpatient,,,,631,536.35,180.8446,631,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,302.88,48,,percent of total billed charges,,100% of DHS outpatient percentage
Xr Or Retrograde Pyelogram,,74420,CPT,Facility,Inpatient,,,,631,536.35,180.8446,631,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Xr Cystogram,,74430,CPT,Facility,Both,,,,497,422.45,142.4402,497,Aetna,Commercial,457.24,92,,percent of total billed charges,,
Xr Cystogram,,74430,CPT,Facility,Outpatient,,,,497,422.45,142.4402,497,Aetna,Medicare Advantage,243.53,49,,percent of total billed charges,,
Xr Cystogram,,74430,CPT,Facility,Inpatient,,,,497,422.45,142.4402,497,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Xr Cystogram,,74430,CPT,Facility,Both,,,,497,422.45,142.4402,497,Aetna,PPO,462.21,93,,percent of total billed charges,,
Xr Cystogram,,74430,CPT,Facility,Both,,,,497,422.45,142.4402,497,America's PPO,America's PPO,477.2691,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Xr Cystogram,,74430,CPT,Facility,Both,,,,497,422.45,142.4402,497,BlueCross BlueShield Minnesota, Federal Employee Program,489.048,98.4,,percent of total billed charges,,
Xr Cystogram,,74430,CPT,Facility,Both,,,,497,422.45,142.4402,497,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,497,100,,percent of total billed charges,,
Xr Cystogram,,74430,CPT,Facility,Both,,,,497,422.45,142.4402,497,BlueCross BlueShield Minnesota,High Value Network Plan,447.3,90,,percent of total billed charges,,
Xr Cystogram,,74430,CPT,Facility,Outpatient,,,,497,422.45,142.4402,497,BlueCross BlueShield Minnesota,Medicare Advantage,243.53,49,,percent of total billed charges,,
Xr Cystogram,,74430,CPT,Facility,Inpatient,,,,497,422.45,142.4402,497,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Xr Cystogram,,74430,CPT,Facility,Both,,,,497,422.45,142.4402,497,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,440.1929,88.57,,percent of total billed charges,,
Xr Cystogram,,74430,CPT,Facility,Both,,,,497,422.45,142.4402,497,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,142.4402,28.66,,percent of total billed charges,,
Xr Cystogram,,74430,CPT,Facility,Outpatient,,,,497,422.45,142.4402,497,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),243.53,49,,percent of total billed charges,,
Xr Cystogram,,74430,CPT,Facility,Inpatient,,,,497,422.45,142.4402,497,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Xr Cystogram,,74430,CPT,Facility,Both,,,,497,422.45,142.4402,497,CorVel,Worker's Compensation,497,100,,percent of total billed charges,,
Xr Cystogram,,74430,CPT,Facility,Both,,,,497,422.45,142.4402,497,First Health Group Corporation,First Health Network,482.09,97,,percent of total billed charges,,
Xr Cystogram,,74430,CPT,Facility,Both,,,,497,422.45,142.4402,497,"Health Partners, Inc.",Commercial,470.162,94.6,,percent of total billed charges,,
Xr Cystogram,,74430,CPT,Facility,Outpatient,,,,497,422.45,142.4402,497,"Health Partners, Inc.",Medicare Advantage,243.53,49,,percent of total billed charges,,
Xr Cystogram,,74430,CPT,Facility,Inpatient,,,,497,422.45,142.4402,497,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Cystogram,,74430,CPT,Facility,Both,,,,497,422.45,142.4402,497,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),298.2,60,,percent of total billed charges,,
Xr Cystogram,,74430,CPT,Facility,Both,,,,497,422.45,142.4402,497,"Health Partners, Inc.",State of Minnesota Advantage Program,405.055,81.5,,percent of total billed charges,,
Xr Cystogram,,74430,CPT,Facility,Both,,,,497,422.45,142.4402,497,"Health Partners, Inc.",State Public Programs,248.5,50,,percent of total billed charges,,
Xr Cystogram,,74430,CPT,Facility,Both,,,,497,422.45,142.4402,497,Humana Insurance Company,Commercial PPO,472.15,95,,percent of total billed charges,,
Xr Cystogram,,74430,CPT,Facility,Outpatient,,,,497,422.45,142.4402,497,Humana Insurance Company,Medicare PPO,243.53,49,,percent of total billed charges,,
Xr Cystogram,,74430,CPT,Facility,Inpatient,,,,497,422.45,142.4402,497,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Xr Cystogram,,74430,CPT,Facility,Both,,,,497,422.45,142.4402,497,Medica,Individual & Family,492.527,99.1,,percent of total billed charges,,
Xr Cystogram,,74430,CPT,Facility,Outpatient,,,,497,422.45,142.4402,497,Medica,Medica Advantage Solution,247.506,49.8,,percent of total billed charges,,
Xr Cystogram,,74430,CPT,Facility,Inpatient,,,,497,422.45,142.4402,497,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Xr Cystogram,,74430,CPT,Facility,Outpatient,,,,497,422.45,142.4402,497,Medica,Medical Assistance,221.662,44.6,,percent of total billed charges,,
Xr Cystogram,,74430,CPT,Facility,Inpatient,,,,497,422.45,142.4402,497,Medica,Medical Assistance,,,,,Included in per diem rate,
Xr Cystogram,,74430,CPT,Facility,Outpatient,,,,497,422.45,142.4402,497,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,247.506,49.8,,percent of total billed charges,,
Xr Cystogram,,74430,CPT,Facility,Inpatient,,,,497,422.45,142.4402,497,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Xr Cystogram,,74430,CPT,Facility,Both,,,,497,422.45,142.4402,497,"Multiplan, Inc.","Multiplan, Inc.",467.18,94,,percent of total billed charges,,
Xr Cystogram,,74430,CPT,Facility,Outpatient,,,,497,422.45,142.4402,497,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,447.797,90.1,,percent of total billed charges,,
Xr Cystogram,,74430,CPT,Facility,Inpatient,,,,497,422.45,142.4402,497,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Xr Cystogram,,74430,CPT,Facility,Both,,,,497,422.45,142.4402,497,"Preferred One Administrative Services, INC.",PPO,490.042,98.6,,percent of total billed charges,,
Xr Cystogram,,74430,CPT,Facility,Outpatient,,,,497,422.45,142.4402,497,PrimeWest Health,Minnesota Senior Health Options (MSHO),255.7065,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Xr Cystogram,,74430,CPT,Facility,Inpatient,,,,497,422.45,142.4402,497,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Cystogram,,74430,CPT,Facility,Outpatient,,,,497,422.45,142.4402,497,PrimeWest Health,MinnesotaCare,255.2592,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Xr Cystogram,,74430,CPT,Facility,Inpatient,,,,497,422.45,142.4402,497,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Xr Cystogram,,74430,CPT,Facility,Both,,,,497,422.45,142.4402,497,Sanford Health Plan,Sanford Health Plan,457.24,92,,percent of total billed charges,,
Xr Cystogram,,74430,CPT,Facility,Outpatient,,,,497,422.45,142.4402,497,"UCare Health, Inc.",Individual & Family Plan,280.0595,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Xr Cystogram,,74430,CPT,Facility,Inpatient,,,,497,422.45,142.4402,497,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Xr Cystogram,,74430,CPT,Facility,Outpatient,,,,497,422.45,142.4402,497,"UCare Health, Inc.",Medical Assistance,250.8359,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Cystogram,,74430,CPT,Facility,Inpatient,,,,497,422.45,142.4402,497,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Xr Cystogram,,74430,CPT,Facility,Outpatient,,,,497,422.45,142.4402,497,"UCare Health, Inc.",Medicare Advantage,250.8359,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Cystogram,,74430,CPT,Facility,Inpatient,,,,497,422.45,142.4402,497,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Cystogram,,74430,CPT,Facility,Outpatient,,,,497,422.45,142.4402,497,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),250.8359,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Cystogram,,74430,CPT,Facility,Inpatient,,,,497,422.45,142.4402,497,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Cystogram,,74430,CPT,Facility,Both,,,,497,422.45,142.4402,497,UnitedHealthcare,Individual & Family,467.18,94,,percent of total billed charges,,
Xr Cystogram,,74430,CPT,Facility,Outpatient,,,,497,422.45,142.4402,497,UnitedHealthcare,Medicare Advantage,243.53,49,,percent of total billed charges,,
Xr Cystogram,,74430,CPT,Facility,Inpatient,,,,497,422.45,142.4402,497,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Xr Cystogram,,74430,CPT,Facility,Outpatient,,,,497,422.45,142.4402,497,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,238.56,48,,percent of total billed charges,,100% of DHS outpatient percentage
Xr Cystogram,,74430,CPT,Facility,Inpatient,,,,497,422.45,142.4402,497,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Xr Or Cystogram,,74430,CPT,Facility,Both,,,,497,422.45,142.4402,497,Aetna,Commercial,457.24,92,,percent of total billed charges,,
Xr Or Cystogram,,74430,CPT,Facility,Outpatient,,,,497,422.45,142.4402,497,Aetna,Medicare Advantage,243.53,49,,percent of total billed charges,,
Xr Or Cystogram,,74430,CPT,Facility,Inpatient,,,,497,422.45,142.4402,497,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Xr Or Cystogram,,74430,CPT,Facility,Both,,,,497,422.45,142.4402,497,Aetna,PPO,462.21,93,,percent of total billed charges,,
Xr Or Cystogram,,74430,CPT,Facility,Both,,,,497,422.45,142.4402,497,America's PPO,America's PPO,477.2691,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Xr Or Cystogram,,74430,CPT,Facility,Both,,,,497,422.45,142.4402,497,BlueCross BlueShield Minnesota, Federal Employee Program,489.048,98.4,,percent of total billed charges,,
Xr Or Cystogram,,74430,CPT,Facility,Both,,,,497,422.45,142.4402,497,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,497,100,,percent of total billed charges,,
Xr Or Cystogram,,74430,CPT,Facility,Both,,,,497,422.45,142.4402,497,BlueCross BlueShield Minnesota,High Value Network Plan,447.3,90,,percent of total billed charges,,
Xr Or Cystogram,,74430,CPT,Facility,Outpatient,,,,497,422.45,142.4402,497,BlueCross BlueShield Minnesota,Medicare Advantage,243.53,49,,percent of total billed charges,,
Xr Or Cystogram,,74430,CPT,Facility,Inpatient,,,,497,422.45,142.4402,497,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Xr Or Cystogram,,74430,CPT,Facility,Both,,,,497,422.45,142.4402,497,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,440.1929,88.57,,percent of total billed charges,,
Xr Or Cystogram,,74430,CPT,Facility,Both,,,,497,422.45,142.4402,497,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,142.4402,28.66,,percent of total billed charges,,
Xr Or Cystogram,,74430,CPT,Facility,Outpatient,,,,497,422.45,142.4402,497,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),243.53,49,,percent of total billed charges,,
Xr Or Cystogram,,74430,CPT,Facility,Inpatient,,,,497,422.45,142.4402,497,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Xr Or Cystogram,,74430,CPT,Facility,Both,,,,497,422.45,142.4402,497,CorVel,Worker's Compensation,497,100,,percent of total billed charges,,
Xr Or Cystogram,,74430,CPT,Facility,Both,,,,497,422.45,142.4402,497,First Health Group Corporation,First Health Network,482.09,97,,percent of total billed charges,,
Xr Or Cystogram,,74430,CPT,Facility,Both,,,,497,422.45,142.4402,497,"Health Partners, Inc.",Commercial,470.162,94.6,,percent of total billed charges,,
Xr Or Cystogram,,74430,CPT,Facility,Outpatient,,,,497,422.45,142.4402,497,"Health Partners, Inc.",Medicare Advantage,243.53,49,,percent of total billed charges,,
Xr Or Cystogram,,74430,CPT,Facility,Inpatient,,,,497,422.45,142.4402,497,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Or Cystogram,,74430,CPT,Facility,Both,,,,497,422.45,142.4402,497,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),298.2,60,,percent of total billed charges,,
Xr Or Cystogram,,74430,CPT,Facility,Both,,,,497,422.45,142.4402,497,"Health Partners, Inc.",State of Minnesota Advantage Program,405.055,81.5,,percent of total billed charges,,
Xr Or Cystogram,,74430,CPT,Facility,Both,,,,497,422.45,142.4402,497,"Health Partners, Inc.",State Public Programs,248.5,50,,percent of total billed charges,,
Xr Or Cystogram,,74430,CPT,Facility,Both,,,,497,422.45,142.4402,497,Humana Insurance Company,Commercial PPO,472.15,95,,percent of total billed charges,,
Xr Or Cystogram,,74430,CPT,Facility,Outpatient,,,,497,422.45,142.4402,497,Humana Insurance Company,Medicare PPO,243.53,49,,percent of total billed charges,,
Xr Or Cystogram,,74430,CPT,Facility,Inpatient,,,,497,422.45,142.4402,497,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Xr Or Cystogram,,74430,CPT,Facility,Both,,,,497,422.45,142.4402,497,Medica,Individual & Family,492.527,99.1,,percent of total billed charges,,
Xr Or Cystogram,,74430,CPT,Facility,Outpatient,,,,497,422.45,142.4402,497,Medica,Medica Advantage Solution,247.506,49.8,,percent of total billed charges,,
Xr Or Cystogram,,74430,CPT,Facility,Inpatient,,,,497,422.45,142.4402,497,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Xr Or Cystogram,,74430,CPT,Facility,Outpatient,,,,497,422.45,142.4402,497,Medica,Medical Assistance,221.662,44.6,,percent of total billed charges,,
Xr Or Cystogram,,74430,CPT,Facility,Inpatient,,,,497,422.45,142.4402,497,Medica,Medical Assistance,,,,,Included in per diem rate,
Xr Or Cystogram,,74430,CPT,Facility,Outpatient,,,,497,422.45,142.4402,497,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,247.506,49.8,,percent of total billed charges,,
Xr Or Cystogram,,74430,CPT,Facility,Inpatient,,,,497,422.45,142.4402,497,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Xr Or Cystogram,,74430,CPT,Facility,Both,,,,497,422.45,142.4402,497,"Multiplan, Inc.","Multiplan, Inc.",467.18,94,,percent of total billed charges,,
Xr Or Cystogram,,74430,CPT,Facility,Outpatient,,,,497,422.45,142.4402,497,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,447.797,90.1,,percent of total billed charges,,
Xr Or Cystogram,,74430,CPT,Facility,Inpatient,,,,497,422.45,142.4402,497,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Xr Or Cystogram,,74430,CPT,Facility,Both,,,,497,422.45,142.4402,497,"Preferred One Administrative Services, INC.",PPO,490.042,98.6,,percent of total billed charges,,
Xr Or Cystogram,,74430,CPT,Facility,Outpatient,,,,497,422.45,142.4402,497,PrimeWest Health,Minnesota Senior Health Options (MSHO),255.7065,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Xr Or Cystogram,,74430,CPT,Facility,Inpatient,,,,497,422.45,142.4402,497,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Or Cystogram,,74430,CPT,Facility,Outpatient,,,,497,422.45,142.4402,497,PrimeWest Health,MinnesotaCare,255.2592,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Xr Or Cystogram,,74430,CPT,Facility,Inpatient,,,,497,422.45,142.4402,497,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Xr Or Cystogram,,74430,CPT,Facility,Both,,,,497,422.45,142.4402,497,Sanford Health Plan,Sanford Health Plan,457.24,92,,percent of total billed charges,,
Xr Or Cystogram,,74430,CPT,Facility,Outpatient,,,,497,422.45,142.4402,497,"UCare Health, Inc.",Individual & Family Plan,280.0595,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Xr Or Cystogram,,74430,CPT,Facility,Inpatient,,,,497,422.45,142.4402,497,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Xr Or Cystogram,,74430,CPT,Facility,Outpatient,,,,497,422.45,142.4402,497,"UCare Health, Inc.",Medical Assistance,250.8359,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Or Cystogram,,74430,CPT,Facility,Inpatient,,,,497,422.45,142.4402,497,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Xr Or Cystogram,,74430,CPT,Facility,Outpatient,,,,497,422.45,142.4402,497,"UCare Health, Inc.",Medicare Advantage,250.8359,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Or Cystogram,,74430,CPT,Facility,Inpatient,,,,497,422.45,142.4402,497,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Or Cystogram,,74430,CPT,Facility,Outpatient,,,,497,422.45,142.4402,497,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),250.8359,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Or Cystogram,,74430,CPT,Facility,Inpatient,,,,497,422.45,142.4402,497,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Or Cystogram,,74430,CPT,Facility,Both,,,,497,422.45,142.4402,497,UnitedHealthcare,Individual & Family,467.18,94,,percent of total billed charges,,
Xr Or Cystogram,,74430,CPT,Facility,Outpatient,,,,497,422.45,142.4402,497,UnitedHealthcare,Medicare Advantage,243.53,49,,percent of total billed charges,,
Xr Or Cystogram,,74430,CPT,Facility,Inpatient,,,,497,422.45,142.4402,497,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Xr Or Cystogram,,74430,CPT,Facility,Outpatient,,,,497,422.45,142.4402,497,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,238.56,48,,percent of total billed charges,,100% of DHS outpatient percentage
Xr Or Cystogram,,74430,CPT,Facility,Inpatient,,,,497,422.45,142.4402,497,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Cta Abd Aorta Bil Low Ext Runoff,,75635,CPT,Facility,Both,,,,2346,1994.1,672.3636,2346,Aetna,Commercial,2158.32,92,,percent of total billed charges,,
Cta Abd Aorta Bil Low Ext Runoff,,75635,CPT,Facility,Outpatient,,,,2346,1994.1,672.3636,2346,Aetna,Medicare Advantage,1149.54,49,,percent of total billed charges,,
Cta Abd Aorta Bil Low Ext Runoff,,75635,CPT,Facility,Inpatient,,,,2346,1994.1,672.3636,2346,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Cta Abd Aorta Bil Low Ext Runoff,,75635,CPT,Facility,Both,,,,2346,1994.1,672.3636,2346,Aetna,PPO,2181.78,93,,percent of total billed charges,,
Cta Abd Aorta Bil Low Ext Runoff,,75635,CPT,Facility,Both,,,,2346,1994.1,672.3636,2346,America's PPO,America's PPO,2252.8638,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Cta Abd Aorta Bil Low Ext Runoff,,75635,CPT,Facility,Both,,,,2346,1994.1,672.3636,2346,BlueCross BlueShield Minnesota, Federal Employee Program,2308.464,98.4,,percent of total billed charges,,
Cta Abd Aorta Bil Low Ext Runoff,,75635,CPT,Facility,Both,,,,2346,1994.1,672.3636,2346,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,2346,100,,percent of total billed charges,,
Cta Abd Aorta Bil Low Ext Runoff,,75635,CPT,Facility,Both,,,,2346,1994.1,672.3636,2346,BlueCross BlueShield Minnesota,High Value Network Plan,2111.4,90,,percent of total billed charges,,
Cta Abd Aorta Bil Low Ext Runoff,,75635,CPT,Facility,Outpatient,,,,2346,1994.1,672.3636,2346,BlueCross BlueShield Minnesota,Medicare Advantage,1149.54,49,,percent of total billed charges,,
Cta Abd Aorta Bil Low Ext Runoff,,75635,CPT,Facility,Inpatient,,,,2346,1994.1,672.3636,2346,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Cta Abd Aorta Bil Low Ext Runoff,,75635,CPT,Facility,Both,,,,2346,1994.1,672.3636,2346,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,2077.8522,88.57,,percent of total billed charges,,
Cta Abd Aorta Bil Low Ext Runoff,,75635,CPT,Facility,Both,,,,2346,1994.1,672.3636,2346,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,672.3636,28.66,,percent of total billed charges,,
Cta Abd Aorta Bil Low Ext Runoff,,75635,CPT,Facility,Outpatient,,,,2346,1994.1,672.3636,2346,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1149.54,49,,percent of total billed charges,,
Cta Abd Aorta Bil Low Ext Runoff,,75635,CPT,Facility,Inpatient,,,,2346,1994.1,672.3636,2346,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Cta Abd Aorta Bil Low Ext Runoff,,75635,CPT,Facility,Both,,,,2346,1994.1,672.3636,2346,CorVel,Worker's Compensation,2346,100,,percent of total billed charges,,
Cta Abd Aorta Bil Low Ext Runoff,,75635,CPT,Facility,Both,,,,2346,1994.1,672.3636,2346,First Health Group Corporation,First Health Network,2275.62,97,,percent of total billed charges,,
Cta Abd Aorta Bil Low Ext Runoff,,75635,CPT,Facility,Both,,,,2346,1994.1,672.3636,2346,"Health Partners, Inc.",Commercial,2219.316,94.6,,percent of total billed charges,,
Cta Abd Aorta Bil Low Ext Runoff,,75635,CPT,Facility,Outpatient,,,,2346,1994.1,672.3636,2346,"Health Partners, Inc.",Medicare Advantage,1149.54,49,,percent of total billed charges,,
Cta Abd Aorta Bil Low Ext Runoff,,75635,CPT,Facility,Inpatient,,,,2346,1994.1,672.3636,2346,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Cta Abd Aorta Bil Low Ext Runoff,,75635,CPT,Facility,Both,,,,2346,1994.1,672.3636,2346,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1407.6,60,,percent of total billed charges,,
Cta Abd Aorta Bil Low Ext Runoff,,75635,CPT,Facility,Both,,,,2346,1994.1,672.3636,2346,"Health Partners, Inc.",State of Minnesota Advantage Program,1911.99,81.5,,percent of total billed charges,,
Cta Abd Aorta Bil Low Ext Runoff,,75635,CPT,Facility,Both,,,,2346,1994.1,672.3636,2346,"Health Partners, Inc.",State Public Programs,1173,50,,percent of total billed charges,,
Cta Abd Aorta Bil Low Ext Runoff,,75635,CPT,Facility,Both,,,,2346,1994.1,672.3636,2346,Humana Insurance Company,Commercial PPO,2228.7,95,,percent of total billed charges,,
Cta Abd Aorta Bil Low Ext Runoff,,75635,CPT,Facility,Outpatient,,,,2346,1994.1,672.3636,2346,Humana Insurance Company,Medicare PPO,1149.54,49,,percent of total billed charges,,
Cta Abd Aorta Bil Low Ext Runoff,,75635,CPT,Facility,Inpatient,,,,2346,1994.1,672.3636,2346,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Cta Abd Aorta Bil Low Ext Runoff,,75635,CPT,Facility,Both,,,,2346,1994.1,672.3636,2346,Medica,Individual & Family,2324.886,99.1,,percent of total billed charges,,
Cta Abd Aorta Bil Low Ext Runoff,,75635,CPT,Facility,Outpatient,,,,2346,1994.1,672.3636,2346,Medica,Medica Advantage Solution,1168.308,49.8,,percent of total billed charges,,
Cta Abd Aorta Bil Low Ext Runoff,,75635,CPT,Facility,Inpatient,,,,2346,1994.1,672.3636,2346,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Cta Abd Aorta Bil Low Ext Runoff,,75635,CPT,Facility,Outpatient,,,,2346,1994.1,672.3636,2346,Medica,Medical Assistance,1046.316,44.6,,percent of total billed charges,,
Cta Abd Aorta Bil Low Ext Runoff,,75635,CPT,Facility,Inpatient,,,,2346,1994.1,672.3636,2346,Medica,Medical Assistance,,,,,Included in per diem rate,
Cta Abd Aorta Bil Low Ext Runoff,,75635,CPT,Facility,Outpatient,,,,2346,1994.1,672.3636,2346,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1168.308,49.8,,percent of total billed charges,,
Cta Abd Aorta Bil Low Ext Runoff,,75635,CPT,Facility,Inpatient,,,,2346,1994.1,672.3636,2346,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Cta Abd Aorta Bil Low Ext Runoff,,75635,CPT,Facility,Both,,,,2346,1994.1,672.3636,2346,"Multiplan, Inc.","Multiplan, Inc.",2205.24,94,,percent of total billed charges,,
Cta Abd Aorta Bil Low Ext Runoff,,75635,CPT,Facility,Outpatient,,,,2346,1994.1,672.3636,2346,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1283,,,Other,Per scan,
Cta Abd Aorta Bil Low Ext Runoff,,75635,CPT,Facility,Inpatient,,,,2346,1994.1,672.3636,2346,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Cta Abd Aorta Bil Low Ext Runoff,,75635,CPT,Facility,Both,,,,2346,1994.1,672.3636,2346,"Preferred One Administrative Services, INC.",PPO,2313.156,98.6,,percent of total billed charges,,
Cta Abd Aorta Bil Low Ext Runoff,,75635,CPT,Facility,Outpatient,,,,2346,1994.1,672.3636,2346,PrimeWest Health,Minnesota Senior Health Options (MSHO),1207.017,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Cta Abd Aorta Bil Low Ext Runoff,,75635,CPT,Facility,Inpatient,,,,2346,1994.1,672.3636,2346,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Cta Abd Aorta Bil Low Ext Runoff,,75635,CPT,Facility,Outpatient,,,,2346,1994.1,672.3636,2346,PrimeWest Health,MinnesotaCare,1204.9056,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Cta Abd Aorta Bil Low Ext Runoff,,75635,CPT,Facility,Inpatient,,,,2346,1994.1,672.3636,2346,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Cta Abd Aorta Bil Low Ext Runoff,,75635,CPT,Facility,Both,,,,2346,1994.1,672.3636,2346,Sanford Health Plan,Sanford Health Plan,2158.32,92,,percent of total billed charges,,
Cta Abd Aorta Bil Low Ext Runoff,,75635,CPT,Facility,Outpatient,,,,2346,1994.1,672.3636,2346,"UCare Health, Inc.",Individual & Family Plan,1321.971,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Cta Abd Aorta Bil Low Ext Runoff,,75635,CPT,Facility,Inpatient,,,,2346,1994.1,672.3636,2346,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Cta Abd Aorta Bil Low Ext Runoff,,75635,CPT,Facility,Outpatient,,,,2346,1994.1,672.3636,2346,"UCare Health, Inc.",Medical Assistance,1184.0262,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Cta Abd Aorta Bil Low Ext Runoff,,75635,CPT,Facility,Inpatient,,,,2346,1994.1,672.3636,2346,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Cta Abd Aorta Bil Low Ext Runoff,,75635,CPT,Facility,Outpatient,,,,2346,1994.1,672.3636,2346,"UCare Health, Inc.",Medicare Advantage,1184.0262,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Cta Abd Aorta Bil Low Ext Runoff,,75635,CPT,Facility,Inpatient,,,,2346,1994.1,672.3636,2346,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Cta Abd Aorta Bil Low Ext Runoff,,75635,CPT,Facility,Outpatient,,,,2346,1994.1,672.3636,2346,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1184.0262,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Cta Abd Aorta Bil Low Ext Runoff,,75635,CPT,Facility,Inpatient,,,,2346,1994.1,672.3636,2346,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Cta Abd Aorta Bil Low Ext Runoff,,75635,CPT,Facility,Both,,,,2346,1994.1,672.3636,2346,UnitedHealthcare,Individual & Family,2205.24,94,,percent of total billed charges,,
Cta Abd Aorta Bil Low Ext Runoff,,75635,CPT,Facility,Outpatient,,,,2346,1994.1,672.3636,2346,UnitedHealthcare,Medicare Advantage,1149.54,49,,percent of total billed charges,,
Cta Abd Aorta Bil Low Ext Runoff,,75635,CPT,Facility,Inpatient,,,,2346,1994.1,672.3636,2346,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Cta Abd Aorta Bil Low Ext Runoff,,75635,CPT,Facility,Outpatient,,,,2346,1994.1,672.3636,2346,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1126.08,48,,percent of total billed charges,,100% of DHS outpatient percentage
Cta Abd Aorta Bil Low Ext Runoff,,75635,CPT,Facility,Inpatient,,,,2346,1994.1,672.3636,2346,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Ir Drainage Catheter Change,,75984,CPT,Facility,Both,,,,312,265.2,89.4192,312,Aetna,Commercial,287.04,92,,percent of total billed charges,,
Ir Drainage Catheter Change,,75984,CPT,Facility,Outpatient,,,,312,265.2,89.4192,312,Aetna,Medicare Advantage,152.88,49,,percent of total billed charges,,
Ir Drainage Catheter Change,,75984,CPT,Facility,Inpatient,,,,312,265.2,89.4192,312,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Ir Drainage Catheter Change,,75984,CPT,Facility,Both,,,,312,265.2,89.4192,312,Aetna,PPO,290.16,93,,percent of total billed charges,,
Ir Drainage Catheter Change,,75984,CPT,Facility,Both,,,,312,265.2,89.4192,312,America's PPO,America's PPO,299.6136,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Ir Drainage Catheter Change,,75984,CPT,Facility,Both,,,,312,265.2,89.4192,312,BlueCross BlueShield Minnesota, Federal Employee Program,307.008,98.4,,percent of total billed charges,,
Ir Drainage Catheter Change,,75984,CPT,Facility,Both,,,,312,265.2,89.4192,312,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,312,100,,percent of total billed charges,,
Ir Drainage Catheter Change,,75984,CPT,Facility,Both,,,,312,265.2,89.4192,312,BlueCross BlueShield Minnesota,High Value Network Plan,280.8,90,,percent of total billed charges,,
Ir Drainage Catheter Change,,75984,CPT,Facility,Outpatient,,,,312,265.2,89.4192,312,BlueCross BlueShield Minnesota,Medicare Advantage,152.88,49,,percent of total billed charges,,
Ir Drainage Catheter Change,,75984,CPT,Facility,Inpatient,,,,312,265.2,89.4192,312,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Ir Drainage Catheter Change,,75984,CPT,Facility,Both,,,,312,265.2,89.4192,312,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,276.3384,88.57,,percent of total billed charges,,
Ir Drainage Catheter Change,,75984,CPT,Facility,Both,,,,312,265.2,89.4192,312,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,89.4192,28.66,,percent of total billed charges,,
Ir Drainage Catheter Change,,75984,CPT,Facility,Outpatient,,,,312,265.2,89.4192,312,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),152.88,49,,percent of total billed charges,,
Ir Drainage Catheter Change,,75984,CPT,Facility,Inpatient,,,,312,265.2,89.4192,312,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Ir Drainage Catheter Change,,75984,CPT,Facility,Both,,,,312,265.2,89.4192,312,CorVel,Worker's Compensation,312,100,,percent of total billed charges,,
Ir Drainage Catheter Change,,75984,CPT,Facility,Both,,,,312,265.2,89.4192,312,First Health Group Corporation,First Health Network,302.64,97,,percent of total billed charges,,
Ir Drainage Catheter Change,,75984,CPT,Facility,Both,,,,312,265.2,89.4192,312,"Health Partners, Inc.",Commercial,295.152,94.6,,percent of total billed charges,,
Ir Drainage Catheter Change,,75984,CPT,Facility,Outpatient,,,,312,265.2,89.4192,312,"Health Partners, Inc.",Medicare Advantage,152.88,49,,percent of total billed charges,,
Ir Drainage Catheter Change,,75984,CPT,Facility,Inpatient,,,,312,265.2,89.4192,312,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ir Drainage Catheter Change,,75984,CPT,Facility,Both,,,,312,265.2,89.4192,312,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),187.2,60,,percent of total billed charges,,
Ir Drainage Catheter Change,,75984,CPT,Facility,Both,,,,312,265.2,89.4192,312,"Health Partners, Inc.",State of Minnesota Advantage Program,254.28,81.5,,percent of total billed charges,,
Ir Drainage Catheter Change,,75984,CPT,Facility,Both,,,,312,265.2,89.4192,312,"Health Partners, Inc.",State Public Programs,156,50,,percent of total billed charges,,
Ir Drainage Catheter Change,,75984,CPT,Facility,Both,,,,312,265.2,89.4192,312,Humana Insurance Company,Commercial PPO,296.4,95,,percent of total billed charges,,
Ir Drainage Catheter Change,,75984,CPT,Facility,Outpatient,,,,312,265.2,89.4192,312,Humana Insurance Company,Medicare PPO,152.88,49,,percent of total billed charges,,
Ir Drainage Catheter Change,,75984,CPT,Facility,Inpatient,,,,312,265.2,89.4192,312,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Ir Drainage Catheter Change,,75984,CPT,Facility,Both,,,,312,265.2,89.4192,312,Medica,Individual & Family,309.192,99.1,,percent of total billed charges,,
Ir Drainage Catheter Change,,75984,CPT,Facility,Outpatient,,,,312,265.2,89.4192,312,Medica,Medica Advantage Solution,155.376,49.8,,percent of total billed charges,,
Ir Drainage Catheter Change,,75984,CPT,Facility,Inpatient,,,,312,265.2,89.4192,312,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Ir Drainage Catheter Change,,75984,CPT,Facility,Outpatient,,,,312,265.2,89.4192,312,Medica,Medical Assistance,139.152,44.6,,percent of total billed charges,,
Ir Drainage Catheter Change,,75984,CPT,Facility,Inpatient,,,,312,265.2,89.4192,312,Medica,Medical Assistance,,,,,Included in per diem rate,
Ir Drainage Catheter Change,,75984,CPT,Facility,Outpatient,,,,312,265.2,89.4192,312,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,155.376,49.8,,percent of total billed charges,,
Ir Drainage Catheter Change,,75984,CPT,Facility,Inpatient,,,,312,265.2,89.4192,312,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Ir Drainage Catheter Change,,75984,CPT,Facility,Both,,,,312,265.2,89.4192,312,"Multiplan, Inc.","Multiplan, Inc.",293.28,94,,percent of total billed charges,,
Ir Drainage Catheter Change,,75984,CPT,Facility,Outpatient,,,,312,265.2,89.4192,312,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,281.112,90.1,,percent of total billed charges,,
Ir Drainage Catheter Change,,75984,CPT,Facility,Inpatient,,,,312,265.2,89.4192,312,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Ir Drainage Catheter Change,,75984,CPT,Facility,Both,,,,312,265.2,89.4192,312,"Preferred One Administrative Services, INC.",PPO,307.632,98.6,,percent of total billed charges,,
Ir Drainage Catheter Change,,75984,CPT,Facility,Outpatient,,,,312,265.2,89.4192,312,PrimeWest Health,Minnesota Senior Health Options (MSHO),160.524,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Ir Drainage Catheter Change,,75984,CPT,Facility,Inpatient,,,,312,265.2,89.4192,312,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ir Drainage Catheter Change,,75984,CPT,Facility,Outpatient,,,,312,265.2,89.4192,312,PrimeWest Health,MinnesotaCare,160.2432,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Ir Drainage Catheter Change,,75984,CPT,Facility,Inpatient,,,,312,265.2,89.4192,312,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Ir Drainage Catheter Change,,75984,CPT,Facility,Both,,,,312,265.2,89.4192,312,Sanford Health Plan,Sanford Health Plan,287.04,92,,percent of total billed charges,,
Ir Drainage Catheter Change,,75984,CPT,Facility,Outpatient,,,,312,265.2,89.4192,312,"UCare Health, Inc.",Individual & Family Plan,175.812,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Ir Drainage Catheter Change,,75984,CPT,Facility,Inpatient,,,,312,265.2,89.4192,312,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Ir Drainage Catheter Change,,75984,CPT,Facility,Outpatient,,,,312,265.2,89.4192,312,"UCare Health, Inc.",Medical Assistance,157.4664,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ir Drainage Catheter Change,,75984,CPT,Facility,Inpatient,,,,312,265.2,89.4192,312,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Ir Drainage Catheter Change,,75984,CPT,Facility,Outpatient,,,,312,265.2,89.4192,312,"UCare Health, Inc.",Medicare Advantage,157.4664,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ir Drainage Catheter Change,,75984,CPT,Facility,Inpatient,,,,312,265.2,89.4192,312,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ir Drainage Catheter Change,,75984,CPT,Facility,Outpatient,,,,312,265.2,89.4192,312,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),157.4664,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ir Drainage Catheter Change,,75984,CPT,Facility,Inpatient,,,,312,265.2,89.4192,312,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ir Drainage Catheter Change,,75984,CPT,Facility,Both,,,,312,265.2,89.4192,312,UnitedHealthcare,Individual & Family,293.28,94,,percent of total billed charges,,
Ir Drainage Catheter Change,,75984,CPT,Facility,Outpatient,,,,312,265.2,89.4192,312,UnitedHealthcare,Medicare Advantage,152.88,49,,percent of total billed charges,,
Ir Drainage Catheter Change,,75984,CPT,Facility,Inpatient,,,,312,265.2,89.4192,312,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Ir Drainage Catheter Change,,75984,CPT,Facility,Outpatient,,,,312,265.2,89.4192,312,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,149.76,48,,percent of total billed charges,,100% of DHS outpatient percentage
Ir Drainage Catheter Change,,75984,CPT,Facility,Inpatient,,,,312,265.2,89.4192,312,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Xr Abdomen Child Foreign Body,,76010,CPT,Facility,Both,,,,281,238.85,80.5346,281,Aetna,Commercial,258.52,92,,percent of total billed charges,,
Xr Abdomen Child Foreign Body,,76010,CPT,Facility,Outpatient,,,,281,238.85,80.5346,281,Aetna,Medicare Advantage,137.69,49,,percent of total billed charges,,
Xr Abdomen Child Foreign Body,,76010,CPT,Facility,Inpatient,,,,281,238.85,80.5346,281,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Xr Abdomen Child Foreign Body,,76010,CPT,Facility,Both,,,,281,238.85,80.5346,281,Aetna,PPO,261.33,93,,percent of total billed charges,,
Xr Abdomen Child Foreign Body,,76010,CPT,Facility,Both,,,,281,238.85,80.5346,281,America's PPO,America's PPO,269.8443,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Xr Abdomen Child Foreign Body,,76010,CPT,Facility,Both,,,,281,238.85,80.5346,281,BlueCross BlueShield Minnesota, Federal Employee Program,276.504,98.4,,percent of total billed charges,,
Xr Abdomen Child Foreign Body,,76010,CPT,Facility,Both,,,,281,238.85,80.5346,281,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,281,100,,percent of total billed charges,,
Xr Abdomen Child Foreign Body,,76010,CPT,Facility,Both,,,,281,238.85,80.5346,281,BlueCross BlueShield Minnesota,High Value Network Plan,252.9,90,,percent of total billed charges,,
Xr Abdomen Child Foreign Body,,76010,CPT,Facility,Outpatient,,,,281,238.85,80.5346,281,BlueCross BlueShield Minnesota,Medicare Advantage,137.69,49,,percent of total billed charges,,
Xr Abdomen Child Foreign Body,,76010,CPT,Facility,Inpatient,,,,281,238.85,80.5346,281,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Xr Abdomen Child Foreign Body,,76010,CPT,Facility,Both,,,,281,238.85,80.5346,281,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,248.8817,88.57,,percent of total billed charges,,
Xr Abdomen Child Foreign Body,,76010,CPT,Facility,Both,,,,281,238.85,80.5346,281,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,80.5346,28.66,,percent of total billed charges,,
Xr Abdomen Child Foreign Body,,76010,CPT,Facility,Outpatient,,,,281,238.85,80.5346,281,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),137.69,49,,percent of total billed charges,,
Xr Abdomen Child Foreign Body,,76010,CPT,Facility,Inpatient,,,,281,238.85,80.5346,281,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Xr Abdomen Child Foreign Body,,76010,CPT,Facility,Both,,,,281,238.85,80.5346,281,CorVel,Worker's Compensation,281,100,,percent of total billed charges,,
Xr Abdomen Child Foreign Body,,76010,CPT,Facility,Both,,,,281,238.85,80.5346,281,First Health Group Corporation,First Health Network,272.57,97,,percent of total billed charges,,
Xr Abdomen Child Foreign Body,,76010,CPT,Facility,Both,,,,281,238.85,80.5346,281,"Health Partners, Inc.",Commercial,265.826,94.6,,percent of total billed charges,,
Xr Abdomen Child Foreign Body,,76010,CPT,Facility,Outpatient,,,,281,238.85,80.5346,281,"Health Partners, Inc.",Medicare Advantage,137.69,49,,percent of total billed charges,,
Xr Abdomen Child Foreign Body,,76010,CPT,Facility,Inpatient,,,,281,238.85,80.5346,281,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Abdomen Child Foreign Body,,76010,CPT,Facility,Both,,,,281,238.85,80.5346,281,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),168.6,60,,percent of total billed charges,,
Xr Abdomen Child Foreign Body,,76010,CPT,Facility,Both,,,,281,238.85,80.5346,281,"Health Partners, Inc.",State of Minnesota Advantage Program,229.015,81.5,,percent of total billed charges,,
Xr Abdomen Child Foreign Body,,76010,CPT,Facility,Both,,,,281,238.85,80.5346,281,"Health Partners, Inc.",State Public Programs,140.5,50,,percent of total billed charges,,
Xr Abdomen Child Foreign Body,,76010,CPT,Facility,Both,,,,281,238.85,80.5346,281,Humana Insurance Company,Commercial PPO,266.95,95,,percent of total billed charges,,
Xr Abdomen Child Foreign Body,,76010,CPT,Facility,Outpatient,,,,281,238.85,80.5346,281,Humana Insurance Company,Medicare PPO,137.69,49,,percent of total billed charges,,
Xr Abdomen Child Foreign Body,,76010,CPT,Facility,Inpatient,,,,281,238.85,80.5346,281,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Xr Abdomen Child Foreign Body,,76010,CPT,Facility,Both,,,,281,238.85,80.5346,281,Medica,Individual & Family,278.471,99.1,,percent of total billed charges,,
Xr Abdomen Child Foreign Body,,76010,CPT,Facility,Outpatient,,,,281,238.85,80.5346,281,Medica,Medica Advantage Solution,139.938,49.8,,percent of total billed charges,,
Xr Abdomen Child Foreign Body,,76010,CPT,Facility,Inpatient,,,,281,238.85,80.5346,281,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Xr Abdomen Child Foreign Body,,76010,CPT,Facility,Outpatient,,,,281,238.85,80.5346,281,Medica,Medical Assistance,125.326,44.6,,percent of total billed charges,,
Xr Abdomen Child Foreign Body,,76010,CPT,Facility,Inpatient,,,,281,238.85,80.5346,281,Medica,Medical Assistance,,,,,Included in per diem rate,
Xr Abdomen Child Foreign Body,,76010,CPT,Facility,Outpatient,,,,281,238.85,80.5346,281,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,139.938,49.8,,percent of total billed charges,,
Xr Abdomen Child Foreign Body,,76010,CPT,Facility,Inpatient,,,,281,238.85,80.5346,281,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Xr Abdomen Child Foreign Body,,76010,CPT,Facility,Both,,,,281,238.85,80.5346,281,"Multiplan, Inc.","Multiplan, Inc.",264.14,94,,percent of total billed charges,,
Xr Abdomen Child Foreign Body,,76010,CPT,Facility,Outpatient,,,,281,238.85,80.5346,281,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,253.181,90.1,,percent of total billed charges,,
Xr Abdomen Child Foreign Body,,76010,CPT,Facility,Inpatient,,,,281,238.85,80.5346,281,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Xr Abdomen Child Foreign Body,,76010,CPT,Facility,Both,,,,281,238.85,80.5346,281,"Preferred One Administrative Services, INC.",PPO,277.066,98.6,,percent of total billed charges,,
Xr Abdomen Child Foreign Body,,76010,CPT,Facility,Outpatient,,,,281,238.85,80.5346,281,PrimeWest Health,Minnesota Senior Health Options (MSHO),144.5745,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Xr Abdomen Child Foreign Body,,76010,CPT,Facility,Inpatient,,,,281,238.85,80.5346,281,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Abdomen Child Foreign Body,,76010,CPT,Facility,Outpatient,,,,281,238.85,80.5346,281,PrimeWest Health,MinnesotaCare,144.3216,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Xr Abdomen Child Foreign Body,,76010,CPT,Facility,Inpatient,,,,281,238.85,80.5346,281,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Xr Abdomen Child Foreign Body,,76010,CPT,Facility,Both,,,,281,238.85,80.5346,281,Sanford Health Plan,Sanford Health Plan,258.52,92,,percent of total billed charges,,
Xr Abdomen Child Foreign Body,,76010,CPT,Facility,Outpatient,,,,281,238.85,80.5346,281,"UCare Health, Inc.",Individual & Family Plan,158.3435,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Xr Abdomen Child Foreign Body,,76010,CPT,Facility,Inpatient,,,,281,238.85,80.5346,281,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Xr Abdomen Child Foreign Body,,76010,CPT,Facility,Outpatient,,,,281,238.85,80.5346,281,"UCare Health, Inc.",Medical Assistance,141.8207,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Abdomen Child Foreign Body,,76010,CPT,Facility,Inpatient,,,,281,238.85,80.5346,281,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Xr Abdomen Child Foreign Body,,76010,CPT,Facility,Outpatient,,,,281,238.85,80.5346,281,"UCare Health, Inc.",Medicare Advantage,141.8207,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Abdomen Child Foreign Body,,76010,CPT,Facility,Inpatient,,,,281,238.85,80.5346,281,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Abdomen Child Foreign Body,,76010,CPT,Facility,Outpatient,,,,281,238.85,80.5346,281,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),141.8207,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Abdomen Child Foreign Body,,76010,CPT,Facility,Inpatient,,,,281,238.85,80.5346,281,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Abdomen Child Foreign Body,,76010,CPT,Facility,Both,,,,281,238.85,80.5346,281,UnitedHealthcare,Individual & Family,264.14,94,,percent of total billed charges,,
Xr Abdomen Child Foreign Body,,76010,CPT,Facility,Outpatient,,,,281,238.85,80.5346,281,UnitedHealthcare,Medicare Advantage,137.69,49,,percent of total billed charges,,
Xr Abdomen Child Foreign Body,,76010,CPT,Facility,Inpatient,,,,281,238.85,80.5346,281,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Xr Abdomen Child Foreign Body,,76010,CPT,Facility,Outpatient,,,,281,238.85,80.5346,281,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,134.88,48,,percent of total billed charges,,100% of DHS outpatient percentage
Xr Abdomen Child Foreign Body,,76010,CPT,Facility,Inpatient,,,,281,238.85,80.5346,281,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSP,,104491,LOCAL,Facility,Inpatient,10,mL,,22,18.7,6.3052,22,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSP,,104491,LOCAL,Facility,Inpatient,10,mL,,22,18.7,6.3052,22,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSP,,104491,LOCAL,Facility,Outpatient,10,mL,,22,18.7,6.3052,22,Medica,Medical Assistance,9.812,44.6,,percent of total billed charges,,
MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSP,,104491,LOCAL,Facility,Outpatient,10,mL,,22,18.7,6.3052,22,Medica,Medical Assistance,9.812,44.6,,percent of total billed charges,,
MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSP,,104491,LOCAL,Facility,Inpatient,10,mL,,22,18.7,6.3052,22,Medica,Medical Assistance,,,,,Included in per diem rate,
MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSP,,104491,LOCAL,Facility,Inpatient,10,mL,,22,18.7,6.3052,22,Medica,Medical Assistance,,,,,Included in per diem rate,
MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSP,,104491,LOCAL,Facility,Outpatient,10,mL,,22,18.7,6.3052,22,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,10.956,49.8,,percent of total billed charges,,
MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSP,,104491,LOCAL,Facility,Outpatient,10,mL,,22,18.7,6.3052,22,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,10.956,49.8,,percent of total billed charges,,
MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSP,,104491,LOCAL,Facility,Inpatient,10,mL,,22,18.7,6.3052,22,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSP,,104491,LOCAL,Facility,Inpatient,10,mL,,22,18.7,6.3052,22,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSP,,104491,LOCAL,Facility,Both,10,mL,,22,18.7,6.3052,22,"Multiplan, Inc.","Multiplan, Inc.",20.68,94,,percent of total billed charges,,
MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSP,,104491,LOCAL,Facility,Both,10,mL,,22,18.7,6.3052,22,"Multiplan, Inc.","Multiplan, Inc.",20.68,94,,percent of total billed charges,,
MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSP,,104491,LOCAL,Facility,Outpatient,10,mL,,22,18.7,6.3052,22,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,19.822,90.1,,percent of total billed charges,,
MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSP,,104491,LOCAL,Facility,Outpatient,10,mL,,22,18.7,6.3052,22,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,19.822,90.1,,percent of total billed charges,,
MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSP,,104491,LOCAL,Facility,Inpatient,10,mL,,22,18.7,6.3052,22,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSP,,104491,LOCAL,Facility,Inpatient,10,mL,,22,18.7,6.3052,22,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSP,,104491,LOCAL,Facility,Both,10,mL,,22,18.7,6.3052,22,"Preferred One Administrative Services, INC.",PPO,21.692,98.6,,percent of total billed charges,,
MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSP,,104491,LOCAL,Facility,Both,10,mL,,22,18.7,6.3052,22,"Preferred One Administrative Services, INC.",PPO,21.692,98.6,,percent of total billed charges,,
MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSP,,104491,LOCAL,Facility,Outpatient,10,mL,,22,18.7,6.3052,22,PrimeWest Health,Minnesota Senior Health Options (MSHO),11.319,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSP,,104491,LOCAL,Facility,Outpatient,10,mL,,22,18.7,6.3052,22,PrimeWest Health,Minnesota Senior Health Options (MSHO),11.319,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSP,,104491,LOCAL,Facility,Inpatient,10,mL,,22,18.7,6.3052,22,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSP,,104491,LOCAL,Facility,Inpatient,10,mL,,22,18.7,6.3052,22,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSP,,104491,LOCAL,Facility,Outpatient,10,mL,,22,18.7,6.3052,22,PrimeWest Health,MinnesotaCare,11.2992,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSP,,104491,LOCAL,Facility,Outpatient,10,mL,,22,18.7,6.3052,22,PrimeWest Health,MinnesotaCare,11.2992,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSP,,104491,LOCAL,Facility,Inpatient,10,mL,,22,18.7,6.3052,22,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSP,,104491,LOCAL,Facility,Inpatient,10,mL,,22,18.7,6.3052,22,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSP,,104491,LOCAL,Facility,Both,10,mL,,22,18.7,6.3052,22,Sanford Health Plan,Sanford Health Plan,20.24,92,,percent of total billed charges,,
MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSP,,104491,LOCAL,Facility,Both,10,mL,,22,18.7,6.3052,22,Sanford Health Plan,Sanford Health Plan,20.24,92,,percent of total billed charges,,
MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSP,,104491,LOCAL,Facility,Outpatient,10,mL,,22,18.7,6.3052,22,"UCare Health, Inc.",Individual & Family Plan,12.397,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSP,,104491,LOCAL,Facility,Outpatient,10,mL,,22,18.7,6.3052,22,"UCare Health, Inc.",Individual & Family Plan,12.397,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSP,,104491,LOCAL,Facility,Inpatient,10,mL,,22,18.7,6.3052,22,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSP,,104491,LOCAL,Facility,Inpatient,10,mL,,22,18.7,6.3052,22,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSP,,104491,LOCAL,Facility,Outpatient,10,mL,,22,18.7,6.3052,22,"UCare Health, Inc.",Medical Assistance,11.1034,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSP,,104491,LOCAL,Facility,Outpatient,10,mL,,22,18.7,6.3052,22,"UCare Health, Inc.",Medical Assistance,11.1034,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSP,,104491,LOCAL,Facility,Inpatient,10,mL,,22,18.7,6.3052,22,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSP,,104491,LOCAL,Facility,Inpatient,10,mL,,22,18.7,6.3052,22,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSP,,104491,LOCAL,Facility,Outpatient,10,mL,,22,18.7,6.3052,22,"UCare Health, Inc.",Medicare Advantage,11.1034,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSP,,104491,LOCAL,Facility,Outpatient,10,mL,,22,18.7,6.3052,22,"UCare Health, Inc.",Medicare Advantage,11.1034,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSP,,104491,LOCAL,Facility,Inpatient,10,mL,,22,18.7,6.3052,22,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSP,,104491,LOCAL,Facility,Inpatient,10,mL,,22,18.7,6.3052,22,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSP,,104491,LOCAL,Facility,Outpatient,10,mL,,22,18.7,6.3052,22,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),11.1034,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSP,,104491,LOCAL,Facility,Outpatient,10,mL,,22,18.7,6.3052,22,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),11.1034,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSP,,104491,LOCAL,Facility,Inpatient,10,mL,,22,18.7,6.3052,22,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSP,,104491,LOCAL,Facility,Inpatient,10,mL,,22,18.7,6.3052,22,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSP,,104491,LOCAL,Facility,Both,10,mL,,22,18.7,6.3052,22,UnitedHealthcare,Individual & Family,20.68,94,,percent of total billed charges,,
MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSP,,104491,LOCAL,Facility,Both,10,mL,,22,18.7,6.3052,22,UnitedHealthcare,Individual & Family,20.68,94,,percent of total billed charges,,
MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSP,,104491,LOCAL,Facility,Outpatient,10,mL,,22,18.7,6.3052,22,UnitedHealthcare,Medicare Advantage,10.78,49,,percent of total billed charges,,
MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSP,,104491,LOCAL,Facility,Outpatient,10,mL,,22,18.7,6.3052,22,UnitedHealthcare,Medicare Advantage,10.78,49,,percent of total billed charges,,
MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSP,,104491,LOCAL,Facility,Inpatient,10,mL,,22,18.7,6.3052,22,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSP,,104491,LOCAL,Facility,Inpatient,10,mL,,22,18.7,6.3052,22,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSP,,104491,LOCAL,Facility,Outpatient,10,mL,,22,18.7,6.3052,22,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,10.56,48,,percent of total billed charges,,100% of DHS outpatient percentage
MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSP,,104491,LOCAL,Facility,Outpatient,10,mL,,22,18.7,6.3052,22,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,10.56,48,,percent of total billed charges,,100% of DHS outpatient percentage
MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSP,,104491,LOCAL,Facility,Inpatient,10,mL,,22,18.7,6.3052,22,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSP,,104491,LOCAL,Facility,Inpatient,10,mL,,22,18.7,6.3052,22,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
SODIUM BICARBONATE 4.2 % (0.5 MEQ/ML) IV SYRG (BABY),,414124,LOCAL,Facility,Both,10,mL,,63,53.55,18.0558,63,Aetna,Commercial,57.96,92,,percent of total billed charges,,
SODIUM BICARBONATE 4.2 % (0.5 MEQ/ML) IV SYRG (BABY),,414124,LOCAL,Facility,Outpatient,10,mL,,63,53.55,18.0558,63,Aetna,Medicare Advantage,30.87,49,,percent of total billed charges,,
SODIUM BICARBONATE 4.2 % (0.5 MEQ/ML) IV SYRG (BABY),,414124,LOCAL,Facility,Inpatient,10,mL,,63,53.55,18.0558,63,Aetna,Medicare Advantage,,,,,Included in per diem rate,
SODIUM BICARBONATE 4.2 % (0.5 MEQ/ML) IV SYRG (BABY),,414124,LOCAL,Facility,Both,10,mL,,63,53.55,18.0558,63,Aetna,PPO,58.59,93,,percent of total billed charges,,
SODIUM BICARBONATE 4.2 % (0.5 MEQ/ML) IV SYRG (BABY),,414124,LOCAL,Facility,Both,10,mL,,63,53.55,18.0558,63,America's PPO,America's PPO,60.4989,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SODIUM BICARBONATE 4.2 % (0.5 MEQ/ML) IV SYRG (BABY),,414124,LOCAL,Facility,Both,10,mL,,63,53.55,18.0558,63,BlueCross BlueShield Minnesota, Federal Employee Program,61.992,98.4,,percent of total billed charges,,
SODIUM BICARBONATE 4.2 % (0.5 MEQ/ML) IV SYRG (BABY),,414124,LOCAL,Facility,Both,10,mL,,63,53.55,18.0558,63,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,63,100,,percent of total billed charges,,
SODIUM BICARBONATE 4.2 % (0.5 MEQ/ML) IV SYRG (BABY),,414124,LOCAL,Facility,Both,10,mL,,63,53.55,18.0558,63,BlueCross BlueShield Minnesota,High Value Network Plan,56.7,90,,percent of total billed charges,,
SODIUM BICARBONATE 4.2 % (0.5 MEQ/ML) IV SYRG (BABY),,414124,LOCAL,Facility,Outpatient,10,mL,,63,53.55,18.0558,63,BlueCross BlueShield Minnesota,Medicare Advantage,30.87,49,,percent of total billed charges,,
SODIUM BICARBONATE 4.2 % (0.5 MEQ/ML) IV SYRG (BABY),,414124,LOCAL,Facility,Inpatient,10,mL,,63,53.55,18.0558,63,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
SODIUM BICARBONATE 4.2 % (0.5 MEQ/ML) IV SYRG (BABY),,414124,LOCAL,Facility,Both,10,mL,,63,53.55,18.0558,63,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,55.7991,88.57,,percent of total billed charges,,
SODIUM BICARBONATE 4.2 % (0.5 MEQ/ML) IV SYRG (BABY),,414124,LOCAL,Facility,Both,10,mL,,63,53.55,18.0558,63,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,18.0558,28.66,,percent of total billed charges,,
SODIUM BICARBONATE 4.2 % (0.5 MEQ/ML) IV SYRG (BABY),,414124,LOCAL,Facility,Outpatient,10,mL,,63,53.55,18.0558,63,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),30.87,49,,percent of total billed charges,,
SODIUM BICARBONATE 4.2 % (0.5 MEQ/ML) IV SYRG (BABY),,414124,LOCAL,Facility,Inpatient,10,mL,,63,53.55,18.0558,63,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
SODIUM BICARBONATE 4.2 % (0.5 MEQ/ML) IV SYRG (BABY),,414124,LOCAL,Facility,Both,10,mL,,63,53.55,18.0558,63,CorVel,Worker's Compensation,63,100,,percent of total billed charges,,
SODIUM BICARBONATE 4.2 % (0.5 MEQ/ML) IV SYRG (BABY),,414124,LOCAL,Facility,Both,10,mL,,63,53.55,18.0558,63,First Health Group Corporation,First Health Network,61.11,97,,percent of total billed charges,,
SODIUM BICARBONATE 4.2 % (0.5 MEQ/ML) IV SYRG (BABY),,414124,LOCAL,Facility,Both,10,mL,,63,53.55,18.0558,63,"Health Partners, Inc.",Commercial,59.598,94.6,,percent of total billed charges,,
SODIUM BICARBONATE 4.2 % (0.5 MEQ/ML) IV SYRG (BABY),,414124,LOCAL,Facility,Outpatient,10,mL,,63,53.55,18.0558,63,"Health Partners, Inc.",Medicare Advantage,30.87,49,,percent of total billed charges,,
SODIUM BICARBONATE 4.2 % (0.5 MEQ/ML) IV SYRG (BABY),,414124,LOCAL,Facility,Inpatient,10,mL,,63,53.55,18.0558,63,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SODIUM BICARBONATE 4.2 % (0.5 MEQ/ML) IV SYRG (BABY),,414124,LOCAL,Facility,Both,10,mL,,63,53.55,18.0558,63,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),37.8,60,,percent of total billed charges,,
SODIUM BICARBONATE 4.2 % (0.5 MEQ/ML) IV SYRG (BABY),,414124,LOCAL,Facility,Both,10,mL,,63,53.55,18.0558,63,"Health Partners, Inc.",State of Minnesota Advantage Program,51.345,81.5,,percent of total billed charges,,
SODIUM BICARBONATE 4.2 % (0.5 MEQ/ML) IV SYRG (BABY),,414124,LOCAL,Facility,Both,10,mL,,63,53.55,18.0558,63,"Health Partners, Inc.",State Public Programs,31.5,50,,percent of total billed charges,,
SODIUM BICARBONATE 4.2 % (0.5 MEQ/ML) IV SYRG (BABY),,414124,LOCAL,Facility,Both,10,mL,,63,53.55,18.0558,63,Humana Insurance Company,Commercial PPO,59.85,95,,percent of total billed charges,,
SODIUM BICARBONATE 4.2 % (0.5 MEQ/ML) IV SYRG (BABY),,414124,LOCAL,Facility,Outpatient,10,mL,,63,53.55,18.0558,63,Humana Insurance Company,Medicare PPO,30.87,49,,percent of total billed charges,,
SODIUM BICARBONATE 4.2 % (0.5 MEQ/ML) IV SYRG (BABY),,414124,LOCAL,Facility,Inpatient,10,mL,,63,53.55,18.0558,63,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
SODIUM BICARBONATE 4.2 % (0.5 MEQ/ML) IV SYRG (BABY),,414124,LOCAL,Facility,Both,10,mL,,63,53.55,18.0558,63,Medica,Individual & Family,62.433,99.1,,percent of total billed charges,,
SODIUM BICARBONATE 4.2 % (0.5 MEQ/ML) IV SYRG (BABY),,414124,LOCAL,Facility,Outpatient,10,mL,,63,53.55,18.0558,63,Medica,Medica Advantage Solution,31.374,49.8,,percent of total billed charges,,
SODIUM BICARBONATE 4.2 % (0.5 MEQ/ML) IV SYRG (BABY),,414124,LOCAL,Facility,Inpatient,10,mL,,63,53.55,18.0558,63,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
SODIUM BICARBONATE 4.2 % (0.5 MEQ/ML) IV SYRG (BABY),,414124,LOCAL,Facility,Outpatient,10,mL,,63,53.55,18.0558,63,Medica,Medical Assistance,28.098,44.6,,percent of total billed charges,,
SODIUM BICARBONATE 4.2 % (0.5 MEQ/ML) IV SYRG (BABY),,414124,LOCAL,Facility,Inpatient,10,mL,,63,53.55,18.0558,63,Medica,Medical Assistance,,,,,Included in per diem rate,
SODIUM BICARBONATE 4.2 % (0.5 MEQ/ML) IV SYRG (BABY),,414124,LOCAL,Facility,Outpatient,10,mL,,63,53.55,18.0558,63,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,31.374,49.8,,percent of total billed charges,,
SODIUM BICARBONATE 4.2 % (0.5 MEQ/ML) IV SYRG (BABY),,414124,LOCAL,Facility,Inpatient,10,mL,,63,53.55,18.0558,63,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
SODIUM BICARBONATE 4.2 % (0.5 MEQ/ML) IV SYRG (BABY),,414124,LOCAL,Facility,Both,10,mL,,63,53.55,18.0558,63,"Multiplan, Inc.","Multiplan, Inc.",59.22,94,,percent of total billed charges,,
SODIUM BICARBONATE 4.2 % (0.5 MEQ/ML) IV SYRG (BABY),,414124,LOCAL,Facility,Outpatient,10,mL,,63,53.55,18.0558,63,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,56.763,90.1,,percent of total billed charges,,
SODIUM BICARBONATE 4.2 % (0.5 MEQ/ML) IV SYRG (BABY),,414124,LOCAL,Facility,Inpatient,10,mL,,63,53.55,18.0558,63,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
SODIUM BICARBONATE 4.2 % (0.5 MEQ/ML) IV SYRG (BABY),,414124,LOCAL,Facility,Both,10,mL,,63,53.55,18.0558,63,"Preferred One Administrative Services, INC.",PPO,62.118,98.6,,percent of total billed charges,,
SODIUM BICARBONATE 4.2 % (0.5 MEQ/ML) IV SYRG (BABY),,414124,LOCAL,Facility,Outpatient,10,mL,,63,53.55,18.0558,63,PrimeWest Health,Minnesota Senior Health Options (MSHO),32.4135,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
SODIUM BICARBONATE 4.2 % (0.5 MEQ/ML) IV SYRG (BABY),,414124,LOCAL,Facility,Inpatient,10,mL,,63,53.55,18.0558,63,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SODIUM BICARBONATE 4.2 % (0.5 MEQ/ML) IV SYRG (BABY),,414124,LOCAL,Facility,Outpatient,10,mL,,63,53.55,18.0558,63,PrimeWest Health,MinnesotaCare,32.3568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
SODIUM BICARBONATE 4.2 % (0.5 MEQ/ML) IV SYRG (BABY),,414124,LOCAL,Facility,Inpatient,10,mL,,63,53.55,18.0558,63,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
SODIUM BICARBONATE 4.2 % (0.5 MEQ/ML) IV SYRG (BABY),,414124,LOCAL,Facility,Both,10,mL,,63,53.55,18.0558,63,Sanford Health Plan,Sanford Health Plan,57.96,92,,percent of total billed charges,,
SODIUM BICARBONATE 4.2 % (0.5 MEQ/ML) IV SYRG (BABY),,414124,LOCAL,Facility,Outpatient,10,mL,,63,53.55,18.0558,63,"UCare Health, Inc.",Individual & Family Plan,35.5005,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
SODIUM BICARBONATE 4.2 % (0.5 MEQ/ML) IV SYRG (BABY),,414124,LOCAL,Facility,Inpatient,10,mL,,63,53.55,18.0558,63,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
SODIUM BICARBONATE 4.2 % (0.5 MEQ/ML) IV SYRG (BABY),,414124,LOCAL,Facility,Outpatient,10,mL,,63,53.55,18.0558,63,"UCare Health, Inc.",Medical Assistance,31.7961,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SODIUM BICARBONATE 4.2 % (0.5 MEQ/ML) IV SYRG (BABY),,414124,LOCAL,Facility,Inpatient,10,mL,,63,53.55,18.0558,63,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
SODIUM BICARBONATE 4.2 % (0.5 MEQ/ML) IV SYRG (BABY),,414124,LOCAL,Facility,Outpatient,10,mL,,63,53.55,18.0558,63,"UCare Health, Inc.",Medicare Advantage,31.7961,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SODIUM BICARBONATE 4.2 % (0.5 MEQ/ML) IV SYRG (BABY),,414124,LOCAL,Facility,Inpatient,10,mL,,63,53.55,18.0558,63,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SODIUM BICARBONATE 4.2 % (0.5 MEQ/ML) IV SYRG (BABY),,414124,LOCAL,Facility,Outpatient,10,mL,,63,53.55,18.0558,63,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),31.7961,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SODIUM BICARBONATE 4.2 % (0.5 MEQ/ML) IV SYRG (BABY),,414124,LOCAL,Facility,Inpatient,10,mL,,63,53.55,18.0558,63,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SODIUM BICARBONATE 4.2 % (0.5 MEQ/ML) IV SYRG (BABY),,414124,LOCAL,Facility,Both,10,mL,,63,53.55,18.0558,63,UnitedHealthcare,Individual & Family,59.22,94,,percent of total billed charges,,
SODIUM BICARBONATE 4.2 % (0.5 MEQ/ML) IV SYRG (BABY),,414124,LOCAL,Facility,Outpatient,10,mL,,63,53.55,18.0558,63,UnitedHealthcare,Medicare Advantage,30.87,49,,percent of total billed charges,,
SODIUM BICARBONATE 4.2 % (0.5 MEQ/ML) IV SYRG (BABY),,414124,LOCAL,Facility,Inpatient,10,mL,,63,53.55,18.0558,63,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
SODIUM BICARBONATE 4.2 % (0.5 MEQ/ML) IV SYRG (BABY),,414124,LOCAL,Facility,Outpatient,10,mL,,63,53.55,18.0558,63,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,30.24,48,,percent of total billed charges,,100% of DHS outpatient percentage
SODIUM BICARBONATE 4.2 % (0.5 MEQ/ML) IV SYRG (BABY),,414124,LOCAL,Facility,Inpatient,10,mL,,63,53.55,18.0558,63,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
CALCIUM CHLORIDE 100 MG/ML (10 %) IV SYRG (PEDS 1000 MG MAX),,414129,LOCAL,Facility,Both,10,mL,,61,51.85,17.4826,61,Aetna,Commercial,56.12,92,,percent of total billed charges,,
CALCIUM CHLORIDE 100 MG/ML (10 %) IV SYRG (PEDS 1000 MG MAX),,414129,LOCAL,Facility,Outpatient,10,mL,,61,51.85,17.4826,61,Aetna,Medicare Advantage,29.89,49,,percent of total billed charges,,
CALCIUM CHLORIDE 100 MG/ML (10 %) IV SYRG (PEDS 1000 MG MAX),,414129,LOCAL,Facility,Inpatient,10,mL,,61,51.85,17.4826,61,Aetna,Medicare Advantage,,,,,Included in per diem rate,
CALCIUM CHLORIDE 100 MG/ML (10 %) IV SYRG (PEDS 1000 MG MAX),,414129,LOCAL,Facility,Both,10,mL,,61,51.85,17.4826,61,Aetna,PPO,56.73,93,,percent of total billed charges,,
CALCIUM CHLORIDE 100 MG/ML (10 %) IV SYRG (PEDS 1000 MG MAX),,414129,LOCAL,Facility,Both,10,mL,,61,51.85,17.4826,61,America's PPO,America's PPO,58.5783,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
CALCIUM CHLORIDE 100 MG/ML (10 %) IV SYRG (PEDS 1000 MG MAX),,414129,LOCAL,Facility,Both,10,mL,,61,51.85,17.4826,61,BlueCross BlueShield Minnesota, Federal Employee Program,60.024,98.4,,percent of total billed charges,,
CALCIUM CHLORIDE 100 MG/ML (10 %) IV SYRG (PEDS 1000 MG MAX),,414129,LOCAL,Facility,Both,10,mL,,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,61,100,,percent of total billed charges,,
CALCIUM CHLORIDE 100 MG/ML (10 %) IV SYRG (PEDS 1000 MG MAX),,414129,LOCAL,Facility,Both,10,mL,,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,High Value Network Plan,54.9,90,,percent of total billed charges,,
CALCIUM CHLORIDE 100 MG/ML (10 %) IV SYRG (PEDS 1000 MG MAX),,414129,LOCAL,Facility,Outpatient,10,mL,,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,Medicare Advantage,29.89,49,,percent of total billed charges,,
CALCIUM CHLORIDE 100 MG/ML (10 %) IV SYRG (PEDS 1000 MG MAX),,414129,LOCAL,Facility,Inpatient,10,mL,,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
CALCIUM CHLORIDE 100 MG/ML (10 %) IV SYRG (PEDS 1000 MG MAX),,414129,LOCAL,Facility,Both,10,mL,,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,54.0277,88.57,,percent of total billed charges,,
CALCIUM CHLORIDE 100 MG/ML (10 %) IV SYRG (PEDS 1000 MG MAX),,414129,LOCAL,Facility,Both,10,mL,,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,17.4826,28.66,,percent of total billed charges,,
CALCIUM CHLORIDE 100 MG/ML (10 %) IV SYRG (PEDS 1000 MG MAX),,414129,LOCAL,Facility,Outpatient,10,mL,,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),29.89,49,,percent of total billed charges,,
CALCIUM CHLORIDE 100 MG/ML (10 %) IV SYRG (PEDS 1000 MG MAX),,414129,LOCAL,Facility,Inpatient,10,mL,,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
CALCIUM CHLORIDE 100 MG/ML (10 %) IV SYRG (PEDS 1000 MG MAX),,414129,LOCAL,Facility,Both,10,mL,,61,51.85,17.4826,61,CorVel,Worker's Compensation,61,100,,percent of total billed charges,,
CALCIUM CHLORIDE 100 MG/ML (10 %) IV SYRG (PEDS 1000 MG MAX),,414129,LOCAL,Facility,Both,10,mL,,61,51.85,17.4826,61,First Health Group Corporation,First Health Network,59.17,97,,percent of total billed charges,,
CALCIUM CHLORIDE 100 MG/ML (10 %) IV SYRG (PEDS 1000 MG MAX),,414129,LOCAL,Facility,Both,10,mL,,61,51.85,17.4826,61,"Health Partners, Inc.",Commercial,57.706,94.6,,percent of total billed charges,,
CALCIUM CHLORIDE 100 MG/ML (10 %) IV SYRG (PEDS 1000 MG MAX),,414129,LOCAL,Facility,Outpatient,10,mL,,61,51.85,17.4826,61,"Health Partners, Inc.",Medicare Advantage,29.89,49,,percent of total billed charges,,
CALCIUM CHLORIDE 100 MG/ML (10 %) IV SYRG (PEDS 1000 MG MAX),,414129,LOCAL,Facility,Inpatient,10,mL,,61,51.85,17.4826,61,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CALCIUM CHLORIDE 100 MG/ML (10 %) IV SYRG (PEDS 1000 MG MAX),,414129,LOCAL,Facility,Both,10,mL,,61,51.85,17.4826,61,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),36.6,60,,percent of total billed charges,,
CALCIUM CHLORIDE 100 MG/ML (10 %) IV SYRG (PEDS 1000 MG MAX),,414129,LOCAL,Facility,Both,10,mL,,61,51.85,17.4826,61,"Health Partners, Inc.",State of Minnesota Advantage Program,49.715,81.5,,percent of total billed charges,,
CALCIUM CHLORIDE 100 MG/ML (10 %) IV SYRG (PEDS 1000 MG MAX),,414129,LOCAL,Facility,Both,10,mL,,61,51.85,17.4826,61,"Health Partners, Inc.",State Public Programs,30.5,50,,percent of total billed charges,,
CALCIUM CHLORIDE 100 MG/ML (10 %) IV SYRG (PEDS 1000 MG MAX),,414129,LOCAL,Facility,Both,10,mL,,61,51.85,17.4826,61,Humana Insurance Company,Commercial PPO,57.95,95,,percent of total billed charges,,
CALCIUM CHLORIDE 100 MG/ML (10 %) IV SYRG (PEDS 1000 MG MAX),,414129,LOCAL,Facility,Outpatient,10,mL,,61,51.85,17.4826,61,Humana Insurance Company,Medicare PPO,29.89,49,,percent of total billed charges,,
CALCIUM CHLORIDE 100 MG/ML (10 %) IV SYRG (PEDS 1000 MG MAX),,414129,LOCAL,Facility,Inpatient,10,mL,,61,51.85,17.4826,61,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
CALCIUM CHLORIDE 100 MG/ML (10 %) IV SYRG (PEDS 1000 MG MAX),,414129,LOCAL,Facility,Both,10,mL,,61,51.85,17.4826,61,Medica,Individual & Family,60.451,99.1,,percent of total billed charges,,
CALCIUM CHLORIDE 100 MG/ML (10 %) IV SYRG (PEDS 1000 MG MAX),,414129,LOCAL,Facility,Outpatient,10,mL,,61,51.85,17.4826,61,Medica,Medica Advantage Solution,30.378,49.8,,percent of total billed charges,,
CALCIUM CHLORIDE 100 MG/ML (10 %) IV SYRG (PEDS 1000 MG MAX),,414129,LOCAL,Facility,Inpatient,10,mL,,61,51.85,17.4826,61,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
CALCIUM CHLORIDE 100 MG/ML (10 %) IV SYRG (PEDS 1000 MG MAX),,414129,LOCAL,Facility,Outpatient,10,mL,,61,51.85,17.4826,61,Medica,Medical Assistance,27.206,44.6,,percent of total billed charges,,
CALCIUM CHLORIDE 100 MG/ML (10 %) IV SYRG (PEDS 1000 MG MAX),,414129,LOCAL,Facility,Inpatient,10,mL,,61,51.85,17.4826,61,Medica,Medical Assistance,,,,,Included in per diem rate,
CALCIUM CHLORIDE 100 MG/ML (10 %) IV SYRG (PEDS 1000 MG MAX),,414129,LOCAL,Facility,Outpatient,10,mL,,61,51.85,17.4826,61,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,30.378,49.8,,percent of total billed charges,,
CALCIUM CHLORIDE 100 MG/ML (10 %) IV SYRG (PEDS 1000 MG MAX),,414129,LOCAL,Facility,Inpatient,10,mL,,61,51.85,17.4826,61,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
CALCIUM CHLORIDE 100 MG/ML (10 %) IV SYRG (PEDS 1000 MG MAX),,414129,LOCAL,Facility,Both,10,mL,,61,51.85,17.4826,61,"Multiplan, Inc.","Multiplan, Inc.",57.34,94,,percent of total billed charges,,
CALCIUM CHLORIDE 100 MG/ML (10 %) IV SYRG (PEDS 1000 MG MAX),,414129,LOCAL,Facility,Outpatient,10,mL,,61,51.85,17.4826,61,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,54.961,90.1,,percent of total billed charges,,
CALCIUM CHLORIDE 100 MG/ML (10 %) IV SYRG (PEDS 1000 MG MAX),,414129,LOCAL,Facility,Inpatient,10,mL,,61,51.85,17.4826,61,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
CALCIUM CHLORIDE 100 MG/ML (10 %) IV SYRG (PEDS 1000 MG MAX),,414129,LOCAL,Facility,Both,10,mL,,61,51.85,17.4826,61,"Preferred One Administrative Services, INC.",PPO,60.146,98.6,,percent of total billed charges,,
CALCIUM CHLORIDE 100 MG/ML (10 %) IV SYRG (PEDS 1000 MG MAX),,414129,LOCAL,Facility,Outpatient,10,mL,,61,51.85,17.4826,61,PrimeWest Health,Minnesota Senior Health Options (MSHO),31.3845,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
CALCIUM CHLORIDE 100 MG/ML (10 %) IV SYRG (PEDS 1000 MG MAX),,414129,LOCAL,Facility,Inpatient,10,mL,,61,51.85,17.4826,61,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CALCIUM CHLORIDE 100 MG/ML (10 %) IV SYRG (PEDS 1000 MG MAX),,414129,LOCAL,Facility,Outpatient,10,mL,,61,51.85,17.4826,61,PrimeWest Health,MinnesotaCare,31.3296,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
CALCIUM CHLORIDE 100 MG/ML (10 %) IV SYRG (PEDS 1000 MG MAX),,414129,LOCAL,Facility,Inpatient,10,mL,,61,51.85,17.4826,61,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
CALCIUM CHLORIDE 100 MG/ML (10 %) IV SYRG (PEDS 1000 MG MAX),,414129,LOCAL,Facility,Both,10,mL,,61,51.85,17.4826,61,Sanford Health Plan,Sanford Health Plan,56.12,92,,percent of total billed charges,,
CALCIUM CHLORIDE 100 MG/ML (10 %) IV SYRG (PEDS 1000 MG MAX),,414129,LOCAL,Facility,Outpatient,10,mL,,61,51.85,17.4826,61,"UCare Health, Inc.",Individual & Family Plan,34.3735,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
CALCIUM CHLORIDE 100 MG/ML (10 %) IV SYRG (PEDS 1000 MG MAX),,414129,LOCAL,Facility,Inpatient,10,mL,,61,51.85,17.4826,61,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
CALCIUM CHLORIDE 100 MG/ML (10 %) IV SYRG (PEDS 1000 MG MAX),,414129,LOCAL,Facility,Outpatient,10,mL,,61,51.85,17.4826,61,"UCare Health, Inc.",Medical Assistance,30.7867,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CALCIUM CHLORIDE 100 MG/ML (10 %) IV SYRG (PEDS 1000 MG MAX),,414129,LOCAL,Facility,Inpatient,10,mL,,61,51.85,17.4826,61,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
CALCIUM CHLORIDE 100 MG/ML (10 %) IV SYRG (PEDS 1000 MG MAX),,414129,LOCAL,Facility,Outpatient,10,mL,,61,51.85,17.4826,61,"UCare Health, Inc.",Medicare Advantage,30.7867,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CALCIUM CHLORIDE 100 MG/ML (10 %) IV SYRG (PEDS 1000 MG MAX),,414129,LOCAL,Facility,Inpatient,10,mL,,61,51.85,17.4826,61,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CALCIUM CHLORIDE 100 MG/ML (10 %) IV SYRG (PEDS 1000 MG MAX),,414129,LOCAL,Facility,Outpatient,10,mL,,61,51.85,17.4826,61,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),30.7867,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CALCIUM CHLORIDE 100 MG/ML (10 %) IV SYRG (PEDS 1000 MG MAX),,414129,LOCAL,Facility,Inpatient,10,mL,,61,51.85,17.4826,61,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CALCIUM CHLORIDE 100 MG/ML (10 %) IV SYRG (PEDS 1000 MG MAX),,414129,LOCAL,Facility,Both,10,mL,,61,51.85,17.4826,61,UnitedHealthcare,Individual & Family,57.34,94,,percent of total billed charges,,
CALCIUM CHLORIDE 100 MG/ML (10 %) IV SYRG (PEDS 1000 MG MAX),,414129,LOCAL,Facility,Outpatient,10,mL,,61,51.85,17.4826,61,UnitedHealthcare,Medicare Advantage,29.89,49,,percent of total billed charges,,
CALCIUM CHLORIDE 100 MG/ML (10 %) IV SYRG (PEDS 1000 MG MAX),,414129,LOCAL,Facility,Inpatient,10,mL,,61,51.85,17.4826,61,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
CALCIUM CHLORIDE 100 MG/ML (10 %) IV SYRG (PEDS 1000 MG MAX),,414129,LOCAL,Facility,Outpatient,10,mL,,61,51.85,17.4826,61,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,29.28,48,,percent of total billed charges,,100% of DHS outpatient percentage
CALCIUM CHLORIDE 100 MG/ML (10 %) IV SYRG (PEDS 1000 MG MAX),,414129,LOCAL,Facility,Inpatient,10,mL,,61,51.85,17.4826,61,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
3D Recon Wo Wkstn,,76376,CPT,Facility,Both,,,,572,486.2,163.9352,1535,Aetna,Commercial,526.24,92,,percent of total billed charges,,
3D Recon Wo Wkstn,,76376,CPT,Facility,Outpatient,,,,572,486.2,163.9352,1535,Aetna,Medicare Advantage,280.28,49,,percent of total billed charges,,
3D Recon Wo Wkstn,,76376,CPT,Facility,Inpatient,,,,572,486.2,163.9352,1535,Aetna,Medicare Advantage,,,,,Included in per diem rate,
3D Recon Wo Wkstn,,76376,CPT,Facility,Both,,,,572,486.2,163.9352,1535,Aetna,PPO,531.96,93,,percent of total billed charges,,
3D Recon Wo Wkstn,,76376,CPT,Facility,Both,,,,572,486.2,163.9352,1535,America's PPO,America's PPO,549.2916,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
3D Recon Wo Wkstn,,76376,CPT,Facility,Both,,,,572,486.2,163.9352,1535,BlueCross BlueShield Minnesota, Federal Employee Program,562.848,98.4,,percent of total billed charges,,
3D Recon Wo Wkstn,,76376,CPT,Facility,Both,,,,572,486.2,163.9352,1535,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,572,100,,percent of total billed charges,,
3D Recon Wo Wkstn,,76376,CPT,Facility,Both,,,,572,486.2,163.9352,1535,BlueCross BlueShield Minnesota,High Value Network Plan,514.8,90,,percent of total billed charges,,
3D Recon Wo Wkstn,,76376,CPT,Facility,Outpatient,,,,572,486.2,163.9352,1535,BlueCross BlueShield Minnesota,Medicare Advantage,280.28,49,,percent of total billed charges,,
3D Recon Wo Wkstn,,76376,CPT,Facility,Inpatient,,,,572,486.2,163.9352,1535,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
3D Recon Wo Wkstn,,76376,CPT,Facility,Both,,,,572,486.2,163.9352,1535,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,506.6204,88.57,,percent of total billed charges,,
3D Recon Wo Wkstn,,76376,CPT,Facility,Both,,,,572,486.2,163.9352,1535,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,163.9352,28.66,,percent of total billed charges,,
3D Recon Wo Wkstn,,76376,CPT,Facility,Outpatient,,,,572,486.2,163.9352,1535,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),280.28,49,,percent of total billed charges,,
3D Recon Wo Wkstn,,76376,CPT,Facility,Inpatient,,,,572,486.2,163.9352,1535,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
3D Recon Wo Wkstn,,76376,CPT,Facility,Both,,,,572,486.2,163.9352,1535,CorVel,Worker's Compensation,572,100,,percent of total billed charges,,
3D Recon Wo Wkstn,,76376,CPT,Facility,Both,,,,572,486.2,163.9352,1535,First Health Group Corporation,First Health Network,554.84,97,,percent of total billed charges,,
3D Recon Wo Wkstn,,76376,CPT,Facility,Both,,,,572,486.2,163.9352,1535,"Health Partners, Inc.",Commercial,541.112,94.6,,percent of total billed charges,,
3D Recon Wo Wkstn,,76376,CPT,Facility,Outpatient,,,,572,486.2,163.9352,1535,"Health Partners, Inc.",Medicare Advantage,280.28,49,,percent of total billed charges,,
3D Recon Wo Wkstn,,76376,CPT,Facility,Inpatient,,,,572,486.2,163.9352,1535,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
3D Recon Wo Wkstn,,76376,CPT,Facility,Both,,,,572,486.2,163.9352,1535,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),343.2,60,,percent of total billed charges,,
3D Recon Wo Wkstn,,76376,CPT,Facility,Both,,,,572,486.2,163.9352,1535,"Health Partners, Inc.",State of Minnesota Advantage Program,466.18,81.5,,percent of total billed charges,,
3D Recon Wo Wkstn,,76376,CPT,Facility,Both,,,,572,486.2,163.9352,1535,"Health Partners, Inc.",State Public Programs,286,50,,percent of total billed charges,,
3D Recon Wo Wkstn,,76376,CPT,Facility,Both,,,,572,486.2,163.9352,1535,Humana Insurance Company,Commercial PPO,543.4,95,,percent of total billed charges,,
3D Recon Wo Wkstn,,76376,CPT,Facility,Outpatient,,,,572,486.2,163.9352,1535,Humana Insurance Company,Medicare PPO,280.28,49,,percent of total billed charges,,
3D Recon Wo Wkstn,,76376,CPT,Facility,Inpatient,,,,572,486.2,163.9352,1535,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
3D Recon Wo Wkstn,,76376,CPT,Facility,Both,,,,572,486.2,163.9352,1535,Medica,Individual & Family,566.852,99.1,,percent of total billed charges,,
3D Recon Wo Wkstn,,76376,CPT,Facility,Outpatient,,,,572,486.2,163.9352,1535,Medica,Medica Advantage Solution,284.856,49.8,,percent of total billed charges,,
3D Recon Wo Wkstn,,76376,CPT,Facility,Inpatient,,,,572,486.2,163.9352,1535,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
3D Recon Wo Wkstn,,76376,CPT,Facility,Outpatient,,,,572,486.2,163.9352,1535,Medica,Medical Assistance,747,,,Other,per vist,Pays in addition to all Outpatient Service Categories
3D Recon Wo Wkstn,,76376,CPT,Facility,Inpatient,,,,572,486.2,163.9352,1535,Medica,Medical Assistance,,,,,Included in per diem rate,
3D Recon Wo Wkstn,,76376,CPT,Facility,Outpatient,,,,572,486.2,163.9352,1535,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,284.856,49.8,,percent of total billed charges,,
3D Recon Wo Wkstn,,76376,CPT,Facility,Inpatient,,,,572,486.2,163.9352,1535,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
3D Recon Wo Wkstn,,76376,CPT,Facility,Both,,,,572,486.2,163.9352,1535,"Multiplan, Inc.","Multiplan, Inc.",537.68,94,,percent of total billed charges,,
3D Recon Wo Wkstn,,76376,CPT,Facility,Outpatient,,,,572,486.2,163.9352,1535,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1535,,,Other,Per scan,
3D Recon Wo Wkstn,,76376,CPT,Facility,Inpatient,,,,572,486.2,163.9352,1535,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
3D Recon Wo Wkstn,,76376,CPT,Facility,Both,,,,572,486.2,163.9352,1535,"Preferred One Administrative Services, INC.",PPO,563.992,98.6,,percent of total billed charges,,
3D Recon Wo Wkstn,,76376,CPT,Facility,Outpatient,,,,572,486.2,163.9352,1535,PrimeWest Health,Minnesota Senior Health Options (MSHO),294.294,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
3D Recon Wo Wkstn,,76376,CPT,Facility,Inpatient,,,,572,486.2,163.9352,1535,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
3D Recon Wo Wkstn,,76376,CPT,Facility,Outpatient,,,,572,486.2,163.9352,1535,PrimeWest Health,MinnesotaCare,293.7792,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
3D Recon Wo Wkstn,,76376,CPT,Facility,Inpatient,,,,572,486.2,163.9352,1535,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
3D Recon Wo Wkstn,,76376,CPT,Facility,Both,,,,572,486.2,163.9352,1535,Sanford Health Plan,Sanford Health Plan,526.24,92,,percent of total billed charges,,
3D Recon Wo Wkstn,,76376,CPT,Facility,Outpatient,,,,572,486.2,163.9352,1535,"UCare Health, Inc.",Individual & Family Plan,322.322,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
3D Recon Wo Wkstn,,76376,CPT,Facility,Inpatient,,,,572,486.2,163.9352,1535,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
3D Recon Wo Wkstn,,76376,CPT,Facility,Outpatient,,,,572,486.2,163.9352,1535,"UCare Health, Inc.",Medical Assistance,288.6884,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
3D Recon Wo Wkstn,,76376,CPT,Facility,Inpatient,,,,572,486.2,163.9352,1535,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
3D Recon Wo Wkstn,,76376,CPT,Facility,Outpatient,,,,572,486.2,163.9352,1535,"UCare Health, Inc.",Medicare Advantage,288.6884,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
3D Recon Wo Wkstn,,76376,CPT,Facility,Inpatient,,,,572,486.2,163.9352,1535,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
3D Recon Wo Wkstn,,76376,CPT,Facility,Outpatient,,,,572,486.2,163.9352,1535,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),288.6884,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
3D Recon Wo Wkstn,,76376,CPT,Facility,Inpatient,,,,572,486.2,163.9352,1535,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
3D Recon Wo Wkstn,,76376,CPT,Facility,Both,,,,572,486.2,163.9352,1535,UnitedHealthcare,Individual & Family,537.68,94,,percent of total billed charges,,
3D Recon Wo Wkstn,,76376,CPT,Facility,Outpatient,,,,572,486.2,163.9352,1535,UnitedHealthcare,Medicare Advantage,280.28,49,,percent of total billed charges,,
3D Recon Wo Wkstn,,76376,CPT,Facility,Inpatient,,,,572,486.2,163.9352,1535,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
3D Recon Wo Wkstn,,76376,CPT,Facility,Outpatient,,,,572,486.2,163.9352,1535,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,274.56,48,,percent of total billed charges,,100% of DHS outpatient percentage
3D Recon Wo Wkstn,,76376,CPT,Facility,Inpatient,,,,572,486.2,163.9352,1535,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Ct Limited Study,,76380,CPT,Facility,Both,,,,1373,1167.05,393.5018,1373,Aetna,Commercial,1263.16,92,,percent of total billed charges,,
Ct Limited Study,,76380,CPT,Facility,Outpatient,,,,1373,1167.05,393.5018,1373,Aetna,Medicare Advantage,672.77,49,,percent of total billed charges,,
Ct Limited Study,,76380,CPT,Facility,Inpatient,,,,1373,1167.05,393.5018,1373,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Ct Limited Study,,76380,CPT,Facility,Both,,,,1373,1167.05,393.5018,1373,Aetna,PPO,1276.89,93,,percent of total billed charges,,
Ct Limited Study,,76380,CPT,Facility,Both,,,,1373,1167.05,393.5018,1373,America's PPO,America's PPO,1318.4919,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Ct Limited Study,,76380,CPT,Facility,Both,,,,1373,1167.05,393.5018,1373,BlueCross BlueShield Minnesota, Federal Employee Program,1351.032,98.4,,percent of total billed charges,,
Ct Limited Study,,76380,CPT,Facility,Both,,,,1373,1167.05,393.5018,1373,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1373,100,,percent of total billed charges,,
Ct Limited Study,,76380,CPT,Facility,Both,,,,1373,1167.05,393.5018,1373,BlueCross BlueShield Minnesota,High Value Network Plan,1235.7,90,,percent of total billed charges,,
Ct Limited Study,,76380,CPT,Facility,Outpatient,,,,1373,1167.05,393.5018,1373,BlueCross BlueShield Minnesota,Medicare Advantage,672.77,49,,percent of total billed charges,,
Ct Limited Study,,76380,CPT,Facility,Inpatient,,,,1373,1167.05,393.5018,1373,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Ct Limited Study,,76380,CPT,Facility,Both,,,,1373,1167.05,393.5018,1373,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1216.0661,88.57,,percent of total billed charges,,
Ct Limited Study,,76380,CPT,Facility,Both,,,,1373,1167.05,393.5018,1373,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,393.5018,28.66,,percent of total billed charges,,
Ct Limited Study,,76380,CPT,Facility,Outpatient,,,,1373,1167.05,393.5018,1373,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),672.77,49,,percent of total billed charges,,
Ct Limited Study,,76380,CPT,Facility,Inpatient,,,,1373,1167.05,393.5018,1373,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Ct Limited Study,,76380,CPT,Facility,Both,,,,1373,1167.05,393.5018,1373,CorVel,Worker's Compensation,1373,100,,percent of total billed charges,,
Ct Limited Study,,76380,CPT,Facility,Both,,,,1373,1167.05,393.5018,1373,First Health Group Corporation,First Health Network,1331.81,97,,percent of total billed charges,,
Ct Limited Study,,76380,CPT,Facility,Both,,,,1373,1167.05,393.5018,1373,"Health Partners, Inc.",Commercial,1298.858,94.6,,percent of total billed charges,,
Ct Limited Study,,76380,CPT,Facility,Outpatient,,,,1373,1167.05,393.5018,1373,"Health Partners, Inc.",Medicare Advantage,672.77,49,,percent of total billed charges,,
Ct Limited Study,,76380,CPT,Facility,Inpatient,,,,1373,1167.05,393.5018,1373,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ct Limited Study,,76380,CPT,Facility,Both,,,,1373,1167.05,393.5018,1373,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),823.8,60,,percent of total billed charges,,
Ct Limited Study,,76380,CPT,Facility,Both,,,,1373,1167.05,393.5018,1373,"Health Partners, Inc.",State of Minnesota Advantage Program,1118.995,81.5,,percent of total billed charges,,
Ct Limited Study,,76380,CPT,Facility,Both,,,,1373,1167.05,393.5018,1373,"Health Partners, Inc.",State Public Programs,686.5,50,,percent of total billed charges,,
Ct Limited Study,,76380,CPT,Facility,Both,,,,1373,1167.05,393.5018,1373,Humana Insurance Company,Commercial PPO,1304.35,95,,percent of total billed charges,,
Ct Limited Study,,76380,CPT,Facility,Outpatient,,,,1373,1167.05,393.5018,1373,Humana Insurance Company,Medicare PPO,672.77,49,,percent of total billed charges,,
Ct Limited Study,,76380,CPT,Facility,Inpatient,,,,1373,1167.05,393.5018,1373,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Ct Limited Study,,76380,CPT,Facility,Both,,,,1373,1167.05,393.5018,1373,Medica,Individual & Family,1360.643,99.1,,percent of total billed charges,,
Ct Limited Study,,76380,CPT,Facility,Outpatient,,,,1373,1167.05,393.5018,1373,Medica,Medica Advantage Solution,683.754,49.8,,percent of total billed charges,,
Ct Limited Study,,76380,CPT,Facility,Inpatient,,,,1373,1167.05,393.5018,1373,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Ct Limited Study,,76380,CPT,Facility,Outpatient,,,,1373,1167.05,393.5018,1373,Medica,Medical Assistance,612.358,44.6,,percent of total billed charges,,
Ct Limited Study,,76380,CPT,Facility,Inpatient,,,,1373,1167.05,393.5018,1373,Medica,Medical Assistance,,,,,Included in per diem rate,
Ct Limited Study,,76380,CPT,Facility,Outpatient,,,,1373,1167.05,393.5018,1373,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,683.754,49.8,,percent of total billed charges,,
Ct Limited Study,,76380,CPT,Facility,Inpatient,,,,1373,1167.05,393.5018,1373,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Ct Limited Study,,76380,CPT,Facility,Both,,,,1373,1167.05,393.5018,1373,"Multiplan, Inc.","Multiplan, Inc.",1290.62,94,,percent of total billed charges,,
Ct Limited Study,,76380,CPT,Facility,Outpatient,,,,1373,1167.05,393.5018,1373,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1283,,,Other,Per scan,
Ct Limited Study,,76380,CPT,Facility,Inpatient,,,,1373,1167.05,393.5018,1373,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Ct Limited Study,,76380,CPT,Facility,Both,,,,1373,1167.05,393.5018,1373,"Preferred One Administrative Services, INC.",PPO,1353.778,98.6,,percent of total billed charges,,
Ct Limited Study,,76380,CPT,Facility,Outpatient,,,,1373,1167.05,393.5018,1373,PrimeWest Health,Minnesota Senior Health Options (MSHO),706.4085,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Ct Limited Study,,76380,CPT,Facility,Inpatient,,,,1373,1167.05,393.5018,1373,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ct Limited Study,,76380,CPT,Facility,Outpatient,,,,1373,1167.05,393.5018,1373,PrimeWest Health,MinnesotaCare,705.1728,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Ct Limited Study,,76380,CPT,Facility,Inpatient,,,,1373,1167.05,393.5018,1373,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Ct Limited Study,,76380,CPT,Facility,Both,,,,1373,1167.05,393.5018,1373,Sanford Health Plan,Sanford Health Plan,1263.16,92,,percent of total billed charges,,
Ct Limited Study,,76380,CPT,Facility,Outpatient,,,,1373,1167.05,393.5018,1373,"UCare Health, Inc.",Individual & Family Plan,773.6855,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Ct Limited Study,,76380,CPT,Facility,Inpatient,,,,1373,1167.05,393.5018,1373,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Ct Limited Study,,76380,CPT,Facility,Outpatient,,,,1373,1167.05,393.5018,1373,"UCare Health, Inc.",Medical Assistance,692.9531,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ct Limited Study,,76380,CPT,Facility,Inpatient,,,,1373,1167.05,393.5018,1373,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Ct Limited Study,,76380,CPT,Facility,Outpatient,,,,1373,1167.05,393.5018,1373,"UCare Health, Inc.",Medicare Advantage,692.9531,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ct Limited Study,,76380,CPT,Facility,Inpatient,,,,1373,1167.05,393.5018,1373,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ct Limited Study,,76380,CPT,Facility,Outpatient,,,,1373,1167.05,393.5018,1373,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),692.9531,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ct Limited Study,,76380,CPT,Facility,Inpatient,,,,1373,1167.05,393.5018,1373,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ct Limited Study,,76380,CPT,Facility,Both,,,,1373,1167.05,393.5018,1373,UnitedHealthcare,Individual & Family,1290.62,94,,percent of total billed charges,,
Ct Limited Study,,76380,CPT,Facility,Outpatient,,,,1373,1167.05,393.5018,1373,UnitedHealthcare,Medicare Advantage,672.77,49,,percent of total billed charges,,
Ct Limited Study,,76380,CPT,Facility,Inpatient,,,,1373,1167.05,393.5018,1373,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Ct Limited Study,,76380,CPT,Facility,Outpatient,,,,1373,1167.05,393.5018,1373,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,659.04,48,,percent of total billed charges,,100% of DHS outpatient percentage
Ct Limited Study,,76380,CPT,Facility,Inpatient,,,,1373,1167.05,393.5018,1373,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Us Neonatal Head,,76506,CPT,Facility,Both,,,,572,486.2,163.9352,572,Aetna,Commercial,526.24,92,,percent of total billed charges,,
Us Neonatal Head,,76506,CPT,Facility,Outpatient,,,,572,486.2,163.9352,572,Aetna,Medicare Advantage,280.28,49,,percent of total billed charges,,
Us Neonatal Head,,76506,CPT,Facility,Inpatient,,,,572,486.2,163.9352,572,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Us Neonatal Head,,76506,CPT,Facility,Both,,,,572,486.2,163.9352,572,Aetna,PPO,531.96,93,,percent of total billed charges,,
Us Neonatal Head,,76506,CPT,Facility,Both,,,,572,486.2,163.9352,572,America's PPO,America's PPO,549.2916,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Us Neonatal Head,,76506,CPT,Facility,Both,,,,572,486.2,163.9352,572,BlueCross BlueShield Minnesota, Federal Employee Program,562.848,98.4,,percent of total billed charges,,
Us Neonatal Head,,76506,CPT,Facility,Both,,,,572,486.2,163.9352,572,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,572,100,,percent of total billed charges,,
Us Neonatal Head,,76506,CPT,Facility,Both,,,,572,486.2,163.9352,572,BlueCross BlueShield Minnesota,High Value Network Plan,514.8,90,,percent of total billed charges,,
Us Neonatal Head,,76506,CPT,Facility,Outpatient,,,,572,486.2,163.9352,572,BlueCross BlueShield Minnesota,Medicare Advantage,280.28,49,,percent of total billed charges,,
Us Neonatal Head,,76506,CPT,Facility,Inpatient,,,,572,486.2,163.9352,572,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Us Neonatal Head,,76506,CPT,Facility,Both,,,,572,486.2,163.9352,572,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,506.6204,88.57,,percent of total billed charges,,
Us Neonatal Head,,76506,CPT,Facility,Both,,,,572,486.2,163.9352,572,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,163.9352,28.66,,percent of total billed charges,,
Us Neonatal Head,,76506,CPT,Facility,Outpatient,,,,572,486.2,163.9352,572,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),280.28,49,,percent of total billed charges,,
Us Neonatal Head,,76506,CPT,Facility,Inpatient,,,,572,486.2,163.9352,572,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Us Neonatal Head,,76506,CPT,Facility,Both,,,,572,486.2,163.9352,572,CorVel,Worker's Compensation,572,100,,percent of total billed charges,,
Us Neonatal Head,,76506,CPT,Facility,Both,,,,572,486.2,163.9352,572,First Health Group Corporation,First Health Network,554.84,97,,percent of total billed charges,,
Us Neonatal Head,,76506,CPT,Facility,Both,,,,572,486.2,163.9352,572,"Health Partners, Inc.",Commercial,541.112,94.6,,percent of total billed charges,,
Us Neonatal Head,,76506,CPT,Facility,Outpatient,,,,572,486.2,163.9352,572,"Health Partners, Inc.",Medicare Advantage,280.28,49,,percent of total billed charges,,
Us Neonatal Head,,76506,CPT,Facility,Inpatient,,,,572,486.2,163.9352,572,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Us Neonatal Head,,76506,CPT,Facility,Both,,,,572,486.2,163.9352,572,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),343.2,60,,percent of total billed charges,,
Us Neonatal Head,,76506,CPT,Facility,Both,,,,572,486.2,163.9352,572,"Health Partners, Inc.",State of Minnesota Advantage Program,466.18,81.5,,percent of total billed charges,,
Us Neonatal Head,,76506,CPT,Facility,Both,,,,572,486.2,163.9352,572,"Health Partners, Inc.",State Public Programs,286,50,,percent of total billed charges,,
Us Neonatal Head,,76506,CPT,Facility,Both,,,,572,486.2,163.9352,572,Humana Insurance Company,Commercial PPO,543.4,95,,percent of total billed charges,,
Us Neonatal Head,,76506,CPT,Facility,Outpatient,,,,572,486.2,163.9352,572,Humana Insurance Company,Medicare PPO,280.28,49,,percent of total billed charges,,
Us Neonatal Head,,76506,CPT,Facility,Inpatient,,,,572,486.2,163.9352,572,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Us Neonatal Head,,76506,CPT,Facility,Both,,,,572,486.2,163.9352,572,Medica,Individual & Family,566.852,99.1,,percent of total billed charges,,
Us Neonatal Head,,76506,CPT,Facility,Outpatient,,,,572,486.2,163.9352,572,Medica,Medica Advantage Solution,284.856,49.8,,percent of total billed charges,,
Us Neonatal Head,,76506,CPT,Facility,Inpatient,,,,572,486.2,163.9352,572,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Us Neonatal Head,,76506,CPT,Facility,Outpatient,,,,572,486.2,163.9352,572,Medica,Medical Assistance,255.112,44.6,,percent of total billed charges,,
Us Neonatal Head,,76506,CPT,Facility,Inpatient,,,,572,486.2,163.9352,572,Medica,Medical Assistance,,,,,Included in per diem rate,
Us Neonatal Head,,76506,CPT,Facility,Outpatient,,,,572,486.2,163.9352,572,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,284.856,49.8,,percent of total billed charges,,
Us Neonatal Head,,76506,CPT,Facility,Inpatient,,,,572,486.2,163.9352,572,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Us Neonatal Head,,76506,CPT,Facility,Both,,,,572,486.2,163.9352,572,"Multiplan, Inc.","Multiplan, Inc.",537.68,94,,percent of total billed charges,,
Us Neonatal Head,,76506,CPT,Facility,Outpatient,,,,572,486.2,163.9352,572,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,515.372,90.1,,percent of total billed charges,,
Us Neonatal Head,,76506,CPT,Facility,Inpatient,,,,572,486.2,163.9352,572,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Us Neonatal Head,,76506,CPT,Facility,Both,,,,572,486.2,163.9352,572,"Preferred One Administrative Services, INC.",PPO,563.992,98.6,,percent of total billed charges,,
Us Neonatal Head,,76506,CPT,Facility,Outpatient,,,,572,486.2,163.9352,572,PrimeWest Health,Minnesota Senior Health Options (MSHO),294.294,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Us Neonatal Head,,76506,CPT,Facility,Inpatient,,,,572,486.2,163.9352,572,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Us Neonatal Head,,76506,CPT,Facility,Outpatient,,,,572,486.2,163.9352,572,PrimeWest Health,MinnesotaCare,293.7792,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Us Neonatal Head,,76506,CPT,Facility,Inpatient,,,,572,486.2,163.9352,572,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Us Neonatal Head,,76506,CPT,Facility,Both,,,,572,486.2,163.9352,572,Sanford Health Plan,Sanford Health Plan,526.24,92,,percent of total billed charges,,
Us Neonatal Head,,76506,CPT,Facility,Outpatient,,,,572,486.2,163.9352,572,"UCare Health, Inc.",Individual & Family Plan,322.322,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Us Neonatal Head,,76506,CPT,Facility,Inpatient,,,,572,486.2,163.9352,572,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Us Neonatal Head,,76506,CPT,Facility,Outpatient,,,,572,486.2,163.9352,572,"UCare Health, Inc.",Medical Assistance,288.6884,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Neonatal Head,,76506,CPT,Facility,Inpatient,,,,572,486.2,163.9352,572,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Us Neonatal Head,,76506,CPT,Facility,Outpatient,,,,572,486.2,163.9352,572,"UCare Health, Inc.",Medicare Advantage,288.6884,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Neonatal Head,,76506,CPT,Facility,Inpatient,,,,572,486.2,163.9352,572,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Us Neonatal Head,,76506,CPT,Facility,Outpatient,,,,572,486.2,163.9352,572,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),288.6884,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Neonatal Head,,76506,CPT,Facility,Inpatient,,,,572,486.2,163.9352,572,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Us Neonatal Head,,76506,CPT,Facility,Both,,,,572,486.2,163.9352,572,UnitedHealthcare,Individual & Family,537.68,94,,percent of total billed charges,,
Us Neonatal Head,,76506,CPT,Facility,Outpatient,,,,572,486.2,163.9352,572,UnitedHealthcare,Medicare Advantage,280.28,49,,percent of total billed charges,,
Us Neonatal Head,,76506,CPT,Facility,Inpatient,,,,572,486.2,163.9352,572,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Us Neonatal Head,,76506,CPT,Facility,Outpatient,,,,572,486.2,163.9352,572,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,274.56,48,,percent of total billed charges,,100% of DHS outpatient percentage
Us Neonatal Head,,76506,CPT,Facility,Inpatient,,,,572,486.2,163.9352,572,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Us Head Neck Soft Tissue,,76536,CPT,Facility,Both,,,,556,472.6,159.3496,556,Aetna,Commercial,511.52,92,,percent of total billed charges,,
Us Head Neck Soft Tissue,,76536,CPT,Facility,Outpatient,,,,556,472.6,159.3496,556,Aetna,Medicare Advantage,272.44,49,,percent of total billed charges,,
Us Head Neck Soft Tissue,,76536,CPT,Facility,Inpatient,,,,556,472.6,159.3496,556,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Us Head Neck Soft Tissue,,76536,CPT,Facility,Both,,,,556,472.6,159.3496,556,Aetna,PPO,517.08,93,,percent of total billed charges,,
Us Head Neck Soft Tissue,,76536,CPT,Facility,Both,,,,556,472.6,159.3496,556,America's PPO,America's PPO,533.9268,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Us Head Neck Soft Tissue,,76536,CPT,Facility,Both,,,,556,472.6,159.3496,556,BlueCross BlueShield Minnesota, Federal Employee Program,547.104,98.4,,percent of total billed charges,,
Us Head Neck Soft Tissue,,76536,CPT,Facility,Both,,,,556,472.6,159.3496,556,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,556,100,,percent of total billed charges,,
Us Head Neck Soft Tissue,,76536,CPT,Facility,Both,,,,556,472.6,159.3496,556,BlueCross BlueShield Minnesota,High Value Network Plan,500.4,90,,percent of total billed charges,,
Us Head Neck Soft Tissue,,76536,CPT,Facility,Outpatient,,,,556,472.6,159.3496,556,BlueCross BlueShield Minnesota,Medicare Advantage,272.44,49,,percent of total billed charges,,
Us Head Neck Soft Tissue,,76536,CPT,Facility,Inpatient,,,,556,472.6,159.3496,556,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Us Head Neck Soft Tissue,,76536,CPT,Facility,Both,,,,556,472.6,159.3496,556,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,492.4492,88.57,,percent of total billed charges,,
Us Head Neck Soft Tissue,,76536,CPT,Facility,Both,,,,556,472.6,159.3496,556,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,159.3496,28.66,,percent of total billed charges,,
Us Head Neck Soft Tissue,,76536,CPT,Facility,Outpatient,,,,556,472.6,159.3496,556,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),272.44,49,,percent of total billed charges,,
Us Head Neck Soft Tissue,,76536,CPT,Facility,Inpatient,,,,556,472.6,159.3496,556,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Us Head Neck Soft Tissue,,76536,CPT,Facility,Both,,,,556,472.6,159.3496,556,CorVel,Worker's Compensation,556,100,,percent of total billed charges,,
Us Head Neck Soft Tissue,,76536,CPT,Facility,Both,,,,556,472.6,159.3496,556,First Health Group Corporation,First Health Network,539.32,97,,percent of total billed charges,,
Us Head Neck Soft Tissue,,76536,CPT,Facility,Both,,,,556,472.6,159.3496,556,"Health Partners, Inc.",Commercial,525.976,94.6,,percent of total billed charges,,
Us Head Neck Soft Tissue,,76536,CPT,Facility,Outpatient,,,,556,472.6,159.3496,556,"Health Partners, Inc.",Medicare Advantage,272.44,49,,percent of total billed charges,,
Us Head Neck Soft Tissue,,76536,CPT,Facility,Inpatient,,,,556,472.6,159.3496,556,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Us Head Neck Soft Tissue,,76536,CPT,Facility,Both,,,,556,472.6,159.3496,556,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),333.6,60,,percent of total billed charges,,
Us Head Neck Soft Tissue,,76536,CPT,Facility,Both,,,,556,472.6,159.3496,556,"Health Partners, Inc.",State of Minnesota Advantage Program,453.14,81.5,,percent of total billed charges,,
Us Head Neck Soft Tissue,,76536,CPT,Facility,Both,,,,556,472.6,159.3496,556,"Health Partners, Inc.",State Public Programs,278,50,,percent of total billed charges,,
Us Head Neck Soft Tissue,,76536,CPT,Facility,Both,,,,556,472.6,159.3496,556,Humana Insurance Company,Commercial PPO,528.2,95,,percent of total billed charges,,
Us Head Neck Soft Tissue,,76536,CPT,Facility,Outpatient,,,,556,472.6,159.3496,556,Humana Insurance Company,Medicare PPO,272.44,49,,percent of total billed charges,,
Us Head Neck Soft Tissue,,76536,CPT,Facility,Inpatient,,,,556,472.6,159.3496,556,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Us Head Neck Soft Tissue,,76536,CPT,Facility,Both,,,,556,472.6,159.3496,556,Medica,Individual & Family,550.996,99.1,,percent of total billed charges,,
Us Head Neck Soft Tissue,,76536,CPT,Facility,Outpatient,,,,556,472.6,159.3496,556,Medica,Medica Advantage Solution,276.888,49.8,,percent of total billed charges,,
Us Head Neck Soft Tissue,,76536,CPT,Facility,Inpatient,,,,556,472.6,159.3496,556,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Us Head Neck Soft Tissue,,76536,CPT,Facility,Outpatient,,,,556,472.6,159.3496,556,Medica,Medical Assistance,247.976,44.6,,percent of total billed charges,,
Us Head Neck Soft Tissue,,76536,CPT,Facility,Inpatient,,,,556,472.6,159.3496,556,Medica,Medical Assistance,,,,,Included in per diem rate,
Us Head Neck Soft Tissue,,76536,CPT,Facility,Outpatient,,,,556,472.6,159.3496,556,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,276.888,49.8,,percent of total billed charges,,
Us Head Neck Soft Tissue,,76536,CPT,Facility,Inpatient,,,,556,472.6,159.3496,556,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Us Head Neck Soft Tissue,,76536,CPT,Facility,Both,,,,556,472.6,159.3496,556,"Multiplan, Inc.","Multiplan, Inc.",522.64,94,,percent of total billed charges,,
Us Head Neck Soft Tissue,,76536,CPT,Facility,Outpatient,,,,556,472.6,159.3496,556,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,500.956,90.1,,percent of total billed charges,,
Us Head Neck Soft Tissue,,76536,CPT,Facility,Inpatient,,,,556,472.6,159.3496,556,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Us Head Neck Soft Tissue,,76536,CPT,Facility,Both,,,,556,472.6,159.3496,556,"Preferred One Administrative Services, INC.",PPO,548.216,98.6,,percent of total billed charges,,
Us Head Neck Soft Tissue,,76536,CPT,Facility,Outpatient,,,,556,472.6,159.3496,556,PrimeWest Health,Minnesota Senior Health Options (MSHO),286.062,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Us Head Neck Soft Tissue,,76536,CPT,Facility,Inpatient,,,,556,472.6,159.3496,556,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Us Head Neck Soft Tissue,,76536,CPT,Facility,Outpatient,,,,556,472.6,159.3496,556,PrimeWest Health,MinnesotaCare,285.5616,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Us Head Neck Soft Tissue,,76536,CPT,Facility,Inpatient,,,,556,472.6,159.3496,556,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Us Head Neck Soft Tissue,,76536,CPT,Facility,Both,,,,556,472.6,159.3496,556,Sanford Health Plan,Sanford Health Plan,511.52,92,,percent of total billed charges,,
Us Head Neck Soft Tissue,,76536,CPT,Facility,Outpatient,,,,556,472.6,159.3496,556,"UCare Health, Inc.",Individual & Family Plan,313.306,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Us Head Neck Soft Tissue,,76536,CPT,Facility,Inpatient,,,,556,472.6,159.3496,556,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Us Head Neck Soft Tissue,,76536,CPT,Facility,Outpatient,,,,556,472.6,159.3496,556,"UCare Health, Inc.",Medical Assistance,280.6132,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Head Neck Soft Tissue,,76536,CPT,Facility,Inpatient,,,,556,472.6,159.3496,556,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Us Head Neck Soft Tissue,,76536,CPT,Facility,Outpatient,,,,556,472.6,159.3496,556,"UCare Health, Inc.",Medicare Advantage,280.6132,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Head Neck Soft Tissue,,76536,CPT,Facility,Inpatient,,,,556,472.6,159.3496,556,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Us Head Neck Soft Tissue,,76536,CPT,Facility,Outpatient,,,,556,472.6,159.3496,556,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),280.6132,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Head Neck Soft Tissue,,76536,CPT,Facility,Inpatient,,,,556,472.6,159.3496,556,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Us Head Neck Soft Tissue,,76536,CPT,Facility,Both,,,,556,472.6,159.3496,556,UnitedHealthcare,Individual & Family,522.64,94,,percent of total billed charges,,
Us Head Neck Soft Tissue,,76536,CPT,Facility,Outpatient,,,,556,472.6,159.3496,556,UnitedHealthcare,Medicare Advantage,272.44,49,,percent of total billed charges,,
Us Head Neck Soft Tissue,,76536,CPT,Facility,Inpatient,,,,556,472.6,159.3496,556,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Us Head Neck Soft Tissue,,76536,CPT,Facility,Outpatient,,,,556,472.6,159.3496,556,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,266.88,48,,percent of total billed charges,,100% of DHS outpatient percentage
Us Head Neck Soft Tissue,,76536,CPT,Facility,Inpatient,,,,556,472.6,159.3496,556,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Us Thyroid,,76536,CPT,Facility,Both,,,,556,472.6,159.3496,556,Aetna,Commercial,511.52,92,,percent of total billed charges,,
Us Thyroid,,76536,CPT,Facility,Outpatient,,,,556,472.6,159.3496,556,Aetna,Medicare Advantage,272.44,49,,percent of total billed charges,,
Us Thyroid,,76536,CPT,Facility,Inpatient,,,,556,472.6,159.3496,556,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Us Thyroid,,76536,CPT,Facility,Both,,,,556,472.6,159.3496,556,Aetna,PPO,517.08,93,,percent of total billed charges,,
Us Thyroid,,76536,CPT,Facility,Both,,,,556,472.6,159.3496,556,America's PPO,America's PPO,533.9268,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Us Thyroid,,76536,CPT,Facility,Both,,,,556,472.6,159.3496,556,BlueCross BlueShield Minnesota, Federal Employee Program,547.104,98.4,,percent of total billed charges,,
Us Thyroid,,76536,CPT,Facility,Both,,,,556,472.6,159.3496,556,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,556,100,,percent of total billed charges,,
Us Thyroid,,76536,CPT,Facility,Both,,,,556,472.6,159.3496,556,BlueCross BlueShield Minnesota,High Value Network Plan,500.4,90,,percent of total billed charges,,
Us Thyroid,,76536,CPT,Facility,Outpatient,,,,556,472.6,159.3496,556,BlueCross BlueShield Minnesota,Medicare Advantage,272.44,49,,percent of total billed charges,,
Us Thyroid,,76536,CPT,Facility,Inpatient,,,,556,472.6,159.3496,556,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Us Thyroid,,76536,CPT,Facility,Both,,,,556,472.6,159.3496,556,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,492.4492,88.57,,percent of total billed charges,,
Us Thyroid,,76536,CPT,Facility,Both,,,,556,472.6,159.3496,556,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,159.3496,28.66,,percent of total billed charges,,
Us Thyroid,,76536,CPT,Facility,Outpatient,,,,556,472.6,159.3496,556,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),272.44,49,,percent of total billed charges,,
Us Thyroid,,76536,CPT,Facility,Inpatient,,,,556,472.6,159.3496,556,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Us Thyroid,,76536,CPT,Facility,Both,,,,556,472.6,159.3496,556,CorVel,Worker's Compensation,556,100,,percent of total billed charges,,
Us Thyroid,,76536,CPT,Facility,Both,,,,556,472.6,159.3496,556,First Health Group Corporation,First Health Network,539.32,97,,percent of total billed charges,,
Us Thyroid,,76536,CPT,Facility,Both,,,,556,472.6,159.3496,556,"Health Partners, Inc.",Commercial,525.976,94.6,,percent of total billed charges,,
Us Thyroid,,76536,CPT,Facility,Outpatient,,,,556,472.6,159.3496,556,"Health Partners, Inc.",Medicare Advantage,272.44,49,,percent of total billed charges,,
Us Thyroid,,76536,CPT,Facility,Inpatient,,,,556,472.6,159.3496,556,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Us Thyroid,,76536,CPT,Facility,Both,,,,556,472.6,159.3496,556,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),333.6,60,,percent of total billed charges,,
Us Thyroid,,76536,CPT,Facility,Both,,,,556,472.6,159.3496,556,"Health Partners, Inc.",State of Minnesota Advantage Program,453.14,81.5,,percent of total billed charges,,
Us Thyroid,,76536,CPT,Facility,Both,,,,556,472.6,159.3496,556,"Health Partners, Inc.",State Public Programs,278,50,,percent of total billed charges,,
Us Thyroid,,76536,CPT,Facility,Both,,,,556,472.6,159.3496,556,Humana Insurance Company,Commercial PPO,528.2,95,,percent of total billed charges,,
Us Thyroid,,76536,CPT,Facility,Outpatient,,,,556,472.6,159.3496,556,Humana Insurance Company,Medicare PPO,272.44,49,,percent of total billed charges,,
Us Thyroid,,76536,CPT,Facility,Inpatient,,,,556,472.6,159.3496,556,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Us Thyroid,,76536,CPT,Facility,Both,,,,556,472.6,159.3496,556,Medica,Individual & Family,550.996,99.1,,percent of total billed charges,,
Us Thyroid,,76536,CPT,Facility,Outpatient,,,,556,472.6,159.3496,556,Medica,Medica Advantage Solution,276.888,49.8,,percent of total billed charges,,
Us Thyroid,,76536,CPT,Facility,Inpatient,,,,556,472.6,159.3496,556,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Us Thyroid,,76536,CPT,Facility,Outpatient,,,,556,472.6,159.3496,556,Medica,Medical Assistance,247.976,44.6,,percent of total billed charges,,
Us Thyroid,,76536,CPT,Facility,Inpatient,,,,556,472.6,159.3496,556,Medica,Medical Assistance,,,,,Included in per diem rate,
Us Thyroid,,76536,CPT,Facility,Outpatient,,,,556,472.6,159.3496,556,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,276.888,49.8,,percent of total billed charges,,
Us Thyroid,,76536,CPT,Facility,Inpatient,,,,556,472.6,159.3496,556,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Us Thyroid,,76536,CPT,Facility,Both,,,,556,472.6,159.3496,556,"Multiplan, Inc.","Multiplan, Inc.",522.64,94,,percent of total billed charges,,
Us Thyroid,,76536,CPT,Facility,Outpatient,,,,556,472.6,159.3496,556,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,500.956,90.1,,percent of total billed charges,,
Us Thyroid,,76536,CPT,Facility,Inpatient,,,,556,472.6,159.3496,556,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Us Thyroid,,76536,CPT,Facility,Both,,,,556,472.6,159.3496,556,"Preferred One Administrative Services, INC.",PPO,548.216,98.6,,percent of total billed charges,,
Us Thyroid,,76536,CPT,Facility,Outpatient,,,,556,472.6,159.3496,556,PrimeWest Health,Minnesota Senior Health Options (MSHO),286.062,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Us Thyroid,,76536,CPT,Facility,Inpatient,,,,556,472.6,159.3496,556,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Us Thyroid,,76536,CPT,Facility,Outpatient,,,,556,472.6,159.3496,556,PrimeWest Health,MinnesotaCare,285.5616,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Us Thyroid,,76536,CPT,Facility,Inpatient,,,,556,472.6,159.3496,556,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Us Thyroid,,76536,CPT,Facility,Both,,,,556,472.6,159.3496,556,Sanford Health Plan,Sanford Health Plan,511.52,92,,percent of total billed charges,,
Us Thyroid,,76536,CPT,Facility,Outpatient,,,,556,472.6,159.3496,556,"UCare Health, Inc.",Individual & Family Plan,313.306,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Us Thyroid,,76536,CPT,Facility,Inpatient,,,,556,472.6,159.3496,556,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Us Thyroid,,76536,CPT,Facility,Outpatient,,,,556,472.6,159.3496,556,"UCare Health, Inc.",Medical Assistance,280.6132,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Thyroid,,76536,CPT,Facility,Inpatient,,,,556,472.6,159.3496,556,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Us Thyroid,,76536,CPT,Facility,Outpatient,,,,556,472.6,159.3496,556,"UCare Health, Inc.",Medicare Advantage,280.6132,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Thyroid,,76536,CPT,Facility,Inpatient,,,,556,472.6,159.3496,556,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Us Thyroid,,76536,CPT,Facility,Outpatient,,,,556,472.6,159.3496,556,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),280.6132,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Thyroid,,76536,CPT,Facility,Inpatient,,,,556,472.6,159.3496,556,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Us Thyroid,,76536,CPT,Facility,Both,,,,556,472.6,159.3496,556,UnitedHealthcare,Individual & Family,522.64,94,,percent of total billed charges,,
Us Thyroid,,76536,CPT,Facility,Outpatient,,,,556,472.6,159.3496,556,UnitedHealthcare,Medicare Advantage,272.44,49,,percent of total billed charges,,
Us Thyroid,,76536,CPT,Facility,Inpatient,,,,556,472.6,159.3496,556,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Us Thyroid,,76536,CPT,Facility,Outpatient,,,,556,472.6,159.3496,556,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,266.88,48,,percent of total billed charges,,100% of DHS outpatient percentage
Us Thyroid,,76536,CPT,Facility,Inpatient,,,,556,472.6,159.3496,556,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
DEXTROSE 25 % IN WATER (D25W) IV SYRG (PEDS 25 GM MAX),,414130,LOCAL,Facility,Both,10,mL,,81,68.85,23.2146,81,Aetna,Commercial,74.52,92,,percent of total billed charges,,
DEXTROSE 25 % IN WATER (D25W) IV SYRG (PEDS 25 GM MAX),,414130,LOCAL,Facility,Outpatient,10,mL,,81,68.85,23.2146,81,Aetna,Medicare Advantage,39.69,49,,percent of total billed charges,,
DEXTROSE 25 % IN WATER (D25W) IV SYRG (PEDS 25 GM MAX),,414130,LOCAL,Facility,Inpatient,10,mL,,81,68.85,23.2146,81,Aetna,Medicare Advantage,,,,,Included in per diem rate,
DEXTROSE 25 % IN WATER (D25W) IV SYRG (PEDS 25 GM MAX),,414130,LOCAL,Facility,Both,10,mL,,81,68.85,23.2146,81,Aetna,PPO,75.33,93,,percent of total billed charges,,
DEXTROSE 25 % IN WATER (D25W) IV SYRG (PEDS 25 GM MAX),,414130,LOCAL,Facility,Both,10,mL,,81,68.85,23.2146,81,America's PPO,America's PPO,77.7843,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
DEXTROSE 25 % IN WATER (D25W) IV SYRG (PEDS 25 GM MAX),,414130,LOCAL,Facility,Both,10,mL,,81,68.85,23.2146,81,BlueCross BlueShield Minnesota, Federal Employee Program,79.704,98.4,,percent of total billed charges,,
DEXTROSE 25 % IN WATER (D25W) IV SYRG (PEDS 25 GM MAX),,414130,LOCAL,Facility,Both,10,mL,,81,68.85,23.2146,81,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,81,100,,percent of total billed charges,,
DEXTROSE 25 % IN WATER (D25W) IV SYRG (PEDS 25 GM MAX),,414130,LOCAL,Facility,Both,10,mL,,81,68.85,23.2146,81,BlueCross BlueShield Minnesota,High Value Network Plan,72.9,90,,percent of total billed charges,,
DEXTROSE 25 % IN WATER (D25W) IV SYRG (PEDS 25 GM MAX),,414130,LOCAL,Facility,Outpatient,10,mL,,81,68.85,23.2146,81,BlueCross BlueShield Minnesota,Medicare Advantage,39.69,49,,percent of total billed charges,,
DEXTROSE 25 % IN WATER (D25W) IV SYRG (PEDS 25 GM MAX),,414130,LOCAL,Facility,Inpatient,10,mL,,81,68.85,23.2146,81,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
DEXTROSE 25 % IN WATER (D25W) IV SYRG (PEDS 25 GM MAX),,414130,LOCAL,Facility,Both,10,mL,,81,68.85,23.2146,81,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,71.7417,88.57,,percent of total billed charges,,
DEXTROSE 25 % IN WATER (D25W) IV SYRG (PEDS 25 GM MAX),,414130,LOCAL,Facility,Both,10,mL,,81,68.85,23.2146,81,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,23.2146,28.66,,percent of total billed charges,,
DEXTROSE 25 % IN WATER (D25W) IV SYRG (PEDS 25 GM MAX),,414130,LOCAL,Facility,Outpatient,10,mL,,81,68.85,23.2146,81,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),39.69,49,,percent of total billed charges,,
DEXTROSE 25 % IN WATER (D25W) IV SYRG (PEDS 25 GM MAX),,414130,LOCAL,Facility,Inpatient,10,mL,,81,68.85,23.2146,81,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
DEXTROSE 25 % IN WATER (D25W) IV SYRG (PEDS 25 GM MAX),,414130,LOCAL,Facility,Both,10,mL,,81,68.85,23.2146,81,CorVel,Worker's Compensation,81,100,,percent of total billed charges,,
DEXTROSE 25 % IN WATER (D25W) IV SYRG (PEDS 25 GM MAX),,414130,LOCAL,Facility,Both,10,mL,,81,68.85,23.2146,81,First Health Group Corporation,First Health Network,78.57,97,,percent of total billed charges,,
DEXTROSE 25 % IN WATER (D25W) IV SYRG (PEDS 25 GM MAX),,414130,LOCAL,Facility,Both,10,mL,,81,68.85,23.2146,81,"Health Partners, Inc.",Commercial,76.626,94.6,,percent of total billed charges,,
DEXTROSE 25 % IN WATER (D25W) IV SYRG (PEDS 25 GM MAX),,414130,LOCAL,Facility,Outpatient,10,mL,,81,68.85,23.2146,81,"Health Partners, Inc.",Medicare Advantage,39.69,49,,percent of total billed charges,,
DEXTROSE 25 % IN WATER (D25W) IV SYRG (PEDS 25 GM MAX),,414130,LOCAL,Facility,Inpatient,10,mL,,81,68.85,23.2146,81,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DEXTROSE 25 % IN WATER (D25W) IV SYRG (PEDS 25 GM MAX),,414130,LOCAL,Facility,Both,10,mL,,81,68.85,23.2146,81,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),48.6,60,,percent of total billed charges,,
DEXTROSE 25 % IN WATER (D25W) IV SYRG (PEDS 25 GM MAX),,414130,LOCAL,Facility,Both,10,mL,,81,68.85,23.2146,81,"Health Partners, Inc.",State of Minnesota Advantage Program,66.015,81.5,,percent of total billed charges,,
DEXTROSE 25 % IN WATER (D25W) IV SYRG (PEDS 25 GM MAX),,414130,LOCAL,Facility,Both,10,mL,,81,68.85,23.2146,81,"Health Partners, Inc.",State Public Programs,40.5,50,,percent of total billed charges,,
DEXTROSE 25 % IN WATER (D25W) IV SYRG (PEDS 25 GM MAX),,414130,LOCAL,Facility,Both,10,mL,,81,68.85,23.2146,81,Humana Insurance Company,Commercial PPO,76.95,95,,percent of total billed charges,,
DEXTROSE 25 % IN WATER (D25W) IV SYRG (PEDS 25 GM MAX),,414130,LOCAL,Facility,Outpatient,10,mL,,81,68.85,23.2146,81,Humana Insurance Company,Medicare PPO,39.69,49,,percent of total billed charges,,
DEXTROSE 25 % IN WATER (D25W) IV SYRG (PEDS 25 GM MAX),,414130,LOCAL,Facility,Inpatient,10,mL,,81,68.85,23.2146,81,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
DEXTROSE 25 % IN WATER (D25W) IV SYRG (PEDS 25 GM MAX),,414130,LOCAL,Facility,Both,10,mL,,81,68.85,23.2146,81,Medica,Individual & Family,80.271,99.1,,percent of total billed charges,,
DEXTROSE 25 % IN WATER (D25W) IV SYRG (PEDS 25 GM MAX),,414130,LOCAL,Facility,Outpatient,10,mL,,81,68.85,23.2146,81,Medica,Medica Advantage Solution,40.338,49.8,,percent of total billed charges,,
DEXTROSE 25 % IN WATER (D25W) IV SYRG (PEDS 25 GM MAX),,414130,LOCAL,Facility,Inpatient,10,mL,,81,68.85,23.2146,81,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
DEXTROSE 25 % IN WATER (D25W) IV SYRG (PEDS 25 GM MAX),,414130,LOCAL,Facility,Outpatient,10,mL,,81,68.85,23.2146,81,Medica,Medical Assistance,36.126,44.6,,percent of total billed charges,,
DEXTROSE 25 % IN WATER (D25W) IV SYRG (PEDS 25 GM MAX),,414130,LOCAL,Facility,Inpatient,10,mL,,81,68.85,23.2146,81,Medica,Medical Assistance,,,,,Included in per diem rate,
DEXTROSE 25 % IN WATER (D25W) IV SYRG (PEDS 25 GM MAX),,414130,LOCAL,Facility,Outpatient,10,mL,,81,68.85,23.2146,81,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,40.338,49.8,,percent of total billed charges,,
DEXTROSE 25 % IN WATER (D25W) IV SYRG (PEDS 25 GM MAX),,414130,LOCAL,Facility,Inpatient,10,mL,,81,68.85,23.2146,81,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
DEXTROSE 25 % IN WATER (D25W) IV SYRG (PEDS 25 GM MAX),,414130,LOCAL,Facility,Both,10,mL,,81,68.85,23.2146,81,"Multiplan, Inc.","Multiplan, Inc.",76.14,94,,percent of total billed charges,,
DEXTROSE 25 % IN WATER (D25W) IV SYRG (PEDS 25 GM MAX),,414130,LOCAL,Facility,Outpatient,10,mL,,81,68.85,23.2146,81,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,72.981,90.1,,percent of total billed charges,,
DEXTROSE 25 % IN WATER (D25W) IV SYRG (PEDS 25 GM MAX),,414130,LOCAL,Facility,Inpatient,10,mL,,81,68.85,23.2146,81,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
DEXTROSE 25 % IN WATER (D25W) IV SYRG (PEDS 25 GM MAX),,414130,LOCAL,Facility,Both,10,mL,,81,68.85,23.2146,81,"Preferred One Administrative Services, INC.",PPO,79.866,98.6,,percent of total billed charges,,
DEXTROSE 25 % IN WATER (D25W) IV SYRG (PEDS 25 GM MAX),,414130,LOCAL,Facility,Outpatient,10,mL,,81,68.85,23.2146,81,PrimeWest Health,Minnesota Senior Health Options (MSHO),41.6745,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
DEXTROSE 25 % IN WATER (D25W) IV SYRG (PEDS 25 GM MAX),,414130,LOCAL,Facility,Inpatient,10,mL,,81,68.85,23.2146,81,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DEXTROSE 25 % IN WATER (D25W) IV SYRG (PEDS 25 GM MAX),,414130,LOCAL,Facility,Outpatient,10,mL,,81,68.85,23.2146,81,PrimeWest Health,MinnesotaCare,41.6016,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
DEXTROSE 25 % IN WATER (D25W) IV SYRG (PEDS 25 GM MAX),,414130,LOCAL,Facility,Inpatient,10,mL,,81,68.85,23.2146,81,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
DEXTROSE 25 % IN WATER (D25W) IV SYRG (PEDS 25 GM MAX),,414130,LOCAL,Facility,Both,10,mL,,81,68.85,23.2146,81,Sanford Health Plan,Sanford Health Plan,74.52,92,,percent of total billed charges,,
DEXTROSE 25 % IN WATER (D25W) IV SYRG (PEDS 25 GM MAX),,414130,LOCAL,Facility,Outpatient,10,mL,,81,68.85,23.2146,81,"UCare Health, Inc.",Individual & Family Plan,45.6435,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
DEXTROSE 25 % IN WATER (D25W) IV SYRG (PEDS 25 GM MAX),,414130,LOCAL,Facility,Inpatient,10,mL,,81,68.85,23.2146,81,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
DEXTROSE 25 % IN WATER (D25W) IV SYRG (PEDS 25 GM MAX),,414130,LOCAL,Facility,Outpatient,10,mL,,81,68.85,23.2146,81,"UCare Health, Inc.",Medical Assistance,40.8807,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DEXTROSE 25 % IN WATER (D25W) IV SYRG (PEDS 25 GM MAX),,414130,LOCAL,Facility,Inpatient,10,mL,,81,68.85,23.2146,81,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
DEXTROSE 25 % IN WATER (D25W) IV SYRG (PEDS 25 GM MAX),,414130,LOCAL,Facility,Outpatient,10,mL,,81,68.85,23.2146,81,"UCare Health, Inc.",Medicare Advantage,40.8807,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DEXTROSE 25 % IN WATER (D25W) IV SYRG (PEDS 25 GM MAX),,414130,LOCAL,Facility,Inpatient,10,mL,,81,68.85,23.2146,81,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DEXTROSE 25 % IN WATER (D25W) IV SYRG (PEDS 25 GM MAX),,414130,LOCAL,Facility,Outpatient,10,mL,,81,68.85,23.2146,81,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),40.8807,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DEXTROSE 25 % IN WATER (D25W) IV SYRG (PEDS 25 GM MAX),,414130,LOCAL,Facility,Inpatient,10,mL,,81,68.85,23.2146,81,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DEXTROSE 25 % IN WATER (D25W) IV SYRG (PEDS 25 GM MAX),,414130,LOCAL,Facility,Both,10,mL,,81,68.85,23.2146,81,UnitedHealthcare,Individual & Family,76.14,94,,percent of total billed charges,,
DEXTROSE 25 % IN WATER (D25W) IV SYRG (PEDS 25 GM MAX),,414130,LOCAL,Facility,Outpatient,10,mL,,81,68.85,23.2146,81,UnitedHealthcare,Medicare Advantage,39.69,49,,percent of total billed charges,,
DEXTROSE 25 % IN WATER (D25W) IV SYRG (PEDS 25 GM MAX),,414130,LOCAL,Facility,Inpatient,10,mL,,81,68.85,23.2146,81,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
DEXTROSE 25 % IN WATER (D25W) IV SYRG (PEDS 25 GM MAX),,414130,LOCAL,Facility,Outpatient,10,mL,,81,68.85,23.2146,81,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,38.88,48,,percent of total billed charges,,100% of DHS outpatient percentage
DEXTROSE 25 % IN WATER (D25W) IV SYRG (PEDS 25 GM MAX),,414130,LOCAL,Facility,Inpatient,10,mL,,81,68.85,23.2146,81,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Us Chest,,76604,CPT,Facility,Both,,,,449,381.65,128.6834,449,Aetna,Commercial,413.08,92,,percent of total billed charges,,
Us Chest,,76604,CPT,Facility,Outpatient,,,,449,381.65,128.6834,449,Aetna,Medicare Advantage,220.01,49,,percent of total billed charges,,
Us Chest,,76604,CPT,Facility,Inpatient,,,,449,381.65,128.6834,449,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Us Chest,,76604,CPT,Facility,Both,,,,449,381.65,128.6834,449,Aetna,PPO,417.57,93,,percent of total billed charges,,
Us Chest,,76604,CPT,Facility,Both,,,,449,381.65,128.6834,449,America's PPO,America's PPO,431.1747,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Us Chest,,76604,CPT,Facility,Both,,,,449,381.65,128.6834,449,BlueCross BlueShield Minnesota, Federal Employee Program,441.816,98.4,,percent of total billed charges,,
Us Chest,,76604,CPT,Facility,Both,,,,449,381.65,128.6834,449,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,449,100,,percent of total billed charges,,
Us Chest,,76604,CPT,Facility,Both,,,,449,381.65,128.6834,449,BlueCross BlueShield Minnesota,High Value Network Plan,404.1,90,,percent of total billed charges,,
Us Chest,,76604,CPT,Facility,Outpatient,,,,449,381.65,128.6834,449,BlueCross BlueShield Minnesota,Medicare Advantage,220.01,49,,percent of total billed charges,,
Us Chest,,76604,CPT,Facility,Inpatient,,,,449,381.65,128.6834,449,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Us Chest,,76604,CPT,Facility,Both,,,,449,381.65,128.6834,449,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,397.6793,88.57,,percent of total billed charges,,
Us Chest,,76604,CPT,Facility,Both,,,,449,381.65,128.6834,449,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,128.6834,28.66,,percent of total billed charges,,
Us Chest,,76604,CPT,Facility,Outpatient,,,,449,381.65,128.6834,449,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),220.01,49,,percent of total billed charges,,
Us Chest,,76604,CPT,Facility,Inpatient,,,,449,381.65,128.6834,449,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Us Chest,,76604,CPT,Facility,Both,,,,449,381.65,128.6834,449,CorVel,Worker's Compensation,449,100,,percent of total billed charges,,
Us Chest,,76604,CPT,Facility,Both,,,,449,381.65,128.6834,449,First Health Group Corporation,First Health Network,435.53,97,,percent of total billed charges,,
Us Chest,,76604,CPT,Facility,Both,,,,449,381.65,128.6834,449,"Health Partners, Inc.",Commercial,424.754,94.6,,percent of total billed charges,,
Us Chest,,76604,CPT,Facility,Outpatient,,,,449,381.65,128.6834,449,"Health Partners, Inc.",Medicare Advantage,220.01,49,,percent of total billed charges,,
Us Chest,,76604,CPT,Facility,Inpatient,,,,449,381.65,128.6834,449,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Us Chest,,76604,CPT,Facility,Both,,,,449,381.65,128.6834,449,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),269.4,60,,percent of total billed charges,,
Us Chest,,76604,CPT,Facility,Both,,,,449,381.65,128.6834,449,"Health Partners, Inc.",State of Minnesota Advantage Program,365.935,81.5,,percent of total billed charges,,
Us Chest,,76604,CPT,Facility,Both,,,,449,381.65,128.6834,449,"Health Partners, Inc.",State Public Programs,224.5,50,,percent of total billed charges,,
Us Chest,,76604,CPT,Facility,Both,,,,449,381.65,128.6834,449,Humana Insurance Company,Commercial PPO,426.55,95,,percent of total billed charges,,
Us Chest,,76604,CPT,Facility,Outpatient,,,,449,381.65,128.6834,449,Humana Insurance Company,Medicare PPO,220.01,49,,percent of total billed charges,,
Us Chest,,76604,CPT,Facility,Inpatient,,,,449,381.65,128.6834,449,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Us Chest,,76604,CPT,Facility,Both,,,,449,381.65,128.6834,449,Medica,Individual & Family,444.959,99.1,,percent of total billed charges,,
Us Chest,,76604,CPT,Facility,Outpatient,,,,449,381.65,128.6834,449,Medica,Medica Advantage Solution,223.602,49.8,,percent of total billed charges,,
Us Chest,,76604,CPT,Facility,Inpatient,,,,449,381.65,128.6834,449,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Us Chest,,76604,CPT,Facility,Outpatient,,,,449,381.65,128.6834,449,Medica,Medical Assistance,200.254,44.6,,percent of total billed charges,,
Us Chest,,76604,CPT,Facility,Inpatient,,,,449,381.65,128.6834,449,Medica,Medical Assistance,,,,,Included in per diem rate,
Us Chest,,76604,CPT,Facility,Outpatient,,,,449,381.65,128.6834,449,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,223.602,49.8,,percent of total billed charges,,
Us Chest,,76604,CPT,Facility,Inpatient,,,,449,381.65,128.6834,449,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Us Chest,,76604,CPT,Facility,Both,,,,449,381.65,128.6834,449,"Multiplan, Inc.","Multiplan, Inc.",422.06,94,,percent of total billed charges,,
Us Chest,,76604,CPT,Facility,Outpatient,,,,449,381.65,128.6834,449,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,404.549,90.1,,percent of total billed charges,,
Us Chest,,76604,CPT,Facility,Inpatient,,,,449,381.65,128.6834,449,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Us Chest,,76604,CPT,Facility,Both,,,,449,381.65,128.6834,449,"Preferred One Administrative Services, INC.",PPO,442.714,98.6,,percent of total billed charges,,
Us Chest,,76604,CPT,Facility,Outpatient,,,,449,381.65,128.6834,449,PrimeWest Health,Minnesota Senior Health Options (MSHO),231.0105,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Us Chest,,76604,CPT,Facility,Inpatient,,,,449,381.65,128.6834,449,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Us Chest,,76604,CPT,Facility,Outpatient,,,,449,381.65,128.6834,449,PrimeWest Health,MinnesotaCare,230.6064,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Us Chest,,76604,CPT,Facility,Inpatient,,,,449,381.65,128.6834,449,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Us Chest,,76604,CPT,Facility,Both,,,,449,381.65,128.6834,449,Sanford Health Plan,Sanford Health Plan,413.08,92,,percent of total billed charges,,
Us Chest,,76604,CPT,Facility,Outpatient,,,,449,381.65,128.6834,449,"UCare Health, Inc.",Individual & Family Plan,253.0115,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Us Chest,,76604,CPT,Facility,Inpatient,,,,449,381.65,128.6834,449,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Us Chest,,76604,CPT,Facility,Outpatient,,,,449,381.65,128.6834,449,"UCare Health, Inc.",Medical Assistance,226.6103,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Chest,,76604,CPT,Facility,Inpatient,,,,449,381.65,128.6834,449,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Us Chest,,76604,CPT,Facility,Outpatient,,,,449,381.65,128.6834,449,"UCare Health, Inc.",Medicare Advantage,226.6103,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Chest,,76604,CPT,Facility,Inpatient,,,,449,381.65,128.6834,449,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Us Chest,,76604,CPT,Facility,Outpatient,,,,449,381.65,128.6834,449,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),226.6103,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Chest,,76604,CPT,Facility,Inpatient,,,,449,381.65,128.6834,449,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Us Chest,,76604,CPT,Facility,Both,,,,449,381.65,128.6834,449,UnitedHealthcare,Individual & Family,422.06,94,,percent of total billed charges,,
Us Chest,,76604,CPT,Facility,Outpatient,,,,449,381.65,128.6834,449,UnitedHealthcare,Medicare Advantage,220.01,49,,percent of total billed charges,,
Us Chest,,76604,CPT,Facility,Inpatient,,,,449,381.65,128.6834,449,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Us Chest,,76604,CPT,Facility,Outpatient,,,,449,381.65,128.6834,449,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,215.52,48,,percent of total billed charges,,100% of DHS outpatient percentage
Us Chest,,76604,CPT,Facility,Inpatient,,,,449,381.65,128.6834,449,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Us Breast Sage Unilateral Complete,,76641,CPT,Facility,Both,,,,447,379.95,128.1102,447,Aetna,Commercial,411.24,92,,percent of total billed charges,,
Us Breast Sage Unilateral Complete,,76641,CPT,Facility,Outpatient,,,,447,379.95,128.1102,447,Aetna,Medicare Advantage,219.03,49,,percent of total billed charges,,
Us Breast Sage Unilateral Complete,,76641,CPT,Facility,Inpatient,,,,447,379.95,128.1102,447,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Us Breast Sage Unilateral Complete,,76641,CPT,Facility,Both,,,,447,379.95,128.1102,447,Aetna,PPO,415.71,93,,percent of total billed charges,,
Us Breast Sage Unilateral Complete,,76641,CPT,Facility,Both,,,,447,379.95,128.1102,447,America's PPO,America's PPO,429.2541,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Us Breast Sage Unilateral Complete,,76641,CPT,Facility,Both,,,,447,379.95,128.1102,447,BlueCross BlueShield Minnesota, Federal Employee Program,439.848,98.4,,percent of total billed charges,,
Us Breast Sage Unilateral Complete,,76641,CPT,Facility,Both,,,,447,379.95,128.1102,447,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,447,100,,percent of total billed charges,,
Us Breast Sage Unilateral Complete,,76641,CPT,Facility,Both,,,,447,379.95,128.1102,447,BlueCross BlueShield Minnesota,High Value Network Plan,402.3,90,,percent of total billed charges,,
Us Breast Sage Unilateral Complete,,76641,CPT,Facility,Outpatient,,,,447,379.95,128.1102,447,BlueCross BlueShield Minnesota,Medicare Advantage,219.03,49,,percent of total billed charges,,
Us Breast Sage Unilateral Complete,,76641,CPT,Facility,Inpatient,,,,447,379.95,128.1102,447,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Us Breast Sage Unilateral Complete,,76641,CPT,Facility,Both,,,,447,379.95,128.1102,447,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,395.9079,88.57,,percent of total billed charges,,
Us Breast Sage Unilateral Complete,,76641,CPT,Facility,Both,,,,447,379.95,128.1102,447,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,128.1102,28.66,,percent of total billed charges,,
Us Breast Sage Unilateral Complete,,76641,CPT,Facility,Outpatient,,,,447,379.95,128.1102,447,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),219.03,49,,percent of total billed charges,,
Us Breast Sage Unilateral Complete,,76641,CPT,Facility,Inpatient,,,,447,379.95,128.1102,447,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Us Breast Sage Unilateral Complete,,76641,CPT,Facility,Both,,,,447,379.95,128.1102,447,CorVel,Worker's Compensation,447,100,,percent of total billed charges,,
Us Breast Sage Unilateral Complete,,76641,CPT,Facility,Both,,,,447,379.95,128.1102,447,First Health Group Corporation,First Health Network,433.59,97,,percent of total billed charges,,
Us Breast Sage Unilateral Complete,,76641,CPT,Facility,Both,,,,447,379.95,128.1102,447,"Health Partners, Inc.",Commercial,422.862,94.6,,percent of total billed charges,,
Us Breast Sage Unilateral Complete,,76641,CPT,Facility,Outpatient,,,,447,379.95,128.1102,447,"Health Partners, Inc.",Medicare Advantage,219.03,49,,percent of total billed charges,,
Us Breast Sage Unilateral Complete,,76641,CPT,Facility,Inpatient,,,,447,379.95,128.1102,447,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Us Breast Sage Unilateral Complete,,76641,CPT,Facility,Both,,,,447,379.95,128.1102,447,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),268.2,60,,percent of total billed charges,,
Us Breast Sage Unilateral Complete,,76641,CPT,Facility,Both,,,,447,379.95,128.1102,447,"Health Partners, Inc.",State of Minnesota Advantage Program,364.305,81.5,,percent of total billed charges,,
Us Breast Sage Unilateral Complete,,76641,CPT,Facility,Both,,,,447,379.95,128.1102,447,"Health Partners, Inc.",State Public Programs,223.5,50,,percent of total billed charges,,
Us Breast Sage Unilateral Complete,,76641,CPT,Facility,Both,,,,447,379.95,128.1102,447,Humana Insurance Company,Commercial PPO,424.65,95,,percent of total billed charges,,
Us Breast Sage Unilateral Complete,,76641,CPT,Facility,Outpatient,,,,447,379.95,128.1102,447,Humana Insurance Company,Medicare PPO,219.03,49,,percent of total billed charges,,
Us Breast Sage Unilateral Complete,,76641,CPT,Facility,Inpatient,,,,447,379.95,128.1102,447,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Us Breast Sage Unilateral Complete,,76641,CPT,Facility,Both,,,,447,379.95,128.1102,447,Medica,Individual & Family,442.977,99.1,,percent of total billed charges,,
Us Breast Sage Unilateral Complete,,76641,CPT,Facility,Outpatient,,,,447,379.95,128.1102,447,Medica,Medica Advantage Solution,222.606,49.8,,percent of total billed charges,,
Us Breast Sage Unilateral Complete,,76641,CPT,Facility,Inpatient,,,,447,379.95,128.1102,447,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Us Breast Sage Unilateral Complete,,76641,CPT,Facility,Outpatient,,,,447,379.95,128.1102,447,Medica,Medical Assistance,199.362,44.6,,percent of total billed charges,,
Us Breast Sage Unilateral Complete,,76641,CPT,Facility,Inpatient,,,,447,379.95,128.1102,447,Medica,Medical Assistance,,,,,Included in per diem rate,
Us Breast Sage Unilateral Complete,,76641,CPT,Facility,Outpatient,,,,447,379.95,128.1102,447,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,222.606,49.8,,percent of total billed charges,,
Us Breast Sage Unilateral Complete,,76641,CPT,Facility,Inpatient,,,,447,379.95,128.1102,447,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Us Breast Sage Unilateral Complete,,76641,CPT,Facility,Both,,,,447,379.95,128.1102,447,"Multiplan, Inc.","Multiplan, Inc.",420.18,94,,percent of total billed charges,,
Us Breast Sage Unilateral Complete,,76641,CPT,Facility,Outpatient,,,,447,379.95,128.1102,447,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,402.747,90.1,,percent of total billed charges,,
Us Breast Sage Unilateral Complete,,76641,CPT,Facility,Inpatient,,,,447,379.95,128.1102,447,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Us Breast Sage Unilateral Complete,,76641,CPT,Facility,Both,,,,447,379.95,128.1102,447,"Preferred One Administrative Services, INC.",PPO,440.742,98.6,,percent of total billed charges,,
Us Breast Sage Unilateral Complete,,76641,CPT,Facility,Outpatient,,,,447,379.95,128.1102,447,PrimeWest Health,Minnesota Senior Health Options (MSHO),229.9815,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Us Breast Sage Unilateral Complete,,76641,CPT,Facility,Inpatient,,,,447,379.95,128.1102,447,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Us Breast Sage Unilateral Complete,,76641,CPT,Facility,Outpatient,,,,447,379.95,128.1102,447,PrimeWest Health,MinnesotaCare,229.5792,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Us Breast Sage Unilateral Complete,,76641,CPT,Facility,Inpatient,,,,447,379.95,128.1102,447,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Us Breast Sage Unilateral Complete,,76641,CPT,Facility,Both,,,,447,379.95,128.1102,447,Sanford Health Plan,Sanford Health Plan,411.24,92,,percent of total billed charges,,
Us Breast Sage Unilateral Complete,,76641,CPT,Facility,Outpatient,,,,447,379.95,128.1102,447,"UCare Health, Inc.",Individual & Family Plan,251.8845,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Us Breast Sage Unilateral Complete,,76641,CPT,Facility,Inpatient,,,,447,379.95,128.1102,447,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Us Breast Sage Unilateral Complete,,76641,CPT,Facility,Outpatient,,,,447,379.95,128.1102,447,"UCare Health, Inc.",Medical Assistance,225.6009,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Breast Sage Unilateral Complete,,76641,CPT,Facility,Inpatient,,,,447,379.95,128.1102,447,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Us Breast Sage Unilateral Complete,,76641,CPT,Facility,Outpatient,,,,447,379.95,128.1102,447,"UCare Health, Inc.",Medicare Advantage,225.6009,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Breast Sage Unilateral Complete,,76641,CPT,Facility,Inpatient,,,,447,379.95,128.1102,447,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Us Breast Sage Unilateral Complete,,76641,CPT,Facility,Outpatient,,,,447,379.95,128.1102,447,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),225.6009,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Breast Sage Unilateral Complete,,76641,CPT,Facility,Inpatient,,,,447,379.95,128.1102,447,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Us Breast Sage Unilateral Complete,,76641,CPT,Facility,Both,,,,447,379.95,128.1102,447,UnitedHealthcare,Individual & Family,420.18,94,,percent of total billed charges,,
Us Breast Sage Unilateral Complete,,76641,CPT,Facility,Outpatient,,,,447,379.95,128.1102,447,UnitedHealthcare,Medicare Advantage,219.03,49,,percent of total billed charges,,
Us Breast Sage Unilateral Complete,,76641,CPT,Facility,Inpatient,,,,447,379.95,128.1102,447,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Us Breast Sage Unilateral Complete,,76641,CPT,Facility,Outpatient,,,,447,379.95,128.1102,447,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,214.56,48,,percent of total billed charges,,100% of DHS outpatient percentage
Us Breast Sage Unilateral Complete,,76641,CPT,Facility,Inpatient,,,,447,379.95,128.1102,447,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Us Breast Unilateral Complete,,76641,CPT,Facility,Both,,,,447,379.95,128.1102,447,Aetna,Commercial,411.24,92,,percent of total billed charges,,
Us Breast Unilateral Complete,,76641,CPT,Facility,Outpatient,,,,447,379.95,128.1102,447,Aetna,Medicare Advantage,219.03,49,,percent of total billed charges,,
Us Breast Unilateral Complete,,76641,CPT,Facility,Inpatient,,,,447,379.95,128.1102,447,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Us Breast Unilateral Complete,,76641,CPT,Facility,Both,,,,447,379.95,128.1102,447,Aetna,PPO,415.71,93,,percent of total billed charges,,
Us Breast Unilateral Complete,,76641,CPT,Facility,Both,,,,447,379.95,128.1102,447,America's PPO,America's PPO,429.2541,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Us Breast Unilateral Complete,,76641,CPT,Facility,Both,,,,447,379.95,128.1102,447,BlueCross BlueShield Minnesota, Federal Employee Program,439.848,98.4,,percent of total billed charges,,
Us Breast Unilateral Complete,,76641,CPT,Facility,Both,,,,447,379.95,128.1102,447,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,447,100,,percent of total billed charges,,
Us Breast Unilateral Complete,,76641,CPT,Facility,Both,,,,447,379.95,128.1102,447,BlueCross BlueShield Minnesota,High Value Network Plan,402.3,90,,percent of total billed charges,,
Us Breast Unilateral Complete,,76641,CPT,Facility,Outpatient,,,,447,379.95,128.1102,447,BlueCross BlueShield Minnesota,Medicare Advantage,219.03,49,,percent of total billed charges,,
Us Breast Unilateral Complete,,76641,CPT,Facility,Inpatient,,,,447,379.95,128.1102,447,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Us Breast Unilateral Complete,,76641,CPT,Facility,Both,,,,447,379.95,128.1102,447,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,395.9079,88.57,,percent of total billed charges,,
Us Breast Unilateral Complete,,76641,CPT,Facility,Both,,,,447,379.95,128.1102,447,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,128.1102,28.66,,percent of total billed charges,,
Us Breast Unilateral Complete,,76641,CPT,Facility,Outpatient,,,,447,379.95,128.1102,447,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),219.03,49,,percent of total billed charges,,
Us Breast Unilateral Complete,,76641,CPT,Facility,Inpatient,,,,447,379.95,128.1102,447,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Us Breast Unilateral Complete,,76641,CPT,Facility,Both,,,,447,379.95,128.1102,447,CorVel,Worker's Compensation,447,100,,percent of total billed charges,,
Us Breast Unilateral Complete,,76641,CPT,Facility,Both,,,,447,379.95,128.1102,447,First Health Group Corporation,First Health Network,433.59,97,,percent of total billed charges,,
Us Breast Unilateral Complete,,76641,CPT,Facility,Both,,,,447,379.95,128.1102,447,"Health Partners, Inc.",Commercial,422.862,94.6,,percent of total billed charges,,
Us Breast Unilateral Complete,,76641,CPT,Facility,Outpatient,,,,447,379.95,128.1102,447,"Health Partners, Inc.",Medicare Advantage,219.03,49,,percent of total billed charges,,
Us Breast Unilateral Complete,,76641,CPT,Facility,Inpatient,,,,447,379.95,128.1102,447,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Us Breast Unilateral Complete,,76641,CPT,Facility,Both,,,,447,379.95,128.1102,447,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),268.2,60,,percent of total billed charges,,
Us Breast Unilateral Complete,,76641,CPT,Facility,Both,,,,447,379.95,128.1102,447,"Health Partners, Inc.",State of Minnesota Advantage Program,364.305,81.5,,percent of total billed charges,,
Us Breast Unilateral Complete,,76641,CPT,Facility,Both,,,,447,379.95,128.1102,447,"Health Partners, Inc.",State Public Programs,223.5,50,,percent of total billed charges,,
Us Breast Unilateral Complete,,76641,CPT,Facility,Both,,,,447,379.95,128.1102,447,Humana Insurance Company,Commercial PPO,424.65,95,,percent of total billed charges,,
Us Breast Unilateral Complete,,76641,CPT,Facility,Outpatient,,,,447,379.95,128.1102,447,Humana Insurance Company,Medicare PPO,219.03,49,,percent of total billed charges,,
Us Breast Unilateral Complete,,76641,CPT,Facility,Inpatient,,,,447,379.95,128.1102,447,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Us Breast Unilateral Complete,,76641,CPT,Facility,Both,,,,447,379.95,128.1102,447,Medica,Individual & Family,442.977,99.1,,percent of total billed charges,,
Us Breast Unilateral Complete,,76641,CPT,Facility,Outpatient,,,,447,379.95,128.1102,447,Medica,Medica Advantage Solution,222.606,49.8,,percent of total billed charges,,
Us Breast Unilateral Complete,,76641,CPT,Facility,Inpatient,,,,447,379.95,128.1102,447,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Us Breast Unilateral Complete,,76641,CPT,Facility,Outpatient,,,,447,379.95,128.1102,447,Medica,Medical Assistance,199.362,44.6,,percent of total billed charges,,
Us Breast Unilateral Complete,,76641,CPT,Facility,Inpatient,,,,447,379.95,128.1102,447,Medica,Medical Assistance,,,,,Included in per diem rate,
Us Breast Unilateral Complete,,76641,CPT,Facility,Outpatient,,,,447,379.95,128.1102,447,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,222.606,49.8,,percent of total billed charges,,
Us Breast Unilateral Complete,,76641,CPT,Facility,Inpatient,,,,447,379.95,128.1102,447,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Us Breast Unilateral Complete,,76641,CPT,Facility,Both,,,,447,379.95,128.1102,447,"Multiplan, Inc.","Multiplan, Inc.",420.18,94,,percent of total billed charges,,
Us Breast Unilateral Complete,,76641,CPT,Facility,Outpatient,,,,447,379.95,128.1102,447,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,402.747,90.1,,percent of total billed charges,,
Us Breast Unilateral Complete,,76641,CPT,Facility,Inpatient,,,,447,379.95,128.1102,447,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Us Breast Unilateral Complete,,76641,CPT,Facility,Both,,,,447,379.95,128.1102,447,"Preferred One Administrative Services, INC.",PPO,440.742,98.6,,percent of total billed charges,,
Us Breast Unilateral Complete,,76641,CPT,Facility,Outpatient,,,,447,379.95,128.1102,447,PrimeWest Health,Minnesota Senior Health Options (MSHO),229.9815,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Us Breast Unilateral Complete,,76641,CPT,Facility,Inpatient,,,,447,379.95,128.1102,447,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Us Breast Unilateral Complete,,76641,CPT,Facility,Outpatient,,,,447,379.95,128.1102,447,PrimeWest Health,MinnesotaCare,229.5792,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Us Breast Unilateral Complete,,76641,CPT,Facility,Inpatient,,,,447,379.95,128.1102,447,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Us Breast Unilateral Complete,,76641,CPT,Facility,Both,,,,447,379.95,128.1102,447,Sanford Health Plan,Sanford Health Plan,411.24,92,,percent of total billed charges,,
Us Breast Unilateral Complete,,76641,CPT,Facility,Outpatient,,,,447,379.95,128.1102,447,"UCare Health, Inc.",Individual & Family Plan,251.8845,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Us Breast Unilateral Complete,,76641,CPT,Facility,Inpatient,,,,447,379.95,128.1102,447,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Us Breast Unilateral Complete,,76641,CPT,Facility,Outpatient,,,,447,379.95,128.1102,447,"UCare Health, Inc.",Medical Assistance,225.6009,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Breast Unilateral Complete,,76641,CPT,Facility,Inpatient,,,,447,379.95,128.1102,447,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Us Breast Unilateral Complete,,76641,CPT,Facility,Outpatient,,,,447,379.95,128.1102,447,"UCare Health, Inc.",Medicare Advantage,225.6009,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Breast Unilateral Complete,,76641,CPT,Facility,Inpatient,,,,447,379.95,128.1102,447,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Us Breast Unilateral Complete,,76641,CPT,Facility,Outpatient,,,,447,379.95,128.1102,447,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),225.6009,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Breast Unilateral Complete,,76641,CPT,Facility,Inpatient,,,,447,379.95,128.1102,447,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Us Breast Unilateral Complete,,76641,CPT,Facility,Both,,,,447,379.95,128.1102,447,UnitedHealthcare,Individual & Family,420.18,94,,percent of total billed charges,,
Us Breast Unilateral Complete,,76641,CPT,Facility,Outpatient,,,,447,379.95,128.1102,447,UnitedHealthcare,Medicare Advantage,219.03,49,,percent of total billed charges,,
Us Breast Unilateral Complete,,76641,CPT,Facility,Inpatient,,,,447,379.95,128.1102,447,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Us Breast Unilateral Complete,,76641,CPT,Facility,Outpatient,,,,447,379.95,128.1102,447,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,214.56,48,,percent of total billed charges,,100% of DHS outpatient percentage
Us Breast Unilateral Complete,,76641,CPT,Facility,Inpatient,,,,447,379.95,128.1102,447,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Us Breast Sage Unilateral Limited,,76642,CPT,Facility,Both,,,,477,405.45,136.7082,477,Aetna,Commercial,438.84,92,,percent of total billed charges,,
Us Breast Sage Unilateral Limited,,76642,CPT,Facility,Outpatient,,,,477,405.45,136.7082,477,Aetna,Medicare Advantage,233.73,49,,percent of total billed charges,,
Us Breast Sage Unilateral Limited,,76642,CPT,Facility,Inpatient,,,,477,405.45,136.7082,477,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Us Breast Sage Unilateral Limited,,76642,CPT,Facility,Both,,,,477,405.45,136.7082,477,Aetna,PPO,443.61,93,,percent of total billed charges,,
Us Breast Sage Unilateral Limited,,76642,CPT,Facility,Both,,,,477,405.45,136.7082,477,America's PPO,America's PPO,458.0631,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Us Breast Sage Unilateral Limited,,76642,CPT,Facility,Both,,,,477,405.45,136.7082,477,BlueCross BlueShield Minnesota, Federal Employee Program,469.368,98.4,,percent of total billed charges,,
Us Breast Sage Unilateral Limited,,76642,CPT,Facility,Both,,,,477,405.45,136.7082,477,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,477,100,,percent of total billed charges,,
Us Breast Sage Unilateral Limited,,76642,CPT,Facility,Both,,,,477,405.45,136.7082,477,BlueCross BlueShield Minnesota,High Value Network Plan,429.3,90,,percent of total billed charges,,
Us Breast Sage Unilateral Limited,,76642,CPT,Facility,Outpatient,,,,477,405.45,136.7082,477,BlueCross BlueShield Minnesota,Medicare Advantage,233.73,49,,percent of total billed charges,,
Us Breast Sage Unilateral Limited,,76642,CPT,Facility,Inpatient,,,,477,405.45,136.7082,477,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Us Breast Sage Unilateral Limited,,76642,CPT,Facility,Both,,,,477,405.45,136.7082,477,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,422.4789,88.57,,percent of total billed charges,,
Us Breast Sage Unilateral Limited,,76642,CPT,Facility,Both,,,,477,405.45,136.7082,477,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,136.7082,28.66,,percent of total billed charges,,
Us Breast Sage Unilateral Limited,,76642,CPT,Facility,Outpatient,,,,477,405.45,136.7082,477,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),233.73,49,,percent of total billed charges,,
Us Breast Sage Unilateral Limited,,76642,CPT,Facility,Inpatient,,,,477,405.45,136.7082,477,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Us Breast Sage Unilateral Limited,,76642,CPT,Facility,Both,,,,477,405.45,136.7082,477,CorVel,Worker's Compensation,477,100,,percent of total billed charges,,
Us Breast Sage Unilateral Limited,,76642,CPT,Facility,Both,,,,477,405.45,136.7082,477,First Health Group Corporation,First Health Network,462.69,97,,percent of total billed charges,,
Us Breast Sage Unilateral Limited,,76642,CPT,Facility,Both,,,,477,405.45,136.7082,477,"Health Partners, Inc.",Commercial,451.242,94.6,,percent of total billed charges,,
Us Breast Sage Unilateral Limited,,76642,CPT,Facility,Outpatient,,,,477,405.45,136.7082,477,"Health Partners, Inc.",Medicare Advantage,233.73,49,,percent of total billed charges,,
Us Breast Sage Unilateral Limited,,76642,CPT,Facility,Inpatient,,,,477,405.45,136.7082,477,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Us Breast Sage Unilateral Limited,,76642,CPT,Facility,Both,,,,477,405.45,136.7082,477,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),286.2,60,,percent of total billed charges,,
Us Breast Sage Unilateral Limited,,76642,CPT,Facility,Both,,,,477,405.45,136.7082,477,"Health Partners, Inc.",State of Minnesota Advantage Program,388.755,81.5,,percent of total billed charges,,
Us Breast Sage Unilateral Limited,,76642,CPT,Facility,Both,,,,477,405.45,136.7082,477,"Health Partners, Inc.",State Public Programs,238.5,50,,percent of total billed charges,,
Us Breast Sage Unilateral Limited,,76642,CPT,Facility,Both,,,,477,405.45,136.7082,477,Humana Insurance Company,Commercial PPO,453.15,95,,percent of total billed charges,,
Us Breast Sage Unilateral Limited,,76642,CPT,Facility,Outpatient,,,,477,405.45,136.7082,477,Humana Insurance Company,Medicare PPO,233.73,49,,percent of total billed charges,,
Us Breast Sage Unilateral Limited,,76642,CPT,Facility,Inpatient,,,,477,405.45,136.7082,477,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Us Breast Sage Unilateral Limited,,76642,CPT,Facility,Both,,,,477,405.45,136.7082,477,Medica,Individual & Family,472.707,99.1,,percent of total billed charges,,
Us Breast Sage Unilateral Limited,,76642,CPT,Facility,Outpatient,,,,477,405.45,136.7082,477,Medica,Medica Advantage Solution,237.546,49.8,,percent of total billed charges,,
Us Breast Sage Unilateral Limited,,76642,CPT,Facility,Inpatient,,,,477,405.45,136.7082,477,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Us Breast Sage Unilateral Limited,,76642,CPT,Facility,Outpatient,,,,477,405.45,136.7082,477,Medica,Medical Assistance,212.742,44.6,,percent of total billed charges,,
Us Breast Sage Unilateral Limited,,76642,CPT,Facility,Inpatient,,,,477,405.45,136.7082,477,Medica,Medical Assistance,,,,,Included in per diem rate,
Us Breast Sage Unilateral Limited,,76642,CPT,Facility,Outpatient,,,,477,405.45,136.7082,477,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,237.546,49.8,,percent of total billed charges,,
Us Breast Sage Unilateral Limited,,76642,CPT,Facility,Inpatient,,,,477,405.45,136.7082,477,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Us Breast Sage Unilateral Limited,,76642,CPT,Facility,Both,,,,477,405.45,136.7082,477,"Multiplan, Inc.","Multiplan, Inc.",448.38,94,,percent of total billed charges,,
Us Breast Sage Unilateral Limited,,76642,CPT,Facility,Outpatient,,,,477,405.45,136.7082,477,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,429.777,90.1,,percent of total billed charges,,
Us Breast Sage Unilateral Limited,,76642,CPT,Facility,Inpatient,,,,477,405.45,136.7082,477,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Us Breast Sage Unilateral Limited,,76642,CPT,Facility,Both,,,,477,405.45,136.7082,477,"Preferred One Administrative Services, INC.",PPO,470.322,98.6,,percent of total billed charges,,
Us Breast Sage Unilateral Limited,,76642,CPT,Facility,Outpatient,,,,477,405.45,136.7082,477,PrimeWest Health,Minnesota Senior Health Options (MSHO),245.4165,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Us Breast Sage Unilateral Limited,,76642,CPT,Facility,Inpatient,,,,477,405.45,136.7082,477,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Us Breast Sage Unilateral Limited,,76642,CPT,Facility,Outpatient,,,,477,405.45,136.7082,477,PrimeWest Health,MinnesotaCare,244.9872,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Us Breast Sage Unilateral Limited,,76642,CPT,Facility,Inpatient,,,,477,405.45,136.7082,477,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Us Breast Sage Unilateral Limited,,76642,CPT,Facility,Both,,,,477,405.45,136.7082,477,Sanford Health Plan,Sanford Health Plan,438.84,92,,percent of total billed charges,,
Us Breast Sage Unilateral Limited,,76642,CPT,Facility,Outpatient,,,,477,405.45,136.7082,477,"UCare Health, Inc.",Individual & Family Plan,268.7895,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Us Breast Sage Unilateral Limited,,76642,CPT,Facility,Inpatient,,,,477,405.45,136.7082,477,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Us Breast Sage Unilateral Limited,,76642,CPT,Facility,Outpatient,,,,477,405.45,136.7082,477,"UCare Health, Inc.",Medical Assistance,240.7419,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Breast Sage Unilateral Limited,,76642,CPT,Facility,Inpatient,,,,477,405.45,136.7082,477,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Us Breast Sage Unilateral Limited,,76642,CPT,Facility,Outpatient,,,,477,405.45,136.7082,477,"UCare Health, Inc.",Medicare Advantage,240.7419,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Breast Sage Unilateral Limited,,76642,CPT,Facility,Inpatient,,,,477,405.45,136.7082,477,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Us Breast Sage Unilateral Limited,,76642,CPT,Facility,Outpatient,,,,477,405.45,136.7082,477,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),240.7419,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Breast Sage Unilateral Limited,,76642,CPT,Facility,Inpatient,,,,477,405.45,136.7082,477,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Us Breast Sage Unilateral Limited,,76642,CPT,Facility,Both,,,,477,405.45,136.7082,477,UnitedHealthcare,Individual & Family,448.38,94,,percent of total billed charges,,
Us Breast Sage Unilateral Limited,,76642,CPT,Facility,Outpatient,,,,477,405.45,136.7082,477,UnitedHealthcare,Medicare Advantage,233.73,49,,percent of total billed charges,,
Us Breast Sage Unilateral Limited,,76642,CPT,Facility,Inpatient,,,,477,405.45,136.7082,477,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Us Breast Sage Unilateral Limited,,76642,CPT,Facility,Outpatient,,,,477,405.45,136.7082,477,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,228.96,48,,percent of total billed charges,,100% of DHS outpatient percentage
Us Breast Sage Unilateral Limited,,76642,CPT,Facility,Inpatient,,,,477,405.45,136.7082,477,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Us Breast Unilateral Limited,,76642,CPT,Facility,Both,,,,437,371.45,125.2442,437,Aetna,Commercial,402.04,92,,percent of total billed charges,,
Us Breast Unilateral Limited,,76642,CPT,Facility,Outpatient,,,,437,371.45,125.2442,437,Aetna,Medicare Advantage,214.13,49,,percent of total billed charges,,
Us Breast Unilateral Limited,,76642,CPT,Facility,Inpatient,,,,437,371.45,125.2442,437,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Us Breast Unilateral Limited,,76642,CPT,Facility,Both,,,,437,371.45,125.2442,437,Aetna,PPO,406.41,93,,percent of total billed charges,,
Us Breast Unilateral Limited,,76642,CPT,Facility,Both,,,,437,371.45,125.2442,437,America's PPO,America's PPO,419.6511,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Us Breast Unilateral Limited,,76642,CPT,Facility,Both,,,,437,371.45,125.2442,437,BlueCross BlueShield Minnesota, Federal Employee Program,430.008,98.4,,percent of total billed charges,,
Us Breast Unilateral Limited,,76642,CPT,Facility,Both,,,,437,371.45,125.2442,437,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,437,100,,percent of total billed charges,,
Us Breast Unilateral Limited,,76642,CPT,Facility,Both,,,,437,371.45,125.2442,437,BlueCross BlueShield Minnesota,High Value Network Plan,393.3,90,,percent of total billed charges,,
Us Breast Unilateral Limited,,76642,CPT,Facility,Outpatient,,,,437,371.45,125.2442,437,BlueCross BlueShield Minnesota,Medicare Advantage,214.13,49,,percent of total billed charges,,
Us Breast Unilateral Limited,,76642,CPT,Facility,Inpatient,,,,437,371.45,125.2442,437,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Us Breast Unilateral Limited,,76642,CPT,Facility,Both,,,,437,371.45,125.2442,437,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,387.0509,88.57,,percent of total billed charges,,
Us Breast Unilateral Limited,,76642,CPT,Facility,Both,,,,437,371.45,125.2442,437,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,125.2442,28.66,,percent of total billed charges,,
Us Breast Unilateral Limited,,76642,CPT,Facility,Outpatient,,,,437,371.45,125.2442,437,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),214.13,49,,percent of total billed charges,,
Us Breast Unilateral Limited,,76642,CPT,Facility,Inpatient,,,,437,371.45,125.2442,437,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Us Breast Unilateral Limited,,76642,CPT,Facility,Both,,,,437,371.45,125.2442,437,CorVel,Worker's Compensation,437,100,,percent of total billed charges,,
Us Breast Unilateral Limited,,76642,CPT,Facility,Both,,,,437,371.45,125.2442,437,First Health Group Corporation,First Health Network,423.89,97,,percent of total billed charges,,
Us Breast Unilateral Limited,,76642,CPT,Facility,Both,,,,437,371.45,125.2442,437,"Health Partners, Inc.",Commercial,413.402,94.6,,percent of total billed charges,,
Us Breast Unilateral Limited,,76642,CPT,Facility,Outpatient,,,,437,371.45,125.2442,437,"Health Partners, Inc.",Medicare Advantage,214.13,49,,percent of total billed charges,,
Us Breast Unilateral Limited,,76642,CPT,Facility,Inpatient,,,,437,371.45,125.2442,437,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Us Breast Unilateral Limited,,76642,CPT,Facility,Both,,,,437,371.45,125.2442,437,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),262.2,60,,percent of total billed charges,,
Us Breast Unilateral Limited,,76642,CPT,Facility,Both,,,,437,371.45,125.2442,437,"Health Partners, Inc.",State of Minnesota Advantage Program,356.155,81.5,,percent of total billed charges,,
Us Breast Unilateral Limited,,76642,CPT,Facility,Both,,,,437,371.45,125.2442,437,"Health Partners, Inc.",State Public Programs,218.5,50,,percent of total billed charges,,
Us Breast Unilateral Limited,,76642,CPT,Facility,Both,,,,437,371.45,125.2442,437,Humana Insurance Company,Commercial PPO,415.15,95,,percent of total billed charges,,
Us Breast Unilateral Limited,,76642,CPT,Facility,Outpatient,,,,437,371.45,125.2442,437,Humana Insurance Company,Medicare PPO,214.13,49,,percent of total billed charges,,
Us Breast Unilateral Limited,,76642,CPT,Facility,Inpatient,,,,437,371.45,125.2442,437,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Us Breast Unilateral Limited,,76642,CPT,Facility,Both,,,,437,371.45,125.2442,437,Medica,Individual & Family,433.067,99.1,,percent of total billed charges,,
Us Breast Unilateral Limited,,76642,CPT,Facility,Outpatient,,,,437,371.45,125.2442,437,Medica,Medica Advantage Solution,217.626,49.8,,percent of total billed charges,,
Us Breast Unilateral Limited,,76642,CPT,Facility,Inpatient,,,,437,371.45,125.2442,437,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Us Breast Unilateral Limited,,76642,CPT,Facility,Outpatient,,,,437,371.45,125.2442,437,Medica,Medical Assistance,194.902,44.6,,percent of total billed charges,,
Us Breast Unilateral Limited,,76642,CPT,Facility,Inpatient,,,,437,371.45,125.2442,437,Medica,Medical Assistance,,,,,Included in per diem rate,
Us Breast Unilateral Limited,,76642,CPT,Facility,Outpatient,,,,437,371.45,125.2442,437,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,217.626,49.8,,percent of total billed charges,,
Us Breast Unilateral Limited,,76642,CPT,Facility,Inpatient,,,,437,371.45,125.2442,437,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Us Breast Unilateral Limited,,76642,CPT,Facility,Both,,,,437,371.45,125.2442,437,"Multiplan, Inc.","Multiplan, Inc.",410.78,94,,percent of total billed charges,,
Us Breast Unilateral Limited,,76642,CPT,Facility,Outpatient,,,,437,371.45,125.2442,437,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,393.737,90.1,,percent of total billed charges,,
Us Breast Unilateral Limited,,76642,CPT,Facility,Inpatient,,,,437,371.45,125.2442,437,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Us Breast Unilateral Limited,,76642,CPT,Facility,Both,,,,437,371.45,125.2442,437,"Preferred One Administrative Services, INC.",PPO,430.882,98.6,,percent of total billed charges,,
Us Breast Unilateral Limited,,76642,CPT,Facility,Outpatient,,,,437,371.45,125.2442,437,PrimeWest Health,Minnesota Senior Health Options (MSHO),224.8365,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Us Breast Unilateral Limited,,76642,CPT,Facility,Inpatient,,,,437,371.45,125.2442,437,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Us Breast Unilateral Limited,,76642,CPT,Facility,Outpatient,,,,437,371.45,125.2442,437,PrimeWest Health,MinnesotaCare,224.4432,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Us Breast Unilateral Limited,,76642,CPT,Facility,Inpatient,,,,437,371.45,125.2442,437,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Us Breast Unilateral Limited,,76642,CPT,Facility,Both,,,,437,371.45,125.2442,437,Sanford Health Plan,Sanford Health Plan,402.04,92,,percent of total billed charges,,
Us Breast Unilateral Limited,,76642,CPT,Facility,Outpatient,,,,437,371.45,125.2442,437,"UCare Health, Inc.",Individual & Family Plan,246.2495,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Us Breast Unilateral Limited,,76642,CPT,Facility,Inpatient,,,,437,371.45,125.2442,437,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Us Breast Unilateral Limited,,76642,CPT,Facility,Outpatient,,,,437,371.45,125.2442,437,"UCare Health, Inc.",Medical Assistance,220.5539,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Breast Unilateral Limited,,76642,CPT,Facility,Inpatient,,,,437,371.45,125.2442,437,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Us Breast Unilateral Limited,,76642,CPT,Facility,Outpatient,,,,437,371.45,125.2442,437,"UCare Health, Inc.",Medicare Advantage,220.5539,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Breast Unilateral Limited,,76642,CPT,Facility,Inpatient,,,,437,371.45,125.2442,437,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Us Breast Unilateral Limited,,76642,CPT,Facility,Outpatient,,,,437,371.45,125.2442,437,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),220.5539,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Breast Unilateral Limited,,76642,CPT,Facility,Inpatient,,,,437,371.45,125.2442,437,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Us Breast Unilateral Limited,,76642,CPT,Facility,Both,,,,437,371.45,125.2442,437,UnitedHealthcare,Individual & Family,410.78,94,,percent of total billed charges,,
Us Breast Unilateral Limited,,76642,CPT,Facility,Outpatient,,,,437,371.45,125.2442,437,UnitedHealthcare,Medicare Advantage,214.13,49,,percent of total billed charges,,
Us Breast Unilateral Limited,,76642,CPT,Facility,Inpatient,,,,437,371.45,125.2442,437,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Us Breast Unilateral Limited,,76642,CPT,Facility,Outpatient,,,,437,371.45,125.2442,437,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,209.76,48,,percent of total billed charges,,100% of DHS outpatient percentage
Us Breast Unilateral Limited,,76642,CPT,Facility,Inpatient,,,,437,371.45,125.2442,437,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Us Abd Complete,,76700,CPT,Facility,Both,,,,581,493.85,166.5146,581,Aetna,Commercial,534.52,92,,percent of total billed charges,,
Us Abd Complete,,76700,CPT,Facility,Outpatient,,,,581,493.85,166.5146,581,Aetna,Medicare Advantage,284.69,49,,percent of total billed charges,,
Us Abd Complete,,76700,CPT,Facility,Inpatient,,,,581,493.85,166.5146,581,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Us Abd Complete,,76700,CPT,Facility,Both,,,,581,493.85,166.5146,581,Aetna,PPO,540.33,93,,percent of total billed charges,,
Us Abd Complete,,76700,CPT,Facility,Both,,,,581,493.85,166.5146,581,America's PPO,America's PPO,557.9343,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Us Abd Complete,,76700,CPT,Facility,Both,,,,581,493.85,166.5146,581,BlueCross BlueShield Minnesota, Federal Employee Program,571.704,98.4,,percent of total billed charges,,
Us Abd Complete,,76700,CPT,Facility,Both,,,,581,493.85,166.5146,581,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,581,100,,percent of total billed charges,,
Us Abd Complete,,76700,CPT,Facility,Both,,,,581,493.85,166.5146,581,BlueCross BlueShield Minnesota,High Value Network Plan,522.9,90,,percent of total billed charges,,
Us Abd Complete,,76700,CPT,Facility,Outpatient,,,,581,493.85,166.5146,581,BlueCross BlueShield Minnesota,Medicare Advantage,284.69,49,,percent of total billed charges,,
Us Abd Complete,,76700,CPT,Facility,Inpatient,,,,581,493.85,166.5146,581,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Us Abd Complete,,76700,CPT,Facility,Both,,,,581,493.85,166.5146,581,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,514.5917,88.57,,percent of total billed charges,,
Us Abd Complete,,76700,CPT,Facility,Both,,,,581,493.85,166.5146,581,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,166.5146,28.66,,percent of total billed charges,,
Us Abd Complete,,76700,CPT,Facility,Outpatient,,,,581,493.85,166.5146,581,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),284.69,49,,percent of total billed charges,,
Us Abd Complete,,76700,CPT,Facility,Inpatient,,,,581,493.85,166.5146,581,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Us Abd Complete,,76700,CPT,Facility,Both,,,,581,493.85,166.5146,581,CorVel,Worker's Compensation,581,100,,percent of total billed charges,,
Us Abd Complete,,76700,CPT,Facility,Both,,,,581,493.85,166.5146,581,First Health Group Corporation,First Health Network,563.57,97,,percent of total billed charges,,
Us Abd Complete,,76700,CPT,Facility,Both,,,,581,493.85,166.5146,581,"Health Partners, Inc.",Commercial,549.626,94.6,,percent of total billed charges,,
Us Abd Complete,,76700,CPT,Facility,Outpatient,,,,581,493.85,166.5146,581,"Health Partners, Inc.",Medicare Advantage,284.69,49,,percent of total billed charges,,
Us Abd Complete,,76700,CPT,Facility,Inpatient,,,,581,493.85,166.5146,581,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Us Abd Complete,,76700,CPT,Facility,Both,,,,581,493.85,166.5146,581,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),348.6,60,,percent of total billed charges,,
Us Abd Complete,,76700,CPT,Facility,Both,,,,581,493.85,166.5146,581,"Health Partners, Inc.",State of Minnesota Advantage Program,473.515,81.5,,percent of total billed charges,,
Us Abd Complete,,76700,CPT,Facility,Both,,,,581,493.85,166.5146,581,"Health Partners, Inc.",State Public Programs,290.5,50,,percent of total billed charges,,
Us Abd Complete,,76700,CPT,Facility,Both,,,,581,493.85,166.5146,581,Humana Insurance Company,Commercial PPO,551.95,95,,percent of total billed charges,,
Us Abd Complete,,76700,CPT,Facility,Outpatient,,,,581,493.85,166.5146,581,Humana Insurance Company,Medicare PPO,284.69,49,,percent of total billed charges,,
Us Abd Complete,,76700,CPT,Facility,Inpatient,,,,581,493.85,166.5146,581,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Us Abd Complete,,76700,CPT,Facility,Both,,,,581,493.85,166.5146,581,Medica,Individual & Family,575.771,99.1,,percent of total billed charges,,
Us Abd Complete,,76700,CPT,Facility,Outpatient,,,,581,493.85,166.5146,581,Medica,Medica Advantage Solution,289.338,49.8,,percent of total billed charges,,
Us Abd Complete,,76700,CPT,Facility,Inpatient,,,,581,493.85,166.5146,581,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Us Abd Complete,,76700,CPT,Facility,Outpatient,,,,581,493.85,166.5146,581,Medica,Medical Assistance,259.126,44.6,,percent of total billed charges,,
Us Abd Complete,,76700,CPT,Facility,Inpatient,,,,581,493.85,166.5146,581,Medica,Medical Assistance,,,,,Included in per diem rate,
Us Abd Complete,,76700,CPT,Facility,Outpatient,,,,581,493.85,166.5146,581,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,289.338,49.8,,percent of total billed charges,,
Us Abd Complete,,76700,CPT,Facility,Inpatient,,,,581,493.85,166.5146,581,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Us Abd Complete,,76700,CPT,Facility,Both,,,,581,493.85,166.5146,581,"Multiplan, Inc.","Multiplan, Inc.",546.14,94,,percent of total billed charges,,
Us Abd Complete,,76700,CPT,Facility,Outpatient,,,,581,493.85,166.5146,581,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,523.481,90.1,,percent of total billed charges,,
Us Abd Complete,,76700,CPT,Facility,Inpatient,,,,581,493.85,166.5146,581,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Us Abd Complete,,76700,CPT,Facility,Both,,,,581,493.85,166.5146,581,"Preferred One Administrative Services, INC.",PPO,572.866,98.6,,percent of total billed charges,,
Us Abd Complete,,76700,CPT,Facility,Outpatient,,,,581,493.85,166.5146,581,PrimeWest Health,Minnesota Senior Health Options (MSHO),298.9245,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Us Abd Complete,,76700,CPT,Facility,Inpatient,,,,581,493.85,166.5146,581,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Us Abd Complete,,76700,CPT,Facility,Outpatient,,,,581,493.85,166.5146,581,PrimeWest Health,MinnesotaCare,298.4016,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Us Abd Complete,,76700,CPT,Facility,Inpatient,,,,581,493.85,166.5146,581,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Us Abd Complete,,76700,CPT,Facility,Both,,,,581,493.85,166.5146,581,Sanford Health Plan,Sanford Health Plan,534.52,92,,percent of total billed charges,,
Us Abd Complete,,76700,CPT,Facility,Outpatient,,,,581,493.85,166.5146,581,"UCare Health, Inc.",Individual & Family Plan,327.3935,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Us Abd Complete,,76700,CPT,Facility,Inpatient,,,,581,493.85,166.5146,581,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Us Abd Complete,,76700,CPT,Facility,Outpatient,,,,581,493.85,166.5146,581,"UCare Health, Inc.",Medical Assistance,293.2307,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Abd Complete,,76700,CPT,Facility,Inpatient,,,,581,493.85,166.5146,581,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Us Abd Complete,,76700,CPT,Facility,Outpatient,,,,581,493.85,166.5146,581,"UCare Health, Inc.",Medicare Advantage,293.2307,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Abd Complete,,76700,CPT,Facility,Inpatient,,,,581,493.85,166.5146,581,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Us Abd Complete,,76700,CPT,Facility,Outpatient,,,,581,493.85,166.5146,581,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),293.2307,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Abd Complete,,76700,CPT,Facility,Inpatient,,,,581,493.85,166.5146,581,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Us Abd Complete,,76700,CPT,Facility,Both,,,,581,493.85,166.5146,581,UnitedHealthcare,Individual & Family,546.14,94,,percent of total billed charges,,
Us Abd Complete,,76700,CPT,Facility,Outpatient,,,,581,493.85,166.5146,581,UnitedHealthcare,Medicare Advantage,284.69,49,,percent of total billed charges,,
Us Abd Complete,,76700,CPT,Facility,Inpatient,,,,581,493.85,166.5146,581,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Us Abd Complete,,76700,CPT,Facility,Outpatient,,,,581,493.85,166.5146,581,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,278.88,48,,percent of total billed charges,,100% of DHS outpatient percentage
Us Abd Complete,,76700,CPT,Facility,Inpatient,,,,581,493.85,166.5146,581,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Us Abd Ltd,,76705,CPT,Facility,Both,,,,551,468.35,157.9166,551,Aetna,Commercial,506.92,92,,percent of total billed charges,,
Us Abd Ltd,,76705,CPT,Facility,Outpatient,,,,551,468.35,157.9166,551,Aetna,Medicare Advantage,269.99,49,,percent of total billed charges,,
Us Abd Ltd,,76705,CPT,Facility,Inpatient,,,,551,468.35,157.9166,551,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Us Abd Ltd,,76705,CPT,Facility,Both,,,,551,468.35,157.9166,551,Aetna,PPO,512.43,93,,percent of total billed charges,,
Us Abd Ltd,,76705,CPT,Facility,Both,,,,551,468.35,157.9166,551,America's PPO,America's PPO,529.1253,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Us Abd Ltd,,76705,CPT,Facility,Both,,,,551,468.35,157.9166,551,BlueCross BlueShield Minnesota, Federal Employee Program,542.184,98.4,,percent of total billed charges,,
Us Abd Ltd,,76705,CPT,Facility,Both,,,,551,468.35,157.9166,551,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,551,100,,percent of total billed charges,,
Us Abd Ltd,,76705,CPT,Facility,Both,,,,551,468.35,157.9166,551,BlueCross BlueShield Minnesota,High Value Network Plan,495.9,90,,percent of total billed charges,,
Us Abd Ltd,,76705,CPT,Facility,Outpatient,,,,551,468.35,157.9166,551,BlueCross BlueShield Minnesota,Medicare Advantage,269.99,49,,percent of total billed charges,,
Us Abd Ltd,,76705,CPT,Facility,Inpatient,,,,551,468.35,157.9166,551,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Us Abd Ltd,,76705,CPT,Facility,Both,,,,551,468.35,157.9166,551,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,488.0207,88.57,,percent of total billed charges,,
Us Abd Ltd,,76705,CPT,Facility,Both,,,,551,468.35,157.9166,551,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,157.9166,28.66,,percent of total billed charges,,
Us Abd Ltd,,76705,CPT,Facility,Outpatient,,,,551,468.35,157.9166,551,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),269.99,49,,percent of total billed charges,,
Us Abd Ltd,,76705,CPT,Facility,Inpatient,,,,551,468.35,157.9166,551,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Us Abd Ltd,,76705,CPT,Facility,Both,,,,551,468.35,157.9166,551,CorVel,Worker's Compensation,551,100,,percent of total billed charges,,
Us Abd Ltd,,76705,CPT,Facility,Both,,,,551,468.35,157.9166,551,First Health Group Corporation,First Health Network,534.47,97,,percent of total billed charges,,
Us Abd Ltd,,76705,CPT,Facility,Both,,,,551,468.35,157.9166,551,"Health Partners, Inc.",Commercial,521.246,94.6,,percent of total billed charges,,
Us Abd Ltd,,76705,CPT,Facility,Outpatient,,,,551,468.35,157.9166,551,"Health Partners, Inc.",Medicare Advantage,269.99,49,,percent of total billed charges,,
Us Abd Ltd,,76705,CPT,Facility,Inpatient,,,,551,468.35,157.9166,551,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Us Abd Ltd,,76705,CPT,Facility,Both,,,,551,468.35,157.9166,551,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),330.6,60,,percent of total billed charges,,
Us Abd Ltd,,76705,CPT,Facility,Both,,,,551,468.35,157.9166,551,"Health Partners, Inc.",State of Minnesota Advantage Program,449.065,81.5,,percent of total billed charges,,
Us Abd Ltd,,76705,CPT,Facility,Both,,,,551,468.35,157.9166,551,"Health Partners, Inc.",State Public Programs,275.5,50,,percent of total billed charges,,
Us Abd Ltd,,76705,CPT,Facility,Both,,,,551,468.35,157.9166,551,Humana Insurance Company,Commercial PPO,523.45,95,,percent of total billed charges,,
Us Abd Ltd,,76705,CPT,Facility,Outpatient,,,,551,468.35,157.9166,551,Humana Insurance Company,Medicare PPO,269.99,49,,percent of total billed charges,,
Us Abd Ltd,,76705,CPT,Facility,Inpatient,,,,551,468.35,157.9166,551,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Us Abd Ltd,,76705,CPT,Facility,Both,,,,551,468.35,157.9166,551,Medica,Individual & Family,546.041,99.1,,percent of total billed charges,,
Us Abd Ltd,,76705,CPT,Facility,Outpatient,,,,551,468.35,157.9166,551,Medica,Medica Advantage Solution,274.398,49.8,,percent of total billed charges,,
Us Abd Ltd,,76705,CPT,Facility,Inpatient,,,,551,468.35,157.9166,551,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Us Abd Ltd,,76705,CPT,Facility,Outpatient,,,,551,468.35,157.9166,551,Medica,Medical Assistance,245.746,44.6,,percent of total billed charges,,
Us Abd Ltd,,76705,CPT,Facility,Inpatient,,,,551,468.35,157.9166,551,Medica,Medical Assistance,,,,,Included in per diem rate,
Us Abd Ltd,,76705,CPT,Facility,Outpatient,,,,551,468.35,157.9166,551,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,274.398,49.8,,percent of total billed charges,,
Us Abd Ltd,,76705,CPT,Facility,Inpatient,,,,551,468.35,157.9166,551,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Us Abd Ltd,,76705,CPT,Facility,Both,,,,551,468.35,157.9166,551,"Multiplan, Inc.","Multiplan, Inc.",517.94,94,,percent of total billed charges,,
Us Abd Ltd,,76705,CPT,Facility,Outpatient,,,,551,468.35,157.9166,551,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,496.451,90.1,,percent of total billed charges,,
Us Abd Ltd,,76705,CPT,Facility,Inpatient,,,,551,468.35,157.9166,551,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Us Abd Ltd,,76705,CPT,Facility,Both,,,,551,468.35,157.9166,551,"Preferred One Administrative Services, INC.",PPO,543.286,98.6,,percent of total billed charges,,
Us Abd Ltd,,76705,CPT,Facility,Outpatient,,,,551,468.35,157.9166,551,PrimeWest Health,Minnesota Senior Health Options (MSHO),283.4895,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Us Abd Ltd,,76705,CPT,Facility,Inpatient,,,,551,468.35,157.9166,551,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Us Abd Ltd,,76705,CPT,Facility,Outpatient,,,,551,468.35,157.9166,551,PrimeWest Health,MinnesotaCare,282.9936,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Us Abd Ltd,,76705,CPT,Facility,Inpatient,,,,551,468.35,157.9166,551,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Us Abd Ltd,,76705,CPT,Facility,Both,,,,551,468.35,157.9166,551,Sanford Health Plan,Sanford Health Plan,506.92,92,,percent of total billed charges,,
Us Abd Ltd,,76705,CPT,Facility,Outpatient,,,,551,468.35,157.9166,551,"UCare Health, Inc.",Individual & Family Plan,310.4885,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Us Abd Ltd,,76705,CPT,Facility,Inpatient,,,,551,468.35,157.9166,551,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Us Abd Ltd,,76705,CPT,Facility,Outpatient,,,,551,468.35,157.9166,551,"UCare Health, Inc.",Medical Assistance,278.0897,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Abd Ltd,,76705,CPT,Facility,Inpatient,,,,551,468.35,157.9166,551,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Us Abd Ltd,,76705,CPT,Facility,Outpatient,,,,551,468.35,157.9166,551,"UCare Health, Inc.",Medicare Advantage,278.0897,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Abd Ltd,,76705,CPT,Facility,Inpatient,,,,551,468.35,157.9166,551,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Us Abd Ltd,,76705,CPT,Facility,Outpatient,,,,551,468.35,157.9166,551,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),278.0897,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Abd Ltd,,76705,CPT,Facility,Inpatient,,,,551,468.35,157.9166,551,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Us Abd Ltd,,76705,CPT,Facility,Both,,,,551,468.35,157.9166,551,UnitedHealthcare,Individual & Family,517.94,94,,percent of total billed charges,,
Us Abd Ltd,,76705,CPT,Facility,Outpatient,,,,551,468.35,157.9166,551,UnitedHealthcare,Medicare Advantage,269.99,49,,percent of total billed charges,,
Us Abd Ltd,,76705,CPT,Facility,Inpatient,,,,551,468.35,157.9166,551,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Us Abd Ltd,,76705,CPT,Facility,Outpatient,,,,551,468.35,157.9166,551,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,264.48,48,,percent of total billed charges,,100% of DHS outpatient percentage
Us Abd Ltd,,76705,CPT,Facility,Inpatient,,,,551,468.35,157.9166,551,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Us Abd Ruq,,76705,CPT,Facility,Both,,,,551,468.35,157.9166,551,Aetna,Commercial,506.92,92,,percent of total billed charges,,
Us Abd Ruq,,76705,CPT,Facility,Outpatient,,,,551,468.35,157.9166,551,Aetna,Medicare Advantage,269.99,49,,percent of total billed charges,,
Us Abd Ruq,,76705,CPT,Facility,Inpatient,,,,551,468.35,157.9166,551,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Us Abd Ruq,,76705,CPT,Facility,Both,,,,551,468.35,157.9166,551,Aetna,PPO,512.43,93,,percent of total billed charges,,
Us Abd Ruq,,76705,CPT,Facility,Both,,,,551,468.35,157.9166,551,America's PPO,America's PPO,529.1253,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Us Abd Ruq,,76705,CPT,Facility,Both,,,,551,468.35,157.9166,551,BlueCross BlueShield Minnesota, Federal Employee Program,542.184,98.4,,percent of total billed charges,,
Us Abd Ruq,,76705,CPT,Facility,Both,,,,551,468.35,157.9166,551,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,551,100,,percent of total billed charges,,
Us Abd Ruq,,76705,CPT,Facility,Both,,,,551,468.35,157.9166,551,BlueCross BlueShield Minnesota,High Value Network Plan,495.9,90,,percent of total billed charges,,
Us Abd Ruq,,76705,CPT,Facility,Outpatient,,,,551,468.35,157.9166,551,BlueCross BlueShield Minnesota,Medicare Advantage,269.99,49,,percent of total billed charges,,
Us Abd Ruq,,76705,CPT,Facility,Inpatient,,,,551,468.35,157.9166,551,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Us Abd Ruq,,76705,CPT,Facility,Both,,,,551,468.35,157.9166,551,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,488.0207,88.57,,percent of total billed charges,,
Us Abd Ruq,,76705,CPT,Facility,Both,,,,551,468.35,157.9166,551,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,157.9166,28.66,,percent of total billed charges,,
Us Abd Ruq,,76705,CPT,Facility,Outpatient,,,,551,468.35,157.9166,551,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),269.99,49,,percent of total billed charges,,
Us Abd Ruq,,76705,CPT,Facility,Inpatient,,,,551,468.35,157.9166,551,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Us Abd Ruq,,76705,CPT,Facility,Both,,,,551,468.35,157.9166,551,CorVel,Worker's Compensation,551,100,,percent of total billed charges,,
Us Abd Ruq,,76705,CPT,Facility,Both,,,,551,468.35,157.9166,551,First Health Group Corporation,First Health Network,534.47,97,,percent of total billed charges,,
Us Abd Ruq,,76705,CPT,Facility,Both,,,,551,468.35,157.9166,551,"Health Partners, Inc.",Commercial,521.246,94.6,,percent of total billed charges,,
Us Abd Ruq,,76705,CPT,Facility,Outpatient,,,,551,468.35,157.9166,551,"Health Partners, Inc.",Medicare Advantage,269.99,49,,percent of total billed charges,,
Us Abd Ruq,,76705,CPT,Facility,Inpatient,,,,551,468.35,157.9166,551,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Us Abd Ruq,,76705,CPT,Facility,Both,,,,551,468.35,157.9166,551,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),330.6,60,,percent of total billed charges,,
Us Abd Ruq,,76705,CPT,Facility,Both,,,,551,468.35,157.9166,551,"Health Partners, Inc.",State of Minnesota Advantage Program,449.065,81.5,,percent of total billed charges,,
Us Abd Ruq,,76705,CPT,Facility,Both,,,,551,468.35,157.9166,551,"Health Partners, Inc.",State Public Programs,275.5,50,,percent of total billed charges,,
Us Abd Ruq,,76705,CPT,Facility,Both,,,,551,468.35,157.9166,551,Humana Insurance Company,Commercial PPO,523.45,95,,percent of total billed charges,,
Us Abd Ruq,,76705,CPT,Facility,Outpatient,,,,551,468.35,157.9166,551,Humana Insurance Company,Medicare PPO,269.99,49,,percent of total billed charges,,
Us Abd Ruq,,76705,CPT,Facility,Inpatient,,,,551,468.35,157.9166,551,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Us Abd Ruq,,76705,CPT,Facility,Both,,,,551,468.35,157.9166,551,Medica,Individual & Family,546.041,99.1,,percent of total billed charges,,
Us Abd Ruq,,76705,CPT,Facility,Outpatient,,,,551,468.35,157.9166,551,Medica,Medica Advantage Solution,274.398,49.8,,percent of total billed charges,,
Us Abd Ruq,,76705,CPT,Facility,Inpatient,,,,551,468.35,157.9166,551,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Us Abd Ruq,,76705,CPT,Facility,Outpatient,,,,551,468.35,157.9166,551,Medica,Medical Assistance,245.746,44.6,,percent of total billed charges,,
Us Abd Ruq,,76705,CPT,Facility,Inpatient,,,,551,468.35,157.9166,551,Medica,Medical Assistance,,,,,Included in per diem rate,
Us Abd Ruq,,76705,CPT,Facility,Outpatient,,,,551,468.35,157.9166,551,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,274.398,49.8,,percent of total billed charges,,
Us Abd Ruq,,76705,CPT,Facility,Inpatient,,,,551,468.35,157.9166,551,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Us Abd Ruq,,76705,CPT,Facility,Both,,,,551,468.35,157.9166,551,"Multiplan, Inc.","Multiplan, Inc.",517.94,94,,percent of total billed charges,,
Us Abd Ruq,,76705,CPT,Facility,Outpatient,,,,551,468.35,157.9166,551,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,496.451,90.1,,percent of total billed charges,,
Us Abd Ruq,,76705,CPT,Facility,Inpatient,,,,551,468.35,157.9166,551,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Us Abd Ruq,,76705,CPT,Facility,Both,,,,551,468.35,157.9166,551,"Preferred One Administrative Services, INC.",PPO,543.286,98.6,,percent of total billed charges,,
Us Abd Ruq,,76705,CPT,Facility,Outpatient,,,,551,468.35,157.9166,551,PrimeWest Health,Minnesota Senior Health Options (MSHO),283.4895,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Us Abd Ruq,,76705,CPT,Facility,Inpatient,,,,551,468.35,157.9166,551,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Us Abd Ruq,,76705,CPT,Facility,Outpatient,,,,551,468.35,157.9166,551,PrimeWest Health,MinnesotaCare,282.9936,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Us Abd Ruq,,76705,CPT,Facility,Inpatient,,,,551,468.35,157.9166,551,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Us Abd Ruq,,76705,CPT,Facility,Both,,,,551,468.35,157.9166,551,Sanford Health Plan,Sanford Health Plan,506.92,92,,percent of total billed charges,,
Us Abd Ruq,,76705,CPT,Facility,Outpatient,,,,551,468.35,157.9166,551,"UCare Health, Inc.",Individual & Family Plan,310.4885,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Us Abd Ruq,,76705,CPT,Facility,Inpatient,,,,551,468.35,157.9166,551,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Us Abd Ruq,,76705,CPT,Facility,Outpatient,,,,551,468.35,157.9166,551,"UCare Health, Inc.",Medical Assistance,278.0897,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Abd Ruq,,76705,CPT,Facility,Inpatient,,,,551,468.35,157.9166,551,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Us Abd Ruq,,76705,CPT,Facility,Outpatient,,,,551,468.35,157.9166,551,"UCare Health, Inc.",Medicare Advantage,278.0897,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Abd Ruq,,76705,CPT,Facility,Inpatient,,,,551,468.35,157.9166,551,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Us Abd Ruq,,76705,CPT,Facility,Outpatient,,,,551,468.35,157.9166,551,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),278.0897,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Abd Ruq,,76705,CPT,Facility,Inpatient,,,,551,468.35,157.9166,551,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Us Abd Ruq,,76705,CPT,Facility,Both,,,,551,468.35,157.9166,551,UnitedHealthcare,Individual & Family,517.94,94,,percent of total billed charges,,
Us Abd Ruq,,76705,CPT,Facility,Outpatient,,,,551,468.35,157.9166,551,UnitedHealthcare,Medicare Advantage,269.99,49,,percent of total billed charges,,
Us Abd Ruq,,76705,CPT,Facility,Inpatient,,,,551,468.35,157.9166,551,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Us Abd Ruq,,76705,CPT,Facility,Outpatient,,,,551,468.35,157.9166,551,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,264.48,48,,percent of total billed charges,,100% of DHS outpatient percentage
Us Abd Ruq,,76705,CPT,Facility,Inpatient,,,,551,468.35,157.9166,551,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Us Aaa Screening Medicare Benefit,,76706,CPT,Facility,Both,,,,412,350.2,118.0792,412,Aetna,Commercial,379.04,92,,percent of total billed charges,,
Us Aaa Screening Medicare Benefit,,76706,CPT,Facility,Outpatient,,,,412,350.2,118.0792,412,Aetna,Medicare Advantage,201.88,49,,percent of total billed charges,,
Us Aaa Screening Medicare Benefit,,76706,CPT,Facility,Inpatient,,,,412,350.2,118.0792,412,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Us Aaa Screening Medicare Benefit,,76706,CPT,Facility,Both,,,,412,350.2,118.0792,412,Aetna,PPO,383.16,93,,percent of total billed charges,,
Us Aaa Screening Medicare Benefit,,76706,CPT,Facility,Both,,,,412,350.2,118.0792,412,America's PPO,America's PPO,395.6436,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Us Aaa Screening Medicare Benefit,,76706,CPT,Facility,Both,,,,412,350.2,118.0792,412,BlueCross BlueShield Minnesota, Federal Employee Program,405.408,98.4,,percent of total billed charges,,
Us Aaa Screening Medicare Benefit,,76706,CPT,Facility,Both,,,,412,350.2,118.0792,412,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,412,100,,percent of total billed charges,,
Us Aaa Screening Medicare Benefit,,76706,CPT,Facility,Both,,,,412,350.2,118.0792,412,BlueCross BlueShield Minnesota,High Value Network Plan,370.8,90,,percent of total billed charges,,
Us Aaa Screening Medicare Benefit,,76706,CPT,Facility,Outpatient,,,,412,350.2,118.0792,412,BlueCross BlueShield Minnesota,Medicare Advantage,201.88,49,,percent of total billed charges,,
Us Aaa Screening Medicare Benefit,,76706,CPT,Facility,Inpatient,,,,412,350.2,118.0792,412,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Us Aaa Screening Medicare Benefit,,76706,CPT,Facility,Both,,,,412,350.2,118.0792,412,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,364.9084,88.57,,percent of total billed charges,,
Us Aaa Screening Medicare Benefit,,76706,CPT,Facility,Both,,,,412,350.2,118.0792,412,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,118.0792,28.66,,percent of total billed charges,,
Us Aaa Screening Medicare Benefit,,76706,CPT,Facility,Outpatient,,,,412,350.2,118.0792,412,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),201.88,49,,percent of total billed charges,,
Us Aaa Screening Medicare Benefit,,76706,CPT,Facility,Inpatient,,,,412,350.2,118.0792,412,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Us Aaa Screening Medicare Benefit,,76706,CPT,Facility,Both,,,,412,350.2,118.0792,412,CorVel,Worker's Compensation,412,100,,percent of total billed charges,,
Us Aaa Screening Medicare Benefit,,76706,CPT,Facility,Both,,,,412,350.2,118.0792,412,First Health Group Corporation,First Health Network,399.64,97,,percent of total billed charges,,
Us Aaa Screening Medicare Benefit,,76706,CPT,Facility,Both,,,,412,350.2,118.0792,412,"Health Partners, Inc.",Commercial,389.752,94.6,,percent of total billed charges,,
Us Aaa Screening Medicare Benefit,,76706,CPT,Facility,Outpatient,,,,412,350.2,118.0792,412,"Health Partners, Inc.",Medicare Advantage,201.88,49,,percent of total billed charges,,
Us Aaa Screening Medicare Benefit,,76706,CPT,Facility,Inpatient,,,,412,350.2,118.0792,412,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Us Aaa Screening Medicare Benefit,,76706,CPT,Facility,Both,,,,412,350.2,118.0792,412,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),247.2,60,,percent of total billed charges,,
Us Aaa Screening Medicare Benefit,,76706,CPT,Facility,Both,,,,412,350.2,118.0792,412,"Health Partners, Inc.",State of Minnesota Advantage Program,335.78,81.5,,percent of total billed charges,,
Us Aaa Screening Medicare Benefit,,76706,CPT,Facility,Both,,,,412,350.2,118.0792,412,"Health Partners, Inc.",State Public Programs,206,50,,percent of total billed charges,,
Us Aaa Screening Medicare Benefit,,76706,CPT,Facility,Both,,,,412,350.2,118.0792,412,Humana Insurance Company,Commercial PPO,391.4,95,,percent of total billed charges,,
Us Aaa Screening Medicare Benefit,,76706,CPT,Facility,Outpatient,,,,412,350.2,118.0792,412,Humana Insurance Company,Medicare PPO,201.88,49,,percent of total billed charges,,
Us Aaa Screening Medicare Benefit,,76706,CPT,Facility,Inpatient,,,,412,350.2,118.0792,412,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Us Aaa Screening Medicare Benefit,,76706,CPT,Facility,Both,,,,412,350.2,118.0792,412,Medica,Individual & Family,408.292,99.1,,percent of total billed charges,,
Us Aaa Screening Medicare Benefit,,76706,CPT,Facility,Outpatient,,,,412,350.2,118.0792,412,Medica,Medica Advantage Solution,205.176,49.8,,percent of total billed charges,,
Us Aaa Screening Medicare Benefit,,76706,CPT,Facility,Inpatient,,,,412,350.2,118.0792,412,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Us Aaa Screening Medicare Benefit,,76706,CPT,Facility,Outpatient,,,,412,350.2,118.0792,412,Medica,Medical Assistance,183.752,44.6,,percent of total billed charges,,
Us Aaa Screening Medicare Benefit,,76706,CPT,Facility,Inpatient,,,,412,350.2,118.0792,412,Medica,Medical Assistance,,,,,Included in per diem rate,
Us Aaa Screening Medicare Benefit,,76706,CPT,Facility,Outpatient,,,,412,350.2,118.0792,412,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,205.176,49.8,,percent of total billed charges,,
Us Aaa Screening Medicare Benefit,,76706,CPT,Facility,Inpatient,,,,412,350.2,118.0792,412,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Us Aaa Screening Medicare Benefit,,76706,CPT,Facility,Both,,,,412,350.2,118.0792,412,"Multiplan, Inc.","Multiplan, Inc.",387.28,94,,percent of total billed charges,,
Us Aaa Screening Medicare Benefit,,76706,CPT,Facility,Outpatient,,,,412,350.2,118.0792,412,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,371.212,90.1,,percent of total billed charges,,
Us Aaa Screening Medicare Benefit,,76706,CPT,Facility,Inpatient,,,,412,350.2,118.0792,412,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Us Aaa Screening Medicare Benefit,,76706,CPT,Facility,Both,,,,412,350.2,118.0792,412,"Preferred One Administrative Services, INC.",PPO,406.232,98.6,,percent of total billed charges,,
Us Aaa Screening Medicare Benefit,,76706,CPT,Facility,Outpatient,,,,412,350.2,118.0792,412,PrimeWest Health,Minnesota Senior Health Options (MSHO),211.974,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Us Aaa Screening Medicare Benefit,,76706,CPT,Facility,Inpatient,,,,412,350.2,118.0792,412,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Us Aaa Screening Medicare Benefit,,76706,CPT,Facility,Outpatient,,,,412,350.2,118.0792,412,PrimeWest Health,MinnesotaCare,211.6032,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Us Aaa Screening Medicare Benefit,,76706,CPT,Facility,Inpatient,,,,412,350.2,118.0792,412,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Us Aaa Screening Medicare Benefit,,76706,CPT,Facility,Both,,,,412,350.2,118.0792,412,Sanford Health Plan,Sanford Health Plan,379.04,92,,percent of total billed charges,,
Us Aaa Screening Medicare Benefit,,76706,CPT,Facility,Outpatient,,,,412,350.2,118.0792,412,"UCare Health, Inc.",Individual & Family Plan,232.162,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Us Aaa Screening Medicare Benefit,,76706,CPT,Facility,Inpatient,,,,412,350.2,118.0792,412,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Us Aaa Screening Medicare Benefit,,76706,CPT,Facility,Outpatient,,,,412,350.2,118.0792,412,"UCare Health, Inc.",Medical Assistance,207.9364,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Aaa Screening Medicare Benefit,,76706,CPT,Facility,Inpatient,,,,412,350.2,118.0792,412,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Us Aaa Screening Medicare Benefit,,76706,CPT,Facility,Outpatient,,,,412,350.2,118.0792,412,"UCare Health, Inc.",Medicare Advantage,207.9364,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Aaa Screening Medicare Benefit,,76706,CPT,Facility,Inpatient,,,,412,350.2,118.0792,412,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Us Aaa Screening Medicare Benefit,,76706,CPT,Facility,Outpatient,,,,412,350.2,118.0792,412,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),207.9364,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Aaa Screening Medicare Benefit,,76706,CPT,Facility,Inpatient,,,,412,350.2,118.0792,412,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Us Aaa Screening Medicare Benefit,,76706,CPT,Facility,Both,,,,412,350.2,118.0792,412,UnitedHealthcare,Individual & Family,387.28,94,,percent of total billed charges,,
Us Aaa Screening Medicare Benefit,,76706,CPT,Facility,Outpatient,,,,412,350.2,118.0792,412,UnitedHealthcare,Medicare Advantage,201.88,49,,percent of total billed charges,,
Us Aaa Screening Medicare Benefit,,76706,CPT,Facility,Inpatient,,,,412,350.2,118.0792,412,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Us Aaa Screening Medicare Benefit,,76706,CPT,Facility,Outpatient,,,,412,350.2,118.0792,412,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,197.76,48,,percent of total billed charges,,100% of DHS outpatient percentage
Us Aaa Screening Medicare Benefit,,76706,CPT,Facility,Inpatient,,,,412,350.2,118.0792,412,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Retroperitoneal, Complete",,76770,CPT,Facility,Both,,,,551,468.35,157.9166,551,Aetna,Commercial,506.92,92,,percent of total billed charges,,
"Retroperitoneal, Complete",,76770,CPT,Facility,Outpatient,,,,551,468.35,157.9166,551,Aetna,Medicare Advantage,269.99,49,,percent of total billed charges,,
"Retroperitoneal, Complete",,76770,CPT,Facility,Inpatient,,,,551,468.35,157.9166,551,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Retroperitoneal, Complete",,76770,CPT,Facility,Both,,,,551,468.35,157.9166,551,Aetna,PPO,512.43,93,,percent of total billed charges,,
"Retroperitoneal, Complete",,76770,CPT,Facility,Both,,,,551,468.35,157.9166,551,America's PPO,America's PPO,529.1253,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Retroperitoneal, Complete",,76770,CPT,Facility,Both,,,,551,468.35,157.9166,551,BlueCross BlueShield Minnesota, Federal Employee Program,542.184,98.4,,percent of total billed charges,,
"Retroperitoneal, Complete",,76770,CPT,Facility,Both,,,,551,468.35,157.9166,551,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,551,100,,percent of total billed charges,,
"Retroperitoneal, Complete",,76770,CPT,Facility,Both,,,,551,468.35,157.9166,551,BlueCross BlueShield Minnesota,High Value Network Plan,495.9,90,,percent of total billed charges,,
"Retroperitoneal, Complete",,76770,CPT,Facility,Outpatient,,,,551,468.35,157.9166,551,BlueCross BlueShield Minnesota,Medicare Advantage,269.99,49,,percent of total billed charges,,
"Retroperitoneal, Complete",,76770,CPT,Facility,Inpatient,,,,551,468.35,157.9166,551,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Retroperitoneal, Complete",,76770,CPT,Facility,Both,,,,551,468.35,157.9166,551,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,488.0207,88.57,,percent of total billed charges,,
"Retroperitoneal, Complete",,76770,CPT,Facility,Both,,,,551,468.35,157.9166,551,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,157.9166,28.66,,percent of total billed charges,,
"Retroperitoneal, Complete",,76770,CPT,Facility,Outpatient,,,,551,468.35,157.9166,551,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),269.99,49,,percent of total billed charges,,
"Retroperitoneal, Complete",,76770,CPT,Facility,Inpatient,,,,551,468.35,157.9166,551,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Retroperitoneal, Complete",,76770,CPT,Facility,Both,,,,551,468.35,157.9166,551,CorVel,Worker's Compensation,551,100,,percent of total billed charges,,
"Retroperitoneal, Complete",,76770,CPT,Facility,Both,,,,551,468.35,157.9166,551,First Health Group Corporation,First Health Network,534.47,97,,percent of total billed charges,,
"Retroperitoneal, Complete",,76770,CPT,Facility,Both,,,,551,468.35,157.9166,551,"Health Partners, Inc.",Commercial,521.246,94.6,,percent of total billed charges,,
"Retroperitoneal, Complete",,76770,CPT,Facility,Outpatient,,,,551,468.35,157.9166,551,"Health Partners, Inc.",Medicare Advantage,269.99,49,,percent of total billed charges,,
"Retroperitoneal, Complete",,76770,CPT,Facility,Inpatient,,,,551,468.35,157.9166,551,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Retroperitoneal, Complete",,76770,CPT,Facility,Both,,,,551,468.35,157.9166,551,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),330.6,60,,percent of total billed charges,,
"Retroperitoneal, Complete",,76770,CPT,Facility,Both,,,,551,468.35,157.9166,551,"Health Partners, Inc.",State of Minnesota Advantage Program,449.065,81.5,,percent of total billed charges,,
"Retroperitoneal, Complete",,76770,CPT,Facility,Both,,,,551,468.35,157.9166,551,"Health Partners, Inc.",State Public Programs,275.5,50,,percent of total billed charges,,
"Retroperitoneal, Complete",,76770,CPT,Facility,Both,,,,551,468.35,157.9166,551,Humana Insurance Company,Commercial PPO,523.45,95,,percent of total billed charges,,
"Retroperitoneal, Complete",,76770,CPT,Facility,Outpatient,,,,551,468.35,157.9166,551,Humana Insurance Company,Medicare PPO,269.99,49,,percent of total billed charges,,
"Retroperitoneal, Complete",,76770,CPT,Facility,Inpatient,,,,551,468.35,157.9166,551,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Retroperitoneal, Complete",,76770,CPT,Facility,Both,,,,551,468.35,157.9166,551,Medica,Individual & Family,546.041,99.1,,percent of total billed charges,,
"Retroperitoneal, Complete",,76770,CPT,Facility,Outpatient,,,,551,468.35,157.9166,551,Medica,Medica Advantage Solution,274.398,49.8,,percent of total billed charges,,
"Retroperitoneal, Complete",,76770,CPT,Facility,Inpatient,,,,551,468.35,157.9166,551,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Retroperitoneal, Complete",,76770,CPT,Facility,Outpatient,,,,551,468.35,157.9166,551,Medica,Medical Assistance,245.746,44.6,,percent of total billed charges,,
"Retroperitoneal, Complete",,76770,CPT,Facility,Inpatient,,,,551,468.35,157.9166,551,Medica,Medical Assistance,,,,,Included in per diem rate,
"Retroperitoneal, Complete",,76770,CPT,Facility,Outpatient,,,,551,468.35,157.9166,551,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,274.398,49.8,,percent of total billed charges,,
"Retroperitoneal, Complete",,76770,CPT,Facility,Inpatient,,,,551,468.35,157.9166,551,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Retroperitoneal, Complete",,76770,CPT,Facility,Both,,,,551,468.35,157.9166,551,"Multiplan, Inc.","Multiplan, Inc.",517.94,94,,percent of total billed charges,,
"Retroperitoneal, Complete",,76770,CPT,Facility,Outpatient,,,,551,468.35,157.9166,551,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,496.451,90.1,,percent of total billed charges,,
"Retroperitoneal, Complete",,76770,CPT,Facility,Inpatient,,,,551,468.35,157.9166,551,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Retroperitoneal, Complete",,76770,CPT,Facility,Both,,,,551,468.35,157.9166,551,"Preferred One Administrative Services, INC.",PPO,543.286,98.6,,percent of total billed charges,,
"Retroperitoneal, Complete",,76770,CPT,Facility,Outpatient,,,,551,468.35,157.9166,551,PrimeWest Health,Minnesota Senior Health Options (MSHO),283.4895,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Retroperitoneal, Complete",,76770,CPT,Facility,Inpatient,,,,551,468.35,157.9166,551,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Retroperitoneal, Complete",,76770,CPT,Facility,Outpatient,,,,551,468.35,157.9166,551,PrimeWest Health,MinnesotaCare,282.9936,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Retroperitoneal, Complete",,76770,CPT,Facility,Inpatient,,,,551,468.35,157.9166,551,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Retroperitoneal, Complete",,76770,CPT,Facility,Both,,,,551,468.35,157.9166,551,Sanford Health Plan,Sanford Health Plan,506.92,92,,percent of total billed charges,,
"Retroperitoneal, Complete",,76770,CPT,Facility,Outpatient,,,,551,468.35,157.9166,551,"UCare Health, Inc.",Individual & Family Plan,310.4885,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Retroperitoneal, Complete",,76770,CPT,Facility,Inpatient,,,,551,468.35,157.9166,551,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Retroperitoneal, Complete",,76770,CPT,Facility,Outpatient,,,,551,468.35,157.9166,551,"UCare Health, Inc.",Medical Assistance,278.0897,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Retroperitoneal, Complete",,76770,CPT,Facility,Inpatient,,,,551,468.35,157.9166,551,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Retroperitoneal, Complete",,76770,CPT,Facility,Outpatient,,,,551,468.35,157.9166,551,"UCare Health, Inc.",Medicare Advantage,278.0897,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Retroperitoneal, Complete",,76770,CPT,Facility,Inpatient,,,,551,468.35,157.9166,551,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Retroperitoneal, Complete",,76770,CPT,Facility,Outpatient,,,,551,468.35,157.9166,551,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),278.0897,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Retroperitoneal, Complete",,76770,CPT,Facility,Inpatient,,,,551,468.35,157.9166,551,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Retroperitoneal, Complete",,76770,CPT,Facility,Both,,,,551,468.35,157.9166,551,UnitedHealthcare,Individual & Family,517.94,94,,percent of total billed charges,,
"Retroperitoneal, Complete",,76770,CPT,Facility,Outpatient,,,,551,468.35,157.9166,551,UnitedHealthcare,Medicare Advantage,269.99,49,,percent of total billed charges,,
"Retroperitoneal, Complete",,76770,CPT,Facility,Inpatient,,,,551,468.35,157.9166,551,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Retroperitoneal, Complete",,76770,CPT,Facility,Outpatient,,,,551,468.35,157.9166,551,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,264.48,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Retroperitoneal, Complete",,76770,CPT,Facility,Inpatient,,,,551,468.35,157.9166,551,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Us Renal Bil,,76770,CPT,Facility,Both,,,,551,468.35,157.9166,551,Aetna,Commercial,506.92,92,,percent of total billed charges,,
Us Renal Bil,,76770,CPT,Facility,Outpatient,,,,551,468.35,157.9166,551,Aetna,Medicare Advantage,269.99,49,,percent of total billed charges,,
Us Renal Bil,,76770,CPT,Facility,Inpatient,,,,551,468.35,157.9166,551,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Us Renal Bil,,76770,CPT,Facility,Both,,,,551,468.35,157.9166,551,Aetna,PPO,512.43,93,,percent of total billed charges,,
Us Renal Bil,,76770,CPT,Facility,Both,,,,551,468.35,157.9166,551,America's PPO,America's PPO,529.1253,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Us Renal Bil,,76770,CPT,Facility,Both,,,,551,468.35,157.9166,551,BlueCross BlueShield Minnesota, Federal Employee Program,542.184,98.4,,percent of total billed charges,,
Us Renal Bil,,76770,CPT,Facility,Both,,,,551,468.35,157.9166,551,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,551,100,,percent of total billed charges,,
Us Renal Bil,,76770,CPT,Facility,Both,,,,551,468.35,157.9166,551,BlueCross BlueShield Minnesota,High Value Network Plan,495.9,90,,percent of total billed charges,,
Us Renal Bil,,76770,CPT,Facility,Outpatient,,,,551,468.35,157.9166,551,BlueCross BlueShield Minnesota,Medicare Advantage,269.99,49,,percent of total billed charges,,
Us Renal Bil,,76770,CPT,Facility,Inpatient,,,,551,468.35,157.9166,551,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Us Renal Bil,,76770,CPT,Facility,Both,,,,551,468.35,157.9166,551,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,488.0207,88.57,,percent of total billed charges,,
Us Renal Bil,,76770,CPT,Facility,Both,,,,551,468.35,157.9166,551,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,157.9166,28.66,,percent of total billed charges,,
Us Renal Bil,,76770,CPT,Facility,Outpatient,,,,551,468.35,157.9166,551,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),269.99,49,,percent of total billed charges,,
Us Renal Bil,,76770,CPT,Facility,Inpatient,,,,551,468.35,157.9166,551,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Us Renal Bil,,76770,CPT,Facility,Both,,,,551,468.35,157.9166,551,CorVel,Worker's Compensation,551,100,,percent of total billed charges,,
Us Renal Bil,,76770,CPT,Facility,Both,,,,551,468.35,157.9166,551,First Health Group Corporation,First Health Network,534.47,97,,percent of total billed charges,,
Us Renal Bil,,76770,CPT,Facility,Both,,,,551,468.35,157.9166,551,"Health Partners, Inc.",Commercial,521.246,94.6,,percent of total billed charges,,
Us Renal Bil,,76770,CPT,Facility,Outpatient,,,,551,468.35,157.9166,551,"Health Partners, Inc.",Medicare Advantage,269.99,49,,percent of total billed charges,,
Us Renal Bil,,76770,CPT,Facility,Inpatient,,,,551,468.35,157.9166,551,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Us Renal Bil,,76770,CPT,Facility,Both,,,,551,468.35,157.9166,551,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),330.6,60,,percent of total billed charges,,
Us Renal Bil,,76770,CPT,Facility,Both,,,,551,468.35,157.9166,551,"Health Partners, Inc.",State of Minnesota Advantage Program,449.065,81.5,,percent of total billed charges,,
Us Renal Bil,,76770,CPT,Facility,Both,,,,551,468.35,157.9166,551,"Health Partners, Inc.",State Public Programs,275.5,50,,percent of total billed charges,,
Us Renal Bil,,76770,CPT,Facility,Both,,,,551,468.35,157.9166,551,Humana Insurance Company,Commercial PPO,523.45,95,,percent of total billed charges,,
Us Renal Bil,,76770,CPT,Facility,Outpatient,,,,551,468.35,157.9166,551,Humana Insurance Company,Medicare PPO,269.99,49,,percent of total billed charges,,
Us Renal Bil,,76770,CPT,Facility,Inpatient,,,,551,468.35,157.9166,551,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Us Renal Bil,,76770,CPT,Facility,Both,,,,551,468.35,157.9166,551,Medica,Individual & Family,546.041,99.1,,percent of total billed charges,,
Us Renal Bil,,76770,CPT,Facility,Outpatient,,,,551,468.35,157.9166,551,Medica,Medica Advantage Solution,274.398,49.8,,percent of total billed charges,,
Us Renal Bil,,76770,CPT,Facility,Inpatient,,,,551,468.35,157.9166,551,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Us Renal Bil,,76770,CPT,Facility,Outpatient,,,,551,468.35,157.9166,551,Medica,Medical Assistance,245.746,44.6,,percent of total billed charges,,
Us Renal Bil,,76770,CPT,Facility,Inpatient,,,,551,468.35,157.9166,551,Medica,Medical Assistance,,,,,Included in per diem rate,
Us Renal Bil,,76770,CPT,Facility,Outpatient,,,,551,468.35,157.9166,551,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,274.398,49.8,,percent of total billed charges,,
Us Renal Bil,,76770,CPT,Facility,Inpatient,,,,551,468.35,157.9166,551,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Us Renal Bil,,76770,CPT,Facility,Both,,,,551,468.35,157.9166,551,"Multiplan, Inc.","Multiplan, Inc.",517.94,94,,percent of total billed charges,,
Us Renal Bil,,76770,CPT,Facility,Outpatient,,,,551,468.35,157.9166,551,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,496.451,90.1,,percent of total billed charges,,
Us Renal Bil,,76770,CPT,Facility,Inpatient,,,,551,468.35,157.9166,551,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Us Renal Bil,,76770,CPT,Facility,Both,,,,551,468.35,157.9166,551,"Preferred One Administrative Services, INC.",PPO,543.286,98.6,,percent of total billed charges,,
Us Renal Bil,,76770,CPT,Facility,Outpatient,,,,551,468.35,157.9166,551,PrimeWest Health,Minnesota Senior Health Options (MSHO),283.4895,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Us Renal Bil,,76770,CPT,Facility,Inpatient,,,,551,468.35,157.9166,551,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Us Renal Bil,,76770,CPT,Facility,Outpatient,,,,551,468.35,157.9166,551,PrimeWest Health,MinnesotaCare,282.9936,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Us Renal Bil,,76770,CPT,Facility,Inpatient,,,,551,468.35,157.9166,551,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Us Renal Bil,,76770,CPT,Facility,Both,,,,551,468.35,157.9166,551,Sanford Health Plan,Sanford Health Plan,506.92,92,,percent of total billed charges,,
Us Renal Bil,,76770,CPT,Facility,Outpatient,,,,551,468.35,157.9166,551,"UCare Health, Inc.",Individual & Family Plan,310.4885,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Us Renal Bil,,76770,CPT,Facility,Inpatient,,,,551,468.35,157.9166,551,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Us Renal Bil,,76770,CPT,Facility,Outpatient,,,,551,468.35,157.9166,551,"UCare Health, Inc.",Medical Assistance,278.0897,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Renal Bil,,76770,CPT,Facility,Inpatient,,,,551,468.35,157.9166,551,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Us Renal Bil,,76770,CPT,Facility,Outpatient,,,,551,468.35,157.9166,551,"UCare Health, Inc.",Medicare Advantage,278.0897,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Renal Bil,,76770,CPT,Facility,Inpatient,,,,551,468.35,157.9166,551,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Us Renal Bil,,76770,CPT,Facility,Outpatient,,,,551,468.35,157.9166,551,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),278.0897,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Renal Bil,,76770,CPT,Facility,Inpatient,,,,551,468.35,157.9166,551,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Us Renal Bil,,76770,CPT,Facility,Both,,,,551,468.35,157.9166,551,UnitedHealthcare,Individual & Family,517.94,94,,percent of total billed charges,,
Us Renal Bil,,76770,CPT,Facility,Outpatient,,,,551,468.35,157.9166,551,UnitedHealthcare,Medicare Advantage,269.99,49,,percent of total billed charges,,
Us Renal Bil,,76770,CPT,Facility,Inpatient,,,,551,468.35,157.9166,551,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Us Renal Bil,,76770,CPT,Facility,Outpatient,,,,551,468.35,157.9166,551,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,264.48,48,,percent of total billed charges,,100% of DHS outpatient percentage
Us Renal Bil,,76770,CPT,Facility,Inpatient,,,,551,468.35,157.9166,551,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Us Abd Aorta,,76775,CPT,Facility,Both,,,,453,385.05,129.8298,453,Aetna,Commercial,416.76,92,,percent of total billed charges,,
Us Abd Aorta,,76775,CPT,Facility,Outpatient,,,,453,385.05,129.8298,453,Aetna,Medicare Advantage,221.97,49,,percent of total billed charges,,
Us Abd Aorta,,76775,CPT,Facility,Inpatient,,,,453,385.05,129.8298,453,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Us Abd Aorta,,76775,CPT,Facility,Both,,,,453,385.05,129.8298,453,Aetna,PPO,421.29,93,,percent of total billed charges,,
Us Abd Aorta,,76775,CPT,Facility,Both,,,,453,385.05,129.8298,453,America's PPO,America's PPO,435.0159,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Us Abd Aorta,,76775,CPT,Facility,Both,,,,453,385.05,129.8298,453,BlueCross BlueShield Minnesota, Federal Employee Program,445.752,98.4,,percent of total billed charges,,
Us Abd Aorta,,76775,CPT,Facility,Both,,,,453,385.05,129.8298,453,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,453,100,,percent of total billed charges,,
Us Abd Aorta,,76775,CPT,Facility,Both,,,,453,385.05,129.8298,453,BlueCross BlueShield Minnesota,High Value Network Plan,407.7,90,,percent of total billed charges,,
Us Abd Aorta,,76775,CPT,Facility,Outpatient,,,,453,385.05,129.8298,453,BlueCross BlueShield Minnesota,Medicare Advantage,221.97,49,,percent of total billed charges,,
Us Abd Aorta,,76775,CPT,Facility,Inpatient,,,,453,385.05,129.8298,453,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Us Abd Aorta,,76775,CPT,Facility,Both,,,,453,385.05,129.8298,453,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,401.2221,88.57,,percent of total billed charges,,
Us Abd Aorta,,76775,CPT,Facility,Both,,,,453,385.05,129.8298,453,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,129.8298,28.66,,percent of total billed charges,,
Us Abd Aorta,,76775,CPT,Facility,Outpatient,,,,453,385.05,129.8298,453,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),221.97,49,,percent of total billed charges,,
Us Abd Aorta,,76775,CPT,Facility,Inpatient,,,,453,385.05,129.8298,453,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Us Abd Aorta,,76775,CPT,Facility,Both,,,,453,385.05,129.8298,453,CorVel,Worker's Compensation,453,100,,percent of total billed charges,,
Us Abd Aorta,,76775,CPT,Facility,Both,,,,453,385.05,129.8298,453,First Health Group Corporation,First Health Network,439.41,97,,percent of total billed charges,,
Us Abd Aorta,,76775,CPT,Facility,Both,,,,453,385.05,129.8298,453,"Health Partners, Inc.",Commercial,428.538,94.6,,percent of total billed charges,,
Us Abd Aorta,,76775,CPT,Facility,Outpatient,,,,453,385.05,129.8298,453,"Health Partners, Inc.",Medicare Advantage,221.97,49,,percent of total billed charges,,
Us Abd Aorta,,76775,CPT,Facility,Inpatient,,,,453,385.05,129.8298,453,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Us Abd Aorta,,76775,CPT,Facility,Both,,,,453,385.05,129.8298,453,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),271.8,60,,percent of total billed charges,,
Us Abd Aorta,,76775,CPT,Facility,Both,,,,453,385.05,129.8298,453,"Health Partners, Inc.",State of Minnesota Advantage Program,369.195,81.5,,percent of total billed charges,,
Us Abd Aorta,,76775,CPT,Facility,Both,,,,453,385.05,129.8298,453,"Health Partners, Inc.",State Public Programs,226.5,50,,percent of total billed charges,,
Us Abd Aorta,,76775,CPT,Facility,Both,,,,453,385.05,129.8298,453,Humana Insurance Company,Commercial PPO,430.35,95,,percent of total billed charges,,
Us Abd Aorta,,76775,CPT,Facility,Outpatient,,,,453,385.05,129.8298,453,Humana Insurance Company,Medicare PPO,221.97,49,,percent of total billed charges,,
Us Abd Aorta,,76775,CPT,Facility,Inpatient,,,,453,385.05,129.8298,453,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Us Abd Aorta,,76775,CPT,Facility,Both,,,,453,385.05,129.8298,453,Medica,Individual & Family,448.923,99.1,,percent of total billed charges,,
Us Abd Aorta,,76775,CPT,Facility,Outpatient,,,,453,385.05,129.8298,453,Medica,Medica Advantage Solution,225.594,49.8,,percent of total billed charges,,
Us Abd Aorta,,76775,CPT,Facility,Inpatient,,,,453,385.05,129.8298,453,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Us Abd Aorta,,76775,CPT,Facility,Outpatient,,,,453,385.05,129.8298,453,Medica,Medical Assistance,202.038,44.6,,percent of total billed charges,,
Us Abd Aorta,,76775,CPT,Facility,Inpatient,,,,453,385.05,129.8298,453,Medica,Medical Assistance,,,,,Included in per diem rate,
Us Abd Aorta,,76775,CPT,Facility,Outpatient,,,,453,385.05,129.8298,453,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,225.594,49.8,,percent of total billed charges,,
Us Abd Aorta,,76775,CPT,Facility,Inpatient,,,,453,385.05,129.8298,453,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Us Abd Aorta,,76775,CPT,Facility,Both,,,,453,385.05,129.8298,453,"Multiplan, Inc.","Multiplan, Inc.",425.82,94,,percent of total billed charges,,
Us Abd Aorta,,76775,CPT,Facility,Outpatient,,,,453,385.05,129.8298,453,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,408.153,90.1,,percent of total billed charges,,
Us Abd Aorta,,76775,CPT,Facility,Inpatient,,,,453,385.05,129.8298,453,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Us Abd Aorta,,76775,CPT,Facility,Both,,,,453,385.05,129.8298,453,"Preferred One Administrative Services, INC.",PPO,446.658,98.6,,percent of total billed charges,,
Us Abd Aorta,,76775,CPT,Facility,Outpatient,,,,453,385.05,129.8298,453,PrimeWest Health,Minnesota Senior Health Options (MSHO),233.0685,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Us Abd Aorta,,76775,CPT,Facility,Inpatient,,,,453,385.05,129.8298,453,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Us Abd Aorta,,76775,CPT,Facility,Outpatient,,,,453,385.05,129.8298,453,PrimeWest Health,MinnesotaCare,232.6608,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Us Abd Aorta,,76775,CPT,Facility,Inpatient,,,,453,385.05,129.8298,453,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Us Abd Aorta,,76775,CPT,Facility,Both,,,,453,385.05,129.8298,453,Sanford Health Plan,Sanford Health Plan,416.76,92,,percent of total billed charges,,
Us Abd Aorta,,76775,CPT,Facility,Outpatient,,,,453,385.05,129.8298,453,"UCare Health, Inc.",Individual & Family Plan,255.2655,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Us Abd Aorta,,76775,CPT,Facility,Inpatient,,,,453,385.05,129.8298,453,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Us Abd Aorta,,76775,CPT,Facility,Outpatient,,,,453,385.05,129.8298,453,"UCare Health, Inc.",Medical Assistance,228.6291,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Abd Aorta,,76775,CPT,Facility,Inpatient,,,,453,385.05,129.8298,453,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Us Abd Aorta,,76775,CPT,Facility,Outpatient,,,,453,385.05,129.8298,453,"UCare Health, Inc.",Medicare Advantage,228.6291,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Abd Aorta,,76775,CPT,Facility,Inpatient,,,,453,385.05,129.8298,453,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Us Abd Aorta,,76775,CPT,Facility,Outpatient,,,,453,385.05,129.8298,453,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),228.6291,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Abd Aorta,,76775,CPT,Facility,Inpatient,,,,453,385.05,129.8298,453,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Us Abd Aorta,,76775,CPT,Facility,Both,,,,453,385.05,129.8298,453,UnitedHealthcare,Individual & Family,425.82,94,,percent of total billed charges,,
Us Abd Aorta,,76775,CPT,Facility,Outpatient,,,,453,385.05,129.8298,453,UnitedHealthcare,Medicare Advantage,221.97,49,,percent of total billed charges,,
Us Abd Aorta,,76775,CPT,Facility,Inpatient,,,,453,385.05,129.8298,453,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Us Abd Aorta,,76775,CPT,Facility,Outpatient,,,,453,385.05,129.8298,453,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,217.44,48,,percent of total billed charges,,100% of DHS outpatient percentage
Us Abd Aorta,,76775,CPT,Facility,Inpatient,,,,453,385.05,129.8298,453,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Us Renal Unil,,76775,CPT,Facility,Both,,,,453,385.05,129.8298,453,Aetna,Commercial,416.76,92,,percent of total billed charges,,
Us Renal Unil,,76775,CPT,Facility,Outpatient,,,,453,385.05,129.8298,453,Aetna,Medicare Advantage,221.97,49,,percent of total billed charges,,
Us Renal Unil,,76775,CPT,Facility,Inpatient,,,,453,385.05,129.8298,453,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Us Renal Unil,,76775,CPT,Facility,Both,,,,453,385.05,129.8298,453,Aetna,PPO,421.29,93,,percent of total billed charges,,
Us Renal Unil,,76775,CPT,Facility,Both,,,,453,385.05,129.8298,453,America's PPO,America's PPO,435.0159,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Us Renal Unil,,76775,CPT,Facility,Both,,,,453,385.05,129.8298,453,BlueCross BlueShield Minnesota, Federal Employee Program,445.752,98.4,,percent of total billed charges,,
Us Renal Unil,,76775,CPT,Facility,Both,,,,453,385.05,129.8298,453,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,453,100,,percent of total billed charges,,
Us Renal Unil,,76775,CPT,Facility,Both,,,,453,385.05,129.8298,453,BlueCross BlueShield Minnesota,High Value Network Plan,407.7,90,,percent of total billed charges,,
Us Renal Unil,,76775,CPT,Facility,Outpatient,,,,453,385.05,129.8298,453,BlueCross BlueShield Minnesota,Medicare Advantage,221.97,49,,percent of total billed charges,,
Us Renal Unil,,76775,CPT,Facility,Inpatient,,,,453,385.05,129.8298,453,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Us Renal Unil,,76775,CPT,Facility,Both,,,,453,385.05,129.8298,453,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,401.2221,88.57,,percent of total billed charges,,
Us Renal Unil,,76775,CPT,Facility,Both,,,,453,385.05,129.8298,453,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,129.8298,28.66,,percent of total billed charges,,
Us Renal Unil,,76775,CPT,Facility,Outpatient,,,,453,385.05,129.8298,453,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),221.97,49,,percent of total billed charges,,
Us Renal Unil,,76775,CPT,Facility,Inpatient,,,,453,385.05,129.8298,453,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Us Renal Unil,,76775,CPT,Facility,Both,,,,453,385.05,129.8298,453,CorVel,Worker's Compensation,453,100,,percent of total billed charges,,
Us Renal Unil,,76775,CPT,Facility,Both,,,,453,385.05,129.8298,453,First Health Group Corporation,First Health Network,439.41,97,,percent of total billed charges,,
Us Renal Unil,,76775,CPT,Facility,Both,,,,453,385.05,129.8298,453,"Health Partners, Inc.",Commercial,428.538,94.6,,percent of total billed charges,,
Us Renal Unil,,76775,CPT,Facility,Outpatient,,,,453,385.05,129.8298,453,"Health Partners, Inc.",Medicare Advantage,221.97,49,,percent of total billed charges,,
Us Renal Unil,,76775,CPT,Facility,Inpatient,,,,453,385.05,129.8298,453,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Us Renal Unil,,76775,CPT,Facility,Both,,,,453,385.05,129.8298,453,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),271.8,60,,percent of total billed charges,,
Us Renal Unil,,76775,CPT,Facility,Both,,,,453,385.05,129.8298,453,"Health Partners, Inc.",State of Minnesota Advantage Program,369.195,81.5,,percent of total billed charges,,
Us Renal Unil,,76775,CPT,Facility,Both,,,,453,385.05,129.8298,453,"Health Partners, Inc.",State Public Programs,226.5,50,,percent of total billed charges,,
Us Renal Unil,,76775,CPT,Facility,Both,,,,453,385.05,129.8298,453,Humana Insurance Company,Commercial PPO,430.35,95,,percent of total billed charges,,
Us Renal Unil,,76775,CPT,Facility,Outpatient,,,,453,385.05,129.8298,453,Humana Insurance Company,Medicare PPO,221.97,49,,percent of total billed charges,,
Us Renal Unil,,76775,CPT,Facility,Inpatient,,,,453,385.05,129.8298,453,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Us Renal Unil,,76775,CPT,Facility,Both,,,,453,385.05,129.8298,453,Medica,Individual & Family,448.923,99.1,,percent of total billed charges,,
Us Renal Unil,,76775,CPT,Facility,Outpatient,,,,453,385.05,129.8298,453,Medica,Medica Advantage Solution,225.594,49.8,,percent of total billed charges,,
Us Renal Unil,,76775,CPT,Facility,Inpatient,,,,453,385.05,129.8298,453,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Us Renal Unil,,76775,CPT,Facility,Outpatient,,,,453,385.05,129.8298,453,Medica,Medical Assistance,202.038,44.6,,percent of total billed charges,,
Us Renal Unil,,76775,CPT,Facility,Inpatient,,,,453,385.05,129.8298,453,Medica,Medical Assistance,,,,,Included in per diem rate,
Us Renal Unil,,76775,CPT,Facility,Outpatient,,,,453,385.05,129.8298,453,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,225.594,49.8,,percent of total billed charges,,
Us Renal Unil,,76775,CPT,Facility,Inpatient,,,,453,385.05,129.8298,453,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Us Renal Unil,,76775,CPT,Facility,Both,,,,453,385.05,129.8298,453,"Multiplan, Inc.","Multiplan, Inc.",425.82,94,,percent of total billed charges,,
Us Renal Unil,,76775,CPT,Facility,Outpatient,,,,453,385.05,129.8298,453,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,408.153,90.1,,percent of total billed charges,,
Us Renal Unil,,76775,CPT,Facility,Inpatient,,,,453,385.05,129.8298,453,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Us Renal Unil,,76775,CPT,Facility,Both,,,,453,385.05,129.8298,453,"Preferred One Administrative Services, INC.",PPO,446.658,98.6,,percent of total billed charges,,
Us Renal Unil,,76775,CPT,Facility,Outpatient,,,,453,385.05,129.8298,453,PrimeWest Health,Minnesota Senior Health Options (MSHO),233.0685,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Us Renal Unil,,76775,CPT,Facility,Inpatient,,,,453,385.05,129.8298,453,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Us Renal Unil,,76775,CPT,Facility,Outpatient,,,,453,385.05,129.8298,453,PrimeWest Health,MinnesotaCare,232.6608,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Us Renal Unil,,76775,CPT,Facility,Inpatient,,,,453,385.05,129.8298,453,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Us Renal Unil,,76775,CPT,Facility,Both,,,,453,385.05,129.8298,453,Sanford Health Plan,Sanford Health Plan,416.76,92,,percent of total billed charges,,
Us Renal Unil,,76775,CPT,Facility,Outpatient,,,,453,385.05,129.8298,453,"UCare Health, Inc.",Individual & Family Plan,255.2655,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Us Renal Unil,,76775,CPT,Facility,Inpatient,,,,453,385.05,129.8298,453,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Us Renal Unil,,76775,CPT,Facility,Outpatient,,,,453,385.05,129.8298,453,"UCare Health, Inc.",Medical Assistance,228.6291,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Renal Unil,,76775,CPT,Facility,Inpatient,,,,453,385.05,129.8298,453,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Us Renal Unil,,76775,CPT,Facility,Outpatient,,,,453,385.05,129.8298,453,"UCare Health, Inc.",Medicare Advantage,228.6291,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Renal Unil,,76775,CPT,Facility,Inpatient,,,,453,385.05,129.8298,453,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Us Renal Unil,,76775,CPT,Facility,Outpatient,,,,453,385.05,129.8298,453,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),228.6291,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Renal Unil,,76775,CPT,Facility,Inpatient,,,,453,385.05,129.8298,453,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Us Renal Unil,,76775,CPT,Facility,Both,,,,453,385.05,129.8298,453,UnitedHealthcare,Individual & Family,425.82,94,,percent of total billed charges,,
Us Renal Unil,,76775,CPT,Facility,Outpatient,,,,453,385.05,129.8298,453,UnitedHealthcare,Medicare Advantage,221.97,49,,percent of total billed charges,,
Us Renal Unil,,76775,CPT,Facility,Inpatient,,,,453,385.05,129.8298,453,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Us Renal Unil,,76775,CPT,Facility,Outpatient,,,,453,385.05,129.8298,453,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,217.44,48,,percent of total billed charges,,100% of DHS outpatient percentage
Us Renal Unil,,76775,CPT,Facility,Inpatient,,,,453,385.05,129.8298,453,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Us Ob Under 14 Wks Comp,,76801,CPT,Facility,Both,,,,572,486.2,163.9352,572,Aetna,Commercial,526.24,92,,percent of total billed charges,,
Us Ob Under 14 Wks Comp,,76801,CPT,Facility,Outpatient,,,,572,486.2,163.9352,572,Aetna,Medicare Advantage,280.28,49,,percent of total billed charges,,
Us Ob Under 14 Wks Comp,,76801,CPT,Facility,Inpatient,,,,572,486.2,163.9352,572,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Us Ob Under 14 Wks Comp,,76801,CPT,Facility,Both,,,,572,486.2,163.9352,572,Aetna,PPO,531.96,93,,percent of total billed charges,,
Us Ob Under 14 Wks Comp,,76801,CPT,Facility,Both,,,,572,486.2,163.9352,572,America's PPO,America's PPO,549.2916,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Us Ob Under 14 Wks Comp,,76801,CPT,Facility,Both,,,,572,486.2,163.9352,572,BlueCross BlueShield Minnesota, Federal Employee Program,562.848,98.4,,percent of total billed charges,,
Us Ob Under 14 Wks Comp,,76801,CPT,Facility,Both,,,,572,486.2,163.9352,572,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,572,100,,percent of total billed charges,,
Us Ob Under 14 Wks Comp,,76801,CPT,Facility,Both,,,,572,486.2,163.9352,572,BlueCross BlueShield Minnesota,High Value Network Plan,514.8,90,,percent of total billed charges,,
Us Ob Under 14 Wks Comp,,76801,CPT,Facility,Outpatient,,,,572,486.2,163.9352,572,BlueCross BlueShield Minnesota,Medicare Advantage,280.28,49,,percent of total billed charges,,
Us Ob Under 14 Wks Comp,,76801,CPT,Facility,Inpatient,,,,572,486.2,163.9352,572,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Us Ob Under 14 Wks Comp,,76801,CPT,Facility,Both,,,,572,486.2,163.9352,572,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,506.6204,88.57,,percent of total billed charges,,
Us Ob Under 14 Wks Comp,,76801,CPT,Facility,Both,,,,572,486.2,163.9352,572,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,163.9352,28.66,,percent of total billed charges,,
Us Ob Under 14 Wks Comp,,76801,CPT,Facility,Outpatient,,,,572,486.2,163.9352,572,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),280.28,49,,percent of total billed charges,,
Us Ob Under 14 Wks Comp,,76801,CPT,Facility,Inpatient,,,,572,486.2,163.9352,572,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Us Ob Under 14 Wks Comp,,76801,CPT,Facility,Both,,,,572,486.2,163.9352,572,CorVel,Worker's Compensation,572,100,,percent of total billed charges,,
Us Ob Under 14 Wks Comp,,76801,CPT,Facility,Both,,,,572,486.2,163.9352,572,First Health Group Corporation,First Health Network,554.84,97,,percent of total billed charges,,
Us Ob Under 14 Wks Comp,,76801,CPT,Facility,Both,,,,572,486.2,163.9352,572,"Health Partners, Inc.",Commercial,541.112,94.6,,percent of total billed charges,,
Us Ob Under 14 Wks Comp,,76801,CPT,Facility,Outpatient,,,,572,486.2,163.9352,572,"Health Partners, Inc.",Medicare Advantage,280.28,49,,percent of total billed charges,,
Us Ob Under 14 Wks Comp,,76801,CPT,Facility,Inpatient,,,,572,486.2,163.9352,572,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Us Ob Under 14 Wks Comp,,76801,CPT,Facility,Both,,,,572,486.2,163.9352,572,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),343.2,60,,percent of total billed charges,,
Us Ob Under 14 Wks Comp,,76801,CPT,Facility,Both,,,,572,486.2,163.9352,572,"Health Partners, Inc.",State of Minnesota Advantage Program,466.18,81.5,,percent of total billed charges,,
Us Ob Under 14 Wks Comp,,76801,CPT,Facility,Both,,,,572,486.2,163.9352,572,"Health Partners, Inc.",State Public Programs,286,50,,percent of total billed charges,,
Us Ob Under 14 Wks Comp,,76801,CPT,Facility,Both,,,,572,486.2,163.9352,572,Humana Insurance Company,Commercial PPO,543.4,95,,percent of total billed charges,,
Us Ob Under 14 Wks Comp,,76801,CPT,Facility,Outpatient,,,,572,486.2,163.9352,572,Humana Insurance Company,Medicare PPO,280.28,49,,percent of total billed charges,,
Us Ob Under 14 Wks Comp,,76801,CPT,Facility,Inpatient,,,,572,486.2,163.9352,572,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Us Ob Under 14 Wks Comp,,76801,CPT,Facility,Both,,,,572,486.2,163.9352,572,Medica,Individual & Family,566.852,99.1,,percent of total billed charges,,
Us Ob Under 14 Wks Comp,,76801,CPT,Facility,Outpatient,,,,572,486.2,163.9352,572,Medica,Medica Advantage Solution,284.856,49.8,,percent of total billed charges,,
Us Ob Under 14 Wks Comp,,76801,CPT,Facility,Inpatient,,,,572,486.2,163.9352,572,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Us Ob Under 14 Wks Comp,,76801,CPT,Facility,Outpatient,,,,572,486.2,163.9352,572,Medica,Medical Assistance,255.112,44.6,,percent of total billed charges,,
Us Ob Under 14 Wks Comp,,76801,CPT,Facility,Inpatient,,,,572,486.2,163.9352,572,Medica,Medical Assistance,,,,,Included in per diem rate,
Us Ob Under 14 Wks Comp,,76801,CPT,Facility,Outpatient,,,,572,486.2,163.9352,572,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,284.856,49.8,,percent of total billed charges,,
Us Ob Under 14 Wks Comp,,76801,CPT,Facility,Inpatient,,,,572,486.2,163.9352,572,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Us Ob Under 14 Wks Comp,,76801,CPT,Facility,Both,,,,572,486.2,163.9352,572,"Multiplan, Inc.","Multiplan, Inc.",537.68,94,,percent of total billed charges,,
Us Ob Under 14 Wks Comp,,76801,CPT,Facility,Outpatient,,,,572,486.2,163.9352,572,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,515.372,90.1,,percent of total billed charges,,
Us Ob Under 14 Wks Comp,,76801,CPT,Facility,Inpatient,,,,572,486.2,163.9352,572,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Us Ob Under 14 Wks Comp,,76801,CPT,Facility,Both,,,,572,486.2,163.9352,572,"Preferred One Administrative Services, INC.",PPO,563.992,98.6,,percent of total billed charges,,
Us Ob Under 14 Wks Comp,,76801,CPT,Facility,Outpatient,,,,572,486.2,163.9352,572,PrimeWest Health,Minnesota Senior Health Options (MSHO),294.294,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Us Ob Under 14 Wks Comp,,76801,CPT,Facility,Inpatient,,,,572,486.2,163.9352,572,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Us Ob Under 14 Wks Comp,,76801,CPT,Facility,Outpatient,,,,572,486.2,163.9352,572,PrimeWest Health,MinnesotaCare,293.7792,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Us Ob Under 14 Wks Comp,,76801,CPT,Facility,Inpatient,,,,572,486.2,163.9352,572,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Us Ob Under 14 Wks Comp,,76801,CPT,Facility,Both,,,,572,486.2,163.9352,572,Sanford Health Plan,Sanford Health Plan,526.24,92,,percent of total billed charges,,
Us Ob Under 14 Wks Comp,,76801,CPT,Facility,Outpatient,,,,572,486.2,163.9352,572,"UCare Health, Inc.",Individual & Family Plan,322.322,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Us Ob Under 14 Wks Comp,,76801,CPT,Facility,Inpatient,,,,572,486.2,163.9352,572,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Us Ob Under 14 Wks Comp,,76801,CPT,Facility,Outpatient,,,,572,486.2,163.9352,572,"UCare Health, Inc.",Medical Assistance,288.6884,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Ob Under 14 Wks Comp,,76801,CPT,Facility,Inpatient,,,,572,486.2,163.9352,572,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Us Ob Under 14 Wks Comp,,76801,CPT,Facility,Outpatient,,,,572,486.2,163.9352,572,"UCare Health, Inc.",Medicare Advantage,288.6884,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Ob Under 14 Wks Comp,,76801,CPT,Facility,Inpatient,,,,572,486.2,163.9352,572,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Us Ob Under 14 Wks Comp,,76801,CPT,Facility,Outpatient,,,,572,486.2,163.9352,572,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),288.6884,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Ob Under 14 Wks Comp,,76801,CPT,Facility,Inpatient,,,,572,486.2,163.9352,572,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Us Ob Under 14 Wks Comp,,76801,CPT,Facility,Both,,,,572,486.2,163.9352,572,UnitedHealthcare,Individual & Family,537.68,94,,percent of total billed charges,,
Us Ob Under 14 Wks Comp,,76801,CPT,Facility,Outpatient,,,,572,486.2,163.9352,572,UnitedHealthcare,Medicare Advantage,280.28,49,,percent of total billed charges,,
Us Ob Under 14 Wks Comp,,76801,CPT,Facility,Inpatient,,,,572,486.2,163.9352,572,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Us Ob Under 14 Wks Comp,,76801,CPT,Facility,Outpatient,,,,572,486.2,163.9352,572,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,274.56,48,,percent of total billed charges,,100% of DHS outpatient percentage
Us Ob Under 14 Wks Comp,,76801,CPT,Facility,Inpatient,,,,572,486.2,163.9352,572,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Us Ob Under 14 Wks Ea Addl Gest,,76802,CPT,Facility,Both,,,,624,530.4,178.8384,624,Aetna,Commercial,574.08,92,,percent of total billed charges,,
Us Ob Under 14 Wks Ea Addl Gest,,76802,CPT,Facility,Outpatient,,,,624,530.4,178.8384,624,Aetna,Medicare Advantage,305.76,49,,percent of total billed charges,,
Us Ob Under 14 Wks Ea Addl Gest,,76802,CPT,Facility,Inpatient,,,,624,530.4,178.8384,624,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Us Ob Under 14 Wks Ea Addl Gest,,76802,CPT,Facility,Both,,,,624,530.4,178.8384,624,Aetna,PPO,580.32,93,,percent of total billed charges,,
Us Ob Under 14 Wks Ea Addl Gest,,76802,CPT,Facility,Both,,,,624,530.4,178.8384,624,America's PPO,America's PPO,599.2272,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Us Ob Under 14 Wks Ea Addl Gest,,76802,CPT,Facility,Both,,,,624,530.4,178.8384,624,BlueCross BlueShield Minnesota, Federal Employee Program,614.016,98.4,,percent of total billed charges,,
Us Ob Under 14 Wks Ea Addl Gest,,76802,CPT,Facility,Both,,,,624,530.4,178.8384,624,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,624,100,,percent of total billed charges,,
Us Ob Under 14 Wks Ea Addl Gest,,76802,CPT,Facility,Both,,,,624,530.4,178.8384,624,BlueCross BlueShield Minnesota,High Value Network Plan,561.6,90,,percent of total billed charges,,
Us Ob Under 14 Wks Ea Addl Gest,,76802,CPT,Facility,Outpatient,,,,624,530.4,178.8384,624,BlueCross BlueShield Minnesota,Medicare Advantage,305.76,49,,percent of total billed charges,,
Us Ob Under 14 Wks Ea Addl Gest,,76802,CPT,Facility,Inpatient,,,,624,530.4,178.8384,624,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Us Ob Under 14 Wks Ea Addl Gest,,76802,CPT,Facility,Both,,,,624,530.4,178.8384,624,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,552.6768,88.57,,percent of total billed charges,,
Us Ob Under 14 Wks Ea Addl Gest,,76802,CPT,Facility,Both,,,,624,530.4,178.8384,624,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,178.8384,28.66,,percent of total billed charges,,
Us Ob Under 14 Wks Ea Addl Gest,,76802,CPT,Facility,Outpatient,,,,624,530.4,178.8384,624,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),305.76,49,,percent of total billed charges,,
Us Ob Under 14 Wks Ea Addl Gest,,76802,CPT,Facility,Inpatient,,,,624,530.4,178.8384,624,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Us Ob Under 14 Wks Ea Addl Gest,,76802,CPT,Facility,Both,,,,624,530.4,178.8384,624,CorVel,Worker's Compensation,624,100,,percent of total billed charges,,
Us Ob Under 14 Wks Ea Addl Gest,,76802,CPT,Facility,Both,,,,624,530.4,178.8384,624,First Health Group Corporation,First Health Network,605.28,97,,percent of total billed charges,,
Us Ob Under 14 Wks Ea Addl Gest,,76802,CPT,Facility,Both,,,,624,530.4,178.8384,624,"Health Partners, Inc.",Commercial,590.304,94.6,,percent of total billed charges,,
Us Ob Under 14 Wks Ea Addl Gest,,76802,CPT,Facility,Outpatient,,,,624,530.4,178.8384,624,"Health Partners, Inc.",Medicare Advantage,305.76,49,,percent of total billed charges,,
Us Ob Under 14 Wks Ea Addl Gest,,76802,CPT,Facility,Inpatient,,,,624,530.4,178.8384,624,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Us Ob Under 14 Wks Ea Addl Gest,,76802,CPT,Facility,Both,,,,624,530.4,178.8384,624,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),374.4,60,,percent of total billed charges,,
Us Ob Under 14 Wks Ea Addl Gest,,76802,CPT,Facility,Both,,,,624,530.4,178.8384,624,"Health Partners, Inc.",State of Minnesota Advantage Program,508.56,81.5,,percent of total billed charges,,
Us Ob Under 14 Wks Ea Addl Gest,,76802,CPT,Facility,Both,,,,624,530.4,178.8384,624,"Health Partners, Inc.",State Public Programs,312,50,,percent of total billed charges,,
Us Ob Under 14 Wks Ea Addl Gest,,76802,CPT,Facility,Both,,,,624,530.4,178.8384,624,Humana Insurance Company,Commercial PPO,592.8,95,,percent of total billed charges,,
Us Ob Under 14 Wks Ea Addl Gest,,76802,CPT,Facility,Outpatient,,,,624,530.4,178.8384,624,Humana Insurance Company,Medicare PPO,305.76,49,,percent of total billed charges,,
Us Ob Under 14 Wks Ea Addl Gest,,76802,CPT,Facility,Inpatient,,,,624,530.4,178.8384,624,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Us Ob Under 14 Wks Ea Addl Gest,,76802,CPT,Facility,Both,,,,624,530.4,178.8384,624,Medica,Individual & Family,618.384,99.1,,percent of total billed charges,,
Us Ob Under 14 Wks Ea Addl Gest,,76802,CPT,Facility,Outpatient,,,,624,530.4,178.8384,624,Medica,Medica Advantage Solution,310.752,49.8,,percent of total billed charges,,
Us Ob Under 14 Wks Ea Addl Gest,,76802,CPT,Facility,Inpatient,,,,624,530.4,178.8384,624,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Us Ob Under 14 Wks Ea Addl Gest,,76802,CPT,Facility,Outpatient,,,,624,530.4,178.8384,624,Medica,Medical Assistance,278.304,44.6,,percent of total billed charges,,
Us Ob Under 14 Wks Ea Addl Gest,,76802,CPT,Facility,Inpatient,,,,624,530.4,178.8384,624,Medica,Medical Assistance,,,,,Included in per diem rate,
Us Ob Under 14 Wks Ea Addl Gest,,76802,CPT,Facility,Outpatient,,,,624,530.4,178.8384,624,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,310.752,49.8,,percent of total billed charges,,
Us Ob Under 14 Wks Ea Addl Gest,,76802,CPT,Facility,Inpatient,,,,624,530.4,178.8384,624,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Us Ob Under 14 Wks Ea Addl Gest,,76802,CPT,Facility,Both,,,,624,530.4,178.8384,624,"Multiplan, Inc.","Multiplan, Inc.",586.56,94,,percent of total billed charges,,
Us Ob Under 14 Wks Ea Addl Gest,,76802,CPT,Facility,Outpatient,,,,624,530.4,178.8384,624,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,562.224,90.1,,percent of total billed charges,,
Us Ob Under 14 Wks Ea Addl Gest,,76802,CPT,Facility,Inpatient,,,,624,530.4,178.8384,624,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Us Ob Under 14 Wks Ea Addl Gest,,76802,CPT,Facility,Both,,,,624,530.4,178.8384,624,"Preferred One Administrative Services, INC.",PPO,615.264,98.6,,percent of total billed charges,,
Us Ob Under 14 Wks Ea Addl Gest,,76802,CPT,Facility,Outpatient,,,,624,530.4,178.8384,624,PrimeWest Health,Minnesota Senior Health Options (MSHO),321.048,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Us Ob Under 14 Wks Ea Addl Gest,,76802,CPT,Facility,Inpatient,,,,624,530.4,178.8384,624,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Us Ob Under 14 Wks Ea Addl Gest,,76802,CPT,Facility,Outpatient,,,,624,530.4,178.8384,624,PrimeWest Health,MinnesotaCare,320.4864,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Us Ob Under 14 Wks Ea Addl Gest,,76802,CPT,Facility,Inpatient,,,,624,530.4,178.8384,624,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Us Ob Under 14 Wks Ea Addl Gest,,76802,CPT,Facility,Both,,,,624,530.4,178.8384,624,Sanford Health Plan,Sanford Health Plan,574.08,92,,percent of total billed charges,,
Us Ob Under 14 Wks Ea Addl Gest,,76802,CPT,Facility,Outpatient,,,,624,530.4,178.8384,624,"UCare Health, Inc.",Individual & Family Plan,351.624,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Us Ob Under 14 Wks Ea Addl Gest,,76802,CPT,Facility,Inpatient,,,,624,530.4,178.8384,624,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Us Ob Under 14 Wks Ea Addl Gest,,76802,CPT,Facility,Outpatient,,,,624,530.4,178.8384,624,"UCare Health, Inc.",Medical Assistance,314.9328,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Ob Under 14 Wks Ea Addl Gest,,76802,CPT,Facility,Inpatient,,,,624,530.4,178.8384,624,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Us Ob Under 14 Wks Ea Addl Gest,,76802,CPT,Facility,Outpatient,,,,624,530.4,178.8384,624,"UCare Health, Inc.",Medicare Advantage,314.9328,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Ob Under 14 Wks Ea Addl Gest,,76802,CPT,Facility,Inpatient,,,,624,530.4,178.8384,624,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Us Ob Under 14 Wks Ea Addl Gest,,76802,CPT,Facility,Outpatient,,,,624,530.4,178.8384,624,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),314.9328,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Ob Under 14 Wks Ea Addl Gest,,76802,CPT,Facility,Inpatient,,,,624,530.4,178.8384,624,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Us Ob Under 14 Wks Ea Addl Gest,,76802,CPT,Facility,Both,,,,624,530.4,178.8384,624,UnitedHealthcare,Individual & Family,586.56,94,,percent of total billed charges,,
Us Ob Under 14 Wks Ea Addl Gest,,76802,CPT,Facility,Outpatient,,,,624,530.4,178.8384,624,UnitedHealthcare,Medicare Advantage,305.76,49,,percent of total billed charges,,
Us Ob Under 14 Wks Ea Addl Gest,,76802,CPT,Facility,Inpatient,,,,624,530.4,178.8384,624,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Us Ob Under 14 Wks Ea Addl Gest,,76802,CPT,Facility,Outpatient,,,,624,530.4,178.8384,624,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,299.52,48,,percent of total billed charges,,100% of DHS outpatient percentage
Us Ob Under 14 Wks Ea Addl Gest,,76802,CPT,Facility,Inpatient,,,,624,530.4,178.8384,624,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Us Ob Over 14 Wks Comp,,76805,CPT,Facility,Both,,,,671,570.35,192.3086,671,Aetna,Commercial,617.32,92,,percent of total billed charges,,
Us Ob Over 14 Wks Comp,,76805,CPT,Facility,Outpatient,,,,671,570.35,192.3086,671,Aetna,Medicare Advantage,328.79,49,,percent of total billed charges,,
Us Ob Over 14 Wks Comp,,76805,CPT,Facility,Inpatient,,,,671,570.35,192.3086,671,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Us Ob Over 14 Wks Comp,,76805,CPT,Facility,Both,,,,671,570.35,192.3086,671,Aetna,PPO,624.03,93,,percent of total billed charges,,
Us Ob Over 14 Wks Comp,,76805,CPT,Facility,Both,,,,671,570.35,192.3086,671,America's PPO,America's PPO,644.3613,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Us Ob Over 14 Wks Comp,,76805,CPT,Facility,Both,,,,671,570.35,192.3086,671,BlueCross BlueShield Minnesota, Federal Employee Program,660.264,98.4,,percent of total billed charges,,
Us Ob Over 14 Wks Comp,,76805,CPT,Facility,Both,,,,671,570.35,192.3086,671,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,671,100,,percent of total billed charges,,
Us Ob Over 14 Wks Comp,,76805,CPT,Facility,Both,,,,671,570.35,192.3086,671,BlueCross BlueShield Minnesota,High Value Network Plan,603.9,90,,percent of total billed charges,,
Us Ob Over 14 Wks Comp,,76805,CPT,Facility,Outpatient,,,,671,570.35,192.3086,671,BlueCross BlueShield Minnesota,Medicare Advantage,328.79,49,,percent of total billed charges,,
Us Ob Over 14 Wks Comp,,76805,CPT,Facility,Inpatient,,,,671,570.35,192.3086,671,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Us Ob Over 14 Wks Comp,,76805,CPT,Facility,Both,,,,671,570.35,192.3086,671,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,594.3047,88.57,,percent of total billed charges,,
Us Ob Over 14 Wks Comp,,76805,CPT,Facility,Both,,,,671,570.35,192.3086,671,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,192.3086,28.66,,percent of total billed charges,,
Us Ob Over 14 Wks Comp,,76805,CPT,Facility,Outpatient,,,,671,570.35,192.3086,671,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),328.79,49,,percent of total billed charges,,
Us Ob Over 14 Wks Comp,,76805,CPT,Facility,Inpatient,,,,671,570.35,192.3086,671,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Us Ob Over 14 Wks Comp,,76805,CPT,Facility,Both,,,,671,570.35,192.3086,671,CorVel,Worker's Compensation,671,100,,percent of total billed charges,,
Us Ob Over 14 Wks Comp,,76805,CPT,Facility,Both,,,,671,570.35,192.3086,671,First Health Group Corporation,First Health Network,650.87,97,,percent of total billed charges,,
Us Ob Over 14 Wks Comp,,76805,CPT,Facility,Both,,,,671,570.35,192.3086,671,"Health Partners, Inc.",Commercial,634.766,94.6,,percent of total billed charges,,
Us Ob Over 14 Wks Comp,,76805,CPT,Facility,Outpatient,,,,671,570.35,192.3086,671,"Health Partners, Inc.",Medicare Advantage,328.79,49,,percent of total billed charges,,
Us Ob Over 14 Wks Comp,,76805,CPT,Facility,Inpatient,,,,671,570.35,192.3086,671,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Us Ob Over 14 Wks Comp,,76805,CPT,Facility,Both,,,,671,570.35,192.3086,671,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),402.6,60,,percent of total billed charges,,
Us Ob Over 14 Wks Comp,,76805,CPT,Facility,Both,,,,671,570.35,192.3086,671,"Health Partners, Inc.",State of Minnesota Advantage Program,546.865,81.5,,percent of total billed charges,,
Us Ob Over 14 Wks Comp,,76805,CPT,Facility,Both,,,,671,570.35,192.3086,671,"Health Partners, Inc.",State Public Programs,335.5,50,,percent of total billed charges,,
Us Ob Over 14 Wks Comp,,76805,CPT,Facility,Both,,,,671,570.35,192.3086,671,Humana Insurance Company,Commercial PPO,637.45,95,,percent of total billed charges,,
Us Ob Over 14 Wks Comp,,76805,CPT,Facility,Outpatient,,,,671,570.35,192.3086,671,Humana Insurance Company,Medicare PPO,328.79,49,,percent of total billed charges,,
Us Ob Over 14 Wks Comp,,76805,CPT,Facility,Inpatient,,,,671,570.35,192.3086,671,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Us Ob Over 14 Wks Comp,,76805,CPT,Facility,Both,,,,671,570.35,192.3086,671,Medica,Individual & Family,664.961,99.1,,percent of total billed charges,,
Us Ob Over 14 Wks Comp,,76805,CPT,Facility,Outpatient,,,,671,570.35,192.3086,671,Medica,Medica Advantage Solution,334.158,49.8,,percent of total billed charges,,
Us Ob Over 14 Wks Comp,,76805,CPT,Facility,Inpatient,,,,671,570.35,192.3086,671,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Us Ob Over 14 Wks Comp,,76805,CPT,Facility,Outpatient,,,,671,570.35,192.3086,671,Medica,Medical Assistance,299.266,44.6,,percent of total billed charges,,
Us Ob Over 14 Wks Comp,,76805,CPT,Facility,Inpatient,,,,671,570.35,192.3086,671,Medica,Medical Assistance,,,,,Included in per diem rate,
Us Ob Over 14 Wks Comp,,76805,CPT,Facility,Outpatient,,,,671,570.35,192.3086,671,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,334.158,49.8,,percent of total billed charges,,
Us Ob Over 14 Wks Comp,,76805,CPT,Facility,Inpatient,,,,671,570.35,192.3086,671,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Us Ob Over 14 Wks Comp,,76805,CPT,Facility,Both,,,,671,570.35,192.3086,671,"Multiplan, Inc.","Multiplan, Inc.",630.74,94,,percent of total billed charges,,
Us Ob Over 14 Wks Comp,,76805,CPT,Facility,Outpatient,,,,671,570.35,192.3086,671,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,604.571,90.1,,percent of total billed charges,,
Us Ob Over 14 Wks Comp,,76805,CPT,Facility,Inpatient,,,,671,570.35,192.3086,671,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Us Ob Over 14 Wks Comp,,76805,CPT,Facility,Both,,,,671,570.35,192.3086,671,"Preferred One Administrative Services, INC.",PPO,661.606,98.6,,percent of total billed charges,,
Us Ob Over 14 Wks Comp,,76805,CPT,Facility,Outpatient,,,,671,570.35,192.3086,671,PrimeWest Health,Minnesota Senior Health Options (MSHO),345.2295,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Us Ob Over 14 Wks Comp,,76805,CPT,Facility,Inpatient,,,,671,570.35,192.3086,671,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Us Ob Over 14 Wks Comp,,76805,CPT,Facility,Outpatient,,,,671,570.35,192.3086,671,PrimeWest Health,MinnesotaCare,344.6256,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Us Ob Over 14 Wks Comp,,76805,CPT,Facility,Inpatient,,,,671,570.35,192.3086,671,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Us Ob Over 14 Wks Comp,,76805,CPT,Facility,Both,,,,671,570.35,192.3086,671,Sanford Health Plan,Sanford Health Plan,617.32,92,,percent of total billed charges,,
Us Ob Over 14 Wks Comp,,76805,CPT,Facility,Outpatient,,,,671,570.35,192.3086,671,"UCare Health, Inc.",Individual & Family Plan,378.1085,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Us Ob Over 14 Wks Comp,,76805,CPT,Facility,Inpatient,,,,671,570.35,192.3086,671,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Us Ob Over 14 Wks Comp,,76805,CPT,Facility,Outpatient,,,,671,570.35,192.3086,671,"UCare Health, Inc.",Medical Assistance,338.6537,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Ob Over 14 Wks Comp,,76805,CPT,Facility,Inpatient,,,,671,570.35,192.3086,671,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Us Ob Over 14 Wks Comp,,76805,CPT,Facility,Outpatient,,,,671,570.35,192.3086,671,"UCare Health, Inc.",Medicare Advantage,338.6537,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Ob Over 14 Wks Comp,,76805,CPT,Facility,Inpatient,,,,671,570.35,192.3086,671,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Us Ob Over 14 Wks Comp,,76805,CPT,Facility,Outpatient,,,,671,570.35,192.3086,671,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),338.6537,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Ob Over 14 Wks Comp,,76805,CPT,Facility,Inpatient,,,,671,570.35,192.3086,671,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Us Ob Over 14 Wks Comp,,76805,CPT,Facility,Both,,,,671,570.35,192.3086,671,UnitedHealthcare,Individual & Family,630.74,94,,percent of total billed charges,,
Us Ob Over 14 Wks Comp,,76805,CPT,Facility,Outpatient,,,,671,570.35,192.3086,671,UnitedHealthcare,Medicare Advantage,328.79,49,,percent of total billed charges,,
Us Ob Over 14 Wks Comp,,76805,CPT,Facility,Inpatient,,,,671,570.35,192.3086,671,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Us Ob Over 14 Wks Comp,,76805,CPT,Facility,Outpatient,,,,671,570.35,192.3086,671,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,322.08,48,,percent of total billed charges,,100% of DHS outpatient percentage
Us Ob Over 14 Wks Comp,,76805,CPT,Facility,Inpatient,,,,671,570.35,192.3086,671,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Us Ob Over 14 Wks Ea Addl Gest,,76810,CPT,Facility,Both,,,,624,530.4,178.8384,624,Aetna,Commercial,574.08,92,,percent of total billed charges,,
Us Ob Over 14 Wks Ea Addl Gest,,76810,CPT,Facility,Outpatient,,,,624,530.4,178.8384,624,Aetna,Medicare Advantage,305.76,49,,percent of total billed charges,,
Us Ob Over 14 Wks Ea Addl Gest,,76810,CPT,Facility,Inpatient,,,,624,530.4,178.8384,624,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Us Ob Over 14 Wks Ea Addl Gest,,76810,CPT,Facility,Both,,,,624,530.4,178.8384,624,Aetna,PPO,580.32,93,,percent of total billed charges,,
Us Ob Over 14 Wks Ea Addl Gest,,76810,CPT,Facility,Both,,,,624,530.4,178.8384,624,America's PPO,America's PPO,599.2272,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Us Ob Over 14 Wks Ea Addl Gest,,76810,CPT,Facility,Both,,,,624,530.4,178.8384,624,BlueCross BlueShield Minnesota, Federal Employee Program,614.016,98.4,,percent of total billed charges,,
Us Ob Over 14 Wks Ea Addl Gest,,76810,CPT,Facility,Both,,,,624,530.4,178.8384,624,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,624,100,,percent of total billed charges,,
Us Ob Over 14 Wks Ea Addl Gest,,76810,CPT,Facility,Both,,,,624,530.4,178.8384,624,BlueCross BlueShield Minnesota,High Value Network Plan,561.6,90,,percent of total billed charges,,
Us Ob Over 14 Wks Ea Addl Gest,,76810,CPT,Facility,Outpatient,,,,624,530.4,178.8384,624,BlueCross BlueShield Minnesota,Medicare Advantage,305.76,49,,percent of total billed charges,,
Us Ob Over 14 Wks Ea Addl Gest,,76810,CPT,Facility,Inpatient,,,,624,530.4,178.8384,624,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Us Ob Over 14 Wks Ea Addl Gest,,76810,CPT,Facility,Both,,,,624,530.4,178.8384,624,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,552.6768,88.57,,percent of total billed charges,,
Us Ob Over 14 Wks Ea Addl Gest,,76810,CPT,Facility,Both,,,,624,530.4,178.8384,624,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,178.8384,28.66,,percent of total billed charges,,
Us Ob Over 14 Wks Ea Addl Gest,,76810,CPT,Facility,Outpatient,,,,624,530.4,178.8384,624,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),305.76,49,,percent of total billed charges,,
Us Ob Over 14 Wks Ea Addl Gest,,76810,CPT,Facility,Inpatient,,,,624,530.4,178.8384,624,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Us Ob Over 14 Wks Ea Addl Gest,,76810,CPT,Facility,Both,,,,624,530.4,178.8384,624,CorVel,Worker's Compensation,624,100,,percent of total billed charges,,
Us Ob Over 14 Wks Ea Addl Gest,,76810,CPT,Facility,Both,,,,624,530.4,178.8384,624,First Health Group Corporation,First Health Network,605.28,97,,percent of total billed charges,,
Us Ob Over 14 Wks Ea Addl Gest,,76810,CPT,Facility,Both,,,,624,530.4,178.8384,624,"Health Partners, Inc.",Commercial,590.304,94.6,,percent of total billed charges,,
Us Ob Over 14 Wks Ea Addl Gest,,76810,CPT,Facility,Outpatient,,,,624,530.4,178.8384,624,"Health Partners, Inc.",Medicare Advantage,305.76,49,,percent of total billed charges,,
Us Ob Over 14 Wks Ea Addl Gest,,76810,CPT,Facility,Inpatient,,,,624,530.4,178.8384,624,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Us Ob Over 14 Wks Ea Addl Gest,,76810,CPT,Facility,Both,,,,624,530.4,178.8384,624,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),374.4,60,,percent of total billed charges,,
Us Ob Over 14 Wks Ea Addl Gest,,76810,CPT,Facility,Both,,,,624,530.4,178.8384,624,"Health Partners, Inc.",State of Minnesota Advantage Program,508.56,81.5,,percent of total billed charges,,
Us Ob Over 14 Wks Ea Addl Gest,,76810,CPT,Facility,Both,,,,624,530.4,178.8384,624,"Health Partners, Inc.",State Public Programs,312,50,,percent of total billed charges,,
Us Ob Over 14 Wks Ea Addl Gest,,76810,CPT,Facility,Both,,,,624,530.4,178.8384,624,Humana Insurance Company,Commercial PPO,592.8,95,,percent of total billed charges,,
Us Ob Over 14 Wks Ea Addl Gest,,76810,CPT,Facility,Outpatient,,,,624,530.4,178.8384,624,Humana Insurance Company,Medicare PPO,305.76,49,,percent of total billed charges,,
Us Ob Over 14 Wks Ea Addl Gest,,76810,CPT,Facility,Inpatient,,,,624,530.4,178.8384,624,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Us Ob Over 14 Wks Ea Addl Gest,,76810,CPT,Facility,Both,,,,624,530.4,178.8384,624,Medica,Individual & Family,618.384,99.1,,percent of total billed charges,,
Us Ob Over 14 Wks Ea Addl Gest,,76810,CPT,Facility,Outpatient,,,,624,530.4,178.8384,624,Medica,Medica Advantage Solution,310.752,49.8,,percent of total billed charges,,
Us Ob Over 14 Wks Ea Addl Gest,,76810,CPT,Facility,Inpatient,,,,624,530.4,178.8384,624,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Us Ob Over 14 Wks Ea Addl Gest,,76810,CPT,Facility,Outpatient,,,,624,530.4,178.8384,624,Medica,Medical Assistance,278.304,44.6,,percent of total billed charges,,
Us Ob Over 14 Wks Ea Addl Gest,,76810,CPT,Facility,Inpatient,,,,624,530.4,178.8384,624,Medica,Medical Assistance,,,,,Included in per diem rate,
Us Ob Over 14 Wks Ea Addl Gest,,76810,CPT,Facility,Outpatient,,,,624,530.4,178.8384,624,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,310.752,49.8,,percent of total billed charges,,
Us Ob Over 14 Wks Ea Addl Gest,,76810,CPT,Facility,Inpatient,,,,624,530.4,178.8384,624,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Us Ob Over 14 Wks Ea Addl Gest,,76810,CPT,Facility,Both,,,,624,530.4,178.8384,624,"Multiplan, Inc.","Multiplan, Inc.",586.56,94,,percent of total billed charges,,
Us Ob Over 14 Wks Ea Addl Gest,,76810,CPT,Facility,Outpatient,,,,624,530.4,178.8384,624,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,562.224,90.1,,percent of total billed charges,,
Us Ob Over 14 Wks Ea Addl Gest,,76810,CPT,Facility,Inpatient,,,,624,530.4,178.8384,624,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Us Ob Over 14 Wks Ea Addl Gest,,76810,CPT,Facility,Both,,,,624,530.4,178.8384,624,"Preferred One Administrative Services, INC.",PPO,615.264,98.6,,percent of total billed charges,,
Us Ob Over 14 Wks Ea Addl Gest,,76810,CPT,Facility,Outpatient,,,,624,530.4,178.8384,624,PrimeWest Health,Minnesota Senior Health Options (MSHO),321.048,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Us Ob Over 14 Wks Ea Addl Gest,,76810,CPT,Facility,Inpatient,,,,624,530.4,178.8384,624,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Us Ob Over 14 Wks Ea Addl Gest,,76810,CPT,Facility,Outpatient,,,,624,530.4,178.8384,624,PrimeWest Health,MinnesotaCare,320.4864,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Us Ob Over 14 Wks Ea Addl Gest,,76810,CPT,Facility,Inpatient,,,,624,530.4,178.8384,624,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Us Ob Over 14 Wks Ea Addl Gest,,76810,CPT,Facility,Both,,,,624,530.4,178.8384,624,Sanford Health Plan,Sanford Health Plan,574.08,92,,percent of total billed charges,,
Us Ob Over 14 Wks Ea Addl Gest,,76810,CPT,Facility,Outpatient,,,,624,530.4,178.8384,624,"UCare Health, Inc.",Individual & Family Plan,351.624,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Us Ob Over 14 Wks Ea Addl Gest,,76810,CPT,Facility,Inpatient,,,,624,530.4,178.8384,624,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Us Ob Over 14 Wks Ea Addl Gest,,76810,CPT,Facility,Outpatient,,,,624,530.4,178.8384,624,"UCare Health, Inc.",Medical Assistance,314.9328,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Ob Over 14 Wks Ea Addl Gest,,76810,CPT,Facility,Inpatient,,,,624,530.4,178.8384,624,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Us Ob Over 14 Wks Ea Addl Gest,,76810,CPT,Facility,Outpatient,,,,624,530.4,178.8384,624,"UCare Health, Inc.",Medicare Advantage,314.9328,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Ob Over 14 Wks Ea Addl Gest,,76810,CPT,Facility,Inpatient,,,,624,530.4,178.8384,624,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Us Ob Over 14 Wks Ea Addl Gest,,76810,CPT,Facility,Outpatient,,,,624,530.4,178.8384,624,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),314.9328,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Ob Over 14 Wks Ea Addl Gest,,76810,CPT,Facility,Inpatient,,,,624,530.4,178.8384,624,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Us Ob Over 14 Wks Ea Addl Gest,,76810,CPT,Facility,Both,,,,624,530.4,178.8384,624,UnitedHealthcare,Individual & Family,586.56,94,,percent of total billed charges,,
Us Ob Over 14 Wks Ea Addl Gest,,76810,CPT,Facility,Outpatient,,,,624,530.4,178.8384,624,UnitedHealthcare,Medicare Advantage,305.76,49,,percent of total billed charges,,
Us Ob Over 14 Wks Ea Addl Gest,,76810,CPT,Facility,Inpatient,,,,624,530.4,178.8384,624,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Us Ob Over 14 Wks Ea Addl Gest,,76810,CPT,Facility,Outpatient,,,,624,530.4,178.8384,624,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,299.52,48,,percent of total billed charges,,100% of DHS outpatient percentage
Us Ob Over 14 Wks Ea Addl Gest,,76810,CPT,Facility,Inpatient,,,,624,530.4,178.8384,624,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Us Ob Ltd,,76815,CPT,Facility,Both,,,,439,373.15,125.8174,439,Aetna,Commercial,403.88,92,,percent of total billed charges,,
Us Ob Ltd,,76815,CPT,Facility,Outpatient,,,,439,373.15,125.8174,439,Aetna,Medicare Advantage,215.11,49,,percent of total billed charges,,
Us Ob Ltd,,76815,CPT,Facility,Inpatient,,,,439,373.15,125.8174,439,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Us Ob Ltd,,76815,CPT,Facility,Both,,,,439,373.15,125.8174,439,Aetna,PPO,408.27,93,,percent of total billed charges,,
Us Ob Ltd,,76815,CPT,Facility,Both,,,,439,373.15,125.8174,439,America's PPO,America's PPO,421.5717,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Us Ob Ltd,,76815,CPT,Facility,Both,,,,439,373.15,125.8174,439,BlueCross BlueShield Minnesota, Federal Employee Program,431.976,98.4,,percent of total billed charges,,
Us Ob Ltd,,76815,CPT,Facility,Both,,,,439,373.15,125.8174,439,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,439,100,,percent of total billed charges,,
Us Ob Ltd,,76815,CPT,Facility,Both,,,,439,373.15,125.8174,439,BlueCross BlueShield Minnesota,High Value Network Plan,395.1,90,,percent of total billed charges,,
Us Ob Ltd,,76815,CPT,Facility,Outpatient,,,,439,373.15,125.8174,439,BlueCross BlueShield Minnesota,Medicare Advantage,215.11,49,,percent of total billed charges,,
Us Ob Ltd,,76815,CPT,Facility,Inpatient,,,,439,373.15,125.8174,439,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Us Ob Ltd,,76815,CPT,Facility,Both,,,,439,373.15,125.8174,439,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,388.8223,88.57,,percent of total billed charges,,
Us Ob Ltd,,76815,CPT,Facility,Both,,,,439,373.15,125.8174,439,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,125.8174,28.66,,percent of total billed charges,,
Us Ob Ltd,,76815,CPT,Facility,Outpatient,,,,439,373.15,125.8174,439,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),215.11,49,,percent of total billed charges,,
Us Ob Ltd,,76815,CPT,Facility,Inpatient,,,,439,373.15,125.8174,439,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Us Ob Ltd,,76815,CPT,Facility,Both,,,,439,373.15,125.8174,439,CorVel,Worker's Compensation,439,100,,percent of total billed charges,,
Us Ob Ltd,,76815,CPT,Facility,Both,,,,439,373.15,125.8174,439,First Health Group Corporation,First Health Network,425.83,97,,percent of total billed charges,,
Us Ob Ltd,,76815,CPT,Facility,Both,,,,439,373.15,125.8174,439,"Health Partners, Inc.",Commercial,415.294,94.6,,percent of total billed charges,,
Us Ob Ltd,,76815,CPT,Facility,Outpatient,,,,439,373.15,125.8174,439,"Health Partners, Inc.",Medicare Advantage,215.11,49,,percent of total billed charges,,
Us Ob Ltd,,76815,CPT,Facility,Inpatient,,,,439,373.15,125.8174,439,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Us Ob Ltd,,76815,CPT,Facility,Both,,,,439,373.15,125.8174,439,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),263.4,60,,percent of total billed charges,,
Us Ob Ltd,,76815,CPT,Facility,Both,,,,439,373.15,125.8174,439,"Health Partners, Inc.",State of Minnesota Advantage Program,357.785,81.5,,percent of total billed charges,,
Us Ob Ltd,,76815,CPT,Facility,Both,,,,439,373.15,125.8174,439,"Health Partners, Inc.",State Public Programs,219.5,50,,percent of total billed charges,,
Us Ob Ltd,,76815,CPT,Facility,Both,,,,439,373.15,125.8174,439,Humana Insurance Company,Commercial PPO,417.05,95,,percent of total billed charges,,
Us Ob Ltd,,76815,CPT,Facility,Outpatient,,,,439,373.15,125.8174,439,Humana Insurance Company,Medicare PPO,215.11,49,,percent of total billed charges,,
Us Ob Ltd,,76815,CPT,Facility,Inpatient,,,,439,373.15,125.8174,439,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Us Ob Ltd,,76815,CPT,Facility,Both,,,,439,373.15,125.8174,439,Medica,Individual & Family,435.049,99.1,,percent of total billed charges,,
Us Ob Ltd,,76815,CPT,Facility,Outpatient,,,,439,373.15,125.8174,439,Medica,Medica Advantage Solution,218.622,49.8,,percent of total billed charges,,
Us Ob Ltd,,76815,CPT,Facility,Inpatient,,,,439,373.15,125.8174,439,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Us Ob Ltd,,76815,CPT,Facility,Outpatient,,,,439,373.15,125.8174,439,Medica,Medical Assistance,195.794,44.6,,percent of total billed charges,,
Us Ob Ltd,,76815,CPT,Facility,Inpatient,,,,439,373.15,125.8174,439,Medica,Medical Assistance,,,,,Included in per diem rate,
Us Ob Ltd,,76815,CPT,Facility,Outpatient,,,,439,373.15,125.8174,439,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,218.622,49.8,,percent of total billed charges,,
Us Ob Ltd,,76815,CPT,Facility,Inpatient,,,,439,373.15,125.8174,439,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Us Ob Ltd,,76815,CPT,Facility,Both,,,,439,373.15,125.8174,439,"Multiplan, Inc.","Multiplan, Inc.",412.66,94,,percent of total billed charges,,
Us Ob Ltd,,76815,CPT,Facility,Outpatient,,,,439,373.15,125.8174,439,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,395.539,90.1,,percent of total billed charges,,
Us Ob Ltd,,76815,CPT,Facility,Inpatient,,,,439,373.15,125.8174,439,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Us Ob Ltd,,76815,CPT,Facility,Both,,,,439,373.15,125.8174,439,"Preferred One Administrative Services, INC.",PPO,432.854,98.6,,percent of total billed charges,,
Us Ob Ltd,,76815,CPT,Facility,Outpatient,,,,439,373.15,125.8174,439,PrimeWest Health,Minnesota Senior Health Options (MSHO),225.8655,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Us Ob Ltd,,76815,CPT,Facility,Inpatient,,,,439,373.15,125.8174,439,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Us Ob Ltd,,76815,CPT,Facility,Outpatient,,,,439,373.15,125.8174,439,PrimeWest Health,MinnesotaCare,225.4704,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Us Ob Ltd,,76815,CPT,Facility,Inpatient,,,,439,373.15,125.8174,439,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Us Ob Ltd,,76815,CPT,Facility,Both,,,,439,373.15,125.8174,439,Sanford Health Plan,Sanford Health Plan,403.88,92,,percent of total billed charges,,
Us Ob Ltd,,76815,CPT,Facility,Outpatient,,,,439,373.15,125.8174,439,"UCare Health, Inc.",Individual & Family Plan,247.3765,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Us Ob Ltd,,76815,CPT,Facility,Inpatient,,,,439,373.15,125.8174,439,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Us Ob Ltd,,76815,CPT,Facility,Outpatient,,,,439,373.15,125.8174,439,"UCare Health, Inc.",Medical Assistance,221.5633,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Ob Ltd,,76815,CPT,Facility,Inpatient,,,,439,373.15,125.8174,439,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Us Ob Ltd,,76815,CPT,Facility,Outpatient,,,,439,373.15,125.8174,439,"UCare Health, Inc.",Medicare Advantage,221.5633,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Ob Ltd,,76815,CPT,Facility,Inpatient,,,,439,373.15,125.8174,439,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Us Ob Ltd,,76815,CPT,Facility,Outpatient,,,,439,373.15,125.8174,439,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),221.5633,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Ob Ltd,,76815,CPT,Facility,Inpatient,,,,439,373.15,125.8174,439,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Us Ob Ltd,,76815,CPT,Facility,Both,,,,439,373.15,125.8174,439,UnitedHealthcare,Individual & Family,412.66,94,,percent of total billed charges,,
Us Ob Ltd,,76815,CPT,Facility,Outpatient,,,,439,373.15,125.8174,439,UnitedHealthcare,Medicare Advantage,215.11,49,,percent of total billed charges,,
Us Ob Ltd,,76815,CPT,Facility,Inpatient,,,,439,373.15,125.8174,439,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Us Ob Ltd,,76815,CPT,Facility,Outpatient,,,,439,373.15,125.8174,439,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,210.72,48,,percent of total billed charges,,100% of DHS outpatient percentage
Us Ob Ltd,,76815,CPT,Facility,Inpatient,,,,439,373.15,125.8174,439,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Us Ob Follow Up,,76816,CPT,Facility,Both,,,,483,410.55,138.4278,483,Aetna,Commercial,444.36,92,,percent of total billed charges,,
Us Ob Follow Up,,76816,CPT,Facility,Outpatient,,,,483,410.55,138.4278,483,Aetna,Medicare Advantage,236.67,49,,percent of total billed charges,,
Us Ob Follow Up,,76816,CPT,Facility,Inpatient,,,,483,410.55,138.4278,483,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Us Ob Follow Up,,76816,CPT,Facility,Both,,,,483,410.55,138.4278,483,Aetna,PPO,449.19,93,,percent of total billed charges,,
Us Ob Follow Up,,76816,CPT,Facility,Both,,,,483,410.55,138.4278,483,America's PPO,America's PPO,463.8249,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Us Ob Follow Up,,76816,CPT,Facility,Both,,,,483,410.55,138.4278,483,BlueCross BlueShield Minnesota, Federal Employee Program,475.272,98.4,,percent of total billed charges,,
Us Ob Follow Up,,76816,CPT,Facility,Both,,,,483,410.55,138.4278,483,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,483,100,,percent of total billed charges,,
Us Ob Follow Up,,76816,CPT,Facility,Both,,,,483,410.55,138.4278,483,BlueCross BlueShield Minnesota,High Value Network Plan,434.7,90,,percent of total billed charges,,
Us Ob Follow Up,,76816,CPT,Facility,Outpatient,,,,483,410.55,138.4278,483,BlueCross BlueShield Minnesota,Medicare Advantage,236.67,49,,percent of total billed charges,,
Us Ob Follow Up,,76816,CPT,Facility,Inpatient,,,,483,410.55,138.4278,483,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Us Ob Follow Up,,76816,CPT,Facility,Both,,,,483,410.55,138.4278,483,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,427.7931,88.57,,percent of total billed charges,,
Us Ob Follow Up,,76816,CPT,Facility,Both,,,,483,410.55,138.4278,483,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,138.4278,28.66,,percent of total billed charges,,
Us Ob Follow Up,,76816,CPT,Facility,Outpatient,,,,483,410.55,138.4278,483,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),236.67,49,,percent of total billed charges,,
Us Ob Follow Up,,76816,CPT,Facility,Inpatient,,,,483,410.55,138.4278,483,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Us Ob Follow Up,,76816,CPT,Facility,Both,,,,483,410.55,138.4278,483,CorVel,Worker's Compensation,483,100,,percent of total billed charges,,
Us Ob Follow Up,,76816,CPT,Facility,Both,,,,483,410.55,138.4278,483,First Health Group Corporation,First Health Network,468.51,97,,percent of total billed charges,,
Us Ob Follow Up,,76816,CPT,Facility,Both,,,,483,410.55,138.4278,483,"Health Partners, Inc.",Commercial,456.918,94.6,,percent of total billed charges,,
Us Ob Follow Up,,76816,CPT,Facility,Outpatient,,,,483,410.55,138.4278,483,"Health Partners, Inc.",Medicare Advantage,236.67,49,,percent of total billed charges,,
Us Ob Follow Up,,76816,CPT,Facility,Inpatient,,,,483,410.55,138.4278,483,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Us Ob Follow Up,,76816,CPT,Facility,Both,,,,483,410.55,138.4278,483,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),289.8,60,,percent of total billed charges,,
Us Ob Follow Up,,76816,CPT,Facility,Both,,,,483,410.55,138.4278,483,"Health Partners, Inc.",State of Minnesota Advantage Program,393.645,81.5,,percent of total billed charges,,
Us Ob Follow Up,,76816,CPT,Facility,Both,,,,483,410.55,138.4278,483,"Health Partners, Inc.",State Public Programs,241.5,50,,percent of total billed charges,,
Us Ob Follow Up,,76816,CPT,Facility,Both,,,,483,410.55,138.4278,483,Humana Insurance Company,Commercial PPO,458.85,95,,percent of total billed charges,,
Us Ob Follow Up,,76816,CPT,Facility,Outpatient,,,,483,410.55,138.4278,483,Humana Insurance Company,Medicare PPO,236.67,49,,percent of total billed charges,,
Us Ob Follow Up,,76816,CPT,Facility,Inpatient,,,,483,410.55,138.4278,483,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Us Ob Follow Up,,76816,CPT,Facility,Both,,,,483,410.55,138.4278,483,Medica,Individual & Family,478.653,99.1,,percent of total billed charges,,
Us Ob Follow Up,,76816,CPT,Facility,Outpatient,,,,483,410.55,138.4278,483,Medica,Medica Advantage Solution,240.534,49.8,,percent of total billed charges,,
Us Ob Follow Up,,76816,CPT,Facility,Inpatient,,,,483,410.55,138.4278,483,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Us Ob Follow Up,,76816,CPT,Facility,Outpatient,,,,483,410.55,138.4278,483,Medica,Medical Assistance,215.418,44.6,,percent of total billed charges,,
Us Ob Follow Up,,76816,CPT,Facility,Inpatient,,,,483,410.55,138.4278,483,Medica,Medical Assistance,,,,,Included in per diem rate,
Us Ob Follow Up,,76816,CPT,Facility,Outpatient,,,,483,410.55,138.4278,483,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,240.534,49.8,,percent of total billed charges,,
Us Ob Follow Up,,76816,CPT,Facility,Inpatient,,,,483,410.55,138.4278,483,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Us Ob Follow Up,,76816,CPT,Facility,Both,,,,483,410.55,138.4278,483,"Multiplan, Inc.","Multiplan, Inc.",454.02,94,,percent of total billed charges,,
Us Ob Follow Up,,76816,CPT,Facility,Outpatient,,,,483,410.55,138.4278,483,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,435.183,90.1,,percent of total billed charges,,
Us Ob Follow Up,,76816,CPT,Facility,Inpatient,,,,483,410.55,138.4278,483,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Us Ob Follow Up,,76816,CPT,Facility,Both,,,,483,410.55,138.4278,483,"Preferred One Administrative Services, INC.",PPO,476.238,98.6,,percent of total billed charges,,
Us Ob Follow Up,,76816,CPT,Facility,Outpatient,,,,483,410.55,138.4278,483,PrimeWest Health,Minnesota Senior Health Options (MSHO),248.5035,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Us Ob Follow Up,,76816,CPT,Facility,Inpatient,,,,483,410.55,138.4278,483,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Us Ob Follow Up,,76816,CPT,Facility,Outpatient,,,,483,410.55,138.4278,483,PrimeWest Health,MinnesotaCare,248.0688,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Us Ob Follow Up,,76816,CPT,Facility,Inpatient,,,,483,410.55,138.4278,483,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Us Ob Follow Up,,76816,CPT,Facility,Both,,,,483,410.55,138.4278,483,Sanford Health Plan,Sanford Health Plan,444.36,92,,percent of total billed charges,,
Us Ob Follow Up,,76816,CPT,Facility,Outpatient,,,,483,410.55,138.4278,483,"UCare Health, Inc.",Individual & Family Plan,272.1705,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Us Ob Follow Up,,76816,CPT,Facility,Inpatient,,,,483,410.55,138.4278,483,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Us Ob Follow Up,,76816,CPT,Facility,Outpatient,,,,483,410.55,138.4278,483,"UCare Health, Inc.",Medical Assistance,243.7701,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Ob Follow Up,,76816,CPT,Facility,Inpatient,,,,483,410.55,138.4278,483,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Us Ob Follow Up,,76816,CPT,Facility,Outpatient,,,,483,410.55,138.4278,483,"UCare Health, Inc.",Medicare Advantage,243.7701,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Ob Follow Up,,76816,CPT,Facility,Inpatient,,,,483,410.55,138.4278,483,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Us Ob Follow Up,,76816,CPT,Facility,Outpatient,,,,483,410.55,138.4278,483,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),243.7701,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Ob Follow Up,,76816,CPT,Facility,Inpatient,,,,483,410.55,138.4278,483,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Us Ob Follow Up,,76816,CPT,Facility,Both,,,,483,410.55,138.4278,483,UnitedHealthcare,Individual & Family,454.02,94,,percent of total billed charges,,
Us Ob Follow Up,,76816,CPT,Facility,Outpatient,,,,483,410.55,138.4278,483,UnitedHealthcare,Medicare Advantage,236.67,49,,percent of total billed charges,,
Us Ob Follow Up,,76816,CPT,Facility,Inpatient,,,,483,410.55,138.4278,483,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Us Ob Follow Up,,76816,CPT,Facility,Outpatient,,,,483,410.55,138.4278,483,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,231.84,48,,percent of total billed charges,,100% of DHS outpatient percentage
Us Ob Follow Up,,76816,CPT,Facility,Inpatient,,,,483,410.55,138.4278,483,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Us Ob Transvaginal,,76817,CPT,Facility,Both,,,,501,425.85,143.5866,501,Aetna,Commercial,460.92,92,,percent of total billed charges,,
Us Ob Transvaginal,,76817,CPT,Facility,Outpatient,,,,501,425.85,143.5866,501,Aetna,Medicare Advantage,245.49,49,,percent of total billed charges,,
Us Ob Transvaginal,,76817,CPT,Facility,Inpatient,,,,501,425.85,143.5866,501,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Us Ob Transvaginal,,76817,CPT,Facility,Both,,,,501,425.85,143.5866,501,Aetna,PPO,465.93,93,,percent of total billed charges,,
Us Ob Transvaginal,,76817,CPT,Facility,Both,,,,501,425.85,143.5866,501,America's PPO,America's PPO,481.1103,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Us Ob Transvaginal,,76817,CPT,Facility,Both,,,,501,425.85,143.5866,501,BlueCross BlueShield Minnesota, Federal Employee Program,492.984,98.4,,percent of total billed charges,,
Us Ob Transvaginal,,76817,CPT,Facility,Both,,,,501,425.85,143.5866,501,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,501,100,,percent of total billed charges,,
Us Ob Transvaginal,,76817,CPT,Facility,Both,,,,501,425.85,143.5866,501,BlueCross BlueShield Minnesota,High Value Network Plan,450.9,90,,percent of total billed charges,,
Us Ob Transvaginal,,76817,CPT,Facility,Outpatient,,,,501,425.85,143.5866,501,BlueCross BlueShield Minnesota,Medicare Advantage,245.49,49,,percent of total billed charges,,
Us Ob Transvaginal,,76817,CPT,Facility,Inpatient,,,,501,425.85,143.5866,501,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Us Ob Transvaginal,,76817,CPT,Facility,Both,,,,501,425.85,143.5866,501,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,443.7357,88.57,,percent of total billed charges,,
Us Ob Transvaginal,,76817,CPT,Facility,Both,,,,501,425.85,143.5866,501,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,143.5866,28.66,,percent of total billed charges,,
Us Ob Transvaginal,,76817,CPT,Facility,Outpatient,,,,501,425.85,143.5866,501,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),245.49,49,,percent of total billed charges,,
Us Ob Transvaginal,,76817,CPT,Facility,Inpatient,,,,501,425.85,143.5866,501,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Us Ob Transvaginal,,76817,CPT,Facility,Both,,,,501,425.85,143.5866,501,CorVel,Worker's Compensation,501,100,,percent of total billed charges,,
Us Ob Transvaginal,,76817,CPT,Facility,Both,,,,501,425.85,143.5866,501,First Health Group Corporation,First Health Network,485.97,97,,percent of total billed charges,,
Us Ob Transvaginal,,76817,CPT,Facility,Both,,,,501,425.85,143.5866,501,"Health Partners, Inc.",Commercial,473.946,94.6,,percent of total billed charges,,
Us Ob Transvaginal,,76817,CPT,Facility,Outpatient,,,,501,425.85,143.5866,501,"Health Partners, Inc.",Medicare Advantage,245.49,49,,percent of total billed charges,,
Us Ob Transvaginal,,76817,CPT,Facility,Inpatient,,,,501,425.85,143.5866,501,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Us Ob Transvaginal,,76817,CPT,Facility,Both,,,,501,425.85,143.5866,501,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),300.6,60,,percent of total billed charges,,
Us Ob Transvaginal,,76817,CPT,Facility,Both,,,,501,425.85,143.5866,501,"Health Partners, Inc.",State of Minnesota Advantage Program,408.315,81.5,,percent of total billed charges,,
Us Ob Transvaginal,,76817,CPT,Facility,Both,,,,501,425.85,143.5866,501,"Health Partners, Inc.",State Public Programs,250.5,50,,percent of total billed charges,,
Us Ob Transvaginal,,76817,CPT,Facility,Both,,,,501,425.85,143.5866,501,Humana Insurance Company,Commercial PPO,475.95,95,,percent of total billed charges,,
Us Ob Transvaginal,,76817,CPT,Facility,Outpatient,,,,501,425.85,143.5866,501,Humana Insurance Company,Medicare PPO,245.49,49,,percent of total billed charges,,
Us Ob Transvaginal,,76817,CPT,Facility,Inpatient,,,,501,425.85,143.5866,501,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Us Ob Transvaginal,,76817,CPT,Facility,Both,,,,501,425.85,143.5866,501,Medica,Individual & Family,496.491,99.1,,percent of total billed charges,,
Us Ob Transvaginal,,76817,CPT,Facility,Outpatient,,,,501,425.85,143.5866,501,Medica,Medica Advantage Solution,249.498,49.8,,percent of total billed charges,,
Us Ob Transvaginal,,76817,CPT,Facility,Inpatient,,,,501,425.85,143.5866,501,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Us Ob Transvaginal,,76817,CPT,Facility,Outpatient,,,,501,425.85,143.5866,501,Medica,Medical Assistance,223.446,44.6,,percent of total billed charges,,
Us Ob Transvaginal,,76817,CPT,Facility,Inpatient,,,,501,425.85,143.5866,501,Medica,Medical Assistance,,,,,Included in per diem rate,
Us Ob Transvaginal,,76817,CPT,Facility,Outpatient,,,,501,425.85,143.5866,501,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,249.498,49.8,,percent of total billed charges,,
Us Ob Transvaginal,,76817,CPT,Facility,Inpatient,,,,501,425.85,143.5866,501,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Us Ob Transvaginal,,76817,CPT,Facility,Both,,,,501,425.85,143.5866,501,"Multiplan, Inc.","Multiplan, Inc.",470.94,94,,percent of total billed charges,,
Us Ob Transvaginal,,76817,CPT,Facility,Outpatient,,,,501,425.85,143.5866,501,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,451.401,90.1,,percent of total billed charges,,
Us Ob Transvaginal,,76817,CPT,Facility,Inpatient,,,,501,425.85,143.5866,501,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Us Ob Transvaginal,,76817,CPT,Facility,Both,,,,501,425.85,143.5866,501,"Preferred One Administrative Services, INC.",PPO,493.986,98.6,,percent of total billed charges,,
Us Ob Transvaginal,,76817,CPT,Facility,Outpatient,,,,501,425.85,143.5866,501,PrimeWest Health,Minnesota Senior Health Options (MSHO),257.7645,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Us Ob Transvaginal,,76817,CPT,Facility,Inpatient,,,,501,425.85,143.5866,501,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Us Ob Transvaginal,,76817,CPT,Facility,Outpatient,,,,501,425.85,143.5866,501,PrimeWest Health,MinnesotaCare,257.3136,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Us Ob Transvaginal,,76817,CPT,Facility,Inpatient,,,,501,425.85,143.5866,501,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Us Ob Transvaginal,,76817,CPT,Facility,Both,,,,501,425.85,143.5866,501,Sanford Health Plan,Sanford Health Plan,460.92,92,,percent of total billed charges,,
Us Ob Transvaginal,,76817,CPT,Facility,Outpatient,,,,501,425.85,143.5866,501,"UCare Health, Inc.",Individual & Family Plan,282.3135,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Us Ob Transvaginal,,76817,CPT,Facility,Inpatient,,,,501,425.85,143.5866,501,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Us Ob Transvaginal,,76817,CPT,Facility,Outpatient,,,,501,425.85,143.5866,501,"UCare Health, Inc.",Medical Assistance,252.8547,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Ob Transvaginal,,76817,CPT,Facility,Inpatient,,,,501,425.85,143.5866,501,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Us Ob Transvaginal,,76817,CPT,Facility,Outpatient,,,,501,425.85,143.5866,501,"UCare Health, Inc.",Medicare Advantage,252.8547,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Ob Transvaginal,,76817,CPT,Facility,Inpatient,,,,501,425.85,143.5866,501,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Us Ob Transvaginal,,76817,CPT,Facility,Outpatient,,,,501,425.85,143.5866,501,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),252.8547,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Ob Transvaginal,,76817,CPT,Facility,Inpatient,,,,501,425.85,143.5866,501,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Us Ob Transvaginal,,76817,CPT,Facility,Both,,,,501,425.85,143.5866,501,UnitedHealthcare,Individual & Family,470.94,94,,percent of total billed charges,,
Us Ob Transvaginal,,76817,CPT,Facility,Outpatient,,,,501,425.85,143.5866,501,UnitedHealthcare,Medicare Advantage,245.49,49,,percent of total billed charges,,
Us Ob Transvaginal,,76817,CPT,Facility,Inpatient,,,,501,425.85,143.5866,501,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Us Ob Transvaginal,,76817,CPT,Facility,Outpatient,,,,501,425.85,143.5866,501,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,240.48,48,,percent of total billed charges,,100% of DHS outpatient percentage
Us Ob Transvaginal,,76817,CPT,Facility,Inpatient,,,,501,425.85,143.5866,501,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Us Ob Biophysical Profile W Non Stress,,76818,CPT,Facility,Both,,,,728,618.8,208.6448,728,Aetna,Commercial,669.76,92,,percent of total billed charges,,
Us Ob Biophysical Profile W Non Stress,,76818,CPT,Facility,Outpatient,,,,728,618.8,208.6448,728,Aetna,Medicare Advantage,356.72,49,,percent of total billed charges,,
Us Ob Biophysical Profile W Non Stress,,76818,CPT,Facility,Inpatient,,,,728,618.8,208.6448,728,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Us Ob Biophysical Profile W Non Stress,,76818,CPT,Facility,Both,,,,728,618.8,208.6448,728,Aetna,PPO,677.04,93,,percent of total billed charges,,
Us Ob Biophysical Profile W Non Stress,,76818,CPT,Facility,Both,,,,728,618.8,208.6448,728,America's PPO,America's PPO,699.0984,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Us Ob Biophysical Profile W Non Stress,,76818,CPT,Facility,Both,,,,728,618.8,208.6448,728,BlueCross BlueShield Minnesota, Federal Employee Program,716.352,98.4,,percent of total billed charges,,
Us Ob Biophysical Profile W Non Stress,,76818,CPT,Facility,Both,,,,728,618.8,208.6448,728,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,728,100,,percent of total billed charges,,
Us Ob Biophysical Profile W Non Stress,,76818,CPT,Facility,Both,,,,728,618.8,208.6448,728,BlueCross BlueShield Minnesota,High Value Network Plan,655.2,90,,percent of total billed charges,,
Us Ob Biophysical Profile W Non Stress,,76818,CPT,Facility,Outpatient,,,,728,618.8,208.6448,728,BlueCross BlueShield Minnesota,Medicare Advantage,356.72,49,,percent of total billed charges,,
Us Ob Biophysical Profile W Non Stress,,76818,CPT,Facility,Inpatient,,,,728,618.8,208.6448,728,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Us Ob Biophysical Profile W Non Stress,,76818,CPT,Facility,Both,,,,728,618.8,208.6448,728,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,644.7896,88.57,,percent of total billed charges,,
Us Ob Biophysical Profile W Non Stress,,76818,CPT,Facility,Both,,,,728,618.8,208.6448,728,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,208.6448,28.66,,percent of total billed charges,,
Us Ob Biophysical Profile W Non Stress,,76818,CPT,Facility,Outpatient,,,,728,618.8,208.6448,728,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),356.72,49,,percent of total billed charges,,
Us Ob Biophysical Profile W Non Stress,,76818,CPT,Facility,Inpatient,,,,728,618.8,208.6448,728,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Us Ob Biophysical Profile W Non Stress,,76818,CPT,Facility,Both,,,,728,618.8,208.6448,728,CorVel,Worker's Compensation,728,100,,percent of total billed charges,,
Us Ob Biophysical Profile W Non Stress,,76818,CPT,Facility,Both,,,,728,618.8,208.6448,728,First Health Group Corporation,First Health Network,706.16,97,,percent of total billed charges,,
Us Ob Biophysical Profile W Non Stress,,76818,CPT,Facility,Both,,,,728,618.8,208.6448,728,"Health Partners, Inc.",Commercial,688.688,94.6,,percent of total billed charges,,
Us Ob Biophysical Profile W Non Stress,,76818,CPT,Facility,Outpatient,,,,728,618.8,208.6448,728,"Health Partners, Inc.",Medicare Advantage,356.72,49,,percent of total billed charges,,
Us Ob Biophysical Profile W Non Stress,,76818,CPT,Facility,Inpatient,,,,728,618.8,208.6448,728,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Us Ob Biophysical Profile W Non Stress,,76818,CPT,Facility,Both,,,,728,618.8,208.6448,728,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),436.8,60,,percent of total billed charges,,
Us Ob Biophysical Profile W Non Stress,,76818,CPT,Facility,Both,,,,728,618.8,208.6448,728,"Health Partners, Inc.",State of Minnesota Advantage Program,593.32,81.5,,percent of total billed charges,,
Us Ob Biophysical Profile W Non Stress,,76818,CPT,Facility,Both,,,,728,618.8,208.6448,728,"Health Partners, Inc.",State Public Programs,364,50,,percent of total billed charges,,
Us Ob Biophysical Profile W Non Stress,,76818,CPT,Facility,Both,,,,728,618.8,208.6448,728,Humana Insurance Company,Commercial PPO,691.6,95,,percent of total billed charges,,
Us Ob Biophysical Profile W Non Stress,,76818,CPT,Facility,Outpatient,,,,728,618.8,208.6448,728,Humana Insurance Company,Medicare PPO,356.72,49,,percent of total billed charges,,
Us Ob Biophysical Profile W Non Stress,,76818,CPT,Facility,Inpatient,,,,728,618.8,208.6448,728,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Us Ob Biophysical Profile W Non Stress,,76818,CPT,Facility,Both,,,,728,618.8,208.6448,728,Medica,Individual & Family,721.448,99.1,,percent of total billed charges,,
Us Ob Biophysical Profile W Non Stress,,76818,CPT,Facility,Outpatient,,,,728,618.8,208.6448,728,Medica,Medica Advantage Solution,362.544,49.8,,percent of total billed charges,,
Us Ob Biophysical Profile W Non Stress,,76818,CPT,Facility,Inpatient,,,,728,618.8,208.6448,728,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Us Ob Biophysical Profile W Non Stress,,76818,CPT,Facility,Outpatient,,,,728,618.8,208.6448,728,Medica,Medical Assistance,324.688,44.6,,percent of total billed charges,,
Us Ob Biophysical Profile W Non Stress,,76818,CPT,Facility,Inpatient,,,,728,618.8,208.6448,728,Medica,Medical Assistance,,,,,Included in per diem rate,
Us Ob Biophysical Profile W Non Stress,,76818,CPT,Facility,Outpatient,,,,728,618.8,208.6448,728,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,362.544,49.8,,percent of total billed charges,,
Us Ob Biophysical Profile W Non Stress,,76818,CPT,Facility,Inpatient,,,,728,618.8,208.6448,728,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Us Ob Biophysical Profile W Non Stress,,76818,CPT,Facility,Both,,,,728,618.8,208.6448,728,"Multiplan, Inc.","Multiplan, Inc.",684.32,94,,percent of total billed charges,,
Us Ob Biophysical Profile W Non Stress,,76818,CPT,Facility,Outpatient,,,,728,618.8,208.6448,728,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,655.928,90.1,,percent of total billed charges,,
Us Ob Biophysical Profile W Non Stress,,76818,CPT,Facility,Inpatient,,,,728,618.8,208.6448,728,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Us Ob Biophysical Profile W Non Stress,,76818,CPT,Facility,Both,,,,728,618.8,208.6448,728,"Preferred One Administrative Services, INC.",PPO,717.808,98.6,,percent of total billed charges,,
Us Ob Biophysical Profile W Non Stress,,76818,CPT,Facility,Outpatient,,,,728,618.8,208.6448,728,PrimeWest Health,Minnesota Senior Health Options (MSHO),374.556,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Us Ob Biophysical Profile W Non Stress,,76818,CPT,Facility,Inpatient,,,,728,618.8,208.6448,728,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Us Ob Biophysical Profile W Non Stress,,76818,CPT,Facility,Outpatient,,,,728,618.8,208.6448,728,PrimeWest Health,MinnesotaCare,373.9008,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Us Ob Biophysical Profile W Non Stress,,76818,CPT,Facility,Inpatient,,,,728,618.8,208.6448,728,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Us Ob Biophysical Profile W Non Stress,,76818,CPT,Facility,Both,,,,728,618.8,208.6448,728,Sanford Health Plan,Sanford Health Plan,669.76,92,,percent of total billed charges,,
Us Ob Biophysical Profile W Non Stress,,76818,CPT,Facility,Outpatient,,,,728,618.8,208.6448,728,"UCare Health, Inc.",Individual & Family Plan,410.228,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Us Ob Biophysical Profile W Non Stress,,76818,CPT,Facility,Inpatient,,,,728,618.8,208.6448,728,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Us Ob Biophysical Profile W Non Stress,,76818,CPT,Facility,Outpatient,,,,728,618.8,208.6448,728,"UCare Health, Inc.",Medical Assistance,367.4216,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Ob Biophysical Profile W Non Stress,,76818,CPT,Facility,Inpatient,,,,728,618.8,208.6448,728,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Us Ob Biophysical Profile W Non Stress,,76818,CPT,Facility,Outpatient,,,,728,618.8,208.6448,728,"UCare Health, Inc.",Medicare Advantage,367.4216,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Ob Biophysical Profile W Non Stress,,76818,CPT,Facility,Inpatient,,,,728,618.8,208.6448,728,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Us Ob Biophysical Profile W Non Stress,,76818,CPT,Facility,Outpatient,,,,728,618.8,208.6448,728,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),367.4216,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Ob Biophysical Profile W Non Stress,,76818,CPT,Facility,Inpatient,,,,728,618.8,208.6448,728,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Us Ob Biophysical Profile W Non Stress,,76818,CPT,Facility,Both,,,,728,618.8,208.6448,728,UnitedHealthcare,Individual & Family,684.32,94,,percent of total billed charges,,
Us Ob Biophysical Profile W Non Stress,,76818,CPT,Facility,Outpatient,,,,728,618.8,208.6448,728,UnitedHealthcare,Medicare Advantage,356.72,49,,percent of total billed charges,,
Us Ob Biophysical Profile W Non Stress,,76818,CPT,Facility,Inpatient,,,,728,618.8,208.6448,728,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Us Ob Biophysical Profile W Non Stress,,76818,CPT,Facility,Outpatient,,,,728,618.8,208.6448,728,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,349.44,48,,percent of total billed charges,,100% of DHS outpatient percentage
Us Ob Biophysical Profile W Non Stress,,76818,CPT,Facility,Inpatient,,,,728,618.8,208.6448,728,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Us Ob Biophysical Profile Wo Non Stress,,76819,CPT,Facility,Both,,,,562,477.7,161.0692,562,Aetna,Commercial,517.04,92,,percent of total billed charges,,
Us Ob Biophysical Profile Wo Non Stress,,76819,CPT,Facility,Outpatient,,,,562,477.7,161.0692,562,Aetna,Medicare Advantage,275.38,49,,percent of total billed charges,,
Us Ob Biophysical Profile Wo Non Stress,,76819,CPT,Facility,Inpatient,,,,562,477.7,161.0692,562,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Us Ob Biophysical Profile Wo Non Stress,,76819,CPT,Facility,Both,,,,562,477.7,161.0692,562,Aetna,PPO,522.66,93,,percent of total billed charges,,
Us Ob Biophysical Profile Wo Non Stress,,76819,CPT,Facility,Both,,,,562,477.7,161.0692,562,America's PPO,America's PPO,539.6886,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Us Ob Biophysical Profile Wo Non Stress,,76819,CPT,Facility,Both,,,,562,477.7,161.0692,562,BlueCross BlueShield Minnesota, Federal Employee Program,553.008,98.4,,percent of total billed charges,,
Us Ob Biophysical Profile Wo Non Stress,,76819,CPT,Facility,Both,,,,562,477.7,161.0692,562,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,562,100,,percent of total billed charges,,
Us Ob Biophysical Profile Wo Non Stress,,76819,CPT,Facility,Both,,,,562,477.7,161.0692,562,BlueCross BlueShield Minnesota,High Value Network Plan,505.8,90,,percent of total billed charges,,
Us Ob Biophysical Profile Wo Non Stress,,76819,CPT,Facility,Outpatient,,,,562,477.7,161.0692,562,BlueCross BlueShield Minnesota,Medicare Advantage,275.38,49,,percent of total billed charges,,
Us Ob Biophysical Profile Wo Non Stress,,76819,CPT,Facility,Inpatient,,,,562,477.7,161.0692,562,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Us Ob Biophysical Profile Wo Non Stress,,76819,CPT,Facility,Both,,,,562,477.7,161.0692,562,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,497.7634,88.57,,percent of total billed charges,,
Us Ob Biophysical Profile Wo Non Stress,,76819,CPT,Facility,Both,,,,562,477.7,161.0692,562,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,161.0692,28.66,,percent of total billed charges,,
Us Ob Biophysical Profile Wo Non Stress,,76819,CPT,Facility,Outpatient,,,,562,477.7,161.0692,562,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),275.38,49,,percent of total billed charges,,
Us Ob Biophysical Profile Wo Non Stress,,76819,CPT,Facility,Inpatient,,,,562,477.7,161.0692,562,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Us Ob Biophysical Profile Wo Non Stress,,76819,CPT,Facility,Both,,,,562,477.7,161.0692,562,CorVel,Worker's Compensation,562,100,,percent of total billed charges,,
Us Ob Biophysical Profile Wo Non Stress,,76819,CPT,Facility,Both,,,,562,477.7,161.0692,562,First Health Group Corporation,First Health Network,545.14,97,,percent of total billed charges,,
Us Ob Biophysical Profile Wo Non Stress,,76819,CPT,Facility,Both,,,,562,477.7,161.0692,562,"Health Partners, Inc.",Commercial,531.652,94.6,,percent of total billed charges,,
Us Ob Biophysical Profile Wo Non Stress,,76819,CPT,Facility,Outpatient,,,,562,477.7,161.0692,562,"Health Partners, Inc.",Medicare Advantage,275.38,49,,percent of total billed charges,,
Us Ob Biophysical Profile Wo Non Stress,,76819,CPT,Facility,Inpatient,,,,562,477.7,161.0692,562,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Us Ob Biophysical Profile Wo Non Stress,,76819,CPT,Facility,Both,,,,562,477.7,161.0692,562,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),337.2,60,,percent of total billed charges,,
Us Ob Biophysical Profile Wo Non Stress,,76819,CPT,Facility,Both,,,,562,477.7,161.0692,562,"Health Partners, Inc.",State of Minnesota Advantage Program,458.03,81.5,,percent of total billed charges,,
Us Ob Biophysical Profile Wo Non Stress,,76819,CPT,Facility,Both,,,,562,477.7,161.0692,562,"Health Partners, Inc.",State Public Programs,281,50,,percent of total billed charges,,
Us Ob Biophysical Profile Wo Non Stress,,76819,CPT,Facility,Both,,,,562,477.7,161.0692,562,Humana Insurance Company,Commercial PPO,533.9,95,,percent of total billed charges,,
Us Ob Biophysical Profile Wo Non Stress,,76819,CPT,Facility,Outpatient,,,,562,477.7,161.0692,562,Humana Insurance Company,Medicare PPO,275.38,49,,percent of total billed charges,,
Us Ob Biophysical Profile Wo Non Stress,,76819,CPT,Facility,Inpatient,,,,562,477.7,161.0692,562,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Us Ob Biophysical Profile Wo Non Stress,,76819,CPT,Facility,Both,,,,562,477.7,161.0692,562,Medica,Individual & Family,556.942,99.1,,percent of total billed charges,,
Us Ob Biophysical Profile Wo Non Stress,,76819,CPT,Facility,Outpatient,,,,562,477.7,161.0692,562,Medica,Medica Advantage Solution,279.876,49.8,,percent of total billed charges,,
Us Ob Biophysical Profile Wo Non Stress,,76819,CPT,Facility,Inpatient,,,,562,477.7,161.0692,562,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Us Ob Biophysical Profile Wo Non Stress,,76819,CPT,Facility,Outpatient,,,,562,477.7,161.0692,562,Medica,Medical Assistance,250.652,44.6,,percent of total billed charges,,
Us Ob Biophysical Profile Wo Non Stress,,76819,CPT,Facility,Inpatient,,,,562,477.7,161.0692,562,Medica,Medical Assistance,,,,,Included in per diem rate,
Us Ob Biophysical Profile Wo Non Stress,,76819,CPT,Facility,Outpatient,,,,562,477.7,161.0692,562,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,279.876,49.8,,percent of total billed charges,,
Us Ob Biophysical Profile Wo Non Stress,,76819,CPT,Facility,Inpatient,,,,562,477.7,161.0692,562,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Us Ob Biophysical Profile Wo Non Stress,,76819,CPT,Facility,Both,,,,562,477.7,161.0692,562,"Multiplan, Inc.","Multiplan, Inc.",528.28,94,,percent of total billed charges,,
Us Ob Biophysical Profile Wo Non Stress,,76819,CPT,Facility,Outpatient,,,,562,477.7,161.0692,562,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,506.362,90.1,,percent of total billed charges,,
Us Ob Biophysical Profile Wo Non Stress,,76819,CPT,Facility,Inpatient,,,,562,477.7,161.0692,562,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Us Ob Biophysical Profile Wo Non Stress,,76819,CPT,Facility,Both,,,,562,477.7,161.0692,562,"Preferred One Administrative Services, INC.",PPO,554.132,98.6,,percent of total billed charges,,
Us Ob Biophysical Profile Wo Non Stress,,76819,CPT,Facility,Outpatient,,,,562,477.7,161.0692,562,PrimeWest Health,Minnesota Senior Health Options (MSHO),289.149,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Us Ob Biophysical Profile Wo Non Stress,,76819,CPT,Facility,Inpatient,,,,562,477.7,161.0692,562,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Us Ob Biophysical Profile Wo Non Stress,,76819,CPT,Facility,Outpatient,,,,562,477.7,161.0692,562,PrimeWest Health,MinnesotaCare,288.6432,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Us Ob Biophysical Profile Wo Non Stress,,76819,CPT,Facility,Inpatient,,,,562,477.7,161.0692,562,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Us Ob Biophysical Profile Wo Non Stress,,76819,CPT,Facility,Both,,,,562,477.7,161.0692,562,Sanford Health Plan,Sanford Health Plan,517.04,92,,percent of total billed charges,,
Us Ob Biophysical Profile Wo Non Stress,,76819,CPT,Facility,Outpatient,,,,562,477.7,161.0692,562,"UCare Health, Inc.",Individual & Family Plan,316.687,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Us Ob Biophysical Profile Wo Non Stress,,76819,CPT,Facility,Inpatient,,,,562,477.7,161.0692,562,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Us Ob Biophysical Profile Wo Non Stress,,76819,CPT,Facility,Outpatient,,,,562,477.7,161.0692,562,"UCare Health, Inc.",Medical Assistance,283.6414,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Ob Biophysical Profile Wo Non Stress,,76819,CPT,Facility,Inpatient,,,,562,477.7,161.0692,562,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Us Ob Biophysical Profile Wo Non Stress,,76819,CPT,Facility,Outpatient,,,,562,477.7,161.0692,562,"UCare Health, Inc.",Medicare Advantage,283.6414,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Ob Biophysical Profile Wo Non Stress,,76819,CPT,Facility,Inpatient,,,,562,477.7,161.0692,562,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Us Ob Biophysical Profile Wo Non Stress,,76819,CPT,Facility,Outpatient,,,,562,477.7,161.0692,562,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),283.6414,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Ob Biophysical Profile Wo Non Stress,,76819,CPT,Facility,Inpatient,,,,562,477.7,161.0692,562,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Us Ob Biophysical Profile Wo Non Stress,,76819,CPT,Facility,Both,,,,562,477.7,161.0692,562,UnitedHealthcare,Individual & Family,528.28,94,,percent of total billed charges,,
Us Ob Biophysical Profile Wo Non Stress,,76819,CPT,Facility,Outpatient,,,,562,477.7,161.0692,562,UnitedHealthcare,Medicare Advantage,275.38,49,,percent of total billed charges,,
Us Ob Biophysical Profile Wo Non Stress,,76819,CPT,Facility,Inpatient,,,,562,477.7,161.0692,562,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Us Ob Biophysical Profile Wo Non Stress,,76819,CPT,Facility,Outpatient,,,,562,477.7,161.0692,562,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,269.76,48,,percent of total billed charges,,100% of DHS outpatient percentage
Us Ob Biophysical Profile Wo Non Stress,,76819,CPT,Facility,Inpatient,,,,562,477.7,161.0692,562,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Us Ob Umbilical Doppler,,76820,CPT,Facility,Both,,,,551,468.35,157.9166,551,Aetna,Commercial,506.92,92,,percent of total billed charges,,
Us Ob Umbilical Doppler,,76820,CPT,Facility,Outpatient,,,,551,468.35,157.9166,551,Aetna,Medicare Advantage,269.99,49,,percent of total billed charges,,
Us Ob Umbilical Doppler,,76820,CPT,Facility,Inpatient,,,,551,468.35,157.9166,551,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Us Ob Umbilical Doppler,,76820,CPT,Facility,Both,,,,551,468.35,157.9166,551,Aetna,PPO,512.43,93,,percent of total billed charges,,
Us Ob Umbilical Doppler,,76820,CPT,Facility,Both,,,,551,468.35,157.9166,551,America's PPO,America's PPO,529.1253,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Us Ob Umbilical Doppler,,76820,CPT,Facility,Both,,,,551,468.35,157.9166,551,BlueCross BlueShield Minnesota, Federal Employee Program,542.184,98.4,,percent of total billed charges,,
Us Ob Umbilical Doppler,,76820,CPT,Facility,Both,,,,551,468.35,157.9166,551,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,551,100,,percent of total billed charges,,
Us Ob Umbilical Doppler,,76820,CPT,Facility,Both,,,,551,468.35,157.9166,551,BlueCross BlueShield Minnesota,High Value Network Plan,495.9,90,,percent of total billed charges,,
Us Ob Umbilical Doppler,,76820,CPT,Facility,Outpatient,,,,551,468.35,157.9166,551,BlueCross BlueShield Minnesota,Medicare Advantage,269.99,49,,percent of total billed charges,,
Us Ob Umbilical Doppler,,76820,CPT,Facility,Inpatient,,,,551,468.35,157.9166,551,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Us Ob Umbilical Doppler,,76820,CPT,Facility,Both,,,,551,468.35,157.9166,551,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,488.0207,88.57,,percent of total billed charges,,
Us Ob Umbilical Doppler,,76820,CPT,Facility,Both,,,,551,468.35,157.9166,551,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,157.9166,28.66,,percent of total billed charges,,
Us Ob Umbilical Doppler,,76820,CPT,Facility,Outpatient,,,,551,468.35,157.9166,551,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),269.99,49,,percent of total billed charges,,
Us Ob Umbilical Doppler,,76820,CPT,Facility,Inpatient,,,,551,468.35,157.9166,551,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Us Ob Umbilical Doppler,,76820,CPT,Facility,Both,,,,551,468.35,157.9166,551,CorVel,Worker's Compensation,551,100,,percent of total billed charges,,
Us Ob Umbilical Doppler,,76820,CPT,Facility,Both,,,,551,468.35,157.9166,551,First Health Group Corporation,First Health Network,534.47,97,,percent of total billed charges,,
Us Ob Umbilical Doppler,,76820,CPT,Facility,Both,,,,551,468.35,157.9166,551,"Health Partners, Inc.",Commercial,521.246,94.6,,percent of total billed charges,,
Us Ob Umbilical Doppler,,76820,CPT,Facility,Outpatient,,,,551,468.35,157.9166,551,"Health Partners, Inc.",Medicare Advantage,269.99,49,,percent of total billed charges,,
Us Ob Umbilical Doppler,,76820,CPT,Facility,Inpatient,,,,551,468.35,157.9166,551,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Us Ob Umbilical Doppler,,76820,CPT,Facility,Both,,,,551,468.35,157.9166,551,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),330.6,60,,percent of total billed charges,,
Us Ob Umbilical Doppler,,76820,CPT,Facility,Both,,,,551,468.35,157.9166,551,"Health Partners, Inc.",State of Minnesota Advantage Program,449.065,81.5,,percent of total billed charges,,
Us Ob Umbilical Doppler,,76820,CPT,Facility,Both,,,,551,468.35,157.9166,551,"Health Partners, Inc.",State Public Programs,275.5,50,,percent of total billed charges,,
Us Ob Umbilical Doppler,,76820,CPT,Facility,Both,,,,551,468.35,157.9166,551,Humana Insurance Company,Commercial PPO,523.45,95,,percent of total billed charges,,
Us Ob Umbilical Doppler,,76820,CPT,Facility,Outpatient,,,,551,468.35,157.9166,551,Humana Insurance Company,Medicare PPO,269.99,49,,percent of total billed charges,,
Us Ob Umbilical Doppler,,76820,CPT,Facility,Inpatient,,,,551,468.35,157.9166,551,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Us Ob Umbilical Doppler,,76820,CPT,Facility,Both,,,,551,468.35,157.9166,551,Medica,Individual & Family,546.041,99.1,,percent of total billed charges,,
Us Ob Umbilical Doppler,,76820,CPT,Facility,Outpatient,,,,551,468.35,157.9166,551,Medica,Medica Advantage Solution,274.398,49.8,,percent of total billed charges,,
Us Ob Umbilical Doppler,,76820,CPT,Facility,Inpatient,,,,551,468.35,157.9166,551,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Us Ob Umbilical Doppler,,76820,CPT,Facility,Outpatient,,,,551,468.35,157.9166,551,Medica,Medical Assistance,245.746,44.6,,percent of total billed charges,,
Us Ob Umbilical Doppler,,76820,CPT,Facility,Inpatient,,,,551,468.35,157.9166,551,Medica,Medical Assistance,,,,,Included in per diem rate,
Us Ob Umbilical Doppler,,76820,CPT,Facility,Outpatient,,,,551,468.35,157.9166,551,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,274.398,49.8,,percent of total billed charges,,
Us Ob Umbilical Doppler,,76820,CPT,Facility,Inpatient,,,,551,468.35,157.9166,551,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Us Ob Umbilical Doppler,,76820,CPT,Facility,Both,,,,551,468.35,157.9166,551,"Multiplan, Inc.","Multiplan, Inc.",517.94,94,,percent of total billed charges,,
Us Ob Umbilical Doppler,,76820,CPT,Facility,Outpatient,,,,551,468.35,157.9166,551,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,496.451,90.1,,percent of total billed charges,,
Us Ob Umbilical Doppler,,76820,CPT,Facility,Inpatient,,,,551,468.35,157.9166,551,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Us Ob Umbilical Doppler,,76820,CPT,Facility,Both,,,,551,468.35,157.9166,551,"Preferred One Administrative Services, INC.",PPO,543.286,98.6,,percent of total billed charges,,
Us Ob Umbilical Doppler,,76820,CPT,Facility,Outpatient,,,,551,468.35,157.9166,551,PrimeWest Health,Minnesota Senior Health Options (MSHO),283.4895,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Us Ob Umbilical Doppler,,76820,CPT,Facility,Inpatient,,,,551,468.35,157.9166,551,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Us Ob Umbilical Doppler,,76820,CPT,Facility,Outpatient,,,,551,468.35,157.9166,551,PrimeWest Health,MinnesotaCare,282.9936,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Us Ob Umbilical Doppler,,76820,CPT,Facility,Inpatient,,,,551,468.35,157.9166,551,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Us Ob Umbilical Doppler,,76820,CPT,Facility,Both,,,,551,468.35,157.9166,551,Sanford Health Plan,Sanford Health Plan,506.92,92,,percent of total billed charges,,
Us Ob Umbilical Doppler,,76820,CPT,Facility,Outpatient,,,,551,468.35,157.9166,551,"UCare Health, Inc.",Individual & Family Plan,310.4885,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Us Ob Umbilical Doppler,,76820,CPT,Facility,Inpatient,,,,551,468.35,157.9166,551,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Us Ob Umbilical Doppler,,76820,CPT,Facility,Outpatient,,,,551,468.35,157.9166,551,"UCare Health, Inc.",Medical Assistance,278.0897,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Ob Umbilical Doppler,,76820,CPT,Facility,Inpatient,,,,551,468.35,157.9166,551,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Us Ob Umbilical Doppler,,76820,CPT,Facility,Outpatient,,,,551,468.35,157.9166,551,"UCare Health, Inc.",Medicare Advantage,278.0897,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Ob Umbilical Doppler,,76820,CPT,Facility,Inpatient,,,,551,468.35,157.9166,551,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Us Ob Umbilical Doppler,,76820,CPT,Facility,Outpatient,,,,551,468.35,157.9166,551,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),278.0897,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Ob Umbilical Doppler,,76820,CPT,Facility,Inpatient,,,,551,468.35,157.9166,551,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Us Ob Umbilical Doppler,,76820,CPT,Facility,Both,,,,551,468.35,157.9166,551,UnitedHealthcare,Individual & Family,517.94,94,,percent of total billed charges,,
Us Ob Umbilical Doppler,,76820,CPT,Facility,Outpatient,,,,551,468.35,157.9166,551,UnitedHealthcare,Medicare Advantage,269.99,49,,percent of total billed charges,,
Us Ob Umbilical Doppler,,76820,CPT,Facility,Inpatient,,,,551,468.35,157.9166,551,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Us Ob Umbilical Doppler,,76820,CPT,Facility,Outpatient,,,,551,468.35,157.9166,551,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,264.48,48,,percent of total billed charges,,100% of DHS outpatient percentage
Us Ob Umbilical Doppler,,76820,CPT,Facility,Inpatient,,,,551,468.35,157.9166,551,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Us Transvaginal Non Ob,,76830,CPT,Facility,Both,,,,559,475.15,160.2094,559,Aetna,Commercial,514.28,92,,percent of total billed charges,,
Us Transvaginal Non Ob,,76830,CPT,Facility,Outpatient,,,,559,475.15,160.2094,559,Aetna,Medicare Advantage,273.91,49,,percent of total billed charges,,
Us Transvaginal Non Ob,,76830,CPT,Facility,Inpatient,,,,559,475.15,160.2094,559,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Us Transvaginal Non Ob,,76830,CPT,Facility,Both,,,,559,475.15,160.2094,559,Aetna,PPO,519.87,93,,percent of total billed charges,,
Us Transvaginal Non Ob,,76830,CPT,Facility,Both,,,,559,475.15,160.2094,559,America's PPO,America's PPO,536.8077,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Us Transvaginal Non Ob,,76830,CPT,Facility,Both,,,,559,475.15,160.2094,559,BlueCross BlueShield Minnesota, Federal Employee Program,550.056,98.4,,percent of total billed charges,,
Us Transvaginal Non Ob,,76830,CPT,Facility,Both,,,,559,475.15,160.2094,559,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,559,100,,percent of total billed charges,,
Us Transvaginal Non Ob,,76830,CPT,Facility,Both,,,,559,475.15,160.2094,559,BlueCross BlueShield Minnesota,High Value Network Plan,503.1,90,,percent of total billed charges,,
Us Transvaginal Non Ob,,76830,CPT,Facility,Outpatient,,,,559,475.15,160.2094,559,BlueCross BlueShield Minnesota,Medicare Advantage,273.91,49,,percent of total billed charges,,
Us Transvaginal Non Ob,,76830,CPT,Facility,Inpatient,,,,559,475.15,160.2094,559,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Us Transvaginal Non Ob,,76830,CPT,Facility,Both,,,,559,475.15,160.2094,559,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,495.1063,88.57,,percent of total billed charges,,
Us Transvaginal Non Ob,,76830,CPT,Facility,Both,,,,559,475.15,160.2094,559,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,160.2094,28.66,,percent of total billed charges,,
Us Transvaginal Non Ob,,76830,CPT,Facility,Outpatient,,,,559,475.15,160.2094,559,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),273.91,49,,percent of total billed charges,,
Us Transvaginal Non Ob,,76830,CPT,Facility,Inpatient,,,,559,475.15,160.2094,559,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Us Transvaginal Non Ob,,76830,CPT,Facility,Both,,,,559,475.15,160.2094,559,CorVel,Worker's Compensation,559,100,,percent of total billed charges,,
Us Transvaginal Non Ob,,76830,CPT,Facility,Both,,,,559,475.15,160.2094,559,First Health Group Corporation,First Health Network,542.23,97,,percent of total billed charges,,
Us Transvaginal Non Ob,,76830,CPT,Facility,Both,,,,559,475.15,160.2094,559,"Health Partners, Inc.",Commercial,528.814,94.6,,percent of total billed charges,,
Us Transvaginal Non Ob,,76830,CPT,Facility,Outpatient,,,,559,475.15,160.2094,559,"Health Partners, Inc.",Medicare Advantage,273.91,49,,percent of total billed charges,,
Us Transvaginal Non Ob,,76830,CPT,Facility,Inpatient,,,,559,475.15,160.2094,559,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Us Transvaginal Non Ob,,76830,CPT,Facility,Both,,,,559,475.15,160.2094,559,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),335.4,60,,percent of total billed charges,,
Us Transvaginal Non Ob,,76830,CPT,Facility,Both,,,,559,475.15,160.2094,559,"Health Partners, Inc.",State of Minnesota Advantage Program,455.585,81.5,,percent of total billed charges,,
Us Transvaginal Non Ob,,76830,CPT,Facility,Both,,,,559,475.15,160.2094,559,"Health Partners, Inc.",State Public Programs,279.5,50,,percent of total billed charges,,
Us Transvaginal Non Ob,,76830,CPT,Facility,Both,,,,559,475.15,160.2094,559,Humana Insurance Company,Commercial PPO,531.05,95,,percent of total billed charges,,
Us Transvaginal Non Ob,,76830,CPT,Facility,Outpatient,,,,559,475.15,160.2094,559,Humana Insurance Company,Medicare PPO,273.91,49,,percent of total billed charges,,
Us Transvaginal Non Ob,,76830,CPT,Facility,Inpatient,,,,559,475.15,160.2094,559,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Us Transvaginal Non Ob,,76830,CPT,Facility,Both,,,,559,475.15,160.2094,559,Medica,Individual & Family,553.969,99.1,,percent of total billed charges,,
Us Transvaginal Non Ob,,76830,CPT,Facility,Outpatient,,,,559,475.15,160.2094,559,Medica,Medica Advantage Solution,278.382,49.8,,percent of total billed charges,,
Us Transvaginal Non Ob,,76830,CPT,Facility,Inpatient,,,,559,475.15,160.2094,559,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Us Transvaginal Non Ob,,76830,CPT,Facility,Outpatient,,,,559,475.15,160.2094,559,Medica,Medical Assistance,249.314,44.6,,percent of total billed charges,,
Us Transvaginal Non Ob,,76830,CPT,Facility,Inpatient,,,,559,475.15,160.2094,559,Medica,Medical Assistance,,,,,Included in per diem rate,
Us Transvaginal Non Ob,,76830,CPT,Facility,Outpatient,,,,559,475.15,160.2094,559,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,278.382,49.8,,percent of total billed charges,,
Us Transvaginal Non Ob,,76830,CPT,Facility,Inpatient,,,,559,475.15,160.2094,559,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Us Transvaginal Non Ob,,76830,CPT,Facility,Both,,,,559,475.15,160.2094,559,"Multiplan, Inc.","Multiplan, Inc.",525.46,94,,percent of total billed charges,,
Us Transvaginal Non Ob,,76830,CPT,Facility,Outpatient,,,,559,475.15,160.2094,559,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,503.659,90.1,,percent of total billed charges,,
Us Transvaginal Non Ob,,76830,CPT,Facility,Inpatient,,,,559,475.15,160.2094,559,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Us Transvaginal Non Ob,,76830,CPT,Facility,Both,,,,559,475.15,160.2094,559,"Preferred One Administrative Services, INC.",PPO,551.174,98.6,,percent of total billed charges,,
Us Transvaginal Non Ob,,76830,CPT,Facility,Outpatient,,,,559,475.15,160.2094,559,PrimeWest Health,Minnesota Senior Health Options (MSHO),287.6055,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Us Transvaginal Non Ob,,76830,CPT,Facility,Inpatient,,,,559,475.15,160.2094,559,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Us Transvaginal Non Ob,,76830,CPT,Facility,Outpatient,,,,559,475.15,160.2094,559,PrimeWest Health,MinnesotaCare,287.1024,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Us Transvaginal Non Ob,,76830,CPT,Facility,Inpatient,,,,559,475.15,160.2094,559,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Us Transvaginal Non Ob,,76830,CPT,Facility,Both,,,,559,475.15,160.2094,559,Sanford Health Plan,Sanford Health Plan,514.28,92,,percent of total billed charges,,
Us Transvaginal Non Ob,,76830,CPT,Facility,Outpatient,,,,559,475.15,160.2094,559,"UCare Health, Inc.",Individual & Family Plan,314.9965,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Us Transvaginal Non Ob,,76830,CPT,Facility,Inpatient,,,,559,475.15,160.2094,559,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Us Transvaginal Non Ob,,76830,CPT,Facility,Outpatient,,,,559,475.15,160.2094,559,"UCare Health, Inc.",Medical Assistance,282.1273,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Transvaginal Non Ob,,76830,CPT,Facility,Inpatient,,,,559,475.15,160.2094,559,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Us Transvaginal Non Ob,,76830,CPT,Facility,Outpatient,,,,559,475.15,160.2094,559,"UCare Health, Inc.",Medicare Advantage,282.1273,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Transvaginal Non Ob,,76830,CPT,Facility,Inpatient,,,,559,475.15,160.2094,559,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Us Transvaginal Non Ob,,76830,CPT,Facility,Outpatient,,,,559,475.15,160.2094,559,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),282.1273,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Transvaginal Non Ob,,76830,CPT,Facility,Inpatient,,,,559,475.15,160.2094,559,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Us Transvaginal Non Ob,,76830,CPT,Facility,Both,,,,559,475.15,160.2094,559,UnitedHealthcare,Individual & Family,525.46,94,,percent of total billed charges,,
Us Transvaginal Non Ob,,76830,CPT,Facility,Outpatient,,,,559,475.15,160.2094,559,UnitedHealthcare,Medicare Advantage,273.91,49,,percent of total billed charges,,
Us Transvaginal Non Ob,,76830,CPT,Facility,Inpatient,,,,559,475.15,160.2094,559,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Us Transvaginal Non Ob,,76830,CPT,Facility,Outpatient,,,,559,475.15,160.2094,559,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,268.32,48,,percent of total billed charges,,100% of DHS outpatient percentage
Us Transvaginal Non Ob,,76830,CPT,Facility,Inpatient,,,,559,475.15,160.2094,559,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
ROCURONIUM 10 MG/ML IV SOLN (PEDS),,414141,LOCAL,Facility,Both,10,mL,,170,144.5,48.722,170,Aetna,Commercial,156.4,92,,percent of total billed charges,,
ROCURONIUM 10 MG/ML IV SOLN (PEDS),,414141,LOCAL,Facility,Outpatient,10,mL,,170,144.5,48.722,170,Aetna,Medicare Advantage,83.3,49,,percent of total billed charges,,
ROCURONIUM 10 MG/ML IV SOLN (PEDS),,414141,LOCAL,Facility,Inpatient,10,mL,,170,144.5,48.722,170,Aetna,Medicare Advantage,,,,,Included in per diem rate,
ROCURONIUM 10 MG/ML IV SOLN (PEDS),,414141,LOCAL,Facility,Both,10,mL,,170,144.5,48.722,170,Aetna,PPO,158.1,93,,percent of total billed charges,,
ROCURONIUM 10 MG/ML IV SOLN (PEDS),,414141,LOCAL,Facility,Both,10,mL,,170,144.5,48.722,170,America's PPO,America's PPO,163.251,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
ROCURONIUM 10 MG/ML IV SOLN (PEDS),,414141,LOCAL,Facility,Both,10,mL,,170,144.5,48.722,170,BlueCross BlueShield Minnesota, Federal Employee Program,167.28,98.4,,percent of total billed charges,,
ROCURONIUM 10 MG/ML IV SOLN (PEDS),,414141,LOCAL,Facility,Both,10,mL,,170,144.5,48.722,170,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,170,100,,percent of total billed charges,,
ROCURONIUM 10 MG/ML IV SOLN (PEDS),,414141,LOCAL,Facility,Both,10,mL,,170,144.5,48.722,170,BlueCross BlueShield Minnesota,High Value Network Plan,153,90,,percent of total billed charges,,
ROCURONIUM 10 MG/ML IV SOLN (PEDS),,414141,LOCAL,Facility,Outpatient,10,mL,,170,144.5,48.722,170,BlueCross BlueShield Minnesota,Medicare Advantage,83.3,49,,percent of total billed charges,,
ROCURONIUM 10 MG/ML IV SOLN (PEDS),,414141,LOCAL,Facility,Inpatient,10,mL,,170,144.5,48.722,170,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
ROCURONIUM 10 MG/ML IV SOLN (PEDS),,414141,LOCAL,Facility,Both,10,mL,,170,144.5,48.722,170,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,150.569,88.57,,percent of total billed charges,,
ROCURONIUM 10 MG/ML IV SOLN (PEDS),,414141,LOCAL,Facility,Both,10,mL,,170,144.5,48.722,170,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,48.722,28.66,,percent of total billed charges,,
ROCURONIUM 10 MG/ML IV SOLN (PEDS),,414141,LOCAL,Facility,Outpatient,10,mL,,170,144.5,48.722,170,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),83.3,49,,percent of total billed charges,,
ROCURONIUM 10 MG/ML IV SOLN (PEDS),,414141,LOCAL,Facility,Inpatient,10,mL,,170,144.5,48.722,170,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
ROCURONIUM 10 MG/ML IV SOLN (PEDS),,414141,LOCAL,Facility,Both,10,mL,,170,144.5,48.722,170,CorVel,Worker's Compensation,170,100,,percent of total billed charges,,
ROCURONIUM 10 MG/ML IV SOLN (PEDS),,414141,LOCAL,Facility,Both,10,mL,,170,144.5,48.722,170,First Health Group Corporation,First Health Network,164.9,97,,percent of total billed charges,,
ROCURONIUM 10 MG/ML IV SOLN (PEDS),,414141,LOCAL,Facility,Both,10,mL,,170,144.5,48.722,170,"Health Partners, Inc.",Commercial,160.82,94.6,,percent of total billed charges,,
ROCURONIUM 10 MG/ML IV SOLN (PEDS),,414141,LOCAL,Facility,Outpatient,10,mL,,170,144.5,48.722,170,"Health Partners, Inc.",Medicare Advantage,83.3,49,,percent of total billed charges,,
ROCURONIUM 10 MG/ML IV SOLN (PEDS),,414141,LOCAL,Facility,Inpatient,10,mL,,170,144.5,48.722,170,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ROCURONIUM 10 MG/ML IV SOLN (PEDS),,414141,LOCAL,Facility,Both,10,mL,,170,144.5,48.722,170,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),102,60,,percent of total billed charges,,
ROCURONIUM 10 MG/ML IV SOLN (PEDS),,414141,LOCAL,Facility,Both,10,mL,,170,144.5,48.722,170,"Health Partners, Inc.",State of Minnesota Advantage Program,138.55,81.5,,percent of total billed charges,,
ROCURONIUM 10 MG/ML IV SOLN (PEDS),,414141,LOCAL,Facility,Both,10,mL,,170,144.5,48.722,170,"Health Partners, Inc.",State Public Programs,85,50,,percent of total billed charges,,
ROCURONIUM 10 MG/ML IV SOLN (PEDS),,414141,LOCAL,Facility,Both,10,mL,,170,144.5,48.722,170,Humana Insurance Company,Commercial PPO,161.5,95,,percent of total billed charges,,
ROCURONIUM 10 MG/ML IV SOLN (PEDS),,414141,LOCAL,Facility,Outpatient,10,mL,,170,144.5,48.722,170,Humana Insurance Company,Medicare PPO,83.3,49,,percent of total billed charges,,
ROCURONIUM 10 MG/ML IV SOLN (PEDS),,414141,LOCAL,Facility,Inpatient,10,mL,,170,144.5,48.722,170,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
ROCURONIUM 10 MG/ML IV SOLN (PEDS),,414141,LOCAL,Facility,Both,10,mL,,170,144.5,48.722,170,Medica,Individual & Family,168.47,99.1,,percent of total billed charges,,
ROCURONIUM 10 MG/ML IV SOLN (PEDS),,414141,LOCAL,Facility,Outpatient,10,mL,,170,144.5,48.722,170,Medica,Medica Advantage Solution,84.66,49.8,,percent of total billed charges,,
ROCURONIUM 10 MG/ML IV SOLN (PEDS),,414141,LOCAL,Facility,Inpatient,10,mL,,170,144.5,48.722,170,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
ROCURONIUM 10 MG/ML IV SOLN (PEDS),,414141,LOCAL,Facility,Outpatient,10,mL,,170,144.5,48.722,170,Medica,Medical Assistance,75.82,44.6,,percent of total billed charges,,
ROCURONIUM 10 MG/ML IV SOLN (PEDS),,414141,LOCAL,Facility,Inpatient,10,mL,,170,144.5,48.722,170,Medica,Medical Assistance,,,,,Included in per diem rate,
ROCURONIUM 10 MG/ML IV SOLN (PEDS),,414141,LOCAL,Facility,Outpatient,10,mL,,170,144.5,48.722,170,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,84.66,49.8,,percent of total billed charges,,
ROCURONIUM 10 MG/ML IV SOLN (PEDS),,414141,LOCAL,Facility,Inpatient,10,mL,,170,144.5,48.722,170,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
ROCURONIUM 10 MG/ML IV SOLN (PEDS),,414141,LOCAL,Facility,Both,10,mL,,170,144.5,48.722,170,"Multiplan, Inc.","Multiplan, Inc.",159.8,94,,percent of total billed charges,,
ROCURONIUM 10 MG/ML IV SOLN (PEDS),,414141,LOCAL,Facility,Outpatient,10,mL,,170,144.5,48.722,170,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,153.17,90.1,,percent of total billed charges,,
ROCURONIUM 10 MG/ML IV SOLN (PEDS),,414141,LOCAL,Facility,Inpatient,10,mL,,170,144.5,48.722,170,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
ROCURONIUM 10 MG/ML IV SOLN (PEDS),,414141,LOCAL,Facility,Both,10,mL,,170,144.5,48.722,170,"Preferred One Administrative Services, INC.",PPO,167.62,98.6,,percent of total billed charges,,
ROCURONIUM 10 MG/ML IV SOLN (PEDS),,414141,LOCAL,Facility,Outpatient,10,mL,,170,144.5,48.722,170,PrimeWest Health,Minnesota Senior Health Options (MSHO),87.465,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
ROCURONIUM 10 MG/ML IV SOLN (PEDS),,414141,LOCAL,Facility,Inpatient,10,mL,,170,144.5,48.722,170,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ROCURONIUM 10 MG/ML IV SOLN (PEDS),,414141,LOCAL,Facility,Outpatient,10,mL,,170,144.5,48.722,170,PrimeWest Health,MinnesotaCare,87.312,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
ROCURONIUM 10 MG/ML IV SOLN (PEDS),,414141,LOCAL,Facility,Inpatient,10,mL,,170,144.5,48.722,170,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
ROCURONIUM 10 MG/ML IV SOLN (PEDS),,414141,LOCAL,Facility,Both,10,mL,,170,144.5,48.722,170,Sanford Health Plan,Sanford Health Plan,156.4,92,,percent of total billed charges,,
ROCURONIUM 10 MG/ML IV SOLN (PEDS),,414141,LOCAL,Facility,Outpatient,10,mL,,170,144.5,48.722,170,"UCare Health, Inc.",Individual & Family Plan,95.795,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
ROCURONIUM 10 MG/ML IV SOLN (PEDS),,414141,LOCAL,Facility,Inpatient,10,mL,,170,144.5,48.722,170,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
ROCURONIUM 10 MG/ML IV SOLN (PEDS),,414141,LOCAL,Facility,Outpatient,10,mL,,170,144.5,48.722,170,"UCare Health, Inc.",Medical Assistance,85.799,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ROCURONIUM 10 MG/ML IV SOLN (PEDS),,414141,LOCAL,Facility,Inpatient,10,mL,,170,144.5,48.722,170,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
ROCURONIUM 10 MG/ML IV SOLN (PEDS),,414141,LOCAL,Facility,Outpatient,10,mL,,170,144.5,48.722,170,"UCare Health, Inc.",Medicare Advantage,85.799,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ROCURONIUM 10 MG/ML IV SOLN (PEDS),,414141,LOCAL,Facility,Inpatient,10,mL,,170,144.5,48.722,170,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ROCURONIUM 10 MG/ML IV SOLN (PEDS),,414141,LOCAL,Facility,Outpatient,10,mL,,170,144.5,48.722,170,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),85.799,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ROCURONIUM 10 MG/ML IV SOLN (PEDS),,414141,LOCAL,Facility,Inpatient,10,mL,,170,144.5,48.722,170,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ROCURONIUM 10 MG/ML IV SOLN (PEDS),,414141,LOCAL,Facility,Both,10,mL,,170,144.5,48.722,170,UnitedHealthcare,Individual & Family,159.8,94,,percent of total billed charges,,
ROCURONIUM 10 MG/ML IV SOLN (PEDS),,414141,LOCAL,Facility,Outpatient,10,mL,,170,144.5,48.722,170,UnitedHealthcare,Medicare Advantage,83.3,49,,percent of total billed charges,,
ROCURONIUM 10 MG/ML IV SOLN (PEDS),,414141,LOCAL,Facility,Inpatient,10,mL,,170,144.5,48.722,170,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
ROCURONIUM 10 MG/ML IV SOLN (PEDS),,414141,LOCAL,Facility,Outpatient,10,mL,,170,144.5,48.722,170,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,81.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
ROCURONIUM 10 MG/ML IV SOLN (PEDS),,414141,LOCAL,Facility,Inpatient,10,mL,,170,144.5,48.722,170,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
ACETYLCYSTEINE 200 MG/ML ORAL SOLN,,414492,LOCAL,Facility,Both,10,mL,,77,65.45,22.0682,77,Aetna,Commercial,70.84,92,,percent of total billed charges,,
ACETYLCYSTEINE 200 MG/ML ORAL SOLN,,414492,LOCAL,Facility,Outpatient,10,mL,,77,65.45,22.0682,77,Aetna,Medicare Advantage,37.73,49,,percent of total billed charges,,
ACETYLCYSTEINE 200 MG/ML ORAL SOLN,,414492,LOCAL,Facility,Inpatient,10,mL,,77,65.45,22.0682,77,Aetna,Medicare Advantage,,,,,Included in per diem rate,
ACETYLCYSTEINE 200 MG/ML ORAL SOLN,,414492,LOCAL,Facility,Both,10,mL,,77,65.45,22.0682,77,Aetna,PPO,71.61,93,,percent of total billed charges,,
ACETYLCYSTEINE 200 MG/ML ORAL SOLN,,414492,LOCAL,Facility,Both,10,mL,,77,65.45,22.0682,77,America's PPO,America's PPO,73.9431,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
ACETYLCYSTEINE 200 MG/ML ORAL SOLN,,414492,LOCAL,Facility,Both,10,mL,,77,65.45,22.0682,77,BlueCross BlueShield Minnesota, Federal Employee Program,75.768,98.4,,percent of total billed charges,,
ACETYLCYSTEINE 200 MG/ML ORAL SOLN,,414492,LOCAL,Facility,Both,10,mL,,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,77,100,,percent of total billed charges,,
ACETYLCYSTEINE 200 MG/ML ORAL SOLN,,414492,LOCAL,Facility,Both,10,mL,,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,High Value Network Plan,69.3,90,,percent of total billed charges,,
ACETYLCYSTEINE 200 MG/ML ORAL SOLN,,414492,LOCAL,Facility,Outpatient,10,mL,,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,Medicare Advantage,37.73,49,,percent of total billed charges,,
ACETYLCYSTEINE 200 MG/ML ORAL SOLN,,414492,LOCAL,Facility,Inpatient,10,mL,,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
ACETYLCYSTEINE 200 MG/ML ORAL SOLN,,414492,LOCAL,Facility,Both,10,mL,,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,68.1989,88.57,,percent of total billed charges,,
ACETYLCYSTEINE 200 MG/ML ORAL SOLN,,414492,LOCAL,Facility,Both,10,mL,,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,22.0682,28.66,,percent of total billed charges,,
ACETYLCYSTEINE 200 MG/ML ORAL SOLN,,414492,LOCAL,Facility,Outpatient,10,mL,,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),37.73,49,,percent of total billed charges,,
ACETYLCYSTEINE 200 MG/ML ORAL SOLN,,414492,LOCAL,Facility,Inpatient,10,mL,,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
ACETYLCYSTEINE 200 MG/ML ORAL SOLN,,414492,LOCAL,Facility,Both,10,mL,,77,65.45,22.0682,77,CorVel,Worker's Compensation,77,100,,percent of total billed charges,,
ACETYLCYSTEINE 200 MG/ML ORAL SOLN,,414492,LOCAL,Facility,Both,10,mL,,77,65.45,22.0682,77,First Health Group Corporation,First Health Network,74.69,97,,percent of total billed charges,,
ACETYLCYSTEINE 200 MG/ML ORAL SOLN,,414492,LOCAL,Facility,Both,10,mL,,77,65.45,22.0682,77,"Health Partners, Inc.",Commercial,72.842,94.6,,percent of total billed charges,,
ACETYLCYSTEINE 200 MG/ML ORAL SOLN,,414492,LOCAL,Facility,Outpatient,10,mL,,77,65.45,22.0682,77,"Health Partners, Inc.",Medicare Advantage,37.73,49,,percent of total billed charges,,
ACETYLCYSTEINE 200 MG/ML ORAL SOLN,,414492,LOCAL,Facility,Inpatient,10,mL,,77,65.45,22.0682,77,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ACETYLCYSTEINE 200 MG/ML ORAL SOLN,,414492,LOCAL,Facility,Both,10,mL,,77,65.45,22.0682,77,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),46.2,60,,percent of total billed charges,,
ACETYLCYSTEINE 200 MG/ML ORAL SOLN,,414492,LOCAL,Facility,Both,10,mL,,77,65.45,22.0682,77,"Health Partners, Inc.",State of Minnesota Advantage Program,62.755,81.5,,percent of total billed charges,,
ACETYLCYSTEINE 200 MG/ML ORAL SOLN,,414492,LOCAL,Facility,Both,10,mL,,77,65.45,22.0682,77,"Health Partners, Inc.",State Public Programs,38.5,50,,percent of total billed charges,,
ACETYLCYSTEINE 200 MG/ML ORAL SOLN,,414492,LOCAL,Facility,Both,10,mL,,77,65.45,22.0682,77,Humana Insurance Company,Commercial PPO,73.15,95,,percent of total billed charges,,
ACETYLCYSTEINE 200 MG/ML ORAL SOLN,,414492,LOCAL,Facility,Outpatient,10,mL,,77,65.45,22.0682,77,Humana Insurance Company,Medicare PPO,37.73,49,,percent of total billed charges,,
ACETYLCYSTEINE 200 MG/ML ORAL SOLN,,414492,LOCAL,Facility,Inpatient,10,mL,,77,65.45,22.0682,77,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
ACETYLCYSTEINE 200 MG/ML ORAL SOLN,,414492,LOCAL,Facility,Both,10,mL,,77,65.45,22.0682,77,Medica,Individual & Family,76.307,99.1,,percent of total billed charges,,
ACETYLCYSTEINE 200 MG/ML ORAL SOLN,,414492,LOCAL,Facility,Outpatient,10,mL,,77,65.45,22.0682,77,Medica,Medica Advantage Solution,38.346,49.8,,percent of total billed charges,,
ACETYLCYSTEINE 200 MG/ML ORAL SOLN,,414492,LOCAL,Facility,Inpatient,10,mL,,77,65.45,22.0682,77,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
ACETYLCYSTEINE 200 MG/ML ORAL SOLN,,414492,LOCAL,Facility,Outpatient,10,mL,,77,65.45,22.0682,77,Medica,Medical Assistance,34.342,44.6,,percent of total billed charges,,
ACETYLCYSTEINE 200 MG/ML ORAL SOLN,,414492,LOCAL,Facility,Inpatient,10,mL,,77,65.45,22.0682,77,Medica,Medical Assistance,,,,,Included in per diem rate,
ACETYLCYSTEINE 200 MG/ML ORAL SOLN,,414492,LOCAL,Facility,Outpatient,10,mL,,77,65.45,22.0682,77,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,38.346,49.8,,percent of total billed charges,,
ACETYLCYSTEINE 200 MG/ML ORAL SOLN,,414492,LOCAL,Facility,Inpatient,10,mL,,77,65.45,22.0682,77,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
ACETYLCYSTEINE 200 MG/ML ORAL SOLN,,414492,LOCAL,Facility,Both,10,mL,,77,65.45,22.0682,77,"Multiplan, Inc.","Multiplan, Inc.",72.38,94,,percent of total billed charges,,
ACETYLCYSTEINE 200 MG/ML ORAL SOLN,,414492,LOCAL,Facility,Outpatient,10,mL,,77,65.45,22.0682,77,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,69.377,90.1,,percent of total billed charges,,
ACETYLCYSTEINE 200 MG/ML ORAL SOLN,,414492,LOCAL,Facility,Inpatient,10,mL,,77,65.45,22.0682,77,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
ACETYLCYSTEINE 200 MG/ML ORAL SOLN,,414492,LOCAL,Facility,Both,10,mL,,77,65.45,22.0682,77,"Preferred One Administrative Services, INC.",PPO,75.922,98.6,,percent of total billed charges,,
ACETYLCYSTEINE 200 MG/ML ORAL SOLN,,414492,LOCAL,Facility,Outpatient,10,mL,,77,65.45,22.0682,77,PrimeWest Health,Minnesota Senior Health Options (MSHO),39.6165,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
ACETYLCYSTEINE 200 MG/ML ORAL SOLN,,414492,LOCAL,Facility,Inpatient,10,mL,,77,65.45,22.0682,77,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ACETYLCYSTEINE 200 MG/ML ORAL SOLN,,414492,LOCAL,Facility,Outpatient,10,mL,,77,65.45,22.0682,77,PrimeWest Health,MinnesotaCare,39.5472,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
ACETYLCYSTEINE 200 MG/ML ORAL SOLN,,414492,LOCAL,Facility,Inpatient,10,mL,,77,65.45,22.0682,77,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
ACETYLCYSTEINE 200 MG/ML ORAL SOLN,,414492,LOCAL,Facility,Both,10,mL,,77,65.45,22.0682,77,Sanford Health Plan,Sanford Health Plan,70.84,92,,percent of total billed charges,,
ACETYLCYSTEINE 200 MG/ML ORAL SOLN,,414492,LOCAL,Facility,Outpatient,10,mL,,77,65.45,22.0682,77,"UCare Health, Inc.",Individual & Family Plan,43.3895,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
ACETYLCYSTEINE 200 MG/ML ORAL SOLN,,414492,LOCAL,Facility,Inpatient,10,mL,,77,65.45,22.0682,77,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
ACETYLCYSTEINE 200 MG/ML ORAL SOLN,,414492,LOCAL,Facility,Outpatient,10,mL,,77,65.45,22.0682,77,"UCare Health, Inc.",Medical Assistance,38.8619,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ACETYLCYSTEINE 200 MG/ML ORAL SOLN,,414492,LOCAL,Facility,Inpatient,10,mL,,77,65.45,22.0682,77,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
ACETYLCYSTEINE 200 MG/ML ORAL SOLN,,414492,LOCAL,Facility,Outpatient,10,mL,,77,65.45,22.0682,77,"UCare Health, Inc.",Medicare Advantage,38.8619,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ACETYLCYSTEINE 200 MG/ML ORAL SOLN,,414492,LOCAL,Facility,Inpatient,10,mL,,77,65.45,22.0682,77,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ACETYLCYSTEINE 200 MG/ML ORAL SOLN,,414492,LOCAL,Facility,Outpatient,10,mL,,77,65.45,22.0682,77,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),38.8619,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ACETYLCYSTEINE 200 MG/ML ORAL SOLN,,414492,LOCAL,Facility,Inpatient,10,mL,,77,65.45,22.0682,77,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ACETYLCYSTEINE 200 MG/ML ORAL SOLN,,414492,LOCAL,Facility,Both,10,mL,,77,65.45,22.0682,77,UnitedHealthcare,Individual & Family,72.38,94,,percent of total billed charges,,
ACETYLCYSTEINE 200 MG/ML ORAL SOLN,,414492,LOCAL,Facility,Outpatient,10,mL,,77,65.45,22.0682,77,UnitedHealthcare,Medicare Advantage,37.73,49,,percent of total billed charges,,
ACETYLCYSTEINE 200 MG/ML ORAL SOLN,,414492,LOCAL,Facility,Inpatient,10,mL,,77,65.45,22.0682,77,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
ACETYLCYSTEINE 200 MG/ML ORAL SOLN,,414492,LOCAL,Facility,Outpatient,10,mL,,77,65.45,22.0682,77,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,36.96,48,,percent of total billed charges,,100% of DHS outpatient percentage
ACETYLCYSTEINE 200 MG/ML ORAL SOLN,,414492,LOCAL,Facility,Inpatient,10,mL,,77,65.45,22.0682,77,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
BUPIVACAINE LIPOSOME (PF) 1.3 % (13.3 MG/ML) LINF SUSP,,C9290,HCPCS,Facility,Both,10,mL,,1005,854.25,288.033,1005,Aetna,Commercial,924.6,92,,percent of total billed charges,,
BUPIVACAINE LIPOSOME (PF) 1.3 % (13.3 MG/ML) LINF SUSP,,C9290,HCPCS,Facility,Outpatient,10,mL,,1005,854.25,288.033,1005,Aetna,Medicare Advantage,492.45,49,,percent of total billed charges,,
BUPIVACAINE LIPOSOME (PF) 1.3 % (13.3 MG/ML) LINF SUSP,,C9290,HCPCS,Facility,Inpatient,10,mL,,1005,854.25,288.033,1005,Aetna,Medicare Advantage,,,,,Included in per diem rate,
BUPIVACAINE LIPOSOME (PF) 1.3 % (13.3 MG/ML) LINF SUSP,,C9290,HCPCS,Facility,Both,10,mL,,1005,854.25,288.033,1005,Aetna,PPO,934.65,93,,percent of total billed charges,,
BUPIVACAINE LIPOSOME (PF) 1.3 % (13.3 MG/ML) LINF SUSP,,C9290,HCPCS,Facility,Both,10,mL,,1005,854.25,288.033,1005,America's PPO,America's PPO,965.1015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
BUPIVACAINE LIPOSOME (PF) 1.3 % (13.3 MG/ML) LINF SUSP,,C9290,HCPCS,Facility,Both,10,mL,,1005,854.25,288.033,1005,BlueCross BlueShield Minnesota, Federal Employee Program,988.92,98.4,,percent of total billed charges,,
BUPIVACAINE LIPOSOME (PF) 1.3 % (13.3 MG/ML) LINF SUSP,,C9290,HCPCS,Facility,Both,10,mL,,1005,854.25,288.033,1005,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1005,100,,percent of total billed charges,,
BUPIVACAINE LIPOSOME (PF) 1.3 % (13.3 MG/ML) LINF SUSP,,C9290,HCPCS,Facility,Both,10,mL,,1005,854.25,288.033,1005,BlueCross BlueShield Minnesota,High Value Network Plan,904.5,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
BUPIVACAINE LIPOSOME (PF) 1.3 % (13.3 MG/ML) LINF SUSP,,C9290,HCPCS,Facility,Outpatient,10,mL,,1005,854.25,288.033,1005,BlueCross BlueShield Minnesota,Medicare Advantage,492.45,49,,percent of total billed charges,,
BUPIVACAINE LIPOSOME (PF) 1.3 % (13.3 MG/ML) LINF SUSP,,C9290,HCPCS,Facility,Inpatient,10,mL,,1005,854.25,288.033,1005,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
BUPIVACAINE LIPOSOME (PF) 1.3 % (13.3 MG/ML) LINF SUSP,,C9290,HCPCS,Facility,Both,10,mL,,1005,854.25,288.033,1005,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,890.1285,88.57,,percent of total billed charges,,
BUPIVACAINE LIPOSOME (PF) 1.3 % (13.3 MG/ML) LINF SUSP,,C9290,HCPCS,Facility,Both,10,mL,,1005,854.25,288.033,1005,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,288.033,28.66,,percent of total billed charges,,
BUPIVACAINE LIPOSOME (PF) 1.3 % (13.3 MG/ML) LINF SUSP,,C9290,HCPCS,Facility,Outpatient,10,mL,,1005,854.25,288.033,1005,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),492.45,49,,percent of total billed charges,,
BUPIVACAINE LIPOSOME (PF) 1.3 % (13.3 MG/ML) LINF SUSP,,C9290,HCPCS,Facility,Inpatient,10,mL,,1005,854.25,288.033,1005,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
BUPIVACAINE LIPOSOME (PF) 1.3 % (13.3 MG/ML) LINF SUSP,,C9290,HCPCS,Facility,Both,10,mL,,1005,854.25,288.033,1005,CorVel,Worker's Compensation,1005,100,,percent of total billed charges,,
BUPIVACAINE LIPOSOME (PF) 1.3 % (13.3 MG/ML) LINF SUSP,,C9290,HCPCS,Facility,Both,10,mL,,1005,854.25,288.033,1005,First Health Group Corporation,First Health Network,974.85,97,,percent of total billed charges,,
BUPIVACAINE LIPOSOME (PF) 1.3 % (13.3 MG/ML) LINF SUSP,,C9290,HCPCS,Facility,Both,10,mL,,1005,854.25,288.033,1005,"Health Partners, Inc.",Commercial,950.73,94.6,,percent of total billed charges,,
BUPIVACAINE LIPOSOME (PF) 1.3 % (13.3 MG/ML) LINF SUSP,,C9290,HCPCS,Facility,Outpatient,10,mL,,1005,854.25,288.033,1005,"Health Partners, Inc.",Medicare Advantage,492.45,49,,percent of total billed charges,,
BUPIVACAINE LIPOSOME (PF) 1.3 % (13.3 MG/ML) LINF SUSP,,C9290,HCPCS,Facility,Inpatient,10,mL,,1005,854.25,288.033,1005,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
BUPIVACAINE LIPOSOME (PF) 1.3 % (13.3 MG/ML) LINF SUSP,,C9290,HCPCS,Facility,Both,10,mL,,1005,854.25,288.033,1005,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),603,60,,percent of total billed charges,,
BUPIVACAINE LIPOSOME (PF) 1.3 % (13.3 MG/ML) LINF SUSP,,C9290,HCPCS,Facility,Both,10,mL,,1005,854.25,288.033,1005,"Health Partners, Inc.",State of Minnesota Advantage Program,819.075,81.5,,percent of total billed charges,,
BUPIVACAINE LIPOSOME (PF) 1.3 % (13.3 MG/ML) LINF SUSP,,C9290,HCPCS,Facility,Both,10,mL,,1005,854.25,288.033,1005,"Health Partners, Inc.",State Public Programs,502.5,50,,percent of total billed charges,,
BUPIVACAINE LIPOSOME (PF) 1.3 % (13.3 MG/ML) LINF SUSP,,C9290,HCPCS,Facility,Both,10,mL,,1005,854.25,288.033,1005,Humana Insurance Company,Commercial PPO,954.75,95,,percent of total billed charges,,
BUPIVACAINE LIPOSOME (PF) 1.3 % (13.3 MG/ML) LINF SUSP,,C9290,HCPCS,Facility,Outpatient,10,mL,,1005,854.25,288.033,1005,Humana Insurance Company,Medicare PPO,492.45,49,,percent of total billed charges,,
BUPIVACAINE LIPOSOME (PF) 1.3 % (13.3 MG/ML) LINF SUSP,,C9290,HCPCS,Facility,Inpatient,10,mL,,1005,854.25,288.033,1005,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
BUPIVACAINE LIPOSOME (PF) 1.3 % (13.3 MG/ML) LINF SUSP,,C9290,HCPCS,Facility,Both,10,mL,,1005,854.25,288.033,1005,Medica,Individual & Family,995.955,99.1,,percent of total billed charges,,
BUPIVACAINE LIPOSOME (PF) 1.3 % (13.3 MG/ML) LINF SUSP,,C9290,HCPCS,Facility,Outpatient,10,mL,,1005,854.25,288.033,1005,Medica,Medica Advantage Solution,500.49,49.8,,percent of total billed charges,,
BUPIVACAINE LIPOSOME (PF) 1.3 % (13.3 MG/ML) LINF SUSP,,C9290,HCPCS,Facility,Inpatient,10,mL,,1005,854.25,288.033,1005,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
BUPIVACAINE LIPOSOME (PF) 1.3 % (13.3 MG/ML) LINF SUSP,,C9290,HCPCS,Facility,Outpatient,10,mL,,1005,854.25,288.033,1005,Medica,Medical Assistance,448.23,44.6,,percent of total billed charges,,
BUPIVACAINE LIPOSOME (PF) 1.3 % (13.3 MG/ML) LINF SUSP,,C9290,HCPCS,Facility,Inpatient,10,mL,,1005,854.25,288.033,1005,Medica,Medical Assistance,,,,,Included in per diem rate,
BUPIVACAINE LIPOSOME (PF) 1.3 % (13.3 MG/ML) LINF SUSP,,C9290,HCPCS,Facility,Outpatient,10,mL,,1005,854.25,288.033,1005,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,500.49,49.8,,percent of total billed charges,,
BUPIVACAINE LIPOSOME (PF) 1.3 % (13.3 MG/ML) LINF SUSP,,C9290,HCPCS,Facility,Inpatient,10,mL,,1005,854.25,288.033,1005,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
BUPIVACAINE LIPOSOME (PF) 1.3 % (13.3 MG/ML) LINF SUSP,,C9290,HCPCS,Facility,Both,10,mL,,1005,854.25,288.033,1005,"Multiplan, Inc.","Multiplan, Inc.",944.7,94,,percent of total billed charges,,
BUPIVACAINE LIPOSOME (PF) 1.3 % (13.3 MG/ML) LINF SUSP,,C9290,HCPCS,Facility,Outpatient,10,mL,,1005,854.25,288.033,1005,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,905.505,90.1,,percent of total billed charges,,
BUPIVACAINE LIPOSOME (PF) 1.3 % (13.3 MG/ML) LINF SUSP,,C9290,HCPCS,Facility,Inpatient,10,mL,,1005,854.25,288.033,1005,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
BUPIVACAINE LIPOSOME (PF) 1.3 % (13.3 MG/ML) LINF SUSP,,C9290,HCPCS,Facility,Both,10,mL,,1005,854.25,288.033,1005,"Preferred One Administrative Services, INC.",PPO,990.93,98.6,,percent of total billed charges,,
BUPIVACAINE LIPOSOME (PF) 1.3 % (13.3 MG/ML) LINF SUSP,,C9290,HCPCS,Facility,Outpatient,10,mL,,1005,854.25,288.033,1005,PrimeWest Health,Minnesota Senior Health Options (MSHO),517.0725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
BUPIVACAINE LIPOSOME (PF) 1.3 % (13.3 MG/ML) LINF SUSP,,C9290,HCPCS,Facility,Inpatient,10,mL,,1005,854.25,288.033,1005,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
BUPIVACAINE LIPOSOME (PF) 1.3 % (13.3 MG/ML) LINF SUSP,,C9290,HCPCS,Facility,Outpatient,10,mL,,1005,854.25,288.033,1005,PrimeWest Health,MinnesotaCare,516.168,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
BUPIVACAINE LIPOSOME (PF) 1.3 % (13.3 MG/ML) LINF SUSP,,C9290,HCPCS,Facility,Inpatient,10,mL,,1005,854.25,288.033,1005,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
BUPIVACAINE LIPOSOME (PF) 1.3 % (13.3 MG/ML) LINF SUSP,,C9290,HCPCS,Facility,Both,10,mL,,1005,854.25,288.033,1005,Sanford Health Plan,Sanford Health Plan,924.6,92,,percent of total billed charges,,
BUPIVACAINE LIPOSOME (PF) 1.3 % (13.3 MG/ML) LINF SUSP,,C9290,HCPCS,Facility,Outpatient,10,mL,,1005,854.25,288.033,1005,"UCare Health, Inc.",Individual & Family Plan,566.3175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
BUPIVACAINE LIPOSOME (PF) 1.3 % (13.3 MG/ML) LINF SUSP,,C9290,HCPCS,Facility,Inpatient,10,mL,,1005,854.25,288.033,1005,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
BUPIVACAINE LIPOSOME (PF) 1.3 % (13.3 MG/ML) LINF SUSP,,C9290,HCPCS,Facility,Outpatient,10,mL,,1005,854.25,288.033,1005,"UCare Health, Inc.",Medical Assistance,507.2235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BUPIVACAINE LIPOSOME (PF) 1.3 % (13.3 MG/ML) LINF SUSP,,C9290,HCPCS,Facility,Inpatient,10,mL,,1005,854.25,288.033,1005,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
BUPIVACAINE LIPOSOME (PF) 1.3 % (13.3 MG/ML) LINF SUSP,,C9290,HCPCS,Facility,Outpatient,10,mL,,1005,854.25,288.033,1005,"UCare Health, Inc.",Medicare Advantage,507.2235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BUPIVACAINE LIPOSOME (PF) 1.3 % (13.3 MG/ML) LINF SUSP,,C9290,HCPCS,Facility,Inpatient,10,mL,,1005,854.25,288.033,1005,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
BUPIVACAINE LIPOSOME (PF) 1.3 % (13.3 MG/ML) LINF SUSP,,C9290,HCPCS,Facility,Outpatient,10,mL,,1005,854.25,288.033,1005,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),507.2235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BUPIVACAINE LIPOSOME (PF) 1.3 % (13.3 MG/ML) LINF SUSP,,C9290,HCPCS,Facility,Inpatient,10,mL,,1005,854.25,288.033,1005,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
BUPIVACAINE LIPOSOME (PF) 1.3 % (13.3 MG/ML) LINF SUSP,,C9290,HCPCS,Facility,Both,10,mL,,1005,854.25,288.033,1005,UnitedHealthcare,Individual & Family,944.7,94,,percent of total billed charges,,
BUPIVACAINE LIPOSOME (PF) 1.3 % (13.3 MG/ML) LINF SUSP,,C9290,HCPCS,Facility,Outpatient,10,mL,,1005,854.25,288.033,1005,UnitedHealthcare,Medicare Advantage,492.45,49,,percent of total billed charges,,
BUPIVACAINE LIPOSOME (PF) 1.3 % (13.3 MG/ML) LINF SUSP,,C9290,HCPCS,Facility,Inpatient,10,mL,,1005,854.25,288.033,1005,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
BUPIVACAINE LIPOSOME (PF) 1.3 % (13.3 MG/ML) LINF SUSP,,C9290,HCPCS,Facility,Outpatient,10,mL,,1005,854.25,288.033,1005,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,482.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
BUPIVACAINE LIPOSOME (PF) 1.3 % (13.3 MG/ML) LINF SUSP,,C9290,HCPCS,Facility,Inpatient,10,mL,,1005,854.25,288.033,1005,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Us Pelvic Non Ob,,76856,CPT,Facility,Both,,,,556,472.6,159.3496,556,Aetna,Commercial,511.52,92,,percent of total billed charges,,
Us Pelvic Non Ob,,76856,CPT,Facility,Outpatient,,,,556,472.6,159.3496,556,Aetna,Medicare Advantage,272.44,49,,percent of total billed charges,,
Us Pelvic Non Ob,,76856,CPT,Facility,Inpatient,,,,556,472.6,159.3496,556,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Us Pelvic Non Ob,,76856,CPT,Facility,Both,,,,556,472.6,159.3496,556,Aetna,PPO,517.08,93,,percent of total billed charges,,
Us Pelvic Non Ob,,76856,CPT,Facility,Both,,,,556,472.6,159.3496,556,America's PPO,America's PPO,533.9268,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Us Pelvic Non Ob,,76856,CPT,Facility,Both,,,,556,472.6,159.3496,556,BlueCross BlueShield Minnesota, Federal Employee Program,547.104,98.4,,percent of total billed charges,,
Us Pelvic Non Ob,,76856,CPT,Facility,Both,,,,556,472.6,159.3496,556,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,556,100,,percent of total billed charges,,
Us Pelvic Non Ob,,76856,CPT,Facility,Both,,,,556,472.6,159.3496,556,BlueCross BlueShield Minnesota,High Value Network Plan,500.4,90,,percent of total billed charges,,
Us Pelvic Non Ob,,76856,CPT,Facility,Outpatient,,,,556,472.6,159.3496,556,BlueCross BlueShield Minnesota,Medicare Advantage,272.44,49,,percent of total billed charges,,
Us Pelvic Non Ob,,76856,CPT,Facility,Inpatient,,,,556,472.6,159.3496,556,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Us Pelvic Non Ob,,76856,CPT,Facility,Both,,,,556,472.6,159.3496,556,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,492.4492,88.57,,percent of total billed charges,,
Us Pelvic Non Ob,,76856,CPT,Facility,Both,,,,556,472.6,159.3496,556,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,159.3496,28.66,,percent of total billed charges,,
Us Pelvic Non Ob,,76856,CPT,Facility,Outpatient,,,,556,472.6,159.3496,556,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),272.44,49,,percent of total billed charges,,
Us Pelvic Non Ob,,76856,CPT,Facility,Inpatient,,,,556,472.6,159.3496,556,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Us Pelvic Non Ob,,76856,CPT,Facility,Both,,,,556,472.6,159.3496,556,CorVel,Worker's Compensation,556,100,,percent of total billed charges,,
Us Pelvic Non Ob,,76856,CPT,Facility,Both,,,,556,472.6,159.3496,556,First Health Group Corporation,First Health Network,539.32,97,,percent of total billed charges,,
Us Pelvic Non Ob,,76856,CPT,Facility,Both,,,,556,472.6,159.3496,556,"Health Partners, Inc.",Commercial,525.976,94.6,,percent of total billed charges,,
Us Pelvic Non Ob,,76856,CPT,Facility,Outpatient,,,,556,472.6,159.3496,556,"Health Partners, Inc.",Medicare Advantage,272.44,49,,percent of total billed charges,,
Us Pelvic Non Ob,,76856,CPT,Facility,Inpatient,,,,556,472.6,159.3496,556,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Us Pelvic Non Ob,,76856,CPT,Facility,Both,,,,556,472.6,159.3496,556,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),333.6,60,,percent of total billed charges,,
Us Pelvic Non Ob,,76856,CPT,Facility,Both,,,,556,472.6,159.3496,556,"Health Partners, Inc.",State of Minnesota Advantage Program,453.14,81.5,,percent of total billed charges,,
Us Pelvic Non Ob,,76856,CPT,Facility,Both,,,,556,472.6,159.3496,556,"Health Partners, Inc.",State Public Programs,278,50,,percent of total billed charges,,
Us Pelvic Non Ob,,76856,CPT,Facility,Both,,,,556,472.6,159.3496,556,Humana Insurance Company,Commercial PPO,528.2,95,,percent of total billed charges,,
Us Pelvic Non Ob,,76856,CPT,Facility,Outpatient,,,,556,472.6,159.3496,556,Humana Insurance Company,Medicare PPO,272.44,49,,percent of total billed charges,,
Us Pelvic Non Ob,,76856,CPT,Facility,Inpatient,,,,556,472.6,159.3496,556,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Us Pelvic Non Ob,,76856,CPT,Facility,Both,,,,556,472.6,159.3496,556,Medica,Individual & Family,550.996,99.1,,percent of total billed charges,,
Us Pelvic Non Ob,,76856,CPT,Facility,Outpatient,,,,556,472.6,159.3496,556,Medica,Medica Advantage Solution,276.888,49.8,,percent of total billed charges,,
Us Pelvic Non Ob,,76856,CPT,Facility,Inpatient,,,,556,472.6,159.3496,556,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Us Pelvic Non Ob,,76856,CPT,Facility,Outpatient,,,,556,472.6,159.3496,556,Medica,Medical Assistance,247.976,44.6,,percent of total billed charges,,
Us Pelvic Non Ob,,76856,CPT,Facility,Inpatient,,,,556,472.6,159.3496,556,Medica,Medical Assistance,,,,,Included in per diem rate,
Us Pelvic Non Ob,,76856,CPT,Facility,Outpatient,,,,556,472.6,159.3496,556,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,276.888,49.8,,percent of total billed charges,,
Us Pelvic Non Ob,,76856,CPT,Facility,Inpatient,,,,556,472.6,159.3496,556,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Us Pelvic Non Ob,,76856,CPT,Facility,Both,,,,556,472.6,159.3496,556,"Multiplan, Inc.","Multiplan, Inc.",522.64,94,,percent of total billed charges,,
Us Pelvic Non Ob,,76856,CPT,Facility,Outpatient,,,,556,472.6,159.3496,556,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,500.956,90.1,,percent of total billed charges,,
Us Pelvic Non Ob,,76856,CPT,Facility,Inpatient,,,,556,472.6,159.3496,556,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Us Pelvic Non Ob,,76856,CPT,Facility,Both,,,,556,472.6,159.3496,556,"Preferred One Administrative Services, INC.",PPO,548.216,98.6,,percent of total billed charges,,
Us Pelvic Non Ob,,76856,CPT,Facility,Outpatient,,,,556,472.6,159.3496,556,PrimeWest Health,Minnesota Senior Health Options (MSHO),286.062,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Us Pelvic Non Ob,,76856,CPT,Facility,Inpatient,,,,556,472.6,159.3496,556,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Us Pelvic Non Ob,,76856,CPT,Facility,Outpatient,,,,556,472.6,159.3496,556,PrimeWest Health,MinnesotaCare,285.5616,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Us Pelvic Non Ob,,76856,CPT,Facility,Inpatient,,,,556,472.6,159.3496,556,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Us Pelvic Non Ob,,76856,CPT,Facility,Both,,,,556,472.6,159.3496,556,Sanford Health Plan,Sanford Health Plan,511.52,92,,percent of total billed charges,,
Us Pelvic Non Ob,,76856,CPT,Facility,Outpatient,,,,556,472.6,159.3496,556,"UCare Health, Inc.",Individual & Family Plan,313.306,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Us Pelvic Non Ob,,76856,CPT,Facility,Inpatient,,,,556,472.6,159.3496,556,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Us Pelvic Non Ob,,76856,CPT,Facility,Outpatient,,,,556,472.6,159.3496,556,"UCare Health, Inc.",Medical Assistance,280.6132,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Pelvic Non Ob,,76856,CPT,Facility,Inpatient,,,,556,472.6,159.3496,556,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Us Pelvic Non Ob,,76856,CPT,Facility,Outpatient,,,,556,472.6,159.3496,556,"UCare Health, Inc.",Medicare Advantage,280.6132,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Pelvic Non Ob,,76856,CPT,Facility,Inpatient,,,,556,472.6,159.3496,556,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Us Pelvic Non Ob,,76856,CPT,Facility,Outpatient,,,,556,472.6,159.3496,556,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),280.6132,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Pelvic Non Ob,,76856,CPT,Facility,Inpatient,,,,556,472.6,159.3496,556,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Us Pelvic Non Ob,,76856,CPT,Facility,Both,,,,556,472.6,159.3496,556,UnitedHealthcare,Individual & Family,522.64,94,,percent of total billed charges,,
Us Pelvic Non Ob,,76856,CPT,Facility,Outpatient,,,,556,472.6,159.3496,556,UnitedHealthcare,Medicare Advantage,272.44,49,,percent of total billed charges,,
Us Pelvic Non Ob,,76856,CPT,Facility,Inpatient,,,,556,472.6,159.3496,556,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Us Pelvic Non Ob,,76856,CPT,Facility,Outpatient,,,,556,472.6,159.3496,556,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,266.88,48,,percent of total billed charges,,100% of DHS outpatient percentage
Us Pelvic Non Ob,,76856,CPT,Facility,Inpatient,,,,556,472.6,159.3496,556,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Us Bladder,,76857,CPT,Facility,Both,,,,395,335.75,113.207,395,Aetna,Commercial,363.4,92,,percent of total billed charges,,
Us Bladder,,76857,CPT,Facility,Outpatient,,,,395,335.75,113.207,395,Aetna,Medicare Advantage,193.55,49,,percent of total billed charges,,
Us Bladder,,76857,CPT,Facility,Inpatient,,,,395,335.75,113.207,395,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Us Bladder,,76857,CPT,Facility,Both,,,,395,335.75,113.207,395,Aetna,PPO,367.35,93,,percent of total billed charges,,
Us Bladder,,76857,CPT,Facility,Both,,,,395,335.75,113.207,395,America's PPO,America's PPO,379.3185,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Us Bladder,,76857,CPT,Facility,Both,,,,395,335.75,113.207,395,BlueCross BlueShield Minnesota, Federal Employee Program,388.68,98.4,,percent of total billed charges,,
Us Bladder,,76857,CPT,Facility,Both,,,,395,335.75,113.207,395,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,395,100,,percent of total billed charges,,
Us Bladder,,76857,CPT,Facility,Both,,,,395,335.75,113.207,395,BlueCross BlueShield Minnesota,High Value Network Plan,355.5,90,,percent of total billed charges,,
Us Bladder,,76857,CPT,Facility,Outpatient,,,,395,335.75,113.207,395,BlueCross BlueShield Minnesota,Medicare Advantage,193.55,49,,percent of total billed charges,,
Us Bladder,,76857,CPT,Facility,Inpatient,,,,395,335.75,113.207,395,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Us Bladder,,76857,CPT,Facility,Both,,,,395,335.75,113.207,395,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,349.8515,88.57,,percent of total billed charges,,
Us Bladder,,76857,CPT,Facility,Both,,,,395,335.75,113.207,395,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,113.207,28.66,,percent of total billed charges,,
Us Bladder,,76857,CPT,Facility,Outpatient,,,,395,335.75,113.207,395,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),193.55,49,,percent of total billed charges,,
Us Bladder,,76857,CPT,Facility,Inpatient,,,,395,335.75,113.207,395,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Us Bladder,,76857,CPT,Facility,Both,,,,395,335.75,113.207,395,CorVel,Worker's Compensation,395,100,,percent of total billed charges,,
Us Bladder,,76857,CPT,Facility,Both,,,,395,335.75,113.207,395,First Health Group Corporation,First Health Network,383.15,97,,percent of total billed charges,,
Us Bladder,,76857,CPT,Facility,Both,,,,395,335.75,113.207,395,"Health Partners, Inc.",Commercial,373.67,94.6,,percent of total billed charges,,
Us Bladder,,76857,CPT,Facility,Outpatient,,,,395,335.75,113.207,395,"Health Partners, Inc.",Medicare Advantage,193.55,49,,percent of total billed charges,,
Us Bladder,,76857,CPT,Facility,Inpatient,,,,395,335.75,113.207,395,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Us Bladder,,76857,CPT,Facility,Both,,,,395,335.75,113.207,395,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),237,60,,percent of total billed charges,,
Us Bladder,,76857,CPT,Facility,Both,,,,395,335.75,113.207,395,"Health Partners, Inc.",State of Minnesota Advantage Program,321.925,81.5,,percent of total billed charges,,
Us Bladder,,76857,CPT,Facility,Both,,,,395,335.75,113.207,395,"Health Partners, Inc.",State Public Programs,197.5,50,,percent of total billed charges,,
Us Bladder,,76857,CPT,Facility,Both,,,,395,335.75,113.207,395,Humana Insurance Company,Commercial PPO,375.25,95,,percent of total billed charges,,
Us Bladder,,76857,CPT,Facility,Outpatient,,,,395,335.75,113.207,395,Humana Insurance Company,Medicare PPO,193.55,49,,percent of total billed charges,,
Us Bladder,,76857,CPT,Facility,Inpatient,,,,395,335.75,113.207,395,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Us Bladder,,76857,CPT,Facility,Both,,,,395,335.75,113.207,395,Medica,Individual & Family,391.445,99.1,,percent of total billed charges,,
Us Bladder,,76857,CPT,Facility,Outpatient,,,,395,335.75,113.207,395,Medica,Medica Advantage Solution,196.71,49.8,,percent of total billed charges,,
Us Bladder,,76857,CPT,Facility,Inpatient,,,,395,335.75,113.207,395,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Us Bladder,,76857,CPT,Facility,Outpatient,,,,395,335.75,113.207,395,Medica,Medical Assistance,176.17,44.6,,percent of total billed charges,,
Us Bladder,,76857,CPT,Facility,Inpatient,,,,395,335.75,113.207,395,Medica,Medical Assistance,,,,,Included in per diem rate,
Us Bladder,,76857,CPT,Facility,Outpatient,,,,395,335.75,113.207,395,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,196.71,49.8,,percent of total billed charges,,
Us Bladder,,76857,CPT,Facility,Inpatient,,,,395,335.75,113.207,395,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Us Bladder,,76857,CPT,Facility,Both,,,,395,335.75,113.207,395,"Multiplan, Inc.","Multiplan, Inc.",371.3,94,,percent of total billed charges,,
Us Bladder,,76857,CPT,Facility,Outpatient,,,,395,335.75,113.207,395,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,355.895,90.1,,percent of total billed charges,,
Us Bladder,,76857,CPT,Facility,Inpatient,,,,395,335.75,113.207,395,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Us Bladder,,76857,CPT,Facility,Both,,,,395,335.75,113.207,395,"Preferred One Administrative Services, INC.",PPO,389.47,98.6,,percent of total billed charges,,
Us Bladder,,76857,CPT,Facility,Outpatient,,,,395,335.75,113.207,395,PrimeWest Health,Minnesota Senior Health Options (MSHO),203.2275,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Us Bladder,,76857,CPT,Facility,Inpatient,,,,395,335.75,113.207,395,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Us Bladder,,76857,CPT,Facility,Outpatient,,,,395,335.75,113.207,395,PrimeWest Health,MinnesotaCare,202.872,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Us Bladder,,76857,CPT,Facility,Inpatient,,,,395,335.75,113.207,395,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Us Bladder,,76857,CPT,Facility,Both,,,,395,335.75,113.207,395,Sanford Health Plan,Sanford Health Plan,363.4,92,,percent of total billed charges,,
Us Bladder,,76857,CPT,Facility,Outpatient,,,,395,335.75,113.207,395,"UCare Health, Inc.",Individual & Family Plan,222.5825,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Us Bladder,,76857,CPT,Facility,Inpatient,,,,395,335.75,113.207,395,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Us Bladder,,76857,CPT,Facility,Outpatient,,,,395,335.75,113.207,395,"UCare Health, Inc.",Medical Assistance,199.3565,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Bladder,,76857,CPT,Facility,Inpatient,,,,395,335.75,113.207,395,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Us Bladder,,76857,CPT,Facility,Outpatient,,,,395,335.75,113.207,395,"UCare Health, Inc.",Medicare Advantage,199.3565,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Bladder,,76857,CPT,Facility,Inpatient,,,,395,335.75,113.207,395,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Us Bladder,,76857,CPT,Facility,Outpatient,,,,395,335.75,113.207,395,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),199.3565,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Bladder,,76857,CPT,Facility,Inpatient,,,,395,335.75,113.207,395,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Us Bladder,,76857,CPT,Facility,Both,,,,395,335.75,113.207,395,UnitedHealthcare,Individual & Family,371.3,94,,percent of total billed charges,,
Us Bladder,,76857,CPT,Facility,Outpatient,,,,395,335.75,113.207,395,UnitedHealthcare,Medicare Advantage,193.55,49,,percent of total billed charges,,
Us Bladder,,76857,CPT,Facility,Inpatient,,,,395,335.75,113.207,395,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Us Bladder,,76857,CPT,Facility,Outpatient,,,,395,335.75,113.207,395,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,189.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
Us Bladder,,76857,CPT,Facility,Inpatient,,,,395,335.75,113.207,395,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Us Pelvic Ltd Non Ob,,76857,CPT,Facility,Both,,,,395,335.75,113.207,395,Aetna,Commercial,363.4,92,,percent of total billed charges,,
Us Pelvic Ltd Non Ob,,76857,CPT,Facility,Outpatient,,,,395,335.75,113.207,395,Aetna,Medicare Advantage,193.55,49,,percent of total billed charges,,
Us Pelvic Ltd Non Ob,,76857,CPT,Facility,Inpatient,,,,395,335.75,113.207,395,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Us Pelvic Ltd Non Ob,,76857,CPT,Facility,Both,,,,395,335.75,113.207,395,Aetna,PPO,367.35,93,,percent of total billed charges,,
Us Pelvic Ltd Non Ob,,76857,CPT,Facility,Both,,,,395,335.75,113.207,395,America's PPO,America's PPO,379.3185,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Us Pelvic Ltd Non Ob,,76857,CPT,Facility,Both,,,,395,335.75,113.207,395,BlueCross BlueShield Minnesota, Federal Employee Program,388.68,98.4,,percent of total billed charges,,
Us Pelvic Ltd Non Ob,,76857,CPT,Facility,Both,,,,395,335.75,113.207,395,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,395,100,,percent of total billed charges,,
Us Pelvic Ltd Non Ob,,76857,CPT,Facility,Both,,,,395,335.75,113.207,395,BlueCross BlueShield Minnesota,High Value Network Plan,355.5,90,,percent of total billed charges,,
Us Pelvic Ltd Non Ob,,76857,CPT,Facility,Outpatient,,,,395,335.75,113.207,395,BlueCross BlueShield Minnesota,Medicare Advantage,193.55,49,,percent of total billed charges,,
Us Pelvic Ltd Non Ob,,76857,CPT,Facility,Inpatient,,,,395,335.75,113.207,395,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Us Pelvic Ltd Non Ob,,76857,CPT,Facility,Both,,,,395,335.75,113.207,395,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,349.8515,88.57,,percent of total billed charges,,
Us Pelvic Ltd Non Ob,,76857,CPT,Facility,Both,,,,395,335.75,113.207,395,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,113.207,28.66,,percent of total billed charges,,
Us Pelvic Ltd Non Ob,,76857,CPT,Facility,Outpatient,,,,395,335.75,113.207,395,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),193.55,49,,percent of total billed charges,,
Us Pelvic Ltd Non Ob,,76857,CPT,Facility,Inpatient,,,,395,335.75,113.207,395,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Us Pelvic Ltd Non Ob,,76857,CPT,Facility,Both,,,,395,335.75,113.207,395,CorVel,Worker's Compensation,395,100,,percent of total billed charges,,
Us Pelvic Ltd Non Ob,,76857,CPT,Facility,Both,,,,395,335.75,113.207,395,First Health Group Corporation,First Health Network,383.15,97,,percent of total billed charges,,
Us Pelvic Ltd Non Ob,,76857,CPT,Facility,Both,,,,395,335.75,113.207,395,"Health Partners, Inc.",Commercial,373.67,94.6,,percent of total billed charges,,
Us Pelvic Ltd Non Ob,,76857,CPT,Facility,Outpatient,,,,395,335.75,113.207,395,"Health Partners, Inc.",Medicare Advantage,193.55,49,,percent of total billed charges,,
Us Pelvic Ltd Non Ob,,76857,CPT,Facility,Inpatient,,,,395,335.75,113.207,395,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Us Pelvic Ltd Non Ob,,76857,CPT,Facility,Both,,,,395,335.75,113.207,395,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),237,60,,percent of total billed charges,,
Us Pelvic Ltd Non Ob,,76857,CPT,Facility,Both,,,,395,335.75,113.207,395,"Health Partners, Inc.",State of Minnesota Advantage Program,321.925,81.5,,percent of total billed charges,,
Us Pelvic Ltd Non Ob,,76857,CPT,Facility,Both,,,,395,335.75,113.207,395,"Health Partners, Inc.",State Public Programs,197.5,50,,percent of total billed charges,,
Us Pelvic Ltd Non Ob,,76857,CPT,Facility,Both,,,,395,335.75,113.207,395,Humana Insurance Company,Commercial PPO,375.25,95,,percent of total billed charges,,
Us Pelvic Ltd Non Ob,,76857,CPT,Facility,Outpatient,,,,395,335.75,113.207,395,Humana Insurance Company,Medicare PPO,193.55,49,,percent of total billed charges,,
Us Pelvic Ltd Non Ob,,76857,CPT,Facility,Inpatient,,,,395,335.75,113.207,395,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Us Pelvic Ltd Non Ob,,76857,CPT,Facility,Both,,,,395,335.75,113.207,395,Medica,Individual & Family,391.445,99.1,,percent of total billed charges,,
Us Pelvic Ltd Non Ob,,76857,CPT,Facility,Outpatient,,,,395,335.75,113.207,395,Medica,Medica Advantage Solution,196.71,49.8,,percent of total billed charges,,
Us Pelvic Ltd Non Ob,,76857,CPT,Facility,Inpatient,,,,395,335.75,113.207,395,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Us Pelvic Ltd Non Ob,,76857,CPT,Facility,Outpatient,,,,395,335.75,113.207,395,Medica,Medical Assistance,176.17,44.6,,percent of total billed charges,,
Us Pelvic Ltd Non Ob,,76857,CPT,Facility,Inpatient,,,,395,335.75,113.207,395,Medica,Medical Assistance,,,,,Included in per diem rate,
Us Pelvic Ltd Non Ob,,76857,CPT,Facility,Outpatient,,,,395,335.75,113.207,395,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,196.71,49.8,,percent of total billed charges,,
Us Pelvic Ltd Non Ob,,76857,CPT,Facility,Inpatient,,,,395,335.75,113.207,395,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Us Pelvic Ltd Non Ob,,76857,CPT,Facility,Both,,,,395,335.75,113.207,395,"Multiplan, Inc.","Multiplan, Inc.",371.3,94,,percent of total billed charges,,
Us Pelvic Ltd Non Ob,,76857,CPT,Facility,Outpatient,,,,395,335.75,113.207,395,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,355.895,90.1,,percent of total billed charges,,
Us Pelvic Ltd Non Ob,,76857,CPT,Facility,Inpatient,,,,395,335.75,113.207,395,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Us Pelvic Ltd Non Ob,,76857,CPT,Facility,Both,,,,395,335.75,113.207,395,"Preferred One Administrative Services, INC.",PPO,389.47,98.6,,percent of total billed charges,,
Us Pelvic Ltd Non Ob,,76857,CPT,Facility,Outpatient,,,,395,335.75,113.207,395,PrimeWest Health,Minnesota Senior Health Options (MSHO),203.2275,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Us Pelvic Ltd Non Ob,,76857,CPT,Facility,Inpatient,,,,395,335.75,113.207,395,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Us Pelvic Ltd Non Ob,,76857,CPT,Facility,Outpatient,,,,395,335.75,113.207,395,PrimeWest Health,MinnesotaCare,202.872,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Us Pelvic Ltd Non Ob,,76857,CPT,Facility,Inpatient,,,,395,335.75,113.207,395,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Us Pelvic Ltd Non Ob,,76857,CPT,Facility,Both,,,,395,335.75,113.207,395,Sanford Health Plan,Sanford Health Plan,363.4,92,,percent of total billed charges,,
Us Pelvic Ltd Non Ob,,76857,CPT,Facility,Outpatient,,,,395,335.75,113.207,395,"UCare Health, Inc.",Individual & Family Plan,222.5825,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Us Pelvic Ltd Non Ob,,76857,CPT,Facility,Inpatient,,,,395,335.75,113.207,395,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Us Pelvic Ltd Non Ob,,76857,CPT,Facility,Outpatient,,,,395,335.75,113.207,395,"UCare Health, Inc.",Medical Assistance,199.3565,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Pelvic Ltd Non Ob,,76857,CPT,Facility,Inpatient,,,,395,335.75,113.207,395,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Us Pelvic Ltd Non Ob,,76857,CPT,Facility,Outpatient,,,,395,335.75,113.207,395,"UCare Health, Inc.",Medicare Advantage,199.3565,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Pelvic Ltd Non Ob,,76857,CPT,Facility,Inpatient,,,,395,335.75,113.207,395,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Us Pelvic Ltd Non Ob,,76857,CPT,Facility,Outpatient,,,,395,335.75,113.207,395,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),199.3565,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Pelvic Ltd Non Ob,,76857,CPT,Facility,Inpatient,,,,395,335.75,113.207,395,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Us Pelvic Ltd Non Ob,,76857,CPT,Facility,Both,,,,395,335.75,113.207,395,UnitedHealthcare,Individual & Family,371.3,94,,percent of total billed charges,,
Us Pelvic Ltd Non Ob,,76857,CPT,Facility,Outpatient,,,,395,335.75,113.207,395,UnitedHealthcare,Medicare Advantage,193.55,49,,percent of total billed charges,,
Us Pelvic Ltd Non Ob,,76857,CPT,Facility,Inpatient,,,,395,335.75,113.207,395,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Us Pelvic Ltd Non Ob,,76857,CPT,Facility,Outpatient,,,,395,335.75,113.207,395,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,189.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
Us Pelvic Ltd Non Ob,,76857,CPT,Facility,Inpatient,,,,395,335.75,113.207,395,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Us Scrotum,,76870,CPT,Facility,Both,,,,558,474.3,159.9228,558,Aetna,Commercial,513.36,92,,percent of total billed charges,,
Us Scrotum,,76870,CPT,Facility,Outpatient,,,,558,474.3,159.9228,558,Aetna,Medicare Advantage,273.42,49,,percent of total billed charges,,
Us Scrotum,,76870,CPT,Facility,Inpatient,,,,558,474.3,159.9228,558,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Us Scrotum,,76870,CPT,Facility,Both,,,,558,474.3,159.9228,558,Aetna,PPO,518.94,93,,percent of total billed charges,,
Us Scrotum,,76870,CPT,Facility,Both,,,,558,474.3,159.9228,558,America's PPO,America's PPO,535.8474,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Us Scrotum,,76870,CPT,Facility,Both,,,,558,474.3,159.9228,558,BlueCross BlueShield Minnesota, Federal Employee Program,549.072,98.4,,percent of total billed charges,,
Us Scrotum,,76870,CPT,Facility,Both,,,,558,474.3,159.9228,558,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,558,100,,percent of total billed charges,,
Us Scrotum,,76870,CPT,Facility,Both,,,,558,474.3,159.9228,558,BlueCross BlueShield Minnesota,High Value Network Plan,502.2,90,,percent of total billed charges,,
Us Scrotum,,76870,CPT,Facility,Outpatient,,,,558,474.3,159.9228,558,BlueCross BlueShield Minnesota,Medicare Advantage,273.42,49,,percent of total billed charges,,
Us Scrotum,,76870,CPT,Facility,Inpatient,,,,558,474.3,159.9228,558,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Us Scrotum,,76870,CPT,Facility,Both,,,,558,474.3,159.9228,558,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,494.2206,88.57,,percent of total billed charges,,
Us Scrotum,,76870,CPT,Facility,Both,,,,558,474.3,159.9228,558,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,159.9228,28.66,,percent of total billed charges,,
Us Scrotum,,76870,CPT,Facility,Outpatient,,,,558,474.3,159.9228,558,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),273.42,49,,percent of total billed charges,,
Us Scrotum,,76870,CPT,Facility,Inpatient,,,,558,474.3,159.9228,558,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Us Scrotum,,76870,CPT,Facility,Both,,,,558,474.3,159.9228,558,CorVel,Worker's Compensation,558,100,,percent of total billed charges,,
Us Scrotum,,76870,CPT,Facility,Both,,,,558,474.3,159.9228,558,First Health Group Corporation,First Health Network,541.26,97,,percent of total billed charges,,
Us Scrotum,,76870,CPT,Facility,Both,,,,558,474.3,159.9228,558,"Health Partners, Inc.",Commercial,527.868,94.6,,percent of total billed charges,,
Us Scrotum,,76870,CPT,Facility,Outpatient,,,,558,474.3,159.9228,558,"Health Partners, Inc.",Medicare Advantage,273.42,49,,percent of total billed charges,,
Us Scrotum,,76870,CPT,Facility,Inpatient,,,,558,474.3,159.9228,558,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Us Scrotum,,76870,CPT,Facility,Both,,,,558,474.3,159.9228,558,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),334.8,60,,percent of total billed charges,,
Us Scrotum,,76870,CPT,Facility,Both,,,,558,474.3,159.9228,558,"Health Partners, Inc.",State of Minnesota Advantage Program,454.77,81.5,,percent of total billed charges,,
Us Scrotum,,76870,CPT,Facility,Both,,,,558,474.3,159.9228,558,"Health Partners, Inc.",State Public Programs,279,50,,percent of total billed charges,,
Us Scrotum,,76870,CPT,Facility,Both,,,,558,474.3,159.9228,558,Humana Insurance Company,Commercial PPO,530.1,95,,percent of total billed charges,,
Us Scrotum,,76870,CPT,Facility,Outpatient,,,,558,474.3,159.9228,558,Humana Insurance Company,Medicare PPO,273.42,49,,percent of total billed charges,,
Us Scrotum,,76870,CPT,Facility,Inpatient,,,,558,474.3,159.9228,558,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Us Scrotum,,76870,CPT,Facility,Both,,,,558,474.3,159.9228,558,Medica,Individual & Family,552.978,99.1,,percent of total billed charges,,
Us Scrotum,,76870,CPT,Facility,Outpatient,,,,558,474.3,159.9228,558,Medica,Medica Advantage Solution,277.884,49.8,,percent of total billed charges,,
Us Scrotum,,76870,CPT,Facility,Inpatient,,,,558,474.3,159.9228,558,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Us Scrotum,,76870,CPT,Facility,Outpatient,,,,558,474.3,159.9228,558,Medica,Medical Assistance,248.868,44.6,,percent of total billed charges,,
Us Scrotum,,76870,CPT,Facility,Inpatient,,,,558,474.3,159.9228,558,Medica,Medical Assistance,,,,,Included in per diem rate,
Us Scrotum,,76870,CPT,Facility,Outpatient,,,,558,474.3,159.9228,558,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,277.884,49.8,,percent of total billed charges,,
Us Scrotum,,76870,CPT,Facility,Inpatient,,,,558,474.3,159.9228,558,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Us Scrotum,,76870,CPT,Facility,Both,,,,558,474.3,159.9228,558,"Multiplan, Inc.","Multiplan, Inc.",524.52,94,,percent of total billed charges,,
Us Scrotum,,76870,CPT,Facility,Outpatient,,,,558,474.3,159.9228,558,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,502.758,90.1,,percent of total billed charges,,
Us Scrotum,,76870,CPT,Facility,Inpatient,,,,558,474.3,159.9228,558,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Us Scrotum,,76870,CPT,Facility,Both,,,,558,474.3,159.9228,558,"Preferred One Administrative Services, INC.",PPO,550.188,98.6,,percent of total billed charges,,
Us Scrotum,,76870,CPT,Facility,Outpatient,,,,558,474.3,159.9228,558,PrimeWest Health,Minnesota Senior Health Options (MSHO),287.091,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Us Scrotum,,76870,CPT,Facility,Inpatient,,,,558,474.3,159.9228,558,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Us Scrotum,,76870,CPT,Facility,Outpatient,,,,558,474.3,159.9228,558,PrimeWest Health,MinnesotaCare,286.5888,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Us Scrotum,,76870,CPT,Facility,Inpatient,,,,558,474.3,159.9228,558,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Us Scrotum,,76870,CPT,Facility,Both,,,,558,474.3,159.9228,558,Sanford Health Plan,Sanford Health Plan,513.36,92,,percent of total billed charges,,
Us Scrotum,,76870,CPT,Facility,Outpatient,,,,558,474.3,159.9228,558,"UCare Health, Inc.",Individual & Family Plan,314.433,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Us Scrotum,,76870,CPT,Facility,Inpatient,,,,558,474.3,159.9228,558,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Us Scrotum,,76870,CPT,Facility,Outpatient,,,,558,474.3,159.9228,558,"UCare Health, Inc.",Medical Assistance,281.6226,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Scrotum,,76870,CPT,Facility,Inpatient,,,,558,474.3,159.9228,558,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Us Scrotum,,76870,CPT,Facility,Outpatient,,,,558,474.3,159.9228,558,"UCare Health, Inc.",Medicare Advantage,281.6226,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Scrotum,,76870,CPT,Facility,Inpatient,,,,558,474.3,159.9228,558,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Us Scrotum,,76870,CPT,Facility,Outpatient,,,,558,474.3,159.9228,558,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),281.6226,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Scrotum,,76870,CPT,Facility,Inpatient,,,,558,474.3,159.9228,558,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Us Scrotum,,76870,CPT,Facility,Both,,,,558,474.3,159.9228,558,UnitedHealthcare,Individual & Family,524.52,94,,percent of total billed charges,,
Us Scrotum,,76870,CPT,Facility,Outpatient,,,,558,474.3,159.9228,558,UnitedHealthcare,Medicare Advantage,273.42,49,,percent of total billed charges,,
Us Scrotum,,76870,CPT,Facility,Inpatient,,,,558,474.3,159.9228,558,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Us Scrotum,,76870,CPT,Facility,Outpatient,,,,558,474.3,159.9228,558,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,267.84,48,,percent of total billed charges,,100% of DHS outpatient percentage
Us Scrotum,,76870,CPT,Facility,Inpatient,,,,558,474.3,159.9228,558,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Us Extremity Non-Vascular; Complete,,76881,CPT,Facility,Both,,,,449,381.65,128.6834,449,Aetna,Commercial,413.08,92,,percent of total billed charges,,
Us Extremity Non-Vascular; Complete,,76881,CPT,Facility,Outpatient,,,,449,381.65,128.6834,449,Aetna,Medicare Advantage,220.01,49,,percent of total billed charges,,
Us Extremity Non-Vascular; Complete,,76881,CPT,Facility,Inpatient,,,,449,381.65,128.6834,449,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Us Extremity Non-Vascular; Complete,,76881,CPT,Facility,Both,,,,449,381.65,128.6834,449,Aetna,PPO,417.57,93,,percent of total billed charges,,
Us Extremity Non-Vascular; Complete,,76881,CPT,Facility,Both,,,,449,381.65,128.6834,449,America's PPO,America's PPO,431.1747,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Us Extremity Non-Vascular; Complete,,76881,CPT,Facility,Both,,,,449,381.65,128.6834,449,BlueCross BlueShield Minnesota, Federal Employee Program,441.816,98.4,,percent of total billed charges,,
Us Extremity Non-Vascular; Complete,,76881,CPT,Facility,Both,,,,449,381.65,128.6834,449,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,449,100,,percent of total billed charges,,
Us Extremity Non-Vascular; Complete,,76881,CPT,Facility,Both,,,,449,381.65,128.6834,449,BlueCross BlueShield Minnesota,High Value Network Plan,404.1,90,,percent of total billed charges,,
Us Extremity Non-Vascular; Complete,,76881,CPT,Facility,Outpatient,,,,449,381.65,128.6834,449,BlueCross BlueShield Minnesota,Medicare Advantage,220.01,49,,percent of total billed charges,,
Us Extremity Non-Vascular; Complete,,76881,CPT,Facility,Inpatient,,,,449,381.65,128.6834,449,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Us Extremity Non-Vascular; Complete,,76881,CPT,Facility,Both,,,,449,381.65,128.6834,449,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,397.6793,88.57,,percent of total billed charges,,
Us Extremity Non-Vascular; Complete,,76881,CPT,Facility,Both,,,,449,381.65,128.6834,449,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,128.6834,28.66,,percent of total billed charges,,
Us Extremity Non-Vascular; Complete,,76881,CPT,Facility,Outpatient,,,,449,381.65,128.6834,449,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),220.01,49,,percent of total billed charges,,
Us Extremity Non-Vascular; Complete,,76881,CPT,Facility,Inpatient,,,,449,381.65,128.6834,449,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Us Extremity Non-Vascular; Complete,,76881,CPT,Facility,Both,,,,449,381.65,128.6834,449,CorVel,Worker's Compensation,449,100,,percent of total billed charges,,
Us Extremity Non-Vascular; Complete,,76881,CPT,Facility,Both,,,,449,381.65,128.6834,449,First Health Group Corporation,First Health Network,435.53,97,,percent of total billed charges,,
Us Extremity Non-Vascular; Complete,,76881,CPT,Facility,Both,,,,449,381.65,128.6834,449,"Health Partners, Inc.",Commercial,424.754,94.6,,percent of total billed charges,,
Us Extremity Non-Vascular; Complete,,76881,CPT,Facility,Outpatient,,,,449,381.65,128.6834,449,"Health Partners, Inc.",Medicare Advantage,220.01,49,,percent of total billed charges,,
Us Extremity Non-Vascular; Complete,,76881,CPT,Facility,Inpatient,,,,449,381.65,128.6834,449,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Us Extremity Non-Vascular; Complete,,76881,CPT,Facility,Both,,,,449,381.65,128.6834,449,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),269.4,60,,percent of total billed charges,,
Us Extremity Non-Vascular; Complete,,76881,CPT,Facility,Both,,,,449,381.65,128.6834,449,"Health Partners, Inc.",State of Minnesota Advantage Program,365.935,81.5,,percent of total billed charges,,
Us Extremity Non-Vascular; Complete,,76881,CPT,Facility,Both,,,,449,381.65,128.6834,449,"Health Partners, Inc.",State Public Programs,224.5,50,,percent of total billed charges,,
Us Extremity Non-Vascular; Complete,,76881,CPT,Facility,Both,,,,449,381.65,128.6834,449,Humana Insurance Company,Commercial PPO,426.55,95,,percent of total billed charges,,
Us Extremity Non-Vascular; Complete,,76881,CPT,Facility,Outpatient,,,,449,381.65,128.6834,449,Humana Insurance Company,Medicare PPO,220.01,49,,percent of total billed charges,,
Us Extremity Non-Vascular; Complete,,76881,CPT,Facility,Inpatient,,,,449,381.65,128.6834,449,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Us Extremity Non-Vascular; Complete,,76881,CPT,Facility,Both,,,,449,381.65,128.6834,449,Medica,Individual & Family,444.959,99.1,,percent of total billed charges,,
Us Extremity Non-Vascular; Complete,,76881,CPT,Facility,Outpatient,,,,449,381.65,128.6834,449,Medica,Medica Advantage Solution,223.602,49.8,,percent of total billed charges,,
Us Extremity Non-Vascular; Complete,,76881,CPT,Facility,Inpatient,,,,449,381.65,128.6834,449,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Us Extremity Non-Vascular; Complete,,76881,CPT,Facility,Outpatient,,,,449,381.65,128.6834,449,Medica,Medical Assistance,200.254,44.6,,percent of total billed charges,,
Us Extremity Non-Vascular; Complete,,76881,CPT,Facility,Inpatient,,,,449,381.65,128.6834,449,Medica,Medical Assistance,,,,,Included in per diem rate,
Us Extremity Non-Vascular; Complete,,76881,CPT,Facility,Outpatient,,,,449,381.65,128.6834,449,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,223.602,49.8,,percent of total billed charges,,
Us Extremity Non-Vascular; Complete,,76881,CPT,Facility,Inpatient,,,,449,381.65,128.6834,449,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Us Extremity Non-Vascular; Complete,,76881,CPT,Facility,Both,,,,449,381.65,128.6834,449,"Multiplan, Inc.","Multiplan, Inc.",422.06,94,,percent of total billed charges,,
Us Extremity Non-Vascular; Complete,,76881,CPT,Facility,Outpatient,,,,449,381.65,128.6834,449,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,404.549,90.1,,percent of total billed charges,,
Us Extremity Non-Vascular; Complete,,76881,CPT,Facility,Inpatient,,,,449,381.65,128.6834,449,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Us Extremity Non-Vascular; Complete,,76881,CPT,Facility,Both,,,,449,381.65,128.6834,449,"Preferred One Administrative Services, INC.",PPO,442.714,98.6,,percent of total billed charges,,
Us Extremity Non-Vascular; Complete,,76881,CPT,Facility,Outpatient,,,,449,381.65,128.6834,449,PrimeWest Health,Minnesota Senior Health Options (MSHO),231.0105,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Us Extremity Non-Vascular; Complete,,76881,CPT,Facility,Inpatient,,,,449,381.65,128.6834,449,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Us Extremity Non-Vascular; Complete,,76881,CPT,Facility,Outpatient,,,,449,381.65,128.6834,449,PrimeWest Health,MinnesotaCare,230.6064,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Us Extremity Non-Vascular; Complete,,76881,CPT,Facility,Inpatient,,,,449,381.65,128.6834,449,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Us Extremity Non-Vascular; Complete,,76881,CPT,Facility,Both,,,,449,381.65,128.6834,449,Sanford Health Plan,Sanford Health Plan,413.08,92,,percent of total billed charges,,
Us Extremity Non-Vascular; Complete,,76881,CPT,Facility,Outpatient,,,,449,381.65,128.6834,449,"UCare Health, Inc.",Individual & Family Plan,253.0115,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Us Extremity Non-Vascular; Complete,,76881,CPT,Facility,Inpatient,,,,449,381.65,128.6834,449,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Us Extremity Non-Vascular; Complete,,76881,CPT,Facility,Outpatient,,,,449,381.65,128.6834,449,"UCare Health, Inc.",Medical Assistance,226.6103,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Extremity Non-Vascular; Complete,,76881,CPT,Facility,Inpatient,,,,449,381.65,128.6834,449,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Us Extremity Non-Vascular; Complete,,76881,CPT,Facility,Outpatient,,,,449,381.65,128.6834,449,"UCare Health, Inc.",Medicare Advantage,226.6103,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Extremity Non-Vascular; Complete,,76881,CPT,Facility,Inpatient,,,,449,381.65,128.6834,449,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Us Extremity Non-Vascular; Complete,,76881,CPT,Facility,Outpatient,,,,449,381.65,128.6834,449,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),226.6103,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Extremity Non-Vascular; Complete,,76881,CPT,Facility,Inpatient,,,,449,381.65,128.6834,449,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Us Extremity Non-Vascular; Complete,,76881,CPT,Facility,Both,,,,449,381.65,128.6834,449,UnitedHealthcare,Individual & Family,422.06,94,,percent of total billed charges,,
Us Extremity Non-Vascular; Complete,,76881,CPT,Facility,Outpatient,,,,449,381.65,128.6834,449,UnitedHealthcare,Medicare Advantage,220.01,49,,percent of total billed charges,,
Us Extremity Non-Vascular; Complete,,76881,CPT,Facility,Inpatient,,,,449,381.65,128.6834,449,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Us Extremity Non-Vascular; Complete,,76881,CPT,Facility,Outpatient,,,,449,381.65,128.6834,449,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,215.52,48,,percent of total billed charges,,100% of DHS outpatient percentage
Us Extremity Non-Vascular; Complete,,76881,CPT,Facility,Inpatient,,,,449,381.65,128.6834,449,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Us Extremity Non Vascular,,76882,CPT,Facility,Both,,,,449,381.65,128.6834,449,Aetna,Commercial,413.08,92,,percent of total billed charges,,
Us Extremity Non Vascular,,76882,CPT,Facility,Outpatient,,,,449,381.65,128.6834,449,Aetna,Medicare Advantage,220.01,49,,percent of total billed charges,,
Us Extremity Non Vascular,,76882,CPT,Facility,Inpatient,,,,449,381.65,128.6834,449,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Us Extremity Non Vascular,,76882,CPT,Facility,Both,,,,449,381.65,128.6834,449,Aetna,PPO,417.57,93,,percent of total billed charges,,
Us Extremity Non Vascular,,76882,CPT,Facility,Both,,,,449,381.65,128.6834,449,America's PPO,America's PPO,431.1747,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Us Extremity Non Vascular,,76882,CPT,Facility,Both,,,,449,381.65,128.6834,449,BlueCross BlueShield Minnesota, Federal Employee Program,441.816,98.4,,percent of total billed charges,,
Us Extremity Non Vascular,,76882,CPT,Facility,Both,,,,449,381.65,128.6834,449,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,449,100,,percent of total billed charges,,
Us Extremity Non Vascular,,76882,CPT,Facility,Both,,,,449,381.65,128.6834,449,BlueCross BlueShield Minnesota,High Value Network Plan,404.1,90,,percent of total billed charges,,
Us Extremity Non Vascular,,76882,CPT,Facility,Outpatient,,,,449,381.65,128.6834,449,BlueCross BlueShield Minnesota,Medicare Advantage,220.01,49,,percent of total billed charges,,
Us Extremity Non Vascular,,76882,CPT,Facility,Inpatient,,,,449,381.65,128.6834,449,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Us Extremity Non Vascular,,76882,CPT,Facility,Both,,,,449,381.65,128.6834,449,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,397.6793,88.57,,percent of total billed charges,,
Us Extremity Non Vascular,,76882,CPT,Facility,Both,,,,449,381.65,128.6834,449,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,128.6834,28.66,,percent of total billed charges,,
Us Extremity Non Vascular,,76882,CPT,Facility,Outpatient,,,,449,381.65,128.6834,449,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),220.01,49,,percent of total billed charges,,
Us Extremity Non Vascular,,76882,CPT,Facility,Inpatient,,,,449,381.65,128.6834,449,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Us Extremity Non Vascular,,76882,CPT,Facility,Both,,,,449,381.65,128.6834,449,CorVel,Worker's Compensation,449,100,,percent of total billed charges,,
Us Extremity Non Vascular,,76882,CPT,Facility,Both,,,,449,381.65,128.6834,449,First Health Group Corporation,First Health Network,435.53,97,,percent of total billed charges,,
Us Extremity Non Vascular,,76882,CPT,Facility,Both,,,,449,381.65,128.6834,449,"Health Partners, Inc.",Commercial,424.754,94.6,,percent of total billed charges,,
Us Extremity Non Vascular,,76882,CPT,Facility,Outpatient,,,,449,381.65,128.6834,449,"Health Partners, Inc.",Medicare Advantage,220.01,49,,percent of total billed charges,,
Us Extremity Non Vascular,,76882,CPT,Facility,Inpatient,,,,449,381.65,128.6834,449,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Us Extremity Non Vascular,,76882,CPT,Facility,Both,,,,449,381.65,128.6834,449,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),269.4,60,,percent of total billed charges,,
Us Extremity Non Vascular,,76882,CPT,Facility,Both,,,,449,381.65,128.6834,449,"Health Partners, Inc.",State of Minnesota Advantage Program,365.935,81.5,,percent of total billed charges,,
Us Extremity Non Vascular,,76882,CPT,Facility,Both,,,,449,381.65,128.6834,449,"Health Partners, Inc.",State Public Programs,224.5,50,,percent of total billed charges,,
Us Extremity Non Vascular,,76882,CPT,Facility,Both,,,,449,381.65,128.6834,449,Humana Insurance Company,Commercial PPO,426.55,95,,percent of total billed charges,,
Us Extremity Non Vascular,,76882,CPT,Facility,Outpatient,,,,449,381.65,128.6834,449,Humana Insurance Company,Medicare PPO,220.01,49,,percent of total billed charges,,
Us Extremity Non Vascular,,76882,CPT,Facility,Inpatient,,,,449,381.65,128.6834,449,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Us Extremity Non Vascular,,76882,CPT,Facility,Both,,,,449,381.65,128.6834,449,Medica,Individual & Family,444.959,99.1,,percent of total billed charges,,
Us Extremity Non Vascular,,76882,CPT,Facility,Outpatient,,,,449,381.65,128.6834,449,Medica,Medica Advantage Solution,223.602,49.8,,percent of total billed charges,,
Us Extremity Non Vascular,,76882,CPT,Facility,Inpatient,,,,449,381.65,128.6834,449,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Us Extremity Non Vascular,,76882,CPT,Facility,Outpatient,,,,449,381.65,128.6834,449,Medica,Medical Assistance,200.254,44.6,,percent of total billed charges,,
Us Extremity Non Vascular,,76882,CPT,Facility,Inpatient,,,,449,381.65,128.6834,449,Medica,Medical Assistance,,,,,Included in per diem rate,
Us Extremity Non Vascular,,76882,CPT,Facility,Outpatient,,,,449,381.65,128.6834,449,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,223.602,49.8,,percent of total billed charges,,
Us Extremity Non Vascular,,76882,CPT,Facility,Inpatient,,,,449,381.65,128.6834,449,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Us Extremity Non Vascular,,76882,CPT,Facility,Both,,,,449,381.65,128.6834,449,"Multiplan, Inc.","Multiplan, Inc.",422.06,94,,percent of total billed charges,,
Us Extremity Non Vascular,,76882,CPT,Facility,Outpatient,,,,449,381.65,128.6834,449,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,404.549,90.1,,percent of total billed charges,,
Us Extremity Non Vascular,,76882,CPT,Facility,Inpatient,,,,449,381.65,128.6834,449,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Us Extremity Non Vascular,,76882,CPT,Facility,Both,,,,449,381.65,128.6834,449,"Preferred One Administrative Services, INC.",PPO,442.714,98.6,,percent of total billed charges,,
Us Extremity Non Vascular,,76882,CPT,Facility,Outpatient,,,,449,381.65,128.6834,449,PrimeWest Health,Minnesota Senior Health Options (MSHO),231.0105,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Us Extremity Non Vascular,,76882,CPT,Facility,Inpatient,,,,449,381.65,128.6834,449,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Us Extremity Non Vascular,,76882,CPT,Facility,Outpatient,,,,449,381.65,128.6834,449,PrimeWest Health,MinnesotaCare,230.6064,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Us Extremity Non Vascular,,76882,CPT,Facility,Inpatient,,,,449,381.65,128.6834,449,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Us Extremity Non Vascular,,76882,CPT,Facility,Both,,,,449,381.65,128.6834,449,Sanford Health Plan,Sanford Health Plan,413.08,92,,percent of total billed charges,,
Us Extremity Non Vascular,,76882,CPT,Facility,Outpatient,,,,449,381.65,128.6834,449,"UCare Health, Inc.",Individual & Family Plan,253.0115,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Us Extremity Non Vascular,,76882,CPT,Facility,Inpatient,,,,449,381.65,128.6834,449,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Us Extremity Non Vascular,,76882,CPT,Facility,Outpatient,,,,449,381.65,128.6834,449,"UCare Health, Inc.",Medical Assistance,226.6103,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Extremity Non Vascular,,76882,CPT,Facility,Inpatient,,,,449,381.65,128.6834,449,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Us Extremity Non Vascular,,76882,CPT,Facility,Outpatient,,,,449,381.65,128.6834,449,"UCare Health, Inc.",Medicare Advantage,226.6103,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Extremity Non Vascular,,76882,CPT,Facility,Inpatient,,,,449,381.65,128.6834,449,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Us Extremity Non Vascular,,76882,CPT,Facility,Outpatient,,,,449,381.65,128.6834,449,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),226.6103,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Extremity Non Vascular,,76882,CPT,Facility,Inpatient,,,,449,381.65,128.6834,449,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Us Extremity Non Vascular,,76882,CPT,Facility,Both,,,,449,381.65,128.6834,449,UnitedHealthcare,Individual & Family,422.06,94,,percent of total billed charges,,
Us Extremity Non Vascular,,76882,CPT,Facility,Outpatient,,,,449,381.65,128.6834,449,UnitedHealthcare,Medicare Advantage,220.01,49,,percent of total billed charges,,
Us Extremity Non Vascular,,76882,CPT,Facility,Inpatient,,,,449,381.65,128.6834,449,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Us Extremity Non Vascular,,76882,CPT,Facility,Outpatient,,,,449,381.65,128.6834,449,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,215.52,48,,percent of total billed charges,,100% of DHS outpatient percentage
Us Extremity Non Vascular,,76882,CPT,Facility,Inpatient,,,,449,381.65,128.6834,449,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
ACYCLOVIR SODIUM 50 MG/ML IV SOLN,,J0133,HCPCS,Facility,Both,10,mL,,102,86.7,29.2332,102,Aetna,Commercial,93.84,92,,percent of total billed charges,,
ACYCLOVIR SODIUM 50 MG/ML IV SOLN,,J0133,HCPCS,Facility,Outpatient,10,mL,,102,86.7,29.2332,102,Aetna,Medicare Advantage,49.98,49,,percent of total billed charges,,
ACYCLOVIR SODIUM 50 MG/ML IV SOLN,,J0133,HCPCS,Facility,Inpatient,10,mL,,102,86.7,29.2332,102,Aetna,Medicare Advantage,,,,,Included in per diem rate,
ACYCLOVIR SODIUM 50 MG/ML IV SOLN,,J0133,HCPCS,Facility,Both,10,mL,,102,86.7,29.2332,102,Aetna,PPO,94.86,93,,percent of total billed charges,,
ACYCLOVIR SODIUM 50 MG/ML IV SOLN,,J0133,HCPCS,Facility,Both,10,mL,,102,86.7,29.2332,102,America's PPO,America's PPO,97.9506,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
ACYCLOVIR SODIUM 50 MG/ML IV SOLN,,J0133,HCPCS,Facility,Both,10,mL,,102,86.7,29.2332,102,BlueCross BlueShield Minnesota, Federal Employee Program,100.368,98.4,,percent of total billed charges,,
ACYCLOVIR SODIUM 50 MG/ML IV SOLN,,J0133,HCPCS,Facility,Both,10,mL,,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,102,100,,percent of total billed charges,,
ACYCLOVIR SODIUM 50 MG/ML IV SOLN,,J0133,HCPCS,Facility,Both,10,mL,,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,High Value Network Plan,91.8,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
ACYCLOVIR SODIUM 50 MG/ML IV SOLN,,J0133,HCPCS,Facility,Outpatient,10,mL,,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,Medicare Advantage,49.98,49,,percent of total billed charges,,
ACYCLOVIR SODIUM 50 MG/ML IV SOLN,,J0133,HCPCS,Facility,Inpatient,10,mL,,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
ACYCLOVIR SODIUM 50 MG/ML IV SOLN,,J0133,HCPCS,Facility,Both,10,mL,,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,90.3414,88.57,,percent of total billed charges,,
ACYCLOVIR SODIUM 50 MG/ML IV SOLN,,J0133,HCPCS,Facility,Both,10,mL,,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,29.2332,28.66,,percent of total billed charges,,
ACYCLOVIR SODIUM 50 MG/ML IV SOLN,,J0133,HCPCS,Facility,Outpatient,10,mL,,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),49.98,49,,percent of total billed charges,,
ACYCLOVIR SODIUM 50 MG/ML IV SOLN,,J0133,HCPCS,Facility,Inpatient,10,mL,,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
ACYCLOVIR SODIUM 50 MG/ML IV SOLN,,J0133,HCPCS,Facility,Both,10,mL,,102,86.7,29.2332,102,CorVel,Worker's Compensation,102,100,,percent of total billed charges,,
ACYCLOVIR SODIUM 50 MG/ML IV SOLN,,J0133,HCPCS,Facility,Both,10,mL,,102,86.7,29.2332,102,First Health Group Corporation,First Health Network,98.94,97,,percent of total billed charges,,
ACYCLOVIR SODIUM 50 MG/ML IV SOLN,,J0133,HCPCS,Facility,Both,10,mL,,102,86.7,29.2332,102,"Health Partners, Inc.",Commercial,96.492,94.6,,percent of total billed charges,,
ACYCLOVIR SODIUM 50 MG/ML IV SOLN,,J0133,HCPCS,Facility,Outpatient,10,mL,,102,86.7,29.2332,102,"Health Partners, Inc.",Medicare Advantage,49.98,49,,percent of total billed charges,,
ACYCLOVIR SODIUM 50 MG/ML IV SOLN,,J0133,HCPCS,Facility,Inpatient,10,mL,,102,86.7,29.2332,102,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ACYCLOVIR SODIUM 50 MG/ML IV SOLN,,J0133,HCPCS,Facility,Both,10,mL,,102,86.7,29.2332,102,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),61.2,60,,percent of total billed charges,,
ACYCLOVIR SODIUM 50 MG/ML IV SOLN,,J0133,HCPCS,Facility,Both,10,mL,,102,86.7,29.2332,102,"Health Partners, Inc.",State of Minnesota Advantage Program,83.13,81.5,,percent of total billed charges,,
ACYCLOVIR SODIUM 50 MG/ML IV SOLN,,J0133,HCPCS,Facility,Both,10,mL,,102,86.7,29.2332,102,"Health Partners, Inc.",State Public Programs,51,50,,percent of total billed charges,,
ACYCLOVIR SODIUM 50 MG/ML IV SOLN,,J0133,HCPCS,Facility,Both,10,mL,,102,86.7,29.2332,102,Humana Insurance Company,Commercial PPO,96.9,95,,percent of total billed charges,,
ACYCLOVIR SODIUM 50 MG/ML IV SOLN,,J0133,HCPCS,Facility,Outpatient,10,mL,,102,86.7,29.2332,102,Humana Insurance Company,Medicare PPO,49.98,49,,percent of total billed charges,,
ACYCLOVIR SODIUM 50 MG/ML IV SOLN,,J0133,HCPCS,Facility,Inpatient,10,mL,,102,86.7,29.2332,102,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
ACYCLOVIR SODIUM 50 MG/ML IV SOLN,,J0133,HCPCS,Facility,Both,10,mL,,102,86.7,29.2332,102,Medica,Individual & Family,101.082,99.1,,percent of total billed charges,,
ACYCLOVIR SODIUM 50 MG/ML IV SOLN,,J0133,HCPCS,Facility,Outpatient,10,mL,,102,86.7,29.2332,102,Medica,Medica Advantage Solution,50.796,49.8,,percent of total billed charges,,
ACYCLOVIR SODIUM 50 MG/ML IV SOLN,,J0133,HCPCS,Facility,Inpatient,10,mL,,102,86.7,29.2332,102,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
ACYCLOVIR SODIUM 50 MG/ML IV SOLN,,J0133,HCPCS,Facility,Outpatient,10,mL,,102,86.7,29.2332,102,Medica,Medical Assistance,45.492,44.6,,percent of total billed charges,,
ACYCLOVIR SODIUM 50 MG/ML IV SOLN,,J0133,HCPCS,Facility,Inpatient,10,mL,,102,86.7,29.2332,102,Medica,Medical Assistance,,,,,Included in per diem rate,
ACYCLOVIR SODIUM 50 MG/ML IV SOLN,,J0133,HCPCS,Facility,Outpatient,10,mL,,102,86.7,29.2332,102,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,50.796,49.8,,percent of total billed charges,,
ACYCLOVIR SODIUM 50 MG/ML IV SOLN,,J0133,HCPCS,Facility,Inpatient,10,mL,,102,86.7,29.2332,102,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
ACYCLOVIR SODIUM 50 MG/ML IV SOLN,,J0133,HCPCS,Facility,Both,10,mL,,102,86.7,29.2332,102,"Multiplan, Inc.","Multiplan, Inc.",95.88,94,,percent of total billed charges,,
ACYCLOVIR SODIUM 50 MG/ML IV SOLN,,J0133,HCPCS,Facility,Outpatient,10,mL,,102,86.7,29.2332,102,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,91.902,90.1,,percent of total billed charges,,
ACYCLOVIR SODIUM 50 MG/ML IV SOLN,,J0133,HCPCS,Facility,Inpatient,10,mL,,102,86.7,29.2332,102,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
ACYCLOVIR SODIUM 50 MG/ML IV SOLN,,J0133,HCPCS,Facility,Both,10,mL,,102,86.7,29.2332,102,"Preferred One Administrative Services, INC.",PPO,100.572,98.6,,percent of total billed charges,,
ACYCLOVIR SODIUM 50 MG/ML IV SOLN,,J0133,HCPCS,Facility,Outpatient,10,mL,,102,86.7,29.2332,102,PrimeWest Health,Minnesota Senior Health Options (MSHO),52.479,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
ACYCLOVIR SODIUM 50 MG/ML IV SOLN,,J0133,HCPCS,Facility,Inpatient,10,mL,,102,86.7,29.2332,102,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ACYCLOVIR SODIUM 50 MG/ML IV SOLN,,J0133,HCPCS,Facility,Outpatient,10,mL,,102,86.7,29.2332,102,PrimeWest Health,MinnesotaCare,52.3872,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
ACYCLOVIR SODIUM 50 MG/ML IV SOLN,,J0133,HCPCS,Facility,Inpatient,10,mL,,102,86.7,29.2332,102,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
ACYCLOVIR SODIUM 50 MG/ML IV SOLN,,J0133,HCPCS,Facility,Both,10,mL,,102,86.7,29.2332,102,Sanford Health Plan,Sanford Health Plan,93.84,92,,percent of total billed charges,,
ACYCLOVIR SODIUM 50 MG/ML IV SOLN,,J0133,HCPCS,Facility,Outpatient,10,mL,,102,86.7,29.2332,102,"UCare Health, Inc.",Individual & Family Plan,57.477,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
ACYCLOVIR SODIUM 50 MG/ML IV SOLN,,J0133,HCPCS,Facility,Inpatient,10,mL,,102,86.7,29.2332,102,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
ACYCLOVIR SODIUM 50 MG/ML IV SOLN,,J0133,HCPCS,Facility,Outpatient,10,mL,,102,86.7,29.2332,102,"UCare Health, Inc.",Medical Assistance,51.4794,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ACYCLOVIR SODIUM 50 MG/ML IV SOLN,,J0133,HCPCS,Facility,Inpatient,10,mL,,102,86.7,29.2332,102,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
ACYCLOVIR SODIUM 50 MG/ML IV SOLN,,J0133,HCPCS,Facility,Outpatient,10,mL,,102,86.7,29.2332,102,"UCare Health, Inc.",Medicare Advantage,51.4794,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ACYCLOVIR SODIUM 50 MG/ML IV SOLN,,J0133,HCPCS,Facility,Inpatient,10,mL,,102,86.7,29.2332,102,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ACYCLOVIR SODIUM 50 MG/ML IV SOLN,,J0133,HCPCS,Facility,Outpatient,10,mL,,102,86.7,29.2332,102,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),51.4794,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ACYCLOVIR SODIUM 50 MG/ML IV SOLN,,J0133,HCPCS,Facility,Inpatient,10,mL,,102,86.7,29.2332,102,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ACYCLOVIR SODIUM 50 MG/ML IV SOLN,,J0133,HCPCS,Facility,Both,10,mL,,102,86.7,29.2332,102,UnitedHealthcare,Individual & Family,95.88,94,,percent of total billed charges,,
ACYCLOVIR SODIUM 50 MG/ML IV SOLN,,J0133,HCPCS,Facility,Outpatient,10,mL,,102,86.7,29.2332,102,UnitedHealthcare,Medicare Advantage,49.98,49,,percent of total billed charges,,
ACYCLOVIR SODIUM 50 MG/ML IV SOLN,,J0133,HCPCS,Facility,Inpatient,10,mL,,102,86.7,29.2332,102,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
ACYCLOVIR SODIUM 50 MG/ML IV SOLN,,J0133,HCPCS,Facility,Outpatient,10,mL,,102,86.7,29.2332,102,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,48.96,48,,percent of total billed charges,,100% of DHS outpatient percentage
ACYCLOVIR SODIUM 50 MG/ML IV SOLN,,J0133,HCPCS,Facility,Inpatient,10,mL,,102,86.7,29.2332,102,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Us Guide Vasc Access W Docum,,76937,CPT,Facility,Both,,,,225,191.25,64.485,225,Aetna,Commercial,207,92,,percent of total billed charges,,
Us Guide Vasc Access W Docum,,76937,CPT,Facility,Outpatient,,,,225,191.25,64.485,225,Aetna,Medicare Advantage,110.25,49,,percent of total billed charges,,
Us Guide Vasc Access W Docum,,76937,CPT,Facility,Inpatient,,,,225,191.25,64.485,225,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Us Guide Vasc Access W Docum,,76937,CPT,Facility,Both,,,,225,191.25,64.485,225,Aetna,PPO,209.25,93,,percent of total billed charges,,
Us Guide Vasc Access W Docum,,76937,CPT,Facility,Both,,,,225,191.25,64.485,225,America's PPO,America's PPO,216.0675,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Us Guide Vasc Access W Docum,,76937,CPT,Facility,Both,,,,225,191.25,64.485,225,BlueCross BlueShield Minnesota, Federal Employee Program,221.4,98.4,,percent of total billed charges,,
Us Guide Vasc Access W Docum,,76937,CPT,Facility,Both,,,,225,191.25,64.485,225,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,225,100,,percent of total billed charges,,
Us Guide Vasc Access W Docum,,76937,CPT,Facility,Both,,,,225,191.25,64.485,225,BlueCross BlueShield Minnesota,High Value Network Plan,202.5,90,,percent of total billed charges,,
Us Guide Vasc Access W Docum,,76937,CPT,Facility,Outpatient,,,,225,191.25,64.485,225,BlueCross BlueShield Minnesota,Medicare Advantage,110.25,49,,percent of total billed charges,,
Us Guide Vasc Access W Docum,,76937,CPT,Facility,Inpatient,,,,225,191.25,64.485,225,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Us Guide Vasc Access W Docum,,76937,CPT,Facility,Both,,,,225,191.25,64.485,225,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,199.2825,88.57,,percent of total billed charges,,
Us Guide Vasc Access W Docum,,76937,CPT,Facility,Both,,,,225,191.25,64.485,225,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,64.485,28.66,,percent of total billed charges,,
Us Guide Vasc Access W Docum,,76937,CPT,Facility,Outpatient,,,,225,191.25,64.485,225,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),110.25,49,,percent of total billed charges,,
Us Guide Vasc Access W Docum,,76937,CPT,Facility,Inpatient,,,,225,191.25,64.485,225,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Us Guide Vasc Access W Docum,,76937,CPT,Facility,Both,,,,225,191.25,64.485,225,CorVel,Worker's Compensation,225,100,,percent of total billed charges,,
Us Guide Vasc Access W Docum,,76937,CPT,Facility,Both,,,,225,191.25,64.485,225,First Health Group Corporation,First Health Network,218.25,97,,percent of total billed charges,,
Us Guide Vasc Access W Docum,,76937,CPT,Facility,Both,,,,225,191.25,64.485,225,"Health Partners, Inc.",Commercial,212.85,94.6,,percent of total billed charges,,
Us Guide Vasc Access W Docum,,76937,CPT,Facility,Outpatient,,,,225,191.25,64.485,225,"Health Partners, Inc.",Medicare Advantage,110.25,49,,percent of total billed charges,,
Us Guide Vasc Access W Docum,,76937,CPT,Facility,Inpatient,,,,225,191.25,64.485,225,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Us Guide Vasc Access W Docum,,76937,CPT,Facility,Both,,,,225,191.25,64.485,225,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),135,60,,percent of total billed charges,,
Us Guide Vasc Access W Docum,,76937,CPT,Facility,Both,,,,225,191.25,64.485,225,"Health Partners, Inc.",State of Minnesota Advantage Program,183.375,81.5,,percent of total billed charges,,
Us Guide Vasc Access W Docum,,76937,CPT,Facility,Both,,,,225,191.25,64.485,225,"Health Partners, Inc.",State Public Programs,112.5,50,,percent of total billed charges,,
Us Guide Vasc Access W Docum,,76937,CPT,Facility,Both,,,,225,191.25,64.485,225,Humana Insurance Company,Commercial PPO,213.75,95,,percent of total billed charges,,
Us Guide Vasc Access W Docum,,76937,CPT,Facility,Outpatient,,,,225,191.25,64.485,225,Humana Insurance Company,Medicare PPO,110.25,49,,percent of total billed charges,,
Us Guide Vasc Access W Docum,,76937,CPT,Facility,Inpatient,,,,225,191.25,64.485,225,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Us Guide Vasc Access W Docum,,76937,CPT,Facility,Both,,,,225,191.25,64.485,225,Medica,Individual & Family,222.975,99.1,,percent of total billed charges,,
Us Guide Vasc Access W Docum,,76937,CPT,Facility,Outpatient,,,,225,191.25,64.485,225,Medica,Medica Advantage Solution,112.05,49.8,,percent of total billed charges,,
Us Guide Vasc Access W Docum,,76937,CPT,Facility,Inpatient,,,,225,191.25,64.485,225,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Us Guide Vasc Access W Docum,,76937,CPT,Facility,Outpatient,,,,225,191.25,64.485,225,Medica,Medical Assistance,100.35,44.6,,percent of total billed charges,,
Us Guide Vasc Access W Docum,,76937,CPT,Facility,Inpatient,,,,225,191.25,64.485,225,Medica,Medical Assistance,,,,,Included in per diem rate,
Us Guide Vasc Access W Docum,,76937,CPT,Facility,Outpatient,,,,225,191.25,64.485,225,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,112.05,49.8,,percent of total billed charges,,
Us Guide Vasc Access W Docum,,76937,CPT,Facility,Inpatient,,,,225,191.25,64.485,225,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Us Guide Vasc Access W Docum,,76937,CPT,Facility,Both,,,,225,191.25,64.485,225,"Multiplan, Inc.","Multiplan, Inc.",211.5,94,,percent of total billed charges,,
Us Guide Vasc Access W Docum,,76937,CPT,Facility,Outpatient,,,,225,191.25,64.485,225,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,202.725,90.1,,percent of total billed charges,,
Us Guide Vasc Access W Docum,,76937,CPT,Facility,Inpatient,,,,225,191.25,64.485,225,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Us Guide Vasc Access W Docum,,76937,CPT,Facility,Both,,,,225,191.25,64.485,225,"Preferred One Administrative Services, INC.",PPO,221.85,98.6,,percent of total billed charges,,
Us Guide Vasc Access W Docum,,76937,CPT,Facility,Outpatient,,,,225,191.25,64.485,225,PrimeWest Health,Minnesota Senior Health Options (MSHO),115.7625,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Us Guide Vasc Access W Docum,,76937,CPT,Facility,Inpatient,,,,225,191.25,64.485,225,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Us Guide Vasc Access W Docum,,76937,CPT,Facility,Outpatient,,,,225,191.25,64.485,225,PrimeWest Health,MinnesotaCare,115.56,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Us Guide Vasc Access W Docum,,76937,CPT,Facility,Inpatient,,,,225,191.25,64.485,225,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Us Guide Vasc Access W Docum,,76937,CPT,Facility,Both,,,,225,191.25,64.485,225,Sanford Health Plan,Sanford Health Plan,207,92,,percent of total billed charges,,
Us Guide Vasc Access W Docum,,76937,CPT,Facility,Outpatient,,,,225,191.25,64.485,225,"UCare Health, Inc.",Individual & Family Plan,126.7875,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Us Guide Vasc Access W Docum,,76937,CPT,Facility,Inpatient,,,,225,191.25,64.485,225,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Us Guide Vasc Access W Docum,,76937,CPT,Facility,Outpatient,,,,225,191.25,64.485,225,"UCare Health, Inc.",Medical Assistance,113.5575,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Guide Vasc Access W Docum,,76937,CPT,Facility,Inpatient,,,,225,191.25,64.485,225,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Us Guide Vasc Access W Docum,,76937,CPT,Facility,Outpatient,,,,225,191.25,64.485,225,"UCare Health, Inc.",Medicare Advantage,113.5575,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Guide Vasc Access W Docum,,76937,CPT,Facility,Inpatient,,,,225,191.25,64.485,225,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Us Guide Vasc Access W Docum,,76937,CPT,Facility,Outpatient,,,,225,191.25,64.485,225,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),113.5575,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Guide Vasc Access W Docum,,76937,CPT,Facility,Inpatient,,,,225,191.25,64.485,225,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Us Guide Vasc Access W Docum,,76937,CPT,Facility,Both,,,,225,191.25,64.485,225,UnitedHealthcare,Individual & Family,211.5,94,,percent of total billed charges,,
Us Guide Vasc Access W Docum,,76937,CPT,Facility,Outpatient,,,,225,191.25,64.485,225,UnitedHealthcare,Medicare Advantage,110.25,49,,percent of total billed charges,,
Us Guide Vasc Access W Docum,,76937,CPT,Facility,Inpatient,,,,225,191.25,64.485,225,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Us Guide Vasc Access W Docum,,76937,CPT,Facility,Outpatient,,,,225,191.25,64.485,225,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,108,48,,percent of total billed charges,,100% of DHS outpatient percentage
Us Guide Vasc Access W Docum,,76937,CPT,Facility,Inpatient,,,,225,191.25,64.485,225,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Ultrasound Guidance Needle Placement, Imaging Supervision And Interp (Pbb)",,76942,CPT,Facility,Outpatient,,,,622,528.7,178.2652,622,Aetna,Commercial,572.24,92,,percent of total billed charges,,
"Ultrasound Guidance Needle Placement, Imaging Supervision And Interp (Pbb)",,76942,CPT,Facility,Outpatient,,,,622,528.7,178.2652,622,Aetna,Medicare Advantage,304.78,49,,percent of total billed charges,,
"Ultrasound Guidance Needle Placement, Imaging Supervision And Interp (Pbb)",,76942,CPT,Facility,Outpatient,,,,622,528.7,178.2652,622,Aetna,PPO,578.46,93,,percent of total billed charges,,
"Ultrasound Guidance Needle Placement, Imaging Supervision And Interp (Pbb)",,76942,CPT,Facility,Outpatient,,,,622,528.7,178.2652,622,America's PPO,America's PPO,597.3066,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Ultrasound Guidance Needle Placement, Imaging Supervision And Interp (Pbb)",,76942,CPT,Facility,Outpatient,,,,622,528.7,178.2652,622,BlueCross BlueShield Minnesota, Federal Employee Program,612.048,98.4,,percent of total billed charges,,
"Ultrasound Guidance Needle Placement, Imaging Supervision And Interp (Pbb)",,76942,CPT,Facility,Outpatient,,,,622,528.7,178.2652,622,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,622,100,,percent of total billed charges,,
"Ultrasound Guidance Needle Placement, Imaging Supervision And Interp (Pbb)",,76942,CPT,Facility,Outpatient,,,,622,528.7,178.2652,622,BlueCross BlueShield Minnesota,High Value Network Plan,559.8,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
"Ultrasound Guidance Needle Placement, Imaging Supervision And Interp (Pbb)",,76942,CPT,Facility,Outpatient,,,,622,528.7,178.2652,622,BlueCross BlueShield Minnesota,Medicare Advantage,304.78,49,,percent of total billed charges,,
"Ultrasound Guidance Needle Placement, Imaging Supervision And Interp (Pbb)",,76942,CPT,Facility,Outpatient,,,,622,528.7,178.2652,622,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,178.2652,28.66,,percent of total billed charges,,
"Ultrasound Guidance Needle Placement, Imaging Supervision And Interp (Pbb)",,76942,CPT,Facility,Outpatient,,,,622,528.7,178.2652,622,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),304.78,49,,percent of total billed charges,,
"Ultrasound Guidance Needle Placement, Imaging Supervision And Interp (Pbb)",,76942,CPT,Facility,Outpatient,,,,622,528.7,178.2652,622,CorVel,Worker's Compensation,622,100,,percent of total billed charges,,
"Ultrasound Guidance Needle Placement, Imaging Supervision And Interp (Pbb)",,76942,CPT,Facility,Outpatient,,,,622,528.7,178.2652,622,First Health Group Corporation,First Health Network,603.34,97,,percent of total billed charges,,
"Ultrasound Guidance Needle Placement, Imaging Supervision And Interp (Pbb)",,76942,CPT,Facility,Outpatient,,,,622,528.7,178.2652,622,"Health Partners, Inc.",Commercial,588.412,94.6,,percent of total billed charges,,
"Ultrasound Guidance Needle Placement, Imaging Supervision And Interp (Pbb)",,76942,CPT,Facility,Outpatient,,,,622,528.7,178.2652,622,"Health Partners, Inc.",Medicare Advantage,304.78,49,,percent of total billed charges,,
"Ultrasound Guidance Needle Placement, Imaging Supervision And Interp (Pbb)",,76942,CPT,Facility,Outpatient,,,,622,528.7,178.2652,622,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),373.2,60,,percent of total billed charges,,
"Ultrasound Guidance Needle Placement, Imaging Supervision And Interp (Pbb)",,76942,CPT,Facility,Outpatient,,,,622,528.7,178.2652,622,"Health Partners, Inc.",State of Minnesota Advantage Program,506.93,81.5,,percent of total billed charges,,
"Ultrasound Guidance Needle Placement, Imaging Supervision And Interp (Pbb)",,76942,CPT,Facility,Outpatient,,,,622,528.7,178.2652,622,"Health Partners, Inc.",State Public Programs,311,50,,percent of total billed charges,,
"Ultrasound Guidance Needle Placement, Imaging Supervision And Interp (Pbb)",,76942,CPT,Facility,Outpatient,,,,622,528.7,178.2652,622,Humana Insurance Company,Commercial PPO,590.9,95,,percent of total billed charges,,
"Ultrasound Guidance Needle Placement, Imaging Supervision And Interp (Pbb)",,76942,CPT,Facility,Outpatient,,,,622,528.7,178.2652,622,Humana Insurance Company,Medicare PPO,304.78,49,,percent of total billed charges,,
"Ultrasound Guidance Needle Placement, Imaging Supervision And Interp (Pbb)",,76942,CPT,Facility,Outpatient,,,,622,528.7,178.2652,622,Medica,Individual & Family,616.402,99.1,,percent of total billed charges,,
"Ultrasound Guidance Needle Placement, Imaging Supervision And Interp (Pbb)",,76942,CPT,Facility,Outpatient,,,,622,528.7,178.2652,622,Medica,Medica Advantage Solution,309.756,49.8,,percent of total billed charges,,
"Ultrasound Guidance Needle Placement, Imaging Supervision And Interp (Pbb)",,76942,CPT,Facility,Outpatient,,,,622,528.7,178.2652,622,Medica,Medical Assistance,277.412,44.6,,percent of total billed charges,,
"Ultrasound Guidance Needle Placement, Imaging Supervision And Interp (Pbb)",,76942,CPT,Facility,Outpatient,,,,622,528.7,178.2652,622,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,309.756,49.8,,percent of total billed charges,,
"Ultrasound Guidance Needle Placement, Imaging Supervision And Interp (Pbb)",,76942,CPT,Facility,Outpatient,,,,622,528.7,178.2652,622,"Multiplan, Inc.","Multiplan, Inc.",584.68,94,,percent of total billed charges,,
"Ultrasound Guidance Needle Placement, Imaging Supervision And Interp (Pbb)",,76942,CPT,Facility,Outpatient,,,,622,528.7,178.2652,622,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,560.422,90.1,,percent of total billed charges,,
"Ultrasound Guidance Needle Placement, Imaging Supervision And Interp (Pbb)",,76942,CPT,Facility,Outpatient,,,,622,528.7,178.2652,622,"Preferred One Administrative Services, INC.",PPO,613.292,98.6,,percent of total billed charges,,
"Ultrasound Guidance Needle Placement, Imaging Supervision And Interp (Pbb)",,76942,CPT,Facility,Outpatient,,,,622,528.7,178.2652,622,PrimeWest Health,Minnesota Senior Health Options (MSHO),320.019,51.45,,percent of total billed charges,,
"Ultrasound Guidance Needle Placement, Imaging Supervision And Interp (Pbb)",,76942,CPT,Facility,Outpatient,,,,622,528.7,178.2652,622,PrimeWest Health,MinnesotaCare,319.4592,51.36,,percent of total billed charges,,
"Ultrasound Guidance Needle Placement, Imaging Supervision And Interp (Pbb)",,76942,CPT,Facility,Outpatient,,,,622,528.7,178.2652,622,Sanford Health Plan,Sanford Health Plan,572.24,92,,percent of total billed charges,,
"Ultrasound Guidance Needle Placement, Imaging Supervision And Interp (Pbb)",,76942,CPT,Facility,Outpatient,,,,622,528.7,178.2652,622,"UCare Health, Inc.",Individual & Family Plan,350.497,56.35,,percent of total billed charges,,
"Ultrasound Guidance Needle Placement, Imaging Supervision And Interp (Pbb)",,76942,CPT,Facility,Outpatient,,,,622,528.7,178.2652,622,"UCare Health, Inc.",Medical Assistance,313.9234,50.47,,percent of total billed charges,,
"Ultrasound Guidance Needle Placement, Imaging Supervision And Interp (Pbb)",,76942,CPT,Facility,Outpatient,,,,622,528.7,178.2652,622,"UCare Health, Inc.",Medicare Advantage,313.9234,50.47,,percent of total billed charges,,
"Ultrasound Guidance Needle Placement, Imaging Supervision And Interp (Pbb)",,76942,CPT,Facility,Outpatient,,,,622,528.7,178.2652,622,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),313.9234,50.47,,percent of total billed charges,,
"Ultrasound Guidance Needle Placement, Imaging Supervision And Interp (Pbb)",,76942,CPT,Facility,Outpatient,,,,622,528.7,178.2652,622,UnitedHealthcare,Individual & Family,584.68,94,,percent of total billed charges,,
"Ultrasound Guidance Needle Placement, Imaging Supervision And Interp (Pbb)",,76942,CPT,Facility,Outpatient,,,,622,528.7,178.2652,622,UnitedHealthcare,Medicare Advantage,304.78,49,,percent of total billed charges,,
"Ultrasound Guidance Needle Placement, Imaging Supervision And Interp (Pbb)",,76942,CPT,Facility,Outpatient,,,,622,528.7,178.2652,622,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,298.56,48,,percent of total billed charges,,100% of DHS outpatient percentage
Us Guide,,76942,CPT,Facility,Both,,,,505,429.25,144.733,505,Aetna,Commercial,464.6,92,,percent of total billed charges,,
Us Guide,,76942,CPT,Facility,Outpatient,,,,505,429.25,144.733,505,Aetna,Medicare Advantage,247.45,49,,percent of total billed charges,,
Us Guide,,76942,CPT,Facility,Inpatient,,,,505,429.25,144.733,505,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Us Guide,,76942,CPT,Facility,Both,,,,505,429.25,144.733,505,Aetna,PPO,469.65,93,,percent of total billed charges,,
Us Guide,,76942,CPT,Facility,Both,,,,505,429.25,144.733,505,America's PPO,America's PPO,484.9515,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Us Guide,,76942,CPT,Facility,Both,,,,505,429.25,144.733,505,BlueCross BlueShield Minnesota, Federal Employee Program,496.92,98.4,,percent of total billed charges,,
Us Guide,,76942,CPT,Facility,Both,,,,505,429.25,144.733,505,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,505,100,,percent of total billed charges,,
Us Guide,,76942,CPT,Facility,Both,,,,505,429.25,144.733,505,BlueCross BlueShield Minnesota,High Value Network Plan,454.5,90,,percent of total billed charges,,
Us Guide,,76942,CPT,Facility,Outpatient,,,,505,429.25,144.733,505,BlueCross BlueShield Minnesota,Medicare Advantage,247.45,49,,percent of total billed charges,,
Us Guide,,76942,CPT,Facility,Inpatient,,,,505,429.25,144.733,505,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Us Guide,,76942,CPT,Facility,Both,,,,505,429.25,144.733,505,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,447.2785,88.57,,percent of total billed charges,,
Us Guide,,76942,CPT,Facility,Both,,,,505,429.25,144.733,505,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,144.733,28.66,,percent of total billed charges,,
Us Guide,,76942,CPT,Facility,Outpatient,,,,505,429.25,144.733,505,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),247.45,49,,percent of total billed charges,,
Us Guide,,76942,CPT,Facility,Inpatient,,,,505,429.25,144.733,505,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Us Guide,,76942,CPT,Facility,Both,,,,505,429.25,144.733,505,CorVel,Worker's Compensation,505,100,,percent of total billed charges,,
Us Guide,,76942,CPT,Facility,Both,,,,505,429.25,144.733,505,First Health Group Corporation,First Health Network,489.85,97,,percent of total billed charges,,
Us Guide,,76942,CPT,Facility,Both,,,,505,429.25,144.733,505,"Health Partners, Inc.",Commercial,477.73,94.6,,percent of total billed charges,,
Us Guide,,76942,CPT,Facility,Outpatient,,,,505,429.25,144.733,505,"Health Partners, Inc.",Medicare Advantage,247.45,49,,percent of total billed charges,,
Us Guide,,76942,CPT,Facility,Inpatient,,,,505,429.25,144.733,505,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Us Guide,,76942,CPT,Facility,Both,,,,505,429.25,144.733,505,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),303,60,,percent of total billed charges,,
Us Guide,,76942,CPT,Facility,Both,,,,505,429.25,144.733,505,"Health Partners, Inc.",State of Minnesota Advantage Program,411.575,81.5,,percent of total billed charges,,
Us Guide,,76942,CPT,Facility,Both,,,,505,429.25,144.733,505,"Health Partners, Inc.",State Public Programs,252.5,50,,percent of total billed charges,,
Us Guide,,76942,CPT,Facility,Both,,,,505,429.25,144.733,505,Humana Insurance Company,Commercial PPO,479.75,95,,percent of total billed charges,,
Us Guide,,76942,CPT,Facility,Outpatient,,,,505,429.25,144.733,505,Humana Insurance Company,Medicare PPO,247.45,49,,percent of total billed charges,,
Us Guide,,76942,CPT,Facility,Inpatient,,,,505,429.25,144.733,505,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Us Guide,,76942,CPT,Facility,Both,,,,505,429.25,144.733,505,Medica,Individual & Family,500.455,99.1,,percent of total billed charges,,
Us Guide,,76942,CPT,Facility,Outpatient,,,,505,429.25,144.733,505,Medica,Medica Advantage Solution,251.49,49.8,,percent of total billed charges,,
Us Guide,,76942,CPT,Facility,Inpatient,,,,505,429.25,144.733,505,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Us Guide,,76942,CPT,Facility,Outpatient,,,,505,429.25,144.733,505,Medica,Medical Assistance,225.23,44.6,,percent of total billed charges,,
Us Guide,,76942,CPT,Facility,Inpatient,,,,505,429.25,144.733,505,Medica,Medical Assistance,,,,,Included in per diem rate,
Us Guide,,76942,CPT,Facility,Outpatient,,,,505,429.25,144.733,505,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,251.49,49.8,,percent of total billed charges,,
Us Guide,,76942,CPT,Facility,Inpatient,,,,505,429.25,144.733,505,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Us Guide,,76942,CPT,Facility,Both,,,,505,429.25,144.733,505,"Multiplan, Inc.","Multiplan, Inc.",474.7,94,,percent of total billed charges,,
Us Guide,,76942,CPT,Facility,Outpatient,,,,505,429.25,144.733,505,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,455.005,90.1,,percent of total billed charges,,
Us Guide,,76942,CPT,Facility,Inpatient,,,,505,429.25,144.733,505,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Us Guide,,76942,CPT,Facility,Both,,,,505,429.25,144.733,505,"Preferred One Administrative Services, INC.",PPO,497.93,98.6,,percent of total billed charges,,
Us Guide,,76942,CPT,Facility,Outpatient,,,,505,429.25,144.733,505,PrimeWest Health,Minnesota Senior Health Options (MSHO),259.8225,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Us Guide,,76942,CPT,Facility,Inpatient,,,,505,429.25,144.733,505,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Us Guide,,76942,CPT,Facility,Outpatient,,,,505,429.25,144.733,505,PrimeWest Health,MinnesotaCare,259.368,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Us Guide,,76942,CPT,Facility,Inpatient,,,,505,429.25,144.733,505,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Us Guide,,76942,CPT,Facility,Both,,,,505,429.25,144.733,505,Sanford Health Plan,Sanford Health Plan,464.6,92,,percent of total billed charges,,
Us Guide,,76942,CPT,Facility,Outpatient,,,,505,429.25,144.733,505,"UCare Health, Inc.",Individual & Family Plan,284.5675,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Us Guide,,76942,CPT,Facility,Inpatient,,,,505,429.25,144.733,505,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Us Guide,,76942,CPT,Facility,Outpatient,,,,505,429.25,144.733,505,"UCare Health, Inc.",Medical Assistance,254.8735,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Guide,,76942,CPT,Facility,Inpatient,,,,505,429.25,144.733,505,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Us Guide,,76942,CPT,Facility,Outpatient,,,,505,429.25,144.733,505,"UCare Health, Inc.",Medicare Advantage,254.8735,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Guide,,76942,CPT,Facility,Inpatient,,,,505,429.25,144.733,505,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Us Guide,,76942,CPT,Facility,Outpatient,,,,505,429.25,144.733,505,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),254.8735,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Guide,,76942,CPT,Facility,Inpatient,,,,505,429.25,144.733,505,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Us Guide,,76942,CPT,Facility,Both,,,,505,429.25,144.733,505,UnitedHealthcare,Individual & Family,474.7,94,,percent of total billed charges,,
Us Guide,,76942,CPT,Facility,Outpatient,,,,505,429.25,144.733,505,UnitedHealthcare,Medicare Advantage,247.45,49,,percent of total billed charges,,
Us Guide,,76942,CPT,Facility,Inpatient,,,,505,429.25,144.733,505,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Us Guide,,76942,CPT,Facility,Outpatient,,,,505,429.25,144.733,505,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,242.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
Us Guide,,76942,CPT,Facility,Inpatient,,,,505,429.25,144.733,505,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Us Guide Breast Aspir,,76942,CPT,Facility,Both,,,,1066,906.1,305.5156,1066,Aetna,Commercial,980.72,92,,percent of total billed charges,,
Us Guide Breast Aspir,,76942,CPT,Facility,Outpatient,,,,1066,906.1,305.5156,1066,Aetna,Medicare Advantage,522.34,49,,percent of total billed charges,,
Us Guide Breast Aspir,,76942,CPT,Facility,Inpatient,,,,1066,906.1,305.5156,1066,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Us Guide Breast Aspir,,76942,CPT,Facility,Both,,,,1066,906.1,305.5156,1066,Aetna,PPO,991.38,93,,percent of total billed charges,,
Us Guide Breast Aspir,,76942,CPT,Facility,Both,,,,1066,906.1,305.5156,1066,America's PPO,America's PPO,1023.6798,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Us Guide Breast Aspir,,76942,CPT,Facility,Both,,,,1066,906.1,305.5156,1066,BlueCross BlueShield Minnesota, Federal Employee Program,1048.944,98.4,,percent of total billed charges,,
Us Guide Breast Aspir,,76942,CPT,Facility,Both,,,,1066,906.1,305.5156,1066,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1066,100,,percent of total billed charges,,
Us Guide Breast Aspir,,76942,CPT,Facility,Both,,,,1066,906.1,305.5156,1066,BlueCross BlueShield Minnesota,High Value Network Plan,959.4,90,,percent of total billed charges,,
Us Guide Breast Aspir,,76942,CPT,Facility,Outpatient,,,,1066,906.1,305.5156,1066,BlueCross BlueShield Minnesota,Medicare Advantage,522.34,49,,percent of total billed charges,,
Us Guide Breast Aspir,,76942,CPT,Facility,Inpatient,,,,1066,906.1,305.5156,1066,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Us Guide Breast Aspir,,76942,CPT,Facility,Both,,,,1066,906.1,305.5156,1066,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,944.1562,88.57,,percent of total billed charges,,
Us Guide Breast Aspir,,76942,CPT,Facility,Both,,,,1066,906.1,305.5156,1066,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,305.5156,28.66,,percent of total billed charges,,
Us Guide Breast Aspir,,76942,CPT,Facility,Outpatient,,,,1066,906.1,305.5156,1066,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),522.34,49,,percent of total billed charges,,
Us Guide Breast Aspir,,76942,CPT,Facility,Inpatient,,,,1066,906.1,305.5156,1066,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Us Guide Breast Aspir,,76942,CPT,Facility,Both,,,,1066,906.1,305.5156,1066,CorVel,Worker's Compensation,1066,100,,percent of total billed charges,,
Us Guide Breast Aspir,,76942,CPT,Facility,Both,,,,1066,906.1,305.5156,1066,First Health Group Corporation,First Health Network,1034.02,97,,percent of total billed charges,,
Us Guide Breast Aspir,,76942,CPT,Facility,Both,,,,1066,906.1,305.5156,1066,"Health Partners, Inc.",Commercial,1008.436,94.6,,percent of total billed charges,,
Us Guide Breast Aspir,,76942,CPT,Facility,Outpatient,,,,1066,906.1,305.5156,1066,"Health Partners, Inc.",Medicare Advantage,522.34,49,,percent of total billed charges,,
Us Guide Breast Aspir,,76942,CPT,Facility,Inpatient,,,,1066,906.1,305.5156,1066,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Us Guide Breast Aspir,,76942,CPT,Facility,Both,,,,1066,906.1,305.5156,1066,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),639.6,60,,percent of total billed charges,,
Us Guide Breast Aspir,,76942,CPT,Facility,Both,,,,1066,906.1,305.5156,1066,"Health Partners, Inc.",State of Minnesota Advantage Program,868.79,81.5,,percent of total billed charges,,
Us Guide Breast Aspir,,76942,CPT,Facility,Both,,,,1066,906.1,305.5156,1066,"Health Partners, Inc.",State Public Programs,533,50,,percent of total billed charges,,
Us Guide Breast Aspir,,76942,CPT,Facility,Both,,,,1066,906.1,305.5156,1066,Humana Insurance Company,Commercial PPO,1012.7,95,,percent of total billed charges,,
Us Guide Breast Aspir,,76942,CPT,Facility,Outpatient,,,,1066,906.1,305.5156,1066,Humana Insurance Company,Medicare PPO,522.34,49,,percent of total billed charges,,
Us Guide Breast Aspir,,76942,CPT,Facility,Inpatient,,,,1066,906.1,305.5156,1066,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Us Guide Breast Aspir,,76942,CPT,Facility,Both,,,,1066,906.1,305.5156,1066,Medica,Individual & Family,1056.406,99.1,,percent of total billed charges,,
Us Guide Breast Aspir,,76942,CPT,Facility,Outpatient,,,,1066,906.1,305.5156,1066,Medica,Medica Advantage Solution,530.868,49.8,,percent of total billed charges,,
Us Guide Breast Aspir,,76942,CPT,Facility,Inpatient,,,,1066,906.1,305.5156,1066,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Us Guide Breast Aspir,,76942,CPT,Facility,Outpatient,,,,1066,906.1,305.5156,1066,Medica,Medical Assistance,475.436,44.6,,percent of total billed charges,,
Us Guide Breast Aspir,,76942,CPT,Facility,Inpatient,,,,1066,906.1,305.5156,1066,Medica,Medical Assistance,,,,,Included in per diem rate,
Us Guide Breast Aspir,,76942,CPT,Facility,Outpatient,,,,1066,906.1,305.5156,1066,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,530.868,49.8,,percent of total billed charges,,
Us Guide Breast Aspir,,76942,CPT,Facility,Inpatient,,,,1066,906.1,305.5156,1066,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Us Guide Breast Aspir,,76942,CPT,Facility,Both,,,,1066,906.1,305.5156,1066,"Multiplan, Inc.","Multiplan, Inc.",1002.04,94,,percent of total billed charges,,
Us Guide Breast Aspir,,76942,CPT,Facility,Outpatient,,,,1066,906.1,305.5156,1066,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,960.466,90.1,,percent of total billed charges,,
Us Guide Breast Aspir,,76942,CPT,Facility,Inpatient,,,,1066,906.1,305.5156,1066,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Us Guide Breast Aspir,,76942,CPT,Facility,Both,,,,1066,906.1,305.5156,1066,"Preferred One Administrative Services, INC.",PPO,1051.076,98.6,,percent of total billed charges,,
Us Guide Breast Aspir,,76942,CPT,Facility,Outpatient,,,,1066,906.1,305.5156,1066,PrimeWest Health,Minnesota Senior Health Options (MSHO),548.457,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Us Guide Breast Aspir,,76942,CPT,Facility,Inpatient,,,,1066,906.1,305.5156,1066,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Us Guide Breast Aspir,,76942,CPT,Facility,Outpatient,,,,1066,906.1,305.5156,1066,PrimeWest Health,MinnesotaCare,547.4976,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Us Guide Breast Aspir,,76942,CPT,Facility,Inpatient,,,,1066,906.1,305.5156,1066,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Us Guide Breast Aspir,,76942,CPT,Facility,Both,,,,1066,906.1,305.5156,1066,Sanford Health Plan,Sanford Health Plan,980.72,92,,percent of total billed charges,,
Us Guide Breast Aspir,,76942,CPT,Facility,Outpatient,,,,1066,906.1,305.5156,1066,"UCare Health, Inc.",Individual & Family Plan,600.691,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Us Guide Breast Aspir,,76942,CPT,Facility,Inpatient,,,,1066,906.1,305.5156,1066,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Us Guide Breast Aspir,,76942,CPT,Facility,Outpatient,,,,1066,906.1,305.5156,1066,"UCare Health, Inc.",Medical Assistance,538.0102,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Guide Breast Aspir,,76942,CPT,Facility,Inpatient,,,,1066,906.1,305.5156,1066,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Us Guide Breast Aspir,,76942,CPT,Facility,Outpatient,,,,1066,906.1,305.5156,1066,"UCare Health, Inc.",Medicare Advantage,538.0102,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Guide Breast Aspir,,76942,CPT,Facility,Inpatient,,,,1066,906.1,305.5156,1066,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Us Guide Breast Aspir,,76942,CPT,Facility,Outpatient,,,,1066,906.1,305.5156,1066,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),538.0102,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Guide Breast Aspir,,76942,CPT,Facility,Inpatient,,,,1066,906.1,305.5156,1066,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Us Guide Breast Aspir,,76942,CPT,Facility,Both,,,,1066,906.1,305.5156,1066,UnitedHealthcare,Individual & Family,1002.04,94,,percent of total billed charges,,
Us Guide Breast Aspir,,76942,CPT,Facility,Outpatient,,,,1066,906.1,305.5156,1066,UnitedHealthcare,Medicare Advantage,522.34,49,,percent of total billed charges,,
Us Guide Breast Aspir,,76942,CPT,Facility,Inpatient,,,,1066,906.1,305.5156,1066,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Us Guide Breast Aspir,,76942,CPT,Facility,Outpatient,,,,1066,906.1,305.5156,1066,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,511.68,48,,percent of total billed charges,,100% of DHS outpatient percentage
Us Guide Breast Aspir,,76942,CPT,Facility,Inpatient,,,,1066,906.1,305.5156,1066,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Us Guide Breast Bx,,76942,CPT,Facility,Both,,,,1066,906.1,305.5156,1066,Aetna,Commercial,980.72,92,,percent of total billed charges,,
Us Guide Breast Bx,,76942,CPT,Facility,Outpatient,,,,1066,906.1,305.5156,1066,Aetna,Medicare Advantage,522.34,49,,percent of total billed charges,,
Us Guide Breast Bx,,76942,CPT,Facility,Inpatient,,,,1066,906.1,305.5156,1066,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Us Guide Breast Bx,,76942,CPT,Facility,Both,,,,1066,906.1,305.5156,1066,Aetna,PPO,991.38,93,,percent of total billed charges,,
Us Guide Breast Bx,,76942,CPT,Facility,Both,,,,1066,906.1,305.5156,1066,America's PPO,America's PPO,1023.6798,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Us Guide Breast Bx,,76942,CPT,Facility,Both,,,,1066,906.1,305.5156,1066,BlueCross BlueShield Minnesota, Federal Employee Program,1048.944,98.4,,percent of total billed charges,,
Us Guide Breast Bx,,76942,CPT,Facility,Both,,,,1066,906.1,305.5156,1066,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1066,100,,percent of total billed charges,,
Us Guide Breast Bx,,76942,CPT,Facility,Both,,,,1066,906.1,305.5156,1066,BlueCross BlueShield Minnesota,High Value Network Plan,959.4,90,,percent of total billed charges,,
Us Guide Breast Bx,,76942,CPT,Facility,Outpatient,,,,1066,906.1,305.5156,1066,BlueCross BlueShield Minnesota,Medicare Advantage,522.34,49,,percent of total billed charges,,
Us Guide Breast Bx,,76942,CPT,Facility,Inpatient,,,,1066,906.1,305.5156,1066,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Us Guide Breast Bx,,76942,CPT,Facility,Both,,,,1066,906.1,305.5156,1066,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,944.1562,88.57,,percent of total billed charges,,
Us Guide Breast Bx,,76942,CPT,Facility,Both,,,,1066,906.1,305.5156,1066,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,305.5156,28.66,,percent of total billed charges,,
Us Guide Breast Bx,,76942,CPT,Facility,Outpatient,,,,1066,906.1,305.5156,1066,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),522.34,49,,percent of total billed charges,,
Us Guide Breast Bx,,76942,CPT,Facility,Inpatient,,,,1066,906.1,305.5156,1066,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Us Guide Breast Bx,,76942,CPT,Facility,Both,,,,1066,906.1,305.5156,1066,CorVel,Worker's Compensation,1066,100,,percent of total billed charges,,
Us Guide Breast Bx,,76942,CPT,Facility,Both,,,,1066,906.1,305.5156,1066,First Health Group Corporation,First Health Network,1034.02,97,,percent of total billed charges,,
Us Guide Breast Bx,,76942,CPT,Facility,Both,,,,1066,906.1,305.5156,1066,"Health Partners, Inc.",Commercial,1008.436,94.6,,percent of total billed charges,,
Us Guide Breast Bx,,76942,CPT,Facility,Outpatient,,,,1066,906.1,305.5156,1066,"Health Partners, Inc.",Medicare Advantage,522.34,49,,percent of total billed charges,,
Us Guide Breast Bx,,76942,CPT,Facility,Inpatient,,,,1066,906.1,305.5156,1066,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Us Guide Breast Bx,,76942,CPT,Facility,Both,,,,1066,906.1,305.5156,1066,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),639.6,60,,percent of total billed charges,,
Us Guide Breast Bx,,76942,CPT,Facility,Both,,,,1066,906.1,305.5156,1066,"Health Partners, Inc.",State of Minnesota Advantage Program,868.79,81.5,,percent of total billed charges,,
Us Guide Breast Bx,,76942,CPT,Facility,Both,,,,1066,906.1,305.5156,1066,"Health Partners, Inc.",State Public Programs,533,50,,percent of total billed charges,,
Us Guide Breast Bx,,76942,CPT,Facility,Both,,,,1066,906.1,305.5156,1066,Humana Insurance Company,Commercial PPO,1012.7,95,,percent of total billed charges,,
Us Guide Breast Bx,,76942,CPT,Facility,Outpatient,,,,1066,906.1,305.5156,1066,Humana Insurance Company,Medicare PPO,522.34,49,,percent of total billed charges,,
Us Guide Breast Bx,,76942,CPT,Facility,Inpatient,,,,1066,906.1,305.5156,1066,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Us Guide Breast Bx,,76942,CPT,Facility,Both,,,,1066,906.1,305.5156,1066,Medica,Individual & Family,1056.406,99.1,,percent of total billed charges,,
Us Guide Breast Bx,,76942,CPT,Facility,Outpatient,,,,1066,906.1,305.5156,1066,Medica,Medica Advantage Solution,530.868,49.8,,percent of total billed charges,,
Us Guide Breast Bx,,76942,CPT,Facility,Inpatient,,,,1066,906.1,305.5156,1066,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Us Guide Breast Bx,,76942,CPT,Facility,Outpatient,,,,1066,906.1,305.5156,1066,Medica,Medical Assistance,475.436,44.6,,percent of total billed charges,,
Us Guide Breast Bx,,76942,CPT,Facility,Inpatient,,,,1066,906.1,305.5156,1066,Medica,Medical Assistance,,,,,Included in per diem rate,
Us Guide Breast Bx,,76942,CPT,Facility,Outpatient,,,,1066,906.1,305.5156,1066,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,530.868,49.8,,percent of total billed charges,,
Us Guide Breast Bx,,76942,CPT,Facility,Inpatient,,,,1066,906.1,305.5156,1066,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Us Guide Breast Bx,,76942,CPT,Facility,Both,,,,1066,906.1,305.5156,1066,"Multiplan, Inc.","Multiplan, Inc.",1002.04,94,,percent of total billed charges,,
Us Guide Breast Bx,,76942,CPT,Facility,Outpatient,,,,1066,906.1,305.5156,1066,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,960.466,90.1,,percent of total billed charges,,
Us Guide Breast Bx,,76942,CPT,Facility,Inpatient,,,,1066,906.1,305.5156,1066,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Us Guide Breast Bx,,76942,CPT,Facility,Both,,,,1066,906.1,305.5156,1066,"Preferred One Administrative Services, INC.",PPO,1051.076,98.6,,percent of total billed charges,,
Us Guide Breast Bx,,76942,CPT,Facility,Outpatient,,,,1066,906.1,305.5156,1066,PrimeWest Health,Minnesota Senior Health Options (MSHO),548.457,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Us Guide Breast Bx,,76942,CPT,Facility,Inpatient,,,,1066,906.1,305.5156,1066,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Us Guide Breast Bx,,76942,CPT,Facility,Outpatient,,,,1066,906.1,305.5156,1066,PrimeWest Health,MinnesotaCare,547.4976,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Us Guide Breast Bx,,76942,CPT,Facility,Inpatient,,,,1066,906.1,305.5156,1066,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Us Guide Breast Bx,,76942,CPT,Facility,Both,,,,1066,906.1,305.5156,1066,Sanford Health Plan,Sanford Health Plan,980.72,92,,percent of total billed charges,,
Us Guide Breast Bx,,76942,CPT,Facility,Outpatient,,,,1066,906.1,305.5156,1066,"UCare Health, Inc.",Individual & Family Plan,600.691,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Us Guide Breast Bx,,76942,CPT,Facility,Inpatient,,,,1066,906.1,305.5156,1066,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Us Guide Breast Bx,,76942,CPT,Facility,Outpatient,,,,1066,906.1,305.5156,1066,"UCare Health, Inc.",Medical Assistance,538.0102,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Guide Breast Bx,,76942,CPT,Facility,Inpatient,,,,1066,906.1,305.5156,1066,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Us Guide Breast Bx,,76942,CPT,Facility,Outpatient,,,,1066,906.1,305.5156,1066,"UCare Health, Inc.",Medicare Advantage,538.0102,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Guide Breast Bx,,76942,CPT,Facility,Inpatient,,,,1066,906.1,305.5156,1066,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Us Guide Breast Bx,,76942,CPT,Facility,Outpatient,,,,1066,906.1,305.5156,1066,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),538.0102,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Guide Breast Bx,,76942,CPT,Facility,Inpatient,,,,1066,906.1,305.5156,1066,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Us Guide Breast Bx,,76942,CPT,Facility,Both,,,,1066,906.1,305.5156,1066,UnitedHealthcare,Individual & Family,1002.04,94,,percent of total billed charges,,
Us Guide Breast Bx,,76942,CPT,Facility,Outpatient,,,,1066,906.1,305.5156,1066,UnitedHealthcare,Medicare Advantage,522.34,49,,percent of total billed charges,,
Us Guide Breast Bx,,76942,CPT,Facility,Inpatient,,,,1066,906.1,305.5156,1066,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Us Guide Breast Bx,,76942,CPT,Facility,Outpatient,,,,1066,906.1,305.5156,1066,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,511.68,48,,percent of total billed charges,,100% of DHS outpatient percentage
Us Guide Breast Bx,,76942,CPT,Facility,Inpatient,,,,1066,906.1,305.5156,1066,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Us Guide Bx Prostate,,76942,CPT,Facility,Both,,,,1066,906.1,305.5156,1066,Aetna,Commercial,980.72,92,,percent of total billed charges,,
Us Guide Bx Prostate,,76942,CPT,Facility,Outpatient,,,,1066,906.1,305.5156,1066,Aetna,Medicare Advantage,522.34,49,,percent of total billed charges,,
Us Guide Bx Prostate,,76942,CPT,Facility,Inpatient,,,,1066,906.1,305.5156,1066,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Us Guide Bx Prostate,,76942,CPT,Facility,Both,,,,1066,906.1,305.5156,1066,Aetna,PPO,991.38,93,,percent of total billed charges,,
Us Guide Bx Prostate,,76942,CPT,Facility,Both,,,,1066,906.1,305.5156,1066,America's PPO,America's PPO,1023.6798,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Us Guide Bx Prostate,,76942,CPT,Facility,Both,,,,1066,906.1,305.5156,1066,BlueCross BlueShield Minnesota, Federal Employee Program,1048.944,98.4,,percent of total billed charges,,
Us Guide Bx Prostate,,76942,CPT,Facility,Both,,,,1066,906.1,305.5156,1066,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1066,100,,percent of total billed charges,,
Us Guide Bx Prostate,,76942,CPT,Facility,Both,,,,1066,906.1,305.5156,1066,BlueCross BlueShield Minnesota,High Value Network Plan,959.4,90,,percent of total billed charges,,
Us Guide Bx Prostate,,76942,CPT,Facility,Outpatient,,,,1066,906.1,305.5156,1066,BlueCross BlueShield Minnesota,Medicare Advantage,522.34,49,,percent of total billed charges,,
Us Guide Bx Prostate,,76942,CPT,Facility,Inpatient,,,,1066,906.1,305.5156,1066,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Us Guide Bx Prostate,,76942,CPT,Facility,Both,,,,1066,906.1,305.5156,1066,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,944.1562,88.57,,percent of total billed charges,,
Us Guide Bx Prostate,,76942,CPT,Facility,Both,,,,1066,906.1,305.5156,1066,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,305.5156,28.66,,percent of total billed charges,,
Us Guide Bx Prostate,,76942,CPT,Facility,Outpatient,,,,1066,906.1,305.5156,1066,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),522.34,49,,percent of total billed charges,,
Us Guide Bx Prostate,,76942,CPT,Facility,Inpatient,,,,1066,906.1,305.5156,1066,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Us Guide Bx Prostate,,76942,CPT,Facility,Both,,,,1066,906.1,305.5156,1066,CorVel,Worker's Compensation,1066,100,,percent of total billed charges,,
Us Guide Bx Prostate,,76942,CPT,Facility,Both,,,,1066,906.1,305.5156,1066,First Health Group Corporation,First Health Network,1034.02,97,,percent of total billed charges,,
Us Guide Bx Prostate,,76942,CPT,Facility,Both,,,,1066,906.1,305.5156,1066,"Health Partners, Inc.",Commercial,1008.436,94.6,,percent of total billed charges,,
Us Guide Bx Prostate,,76942,CPT,Facility,Outpatient,,,,1066,906.1,305.5156,1066,"Health Partners, Inc.",Medicare Advantage,522.34,49,,percent of total billed charges,,
Us Guide Bx Prostate,,76942,CPT,Facility,Inpatient,,,,1066,906.1,305.5156,1066,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Us Guide Bx Prostate,,76942,CPT,Facility,Both,,,,1066,906.1,305.5156,1066,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),639.6,60,,percent of total billed charges,,
Us Guide Bx Prostate,,76942,CPT,Facility,Both,,,,1066,906.1,305.5156,1066,"Health Partners, Inc.",State of Minnesota Advantage Program,868.79,81.5,,percent of total billed charges,,
Us Guide Bx Prostate,,76942,CPT,Facility,Both,,,,1066,906.1,305.5156,1066,"Health Partners, Inc.",State Public Programs,533,50,,percent of total billed charges,,
Us Guide Bx Prostate,,76942,CPT,Facility,Both,,,,1066,906.1,305.5156,1066,Humana Insurance Company,Commercial PPO,1012.7,95,,percent of total billed charges,,
Us Guide Bx Prostate,,76942,CPT,Facility,Outpatient,,,,1066,906.1,305.5156,1066,Humana Insurance Company,Medicare PPO,522.34,49,,percent of total billed charges,,
Us Guide Bx Prostate,,76942,CPT,Facility,Inpatient,,,,1066,906.1,305.5156,1066,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Us Guide Bx Prostate,,76942,CPT,Facility,Both,,,,1066,906.1,305.5156,1066,Medica,Individual & Family,1056.406,99.1,,percent of total billed charges,,
Us Guide Bx Prostate,,76942,CPT,Facility,Outpatient,,,,1066,906.1,305.5156,1066,Medica,Medica Advantage Solution,530.868,49.8,,percent of total billed charges,,
Us Guide Bx Prostate,,76942,CPT,Facility,Inpatient,,,,1066,906.1,305.5156,1066,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Us Guide Bx Prostate,,76942,CPT,Facility,Outpatient,,,,1066,906.1,305.5156,1066,Medica,Medical Assistance,475.436,44.6,,percent of total billed charges,,
Us Guide Bx Prostate,,76942,CPT,Facility,Inpatient,,,,1066,906.1,305.5156,1066,Medica,Medical Assistance,,,,,Included in per diem rate,
Us Guide Bx Prostate,,76942,CPT,Facility,Outpatient,,,,1066,906.1,305.5156,1066,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,530.868,49.8,,percent of total billed charges,,
Us Guide Bx Prostate,,76942,CPT,Facility,Inpatient,,,,1066,906.1,305.5156,1066,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Us Guide Bx Prostate,,76942,CPT,Facility,Both,,,,1066,906.1,305.5156,1066,"Multiplan, Inc.","Multiplan, Inc.",1002.04,94,,percent of total billed charges,,
Us Guide Bx Prostate,,76942,CPT,Facility,Outpatient,,,,1066,906.1,305.5156,1066,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,960.466,90.1,,percent of total billed charges,,
Us Guide Bx Prostate,,76942,CPT,Facility,Inpatient,,,,1066,906.1,305.5156,1066,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Us Guide Bx Prostate,,76942,CPT,Facility,Both,,,,1066,906.1,305.5156,1066,"Preferred One Administrative Services, INC.",PPO,1051.076,98.6,,percent of total billed charges,,
Us Guide Bx Prostate,,76942,CPT,Facility,Outpatient,,,,1066,906.1,305.5156,1066,PrimeWest Health,Minnesota Senior Health Options (MSHO),548.457,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Us Guide Bx Prostate,,76942,CPT,Facility,Inpatient,,,,1066,906.1,305.5156,1066,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Us Guide Bx Prostate,,76942,CPT,Facility,Outpatient,,,,1066,906.1,305.5156,1066,PrimeWest Health,MinnesotaCare,547.4976,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Us Guide Bx Prostate,,76942,CPT,Facility,Inpatient,,,,1066,906.1,305.5156,1066,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Us Guide Bx Prostate,,76942,CPT,Facility,Both,,,,1066,906.1,305.5156,1066,Sanford Health Plan,Sanford Health Plan,980.72,92,,percent of total billed charges,,
Us Guide Bx Prostate,,76942,CPT,Facility,Outpatient,,,,1066,906.1,305.5156,1066,"UCare Health, Inc.",Individual & Family Plan,600.691,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Us Guide Bx Prostate,,76942,CPT,Facility,Inpatient,,,,1066,906.1,305.5156,1066,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Us Guide Bx Prostate,,76942,CPT,Facility,Outpatient,,,,1066,906.1,305.5156,1066,"UCare Health, Inc.",Medical Assistance,538.0102,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Guide Bx Prostate,,76942,CPT,Facility,Inpatient,,,,1066,906.1,305.5156,1066,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Us Guide Bx Prostate,,76942,CPT,Facility,Outpatient,,,,1066,906.1,305.5156,1066,"UCare Health, Inc.",Medicare Advantage,538.0102,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Guide Bx Prostate,,76942,CPT,Facility,Inpatient,,,,1066,906.1,305.5156,1066,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Us Guide Bx Prostate,,76942,CPT,Facility,Outpatient,,,,1066,906.1,305.5156,1066,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),538.0102,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Guide Bx Prostate,,76942,CPT,Facility,Inpatient,,,,1066,906.1,305.5156,1066,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Us Guide Bx Prostate,,76942,CPT,Facility,Both,,,,1066,906.1,305.5156,1066,UnitedHealthcare,Individual & Family,1002.04,94,,percent of total billed charges,,
Us Guide Bx Prostate,,76942,CPT,Facility,Outpatient,,,,1066,906.1,305.5156,1066,UnitedHealthcare,Medicare Advantage,522.34,49,,percent of total billed charges,,
Us Guide Bx Prostate,,76942,CPT,Facility,Inpatient,,,,1066,906.1,305.5156,1066,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Us Guide Bx Prostate,,76942,CPT,Facility,Outpatient,,,,1066,906.1,305.5156,1066,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,511.68,48,,percent of total billed charges,,100% of DHS outpatient percentage
Us Guide Bx Prostate,,76942,CPT,Facility,Inpatient,,,,1066,906.1,305.5156,1066,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Ultrasound Intra Operative,,76998,CPT,Facility,Both,,,,1066,906.1,305.5156,1066,Aetna,Commercial,980.72,92,,percent of total billed charges,,
Ultrasound Intra Operative,,76998,CPT,Facility,Outpatient,,,,1066,906.1,305.5156,1066,Aetna,Medicare Advantage,522.34,49,,percent of total billed charges,,
Ultrasound Intra Operative,,76998,CPT,Facility,Inpatient,,,,1066,906.1,305.5156,1066,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Ultrasound Intra Operative,,76998,CPT,Facility,Both,,,,1066,906.1,305.5156,1066,Aetna,PPO,991.38,93,,percent of total billed charges,,
Ultrasound Intra Operative,,76998,CPT,Facility,Both,,,,1066,906.1,305.5156,1066,America's PPO,America's PPO,1023.6798,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Ultrasound Intra Operative,,76998,CPT,Facility,Both,,,,1066,906.1,305.5156,1066,BlueCross BlueShield Minnesota, Federal Employee Program,1048.944,98.4,,percent of total billed charges,,
Ultrasound Intra Operative,,76998,CPT,Facility,Both,,,,1066,906.1,305.5156,1066,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1066,100,,percent of total billed charges,,
Ultrasound Intra Operative,,76998,CPT,Facility,Both,,,,1066,906.1,305.5156,1066,BlueCross BlueShield Minnesota,High Value Network Plan,959.4,90,,percent of total billed charges,,
Ultrasound Intra Operative,,76998,CPT,Facility,Outpatient,,,,1066,906.1,305.5156,1066,BlueCross BlueShield Minnesota,Medicare Advantage,522.34,49,,percent of total billed charges,,
Ultrasound Intra Operative,,76998,CPT,Facility,Inpatient,,,,1066,906.1,305.5156,1066,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Ultrasound Intra Operative,,76998,CPT,Facility,Both,,,,1066,906.1,305.5156,1066,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,944.1562,88.57,,percent of total billed charges,,
Ultrasound Intra Operative,,76998,CPT,Facility,Both,,,,1066,906.1,305.5156,1066,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,305.5156,28.66,,percent of total billed charges,,
Ultrasound Intra Operative,,76998,CPT,Facility,Outpatient,,,,1066,906.1,305.5156,1066,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),522.34,49,,percent of total billed charges,,
Ultrasound Intra Operative,,76998,CPT,Facility,Inpatient,,,,1066,906.1,305.5156,1066,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Ultrasound Intra Operative,,76998,CPT,Facility,Both,,,,1066,906.1,305.5156,1066,CorVel,Worker's Compensation,1066,100,,percent of total billed charges,,
Ultrasound Intra Operative,,76998,CPT,Facility,Both,,,,1066,906.1,305.5156,1066,First Health Group Corporation,First Health Network,1034.02,97,,percent of total billed charges,,
Ultrasound Intra Operative,,76998,CPT,Facility,Both,,,,1066,906.1,305.5156,1066,"Health Partners, Inc.",Commercial,1008.436,94.6,,percent of total billed charges,,
Ultrasound Intra Operative,,76998,CPT,Facility,Outpatient,,,,1066,906.1,305.5156,1066,"Health Partners, Inc.",Medicare Advantage,522.34,49,,percent of total billed charges,,
Ultrasound Intra Operative,,76998,CPT,Facility,Inpatient,,,,1066,906.1,305.5156,1066,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ultrasound Intra Operative,,76998,CPT,Facility,Both,,,,1066,906.1,305.5156,1066,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),639.6,60,,percent of total billed charges,,
Ultrasound Intra Operative,,76998,CPT,Facility,Both,,,,1066,906.1,305.5156,1066,"Health Partners, Inc.",State of Minnesota Advantage Program,868.79,81.5,,percent of total billed charges,,
Ultrasound Intra Operative,,76998,CPT,Facility,Both,,,,1066,906.1,305.5156,1066,"Health Partners, Inc.",State Public Programs,533,50,,percent of total billed charges,,
Ultrasound Intra Operative,,76998,CPT,Facility,Both,,,,1066,906.1,305.5156,1066,Humana Insurance Company,Commercial PPO,1012.7,95,,percent of total billed charges,,
Ultrasound Intra Operative,,76998,CPT,Facility,Outpatient,,,,1066,906.1,305.5156,1066,Humana Insurance Company,Medicare PPO,522.34,49,,percent of total billed charges,,
Ultrasound Intra Operative,,76998,CPT,Facility,Inpatient,,,,1066,906.1,305.5156,1066,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Ultrasound Intra Operative,,76998,CPT,Facility,Both,,,,1066,906.1,305.5156,1066,Medica,Individual & Family,1056.406,99.1,,percent of total billed charges,,
Ultrasound Intra Operative,,76998,CPT,Facility,Outpatient,,,,1066,906.1,305.5156,1066,Medica,Medica Advantage Solution,530.868,49.8,,percent of total billed charges,,
Ultrasound Intra Operative,,76998,CPT,Facility,Inpatient,,,,1066,906.1,305.5156,1066,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Ultrasound Intra Operative,,76998,CPT,Facility,Outpatient,,,,1066,906.1,305.5156,1066,Medica,Medical Assistance,475.436,44.6,,percent of total billed charges,,
Ultrasound Intra Operative,,76998,CPT,Facility,Inpatient,,,,1066,906.1,305.5156,1066,Medica,Medical Assistance,,,,,Included in per diem rate,
Ultrasound Intra Operative,,76998,CPT,Facility,Outpatient,,,,1066,906.1,305.5156,1066,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,530.868,49.8,,percent of total billed charges,,
Ultrasound Intra Operative,,76998,CPT,Facility,Inpatient,,,,1066,906.1,305.5156,1066,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Ultrasound Intra Operative,,76998,CPT,Facility,Both,,,,1066,906.1,305.5156,1066,"Multiplan, Inc.","Multiplan, Inc.",1002.04,94,,percent of total billed charges,,
Ultrasound Intra Operative,,76998,CPT,Facility,Outpatient,,,,1066,906.1,305.5156,1066,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,960.466,90.1,,percent of total billed charges,,
Ultrasound Intra Operative,,76998,CPT,Facility,Inpatient,,,,1066,906.1,305.5156,1066,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Ultrasound Intra Operative,,76998,CPT,Facility,Both,,,,1066,906.1,305.5156,1066,"Preferred One Administrative Services, INC.",PPO,1051.076,98.6,,percent of total billed charges,,
Ultrasound Intra Operative,,76998,CPT,Facility,Outpatient,,,,1066,906.1,305.5156,1066,PrimeWest Health,Minnesota Senior Health Options (MSHO),548.457,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Ultrasound Intra Operative,,76998,CPT,Facility,Inpatient,,,,1066,906.1,305.5156,1066,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ultrasound Intra Operative,,76998,CPT,Facility,Outpatient,,,,1066,906.1,305.5156,1066,PrimeWest Health,MinnesotaCare,547.4976,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Ultrasound Intra Operative,,76998,CPT,Facility,Inpatient,,,,1066,906.1,305.5156,1066,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Ultrasound Intra Operative,,76998,CPT,Facility,Both,,,,1066,906.1,305.5156,1066,Sanford Health Plan,Sanford Health Plan,980.72,92,,percent of total billed charges,,
Ultrasound Intra Operative,,76998,CPT,Facility,Outpatient,,,,1066,906.1,305.5156,1066,"UCare Health, Inc.",Individual & Family Plan,600.691,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Ultrasound Intra Operative,,76998,CPT,Facility,Inpatient,,,,1066,906.1,305.5156,1066,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Ultrasound Intra Operative,,76998,CPT,Facility,Outpatient,,,,1066,906.1,305.5156,1066,"UCare Health, Inc.",Medical Assistance,538.0102,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ultrasound Intra Operative,,76998,CPT,Facility,Inpatient,,,,1066,906.1,305.5156,1066,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Ultrasound Intra Operative,,76998,CPT,Facility,Outpatient,,,,1066,906.1,305.5156,1066,"UCare Health, Inc.",Medicare Advantage,538.0102,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ultrasound Intra Operative,,76998,CPT,Facility,Inpatient,,,,1066,906.1,305.5156,1066,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ultrasound Intra Operative,,76998,CPT,Facility,Outpatient,,,,1066,906.1,305.5156,1066,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),538.0102,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ultrasound Intra Operative,,76998,CPT,Facility,Inpatient,,,,1066,906.1,305.5156,1066,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ultrasound Intra Operative,,76998,CPT,Facility,Both,,,,1066,906.1,305.5156,1066,UnitedHealthcare,Individual & Family,1002.04,94,,percent of total billed charges,,
Ultrasound Intra Operative,,76998,CPT,Facility,Outpatient,,,,1066,906.1,305.5156,1066,UnitedHealthcare,Medicare Advantage,522.34,49,,percent of total billed charges,,
Ultrasound Intra Operative,,76998,CPT,Facility,Inpatient,,,,1066,906.1,305.5156,1066,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Ultrasound Intra Operative,,76998,CPT,Facility,Outpatient,,,,1066,906.1,305.5156,1066,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,511.68,48,,percent of total billed charges,,100% of DHS outpatient percentage
Ultrasound Intra Operative,,76998,CPT,Facility,Inpatient,,,,1066,906.1,305.5156,1066,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Us Unlisted Diagnostic Exam,,76999,CPT,Facility,Both,,,,477,405.45,136.7082,477,Aetna,Commercial,438.84,92,,percent of total billed charges,,
Us Unlisted Diagnostic Exam,,76999,CPT,Facility,Outpatient,,,,477,405.45,136.7082,477,Aetna,Medicare Advantage,233.73,49,,percent of total billed charges,,
Us Unlisted Diagnostic Exam,,76999,CPT,Facility,Inpatient,,,,477,405.45,136.7082,477,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Us Unlisted Diagnostic Exam,,76999,CPT,Facility,Both,,,,477,405.45,136.7082,477,Aetna,PPO,443.61,93,,percent of total billed charges,,
Us Unlisted Diagnostic Exam,,76999,CPT,Facility,Both,,,,477,405.45,136.7082,477,America's PPO,America's PPO,458.0631,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Us Unlisted Diagnostic Exam,,76999,CPT,Facility,Both,,,,477,405.45,136.7082,477,BlueCross BlueShield Minnesota, Federal Employee Program,469.368,98.4,,percent of total billed charges,,
Us Unlisted Diagnostic Exam,,76999,CPT,Facility,Both,,,,477,405.45,136.7082,477,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,477,100,,percent of total billed charges,,
Us Unlisted Diagnostic Exam,,76999,CPT,Facility,Both,,,,477,405.45,136.7082,477,BlueCross BlueShield Minnesota,High Value Network Plan,429.3,90,,percent of total billed charges,,
Us Unlisted Diagnostic Exam,,76999,CPT,Facility,Outpatient,,,,477,405.45,136.7082,477,BlueCross BlueShield Minnesota,Medicare Advantage,233.73,49,,percent of total billed charges,,
Us Unlisted Diagnostic Exam,,76999,CPT,Facility,Inpatient,,,,477,405.45,136.7082,477,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Us Unlisted Diagnostic Exam,,76999,CPT,Facility,Both,,,,477,405.45,136.7082,477,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,422.4789,88.57,,percent of total billed charges,,
Us Unlisted Diagnostic Exam,,76999,CPT,Facility,Both,,,,477,405.45,136.7082,477,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,136.7082,28.66,,percent of total billed charges,,
Us Unlisted Diagnostic Exam,,76999,CPT,Facility,Outpatient,,,,477,405.45,136.7082,477,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),233.73,49,,percent of total billed charges,,
Us Unlisted Diagnostic Exam,,76999,CPT,Facility,Inpatient,,,,477,405.45,136.7082,477,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Us Unlisted Diagnostic Exam,,76999,CPT,Facility,Both,,,,477,405.45,136.7082,477,CorVel,Worker's Compensation,477,100,,percent of total billed charges,,
Us Unlisted Diagnostic Exam,,76999,CPT,Facility,Both,,,,477,405.45,136.7082,477,First Health Group Corporation,First Health Network,462.69,97,,percent of total billed charges,,
Us Unlisted Diagnostic Exam,,76999,CPT,Facility,Both,,,,477,405.45,136.7082,477,"Health Partners, Inc.",Commercial,451.242,94.6,,percent of total billed charges,,
Us Unlisted Diagnostic Exam,,76999,CPT,Facility,Outpatient,,,,477,405.45,136.7082,477,"Health Partners, Inc.",Medicare Advantage,233.73,49,,percent of total billed charges,,
Us Unlisted Diagnostic Exam,,76999,CPT,Facility,Inpatient,,,,477,405.45,136.7082,477,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Us Unlisted Diagnostic Exam,,76999,CPT,Facility,Both,,,,477,405.45,136.7082,477,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),286.2,60,,percent of total billed charges,,
Us Unlisted Diagnostic Exam,,76999,CPT,Facility,Both,,,,477,405.45,136.7082,477,"Health Partners, Inc.",State of Minnesota Advantage Program,388.755,81.5,,percent of total billed charges,,
Us Unlisted Diagnostic Exam,,76999,CPT,Facility,Both,,,,477,405.45,136.7082,477,"Health Partners, Inc.",State Public Programs,238.5,50,,percent of total billed charges,,
Us Unlisted Diagnostic Exam,,76999,CPT,Facility,Both,,,,477,405.45,136.7082,477,Humana Insurance Company,Commercial PPO,453.15,95,,percent of total billed charges,,
Us Unlisted Diagnostic Exam,,76999,CPT,Facility,Outpatient,,,,477,405.45,136.7082,477,Humana Insurance Company,Medicare PPO,233.73,49,,percent of total billed charges,,
Us Unlisted Diagnostic Exam,,76999,CPT,Facility,Inpatient,,,,477,405.45,136.7082,477,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Us Unlisted Diagnostic Exam,,76999,CPT,Facility,Both,,,,477,405.45,136.7082,477,Medica,Individual & Family,472.707,99.1,,percent of total billed charges,,
Us Unlisted Diagnostic Exam,,76999,CPT,Facility,Outpatient,,,,477,405.45,136.7082,477,Medica,Medica Advantage Solution,237.546,49.8,,percent of total billed charges,,
Us Unlisted Diagnostic Exam,,76999,CPT,Facility,Inpatient,,,,477,405.45,136.7082,477,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Us Unlisted Diagnostic Exam,,76999,CPT,Facility,Outpatient,,,,477,405.45,136.7082,477,Medica,Medical Assistance,212.742,44.6,,percent of total billed charges,,
Us Unlisted Diagnostic Exam,,76999,CPT,Facility,Inpatient,,,,477,405.45,136.7082,477,Medica,Medical Assistance,,,,,Included in per diem rate,
Us Unlisted Diagnostic Exam,,76999,CPT,Facility,Outpatient,,,,477,405.45,136.7082,477,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,237.546,49.8,,percent of total billed charges,,
Us Unlisted Diagnostic Exam,,76999,CPT,Facility,Inpatient,,,,477,405.45,136.7082,477,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Us Unlisted Diagnostic Exam,,76999,CPT,Facility,Both,,,,477,405.45,136.7082,477,"Multiplan, Inc.","Multiplan, Inc.",448.38,94,,percent of total billed charges,,
Us Unlisted Diagnostic Exam,,76999,CPT,Facility,Outpatient,,,,477,405.45,136.7082,477,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,429.777,90.1,,percent of total billed charges,,
Us Unlisted Diagnostic Exam,,76999,CPT,Facility,Inpatient,,,,477,405.45,136.7082,477,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Us Unlisted Diagnostic Exam,,76999,CPT,Facility,Both,,,,477,405.45,136.7082,477,"Preferred One Administrative Services, INC.",PPO,470.322,98.6,,percent of total billed charges,,
Us Unlisted Diagnostic Exam,,76999,CPT,Facility,Outpatient,,,,477,405.45,136.7082,477,PrimeWest Health,Minnesota Senior Health Options (MSHO),245.4165,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Us Unlisted Diagnostic Exam,,76999,CPT,Facility,Inpatient,,,,477,405.45,136.7082,477,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Us Unlisted Diagnostic Exam,,76999,CPT,Facility,Outpatient,,,,477,405.45,136.7082,477,PrimeWest Health,MinnesotaCare,244.9872,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Us Unlisted Diagnostic Exam,,76999,CPT,Facility,Inpatient,,,,477,405.45,136.7082,477,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Us Unlisted Diagnostic Exam,,76999,CPT,Facility,Both,,,,477,405.45,136.7082,477,Sanford Health Plan,Sanford Health Plan,438.84,92,,percent of total billed charges,,
Us Unlisted Diagnostic Exam,,76999,CPT,Facility,Outpatient,,,,477,405.45,136.7082,477,"UCare Health, Inc.",Individual & Family Plan,268.7895,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Us Unlisted Diagnostic Exam,,76999,CPT,Facility,Inpatient,,,,477,405.45,136.7082,477,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Us Unlisted Diagnostic Exam,,76999,CPT,Facility,Outpatient,,,,477,405.45,136.7082,477,"UCare Health, Inc.",Medical Assistance,240.7419,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Unlisted Diagnostic Exam,,76999,CPT,Facility,Inpatient,,,,477,405.45,136.7082,477,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Us Unlisted Diagnostic Exam,,76999,CPT,Facility,Outpatient,,,,477,405.45,136.7082,477,"UCare Health, Inc.",Medicare Advantage,240.7419,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Unlisted Diagnostic Exam,,76999,CPT,Facility,Inpatient,,,,477,405.45,136.7082,477,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Us Unlisted Diagnostic Exam,,76999,CPT,Facility,Outpatient,,,,477,405.45,136.7082,477,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),240.7419,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Unlisted Diagnostic Exam,,76999,CPT,Facility,Inpatient,,,,477,405.45,136.7082,477,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Us Unlisted Diagnostic Exam,,76999,CPT,Facility,Both,,,,477,405.45,136.7082,477,UnitedHealthcare,Individual & Family,448.38,94,,percent of total billed charges,,
Us Unlisted Diagnostic Exam,,76999,CPT,Facility,Outpatient,,,,477,405.45,136.7082,477,UnitedHealthcare,Medicare Advantage,233.73,49,,percent of total billed charges,,
Us Unlisted Diagnostic Exam,,76999,CPT,Facility,Inpatient,,,,477,405.45,136.7082,477,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Us Unlisted Diagnostic Exam,,76999,CPT,Facility,Outpatient,,,,477,405.45,136.7082,477,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,228.96,48,,percent of total billed charges,,100% of DHS outpatient percentage
Us Unlisted Diagnostic Exam,,76999,CPT,Facility,Inpatient,,,,477,405.45,136.7082,477,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Ir Venous Access Port Insertion,,77001,CPT,Facility,Both,,,,494,419.9,141.5804,494,Aetna,Commercial,454.48,92,,percent of total billed charges,,
Ir Venous Access Port Insertion,,77001,CPT,Facility,Outpatient,,,,494,419.9,141.5804,494,Aetna,Medicare Advantage,242.06,49,,percent of total billed charges,,
Ir Venous Access Port Insertion,,77001,CPT,Facility,Inpatient,,,,494,419.9,141.5804,494,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Ir Venous Access Port Insertion,,77001,CPT,Facility,Both,,,,494,419.9,141.5804,494,Aetna,PPO,459.42,93,,percent of total billed charges,,
Ir Venous Access Port Insertion,,77001,CPT,Facility,Both,,,,494,419.9,141.5804,494,America's PPO,America's PPO,474.3882,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Ir Venous Access Port Insertion,,77001,CPT,Facility,Both,,,,494,419.9,141.5804,494,BlueCross BlueShield Minnesota, Federal Employee Program,486.096,98.4,,percent of total billed charges,,
Ir Venous Access Port Insertion,,77001,CPT,Facility,Both,,,,494,419.9,141.5804,494,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,494,100,,percent of total billed charges,,
Ir Venous Access Port Insertion,,77001,CPT,Facility,Both,,,,494,419.9,141.5804,494,BlueCross BlueShield Minnesota,High Value Network Plan,444.6,90,,percent of total billed charges,,
Ir Venous Access Port Insertion,,77001,CPT,Facility,Outpatient,,,,494,419.9,141.5804,494,BlueCross BlueShield Minnesota,Medicare Advantage,242.06,49,,percent of total billed charges,,
Ir Venous Access Port Insertion,,77001,CPT,Facility,Inpatient,,,,494,419.9,141.5804,494,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Ir Venous Access Port Insertion,,77001,CPT,Facility,Both,,,,494,419.9,141.5804,494,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,437.5358,88.57,,percent of total billed charges,,
Ir Venous Access Port Insertion,,77001,CPT,Facility,Both,,,,494,419.9,141.5804,494,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,141.5804,28.66,,percent of total billed charges,,
Ir Venous Access Port Insertion,,77001,CPT,Facility,Outpatient,,,,494,419.9,141.5804,494,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),242.06,49,,percent of total billed charges,,
Ir Venous Access Port Insertion,,77001,CPT,Facility,Inpatient,,,,494,419.9,141.5804,494,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Ir Venous Access Port Insertion,,77001,CPT,Facility,Both,,,,494,419.9,141.5804,494,CorVel,Worker's Compensation,494,100,,percent of total billed charges,,
Ir Venous Access Port Insertion,,77001,CPT,Facility,Both,,,,494,419.9,141.5804,494,First Health Group Corporation,First Health Network,479.18,97,,percent of total billed charges,,
Ir Venous Access Port Insertion,,77001,CPT,Facility,Both,,,,494,419.9,141.5804,494,"Health Partners, Inc.",Commercial,467.324,94.6,,percent of total billed charges,,
Ir Venous Access Port Insertion,,77001,CPT,Facility,Outpatient,,,,494,419.9,141.5804,494,"Health Partners, Inc.",Medicare Advantage,242.06,49,,percent of total billed charges,,
Ir Venous Access Port Insertion,,77001,CPT,Facility,Inpatient,,,,494,419.9,141.5804,494,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ir Venous Access Port Insertion,,77001,CPT,Facility,Both,,,,494,419.9,141.5804,494,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),296.4,60,,percent of total billed charges,,
Ir Venous Access Port Insertion,,77001,CPT,Facility,Both,,,,494,419.9,141.5804,494,"Health Partners, Inc.",State of Minnesota Advantage Program,402.61,81.5,,percent of total billed charges,,
Ir Venous Access Port Insertion,,77001,CPT,Facility,Both,,,,494,419.9,141.5804,494,"Health Partners, Inc.",State Public Programs,247,50,,percent of total billed charges,,
Ir Venous Access Port Insertion,,77001,CPT,Facility,Both,,,,494,419.9,141.5804,494,Humana Insurance Company,Commercial PPO,469.3,95,,percent of total billed charges,,
Ir Venous Access Port Insertion,,77001,CPT,Facility,Outpatient,,,,494,419.9,141.5804,494,Humana Insurance Company,Medicare PPO,242.06,49,,percent of total billed charges,,
Ir Venous Access Port Insertion,,77001,CPT,Facility,Inpatient,,,,494,419.9,141.5804,494,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Ir Venous Access Port Insertion,,77001,CPT,Facility,Both,,,,494,419.9,141.5804,494,Medica,Individual & Family,489.554,99.1,,percent of total billed charges,,
Ir Venous Access Port Insertion,,77001,CPT,Facility,Outpatient,,,,494,419.9,141.5804,494,Medica,Medica Advantage Solution,246.012,49.8,,percent of total billed charges,,
Ir Venous Access Port Insertion,,77001,CPT,Facility,Inpatient,,,,494,419.9,141.5804,494,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Ir Venous Access Port Insertion,,77001,CPT,Facility,Outpatient,,,,494,419.9,141.5804,494,Medica,Medical Assistance,220.324,44.6,,percent of total billed charges,,
Ir Venous Access Port Insertion,,77001,CPT,Facility,Inpatient,,,,494,419.9,141.5804,494,Medica,Medical Assistance,,,,,Included in per diem rate,
Ir Venous Access Port Insertion,,77001,CPT,Facility,Outpatient,,,,494,419.9,141.5804,494,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,246.012,49.8,,percent of total billed charges,,
Ir Venous Access Port Insertion,,77001,CPT,Facility,Inpatient,,,,494,419.9,141.5804,494,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Ir Venous Access Port Insertion,,77001,CPT,Facility,Both,,,,494,419.9,141.5804,494,"Multiplan, Inc.","Multiplan, Inc.",464.36,94,,percent of total billed charges,,
Ir Venous Access Port Insertion,,77001,CPT,Facility,Outpatient,,,,494,419.9,141.5804,494,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,445.094,90.1,,percent of total billed charges,,
Ir Venous Access Port Insertion,,77001,CPT,Facility,Inpatient,,,,494,419.9,141.5804,494,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Ir Venous Access Port Insertion,,77001,CPT,Facility,Both,,,,494,419.9,141.5804,494,"Preferred One Administrative Services, INC.",PPO,487.084,98.6,,percent of total billed charges,,
Ir Venous Access Port Insertion,,77001,CPT,Facility,Outpatient,,,,494,419.9,141.5804,494,PrimeWest Health,Minnesota Senior Health Options (MSHO),254.163,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Ir Venous Access Port Insertion,,77001,CPT,Facility,Inpatient,,,,494,419.9,141.5804,494,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ir Venous Access Port Insertion,,77001,CPT,Facility,Outpatient,,,,494,419.9,141.5804,494,PrimeWest Health,MinnesotaCare,253.7184,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Ir Venous Access Port Insertion,,77001,CPT,Facility,Inpatient,,,,494,419.9,141.5804,494,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Ir Venous Access Port Insertion,,77001,CPT,Facility,Both,,,,494,419.9,141.5804,494,Sanford Health Plan,Sanford Health Plan,454.48,92,,percent of total billed charges,,
Ir Venous Access Port Insertion,,77001,CPT,Facility,Outpatient,,,,494,419.9,141.5804,494,"UCare Health, Inc.",Individual & Family Plan,278.369,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Ir Venous Access Port Insertion,,77001,CPT,Facility,Inpatient,,,,494,419.9,141.5804,494,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Ir Venous Access Port Insertion,,77001,CPT,Facility,Outpatient,,,,494,419.9,141.5804,494,"UCare Health, Inc.",Medical Assistance,249.3218,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ir Venous Access Port Insertion,,77001,CPT,Facility,Inpatient,,,,494,419.9,141.5804,494,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Ir Venous Access Port Insertion,,77001,CPT,Facility,Outpatient,,,,494,419.9,141.5804,494,"UCare Health, Inc.",Medicare Advantage,249.3218,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ir Venous Access Port Insertion,,77001,CPT,Facility,Inpatient,,,,494,419.9,141.5804,494,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ir Venous Access Port Insertion,,77001,CPT,Facility,Outpatient,,,,494,419.9,141.5804,494,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),249.3218,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ir Venous Access Port Insertion,,77001,CPT,Facility,Inpatient,,,,494,419.9,141.5804,494,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ir Venous Access Port Insertion,,77001,CPT,Facility,Both,,,,494,419.9,141.5804,494,UnitedHealthcare,Individual & Family,464.36,94,,percent of total billed charges,,
Ir Venous Access Port Insertion,,77001,CPT,Facility,Outpatient,,,,494,419.9,141.5804,494,UnitedHealthcare,Medicare Advantage,242.06,49,,percent of total billed charges,,
Ir Venous Access Port Insertion,,77001,CPT,Facility,Inpatient,,,,494,419.9,141.5804,494,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Ir Venous Access Port Insertion,,77001,CPT,Facility,Outpatient,,,,494,419.9,141.5804,494,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,237.12,48,,percent of total billed charges,,100% of DHS outpatient percentage
Ir Venous Access Port Insertion,,77001,CPT,Facility,Inpatient,,,,494,419.9,141.5804,494,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Xr Fluoro Guided Needle Biopsy Inj Asp,,77002,CPT,Facility,Both,,,,204,173.4,58.4664,204,Aetna,Commercial,187.68,92,,percent of total billed charges,,
Xr Fluoro Guided Needle Biopsy Inj Asp,,77002,CPT,Facility,Outpatient,,,,204,173.4,58.4664,204,Aetna,Medicare Advantage,99.96,49,,percent of total billed charges,,
Xr Fluoro Guided Needle Biopsy Inj Asp,,77002,CPT,Facility,Inpatient,,,,204,173.4,58.4664,204,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Xr Fluoro Guided Needle Biopsy Inj Asp,,77002,CPT,Facility,Both,,,,204,173.4,58.4664,204,Aetna,PPO,189.72,93,,percent of total billed charges,,
Xr Fluoro Guided Needle Biopsy Inj Asp,,77002,CPT,Facility,Both,,,,204,173.4,58.4664,204,America's PPO,America's PPO,195.9012,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Xr Fluoro Guided Needle Biopsy Inj Asp,,77002,CPT,Facility,Both,,,,204,173.4,58.4664,204,BlueCross BlueShield Minnesota, Federal Employee Program,200.736,98.4,,percent of total billed charges,,
Xr Fluoro Guided Needle Biopsy Inj Asp,,77002,CPT,Facility,Both,,,,204,173.4,58.4664,204,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,204,100,,percent of total billed charges,,
Xr Fluoro Guided Needle Biopsy Inj Asp,,77002,CPT,Facility,Both,,,,204,173.4,58.4664,204,BlueCross BlueShield Minnesota,High Value Network Plan,183.6,90,,percent of total billed charges,,
Xr Fluoro Guided Needle Biopsy Inj Asp,,77002,CPT,Facility,Outpatient,,,,204,173.4,58.4664,204,BlueCross BlueShield Minnesota,Medicare Advantage,99.96,49,,percent of total billed charges,,
Xr Fluoro Guided Needle Biopsy Inj Asp,,77002,CPT,Facility,Inpatient,,,,204,173.4,58.4664,204,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Xr Fluoro Guided Needle Biopsy Inj Asp,,77002,CPT,Facility,Both,,,,204,173.4,58.4664,204,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,180.6828,88.57,,percent of total billed charges,,
Xr Fluoro Guided Needle Biopsy Inj Asp,,77002,CPT,Facility,Both,,,,204,173.4,58.4664,204,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,58.4664,28.66,,percent of total billed charges,,
Xr Fluoro Guided Needle Biopsy Inj Asp,,77002,CPT,Facility,Outpatient,,,,204,173.4,58.4664,204,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),99.96,49,,percent of total billed charges,,
Xr Fluoro Guided Needle Biopsy Inj Asp,,77002,CPT,Facility,Inpatient,,,,204,173.4,58.4664,204,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Xr Fluoro Guided Needle Biopsy Inj Asp,,77002,CPT,Facility,Both,,,,204,173.4,58.4664,204,CorVel,Worker's Compensation,204,100,,percent of total billed charges,,
Xr Fluoro Guided Needle Biopsy Inj Asp,,77002,CPT,Facility,Both,,,,204,173.4,58.4664,204,First Health Group Corporation,First Health Network,197.88,97,,percent of total billed charges,,
Xr Fluoro Guided Needle Biopsy Inj Asp,,77002,CPT,Facility,Both,,,,204,173.4,58.4664,204,"Health Partners, Inc.",Commercial,192.984,94.6,,percent of total billed charges,,
Xr Fluoro Guided Needle Biopsy Inj Asp,,77002,CPT,Facility,Outpatient,,,,204,173.4,58.4664,204,"Health Partners, Inc.",Medicare Advantage,99.96,49,,percent of total billed charges,,
Xr Fluoro Guided Needle Biopsy Inj Asp,,77002,CPT,Facility,Inpatient,,,,204,173.4,58.4664,204,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Fluoro Guided Needle Biopsy Inj Asp,,77002,CPT,Facility,Both,,,,204,173.4,58.4664,204,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),122.4,60,,percent of total billed charges,,
Xr Fluoro Guided Needle Biopsy Inj Asp,,77002,CPT,Facility,Both,,,,204,173.4,58.4664,204,"Health Partners, Inc.",State of Minnesota Advantage Program,166.26,81.5,,percent of total billed charges,,
Xr Fluoro Guided Needle Biopsy Inj Asp,,77002,CPT,Facility,Both,,,,204,173.4,58.4664,204,"Health Partners, Inc.",State Public Programs,102,50,,percent of total billed charges,,
Xr Fluoro Guided Needle Biopsy Inj Asp,,77002,CPT,Facility,Both,,,,204,173.4,58.4664,204,Humana Insurance Company,Commercial PPO,193.8,95,,percent of total billed charges,,
Xr Fluoro Guided Needle Biopsy Inj Asp,,77002,CPT,Facility,Outpatient,,,,204,173.4,58.4664,204,Humana Insurance Company,Medicare PPO,99.96,49,,percent of total billed charges,,
Xr Fluoro Guided Needle Biopsy Inj Asp,,77002,CPT,Facility,Inpatient,,,,204,173.4,58.4664,204,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Xr Fluoro Guided Needle Biopsy Inj Asp,,77002,CPT,Facility,Both,,,,204,173.4,58.4664,204,Medica,Individual & Family,202.164,99.1,,percent of total billed charges,,
Xr Fluoro Guided Needle Biopsy Inj Asp,,77002,CPT,Facility,Outpatient,,,,204,173.4,58.4664,204,Medica,Medica Advantage Solution,101.592,49.8,,percent of total billed charges,,
Xr Fluoro Guided Needle Biopsy Inj Asp,,77002,CPT,Facility,Inpatient,,,,204,173.4,58.4664,204,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Xr Fluoro Guided Needle Biopsy Inj Asp,,77002,CPT,Facility,Outpatient,,,,204,173.4,58.4664,204,Medica,Medical Assistance,90.984,44.6,,percent of total billed charges,,
Xr Fluoro Guided Needle Biopsy Inj Asp,,77002,CPT,Facility,Inpatient,,,,204,173.4,58.4664,204,Medica,Medical Assistance,,,,,Included in per diem rate,
Xr Fluoro Guided Needle Biopsy Inj Asp,,77002,CPT,Facility,Outpatient,,,,204,173.4,58.4664,204,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,101.592,49.8,,percent of total billed charges,,
Xr Fluoro Guided Needle Biopsy Inj Asp,,77002,CPT,Facility,Inpatient,,,,204,173.4,58.4664,204,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Xr Fluoro Guided Needle Biopsy Inj Asp,,77002,CPT,Facility,Both,,,,204,173.4,58.4664,204,"Multiplan, Inc.","Multiplan, Inc.",191.76,94,,percent of total billed charges,,
Xr Fluoro Guided Needle Biopsy Inj Asp,,77002,CPT,Facility,Outpatient,,,,204,173.4,58.4664,204,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,183.804,90.1,,percent of total billed charges,,
Xr Fluoro Guided Needle Biopsy Inj Asp,,77002,CPT,Facility,Inpatient,,,,204,173.4,58.4664,204,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Xr Fluoro Guided Needle Biopsy Inj Asp,,77002,CPT,Facility,Both,,,,204,173.4,58.4664,204,"Preferred One Administrative Services, INC.",PPO,201.144,98.6,,percent of total billed charges,,
Xr Fluoro Guided Needle Biopsy Inj Asp,,77002,CPT,Facility,Outpatient,,,,204,173.4,58.4664,204,PrimeWest Health,Minnesota Senior Health Options (MSHO),104.958,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Xr Fluoro Guided Needle Biopsy Inj Asp,,77002,CPT,Facility,Inpatient,,,,204,173.4,58.4664,204,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Fluoro Guided Needle Biopsy Inj Asp,,77002,CPT,Facility,Outpatient,,,,204,173.4,58.4664,204,PrimeWest Health,MinnesotaCare,104.7744,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Xr Fluoro Guided Needle Biopsy Inj Asp,,77002,CPT,Facility,Inpatient,,,,204,173.4,58.4664,204,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Xr Fluoro Guided Needle Biopsy Inj Asp,,77002,CPT,Facility,Both,,,,204,173.4,58.4664,204,Sanford Health Plan,Sanford Health Plan,187.68,92,,percent of total billed charges,,
Xr Fluoro Guided Needle Biopsy Inj Asp,,77002,CPT,Facility,Outpatient,,,,204,173.4,58.4664,204,"UCare Health, Inc.",Individual & Family Plan,114.954,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Xr Fluoro Guided Needle Biopsy Inj Asp,,77002,CPT,Facility,Inpatient,,,,204,173.4,58.4664,204,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Xr Fluoro Guided Needle Biopsy Inj Asp,,77002,CPT,Facility,Outpatient,,,,204,173.4,58.4664,204,"UCare Health, Inc.",Medical Assistance,102.9588,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Fluoro Guided Needle Biopsy Inj Asp,,77002,CPT,Facility,Inpatient,,,,204,173.4,58.4664,204,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Xr Fluoro Guided Needle Biopsy Inj Asp,,77002,CPT,Facility,Outpatient,,,,204,173.4,58.4664,204,"UCare Health, Inc.",Medicare Advantage,102.9588,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Fluoro Guided Needle Biopsy Inj Asp,,77002,CPT,Facility,Inpatient,,,,204,173.4,58.4664,204,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Fluoro Guided Needle Biopsy Inj Asp,,77002,CPT,Facility,Outpatient,,,,204,173.4,58.4664,204,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),102.9588,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Fluoro Guided Needle Biopsy Inj Asp,,77002,CPT,Facility,Inpatient,,,,204,173.4,58.4664,204,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Fluoro Guided Needle Biopsy Inj Asp,,77002,CPT,Facility,Both,,,,204,173.4,58.4664,204,UnitedHealthcare,Individual & Family,191.76,94,,percent of total billed charges,,
Xr Fluoro Guided Needle Biopsy Inj Asp,,77002,CPT,Facility,Outpatient,,,,204,173.4,58.4664,204,UnitedHealthcare,Medicare Advantage,99.96,49,,percent of total billed charges,,
Xr Fluoro Guided Needle Biopsy Inj Asp,,77002,CPT,Facility,Inpatient,,,,204,173.4,58.4664,204,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Xr Fluoro Guided Needle Biopsy Inj Asp,,77002,CPT,Facility,Outpatient,,,,204,173.4,58.4664,204,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,97.92,48,,percent of total billed charges,,100% of DHS outpatient percentage
Xr Fluoro Guided Needle Biopsy Inj Asp,,77002,CPT,Facility,Inpatient,,,,204,173.4,58.4664,204,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Xr Lumbar Puncture,,77003,CPT,Facility,Both,,,,194,164.9,55.6004,194,Aetna,Commercial,178.48,92,,percent of total billed charges,,
Xr Lumbar Puncture,,77003,CPT,Facility,Outpatient,,,,194,164.9,55.6004,194,Aetna,Medicare Advantage,95.06,49,,percent of total billed charges,,
Xr Lumbar Puncture,,77003,CPT,Facility,Inpatient,,,,194,164.9,55.6004,194,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Xr Lumbar Puncture,,77003,CPT,Facility,Both,,,,194,164.9,55.6004,194,Aetna,PPO,180.42,93,,percent of total billed charges,,
Xr Lumbar Puncture,,77003,CPT,Facility,Both,,,,194,164.9,55.6004,194,America's PPO,America's PPO,186.2982,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Xr Lumbar Puncture,,77003,CPT,Facility,Both,,,,194,164.9,55.6004,194,BlueCross BlueShield Minnesota, Federal Employee Program,190.896,98.4,,percent of total billed charges,,
Xr Lumbar Puncture,,77003,CPT,Facility,Both,,,,194,164.9,55.6004,194,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,194,100,,percent of total billed charges,,
Xr Lumbar Puncture,,77003,CPT,Facility,Both,,,,194,164.9,55.6004,194,BlueCross BlueShield Minnesota,High Value Network Plan,174.6,90,,percent of total billed charges,,
Xr Lumbar Puncture,,77003,CPT,Facility,Outpatient,,,,194,164.9,55.6004,194,BlueCross BlueShield Minnesota,Medicare Advantage,95.06,49,,percent of total billed charges,,
Xr Lumbar Puncture,,77003,CPT,Facility,Inpatient,,,,194,164.9,55.6004,194,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Xr Lumbar Puncture,,77003,CPT,Facility,Both,,,,194,164.9,55.6004,194,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,171.8258,88.57,,percent of total billed charges,,
Xr Lumbar Puncture,,77003,CPT,Facility,Both,,,,194,164.9,55.6004,194,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,55.6004,28.66,,percent of total billed charges,,
Xr Lumbar Puncture,,77003,CPT,Facility,Outpatient,,,,194,164.9,55.6004,194,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),95.06,49,,percent of total billed charges,,
Xr Lumbar Puncture,,77003,CPT,Facility,Inpatient,,,,194,164.9,55.6004,194,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Xr Lumbar Puncture,,77003,CPT,Facility,Both,,,,194,164.9,55.6004,194,CorVel,Worker's Compensation,194,100,,percent of total billed charges,,
Xr Lumbar Puncture,,77003,CPT,Facility,Both,,,,194,164.9,55.6004,194,First Health Group Corporation,First Health Network,188.18,97,,percent of total billed charges,,
Xr Lumbar Puncture,,77003,CPT,Facility,Both,,,,194,164.9,55.6004,194,"Health Partners, Inc.",Commercial,183.524,94.6,,percent of total billed charges,,
Xr Lumbar Puncture,,77003,CPT,Facility,Outpatient,,,,194,164.9,55.6004,194,"Health Partners, Inc.",Medicare Advantage,95.06,49,,percent of total billed charges,,
Xr Lumbar Puncture,,77003,CPT,Facility,Inpatient,,,,194,164.9,55.6004,194,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Lumbar Puncture,,77003,CPT,Facility,Both,,,,194,164.9,55.6004,194,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),116.4,60,,percent of total billed charges,,
Xr Lumbar Puncture,,77003,CPT,Facility,Both,,,,194,164.9,55.6004,194,"Health Partners, Inc.",State of Minnesota Advantage Program,158.11,81.5,,percent of total billed charges,,
Xr Lumbar Puncture,,77003,CPT,Facility,Both,,,,194,164.9,55.6004,194,"Health Partners, Inc.",State Public Programs,97,50,,percent of total billed charges,,
Xr Lumbar Puncture,,77003,CPT,Facility,Both,,,,194,164.9,55.6004,194,Humana Insurance Company,Commercial PPO,184.3,95,,percent of total billed charges,,
Xr Lumbar Puncture,,77003,CPT,Facility,Outpatient,,,,194,164.9,55.6004,194,Humana Insurance Company,Medicare PPO,95.06,49,,percent of total billed charges,,
Xr Lumbar Puncture,,77003,CPT,Facility,Inpatient,,,,194,164.9,55.6004,194,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Xr Lumbar Puncture,,77003,CPT,Facility,Both,,,,194,164.9,55.6004,194,Medica,Individual & Family,192.254,99.1,,percent of total billed charges,,
Xr Lumbar Puncture,,77003,CPT,Facility,Outpatient,,,,194,164.9,55.6004,194,Medica,Medica Advantage Solution,96.612,49.8,,percent of total billed charges,,
Xr Lumbar Puncture,,77003,CPT,Facility,Inpatient,,,,194,164.9,55.6004,194,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Xr Lumbar Puncture,,77003,CPT,Facility,Outpatient,,,,194,164.9,55.6004,194,Medica,Medical Assistance,86.524,44.6,,percent of total billed charges,,
Xr Lumbar Puncture,,77003,CPT,Facility,Inpatient,,,,194,164.9,55.6004,194,Medica,Medical Assistance,,,,,Included in per diem rate,
Xr Lumbar Puncture,,77003,CPT,Facility,Outpatient,,,,194,164.9,55.6004,194,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,96.612,49.8,,percent of total billed charges,,
Xr Lumbar Puncture,,77003,CPT,Facility,Inpatient,,,,194,164.9,55.6004,194,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Xr Lumbar Puncture,,77003,CPT,Facility,Both,,,,194,164.9,55.6004,194,"Multiplan, Inc.","Multiplan, Inc.",182.36,94,,percent of total billed charges,,
Xr Lumbar Puncture,,77003,CPT,Facility,Outpatient,,,,194,164.9,55.6004,194,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,174.794,90.1,,percent of total billed charges,,
Xr Lumbar Puncture,,77003,CPT,Facility,Inpatient,,,,194,164.9,55.6004,194,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Xr Lumbar Puncture,,77003,CPT,Facility,Both,,,,194,164.9,55.6004,194,"Preferred One Administrative Services, INC.",PPO,191.284,98.6,,percent of total billed charges,,
Xr Lumbar Puncture,,77003,CPT,Facility,Outpatient,,,,194,164.9,55.6004,194,PrimeWest Health,Minnesota Senior Health Options (MSHO),99.813,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Xr Lumbar Puncture,,77003,CPT,Facility,Inpatient,,,,194,164.9,55.6004,194,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Lumbar Puncture,,77003,CPT,Facility,Outpatient,,,,194,164.9,55.6004,194,PrimeWest Health,MinnesotaCare,99.6384,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Xr Lumbar Puncture,,77003,CPT,Facility,Inpatient,,,,194,164.9,55.6004,194,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Xr Lumbar Puncture,,77003,CPT,Facility,Both,,,,194,164.9,55.6004,194,Sanford Health Plan,Sanford Health Plan,178.48,92,,percent of total billed charges,,
Xr Lumbar Puncture,,77003,CPT,Facility,Outpatient,,,,194,164.9,55.6004,194,"UCare Health, Inc.",Individual & Family Plan,109.319,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Xr Lumbar Puncture,,77003,CPT,Facility,Inpatient,,,,194,164.9,55.6004,194,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Xr Lumbar Puncture,,77003,CPT,Facility,Outpatient,,,,194,164.9,55.6004,194,"UCare Health, Inc.",Medical Assistance,97.9118,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Lumbar Puncture,,77003,CPT,Facility,Inpatient,,,,194,164.9,55.6004,194,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Xr Lumbar Puncture,,77003,CPT,Facility,Outpatient,,,,194,164.9,55.6004,194,"UCare Health, Inc.",Medicare Advantage,97.9118,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Lumbar Puncture,,77003,CPT,Facility,Inpatient,,,,194,164.9,55.6004,194,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Lumbar Puncture,,77003,CPT,Facility,Outpatient,,,,194,164.9,55.6004,194,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),97.9118,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Lumbar Puncture,,77003,CPT,Facility,Inpatient,,,,194,164.9,55.6004,194,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Lumbar Puncture,,77003,CPT,Facility,Both,,,,194,164.9,55.6004,194,UnitedHealthcare,Individual & Family,182.36,94,,percent of total billed charges,,
Xr Lumbar Puncture,,77003,CPT,Facility,Outpatient,,,,194,164.9,55.6004,194,UnitedHealthcare,Medicare Advantage,95.06,49,,percent of total billed charges,,
Xr Lumbar Puncture,,77003,CPT,Facility,Inpatient,,,,194,164.9,55.6004,194,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Xr Lumbar Puncture,,77003,CPT,Facility,Outpatient,,,,194,164.9,55.6004,194,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,93.12,48,,percent of total billed charges,,100% of DHS outpatient percentage
Xr Lumbar Puncture,,77003,CPT,Facility,Inpatient,,,,194,164.9,55.6004,194,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Xr Pre Ct Myelogram Injection,,77003,CPT,Facility,Both,,,,194,164.9,55.6004,194,Aetna,Commercial,178.48,92,,percent of total billed charges,,
Xr Pre Ct Myelogram Injection,,77003,CPT,Facility,Outpatient,,,,194,164.9,55.6004,194,Aetna,Medicare Advantage,95.06,49,,percent of total billed charges,,
Xr Pre Ct Myelogram Injection,,77003,CPT,Facility,Inpatient,,,,194,164.9,55.6004,194,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Xr Pre Ct Myelogram Injection,,77003,CPT,Facility,Both,,,,194,164.9,55.6004,194,Aetna,PPO,180.42,93,,percent of total billed charges,,
Xr Pre Ct Myelogram Injection,,77003,CPT,Facility,Both,,,,194,164.9,55.6004,194,America's PPO,America's PPO,186.2982,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Xr Pre Ct Myelogram Injection,,77003,CPT,Facility,Both,,,,194,164.9,55.6004,194,BlueCross BlueShield Minnesota, Federal Employee Program,190.896,98.4,,percent of total billed charges,,
Xr Pre Ct Myelogram Injection,,77003,CPT,Facility,Both,,,,194,164.9,55.6004,194,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,194,100,,percent of total billed charges,,
Xr Pre Ct Myelogram Injection,,77003,CPT,Facility,Both,,,,194,164.9,55.6004,194,BlueCross BlueShield Minnesota,High Value Network Plan,174.6,90,,percent of total billed charges,,
Xr Pre Ct Myelogram Injection,,77003,CPT,Facility,Outpatient,,,,194,164.9,55.6004,194,BlueCross BlueShield Minnesota,Medicare Advantage,95.06,49,,percent of total billed charges,,
Xr Pre Ct Myelogram Injection,,77003,CPT,Facility,Inpatient,,,,194,164.9,55.6004,194,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Xr Pre Ct Myelogram Injection,,77003,CPT,Facility,Both,,,,194,164.9,55.6004,194,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,171.8258,88.57,,percent of total billed charges,,
Xr Pre Ct Myelogram Injection,,77003,CPT,Facility,Both,,,,194,164.9,55.6004,194,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,55.6004,28.66,,percent of total billed charges,,
Xr Pre Ct Myelogram Injection,,77003,CPT,Facility,Outpatient,,,,194,164.9,55.6004,194,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),95.06,49,,percent of total billed charges,,
Xr Pre Ct Myelogram Injection,,77003,CPT,Facility,Inpatient,,,,194,164.9,55.6004,194,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Xr Pre Ct Myelogram Injection,,77003,CPT,Facility,Both,,,,194,164.9,55.6004,194,CorVel,Worker's Compensation,194,100,,percent of total billed charges,,
Xr Pre Ct Myelogram Injection,,77003,CPT,Facility,Both,,,,194,164.9,55.6004,194,First Health Group Corporation,First Health Network,188.18,97,,percent of total billed charges,,
Xr Pre Ct Myelogram Injection,,77003,CPT,Facility,Both,,,,194,164.9,55.6004,194,"Health Partners, Inc.",Commercial,183.524,94.6,,percent of total billed charges,,
Xr Pre Ct Myelogram Injection,,77003,CPT,Facility,Outpatient,,,,194,164.9,55.6004,194,"Health Partners, Inc.",Medicare Advantage,95.06,49,,percent of total billed charges,,
Xr Pre Ct Myelogram Injection,,77003,CPT,Facility,Inpatient,,,,194,164.9,55.6004,194,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Pre Ct Myelogram Injection,,77003,CPT,Facility,Both,,,,194,164.9,55.6004,194,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),116.4,60,,percent of total billed charges,,
Xr Pre Ct Myelogram Injection,,77003,CPT,Facility,Both,,,,194,164.9,55.6004,194,"Health Partners, Inc.",State of Minnesota Advantage Program,158.11,81.5,,percent of total billed charges,,
Xr Pre Ct Myelogram Injection,,77003,CPT,Facility,Both,,,,194,164.9,55.6004,194,"Health Partners, Inc.",State Public Programs,97,50,,percent of total billed charges,,
Xr Pre Ct Myelogram Injection,,77003,CPT,Facility,Both,,,,194,164.9,55.6004,194,Humana Insurance Company,Commercial PPO,184.3,95,,percent of total billed charges,,
Xr Pre Ct Myelogram Injection,,77003,CPT,Facility,Outpatient,,,,194,164.9,55.6004,194,Humana Insurance Company,Medicare PPO,95.06,49,,percent of total billed charges,,
Xr Pre Ct Myelogram Injection,,77003,CPT,Facility,Inpatient,,,,194,164.9,55.6004,194,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Xr Pre Ct Myelogram Injection,,77003,CPT,Facility,Both,,,,194,164.9,55.6004,194,Medica,Individual & Family,192.254,99.1,,percent of total billed charges,,
Xr Pre Ct Myelogram Injection,,77003,CPT,Facility,Outpatient,,,,194,164.9,55.6004,194,Medica,Medica Advantage Solution,96.612,49.8,,percent of total billed charges,,
Xr Pre Ct Myelogram Injection,,77003,CPT,Facility,Inpatient,,,,194,164.9,55.6004,194,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Xr Pre Ct Myelogram Injection,,77003,CPT,Facility,Outpatient,,,,194,164.9,55.6004,194,Medica,Medical Assistance,86.524,44.6,,percent of total billed charges,,
Xr Pre Ct Myelogram Injection,,77003,CPT,Facility,Inpatient,,,,194,164.9,55.6004,194,Medica,Medical Assistance,,,,,Included in per diem rate,
Xr Pre Ct Myelogram Injection,,77003,CPT,Facility,Outpatient,,,,194,164.9,55.6004,194,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,96.612,49.8,,percent of total billed charges,,
Xr Pre Ct Myelogram Injection,,77003,CPT,Facility,Inpatient,,,,194,164.9,55.6004,194,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Xr Pre Ct Myelogram Injection,,77003,CPT,Facility,Both,,,,194,164.9,55.6004,194,"Multiplan, Inc.","Multiplan, Inc.",182.36,94,,percent of total billed charges,,
Xr Pre Ct Myelogram Injection,,77003,CPT,Facility,Outpatient,,,,194,164.9,55.6004,194,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,174.794,90.1,,percent of total billed charges,,
Xr Pre Ct Myelogram Injection,,77003,CPT,Facility,Inpatient,,,,194,164.9,55.6004,194,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Xr Pre Ct Myelogram Injection,,77003,CPT,Facility,Both,,,,194,164.9,55.6004,194,"Preferred One Administrative Services, INC.",PPO,191.284,98.6,,percent of total billed charges,,
Xr Pre Ct Myelogram Injection,,77003,CPT,Facility,Outpatient,,,,194,164.9,55.6004,194,PrimeWest Health,Minnesota Senior Health Options (MSHO),99.813,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Xr Pre Ct Myelogram Injection,,77003,CPT,Facility,Inpatient,,,,194,164.9,55.6004,194,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Pre Ct Myelogram Injection,,77003,CPT,Facility,Outpatient,,,,194,164.9,55.6004,194,PrimeWest Health,MinnesotaCare,99.6384,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Xr Pre Ct Myelogram Injection,,77003,CPT,Facility,Inpatient,,,,194,164.9,55.6004,194,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Xr Pre Ct Myelogram Injection,,77003,CPT,Facility,Both,,,,194,164.9,55.6004,194,Sanford Health Plan,Sanford Health Plan,178.48,92,,percent of total billed charges,,
Xr Pre Ct Myelogram Injection,,77003,CPT,Facility,Outpatient,,,,194,164.9,55.6004,194,"UCare Health, Inc.",Individual & Family Plan,109.319,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Xr Pre Ct Myelogram Injection,,77003,CPT,Facility,Inpatient,,,,194,164.9,55.6004,194,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Xr Pre Ct Myelogram Injection,,77003,CPT,Facility,Outpatient,,,,194,164.9,55.6004,194,"UCare Health, Inc.",Medical Assistance,97.9118,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Pre Ct Myelogram Injection,,77003,CPT,Facility,Inpatient,,,,194,164.9,55.6004,194,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Xr Pre Ct Myelogram Injection,,77003,CPT,Facility,Outpatient,,,,194,164.9,55.6004,194,"UCare Health, Inc.",Medicare Advantage,97.9118,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Pre Ct Myelogram Injection,,77003,CPT,Facility,Inpatient,,,,194,164.9,55.6004,194,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Pre Ct Myelogram Injection,,77003,CPT,Facility,Outpatient,,,,194,164.9,55.6004,194,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),97.9118,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Pre Ct Myelogram Injection,,77003,CPT,Facility,Inpatient,,,,194,164.9,55.6004,194,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Pre Ct Myelogram Injection,,77003,CPT,Facility,Both,,,,194,164.9,55.6004,194,UnitedHealthcare,Individual & Family,182.36,94,,percent of total billed charges,,
Xr Pre Ct Myelogram Injection,,77003,CPT,Facility,Outpatient,,,,194,164.9,55.6004,194,UnitedHealthcare,Medicare Advantage,95.06,49,,percent of total billed charges,,
Xr Pre Ct Myelogram Injection,,77003,CPT,Facility,Inpatient,,,,194,164.9,55.6004,194,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Xr Pre Ct Myelogram Injection,,77003,CPT,Facility,Outpatient,,,,194,164.9,55.6004,194,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,93.12,48,,percent of total billed charges,,100% of DHS outpatient percentage
Xr Pre Ct Myelogram Injection,,77003,CPT,Facility,Inpatient,,,,194,164.9,55.6004,194,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Mammo Tomosyn Diag Bil,,77062,CPT,Facility,Both,,,,60,51,17.196,60,Aetna,Commercial,55.2,92,,percent of total billed charges,,
Mammo Tomosyn Diag Bil,,77062,CPT,Facility,Outpatient,,,,60,51,17.196,60,Aetna,Medicare Advantage,29.4,49,,percent of total billed charges,,
Mammo Tomosyn Diag Bil,,77062,CPT,Facility,Inpatient,,,,60,51,17.196,60,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Mammo Tomosyn Diag Bil,,77062,CPT,Facility,Both,,,,60,51,17.196,60,Aetna,PPO,55.8,93,,percent of total billed charges,,
Mammo Tomosyn Diag Bil,,77062,CPT,Facility,Both,,,,60,51,17.196,60,America's PPO,America's PPO,57.618,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Mammo Tomosyn Diag Bil,,77062,CPT,Facility,Both,,,,60,51,17.196,60,BlueCross BlueShield Minnesota, Federal Employee Program,59.04,98.4,,percent of total billed charges,,
Mammo Tomosyn Diag Bil,,77062,CPT,Facility,Both,,,,60,51,17.196,60,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,60,100,,percent of total billed charges,,
Mammo Tomosyn Diag Bil,,77062,CPT,Facility,Both,,,,60,51,17.196,60,BlueCross BlueShield Minnesota,High Value Network Plan,54,90,,percent of total billed charges,,
Mammo Tomosyn Diag Bil,,77062,CPT,Facility,Outpatient,,,,60,51,17.196,60,BlueCross BlueShield Minnesota,Medicare Advantage,29.4,49,,percent of total billed charges,,
Mammo Tomosyn Diag Bil,,77062,CPT,Facility,Inpatient,,,,60,51,17.196,60,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Mammo Tomosyn Diag Bil,,77062,CPT,Facility,Both,,,,60,51,17.196,60,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,53.142,88.57,,percent of total billed charges,,
Mammo Tomosyn Diag Bil,,77062,CPT,Facility,Both,,,,60,51,17.196,60,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,17.196,28.66,,percent of total billed charges,,
Mammo Tomosyn Diag Bil,,77062,CPT,Facility,Outpatient,,,,60,51,17.196,60,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),29.4,49,,percent of total billed charges,,
Mammo Tomosyn Diag Bil,,77062,CPT,Facility,Inpatient,,,,60,51,17.196,60,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Mammo Tomosyn Diag Bil,,77062,CPT,Facility,Both,,,,60,51,17.196,60,CorVel,Worker's Compensation,60,100,,percent of total billed charges,,
Mammo Tomosyn Diag Bil,,77062,CPT,Facility,Both,,,,60,51,17.196,60,First Health Group Corporation,First Health Network,58.2,97,,percent of total billed charges,,
Mammo Tomosyn Diag Bil,,77062,CPT,Facility,Both,,,,60,51,17.196,60,"Health Partners, Inc.",Commercial,56.76,94.6,,percent of total billed charges,,
Mammo Tomosyn Diag Bil,,77062,CPT,Facility,Outpatient,,,,60,51,17.196,60,"Health Partners, Inc.",Medicare Advantage,29.4,49,,percent of total billed charges,,
Mammo Tomosyn Diag Bil,,77062,CPT,Facility,Inpatient,,,,60,51,17.196,60,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mammo Tomosyn Diag Bil,,77062,CPT,Facility,Both,,,,60,51,17.196,60,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),36,60,,percent of total billed charges,,
Mammo Tomosyn Diag Bil,,77062,CPT,Facility,Both,,,,60,51,17.196,60,"Health Partners, Inc.",State of Minnesota Advantage Program,48.9,81.5,,percent of total billed charges,,
Mammo Tomosyn Diag Bil,,77062,CPT,Facility,Both,,,,60,51,17.196,60,"Health Partners, Inc.",State Public Programs,30,50,,percent of total billed charges,,
Mammo Tomosyn Diag Bil,,77062,CPT,Facility,Both,,,,60,51,17.196,60,Humana Insurance Company,Commercial PPO,57,95,,percent of total billed charges,,
Mammo Tomosyn Diag Bil,,77062,CPT,Facility,Outpatient,,,,60,51,17.196,60,Humana Insurance Company,Medicare PPO,29.4,49,,percent of total billed charges,,
Mammo Tomosyn Diag Bil,,77062,CPT,Facility,Inpatient,,,,60,51,17.196,60,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Mammo Tomosyn Diag Bil,,77062,CPT,Facility,Both,,,,60,51,17.196,60,Medica,Individual & Family,59.46,99.1,,percent of total billed charges,,
Mammo Tomosyn Diag Bil,,77062,CPT,Facility,Outpatient,,,,60,51,17.196,60,Medica,Medica Advantage Solution,29.88,49.8,,percent of total billed charges,,
Mammo Tomosyn Diag Bil,,77062,CPT,Facility,Inpatient,,,,60,51,17.196,60,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Mammo Tomosyn Diag Bil,,77062,CPT,Facility,Outpatient,,,,60,51,17.196,60,Medica,Medical Assistance,26.76,44.6,,percent of total billed charges,,
Mammo Tomosyn Diag Bil,,77062,CPT,Facility,Inpatient,,,,60,51,17.196,60,Medica,Medical Assistance,,,,,Included in per diem rate,
Mammo Tomosyn Diag Bil,,77062,CPT,Facility,Outpatient,,,,60,51,17.196,60,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,29.88,49.8,,percent of total billed charges,,
Mammo Tomosyn Diag Bil,,77062,CPT,Facility,Inpatient,,,,60,51,17.196,60,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Mammo Tomosyn Diag Bil,,77062,CPT,Facility,Both,,,,60,51,17.196,60,"Multiplan, Inc.","Multiplan, Inc.",56.4,94,,percent of total billed charges,,
Mammo Tomosyn Diag Bil,,77062,CPT,Facility,Outpatient,,,,60,51,17.196,60,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,54.06,90.1,,percent of total billed charges,,
Mammo Tomosyn Diag Bil,,77062,CPT,Facility,Inpatient,,,,60,51,17.196,60,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Mammo Tomosyn Diag Bil,,77062,CPT,Facility,Both,,,,60,51,17.196,60,"Preferred One Administrative Services, INC.",PPO,59.16,98.6,,percent of total billed charges,,
Mammo Tomosyn Diag Bil,,77062,CPT,Facility,Outpatient,,,,60,51,17.196,60,PrimeWest Health,Minnesota Senior Health Options (MSHO),30.87,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Mammo Tomosyn Diag Bil,,77062,CPT,Facility,Inpatient,,,,60,51,17.196,60,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mammo Tomosyn Diag Bil,,77062,CPT,Facility,Outpatient,,,,60,51,17.196,60,PrimeWest Health,MinnesotaCare,30.816,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Mammo Tomosyn Diag Bil,,77062,CPT,Facility,Inpatient,,,,60,51,17.196,60,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Mammo Tomosyn Diag Bil,,77062,CPT,Facility,Both,,,,60,51,17.196,60,Sanford Health Plan,Sanford Health Plan,55.2,92,,percent of total billed charges,,
Mammo Tomosyn Diag Bil,,77062,CPT,Facility,Outpatient,,,,60,51,17.196,60,"UCare Health, Inc.",Individual & Family Plan,33.81,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Mammo Tomosyn Diag Bil,,77062,CPT,Facility,Inpatient,,,,60,51,17.196,60,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Mammo Tomosyn Diag Bil,,77062,CPT,Facility,Outpatient,,,,60,51,17.196,60,"UCare Health, Inc.",Medical Assistance,30.282,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mammo Tomosyn Diag Bil,,77062,CPT,Facility,Inpatient,,,,60,51,17.196,60,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Mammo Tomosyn Diag Bil,,77062,CPT,Facility,Outpatient,,,,60,51,17.196,60,"UCare Health, Inc.",Medicare Advantage,30.282,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mammo Tomosyn Diag Bil,,77062,CPT,Facility,Inpatient,,,,60,51,17.196,60,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mammo Tomosyn Diag Bil,,77062,CPT,Facility,Outpatient,,,,60,51,17.196,60,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),30.282,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mammo Tomosyn Diag Bil,,77062,CPT,Facility,Inpatient,,,,60,51,17.196,60,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mammo Tomosyn Diag Bil,,77062,CPT,Facility,Both,,,,60,51,17.196,60,UnitedHealthcare,Individual & Family,56.4,94,,percent of total billed charges,,
Mammo Tomosyn Diag Bil,,77062,CPT,Facility,Outpatient,,,,60,51,17.196,60,UnitedHealthcare,Medicare Advantage,29.4,49,,percent of total billed charges,,
Mammo Tomosyn Diag Bil,,77062,CPT,Facility,Inpatient,,,,60,51,17.196,60,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Mammo Tomosyn Diag Bil,,77062,CPT,Facility,Outpatient,,,,60,51,17.196,60,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,28.8,48,,percent of total billed charges,,100% of DHS outpatient percentage
Mammo Tomosyn Diag Bil,,77062,CPT,Facility,Inpatient,,,,60,51,17.196,60,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Mammo Tomosyn Scrn Bil,,77063,CPT,Facility,Both,,,,60,51,26.76,152.4,Aetna,Commercial,55.2,92,,percent of total billed charges,,
Mammo Tomosyn Scrn Bil,,77063,CPT,Facility,Outpatient,,,,60,51,26.76,152.4,Aetna,Medicare Advantage,29.4,49,,percent of total billed charges,,
Mammo Tomosyn Scrn Bil,,77063,CPT,Facility,Inpatient,,,,60,51,26.76,152.4,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Mammo Tomosyn Scrn Bil,,77063,CPT,Facility,Both,,,,60,51,26.76,152.4,Aetna,PPO,55.8,93,,percent of total billed charges,,
Mammo Tomosyn Scrn Bil,,77063,CPT,Facility,Both,,,,60,51,26.76,152.4,America's PPO,America's PPO,57.618,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Mammo Tomosyn Scrn Bil,,77063,CPT,Facility,Both,,,,60,51,26.76,152.4,BlueCross BlueShield Minnesota, Federal Employee Program,150,,,Fee schedule,,100% of BCBS commercial commodity fee schedule
Mammo Tomosyn Scrn Bil,,77063,CPT,Facility,Both,,,,60,51,26.76,152.4,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,152.4,,,Fee schedule,,"100% of BCBS commercial commodity fee schedule, plus MN Care tax"
Mammo Tomosyn Scrn Bil,,77063,CPT,Facility,Both,,,,60,51,26.76,152.4,BlueCross BlueShield Minnesota,High Value Network Plan,137.16,,,Fee schedule,,"90% of BCBS commercial commodity fee schedule, plus MN Care tax; see disclaimer for more information"
Mammo Tomosyn Scrn Bil,,77063,CPT,Facility,Outpatient,,,,60,51,26.76,152.4,BlueCross BlueShield Minnesota,Medicare Advantage,29.4,49,,percent of total billed charges,,
Mammo Tomosyn Scrn Bil,,77063,CPT,Facility,Inpatient,,,,60,51,26.76,152.4,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Mammo Tomosyn Scrn Bil,,77063,CPT,Facility,Both,,,,60,51,26.76,152.4,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,134.98068,,,Fee schedule,,"88.57% of BCBS commercial commodity fee schedule, plus MN Care tax"
Mammo Tomosyn Scrn Bil,,77063,CPT,Facility,Both,,,,60,51,26.76,152.4,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,76.2,,,Fee schedule,,"100% of BCBS Medicaid commodity fee schedule, plus MN Care tax"
Mammo Tomosyn Scrn Bil,,77063,CPT,Facility,Outpatient,,,,60,51,26.76,152.4,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),29.4,49,,percent of total billed charges,,
Mammo Tomosyn Scrn Bil,,77063,CPT,Facility,Inpatient,,,,60,51,26.76,152.4,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Mammo Tomosyn Scrn Bil,,77063,CPT,Facility,Both,,,,60,51,26.76,152.4,CorVel,Worker's Compensation,60,100,,percent of total billed charges,,
Mammo Tomosyn Scrn Bil,,77063,CPT,Facility,Both,,,,60,51,26.76,152.4,First Health Group Corporation,First Health Network,58.2,97,,percent of total billed charges,,
Mammo Tomosyn Scrn Bil,,77063,CPT,Facility,Both,,,,60,51,26.76,152.4,"Health Partners, Inc.",Commercial,56.76,94.6,,percent of total billed charges,,
Mammo Tomosyn Scrn Bil,,77063,CPT,Facility,Outpatient,,,,60,51,26.76,152.4,"Health Partners, Inc.",Medicare Advantage,29.4,49,,percent of total billed charges,,
Mammo Tomosyn Scrn Bil,,77063,CPT,Facility,Inpatient,,,,60,51,26.76,152.4,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mammo Tomosyn Scrn Bil,,77063,CPT,Facility,Both,,,,60,51,26.76,152.4,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),36,60,,percent of total billed charges,,
Mammo Tomosyn Scrn Bil,,77063,CPT,Facility,Both,,,,60,51,26.76,152.4,"Health Partners, Inc.",State of Minnesota Advantage Program,48.9,81.5,,percent of total billed charges,,
Mammo Tomosyn Scrn Bil,,77063,CPT,Facility,Both,,,,60,51,26.76,152.4,"Health Partners, Inc.",State Public Programs,30,50,,percent of total billed charges,,
Mammo Tomosyn Scrn Bil,,77063,CPT,Facility,Both,,,,60,51,26.76,152.4,Humana Insurance Company,Commercial PPO,57,95,,percent of total billed charges,,
Mammo Tomosyn Scrn Bil,,77063,CPT,Facility,Outpatient,,,,60,51,26.76,152.4,Humana Insurance Company,Medicare PPO,29.4,49,,percent of total billed charges,,
Mammo Tomosyn Scrn Bil,,77063,CPT,Facility,Inpatient,,,,60,51,26.76,152.4,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Mammo Tomosyn Scrn Bil,,77063,CPT,Facility,Both,,,,60,51,26.76,152.4,Medica,Individual & Family,59.46,99.1,,percent of total billed charges,,
Mammo Tomosyn Scrn Bil,,77063,CPT,Facility,Outpatient,,,,60,51,26.76,152.4,Medica,Medica Advantage Solution,29.88,49.8,,percent of total billed charges,,
Mammo Tomosyn Scrn Bil,,77063,CPT,Facility,Inpatient,,,,60,51,26.76,152.4,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Mammo Tomosyn Scrn Bil,,77063,CPT,Facility,Outpatient,,,,60,51,26.76,152.4,Medica,Medical Assistance,26.76,44.6,,percent of total billed charges,,
Mammo Tomosyn Scrn Bil,,77063,CPT,Facility,Inpatient,,,,60,51,26.76,152.4,Medica,Medical Assistance,,,,,Included in per diem rate,
Mammo Tomosyn Scrn Bil,,77063,CPT,Facility,Outpatient,,,,60,51,26.76,152.4,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,29.88,49.8,,percent of total billed charges,,
Mammo Tomosyn Scrn Bil,,77063,CPT,Facility,Inpatient,,,,60,51,26.76,152.4,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Mammo Tomosyn Scrn Bil,,77063,CPT,Facility,Both,,,,60,51,26.76,152.4,"Multiplan, Inc.","Multiplan, Inc.",56.4,94,,percent of total billed charges,,
Mammo Tomosyn Scrn Bil,,77063,CPT,Facility,Outpatient,,,,60,51,26.76,152.4,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,54.06,90.1,,percent of total billed charges,,
Mammo Tomosyn Scrn Bil,,77063,CPT,Facility,Inpatient,,,,60,51,26.76,152.4,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Mammo Tomosyn Scrn Bil,,77063,CPT,Facility,Both,,,,60,51,26.76,152.4,"Preferred One Administrative Services, INC.",PPO,59.16,98.6,,percent of total billed charges,,
Mammo Tomosyn Scrn Bil,,77063,CPT,Facility,Outpatient,,,,60,51,26.76,152.4,PrimeWest Health,Minnesota Senior Health Options (MSHO),30.87,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Mammo Tomosyn Scrn Bil,,77063,CPT,Facility,Inpatient,,,,60,51,26.76,152.4,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mammo Tomosyn Scrn Bil,,77063,CPT,Facility,Outpatient,,,,60,51,26.76,152.4,PrimeWest Health,MinnesotaCare,30.816,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Mammo Tomosyn Scrn Bil,,77063,CPT,Facility,Inpatient,,,,60,51,26.76,152.4,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Mammo Tomosyn Scrn Bil,,77063,CPT,Facility,Both,,,,60,51,26.76,152.4,Sanford Health Plan,Sanford Health Plan,55.2,92,,percent of total billed charges,,
Mammo Tomosyn Scrn Bil,,77063,CPT,Facility,Outpatient,,,,60,51,26.76,152.4,"UCare Health, Inc.",Individual & Family Plan,33.81,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Mammo Tomosyn Scrn Bil,,77063,CPT,Facility,Inpatient,,,,60,51,26.76,152.4,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Mammo Tomosyn Scrn Bil,,77063,CPT,Facility,Outpatient,,,,60,51,26.76,152.4,"UCare Health, Inc.",Medical Assistance,30.282,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mammo Tomosyn Scrn Bil,,77063,CPT,Facility,Inpatient,,,,60,51,26.76,152.4,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Mammo Tomosyn Scrn Bil,,77063,CPT,Facility,Outpatient,,,,60,51,26.76,152.4,"UCare Health, Inc.",Medicare Advantage,30.282,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mammo Tomosyn Scrn Bil,,77063,CPT,Facility,Inpatient,,,,60,51,26.76,152.4,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mammo Tomosyn Scrn Bil,,77063,CPT,Facility,Outpatient,,,,60,51,26.76,152.4,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),30.282,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mammo Tomosyn Scrn Bil,,77063,CPT,Facility,Inpatient,,,,60,51,26.76,152.4,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mammo Tomosyn Scrn Bil,,77063,CPT,Facility,Both,,,,60,51,26.76,152.4,UnitedHealthcare,Individual & Family,56.4,94,,percent of total billed charges,,
Mammo Tomosyn Scrn Bil,,77063,CPT,Facility,Outpatient,,,,60,51,26.76,152.4,UnitedHealthcare,Medicare Advantage,29.4,49,,percent of total billed charges,,
Mammo Tomosyn Scrn Bil,,77063,CPT,Facility,Inpatient,,,,60,51,26.76,152.4,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Mammo Tomosyn Scrn Bil,,77063,CPT,Facility,Outpatient,,,,60,51,26.76,152.4,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,28.8,48,,percent of total billed charges,,100% of DHS outpatient percentage
Mammo Tomosyn Scrn Bil,,77063,CPT,Facility,Inpatient,,,,60,51,26.76,152.4,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Mammo Diag Uni,,77065,CPT,Facility,Both,,,,464,394.4,132.9824,464,Aetna,Commercial,426.88,92,,percent of total billed charges,,
Mammo Diag Uni,,77065,CPT,Facility,Outpatient,,,,464,394.4,132.9824,464,Aetna,Medicare Advantage,227.36,49,,percent of total billed charges,,
Mammo Diag Uni,,77065,CPT,Facility,Inpatient,,,,464,394.4,132.9824,464,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Mammo Diag Uni,,77065,CPT,Facility,Both,,,,464,394.4,132.9824,464,Aetna,PPO,431.52,93,,percent of total billed charges,,
Mammo Diag Uni,,77065,CPT,Facility,Both,,,,464,394.4,132.9824,464,America's PPO,America's PPO,445.5792,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Mammo Diag Uni,,77065,CPT,Facility,Both,,,,464,394.4,132.9824,464,BlueCross BlueShield Minnesota, Federal Employee Program,456.576,98.4,,percent of total billed charges,,
Mammo Diag Uni,,77065,CPT,Facility,Both,,,,464,394.4,132.9824,464,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,464,100,,percent of total billed charges,,
Mammo Diag Uni,,77065,CPT,Facility,Both,,,,464,394.4,132.9824,464,BlueCross BlueShield Minnesota,High Value Network Plan,417.6,90,,percent of total billed charges,,
Mammo Diag Uni,,77065,CPT,Facility,Outpatient,,,,464,394.4,132.9824,464,BlueCross BlueShield Minnesota,Medicare Advantage,227.36,49,,percent of total billed charges,,
Mammo Diag Uni,,77065,CPT,Facility,Inpatient,,,,464,394.4,132.9824,464,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Mammo Diag Uni,,77065,CPT,Facility,Both,,,,464,394.4,132.9824,464,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,410.9648,88.57,,percent of total billed charges,,
Mammo Diag Uni,,77065,CPT,Facility,Both,,,,464,394.4,132.9824,464,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,132.9824,28.66,,percent of total billed charges,,
Mammo Diag Uni,,77065,CPT,Facility,Outpatient,,,,464,394.4,132.9824,464,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),227.36,49,,percent of total billed charges,,
Mammo Diag Uni,,77065,CPT,Facility,Inpatient,,,,464,394.4,132.9824,464,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Mammo Diag Uni,,77065,CPT,Facility,Both,,,,464,394.4,132.9824,464,CorVel,Worker's Compensation,464,100,,percent of total billed charges,,
Mammo Diag Uni,,77065,CPT,Facility,Both,,,,464,394.4,132.9824,464,First Health Group Corporation,First Health Network,450.08,97,,percent of total billed charges,,
Mammo Diag Uni,,77065,CPT,Facility,Both,,,,464,394.4,132.9824,464,"Health Partners, Inc.",Commercial,438.944,94.6,,percent of total billed charges,,
Mammo Diag Uni,,77065,CPT,Facility,Outpatient,,,,464,394.4,132.9824,464,"Health Partners, Inc.",Medicare Advantage,227.36,49,,percent of total billed charges,,
Mammo Diag Uni,,77065,CPT,Facility,Inpatient,,,,464,394.4,132.9824,464,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mammo Diag Uni,,77065,CPT,Facility,Both,,,,464,394.4,132.9824,464,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),278.4,60,,percent of total billed charges,,
Mammo Diag Uni,,77065,CPT,Facility,Both,,,,464,394.4,132.9824,464,"Health Partners, Inc.",State of Minnesota Advantage Program,378.16,81.5,,percent of total billed charges,,
Mammo Diag Uni,,77065,CPT,Facility,Both,,,,464,394.4,132.9824,464,"Health Partners, Inc.",State Public Programs,232,50,,percent of total billed charges,,
Mammo Diag Uni,,77065,CPT,Facility,Both,,,,464,394.4,132.9824,464,Humana Insurance Company,Commercial PPO,440.8,95,,percent of total billed charges,,
Mammo Diag Uni,,77065,CPT,Facility,Outpatient,,,,464,394.4,132.9824,464,Humana Insurance Company,Medicare PPO,227.36,49,,percent of total billed charges,,
Mammo Diag Uni,,77065,CPT,Facility,Inpatient,,,,464,394.4,132.9824,464,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Mammo Diag Uni,,77065,CPT,Facility,Both,,,,464,394.4,132.9824,464,Medica,Individual & Family,459.824,99.1,,percent of total billed charges,,
Mammo Diag Uni,,77065,CPT,Facility,Outpatient,,,,464,394.4,132.9824,464,Medica,Medica Advantage Solution,231.072,49.8,,percent of total billed charges,,
Mammo Diag Uni,,77065,CPT,Facility,Inpatient,,,,464,394.4,132.9824,464,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Mammo Diag Uni,,77065,CPT,Facility,Outpatient,,,,464,394.4,132.9824,464,Medica,Medical Assistance,206.944,44.6,,percent of total billed charges,,
Mammo Diag Uni,,77065,CPT,Facility,Inpatient,,,,464,394.4,132.9824,464,Medica,Medical Assistance,,,,,Included in per diem rate,
Mammo Diag Uni,,77065,CPT,Facility,Outpatient,,,,464,394.4,132.9824,464,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,231.072,49.8,,percent of total billed charges,,
Mammo Diag Uni,,77065,CPT,Facility,Inpatient,,,,464,394.4,132.9824,464,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Mammo Diag Uni,,77065,CPT,Facility,Both,,,,464,394.4,132.9824,464,"Multiplan, Inc.","Multiplan, Inc.",436.16,94,,percent of total billed charges,,
Mammo Diag Uni,,77065,CPT,Facility,Outpatient,,,,464,394.4,132.9824,464,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,418.064,90.1,,percent of total billed charges,,
Mammo Diag Uni,,77065,CPT,Facility,Inpatient,,,,464,394.4,132.9824,464,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Mammo Diag Uni,,77065,CPT,Facility,Both,,,,464,394.4,132.9824,464,"Preferred One Administrative Services, INC.",PPO,457.504,98.6,,percent of total billed charges,,
Mammo Diag Uni,,77065,CPT,Facility,Outpatient,,,,464,394.4,132.9824,464,PrimeWest Health,Minnesota Senior Health Options (MSHO),238.728,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Mammo Diag Uni,,77065,CPT,Facility,Inpatient,,,,464,394.4,132.9824,464,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mammo Diag Uni,,77065,CPT,Facility,Outpatient,,,,464,394.4,132.9824,464,PrimeWest Health,MinnesotaCare,238.3104,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Mammo Diag Uni,,77065,CPT,Facility,Inpatient,,,,464,394.4,132.9824,464,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Mammo Diag Uni,,77065,CPT,Facility,Both,,,,464,394.4,132.9824,464,Sanford Health Plan,Sanford Health Plan,426.88,92,,percent of total billed charges,,
Mammo Diag Uni,,77065,CPT,Facility,Outpatient,,,,464,394.4,132.9824,464,"UCare Health, Inc.",Individual & Family Plan,261.464,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Mammo Diag Uni,,77065,CPT,Facility,Inpatient,,,,464,394.4,132.9824,464,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Mammo Diag Uni,,77065,CPT,Facility,Outpatient,,,,464,394.4,132.9824,464,"UCare Health, Inc.",Medical Assistance,234.1808,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mammo Diag Uni,,77065,CPT,Facility,Inpatient,,,,464,394.4,132.9824,464,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Mammo Diag Uni,,77065,CPT,Facility,Outpatient,,,,464,394.4,132.9824,464,"UCare Health, Inc.",Medicare Advantage,234.1808,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mammo Diag Uni,,77065,CPT,Facility,Inpatient,,,,464,394.4,132.9824,464,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mammo Diag Uni,,77065,CPT,Facility,Outpatient,,,,464,394.4,132.9824,464,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),234.1808,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mammo Diag Uni,,77065,CPT,Facility,Inpatient,,,,464,394.4,132.9824,464,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mammo Diag Uni,,77065,CPT,Facility,Both,,,,464,394.4,132.9824,464,UnitedHealthcare,Individual & Family,436.16,94,,percent of total billed charges,,
Mammo Diag Uni,,77065,CPT,Facility,Outpatient,,,,464,394.4,132.9824,464,UnitedHealthcare,Medicare Advantage,227.36,49,,percent of total billed charges,,
Mammo Diag Uni,,77065,CPT,Facility,Inpatient,,,,464,394.4,132.9824,464,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Mammo Diag Uni,,77065,CPT,Facility,Outpatient,,,,464,394.4,132.9824,464,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,222.72,48,,percent of total billed charges,,100% of DHS outpatient percentage
Mammo Diag Uni,,77065,CPT,Facility,Inpatient,,,,464,394.4,132.9824,464,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Mammo Diag W Implants Uni,,77065,CPT,Facility,Both,,,,464,394.4,132.9824,464,Aetna,Commercial,426.88,92,,percent of total billed charges,,
Mammo Diag W Implants Uni,,77065,CPT,Facility,Outpatient,,,,464,394.4,132.9824,464,Aetna,Medicare Advantage,227.36,49,,percent of total billed charges,,
Mammo Diag W Implants Uni,,77065,CPT,Facility,Inpatient,,,,464,394.4,132.9824,464,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Mammo Diag W Implants Uni,,77065,CPT,Facility,Both,,,,464,394.4,132.9824,464,Aetna,PPO,431.52,93,,percent of total billed charges,,
Mammo Diag W Implants Uni,,77065,CPT,Facility,Both,,,,464,394.4,132.9824,464,America's PPO,America's PPO,445.5792,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Mammo Diag W Implants Uni,,77065,CPT,Facility,Both,,,,464,394.4,132.9824,464,BlueCross BlueShield Minnesota, Federal Employee Program,456.576,98.4,,percent of total billed charges,,
Mammo Diag W Implants Uni,,77065,CPT,Facility,Both,,,,464,394.4,132.9824,464,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,464,100,,percent of total billed charges,,
Mammo Diag W Implants Uni,,77065,CPT,Facility,Both,,,,464,394.4,132.9824,464,BlueCross BlueShield Minnesota,High Value Network Plan,417.6,90,,percent of total billed charges,,
Mammo Diag W Implants Uni,,77065,CPT,Facility,Outpatient,,,,464,394.4,132.9824,464,BlueCross BlueShield Minnesota,Medicare Advantage,227.36,49,,percent of total billed charges,,
Mammo Diag W Implants Uni,,77065,CPT,Facility,Inpatient,,,,464,394.4,132.9824,464,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Mammo Diag W Implants Uni,,77065,CPT,Facility,Both,,,,464,394.4,132.9824,464,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,410.9648,88.57,,percent of total billed charges,,
Mammo Diag W Implants Uni,,77065,CPT,Facility,Both,,,,464,394.4,132.9824,464,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,132.9824,28.66,,percent of total billed charges,,
Mammo Diag W Implants Uni,,77065,CPT,Facility,Outpatient,,,,464,394.4,132.9824,464,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),227.36,49,,percent of total billed charges,,
Mammo Diag W Implants Uni,,77065,CPT,Facility,Inpatient,,,,464,394.4,132.9824,464,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Mammo Diag W Implants Uni,,77065,CPT,Facility,Both,,,,464,394.4,132.9824,464,CorVel,Worker's Compensation,464,100,,percent of total billed charges,,
Mammo Diag W Implants Uni,,77065,CPT,Facility,Both,,,,464,394.4,132.9824,464,First Health Group Corporation,First Health Network,450.08,97,,percent of total billed charges,,
Mammo Diag W Implants Uni,,77065,CPT,Facility,Both,,,,464,394.4,132.9824,464,"Health Partners, Inc.",Commercial,438.944,94.6,,percent of total billed charges,,
Mammo Diag W Implants Uni,,77065,CPT,Facility,Outpatient,,,,464,394.4,132.9824,464,"Health Partners, Inc.",Medicare Advantage,227.36,49,,percent of total billed charges,,
Mammo Diag W Implants Uni,,77065,CPT,Facility,Inpatient,,,,464,394.4,132.9824,464,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mammo Diag W Implants Uni,,77065,CPT,Facility,Both,,,,464,394.4,132.9824,464,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),278.4,60,,percent of total billed charges,,
Mammo Diag W Implants Uni,,77065,CPT,Facility,Both,,,,464,394.4,132.9824,464,"Health Partners, Inc.",State of Minnesota Advantage Program,378.16,81.5,,percent of total billed charges,,
Mammo Diag W Implants Uni,,77065,CPT,Facility,Both,,,,464,394.4,132.9824,464,"Health Partners, Inc.",State Public Programs,232,50,,percent of total billed charges,,
Mammo Diag W Implants Uni,,77065,CPT,Facility,Both,,,,464,394.4,132.9824,464,Humana Insurance Company,Commercial PPO,440.8,95,,percent of total billed charges,,
Mammo Diag W Implants Uni,,77065,CPT,Facility,Outpatient,,,,464,394.4,132.9824,464,Humana Insurance Company,Medicare PPO,227.36,49,,percent of total billed charges,,
Mammo Diag W Implants Uni,,77065,CPT,Facility,Inpatient,,,,464,394.4,132.9824,464,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Mammo Diag W Implants Uni,,77065,CPT,Facility,Both,,,,464,394.4,132.9824,464,Medica,Individual & Family,459.824,99.1,,percent of total billed charges,,
Mammo Diag W Implants Uni,,77065,CPT,Facility,Outpatient,,,,464,394.4,132.9824,464,Medica,Medica Advantage Solution,231.072,49.8,,percent of total billed charges,,
Mammo Diag W Implants Uni,,77065,CPT,Facility,Inpatient,,,,464,394.4,132.9824,464,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Mammo Diag W Implants Uni,,77065,CPT,Facility,Outpatient,,,,464,394.4,132.9824,464,Medica,Medical Assistance,206.944,44.6,,percent of total billed charges,,
Mammo Diag W Implants Uni,,77065,CPT,Facility,Inpatient,,,,464,394.4,132.9824,464,Medica,Medical Assistance,,,,,Included in per diem rate,
Mammo Diag W Implants Uni,,77065,CPT,Facility,Outpatient,,,,464,394.4,132.9824,464,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,231.072,49.8,,percent of total billed charges,,
Mammo Diag W Implants Uni,,77065,CPT,Facility,Inpatient,,,,464,394.4,132.9824,464,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Mammo Diag W Implants Uni,,77065,CPT,Facility,Both,,,,464,394.4,132.9824,464,"Multiplan, Inc.","Multiplan, Inc.",436.16,94,,percent of total billed charges,,
Mammo Diag W Implants Uni,,77065,CPT,Facility,Outpatient,,,,464,394.4,132.9824,464,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,418.064,90.1,,percent of total billed charges,,
Mammo Diag W Implants Uni,,77065,CPT,Facility,Inpatient,,,,464,394.4,132.9824,464,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Mammo Diag W Implants Uni,,77065,CPT,Facility,Both,,,,464,394.4,132.9824,464,"Preferred One Administrative Services, INC.",PPO,457.504,98.6,,percent of total billed charges,,
Mammo Diag W Implants Uni,,77065,CPT,Facility,Outpatient,,,,464,394.4,132.9824,464,PrimeWest Health,Minnesota Senior Health Options (MSHO),238.728,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Mammo Diag W Implants Uni,,77065,CPT,Facility,Inpatient,,,,464,394.4,132.9824,464,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mammo Diag W Implants Uni,,77065,CPT,Facility,Outpatient,,,,464,394.4,132.9824,464,PrimeWest Health,MinnesotaCare,238.3104,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Mammo Diag W Implants Uni,,77065,CPT,Facility,Inpatient,,,,464,394.4,132.9824,464,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Mammo Diag W Implants Uni,,77065,CPT,Facility,Both,,,,464,394.4,132.9824,464,Sanford Health Plan,Sanford Health Plan,426.88,92,,percent of total billed charges,,
Mammo Diag W Implants Uni,,77065,CPT,Facility,Outpatient,,,,464,394.4,132.9824,464,"UCare Health, Inc.",Individual & Family Plan,261.464,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Mammo Diag W Implants Uni,,77065,CPT,Facility,Inpatient,,,,464,394.4,132.9824,464,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Mammo Diag W Implants Uni,,77065,CPT,Facility,Outpatient,,,,464,394.4,132.9824,464,"UCare Health, Inc.",Medical Assistance,234.1808,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mammo Diag W Implants Uni,,77065,CPT,Facility,Inpatient,,,,464,394.4,132.9824,464,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Mammo Diag W Implants Uni,,77065,CPT,Facility,Outpatient,,,,464,394.4,132.9824,464,"UCare Health, Inc.",Medicare Advantage,234.1808,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mammo Diag W Implants Uni,,77065,CPT,Facility,Inpatient,,,,464,394.4,132.9824,464,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mammo Diag W Implants Uni,,77065,CPT,Facility,Outpatient,,,,464,394.4,132.9824,464,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),234.1808,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mammo Diag W Implants Uni,,77065,CPT,Facility,Inpatient,,,,464,394.4,132.9824,464,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mammo Diag W Implants Uni,,77065,CPT,Facility,Both,,,,464,394.4,132.9824,464,UnitedHealthcare,Individual & Family,436.16,94,,percent of total billed charges,,
Mammo Diag W Implants Uni,,77065,CPT,Facility,Outpatient,,,,464,394.4,132.9824,464,UnitedHealthcare,Medicare Advantage,227.36,49,,percent of total billed charges,,
Mammo Diag W Implants Uni,,77065,CPT,Facility,Inpatient,,,,464,394.4,132.9824,464,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Mammo Diag W Implants Uni,,77065,CPT,Facility,Outpatient,,,,464,394.4,132.9824,464,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,222.72,48,,percent of total billed charges,,100% of DHS outpatient percentage
Mammo Diag W Implants Uni,,77065,CPT,Facility,Inpatient,,,,464,394.4,132.9824,464,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Mammo Sage Diag Uni,,77065,CPT,Facility,Both,,,,464,394.4,132.9824,464,Aetna,Commercial,426.88,92,,percent of total billed charges,,
Mammo Sage Diag Uni,,77065,CPT,Facility,Outpatient,,,,464,394.4,132.9824,464,Aetna,Medicare Advantage,227.36,49,,percent of total billed charges,,
Mammo Sage Diag Uni,,77065,CPT,Facility,Inpatient,,,,464,394.4,132.9824,464,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Mammo Sage Diag Uni,,77065,CPT,Facility,Both,,,,464,394.4,132.9824,464,Aetna,PPO,431.52,93,,percent of total billed charges,,
Mammo Sage Diag Uni,,77065,CPT,Facility,Both,,,,464,394.4,132.9824,464,America's PPO,America's PPO,445.5792,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Mammo Sage Diag Uni,,77065,CPT,Facility,Both,,,,464,394.4,132.9824,464,BlueCross BlueShield Minnesota, Federal Employee Program,456.576,98.4,,percent of total billed charges,,
Mammo Sage Diag Uni,,77065,CPT,Facility,Both,,,,464,394.4,132.9824,464,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,464,100,,percent of total billed charges,,
Mammo Sage Diag Uni,,77065,CPT,Facility,Both,,,,464,394.4,132.9824,464,BlueCross BlueShield Minnesota,High Value Network Plan,417.6,90,,percent of total billed charges,,
Mammo Sage Diag Uni,,77065,CPT,Facility,Outpatient,,,,464,394.4,132.9824,464,BlueCross BlueShield Minnesota,Medicare Advantage,227.36,49,,percent of total billed charges,,
Mammo Sage Diag Uni,,77065,CPT,Facility,Inpatient,,,,464,394.4,132.9824,464,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Mammo Sage Diag Uni,,77065,CPT,Facility,Both,,,,464,394.4,132.9824,464,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,410.9648,88.57,,percent of total billed charges,,
Mammo Sage Diag Uni,,77065,CPT,Facility,Both,,,,464,394.4,132.9824,464,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,132.9824,28.66,,percent of total billed charges,,
Mammo Sage Diag Uni,,77065,CPT,Facility,Outpatient,,,,464,394.4,132.9824,464,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),227.36,49,,percent of total billed charges,,
Mammo Sage Diag Uni,,77065,CPT,Facility,Inpatient,,,,464,394.4,132.9824,464,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Mammo Sage Diag Uni,,77065,CPT,Facility,Both,,,,464,394.4,132.9824,464,CorVel,Worker's Compensation,464,100,,percent of total billed charges,,
Mammo Sage Diag Uni,,77065,CPT,Facility,Both,,,,464,394.4,132.9824,464,First Health Group Corporation,First Health Network,450.08,97,,percent of total billed charges,,
Mammo Sage Diag Uni,,77065,CPT,Facility,Both,,,,464,394.4,132.9824,464,"Health Partners, Inc.",Commercial,438.944,94.6,,percent of total billed charges,,
Mammo Sage Diag Uni,,77065,CPT,Facility,Outpatient,,,,464,394.4,132.9824,464,"Health Partners, Inc.",Medicare Advantage,227.36,49,,percent of total billed charges,,
Mammo Sage Diag Uni,,77065,CPT,Facility,Inpatient,,,,464,394.4,132.9824,464,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mammo Sage Diag Uni,,77065,CPT,Facility,Both,,,,464,394.4,132.9824,464,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),278.4,60,,percent of total billed charges,,
Mammo Sage Diag Uni,,77065,CPT,Facility,Both,,,,464,394.4,132.9824,464,"Health Partners, Inc.",State of Minnesota Advantage Program,378.16,81.5,,percent of total billed charges,,
Mammo Sage Diag Uni,,77065,CPT,Facility,Both,,,,464,394.4,132.9824,464,"Health Partners, Inc.",State Public Programs,232,50,,percent of total billed charges,,
Mammo Sage Diag Uni,,77065,CPT,Facility,Both,,,,464,394.4,132.9824,464,Humana Insurance Company,Commercial PPO,440.8,95,,percent of total billed charges,,
Mammo Sage Diag Uni,,77065,CPT,Facility,Outpatient,,,,464,394.4,132.9824,464,Humana Insurance Company,Medicare PPO,227.36,49,,percent of total billed charges,,
Mammo Sage Diag Uni,,77065,CPT,Facility,Inpatient,,,,464,394.4,132.9824,464,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Mammo Sage Diag Uni,,77065,CPT,Facility,Both,,,,464,394.4,132.9824,464,Medica,Individual & Family,459.824,99.1,,percent of total billed charges,,
Mammo Sage Diag Uni,,77065,CPT,Facility,Outpatient,,,,464,394.4,132.9824,464,Medica,Medica Advantage Solution,231.072,49.8,,percent of total billed charges,,
Mammo Sage Diag Uni,,77065,CPT,Facility,Inpatient,,,,464,394.4,132.9824,464,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Mammo Sage Diag Uni,,77065,CPT,Facility,Outpatient,,,,464,394.4,132.9824,464,Medica,Medical Assistance,206.944,44.6,,percent of total billed charges,,
Mammo Sage Diag Uni,,77065,CPT,Facility,Inpatient,,,,464,394.4,132.9824,464,Medica,Medical Assistance,,,,,Included in per diem rate,
Mammo Sage Diag Uni,,77065,CPT,Facility,Outpatient,,,,464,394.4,132.9824,464,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,231.072,49.8,,percent of total billed charges,,
Mammo Sage Diag Uni,,77065,CPT,Facility,Inpatient,,,,464,394.4,132.9824,464,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Mammo Sage Diag Uni,,77065,CPT,Facility,Both,,,,464,394.4,132.9824,464,"Multiplan, Inc.","Multiplan, Inc.",436.16,94,,percent of total billed charges,,
Mammo Sage Diag Uni,,77065,CPT,Facility,Outpatient,,,,464,394.4,132.9824,464,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,418.064,90.1,,percent of total billed charges,,
Mammo Sage Diag Uni,,77065,CPT,Facility,Inpatient,,,,464,394.4,132.9824,464,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Mammo Sage Diag Uni,,77065,CPT,Facility,Both,,,,464,394.4,132.9824,464,"Preferred One Administrative Services, INC.",PPO,457.504,98.6,,percent of total billed charges,,
Mammo Sage Diag Uni,,77065,CPT,Facility,Outpatient,,,,464,394.4,132.9824,464,PrimeWest Health,Minnesota Senior Health Options (MSHO),238.728,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Mammo Sage Diag Uni,,77065,CPT,Facility,Inpatient,,,,464,394.4,132.9824,464,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mammo Sage Diag Uni,,77065,CPT,Facility,Outpatient,,,,464,394.4,132.9824,464,PrimeWest Health,MinnesotaCare,238.3104,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Mammo Sage Diag Uni,,77065,CPT,Facility,Inpatient,,,,464,394.4,132.9824,464,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Mammo Sage Diag Uni,,77065,CPT,Facility,Both,,,,464,394.4,132.9824,464,Sanford Health Plan,Sanford Health Plan,426.88,92,,percent of total billed charges,,
Mammo Sage Diag Uni,,77065,CPT,Facility,Outpatient,,,,464,394.4,132.9824,464,"UCare Health, Inc.",Individual & Family Plan,261.464,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Mammo Sage Diag Uni,,77065,CPT,Facility,Inpatient,,,,464,394.4,132.9824,464,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Mammo Sage Diag Uni,,77065,CPT,Facility,Outpatient,,,,464,394.4,132.9824,464,"UCare Health, Inc.",Medical Assistance,234.1808,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mammo Sage Diag Uni,,77065,CPT,Facility,Inpatient,,,,464,394.4,132.9824,464,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Mammo Sage Diag Uni,,77065,CPT,Facility,Outpatient,,,,464,394.4,132.9824,464,"UCare Health, Inc.",Medicare Advantage,234.1808,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mammo Sage Diag Uni,,77065,CPT,Facility,Inpatient,,,,464,394.4,132.9824,464,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mammo Sage Diag Uni,,77065,CPT,Facility,Outpatient,,,,464,394.4,132.9824,464,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),234.1808,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mammo Sage Diag Uni,,77065,CPT,Facility,Inpatient,,,,464,394.4,132.9824,464,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mammo Sage Diag Uni,,77065,CPT,Facility,Both,,,,464,394.4,132.9824,464,UnitedHealthcare,Individual & Family,436.16,94,,percent of total billed charges,,
Mammo Sage Diag Uni,,77065,CPT,Facility,Outpatient,,,,464,394.4,132.9824,464,UnitedHealthcare,Medicare Advantage,227.36,49,,percent of total billed charges,,
Mammo Sage Diag Uni,,77065,CPT,Facility,Inpatient,,,,464,394.4,132.9824,464,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Mammo Sage Diag Uni,,77065,CPT,Facility,Outpatient,,,,464,394.4,132.9824,464,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,222.72,48,,percent of total billed charges,,100% of DHS outpatient percentage
Mammo Sage Diag Uni,,77065,CPT,Facility,Inpatient,,,,464,394.4,132.9824,464,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Mammo Baseline Diag Bil,,77066,CPT,Facility,Both,,,,566,481.1,162.2156,566,Aetna,Commercial,520.72,92,,percent of total billed charges,,
Mammo Baseline Diag Bil,,77066,CPT,Facility,Outpatient,,,,566,481.1,162.2156,566,Aetna,Medicare Advantage,277.34,49,,percent of total billed charges,,
Mammo Baseline Diag Bil,,77066,CPT,Facility,Inpatient,,,,566,481.1,162.2156,566,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Mammo Baseline Diag Bil,,77066,CPT,Facility,Both,,,,566,481.1,162.2156,566,Aetna,PPO,526.38,93,,percent of total billed charges,,
Mammo Baseline Diag Bil,,77066,CPT,Facility,Both,,,,566,481.1,162.2156,566,America's PPO,America's PPO,543.5298,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Mammo Baseline Diag Bil,,77066,CPT,Facility,Both,,,,566,481.1,162.2156,566,BlueCross BlueShield Minnesota, Federal Employee Program,556.944,98.4,,percent of total billed charges,,
Mammo Baseline Diag Bil,,77066,CPT,Facility,Both,,,,566,481.1,162.2156,566,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,566,100,,percent of total billed charges,,
Mammo Baseline Diag Bil,,77066,CPT,Facility,Both,,,,566,481.1,162.2156,566,BlueCross BlueShield Minnesota,High Value Network Plan,509.4,90,,percent of total billed charges,,
Mammo Baseline Diag Bil,,77066,CPT,Facility,Outpatient,,,,566,481.1,162.2156,566,BlueCross BlueShield Minnesota,Medicare Advantage,277.34,49,,percent of total billed charges,,
Mammo Baseline Diag Bil,,77066,CPT,Facility,Inpatient,,,,566,481.1,162.2156,566,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Mammo Baseline Diag Bil,,77066,CPT,Facility,Both,,,,566,481.1,162.2156,566,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,501.3062,88.57,,percent of total billed charges,,
Mammo Baseline Diag Bil,,77066,CPT,Facility,Both,,,,566,481.1,162.2156,566,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,162.2156,28.66,,percent of total billed charges,,
Mammo Baseline Diag Bil,,77066,CPT,Facility,Outpatient,,,,566,481.1,162.2156,566,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),277.34,49,,percent of total billed charges,,
Mammo Baseline Diag Bil,,77066,CPT,Facility,Inpatient,,,,566,481.1,162.2156,566,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Mammo Baseline Diag Bil,,77066,CPT,Facility,Both,,,,566,481.1,162.2156,566,CorVel,Worker's Compensation,566,100,,percent of total billed charges,,
Mammo Baseline Diag Bil,,77066,CPT,Facility,Both,,,,566,481.1,162.2156,566,First Health Group Corporation,First Health Network,549.02,97,,percent of total billed charges,,
Mammo Baseline Diag Bil,,77066,CPT,Facility,Both,,,,566,481.1,162.2156,566,"Health Partners, Inc.",Commercial,535.436,94.6,,percent of total billed charges,,
Mammo Baseline Diag Bil,,77066,CPT,Facility,Outpatient,,,,566,481.1,162.2156,566,"Health Partners, Inc.",Medicare Advantage,277.34,49,,percent of total billed charges,,
Mammo Baseline Diag Bil,,77066,CPT,Facility,Inpatient,,,,566,481.1,162.2156,566,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mammo Baseline Diag Bil,,77066,CPT,Facility,Both,,,,566,481.1,162.2156,566,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),339.6,60,,percent of total billed charges,,
Mammo Baseline Diag Bil,,77066,CPT,Facility,Both,,,,566,481.1,162.2156,566,"Health Partners, Inc.",State of Minnesota Advantage Program,461.29,81.5,,percent of total billed charges,,
Mammo Baseline Diag Bil,,77066,CPT,Facility,Both,,,,566,481.1,162.2156,566,"Health Partners, Inc.",State Public Programs,283,50,,percent of total billed charges,,
Mammo Baseline Diag Bil,,77066,CPT,Facility,Both,,,,566,481.1,162.2156,566,Humana Insurance Company,Commercial PPO,537.7,95,,percent of total billed charges,,
Mammo Baseline Diag Bil,,77066,CPT,Facility,Outpatient,,,,566,481.1,162.2156,566,Humana Insurance Company,Medicare PPO,277.34,49,,percent of total billed charges,,
Mammo Baseline Diag Bil,,77066,CPT,Facility,Inpatient,,,,566,481.1,162.2156,566,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Mammo Baseline Diag Bil,,77066,CPT,Facility,Both,,,,566,481.1,162.2156,566,Medica,Individual & Family,560.906,99.1,,percent of total billed charges,,
Mammo Baseline Diag Bil,,77066,CPT,Facility,Outpatient,,,,566,481.1,162.2156,566,Medica,Medica Advantage Solution,281.868,49.8,,percent of total billed charges,,
Mammo Baseline Diag Bil,,77066,CPT,Facility,Inpatient,,,,566,481.1,162.2156,566,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Mammo Baseline Diag Bil,,77066,CPT,Facility,Outpatient,,,,566,481.1,162.2156,566,Medica,Medical Assistance,252.436,44.6,,percent of total billed charges,,
Mammo Baseline Diag Bil,,77066,CPT,Facility,Inpatient,,,,566,481.1,162.2156,566,Medica,Medical Assistance,,,,,Included in per diem rate,
Mammo Baseline Diag Bil,,77066,CPT,Facility,Outpatient,,,,566,481.1,162.2156,566,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,281.868,49.8,,percent of total billed charges,,
Mammo Baseline Diag Bil,,77066,CPT,Facility,Inpatient,,,,566,481.1,162.2156,566,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Mammo Baseline Diag Bil,,77066,CPT,Facility,Both,,,,566,481.1,162.2156,566,"Multiplan, Inc.","Multiplan, Inc.",532.04,94,,percent of total billed charges,,
Mammo Baseline Diag Bil,,77066,CPT,Facility,Outpatient,,,,566,481.1,162.2156,566,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,509.966,90.1,,percent of total billed charges,,
Mammo Baseline Diag Bil,,77066,CPT,Facility,Inpatient,,,,566,481.1,162.2156,566,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Mammo Baseline Diag Bil,,77066,CPT,Facility,Both,,,,566,481.1,162.2156,566,"Preferred One Administrative Services, INC.",PPO,558.076,98.6,,percent of total billed charges,,
Mammo Baseline Diag Bil,,77066,CPT,Facility,Outpatient,,,,566,481.1,162.2156,566,PrimeWest Health,Minnesota Senior Health Options (MSHO),291.207,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Mammo Baseline Diag Bil,,77066,CPT,Facility,Inpatient,,,,566,481.1,162.2156,566,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mammo Baseline Diag Bil,,77066,CPT,Facility,Outpatient,,,,566,481.1,162.2156,566,PrimeWest Health,MinnesotaCare,290.6976,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Mammo Baseline Diag Bil,,77066,CPT,Facility,Inpatient,,,,566,481.1,162.2156,566,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Mammo Baseline Diag Bil,,77066,CPT,Facility,Both,,,,566,481.1,162.2156,566,Sanford Health Plan,Sanford Health Plan,520.72,92,,percent of total billed charges,,
Mammo Baseline Diag Bil,,77066,CPT,Facility,Outpatient,,,,566,481.1,162.2156,566,"UCare Health, Inc.",Individual & Family Plan,318.941,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Mammo Baseline Diag Bil,,77066,CPT,Facility,Inpatient,,,,566,481.1,162.2156,566,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Mammo Baseline Diag Bil,,77066,CPT,Facility,Outpatient,,,,566,481.1,162.2156,566,"UCare Health, Inc.",Medical Assistance,285.6602,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mammo Baseline Diag Bil,,77066,CPT,Facility,Inpatient,,,,566,481.1,162.2156,566,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Mammo Baseline Diag Bil,,77066,CPT,Facility,Outpatient,,,,566,481.1,162.2156,566,"UCare Health, Inc.",Medicare Advantage,285.6602,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mammo Baseline Diag Bil,,77066,CPT,Facility,Inpatient,,,,566,481.1,162.2156,566,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mammo Baseline Diag Bil,,77066,CPT,Facility,Outpatient,,,,566,481.1,162.2156,566,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),285.6602,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mammo Baseline Diag Bil,,77066,CPT,Facility,Inpatient,,,,566,481.1,162.2156,566,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mammo Baseline Diag Bil,,77066,CPT,Facility,Both,,,,566,481.1,162.2156,566,UnitedHealthcare,Individual & Family,532.04,94,,percent of total billed charges,,
Mammo Baseline Diag Bil,,77066,CPT,Facility,Outpatient,,,,566,481.1,162.2156,566,UnitedHealthcare,Medicare Advantage,277.34,49,,percent of total billed charges,,
Mammo Baseline Diag Bil,,77066,CPT,Facility,Inpatient,,,,566,481.1,162.2156,566,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Mammo Baseline Diag Bil,,77066,CPT,Facility,Outpatient,,,,566,481.1,162.2156,566,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,271.68,48,,percent of total billed charges,,100% of DHS outpatient percentage
Mammo Baseline Diag Bil,,77066,CPT,Facility,Inpatient,,,,566,481.1,162.2156,566,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Mammo Diag Bil,,77066,CPT,Facility,Both,,,,566,481.1,162.2156,566,Aetna,Commercial,520.72,92,,percent of total billed charges,,
Mammo Diag Bil,,77066,CPT,Facility,Outpatient,,,,566,481.1,162.2156,566,Aetna,Medicare Advantage,277.34,49,,percent of total billed charges,,
Mammo Diag Bil,,77066,CPT,Facility,Inpatient,,,,566,481.1,162.2156,566,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Mammo Diag Bil,,77066,CPT,Facility,Both,,,,566,481.1,162.2156,566,Aetna,PPO,526.38,93,,percent of total billed charges,,
Mammo Diag Bil,,77066,CPT,Facility,Both,,,,566,481.1,162.2156,566,America's PPO,America's PPO,543.5298,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Mammo Diag Bil,,77066,CPT,Facility,Both,,,,566,481.1,162.2156,566,BlueCross BlueShield Minnesota, Federal Employee Program,556.944,98.4,,percent of total billed charges,,
Mammo Diag Bil,,77066,CPT,Facility,Both,,,,566,481.1,162.2156,566,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,566,100,,percent of total billed charges,,
Mammo Diag Bil,,77066,CPT,Facility,Both,,,,566,481.1,162.2156,566,BlueCross BlueShield Minnesota,High Value Network Plan,509.4,90,,percent of total billed charges,,
Mammo Diag Bil,,77066,CPT,Facility,Outpatient,,,,566,481.1,162.2156,566,BlueCross BlueShield Minnesota,Medicare Advantage,277.34,49,,percent of total billed charges,,
Mammo Diag Bil,,77066,CPT,Facility,Inpatient,,,,566,481.1,162.2156,566,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Mammo Diag Bil,,77066,CPT,Facility,Both,,,,566,481.1,162.2156,566,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,501.3062,88.57,,percent of total billed charges,,
Mammo Diag Bil,,77066,CPT,Facility,Both,,,,566,481.1,162.2156,566,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,162.2156,28.66,,percent of total billed charges,,
Mammo Diag Bil,,77066,CPT,Facility,Outpatient,,,,566,481.1,162.2156,566,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),277.34,49,,percent of total billed charges,,
Mammo Diag Bil,,77066,CPT,Facility,Inpatient,,,,566,481.1,162.2156,566,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Mammo Diag Bil,,77066,CPT,Facility,Both,,,,566,481.1,162.2156,566,CorVel,Worker's Compensation,566,100,,percent of total billed charges,,
Mammo Diag Bil,,77066,CPT,Facility,Both,,,,566,481.1,162.2156,566,First Health Group Corporation,First Health Network,549.02,97,,percent of total billed charges,,
Mammo Diag Bil,,77066,CPT,Facility,Both,,,,566,481.1,162.2156,566,"Health Partners, Inc.",Commercial,535.436,94.6,,percent of total billed charges,,
Mammo Diag Bil,,77066,CPT,Facility,Outpatient,,,,566,481.1,162.2156,566,"Health Partners, Inc.",Medicare Advantage,277.34,49,,percent of total billed charges,,
Mammo Diag Bil,,77066,CPT,Facility,Inpatient,,,,566,481.1,162.2156,566,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mammo Diag Bil,,77066,CPT,Facility,Both,,,,566,481.1,162.2156,566,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),339.6,60,,percent of total billed charges,,
Mammo Diag Bil,,77066,CPT,Facility,Both,,,,566,481.1,162.2156,566,"Health Partners, Inc.",State of Minnesota Advantage Program,461.29,81.5,,percent of total billed charges,,
Mammo Diag Bil,,77066,CPT,Facility,Both,,,,566,481.1,162.2156,566,"Health Partners, Inc.",State Public Programs,283,50,,percent of total billed charges,,
Mammo Diag Bil,,77066,CPT,Facility,Both,,,,566,481.1,162.2156,566,Humana Insurance Company,Commercial PPO,537.7,95,,percent of total billed charges,,
Mammo Diag Bil,,77066,CPT,Facility,Outpatient,,,,566,481.1,162.2156,566,Humana Insurance Company,Medicare PPO,277.34,49,,percent of total billed charges,,
Mammo Diag Bil,,77066,CPT,Facility,Inpatient,,,,566,481.1,162.2156,566,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Mammo Diag Bil,,77066,CPT,Facility,Both,,,,566,481.1,162.2156,566,Medica,Individual & Family,560.906,99.1,,percent of total billed charges,,
Mammo Diag Bil,,77066,CPT,Facility,Outpatient,,,,566,481.1,162.2156,566,Medica,Medica Advantage Solution,281.868,49.8,,percent of total billed charges,,
Mammo Diag Bil,,77066,CPT,Facility,Inpatient,,,,566,481.1,162.2156,566,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Mammo Diag Bil,,77066,CPT,Facility,Outpatient,,,,566,481.1,162.2156,566,Medica,Medical Assistance,252.436,44.6,,percent of total billed charges,,
Mammo Diag Bil,,77066,CPT,Facility,Inpatient,,,,566,481.1,162.2156,566,Medica,Medical Assistance,,,,,Included in per diem rate,
Mammo Diag Bil,,77066,CPT,Facility,Outpatient,,,,566,481.1,162.2156,566,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,281.868,49.8,,percent of total billed charges,,
Mammo Diag Bil,,77066,CPT,Facility,Inpatient,,,,566,481.1,162.2156,566,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Mammo Diag Bil,,77066,CPT,Facility,Both,,,,566,481.1,162.2156,566,"Multiplan, Inc.","Multiplan, Inc.",532.04,94,,percent of total billed charges,,
Mammo Diag Bil,,77066,CPT,Facility,Outpatient,,,,566,481.1,162.2156,566,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,509.966,90.1,,percent of total billed charges,,
Mammo Diag Bil,,77066,CPT,Facility,Inpatient,,,,566,481.1,162.2156,566,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Mammo Diag Bil,,77066,CPT,Facility,Both,,,,566,481.1,162.2156,566,"Preferred One Administrative Services, INC.",PPO,558.076,98.6,,percent of total billed charges,,
Mammo Diag Bil,,77066,CPT,Facility,Outpatient,,,,566,481.1,162.2156,566,PrimeWest Health,Minnesota Senior Health Options (MSHO),291.207,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Mammo Diag Bil,,77066,CPT,Facility,Inpatient,,,,566,481.1,162.2156,566,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mammo Diag Bil,,77066,CPT,Facility,Outpatient,,,,566,481.1,162.2156,566,PrimeWest Health,MinnesotaCare,290.6976,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Mammo Diag Bil,,77066,CPT,Facility,Inpatient,,,,566,481.1,162.2156,566,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Mammo Diag Bil,,77066,CPT,Facility,Both,,,,566,481.1,162.2156,566,Sanford Health Plan,Sanford Health Plan,520.72,92,,percent of total billed charges,,
Mammo Diag Bil,,77066,CPT,Facility,Outpatient,,,,566,481.1,162.2156,566,"UCare Health, Inc.",Individual & Family Plan,318.941,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Mammo Diag Bil,,77066,CPT,Facility,Inpatient,,,,566,481.1,162.2156,566,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Mammo Diag Bil,,77066,CPT,Facility,Outpatient,,,,566,481.1,162.2156,566,"UCare Health, Inc.",Medical Assistance,285.6602,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mammo Diag Bil,,77066,CPT,Facility,Inpatient,,,,566,481.1,162.2156,566,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Mammo Diag Bil,,77066,CPT,Facility,Outpatient,,,,566,481.1,162.2156,566,"UCare Health, Inc.",Medicare Advantage,285.6602,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mammo Diag Bil,,77066,CPT,Facility,Inpatient,,,,566,481.1,162.2156,566,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mammo Diag Bil,,77066,CPT,Facility,Outpatient,,,,566,481.1,162.2156,566,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),285.6602,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mammo Diag Bil,,77066,CPT,Facility,Inpatient,,,,566,481.1,162.2156,566,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mammo Diag Bil,,77066,CPT,Facility,Both,,,,566,481.1,162.2156,566,UnitedHealthcare,Individual & Family,532.04,94,,percent of total billed charges,,
Mammo Diag Bil,,77066,CPT,Facility,Outpatient,,,,566,481.1,162.2156,566,UnitedHealthcare,Medicare Advantage,277.34,49,,percent of total billed charges,,
Mammo Diag Bil,,77066,CPT,Facility,Inpatient,,,,566,481.1,162.2156,566,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Mammo Diag Bil,,77066,CPT,Facility,Outpatient,,,,566,481.1,162.2156,566,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,271.68,48,,percent of total billed charges,,100% of DHS outpatient percentage
Mammo Diag Bil,,77066,CPT,Facility,Inpatient,,,,566,481.1,162.2156,566,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Mammo Diag W Implants Bil,,77066,CPT,Facility,Both,,,,566,481.1,162.2156,566,Aetna,Commercial,520.72,92,,percent of total billed charges,,
Mammo Diag W Implants Bil,,77066,CPT,Facility,Outpatient,,,,566,481.1,162.2156,566,Aetna,Medicare Advantage,277.34,49,,percent of total billed charges,,
Mammo Diag W Implants Bil,,77066,CPT,Facility,Inpatient,,,,566,481.1,162.2156,566,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Mammo Diag W Implants Bil,,77066,CPT,Facility,Both,,,,566,481.1,162.2156,566,Aetna,PPO,526.38,93,,percent of total billed charges,,
Mammo Diag W Implants Bil,,77066,CPT,Facility,Both,,,,566,481.1,162.2156,566,America's PPO,America's PPO,543.5298,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Mammo Diag W Implants Bil,,77066,CPT,Facility,Both,,,,566,481.1,162.2156,566,BlueCross BlueShield Minnesota, Federal Employee Program,556.944,98.4,,percent of total billed charges,,
Mammo Diag W Implants Bil,,77066,CPT,Facility,Both,,,,566,481.1,162.2156,566,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,566,100,,percent of total billed charges,,
Mammo Diag W Implants Bil,,77066,CPT,Facility,Both,,,,566,481.1,162.2156,566,BlueCross BlueShield Minnesota,High Value Network Plan,509.4,90,,percent of total billed charges,,
Mammo Diag W Implants Bil,,77066,CPT,Facility,Outpatient,,,,566,481.1,162.2156,566,BlueCross BlueShield Minnesota,Medicare Advantage,277.34,49,,percent of total billed charges,,
Mammo Diag W Implants Bil,,77066,CPT,Facility,Inpatient,,,,566,481.1,162.2156,566,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Mammo Diag W Implants Bil,,77066,CPT,Facility,Both,,,,566,481.1,162.2156,566,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,501.3062,88.57,,percent of total billed charges,,
Mammo Diag W Implants Bil,,77066,CPT,Facility,Both,,,,566,481.1,162.2156,566,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,162.2156,28.66,,percent of total billed charges,,
Mammo Diag W Implants Bil,,77066,CPT,Facility,Outpatient,,,,566,481.1,162.2156,566,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),277.34,49,,percent of total billed charges,,
Mammo Diag W Implants Bil,,77066,CPT,Facility,Inpatient,,,,566,481.1,162.2156,566,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Mammo Diag W Implants Bil,,77066,CPT,Facility,Both,,,,566,481.1,162.2156,566,CorVel,Worker's Compensation,566,100,,percent of total billed charges,,
Mammo Diag W Implants Bil,,77066,CPT,Facility,Both,,,,566,481.1,162.2156,566,First Health Group Corporation,First Health Network,549.02,97,,percent of total billed charges,,
Mammo Diag W Implants Bil,,77066,CPT,Facility,Both,,,,566,481.1,162.2156,566,"Health Partners, Inc.",Commercial,535.436,94.6,,percent of total billed charges,,
Mammo Diag W Implants Bil,,77066,CPT,Facility,Outpatient,,,,566,481.1,162.2156,566,"Health Partners, Inc.",Medicare Advantage,277.34,49,,percent of total billed charges,,
Mammo Diag W Implants Bil,,77066,CPT,Facility,Inpatient,,,,566,481.1,162.2156,566,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mammo Diag W Implants Bil,,77066,CPT,Facility,Both,,,,566,481.1,162.2156,566,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),339.6,60,,percent of total billed charges,,
Mammo Diag W Implants Bil,,77066,CPT,Facility,Both,,,,566,481.1,162.2156,566,"Health Partners, Inc.",State of Minnesota Advantage Program,461.29,81.5,,percent of total billed charges,,
Mammo Diag W Implants Bil,,77066,CPT,Facility,Both,,,,566,481.1,162.2156,566,"Health Partners, Inc.",State Public Programs,283,50,,percent of total billed charges,,
Mammo Diag W Implants Bil,,77066,CPT,Facility,Both,,,,566,481.1,162.2156,566,Humana Insurance Company,Commercial PPO,537.7,95,,percent of total billed charges,,
Mammo Diag W Implants Bil,,77066,CPT,Facility,Outpatient,,,,566,481.1,162.2156,566,Humana Insurance Company,Medicare PPO,277.34,49,,percent of total billed charges,,
Mammo Diag W Implants Bil,,77066,CPT,Facility,Inpatient,,,,566,481.1,162.2156,566,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Mammo Diag W Implants Bil,,77066,CPT,Facility,Both,,,,566,481.1,162.2156,566,Medica,Individual & Family,560.906,99.1,,percent of total billed charges,,
Mammo Diag W Implants Bil,,77066,CPT,Facility,Outpatient,,,,566,481.1,162.2156,566,Medica,Medica Advantage Solution,281.868,49.8,,percent of total billed charges,,
Mammo Diag W Implants Bil,,77066,CPT,Facility,Inpatient,,,,566,481.1,162.2156,566,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Mammo Diag W Implants Bil,,77066,CPT,Facility,Outpatient,,,,566,481.1,162.2156,566,Medica,Medical Assistance,252.436,44.6,,percent of total billed charges,,
Mammo Diag W Implants Bil,,77066,CPT,Facility,Inpatient,,,,566,481.1,162.2156,566,Medica,Medical Assistance,,,,,Included in per diem rate,
Mammo Diag W Implants Bil,,77066,CPT,Facility,Outpatient,,,,566,481.1,162.2156,566,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,281.868,49.8,,percent of total billed charges,,
Mammo Diag W Implants Bil,,77066,CPT,Facility,Inpatient,,,,566,481.1,162.2156,566,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Mammo Diag W Implants Bil,,77066,CPT,Facility,Both,,,,566,481.1,162.2156,566,"Multiplan, Inc.","Multiplan, Inc.",532.04,94,,percent of total billed charges,,
Mammo Diag W Implants Bil,,77066,CPT,Facility,Outpatient,,,,566,481.1,162.2156,566,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,509.966,90.1,,percent of total billed charges,,
Mammo Diag W Implants Bil,,77066,CPT,Facility,Inpatient,,,,566,481.1,162.2156,566,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Mammo Diag W Implants Bil,,77066,CPT,Facility,Both,,,,566,481.1,162.2156,566,"Preferred One Administrative Services, INC.",PPO,558.076,98.6,,percent of total billed charges,,
Mammo Diag W Implants Bil,,77066,CPT,Facility,Outpatient,,,,566,481.1,162.2156,566,PrimeWest Health,Minnesota Senior Health Options (MSHO),291.207,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Mammo Diag W Implants Bil,,77066,CPT,Facility,Inpatient,,,,566,481.1,162.2156,566,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mammo Diag W Implants Bil,,77066,CPT,Facility,Outpatient,,,,566,481.1,162.2156,566,PrimeWest Health,MinnesotaCare,290.6976,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Mammo Diag W Implants Bil,,77066,CPT,Facility,Inpatient,,,,566,481.1,162.2156,566,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Mammo Diag W Implants Bil,,77066,CPT,Facility,Both,,,,566,481.1,162.2156,566,Sanford Health Plan,Sanford Health Plan,520.72,92,,percent of total billed charges,,
Mammo Diag W Implants Bil,,77066,CPT,Facility,Outpatient,,,,566,481.1,162.2156,566,"UCare Health, Inc.",Individual & Family Plan,318.941,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Mammo Diag W Implants Bil,,77066,CPT,Facility,Inpatient,,,,566,481.1,162.2156,566,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Mammo Diag W Implants Bil,,77066,CPT,Facility,Outpatient,,,,566,481.1,162.2156,566,"UCare Health, Inc.",Medical Assistance,285.6602,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mammo Diag W Implants Bil,,77066,CPT,Facility,Inpatient,,,,566,481.1,162.2156,566,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Mammo Diag W Implants Bil,,77066,CPT,Facility,Outpatient,,,,566,481.1,162.2156,566,"UCare Health, Inc.",Medicare Advantage,285.6602,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mammo Diag W Implants Bil,,77066,CPT,Facility,Inpatient,,,,566,481.1,162.2156,566,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mammo Diag W Implants Bil,,77066,CPT,Facility,Outpatient,,,,566,481.1,162.2156,566,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),285.6602,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mammo Diag W Implants Bil,,77066,CPT,Facility,Inpatient,,,,566,481.1,162.2156,566,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mammo Diag W Implants Bil,,77066,CPT,Facility,Both,,,,566,481.1,162.2156,566,UnitedHealthcare,Individual & Family,532.04,94,,percent of total billed charges,,
Mammo Diag W Implants Bil,,77066,CPT,Facility,Outpatient,,,,566,481.1,162.2156,566,UnitedHealthcare,Medicare Advantage,277.34,49,,percent of total billed charges,,
Mammo Diag W Implants Bil,,77066,CPT,Facility,Inpatient,,,,566,481.1,162.2156,566,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Mammo Diag W Implants Bil,,77066,CPT,Facility,Outpatient,,,,566,481.1,162.2156,566,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,271.68,48,,percent of total billed charges,,100% of DHS outpatient percentage
Mammo Diag W Implants Bil,,77066,CPT,Facility,Inpatient,,,,566,481.1,162.2156,566,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Mammo Sage Diag Bsl Bil,,77066,CPT,Facility,Both,,,,566,481.1,162.2156,566,Aetna,Commercial,520.72,92,,percent of total billed charges,,
Mammo Sage Diag Bsl Bil,,77066,CPT,Facility,Outpatient,,,,566,481.1,162.2156,566,Aetna,Medicare Advantage,277.34,49,,percent of total billed charges,,
Mammo Sage Diag Bsl Bil,,77066,CPT,Facility,Inpatient,,,,566,481.1,162.2156,566,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Mammo Sage Diag Bsl Bil,,77066,CPT,Facility,Both,,,,566,481.1,162.2156,566,Aetna,PPO,526.38,93,,percent of total billed charges,,
Mammo Sage Diag Bsl Bil,,77066,CPT,Facility,Both,,,,566,481.1,162.2156,566,America's PPO,America's PPO,543.5298,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Mammo Sage Diag Bsl Bil,,77066,CPT,Facility,Both,,,,566,481.1,162.2156,566,BlueCross BlueShield Minnesota, Federal Employee Program,556.944,98.4,,percent of total billed charges,,
Mammo Sage Diag Bsl Bil,,77066,CPT,Facility,Both,,,,566,481.1,162.2156,566,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,566,100,,percent of total billed charges,,
Mammo Sage Diag Bsl Bil,,77066,CPT,Facility,Both,,,,566,481.1,162.2156,566,BlueCross BlueShield Minnesota,High Value Network Plan,509.4,90,,percent of total billed charges,,
Mammo Sage Diag Bsl Bil,,77066,CPT,Facility,Outpatient,,,,566,481.1,162.2156,566,BlueCross BlueShield Minnesota,Medicare Advantage,277.34,49,,percent of total billed charges,,
Mammo Sage Diag Bsl Bil,,77066,CPT,Facility,Inpatient,,,,566,481.1,162.2156,566,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Mammo Sage Diag Bsl Bil,,77066,CPT,Facility,Both,,,,566,481.1,162.2156,566,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,501.3062,88.57,,percent of total billed charges,,
Mammo Sage Diag Bsl Bil,,77066,CPT,Facility,Both,,,,566,481.1,162.2156,566,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,162.2156,28.66,,percent of total billed charges,,
Mammo Sage Diag Bsl Bil,,77066,CPT,Facility,Outpatient,,,,566,481.1,162.2156,566,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),277.34,49,,percent of total billed charges,,
Mammo Sage Diag Bsl Bil,,77066,CPT,Facility,Inpatient,,,,566,481.1,162.2156,566,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Mammo Sage Diag Bsl Bil,,77066,CPT,Facility,Both,,,,566,481.1,162.2156,566,CorVel,Worker's Compensation,566,100,,percent of total billed charges,,
Mammo Sage Diag Bsl Bil,,77066,CPT,Facility,Both,,,,566,481.1,162.2156,566,First Health Group Corporation,First Health Network,549.02,97,,percent of total billed charges,,
Mammo Sage Diag Bsl Bil,,77066,CPT,Facility,Both,,,,566,481.1,162.2156,566,"Health Partners, Inc.",Commercial,535.436,94.6,,percent of total billed charges,,
Mammo Sage Diag Bsl Bil,,77066,CPT,Facility,Outpatient,,,,566,481.1,162.2156,566,"Health Partners, Inc.",Medicare Advantage,277.34,49,,percent of total billed charges,,
Mammo Sage Diag Bsl Bil,,77066,CPT,Facility,Inpatient,,,,566,481.1,162.2156,566,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mammo Sage Diag Bsl Bil,,77066,CPT,Facility,Both,,,,566,481.1,162.2156,566,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),339.6,60,,percent of total billed charges,,
Mammo Sage Diag Bsl Bil,,77066,CPT,Facility,Both,,,,566,481.1,162.2156,566,"Health Partners, Inc.",State of Minnesota Advantage Program,461.29,81.5,,percent of total billed charges,,
Mammo Sage Diag Bsl Bil,,77066,CPT,Facility,Both,,,,566,481.1,162.2156,566,"Health Partners, Inc.",State Public Programs,283,50,,percent of total billed charges,,
Mammo Sage Diag Bsl Bil,,77066,CPT,Facility,Both,,,,566,481.1,162.2156,566,Humana Insurance Company,Commercial PPO,537.7,95,,percent of total billed charges,,
Mammo Sage Diag Bsl Bil,,77066,CPT,Facility,Outpatient,,,,566,481.1,162.2156,566,Humana Insurance Company,Medicare PPO,277.34,49,,percent of total billed charges,,
Mammo Sage Diag Bsl Bil,,77066,CPT,Facility,Inpatient,,,,566,481.1,162.2156,566,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Mammo Sage Diag Bsl Bil,,77066,CPT,Facility,Both,,,,566,481.1,162.2156,566,Medica,Individual & Family,560.906,99.1,,percent of total billed charges,,
Mammo Sage Diag Bsl Bil,,77066,CPT,Facility,Outpatient,,,,566,481.1,162.2156,566,Medica,Medica Advantage Solution,281.868,49.8,,percent of total billed charges,,
Mammo Sage Diag Bsl Bil,,77066,CPT,Facility,Inpatient,,,,566,481.1,162.2156,566,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Mammo Sage Diag Bsl Bil,,77066,CPT,Facility,Outpatient,,,,566,481.1,162.2156,566,Medica,Medical Assistance,252.436,44.6,,percent of total billed charges,,
Mammo Sage Diag Bsl Bil,,77066,CPT,Facility,Inpatient,,,,566,481.1,162.2156,566,Medica,Medical Assistance,,,,,Included in per diem rate,
Mammo Sage Diag Bsl Bil,,77066,CPT,Facility,Outpatient,,,,566,481.1,162.2156,566,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,281.868,49.8,,percent of total billed charges,,
Mammo Sage Diag Bsl Bil,,77066,CPT,Facility,Inpatient,,,,566,481.1,162.2156,566,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Mammo Sage Diag Bsl Bil,,77066,CPT,Facility,Both,,,,566,481.1,162.2156,566,"Multiplan, Inc.","Multiplan, Inc.",532.04,94,,percent of total billed charges,,
Mammo Sage Diag Bsl Bil,,77066,CPT,Facility,Outpatient,,,,566,481.1,162.2156,566,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,509.966,90.1,,percent of total billed charges,,
Mammo Sage Diag Bsl Bil,,77066,CPT,Facility,Inpatient,,,,566,481.1,162.2156,566,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Mammo Sage Diag Bsl Bil,,77066,CPT,Facility,Both,,,,566,481.1,162.2156,566,"Preferred One Administrative Services, INC.",PPO,558.076,98.6,,percent of total billed charges,,
Mammo Sage Diag Bsl Bil,,77066,CPT,Facility,Outpatient,,,,566,481.1,162.2156,566,PrimeWest Health,Minnesota Senior Health Options (MSHO),291.207,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Mammo Sage Diag Bsl Bil,,77066,CPT,Facility,Inpatient,,,,566,481.1,162.2156,566,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mammo Sage Diag Bsl Bil,,77066,CPT,Facility,Outpatient,,,,566,481.1,162.2156,566,PrimeWest Health,MinnesotaCare,290.6976,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Mammo Sage Diag Bsl Bil,,77066,CPT,Facility,Inpatient,,,,566,481.1,162.2156,566,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Mammo Sage Diag Bsl Bil,,77066,CPT,Facility,Both,,,,566,481.1,162.2156,566,Sanford Health Plan,Sanford Health Plan,520.72,92,,percent of total billed charges,,
Mammo Sage Diag Bsl Bil,,77066,CPT,Facility,Outpatient,,,,566,481.1,162.2156,566,"UCare Health, Inc.",Individual & Family Plan,318.941,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Mammo Sage Diag Bsl Bil,,77066,CPT,Facility,Inpatient,,,,566,481.1,162.2156,566,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Mammo Sage Diag Bsl Bil,,77066,CPT,Facility,Outpatient,,,,566,481.1,162.2156,566,"UCare Health, Inc.",Medical Assistance,285.6602,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mammo Sage Diag Bsl Bil,,77066,CPT,Facility,Inpatient,,,,566,481.1,162.2156,566,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Mammo Sage Diag Bsl Bil,,77066,CPT,Facility,Outpatient,,,,566,481.1,162.2156,566,"UCare Health, Inc.",Medicare Advantage,285.6602,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mammo Sage Diag Bsl Bil,,77066,CPT,Facility,Inpatient,,,,566,481.1,162.2156,566,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mammo Sage Diag Bsl Bil,,77066,CPT,Facility,Outpatient,,,,566,481.1,162.2156,566,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),285.6602,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mammo Sage Diag Bsl Bil,,77066,CPT,Facility,Inpatient,,,,566,481.1,162.2156,566,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mammo Sage Diag Bsl Bil,,77066,CPT,Facility,Both,,,,566,481.1,162.2156,566,UnitedHealthcare,Individual & Family,532.04,94,,percent of total billed charges,,
Mammo Sage Diag Bsl Bil,,77066,CPT,Facility,Outpatient,,,,566,481.1,162.2156,566,UnitedHealthcare,Medicare Advantage,277.34,49,,percent of total billed charges,,
Mammo Sage Diag Bsl Bil,,77066,CPT,Facility,Inpatient,,,,566,481.1,162.2156,566,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Mammo Sage Diag Bsl Bil,,77066,CPT,Facility,Outpatient,,,,566,481.1,162.2156,566,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,271.68,48,,percent of total billed charges,,100% of DHS outpatient percentage
Mammo Sage Diag Bsl Bil,,77066,CPT,Facility,Inpatient,,,,566,481.1,162.2156,566,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Mammo Sage Diag W Implants Bil,,77066,CPT,Facility,Both,,,,566,481.1,162.2156,566,Aetna,Commercial,520.72,92,,percent of total billed charges,,
Mammo Sage Diag W Implants Bil,,77066,CPT,Facility,Outpatient,,,,566,481.1,162.2156,566,Aetna,Medicare Advantage,277.34,49,,percent of total billed charges,,
Mammo Sage Diag W Implants Bil,,77066,CPT,Facility,Inpatient,,,,566,481.1,162.2156,566,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Mammo Sage Diag W Implants Bil,,77066,CPT,Facility,Both,,,,566,481.1,162.2156,566,Aetna,PPO,526.38,93,,percent of total billed charges,,
Mammo Sage Diag W Implants Bil,,77066,CPT,Facility,Both,,,,566,481.1,162.2156,566,America's PPO,America's PPO,543.5298,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Mammo Sage Diag W Implants Bil,,77066,CPT,Facility,Both,,,,566,481.1,162.2156,566,BlueCross BlueShield Minnesota, Federal Employee Program,556.944,98.4,,percent of total billed charges,,
Mammo Sage Diag W Implants Bil,,77066,CPT,Facility,Both,,,,566,481.1,162.2156,566,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,566,100,,percent of total billed charges,,
Mammo Sage Diag W Implants Bil,,77066,CPT,Facility,Both,,,,566,481.1,162.2156,566,BlueCross BlueShield Minnesota,High Value Network Plan,509.4,90,,percent of total billed charges,,
Mammo Sage Diag W Implants Bil,,77066,CPT,Facility,Outpatient,,,,566,481.1,162.2156,566,BlueCross BlueShield Minnesota,Medicare Advantage,277.34,49,,percent of total billed charges,,
Mammo Sage Diag W Implants Bil,,77066,CPT,Facility,Inpatient,,,,566,481.1,162.2156,566,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Mammo Sage Diag W Implants Bil,,77066,CPT,Facility,Both,,,,566,481.1,162.2156,566,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,501.3062,88.57,,percent of total billed charges,,
Mammo Sage Diag W Implants Bil,,77066,CPT,Facility,Both,,,,566,481.1,162.2156,566,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,162.2156,28.66,,percent of total billed charges,,
Mammo Sage Diag W Implants Bil,,77066,CPT,Facility,Outpatient,,,,566,481.1,162.2156,566,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),277.34,49,,percent of total billed charges,,
Mammo Sage Diag W Implants Bil,,77066,CPT,Facility,Inpatient,,,,566,481.1,162.2156,566,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Mammo Sage Diag W Implants Bil,,77066,CPT,Facility,Both,,,,566,481.1,162.2156,566,CorVel,Worker's Compensation,566,100,,percent of total billed charges,,
Mammo Sage Diag W Implants Bil,,77066,CPT,Facility,Both,,,,566,481.1,162.2156,566,First Health Group Corporation,First Health Network,549.02,97,,percent of total billed charges,,
Mammo Sage Diag W Implants Bil,,77066,CPT,Facility,Both,,,,566,481.1,162.2156,566,"Health Partners, Inc.",Commercial,535.436,94.6,,percent of total billed charges,,
Mammo Sage Diag W Implants Bil,,77066,CPT,Facility,Outpatient,,,,566,481.1,162.2156,566,"Health Partners, Inc.",Medicare Advantage,277.34,49,,percent of total billed charges,,
Mammo Sage Diag W Implants Bil,,77066,CPT,Facility,Inpatient,,,,566,481.1,162.2156,566,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mammo Sage Diag W Implants Bil,,77066,CPT,Facility,Both,,,,566,481.1,162.2156,566,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),339.6,60,,percent of total billed charges,,
Mammo Sage Diag W Implants Bil,,77066,CPT,Facility,Both,,,,566,481.1,162.2156,566,"Health Partners, Inc.",State of Minnesota Advantage Program,461.29,81.5,,percent of total billed charges,,
Mammo Sage Diag W Implants Bil,,77066,CPT,Facility,Both,,,,566,481.1,162.2156,566,"Health Partners, Inc.",State Public Programs,283,50,,percent of total billed charges,,
Mammo Sage Diag W Implants Bil,,77066,CPT,Facility,Both,,,,566,481.1,162.2156,566,Humana Insurance Company,Commercial PPO,537.7,95,,percent of total billed charges,,
Mammo Sage Diag W Implants Bil,,77066,CPT,Facility,Outpatient,,,,566,481.1,162.2156,566,Humana Insurance Company,Medicare PPO,277.34,49,,percent of total billed charges,,
Mammo Sage Diag W Implants Bil,,77066,CPT,Facility,Inpatient,,,,566,481.1,162.2156,566,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Mammo Sage Diag W Implants Bil,,77066,CPT,Facility,Both,,,,566,481.1,162.2156,566,Medica,Individual & Family,560.906,99.1,,percent of total billed charges,,
Mammo Sage Diag W Implants Bil,,77066,CPT,Facility,Outpatient,,,,566,481.1,162.2156,566,Medica,Medica Advantage Solution,281.868,49.8,,percent of total billed charges,,
Mammo Sage Diag W Implants Bil,,77066,CPT,Facility,Inpatient,,,,566,481.1,162.2156,566,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Mammo Sage Diag W Implants Bil,,77066,CPT,Facility,Outpatient,,,,566,481.1,162.2156,566,Medica,Medical Assistance,252.436,44.6,,percent of total billed charges,,
Mammo Sage Diag W Implants Bil,,77066,CPT,Facility,Inpatient,,,,566,481.1,162.2156,566,Medica,Medical Assistance,,,,,Included in per diem rate,
Mammo Sage Diag W Implants Bil,,77066,CPT,Facility,Outpatient,,,,566,481.1,162.2156,566,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,281.868,49.8,,percent of total billed charges,,
Mammo Sage Diag W Implants Bil,,77066,CPT,Facility,Inpatient,,,,566,481.1,162.2156,566,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Mammo Sage Diag W Implants Bil,,77066,CPT,Facility,Both,,,,566,481.1,162.2156,566,"Multiplan, Inc.","Multiplan, Inc.",532.04,94,,percent of total billed charges,,
Mammo Sage Diag W Implants Bil,,77066,CPT,Facility,Outpatient,,,,566,481.1,162.2156,566,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,509.966,90.1,,percent of total billed charges,,
Mammo Sage Diag W Implants Bil,,77066,CPT,Facility,Inpatient,,,,566,481.1,162.2156,566,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Mammo Sage Diag W Implants Bil,,77066,CPT,Facility,Both,,,,566,481.1,162.2156,566,"Preferred One Administrative Services, INC.",PPO,558.076,98.6,,percent of total billed charges,,
Mammo Sage Diag W Implants Bil,,77066,CPT,Facility,Outpatient,,,,566,481.1,162.2156,566,PrimeWest Health,Minnesota Senior Health Options (MSHO),291.207,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Mammo Sage Diag W Implants Bil,,77066,CPT,Facility,Inpatient,,,,566,481.1,162.2156,566,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mammo Sage Diag W Implants Bil,,77066,CPT,Facility,Outpatient,,,,566,481.1,162.2156,566,PrimeWest Health,MinnesotaCare,290.6976,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Mammo Sage Diag W Implants Bil,,77066,CPT,Facility,Inpatient,,,,566,481.1,162.2156,566,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Mammo Sage Diag W Implants Bil,,77066,CPT,Facility,Both,,,,566,481.1,162.2156,566,Sanford Health Plan,Sanford Health Plan,520.72,92,,percent of total billed charges,,
Mammo Sage Diag W Implants Bil,,77066,CPT,Facility,Outpatient,,,,566,481.1,162.2156,566,"UCare Health, Inc.",Individual & Family Plan,318.941,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Mammo Sage Diag W Implants Bil,,77066,CPT,Facility,Inpatient,,,,566,481.1,162.2156,566,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Mammo Sage Diag W Implants Bil,,77066,CPT,Facility,Outpatient,,,,566,481.1,162.2156,566,"UCare Health, Inc.",Medical Assistance,285.6602,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mammo Sage Diag W Implants Bil,,77066,CPT,Facility,Inpatient,,,,566,481.1,162.2156,566,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Mammo Sage Diag W Implants Bil,,77066,CPT,Facility,Outpatient,,,,566,481.1,162.2156,566,"UCare Health, Inc.",Medicare Advantage,285.6602,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mammo Sage Diag W Implants Bil,,77066,CPT,Facility,Inpatient,,,,566,481.1,162.2156,566,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mammo Sage Diag W Implants Bil,,77066,CPT,Facility,Outpatient,,,,566,481.1,162.2156,566,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),285.6602,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mammo Sage Diag W Implants Bil,,77066,CPT,Facility,Inpatient,,,,566,481.1,162.2156,566,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mammo Sage Diag W Implants Bil,,77066,CPT,Facility,Both,,,,566,481.1,162.2156,566,UnitedHealthcare,Individual & Family,532.04,94,,percent of total billed charges,,
Mammo Sage Diag W Implants Bil,,77066,CPT,Facility,Outpatient,,,,566,481.1,162.2156,566,UnitedHealthcare,Medicare Advantage,277.34,49,,percent of total billed charges,,
Mammo Sage Diag W Implants Bil,,77066,CPT,Facility,Inpatient,,,,566,481.1,162.2156,566,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Mammo Sage Diag W Implants Bil,,77066,CPT,Facility,Outpatient,,,,566,481.1,162.2156,566,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,271.68,48,,percent of total billed charges,,100% of DHS outpatient percentage
Mammo Sage Diag W Implants Bil,,77066,CPT,Facility,Inpatient,,,,566,481.1,162.2156,566,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Mammo Baseline Screen Bil,,77067,CPT,Facility,Both,,,,490,416.5,152.4,490,Aetna,Commercial,450.8,92,,percent of total billed charges,,
Mammo Baseline Screen Bil,,77067,CPT,Facility,Outpatient,,,,490,416.5,152.4,490,Aetna,Medicare Advantage,240.1,49,,percent of total billed charges,,
Mammo Baseline Screen Bil,,77067,CPT,Facility,Inpatient,,,,490,416.5,152.4,490,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Mammo Baseline Screen Bil,,77067,CPT,Facility,Both,,,,490,416.5,152.4,490,Aetna,PPO,455.7,93,,percent of total billed charges,,
Mammo Baseline Screen Bil,,77067,CPT,Facility,Both,,,,490,416.5,152.4,490,America's PPO,America's PPO,470.547,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Mammo Baseline Screen Bil,,77067,CPT,Facility,Both,,,,490,416.5,152.4,490,BlueCross BlueShield Minnesota, Federal Employee Program,300,,,Fee schedule,,100% of BCBS commercial commodity fee schedule
Mammo Baseline Screen Bil,,77067,CPT,Facility,Both,,,,490,416.5,152.4,490,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,304.8,,,Fee schedule,,"100% of BCBS commercial commodity fee schedule, plus MN Care tax"
Mammo Baseline Screen Bil,,77067,CPT,Facility,Both,,,,490,416.5,152.4,490,BlueCross BlueShield Minnesota,High Value Network Plan,274.32,,,Fee schedule,,"90% of BCBS commercial commodity fee schedule, plus MN Care tax; see disclaimer for more information"
Mammo Baseline Screen Bil,,77067,CPT,Facility,Outpatient,,,,490,416.5,152.4,490,BlueCross BlueShield Minnesota,Medicare Advantage,240.1,49,,percent of total billed charges,,
Mammo Baseline Screen Bil,,77067,CPT,Facility,Inpatient,,,,490,416.5,152.4,490,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Mammo Baseline Screen Bil,,77067,CPT,Facility,Both,,,,490,416.5,152.4,490,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,269.96136,,,Fee schedule,,"88.57% of BCBS commercial commodity fee schedule, plus MN Care tax"
Mammo Baseline Screen Bil,,77067,CPT,Facility,Both,,,,490,416.5,152.4,490,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,152.4,,,Fee schedule,,"100% of BCBS Medicaid commodity fee schedule, plus MN Care tax"
Mammo Baseline Screen Bil,,77067,CPT,Facility,Outpatient,,,,490,416.5,152.4,490,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),240.1,49,,percent of total billed charges,,
Mammo Baseline Screen Bil,,77067,CPT,Facility,Inpatient,,,,490,416.5,152.4,490,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Mammo Baseline Screen Bil,,77067,CPT,Facility,Both,,,,490,416.5,152.4,490,CorVel,Worker's Compensation,490,100,,percent of total billed charges,,
Mammo Baseline Screen Bil,,77067,CPT,Facility,Both,,,,490,416.5,152.4,490,First Health Group Corporation,First Health Network,475.3,97,,percent of total billed charges,,
Mammo Baseline Screen Bil,,77067,CPT,Facility,Both,,,,490,416.5,152.4,490,"Health Partners, Inc.",Commercial,463.54,94.6,,percent of total billed charges,,
Mammo Baseline Screen Bil,,77067,CPT,Facility,Outpatient,,,,490,416.5,152.4,490,"Health Partners, Inc.",Medicare Advantage,240.1,49,,percent of total billed charges,,
Mammo Baseline Screen Bil,,77067,CPT,Facility,Inpatient,,,,490,416.5,152.4,490,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mammo Baseline Screen Bil,,77067,CPT,Facility,Both,,,,490,416.5,152.4,490,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),294,60,,percent of total billed charges,,
Mammo Baseline Screen Bil,,77067,CPT,Facility,Both,,,,490,416.5,152.4,490,"Health Partners, Inc.",State of Minnesota Advantage Program,399.35,81.5,,percent of total billed charges,,
Mammo Baseline Screen Bil,,77067,CPT,Facility,Both,,,,490,416.5,152.4,490,"Health Partners, Inc.",State Public Programs,245,50,,percent of total billed charges,,
Mammo Baseline Screen Bil,,77067,CPT,Facility,Both,,,,490,416.5,152.4,490,Humana Insurance Company,Commercial PPO,465.5,95,,percent of total billed charges,,
Mammo Baseline Screen Bil,,77067,CPT,Facility,Outpatient,,,,490,416.5,152.4,490,Humana Insurance Company,Medicare PPO,240.1,49,,percent of total billed charges,,
Mammo Baseline Screen Bil,,77067,CPT,Facility,Inpatient,,,,490,416.5,152.4,490,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Mammo Baseline Screen Bil,,77067,CPT,Facility,Both,,,,490,416.5,152.4,490,Medica,Individual & Family,485.59,99.1,,percent of total billed charges,,
Mammo Baseline Screen Bil,,77067,CPT,Facility,Outpatient,,,,490,416.5,152.4,490,Medica,Medica Advantage Solution,244.02,49.8,,percent of total billed charges,,
Mammo Baseline Screen Bil,,77067,CPT,Facility,Inpatient,,,,490,416.5,152.4,490,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Mammo Baseline Screen Bil,,77067,CPT,Facility,Outpatient,,,,490,416.5,152.4,490,Medica,Medical Assistance,218.54,44.6,,percent of total billed charges,,
Mammo Baseline Screen Bil,,77067,CPT,Facility,Inpatient,,,,490,416.5,152.4,490,Medica,Medical Assistance,,,,,Included in per diem rate,
Mammo Baseline Screen Bil,,77067,CPT,Facility,Outpatient,,,,490,416.5,152.4,490,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,244.02,49.8,,percent of total billed charges,,
Mammo Baseline Screen Bil,,77067,CPT,Facility,Inpatient,,,,490,416.5,152.4,490,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Mammo Baseline Screen Bil,,77067,CPT,Facility,Both,,,,490,416.5,152.4,490,"Multiplan, Inc.","Multiplan, Inc.",460.6,94,,percent of total billed charges,,
Mammo Baseline Screen Bil,,77067,CPT,Facility,Outpatient,,,,490,416.5,152.4,490,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,441.49,90.1,,percent of total billed charges,,
Mammo Baseline Screen Bil,,77067,CPT,Facility,Inpatient,,,,490,416.5,152.4,490,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Mammo Baseline Screen Bil,,77067,CPT,Facility,Both,,,,490,416.5,152.4,490,"Preferred One Administrative Services, INC.",PPO,483.14,98.6,,percent of total billed charges,,
Mammo Baseline Screen Bil,,77067,CPT,Facility,Outpatient,,,,490,416.5,152.4,490,PrimeWest Health,Minnesota Senior Health Options (MSHO),252.105,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Mammo Baseline Screen Bil,,77067,CPT,Facility,Inpatient,,,,490,416.5,152.4,490,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mammo Baseline Screen Bil,,77067,CPT,Facility,Outpatient,,,,490,416.5,152.4,490,PrimeWest Health,MinnesotaCare,251.664,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Mammo Baseline Screen Bil,,77067,CPT,Facility,Inpatient,,,,490,416.5,152.4,490,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Mammo Baseline Screen Bil,,77067,CPT,Facility,Both,,,,490,416.5,152.4,490,Sanford Health Plan,Sanford Health Plan,450.8,92,,percent of total billed charges,,
Mammo Baseline Screen Bil,,77067,CPT,Facility,Outpatient,,,,490,416.5,152.4,490,"UCare Health, Inc.",Individual & Family Plan,276.115,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Mammo Baseline Screen Bil,,77067,CPT,Facility,Inpatient,,,,490,416.5,152.4,490,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Mammo Baseline Screen Bil,,77067,CPT,Facility,Outpatient,,,,490,416.5,152.4,490,"UCare Health, Inc.",Medical Assistance,247.303,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mammo Baseline Screen Bil,,77067,CPT,Facility,Inpatient,,,,490,416.5,152.4,490,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Mammo Baseline Screen Bil,,77067,CPT,Facility,Outpatient,,,,490,416.5,152.4,490,"UCare Health, Inc.",Medicare Advantage,247.303,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mammo Baseline Screen Bil,,77067,CPT,Facility,Inpatient,,,,490,416.5,152.4,490,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mammo Baseline Screen Bil,,77067,CPT,Facility,Outpatient,,,,490,416.5,152.4,490,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),247.303,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mammo Baseline Screen Bil,,77067,CPT,Facility,Inpatient,,,,490,416.5,152.4,490,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mammo Baseline Screen Bil,,77067,CPT,Facility,Both,,,,490,416.5,152.4,490,UnitedHealthcare,Individual & Family,460.6,94,,percent of total billed charges,,
Mammo Baseline Screen Bil,,77067,CPT,Facility,Outpatient,,,,490,416.5,152.4,490,UnitedHealthcare,Medicare Advantage,240.1,49,,percent of total billed charges,,
Mammo Baseline Screen Bil,,77067,CPT,Facility,Inpatient,,,,490,416.5,152.4,490,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Mammo Baseline Screen Bil,,77067,CPT,Facility,Outpatient,,,,490,416.5,152.4,490,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,235.2,48,,percent of total billed charges,,100% of DHS outpatient percentage
Mammo Baseline Screen Bil,,77067,CPT,Facility,Inpatient,,,,490,416.5,152.4,490,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Mammo Sage Screen Bil,,77067,CPT,Facility,Both,,,,490,416.5,152.4,490,Aetna,Commercial,450.8,92,,percent of total billed charges,,
Mammo Sage Screen Bil,,77067,CPT,Facility,Outpatient,,,,490,416.5,152.4,490,Aetna,Medicare Advantage,240.1,49,,percent of total billed charges,,
Mammo Sage Screen Bil,,77067,CPT,Facility,Inpatient,,,,490,416.5,152.4,490,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Mammo Sage Screen Bil,,77067,CPT,Facility,Both,,,,490,416.5,152.4,490,Aetna,PPO,455.7,93,,percent of total billed charges,,
Mammo Sage Screen Bil,,77067,CPT,Facility,Both,,,,490,416.5,152.4,490,America's PPO,America's PPO,470.547,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Mammo Sage Screen Bil,,77067,CPT,Facility,Both,,,,490,416.5,152.4,490,BlueCross BlueShield Minnesota, Federal Employee Program,300,,,Fee schedule,,100% of BCBS commercial commodity fee schedule
Mammo Sage Screen Bil,,77067,CPT,Facility,Both,,,,490,416.5,152.4,490,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,304.8,,,Fee schedule,,"100% of BCBS commercial commodity fee schedule, plus MN Care tax"
Mammo Sage Screen Bil,,77067,CPT,Facility,Both,,,,490,416.5,152.4,490,BlueCross BlueShield Minnesota,High Value Network Plan,274.32,,,Fee schedule,,"90% of BCBS commercial commodity fee schedule, plus MN Care tax; see disclaimer for more information"
Mammo Sage Screen Bil,,77067,CPT,Facility,Outpatient,,,,490,416.5,152.4,490,BlueCross BlueShield Minnesota,Medicare Advantage,240.1,49,,percent of total billed charges,,
Mammo Sage Screen Bil,,77067,CPT,Facility,Inpatient,,,,490,416.5,152.4,490,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Mammo Sage Screen Bil,,77067,CPT,Facility,Both,,,,490,416.5,152.4,490,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,269.96136,,,Fee schedule,,"88.57% of BCBS commercial commodity fee schedule, plus MN Care tax"
Mammo Sage Screen Bil,,77067,CPT,Facility,Both,,,,490,416.5,152.4,490,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,152.4,,,Fee schedule,,"100% of BCBS Medicaid commodity fee schedule, plus MN Care tax"
Mammo Sage Screen Bil,,77067,CPT,Facility,Outpatient,,,,490,416.5,152.4,490,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),240.1,49,,percent of total billed charges,,
Mammo Sage Screen Bil,,77067,CPT,Facility,Inpatient,,,,490,416.5,152.4,490,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Mammo Sage Screen Bil,,77067,CPT,Facility,Both,,,,490,416.5,152.4,490,CorVel,Worker's Compensation,490,100,,percent of total billed charges,,
Mammo Sage Screen Bil,,77067,CPT,Facility,Both,,,,490,416.5,152.4,490,First Health Group Corporation,First Health Network,475.3,97,,percent of total billed charges,,
Mammo Sage Screen Bil,,77067,CPT,Facility,Both,,,,490,416.5,152.4,490,"Health Partners, Inc.",Commercial,463.54,94.6,,percent of total billed charges,,
Mammo Sage Screen Bil,,77067,CPT,Facility,Outpatient,,,,490,416.5,152.4,490,"Health Partners, Inc.",Medicare Advantage,240.1,49,,percent of total billed charges,,
Mammo Sage Screen Bil,,77067,CPT,Facility,Inpatient,,,,490,416.5,152.4,490,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mammo Sage Screen Bil,,77067,CPT,Facility,Both,,,,490,416.5,152.4,490,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),294,60,,percent of total billed charges,,
Mammo Sage Screen Bil,,77067,CPT,Facility,Both,,,,490,416.5,152.4,490,"Health Partners, Inc.",State of Minnesota Advantage Program,399.35,81.5,,percent of total billed charges,,
Mammo Sage Screen Bil,,77067,CPT,Facility,Both,,,,490,416.5,152.4,490,"Health Partners, Inc.",State Public Programs,245,50,,percent of total billed charges,,
Mammo Sage Screen Bil,,77067,CPT,Facility,Both,,,,490,416.5,152.4,490,Humana Insurance Company,Commercial PPO,465.5,95,,percent of total billed charges,,
Mammo Sage Screen Bil,,77067,CPT,Facility,Outpatient,,,,490,416.5,152.4,490,Humana Insurance Company,Medicare PPO,240.1,49,,percent of total billed charges,,
Mammo Sage Screen Bil,,77067,CPT,Facility,Inpatient,,,,490,416.5,152.4,490,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Mammo Sage Screen Bil,,77067,CPT,Facility,Both,,,,490,416.5,152.4,490,Medica,Individual & Family,485.59,99.1,,percent of total billed charges,,
Mammo Sage Screen Bil,,77067,CPT,Facility,Outpatient,,,,490,416.5,152.4,490,Medica,Medica Advantage Solution,244.02,49.8,,percent of total billed charges,,
Mammo Sage Screen Bil,,77067,CPT,Facility,Inpatient,,,,490,416.5,152.4,490,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Mammo Sage Screen Bil,,77067,CPT,Facility,Outpatient,,,,490,416.5,152.4,490,Medica,Medical Assistance,218.54,44.6,,percent of total billed charges,,
Mammo Sage Screen Bil,,77067,CPT,Facility,Inpatient,,,,490,416.5,152.4,490,Medica,Medical Assistance,,,,,Included in per diem rate,
Mammo Sage Screen Bil,,77067,CPT,Facility,Outpatient,,,,490,416.5,152.4,490,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,244.02,49.8,,percent of total billed charges,,
Mammo Sage Screen Bil,,77067,CPT,Facility,Inpatient,,,,490,416.5,152.4,490,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Mammo Sage Screen Bil,,77067,CPT,Facility,Both,,,,490,416.5,152.4,490,"Multiplan, Inc.","Multiplan, Inc.",460.6,94,,percent of total billed charges,,
Mammo Sage Screen Bil,,77067,CPT,Facility,Outpatient,,,,490,416.5,152.4,490,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,441.49,90.1,,percent of total billed charges,,
Mammo Sage Screen Bil,,77067,CPT,Facility,Inpatient,,,,490,416.5,152.4,490,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Mammo Sage Screen Bil,,77067,CPT,Facility,Both,,,,490,416.5,152.4,490,"Preferred One Administrative Services, INC.",PPO,483.14,98.6,,percent of total billed charges,,
Mammo Sage Screen Bil,,77067,CPT,Facility,Outpatient,,,,490,416.5,152.4,490,PrimeWest Health,Minnesota Senior Health Options (MSHO),252.105,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Mammo Sage Screen Bil,,77067,CPT,Facility,Inpatient,,,,490,416.5,152.4,490,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mammo Sage Screen Bil,,77067,CPT,Facility,Outpatient,,,,490,416.5,152.4,490,PrimeWest Health,MinnesotaCare,251.664,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Mammo Sage Screen Bil,,77067,CPT,Facility,Inpatient,,,,490,416.5,152.4,490,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Mammo Sage Screen Bil,,77067,CPT,Facility,Both,,,,490,416.5,152.4,490,Sanford Health Plan,Sanford Health Plan,450.8,92,,percent of total billed charges,,
Mammo Sage Screen Bil,,77067,CPT,Facility,Outpatient,,,,490,416.5,152.4,490,"UCare Health, Inc.",Individual & Family Plan,276.115,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Mammo Sage Screen Bil,,77067,CPT,Facility,Inpatient,,,,490,416.5,152.4,490,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Mammo Sage Screen Bil,,77067,CPT,Facility,Outpatient,,,,490,416.5,152.4,490,"UCare Health, Inc.",Medical Assistance,247.303,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mammo Sage Screen Bil,,77067,CPT,Facility,Inpatient,,,,490,416.5,152.4,490,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Mammo Sage Screen Bil,,77067,CPT,Facility,Outpatient,,,,490,416.5,152.4,490,"UCare Health, Inc.",Medicare Advantage,247.303,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mammo Sage Screen Bil,,77067,CPT,Facility,Inpatient,,,,490,416.5,152.4,490,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mammo Sage Screen Bil,,77067,CPT,Facility,Outpatient,,,,490,416.5,152.4,490,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),247.303,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mammo Sage Screen Bil,,77067,CPT,Facility,Inpatient,,,,490,416.5,152.4,490,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mammo Sage Screen Bil,,77067,CPT,Facility,Both,,,,490,416.5,152.4,490,UnitedHealthcare,Individual & Family,460.6,94,,percent of total billed charges,,
Mammo Sage Screen Bil,,77067,CPT,Facility,Outpatient,,,,490,416.5,152.4,490,UnitedHealthcare,Medicare Advantage,240.1,49,,percent of total billed charges,,
Mammo Sage Screen Bil,,77067,CPT,Facility,Inpatient,,,,490,416.5,152.4,490,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Mammo Sage Screen Bil,,77067,CPT,Facility,Outpatient,,,,490,416.5,152.4,490,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,235.2,48,,percent of total billed charges,,100% of DHS outpatient percentage
Mammo Sage Screen Bil,,77067,CPT,Facility,Inpatient,,,,490,416.5,152.4,490,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Mammo Sage Screen Bsl Bil,,77067,CPT,Facility,Both,,,,490,416.5,152.4,490,Aetna,Commercial,450.8,92,,percent of total billed charges,,
Mammo Sage Screen Bsl Bil,,77067,CPT,Facility,Outpatient,,,,490,416.5,152.4,490,Aetna,Medicare Advantage,240.1,49,,percent of total billed charges,,
Mammo Sage Screen Bsl Bil,,77067,CPT,Facility,Inpatient,,,,490,416.5,152.4,490,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Mammo Sage Screen Bsl Bil,,77067,CPT,Facility,Both,,,,490,416.5,152.4,490,Aetna,PPO,455.7,93,,percent of total billed charges,,
Mammo Sage Screen Bsl Bil,,77067,CPT,Facility,Both,,,,490,416.5,152.4,490,America's PPO,America's PPO,470.547,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Mammo Sage Screen Bsl Bil,,77067,CPT,Facility,Both,,,,490,416.5,152.4,490,BlueCross BlueShield Minnesota, Federal Employee Program,300,,,Fee schedule,,100% of BCBS commercial commodity fee schedule
Mammo Sage Screen Bsl Bil,,77067,CPT,Facility,Both,,,,490,416.5,152.4,490,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,304.8,,,Fee schedule,,"100% of BCBS commercial commodity fee schedule, plus MN Care tax"
Mammo Sage Screen Bsl Bil,,77067,CPT,Facility,Both,,,,490,416.5,152.4,490,BlueCross BlueShield Minnesota,High Value Network Plan,274.32,,,Fee schedule,,"90% of BCBS commercial commodity fee schedule, plus MN Care tax; see disclaimer for more information"
Mammo Sage Screen Bsl Bil,,77067,CPT,Facility,Outpatient,,,,490,416.5,152.4,490,BlueCross BlueShield Minnesota,Medicare Advantage,240.1,49,,percent of total billed charges,,
Mammo Sage Screen Bsl Bil,,77067,CPT,Facility,Inpatient,,,,490,416.5,152.4,490,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Mammo Sage Screen Bsl Bil,,77067,CPT,Facility,Both,,,,490,416.5,152.4,490,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,269.96136,,,Fee schedule,,"88.57% of BCBS commercial commodity fee schedule, plus MN Care tax"
Mammo Sage Screen Bsl Bil,,77067,CPT,Facility,Both,,,,490,416.5,152.4,490,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,152.4,,,Fee schedule,,"100% of BCBS Medicaid commodity fee schedule, plus MN Care tax"
Mammo Sage Screen Bsl Bil,,77067,CPT,Facility,Outpatient,,,,490,416.5,152.4,490,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),240.1,49,,percent of total billed charges,,
Mammo Sage Screen Bsl Bil,,77067,CPT,Facility,Inpatient,,,,490,416.5,152.4,490,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Mammo Sage Screen Bsl Bil,,77067,CPT,Facility,Both,,,,490,416.5,152.4,490,CorVel,Worker's Compensation,490,100,,percent of total billed charges,,
Mammo Sage Screen Bsl Bil,,77067,CPT,Facility,Both,,,,490,416.5,152.4,490,First Health Group Corporation,First Health Network,475.3,97,,percent of total billed charges,,
Mammo Sage Screen Bsl Bil,,77067,CPT,Facility,Both,,,,490,416.5,152.4,490,"Health Partners, Inc.",Commercial,463.54,94.6,,percent of total billed charges,,
Mammo Sage Screen Bsl Bil,,77067,CPT,Facility,Outpatient,,,,490,416.5,152.4,490,"Health Partners, Inc.",Medicare Advantage,240.1,49,,percent of total billed charges,,
Mammo Sage Screen Bsl Bil,,77067,CPT,Facility,Inpatient,,,,490,416.5,152.4,490,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mammo Sage Screen Bsl Bil,,77067,CPT,Facility,Both,,,,490,416.5,152.4,490,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),294,60,,percent of total billed charges,,
Mammo Sage Screen Bsl Bil,,77067,CPT,Facility,Both,,,,490,416.5,152.4,490,"Health Partners, Inc.",State of Minnesota Advantage Program,399.35,81.5,,percent of total billed charges,,
Mammo Sage Screen Bsl Bil,,77067,CPT,Facility,Both,,,,490,416.5,152.4,490,"Health Partners, Inc.",State Public Programs,245,50,,percent of total billed charges,,
Mammo Sage Screen Bsl Bil,,77067,CPT,Facility,Both,,,,490,416.5,152.4,490,Humana Insurance Company,Commercial PPO,465.5,95,,percent of total billed charges,,
Mammo Sage Screen Bsl Bil,,77067,CPT,Facility,Outpatient,,,,490,416.5,152.4,490,Humana Insurance Company,Medicare PPO,240.1,49,,percent of total billed charges,,
Mammo Sage Screen Bsl Bil,,77067,CPT,Facility,Inpatient,,,,490,416.5,152.4,490,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Mammo Sage Screen Bsl Bil,,77067,CPT,Facility,Both,,,,490,416.5,152.4,490,Medica,Individual & Family,485.59,99.1,,percent of total billed charges,,
Mammo Sage Screen Bsl Bil,,77067,CPT,Facility,Outpatient,,,,490,416.5,152.4,490,Medica,Medica Advantage Solution,244.02,49.8,,percent of total billed charges,,
Mammo Sage Screen Bsl Bil,,77067,CPT,Facility,Inpatient,,,,490,416.5,152.4,490,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Mammo Sage Screen Bsl Bil,,77067,CPT,Facility,Outpatient,,,,490,416.5,152.4,490,Medica,Medical Assistance,218.54,44.6,,percent of total billed charges,,
Mammo Sage Screen Bsl Bil,,77067,CPT,Facility,Inpatient,,,,490,416.5,152.4,490,Medica,Medical Assistance,,,,,Included in per diem rate,
Mammo Sage Screen Bsl Bil,,77067,CPT,Facility,Outpatient,,,,490,416.5,152.4,490,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,244.02,49.8,,percent of total billed charges,,
Mammo Sage Screen Bsl Bil,,77067,CPT,Facility,Inpatient,,,,490,416.5,152.4,490,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Mammo Sage Screen Bsl Bil,,77067,CPT,Facility,Both,,,,490,416.5,152.4,490,"Multiplan, Inc.","Multiplan, Inc.",460.6,94,,percent of total billed charges,,
Mammo Sage Screen Bsl Bil,,77067,CPT,Facility,Outpatient,,,,490,416.5,152.4,490,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,441.49,90.1,,percent of total billed charges,,
Mammo Sage Screen Bsl Bil,,77067,CPT,Facility,Inpatient,,,,490,416.5,152.4,490,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Mammo Sage Screen Bsl Bil,,77067,CPT,Facility,Both,,,,490,416.5,152.4,490,"Preferred One Administrative Services, INC.",PPO,483.14,98.6,,percent of total billed charges,,
Mammo Sage Screen Bsl Bil,,77067,CPT,Facility,Outpatient,,,,490,416.5,152.4,490,PrimeWest Health,Minnesota Senior Health Options (MSHO),252.105,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Mammo Sage Screen Bsl Bil,,77067,CPT,Facility,Inpatient,,,,490,416.5,152.4,490,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mammo Sage Screen Bsl Bil,,77067,CPT,Facility,Outpatient,,,,490,416.5,152.4,490,PrimeWest Health,MinnesotaCare,251.664,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Mammo Sage Screen Bsl Bil,,77067,CPT,Facility,Inpatient,,,,490,416.5,152.4,490,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Mammo Sage Screen Bsl Bil,,77067,CPT,Facility,Both,,,,490,416.5,152.4,490,Sanford Health Plan,Sanford Health Plan,450.8,92,,percent of total billed charges,,
Mammo Sage Screen Bsl Bil,,77067,CPT,Facility,Outpatient,,,,490,416.5,152.4,490,"UCare Health, Inc.",Individual & Family Plan,276.115,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Mammo Sage Screen Bsl Bil,,77067,CPT,Facility,Inpatient,,,,490,416.5,152.4,490,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Mammo Sage Screen Bsl Bil,,77067,CPT,Facility,Outpatient,,,,490,416.5,152.4,490,"UCare Health, Inc.",Medical Assistance,247.303,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mammo Sage Screen Bsl Bil,,77067,CPT,Facility,Inpatient,,,,490,416.5,152.4,490,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Mammo Sage Screen Bsl Bil,,77067,CPT,Facility,Outpatient,,,,490,416.5,152.4,490,"UCare Health, Inc.",Medicare Advantage,247.303,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mammo Sage Screen Bsl Bil,,77067,CPT,Facility,Inpatient,,,,490,416.5,152.4,490,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mammo Sage Screen Bsl Bil,,77067,CPT,Facility,Outpatient,,,,490,416.5,152.4,490,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),247.303,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mammo Sage Screen Bsl Bil,,77067,CPT,Facility,Inpatient,,,,490,416.5,152.4,490,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mammo Sage Screen Bsl Bil,,77067,CPT,Facility,Both,,,,490,416.5,152.4,490,UnitedHealthcare,Individual & Family,460.6,94,,percent of total billed charges,,
Mammo Sage Screen Bsl Bil,,77067,CPT,Facility,Outpatient,,,,490,416.5,152.4,490,UnitedHealthcare,Medicare Advantage,240.1,49,,percent of total billed charges,,
Mammo Sage Screen Bsl Bil,,77067,CPT,Facility,Inpatient,,,,490,416.5,152.4,490,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Mammo Sage Screen Bsl Bil,,77067,CPT,Facility,Outpatient,,,,490,416.5,152.4,490,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,235.2,48,,percent of total billed charges,,100% of DHS outpatient percentage
Mammo Sage Screen Bsl Bil,,77067,CPT,Facility,Inpatient,,,,490,416.5,152.4,490,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Mammo Sage Screen W Implants Bil,,77067,CPT,Facility,Both,,,,490,416.5,152.4,490,Aetna,Commercial,450.8,92,,percent of total billed charges,,
Mammo Sage Screen W Implants Bil,,77067,CPT,Facility,Outpatient,,,,490,416.5,152.4,490,Aetna,Medicare Advantage,240.1,49,,percent of total billed charges,,
Mammo Sage Screen W Implants Bil,,77067,CPT,Facility,Inpatient,,,,490,416.5,152.4,490,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Mammo Sage Screen W Implants Bil,,77067,CPT,Facility,Both,,,,490,416.5,152.4,490,Aetna,PPO,455.7,93,,percent of total billed charges,,
Mammo Sage Screen W Implants Bil,,77067,CPT,Facility,Both,,,,490,416.5,152.4,490,America's PPO,America's PPO,470.547,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Mammo Sage Screen W Implants Bil,,77067,CPT,Facility,Both,,,,490,416.5,152.4,490,BlueCross BlueShield Minnesota, Federal Employee Program,300,,,Fee schedule,,100% of BCBS commercial commodity fee schedule
Mammo Sage Screen W Implants Bil,,77067,CPT,Facility,Both,,,,490,416.5,152.4,490,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,304.8,,,Fee schedule,,"100% of BCBS commercial commodity fee schedule, plus MN Care tax"
Mammo Sage Screen W Implants Bil,,77067,CPT,Facility,Both,,,,490,416.5,152.4,490,BlueCross BlueShield Minnesota,High Value Network Plan,274.32,,,Fee schedule,,"90% of BCBS commercial commodity fee schedule, plus MN Care tax; see disclaimer for more information"
Mammo Sage Screen W Implants Bil,,77067,CPT,Facility,Outpatient,,,,490,416.5,152.4,490,BlueCross BlueShield Minnesota,Medicare Advantage,240.1,49,,percent of total billed charges,,
Mammo Sage Screen W Implants Bil,,77067,CPT,Facility,Inpatient,,,,490,416.5,152.4,490,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Mammo Sage Screen W Implants Bil,,77067,CPT,Facility,Both,,,,490,416.5,152.4,490,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,269.96136,,,Fee schedule,,"88.57% of BCBS commercial commodity fee schedule, plus MN Care tax"
Mammo Sage Screen W Implants Bil,,77067,CPT,Facility,Both,,,,490,416.5,152.4,490,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,152.4,,,Fee schedule,,"100% of BCBS Medicaid commodity fee schedule, plus MN Care tax"
Mammo Sage Screen W Implants Bil,,77067,CPT,Facility,Outpatient,,,,490,416.5,152.4,490,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),240.1,49,,percent of total billed charges,,
Mammo Sage Screen W Implants Bil,,77067,CPT,Facility,Inpatient,,,,490,416.5,152.4,490,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Mammo Sage Screen W Implants Bil,,77067,CPT,Facility,Both,,,,490,416.5,152.4,490,CorVel,Worker's Compensation,490,100,,percent of total billed charges,,
Mammo Sage Screen W Implants Bil,,77067,CPT,Facility,Both,,,,490,416.5,152.4,490,First Health Group Corporation,First Health Network,475.3,97,,percent of total billed charges,,
Mammo Sage Screen W Implants Bil,,77067,CPT,Facility,Both,,,,490,416.5,152.4,490,"Health Partners, Inc.",Commercial,463.54,94.6,,percent of total billed charges,,
Mammo Sage Screen W Implants Bil,,77067,CPT,Facility,Outpatient,,,,490,416.5,152.4,490,"Health Partners, Inc.",Medicare Advantage,240.1,49,,percent of total billed charges,,
Mammo Sage Screen W Implants Bil,,77067,CPT,Facility,Inpatient,,,,490,416.5,152.4,490,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mammo Sage Screen W Implants Bil,,77067,CPT,Facility,Both,,,,490,416.5,152.4,490,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),294,60,,percent of total billed charges,,
Mammo Sage Screen W Implants Bil,,77067,CPT,Facility,Both,,,,490,416.5,152.4,490,"Health Partners, Inc.",State of Minnesota Advantage Program,399.35,81.5,,percent of total billed charges,,
Mammo Sage Screen W Implants Bil,,77067,CPT,Facility,Both,,,,490,416.5,152.4,490,"Health Partners, Inc.",State Public Programs,245,50,,percent of total billed charges,,
Mammo Sage Screen W Implants Bil,,77067,CPT,Facility,Both,,,,490,416.5,152.4,490,Humana Insurance Company,Commercial PPO,465.5,95,,percent of total billed charges,,
Mammo Sage Screen W Implants Bil,,77067,CPT,Facility,Outpatient,,,,490,416.5,152.4,490,Humana Insurance Company,Medicare PPO,240.1,49,,percent of total billed charges,,
Mammo Sage Screen W Implants Bil,,77067,CPT,Facility,Inpatient,,,,490,416.5,152.4,490,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Mammo Sage Screen W Implants Bil,,77067,CPT,Facility,Both,,,,490,416.5,152.4,490,Medica,Individual & Family,485.59,99.1,,percent of total billed charges,,
Mammo Sage Screen W Implants Bil,,77067,CPT,Facility,Outpatient,,,,490,416.5,152.4,490,Medica,Medica Advantage Solution,244.02,49.8,,percent of total billed charges,,
Mammo Sage Screen W Implants Bil,,77067,CPT,Facility,Inpatient,,,,490,416.5,152.4,490,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Mammo Sage Screen W Implants Bil,,77067,CPT,Facility,Outpatient,,,,490,416.5,152.4,490,Medica,Medical Assistance,218.54,44.6,,percent of total billed charges,,
Mammo Sage Screen W Implants Bil,,77067,CPT,Facility,Inpatient,,,,490,416.5,152.4,490,Medica,Medical Assistance,,,,,Included in per diem rate,
Mammo Sage Screen W Implants Bil,,77067,CPT,Facility,Outpatient,,,,490,416.5,152.4,490,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,244.02,49.8,,percent of total billed charges,,
Mammo Sage Screen W Implants Bil,,77067,CPT,Facility,Inpatient,,,,490,416.5,152.4,490,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Mammo Sage Screen W Implants Bil,,77067,CPT,Facility,Both,,,,490,416.5,152.4,490,"Multiplan, Inc.","Multiplan, Inc.",460.6,94,,percent of total billed charges,,
Mammo Sage Screen W Implants Bil,,77067,CPT,Facility,Outpatient,,,,490,416.5,152.4,490,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,441.49,90.1,,percent of total billed charges,,
Mammo Sage Screen W Implants Bil,,77067,CPT,Facility,Inpatient,,,,490,416.5,152.4,490,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Mammo Sage Screen W Implants Bil,,77067,CPT,Facility,Both,,,,490,416.5,152.4,490,"Preferred One Administrative Services, INC.",PPO,483.14,98.6,,percent of total billed charges,,
Mammo Sage Screen W Implants Bil,,77067,CPT,Facility,Outpatient,,,,490,416.5,152.4,490,PrimeWest Health,Minnesota Senior Health Options (MSHO),252.105,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Mammo Sage Screen W Implants Bil,,77067,CPT,Facility,Inpatient,,,,490,416.5,152.4,490,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mammo Sage Screen W Implants Bil,,77067,CPT,Facility,Outpatient,,,,490,416.5,152.4,490,PrimeWest Health,MinnesotaCare,251.664,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Mammo Sage Screen W Implants Bil,,77067,CPT,Facility,Inpatient,,,,490,416.5,152.4,490,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Mammo Sage Screen W Implants Bil,,77067,CPT,Facility,Both,,,,490,416.5,152.4,490,Sanford Health Plan,Sanford Health Plan,450.8,92,,percent of total billed charges,,
Mammo Sage Screen W Implants Bil,,77067,CPT,Facility,Outpatient,,,,490,416.5,152.4,490,"UCare Health, Inc.",Individual & Family Plan,276.115,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Mammo Sage Screen W Implants Bil,,77067,CPT,Facility,Inpatient,,,,490,416.5,152.4,490,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Mammo Sage Screen W Implants Bil,,77067,CPT,Facility,Outpatient,,,,490,416.5,152.4,490,"UCare Health, Inc.",Medical Assistance,247.303,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mammo Sage Screen W Implants Bil,,77067,CPT,Facility,Inpatient,,,,490,416.5,152.4,490,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Mammo Sage Screen W Implants Bil,,77067,CPT,Facility,Outpatient,,,,490,416.5,152.4,490,"UCare Health, Inc.",Medicare Advantage,247.303,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mammo Sage Screen W Implants Bil,,77067,CPT,Facility,Inpatient,,,,490,416.5,152.4,490,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mammo Sage Screen W Implants Bil,,77067,CPT,Facility,Outpatient,,,,490,416.5,152.4,490,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),247.303,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mammo Sage Screen W Implants Bil,,77067,CPT,Facility,Inpatient,,,,490,416.5,152.4,490,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mammo Sage Screen W Implants Bil,,77067,CPT,Facility,Both,,,,490,416.5,152.4,490,UnitedHealthcare,Individual & Family,460.6,94,,percent of total billed charges,,
Mammo Sage Screen W Implants Bil,,77067,CPT,Facility,Outpatient,,,,490,416.5,152.4,490,UnitedHealthcare,Medicare Advantage,240.1,49,,percent of total billed charges,,
Mammo Sage Screen W Implants Bil,,77067,CPT,Facility,Inpatient,,,,490,416.5,152.4,490,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Mammo Sage Screen W Implants Bil,,77067,CPT,Facility,Outpatient,,,,490,416.5,152.4,490,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,235.2,48,,percent of total billed charges,,100% of DHS outpatient percentage
Mammo Sage Screen W Implants Bil,,77067,CPT,Facility,Inpatient,,,,490,416.5,152.4,490,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Mammo Screen Bil,,77067,CPT,Facility,Both,,,,490,416.5,152.4,490,Aetna,Commercial,450.8,92,,percent of total billed charges,,
Mammo Screen Bil,,77067,CPT,Facility,Outpatient,,,,490,416.5,152.4,490,Aetna,Medicare Advantage,240.1,49,,percent of total billed charges,,
Mammo Screen Bil,,77067,CPT,Facility,Inpatient,,,,490,416.5,152.4,490,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Mammo Screen Bil,,77067,CPT,Facility,Both,,,,490,416.5,152.4,490,Aetna,PPO,455.7,93,,percent of total billed charges,,
Mammo Screen Bil,,77067,CPT,Facility,Both,,,,490,416.5,152.4,490,America's PPO,America's PPO,470.547,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Mammo Screen Bil,,77067,CPT,Facility,Both,,,,490,416.5,152.4,490,BlueCross BlueShield Minnesota, Federal Employee Program,300,,,Fee schedule,,100% of BCBS commercial commodity fee schedule
Mammo Screen Bil,,77067,CPT,Facility,Both,,,,490,416.5,152.4,490,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,304.8,,,Fee schedule,,"100% of BCBS commercial commodity fee schedule, plus MN Care tax"
Mammo Screen Bil,,77067,CPT,Facility,Both,,,,490,416.5,152.4,490,BlueCross BlueShield Minnesota,High Value Network Plan,274.32,,,Fee schedule,,"90% of BCBS commercial commodity fee schedule, plus MN Care tax; see disclaimer for more information"
Mammo Screen Bil,,77067,CPT,Facility,Outpatient,,,,490,416.5,152.4,490,BlueCross BlueShield Minnesota,Medicare Advantage,240.1,49,,percent of total billed charges,,
Mammo Screen Bil,,77067,CPT,Facility,Inpatient,,,,490,416.5,152.4,490,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Mammo Screen Bil,,77067,CPT,Facility,Both,,,,490,416.5,152.4,490,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,269.96136,,,Fee schedule,,"88.57% of BCBS commercial commodity fee schedule, plus MN Care tax"
Mammo Screen Bil,,77067,CPT,Facility,Both,,,,490,416.5,152.4,490,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,152.4,,,Fee schedule,,"100% of BCBS Medicaid commodity fee schedule, plus MN Care tax"
Mammo Screen Bil,,77067,CPT,Facility,Outpatient,,,,490,416.5,152.4,490,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),240.1,49,,percent of total billed charges,,
Mammo Screen Bil,,77067,CPT,Facility,Inpatient,,,,490,416.5,152.4,490,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Mammo Screen Bil,,77067,CPT,Facility,Both,,,,490,416.5,152.4,490,CorVel,Worker's Compensation,490,100,,percent of total billed charges,,
Mammo Screen Bil,,77067,CPT,Facility,Both,,,,490,416.5,152.4,490,First Health Group Corporation,First Health Network,475.3,97,,percent of total billed charges,,
Mammo Screen Bil,,77067,CPT,Facility,Both,,,,490,416.5,152.4,490,"Health Partners, Inc.",Commercial,463.54,94.6,,percent of total billed charges,,
Mammo Screen Bil,,77067,CPT,Facility,Outpatient,,,,490,416.5,152.4,490,"Health Partners, Inc.",Medicare Advantage,240.1,49,,percent of total billed charges,,
Mammo Screen Bil,,77067,CPT,Facility,Inpatient,,,,490,416.5,152.4,490,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mammo Screen Bil,,77067,CPT,Facility,Both,,,,490,416.5,152.4,490,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),294,60,,percent of total billed charges,,
Mammo Screen Bil,,77067,CPT,Facility,Both,,,,490,416.5,152.4,490,"Health Partners, Inc.",State of Minnesota Advantage Program,399.35,81.5,,percent of total billed charges,,
Mammo Screen Bil,,77067,CPT,Facility,Both,,,,490,416.5,152.4,490,"Health Partners, Inc.",State Public Programs,245,50,,percent of total billed charges,,
Mammo Screen Bil,,77067,CPT,Facility,Both,,,,490,416.5,152.4,490,Humana Insurance Company,Commercial PPO,465.5,95,,percent of total billed charges,,
Mammo Screen Bil,,77067,CPT,Facility,Outpatient,,,,490,416.5,152.4,490,Humana Insurance Company,Medicare PPO,240.1,49,,percent of total billed charges,,
Mammo Screen Bil,,77067,CPT,Facility,Inpatient,,,,490,416.5,152.4,490,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Mammo Screen Bil,,77067,CPT,Facility,Both,,,,490,416.5,152.4,490,Medica,Individual & Family,485.59,99.1,,percent of total billed charges,,
Mammo Screen Bil,,77067,CPT,Facility,Outpatient,,,,490,416.5,152.4,490,Medica,Medica Advantage Solution,244.02,49.8,,percent of total billed charges,,
Mammo Screen Bil,,77067,CPT,Facility,Inpatient,,,,490,416.5,152.4,490,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Mammo Screen Bil,,77067,CPT,Facility,Outpatient,,,,490,416.5,152.4,490,Medica,Medical Assistance,218.54,44.6,,percent of total billed charges,,
Mammo Screen Bil,,77067,CPT,Facility,Inpatient,,,,490,416.5,152.4,490,Medica,Medical Assistance,,,,,Included in per diem rate,
Mammo Screen Bil,,77067,CPT,Facility,Outpatient,,,,490,416.5,152.4,490,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,244.02,49.8,,percent of total billed charges,,
Mammo Screen Bil,,77067,CPT,Facility,Inpatient,,,,490,416.5,152.4,490,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Mammo Screen Bil,,77067,CPT,Facility,Both,,,,490,416.5,152.4,490,"Multiplan, Inc.","Multiplan, Inc.",460.6,94,,percent of total billed charges,,
Mammo Screen Bil,,77067,CPT,Facility,Outpatient,,,,490,416.5,152.4,490,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,441.49,90.1,,percent of total billed charges,,
Mammo Screen Bil,,77067,CPT,Facility,Inpatient,,,,490,416.5,152.4,490,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Mammo Screen Bil,,77067,CPT,Facility,Both,,,,490,416.5,152.4,490,"Preferred One Administrative Services, INC.",PPO,483.14,98.6,,percent of total billed charges,,
Mammo Screen Bil,,77067,CPT,Facility,Outpatient,,,,490,416.5,152.4,490,PrimeWest Health,Minnesota Senior Health Options (MSHO),252.105,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Mammo Screen Bil,,77067,CPT,Facility,Inpatient,,,,490,416.5,152.4,490,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mammo Screen Bil,,77067,CPT,Facility,Outpatient,,,,490,416.5,152.4,490,PrimeWest Health,MinnesotaCare,251.664,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Mammo Screen Bil,,77067,CPT,Facility,Inpatient,,,,490,416.5,152.4,490,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Mammo Screen Bil,,77067,CPT,Facility,Both,,,,490,416.5,152.4,490,Sanford Health Plan,Sanford Health Plan,450.8,92,,percent of total billed charges,,
Mammo Screen Bil,,77067,CPT,Facility,Outpatient,,,,490,416.5,152.4,490,"UCare Health, Inc.",Individual & Family Plan,276.115,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Mammo Screen Bil,,77067,CPT,Facility,Inpatient,,,,490,416.5,152.4,490,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Mammo Screen Bil,,77067,CPT,Facility,Outpatient,,,,490,416.5,152.4,490,"UCare Health, Inc.",Medical Assistance,247.303,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mammo Screen Bil,,77067,CPT,Facility,Inpatient,,,,490,416.5,152.4,490,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Mammo Screen Bil,,77067,CPT,Facility,Outpatient,,,,490,416.5,152.4,490,"UCare Health, Inc.",Medicare Advantage,247.303,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mammo Screen Bil,,77067,CPT,Facility,Inpatient,,,,490,416.5,152.4,490,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mammo Screen Bil,,77067,CPT,Facility,Outpatient,,,,490,416.5,152.4,490,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),247.303,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mammo Screen Bil,,77067,CPT,Facility,Inpatient,,,,490,416.5,152.4,490,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mammo Screen Bil,,77067,CPT,Facility,Both,,,,490,416.5,152.4,490,UnitedHealthcare,Individual & Family,460.6,94,,percent of total billed charges,,
Mammo Screen Bil,,77067,CPT,Facility,Outpatient,,,,490,416.5,152.4,490,UnitedHealthcare,Medicare Advantage,240.1,49,,percent of total billed charges,,
Mammo Screen Bil,,77067,CPT,Facility,Inpatient,,,,490,416.5,152.4,490,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Mammo Screen Bil,,77067,CPT,Facility,Outpatient,,,,490,416.5,152.4,490,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,235.2,48,,percent of total billed charges,,100% of DHS outpatient percentage
Mammo Screen Bil,,77067,CPT,Facility,Inpatient,,,,490,416.5,152.4,490,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Mammo Screen W Implants Bil,,77067,CPT,Facility,Both,,,,490,416.5,152.4,490,Aetna,Commercial,450.8,92,,percent of total billed charges,,
Mammo Screen W Implants Bil,,77067,CPT,Facility,Outpatient,,,,490,416.5,152.4,490,Aetna,Medicare Advantage,240.1,49,,percent of total billed charges,,
Mammo Screen W Implants Bil,,77067,CPT,Facility,Inpatient,,,,490,416.5,152.4,490,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Mammo Screen W Implants Bil,,77067,CPT,Facility,Both,,,,490,416.5,152.4,490,Aetna,PPO,455.7,93,,percent of total billed charges,,
Mammo Screen W Implants Bil,,77067,CPT,Facility,Both,,,,490,416.5,152.4,490,America's PPO,America's PPO,470.547,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Mammo Screen W Implants Bil,,77067,CPT,Facility,Both,,,,490,416.5,152.4,490,BlueCross BlueShield Minnesota, Federal Employee Program,300,,,Fee schedule,,100% of BCBS commercial commodity fee schedule
Mammo Screen W Implants Bil,,77067,CPT,Facility,Both,,,,490,416.5,152.4,490,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,304.8,,,Fee schedule,,"100% of BCBS commercial commodity fee schedule, plus MN Care tax"
Mammo Screen W Implants Bil,,77067,CPT,Facility,Both,,,,490,416.5,152.4,490,BlueCross BlueShield Minnesota,High Value Network Plan,274.32,,,Fee schedule,,"90% of BCBS commercial commodity fee schedule, plus MN Care tax; see disclaimer for more information"
Mammo Screen W Implants Bil,,77067,CPT,Facility,Outpatient,,,,490,416.5,152.4,490,BlueCross BlueShield Minnesota,Medicare Advantage,240.1,49,,percent of total billed charges,,
Mammo Screen W Implants Bil,,77067,CPT,Facility,Inpatient,,,,490,416.5,152.4,490,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Mammo Screen W Implants Bil,,77067,CPT,Facility,Both,,,,490,416.5,152.4,490,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,269.96136,,,Fee schedule,,"88.57% of BCBS commercial commodity fee schedule, plus MN Care tax"
Mammo Screen W Implants Bil,,77067,CPT,Facility,Both,,,,490,416.5,152.4,490,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,152.4,,,Fee schedule,,"100% of BCBS Medicaid commodity fee schedule, plus MN Care tax"
Mammo Screen W Implants Bil,,77067,CPT,Facility,Outpatient,,,,490,416.5,152.4,490,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),240.1,49,,percent of total billed charges,,
Mammo Screen W Implants Bil,,77067,CPT,Facility,Inpatient,,,,490,416.5,152.4,490,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Mammo Screen W Implants Bil,,77067,CPT,Facility,Both,,,,490,416.5,152.4,490,CorVel,Worker's Compensation,490,100,,percent of total billed charges,,
Mammo Screen W Implants Bil,,77067,CPT,Facility,Both,,,,490,416.5,152.4,490,First Health Group Corporation,First Health Network,475.3,97,,percent of total billed charges,,
Mammo Screen W Implants Bil,,77067,CPT,Facility,Both,,,,490,416.5,152.4,490,"Health Partners, Inc.",Commercial,463.54,94.6,,percent of total billed charges,,
Mammo Screen W Implants Bil,,77067,CPT,Facility,Outpatient,,,,490,416.5,152.4,490,"Health Partners, Inc.",Medicare Advantage,240.1,49,,percent of total billed charges,,
Mammo Screen W Implants Bil,,77067,CPT,Facility,Inpatient,,,,490,416.5,152.4,490,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mammo Screen W Implants Bil,,77067,CPT,Facility,Both,,,,490,416.5,152.4,490,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),294,60,,percent of total billed charges,,
Mammo Screen W Implants Bil,,77067,CPT,Facility,Both,,,,490,416.5,152.4,490,"Health Partners, Inc.",State of Minnesota Advantage Program,399.35,81.5,,percent of total billed charges,,
Mammo Screen W Implants Bil,,77067,CPT,Facility,Both,,,,490,416.5,152.4,490,"Health Partners, Inc.",State Public Programs,245,50,,percent of total billed charges,,
Mammo Screen W Implants Bil,,77067,CPT,Facility,Both,,,,490,416.5,152.4,490,Humana Insurance Company,Commercial PPO,465.5,95,,percent of total billed charges,,
Mammo Screen W Implants Bil,,77067,CPT,Facility,Outpatient,,,,490,416.5,152.4,490,Humana Insurance Company,Medicare PPO,240.1,49,,percent of total billed charges,,
Mammo Screen W Implants Bil,,77067,CPT,Facility,Inpatient,,,,490,416.5,152.4,490,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Mammo Screen W Implants Bil,,77067,CPT,Facility,Both,,,,490,416.5,152.4,490,Medica,Individual & Family,485.59,99.1,,percent of total billed charges,,
Mammo Screen W Implants Bil,,77067,CPT,Facility,Outpatient,,,,490,416.5,152.4,490,Medica,Medica Advantage Solution,244.02,49.8,,percent of total billed charges,,
Mammo Screen W Implants Bil,,77067,CPT,Facility,Inpatient,,,,490,416.5,152.4,490,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Mammo Screen W Implants Bil,,77067,CPT,Facility,Outpatient,,,,490,416.5,152.4,490,Medica,Medical Assistance,218.54,44.6,,percent of total billed charges,,
Mammo Screen W Implants Bil,,77067,CPT,Facility,Inpatient,,,,490,416.5,152.4,490,Medica,Medical Assistance,,,,,Included in per diem rate,
Mammo Screen W Implants Bil,,77067,CPT,Facility,Outpatient,,,,490,416.5,152.4,490,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,244.02,49.8,,percent of total billed charges,,
Mammo Screen W Implants Bil,,77067,CPT,Facility,Inpatient,,,,490,416.5,152.4,490,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Mammo Screen W Implants Bil,,77067,CPT,Facility,Both,,,,490,416.5,152.4,490,"Multiplan, Inc.","Multiplan, Inc.",460.6,94,,percent of total billed charges,,
Mammo Screen W Implants Bil,,77067,CPT,Facility,Outpatient,,,,490,416.5,152.4,490,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,441.49,90.1,,percent of total billed charges,,
Mammo Screen W Implants Bil,,77067,CPT,Facility,Inpatient,,,,490,416.5,152.4,490,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Mammo Screen W Implants Bil,,77067,CPT,Facility,Both,,,,490,416.5,152.4,490,"Preferred One Administrative Services, INC.",PPO,483.14,98.6,,percent of total billed charges,,
Mammo Screen W Implants Bil,,77067,CPT,Facility,Outpatient,,,,490,416.5,152.4,490,PrimeWest Health,Minnesota Senior Health Options (MSHO),252.105,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Mammo Screen W Implants Bil,,77067,CPT,Facility,Inpatient,,,,490,416.5,152.4,490,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mammo Screen W Implants Bil,,77067,CPT,Facility,Outpatient,,,,490,416.5,152.4,490,PrimeWest Health,MinnesotaCare,251.664,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Mammo Screen W Implants Bil,,77067,CPT,Facility,Inpatient,,,,490,416.5,152.4,490,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Mammo Screen W Implants Bil,,77067,CPT,Facility,Both,,,,490,416.5,152.4,490,Sanford Health Plan,Sanford Health Plan,450.8,92,,percent of total billed charges,,
Mammo Screen W Implants Bil,,77067,CPT,Facility,Outpatient,,,,490,416.5,152.4,490,"UCare Health, Inc.",Individual & Family Plan,276.115,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Mammo Screen W Implants Bil,,77067,CPT,Facility,Inpatient,,,,490,416.5,152.4,490,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Mammo Screen W Implants Bil,,77067,CPT,Facility,Outpatient,,,,490,416.5,152.4,490,"UCare Health, Inc.",Medical Assistance,247.303,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mammo Screen W Implants Bil,,77067,CPT,Facility,Inpatient,,,,490,416.5,152.4,490,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Mammo Screen W Implants Bil,,77067,CPT,Facility,Outpatient,,,,490,416.5,152.4,490,"UCare Health, Inc.",Medicare Advantage,247.303,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mammo Screen W Implants Bil,,77067,CPT,Facility,Inpatient,,,,490,416.5,152.4,490,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mammo Screen W Implants Bil,,77067,CPT,Facility,Outpatient,,,,490,416.5,152.4,490,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),247.303,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mammo Screen W Implants Bil,,77067,CPT,Facility,Inpatient,,,,490,416.5,152.4,490,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mammo Screen W Implants Bil,,77067,CPT,Facility,Both,,,,490,416.5,152.4,490,UnitedHealthcare,Individual & Family,460.6,94,,percent of total billed charges,,
Mammo Screen W Implants Bil,,77067,CPT,Facility,Outpatient,,,,490,416.5,152.4,490,UnitedHealthcare,Medicare Advantage,240.1,49,,percent of total billed charges,,
Mammo Screen W Implants Bil,,77067,CPT,Facility,Inpatient,,,,490,416.5,152.4,490,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Mammo Screen W Implants Bil,,77067,CPT,Facility,Outpatient,,,,490,416.5,152.4,490,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,235.2,48,,percent of total billed charges,,100% of DHS outpatient percentage
Mammo Screen W Implants Bil,,77067,CPT,Facility,Inpatient,,,,490,416.5,152.4,490,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Xr Bone Age,,77072,CPT,Facility,Both,,,,224,190.4,64.1984,224,Aetna,Commercial,206.08,92,,percent of total billed charges,,
Xr Bone Age,,77072,CPT,Facility,Outpatient,,,,224,190.4,64.1984,224,Aetna,Medicare Advantage,109.76,49,,percent of total billed charges,,
Xr Bone Age,,77072,CPT,Facility,Inpatient,,,,224,190.4,64.1984,224,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Xr Bone Age,,77072,CPT,Facility,Both,,,,224,190.4,64.1984,224,Aetna,PPO,208.32,93,,percent of total billed charges,,
Xr Bone Age,,77072,CPT,Facility,Both,,,,224,190.4,64.1984,224,America's PPO,America's PPO,215.1072,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Xr Bone Age,,77072,CPT,Facility,Both,,,,224,190.4,64.1984,224,BlueCross BlueShield Minnesota, Federal Employee Program,220.416,98.4,,percent of total billed charges,,
Xr Bone Age,,77072,CPT,Facility,Both,,,,224,190.4,64.1984,224,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,224,100,,percent of total billed charges,,
Xr Bone Age,,77072,CPT,Facility,Both,,,,224,190.4,64.1984,224,BlueCross BlueShield Minnesota,High Value Network Plan,201.6,90,,percent of total billed charges,,
Xr Bone Age,,77072,CPT,Facility,Outpatient,,,,224,190.4,64.1984,224,BlueCross BlueShield Minnesota,Medicare Advantage,109.76,49,,percent of total billed charges,,
Xr Bone Age,,77072,CPT,Facility,Inpatient,,,,224,190.4,64.1984,224,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Xr Bone Age,,77072,CPT,Facility,Both,,,,224,190.4,64.1984,224,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,198.3968,88.57,,percent of total billed charges,,
Xr Bone Age,,77072,CPT,Facility,Both,,,,224,190.4,64.1984,224,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,64.1984,28.66,,percent of total billed charges,,
Xr Bone Age,,77072,CPT,Facility,Outpatient,,,,224,190.4,64.1984,224,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),109.76,49,,percent of total billed charges,,
Xr Bone Age,,77072,CPT,Facility,Inpatient,,,,224,190.4,64.1984,224,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Xr Bone Age,,77072,CPT,Facility,Both,,,,224,190.4,64.1984,224,CorVel,Worker's Compensation,224,100,,percent of total billed charges,,
Xr Bone Age,,77072,CPT,Facility,Both,,,,224,190.4,64.1984,224,First Health Group Corporation,First Health Network,217.28,97,,percent of total billed charges,,
Xr Bone Age,,77072,CPT,Facility,Both,,,,224,190.4,64.1984,224,"Health Partners, Inc.",Commercial,211.904,94.6,,percent of total billed charges,,
Xr Bone Age,,77072,CPT,Facility,Outpatient,,,,224,190.4,64.1984,224,"Health Partners, Inc.",Medicare Advantage,109.76,49,,percent of total billed charges,,
Xr Bone Age,,77072,CPT,Facility,Inpatient,,,,224,190.4,64.1984,224,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Bone Age,,77072,CPT,Facility,Both,,,,224,190.4,64.1984,224,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),134.4,60,,percent of total billed charges,,
Xr Bone Age,,77072,CPT,Facility,Both,,,,224,190.4,64.1984,224,"Health Partners, Inc.",State of Minnesota Advantage Program,182.56,81.5,,percent of total billed charges,,
Xr Bone Age,,77072,CPT,Facility,Both,,,,224,190.4,64.1984,224,"Health Partners, Inc.",State Public Programs,112,50,,percent of total billed charges,,
Xr Bone Age,,77072,CPT,Facility,Both,,,,224,190.4,64.1984,224,Humana Insurance Company,Commercial PPO,212.8,95,,percent of total billed charges,,
Xr Bone Age,,77072,CPT,Facility,Outpatient,,,,224,190.4,64.1984,224,Humana Insurance Company,Medicare PPO,109.76,49,,percent of total billed charges,,
Xr Bone Age,,77072,CPT,Facility,Inpatient,,,,224,190.4,64.1984,224,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Xr Bone Age,,77072,CPT,Facility,Both,,,,224,190.4,64.1984,224,Medica,Individual & Family,221.984,99.1,,percent of total billed charges,,
Xr Bone Age,,77072,CPT,Facility,Outpatient,,,,224,190.4,64.1984,224,Medica,Medica Advantage Solution,111.552,49.8,,percent of total billed charges,,
Xr Bone Age,,77072,CPT,Facility,Inpatient,,,,224,190.4,64.1984,224,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Xr Bone Age,,77072,CPT,Facility,Outpatient,,,,224,190.4,64.1984,224,Medica,Medical Assistance,99.904,44.6,,percent of total billed charges,,
Xr Bone Age,,77072,CPT,Facility,Inpatient,,,,224,190.4,64.1984,224,Medica,Medical Assistance,,,,,Included in per diem rate,
Xr Bone Age,,77072,CPT,Facility,Outpatient,,,,224,190.4,64.1984,224,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,111.552,49.8,,percent of total billed charges,,
Xr Bone Age,,77072,CPT,Facility,Inpatient,,,,224,190.4,64.1984,224,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Xr Bone Age,,77072,CPT,Facility,Both,,,,224,190.4,64.1984,224,"Multiplan, Inc.","Multiplan, Inc.",210.56,94,,percent of total billed charges,,
Xr Bone Age,,77072,CPT,Facility,Outpatient,,,,224,190.4,64.1984,224,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,201.824,90.1,,percent of total billed charges,,
Xr Bone Age,,77072,CPT,Facility,Inpatient,,,,224,190.4,64.1984,224,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Xr Bone Age,,77072,CPT,Facility,Both,,,,224,190.4,64.1984,224,"Preferred One Administrative Services, INC.",PPO,220.864,98.6,,percent of total billed charges,,
Xr Bone Age,,77072,CPT,Facility,Outpatient,,,,224,190.4,64.1984,224,PrimeWest Health,Minnesota Senior Health Options (MSHO),115.248,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Xr Bone Age,,77072,CPT,Facility,Inpatient,,,,224,190.4,64.1984,224,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Bone Age,,77072,CPT,Facility,Outpatient,,,,224,190.4,64.1984,224,PrimeWest Health,MinnesotaCare,115.0464,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Xr Bone Age,,77072,CPT,Facility,Inpatient,,,,224,190.4,64.1984,224,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Xr Bone Age,,77072,CPT,Facility,Both,,,,224,190.4,64.1984,224,Sanford Health Plan,Sanford Health Plan,206.08,92,,percent of total billed charges,,
Xr Bone Age,,77072,CPT,Facility,Outpatient,,,,224,190.4,64.1984,224,"UCare Health, Inc.",Individual & Family Plan,126.224,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Xr Bone Age,,77072,CPT,Facility,Inpatient,,,,224,190.4,64.1984,224,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Xr Bone Age,,77072,CPT,Facility,Outpatient,,,,224,190.4,64.1984,224,"UCare Health, Inc.",Medical Assistance,113.0528,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Bone Age,,77072,CPT,Facility,Inpatient,,,,224,190.4,64.1984,224,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Xr Bone Age,,77072,CPT,Facility,Outpatient,,,,224,190.4,64.1984,224,"UCare Health, Inc.",Medicare Advantage,113.0528,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Bone Age,,77072,CPT,Facility,Inpatient,,,,224,190.4,64.1984,224,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Bone Age,,77072,CPT,Facility,Outpatient,,,,224,190.4,64.1984,224,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),113.0528,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Bone Age,,77072,CPT,Facility,Inpatient,,,,224,190.4,64.1984,224,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Bone Age,,77072,CPT,Facility,Both,,,,224,190.4,64.1984,224,UnitedHealthcare,Individual & Family,210.56,94,,percent of total billed charges,,
Xr Bone Age,,77072,CPT,Facility,Outpatient,,,,224,190.4,64.1984,224,UnitedHealthcare,Medicare Advantage,109.76,49,,percent of total billed charges,,
Xr Bone Age,,77072,CPT,Facility,Inpatient,,,,224,190.4,64.1984,224,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Xr Bone Age,,77072,CPT,Facility,Outpatient,,,,224,190.4,64.1984,224,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,107.52,48,,percent of total billed charges,,100% of DHS outpatient percentage
Xr Bone Age,,77072,CPT,Facility,Inpatient,,,,224,190.4,64.1984,224,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Xr Bone Survey Complete,,77075,CPT,Facility,Both,,,,530,450.5,151.898,530,Aetna,Commercial,487.6,92,,percent of total billed charges,,
Xr Bone Survey Complete,,77075,CPT,Facility,Outpatient,,,,530,450.5,151.898,530,Aetna,Medicare Advantage,259.7,49,,percent of total billed charges,,
Xr Bone Survey Complete,,77075,CPT,Facility,Inpatient,,,,530,450.5,151.898,530,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Xr Bone Survey Complete,,77075,CPT,Facility,Both,,,,530,450.5,151.898,530,Aetna,PPO,492.9,93,,percent of total billed charges,,
Xr Bone Survey Complete,,77075,CPT,Facility,Both,,,,530,450.5,151.898,530,America's PPO,America's PPO,508.959,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Xr Bone Survey Complete,,77075,CPT,Facility,Both,,,,530,450.5,151.898,530,BlueCross BlueShield Minnesota, Federal Employee Program,521.52,98.4,,percent of total billed charges,,
Xr Bone Survey Complete,,77075,CPT,Facility,Both,,,,530,450.5,151.898,530,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,530,100,,percent of total billed charges,,
Xr Bone Survey Complete,,77075,CPT,Facility,Both,,,,530,450.5,151.898,530,BlueCross BlueShield Minnesota,High Value Network Plan,477,90,,percent of total billed charges,,
Xr Bone Survey Complete,,77075,CPT,Facility,Outpatient,,,,530,450.5,151.898,530,BlueCross BlueShield Minnesota,Medicare Advantage,259.7,49,,percent of total billed charges,,
Xr Bone Survey Complete,,77075,CPT,Facility,Inpatient,,,,530,450.5,151.898,530,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Xr Bone Survey Complete,,77075,CPT,Facility,Both,,,,530,450.5,151.898,530,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,469.421,88.57,,percent of total billed charges,,
Xr Bone Survey Complete,,77075,CPT,Facility,Both,,,,530,450.5,151.898,530,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,151.898,28.66,,percent of total billed charges,,
Xr Bone Survey Complete,,77075,CPT,Facility,Outpatient,,,,530,450.5,151.898,530,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),259.7,49,,percent of total billed charges,,
Xr Bone Survey Complete,,77075,CPT,Facility,Inpatient,,,,530,450.5,151.898,530,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Xr Bone Survey Complete,,77075,CPT,Facility,Both,,,,530,450.5,151.898,530,CorVel,Worker's Compensation,530,100,,percent of total billed charges,,
Xr Bone Survey Complete,,77075,CPT,Facility,Both,,,,530,450.5,151.898,530,First Health Group Corporation,First Health Network,514.1,97,,percent of total billed charges,,
Xr Bone Survey Complete,,77075,CPT,Facility,Both,,,,530,450.5,151.898,530,"Health Partners, Inc.",Commercial,501.38,94.6,,percent of total billed charges,,
Xr Bone Survey Complete,,77075,CPT,Facility,Outpatient,,,,530,450.5,151.898,530,"Health Partners, Inc.",Medicare Advantage,259.7,49,,percent of total billed charges,,
Xr Bone Survey Complete,,77075,CPT,Facility,Inpatient,,,,530,450.5,151.898,530,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Bone Survey Complete,,77075,CPT,Facility,Both,,,,530,450.5,151.898,530,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),318,60,,percent of total billed charges,,
Xr Bone Survey Complete,,77075,CPT,Facility,Both,,,,530,450.5,151.898,530,"Health Partners, Inc.",State of Minnesota Advantage Program,431.95,81.5,,percent of total billed charges,,
Xr Bone Survey Complete,,77075,CPT,Facility,Both,,,,530,450.5,151.898,530,"Health Partners, Inc.",State Public Programs,265,50,,percent of total billed charges,,
Xr Bone Survey Complete,,77075,CPT,Facility,Both,,,,530,450.5,151.898,530,Humana Insurance Company,Commercial PPO,503.5,95,,percent of total billed charges,,
Xr Bone Survey Complete,,77075,CPT,Facility,Outpatient,,,,530,450.5,151.898,530,Humana Insurance Company,Medicare PPO,259.7,49,,percent of total billed charges,,
Xr Bone Survey Complete,,77075,CPT,Facility,Inpatient,,,,530,450.5,151.898,530,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Xr Bone Survey Complete,,77075,CPT,Facility,Both,,,,530,450.5,151.898,530,Medica,Individual & Family,525.23,99.1,,percent of total billed charges,,
Xr Bone Survey Complete,,77075,CPT,Facility,Outpatient,,,,530,450.5,151.898,530,Medica,Medica Advantage Solution,263.94,49.8,,percent of total billed charges,,
Xr Bone Survey Complete,,77075,CPT,Facility,Inpatient,,,,530,450.5,151.898,530,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Xr Bone Survey Complete,,77075,CPT,Facility,Outpatient,,,,530,450.5,151.898,530,Medica,Medical Assistance,236.38,44.6,,percent of total billed charges,,
Xr Bone Survey Complete,,77075,CPT,Facility,Inpatient,,,,530,450.5,151.898,530,Medica,Medical Assistance,,,,,Included in per diem rate,
Xr Bone Survey Complete,,77075,CPT,Facility,Outpatient,,,,530,450.5,151.898,530,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,263.94,49.8,,percent of total billed charges,,
Xr Bone Survey Complete,,77075,CPT,Facility,Inpatient,,,,530,450.5,151.898,530,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Xr Bone Survey Complete,,77075,CPT,Facility,Both,,,,530,450.5,151.898,530,"Multiplan, Inc.","Multiplan, Inc.",498.2,94,,percent of total billed charges,,
Xr Bone Survey Complete,,77075,CPT,Facility,Outpatient,,,,530,450.5,151.898,530,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,477.53,90.1,,percent of total billed charges,,
Xr Bone Survey Complete,,77075,CPT,Facility,Inpatient,,,,530,450.5,151.898,530,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Xr Bone Survey Complete,,77075,CPT,Facility,Both,,,,530,450.5,151.898,530,"Preferred One Administrative Services, INC.",PPO,522.58,98.6,,percent of total billed charges,,
Xr Bone Survey Complete,,77075,CPT,Facility,Outpatient,,,,530,450.5,151.898,530,PrimeWest Health,Minnesota Senior Health Options (MSHO),272.685,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Xr Bone Survey Complete,,77075,CPT,Facility,Inpatient,,,,530,450.5,151.898,530,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Bone Survey Complete,,77075,CPT,Facility,Outpatient,,,,530,450.5,151.898,530,PrimeWest Health,MinnesotaCare,272.208,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Xr Bone Survey Complete,,77075,CPT,Facility,Inpatient,,,,530,450.5,151.898,530,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Xr Bone Survey Complete,,77075,CPT,Facility,Both,,,,530,450.5,151.898,530,Sanford Health Plan,Sanford Health Plan,487.6,92,,percent of total billed charges,,
Xr Bone Survey Complete,,77075,CPT,Facility,Outpatient,,,,530,450.5,151.898,530,"UCare Health, Inc.",Individual & Family Plan,298.655,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Xr Bone Survey Complete,,77075,CPT,Facility,Inpatient,,,,530,450.5,151.898,530,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Xr Bone Survey Complete,,77075,CPT,Facility,Outpatient,,,,530,450.5,151.898,530,"UCare Health, Inc.",Medical Assistance,267.491,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Bone Survey Complete,,77075,CPT,Facility,Inpatient,,,,530,450.5,151.898,530,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Xr Bone Survey Complete,,77075,CPT,Facility,Outpatient,,,,530,450.5,151.898,530,"UCare Health, Inc.",Medicare Advantage,267.491,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Bone Survey Complete,,77075,CPT,Facility,Inpatient,,,,530,450.5,151.898,530,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Bone Survey Complete,,77075,CPT,Facility,Outpatient,,,,530,450.5,151.898,530,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),267.491,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Bone Survey Complete,,77075,CPT,Facility,Inpatient,,,,530,450.5,151.898,530,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Bone Survey Complete,,77075,CPT,Facility,Both,,,,530,450.5,151.898,530,UnitedHealthcare,Individual & Family,498.2,94,,percent of total billed charges,,
Xr Bone Survey Complete,,77075,CPT,Facility,Outpatient,,,,530,450.5,151.898,530,UnitedHealthcare,Medicare Advantage,259.7,49,,percent of total billed charges,,
Xr Bone Survey Complete,,77075,CPT,Facility,Inpatient,,,,530,450.5,151.898,530,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Xr Bone Survey Complete,,77075,CPT,Facility,Outpatient,,,,530,450.5,151.898,530,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,254.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
Xr Bone Survey Complete,,77075,CPT,Facility,Inpatient,,,,530,450.5,151.898,530,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Xr Bone Survey Infant,,77076,CPT,Facility,Both,,,,459,390.15,131.5494,459,Aetna,Commercial,422.28,92,,percent of total billed charges,,
Xr Bone Survey Infant,,77076,CPT,Facility,Outpatient,,,,459,390.15,131.5494,459,Aetna,Medicare Advantage,224.91,49,,percent of total billed charges,,
Xr Bone Survey Infant,,77076,CPT,Facility,Inpatient,,,,459,390.15,131.5494,459,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Xr Bone Survey Infant,,77076,CPT,Facility,Both,,,,459,390.15,131.5494,459,Aetna,PPO,426.87,93,,percent of total billed charges,,
Xr Bone Survey Infant,,77076,CPT,Facility,Both,,,,459,390.15,131.5494,459,America's PPO,America's PPO,440.7777,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Xr Bone Survey Infant,,77076,CPT,Facility,Both,,,,459,390.15,131.5494,459,BlueCross BlueShield Minnesota, Federal Employee Program,451.656,98.4,,percent of total billed charges,,
Xr Bone Survey Infant,,77076,CPT,Facility,Both,,,,459,390.15,131.5494,459,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,459,100,,percent of total billed charges,,
Xr Bone Survey Infant,,77076,CPT,Facility,Both,,,,459,390.15,131.5494,459,BlueCross BlueShield Minnesota,High Value Network Plan,413.1,90,,percent of total billed charges,,
Xr Bone Survey Infant,,77076,CPT,Facility,Outpatient,,,,459,390.15,131.5494,459,BlueCross BlueShield Minnesota,Medicare Advantage,224.91,49,,percent of total billed charges,,
Xr Bone Survey Infant,,77076,CPT,Facility,Inpatient,,,,459,390.15,131.5494,459,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Xr Bone Survey Infant,,77076,CPT,Facility,Both,,,,459,390.15,131.5494,459,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,406.5363,88.57,,percent of total billed charges,,
Xr Bone Survey Infant,,77076,CPT,Facility,Both,,,,459,390.15,131.5494,459,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,131.5494,28.66,,percent of total billed charges,,
Xr Bone Survey Infant,,77076,CPT,Facility,Outpatient,,,,459,390.15,131.5494,459,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),224.91,49,,percent of total billed charges,,
Xr Bone Survey Infant,,77076,CPT,Facility,Inpatient,,,,459,390.15,131.5494,459,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Xr Bone Survey Infant,,77076,CPT,Facility,Both,,,,459,390.15,131.5494,459,CorVel,Worker's Compensation,459,100,,percent of total billed charges,,
Xr Bone Survey Infant,,77076,CPT,Facility,Both,,,,459,390.15,131.5494,459,First Health Group Corporation,First Health Network,445.23,97,,percent of total billed charges,,
Xr Bone Survey Infant,,77076,CPT,Facility,Both,,,,459,390.15,131.5494,459,"Health Partners, Inc.",Commercial,434.214,94.6,,percent of total billed charges,,
Xr Bone Survey Infant,,77076,CPT,Facility,Outpatient,,,,459,390.15,131.5494,459,"Health Partners, Inc.",Medicare Advantage,224.91,49,,percent of total billed charges,,
Xr Bone Survey Infant,,77076,CPT,Facility,Inpatient,,,,459,390.15,131.5494,459,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Bone Survey Infant,,77076,CPT,Facility,Both,,,,459,390.15,131.5494,459,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),275.4,60,,percent of total billed charges,,
Xr Bone Survey Infant,,77076,CPT,Facility,Both,,,,459,390.15,131.5494,459,"Health Partners, Inc.",State of Minnesota Advantage Program,374.085,81.5,,percent of total billed charges,,
Xr Bone Survey Infant,,77076,CPT,Facility,Both,,,,459,390.15,131.5494,459,"Health Partners, Inc.",State Public Programs,229.5,50,,percent of total billed charges,,
Xr Bone Survey Infant,,77076,CPT,Facility,Both,,,,459,390.15,131.5494,459,Humana Insurance Company,Commercial PPO,436.05,95,,percent of total billed charges,,
Xr Bone Survey Infant,,77076,CPT,Facility,Outpatient,,,,459,390.15,131.5494,459,Humana Insurance Company,Medicare PPO,224.91,49,,percent of total billed charges,,
Xr Bone Survey Infant,,77076,CPT,Facility,Inpatient,,,,459,390.15,131.5494,459,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Xr Bone Survey Infant,,77076,CPT,Facility,Both,,,,459,390.15,131.5494,459,Medica,Individual & Family,454.869,99.1,,percent of total billed charges,,
Xr Bone Survey Infant,,77076,CPT,Facility,Outpatient,,,,459,390.15,131.5494,459,Medica,Medica Advantage Solution,228.582,49.8,,percent of total billed charges,,
Xr Bone Survey Infant,,77076,CPT,Facility,Inpatient,,,,459,390.15,131.5494,459,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Xr Bone Survey Infant,,77076,CPT,Facility,Outpatient,,,,459,390.15,131.5494,459,Medica,Medical Assistance,204.714,44.6,,percent of total billed charges,,
Xr Bone Survey Infant,,77076,CPT,Facility,Inpatient,,,,459,390.15,131.5494,459,Medica,Medical Assistance,,,,,Included in per diem rate,
Xr Bone Survey Infant,,77076,CPT,Facility,Outpatient,,,,459,390.15,131.5494,459,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,228.582,49.8,,percent of total billed charges,,
Xr Bone Survey Infant,,77076,CPT,Facility,Inpatient,,,,459,390.15,131.5494,459,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Xr Bone Survey Infant,,77076,CPT,Facility,Both,,,,459,390.15,131.5494,459,"Multiplan, Inc.","Multiplan, Inc.",431.46,94,,percent of total billed charges,,
Xr Bone Survey Infant,,77076,CPT,Facility,Outpatient,,,,459,390.15,131.5494,459,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,413.559,90.1,,percent of total billed charges,,
Xr Bone Survey Infant,,77076,CPT,Facility,Inpatient,,,,459,390.15,131.5494,459,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Xr Bone Survey Infant,,77076,CPT,Facility,Both,,,,459,390.15,131.5494,459,"Preferred One Administrative Services, INC.",PPO,452.574,98.6,,percent of total billed charges,,
Xr Bone Survey Infant,,77076,CPT,Facility,Outpatient,,,,459,390.15,131.5494,459,PrimeWest Health,Minnesota Senior Health Options (MSHO),236.1555,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Xr Bone Survey Infant,,77076,CPT,Facility,Inpatient,,,,459,390.15,131.5494,459,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Bone Survey Infant,,77076,CPT,Facility,Outpatient,,,,459,390.15,131.5494,459,PrimeWest Health,MinnesotaCare,235.7424,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Xr Bone Survey Infant,,77076,CPT,Facility,Inpatient,,,,459,390.15,131.5494,459,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Xr Bone Survey Infant,,77076,CPT,Facility,Both,,,,459,390.15,131.5494,459,Sanford Health Plan,Sanford Health Plan,422.28,92,,percent of total billed charges,,
Xr Bone Survey Infant,,77076,CPT,Facility,Outpatient,,,,459,390.15,131.5494,459,"UCare Health, Inc.",Individual & Family Plan,258.6465,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Xr Bone Survey Infant,,77076,CPT,Facility,Inpatient,,,,459,390.15,131.5494,459,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Xr Bone Survey Infant,,77076,CPT,Facility,Outpatient,,,,459,390.15,131.5494,459,"UCare Health, Inc.",Medical Assistance,231.6573,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Bone Survey Infant,,77076,CPT,Facility,Inpatient,,,,459,390.15,131.5494,459,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Xr Bone Survey Infant,,77076,CPT,Facility,Outpatient,,,,459,390.15,131.5494,459,"UCare Health, Inc.",Medicare Advantage,231.6573,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Bone Survey Infant,,77076,CPT,Facility,Inpatient,,,,459,390.15,131.5494,459,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Bone Survey Infant,,77076,CPT,Facility,Outpatient,,,,459,390.15,131.5494,459,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),231.6573,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Bone Survey Infant,,77076,CPT,Facility,Inpatient,,,,459,390.15,131.5494,459,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Bone Survey Infant,,77076,CPT,Facility,Both,,,,459,390.15,131.5494,459,UnitedHealthcare,Individual & Family,431.46,94,,percent of total billed charges,,
Xr Bone Survey Infant,,77076,CPT,Facility,Outpatient,,,,459,390.15,131.5494,459,UnitedHealthcare,Medicare Advantage,224.91,49,,percent of total billed charges,,
Xr Bone Survey Infant,,77076,CPT,Facility,Inpatient,,,,459,390.15,131.5494,459,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Xr Bone Survey Infant,,77076,CPT,Facility,Outpatient,,,,459,390.15,131.5494,459,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,220.32,48,,percent of total billed charges,,100% of DHS outpatient percentage
Xr Bone Survey Infant,,77076,CPT,Facility,Inpatient,,,,459,390.15,131.5494,459,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Xr Hand Pa Lt And Rt,,77077,CPT,Facility,Both,,,,270,229.5,77.382,270,Aetna,Commercial,248.4,92,,percent of total billed charges,,
Xr Hand Pa Lt And Rt,,77077,CPT,Facility,Outpatient,,,,270,229.5,77.382,270,Aetna,Medicare Advantage,132.3,49,,percent of total billed charges,,
Xr Hand Pa Lt And Rt,,77077,CPT,Facility,Inpatient,,,,270,229.5,77.382,270,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Xr Hand Pa Lt And Rt,,77077,CPT,Facility,Both,,,,270,229.5,77.382,270,Aetna,PPO,251.1,93,,percent of total billed charges,,
Xr Hand Pa Lt And Rt,,77077,CPT,Facility,Both,,,,270,229.5,77.382,270,America's PPO,America's PPO,259.281,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Xr Hand Pa Lt And Rt,,77077,CPT,Facility,Both,,,,270,229.5,77.382,270,BlueCross BlueShield Minnesota, Federal Employee Program,265.68,98.4,,percent of total billed charges,,
Xr Hand Pa Lt And Rt,,77077,CPT,Facility,Both,,,,270,229.5,77.382,270,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,270,100,,percent of total billed charges,,
Xr Hand Pa Lt And Rt,,77077,CPT,Facility,Both,,,,270,229.5,77.382,270,BlueCross BlueShield Minnesota,High Value Network Plan,243,90,,percent of total billed charges,,
Xr Hand Pa Lt And Rt,,77077,CPT,Facility,Outpatient,,,,270,229.5,77.382,270,BlueCross BlueShield Minnesota,Medicare Advantage,132.3,49,,percent of total billed charges,,
Xr Hand Pa Lt And Rt,,77077,CPT,Facility,Inpatient,,,,270,229.5,77.382,270,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Xr Hand Pa Lt And Rt,,77077,CPT,Facility,Both,,,,270,229.5,77.382,270,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,239.139,88.57,,percent of total billed charges,,
Xr Hand Pa Lt And Rt,,77077,CPT,Facility,Both,,,,270,229.5,77.382,270,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,77.382,28.66,,percent of total billed charges,,
Xr Hand Pa Lt And Rt,,77077,CPT,Facility,Outpatient,,,,270,229.5,77.382,270,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),132.3,49,,percent of total billed charges,,
Xr Hand Pa Lt And Rt,,77077,CPT,Facility,Inpatient,,,,270,229.5,77.382,270,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Xr Hand Pa Lt And Rt,,77077,CPT,Facility,Both,,,,270,229.5,77.382,270,CorVel,Worker's Compensation,270,100,,percent of total billed charges,,
Xr Hand Pa Lt And Rt,,77077,CPT,Facility,Both,,,,270,229.5,77.382,270,First Health Group Corporation,First Health Network,261.9,97,,percent of total billed charges,,
Xr Hand Pa Lt And Rt,,77077,CPT,Facility,Both,,,,270,229.5,77.382,270,"Health Partners, Inc.",Commercial,255.42,94.6,,percent of total billed charges,,
Xr Hand Pa Lt And Rt,,77077,CPT,Facility,Outpatient,,,,270,229.5,77.382,270,"Health Partners, Inc.",Medicare Advantage,132.3,49,,percent of total billed charges,,
Xr Hand Pa Lt And Rt,,77077,CPT,Facility,Inpatient,,,,270,229.5,77.382,270,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Hand Pa Lt And Rt,,77077,CPT,Facility,Both,,,,270,229.5,77.382,270,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),162,60,,percent of total billed charges,,
Xr Hand Pa Lt And Rt,,77077,CPT,Facility,Both,,,,270,229.5,77.382,270,"Health Partners, Inc.",State of Minnesota Advantage Program,220.05,81.5,,percent of total billed charges,,
Xr Hand Pa Lt And Rt,,77077,CPT,Facility,Both,,,,270,229.5,77.382,270,"Health Partners, Inc.",State Public Programs,135,50,,percent of total billed charges,,
Xr Hand Pa Lt And Rt,,77077,CPT,Facility,Both,,,,270,229.5,77.382,270,Humana Insurance Company,Commercial PPO,256.5,95,,percent of total billed charges,,
Xr Hand Pa Lt And Rt,,77077,CPT,Facility,Outpatient,,,,270,229.5,77.382,270,Humana Insurance Company,Medicare PPO,132.3,49,,percent of total billed charges,,
Xr Hand Pa Lt And Rt,,77077,CPT,Facility,Inpatient,,,,270,229.5,77.382,270,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Xr Hand Pa Lt And Rt,,77077,CPT,Facility,Both,,,,270,229.5,77.382,270,Medica,Individual & Family,267.57,99.1,,percent of total billed charges,,
Xr Hand Pa Lt And Rt,,77077,CPT,Facility,Outpatient,,,,270,229.5,77.382,270,Medica,Medica Advantage Solution,134.46,49.8,,percent of total billed charges,,
Xr Hand Pa Lt And Rt,,77077,CPT,Facility,Inpatient,,,,270,229.5,77.382,270,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Xr Hand Pa Lt And Rt,,77077,CPT,Facility,Outpatient,,,,270,229.5,77.382,270,Medica,Medical Assistance,120.42,44.6,,percent of total billed charges,,
Xr Hand Pa Lt And Rt,,77077,CPT,Facility,Inpatient,,,,270,229.5,77.382,270,Medica,Medical Assistance,,,,,Included in per diem rate,
Xr Hand Pa Lt And Rt,,77077,CPT,Facility,Outpatient,,,,270,229.5,77.382,270,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,134.46,49.8,,percent of total billed charges,,
Xr Hand Pa Lt And Rt,,77077,CPT,Facility,Inpatient,,,,270,229.5,77.382,270,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Xr Hand Pa Lt And Rt,,77077,CPT,Facility,Both,,,,270,229.5,77.382,270,"Multiplan, Inc.","Multiplan, Inc.",253.8,94,,percent of total billed charges,,
Xr Hand Pa Lt And Rt,,77077,CPT,Facility,Outpatient,,,,270,229.5,77.382,270,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,243.27,90.1,,percent of total billed charges,,
Xr Hand Pa Lt And Rt,,77077,CPT,Facility,Inpatient,,,,270,229.5,77.382,270,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Xr Hand Pa Lt And Rt,,77077,CPT,Facility,Both,,,,270,229.5,77.382,270,"Preferred One Administrative Services, INC.",PPO,266.22,98.6,,percent of total billed charges,,
Xr Hand Pa Lt And Rt,,77077,CPT,Facility,Outpatient,,,,270,229.5,77.382,270,PrimeWest Health,Minnesota Senior Health Options (MSHO),138.915,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Xr Hand Pa Lt And Rt,,77077,CPT,Facility,Inpatient,,,,270,229.5,77.382,270,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Hand Pa Lt And Rt,,77077,CPT,Facility,Outpatient,,,,270,229.5,77.382,270,PrimeWest Health,MinnesotaCare,138.672,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Xr Hand Pa Lt And Rt,,77077,CPT,Facility,Inpatient,,,,270,229.5,77.382,270,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Xr Hand Pa Lt And Rt,,77077,CPT,Facility,Both,,,,270,229.5,77.382,270,Sanford Health Plan,Sanford Health Plan,248.4,92,,percent of total billed charges,,
Xr Hand Pa Lt And Rt,,77077,CPT,Facility,Outpatient,,,,270,229.5,77.382,270,"UCare Health, Inc.",Individual & Family Plan,152.145,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Xr Hand Pa Lt And Rt,,77077,CPT,Facility,Inpatient,,,,270,229.5,77.382,270,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Xr Hand Pa Lt And Rt,,77077,CPT,Facility,Outpatient,,,,270,229.5,77.382,270,"UCare Health, Inc.",Medical Assistance,136.269,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Hand Pa Lt And Rt,,77077,CPT,Facility,Inpatient,,,,270,229.5,77.382,270,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Xr Hand Pa Lt And Rt,,77077,CPT,Facility,Outpatient,,,,270,229.5,77.382,270,"UCare Health, Inc.",Medicare Advantage,136.269,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Hand Pa Lt And Rt,,77077,CPT,Facility,Inpatient,,,,270,229.5,77.382,270,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Hand Pa Lt And Rt,,77077,CPT,Facility,Outpatient,,,,270,229.5,77.382,270,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),136.269,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Hand Pa Lt And Rt,,77077,CPT,Facility,Inpatient,,,,270,229.5,77.382,270,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Hand Pa Lt And Rt,,77077,CPT,Facility,Both,,,,270,229.5,77.382,270,UnitedHealthcare,Individual & Family,253.8,94,,percent of total billed charges,,
Xr Hand Pa Lt And Rt,,77077,CPT,Facility,Outpatient,,,,270,229.5,77.382,270,UnitedHealthcare,Medicare Advantage,132.3,49,,percent of total billed charges,,
Xr Hand Pa Lt And Rt,,77077,CPT,Facility,Inpatient,,,,270,229.5,77.382,270,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Xr Hand Pa Lt And Rt,,77077,CPT,Facility,Outpatient,,,,270,229.5,77.382,270,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,129.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
Xr Hand Pa Lt And Rt,,77077,CPT,Facility,Inpatient,,,,270,229.5,77.382,270,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Xr Joint Survey Sngl View 2 Or More Joints,,77077,CPT,Facility,Both,,,,270,229.5,77.382,270,Aetna,Commercial,248.4,92,,percent of total billed charges,,
Xr Joint Survey Sngl View 2 Or More Joints,,77077,CPT,Facility,Outpatient,,,,270,229.5,77.382,270,Aetna,Medicare Advantage,132.3,49,,percent of total billed charges,,
Xr Joint Survey Sngl View 2 Or More Joints,,77077,CPT,Facility,Inpatient,,,,270,229.5,77.382,270,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Xr Joint Survey Sngl View 2 Or More Joints,,77077,CPT,Facility,Both,,,,270,229.5,77.382,270,Aetna,PPO,251.1,93,,percent of total billed charges,,
Xr Joint Survey Sngl View 2 Or More Joints,,77077,CPT,Facility,Both,,,,270,229.5,77.382,270,America's PPO,America's PPO,259.281,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Xr Joint Survey Sngl View 2 Or More Joints,,77077,CPT,Facility,Both,,,,270,229.5,77.382,270,BlueCross BlueShield Minnesota, Federal Employee Program,265.68,98.4,,percent of total billed charges,,
Xr Joint Survey Sngl View 2 Or More Joints,,77077,CPT,Facility,Both,,,,270,229.5,77.382,270,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,270,100,,percent of total billed charges,,
Xr Joint Survey Sngl View 2 Or More Joints,,77077,CPT,Facility,Both,,,,270,229.5,77.382,270,BlueCross BlueShield Minnesota,High Value Network Plan,243,90,,percent of total billed charges,,
Xr Joint Survey Sngl View 2 Or More Joints,,77077,CPT,Facility,Outpatient,,,,270,229.5,77.382,270,BlueCross BlueShield Minnesota,Medicare Advantage,132.3,49,,percent of total billed charges,,
Xr Joint Survey Sngl View 2 Or More Joints,,77077,CPT,Facility,Inpatient,,,,270,229.5,77.382,270,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Xr Joint Survey Sngl View 2 Or More Joints,,77077,CPT,Facility,Both,,,,270,229.5,77.382,270,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,239.139,88.57,,percent of total billed charges,,
Xr Joint Survey Sngl View 2 Or More Joints,,77077,CPT,Facility,Both,,,,270,229.5,77.382,270,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,77.382,28.66,,percent of total billed charges,,
Xr Joint Survey Sngl View 2 Or More Joints,,77077,CPT,Facility,Outpatient,,,,270,229.5,77.382,270,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),132.3,49,,percent of total billed charges,,
Xr Joint Survey Sngl View 2 Or More Joints,,77077,CPT,Facility,Inpatient,,,,270,229.5,77.382,270,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Xr Joint Survey Sngl View 2 Or More Joints,,77077,CPT,Facility,Both,,,,270,229.5,77.382,270,CorVel,Worker's Compensation,270,100,,percent of total billed charges,,
Xr Joint Survey Sngl View 2 Or More Joints,,77077,CPT,Facility,Both,,,,270,229.5,77.382,270,First Health Group Corporation,First Health Network,261.9,97,,percent of total billed charges,,
Xr Joint Survey Sngl View 2 Or More Joints,,77077,CPT,Facility,Both,,,,270,229.5,77.382,270,"Health Partners, Inc.",Commercial,255.42,94.6,,percent of total billed charges,,
Xr Joint Survey Sngl View 2 Or More Joints,,77077,CPT,Facility,Outpatient,,,,270,229.5,77.382,270,"Health Partners, Inc.",Medicare Advantage,132.3,49,,percent of total billed charges,,
Xr Joint Survey Sngl View 2 Or More Joints,,77077,CPT,Facility,Inpatient,,,,270,229.5,77.382,270,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Joint Survey Sngl View 2 Or More Joints,,77077,CPT,Facility,Both,,,,270,229.5,77.382,270,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),162,60,,percent of total billed charges,,
Xr Joint Survey Sngl View 2 Or More Joints,,77077,CPT,Facility,Both,,,,270,229.5,77.382,270,"Health Partners, Inc.",State of Minnesota Advantage Program,220.05,81.5,,percent of total billed charges,,
Xr Joint Survey Sngl View 2 Or More Joints,,77077,CPT,Facility,Both,,,,270,229.5,77.382,270,"Health Partners, Inc.",State Public Programs,135,50,,percent of total billed charges,,
Xr Joint Survey Sngl View 2 Or More Joints,,77077,CPT,Facility,Both,,,,270,229.5,77.382,270,Humana Insurance Company,Commercial PPO,256.5,95,,percent of total billed charges,,
Xr Joint Survey Sngl View 2 Or More Joints,,77077,CPT,Facility,Outpatient,,,,270,229.5,77.382,270,Humana Insurance Company,Medicare PPO,132.3,49,,percent of total billed charges,,
Xr Joint Survey Sngl View 2 Or More Joints,,77077,CPT,Facility,Inpatient,,,,270,229.5,77.382,270,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Xr Joint Survey Sngl View 2 Or More Joints,,77077,CPT,Facility,Both,,,,270,229.5,77.382,270,Medica,Individual & Family,267.57,99.1,,percent of total billed charges,,
Xr Joint Survey Sngl View 2 Or More Joints,,77077,CPT,Facility,Outpatient,,,,270,229.5,77.382,270,Medica,Medica Advantage Solution,134.46,49.8,,percent of total billed charges,,
Xr Joint Survey Sngl View 2 Or More Joints,,77077,CPT,Facility,Inpatient,,,,270,229.5,77.382,270,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Xr Joint Survey Sngl View 2 Or More Joints,,77077,CPT,Facility,Outpatient,,,,270,229.5,77.382,270,Medica,Medical Assistance,120.42,44.6,,percent of total billed charges,,
Xr Joint Survey Sngl View 2 Or More Joints,,77077,CPT,Facility,Inpatient,,,,270,229.5,77.382,270,Medica,Medical Assistance,,,,,Included in per diem rate,
Xr Joint Survey Sngl View 2 Or More Joints,,77077,CPT,Facility,Outpatient,,,,270,229.5,77.382,270,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,134.46,49.8,,percent of total billed charges,,
Xr Joint Survey Sngl View 2 Or More Joints,,77077,CPT,Facility,Inpatient,,,,270,229.5,77.382,270,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Xr Joint Survey Sngl View 2 Or More Joints,,77077,CPT,Facility,Both,,,,270,229.5,77.382,270,"Multiplan, Inc.","Multiplan, Inc.",253.8,94,,percent of total billed charges,,
Xr Joint Survey Sngl View 2 Or More Joints,,77077,CPT,Facility,Outpatient,,,,270,229.5,77.382,270,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,243.27,90.1,,percent of total billed charges,,
Xr Joint Survey Sngl View 2 Or More Joints,,77077,CPT,Facility,Inpatient,,,,270,229.5,77.382,270,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Xr Joint Survey Sngl View 2 Or More Joints,,77077,CPT,Facility,Both,,,,270,229.5,77.382,270,"Preferred One Administrative Services, INC.",PPO,266.22,98.6,,percent of total billed charges,,
Xr Joint Survey Sngl View 2 Or More Joints,,77077,CPT,Facility,Outpatient,,,,270,229.5,77.382,270,PrimeWest Health,Minnesota Senior Health Options (MSHO),138.915,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Xr Joint Survey Sngl View 2 Or More Joints,,77077,CPT,Facility,Inpatient,,,,270,229.5,77.382,270,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Joint Survey Sngl View 2 Or More Joints,,77077,CPT,Facility,Outpatient,,,,270,229.5,77.382,270,PrimeWest Health,MinnesotaCare,138.672,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Xr Joint Survey Sngl View 2 Or More Joints,,77077,CPT,Facility,Inpatient,,,,270,229.5,77.382,270,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Xr Joint Survey Sngl View 2 Or More Joints,,77077,CPT,Facility,Both,,,,270,229.5,77.382,270,Sanford Health Plan,Sanford Health Plan,248.4,92,,percent of total billed charges,,
Xr Joint Survey Sngl View 2 Or More Joints,,77077,CPT,Facility,Outpatient,,,,270,229.5,77.382,270,"UCare Health, Inc.",Individual & Family Plan,152.145,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Xr Joint Survey Sngl View 2 Or More Joints,,77077,CPT,Facility,Inpatient,,,,270,229.5,77.382,270,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Xr Joint Survey Sngl View 2 Or More Joints,,77077,CPT,Facility,Outpatient,,,,270,229.5,77.382,270,"UCare Health, Inc.",Medical Assistance,136.269,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Joint Survey Sngl View 2 Or More Joints,,77077,CPT,Facility,Inpatient,,,,270,229.5,77.382,270,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Xr Joint Survey Sngl View 2 Or More Joints,,77077,CPT,Facility,Outpatient,,,,270,229.5,77.382,270,"UCare Health, Inc.",Medicare Advantage,136.269,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Joint Survey Sngl View 2 Or More Joints,,77077,CPT,Facility,Inpatient,,,,270,229.5,77.382,270,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Xr Joint Survey Sngl View 2 Or More Joints,,77077,CPT,Facility,Outpatient,,,,270,229.5,77.382,270,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),136.269,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Xr Joint Survey Sngl View 2 Or More Joints,,77077,CPT,Facility,Inpatient,,,,270,229.5,77.382,270,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Xr Joint Survey Sngl View 2 Or More Joints,,77077,CPT,Facility,Both,,,,270,229.5,77.382,270,UnitedHealthcare,Individual & Family,253.8,94,,percent of total billed charges,,
Xr Joint Survey Sngl View 2 Or More Joints,,77077,CPT,Facility,Outpatient,,,,270,229.5,77.382,270,UnitedHealthcare,Medicare Advantage,132.3,49,,percent of total billed charges,,
Xr Joint Survey Sngl View 2 Or More Joints,,77077,CPT,Facility,Inpatient,,,,270,229.5,77.382,270,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Xr Joint Survey Sngl View 2 Or More Joints,,77077,CPT,Facility,Outpatient,,,,270,229.5,77.382,270,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,129.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
Xr Joint Survey Sngl View 2 Or More Joints,,77077,CPT,Facility,Inpatient,,,,270,229.5,77.382,270,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Dexa Hip,,77080,CPT,Facility,Both,,,,525,446.25,150.465,525,Aetna,Commercial,483,92,,percent of total billed charges,,
Dexa Hip,,77080,CPT,Facility,Outpatient,,,,525,446.25,150.465,525,Aetna,Medicare Advantage,257.25,49,,percent of total billed charges,,
Dexa Hip,,77080,CPT,Facility,Inpatient,,,,525,446.25,150.465,525,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Dexa Hip,,77080,CPT,Facility,Both,,,,525,446.25,150.465,525,Aetna,PPO,488.25,93,,percent of total billed charges,,
Dexa Hip,,77080,CPT,Facility,Both,,,,525,446.25,150.465,525,America's PPO,America's PPO,504.1575,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Dexa Hip,,77080,CPT,Facility,Both,,,,525,446.25,150.465,525,BlueCross BlueShield Minnesota, Federal Employee Program,516.6,98.4,,percent of total billed charges,,
Dexa Hip,,77080,CPT,Facility,Both,,,,525,446.25,150.465,525,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,525,100,,percent of total billed charges,,
Dexa Hip,,77080,CPT,Facility,Both,,,,525,446.25,150.465,525,BlueCross BlueShield Minnesota,High Value Network Plan,472.5,90,,percent of total billed charges,,
Dexa Hip,,77080,CPT,Facility,Outpatient,,,,525,446.25,150.465,525,BlueCross BlueShield Minnesota,Medicare Advantage,257.25,49,,percent of total billed charges,,
Dexa Hip,,77080,CPT,Facility,Inpatient,,,,525,446.25,150.465,525,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Dexa Hip,,77080,CPT,Facility,Both,,,,525,446.25,150.465,525,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,464.9925,88.57,,percent of total billed charges,,
Dexa Hip,,77080,CPT,Facility,Both,,,,525,446.25,150.465,525,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,150.465,28.66,,percent of total billed charges,,
Dexa Hip,,77080,CPT,Facility,Outpatient,,,,525,446.25,150.465,525,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),257.25,49,,percent of total billed charges,,
Dexa Hip,,77080,CPT,Facility,Inpatient,,,,525,446.25,150.465,525,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Dexa Hip,,77080,CPT,Facility,Both,,,,525,446.25,150.465,525,CorVel,Worker's Compensation,525,100,,percent of total billed charges,,
Dexa Hip,,77080,CPT,Facility,Both,,,,525,446.25,150.465,525,First Health Group Corporation,First Health Network,509.25,97,,percent of total billed charges,,
Dexa Hip,,77080,CPT,Facility,Both,,,,525,446.25,150.465,525,"Health Partners, Inc.",Commercial,496.65,94.6,,percent of total billed charges,,
Dexa Hip,,77080,CPT,Facility,Outpatient,,,,525,446.25,150.465,525,"Health Partners, Inc.",Medicare Advantage,257.25,49,,percent of total billed charges,,
Dexa Hip,,77080,CPT,Facility,Inpatient,,,,525,446.25,150.465,525,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Dexa Hip,,77080,CPT,Facility,Both,,,,525,446.25,150.465,525,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),315,60,,percent of total billed charges,,
Dexa Hip,,77080,CPT,Facility,Both,,,,525,446.25,150.465,525,"Health Partners, Inc.",State of Minnesota Advantage Program,427.875,81.5,,percent of total billed charges,,
Dexa Hip,,77080,CPT,Facility,Both,,,,525,446.25,150.465,525,"Health Partners, Inc.",State Public Programs,262.5,50,,percent of total billed charges,,
Dexa Hip,,77080,CPT,Facility,Both,,,,525,446.25,150.465,525,Humana Insurance Company,Commercial PPO,498.75,95,,percent of total billed charges,,
Dexa Hip,,77080,CPT,Facility,Outpatient,,,,525,446.25,150.465,525,Humana Insurance Company,Medicare PPO,257.25,49,,percent of total billed charges,,
Dexa Hip,,77080,CPT,Facility,Inpatient,,,,525,446.25,150.465,525,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Dexa Hip,,77080,CPT,Facility,Both,,,,525,446.25,150.465,525,Medica,Individual & Family,520.275,99.1,,percent of total billed charges,,
Dexa Hip,,77080,CPT,Facility,Outpatient,,,,525,446.25,150.465,525,Medica,Medica Advantage Solution,261.45,49.8,,percent of total billed charges,,
Dexa Hip,,77080,CPT,Facility,Inpatient,,,,525,446.25,150.465,525,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Dexa Hip,,77080,CPT,Facility,Outpatient,,,,525,446.25,150.465,525,Medica,Medical Assistance,234.15,44.6,,percent of total billed charges,,
Dexa Hip,,77080,CPT,Facility,Inpatient,,,,525,446.25,150.465,525,Medica,Medical Assistance,,,,,Included in per diem rate,
Dexa Hip,,77080,CPT,Facility,Outpatient,,,,525,446.25,150.465,525,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,261.45,49.8,,percent of total billed charges,,
Dexa Hip,,77080,CPT,Facility,Inpatient,,,,525,446.25,150.465,525,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Dexa Hip,,77080,CPT,Facility,Both,,,,525,446.25,150.465,525,"Multiplan, Inc.","Multiplan, Inc.",493.5,94,,percent of total billed charges,,
Dexa Hip,,77080,CPT,Facility,Outpatient,,,,525,446.25,150.465,525,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,473.025,90.1,,percent of total billed charges,,
Dexa Hip,,77080,CPT,Facility,Inpatient,,,,525,446.25,150.465,525,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Dexa Hip,,77080,CPT,Facility,Both,,,,525,446.25,150.465,525,"Preferred One Administrative Services, INC.",PPO,517.65,98.6,,percent of total billed charges,,
Dexa Hip,,77080,CPT,Facility,Outpatient,,,,525,446.25,150.465,525,PrimeWest Health,Minnesota Senior Health Options (MSHO),270.1125,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Dexa Hip,,77080,CPT,Facility,Inpatient,,,,525,446.25,150.465,525,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Dexa Hip,,77080,CPT,Facility,Outpatient,,,,525,446.25,150.465,525,PrimeWest Health,MinnesotaCare,269.64,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Dexa Hip,,77080,CPT,Facility,Inpatient,,,,525,446.25,150.465,525,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Dexa Hip,,77080,CPT,Facility,Both,,,,525,446.25,150.465,525,Sanford Health Plan,Sanford Health Plan,483,92,,percent of total billed charges,,
Dexa Hip,,77080,CPT,Facility,Outpatient,,,,525,446.25,150.465,525,"UCare Health, Inc.",Individual & Family Plan,295.8375,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Dexa Hip,,77080,CPT,Facility,Inpatient,,,,525,446.25,150.465,525,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Dexa Hip,,77080,CPT,Facility,Outpatient,,,,525,446.25,150.465,525,"UCare Health, Inc.",Medical Assistance,264.9675,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Dexa Hip,,77080,CPT,Facility,Inpatient,,,,525,446.25,150.465,525,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Dexa Hip,,77080,CPT,Facility,Outpatient,,,,525,446.25,150.465,525,"UCare Health, Inc.",Medicare Advantage,264.9675,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Dexa Hip,,77080,CPT,Facility,Inpatient,,,,525,446.25,150.465,525,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Dexa Hip,,77080,CPT,Facility,Outpatient,,,,525,446.25,150.465,525,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),264.9675,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Dexa Hip,,77080,CPT,Facility,Inpatient,,,,525,446.25,150.465,525,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Dexa Hip,,77080,CPT,Facility,Both,,,,525,446.25,150.465,525,UnitedHealthcare,Individual & Family,493.5,94,,percent of total billed charges,,
Dexa Hip,,77080,CPT,Facility,Outpatient,,,,525,446.25,150.465,525,UnitedHealthcare,Medicare Advantage,257.25,49,,percent of total billed charges,,
Dexa Hip,,77080,CPT,Facility,Inpatient,,,,525,446.25,150.465,525,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Dexa Hip,,77080,CPT,Facility,Outpatient,,,,525,446.25,150.465,525,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,252,48,,percent of total billed charges,,100% of DHS outpatient percentage
Dexa Hip,,77080,CPT,Facility,Inpatient,,,,525,446.25,150.465,525,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Dexa Hip And Spine,,77080,CPT,Facility,Both,,,,587,498.95,168.2342,587,Aetna,Commercial,540.04,92,,percent of total billed charges,,
Dexa Hip And Spine,,77080,CPT,Facility,Outpatient,,,,587,498.95,168.2342,587,Aetna,Medicare Advantage,287.63,49,,percent of total billed charges,,
Dexa Hip And Spine,,77080,CPT,Facility,Inpatient,,,,587,498.95,168.2342,587,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Dexa Hip And Spine,,77080,CPT,Facility,Both,,,,587,498.95,168.2342,587,Aetna,PPO,545.91,93,,percent of total billed charges,,
Dexa Hip And Spine,,77080,CPT,Facility,Both,,,,587,498.95,168.2342,587,America's PPO,America's PPO,563.6961,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Dexa Hip And Spine,,77080,CPT,Facility,Both,,,,587,498.95,168.2342,587,BlueCross BlueShield Minnesota, Federal Employee Program,577.608,98.4,,percent of total billed charges,,
Dexa Hip And Spine,,77080,CPT,Facility,Both,,,,587,498.95,168.2342,587,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,587,100,,percent of total billed charges,,
Dexa Hip And Spine,,77080,CPT,Facility,Both,,,,587,498.95,168.2342,587,BlueCross BlueShield Minnesota,High Value Network Plan,528.3,90,,percent of total billed charges,,
Dexa Hip And Spine,,77080,CPT,Facility,Outpatient,,,,587,498.95,168.2342,587,BlueCross BlueShield Minnesota,Medicare Advantage,287.63,49,,percent of total billed charges,,
Dexa Hip And Spine,,77080,CPT,Facility,Inpatient,,,,587,498.95,168.2342,587,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Dexa Hip And Spine,,77080,CPT,Facility,Both,,,,587,498.95,168.2342,587,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,519.9059,88.57,,percent of total billed charges,,
Dexa Hip And Spine,,77080,CPT,Facility,Both,,,,587,498.95,168.2342,587,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,168.2342,28.66,,percent of total billed charges,,
Dexa Hip And Spine,,77080,CPT,Facility,Outpatient,,,,587,498.95,168.2342,587,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),287.63,49,,percent of total billed charges,,
Dexa Hip And Spine,,77080,CPT,Facility,Inpatient,,,,587,498.95,168.2342,587,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Dexa Hip And Spine,,77080,CPT,Facility,Both,,,,587,498.95,168.2342,587,CorVel,Worker's Compensation,587,100,,percent of total billed charges,,
Dexa Hip And Spine,,77080,CPT,Facility,Both,,,,587,498.95,168.2342,587,First Health Group Corporation,First Health Network,569.39,97,,percent of total billed charges,,
Dexa Hip And Spine,,77080,CPT,Facility,Both,,,,587,498.95,168.2342,587,"Health Partners, Inc.",Commercial,555.302,94.6,,percent of total billed charges,,
Dexa Hip And Spine,,77080,CPT,Facility,Outpatient,,,,587,498.95,168.2342,587,"Health Partners, Inc.",Medicare Advantage,287.63,49,,percent of total billed charges,,
Dexa Hip And Spine,,77080,CPT,Facility,Inpatient,,,,587,498.95,168.2342,587,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Dexa Hip And Spine,,77080,CPT,Facility,Both,,,,587,498.95,168.2342,587,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),352.2,60,,percent of total billed charges,,
Dexa Hip And Spine,,77080,CPT,Facility,Both,,,,587,498.95,168.2342,587,"Health Partners, Inc.",State of Minnesota Advantage Program,478.405,81.5,,percent of total billed charges,,
Dexa Hip And Spine,,77080,CPT,Facility,Both,,,,587,498.95,168.2342,587,"Health Partners, Inc.",State Public Programs,293.5,50,,percent of total billed charges,,
Dexa Hip And Spine,,77080,CPT,Facility,Both,,,,587,498.95,168.2342,587,Humana Insurance Company,Commercial PPO,557.65,95,,percent of total billed charges,,
Dexa Hip And Spine,,77080,CPT,Facility,Outpatient,,,,587,498.95,168.2342,587,Humana Insurance Company,Medicare PPO,287.63,49,,percent of total billed charges,,
Dexa Hip And Spine,,77080,CPT,Facility,Inpatient,,,,587,498.95,168.2342,587,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Dexa Hip And Spine,,77080,CPT,Facility,Both,,,,587,498.95,168.2342,587,Medica,Individual & Family,581.717,99.1,,percent of total billed charges,,
Dexa Hip And Spine,,77080,CPT,Facility,Outpatient,,,,587,498.95,168.2342,587,Medica,Medica Advantage Solution,292.326,49.8,,percent of total billed charges,,
Dexa Hip And Spine,,77080,CPT,Facility,Inpatient,,,,587,498.95,168.2342,587,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Dexa Hip And Spine,,77080,CPT,Facility,Outpatient,,,,587,498.95,168.2342,587,Medica,Medical Assistance,261.802,44.6,,percent of total billed charges,,
Dexa Hip And Spine,,77080,CPT,Facility,Inpatient,,,,587,498.95,168.2342,587,Medica,Medical Assistance,,,,,Included in per diem rate,
Dexa Hip And Spine,,77080,CPT,Facility,Outpatient,,,,587,498.95,168.2342,587,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,292.326,49.8,,percent of total billed charges,,
Dexa Hip And Spine,,77080,CPT,Facility,Inpatient,,,,587,498.95,168.2342,587,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Dexa Hip And Spine,,77080,CPT,Facility,Both,,,,587,498.95,168.2342,587,"Multiplan, Inc.","Multiplan, Inc.",551.78,94,,percent of total billed charges,,
Dexa Hip And Spine,,77080,CPT,Facility,Outpatient,,,,587,498.95,168.2342,587,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,528.887,90.1,,percent of total billed charges,,
Dexa Hip And Spine,,77080,CPT,Facility,Inpatient,,,,587,498.95,168.2342,587,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Dexa Hip And Spine,,77080,CPT,Facility,Both,,,,587,498.95,168.2342,587,"Preferred One Administrative Services, INC.",PPO,578.782,98.6,,percent of total billed charges,,
Dexa Hip And Spine,,77080,CPT,Facility,Outpatient,,,,587,498.95,168.2342,587,PrimeWest Health,Minnesota Senior Health Options (MSHO),302.0115,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Dexa Hip And Spine,,77080,CPT,Facility,Inpatient,,,,587,498.95,168.2342,587,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Dexa Hip And Spine,,77080,CPT,Facility,Outpatient,,,,587,498.95,168.2342,587,PrimeWest Health,MinnesotaCare,301.4832,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Dexa Hip And Spine,,77080,CPT,Facility,Inpatient,,,,587,498.95,168.2342,587,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Dexa Hip And Spine,,77080,CPT,Facility,Both,,,,587,498.95,168.2342,587,Sanford Health Plan,Sanford Health Plan,540.04,92,,percent of total billed charges,,
Dexa Hip And Spine,,77080,CPT,Facility,Outpatient,,,,587,498.95,168.2342,587,"UCare Health, Inc.",Individual & Family Plan,330.7745,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Dexa Hip And Spine,,77080,CPT,Facility,Inpatient,,,,587,498.95,168.2342,587,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Dexa Hip And Spine,,77080,CPT,Facility,Outpatient,,,,587,498.95,168.2342,587,"UCare Health, Inc.",Medical Assistance,296.2589,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Dexa Hip And Spine,,77080,CPT,Facility,Inpatient,,,,587,498.95,168.2342,587,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Dexa Hip And Spine,,77080,CPT,Facility,Outpatient,,,,587,498.95,168.2342,587,"UCare Health, Inc.",Medicare Advantage,296.2589,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Dexa Hip And Spine,,77080,CPT,Facility,Inpatient,,,,587,498.95,168.2342,587,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Dexa Hip And Spine,,77080,CPT,Facility,Outpatient,,,,587,498.95,168.2342,587,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),296.2589,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Dexa Hip And Spine,,77080,CPT,Facility,Inpatient,,,,587,498.95,168.2342,587,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Dexa Hip And Spine,,77080,CPT,Facility,Both,,,,587,498.95,168.2342,587,UnitedHealthcare,Individual & Family,551.78,94,,percent of total billed charges,,
Dexa Hip And Spine,,77080,CPT,Facility,Outpatient,,,,587,498.95,168.2342,587,UnitedHealthcare,Medicare Advantage,287.63,49,,percent of total billed charges,,
Dexa Hip And Spine,,77080,CPT,Facility,Inpatient,,,,587,498.95,168.2342,587,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Dexa Hip And Spine,,77080,CPT,Facility,Outpatient,,,,587,498.95,168.2342,587,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,281.76,48,,percent of total billed charges,,100% of DHS outpatient percentage
Dexa Hip And Spine,,77080,CPT,Facility,Inpatient,,,,587,498.95,168.2342,587,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Dexa Spine,,77080,CPT,Facility,Both,,,,525,446.25,150.465,525,Aetna,Commercial,483,92,,percent of total billed charges,,
Dexa Spine,,77080,CPT,Facility,Outpatient,,,,525,446.25,150.465,525,Aetna,Medicare Advantage,257.25,49,,percent of total billed charges,,
Dexa Spine,,77080,CPT,Facility,Inpatient,,,,525,446.25,150.465,525,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Dexa Spine,,77080,CPT,Facility,Both,,,,525,446.25,150.465,525,Aetna,PPO,488.25,93,,percent of total billed charges,,
Dexa Spine,,77080,CPT,Facility,Both,,,,525,446.25,150.465,525,America's PPO,America's PPO,504.1575,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Dexa Spine,,77080,CPT,Facility,Both,,,,525,446.25,150.465,525,BlueCross BlueShield Minnesota, Federal Employee Program,516.6,98.4,,percent of total billed charges,,
Dexa Spine,,77080,CPT,Facility,Both,,,,525,446.25,150.465,525,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,525,100,,percent of total billed charges,,
Dexa Spine,,77080,CPT,Facility,Both,,,,525,446.25,150.465,525,BlueCross BlueShield Minnesota,High Value Network Plan,472.5,90,,percent of total billed charges,,
Dexa Spine,,77080,CPT,Facility,Outpatient,,,,525,446.25,150.465,525,BlueCross BlueShield Minnesota,Medicare Advantage,257.25,49,,percent of total billed charges,,
Dexa Spine,,77080,CPT,Facility,Inpatient,,,,525,446.25,150.465,525,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Dexa Spine,,77080,CPT,Facility,Both,,,,525,446.25,150.465,525,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,464.9925,88.57,,percent of total billed charges,,
Dexa Spine,,77080,CPT,Facility,Both,,,,525,446.25,150.465,525,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,150.465,28.66,,percent of total billed charges,,
Dexa Spine,,77080,CPT,Facility,Outpatient,,,,525,446.25,150.465,525,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),257.25,49,,percent of total billed charges,,
Dexa Spine,,77080,CPT,Facility,Inpatient,,,,525,446.25,150.465,525,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Dexa Spine,,77080,CPT,Facility,Both,,,,525,446.25,150.465,525,CorVel,Worker's Compensation,525,100,,percent of total billed charges,,
Dexa Spine,,77080,CPT,Facility,Both,,,,525,446.25,150.465,525,First Health Group Corporation,First Health Network,509.25,97,,percent of total billed charges,,
Dexa Spine,,77080,CPT,Facility,Both,,,,525,446.25,150.465,525,"Health Partners, Inc.",Commercial,496.65,94.6,,percent of total billed charges,,
Dexa Spine,,77080,CPT,Facility,Outpatient,,,,525,446.25,150.465,525,"Health Partners, Inc.",Medicare Advantage,257.25,49,,percent of total billed charges,,
Dexa Spine,,77080,CPT,Facility,Inpatient,,,,525,446.25,150.465,525,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Dexa Spine,,77080,CPT,Facility,Both,,,,525,446.25,150.465,525,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),315,60,,percent of total billed charges,,
Dexa Spine,,77080,CPT,Facility,Both,,,,525,446.25,150.465,525,"Health Partners, Inc.",State of Minnesota Advantage Program,427.875,81.5,,percent of total billed charges,,
Dexa Spine,,77080,CPT,Facility,Both,,,,525,446.25,150.465,525,"Health Partners, Inc.",State Public Programs,262.5,50,,percent of total billed charges,,
Dexa Spine,,77080,CPT,Facility,Both,,,,525,446.25,150.465,525,Humana Insurance Company,Commercial PPO,498.75,95,,percent of total billed charges,,
Dexa Spine,,77080,CPT,Facility,Outpatient,,,,525,446.25,150.465,525,Humana Insurance Company,Medicare PPO,257.25,49,,percent of total billed charges,,
Dexa Spine,,77080,CPT,Facility,Inpatient,,,,525,446.25,150.465,525,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Dexa Spine,,77080,CPT,Facility,Both,,,,525,446.25,150.465,525,Medica,Individual & Family,520.275,99.1,,percent of total billed charges,,
Dexa Spine,,77080,CPT,Facility,Outpatient,,,,525,446.25,150.465,525,Medica,Medica Advantage Solution,261.45,49.8,,percent of total billed charges,,
Dexa Spine,,77080,CPT,Facility,Inpatient,,,,525,446.25,150.465,525,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Dexa Spine,,77080,CPT,Facility,Outpatient,,,,525,446.25,150.465,525,Medica,Medical Assistance,234.15,44.6,,percent of total billed charges,,
Dexa Spine,,77080,CPT,Facility,Inpatient,,,,525,446.25,150.465,525,Medica,Medical Assistance,,,,,Included in per diem rate,
Dexa Spine,,77080,CPT,Facility,Outpatient,,,,525,446.25,150.465,525,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,261.45,49.8,,percent of total billed charges,,
Dexa Spine,,77080,CPT,Facility,Inpatient,,,,525,446.25,150.465,525,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Dexa Spine,,77080,CPT,Facility,Both,,,,525,446.25,150.465,525,"Multiplan, Inc.","Multiplan, Inc.",493.5,94,,percent of total billed charges,,
Dexa Spine,,77080,CPT,Facility,Outpatient,,,,525,446.25,150.465,525,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,473.025,90.1,,percent of total billed charges,,
Dexa Spine,,77080,CPT,Facility,Inpatient,,,,525,446.25,150.465,525,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Dexa Spine,,77080,CPT,Facility,Both,,,,525,446.25,150.465,525,"Preferred One Administrative Services, INC.",PPO,517.65,98.6,,percent of total billed charges,,
Dexa Spine,,77080,CPT,Facility,Outpatient,,,,525,446.25,150.465,525,PrimeWest Health,Minnesota Senior Health Options (MSHO),270.1125,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Dexa Spine,,77080,CPT,Facility,Inpatient,,,,525,446.25,150.465,525,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Dexa Spine,,77080,CPT,Facility,Outpatient,,,,525,446.25,150.465,525,PrimeWest Health,MinnesotaCare,269.64,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Dexa Spine,,77080,CPT,Facility,Inpatient,,,,525,446.25,150.465,525,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Dexa Spine,,77080,CPT,Facility,Both,,,,525,446.25,150.465,525,Sanford Health Plan,Sanford Health Plan,483,92,,percent of total billed charges,,
Dexa Spine,,77080,CPT,Facility,Outpatient,,,,525,446.25,150.465,525,"UCare Health, Inc.",Individual & Family Plan,295.8375,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Dexa Spine,,77080,CPT,Facility,Inpatient,,,,525,446.25,150.465,525,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Dexa Spine,,77080,CPT,Facility,Outpatient,,,,525,446.25,150.465,525,"UCare Health, Inc.",Medical Assistance,264.9675,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Dexa Spine,,77080,CPT,Facility,Inpatient,,,,525,446.25,150.465,525,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Dexa Spine,,77080,CPT,Facility,Outpatient,,,,525,446.25,150.465,525,"UCare Health, Inc.",Medicare Advantage,264.9675,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Dexa Spine,,77080,CPT,Facility,Inpatient,,,,525,446.25,150.465,525,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Dexa Spine,,77080,CPT,Facility,Outpatient,,,,525,446.25,150.465,525,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),264.9675,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Dexa Spine,,77080,CPT,Facility,Inpatient,,,,525,446.25,150.465,525,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Dexa Spine,,77080,CPT,Facility,Both,,,,525,446.25,150.465,525,UnitedHealthcare,Individual & Family,493.5,94,,percent of total billed charges,,
Dexa Spine,,77080,CPT,Facility,Outpatient,,,,525,446.25,150.465,525,UnitedHealthcare,Medicare Advantage,257.25,49,,percent of total billed charges,,
Dexa Spine,,77080,CPT,Facility,Inpatient,,,,525,446.25,150.465,525,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Dexa Spine,,77080,CPT,Facility,Outpatient,,,,525,446.25,150.465,525,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,252,48,,percent of total billed charges,,100% of DHS outpatient percentage
Dexa Spine,,77080,CPT,Facility,Inpatient,,,,525,446.25,150.465,525,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Dexa Forearm,,77081,CPT,Facility,Both,,,,536,455.6,153.6176,536,Aetna,Commercial,493.12,92,,percent of total billed charges,,
Dexa Forearm,,77081,CPT,Facility,Outpatient,,,,536,455.6,153.6176,536,Aetna,Medicare Advantage,262.64,49,,percent of total billed charges,,
Dexa Forearm,,77081,CPT,Facility,Inpatient,,,,536,455.6,153.6176,536,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Dexa Forearm,,77081,CPT,Facility,Both,,,,536,455.6,153.6176,536,Aetna,PPO,498.48,93,,percent of total billed charges,,
Dexa Forearm,,77081,CPT,Facility,Both,,,,536,455.6,153.6176,536,America's PPO,America's PPO,514.7208,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Dexa Forearm,,77081,CPT,Facility,Both,,,,536,455.6,153.6176,536,BlueCross BlueShield Minnesota, Federal Employee Program,527.424,98.4,,percent of total billed charges,,
Dexa Forearm,,77081,CPT,Facility,Both,,,,536,455.6,153.6176,536,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,536,100,,percent of total billed charges,,
Dexa Forearm,,77081,CPT,Facility,Both,,,,536,455.6,153.6176,536,BlueCross BlueShield Minnesota,High Value Network Plan,482.4,90,,percent of total billed charges,,
Dexa Forearm,,77081,CPT,Facility,Outpatient,,,,536,455.6,153.6176,536,BlueCross BlueShield Minnesota,Medicare Advantage,262.64,49,,percent of total billed charges,,
Dexa Forearm,,77081,CPT,Facility,Inpatient,,,,536,455.6,153.6176,536,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Dexa Forearm,,77081,CPT,Facility,Both,,,,536,455.6,153.6176,536,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,474.7352,88.57,,percent of total billed charges,,
Dexa Forearm,,77081,CPT,Facility,Both,,,,536,455.6,153.6176,536,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,153.6176,28.66,,percent of total billed charges,,
Dexa Forearm,,77081,CPT,Facility,Outpatient,,,,536,455.6,153.6176,536,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),262.64,49,,percent of total billed charges,,
Dexa Forearm,,77081,CPT,Facility,Inpatient,,,,536,455.6,153.6176,536,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Dexa Forearm,,77081,CPT,Facility,Both,,,,536,455.6,153.6176,536,CorVel,Worker's Compensation,536,100,,percent of total billed charges,,
Dexa Forearm,,77081,CPT,Facility,Both,,,,536,455.6,153.6176,536,First Health Group Corporation,First Health Network,519.92,97,,percent of total billed charges,,
Dexa Forearm,,77081,CPT,Facility,Both,,,,536,455.6,153.6176,536,"Health Partners, Inc.",Commercial,507.056,94.6,,percent of total billed charges,,
Dexa Forearm,,77081,CPT,Facility,Outpatient,,,,536,455.6,153.6176,536,"Health Partners, Inc.",Medicare Advantage,262.64,49,,percent of total billed charges,,
Dexa Forearm,,77081,CPT,Facility,Inpatient,,,,536,455.6,153.6176,536,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Dexa Forearm,,77081,CPT,Facility,Both,,,,536,455.6,153.6176,536,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),321.6,60,,percent of total billed charges,,
Dexa Forearm,,77081,CPT,Facility,Both,,,,536,455.6,153.6176,536,"Health Partners, Inc.",State of Minnesota Advantage Program,436.84,81.5,,percent of total billed charges,,
Dexa Forearm,,77081,CPT,Facility,Both,,,,536,455.6,153.6176,536,"Health Partners, Inc.",State Public Programs,268,50,,percent of total billed charges,,
Dexa Forearm,,77081,CPT,Facility,Both,,,,536,455.6,153.6176,536,Humana Insurance Company,Commercial PPO,509.2,95,,percent of total billed charges,,
Dexa Forearm,,77081,CPT,Facility,Outpatient,,,,536,455.6,153.6176,536,Humana Insurance Company,Medicare PPO,262.64,49,,percent of total billed charges,,
Dexa Forearm,,77081,CPT,Facility,Inpatient,,,,536,455.6,153.6176,536,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Dexa Forearm,,77081,CPT,Facility,Both,,,,536,455.6,153.6176,536,Medica,Individual & Family,531.176,99.1,,percent of total billed charges,,
Dexa Forearm,,77081,CPT,Facility,Outpatient,,,,536,455.6,153.6176,536,Medica,Medica Advantage Solution,266.928,49.8,,percent of total billed charges,,
Dexa Forearm,,77081,CPT,Facility,Inpatient,,,,536,455.6,153.6176,536,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Dexa Forearm,,77081,CPT,Facility,Outpatient,,,,536,455.6,153.6176,536,Medica,Medical Assistance,239.056,44.6,,percent of total billed charges,,
Dexa Forearm,,77081,CPT,Facility,Inpatient,,,,536,455.6,153.6176,536,Medica,Medical Assistance,,,,,Included in per diem rate,
Dexa Forearm,,77081,CPT,Facility,Outpatient,,,,536,455.6,153.6176,536,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,266.928,49.8,,percent of total billed charges,,
Dexa Forearm,,77081,CPT,Facility,Inpatient,,,,536,455.6,153.6176,536,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Dexa Forearm,,77081,CPT,Facility,Both,,,,536,455.6,153.6176,536,"Multiplan, Inc.","Multiplan, Inc.",503.84,94,,percent of total billed charges,,
Dexa Forearm,,77081,CPT,Facility,Outpatient,,,,536,455.6,153.6176,536,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,482.936,90.1,,percent of total billed charges,,
Dexa Forearm,,77081,CPT,Facility,Inpatient,,,,536,455.6,153.6176,536,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Dexa Forearm,,77081,CPT,Facility,Both,,,,536,455.6,153.6176,536,"Preferred One Administrative Services, INC.",PPO,528.496,98.6,,percent of total billed charges,,
Dexa Forearm,,77081,CPT,Facility,Outpatient,,,,536,455.6,153.6176,536,PrimeWest Health,Minnesota Senior Health Options (MSHO),275.772,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Dexa Forearm,,77081,CPT,Facility,Inpatient,,,,536,455.6,153.6176,536,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Dexa Forearm,,77081,CPT,Facility,Outpatient,,,,536,455.6,153.6176,536,PrimeWest Health,MinnesotaCare,275.2896,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Dexa Forearm,,77081,CPT,Facility,Inpatient,,,,536,455.6,153.6176,536,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Dexa Forearm,,77081,CPT,Facility,Both,,,,536,455.6,153.6176,536,Sanford Health Plan,Sanford Health Plan,493.12,92,,percent of total billed charges,,
Dexa Forearm,,77081,CPT,Facility,Outpatient,,,,536,455.6,153.6176,536,"UCare Health, Inc.",Individual & Family Plan,302.036,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Dexa Forearm,,77081,CPT,Facility,Inpatient,,,,536,455.6,153.6176,536,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Dexa Forearm,,77081,CPT,Facility,Outpatient,,,,536,455.6,153.6176,536,"UCare Health, Inc.",Medical Assistance,270.5192,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Dexa Forearm,,77081,CPT,Facility,Inpatient,,,,536,455.6,153.6176,536,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Dexa Forearm,,77081,CPT,Facility,Outpatient,,,,536,455.6,153.6176,536,"UCare Health, Inc.",Medicare Advantage,270.5192,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Dexa Forearm,,77081,CPT,Facility,Inpatient,,,,536,455.6,153.6176,536,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Dexa Forearm,,77081,CPT,Facility,Outpatient,,,,536,455.6,153.6176,536,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),270.5192,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Dexa Forearm,,77081,CPT,Facility,Inpatient,,,,536,455.6,153.6176,536,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Dexa Forearm,,77081,CPT,Facility,Both,,,,536,455.6,153.6176,536,UnitedHealthcare,Individual & Family,503.84,94,,percent of total billed charges,,
Dexa Forearm,,77081,CPT,Facility,Outpatient,,,,536,455.6,153.6176,536,UnitedHealthcare,Medicare Advantage,262.64,49,,percent of total billed charges,,
Dexa Forearm,,77081,CPT,Facility,Inpatient,,,,536,455.6,153.6176,536,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Dexa Forearm,,77081,CPT,Facility,Outpatient,,,,536,455.6,153.6176,536,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,257.28,48,,percent of total billed charges,,100% of DHS outpatient percentage
Dexa Forearm,,77081,CPT,Facility,Inpatient,,,,536,455.6,153.6176,536,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
EPINEPHRINE 0.1 MG/ML INJ SYRG,,J0171,HCPCS,Facility,Both,10,mL,,72,61.2,20.6352,72,Aetna,Commercial,66.24,92,,percent of total billed charges,,
EPINEPHRINE 0.1 MG/ML INJ SYRG,,J0171,HCPCS,Facility,Outpatient,10,mL,,72,61.2,20.6352,72,Aetna,Medicare Advantage,35.28,49,,percent of total billed charges,,
EPINEPHRINE 0.1 MG/ML INJ SYRG,,J0171,HCPCS,Facility,Inpatient,10,mL,,72,61.2,20.6352,72,Aetna,Medicare Advantage,,,,,Included in per diem rate,
EPINEPHRINE 0.1 MG/ML INJ SYRG,,J0171,HCPCS,Facility,Both,10,mL,,72,61.2,20.6352,72,Aetna,PPO,66.96,93,,percent of total billed charges,,
EPINEPHRINE 0.1 MG/ML INJ SYRG,,J0171,HCPCS,Facility,Both,10,mL,,72,61.2,20.6352,72,America's PPO,America's PPO,69.1416,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
EPINEPHRINE 0.1 MG/ML INJ SYRG,,J0171,HCPCS,Facility,Both,10,mL,,72,61.2,20.6352,72,BlueCross BlueShield Minnesota, Federal Employee Program,70.848,98.4,,percent of total billed charges,,
EPINEPHRINE 0.1 MG/ML INJ SYRG,,J0171,HCPCS,Facility,Both,10,mL,,72,61.2,20.6352,72,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,72,100,,percent of total billed charges,,
EPINEPHRINE 0.1 MG/ML INJ SYRG,,J0171,HCPCS,Facility,Both,10,mL,,72,61.2,20.6352,72,BlueCross BlueShield Minnesota,High Value Network Plan,64.8,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
EPINEPHRINE 0.1 MG/ML INJ SYRG,,J0171,HCPCS,Facility,Outpatient,10,mL,,72,61.2,20.6352,72,BlueCross BlueShield Minnesota,Medicare Advantage,35.28,49,,percent of total billed charges,,
EPINEPHRINE 0.1 MG/ML INJ SYRG,,J0171,HCPCS,Facility,Inpatient,10,mL,,72,61.2,20.6352,72,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
EPINEPHRINE 0.1 MG/ML INJ SYRG,,J0171,HCPCS,Facility,Both,10,mL,,72,61.2,20.6352,72,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,63.7704,88.57,,percent of total billed charges,,
EPINEPHRINE 0.1 MG/ML INJ SYRG,,J0171,HCPCS,Facility,Both,10,mL,,72,61.2,20.6352,72,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,20.6352,28.66,,percent of total billed charges,,
EPINEPHRINE 0.1 MG/ML INJ SYRG,,J0171,HCPCS,Facility,Outpatient,10,mL,,72,61.2,20.6352,72,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),35.28,49,,percent of total billed charges,,
EPINEPHRINE 0.1 MG/ML INJ SYRG,,J0171,HCPCS,Facility,Inpatient,10,mL,,72,61.2,20.6352,72,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
EPINEPHRINE 0.1 MG/ML INJ SYRG,,J0171,HCPCS,Facility,Both,10,mL,,72,61.2,20.6352,72,CorVel,Worker's Compensation,72,100,,percent of total billed charges,,
EPINEPHRINE 0.1 MG/ML INJ SYRG,,J0171,HCPCS,Facility,Both,10,mL,,72,61.2,20.6352,72,First Health Group Corporation,First Health Network,69.84,97,,percent of total billed charges,,
EPINEPHRINE 0.1 MG/ML INJ SYRG,,J0171,HCPCS,Facility,Both,10,mL,,72,61.2,20.6352,72,"Health Partners, Inc.",Commercial,68.112,94.6,,percent of total billed charges,,
EPINEPHRINE 0.1 MG/ML INJ SYRG,,J0171,HCPCS,Facility,Outpatient,10,mL,,72,61.2,20.6352,72,"Health Partners, Inc.",Medicare Advantage,35.28,49,,percent of total billed charges,,
EPINEPHRINE 0.1 MG/ML INJ SYRG,,J0171,HCPCS,Facility,Inpatient,10,mL,,72,61.2,20.6352,72,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
EPINEPHRINE 0.1 MG/ML INJ SYRG,,J0171,HCPCS,Facility,Both,10,mL,,72,61.2,20.6352,72,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),43.2,60,,percent of total billed charges,,
EPINEPHRINE 0.1 MG/ML INJ SYRG,,J0171,HCPCS,Facility,Both,10,mL,,72,61.2,20.6352,72,"Health Partners, Inc.",State of Minnesota Advantage Program,58.68,81.5,,percent of total billed charges,,
EPINEPHRINE 0.1 MG/ML INJ SYRG,,J0171,HCPCS,Facility,Both,10,mL,,72,61.2,20.6352,72,"Health Partners, Inc.",State Public Programs,36,50,,percent of total billed charges,,
EPINEPHRINE 0.1 MG/ML INJ SYRG,,J0171,HCPCS,Facility,Both,10,mL,,72,61.2,20.6352,72,Humana Insurance Company,Commercial PPO,68.4,95,,percent of total billed charges,,
EPINEPHRINE 0.1 MG/ML INJ SYRG,,J0171,HCPCS,Facility,Outpatient,10,mL,,72,61.2,20.6352,72,Humana Insurance Company,Medicare PPO,35.28,49,,percent of total billed charges,,
EPINEPHRINE 0.1 MG/ML INJ SYRG,,J0171,HCPCS,Facility,Inpatient,10,mL,,72,61.2,20.6352,72,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
EPINEPHRINE 0.1 MG/ML INJ SYRG,,J0171,HCPCS,Facility,Both,10,mL,,72,61.2,20.6352,72,Medica,Individual & Family,71.352,99.1,,percent of total billed charges,,
EPINEPHRINE 0.1 MG/ML INJ SYRG,,J0171,HCPCS,Facility,Outpatient,10,mL,,72,61.2,20.6352,72,Medica,Medica Advantage Solution,35.856,49.8,,percent of total billed charges,,
EPINEPHRINE 0.1 MG/ML INJ SYRG,,J0171,HCPCS,Facility,Inpatient,10,mL,,72,61.2,20.6352,72,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
EPINEPHRINE 0.1 MG/ML INJ SYRG,,J0171,HCPCS,Facility,Outpatient,10,mL,,72,61.2,20.6352,72,Medica,Medical Assistance,32.112,44.6,,percent of total billed charges,,
EPINEPHRINE 0.1 MG/ML INJ SYRG,,J0171,HCPCS,Facility,Inpatient,10,mL,,72,61.2,20.6352,72,Medica,Medical Assistance,,,,,Included in per diem rate,
EPINEPHRINE 0.1 MG/ML INJ SYRG,,J0171,HCPCS,Facility,Outpatient,10,mL,,72,61.2,20.6352,72,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,35.856,49.8,,percent of total billed charges,,
EPINEPHRINE 0.1 MG/ML INJ SYRG,,J0171,HCPCS,Facility,Inpatient,10,mL,,72,61.2,20.6352,72,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
EPINEPHRINE 0.1 MG/ML INJ SYRG,,J0171,HCPCS,Facility,Both,10,mL,,72,61.2,20.6352,72,"Multiplan, Inc.","Multiplan, Inc.",67.68,94,,percent of total billed charges,,
EPINEPHRINE 0.1 MG/ML INJ SYRG,,J0171,HCPCS,Facility,Outpatient,10,mL,,72,61.2,20.6352,72,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,64.872,90.1,,percent of total billed charges,,
EPINEPHRINE 0.1 MG/ML INJ SYRG,,J0171,HCPCS,Facility,Inpatient,10,mL,,72,61.2,20.6352,72,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
EPINEPHRINE 0.1 MG/ML INJ SYRG,,J0171,HCPCS,Facility,Both,10,mL,,72,61.2,20.6352,72,"Preferred One Administrative Services, INC.",PPO,70.992,98.6,,percent of total billed charges,,
EPINEPHRINE 0.1 MG/ML INJ SYRG,,J0171,HCPCS,Facility,Outpatient,10,mL,,72,61.2,20.6352,72,PrimeWest Health,Minnesota Senior Health Options (MSHO),37.044,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
EPINEPHRINE 0.1 MG/ML INJ SYRG,,J0171,HCPCS,Facility,Inpatient,10,mL,,72,61.2,20.6352,72,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
EPINEPHRINE 0.1 MG/ML INJ SYRG,,J0171,HCPCS,Facility,Outpatient,10,mL,,72,61.2,20.6352,72,PrimeWest Health,MinnesotaCare,36.9792,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
EPINEPHRINE 0.1 MG/ML INJ SYRG,,J0171,HCPCS,Facility,Inpatient,10,mL,,72,61.2,20.6352,72,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
EPINEPHRINE 0.1 MG/ML INJ SYRG,,J0171,HCPCS,Facility,Both,10,mL,,72,61.2,20.6352,72,Sanford Health Plan,Sanford Health Plan,66.24,92,,percent of total billed charges,,
EPINEPHRINE 0.1 MG/ML INJ SYRG,,J0171,HCPCS,Facility,Outpatient,10,mL,,72,61.2,20.6352,72,"UCare Health, Inc.",Individual & Family Plan,40.572,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
EPINEPHRINE 0.1 MG/ML INJ SYRG,,J0171,HCPCS,Facility,Inpatient,10,mL,,72,61.2,20.6352,72,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
EPINEPHRINE 0.1 MG/ML INJ SYRG,,J0171,HCPCS,Facility,Outpatient,10,mL,,72,61.2,20.6352,72,"UCare Health, Inc.",Medical Assistance,36.3384,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
EPINEPHRINE 0.1 MG/ML INJ SYRG,,J0171,HCPCS,Facility,Inpatient,10,mL,,72,61.2,20.6352,72,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
EPINEPHRINE 0.1 MG/ML INJ SYRG,,J0171,HCPCS,Facility,Outpatient,10,mL,,72,61.2,20.6352,72,"UCare Health, Inc.",Medicare Advantage,36.3384,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
EPINEPHRINE 0.1 MG/ML INJ SYRG,,J0171,HCPCS,Facility,Inpatient,10,mL,,72,61.2,20.6352,72,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
EPINEPHRINE 0.1 MG/ML INJ SYRG,,J0171,HCPCS,Facility,Outpatient,10,mL,,72,61.2,20.6352,72,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),36.3384,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
EPINEPHRINE 0.1 MG/ML INJ SYRG,,J0171,HCPCS,Facility,Inpatient,10,mL,,72,61.2,20.6352,72,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
EPINEPHRINE 0.1 MG/ML INJ SYRG,,J0171,HCPCS,Facility,Both,10,mL,,72,61.2,20.6352,72,UnitedHealthcare,Individual & Family,67.68,94,,percent of total billed charges,,
EPINEPHRINE 0.1 MG/ML INJ SYRG,,J0171,HCPCS,Facility,Outpatient,10,mL,,72,61.2,20.6352,72,UnitedHealthcare,Medicare Advantage,35.28,49,,percent of total billed charges,,
EPINEPHRINE 0.1 MG/ML INJ SYRG,,J0171,HCPCS,Facility,Inpatient,10,mL,,72,61.2,20.6352,72,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
EPINEPHRINE 0.1 MG/ML INJ SYRG,,J0171,HCPCS,Facility,Outpatient,10,mL,,72,61.2,20.6352,72,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,34.56,48,,percent of total billed charges,,100% of DHS outpatient percentage
EPINEPHRINE 0.1 MG/ML INJ SYRG,,J0171,HCPCS,Facility,Inpatient,10,mL,,72,61.2,20.6352,72,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
EPINEPHRINE 0.1 MG/ML INJ SYRG (BABY),,J0171,HCPCS,Facility,Both,10,mL,,32,27.2,9.1712,32,Aetna,Commercial,29.44,92,,percent of total billed charges,,
EPINEPHRINE 0.1 MG/ML INJ SYRG (BABY),,J0171,HCPCS,Facility,Outpatient,10,mL,,32,27.2,9.1712,32,Aetna,Medicare Advantage,15.68,49,,percent of total billed charges,,
EPINEPHRINE 0.1 MG/ML INJ SYRG (BABY),,J0171,HCPCS,Facility,Inpatient,10,mL,,32,27.2,9.1712,32,Aetna,Medicare Advantage,,,,,Included in per diem rate,
EPINEPHRINE 0.1 MG/ML INJ SYRG (BABY),,J0171,HCPCS,Facility,Both,10,mL,,32,27.2,9.1712,32,Aetna,PPO,29.76,93,,percent of total billed charges,,
EPINEPHRINE 0.1 MG/ML INJ SYRG (BABY),,J0171,HCPCS,Facility,Both,10,mL,,32,27.2,9.1712,32,America's PPO,America's PPO,30.7296,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
EPINEPHRINE 0.1 MG/ML INJ SYRG (BABY),,J0171,HCPCS,Facility,Both,10,mL,,32,27.2,9.1712,32,BlueCross BlueShield Minnesota, Federal Employee Program,31.488,98.4,,percent of total billed charges,,
EPINEPHRINE 0.1 MG/ML INJ SYRG (BABY),,J0171,HCPCS,Facility,Both,10,mL,,32,27.2,9.1712,32,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,32,100,,percent of total billed charges,,
EPINEPHRINE 0.1 MG/ML INJ SYRG (BABY),,J0171,HCPCS,Facility,Both,10,mL,,32,27.2,9.1712,32,BlueCross BlueShield Minnesota,High Value Network Plan,28.8,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
EPINEPHRINE 0.1 MG/ML INJ SYRG (BABY),,J0171,HCPCS,Facility,Outpatient,10,mL,,32,27.2,9.1712,32,BlueCross BlueShield Minnesota,Medicare Advantage,15.68,49,,percent of total billed charges,,
EPINEPHRINE 0.1 MG/ML INJ SYRG (BABY),,J0171,HCPCS,Facility,Inpatient,10,mL,,32,27.2,9.1712,32,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
EPINEPHRINE 0.1 MG/ML INJ SYRG (BABY),,J0171,HCPCS,Facility,Both,10,mL,,32,27.2,9.1712,32,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,28.3424,88.57,,percent of total billed charges,,
EPINEPHRINE 0.1 MG/ML INJ SYRG (BABY),,J0171,HCPCS,Facility,Both,10,mL,,32,27.2,9.1712,32,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,9.1712,28.66,,percent of total billed charges,,
EPINEPHRINE 0.1 MG/ML INJ SYRG (BABY),,J0171,HCPCS,Facility,Outpatient,10,mL,,32,27.2,9.1712,32,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),15.68,49,,percent of total billed charges,,
EPINEPHRINE 0.1 MG/ML INJ SYRG (BABY),,J0171,HCPCS,Facility,Inpatient,10,mL,,32,27.2,9.1712,32,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
EPINEPHRINE 0.1 MG/ML INJ SYRG (BABY),,J0171,HCPCS,Facility,Both,10,mL,,32,27.2,9.1712,32,CorVel,Worker's Compensation,32,100,,percent of total billed charges,,
EPINEPHRINE 0.1 MG/ML INJ SYRG (BABY),,J0171,HCPCS,Facility,Both,10,mL,,32,27.2,9.1712,32,First Health Group Corporation,First Health Network,31.04,97,,percent of total billed charges,,
EPINEPHRINE 0.1 MG/ML INJ SYRG (BABY),,J0171,HCPCS,Facility,Both,10,mL,,32,27.2,9.1712,32,"Health Partners, Inc.",Commercial,30.272,94.6,,percent of total billed charges,,
EPINEPHRINE 0.1 MG/ML INJ SYRG (BABY),,J0171,HCPCS,Facility,Outpatient,10,mL,,32,27.2,9.1712,32,"Health Partners, Inc.",Medicare Advantage,15.68,49,,percent of total billed charges,,
EPINEPHRINE 0.1 MG/ML INJ SYRG (BABY),,J0171,HCPCS,Facility,Inpatient,10,mL,,32,27.2,9.1712,32,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
EPINEPHRINE 0.1 MG/ML INJ SYRG (BABY),,J0171,HCPCS,Facility,Both,10,mL,,32,27.2,9.1712,32,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),19.2,60,,percent of total billed charges,,
EPINEPHRINE 0.1 MG/ML INJ SYRG (BABY),,J0171,HCPCS,Facility,Both,10,mL,,32,27.2,9.1712,32,"Health Partners, Inc.",State of Minnesota Advantage Program,26.08,81.5,,percent of total billed charges,,
EPINEPHRINE 0.1 MG/ML INJ SYRG (BABY),,J0171,HCPCS,Facility,Both,10,mL,,32,27.2,9.1712,32,"Health Partners, Inc.",State Public Programs,16,50,,percent of total billed charges,,
EPINEPHRINE 0.1 MG/ML INJ SYRG (BABY),,J0171,HCPCS,Facility,Both,10,mL,,32,27.2,9.1712,32,Humana Insurance Company,Commercial PPO,30.4,95,,percent of total billed charges,,
EPINEPHRINE 0.1 MG/ML INJ SYRG (BABY),,J0171,HCPCS,Facility,Outpatient,10,mL,,32,27.2,9.1712,32,Humana Insurance Company,Medicare PPO,15.68,49,,percent of total billed charges,,
EPINEPHRINE 0.1 MG/ML INJ SYRG (BABY),,J0171,HCPCS,Facility,Inpatient,10,mL,,32,27.2,9.1712,32,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
EPINEPHRINE 0.1 MG/ML INJ SYRG (BABY),,J0171,HCPCS,Facility,Both,10,mL,,32,27.2,9.1712,32,Medica,Individual & Family,31.712,99.1,,percent of total billed charges,,
EPINEPHRINE 0.1 MG/ML INJ SYRG (BABY),,J0171,HCPCS,Facility,Outpatient,10,mL,,32,27.2,9.1712,32,Medica,Medica Advantage Solution,15.936,49.8,,percent of total billed charges,,
EPINEPHRINE 0.1 MG/ML INJ SYRG (BABY),,J0171,HCPCS,Facility,Inpatient,10,mL,,32,27.2,9.1712,32,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
EPINEPHRINE 0.1 MG/ML INJ SYRG (BABY),,J0171,HCPCS,Facility,Outpatient,10,mL,,32,27.2,9.1712,32,Medica,Medical Assistance,14.272,44.6,,percent of total billed charges,,
EPINEPHRINE 0.1 MG/ML INJ SYRG (BABY),,J0171,HCPCS,Facility,Inpatient,10,mL,,32,27.2,9.1712,32,Medica,Medical Assistance,,,,,Included in per diem rate,
EPINEPHRINE 0.1 MG/ML INJ SYRG (BABY),,J0171,HCPCS,Facility,Outpatient,10,mL,,32,27.2,9.1712,32,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,15.936,49.8,,percent of total billed charges,,
EPINEPHRINE 0.1 MG/ML INJ SYRG (BABY),,J0171,HCPCS,Facility,Inpatient,10,mL,,32,27.2,9.1712,32,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
EPINEPHRINE 0.1 MG/ML INJ SYRG (BABY),,J0171,HCPCS,Facility,Both,10,mL,,32,27.2,9.1712,32,"Multiplan, Inc.","Multiplan, Inc.",30.08,94,,percent of total billed charges,,
EPINEPHRINE 0.1 MG/ML INJ SYRG (BABY),,J0171,HCPCS,Facility,Outpatient,10,mL,,32,27.2,9.1712,32,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,28.832,90.1,,percent of total billed charges,,
EPINEPHRINE 0.1 MG/ML INJ SYRG (BABY),,J0171,HCPCS,Facility,Inpatient,10,mL,,32,27.2,9.1712,32,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
EPINEPHRINE 0.1 MG/ML INJ SYRG (BABY),,J0171,HCPCS,Facility,Both,10,mL,,32,27.2,9.1712,32,"Preferred One Administrative Services, INC.",PPO,31.552,98.6,,percent of total billed charges,,
EPINEPHRINE 0.1 MG/ML INJ SYRG (BABY),,J0171,HCPCS,Facility,Outpatient,10,mL,,32,27.2,9.1712,32,PrimeWest Health,Minnesota Senior Health Options (MSHO),16.464,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
EPINEPHRINE 0.1 MG/ML INJ SYRG (BABY),,J0171,HCPCS,Facility,Inpatient,10,mL,,32,27.2,9.1712,32,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
EPINEPHRINE 0.1 MG/ML INJ SYRG (BABY),,J0171,HCPCS,Facility,Outpatient,10,mL,,32,27.2,9.1712,32,PrimeWest Health,MinnesotaCare,16.4352,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
EPINEPHRINE 0.1 MG/ML INJ SYRG (BABY),,J0171,HCPCS,Facility,Inpatient,10,mL,,32,27.2,9.1712,32,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
EPINEPHRINE 0.1 MG/ML INJ SYRG (BABY),,J0171,HCPCS,Facility,Both,10,mL,,32,27.2,9.1712,32,Sanford Health Plan,Sanford Health Plan,29.44,92,,percent of total billed charges,,
EPINEPHRINE 0.1 MG/ML INJ SYRG (BABY),,J0171,HCPCS,Facility,Outpatient,10,mL,,32,27.2,9.1712,32,"UCare Health, Inc.",Individual & Family Plan,18.032,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
EPINEPHRINE 0.1 MG/ML INJ SYRG (BABY),,J0171,HCPCS,Facility,Inpatient,10,mL,,32,27.2,9.1712,32,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
EPINEPHRINE 0.1 MG/ML INJ SYRG (BABY),,J0171,HCPCS,Facility,Outpatient,10,mL,,32,27.2,9.1712,32,"UCare Health, Inc.",Medical Assistance,16.1504,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
EPINEPHRINE 0.1 MG/ML INJ SYRG (BABY),,J0171,HCPCS,Facility,Inpatient,10,mL,,32,27.2,9.1712,32,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
EPINEPHRINE 0.1 MG/ML INJ SYRG (BABY),,J0171,HCPCS,Facility,Outpatient,10,mL,,32,27.2,9.1712,32,"UCare Health, Inc.",Medicare Advantage,16.1504,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
EPINEPHRINE 0.1 MG/ML INJ SYRG (BABY),,J0171,HCPCS,Facility,Inpatient,10,mL,,32,27.2,9.1712,32,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
EPINEPHRINE 0.1 MG/ML INJ SYRG (BABY),,J0171,HCPCS,Facility,Outpatient,10,mL,,32,27.2,9.1712,32,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),16.1504,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
EPINEPHRINE 0.1 MG/ML INJ SYRG (BABY),,J0171,HCPCS,Facility,Inpatient,10,mL,,32,27.2,9.1712,32,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
EPINEPHRINE 0.1 MG/ML INJ SYRG (BABY),,J0171,HCPCS,Facility,Both,10,mL,,32,27.2,9.1712,32,UnitedHealthcare,Individual & Family,30.08,94,,percent of total billed charges,,
EPINEPHRINE 0.1 MG/ML INJ SYRG (BABY),,J0171,HCPCS,Facility,Outpatient,10,mL,,32,27.2,9.1712,32,UnitedHealthcare,Medicare Advantage,15.68,49,,percent of total billed charges,,
EPINEPHRINE 0.1 MG/ML INJ SYRG (BABY),,J0171,HCPCS,Facility,Inpatient,10,mL,,32,27.2,9.1712,32,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
EPINEPHRINE 0.1 MG/ML INJ SYRG (BABY),,J0171,HCPCS,Facility,Outpatient,10,mL,,32,27.2,9.1712,32,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,15.36,48,,percent of total billed charges,,100% of DHS outpatient percentage
EPINEPHRINE 0.1 MG/ML INJ SYRG (BABY),,J0171,HCPCS,Facility,Inpatient,10,mL,,32,27.2,9.1712,32,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Nm Thyroid Imaging Only,,78013,CPT,Facility,Both,,,,1224,1040.4,350.7984,1224,Aetna,Commercial,1126.08,92,,percent of total billed charges,,
Nm Thyroid Imaging Only,,78013,CPT,Facility,Outpatient,,,,1224,1040.4,350.7984,1224,Aetna,Medicare Advantage,599.76,49,,percent of total billed charges,,
Nm Thyroid Imaging Only,,78013,CPT,Facility,Inpatient,,,,1224,1040.4,350.7984,1224,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Nm Thyroid Imaging Only,,78013,CPT,Facility,Both,,,,1224,1040.4,350.7984,1224,Aetna,PPO,1138.32,93,,percent of total billed charges,,
Nm Thyroid Imaging Only,,78013,CPT,Facility,Both,,,,1224,1040.4,350.7984,1224,America's PPO,America's PPO,1175.4072,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Nm Thyroid Imaging Only,,78013,CPT,Facility,Both,,,,1224,1040.4,350.7984,1224,BlueCross BlueShield Minnesota, Federal Employee Program,1204.416,98.4,,percent of total billed charges,,
Nm Thyroid Imaging Only,,78013,CPT,Facility,Both,,,,1224,1040.4,350.7984,1224,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1224,100,,percent of total billed charges,,
Nm Thyroid Imaging Only,,78013,CPT,Facility,Both,,,,1224,1040.4,350.7984,1224,BlueCross BlueShield Minnesota,High Value Network Plan,1101.6,90,,percent of total billed charges,,
Nm Thyroid Imaging Only,,78013,CPT,Facility,Outpatient,,,,1224,1040.4,350.7984,1224,BlueCross BlueShield Minnesota,Medicare Advantage,599.76,49,,percent of total billed charges,,
Nm Thyroid Imaging Only,,78013,CPT,Facility,Inpatient,,,,1224,1040.4,350.7984,1224,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Nm Thyroid Imaging Only,,78013,CPT,Facility,Both,,,,1224,1040.4,350.7984,1224,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1084.0968,88.57,,percent of total billed charges,,
Nm Thyroid Imaging Only,,78013,CPT,Facility,Both,,,,1224,1040.4,350.7984,1224,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,350.7984,28.66,,percent of total billed charges,,
Nm Thyroid Imaging Only,,78013,CPT,Facility,Outpatient,,,,1224,1040.4,350.7984,1224,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),599.76,49,,percent of total billed charges,,
Nm Thyroid Imaging Only,,78013,CPT,Facility,Inpatient,,,,1224,1040.4,350.7984,1224,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Nm Thyroid Imaging Only,,78013,CPT,Facility,Both,,,,1224,1040.4,350.7984,1224,CorVel,Worker's Compensation,1224,100,,percent of total billed charges,,
Nm Thyroid Imaging Only,,78013,CPT,Facility,Both,,,,1224,1040.4,350.7984,1224,First Health Group Corporation,First Health Network,1187.28,97,,percent of total billed charges,,
Nm Thyroid Imaging Only,,78013,CPT,Facility,Both,,,,1224,1040.4,350.7984,1224,"Health Partners, Inc.",Commercial,1157.904,94.6,,percent of total billed charges,,
Nm Thyroid Imaging Only,,78013,CPT,Facility,Outpatient,,,,1224,1040.4,350.7984,1224,"Health Partners, Inc.",Medicare Advantage,599.76,49,,percent of total billed charges,,
Nm Thyroid Imaging Only,,78013,CPT,Facility,Inpatient,,,,1224,1040.4,350.7984,1224,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Nm Thyroid Imaging Only,,78013,CPT,Facility,Both,,,,1224,1040.4,350.7984,1224,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),734.4,60,,percent of total billed charges,,
Nm Thyroid Imaging Only,,78013,CPT,Facility,Both,,,,1224,1040.4,350.7984,1224,"Health Partners, Inc.",State of Minnesota Advantage Program,997.56,81.5,,percent of total billed charges,,
Nm Thyroid Imaging Only,,78013,CPT,Facility,Both,,,,1224,1040.4,350.7984,1224,"Health Partners, Inc.",State Public Programs,612,50,,percent of total billed charges,,
Nm Thyroid Imaging Only,,78013,CPT,Facility,Both,,,,1224,1040.4,350.7984,1224,Humana Insurance Company,Commercial PPO,1162.8,95,,percent of total billed charges,,
Nm Thyroid Imaging Only,,78013,CPT,Facility,Outpatient,,,,1224,1040.4,350.7984,1224,Humana Insurance Company,Medicare PPO,599.76,49,,percent of total billed charges,,
Nm Thyroid Imaging Only,,78013,CPT,Facility,Inpatient,,,,1224,1040.4,350.7984,1224,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Nm Thyroid Imaging Only,,78013,CPT,Facility,Both,,,,1224,1040.4,350.7984,1224,Medica,Individual & Family,1212.984,99.1,,percent of total billed charges,,
Nm Thyroid Imaging Only,,78013,CPT,Facility,Outpatient,,,,1224,1040.4,350.7984,1224,Medica,Medica Advantage Solution,609.552,49.8,,percent of total billed charges,,
Nm Thyroid Imaging Only,,78013,CPT,Facility,Inpatient,,,,1224,1040.4,350.7984,1224,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Nm Thyroid Imaging Only,,78013,CPT,Facility,Outpatient,,,,1224,1040.4,350.7984,1224,Medica,Medical Assistance,545.904,44.6,,percent of total billed charges,,
Nm Thyroid Imaging Only,,78013,CPT,Facility,Inpatient,,,,1224,1040.4,350.7984,1224,Medica,Medical Assistance,,,,,Included in per diem rate,
Nm Thyroid Imaging Only,,78013,CPT,Facility,Outpatient,,,,1224,1040.4,350.7984,1224,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,609.552,49.8,,percent of total billed charges,,
Nm Thyroid Imaging Only,,78013,CPT,Facility,Inpatient,,,,1224,1040.4,350.7984,1224,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Nm Thyroid Imaging Only,,78013,CPT,Facility,Both,,,,1224,1040.4,350.7984,1224,"Multiplan, Inc.","Multiplan, Inc.",1150.56,94,,percent of total billed charges,,
Nm Thyroid Imaging Only,,78013,CPT,Facility,Outpatient,,,,1224,1040.4,350.7984,1224,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1102.824,90.1,,percent of total billed charges,,
Nm Thyroid Imaging Only,,78013,CPT,Facility,Inpatient,,,,1224,1040.4,350.7984,1224,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Nm Thyroid Imaging Only,,78013,CPT,Facility,Both,,,,1224,1040.4,350.7984,1224,"Preferred One Administrative Services, INC.",PPO,1206.864,98.6,,percent of total billed charges,,
Nm Thyroid Imaging Only,,78013,CPT,Facility,Outpatient,,,,1224,1040.4,350.7984,1224,PrimeWest Health,Minnesota Senior Health Options (MSHO),629.748,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Nm Thyroid Imaging Only,,78013,CPT,Facility,Inpatient,,,,1224,1040.4,350.7984,1224,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Nm Thyroid Imaging Only,,78013,CPT,Facility,Outpatient,,,,1224,1040.4,350.7984,1224,PrimeWest Health,MinnesotaCare,628.6464,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Nm Thyroid Imaging Only,,78013,CPT,Facility,Inpatient,,,,1224,1040.4,350.7984,1224,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Nm Thyroid Imaging Only,,78013,CPT,Facility,Both,,,,1224,1040.4,350.7984,1224,Sanford Health Plan,Sanford Health Plan,1126.08,92,,percent of total billed charges,,
Nm Thyroid Imaging Only,,78013,CPT,Facility,Outpatient,,,,1224,1040.4,350.7984,1224,"UCare Health, Inc.",Individual & Family Plan,689.724,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Nm Thyroid Imaging Only,,78013,CPT,Facility,Inpatient,,,,1224,1040.4,350.7984,1224,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Nm Thyroid Imaging Only,,78013,CPT,Facility,Outpatient,,,,1224,1040.4,350.7984,1224,"UCare Health, Inc.",Medical Assistance,617.7528,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Nm Thyroid Imaging Only,,78013,CPT,Facility,Inpatient,,,,1224,1040.4,350.7984,1224,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Nm Thyroid Imaging Only,,78013,CPT,Facility,Outpatient,,,,1224,1040.4,350.7984,1224,"UCare Health, Inc.",Medicare Advantage,617.7528,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Nm Thyroid Imaging Only,,78013,CPT,Facility,Inpatient,,,,1224,1040.4,350.7984,1224,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Nm Thyroid Imaging Only,,78013,CPT,Facility,Outpatient,,,,1224,1040.4,350.7984,1224,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),617.7528,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Nm Thyroid Imaging Only,,78013,CPT,Facility,Inpatient,,,,1224,1040.4,350.7984,1224,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Nm Thyroid Imaging Only,,78013,CPT,Facility,Both,,,,1224,1040.4,350.7984,1224,UnitedHealthcare,Individual & Family,1150.56,94,,percent of total billed charges,,
Nm Thyroid Imaging Only,,78013,CPT,Facility,Outpatient,,,,1224,1040.4,350.7984,1224,UnitedHealthcare,Medicare Advantage,599.76,49,,percent of total billed charges,,
Nm Thyroid Imaging Only,,78013,CPT,Facility,Inpatient,,,,1224,1040.4,350.7984,1224,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Nm Thyroid Imaging Only,,78013,CPT,Facility,Outpatient,,,,1224,1040.4,350.7984,1224,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,587.52,48,,percent of total billed charges,,100% of DHS outpatient percentage
Nm Thyroid Imaging Only,,78013,CPT,Facility,Inpatient,,,,1224,1040.4,350.7984,1224,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Nm Thyroid Imaging W Uptake,,78014,CPT,Facility,Both,,,,1326,1127.1,380.0316,1326,Aetna,Commercial,1219.92,92,,percent of total billed charges,,
Nm Thyroid Imaging W Uptake,,78014,CPT,Facility,Outpatient,,,,1326,1127.1,380.0316,1326,Aetna,Medicare Advantage,649.74,49,,percent of total billed charges,,
Nm Thyroid Imaging W Uptake,,78014,CPT,Facility,Inpatient,,,,1326,1127.1,380.0316,1326,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Nm Thyroid Imaging W Uptake,,78014,CPT,Facility,Both,,,,1326,1127.1,380.0316,1326,Aetna,PPO,1233.18,93,,percent of total billed charges,,
Nm Thyroid Imaging W Uptake,,78014,CPT,Facility,Both,,,,1326,1127.1,380.0316,1326,America's PPO,America's PPO,1273.3578,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Nm Thyroid Imaging W Uptake,,78014,CPT,Facility,Both,,,,1326,1127.1,380.0316,1326,BlueCross BlueShield Minnesota, Federal Employee Program,1304.784,98.4,,percent of total billed charges,,
Nm Thyroid Imaging W Uptake,,78014,CPT,Facility,Both,,,,1326,1127.1,380.0316,1326,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1326,100,,percent of total billed charges,,
Nm Thyroid Imaging W Uptake,,78014,CPT,Facility,Both,,,,1326,1127.1,380.0316,1326,BlueCross BlueShield Minnesota,High Value Network Plan,1193.4,90,,percent of total billed charges,,
Nm Thyroid Imaging W Uptake,,78014,CPT,Facility,Outpatient,,,,1326,1127.1,380.0316,1326,BlueCross BlueShield Minnesota,Medicare Advantage,649.74,49,,percent of total billed charges,,
Nm Thyroid Imaging W Uptake,,78014,CPT,Facility,Inpatient,,,,1326,1127.1,380.0316,1326,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Nm Thyroid Imaging W Uptake,,78014,CPT,Facility,Both,,,,1326,1127.1,380.0316,1326,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1174.4382,88.57,,percent of total billed charges,,
Nm Thyroid Imaging W Uptake,,78014,CPT,Facility,Both,,,,1326,1127.1,380.0316,1326,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,380.0316,28.66,,percent of total billed charges,,
Nm Thyroid Imaging W Uptake,,78014,CPT,Facility,Outpatient,,,,1326,1127.1,380.0316,1326,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),649.74,49,,percent of total billed charges,,
Nm Thyroid Imaging W Uptake,,78014,CPT,Facility,Inpatient,,,,1326,1127.1,380.0316,1326,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Nm Thyroid Imaging W Uptake,,78014,CPT,Facility,Both,,,,1326,1127.1,380.0316,1326,CorVel,Worker's Compensation,1326,100,,percent of total billed charges,,
Nm Thyroid Imaging W Uptake,,78014,CPT,Facility,Both,,,,1326,1127.1,380.0316,1326,First Health Group Corporation,First Health Network,1286.22,97,,percent of total billed charges,,
Nm Thyroid Imaging W Uptake,,78014,CPT,Facility,Both,,,,1326,1127.1,380.0316,1326,"Health Partners, Inc.",Commercial,1254.396,94.6,,percent of total billed charges,,
Nm Thyroid Imaging W Uptake,,78014,CPT,Facility,Outpatient,,,,1326,1127.1,380.0316,1326,"Health Partners, Inc.",Medicare Advantage,649.74,49,,percent of total billed charges,,
Nm Thyroid Imaging W Uptake,,78014,CPT,Facility,Inpatient,,,,1326,1127.1,380.0316,1326,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Nm Thyroid Imaging W Uptake,,78014,CPT,Facility,Both,,,,1326,1127.1,380.0316,1326,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),795.6,60,,percent of total billed charges,,
Nm Thyroid Imaging W Uptake,,78014,CPT,Facility,Both,,,,1326,1127.1,380.0316,1326,"Health Partners, Inc.",State of Minnesota Advantage Program,1080.69,81.5,,percent of total billed charges,,
Nm Thyroid Imaging W Uptake,,78014,CPT,Facility,Both,,,,1326,1127.1,380.0316,1326,"Health Partners, Inc.",State Public Programs,663,50,,percent of total billed charges,,
Nm Thyroid Imaging W Uptake,,78014,CPT,Facility,Both,,,,1326,1127.1,380.0316,1326,Humana Insurance Company,Commercial PPO,1259.7,95,,percent of total billed charges,,
Nm Thyroid Imaging W Uptake,,78014,CPT,Facility,Outpatient,,,,1326,1127.1,380.0316,1326,Humana Insurance Company,Medicare PPO,649.74,49,,percent of total billed charges,,
Nm Thyroid Imaging W Uptake,,78014,CPT,Facility,Inpatient,,,,1326,1127.1,380.0316,1326,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Nm Thyroid Imaging W Uptake,,78014,CPT,Facility,Both,,,,1326,1127.1,380.0316,1326,Medica,Individual & Family,1314.066,99.1,,percent of total billed charges,,
Nm Thyroid Imaging W Uptake,,78014,CPT,Facility,Outpatient,,,,1326,1127.1,380.0316,1326,Medica,Medica Advantage Solution,660.348,49.8,,percent of total billed charges,,
Nm Thyroid Imaging W Uptake,,78014,CPT,Facility,Inpatient,,,,1326,1127.1,380.0316,1326,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Nm Thyroid Imaging W Uptake,,78014,CPT,Facility,Outpatient,,,,1326,1127.1,380.0316,1326,Medica,Medical Assistance,591.396,44.6,,percent of total billed charges,,
Nm Thyroid Imaging W Uptake,,78014,CPT,Facility,Inpatient,,,,1326,1127.1,380.0316,1326,Medica,Medical Assistance,,,,,Included in per diem rate,
Nm Thyroid Imaging W Uptake,,78014,CPT,Facility,Outpatient,,,,1326,1127.1,380.0316,1326,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,660.348,49.8,,percent of total billed charges,,
Nm Thyroid Imaging W Uptake,,78014,CPT,Facility,Inpatient,,,,1326,1127.1,380.0316,1326,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Nm Thyroid Imaging W Uptake,,78014,CPT,Facility,Both,,,,1326,1127.1,380.0316,1326,"Multiplan, Inc.","Multiplan, Inc.",1246.44,94,,percent of total billed charges,,
Nm Thyroid Imaging W Uptake,,78014,CPT,Facility,Outpatient,,,,1326,1127.1,380.0316,1326,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1194.726,90.1,,percent of total billed charges,,
Nm Thyroid Imaging W Uptake,,78014,CPT,Facility,Inpatient,,,,1326,1127.1,380.0316,1326,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Nm Thyroid Imaging W Uptake,,78014,CPT,Facility,Both,,,,1326,1127.1,380.0316,1326,"Preferred One Administrative Services, INC.",PPO,1307.436,98.6,,percent of total billed charges,,
Nm Thyroid Imaging W Uptake,,78014,CPT,Facility,Outpatient,,,,1326,1127.1,380.0316,1326,PrimeWest Health,Minnesota Senior Health Options (MSHO),682.227,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Nm Thyroid Imaging W Uptake,,78014,CPT,Facility,Inpatient,,,,1326,1127.1,380.0316,1326,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Nm Thyroid Imaging W Uptake,,78014,CPT,Facility,Outpatient,,,,1326,1127.1,380.0316,1326,PrimeWest Health,MinnesotaCare,681.0336,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Nm Thyroid Imaging W Uptake,,78014,CPT,Facility,Inpatient,,,,1326,1127.1,380.0316,1326,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Nm Thyroid Imaging W Uptake,,78014,CPT,Facility,Both,,,,1326,1127.1,380.0316,1326,Sanford Health Plan,Sanford Health Plan,1219.92,92,,percent of total billed charges,,
Nm Thyroid Imaging W Uptake,,78014,CPT,Facility,Outpatient,,,,1326,1127.1,380.0316,1326,"UCare Health, Inc.",Individual & Family Plan,747.201,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Nm Thyroid Imaging W Uptake,,78014,CPT,Facility,Inpatient,,,,1326,1127.1,380.0316,1326,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Nm Thyroid Imaging W Uptake,,78014,CPT,Facility,Outpatient,,,,1326,1127.1,380.0316,1326,"UCare Health, Inc.",Medical Assistance,669.2322,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Nm Thyroid Imaging W Uptake,,78014,CPT,Facility,Inpatient,,,,1326,1127.1,380.0316,1326,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Nm Thyroid Imaging W Uptake,,78014,CPT,Facility,Outpatient,,,,1326,1127.1,380.0316,1326,"UCare Health, Inc.",Medicare Advantage,669.2322,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Nm Thyroid Imaging W Uptake,,78014,CPT,Facility,Inpatient,,,,1326,1127.1,380.0316,1326,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Nm Thyroid Imaging W Uptake,,78014,CPT,Facility,Outpatient,,,,1326,1127.1,380.0316,1326,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),669.2322,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Nm Thyroid Imaging W Uptake,,78014,CPT,Facility,Inpatient,,,,1326,1127.1,380.0316,1326,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Nm Thyroid Imaging W Uptake,,78014,CPT,Facility,Both,,,,1326,1127.1,380.0316,1326,UnitedHealthcare,Individual & Family,1246.44,94,,percent of total billed charges,,
Nm Thyroid Imaging W Uptake,,78014,CPT,Facility,Outpatient,,,,1326,1127.1,380.0316,1326,UnitedHealthcare,Medicare Advantage,649.74,49,,percent of total billed charges,,
Nm Thyroid Imaging W Uptake,,78014,CPT,Facility,Inpatient,,,,1326,1127.1,380.0316,1326,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Nm Thyroid Imaging W Uptake,,78014,CPT,Facility,Outpatient,,,,1326,1127.1,380.0316,1326,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,636.48,48,,percent of total billed charges,,100% of DHS outpatient percentage
Nm Thyroid Imaging W Uptake,,78014,CPT,Facility,Inpatient,,,,1326,1127.1,380.0316,1326,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Nm Parathyroid Scan,,78070,CPT,Facility,Both,,,,1326,1127.1,380.0316,1326,Aetna,Commercial,1219.92,92,,percent of total billed charges,,
Nm Parathyroid Scan,,78070,CPT,Facility,Outpatient,,,,1326,1127.1,380.0316,1326,Aetna,Medicare Advantage,649.74,49,,percent of total billed charges,,
Nm Parathyroid Scan,,78070,CPT,Facility,Inpatient,,,,1326,1127.1,380.0316,1326,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Nm Parathyroid Scan,,78070,CPT,Facility,Both,,,,1326,1127.1,380.0316,1326,Aetna,PPO,1233.18,93,,percent of total billed charges,,
Nm Parathyroid Scan,,78070,CPT,Facility,Both,,,,1326,1127.1,380.0316,1326,America's PPO,America's PPO,1273.3578,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Nm Parathyroid Scan,,78070,CPT,Facility,Both,,,,1326,1127.1,380.0316,1326,BlueCross BlueShield Minnesota, Federal Employee Program,1304.784,98.4,,percent of total billed charges,,
Nm Parathyroid Scan,,78070,CPT,Facility,Both,,,,1326,1127.1,380.0316,1326,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1326,100,,percent of total billed charges,,
Nm Parathyroid Scan,,78070,CPT,Facility,Both,,,,1326,1127.1,380.0316,1326,BlueCross BlueShield Minnesota,High Value Network Plan,1193.4,90,,percent of total billed charges,,
Nm Parathyroid Scan,,78070,CPT,Facility,Outpatient,,,,1326,1127.1,380.0316,1326,BlueCross BlueShield Minnesota,Medicare Advantage,649.74,49,,percent of total billed charges,,
Nm Parathyroid Scan,,78070,CPT,Facility,Inpatient,,,,1326,1127.1,380.0316,1326,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Nm Parathyroid Scan,,78070,CPT,Facility,Both,,,,1326,1127.1,380.0316,1326,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1174.4382,88.57,,percent of total billed charges,,
Nm Parathyroid Scan,,78070,CPT,Facility,Both,,,,1326,1127.1,380.0316,1326,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,380.0316,28.66,,percent of total billed charges,,
Nm Parathyroid Scan,,78070,CPT,Facility,Outpatient,,,,1326,1127.1,380.0316,1326,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),649.74,49,,percent of total billed charges,,
Nm Parathyroid Scan,,78070,CPT,Facility,Inpatient,,,,1326,1127.1,380.0316,1326,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Nm Parathyroid Scan,,78070,CPT,Facility,Both,,,,1326,1127.1,380.0316,1326,CorVel,Worker's Compensation,1326,100,,percent of total billed charges,,
Nm Parathyroid Scan,,78070,CPT,Facility,Both,,,,1326,1127.1,380.0316,1326,First Health Group Corporation,First Health Network,1286.22,97,,percent of total billed charges,,
Nm Parathyroid Scan,,78070,CPT,Facility,Both,,,,1326,1127.1,380.0316,1326,"Health Partners, Inc.",Commercial,1254.396,94.6,,percent of total billed charges,,
Nm Parathyroid Scan,,78070,CPT,Facility,Outpatient,,,,1326,1127.1,380.0316,1326,"Health Partners, Inc.",Medicare Advantage,649.74,49,,percent of total billed charges,,
Nm Parathyroid Scan,,78070,CPT,Facility,Inpatient,,,,1326,1127.1,380.0316,1326,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Nm Parathyroid Scan,,78070,CPT,Facility,Both,,,,1326,1127.1,380.0316,1326,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),795.6,60,,percent of total billed charges,,
Nm Parathyroid Scan,,78070,CPT,Facility,Both,,,,1326,1127.1,380.0316,1326,"Health Partners, Inc.",State of Minnesota Advantage Program,1080.69,81.5,,percent of total billed charges,,
Nm Parathyroid Scan,,78070,CPT,Facility,Both,,,,1326,1127.1,380.0316,1326,"Health Partners, Inc.",State Public Programs,663,50,,percent of total billed charges,,
Nm Parathyroid Scan,,78070,CPT,Facility,Both,,,,1326,1127.1,380.0316,1326,Humana Insurance Company,Commercial PPO,1259.7,95,,percent of total billed charges,,
Nm Parathyroid Scan,,78070,CPT,Facility,Outpatient,,,,1326,1127.1,380.0316,1326,Humana Insurance Company,Medicare PPO,649.74,49,,percent of total billed charges,,
Nm Parathyroid Scan,,78070,CPT,Facility,Inpatient,,,,1326,1127.1,380.0316,1326,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Nm Parathyroid Scan,,78070,CPT,Facility,Both,,,,1326,1127.1,380.0316,1326,Medica,Individual & Family,1314.066,99.1,,percent of total billed charges,,
Nm Parathyroid Scan,,78070,CPT,Facility,Outpatient,,,,1326,1127.1,380.0316,1326,Medica,Medica Advantage Solution,660.348,49.8,,percent of total billed charges,,
Nm Parathyroid Scan,,78070,CPT,Facility,Inpatient,,,,1326,1127.1,380.0316,1326,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Nm Parathyroid Scan,,78070,CPT,Facility,Outpatient,,,,1326,1127.1,380.0316,1326,Medica,Medical Assistance,591.396,44.6,,percent of total billed charges,,
Nm Parathyroid Scan,,78070,CPT,Facility,Inpatient,,,,1326,1127.1,380.0316,1326,Medica,Medical Assistance,,,,,Included in per diem rate,
Nm Parathyroid Scan,,78070,CPT,Facility,Outpatient,,,,1326,1127.1,380.0316,1326,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,660.348,49.8,,percent of total billed charges,,
Nm Parathyroid Scan,,78070,CPT,Facility,Inpatient,,,,1326,1127.1,380.0316,1326,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Nm Parathyroid Scan,,78070,CPT,Facility,Both,,,,1326,1127.1,380.0316,1326,"Multiplan, Inc.","Multiplan, Inc.",1246.44,94,,percent of total billed charges,,
Nm Parathyroid Scan,,78070,CPT,Facility,Outpatient,,,,1326,1127.1,380.0316,1326,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1194.726,90.1,,percent of total billed charges,,
Nm Parathyroid Scan,,78070,CPT,Facility,Inpatient,,,,1326,1127.1,380.0316,1326,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Nm Parathyroid Scan,,78070,CPT,Facility,Both,,,,1326,1127.1,380.0316,1326,"Preferred One Administrative Services, INC.",PPO,1307.436,98.6,,percent of total billed charges,,
Nm Parathyroid Scan,,78070,CPT,Facility,Outpatient,,,,1326,1127.1,380.0316,1326,PrimeWest Health,Minnesota Senior Health Options (MSHO),682.227,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Nm Parathyroid Scan,,78070,CPT,Facility,Inpatient,,,,1326,1127.1,380.0316,1326,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Nm Parathyroid Scan,,78070,CPT,Facility,Outpatient,,,,1326,1127.1,380.0316,1326,PrimeWest Health,MinnesotaCare,681.0336,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Nm Parathyroid Scan,,78070,CPT,Facility,Inpatient,,,,1326,1127.1,380.0316,1326,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Nm Parathyroid Scan,,78070,CPT,Facility,Both,,,,1326,1127.1,380.0316,1326,Sanford Health Plan,Sanford Health Plan,1219.92,92,,percent of total billed charges,,
Nm Parathyroid Scan,,78070,CPT,Facility,Outpatient,,,,1326,1127.1,380.0316,1326,"UCare Health, Inc.",Individual & Family Plan,747.201,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Nm Parathyroid Scan,,78070,CPT,Facility,Inpatient,,,,1326,1127.1,380.0316,1326,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Nm Parathyroid Scan,,78070,CPT,Facility,Outpatient,,,,1326,1127.1,380.0316,1326,"UCare Health, Inc.",Medical Assistance,669.2322,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Nm Parathyroid Scan,,78070,CPT,Facility,Inpatient,,,,1326,1127.1,380.0316,1326,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Nm Parathyroid Scan,,78070,CPT,Facility,Outpatient,,,,1326,1127.1,380.0316,1326,"UCare Health, Inc.",Medicare Advantage,669.2322,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Nm Parathyroid Scan,,78070,CPT,Facility,Inpatient,,,,1326,1127.1,380.0316,1326,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Nm Parathyroid Scan,,78070,CPT,Facility,Outpatient,,,,1326,1127.1,380.0316,1326,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),669.2322,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Nm Parathyroid Scan,,78070,CPT,Facility,Inpatient,,,,1326,1127.1,380.0316,1326,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Nm Parathyroid Scan,,78070,CPT,Facility,Both,,,,1326,1127.1,380.0316,1326,UnitedHealthcare,Individual & Family,1246.44,94,,percent of total billed charges,,
Nm Parathyroid Scan,,78070,CPT,Facility,Outpatient,,,,1326,1127.1,380.0316,1326,UnitedHealthcare,Medicare Advantage,649.74,49,,percent of total billed charges,,
Nm Parathyroid Scan,,78070,CPT,Facility,Inpatient,,,,1326,1127.1,380.0316,1326,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Nm Parathyroid Scan,,78070,CPT,Facility,Outpatient,,,,1326,1127.1,380.0316,1326,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,636.48,48,,percent of total billed charges,,100% of DHS outpatient percentage
Nm Parathyroid Scan,,78070,CPT,Facility,Inpatient,,,,1326,1127.1,380.0316,1326,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Nm Liver Spleen Planar,,78215,CPT,Facility,Both,,,,1224,1040.4,350.7984,1224,Aetna,Commercial,1126.08,92,,percent of total billed charges,,
Nm Liver Spleen Planar,,78215,CPT,Facility,Outpatient,,,,1224,1040.4,350.7984,1224,Aetna,Medicare Advantage,599.76,49,,percent of total billed charges,,
Nm Liver Spleen Planar,,78215,CPT,Facility,Inpatient,,,,1224,1040.4,350.7984,1224,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Nm Liver Spleen Planar,,78215,CPT,Facility,Both,,,,1224,1040.4,350.7984,1224,Aetna,PPO,1138.32,93,,percent of total billed charges,,
Nm Liver Spleen Planar,,78215,CPT,Facility,Both,,,,1224,1040.4,350.7984,1224,America's PPO,America's PPO,1175.4072,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Nm Liver Spleen Planar,,78215,CPT,Facility,Both,,,,1224,1040.4,350.7984,1224,BlueCross BlueShield Minnesota, Federal Employee Program,1204.416,98.4,,percent of total billed charges,,
Nm Liver Spleen Planar,,78215,CPT,Facility,Both,,,,1224,1040.4,350.7984,1224,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1224,100,,percent of total billed charges,,
Nm Liver Spleen Planar,,78215,CPT,Facility,Both,,,,1224,1040.4,350.7984,1224,BlueCross BlueShield Minnesota,High Value Network Plan,1101.6,90,,percent of total billed charges,,
Nm Liver Spleen Planar,,78215,CPT,Facility,Outpatient,,,,1224,1040.4,350.7984,1224,BlueCross BlueShield Minnesota,Medicare Advantage,599.76,49,,percent of total billed charges,,
Nm Liver Spleen Planar,,78215,CPT,Facility,Inpatient,,,,1224,1040.4,350.7984,1224,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Nm Liver Spleen Planar,,78215,CPT,Facility,Both,,,,1224,1040.4,350.7984,1224,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1084.0968,88.57,,percent of total billed charges,,
Nm Liver Spleen Planar,,78215,CPT,Facility,Both,,,,1224,1040.4,350.7984,1224,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,350.7984,28.66,,percent of total billed charges,,
Nm Liver Spleen Planar,,78215,CPT,Facility,Outpatient,,,,1224,1040.4,350.7984,1224,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),599.76,49,,percent of total billed charges,,
Nm Liver Spleen Planar,,78215,CPT,Facility,Inpatient,,,,1224,1040.4,350.7984,1224,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Nm Liver Spleen Planar,,78215,CPT,Facility,Both,,,,1224,1040.4,350.7984,1224,CorVel,Worker's Compensation,1224,100,,percent of total billed charges,,
Nm Liver Spleen Planar,,78215,CPT,Facility,Both,,,,1224,1040.4,350.7984,1224,First Health Group Corporation,First Health Network,1187.28,97,,percent of total billed charges,,
Nm Liver Spleen Planar,,78215,CPT,Facility,Both,,,,1224,1040.4,350.7984,1224,"Health Partners, Inc.",Commercial,1157.904,94.6,,percent of total billed charges,,
Nm Liver Spleen Planar,,78215,CPT,Facility,Outpatient,,,,1224,1040.4,350.7984,1224,"Health Partners, Inc.",Medicare Advantage,599.76,49,,percent of total billed charges,,
Nm Liver Spleen Planar,,78215,CPT,Facility,Inpatient,,,,1224,1040.4,350.7984,1224,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Nm Liver Spleen Planar,,78215,CPT,Facility,Both,,,,1224,1040.4,350.7984,1224,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),734.4,60,,percent of total billed charges,,
Nm Liver Spleen Planar,,78215,CPT,Facility,Both,,,,1224,1040.4,350.7984,1224,"Health Partners, Inc.",State of Minnesota Advantage Program,997.56,81.5,,percent of total billed charges,,
Nm Liver Spleen Planar,,78215,CPT,Facility,Both,,,,1224,1040.4,350.7984,1224,"Health Partners, Inc.",State Public Programs,612,50,,percent of total billed charges,,
Nm Liver Spleen Planar,,78215,CPT,Facility,Both,,,,1224,1040.4,350.7984,1224,Humana Insurance Company,Commercial PPO,1162.8,95,,percent of total billed charges,,
Nm Liver Spleen Planar,,78215,CPT,Facility,Outpatient,,,,1224,1040.4,350.7984,1224,Humana Insurance Company,Medicare PPO,599.76,49,,percent of total billed charges,,
Nm Liver Spleen Planar,,78215,CPT,Facility,Inpatient,,,,1224,1040.4,350.7984,1224,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Nm Liver Spleen Planar,,78215,CPT,Facility,Both,,,,1224,1040.4,350.7984,1224,Medica,Individual & Family,1212.984,99.1,,percent of total billed charges,,
Nm Liver Spleen Planar,,78215,CPT,Facility,Outpatient,,,,1224,1040.4,350.7984,1224,Medica,Medica Advantage Solution,609.552,49.8,,percent of total billed charges,,
Nm Liver Spleen Planar,,78215,CPT,Facility,Inpatient,,,,1224,1040.4,350.7984,1224,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Nm Liver Spleen Planar,,78215,CPT,Facility,Outpatient,,,,1224,1040.4,350.7984,1224,Medica,Medical Assistance,545.904,44.6,,percent of total billed charges,,
Nm Liver Spleen Planar,,78215,CPT,Facility,Inpatient,,,,1224,1040.4,350.7984,1224,Medica,Medical Assistance,,,,,Included in per diem rate,
Nm Liver Spleen Planar,,78215,CPT,Facility,Outpatient,,,,1224,1040.4,350.7984,1224,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,609.552,49.8,,percent of total billed charges,,
Nm Liver Spleen Planar,,78215,CPT,Facility,Inpatient,,,,1224,1040.4,350.7984,1224,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Nm Liver Spleen Planar,,78215,CPT,Facility,Both,,,,1224,1040.4,350.7984,1224,"Multiplan, Inc.","Multiplan, Inc.",1150.56,94,,percent of total billed charges,,
Nm Liver Spleen Planar,,78215,CPT,Facility,Outpatient,,,,1224,1040.4,350.7984,1224,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1102.824,90.1,,percent of total billed charges,,
Nm Liver Spleen Planar,,78215,CPT,Facility,Inpatient,,,,1224,1040.4,350.7984,1224,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Nm Liver Spleen Planar,,78215,CPT,Facility,Both,,,,1224,1040.4,350.7984,1224,"Preferred One Administrative Services, INC.",PPO,1206.864,98.6,,percent of total billed charges,,
Nm Liver Spleen Planar,,78215,CPT,Facility,Outpatient,,,,1224,1040.4,350.7984,1224,PrimeWest Health,Minnesota Senior Health Options (MSHO),629.748,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Nm Liver Spleen Planar,,78215,CPT,Facility,Inpatient,,,,1224,1040.4,350.7984,1224,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Nm Liver Spleen Planar,,78215,CPT,Facility,Outpatient,,,,1224,1040.4,350.7984,1224,PrimeWest Health,MinnesotaCare,628.6464,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Nm Liver Spleen Planar,,78215,CPT,Facility,Inpatient,,,,1224,1040.4,350.7984,1224,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Nm Liver Spleen Planar,,78215,CPT,Facility,Both,,,,1224,1040.4,350.7984,1224,Sanford Health Plan,Sanford Health Plan,1126.08,92,,percent of total billed charges,,
Nm Liver Spleen Planar,,78215,CPT,Facility,Outpatient,,,,1224,1040.4,350.7984,1224,"UCare Health, Inc.",Individual & Family Plan,689.724,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Nm Liver Spleen Planar,,78215,CPT,Facility,Inpatient,,,,1224,1040.4,350.7984,1224,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Nm Liver Spleen Planar,,78215,CPT,Facility,Outpatient,,,,1224,1040.4,350.7984,1224,"UCare Health, Inc.",Medical Assistance,617.7528,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Nm Liver Spleen Planar,,78215,CPT,Facility,Inpatient,,,,1224,1040.4,350.7984,1224,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Nm Liver Spleen Planar,,78215,CPT,Facility,Outpatient,,,,1224,1040.4,350.7984,1224,"UCare Health, Inc.",Medicare Advantage,617.7528,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Nm Liver Spleen Planar,,78215,CPT,Facility,Inpatient,,,,1224,1040.4,350.7984,1224,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Nm Liver Spleen Planar,,78215,CPT,Facility,Outpatient,,,,1224,1040.4,350.7984,1224,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),617.7528,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Nm Liver Spleen Planar,,78215,CPT,Facility,Inpatient,,,,1224,1040.4,350.7984,1224,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Nm Liver Spleen Planar,,78215,CPT,Facility,Both,,,,1224,1040.4,350.7984,1224,UnitedHealthcare,Individual & Family,1150.56,94,,percent of total billed charges,,
Nm Liver Spleen Planar,,78215,CPT,Facility,Outpatient,,,,1224,1040.4,350.7984,1224,UnitedHealthcare,Medicare Advantage,599.76,49,,percent of total billed charges,,
Nm Liver Spleen Planar,,78215,CPT,Facility,Inpatient,,,,1224,1040.4,350.7984,1224,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Nm Liver Spleen Planar,,78215,CPT,Facility,Outpatient,,,,1224,1040.4,350.7984,1224,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,587.52,48,,percent of total billed charges,,100% of DHS outpatient percentage
Nm Liver Spleen Planar,,78215,CPT,Facility,Inpatient,,,,1224,1040.4,350.7984,1224,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Nm Hepatobiliary Scan,,78226,CPT,Facility,Both,,,,1428,1213.8,409.2648,1428,Aetna,Commercial,1313.76,92,,percent of total billed charges,,
Nm Hepatobiliary Scan,,78226,CPT,Facility,Outpatient,,,,1428,1213.8,409.2648,1428,Aetna,Medicare Advantage,699.72,49,,percent of total billed charges,,
Nm Hepatobiliary Scan,,78226,CPT,Facility,Inpatient,,,,1428,1213.8,409.2648,1428,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Nm Hepatobiliary Scan,,78226,CPT,Facility,Both,,,,1428,1213.8,409.2648,1428,Aetna,PPO,1328.04,93,,percent of total billed charges,,
Nm Hepatobiliary Scan,,78226,CPT,Facility,Both,,,,1428,1213.8,409.2648,1428,America's PPO,America's PPO,1371.3084,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Nm Hepatobiliary Scan,,78226,CPT,Facility,Both,,,,1428,1213.8,409.2648,1428,BlueCross BlueShield Minnesota, Federal Employee Program,1405.152,98.4,,percent of total billed charges,,
Nm Hepatobiliary Scan,,78226,CPT,Facility,Both,,,,1428,1213.8,409.2648,1428,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1428,100,,percent of total billed charges,,
Nm Hepatobiliary Scan,,78226,CPT,Facility,Both,,,,1428,1213.8,409.2648,1428,BlueCross BlueShield Minnesota,High Value Network Plan,1285.2,90,,percent of total billed charges,,
Nm Hepatobiliary Scan,,78226,CPT,Facility,Outpatient,,,,1428,1213.8,409.2648,1428,BlueCross BlueShield Minnesota,Medicare Advantage,699.72,49,,percent of total billed charges,,
Nm Hepatobiliary Scan,,78226,CPT,Facility,Inpatient,,,,1428,1213.8,409.2648,1428,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Nm Hepatobiliary Scan,,78226,CPT,Facility,Both,,,,1428,1213.8,409.2648,1428,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1264.7796,88.57,,percent of total billed charges,,
Nm Hepatobiliary Scan,,78226,CPT,Facility,Both,,,,1428,1213.8,409.2648,1428,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,409.2648,28.66,,percent of total billed charges,,
Nm Hepatobiliary Scan,,78226,CPT,Facility,Outpatient,,,,1428,1213.8,409.2648,1428,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),699.72,49,,percent of total billed charges,,
Nm Hepatobiliary Scan,,78226,CPT,Facility,Inpatient,,,,1428,1213.8,409.2648,1428,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Nm Hepatobiliary Scan,,78226,CPT,Facility,Both,,,,1428,1213.8,409.2648,1428,CorVel,Worker's Compensation,1428,100,,percent of total billed charges,,
Nm Hepatobiliary Scan,,78226,CPT,Facility,Both,,,,1428,1213.8,409.2648,1428,First Health Group Corporation,First Health Network,1385.16,97,,percent of total billed charges,,
Nm Hepatobiliary Scan,,78226,CPT,Facility,Both,,,,1428,1213.8,409.2648,1428,"Health Partners, Inc.",Commercial,1350.888,94.6,,percent of total billed charges,,
Nm Hepatobiliary Scan,,78226,CPT,Facility,Outpatient,,,,1428,1213.8,409.2648,1428,"Health Partners, Inc.",Medicare Advantage,699.72,49,,percent of total billed charges,,
Nm Hepatobiliary Scan,,78226,CPT,Facility,Inpatient,,,,1428,1213.8,409.2648,1428,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Nm Hepatobiliary Scan,,78226,CPT,Facility,Both,,,,1428,1213.8,409.2648,1428,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),856.8,60,,percent of total billed charges,,
Nm Hepatobiliary Scan,,78226,CPT,Facility,Both,,,,1428,1213.8,409.2648,1428,"Health Partners, Inc.",State of Minnesota Advantage Program,1163.82,81.5,,percent of total billed charges,,
Nm Hepatobiliary Scan,,78226,CPT,Facility,Both,,,,1428,1213.8,409.2648,1428,"Health Partners, Inc.",State Public Programs,714,50,,percent of total billed charges,,
Nm Hepatobiliary Scan,,78226,CPT,Facility,Both,,,,1428,1213.8,409.2648,1428,Humana Insurance Company,Commercial PPO,1356.6,95,,percent of total billed charges,,
Nm Hepatobiliary Scan,,78226,CPT,Facility,Outpatient,,,,1428,1213.8,409.2648,1428,Humana Insurance Company,Medicare PPO,699.72,49,,percent of total billed charges,,
Nm Hepatobiliary Scan,,78226,CPT,Facility,Inpatient,,,,1428,1213.8,409.2648,1428,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Nm Hepatobiliary Scan,,78226,CPT,Facility,Both,,,,1428,1213.8,409.2648,1428,Medica,Individual & Family,1415.148,99.1,,percent of total billed charges,,
Nm Hepatobiliary Scan,,78226,CPT,Facility,Outpatient,,,,1428,1213.8,409.2648,1428,Medica,Medica Advantage Solution,711.144,49.8,,percent of total billed charges,,
Nm Hepatobiliary Scan,,78226,CPT,Facility,Inpatient,,,,1428,1213.8,409.2648,1428,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Nm Hepatobiliary Scan,,78226,CPT,Facility,Outpatient,,,,1428,1213.8,409.2648,1428,Medica,Medical Assistance,636.888,44.6,,percent of total billed charges,,
Nm Hepatobiliary Scan,,78226,CPT,Facility,Inpatient,,,,1428,1213.8,409.2648,1428,Medica,Medical Assistance,,,,,Included in per diem rate,
Nm Hepatobiliary Scan,,78226,CPT,Facility,Outpatient,,,,1428,1213.8,409.2648,1428,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,711.144,49.8,,percent of total billed charges,,
Nm Hepatobiliary Scan,,78226,CPT,Facility,Inpatient,,,,1428,1213.8,409.2648,1428,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Nm Hepatobiliary Scan,,78226,CPT,Facility,Both,,,,1428,1213.8,409.2648,1428,"Multiplan, Inc.","Multiplan, Inc.",1342.32,94,,percent of total billed charges,,
Nm Hepatobiliary Scan,,78226,CPT,Facility,Outpatient,,,,1428,1213.8,409.2648,1428,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1286.628,90.1,,percent of total billed charges,,
Nm Hepatobiliary Scan,,78226,CPT,Facility,Inpatient,,,,1428,1213.8,409.2648,1428,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Nm Hepatobiliary Scan,,78226,CPT,Facility,Both,,,,1428,1213.8,409.2648,1428,"Preferred One Administrative Services, INC.",PPO,1408.008,98.6,,percent of total billed charges,,
Nm Hepatobiliary Scan,,78226,CPT,Facility,Outpatient,,,,1428,1213.8,409.2648,1428,PrimeWest Health,Minnesota Senior Health Options (MSHO),734.706,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Nm Hepatobiliary Scan,,78226,CPT,Facility,Inpatient,,,,1428,1213.8,409.2648,1428,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Nm Hepatobiliary Scan,,78226,CPT,Facility,Outpatient,,,,1428,1213.8,409.2648,1428,PrimeWest Health,MinnesotaCare,733.4208,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Nm Hepatobiliary Scan,,78226,CPT,Facility,Inpatient,,,,1428,1213.8,409.2648,1428,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Nm Hepatobiliary Scan,,78226,CPT,Facility,Both,,,,1428,1213.8,409.2648,1428,Sanford Health Plan,Sanford Health Plan,1313.76,92,,percent of total billed charges,,
Nm Hepatobiliary Scan,,78226,CPT,Facility,Outpatient,,,,1428,1213.8,409.2648,1428,"UCare Health, Inc.",Individual & Family Plan,804.678,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Nm Hepatobiliary Scan,,78226,CPT,Facility,Inpatient,,,,1428,1213.8,409.2648,1428,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Nm Hepatobiliary Scan,,78226,CPT,Facility,Outpatient,,,,1428,1213.8,409.2648,1428,"UCare Health, Inc.",Medical Assistance,720.7116,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Nm Hepatobiliary Scan,,78226,CPT,Facility,Inpatient,,,,1428,1213.8,409.2648,1428,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Nm Hepatobiliary Scan,,78226,CPT,Facility,Outpatient,,,,1428,1213.8,409.2648,1428,"UCare Health, Inc.",Medicare Advantage,720.7116,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Nm Hepatobiliary Scan,,78226,CPT,Facility,Inpatient,,,,1428,1213.8,409.2648,1428,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Nm Hepatobiliary Scan,,78226,CPT,Facility,Outpatient,,,,1428,1213.8,409.2648,1428,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),720.7116,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Nm Hepatobiliary Scan,,78226,CPT,Facility,Inpatient,,,,1428,1213.8,409.2648,1428,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Nm Hepatobiliary Scan,,78226,CPT,Facility,Both,,,,1428,1213.8,409.2648,1428,UnitedHealthcare,Individual & Family,1342.32,94,,percent of total billed charges,,
Nm Hepatobiliary Scan,,78226,CPT,Facility,Outpatient,,,,1428,1213.8,409.2648,1428,UnitedHealthcare,Medicare Advantage,699.72,49,,percent of total billed charges,,
Nm Hepatobiliary Scan,,78226,CPT,Facility,Inpatient,,,,1428,1213.8,409.2648,1428,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Nm Hepatobiliary Scan,,78226,CPT,Facility,Outpatient,,,,1428,1213.8,409.2648,1428,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,685.44,48,,percent of total billed charges,,100% of DHS outpatient percentage
Nm Hepatobiliary Scan,,78226,CPT,Facility,Inpatient,,,,1428,1213.8,409.2648,1428,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Nm Hepatobiliary Scan W Pharm,,78227,CPT,Facility,Both,,,,1632,1387.2,467.7312,1632,Aetna,Commercial,1501.44,92,,percent of total billed charges,,
Nm Hepatobiliary Scan W Pharm,,78227,CPT,Facility,Outpatient,,,,1632,1387.2,467.7312,1632,Aetna,Medicare Advantage,799.68,49,,percent of total billed charges,,
Nm Hepatobiliary Scan W Pharm,,78227,CPT,Facility,Inpatient,,,,1632,1387.2,467.7312,1632,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Nm Hepatobiliary Scan W Pharm,,78227,CPT,Facility,Both,,,,1632,1387.2,467.7312,1632,Aetna,PPO,1517.76,93,,percent of total billed charges,,
Nm Hepatobiliary Scan W Pharm,,78227,CPT,Facility,Both,,,,1632,1387.2,467.7312,1632,America's PPO,America's PPO,1567.2096,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Nm Hepatobiliary Scan W Pharm,,78227,CPT,Facility,Both,,,,1632,1387.2,467.7312,1632,BlueCross BlueShield Minnesota, Federal Employee Program,1605.888,98.4,,percent of total billed charges,,
Nm Hepatobiliary Scan W Pharm,,78227,CPT,Facility,Both,,,,1632,1387.2,467.7312,1632,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1632,100,,percent of total billed charges,,
Nm Hepatobiliary Scan W Pharm,,78227,CPT,Facility,Both,,,,1632,1387.2,467.7312,1632,BlueCross BlueShield Minnesota,High Value Network Plan,1468.8,90,,percent of total billed charges,,
Nm Hepatobiliary Scan W Pharm,,78227,CPT,Facility,Outpatient,,,,1632,1387.2,467.7312,1632,BlueCross BlueShield Minnesota,Medicare Advantage,799.68,49,,percent of total billed charges,,
Nm Hepatobiliary Scan W Pharm,,78227,CPT,Facility,Inpatient,,,,1632,1387.2,467.7312,1632,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Nm Hepatobiliary Scan W Pharm,,78227,CPT,Facility,Both,,,,1632,1387.2,467.7312,1632,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1445.4624,88.57,,percent of total billed charges,,
Nm Hepatobiliary Scan W Pharm,,78227,CPT,Facility,Both,,,,1632,1387.2,467.7312,1632,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,467.7312,28.66,,percent of total billed charges,,
Nm Hepatobiliary Scan W Pharm,,78227,CPT,Facility,Outpatient,,,,1632,1387.2,467.7312,1632,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),799.68,49,,percent of total billed charges,,
Nm Hepatobiliary Scan W Pharm,,78227,CPT,Facility,Inpatient,,,,1632,1387.2,467.7312,1632,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Nm Hepatobiliary Scan W Pharm,,78227,CPT,Facility,Both,,,,1632,1387.2,467.7312,1632,CorVel,Worker's Compensation,1632,100,,percent of total billed charges,,
Nm Hepatobiliary Scan W Pharm,,78227,CPT,Facility,Both,,,,1632,1387.2,467.7312,1632,First Health Group Corporation,First Health Network,1583.04,97,,percent of total billed charges,,
Nm Hepatobiliary Scan W Pharm,,78227,CPT,Facility,Both,,,,1632,1387.2,467.7312,1632,"Health Partners, Inc.",Commercial,1543.872,94.6,,percent of total billed charges,,
Nm Hepatobiliary Scan W Pharm,,78227,CPT,Facility,Outpatient,,,,1632,1387.2,467.7312,1632,"Health Partners, Inc.",Medicare Advantage,799.68,49,,percent of total billed charges,,
Nm Hepatobiliary Scan W Pharm,,78227,CPT,Facility,Inpatient,,,,1632,1387.2,467.7312,1632,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Nm Hepatobiliary Scan W Pharm,,78227,CPT,Facility,Both,,,,1632,1387.2,467.7312,1632,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),979.2,60,,percent of total billed charges,,
Nm Hepatobiliary Scan W Pharm,,78227,CPT,Facility,Both,,,,1632,1387.2,467.7312,1632,"Health Partners, Inc.",State of Minnesota Advantage Program,1330.08,81.5,,percent of total billed charges,,
Nm Hepatobiliary Scan W Pharm,,78227,CPT,Facility,Both,,,,1632,1387.2,467.7312,1632,"Health Partners, Inc.",State Public Programs,816,50,,percent of total billed charges,,
Nm Hepatobiliary Scan W Pharm,,78227,CPT,Facility,Both,,,,1632,1387.2,467.7312,1632,Humana Insurance Company,Commercial PPO,1550.4,95,,percent of total billed charges,,
Nm Hepatobiliary Scan W Pharm,,78227,CPT,Facility,Outpatient,,,,1632,1387.2,467.7312,1632,Humana Insurance Company,Medicare PPO,799.68,49,,percent of total billed charges,,
Nm Hepatobiliary Scan W Pharm,,78227,CPT,Facility,Inpatient,,,,1632,1387.2,467.7312,1632,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Nm Hepatobiliary Scan W Pharm,,78227,CPT,Facility,Both,,,,1632,1387.2,467.7312,1632,Medica,Individual & Family,1617.312,99.1,,percent of total billed charges,,
Nm Hepatobiliary Scan W Pharm,,78227,CPT,Facility,Outpatient,,,,1632,1387.2,467.7312,1632,Medica,Medica Advantage Solution,812.736,49.8,,percent of total billed charges,,
Nm Hepatobiliary Scan W Pharm,,78227,CPT,Facility,Inpatient,,,,1632,1387.2,467.7312,1632,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Nm Hepatobiliary Scan W Pharm,,78227,CPT,Facility,Outpatient,,,,1632,1387.2,467.7312,1632,Medica,Medical Assistance,727.872,44.6,,percent of total billed charges,,
Nm Hepatobiliary Scan W Pharm,,78227,CPT,Facility,Inpatient,,,,1632,1387.2,467.7312,1632,Medica,Medical Assistance,,,,,Included in per diem rate,
Nm Hepatobiliary Scan W Pharm,,78227,CPT,Facility,Outpatient,,,,1632,1387.2,467.7312,1632,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,812.736,49.8,,percent of total billed charges,,
Nm Hepatobiliary Scan W Pharm,,78227,CPT,Facility,Inpatient,,,,1632,1387.2,467.7312,1632,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Nm Hepatobiliary Scan W Pharm,,78227,CPT,Facility,Both,,,,1632,1387.2,467.7312,1632,"Multiplan, Inc.","Multiplan, Inc.",1534.08,94,,percent of total billed charges,,
Nm Hepatobiliary Scan W Pharm,,78227,CPT,Facility,Outpatient,,,,1632,1387.2,467.7312,1632,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1470.432,90.1,,percent of total billed charges,,
Nm Hepatobiliary Scan W Pharm,,78227,CPT,Facility,Inpatient,,,,1632,1387.2,467.7312,1632,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Nm Hepatobiliary Scan W Pharm,,78227,CPT,Facility,Both,,,,1632,1387.2,467.7312,1632,"Preferred One Administrative Services, INC.",PPO,1609.152,98.6,,percent of total billed charges,,
Nm Hepatobiliary Scan W Pharm,,78227,CPT,Facility,Outpatient,,,,1632,1387.2,467.7312,1632,PrimeWest Health,Minnesota Senior Health Options (MSHO),839.664,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Nm Hepatobiliary Scan W Pharm,,78227,CPT,Facility,Inpatient,,,,1632,1387.2,467.7312,1632,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Nm Hepatobiliary Scan W Pharm,,78227,CPT,Facility,Outpatient,,,,1632,1387.2,467.7312,1632,PrimeWest Health,MinnesotaCare,838.1952,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Nm Hepatobiliary Scan W Pharm,,78227,CPT,Facility,Inpatient,,,,1632,1387.2,467.7312,1632,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Nm Hepatobiliary Scan W Pharm,,78227,CPT,Facility,Both,,,,1632,1387.2,467.7312,1632,Sanford Health Plan,Sanford Health Plan,1501.44,92,,percent of total billed charges,,
Nm Hepatobiliary Scan W Pharm,,78227,CPT,Facility,Outpatient,,,,1632,1387.2,467.7312,1632,"UCare Health, Inc.",Individual & Family Plan,919.632,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Nm Hepatobiliary Scan W Pharm,,78227,CPT,Facility,Inpatient,,,,1632,1387.2,467.7312,1632,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Nm Hepatobiliary Scan W Pharm,,78227,CPT,Facility,Outpatient,,,,1632,1387.2,467.7312,1632,"UCare Health, Inc.",Medical Assistance,823.6704,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Nm Hepatobiliary Scan W Pharm,,78227,CPT,Facility,Inpatient,,,,1632,1387.2,467.7312,1632,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Nm Hepatobiliary Scan W Pharm,,78227,CPT,Facility,Outpatient,,,,1632,1387.2,467.7312,1632,"UCare Health, Inc.",Medicare Advantage,823.6704,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Nm Hepatobiliary Scan W Pharm,,78227,CPT,Facility,Inpatient,,,,1632,1387.2,467.7312,1632,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Nm Hepatobiliary Scan W Pharm,,78227,CPT,Facility,Outpatient,,,,1632,1387.2,467.7312,1632,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),823.6704,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Nm Hepatobiliary Scan W Pharm,,78227,CPT,Facility,Inpatient,,,,1632,1387.2,467.7312,1632,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Nm Hepatobiliary Scan W Pharm,,78227,CPT,Facility,Both,,,,1632,1387.2,467.7312,1632,UnitedHealthcare,Individual & Family,1534.08,94,,percent of total billed charges,,
Nm Hepatobiliary Scan W Pharm,,78227,CPT,Facility,Outpatient,,,,1632,1387.2,467.7312,1632,UnitedHealthcare,Medicare Advantage,799.68,49,,percent of total billed charges,,
Nm Hepatobiliary Scan W Pharm,,78227,CPT,Facility,Inpatient,,,,1632,1387.2,467.7312,1632,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Nm Hepatobiliary Scan W Pharm,,78227,CPT,Facility,Outpatient,,,,1632,1387.2,467.7312,1632,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,783.36,48,,percent of total billed charges,,100% of DHS outpatient percentage
Nm Hepatobiliary Scan W Pharm,,78227,CPT,Facility,Inpatient,,,,1632,1387.2,467.7312,1632,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Nm Gastric Emptying Study,,78264,CPT,Facility,Both,,,,1326,1127.1,380.0316,1326,Aetna,Commercial,1219.92,92,,percent of total billed charges,,
Nm Gastric Emptying Study,,78264,CPT,Facility,Outpatient,,,,1326,1127.1,380.0316,1326,Aetna,Medicare Advantage,649.74,49,,percent of total billed charges,,
Nm Gastric Emptying Study,,78264,CPT,Facility,Inpatient,,,,1326,1127.1,380.0316,1326,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Nm Gastric Emptying Study,,78264,CPT,Facility,Both,,,,1326,1127.1,380.0316,1326,Aetna,PPO,1233.18,93,,percent of total billed charges,,
Nm Gastric Emptying Study,,78264,CPT,Facility,Both,,,,1326,1127.1,380.0316,1326,America's PPO,America's PPO,1273.3578,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Nm Gastric Emptying Study,,78264,CPT,Facility,Both,,,,1326,1127.1,380.0316,1326,BlueCross BlueShield Minnesota, Federal Employee Program,1304.784,98.4,,percent of total billed charges,,
Nm Gastric Emptying Study,,78264,CPT,Facility,Both,,,,1326,1127.1,380.0316,1326,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1326,100,,percent of total billed charges,,
Nm Gastric Emptying Study,,78264,CPT,Facility,Both,,,,1326,1127.1,380.0316,1326,BlueCross BlueShield Minnesota,High Value Network Plan,1193.4,90,,percent of total billed charges,,
Nm Gastric Emptying Study,,78264,CPT,Facility,Outpatient,,,,1326,1127.1,380.0316,1326,BlueCross BlueShield Minnesota,Medicare Advantage,649.74,49,,percent of total billed charges,,
Nm Gastric Emptying Study,,78264,CPT,Facility,Inpatient,,,,1326,1127.1,380.0316,1326,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Nm Gastric Emptying Study,,78264,CPT,Facility,Both,,,,1326,1127.1,380.0316,1326,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1174.4382,88.57,,percent of total billed charges,,
Nm Gastric Emptying Study,,78264,CPT,Facility,Both,,,,1326,1127.1,380.0316,1326,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,380.0316,28.66,,percent of total billed charges,,
Nm Gastric Emptying Study,,78264,CPT,Facility,Outpatient,,,,1326,1127.1,380.0316,1326,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),649.74,49,,percent of total billed charges,,
Nm Gastric Emptying Study,,78264,CPT,Facility,Inpatient,,,,1326,1127.1,380.0316,1326,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Nm Gastric Emptying Study,,78264,CPT,Facility,Both,,,,1326,1127.1,380.0316,1326,CorVel,Worker's Compensation,1326,100,,percent of total billed charges,,
Nm Gastric Emptying Study,,78264,CPT,Facility,Both,,,,1326,1127.1,380.0316,1326,First Health Group Corporation,First Health Network,1286.22,97,,percent of total billed charges,,
Nm Gastric Emptying Study,,78264,CPT,Facility,Both,,,,1326,1127.1,380.0316,1326,"Health Partners, Inc.",Commercial,1254.396,94.6,,percent of total billed charges,,
Nm Gastric Emptying Study,,78264,CPT,Facility,Outpatient,,,,1326,1127.1,380.0316,1326,"Health Partners, Inc.",Medicare Advantage,649.74,49,,percent of total billed charges,,
Nm Gastric Emptying Study,,78264,CPT,Facility,Inpatient,,,,1326,1127.1,380.0316,1326,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Nm Gastric Emptying Study,,78264,CPT,Facility,Both,,,,1326,1127.1,380.0316,1326,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),795.6,60,,percent of total billed charges,,
Nm Gastric Emptying Study,,78264,CPT,Facility,Both,,,,1326,1127.1,380.0316,1326,"Health Partners, Inc.",State of Minnesota Advantage Program,1080.69,81.5,,percent of total billed charges,,
Nm Gastric Emptying Study,,78264,CPT,Facility,Both,,,,1326,1127.1,380.0316,1326,"Health Partners, Inc.",State Public Programs,663,50,,percent of total billed charges,,
Nm Gastric Emptying Study,,78264,CPT,Facility,Both,,,,1326,1127.1,380.0316,1326,Humana Insurance Company,Commercial PPO,1259.7,95,,percent of total billed charges,,
Nm Gastric Emptying Study,,78264,CPT,Facility,Outpatient,,,,1326,1127.1,380.0316,1326,Humana Insurance Company,Medicare PPO,649.74,49,,percent of total billed charges,,
Nm Gastric Emptying Study,,78264,CPT,Facility,Inpatient,,,,1326,1127.1,380.0316,1326,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Nm Gastric Emptying Study,,78264,CPT,Facility,Both,,,,1326,1127.1,380.0316,1326,Medica,Individual & Family,1314.066,99.1,,percent of total billed charges,,
Nm Gastric Emptying Study,,78264,CPT,Facility,Outpatient,,,,1326,1127.1,380.0316,1326,Medica,Medica Advantage Solution,660.348,49.8,,percent of total billed charges,,
Nm Gastric Emptying Study,,78264,CPT,Facility,Inpatient,,,,1326,1127.1,380.0316,1326,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Nm Gastric Emptying Study,,78264,CPT,Facility,Outpatient,,,,1326,1127.1,380.0316,1326,Medica,Medical Assistance,591.396,44.6,,percent of total billed charges,,
Nm Gastric Emptying Study,,78264,CPT,Facility,Inpatient,,,,1326,1127.1,380.0316,1326,Medica,Medical Assistance,,,,,Included in per diem rate,
Nm Gastric Emptying Study,,78264,CPT,Facility,Outpatient,,,,1326,1127.1,380.0316,1326,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,660.348,49.8,,percent of total billed charges,,
Nm Gastric Emptying Study,,78264,CPT,Facility,Inpatient,,,,1326,1127.1,380.0316,1326,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Nm Gastric Emptying Study,,78264,CPT,Facility,Both,,,,1326,1127.1,380.0316,1326,"Multiplan, Inc.","Multiplan, Inc.",1246.44,94,,percent of total billed charges,,
Nm Gastric Emptying Study,,78264,CPT,Facility,Outpatient,,,,1326,1127.1,380.0316,1326,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1194.726,90.1,,percent of total billed charges,,
Nm Gastric Emptying Study,,78264,CPT,Facility,Inpatient,,,,1326,1127.1,380.0316,1326,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Nm Gastric Emptying Study,,78264,CPT,Facility,Both,,,,1326,1127.1,380.0316,1326,"Preferred One Administrative Services, INC.",PPO,1307.436,98.6,,percent of total billed charges,,
Nm Gastric Emptying Study,,78264,CPT,Facility,Outpatient,,,,1326,1127.1,380.0316,1326,PrimeWest Health,Minnesota Senior Health Options (MSHO),682.227,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Nm Gastric Emptying Study,,78264,CPT,Facility,Inpatient,,,,1326,1127.1,380.0316,1326,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Nm Gastric Emptying Study,,78264,CPT,Facility,Outpatient,,,,1326,1127.1,380.0316,1326,PrimeWest Health,MinnesotaCare,681.0336,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Nm Gastric Emptying Study,,78264,CPT,Facility,Inpatient,,,,1326,1127.1,380.0316,1326,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Nm Gastric Emptying Study,,78264,CPT,Facility,Both,,,,1326,1127.1,380.0316,1326,Sanford Health Plan,Sanford Health Plan,1219.92,92,,percent of total billed charges,,
Nm Gastric Emptying Study,,78264,CPT,Facility,Outpatient,,,,1326,1127.1,380.0316,1326,"UCare Health, Inc.",Individual & Family Plan,747.201,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Nm Gastric Emptying Study,,78264,CPT,Facility,Inpatient,,,,1326,1127.1,380.0316,1326,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Nm Gastric Emptying Study,,78264,CPT,Facility,Outpatient,,,,1326,1127.1,380.0316,1326,"UCare Health, Inc.",Medical Assistance,669.2322,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Nm Gastric Emptying Study,,78264,CPT,Facility,Inpatient,,,,1326,1127.1,380.0316,1326,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Nm Gastric Emptying Study,,78264,CPT,Facility,Outpatient,,,,1326,1127.1,380.0316,1326,"UCare Health, Inc.",Medicare Advantage,669.2322,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Nm Gastric Emptying Study,,78264,CPT,Facility,Inpatient,,,,1326,1127.1,380.0316,1326,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Nm Gastric Emptying Study,,78264,CPT,Facility,Outpatient,,,,1326,1127.1,380.0316,1326,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),669.2322,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Nm Gastric Emptying Study,,78264,CPT,Facility,Inpatient,,,,1326,1127.1,380.0316,1326,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Nm Gastric Emptying Study,,78264,CPT,Facility,Both,,,,1326,1127.1,380.0316,1326,UnitedHealthcare,Individual & Family,1246.44,94,,percent of total billed charges,,
Nm Gastric Emptying Study,,78264,CPT,Facility,Outpatient,,,,1326,1127.1,380.0316,1326,UnitedHealthcare,Medicare Advantage,649.74,49,,percent of total billed charges,,
Nm Gastric Emptying Study,,78264,CPT,Facility,Inpatient,,,,1326,1127.1,380.0316,1326,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Nm Gastric Emptying Study,,78264,CPT,Facility,Outpatient,,,,1326,1127.1,380.0316,1326,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,636.48,48,,percent of total billed charges,,100% of DHS outpatient percentage
Nm Gastric Emptying Study,,78264,CPT,Facility,Inpatient,,,,1326,1127.1,380.0316,1326,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Nm Gi Hemorrhage Local Red Blood Cell,,78278,CPT,Facility,Both,,,,1785,1517.25,511.581,1785,Aetna,Commercial,1642.2,92,,percent of total billed charges,,
Nm Gi Hemorrhage Local Red Blood Cell,,78278,CPT,Facility,Outpatient,,,,1785,1517.25,511.581,1785,Aetna,Medicare Advantage,874.65,49,,percent of total billed charges,,
Nm Gi Hemorrhage Local Red Blood Cell,,78278,CPT,Facility,Inpatient,,,,1785,1517.25,511.581,1785,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Nm Gi Hemorrhage Local Red Blood Cell,,78278,CPT,Facility,Both,,,,1785,1517.25,511.581,1785,Aetna,PPO,1660.05,93,,percent of total billed charges,,
Nm Gi Hemorrhage Local Red Blood Cell,,78278,CPT,Facility,Both,,,,1785,1517.25,511.581,1785,America's PPO,America's PPO,1714.1355,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Nm Gi Hemorrhage Local Red Blood Cell,,78278,CPT,Facility,Both,,,,1785,1517.25,511.581,1785,BlueCross BlueShield Minnesota, Federal Employee Program,1756.44,98.4,,percent of total billed charges,,
Nm Gi Hemorrhage Local Red Blood Cell,,78278,CPT,Facility,Both,,,,1785,1517.25,511.581,1785,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1785,100,,percent of total billed charges,,
Nm Gi Hemorrhage Local Red Blood Cell,,78278,CPT,Facility,Both,,,,1785,1517.25,511.581,1785,BlueCross BlueShield Minnesota,High Value Network Plan,1606.5,90,,percent of total billed charges,,
Nm Gi Hemorrhage Local Red Blood Cell,,78278,CPT,Facility,Outpatient,,,,1785,1517.25,511.581,1785,BlueCross BlueShield Minnesota,Medicare Advantage,874.65,49,,percent of total billed charges,,
Nm Gi Hemorrhage Local Red Blood Cell,,78278,CPT,Facility,Inpatient,,,,1785,1517.25,511.581,1785,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Nm Gi Hemorrhage Local Red Blood Cell,,78278,CPT,Facility,Both,,,,1785,1517.25,511.581,1785,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1580.9745,88.57,,percent of total billed charges,,
Nm Gi Hemorrhage Local Red Blood Cell,,78278,CPT,Facility,Both,,,,1785,1517.25,511.581,1785,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,511.581,28.66,,percent of total billed charges,,
Nm Gi Hemorrhage Local Red Blood Cell,,78278,CPT,Facility,Outpatient,,,,1785,1517.25,511.581,1785,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),874.65,49,,percent of total billed charges,,
Nm Gi Hemorrhage Local Red Blood Cell,,78278,CPT,Facility,Inpatient,,,,1785,1517.25,511.581,1785,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Nm Gi Hemorrhage Local Red Blood Cell,,78278,CPT,Facility,Both,,,,1785,1517.25,511.581,1785,CorVel,Worker's Compensation,1785,100,,percent of total billed charges,,
Nm Gi Hemorrhage Local Red Blood Cell,,78278,CPT,Facility,Both,,,,1785,1517.25,511.581,1785,First Health Group Corporation,First Health Network,1731.45,97,,percent of total billed charges,,
Nm Gi Hemorrhage Local Red Blood Cell,,78278,CPT,Facility,Both,,,,1785,1517.25,511.581,1785,"Health Partners, Inc.",Commercial,1688.61,94.6,,percent of total billed charges,,
Nm Gi Hemorrhage Local Red Blood Cell,,78278,CPT,Facility,Outpatient,,,,1785,1517.25,511.581,1785,"Health Partners, Inc.",Medicare Advantage,874.65,49,,percent of total billed charges,,
Nm Gi Hemorrhage Local Red Blood Cell,,78278,CPT,Facility,Inpatient,,,,1785,1517.25,511.581,1785,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Nm Gi Hemorrhage Local Red Blood Cell,,78278,CPT,Facility,Both,,,,1785,1517.25,511.581,1785,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1071,60,,percent of total billed charges,,
Nm Gi Hemorrhage Local Red Blood Cell,,78278,CPT,Facility,Both,,,,1785,1517.25,511.581,1785,"Health Partners, Inc.",State of Minnesota Advantage Program,1454.775,81.5,,percent of total billed charges,,
Nm Gi Hemorrhage Local Red Blood Cell,,78278,CPT,Facility,Both,,,,1785,1517.25,511.581,1785,"Health Partners, Inc.",State Public Programs,892.5,50,,percent of total billed charges,,
Nm Gi Hemorrhage Local Red Blood Cell,,78278,CPT,Facility,Both,,,,1785,1517.25,511.581,1785,Humana Insurance Company,Commercial PPO,1695.75,95,,percent of total billed charges,,
Nm Gi Hemorrhage Local Red Blood Cell,,78278,CPT,Facility,Outpatient,,,,1785,1517.25,511.581,1785,Humana Insurance Company,Medicare PPO,874.65,49,,percent of total billed charges,,
Nm Gi Hemorrhage Local Red Blood Cell,,78278,CPT,Facility,Inpatient,,,,1785,1517.25,511.581,1785,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Nm Gi Hemorrhage Local Red Blood Cell,,78278,CPT,Facility,Both,,,,1785,1517.25,511.581,1785,Medica,Individual & Family,1768.935,99.1,,percent of total billed charges,,
Nm Gi Hemorrhage Local Red Blood Cell,,78278,CPT,Facility,Outpatient,,,,1785,1517.25,511.581,1785,Medica,Medica Advantage Solution,888.93,49.8,,percent of total billed charges,,
Nm Gi Hemorrhage Local Red Blood Cell,,78278,CPT,Facility,Inpatient,,,,1785,1517.25,511.581,1785,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Nm Gi Hemorrhage Local Red Blood Cell,,78278,CPT,Facility,Outpatient,,,,1785,1517.25,511.581,1785,Medica,Medical Assistance,796.11,44.6,,percent of total billed charges,,
Nm Gi Hemorrhage Local Red Blood Cell,,78278,CPT,Facility,Inpatient,,,,1785,1517.25,511.581,1785,Medica,Medical Assistance,,,,,Included in per diem rate,
Nm Gi Hemorrhage Local Red Blood Cell,,78278,CPT,Facility,Outpatient,,,,1785,1517.25,511.581,1785,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,888.93,49.8,,percent of total billed charges,,
Nm Gi Hemorrhage Local Red Blood Cell,,78278,CPT,Facility,Inpatient,,,,1785,1517.25,511.581,1785,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Nm Gi Hemorrhage Local Red Blood Cell,,78278,CPT,Facility,Both,,,,1785,1517.25,511.581,1785,"Multiplan, Inc.","Multiplan, Inc.",1677.9,94,,percent of total billed charges,,
Nm Gi Hemorrhage Local Red Blood Cell,,78278,CPT,Facility,Outpatient,,,,1785,1517.25,511.581,1785,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1608.285,90.1,,percent of total billed charges,,
Nm Gi Hemorrhage Local Red Blood Cell,,78278,CPT,Facility,Inpatient,,,,1785,1517.25,511.581,1785,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Nm Gi Hemorrhage Local Red Blood Cell,,78278,CPT,Facility,Both,,,,1785,1517.25,511.581,1785,"Preferred One Administrative Services, INC.",PPO,1760.01,98.6,,percent of total billed charges,,
Nm Gi Hemorrhage Local Red Blood Cell,,78278,CPT,Facility,Outpatient,,,,1785,1517.25,511.581,1785,PrimeWest Health,Minnesota Senior Health Options (MSHO),918.3825,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Nm Gi Hemorrhage Local Red Blood Cell,,78278,CPT,Facility,Inpatient,,,,1785,1517.25,511.581,1785,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Nm Gi Hemorrhage Local Red Blood Cell,,78278,CPT,Facility,Outpatient,,,,1785,1517.25,511.581,1785,PrimeWest Health,MinnesotaCare,916.776,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Nm Gi Hemorrhage Local Red Blood Cell,,78278,CPT,Facility,Inpatient,,,,1785,1517.25,511.581,1785,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Nm Gi Hemorrhage Local Red Blood Cell,,78278,CPT,Facility,Both,,,,1785,1517.25,511.581,1785,Sanford Health Plan,Sanford Health Plan,1642.2,92,,percent of total billed charges,,
Nm Gi Hemorrhage Local Red Blood Cell,,78278,CPT,Facility,Outpatient,,,,1785,1517.25,511.581,1785,"UCare Health, Inc.",Individual & Family Plan,1005.8475,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Nm Gi Hemorrhage Local Red Blood Cell,,78278,CPT,Facility,Inpatient,,,,1785,1517.25,511.581,1785,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Nm Gi Hemorrhage Local Red Blood Cell,,78278,CPT,Facility,Outpatient,,,,1785,1517.25,511.581,1785,"UCare Health, Inc.",Medical Assistance,900.8895,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Nm Gi Hemorrhage Local Red Blood Cell,,78278,CPT,Facility,Inpatient,,,,1785,1517.25,511.581,1785,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Nm Gi Hemorrhage Local Red Blood Cell,,78278,CPT,Facility,Outpatient,,,,1785,1517.25,511.581,1785,"UCare Health, Inc.",Medicare Advantage,900.8895,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Nm Gi Hemorrhage Local Red Blood Cell,,78278,CPT,Facility,Inpatient,,,,1785,1517.25,511.581,1785,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Nm Gi Hemorrhage Local Red Blood Cell,,78278,CPT,Facility,Outpatient,,,,1785,1517.25,511.581,1785,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),900.8895,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Nm Gi Hemorrhage Local Red Blood Cell,,78278,CPT,Facility,Inpatient,,,,1785,1517.25,511.581,1785,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Nm Gi Hemorrhage Local Red Blood Cell,,78278,CPT,Facility,Both,,,,1785,1517.25,511.581,1785,UnitedHealthcare,Individual & Family,1677.9,94,,percent of total billed charges,,
Nm Gi Hemorrhage Local Red Blood Cell,,78278,CPT,Facility,Outpatient,,,,1785,1517.25,511.581,1785,UnitedHealthcare,Medicare Advantage,874.65,49,,percent of total billed charges,,
Nm Gi Hemorrhage Local Red Blood Cell,,78278,CPT,Facility,Inpatient,,,,1785,1517.25,511.581,1785,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Nm Gi Hemorrhage Local Red Blood Cell,,78278,CPT,Facility,Outpatient,,,,1785,1517.25,511.581,1785,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,856.8,48,,percent of total billed charges,,100% of DHS outpatient percentage
Nm Gi Hemorrhage Local Red Blood Cell,,78278,CPT,Facility,Inpatient,,,,1785,1517.25,511.581,1785,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Nm Meckels Scan,,78290,CPT,Facility,Both,,,,1428,1213.8,409.2648,1428,Aetna,Commercial,1313.76,92,,percent of total billed charges,,
Nm Meckels Scan,,78290,CPT,Facility,Outpatient,,,,1428,1213.8,409.2648,1428,Aetna,Medicare Advantage,699.72,49,,percent of total billed charges,,
Nm Meckels Scan,,78290,CPT,Facility,Inpatient,,,,1428,1213.8,409.2648,1428,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Nm Meckels Scan,,78290,CPT,Facility,Both,,,,1428,1213.8,409.2648,1428,Aetna,PPO,1328.04,93,,percent of total billed charges,,
Nm Meckels Scan,,78290,CPT,Facility,Both,,,,1428,1213.8,409.2648,1428,America's PPO,America's PPO,1371.3084,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Nm Meckels Scan,,78290,CPT,Facility,Both,,,,1428,1213.8,409.2648,1428,BlueCross BlueShield Minnesota, Federal Employee Program,1405.152,98.4,,percent of total billed charges,,
Nm Meckels Scan,,78290,CPT,Facility,Both,,,,1428,1213.8,409.2648,1428,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1428,100,,percent of total billed charges,,
Nm Meckels Scan,,78290,CPT,Facility,Both,,,,1428,1213.8,409.2648,1428,BlueCross BlueShield Minnesota,High Value Network Plan,1285.2,90,,percent of total billed charges,,
Nm Meckels Scan,,78290,CPT,Facility,Outpatient,,,,1428,1213.8,409.2648,1428,BlueCross BlueShield Minnesota,Medicare Advantage,699.72,49,,percent of total billed charges,,
Nm Meckels Scan,,78290,CPT,Facility,Inpatient,,,,1428,1213.8,409.2648,1428,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Nm Meckels Scan,,78290,CPT,Facility,Both,,,,1428,1213.8,409.2648,1428,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1264.7796,88.57,,percent of total billed charges,,
Nm Meckels Scan,,78290,CPT,Facility,Both,,,,1428,1213.8,409.2648,1428,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,409.2648,28.66,,percent of total billed charges,,
Nm Meckels Scan,,78290,CPT,Facility,Outpatient,,,,1428,1213.8,409.2648,1428,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),699.72,49,,percent of total billed charges,,
Nm Meckels Scan,,78290,CPT,Facility,Inpatient,,,,1428,1213.8,409.2648,1428,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Nm Meckels Scan,,78290,CPT,Facility,Both,,,,1428,1213.8,409.2648,1428,CorVel,Worker's Compensation,1428,100,,percent of total billed charges,,
Nm Meckels Scan,,78290,CPT,Facility,Both,,,,1428,1213.8,409.2648,1428,First Health Group Corporation,First Health Network,1385.16,97,,percent of total billed charges,,
Nm Meckels Scan,,78290,CPT,Facility,Both,,,,1428,1213.8,409.2648,1428,"Health Partners, Inc.",Commercial,1350.888,94.6,,percent of total billed charges,,
Nm Meckels Scan,,78290,CPT,Facility,Outpatient,,,,1428,1213.8,409.2648,1428,"Health Partners, Inc.",Medicare Advantage,699.72,49,,percent of total billed charges,,
Nm Meckels Scan,,78290,CPT,Facility,Inpatient,,,,1428,1213.8,409.2648,1428,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Nm Meckels Scan,,78290,CPT,Facility,Both,,,,1428,1213.8,409.2648,1428,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),856.8,60,,percent of total billed charges,,
Nm Meckels Scan,,78290,CPT,Facility,Both,,,,1428,1213.8,409.2648,1428,"Health Partners, Inc.",State of Minnesota Advantage Program,1163.82,81.5,,percent of total billed charges,,
Nm Meckels Scan,,78290,CPT,Facility,Both,,,,1428,1213.8,409.2648,1428,"Health Partners, Inc.",State Public Programs,714,50,,percent of total billed charges,,
Nm Meckels Scan,,78290,CPT,Facility,Both,,,,1428,1213.8,409.2648,1428,Humana Insurance Company,Commercial PPO,1356.6,95,,percent of total billed charges,,
Nm Meckels Scan,,78290,CPT,Facility,Outpatient,,,,1428,1213.8,409.2648,1428,Humana Insurance Company,Medicare PPO,699.72,49,,percent of total billed charges,,
Nm Meckels Scan,,78290,CPT,Facility,Inpatient,,,,1428,1213.8,409.2648,1428,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Nm Meckels Scan,,78290,CPT,Facility,Both,,,,1428,1213.8,409.2648,1428,Medica,Individual & Family,1415.148,99.1,,percent of total billed charges,,
Nm Meckels Scan,,78290,CPT,Facility,Outpatient,,,,1428,1213.8,409.2648,1428,Medica,Medica Advantage Solution,711.144,49.8,,percent of total billed charges,,
Nm Meckels Scan,,78290,CPT,Facility,Inpatient,,,,1428,1213.8,409.2648,1428,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Nm Meckels Scan,,78290,CPT,Facility,Outpatient,,,,1428,1213.8,409.2648,1428,Medica,Medical Assistance,636.888,44.6,,percent of total billed charges,,
Nm Meckels Scan,,78290,CPT,Facility,Inpatient,,,,1428,1213.8,409.2648,1428,Medica,Medical Assistance,,,,,Included in per diem rate,
Nm Meckels Scan,,78290,CPT,Facility,Outpatient,,,,1428,1213.8,409.2648,1428,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,711.144,49.8,,percent of total billed charges,,
Nm Meckels Scan,,78290,CPT,Facility,Inpatient,,,,1428,1213.8,409.2648,1428,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Nm Meckels Scan,,78290,CPT,Facility,Both,,,,1428,1213.8,409.2648,1428,"Multiplan, Inc.","Multiplan, Inc.",1342.32,94,,percent of total billed charges,,
Nm Meckels Scan,,78290,CPT,Facility,Outpatient,,,,1428,1213.8,409.2648,1428,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1286.628,90.1,,percent of total billed charges,,
Nm Meckels Scan,,78290,CPT,Facility,Inpatient,,,,1428,1213.8,409.2648,1428,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Nm Meckels Scan,,78290,CPT,Facility,Both,,,,1428,1213.8,409.2648,1428,"Preferred One Administrative Services, INC.",PPO,1408.008,98.6,,percent of total billed charges,,
Nm Meckels Scan,,78290,CPT,Facility,Outpatient,,,,1428,1213.8,409.2648,1428,PrimeWest Health,Minnesota Senior Health Options (MSHO),734.706,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Nm Meckels Scan,,78290,CPT,Facility,Inpatient,,,,1428,1213.8,409.2648,1428,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Nm Meckels Scan,,78290,CPT,Facility,Outpatient,,,,1428,1213.8,409.2648,1428,PrimeWest Health,MinnesotaCare,733.4208,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Nm Meckels Scan,,78290,CPT,Facility,Inpatient,,,,1428,1213.8,409.2648,1428,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Nm Meckels Scan,,78290,CPT,Facility,Both,,,,1428,1213.8,409.2648,1428,Sanford Health Plan,Sanford Health Plan,1313.76,92,,percent of total billed charges,,
Nm Meckels Scan,,78290,CPT,Facility,Outpatient,,,,1428,1213.8,409.2648,1428,"UCare Health, Inc.",Individual & Family Plan,804.678,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Nm Meckels Scan,,78290,CPT,Facility,Inpatient,,,,1428,1213.8,409.2648,1428,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Nm Meckels Scan,,78290,CPT,Facility,Outpatient,,,,1428,1213.8,409.2648,1428,"UCare Health, Inc.",Medical Assistance,720.7116,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Nm Meckels Scan,,78290,CPT,Facility,Inpatient,,,,1428,1213.8,409.2648,1428,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Nm Meckels Scan,,78290,CPT,Facility,Outpatient,,,,1428,1213.8,409.2648,1428,"UCare Health, Inc.",Medicare Advantage,720.7116,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Nm Meckels Scan,,78290,CPT,Facility,Inpatient,,,,1428,1213.8,409.2648,1428,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Nm Meckels Scan,,78290,CPT,Facility,Outpatient,,,,1428,1213.8,409.2648,1428,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),720.7116,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Nm Meckels Scan,,78290,CPT,Facility,Inpatient,,,,1428,1213.8,409.2648,1428,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Nm Meckels Scan,,78290,CPT,Facility,Both,,,,1428,1213.8,409.2648,1428,UnitedHealthcare,Individual & Family,1342.32,94,,percent of total billed charges,,
Nm Meckels Scan,,78290,CPT,Facility,Outpatient,,,,1428,1213.8,409.2648,1428,UnitedHealthcare,Medicare Advantage,699.72,49,,percent of total billed charges,,
Nm Meckels Scan,,78290,CPT,Facility,Inpatient,,,,1428,1213.8,409.2648,1428,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Nm Meckels Scan,,78290,CPT,Facility,Outpatient,,,,1428,1213.8,409.2648,1428,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,685.44,48,,percent of total billed charges,,100% of DHS outpatient percentage
Nm Meckels Scan,,78290,CPT,Facility,Inpatient,,,,1428,1213.8,409.2648,1428,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Nm Bone Scan Ltd,,78300,CPT,Facility,Both,,,,1173,997.05,336.1818,1173,Aetna,Commercial,1079.16,92,,percent of total billed charges,,
Nm Bone Scan Ltd,,78300,CPT,Facility,Outpatient,,,,1173,997.05,336.1818,1173,Aetna,Medicare Advantage,574.77,49,,percent of total billed charges,,
Nm Bone Scan Ltd,,78300,CPT,Facility,Inpatient,,,,1173,997.05,336.1818,1173,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Nm Bone Scan Ltd,,78300,CPT,Facility,Both,,,,1173,997.05,336.1818,1173,Aetna,PPO,1090.89,93,,percent of total billed charges,,
Nm Bone Scan Ltd,,78300,CPT,Facility,Both,,,,1173,997.05,336.1818,1173,America's PPO,America's PPO,1126.4319,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Nm Bone Scan Ltd,,78300,CPT,Facility,Both,,,,1173,997.05,336.1818,1173,BlueCross BlueShield Minnesota, Federal Employee Program,1154.232,98.4,,percent of total billed charges,,
Nm Bone Scan Ltd,,78300,CPT,Facility,Both,,,,1173,997.05,336.1818,1173,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1173,100,,percent of total billed charges,,
Nm Bone Scan Ltd,,78300,CPT,Facility,Both,,,,1173,997.05,336.1818,1173,BlueCross BlueShield Minnesota,High Value Network Plan,1055.7,90,,percent of total billed charges,,
Nm Bone Scan Ltd,,78300,CPT,Facility,Outpatient,,,,1173,997.05,336.1818,1173,BlueCross BlueShield Minnesota,Medicare Advantage,574.77,49,,percent of total billed charges,,
Nm Bone Scan Ltd,,78300,CPT,Facility,Inpatient,,,,1173,997.05,336.1818,1173,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Nm Bone Scan Ltd,,78300,CPT,Facility,Both,,,,1173,997.05,336.1818,1173,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1038.9261,88.57,,percent of total billed charges,,
Nm Bone Scan Ltd,,78300,CPT,Facility,Both,,,,1173,997.05,336.1818,1173,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,336.1818,28.66,,percent of total billed charges,,
Nm Bone Scan Ltd,,78300,CPT,Facility,Outpatient,,,,1173,997.05,336.1818,1173,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),574.77,49,,percent of total billed charges,,
Nm Bone Scan Ltd,,78300,CPT,Facility,Inpatient,,,,1173,997.05,336.1818,1173,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Nm Bone Scan Ltd,,78300,CPT,Facility,Both,,,,1173,997.05,336.1818,1173,CorVel,Worker's Compensation,1173,100,,percent of total billed charges,,
Nm Bone Scan Ltd,,78300,CPT,Facility,Both,,,,1173,997.05,336.1818,1173,First Health Group Corporation,First Health Network,1137.81,97,,percent of total billed charges,,
Nm Bone Scan Ltd,,78300,CPT,Facility,Both,,,,1173,997.05,336.1818,1173,"Health Partners, Inc.",Commercial,1109.658,94.6,,percent of total billed charges,,
Nm Bone Scan Ltd,,78300,CPT,Facility,Outpatient,,,,1173,997.05,336.1818,1173,"Health Partners, Inc.",Medicare Advantage,574.77,49,,percent of total billed charges,,
Nm Bone Scan Ltd,,78300,CPT,Facility,Inpatient,,,,1173,997.05,336.1818,1173,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Nm Bone Scan Ltd,,78300,CPT,Facility,Both,,,,1173,997.05,336.1818,1173,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),703.8,60,,percent of total billed charges,,
Nm Bone Scan Ltd,,78300,CPT,Facility,Both,,,,1173,997.05,336.1818,1173,"Health Partners, Inc.",State of Minnesota Advantage Program,955.995,81.5,,percent of total billed charges,,
Nm Bone Scan Ltd,,78300,CPT,Facility,Both,,,,1173,997.05,336.1818,1173,"Health Partners, Inc.",State Public Programs,586.5,50,,percent of total billed charges,,
Nm Bone Scan Ltd,,78300,CPT,Facility,Both,,,,1173,997.05,336.1818,1173,Humana Insurance Company,Commercial PPO,1114.35,95,,percent of total billed charges,,
Nm Bone Scan Ltd,,78300,CPT,Facility,Outpatient,,,,1173,997.05,336.1818,1173,Humana Insurance Company,Medicare PPO,574.77,49,,percent of total billed charges,,
Nm Bone Scan Ltd,,78300,CPT,Facility,Inpatient,,,,1173,997.05,336.1818,1173,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Nm Bone Scan Ltd,,78300,CPT,Facility,Both,,,,1173,997.05,336.1818,1173,Medica,Individual & Family,1162.443,99.1,,percent of total billed charges,,
Nm Bone Scan Ltd,,78300,CPT,Facility,Outpatient,,,,1173,997.05,336.1818,1173,Medica,Medica Advantage Solution,584.154,49.8,,percent of total billed charges,,
Nm Bone Scan Ltd,,78300,CPT,Facility,Inpatient,,,,1173,997.05,336.1818,1173,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Nm Bone Scan Ltd,,78300,CPT,Facility,Outpatient,,,,1173,997.05,336.1818,1173,Medica,Medical Assistance,523.158,44.6,,percent of total billed charges,,
Nm Bone Scan Ltd,,78300,CPT,Facility,Inpatient,,,,1173,997.05,336.1818,1173,Medica,Medical Assistance,,,,,Included in per diem rate,
Nm Bone Scan Ltd,,78300,CPT,Facility,Outpatient,,,,1173,997.05,336.1818,1173,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,584.154,49.8,,percent of total billed charges,,
Nm Bone Scan Ltd,,78300,CPT,Facility,Inpatient,,,,1173,997.05,336.1818,1173,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Nm Bone Scan Ltd,,78300,CPT,Facility,Both,,,,1173,997.05,336.1818,1173,"Multiplan, Inc.","Multiplan, Inc.",1102.62,94,,percent of total billed charges,,
Nm Bone Scan Ltd,,78300,CPT,Facility,Outpatient,,,,1173,997.05,336.1818,1173,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1056.873,90.1,,percent of total billed charges,,
Nm Bone Scan Ltd,,78300,CPT,Facility,Inpatient,,,,1173,997.05,336.1818,1173,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Nm Bone Scan Ltd,,78300,CPT,Facility,Both,,,,1173,997.05,336.1818,1173,"Preferred One Administrative Services, INC.",PPO,1156.578,98.6,,percent of total billed charges,,
Nm Bone Scan Ltd,,78300,CPT,Facility,Outpatient,,,,1173,997.05,336.1818,1173,PrimeWest Health,Minnesota Senior Health Options (MSHO),603.5085,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Nm Bone Scan Ltd,,78300,CPT,Facility,Inpatient,,,,1173,997.05,336.1818,1173,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Nm Bone Scan Ltd,,78300,CPT,Facility,Outpatient,,,,1173,997.05,336.1818,1173,PrimeWest Health,MinnesotaCare,602.4528,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Nm Bone Scan Ltd,,78300,CPT,Facility,Inpatient,,,,1173,997.05,336.1818,1173,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Nm Bone Scan Ltd,,78300,CPT,Facility,Both,,,,1173,997.05,336.1818,1173,Sanford Health Plan,Sanford Health Plan,1079.16,92,,percent of total billed charges,,
Nm Bone Scan Ltd,,78300,CPT,Facility,Outpatient,,,,1173,997.05,336.1818,1173,"UCare Health, Inc.",Individual & Family Plan,660.9855,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Nm Bone Scan Ltd,,78300,CPT,Facility,Inpatient,,,,1173,997.05,336.1818,1173,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Nm Bone Scan Ltd,,78300,CPT,Facility,Outpatient,,,,1173,997.05,336.1818,1173,"UCare Health, Inc.",Medical Assistance,592.0131,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Nm Bone Scan Ltd,,78300,CPT,Facility,Inpatient,,,,1173,997.05,336.1818,1173,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Nm Bone Scan Ltd,,78300,CPT,Facility,Outpatient,,,,1173,997.05,336.1818,1173,"UCare Health, Inc.",Medicare Advantage,592.0131,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Nm Bone Scan Ltd,,78300,CPT,Facility,Inpatient,,,,1173,997.05,336.1818,1173,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Nm Bone Scan Ltd,,78300,CPT,Facility,Outpatient,,,,1173,997.05,336.1818,1173,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),592.0131,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Nm Bone Scan Ltd,,78300,CPT,Facility,Inpatient,,,,1173,997.05,336.1818,1173,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Nm Bone Scan Ltd,,78300,CPT,Facility,Both,,,,1173,997.05,336.1818,1173,UnitedHealthcare,Individual & Family,1102.62,94,,percent of total billed charges,,
Nm Bone Scan Ltd,,78300,CPT,Facility,Outpatient,,,,1173,997.05,336.1818,1173,UnitedHealthcare,Medicare Advantage,574.77,49,,percent of total billed charges,,
Nm Bone Scan Ltd,,78300,CPT,Facility,Inpatient,,,,1173,997.05,336.1818,1173,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Nm Bone Scan Ltd,,78300,CPT,Facility,Outpatient,,,,1173,997.05,336.1818,1173,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,563.04,48,,percent of total billed charges,,100% of DHS outpatient percentage
Nm Bone Scan Ltd,,78300,CPT,Facility,Inpatient,,,,1173,997.05,336.1818,1173,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Nm Bone Scan Multiple,,78305,CPT,Facility,Both,,,,1224,1040.4,350.7984,1224,Aetna,Commercial,1126.08,92,,percent of total billed charges,,
Nm Bone Scan Multiple,,78305,CPT,Facility,Outpatient,,,,1224,1040.4,350.7984,1224,Aetna,Medicare Advantage,599.76,49,,percent of total billed charges,,
Nm Bone Scan Multiple,,78305,CPT,Facility,Inpatient,,,,1224,1040.4,350.7984,1224,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Nm Bone Scan Multiple,,78305,CPT,Facility,Both,,,,1224,1040.4,350.7984,1224,Aetna,PPO,1138.32,93,,percent of total billed charges,,
Nm Bone Scan Multiple,,78305,CPT,Facility,Both,,,,1224,1040.4,350.7984,1224,America's PPO,America's PPO,1175.4072,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Nm Bone Scan Multiple,,78305,CPT,Facility,Both,,,,1224,1040.4,350.7984,1224,BlueCross BlueShield Minnesota, Federal Employee Program,1204.416,98.4,,percent of total billed charges,,
Nm Bone Scan Multiple,,78305,CPT,Facility,Both,,,,1224,1040.4,350.7984,1224,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1224,100,,percent of total billed charges,,
Nm Bone Scan Multiple,,78305,CPT,Facility,Both,,,,1224,1040.4,350.7984,1224,BlueCross BlueShield Minnesota,High Value Network Plan,1101.6,90,,percent of total billed charges,,
Nm Bone Scan Multiple,,78305,CPT,Facility,Outpatient,,,,1224,1040.4,350.7984,1224,BlueCross BlueShield Minnesota,Medicare Advantage,599.76,49,,percent of total billed charges,,
Nm Bone Scan Multiple,,78305,CPT,Facility,Inpatient,,,,1224,1040.4,350.7984,1224,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Nm Bone Scan Multiple,,78305,CPT,Facility,Both,,,,1224,1040.4,350.7984,1224,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1084.0968,88.57,,percent of total billed charges,,
Nm Bone Scan Multiple,,78305,CPT,Facility,Both,,,,1224,1040.4,350.7984,1224,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,350.7984,28.66,,percent of total billed charges,,
Nm Bone Scan Multiple,,78305,CPT,Facility,Outpatient,,,,1224,1040.4,350.7984,1224,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),599.76,49,,percent of total billed charges,,
Nm Bone Scan Multiple,,78305,CPT,Facility,Inpatient,,,,1224,1040.4,350.7984,1224,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Nm Bone Scan Multiple,,78305,CPT,Facility,Both,,,,1224,1040.4,350.7984,1224,CorVel,Worker's Compensation,1224,100,,percent of total billed charges,,
Nm Bone Scan Multiple,,78305,CPT,Facility,Both,,,,1224,1040.4,350.7984,1224,First Health Group Corporation,First Health Network,1187.28,97,,percent of total billed charges,,
Nm Bone Scan Multiple,,78305,CPT,Facility,Both,,,,1224,1040.4,350.7984,1224,"Health Partners, Inc.",Commercial,1157.904,94.6,,percent of total billed charges,,
Nm Bone Scan Multiple,,78305,CPT,Facility,Outpatient,,,,1224,1040.4,350.7984,1224,"Health Partners, Inc.",Medicare Advantage,599.76,49,,percent of total billed charges,,
Nm Bone Scan Multiple,,78305,CPT,Facility,Inpatient,,,,1224,1040.4,350.7984,1224,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Nm Bone Scan Multiple,,78305,CPT,Facility,Both,,,,1224,1040.4,350.7984,1224,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),734.4,60,,percent of total billed charges,,
Nm Bone Scan Multiple,,78305,CPT,Facility,Both,,,,1224,1040.4,350.7984,1224,"Health Partners, Inc.",State of Minnesota Advantage Program,997.56,81.5,,percent of total billed charges,,
Nm Bone Scan Multiple,,78305,CPT,Facility,Both,,,,1224,1040.4,350.7984,1224,"Health Partners, Inc.",State Public Programs,612,50,,percent of total billed charges,,
Nm Bone Scan Multiple,,78305,CPT,Facility,Both,,,,1224,1040.4,350.7984,1224,Humana Insurance Company,Commercial PPO,1162.8,95,,percent of total billed charges,,
Nm Bone Scan Multiple,,78305,CPT,Facility,Outpatient,,,,1224,1040.4,350.7984,1224,Humana Insurance Company,Medicare PPO,599.76,49,,percent of total billed charges,,
Nm Bone Scan Multiple,,78305,CPT,Facility,Inpatient,,,,1224,1040.4,350.7984,1224,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Nm Bone Scan Multiple,,78305,CPT,Facility,Both,,,,1224,1040.4,350.7984,1224,Medica,Individual & Family,1212.984,99.1,,percent of total billed charges,,
Nm Bone Scan Multiple,,78305,CPT,Facility,Outpatient,,,,1224,1040.4,350.7984,1224,Medica,Medica Advantage Solution,609.552,49.8,,percent of total billed charges,,
Nm Bone Scan Multiple,,78305,CPT,Facility,Inpatient,,,,1224,1040.4,350.7984,1224,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Nm Bone Scan Multiple,,78305,CPT,Facility,Outpatient,,,,1224,1040.4,350.7984,1224,Medica,Medical Assistance,545.904,44.6,,percent of total billed charges,,
Nm Bone Scan Multiple,,78305,CPT,Facility,Inpatient,,,,1224,1040.4,350.7984,1224,Medica,Medical Assistance,,,,,Included in per diem rate,
Nm Bone Scan Multiple,,78305,CPT,Facility,Outpatient,,,,1224,1040.4,350.7984,1224,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,609.552,49.8,,percent of total billed charges,,
Nm Bone Scan Multiple,,78305,CPT,Facility,Inpatient,,,,1224,1040.4,350.7984,1224,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Nm Bone Scan Multiple,,78305,CPT,Facility,Both,,,,1224,1040.4,350.7984,1224,"Multiplan, Inc.","Multiplan, Inc.",1150.56,94,,percent of total billed charges,,
Nm Bone Scan Multiple,,78305,CPT,Facility,Outpatient,,,,1224,1040.4,350.7984,1224,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1102.824,90.1,,percent of total billed charges,,
Nm Bone Scan Multiple,,78305,CPT,Facility,Inpatient,,,,1224,1040.4,350.7984,1224,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Nm Bone Scan Multiple,,78305,CPT,Facility,Both,,,,1224,1040.4,350.7984,1224,"Preferred One Administrative Services, INC.",PPO,1206.864,98.6,,percent of total billed charges,,
Nm Bone Scan Multiple,,78305,CPT,Facility,Outpatient,,,,1224,1040.4,350.7984,1224,PrimeWest Health,Minnesota Senior Health Options (MSHO),629.748,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Nm Bone Scan Multiple,,78305,CPT,Facility,Inpatient,,,,1224,1040.4,350.7984,1224,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Nm Bone Scan Multiple,,78305,CPT,Facility,Outpatient,,,,1224,1040.4,350.7984,1224,PrimeWest Health,MinnesotaCare,628.6464,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Nm Bone Scan Multiple,,78305,CPT,Facility,Inpatient,,,,1224,1040.4,350.7984,1224,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Nm Bone Scan Multiple,,78305,CPT,Facility,Both,,,,1224,1040.4,350.7984,1224,Sanford Health Plan,Sanford Health Plan,1126.08,92,,percent of total billed charges,,
Nm Bone Scan Multiple,,78305,CPT,Facility,Outpatient,,,,1224,1040.4,350.7984,1224,"UCare Health, Inc.",Individual & Family Plan,689.724,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Nm Bone Scan Multiple,,78305,CPT,Facility,Inpatient,,,,1224,1040.4,350.7984,1224,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Nm Bone Scan Multiple,,78305,CPT,Facility,Outpatient,,,,1224,1040.4,350.7984,1224,"UCare Health, Inc.",Medical Assistance,617.7528,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Nm Bone Scan Multiple,,78305,CPT,Facility,Inpatient,,,,1224,1040.4,350.7984,1224,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Nm Bone Scan Multiple,,78305,CPT,Facility,Outpatient,,,,1224,1040.4,350.7984,1224,"UCare Health, Inc.",Medicare Advantage,617.7528,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Nm Bone Scan Multiple,,78305,CPT,Facility,Inpatient,,,,1224,1040.4,350.7984,1224,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Nm Bone Scan Multiple,,78305,CPT,Facility,Outpatient,,,,1224,1040.4,350.7984,1224,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),617.7528,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Nm Bone Scan Multiple,,78305,CPT,Facility,Inpatient,,,,1224,1040.4,350.7984,1224,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Nm Bone Scan Multiple,,78305,CPT,Facility,Both,,,,1224,1040.4,350.7984,1224,UnitedHealthcare,Individual & Family,1150.56,94,,percent of total billed charges,,
Nm Bone Scan Multiple,,78305,CPT,Facility,Outpatient,,,,1224,1040.4,350.7984,1224,UnitedHealthcare,Medicare Advantage,599.76,49,,percent of total billed charges,,
Nm Bone Scan Multiple,,78305,CPT,Facility,Inpatient,,,,1224,1040.4,350.7984,1224,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Nm Bone Scan Multiple,,78305,CPT,Facility,Outpatient,,,,1224,1040.4,350.7984,1224,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,587.52,48,,percent of total billed charges,,100% of DHS outpatient percentage
Nm Bone Scan Multiple,,78305,CPT,Facility,Inpatient,,,,1224,1040.4,350.7984,1224,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Nm Bone Scan Whole Body,,78306,CPT,Facility,Both,,,,1530,1300.5,438.498,1530,Aetna,Commercial,1407.6,92,,percent of total billed charges,,
Nm Bone Scan Whole Body,,78306,CPT,Facility,Outpatient,,,,1530,1300.5,438.498,1530,Aetna,Medicare Advantage,749.7,49,,percent of total billed charges,,
Nm Bone Scan Whole Body,,78306,CPT,Facility,Inpatient,,,,1530,1300.5,438.498,1530,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Nm Bone Scan Whole Body,,78306,CPT,Facility,Both,,,,1530,1300.5,438.498,1530,Aetna,PPO,1422.9,93,,percent of total billed charges,,
Nm Bone Scan Whole Body,,78306,CPT,Facility,Both,,,,1530,1300.5,438.498,1530,America's PPO,America's PPO,1469.259,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Nm Bone Scan Whole Body,,78306,CPT,Facility,Both,,,,1530,1300.5,438.498,1530,BlueCross BlueShield Minnesota, Federal Employee Program,1505.52,98.4,,percent of total billed charges,,
Nm Bone Scan Whole Body,,78306,CPT,Facility,Both,,,,1530,1300.5,438.498,1530,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1530,100,,percent of total billed charges,,
Nm Bone Scan Whole Body,,78306,CPT,Facility,Both,,,,1530,1300.5,438.498,1530,BlueCross BlueShield Minnesota,High Value Network Plan,1377,90,,percent of total billed charges,,
Nm Bone Scan Whole Body,,78306,CPT,Facility,Outpatient,,,,1530,1300.5,438.498,1530,BlueCross BlueShield Minnesota,Medicare Advantage,749.7,49,,percent of total billed charges,,
Nm Bone Scan Whole Body,,78306,CPT,Facility,Inpatient,,,,1530,1300.5,438.498,1530,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Nm Bone Scan Whole Body,,78306,CPT,Facility,Both,,,,1530,1300.5,438.498,1530,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1355.121,88.57,,percent of total billed charges,,
Nm Bone Scan Whole Body,,78306,CPT,Facility,Both,,,,1530,1300.5,438.498,1530,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,438.498,28.66,,percent of total billed charges,,
Nm Bone Scan Whole Body,,78306,CPT,Facility,Outpatient,,,,1530,1300.5,438.498,1530,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),749.7,49,,percent of total billed charges,,
Nm Bone Scan Whole Body,,78306,CPT,Facility,Inpatient,,,,1530,1300.5,438.498,1530,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Nm Bone Scan Whole Body,,78306,CPT,Facility,Both,,,,1530,1300.5,438.498,1530,CorVel,Worker's Compensation,1530,100,,percent of total billed charges,,
Nm Bone Scan Whole Body,,78306,CPT,Facility,Both,,,,1530,1300.5,438.498,1530,First Health Group Corporation,First Health Network,1484.1,97,,percent of total billed charges,,
Nm Bone Scan Whole Body,,78306,CPT,Facility,Both,,,,1530,1300.5,438.498,1530,"Health Partners, Inc.",Commercial,1447.38,94.6,,percent of total billed charges,,
Nm Bone Scan Whole Body,,78306,CPT,Facility,Outpatient,,,,1530,1300.5,438.498,1530,"Health Partners, Inc.",Medicare Advantage,749.7,49,,percent of total billed charges,,
Nm Bone Scan Whole Body,,78306,CPT,Facility,Inpatient,,,,1530,1300.5,438.498,1530,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Nm Bone Scan Whole Body,,78306,CPT,Facility,Both,,,,1530,1300.5,438.498,1530,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),918,60,,percent of total billed charges,,
Nm Bone Scan Whole Body,,78306,CPT,Facility,Both,,,,1530,1300.5,438.498,1530,"Health Partners, Inc.",State of Minnesota Advantage Program,1246.95,81.5,,percent of total billed charges,,
Nm Bone Scan Whole Body,,78306,CPT,Facility,Both,,,,1530,1300.5,438.498,1530,"Health Partners, Inc.",State Public Programs,765,50,,percent of total billed charges,,
Nm Bone Scan Whole Body,,78306,CPT,Facility,Both,,,,1530,1300.5,438.498,1530,Humana Insurance Company,Commercial PPO,1453.5,95,,percent of total billed charges,,
Nm Bone Scan Whole Body,,78306,CPT,Facility,Outpatient,,,,1530,1300.5,438.498,1530,Humana Insurance Company,Medicare PPO,749.7,49,,percent of total billed charges,,
Nm Bone Scan Whole Body,,78306,CPT,Facility,Inpatient,,,,1530,1300.5,438.498,1530,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Nm Bone Scan Whole Body,,78306,CPT,Facility,Both,,,,1530,1300.5,438.498,1530,Medica,Individual & Family,1516.23,99.1,,percent of total billed charges,,
Nm Bone Scan Whole Body,,78306,CPT,Facility,Outpatient,,,,1530,1300.5,438.498,1530,Medica,Medica Advantage Solution,761.94,49.8,,percent of total billed charges,,
Nm Bone Scan Whole Body,,78306,CPT,Facility,Inpatient,,,,1530,1300.5,438.498,1530,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Nm Bone Scan Whole Body,,78306,CPT,Facility,Outpatient,,,,1530,1300.5,438.498,1530,Medica,Medical Assistance,682.38,44.6,,percent of total billed charges,,
Nm Bone Scan Whole Body,,78306,CPT,Facility,Inpatient,,,,1530,1300.5,438.498,1530,Medica,Medical Assistance,,,,,Included in per diem rate,
Nm Bone Scan Whole Body,,78306,CPT,Facility,Outpatient,,,,1530,1300.5,438.498,1530,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,761.94,49.8,,percent of total billed charges,,
Nm Bone Scan Whole Body,,78306,CPT,Facility,Inpatient,,,,1530,1300.5,438.498,1530,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Nm Bone Scan Whole Body,,78306,CPT,Facility,Both,,,,1530,1300.5,438.498,1530,"Multiplan, Inc.","Multiplan, Inc.",1438.2,94,,percent of total billed charges,,
Nm Bone Scan Whole Body,,78306,CPT,Facility,Outpatient,,,,1530,1300.5,438.498,1530,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1378.53,90.1,,percent of total billed charges,,
Nm Bone Scan Whole Body,,78306,CPT,Facility,Inpatient,,,,1530,1300.5,438.498,1530,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Nm Bone Scan Whole Body,,78306,CPT,Facility,Both,,,,1530,1300.5,438.498,1530,"Preferred One Administrative Services, INC.",PPO,1508.58,98.6,,percent of total billed charges,,
Nm Bone Scan Whole Body,,78306,CPT,Facility,Outpatient,,,,1530,1300.5,438.498,1530,PrimeWest Health,Minnesota Senior Health Options (MSHO),787.185,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Nm Bone Scan Whole Body,,78306,CPT,Facility,Inpatient,,,,1530,1300.5,438.498,1530,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Nm Bone Scan Whole Body,,78306,CPT,Facility,Outpatient,,,,1530,1300.5,438.498,1530,PrimeWest Health,MinnesotaCare,785.808,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Nm Bone Scan Whole Body,,78306,CPT,Facility,Inpatient,,,,1530,1300.5,438.498,1530,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Nm Bone Scan Whole Body,,78306,CPT,Facility,Both,,,,1530,1300.5,438.498,1530,Sanford Health Plan,Sanford Health Plan,1407.6,92,,percent of total billed charges,,
Nm Bone Scan Whole Body,,78306,CPT,Facility,Outpatient,,,,1530,1300.5,438.498,1530,"UCare Health, Inc.",Individual & Family Plan,862.155,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Nm Bone Scan Whole Body,,78306,CPT,Facility,Inpatient,,,,1530,1300.5,438.498,1530,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Nm Bone Scan Whole Body,,78306,CPT,Facility,Outpatient,,,,1530,1300.5,438.498,1530,"UCare Health, Inc.",Medical Assistance,772.191,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Nm Bone Scan Whole Body,,78306,CPT,Facility,Inpatient,,,,1530,1300.5,438.498,1530,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Nm Bone Scan Whole Body,,78306,CPT,Facility,Outpatient,,,,1530,1300.5,438.498,1530,"UCare Health, Inc.",Medicare Advantage,772.191,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Nm Bone Scan Whole Body,,78306,CPT,Facility,Inpatient,,,,1530,1300.5,438.498,1530,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Nm Bone Scan Whole Body,,78306,CPT,Facility,Outpatient,,,,1530,1300.5,438.498,1530,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),772.191,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Nm Bone Scan Whole Body,,78306,CPT,Facility,Inpatient,,,,1530,1300.5,438.498,1530,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Nm Bone Scan Whole Body,,78306,CPT,Facility,Both,,,,1530,1300.5,438.498,1530,UnitedHealthcare,Individual & Family,1438.2,94,,percent of total billed charges,,
Nm Bone Scan Whole Body,,78306,CPT,Facility,Outpatient,,,,1530,1300.5,438.498,1530,UnitedHealthcare,Medicare Advantage,749.7,49,,percent of total billed charges,,
Nm Bone Scan Whole Body,,78306,CPT,Facility,Inpatient,,,,1530,1300.5,438.498,1530,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Nm Bone Scan Whole Body,,78306,CPT,Facility,Outpatient,,,,1530,1300.5,438.498,1530,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,734.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
Nm Bone Scan Whole Body,,78306,CPT,Facility,Inpatient,,,,1530,1300.5,438.498,1530,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Nm Bone Scan Three Phase,,78315,CPT,Facility,Both,,,,1683,1430.55,482.3478,1683,Aetna,Commercial,1548.36,92,,percent of total billed charges,,
Nm Bone Scan Three Phase,,78315,CPT,Facility,Outpatient,,,,1683,1430.55,482.3478,1683,Aetna,Medicare Advantage,824.67,49,,percent of total billed charges,,
Nm Bone Scan Three Phase,,78315,CPT,Facility,Inpatient,,,,1683,1430.55,482.3478,1683,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Nm Bone Scan Three Phase,,78315,CPT,Facility,Both,,,,1683,1430.55,482.3478,1683,Aetna,PPO,1565.19,93,,percent of total billed charges,,
Nm Bone Scan Three Phase,,78315,CPT,Facility,Both,,,,1683,1430.55,482.3478,1683,America's PPO,America's PPO,1616.1849,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Nm Bone Scan Three Phase,,78315,CPT,Facility,Both,,,,1683,1430.55,482.3478,1683,BlueCross BlueShield Minnesota, Federal Employee Program,1656.072,98.4,,percent of total billed charges,,
Nm Bone Scan Three Phase,,78315,CPT,Facility,Both,,,,1683,1430.55,482.3478,1683,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1683,100,,percent of total billed charges,,
Nm Bone Scan Three Phase,,78315,CPT,Facility,Both,,,,1683,1430.55,482.3478,1683,BlueCross BlueShield Minnesota,High Value Network Plan,1514.7,90,,percent of total billed charges,,
Nm Bone Scan Three Phase,,78315,CPT,Facility,Outpatient,,,,1683,1430.55,482.3478,1683,BlueCross BlueShield Minnesota,Medicare Advantage,824.67,49,,percent of total billed charges,,
Nm Bone Scan Three Phase,,78315,CPT,Facility,Inpatient,,,,1683,1430.55,482.3478,1683,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Nm Bone Scan Three Phase,,78315,CPT,Facility,Both,,,,1683,1430.55,482.3478,1683,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1490.6331,88.57,,percent of total billed charges,,
Nm Bone Scan Three Phase,,78315,CPT,Facility,Both,,,,1683,1430.55,482.3478,1683,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,482.3478,28.66,,percent of total billed charges,,
Nm Bone Scan Three Phase,,78315,CPT,Facility,Outpatient,,,,1683,1430.55,482.3478,1683,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),824.67,49,,percent of total billed charges,,
Nm Bone Scan Three Phase,,78315,CPT,Facility,Inpatient,,,,1683,1430.55,482.3478,1683,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Nm Bone Scan Three Phase,,78315,CPT,Facility,Both,,,,1683,1430.55,482.3478,1683,CorVel,Worker's Compensation,1683,100,,percent of total billed charges,,
Nm Bone Scan Three Phase,,78315,CPT,Facility,Both,,,,1683,1430.55,482.3478,1683,First Health Group Corporation,First Health Network,1632.51,97,,percent of total billed charges,,
Nm Bone Scan Three Phase,,78315,CPT,Facility,Both,,,,1683,1430.55,482.3478,1683,"Health Partners, Inc.",Commercial,1592.118,94.6,,percent of total billed charges,,
Nm Bone Scan Three Phase,,78315,CPT,Facility,Outpatient,,,,1683,1430.55,482.3478,1683,"Health Partners, Inc.",Medicare Advantage,824.67,49,,percent of total billed charges,,
Nm Bone Scan Three Phase,,78315,CPT,Facility,Inpatient,,,,1683,1430.55,482.3478,1683,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Nm Bone Scan Three Phase,,78315,CPT,Facility,Both,,,,1683,1430.55,482.3478,1683,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1009.8,60,,percent of total billed charges,,
Nm Bone Scan Three Phase,,78315,CPT,Facility,Both,,,,1683,1430.55,482.3478,1683,"Health Partners, Inc.",State of Minnesota Advantage Program,1371.645,81.5,,percent of total billed charges,,
Nm Bone Scan Three Phase,,78315,CPT,Facility,Both,,,,1683,1430.55,482.3478,1683,"Health Partners, Inc.",State Public Programs,841.5,50,,percent of total billed charges,,
Nm Bone Scan Three Phase,,78315,CPT,Facility,Both,,,,1683,1430.55,482.3478,1683,Humana Insurance Company,Commercial PPO,1598.85,95,,percent of total billed charges,,
Nm Bone Scan Three Phase,,78315,CPT,Facility,Outpatient,,,,1683,1430.55,482.3478,1683,Humana Insurance Company,Medicare PPO,824.67,49,,percent of total billed charges,,
Nm Bone Scan Three Phase,,78315,CPT,Facility,Inpatient,,,,1683,1430.55,482.3478,1683,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Nm Bone Scan Three Phase,,78315,CPT,Facility,Both,,,,1683,1430.55,482.3478,1683,Medica,Individual & Family,1667.853,99.1,,percent of total billed charges,,
Nm Bone Scan Three Phase,,78315,CPT,Facility,Outpatient,,,,1683,1430.55,482.3478,1683,Medica,Medica Advantage Solution,838.134,49.8,,percent of total billed charges,,
Nm Bone Scan Three Phase,,78315,CPT,Facility,Inpatient,,,,1683,1430.55,482.3478,1683,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Nm Bone Scan Three Phase,,78315,CPT,Facility,Outpatient,,,,1683,1430.55,482.3478,1683,Medica,Medical Assistance,750.618,44.6,,percent of total billed charges,,
Nm Bone Scan Three Phase,,78315,CPT,Facility,Inpatient,,,,1683,1430.55,482.3478,1683,Medica,Medical Assistance,,,,,Included in per diem rate,
Nm Bone Scan Three Phase,,78315,CPT,Facility,Outpatient,,,,1683,1430.55,482.3478,1683,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,838.134,49.8,,percent of total billed charges,,
Nm Bone Scan Three Phase,,78315,CPT,Facility,Inpatient,,,,1683,1430.55,482.3478,1683,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Nm Bone Scan Three Phase,,78315,CPT,Facility,Both,,,,1683,1430.55,482.3478,1683,"Multiplan, Inc.","Multiplan, Inc.",1582.02,94,,percent of total billed charges,,
Nm Bone Scan Three Phase,,78315,CPT,Facility,Outpatient,,,,1683,1430.55,482.3478,1683,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1516.383,90.1,,percent of total billed charges,,
Nm Bone Scan Three Phase,,78315,CPT,Facility,Inpatient,,,,1683,1430.55,482.3478,1683,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Nm Bone Scan Three Phase,,78315,CPT,Facility,Both,,,,1683,1430.55,482.3478,1683,"Preferred One Administrative Services, INC.",PPO,1659.438,98.6,,percent of total billed charges,,
Nm Bone Scan Three Phase,,78315,CPT,Facility,Outpatient,,,,1683,1430.55,482.3478,1683,PrimeWest Health,Minnesota Senior Health Options (MSHO),865.9035,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Nm Bone Scan Three Phase,,78315,CPT,Facility,Inpatient,,,,1683,1430.55,482.3478,1683,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Nm Bone Scan Three Phase,,78315,CPT,Facility,Outpatient,,,,1683,1430.55,482.3478,1683,PrimeWest Health,MinnesotaCare,864.3888,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Nm Bone Scan Three Phase,,78315,CPT,Facility,Inpatient,,,,1683,1430.55,482.3478,1683,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Nm Bone Scan Three Phase,,78315,CPT,Facility,Both,,,,1683,1430.55,482.3478,1683,Sanford Health Plan,Sanford Health Plan,1548.36,92,,percent of total billed charges,,
Nm Bone Scan Three Phase,,78315,CPT,Facility,Outpatient,,,,1683,1430.55,482.3478,1683,"UCare Health, Inc.",Individual & Family Plan,948.3705,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Nm Bone Scan Three Phase,,78315,CPT,Facility,Inpatient,,,,1683,1430.55,482.3478,1683,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Nm Bone Scan Three Phase,,78315,CPT,Facility,Outpatient,,,,1683,1430.55,482.3478,1683,"UCare Health, Inc.",Medical Assistance,849.4101,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Nm Bone Scan Three Phase,,78315,CPT,Facility,Inpatient,,,,1683,1430.55,482.3478,1683,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Nm Bone Scan Three Phase,,78315,CPT,Facility,Outpatient,,,,1683,1430.55,482.3478,1683,"UCare Health, Inc.",Medicare Advantage,849.4101,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Nm Bone Scan Three Phase,,78315,CPT,Facility,Inpatient,,,,1683,1430.55,482.3478,1683,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Nm Bone Scan Three Phase,,78315,CPT,Facility,Outpatient,,,,1683,1430.55,482.3478,1683,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),849.4101,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Nm Bone Scan Three Phase,,78315,CPT,Facility,Inpatient,,,,1683,1430.55,482.3478,1683,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Nm Bone Scan Three Phase,,78315,CPT,Facility,Both,,,,1683,1430.55,482.3478,1683,UnitedHealthcare,Individual & Family,1582.02,94,,percent of total billed charges,,
Nm Bone Scan Three Phase,,78315,CPT,Facility,Outpatient,,,,1683,1430.55,482.3478,1683,UnitedHealthcare,Medicare Advantage,824.67,49,,percent of total billed charges,,
Nm Bone Scan Three Phase,,78315,CPT,Facility,Inpatient,,,,1683,1430.55,482.3478,1683,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Nm Bone Scan Three Phase,,78315,CPT,Facility,Outpatient,,,,1683,1430.55,482.3478,1683,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,807.84,48,,percent of total billed charges,,100% of DHS outpatient percentage
Nm Bone Scan Three Phase,,78315,CPT,Facility,Inpatient,,,,1683,1430.55,482.3478,1683,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Nm Vascular Flow Study,,78445,CPT,Facility,Both,,,,617,524.45,176.8322,617,Aetna,Commercial,567.64,92,,percent of total billed charges,,
Nm Vascular Flow Study,,78445,CPT,Facility,Outpatient,,,,617,524.45,176.8322,617,Aetna,Medicare Advantage,302.33,49,,percent of total billed charges,,
Nm Vascular Flow Study,,78445,CPT,Facility,Inpatient,,,,617,524.45,176.8322,617,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Nm Vascular Flow Study,,78445,CPT,Facility,Both,,,,617,524.45,176.8322,617,Aetna,PPO,573.81,93,,percent of total billed charges,,
Nm Vascular Flow Study,,78445,CPT,Facility,Both,,,,617,524.45,176.8322,617,America's PPO,America's PPO,592.5051,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Nm Vascular Flow Study,,78445,CPT,Facility,Both,,,,617,524.45,176.8322,617,BlueCross BlueShield Minnesota, Federal Employee Program,607.128,98.4,,percent of total billed charges,,
Nm Vascular Flow Study,,78445,CPT,Facility,Both,,,,617,524.45,176.8322,617,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,617,100,,percent of total billed charges,,
Nm Vascular Flow Study,,78445,CPT,Facility,Both,,,,617,524.45,176.8322,617,BlueCross BlueShield Minnesota,High Value Network Plan,555.3,90,,percent of total billed charges,,
Nm Vascular Flow Study,,78445,CPT,Facility,Outpatient,,,,617,524.45,176.8322,617,BlueCross BlueShield Minnesota,Medicare Advantage,302.33,49,,percent of total billed charges,,
Nm Vascular Flow Study,,78445,CPT,Facility,Inpatient,,,,617,524.45,176.8322,617,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Nm Vascular Flow Study,,78445,CPT,Facility,Both,,,,617,524.45,176.8322,617,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,546.4769,88.57,,percent of total billed charges,,
Nm Vascular Flow Study,,78445,CPT,Facility,Both,,,,617,524.45,176.8322,617,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,176.8322,28.66,,percent of total billed charges,,
Nm Vascular Flow Study,,78445,CPT,Facility,Outpatient,,,,617,524.45,176.8322,617,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),302.33,49,,percent of total billed charges,,
Nm Vascular Flow Study,,78445,CPT,Facility,Inpatient,,,,617,524.45,176.8322,617,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Nm Vascular Flow Study,,78445,CPT,Facility,Both,,,,617,524.45,176.8322,617,CorVel,Worker's Compensation,617,100,,percent of total billed charges,,
Nm Vascular Flow Study,,78445,CPT,Facility,Both,,,,617,524.45,176.8322,617,First Health Group Corporation,First Health Network,598.49,97,,percent of total billed charges,,
Nm Vascular Flow Study,,78445,CPT,Facility,Both,,,,617,524.45,176.8322,617,"Health Partners, Inc.",Commercial,583.682,94.6,,percent of total billed charges,,
Nm Vascular Flow Study,,78445,CPT,Facility,Outpatient,,,,617,524.45,176.8322,617,"Health Partners, Inc.",Medicare Advantage,302.33,49,,percent of total billed charges,,
Nm Vascular Flow Study,,78445,CPT,Facility,Inpatient,,,,617,524.45,176.8322,617,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Nm Vascular Flow Study,,78445,CPT,Facility,Both,,,,617,524.45,176.8322,617,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),370.2,60,,percent of total billed charges,,
Nm Vascular Flow Study,,78445,CPT,Facility,Both,,,,617,524.45,176.8322,617,"Health Partners, Inc.",State of Minnesota Advantage Program,502.855,81.5,,percent of total billed charges,,
Nm Vascular Flow Study,,78445,CPT,Facility,Both,,,,617,524.45,176.8322,617,"Health Partners, Inc.",State Public Programs,308.5,50,,percent of total billed charges,,
Nm Vascular Flow Study,,78445,CPT,Facility,Both,,,,617,524.45,176.8322,617,Humana Insurance Company,Commercial PPO,586.15,95,,percent of total billed charges,,
Nm Vascular Flow Study,,78445,CPT,Facility,Outpatient,,,,617,524.45,176.8322,617,Humana Insurance Company,Medicare PPO,302.33,49,,percent of total billed charges,,
Nm Vascular Flow Study,,78445,CPT,Facility,Inpatient,,,,617,524.45,176.8322,617,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Nm Vascular Flow Study,,78445,CPT,Facility,Both,,,,617,524.45,176.8322,617,Medica,Individual & Family,611.447,99.1,,percent of total billed charges,,
Nm Vascular Flow Study,,78445,CPT,Facility,Outpatient,,,,617,524.45,176.8322,617,Medica,Medica Advantage Solution,307.266,49.8,,percent of total billed charges,,
Nm Vascular Flow Study,,78445,CPT,Facility,Inpatient,,,,617,524.45,176.8322,617,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Nm Vascular Flow Study,,78445,CPT,Facility,Outpatient,,,,617,524.45,176.8322,617,Medica,Medical Assistance,275.182,44.6,,percent of total billed charges,,
Nm Vascular Flow Study,,78445,CPT,Facility,Inpatient,,,,617,524.45,176.8322,617,Medica,Medical Assistance,,,,,Included in per diem rate,
Nm Vascular Flow Study,,78445,CPT,Facility,Outpatient,,,,617,524.45,176.8322,617,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,307.266,49.8,,percent of total billed charges,,
Nm Vascular Flow Study,,78445,CPT,Facility,Inpatient,,,,617,524.45,176.8322,617,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Nm Vascular Flow Study,,78445,CPT,Facility,Both,,,,617,524.45,176.8322,617,"Multiplan, Inc.","Multiplan, Inc.",579.98,94,,percent of total billed charges,,
Nm Vascular Flow Study,,78445,CPT,Facility,Outpatient,,,,617,524.45,176.8322,617,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,555.917,90.1,,percent of total billed charges,,
Nm Vascular Flow Study,,78445,CPT,Facility,Inpatient,,,,617,524.45,176.8322,617,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Nm Vascular Flow Study,,78445,CPT,Facility,Both,,,,617,524.45,176.8322,617,"Preferred One Administrative Services, INC.",PPO,608.362,98.6,,percent of total billed charges,,
Nm Vascular Flow Study,,78445,CPT,Facility,Outpatient,,,,617,524.45,176.8322,617,PrimeWest Health,Minnesota Senior Health Options (MSHO),317.4465,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Nm Vascular Flow Study,,78445,CPT,Facility,Inpatient,,,,617,524.45,176.8322,617,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Nm Vascular Flow Study,,78445,CPT,Facility,Outpatient,,,,617,524.45,176.8322,617,PrimeWest Health,MinnesotaCare,316.8912,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Nm Vascular Flow Study,,78445,CPT,Facility,Inpatient,,,,617,524.45,176.8322,617,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Nm Vascular Flow Study,,78445,CPT,Facility,Both,,,,617,524.45,176.8322,617,Sanford Health Plan,Sanford Health Plan,567.64,92,,percent of total billed charges,,
Nm Vascular Flow Study,,78445,CPT,Facility,Outpatient,,,,617,524.45,176.8322,617,"UCare Health, Inc.",Individual & Family Plan,347.6795,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Nm Vascular Flow Study,,78445,CPT,Facility,Inpatient,,,,617,524.45,176.8322,617,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Nm Vascular Flow Study,,78445,CPT,Facility,Outpatient,,,,617,524.45,176.8322,617,"UCare Health, Inc.",Medical Assistance,311.3999,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Nm Vascular Flow Study,,78445,CPT,Facility,Inpatient,,,,617,524.45,176.8322,617,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Nm Vascular Flow Study,,78445,CPT,Facility,Outpatient,,,,617,524.45,176.8322,617,"UCare Health, Inc.",Medicare Advantage,311.3999,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Nm Vascular Flow Study,,78445,CPT,Facility,Inpatient,,,,617,524.45,176.8322,617,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Nm Vascular Flow Study,,78445,CPT,Facility,Outpatient,,,,617,524.45,176.8322,617,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),311.3999,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Nm Vascular Flow Study,,78445,CPT,Facility,Inpatient,,,,617,524.45,176.8322,617,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Nm Vascular Flow Study,,78445,CPT,Facility,Both,,,,617,524.45,176.8322,617,UnitedHealthcare,Individual & Family,579.98,94,,percent of total billed charges,,
Nm Vascular Flow Study,,78445,CPT,Facility,Outpatient,,,,617,524.45,176.8322,617,UnitedHealthcare,Medicare Advantage,302.33,49,,percent of total billed charges,,
Nm Vascular Flow Study,,78445,CPT,Facility,Inpatient,,,,617,524.45,176.8322,617,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Nm Vascular Flow Study,,78445,CPT,Facility,Outpatient,,,,617,524.45,176.8322,617,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,296.16,48,,percent of total billed charges,,100% of DHS outpatient percentage
Nm Vascular Flow Study,,78445,CPT,Facility,Inpatient,,,,617,524.45,176.8322,617,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Myocardial Perfusion Single Study,,78451,CPT,Facility,Both,,,,2550,2167.5,730.83,2550,Aetna,Commercial,2346,92,,percent of total billed charges,,
Myocardial Perfusion Single Study,,78451,CPT,Facility,Outpatient,,,,2550,2167.5,730.83,2550,Aetna,Medicare Advantage,1249.5,49,,percent of total billed charges,,
Myocardial Perfusion Single Study,,78451,CPT,Facility,Inpatient,,,,2550,2167.5,730.83,2550,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Myocardial Perfusion Single Study,,78451,CPT,Facility,Both,,,,2550,2167.5,730.83,2550,Aetna,PPO,2371.5,93,,percent of total billed charges,,
Myocardial Perfusion Single Study,,78451,CPT,Facility,Both,,,,2550,2167.5,730.83,2550,America's PPO,America's PPO,2448.765,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Myocardial Perfusion Single Study,,78451,CPT,Facility,Both,,,,2550,2167.5,730.83,2550,BlueCross BlueShield Minnesota, Federal Employee Program,2509.2,98.4,,percent of total billed charges,,
Myocardial Perfusion Single Study,,78451,CPT,Facility,Both,,,,2550,2167.5,730.83,2550,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,2550,100,,percent of total billed charges,,
Myocardial Perfusion Single Study,,78451,CPT,Facility,Both,,,,2550,2167.5,730.83,2550,BlueCross BlueShield Minnesota,High Value Network Plan,2295,90,,percent of total billed charges,,
Myocardial Perfusion Single Study,,78451,CPT,Facility,Outpatient,,,,2550,2167.5,730.83,2550,BlueCross BlueShield Minnesota,Medicare Advantage,1249.5,49,,percent of total billed charges,,
Myocardial Perfusion Single Study,,78451,CPT,Facility,Inpatient,,,,2550,2167.5,730.83,2550,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Myocardial Perfusion Single Study,,78451,CPT,Facility,Both,,,,2550,2167.5,730.83,2550,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,2258.535,88.57,,percent of total billed charges,,
Myocardial Perfusion Single Study,,78451,CPT,Facility,Both,,,,2550,2167.5,730.83,2550,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,730.83,28.66,,percent of total billed charges,,
Myocardial Perfusion Single Study,,78451,CPT,Facility,Outpatient,,,,2550,2167.5,730.83,2550,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1249.5,49,,percent of total billed charges,,
Myocardial Perfusion Single Study,,78451,CPT,Facility,Inpatient,,,,2550,2167.5,730.83,2550,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Myocardial Perfusion Single Study,,78451,CPT,Facility,Both,,,,2550,2167.5,730.83,2550,CorVel,Worker's Compensation,2550,100,,percent of total billed charges,,
Myocardial Perfusion Single Study,,78451,CPT,Facility,Both,,,,2550,2167.5,730.83,2550,First Health Group Corporation,First Health Network,2473.5,97,,percent of total billed charges,,
Myocardial Perfusion Single Study,,78451,CPT,Facility,Both,,,,2550,2167.5,730.83,2550,"Health Partners, Inc.",Commercial,2412.3,94.6,,percent of total billed charges,,
Myocardial Perfusion Single Study,,78451,CPT,Facility,Outpatient,,,,2550,2167.5,730.83,2550,"Health Partners, Inc.",Medicare Advantage,1249.5,49,,percent of total billed charges,,
Myocardial Perfusion Single Study,,78451,CPT,Facility,Inpatient,,,,2550,2167.5,730.83,2550,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Myocardial Perfusion Single Study,,78451,CPT,Facility,Both,,,,2550,2167.5,730.83,2550,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1530,60,,percent of total billed charges,,
Myocardial Perfusion Single Study,,78451,CPT,Facility,Both,,,,2550,2167.5,730.83,2550,"Health Partners, Inc.",State of Minnesota Advantage Program,2078.25,81.5,,percent of total billed charges,,
Myocardial Perfusion Single Study,,78451,CPT,Facility,Both,,,,2550,2167.5,730.83,2550,"Health Partners, Inc.",State Public Programs,1275,50,,percent of total billed charges,,
Myocardial Perfusion Single Study,,78451,CPT,Facility,Both,,,,2550,2167.5,730.83,2550,Humana Insurance Company,Commercial PPO,2422.5,95,,percent of total billed charges,,
Myocardial Perfusion Single Study,,78451,CPT,Facility,Outpatient,,,,2550,2167.5,730.83,2550,Humana Insurance Company,Medicare PPO,1249.5,49,,percent of total billed charges,,
Myocardial Perfusion Single Study,,78451,CPT,Facility,Inpatient,,,,2550,2167.5,730.83,2550,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Myocardial Perfusion Single Study,,78451,CPT,Facility,Both,,,,2550,2167.5,730.83,2550,Medica,Individual & Family,2527.05,99.1,,percent of total billed charges,,
Myocardial Perfusion Single Study,,78451,CPT,Facility,Outpatient,,,,2550,2167.5,730.83,2550,Medica,Medica Advantage Solution,1269.9,49.8,,percent of total billed charges,,
Myocardial Perfusion Single Study,,78451,CPT,Facility,Inpatient,,,,2550,2167.5,730.83,2550,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Myocardial Perfusion Single Study,,78451,CPT,Facility,Outpatient,,,,2550,2167.5,730.83,2550,Medica,Medical Assistance,1137.3,44.6,,percent of total billed charges,,
Myocardial Perfusion Single Study,,78451,CPT,Facility,Inpatient,,,,2550,2167.5,730.83,2550,Medica,Medical Assistance,,,,,Included in per diem rate,
Myocardial Perfusion Single Study,,78451,CPT,Facility,Outpatient,,,,2550,2167.5,730.83,2550,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1269.9,49.8,,percent of total billed charges,,
Myocardial Perfusion Single Study,,78451,CPT,Facility,Inpatient,,,,2550,2167.5,730.83,2550,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Myocardial Perfusion Single Study,,78451,CPT,Facility,Both,,,,2550,2167.5,730.83,2550,"Multiplan, Inc.","Multiplan, Inc.",2397,94,,percent of total billed charges,,
Myocardial Perfusion Single Study,,78451,CPT,Facility,Outpatient,,,,2550,2167.5,730.83,2550,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,2297.55,90.1,,percent of total billed charges,,
Myocardial Perfusion Single Study,,78451,CPT,Facility,Inpatient,,,,2550,2167.5,730.83,2550,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Myocardial Perfusion Single Study,,78451,CPT,Facility,Both,,,,2550,2167.5,730.83,2550,"Preferred One Administrative Services, INC.",PPO,2514.3,98.6,,percent of total billed charges,,
Myocardial Perfusion Single Study,,78451,CPT,Facility,Outpatient,,,,2550,2167.5,730.83,2550,PrimeWest Health,Minnesota Senior Health Options (MSHO),1311.975,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Myocardial Perfusion Single Study,,78451,CPT,Facility,Inpatient,,,,2550,2167.5,730.83,2550,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Myocardial Perfusion Single Study,,78451,CPT,Facility,Outpatient,,,,2550,2167.5,730.83,2550,PrimeWest Health,MinnesotaCare,1309.68,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Myocardial Perfusion Single Study,,78451,CPT,Facility,Inpatient,,,,2550,2167.5,730.83,2550,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Myocardial Perfusion Single Study,,78451,CPT,Facility,Both,,,,2550,2167.5,730.83,2550,Sanford Health Plan,Sanford Health Plan,2346,92,,percent of total billed charges,,
Myocardial Perfusion Single Study,,78451,CPT,Facility,Outpatient,,,,2550,2167.5,730.83,2550,"UCare Health, Inc.",Individual & Family Plan,1436.925,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Myocardial Perfusion Single Study,,78451,CPT,Facility,Inpatient,,,,2550,2167.5,730.83,2550,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Myocardial Perfusion Single Study,,78451,CPT,Facility,Outpatient,,,,2550,2167.5,730.83,2550,"UCare Health, Inc.",Medical Assistance,1286.985,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Myocardial Perfusion Single Study,,78451,CPT,Facility,Inpatient,,,,2550,2167.5,730.83,2550,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Myocardial Perfusion Single Study,,78451,CPT,Facility,Outpatient,,,,2550,2167.5,730.83,2550,"UCare Health, Inc.",Medicare Advantage,1286.985,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Myocardial Perfusion Single Study,,78451,CPT,Facility,Inpatient,,,,2550,2167.5,730.83,2550,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Myocardial Perfusion Single Study,,78451,CPT,Facility,Outpatient,,,,2550,2167.5,730.83,2550,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1286.985,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Myocardial Perfusion Single Study,,78451,CPT,Facility,Inpatient,,,,2550,2167.5,730.83,2550,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Myocardial Perfusion Single Study,,78451,CPT,Facility,Both,,,,2550,2167.5,730.83,2550,UnitedHealthcare,Individual & Family,2397,94,,percent of total billed charges,,
Myocardial Perfusion Single Study,,78451,CPT,Facility,Outpatient,,,,2550,2167.5,730.83,2550,UnitedHealthcare,Medicare Advantage,1249.5,49,,percent of total billed charges,,
Myocardial Perfusion Single Study,,78451,CPT,Facility,Inpatient,,,,2550,2167.5,730.83,2550,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Myocardial Perfusion Single Study,,78451,CPT,Facility,Outpatient,,,,2550,2167.5,730.83,2550,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1224,48,,percent of total billed charges,,100% of DHS outpatient percentage
Myocardial Perfusion Single Study,,78451,CPT,Facility,Inpatient,,,,2550,2167.5,730.83,2550,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Myocardial Perfusion Scan Spect Multiple,,78452,CPT,Facility,Both,,,,3264,2774.4,1437.64,3264,Aetna,Commercial,3002.88,92,,percent of total billed charges,,
Myocardial Perfusion Scan Spect Multiple,,78452,CPT,Facility,Outpatient,,,,3264,2774.4,1437.64,3264,Aetna,Medicare Advantage,1599.36,49,,percent of total billed charges,,
Myocardial Perfusion Scan Spect Multiple,,78452,CPT,Facility,Inpatient,,,,3264,2774.4,1437.64,3264,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Myocardial Perfusion Scan Spect Multiple,,78452,CPT,Facility,Both,,,,3264,2774.4,1437.64,3264,Aetna,PPO,3035.52,93,,percent of total billed charges,,
Myocardial Perfusion Scan Spect Multiple,,78452,CPT,Facility,Both,,,,3264,2774.4,1437.64,3264,America's PPO,America's PPO,3134.4192,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Myocardial Perfusion Scan Spect Multiple,,78452,CPT,Facility,Both,,,,3264,2774.4,1437.64,3264,BlueCross BlueShield Minnesota, Federal Employee Program,2830,,,Fee schedule,,100% of BCBS commercial commodity fee schedule
Myocardial Perfusion Scan Spect Multiple,,78452,CPT,Facility,Both,,,,3264,2774.4,1437.64,3264,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,2875.28,,,Fee schedule,,"100% of BCBS commercial commodity fee schedule, plus MN Care tax"
Myocardial Perfusion Scan Spect Multiple,,78452,CPT,Facility,Both,,,,3264,2774.4,1437.64,3264,BlueCross BlueShield Minnesota,High Value Network Plan,2587.752,,,Fee schedule,,"90% of BCBS commercial commodity fee schedule, plus MN Care tax; see disclaimer for more information"
Myocardial Perfusion Scan Spect Multiple,,78452,CPT,Facility,Outpatient,,,,3264,2774.4,1437.64,3264,BlueCross BlueShield Minnesota,Medicare Advantage,1599.36,49,,percent of total billed charges,,
Myocardial Perfusion Scan Spect Multiple,,78452,CPT,Facility,Inpatient,,,,3264,2774.4,1437.64,3264,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Myocardial Perfusion Scan Spect Multiple,,78452,CPT,Facility,Both,,,,3264,2774.4,1437.64,3264,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,2546.635496,,,Fee schedule,,"88.57% of BCBS commercial commodity fee schedule, plus MN Care tax"
Myocardial Perfusion Scan Spect Multiple,,78452,CPT,Facility,Both,,,,3264,2774.4,1437.64,3264,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1437.64,,,Fee schedule,,"100% of BCBS Medicaid commodity fee schedule, plus MN Care tax"
Myocardial Perfusion Scan Spect Multiple,,78452,CPT,Facility,Outpatient,,,,3264,2774.4,1437.64,3264,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1599.36,49,,percent of total billed charges,,
Myocardial Perfusion Scan Spect Multiple,,78452,CPT,Facility,Inpatient,,,,3264,2774.4,1437.64,3264,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Myocardial Perfusion Scan Spect Multiple,,78452,CPT,Facility,Both,,,,3264,2774.4,1437.64,3264,CorVel,Worker's Compensation,3264,100,,percent of total billed charges,,
Myocardial Perfusion Scan Spect Multiple,,78452,CPT,Facility,Both,,,,3264,2774.4,1437.64,3264,First Health Group Corporation,First Health Network,3166.08,97,,percent of total billed charges,,
Myocardial Perfusion Scan Spect Multiple,,78452,CPT,Facility,Both,,,,3264,2774.4,1437.64,3264,"Health Partners, Inc.",Commercial,3087.744,94.6,,percent of total billed charges,,
Myocardial Perfusion Scan Spect Multiple,,78452,CPT,Facility,Outpatient,,,,3264,2774.4,1437.64,3264,"Health Partners, Inc.",Medicare Advantage,1599.36,49,,percent of total billed charges,,
Myocardial Perfusion Scan Spect Multiple,,78452,CPT,Facility,Inpatient,,,,3264,2774.4,1437.64,3264,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Myocardial Perfusion Scan Spect Multiple,,78452,CPT,Facility,Both,,,,3264,2774.4,1437.64,3264,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1958.4,60,,percent of total billed charges,,
Myocardial Perfusion Scan Spect Multiple,,78452,CPT,Facility,Both,,,,3264,2774.4,1437.64,3264,"Health Partners, Inc.",State of Minnesota Advantage Program,2660.16,81.5,,percent of total billed charges,,
Myocardial Perfusion Scan Spect Multiple,,78452,CPT,Facility,Both,,,,3264,2774.4,1437.64,3264,"Health Partners, Inc.",State Public Programs,1632,50,,percent of total billed charges,,
Myocardial Perfusion Scan Spect Multiple,,78452,CPT,Facility,Both,,,,3264,2774.4,1437.64,3264,Humana Insurance Company,Commercial PPO,3100.8,95,,percent of total billed charges,,
Myocardial Perfusion Scan Spect Multiple,,78452,CPT,Facility,Outpatient,,,,3264,2774.4,1437.64,3264,Humana Insurance Company,Medicare PPO,1599.36,49,,percent of total billed charges,,
Myocardial Perfusion Scan Spect Multiple,,78452,CPT,Facility,Inpatient,,,,3264,2774.4,1437.64,3264,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Myocardial Perfusion Scan Spect Multiple,,78452,CPT,Facility,Both,,,,3264,2774.4,1437.64,3264,Medica,Individual & Family,3234.624,99.1,,percent of total billed charges,,
Myocardial Perfusion Scan Spect Multiple,,78452,CPT,Facility,Outpatient,,,,3264,2774.4,1437.64,3264,Medica,Medica Advantage Solution,1625.472,49.8,,percent of total billed charges,,
Myocardial Perfusion Scan Spect Multiple,,78452,CPT,Facility,Inpatient,,,,3264,2774.4,1437.64,3264,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Myocardial Perfusion Scan Spect Multiple,,78452,CPT,Facility,Outpatient,,,,3264,2774.4,1437.64,3264,Medica,Medical Assistance,1455.744,44.6,,percent of total billed charges,,
Myocardial Perfusion Scan Spect Multiple,,78452,CPT,Facility,Inpatient,,,,3264,2774.4,1437.64,3264,Medica,Medical Assistance,,,,,Included in per diem rate,
Myocardial Perfusion Scan Spect Multiple,,78452,CPT,Facility,Outpatient,,,,3264,2774.4,1437.64,3264,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1625.472,49.8,,percent of total billed charges,,
Myocardial Perfusion Scan Spect Multiple,,78452,CPT,Facility,Inpatient,,,,3264,2774.4,1437.64,3264,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Myocardial Perfusion Scan Spect Multiple,,78452,CPT,Facility,Both,,,,3264,2774.4,1437.64,3264,"Multiplan, Inc.","Multiplan, Inc.",3068.16,94,,percent of total billed charges,,
Myocardial Perfusion Scan Spect Multiple,,78452,CPT,Facility,Outpatient,,,,3264,2774.4,1437.64,3264,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,2940.864,90.1,,percent of total billed charges,,
Myocardial Perfusion Scan Spect Multiple,,78452,CPT,Facility,Inpatient,,,,3264,2774.4,1437.64,3264,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Myocardial Perfusion Scan Spect Multiple,,78452,CPT,Facility,Both,,,,3264,2774.4,1437.64,3264,"Preferred One Administrative Services, INC.",PPO,3218.304,98.6,,percent of total billed charges,,
Myocardial Perfusion Scan Spect Multiple,,78452,CPT,Facility,Outpatient,,,,3264,2774.4,1437.64,3264,PrimeWest Health,Minnesota Senior Health Options (MSHO),1679.328,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Myocardial Perfusion Scan Spect Multiple,,78452,CPT,Facility,Inpatient,,,,3264,2774.4,1437.64,3264,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Myocardial Perfusion Scan Spect Multiple,,78452,CPT,Facility,Outpatient,,,,3264,2774.4,1437.64,3264,PrimeWest Health,MinnesotaCare,1676.3904,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Myocardial Perfusion Scan Spect Multiple,,78452,CPT,Facility,Inpatient,,,,3264,2774.4,1437.64,3264,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Myocardial Perfusion Scan Spect Multiple,,78452,CPT,Facility,Both,,,,3264,2774.4,1437.64,3264,Sanford Health Plan,Sanford Health Plan,3002.88,92,,percent of total billed charges,,
Myocardial Perfusion Scan Spect Multiple,,78452,CPT,Facility,Outpatient,,,,3264,2774.4,1437.64,3264,"UCare Health, Inc.",Individual & Family Plan,1839.264,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Myocardial Perfusion Scan Spect Multiple,,78452,CPT,Facility,Inpatient,,,,3264,2774.4,1437.64,3264,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Myocardial Perfusion Scan Spect Multiple,,78452,CPT,Facility,Outpatient,,,,3264,2774.4,1437.64,3264,"UCare Health, Inc.",Medical Assistance,1647.3408,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Myocardial Perfusion Scan Spect Multiple,,78452,CPT,Facility,Inpatient,,,,3264,2774.4,1437.64,3264,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Myocardial Perfusion Scan Spect Multiple,,78452,CPT,Facility,Outpatient,,,,3264,2774.4,1437.64,3264,"UCare Health, Inc.",Medicare Advantage,1647.3408,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Myocardial Perfusion Scan Spect Multiple,,78452,CPT,Facility,Inpatient,,,,3264,2774.4,1437.64,3264,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Myocardial Perfusion Scan Spect Multiple,,78452,CPT,Facility,Outpatient,,,,3264,2774.4,1437.64,3264,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1647.3408,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Myocardial Perfusion Scan Spect Multiple,,78452,CPT,Facility,Inpatient,,,,3264,2774.4,1437.64,3264,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Myocardial Perfusion Scan Spect Multiple,,78452,CPT,Facility,Both,,,,3264,2774.4,1437.64,3264,UnitedHealthcare,Individual & Family,3068.16,94,,percent of total billed charges,,
Myocardial Perfusion Scan Spect Multiple,,78452,CPT,Facility,Outpatient,,,,3264,2774.4,1437.64,3264,UnitedHealthcare,Medicare Advantage,1599.36,49,,percent of total billed charges,,
Myocardial Perfusion Scan Spect Multiple,,78452,CPT,Facility,Inpatient,,,,3264,2774.4,1437.64,3264,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Myocardial Perfusion Scan Spect Multiple,,78452,CPT,Facility,Outpatient,,,,3264,2774.4,1437.64,3264,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1566.72,48,,percent of total billed charges,,100% of DHS outpatient percentage
Myocardial Perfusion Scan Spect Multiple,,78452,CPT,Facility,Inpatient,,,,3264,2774.4,1437.64,3264,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Nm Lung Scan Ventilation,,78579,CPT,Facility,Both,,,,1224,1040.4,350.7984,1224,Aetna,Commercial,1126.08,92,,percent of total billed charges,,
Nm Lung Scan Ventilation,,78579,CPT,Facility,Outpatient,,,,1224,1040.4,350.7984,1224,Aetna,Medicare Advantage,599.76,49,,percent of total billed charges,,
Nm Lung Scan Ventilation,,78579,CPT,Facility,Inpatient,,,,1224,1040.4,350.7984,1224,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Nm Lung Scan Ventilation,,78579,CPT,Facility,Both,,,,1224,1040.4,350.7984,1224,Aetna,PPO,1138.32,93,,percent of total billed charges,,
Nm Lung Scan Ventilation,,78579,CPT,Facility,Both,,,,1224,1040.4,350.7984,1224,America's PPO,America's PPO,1175.4072,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Nm Lung Scan Ventilation,,78579,CPT,Facility,Both,,,,1224,1040.4,350.7984,1224,BlueCross BlueShield Minnesota, Federal Employee Program,1204.416,98.4,,percent of total billed charges,,
Nm Lung Scan Ventilation,,78579,CPT,Facility,Both,,,,1224,1040.4,350.7984,1224,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1224,100,,percent of total billed charges,,
Nm Lung Scan Ventilation,,78579,CPT,Facility,Both,,,,1224,1040.4,350.7984,1224,BlueCross BlueShield Minnesota,High Value Network Plan,1101.6,90,,percent of total billed charges,,
Nm Lung Scan Ventilation,,78579,CPT,Facility,Outpatient,,,,1224,1040.4,350.7984,1224,BlueCross BlueShield Minnesota,Medicare Advantage,599.76,49,,percent of total billed charges,,
Nm Lung Scan Ventilation,,78579,CPT,Facility,Inpatient,,,,1224,1040.4,350.7984,1224,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Nm Lung Scan Ventilation,,78579,CPT,Facility,Both,,,,1224,1040.4,350.7984,1224,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1084.0968,88.57,,percent of total billed charges,,
Nm Lung Scan Ventilation,,78579,CPT,Facility,Both,,,,1224,1040.4,350.7984,1224,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,350.7984,28.66,,percent of total billed charges,,
Nm Lung Scan Ventilation,,78579,CPT,Facility,Outpatient,,,,1224,1040.4,350.7984,1224,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),599.76,49,,percent of total billed charges,,
Nm Lung Scan Ventilation,,78579,CPT,Facility,Inpatient,,,,1224,1040.4,350.7984,1224,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Nm Lung Scan Ventilation,,78579,CPT,Facility,Both,,,,1224,1040.4,350.7984,1224,CorVel,Worker's Compensation,1224,100,,percent of total billed charges,,
Nm Lung Scan Ventilation,,78579,CPT,Facility,Both,,,,1224,1040.4,350.7984,1224,First Health Group Corporation,First Health Network,1187.28,97,,percent of total billed charges,,
Nm Lung Scan Ventilation,,78579,CPT,Facility,Both,,,,1224,1040.4,350.7984,1224,"Health Partners, Inc.",Commercial,1157.904,94.6,,percent of total billed charges,,
Nm Lung Scan Ventilation,,78579,CPT,Facility,Outpatient,,,,1224,1040.4,350.7984,1224,"Health Partners, Inc.",Medicare Advantage,599.76,49,,percent of total billed charges,,
Nm Lung Scan Ventilation,,78579,CPT,Facility,Inpatient,,,,1224,1040.4,350.7984,1224,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Nm Lung Scan Ventilation,,78579,CPT,Facility,Both,,,,1224,1040.4,350.7984,1224,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),734.4,60,,percent of total billed charges,,
Nm Lung Scan Ventilation,,78579,CPT,Facility,Both,,,,1224,1040.4,350.7984,1224,"Health Partners, Inc.",State of Minnesota Advantage Program,997.56,81.5,,percent of total billed charges,,
Nm Lung Scan Ventilation,,78579,CPT,Facility,Both,,,,1224,1040.4,350.7984,1224,"Health Partners, Inc.",State Public Programs,612,50,,percent of total billed charges,,
Nm Lung Scan Ventilation,,78579,CPT,Facility,Both,,,,1224,1040.4,350.7984,1224,Humana Insurance Company,Commercial PPO,1162.8,95,,percent of total billed charges,,
Nm Lung Scan Ventilation,,78579,CPT,Facility,Outpatient,,,,1224,1040.4,350.7984,1224,Humana Insurance Company,Medicare PPO,599.76,49,,percent of total billed charges,,
Nm Lung Scan Ventilation,,78579,CPT,Facility,Inpatient,,,,1224,1040.4,350.7984,1224,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Nm Lung Scan Ventilation,,78579,CPT,Facility,Both,,,,1224,1040.4,350.7984,1224,Medica,Individual & Family,1212.984,99.1,,percent of total billed charges,,
Nm Lung Scan Ventilation,,78579,CPT,Facility,Outpatient,,,,1224,1040.4,350.7984,1224,Medica,Medica Advantage Solution,609.552,49.8,,percent of total billed charges,,
Nm Lung Scan Ventilation,,78579,CPT,Facility,Inpatient,,,,1224,1040.4,350.7984,1224,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Nm Lung Scan Ventilation,,78579,CPT,Facility,Outpatient,,,,1224,1040.4,350.7984,1224,Medica,Medical Assistance,545.904,44.6,,percent of total billed charges,,
Nm Lung Scan Ventilation,,78579,CPT,Facility,Inpatient,,,,1224,1040.4,350.7984,1224,Medica,Medical Assistance,,,,,Included in per diem rate,
Nm Lung Scan Ventilation,,78579,CPT,Facility,Outpatient,,,,1224,1040.4,350.7984,1224,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,609.552,49.8,,percent of total billed charges,,
Nm Lung Scan Ventilation,,78579,CPT,Facility,Inpatient,,,,1224,1040.4,350.7984,1224,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Nm Lung Scan Ventilation,,78579,CPT,Facility,Both,,,,1224,1040.4,350.7984,1224,"Multiplan, Inc.","Multiplan, Inc.",1150.56,94,,percent of total billed charges,,
Nm Lung Scan Ventilation,,78579,CPT,Facility,Outpatient,,,,1224,1040.4,350.7984,1224,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1102.824,90.1,,percent of total billed charges,,
Nm Lung Scan Ventilation,,78579,CPT,Facility,Inpatient,,,,1224,1040.4,350.7984,1224,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Nm Lung Scan Ventilation,,78579,CPT,Facility,Both,,,,1224,1040.4,350.7984,1224,"Preferred One Administrative Services, INC.",PPO,1206.864,98.6,,percent of total billed charges,,
Nm Lung Scan Ventilation,,78579,CPT,Facility,Outpatient,,,,1224,1040.4,350.7984,1224,PrimeWest Health,Minnesota Senior Health Options (MSHO),629.748,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Nm Lung Scan Ventilation,,78579,CPT,Facility,Inpatient,,,,1224,1040.4,350.7984,1224,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Nm Lung Scan Ventilation,,78579,CPT,Facility,Outpatient,,,,1224,1040.4,350.7984,1224,PrimeWest Health,MinnesotaCare,628.6464,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Nm Lung Scan Ventilation,,78579,CPT,Facility,Inpatient,,,,1224,1040.4,350.7984,1224,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Nm Lung Scan Ventilation,,78579,CPT,Facility,Both,,,,1224,1040.4,350.7984,1224,Sanford Health Plan,Sanford Health Plan,1126.08,92,,percent of total billed charges,,
Nm Lung Scan Ventilation,,78579,CPT,Facility,Outpatient,,,,1224,1040.4,350.7984,1224,"UCare Health, Inc.",Individual & Family Plan,689.724,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Nm Lung Scan Ventilation,,78579,CPT,Facility,Inpatient,,,,1224,1040.4,350.7984,1224,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Nm Lung Scan Ventilation,,78579,CPT,Facility,Outpatient,,,,1224,1040.4,350.7984,1224,"UCare Health, Inc.",Medical Assistance,617.7528,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Nm Lung Scan Ventilation,,78579,CPT,Facility,Inpatient,,,,1224,1040.4,350.7984,1224,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Nm Lung Scan Ventilation,,78579,CPT,Facility,Outpatient,,,,1224,1040.4,350.7984,1224,"UCare Health, Inc.",Medicare Advantage,617.7528,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Nm Lung Scan Ventilation,,78579,CPT,Facility,Inpatient,,,,1224,1040.4,350.7984,1224,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Nm Lung Scan Ventilation,,78579,CPT,Facility,Outpatient,,,,1224,1040.4,350.7984,1224,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),617.7528,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Nm Lung Scan Ventilation,,78579,CPT,Facility,Inpatient,,,,1224,1040.4,350.7984,1224,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Nm Lung Scan Ventilation,,78579,CPT,Facility,Both,,,,1224,1040.4,350.7984,1224,UnitedHealthcare,Individual & Family,1150.56,94,,percent of total billed charges,,
Nm Lung Scan Ventilation,,78579,CPT,Facility,Outpatient,,,,1224,1040.4,350.7984,1224,UnitedHealthcare,Medicare Advantage,599.76,49,,percent of total billed charges,,
Nm Lung Scan Ventilation,,78579,CPT,Facility,Inpatient,,,,1224,1040.4,350.7984,1224,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Nm Lung Scan Ventilation,,78579,CPT,Facility,Outpatient,,,,1224,1040.4,350.7984,1224,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,587.52,48,,percent of total billed charges,,100% of DHS outpatient percentage
Nm Lung Scan Ventilation,,78579,CPT,Facility,Inpatient,,,,1224,1040.4,350.7984,1224,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Nm Lung Scan Perfusion,,78580,CPT,Facility,Both,,,,1224,1040.4,350.7984,1224,Aetna,Commercial,1126.08,92,,percent of total billed charges,,
Nm Lung Scan Perfusion,,78580,CPT,Facility,Outpatient,,,,1224,1040.4,350.7984,1224,Aetna,Medicare Advantage,599.76,49,,percent of total billed charges,,
Nm Lung Scan Perfusion,,78580,CPT,Facility,Inpatient,,,,1224,1040.4,350.7984,1224,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Nm Lung Scan Perfusion,,78580,CPT,Facility,Both,,,,1224,1040.4,350.7984,1224,Aetna,PPO,1138.32,93,,percent of total billed charges,,
Nm Lung Scan Perfusion,,78580,CPT,Facility,Both,,,,1224,1040.4,350.7984,1224,America's PPO,America's PPO,1175.4072,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Nm Lung Scan Perfusion,,78580,CPT,Facility,Both,,,,1224,1040.4,350.7984,1224,BlueCross BlueShield Minnesota, Federal Employee Program,1204.416,98.4,,percent of total billed charges,,
Nm Lung Scan Perfusion,,78580,CPT,Facility,Both,,,,1224,1040.4,350.7984,1224,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1224,100,,percent of total billed charges,,
Nm Lung Scan Perfusion,,78580,CPT,Facility,Both,,,,1224,1040.4,350.7984,1224,BlueCross BlueShield Minnesota,High Value Network Plan,1101.6,90,,percent of total billed charges,,
Nm Lung Scan Perfusion,,78580,CPT,Facility,Outpatient,,,,1224,1040.4,350.7984,1224,BlueCross BlueShield Minnesota,Medicare Advantage,599.76,49,,percent of total billed charges,,
Nm Lung Scan Perfusion,,78580,CPT,Facility,Inpatient,,,,1224,1040.4,350.7984,1224,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Nm Lung Scan Perfusion,,78580,CPT,Facility,Both,,,,1224,1040.4,350.7984,1224,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1084.0968,88.57,,percent of total billed charges,,
Nm Lung Scan Perfusion,,78580,CPT,Facility,Both,,,,1224,1040.4,350.7984,1224,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,350.7984,28.66,,percent of total billed charges,,
Nm Lung Scan Perfusion,,78580,CPT,Facility,Outpatient,,,,1224,1040.4,350.7984,1224,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),599.76,49,,percent of total billed charges,,
Nm Lung Scan Perfusion,,78580,CPT,Facility,Inpatient,,,,1224,1040.4,350.7984,1224,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Nm Lung Scan Perfusion,,78580,CPT,Facility,Both,,,,1224,1040.4,350.7984,1224,CorVel,Worker's Compensation,1224,100,,percent of total billed charges,,
Nm Lung Scan Perfusion,,78580,CPT,Facility,Both,,,,1224,1040.4,350.7984,1224,First Health Group Corporation,First Health Network,1187.28,97,,percent of total billed charges,,
Nm Lung Scan Perfusion,,78580,CPT,Facility,Both,,,,1224,1040.4,350.7984,1224,"Health Partners, Inc.",Commercial,1157.904,94.6,,percent of total billed charges,,
Nm Lung Scan Perfusion,,78580,CPT,Facility,Outpatient,,,,1224,1040.4,350.7984,1224,"Health Partners, Inc.",Medicare Advantage,599.76,49,,percent of total billed charges,,
Nm Lung Scan Perfusion,,78580,CPT,Facility,Inpatient,,,,1224,1040.4,350.7984,1224,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Nm Lung Scan Perfusion,,78580,CPT,Facility,Both,,,,1224,1040.4,350.7984,1224,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),734.4,60,,percent of total billed charges,,
Nm Lung Scan Perfusion,,78580,CPT,Facility,Both,,,,1224,1040.4,350.7984,1224,"Health Partners, Inc.",State of Minnesota Advantage Program,997.56,81.5,,percent of total billed charges,,
Nm Lung Scan Perfusion,,78580,CPT,Facility,Both,,,,1224,1040.4,350.7984,1224,"Health Partners, Inc.",State Public Programs,612,50,,percent of total billed charges,,
Nm Lung Scan Perfusion,,78580,CPT,Facility,Both,,,,1224,1040.4,350.7984,1224,Humana Insurance Company,Commercial PPO,1162.8,95,,percent of total billed charges,,
Nm Lung Scan Perfusion,,78580,CPT,Facility,Outpatient,,,,1224,1040.4,350.7984,1224,Humana Insurance Company,Medicare PPO,599.76,49,,percent of total billed charges,,
Nm Lung Scan Perfusion,,78580,CPT,Facility,Inpatient,,,,1224,1040.4,350.7984,1224,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Nm Lung Scan Perfusion,,78580,CPT,Facility,Both,,,,1224,1040.4,350.7984,1224,Medica,Individual & Family,1212.984,99.1,,percent of total billed charges,,
Nm Lung Scan Perfusion,,78580,CPT,Facility,Outpatient,,,,1224,1040.4,350.7984,1224,Medica,Medica Advantage Solution,609.552,49.8,,percent of total billed charges,,
Nm Lung Scan Perfusion,,78580,CPT,Facility,Inpatient,,,,1224,1040.4,350.7984,1224,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Nm Lung Scan Perfusion,,78580,CPT,Facility,Outpatient,,,,1224,1040.4,350.7984,1224,Medica,Medical Assistance,545.904,44.6,,percent of total billed charges,,
Nm Lung Scan Perfusion,,78580,CPT,Facility,Inpatient,,,,1224,1040.4,350.7984,1224,Medica,Medical Assistance,,,,,Included in per diem rate,
Nm Lung Scan Perfusion,,78580,CPT,Facility,Outpatient,,,,1224,1040.4,350.7984,1224,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,609.552,49.8,,percent of total billed charges,,
Nm Lung Scan Perfusion,,78580,CPT,Facility,Inpatient,,,,1224,1040.4,350.7984,1224,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Nm Lung Scan Perfusion,,78580,CPT,Facility,Both,,,,1224,1040.4,350.7984,1224,"Multiplan, Inc.","Multiplan, Inc.",1150.56,94,,percent of total billed charges,,
Nm Lung Scan Perfusion,,78580,CPT,Facility,Outpatient,,,,1224,1040.4,350.7984,1224,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1102.824,90.1,,percent of total billed charges,,
Nm Lung Scan Perfusion,,78580,CPT,Facility,Inpatient,,,,1224,1040.4,350.7984,1224,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Nm Lung Scan Perfusion,,78580,CPT,Facility,Both,,,,1224,1040.4,350.7984,1224,"Preferred One Administrative Services, INC.",PPO,1206.864,98.6,,percent of total billed charges,,
Nm Lung Scan Perfusion,,78580,CPT,Facility,Outpatient,,,,1224,1040.4,350.7984,1224,PrimeWest Health,Minnesota Senior Health Options (MSHO),629.748,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Nm Lung Scan Perfusion,,78580,CPT,Facility,Inpatient,,,,1224,1040.4,350.7984,1224,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Nm Lung Scan Perfusion,,78580,CPT,Facility,Outpatient,,,,1224,1040.4,350.7984,1224,PrimeWest Health,MinnesotaCare,628.6464,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Nm Lung Scan Perfusion,,78580,CPT,Facility,Inpatient,,,,1224,1040.4,350.7984,1224,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Nm Lung Scan Perfusion,,78580,CPT,Facility,Both,,,,1224,1040.4,350.7984,1224,Sanford Health Plan,Sanford Health Plan,1126.08,92,,percent of total billed charges,,
Nm Lung Scan Perfusion,,78580,CPT,Facility,Outpatient,,,,1224,1040.4,350.7984,1224,"UCare Health, Inc.",Individual & Family Plan,689.724,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Nm Lung Scan Perfusion,,78580,CPT,Facility,Inpatient,,,,1224,1040.4,350.7984,1224,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Nm Lung Scan Perfusion,,78580,CPT,Facility,Outpatient,,,,1224,1040.4,350.7984,1224,"UCare Health, Inc.",Medical Assistance,617.7528,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Nm Lung Scan Perfusion,,78580,CPT,Facility,Inpatient,,,,1224,1040.4,350.7984,1224,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Nm Lung Scan Perfusion,,78580,CPT,Facility,Outpatient,,,,1224,1040.4,350.7984,1224,"UCare Health, Inc.",Medicare Advantage,617.7528,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Nm Lung Scan Perfusion,,78580,CPT,Facility,Inpatient,,,,1224,1040.4,350.7984,1224,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Nm Lung Scan Perfusion,,78580,CPT,Facility,Outpatient,,,,1224,1040.4,350.7984,1224,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),617.7528,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Nm Lung Scan Perfusion,,78580,CPT,Facility,Inpatient,,,,1224,1040.4,350.7984,1224,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Nm Lung Scan Perfusion,,78580,CPT,Facility,Both,,,,1224,1040.4,350.7984,1224,UnitedHealthcare,Individual & Family,1150.56,94,,percent of total billed charges,,
Nm Lung Scan Perfusion,,78580,CPT,Facility,Outpatient,,,,1224,1040.4,350.7984,1224,UnitedHealthcare,Medicare Advantage,599.76,49,,percent of total billed charges,,
Nm Lung Scan Perfusion,,78580,CPT,Facility,Inpatient,,,,1224,1040.4,350.7984,1224,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Nm Lung Scan Perfusion,,78580,CPT,Facility,Outpatient,,,,1224,1040.4,350.7984,1224,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,587.52,48,,percent of total billed charges,,100% of DHS outpatient percentage
Nm Lung Scan Perfusion,,78580,CPT,Facility,Inpatient,,,,1224,1040.4,350.7984,1224,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Nm Lung Scan Vent And Perf,,78582,CPT,Facility,Both,,,,1428,1213.8,409.2648,1428,Aetna,Commercial,1313.76,92,,percent of total billed charges,,
Nm Lung Scan Vent And Perf,,78582,CPT,Facility,Outpatient,,,,1428,1213.8,409.2648,1428,Aetna,Medicare Advantage,699.72,49,,percent of total billed charges,,
Nm Lung Scan Vent And Perf,,78582,CPT,Facility,Inpatient,,,,1428,1213.8,409.2648,1428,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Nm Lung Scan Vent And Perf,,78582,CPT,Facility,Both,,,,1428,1213.8,409.2648,1428,Aetna,PPO,1328.04,93,,percent of total billed charges,,
Nm Lung Scan Vent And Perf,,78582,CPT,Facility,Both,,,,1428,1213.8,409.2648,1428,America's PPO,America's PPO,1371.3084,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Nm Lung Scan Vent And Perf,,78582,CPT,Facility,Both,,,,1428,1213.8,409.2648,1428,BlueCross BlueShield Minnesota, Federal Employee Program,1405.152,98.4,,percent of total billed charges,,
Nm Lung Scan Vent And Perf,,78582,CPT,Facility,Both,,,,1428,1213.8,409.2648,1428,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1428,100,,percent of total billed charges,,
Nm Lung Scan Vent And Perf,,78582,CPT,Facility,Both,,,,1428,1213.8,409.2648,1428,BlueCross BlueShield Minnesota,High Value Network Plan,1285.2,90,,percent of total billed charges,,
Nm Lung Scan Vent And Perf,,78582,CPT,Facility,Outpatient,,,,1428,1213.8,409.2648,1428,BlueCross BlueShield Minnesota,Medicare Advantage,699.72,49,,percent of total billed charges,,
Nm Lung Scan Vent And Perf,,78582,CPT,Facility,Inpatient,,,,1428,1213.8,409.2648,1428,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Nm Lung Scan Vent And Perf,,78582,CPT,Facility,Both,,,,1428,1213.8,409.2648,1428,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1264.7796,88.57,,percent of total billed charges,,
Nm Lung Scan Vent And Perf,,78582,CPT,Facility,Both,,,,1428,1213.8,409.2648,1428,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,409.2648,28.66,,percent of total billed charges,,
Nm Lung Scan Vent And Perf,,78582,CPT,Facility,Outpatient,,,,1428,1213.8,409.2648,1428,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),699.72,49,,percent of total billed charges,,
Nm Lung Scan Vent And Perf,,78582,CPT,Facility,Inpatient,,,,1428,1213.8,409.2648,1428,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Nm Lung Scan Vent And Perf,,78582,CPT,Facility,Both,,,,1428,1213.8,409.2648,1428,CorVel,Worker's Compensation,1428,100,,percent of total billed charges,,
Nm Lung Scan Vent And Perf,,78582,CPT,Facility,Both,,,,1428,1213.8,409.2648,1428,First Health Group Corporation,First Health Network,1385.16,97,,percent of total billed charges,,
Nm Lung Scan Vent And Perf,,78582,CPT,Facility,Both,,,,1428,1213.8,409.2648,1428,"Health Partners, Inc.",Commercial,1350.888,94.6,,percent of total billed charges,,
Nm Lung Scan Vent And Perf,,78582,CPT,Facility,Outpatient,,,,1428,1213.8,409.2648,1428,"Health Partners, Inc.",Medicare Advantage,699.72,49,,percent of total billed charges,,
Nm Lung Scan Vent And Perf,,78582,CPT,Facility,Inpatient,,,,1428,1213.8,409.2648,1428,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Nm Lung Scan Vent And Perf,,78582,CPT,Facility,Both,,,,1428,1213.8,409.2648,1428,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),856.8,60,,percent of total billed charges,,
Nm Lung Scan Vent And Perf,,78582,CPT,Facility,Both,,,,1428,1213.8,409.2648,1428,"Health Partners, Inc.",State of Minnesota Advantage Program,1163.82,81.5,,percent of total billed charges,,
Nm Lung Scan Vent And Perf,,78582,CPT,Facility,Both,,,,1428,1213.8,409.2648,1428,"Health Partners, Inc.",State Public Programs,714,50,,percent of total billed charges,,
Nm Lung Scan Vent And Perf,,78582,CPT,Facility,Both,,,,1428,1213.8,409.2648,1428,Humana Insurance Company,Commercial PPO,1356.6,95,,percent of total billed charges,,
Nm Lung Scan Vent And Perf,,78582,CPT,Facility,Outpatient,,,,1428,1213.8,409.2648,1428,Humana Insurance Company,Medicare PPO,699.72,49,,percent of total billed charges,,
Nm Lung Scan Vent And Perf,,78582,CPT,Facility,Inpatient,,,,1428,1213.8,409.2648,1428,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Nm Lung Scan Vent And Perf,,78582,CPT,Facility,Both,,,,1428,1213.8,409.2648,1428,Medica,Individual & Family,1415.148,99.1,,percent of total billed charges,,
Nm Lung Scan Vent And Perf,,78582,CPT,Facility,Outpatient,,,,1428,1213.8,409.2648,1428,Medica,Medica Advantage Solution,711.144,49.8,,percent of total billed charges,,
Nm Lung Scan Vent And Perf,,78582,CPT,Facility,Inpatient,,,,1428,1213.8,409.2648,1428,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Nm Lung Scan Vent And Perf,,78582,CPT,Facility,Outpatient,,,,1428,1213.8,409.2648,1428,Medica,Medical Assistance,636.888,44.6,,percent of total billed charges,,
Nm Lung Scan Vent And Perf,,78582,CPT,Facility,Inpatient,,,,1428,1213.8,409.2648,1428,Medica,Medical Assistance,,,,,Included in per diem rate,
Nm Lung Scan Vent And Perf,,78582,CPT,Facility,Outpatient,,,,1428,1213.8,409.2648,1428,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,711.144,49.8,,percent of total billed charges,,
Nm Lung Scan Vent And Perf,,78582,CPT,Facility,Inpatient,,,,1428,1213.8,409.2648,1428,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Nm Lung Scan Vent And Perf,,78582,CPT,Facility,Both,,,,1428,1213.8,409.2648,1428,"Multiplan, Inc.","Multiplan, Inc.",1342.32,94,,percent of total billed charges,,
Nm Lung Scan Vent And Perf,,78582,CPT,Facility,Outpatient,,,,1428,1213.8,409.2648,1428,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1286.628,90.1,,percent of total billed charges,,
Nm Lung Scan Vent And Perf,,78582,CPT,Facility,Inpatient,,,,1428,1213.8,409.2648,1428,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Nm Lung Scan Vent And Perf,,78582,CPT,Facility,Both,,,,1428,1213.8,409.2648,1428,"Preferred One Administrative Services, INC.",PPO,1408.008,98.6,,percent of total billed charges,,
Nm Lung Scan Vent And Perf,,78582,CPT,Facility,Outpatient,,,,1428,1213.8,409.2648,1428,PrimeWest Health,Minnesota Senior Health Options (MSHO),734.706,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Nm Lung Scan Vent And Perf,,78582,CPT,Facility,Inpatient,,,,1428,1213.8,409.2648,1428,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Nm Lung Scan Vent And Perf,,78582,CPT,Facility,Outpatient,,,,1428,1213.8,409.2648,1428,PrimeWest Health,MinnesotaCare,733.4208,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Nm Lung Scan Vent And Perf,,78582,CPT,Facility,Inpatient,,,,1428,1213.8,409.2648,1428,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Nm Lung Scan Vent And Perf,,78582,CPT,Facility,Both,,,,1428,1213.8,409.2648,1428,Sanford Health Plan,Sanford Health Plan,1313.76,92,,percent of total billed charges,,
Nm Lung Scan Vent And Perf,,78582,CPT,Facility,Outpatient,,,,1428,1213.8,409.2648,1428,"UCare Health, Inc.",Individual & Family Plan,804.678,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Nm Lung Scan Vent And Perf,,78582,CPT,Facility,Inpatient,,,,1428,1213.8,409.2648,1428,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Nm Lung Scan Vent And Perf,,78582,CPT,Facility,Outpatient,,,,1428,1213.8,409.2648,1428,"UCare Health, Inc.",Medical Assistance,720.7116,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Nm Lung Scan Vent And Perf,,78582,CPT,Facility,Inpatient,,,,1428,1213.8,409.2648,1428,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Nm Lung Scan Vent And Perf,,78582,CPT,Facility,Outpatient,,,,1428,1213.8,409.2648,1428,"UCare Health, Inc.",Medicare Advantage,720.7116,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Nm Lung Scan Vent And Perf,,78582,CPT,Facility,Inpatient,,,,1428,1213.8,409.2648,1428,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Nm Lung Scan Vent And Perf,,78582,CPT,Facility,Outpatient,,,,1428,1213.8,409.2648,1428,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),720.7116,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Nm Lung Scan Vent And Perf,,78582,CPT,Facility,Inpatient,,,,1428,1213.8,409.2648,1428,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Nm Lung Scan Vent And Perf,,78582,CPT,Facility,Both,,,,1428,1213.8,409.2648,1428,UnitedHealthcare,Individual & Family,1342.32,94,,percent of total billed charges,,
Nm Lung Scan Vent And Perf,,78582,CPT,Facility,Outpatient,,,,1428,1213.8,409.2648,1428,UnitedHealthcare,Medicare Advantage,699.72,49,,percent of total billed charges,,
Nm Lung Scan Vent And Perf,,78582,CPT,Facility,Inpatient,,,,1428,1213.8,409.2648,1428,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Nm Lung Scan Vent And Perf,,78582,CPT,Facility,Outpatient,,,,1428,1213.8,409.2648,1428,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,685.44,48,,percent of total billed charges,,100% of DHS outpatient percentage
Nm Lung Scan Vent And Perf,,78582,CPT,Facility,Inpatient,,,,1428,1213.8,409.2648,1428,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Nm Kidney Dmsa Planar,,78700,CPT,Facility,Both,,,,1122,953.7,321.5652,1122,Aetna,Commercial,1032.24,92,,percent of total billed charges,,
Nm Kidney Dmsa Planar,,78700,CPT,Facility,Outpatient,,,,1122,953.7,321.5652,1122,Aetna,Medicare Advantage,549.78,49,,percent of total billed charges,,
Nm Kidney Dmsa Planar,,78700,CPT,Facility,Inpatient,,,,1122,953.7,321.5652,1122,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Nm Kidney Dmsa Planar,,78700,CPT,Facility,Both,,,,1122,953.7,321.5652,1122,Aetna,PPO,1043.46,93,,percent of total billed charges,,
Nm Kidney Dmsa Planar,,78700,CPT,Facility,Both,,,,1122,953.7,321.5652,1122,America's PPO,America's PPO,1077.4566,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Nm Kidney Dmsa Planar,,78700,CPT,Facility,Both,,,,1122,953.7,321.5652,1122,BlueCross BlueShield Minnesota, Federal Employee Program,1104.048,98.4,,percent of total billed charges,,
Nm Kidney Dmsa Planar,,78700,CPT,Facility,Both,,,,1122,953.7,321.5652,1122,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1122,100,,percent of total billed charges,,
Nm Kidney Dmsa Planar,,78700,CPT,Facility,Both,,,,1122,953.7,321.5652,1122,BlueCross BlueShield Minnesota,High Value Network Plan,1009.8,90,,percent of total billed charges,,
Nm Kidney Dmsa Planar,,78700,CPT,Facility,Outpatient,,,,1122,953.7,321.5652,1122,BlueCross BlueShield Minnesota,Medicare Advantage,549.78,49,,percent of total billed charges,,
Nm Kidney Dmsa Planar,,78700,CPT,Facility,Inpatient,,,,1122,953.7,321.5652,1122,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Nm Kidney Dmsa Planar,,78700,CPT,Facility,Both,,,,1122,953.7,321.5652,1122,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,993.7554,88.57,,percent of total billed charges,,
Nm Kidney Dmsa Planar,,78700,CPT,Facility,Both,,,,1122,953.7,321.5652,1122,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,321.5652,28.66,,percent of total billed charges,,
Nm Kidney Dmsa Planar,,78700,CPT,Facility,Outpatient,,,,1122,953.7,321.5652,1122,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),549.78,49,,percent of total billed charges,,
Nm Kidney Dmsa Planar,,78700,CPT,Facility,Inpatient,,,,1122,953.7,321.5652,1122,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Nm Kidney Dmsa Planar,,78700,CPT,Facility,Both,,,,1122,953.7,321.5652,1122,CorVel,Worker's Compensation,1122,100,,percent of total billed charges,,
Nm Kidney Dmsa Planar,,78700,CPT,Facility,Both,,,,1122,953.7,321.5652,1122,First Health Group Corporation,First Health Network,1088.34,97,,percent of total billed charges,,
Nm Kidney Dmsa Planar,,78700,CPT,Facility,Both,,,,1122,953.7,321.5652,1122,"Health Partners, Inc.",Commercial,1061.412,94.6,,percent of total billed charges,,
Nm Kidney Dmsa Planar,,78700,CPT,Facility,Outpatient,,,,1122,953.7,321.5652,1122,"Health Partners, Inc.",Medicare Advantage,549.78,49,,percent of total billed charges,,
Nm Kidney Dmsa Planar,,78700,CPT,Facility,Inpatient,,,,1122,953.7,321.5652,1122,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Nm Kidney Dmsa Planar,,78700,CPT,Facility,Both,,,,1122,953.7,321.5652,1122,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),673.2,60,,percent of total billed charges,,
Nm Kidney Dmsa Planar,,78700,CPT,Facility,Both,,,,1122,953.7,321.5652,1122,"Health Partners, Inc.",State of Minnesota Advantage Program,914.43,81.5,,percent of total billed charges,,
Nm Kidney Dmsa Planar,,78700,CPT,Facility,Both,,,,1122,953.7,321.5652,1122,"Health Partners, Inc.",State Public Programs,561,50,,percent of total billed charges,,
Nm Kidney Dmsa Planar,,78700,CPT,Facility,Both,,,,1122,953.7,321.5652,1122,Humana Insurance Company,Commercial PPO,1065.9,95,,percent of total billed charges,,
Nm Kidney Dmsa Planar,,78700,CPT,Facility,Outpatient,,,,1122,953.7,321.5652,1122,Humana Insurance Company,Medicare PPO,549.78,49,,percent of total billed charges,,
Nm Kidney Dmsa Planar,,78700,CPT,Facility,Inpatient,,,,1122,953.7,321.5652,1122,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Nm Kidney Dmsa Planar,,78700,CPT,Facility,Both,,,,1122,953.7,321.5652,1122,Medica,Individual & Family,1111.902,99.1,,percent of total billed charges,,
Nm Kidney Dmsa Planar,,78700,CPT,Facility,Outpatient,,,,1122,953.7,321.5652,1122,Medica,Medica Advantage Solution,558.756,49.8,,percent of total billed charges,,
Nm Kidney Dmsa Planar,,78700,CPT,Facility,Inpatient,,,,1122,953.7,321.5652,1122,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Nm Kidney Dmsa Planar,,78700,CPT,Facility,Outpatient,,,,1122,953.7,321.5652,1122,Medica,Medical Assistance,500.412,44.6,,percent of total billed charges,,
Nm Kidney Dmsa Planar,,78700,CPT,Facility,Inpatient,,,,1122,953.7,321.5652,1122,Medica,Medical Assistance,,,,,Included in per diem rate,
Nm Kidney Dmsa Planar,,78700,CPT,Facility,Outpatient,,,,1122,953.7,321.5652,1122,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,558.756,49.8,,percent of total billed charges,,
Nm Kidney Dmsa Planar,,78700,CPT,Facility,Inpatient,,,,1122,953.7,321.5652,1122,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Nm Kidney Dmsa Planar,,78700,CPT,Facility,Both,,,,1122,953.7,321.5652,1122,"Multiplan, Inc.","Multiplan, Inc.",1054.68,94,,percent of total billed charges,,
Nm Kidney Dmsa Planar,,78700,CPT,Facility,Outpatient,,,,1122,953.7,321.5652,1122,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1010.922,90.1,,percent of total billed charges,,
Nm Kidney Dmsa Planar,,78700,CPT,Facility,Inpatient,,,,1122,953.7,321.5652,1122,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Nm Kidney Dmsa Planar,,78700,CPT,Facility,Both,,,,1122,953.7,321.5652,1122,"Preferred One Administrative Services, INC.",PPO,1106.292,98.6,,percent of total billed charges,,
Nm Kidney Dmsa Planar,,78700,CPT,Facility,Outpatient,,,,1122,953.7,321.5652,1122,PrimeWest Health,Minnesota Senior Health Options (MSHO),577.269,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Nm Kidney Dmsa Planar,,78700,CPT,Facility,Inpatient,,,,1122,953.7,321.5652,1122,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Nm Kidney Dmsa Planar,,78700,CPT,Facility,Outpatient,,,,1122,953.7,321.5652,1122,PrimeWest Health,MinnesotaCare,576.2592,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Nm Kidney Dmsa Planar,,78700,CPT,Facility,Inpatient,,,,1122,953.7,321.5652,1122,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Nm Kidney Dmsa Planar,,78700,CPT,Facility,Both,,,,1122,953.7,321.5652,1122,Sanford Health Plan,Sanford Health Plan,1032.24,92,,percent of total billed charges,,
Nm Kidney Dmsa Planar,,78700,CPT,Facility,Outpatient,,,,1122,953.7,321.5652,1122,"UCare Health, Inc.",Individual & Family Plan,632.247,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Nm Kidney Dmsa Planar,,78700,CPT,Facility,Inpatient,,,,1122,953.7,321.5652,1122,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Nm Kidney Dmsa Planar,,78700,CPT,Facility,Outpatient,,,,1122,953.7,321.5652,1122,"UCare Health, Inc.",Medical Assistance,566.2734,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Nm Kidney Dmsa Planar,,78700,CPT,Facility,Inpatient,,,,1122,953.7,321.5652,1122,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Nm Kidney Dmsa Planar,,78700,CPT,Facility,Outpatient,,,,1122,953.7,321.5652,1122,"UCare Health, Inc.",Medicare Advantage,566.2734,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Nm Kidney Dmsa Planar,,78700,CPT,Facility,Inpatient,,,,1122,953.7,321.5652,1122,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Nm Kidney Dmsa Planar,,78700,CPT,Facility,Outpatient,,,,1122,953.7,321.5652,1122,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),566.2734,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Nm Kidney Dmsa Planar,,78700,CPT,Facility,Inpatient,,,,1122,953.7,321.5652,1122,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Nm Kidney Dmsa Planar,,78700,CPT,Facility,Both,,,,1122,953.7,321.5652,1122,UnitedHealthcare,Individual & Family,1054.68,94,,percent of total billed charges,,
Nm Kidney Dmsa Planar,,78700,CPT,Facility,Outpatient,,,,1122,953.7,321.5652,1122,UnitedHealthcare,Medicare Advantage,549.78,49,,percent of total billed charges,,
Nm Kidney Dmsa Planar,,78700,CPT,Facility,Inpatient,,,,1122,953.7,321.5652,1122,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Nm Kidney Dmsa Planar,,78700,CPT,Facility,Outpatient,,,,1122,953.7,321.5652,1122,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,538.56,48,,percent of total billed charges,,100% of DHS outpatient percentage
Nm Kidney Dmsa Planar,,78700,CPT,Facility,Inpatient,,,,1122,953.7,321.5652,1122,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Nm Kidney W Vascular Flow,,78701,CPT,Facility,Both,,,,1224,1040.4,350.7984,1224,Aetna,Commercial,1126.08,92,,percent of total billed charges,,
Nm Kidney W Vascular Flow,,78701,CPT,Facility,Outpatient,,,,1224,1040.4,350.7984,1224,Aetna,Medicare Advantage,599.76,49,,percent of total billed charges,,
Nm Kidney W Vascular Flow,,78701,CPT,Facility,Inpatient,,,,1224,1040.4,350.7984,1224,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Nm Kidney W Vascular Flow,,78701,CPT,Facility,Both,,,,1224,1040.4,350.7984,1224,Aetna,PPO,1138.32,93,,percent of total billed charges,,
Nm Kidney W Vascular Flow,,78701,CPT,Facility,Both,,,,1224,1040.4,350.7984,1224,America's PPO,America's PPO,1175.4072,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Nm Kidney W Vascular Flow,,78701,CPT,Facility,Both,,,,1224,1040.4,350.7984,1224,BlueCross BlueShield Minnesota, Federal Employee Program,1204.416,98.4,,percent of total billed charges,,
Nm Kidney W Vascular Flow,,78701,CPT,Facility,Both,,,,1224,1040.4,350.7984,1224,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1224,100,,percent of total billed charges,,
Nm Kidney W Vascular Flow,,78701,CPT,Facility,Both,,,,1224,1040.4,350.7984,1224,BlueCross BlueShield Minnesota,High Value Network Plan,1101.6,90,,percent of total billed charges,,
Nm Kidney W Vascular Flow,,78701,CPT,Facility,Outpatient,,,,1224,1040.4,350.7984,1224,BlueCross BlueShield Minnesota,Medicare Advantage,599.76,49,,percent of total billed charges,,
Nm Kidney W Vascular Flow,,78701,CPT,Facility,Inpatient,,,,1224,1040.4,350.7984,1224,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Nm Kidney W Vascular Flow,,78701,CPT,Facility,Both,,,,1224,1040.4,350.7984,1224,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1084.0968,88.57,,percent of total billed charges,,
Nm Kidney W Vascular Flow,,78701,CPT,Facility,Both,,,,1224,1040.4,350.7984,1224,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,350.7984,28.66,,percent of total billed charges,,
Nm Kidney W Vascular Flow,,78701,CPT,Facility,Outpatient,,,,1224,1040.4,350.7984,1224,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),599.76,49,,percent of total billed charges,,
Nm Kidney W Vascular Flow,,78701,CPT,Facility,Inpatient,,,,1224,1040.4,350.7984,1224,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Nm Kidney W Vascular Flow,,78701,CPT,Facility,Both,,,,1224,1040.4,350.7984,1224,CorVel,Worker's Compensation,1224,100,,percent of total billed charges,,
Nm Kidney W Vascular Flow,,78701,CPT,Facility,Both,,,,1224,1040.4,350.7984,1224,First Health Group Corporation,First Health Network,1187.28,97,,percent of total billed charges,,
Nm Kidney W Vascular Flow,,78701,CPT,Facility,Both,,,,1224,1040.4,350.7984,1224,"Health Partners, Inc.",Commercial,1157.904,94.6,,percent of total billed charges,,
Nm Kidney W Vascular Flow,,78701,CPT,Facility,Outpatient,,,,1224,1040.4,350.7984,1224,"Health Partners, Inc.",Medicare Advantage,599.76,49,,percent of total billed charges,,
Nm Kidney W Vascular Flow,,78701,CPT,Facility,Inpatient,,,,1224,1040.4,350.7984,1224,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Nm Kidney W Vascular Flow,,78701,CPT,Facility,Both,,,,1224,1040.4,350.7984,1224,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),734.4,60,,percent of total billed charges,,
Nm Kidney W Vascular Flow,,78701,CPT,Facility,Both,,,,1224,1040.4,350.7984,1224,"Health Partners, Inc.",State of Minnesota Advantage Program,997.56,81.5,,percent of total billed charges,,
Nm Kidney W Vascular Flow,,78701,CPT,Facility,Both,,,,1224,1040.4,350.7984,1224,"Health Partners, Inc.",State Public Programs,612,50,,percent of total billed charges,,
Nm Kidney W Vascular Flow,,78701,CPT,Facility,Both,,,,1224,1040.4,350.7984,1224,Humana Insurance Company,Commercial PPO,1162.8,95,,percent of total billed charges,,
Nm Kidney W Vascular Flow,,78701,CPT,Facility,Outpatient,,,,1224,1040.4,350.7984,1224,Humana Insurance Company,Medicare PPO,599.76,49,,percent of total billed charges,,
Nm Kidney W Vascular Flow,,78701,CPT,Facility,Inpatient,,,,1224,1040.4,350.7984,1224,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Nm Kidney W Vascular Flow,,78701,CPT,Facility,Both,,,,1224,1040.4,350.7984,1224,Medica,Individual & Family,1212.984,99.1,,percent of total billed charges,,
Nm Kidney W Vascular Flow,,78701,CPT,Facility,Outpatient,,,,1224,1040.4,350.7984,1224,Medica,Medica Advantage Solution,609.552,49.8,,percent of total billed charges,,
Nm Kidney W Vascular Flow,,78701,CPT,Facility,Inpatient,,,,1224,1040.4,350.7984,1224,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Nm Kidney W Vascular Flow,,78701,CPT,Facility,Outpatient,,,,1224,1040.4,350.7984,1224,Medica,Medical Assistance,545.904,44.6,,percent of total billed charges,,
Nm Kidney W Vascular Flow,,78701,CPT,Facility,Inpatient,,,,1224,1040.4,350.7984,1224,Medica,Medical Assistance,,,,,Included in per diem rate,
Nm Kidney W Vascular Flow,,78701,CPT,Facility,Outpatient,,,,1224,1040.4,350.7984,1224,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,609.552,49.8,,percent of total billed charges,,
Nm Kidney W Vascular Flow,,78701,CPT,Facility,Inpatient,,,,1224,1040.4,350.7984,1224,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Nm Kidney W Vascular Flow,,78701,CPT,Facility,Both,,,,1224,1040.4,350.7984,1224,"Multiplan, Inc.","Multiplan, Inc.",1150.56,94,,percent of total billed charges,,
Nm Kidney W Vascular Flow,,78701,CPT,Facility,Outpatient,,,,1224,1040.4,350.7984,1224,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1102.824,90.1,,percent of total billed charges,,
Nm Kidney W Vascular Flow,,78701,CPT,Facility,Inpatient,,,,1224,1040.4,350.7984,1224,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Nm Kidney W Vascular Flow,,78701,CPT,Facility,Both,,,,1224,1040.4,350.7984,1224,"Preferred One Administrative Services, INC.",PPO,1206.864,98.6,,percent of total billed charges,,
Nm Kidney W Vascular Flow,,78701,CPT,Facility,Outpatient,,,,1224,1040.4,350.7984,1224,PrimeWest Health,Minnesota Senior Health Options (MSHO),629.748,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Nm Kidney W Vascular Flow,,78701,CPT,Facility,Inpatient,,,,1224,1040.4,350.7984,1224,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Nm Kidney W Vascular Flow,,78701,CPT,Facility,Outpatient,,,,1224,1040.4,350.7984,1224,PrimeWest Health,MinnesotaCare,628.6464,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Nm Kidney W Vascular Flow,,78701,CPT,Facility,Inpatient,,,,1224,1040.4,350.7984,1224,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Nm Kidney W Vascular Flow,,78701,CPT,Facility,Both,,,,1224,1040.4,350.7984,1224,Sanford Health Plan,Sanford Health Plan,1126.08,92,,percent of total billed charges,,
Nm Kidney W Vascular Flow,,78701,CPT,Facility,Outpatient,,,,1224,1040.4,350.7984,1224,"UCare Health, Inc.",Individual & Family Plan,689.724,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Nm Kidney W Vascular Flow,,78701,CPT,Facility,Inpatient,,,,1224,1040.4,350.7984,1224,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Nm Kidney W Vascular Flow,,78701,CPT,Facility,Outpatient,,,,1224,1040.4,350.7984,1224,"UCare Health, Inc.",Medical Assistance,617.7528,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Nm Kidney W Vascular Flow,,78701,CPT,Facility,Inpatient,,,,1224,1040.4,350.7984,1224,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Nm Kidney W Vascular Flow,,78701,CPT,Facility,Outpatient,,,,1224,1040.4,350.7984,1224,"UCare Health, Inc.",Medicare Advantage,617.7528,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Nm Kidney W Vascular Flow,,78701,CPT,Facility,Inpatient,,,,1224,1040.4,350.7984,1224,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Nm Kidney W Vascular Flow,,78701,CPT,Facility,Outpatient,,,,1224,1040.4,350.7984,1224,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),617.7528,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Nm Kidney W Vascular Flow,,78701,CPT,Facility,Inpatient,,,,1224,1040.4,350.7984,1224,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Nm Kidney W Vascular Flow,,78701,CPT,Facility,Both,,,,1224,1040.4,350.7984,1224,UnitedHealthcare,Individual & Family,1150.56,94,,percent of total billed charges,,
Nm Kidney W Vascular Flow,,78701,CPT,Facility,Outpatient,,,,1224,1040.4,350.7984,1224,UnitedHealthcare,Medicare Advantage,599.76,49,,percent of total billed charges,,
Nm Kidney W Vascular Flow,,78701,CPT,Facility,Inpatient,,,,1224,1040.4,350.7984,1224,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Nm Kidney W Vascular Flow,,78701,CPT,Facility,Outpatient,,,,1224,1040.4,350.7984,1224,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,587.52,48,,percent of total billed charges,,100% of DHS outpatient percentage
Nm Kidney W Vascular Flow,,78701,CPT,Facility,Inpatient,,,,1224,1040.4,350.7984,1224,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Nm Renogram Mag 3,,78707,CPT,Facility,Both,,,,1326,1127.1,380.0316,1326,Aetna,Commercial,1219.92,92,,percent of total billed charges,,
Nm Renogram Mag 3,,78707,CPT,Facility,Outpatient,,,,1326,1127.1,380.0316,1326,Aetna,Medicare Advantage,649.74,49,,percent of total billed charges,,
Nm Renogram Mag 3,,78707,CPT,Facility,Inpatient,,,,1326,1127.1,380.0316,1326,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Nm Renogram Mag 3,,78707,CPT,Facility,Both,,,,1326,1127.1,380.0316,1326,Aetna,PPO,1233.18,93,,percent of total billed charges,,
Nm Renogram Mag 3,,78707,CPT,Facility,Both,,,,1326,1127.1,380.0316,1326,America's PPO,America's PPO,1273.3578,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Nm Renogram Mag 3,,78707,CPT,Facility,Both,,,,1326,1127.1,380.0316,1326,BlueCross BlueShield Minnesota, Federal Employee Program,1304.784,98.4,,percent of total billed charges,,
Nm Renogram Mag 3,,78707,CPT,Facility,Both,,,,1326,1127.1,380.0316,1326,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1326,100,,percent of total billed charges,,
Nm Renogram Mag 3,,78707,CPT,Facility,Both,,,,1326,1127.1,380.0316,1326,BlueCross BlueShield Minnesota,High Value Network Plan,1193.4,90,,percent of total billed charges,,
Nm Renogram Mag 3,,78707,CPT,Facility,Outpatient,,,,1326,1127.1,380.0316,1326,BlueCross BlueShield Minnesota,Medicare Advantage,649.74,49,,percent of total billed charges,,
Nm Renogram Mag 3,,78707,CPT,Facility,Inpatient,,,,1326,1127.1,380.0316,1326,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Nm Renogram Mag 3,,78707,CPT,Facility,Both,,,,1326,1127.1,380.0316,1326,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1174.4382,88.57,,percent of total billed charges,,
Nm Renogram Mag 3,,78707,CPT,Facility,Both,,,,1326,1127.1,380.0316,1326,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,380.0316,28.66,,percent of total billed charges,,
Nm Renogram Mag 3,,78707,CPT,Facility,Outpatient,,,,1326,1127.1,380.0316,1326,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),649.74,49,,percent of total billed charges,,
Nm Renogram Mag 3,,78707,CPT,Facility,Inpatient,,,,1326,1127.1,380.0316,1326,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Nm Renogram Mag 3,,78707,CPT,Facility,Both,,,,1326,1127.1,380.0316,1326,CorVel,Worker's Compensation,1326,100,,percent of total billed charges,,
Nm Renogram Mag 3,,78707,CPT,Facility,Both,,,,1326,1127.1,380.0316,1326,First Health Group Corporation,First Health Network,1286.22,97,,percent of total billed charges,,
Nm Renogram Mag 3,,78707,CPT,Facility,Both,,,,1326,1127.1,380.0316,1326,"Health Partners, Inc.",Commercial,1254.396,94.6,,percent of total billed charges,,
Nm Renogram Mag 3,,78707,CPT,Facility,Outpatient,,,,1326,1127.1,380.0316,1326,"Health Partners, Inc.",Medicare Advantage,649.74,49,,percent of total billed charges,,
Nm Renogram Mag 3,,78707,CPT,Facility,Inpatient,,,,1326,1127.1,380.0316,1326,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Nm Renogram Mag 3,,78707,CPT,Facility,Both,,,,1326,1127.1,380.0316,1326,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),795.6,60,,percent of total billed charges,,
Nm Renogram Mag 3,,78707,CPT,Facility,Both,,,,1326,1127.1,380.0316,1326,"Health Partners, Inc.",State of Minnesota Advantage Program,1080.69,81.5,,percent of total billed charges,,
Nm Renogram Mag 3,,78707,CPT,Facility,Both,,,,1326,1127.1,380.0316,1326,"Health Partners, Inc.",State Public Programs,663,50,,percent of total billed charges,,
Nm Renogram Mag 3,,78707,CPT,Facility,Both,,,,1326,1127.1,380.0316,1326,Humana Insurance Company,Commercial PPO,1259.7,95,,percent of total billed charges,,
Nm Renogram Mag 3,,78707,CPT,Facility,Outpatient,,,,1326,1127.1,380.0316,1326,Humana Insurance Company,Medicare PPO,649.74,49,,percent of total billed charges,,
Nm Renogram Mag 3,,78707,CPT,Facility,Inpatient,,,,1326,1127.1,380.0316,1326,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Nm Renogram Mag 3,,78707,CPT,Facility,Both,,,,1326,1127.1,380.0316,1326,Medica,Individual & Family,1314.066,99.1,,percent of total billed charges,,
Nm Renogram Mag 3,,78707,CPT,Facility,Outpatient,,,,1326,1127.1,380.0316,1326,Medica,Medica Advantage Solution,660.348,49.8,,percent of total billed charges,,
Nm Renogram Mag 3,,78707,CPT,Facility,Inpatient,,,,1326,1127.1,380.0316,1326,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Nm Renogram Mag 3,,78707,CPT,Facility,Outpatient,,,,1326,1127.1,380.0316,1326,Medica,Medical Assistance,591.396,44.6,,percent of total billed charges,,
Nm Renogram Mag 3,,78707,CPT,Facility,Inpatient,,,,1326,1127.1,380.0316,1326,Medica,Medical Assistance,,,,,Included in per diem rate,
Nm Renogram Mag 3,,78707,CPT,Facility,Outpatient,,,,1326,1127.1,380.0316,1326,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,660.348,49.8,,percent of total billed charges,,
Nm Renogram Mag 3,,78707,CPT,Facility,Inpatient,,,,1326,1127.1,380.0316,1326,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Nm Renogram Mag 3,,78707,CPT,Facility,Both,,,,1326,1127.1,380.0316,1326,"Multiplan, Inc.","Multiplan, Inc.",1246.44,94,,percent of total billed charges,,
Nm Renogram Mag 3,,78707,CPT,Facility,Outpatient,,,,1326,1127.1,380.0316,1326,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1194.726,90.1,,percent of total billed charges,,
Nm Renogram Mag 3,,78707,CPT,Facility,Inpatient,,,,1326,1127.1,380.0316,1326,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Nm Renogram Mag 3,,78707,CPT,Facility,Both,,,,1326,1127.1,380.0316,1326,"Preferred One Administrative Services, INC.",PPO,1307.436,98.6,,percent of total billed charges,,
Nm Renogram Mag 3,,78707,CPT,Facility,Outpatient,,,,1326,1127.1,380.0316,1326,PrimeWest Health,Minnesota Senior Health Options (MSHO),682.227,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Nm Renogram Mag 3,,78707,CPT,Facility,Inpatient,,,,1326,1127.1,380.0316,1326,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Nm Renogram Mag 3,,78707,CPT,Facility,Outpatient,,,,1326,1127.1,380.0316,1326,PrimeWest Health,MinnesotaCare,681.0336,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Nm Renogram Mag 3,,78707,CPT,Facility,Inpatient,,,,1326,1127.1,380.0316,1326,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Nm Renogram Mag 3,,78707,CPT,Facility,Both,,,,1326,1127.1,380.0316,1326,Sanford Health Plan,Sanford Health Plan,1219.92,92,,percent of total billed charges,,
Nm Renogram Mag 3,,78707,CPT,Facility,Outpatient,,,,1326,1127.1,380.0316,1326,"UCare Health, Inc.",Individual & Family Plan,747.201,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Nm Renogram Mag 3,,78707,CPT,Facility,Inpatient,,,,1326,1127.1,380.0316,1326,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Nm Renogram Mag 3,,78707,CPT,Facility,Outpatient,,,,1326,1127.1,380.0316,1326,"UCare Health, Inc.",Medical Assistance,669.2322,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Nm Renogram Mag 3,,78707,CPT,Facility,Inpatient,,,,1326,1127.1,380.0316,1326,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Nm Renogram Mag 3,,78707,CPT,Facility,Outpatient,,,,1326,1127.1,380.0316,1326,"UCare Health, Inc.",Medicare Advantage,669.2322,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Nm Renogram Mag 3,,78707,CPT,Facility,Inpatient,,,,1326,1127.1,380.0316,1326,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Nm Renogram Mag 3,,78707,CPT,Facility,Outpatient,,,,1326,1127.1,380.0316,1326,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),669.2322,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Nm Renogram Mag 3,,78707,CPT,Facility,Inpatient,,,,1326,1127.1,380.0316,1326,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Nm Renogram Mag 3,,78707,CPT,Facility,Both,,,,1326,1127.1,380.0316,1326,UnitedHealthcare,Individual & Family,1246.44,94,,percent of total billed charges,,
Nm Renogram Mag 3,,78707,CPT,Facility,Outpatient,,,,1326,1127.1,380.0316,1326,UnitedHealthcare,Medicare Advantage,649.74,49,,percent of total billed charges,,
Nm Renogram Mag 3,,78707,CPT,Facility,Inpatient,,,,1326,1127.1,380.0316,1326,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Nm Renogram Mag 3,,78707,CPT,Facility,Outpatient,,,,1326,1127.1,380.0316,1326,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,636.48,48,,percent of total billed charges,,100% of DHS outpatient percentage
Nm Renogram Mag 3,,78707,CPT,Facility,Inpatient,,,,1326,1127.1,380.0316,1326,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Nm Renogram Mag 3 W Lasix,,78708,CPT,Facility,Both,,,,1530,1300.5,438.498,1530,Aetna,Commercial,1407.6,92,,percent of total billed charges,,
Nm Renogram Mag 3 W Lasix,,78708,CPT,Facility,Outpatient,,,,1530,1300.5,438.498,1530,Aetna,Medicare Advantage,749.7,49,,percent of total billed charges,,
Nm Renogram Mag 3 W Lasix,,78708,CPT,Facility,Inpatient,,,,1530,1300.5,438.498,1530,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Nm Renogram Mag 3 W Lasix,,78708,CPT,Facility,Both,,,,1530,1300.5,438.498,1530,Aetna,PPO,1422.9,93,,percent of total billed charges,,
Nm Renogram Mag 3 W Lasix,,78708,CPT,Facility,Both,,,,1530,1300.5,438.498,1530,America's PPO,America's PPO,1469.259,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Nm Renogram Mag 3 W Lasix,,78708,CPT,Facility,Both,,,,1530,1300.5,438.498,1530,BlueCross BlueShield Minnesota, Federal Employee Program,1505.52,98.4,,percent of total billed charges,,
Nm Renogram Mag 3 W Lasix,,78708,CPT,Facility,Both,,,,1530,1300.5,438.498,1530,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1530,100,,percent of total billed charges,,
Nm Renogram Mag 3 W Lasix,,78708,CPT,Facility,Both,,,,1530,1300.5,438.498,1530,BlueCross BlueShield Minnesota,High Value Network Plan,1377,90,,percent of total billed charges,,
Nm Renogram Mag 3 W Lasix,,78708,CPT,Facility,Outpatient,,,,1530,1300.5,438.498,1530,BlueCross BlueShield Minnesota,Medicare Advantage,749.7,49,,percent of total billed charges,,
Nm Renogram Mag 3 W Lasix,,78708,CPT,Facility,Inpatient,,,,1530,1300.5,438.498,1530,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Nm Renogram Mag 3 W Lasix,,78708,CPT,Facility,Both,,,,1530,1300.5,438.498,1530,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1355.121,88.57,,percent of total billed charges,,
Nm Renogram Mag 3 W Lasix,,78708,CPT,Facility,Both,,,,1530,1300.5,438.498,1530,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,438.498,28.66,,percent of total billed charges,,
Nm Renogram Mag 3 W Lasix,,78708,CPT,Facility,Outpatient,,,,1530,1300.5,438.498,1530,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),749.7,49,,percent of total billed charges,,
Nm Renogram Mag 3 W Lasix,,78708,CPT,Facility,Inpatient,,,,1530,1300.5,438.498,1530,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Nm Renogram Mag 3 W Lasix,,78708,CPT,Facility,Both,,,,1530,1300.5,438.498,1530,CorVel,Worker's Compensation,1530,100,,percent of total billed charges,,
Nm Renogram Mag 3 W Lasix,,78708,CPT,Facility,Both,,,,1530,1300.5,438.498,1530,First Health Group Corporation,First Health Network,1484.1,97,,percent of total billed charges,,
Nm Renogram Mag 3 W Lasix,,78708,CPT,Facility,Both,,,,1530,1300.5,438.498,1530,"Health Partners, Inc.",Commercial,1447.38,94.6,,percent of total billed charges,,
Nm Renogram Mag 3 W Lasix,,78708,CPT,Facility,Outpatient,,,,1530,1300.5,438.498,1530,"Health Partners, Inc.",Medicare Advantage,749.7,49,,percent of total billed charges,,
Nm Renogram Mag 3 W Lasix,,78708,CPT,Facility,Inpatient,,,,1530,1300.5,438.498,1530,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Nm Renogram Mag 3 W Lasix,,78708,CPT,Facility,Both,,,,1530,1300.5,438.498,1530,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),918,60,,percent of total billed charges,,
Nm Renogram Mag 3 W Lasix,,78708,CPT,Facility,Both,,,,1530,1300.5,438.498,1530,"Health Partners, Inc.",State of Minnesota Advantage Program,1246.95,81.5,,percent of total billed charges,,
Nm Renogram Mag 3 W Lasix,,78708,CPT,Facility,Both,,,,1530,1300.5,438.498,1530,"Health Partners, Inc.",State Public Programs,765,50,,percent of total billed charges,,
Nm Renogram Mag 3 W Lasix,,78708,CPT,Facility,Both,,,,1530,1300.5,438.498,1530,Humana Insurance Company,Commercial PPO,1453.5,95,,percent of total billed charges,,
Nm Renogram Mag 3 W Lasix,,78708,CPT,Facility,Outpatient,,,,1530,1300.5,438.498,1530,Humana Insurance Company,Medicare PPO,749.7,49,,percent of total billed charges,,
Nm Renogram Mag 3 W Lasix,,78708,CPT,Facility,Inpatient,,,,1530,1300.5,438.498,1530,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Nm Renogram Mag 3 W Lasix,,78708,CPT,Facility,Both,,,,1530,1300.5,438.498,1530,Medica,Individual & Family,1516.23,99.1,,percent of total billed charges,,
Nm Renogram Mag 3 W Lasix,,78708,CPT,Facility,Outpatient,,,,1530,1300.5,438.498,1530,Medica,Medica Advantage Solution,761.94,49.8,,percent of total billed charges,,
Nm Renogram Mag 3 W Lasix,,78708,CPT,Facility,Inpatient,,,,1530,1300.5,438.498,1530,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Nm Renogram Mag 3 W Lasix,,78708,CPT,Facility,Outpatient,,,,1530,1300.5,438.498,1530,Medica,Medical Assistance,682.38,44.6,,percent of total billed charges,,
Nm Renogram Mag 3 W Lasix,,78708,CPT,Facility,Inpatient,,,,1530,1300.5,438.498,1530,Medica,Medical Assistance,,,,,Included in per diem rate,
Nm Renogram Mag 3 W Lasix,,78708,CPT,Facility,Outpatient,,,,1530,1300.5,438.498,1530,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,761.94,49.8,,percent of total billed charges,,
Nm Renogram Mag 3 W Lasix,,78708,CPT,Facility,Inpatient,,,,1530,1300.5,438.498,1530,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Nm Renogram Mag 3 W Lasix,,78708,CPT,Facility,Both,,,,1530,1300.5,438.498,1530,"Multiplan, Inc.","Multiplan, Inc.",1438.2,94,,percent of total billed charges,,
Nm Renogram Mag 3 W Lasix,,78708,CPT,Facility,Outpatient,,,,1530,1300.5,438.498,1530,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1378.53,90.1,,percent of total billed charges,,
Nm Renogram Mag 3 W Lasix,,78708,CPT,Facility,Inpatient,,,,1530,1300.5,438.498,1530,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Nm Renogram Mag 3 W Lasix,,78708,CPT,Facility,Both,,,,1530,1300.5,438.498,1530,"Preferred One Administrative Services, INC.",PPO,1508.58,98.6,,percent of total billed charges,,
Nm Renogram Mag 3 W Lasix,,78708,CPT,Facility,Outpatient,,,,1530,1300.5,438.498,1530,PrimeWest Health,Minnesota Senior Health Options (MSHO),787.185,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Nm Renogram Mag 3 W Lasix,,78708,CPT,Facility,Inpatient,,,,1530,1300.5,438.498,1530,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Nm Renogram Mag 3 W Lasix,,78708,CPT,Facility,Outpatient,,,,1530,1300.5,438.498,1530,PrimeWest Health,MinnesotaCare,785.808,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Nm Renogram Mag 3 W Lasix,,78708,CPT,Facility,Inpatient,,,,1530,1300.5,438.498,1530,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Nm Renogram Mag 3 W Lasix,,78708,CPT,Facility,Both,,,,1530,1300.5,438.498,1530,Sanford Health Plan,Sanford Health Plan,1407.6,92,,percent of total billed charges,,
Nm Renogram Mag 3 W Lasix,,78708,CPT,Facility,Outpatient,,,,1530,1300.5,438.498,1530,"UCare Health, Inc.",Individual & Family Plan,862.155,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Nm Renogram Mag 3 W Lasix,,78708,CPT,Facility,Inpatient,,,,1530,1300.5,438.498,1530,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Nm Renogram Mag 3 W Lasix,,78708,CPT,Facility,Outpatient,,,,1530,1300.5,438.498,1530,"UCare Health, Inc.",Medical Assistance,772.191,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Nm Renogram Mag 3 W Lasix,,78708,CPT,Facility,Inpatient,,,,1530,1300.5,438.498,1530,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Nm Renogram Mag 3 W Lasix,,78708,CPT,Facility,Outpatient,,,,1530,1300.5,438.498,1530,"UCare Health, Inc.",Medicare Advantage,772.191,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Nm Renogram Mag 3 W Lasix,,78708,CPT,Facility,Inpatient,,,,1530,1300.5,438.498,1530,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Nm Renogram Mag 3 W Lasix,,78708,CPT,Facility,Outpatient,,,,1530,1300.5,438.498,1530,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),772.191,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Nm Renogram Mag 3 W Lasix,,78708,CPT,Facility,Inpatient,,,,1530,1300.5,438.498,1530,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Nm Renogram Mag 3 W Lasix,,78708,CPT,Facility,Both,,,,1530,1300.5,438.498,1530,UnitedHealthcare,Individual & Family,1438.2,94,,percent of total billed charges,,
Nm Renogram Mag 3 W Lasix,,78708,CPT,Facility,Outpatient,,,,1530,1300.5,438.498,1530,UnitedHealthcare,Medicare Advantage,749.7,49,,percent of total billed charges,,
Nm Renogram Mag 3 W Lasix,,78708,CPT,Facility,Inpatient,,,,1530,1300.5,438.498,1530,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Nm Renogram Mag 3 W Lasix,,78708,CPT,Facility,Outpatient,,,,1530,1300.5,438.498,1530,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,734.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
Nm Renogram Mag 3 W Lasix,,78708,CPT,Facility,Inpatient,,,,1530,1300.5,438.498,1530,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Nm Renogram Mag 3 Mult W Captopril,,78709,CPT,Facility,Both,,,,1428,1213.8,409.2648,1428,Aetna,Commercial,1313.76,92,,percent of total billed charges,,
Nm Renogram Mag 3 Mult W Captopril,,78709,CPT,Facility,Outpatient,,,,1428,1213.8,409.2648,1428,Aetna,Medicare Advantage,699.72,49,,percent of total billed charges,,
Nm Renogram Mag 3 Mult W Captopril,,78709,CPT,Facility,Inpatient,,,,1428,1213.8,409.2648,1428,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Nm Renogram Mag 3 Mult W Captopril,,78709,CPT,Facility,Both,,,,1428,1213.8,409.2648,1428,Aetna,PPO,1328.04,93,,percent of total billed charges,,
Nm Renogram Mag 3 Mult W Captopril,,78709,CPT,Facility,Both,,,,1428,1213.8,409.2648,1428,America's PPO,America's PPO,1371.3084,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Nm Renogram Mag 3 Mult W Captopril,,78709,CPT,Facility,Both,,,,1428,1213.8,409.2648,1428,BlueCross BlueShield Minnesota, Federal Employee Program,1405.152,98.4,,percent of total billed charges,,
Nm Renogram Mag 3 Mult W Captopril,,78709,CPT,Facility,Both,,,,1428,1213.8,409.2648,1428,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1428,100,,percent of total billed charges,,
Nm Renogram Mag 3 Mult W Captopril,,78709,CPT,Facility,Both,,,,1428,1213.8,409.2648,1428,BlueCross BlueShield Minnesota,High Value Network Plan,1285.2,90,,percent of total billed charges,,
Nm Renogram Mag 3 Mult W Captopril,,78709,CPT,Facility,Outpatient,,,,1428,1213.8,409.2648,1428,BlueCross BlueShield Minnesota,Medicare Advantage,699.72,49,,percent of total billed charges,,
Nm Renogram Mag 3 Mult W Captopril,,78709,CPT,Facility,Inpatient,,,,1428,1213.8,409.2648,1428,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Nm Renogram Mag 3 Mult W Captopril,,78709,CPT,Facility,Both,,,,1428,1213.8,409.2648,1428,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1264.7796,88.57,,percent of total billed charges,,
Nm Renogram Mag 3 Mult W Captopril,,78709,CPT,Facility,Both,,,,1428,1213.8,409.2648,1428,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,409.2648,28.66,,percent of total billed charges,,
Nm Renogram Mag 3 Mult W Captopril,,78709,CPT,Facility,Outpatient,,,,1428,1213.8,409.2648,1428,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),699.72,49,,percent of total billed charges,,
Nm Renogram Mag 3 Mult W Captopril,,78709,CPT,Facility,Inpatient,,,,1428,1213.8,409.2648,1428,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Nm Renogram Mag 3 Mult W Captopril,,78709,CPT,Facility,Both,,,,1428,1213.8,409.2648,1428,CorVel,Worker's Compensation,1428,100,,percent of total billed charges,,
Nm Renogram Mag 3 Mult W Captopril,,78709,CPT,Facility,Both,,,,1428,1213.8,409.2648,1428,First Health Group Corporation,First Health Network,1385.16,97,,percent of total billed charges,,
Nm Renogram Mag 3 Mult W Captopril,,78709,CPT,Facility,Both,,,,1428,1213.8,409.2648,1428,"Health Partners, Inc.",Commercial,1350.888,94.6,,percent of total billed charges,,
Nm Renogram Mag 3 Mult W Captopril,,78709,CPT,Facility,Outpatient,,,,1428,1213.8,409.2648,1428,"Health Partners, Inc.",Medicare Advantage,699.72,49,,percent of total billed charges,,
Nm Renogram Mag 3 Mult W Captopril,,78709,CPT,Facility,Inpatient,,,,1428,1213.8,409.2648,1428,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Nm Renogram Mag 3 Mult W Captopril,,78709,CPT,Facility,Both,,,,1428,1213.8,409.2648,1428,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),856.8,60,,percent of total billed charges,,
Nm Renogram Mag 3 Mult W Captopril,,78709,CPT,Facility,Both,,,,1428,1213.8,409.2648,1428,"Health Partners, Inc.",State of Minnesota Advantage Program,1163.82,81.5,,percent of total billed charges,,
Nm Renogram Mag 3 Mult W Captopril,,78709,CPT,Facility,Both,,,,1428,1213.8,409.2648,1428,"Health Partners, Inc.",State Public Programs,714,50,,percent of total billed charges,,
Nm Renogram Mag 3 Mult W Captopril,,78709,CPT,Facility,Both,,,,1428,1213.8,409.2648,1428,Humana Insurance Company,Commercial PPO,1356.6,95,,percent of total billed charges,,
Nm Renogram Mag 3 Mult W Captopril,,78709,CPT,Facility,Outpatient,,,,1428,1213.8,409.2648,1428,Humana Insurance Company,Medicare PPO,699.72,49,,percent of total billed charges,,
Nm Renogram Mag 3 Mult W Captopril,,78709,CPT,Facility,Inpatient,,,,1428,1213.8,409.2648,1428,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Nm Renogram Mag 3 Mult W Captopril,,78709,CPT,Facility,Both,,,,1428,1213.8,409.2648,1428,Medica,Individual & Family,1415.148,99.1,,percent of total billed charges,,
Nm Renogram Mag 3 Mult W Captopril,,78709,CPT,Facility,Outpatient,,,,1428,1213.8,409.2648,1428,Medica,Medica Advantage Solution,711.144,49.8,,percent of total billed charges,,
Nm Renogram Mag 3 Mult W Captopril,,78709,CPT,Facility,Inpatient,,,,1428,1213.8,409.2648,1428,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Nm Renogram Mag 3 Mult W Captopril,,78709,CPT,Facility,Outpatient,,,,1428,1213.8,409.2648,1428,Medica,Medical Assistance,636.888,44.6,,percent of total billed charges,,
Nm Renogram Mag 3 Mult W Captopril,,78709,CPT,Facility,Inpatient,,,,1428,1213.8,409.2648,1428,Medica,Medical Assistance,,,,,Included in per diem rate,
Nm Renogram Mag 3 Mult W Captopril,,78709,CPT,Facility,Outpatient,,,,1428,1213.8,409.2648,1428,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,711.144,49.8,,percent of total billed charges,,
Nm Renogram Mag 3 Mult W Captopril,,78709,CPT,Facility,Inpatient,,,,1428,1213.8,409.2648,1428,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Nm Renogram Mag 3 Mult W Captopril,,78709,CPT,Facility,Both,,,,1428,1213.8,409.2648,1428,"Multiplan, Inc.","Multiplan, Inc.",1342.32,94,,percent of total billed charges,,
Nm Renogram Mag 3 Mult W Captopril,,78709,CPT,Facility,Outpatient,,,,1428,1213.8,409.2648,1428,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1286.628,90.1,,percent of total billed charges,,
Nm Renogram Mag 3 Mult W Captopril,,78709,CPT,Facility,Inpatient,,,,1428,1213.8,409.2648,1428,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Nm Renogram Mag 3 Mult W Captopril,,78709,CPT,Facility,Both,,,,1428,1213.8,409.2648,1428,"Preferred One Administrative Services, INC.",PPO,1408.008,98.6,,percent of total billed charges,,
Nm Renogram Mag 3 Mult W Captopril,,78709,CPT,Facility,Outpatient,,,,1428,1213.8,409.2648,1428,PrimeWest Health,Minnesota Senior Health Options (MSHO),734.706,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Nm Renogram Mag 3 Mult W Captopril,,78709,CPT,Facility,Inpatient,,,,1428,1213.8,409.2648,1428,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Nm Renogram Mag 3 Mult W Captopril,,78709,CPT,Facility,Outpatient,,,,1428,1213.8,409.2648,1428,PrimeWest Health,MinnesotaCare,733.4208,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Nm Renogram Mag 3 Mult W Captopril,,78709,CPT,Facility,Inpatient,,,,1428,1213.8,409.2648,1428,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Nm Renogram Mag 3 Mult W Captopril,,78709,CPT,Facility,Both,,,,1428,1213.8,409.2648,1428,Sanford Health Plan,Sanford Health Plan,1313.76,92,,percent of total billed charges,,
Nm Renogram Mag 3 Mult W Captopril,,78709,CPT,Facility,Outpatient,,,,1428,1213.8,409.2648,1428,"UCare Health, Inc.",Individual & Family Plan,804.678,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Nm Renogram Mag 3 Mult W Captopril,,78709,CPT,Facility,Inpatient,,,,1428,1213.8,409.2648,1428,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Nm Renogram Mag 3 Mult W Captopril,,78709,CPT,Facility,Outpatient,,,,1428,1213.8,409.2648,1428,"UCare Health, Inc.",Medical Assistance,720.7116,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Nm Renogram Mag 3 Mult W Captopril,,78709,CPT,Facility,Inpatient,,,,1428,1213.8,409.2648,1428,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Nm Renogram Mag 3 Mult W Captopril,,78709,CPT,Facility,Outpatient,,,,1428,1213.8,409.2648,1428,"UCare Health, Inc.",Medicare Advantage,720.7116,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Nm Renogram Mag 3 Mult W Captopril,,78709,CPT,Facility,Inpatient,,,,1428,1213.8,409.2648,1428,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Nm Renogram Mag 3 Mult W Captopril,,78709,CPT,Facility,Outpatient,,,,1428,1213.8,409.2648,1428,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),720.7116,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Nm Renogram Mag 3 Mult W Captopril,,78709,CPT,Facility,Inpatient,,,,1428,1213.8,409.2648,1428,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Nm Renogram Mag 3 Mult W Captopril,,78709,CPT,Facility,Both,,,,1428,1213.8,409.2648,1428,UnitedHealthcare,Individual & Family,1342.32,94,,percent of total billed charges,,
Nm Renogram Mag 3 Mult W Captopril,,78709,CPT,Facility,Outpatient,,,,1428,1213.8,409.2648,1428,UnitedHealthcare,Medicare Advantage,699.72,49,,percent of total billed charges,,
Nm Renogram Mag 3 Mult W Captopril,,78709,CPT,Facility,Inpatient,,,,1428,1213.8,409.2648,1428,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Nm Renogram Mag 3 Mult W Captopril,,78709,CPT,Facility,Outpatient,,,,1428,1213.8,409.2648,1428,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,685.44,48,,percent of total billed charges,,100% of DHS outpatient percentage
Nm Renogram Mag 3 Mult W Captopril,,78709,CPT,Facility,Inpatient,,,,1428,1213.8,409.2648,1428,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
EPINEPHRINE 0.1 MG/ML INJ SYRG (PEDS 1 MG MAX),,J0171,HCPCS,Facility,Both,10,mL,,32,27.2,9.1712,32,Aetna,Commercial,29.44,92,,percent of total billed charges,,
EPINEPHRINE 0.1 MG/ML INJ SYRG (PEDS 1 MG MAX),,J0171,HCPCS,Facility,Outpatient,10,mL,,32,27.2,9.1712,32,Aetna,Medicare Advantage,15.68,49,,percent of total billed charges,,
EPINEPHRINE 0.1 MG/ML INJ SYRG (PEDS 1 MG MAX),,J0171,HCPCS,Facility,Inpatient,10,mL,,32,27.2,9.1712,32,Aetna,Medicare Advantage,,,,,Included in per diem rate,
EPINEPHRINE 0.1 MG/ML INJ SYRG (PEDS 1 MG MAX),,J0171,HCPCS,Facility,Both,10,mL,,32,27.2,9.1712,32,Aetna,PPO,29.76,93,,percent of total billed charges,,
EPINEPHRINE 0.1 MG/ML INJ SYRG (PEDS 1 MG MAX),,J0171,HCPCS,Facility,Both,10,mL,,32,27.2,9.1712,32,America's PPO,America's PPO,30.7296,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
EPINEPHRINE 0.1 MG/ML INJ SYRG (PEDS 1 MG MAX),,J0171,HCPCS,Facility,Both,10,mL,,32,27.2,9.1712,32,BlueCross BlueShield Minnesota, Federal Employee Program,31.488,98.4,,percent of total billed charges,,
EPINEPHRINE 0.1 MG/ML INJ SYRG (PEDS 1 MG MAX),,J0171,HCPCS,Facility,Both,10,mL,,32,27.2,9.1712,32,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,32,100,,percent of total billed charges,,
EPINEPHRINE 0.1 MG/ML INJ SYRG (PEDS 1 MG MAX),,J0171,HCPCS,Facility,Both,10,mL,,32,27.2,9.1712,32,BlueCross BlueShield Minnesota,High Value Network Plan,28.8,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
EPINEPHRINE 0.1 MG/ML INJ SYRG (PEDS 1 MG MAX),,J0171,HCPCS,Facility,Outpatient,10,mL,,32,27.2,9.1712,32,BlueCross BlueShield Minnesota,Medicare Advantage,15.68,49,,percent of total billed charges,,
EPINEPHRINE 0.1 MG/ML INJ SYRG (PEDS 1 MG MAX),,J0171,HCPCS,Facility,Inpatient,10,mL,,32,27.2,9.1712,32,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
EPINEPHRINE 0.1 MG/ML INJ SYRG (PEDS 1 MG MAX),,J0171,HCPCS,Facility,Both,10,mL,,32,27.2,9.1712,32,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,28.3424,88.57,,percent of total billed charges,,
EPINEPHRINE 0.1 MG/ML INJ SYRG (PEDS 1 MG MAX),,J0171,HCPCS,Facility,Both,10,mL,,32,27.2,9.1712,32,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,9.1712,28.66,,percent of total billed charges,,
EPINEPHRINE 0.1 MG/ML INJ SYRG (PEDS 1 MG MAX),,J0171,HCPCS,Facility,Outpatient,10,mL,,32,27.2,9.1712,32,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),15.68,49,,percent of total billed charges,,
EPINEPHRINE 0.1 MG/ML INJ SYRG (PEDS 1 MG MAX),,J0171,HCPCS,Facility,Inpatient,10,mL,,32,27.2,9.1712,32,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
EPINEPHRINE 0.1 MG/ML INJ SYRG (PEDS 1 MG MAX),,J0171,HCPCS,Facility,Both,10,mL,,32,27.2,9.1712,32,CorVel,Worker's Compensation,32,100,,percent of total billed charges,,
EPINEPHRINE 0.1 MG/ML INJ SYRG (PEDS 1 MG MAX),,J0171,HCPCS,Facility,Both,10,mL,,32,27.2,9.1712,32,First Health Group Corporation,First Health Network,31.04,97,,percent of total billed charges,,
EPINEPHRINE 0.1 MG/ML INJ SYRG (PEDS 1 MG MAX),,J0171,HCPCS,Facility,Both,10,mL,,32,27.2,9.1712,32,"Health Partners, Inc.",Commercial,30.272,94.6,,percent of total billed charges,,
EPINEPHRINE 0.1 MG/ML INJ SYRG (PEDS 1 MG MAX),,J0171,HCPCS,Facility,Outpatient,10,mL,,32,27.2,9.1712,32,"Health Partners, Inc.",Medicare Advantage,15.68,49,,percent of total billed charges,,
EPINEPHRINE 0.1 MG/ML INJ SYRG (PEDS 1 MG MAX),,J0171,HCPCS,Facility,Inpatient,10,mL,,32,27.2,9.1712,32,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
EPINEPHRINE 0.1 MG/ML INJ SYRG (PEDS 1 MG MAX),,J0171,HCPCS,Facility,Both,10,mL,,32,27.2,9.1712,32,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),19.2,60,,percent of total billed charges,,
EPINEPHRINE 0.1 MG/ML INJ SYRG (PEDS 1 MG MAX),,J0171,HCPCS,Facility,Both,10,mL,,32,27.2,9.1712,32,"Health Partners, Inc.",State of Minnesota Advantage Program,26.08,81.5,,percent of total billed charges,,
EPINEPHRINE 0.1 MG/ML INJ SYRG (PEDS 1 MG MAX),,J0171,HCPCS,Facility,Both,10,mL,,32,27.2,9.1712,32,"Health Partners, Inc.",State Public Programs,16,50,,percent of total billed charges,,
EPINEPHRINE 0.1 MG/ML INJ SYRG (PEDS 1 MG MAX),,J0171,HCPCS,Facility,Both,10,mL,,32,27.2,9.1712,32,Humana Insurance Company,Commercial PPO,30.4,95,,percent of total billed charges,,
EPINEPHRINE 0.1 MG/ML INJ SYRG (PEDS 1 MG MAX),,J0171,HCPCS,Facility,Outpatient,10,mL,,32,27.2,9.1712,32,Humana Insurance Company,Medicare PPO,15.68,49,,percent of total billed charges,,
EPINEPHRINE 0.1 MG/ML INJ SYRG (PEDS 1 MG MAX),,J0171,HCPCS,Facility,Inpatient,10,mL,,32,27.2,9.1712,32,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
EPINEPHRINE 0.1 MG/ML INJ SYRG (PEDS 1 MG MAX),,J0171,HCPCS,Facility,Both,10,mL,,32,27.2,9.1712,32,Medica,Individual & Family,31.712,99.1,,percent of total billed charges,,
EPINEPHRINE 0.1 MG/ML INJ SYRG (PEDS 1 MG MAX),,J0171,HCPCS,Facility,Outpatient,10,mL,,32,27.2,9.1712,32,Medica,Medica Advantage Solution,15.936,49.8,,percent of total billed charges,,
EPINEPHRINE 0.1 MG/ML INJ SYRG (PEDS 1 MG MAX),,J0171,HCPCS,Facility,Inpatient,10,mL,,32,27.2,9.1712,32,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
EPINEPHRINE 0.1 MG/ML INJ SYRG (PEDS 1 MG MAX),,J0171,HCPCS,Facility,Outpatient,10,mL,,32,27.2,9.1712,32,Medica,Medical Assistance,14.272,44.6,,percent of total billed charges,,
EPINEPHRINE 0.1 MG/ML INJ SYRG (PEDS 1 MG MAX),,J0171,HCPCS,Facility,Inpatient,10,mL,,32,27.2,9.1712,32,Medica,Medical Assistance,,,,,Included in per diem rate,
EPINEPHRINE 0.1 MG/ML INJ SYRG (PEDS 1 MG MAX),,J0171,HCPCS,Facility,Outpatient,10,mL,,32,27.2,9.1712,32,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,15.936,49.8,,percent of total billed charges,,
EPINEPHRINE 0.1 MG/ML INJ SYRG (PEDS 1 MG MAX),,J0171,HCPCS,Facility,Inpatient,10,mL,,32,27.2,9.1712,32,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
EPINEPHRINE 0.1 MG/ML INJ SYRG (PEDS 1 MG MAX),,J0171,HCPCS,Facility,Both,10,mL,,32,27.2,9.1712,32,"Multiplan, Inc.","Multiplan, Inc.",30.08,94,,percent of total billed charges,,
EPINEPHRINE 0.1 MG/ML INJ SYRG (PEDS 1 MG MAX),,J0171,HCPCS,Facility,Outpatient,10,mL,,32,27.2,9.1712,32,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,28.832,90.1,,percent of total billed charges,,
EPINEPHRINE 0.1 MG/ML INJ SYRG (PEDS 1 MG MAX),,J0171,HCPCS,Facility,Inpatient,10,mL,,32,27.2,9.1712,32,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
EPINEPHRINE 0.1 MG/ML INJ SYRG (PEDS 1 MG MAX),,J0171,HCPCS,Facility,Both,10,mL,,32,27.2,9.1712,32,"Preferred One Administrative Services, INC.",PPO,31.552,98.6,,percent of total billed charges,,
EPINEPHRINE 0.1 MG/ML INJ SYRG (PEDS 1 MG MAX),,J0171,HCPCS,Facility,Outpatient,10,mL,,32,27.2,9.1712,32,PrimeWest Health,Minnesota Senior Health Options (MSHO),16.464,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
EPINEPHRINE 0.1 MG/ML INJ SYRG (PEDS 1 MG MAX),,J0171,HCPCS,Facility,Inpatient,10,mL,,32,27.2,9.1712,32,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
EPINEPHRINE 0.1 MG/ML INJ SYRG (PEDS 1 MG MAX),,J0171,HCPCS,Facility,Outpatient,10,mL,,32,27.2,9.1712,32,PrimeWest Health,MinnesotaCare,16.4352,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
EPINEPHRINE 0.1 MG/ML INJ SYRG (PEDS 1 MG MAX),,J0171,HCPCS,Facility,Inpatient,10,mL,,32,27.2,9.1712,32,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
EPINEPHRINE 0.1 MG/ML INJ SYRG (PEDS 1 MG MAX),,J0171,HCPCS,Facility,Both,10,mL,,32,27.2,9.1712,32,Sanford Health Plan,Sanford Health Plan,29.44,92,,percent of total billed charges,,
EPINEPHRINE 0.1 MG/ML INJ SYRG (PEDS 1 MG MAX),,J0171,HCPCS,Facility,Outpatient,10,mL,,32,27.2,9.1712,32,"UCare Health, Inc.",Individual & Family Plan,18.032,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
EPINEPHRINE 0.1 MG/ML INJ SYRG (PEDS 1 MG MAX),,J0171,HCPCS,Facility,Inpatient,10,mL,,32,27.2,9.1712,32,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
EPINEPHRINE 0.1 MG/ML INJ SYRG (PEDS 1 MG MAX),,J0171,HCPCS,Facility,Outpatient,10,mL,,32,27.2,9.1712,32,"UCare Health, Inc.",Medical Assistance,16.1504,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
EPINEPHRINE 0.1 MG/ML INJ SYRG (PEDS 1 MG MAX),,J0171,HCPCS,Facility,Inpatient,10,mL,,32,27.2,9.1712,32,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
EPINEPHRINE 0.1 MG/ML INJ SYRG (PEDS 1 MG MAX),,J0171,HCPCS,Facility,Outpatient,10,mL,,32,27.2,9.1712,32,"UCare Health, Inc.",Medicare Advantage,16.1504,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
EPINEPHRINE 0.1 MG/ML INJ SYRG (PEDS 1 MG MAX),,J0171,HCPCS,Facility,Inpatient,10,mL,,32,27.2,9.1712,32,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
EPINEPHRINE 0.1 MG/ML INJ SYRG (PEDS 1 MG MAX),,J0171,HCPCS,Facility,Outpatient,10,mL,,32,27.2,9.1712,32,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),16.1504,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
EPINEPHRINE 0.1 MG/ML INJ SYRG (PEDS 1 MG MAX),,J0171,HCPCS,Facility,Inpatient,10,mL,,32,27.2,9.1712,32,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
EPINEPHRINE 0.1 MG/ML INJ SYRG (PEDS 1 MG MAX),,J0171,HCPCS,Facility,Both,10,mL,,32,27.2,9.1712,32,UnitedHealthcare,Individual & Family,30.08,94,,percent of total billed charges,,
EPINEPHRINE 0.1 MG/ML INJ SYRG (PEDS 1 MG MAX),,J0171,HCPCS,Facility,Outpatient,10,mL,,32,27.2,9.1712,32,UnitedHealthcare,Medicare Advantage,15.68,49,,percent of total billed charges,,
EPINEPHRINE 0.1 MG/ML INJ SYRG (PEDS 1 MG MAX),,J0171,HCPCS,Facility,Inpatient,10,mL,,32,27.2,9.1712,32,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
EPINEPHRINE 0.1 MG/ML INJ SYRG (PEDS 1 MG MAX),,J0171,HCPCS,Facility,Outpatient,10,mL,,32,27.2,9.1712,32,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,15.36,48,,percent of total billed charges,,100% of DHS outpatient percentage
EPINEPHRINE 0.1 MG/ML INJ SYRG (PEDS 1 MG MAX),,J0171,HCPCS,Facility,Inpatient,10,mL,,32,27.2,9.1712,32,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
EPINEPHRINE 0.1 MG/ML INJ SYRG FOR ETT (BABY),,J0171,HCPCS,Facility,Both,10,mL,,32,27.2,9.1712,32,Aetna,Commercial,29.44,92,,percent of total billed charges,,
EPINEPHRINE 0.1 MG/ML INJ SYRG FOR ETT (BABY),,J0171,HCPCS,Facility,Outpatient,10,mL,,32,27.2,9.1712,32,Aetna,Medicare Advantage,15.68,49,,percent of total billed charges,,
EPINEPHRINE 0.1 MG/ML INJ SYRG FOR ETT (BABY),,J0171,HCPCS,Facility,Inpatient,10,mL,,32,27.2,9.1712,32,Aetna,Medicare Advantage,,,,,Included in per diem rate,
EPINEPHRINE 0.1 MG/ML INJ SYRG FOR ETT (BABY),,J0171,HCPCS,Facility,Both,10,mL,,32,27.2,9.1712,32,Aetna,PPO,29.76,93,,percent of total billed charges,,
EPINEPHRINE 0.1 MG/ML INJ SYRG FOR ETT (BABY),,J0171,HCPCS,Facility,Both,10,mL,,32,27.2,9.1712,32,America's PPO,America's PPO,30.7296,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
EPINEPHRINE 0.1 MG/ML INJ SYRG FOR ETT (BABY),,J0171,HCPCS,Facility,Both,10,mL,,32,27.2,9.1712,32,BlueCross BlueShield Minnesota, Federal Employee Program,31.488,98.4,,percent of total billed charges,,
EPINEPHRINE 0.1 MG/ML INJ SYRG FOR ETT (BABY),,J0171,HCPCS,Facility,Both,10,mL,,32,27.2,9.1712,32,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,32,100,,percent of total billed charges,,
EPINEPHRINE 0.1 MG/ML INJ SYRG FOR ETT (BABY),,J0171,HCPCS,Facility,Both,10,mL,,32,27.2,9.1712,32,BlueCross BlueShield Minnesota,High Value Network Plan,28.8,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
EPINEPHRINE 0.1 MG/ML INJ SYRG FOR ETT (BABY),,J0171,HCPCS,Facility,Outpatient,10,mL,,32,27.2,9.1712,32,BlueCross BlueShield Minnesota,Medicare Advantage,15.68,49,,percent of total billed charges,,
EPINEPHRINE 0.1 MG/ML INJ SYRG FOR ETT (BABY),,J0171,HCPCS,Facility,Inpatient,10,mL,,32,27.2,9.1712,32,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
EPINEPHRINE 0.1 MG/ML INJ SYRG FOR ETT (BABY),,J0171,HCPCS,Facility,Both,10,mL,,32,27.2,9.1712,32,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,28.3424,88.57,,percent of total billed charges,,
EPINEPHRINE 0.1 MG/ML INJ SYRG FOR ETT (BABY),,J0171,HCPCS,Facility,Both,10,mL,,32,27.2,9.1712,32,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,9.1712,28.66,,percent of total billed charges,,
EPINEPHRINE 0.1 MG/ML INJ SYRG FOR ETT (BABY),,J0171,HCPCS,Facility,Outpatient,10,mL,,32,27.2,9.1712,32,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),15.68,49,,percent of total billed charges,,
EPINEPHRINE 0.1 MG/ML INJ SYRG FOR ETT (BABY),,J0171,HCPCS,Facility,Inpatient,10,mL,,32,27.2,9.1712,32,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
EPINEPHRINE 0.1 MG/ML INJ SYRG FOR ETT (BABY),,J0171,HCPCS,Facility,Both,10,mL,,32,27.2,9.1712,32,CorVel,Worker's Compensation,32,100,,percent of total billed charges,,
EPINEPHRINE 0.1 MG/ML INJ SYRG FOR ETT (BABY),,J0171,HCPCS,Facility,Both,10,mL,,32,27.2,9.1712,32,First Health Group Corporation,First Health Network,31.04,97,,percent of total billed charges,,
EPINEPHRINE 0.1 MG/ML INJ SYRG FOR ETT (BABY),,J0171,HCPCS,Facility,Both,10,mL,,32,27.2,9.1712,32,"Health Partners, Inc.",Commercial,30.272,94.6,,percent of total billed charges,,
EPINEPHRINE 0.1 MG/ML INJ SYRG FOR ETT (BABY),,J0171,HCPCS,Facility,Outpatient,10,mL,,32,27.2,9.1712,32,"Health Partners, Inc.",Medicare Advantage,15.68,49,,percent of total billed charges,,
EPINEPHRINE 0.1 MG/ML INJ SYRG FOR ETT (BABY),,J0171,HCPCS,Facility,Inpatient,10,mL,,32,27.2,9.1712,32,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
EPINEPHRINE 0.1 MG/ML INJ SYRG FOR ETT (BABY),,J0171,HCPCS,Facility,Both,10,mL,,32,27.2,9.1712,32,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),19.2,60,,percent of total billed charges,,
EPINEPHRINE 0.1 MG/ML INJ SYRG FOR ETT (BABY),,J0171,HCPCS,Facility,Both,10,mL,,32,27.2,9.1712,32,"Health Partners, Inc.",State of Minnesota Advantage Program,26.08,81.5,,percent of total billed charges,,
EPINEPHRINE 0.1 MG/ML INJ SYRG FOR ETT (BABY),,J0171,HCPCS,Facility,Both,10,mL,,32,27.2,9.1712,32,"Health Partners, Inc.",State Public Programs,16,50,,percent of total billed charges,,
EPINEPHRINE 0.1 MG/ML INJ SYRG FOR ETT (BABY),,J0171,HCPCS,Facility,Both,10,mL,,32,27.2,9.1712,32,Humana Insurance Company,Commercial PPO,30.4,95,,percent of total billed charges,,
EPINEPHRINE 0.1 MG/ML INJ SYRG FOR ETT (BABY),,J0171,HCPCS,Facility,Outpatient,10,mL,,32,27.2,9.1712,32,Humana Insurance Company,Medicare PPO,15.68,49,,percent of total billed charges,,
EPINEPHRINE 0.1 MG/ML INJ SYRG FOR ETT (BABY),,J0171,HCPCS,Facility,Inpatient,10,mL,,32,27.2,9.1712,32,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
EPINEPHRINE 0.1 MG/ML INJ SYRG FOR ETT (BABY),,J0171,HCPCS,Facility,Both,10,mL,,32,27.2,9.1712,32,Medica,Individual & Family,31.712,99.1,,percent of total billed charges,,
EPINEPHRINE 0.1 MG/ML INJ SYRG FOR ETT (BABY),,J0171,HCPCS,Facility,Outpatient,10,mL,,32,27.2,9.1712,32,Medica,Medica Advantage Solution,15.936,49.8,,percent of total billed charges,,
EPINEPHRINE 0.1 MG/ML INJ SYRG FOR ETT (BABY),,J0171,HCPCS,Facility,Inpatient,10,mL,,32,27.2,9.1712,32,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
EPINEPHRINE 0.1 MG/ML INJ SYRG FOR ETT (BABY),,J0171,HCPCS,Facility,Outpatient,10,mL,,32,27.2,9.1712,32,Medica,Medical Assistance,14.272,44.6,,percent of total billed charges,,
EPINEPHRINE 0.1 MG/ML INJ SYRG FOR ETT (BABY),,J0171,HCPCS,Facility,Inpatient,10,mL,,32,27.2,9.1712,32,Medica,Medical Assistance,,,,,Included in per diem rate,
EPINEPHRINE 0.1 MG/ML INJ SYRG FOR ETT (BABY),,J0171,HCPCS,Facility,Outpatient,10,mL,,32,27.2,9.1712,32,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,15.936,49.8,,percent of total billed charges,,
EPINEPHRINE 0.1 MG/ML INJ SYRG FOR ETT (BABY),,J0171,HCPCS,Facility,Inpatient,10,mL,,32,27.2,9.1712,32,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
EPINEPHRINE 0.1 MG/ML INJ SYRG FOR ETT (BABY),,J0171,HCPCS,Facility,Both,10,mL,,32,27.2,9.1712,32,"Multiplan, Inc.","Multiplan, Inc.",30.08,94,,percent of total billed charges,,
EPINEPHRINE 0.1 MG/ML INJ SYRG FOR ETT (BABY),,J0171,HCPCS,Facility,Outpatient,10,mL,,32,27.2,9.1712,32,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,28.832,90.1,,percent of total billed charges,,
EPINEPHRINE 0.1 MG/ML INJ SYRG FOR ETT (BABY),,J0171,HCPCS,Facility,Inpatient,10,mL,,32,27.2,9.1712,32,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
EPINEPHRINE 0.1 MG/ML INJ SYRG FOR ETT (BABY),,J0171,HCPCS,Facility,Both,10,mL,,32,27.2,9.1712,32,"Preferred One Administrative Services, INC.",PPO,31.552,98.6,,percent of total billed charges,,
EPINEPHRINE 0.1 MG/ML INJ SYRG FOR ETT (BABY),,J0171,HCPCS,Facility,Outpatient,10,mL,,32,27.2,9.1712,32,PrimeWest Health,Minnesota Senior Health Options (MSHO),16.464,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
EPINEPHRINE 0.1 MG/ML INJ SYRG FOR ETT (BABY),,J0171,HCPCS,Facility,Inpatient,10,mL,,32,27.2,9.1712,32,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
EPINEPHRINE 0.1 MG/ML INJ SYRG FOR ETT (BABY),,J0171,HCPCS,Facility,Outpatient,10,mL,,32,27.2,9.1712,32,PrimeWest Health,MinnesotaCare,16.4352,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
EPINEPHRINE 0.1 MG/ML INJ SYRG FOR ETT (BABY),,J0171,HCPCS,Facility,Inpatient,10,mL,,32,27.2,9.1712,32,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
EPINEPHRINE 0.1 MG/ML INJ SYRG FOR ETT (BABY),,J0171,HCPCS,Facility,Both,10,mL,,32,27.2,9.1712,32,Sanford Health Plan,Sanford Health Plan,29.44,92,,percent of total billed charges,,
EPINEPHRINE 0.1 MG/ML INJ SYRG FOR ETT (BABY),,J0171,HCPCS,Facility,Outpatient,10,mL,,32,27.2,9.1712,32,"UCare Health, Inc.",Individual & Family Plan,18.032,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
EPINEPHRINE 0.1 MG/ML INJ SYRG FOR ETT (BABY),,J0171,HCPCS,Facility,Inpatient,10,mL,,32,27.2,9.1712,32,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
EPINEPHRINE 0.1 MG/ML INJ SYRG FOR ETT (BABY),,J0171,HCPCS,Facility,Outpatient,10,mL,,32,27.2,9.1712,32,"UCare Health, Inc.",Medical Assistance,16.1504,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
EPINEPHRINE 0.1 MG/ML INJ SYRG FOR ETT (BABY),,J0171,HCPCS,Facility,Inpatient,10,mL,,32,27.2,9.1712,32,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
EPINEPHRINE 0.1 MG/ML INJ SYRG FOR ETT (BABY),,J0171,HCPCS,Facility,Outpatient,10,mL,,32,27.2,9.1712,32,"UCare Health, Inc.",Medicare Advantage,16.1504,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
EPINEPHRINE 0.1 MG/ML INJ SYRG FOR ETT (BABY),,J0171,HCPCS,Facility,Inpatient,10,mL,,32,27.2,9.1712,32,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
EPINEPHRINE 0.1 MG/ML INJ SYRG FOR ETT (BABY),,J0171,HCPCS,Facility,Outpatient,10,mL,,32,27.2,9.1712,32,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),16.1504,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
EPINEPHRINE 0.1 MG/ML INJ SYRG FOR ETT (BABY),,J0171,HCPCS,Facility,Inpatient,10,mL,,32,27.2,9.1712,32,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
EPINEPHRINE 0.1 MG/ML INJ SYRG FOR ETT (BABY),,J0171,HCPCS,Facility,Both,10,mL,,32,27.2,9.1712,32,UnitedHealthcare,Individual & Family,30.08,94,,percent of total billed charges,,
EPINEPHRINE 0.1 MG/ML INJ SYRG FOR ETT (BABY),,J0171,HCPCS,Facility,Outpatient,10,mL,,32,27.2,9.1712,32,UnitedHealthcare,Medicare Advantage,15.68,49,,percent of total billed charges,,
EPINEPHRINE 0.1 MG/ML INJ SYRG FOR ETT (BABY),,J0171,HCPCS,Facility,Inpatient,10,mL,,32,27.2,9.1712,32,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
EPINEPHRINE 0.1 MG/ML INJ SYRG FOR ETT (BABY),,J0171,HCPCS,Facility,Outpatient,10,mL,,32,27.2,9.1712,32,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,15.36,48,,percent of total billed charges,,100% of DHS outpatient percentage
EPINEPHRINE 0.1 MG/ML INJ SYRG FOR ETT (BABY),,J0171,HCPCS,Facility,Inpatient,10,mL,,32,27.2,9.1712,32,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
AMINOPHYLLINE 250 MG/10 ML IV SOLN,,J0280,HCPCS,Facility,Both,10,mL,,83,70.55,23.7878,83,Aetna,Commercial,76.36,92,,percent of total billed charges,,
AMINOPHYLLINE 250 MG/10 ML IV SOLN,,J0280,HCPCS,Facility,Outpatient,10,mL,,83,70.55,23.7878,83,Aetna,Medicare Advantage,40.67,49,,percent of total billed charges,,
AMINOPHYLLINE 250 MG/10 ML IV SOLN,,J0280,HCPCS,Facility,Inpatient,10,mL,,83,70.55,23.7878,83,Aetna,Medicare Advantage,,,,,Included in per diem rate,
AMINOPHYLLINE 250 MG/10 ML IV SOLN,,J0280,HCPCS,Facility,Both,10,mL,,83,70.55,23.7878,83,Aetna,PPO,77.19,93,,percent of total billed charges,,
AMINOPHYLLINE 250 MG/10 ML IV SOLN,,J0280,HCPCS,Facility,Both,10,mL,,83,70.55,23.7878,83,America's PPO,America's PPO,79.7049,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
AMINOPHYLLINE 250 MG/10 ML IV SOLN,,J0280,HCPCS,Facility,Both,10,mL,,83,70.55,23.7878,83,BlueCross BlueShield Minnesota, Federal Employee Program,81.672,98.4,,percent of total billed charges,,
AMINOPHYLLINE 250 MG/10 ML IV SOLN,,J0280,HCPCS,Facility,Both,10,mL,,83,70.55,23.7878,83,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,83,100,,percent of total billed charges,,
AMINOPHYLLINE 250 MG/10 ML IV SOLN,,J0280,HCPCS,Facility,Both,10,mL,,83,70.55,23.7878,83,BlueCross BlueShield Minnesota,High Value Network Plan,74.7,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
AMINOPHYLLINE 250 MG/10 ML IV SOLN,,J0280,HCPCS,Facility,Outpatient,10,mL,,83,70.55,23.7878,83,BlueCross BlueShield Minnesota,Medicare Advantage,40.67,49,,percent of total billed charges,,
AMINOPHYLLINE 250 MG/10 ML IV SOLN,,J0280,HCPCS,Facility,Inpatient,10,mL,,83,70.55,23.7878,83,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
AMINOPHYLLINE 250 MG/10 ML IV SOLN,,J0280,HCPCS,Facility,Both,10,mL,,83,70.55,23.7878,83,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,73.5131,88.57,,percent of total billed charges,,
AMINOPHYLLINE 250 MG/10 ML IV SOLN,,J0280,HCPCS,Facility,Both,10,mL,,83,70.55,23.7878,83,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,23.7878,28.66,,percent of total billed charges,,
AMINOPHYLLINE 250 MG/10 ML IV SOLN,,J0280,HCPCS,Facility,Outpatient,10,mL,,83,70.55,23.7878,83,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),40.67,49,,percent of total billed charges,,
AMINOPHYLLINE 250 MG/10 ML IV SOLN,,J0280,HCPCS,Facility,Inpatient,10,mL,,83,70.55,23.7878,83,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
AMINOPHYLLINE 250 MG/10 ML IV SOLN,,J0280,HCPCS,Facility,Both,10,mL,,83,70.55,23.7878,83,CorVel,Worker's Compensation,83,100,,percent of total billed charges,,
AMINOPHYLLINE 250 MG/10 ML IV SOLN,,J0280,HCPCS,Facility,Both,10,mL,,83,70.55,23.7878,83,First Health Group Corporation,First Health Network,80.51,97,,percent of total billed charges,,
AMINOPHYLLINE 250 MG/10 ML IV SOLN,,J0280,HCPCS,Facility,Both,10,mL,,83,70.55,23.7878,83,"Health Partners, Inc.",Commercial,78.518,94.6,,percent of total billed charges,,
AMINOPHYLLINE 250 MG/10 ML IV SOLN,,J0280,HCPCS,Facility,Outpatient,10,mL,,83,70.55,23.7878,83,"Health Partners, Inc.",Medicare Advantage,40.67,49,,percent of total billed charges,,
AMINOPHYLLINE 250 MG/10 ML IV SOLN,,J0280,HCPCS,Facility,Inpatient,10,mL,,83,70.55,23.7878,83,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
AMINOPHYLLINE 250 MG/10 ML IV SOLN,,J0280,HCPCS,Facility,Both,10,mL,,83,70.55,23.7878,83,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),49.8,60,,percent of total billed charges,,
AMINOPHYLLINE 250 MG/10 ML IV SOLN,,J0280,HCPCS,Facility,Both,10,mL,,83,70.55,23.7878,83,"Health Partners, Inc.",State of Minnesota Advantage Program,67.645,81.5,,percent of total billed charges,,
AMINOPHYLLINE 250 MG/10 ML IV SOLN,,J0280,HCPCS,Facility,Both,10,mL,,83,70.55,23.7878,83,"Health Partners, Inc.",State Public Programs,41.5,50,,percent of total billed charges,,
AMINOPHYLLINE 250 MG/10 ML IV SOLN,,J0280,HCPCS,Facility,Both,10,mL,,83,70.55,23.7878,83,Humana Insurance Company,Commercial PPO,78.85,95,,percent of total billed charges,,
AMINOPHYLLINE 250 MG/10 ML IV SOLN,,J0280,HCPCS,Facility,Outpatient,10,mL,,83,70.55,23.7878,83,Humana Insurance Company,Medicare PPO,40.67,49,,percent of total billed charges,,
AMINOPHYLLINE 250 MG/10 ML IV SOLN,,J0280,HCPCS,Facility,Inpatient,10,mL,,83,70.55,23.7878,83,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
AMINOPHYLLINE 250 MG/10 ML IV SOLN,,J0280,HCPCS,Facility,Both,10,mL,,83,70.55,23.7878,83,Medica,Individual & Family,82.253,99.1,,percent of total billed charges,,
AMINOPHYLLINE 250 MG/10 ML IV SOLN,,J0280,HCPCS,Facility,Outpatient,10,mL,,83,70.55,23.7878,83,Medica,Medica Advantage Solution,41.334,49.8,,percent of total billed charges,,
AMINOPHYLLINE 250 MG/10 ML IV SOLN,,J0280,HCPCS,Facility,Inpatient,10,mL,,83,70.55,23.7878,83,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
AMINOPHYLLINE 250 MG/10 ML IV SOLN,,J0280,HCPCS,Facility,Outpatient,10,mL,,83,70.55,23.7878,83,Medica,Medical Assistance,37.018,44.6,,percent of total billed charges,,
AMINOPHYLLINE 250 MG/10 ML IV SOLN,,J0280,HCPCS,Facility,Inpatient,10,mL,,83,70.55,23.7878,83,Medica,Medical Assistance,,,,,Included in per diem rate,
AMINOPHYLLINE 250 MG/10 ML IV SOLN,,J0280,HCPCS,Facility,Outpatient,10,mL,,83,70.55,23.7878,83,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,41.334,49.8,,percent of total billed charges,,
AMINOPHYLLINE 250 MG/10 ML IV SOLN,,J0280,HCPCS,Facility,Inpatient,10,mL,,83,70.55,23.7878,83,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
AMINOPHYLLINE 250 MG/10 ML IV SOLN,,J0280,HCPCS,Facility,Both,10,mL,,83,70.55,23.7878,83,"Multiplan, Inc.","Multiplan, Inc.",78.02,94,,percent of total billed charges,,
AMINOPHYLLINE 250 MG/10 ML IV SOLN,,J0280,HCPCS,Facility,Outpatient,10,mL,,83,70.55,23.7878,83,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,74.783,90.1,,percent of total billed charges,,
AMINOPHYLLINE 250 MG/10 ML IV SOLN,,J0280,HCPCS,Facility,Inpatient,10,mL,,83,70.55,23.7878,83,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
AMINOPHYLLINE 250 MG/10 ML IV SOLN,,J0280,HCPCS,Facility,Both,10,mL,,83,70.55,23.7878,83,"Preferred One Administrative Services, INC.",PPO,81.838,98.6,,percent of total billed charges,,
AMINOPHYLLINE 250 MG/10 ML IV SOLN,,J0280,HCPCS,Facility,Outpatient,10,mL,,83,70.55,23.7878,83,PrimeWest Health,Minnesota Senior Health Options (MSHO),42.7035,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
AMINOPHYLLINE 250 MG/10 ML IV SOLN,,J0280,HCPCS,Facility,Inpatient,10,mL,,83,70.55,23.7878,83,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
AMINOPHYLLINE 250 MG/10 ML IV SOLN,,J0280,HCPCS,Facility,Outpatient,10,mL,,83,70.55,23.7878,83,PrimeWest Health,MinnesotaCare,42.6288,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
AMINOPHYLLINE 250 MG/10 ML IV SOLN,,J0280,HCPCS,Facility,Inpatient,10,mL,,83,70.55,23.7878,83,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
AMINOPHYLLINE 250 MG/10 ML IV SOLN,,J0280,HCPCS,Facility,Both,10,mL,,83,70.55,23.7878,83,Sanford Health Plan,Sanford Health Plan,76.36,92,,percent of total billed charges,,
AMINOPHYLLINE 250 MG/10 ML IV SOLN,,J0280,HCPCS,Facility,Outpatient,10,mL,,83,70.55,23.7878,83,"UCare Health, Inc.",Individual & Family Plan,46.7705,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
AMINOPHYLLINE 250 MG/10 ML IV SOLN,,J0280,HCPCS,Facility,Inpatient,10,mL,,83,70.55,23.7878,83,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
AMINOPHYLLINE 250 MG/10 ML IV SOLN,,J0280,HCPCS,Facility,Outpatient,10,mL,,83,70.55,23.7878,83,"UCare Health, Inc.",Medical Assistance,41.8901,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
AMINOPHYLLINE 250 MG/10 ML IV SOLN,,J0280,HCPCS,Facility,Inpatient,10,mL,,83,70.55,23.7878,83,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
AMINOPHYLLINE 250 MG/10 ML IV SOLN,,J0280,HCPCS,Facility,Outpatient,10,mL,,83,70.55,23.7878,83,"UCare Health, Inc.",Medicare Advantage,41.8901,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
AMINOPHYLLINE 250 MG/10 ML IV SOLN,,J0280,HCPCS,Facility,Inpatient,10,mL,,83,70.55,23.7878,83,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
AMINOPHYLLINE 250 MG/10 ML IV SOLN,,J0280,HCPCS,Facility,Outpatient,10,mL,,83,70.55,23.7878,83,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),41.8901,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
AMINOPHYLLINE 250 MG/10 ML IV SOLN,,J0280,HCPCS,Facility,Inpatient,10,mL,,83,70.55,23.7878,83,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
AMINOPHYLLINE 250 MG/10 ML IV SOLN,,J0280,HCPCS,Facility,Both,10,mL,,83,70.55,23.7878,83,UnitedHealthcare,Individual & Family,78.02,94,,percent of total billed charges,,
AMINOPHYLLINE 250 MG/10 ML IV SOLN,,J0280,HCPCS,Facility,Outpatient,10,mL,,83,70.55,23.7878,83,UnitedHealthcare,Medicare Advantage,40.67,49,,percent of total billed charges,,
AMINOPHYLLINE 250 MG/10 ML IV SOLN,,J0280,HCPCS,Facility,Inpatient,10,mL,,83,70.55,23.7878,83,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
AMINOPHYLLINE 250 MG/10 ML IV SOLN,,J0280,HCPCS,Facility,Outpatient,10,mL,,83,70.55,23.7878,83,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,39.84,48,,percent of total billed charges,,100% of DHS outpatient percentage
AMINOPHYLLINE 250 MG/10 ML IV SOLN,,J0280,HCPCS,Facility,Inpatient,10,mL,,83,70.55,23.7878,83,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML (10 ML) INJ WRAPPER,,J0330,HCPCS,Facility,Both,10,mL,,104,88.4,29.8064,104,Aetna,Commercial,95.68,92,,percent of total billed charges,,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML (10 ML) INJ WRAPPER,,J0330,HCPCS,Facility,Outpatient,10,mL,,104,88.4,29.8064,104,Aetna,Medicare Advantage,50.96,49,,percent of total billed charges,,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML (10 ML) INJ WRAPPER,,J0330,HCPCS,Facility,Inpatient,10,mL,,104,88.4,29.8064,104,Aetna,Medicare Advantage,,,,,Included in per diem rate,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML (10 ML) INJ WRAPPER,,J0330,HCPCS,Facility,Both,10,mL,,104,88.4,29.8064,104,Aetna,PPO,96.72,93,,percent of total billed charges,,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML (10 ML) INJ WRAPPER,,J0330,HCPCS,Facility,Both,10,mL,,104,88.4,29.8064,104,America's PPO,America's PPO,99.8712,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SUCCINYLCHOLINE CHLORIDE 20 MG/ML (10 ML) INJ WRAPPER,,J0330,HCPCS,Facility,Both,10,mL,,104,88.4,29.8064,104,BlueCross BlueShield Minnesota, Federal Employee Program,102.336,98.4,,percent of total billed charges,,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML (10 ML) INJ WRAPPER,,J0330,HCPCS,Facility,Both,10,mL,,104,88.4,29.8064,104,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,104,100,,percent of total billed charges,,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML (10 ML) INJ WRAPPER,,J0330,HCPCS,Facility,Both,10,mL,,104,88.4,29.8064,104,BlueCross BlueShield Minnesota,High Value Network Plan,93.6,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
SUCCINYLCHOLINE CHLORIDE 20 MG/ML (10 ML) INJ WRAPPER,,J0330,HCPCS,Facility,Outpatient,10,mL,,104,88.4,29.8064,104,BlueCross BlueShield Minnesota,Medicare Advantage,50.96,49,,percent of total billed charges,,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML (10 ML) INJ WRAPPER,,J0330,HCPCS,Facility,Inpatient,10,mL,,104,88.4,29.8064,104,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML (10 ML) INJ WRAPPER,,J0330,HCPCS,Facility,Both,10,mL,,104,88.4,29.8064,104,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,92.1128,88.57,,percent of total billed charges,,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML (10 ML) INJ WRAPPER,,J0330,HCPCS,Facility,Both,10,mL,,104,88.4,29.8064,104,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,29.8064,28.66,,percent of total billed charges,,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML (10 ML) INJ WRAPPER,,J0330,HCPCS,Facility,Outpatient,10,mL,,104,88.4,29.8064,104,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),50.96,49,,percent of total billed charges,,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML (10 ML) INJ WRAPPER,,J0330,HCPCS,Facility,Inpatient,10,mL,,104,88.4,29.8064,104,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML (10 ML) INJ WRAPPER,,J0330,HCPCS,Facility,Both,10,mL,,104,88.4,29.8064,104,CorVel,Worker's Compensation,104,100,,percent of total billed charges,,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML (10 ML) INJ WRAPPER,,J0330,HCPCS,Facility,Both,10,mL,,104,88.4,29.8064,104,First Health Group Corporation,First Health Network,100.88,97,,percent of total billed charges,,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML (10 ML) INJ WRAPPER,,J0330,HCPCS,Facility,Both,10,mL,,104,88.4,29.8064,104,"Health Partners, Inc.",Commercial,98.384,94.6,,percent of total billed charges,,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML (10 ML) INJ WRAPPER,,J0330,HCPCS,Facility,Outpatient,10,mL,,104,88.4,29.8064,104,"Health Partners, Inc.",Medicare Advantage,50.96,49,,percent of total billed charges,,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML (10 ML) INJ WRAPPER,,J0330,HCPCS,Facility,Inpatient,10,mL,,104,88.4,29.8064,104,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML (10 ML) INJ WRAPPER,,J0330,HCPCS,Facility,Both,10,mL,,104,88.4,29.8064,104,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),62.4,60,,percent of total billed charges,,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML (10 ML) INJ WRAPPER,,J0330,HCPCS,Facility,Both,10,mL,,104,88.4,29.8064,104,"Health Partners, Inc.",State of Minnesota Advantage Program,84.76,81.5,,percent of total billed charges,,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML (10 ML) INJ WRAPPER,,J0330,HCPCS,Facility,Both,10,mL,,104,88.4,29.8064,104,"Health Partners, Inc.",State Public Programs,52,50,,percent of total billed charges,,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML (10 ML) INJ WRAPPER,,J0330,HCPCS,Facility,Both,10,mL,,104,88.4,29.8064,104,Humana Insurance Company,Commercial PPO,98.8,95,,percent of total billed charges,,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML (10 ML) INJ WRAPPER,,J0330,HCPCS,Facility,Outpatient,10,mL,,104,88.4,29.8064,104,Humana Insurance Company,Medicare PPO,50.96,49,,percent of total billed charges,,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML (10 ML) INJ WRAPPER,,J0330,HCPCS,Facility,Inpatient,10,mL,,104,88.4,29.8064,104,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML (10 ML) INJ WRAPPER,,J0330,HCPCS,Facility,Both,10,mL,,104,88.4,29.8064,104,Medica,Individual & Family,103.064,99.1,,percent of total billed charges,,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML (10 ML) INJ WRAPPER,,J0330,HCPCS,Facility,Outpatient,10,mL,,104,88.4,29.8064,104,Medica,Medica Advantage Solution,51.792,49.8,,percent of total billed charges,,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML (10 ML) INJ WRAPPER,,J0330,HCPCS,Facility,Inpatient,10,mL,,104,88.4,29.8064,104,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML (10 ML) INJ WRAPPER,,J0330,HCPCS,Facility,Outpatient,10,mL,,104,88.4,29.8064,104,Medica,Medical Assistance,46.384,44.6,,percent of total billed charges,,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML (10 ML) INJ WRAPPER,,J0330,HCPCS,Facility,Inpatient,10,mL,,104,88.4,29.8064,104,Medica,Medical Assistance,,,,,Included in per diem rate,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML (10 ML) INJ WRAPPER,,J0330,HCPCS,Facility,Outpatient,10,mL,,104,88.4,29.8064,104,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,51.792,49.8,,percent of total billed charges,,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML (10 ML) INJ WRAPPER,,J0330,HCPCS,Facility,Inpatient,10,mL,,104,88.4,29.8064,104,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML (10 ML) INJ WRAPPER,,J0330,HCPCS,Facility,Both,10,mL,,104,88.4,29.8064,104,"Multiplan, Inc.","Multiplan, Inc.",97.76,94,,percent of total billed charges,,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML (10 ML) INJ WRAPPER,,J0330,HCPCS,Facility,Outpatient,10,mL,,104,88.4,29.8064,104,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,93.704,90.1,,percent of total billed charges,,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML (10 ML) INJ WRAPPER,,J0330,HCPCS,Facility,Inpatient,10,mL,,104,88.4,29.8064,104,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML (10 ML) INJ WRAPPER,,J0330,HCPCS,Facility,Both,10,mL,,104,88.4,29.8064,104,"Preferred One Administrative Services, INC.",PPO,102.544,98.6,,percent of total billed charges,,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML (10 ML) INJ WRAPPER,,J0330,HCPCS,Facility,Outpatient,10,mL,,104,88.4,29.8064,104,PrimeWest Health,Minnesota Senior Health Options (MSHO),53.508,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
SUCCINYLCHOLINE CHLORIDE 20 MG/ML (10 ML) INJ WRAPPER,,J0330,HCPCS,Facility,Inpatient,10,mL,,104,88.4,29.8064,104,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML (10 ML) INJ WRAPPER,,J0330,HCPCS,Facility,Outpatient,10,mL,,104,88.4,29.8064,104,PrimeWest Health,MinnesotaCare,53.4144,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
SUCCINYLCHOLINE CHLORIDE 20 MG/ML (10 ML) INJ WRAPPER,,J0330,HCPCS,Facility,Inpatient,10,mL,,104,88.4,29.8064,104,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML (10 ML) INJ WRAPPER,,J0330,HCPCS,Facility,Both,10,mL,,104,88.4,29.8064,104,Sanford Health Plan,Sanford Health Plan,95.68,92,,percent of total billed charges,,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML (10 ML) INJ WRAPPER,,J0330,HCPCS,Facility,Outpatient,10,mL,,104,88.4,29.8064,104,"UCare Health, Inc.",Individual & Family Plan,58.604,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
SUCCINYLCHOLINE CHLORIDE 20 MG/ML (10 ML) INJ WRAPPER,,J0330,HCPCS,Facility,Inpatient,10,mL,,104,88.4,29.8064,104,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML (10 ML) INJ WRAPPER,,J0330,HCPCS,Facility,Outpatient,10,mL,,104,88.4,29.8064,104,"UCare Health, Inc.",Medical Assistance,52.4888,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUCCINYLCHOLINE CHLORIDE 20 MG/ML (10 ML) INJ WRAPPER,,J0330,HCPCS,Facility,Inpatient,10,mL,,104,88.4,29.8064,104,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML (10 ML) INJ WRAPPER,,J0330,HCPCS,Facility,Outpatient,10,mL,,104,88.4,29.8064,104,"UCare Health, Inc.",Medicare Advantage,52.4888,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUCCINYLCHOLINE CHLORIDE 20 MG/ML (10 ML) INJ WRAPPER,,J0330,HCPCS,Facility,Inpatient,10,mL,,104,88.4,29.8064,104,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML (10 ML) INJ WRAPPER,,J0330,HCPCS,Facility,Outpatient,10,mL,,104,88.4,29.8064,104,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),52.4888,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUCCINYLCHOLINE CHLORIDE 20 MG/ML (10 ML) INJ WRAPPER,,J0330,HCPCS,Facility,Inpatient,10,mL,,104,88.4,29.8064,104,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML (10 ML) INJ WRAPPER,,J0330,HCPCS,Facility,Both,10,mL,,104,88.4,29.8064,104,UnitedHealthcare,Individual & Family,97.76,94,,percent of total billed charges,,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML (10 ML) INJ WRAPPER,,J0330,HCPCS,Facility,Outpatient,10,mL,,104,88.4,29.8064,104,UnitedHealthcare,Medicare Advantage,50.96,49,,percent of total billed charges,,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML (10 ML) INJ WRAPPER,,J0330,HCPCS,Facility,Inpatient,10,mL,,104,88.4,29.8064,104,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML (10 ML) INJ WRAPPER,,J0330,HCPCS,Facility,Outpatient,10,mL,,104,88.4,29.8064,104,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,49.92,48,,percent of total billed charges,,100% of DHS outpatient percentage
SUCCINYLCHOLINE CHLORIDE 20 MG/ML (10 ML) INJ WRAPPER,,J0330,HCPCS,Facility,Inpatient,10,mL,,104,88.4,29.8064,104,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Basic Metabolic Panel,,80048,CPT,Facility,Both,,,,179,152.15,53.34,179,Aetna,Commercial,164.68,92,,percent of total billed charges,,
Basic Metabolic Panel,,80048,CPT,Facility,Outpatient,,,,179,152.15,53.34,179,Aetna,Medicare Advantage,87.71,49,,percent of total billed charges,,
Basic Metabolic Panel,,80048,CPT,Facility,Inpatient,,,,179,152.15,53.34,179,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Basic Metabolic Panel,,80048,CPT,Facility,Both,,,,179,152.15,53.34,179,Aetna,PPO,166.47,93,,percent of total billed charges,,
Basic Metabolic Panel,,80048,CPT,Facility,Both,,,,179,152.15,53.34,179,America's PPO,America's PPO,171.8937,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Basic Metabolic Panel,,80048,CPT,Facility,Both,,,,179,152.15,53.34,179,BlueCross BlueShield Minnesota, Federal Employee Program,105,,,Fee schedule,,100% of BCBS commercial commodity fee schedule
Basic Metabolic Panel,,80048,CPT,Facility,Both,,,,179,152.15,53.34,179,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,106.68,,,Fee schedule,,"100% of BCBS commercial commodity fee schedule, plus MN Care tax"
Basic Metabolic Panel,,80048,CPT,Facility,Both,,,,179,152.15,53.34,179,BlueCross BlueShield Minnesota,High Value Network Plan,96.012,,,Fee schedule,,"90% of BCBS commercial commodity fee schedule, plus MN Care tax; see disclaimer for more information"
Basic Metabolic Panel,,80048,CPT,Facility,Outpatient,,,,179,152.15,53.34,179,BlueCross BlueShield Minnesota,Medicare Advantage,87.71,49,,percent of total billed charges,,
Basic Metabolic Panel,,80048,CPT,Facility,Inpatient,,,,179,152.15,53.34,179,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Basic Metabolic Panel,,80048,CPT,Facility,Both,,,,179,152.15,53.34,179,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,94.486476,,,Fee schedule,,"88.57% of BCBS commercial commodity fee schedule, plus MN Care tax"
Basic Metabolic Panel,,80048,CPT,Facility,Both,,,,179,152.15,53.34,179,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,53.34,,,Fee schedule,,"100% of BCBS Medicaid commodity fee schedule, plus MN Care tax"
Basic Metabolic Panel,,80048,CPT,Facility,Outpatient,,,,179,152.15,53.34,179,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),87.71,49,,percent of total billed charges,,
Basic Metabolic Panel,,80048,CPT,Facility,Inpatient,,,,179,152.15,53.34,179,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Basic Metabolic Panel,,80048,CPT,Facility,Both,,,,179,152.15,53.34,179,CorVel,Worker's Compensation,179,100,,percent of total billed charges,,
Basic Metabolic Panel,,80048,CPT,Facility,Both,,,,179,152.15,53.34,179,First Health Group Corporation,First Health Network,173.63,97,,percent of total billed charges,,
Basic Metabolic Panel,,80048,CPT,Facility,Both,,,,179,152.15,53.34,179,"Health Partners, Inc.",Commercial,169.334,94.6,,percent of total billed charges,,
Basic Metabolic Panel,,80048,CPT,Facility,Outpatient,,,,179,152.15,53.34,179,"Health Partners, Inc.",Medicare Advantage,87.71,49,,percent of total billed charges,,
Basic Metabolic Panel,,80048,CPT,Facility,Inpatient,,,,179,152.15,53.34,179,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Basic Metabolic Panel,,80048,CPT,Facility,Both,,,,179,152.15,53.34,179,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),107.4,60,,percent of total billed charges,,
Basic Metabolic Panel,,80048,CPT,Facility,Both,,,,179,152.15,53.34,179,"Health Partners, Inc.",State of Minnesota Advantage Program,145.885,81.5,,percent of total billed charges,,
Basic Metabolic Panel,,80048,CPT,Facility,Both,,,,179,152.15,53.34,179,"Health Partners, Inc.",State Public Programs,89.5,50,,percent of total billed charges,,
Basic Metabolic Panel,,80048,CPT,Facility,Both,,,,179,152.15,53.34,179,Humana Insurance Company,Commercial PPO,170.05,95,,percent of total billed charges,,
Basic Metabolic Panel,,80048,CPT,Facility,Outpatient,,,,179,152.15,53.34,179,Humana Insurance Company,Medicare PPO,87.71,49,,percent of total billed charges,,
Basic Metabolic Panel,,80048,CPT,Facility,Inpatient,,,,179,152.15,53.34,179,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Basic Metabolic Panel,,80048,CPT,Facility,Both,,,,179,152.15,53.34,179,Medica,Individual & Family,177.389,99.1,,percent of total billed charges,,
Basic Metabolic Panel,,80048,CPT,Facility,Outpatient,,,,179,152.15,53.34,179,Medica,Medica Advantage Solution,89.142,49.8,,percent of total billed charges,,
Basic Metabolic Panel,,80048,CPT,Facility,Inpatient,,,,179,152.15,53.34,179,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Basic Metabolic Panel,,80048,CPT,Facility,Outpatient,,,,179,152.15,53.34,179,Medica,Medical Assistance,79.834,44.6,,percent of total billed charges,,
Basic Metabolic Panel,,80048,CPT,Facility,Inpatient,,,,179,152.15,53.34,179,Medica,Medical Assistance,,,,,Included in per diem rate,
Basic Metabolic Panel,,80048,CPT,Facility,Outpatient,,,,179,152.15,53.34,179,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,89.142,49.8,,percent of total billed charges,,
Basic Metabolic Panel,,80048,CPT,Facility,Inpatient,,,,179,152.15,53.34,179,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Basic Metabolic Panel,,80048,CPT,Facility,Both,,,,179,152.15,53.34,179,"Multiplan, Inc.","Multiplan, Inc.",168.26,94,,percent of total billed charges,,
Basic Metabolic Panel,,80048,CPT,Facility,Outpatient,,,,179,152.15,53.34,179,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,154.656,86.4,,percent of total billed charges,,
Basic Metabolic Panel,,80048,CPT,Facility,Inpatient,,,,179,152.15,53.34,179,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Basic Metabolic Panel,,80048,CPT,Facility,Both,,,,179,152.15,53.34,179,"Preferred One Administrative Services, INC.",PPO,176.494,98.6,,percent of total billed charges,,
Basic Metabolic Panel,,80048,CPT,Facility,Outpatient,,,,179,152.15,53.34,179,PrimeWest Health,Minnesota Senior Health Options (MSHO),92.0955,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Basic Metabolic Panel,,80048,CPT,Facility,Inpatient,,,,179,152.15,53.34,179,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Basic Metabolic Panel,,80048,CPT,Facility,Outpatient,,,,179,152.15,53.34,179,PrimeWest Health,MinnesotaCare,91.9344,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Basic Metabolic Panel,,80048,CPT,Facility,Inpatient,,,,179,152.15,53.34,179,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Basic Metabolic Panel,,80048,CPT,Facility,Both,,,,179,152.15,53.34,179,Sanford Health Plan,Sanford Health Plan,164.68,92,,percent of total billed charges,,
Basic Metabolic Panel,,80048,CPT,Facility,Outpatient,,,,179,152.15,53.34,179,"UCare Health, Inc.",Individual & Family Plan,100.8665,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Basic Metabolic Panel,,80048,CPT,Facility,Inpatient,,,,179,152.15,53.34,179,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Basic Metabolic Panel,,80048,CPT,Facility,Outpatient,,,,179,152.15,53.34,179,"UCare Health, Inc.",Medical Assistance,90.3413,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Basic Metabolic Panel,,80048,CPT,Facility,Inpatient,,,,179,152.15,53.34,179,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Basic Metabolic Panel,,80048,CPT,Facility,Outpatient,,,,179,152.15,53.34,179,"UCare Health, Inc.",Medicare Advantage,90.3413,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Basic Metabolic Panel,,80048,CPT,Facility,Inpatient,,,,179,152.15,53.34,179,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Basic Metabolic Panel,,80048,CPT,Facility,Outpatient,,,,179,152.15,53.34,179,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),90.3413,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Basic Metabolic Panel,,80048,CPT,Facility,Inpatient,,,,179,152.15,53.34,179,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Basic Metabolic Panel,,80048,CPT,Facility,Both,,,,179,152.15,53.34,179,UnitedHealthcare,Individual & Family,168.26,94,,percent of total billed charges,,
Basic Metabolic Panel,,80048,CPT,Facility,Outpatient,,,,179,152.15,53.34,179,UnitedHealthcare,Medicare Advantage,87.71,49,,percent of total billed charges,,
Basic Metabolic Panel,,80048,CPT,Facility,Inpatient,,,,179,152.15,53.34,179,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Basic Metabolic Panel,,80048,CPT,Facility,Outpatient,,,,179,152.15,53.34,179,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,85.92,48,,percent of total billed charges,,100% of DHS outpatient percentage
Basic Metabolic Panel,,80048,CPT,Facility,Inpatient,,,,179,152.15,53.34,179,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Electrolytes,,80051,CPT,Facility,Both,,,,103,87.55,29.5198,103,Aetna,Commercial,94.76,92,,percent of total billed charges,,
Electrolytes,,80051,CPT,Facility,Outpatient,,,,103,87.55,29.5198,103,Aetna,Medicare Advantage,50.47,49,,percent of total billed charges,,
Electrolytes,,80051,CPT,Facility,Inpatient,,,,103,87.55,29.5198,103,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Electrolytes,,80051,CPT,Facility,Both,,,,103,87.55,29.5198,103,Aetna,PPO,95.79,93,,percent of total billed charges,,
Electrolytes,,80051,CPT,Facility,Both,,,,103,87.55,29.5198,103,America's PPO,America's PPO,98.9109,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Electrolytes,,80051,CPT,Facility,Both,,,,103,87.55,29.5198,103,BlueCross BlueShield Minnesota, Federal Employee Program,101.352,98.4,,percent of total billed charges,,
Electrolytes,,80051,CPT,Facility,Both,,,,103,87.55,29.5198,103,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,103,100,,percent of total billed charges,,
Electrolytes,,80051,CPT,Facility,Both,,,,103,87.55,29.5198,103,BlueCross BlueShield Minnesota,High Value Network Plan,92.7,90,,percent of total billed charges,,
Electrolytes,,80051,CPT,Facility,Outpatient,,,,103,87.55,29.5198,103,BlueCross BlueShield Minnesota,Medicare Advantage,50.47,49,,percent of total billed charges,,
Electrolytes,,80051,CPT,Facility,Inpatient,,,,103,87.55,29.5198,103,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Electrolytes,,80051,CPT,Facility,Both,,,,103,87.55,29.5198,103,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,91.2271,88.57,,percent of total billed charges,,
Electrolytes,,80051,CPT,Facility,Both,,,,103,87.55,29.5198,103,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,29.5198,28.66,,percent of total billed charges,,
Electrolytes,,80051,CPT,Facility,Outpatient,,,,103,87.55,29.5198,103,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),50.47,49,,percent of total billed charges,,
Electrolytes,,80051,CPT,Facility,Inpatient,,,,103,87.55,29.5198,103,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Electrolytes,,80051,CPT,Facility,Both,,,,103,87.55,29.5198,103,CorVel,Worker's Compensation,103,100,,percent of total billed charges,,
Electrolytes,,80051,CPT,Facility,Both,,,,103,87.55,29.5198,103,First Health Group Corporation,First Health Network,99.91,97,,percent of total billed charges,,
Electrolytes,,80051,CPT,Facility,Both,,,,103,87.55,29.5198,103,"Health Partners, Inc.",Commercial,97.438,94.6,,percent of total billed charges,,
Electrolytes,,80051,CPT,Facility,Outpatient,,,,103,87.55,29.5198,103,"Health Partners, Inc.",Medicare Advantage,50.47,49,,percent of total billed charges,,
Electrolytes,,80051,CPT,Facility,Inpatient,,,,103,87.55,29.5198,103,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Electrolytes,,80051,CPT,Facility,Both,,,,103,87.55,29.5198,103,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),61.8,60,,percent of total billed charges,,
Electrolytes,,80051,CPT,Facility,Both,,,,103,87.55,29.5198,103,"Health Partners, Inc.",State of Minnesota Advantage Program,83.945,81.5,,percent of total billed charges,,
Electrolytes,,80051,CPT,Facility,Both,,,,103,87.55,29.5198,103,"Health Partners, Inc.",State Public Programs,51.5,50,,percent of total billed charges,,
Electrolytes,,80051,CPT,Facility,Both,,,,103,87.55,29.5198,103,Humana Insurance Company,Commercial PPO,97.85,95,,percent of total billed charges,,
Electrolytes,,80051,CPT,Facility,Outpatient,,,,103,87.55,29.5198,103,Humana Insurance Company,Medicare PPO,50.47,49,,percent of total billed charges,,
Electrolytes,,80051,CPT,Facility,Inpatient,,,,103,87.55,29.5198,103,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Electrolytes,,80051,CPT,Facility,Both,,,,103,87.55,29.5198,103,Medica,Individual & Family,102.073,99.1,,percent of total billed charges,,
Electrolytes,,80051,CPT,Facility,Outpatient,,,,103,87.55,29.5198,103,Medica,Medica Advantage Solution,51.294,49.8,,percent of total billed charges,,
Electrolytes,,80051,CPT,Facility,Inpatient,,,,103,87.55,29.5198,103,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Electrolytes,,80051,CPT,Facility,Outpatient,,,,103,87.55,29.5198,103,Medica,Medical Assistance,45.938,44.6,,percent of total billed charges,,
Electrolytes,,80051,CPT,Facility,Inpatient,,,,103,87.55,29.5198,103,Medica,Medical Assistance,,,,,Included in per diem rate,
Electrolytes,,80051,CPT,Facility,Outpatient,,,,103,87.55,29.5198,103,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,51.294,49.8,,percent of total billed charges,,
Electrolytes,,80051,CPT,Facility,Inpatient,,,,103,87.55,29.5198,103,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Electrolytes,,80051,CPT,Facility,Both,,,,103,87.55,29.5198,103,"Multiplan, Inc.","Multiplan, Inc.",96.82,94,,percent of total billed charges,,
Electrolytes,,80051,CPT,Facility,Outpatient,,,,103,87.55,29.5198,103,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,88.992,86.4,,percent of total billed charges,,
Electrolytes,,80051,CPT,Facility,Inpatient,,,,103,87.55,29.5198,103,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Electrolytes,,80051,CPT,Facility,Both,,,,103,87.55,29.5198,103,"Preferred One Administrative Services, INC.",PPO,101.558,98.6,,percent of total billed charges,,
Electrolytes,,80051,CPT,Facility,Outpatient,,,,103,87.55,29.5198,103,PrimeWest Health,Minnesota Senior Health Options (MSHO),52.9935,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Electrolytes,,80051,CPT,Facility,Inpatient,,,,103,87.55,29.5198,103,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Electrolytes,,80051,CPT,Facility,Outpatient,,,,103,87.55,29.5198,103,PrimeWest Health,MinnesotaCare,52.9008,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Electrolytes,,80051,CPT,Facility,Inpatient,,,,103,87.55,29.5198,103,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Electrolytes,,80051,CPT,Facility,Both,,,,103,87.55,29.5198,103,Sanford Health Plan,Sanford Health Plan,94.76,92,,percent of total billed charges,,
Electrolytes,,80051,CPT,Facility,Outpatient,,,,103,87.55,29.5198,103,"UCare Health, Inc.",Individual & Family Plan,58.0405,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Electrolytes,,80051,CPT,Facility,Inpatient,,,,103,87.55,29.5198,103,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Electrolytes,,80051,CPT,Facility,Outpatient,,,,103,87.55,29.5198,103,"UCare Health, Inc.",Medical Assistance,51.9841,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Electrolytes,,80051,CPT,Facility,Inpatient,,,,103,87.55,29.5198,103,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Electrolytes,,80051,CPT,Facility,Outpatient,,,,103,87.55,29.5198,103,"UCare Health, Inc.",Medicare Advantage,51.9841,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Electrolytes,,80051,CPT,Facility,Inpatient,,,,103,87.55,29.5198,103,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Electrolytes,,80051,CPT,Facility,Outpatient,,,,103,87.55,29.5198,103,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),51.9841,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Electrolytes,,80051,CPT,Facility,Inpatient,,,,103,87.55,29.5198,103,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Electrolytes,,80051,CPT,Facility,Both,,,,103,87.55,29.5198,103,UnitedHealthcare,Individual & Family,96.82,94,,percent of total billed charges,,
Electrolytes,,80051,CPT,Facility,Outpatient,,,,103,87.55,29.5198,103,UnitedHealthcare,Medicare Advantage,50.47,49,,percent of total billed charges,,
Electrolytes,,80051,CPT,Facility,Inpatient,,,,103,87.55,29.5198,103,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Electrolytes,,80051,CPT,Facility,Outpatient,,,,103,87.55,29.5198,103,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,49.44,48,,percent of total billed charges,,100% of DHS outpatient percentage
Electrolytes,,80051,CPT,Facility,Inpatient,,,,103,87.55,29.5198,103,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Comprehensive Metabolic Panel,,80053,CPT,Facility,Both,,,,265,225.25,68.58,265,Aetna,Commercial,243.8,92,,percent of total billed charges,,
Comprehensive Metabolic Panel,,80053,CPT,Facility,Outpatient,,,,265,225.25,68.58,265,Aetna,Medicare Advantage,129.85,49,,percent of total billed charges,,
Comprehensive Metabolic Panel,,80053,CPT,Facility,Inpatient,,,,265,225.25,68.58,265,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Comprehensive Metabolic Panel,,80053,CPT,Facility,Both,,,,265,225.25,68.58,265,Aetna,PPO,246.45,93,,percent of total billed charges,,
Comprehensive Metabolic Panel,,80053,CPT,Facility,Both,,,,265,225.25,68.58,265,America's PPO,America's PPO,254.4795,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Comprehensive Metabolic Panel,,80053,CPT,Facility,Both,,,,265,225.25,68.58,265,BlueCross BlueShield Minnesota, Federal Employee Program,135,,,Fee schedule,,100% of BCBS commercial commodity fee schedule
Comprehensive Metabolic Panel,,80053,CPT,Facility,Both,,,,265,225.25,68.58,265,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,137.16,,,Fee schedule,,"100% of BCBS commercial commodity fee schedule, plus MN Care tax"
Comprehensive Metabolic Panel,,80053,CPT,Facility,Both,,,,265,225.25,68.58,265,BlueCross BlueShield Minnesota,High Value Network Plan,123.444,,,Fee schedule,,"90% of BCBS commercial commodity fee schedule, plus MN Care tax; see disclaimer for more information"
Comprehensive Metabolic Panel,,80053,CPT,Facility,Outpatient,,,,265,225.25,68.58,265,BlueCross BlueShield Minnesota,Medicare Advantage,129.85,49,,percent of total billed charges,,
Comprehensive Metabolic Panel,,80053,CPT,Facility,Inpatient,,,,265,225.25,68.58,265,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Comprehensive Metabolic Panel,,80053,CPT,Facility,Both,,,,265,225.25,68.58,265,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,121.482612,,,Fee schedule,,"88.57% of BCBS commercial commodity fee schedule, plus MN Care tax"
Comprehensive Metabolic Panel,,80053,CPT,Facility,Both,,,,265,225.25,68.58,265,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,68.58,,,Fee schedule,,"100% of BCBS Medicaid commodity fee schedule, plus MN Care tax"
Comprehensive Metabolic Panel,,80053,CPT,Facility,Outpatient,,,,265,225.25,68.58,265,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),129.85,49,,percent of total billed charges,,
Comprehensive Metabolic Panel,,80053,CPT,Facility,Inpatient,,,,265,225.25,68.58,265,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Comprehensive Metabolic Panel,,80053,CPT,Facility,Both,,,,265,225.25,68.58,265,CorVel,Worker's Compensation,265,100,,percent of total billed charges,,
Comprehensive Metabolic Panel,,80053,CPT,Facility,Both,,,,265,225.25,68.58,265,First Health Group Corporation,First Health Network,257.05,97,,percent of total billed charges,,
Comprehensive Metabolic Panel,,80053,CPT,Facility,Both,,,,265,225.25,68.58,265,"Health Partners, Inc.",Commercial,250.69,94.6,,percent of total billed charges,,
Comprehensive Metabolic Panel,,80053,CPT,Facility,Outpatient,,,,265,225.25,68.58,265,"Health Partners, Inc.",Medicare Advantage,129.85,49,,percent of total billed charges,,
Comprehensive Metabolic Panel,,80053,CPT,Facility,Inpatient,,,,265,225.25,68.58,265,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Comprehensive Metabolic Panel,,80053,CPT,Facility,Both,,,,265,225.25,68.58,265,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),159,60,,percent of total billed charges,,
Comprehensive Metabolic Panel,,80053,CPT,Facility,Both,,,,265,225.25,68.58,265,"Health Partners, Inc.",State of Minnesota Advantage Program,215.975,81.5,,percent of total billed charges,,
Comprehensive Metabolic Panel,,80053,CPT,Facility,Both,,,,265,225.25,68.58,265,"Health Partners, Inc.",State Public Programs,132.5,50,,percent of total billed charges,,
Comprehensive Metabolic Panel,,80053,CPT,Facility,Both,,,,265,225.25,68.58,265,Humana Insurance Company,Commercial PPO,251.75,95,,percent of total billed charges,,
Comprehensive Metabolic Panel,,80053,CPT,Facility,Outpatient,,,,265,225.25,68.58,265,Humana Insurance Company,Medicare PPO,129.85,49,,percent of total billed charges,,
Comprehensive Metabolic Panel,,80053,CPT,Facility,Inpatient,,,,265,225.25,68.58,265,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Comprehensive Metabolic Panel,,80053,CPT,Facility,Both,,,,265,225.25,68.58,265,Medica,Individual & Family,262.615,99.1,,percent of total billed charges,,
Comprehensive Metabolic Panel,,80053,CPT,Facility,Outpatient,,,,265,225.25,68.58,265,Medica,Medica Advantage Solution,131.97,49.8,,percent of total billed charges,,
Comprehensive Metabolic Panel,,80053,CPT,Facility,Inpatient,,,,265,225.25,68.58,265,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Comprehensive Metabolic Panel,,80053,CPT,Facility,Outpatient,,,,265,225.25,68.58,265,Medica,Medical Assistance,118.19,44.6,,percent of total billed charges,,
Comprehensive Metabolic Panel,,80053,CPT,Facility,Inpatient,,,,265,225.25,68.58,265,Medica,Medical Assistance,,,,,Included in per diem rate,
Comprehensive Metabolic Panel,,80053,CPT,Facility,Outpatient,,,,265,225.25,68.58,265,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,131.97,49.8,,percent of total billed charges,,
Comprehensive Metabolic Panel,,80053,CPT,Facility,Inpatient,,,,265,225.25,68.58,265,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Comprehensive Metabolic Panel,,80053,CPT,Facility,Both,,,,265,225.25,68.58,265,"Multiplan, Inc.","Multiplan, Inc.",249.1,94,,percent of total billed charges,,
Comprehensive Metabolic Panel,,80053,CPT,Facility,Outpatient,,,,265,225.25,68.58,265,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,228.96,86.4,,percent of total billed charges,,
Comprehensive Metabolic Panel,,80053,CPT,Facility,Inpatient,,,,265,225.25,68.58,265,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Comprehensive Metabolic Panel,,80053,CPT,Facility,Both,,,,265,225.25,68.58,265,"Preferred One Administrative Services, INC.",PPO,261.29,98.6,,percent of total billed charges,,
Comprehensive Metabolic Panel,,80053,CPT,Facility,Outpatient,,,,265,225.25,68.58,265,PrimeWest Health,Minnesota Senior Health Options (MSHO),136.3425,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Comprehensive Metabolic Panel,,80053,CPT,Facility,Inpatient,,,,265,225.25,68.58,265,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Comprehensive Metabolic Panel,,80053,CPT,Facility,Outpatient,,,,265,225.25,68.58,265,PrimeWest Health,MinnesotaCare,136.104,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Comprehensive Metabolic Panel,,80053,CPT,Facility,Inpatient,,,,265,225.25,68.58,265,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Comprehensive Metabolic Panel,,80053,CPT,Facility,Both,,,,265,225.25,68.58,265,Sanford Health Plan,Sanford Health Plan,243.8,92,,percent of total billed charges,,
Comprehensive Metabolic Panel,,80053,CPT,Facility,Outpatient,,,,265,225.25,68.58,265,"UCare Health, Inc.",Individual & Family Plan,149.3275,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Comprehensive Metabolic Panel,,80053,CPT,Facility,Inpatient,,,,265,225.25,68.58,265,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Comprehensive Metabolic Panel,,80053,CPT,Facility,Outpatient,,,,265,225.25,68.58,265,"UCare Health, Inc.",Medical Assistance,133.7455,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Comprehensive Metabolic Panel,,80053,CPT,Facility,Inpatient,,,,265,225.25,68.58,265,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Comprehensive Metabolic Panel,,80053,CPT,Facility,Outpatient,,,,265,225.25,68.58,265,"UCare Health, Inc.",Medicare Advantage,133.7455,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Comprehensive Metabolic Panel,,80053,CPT,Facility,Inpatient,,,,265,225.25,68.58,265,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Comprehensive Metabolic Panel,,80053,CPT,Facility,Outpatient,,,,265,225.25,68.58,265,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),133.7455,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Comprehensive Metabolic Panel,,80053,CPT,Facility,Inpatient,,,,265,225.25,68.58,265,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Comprehensive Metabolic Panel,,80053,CPT,Facility,Both,,,,265,225.25,68.58,265,UnitedHealthcare,Individual & Family,249.1,94,,percent of total billed charges,,
Comprehensive Metabolic Panel,,80053,CPT,Facility,Outpatient,,,,265,225.25,68.58,265,UnitedHealthcare,Medicare Advantage,129.85,49,,percent of total billed charges,,
Comprehensive Metabolic Panel,,80053,CPT,Facility,Inpatient,,,,265,225.25,68.58,265,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Comprehensive Metabolic Panel,,80053,CPT,Facility,Outpatient,,,,265,225.25,68.58,265,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,127.2,48,,percent of total billed charges,,100% of DHS outpatient percentage
Comprehensive Metabolic Panel,,80053,CPT,Facility,Inpatient,,,,265,225.25,68.58,265,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Lipid Panel,,80061,CPT,Facility,Both,,,,133,113.05,43.18,133,Aetna,Commercial,122.36,92,,percent of total billed charges,,
Lipid Panel,,80061,CPT,Facility,Outpatient,,,,133,113.05,43.18,133,Aetna,Medicare Advantage,65.17,49,,percent of total billed charges,,
Lipid Panel,,80061,CPT,Facility,Inpatient,,,,133,113.05,43.18,133,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Lipid Panel,,80061,CPT,Facility,Both,,,,133,113.05,43.18,133,Aetna,PPO,123.69,93,,percent of total billed charges,,
Lipid Panel,,80061,CPT,Facility,Both,,,,133,113.05,43.18,133,America's PPO,America's PPO,127.7199,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Lipid Panel,,80061,CPT,Facility,Both,,,,133,113.05,43.18,133,BlueCross BlueShield Minnesota, Federal Employee Program,85,,,Fee schedule,,100% of BCBS commercial commodity fee schedule
Lipid Panel,,80061,CPT,Facility,Both,,,,133,113.05,43.18,133,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,86.36,,,Fee schedule,,"100% of BCBS commercial commodity fee schedule, plus MN Care tax"
Lipid Panel,,80061,CPT,Facility,Both,,,,133,113.05,43.18,133,BlueCross BlueShield Minnesota,High Value Network Plan,77.724,,,Fee schedule,,"90% of BCBS commercial commodity fee schedule, plus MN Care tax; see disclaimer for more information"
Lipid Panel,,80061,CPT,Facility,Outpatient,,,,133,113.05,43.18,133,BlueCross BlueShield Minnesota,Medicare Advantage,65.17,49,,percent of total billed charges,,
Lipid Panel,,80061,CPT,Facility,Inpatient,,,,133,113.05,43.18,133,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Lipid Panel,,80061,CPT,Facility,Both,,,,133,113.05,43.18,133,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,76.489052,,,Fee schedule,,"88.57% of BCBS commercial commodity fee schedule, plus MN Care tax"
Lipid Panel,,80061,CPT,Facility,Both,,,,133,113.05,43.18,133,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,43.18,,,Fee schedule,,"100% of BCBS Medicaid commodity fee schedule, plus MN Care tax"
Lipid Panel,,80061,CPT,Facility,Outpatient,,,,133,113.05,43.18,133,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),65.17,49,,percent of total billed charges,,
Lipid Panel,,80061,CPT,Facility,Inpatient,,,,133,113.05,43.18,133,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Lipid Panel,,80061,CPT,Facility,Both,,,,133,113.05,43.18,133,CorVel,Worker's Compensation,133,100,,percent of total billed charges,,
Lipid Panel,,80061,CPT,Facility,Both,,,,133,113.05,43.18,133,First Health Group Corporation,First Health Network,129.01,97,,percent of total billed charges,,
Lipid Panel,,80061,CPT,Facility,Both,,,,133,113.05,43.18,133,"Health Partners, Inc.",Commercial,125.818,94.6,,percent of total billed charges,,
Lipid Panel,,80061,CPT,Facility,Outpatient,,,,133,113.05,43.18,133,"Health Partners, Inc.",Medicare Advantage,65.17,49,,percent of total billed charges,,
Lipid Panel,,80061,CPT,Facility,Inpatient,,,,133,113.05,43.18,133,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Lipid Panel,,80061,CPT,Facility,Both,,,,133,113.05,43.18,133,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),79.8,60,,percent of total billed charges,,
Lipid Panel,,80061,CPT,Facility,Both,,,,133,113.05,43.18,133,"Health Partners, Inc.",State of Minnesota Advantage Program,108.395,81.5,,percent of total billed charges,,
Lipid Panel,,80061,CPT,Facility,Both,,,,133,113.05,43.18,133,"Health Partners, Inc.",State Public Programs,66.5,50,,percent of total billed charges,,
Lipid Panel,,80061,CPT,Facility,Both,,,,133,113.05,43.18,133,Humana Insurance Company,Commercial PPO,126.35,95,,percent of total billed charges,,
Lipid Panel,,80061,CPT,Facility,Outpatient,,,,133,113.05,43.18,133,Humana Insurance Company,Medicare PPO,65.17,49,,percent of total billed charges,,
Lipid Panel,,80061,CPT,Facility,Inpatient,,,,133,113.05,43.18,133,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Lipid Panel,,80061,CPT,Facility,Both,,,,133,113.05,43.18,133,Medica,Individual & Family,131.803,99.1,,percent of total billed charges,,
Lipid Panel,,80061,CPT,Facility,Outpatient,,,,133,113.05,43.18,133,Medica,Medica Advantage Solution,66.234,49.8,,percent of total billed charges,,
Lipid Panel,,80061,CPT,Facility,Inpatient,,,,133,113.05,43.18,133,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Lipid Panel,,80061,CPT,Facility,Outpatient,,,,133,113.05,43.18,133,Medica,Medical Assistance,59.318,44.6,,percent of total billed charges,,
Lipid Panel,,80061,CPT,Facility,Inpatient,,,,133,113.05,43.18,133,Medica,Medical Assistance,,,,,Included in per diem rate,
Lipid Panel,,80061,CPT,Facility,Outpatient,,,,133,113.05,43.18,133,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,66.234,49.8,,percent of total billed charges,,
Lipid Panel,,80061,CPT,Facility,Inpatient,,,,133,113.05,43.18,133,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Lipid Panel,,80061,CPT,Facility,Both,,,,133,113.05,43.18,133,"Multiplan, Inc.","Multiplan, Inc.",125.02,94,,percent of total billed charges,,
Lipid Panel,,80061,CPT,Facility,Outpatient,,,,133,113.05,43.18,133,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,114.912,86.4,,percent of total billed charges,,
Lipid Panel,,80061,CPT,Facility,Inpatient,,,,133,113.05,43.18,133,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Lipid Panel,,80061,CPT,Facility,Both,,,,133,113.05,43.18,133,"Preferred One Administrative Services, INC.",PPO,131.138,98.6,,percent of total billed charges,,
Lipid Panel,,80061,CPT,Facility,Outpatient,,,,133,113.05,43.18,133,PrimeWest Health,Minnesota Senior Health Options (MSHO),68.4285,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Lipid Panel,,80061,CPT,Facility,Inpatient,,,,133,113.05,43.18,133,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Lipid Panel,,80061,CPT,Facility,Outpatient,,,,133,113.05,43.18,133,PrimeWest Health,MinnesotaCare,68.3088,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Lipid Panel,,80061,CPT,Facility,Inpatient,,,,133,113.05,43.18,133,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Lipid Panel,,80061,CPT,Facility,Both,,,,133,113.05,43.18,133,Sanford Health Plan,Sanford Health Plan,122.36,92,,percent of total billed charges,,
Lipid Panel,,80061,CPT,Facility,Outpatient,,,,133,113.05,43.18,133,"UCare Health, Inc.",Individual & Family Plan,74.9455,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Lipid Panel,,80061,CPT,Facility,Inpatient,,,,133,113.05,43.18,133,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Lipid Panel,,80061,CPT,Facility,Outpatient,,,,133,113.05,43.18,133,"UCare Health, Inc.",Medical Assistance,67.1251,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Lipid Panel,,80061,CPT,Facility,Inpatient,,,,133,113.05,43.18,133,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Lipid Panel,,80061,CPT,Facility,Outpatient,,,,133,113.05,43.18,133,"UCare Health, Inc.",Medicare Advantage,67.1251,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Lipid Panel,,80061,CPT,Facility,Inpatient,,,,133,113.05,43.18,133,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Lipid Panel,,80061,CPT,Facility,Outpatient,,,,133,113.05,43.18,133,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),67.1251,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Lipid Panel,,80061,CPT,Facility,Inpatient,,,,133,113.05,43.18,133,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Lipid Panel,,80061,CPT,Facility,Both,,,,133,113.05,43.18,133,UnitedHealthcare,Individual & Family,125.02,94,,percent of total billed charges,,
Lipid Panel,,80061,CPT,Facility,Outpatient,,,,133,113.05,43.18,133,UnitedHealthcare,Medicare Advantage,65.17,49,,percent of total billed charges,,
Lipid Panel,,80061,CPT,Facility,Inpatient,,,,133,113.05,43.18,133,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Lipid Panel,,80061,CPT,Facility,Outpatient,,,,133,113.05,43.18,133,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,63.84,48,,percent of total billed charges,,100% of DHS outpatient percentage
Lipid Panel,,80061,CPT,Facility,Inpatient,,,,133,113.05,43.18,133,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Renal Function Panel,,80069,CPT,Facility,Both,,,,153,130.05,43.8498,153,Aetna,Commercial,140.76,92,,percent of total billed charges,,
Renal Function Panel,,80069,CPT,Facility,Outpatient,,,,153,130.05,43.8498,153,Aetna,Medicare Advantage,74.97,49,,percent of total billed charges,,
Renal Function Panel,,80069,CPT,Facility,Inpatient,,,,153,130.05,43.8498,153,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Renal Function Panel,,80069,CPT,Facility,Both,,,,153,130.05,43.8498,153,Aetna,PPO,142.29,93,,percent of total billed charges,,
Renal Function Panel,,80069,CPT,Facility,Both,,,,153,130.05,43.8498,153,America's PPO,America's PPO,146.9259,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Renal Function Panel,,80069,CPT,Facility,Both,,,,153,130.05,43.8498,153,BlueCross BlueShield Minnesota, Federal Employee Program,150.552,98.4,,percent of total billed charges,,
Renal Function Panel,,80069,CPT,Facility,Both,,,,153,130.05,43.8498,153,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,153,100,,percent of total billed charges,,
Renal Function Panel,,80069,CPT,Facility,Both,,,,153,130.05,43.8498,153,BlueCross BlueShield Minnesota,High Value Network Plan,137.7,90,,percent of total billed charges,,
Renal Function Panel,,80069,CPT,Facility,Outpatient,,,,153,130.05,43.8498,153,BlueCross BlueShield Minnesota,Medicare Advantage,74.97,49,,percent of total billed charges,,
Renal Function Panel,,80069,CPT,Facility,Inpatient,,,,153,130.05,43.8498,153,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Renal Function Panel,,80069,CPT,Facility,Both,,,,153,130.05,43.8498,153,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,135.5121,88.57,,percent of total billed charges,,
Renal Function Panel,,80069,CPT,Facility,Both,,,,153,130.05,43.8498,153,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,43.8498,28.66,,percent of total billed charges,,
Renal Function Panel,,80069,CPT,Facility,Outpatient,,,,153,130.05,43.8498,153,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),74.97,49,,percent of total billed charges,,
Renal Function Panel,,80069,CPT,Facility,Inpatient,,,,153,130.05,43.8498,153,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Renal Function Panel,,80069,CPT,Facility,Both,,,,153,130.05,43.8498,153,CorVel,Worker's Compensation,153,100,,percent of total billed charges,,
Renal Function Panel,,80069,CPT,Facility,Both,,,,153,130.05,43.8498,153,First Health Group Corporation,First Health Network,148.41,97,,percent of total billed charges,,
Renal Function Panel,,80069,CPT,Facility,Both,,,,153,130.05,43.8498,153,"Health Partners, Inc.",Commercial,144.738,94.6,,percent of total billed charges,,
Renal Function Panel,,80069,CPT,Facility,Outpatient,,,,153,130.05,43.8498,153,"Health Partners, Inc.",Medicare Advantage,74.97,49,,percent of total billed charges,,
Renal Function Panel,,80069,CPT,Facility,Inpatient,,,,153,130.05,43.8498,153,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Renal Function Panel,,80069,CPT,Facility,Both,,,,153,130.05,43.8498,153,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),91.8,60,,percent of total billed charges,,
Renal Function Panel,,80069,CPT,Facility,Both,,,,153,130.05,43.8498,153,"Health Partners, Inc.",State of Minnesota Advantage Program,124.695,81.5,,percent of total billed charges,,
Renal Function Panel,,80069,CPT,Facility,Both,,,,153,130.05,43.8498,153,"Health Partners, Inc.",State Public Programs,76.5,50,,percent of total billed charges,,
Renal Function Panel,,80069,CPT,Facility,Both,,,,153,130.05,43.8498,153,Humana Insurance Company,Commercial PPO,145.35,95,,percent of total billed charges,,
Renal Function Panel,,80069,CPT,Facility,Outpatient,,,,153,130.05,43.8498,153,Humana Insurance Company,Medicare PPO,74.97,49,,percent of total billed charges,,
Renal Function Panel,,80069,CPT,Facility,Inpatient,,,,153,130.05,43.8498,153,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Renal Function Panel,,80069,CPT,Facility,Both,,,,153,130.05,43.8498,153,Medica,Individual & Family,151.623,99.1,,percent of total billed charges,,
Renal Function Panel,,80069,CPT,Facility,Outpatient,,,,153,130.05,43.8498,153,Medica,Medica Advantage Solution,76.194,49.8,,percent of total billed charges,,
Renal Function Panel,,80069,CPT,Facility,Inpatient,,,,153,130.05,43.8498,153,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Renal Function Panel,,80069,CPT,Facility,Outpatient,,,,153,130.05,43.8498,153,Medica,Medical Assistance,68.238,44.6,,percent of total billed charges,,
Renal Function Panel,,80069,CPT,Facility,Inpatient,,,,153,130.05,43.8498,153,Medica,Medical Assistance,,,,,Included in per diem rate,
Renal Function Panel,,80069,CPT,Facility,Outpatient,,,,153,130.05,43.8498,153,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,76.194,49.8,,percent of total billed charges,,
Renal Function Panel,,80069,CPT,Facility,Inpatient,,,,153,130.05,43.8498,153,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Renal Function Panel,,80069,CPT,Facility,Both,,,,153,130.05,43.8498,153,"Multiplan, Inc.","Multiplan, Inc.",143.82,94,,percent of total billed charges,,
Renal Function Panel,,80069,CPT,Facility,Outpatient,,,,153,130.05,43.8498,153,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,132.192,86.4,,percent of total billed charges,,
Renal Function Panel,,80069,CPT,Facility,Inpatient,,,,153,130.05,43.8498,153,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Renal Function Panel,,80069,CPT,Facility,Both,,,,153,130.05,43.8498,153,"Preferred One Administrative Services, INC.",PPO,150.858,98.6,,percent of total billed charges,,
Renal Function Panel,,80069,CPT,Facility,Outpatient,,,,153,130.05,43.8498,153,PrimeWest Health,Minnesota Senior Health Options (MSHO),78.7185,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Renal Function Panel,,80069,CPT,Facility,Inpatient,,,,153,130.05,43.8498,153,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Renal Function Panel,,80069,CPT,Facility,Outpatient,,,,153,130.05,43.8498,153,PrimeWest Health,MinnesotaCare,78.5808,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Renal Function Panel,,80069,CPT,Facility,Inpatient,,,,153,130.05,43.8498,153,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Renal Function Panel,,80069,CPT,Facility,Both,,,,153,130.05,43.8498,153,Sanford Health Plan,Sanford Health Plan,140.76,92,,percent of total billed charges,,
Renal Function Panel,,80069,CPT,Facility,Outpatient,,,,153,130.05,43.8498,153,"UCare Health, Inc.",Individual & Family Plan,86.2155,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Renal Function Panel,,80069,CPT,Facility,Inpatient,,,,153,130.05,43.8498,153,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Renal Function Panel,,80069,CPT,Facility,Outpatient,,,,153,130.05,43.8498,153,"UCare Health, Inc.",Medical Assistance,77.2191,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Renal Function Panel,,80069,CPT,Facility,Inpatient,,,,153,130.05,43.8498,153,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Renal Function Panel,,80069,CPT,Facility,Outpatient,,,,153,130.05,43.8498,153,"UCare Health, Inc.",Medicare Advantage,77.2191,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Renal Function Panel,,80069,CPT,Facility,Inpatient,,,,153,130.05,43.8498,153,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Renal Function Panel,,80069,CPT,Facility,Outpatient,,,,153,130.05,43.8498,153,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),77.2191,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Renal Function Panel,,80069,CPT,Facility,Inpatient,,,,153,130.05,43.8498,153,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Renal Function Panel,,80069,CPT,Facility,Both,,,,153,130.05,43.8498,153,UnitedHealthcare,Individual & Family,143.82,94,,percent of total billed charges,,
Renal Function Panel,,80069,CPT,Facility,Outpatient,,,,153,130.05,43.8498,153,UnitedHealthcare,Medicare Advantage,74.97,49,,percent of total billed charges,,
Renal Function Panel,,80069,CPT,Facility,Inpatient,,,,153,130.05,43.8498,153,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Renal Function Panel,,80069,CPT,Facility,Outpatient,,,,153,130.05,43.8498,153,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,73.44,48,,percent of total billed charges,,100% of DHS outpatient percentage
Renal Function Panel,,80069,CPT,Facility,Inpatient,,,,153,130.05,43.8498,153,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Hepatitis Panel, Acute",,80074,CPT,Facility,Both,,,,193,164.05,55.3138,193,Aetna,Commercial,177.56,92,,percent of total billed charges,,
"Hepatitis Panel, Acute",,80074,CPT,Facility,Outpatient,,,,193,164.05,55.3138,193,Aetna,Medicare Advantage,94.57,49,,percent of total billed charges,,
"Hepatitis Panel, Acute",,80074,CPT,Facility,Inpatient,,,,193,164.05,55.3138,193,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Hepatitis Panel, Acute",,80074,CPT,Facility,Both,,,,193,164.05,55.3138,193,Aetna,PPO,179.49,93,,percent of total billed charges,,
"Hepatitis Panel, Acute",,80074,CPT,Facility,Both,,,,193,164.05,55.3138,193,America's PPO,America's PPO,185.3379,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Hepatitis Panel, Acute",,80074,CPT,Facility,Both,,,,193,164.05,55.3138,193,BlueCross BlueShield Minnesota, Federal Employee Program,189.912,98.4,,percent of total billed charges,,
"Hepatitis Panel, Acute",,80074,CPT,Facility,Both,,,,193,164.05,55.3138,193,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,193,100,,percent of total billed charges,,
"Hepatitis Panel, Acute",,80074,CPT,Facility,Both,,,,193,164.05,55.3138,193,BlueCross BlueShield Minnesota,High Value Network Plan,173.7,90,,percent of total billed charges,,
"Hepatitis Panel, Acute",,80074,CPT,Facility,Outpatient,,,,193,164.05,55.3138,193,BlueCross BlueShield Minnesota,Medicare Advantage,94.57,49,,percent of total billed charges,,
"Hepatitis Panel, Acute",,80074,CPT,Facility,Inpatient,,,,193,164.05,55.3138,193,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Hepatitis Panel, Acute",,80074,CPT,Facility,Both,,,,193,164.05,55.3138,193,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,170.9401,88.57,,percent of total billed charges,,
"Hepatitis Panel, Acute",,80074,CPT,Facility,Both,,,,193,164.05,55.3138,193,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,55.3138,28.66,,percent of total billed charges,,
"Hepatitis Panel, Acute",,80074,CPT,Facility,Outpatient,,,,193,164.05,55.3138,193,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),94.57,49,,percent of total billed charges,,
"Hepatitis Panel, Acute",,80074,CPT,Facility,Inpatient,,,,193,164.05,55.3138,193,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Hepatitis Panel, Acute",,80074,CPT,Facility,Both,,,,193,164.05,55.3138,193,CorVel,Worker's Compensation,193,100,,percent of total billed charges,,
"Hepatitis Panel, Acute",,80074,CPT,Facility,Both,,,,193,164.05,55.3138,193,First Health Group Corporation,First Health Network,187.21,97,,percent of total billed charges,,
"Hepatitis Panel, Acute",,80074,CPT,Facility,Both,,,,193,164.05,55.3138,193,"Health Partners, Inc.",Commercial,182.578,94.6,,percent of total billed charges,,
"Hepatitis Panel, Acute",,80074,CPT,Facility,Outpatient,,,,193,164.05,55.3138,193,"Health Partners, Inc.",Medicare Advantage,94.57,49,,percent of total billed charges,,
"Hepatitis Panel, Acute",,80074,CPT,Facility,Inpatient,,,,193,164.05,55.3138,193,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Hepatitis Panel, Acute",,80074,CPT,Facility,Both,,,,193,164.05,55.3138,193,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),115.8,60,,percent of total billed charges,,
"Hepatitis Panel, Acute",,80074,CPT,Facility,Both,,,,193,164.05,55.3138,193,"Health Partners, Inc.",State of Minnesota Advantage Program,157.295,81.5,,percent of total billed charges,,
"Hepatitis Panel, Acute",,80074,CPT,Facility,Both,,,,193,164.05,55.3138,193,"Health Partners, Inc.",State Public Programs,96.5,50,,percent of total billed charges,,
"Hepatitis Panel, Acute",,80074,CPT,Facility,Both,,,,193,164.05,55.3138,193,Humana Insurance Company,Commercial PPO,183.35,95,,percent of total billed charges,,
"Hepatitis Panel, Acute",,80074,CPT,Facility,Outpatient,,,,193,164.05,55.3138,193,Humana Insurance Company,Medicare PPO,94.57,49,,percent of total billed charges,,
"Hepatitis Panel, Acute",,80074,CPT,Facility,Inpatient,,,,193,164.05,55.3138,193,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Hepatitis Panel, Acute",,80074,CPT,Facility,Both,,,,193,164.05,55.3138,193,Medica,Individual & Family,191.263,99.1,,percent of total billed charges,,
"Hepatitis Panel, Acute",,80074,CPT,Facility,Outpatient,,,,193,164.05,55.3138,193,Medica,Medica Advantage Solution,96.114,49.8,,percent of total billed charges,,
"Hepatitis Panel, Acute",,80074,CPT,Facility,Inpatient,,,,193,164.05,55.3138,193,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Hepatitis Panel, Acute",,80074,CPT,Facility,Outpatient,,,,193,164.05,55.3138,193,Medica,Medical Assistance,86.078,44.6,,percent of total billed charges,,
"Hepatitis Panel, Acute",,80074,CPT,Facility,Inpatient,,,,193,164.05,55.3138,193,Medica,Medical Assistance,,,,,Included in per diem rate,
"Hepatitis Panel, Acute",,80074,CPT,Facility,Outpatient,,,,193,164.05,55.3138,193,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,96.114,49.8,,percent of total billed charges,,
"Hepatitis Panel, Acute",,80074,CPT,Facility,Inpatient,,,,193,164.05,55.3138,193,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Hepatitis Panel, Acute",,80074,CPT,Facility,Both,,,,193,164.05,55.3138,193,"Multiplan, Inc.","Multiplan, Inc.",181.42,94,,percent of total billed charges,,
"Hepatitis Panel, Acute",,80074,CPT,Facility,Outpatient,,,,193,164.05,55.3138,193,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,166.752,86.4,,percent of total billed charges,,
"Hepatitis Panel, Acute",,80074,CPT,Facility,Inpatient,,,,193,164.05,55.3138,193,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Hepatitis Panel, Acute",,80074,CPT,Facility,Both,,,,193,164.05,55.3138,193,"Preferred One Administrative Services, INC.",PPO,190.298,98.6,,percent of total billed charges,,
"Hepatitis Panel, Acute",,80074,CPT,Facility,Outpatient,,,,193,164.05,55.3138,193,PrimeWest Health,Minnesota Senior Health Options (MSHO),99.2985,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Hepatitis Panel, Acute",,80074,CPT,Facility,Inpatient,,,,193,164.05,55.3138,193,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Hepatitis Panel, Acute",,80074,CPT,Facility,Outpatient,,,,193,164.05,55.3138,193,PrimeWest Health,MinnesotaCare,99.1248,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Hepatitis Panel, Acute",,80074,CPT,Facility,Inpatient,,,,193,164.05,55.3138,193,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Hepatitis Panel, Acute",,80074,CPT,Facility,Both,,,,193,164.05,55.3138,193,Sanford Health Plan,Sanford Health Plan,177.56,92,,percent of total billed charges,,
"Hepatitis Panel, Acute",,80074,CPT,Facility,Outpatient,,,,193,164.05,55.3138,193,"UCare Health, Inc.",Individual & Family Plan,108.7555,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Hepatitis Panel, Acute",,80074,CPT,Facility,Inpatient,,,,193,164.05,55.3138,193,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Hepatitis Panel, Acute",,80074,CPT,Facility,Outpatient,,,,193,164.05,55.3138,193,"UCare Health, Inc.",Medical Assistance,97.4071,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Hepatitis Panel, Acute",,80074,CPT,Facility,Inpatient,,,,193,164.05,55.3138,193,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Hepatitis Panel, Acute",,80074,CPT,Facility,Outpatient,,,,193,164.05,55.3138,193,"UCare Health, Inc.",Medicare Advantage,97.4071,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Hepatitis Panel, Acute",,80074,CPT,Facility,Inpatient,,,,193,164.05,55.3138,193,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Hepatitis Panel, Acute",,80074,CPT,Facility,Outpatient,,,,193,164.05,55.3138,193,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),97.4071,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Hepatitis Panel, Acute",,80074,CPT,Facility,Inpatient,,,,193,164.05,55.3138,193,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Hepatitis Panel, Acute",,80074,CPT,Facility,Both,,,,193,164.05,55.3138,193,UnitedHealthcare,Individual & Family,181.42,94,,percent of total billed charges,,
"Hepatitis Panel, Acute",,80074,CPT,Facility,Outpatient,,,,193,164.05,55.3138,193,UnitedHealthcare,Medicare Advantage,94.57,49,,percent of total billed charges,,
"Hepatitis Panel, Acute",,80074,CPT,Facility,Inpatient,,,,193,164.05,55.3138,193,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Hepatitis Panel, Acute",,80074,CPT,Facility,Outpatient,,,,193,164.05,55.3138,193,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,92.64,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Hepatitis Panel, Acute",,80074,CPT,Facility,Inpatient,,,,193,164.05,55.3138,193,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Hepatic Function Panel,,80076,CPT,Facility,Both,,,,163,138.55,46.7158,163,Aetna,Commercial,149.96,92,,percent of total billed charges,,
Hepatic Function Panel,,80076,CPT,Facility,Outpatient,,,,163,138.55,46.7158,163,Aetna,Medicare Advantage,79.87,49,,percent of total billed charges,,
Hepatic Function Panel,,80076,CPT,Facility,Inpatient,,,,163,138.55,46.7158,163,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Hepatic Function Panel,,80076,CPT,Facility,Both,,,,163,138.55,46.7158,163,Aetna,PPO,151.59,93,,percent of total billed charges,,
Hepatic Function Panel,,80076,CPT,Facility,Both,,,,163,138.55,46.7158,163,America's PPO,America's PPO,156.5289,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Hepatic Function Panel,,80076,CPT,Facility,Both,,,,163,138.55,46.7158,163,BlueCross BlueShield Minnesota, Federal Employee Program,160.392,98.4,,percent of total billed charges,,
Hepatic Function Panel,,80076,CPT,Facility,Both,,,,163,138.55,46.7158,163,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,163,100,,percent of total billed charges,,
Hepatic Function Panel,,80076,CPT,Facility,Both,,,,163,138.55,46.7158,163,BlueCross BlueShield Minnesota,High Value Network Plan,146.7,90,,percent of total billed charges,,
Hepatic Function Panel,,80076,CPT,Facility,Outpatient,,,,163,138.55,46.7158,163,BlueCross BlueShield Minnesota,Medicare Advantage,79.87,49,,percent of total billed charges,,
Hepatic Function Panel,,80076,CPT,Facility,Inpatient,,,,163,138.55,46.7158,163,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Hepatic Function Panel,,80076,CPT,Facility,Both,,,,163,138.55,46.7158,163,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,144.3691,88.57,,percent of total billed charges,,
Hepatic Function Panel,,80076,CPT,Facility,Both,,,,163,138.55,46.7158,163,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,46.7158,28.66,,percent of total billed charges,,
Hepatic Function Panel,,80076,CPT,Facility,Outpatient,,,,163,138.55,46.7158,163,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),79.87,49,,percent of total billed charges,,
Hepatic Function Panel,,80076,CPT,Facility,Inpatient,,,,163,138.55,46.7158,163,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Hepatic Function Panel,,80076,CPT,Facility,Both,,,,163,138.55,46.7158,163,CorVel,Worker's Compensation,163,100,,percent of total billed charges,,
Hepatic Function Panel,,80076,CPT,Facility,Both,,,,163,138.55,46.7158,163,First Health Group Corporation,First Health Network,158.11,97,,percent of total billed charges,,
Hepatic Function Panel,,80076,CPT,Facility,Both,,,,163,138.55,46.7158,163,"Health Partners, Inc.",Commercial,154.198,94.6,,percent of total billed charges,,
Hepatic Function Panel,,80076,CPT,Facility,Outpatient,,,,163,138.55,46.7158,163,"Health Partners, Inc.",Medicare Advantage,79.87,49,,percent of total billed charges,,
Hepatic Function Panel,,80076,CPT,Facility,Inpatient,,,,163,138.55,46.7158,163,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Hepatic Function Panel,,80076,CPT,Facility,Both,,,,163,138.55,46.7158,163,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),97.8,60,,percent of total billed charges,,
Hepatic Function Panel,,80076,CPT,Facility,Both,,,,163,138.55,46.7158,163,"Health Partners, Inc.",State of Minnesota Advantage Program,132.845,81.5,,percent of total billed charges,,
Hepatic Function Panel,,80076,CPT,Facility,Both,,,,163,138.55,46.7158,163,"Health Partners, Inc.",State Public Programs,81.5,50,,percent of total billed charges,,
Hepatic Function Panel,,80076,CPT,Facility,Both,,,,163,138.55,46.7158,163,Humana Insurance Company,Commercial PPO,154.85,95,,percent of total billed charges,,
Hepatic Function Panel,,80076,CPT,Facility,Outpatient,,,,163,138.55,46.7158,163,Humana Insurance Company,Medicare PPO,79.87,49,,percent of total billed charges,,
Hepatic Function Panel,,80076,CPT,Facility,Inpatient,,,,163,138.55,46.7158,163,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Hepatic Function Panel,,80076,CPT,Facility,Both,,,,163,138.55,46.7158,163,Medica,Individual & Family,161.533,99.1,,percent of total billed charges,,
Hepatic Function Panel,,80076,CPT,Facility,Outpatient,,,,163,138.55,46.7158,163,Medica,Medica Advantage Solution,81.174,49.8,,percent of total billed charges,,
Hepatic Function Panel,,80076,CPT,Facility,Inpatient,,,,163,138.55,46.7158,163,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Hepatic Function Panel,,80076,CPT,Facility,Outpatient,,,,163,138.55,46.7158,163,Medica,Medical Assistance,72.698,44.6,,percent of total billed charges,,
Hepatic Function Panel,,80076,CPT,Facility,Inpatient,,,,163,138.55,46.7158,163,Medica,Medical Assistance,,,,,Included in per diem rate,
Hepatic Function Panel,,80076,CPT,Facility,Outpatient,,,,163,138.55,46.7158,163,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,81.174,49.8,,percent of total billed charges,,
Hepatic Function Panel,,80076,CPT,Facility,Inpatient,,,,163,138.55,46.7158,163,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Hepatic Function Panel,,80076,CPT,Facility,Both,,,,163,138.55,46.7158,163,"Multiplan, Inc.","Multiplan, Inc.",153.22,94,,percent of total billed charges,,
Hepatic Function Panel,,80076,CPT,Facility,Outpatient,,,,163,138.55,46.7158,163,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,140.832,86.4,,percent of total billed charges,,
Hepatic Function Panel,,80076,CPT,Facility,Inpatient,,,,163,138.55,46.7158,163,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Hepatic Function Panel,,80076,CPT,Facility,Both,,,,163,138.55,46.7158,163,"Preferred One Administrative Services, INC.",PPO,160.718,98.6,,percent of total billed charges,,
Hepatic Function Panel,,80076,CPT,Facility,Outpatient,,,,163,138.55,46.7158,163,PrimeWest Health,Minnesota Senior Health Options (MSHO),83.8635,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Hepatic Function Panel,,80076,CPT,Facility,Inpatient,,,,163,138.55,46.7158,163,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Hepatic Function Panel,,80076,CPT,Facility,Outpatient,,,,163,138.55,46.7158,163,PrimeWest Health,MinnesotaCare,83.7168,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Hepatic Function Panel,,80076,CPT,Facility,Inpatient,,,,163,138.55,46.7158,163,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Hepatic Function Panel,,80076,CPT,Facility,Both,,,,163,138.55,46.7158,163,Sanford Health Plan,Sanford Health Plan,149.96,92,,percent of total billed charges,,
Hepatic Function Panel,,80076,CPT,Facility,Outpatient,,,,163,138.55,46.7158,163,"UCare Health, Inc.",Individual & Family Plan,91.8505,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Hepatic Function Panel,,80076,CPT,Facility,Inpatient,,,,163,138.55,46.7158,163,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Hepatic Function Panel,,80076,CPT,Facility,Outpatient,,,,163,138.55,46.7158,163,"UCare Health, Inc.",Medical Assistance,82.2661,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Hepatic Function Panel,,80076,CPT,Facility,Inpatient,,,,163,138.55,46.7158,163,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Hepatic Function Panel,,80076,CPT,Facility,Outpatient,,,,163,138.55,46.7158,163,"UCare Health, Inc.",Medicare Advantage,82.2661,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Hepatic Function Panel,,80076,CPT,Facility,Inpatient,,,,163,138.55,46.7158,163,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Hepatic Function Panel,,80076,CPT,Facility,Outpatient,,,,163,138.55,46.7158,163,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),82.2661,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Hepatic Function Panel,,80076,CPT,Facility,Inpatient,,,,163,138.55,46.7158,163,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Hepatic Function Panel,,80076,CPT,Facility,Both,,,,163,138.55,46.7158,163,UnitedHealthcare,Individual & Family,153.22,94,,percent of total billed charges,,
Hepatic Function Panel,,80076,CPT,Facility,Outpatient,,,,163,138.55,46.7158,163,UnitedHealthcare,Medicare Advantage,79.87,49,,percent of total billed charges,,
Hepatic Function Panel,,80076,CPT,Facility,Inpatient,,,,163,138.55,46.7158,163,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Hepatic Function Panel,,80076,CPT,Facility,Outpatient,,,,163,138.55,46.7158,163,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,78.24,48,,percent of total billed charges,,100% of DHS outpatient percentage
Hepatic Function Panel,,80076,CPT,Facility,Inpatient,,,,163,138.55,46.7158,163,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Acetaminophen,,80143,CPT,Facility,Both,,,,147,124.95,42.1302,147,Aetna,Commercial,135.24,92,,percent of total billed charges,,
Acetaminophen,,80143,CPT,Facility,Outpatient,,,,147,124.95,42.1302,147,Aetna,Medicare Advantage,72.03,49,,percent of total billed charges,,
Acetaminophen,,80143,CPT,Facility,Inpatient,,,,147,124.95,42.1302,147,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Acetaminophen,,80143,CPT,Facility,Both,,,,147,124.95,42.1302,147,Aetna,PPO,136.71,93,,percent of total billed charges,,
Acetaminophen,,80143,CPT,Facility,Both,,,,147,124.95,42.1302,147,America's PPO,America's PPO,141.1641,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Acetaminophen,,80143,CPT,Facility,Both,,,,147,124.95,42.1302,147,BlueCross BlueShield Minnesota, Federal Employee Program,144.648,98.4,,percent of total billed charges,,
Acetaminophen,,80143,CPT,Facility,Both,,,,147,124.95,42.1302,147,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,147,100,,percent of total billed charges,,
Acetaminophen,,80143,CPT,Facility,Both,,,,147,124.95,42.1302,147,BlueCross BlueShield Minnesota,High Value Network Plan,132.3,90,,percent of total billed charges,,
Acetaminophen,,80143,CPT,Facility,Outpatient,,,,147,124.95,42.1302,147,BlueCross BlueShield Minnesota,Medicare Advantage,72.03,49,,percent of total billed charges,,
Acetaminophen,,80143,CPT,Facility,Inpatient,,,,147,124.95,42.1302,147,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Acetaminophen,,80143,CPT,Facility,Both,,,,147,124.95,42.1302,147,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,130.1979,88.57,,percent of total billed charges,,
Acetaminophen,,80143,CPT,Facility,Both,,,,147,124.95,42.1302,147,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,42.1302,28.66,,percent of total billed charges,,
Acetaminophen,,80143,CPT,Facility,Outpatient,,,,147,124.95,42.1302,147,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),72.03,49,,percent of total billed charges,,
Acetaminophen,,80143,CPT,Facility,Inpatient,,,,147,124.95,42.1302,147,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Acetaminophen,,80143,CPT,Facility,Both,,,,147,124.95,42.1302,147,CorVel,Worker's Compensation,147,100,,percent of total billed charges,,
Acetaminophen,,80143,CPT,Facility,Both,,,,147,124.95,42.1302,147,First Health Group Corporation,First Health Network,142.59,97,,percent of total billed charges,,
Acetaminophen,,80143,CPT,Facility,Both,,,,147,124.95,42.1302,147,"Health Partners, Inc.",Commercial,139.062,94.6,,percent of total billed charges,,
Acetaminophen,,80143,CPT,Facility,Outpatient,,,,147,124.95,42.1302,147,"Health Partners, Inc.",Medicare Advantage,72.03,49,,percent of total billed charges,,
Acetaminophen,,80143,CPT,Facility,Inpatient,,,,147,124.95,42.1302,147,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Acetaminophen,,80143,CPT,Facility,Both,,,,147,124.95,42.1302,147,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),88.2,60,,percent of total billed charges,,
Acetaminophen,,80143,CPT,Facility,Both,,,,147,124.95,42.1302,147,"Health Partners, Inc.",State of Minnesota Advantage Program,119.805,81.5,,percent of total billed charges,,
Acetaminophen,,80143,CPT,Facility,Both,,,,147,124.95,42.1302,147,"Health Partners, Inc.",State Public Programs,73.5,50,,percent of total billed charges,,
Acetaminophen,,80143,CPT,Facility,Both,,,,147,124.95,42.1302,147,Humana Insurance Company,Commercial PPO,139.65,95,,percent of total billed charges,,
Acetaminophen,,80143,CPT,Facility,Outpatient,,,,147,124.95,42.1302,147,Humana Insurance Company,Medicare PPO,72.03,49,,percent of total billed charges,,
Acetaminophen,,80143,CPT,Facility,Inpatient,,,,147,124.95,42.1302,147,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Acetaminophen,,80143,CPT,Facility,Both,,,,147,124.95,42.1302,147,Medica,Individual & Family,145.677,99.1,,percent of total billed charges,,
Acetaminophen,,80143,CPT,Facility,Outpatient,,,,147,124.95,42.1302,147,Medica,Medica Advantage Solution,73.206,49.8,,percent of total billed charges,,
Acetaminophen,,80143,CPT,Facility,Inpatient,,,,147,124.95,42.1302,147,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Acetaminophen,,80143,CPT,Facility,Outpatient,,,,147,124.95,42.1302,147,Medica,Medical Assistance,65.562,44.6,,percent of total billed charges,,
Acetaminophen,,80143,CPT,Facility,Inpatient,,,,147,124.95,42.1302,147,Medica,Medical Assistance,,,,,Included in per diem rate,
Acetaminophen,,80143,CPT,Facility,Outpatient,,,,147,124.95,42.1302,147,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,73.206,49.8,,percent of total billed charges,,
Acetaminophen,,80143,CPT,Facility,Inpatient,,,,147,124.95,42.1302,147,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Acetaminophen,,80143,CPT,Facility,Both,,,,147,124.95,42.1302,147,"Multiplan, Inc.","Multiplan, Inc.",138.18,94,,percent of total billed charges,,
Acetaminophen,,80143,CPT,Facility,Outpatient,,,,147,124.95,42.1302,147,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,127.008,86.4,,percent of total billed charges,,
Acetaminophen,,80143,CPT,Facility,Inpatient,,,,147,124.95,42.1302,147,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Acetaminophen,,80143,CPT,Facility,Both,,,,147,124.95,42.1302,147,"Preferred One Administrative Services, INC.",PPO,144.942,98.6,,percent of total billed charges,,
Acetaminophen,,80143,CPT,Facility,Outpatient,,,,147,124.95,42.1302,147,PrimeWest Health,Minnesota Senior Health Options (MSHO),75.6315,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Acetaminophen,,80143,CPT,Facility,Inpatient,,,,147,124.95,42.1302,147,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Acetaminophen,,80143,CPT,Facility,Outpatient,,,,147,124.95,42.1302,147,PrimeWest Health,MinnesotaCare,75.4992,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Acetaminophen,,80143,CPT,Facility,Inpatient,,,,147,124.95,42.1302,147,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Acetaminophen,,80143,CPT,Facility,Both,,,,147,124.95,42.1302,147,Sanford Health Plan,Sanford Health Plan,135.24,92,,percent of total billed charges,,
Acetaminophen,,80143,CPT,Facility,Outpatient,,,,147,124.95,42.1302,147,"UCare Health, Inc.",Individual & Family Plan,82.8345,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Acetaminophen,,80143,CPT,Facility,Inpatient,,,,147,124.95,42.1302,147,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Acetaminophen,,80143,CPT,Facility,Outpatient,,,,147,124.95,42.1302,147,"UCare Health, Inc.",Medical Assistance,74.1909,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Acetaminophen,,80143,CPT,Facility,Inpatient,,,,147,124.95,42.1302,147,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Acetaminophen,,80143,CPT,Facility,Outpatient,,,,147,124.95,42.1302,147,"UCare Health, Inc.",Medicare Advantage,74.1909,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Acetaminophen,,80143,CPT,Facility,Inpatient,,,,147,124.95,42.1302,147,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Acetaminophen,,80143,CPT,Facility,Outpatient,,,,147,124.95,42.1302,147,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),74.1909,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Acetaminophen,,80143,CPT,Facility,Inpatient,,,,147,124.95,42.1302,147,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Acetaminophen,,80143,CPT,Facility,Both,,,,147,124.95,42.1302,147,UnitedHealthcare,Individual & Family,138.18,94,,percent of total billed charges,,
Acetaminophen,,80143,CPT,Facility,Outpatient,,,,147,124.95,42.1302,147,UnitedHealthcare,Medicare Advantage,72.03,49,,percent of total billed charges,,
Acetaminophen,,80143,CPT,Facility,Inpatient,,,,147,124.95,42.1302,147,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Acetaminophen,,80143,CPT,Facility,Outpatient,,,,147,124.95,42.1302,147,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,70.56,48,,percent of total billed charges,,100% of DHS outpatient percentage
Acetaminophen,,80143,CPT,Facility,Inpatient,,,,147,124.95,42.1302,147,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Carbamazepine,,80156,CPT,Facility,Both,,,,92,78.2,26.3672,92,Aetna,Commercial,84.64,92,,percent of total billed charges,,
Carbamazepine,,80156,CPT,Facility,Outpatient,,,,92,78.2,26.3672,92,Aetna,Medicare Advantage,45.08,49,,percent of total billed charges,,
Carbamazepine,,80156,CPT,Facility,Inpatient,,,,92,78.2,26.3672,92,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Carbamazepine,,80156,CPT,Facility,Both,,,,92,78.2,26.3672,92,Aetna,PPO,85.56,93,,percent of total billed charges,,
Carbamazepine,,80156,CPT,Facility,Both,,,,92,78.2,26.3672,92,America's PPO,America's PPO,88.3476,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Carbamazepine,,80156,CPT,Facility,Both,,,,92,78.2,26.3672,92,BlueCross BlueShield Minnesota, Federal Employee Program,90.528,98.4,,percent of total billed charges,,
Carbamazepine,,80156,CPT,Facility,Both,,,,92,78.2,26.3672,92,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,92,100,,percent of total billed charges,,
Carbamazepine,,80156,CPT,Facility,Both,,,,92,78.2,26.3672,92,BlueCross BlueShield Minnesota,High Value Network Plan,82.8,90,,percent of total billed charges,,
Carbamazepine,,80156,CPT,Facility,Outpatient,,,,92,78.2,26.3672,92,BlueCross BlueShield Minnesota,Medicare Advantage,45.08,49,,percent of total billed charges,,
Carbamazepine,,80156,CPT,Facility,Inpatient,,,,92,78.2,26.3672,92,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Carbamazepine,,80156,CPT,Facility,Both,,,,92,78.2,26.3672,92,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,81.4844,88.57,,percent of total billed charges,,
Carbamazepine,,80156,CPT,Facility,Both,,,,92,78.2,26.3672,92,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,26.3672,28.66,,percent of total billed charges,,
Carbamazepine,,80156,CPT,Facility,Outpatient,,,,92,78.2,26.3672,92,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),45.08,49,,percent of total billed charges,,
Carbamazepine,,80156,CPT,Facility,Inpatient,,,,92,78.2,26.3672,92,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Carbamazepine,,80156,CPT,Facility,Both,,,,92,78.2,26.3672,92,CorVel,Worker's Compensation,92,100,,percent of total billed charges,,
Carbamazepine,,80156,CPT,Facility,Both,,,,92,78.2,26.3672,92,First Health Group Corporation,First Health Network,89.24,97,,percent of total billed charges,,
Carbamazepine,,80156,CPT,Facility,Both,,,,92,78.2,26.3672,92,"Health Partners, Inc.",Commercial,87.032,94.6,,percent of total billed charges,,
Carbamazepine,,80156,CPT,Facility,Outpatient,,,,92,78.2,26.3672,92,"Health Partners, Inc.",Medicare Advantage,45.08,49,,percent of total billed charges,,
Carbamazepine,,80156,CPT,Facility,Inpatient,,,,92,78.2,26.3672,92,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Carbamazepine,,80156,CPT,Facility,Both,,,,92,78.2,26.3672,92,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),55.2,60,,percent of total billed charges,,
Carbamazepine,,80156,CPT,Facility,Both,,,,92,78.2,26.3672,92,"Health Partners, Inc.",State of Minnesota Advantage Program,74.98,81.5,,percent of total billed charges,,
Carbamazepine,,80156,CPT,Facility,Both,,,,92,78.2,26.3672,92,"Health Partners, Inc.",State Public Programs,46,50,,percent of total billed charges,,
Carbamazepine,,80156,CPT,Facility,Both,,,,92,78.2,26.3672,92,Humana Insurance Company,Commercial PPO,87.4,95,,percent of total billed charges,,
Carbamazepine,,80156,CPT,Facility,Outpatient,,,,92,78.2,26.3672,92,Humana Insurance Company,Medicare PPO,45.08,49,,percent of total billed charges,,
Carbamazepine,,80156,CPT,Facility,Inpatient,,,,92,78.2,26.3672,92,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Carbamazepine,,80156,CPT,Facility,Both,,,,92,78.2,26.3672,92,Medica,Individual & Family,91.172,99.1,,percent of total billed charges,,
Carbamazepine,,80156,CPT,Facility,Outpatient,,,,92,78.2,26.3672,92,Medica,Medica Advantage Solution,45.816,49.8,,percent of total billed charges,,
Carbamazepine,,80156,CPT,Facility,Inpatient,,,,92,78.2,26.3672,92,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Carbamazepine,,80156,CPT,Facility,Outpatient,,,,92,78.2,26.3672,92,Medica,Medical Assistance,41.032,44.6,,percent of total billed charges,,
Carbamazepine,,80156,CPT,Facility,Inpatient,,,,92,78.2,26.3672,92,Medica,Medical Assistance,,,,,Included in per diem rate,
Carbamazepine,,80156,CPT,Facility,Outpatient,,,,92,78.2,26.3672,92,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,45.816,49.8,,percent of total billed charges,,
Carbamazepine,,80156,CPT,Facility,Inpatient,,,,92,78.2,26.3672,92,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Carbamazepine,,80156,CPT,Facility,Both,,,,92,78.2,26.3672,92,"Multiplan, Inc.","Multiplan, Inc.",86.48,94,,percent of total billed charges,,
Carbamazepine,,80156,CPT,Facility,Outpatient,,,,92,78.2,26.3672,92,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,79.488,86.4,,percent of total billed charges,,
Carbamazepine,,80156,CPT,Facility,Inpatient,,,,92,78.2,26.3672,92,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Carbamazepine,,80156,CPT,Facility,Both,,,,92,78.2,26.3672,92,"Preferred One Administrative Services, INC.",PPO,90.712,98.6,,percent of total billed charges,,
Carbamazepine,,80156,CPT,Facility,Outpatient,,,,92,78.2,26.3672,92,PrimeWest Health,Minnesota Senior Health Options (MSHO),47.334,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Carbamazepine,,80156,CPT,Facility,Inpatient,,,,92,78.2,26.3672,92,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Carbamazepine,,80156,CPT,Facility,Outpatient,,,,92,78.2,26.3672,92,PrimeWest Health,MinnesotaCare,47.2512,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Carbamazepine,,80156,CPT,Facility,Inpatient,,,,92,78.2,26.3672,92,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Carbamazepine,,80156,CPT,Facility,Both,,,,92,78.2,26.3672,92,Sanford Health Plan,Sanford Health Plan,84.64,92,,percent of total billed charges,,
Carbamazepine,,80156,CPT,Facility,Outpatient,,,,92,78.2,26.3672,92,"UCare Health, Inc.",Individual & Family Plan,51.842,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Carbamazepine,,80156,CPT,Facility,Inpatient,,,,92,78.2,26.3672,92,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Carbamazepine,,80156,CPT,Facility,Outpatient,,,,92,78.2,26.3672,92,"UCare Health, Inc.",Medical Assistance,46.4324,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Carbamazepine,,80156,CPT,Facility,Inpatient,,,,92,78.2,26.3672,92,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Carbamazepine,,80156,CPT,Facility,Outpatient,,,,92,78.2,26.3672,92,"UCare Health, Inc.",Medicare Advantage,46.4324,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Carbamazepine,,80156,CPT,Facility,Inpatient,,,,92,78.2,26.3672,92,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Carbamazepine,,80156,CPT,Facility,Outpatient,,,,92,78.2,26.3672,92,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),46.4324,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Carbamazepine,,80156,CPT,Facility,Inpatient,,,,92,78.2,26.3672,92,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Carbamazepine,,80156,CPT,Facility,Both,,,,92,78.2,26.3672,92,UnitedHealthcare,Individual & Family,86.48,94,,percent of total billed charges,,
Carbamazepine,,80156,CPT,Facility,Outpatient,,,,92,78.2,26.3672,92,UnitedHealthcare,Medicare Advantage,45.08,49,,percent of total billed charges,,
Carbamazepine,,80156,CPT,Facility,Inpatient,,,,92,78.2,26.3672,92,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Carbamazepine,,80156,CPT,Facility,Outpatient,,,,92,78.2,26.3672,92,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,44.16,48,,percent of total billed charges,,100% of DHS outpatient percentage
Carbamazepine,,80156,CPT,Facility,Inpatient,,,,92,78.2,26.3672,92,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Digoxin, Serum Or Plasma",,80162,CPT,Facility,Both,,,,120,102,34.392,120,Aetna,Commercial,110.4,92,,percent of total billed charges,,
"Digoxin, Serum Or Plasma",,80162,CPT,Facility,Outpatient,,,,120,102,34.392,120,Aetna,Medicare Advantage,58.8,49,,percent of total billed charges,,
"Digoxin, Serum Or Plasma",,80162,CPT,Facility,Inpatient,,,,120,102,34.392,120,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Digoxin, Serum Or Plasma",,80162,CPT,Facility,Both,,,,120,102,34.392,120,Aetna,PPO,111.6,93,,percent of total billed charges,,
"Digoxin, Serum Or Plasma",,80162,CPT,Facility,Both,,,,120,102,34.392,120,America's PPO,America's PPO,115.236,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Digoxin, Serum Or Plasma",,80162,CPT,Facility,Both,,,,120,102,34.392,120,BlueCross BlueShield Minnesota, Federal Employee Program,118.08,98.4,,percent of total billed charges,,
"Digoxin, Serum Or Plasma",,80162,CPT,Facility,Both,,,,120,102,34.392,120,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,120,100,,percent of total billed charges,,
"Digoxin, Serum Or Plasma",,80162,CPT,Facility,Both,,,,120,102,34.392,120,BlueCross BlueShield Minnesota,High Value Network Plan,108,90,,percent of total billed charges,,
"Digoxin, Serum Or Plasma",,80162,CPT,Facility,Outpatient,,,,120,102,34.392,120,BlueCross BlueShield Minnesota,Medicare Advantage,58.8,49,,percent of total billed charges,,
"Digoxin, Serum Or Plasma",,80162,CPT,Facility,Inpatient,,,,120,102,34.392,120,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Digoxin, Serum Or Plasma",,80162,CPT,Facility,Both,,,,120,102,34.392,120,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,106.284,88.57,,percent of total billed charges,,
"Digoxin, Serum Or Plasma",,80162,CPT,Facility,Both,,,,120,102,34.392,120,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,34.392,28.66,,percent of total billed charges,,
"Digoxin, Serum Or Plasma",,80162,CPT,Facility,Outpatient,,,,120,102,34.392,120,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),58.8,49,,percent of total billed charges,,
"Digoxin, Serum Or Plasma",,80162,CPT,Facility,Inpatient,,,,120,102,34.392,120,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Digoxin, Serum Or Plasma",,80162,CPT,Facility,Both,,,,120,102,34.392,120,CorVel,Worker's Compensation,120,100,,percent of total billed charges,,
"Digoxin, Serum Or Plasma",,80162,CPT,Facility,Both,,,,120,102,34.392,120,First Health Group Corporation,First Health Network,116.4,97,,percent of total billed charges,,
"Digoxin, Serum Or Plasma",,80162,CPT,Facility,Both,,,,120,102,34.392,120,"Health Partners, Inc.",Commercial,113.52,94.6,,percent of total billed charges,,
"Digoxin, Serum Or Plasma",,80162,CPT,Facility,Outpatient,,,,120,102,34.392,120,"Health Partners, Inc.",Medicare Advantage,58.8,49,,percent of total billed charges,,
"Digoxin, Serum Or Plasma",,80162,CPT,Facility,Inpatient,,,,120,102,34.392,120,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Digoxin, Serum Or Plasma",,80162,CPT,Facility,Both,,,,120,102,34.392,120,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),72,60,,percent of total billed charges,,
"Digoxin, Serum Or Plasma",,80162,CPT,Facility,Both,,,,120,102,34.392,120,"Health Partners, Inc.",State of Minnesota Advantage Program,97.8,81.5,,percent of total billed charges,,
"Digoxin, Serum Or Plasma",,80162,CPT,Facility,Both,,,,120,102,34.392,120,"Health Partners, Inc.",State Public Programs,60,50,,percent of total billed charges,,
"Digoxin, Serum Or Plasma",,80162,CPT,Facility,Both,,,,120,102,34.392,120,Humana Insurance Company,Commercial PPO,114,95,,percent of total billed charges,,
"Digoxin, Serum Or Plasma",,80162,CPT,Facility,Outpatient,,,,120,102,34.392,120,Humana Insurance Company,Medicare PPO,58.8,49,,percent of total billed charges,,
"Digoxin, Serum Or Plasma",,80162,CPT,Facility,Inpatient,,,,120,102,34.392,120,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Digoxin, Serum Or Plasma",,80162,CPT,Facility,Both,,,,120,102,34.392,120,Medica,Individual & Family,118.92,99.1,,percent of total billed charges,,
"Digoxin, Serum Or Plasma",,80162,CPT,Facility,Outpatient,,,,120,102,34.392,120,Medica,Medica Advantage Solution,59.76,49.8,,percent of total billed charges,,
"Digoxin, Serum Or Plasma",,80162,CPT,Facility,Inpatient,,,,120,102,34.392,120,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Digoxin, Serum Or Plasma",,80162,CPT,Facility,Outpatient,,,,120,102,34.392,120,Medica,Medical Assistance,53.52,44.6,,percent of total billed charges,,
"Digoxin, Serum Or Plasma",,80162,CPT,Facility,Inpatient,,,,120,102,34.392,120,Medica,Medical Assistance,,,,,Included in per diem rate,
"Digoxin, Serum Or Plasma",,80162,CPT,Facility,Outpatient,,,,120,102,34.392,120,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,59.76,49.8,,percent of total billed charges,,
"Digoxin, Serum Or Plasma",,80162,CPT,Facility,Inpatient,,,,120,102,34.392,120,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Digoxin, Serum Or Plasma",,80162,CPT,Facility,Both,,,,120,102,34.392,120,"Multiplan, Inc.","Multiplan, Inc.",112.8,94,,percent of total billed charges,,
"Digoxin, Serum Or Plasma",,80162,CPT,Facility,Outpatient,,,,120,102,34.392,120,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,103.68,86.4,,percent of total billed charges,,
"Digoxin, Serum Or Plasma",,80162,CPT,Facility,Inpatient,,,,120,102,34.392,120,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Digoxin, Serum Or Plasma",,80162,CPT,Facility,Both,,,,120,102,34.392,120,"Preferred One Administrative Services, INC.",PPO,118.32,98.6,,percent of total billed charges,,
"Digoxin, Serum Or Plasma",,80162,CPT,Facility,Outpatient,,,,120,102,34.392,120,PrimeWest Health,Minnesota Senior Health Options (MSHO),61.74,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Digoxin, Serum Or Plasma",,80162,CPT,Facility,Inpatient,,,,120,102,34.392,120,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Digoxin, Serum Or Plasma",,80162,CPT,Facility,Outpatient,,,,120,102,34.392,120,PrimeWest Health,MinnesotaCare,61.632,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Digoxin, Serum Or Plasma",,80162,CPT,Facility,Inpatient,,,,120,102,34.392,120,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Digoxin, Serum Or Plasma",,80162,CPT,Facility,Both,,,,120,102,34.392,120,Sanford Health Plan,Sanford Health Plan,110.4,92,,percent of total billed charges,,
"Digoxin, Serum Or Plasma",,80162,CPT,Facility,Outpatient,,,,120,102,34.392,120,"UCare Health, Inc.",Individual & Family Plan,67.62,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Digoxin, Serum Or Plasma",,80162,CPT,Facility,Inpatient,,,,120,102,34.392,120,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Digoxin, Serum Or Plasma",,80162,CPT,Facility,Outpatient,,,,120,102,34.392,120,"UCare Health, Inc.",Medical Assistance,60.564,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Digoxin, Serum Or Plasma",,80162,CPT,Facility,Inpatient,,,,120,102,34.392,120,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Digoxin, Serum Or Plasma",,80162,CPT,Facility,Outpatient,,,,120,102,34.392,120,"UCare Health, Inc.",Medicare Advantage,60.564,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Digoxin, Serum Or Plasma",,80162,CPT,Facility,Inpatient,,,,120,102,34.392,120,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Digoxin, Serum Or Plasma",,80162,CPT,Facility,Outpatient,,,,120,102,34.392,120,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),60.564,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Digoxin, Serum Or Plasma",,80162,CPT,Facility,Inpatient,,,,120,102,34.392,120,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Digoxin, Serum Or Plasma",,80162,CPT,Facility,Both,,,,120,102,34.392,120,UnitedHealthcare,Individual & Family,112.8,94,,percent of total billed charges,,
"Digoxin, Serum Or Plasma",,80162,CPT,Facility,Outpatient,,,,120,102,34.392,120,UnitedHealthcare,Medicare Advantage,58.8,49,,percent of total billed charges,,
"Digoxin, Serum Or Plasma",,80162,CPT,Facility,Inpatient,,,,120,102,34.392,120,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Digoxin, Serum Or Plasma",,80162,CPT,Facility,Outpatient,,,,120,102,34.392,120,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,57.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Digoxin, Serum Or Plasma",,80162,CPT,Facility,Inpatient,,,,120,102,34.392,120,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Valproic Acid,,80164,CPT,Facility,Both,,,,123,104.55,35.2518,123,Aetna,Commercial,113.16,92,,percent of total billed charges,,
Valproic Acid,,80164,CPT,Facility,Outpatient,,,,123,104.55,35.2518,123,Aetna,Medicare Advantage,60.27,49,,percent of total billed charges,,
Valproic Acid,,80164,CPT,Facility,Inpatient,,,,123,104.55,35.2518,123,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Valproic Acid,,80164,CPT,Facility,Both,,,,123,104.55,35.2518,123,Aetna,PPO,114.39,93,,percent of total billed charges,,
Valproic Acid,,80164,CPT,Facility,Both,,,,123,104.55,35.2518,123,America's PPO,America's PPO,118.1169,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Valproic Acid,,80164,CPT,Facility,Both,,,,123,104.55,35.2518,123,BlueCross BlueShield Minnesota, Federal Employee Program,121.032,98.4,,percent of total billed charges,,
Valproic Acid,,80164,CPT,Facility,Both,,,,123,104.55,35.2518,123,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,123,100,,percent of total billed charges,,
Valproic Acid,,80164,CPT,Facility,Both,,,,123,104.55,35.2518,123,BlueCross BlueShield Minnesota,High Value Network Plan,110.7,90,,percent of total billed charges,,
Valproic Acid,,80164,CPT,Facility,Outpatient,,,,123,104.55,35.2518,123,BlueCross BlueShield Minnesota,Medicare Advantage,60.27,49,,percent of total billed charges,,
Valproic Acid,,80164,CPT,Facility,Inpatient,,,,123,104.55,35.2518,123,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Valproic Acid,,80164,CPT,Facility,Both,,,,123,104.55,35.2518,123,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,108.9411,88.57,,percent of total billed charges,,
Valproic Acid,,80164,CPT,Facility,Both,,,,123,104.55,35.2518,123,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,35.2518,28.66,,percent of total billed charges,,
Valproic Acid,,80164,CPT,Facility,Outpatient,,,,123,104.55,35.2518,123,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),60.27,49,,percent of total billed charges,,
Valproic Acid,,80164,CPT,Facility,Inpatient,,,,123,104.55,35.2518,123,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Valproic Acid,,80164,CPT,Facility,Both,,,,123,104.55,35.2518,123,CorVel,Worker's Compensation,123,100,,percent of total billed charges,,
Valproic Acid,,80164,CPT,Facility,Both,,,,123,104.55,35.2518,123,First Health Group Corporation,First Health Network,119.31,97,,percent of total billed charges,,
Valproic Acid,,80164,CPT,Facility,Both,,,,123,104.55,35.2518,123,"Health Partners, Inc.",Commercial,116.358,94.6,,percent of total billed charges,,
Valproic Acid,,80164,CPT,Facility,Outpatient,,,,123,104.55,35.2518,123,"Health Partners, Inc.",Medicare Advantage,60.27,49,,percent of total billed charges,,
Valproic Acid,,80164,CPT,Facility,Inpatient,,,,123,104.55,35.2518,123,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Valproic Acid,,80164,CPT,Facility,Both,,,,123,104.55,35.2518,123,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),73.8,60,,percent of total billed charges,,
Valproic Acid,,80164,CPT,Facility,Both,,,,123,104.55,35.2518,123,"Health Partners, Inc.",State of Minnesota Advantage Program,100.245,81.5,,percent of total billed charges,,
Valproic Acid,,80164,CPT,Facility,Both,,,,123,104.55,35.2518,123,"Health Partners, Inc.",State Public Programs,61.5,50,,percent of total billed charges,,
Valproic Acid,,80164,CPT,Facility,Both,,,,123,104.55,35.2518,123,Humana Insurance Company,Commercial PPO,116.85,95,,percent of total billed charges,,
Valproic Acid,,80164,CPT,Facility,Outpatient,,,,123,104.55,35.2518,123,Humana Insurance Company,Medicare PPO,60.27,49,,percent of total billed charges,,
Valproic Acid,,80164,CPT,Facility,Inpatient,,,,123,104.55,35.2518,123,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Valproic Acid,,80164,CPT,Facility,Both,,,,123,104.55,35.2518,123,Medica,Individual & Family,121.893,99.1,,percent of total billed charges,,
Valproic Acid,,80164,CPT,Facility,Outpatient,,,,123,104.55,35.2518,123,Medica,Medica Advantage Solution,61.254,49.8,,percent of total billed charges,,
Valproic Acid,,80164,CPT,Facility,Inpatient,,,,123,104.55,35.2518,123,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Valproic Acid,,80164,CPT,Facility,Outpatient,,,,123,104.55,35.2518,123,Medica,Medical Assistance,54.858,44.6,,percent of total billed charges,,
Valproic Acid,,80164,CPT,Facility,Inpatient,,,,123,104.55,35.2518,123,Medica,Medical Assistance,,,,,Included in per diem rate,
Valproic Acid,,80164,CPT,Facility,Outpatient,,,,123,104.55,35.2518,123,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,61.254,49.8,,percent of total billed charges,,
Valproic Acid,,80164,CPT,Facility,Inpatient,,,,123,104.55,35.2518,123,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Valproic Acid,,80164,CPT,Facility,Both,,,,123,104.55,35.2518,123,"Multiplan, Inc.","Multiplan, Inc.",115.62,94,,percent of total billed charges,,
Valproic Acid,,80164,CPT,Facility,Outpatient,,,,123,104.55,35.2518,123,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,106.272,86.4,,percent of total billed charges,,
Valproic Acid,,80164,CPT,Facility,Inpatient,,,,123,104.55,35.2518,123,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Valproic Acid,,80164,CPT,Facility,Both,,,,123,104.55,35.2518,123,"Preferred One Administrative Services, INC.",PPO,121.278,98.6,,percent of total billed charges,,
Valproic Acid,,80164,CPT,Facility,Outpatient,,,,123,104.55,35.2518,123,PrimeWest Health,Minnesota Senior Health Options (MSHO),63.2835,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Valproic Acid,,80164,CPT,Facility,Inpatient,,,,123,104.55,35.2518,123,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Valproic Acid,,80164,CPT,Facility,Outpatient,,,,123,104.55,35.2518,123,PrimeWest Health,MinnesotaCare,63.1728,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Valproic Acid,,80164,CPT,Facility,Inpatient,,,,123,104.55,35.2518,123,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Valproic Acid,,80164,CPT,Facility,Both,,,,123,104.55,35.2518,123,Sanford Health Plan,Sanford Health Plan,113.16,92,,percent of total billed charges,,
Valproic Acid,,80164,CPT,Facility,Outpatient,,,,123,104.55,35.2518,123,"UCare Health, Inc.",Individual & Family Plan,69.3105,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Valproic Acid,,80164,CPT,Facility,Inpatient,,,,123,104.55,35.2518,123,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Valproic Acid,,80164,CPT,Facility,Outpatient,,,,123,104.55,35.2518,123,"UCare Health, Inc.",Medical Assistance,62.0781,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Valproic Acid,,80164,CPT,Facility,Inpatient,,,,123,104.55,35.2518,123,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Valproic Acid,,80164,CPT,Facility,Outpatient,,,,123,104.55,35.2518,123,"UCare Health, Inc.",Medicare Advantage,62.0781,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Valproic Acid,,80164,CPT,Facility,Inpatient,,,,123,104.55,35.2518,123,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Valproic Acid,,80164,CPT,Facility,Outpatient,,,,123,104.55,35.2518,123,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),62.0781,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Valproic Acid,,80164,CPT,Facility,Inpatient,,,,123,104.55,35.2518,123,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Valproic Acid,,80164,CPT,Facility,Both,,,,123,104.55,35.2518,123,UnitedHealthcare,Individual & Family,115.62,94,,percent of total billed charges,,
Valproic Acid,,80164,CPT,Facility,Outpatient,,,,123,104.55,35.2518,123,UnitedHealthcare,Medicare Advantage,60.27,49,,percent of total billed charges,,
Valproic Acid,,80164,CPT,Facility,Inpatient,,,,123,104.55,35.2518,123,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Valproic Acid,,80164,CPT,Facility,Outpatient,,,,123,104.55,35.2518,123,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,59.04,48,,percent of total billed charges,,100% of DHS outpatient percentage
Valproic Acid,,80164,CPT,Facility,Inpatient,,,,123,104.55,35.2518,123,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Gentamicin, Random",,80170,CPT,Facility,Both,,,,142,120.7,40.6972,142,Aetna,Commercial,130.64,92,,percent of total billed charges,,
"Gentamicin, Random",,80170,CPT,Facility,Outpatient,,,,142,120.7,40.6972,142,Aetna,Medicare Advantage,69.58,49,,percent of total billed charges,,
"Gentamicin, Random",,80170,CPT,Facility,Inpatient,,,,142,120.7,40.6972,142,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Gentamicin, Random",,80170,CPT,Facility,Both,,,,142,120.7,40.6972,142,Aetna,PPO,132.06,93,,percent of total billed charges,,
"Gentamicin, Random",,80170,CPT,Facility,Both,,,,142,120.7,40.6972,142,America's PPO,America's PPO,136.3626,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Gentamicin, Random",,80170,CPT,Facility,Both,,,,142,120.7,40.6972,142,BlueCross BlueShield Minnesota, Federal Employee Program,139.728,98.4,,percent of total billed charges,,
"Gentamicin, Random",,80170,CPT,Facility,Both,,,,142,120.7,40.6972,142,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,142,100,,percent of total billed charges,,
"Gentamicin, Random",,80170,CPT,Facility,Both,,,,142,120.7,40.6972,142,BlueCross BlueShield Minnesota,High Value Network Plan,127.8,90,,percent of total billed charges,,
"Gentamicin, Random",,80170,CPT,Facility,Outpatient,,,,142,120.7,40.6972,142,BlueCross BlueShield Minnesota,Medicare Advantage,69.58,49,,percent of total billed charges,,
"Gentamicin, Random",,80170,CPT,Facility,Inpatient,,,,142,120.7,40.6972,142,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Gentamicin, Random",,80170,CPT,Facility,Both,,,,142,120.7,40.6972,142,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,125.7694,88.57,,percent of total billed charges,,
"Gentamicin, Random",,80170,CPT,Facility,Both,,,,142,120.7,40.6972,142,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,40.6972,28.66,,percent of total billed charges,,
"Gentamicin, Random",,80170,CPT,Facility,Outpatient,,,,142,120.7,40.6972,142,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),69.58,49,,percent of total billed charges,,
"Gentamicin, Random",,80170,CPT,Facility,Inpatient,,,,142,120.7,40.6972,142,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Gentamicin, Random",,80170,CPT,Facility,Both,,,,142,120.7,40.6972,142,CorVel,Worker's Compensation,142,100,,percent of total billed charges,,
"Gentamicin, Random",,80170,CPT,Facility,Both,,,,142,120.7,40.6972,142,First Health Group Corporation,First Health Network,137.74,97,,percent of total billed charges,,
"Gentamicin, Random",,80170,CPT,Facility,Both,,,,142,120.7,40.6972,142,"Health Partners, Inc.",Commercial,134.332,94.6,,percent of total billed charges,,
"Gentamicin, Random",,80170,CPT,Facility,Outpatient,,,,142,120.7,40.6972,142,"Health Partners, Inc.",Medicare Advantage,69.58,49,,percent of total billed charges,,
"Gentamicin, Random",,80170,CPT,Facility,Inpatient,,,,142,120.7,40.6972,142,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Gentamicin, Random",,80170,CPT,Facility,Both,,,,142,120.7,40.6972,142,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),85.2,60,,percent of total billed charges,,
"Gentamicin, Random",,80170,CPT,Facility,Both,,,,142,120.7,40.6972,142,"Health Partners, Inc.",State of Minnesota Advantage Program,115.73,81.5,,percent of total billed charges,,
"Gentamicin, Random",,80170,CPT,Facility,Both,,,,142,120.7,40.6972,142,"Health Partners, Inc.",State Public Programs,71,50,,percent of total billed charges,,
"Gentamicin, Random",,80170,CPT,Facility,Both,,,,142,120.7,40.6972,142,Humana Insurance Company,Commercial PPO,134.9,95,,percent of total billed charges,,
"Gentamicin, Random",,80170,CPT,Facility,Outpatient,,,,142,120.7,40.6972,142,Humana Insurance Company,Medicare PPO,69.58,49,,percent of total billed charges,,
"Gentamicin, Random",,80170,CPT,Facility,Inpatient,,,,142,120.7,40.6972,142,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Gentamicin, Random",,80170,CPT,Facility,Both,,,,142,120.7,40.6972,142,Medica,Individual & Family,140.722,99.1,,percent of total billed charges,,
"Gentamicin, Random",,80170,CPT,Facility,Outpatient,,,,142,120.7,40.6972,142,Medica,Medica Advantage Solution,70.716,49.8,,percent of total billed charges,,
"Gentamicin, Random",,80170,CPT,Facility,Inpatient,,,,142,120.7,40.6972,142,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Gentamicin, Random",,80170,CPT,Facility,Outpatient,,,,142,120.7,40.6972,142,Medica,Medical Assistance,63.332,44.6,,percent of total billed charges,,
"Gentamicin, Random",,80170,CPT,Facility,Inpatient,,,,142,120.7,40.6972,142,Medica,Medical Assistance,,,,,Included in per diem rate,
"Gentamicin, Random",,80170,CPT,Facility,Outpatient,,,,142,120.7,40.6972,142,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,70.716,49.8,,percent of total billed charges,,
"Gentamicin, Random",,80170,CPT,Facility,Inpatient,,,,142,120.7,40.6972,142,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Gentamicin, Random",,80170,CPT,Facility,Both,,,,142,120.7,40.6972,142,"Multiplan, Inc.","Multiplan, Inc.",133.48,94,,percent of total billed charges,,
"Gentamicin, Random",,80170,CPT,Facility,Outpatient,,,,142,120.7,40.6972,142,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,122.688,86.4,,percent of total billed charges,,
"Gentamicin, Random",,80170,CPT,Facility,Inpatient,,,,142,120.7,40.6972,142,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Gentamicin, Random",,80170,CPT,Facility,Both,,,,142,120.7,40.6972,142,"Preferred One Administrative Services, INC.",PPO,140.012,98.6,,percent of total billed charges,,
"Gentamicin, Random",,80170,CPT,Facility,Outpatient,,,,142,120.7,40.6972,142,PrimeWest Health,Minnesota Senior Health Options (MSHO),73.059,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Gentamicin, Random",,80170,CPT,Facility,Inpatient,,,,142,120.7,40.6972,142,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Gentamicin, Random",,80170,CPT,Facility,Outpatient,,,,142,120.7,40.6972,142,PrimeWest Health,MinnesotaCare,72.9312,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Gentamicin, Random",,80170,CPT,Facility,Inpatient,,,,142,120.7,40.6972,142,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Gentamicin, Random",,80170,CPT,Facility,Both,,,,142,120.7,40.6972,142,Sanford Health Plan,Sanford Health Plan,130.64,92,,percent of total billed charges,,
"Gentamicin, Random",,80170,CPT,Facility,Outpatient,,,,142,120.7,40.6972,142,"UCare Health, Inc.",Individual & Family Plan,80.017,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Gentamicin, Random",,80170,CPT,Facility,Inpatient,,,,142,120.7,40.6972,142,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Gentamicin, Random",,80170,CPT,Facility,Outpatient,,,,142,120.7,40.6972,142,"UCare Health, Inc.",Medical Assistance,71.6674,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Gentamicin, Random",,80170,CPT,Facility,Inpatient,,,,142,120.7,40.6972,142,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Gentamicin, Random",,80170,CPT,Facility,Outpatient,,,,142,120.7,40.6972,142,"UCare Health, Inc.",Medicare Advantage,71.6674,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Gentamicin, Random",,80170,CPT,Facility,Inpatient,,,,142,120.7,40.6972,142,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Gentamicin, Random",,80170,CPT,Facility,Outpatient,,,,142,120.7,40.6972,142,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),71.6674,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Gentamicin, Random",,80170,CPT,Facility,Inpatient,,,,142,120.7,40.6972,142,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Gentamicin, Random",,80170,CPT,Facility,Both,,,,142,120.7,40.6972,142,UnitedHealthcare,Individual & Family,133.48,94,,percent of total billed charges,,
"Gentamicin, Random",,80170,CPT,Facility,Outpatient,,,,142,120.7,40.6972,142,UnitedHealthcare,Medicare Advantage,69.58,49,,percent of total billed charges,,
"Gentamicin, Random",,80170,CPT,Facility,Inpatient,,,,142,120.7,40.6972,142,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Gentamicin, Random",,80170,CPT,Facility,Outpatient,,,,142,120.7,40.6972,142,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,68.16,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Gentamicin, Random",,80170,CPT,Facility,Inpatient,,,,142,120.7,40.6972,142,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Lithium,,80178,CPT,Facility,Both,,,,103,87.55,29.5198,103,Aetna,Commercial,94.76,92,,percent of total billed charges,,
Lithium,,80178,CPT,Facility,Outpatient,,,,103,87.55,29.5198,103,Aetna,Medicare Advantage,50.47,49,,percent of total billed charges,,
Lithium,,80178,CPT,Facility,Inpatient,,,,103,87.55,29.5198,103,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Lithium,,80178,CPT,Facility,Both,,,,103,87.55,29.5198,103,Aetna,PPO,95.79,93,,percent of total billed charges,,
Lithium,,80178,CPT,Facility,Both,,,,103,87.55,29.5198,103,America's PPO,America's PPO,98.9109,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Lithium,,80178,CPT,Facility,Both,,,,103,87.55,29.5198,103,BlueCross BlueShield Minnesota, Federal Employee Program,101.352,98.4,,percent of total billed charges,,
Lithium,,80178,CPT,Facility,Both,,,,103,87.55,29.5198,103,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,103,100,,percent of total billed charges,,
Lithium,,80178,CPT,Facility,Both,,,,103,87.55,29.5198,103,BlueCross BlueShield Minnesota,High Value Network Plan,92.7,90,,percent of total billed charges,,
Lithium,,80178,CPT,Facility,Outpatient,,,,103,87.55,29.5198,103,BlueCross BlueShield Minnesota,Medicare Advantage,50.47,49,,percent of total billed charges,,
Lithium,,80178,CPT,Facility,Inpatient,,,,103,87.55,29.5198,103,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Lithium,,80178,CPT,Facility,Both,,,,103,87.55,29.5198,103,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,91.2271,88.57,,percent of total billed charges,,
Lithium,,80178,CPT,Facility,Both,,,,103,87.55,29.5198,103,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,29.5198,28.66,,percent of total billed charges,,
Lithium,,80178,CPT,Facility,Outpatient,,,,103,87.55,29.5198,103,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),50.47,49,,percent of total billed charges,,
Lithium,,80178,CPT,Facility,Inpatient,,,,103,87.55,29.5198,103,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Lithium,,80178,CPT,Facility,Both,,,,103,87.55,29.5198,103,CorVel,Worker's Compensation,103,100,,percent of total billed charges,,
Lithium,,80178,CPT,Facility,Both,,,,103,87.55,29.5198,103,First Health Group Corporation,First Health Network,99.91,97,,percent of total billed charges,,
Lithium,,80178,CPT,Facility,Both,,,,103,87.55,29.5198,103,"Health Partners, Inc.",Commercial,97.438,94.6,,percent of total billed charges,,
Lithium,,80178,CPT,Facility,Outpatient,,,,103,87.55,29.5198,103,"Health Partners, Inc.",Medicare Advantage,50.47,49,,percent of total billed charges,,
Lithium,,80178,CPT,Facility,Inpatient,,,,103,87.55,29.5198,103,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Lithium,,80178,CPT,Facility,Both,,,,103,87.55,29.5198,103,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),61.8,60,,percent of total billed charges,,
Lithium,,80178,CPT,Facility,Both,,,,103,87.55,29.5198,103,"Health Partners, Inc.",State of Minnesota Advantage Program,83.945,81.5,,percent of total billed charges,,
Lithium,,80178,CPT,Facility,Both,,,,103,87.55,29.5198,103,"Health Partners, Inc.",State Public Programs,51.5,50,,percent of total billed charges,,
Lithium,,80178,CPT,Facility,Both,,,,103,87.55,29.5198,103,Humana Insurance Company,Commercial PPO,97.85,95,,percent of total billed charges,,
Lithium,,80178,CPT,Facility,Outpatient,,,,103,87.55,29.5198,103,Humana Insurance Company,Medicare PPO,50.47,49,,percent of total billed charges,,
Lithium,,80178,CPT,Facility,Inpatient,,,,103,87.55,29.5198,103,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Lithium,,80178,CPT,Facility,Both,,,,103,87.55,29.5198,103,Medica,Individual & Family,102.073,99.1,,percent of total billed charges,,
Lithium,,80178,CPT,Facility,Outpatient,,,,103,87.55,29.5198,103,Medica,Medica Advantage Solution,51.294,49.8,,percent of total billed charges,,
Lithium,,80178,CPT,Facility,Inpatient,,,,103,87.55,29.5198,103,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Lithium,,80178,CPT,Facility,Outpatient,,,,103,87.55,29.5198,103,Medica,Medical Assistance,45.938,44.6,,percent of total billed charges,,
Lithium,,80178,CPT,Facility,Inpatient,,,,103,87.55,29.5198,103,Medica,Medical Assistance,,,,,Included in per diem rate,
Lithium,,80178,CPT,Facility,Outpatient,,,,103,87.55,29.5198,103,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,51.294,49.8,,percent of total billed charges,,
Lithium,,80178,CPT,Facility,Inpatient,,,,103,87.55,29.5198,103,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Lithium,,80178,CPT,Facility,Both,,,,103,87.55,29.5198,103,"Multiplan, Inc.","Multiplan, Inc.",96.82,94,,percent of total billed charges,,
Lithium,,80178,CPT,Facility,Outpatient,,,,103,87.55,29.5198,103,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,88.992,86.4,,percent of total billed charges,,
Lithium,,80178,CPT,Facility,Inpatient,,,,103,87.55,29.5198,103,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Lithium,,80178,CPT,Facility,Both,,,,103,87.55,29.5198,103,"Preferred One Administrative Services, INC.",PPO,101.558,98.6,,percent of total billed charges,,
Lithium,,80178,CPT,Facility,Outpatient,,,,103,87.55,29.5198,103,PrimeWest Health,Minnesota Senior Health Options (MSHO),52.9935,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Lithium,,80178,CPT,Facility,Inpatient,,,,103,87.55,29.5198,103,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Lithium,,80178,CPT,Facility,Outpatient,,,,103,87.55,29.5198,103,PrimeWest Health,MinnesotaCare,52.9008,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Lithium,,80178,CPT,Facility,Inpatient,,,,103,87.55,29.5198,103,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Lithium,,80178,CPT,Facility,Both,,,,103,87.55,29.5198,103,Sanford Health Plan,Sanford Health Plan,94.76,92,,percent of total billed charges,,
Lithium,,80178,CPT,Facility,Outpatient,,,,103,87.55,29.5198,103,"UCare Health, Inc.",Individual & Family Plan,58.0405,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Lithium,,80178,CPT,Facility,Inpatient,,,,103,87.55,29.5198,103,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Lithium,,80178,CPT,Facility,Outpatient,,,,103,87.55,29.5198,103,"UCare Health, Inc.",Medical Assistance,51.9841,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Lithium,,80178,CPT,Facility,Inpatient,,,,103,87.55,29.5198,103,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Lithium,,80178,CPT,Facility,Outpatient,,,,103,87.55,29.5198,103,"UCare Health, Inc.",Medicare Advantage,51.9841,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Lithium,,80178,CPT,Facility,Inpatient,,,,103,87.55,29.5198,103,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Lithium,,80178,CPT,Facility,Outpatient,,,,103,87.55,29.5198,103,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),51.9841,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Lithium,,80178,CPT,Facility,Inpatient,,,,103,87.55,29.5198,103,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Lithium,,80178,CPT,Facility,Both,,,,103,87.55,29.5198,103,UnitedHealthcare,Individual & Family,96.82,94,,percent of total billed charges,,
Lithium,,80178,CPT,Facility,Outpatient,,,,103,87.55,29.5198,103,UnitedHealthcare,Medicare Advantage,50.47,49,,percent of total billed charges,,
Lithium,,80178,CPT,Facility,Inpatient,,,,103,87.55,29.5198,103,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Lithium,,80178,CPT,Facility,Outpatient,,,,103,87.55,29.5198,103,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,49.44,48,,percent of total billed charges,,100% of DHS outpatient percentage
Lithium,,80178,CPT,Facility,Inpatient,,,,103,87.55,29.5198,103,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Salicylate,,80179,CPT,Facility,Both,,,,101,85.85,28.9466,101,Aetna,Commercial,92.92,92,,percent of total billed charges,,
Salicylate,,80179,CPT,Facility,Outpatient,,,,101,85.85,28.9466,101,Aetna,Medicare Advantage,49.49,49,,percent of total billed charges,,
Salicylate,,80179,CPT,Facility,Inpatient,,,,101,85.85,28.9466,101,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Salicylate,,80179,CPT,Facility,Both,,,,101,85.85,28.9466,101,Aetna,PPO,93.93,93,,percent of total billed charges,,
Salicylate,,80179,CPT,Facility,Both,,,,101,85.85,28.9466,101,America's PPO,America's PPO,96.9903,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Salicylate,,80179,CPT,Facility,Both,,,,101,85.85,28.9466,101,BlueCross BlueShield Minnesota, Federal Employee Program,99.384,98.4,,percent of total billed charges,,
Salicylate,,80179,CPT,Facility,Both,,,,101,85.85,28.9466,101,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,101,100,,percent of total billed charges,,
Salicylate,,80179,CPT,Facility,Both,,,,101,85.85,28.9466,101,BlueCross BlueShield Minnesota,High Value Network Plan,90.9,90,,percent of total billed charges,,
Salicylate,,80179,CPT,Facility,Outpatient,,,,101,85.85,28.9466,101,BlueCross BlueShield Minnesota,Medicare Advantage,49.49,49,,percent of total billed charges,,
Salicylate,,80179,CPT,Facility,Inpatient,,,,101,85.85,28.9466,101,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Salicylate,,80179,CPT,Facility,Both,,,,101,85.85,28.9466,101,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,89.4557,88.57,,percent of total billed charges,,
Salicylate,,80179,CPT,Facility,Both,,,,101,85.85,28.9466,101,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,28.9466,28.66,,percent of total billed charges,,
Salicylate,,80179,CPT,Facility,Outpatient,,,,101,85.85,28.9466,101,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),49.49,49,,percent of total billed charges,,
Salicylate,,80179,CPT,Facility,Inpatient,,,,101,85.85,28.9466,101,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Salicylate,,80179,CPT,Facility,Both,,,,101,85.85,28.9466,101,CorVel,Worker's Compensation,101,100,,percent of total billed charges,,
Salicylate,,80179,CPT,Facility,Both,,,,101,85.85,28.9466,101,First Health Group Corporation,First Health Network,97.97,97,,percent of total billed charges,,
Salicylate,,80179,CPT,Facility,Both,,,,101,85.85,28.9466,101,"Health Partners, Inc.",Commercial,95.546,94.6,,percent of total billed charges,,
Salicylate,,80179,CPT,Facility,Outpatient,,,,101,85.85,28.9466,101,"Health Partners, Inc.",Medicare Advantage,49.49,49,,percent of total billed charges,,
Salicylate,,80179,CPT,Facility,Inpatient,,,,101,85.85,28.9466,101,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Salicylate,,80179,CPT,Facility,Both,,,,101,85.85,28.9466,101,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),60.6,60,,percent of total billed charges,,
Salicylate,,80179,CPT,Facility,Both,,,,101,85.85,28.9466,101,"Health Partners, Inc.",State of Minnesota Advantage Program,82.315,81.5,,percent of total billed charges,,
Salicylate,,80179,CPT,Facility,Both,,,,101,85.85,28.9466,101,"Health Partners, Inc.",State Public Programs,50.5,50,,percent of total billed charges,,
Salicylate,,80179,CPT,Facility,Both,,,,101,85.85,28.9466,101,Humana Insurance Company,Commercial PPO,95.95,95,,percent of total billed charges,,
Salicylate,,80179,CPT,Facility,Outpatient,,,,101,85.85,28.9466,101,Humana Insurance Company,Medicare PPO,49.49,49,,percent of total billed charges,,
Salicylate,,80179,CPT,Facility,Inpatient,,,,101,85.85,28.9466,101,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Salicylate,,80179,CPT,Facility,Both,,,,101,85.85,28.9466,101,Medica,Individual & Family,100.091,99.1,,percent of total billed charges,,
Salicylate,,80179,CPT,Facility,Outpatient,,,,101,85.85,28.9466,101,Medica,Medica Advantage Solution,50.298,49.8,,percent of total billed charges,,
Salicylate,,80179,CPT,Facility,Inpatient,,,,101,85.85,28.9466,101,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Salicylate,,80179,CPT,Facility,Outpatient,,,,101,85.85,28.9466,101,Medica,Medical Assistance,45.046,44.6,,percent of total billed charges,,
Salicylate,,80179,CPT,Facility,Inpatient,,,,101,85.85,28.9466,101,Medica,Medical Assistance,,,,,Included in per diem rate,
Salicylate,,80179,CPT,Facility,Outpatient,,,,101,85.85,28.9466,101,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,50.298,49.8,,percent of total billed charges,,
Salicylate,,80179,CPT,Facility,Inpatient,,,,101,85.85,28.9466,101,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Salicylate,,80179,CPT,Facility,Both,,,,101,85.85,28.9466,101,"Multiplan, Inc.","Multiplan, Inc.",94.94,94,,percent of total billed charges,,
Salicylate,,80179,CPT,Facility,Outpatient,,,,101,85.85,28.9466,101,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,87.264,86.4,,percent of total billed charges,,
Salicylate,,80179,CPT,Facility,Inpatient,,,,101,85.85,28.9466,101,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Salicylate,,80179,CPT,Facility,Both,,,,101,85.85,28.9466,101,"Preferred One Administrative Services, INC.",PPO,99.586,98.6,,percent of total billed charges,,
Salicylate,,80179,CPT,Facility,Outpatient,,,,101,85.85,28.9466,101,PrimeWest Health,Minnesota Senior Health Options (MSHO),51.9645,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Salicylate,,80179,CPT,Facility,Inpatient,,,,101,85.85,28.9466,101,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Salicylate,,80179,CPT,Facility,Outpatient,,,,101,85.85,28.9466,101,PrimeWest Health,MinnesotaCare,51.8736,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Salicylate,,80179,CPT,Facility,Inpatient,,,,101,85.85,28.9466,101,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Salicylate,,80179,CPT,Facility,Both,,,,101,85.85,28.9466,101,Sanford Health Plan,Sanford Health Plan,92.92,92,,percent of total billed charges,,
Salicylate,,80179,CPT,Facility,Outpatient,,,,101,85.85,28.9466,101,"UCare Health, Inc.",Individual & Family Plan,56.9135,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Salicylate,,80179,CPT,Facility,Inpatient,,,,101,85.85,28.9466,101,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Salicylate,,80179,CPT,Facility,Outpatient,,,,101,85.85,28.9466,101,"UCare Health, Inc.",Medical Assistance,50.9747,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Salicylate,,80179,CPT,Facility,Inpatient,,,,101,85.85,28.9466,101,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Salicylate,,80179,CPT,Facility,Outpatient,,,,101,85.85,28.9466,101,"UCare Health, Inc.",Medicare Advantage,50.9747,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Salicylate,,80179,CPT,Facility,Inpatient,,,,101,85.85,28.9466,101,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Salicylate,,80179,CPT,Facility,Outpatient,,,,101,85.85,28.9466,101,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),50.9747,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Salicylate,,80179,CPT,Facility,Inpatient,,,,101,85.85,28.9466,101,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Salicylate,,80179,CPT,Facility,Both,,,,101,85.85,28.9466,101,UnitedHealthcare,Individual & Family,94.94,94,,percent of total billed charges,,
Salicylate,,80179,CPT,Facility,Outpatient,,,,101,85.85,28.9466,101,UnitedHealthcare,Medicare Advantage,49.49,49,,percent of total billed charges,,
Salicylate,,80179,CPT,Facility,Inpatient,,,,101,85.85,28.9466,101,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Salicylate,,80179,CPT,Facility,Outpatient,,,,101,85.85,28.9466,101,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,48.48,48,,percent of total billed charges,,100% of DHS outpatient percentage
Salicylate,,80179,CPT,Facility,Inpatient,,,,101,85.85,28.9466,101,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Phenobarbital,,80184,CPT,Facility,Both,,,,96,81.6,27.5136,96,Aetna,Commercial,88.32,92,,percent of total billed charges,,
Phenobarbital,,80184,CPT,Facility,Outpatient,,,,96,81.6,27.5136,96,Aetna,Medicare Advantage,47.04,49,,percent of total billed charges,,
Phenobarbital,,80184,CPT,Facility,Inpatient,,,,96,81.6,27.5136,96,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Phenobarbital,,80184,CPT,Facility,Both,,,,96,81.6,27.5136,96,Aetna,PPO,89.28,93,,percent of total billed charges,,
Phenobarbital,,80184,CPT,Facility,Both,,,,96,81.6,27.5136,96,America's PPO,America's PPO,92.1888,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Phenobarbital,,80184,CPT,Facility,Both,,,,96,81.6,27.5136,96,BlueCross BlueShield Minnesota, Federal Employee Program,94.464,98.4,,percent of total billed charges,,
Phenobarbital,,80184,CPT,Facility,Both,,,,96,81.6,27.5136,96,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,96,100,,percent of total billed charges,,
Phenobarbital,,80184,CPT,Facility,Both,,,,96,81.6,27.5136,96,BlueCross BlueShield Minnesota,High Value Network Plan,86.4,90,,percent of total billed charges,,
Phenobarbital,,80184,CPT,Facility,Outpatient,,,,96,81.6,27.5136,96,BlueCross BlueShield Minnesota,Medicare Advantage,47.04,49,,percent of total billed charges,,
Phenobarbital,,80184,CPT,Facility,Inpatient,,,,96,81.6,27.5136,96,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Phenobarbital,,80184,CPT,Facility,Both,,,,96,81.6,27.5136,96,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,85.0272,88.57,,percent of total billed charges,,
Phenobarbital,,80184,CPT,Facility,Both,,,,96,81.6,27.5136,96,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,27.5136,28.66,,percent of total billed charges,,
Phenobarbital,,80184,CPT,Facility,Outpatient,,,,96,81.6,27.5136,96,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),47.04,49,,percent of total billed charges,,
Phenobarbital,,80184,CPT,Facility,Inpatient,,,,96,81.6,27.5136,96,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Phenobarbital,,80184,CPT,Facility,Both,,,,96,81.6,27.5136,96,CorVel,Worker's Compensation,96,100,,percent of total billed charges,,
Phenobarbital,,80184,CPT,Facility,Both,,,,96,81.6,27.5136,96,First Health Group Corporation,First Health Network,93.12,97,,percent of total billed charges,,
Phenobarbital,,80184,CPT,Facility,Both,,,,96,81.6,27.5136,96,"Health Partners, Inc.",Commercial,90.816,94.6,,percent of total billed charges,,
Phenobarbital,,80184,CPT,Facility,Outpatient,,,,96,81.6,27.5136,96,"Health Partners, Inc.",Medicare Advantage,47.04,49,,percent of total billed charges,,
Phenobarbital,,80184,CPT,Facility,Inpatient,,,,96,81.6,27.5136,96,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Phenobarbital,,80184,CPT,Facility,Both,,,,96,81.6,27.5136,96,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),57.6,60,,percent of total billed charges,,
Phenobarbital,,80184,CPT,Facility,Both,,,,96,81.6,27.5136,96,"Health Partners, Inc.",State of Minnesota Advantage Program,78.24,81.5,,percent of total billed charges,,
Phenobarbital,,80184,CPT,Facility,Both,,,,96,81.6,27.5136,96,"Health Partners, Inc.",State Public Programs,48,50,,percent of total billed charges,,
Phenobarbital,,80184,CPT,Facility,Both,,,,96,81.6,27.5136,96,Humana Insurance Company,Commercial PPO,91.2,95,,percent of total billed charges,,
Phenobarbital,,80184,CPT,Facility,Outpatient,,,,96,81.6,27.5136,96,Humana Insurance Company,Medicare PPO,47.04,49,,percent of total billed charges,,
Phenobarbital,,80184,CPT,Facility,Inpatient,,,,96,81.6,27.5136,96,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Phenobarbital,,80184,CPT,Facility,Both,,,,96,81.6,27.5136,96,Medica,Individual & Family,95.136,99.1,,percent of total billed charges,,
Phenobarbital,,80184,CPT,Facility,Outpatient,,,,96,81.6,27.5136,96,Medica,Medica Advantage Solution,47.808,49.8,,percent of total billed charges,,
Phenobarbital,,80184,CPT,Facility,Inpatient,,,,96,81.6,27.5136,96,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Phenobarbital,,80184,CPT,Facility,Outpatient,,,,96,81.6,27.5136,96,Medica,Medical Assistance,42.816,44.6,,percent of total billed charges,,
Phenobarbital,,80184,CPT,Facility,Inpatient,,,,96,81.6,27.5136,96,Medica,Medical Assistance,,,,,Included in per diem rate,
Phenobarbital,,80184,CPT,Facility,Outpatient,,,,96,81.6,27.5136,96,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,47.808,49.8,,percent of total billed charges,,
Phenobarbital,,80184,CPT,Facility,Inpatient,,,,96,81.6,27.5136,96,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Phenobarbital,,80184,CPT,Facility,Both,,,,96,81.6,27.5136,96,"Multiplan, Inc.","Multiplan, Inc.",90.24,94,,percent of total billed charges,,
Phenobarbital,,80184,CPT,Facility,Outpatient,,,,96,81.6,27.5136,96,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,82.944,86.4,,percent of total billed charges,,
Phenobarbital,,80184,CPT,Facility,Inpatient,,,,96,81.6,27.5136,96,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Phenobarbital,,80184,CPT,Facility,Both,,,,96,81.6,27.5136,96,"Preferred One Administrative Services, INC.",PPO,94.656,98.6,,percent of total billed charges,,
Phenobarbital,,80184,CPT,Facility,Outpatient,,,,96,81.6,27.5136,96,PrimeWest Health,Minnesota Senior Health Options (MSHO),49.392,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Phenobarbital,,80184,CPT,Facility,Inpatient,,,,96,81.6,27.5136,96,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Phenobarbital,,80184,CPT,Facility,Outpatient,,,,96,81.6,27.5136,96,PrimeWest Health,MinnesotaCare,49.3056,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Phenobarbital,,80184,CPT,Facility,Inpatient,,,,96,81.6,27.5136,96,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Phenobarbital,,80184,CPT,Facility,Both,,,,96,81.6,27.5136,96,Sanford Health Plan,Sanford Health Plan,88.32,92,,percent of total billed charges,,
Phenobarbital,,80184,CPT,Facility,Outpatient,,,,96,81.6,27.5136,96,"UCare Health, Inc.",Individual & Family Plan,54.096,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Phenobarbital,,80184,CPT,Facility,Inpatient,,,,96,81.6,27.5136,96,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Phenobarbital,,80184,CPT,Facility,Outpatient,,,,96,81.6,27.5136,96,"UCare Health, Inc.",Medical Assistance,48.4512,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Phenobarbital,,80184,CPT,Facility,Inpatient,,,,96,81.6,27.5136,96,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Phenobarbital,,80184,CPT,Facility,Outpatient,,,,96,81.6,27.5136,96,"UCare Health, Inc.",Medicare Advantage,48.4512,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Phenobarbital,,80184,CPT,Facility,Inpatient,,,,96,81.6,27.5136,96,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Phenobarbital,,80184,CPT,Facility,Outpatient,,,,96,81.6,27.5136,96,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),48.4512,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Phenobarbital,,80184,CPT,Facility,Inpatient,,,,96,81.6,27.5136,96,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Phenobarbital,,80184,CPT,Facility,Both,,,,96,81.6,27.5136,96,UnitedHealthcare,Individual & Family,90.24,94,,percent of total billed charges,,
Phenobarbital,,80184,CPT,Facility,Outpatient,,,,96,81.6,27.5136,96,UnitedHealthcare,Medicare Advantage,47.04,49,,percent of total billed charges,,
Phenobarbital,,80184,CPT,Facility,Inpatient,,,,96,81.6,27.5136,96,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Phenobarbital,,80184,CPT,Facility,Outpatient,,,,96,81.6,27.5136,96,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,46.08,48,,percent of total billed charges,,100% of DHS outpatient percentage
Phenobarbital,,80184,CPT,Facility,Inpatient,,,,96,81.6,27.5136,96,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Phenytoin, Total",,80185,CPT,Facility,Both,,,,110,93.5,31.526,110,Aetna,Commercial,101.2,92,,percent of total billed charges,,
"Phenytoin, Total",,80185,CPT,Facility,Outpatient,,,,110,93.5,31.526,110,Aetna,Medicare Advantage,53.9,49,,percent of total billed charges,,
"Phenytoin, Total",,80185,CPT,Facility,Inpatient,,,,110,93.5,31.526,110,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Phenytoin, Total",,80185,CPT,Facility,Both,,,,110,93.5,31.526,110,Aetna,PPO,102.3,93,,percent of total billed charges,,
"Phenytoin, Total",,80185,CPT,Facility,Both,,,,110,93.5,31.526,110,America's PPO,America's PPO,105.633,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Phenytoin, Total",,80185,CPT,Facility,Both,,,,110,93.5,31.526,110,BlueCross BlueShield Minnesota, Federal Employee Program,108.24,98.4,,percent of total billed charges,,
"Phenytoin, Total",,80185,CPT,Facility,Both,,,,110,93.5,31.526,110,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,110,100,,percent of total billed charges,,
"Phenytoin, Total",,80185,CPT,Facility,Both,,,,110,93.5,31.526,110,BlueCross BlueShield Minnesota,High Value Network Plan,99,90,,percent of total billed charges,,
"Phenytoin, Total",,80185,CPT,Facility,Outpatient,,,,110,93.5,31.526,110,BlueCross BlueShield Minnesota,Medicare Advantage,53.9,49,,percent of total billed charges,,
"Phenytoin, Total",,80185,CPT,Facility,Inpatient,,,,110,93.5,31.526,110,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Phenytoin, Total",,80185,CPT,Facility,Both,,,,110,93.5,31.526,110,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,97.427,88.57,,percent of total billed charges,,
"Phenytoin, Total",,80185,CPT,Facility,Both,,,,110,93.5,31.526,110,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,31.526,28.66,,percent of total billed charges,,
"Phenytoin, Total",,80185,CPT,Facility,Outpatient,,,,110,93.5,31.526,110,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),53.9,49,,percent of total billed charges,,
"Phenytoin, Total",,80185,CPT,Facility,Inpatient,,,,110,93.5,31.526,110,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Phenytoin, Total",,80185,CPT,Facility,Both,,,,110,93.5,31.526,110,CorVel,Worker's Compensation,110,100,,percent of total billed charges,,
"Phenytoin, Total",,80185,CPT,Facility,Both,,,,110,93.5,31.526,110,First Health Group Corporation,First Health Network,106.7,97,,percent of total billed charges,,
"Phenytoin, Total",,80185,CPT,Facility,Both,,,,110,93.5,31.526,110,"Health Partners, Inc.",Commercial,104.06,94.6,,percent of total billed charges,,
"Phenytoin, Total",,80185,CPT,Facility,Outpatient,,,,110,93.5,31.526,110,"Health Partners, Inc.",Medicare Advantage,53.9,49,,percent of total billed charges,,
"Phenytoin, Total",,80185,CPT,Facility,Inpatient,,,,110,93.5,31.526,110,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Phenytoin, Total",,80185,CPT,Facility,Both,,,,110,93.5,31.526,110,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),66,60,,percent of total billed charges,,
"Phenytoin, Total",,80185,CPT,Facility,Both,,,,110,93.5,31.526,110,"Health Partners, Inc.",State of Minnesota Advantage Program,89.65,81.5,,percent of total billed charges,,
"Phenytoin, Total",,80185,CPT,Facility,Both,,,,110,93.5,31.526,110,"Health Partners, Inc.",State Public Programs,55,50,,percent of total billed charges,,
"Phenytoin, Total",,80185,CPT,Facility,Both,,,,110,93.5,31.526,110,Humana Insurance Company,Commercial PPO,104.5,95,,percent of total billed charges,,
"Phenytoin, Total",,80185,CPT,Facility,Outpatient,,,,110,93.5,31.526,110,Humana Insurance Company,Medicare PPO,53.9,49,,percent of total billed charges,,
"Phenytoin, Total",,80185,CPT,Facility,Inpatient,,,,110,93.5,31.526,110,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Phenytoin, Total",,80185,CPT,Facility,Both,,,,110,93.5,31.526,110,Medica,Individual & Family,109.01,99.1,,percent of total billed charges,,
"Phenytoin, Total",,80185,CPT,Facility,Outpatient,,,,110,93.5,31.526,110,Medica,Medica Advantage Solution,54.78,49.8,,percent of total billed charges,,
"Phenytoin, Total",,80185,CPT,Facility,Inpatient,,,,110,93.5,31.526,110,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Phenytoin, Total",,80185,CPT,Facility,Outpatient,,,,110,93.5,31.526,110,Medica,Medical Assistance,49.06,44.6,,percent of total billed charges,,
"Phenytoin, Total",,80185,CPT,Facility,Inpatient,,,,110,93.5,31.526,110,Medica,Medical Assistance,,,,,Included in per diem rate,
"Phenytoin, Total",,80185,CPT,Facility,Outpatient,,,,110,93.5,31.526,110,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,54.78,49.8,,percent of total billed charges,,
"Phenytoin, Total",,80185,CPT,Facility,Inpatient,,,,110,93.5,31.526,110,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Phenytoin, Total",,80185,CPT,Facility,Both,,,,110,93.5,31.526,110,"Multiplan, Inc.","Multiplan, Inc.",103.4,94,,percent of total billed charges,,
"Phenytoin, Total",,80185,CPT,Facility,Outpatient,,,,110,93.5,31.526,110,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,95.04,86.4,,percent of total billed charges,,
"Phenytoin, Total",,80185,CPT,Facility,Inpatient,,,,110,93.5,31.526,110,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Phenytoin, Total",,80185,CPT,Facility,Both,,,,110,93.5,31.526,110,"Preferred One Administrative Services, INC.",PPO,108.46,98.6,,percent of total billed charges,,
"Phenytoin, Total",,80185,CPT,Facility,Outpatient,,,,110,93.5,31.526,110,PrimeWest Health,Minnesota Senior Health Options (MSHO),56.595,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Phenytoin, Total",,80185,CPT,Facility,Inpatient,,,,110,93.5,31.526,110,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Phenytoin, Total",,80185,CPT,Facility,Outpatient,,,,110,93.5,31.526,110,PrimeWest Health,MinnesotaCare,56.496,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Phenytoin, Total",,80185,CPT,Facility,Inpatient,,,,110,93.5,31.526,110,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Phenytoin, Total",,80185,CPT,Facility,Both,,,,110,93.5,31.526,110,Sanford Health Plan,Sanford Health Plan,101.2,92,,percent of total billed charges,,
"Phenytoin, Total",,80185,CPT,Facility,Outpatient,,,,110,93.5,31.526,110,"UCare Health, Inc.",Individual & Family Plan,61.985,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Phenytoin, Total",,80185,CPT,Facility,Inpatient,,,,110,93.5,31.526,110,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Phenytoin, Total",,80185,CPT,Facility,Outpatient,,,,110,93.5,31.526,110,"UCare Health, Inc.",Medical Assistance,55.517,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Phenytoin, Total",,80185,CPT,Facility,Inpatient,,,,110,93.5,31.526,110,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Phenytoin, Total",,80185,CPT,Facility,Outpatient,,,,110,93.5,31.526,110,"UCare Health, Inc.",Medicare Advantage,55.517,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Phenytoin, Total",,80185,CPT,Facility,Inpatient,,,,110,93.5,31.526,110,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Phenytoin, Total",,80185,CPT,Facility,Outpatient,,,,110,93.5,31.526,110,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),55.517,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Phenytoin, Total",,80185,CPT,Facility,Inpatient,,,,110,93.5,31.526,110,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Phenytoin, Total",,80185,CPT,Facility,Both,,,,110,93.5,31.526,110,UnitedHealthcare,Individual & Family,103.4,94,,percent of total billed charges,,
"Phenytoin, Total",,80185,CPT,Facility,Outpatient,,,,110,93.5,31.526,110,UnitedHealthcare,Medicare Advantage,53.9,49,,percent of total billed charges,,
"Phenytoin, Total",,80185,CPT,Facility,Inpatient,,,,110,93.5,31.526,110,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Phenytoin, Total",,80185,CPT,Facility,Outpatient,,,,110,93.5,31.526,110,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,52.8,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Phenytoin, Total",,80185,CPT,Facility,Inpatient,,,,110,93.5,31.526,110,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Tobramycin, Peak",,80200,CPT,Facility,Both,,,,49,41.65,14.0434,49,Aetna,Commercial,45.08,92,,percent of total billed charges,,
"Tobramycin, Peak",,80200,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,Aetna,Medicare Advantage,24.01,49,,percent of total billed charges,,
"Tobramycin, Peak",,80200,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Tobramycin, Peak",,80200,CPT,Facility,Both,,,,49,41.65,14.0434,49,Aetna,PPO,45.57,93,,percent of total billed charges,,
"Tobramycin, Peak",,80200,CPT,Facility,Both,,,,49,41.65,14.0434,49,America's PPO,America's PPO,47.0547,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Tobramycin, Peak",,80200,CPT,Facility,Both,,,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota, Federal Employee Program,48.216,98.4,,percent of total billed charges,,
"Tobramycin, Peak",,80200,CPT,Facility,Both,,,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,49,100,,percent of total billed charges,,
"Tobramycin, Peak",,80200,CPT,Facility,Both,,,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,High Value Network Plan,44.1,90,,percent of total billed charges,,
"Tobramycin, Peak",,80200,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Medicare Advantage,24.01,49,,percent of total billed charges,,
"Tobramycin, Peak",,80200,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Tobramycin, Peak",,80200,CPT,Facility,Both,,,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,43.3993,88.57,,percent of total billed charges,,
"Tobramycin, Peak",,80200,CPT,Facility,Both,,,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,14.0434,28.66,,percent of total billed charges,,
"Tobramycin, Peak",,80200,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),24.01,49,,percent of total billed charges,,
"Tobramycin, Peak",,80200,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Tobramycin, Peak",,80200,CPT,Facility,Both,,,,49,41.65,14.0434,49,CorVel,Worker's Compensation,49,100,,percent of total billed charges,,
"Tobramycin, Peak",,80200,CPT,Facility,Both,,,,49,41.65,14.0434,49,First Health Group Corporation,First Health Network,47.53,97,,percent of total billed charges,,
"Tobramycin, Peak",,80200,CPT,Facility,Both,,,,49,41.65,14.0434,49,"Health Partners, Inc.",Commercial,46.354,94.6,,percent of total billed charges,,
"Tobramycin, Peak",,80200,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,"Health Partners, Inc.",Medicare Advantage,24.01,49,,percent of total billed charges,,
"Tobramycin, Peak",,80200,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Tobramycin, Peak",,80200,CPT,Facility,Both,,,,49,41.65,14.0434,49,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),29.4,60,,percent of total billed charges,,
"Tobramycin, Peak",,80200,CPT,Facility,Both,,,,49,41.65,14.0434,49,"Health Partners, Inc.",State of Minnesota Advantage Program,39.935,81.5,,percent of total billed charges,,
"Tobramycin, Peak",,80200,CPT,Facility,Both,,,,49,41.65,14.0434,49,"Health Partners, Inc.",State Public Programs,24.5,50,,percent of total billed charges,,
"Tobramycin, Peak",,80200,CPT,Facility,Both,,,,49,41.65,14.0434,49,Humana Insurance Company,Commercial PPO,46.55,95,,percent of total billed charges,,
"Tobramycin, Peak",,80200,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,Humana Insurance Company,Medicare PPO,24.01,49,,percent of total billed charges,,
"Tobramycin, Peak",,80200,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Tobramycin, Peak",,80200,CPT,Facility,Both,,,,49,41.65,14.0434,49,Medica,Individual & Family,48.559,99.1,,percent of total billed charges,,
"Tobramycin, Peak",,80200,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,Medica,Medica Advantage Solution,24.402,49.8,,percent of total billed charges,,
"Tobramycin, Peak",,80200,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Tobramycin, Peak",,80200,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,Medica,Medical Assistance,21.854,44.6,,percent of total billed charges,,
"Tobramycin, Peak",,80200,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,Medica,Medical Assistance,,,,,Included in per diem rate,
"Tobramycin, Peak",,80200,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,24.402,49.8,,percent of total billed charges,,
"Tobramycin, Peak",,80200,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Tobramycin, Peak",,80200,CPT,Facility,Both,,,,49,41.65,14.0434,49,"Multiplan, Inc.","Multiplan, Inc.",46.06,94,,percent of total billed charges,,
"Tobramycin, Peak",,80200,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,42.336,86.4,,percent of total billed charges,,
"Tobramycin, Peak",,80200,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Tobramycin, Peak",,80200,CPT,Facility,Both,,,,49,41.65,14.0434,49,"Preferred One Administrative Services, INC.",PPO,48.314,98.6,,percent of total billed charges,,
"Tobramycin, Peak",,80200,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,PrimeWest Health,Minnesota Senior Health Options (MSHO),25.2105,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Tobramycin, Peak",,80200,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Tobramycin, Peak",,80200,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,PrimeWest Health,MinnesotaCare,25.1664,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Tobramycin, Peak",,80200,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Tobramycin, Peak",,80200,CPT,Facility,Both,,,,49,41.65,14.0434,49,Sanford Health Plan,Sanford Health Plan,45.08,92,,percent of total billed charges,,
"Tobramycin, Peak",,80200,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,"UCare Health, Inc.",Individual & Family Plan,27.6115,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Tobramycin, Peak",,80200,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Tobramycin, Peak",,80200,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,"UCare Health, Inc.",Medical Assistance,24.7303,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Tobramycin, Peak",,80200,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Tobramycin, Peak",,80200,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,"UCare Health, Inc.",Medicare Advantage,24.7303,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Tobramycin, Peak",,80200,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Tobramycin, Peak",,80200,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),24.7303,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Tobramycin, Peak",,80200,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Tobramycin, Peak",,80200,CPT,Facility,Both,,,,49,41.65,14.0434,49,UnitedHealthcare,Individual & Family,46.06,94,,percent of total billed charges,,
"Tobramycin, Peak",,80200,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,UnitedHealthcare,Medicare Advantage,24.01,49,,percent of total billed charges,,
"Tobramycin, Peak",,80200,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Tobramycin, Peak",,80200,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,23.52,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Tobramycin, Peak",,80200,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Tobramycin, Random",,80200,CPT,Facility,Both,,,,51,43.35,14.6166,51,Aetna,Commercial,46.92,92,,percent of total billed charges,,
"Tobramycin, Random",,80200,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,Aetna,Medicare Advantage,24.99,49,,percent of total billed charges,,
"Tobramycin, Random",,80200,CPT,Facility,Inpatient,,,,51,43.35,14.6166,51,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Tobramycin, Random",,80200,CPT,Facility,Both,,,,51,43.35,14.6166,51,Aetna,PPO,47.43,93,,percent of total billed charges,,
"Tobramycin, Random",,80200,CPT,Facility,Both,,,,51,43.35,14.6166,51,America's PPO,America's PPO,48.9753,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Tobramycin, Random",,80200,CPT,Facility,Both,,,,51,43.35,14.6166,51,BlueCross BlueShield Minnesota, Federal Employee Program,50.184,98.4,,percent of total billed charges,,
"Tobramycin, Random",,80200,CPT,Facility,Both,,,,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,51,100,,percent of total billed charges,,
"Tobramycin, Random",,80200,CPT,Facility,Both,,,,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,High Value Network Plan,45.9,90,,percent of total billed charges,,
"Tobramycin, Random",,80200,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,Medicare Advantage,24.99,49,,percent of total billed charges,,
"Tobramycin, Random",,80200,CPT,Facility,Inpatient,,,,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Tobramycin, Random",,80200,CPT,Facility,Both,,,,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,45.1707,88.57,,percent of total billed charges,,
"Tobramycin, Random",,80200,CPT,Facility,Both,,,,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,14.6166,28.66,,percent of total billed charges,,
"Tobramycin, Random",,80200,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),24.99,49,,percent of total billed charges,,
"Tobramycin, Random",,80200,CPT,Facility,Inpatient,,,,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Tobramycin, Random",,80200,CPT,Facility,Both,,,,51,43.35,14.6166,51,CorVel,Worker's Compensation,51,100,,percent of total billed charges,,
"Tobramycin, Random",,80200,CPT,Facility,Both,,,,51,43.35,14.6166,51,First Health Group Corporation,First Health Network,49.47,97,,percent of total billed charges,,
"Tobramycin, Random",,80200,CPT,Facility,Both,,,,51,43.35,14.6166,51,"Health Partners, Inc.",Commercial,48.246,94.6,,percent of total billed charges,,
"Tobramycin, Random",,80200,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,"Health Partners, Inc.",Medicare Advantage,24.99,49,,percent of total billed charges,,
"Tobramycin, Random",,80200,CPT,Facility,Inpatient,,,,51,43.35,14.6166,51,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Tobramycin, Random",,80200,CPT,Facility,Both,,,,51,43.35,14.6166,51,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),30.6,60,,percent of total billed charges,,
"Tobramycin, Random",,80200,CPT,Facility,Both,,,,51,43.35,14.6166,51,"Health Partners, Inc.",State of Minnesota Advantage Program,41.565,81.5,,percent of total billed charges,,
"Tobramycin, Random",,80200,CPT,Facility,Both,,,,51,43.35,14.6166,51,"Health Partners, Inc.",State Public Programs,25.5,50,,percent of total billed charges,,
"Tobramycin, Random",,80200,CPT,Facility,Both,,,,51,43.35,14.6166,51,Humana Insurance Company,Commercial PPO,48.45,95,,percent of total billed charges,,
"Tobramycin, Random",,80200,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,Humana Insurance Company,Medicare PPO,24.99,49,,percent of total billed charges,,
"Tobramycin, Random",,80200,CPT,Facility,Inpatient,,,,51,43.35,14.6166,51,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Tobramycin, Random",,80200,CPT,Facility,Both,,,,51,43.35,14.6166,51,Medica,Individual & Family,50.541,99.1,,percent of total billed charges,,
"Tobramycin, Random",,80200,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,Medica,Medica Advantage Solution,25.398,49.8,,percent of total billed charges,,
"Tobramycin, Random",,80200,CPT,Facility,Inpatient,,,,51,43.35,14.6166,51,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Tobramycin, Random",,80200,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,Medica,Medical Assistance,22.746,44.6,,percent of total billed charges,,
"Tobramycin, Random",,80200,CPT,Facility,Inpatient,,,,51,43.35,14.6166,51,Medica,Medical Assistance,,,,,Included in per diem rate,
"Tobramycin, Random",,80200,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,25.398,49.8,,percent of total billed charges,,
"Tobramycin, Random",,80200,CPT,Facility,Inpatient,,,,51,43.35,14.6166,51,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Tobramycin, Random",,80200,CPT,Facility,Both,,,,51,43.35,14.6166,51,"Multiplan, Inc.","Multiplan, Inc.",47.94,94,,percent of total billed charges,,
"Tobramycin, Random",,80200,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,44.064,86.4,,percent of total billed charges,,
"Tobramycin, Random",,80200,CPT,Facility,Inpatient,,,,51,43.35,14.6166,51,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Tobramycin, Random",,80200,CPT,Facility,Both,,,,51,43.35,14.6166,51,"Preferred One Administrative Services, INC.",PPO,50.286,98.6,,percent of total billed charges,,
"Tobramycin, Random",,80200,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,PrimeWest Health,Minnesota Senior Health Options (MSHO),26.2395,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Tobramycin, Random",,80200,CPT,Facility,Inpatient,,,,51,43.35,14.6166,51,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Tobramycin, Random",,80200,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,PrimeWest Health,MinnesotaCare,26.1936,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Tobramycin, Random",,80200,CPT,Facility,Inpatient,,,,51,43.35,14.6166,51,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Tobramycin, Random",,80200,CPT,Facility,Both,,,,51,43.35,14.6166,51,Sanford Health Plan,Sanford Health Plan,46.92,92,,percent of total billed charges,,
"Tobramycin, Random",,80200,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,"UCare Health, Inc.",Individual & Family Plan,28.7385,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Tobramycin, Random",,80200,CPT,Facility,Inpatient,,,,51,43.35,14.6166,51,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Tobramycin, Random",,80200,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,"UCare Health, Inc.",Medical Assistance,25.7397,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Tobramycin, Random",,80200,CPT,Facility,Inpatient,,,,51,43.35,14.6166,51,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Tobramycin, Random",,80200,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,"UCare Health, Inc.",Medicare Advantage,25.7397,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Tobramycin, Random",,80200,CPT,Facility,Inpatient,,,,51,43.35,14.6166,51,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Tobramycin, Random",,80200,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),25.7397,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Tobramycin, Random",,80200,CPT,Facility,Inpatient,,,,51,43.35,14.6166,51,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Tobramycin, Random",,80200,CPT,Facility,Both,,,,51,43.35,14.6166,51,UnitedHealthcare,Individual & Family,47.94,94,,percent of total billed charges,,
"Tobramycin, Random",,80200,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,UnitedHealthcare,Medicare Advantage,24.99,49,,percent of total billed charges,,
"Tobramycin, Random",,80200,CPT,Facility,Inpatient,,,,51,43.35,14.6166,51,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Tobramycin, Random",,80200,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,24.48,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Tobramycin, Random",,80200,CPT,Facility,Inpatient,,,,51,43.35,14.6166,51,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Vancomycin, Peak",,80202,CPT,Facility,Both,,,,140,119,40.124,140,Aetna,Commercial,128.8,92,,percent of total billed charges,,
"Vancomycin, Peak",,80202,CPT,Facility,Outpatient,,,,140,119,40.124,140,Aetna,Medicare Advantage,68.6,49,,percent of total billed charges,,
"Vancomycin, Peak",,80202,CPT,Facility,Inpatient,,,,140,119,40.124,140,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Vancomycin, Peak",,80202,CPT,Facility,Both,,,,140,119,40.124,140,Aetna,PPO,130.2,93,,percent of total billed charges,,
"Vancomycin, Peak",,80202,CPT,Facility,Both,,,,140,119,40.124,140,America's PPO,America's PPO,134.442,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Vancomycin, Peak",,80202,CPT,Facility,Both,,,,140,119,40.124,140,BlueCross BlueShield Minnesota, Federal Employee Program,137.76,98.4,,percent of total billed charges,,
"Vancomycin, Peak",,80202,CPT,Facility,Both,,,,140,119,40.124,140,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,140,100,,percent of total billed charges,,
"Vancomycin, Peak",,80202,CPT,Facility,Both,,,,140,119,40.124,140,BlueCross BlueShield Minnesota,High Value Network Plan,126,90,,percent of total billed charges,,
"Vancomycin, Peak",,80202,CPT,Facility,Outpatient,,,,140,119,40.124,140,BlueCross BlueShield Minnesota,Medicare Advantage,68.6,49,,percent of total billed charges,,
"Vancomycin, Peak",,80202,CPT,Facility,Inpatient,,,,140,119,40.124,140,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Vancomycin, Peak",,80202,CPT,Facility,Both,,,,140,119,40.124,140,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,123.998,88.57,,percent of total billed charges,,
"Vancomycin, Peak",,80202,CPT,Facility,Both,,,,140,119,40.124,140,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,40.124,28.66,,percent of total billed charges,,
"Vancomycin, Peak",,80202,CPT,Facility,Outpatient,,,,140,119,40.124,140,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),68.6,49,,percent of total billed charges,,
"Vancomycin, Peak",,80202,CPT,Facility,Inpatient,,,,140,119,40.124,140,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Vancomycin, Peak",,80202,CPT,Facility,Both,,,,140,119,40.124,140,CorVel,Worker's Compensation,140,100,,percent of total billed charges,,
"Vancomycin, Peak",,80202,CPT,Facility,Both,,,,140,119,40.124,140,First Health Group Corporation,First Health Network,135.8,97,,percent of total billed charges,,
"Vancomycin, Peak",,80202,CPT,Facility,Both,,,,140,119,40.124,140,"Health Partners, Inc.",Commercial,132.44,94.6,,percent of total billed charges,,
"Vancomycin, Peak",,80202,CPT,Facility,Outpatient,,,,140,119,40.124,140,"Health Partners, Inc.",Medicare Advantage,68.6,49,,percent of total billed charges,,
"Vancomycin, Peak",,80202,CPT,Facility,Inpatient,,,,140,119,40.124,140,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Vancomycin, Peak",,80202,CPT,Facility,Both,,,,140,119,40.124,140,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),84,60,,percent of total billed charges,,
"Vancomycin, Peak",,80202,CPT,Facility,Both,,,,140,119,40.124,140,"Health Partners, Inc.",State of Minnesota Advantage Program,114.1,81.5,,percent of total billed charges,,
"Vancomycin, Peak",,80202,CPT,Facility,Both,,,,140,119,40.124,140,"Health Partners, Inc.",State Public Programs,70,50,,percent of total billed charges,,
"Vancomycin, Peak",,80202,CPT,Facility,Both,,,,140,119,40.124,140,Humana Insurance Company,Commercial PPO,133,95,,percent of total billed charges,,
"Vancomycin, Peak",,80202,CPT,Facility,Outpatient,,,,140,119,40.124,140,Humana Insurance Company,Medicare PPO,68.6,49,,percent of total billed charges,,
"Vancomycin, Peak",,80202,CPT,Facility,Inpatient,,,,140,119,40.124,140,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Vancomycin, Peak",,80202,CPT,Facility,Both,,,,140,119,40.124,140,Medica,Individual & Family,138.74,99.1,,percent of total billed charges,,
"Vancomycin, Peak",,80202,CPT,Facility,Outpatient,,,,140,119,40.124,140,Medica,Medica Advantage Solution,69.72,49.8,,percent of total billed charges,,
"Vancomycin, Peak",,80202,CPT,Facility,Inpatient,,,,140,119,40.124,140,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Vancomycin, Peak",,80202,CPT,Facility,Outpatient,,,,140,119,40.124,140,Medica,Medical Assistance,62.44,44.6,,percent of total billed charges,,
"Vancomycin, Peak",,80202,CPT,Facility,Inpatient,,,,140,119,40.124,140,Medica,Medical Assistance,,,,,Included in per diem rate,
"Vancomycin, Peak",,80202,CPT,Facility,Outpatient,,,,140,119,40.124,140,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,69.72,49.8,,percent of total billed charges,,
"Vancomycin, Peak",,80202,CPT,Facility,Inpatient,,,,140,119,40.124,140,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Vancomycin, Peak",,80202,CPT,Facility,Both,,,,140,119,40.124,140,"Multiplan, Inc.","Multiplan, Inc.",131.6,94,,percent of total billed charges,,
"Vancomycin, Peak",,80202,CPT,Facility,Outpatient,,,,140,119,40.124,140,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,120.96,86.4,,percent of total billed charges,,
"Vancomycin, Peak",,80202,CPT,Facility,Inpatient,,,,140,119,40.124,140,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Vancomycin, Peak",,80202,CPT,Facility,Both,,,,140,119,40.124,140,"Preferred One Administrative Services, INC.",PPO,138.04,98.6,,percent of total billed charges,,
"Vancomycin, Peak",,80202,CPT,Facility,Outpatient,,,,140,119,40.124,140,PrimeWest Health,Minnesota Senior Health Options (MSHO),72.03,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Vancomycin, Peak",,80202,CPT,Facility,Inpatient,,,,140,119,40.124,140,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Vancomycin, Peak",,80202,CPT,Facility,Outpatient,,,,140,119,40.124,140,PrimeWest Health,MinnesotaCare,71.904,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Vancomycin, Peak",,80202,CPT,Facility,Inpatient,,,,140,119,40.124,140,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Vancomycin, Peak",,80202,CPT,Facility,Both,,,,140,119,40.124,140,Sanford Health Plan,Sanford Health Plan,128.8,92,,percent of total billed charges,,
"Vancomycin, Peak",,80202,CPT,Facility,Outpatient,,,,140,119,40.124,140,"UCare Health, Inc.",Individual & Family Plan,78.89,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Vancomycin, Peak",,80202,CPT,Facility,Inpatient,,,,140,119,40.124,140,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Vancomycin, Peak",,80202,CPT,Facility,Outpatient,,,,140,119,40.124,140,"UCare Health, Inc.",Medical Assistance,70.658,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Vancomycin, Peak",,80202,CPT,Facility,Inpatient,,,,140,119,40.124,140,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Vancomycin, Peak",,80202,CPT,Facility,Outpatient,,,,140,119,40.124,140,"UCare Health, Inc.",Medicare Advantage,70.658,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Vancomycin, Peak",,80202,CPT,Facility,Inpatient,,,,140,119,40.124,140,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Vancomycin, Peak",,80202,CPT,Facility,Outpatient,,,,140,119,40.124,140,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),70.658,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Vancomycin, Peak",,80202,CPT,Facility,Inpatient,,,,140,119,40.124,140,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Vancomycin, Peak",,80202,CPT,Facility,Both,,,,140,119,40.124,140,UnitedHealthcare,Individual & Family,131.6,94,,percent of total billed charges,,
"Vancomycin, Peak",,80202,CPT,Facility,Outpatient,,,,140,119,40.124,140,UnitedHealthcare,Medicare Advantage,68.6,49,,percent of total billed charges,,
"Vancomycin, Peak",,80202,CPT,Facility,Inpatient,,,,140,119,40.124,140,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Vancomycin, Peak",,80202,CPT,Facility,Outpatient,,,,140,119,40.124,140,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,67.2,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Vancomycin, Peak",,80202,CPT,Facility,Inpatient,,,,140,119,40.124,140,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Vancomycin, Random",,80202,CPT,Facility,Both,,,,140,119,40.124,140,Aetna,Commercial,128.8,92,,percent of total billed charges,,
"Vancomycin, Random",,80202,CPT,Facility,Outpatient,,,,140,119,40.124,140,Aetna,Medicare Advantage,68.6,49,,percent of total billed charges,,
"Vancomycin, Random",,80202,CPT,Facility,Inpatient,,,,140,119,40.124,140,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Vancomycin, Random",,80202,CPT,Facility,Both,,,,140,119,40.124,140,Aetna,PPO,130.2,93,,percent of total billed charges,,
"Vancomycin, Random",,80202,CPT,Facility,Both,,,,140,119,40.124,140,America's PPO,America's PPO,134.442,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Vancomycin, Random",,80202,CPT,Facility,Both,,,,140,119,40.124,140,BlueCross BlueShield Minnesota, Federal Employee Program,137.76,98.4,,percent of total billed charges,,
"Vancomycin, Random",,80202,CPT,Facility,Both,,,,140,119,40.124,140,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,140,100,,percent of total billed charges,,
"Vancomycin, Random",,80202,CPT,Facility,Both,,,,140,119,40.124,140,BlueCross BlueShield Minnesota,High Value Network Plan,126,90,,percent of total billed charges,,
"Vancomycin, Random",,80202,CPT,Facility,Outpatient,,,,140,119,40.124,140,BlueCross BlueShield Minnesota,Medicare Advantage,68.6,49,,percent of total billed charges,,
"Vancomycin, Random",,80202,CPT,Facility,Inpatient,,,,140,119,40.124,140,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Vancomycin, Random",,80202,CPT,Facility,Both,,,,140,119,40.124,140,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,123.998,88.57,,percent of total billed charges,,
"Vancomycin, Random",,80202,CPT,Facility,Both,,,,140,119,40.124,140,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,40.124,28.66,,percent of total billed charges,,
"Vancomycin, Random",,80202,CPT,Facility,Outpatient,,,,140,119,40.124,140,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),68.6,49,,percent of total billed charges,,
"Vancomycin, Random",,80202,CPT,Facility,Inpatient,,,,140,119,40.124,140,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Vancomycin, Random",,80202,CPT,Facility,Both,,,,140,119,40.124,140,CorVel,Worker's Compensation,140,100,,percent of total billed charges,,
"Vancomycin, Random",,80202,CPT,Facility,Both,,,,140,119,40.124,140,First Health Group Corporation,First Health Network,135.8,97,,percent of total billed charges,,
"Vancomycin, Random",,80202,CPT,Facility,Both,,,,140,119,40.124,140,"Health Partners, Inc.",Commercial,132.44,94.6,,percent of total billed charges,,
"Vancomycin, Random",,80202,CPT,Facility,Outpatient,,,,140,119,40.124,140,"Health Partners, Inc.",Medicare Advantage,68.6,49,,percent of total billed charges,,
"Vancomycin, Random",,80202,CPT,Facility,Inpatient,,,,140,119,40.124,140,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Vancomycin, Random",,80202,CPT,Facility,Both,,,,140,119,40.124,140,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),84,60,,percent of total billed charges,,
"Vancomycin, Random",,80202,CPT,Facility,Both,,,,140,119,40.124,140,"Health Partners, Inc.",State of Minnesota Advantage Program,114.1,81.5,,percent of total billed charges,,
"Vancomycin, Random",,80202,CPT,Facility,Both,,,,140,119,40.124,140,"Health Partners, Inc.",State Public Programs,70,50,,percent of total billed charges,,
"Vancomycin, Random",,80202,CPT,Facility,Both,,,,140,119,40.124,140,Humana Insurance Company,Commercial PPO,133,95,,percent of total billed charges,,
"Vancomycin, Random",,80202,CPT,Facility,Outpatient,,,,140,119,40.124,140,Humana Insurance Company,Medicare PPO,68.6,49,,percent of total billed charges,,
"Vancomycin, Random",,80202,CPT,Facility,Inpatient,,,,140,119,40.124,140,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Vancomycin, Random",,80202,CPT,Facility,Both,,,,140,119,40.124,140,Medica,Individual & Family,138.74,99.1,,percent of total billed charges,,
"Vancomycin, Random",,80202,CPT,Facility,Outpatient,,,,140,119,40.124,140,Medica,Medica Advantage Solution,69.72,49.8,,percent of total billed charges,,
"Vancomycin, Random",,80202,CPT,Facility,Inpatient,,,,140,119,40.124,140,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Vancomycin, Random",,80202,CPT,Facility,Outpatient,,,,140,119,40.124,140,Medica,Medical Assistance,62.44,44.6,,percent of total billed charges,,
"Vancomycin, Random",,80202,CPT,Facility,Inpatient,,,,140,119,40.124,140,Medica,Medical Assistance,,,,,Included in per diem rate,
"Vancomycin, Random",,80202,CPT,Facility,Outpatient,,,,140,119,40.124,140,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,69.72,49.8,,percent of total billed charges,,
"Vancomycin, Random",,80202,CPT,Facility,Inpatient,,,,140,119,40.124,140,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Vancomycin, Random",,80202,CPT,Facility,Both,,,,140,119,40.124,140,"Multiplan, Inc.","Multiplan, Inc.",131.6,94,,percent of total billed charges,,
"Vancomycin, Random",,80202,CPT,Facility,Outpatient,,,,140,119,40.124,140,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,120.96,86.4,,percent of total billed charges,,
"Vancomycin, Random",,80202,CPT,Facility,Inpatient,,,,140,119,40.124,140,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Vancomycin, Random",,80202,CPT,Facility,Both,,,,140,119,40.124,140,"Preferred One Administrative Services, INC.",PPO,138.04,98.6,,percent of total billed charges,,
"Vancomycin, Random",,80202,CPT,Facility,Outpatient,,,,140,119,40.124,140,PrimeWest Health,Minnesota Senior Health Options (MSHO),72.03,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Vancomycin, Random",,80202,CPT,Facility,Inpatient,,,,140,119,40.124,140,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Vancomycin, Random",,80202,CPT,Facility,Outpatient,,,,140,119,40.124,140,PrimeWest Health,MinnesotaCare,71.904,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Vancomycin, Random",,80202,CPT,Facility,Inpatient,,,,140,119,40.124,140,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Vancomycin, Random",,80202,CPT,Facility,Both,,,,140,119,40.124,140,Sanford Health Plan,Sanford Health Plan,128.8,92,,percent of total billed charges,,
"Vancomycin, Random",,80202,CPT,Facility,Outpatient,,,,140,119,40.124,140,"UCare Health, Inc.",Individual & Family Plan,78.89,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Vancomycin, Random",,80202,CPT,Facility,Inpatient,,,,140,119,40.124,140,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Vancomycin, Random",,80202,CPT,Facility,Outpatient,,,,140,119,40.124,140,"UCare Health, Inc.",Medical Assistance,70.658,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Vancomycin, Random",,80202,CPT,Facility,Inpatient,,,,140,119,40.124,140,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Vancomycin, Random",,80202,CPT,Facility,Outpatient,,,,140,119,40.124,140,"UCare Health, Inc.",Medicare Advantage,70.658,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Vancomycin, Random",,80202,CPT,Facility,Inpatient,,,,140,119,40.124,140,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Vancomycin, Random",,80202,CPT,Facility,Outpatient,,,,140,119,40.124,140,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),70.658,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Vancomycin, Random",,80202,CPT,Facility,Inpatient,,,,140,119,40.124,140,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Vancomycin, Random",,80202,CPT,Facility,Both,,,,140,119,40.124,140,UnitedHealthcare,Individual & Family,131.6,94,,percent of total billed charges,,
"Vancomycin, Random",,80202,CPT,Facility,Outpatient,,,,140,119,40.124,140,UnitedHealthcare,Medicare Advantage,68.6,49,,percent of total billed charges,,
"Vancomycin, Random",,80202,CPT,Facility,Inpatient,,,,140,119,40.124,140,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Vancomycin, Random",,80202,CPT,Facility,Outpatient,,,,140,119,40.124,140,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,67.2,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Vancomycin, Random",,80202,CPT,Facility,Inpatient,,,,140,119,40.124,140,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Vancomycin, Trough",,80202,CPT,Facility,Both,,,,140,119,40.124,140,Aetna,Commercial,128.8,92,,percent of total billed charges,,
"Vancomycin, Trough",,80202,CPT,Facility,Outpatient,,,,140,119,40.124,140,Aetna,Medicare Advantage,68.6,49,,percent of total billed charges,,
"Vancomycin, Trough",,80202,CPT,Facility,Inpatient,,,,140,119,40.124,140,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Vancomycin, Trough",,80202,CPT,Facility,Both,,,,140,119,40.124,140,Aetna,PPO,130.2,93,,percent of total billed charges,,
"Vancomycin, Trough",,80202,CPT,Facility,Both,,,,140,119,40.124,140,America's PPO,America's PPO,134.442,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Vancomycin, Trough",,80202,CPT,Facility,Both,,,,140,119,40.124,140,BlueCross BlueShield Minnesota, Federal Employee Program,137.76,98.4,,percent of total billed charges,,
"Vancomycin, Trough",,80202,CPT,Facility,Both,,,,140,119,40.124,140,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,140,100,,percent of total billed charges,,
"Vancomycin, Trough",,80202,CPT,Facility,Both,,,,140,119,40.124,140,BlueCross BlueShield Minnesota,High Value Network Plan,126,90,,percent of total billed charges,,
"Vancomycin, Trough",,80202,CPT,Facility,Outpatient,,,,140,119,40.124,140,BlueCross BlueShield Minnesota,Medicare Advantage,68.6,49,,percent of total billed charges,,
"Vancomycin, Trough",,80202,CPT,Facility,Inpatient,,,,140,119,40.124,140,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Vancomycin, Trough",,80202,CPT,Facility,Both,,,,140,119,40.124,140,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,123.998,88.57,,percent of total billed charges,,
"Vancomycin, Trough",,80202,CPT,Facility,Both,,,,140,119,40.124,140,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,40.124,28.66,,percent of total billed charges,,
"Vancomycin, Trough",,80202,CPT,Facility,Outpatient,,,,140,119,40.124,140,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),68.6,49,,percent of total billed charges,,
"Vancomycin, Trough",,80202,CPT,Facility,Inpatient,,,,140,119,40.124,140,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Vancomycin, Trough",,80202,CPT,Facility,Both,,,,140,119,40.124,140,CorVel,Worker's Compensation,140,100,,percent of total billed charges,,
"Vancomycin, Trough",,80202,CPT,Facility,Both,,,,140,119,40.124,140,First Health Group Corporation,First Health Network,135.8,97,,percent of total billed charges,,
"Vancomycin, Trough",,80202,CPT,Facility,Both,,,,140,119,40.124,140,"Health Partners, Inc.",Commercial,132.44,94.6,,percent of total billed charges,,
"Vancomycin, Trough",,80202,CPT,Facility,Outpatient,,,,140,119,40.124,140,"Health Partners, Inc.",Medicare Advantage,68.6,49,,percent of total billed charges,,
"Vancomycin, Trough",,80202,CPT,Facility,Inpatient,,,,140,119,40.124,140,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Vancomycin, Trough",,80202,CPT,Facility,Both,,,,140,119,40.124,140,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),84,60,,percent of total billed charges,,
"Vancomycin, Trough",,80202,CPT,Facility,Both,,,,140,119,40.124,140,"Health Partners, Inc.",State of Minnesota Advantage Program,114.1,81.5,,percent of total billed charges,,
"Vancomycin, Trough",,80202,CPT,Facility,Both,,,,140,119,40.124,140,"Health Partners, Inc.",State Public Programs,70,50,,percent of total billed charges,,
"Vancomycin, Trough",,80202,CPT,Facility,Both,,,,140,119,40.124,140,Humana Insurance Company,Commercial PPO,133,95,,percent of total billed charges,,
"Vancomycin, Trough",,80202,CPT,Facility,Outpatient,,,,140,119,40.124,140,Humana Insurance Company,Medicare PPO,68.6,49,,percent of total billed charges,,
"Vancomycin, Trough",,80202,CPT,Facility,Inpatient,,,,140,119,40.124,140,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Vancomycin, Trough",,80202,CPT,Facility,Both,,,,140,119,40.124,140,Medica,Individual & Family,138.74,99.1,,percent of total billed charges,,
"Vancomycin, Trough",,80202,CPT,Facility,Outpatient,,,,140,119,40.124,140,Medica,Medica Advantage Solution,69.72,49.8,,percent of total billed charges,,
"Vancomycin, Trough",,80202,CPT,Facility,Inpatient,,,,140,119,40.124,140,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Vancomycin, Trough",,80202,CPT,Facility,Outpatient,,,,140,119,40.124,140,Medica,Medical Assistance,62.44,44.6,,percent of total billed charges,,
"Vancomycin, Trough",,80202,CPT,Facility,Inpatient,,,,140,119,40.124,140,Medica,Medical Assistance,,,,,Included in per diem rate,
"Vancomycin, Trough",,80202,CPT,Facility,Outpatient,,,,140,119,40.124,140,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,69.72,49.8,,percent of total billed charges,,
"Vancomycin, Trough",,80202,CPT,Facility,Inpatient,,,,140,119,40.124,140,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Vancomycin, Trough",,80202,CPT,Facility,Both,,,,140,119,40.124,140,"Multiplan, Inc.","Multiplan, Inc.",131.6,94,,percent of total billed charges,,
"Vancomycin, Trough",,80202,CPT,Facility,Outpatient,,,,140,119,40.124,140,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,120.96,86.4,,percent of total billed charges,,
"Vancomycin, Trough",,80202,CPT,Facility,Inpatient,,,,140,119,40.124,140,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Vancomycin, Trough",,80202,CPT,Facility,Both,,,,140,119,40.124,140,"Preferred One Administrative Services, INC.",PPO,138.04,98.6,,percent of total billed charges,,
"Vancomycin, Trough",,80202,CPT,Facility,Outpatient,,,,140,119,40.124,140,PrimeWest Health,Minnesota Senior Health Options (MSHO),72.03,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Vancomycin, Trough",,80202,CPT,Facility,Inpatient,,,,140,119,40.124,140,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Vancomycin, Trough",,80202,CPT,Facility,Outpatient,,,,140,119,40.124,140,PrimeWest Health,MinnesotaCare,71.904,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Vancomycin, Trough",,80202,CPT,Facility,Inpatient,,,,140,119,40.124,140,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Vancomycin, Trough",,80202,CPT,Facility,Both,,,,140,119,40.124,140,Sanford Health Plan,Sanford Health Plan,128.8,92,,percent of total billed charges,,
"Vancomycin, Trough",,80202,CPT,Facility,Outpatient,,,,140,119,40.124,140,"UCare Health, Inc.",Individual & Family Plan,78.89,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Vancomycin, Trough",,80202,CPT,Facility,Inpatient,,,,140,119,40.124,140,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Vancomycin, Trough",,80202,CPT,Facility,Outpatient,,,,140,119,40.124,140,"UCare Health, Inc.",Medical Assistance,70.658,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Vancomycin, Trough",,80202,CPT,Facility,Inpatient,,,,140,119,40.124,140,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Vancomycin, Trough",,80202,CPT,Facility,Outpatient,,,,140,119,40.124,140,"UCare Health, Inc.",Medicare Advantage,70.658,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Vancomycin, Trough",,80202,CPT,Facility,Inpatient,,,,140,119,40.124,140,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Vancomycin, Trough",,80202,CPT,Facility,Outpatient,,,,140,119,40.124,140,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),70.658,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Vancomycin, Trough",,80202,CPT,Facility,Inpatient,,,,140,119,40.124,140,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Vancomycin, Trough",,80202,CPT,Facility,Both,,,,140,119,40.124,140,UnitedHealthcare,Individual & Family,131.6,94,,percent of total billed charges,,
"Vancomycin, Trough",,80202,CPT,Facility,Outpatient,,,,140,119,40.124,140,UnitedHealthcare,Medicare Advantage,68.6,49,,percent of total billed charges,,
"Vancomycin, Trough",,80202,CPT,Facility,Inpatient,,,,140,119,40.124,140,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Vancomycin, Trough",,80202,CPT,Facility,Outpatient,,,,140,119,40.124,140,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,67.2,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Vancomycin, Trough",,80202,CPT,Facility,Inpatient,,,,140,119,40.124,140,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Drugs Of Abuse Screen, Urine",,80306,CPT,Facility,Both,,,,249,211.65,71.3634,249,Aetna,Commercial,229.08,92,,percent of total billed charges,,
"Drugs Of Abuse Screen, Urine",,80306,CPT,Facility,Outpatient,,,,249,211.65,71.3634,249,Aetna,Medicare Advantage,122.01,49,,percent of total billed charges,,
"Drugs Of Abuse Screen, Urine",,80306,CPT,Facility,Inpatient,,,,249,211.65,71.3634,249,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Drugs Of Abuse Screen, Urine",,80306,CPT,Facility,Both,,,,249,211.65,71.3634,249,Aetna,PPO,231.57,93,,percent of total billed charges,,
"Drugs Of Abuse Screen, Urine",,80306,CPT,Facility,Both,,,,249,211.65,71.3634,249,America's PPO,America's PPO,239.1147,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Drugs Of Abuse Screen, Urine",,80306,CPT,Facility,Both,,,,249,211.65,71.3634,249,BlueCross BlueShield Minnesota, Federal Employee Program,245.016,98.4,,percent of total billed charges,,
"Drugs Of Abuse Screen, Urine",,80306,CPT,Facility,Both,,,,249,211.65,71.3634,249,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,249,100,,percent of total billed charges,,
"Drugs Of Abuse Screen, Urine",,80306,CPT,Facility,Both,,,,249,211.65,71.3634,249,BlueCross BlueShield Minnesota,High Value Network Plan,224.1,90,,percent of total billed charges,,
"Drugs Of Abuse Screen, Urine",,80306,CPT,Facility,Outpatient,,,,249,211.65,71.3634,249,BlueCross BlueShield Minnesota,Medicare Advantage,122.01,49,,percent of total billed charges,,
"Drugs Of Abuse Screen, Urine",,80306,CPT,Facility,Inpatient,,,,249,211.65,71.3634,249,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Drugs Of Abuse Screen, Urine",,80306,CPT,Facility,Both,,,,249,211.65,71.3634,249,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,220.5393,88.57,,percent of total billed charges,,
"Drugs Of Abuse Screen, Urine",,80306,CPT,Facility,Both,,,,249,211.65,71.3634,249,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,71.3634,28.66,,percent of total billed charges,,
"Drugs Of Abuse Screen, Urine",,80306,CPT,Facility,Outpatient,,,,249,211.65,71.3634,249,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),122.01,49,,percent of total billed charges,,
"Drugs Of Abuse Screen, Urine",,80306,CPT,Facility,Inpatient,,,,249,211.65,71.3634,249,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Drugs Of Abuse Screen, Urine",,80306,CPT,Facility,Both,,,,249,211.65,71.3634,249,CorVel,Worker's Compensation,249,100,,percent of total billed charges,,
"Drugs Of Abuse Screen, Urine",,80306,CPT,Facility,Both,,,,249,211.65,71.3634,249,First Health Group Corporation,First Health Network,241.53,97,,percent of total billed charges,,
"Drugs Of Abuse Screen, Urine",,80306,CPT,Facility,Both,,,,249,211.65,71.3634,249,"Health Partners, Inc.",Commercial,235.554,94.6,,percent of total billed charges,,
"Drugs Of Abuse Screen, Urine",,80306,CPT,Facility,Outpatient,,,,249,211.65,71.3634,249,"Health Partners, Inc.",Medicare Advantage,122.01,49,,percent of total billed charges,,
"Drugs Of Abuse Screen, Urine",,80306,CPT,Facility,Inpatient,,,,249,211.65,71.3634,249,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Drugs Of Abuse Screen, Urine",,80306,CPT,Facility,Both,,,,249,211.65,71.3634,249,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),149.4,60,,percent of total billed charges,,
"Drugs Of Abuse Screen, Urine",,80306,CPT,Facility,Both,,,,249,211.65,71.3634,249,"Health Partners, Inc.",State of Minnesota Advantage Program,202.935,81.5,,percent of total billed charges,,
"Drugs Of Abuse Screen, Urine",,80306,CPT,Facility,Both,,,,249,211.65,71.3634,249,"Health Partners, Inc.",State Public Programs,124.5,50,,percent of total billed charges,,
"Drugs Of Abuse Screen, Urine",,80306,CPT,Facility,Both,,,,249,211.65,71.3634,249,Humana Insurance Company,Commercial PPO,236.55,95,,percent of total billed charges,,
"Drugs Of Abuse Screen, Urine",,80306,CPT,Facility,Outpatient,,,,249,211.65,71.3634,249,Humana Insurance Company,Medicare PPO,122.01,49,,percent of total billed charges,,
"Drugs Of Abuse Screen, Urine",,80306,CPT,Facility,Inpatient,,,,249,211.65,71.3634,249,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Drugs Of Abuse Screen, Urine",,80306,CPT,Facility,Both,,,,249,211.65,71.3634,249,Medica,Individual & Family,246.759,99.1,,percent of total billed charges,,
"Drugs Of Abuse Screen, Urine",,80306,CPT,Facility,Outpatient,,,,249,211.65,71.3634,249,Medica,Medica Advantage Solution,124.002,49.8,,percent of total billed charges,,
"Drugs Of Abuse Screen, Urine",,80306,CPT,Facility,Inpatient,,,,249,211.65,71.3634,249,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Drugs Of Abuse Screen, Urine",,80306,CPT,Facility,Outpatient,,,,249,211.65,71.3634,249,Medica,Medical Assistance,111.054,44.6,,percent of total billed charges,,
"Drugs Of Abuse Screen, Urine",,80306,CPT,Facility,Inpatient,,,,249,211.65,71.3634,249,Medica,Medical Assistance,,,,,Included in per diem rate,
"Drugs Of Abuse Screen, Urine",,80306,CPT,Facility,Outpatient,,,,249,211.65,71.3634,249,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,124.002,49.8,,percent of total billed charges,,
"Drugs Of Abuse Screen, Urine",,80306,CPT,Facility,Inpatient,,,,249,211.65,71.3634,249,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Drugs Of Abuse Screen, Urine",,80306,CPT,Facility,Both,,,,249,211.65,71.3634,249,"Multiplan, Inc.","Multiplan, Inc.",234.06,94,,percent of total billed charges,,
"Drugs Of Abuse Screen, Urine",,80306,CPT,Facility,Outpatient,,,,249,211.65,71.3634,249,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,215.136,86.4,,percent of total billed charges,,
"Drugs Of Abuse Screen, Urine",,80306,CPT,Facility,Inpatient,,,,249,211.65,71.3634,249,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Drugs Of Abuse Screen, Urine",,80306,CPT,Facility,Both,,,,249,211.65,71.3634,249,"Preferred One Administrative Services, INC.",PPO,245.514,98.6,,percent of total billed charges,,
"Drugs Of Abuse Screen, Urine",,80306,CPT,Facility,Outpatient,,,,249,211.65,71.3634,249,PrimeWest Health,Minnesota Senior Health Options (MSHO),128.1105,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Drugs Of Abuse Screen, Urine",,80306,CPT,Facility,Inpatient,,,,249,211.65,71.3634,249,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Drugs Of Abuse Screen, Urine",,80306,CPT,Facility,Outpatient,,,,249,211.65,71.3634,249,PrimeWest Health,MinnesotaCare,127.8864,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Drugs Of Abuse Screen, Urine",,80306,CPT,Facility,Inpatient,,,,249,211.65,71.3634,249,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Drugs Of Abuse Screen, Urine",,80306,CPT,Facility,Both,,,,249,211.65,71.3634,249,Sanford Health Plan,Sanford Health Plan,229.08,92,,percent of total billed charges,,
"Drugs Of Abuse Screen, Urine",,80306,CPT,Facility,Outpatient,,,,249,211.65,71.3634,249,"UCare Health, Inc.",Individual & Family Plan,140.3115,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Drugs Of Abuse Screen, Urine",,80306,CPT,Facility,Inpatient,,,,249,211.65,71.3634,249,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Drugs Of Abuse Screen, Urine",,80306,CPT,Facility,Outpatient,,,,249,211.65,71.3634,249,"UCare Health, Inc.",Medical Assistance,125.6703,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Drugs Of Abuse Screen, Urine",,80306,CPT,Facility,Inpatient,,,,249,211.65,71.3634,249,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Drugs Of Abuse Screen, Urine",,80306,CPT,Facility,Outpatient,,,,249,211.65,71.3634,249,"UCare Health, Inc.",Medicare Advantage,125.6703,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Drugs Of Abuse Screen, Urine",,80306,CPT,Facility,Inpatient,,,,249,211.65,71.3634,249,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Drugs Of Abuse Screen, Urine",,80306,CPT,Facility,Outpatient,,,,249,211.65,71.3634,249,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),125.6703,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Drugs Of Abuse Screen, Urine",,80306,CPT,Facility,Inpatient,,,,249,211.65,71.3634,249,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Drugs Of Abuse Screen, Urine",,80306,CPT,Facility,Both,,,,249,211.65,71.3634,249,UnitedHealthcare,Individual & Family,234.06,94,,percent of total billed charges,,
"Drugs Of Abuse Screen, Urine",,80306,CPT,Facility,Outpatient,,,,249,211.65,71.3634,249,UnitedHealthcare,Medicare Advantage,122.01,49,,percent of total billed charges,,
"Drugs Of Abuse Screen, Urine",,80306,CPT,Facility,Inpatient,,,,249,211.65,71.3634,249,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Drugs Of Abuse Screen, Urine",,80306,CPT,Facility,Outpatient,,,,249,211.65,71.3634,249,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,119.52,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Drugs Of Abuse Screen, Urine",,80306,CPT,Facility,Inpatient,,,,249,211.65,71.3634,249,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Acetaminophen (Spectrophotometry Method),,80329,CPT,Facility,Both,,,,147,124.95,42.1302,147,Aetna,Commercial,135.24,92,,percent of total billed charges,,
Acetaminophen (Spectrophotometry Method),,80329,CPT,Facility,Outpatient,,,,147,124.95,42.1302,147,Aetna,Medicare Advantage,72.03,49,,percent of total billed charges,,
Acetaminophen (Spectrophotometry Method),,80329,CPT,Facility,Inpatient,,,,147,124.95,42.1302,147,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Acetaminophen (Spectrophotometry Method),,80329,CPT,Facility,Both,,,,147,124.95,42.1302,147,Aetna,PPO,136.71,93,,percent of total billed charges,,
Acetaminophen (Spectrophotometry Method),,80329,CPT,Facility,Both,,,,147,124.95,42.1302,147,America's PPO,America's PPO,141.1641,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Acetaminophen (Spectrophotometry Method),,80329,CPT,Facility,Both,,,,147,124.95,42.1302,147,BlueCross BlueShield Minnesota, Federal Employee Program,144.648,98.4,,percent of total billed charges,,
Acetaminophen (Spectrophotometry Method),,80329,CPT,Facility,Both,,,,147,124.95,42.1302,147,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,147,100,,percent of total billed charges,,
Acetaminophen (Spectrophotometry Method),,80329,CPT,Facility,Both,,,,147,124.95,42.1302,147,BlueCross BlueShield Minnesota,High Value Network Plan,132.3,90,,percent of total billed charges,,
Acetaminophen (Spectrophotometry Method),,80329,CPT,Facility,Outpatient,,,,147,124.95,42.1302,147,BlueCross BlueShield Minnesota,Medicare Advantage,72.03,49,,percent of total billed charges,,
Acetaminophen (Spectrophotometry Method),,80329,CPT,Facility,Inpatient,,,,147,124.95,42.1302,147,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Acetaminophen (Spectrophotometry Method),,80329,CPT,Facility,Both,,,,147,124.95,42.1302,147,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,130.1979,88.57,,percent of total billed charges,,
Acetaminophen (Spectrophotometry Method),,80329,CPT,Facility,Both,,,,147,124.95,42.1302,147,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,42.1302,28.66,,percent of total billed charges,,
Acetaminophen (Spectrophotometry Method),,80329,CPT,Facility,Outpatient,,,,147,124.95,42.1302,147,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),72.03,49,,percent of total billed charges,,
Acetaminophen (Spectrophotometry Method),,80329,CPT,Facility,Inpatient,,,,147,124.95,42.1302,147,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Acetaminophen (Spectrophotometry Method),,80329,CPT,Facility,Both,,,,147,124.95,42.1302,147,CorVel,Worker's Compensation,147,100,,percent of total billed charges,,
Acetaminophen (Spectrophotometry Method),,80329,CPT,Facility,Both,,,,147,124.95,42.1302,147,First Health Group Corporation,First Health Network,142.59,97,,percent of total billed charges,,
Acetaminophen (Spectrophotometry Method),,80329,CPT,Facility,Both,,,,147,124.95,42.1302,147,"Health Partners, Inc.",Commercial,139.062,94.6,,percent of total billed charges,,
Acetaminophen (Spectrophotometry Method),,80329,CPT,Facility,Outpatient,,,,147,124.95,42.1302,147,"Health Partners, Inc.",Medicare Advantage,72.03,49,,percent of total billed charges,,
Acetaminophen (Spectrophotometry Method),,80329,CPT,Facility,Inpatient,,,,147,124.95,42.1302,147,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Acetaminophen (Spectrophotometry Method),,80329,CPT,Facility,Both,,,,147,124.95,42.1302,147,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),88.2,60,,percent of total billed charges,,
Acetaminophen (Spectrophotometry Method),,80329,CPT,Facility,Both,,,,147,124.95,42.1302,147,"Health Partners, Inc.",State of Minnesota Advantage Program,119.805,81.5,,percent of total billed charges,,
Acetaminophen (Spectrophotometry Method),,80329,CPT,Facility,Both,,,,147,124.95,42.1302,147,"Health Partners, Inc.",State Public Programs,73.5,50,,percent of total billed charges,,
Acetaminophen (Spectrophotometry Method),,80329,CPT,Facility,Both,,,,147,124.95,42.1302,147,Humana Insurance Company,Commercial PPO,139.65,95,,percent of total billed charges,,
Acetaminophen (Spectrophotometry Method),,80329,CPT,Facility,Outpatient,,,,147,124.95,42.1302,147,Humana Insurance Company,Medicare PPO,72.03,49,,percent of total billed charges,,
Acetaminophen (Spectrophotometry Method),,80329,CPT,Facility,Inpatient,,,,147,124.95,42.1302,147,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Acetaminophen (Spectrophotometry Method),,80329,CPT,Facility,Both,,,,147,124.95,42.1302,147,Medica,Individual & Family,145.677,99.1,,percent of total billed charges,,
Acetaminophen (Spectrophotometry Method),,80329,CPT,Facility,Outpatient,,,,147,124.95,42.1302,147,Medica,Medica Advantage Solution,73.206,49.8,,percent of total billed charges,,
Acetaminophen (Spectrophotometry Method),,80329,CPT,Facility,Inpatient,,,,147,124.95,42.1302,147,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Acetaminophen (Spectrophotometry Method),,80329,CPT,Facility,Outpatient,,,,147,124.95,42.1302,147,Medica,Medical Assistance,65.562,44.6,,percent of total billed charges,,
Acetaminophen (Spectrophotometry Method),,80329,CPT,Facility,Inpatient,,,,147,124.95,42.1302,147,Medica,Medical Assistance,,,,,Included in per diem rate,
Acetaminophen (Spectrophotometry Method),,80329,CPT,Facility,Outpatient,,,,147,124.95,42.1302,147,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,73.206,49.8,,percent of total billed charges,,
Acetaminophen (Spectrophotometry Method),,80329,CPT,Facility,Inpatient,,,,147,124.95,42.1302,147,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Acetaminophen (Spectrophotometry Method),,80329,CPT,Facility,Both,,,,147,124.95,42.1302,147,"Multiplan, Inc.","Multiplan, Inc.",138.18,94,,percent of total billed charges,,
Acetaminophen (Spectrophotometry Method),,80329,CPT,Facility,Outpatient,,,,147,124.95,42.1302,147,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,127.008,86.4,,percent of total billed charges,,
Acetaminophen (Spectrophotometry Method),,80329,CPT,Facility,Inpatient,,,,147,124.95,42.1302,147,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Acetaminophen (Spectrophotometry Method),,80329,CPT,Facility,Both,,,,147,124.95,42.1302,147,"Preferred One Administrative Services, INC.",PPO,144.942,98.6,,percent of total billed charges,,
Acetaminophen (Spectrophotometry Method),,80329,CPT,Facility,Outpatient,,,,147,124.95,42.1302,147,PrimeWest Health,Minnesota Senior Health Options (MSHO),75.6315,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Acetaminophen (Spectrophotometry Method),,80329,CPT,Facility,Inpatient,,,,147,124.95,42.1302,147,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Acetaminophen (Spectrophotometry Method),,80329,CPT,Facility,Outpatient,,,,147,124.95,42.1302,147,PrimeWest Health,MinnesotaCare,75.4992,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Acetaminophen (Spectrophotometry Method),,80329,CPT,Facility,Inpatient,,,,147,124.95,42.1302,147,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Acetaminophen (Spectrophotometry Method),,80329,CPT,Facility,Both,,,,147,124.95,42.1302,147,Sanford Health Plan,Sanford Health Plan,135.24,92,,percent of total billed charges,,
Acetaminophen (Spectrophotometry Method),,80329,CPT,Facility,Outpatient,,,,147,124.95,42.1302,147,"UCare Health, Inc.",Individual & Family Plan,82.8345,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Acetaminophen (Spectrophotometry Method),,80329,CPT,Facility,Inpatient,,,,147,124.95,42.1302,147,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Acetaminophen (Spectrophotometry Method),,80329,CPT,Facility,Outpatient,,,,147,124.95,42.1302,147,"UCare Health, Inc.",Medical Assistance,74.1909,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Acetaminophen (Spectrophotometry Method),,80329,CPT,Facility,Inpatient,,,,147,124.95,42.1302,147,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Acetaminophen (Spectrophotometry Method),,80329,CPT,Facility,Outpatient,,,,147,124.95,42.1302,147,"UCare Health, Inc.",Medicare Advantage,74.1909,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Acetaminophen (Spectrophotometry Method),,80329,CPT,Facility,Inpatient,,,,147,124.95,42.1302,147,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Acetaminophen (Spectrophotometry Method),,80329,CPT,Facility,Outpatient,,,,147,124.95,42.1302,147,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),74.1909,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Acetaminophen (Spectrophotometry Method),,80329,CPT,Facility,Inpatient,,,,147,124.95,42.1302,147,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Acetaminophen (Spectrophotometry Method),,80329,CPT,Facility,Both,,,,147,124.95,42.1302,147,UnitedHealthcare,Individual & Family,138.18,94,,percent of total billed charges,,
Acetaminophen (Spectrophotometry Method),,80329,CPT,Facility,Outpatient,,,,147,124.95,42.1302,147,UnitedHealthcare,Medicare Advantage,72.03,49,,percent of total billed charges,,
Acetaminophen (Spectrophotometry Method),,80329,CPT,Facility,Inpatient,,,,147,124.95,42.1302,147,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Acetaminophen (Spectrophotometry Method),,80329,CPT,Facility,Outpatient,,,,147,124.95,42.1302,147,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,70.56,48,,percent of total billed charges,,100% of DHS outpatient percentage
Acetaminophen (Spectrophotometry Method),,80329,CPT,Facility,Inpatient,,,,147,124.95,42.1302,147,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Salicylate (Spectrophotometry Method),,80329,CPT,Facility,Both,,,,101,85.85,28.9466,101,Aetna,Commercial,92.92,92,,percent of total billed charges,,
Salicylate (Spectrophotometry Method),,80329,CPT,Facility,Outpatient,,,,101,85.85,28.9466,101,Aetna,Medicare Advantage,49.49,49,,percent of total billed charges,,
Salicylate (Spectrophotometry Method),,80329,CPT,Facility,Inpatient,,,,101,85.85,28.9466,101,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Salicylate (Spectrophotometry Method),,80329,CPT,Facility,Both,,,,101,85.85,28.9466,101,Aetna,PPO,93.93,93,,percent of total billed charges,,
Salicylate (Spectrophotometry Method),,80329,CPT,Facility,Both,,,,101,85.85,28.9466,101,America's PPO,America's PPO,96.9903,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Salicylate (Spectrophotometry Method),,80329,CPT,Facility,Both,,,,101,85.85,28.9466,101,BlueCross BlueShield Minnesota, Federal Employee Program,99.384,98.4,,percent of total billed charges,,
Salicylate (Spectrophotometry Method),,80329,CPT,Facility,Both,,,,101,85.85,28.9466,101,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,101,100,,percent of total billed charges,,
Salicylate (Spectrophotometry Method),,80329,CPT,Facility,Both,,,,101,85.85,28.9466,101,BlueCross BlueShield Minnesota,High Value Network Plan,90.9,90,,percent of total billed charges,,
Salicylate (Spectrophotometry Method),,80329,CPT,Facility,Outpatient,,,,101,85.85,28.9466,101,BlueCross BlueShield Minnesota,Medicare Advantage,49.49,49,,percent of total billed charges,,
Salicylate (Spectrophotometry Method),,80329,CPT,Facility,Inpatient,,,,101,85.85,28.9466,101,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Salicylate (Spectrophotometry Method),,80329,CPT,Facility,Both,,,,101,85.85,28.9466,101,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,89.4557,88.57,,percent of total billed charges,,
Salicylate (Spectrophotometry Method),,80329,CPT,Facility,Both,,,,101,85.85,28.9466,101,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,28.9466,28.66,,percent of total billed charges,,
Salicylate (Spectrophotometry Method),,80329,CPT,Facility,Outpatient,,,,101,85.85,28.9466,101,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),49.49,49,,percent of total billed charges,,
Salicylate (Spectrophotometry Method),,80329,CPT,Facility,Inpatient,,,,101,85.85,28.9466,101,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Salicylate (Spectrophotometry Method),,80329,CPT,Facility,Both,,,,101,85.85,28.9466,101,CorVel,Worker's Compensation,101,100,,percent of total billed charges,,
Salicylate (Spectrophotometry Method),,80329,CPT,Facility,Both,,,,101,85.85,28.9466,101,First Health Group Corporation,First Health Network,97.97,97,,percent of total billed charges,,
Salicylate (Spectrophotometry Method),,80329,CPT,Facility,Both,,,,101,85.85,28.9466,101,"Health Partners, Inc.",Commercial,95.546,94.6,,percent of total billed charges,,
Salicylate (Spectrophotometry Method),,80329,CPT,Facility,Outpatient,,,,101,85.85,28.9466,101,"Health Partners, Inc.",Medicare Advantage,49.49,49,,percent of total billed charges,,
Salicylate (Spectrophotometry Method),,80329,CPT,Facility,Inpatient,,,,101,85.85,28.9466,101,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Salicylate (Spectrophotometry Method),,80329,CPT,Facility,Both,,,,101,85.85,28.9466,101,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),60.6,60,,percent of total billed charges,,
Salicylate (Spectrophotometry Method),,80329,CPT,Facility,Both,,,,101,85.85,28.9466,101,"Health Partners, Inc.",State of Minnesota Advantage Program,82.315,81.5,,percent of total billed charges,,
Salicylate (Spectrophotometry Method),,80329,CPT,Facility,Both,,,,101,85.85,28.9466,101,"Health Partners, Inc.",State Public Programs,50.5,50,,percent of total billed charges,,
Salicylate (Spectrophotometry Method),,80329,CPT,Facility,Both,,,,101,85.85,28.9466,101,Humana Insurance Company,Commercial PPO,95.95,95,,percent of total billed charges,,
Salicylate (Spectrophotometry Method),,80329,CPT,Facility,Outpatient,,,,101,85.85,28.9466,101,Humana Insurance Company,Medicare PPO,49.49,49,,percent of total billed charges,,
Salicylate (Spectrophotometry Method),,80329,CPT,Facility,Inpatient,,,,101,85.85,28.9466,101,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Salicylate (Spectrophotometry Method),,80329,CPT,Facility,Both,,,,101,85.85,28.9466,101,Medica,Individual & Family,100.091,99.1,,percent of total billed charges,,
Salicylate (Spectrophotometry Method),,80329,CPT,Facility,Outpatient,,,,101,85.85,28.9466,101,Medica,Medica Advantage Solution,50.298,49.8,,percent of total billed charges,,
Salicylate (Spectrophotometry Method),,80329,CPT,Facility,Inpatient,,,,101,85.85,28.9466,101,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Salicylate (Spectrophotometry Method),,80329,CPT,Facility,Outpatient,,,,101,85.85,28.9466,101,Medica,Medical Assistance,45.046,44.6,,percent of total billed charges,,
Salicylate (Spectrophotometry Method),,80329,CPT,Facility,Inpatient,,,,101,85.85,28.9466,101,Medica,Medical Assistance,,,,,Included in per diem rate,
Salicylate (Spectrophotometry Method),,80329,CPT,Facility,Outpatient,,,,101,85.85,28.9466,101,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,50.298,49.8,,percent of total billed charges,,
Salicylate (Spectrophotometry Method),,80329,CPT,Facility,Inpatient,,,,101,85.85,28.9466,101,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Salicylate (Spectrophotometry Method),,80329,CPT,Facility,Both,,,,101,85.85,28.9466,101,"Multiplan, Inc.","Multiplan, Inc.",94.94,94,,percent of total billed charges,,
Salicylate (Spectrophotometry Method),,80329,CPT,Facility,Outpatient,,,,101,85.85,28.9466,101,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,87.264,86.4,,percent of total billed charges,,
Salicylate (Spectrophotometry Method),,80329,CPT,Facility,Inpatient,,,,101,85.85,28.9466,101,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Salicylate (Spectrophotometry Method),,80329,CPT,Facility,Both,,,,101,85.85,28.9466,101,"Preferred One Administrative Services, INC.",PPO,99.586,98.6,,percent of total billed charges,,
Salicylate (Spectrophotometry Method),,80329,CPT,Facility,Outpatient,,,,101,85.85,28.9466,101,PrimeWest Health,Minnesota Senior Health Options (MSHO),51.9645,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Salicylate (Spectrophotometry Method),,80329,CPT,Facility,Inpatient,,,,101,85.85,28.9466,101,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Salicylate (Spectrophotometry Method),,80329,CPT,Facility,Outpatient,,,,101,85.85,28.9466,101,PrimeWest Health,MinnesotaCare,51.8736,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Salicylate (Spectrophotometry Method),,80329,CPT,Facility,Inpatient,,,,101,85.85,28.9466,101,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Salicylate (Spectrophotometry Method),,80329,CPT,Facility,Both,,,,101,85.85,28.9466,101,Sanford Health Plan,Sanford Health Plan,92.92,92,,percent of total billed charges,,
Salicylate (Spectrophotometry Method),,80329,CPT,Facility,Outpatient,,,,101,85.85,28.9466,101,"UCare Health, Inc.",Individual & Family Plan,56.9135,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Salicylate (Spectrophotometry Method),,80329,CPT,Facility,Inpatient,,,,101,85.85,28.9466,101,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Salicylate (Spectrophotometry Method),,80329,CPT,Facility,Outpatient,,,,101,85.85,28.9466,101,"UCare Health, Inc.",Medical Assistance,50.9747,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Salicylate (Spectrophotometry Method),,80329,CPT,Facility,Inpatient,,,,101,85.85,28.9466,101,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Salicylate (Spectrophotometry Method),,80329,CPT,Facility,Outpatient,,,,101,85.85,28.9466,101,"UCare Health, Inc.",Medicare Advantage,50.9747,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Salicylate (Spectrophotometry Method),,80329,CPT,Facility,Inpatient,,,,101,85.85,28.9466,101,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Salicylate (Spectrophotometry Method),,80329,CPT,Facility,Outpatient,,,,101,85.85,28.9466,101,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),50.9747,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Salicylate (Spectrophotometry Method),,80329,CPT,Facility,Inpatient,,,,101,85.85,28.9466,101,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Salicylate (Spectrophotometry Method),,80329,CPT,Facility,Both,,,,101,85.85,28.9466,101,UnitedHealthcare,Individual & Family,94.94,94,,percent of total billed charges,,
Salicylate (Spectrophotometry Method),,80329,CPT,Facility,Outpatient,,,,101,85.85,28.9466,101,UnitedHealthcare,Medicare Advantage,49.49,49,,percent of total billed charges,,
Salicylate (Spectrophotometry Method),,80329,CPT,Facility,Inpatient,,,,101,85.85,28.9466,101,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Salicylate (Spectrophotometry Method),,80329,CPT,Facility,Outpatient,,,,101,85.85,28.9466,101,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,48.48,48,,percent of total billed charges,,100% of DHS outpatient percentage
Salicylate (Spectrophotometry Method),,80329,CPT,Facility,Inpatient,,,,101,85.85,28.9466,101,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJ SOLN,,J0330,HCPCS,Facility,Both,10,mL,,108,91.8,30.9528,108,Aetna,Commercial,99.36,92,,percent of total billed charges,,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJ SOLN,,J0330,HCPCS,Facility,Both,10,mL,,108,91.8,30.9528,108,Aetna,Commercial,99.36,92,,percent of total billed charges,,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJ SOLN,,J0330,HCPCS,Facility,Outpatient,10,mL,,108,91.8,30.9528,108,Aetna,Medicare Advantage,52.92,49,,percent of total billed charges,,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJ SOLN,,J0330,HCPCS,Facility,Outpatient,10,mL,,108,91.8,30.9528,108,Aetna,Medicare Advantage,52.92,49,,percent of total billed charges,,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJ SOLN,,J0330,HCPCS,Facility,Inpatient,10,mL,,108,91.8,30.9528,108,Aetna,Medicare Advantage,,,,,Included in per diem rate,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJ SOLN,,J0330,HCPCS,Facility,Inpatient,10,mL,,108,91.8,30.9528,108,Aetna,Medicare Advantage,,,,,Included in per diem rate,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJ SOLN,,J0330,HCPCS,Facility,Both,10,mL,,108,91.8,30.9528,108,Aetna,PPO,100.44,93,,percent of total billed charges,,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJ SOLN,,J0330,HCPCS,Facility,Both,10,mL,,108,91.8,30.9528,108,Aetna,PPO,100.44,93,,percent of total billed charges,,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJ SOLN,,J0330,HCPCS,Facility,Both,10,mL,,108,91.8,30.9528,108,America's PPO,America's PPO,103.7124,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJ SOLN,,J0330,HCPCS,Facility,Both,10,mL,,108,91.8,30.9528,108,America's PPO,America's PPO,103.7124,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJ SOLN,,J0330,HCPCS,Facility,Both,10,mL,,108,91.8,30.9528,108,BlueCross BlueShield Minnesota, Federal Employee Program,106.272,98.4,,percent of total billed charges,,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJ SOLN,,J0330,HCPCS,Facility,Both,10,mL,,108,91.8,30.9528,108,BlueCross BlueShield Minnesota, Federal Employee Program,106.272,98.4,,percent of total billed charges,,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJ SOLN,,J0330,HCPCS,Facility,Both,10,mL,,108,91.8,30.9528,108,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,108,100,,percent of total billed charges,,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJ SOLN,,J0330,HCPCS,Facility,Both,10,mL,,108,91.8,30.9528,108,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,108,100,,percent of total billed charges,,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJ SOLN,,J0330,HCPCS,Facility,Both,10,mL,,108,91.8,30.9528,108,BlueCross BlueShield Minnesota,High Value Network Plan,97.2,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJ SOLN,,J0330,HCPCS,Facility,Both,10,mL,,108,91.8,30.9528,108,BlueCross BlueShield Minnesota,High Value Network Plan,97.2,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJ SOLN,,J0330,HCPCS,Facility,Outpatient,10,mL,,108,91.8,30.9528,108,BlueCross BlueShield Minnesota,Medicare Advantage,52.92,49,,percent of total billed charges,,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJ SOLN,,J0330,HCPCS,Facility,Outpatient,10,mL,,108,91.8,30.9528,108,BlueCross BlueShield Minnesota,Medicare Advantage,52.92,49,,percent of total billed charges,,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJ SOLN,,J0330,HCPCS,Facility,Inpatient,10,mL,,108,91.8,30.9528,108,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJ SOLN,,J0330,HCPCS,Facility,Inpatient,10,mL,,108,91.8,30.9528,108,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJ SOLN,,J0330,HCPCS,Facility,Both,10,mL,,108,91.8,30.9528,108,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,95.6556,88.57,,percent of total billed charges,,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJ SOLN,,J0330,HCPCS,Facility,Both,10,mL,,108,91.8,30.9528,108,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,95.6556,88.57,,percent of total billed charges,,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJ SOLN,,J0330,HCPCS,Facility,Both,10,mL,,108,91.8,30.9528,108,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,30.9528,28.66,,percent of total billed charges,,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJ SOLN,,J0330,HCPCS,Facility,Both,10,mL,,108,91.8,30.9528,108,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,30.9528,28.66,,percent of total billed charges,,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJ SOLN,,J0330,HCPCS,Facility,Outpatient,10,mL,,108,91.8,30.9528,108,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),52.92,49,,percent of total billed charges,,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJ SOLN,,J0330,HCPCS,Facility,Outpatient,10,mL,,108,91.8,30.9528,108,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),52.92,49,,percent of total billed charges,,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJ SOLN,,J0330,HCPCS,Facility,Inpatient,10,mL,,108,91.8,30.9528,108,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJ SOLN,,J0330,HCPCS,Facility,Inpatient,10,mL,,108,91.8,30.9528,108,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJ SOLN,,J0330,HCPCS,Facility,Both,10,mL,,108,91.8,30.9528,108,CorVel,Worker's Compensation,108,100,,percent of total billed charges,,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJ SOLN,,J0330,HCPCS,Facility,Both,10,mL,,108,91.8,30.9528,108,CorVel,Worker's Compensation,108,100,,percent of total billed charges,,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJ SOLN,,J0330,HCPCS,Facility,Both,10,mL,,108,91.8,30.9528,108,First Health Group Corporation,First Health Network,104.76,97,,percent of total billed charges,,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJ SOLN,,J0330,HCPCS,Facility,Both,10,mL,,108,91.8,30.9528,108,First Health Group Corporation,First Health Network,104.76,97,,percent of total billed charges,,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJ SOLN,,J0330,HCPCS,Facility,Both,10,mL,,108,91.8,30.9528,108,"Health Partners, Inc.",Commercial,102.168,94.6,,percent of total billed charges,,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJ SOLN,,J0330,HCPCS,Facility,Both,10,mL,,108,91.8,30.9528,108,"Health Partners, Inc.",Commercial,102.168,94.6,,percent of total billed charges,,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJ SOLN,,J0330,HCPCS,Facility,Outpatient,10,mL,,108,91.8,30.9528,108,"Health Partners, Inc.",Medicare Advantage,52.92,49,,percent of total billed charges,,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJ SOLN,,J0330,HCPCS,Facility,Outpatient,10,mL,,108,91.8,30.9528,108,"Health Partners, Inc.",Medicare Advantage,52.92,49,,percent of total billed charges,,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJ SOLN,,J0330,HCPCS,Facility,Inpatient,10,mL,,108,91.8,30.9528,108,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJ SOLN,,J0330,HCPCS,Facility,Inpatient,10,mL,,108,91.8,30.9528,108,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJ SOLN,,J0330,HCPCS,Facility,Both,10,mL,,108,91.8,30.9528,108,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),64.8,60,,percent of total billed charges,,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJ SOLN,,J0330,HCPCS,Facility,Both,10,mL,,108,91.8,30.9528,108,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),64.8,60,,percent of total billed charges,,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJ SOLN,,J0330,HCPCS,Facility,Both,10,mL,,108,91.8,30.9528,108,"Health Partners, Inc.",State of Minnesota Advantage Program,88.02,81.5,,percent of total billed charges,,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJ SOLN,,J0330,HCPCS,Facility,Both,10,mL,,108,91.8,30.9528,108,"Health Partners, Inc.",State of Minnesota Advantage Program,88.02,81.5,,percent of total billed charges,,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJ SOLN,,J0330,HCPCS,Facility,Both,10,mL,,108,91.8,30.9528,108,"Health Partners, Inc.",State Public Programs,54,50,,percent of total billed charges,,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJ SOLN,,J0330,HCPCS,Facility,Both,10,mL,,108,91.8,30.9528,108,"Health Partners, Inc.",State Public Programs,54,50,,percent of total billed charges,,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJ SOLN,,J0330,HCPCS,Facility,Both,10,mL,,108,91.8,30.9528,108,Humana Insurance Company,Commercial PPO,102.6,95,,percent of total billed charges,,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJ SOLN,,J0330,HCPCS,Facility,Both,10,mL,,108,91.8,30.9528,108,Humana Insurance Company,Commercial PPO,102.6,95,,percent of total billed charges,,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJ SOLN,,J0330,HCPCS,Facility,Outpatient,10,mL,,108,91.8,30.9528,108,Humana Insurance Company,Medicare PPO,52.92,49,,percent of total billed charges,,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJ SOLN,,J0330,HCPCS,Facility,Outpatient,10,mL,,108,91.8,30.9528,108,Humana Insurance Company,Medicare PPO,52.92,49,,percent of total billed charges,,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJ SOLN,,J0330,HCPCS,Facility,Inpatient,10,mL,,108,91.8,30.9528,108,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJ SOLN,,J0330,HCPCS,Facility,Inpatient,10,mL,,108,91.8,30.9528,108,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJ SOLN,,J0330,HCPCS,Facility,Both,10,mL,,108,91.8,30.9528,108,Medica,Individual & Family,107.028,99.1,,percent of total billed charges,,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJ SOLN,,J0330,HCPCS,Facility,Both,10,mL,,108,91.8,30.9528,108,Medica,Individual & Family,107.028,99.1,,percent of total billed charges,,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJ SOLN,,J0330,HCPCS,Facility,Outpatient,10,mL,,108,91.8,30.9528,108,Medica,Medica Advantage Solution,53.784,49.8,,percent of total billed charges,,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJ SOLN,,J0330,HCPCS,Facility,Outpatient,10,mL,,108,91.8,30.9528,108,Medica,Medica Advantage Solution,53.784,49.8,,percent of total billed charges,,
"Urinalysis, Automated, With Microscopy",,81001,CPT,Facility,Both,,,,92,78.2,26.3672,92,Aetna,Commercial,84.64,92,,percent of total billed charges,,
"Urinalysis, Automated, With Microscopy",,81001,CPT,Facility,Outpatient,,,,92,78.2,26.3672,92,Aetna,Medicare Advantage,45.08,49,,percent of total billed charges,,
"Urinalysis, Automated, With Microscopy",,81001,CPT,Facility,Inpatient,,,,92,78.2,26.3672,92,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Urinalysis, Automated, With Microscopy",,81001,CPT,Facility,Both,,,,92,78.2,26.3672,92,Aetna,PPO,85.56,93,,percent of total billed charges,,
"Urinalysis, Automated, With Microscopy",,81001,CPT,Facility,Both,,,,92,78.2,26.3672,92,America's PPO,America's PPO,88.3476,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Urinalysis, Automated, With Microscopy",,81001,CPT,Facility,Both,,,,92,78.2,26.3672,92,BlueCross BlueShield Minnesota, Federal Employee Program,90.528,98.4,,percent of total billed charges,,
"Urinalysis, Automated, With Microscopy",,81001,CPT,Facility,Both,,,,92,78.2,26.3672,92,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,92,100,,percent of total billed charges,,
"Urinalysis, Automated, With Microscopy",,81001,CPT,Facility,Both,,,,92,78.2,26.3672,92,BlueCross BlueShield Minnesota,High Value Network Plan,82.8,90,,percent of total billed charges,,
"Urinalysis, Automated, With Microscopy",,81001,CPT,Facility,Outpatient,,,,92,78.2,26.3672,92,BlueCross BlueShield Minnesota,Medicare Advantage,45.08,49,,percent of total billed charges,,
"Urinalysis, Automated, With Microscopy",,81001,CPT,Facility,Inpatient,,,,92,78.2,26.3672,92,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Urinalysis, Automated, With Microscopy",,81001,CPT,Facility,Both,,,,92,78.2,26.3672,92,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,81.4844,88.57,,percent of total billed charges,,
"Urinalysis, Automated, With Microscopy",,81001,CPT,Facility,Both,,,,92,78.2,26.3672,92,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,26.3672,28.66,,percent of total billed charges,,
"Urinalysis, Automated, With Microscopy",,81001,CPT,Facility,Outpatient,,,,92,78.2,26.3672,92,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),45.08,49,,percent of total billed charges,,
"Urinalysis, Automated, With Microscopy",,81001,CPT,Facility,Inpatient,,,,92,78.2,26.3672,92,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Urinalysis, Automated, With Microscopy",,81001,CPT,Facility,Both,,,,92,78.2,26.3672,92,CorVel,Worker's Compensation,92,100,,percent of total billed charges,,
"Urinalysis, Automated, With Microscopy",,81001,CPT,Facility,Both,,,,92,78.2,26.3672,92,First Health Group Corporation,First Health Network,89.24,97,,percent of total billed charges,,
"Urinalysis, Automated, With Microscopy",,81001,CPT,Facility,Both,,,,92,78.2,26.3672,92,"Health Partners, Inc.",Commercial,87.032,94.6,,percent of total billed charges,,
"Urinalysis, Automated, With Microscopy",,81001,CPT,Facility,Outpatient,,,,92,78.2,26.3672,92,"Health Partners, Inc.",Medicare Advantage,45.08,49,,percent of total billed charges,,
"Urinalysis, Automated, With Microscopy",,81001,CPT,Facility,Inpatient,,,,92,78.2,26.3672,92,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Urinalysis, Automated, With Microscopy",,81001,CPT,Facility,Both,,,,92,78.2,26.3672,92,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),55.2,60,,percent of total billed charges,,
"Urinalysis, Automated, With Microscopy",,81001,CPT,Facility,Both,,,,92,78.2,26.3672,92,"Health Partners, Inc.",State of Minnesota Advantage Program,74.98,81.5,,percent of total billed charges,,
"Urinalysis, Automated, With Microscopy",,81001,CPT,Facility,Both,,,,92,78.2,26.3672,92,"Health Partners, Inc.",State Public Programs,46,50,,percent of total billed charges,,
"Urinalysis, Automated, With Microscopy",,81001,CPT,Facility,Both,,,,92,78.2,26.3672,92,Humana Insurance Company,Commercial PPO,87.4,95,,percent of total billed charges,,
"Urinalysis, Automated, With Microscopy",,81001,CPT,Facility,Outpatient,,,,92,78.2,26.3672,92,Humana Insurance Company,Medicare PPO,45.08,49,,percent of total billed charges,,
"Urinalysis, Automated, With Microscopy",,81001,CPT,Facility,Inpatient,,,,92,78.2,26.3672,92,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Urinalysis, Automated, With Microscopy",,81001,CPT,Facility,Both,,,,92,78.2,26.3672,92,Medica,Individual & Family,91.172,99.1,,percent of total billed charges,,
"Urinalysis, Automated, With Microscopy",,81001,CPT,Facility,Outpatient,,,,92,78.2,26.3672,92,Medica,Medica Advantage Solution,45.816,49.8,,percent of total billed charges,,
"Urinalysis, Automated, With Microscopy",,81001,CPT,Facility,Inpatient,,,,92,78.2,26.3672,92,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Urinalysis, Automated, With Microscopy",,81001,CPT,Facility,Outpatient,,,,92,78.2,26.3672,92,Medica,Medical Assistance,41.032,44.6,,percent of total billed charges,,
"Urinalysis, Automated, With Microscopy",,81001,CPT,Facility,Inpatient,,,,92,78.2,26.3672,92,Medica,Medical Assistance,,,,,Included in per diem rate,
"Urinalysis, Automated, With Microscopy",,81001,CPT,Facility,Outpatient,,,,92,78.2,26.3672,92,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,45.816,49.8,,percent of total billed charges,,
"Urinalysis, Automated, With Microscopy",,81001,CPT,Facility,Inpatient,,,,92,78.2,26.3672,92,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Urinalysis, Automated, With Microscopy",,81001,CPT,Facility,Both,,,,92,78.2,26.3672,92,"Multiplan, Inc.","Multiplan, Inc.",86.48,94,,percent of total billed charges,,
"Urinalysis, Automated, With Microscopy",,81001,CPT,Facility,Outpatient,,,,92,78.2,26.3672,92,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,79.488,86.4,,percent of total billed charges,,
"Urinalysis, Automated, With Microscopy",,81001,CPT,Facility,Inpatient,,,,92,78.2,26.3672,92,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Urinalysis, Automated, With Microscopy",,81001,CPT,Facility,Both,,,,92,78.2,26.3672,92,"Preferred One Administrative Services, INC.",PPO,90.712,98.6,,percent of total billed charges,,
"Urinalysis, Automated, With Microscopy",,81001,CPT,Facility,Outpatient,,,,92,78.2,26.3672,92,PrimeWest Health,Minnesota Senior Health Options (MSHO),47.334,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Urinalysis, Automated, With Microscopy",,81001,CPT,Facility,Inpatient,,,,92,78.2,26.3672,92,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Urinalysis, Automated, With Microscopy",,81001,CPT,Facility,Outpatient,,,,92,78.2,26.3672,92,PrimeWest Health,MinnesotaCare,47.2512,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Urinalysis, Automated, With Microscopy",,81001,CPT,Facility,Inpatient,,,,92,78.2,26.3672,92,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Urinalysis, Automated, With Microscopy",,81001,CPT,Facility,Both,,,,92,78.2,26.3672,92,Sanford Health Plan,Sanford Health Plan,84.64,92,,percent of total billed charges,,
"Urinalysis, Automated, With Microscopy",,81001,CPT,Facility,Outpatient,,,,92,78.2,26.3672,92,"UCare Health, Inc.",Individual & Family Plan,51.842,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Urinalysis, Automated, With Microscopy",,81001,CPT,Facility,Inpatient,,,,92,78.2,26.3672,92,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Urinalysis, Automated, With Microscopy",,81001,CPT,Facility,Outpatient,,,,92,78.2,26.3672,92,"UCare Health, Inc.",Medical Assistance,46.4324,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Urinalysis, Automated, With Microscopy",,81001,CPT,Facility,Inpatient,,,,92,78.2,26.3672,92,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Urinalysis, Automated, With Microscopy",,81001,CPT,Facility,Outpatient,,,,92,78.2,26.3672,92,"UCare Health, Inc.",Medicare Advantage,46.4324,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Urinalysis, Automated, With Microscopy",,81001,CPT,Facility,Inpatient,,,,92,78.2,26.3672,92,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Urinalysis, Automated, With Microscopy",,81001,CPT,Facility,Outpatient,,,,92,78.2,26.3672,92,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),46.4324,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Urinalysis, Automated, With Microscopy",,81001,CPT,Facility,Inpatient,,,,92,78.2,26.3672,92,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Urinalysis, Automated, With Microscopy",,81001,CPT,Facility,Both,,,,92,78.2,26.3672,92,UnitedHealthcare,Individual & Family,86.48,94,,percent of total billed charges,,
"Urinalysis, Automated, With Microscopy",,81001,CPT,Facility,Outpatient,,,,92,78.2,26.3672,92,UnitedHealthcare,Medicare Advantage,45.08,49,,percent of total billed charges,,
"Urinalysis, Automated, With Microscopy",,81001,CPT,Facility,Inpatient,,,,92,78.2,26.3672,92,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Urinalysis, Automated, With Microscopy",,81001,CPT,Facility,Outpatient,,,,92,78.2,26.3672,92,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,44.16,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Urinalysis, Automated, With Microscopy",,81001,CPT,Facility,Inpatient,,,,92,78.2,26.3672,92,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Urinalysis, Macroscopic With Microscopic, Reflex To Culture",,81001,CPT,Facility,Both,,,,92,78.2,26.3672,92,Aetna,Commercial,84.64,92,,percent of total billed charges,,
"Urinalysis, Macroscopic With Microscopic, Reflex To Culture",,81001,CPT,Facility,Outpatient,,,,92,78.2,26.3672,92,Aetna,Medicare Advantage,45.08,49,,percent of total billed charges,,
"Urinalysis, Macroscopic With Microscopic, Reflex To Culture",,81001,CPT,Facility,Inpatient,,,,92,78.2,26.3672,92,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Urinalysis, Macroscopic With Microscopic, Reflex To Culture",,81001,CPT,Facility,Both,,,,92,78.2,26.3672,92,Aetna,PPO,85.56,93,,percent of total billed charges,,
"Urinalysis, Macroscopic With Microscopic, Reflex To Culture",,81001,CPT,Facility,Both,,,,92,78.2,26.3672,92,America's PPO,America's PPO,88.3476,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Urinalysis, Macroscopic With Microscopic, Reflex To Culture",,81001,CPT,Facility,Both,,,,92,78.2,26.3672,92,BlueCross BlueShield Minnesota, Federal Employee Program,90.528,98.4,,percent of total billed charges,,
"Urinalysis, Macroscopic With Microscopic, Reflex To Culture",,81001,CPT,Facility,Both,,,,92,78.2,26.3672,92,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,92,100,,percent of total billed charges,,
"Urinalysis, Macroscopic With Microscopic, Reflex To Culture",,81001,CPT,Facility,Both,,,,92,78.2,26.3672,92,BlueCross BlueShield Minnesota,High Value Network Plan,82.8,90,,percent of total billed charges,,
"Urinalysis, Macroscopic With Microscopic, Reflex To Culture",,81001,CPT,Facility,Outpatient,,,,92,78.2,26.3672,92,BlueCross BlueShield Minnesota,Medicare Advantage,45.08,49,,percent of total billed charges,,
"Urinalysis, Macroscopic With Microscopic, Reflex To Culture",,81001,CPT,Facility,Inpatient,,,,92,78.2,26.3672,92,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Urinalysis, Macroscopic With Microscopic, Reflex To Culture",,81001,CPT,Facility,Both,,,,92,78.2,26.3672,92,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,81.4844,88.57,,percent of total billed charges,,
"Urinalysis, Macroscopic With Microscopic, Reflex To Culture",,81001,CPT,Facility,Both,,,,92,78.2,26.3672,92,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,26.3672,28.66,,percent of total billed charges,,
"Urinalysis, Macroscopic With Microscopic, Reflex To Culture",,81001,CPT,Facility,Outpatient,,,,92,78.2,26.3672,92,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),45.08,49,,percent of total billed charges,,
"Urinalysis, Macroscopic With Microscopic, Reflex To Culture",,81001,CPT,Facility,Inpatient,,,,92,78.2,26.3672,92,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Urinalysis, Macroscopic With Microscopic, Reflex To Culture",,81001,CPT,Facility,Both,,,,92,78.2,26.3672,92,CorVel,Worker's Compensation,92,100,,percent of total billed charges,,
"Urinalysis, Macroscopic With Microscopic, Reflex To Culture",,81001,CPT,Facility,Both,,,,92,78.2,26.3672,92,First Health Group Corporation,First Health Network,89.24,97,,percent of total billed charges,,
"Urinalysis, Macroscopic With Microscopic, Reflex To Culture",,81001,CPT,Facility,Both,,,,92,78.2,26.3672,92,"Health Partners, Inc.",Commercial,87.032,94.6,,percent of total billed charges,,
"Urinalysis, Macroscopic With Microscopic, Reflex To Culture",,81001,CPT,Facility,Outpatient,,,,92,78.2,26.3672,92,"Health Partners, Inc.",Medicare Advantage,45.08,49,,percent of total billed charges,,
"Urinalysis, Macroscopic With Microscopic, Reflex To Culture",,81001,CPT,Facility,Inpatient,,,,92,78.2,26.3672,92,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Urinalysis, Macroscopic With Microscopic, Reflex To Culture",,81001,CPT,Facility,Both,,,,92,78.2,26.3672,92,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),55.2,60,,percent of total billed charges,,
"Urinalysis, Macroscopic With Microscopic, Reflex To Culture",,81001,CPT,Facility,Both,,,,92,78.2,26.3672,92,"Health Partners, Inc.",State of Minnesota Advantage Program,74.98,81.5,,percent of total billed charges,,
"Urinalysis, Macroscopic With Microscopic, Reflex To Culture",,81001,CPT,Facility,Both,,,,92,78.2,26.3672,92,"Health Partners, Inc.",State Public Programs,46,50,,percent of total billed charges,,
"Urinalysis, Macroscopic With Microscopic, Reflex To Culture",,81001,CPT,Facility,Both,,,,92,78.2,26.3672,92,Humana Insurance Company,Commercial PPO,87.4,95,,percent of total billed charges,,
"Urinalysis, Macroscopic With Microscopic, Reflex To Culture",,81001,CPT,Facility,Outpatient,,,,92,78.2,26.3672,92,Humana Insurance Company,Medicare PPO,45.08,49,,percent of total billed charges,,
"Urinalysis, Macroscopic With Microscopic, Reflex To Culture",,81001,CPT,Facility,Inpatient,,,,92,78.2,26.3672,92,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Urinalysis, Macroscopic With Microscopic, Reflex To Culture",,81001,CPT,Facility,Both,,,,92,78.2,26.3672,92,Medica,Individual & Family,91.172,99.1,,percent of total billed charges,,
"Urinalysis, Macroscopic With Microscopic, Reflex To Culture",,81001,CPT,Facility,Outpatient,,,,92,78.2,26.3672,92,Medica,Medica Advantage Solution,45.816,49.8,,percent of total billed charges,,
"Urinalysis, Macroscopic With Microscopic, Reflex To Culture",,81001,CPT,Facility,Inpatient,,,,92,78.2,26.3672,92,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Urinalysis, Macroscopic With Microscopic, Reflex To Culture",,81001,CPT,Facility,Outpatient,,,,92,78.2,26.3672,92,Medica,Medical Assistance,41.032,44.6,,percent of total billed charges,,
"Urinalysis, Macroscopic With Microscopic, Reflex To Culture",,81001,CPT,Facility,Inpatient,,,,92,78.2,26.3672,92,Medica,Medical Assistance,,,,,Included in per diem rate,
"Urinalysis, Macroscopic With Microscopic, Reflex To Culture",,81001,CPT,Facility,Outpatient,,,,92,78.2,26.3672,92,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,45.816,49.8,,percent of total billed charges,,
"Urinalysis, Macroscopic With Microscopic, Reflex To Culture",,81001,CPT,Facility,Inpatient,,,,92,78.2,26.3672,92,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Urinalysis, Macroscopic With Microscopic, Reflex To Culture",,81001,CPT,Facility,Both,,,,92,78.2,26.3672,92,"Multiplan, Inc.","Multiplan, Inc.",86.48,94,,percent of total billed charges,,
"Urinalysis, Macroscopic With Microscopic, Reflex To Culture",,81001,CPT,Facility,Outpatient,,,,92,78.2,26.3672,92,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,79.488,86.4,,percent of total billed charges,,
"Urinalysis, Macroscopic With Microscopic, Reflex To Culture",,81001,CPT,Facility,Inpatient,,,,92,78.2,26.3672,92,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Urinalysis, Macroscopic With Microscopic, Reflex To Culture",,81001,CPT,Facility,Both,,,,92,78.2,26.3672,92,"Preferred One Administrative Services, INC.",PPO,90.712,98.6,,percent of total billed charges,,
"Urinalysis, Macroscopic With Microscopic, Reflex To Culture",,81001,CPT,Facility,Outpatient,,,,92,78.2,26.3672,92,PrimeWest Health,Minnesota Senior Health Options (MSHO),47.334,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Urinalysis, Macroscopic With Microscopic, Reflex To Culture",,81001,CPT,Facility,Inpatient,,,,92,78.2,26.3672,92,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Urinalysis, Macroscopic With Microscopic, Reflex To Culture",,81001,CPT,Facility,Outpatient,,,,92,78.2,26.3672,92,PrimeWest Health,MinnesotaCare,47.2512,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Urinalysis, Macroscopic With Microscopic, Reflex To Culture",,81001,CPT,Facility,Inpatient,,,,92,78.2,26.3672,92,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Urinalysis, Macroscopic With Microscopic, Reflex To Culture",,81001,CPT,Facility,Both,,,,92,78.2,26.3672,92,Sanford Health Plan,Sanford Health Plan,84.64,92,,percent of total billed charges,,
"Urinalysis, Macroscopic With Microscopic, Reflex To Culture",,81001,CPT,Facility,Outpatient,,,,92,78.2,26.3672,92,"UCare Health, Inc.",Individual & Family Plan,51.842,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Urinalysis, Macroscopic With Microscopic, Reflex To Culture",,81001,CPT,Facility,Inpatient,,,,92,78.2,26.3672,92,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Urinalysis, Macroscopic With Microscopic, Reflex To Culture",,81001,CPT,Facility,Outpatient,,,,92,78.2,26.3672,92,"UCare Health, Inc.",Medical Assistance,46.4324,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Urinalysis, Macroscopic With Microscopic, Reflex To Culture",,81001,CPT,Facility,Inpatient,,,,92,78.2,26.3672,92,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Urinalysis, Macroscopic With Microscopic, Reflex To Culture",,81001,CPT,Facility,Outpatient,,,,92,78.2,26.3672,92,"UCare Health, Inc.",Medicare Advantage,46.4324,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Urinalysis, Macroscopic With Microscopic, Reflex To Culture",,81001,CPT,Facility,Inpatient,,,,92,78.2,26.3672,92,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Urinalysis, Macroscopic With Microscopic, Reflex To Culture",,81001,CPT,Facility,Outpatient,,,,92,78.2,26.3672,92,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),46.4324,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Urinalysis, Macroscopic With Microscopic, Reflex To Culture",,81001,CPT,Facility,Inpatient,,,,92,78.2,26.3672,92,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Urinalysis, Macroscopic With Microscopic, Reflex To Culture",,81001,CPT,Facility,Both,,,,92,78.2,26.3672,92,UnitedHealthcare,Individual & Family,86.48,94,,percent of total billed charges,,
"Urinalysis, Macroscopic With Microscopic, Reflex To Culture",,81001,CPT,Facility,Outpatient,,,,92,78.2,26.3672,92,UnitedHealthcare,Medicare Advantage,45.08,49,,percent of total billed charges,,
"Urinalysis, Macroscopic With Microscopic, Reflex To Culture",,81001,CPT,Facility,Inpatient,,,,92,78.2,26.3672,92,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Urinalysis, Macroscopic With Microscopic, Reflex To Culture",,81001,CPT,Facility,Outpatient,,,,92,78.2,26.3672,92,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,44.16,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Urinalysis, Macroscopic With Microscopic, Reflex To Culture",,81001,CPT,Facility,Inpatient,,,,92,78.2,26.3672,92,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Urinalysis With Macroscopic, Reflex To Microscopic (Manual Microscopic)",,81003,CPT,Facility,Both,,,,66,56.1,18.9156,66,Aetna,Commercial,60.72,92,,percent of total billed charges,,
"Urinalysis With Macroscopic, Reflex To Microscopic (Manual Microscopic)",,81003,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,Aetna,Medicare Advantage,32.34,49,,percent of total billed charges,,
"Urinalysis With Macroscopic, Reflex To Microscopic (Manual Microscopic)",,81003,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Urinalysis With Macroscopic, Reflex To Microscopic (Manual Microscopic)",,81003,CPT,Facility,Both,,,,66,56.1,18.9156,66,Aetna,PPO,61.38,93,,percent of total billed charges,,
"Urinalysis With Macroscopic, Reflex To Microscopic (Manual Microscopic)",,81003,CPT,Facility,Both,,,,66,56.1,18.9156,66,America's PPO,America's PPO,63.3798,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Urinalysis With Macroscopic, Reflex To Microscopic (Manual Microscopic)",,81003,CPT,Facility,Both,,,,66,56.1,18.9156,66,BlueCross BlueShield Minnesota, Federal Employee Program,64.944,98.4,,percent of total billed charges,,
"Urinalysis With Macroscopic, Reflex To Microscopic (Manual Microscopic)",,81003,CPT,Facility,Both,,,,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,66,100,,percent of total billed charges,,
"Urinalysis With Macroscopic, Reflex To Microscopic (Manual Microscopic)",,81003,CPT,Facility,Both,,,,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,High Value Network Plan,59.4,90,,percent of total billed charges,,
"Urinalysis With Macroscopic, Reflex To Microscopic (Manual Microscopic)",,81003,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,Medicare Advantage,32.34,49,,percent of total billed charges,,
"Urinalysis With Macroscopic, Reflex To Microscopic (Manual Microscopic)",,81003,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Urinalysis With Macroscopic, Reflex To Microscopic (Manual Microscopic)",,81003,CPT,Facility,Both,,,,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,58.4562,88.57,,percent of total billed charges,,
"Urinalysis With Macroscopic, Reflex To Microscopic (Manual Microscopic)",,81003,CPT,Facility,Both,,,,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,18.9156,28.66,,percent of total billed charges,,
"Urinalysis With Macroscopic, Reflex To Microscopic (Manual Microscopic)",,81003,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),32.34,49,,percent of total billed charges,,
"Urinalysis With Macroscopic, Reflex To Microscopic (Manual Microscopic)",,81003,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Urinalysis With Macroscopic, Reflex To Microscopic (Manual Microscopic)",,81003,CPT,Facility,Both,,,,66,56.1,18.9156,66,CorVel,Worker's Compensation,66,100,,percent of total billed charges,,
"Urinalysis With Macroscopic, Reflex To Microscopic (Manual Microscopic)",,81003,CPT,Facility,Both,,,,66,56.1,18.9156,66,First Health Group Corporation,First Health Network,64.02,97,,percent of total billed charges,,
"Urinalysis With Macroscopic, Reflex To Microscopic (Manual Microscopic)",,81003,CPT,Facility,Both,,,,66,56.1,18.9156,66,"Health Partners, Inc.",Commercial,62.436,94.6,,percent of total billed charges,,
"Urinalysis With Macroscopic, Reflex To Microscopic (Manual Microscopic)",,81003,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,"Health Partners, Inc.",Medicare Advantage,32.34,49,,percent of total billed charges,,
"Urinalysis With Macroscopic, Reflex To Microscopic (Manual Microscopic)",,81003,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Urinalysis With Macroscopic, Reflex To Microscopic (Manual Microscopic)",,81003,CPT,Facility,Both,,,,66,56.1,18.9156,66,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),39.6,60,,percent of total billed charges,,
"Urinalysis With Macroscopic, Reflex To Microscopic (Manual Microscopic)",,81003,CPT,Facility,Both,,,,66,56.1,18.9156,66,"Health Partners, Inc.",State of Minnesota Advantage Program,53.79,81.5,,percent of total billed charges,,
"Urinalysis With Macroscopic, Reflex To Microscopic (Manual Microscopic)",,81003,CPT,Facility,Both,,,,66,56.1,18.9156,66,"Health Partners, Inc.",State Public Programs,33,50,,percent of total billed charges,,
"Urinalysis With Macroscopic, Reflex To Microscopic (Manual Microscopic)",,81003,CPT,Facility,Both,,,,66,56.1,18.9156,66,Humana Insurance Company,Commercial PPO,62.7,95,,percent of total billed charges,,
"Urinalysis With Macroscopic, Reflex To Microscopic (Manual Microscopic)",,81003,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,Humana Insurance Company,Medicare PPO,32.34,49,,percent of total billed charges,,
"Urinalysis With Macroscopic, Reflex To Microscopic (Manual Microscopic)",,81003,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Urinalysis With Macroscopic, Reflex To Microscopic (Manual Microscopic)",,81003,CPT,Facility,Both,,,,66,56.1,18.9156,66,Medica,Individual & Family,65.406,99.1,,percent of total billed charges,,
"Urinalysis With Macroscopic, Reflex To Microscopic (Manual Microscopic)",,81003,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,Medica,Medica Advantage Solution,32.868,49.8,,percent of total billed charges,,
"Urinalysis With Macroscopic, Reflex To Microscopic (Manual Microscopic)",,81003,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Urinalysis With Macroscopic, Reflex To Microscopic (Manual Microscopic)",,81003,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,Medica,Medical Assistance,29.436,44.6,,percent of total billed charges,,
"Urinalysis With Macroscopic, Reflex To Microscopic (Manual Microscopic)",,81003,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,Medica,Medical Assistance,,,,,Included in per diem rate,
"Urinalysis With Macroscopic, Reflex To Microscopic (Manual Microscopic)",,81003,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,32.868,49.8,,percent of total billed charges,,
"Urinalysis With Macroscopic, Reflex To Microscopic (Manual Microscopic)",,81003,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Urinalysis With Macroscopic, Reflex To Microscopic (Manual Microscopic)",,81003,CPT,Facility,Both,,,,66,56.1,18.9156,66,"Multiplan, Inc.","Multiplan, Inc.",62.04,94,,percent of total billed charges,,
"Urinalysis With Macroscopic, Reflex To Microscopic (Manual Microscopic)",,81003,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,57.024,86.4,,percent of total billed charges,,
"Urinalysis With Macroscopic, Reflex To Microscopic (Manual Microscopic)",,81003,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Urinalysis With Macroscopic, Reflex To Microscopic (Manual Microscopic)",,81003,CPT,Facility,Both,,,,66,56.1,18.9156,66,"Preferred One Administrative Services, INC.",PPO,65.076,98.6,,percent of total billed charges,,
"Urinalysis With Macroscopic, Reflex To Microscopic (Manual Microscopic)",,81003,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,PrimeWest Health,Minnesota Senior Health Options (MSHO),33.957,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Urinalysis With Macroscopic, Reflex To Microscopic (Manual Microscopic)",,81003,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Urinalysis With Macroscopic, Reflex To Microscopic (Manual Microscopic)",,81003,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,PrimeWest Health,MinnesotaCare,33.8976,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Urinalysis With Macroscopic, Reflex To Microscopic (Manual Microscopic)",,81003,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Urinalysis With Macroscopic, Reflex To Microscopic (Manual Microscopic)",,81003,CPT,Facility,Both,,,,66,56.1,18.9156,66,Sanford Health Plan,Sanford Health Plan,60.72,92,,percent of total billed charges,,
"Urinalysis With Macroscopic, Reflex To Microscopic (Manual Microscopic)",,81003,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,"UCare Health, Inc.",Individual & Family Plan,37.191,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Urinalysis With Macroscopic, Reflex To Microscopic (Manual Microscopic)",,81003,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Urinalysis With Macroscopic, Reflex To Microscopic (Manual Microscopic)",,81003,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,"UCare Health, Inc.",Medical Assistance,33.3102,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Urinalysis With Macroscopic, Reflex To Microscopic (Manual Microscopic)",,81003,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Urinalysis With Macroscopic, Reflex To Microscopic (Manual Microscopic)",,81003,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,"UCare Health, Inc.",Medicare Advantage,33.3102,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Urinalysis With Macroscopic, Reflex To Microscopic (Manual Microscopic)",,81003,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Urinalysis With Macroscopic, Reflex To Microscopic (Manual Microscopic)",,81003,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),33.3102,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Urinalysis With Macroscopic, Reflex To Microscopic (Manual Microscopic)",,81003,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Urinalysis With Macroscopic, Reflex To Microscopic (Manual Microscopic)",,81003,CPT,Facility,Both,,,,66,56.1,18.9156,66,UnitedHealthcare,Individual & Family,62.04,94,,percent of total billed charges,,
"Urinalysis With Macroscopic, Reflex To Microscopic (Manual Microscopic)",,81003,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,UnitedHealthcare,Medicare Advantage,32.34,49,,percent of total billed charges,,
"Urinalysis With Macroscopic, Reflex To Microscopic (Manual Microscopic)",,81003,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Urinalysis With Macroscopic, Reflex To Microscopic (Manual Microscopic)",,81003,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,31.68,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Urinalysis With Macroscopic, Reflex To Microscopic (Manual Microscopic)",,81003,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Urinalysis, Macroscopic, Automated",,81003,CPT,Facility,Both,,,,49,41.65,14.0434,49,Aetna,Commercial,45.08,92,,percent of total billed charges,,
"Urinalysis, Macroscopic, Automated",,81003,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,Aetna,Medicare Advantage,24.01,49,,percent of total billed charges,,
"Urinalysis, Macroscopic, Automated",,81003,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Urinalysis, Macroscopic, Automated",,81003,CPT,Facility,Both,,,,49,41.65,14.0434,49,Aetna,PPO,45.57,93,,percent of total billed charges,,
"Urinalysis, Macroscopic, Automated",,81003,CPT,Facility,Both,,,,49,41.65,14.0434,49,America's PPO,America's PPO,47.0547,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Urinalysis, Macroscopic, Automated",,81003,CPT,Facility,Both,,,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota, Federal Employee Program,48.216,98.4,,percent of total billed charges,,
"Urinalysis, Macroscopic, Automated",,81003,CPT,Facility,Both,,,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,49,100,,percent of total billed charges,,
"Urinalysis, Macroscopic, Automated",,81003,CPT,Facility,Both,,,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,High Value Network Plan,44.1,90,,percent of total billed charges,,
"Urinalysis, Macroscopic, Automated",,81003,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Medicare Advantage,24.01,49,,percent of total billed charges,,
"Urinalysis, Macroscopic, Automated",,81003,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Urinalysis, Macroscopic, Automated",,81003,CPT,Facility,Both,,,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,43.3993,88.57,,percent of total billed charges,,
"Urinalysis, Macroscopic, Automated",,81003,CPT,Facility,Both,,,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,14.0434,28.66,,percent of total billed charges,,
"Urinalysis, Macroscopic, Automated",,81003,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),24.01,49,,percent of total billed charges,,
"Urinalysis, Macroscopic, Automated",,81003,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Urinalysis, Macroscopic, Automated",,81003,CPT,Facility,Both,,,,49,41.65,14.0434,49,CorVel,Worker's Compensation,49,100,,percent of total billed charges,,
"Urinalysis, Macroscopic, Automated",,81003,CPT,Facility,Both,,,,49,41.65,14.0434,49,First Health Group Corporation,First Health Network,47.53,97,,percent of total billed charges,,
"Urinalysis, Macroscopic, Automated",,81003,CPT,Facility,Both,,,,49,41.65,14.0434,49,"Health Partners, Inc.",Commercial,46.354,94.6,,percent of total billed charges,,
"Urinalysis, Macroscopic, Automated",,81003,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,"Health Partners, Inc.",Medicare Advantage,24.01,49,,percent of total billed charges,,
"Urinalysis, Macroscopic, Automated",,81003,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Urinalysis, Macroscopic, Automated",,81003,CPT,Facility,Both,,,,49,41.65,14.0434,49,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),29.4,60,,percent of total billed charges,,
"Urinalysis, Macroscopic, Automated",,81003,CPT,Facility,Both,,,,49,41.65,14.0434,49,"Health Partners, Inc.",State of Minnesota Advantage Program,39.935,81.5,,percent of total billed charges,,
"Urinalysis, Macroscopic, Automated",,81003,CPT,Facility,Both,,,,49,41.65,14.0434,49,"Health Partners, Inc.",State Public Programs,24.5,50,,percent of total billed charges,,
"Urinalysis, Macroscopic, Automated",,81003,CPT,Facility,Both,,,,49,41.65,14.0434,49,Humana Insurance Company,Commercial PPO,46.55,95,,percent of total billed charges,,
"Urinalysis, Macroscopic, Automated",,81003,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,Humana Insurance Company,Medicare PPO,24.01,49,,percent of total billed charges,,
"Urinalysis, Macroscopic, Automated",,81003,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Urinalysis, Macroscopic, Automated",,81003,CPT,Facility,Both,,,,49,41.65,14.0434,49,Medica,Individual & Family,48.559,99.1,,percent of total billed charges,,
"Urinalysis, Macroscopic, Automated",,81003,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,Medica,Medica Advantage Solution,24.402,49.8,,percent of total billed charges,,
"Urinalysis, Macroscopic, Automated",,81003,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Urinalysis, Macroscopic, Automated",,81003,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,Medica,Medical Assistance,21.854,44.6,,percent of total billed charges,,
"Urinalysis, Macroscopic, Automated",,81003,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,Medica,Medical Assistance,,,,,Included in per diem rate,
"Urinalysis, Macroscopic, Automated",,81003,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,24.402,49.8,,percent of total billed charges,,
"Urinalysis, Macroscopic, Automated",,81003,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Urinalysis, Macroscopic, Automated",,81003,CPT,Facility,Both,,,,49,41.65,14.0434,49,"Multiplan, Inc.","Multiplan, Inc.",46.06,94,,percent of total billed charges,,
"Urinalysis, Macroscopic, Automated",,81003,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,42.336,86.4,,percent of total billed charges,,
"Urinalysis, Macroscopic, Automated",,81003,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Urinalysis, Macroscopic, Automated",,81003,CPT,Facility,Both,,,,49,41.65,14.0434,49,"Preferred One Administrative Services, INC.",PPO,48.314,98.6,,percent of total billed charges,,
"Urinalysis, Macroscopic, Automated",,81003,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,PrimeWest Health,Minnesota Senior Health Options (MSHO),25.2105,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Urinalysis, Macroscopic, Automated",,81003,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Urinalysis, Macroscopic, Automated",,81003,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,PrimeWest Health,MinnesotaCare,25.1664,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Urinalysis, Macroscopic, Automated",,81003,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Urinalysis, Macroscopic, Automated",,81003,CPT,Facility,Both,,,,49,41.65,14.0434,49,Sanford Health Plan,Sanford Health Plan,45.08,92,,percent of total billed charges,,
"Urinalysis, Macroscopic, Automated",,81003,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,"UCare Health, Inc.",Individual & Family Plan,27.6115,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Urinalysis, Macroscopic, Automated",,81003,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Urinalysis, Macroscopic, Automated",,81003,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,"UCare Health, Inc.",Medical Assistance,24.7303,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Urinalysis, Macroscopic, Automated",,81003,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Urinalysis, Macroscopic, Automated",,81003,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,"UCare Health, Inc.",Medicare Advantage,24.7303,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Urinalysis, Macroscopic, Automated",,81003,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Urinalysis, Macroscopic, Automated",,81003,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),24.7303,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Urinalysis, Macroscopic, Automated",,81003,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Urinalysis, Macroscopic, Automated",,81003,CPT,Facility,Both,,,,49,41.65,14.0434,49,UnitedHealthcare,Individual & Family,46.06,94,,percent of total billed charges,,
"Urinalysis, Macroscopic, Automated",,81003,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,UnitedHealthcare,Medicare Advantage,24.01,49,,percent of total billed charges,,
"Urinalysis, Macroscopic, Automated",,81003,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Urinalysis, Macroscopic, Automated",,81003,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,23.52,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Urinalysis, Macroscopic, Automated",,81003,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Urinalysis, Microscopic Only (Manual)",,81015,CPT,Facility,Both,,,,49,41.65,14.0434,49,Aetna,Commercial,45.08,92,,percent of total billed charges,,
"Urinalysis, Microscopic Only (Manual)",,81015,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,Aetna,Medicare Advantage,24.01,49,,percent of total billed charges,,
"Urinalysis, Microscopic Only (Manual)",,81015,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Urinalysis, Microscopic Only (Manual)",,81015,CPT,Facility,Both,,,,49,41.65,14.0434,49,Aetna,PPO,45.57,93,,percent of total billed charges,,
"Urinalysis, Microscopic Only (Manual)",,81015,CPT,Facility,Both,,,,49,41.65,14.0434,49,America's PPO,America's PPO,47.0547,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Urinalysis, Microscopic Only (Manual)",,81015,CPT,Facility,Both,,,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota, Federal Employee Program,48.216,98.4,,percent of total billed charges,,
"Urinalysis, Microscopic Only (Manual)",,81015,CPT,Facility,Both,,,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,49,100,,percent of total billed charges,,
"Urinalysis, Microscopic Only (Manual)",,81015,CPT,Facility,Both,,,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,High Value Network Plan,44.1,90,,percent of total billed charges,,
"Urinalysis, Microscopic Only (Manual)",,81015,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Medicare Advantage,24.01,49,,percent of total billed charges,,
"Urinalysis, Microscopic Only (Manual)",,81015,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Urinalysis, Microscopic Only (Manual)",,81015,CPT,Facility,Both,,,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,43.3993,88.57,,percent of total billed charges,,
"Urinalysis, Microscopic Only (Manual)",,81015,CPT,Facility,Both,,,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,14.0434,28.66,,percent of total billed charges,,
"Urinalysis, Microscopic Only (Manual)",,81015,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),24.01,49,,percent of total billed charges,,
"Urinalysis, Microscopic Only (Manual)",,81015,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Urinalysis, Microscopic Only (Manual)",,81015,CPT,Facility,Both,,,,49,41.65,14.0434,49,CorVel,Worker's Compensation,49,100,,percent of total billed charges,,
"Urinalysis, Microscopic Only (Manual)",,81015,CPT,Facility,Both,,,,49,41.65,14.0434,49,First Health Group Corporation,First Health Network,47.53,97,,percent of total billed charges,,
"Urinalysis, Microscopic Only (Manual)",,81015,CPT,Facility,Both,,,,49,41.65,14.0434,49,"Health Partners, Inc.",Commercial,46.354,94.6,,percent of total billed charges,,
"Urinalysis, Microscopic Only (Manual)",,81015,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,"Health Partners, Inc.",Medicare Advantage,24.01,49,,percent of total billed charges,,
"Urinalysis, Microscopic Only (Manual)",,81015,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Urinalysis, Microscopic Only (Manual)",,81015,CPT,Facility,Both,,,,49,41.65,14.0434,49,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),29.4,60,,percent of total billed charges,,
"Urinalysis, Microscopic Only (Manual)",,81015,CPT,Facility,Both,,,,49,41.65,14.0434,49,"Health Partners, Inc.",State of Minnesota Advantage Program,39.935,81.5,,percent of total billed charges,,
"Urinalysis, Microscopic Only (Manual)",,81015,CPT,Facility,Both,,,,49,41.65,14.0434,49,"Health Partners, Inc.",State Public Programs,24.5,50,,percent of total billed charges,,
"Urinalysis, Microscopic Only (Manual)",,81015,CPT,Facility,Both,,,,49,41.65,14.0434,49,Humana Insurance Company,Commercial PPO,46.55,95,,percent of total billed charges,,
"Urinalysis, Microscopic Only (Manual)",,81015,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,Humana Insurance Company,Medicare PPO,24.01,49,,percent of total billed charges,,
"Urinalysis, Microscopic Only (Manual)",,81015,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Urinalysis, Microscopic Only (Manual)",,81015,CPT,Facility,Both,,,,49,41.65,14.0434,49,Medica,Individual & Family,48.559,99.1,,percent of total billed charges,,
"Urinalysis, Microscopic Only (Manual)",,81015,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,Medica,Medica Advantage Solution,24.402,49.8,,percent of total billed charges,,
"Urinalysis, Microscopic Only (Manual)",,81015,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Urinalysis, Microscopic Only (Manual)",,81015,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,Medica,Medical Assistance,21.854,44.6,,percent of total billed charges,,
"Urinalysis, Microscopic Only (Manual)",,81015,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,Medica,Medical Assistance,,,,,Included in per diem rate,
"Urinalysis, Microscopic Only (Manual)",,81015,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,24.402,49.8,,percent of total billed charges,,
"Urinalysis, Microscopic Only (Manual)",,81015,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Urinalysis, Microscopic Only (Manual)",,81015,CPT,Facility,Both,,,,49,41.65,14.0434,49,"Multiplan, Inc.","Multiplan, Inc.",46.06,94,,percent of total billed charges,,
"Urinalysis, Microscopic Only (Manual)",,81015,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,42.336,86.4,,percent of total billed charges,,
"Urinalysis, Microscopic Only (Manual)",,81015,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Urinalysis, Microscopic Only (Manual)",,81015,CPT,Facility,Both,,,,49,41.65,14.0434,49,"Preferred One Administrative Services, INC.",PPO,48.314,98.6,,percent of total billed charges,,
"Urinalysis, Microscopic Only (Manual)",,81015,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,PrimeWest Health,Minnesota Senior Health Options (MSHO),25.2105,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Urinalysis, Microscopic Only (Manual)",,81015,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Urinalysis, Microscopic Only (Manual)",,81015,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,PrimeWest Health,MinnesotaCare,25.1664,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Urinalysis, Microscopic Only (Manual)",,81015,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Urinalysis, Microscopic Only (Manual)",,81015,CPT,Facility,Both,,,,49,41.65,14.0434,49,Sanford Health Plan,Sanford Health Plan,45.08,92,,percent of total billed charges,,
"Urinalysis, Microscopic Only (Manual)",,81015,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,"UCare Health, Inc.",Individual & Family Plan,27.6115,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Urinalysis, Microscopic Only (Manual)",,81015,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Urinalysis, Microscopic Only (Manual)",,81015,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,"UCare Health, Inc.",Medical Assistance,24.7303,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Urinalysis, Microscopic Only (Manual)",,81015,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Urinalysis, Microscopic Only (Manual)",,81015,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,"UCare Health, Inc.",Medicare Advantage,24.7303,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Urinalysis, Microscopic Only (Manual)",,81015,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Urinalysis, Microscopic Only (Manual)",,81015,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),24.7303,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Urinalysis, Microscopic Only (Manual)",,81015,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Urinalysis, Microscopic Only (Manual)",,81015,CPT,Facility,Both,,,,49,41.65,14.0434,49,UnitedHealthcare,Individual & Family,46.06,94,,percent of total billed charges,,
"Urinalysis, Microscopic Only (Manual)",,81015,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,UnitedHealthcare,Medicare Advantage,24.01,49,,percent of total billed charges,,
"Urinalysis, Microscopic Only (Manual)",,81015,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Urinalysis, Microscopic Only (Manual)",,81015,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,23.52,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Urinalysis, Microscopic Only (Manual)",,81015,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Hcg, Qualitative, Urine",,81025,CPT,Facility,Both,,,,90,76.5,25.794,90,Aetna,Commercial,82.8,92,,percent of total billed charges,,
"Hcg, Qualitative, Urine",,81025,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,Aetna,Medicare Advantage,44.1,49,,percent of total billed charges,,
"Hcg, Qualitative, Urine",,81025,CPT,Facility,Inpatient,,,,90,76.5,25.794,90,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Hcg, Qualitative, Urine",,81025,CPT,Facility,Both,,,,90,76.5,25.794,90,Aetna,PPO,83.7,93,,percent of total billed charges,,
"Hcg, Qualitative, Urine",,81025,CPT,Facility,Both,,,,90,76.5,25.794,90,America's PPO,America's PPO,86.427,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Hcg, Qualitative, Urine",,81025,CPT,Facility,Both,,,,90,76.5,25.794,90,BlueCross BlueShield Minnesota, Federal Employee Program,88.56,98.4,,percent of total billed charges,,
"Hcg, Qualitative, Urine",,81025,CPT,Facility,Both,,,,90,76.5,25.794,90,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,90,100,,percent of total billed charges,,
"Hcg, Qualitative, Urine",,81025,CPT,Facility,Both,,,,90,76.5,25.794,90,BlueCross BlueShield Minnesota,High Value Network Plan,81,90,,percent of total billed charges,,
"Hcg, Qualitative, Urine",,81025,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,BlueCross BlueShield Minnesota,Medicare Advantage,44.1,49,,percent of total billed charges,,
"Hcg, Qualitative, Urine",,81025,CPT,Facility,Inpatient,,,,90,76.5,25.794,90,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Hcg, Qualitative, Urine",,81025,CPT,Facility,Both,,,,90,76.5,25.794,90,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,79.713,88.57,,percent of total billed charges,,
"Hcg, Qualitative, Urine",,81025,CPT,Facility,Both,,,,90,76.5,25.794,90,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,25.794,28.66,,percent of total billed charges,,
"Hcg, Qualitative, Urine",,81025,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),44.1,49,,percent of total billed charges,,
"Hcg, Qualitative, Urine",,81025,CPT,Facility,Inpatient,,,,90,76.5,25.794,90,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Hcg, Qualitative, Urine",,81025,CPT,Facility,Both,,,,90,76.5,25.794,90,CorVel,Worker's Compensation,90,100,,percent of total billed charges,,
"Hcg, Qualitative, Urine",,81025,CPT,Facility,Both,,,,90,76.5,25.794,90,First Health Group Corporation,First Health Network,87.3,97,,percent of total billed charges,,
"Hcg, Qualitative, Urine",,81025,CPT,Facility,Both,,,,90,76.5,25.794,90,"Health Partners, Inc.",Commercial,85.14,94.6,,percent of total billed charges,,
"Hcg, Qualitative, Urine",,81025,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,"Health Partners, Inc.",Medicare Advantage,44.1,49,,percent of total billed charges,,
"Hcg, Qualitative, Urine",,81025,CPT,Facility,Inpatient,,,,90,76.5,25.794,90,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Hcg, Qualitative, Urine",,81025,CPT,Facility,Both,,,,90,76.5,25.794,90,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),54,60,,percent of total billed charges,,
"Hcg, Qualitative, Urine",,81025,CPT,Facility,Both,,,,90,76.5,25.794,90,"Health Partners, Inc.",State of Minnesota Advantage Program,73.35,81.5,,percent of total billed charges,,
"Hcg, Qualitative, Urine",,81025,CPT,Facility,Both,,,,90,76.5,25.794,90,"Health Partners, Inc.",State Public Programs,45,50,,percent of total billed charges,,
"Hcg, Qualitative, Urine",,81025,CPT,Facility,Both,,,,90,76.5,25.794,90,Humana Insurance Company,Commercial PPO,85.5,95,,percent of total billed charges,,
"Hcg, Qualitative, Urine",,81025,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,Humana Insurance Company,Medicare PPO,44.1,49,,percent of total billed charges,,
"Hcg, Qualitative, Urine",,81025,CPT,Facility,Inpatient,,,,90,76.5,25.794,90,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Hcg, Qualitative, Urine",,81025,CPT,Facility,Both,,,,90,76.5,25.794,90,Medica,Individual & Family,89.19,99.1,,percent of total billed charges,,
"Hcg, Qualitative, Urine",,81025,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,Medica,Medica Advantage Solution,44.82,49.8,,percent of total billed charges,,
"Hcg, Qualitative, Urine",,81025,CPT,Facility,Inpatient,,,,90,76.5,25.794,90,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Hcg, Qualitative, Urine",,81025,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,Medica,Medical Assistance,40.14,44.6,,percent of total billed charges,,
"Hcg, Qualitative, Urine",,81025,CPT,Facility,Inpatient,,,,90,76.5,25.794,90,Medica,Medical Assistance,,,,,Included in per diem rate,
"Hcg, Qualitative, Urine",,81025,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,44.82,49.8,,percent of total billed charges,,
"Hcg, Qualitative, Urine",,81025,CPT,Facility,Inpatient,,,,90,76.5,25.794,90,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Hcg, Qualitative, Urine",,81025,CPT,Facility,Both,,,,90,76.5,25.794,90,"Multiplan, Inc.","Multiplan, Inc.",84.6,94,,percent of total billed charges,,
"Hcg, Qualitative, Urine",,81025,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,77.76,86.4,,percent of total billed charges,,
"Hcg, Qualitative, Urine",,81025,CPT,Facility,Inpatient,,,,90,76.5,25.794,90,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Hcg, Qualitative, Urine",,81025,CPT,Facility,Both,,,,90,76.5,25.794,90,"Preferred One Administrative Services, INC.",PPO,88.74,98.6,,percent of total billed charges,,
"Hcg, Qualitative, Urine",,81025,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,PrimeWest Health,Minnesota Senior Health Options (MSHO),46.305,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Hcg, Qualitative, Urine",,81025,CPT,Facility,Inpatient,,,,90,76.5,25.794,90,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Hcg, Qualitative, Urine",,81025,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,PrimeWest Health,MinnesotaCare,46.224,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Hcg, Qualitative, Urine",,81025,CPT,Facility,Inpatient,,,,90,76.5,25.794,90,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Hcg, Qualitative, Urine",,81025,CPT,Facility,Both,,,,90,76.5,25.794,90,Sanford Health Plan,Sanford Health Plan,82.8,92,,percent of total billed charges,,
"Hcg, Qualitative, Urine",,81025,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,"UCare Health, Inc.",Individual & Family Plan,50.715,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Hcg, Qualitative, Urine",,81025,CPT,Facility,Inpatient,,,,90,76.5,25.794,90,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Hcg, Qualitative, Urine",,81025,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,"UCare Health, Inc.",Medical Assistance,45.423,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Hcg, Qualitative, Urine",,81025,CPT,Facility,Inpatient,,,,90,76.5,25.794,90,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Hcg, Qualitative, Urine",,81025,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,"UCare Health, Inc.",Medicare Advantage,45.423,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Hcg, Qualitative, Urine",,81025,CPT,Facility,Inpatient,,,,90,76.5,25.794,90,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Hcg, Qualitative, Urine",,81025,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),45.423,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Hcg, Qualitative, Urine",,81025,CPT,Facility,Inpatient,,,,90,76.5,25.794,90,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Hcg, Qualitative, Urine",,81025,CPT,Facility,Both,,,,90,76.5,25.794,90,UnitedHealthcare,Individual & Family,84.6,94,,percent of total billed charges,,
"Hcg, Qualitative, Urine",,81025,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,UnitedHealthcare,Medicare Advantage,44.1,49,,percent of total billed charges,,
"Hcg, Qualitative, Urine",,81025,CPT,Facility,Inpatient,,,,90,76.5,25.794,90,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Hcg, Qualitative, Urine",,81025,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,43.2,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Hcg, Qualitative, Urine",,81025,CPT,Facility,Inpatient,,,,90,76.5,25.794,90,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Prothrombin 20210 G>A Mutation,,81240,CPT,Facility,Both,,,,128,108.8,36.6848,128,Aetna,Commercial,117.76,92,,percent of total billed charges,,
Prothrombin 20210 G>A Mutation,,81240,CPT,Facility,Outpatient,,,,128,108.8,36.6848,128,Aetna,Medicare Advantage,62.72,49,,percent of total billed charges,,
Prothrombin 20210 G>A Mutation,,81240,CPT,Facility,Inpatient,,,,128,108.8,36.6848,128,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Prothrombin 20210 G>A Mutation,,81240,CPT,Facility,Both,,,,128,108.8,36.6848,128,Aetna,PPO,119.04,93,,percent of total billed charges,,
Prothrombin 20210 G>A Mutation,,81240,CPT,Facility,Both,,,,128,108.8,36.6848,128,America's PPO,America's PPO,122.9184,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Prothrombin 20210 G>A Mutation,,81240,CPT,Facility,Both,,,,128,108.8,36.6848,128,BlueCross BlueShield Minnesota, Federal Employee Program,125.952,98.4,,percent of total billed charges,,
Prothrombin 20210 G>A Mutation,,81240,CPT,Facility,Both,,,,128,108.8,36.6848,128,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,128,100,,percent of total billed charges,,
Prothrombin 20210 G>A Mutation,,81240,CPT,Facility,Both,,,,128,108.8,36.6848,128,BlueCross BlueShield Minnesota,High Value Network Plan,115.2,90,,percent of total billed charges,,
Prothrombin 20210 G>A Mutation,,81240,CPT,Facility,Outpatient,,,,128,108.8,36.6848,128,BlueCross BlueShield Minnesota,Medicare Advantage,62.72,49,,percent of total billed charges,,
Prothrombin 20210 G>A Mutation,,81240,CPT,Facility,Inpatient,,,,128,108.8,36.6848,128,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Prothrombin 20210 G>A Mutation,,81240,CPT,Facility,Both,,,,128,108.8,36.6848,128,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,113.3696,88.57,,percent of total billed charges,,
Prothrombin 20210 G>A Mutation,,81240,CPT,Facility,Both,,,,128,108.8,36.6848,128,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,36.6848,28.66,,percent of total billed charges,,
Prothrombin 20210 G>A Mutation,,81240,CPT,Facility,Outpatient,,,,128,108.8,36.6848,128,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),62.72,49,,percent of total billed charges,,
Prothrombin 20210 G>A Mutation,,81240,CPT,Facility,Inpatient,,,,128,108.8,36.6848,128,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Prothrombin 20210 G>A Mutation,,81240,CPT,Facility,Both,,,,128,108.8,36.6848,128,CorVel,Worker's Compensation,128,100,,percent of total billed charges,,
Prothrombin 20210 G>A Mutation,,81240,CPT,Facility,Both,,,,128,108.8,36.6848,128,First Health Group Corporation,First Health Network,124.16,97,,percent of total billed charges,,
Prothrombin 20210 G>A Mutation,,81240,CPT,Facility,Both,,,,128,108.8,36.6848,128,"Health Partners, Inc.",Commercial,121.088,94.6,,percent of total billed charges,,
Prothrombin 20210 G>A Mutation,,81240,CPT,Facility,Outpatient,,,,128,108.8,36.6848,128,"Health Partners, Inc.",Medicare Advantage,62.72,49,,percent of total billed charges,,
Prothrombin 20210 G>A Mutation,,81240,CPT,Facility,Inpatient,,,,128,108.8,36.6848,128,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Prothrombin 20210 G>A Mutation,,81240,CPT,Facility,Both,,,,128,108.8,36.6848,128,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),76.8,60,,percent of total billed charges,,
Prothrombin 20210 G>A Mutation,,81240,CPT,Facility,Both,,,,128,108.8,36.6848,128,"Health Partners, Inc.",State of Minnesota Advantage Program,104.32,81.5,,percent of total billed charges,,
Prothrombin 20210 G>A Mutation,,81240,CPT,Facility,Both,,,,128,108.8,36.6848,128,"Health Partners, Inc.",State Public Programs,64,50,,percent of total billed charges,,
Prothrombin 20210 G>A Mutation,,81240,CPT,Facility,Both,,,,128,108.8,36.6848,128,Humana Insurance Company,Commercial PPO,121.6,95,,percent of total billed charges,,
Prothrombin 20210 G>A Mutation,,81240,CPT,Facility,Outpatient,,,,128,108.8,36.6848,128,Humana Insurance Company,Medicare PPO,62.72,49,,percent of total billed charges,,
Prothrombin 20210 G>A Mutation,,81240,CPT,Facility,Inpatient,,,,128,108.8,36.6848,128,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Prothrombin 20210 G>A Mutation,,81240,CPT,Facility,Both,,,,128,108.8,36.6848,128,Medica,Individual & Family,126.848,99.1,,percent of total billed charges,,
Prothrombin 20210 G>A Mutation,,81240,CPT,Facility,Outpatient,,,,128,108.8,36.6848,128,Medica,Medica Advantage Solution,63.744,49.8,,percent of total billed charges,,
Prothrombin 20210 G>A Mutation,,81240,CPT,Facility,Inpatient,,,,128,108.8,36.6848,128,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Prothrombin 20210 G>A Mutation,,81240,CPT,Facility,Outpatient,,,,128,108.8,36.6848,128,Medica,Medical Assistance,57.088,44.6,,percent of total billed charges,,
Prothrombin 20210 G>A Mutation,,81240,CPT,Facility,Inpatient,,,,128,108.8,36.6848,128,Medica,Medical Assistance,,,,,Included in per diem rate,
Prothrombin 20210 G>A Mutation,,81240,CPT,Facility,Outpatient,,,,128,108.8,36.6848,128,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,63.744,49.8,,percent of total billed charges,,
Prothrombin 20210 G>A Mutation,,81240,CPT,Facility,Inpatient,,,,128,108.8,36.6848,128,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Prothrombin 20210 G>A Mutation,,81240,CPT,Facility,Both,,,,128,108.8,36.6848,128,"Multiplan, Inc.","Multiplan, Inc.",120.32,94,,percent of total billed charges,,
Prothrombin 20210 G>A Mutation,,81240,CPT,Facility,Outpatient,,,,128,108.8,36.6848,128,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,110.592,86.4,,percent of total billed charges,,
Prothrombin 20210 G>A Mutation,,81240,CPT,Facility,Inpatient,,,,128,108.8,36.6848,128,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Prothrombin 20210 G>A Mutation,,81240,CPT,Facility,Both,,,,128,108.8,36.6848,128,"Preferred One Administrative Services, INC.",PPO,126.208,98.6,,percent of total billed charges,,
Prothrombin 20210 G>A Mutation,,81240,CPT,Facility,Outpatient,,,,128,108.8,36.6848,128,PrimeWest Health,Minnesota Senior Health Options (MSHO),65.856,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Prothrombin 20210 G>A Mutation,,81240,CPT,Facility,Inpatient,,,,128,108.8,36.6848,128,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Prothrombin 20210 G>A Mutation,,81240,CPT,Facility,Outpatient,,,,128,108.8,36.6848,128,PrimeWest Health,MinnesotaCare,65.7408,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Prothrombin 20210 G>A Mutation,,81240,CPT,Facility,Inpatient,,,,128,108.8,36.6848,128,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Prothrombin 20210 G>A Mutation,,81240,CPT,Facility,Both,,,,128,108.8,36.6848,128,Sanford Health Plan,Sanford Health Plan,117.76,92,,percent of total billed charges,,
Prothrombin 20210 G>A Mutation,,81240,CPT,Facility,Outpatient,,,,128,108.8,36.6848,128,"UCare Health, Inc.",Individual & Family Plan,72.128,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Prothrombin 20210 G>A Mutation,,81240,CPT,Facility,Inpatient,,,,128,108.8,36.6848,128,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Prothrombin 20210 G>A Mutation,,81240,CPT,Facility,Outpatient,,,,128,108.8,36.6848,128,"UCare Health, Inc.",Medical Assistance,64.6016,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Prothrombin 20210 G>A Mutation,,81240,CPT,Facility,Inpatient,,,,128,108.8,36.6848,128,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Prothrombin 20210 G>A Mutation,,81240,CPT,Facility,Outpatient,,,,128,108.8,36.6848,128,"UCare Health, Inc.",Medicare Advantage,64.6016,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Prothrombin 20210 G>A Mutation,,81240,CPT,Facility,Inpatient,,,,128,108.8,36.6848,128,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Prothrombin 20210 G>A Mutation,,81240,CPT,Facility,Outpatient,,,,128,108.8,36.6848,128,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),64.6016,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Prothrombin 20210 G>A Mutation,,81240,CPT,Facility,Inpatient,,,,128,108.8,36.6848,128,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Prothrombin 20210 G>A Mutation,,81240,CPT,Facility,Both,,,,128,108.8,36.6848,128,UnitedHealthcare,Individual & Family,120.32,94,,percent of total billed charges,,
Prothrombin 20210 G>A Mutation,,81240,CPT,Facility,Outpatient,,,,128,108.8,36.6848,128,UnitedHealthcare,Medicare Advantage,62.72,49,,percent of total billed charges,,
Prothrombin 20210 G>A Mutation,,81240,CPT,Facility,Inpatient,,,,128,108.8,36.6848,128,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Prothrombin 20210 G>A Mutation,,81240,CPT,Facility,Outpatient,,,,128,108.8,36.6848,128,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,61.44,48,,percent of total billed charges,,100% of DHS outpatient percentage
Prothrombin 20210 G>A Mutation,,81240,CPT,Facility,Inpatient,,,,128,108.8,36.6848,128,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Factor V Leiden Mutation,,81241,CPT,Facility,Both,,,,179,152.15,51.3014,179,Aetna,Commercial,164.68,92,,percent of total billed charges,,
Factor V Leiden Mutation,,81241,CPT,Facility,Outpatient,,,,179,152.15,51.3014,179,Aetna,Medicare Advantage,87.71,49,,percent of total billed charges,,
Factor V Leiden Mutation,,81241,CPT,Facility,Inpatient,,,,179,152.15,51.3014,179,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Factor V Leiden Mutation,,81241,CPT,Facility,Both,,,,179,152.15,51.3014,179,Aetna,PPO,166.47,93,,percent of total billed charges,,
Factor V Leiden Mutation,,81241,CPT,Facility,Both,,,,179,152.15,51.3014,179,America's PPO,America's PPO,171.8937,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Factor V Leiden Mutation,,81241,CPT,Facility,Both,,,,179,152.15,51.3014,179,BlueCross BlueShield Minnesota, Federal Employee Program,176.136,98.4,,percent of total billed charges,,
Factor V Leiden Mutation,,81241,CPT,Facility,Both,,,,179,152.15,51.3014,179,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,179,100,,percent of total billed charges,,
Factor V Leiden Mutation,,81241,CPT,Facility,Both,,,,179,152.15,51.3014,179,BlueCross BlueShield Minnesota,High Value Network Plan,161.1,90,,percent of total billed charges,,
Factor V Leiden Mutation,,81241,CPT,Facility,Outpatient,,,,179,152.15,51.3014,179,BlueCross BlueShield Minnesota,Medicare Advantage,87.71,49,,percent of total billed charges,,
Factor V Leiden Mutation,,81241,CPT,Facility,Inpatient,,,,179,152.15,51.3014,179,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Factor V Leiden Mutation,,81241,CPT,Facility,Both,,,,179,152.15,51.3014,179,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,158.5403,88.57,,percent of total billed charges,,
Factor V Leiden Mutation,,81241,CPT,Facility,Both,,,,179,152.15,51.3014,179,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,51.3014,28.66,,percent of total billed charges,,
Factor V Leiden Mutation,,81241,CPT,Facility,Outpatient,,,,179,152.15,51.3014,179,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),87.71,49,,percent of total billed charges,,
Factor V Leiden Mutation,,81241,CPT,Facility,Inpatient,,,,179,152.15,51.3014,179,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Factor V Leiden Mutation,,81241,CPT,Facility,Both,,,,179,152.15,51.3014,179,CorVel,Worker's Compensation,179,100,,percent of total billed charges,,
Factor V Leiden Mutation,,81241,CPT,Facility,Both,,,,179,152.15,51.3014,179,First Health Group Corporation,First Health Network,173.63,97,,percent of total billed charges,,
Factor V Leiden Mutation,,81241,CPT,Facility,Both,,,,179,152.15,51.3014,179,"Health Partners, Inc.",Commercial,169.334,94.6,,percent of total billed charges,,
Factor V Leiden Mutation,,81241,CPT,Facility,Outpatient,,,,179,152.15,51.3014,179,"Health Partners, Inc.",Medicare Advantage,87.71,49,,percent of total billed charges,,
Factor V Leiden Mutation,,81241,CPT,Facility,Inpatient,,,,179,152.15,51.3014,179,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Factor V Leiden Mutation,,81241,CPT,Facility,Both,,,,179,152.15,51.3014,179,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),107.4,60,,percent of total billed charges,,
Factor V Leiden Mutation,,81241,CPT,Facility,Both,,,,179,152.15,51.3014,179,"Health Partners, Inc.",State of Minnesota Advantage Program,145.885,81.5,,percent of total billed charges,,
Factor V Leiden Mutation,,81241,CPT,Facility,Both,,,,179,152.15,51.3014,179,"Health Partners, Inc.",State Public Programs,89.5,50,,percent of total billed charges,,
Factor V Leiden Mutation,,81241,CPT,Facility,Both,,,,179,152.15,51.3014,179,Humana Insurance Company,Commercial PPO,170.05,95,,percent of total billed charges,,
Factor V Leiden Mutation,,81241,CPT,Facility,Outpatient,,,,179,152.15,51.3014,179,Humana Insurance Company,Medicare PPO,87.71,49,,percent of total billed charges,,
Factor V Leiden Mutation,,81241,CPT,Facility,Inpatient,,,,179,152.15,51.3014,179,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Factor V Leiden Mutation,,81241,CPT,Facility,Both,,,,179,152.15,51.3014,179,Medica,Individual & Family,177.389,99.1,,percent of total billed charges,,
Factor V Leiden Mutation,,81241,CPT,Facility,Outpatient,,,,179,152.15,51.3014,179,Medica,Medica Advantage Solution,89.142,49.8,,percent of total billed charges,,
Factor V Leiden Mutation,,81241,CPT,Facility,Inpatient,,,,179,152.15,51.3014,179,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Factor V Leiden Mutation,,81241,CPT,Facility,Outpatient,,,,179,152.15,51.3014,179,Medica,Medical Assistance,79.834,44.6,,percent of total billed charges,,
Factor V Leiden Mutation,,81241,CPT,Facility,Inpatient,,,,179,152.15,51.3014,179,Medica,Medical Assistance,,,,,Included in per diem rate,
Factor V Leiden Mutation,,81241,CPT,Facility,Outpatient,,,,179,152.15,51.3014,179,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,89.142,49.8,,percent of total billed charges,,
Factor V Leiden Mutation,,81241,CPT,Facility,Inpatient,,,,179,152.15,51.3014,179,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Factor V Leiden Mutation,,81241,CPT,Facility,Both,,,,179,152.15,51.3014,179,"Multiplan, Inc.","Multiplan, Inc.",168.26,94,,percent of total billed charges,,
Factor V Leiden Mutation,,81241,CPT,Facility,Outpatient,,,,179,152.15,51.3014,179,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,154.656,86.4,,percent of total billed charges,,
Factor V Leiden Mutation,,81241,CPT,Facility,Inpatient,,,,179,152.15,51.3014,179,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Factor V Leiden Mutation,,81241,CPT,Facility,Both,,,,179,152.15,51.3014,179,"Preferred One Administrative Services, INC.",PPO,176.494,98.6,,percent of total billed charges,,
Factor V Leiden Mutation,,81241,CPT,Facility,Outpatient,,,,179,152.15,51.3014,179,PrimeWest Health,Minnesota Senior Health Options (MSHO),92.0955,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Factor V Leiden Mutation,,81241,CPT,Facility,Inpatient,,,,179,152.15,51.3014,179,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Factor V Leiden Mutation,,81241,CPT,Facility,Outpatient,,,,179,152.15,51.3014,179,PrimeWest Health,MinnesotaCare,91.9344,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Factor V Leiden Mutation,,81241,CPT,Facility,Inpatient,,,,179,152.15,51.3014,179,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Factor V Leiden Mutation,,81241,CPT,Facility,Both,,,,179,152.15,51.3014,179,Sanford Health Plan,Sanford Health Plan,164.68,92,,percent of total billed charges,,
Factor V Leiden Mutation,,81241,CPT,Facility,Outpatient,,,,179,152.15,51.3014,179,"UCare Health, Inc.",Individual & Family Plan,100.8665,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Factor V Leiden Mutation,,81241,CPT,Facility,Inpatient,,,,179,152.15,51.3014,179,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Factor V Leiden Mutation,,81241,CPT,Facility,Outpatient,,,,179,152.15,51.3014,179,"UCare Health, Inc.",Medical Assistance,90.3413,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Factor V Leiden Mutation,,81241,CPT,Facility,Inpatient,,,,179,152.15,51.3014,179,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Factor V Leiden Mutation,,81241,CPT,Facility,Outpatient,,,,179,152.15,51.3014,179,"UCare Health, Inc.",Medicare Advantage,90.3413,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Factor V Leiden Mutation,,81241,CPT,Facility,Inpatient,,,,179,152.15,51.3014,179,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Factor V Leiden Mutation,,81241,CPT,Facility,Outpatient,,,,179,152.15,51.3014,179,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),90.3413,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Factor V Leiden Mutation,,81241,CPT,Facility,Inpatient,,,,179,152.15,51.3014,179,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Factor V Leiden Mutation,,81241,CPT,Facility,Both,,,,179,152.15,51.3014,179,UnitedHealthcare,Individual & Family,168.26,94,,percent of total billed charges,,
Factor V Leiden Mutation,,81241,CPT,Facility,Outpatient,,,,179,152.15,51.3014,179,UnitedHealthcare,Medicare Advantage,87.71,49,,percent of total billed charges,,
Factor V Leiden Mutation,,81241,CPT,Facility,Inpatient,,,,179,152.15,51.3014,179,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Factor V Leiden Mutation,,81241,CPT,Facility,Outpatient,,,,179,152.15,51.3014,179,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,85.92,48,,percent of total billed charges,,100% of DHS outpatient percentage
Factor V Leiden Mutation,,81241,CPT,Facility,Inpatient,,,,179,152.15,51.3014,179,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJ SOLN,,J0330,HCPCS,Facility,Inpatient,10,mL,,108,91.8,30.9528,108,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJ SOLN,,J0330,HCPCS,Facility,Inpatient,10,mL,,108,91.8,30.9528,108,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJ SOLN,,J0330,HCPCS,Facility,Outpatient,10,mL,,108,91.8,30.9528,108,Medica,Medical Assistance,48.168,44.6,,percent of total billed charges,,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJ SOLN,,J0330,HCPCS,Facility,Outpatient,10,mL,,108,91.8,30.9528,108,Medica,Medical Assistance,48.168,44.6,,percent of total billed charges,,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJ SOLN,,J0330,HCPCS,Facility,Inpatient,10,mL,,108,91.8,30.9528,108,Medica,Medical Assistance,,,,,Included in per diem rate,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJ SOLN,,J0330,HCPCS,Facility,Inpatient,10,mL,,108,91.8,30.9528,108,Medica,Medical Assistance,,,,,Included in per diem rate,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJ SOLN,,J0330,HCPCS,Facility,Outpatient,10,mL,,108,91.8,30.9528,108,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,53.784,49.8,,percent of total billed charges,,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJ SOLN,,J0330,HCPCS,Facility,Outpatient,10,mL,,108,91.8,30.9528,108,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,53.784,49.8,,percent of total billed charges,,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJ SOLN,,J0330,HCPCS,Facility,Inpatient,10,mL,,108,91.8,30.9528,108,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJ SOLN,,J0330,HCPCS,Facility,Inpatient,10,mL,,108,91.8,30.9528,108,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJ SOLN,,J0330,HCPCS,Facility,Both,10,mL,,108,91.8,30.9528,108,"Multiplan, Inc.","Multiplan, Inc.",101.52,94,,percent of total billed charges,,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJ SOLN,,J0330,HCPCS,Facility,Both,10,mL,,108,91.8,30.9528,108,"Multiplan, Inc.","Multiplan, Inc.",101.52,94,,percent of total billed charges,,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJ SOLN,,J0330,HCPCS,Facility,Outpatient,10,mL,,108,91.8,30.9528,108,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,97.308,90.1,,percent of total billed charges,,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJ SOLN,,J0330,HCPCS,Facility,Outpatient,10,mL,,108,91.8,30.9528,108,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,97.308,90.1,,percent of total billed charges,,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJ SOLN,,J0330,HCPCS,Facility,Inpatient,10,mL,,108,91.8,30.9528,108,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJ SOLN,,J0330,HCPCS,Facility,Inpatient,10,mL,,108,91.8,30.9528,108,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJ SOLN,,J0330,HCPCS,Facility,Both,10,mL,,108,91.8,30.9528,108,"Preferred One Administrative Services, INC.",PPO,106.488,98.6,,percent of total billed charges,,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJ SOLN,,J0330,HCPCS,Facility,Both,10,mL,,108,91.8,30.9528,108,"Preferred One Administrative Services, INC.",PPO,106.488,98.6,,percent of total billed charges,,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJ SOLN,,J0330,HCPCS,Facility,Outpatient,10,mL,,108,91.8,30.9528,108,PrimeWest Health,Minnesota Senior Health Options (MSHO),55.566,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJ SOLN,,J0330,HCPCS,Facility,Outpatient,10,mL,,108,91.8,30.9528,108,PrimeWest Health,Minnesota Senior Health Options (MSHO),55.566,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJ SOLN,,J0330,HCPCS,Facility,Inpatient,10,mL,,108,91.8,30.9528,108,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJ SOLN,,J0330,HCPCS,Facility,Inpatient,10,mL,,108,91.8,30.9528,108,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJ SOLN,,J0330,HCPCS,Facility,Outpatient,10,mL,,108,91.8,30.9528,108,PrimeWest Health,MinnesotaCare,55.4688,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJ SOLN,,J0330,HCPCS,Facility,Outpatient,10,mL,,108,91.8,30.9528,108,PrimeWest Health,MinnesotaCare,55.4688,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJ SOLN,,J0330,HCPCS,Facility,Inpatient,10,mL,,108,91.8,30.9528,108,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJ SOLN,,J0330,HCPCS,Facility,Inpatient,10,mL,,108,91.8,30.9528,108,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJ SOLN,,J0330,HCPCS,Facility,Both,10,mL,,108,91.8,30.9528,108,Sanford Health Plan,Sanford Health Plan,99.36,92,,percent of total billed charges,,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJ SOLN,,J0330,HCPCS,Facility,Both,10,mL,,108,91.8,30.9528,108,Sanford Health Plan,Sanford Health Plan,99.36,92,,percent of total billed charges,,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJ SOLN,,J0330,HCPCS,Facility,Outpatient,10,mL,,108,91.8,30.9528,108,"UCare Health, Inc.",Individual & Family Plan,60.858,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJ SOLN,,J0330,HCPCS,Facility,Outpatient,10,mL,,108,91.8,30.9528,108,"UCare Health, Inc.",Individual & Family Plan,60.858,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJ SOLN,,J0330,HCPCS,Facility,Inpatient,10,mL,,108,91.8,30.9528,108,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJ SOLN,,J0330,HCPCS,Facility,Inpatient,10,mL,,108,91.8,30.9528,108,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJ SOLN,,J0330,HCPCS,Facility,Outpatient,10,mL,,108,91.8,30.9528,108,"UCare Health, Inc.",Medical Assistance,54.5076,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJ SOLN,,J0330,HCPCS,Facility,Outpatient,10,mL,,108,91.8,30.9528,108,"UCare Health, Inc.",Medical Assistance,54.5076,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJ SOLN,,J0330,HCPCS,Facility,Inpatient,10,mL,,108,91.8,30.9528,108,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJ SOLN,,J0330,HCPCS,Facility,Inpatient,10,mL,,108,91.8,30.9528,108,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJ SOLN,,J0330,HCPCS,Facility,Outpatient,10,mL,,108,91.8,30.9528,108,"UCare Health, Inc.",Medicare Advantage,54.5076,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJ SOLN,,J0330,HCPCS,Facility,Outpatient,10,mL,,108,91.8,30.9528,108,"UCare Health, Inc.",Medicare Advantage,54.5076,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJ SOLN,,J0330,HCPCS,Facility,Inpatient,10,mL,,108,91.8,30.9528,108,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJ SOLN,,J0330,HCPCS,Facility,Inpatient,10,mL,,108,91.8,30.9528,108,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJ SOLN,,J0330,HCPCS,Facility,Outpatient,10,mL,,108,91.8,30.9528,108,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),54.5076,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJ SOLN,,J0330,HCPCS,Facility,Outpatient,10,mL,,108,91.8,30.9528,108,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),54.5076,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJ SOLN,,J0330,HCPCS,Facility,Inpatient,10,mL,,108,91.8,30.9528,108,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJ SOLN,,J0330,HCPCS,Facility,Inpatient,10,mL,,108,91.8,30.9528,108,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJ SOLN,,J0330,HCPCS,Facility,Both,10,mL,,108,91.8,30.9528,108,UnitedHealthcare,Individual & Family,101.52,94,,percent of total billed charges,,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJ SOLN,,J0330,HCPCS,Facility,Both,10,mL,,108,91.8,30.9528,108,UnitedHealthcare,Individual & Family,101.52,94,,percent of total billed charges,,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJ SOLN,,J0330,HCPCS,Facility,Outpatient,10,mL,,108,91.8,30.9528,108,UnitedHealthcare,Medicare Advantage,52.92,49,,percent of total billed charges,,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJ SOLN,,J0330,HCPCS,Facility,Outpatient,10,mL,,108,91.8,30.9528,108,UnitedHealthcare,Medicare Advantage,52.92,49,,percent of total billed charges,,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJ SOLN,,J0330,HCPCS,Facility,Inpatient,10,mL,,108,91.8,30.9528,108,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJ SOLN,,J0330,HCPCS,Facility,Inpatient,10,mL,,108,91.8,30.9528,108,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJ SOLN,,J0330,HCPCS,Facility,Outpatient,10,mL,,108,91.8,30.9528,108,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,51.84,48,,percent of total billed charges,,100% of DHS outpatient percentage
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJ SOLN,,J0330,HCPCS,Facility,Outpatient,10,mL,,108,91.8,30.9528,108,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,51.84,48,,percent of total billed charges,,100% of DHS outpatient percentage
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJ SOLN,,J0330,HCPCS,Facility,Inpatient,10,mL,,108,91.8,30.9528,108,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJ SOLN,,J0330,HCPCS,Facility,Inpatient,10,mL,,108,91.8,30.9528,108,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJ SOLN (PEDS),,J0330,HCPCS,Facility,Both,10,mL,,105,89.25,30.093,105,Aetna,Commercial,96.6,92,,percent of total billed charges,,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJ SOLN (PEDS),,J0330,HCPCS,Facility,Outpatient,10,mL,,105,89.25,30.093,105,Aetna,Medicare Advantage,51.45,49,,percent of total billed charges,,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJ SOLN (PEDS),,J0330,HCPCS,Facility,Inpatient,10,mL,,105,89.25,30.093,105,Aetna,Medicare Advantage,,,,,Included in per diem rate,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJ SOLN (PEDS),,J0330,HCPCS,Facility,Both,10,mL,,105,89.25,30.093,105,Aetna,PPO,97.65,93,,percent of total billed charges,,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJ SOLN (PEDS),,J0330,HCPCS,Facility,Both,10,mL,,105,89.25,30.093,105,America's PPO,America's PPO,100.8315,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJ SOLN (PEDS),,J0330,HCPCS,Facility,Both,10,mL,,105,89.25,30.093,105,BlueCross BlueShield Minnesota, Federal Employee Program,103.32,98.4,,percent of total billed charges,,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJ SOLN (PEDS),,J0330,HCPCS,Facility,Both,10,mL,,105,89.25,30.093,105,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,105,100,,percent of total billed charges,,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJ SOLN (PEDS),,J0330,HCPCS,Facility,Both,10,mL,,105,89.25,30.093,105,BlueCross BlueShield Minnesota,High Value Network Plan,94.5,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJ SOLN (PEDS),,J0330,HCPCS,Facility,Outpatient,10,mL,,105,89.25,30.093,105,BlueCross BlueShield Minnesota,Medicare Advantage,51.45,49,,percent of total billed charges,,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJ SOLN (PEDS),,J0330,HCPCS,Facility,Inpatient,10,mL,,105,89.25,30.093,105,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJ SOLN (PEDS),,J0330,HCPCS,Facility,Both,10,mL,,105,89.25,30.093,105,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,92.9985,88.57,,percent of total billed charges,,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJ SOLN (PEDS),,J0330,HCPCS,Facility,Both,10,mL,,105,89.25,30.093,105,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,30.093,28.66,,percent of total billed charges,,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJ SOLN (PEDS),,J0330,HCPCS,Facility,Outpatient,10,mL,,105,89.25,30.093,105,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),51.45,49,,percent of total billed charges,,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJ SOLN (PEDS),,J0330,HCPCS,Facility,Inpatient,10,mL,,105,89.25,30.093,105,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJ SOLN (PEDS),,J0330,HCPCS,Facility,Both,10,mL,,105,89.25,30.093,105,CorVel,Worker's Compensation,105,100,,percent of total billed charges,,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJ SOLN (PEDS),,J0330,HCPCS,Facility,Both,10,mL,,105,89.25,30.093,105,First Health Group Corporation,First Health Network,101.85,97,,percent of total billed charges,,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJ SOLN (PEDS),,J0330,HCPCS,Facility,Both,10,mL,,105,89.25,30.093,105,"Health Partners, Inc.",Commercial,99.33,94.6,,percent of total billed charges,,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJ SOLN (PEDS),,J0330,HCPCS,Facility,Outpatient,10,mL,,105,89.25,30.093,105,"Health Partners, Inc.",Medicare Advantage,51.45,49,,percent of total billed charges,,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJ SOLN (PEDS),,J0330,HCPCS,Facility,Inpatient,10,mL,,105,89.25,30.093,105,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJ SOLN (PEDS),,J0330,HCPCS,Facility,Both,10,mL,,105,89.25,30.093,105,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),63,60,,percent of total billed charges,,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJ SOLN (PEDS),,J0330,HCPCS,Facility,Both,10,mL,,105,89.25,30.093,105,"Health Partners, Inc.",State of Minnesota Advantage Program,85.575,81.5,,percent of total billed charges,,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJ SOLN (PEDS),,J0330,HCPCS,Facility,Both,10,mL,,105,89.25,30.093,105,"Health Partners, Inc.",State Public Programs,52.5,50,,percent of total billed charges,,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJ SOLN (PEDS),,J0330,HCPCS,Facility,Both,10,mL,,105,89.25,30.093,105,Humana Insurance Company,Commercial PPO,99.75,95,,percent of total billed charges,,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJ SOLN (PEDS),,J0330,HCPCS,Facility,Outpatient,10,mL,,105,89.25,30.093,105,Humana Insurance Company,Medicare PPO,51.45,49,,percent of total billed charges,,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJ SOLN (PEDS),,J0330,HCPCS,Facility,Inpatient,10,mL,,105,89.25,30.093,105,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJ SOLN (PEDS),,J0330,HCPCS,Facility,Both,10,mL,,105,89.25,30.093,105,Medica,Individual & Family,104.055,99.1,,percent of total billed charges,,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJ SOLN (PEDS),,J0330,HCPCS,Facility,Outpatient,10,mL,,105,89.25,30.093,105,Medica,Medica Advantage Solution,52.29,49.8,,percent of total billed charges,,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJ SOLN (PEDS),,J0330,HCPCS,Facility,Inpatient,10,mL,,105,89.25,30.093,105,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJ SOLN (PEDS),,J0330,HCPCS,Facility,Outpatient,10,mL,,105,89.25,30.093,105,Medica,Medical Assistance,46.83,44.6,,percent of total billed charges,,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJ SOLN (PEDS),,J0330,HCPCS,Facility,Inpatient,10,mL,,105,89.25,30.093,105,Medica,Medical Assistance,,,,,Included in per diem rate,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJ SOLN (PEDS),,J0330,HCPCS,Facility,Outpatient,10,mL,,105,89.25,30.093,105,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,52.29,49.8,,percent of total billed charges,,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJ SOLN (PEDS),,J0330,HCPCS,Facility,Inpatient,10,mL,,105,89.25,30.093,105,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJ SOLN (PEDS),,J0330,HCPCS,Facility,Both,10,mL,,105,89.25,30.093,105,"Multiplan, Inc.","Multiplan, Inc.",98.7,94,,percent of total billed charges,,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJ SOLN (PEDS),,J0330,HCPCS,Facility,Outpatient,10,mL,,105,89.25,30.093,105,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,94.605,90.1,,percent of total billed charges,,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJ SOLN (PEDS),,J0330,HCPCS,Facility,Inpatient,10,mL,,105,89.25,30.093,105,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJ SOLN (PEDS),,J0330,HCPCS,Facility,Both,10,mL,,105,89.25,30.093,105,"Preferred One Administrative Services, INC.",PPO,103.53,98.6,,percent of total billed charges,,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJ SOLN (PEDS),,J0330,HCPCS,Facility,Outpatient,10,mL,,105,89.25,30.093,105,PrimeWest Health,Minnesota Senior Health Options (MSHO),54.0225,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJ SOLN (PEDS),,J0330,HCPCS,Facility,Inpatient,10,mL,,105,89.25,30.093,105,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJ SOLN (PEDS),,J0330,HCPCS,Facility,Outpatient,10,mL,,105,89.25,30.093,105,PrimeWest Health,MinnesotaCare,53.928,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJ SOLN (PEDS),,J0330,HCPCS,Facility,Inpatient,10,mL,,105,89.25,30.093,105,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJ SOLN (PEDS),,J0330,HCPCS,Facility,Both,10,mL,,105,89.25,30.093,105,Sanford Health Plan,Sanford Health Plan,96.6,92,,percent of total billed charges,,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJ SOLN (PEDS),,J0330,HCPCS,Facility,Outpatient,10,mL,,105,89.25,30.093,105,"UCare Health, Inc.",Individual & Family Plan,59.1675,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJ SOLN (PEDS),,J0330,HCPCS,Facility,Inpatient,10,mL,,105,89.25,30.093,105,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJ SOLN (PEDS),,J0330,HCPCS,Facility,Outpatient,10,mL,,105,89.25,30.093,105,"UCare Health, Inc.",Medical Assistance,52.9935,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJ SOLN (PEDS),,J0330,HCPCS,Facility,Inpatient,10,mL,,105,89.25,30.093,105,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJ SOLN (PEDS),,J0330,HCPCS,Facility,Outpatient,10,mL,,105,89.25,30.093,105,"UCare Health, Inc.",Medicare Advantage,52.9935,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJ SOLN (PEDS),,J0330,HCPCS,Facility,Inpatient,10,mL,,105,89.25,30.093,105,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJ SOLN (PEDS),,J0330,HCPCS,Facility,Outpatient,10,mL,,105,89.25,30.093,105,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),52.9935,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJ SOLN (PEDS),,J0330,HCPCS,Facility,Inpatient,10,mL,,105,89.25,30.093,105,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJ SOLN (PEDS),,J0330,HCPCS,Facility,Both,10,mL,,105,89.25,30.093,105,UnitedHealthcare,Individual & Family,98.7,94,,percent of total billed charges,,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJ SOLN (PEDS),,J0330,HCPCS,Facility,Outpatient,10,mL,,105,89.25,30.093,105,UnitedHealthcare,Medicare Advantage,51.45,49,,percent of total billed charges,,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJ SOLN (PEDS),,J0330,HCPCS,Facility,Inpatient,10,mL,,105,89.25,30.093,105,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJ SOLN (PEDS),,J0330,HCPCS,Facility,Outpatient,10,mL,,105,89.25,30.093,105,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,50.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJ SOLN (PEDS),,J0330,HCPCS,Facility,Inpatient,10,mL,,105,89.25,30.093,105,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Acetone, Blood",,82009,CPT,Facility,Both,,,,49,41.65,14.0434,49,Aetna,Commercial,45.08,92,,percent of total billed charges,,
"Acetone, Blood",,82009,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,Aetna,Medicare Advantage,24.01,49,,percent of total billed charges,,
"Acetone, Blood",,82009,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Acetone, Blood",,82009,CPT,Facility,Both,,,,49,41.65,14.0434,49,Aetna,PPO,45.57,93,,percent of total billed charges,,
"Acetone, Blood",,82009,CPT,Facility,Both,,,,49,41.65,14.0434,49,America's PPO,America's PPO,47.0547,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Acetone, Blood",,82009,CPT,Facility,Both,,,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota, Federal Employee Program,48.216,98.4,,percent of total billed charges,,
"Acetone, Blood",,82009,CPT,Facility,Both,,,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,49,100,,percent of total billed charges,,
"Acetone, Blood",,82009,CPT,Facility,Both,,,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,High Value Network Plan,44.1,90,,percent of total billed charges,,
"Acetone, Blood",,82009,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Medicare Advantage,24.01,49,,percent of total billed charges,,
"Acetone, Blood",,82009,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Acetone, Blood",,82009,CPT,Facility,Both,,,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,43.3993,88.57,,percent of total billed charges,,
"Acetone, Blood",,82009,CPT,Facility,Both,,,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,14.0434,28.66,,percent of total billed charges,,
"Acetone, Blood",,82009,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),24.01,49,,percent of total billed charges,,
"Acetone, Blood",,82009,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Acetone, Blood",,82009,CPT,Facility,Both,,,,49,41.65,14.0434,49,CorVel,Worker's Compensation,49,100,,percent of total billed charges,,
"Acetone, Blood",,82009,CPT,Facility,Both,,,,49,41.65,14.0434,49,First Health Group Corporation,First Health Network,47.53,97,,percent of total billed charges,,
"Acetone, Blood",,82009,CPT,Facility,Both,,,,49,41.65,14.0434,49,"Health Partners, Inc.",Commercial,46.354,94.6,,percent of total billed charges,,
"Acetone, Blood",,82009,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,"Health Partners, Inc.",Medicare Advantage,24.01,49,,percent of total billed charges,,
"Acetone, Blood",,82009,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Acetone, Blood",,82009,CPT,Facility,Both,,,,49,41.65,14.0434,49,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),29.4,60,,percent of total billed charges,,
"Acetone, Blood",,82009,CPT,Facility,Both,,,,49,41.65,14.0434,49,"Health Partners, Inc.",State of Minnesota Advantage Program,39.935,81.5,,percent of total billed charges,,
"Acetone, Blood",,82009,CPT,Facility,Both,,,,49,41.65,14.0434,49,"Health Partners, Inc.",State Public Programs,24.5,50,,percent of total billed charges,,
"Acetone, Blood",,82009,CPT,Facility,Both,,,,49,41.65,14.0434,49,Humana Insurance Company,Commercial PPO,46.55,95,,percent of total billed charges,,
"Acetone, Blood",,82009,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,Humana Insurance Company,Medicare PPO,24.01,49,,percent of total billed charges,,
"Acetone, Blood",,82009,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Acetone, Blood",,82009,CPT,Facility,Both,,,,49,41.65,14.0434,49,Medica,Individual & Family,48.559,99.1,,percent of total billed charges,,
"Acetone, Blood",,82009,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,Medica,Medica Advantage Solution,24.402,49.8,,percent of total billed charges,,
"Acetone, Blood",,82009,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Acetone, Blood",,82009,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,Medica,Medical Assistance,21.854,44.6,,percent of total billed charges,,
"Acetone, Blood",,82009,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,Medica,Medical Assistance,,,,,Included in per diem rate,
"Acetone, Blood",,82009,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,24.402,49.8,,percent of total billed charges,,
"Acetone, Blood",,82009,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Acetone, Blood",,82009,CPT,Facility,Both,,,,49,41.65,14.0434,49,"Multiplan, Inc.","Multiplan, Inc.",46.06,94,,percent of total billed charges,,
"Acetone, Blood",,82009,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,42.336,86.4,,percent of total billed charges,,
"Acetone, Blood",,82009,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Acetone, Blood",,82009,CPT,Facility,Both,,,,49,41.65,14.0434,49,"Preferred One Administrative Services, INC.",PPO,48.314,98.6,,percent of total billed charges,,
"Acetone, Blood",,82009,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,PrimeWest Health,Minnesota Senior Health Options (MSHO),25.2105,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Acetone, Blood",,82009,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Acetone, Blood",,82009,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,PrimeWest Health,MinnesotaCare,25.1664,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Acetone, Blood",,82009,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Acetone, Blood",,82009,CPT,Facility,Both,,,,49,41.65,14.0434,49,Sanford Health Plan,Sanford Health Plan,45.08,92,,percent of total billed charges,,
"Acetone, Blood",,82009,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,"UCare Health, Inc.",Individual & Family Plan,27.6115,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Acetone, Blood",,82009,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Acetone, Blood",,82009,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,"UCare Health, Inc.",Medical Assistance,24.7303,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Acetone, Blood",,82009,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Acetone, Blood",,82009,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,"UCare Health, Inc.",Medicare Advantage,24.7303,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Acetone, Blood",,82009,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Acetone, Blood",,82009,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),24.7303,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Acetone, Blood",,82009,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Acetone, Blood",,82009,CPT,Facility,Both,,,,49,41.65,14.0434,49,UnitedHealthcare,Individual & Family,46.06,94,,percent of total billed charges,,
"Acetone, Blood",,82009,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,UnitedHealthcare,Medicare Advantage,24.01,49,,percent of total billed charges,,
"Acetone, Blood",,82009,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Acetone, Blood",,82009,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,23.52,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Acetone, Blood",,82009,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Beta Hydroxybutyrate,,82010,CPT,Facility,Both,,,,86,73.1,24.6476,86,Aetna,Commercial,79.12,92,,percent of total billed charges,,
Beta Hydroxybutyrate,,82010,CPT,Facility,Outpatient,,,,86,73.1,24.6476,86,Aetna,Medicare Advantage,42.14,49,,percent of total billed charges,,
Beta Hydroxybutyrate,,82010,CPT,Facility,Inpatient,,,,86,73.1,24.6476,86,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Beta Hydroxybutyrate,,82010,CPT,Facility,Both,,,,86,73.1,24.6476,86,Aetna,PPO,79.98,93,,percent of total billed charges,,
Beta Hydroxybutyrate,,82010,CPT,Facility,Both,,,,86,73.1,24.6476,86,America's PPO,America's PPO,82.5858,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Beta Hydroxybutyrate,,82010,CPT,Facility,Both,,,,86,73.1,24.6476,86,BlueCross BlueShield Minnesota, Federal Employee Program,84.624,98.4,,percent of total billed charges,,
Beta Hydroxybutyrate,,82010,CPT,Facility,Both,,,,86,73.1,24.6476,86,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,86,100,,percent of total billed charges,,
Beta Hydroxybutyrate,,82010,CPT,Facility,Both,,,,86,73.1,24.6476,86,BlueCross BlueShield Minnesota,High Value Network Plan,77.4,90,,percent of total billed charges,,
Beta Hydroxybutyrate,,82010,CPT,Facility,Outpatient,,,,86,73.1,24.6476,86,BlueCross BlueShield Minnesota,Medicare Advantage,42.14,49,,percent of total billed charges,,
Beta Hydroxybutyrate,,82010,CPT,Facility,Inpatient,,,,86,73.1,24.6476,86,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Beta Hydroxybutyrate,,82010,CPT,Facility,Both,,,,86,73.1,24.6476,86,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,76.1702,88.57,,percent of total billed charges,,
Beta Hydroxybutyrate,,82010,CPT,Facility,Both,,,,86,73.1,24.6476,86,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,24.6476,28.66,,percent of total billed charges,,
Beta Hydroxybutyrate,,82010,CPT,Facility,Outpatient,,,,86,73.1,24.6476,86,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),42.14,49,,percent of total billed charges,,
Beta Hydroxybutyrate,,82010,CPT,Facility,Inpatient,,,,86,73.1,24.6476,86,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Beta Hydroxybutyrate,,82010,CPT,Facility,Both,,,,86,73.1,24.6476,86,CorVel,Worker's Compensation,86,100,,percent of total billed charges,,
Beta Hydroxybutyrate,,82010,CPT,Facility,Both,,,,86,73.1,24.6476,86,First Health Group Corporation,First Health Network,83.42,97,,percent of total billed charges,,
Beta Hydroxybutyrate,,82010,CPT,Facility,Both,,,,86,73.1,24.6476,86,"Health Partners, Inc.",Commercial,81.356,94.6,,percent of total billed charges,,
Beta Hydroxybutyrate,,82010,CPT,Facility,Outpatient,,,,86,73.1,24.6476,86,"Health Partners, Inc.",Medicare Advantage,42.14,49,,percent of total billed charges,,
Beta Hydroxybutyrate,,82010,CPT,Facility,Inpatient,,,,86,73.1,24.6476,86,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Beta Hydroxybutyrate,,82010,CPT,Facility,Both,,,,86,73.1,24.6476,86,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),51.6,60,,percent of total billed charges,,
Beta Hydroxybutyrate,,82010,CPT,Facility,Both,,,,86,73.1,24.6476,86,"Health Partners, Inc.",State of Minnesota Advantage Program,70.09,81.5,,percent of total billed charges,,
Beta Hydroxybutyrate,,82010,CPT,Facility,Both,,,,86,73.1,24.6476,86,"Health Partners, Inc.",State Public Programs,43,50,,percent of total billed charges,,
Beta Hydroxybutyrate,,82010,CPT,Facility,Both,,,,86,73.1,24.6476,86,Humana Insurance Company,Commercial PPO,81.7,95,,percent of total billed charges,,
Beta Hydroxybutyrate,,82010,CPT,Facility,Outpatient,,,,86,73.1,24.6476,86,Humana Insurance Company,Medicare PPO,42.14,49,,percent of total billed charges,,
Beta Hydroxybutyrate,,82010,CPT,Facility,Inpatient,,,,86,73.1,24.6476,86,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Beta Hydroxybutyrate,,82010,CPT,Facility,Both,,,,86,73.1,24.6476,86,Medica,Individual & Family,85.226,99.1,,percent of total billed charges,,
Beta Hydroxybutyrate,,82010,CPT,Facility,Outpatient,,,,86,73.1,24.6476,86,Medica,Medica Advantage Solution,42.828,49.8,,percent of total billed charges,,
Beta Hydroxybutyrate,,82010,CPT,Facility,Inpatient,,,,86,73.1,24.6476,86,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Beta Hydroxybutyrate,,82010,CPT,Facility,Outpatient,,,,86,73.1,24.6476,86,Medica,Medical Assistance,38.356,44.6,,percent of total billed charges,,
Beta Hydroxybutyrate,,82010,CPT,Facility,Inpatient,,,,86,73.1,24.6476,86,Medica,Medical Assistance,,,,,Included in per diem rate,
Beta Hydroxybutyrate,,82010,CPT,Facility,Outpatient,,,,86,73.1,24.6476,86,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,42.828,49.8,,percent of total billed charges,,
Beta Hydroxybutyrate,,82010,CPT,Facility,Inpatient,,,,86,73.1,24.6476,86,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Beta Hydroxybutyrate,,82010,CPT,Facility,Both,,,,86,73.1,24.6476,86,"Multiplan, Inc.","Multiplan, Inc.",80.84,94,,percent of total billed charges,,
Beta Hydroxybutyrate,,82010,CPT,Facility,Outpatient,,,,86,73.1,24.6476,86,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,74.304,86.4,,percent of total billed charges,,
Beta Hydroxybutyrate,,82010,CPT,Facility,Inpatient,,,,86,73.1,24.6476,86,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Beta Hydroxybutyrate,,82010,CPT,Facility,Both,,,,86,73.1,24.6476,86,"Preferred One Administrative Services, INC.",PPO,84.796,98.6,,percent of total billed charges,,
Beta Hydroxybutyrate,,82010,CPT,Facility,Outpatient,,,,86,73.1,24.6476,86,PrimeWest Health,Minnesota Senior Health Options (MSHO),44.247,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Beta Hydroxybutyrate,,82010,CPT,Facility,Inpatient,,,,86,73.1,24.6476,86,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Beta Hydroxybutyrate,,82010,CPT,Facility,Outpatient,,,,86,73.1,24.6476,86,PrimeWest Health,MinnesotaCare,44.1696,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Beta Hydroxybutyrate,,82010,CPT,Facility,Inpatient,,,,86,73.1,24.6476,86,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Beta Hydroxybutyrate,,82010,CPT,Facility,Both,,,,86,73.1,24.6476,86,Sanford Health Plan,Sanford Health Plan,79.12,92,,percent of total billed charges,,
Beta Hydroxybutyrate,,82010,CPT,Facility,Outpatient,,,,86,73.1,24.6476,86,"UCare Health, Inc.",Individual & Family Plan,48.461,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Beta Hydroxybutyrate,,82010,CPT,Facility,Inpatient,,,,86,73.1,24.6476,86,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Beta Hydroxybutyrate,,82010,CPT,Facility,Outpatient,,,,86,73.1,24.6476,86,"UCare Health, Inc.",Medical Assistance,43.4042,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Beta Hydroxybutyrate,,82010,CPT,Facility,Inpatient,,,,86,73.1,24.6476,86,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Beta Hydroxybutyrate,,82010,CPT,Facility,Outpatient,,,,86,73.1,24.6476,86,"UCare Health, Inc.",Medicare Advantage,43.4042,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Beta Hydroxybutyrate,,82010,CPT,Facility,Inpatient,,,,86,73.1,24.6476,86,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Beta Hydroxybutyrate,,82010,CPT,Facility,Outpatient,,,,86,73.1,24.6476,86,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),43.4042,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Beta Hydroxybutyrate,,82010,CPT,Facility,Inpatient,,,,86,73.1,24.6476,86,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Beta Hydroxybutyrate,,82010,CPT,Facility,Both,,,,86,73.1,24.6476,86,UnitedHealthcare,Individual & Family,80.84,94,,percent of total billed charges,,
Beta Hydroxybutyrate,,82010,CPT,Facility,Outpatient,,,,86,73.1,24.6476,86,UnitedHealthcare,Medicare Advantage,42.14,49,,percent of total billed charges,,
Beta Hydroxybutyrate,,82010,CPT,Facility,Inpatient,,,,86,73.1,24.6476,86,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Beta Hydroxybutyrate,,82010,CPT,Facility,Outpatient,,,,86,73.1,24.6476,86,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,41.28,48,,percent of total billed charges,,100% of DHS outpatient percentage
Beta Hydroxybutyrate,,82010,CPT,Facility,Inpatient,,,,86,73.1,24.6476,86,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Albumin,,82040,CPT,Facility,Both,,,,50,42.5,14.33,50,Aetna,Commercial,46,92,,percent of total billed charges,,
Albumin,,82040,CPT,Facility,Outpatient,,,,50,42.5,14.33,50,Aetna,Medicare Advantage,24.5,49,,percent of total billed charges,,
Albumin,,82040,CPT,Facility,Inpatient,,,,50,42.5,14.33,50,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Albumin,,82040,CPT,Facility,Both,,,,50,42.5,14.33,50,Aetna,PPO,46.5,93,,percent of total billed charges,,
Albumin,,82040,CPT,Facility,Both,,,,50,42.5,14.33,50,America's PPO,America's PPO,48.015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Albumin,,82040,CPT,Facility,Both,,,,50,42.5,14.33,50,BlueCross BlueShield Minnesota, Federal Employee Program,49.2,98.4,,percent of total billed charges,,
Albumin,,82040,CPT,Facility,Both,,,,50,42.5,14.33,50,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,50,100,,percent of total billed charges,,
Albumin,,82040,CPT,Facility,Both,,,,50,42.5,14.33,50,BlueCross BlueShield Minnesota,High Value Network Plan,45,90,,percent of total billed charges,,
Albumin,,82040,CPT,Facility,Outpatient,,,,50,42.5,14.33,50,BlueCross BlueShield Minnesota,Medicare Advantage,24.5,49,,percent of total billed charges,,
Albumin,,82040,CPT,Facility,Inpatient,,,,50,42.5,14.33,50,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Albumin,,82040,CPT,Facility,Both,,,,50,42.5,14.33,50,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,44.285,88.57,,percent of total billed charges,,
Albumin,,82040,CPT,Facility,Both,,,,50,42.5,14.33,50,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,14.33,28.66,,percent of total billed charges,,
Albumin,,82040,CPT,Facility,Outpatient,,,,50,42.5,14.33,50,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),24.5,49,,percent of total billed charges,,
Albumin,,82040,CPT,Facility,Inpatient,,,,50,42.5,14.33,50,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Albumin,,82040,CPT,Facility,Both,,,,50,42.5,14.33,50,CorVel,Worker's Compensation,50,100,,percent of total billed charges,,
Albumin,,82040,CPT,Facility,Both,,,,50,42.5,14.33,50,First Health Group Corporation,First Health Network,48.5,97,,percent of total billed charges,,
Albumin,,82040,CPT,Facility,Both,,,,50,42.5,14.33,50,"Health Partners, Inc.",Commercial,47.3,94.6,,percent of total billed charges,,
Albumin,,82040,CPT,Facility,Outpatient,,,,50,42.5,14.33,50,"Health Partners, Inc.",Medicare Advantage,24.5,49,,percent of total billed charges,,
Albumin,,82040,CPT,Facility,Inpatient,,,,50,42.5,14.33,50,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Albumin,,82040,CPT,Facility,Both,,,,50,42.5,14.33,50,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),30,60,,percent of total billed charges,,
Albumin,,82040,CPT,Facility,Both,,,,50,42.5,14.33,50,"Health Partners, Inc.",State of Minnesota Advantage Program,40.75,81.5,,percent of total billed charges,,
Albumin,,82040,CPT,Facility,Both,,,,50,42.5,14.33,50,"Health Partners, Inc.",State Public Programs,25,50,,percent of total billed charges,,
Albumin,,82040,CPT,Facility,Both,,,,50,42.5,14.33,50,Humana Insurance Company,Commercial PPO,47.5,95,,percent of total billed charges,,
Albumin,,82040,CPT,Facility,Outpatient,,,,50,42.5,14.33,50,Humana Insurance Company,Medicare PPO,24.5,49,,percent of total billed charges,,
Albumin,,82040,CPT,Facility,Inpatient,,,,50,42.5,14.33,50,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Albumin,,82040,CPT,Facility,Both,,,,50,42.5,14.33,50,Medica,Individual & Family,49.55,99.1,,percent of total billed charges,,
Albumin,,82040,CPT,Facility,Outpatient,,,,50,42.5,14.33,50,Medica,Medica Advantage Solution,24.9,49.8,,percent of total billed charges,,
Albumin,,82040,CPT,Facility,Inpatient,,,,50,42.5,14.33,50,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Albumin,,82040,CPT,Facility,Outpatient,,,,50,42.5,14.33,50,Medica,Medical Assistance,22.3,44.6,,percent of total billed charges,,
Albumin,,82040,CPT,Facility,Inpatient,,,,50,42.5,14.33,50,Medica,Medical Assistance,,,,,Included in per diem rate,
Albumin,,82040,CPT,Facility,Outpatient,,,,50,42.5,14.33,50,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,24.9,49.8,,percent of total billed charges,,
Albumin,,82040,CPT,Facility,Inpatient,,,,50,42.5,14.33,50,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Albumin,,82040,CPT,Facility,Both,,,,50,42.5,14.33,50,"Multiplan, Inc.","Multiplan, Inc.",47,94,,percent of total billed charges,,
Albumin,,82040,CPT,Facility,Outpatient,,,,50,42.5,14.33,50,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,43.2,86.4,,percent of total billed charges,,
Albumin,,82040,CPT,Facility,Inpatient,,,,50,42.5,14.33,50,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Albumin,,82040,CPT,Facility,Both,,,,50,42.5,14.33,50,"Preferred One Administrative Services, INC.",PPO,49.3,98.6,,percent of total billed charges,,
Albumin,,82040,CPT,Facility,Outpatient,,,,50,42.5,14.33,50,PrimeWest Health,Minnesota Senior Health Options (MSHO),25.725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Albumin,,82040,CPT,Facility,Inpatient,,,,50,42.5,14.33,50,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Albumin,,82040,CPT,Facility,Outpatient,,,,50,42.5,14.33,50,PrimeWest Health,MinnesotaCare,25.68,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Albumin,,82040,CPT,Facility,Inpatient,,,,50,42.5,14.33,50,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Albumin,,82040,CPT,Facility,Both,,,,50,42.5,14.33,50,Sanford Health Plan,Sanford Health Plan,46,92,,percent of total billed charges,,
Albumin,,82040,CPT,Facility,Outpatient,,,,50,42.5,14.33,50,"UCare Health, Inc.",Individual & Family Plan,28.175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Albumin,,82040,CPT,Facility,Inpatient,,,,50,42.5,14.33,50,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Albumin,,82040,CPT,Facility,Outpatient,,,,50,42.5,14.33,50,"UCare Health, Inc.",Medical Assistance,25.235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Albumin,,82040,CPT,Facility,Inpatient,,,,50,42.5,14.33,50,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Albumin,,82040,CPT,Facility,Outpatient,,,,50,42.5,14.33,50,"UCare Health, Inc.",Medicare Advantage,25.235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Albumin,,82040,CPT,Facility,Inpatient,,,,50,42.5,14.33,50,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Albumin,,82040,CPT,Facility,Outpatient,,,,50,42.5,14.33,50,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),25.235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Albumin,,82040,CPT,Facility,Inpatient,,,,50,42.5,14.33,50,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Albumin,,82040,CPT,Facility,Both,,,,50,42.5,14.33,50,UnitedHealthcare,Individual & Family,47,94,,percent of total billed charges,,
Albumin,,82040,CPT,Facility,Outpatient,,,,50,42.5,14.33,50,UnitedHealthcare,Medicare Advantage,24.5,49,,percent of total billed charges,,
Albumin,,82040,CPT,Facility,Inpatient,,,,50,42.5,14.33,50,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Albumin,,82040,CPT,Facility,Outpatient,,,,50,42.5,14.33,50,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,24,48,,percent of total billed charges,,100% of DHS outpatient percentage
Albumin,,82040,CPT,Facility,Inpatient,,,,50,42.5,14.33,50,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Albumin, Body Fluid",,82042,CPT,Facility,Both,,,,55,46.75,15.763,55,Aetna,Commercial,50.6,92,,percent of total billed charges,,
"Albumin, Body Fluid",,82042,CPT,Facility,Outpatient,,,,55,46.75,15.763,55,Aetna,Medicare Advantage,26.95,49,,percent of total billed charges,,
"Albumin, Body Fluid",,82042,CPT,Facility,Inpatient,,,,55,46.75,15.763,55,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Albumin, Body Fluid",,82042,CPT,Facility,Both,,,,55,46.75,15.763,55,Aetna,PPO,51.15,93,,percent of total billed charges,,
"Albumin, Body Fluid",,82042,CPT,Facility,Both,,,,55,46.75,15.763,55,America's PPO,America's PPO,52.8165,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Albumin, Body Fluid",,82042,CPT,Facility,Both,,,,55,46.75,15.763,55,BlueCross BlueShield Minnesota, Federal Employee Program,54.12,98.4,,percent of total billed charges,,
"Albumin, Body Fluid",,82042,CPT,Facility,Both,,,,55,46.75,15.763,55,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,55,100,,percent of total billed charges,,
"Albumin, Body Fluid",,82042,CPT,Facility,Both,,,,55,46.75,15.763,55,BlueCross BlueShield Minnesota,High Value Network Plan,49.5,90,,percent of total billed charges,,
"Albumin, Body Fluid",,82042,CPT,Facility,Outpatient,,,,55,46.75,15.763,55,BlueCross BlueShield Minnesota,Medicare Advantage,26.95,49,,percent of total billed charges,,
"Albumin, Body Fluid",,82042,CPT,Facility,Inpatient,,,,55,46.75,15.763,55,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Albumin, Body Fluid",,82042,CPT,Facility,Both,,,,55,46.75,15.763,55,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,48.7135,88.57,,percent of total billed charges,,
"Albumin, Body Fluid",,82042,CPT,Facility,Both,,,,55,46.75,15.763,55,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,15.763,28.66,,percent of total billed charges,,
"Albumin, Body Fluid",,82042,CPT,Facility,Outpatient,,,,55,46.75,15.763,55,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),26.95,49,,percent of total billed charges,,
"Albumin, Body Fluid",,82042,CPT,Facility,Inpatient,,,,55,46.75,15.763,55,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Albumin, Body Fluid",,82042,CPT,Facility,Both,,,,55,46.75,15.763,55,CorVel,Worker's Compensation,55,100,,percent of total billed charges,,
"Albumin, Body Fluid",,82042,CPT,Facility,Both,,,,55,46.75,15.763,55,First Health Group Corporation,First Health Network,53.35,97,,percent of total billed charges,,
"Albumin, Body Fluid",,82042,CPT,Facility,Both,,,,55,46.75,15.763,55,"Health Partners, Inc.",Commercial,52.03,94.6,,percent of total billed charges,,
"Albumin, Body Fluid",,82042,CPT,Facility,Outpatient,,,,55,46.75,15.763,55,"Health Partners, Inc.",Medicare Advantage,26.95,49,,percent of total billed charges,,
"Albumin, Body Fluid",,82042,CPT,Facility,Inpatient,,,,55,46.75,15.763,55,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Albumin, Body Fluid",,82042,CPT,Facility,Both,,,,55,46.75,15.763,55,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),33,60,,percent of total billed charges,,
"Albumin, Body Fluid",,82042,CPT,Facility,Both,,,,55,46.75,15.763,55,"Health Partners, Inc.",State of Minnesota Advantage Program,44.825,81.5,,percent of total billed charges,,
"Albumin, Body Fluid",,82042,CPT,Facility,Both,,,,55,46.75,15.763,55,"Health Partners, Inc.",State Public Programs,27.5,50,,percent of total billed charges,,
"Albumin, Body Fluid",,82042,CPT,Facility,Both,,,,55,46.75,15.763,55,Humana Insurance Company,Commercial PPO,52.25,95,,percent of total billed charges,,
"Albumin, Body Fluid",,82042,CPT,Facility,Outpatient,,,,55,46.75,15.763,55,Humana Insurance Company,Medicare PPO,26.95,49,,percent of total billed charges,,
"Albumin, Body Fluid",,82042,CPT,Facility,Inpatient,,,,55,46.75,15.763,55,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Albumin, Body Fluid",,82042,CPT,Facility,Both,,,,55,46.75,15.763,55,Medica,Individual & Family,54.505,99.1,,percent of total billed charges,,
"Albumin, Body Fluid",,82042,CPT,Facility,Outpatient,,,,55,46.75,15.763,55,Medica,Medica Advantage Solution,27.39,49.8,,percent of total billed charges,,
"Albumin, Body Fluid",,82042,CPT,Facility,Inpatient,,,,55,46.75,15.763,55,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Albumin, Body Fluid",,82042,CPT,Facility,Outpatient,,,,55,46.75,15.763,55,Medica,Medical Assistance,24.53,44.6,,percent of total billed charges,,
"Albumin, Body Fluid",,82042,CPT,Facility,Inpatient,,,,55,46.75,15.763,55,Medica,Medical Assistance,,,,,Included in per diem rate,
"Albumin, Body Fluid",,82042,CPT,Facility,Outpatient,,,,55,46.75,15.763,55,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,27.39,49.8,,percent of total billed charges,,
"Albumin, Body Fluid",,82042,CPT,Facility,Inpatient,,,,55,46.75,15.763,55,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Albumin, Body Fluid",,82042,CPT,Facility,Both,,,,55,46.75,15.763,55,"Multiplan, Inc.","Multiplan, Inc.",51.7,94,,percent of total billed charges,,
"Albumin, Body Fluid",,82042,CPT,Facility,Outpatient,,,,55,46.75,15.763,55,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,47.52,86.4,,percent of total billed charges,,
"Albumin, Body Fluid",,82042,CPT,Facility,Inpatient,,,,55,46.75,15.763,55,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Albumin, Body Fluid",,82042,CPT,Facility,Both,,,,55,46.75,15.763,55,"Preferred One Administrative Services, INC.",PPO,54.23,98.6,,percent of total billed charges,,
"Albumin, Body Fluid",,82042,CPT,Facility,Outpatient,,,,55,46.75,15.763,55,PrimeWest Health,Minnesota Senior Health Options (MSHO),28.2975,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Albumin, Body Fluid",,82042,CPT,Facility,Inpatient,,,,55,46.75,15.763,55,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Albumin, Body Fluid",,82042,CPT,Facility,Outpatient,,,,55,46.75,15.763,55,PrimeWest Health,MinnesotaCare,28.248,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Albumin, Body Fluid",,82042,CPT,Facility,Inpatient,,,,55,46.75,15.763,55,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Albumin, Body Fluid",,82042,CPT,Facility,Both,,,,55,46.75,15.763,55,Sanford Health Plan,Sanford Health Plan,50.6,92,,percent of total billed charges,,
"Albumin, Body Fluid",,82042,CPT,Facility,Outpatient,,,,55,46.75,15.763,55,"UCare Health, Inc.",Individual & Family Plan,30.9925,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Albumin, Body Fluid",,82042,CPT,Facility,Inpatient,,,,55,46.75,15.763,55,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Albumin, Body Fluid",,82042,CPT,Facility,Outpatient,,,,55,46.75,15.763,55,"UCare Health, Inc.",Medical Assistance,27.7585,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Albumin, Body Fluid",,82042,CPT,Facility,Inpatient,,,,55,46.75,15.763,55,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Albumin, Body Fluid",,82042,CPT,Facility,Outpatient,,,,55,46.75,15.763,55,"UCare Health, Inc.",Medicare Advantage,27.7585,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Albumin, Body Fluid",,82042,CPT,Facility,Inpatient,,,,55,46.75,15.763,55,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Albumin, Body Fluid",,82042,CPT,Facility,Outpatient,,,,55,46.75,15.763,55,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),27.7585,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Albumin, Body Fluid",,82042,CPT,Facility,Inpatient,,,,55,46.75,15.763,55,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Albumin, Body Fluid",,82042,CPT,Facility,Both,,,,55,46.75,15.763,55,UnitedHealthcare,Individual & Family,51.7,94,,percent of total billed charges,,
"Albumin, Body Fluid",,82042,CPT,Facility,Outpatient,,,,55,46.75,15.763,55,UnitedHealthcare,Medicare Advantage,26.95,49,,percent of total billed charges,,
"Albumin, Body Fluid",,82042,CPT,Facility,Inpatient,,,,55,46.75,15.763,55,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Albumin, Body Fluid",,82042,CPT,Facility,Outpatient,,,,55,46.75,15.763,55,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,26.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Albumin, Body Fluid",,82042,CPT,Facility,Inpatient,,,,55,46.75,15.763,55,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Microalbumin, Random, Urine",,82043,CPT,Facility,Both,,,,65,55.25,18.629,65,Aetna,Commercial,59.8,92,,percent of total billed charges,,
"Microalbumin, Random, Urine",,82043,CPT,Facility,Outpatient,,,,65,55.25,18.629,65,Aetna,Medicare Advantage,31.85,49,,percent of total billed charges,,
"Microalbumin, Random, Urine",,82043,CPT,Facility,Inpatient,,,,65,55.25,18.629,65,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Microalbumin, Random, Urine",,82043,CPT,Facility,Both,,,,65,55.25,18.629,65,Aetna,PPO,60.45,93,,percent of total billed charges,,
"Microalbumin, Random, Urine",,82043,CPT,Facility,Both,,,,65,55.25,18.629,65,America's PPO,America's PPO,62.4195,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Microalbumin, Random, Urine",,82043,CPT,Facility,Both,,,,65,55.25,18.629,65,BlueCross BlueShield Minnesota, Federal Employee Program,63.96,98.4,,percent of total billed charges,,
"Microalbumin, Random, Urine",,82043,CPT,Facility,Both,,,,65,55.25,18.629,65,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,65,100,,percent of total billed charges,,
"Microalbumin, Random, Urine",,82043,CPT,Facility,Both,,,,65,55.25,18.629,65,BlueCross BlueShield Minnesota,High Value Network Plan,58.5,90,,percent of total billed charges,,
"Microalbumin, Random, Urine",,82043,CPT,Facility,Outpatient,,,,65,55.25,18.629,65,BlueCross BlueShield Minnesota,Medicare Advantage,31.85,49,,percent of total billed charges,,
"Microalbumin, Random, Urine",,82043,CPT,Facility,Inpatient,,,,65,55.25,18.629,65,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Microalbumin, Random, Urine",,82043,CPT,Facility,Both,,,,65,55.25,18.629,65,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,57.5705,88.57,,percent of total billed charges,,
"Microalbumin, Random, Urine",,82043,CPT,Facility,Both,,,,65,55.25,18.629,65,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,18.629,28.66,,percent of total billed charges,,
"Microalbumin, Random, Urine",,82043,CPT,Facility,Outpatient,,,,65,55.25,18.629,65,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),31.85,49,,percent of total billed charges,,
"Microalbumin, Random, Urine",,82043,CPT,Facility,Inpatient,,,,65,55.25,18.629,65,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Microalbumin, Random, Urine",,82043,CPT,Facility,Both,,,,65,55.25,18.629,65,CorVel,Worker's Compensation,65,100,,percent of total billed charges,,
"Microalbumin, Random, Urine",,82043,CPT,Facility,Both,,,,65,55.25,18.629,65,First Health Group Corporation,First Health Network,63.05,97,,percent of total billed charges,,
"Microalbumin, Random, Urine",,82043,CPT,Facility,Both,,,,65,55.25,18.629,65,"Health Partners, Inc.",Commercial,61.49,94.6,,percent of total billed charges,,
"Microalbumin, Random, Urine",,82043,CPT,Facility,Outpatient,,,,65,55.25,18.629,65,"Health Partners, Inc.",Medicare Advantage,31.85,49,,percent of total billed charges,,
"Microalbumin, Random, Urine",,82043,CPT,Facility,Inpatient,,,,65,55.25,18.629,65,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Microalbumin, Random, Urine",,82043,CPT,Facility,Both,,,,65,55.25,18.629,65,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),39,60,,percent of total billed charges,,
"Microalbumin, Random, Urine",,82043,CPT,Facility,Both,,,,65,55.25,18.629,65,"Health Partners, Inc.",State of Minnesota Advantage Program,52.975,81.5,,percent of total billed charges,,
"Microalbumin, Random, Urine",,82043,CPT,Facility,Both,,,,65,55.25,18.629,65,"Health Partners, Inc.",State Public Programs,32.5,50,,percent of total billed charges,,
"Microalbumin, Random, Urine",,82043,CPT,Facility,Both,,,,65,55.25,18.629,65,Humana Insurance Company,Commercial PPO,61.75,95,,percent of total billed charges,,
"Microalbumin, Random, Urine",,82043,CPT,Facility,Outpatient,,,,65,55.25,18.629,65,Humana Insurance Company,Medicare PPO,31.85,49,,percent of total billed charges,,
"Microalbumin, Random, Urine",,82043,CPT,Facility,Inpatient,,,,65,55.25,18.629,65,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Microalbumin, Random, Urine",,82043,CPT,Facility,Both,,,,65,55.25,18.629,65,Medica,Individual & Family,64.415,99.1,,percent of total billed charges,,
"Microalbumin, Random, Urine",,82043,CPT,Facility,Outpatient,,,,65,55.25,18.629,65,Medica,Medica Advantage Solution,32.37,49.8,,percent of total billed charges,,
"Microalbumin, Random, Urine",,82043,CPT,Facility,Inpatient,,,,65,55.25,18.629,65,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Microalbumin, Random, Urine",,82043,CPT,Facility,Outpatient,,,,65,55.25,18.629,65,Medica,Medical Assistance,28.99,44.6,,percent of total billed charges,,
"Microalbumin, Random, Urine",,82043,CPT,Facility,Inpatient,,,,65,55.25,18.629,65,Medica,Medical Assistance,,,,,Included in per diem rate,
"Microalbumin, Random, Urine",,82043,CPT,Facility,Outpatient,,,,65,55.25,18.629,65,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,32.37,49.8,,percent of total billed charges,,
"Microalbumin, Random, Urine",,82043,CPT,Facility,Inpatient,,,,65,55.25,18.629,65,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Microalbumin, Random, Urine",,82043,CPT,Facility,Both,,,,65,55.25,18.629,65,"Multiplan, Inc.","Multiplan, Inc.",61.1,94,,percent of total billed charges,,
"Microalbumin, Random, Urine",,82043,CPT,Facility,Outpatient,,,,65,55.25,18.629,65,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,56.16,86.4,,percent of total billed charges,,
"Microalbumin, Random, Urine",,82043,CPT,Facility,Inpatient,,,,65,55.25,18.629,65,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Microalbumin, Random, Urine",,82043,CPT,Facility,Both,,,,65,55.25,18.629,65,"Preferred One Administrative Services, INC.",PPO,64.09,98.6,,percent of total billed charges,,
"Microalbumin, Random, Urine",,82043,CPT,Facility,Outpatient,,,,65,55.25,18.629,65,PrimeWest Health,Minnesota Senior Health Options (MSHO),33.4425,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Microalbumin, Random, Urine",,82043,CPT,Facility,Inpatient,,,,65,55.25,18.629,65,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Microalbumin, Random, Urine",,82043,CPT,Facility,Outpatient,,,,65,55.25,18.629,65,PrimeWest Health,MinnesotaCare,33.384,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Microalbumin, Random, Urine",,82043,CPT,Facility,Inpatient,,,,65,55.25,18.629,65,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Microalbumin, Random, Urine",,82043,CPT,Facility,Both,,,,65,55.25,18.629,65,Sanford Health Plan,Sanford Health Plan,59.8,92,,percent of total billed charges,,
"Microalbumin, Random, Urine",,82043,CPT,Facility,Outpatient,,,,65,55.25,18.629,65,"UCare Health, Inc.",Individual & Family Plan,36.6275,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Microalbumin, Random, Urine",,82043,CPT,Facility,Inpatient,,,,65,55.25,18.629,65,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Microalbumin, Random, Urine",,82043,CPT,Facility,Outpatient,,,,65,55.25,18.629,65,"UCare Health, Inc.",Medical Assistance,32.8055,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Microalbumin, Random, Urine",,82043,CPT,Facility,Inpatient,,,,65,55.25,18.629,65,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Microalbumin, Random, Urine",,82043,CPT,Facility,Outpatient,,,,65,55.25,18.629,65,"UCare Health, Inc.",Medicare Advantage,32.8055,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Microalbumin, Random, Urine",,82043,CPT,Facility,Inpatient,,,,65,55.25,18.629,65,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Microalbumin, Random, Urine",,82043,CPT,Facility,Outpatient,,,,65,55.25,18.629,65,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),32.8055,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Microalbumin, Random, Urine",,82043,CPT,Facility,Inpatient,,,,65,55.25,18.629,65,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Microalbumin, Random, Urine",,82043,CPT,Facility,Both,,,,65,55.25,18.629,65,UnitedHealthcare,Individual & Family,61.1,94,,percent of total billed charges,,
"Microalbumin, Random, Urine",,82043,CPT,Facility,Outpatient,,,,65,55.25,18.629,65,UnitedHealthcare,Medicare Advantage,31.85,49,,percent of total billed charges,,
"Microalbumin, Random, Urine",,82043,CPT,Facility,Inpatient,,,,65,55.25,18.629,65,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Microalbumin, Random, Urine",,82043,CPT,Facility,Outpatient,,,,65,55.25,18.629,65,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,31.2,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Microalbumin, Random, Urine",,82043,CPT,Facility,Inpatient,,,,65,55.25,18.629,65,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Microalbumin, Urine, 24 Hr",,82043,CPT,Facility,Both,,,,82,69.7,23.5012,82,Aetna,Commercial,75.44,92,,percent of total billed charges,,
"Microalbumin, Urine, 24 Hr",,82043,CPT,Facility,Outpatient,,,,82,69.7,23.5012,82,Aetna,Medicare Advantage,40.18,49,,percent of total billed charges,,
"Microalbumin, Urine, 24 Hr",,82043,CPT,Facility,Inpatient,,,,82,69.7,23.5012,82,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Microalbumin, Urine, 24 Hr",,82043,CPT,Facility,Both,,,,82,69.7,23.5012,82,Aetna,PPO,76.26,93,,percent of total billed charges,,
"Microalbumin, Urine, 24 Hr",,82043,CPT,Facility,Both,,,,82,69.7,23.5012,82,America's PPO,America's PPO,78.7446,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Microalbumin, Urine, 24 Hr",,82043,CPT,Facility,Both,,,,82,69.7,23.5012,82,BlueCross BlueShield Minnesota, Federal Employee Program,80.688,98.4,,percent of total billed charges,,
"Microalbumin, Urine, 24 Hr",,82043,CPT,Facility,Both,,,,82,69.7,23.5012,82,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,82,100,,percent of total billed charges,,
"Microalbumin, Urine, 24 Hr",,82043,CPT,Facility,Both,,,,82,69.7,23.5012,82,BlueCross BlueShield Minnesota,High Value Network Plan,73.8,90,,percent of total billed charges,,
"Microalbumin, Urine, 24 Hr",,82043,CPT,Facility,Outpatient,,,,82,69.7,23.5012,82,BlueCross BlueShield Minnesota,Medicare Advantage,40.18,49,,percent of total billed charges,,
"Microalbumin, Urine, 24 Hr",,82043,CPT,Facility,Inpatient,,,,82,69.7,23.5012,82,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Microalbumin, Urine, 24 Hr",,82043,CPT,Facility,Both,,,,82,69.7,23.5012,82,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,72.6274,88.57,,percent of total billed charges,,
"Microalbumin, Urine, 24 Hr",,82043,CPT,Facility,Both,,,,82,69.7,23.5012,82,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,23.5012,28.66,,percent of total billed charges,,
"Microalbumin, Urine, 24 Hr",,82043,CPT,Facility,Outpatient,,,,82,69.7,23.5012,82,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),40.18,49,,percent of total billed charges,,
"Microalbumin, Urine, 24 Hr",,82043,CPT,Facility,Inpatient,,,,82,69.7,23.5012,82,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Microalbumin, Urine, 24 Hr",,82043,CPT,Facility,Both,,,,82,69.7,23.5012,82,CorVel,Worker's Compensation,82,100,,percent of total billed charges,,
"Microalbumin, Urine, 24 Hr",,82043,CPT,Facility,Both,,,,82,69.7,23.5012,82,First Health Group Corporation,First Health Network,79.54,97,,percent of total billed charges,,
"Microalbumin, Urine, 24 Hr",,82043,CPT,Facility,Both,,,,82,69.7,23.5012,82,"Health Partners, Inc.",Commercial,77.572,94.6,,percent of total billed charges,,
"Microalbumin, Urine, 24 Hr",,82043,CPT,Facility,Outpatient,,,,82,69.7,23.5012,82,"Health Partners, Inc.",Medicare Advantage,40.18,49,,percent of total billed charges,,
"Microalbumin, Urine, 24 Hr",,82043,CPT,Facility,Inpatient,,,,82,69.7,23.5012,82,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Microalbumin, Urine, 24 Hr",,82043,CPT,Facility,Both,,,,82,69.7,23.5012,82,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),49.2,60,,percent of total billed charges,,
"Microalbumin, Urine, 24 Hr",,82043,CPT,Facility,Both,,,,82,69.7,23.5012,82,"Health Partners, Inc.",State of Minnesota Advantage Program,66.83,81.5,,percent of total billed charges,,
"Microalbumin, Urine, 24 Hr",,82043,CPT,Facility,Both,,,,82,69.7,23.5012,82,"Health Partners, Inc.",State Public Programs,41,50,,percent of total billed charges,,
"Microalbumin, Urine, 24 Hr",,82043,CPT,Facility,Both,,,,82,69.7,23.5012,82,Humana Insurance Company,Commercial PPO,77.9,95,,percent of total billed charges,,
"Microalbumin, Urine, 24 Hr",,82043,CPT,Facility,Outpatient,,,,82,69.7,23.5012,82,Humana Insurance Company,Medicare PPO,40.18,49,,percent of total billed charges,,
"Microalbumin, Urine, 24 Hr",,82043,CPT,Facility,Inpatient,,,,82,69.7,23.5012,82,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Microalbumin, Urine, 24 Hr",,82043,CPT,Facility,Both,,,,82,69.7,23.5012,82,Medica,Individual & Family,81.262,99.1,,percent of total billed charges,,
"Microalbumin, Urine, 24 Hr",,82043,CPT,Facility,Outpatient,,,,82,69.7,23.5012,82,Medica,Medica Advantage Solution,40.836,49.8,,percent of total billed charges,,
"Microalbumin, Urine, 24 Hr",,82043,CPT,Facility,Inpatient,,,,82,69.7,23.5012,82,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Microalbumin, Urine, 24 Hr",,82043,CPT,Facility,Outpatient,,,,82,69.7,23.5012,82,Medica,Medical Assistance,36.572,44.6,,percent of total billed charges,,
"Microalbumin, Urine, 24 Hr",,82043,CPT,Facility,Inpatient,,,,82,69.7,23.5012,82,Medica,Medical Assistance,,,,,Included in per diem rate,
"Microalbumin, Urine, 24 Hr",,82043,CPT,Facility,Outpatient,,,,82,69.7,23.5012,82,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,40.836,49.8,,percent of total billed charges,,
"Microalbumin, Urine, 24 Hr",,82043,CPT,Facility,Inpatient,,,,82,69.7,23.5012,82,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Microalbumin, Urine, 24 Hr",,82043,CPT,Facility,Both,,,,82,69.7,23.5012,82,"Multiplan, Inc.","Multiplan, Inc.",77.08,94,,percent of total billed charges,,
"Microalbumin, Urine, 24 Hr",,82043,CPT,Facility,Outpatient,,,,82,69.7,23.5012,82,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,70.848,86.4,,percent of total billed charges,,
"Microalbumin, Urine, 24 Hr",,82043,CPT,Facility,Inpatient,,,,82,69.7,23.5012,82,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Microalbumin, Urine, 24 Hr",,82043,CPT,Facility,Both,,,,82,69.7,23.5012,82,"Preferred One Administrative Services, INC.",PPO,80.852,98.6,,percent of total billed charges,,
"Microalbumin, Urine, 24 Hr",,82043,CPT,Facility,Outpatient,,,,82,69.7,23.5012,82,PrimeWest Health,Minnesota Senior Health Options (MSHO),42.189,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Microalbumin, Urine, 24 Hr",,82043,CPT,Facility,Inpatient,,,,82,69.7,23.5012,82,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Microalbumin, Urine, 24 Hr",,82043,CPT,Facility,Outpatient,,,,82,69.7,23.5012,82,PrimeWest Health,MinnesotaCare,42.1152,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Microalbumin, Urine, 24 Hr",,82043,CPT,Facility,Inpatient,,,,82,69.7,23.5012,82,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Microalbumin, Urine, 24 Hr",,82043,CPT,Facility,Both,,,,82,69.7,23.5012,82,Sanford Health Plan,Sanford Health Plan,75.44,92,,percent of total billed charges,,
"Microalbumin, Urine, 24 Hr",,82043,CPT,Facility,Outpatient,,,,82,69.7,23.5012,82,"UCare Health, Inc.",Individual & Family Plan,46.207,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Microalbumin, Urine, 24 Hr",,82043,CPT,Facility,Inpatient,,,,82,69.7,23.5012,82,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Microalbumin, Urine, 24 Hr",,82043,CPT,Facility,Outpatient,,,,82,69.7,23.5012,82,"UCare Health, Inc.",Medical Assistance,41.3854,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Microalbumin, Urine, 24 Hr",,82043,CPT,Facility,Inpatient,,,,82,69.7,23.5012,82,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Microalbumin, Urine, 24 Hr",,82043,CPT,Facility,Outpatient,,,,82,69.7,23.5012,82,"UCare Health, Inc.",Medicare Advantage,41.3854,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Microalbumin, Urine, 24 Hr",,82043,CPT,Facility,Inpatient,,,,82,69.7,23.5012,82,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Microalbumin, Urine, 24 Hr",,82043,CPT,Facility,Outpatient,,,,82,69.7,23.5012,82,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),41.3854,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Microalbumin, Urine, 24 Hr",,82043,CPT,Facility,Inpatient,,,,82,69.7,23.5012,82,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Microalbumin, Urine, 24 Hr",,82043,CPT,Facility,Both,,,,82,69.7,23.5012,82,UnitedHealthcare,Individual & Family,77.08,94,,percent of total billed charges,,
"Microalbumin, Urine, 24 Hr",,82043,CPT,Facility,Outpatient,,,,82,69.7,23.5012,82,UnitedHealthcare,Medicare Advantage,40.18,49,,percent of total billed charges,,
"Microalbumin, Urine, 24 Hr",,82043,CPT,Facility,Inpatient,,,,82,69.7,23.5012,82,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Microalbumin, Urine, 24 Hr",,82043,CPT,Facility,Outpatient,,,,82,69.7,23.5012,82,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,39.36,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Microalbumin, Urine, 24 Hr",,82043,CPT,Facility,Inpatient,,,,82,69.7,23.5012,82,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Breath Alcohol Testing,,82075,CPT,Facility,Both,,,,97,82.45,27.8002,97,Aetna,Commercial,89.24,92,,percent of total billed charges,,
Breath Alcohol Testing,,82075,CPT,Facility,Outpatient,,,,97,82.45,27.8002,97,Aetna,Medicare Advantage,47.53,49,,percent of total billed charges,,
Breath Alcohol Testing,,82075,CPT,Facility,Inpatient,,,,97,82.45,27.8002,97,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Breath Alcohol Testing,,82075,CPT,Facility,Both,,,,97,82.45,27.8002,97,Aetna,PPO,90.21,93,,percent of total billed charges,,
Breath Alcohol Testing,,82075,CPT,Facility,Both,,,,97,82.45,27.8002,97,America's PPO,America's PPO,93.1491,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Breath Alcohol Testing,,82075,CPT,Facility,Both,,,,97,82.45,27.8002,97,BlueCross BlueShield Minnesota, Federal Employee Program,95.448,98.4,,percent of total billed charges,,
Breath Alcohol Testing,,82075,CPT,Facility,Both,,,,97,82.45,27.8002,97,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,97,100,,percent of total billed charges,,
Breath Alcohol Testing,,82075,CPT,Facility,Both,,,,97,82.45,27.8002,97,BlueCross BlueShield Minnesota,High Value Network Plan,87.3,90,,percent of total billed charges,,
Breath Alcohol Testing,,82075,CPT,Facility,Outpatient,,,,97,82.45,27.8002,97,BlueCross BlueShield Minnesota,Medicare Advantage,47.53,49,,percent of total billed charges,,
Breath Alcohol Testing,,82075,CPT,Facility,Inpatient,,,,97,82.45,27.8002,97,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Breath Alcohol Testing,,82075,CPT,Facility,Both,,,,97,82.45,27.8002,97,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,85.9129,88.57,,percent of total billed charges,,
Breath Alcohol Testing,,82075,CPT,Facility,Both,,,,97,82.45,27.8002,97,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,27.8002,28.66,,percent of total billed charges,,
Breath Alcohol Testing,,82075,CPT,Facility,Outpatient,,,,97,82.45,27.8002,97,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),47.53,49,,percent of total billed charges,,
Breath Alcohol Testing,,82075,CPT,Facility,Inpatient,,,,97,82.45,27.8002,97,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Breath Alcohol Testing,,82075,CPT,Facility,Both,,,,97,82.45,27.8002,97,CorVel,Worker's Compensation,97,100,,percent of total billed charges,,
Breath Alcohol Testing,,82075,CPT,Facility,Both,,,,97,82.45,27.8002,97,First Health Group Corporation,First Health Network,94.09,97,,percent of total billed charges,,
Breath Alcohol Testing,,82075,CPT,Facility,Both,,,,97,82.45,27.8002,97,"Health Partners, Inc.",Commercial,91.762,94.6,,percent of total billed charges,,
Breath Alcohol Testing,,82075,CPT,Facility,Outpatient,,,,97,82.45,27.8002,97,"Health Partners, Inc.",Medicare Advantage,47.53,49,,percent of total billed charges,,
Breath Alcohol Testing,,82075,CPT,Facility,Inpatient,,,,97,82.45,27.8002,97,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Breath Alcohol Testing,,82075,CPT,Facility,Both,,,,97,82.45,27.8002,97,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),58.2,60,,percent of total billed charges,,
Breath Alcohol Testing,,82075,CPT,Facility,Both,,,,97,82.45,27.8002,97,"Health Partners, Inc.",State of Minnesota Advantage Program,79.055,81.5,,percent of total billed charges,,
Breath Alcohol Testing,,82075,CPT,Facility,Both,,,,97,82.45,27.8002,97,"Health Partners, Inc.",State Public Programs,48.5,50,,percent of total billed charges,,
Breath Alcohol Testing,,82075,CPT,Facility,Both,,,,97,82.45,27.8002,97,Humana Insurance Company,Commercial PPO,92.15,95,,percent of total billed charges,,
Breath Alcohol Testing,,82075,CPT,Facility,Outpatient,,,,97,82.45,27.8002,97,Humana Insurance Company,Medicare PPO,47.53,49,,percent of total billed charges,,
Breath Alcohol Testing,,82075,CPT,Facility,Inpatient,,,,97,82.45,27.8002,97,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Breath Alcohol Testing,,82075,CPT,Facility,Both,,,,97,82.45,27.8002,97,Medica,Individual & Family,96.127,99.1,,percent of total billed charges,,
Breath Alcohol Testing,,82075,CPT,Facility,Outpatient,,,,97,82.45,27.8002,97,Medica,Medica Advantage Solution,48.306,49.8,,percent of total billed charges,,
Breath Alcohol Testing,,82075,CPT,Facility,Inpatient,,,,97,82.45,27.8002,97,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Breath Alcohol Testing,,82075,CPT,Facility,Outpatient,,,,97,82.45,27.8002,97,Medica,Medical Assistance,43.262,44.6,,percent of total billed charges,,
Breath Alcohol Testing,,82075,CPT,Facility,Inpatient,,,,97,82.45,27.8002,97,Medica,Medical Assistance,,,,,Included in per diem rate,
Breath Alcohol Testing,,82075,CPT,Facility,Outpatient,,,,97,82.45,27.8002,97,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,48.306,49.8,,percent of total billed charges,,
Breath Alcohol Testing,,82075,CPT,Facility,Inpatient,,,,97,82.45,27.8002,97,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Breath Alcohol Testing,,82075,CPT,Facility,Both,,,,97,82.45,27.8002,97,"Multiplan, Inc.","Multiplan, Inc.",91.18,94,,percent of total billed charges,,
Breath Alcohol Testing,,82075,CPT,Facility,Outpatient,,,,97,82.45,27.8002,97,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,83.808,86.4,,percent of total billed charges,,
Breath Alcohol Testing,,82075,CPT,Facility,Inpatient,,,,97,82.45,27.8002,97,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Breath Alcohol Testing,,82075,CPT,Facility,Both,,,,97,82.45,27.8002,97,"Preferred One Administrative Services, INC.",PPO,95.642,98.6,,percent of total billed charges,,
Breath Alcohol Testing,,82075,CPT,Facility,Outpatient,,,,97,82.45,27.8002,97,PrimeWest Health,Minnesota Senior Health Options (MSHO),49.9065,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Breath Alcohol Testing,,82075,CPT,Facility,Inpatient,,,,97,82.45,27.8002,97,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Breath Alcohol Testing,,82075,CPT,Facility,Outpatient,,,,97,82.45,27.8002,97,PrimeWest Health,MinnesotaCare,49.8192,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Breath Alcohol Testing,,82075,CPT,Facility,Inpatient,,,,97,82.45,27.8002,97,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Breath Alcohol Testing,,82075,CPT,Facility,Both,,,,97,82.45,27.8002,97,Sanford Health Plan,Sanford Health Plan,89.24,92,,percent of total billed charges,,
Breath Alcohol Testing,,82075,CPT,Facility,Outpatient,,,,97,82.45,27.8002,97,"UCare Health, Inc.",Individual & Family Plan,54.6595,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Breath Alcohol Testing,,82075,CPT,Facility,Inpatient,,,,97,82.45,27.8002,97,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Breath Alcohol Testing,,82075,CPT,Facility,Outpatient,,,,97,82.45,27.8002,97,"UCare Health, Inc.",Medical Assistance,48.9559,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Breath Alcohol Testing,,82075,CPT,Facility,Inpatient,,,,97,82.45,27.8002,97,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Breath Alcohol Testing,,82075,CPT,Facility,Outpatient,,,,97,82.45,27.8002,97,"UCare Health, Inc.",Medicare Advantage,48.9559,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Breath Alcohol Testing,,82075,CPT,Facility,Inpatient,,,,97,82.45,27.8002,97,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Breath Alcohol Testing,,82075,CPT,Facility,Outpatient,,,,97,82.45,27.8002,97,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),48.9559,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Breath Alcohol Testing,,82075,CPT,Facility,Inpatient,,,,97,82.45,27.8002,97,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Breath Alcohol Testing,,82075,CPT,Facility,Both,,,,97,82.45,27.8002,97,UnitedHealthcare,Individual & Family,91.18,94,,percent of total billed charges,,
Breath Alcohol Testing,,82075,CPT,Facility,Outpatient,,,,97,82.45,27.8002,97,UnitedHealthcare,Medicare Advantage,47.53,49,,percent of total billed charges,,
Breath Alcohol Testing,,82075,CPT,Facility,Inpatient,,,,97,82.45,27.8002,97,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Breath Alcohol Testing,,82075,CPT,Facility,Outpatient,,,,97,82.45,27.8002,97,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,46.56,48,,percent of total billed charges,,100% of DHS outpatient percentage
Breath Alcohol Testing,,82075,CPT,Facility,Inpatient,,,,97,82.45,27.8002,97,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Ethanol, Exhaled Gas (Breath)",,82075,CPT,Facility,Both,,,,88,74.8,25.2208,88,Aetna,Commercial,80.96,92,,percent of total billed charges,,
"Ethanol, Exhaled Gas (Breath)",,82075,CPT,Facility,Outpatient,,,,88,74.8,25.2208,88,Aetna,Medicare Advantage,43.12,49,,percent of total billed charges,,
"Ethanol, Exhaled Gas (Breath)",,82075,CPT,Facility,Inpatient,,,,88,74.8,25.2208,88,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Ethanol, Exhaled Gas (Breath)",,82075,CPT,Facility,Both,,,,88,74.8,25.2208,88,Aetna,PPO,81.84,93,,percent of total billed charges,,
"Ethanol, Exhaled Gas (Breath)",,82075,CPT,Facility,Both,,,,88,74.8,25.2208,88,America's PPO,America's PPO,84.5064,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Ethanol, Exhaled Gas (Breath)",,82075,CPT,Facility,Both,,,,88,74.8,25.2208,88,BlueCross BlueShield Minnesota, Federal Employee Program,86.592,98.4,,percent of total billed charges,,
"Ethanol, Exhaled Gas (Breath)",,82075,CPT,Facility,Both,,,,88,74.8,25.2208,88,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,88,100,,percent of total billed charges,,
"Ethanol, Exhaled Gas (Breath)",,82075,CPT,Facility,Both,,,,88,74.8,25.2208,88,BlueCross BlueShield Minnesota,High Value Network Plan,79.2,90,,percent of total billed charges,,
"Ethanol, Exhaled Gas (Breath)",,82075,CPT,Facility,Outpatient,,,,88,74.8,25.2208,88,BlueCross BlueShield Minnesota,Medicare Advantage,43.12,49,,percent of total billed charges,,
"Ethanol, Exhaled Gas (Breath)",,82075,CPT,Facility,Inpatient,,,,88,74.8,25.2208,88,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Ethanol, Exhaled Gas (Breath)",,82075,CPT,Facility,Both,,,,88,74.8,25.2208,88,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,77.9416,88.57,,percent of total billed charges,,
"Ethanol, Exhaled Gas (Breath)",,82075,CPT,Facility,Both,,,,88,74.8,25.2208,88,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,25.2208,28.66,,percent of total billed charges,,
"Ethanol, Exhaled Gas (Breath)",,82075,CPT,Facility,Outpatient,,,,88,74.8,25.2208,88,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),43.12,49,,percent of total billed charges,,
"Ethanol, Exhaled Gas (Breath)",,82075,CPT,Facility,Inpatient,,,,88,74.8,25.2208,88,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Ethanol, Exhaled Gas (Breath)",,82075,CPT,Facility,Both,,,,88,74.8,25.2208,88,CorVel,Worker's Compensation,88,100,,percent of total billed charges,,
"Ethanol, Exhaled Gas (Breath)",,82075,CPT,Facility,Both,,,,88,74.8,25.2208,88,First Health Group Corporation,First Health Network,85.36,97,,percent of total billed charges,,
"Ethanol, Exhaled Gas (Breath)",,82075,CPT,Facility,Both,,,,88,74.8,25.2208,88,"Health Partners, Inc.",Commercial,83.248,94.6,,percent of total billed charges,,
"Ethanol, Exhaled Gas (Breath)",,82075,CPT,Facility,Outpatient,,,,88,74.8,25.2208,88,"Health Partners, Inc.",Medicare Advantage,43.12,49,,percent of total billed charges,,
"Ethanol, Exhaled Gas (Breath)",,82075,CPT,Facility,Inpatient,,,,88,74.8,25.2208,88,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Ethanol, Exhaled Gas (Breath)",,82075,CPT,Facility,Both,,,,88,74.8,25.2208,88,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),52.8,60,,percent of total billed charges,,
"Ethanol, Exhaled Gas (Breath)",,82075,CPT,Facility,Both,,,,88,74.8,25.2208,88,"Health Partners, Inc.",State of Minnesota Advantage Program,71.72,81.5,,percent of total billed charges,,
"Ethanol, Exhaled Gas (Breath)",,82075,CPT,Facility,Both,,,,88,74.8,25.2208,88,"Health Partners, Inc.",State Public Programs,44,50,,percent of total billed charges,,
"Ethanol, Exhaled Gas (Breath)",,82075,CPT,Facility,Both,,,,88,74.8,25.2208,88,Humana Insurance Company,Commercial PPO,83.6,95,,percent of total billed charges,,
"Ethanol, Exhaled Gas (Breath)",,82075,CPT,Facility,Outpatient,,,,88,74.8,25.2208,88,Humana Insurance Company,Medicare PPO,43.12,49,,percent of total billed charges,,
"Ethanol, Exhaled Gas (Breath)",,82075,CPT,Facility,Inpatient,,,,88,74.8,25.2208,88,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Ethanol, Exhaled Gas (Breath)",,82075,CPT,Facility,Both,,,,88,74.8,25.2208,88,Medica,Individual & Family,87.208,99.1,,percent of total billed charges,,
"Ethanol, Exhaled Gas (Breath)",,82075,CPT,Facility,Outpatient,,,,88,74.8,25.2208,88,Medica,Medica Advantage Solution,43.824,49.8,,percent of total billed charges,,
"Ethanol, Exhaled Gas (Breath)",,82075,CPT,Facility,Inpatient,,,,88,74.8,25.2208,88,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Ethanol, Exhaled Gas (Breath)",,82075,CPT,Facility,Outpatient,,,,88,74.8,25.2208,88,Medica,Medical Assistance,39.248,44.6,,percent of total billed charges,,
"Ethanol, Exhaled Gas (Breath)",,82075,CPT,Facility,Inpatient,,,,88,74.8,25.2208,88,Medica,Medical Assistance,,,,,Included in per diem rate,
"Ethanol, Exhaled Gas (Breath)",,82075,CPT,Facility,Outpatient,,,,88,74.8,25.2208,88,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,43.824,49.8,,percent of total billed charges,,
"Ethanol, Exhaled Gas (Breath)",,82075,CPT,Facility,Inpatient,,,,88,74.8,25.2208,88,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Ethanol, Exhaled Gas (Breath)",,82075,CPT,Facility,Both,,,,88,74.8,25.2208,88,"Multiplan, Inc.","Multiplan, Inc.",82.72,94,,percent of total billed charges,,
"Ethanol, Exhaled Gas (Breath)",,82075,CPT,Facility,Outpatient,,,,88,74.8,25.2208,88,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,76.032,86.4,,percent of total billed charges,,
"Ethanol, Exhaled Gas (Breath)",,82075,CPT,Facility,Inpatient,,,,88,74.8,25.2208,88,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Ethanol, Exhaled Gas (Breath)",,82075,CPT,Facility,Both,,,,88,74.8,25.2208,88,"Preferred One Administrative Services, INC.",PPO,86.768,98.6,,percent of total billed charges,,
"Ethanol, Exhaled Gas (Breath)",,82075,CPT,Facility,Outpatient,,,,88,74.8,25.2208,88,PrimeWest Health,Minnesota Senior Health Options (MSHO),45.276,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Ethanol, Exhaled Gas (Breath)",,82075,CPT,Facility,Inpatient,,,,88,74.8,25.2208,88,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Ethanol, Exhaled Gas (Breath)",,82075,CPT,Facility,Outpatient,,,,88,74.8,25.2208,88,PrimeWest Health,MinnesotaCare,45.1968,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Ethanol, Exhaled Gas (Breath)",,82075,CPT,Facility,Inpatient,,,,88,74.8,25.2208,88,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Ethanol, Exhaled Gas (Breath)",,82075,CPT,Facility,Both,,,,88,74.8,25.2208,88,Sanford Health Plan,Sanford Health Plan,80.96,92,,percent of total billed charges,,
"Ethanol, Exhaled Gas (Breath)",,82075,CPT,Facility,Outpatient,,,,88,74.8,25.2208,88,"UCare Health, Inc.",Individual & Family Plan,49.588,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Ethanol, Exhaled Gas (Breath)",,82075,CPT,Facility,Inpatient,,,,88,74.8,25.2208,88,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Ethanol, Exhaled Gas (Breath)",,82075,CPT,Facility,Outpatient,,,,88,74.8,25.2208,88,"UCare Health, Inc.",Medical Assistance,44.4136,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Ethanol, Exhaled Gas (Breath)",,82075,CPT,Facility,Inpatient,,,,88,74.8,25.2208,88,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Ethanol, Exhaled Gas (Breath)",,82075,CPT,Facility,Outpatient,,,,88,74.8,25.2208,88,"UCare Health, Inc.",Medicare Advantage,44.4136,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Ethanol, Exhaled Gas (Breath)",,82075,CPT,Facility,Inpatient,,,,88,74.8,25.2208,88,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Ethanol, Exhaled Gas (Breath)",,82075,CPT,Facility,Outpatient,,,,88,74.8,25.2208,88,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),44.4136,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Ethanol, Exhaled Gas (Breath)",,82075,CPT,Facility,Inpatient,,,,88,74.8,25.2208,88,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Ethanol, Exhaled Gas (Breath)",,82075,CPT,Facility,Both,,,,88,74.8,25.2208,88,UnitedHealthcare,Individual & Family,82.72,94,,percent of total billed charges,,
"Ethanol, Exhaled Gas (Breath)",,82075,CPT,Facility,Outpatient,,,,88,74.8,25.2208,88,UnitedHealthcare,Medicare Advantage,43.12,49,,percent of total billed charges,,
"Ethanol, Exhaled Gas (Breath)",,82075,CPT,Facility,Inpatient,,,,88,74.8,25.2208,88,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Ethanol, Exhaled Gas (Breath)",,82075,CPT,Facility,Outpatient,,,,88,74.8,25.2208,88,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,42.24,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Ethanol, Exhaled Gas (Breath)",,82075,CPT,Facility,Inpatient,,,,88,74.8,25.2208,88,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Alcohol (Ethanol) Assay,,82077,CPT,Facility,Both,,,,161,136.85,46.1426,161,Aetna,Commercial,148.12,92,,percent of total billed charges,,
Alcohol (Ethanol) Assay,,82077,CPT,Facility,Outpatient,,,,161,136.85,46.1426,161,Aetna,Medicare Advantage,78.89,49,,percent of total billed charges,,
Alcohol (Ethanol) Assay,,82077,CPT,Facility,Inpatient,,,,161,136.85,46.1426,161,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Alcohol (Ethanol) Assay,,82077,CPT,Facility,Both,,,,161,136.85,46.1426,161,Aetna,PPO,149.73,93,,percent of total billed charges,,
Alcohol (Ethanol) Assay,,82077,CPT,Facility,Both,,,,161,136.85,46.1426,161,America's PPO,America's PPO,154.6083,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Alcohol (Ethanol) Assay,,82077,CPT,Facility,Both,,,,161,136.85,46.1426,161,BlueCross BlueShield Minnesota, Federal Employee Program,158.424,98.4,,percent of total billed charges,,
Alcohol (Ethanol) Assay,,82077,CPT,Facility,Both,,,,161,136.85,46.1426,161,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,161,100,,percent of total billed charges,,
Alcohol (Ethanol) Assay,,82077,CPT,Facility,Both,,,,161,136.85,46.1426,161,BlueCross BlueShield Minnesota,High Value Network Plan,144.9,90,,percent of total billed charges,,
Alcohol (Ethanol) Assay,,82077,CPT,Facility,Outpatient,,,,161,136.85,46.1426,161,BlueCross BlueShield Minnesota,Medicare Advantage,78.89,49,,percent of total billed charges,,
Alcohol (Ethanol) Assay,,82077,CPT,Facility,Inpatient,,,,161,136.85,46.1426,161,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Alcohol (Ethanol) Assay,,82077,CPT,Facility,Both,,,,161,136.85,46.1426,161,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,142.5977,88.57,,percent of total billed charges,,
Alcohol (Ethanol) Assay,,82077,CPT,Facility,Both,,,,161,136.85,46.1426,161,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,46.1426,28.66,,percent of total billed charges,,
Alcohol (Ethanol) Assay,,82077,CPT,Facility,Outpatient,,,,161,136.85,46.1426,161,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),78.89,49,,percent of total billed charges,,
Alcohol (Ethanol) Assay,,82077,CPT,Facility,Inpatient,,,,161,136.85,46.1426,161,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Alcohol (Ethanol) Assay,,82077,CPT,Facility,Both,,,,161,136.85,46.1426,161,CorVel,Worker's Compensation,161,100,,percent of total billed charges,,
Alcohol (Ethanol) Assay,,82077,CPT,Facility,Both,,,,161,136.85,46.1426,161,First Health Group Corporation,First Health Network,156.17,97,,percent of total billed charges,,
Alcohol (Ethanol) Assay,,82077,CPT,Facility,Both,,,,161,136.85,46.1426,161,"Health Partners, Inc.",Commercial,152.306,94.6,,percent of total billed charges,,
Alcohol (Ethanol) Assay,,82077,CPT,Facility,Outpatient,,,,161,136.85,46.1426,161,"Health Partners, Inc.",Medicare Advantage,78.89,49,,percent of total billed charges,,
Alcohol (Ethanol) Assay,,82077,CPT,Facility,Inpatient,,,,161,136.85,46.1426,161,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Alcohol (Ethanol) Assay,,82077,CPT,Facility,Both,,,,161,136.85,46.1426,161,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),96.6,60,,percent of total billed charges,,
Alcohol (Ethanol) Assay,,82077,CPT,Facility,Both,,,,161,136.85,46.1426,161,"Health Partners, Inc.",State of Minnesota Advantage Program,131.215,81.5,,percent of total billed charges,,
Alcohol (Ethanol) Assay,,82077,CPT,Facility,Both,,,,161,136.85,46.1426,161,"Health Partners, Inc.",State Public Programs,80.5,50,,percent of total billed charges,,
Alcohol (Ethanol) Assay,,82077,CPT,Facility,Both,,,,161,136.85,46.1426,161,Humana Insurance Company,Commercial PPO,152.95,95,,percent of total billed charges,,
Alcohol (Ethanol) Assay,,82077,CPT,Facility,Outpatient,,,,161,136.85,46.1426,161,Humana Insurance Company,Medicare PPO,78.89,49,,percent of total billed charges,,
Alcohol (Ethanol) Assay,,82077,CPT,Facility,Inpatient,,,,161,136.85,46.1426,161,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Alcohol (Ethanol) Assay,,82077,CPT,Facility,Both,,,,161,136.85,46.1426,161,Medica,Individual & Family,159.551,99.1,,percent of total billed charges,,
Alcohol (Ethanol) Assay,,82077,CPT,Facility,Outpatient,,,,161,136.85,46.1426,161,Medica,Medica Advantage Solution,80.178,49.8,,percent of total billed charges,,
Alcohol (Ethanol) Assay,,82077,CPT,Facility,Inpatient,,,,161,136.85,46.1426,161,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Alcohol (Ethanol) Assay,,82077,CPT,Facility,Outpatient,,,,161,136.85,46.1426,161,Medica,Medical Assistance,71.806,44.6,,percent of total billed charges,,
Alcohol (Ethanol) Assay,,82077,CPT,Facility,Inpatient,,,,161,136.85,46.1426,161,Medica,Medical Assistance,,,,,Included in per diem rate,
Alcohol (Ethanol) Assay,,82077,CPT,Facility,Outpatient,,,,161,136.85,46.1426,161,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,80.178,49.8,,percent of total billed charges,,
Alcohol (Ethanol) Assay,,82077,CPT,Facility,Inpatient,,,,161,136.85,46.1426,161,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Alcohol (Ethanol) Assay,,82077,CPT,Facility,Both,,,,161,136.85,46.1426,161,"Multiplan, Inc.","Multiplan, Inc.",151.34,94,,percent of total billed charges,,
Alcohol (Ethanol) Assay,,82077,CPT,Facility,Outpatient,,,,161,136.85,46.1426,161,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,139.104,86.4,,percent of total billed charges,,
Alcohol (Ethanol) Assay,,82077,CPT,Facility,Inpatient,,,,161,136.85,46.1426,161,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Alcohol (Ethanol) Assay,,82077,CPT,Facility,Both,,,,161,136.85,46.1426,161,"Preferred One Administrative Services, INC.",PPO,158.746,98.6,,percent of total billed charges,,
Alcohol (Ethanol) Assay,,82077,CPT,Facility,Outpatient,,,,161,136.85,46.1426,161,PrimeWest Health,Minnesota Senior Health Options (MSHO),82.8345,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Alcohol (Ethanol) Assay,,82077,CPT,Facility,Inpatient,,,,161,136.85,46.1426,161,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Alcohol (Ethanol) Assay,,82077,CPT,Facility,Outpatient,,,,161,136.85,46.1426,161,PrimeWest Health,MinnesotaCare,82.6896,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Alcohol (Ethanol) Assay,,82077,CPT,Facility,Inpatient,,,,161,136.85,46.1426,161,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Alcohol (Ethanol) Assay,,82077,CPT,Facility,Both,,,,161,136.85,46.1426,161,Sanford Health Plan,Sanford Health Plan,148.12,92,,percent of total billed charges,,
Alcohol (Ethanol) Assay,,82077,CPT,Facility,Outpatient,,,,161,136.85,46.1426,161,"UCare Health, Inc.",Individual & Family Plan,90.7235,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Alcohol (Ethanol) Assay,,82077,CPT,Facility,Inpatient,,,,161,136.85,46.1426,161,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Alcohol (Ethanol) Assay,,82077,CPT,Facility,Outpatient,,,,161,136.85,46.1426,161,"UCare Health, Inc.",Medical Assistance,81.2567,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Alcohol (Ethanol) Assay,,82077,CPT,Facility,Inpatient,,,,161,136.85,46.1426,161,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Alcohol (Ethanol) Assay,,82077,CPT,Facility,Outpatient,,,,161,136.85,46.1426,161,"UCare Health, Inc.",Medicare Advantage,81.2567,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Alcohol (Ethanol) Assay,,82077,CPT,Facility,Inpatient,,,,161,136.85,46.1426,161,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Alcohol (Ethanol) Assay,,82077,CPT,Facility,Outpatient,,,,161,136.85,46.1426,161,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),81.2567,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Alcohol (Ethanol) Assay,,82077,CPT,Facility,Inpatient,,,,161,136.85,46.1426,161,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Alcohol (Ethanol) Assay,,82077,CPT,Facility,Both,,,,161,136.85,46.1426,161,UnitedHealthcare,Individual & Family,151.34,94,,percent of total billed charges,,
Alcohol (Ethanol) Assay,,82077,CPT,Facility,Outpatient,,,,161,136.85,46.1426,161,UnitedHealthcare,Medicare Advantage,78.89,49,,percent of total billed charges,,
Alcohol (Ethanol) Assay,,82077,CPT,Facility,Inpatient,,,,161,136.85,46.1426,161,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Alcohol (Ethanol) Assay,,82077,CPT,Facility,Outpatient,,,,161,136.85,46.1426,161,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,77.28,48,,percent of total billed charges,,100% of DHS outpatient percentage
Alcohol (Ethanol) Assay,,82077,CPT,Facility,Inpatient,,,,161,136.85,46.1426,161,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Ammonia,,82140,CPT,Facility,Both,,,,162,137.7,46.4292,162,Aetna,Commercial,149.04,92,,percent of total billed charges,,
Ammonia,,82140,CPT,Facility,Outpatient,,,,162,137.7,46.4292,162,Aetna,Medicare Advantage,79.38,49,,percent of total billed charges,,
Ammonia,,82140,CPT,Facility,Inpatient,,,,162,137.7,46.4292,162,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Ammonia,,82140,CPT,Facility,Both,,,,162,137.7,46.4292,162,Aetna,PPO,150.66,93,,percent of total billed charges,,
Ammonia,,82140,CPT,Facility,Both,,,,162,137.7,46.4292,162,America's PPO,America's PPO,155.5686,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Ammonia,,82140,CPT,Facility,Both,,,,162,137.7,46.4292,162,BlueCross BlueShield Minnesota, Federal Employee Program,159.408,98.4,,percent of total billed charges,,
Ammonia,,82140,CPT,Facility,Both,,,,162,137.7,46.4292,162,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,162,100,,percent of total billed charges,,
Ammonia,,82140,CPT,Facility,Both,,,,162,137.7,46.4292,162,BlueCross BlueShield Minnesota,High Value Network Plan,145.8,90,,percent of total billed charges,,
Ammonia,,82140,CPT,Facility,Outpatient,,,,162,137.7,46.4292,162,BlueCross BlueShield Minnesota,Medicare Advantage,79.38,49,,percent of total billed charges,,
Ammonia,,82140,CPT,Facility,Inpatient,,,,162,137.7,46.4292,162,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Ammonia,,82140,CPT,Facility,Both,,,,162,137.7,46.4292,162,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,143.4834,88.57,,percent of total billed charges,,
Ammonia,,82140,CPT,Facility,Both,,,,162,137.7,46.4292,162,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,46.4292,28.66,,percent of total billed charges,,
Ammonia,,82140,CPT,Facility,Outpatient,,,,162,137.7,46.4292,162,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),79.38,49,,percent of total billed charges,,
Ammonia,,82140,CPT,Facility,Inpatient,,,,162,137.7,46.4292,162,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Ammonia,,82140,CPT,Facility,Both,,,,162,137.7,46.4292,162,CorVel,Worker's Compensation,162,100,,percent of total billed charges,,
Ammonia,,82140,CPT,Facility,Both,,,,162,137.7,46.4292,162,First Health Group Corporation,First Health Network,157.14,97,,percent of total billed charges,,
Ammonia,,82140,CPT,Facility,Both,,,,162,137.7,46.4292,162,"Health Partners, Inc.",Commercial,153.252,94.6,,percent of total billed charges,,
Ammonia,,82140,CPT,Facility,Outpatient,,,,162,137.7,46.4292,162,"Health Partners, Inc.",Medicare Advantage,79.38,49,,percent of total billed charges,,
Ammonia,,82140,CPT,Facility,Inpatient,,,,162,137.7,46.4292,162,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ammonia,,82140,CPT,Facility,Both,,,,162,137.7,46.4292,162,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),97.2,60,,percent of total billed charges,,
Ammonia,,82140,CPT,Facility,Both,,,,162,137.7,46.4292,162,"Health Partners, Inc.",State of Minnesota Advantage Program,132.03,81.5,,percent of total billed charges,,
Ammonia,,82140,CPT,Facility,Both,,,,162,137.7,46.4292,162,"Health Partners, Inc.",State Public Programs,81,50,,percent of total billed charges,,
Ammonia,,82140,CPT,Facility,Both,,,,162,137.7,46.4292,162,Humana Insurance Company,Commercial PPO,153.9,95,,percent of total billed charges,,
Ammonia,,82140,CPT,Facility,Outpatient,,,,162,137.7,46.4292,162,Humana Insurance Company,Medicare PPO,79.38,49,,percent of total billed charges,,
Ammonia,,82140,CPT,Facility,Inpatient,,,,162,137.7,46.4292,162,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Ammonia,,82140,CPT,Facility,Both,,,,162,137.7,46.4292,162,Medica,Individual & Family,160.542,99.1,,percent of total billed charges,,
Ammonia,,82140,CPT,Facility,Outpatient,,,,162,137.7,46.4292,162,Medica,Medica Advantage Solution,80.676,49.8,,percent of total billed charges,,
Ammonia,,82140,CPT,Facility,Inpatient,,,,162,137.7,46.4292,162,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Ammonia,,82140,CPT,Facility,Outpatient,,,,162,137.7,46.4292,162,Medica,Medical Assistance,72.252,44.6,,percent of total billed charges,,
Ammonia,,82140,CPT,Facility,Inpatient,,,,162,137.7,46.4292,162,Medica,Medical Assistance,,,,,Included in per diem rate,
Ammonia,,82140,CPT,Facility,Outpatient,,,,162,137.7,46.4292,162,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,80.676,49.8,,percent of total billed charges,,
Ammonia,,82140,CPT,Facility,Inpatient,,,,162,137.7,46.4292,162,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Ammonia,,82140,CPT,Facility,Both,,,,162,137.7,46.4292,162,"Multiplan, Inc.","Multiplan, Inc.",152.28,94,,percent of total billed charges,,
Ammonia,,82140,CPT,Facility,Outpatient,,,,162,137.7,46.4292,162,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,139.968,86.4,,percent of total billed charges,,
Ammonia,,82140,CPT,Facility,Inpatient,,,,162,137.7,46.4292,162,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Ammonia,,82140,CPT,Facility,Both,,,,162,137.7,46.4292,162,"Preferred One Administrative Services, INC.",PPO,159.732,98.6,,percent of total billed charges,,
Ammonia,,82140,CPT,Facility,Outpatient,,,,162,137.7,46.4292,162,PrimeWest Health,Minnesota Senior Health Options (MSHO),83.349,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Ammonia,,82140,CPT,Facility,Inpatient,,,,162,137.7,46.4292,162,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ammonia,,82140,CPT,Facility,Outpatient,,,,162,137.7,46.4292,162,PrimeWest Health,MinnesotaCare,83.2032,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Ammonia,,82140,CPT,Facility,Inpatient,,,,162,137.7,46.4292,162,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Ammonia,,82140,CPT,Facility,Both,,,,162,137.7,46.4292,162,Sanford Health Plan,Sanford Health Plan,149.04,92,,percent of total billed charges,,
Ammonia,,82140,CPT,Facility,Outpatient,,,,162,137.7,46.4292,162,"UCare Health, Inc.",Individual & Family Plan,91.287,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Ammonia,,82140,CPT,Facility,Inpatient,,,,162,137.7,46.4292,162,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Ammonia,,82140,CPT,Facility,Outpatient,,,,162,137.7,46.4292,162,"UCare Health, Inc.",Medical Assistance,81.7614,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ammonia,,82140,CPT,Facility,Inpatient,,,,162,137.7,46.4292,162,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Ammonia,,82140,CPT,Facility,Outpatient,,,,162,137.7,46.4292,162,"UCare Health, Inc.",Medicare Advantage,81.7614,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ammonia,,82140,CPT,Facility,Inpatient,,,,162,137.7,46.4292,162,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ammonia,,82140,CPT,Facility,Outpatient,,,,162,137.7,46.4292,162,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),81.7614,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ammonia,,82140,CPT,Facility,Inpatient,,,,162,137.7,46.4292,162,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ammonia,,82140,CPT,Facility,Both,,,,162,137.7,46.4292,162,UnitedHealthcare,Individual & Family,152.28,94,,percent of total billed charges,,
Ammonia,,82140,CPT,Facility,Outpatient,,,,162,137.7,46.4292,162,UnitedHealthcare,Medicare Advantage,79.38,49,,percent of total billed charges,,
Ammonia,,82140,CPT,Facility,Inpatient,,,,162,137.7,46.4292,162,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Ammonia,,82140,CPT,Facility,Outpatient,,,,162,137.7,46.4292,162,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,77.76,48,,percent of total billed charges,,100% of DHS outpatient percentage
Ammonia,,82140,CPT,Facility,Inpatient,,,,162,137.7,46.4292,162,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Amylase,,82150,CPT,Facility,Both,,,,93,79.05,26.6538,93,Aetna,Commercial,85.56,92,,percent of total billed charges,,
Amylase,,82150,CPT,Facility,Outpatient,,,,93,79.05,26.6538,93,Aetna,Medicare Advantage,45.57,49,,percent of total billed charges,,
Amylase,,82150,CPT,Facility,Inpatient,,,,93,79.05,26.6538,93,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Amylase,,82150,CPT,Facility,Both,,,,93,79.05,26.6538,93,Aetna,PPO,86.49,93,,percent of total billed charges,,
Amylase,,82150,CPT,Facility,Both,,,,93,79.05,26.6538,93,America's PPO,America's PPO,89.3079,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Amylase,,82150,CPT,Facility,Both,,,,93,79.05,26.6538,93,BlueCross BlueShield Minnesota, Federal Employee Program,91.512,98.4,,percent of total billed charges,,
Amylase,,82150,CPT,Facility,Both,,,,93,79.05,26.6538,93,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,93,100,,percent of total billed charges,,
Amylase,,82150,CPT,Facility,Both,,,,93,79.05,26.6538,93,BlueCross BlueShield Minnesota,High Value Network Plan,83.7,90,,percent of total billed charges,,
Amylase,,82150,CPT,Facility,Outpatient,,,,93,79.05,26.6538,93,BlueCross BlueShield Minnesota,Medicare Advantage,45.57,49,,percent of total billed charges,,
Amylase,,82150,CPT,Facility,Inpatient,,,,93,79.05,26.6538,93,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Amylase,,82150,CPT,Facility,Both,,,,93,79.05,26.6538,93,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,82.3701,88.57,,percent of total billed charges,,
Amylase,,82150,CPT,Facility,Both,,,,93,79.05,26.6538,93,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,26.6538,28.66,,percent of total billed charges,,
Amylase,,82150,CPT,Facility,Outpatient,,,,93,79.05,26.6538,93,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),45.57,49,,percent of total billed charges,,
Amylase,,82150,CPT,Facility,Inpatient,,,,93,79.05,26.6538,93,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Amylase,,82150,CPT,Facility,Both,,,,93,79.05,26.6538,93,CorVel,Worker's Compensation,93,100,,percent of total billed charges,,
Amylase,,82150,CPT,Facility,Both,,,,93,79.05,26.6538,93,First Health Group Corporation,First Health Network,90.21,97,,percent of total billed charges,,
Amylase,,82150,CPT,Facility,Both,,,,93,79.05,26.6538,93,"Health Partners, Inc.",Commercial,87.978,94.6,,percent of total billed charges,,
Amylase,,82150,CPT,Facility,Outpatient,,,,93,79.05,26.6538,93,"Health Partners, Inc.",Medicare Advantage,45.57,49,,percent of total billed charges,,
Amylase,,82150,CPT,Facility,Inpatient,,,,93,79.05,26.6538,93,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Amylase,,82150,CPT,Facility,Both,,,,93,79.05,26.6538,93,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),55.8,60,,percent of total billed charges,,
Amylase,,82150,CPT,Facility,Both,,,,93,79.05,26.6538,93,"Health Partners, Inc.",State of Minnesota Advantage Program,75.795,81.5,,percent of total billed charges,,
Amylase,,82150,CPT,Facility,Both,,,,93,79.05,26.6538,93,"Health Partners, Inc.",State Public Programs,46.5,50,,percent of total billed charges,,
Amylase,,82150,CPT,Facility,Both,,,,93,79.05,26.6538,93,Humana Insurance Company,Commercial PPO,88.35,95,,percent of total billed charges,,
Amylase,,82150,CPT,Facility,Outpatient,,,,93,79.05,26.6538,93,Humana Insurance Company,Medicare PPO,45.57,49,,percent of total billed charges,,
Amylase,,82150,CPT,Facility,Inpatient,,,,93,79.05,26.6538,93,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Amylase,,82150,CPT,Facility,Both,,,,93,79.05,26.6538,93,Medica,Individual & Family,92.163,99.1,,percent of total billed charges,,
Amylase,,82150,CPT,Facility,Outpatient,,,,93,79.05,26.6538,93,Medica,Medica Advantage Solution,46.314,49.8,,percent of total billed charges,,
Amylase,,82150,CPT,Facility,Inpatient,,,,93,79.05,26.6538,93,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Amylase,,82150,CPT,Facility,Outpatient,,,,93,79.05,26.6538,93,Medica,Medical Assistance,41.478,44.6,,percent of total billed charges,,
Amylase,,82150,CPT,Facility,Inpatient,,,,93,79.05,26.6538,93,Medica,Medical Assistance,,,,,Included in per diem rate,
Amylase,,82150,CPT,Facility,Outpatient,,,,93,79.05,26.6538,93,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,46.314,49.8,,percent of total billed charges,,
Amylase,,82150,CPT,Facility,Inpatient,,,,93,79.05,26.6538,93,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Amylase,,82150,CPT,Facility,Both,,,,93,79.05,26.6538,93,"Multiplan, Inc.","Multiplan, Inc.",87.42,94,,percent of total billed charges,,
Amylase,,82150,CPT,Facility,Outpatient,,,,93,79.05,26.6538,93,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,80.352,86.4,,percent of total billed charges,,
Amylase,,82150,CPT,Facility,Inpatient,,,,93,79.05,26.6538,93,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Amylase,,82150,CPT,Facility,Both,,,,93,79.05,26.6538,93,"Preferred One Administrative Services, INC.",PPO,91.698,98.6,,percent of total billed charges,,
Amylase,,82150,CPT,Facility,Outpatient,,,,93,79.05,26.6538,93,PrimeWest Health,Minnesota Senior Health Options (MSHO),47.8485,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Amylase,,82150,CPT,Facility,Inpatient,,,,93,79.05,26.6538,93,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Amylase,,82150,CPT,Facility,Outpatient,,,,93,79.05,26.6538,93,PrimeWest Health,MinnesotaCare,47.7648,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Amylase,,82150,CPT,Facility,Inpatient,,,,93,79.05,26.6538,93,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Amylase,,82150,CPT,Facility,Both,,,,93,79.05,26.6538,93,Sanford Health Plan,Sanford Health Plan,85.56,92,,percent of total billed charges,,
Amylase,,82150,CPT,Facility,Outpatient,,,,93,79.05,26.6538,93,"UCare Health, Inc.",Individual & Family Plan,52.4055,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Amylase,,82150,CPT,Facility,Inpatient,,,,93,79.05,26.6538,93,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Amylase,,82150,CPT,Facility,Outpatient,,,,93,79.05,26.6538,93,"UCare Health, Inc.",Medical Assistance,46.9371,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Amylase,,82150,CPT,Facility,Inpatient,,,,93,79.05,26.6538,93,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Amylase,,82150,CPT,Facility,Outpatient,,,,93,79.05,26.6538,93,"UCare Health, Inc.",Medicare Advantage,46.9371,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Amylase,,82150,CPT,Facility,Inpatient,,,,93,79.05,26.6538,93,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Amylase,,82150,CPT,Facility,Outpatient,,,,93,79.05,26.6538,93,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),46.9371,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Amylase,,82150,CPT,Facility,Inpatient,,,,93,79.05,26.6538,93,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Amylase,,82150,CPT,Facility,Both,,,,93,79.05,26.6538,93,UnitedHealthcare,Individual & Family,87.42,94,,percent of total billed charges,,
Amylase,,82150,CPT,Facility,Outpatient,,,,93,79.05,26.6538,93,UnitedHealthcare,Medicare Advantage,45.57,49,,percent of total billed charges,,
Amylase,,82150,CPT,Facility,Inpatient,,,,93,79.05,26.6538,93,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Amylase,,82150,CPT,Facility,Outpatient,,,,93,79.05,26.6538,93,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,44.64,48,,percent of total billed charges,,100% of DHS outpatient percentage
Amylase,,82150,CPT,Facility,Inpatient,,,,93,79.05,26.6538,93,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Amylase, Body Fluid",,82150,CPT,Facility,Both,,,,93,79.05,26.6538,93,Aetna,Commercial,85.56,92,,percent of total billed charges,,
"Amylase, Body Fluid",,82150,CPT,Facility,Outpatient,,,,93,79.05,26.6538,93,Aetna,Medicare Advantage,45.57,49,,percent of total billed charges,,
"Amylase, Body Fluid",,82150,CPT,Facility,Inpatient,,,,93,79.05,26.6538,93,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Amylase, Body Fluid",,82150,CPT,Facility,Both,,,,93,79.05,26.6538,93,Aetna,PPO,86.49,93,,percent of total billed charges,,
"Amylase, Body Fluid",,82150,CPT,Facility,Both,,,,93,79.05,26.6538,93,America's PPO,America's PPO,89.3079,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Amylase, Body Fluid",,82150,CPT,Facility,Both,,,,93,79.05,26.6538,93,BlueCross BlueShield Minnesota, Federal Employee Program,91.512,98.4,,percent of total billed charges,,
"Amylase, Body Fluid",,82150,CPT,Facility,Both,,,,93,79.05,26.6538,93,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,93,100,,percent of total billed charges,,
"Amylase, Body Fluid",,82150,CPT,Facility,Both,,,,93,79.05,26.6538,93,BlueCross BlueShield Minnesota,High Value Network Plan,83.7,90,,percent of total billed charges,,
"Amylase, Body Fluid",,82150,CPT,Facility,Outpatient,,,,93,79.05,26.6538,93,BlueCross BlueShield Minnesota,Medicare Advantage,45.57,49,,percent of total billed charges,,
"Amylase, Body Fluid",,82150,CPT,Facility,Inpatient,,,,93,79.05,26.6538,93,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Amylase, Body Fluid",,82150,CPT,Facility,Both,,,,93,79.05,26.6538,93,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,82.3701,88.57,,percent of total billed charges,,
"Amylase, Body Fluid",,82150,CPT,Facility,Both,,,,93,79.05,26.6538,93,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,26.6538,28.66,,percent of total billed charges,,
"Amylase, Body Fluid",,82150,CPT,Facility,Outpatient,,,,93,79.05,26.6538,93,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),45.57,49,,percent of total billed charges,,
"Amylase, Body Fluid",,82150,CPT,Facility,Inpatient,,,,93,79.05,26.6538,93,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Amylase, Body Fluid",,82150,CPT,Facility,Both,,,,93,79.05,26.6538,93,CorVel,Worker's Compensation,93,100,,percent of total billed charges,,
"Amylase, Body Fluid",,82150,CPT,Facility,Both,,,,93,79.05,26.6538,93,First Health Group Corporation,First Health Network,90.21,97,,percent of total billed charges,,
"Amylase, Body Fluid",,82150,CPT,Facility,Both,,,,93,79.05,26.6538,93,"Health Partners, Inc.",Commercial,87.978,94.6,,percent of total billed charges,,
"Amylase, Body Fluid",,82150,CPT,Facility,Outpatient,,,,93,79.05,26.6538,93,"Health Partners, Inc.",Medicare Advantage,45.57,49,,percent of total billed charges,,
"Amylase, Body Fluid",,82150,CPT,Facility,Inpatient,,,,93,79.05,26.6538,93,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Amylase, Body Fluid",,82150,CPT,Facility,Both,,,,93,79.05,26.6538,93,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),55.8,60,,percent of total billed charges,,
"Amylase, Body Fluid",,82150,CPT,Facility,Both,,,,93,79.05,26.6538,93,"Health Partners, Inc.",State of Minnesota Advantage Program,75.795,81.5,,percent of total billed charges,,
"Amylase, Body Fluid",,82150,CPT,Facility,Both,,,,93,79.05,26.6538,93,"Health Partners, Inc.",State Public Programs,46.5,50,,percent of total billed charges,,
"Amylase, Body Fluid",,82150,CPT,Facility,Both,,,,93,79.05,26.6538,93,Humana Insurance Company,Commercial PPO,88.35,95,,percent of total billed charges,,
"Amylase, Body Fluid",,82150,CPT,Facility,Outpatient,,,,93,79.05,26.6538,93,Humana Insurance Company,Medicare PPO,45.57,49,,percent of total billed charges,,
"Amylase, Body Fluid",,82150,CPT,Facility,Inpatient,,,,93,79.05,26.6538,93,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Amylase, Body Fluid",,82150,CPT,Facility,Both,,,,93,79.05,26.6538,93,Medica,Individual & Family,92.163,99.1,,percent of total billed charges,,
"Amylase, Body Fluid",,82150,CPT,Facility,Outpatient,,,,93,79.05,26.6538,93,Medica,Medica Advantage Solution,46.314,49.8,,percent of total billed charges,,
"Amylase, Body Fluid",,82150,CPT,Facility,Inpatient,,,,93,79.05,26.6538,93,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Amylase, Body Fluid",,82150,CPT,Facility,Outpatient,,,,93,79.05,26.6538,93,Medica,Medical Assistance,41.478,44.6,,percent of total billed charges,,
"Amylase, Body Fluid",,82150,CPT,Facility,Inpatient,,,,93,79.05,26.6538,93,Medica,Medical Assistance,,,,,Included in per diem rate,
"Amylase, Body Fluid",,82150,CPT,Facility,Outpatient,,,,93,79.05,26.6538,93,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,46.314,49.8,,percent of total billed charges,,
"Amylase, Body Fluid",,82150,CPT,Facility,Inpatient,,,,93,79.05,26.6538,93,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Amylase, Body Fluid",,82150,CPT,Facility,Both,,,,93,79.05,26.6538,93,"Multiplan, Inc.","Multiplan, Inc.",87.42,94,,percent of total billed charges,,
"Amylase, Body Fluid",,82150,CPT,Facility,Outpatient,,,,93,79.05,26.6538,93,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,80.352,86.4,,percent of total billed charges,,
"Amylase, Body Fluid",,82150,CPT,Facility,Inpatient,,,,93,79.05,26.6538,93,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Amylase, Body Fluid",,82150,CPT,Facility,Both,,,,93,79.05,26.6538,93,"Preferred One Administrative Services, INC.",PPO,91.698,98.6,,percent of total billed charges,,
"Amylase, Body Fluid",,82150,CPT,Facility,Outpatient,,,,93,79.05,26.6538,93,PrimeWest Health,Minnesota Senior Health Options (MSHO),47.8485,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Amylase, Body Fluid",,82150,CPT,Facility,Inpatient,,,,93,79.05,26.6538,93,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Amylase, Body Fluid",,82150,CPT,Facility,Outpatient,,,,93,79.05,26.6538,93,PrimeWest Health,MinnesotaCare,47.7648,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Amylase, Body Fluid",,82150,CPT,Facility,Inpatient,,,,93,79.05,26.6538,93,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Amylase, Body Fluid",,82150,CPT,Facility,Both,,,,93,79.05,26.6538,93,Sanford Health Plan,Sanford Health Plan,85.56,92,,percent of total billed charges,,
"Amylase, Body Fluid",,82150,CPT,Facility,Outpatient,,,,93,79.05,26.6538,93,"UCare Health, Inc.",Individual & Family Plan,52.4055,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Amylase, Body Fluid",,82150,CPT,Facility,Inpatient,,,,93,79.05,26.6538,93,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Amylase, Body Fluid",,82150,CPT,Facility,Outpatient,,,,93,79.05,26.6538,93,"UCare Health, Inc.",Medical Assistance,46.9371,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Amylase, Body Fluid",,82150,CPT,Facility,Inpatient,,,,93,79.05,26.6538,93,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Amylase, Body Fluid",,82150,CPT,Facility,Outpatient,,,,93,79.05,26.6538,93,"UCare Health, Inc.",Medicare Advantage,46.9371,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Amylase, Body Fluid",,82150,CPT,Facility,Inpatient,,,,93,79.05,26.6538,93,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Amylase, Body Fluid",,82150,CPT,Facility,Outpatient,,,,93,79.05,26.6538,93,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),46.9371,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Amylase, Body Fluid",,82150,CPT,Facility,Inpatient,,,,93,79.05,26.6538,93,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Amylase, Body Fluid",,82150,CPT,Facility,Both,,,,93,79.05,26.6538,93,UnitedHealthcare,Individual & Family,87.42,94,,percent of total billed charges,,
"Amylase, Body Fluid",,82150,CPT,Facility,Outpatient,,,,93,79.05,26.6538,93,UnitedHealthcare,Medicare Advantage,45.57,49,,percent of total billed charges,,
"Amylase, Body Fluid",,82150,CPT,Facility,Inpatient,,,,93,79.05,26.6538,93,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Amylase, Body Fluid",,82150,CPT,Facility,Outpatient,,,,93,79.05,26.6538,93,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,44.64,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Amylase, Body Fluid",,82150,CPT,Facility,Inpatient,,,,93,79.05,26.6538,93,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Bilirubin, Total Only",,82247,CPT,Facility,Both,,,,79,67.15,22.6414,79,Aetna,Commercial,72.68,92,,percent of total billed charges,,
"Bilirubin, Total Only",,82247,CPT,Facility,Outpatient,,,,79,67.15,22.6414,79,Aetna,Medicare Advantage,38.71,49,,percent of total billed charges,,
"Bilirubin, Total Only",,82247,CPT,Facility,Inpatient,,,,79,67.15,22.6414,79,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Bilirubin, Total Only",,82247,CPT,Facility,Both,,,,79,67.15,22.6414,79,Aetna,PPO,73.47,93,,percent of total billed charges,,
"Bilirubin, Total Only",,82247,CPT,Facility,Both,,,,79,67.15,22.6414,79,America's PPO,America's PPO,75.8637,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Bilirubin, Total Only",,82247,CPT,Facility,Both,,,,79,67.15,22.6414,79,BlueCross BlueShield Minnesota, Federal Employee Program,77.736,98.4,,percent of total billed charges,,
"Bilirubin, Total Only",,82247,CPT,Facility,Both,,,,79,67.15,22.6414,79,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,79,100,,percent of total billed charges,,
"Bilirubin, Total Only",,82247,CPT,Facility,Both,,,,79,67.15,22.6414,79,BlueCross BlueShield Minnesota,High Value Network Plan,71.1,90,,percent of total billed charges,,
"Bilirubin, Total Only",,82247,CPT,Facility,Outpatient,,,,79,67.15,22.6414,79,BlueCross BlueShield Minnesota,Medicare Advantage,38.71,49,,percent of total billed charges,,
"Bilirubin, Total Only",,82247,CPT,Facility,Inpatient,,,,79,67.15,22.6414,79,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Bilirubin, Total Only",,82247,CPT,Facility,Both,,,,79,67.15,22.6414,79,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,69.9703,88.57,,percent of total billed charges,,
"Bilirubin, Total Only",,82247,CPT,Facility,Both,,,,79,67.15,22.6414,79,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,22.6414,28.66,,percent of total billed charges,,
"Bilirubin, Total Only",,82247,CPT,Facility,Outpatient,,,,79,67.15,22.6414,79,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),38.71,49,,percent of total billed charges,,
"Bilirubin, Total Only",,82247,CPT,Facility,Inpatient,,,,79,67.15,22.6414,79,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Bilirubin, Total Only",,82247,CPT,Facility,Both,,,,79,67.15,22.6414,79,CorVel,Worker's Compensation,79,100,,percent of total billed charges,,
"Bilirubin, Total Only",,82247,CPT,Facility,Both,,,,79,67.15,22.6414,79,First Health Group Corporation,First Health Network,76.63,97,,percent of total billed charges,,
"Bilirubin, Total Only",,82247,CPT,Facility,Both,,,,79,67.15,22.6414,79,"Health Partners, Inc.",Commercial,74.734,94.6,,percent of total billed charges,,
"Bilirubin, Total Only",,82247,CPT,Facility,Outpatient,,,,79,67.15,22.6414,79,"Health Partners, Inc.",Medicare Advantage,38.71,49,,percent of total billed charges,,
"Bilirubin, Total Only",,82247,CPT,Facility,Inpatient,,,,79,67.15,22.6414,79,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Bilirubin, Total Only",,82247,CPT,Facility,Both,,,,79,67.15,22.6414,79,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),47.4,60,,percent of total billed charges,,
"Bilirubin, Total Only",,82247,CPT,Facility,Both,,,,79,67.15,22.6414,79,"Health Partners, Inc.",State of Minnesota Advantage Program,64.385,81.5,,percent of total billed charges,,
"Bilirubin, Total Only",,82247,CPT,Facility,Both,,,,79,67.15,22.6414,79,"Health Partners, Inc.",State Public Programs,39.5,50,,percent of total billed charges,,
"Bilirubin, Total Only",,82247,CPT,Facility,Both,,,,79,67.15,22.6414,79,Humana Insurance Company,Commercial PPO,75.05,95,,percent of total billed charges,,
"Bilirubin, Total Only",,82247,CPT,Facility,Outpatient,,,,79,67.15,22.6414,79,Humana Insurance Company,Medicare PPO,38.71,49,,percent of total billed charges,,
"Bilirubin, Total Only",,82247,CPT,Facility,Inpatient,,,,79,67.15,22.6414,79,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Bilirubin, Total Only",,82247,CPT,Facility,Both,,,,79,67.15,22.6414,79,Medica,Individual & Family,78.289,99.1,,percent of total billed charges,,
"Bilirubin, Total Only",,82247,CPT,Facility,Outpatient,,,,79,67.15,22.6414,79,Medica,Medica Advantage Solution,39.342,49.8,,percent of total billed charges,,
"Bilirubin, Total Only",,82247,CPT,Facility,Inpatient,,,,79,67.15,22.6414,79,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Bilirubin, Total Only",,82247,CPT,Facility,Outpatient,,,,79,67.15,22.6414,79,Medica,Medical Assistance,35.234,44.6,,percent of total billed charges,,
"Bilirubin, Total Only",,82247,CPT,Facility,Inpatient,,,,79,67.15,22.6414,79,Medica,Medical Assistance,,,,,Included in per diem rate,
"Bilirubin, Total Only",,82247,CPT,Facility,Outpatient,,,,79,67.15,22.6414,79,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,39.342,49.8,,percent of total billed charges,,
"Bilirubin, Total Only",,82247,CPT,Facility,Inpatient,,,,79,67.15,22.6414,79,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Bilirubin, Total Only",,82247,CPT,Facility,Both,,,,79,67.15,22.6414,79,"Multiplan, Inc.","Multiplan, Inc.",74.26,94,,percent of total billed charges,,
"Bilirubin, Total Only",,82247,CPT,Facility,Outpatient,,,,79,67.15,22.6414,79,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,68.256,86.4,,percent of total billed charges,,
"Bilirubin, Total Only",,82247,CPT,Facility,Inpatient,,,,79,67.15,22.6414,79,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Bilirubin, Total Only",,82247,CPT,Facility,Both,,,,79,67.15,22.6414,79,"Preferred One Administrative Services, INC.",PPO,77.894,98.6,,percent of total billed charges,,
"Bilirubin, Total Only",,82247,CPT,Facility,Outpatient,,,,79,67.15,22.6414,79,PrimeWest Health,Minnesota Senior Health Options (MSHO),40.6455,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Bilirubin, Total Only",,82247,CPT,Facility,Inpatient,,,,79,67.15,22.6414,79,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Bilirubin, Total Only",,82247,CPT,Facility,Outpatient,,,,79,67.15,22.6414,79,PrimeWest Health,MinnesotaCare,40.5744,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Bilirubin, Total Only",,82247,CPT,Facility,Inpatient,,,,79,67.15,22.6414,79,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Bilirubin, Total Only",,82247,CPT,Facility,Both,,,,79,67.15,22.6414,79,Sanford Health Plan,Sanford Health Plan,72.68,92,,percent of total billed charges,,
"Bilirubin, Total Only",,82247,CPT,Facility,Outpatient,,,,79,67.15,22.6414,79,"UCare Health, Inc.",Individual & Family Plan,44.5165,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Bilirubin, Total Only",,82247,CPT,Facility,Inpatient,,,,79,67.15,22.6414,79,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Bilirubin, Total Only",,82247,CPT,Facility,Outpatient,,,,79,67.15,22.6414,79,"UCare Health, Inc.",Medical Assistance,39.8713,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Bilirubin, Total Only",,82247,CPT,Facility,Inpatient,,,,79,67.15,22.6414,79,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Bilirubin, Total Only",,82247,CPT,Facility,Outpatient,,,,79,67.15,22.6414,79,"UCare Health, Inc.",Medicare Advantage,39.8713,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Bilirubin, Total Only",,82247,CPT,Facility,Inpatient,,,,79,67.15,22.6414,79,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Bilirubin, Total Only",,82247,CPT,Facility,Outpatient,,,,79,67.15,22.6414,79,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),39.8713,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Bilirubin, Total Only",,82247,CPT,Facility,Inpatient,,,,79,67.15,22.6414,79,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Bilirubin, Total Only",,82247,CPT,Facility,Both,,,,79,67.15,22.6414,79,UnitedHealthcare,Individual & Family,74.26,94,,percent of total billed charges,,
"Bilirubin, Total Only",,82247,CPT,Facility,Outpatient,,,,79,67.15,22.6414,79,UnitedHealthcare,Medicare Advantage,38.71,49,,percent of total billed charges,,
"Bilirubin, Total Only",,82247,CPT,Facility,Inpatient,,,,79,67.15,22.6414,79,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Bilirubin, Total Only",,82247,CPT,Facility,Outpatient,,,,79,67.15,22.6414,79,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,37.92,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Bilirubin, Total Only",,82247,CPT,Facility,Inpatient,,,,79,67.15,22.6414,79,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Bilirubin, Direct",,82248,CPT,Facility,Both,,,,64,54.4,18.3424,64,Aetna,Commercial,58.88,92,,percent of total billed charges,,
"Bilirubin, Direct",,82248,CPT,Facility,Outpatient,,,,64,54.4,18.3424,64,Aetna,Medicare Advantage,31.36,49,,percent of total billed charges,,
"Bilirubin, Direct",,82248,CPT,Facility,Inpatient,,,,64,54.4,18.3424,64,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Bilirubin, Direct",,82248,CPT,Facility,Both,,,,64,54.4,18.3424,64,Aetna,PPO,59.52,93,,percent of total billed charges,,
"Bilirubin, Direct",,82248,CPT,Facility,Both,,,,64,54.4,18.3424,64,America's PPO,America's PPO,61.4592,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Bilirubin, Direct",,82248,CPT,Facility,Both,,,,64,54.4,18.3424,64,BlueCross BlueShield Minnesota, Federal Employee Program,62.976,98.4,,percent of total billed charges,,
"Bilirubin, Direct",,82248,CPT,Facility,Both,,,,64,54.4,18.3424,64,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,64,100,,percent of total billed charges,,
"Bilirubin, Direct",,82248,CPT,Facility,Both,,,,64,54.4,18.3424,64,BlueCross BlueShield Minnesota,High Value Network Plan,57.6,90,,percent of total billed charges,,
"Bilirubin, Direct",,82248,CPT,Facility,Outpatient,,,,64,54.4,18.3424,64,BlueCross BlueShield Minnesota,Medicare Advantage,31.36,49,,percent of total billed charges,,
"Bilirubin, Direct",,82248,CPT,Facility,Inpatient,,,,64,54.4,18.3424,64,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Bilirubin, Direct",,82248,CPT,Facility,Both,,,,64,54.4,18.3424,64,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,56.6848,88.57,,percent of total billed charges,,
"Bilirubin, Direct",,82248,CPT,Facility,Both,,,,64,54.4,18.3424,64,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,18.3424,28.66,,percent of total billed charges,,
"Bilirubin, Direct",,82248,CPT,Facility,Outpatient,,,,64,54.4,18.3424,64,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),31.36,49,,percent of total billed charges,,
"Bilirubin, Direct",,82248,CPT,Facility,Inpatient,,,,64,54.4,18.3424,64,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Bilirubin, Direct",,82248,CPT,Facility,Both,,,,64,54.4,18.3424,64,CorVel,Worker's Compensation,64,100,,percent of total billed charges,,
"Bilirubin, Direct",,82248,CPT,Facility,Both,,,,64,54.4,18.3424,64,First Health Group Corporation,First Health Network,62.08,97,,percent of total billed charges,,
"Bilirubin, Direct",,82248,CPT,Facility,Both,,,,64,54.4,18.3424,64,"Health Partners, Inc.",Commercial,60.544,94.6,,percent of total billed charges,,
"Bilirubin, Direct",,82248,CPT,Facility,Outpatient,,,,64,54.4,18.3424,64,"Health Partners, Inc.",Medicare Advantage,31.36,49,,percent of total billed charges,,
"Bilirubin, Direct",,82248,CPT,Facility,Inpatient,,,,64,54.4,18.3424,64,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Bilirubin, Direct",,82248,CPT,Facility,Both,,,,64,54.4,18.3424,64,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),38.4,60,,percent of total billed charges,,
"Bilirubin, Direct",,82248,CPT,Facility,Both,,,,64,54.4,18.3424,64,"Health Partners, Inc.",State of Minnesota Advantage Program,52.16,81.5,,percent of total billed charges,,
"Bilirubin, Direct",,82248,CPT,Facility,Both,,,,64,54.4,18.3424,64,"Health Partners, Inc.",State Public Programs,32,50,,percent of total billed charges,,
"Bilirubin, Direct",,82248,CPT,Facility,Both,,,,64,54.4,18.3424,64,Humana Insurance Company,Commercial PPO,60.8,95,,percent of total billed charges,,
"Bilirubin, Direct",,82248,CPT,Facility,Outpatient,,,,64,54.4,18.3424,64,Humana Insurance Company,Medicare PPO,31.36,49,,percent of total billed charges,,
"Bilirubin, Direct",,82248,CPT,Facility,Inpatient,,,,64,54.4,18.3424,64,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Bilirubin, Direct",,82248,CPT,Facility,Both,,,,64,54.4,18.3424,64,Medica,Individual & Family,63.424,99.1,,percent of total billed charges,,
"Bilirubin, Direct",,82248,CPT,Facility,Outpatient,,,,64,54.4,18.3424,64,Medica,Medica Advantage Solution,31.872,49.8,,percent of total billed charges,,
"Bilirubin, Direct",,82248,CPT,Facility,Inpatient,,,,64,54.4,18.3424,64,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Bilirubin, Direct",,82248,CPT,Facility,Outpatient,,,,64,54.4,18.3424,64,Medica,Medical Assistance,28.544,44.6,,percent of total billed charges,,
"Bilirubin, Direct",,82248,CPT,Facility,Inpatient,,,,64,54.4,18.3424,64,Medica,Medical Assistance,,,,,Included in per diem rate,
"Bilirubin, Direct",,82248,CPT,Facility,Outpatient,,,,64,54.4,18.3424,64,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,31.872,49.8,,percent of total billed charges,,
"Bilirubin, Direct",,82248,CPT,Facility,Inpatient,,,,64,54.4,18.3424,64,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Bilirubin, Direct",,82248,CPT,Facility,Both,,,,64,54.4,18.3424,64,"Multiplan, Inc.","Multiplan, Inc.",60.16,94,,percent of total billed charges,,
"Bilirubin, Direct",,82248,CPT,Facility,Outpatient,,,,64,54.4,18.3424,64,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,55.296,86.4,,percent of total billed charges,,
"Bilirubin, Direct",,82248,CPT,Facility,Inpatient,,,,64,54.4,18.3424,64,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Bilirubin, Direct",,82248,CPT,Facility,Both,,,,64,54.4,18.3424,64,"Preferred One Administrative Services, INC.",PPO,63.104,98.6,,percent of total billed charges,,
"Bilirubin, Direct",,82248,CPT,Facility,Outpatient,,,,64,54.4,18.3424,64,PrimeWest Health,Minnesota Senior Health Options (MSHO),32.928,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Bilirubin, Direct",,82248,CPT,Facility,Inpatient,,,,64,54.4,18.3424,64,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Bilirubin, Direct",,82248,CPT,Facility,Outpatient,,,,64,54.4,18.3424,64,PrimeWest Health,MinnesotaCare,32.8704,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Bilirubin, Direct",,82248,CPT,Facility,Inpatient,,,,64,54.4,18.3424,64,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Bilirubin, Direct",,82248,CPT,Facility,Both,,,,64,54.4,18.3424,64,Sanford Health Plan,Sanford Health Plan,58.88,92,,percent of total billed charges,,
"Bilirubin, Direct",,82248,CPT,Facility,Outpatient,,,,64,54.4,18.3424,64,"UCare Health, Inc.",Individual & Family Plan,36.064,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Bilirubin, Direct",,82248,CPT,Facility,Inpatient,,,,64,54.4,18.3424,64,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Bilirubin, Direct",,82248,CPT,Facility,Outpatient,,,,64,54.4,18.3424,64,"UCare Health, Inc.",Medical Assistance,32.3008,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Bilirubin, Direct",,82248,CPT,Facility,Inpatient,,,,64,54.4,18.3424,64,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Bilirubin, Direct",,82248,CPT,Facility,Outpatient,,,,64,54.4,18.3424,64,"UCare Health, Inc.",Medicare Advantage,32.3008,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Bilirubin, Direct",,82248,CPT,Facility,Inpatient,,,,64,54.4,18.3424,64,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Bilirubin, Direct",,82248,CPT,Facility,Outpatient,,,,64,54.4,18.3424,64,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),32.3008,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Bilirubin, Direct",,82248,CPT,Facility,Inpatient,,,,64,54.4,18.3424,64,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Bilirubin, Direct",,82248,CPT,Facility,Both,,,,64,54.4,18.3424,64,UnitedHealthcare,Individual & Family,60.16,94,,percent of total billed charges,,
"Bilirubin, Direct",,82248,CPT,Facility,Outpatient,,,,64,54.4,18.3424,64,UnitedHealthcare,Medicare Advantage,31.36,49,,percent of total billed charges,,
"Bilirubin, Direct",,82248,CPT,Facility,Inpatient,,,,64,54.4,18.3424,64,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Bilirubin, Direct",,82248,CPT,Facility,Outpatient,,,,64,54.4,18.3424,64,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,30.72,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Bilirubin, Direct",,82248,CPT,Facility,Inpatient,,,,64,54.4,18.3424,64,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Occult,Blood, Stool, Consecutive, For Colorectal Neoplasm Screen",,82270,CPT,Facility,Both,,,,26,22.1,7.4516,26,Aetna,Commercial,23.92,92,,percent of total billed charges,,
"Occult,Blood, Stool, Consecutive, For Colorectal Neoplasm Screen",,82270,CPT,Facility,Outpatient,,,,26,22.1,7.4516,26,Aetna,Medicare Advantage,12.74,49,,percent of total billed charges,,
"Occult,Blood, Stool, Consecutive, For Colorectal Neoplasm Screen",,82270,CPT,Facility,Inpatient,,,,26,22.1,7.4516,26,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Occult,Blood, Stool, Consecutive, For Colorectal Neoplasm Screen",,82270,CPT,Facility,Both,,,,26,22.1,7.4516,26,Aetna,PPO,24.18,93,,percent of total billed charges,,
"Occult,Blood, Stool, Consecutive, For Colorectal Neoplasm Screen",,82270,CPT,Facility,Both,,,,26,22.1,7.4516,26,America's PPO,America's PPO,24.9678,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Occult,Blood, Stool, Consecutive, For Colorectal Neoplasm Screen",,82270,CPT,Facility,Both,,,,26,22.1,7.4516,26,BlueCross BlueShield Minnesota, Federal Employee Program,25.584,98.4,,percent of total billed charges,,
"Occult,Blood, Stool, Consecutive, For Colorectal Neoplasm Screen",,82270,CPT,Facility,Both,,,,26,22.1,7.4516,26,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,26,100,,percent of total billed charges,,
"Occult,Blood, Stool, Consecutive, For Colorectal Neoplasm Screen",,82270,CPT,Facility,Both,,,,26,22.1,7.4516,26,BlueCross BlueShield Minnesota,High Value Network Plan,23.4,90,,percent of total billed charges,,
"Occult,Blood, Stool, Consecutive, For Colorectal Neoplasm Screen",,82270,CPT,Facility,Outpatient,,,,26,22.1,7.4516,26,BlueCross BlueShield Minnesota,Medicare Advantage,12.74,49,,percent of total billed charges,,
"Occult,Blood, Stool, Consecutive, For Colorectal Neoplasm Screen",,82270,CPT,Facility,Inpatient,,,,26,22.1,7.4516,26,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Occult,Blood, Stool, Consecutive, For Colorectal Neoplasm Screen",,82270,CPT,Facility,Both,,,,26,22.1,7.4516,26,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,23.0282,88.57,,percent of total billed charges,,
"Occult,Blood, Stool, Consecutive, For Colorectal Neoplasm Screen",,82270,CPT,Facility,Both,,,,26,22.1,7.4516,26,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,7.4516,28.66,,percent of total billed charges,,
"Occult,Blood, Stool, Consecutive, For Colorectal Neoplasm Screen",,82270,CPT,Facility,Outpatient,,,,26,22.1,7.4516,26,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),12.74,49,,percent of total billed charges,,
"Occult,Blood, Stool, Consecutive, For Colorectal Neoplasm Screen",,82270,CPT,Facility,Inpatient,,,,26,22.1,7.4516,26,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Occult,Blood, Stool, Consecutive, For Colorectal Neoplasm Screen",,82270,CPT,Facility,Both,,,,26,22.1,7.4516,26,CorVel,Worker's Compensation,26,100,,percent of total billed charges,,
"Occult,Blood, Stool, Consecutive, For Colorectal Neoplasm Screen",,82270,CPT,Facility,Both,,,,26,22.1,7.4516,26,First Health Group Corporation,First Health Network,25.22,97,,percent of total billed charges,,
"Occult,Blood, Stool, Consecutive, For Colorectal Neoplasm Screen",,82270,CPT,Facility,Both,,,,26,22.1,7.4516,26,"Health Partners, Inc.",Commercial,24.596,94.6,,percent of total billed charges,,
"Occult,Blood, Stool, Consecutive, For Colorectal Neoplasm Screen",,82270,CPT,Facility,Outpatient,,,,26,22.1,7.4516,26,"Health Partners, Inc.",Medicare Advantage,12.74,49,,percent of total billed charges,,
"Occult,Blood, Stool, Consecutive, For Colorectal Neoplasm Screen",,82270,CPT,Facility,Inpatient,,,,26,22.1,7.4516,26,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Occult,Blood, Stool, Consecutive, For Colorectal Neoplasm Screen",,82270,CPT,Facility,Both,,,,26,22.1,7.4516,26,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),15.6,60,,percent of total billed charges,,
"Occult,Blood, Stool, Consecutive, For Colorectal Neoplasm Screen",,82270,CPT,Facility,Both,,,,26,22.1,7.4516,26,"Health Partners, Inc.",State of Minnesota Advantage Program,21.19,81.5,,percent of total billed charges,,
"Occult,Blood, Stool, Consecutive, For Colorectal Neoplasm Screen",,82270,CPT,Facility,Both,,,,26,22.1,7.4516,26,"Health Partners, Inc.",State Public Programs,13,50,,percent of total billed charges,,
"Occult,Blood, Stool, Consecutive, For Colorectal Neoplasm Screen",,82270,CPT,Facility,Both,,,,26,22.1,7.4516,26,Humana Insurance Company,Commercial PPO,24.7,95,,percent of total billed charges,,
"Occult,Blood, Stool, Consecutive, For Colorectal Neoplasm Screen",,82270,CPT,Facility,Outpatient,,,,26,22.1,7.4516,26,Humana Insurance Company,Medicare PPO,12.74,49,,percent of total billed charges,,
"Occult,Blood, Stool, Consecutive, For Colorectal Neoplasm Screen",,82270,CPT,Facility,Inpatient,,,,26,22.1,7.4516,26,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Occult,Blood, Stool, Consecutive, For Colorectal Neoplasm Screen",,82270,CPT,Facility,Both,,,,26,22.1,7.4516,26,Medica,Individual & Family,25.766,99.1,,percent of total billed charges,,
"Occult,Blood, Stool, Consecutive, For Colorectal Neoplasm Screen",,82270,CPT,Facility,Outpatient,,,,26,22.1,7.4516,26,Medica,Medica Advantage Solution,12.948,49.8,,percent of total billed charges,,
"Occult,Blood, Stool, Consecutive, For Colorectal Neoplasm Screen",,82270,CPT,Facility,Inpatient,,,,26,22.1,7.4516,26,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Occult,Blood, Stool, Consecutive, For Colorectal Neoplasm Screen",,82270,CPT,Facility,Outpatient,,,,26,22.1,7.4516,26,Medica,Medical Assistance,11.596,44.6,,percent of total billed charges,,
"Occult,Blood, Stool, Consecutive, For Colorectal Neoplasm Screen",,82270,CPT,Facility,Inpatient,,,,26,22.1,7.4516,26,Medica,Medical Assistance,,,,,Included in per diem rate,
"Occult,Blood, Stool, Consecutive, For Colorectal Neoplasm Screen",,82270,CPT,Facility,Outpatient,,,,26,22.1,7.4516,26,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,12.948,49.8,,percent of total billed charges,,
"Occult,Blood, Stool, Consecutive, For Colorectal Neoplasm Screen",,82270,CPT,Facility,Inpatient,,,,26,22.1,7.4516,26,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Occult,Blood, Stool, Consecutive, For Colorectal Neoplasm Screen",,82270,CPT,Facility,Both,,,,26,22.1,7.4516,26,"Multiplan, Inc.","Multiplan, Inc.",24.44,94,,percent of total billed charges,,
"Occult,Blood, Stool, Consecutive, For Colorectal Neoplasm Screen",,82270,CPT,Facility,Outpatient,,,,26,22.1,7.4516,26,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,22.464,86.4,,percent of total billed charges,,
"Occult,Blood, Stool, Consecutive, For Colorectal Neoplasm Screen",,82270,CPT,Facility,Inpatient,,,,26,22.1,7.4516,26,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Occult,Blood, Stool, Consecutive, For Colorectal Neoplasm Screen",,82270,CPT,Facility,Both,,,,26,22.1,7.4516,26,"Preferred One Administrative Services, INC.",PPO,25.636,98.6,,percent of total billed charges,,
"Occult,Blood, Stool, Consecutive, For Colorectal Neoplasm Screen",,82270,CPT,Facility,Outpatient,,,,26,22.1,7.4516,26,PrimeWest Health,Minnesota Senior Health Options (MSHO),13.377,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Occult,Blood, Stool, Consecutive, For Colorectal Neoplasm Screen",,82270,CPT,Facility,Inpatient,,,,26,22.1,7.4516,26,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Occult,Blood, Stool, Consecutive, For Colorectal Neoplasm Screen",,82270,CPT,Facility,Outpatient,,,,26,22.1,7.4516,26,PrimeWest Health,MinnesotaCare,13.3536,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Occult,Blood, Stool, Consecutive, For Colorectal Neoplasm Screen",,82270,CPT,Facility,Inpatient,,,,26,22.1,7.4516,26,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Occult,Blood, Stool, Consecutive, For Colorectal Neoplasm Screen",,82270,CPT,Facility,Both,,,,26,22.1,7.4516,26,Sanford Health Plan,Sanford Health Plan,23.92,92,,percent of total billed charges,,
"Occult,Blood, Stool, Consecutive, For Colorectal Neoplasm Screen",,82270,CPT,Facility,Outpatient,,,,26,22.1,7.4516,26,"UCare Health, Inc.",Individual & Family Plan,14.651,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Occult,Blood, Stool, Consecutive, For Colorectal Neoplasm Screen",,82270,CPT,Facility,Inpatient,,,,26,22.1,7.4516,26,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Occult,Blood, Stool, Consecutive, For Colorectal Neoplasm Screen",,82270,CPT,Facility,Outpatient,,,,26,22.1,7.4516,26,"UCare Health, Inc.",Medical Assistance,13.1222,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Occult,Blood, Stool, Consecutive, For Colorectal Neoplasm Screen",,82270,CPT,Facility,Inpatient,,,,26,22.1,7.4516,26,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Occult,Blood, Stool, Consecutive, For Colorectal Neoplasm Screen",,82270,CPT,Facility,Outpatient,,,,26,22.1,7.4516,26,"UCare Health, Inc.",Medicare Advantage,13.1222,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Occult,Blood, Stool, Consecutive, For Colorectal Neoplasm Screen",,82270,CPT,Facility,Inpatient,,,,26,22.1,7.4516,26,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Occult,Blood, Stool, Consecutive, For Colorectal Neoplasm Screen",,82270,CPT,Facility,Outpatient,,,,26,22.1,7.4516,26,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),13.1222,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Occult,Blood, Stool, Consecutive, For Colorectal Neoplasm Screen",,82270,CPT,Facility,Inpatient,,,,26,22.1,7.4516,26,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Occult,Blood, Stool, Consecutive, For Colorectal Neoplasm Screen",,82270,CPT,Facility,Both,,,,26,22.1,7.4516,26,UnitedHealthcare,Individual & Family,24.44,94,,percent of total billed charges,,
"Occult,Blood, Stool, Consecutive, For Colorectal Neoplasm Screen",,82270,CPT,Facility,Outpatient,,,,26,22.1,7.4516,26,UnitedHealthcare,Medicare Advantage,12.74,49,,percent of total billed charges,,
"Occult,Blood, Stool, Consecutive, For Colorectal Neoplasm Screen",,82270,CPT,Facility,Inpatient,,,,26,22.1,7.4516,26,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Occult,Blood, Stool, Consecutive, For Colorectal Neoplasm Screen",,82270,CPT,Facility,Outpatient,,,,26,22.1,7.4516,26,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,12.48,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Occult,Blood, Stool, Consecutive, For Colorectal Neoplasm Screen",,82270,CPT,Facility,Inpatient,,,,26,22.1,7.4516,26,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Occult Blood, Fit",,82274,CPT,Facility,Both,,,,71,60.35,20.3486,71,Aetna,Commercial,65.32,92,,percent of total billed charges,,
"Occult Blood, Fit",,82274,CPT,Facility,Outpatient,,,,71,60.35,20.3486,71,Aetna,Medicare Advantage,34.79,49,,percent of total billed charges,,
"Occult Blood, Fit",,82274,CPT,Facility,Inpatient,,,,71,60.35,20.3486,71,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Occult Blood, Fit",,82274,CPT,Facility,Both,,,,71,60.35,20.3486,71,Aetna,PPO,66.03,93,,percent of total billed charges,,
"Occult Blood, Fit",,82274,CPT,Facility,Both,,,,71,60.35,20.3486,71,America's PPO,America's PPO,68.1813,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Occult Blood, Fit",,82274,CPT,Facility,Both,,,,71,60.35,20.3486,71,BlueCross BlueShield Minnesota, Federal Employee Program,69.864,98.4,,percent of total billed charges,,
"Occult Blood, Fit",,82274,CPT,Facility,Both,,,,71,60.35,20.3486,71,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,71,100,,percent of total billed charges,,
"Occult Blood, Fit",,82274,CPT,Facility,Both,,,,71,60.35,20.3486,71,BlueCross BlueShield Minnesota,High Value Network Plan,63.9,90,,percent of total billed charges,,
"Occult Blood, Fit",,82274,CPT,Facility,Outpatient,,,,71,60.35,20.3486,71,BlueCross BlueShield Minnesota,Medicare Advantage,34.79,49,,percent of total billed charges,,
"Occult Blood, Fit",,82274,CPT,Facility,Inpatient,,,,71,60.35,20.3486,71,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Occult Blood, Fit",,82274,CPT,Facility,Both,,,,71,60.35,20.3486,71,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,62.8847,88.57,,percent of total billed charges,,
"Occult Blood, Fit",,82274,CPT,Facility,Both,,,,71,60.35,20.3486,71,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,20.3486,28.66,,percent of total billed charges,,
"Occult Blood, Fit",,82274,CPT,Facility,Outpatient,,,,71,60.35,20.3486,71,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),34.79,49,,percent of total billed charges,,
"Occult Blood, Fit",,82274,CPT,Facility,Inpatient,,,,71,60.35,20.3486,71,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Occult Blood, Fit",,82274,CPT,Facility,Both,,,,71,60.35,20.3486,71,CorVel,Worker's Compensation,71,100,,percent of total billed charges,,
"Occult Blood, Fit",,82274,CPT,Facility,Both,,,,71,60.35,20.3486,71,First Health Group Corporation,First Health Network,68.87,97,,percent of total billed charges,,
"Occult Blood, Fit",,82274,CPT,Facility,Both,,,,71,60.35,20.3486,71,"Health Partners, Inc.",Commercial,67.166,94.6,,percent of total billed charges,,
"Occult Blood, Fit",,82274,CPT,Facility,Outpatient,,,,71,60.35,20.3486,71,"Health Partners, Inc.",Medicare Advantage,34.79,49,,percent of total billed charges,,
"Occult Blood, Fit",,82274,CPT,Facility,Inpatient,,,,71,60.35,20.3486,71,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Occult Blood, Fit",,82274,CPT,Facility,Both,,,,71,60.35,20.3486,71,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),42.6,60,,percent of total billed charges,,
"Occult Blood, Fit",,82274,CPT,Facility,Both,,,,71,60.35,20.3486,71,"Health Partners, Inc.",State of Minnesota Advantage Program,57.865,81.5,,percent of total billed charges,,
"Occult Blood, Fit",,82274,CPT,Facility,Both,,,,71,60.35,20.3486,71,"Health Partners, Inc.",State Public Programs,35.5,50,,percent of total billed charges,,
"Occult Blood, Fit",,82274,CPT,Facility,Both,,,,71,60.35,20.3486,71,Humana Insurance Company,Commercial PPO,67.45,95,,percent of total billed charges,,
"Occult Blood, Fit",,82274,CPT,Facility,Outpatient,,,,71,60.35,20.3486,71,Humana Insurance Company,Medicare PPO,34.79,49,,percent of total billed charges,,
"Occult Blood, Fit",,82274,CPT,Facility,Inpatient,,,,71,60.35,20.3486,71,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Occult Blood, Fit",,82274,CPT,Facility,Both,,,,71,60.35,20.3486,71,Medica,Individual & Family,70.361,99.1,,percent of total billed charges,,
"Occult Blood, Fit",,82274,CPT,Facility,Outpatient,,,,71,60.35,20.3486,71,Medica,Medica Advantage Solution,35.358,49.8,,percent of total billed charges,,
"Occult Blood, Fit",,82274,CPT,Facility,Inpatient,,,,71,60.35,20.3486,71,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Occult Blood, Fit",,82274,CPT,Facility,Outpatient,,,,71,60.35,20.3486,71,Medica,Medical Assistance,31.666,44.6,,percent of total billed charges,,
"Occult Blood, Fit",,82274,CPT,Facility,Inpatient,,,,71,60.35,20.3486,71,Medica,Medical Assistance,,,,,Included in per diem rate,
"Occult Blood, Fit",,82274,CPT,Facility,Outpatient,,,,71,60.35,20.3486,71,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,35.358,49.8,,percent of total billed charges,,
"Occult Blood, Fit",,82274,CPT,Facility,Inpatient,,,,71,60.35,20.3486,71,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Occult Blood, Fit",,82274,CPT,Facility,Both,,,,71,60.35,20.3486,71,"Multiplan, Inc.","Multiplan, Inc.",66.74,94,,percent of total billed charges,,
"Occult Blood, Fit",,82274,CPT,Facility,Outpatient,,,,71,60.35,20.3486,71,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,61.344,86.4,,percent of total billed charges,,
"Occult Blood, Fit",,82274,CPT,Facility,Inpatient,,,,71,60.35,20.3486,71,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Occult Blood, Fit",,82274,CPT,Facility,Both,,,,71,60.35,20.3486,71,"Preferred One Administrative Services, INC.",PPO,70.006,98.6,,percent of total billed charges,,
"Occult Blood, Fit",,82274,CPT,Facility,Outpatient,,,,71,60.35,20.3486,71,PrimeWest Health,Minnesota Senior Health Options (MSHO),36.5295,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Occult Blood, Fit",,82274,CPT,Facility,Inpatient,,,,71,60.35,20.3486,71,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Occult Blood, Fit",,82274,CPT,Facility,Outpatient,,,,71,60.35,20.3486,71,PrimeWest Health,MinnesotaCare,36.4656,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Occult Blood, Fit",,82274,CPT,Facility,Inpatient,,,,71,60.35,20.3486,71,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Occult Blood, Fit",,82274,CPT,Facility,Both,,,,71,60.35,20.3486,71,Sanford Health Plan,Sanford Health Plan,65.32,92,,percent of total billed charges,,
"Occult Blood, Fit",,82274,CPT,Facility,Outpatient,,,,71,60.35,20.3486,71,"UCare Health, Inc.",Individual & Family Plan,40.0085,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Occult Blood, Fit",,82274,CPT,Facility,Inpatient,,,,71,60.35,20.3486,71,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Occult Blood, Fit",,82274,CPT,Facility,Outpatient,,,,71,60.35,20.3486,71,"UCare Health, Inc.",Medical Assistance,35.8337,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Occult Blood, Fit",,82274,CPT,Facility,Inpatient,,,,71,60.35,20.3486,71,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Occult Blood, Fit",,82274,CPT,Facility,Outpatient,,,,71,60.35,20.3486,71,"UCare Health, Inc.",Medicare Advantage,35.8337,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Occult Blood, Fit",,82274,CPT,Facility,Inpatient,,,,71,60.35,20.3486,71,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Occult Blood, Fit",,82274,CPT,Facility,Outpatient,,,,71,60.35,20.3486,71,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),35.8337,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Occult Blood, Fit",,82274,CPT,Facility,Inpatient,,,,71,60.35,20.3486,71,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Occult Blood, Fit",,82274,CPT,Facility,Both,,,,71,60.35,20.3486,71,UnitedHealthcare,Individual & Family,66.74,94,,percent of total billed charges,,
"Occult Blood, Fit",,82274,CPT,Facility,Outpatient,,,,71,60.35,20.3486,71,UnitedHealthcare,Medicare Advantage,34.79,49,,percent of total billed charges,,
"Occult Blood, Fit",,82274,CPT,Facility,Inpatient,,,,71,60.35,20.3486,71,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Occult Blood, Fit",,82274,CPT,Facility,Outpatient,,,,71,60.35,20.3486,71,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,34.08,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Occult Blood, Fit",,82274,CPT,Facility,Inpatient,,,,71,60.35,20.3486,71,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Vitamin D 25-Hydroxy, Total",,82306,CPT,Facility,Both,,,,140,119,40.124,140,Aetna,Commercial,128.8,92,,percent of total billed charges,,
"Vitamin D 25-Hydroxy, Total",,82306,CPT,Facility,Outpatient,,,,140,119,40.124,140,Aetna,Medicare Advantage,68.6,49,,percent of total billed charges,,
"Vitamin D 25-Hydroxy, Total",,82306,CPT,Facility,Inpatient,,,,140,119,40.124,140,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Vitamin D 25-Hydroxy, Total",,82306,CPT,Facility,Both,,,,140,119,40.124,140,Aetna,PPO,130.2,93,,percent of total billed charges,,
"Vitamin D 25-Hydroxy, Total",,82306,CPT,Facility,Both,,,,140,119,40.124,140,America's PPO,America's PPO,134.442,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Vitamin D 25-Hydroxy, Total",,82306,CPT,Facility,Both,,,,140,119,40.124,140,BlueCross BlueShield Minnesota, Federal Employee Program,137.76,98.4,,percent of total billed charges,,
"Vitamin D 25-Hydroxy, Total",,82306,CPT,Facility,Both,,,,140,119,40.124,140,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,140,100,,percent of total billed charges,,
"Vitamin D 25-Hydroxy, Total",,82306,CPT,Facility,Both,,,,140,119,40.124,140,BlueCross BlueShield Minnesota,High Value Network Plan,126,90,,percent of total billed charges,,
"Vitamin D 25-Hydroxy, Total",,82306,CPT,Facility,Outpatient,,,,140,119,40.124,140,BlueCross BlueShield Minnesota,Medicare Advantage,68.6,49,,percent of total billed charges,,
"Vitamin D 25-Hydroxy, Total",,82306,CPT,Facility,Inpatient,,,,140,119,40.124,140,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Vitamin D 25-Hydroxy, Total",,82306,CPT,Facility,Both,,,,140,119,40.124,140,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,123.998,88.57,,percent of total billed charges,,
"Vitamin D 25-Hydroxy, Total",,82306,CPT,Facility,Both,,,,140,119,40.124,140,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,40.124,28.66,,percent of total billed charges,,
"Vitamin D 25-Hydroxy, Total",,82306,CPT,Facility,Outpatient,,,,140,119,40.124,140,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),68.6,49,,percent of total billed charges,,
"Vitamin D 25-Hydroxy, Total",,82306,CPT,Facility,Inpatient,,,,140,119,40.124,140,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Vitamin D 25-Hydroxy, Total",,82306,CPT,Facility,Both,,,,140,119,40.124,140,CorVel,Worker's Compensation,140,100,,percent of total billed charges,,
"Vitamin D 25-Hydroxy, Total",,82306,CPT,Facility,Both,,,,140,119,40.124,140,First Health Group Corporation,First Health Network,135.8,97,,percent of total billed charges,,
"Vitamin D 25-Hydroxy, Total",,82306,CPT,Facility,Both,,,,140,119,40.124,140,"Health Partners, Inc.",Commercial,132.44,94.6,,percent of total billed charges,,
"Vitamin D 25-Hydroxy, Total",,82306,CPT,Facility,Outpatient,,,,140,119,40.124,140,"Health Partners, Inc.",Medicare Advantage,68.6,49,,percent of total billed charges,,
"Vitamin D 25-Hydroxy, Total",,82306,CPT,Facility,Inpatient,,,,140,119,40.124,140,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Vitamin D 25-Hydroxy, Total",,82306,CPT,Facility,Both,,,,140,119,40.124,140,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),84,60,,percent of total billed charges,,
"Vitamin D 25-Hydroxy, Total",,82306,CPT,Facility,Both,,,,140,119,40.124,140,"Health Partners, Inc.",State of Minnesota Advantage Program,114.1,81.5,,percent of total billed charges,,
"Vitamin D 25-Hydroxy, Total",,82306,CPT,Facility,Both,,,,140,119,40.124,140,"Health Partners, Inc.",State Public Programs,70,50,,percent of total billed charges,,
"Vitamin D 25-Hydroxy, Total",,82306,CPT,Facility,Both,,,,140,119,40.124,140,Humana Insurance Company,Commercial PPO,133,95,,percent of total billed charges,,
"Vitamin D 25-Hydroxy, Total",,82306,CPT,Facility,Outpatient,,,,140,119,40.124,140,Humana Insurance Company,Medicare PPO,68.6,49,,percent of total billed charges,,
"Vitamin D 25-Hydroxy, Total",,82306,CPT,Facility,Inpatient,,,,140,119,40.124,140,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Vitamin D 25-Hydroxy, Total",,82306,CPT,Facility,Both,,,,140,119,40.124,140,Medica,Individual & Family,138.74,99.1,,percent of total billed charges,,
"Vitamin D 25-Hydroxy, Total",,82306,CPT,Facility,Outpatient,,,,140,119,40.124,140,Medica,Medica Advantage Solution,69.72,49.8,,percent of total billed charges,,
"Vitamin D 25-Hydroxy, Total",,82306,CPT,Facility,Inpatient,,,,140,119,40.124,140,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Vitamin D 25-Hydroxy, Total",,82306,CPT,Facility,Outpatient,,,,140,119,40.124,140,Medica,Medical Assistance,62.44,44.6,,percent of total billed charges,,
"Vitamin D 25-Hydroxy, Total",,82306,CPT,Facility,Inpatient,,,,140,119,40.124,140,Medica,Medical Assistance,,,,,Included in per diem rate,
"Vitamin D 25-Hydroxy, Total",,82306,CPT,Facility,Outpatient,,,,140,119,40.124,140,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,69.72,49.8,,percent of total billed charges,,
"Vitamin D 25-Hydroxy, Total",,82306,CPT,Facility,Inpatient,,,,140,119,40.124,140,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Vitamin D 25-Hydroxy, Total",,82306,CPT,Facility,Both,,,,140,119,40.124,140,"Multiplan, Inc.","Multiplan, Inc.",131.6,94,,percent of total billed charges,,
"Vitamin D 25-Hydroxy, Total",,82306,CPT,Facility,Outpatient,,,,140,119,40.124,140,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,120.96,86.4,,percent of total billed charges,,
"Vitamin D 25-Hydroxy, Total",,82306,CPT,Facility,Inpatient,,,,140,119,40.124,140,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Vitamin D 25-Hydroxy, Total",,82306,CPT,Facility,Both,,,,140,119,40.124,140,"Preferred One Administrative Services, INC.",PPO,138.04,98.6,,percent of total billed charges,,
"Vitamin D 25-Hydroxy, Total",,82306,CPT,Facility,Outpatient,,,,140,119,40.124,140,PrimeWest Health,Minnesota Senior Health Options (MSHO),72.03,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Vitamin D 25-Hydroxy, Total",,82306,CPT,Facility,Inpatient,,,,140,119,40.124,140,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Vitamin D 25-Hydroxy, Total",,82306,CPT,Facility,Outpatient,,,,140,119,40.124,140,PrimeWest Health,MinnesotaCare,71.904,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Vitamin D 25-Hydroxy, Total",,82306,CPT,Facility,Inpatient,,,,140,119,40.124,140,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Vitamin D 25-Hydroxy, Total",,82306,CPT,Facility,Both,,,,140,119,40.124,140,Sanford Health Plan,Sanford Health Plan,128.8,92,,percent of total billed charges,,
"Vitamin D 25-Hydroxy, Total",,82306,CPT,Facility,Outpatient,,,,140,119,40.124,140,"UCare Health, Inc.",Individual & Family Plan,78.89,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Vitamin D 25-Hydroxy, Total",,82306,CPT,Facility,Inpatient,,,,140,119,40.124,140,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Vitamin D 25-Hydroxy, Total",,82306,CPT,Facility,Outpatient,,,,140,119,40.124,140,"UCare Health, Inc.",Medical Assistance,70.658,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Vitamin D 25-Hydroxy, Total",,82306,CPT,Facility,Inpatient,,,,140,119,40.124,140,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Vitamin D 25-Hydroxy, Total",,82306,CPT,Facility,Outpatient,,,,140,119,40.124,140,"UCare Health, Inc.",Medicare Advantage,70.658,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Vitamin D 25-Hydroxy, Total",,82306,CPT,Facility,Inpatient,,,,140,119,40.124,140,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Vitamin D 25-Hydroxy, Total",,82306,CPT,Facility,Outpatient,,,,140,119,40.124,140,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),70.658,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Vitamin D 25-Hydroxy, Total",,82306,CPT,Facility,Inpatient,,,,140,119,40.124,140,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Vitamin D 25-Hydroxy, Total",,82306,CPT,Facility,Both,,,,140,119,40.124,140,UnitedHealthcare,Individual & Family,131.6,94,,percent of total billed charges,,
"Vitamin D 25-Hydroxy, Total",,82306,CPT,Facility,Outpatient,,,,140,119,40.124,140,UnitedHealthcare,Medicare Advantage,68.6,49,,percent of total billed charges,,
"Vitamin D 25-Hydroxy, Total",,82306,CPT,Facility,Inpatient,,,,140,119,40.124,140,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Vitamin D 25-Hydroxy, Total",,82306,CPT,Facility,Outpatient,,,,140,119,40.124,140,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,67.2,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Vitamin D 25-Hydroxy, Total",,82306,CPT,Facility,Inpatient,,,,140,119,40.124,140,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Calcium; Total,,82310,CPT,Facility,Both,,,,65,55.25,18.629,65,Aetna,Commercial,59.8,92,,percent of total billed charges,,
Calcium; Total,,82310,CPT,Facility,Outpatient,,,,65,55.25,18.629,65,Aetna,Medicare Advantage,31.85,49,,percent of total billed charges,,
Calcium; Total,,82310,CPT,Facility,Inpatient,,,,65,55.25,18.629,65,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Calcium; Total,,82310,CPT,Facility,Both,,,,65,55.25,18.629,65,Aetna,PPO,60.45,93,,percent of total billed charges,,
Calcium; Total,,82310,CPT,Facility,Both,,,,65,55.25,18.629,65,America's PPO,America's PPO,62.4195,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Calcium; Total,,82310,CPT,Facility,Both,,,,65,55.25,18.629,65,BlueCross BlueShield Minnesota, Federal Employee Program,63.96,98.4,,percent of total billed charges,,
Calcium; Total,,82310,CPT,Facility,Both,,,,65,55.25,18.629,65,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,65,100,,percent of total billed charges,,
Calcium; Total,,82310,CPT,Facility,Both,,,,65,55.25,18.629,65,BlueCross BlueShield Minnesota,High Value Network Plan,58.5,90,,percent of total billed charges,,
Calcium; Total,,82310,CPT,Facility,Outpatient,,,,65,55.25,18.629,65,BlueCross BlueShield Minnesota,Medicare Advantage,31.85,49,,percent of total billed charges,,
Calcium; Total,,82310,CPT,Facility,Inpatient,,,,65,55.25,18.629,65,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Calcium; Total,,82310,CPT,Facility,Both,,,,65,55.25,18.629,65,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,57.5705,88.57,,percent of total billed charges,,
Calcium; Total,,82310,CPT,Facility,Both,,,,65,55.25,18.629,65,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,18.629,28.66,,percent of total billed charges,,
Calcium; Total,,82310,CPT,Facility,Outpatient,,,,65,55.25,18.629,65,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),31.85,49,,percent of total billed charges,,
Calcium; Total,,82310,CPT,Facility,Inpatient,,,,65,55.25,18.629,65,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Calcium; Total,,82310,CPT,Facility,Both,,,,65,55.25,18.629,65,CorVel,Worker's Compensation,65,100,,percent of total billed charges,,
Calcium; Total,,82310,CPT,Facility,Both,,,,65,55.25,18.629,65,First Health Group Corporation,First Health Network,63.05,97,,percent of total billed charges,,
Calcium; Total,,82310,CPT,Facility,Both,,,,65,55.25,18.629,65,"Health Partners, Inc.",Commercial,61.49,94.6,,percent of total billed charges,,
Calcium; Total,,82310,CPT,Facility,Outpatient,,,,65,55.25,18.629,65,"Health Partners, Inc.",Medicare Advantage,31.85,49,,percent of total billed charges,,
Calcium; Total,,82310,CPT,Facility,Inpatient,,,,65,55.25,18.629,65,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Calcium; Total,,82310,CPT,Facility,Both,,,,65,55.25,18.629,65,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),39,60,,percent of total billed charges,,
Calcium; Total,,82310,CPT,Facility,Both,,,,65,55.25,18.629,65,"Health Partners, Inc.",State of Minnesota Advantage Program,52.975,81.5,,percent of total billed charges,,
Calcium; Total,,82310,CPT,Facility,Both,,,,65,55.25,18.629,65,"Health Partners, Inc.",State Public Programs,32.5,50,,percent of total billed charges,,
Calcium; Total,,82310,CPT,Facility,Both,,,,65,55.25,18.629,65,Humana Insurance Company,Commercial PPO,61.75,95,,percent of total billed charges,,
Calcium; Total,,82310,CPT,Facility,Outpatient,,,,65,55.25,18.629,65,Humana Insurance Company,Medicare PPO,31.85,49,,percent of total billed charges,,
Calcium; Total,,82310,CPT,Facility,Inpatient,,,,65,55.25,18.629,65,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Calcium; Total,,82310,CPT,Facility,Both,,,,65,55.25,18.629,65,Medica,Individual & Family,64.415,99.1,,percent of total billed charges,,
Calcium; Total,,82310,CPT,Facility,Outpatient,,,,65,55.25,18.629,65,Medica,Medica Advantage Solution,32.37,49.8,,percent of total billed charges,,
Calcium; Total,,82310,CPT,Facility,Inpatient,,,,65,55.25,18.629,65,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Calcium; Total,,82310,CPT,Facility,Outpatient,,,,65,55.25,18.629,65,Medica,Medical Assistance,28.99,44.6,,percent of total billed charges,,
Calcium; Total,,82310,CPT,Facility,Inpatient,,,,65,55.25,18.629,65,Medica,Medical Assistance,,,,,Included in per diem rate,
Calcium; Total,,82310,CPT,Facility,Outpatient,,,,65,55.25,18.629,65,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,32.37,49.8,,percent of total billed charges,,
Calcium; Total,,82310,CPT,Facility,Inpatient,,,,65,55.25,18.629,65,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Calcium; Total,,82310,CPT,Facility,Both,,,,65,55.25,18.629,65,"Multiplan, Inc.","Multiplan, Inc.",61.1,94,,percent of total billed charges,,
Calcium; Total,,82310,CPT,Facility,Outpatient,,,,65,55.25,18.629,65,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,56.16,86.4,,percent of total billed charges,,
Calcium; Total,,82310,CPT,Facility,Inpatient,,,,65,55.25,18.629,65,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Calcium; Total,,82310,CPT,Facility,Both,,,,65,55.25,18.629,65,"Preferred One Administrative Services, INC.",PPO,64.09,98.6,,percent of total billed charges,,
Calcium; Total,,82310,CPT,Facility,Outpatient,,,,65,55.25,18.629,65,PrimeWest Health,Minnesota Senior Health Options (MSHO),33.4425,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Calcium; Total,,82310,CPT,Facility,Inpatient,,,,65,55.25,18.629,65,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Calcium; Total,,82310,CPT,Facility,Outpatient,,,,65,55.25,18.629,65,PrimeWest Health,MinnesotaCare,33.384,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Calcium; Total,,82310,CPT,Facility,Inpatient,,,,65,55.25,18.629,65,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Calcium; Total,,82310,CPT,Facility,Both,,,,65,55.25,18.629,65,Sanford Health Plan,Sanford Health Plan,59.8,92,,percent of total billed charges,,
Calcium; Total,,82310,CPT,Facility,Outpatient,,,,65,55.25,18.629,65,"UCare Health, Inc.",Individual & Family Plan,36.6275,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Calcium; Total,,82310,CPT,Facility,Inpatient,,,,65,55.25,18.629,65,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Calcium; Total,,82310,CPT,Facility,Outpatient,,,,65,55.25,18.629,65,"UCare Health, Inc.",Medical Assistance,32.8055,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Calcium; Total,,82310,CPT,Facility,Inpatient,,,,65,55.25,18.629,65,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Calcium; Total,,82310,CPT,Facility,Outpatient,,,,65,55.25,18.629,65,"UCare Health, Inc.",Medicare Advantage,32.8055,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Calcium; Total,,82310,CPT,Facility,Inpatient,,,,65,55.25,18.629,65,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Calcium; Total,,82310,CPT,Facility,Outpatient,,,,65,55.25,18.629,65,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),32.8055,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Calcium; Total,,82310,CPT,Facility,Inpatient,,,,65,55.25,18.629,65,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Calcium; Total,,82310,CPT,Facility,Both,,,,65,55.25,18.629,65,UnitedHealthcare,Individual & Family,61.1,94,,percent of total billed charges,,
Calcium; Total,,82310,CPT,Facility,Outpatient,,,,65,55.25,18.629,65,UnitedHealthcare,Medicare Advantage,31.85,49,,percent of total billed charges,,
Calcium; Total,,82310,CPT,Facility,Inpatient,,,,65,55.25,18.629,65,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Calcium; Total,,82310,CPT,Facility,Outpatient,,,,65,55.25,18.629,65,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,31.2,48,,percent of total billed charges,,100% of DHS outpatient percentage
Calcium; Total,,82310,CPT,Facility,Inpatient,,,,65,55.25,18.629,65,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Calcium Ionized,,82330,CPT,Facility,Both,,,,123,104.55,35.2518,123,Aetna,Commercial,113.16,92,,percent of total billed charges,,
Calcium Ionized,,82330,CPT,Facility,Outpatient,,,,123,104.55,35.2518,123,Aetna,Medicare Advantage,60.27,49,,percent of total billed charges,,
Calcium Ionized,,82330,CPT,Facility,Inpatient,,,,123,104.55,35.2518,123,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Calcium Ionized,,82330,CPT,Facility,Both,,,,123,104.55,35.2518,123,Aetna,PPO,114.39,93,,percent of total billed charges,,
Calcium Ionized,,82330,CPT,Facility,Both,,,,123,104.55,35.2518,123,America's PPO,America's PPO,118.1169,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Calcium Ionized,,82330,CPT,Facility,Both,,,,123,104.55,35.2518,123,BlueCross BlueShield Minnesota, Federal Employee Program,121.032,98.4,,percent of total billed charges,,
Calcium Ionized,,82330,CPT,Facility,Both,,,,123,104.55,35.2518,123,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,123,100,,percent of total billed charges,,
Calcium Ionized,,82330,CPT,Facility,Both,,,,123,104.55,35.2518,123,BlueCross BlueShield Minnesota,High Value Network Plan,110.7,90,,percent of total billed charges,,
Calcium Ionized,,82330,CPT,Facility,Outpatient,,,,123,104.55,35.2518,123,BlueCross BlueShield Minnesota,Medicare Advantage,60.27,49,,percent of total billed charges,,
Calcium Ionized,,82330,CPT,Facility,Inpatient,,,,123,104.55,35.2518,123,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Calcium Ionized,,82330,CPT,Facility,Both,,,,123,104.55,35.2518,123,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,108.9411,88.57,,percent of total billed charges,,
Calcium Ionized,,82330,CPT,Facility,Both,,,,123,104.55,35.2518,123,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,35.2518,28.66,,percent of total billed charges,,
Calcium Ionized,,82330,CPT,Facility,Outpatient,,,,123,104.55,35.2518,123,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),60.27,49,,percent of total billed charges,,
Calcium Ionized,,82330,CPT,Facility,Inpatient,,,,123,104.55,35.2518,123,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Calcium Ionized,,82330,CPT,Facility,Both,,,,123,104.55,35.2518,123,CorVel,Worker's Compensation,123,100,,percent of total billed charges,,
Calcium Ionized,,82330,CPT,Facility,Both,,,,123,104.55,35.2518,123,First Health Group Corporation,First Health Network,119.31,97,,percent of total billed charges,,
Calcium Ionized,,82330,CPT,Facility,Both,,,,123,104.55,35.2518,123,"Health Partners, Inc.",Commercial,116.358,94.6,,percent of total billed charges,,
Calcium Ionized,,82330,CPT,Facility,Outpatient,,,,123,104.55,35.2518,123,"Health Partners, Inc.",Medicare Advantage,60.27,49,,percent of total billed charges,,
Calcium Ionized,,82330,CPT,Facility,Inpatient,,,,123,104.55,35.2518,123,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Calcium Ionized,,82330,CPT,Facility,Both,,,,123,104.55,35.2518,123,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),73.8,60,,percent of total billed charges,,
Calcium Ionized,,82330,CPT,Facility,Both,,,,123,104.55,35.2518,123,"Health Partners, Inc.",State of Minnesota Advantage Program,100.245,81.5,,percent of total billed charges,,
Calcium Ionized,,82330,CPT,Facility,Both,,,,123,104.55,35.2518,123,"Health Partners, Inc.",State Public Programs,61.5,50,,percent of total billed charges,,
Calcium Ionized,,82330,CPT,Facility,Both,,,,123,104.55,35.2518,123,Humana Insurance Company,Commercial PPO,116.85,95,,percent of total billed charges,,
Calcium Ionized,,82330,CPT,Facility,Outpatient,,,,123,104.55,35.2518,123,Humana Insurance Company,Medicare PPO,60.27,49,,percent of total billed charges,,
Calcium Ionized,,82330,CPT,Facility,Inpatient,,,,123,104.55,35.2518,123,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Calcium Ionized,,82330,CPT,Facility,Both,,,,123,104.55,35.2518,123,Medica,Individual & Family,121.893,99.1,,percent of total billed charges,,
Calcium Ionized,,82330,CPT,Facility,Outpatient,,,,123,104.55,35.2518,123,Medica,Medica Advantage Solution,61.254,49.8,,percent of total billed charges,,
Calcium Ionized,,82330,CPT,Facility,Inpatient,,,,123,104.55,35.2518,123,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Calcium Ionized,,82330,CPT,Facility,Outpatient,,,,123,104.55,35.2518,123,Medica,Medical Assistance,54.858,44.6,,percent of total billed charges,,
Calcium Ionized,,82330,CPT,Facility,Inpatient,,,,123,104.55,35.2518,123,Medica,Medical Assistance,,,,,Included in per diem rate,
Calcium Ionized,,82330,CPT,Facility,Outpatient,,,,123,104.55,35.2518,123,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,61.254,49.8,,percent of total billed charges,,
Calcium Ionized,,82330,CPT,Facility,Inpatient,,,,123,104.55,35.2518,123,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Calcium Ionized,,82330,CPT,Facility,Both,,,,123,104.55,35.2518,123,"Multiplan, Inc.","Multiplan, Inc.",115.62,94,,percent of total billed charges,,
Calcium Ionized,,82330,CPT,Facility,Outpatient,,,,123,104.55,35.2518,123,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,106.272,86.4,,percent of total billed charges,,
Calcium Ionized,,82330,CPT,Facility,Inpatient,,,,123,104.55,35.2518,123,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Calcium Ionized,,82330,CPT,Facility,Both,,,,123,104.55,35.2518,123,"Preferred One Administrative Services, INC.",PPO,121.278,98.6,,percent of total billed charges,,
Calcium Ionized,,82330,CPT,Facility,Outpatient,,,,123,104.55,35.2518,123,PrimeWest Health,Minnesota Senior Health Options (MSHO),63.2835,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Calcium Ionized,,82330,CPT,Facility,Inpatient,,,,123,104.55,35.2518,123,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Calcium Ionized,,82330,CPT,Facility,Outpatient,,,,123,104.55,35.2518,123,PrimeWest Health,MinnesotaCare,63.1728,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Calcium Ionized,,82330,CPT,Facility,Inpatient,,,,123,104.55,35.2518,123,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Calcium Ionized,,82330,CPT,Facility,Both,,,,123,104.55,35.2518,123,Sanford Health Plan,Sanford Health Plan,113.16,92,,percent of total billed charges,,
Calcium Ionized,,82330,CPT,Facility,Outpatient,,,,123,104.55,35.2518,123,"UCare Health, Inc.",Individual & Family Plan,69.3105,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Calcium Ionized,,82330,CPT,Facility,Inpatient,,,,123,104.55,35.2518,123,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Calcium Ionized,,82330,CPT,Facility,Outpatient,,,,123,104.55,35.2518,123,"UCare Health, Inc.",Medical Assistance,62.0781,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Calcium Ionized,,82330,CPT,Facility,Inpatient,,,,123,104.55,35.2518,123,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Calcium Ionized,,82330,CPT,Facility,Outpatient,,,,123,104.55,35.2518,123,"UCare Health, Inc.",Medicare Advantage,62.0781,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Calcium Ionized,,82330,CPT,Facility,Inpatient,,,,123,104.55,35.2518,123,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Calcium Ionized,,82330,CPT,Facility,Outpatient,,,,123,104.55,35.2518,123,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),62.0781,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Calcium Ionized,,82330,CPT,Facility,Inpatient,,,,123,104.55,35.2518,123,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Calcium Ionized,,82330,CPT,Facility,Both,,,,123,104.55,35.2518,123,UnitedHealthcare,Individual & Family,115.62,94,,percent of total billed charges,,
Calcium Ionized,,82330,CPT,Facility,Outpatient,,,,123,104.55,35.2518,123,UnitedHealthcare,Medicare Advantage,60.27,49,,percent of total billed charges,,
Calcium Ionized,,82330,CPT,Facility,Inpatient,,,,123,104.55,35.2518,123,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Calcium Ionized,,82330,CPT,Facility,Outpatient,,,,123,104.55,35.2518,123,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,59.04,48,,percent of total billed charges,,100% of DHS outpatient percentage
Calcium Ionized,,82330,CPT,Facility,Inpatient,,,,123,104.55,35.2518,123,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Calcium, Urine, 24 Hr",,82340,CPT,Facility,Both,,,,59,50.15,16.9094,59,Aetna,Commercial,54.28,92,,percent of total billed charges,,
"Calcium, Urine, 24 Hr",,82340,CPT,Facility,Outpatient,,,,59,50.15,16.9094,59,Aetna,Medicare Advantage,28.91,49,,percent of total billed charges,,
"Calcium, Urine, 24 Hr",,82340,CPT,Facility,Inpatient,,,,59,50.15,16.9094,59,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Calcium, Urine, 24 Hr",,82340,CPT,Facility,Both,,,,59,50.15,16.9094,59,Aetna,PPO,54.87,93,,percent of total billed charges,,
"Calcium, Urine, 24 Hr",,82340,CPT,Facility,Both,,,,59,50.15,16.9094,59,America's PPO,America's PPO,56.6577,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Calcium, Urine, 24 Hr",,82340,CPT,Facility,Both,,,,59,50.15,16.9094,59,BlueCross BlueShield Minnesota, Federal Employee Program,58.056,98.4,,percent of total billed charges,,
"Calcium, Urine, 24 Hr",,82340,CPT,Facility,Both,,,,59,50.15,16.9094,59,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,59,100,,percent of total billed charges,,
"Calcium, Urine, 24 Hr",,82340,CPT,Facility,Both,,,,59,50.15,16.9094,59,BlueCross BlueShield Minnesota,High Value Network Plan,53.1,90,,percent of total billed charges,,
"Calcium, Urine, 24 Hr",,82340,CPT,Facility,Outpatient,,,,59,50.15,16.9094,59,BlueCross BlueShield Minnesota,Medicare Advantage,28.91,49,,percent of total billed charges,,
"Calcium, Urine, 24 Hr",,82340,CPT,Facility,Inpatient,,,,59,50.15,16.9094,59,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Calcium, Urine, 24 Hr",,82340,CPT,Facility,Both,,,,59,50.15,16.9094,59,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,52.2563,88.57,,percent of total billed charges,,
"Calcium, Urine, 24 Hr",,82340,CPT,Facility,Both,,,,59,50.15,16.9094,59,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,16.9094,28.66,,percent of total billed charges,,
"Calcium, Urine, 24 Hr",,82340,CPT,Facility,Outpatient,,,,59,50.15,16.9094,59,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),28.91,49,,percent of total billed charges,,
"Calcium, Urine, 24 Hr",,82340,CPT,Facility,Inpatient,,,,59,50.15,16.9094,59,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Calcium, Urine, 24 Hr",,82340,CPT,Facility,Both,,,,59,50.15,16.9094,59,CorVel,Worker's Compensation,59,100,,percent of total billed charges,,
"Calcium, Urine, 24 Hr",,82340,CPT,Facility,Both,,,,59,50.15,16.9094,59,First Health Group Corporation,First Health Network,57.23,97,,percent of total billed charges,,
"Calcium, Urine, 24 Hr",,82340,CPT,Facility,Both,,,,59,50.15,16.9094,59,"Health Partners, Inc.",Commercial,55.814,94.6,,percent of total billed charges,,
"Calcium, Urine, 24 Hr",,82340,CPT,Facility,Outpatient,,,,59,50.15,16.9094,59,"Health Partners, Inc.",Medicare Advantage,28.91,49,,percent of total billed charges,,
"Calcium, Urine, 24 Hr",,82340,CPT,Facility,Inpatient,,,,59,50.15,16.9094,59,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Calcium, Urine, 24 Hr",,82340,CPT,Facility,Both,,,,59,50.15,16.9094,59,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),35.4,60,,percent of total billed charges,,
"Calcium, Urine, 24 Hr",,82340,CPT,Facility,Both,,,,59,50.15,16.9094,59,"Health Partners, Inc.",State of Minnesota Advantage Program,48.085,81.5,,percent of total billed charges,,
"Calcium, Urine, 24 Hr",,82340,CPT,Facility,Both,,,,59,50.15,16.9094,59,"Health Partners, Inc.",State Public Programs,29.5,50,,percent of total billed charges,,
"Calcium, Urine, 24 Hr",,82340,CPT,Facility,Both,,,,59,50.15,16.9094,59,Humana Insurance Company,Commercial PPO,56.05,95,,percent of total billed charges,,
"Calcium, Urine, 24 Hr",,82340,CPT,Facility,Outpatient,,,,59,50.15,16.9094,59,Humana Insurance Company,Medicare PPO,28.91,49,,percent of total billed charges,,
"Calcium, Urine, 24 Hr",,82340,CPT,Facility,Inpatient,,,,59,50.15,16.9094,59,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Calcium, Urine, 24 Hr",,82340,CPT,Facility,Both,,,,59,50.15,16.9094,59,Medica,Individual & Family,58.469,99.1,,percent of total billed charges,,
"Calcium, Urine, 24 Hr",,82340,CPT,Facility,Outpatient,,,,59,50.15,16.9094,59,Medica,Medica Advantage Solution,29.382,49.8,,percent of total billed charges,,
"Calcium, Urine, 24 Hr",,82340,CPT,Facility,Inpatient,,,,59,50.15,16.9094,59,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Calcium, Urine, 24 Hr",,82340,CPT,Facility,Outpatient,,,,59,50.15,16.9094,59,Medica,Medical Assistance,26.314,44.6,,percent of total billed charges,,
"Calcium, Urine, 24 Hr",,82340,CPT,Facility,Inpatient,,,,59,50.15,16.9094,59,Medica,Medical Assistance,,,,,Included in per diem rate,
"Calcium, Urine, 24 Hr",,82340,CPT,Facility,Outpatient,,,,59,50.15,16.9094,59,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,29.382,49.8,,percent of total billed charges,,
"Calcium, Urine, 24 Hr",,82340,CPT,Facility,Inpatient,,,,59,50.15,16.9094,59,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Calcium, Urine, 24 Hr",,82340,CPT,Facility,Both,,,,59,50.15,16.9094,59,"Multiplan, Inc.","Multiplan, Inc.",55.46,94,,percent of total billed charges,,
"Calcium, Urine, 24 Hr",,82340,CPT,Facility,Outpatient,,,,59,50.15,16.9094,59,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,50.976,86.4,,percent of total billed charges,,
"Calcium, Urine, 24 Hr",,82340,CPT,Facility,Inpatient,,,,59,50.15,16.9094,59,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Calcium, Urine, 24 Hr",,82340,CPT,Facility,Both,,,,59,50.15,16.9094,59,"Preferred One Administrative Services, INC.",PPO,58.174,98.6,,percent of total billed charges,,
"Calcium, Urine, 24 Hr",,82340,CPT,Facility,Outpatient,,,,59,50.15,16.9094,59,PrimeWest Health,Minnesota Senior Health Options (MSHO),30.3555,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Calcium, Urine, 24 Hr",,82340,CPT,Facility,Inpatient,,,,59,50.15,16.9094,59,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Calcium, Urine, 24 Hr",,82340,CPT,Facility,Outpatient,,,,59,50.15,16.9094,59,PrimeWest Health,MinnesotaCare,30.3024,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Calcium, Urine, 24 Hr",,82340,CPT,Facility,Inpatient,,,,59,50.15,16.9094,59,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Calcium, Urine, 24 Hr",,82340,CPT,Facility,Both,,,,59,50.15,16.9094,59,Sanford Health Plan,Sanford Health Plan,54.28,92,,percent of total billed charges,,
"Calcium, Urine, 24 Hr",,82340,CPT,Facility,Outpatient,,,,59,50.15,16.9094,59,"UCare Health, Inc.",Individual & Family Plan,33.2465,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Calcium, Urine, 24 Hr",,82340,CPT,Facility,Inpatient,,,,59,50.15,16.9094,59,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Calcium, Urine, 24 Hr",,82340,CPT,Facility,Outpatient,,,,59,50.15,16.9094,59,"UCare Health, Inc.",Medical Assistance,29.7773,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Calcium, Urine, 24 Hr",,82340,CPT,Facility,Inpatient,,,,59,50.15,16.9094,59,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Calcium, Urine, 24 Hr",,82340,CPT,Facility,Outpatient,,,,59,50.15,16.9094,59,"UCare Health, Inc.",Medicare Advantage,29.7773,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Calcium, Urine, 24 Hr",,82340,CPT,Facility,Inpatient,,,,59,50.15,16.9094,59,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Calcium, Urine, 24 Hr",,82340,CPT,Facility,Outpatient,,,,59,50.15,16.9094,59,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),29.7773,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Calcium, Urine, 24 Hr",,82340,CPT,Facility,Inpatient,,,,59,50.15,16.9094,59,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Calcium, Urine, 24 Hr",,82340,CPT,Facility,Both,,,,59,50.15,16.9094,59,UnitedHealthcare,Individual & Family,55.46,94,,percent of total billed charges,,
"Calcium, Urine, 24 Hr",,82340,CPT,Facility,Outpatient,,,,59,50.15,16.9094,59,UnitedHealthcare,Medicare Advantage,28.91,49,,percent of total billed charges,,
"Calcium, Urine, 24 Hr",,82340,CPT,Facility,Inpatient,,,,59,50.15,16.9094,59,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Calcium, Urine, 24 Hr",,82340,CPT,Facility,Outpatient,,,,59,50.15,16.9094,59,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,28.32,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Calcium, Urine, 24 Hr",,82340,CPT,Facility,Inpatient,,,,59,50.15,16.9094,59,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Calcium, Urine, Random",,82340,CPT,Facility,Both,,,,112,95.2,32.0992,112,Aetna,Commercial,103.04,92,,percent of total billed charges,,
"Calcium, Urine, Random",,82340,CPT,Facility,Outpatient,,,,112,95.2,32.0992,112,Aetna,Medicare Advantage,54.88,49,,percent of total billed charges,,
"Calcium, Urine, Random",,82340,CPT,Facility,Inpatient,,,,112,95.2,32.0992,112,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Calcium, Urine, Random",,82340,CPT,Facility,Both,,,,112,95.2,32.0992,112,Aetna,PPO,104.16,93,,percent of total billed charges,,
"Calcium, Urine, Random",,82340,CPT,Facility,Both,,,,112,95.2,32.0992,112,America's PPO,America's PPO,107.5536,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Calcium, Urine, Random",,82340,CPT,Facility,Both,,,,112,95.2,32.0992,112,BlueCross BlueShield Minnesota, Federal Employee Program,110.208,98.4,,percent of total billed charges,,
"Calcium, Urine, Random",,82340,CPT,Facility,Both,,,,112,95.2,32.0992,112,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,112,100,,percent of total billed charges,,
"Calcium, Urine, Random",,82340,CPT,Facility,Both,,,,112,95.2,32.0992,112,BlueCross BlueShield Minnesota,High Value Network Plan,100.8,90,,percent of total billed charges,,
"Calcium, Urine, Random",,82340,CPT,Facility,Outpatient,,,,112,95.2,32.0992,112,BlueCross BlueShield Minnesota,Medicare Advantage,54.88,49,,percent of total billed charges,,
"Calcium, Urine, Random",,82340,CPT,Facility,Inpatient,,,,112,95.2,32.0992,112,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Calcium, Urine, Random",,82340,CPT,Facility,Both,,,,112,95.2,32.0992,112,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,99.1984,88.57,,percent of total billed charges,,
"Calcium, Urine, Random",,82340,CPT,Facility,Both,,,,112,95.2,32.0992,112,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,32.0992,28.66,,percent of total billed charges,,
"Calcium, Urine, Random",,82340,CPT,Facility,Outpatient,,,,112,95.2,32.0992,112,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),54.88,49,,percent of total billed charges,,
"Calcium, Urine, Random",,82340,CPT,Facility,Inpatient,,,,112,95.2,32.0992,112,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Calcium, Urine, Random",,82340,CPT,Facility,Both,,,,112,95.2,32.0992,112,CorVel,Worker's Compensation,112,100,,percent of total billed charges,,
"Calcium, Urine, Random",,82340,CPT,Facility,Both,,,,112,95.2,32.0992,112,First Health Group Corporation,First Health Network,108.64,97,,percent of total billed charges,,
"Calcium, Urine, Random",,82340,CPT,Facility,Both,,,,112,95.2,32.0992,112,"Health Partners, Inc.",Commercial,105.952,94.6,,percent of total billed charges,,
"Calcium, Urine, Random",,82340,CPT,Facility,Outpatient,,,,112,95.2,32.0992,112,"Health Partners, Inc.",Medicare Advantage,54.88,49,,percent of total billed charges,,
"Calcium, Urine, Random",,82340,CPT,Facility,Inpatient,,,,112,95.2,32.0992,112,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Calcium, Urine, Random",,82340,CPT,Facility,Both,,,,112,95.2,32.0992,112,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),67.2,60,,percent of total billed charges,,
"Calcium, Urine, Random",,82340,CPT,Facility,Both,,,,112,95.2,32.0992,112,"Health Partners, Inc.",State of Minnesota Advantage Program,91.28,81.5,,percent of total billed charges,,
"Calcium, Urine, Random",,82340,CPT,Facility,Both,,,,112,95.2,32.0992,112,"Health Partners, Inc.",State Public Programs,56,50,,percent of total billed charges,,
"Calcium, Urine, Random",,82340,CPT,Facility,Both,,,,112,95.2,32.0992,112,Humana Insurance Company,Commercial PPO,106.4,95,,percent of total billed charges,,
"Calcium, Urine, Random",,82340,CPT,Facility,Outpatient,,,,112,95.2,32.0992,112,Humana Insurance Company,Medicare PPO,54.88,49,,percent of total billed charges,,
"Calcium, Urine, Random",,82340,CPT,Facility,Inpatient,,,,112,95.2,32.0992,112,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Calcium, Urine, Random",,82340,CPT,Facility,Both,,,,112,95.2,32.0992,112,Medica,Individual & Family,110.992,99.1,,percent of total billed charges,,
"Calcium, Urine, Random",,82340,CPT,Facility,Outpatient,,,,112,95.2,32.0992,112,Medica,Medica Advantage Solution,55.776,49.8,,percent of total billed charges,,
"Calcium, Urine, Random",,82340,CPT,Facility,Inpatient,,,,112,95.2,32.0992,112,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Calcium, Urine, Random",,82340,CPT,Facility,Outpatient,,,,112,95.2,32.0992,112,Medica,Medical Assistance,49.952,44.6,,percent of total billed charges,,
"Calcium, Urine, Random",,82340,CPT,Facility,Inpatient,,,,112,95.2,32.0992,112,Medica,Medical Assistance,,,,,Included in per diem rate,
"Calcium, Urine, Random",,82340,CPT,Facility,Outpatient,,,,112,95.2,32.0992,112,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,55.776,49.8,,percent of total billed charges,,
"Calcium, Urine, Random",,82340,CPT,Facility,Inpatient,,,,112,95.2,32.0992,112,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Calcium, Urine, Random",,82340,CPT,Facility,Both,,,,112,95.2,32.0992,112,"Multiplan, Inc.","Multiplan, Inc.",105.28,94,,percent of total billed charges,,
"Calcium, Urine, Random",,82340,CPT,Facility,Outpatient,,,,112,95.2,32.0992,112,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,96.768,86.4,,percent of total billed charges,,
"Calcium, Urine, Random",,82340,CPT,Facility,Inpatient,,,,112,95.2,32.0992,112,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Calcium, Urine, Random",,82340,CPT,Facility,Both,,,,112,95.2,32.0992,112,"Preferred One Administrative Services, INC.",PPO,110.432,98.6,,percent of total billed charges,,
"Calcium, Urine, Random",,82340,CPT,Facility,Outpatient,,,,112,95.2,32.0992,112,PrimeWest Health,Minnesota Senior Health Options (MSHO),57.624,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Calcium, Urine, Random",,82340,CPT,Facility,Inpatient,,,,112,95.2,32.0992,112,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Calcium, Urine, Random",,82340,CPT,Facility,Outpatient,,,,112,95.2,32.0992,112,PrimeWest Health,MinnesotaCare,57.5232,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Calcium, Urine, Random",,82340,CPT,Facility,Inpatient,,,,112,95.2,32.0992,112,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Calcium, Urine, Random",,82340,CPT,Facility,Both,,,,112,95.2,32.0992,112,Sanford Health Plan,Sanford Health Plan,103.04,92,,percent of total billed charges,,
"Calcium, Urine, Random",,82340,CPT,Facility,Outpatient,,,,112,95.2,32.0992,112,"UCare Health, Inc.",Individual & Family Plan,63.112,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Calcium, Urine, Random",,82340,CPT,Facility,Inpatient,,,,112,95.2,32.0992,112,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Calcium, Urine, Random",,82340,CPT,Facility,Outpatient,,,,112,95.2,32.0992,112,"UCare Health, Inc.",Medical Assistance,56.5264,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Calcium, Urine, Random",,82340,CPT,Facility,Inpatient,,,,112,95.2,32.0992,112,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Calcium, Urine, Random",,82340,CPT,Facility,Outpatient,,,,112,95.2,32.0992,112,"UCare Health, Inc.",Medicare Advantage,56.5264,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Calcium, Urine, Random",,82340,CPT,Facility,Inpatient,,,,112,95.2,32.0992,112,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Calcium, Urine, Random",,82340,CPT,Facility,Outpatient,,,,112,95.2,32.0992,112,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),56.5264,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Calcium, Urine, Random",,82340,CPT,Facility,Inpatient,,,,112,95.2,32.0992,112,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Calcium, Urine, Random",,82340,CPT,Facility,Both,,,,112,95.2,32.0992,112,UnitedHealthcare,Individual & Family,105.28,94,,percent of total billed charges,,
"Calcium, Urine, Random",,82340,CPT,Facility,Outpatient,,,,112,95.2,32.0992,112,UnitedHealthcare,Medicare Advantage,54.88,49,,percent of total billed charges,,
"Calcium, Urine, Random",,82340,CPT,Facility,Inpatient,,,,112,95.2,32.0992,112,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Calcium, Urine, Random",,82340,CPT,Facility,Outpatient,,,,112,95.2,32.0992,112,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,53.76,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Calcium, Urine, Random",,82340,CPT,Facility,Inpatient,,,,112,95.2,32.0992,112,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Carbon Dioxide, Total",,82374,CPT,Facility,Both,,,,72,61.2,20.6352,72,Aetna,Commercial,66.24,92,,percent of total billed charges,,
"Carbon Dioxide, Total",,82374,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,Aetna,Medicare Advantage,35.28,49,,percent of total billed charges,,
"Carbon Dioxide, Total",,82374,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Carbon Dioxide, Total",,82374,CPT,Facility,Both,,,,72,61.2,20.6352,72,Aetna,PPO,66.96,93,,percent of total billed charges,,
"Carbon Dioxide, Total",,82374,CPT,Facility,Both,,,,72,61.2,20.6352,72,America's PPO,America's PPO,69.1416,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Carbon Dioxide, Total",,82374,CPT,Facility,Both,,,,72,61.2,20.6352,72,BlueCross BlueShield Minnesota, Federal Employee Program,70.848,98.4,,percent of total billed charges,,
"Carbon Dioxide, Total",,82374,CPT,Facility,Both,,,,72,61.2,20.6352,72,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,72,100,,percent of total billed charges,,
"Carbon Dioxide, Total",,82374,CPT,Facility,Both,,,,72,61.2,20.6352,72,BlueCross BlueShield Minnesota,High Value Network Plan,64.8,90,,percent of total billed charges,,
"Carbon Dioxide, Total",,82374,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,BlueCross BlueShield Minnesota,Medicare Advantage,35.28,49,,percent of total billed charges,,
"Carbon Dioxide, Total",,82374,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Carbon Dioxide, Total",,82374,CPT,Facility,Both,,,,72,61.2,20.6352,72,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,63.7704,88.57,,percent of total billed charges,,
"Carbon Dioxide, Total",,82374,CPT,Facility,Both,,,,72,61.2,20.6352,72,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,20.6352,28.66,,percent of total billed charges,,
"Carbon Dioxide, Total",,82374,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),35.28,49,,percent of total billed charges,,
"Carbon Dioxide, Total",,82374,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Carbon Dioxide, Total",,82374,CPT,Facility,Both,,,,72,61.2,20.6352,72,CorVel,Worker's Compensation,72,100,,percent of total billed charges,,
"Carbon Dioxide, Total",,82374,CPT,Facility,Both,,,,72,61.2,20.6352,72,First Health Group Corporation,First Health Network,69.84,97,,percent of total billed charges,,
"Carbon Dioxide, Total",,82374,CPT,Facility,Both,,,,72,61.2,20.6352,72,"Health Partners, Inc.",Commercial,68.112,94.6,,percent of total billed charges,,
"Carbon Dioxide, Total",,82374,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,"Health Partners, Inc.",Medicare Advantage,35.28,49,,percent of total billed charges,,
"Carbon Dioxide, Total",,82374,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Carbon Dioxide, Total",,82374,CPT,Facility,Both,,,,72,61.2,20.6352,72,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),43.2,60,,percent of total billed charges,,
"Carbon Dioxide, Total",,82374,CPT,Facility,Both,,,,72,61.2,20.6352,72,"Health Partners, Inc.",State of Minnesota Advantage Program,58.68,81.5,,percent of total billed charges,,
"Carbon Dioxide, Total",,82374,CPT,Facility,Both,,,,72,61.2,20.6352,72,"Health Partners, Inc.",State Public Programs,36,50,,percent of total billed charges,,
"Carbon Dioxide, Total",,82374,CPT,Facility,Both,,,,72,61.2,20.6352,72,Humana Insurance Company,Commercial PPO,68.4,95,,percent of total billed charges,,
"Carbon Dioxide, Total",,82374,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,Humana Insurance Company,Medicare PPO,35.28,49,,percent of total billed charges,,
"Carbon Dioxide, Total",,82374,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Carbon Dioxide, Total",,82374,CPT,Facility,Both,,,,72,61.2,20.6352,72,Medica,Individual & Family,71.352,99.1,,percent of total billed charges,,
"Carbon Dioxide, Total",,82374,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,Medica,Medica Advantage Solution,35.856,49.8,,percent of total billed charges,,
"Carbon Dioxide, Total",,82374,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Carbon Dioxide, Total",,82374,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,Medica,Medical Assistance,32.112,44.6,,percent of total billed charges,,
"Carbon Dioxide, Total",,82374,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,Medica,Medical Assistance,,,,,Included in per diem rate,
"Carbon Dioxide, Total",,82374,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,35.856,49.8,,percent of total billed charges,,
"Carbon Dioxide, Total",,82374,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Carbon Dioxide, Total",,82374,CPT,Facility,Both,,,,72,61.2,20.6352,72,"Multiplan, Inc.","Multiplan, Inc.",67.68,94,,percent of total billed charges,,
"Carbon Dioxide, Total",,82374,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,62.208,86.4,,percent of total billed charges,,
"Carbon Dioxide, Total",,82374,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Carbon Dioxide, Total",,82374,CPT,Facility,Both,,,,72,61.2,20.6352,72,"Preferred One Administrative Services, INC.",PPO,70.992,98.6,,percent of total billed charges,,
"Carbon Dioxide, Total",,82374,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,PrimeWest Health,Minnesota Senior Health Options (MSHO),37.044,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Carbon Dioxide, Total",,82374,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Carbon Dioxide, Total",,82374,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,PrimeWest Health,MinnesotaCare,36.9792,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Carbon Dioxide, Total",,82374,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Carbon Dioxide, Total",,82374,CPT,Facility,Both,,,,72,61.2,20.6352,72,Sanford Health Plan,Sanford Health Plan,66.24,92,,percent of total billed charges,,
"Carbon Dioxide, Total",,82374,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,"UCare Health, Inc.",Individual & Family Plan,40.572,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Carbon Dioxide, Total",,82374,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Carbon Dioxide, Total",,82374,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,"UCare Health, Inc.",Medical Assistance,36.3384,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Carbon Dioxide, Total",,82374,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Carbon Dioxide, Total",,82374,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,"UCare Health, Inc.",Medicare Advantage,36.3384,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Carbon Dioxide, Total",,82374,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Carbon Dioxide, Total",,82374,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),36.3384,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Carbon Dioxide, Total",,82374,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Carbon Dioxide, Total",,82374,CPT,Facility,Both,,,,72,61.2,20.6352,72,UnitedHealthcare,Individual & Family,67.68,94,,percent of total billed charges,,
"Carbon Dioxide, Total",,82374,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,UnitedHealthcare,Medicare Advantage,35.28,49,,percent of total billed charges,,
"Carbon Dioxide, Total",,82374,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Carbon Dioxide, Total",,82374,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,34.56,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Carbon Dioxide, Total",,82374,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Carboxyhemoglobin,,82375,CPT,Facility,Both,,,,105,89.25,30.093,105,Aetna,Commercial,96.6,92,,percent of total billed charges,,
Carboxyhemoglobin,,82375,CPT,Facility,Outpatient,,,,105,89.25,30.093,105,Aetna,Medicare Advantage,51.45,49,,percent of total billed charges,,
Carboxyhemoglobin,,82375,CPT,Facility,Inpatient,,,,105,89.25,30.093,105,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Carboxyhemoglobin,,82375,CPT,Facility,Both,,,,105,89.25,30.093,105,Aetna,PPO,97.65,93,,percent of total billed charges,,
Carboxyhemoglobin,,82375,CPT,Facility,Both,,,,105,89.25,30.093,105,America's PPO,America's PPO,100.8315,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Carboxyhemoglobin,,82375,CPT,Facility,Both,,,,105,89.25,30.093,105,BlueCross BlueShield Minnesota, Federal Employee Program,103.32,98.4,,percent of total billed charges,,
Carboxyhemoglobin,,82375,CPT,Facility,Both,,,,105,89.25,30.093,105,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,105,100,,percent of total billed charges,,
Carboxyhemoglobin,,82375,CPT,Facility,Both,,,,105,89.25,30.093,105,BlueCross BlueShield Minnesota,High Value Network Plan,94.5,90,,percent of total billed charges,,
Carboxyhemoglobin,,82375,CPT,Facility,Outpatient,,,,105,89.25,30.093,105,BlueCross BlueShield Minnesota,Medicare Advantage,51.45,49,,percent of total billed charges,,
Carboxyhemoglobin,,82375,CPT,Facility,Inpatient,,,,105,89.25,30.093,105,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Carboxyhemoglobin,,82375,CPT,Facility,Both,,,,105,89.25,30.093,105,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,92.9985,88.57,,percent of total billed charges,,
Carboxyhemoglobin,,82375,CPT,Facility,Both,,,,105,89.25,30.093,105,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,30.093,28.66,,percent of total billed charges,,
Carboxyhemoglobin,,82375,CPT,Facility,Outpatient,,,,105,89.25,30.093,105,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),51.45,49,,percent of total billed charges,,
Carboxyhemoglobin,,82375,CPT,Facility,Inpatient,,,,105,89.25,30.093,105,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Carboxyhemoglobin,,82375,CPT,Facility,Both,,,,105,89.25,30.093,105,CorVel,Worker's Compensation,105,100,,percent of total billed charges,,
Carboxyhemoglobin,,82375,CPT,Facility,Both,,,,105,89.25,30.093,105,First Health Group Corporation,First Health Network,101.85,97,,percent of total billed charges,,
Carboxyhemoglobin,,82375,CPT,Facility,Both,,,,105,89.25,30.093,105,"Health Partners, Inc.",Commercial,99.33,94.6,,percent of total billed charges,,
Carboxyhemoglobin,,82375,CPT,Facility,Outpatient,,,,105,89.25,30.093,105,"Health Partners, Inc.",Medicare Advantage,51.45,49,,percent of total billed charges,,
Carboxyhemoglobin,,82375,CPT,Facility,Inpatient,,,,105,89.25,30.093,105,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Carboxyhemoglobin,,82375,CPT,Facility,Both,,,,105,89.25,30.093,105,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),63,60,,percent of total billed charges,,
Carboxyhemoglobin,,82375,CPT,Facility,Both,,,,105,89.25,30.093,105,"Health Partners, Inc.",State of Minnesota Advantage Program,85.575,81.5,,percent of total billed charges,,
Carboxyhemoglobin,,82375,CPT,Facility,Both,,,,105,89.25,30.093,105,"Health Partners, Inc.",State Public Programs,52.5,50,,percent of total billed charges,,
Carboxyhemoglobin,,82375,CPT,Facility,Both,,,,105,89.25,30.093,105,Humana Insurance Company,Commercial PPO,99.75,95,,percent of total billed charges,,
Carboxyhemoglobin,,82375,CPT,Facility,Outpatient,,,,105,89.25,30.093,105,Humana Insurance Company,Medicare PPO,51.45,49,,percent of total billed charges,,
Carboxyhemoglobin,,82375,CPT,Facility,Inpatient,,,,105,89.25,30.093,105,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Carboxyhemoglobin,,82375,CPT,Facility,Both,,,,105,89.25,30.093,105,Medica,Individual & Family,104.055,99.1,,percent of total billed charges,,
Carboxyhemoglobin,,82375,CPT,Facility,Outpatient,,,,105,89.25,30.093,105,Medica,Medica Advantage Solution,52.29,49.8,,percent of total billed charges,,
Carboxyhemoglobin,,82375,CPT,Facility,Inpatient,,,,105,89.25,30.093,105,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Carboxyhemoglobin,,82375,CPT,Facility,Outpatient,,,,105,89.25,30.093,105,Medica,Medical Assistance,46.83,44.6,,percent of total billed charges,,
Carboxyhemoglobin,,82375,CPT,Facility,Inpatient,,,,105,89.25,30.093,105,Medica,Medical Assistance,,,,,Included in per diem rate,
Carboxyhemoglobin,,82375,CPT,Facility,Outpatient,,,,105,89.25,30.093,105,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,52.29,49.8,,percent of total billed charges,,
Carboxyhemoglobin,,82375,CPT,Facility,Inpatient,,,,105,89.25,30.093,105,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Carboxyhemoglobin,,82375,CPT,Facility,Both,,,,105,89.25,30.093,105,"Multiplan, Inc.","Multiplan, Inc.",98.7,94,,percent of total billed charges,,
Carboxyhemoglobin,,82375,CPT,Facility,Outpatient,,,,105,89.25,30.093,105,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,90.72,86.4,,percent of total billed charges,,
Carboxyhemoglobin,,82375,CPT,Facility,Inpatient,,,,105,89.25,30.093,105,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Carboxyhemoglobin,,82375,CPT,Facility,Both,,,,105,89.25,30.093,105,"Preferred One Administrative Services, INC.",PPO,103.53,98.6,,percent of total billed charges,,
Carboxyhemoglobin,,82375,CPT,Facility,Outpatient,,,,105,89.25,30.093,105,PrimeWest Health,Minnesota Senior Health Options (MSHO),54.0225,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Carboxyhemoglobin,,82375,CPT,Facility,Inpatient,,,,105,89.25,30.093,105,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Carboxyhemoglobin,,82375,CPT,Facility,Outpatient,,,,105,89.25,30.093,105,PrimeWest Health,MinnesotaCare,53.928,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Carboxyhemoglobin,,82375,CPT,Facility,Inpatient,,,,105,89.25,30.093,105,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Carboxyhemoglobin,,82375,CPT,Facility,Both,,,,105,89.25,30.093,105,Sanford Health Plan,Sanford Health Plan,96.6,92,,percent of total billed charges,,
Carboxyhemoglobin,,82375,CPT,Facility,Outpatient,,,,105,89.25,30.093,105,"UCare Health, Inc.",Individual & Family Plan,59.1675,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Carboxyhemoglobin,,82375,CPT,Facility,Inpatient,,,,105,89.25,30.093,105,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Carboxyhemoglobin,,82375,CPT,Facility,Outpatient,,,,105,89.25,30.093,105,"UCare Health, Inc.",Medical Assistance,52.9935,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Carboxyhemoglobin,,82375,CPT,Facility,Inpatient,,,,105,89.25,30.093,105,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Carboxyhemoglobin,,82375,CPT,Facility,Outpatient,,,,105,89.25,30.093,105,"UCare Health, Inc.",Medicare Advantage,52.9935,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Carboxyhemoglobin,,82375,CPT,Facility,Inpatient,,,,105,89.25,30.093,105,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Carboxyhemoglobin,,82375,CPT,Facility,Outpatient,,,,105,89.25,30.093,105,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),52.9935,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Carboxyhemoglobin,,82375,CPT,Facility,Inpatient,,,,105,89.25,30.093,105,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Carboxyhemoglobin,,82375,CPT,Facility,Both,,,,105,89.25,30.093,105,UnitedHealthcare,Individual & Family,98.7,94,,percent of total billed charges,,
Carboxyhemoglobin,,82375,CPT,Facility,Outpatient,,,,105,89.25,30.093,105,UnitedHealthcare,Medicare Advantage,51.45,49,,percent of total billed charges,,
Carboxyhemoglobin,,82375,CPT,Facility,Inpatient,,,,105,89.25,30.093,105,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Carboxyhemoglobin,,82375,CPT,Facility,Outpatient,,,,105,89.25,30.093,105,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,50.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
Carboxyhemoglobin,,82375,CPT,Facility,Inpatient,,,,105,89.25,30.093,105,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Carcinoembryonic Ag, Serum Or Plasma",,82378,CPT,Facility,Both,,,,157,133.45,44.9962,157,Aetna,Commercial,144.44,92,,percent of total billed charges,,
"Carcinoembryonic Ag, Serum Or Plasma",,82378,CPT,Facility,Outpatient,,,,157,133.45,44.9962,157,Aetna,Medicare Advantage,76.93,49,,percent of total billed charges,,
"Carcinoembryonic Ag, Serum Or Plasma",,82378,CPT,Facility,Inpatient,,,,157,133.45,44.9962,157,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Carcinoembryonic Ag, Serum Or Plasma",,82378,CPT,Facility,Both,,,,157,133.45,44.9962,157,Aetna,PPO,146.01,93,,percent of total billed charges,,
"Carcinoembryonic Ag, Serum Or Plasma",,82378,CPT,Facility,Both,,,,157,133.45,44.9962,157,America's PPO,America's PPO,150.7671,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Carcinoembryonic Ag, Serum Or Plasma",,82378,CPT,Facility,Both,,,,157,133.45,44.9962,157,BlueCross BlueShield Minnesota, Federal Employee Program,154.488,98.4,,percent of total billed charges,,
"Carcinoembryonic Ag, Serum Or Plasma",,82378,CPT,Facility,Both,,,,157,133.45,44.9962,157,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,157,100,,percent of total billed charges,,
"Carcinoembryonic Ag, Serum Or Plasma",,82378,CPT,Facility,Both,,,,157,133.45,44.9962,157,BlueCross BlueShield Minnesota,High Value Network Plan,141.3,90,,percent of total billed charges,,
"Carcinoembryonic Ag, Serum Or Plasma",,82378,CPT,Facility,Outpatient,,,,157,133.45,44.9962,157,BlueCross BlueShield Minnesota,Medicare Advantage,76.93,49,,percent of total billed charges,,
"Carcinoembryonic Ag, Serum Or Plasma",,82378,CPT,Facility,Inpatient,,,,157,133.45,44.9962,157,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Carcinoembryonic Ag, Serum Or Plasma",,82378,CPT,Facility,Both,,,,157,133.45,44.9962,157,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,139.0549,88.57,,percent of total billed charges,,
"Carcinoembryonic Ag, Serum Or Plasma",,82378,CPT,Facility,Both,,,,157,133.45,44.9962,157,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,44.9962,28.66,,percent of total billed charges,,
"Carcinoembryonic Ag, Serum Or Plasma",,82378,CPT,Facility,Outpatient,,,,157,133.45,44.9962,157,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),76.93,49,,percent of total billed charges,,
"Carcinoembryonic Ag, Serum Or Plasma",,82378,CPT,Facility,Inpatient,,,,157,133.45,44.9962,157,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Carcinoembryonic Ag, Serum Or Plasma",,82378,CPT,Facility,Both,,,,157,133.45,44.9962,157,CorVel,Worker's Compensation,157,100,,percent of total billed charges,,
"Carcinoembryonic Ag, Serum Or Plasma",,82378,CPT,Facility,Both,,,,157,133.45,44.9962,157,First Health Group Corporation,First Health Network,152.29,97,,percent of total billed charges,,
"Carcinoembryonic Ag, Serum Or Plasma",,82378,CPT,Facility,Both,,,,157,133.45,44.9962,157,"Health Partners, Inc.",Commercial,148.522,94.6,,percent of total billed charges,,
"Carcinoembryonic Ag, Serum Or Plasma",,82378,CPT,Facility,Outpatient,,,,157,133.45,44.9962,157,"Health Partners, Inc.",Medicare Advantage,76.93,49,,percent of total billed charges,,
"Carcinoembryonic Ag, Serum Or Plasma",,82378,CPT,Facility,Inpatient,,,,157,133.45,44.9962,157,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Carcinoembryonic Ag, Serum Or Plasma",,82378,CPT,Facility,Both,,,,157,133.45,44.9962,157,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),94.2,60,,percent of total billed charges,,
"Carcinoembryonic Ag, Serum Or Plasma",,82378,CPT,Facility,Both,,,,157,133.45,44.9962,157,"Health Partners, Inc.",State of Minnesota Advantage Program,127.955,81.5,,percent of total billed charges,,
"Carcinoembryonic Ag, Serum Or Plasma",,82378,CPT,Facility,Both,,,,157,133.45,44.9962,157,"Health Partners, Inc.",State Public Programs,78.5,50,,percent of total billed charges,,
"Carcinoembryonic Ag, Serum Or Plasma",,82378,CPT,Facility,Both,,,,157,133.45,44.9962,157,Humana Insurance Company,Commercial PPO,149.15,95,,percent of total billed charges,,
"Carcinoembryonic Ag, Serum Or Plasma",,82378,CPT,Facility,Outpatient,,,,157,133.45,44.9962,157,Humana Insurance Company,Medicare PPO,76.93,49,,percent of total billed charges,,
"Carcinoembryonic Ag, Serum Or Plasma",,82378,CPT,Facility,Inpatient,,,,157,133.45,44.9962,157,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Carcinoembryonic Ag, Serum Or Plasma",,82378,CPT,Facility,Both,,,,157,133.45,44.9962,157,Medica,Individual & Family,155.587,99.1,,percent of total billed charges,,
"Carcinoembryonic Ag, Serum Or Plasma",,82378,CPT,Facility,Outpatient,,,,157,133.45,44.9962,157,Medica,Medica Advantage Solution,78.186,49.8,,percent of total billed charges,,
"Carcinoembryonic Ag, Serum Or Plasma",,82378,CPT,Facility,Inpatient,,,,157,133.45,44.9962,157,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Carcinoembryonic Ag, Serum Or Plasma",,82378,CPT,Facility,Outpatient,,,,157,133.45,44.9962,157,Medica,Medical Assistance,70.022,44.6,,percent of total billed charges,,
"Carcinoembryonic Ag, Serum Or Plasma",,82378,CPT,Facility,Inpatient,,,,157,133.45,44.9962,157,Medica,Medical Assistance,,,,,Included in per diem rate,
"Carcinoembryonic Ag, Serum Or Plasma",,82378,CPT,Facility,Outpatient,,,,157,133.45,44.9962,157,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,78.186,49.8,,percent of total billed charges,,
"Carcinoembryonic Ag, Serum Or Plasma",,82378,CPT,Facility,Inpatient,,,,157,133.45,44.9962,157,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Carcinoembryonic Ag, Serum Or Plasma",,82378,CPT,Facility,Both,,,,157,133.45,44.9962,157,"Multiplan, Inc.","Multiplan, Inc.",147.58,94,,percent of total billed charges,,
"Carcinoembryonic Ag, Serum Or Plasma",,82378,CPT,Facility,Outpatient,,,,157,133.45,44.9962,157,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,135.648,86.4,,percent of total billed charges,,
"Carcinoembryonic Ag, Serum Or Plasma",,82378,CPT,Facility,Inpatient,,,,157,133.45,44.9962,157,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Carcinoembryonic Ag, Serum Or Plasma",,82378,CPT,Facility,Both,,,,157,133.45,44.9962,157,"Preferred One Administrative Services, INC.",PPO,154.802,98.6,,percent of total billed charges,,
"Carcinoembryonic Ag, Serum Or Plasma",,82378,CPT,Facility,Outpatient,,,,157,133.45,44.9962,157,PrimeWest Health,Minnesota Senior Health Options (MSHO),80.7765,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Carcinoembryonic Ag, Serum Or Plasma",,82378,CPT,Facility,Inpatient,,,,157,133.45,44.9962,157,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Carcinoembryonic Ag, Serum Or Plasma",,82378,CPT,Facility,Outpatient,,,,157,133.45,44.9962,157,PrimeWest Health,MinnesotaCare,80.6352,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Carcinoembryonic Ag, Serum Or Plasma",,82378,CPT,Facility,Inpatient,,,,157,133.45,44.9962,157,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Carcinoembryonic Ag, Serum Or Plasma",,82378,CPT,Facility,Both,,,,157,133.45,44.9962,157,Sanford Health Plan,Sanford Health Plan,144.44,92,,percent of total billed charges,,
"Carcinoembryonic Ag, Serum Or Plasma",,82378,CPT,Facility,Outpatient,,,,157,133.45,44.9962,157,"UCare Health, Inc.",Individual & Family Plan,88.4695,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Carcinoembryonic Ag, Serum Or Plasma",,82378,CPT,Facility,Inpatient,,,,157,133.45,44.9962,157,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Carcinoembryonic Ag, Serum Or Plasma",,82378,CPT,Facility,Outpatient,,,,157,133.45,44.9962,157,"UCare Health, Inc.",Medical Assistance,79.2379,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Carcinoembryonic Ag, Serum Or Plasma",,82378,CPT,Facility,Inpatient,,,,157,133.45,44.9962,157,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Carcinoembryonic Ag, Serum Or Plasma",,82378,CPT,Facility,Outpatient,,,,157,133.45,44.9962,157,"UCare Health, Inc.",Medicare Advantage,79.2379,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Carcinoembryonic Ag, Serum Or Plasma",,82378,CPT,Facility,Inpatient,,,,157,133.45,44.9962,157,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Carcinoembryonic Ag, Serum Or Plasma",,82378,CPT,Facility,Outpatient,,,,157,133.45,44.9962,157,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),79.2379,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Carcinoembryonic Ag, Serum Or Plasma",,82378,CPT,Facility,Inpatient,,,,157,133.45,44.9962,157,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Carcinoembryonic Ag, Serum Or Plasma",,82378,CPT,Facility,Both,,,,157,133.45,44.9962,157,UnitedHealthcare,Individual & Family,147.58,94,,percent of total billed charges,,
"Carcinoembryonic Ag, Serum Or Plasma",,82378,CPT,Facility,Outpatient,,,,157,133.45,44.9962,157,UnitedHealthcare,Medicare Advantage,76.93,49,,percent of total billed charges,,
"Carcinoembryonic Ag, Serum Or Plasma",,82378,CPT,Facility,Inpatient,,,,157,133.45,44.9962,157,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Carcinoembryonic Ag, Serum Or Plasma",,82378,CPT,Facility,Outpatient,,,,157,133.45,44.9962,157,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,75.36,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Carcinoembryonic Ag, Serum Or Plasma",,82378,CPT,Facility,Inpatient,,,,157,133.45,44.9962,157,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Chloride, Serum Or Plasma",,82435,CPT,Facility,Both,,,,60,51,17.196,60,Aetna,Commercial,55.2,92,,percent of total billed charges,,
"Chloride, Serum Or Plasma",,82435,CPT,Facility,Outpatient,,,,60,51,17.196,60,Aetna,Medicare Advantage,29.4,49,,percent of total billed charges,,
"Chloride, Serum Or Plasma",,82435,CPT,Facility,Inpatient,,,,60,51,17.196,60,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Chloride, Serum Or Plasma",,82435,CPT,Facility,Both,,,,60,51,17.196,60,Aetna,PPO,55.8,93,,percent of total billed charges,,
"Chloride, Serum Or Plasma",,82435,CPT,Facility,Both,,,,60,51,17.196,60,America's PPO,America's PPO,57.618,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Chloride, Serum Or Plasma",,82435,CPT,Facility,Both,,,,60,51,17.196,60,BlueCross BlueShield Minnesota, Federal Employee Program,59.04,98.4,,percent of total billed charges,,
"Chloride, Serum Or Plasma",,82435,CPT,Facility,Both,,,,60,51,17.196,60,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,60,100,,percent of total billed charges,,
"Chloride, Serum Or Plasma",,82435,CPT,Facility,Both,,,,60,51,17.196,60,BlueCross BlueShield Minnesota,High Value Network Plan,54,90,,percent of total billed charges,,
"Chloride, Serum Or Plasma",,82435,CPT,Facility,Outpatient,,,,60,51,17.196,60,BlueCross BlueShield Minnesota,Medicare Advantage,29.4,49,,percent of total billed charges,,
"Chloride, Serum Or Plasma",,82435,CPT,Facility,Inpatient,,,,60,51,17.196,60,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Chloride, Serum Or Plasma",,82435,CPT,Facility,Both,,,,60,51,17.196,60,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,53.142,88.57,,percent of total billed charges,,
"Chloride, Serum Or Plasma",,82435,CPT,Facility,Both,,,,60,51,17.196,60,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,17.196,28.66,,percent of total billed charges,,
"Chloride, Serum Or Plasma",,82435,CPT,Facility,Outpatient,,,,60,51,17.196,60,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),29.4,49,,percent of total billed charges,,
"Chloride, Serum Or Plasma",,82435,CPT,Facility,Inpatient,,,,60,51,17.196,60,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Chloride, Serum Or Plasma",,82435,CPT,Facility,Both,,,,60,51,17.196,60,CorVel,Worker's Compensation,60,100,,percent of total billed charges,,
"Chloride, Serum Or Plasma",,82435,CPT,Facility,Both,,,,60,51,17.196,60,First Health Group Corporation,First Health Network,58.2,97,,percent of total billed charges,,
"Chloride, Serum Or Plasma",,82435,CPT,Facility,Both,,,,60,51,17.196,60,"Health Partners, Inc.",Commercial,56.76,94.6,,percent of total billed charges,,
"Chloride, Serum Or Plasma",,82435,CPT,Facility,Outpatient,,,,60,51,17.196,60,"Health Partners, Inc.",Medicare Advantage,29.4,49,,percent of total billed charges,,
"Chloride, Serum Or Plasma",,82435,CPT,Facility,Inpatient,,,,60,51,17.196,60,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Chloride, Serum Or Plasma",,82435,CPT,Facility,Both,,,,60,51,17.196,60,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),36,60,,percent of total billed charges,,
"Chloride, Serum Or Plasma",,82435,CPT,Facility,Both,,,,60,51,17.196,60,"Health Partners, Inc.",State of Minnesota Advantage Program,48.9,81.5,,percent of total billed charges,,
"Chloride, Serum Or Plasma",,82435,CPT,Facility,Both,,,,60,51,17.196,60,"Health Partners, Inc.",State Public Programs,30,50,,percent of total billed charges,,
"Chloride, Serum Or Plasma",,82435,CPT,Facility,Both,,,,60,51,17.196,60,Humana Insurance Company,Commercial PPO,57,95,,percent of total billed charges,,
"Chloride, Serum Or Plasma",,82435,CPT,Facility,Outpatient,,,,60,51,17.196,60,Humana Insurance Company,Medicare PPO,29.4,49,,percent of total billed charges,,
"Chloride, Serum Or Plasma",,82435,CPT,Facility,Inpatient,,,,60,51,17.196,60,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Chloride, Serum Or Plasma",,82435,CPT,Facility,Both,,,,60,51,17.196,60,Medica,Individual & Family,59.46,99.1,,percent of total billed charges,,
"Chloride, Serum Or Plasma",,82435,CPT,Facility,Outpatient,,,,60,51,17.196,60,Medica,Medica Advantage Solution,29.88,49.8,,percent of total billed charges,,
"Chloride, Serum Or Plasma",,82435,CPT,Facility,Inpatient,,,,60,51,17.196,60,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Chloride, Serum Or Plasma",,82435,CPT,Facility,Outpatient,,,,60,51,17.196,60,Medica,Medical Assistance,26.76,44.6,,percent of total billed charges,,
"Chloride, Serum Or Plasma",,82435,CPT,Facility,Inpatient,,,,60,51,17.196,60,Medica,Medical Assistance,,,,,Included in per diem rate,
"Chloride, Serum Or Plasma",,82435,CPT,Facility,Outpatient,,,,60,51,17.196,60,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,29.88,49.8,,percent of total billed charges,,
"Chloride, Serum Or Plasma",,82435,CPT,Facility,Inpatient,,,,60,51,17.196,60,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Chloride, Serum Or Plasma",,82435,CPT,Facility,Both,,,,60,51,17.196,60,"Multiplan, Inc.","Multiplan, Inc.",56.4,94,,percent of total billed charges,,
"Chloride, Serum Or Plasma",,82435,CPT,Facility,Outpatient,,,,60,51,17.196,60,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,51.84,86.4,,percent of total billed charges,,
"Chloride, Serum Or Plasma",,82435,CPT,Facility,Inpatient,,,,60,51,17.196,60,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Chloride, Serum Or Plasma",,82435,CPT,Facility,Both,,,,60,51,17.196,60,"Preferred One Administrative Services, INC.",PPO,59.16,98.6,,percent of total billed charges,,
"Chloride, Serum Or Plasma",,82435,CPT,Facility,Outpatient,,,,60,51,17.196,60,PrimeWest Health,Minnesota Senior Health Options (MSHO),30.87,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Chloride, Serum Or Plasma",,82435,CPT,Facility,Inpatient,,,,60,51,17.196,60,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Chloride, Serum Or Plasma",,82435,CPT,Facility,Outpatient,,,,60,51,17.196,60,PrimeWest Health,MinnesotaCare,30.816,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Chloride, Serum Or Plasma",,82435,CPT,Facility,Inpatient,,,,60,51,17.196,60,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Chloride, Serum Or Plasma",,82435,CPT,Facility,Both,,,,60,51,17.196,60,Sanford Health Plan,Sanford Health Plan,55.2,92,,percent of total billed charges,,
"Chloride, Serum Or Plasma",,82435,CPT,Facility,Outpatient,,,,60,51,17.196,60,"UCare Health, Inc.",Individual & Family Plan,33.81,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Chloride, Serum Or Plasma",,82435,CPT,Facility,Inpatient,,,,60,51,17.196,60,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Chloride, Serum Or Plasma",,82435,CPT,Facility,Outpatient,,,,60,51,17.196,60,"UCare Health, Inc.",Medical Assistance,30.282,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Chloride, Serum Or Plasma",,82435,CPT,Facility,Inpatient,,,,60,51,17.196,60,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Chloride, Serum Or Plasma",,82435,CPT,Facility,Outpatient,,,,60,51,17.196,60,"UCare Health, Inc.",Medicare Advantage,30.282,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Chloride, Serum Or Plasma",,82435,CPT,Facility,Inpatient,,,,60,51,17.196,60,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Chloride, Serum Or Plasma",,82435,CPT,Facility,Outpatient,,,,60,51,17.196,60,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),30.282,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Chloride, Serum Or Plasma",,82435,CPT,Facility,Inpatient,,,,60,51,17.196,60,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Chloride, Serum Or Plasma",,82435,CPT,Facility,Both,,,,60,51,17.196,60,UnitedHealthcare,Individual & Family,56.4,94,,percent of total billed charges,,
"Chloride, Serum Or Plasma",,82435,CPT,Facility,Outpatient,,,,60,51,17.196,60,UnitedHealthcare,Medicare Advantage,29.4,49,,percent of total billed charges,,
"Chloride, Serum Or Plasma",,82435,CPT,Facility,Inpatient,,,,60,51,17.196,60,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Chloride, Serum Or Plasma",,82435,CPT,Facility,Outpatient,,,,60,51,17.196,60,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,28.8,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Chloride, Serum Or Plasma",,82435,CPT,Facility,Inpatient,,,,60,51,17.196,60,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Chloride, Urine 24 Hr",,82436,CPT,Facility,Both,,,,50,42.5,14.33,50,Aetna,Commercial,46,92,,percent of total billed charges,,
"Chloride, Urine 24 Hr",,82436,CPT,Facility,Outpatient,,,,50,42.5,14.33,50,Aetna,Medicare Advantage,24.5,49,,percent of total billed charges,,
"Chloride, Urine 24 Hr",,82436,CPT,Facility,Inpatient,,,,50,42.5,14.33,50,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Chloride, Urine 24 Hr",,82436,CPT,Facility,Both,,,,50,42.5,14.33,50,Aetna,PPO,46.5,93,,percent of total billed charges,,
"Chloride, Urine 24 Hr",,82436,CPT,Facility,Both,,,,50,42.5,14.33,50,America's PPO,America's PPO,48.015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Chloride, Urine 24 Hr",,82436,CPT,Facility,Both,,,,50,42.5,14.33,50,BlueCross BlueShield Minnesota, Federal Employee Program,49.2,98.4,,percent of total billed charges,,
"Chloride, Urine 24 Hr",,82436,CPT,Facility,Both,,,,50,42.5,14.33,50,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,50,100,,percent of total billed charges,,
"Chloride, Urine 24 Hr",,82436,CPT,Facility,Both,,,,50,42.5,14.33,50,BlueCross BlueShield Minnesota,High Value Network Plan,45,90,,percent of total billed charges,,
"Chloride, Urine 24 Hr",,82436,CPT,Facility,Outpatient,,,,50,42.5,14.33,50,BlueCross BlueShield Minnesota,Medicare Advantage,24.5,49,,percent of total billed charges,,
"Chloride, Urine 24 Hr",,82436,CPT,Facility,Inpatient,,,,50,42.5,14.33,50,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Chloride, Urine 24 Hr",,82436,CPT,Facility,Both,,,,50,42.5,14.33,50,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,44.285,88.57,,percent of total billed charges,,
"Chloride, Urine 24 Hr",,82436,CPT,Facility,Both,,,,50,42.5,14.33,50,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,14.33,28.66,,percent of total billed charges,,
"Chloride, Urine 24 Hr",,82436,CPT,Facility,Outpatient,,,,50,42.5,14.33,50,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),24.5,49,,percent of total billed charges,,
"Chloride, Urine 24 Hr",,82436,CPT,Facility,Inpatient,,,,50,42.5,14.33,50,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Chloride, Urine 24 Hr",,82436,CPT,Facility,Both,,,,50,42.5,14.33,50,CorVel,Worker's Compensation,50,100,,percent of total billed charges,,
"Chloride, Urine 24 Hr",,82436,CPT,Facility,Both,,,,50,42.5,14.33,50,First Health Group Corporation,First Health Network,48.5,97,,percent of total billed charges,,
"Chloride, Urine 24 Hr",,82436,CPT,Facility,Both,,,,50,42.5,14.33,50,"Health Partners, Inc.",Commercial,47.3,94.6,,percent of total billed charges,,
"Chloride, Urine 24 Hr",,82436,CPT,Facility,Outpatient,,,,50,42.5,14.33,50,"Health Partners, Inc.",Medicare Advantage,24.5,49,,percent of total billed charges,,
"Chloride, Urine 24 Hr",,82436,CPT,Facility,Inpatient,,,,50,42.5,14.33,50,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Chloride, Urine 24 Hr",,82436,CPT,Facility,Both,,,,50,42.5,14.33,50,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),30,60,,percent of total billed charges,,
"Chloride, Urine 24 Hr",,82436,CPT,Facility,Both,,,,50,42.5,14.33,50,"Health Partners, Inc.",State of Minnesota Advantage Program,40.75,81.5,,percent of total billed charges,,
"Chloride, Urine 24 Hr",,82436,CPT,Facility,Both,,,,50,42.5,14.33,50,"Health Partners, Inc.",State Public Programs,25,50,,percent of total billed charges,,
"Chloride, Urine 24 Hr",,82436,CPT,Facility,Both,,,,50,42.5,14.33,50,Humana Insurance Company,Commercial PPO,47.5,95,,percent of total billed charges,,
"Chloride, Urine 24 Hr",,82436,CPT,Facility,Outpatient,,,,50,42.5,14.33,50,Humana Insurance Company,Medicare PPO,24.5,49,,percent of total billed charges,,
"Chloride, Urine 24 Hr",,82436,CPT,Facility,Inpatient,,,,50,42.5,14.33,50,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Chloride, Urine 24 Hr",,82436,CPT,Facility,Both,,,,50,42.5,14.33,50,Medica,Individual & Family,49.55,99.1,,percent of total billed charges,,
"Chloride, Urine 24 Hr",,82436,CPT,Facility,Outpatient,,,,50,42.5,14.33,50,Medica,Medica Advantage Solution,24.9,49.8,,percent of total billed charges,,
"Chloride, Urine 24 Hr",,82436,CPT,Facility,Inpatient,,,,50,42.5,14.33,50,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Chloride, Urine 24 Hr",,82436,CPT,Facility,Outpatient,,,,50,42.5,14.33,50,Medica,Medical Assistance,22.3,44.6,,percent of total billed charges,,
"Chloride, Urine 24 Hr",,82436,CPT,Facility,Inpatient,,,,50,42.5,14.33,50,Medica,Medical Assistance,,,,,Included in per diem rate,
"Chloride, Urine 24 Hr",,82436,CPT,Facility,Outpatient,,,,50,42.5,14.33,50,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,24.9,49.8,,percent of total billed charges,,
"Chloride, Urine 24 Hr",,82436,CPT,Facility,Inpatient,,,,50,42.5,14.33,50,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Chloride, Urine 24 Hr",,82436,CPT,Facility,Both,,,,50,42.5,14.33,50,"Multiplan, Inc.","Multiplan, Inc.",47,94,,percent of total billed charges,,
"Chloride, Urine 24 Hr",,82436,CPT,Facility,Outpatient,,,,50,42.5,14.33,50,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,43.2,86.4,,percent of total billed charges,,
"Chloride, Urine 24 Hr",,82436,CPT,Facility,Inpatient,,,,50,42.5,14.33,50,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Chloride, Urine 24 Hr",,82436,CPT,Facility,Both,,,,50,42.5,14.33,50,"Preferred One Administrative Services, INC.",PPO,49.3,98.6,,percent of total billed charges,,
"Chloride, Urine 24 Hr",,82436,CPT,Facility,Outpatient,,,,50,42.5,14.33,50,PrimeWest Health,Minnesota Senior Health Options (MSHO),25.725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Chloride, Urine 24 Hr",,82436,CPT,Facility,Inpatient,,,,50,42.5,14.33,50,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Chloride, Urine 24 Hr",,82436,CPT,Facility,Outpatient,,,,50,42.5,14.33,50,PrimeWest Health,MinnesotaCare,25.68,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Chloride, Urine 24 Hr",,82436,CPT,Facility,Inpatient,,,,50,42.5,14.33,50,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Chloride, Urine 24 Hr",,82436,CPT,Facility,Both,,,,50,42.5,14.33,50,Sanford Health Plan,Sanford Health Plan,46,92,,percent of total billed charges,,
"Chloride, Urine 24 Hr",,82436,CPT,Facility,Outpatient,,,,50,42.5,14.33,50,"UCare Health, Inc.",Individual & Family Plan,28.175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Chloride, Urine 24 Hr",,82436,CPT,Facility,Inpatient,,,,50,42.5,14.33,50,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Chloride, Urine 24 Hr",,82436,CPT,Facility,Outpatient,,,,50,42.5,14.33,50,"UCare Health, Inc.",Medical Assistance,25.235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Chloride, Urine 24 Hr",,82436,CPT,Facility,Inpatient,,,,50,42.5,14.33,50,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Chloride, Urine 24 Hr",,82436,CPT,Facility,Outpatient,,,,50,42.5,14.33,50,"UCare Health, Inc.",Medicare Advantage,25.235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Chloride, Urine 24 Hr",,82436,CPT,Facility,Inpatient,,,,50,42.5,14.33,50,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Chloride, Urine 24 Hr",,82436,CPT,Facility,Outpatient,,,,50,42.5,14.33,50,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),25.235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Chloride, Urine 24 Hr",,82436,CPT,Facility,Inpatient,,,,50,42.5,14.33,50,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Chloride, Urine 24 Hr",,82436,CPT,Facility,Both,,,,50,42.5,14.33,50,UnitedHealthcare,Individual & Family,47,94,,percent of total billed charges,,
"Chloride, Urine 24 Hr",,82436,CPT,Facility,Outpatient,,,,50,42.5,14.33,50,UnitedHealthcare,Medicare Advantage,24.5,49,,percent of total billed charges,,
"Chloride, Urine 24 Hr",,82436,CPT,Facility,Inpatient,,,,50,42.5,14.33,50,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Chloride, Urine 24 Hr",,82436,CPT,Facility,Outpatient,,,,50,42.5,14.33,50,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,24,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Chloride, Urine 24 Hr",,82436,CPT,Facility,Inpatient,,,,50,42.5,14.33,50,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Chloride, Urine, Random",,82436,CPT,Facility,Both,,,,60,51,17.196,60,Aetna,Commercial,55.2,92,,percent of total billed charges,,
"Chloride, Urine, Random",,82436,CPT,Facility,Outpatient,,,,60,51,17.196,60,Aetna,Medicare Advantage,29.4,49,,percent of total billed charges,,
"Chloride, Urine, Random",,82436,CPT,Facility,Inpatient,,,,60,51,17.196,60,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Chloride, Urine, Random",,82436,CPT,Facility,Both,,,,60,51,17.196,60,Aetna,PPO,55.8,93,,percent of total billed charges,,
"Chloride, Urine, Random",,82436,CPT,Facility,Both,,,,60,51,17.196,60,America's PPO,America's PPO,57.618,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Chloride, Urine, Random",,82436,CPT,Facility,Both,,,,60,51,17.196,60,BlueCross BlueShield Minnesota, Federal Employee Program,59.04,98.4,,percent of total billed charges,,
"Chloride, Urine, Random",,82436,CPT,Facility,Both,,,,60,51,17.196,60,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,60,100,,percent of total billed charges,,
"Chloride, Urine, Random",,82436,CPT,Facility,Both,,,,60,51,17.196,60,BlueCross BlueShield Minnesota,High Value Network Plan,54,90,,percent of total billed charges,,
"Chloride, Urine, Random",,82436,CPT,Facility,Outpatient,,,,60,51,17.196,60,BlueCross BlueShield Minnesota,Medicare Advantage,29.4,49,,percent of total billed charges,,
"Chloride, Urine, Random",,82436,CPT,Facility,Inpatient,,,,60,51,17.196,60,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Chloride, Urine, Random",,82436,CPT,Facility,Both,,,,60,51,17.196,60,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,53.142,88.57,,percent of total billed charges,,
"Chloride, Urine, Random",,82436,CPT,Facility,Both,,,,60,51,17.196,60,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,17.196,28.66,,percent of total billed charges,,
"Chloride, Urine, Random",,82436,CPT,Facility,Outpatient,,,,60,51,17.196,60,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),29.4,49,,percent of total billed charges,,
"Chloride, Urine, Random",,82436,CPT,Facility,Inpatient,,,,60,51,17.196,60,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Chloride, Urine, Random",,82436,CPT,Facility,Both,,,,60,51,17.196,60,CorVel,Worker's Compensation,60,100,,percent of total billed charges,,
"Chloride, Urine, Random",,82436,CPT,Facility,Both,,,,60,51,17.196,60,First Health Group Corporation,First Health Network,58.2,97,,percent of total billed charges,,
"Chloride, Urine, Random",,82436,CPT,Facility,Both,,,,60,51,17.196,60,"Health Partners, Inc.",Commercial,56.76,94.6,,percent of total billed charges,,
"Chloride, Urine, Random",,82436,CPT,Facility,Outpatient,,,,60,51,17.196,60,"Health Partners, Inc.",Medicare Advantage,29.4,49,,percent of total billed charges,,
"Chloride, Urine, Random",,82436,CPT,Facility,Inpatient,,,,60,51,17.196,60,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Chloride, Urine, Random",,82436,CPT,Facility,Both,,,,60,51,17.196,60,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),36,60,,percent of total billed charges,,
"Chloride, Urine, Random",,82436,CPT,Facility,Both,,,,60,51,17.196,60,"Health Partners, Inc.",State of Minnesota Advantage Program,48.9,81.5,,percent of total billed charges,,
"Chloride, Urine, Random",,82436,CPT,Facility,Both,,,,60,51,17.196,60,"Health Partners, Inc.",State Public Programs,30,50,,percent of total billed charges,,
"Chloride, Urine, Random",,82436,CPT,Facility,Both,,,,60,51,17.196,60,Humana Insurance Company,Commercial PPO,57,95,,percent of total billed charges,,
"Chloride, Urine, Random",,82436,CPT,Facility,Outpatient,,,,60,51,17.196,60,Humana Insurance Company,Medicare PPO,29.4,49,,percent of total billed charges,,
"Chloride, Urine, Random",,82436,CPT,Facility,Inpatient,,,,60,51,17.196,60,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Chloride, Urine, Random",,82436,CPT,Facility,Both,,,,60,51,17.196,60,Medica,Individual & Family,59.46,99.1,,percent of total billed charges,,
"Chloride, Urine, Random",,82436,CPT,Facility,Outpatient,,,,60,51,17.196,60,Medica,Medica Advantage Solution,29.88,49.8,,percent of total billed charges,,
"Chloride, Urine, Random",,82436,CPT,Facility,Inpatient,,,,60,51,17.196,60,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Chloride, Urine, Random",,82436,CPT,Facility,Outpatient,,,,60,51,17.196,60,Medica,Medical Assistance,26.76,44.6,,percent of total billed charges,,
"Chloride, Urine, Random",,82436,CPT,Facility,Inpatient,,,,60,51,17.196,60,Medica,Medical Assistance,,,,,Included in per diem rate,
"Chloride, Urine, Random",,82436,CPT,Facility,Outpatient,,,,60,51,17.196,60,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,29.88,49.8,,percent of total billed charges,,
"Chloride, Urine, Random",,82436,CPT,Facility,Inpatient,,,,60,51,17.196,60,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Chloride, Urine, Random",,82436,CPT,Facility,Both,,,,60,51,17.196,60,"Multiplan, Inc.","Multiplan, Inc.",56.4,94,,percent of total billed charges,,
"Chloride, Urine, Random",,82436,CPT,Facility,Outpatient,,,,60,51,17.196,60,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,51.84,86.4,,percent of total billed charges,,
"Chloride, Urine, Random",,82436,CPT,Facility,Inpatient,,,,60,51,17.196,60,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Chloride, Urine, Random",,82436,CPT,Facility,Both,,,,60,51,17.196,60,"Preferred One Administrative Services, INC.",PPO,59.16,98.6,,percent of total billed charges,,
"Chloride, Urine, Random",,82436,CPT,Facility,Outpatient,,,,60,51,17.196,60,PrimeWest Health,Minnesota Senior Health Options (MSHO),30.87,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Chloride, Urine, Random",,82436,CPT,Facility,Inpatient,,,,60,51,17.196,60,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Chloride, Urine, Random",,82436,CPT,Facility,Outpatient,,,,60,51,17.196,60,PrimeWest Health,MinnesotaCare,30.816,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Chloride, Urine, Random",,82436,CPT,Facility,Inpatient,,,,60,51,17.196,60,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Chloride, Urine, Random",,82436,CPT,Facility,Both,,,,60,51,17.196,60,Sanford Health Plan,Sanford Health Plan,55.2,92,,percent of total billed charges,,
"Chloride, Urine, Random",,82436,CPT,Facility,Outpatient,,,,60,51,17.196,60,"UCare Health, Inc.",Individual & Family Plan,33.81,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Chloride, Urine, Random",,82436,CPT,Facility,Inpatient,,,,60,51,17.196,60,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Chloride, Urine, Random",,82436,CPT,Facility,Outpatient,,,,60,51,17.196,60,"UCare Health, Inc.",Medical Assistance,30.282,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Chloride, Urine, Random",,82436,CPT,Facility,Inpatient,,,,60,51,17.196,60,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Chloride, Urine, Random",,82436,CPT,Facility,Outpatient,,,,60,51,17.196,60,"UCare Health, Inc.",Medicare Advantage,30.282,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Chloride, Urine, Random",,82436,CPT,Facility,Inpatient,,,,60,51,17.196,60,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Chloride, Urine, Random",,82436,CPT,Facility,Outpatient,,,,60,51,17.196,60,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),30.282,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Chloride, Urine, Random",,82436,CPT,Facility,Inpatient,,,,60,51,17.196,60,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Chloride, Urine, Random",,82436,CPT,Facility,Both,,,,60,51,17.196,60,UnitedHealthcare,Individual & Family,56.4,94,,percent of total billed charges,,
"Chloride, Urine, Random",,82436,CPT,Facility,Outpatient,,,,60,51,17.196,60,UnitedHealthcare,Medicare Advantage,29.4,49,,percent of total billed charges,,
"Chloride, Urine, Random",,82436,CPT,Facility,Inpatient,,,,60,51,17.196,60,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Chloride, Urine, Random",,82436,CPT,Facility,Outpatient,,,,60,51,17.196,60,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,28.8,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Chloride, Urine, Random",,82436,CPT,Facility,Inpatient,,,,60,51,17.196,60,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Cholesterol, Serum Or Plasma",,82465,CPT,Facility,Both,,,,66,56.1,18.9156,66,Aetna,Commercial,60.72,92,,percent of total billed charges,,
"Cholesterol, Serum Or Plasma",,82465,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,Aetna,Medicare Advantage,32.34,49,,percent of total billed charges,,
"Cholesterol, Serum Or Plasma",,82465,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Cholesterol, Serum Or Plasma",,82465,CPT,Facility,Both,,,,66,56.1,18.9156,66,Aetna,PPO,61.38,93,,percent of total billed charges,,
"Cholesterol, Serum Or Plasma",,82465,CPT,Facility,Both,,,,66,56.1,18.9156,66,America's PPO,America's PPO,63.3798,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Cholesterol, Serum Or Plasma",,82465,CPT,Facility,Both,,,,66,56.1,18.9156,66,BlueCross BlueShield Minnesota, Federal Employee Program,64.944,98.4,,percent of total billed charges,,
"Cholesterol, Serum Or Plasma",,82465,CPT,Facility,Both,,,,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,66,100,,percent of total billed charges,,
"Cholesterol, Serum Or Plasma",,82465,CPT,Facility,Both,,,,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,High Value Network Plan,59.4,90,,percent of total billed charges,,
"Cholesterol, Serum Or Plasma",,82465,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,Medicare Advantage,32.34,49,,percent of total billed charges,,
"Cholesterol, Serum Or Plasma",,82465,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Cholesterol, Serum Or Plasma",,82465,CPT,Facility,Both,,,,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,58.4562,88.57,,percent of total billed charges,,
"Cholesterol, Serum Or Plasma",,82465,CPT,Facility,Both,,,,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,18.9156,28.66,,percent of total billed charges,,
"Cholesterol, Serum Or Plasma",,82465,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),32.34,49,,percent of total billed charges,,
"Cholesterol, Serum Or Plasma",,82465,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Cholesterol, Serum Or Plasma",,82465,CPT,Facility,Both,,,,66,56.1,18.9156,66,CorVel,Worker's Compensation,66,100,,percent of total billed charges,,
"Cholesterol, Serum Or Plasma",,82465,CPT,Facility,Both,,,,66,56.1,18.9156,66,First Health Group Corporation,First Health Network,64.02,97,,percent of total billed charges,,
"Cholesterol, Serum Or Plasma",,82465,CPT,Facility,Both,,,,66,56.1,18.9156,66,"Health Partners, Inc.",Commercial,62.436,94.6,,percent of total billed charges,,
"Cholesterol, Serum Or Plasma",,82465,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,"Health Partners, Inc.",Medicare Advantage,32.34,49,,percent of total billed charges,,
"Cholesterol, Serum Or Plasma",,82465,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Cholesterol, Serum Or Plasma",,82465,CPT,Facility,Both,,,,66,56.1,18.9156,66,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),39.6,60,,percent of total billed charges,,
"Cholesterol, Serum Or Plasma",,82465,CPT,Facility,Both,,,,66,56.1,18.9156,66,"Health Partners, Inc.",State of Minnesota Advantage Program,53.79,81.5,,percent of total billed charges,,
"Cholesterol, Serum Or Plasma",,82465,CPT,Facility,Both,,,,66,56.1,18.9156,66,"Health Partners, Inc.",State Public Programs,33,50,,percent of total billed charges,,
"Cholesterol, Serum Or Plasma",,82465,CPT,Facility,Both,,,,66,56.1,18.9156,66,Humana Insurance Company,Commercial PPO,62.7,95,,percent of total billed charges,,
"Cholesterol, Serum Or Plasma",,82465,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,Humana Insurance Company,Medicare PPO,32.34,49,,percent of total billed charges,,
"Cholesterol, Serum Or Plasma",,82465,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Cholesterol, Serum Or Plasma",,82465,CPT,Facility,Both,,,,66,56.1,18.9156,66,Medica,Individual & Family,65.406,99.1,,percent of total billed charges,,
"Cholesterol, Serum Or Plasma",,82465,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,Medica,Medica Advantage Solution,32.868,49.8,,percent of total billed charges,,
"Cholesterol, Serum Or Plasma",,82465,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Cholesterol, Serum Or Plasma",,82465,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,Medica,Medical Assistance,29.436,44.6,,percent of total billed charges,,
"Cholesterol, Serum Or Plasma",,82465,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,Medica,Medical Assistance,,,,,Included in per diem rate,
"Cholesterol, Serum Or Plasma",,82465,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,32.868,49.8,,percent of total billed charges,,
"Cholesterol, Serum Or Plasma",,82465,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Cholesterol, Serum Or Plasma",,82465,CPT,Facility,Both,,,,66,56.1,18.9156,66,"Multiplan, Inc.","Multiplan, Inc.",62.04,94,,percent of total billed charges,,
"Cholesterol, Serum Or Plasma",,82465,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,57.024,86.4,,percent of total billed charges,,
"Cholesterol, Serum Or Plasma",,82465,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Cholesterol, Serum Or Plasma",,82465,CPT,Facility,Both,,,,66,56.1,18.9156,66,"Preferred One Administrative Services, INC.",PPO,65.076,98.6,,percent of total billed charges,,
"Cholesterol, Serum Or Plasma",,82465,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,PrimeWest Health,Minnesota Senior Health Options (MSHO),33.957,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Cholesterol, Serum Or Plasma",,82465,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Cholesterol, Serum Or Plasma",,82465,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,PrimeWest Health,MinnesotaCare,33.8976,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Cholesterol, Serum Or Plasma",,82465,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Cholesterol, Serum Or Plasma",,82465,CPT,Facility,Both,,,,66,56.1,18.9156,66,Sanford Health Plan,Sanford Health Plan,60.72,92,,percent of total billed charges,,
"Cholesterol, Serum Or Plasma",,82465,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,"UCare Health, Inc.",Individual & Family Plan,37.191,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Cholesterol, Serum Or Plasma",,82465,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Cholesterol, Serum Or Plasma",,82465,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,"UCare Health, Inc.",Medical Assistance,33.3102,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Cholesterol, Serum Or Plasma",,82465,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Cholesterol, Serum Or Plasma",,82465,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,"UCare Health, Inc.",Medicare Advantage,33.3102,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Cholesterol, Serum Or Plasma",,82465,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Cholesterol, Serum Or Plasma",,82465,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),33.3102,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Cholesterol, Serum Or Plasma",,82465,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Cholesterol, Serum Or Plasma",,82465,CPT,Facility,Both,,,,66,56.1,18.9156,66,UnitedHealthcare,Individual & Family,62.04,94,,percent of total billed charges,,
"Cholesterol, Serum Or Plasma",,82465,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,UnitedHealthcare,Medicare Advantage,32.34,49,,percent of total billed charges,,
"Cholesterol, Serum Or Plasma",,82465,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Cholesterol, Serum Or Plasma",,82465,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,31.68,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Cholesterol, Serum Or Plasma",,82465,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
ATROPINE (CONC: 0.1 MG/ML) FOR ETT (ADULT),,J0461,HCPCS,Facility,Both,10,mL,,52,44.2,14.9032,52,Aetna,Commercial,47.84,92,,percent of total billed charges,,
ATROPINE (CONC: 0.1 MG/ML) FOR ETT (ADULT),,J0461,HCPCS,Facility,Outpatient,10,mL,,52,44.2,14.9032,52,Aetna,Medicare Advantage,25.48,49,,percent of total billed charges,,
ATROPINE (CONC: 0.1 MG/ML) FOR ETT (ADULT),,J0461,HCPCS,Facility,Inpatient,10,mL,,52,44.2,14.9032,52,Aetna,Medicare Advantage,,,,,Included in per diem rate,
ATROPINE (CONC: 0.1 MG/ML) FOR ETT (ADULT),,J0461,HCPCS,Facility,Both,10,mL,,52,44.2,14.9032,52,Aetna,PPO,48.36,93,,percent of total billed charges,,
ATROPINE (CONC: 0.1 MG/ML) FOR ETT (ADULT),,J0461,HCPCS,Facility,Both,10,mL,,52,44.2,14.9032,52,America's PPO,America's PPO,49.9356,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
ATROPINE (CONC: 0.1 MG/ML) FOR ETT (ADULT),,J0461,HCPCS,Facility,Both,10,mL,,52,44.2,14.9032,52,BlueCross BlueShield Minnesota, Federal Employee Program,51.168,98.4,,percent of total billed charges,,
ATROPINE (CONC: 0.1 MG/ML) FOR ETT (ADULT),,J0461,HCPCS,Facility,Both,10,mL,,52,44.2,14.9032,52,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,52,100,,percent of total billed charges,,
ATROPINE (CONC: 0.1 MG/ML) FOR ETT (ADULT),,J0461,HCPCS,Facility,Both,10,mL,,52,44.2,14.9032,52,BlueCross BlueShield Minnesota,High Value Network Plan,46.8,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
ATROPINE (CONC: 0.1 MG/ML) FOR ETT (ADULT),,J0461,HCPCS,Facility,Outpatient,10,mL,,52,44.2,14.9032,52,BlueCross BlueShield Minnesota,Medicare Advantage,25.48,49,,percent of total billed charges,,
ATROPINE (CONC: 0.1 MG/ML) FOR ETT (ADULT),,J0461,HCPCS,Facility,Inpatient,10,mL,,52,44.2,14.9032,52,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
ATROPINE (CONC: 0.1 MG/ML) FOR ETT (ADULT),,J0461,HCPCS,Facility,Both,10,mL,,52,44.2,14.9032,52,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,46.0564,88.57,,percent of total billed charges,,
ATROPINE (CONC: 0.1 MG/ML) FOR ETT (ADULT),,J0461,HCPCS,Facility,Both,10,mL,,52,44.2,14.9032,52,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,14.9032,28.66,,percent of total billed charges,,
ATROPINE (CONC: 0.1 MG/ML) FOR ETT (ADULT),,J0461,HCPCS,Facility,Outpatient,10,mL,,52,44.2,14.9032,52,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),25.48,49,,percent of total billed charges,,
ATROPINE (CONC: 0.1 MG/ML) FOR ETT (ADULT),,J0461,HCPCS,Facility,Inpatient,10,mL,,52,44.2,14.9032,52,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
ATROPINE (CONC: 0.1 MG/ML) FOR ETT (ADULT),,J0461,HCPCS,Facility,Both,10,mL,,52,44.2,14.9032,52,CorVel,Worker's Compensation,52,100,,percent of total billed charges,,
ATROPINE (CONC: 0.1 MG/ML) FOR ETT (ADULT),,J0461,HCPCS,Facility,Both,10,mL,,52,44.2,14.9032,52,First Health Group Corporation,First Health Network,50.44,97,,percent of total billed charges,,
ATROPINE (CONC: 0.1 MG/ML) FOR ETT (ADULT),,J0461,HCPCS,Facility,Both,10,mL,,52,44.2,14.9032,52,"Health Partners, Inc.",Commercial,49.192,94.6,,percent of total billed charges,,
ATROPINE (CONC: 0.1 MG/ML) FOR ETT (ADULT),,J0461,HCPCS,Facility,Outpatient,10,mL,,52,44.2,14.9032,52,"Health Partners, Inc.",Medicare Advantage,25.48,49,,percent of total billed charges,,
ATROPINE (CONC: 0.1 MG/ML) FOR ETT (ADULT),,J0461,HCPCS,Facility,Inpatient,10,mL,,52,44.2,14.9032,52,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ATROPINE (CONC: 0.1 MG/ML) FOR ETT (ADULT),,J0461,HCPCS,Facility,Both,10,mL,,52,44.2,14.9032,52,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),31.2,60,,percent of total billed charges,,
ATROPINE (CONC: 0.1 MG/ML) FOR ETT (ADULT),,J0461,HCPCS,Facility,Both,10,mL,,52,44.2,14.9032,52,"Health Partners, Inc.",State of Minnesota Advantage Program,42.38,81.5,,percent of total billed charges,,
ATROPINE (CONC: 0.1 MG/ML) FOR ETT (ADULT),,J0461,HCPCS,Facility,Both,10,mL,,52,44.2,14.9032,52,"Health Partners, Inc.",State Public Programs,26,50,,percent of total billed charges,,
ATROPINE (CONC: 0.1 MG/ML) FOR ETT (ADULT),,J0461,HCPCS,Facility,Both,10,mL,,52,44.2,14.9032,52,Humana Insurance Company,Commercial PPO,49.4,95,,percent of total billed charges,,
ATROPINE (CONC: 0.1 MG/ML) FOR ETT (ADULT),,J0461,HCPCS,Facility,Outpatient,10,mL,,52,44.2,14.9032,52,Humana Insurance Company,Medicare PPO,25.48,49,,percent of total billed charges,,
ATROPINE (CONC: 0.1 MG/ML) FOR ETT (ADULT),,J0461,HCPCS,Facility,Inpatient,10,mL,,52,44.2,14.9032,52,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
ATROPINE (CONC: 0.1 MG/ML) FOR ETT (ADULT),,J0461,HCPCS,Facility,Both,10,mL,,52,44.2,14.9032,52,Medica,Individual & Family,51.532,99.1,,percent of total billed charges,,
ATROPINE (CONC: 0.1 MG/ML) FOR ETT (ADULT),,J0461,HCPCS,Facility,Outpatient,10,mL,,52,44.2,14.9032,52,Medica,Medica Advantage Solution,25.896,49.8,,percent of total billed charges,,
ATROPINE (CONC: 0.1 MG/ML) FOR ETT (ADULT),,J0461,HCPCS,Facility,Inpatient,10,mL,,52,44.2,14.9032,52,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
ATROPINE (CONC: 0.1 MG/ML) FOR ETT (ADULT),,J0461,HCPCS,Facility,Outpatient,10,mL,,52,44.2,14.9032,52,Medica,Medical Assistance,23.192,44.6,,percent of total billed charges,,
ATROPINE (CONC: 0.1 MG/ML) FOR ETT (ADULT),,J0461,HCPCS,Facility,Inpatient,10,mL,,52,44.2,14.9032,52,Medica,Medical Assistance,,,,,Included in per diem rate,
ATROPINE (CONC: 0.1 MG/ML) FOR ETT (ADULT),,J0461,HCPCS,Facility,Outpatient,10,mL,,52,44.2,14.9032,52,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,25.896,49.8,,percent of total billed charges,,
ATROPINE (CONC: 0.1 MG/ML) FOR ETT (ADULT),,J0461,HCPCS,Facility,Inpatient,10,mL,,52,44.2,14.9032,52,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
ATROPINE (CONC: 0.1 MG/ML) FOR ETT (ADULT),,J0461,HCPCS,Facility,Both,10,mL,,52,44.2,14.9032,52,"Multiplan, Inc.","Multiplan, Inc.",48.88,94,,percent of total billed charges,,
ATROPINE (CONC: 0.1 MG/ML) FOR ETT (ADULT),,J0461,HCPCS,Facility,Outpatient,10,mL,,52,44.2,14.9032,52,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,46.852,90.1,,percent of total billed charges,,
ATROPINE (CONC: 0.1 MG/ML) FOR ETT (ADULT),,J0461,HCPCS,Facility,Inpatient,10,mL,,52,44.2,14.9032,52,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
ATROPINE (CONC: 0.1 MG/ML) FOR ETT (ADULT),,J0461,HCPCS,Facility,Both,10,mL,,52,44.2,14.9032,52,"Preferred One Administrative Services, INC.",PPO,51.272,98.6,,percent of total billed charges,,
ATROPINE (CONC: 0.1 MG/ML) FOR ETT (ADULT),,J0461,HCPCS,Facility,Outpatient,10,mL,,52,44.2,14.9032,52,PrimeWest Health,Minnesota Senior Health Options (MSHO),26.754,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
ATROPINE (CONC: 0.1 MG/ML) FOR ETT (ADULT),,J0461,HCPCS,Facility,Inpatient,10,mL,,52,44.2,14.9032,52,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ATROPINE (CONC: 0.1 MG/ML) FOR ETT (ADULT),,J0461,HCPCS,Facility,Outpatient,10,mL,,52,44.2,14.9032,52,PrimeWest Health,MinnesotaCare,26.7072,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
ATROPINE (CONC: 0.1 MG/ML) FOR ETT (ADULT),,J0461,HCPCS,Facility,Inpatient,10,mL,,52,44.2,14.9032,52,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
ATROPINE (CONC: 0.1 MG/ML) FOR ETT (ADULT),,J0461,HCPCS,Facility,Both,10,mL,,52,44.2,14.9032,52,Sanford Health Plan,Sanford Health Plan,47.84,92,,percent of total billed charges,,
ATROPINE (CONC: 0.1 MG/ML) FOR ETT (ADULT),,J0461,HCPCS,Facility,Outpatient,10,mL,,52,44.2,14.9032,52,"UCare Health, Inc.",Individual & Family Plan,29.302,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
ATROPINE (CONC: 0.1 MG/ML) FOR ETT (ADULT),,J0461,HCPCS,Facility,Inpatient,10,mL,,52,44.2,14.9032,52,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
ATROPINE (CONC: 0.1 MG/ML) FOR ETT (ADULT),,J0461,HCPCS,Facility,Outpatient,10,mL,,52,44.2,14.9032,52,"UCare Health, Inc.",Medical Assistance,26.2444,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ATROPINE (CONC: 0.1 MG/ML) FOR ETT (ADULT),,J0461,HCPCS,Facility,Inpatient,10,mL,,52,44.2,14.9032,52,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
ATROPINE (CONC: 0.1 MG/ML) FOR ETT (ADULT),,J0461,HCPCS,Facility,Outpatient,10,mL,,52,44.2,14.9032,52,"UCare Health, Inc.",Medicare Advantage,26.2444,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ATROPINE (CONC: 0.1 MG/ML) FOR ETT (ADULT),,J0461,HCPCS,Facility,Inpatient,10,mL,,52,44.2,14.9032,52,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ATROPINE (CONC: 0.1 MG/ML) FOR ETT (ADULT),,J0461,HCPCS,Facility,Outpatient,10,mL,,52,44.2,14.9032,52,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),26.2444,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ATROPINE (CONC: 0.1 MG/ML) FOR ETT (ADULT),,J0461,HCPCS,Facility,Inpatient,10,mL,,52,44.2,14.9032,52,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ATROPINE (CONC: 0.1 MG/ML) FOR ETT (ADULT),,J0461,HCPCS,Facility,Both,10,mL,,52,44.2,14.9032,52,UnitedHealthcare,Individual & Family,48.88,94,,percent of total billed charges,,
ATROPINE (CONC: 0.1 MG/ML) FOR ETT (ADULT),,J0461,HCPCS,Facility,Outpatient,10,mL,,52,44.2,14.9032,52,UnitedHealthcare,Medicare Advantage,25.48,49,,percent of total billed charges,,
ATROPINE (CONC: 0.1 MG/ML) FOR ETT (ADULT),,J0461,HCPCS,Facility,Inpatient,10,mL,,52,44.2,14.9032,52,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
ATROPINE (CONC: 0.1 MG/ML) FOR ETT (ADULT),,J0461,HCPCS,Facility,Outpatient,10,mL,,52,44.2,14.9032,52,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,24.96,48,,percent of total billed charges,,100% of DHS outpatient percentage
ATROPINE (CONC: 0.1 MG/ML) FOR ETT (ADULT),,J0461,HCPCS,Facility,Inpatient,10,mL,,52,44.2,14.9032,52,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
ATROPINE 0.1 MG/ML (BABY),,J0461,HCPCS,Facility,Both,10,mL,,52,44.2,14.9032,52,Aetna,Commercial,47.84,92,,percent of total billed charges,,
ATROPINE 0.1 MG/ML (BABY),,J0461,HCPCS,Facility,Outpatient,10,mL,,52,44.2,14.9032,52,Aetna,Medicare Advantage,25.48,49,,percent of total billed charges,,
ATROPINE 0.1 MG/ML (BABY),,J0461,HCPCS,Facility,Inpatient,10,mL,,52,44.2,14.9032,52,Aetna,Medicare Advantage,,,,,Included in per diem rate,
ATROPINE 0.1 MG/ML (BABY),,J0461,HCPCS,Facility,Both,10,mL,,52,44.2,14.9032,52,Aetna,PPO,48.36,93,,percent of total billed charges,,
ATROPINE 0.1 MG/ML (BABY),,J0461,HCPCS,Facility,Both,10,mL,,52,44.2,14.9032,52,America's PPO,America's PPO,49.9356,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
ATROPINE 0.1 MG/ML (BABY),,J0461,HCPCS,Facility,Both,10,mL,,52,44.2,14.9032,52,BlueCross BlueShield Minnesota, Federal Employee Program,51.168,98.4,,percent of total billed charges,,
ATROPINE 0.1 MG/ML (BABY),,J0461,HCPCS,Facility,Both,10,mL,,52,44.2,14.9032,52,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,52,100,,percent of total billed charges,,
ATROPINE 0.1 MG/ML (BABY),,J0461,HCPCS,Facility,Both,10,mL,,52,44.2,14.9032,52,BlueCross BlueShield Minnesota,High Value Network Plan,46.8,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
ATROPINE 0.1 MG/ML (BABY),,J0461,HCPCS,Facility,Outpatient,10,mL,,52,44.2,14.9032,52,BlueCross BlueShield Minnesota,Medicare Advantage,25.48,49,,percent of total billed charges,,
ATROPINE 0.1 MG/ML (BABY),,J0461,HCPCS,Facility,Inpatient,10,mL,,52,44.2,14.9032,52,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
ATROPINE 0.1 MG/ML (BABY),,J0461,HCPCS,Facility,Both,10,mL,,52,44.2,14.9032,52,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,46.0564,88.57,,percent of total billed charges,,
ATROPINE 0.1 MG/ML (BABY),,J0461,HCPCS,Facility,Both,10,mL,,52,44.2,14.9032,52,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,14.9032,28.66,,percent of total billed charges,,
ATROPINE 0.1 MG/ML (BABY),,J0461,HCPCS,Facility,Outpatient,10,mL,,52,44.2,14.9032,52,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),25.48,49,,percent of total billed charges,,
ATROPINE 0.1 MG/ML (BABY),,J0461,HCPCS,Facility,Inpatient,10,mL,,52,44.2,14.9032,52,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
ATROPINE 0.1 MG/ML (BABY),,J0461,HCPCS,Facility,Both,10,mL,,52,44.2,14.9032,52,CorVel,Worker's Compensation,52,100,,percent of total billed charges,,
ATROPINE 0.1 MG/ML (BABY),,J0461,HCPCS,Facility,Both,10,mL,,52,44.2,14.9032,52,First Health Group Corporation,First Health Network,50.44,97,,percent of total billed charges,,
ATROPINE 0.1 MG/ML (BABY),,J0461,HCPCS,Facility,Both,10,mL,,52,44.2,14.9032,52,"Health Partners, Inc.",Commercial,49.192,94.6,,percent of total billed charges,,
ATROPINE 0.1 MG/ML (BABY),,J0461,HCPCS,Facility,Outpatient,10,mL,,52,44.2,14.9032,52,"Health Partners, Inc.",Medicare Advantage,25.48,49,,percent of total billed charges,,
ATROPINE 0.1 MG/ML (BABY),,J0461,HCPCS,Facility,Inpatient,10,mL,,52,44.2,14.9032,52,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ATROPINE 0.1 MG/ML (BABY),,J0461,HCPCS,Facility,Both,10,mL,,52,44.2,14.9032,52,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),31.2,60,,percent of total billed charges,,
ATROPINE 0.1 MG/ML (BABY),,J0461,HCPCS,Facility,Both,10,mL,,52,44.2,14.9032,52,"Health Partners, Inc.",State of Minnesota Advantage Program,42.38,81.5,,percent of total billed charges,,
ATROPINE 0.1 MG/ML (BABY),,J0461,HCPCS,Facility,Both,10,mL,,52,44.2,14.9032,52,"Health Partners, Inc.",State Public Programs,26,50,,percent of total billed charges,,
ATROPINE 0.1 MG/ML (BABY),,J0461,HCPCS,Facility,Both,10,mL,,52,44.2,14.9032,52,Humana Insurance Company,Commercial PPO,49.4,95,,percent of total billed charges,,
ATROPINE 0.1 MG/ML (BABY),,J0461,HCPCS,Facility,Outpatient,10,mL,,52,44.2,14.9032,52,Humana Insurance Company,Medicare PPO,25.48,49,,percent of total billed charges,,
ATROPINE 0.1 MG/ML (BABY),,J0461,HCPCS,Facility,Inpatient,10,mL,,52,44.2,14.9032,52,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
ATROPINE 0.1 MG/ML (BABY),,J0461,HCPCS,Facility,Both,10,mL,,52,44.2,14.9032,52,Medica,Individual & Family,51.532,99.1,,percent of total billed charges,,
ATROPINE 0.1 MG/ML (BABY),,J0461,HCPCS,Facility,Outpatient,10,mL,,52,44.2,14.9032,52,Medica,Medica Advantage Solution,25.896,49.8,,percent of total billed charges,,
ATROPINE 0.1 MG/ML (BABY),,J0461,HCPCS,Facility,Inpatient,10,mL,,52,44.2,14.9032,52,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
ATROPINE 0.1 MG/ML (BABY),,J0461,HCPCS,Facility,Outpatient,10,mL,,52,44.2,14.9032,52,Medica,Medical Assistance,23.192,44.6,,percent of total billed charges,,
ATROPINE 0.1 MG/ML (BABY),,J0461,HCPCS,Facility,Inpatient,10,mL,,52,44.2,14.9032,52,Medica,Medical Assistance,,,,,Included in per diem rate,
ATROPINE 0.1 MG/ML (BABY),,J0461,HCPCS,Facility,Outpatient,10,mL,,52,44.2,14.9032,52,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,25.896,49.8,,percent of total billed charges,,
ATROPINE 0.1 MG/ML (BABY),,J0461,HCPCS,Facility,Inpatient,10,mL,,52,44.2,14.9032,52,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
ATROPINE 0.1 MG/ML (BABY),,J0461,HCPCS,Facility,Both,10,mL,,52,44.2,14.9032,52,"Multiplan, Inc.","Multiplan, Inc.",48.88,94,,percent of total billed charges,,
ATROPINE 0.1 MG/ML (BABY),,J0461,HCPCS,Facility,Outpatient,10,mL,,52,44.2,14.9032,52,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,46.852,90.1,,percent of total billed charges,,
ATROPINE 0.1 MG/ML (BABY),,J0461,HCPCS,Facility,Inpatient,10,mL,,52,44.2,14.9032,52,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
ATROPINE 0.1 MG/ML (BABY),,J0461,HCPCS,Facility,Both,10,mL,,52,44.2,14.9032,52,"Preferred One Administrative Services, INC.",PPO,51.272,98.6,,percent of total billed charges,,
ATROPINE 0.1 MG/ML (BABY),,J0461,HCPCS,Facility,Outpatient,10,mL,,52,44.2,14.9032,52,PrimeWest Health,Minnesota Senior Health Options (MSHO),26.754,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
ATROPINE 0.1 MG/ML (BABY),,J0461,HCPCS,Facility,Inpatient,10,mL,,52,44.2,14.9032,52,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ATROPINE 0.1 MG/ML (BABY),,J0461,HCPCS,Facility,Outpatient,10,mL,,52,44.2,14.9032,52,PrimeWest Health,MinnesotaCare,26.7072,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
ATROPINE 0.1 MG/ML (BABY),,J0461,HCPCS,Facility,Inpatient,10,mL,,52,44.2,14.9032,52,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
ATROPINE 0.1 MG/ML (BABY),,J0461,HCPCS,Facility,Both,10,mL,,52,44.2,14.9032,52,Sanford Health Plan,Sanford Health Plan,47.84,92,,percent of total billed charges,,
ATROPINE 0.1 MG/ML (BABY),,J0461,HCPCS,Facility,Outpatient,10,mL,,52,44.2,14.9032,52,"UCare Health, Inc.",Individual & Family Plan,29.302,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
ATROPINE 0.1 MG/ML (BABY),,J0461,HCPCS,Facility,Inpatient,10,mL,,52,44.2,14.9032,52,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
ATROPINE 0.1 MG/ML (BABY),,J0461,HCPCS,Facility,Outpatient,10,mL,,52,44.2,14.9032,52,"UCare Health, Inc.",Medical Assistance,26.2444,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ATROPINE 0.1 MG/ML (BABY),,J0461,HCPCS,Facility,Inpatient,10,mL,,52,44.2,14.9032,52,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
ATROPINE 0.1 MG/ML (BABY),,J0461,HCPCS,Facility,Outpatient,10,mL,,52,44.2,14.9032,52,"UCare Health, Inc.",Medicare Advantage,26.2444,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ATROPINE 0.1 MG/ML (BABY),,J0461,HCPCS,Facility,Inpatient,10,mL,,52,44.2,14.9032,52,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ATROPINE 0.1 MG/ML (BABY),,J0461,HCPCS,Facility,Outpatient,10,mL,,52,44.2,14.9032,52,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),26.2444,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ATROPINE 0.1 MG/ML (BABY),,J0461,HCPCS,Facility,Inpatient,10,mL,,52,44.2,14.9032,52,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ATROPINE 0.1 MG/ML (BABY),,J0461,HCPCS,Facility,Both,10,mL,,52,44.2,14.9032,52,UnitedHealthcare,Individual & Family,48.88,94,,percent of total billed charges,,
ATROPINE 0.1 MG/ML (BABY),,J0461,HCPCS,Facility,Outpatient,10,mL,,52,44.2,14.9032,52,UnitedHealthcare,Medicare Advantage,25.48,49,,percent of total billed charges,,
ATROPINE 0.1 MG/ML (BABY),,J0461,HCPCS,Facility,Inpatient,10,mL,,52,44.2,14.9032,52,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
ATROPINE 0.1 MG/ML (BABY),,J0461,HCPCS,Facility,Outpatient,10,mL,,52,44.2,14.9032,52,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,24.96,48,,percent of total billed charges,,100% of DHS outpatient percentage
ATROPINE 0.1 MG/ML (BABY),,J0461,HCPCS,Facility,Inpatient,10,mL,,52,44.2,14.9032,52,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Cortisol,,82533,CPT,Facility,Both,,,,53,45.05,15.1898,53,Aetna,Commercial,48.76,92,,percent of total billed charges,,
Cortisol,,82533,CPT,Facility,Outpatient,,,,53,45.05,15.1898,53,Aetna,Medicare Advantage,25.97,49,,percent of total billed charges,,
Cortisol,,82533,CPT,Facility,Inpatient,,,,53,45.05,15.1898,53,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Cortisol,,82533,CPT,Facility,Both,,,,53,45.05,15.1898,53,Aetna,PPO,49.29,93,,percent of total billed charges,,
Cortisol,,82533,CPT,Facility,Both,,,,53,45.05,15.1898,53,America's PPO,America's PPO,50.8959,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Cortisol,,82533,CPT,Facility,Both,,,,53,45.05,15.1898,53,BlueCross BlueShield Minnesota, Federal Employee Program,52.152,98.4,,percent of total billed charges,,
Cortisol,,82533,CPT,Facility,Both,,,,53,45.05,15.1898,53,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,53,100,,percent of total billed charges,,
Cortisol,,82533,CPT,Facility,Both,,,,53,45.05,15.1898,53,BlueCross BlueShield Minnesota,High Value Network Plan,47.7,90,,percent of total billed charges,,
Cortisol,,82533,CPT,Facility,Outpatient,,,,53,45.05,15.1898,53,BlueCross BlueShield Minnesota,Medicare Advantage,25.97,49,,percent of total billed charges,,
Cortisol,,82533,CPT,Facility,Inpatient,,,,53,45.05,15.1898,53,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Cortisol,,82533,CPT,Facility,Both,,,,53,45.05,15.1898,53,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,46.9421,88.57,,percent of total billed charges,,
Cortisol,,82533,CPT,Facility,Both,,,,53,45.05,15.1898,53,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,15.1898,28.66,,percent of total billed charges,,
Cortisol,,82533,CPT,Facility,Outpatient,,,,53,45.05,15.1898,53,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),25.97,49,,percent of total billed charges,,
Cortisol,,82533,CPT,Facility,Inpatient,,,,53,45.05,15.1898,53,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Cortisol,,82533,CPT,Facility,Both,,,,53,45.05,15.1898,53,CorVel,Worker's Compensation,53,100,,percent of total billed charges,,
Cortisol,,82533,CPT,Facility,Both,,,,53,45.05,15.1898,53,First Health Group Corporation,First Health Network,51.41,97,,percent of total billed charges,,
Cortisol,,82533,CPT,Facility,Both,,,,53,45.05,15.1898,53,"Health Partners, Inc.",Commercial,50.138,94.6,,percent of total billed charges,,
Cortisol,,82533,CPT,Facility,Outpatient,,,,53,45.05,15.1898,53,"Health Partners, Inc.",Medicare Advantage,25.97,49,,percent of total billed charges,,
Cortisol,,82533,CPT,Facility,Inpatient,,,,53,45.05,15.1898,53,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Cortisol,,82533,CPT,Facility,Both,,,,53,45.05,15.1898,53,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),31.8,60,,percent of total billed charges,,
Cortisol,,82533,CPT,Facility,Both,,,,53,45.05,15.1898,53,"Health Partners, Inc.",State of Minnesota Advantage Program,43.195,81.5,,percent of total billed charges,,
Cortisol,,82533,CPT,Facility,Both,,,,53,45.05,15.1898,53,"Health Partners, Inc.",State Public Programs,26.5,50,,percent of total billed charges,,
Cortisol,,82533,CPT,Facility,Both,,,,53,45.05,15.1898,53,Humana Insurance Company,Commercial PPO,50.35,95,,percent of total billed charges,,
Cortisol,,82533,CPT,Facility,Outpatient,,,,53,45.05,15.1898,53,Humana Insurance Company,Medicare PPO,25.97,49,,percent of total billed charges,,
Cortisol,,82533,CPT,Facility,Inpatient,,,,53,45.05,15.1898,53,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Cortisol,,82533,CPT,Facility,Both,,,,53,45.05,15.1898,53,Medica,Individual & Family,52.523,99.1,,percent of total billed charges,,
Cortisol,,82533,CPT,Facility,Outpatient,,,,53,45.05,15.1898,53,Medica,Medica Advantage Solution,26.394,49.8,,percent of total billed charges,,
Cortisol,,82533,CPT,Facility,Inpatient,,,,53,45.05,15.1898,53,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Cortisol,,82533,CPT,Facility,Outpatient,,,,53,45.05,15.1898,53,Medica,Medical Assistance,23.638,44.6,,percent of total billed charges,,
Cortisol,,82533,CPT,Facility,Inpatient,,,,53,45.05,15.1898,53,Medica,Medical Assistance,,,,,Included in per diem rate,
Cortisol,,82533,CPT,Facility,Outpatient,,,,53,45.05,15.1898,53,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,26.394,49.8,,percent of total billed charges,,
Cortisol,,82533,CPT,Facility,Inpatient,,,,53,45.05,15.1898,53,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Cortisol,,82533,CPT,Facility,Both,,,,53,45.05,15.1898,53,"Multiplan, Inc.","Multiplan, Inc.",49.82,94,,percent of total billed charges,,
Cortisol,,82533,CPT,Facility,Outpatient,,,,53,45.05,15.1898,53,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,45.792,86.4,,percent of total billed charges,,
Cortisol,,82533,CPT,Facility,Inpatient,,,,53,45.05,15.1898,53,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Cortisol,,82533,CPT,Facility,Both,,,,53,45.05,15.1898,53,"Preferred One Administrative Services, INC.",PPO,52.258,98.6,,percent of total billed charges,,
Cortisol,,82533,CPT,Facility,Outpatient,,,,53,45.05,15.1898,53,PrimeWest Health,Minnesota Senior Health Options (MSHO),27.2685,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Cortisol,,82533,CPT,Facility,Inpatient,,,,53,45.05,15.1898,53,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Cortisol,,82533,CPT,Facility,Outpatient,,,,53,45.05,15.1898,53,PrimeWest Health,MinnesotaCare,27.2208,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Cortisol,,82533,CPT,Facility,Inpatient,,,,53,45.05,15.1898,53,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Cortisol,,82533,CPT,Facility,Both,,,,53,45.05,15.1898,53,Sanford Health Plan,Sanford Health Plan,48.76,92,,percent of total billed charges,,
Cortisol,,82533,CPT,Facility,Outpatient,,,,53,45.05,15.1898,53,"UCare Health, Inc.",Individual & Family Plan,29.8655,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Cortisol,,82533,CPT,Facility,Inpatient,,,,53,45.05,15.1898,53,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Cortisol,,82533,CPT,Facility,Outpatient,,,,53,45.05,15.1898,53,"UCare Health, Inc.",Medical Assistance,26.7491,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Cortisol,,82533,CPT,Facility,Inpatient,,,,53,45.05,15.1898,53,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Cortisol,,82533,CPT,Facility,Outpatient,,,,53,45.05,15.1898,53,"UCare Health, Inc.",Medicare Advantage,26.7491,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Cortisol,,82533,CPT,Facility,Inpatient,,,,53,45.05,15.1898,53,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Cortisol,,82533,CPT,Facility,Outpatient,,,,53,45.05,15.1898,53,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),26.7491,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Cortisol,,82533,CPT,Facility,Inpatient,,,,53,45.05,15.1898,53,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Cortisol,,82533,CPT,Facility,Both,,,,53,45.05,15.1898,53,UnitedHealthcare,Individual & Family,49.82,94,,percent of total billed charges,,
Cortisol,,82533,CPT,Facility,Outpatient,,,,53,45.05,15.1898,53,UnitedHealthcare,Medicare Advantage,25.97,49,,percent of total billed charges,,
Cortisol,,82533,CPT,Facility,Inpatient,,,,53,45.05,15.1898,53,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Cortisol,,82533,CPT,Facility,Outpatient,,,,53,45.05,15.1898,53,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,25.44,48,,percent of total billed charges,,100% of DHS outpatient percentage
Cortisol,,82533,CPT,Facility,Inpatient,,,,53,45.05,15.1898,53,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Cortisol, Am",,82533,CPT,Facility,Both,,,,53,45.05,15.1898,53,Aetna,Commercial,48.76,92,,percent of total billed charges,,
"Cortisol, Am",,82533,CPT,Facility,Outpatient,,,,53,45.05,15.1898,53,Aetna,Medicare Advantage,25.97,49,,percent of total billed charges,,
"Cortisol, Am",,82533,CPT,Facility,Inpatient,,,,53,45.05,15.1898,53,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Cortisol, Am",,82533,CPT,Facility,Both,,,,53,45.05,15.1898,53,Aetna,PPO,49.29,93,,percent of total billed charges,,
"Cortisol, Am",,82533,CPT,Facility,Both,,,,53,45.05,15.1898,53,America's PPO,America's PPO,50.8959,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Cortisol, Am",,82533,CPT,Facility,Both,,,,53,45.05,15.1898,53,BlueCross BlueShield Minnesota, Federal Employee Program,52.152,98.4,,percent of total billed charges,,
"Cortisol, Am",,82533,CPT,Facility,Both,,,,53,45.05,15.1898,53,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,53,100,,percent of total billed charges,,
"Cortisol, Am",,82533,CPT,Facility,Both,,,,53,45.05,15.1898,53,BlueCross BlueShield Minnesota,High Value Network Plan,47.7,90,,percent of total billed charges,,
"Cortisol, Am",,82533,CPT,Facility,Outpatient,,,,53,45.05,15.1898,53,BlueCross BlueShield Minnesota,Medicare Advantage,25.97,49,,percent of total billed charges,,
"Cortisol, Am",,82533,CPT,Facility,Inpatient,,,,53,45.05,15.1898,53,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Cortisol, Am",,82533,CPT,Facility,Both,,,,53,45.05,15.1898,53,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,46.9421,88.57,,percent of total billed charges,,
"Cortisol, Am",,82533,CPT,Facility,Both,,,,53,45.05,15.1898,53,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,15.1898,28.66,,percent of total billed charges,,
"Cortisol, Am",,82533,CPT,Facility,Outpatient,,,,53,45.05,15.1898,53,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),25.97,49,,percent of total billed charges,,
"Cortisol, Am",,82533,CPT,Facility,Inpatient,,,,53,45.05,15.1898,53,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Cortisol, Am",,82533,CPT,Facility,Both,,,,53,45.05,15.1898,53,CorVel,Worker's Compensation,53,100,,percent of total billed charges,,
"Cortisol, Am",,82533,CPT,Facility,Both,,,,53,45.05,15.1898,53,First Health Group Corporation,First Health Network,51.41,97,,percent of total billed charges,,
"Cortisol, Am",,82533,CPT,Facility,Both,,,,53,45.05,15.1898,53,"Health Partners, Inc.",Commercial,50.138,94.6,,percent of total billed charges,,
"Cortisol, Am",,82533,CPT,Facility,Outpatient,,,,53,45.05,15.1898,53,"Health Partners, Inc.",Medicare Advantage,25.97,49,,percent of total billed charges,,
"Cortisol, Am",,82533,CPT,Facility,Inpatient,,,,53,45.05,15.1898,53,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Cortisol, Am",,82533,CPT,Facility,Both,,,,53,45.05,15.1898,53,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),31.8,60,,percent of total billed charges,,
"Cortisol, Am",,82533,CPT,Facility,Both,,,,53,45.05,15.1898,53,"Health Partners, Inc.",State of Minnesota Advantage Program,43.195,81.5,,percent of total billed charges,,
"Cortisol, Am",,82533,CPT,Facility,Both,,,,53,45.05,15.1898,53,"Health Partners, Inc.",State Public Programs,26.5,50,,percent of total billed charges,,
"Cortisol, Am",,82533,CPT,Facility,Both,,,,53,45.05,15.1898,53,Humana Insurance Company,Commercial PPO,50.35,95,,percent of total billed charges,,
"Cortisol, Am",,82533,CPT,Facility,Outpatient,,,,53,45.05,15.1898,53,Humana Insurance Company,Medicare PPO,25.97,49,,percent of total billed charges,,
"Cortisol, Am",,82533,CPT,Facility,Inpatient,,,,53,45.05,15.1898,53,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Cortisol, Am",,82533,CPT,Facility,Both,,,,53,45.05,15.1898,53,Medica,Individual & Family,52.523,99.1,,percent of total billed charges,,
"Cortisol, Am",,82533,CPT,Facility,Outpatient,,,,53,45.05,15.1898,53,Medica,Medica Advantage Solution,26.394,49.8,,percent of total billed charges,,
"Cortisol, Am",,82533,CPT,Facility,Inpatient,,,,53,45.05,15.1898,53,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Cortisol, Am",,82533,CPT,Facility,Outpatient,,,,53,45.05,15.1898,53,Medica,Medical Assistance,23.638,44.6,,percent of total billed charges,,
"Cortisol, Am",,82533,CPT,Facility,Inpatient,,,,53,45.05,15.1898,53,Medica,Medical Assistance,,,,,Included in per diem rate,
"Cortisol, Am",,82533,CPT,Facility,Outpatient,,,,53,45.05,15.1898,53,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,26.394,49.8,,percent of total billed charges,,
"Cortisol, Am",,82533,CPT,Facility,Inpatient,,,,53,45.05,15.1898,53,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Cortisol, Am",,82533,CPT,Facility,Both,,,,53,45.05,15.1898,53,"Multiplan, Inc.","Multiplan, Inc.",49.82,94,,percent of total billed charges,,
"Cortisol, Am",,82533,CPT,Facility,Outpatient,,,,53,45.05,15.1898,53,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,45.792,86.4,,percent of total billed charges,,
"Cortisol, Am",,82533,CPT,Facility,Inpatient,,,,53,45.05,15.1898,53,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Cortisol, Am",,82533,CPT,Facility,Both,,,,53,45.05,15.1898,53,"Preferred One Administrative Services, INC.",PPO,52.258,98.6,,percent of total billed charges,,
"Cortisol, Am",,82533,CPT,Facility,Outpatient,,,,53,45.05,15.1898,53,PrimeWest Health,Minnesota Senior Health Options (MSHO),27.2685,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Cortisol, Am",,82533,CPT,Facility,Inpatient,,,,53,45.05,15.1898,53,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Cortisol, Am",,82533,CPT,Facility,Outpatient,,,,53,45.05,15.1898,53,PrimeWest Health,MinnesotaCare,27.2208,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Cortisol, Am",,82533,CPT,Facility,Inpatient,,,,53,45.05,15.1898,53,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Cortisol, Am",,82533,CPT,Facility,Both,,,,53,45.05,15.1898,53,Sanford Health Plan,Sanford Health Plan,48.76,92,,percent of total billed charges,,
"Cortisol, Am",,82533,CPT,Facility,Outpatient,,,,53,45.05,15.1898,53,"UCare Health, Inc.",Individual & Family Plan,29.8655,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Cortisol, Am",,82533,CPT,Facility,Inpatient,,,,53,45.05,15.1898,53,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Cortisol, Am",,82533,CPT,Facility,Outpatient,,,,53,45.05,15.1898,53,"UCare Health, Inc.",Medical Assistance,26.7491,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Cortisol, Am",,82533,CPT,Facility,Inpatient,,,,53,45.05,15.1898,53,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Cortisol, Am",,82533,CPT,Facility,Outpatient,,,,53,45.05,15.1898,53,"UCare Health, Inc.",Medicare Advantage,26.7491,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Cortisol, Am",,82533,CPT,Facility,Inpatient,,,,53,45.05,15.1898,53,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Cortisol, Am",,82533,CPT,Facility,Outpatient,,,,53,45.05,15.1898,53,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),26.7491,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Cortisol, Am",,82533,CPT,Facility,Inpatient,,,,53,45.05,15.1898,53,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Cortisol, Am",,82533,CPT,Facility,Both,,,,53,45.05,15.1898,53,UnitedHealthcare,Individual & Family,49.82,94,,percent of total billed charges,,
"Cortisol, Am",,82533,CPT,Facility,Outpatient,,,,53,45.05,15.1898,53,UnitedHealthcare,Medicare Advantage,25.97,49,,percent of total billed charges,,
"Cortisol, Am",,82533,CPT,Facility,Inpatient,,,,53,45.05,15.1898,53,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Cortisol, Am",,82533,CPT,Facility,Outpatient,,,,53,45.05,15.1898,53,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,25.44,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Cortisol, Am",,82533,CPT,Facility,Inpatient,,,,53,45.05,15.1898,53,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Cortisol, Pm",,82533,CPT,Facility,Both,,,,53,45.05,15.1898,53,Aetna,Commercial,48.76,92,,percent of total billed charges,,
"Cortisol, Pm",,82533,CPT,Facility,Outpatient,,,,53,45.05,15.1898,53,Aetna,Medicare Advantage,25.97,49,,percent of total billed charges,,
"Cortisol, Pm",,82533,CPT,Facility,Inpatient,,,,53,45.05,15.1898,53,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Cortisol, Pm",,82533,CPT,Facility,Both,,,,53,45.05,15.1898,53,Aetna,PPO,49.29,93,,percent of total billed charges,,
"Cortisol, Pm",,82533,CPT,Facility,Both,,,,53,45.05,15.1898,53,America's PPO,America's PPO,50.8959,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Cortisol, Pm",,82533,CPT,Facility,Both,,,,53,45.05,15.1898,53,BlueCross BlueShield Minnesota, Federal Employee Program,52.152,98.4,,percent of total billed charges,,
"Cortisol, Pm",,82533,CPT,Facility,Both,,,,53,45.05,15.1898,53,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,53,100,,percent of total billed charges,,
"Cortisol, Pm",,82533,CPT,Facility,Both,,,,53,45.05,15.1898,53,BlueCross BlueShield Minnesota,High Value Network Plan,47.7,90,,percent of total billed charges,,
"Cortisol, Pm",,82533,CPT,Facility,Outpatient,,,,53,45.05,15.1898,53,BlueCross BlueShield Minnesota,Medicare Advantage,25.97,49,,percent of total billed charges,,
"Cortisol, Pm",,82533,CPT,Facility,Inpatient,,,,53,45.05,15.1898,53,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Cortisol, Pm",,82533,CPT,Facility,Both,,,,53,45.05,15.1898,53,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,46.9421,88.57,,percent of total billed charges,,
"Cortisol, Pm",,82533,CPT,Facility,Both,,,,53,45.05,15.1898,53,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,15.1898,28.66,,percent of total billed charges,,
"Cortisol, Pm",,82533,CPT,Facility,Outpatient,,,,53,45.05,15.1898,53,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),25.97,49,,percent of total billed charges,,
"Cortisol, Pm",,82533,CPT,Facility,Inpatient,,,,53,45.05,15.1898,53,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Cortisol, Pm",,82533,CPT,Facility,Both,,,,53,45.05,15.1898,53,CorVel,Worker's Compensation,53,100,,percent of total billed charges,,
"Cortisol, Pm",,82533,CPT,Facility,Both,,,,53,45.05,15.1898,53,First Health Group Corporation,First Health Network,51.41,97,,percent of total billed charges,,
"Cortisol, Pm",,82533,CPT,Facility,Both,,,,53,45.05,15.1898,53,"Health Partners, Inc.",Commercial,50.138,94.6,,percent of total billed charges,,
"Cortisol, Pm",,82533,CPT,Facility,Outpatient,,,,53,45.05,15.1898,53,"Health Partners, Inc.",Medicare Advantage,25.97,49,,percent of total billed charges,,
"Cortisol, Pm",,82533,CPT,Facility,Inpatient,,,,53,45.05,15.1898,53,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Cortisol, Pm",,82533,CPT,Facility,Both,,,,53,45.05,15.1898,53,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),31.8,60,,percent of total billed charges,,
"Cortisol, Pm",,82533,CPT,Facility,Both,,,,53,45.05,15.1898,53,"Health Partners, Inc.",State of Minnesota Advantage Program,43.195,81.5,,percent of total billed charges,,
"Cortisol, Pm",,82533,CPT,Facility,Both,,,,53,45.05,15.1898,53,"Health Partners, Inc.",State Public Programs,26.5,50,,percent of total billed charges,,
"Cortisol, Pm",,82533,CPT,Facility,Both,,,,53,45.05,15.1898,53,Humana Insurance Company,Commercial PPO,50.35,95,,percent of total billed charges,,
"Cortisol, Pm",,82533,CPT,Facility,Outpatient,,,,53,45.05,15.1898,53,Humana Insurance Company,Medicare PPO,25.97,49,,percent of total billed charges,,
"Cortisol, Pm",,82533,CPT,Facility,Inpatient,,,,53,45.05,15.1898,53,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Cortisol, Pm",,82533,CPT,Facility,Both,,,,53,45.05,15.1898,53,Medica,Individual & Family,52.523,99.1,,percent of total billed charges,,
"Cortisol, Pm",,82533,CPT,Facility,Outpatient,,,,53,45.05,15.1898,53,Medica,Medica Advantage Solution,26.394,49.8,,percent of total billed charges,,
"Cortisol, Pm",,82533,CPT,Facility,Inpatient,,,,53,45.05,15.1898,53,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Cortisol, Pm",,82533,CPT,Facility,Outpatient,,,,53,45.05,15.1898,53,Medica,Medical Assistance,23.638,44.6,,percent of total billed charges,,
"Cortisol, Pm",,82533,CPT,Facility,Inpatient,,,,53,45.05,15.1898,53,Medica,Medical Assistance,,,,,Included in per diem rate,
"Cortisol, Pm",,82533,CPT,Facility,Outpatient,,,,53,45.05,15.1898,53,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,26.394,49.8,,percent of total billed charges,,
"Cortisol, Pm",,82533,CPT,Facility,Inpatient,,,,53,45.05,15.1898,53,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Cortisol, Pm",,82533,CPT,Facility,Both,,,,53,45.05,15.1898,53,"Multiplan, Inc.","Multiplan, Inc.",49.82,94,,percent of total billed charges,,
"Cortisol, Pm",,82533,CPT,Facility,Outpatient,,,,53,45.05,15.1898,53,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,45.792,86.4,,percent of total billed charges,,
"Cortisol, Pm",,82533,CPT,Facility,Inpatient,,,,53,45.05,15.1898,53,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Cortisol, Pm",,82533,CPT,Facility,Both,,,,53,45.05,15.1898,53,"Preferred One Administrative Services, INC.",PPO,52.258,98.6,,percent of total billed charges,,
"Cortisol, Pm",,82533,CPT,Facility,Outpatient,,,,53,45.05,15.1898,53,PrimeWest Health,Minnesota Senior Health Options (MSHO),27.2685,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Cortisol, Pm",,82533,CPT,Facility,Inpatient,,,,53,45.05,15.1898,53,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Cortisol, Pm",,82533,CPT,Facility,Outpatient,,,,53,45.05,15.1898,53,PrimeWest Health,MinnesotaCare,27.2208,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Cortisol, Pm",,82533,CPT,Facility,Inpatient,,,,53,45.05,15.1898,53,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Cortisol, Pm",,82533,CPT,Facility,Both,,,,53,45.05,15.1898,53,Sanford Health Plan,Sanford Health Plan,48.76,92,,percent of total billed charges,,
"Cortisol, Pm",,82533,CPT,Facility,Outpatient,,,,53,45.05,15.1898,53,"UCare Health, Inc.",Individual & Family Plan,29.8655,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Cortisol, Pm",,82533,CPT,Facility,Inpatient,,,,53,45.05,15.1898,53,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Cortisol, Pm",,82533,CPT,Facility,Outpatient,,,,53,45.05,15.1898,53,"UCare Health, Inc.",Medical Assistance,26.7491,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Cortisol, Pm",,82533,CPT,Facility,Inpatient,,,,53,45.05,15.1898,53,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Cortisol, Pm",,82533,CPT,Facility,Outpatient,,,,53,45.05,15.1898,53,"UCare Health, Inc.",Medicare Advantage,26.7491,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Cortisol, Pm",,82533,CPT,Facility,Inpatient,,,,53,45.05,15.1898,53,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Cortisol, Pm",,82533,CPT,Facility,Outpatient,,,,53,45.05,15.1898,53,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),26.7491,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Cortisol, Pm",,82533,CPT,Facility,Inpatient,,,,53,45.05,15.1898,53,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Cortisol, Pm",,82533,CPT,Facility,Both,,,,53,45.05,15.1898,53,UnitedHealthcare,Individual & Family,49.82,94,,percent of total billed charges,,
"Cortisol, Pm",,82533,CPT,Facility,Outpatient,,,,53,45.05,15.1898,53,UnitedHealthcare,Medicare Advantage,25.97,49,,percent of total billed charges,,
"Cortisol, Pm",,82533,CPT,Facility,Inpatient,,,,53,45.05,15.1898,53,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Cortisol, Pm",,82533,CPT,Facility,Outpatient,,,,53,45.05,15.1898,53,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,25.44,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Cortisol, Pm",,82533,CPT,Facility,Inpatient,,,,53,45.05,15.1898,53,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Creatinine Kinase,,82550,CPT,Facility,Both,,,,90,76.5,25.794,90,Aetna,Commercial,82.8,92,,percent of total billed charges,,
Creatinine Kinase,,82550,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,Aetna,Medicare Advantage,44.1,49,,percent of total billed charges,,
Creatinine Kinase,,82550,CPT,Facility,Inpatient,,,,90,76.5,25.794,90,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Creatinine Kinase,,82550,CPT,Facility,Both,,,,90,76.5,25.794,90,Aetna,PPO,83.7,93,,percent of total billed charges,,
Creatinine Kinase,,82550,CPT,Facility,Both,,,,90,76.5,25.794,90,America's PPO,America's PPO,86.427,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Creatinine Kinase,,82550,CPT,Facility,Both,,,,90,76.5,25.794,90,BlueCross BlueShield Minnesota, Federal Employee Program,88.56,98.4,,percent of total billed charges,,
Creatinine Kinase,,82550,CPT,Facility,Both,,,,90,76.5,25.794,90,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,90,100,,percent of total billed charges,,
Creatinine Kinase,,82550,CPT,Facility,Both,,,,90,76.5,25.794,90,BlueCross BlueShield Minnesota,High Value Network Plan,81,90,,percent of total billed charges,,
Creatinine Kinase,,82550,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,BlueCross BlueShield Minnesota,Medicare Advantage,44.1,49,,percent of total billed charges,,
Creatinine Kinase,,82550,CPT,Facility,Inpatient,,,,90,76.5,25.794,90,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Creatinine Kinase,,82550,CPT,Facility,Both,,,,90,76.5,25.794,90,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,79.713,88.57,,percent of total billed charges,,
Creatinine Kinase,,82550,CPT,Facility,Both,,,,90,76.5,25.794,90,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,25.794,28.66,,percent of total billed charges,,
Creatinine Kinase,,82550,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),44.1,49,,percent of total billed charges,,
Creatinine Kinase,,82550,CPT,Facility,Inpatient,,,,90,76.5,25.794,90,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Creatinine Kinase,,82550,CPT,Facility,Both,,,,90,76.5,25.794,90,CorVel,Worker's Compensation,90,100,,percent of total billed charges,,
Creatinine Kinase,,82550,CPT,Facility,Both,,,,90,76.5,25.794,90,First Health Group Corporation,First Health Network,87.3,97,,percent of total billed charges,,
Creatinine Kinase,,82550,CPT,Facility,Both,,,,90,76.5,25.794,90,"Health Partners, Inc.",Commercial,85.14,94.6,,percent of total billed charges,,
Creatinine Kinase,,82550,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,"Health Partners, Inc.",Medicare Advantage,44.1,49,,percent of total billed charges,,
Creatinine Kinase,,82550,CPT,Facility,Inpatient,,,,90,76.5,25.794,90,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Creatinine Kinase,,82550,CPT,Facility,Both,,,,90,76.5,25.794,90,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),54,60,,percent of total billed charges,,
Creatinine Kinase,,82550,CPT,Facility,Both,,,,90,76.5,25.794,90,"Health Partners, Inc.",State of Minnesota Advantage Program,73.35,81.5,,percent of total billed charges,,
Creatinine Kinase,,82550,CPT,Facility,Both,,,,90,76.5,25.794,90,"Health Partners, Inc.",State Public Programs,45,50,,percent of total billed charges,,
Creatinine Kinase,,82550,CPT,Facility,Both,,,,90,76.5,25.794,90,Humana Insurance Company,Commercial PPO,85.5,95,,percent of total billed charges,,
Creatinine Kinase,,82550,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,Humana Insurance Company,Medicare PPO,44.1,49,,percent of total billed charges,,
Creatinine Kinase,,82550,CPT,Facility,Inpatient,,,,90,76.5,25.794,90,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Creatinine Kinase,,82550,CPT,Facility,Both,,,,90,76.5,25.794,90,Medica,Individual & Family,89.19,99.1,,percent of total billed charges,,
Creatinine Kinase,,82550,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,Medica,Medica Advantage Solution,44.82,49.8,,percent of total billed charges,,
Creatinine Kinase,,82550,CPT,Facility,Inpatient,,,,90,76.5,25.794,90,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Creatinine Kinase,,82550,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,Medica,Medical Assistance,40.14,44.6,,percent of total billed charges,,
Creatinine Kinase,,82550,CPT,Facility,Inpatient,,,,90,76.5,25.794,90,Medica,Medical Assistance,,,,,Included in per diem rate,
Creatinine Kinase,,82550,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,44.82,49.8,,percent of total billed charges,,
Creatinine Kinase,,82550,CPT,Facility,Inpatient,,,,90,76.5,25.794,90,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Creatinine Kinase,,82550,CPT,Facility,Both,,,,90,76.5,25.794,90,"Multiplan, Inc.","Multiplan, Inc.",84.6,94,,percent of total billed charges,,
Creatinine Kinase,,82550,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,77.76,86.4,,percent of total billed charges,,
Creatinine Kinase,,82550,CPT,Facility,Inpatient,,,,90,76.5,25.794,90,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Creatinine Kinase,,82550,CPT,Facility,Both,,,,90,76.5,25.794,90,"Preferred One Administrative Services, INC.",PPO,88.74,98.6,,percent of total billed charges,,
Creatinine Kinase,,82550,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,PrimeWest Health,Minnesota Senior Health Options (MSHO),46.305,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Creatinine Kinase,,82550,CPT,Facility,Inpatient,,,,90,76.5,25.794,90,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Creatinine Kinase,,82550,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,PrimeWest Health,MinnesotaCare,46.224,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Creatinine Kinase,,82550,CPT,Facility,Inpatient,,,,90,76.5,25.794,90,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Creatinine Kinase,,82550,CPT,Facility,Both,,,,90,76.5,25.794,90,Sanford Health Plan,Sanford Health Plan,82.8,92,,percent of total billed charges,,
Creatinine Kinase,,82550,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,"UCare Health, Inc.",Individual & Family Plan,50.715,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Creatinine Kinase,,82550,CPT,Facility,Inpatient,,,,90,76.5,25.794,90,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Creatinine Kinase,,82550,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,"UCare Health, Inc.",Medical Assistance,45.423,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Creatinine Kinase,,82550,CPT,Facility,Inpatient,,,,90,76.5,25.794,90,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Creatinine Kinase,,82550,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,"UCare Health, Inc.",Medicare Advantage,45.423,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Creatinine Kinase,,82550,CPT,Facility,Inpatient,,,,90,76.5,25.794,90,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Creatinine Kinase,,82550,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),45.423,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Creatinine Kinase,,82550,CPT,Facility,Inpatient,,,,90,76.5,25.794,90,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Creatinine Kinase,,82550,CPT,Facility,Both,,,,90,76.5,25.794,90,UnitedHealthcare,Individual & Family,84.6,94,,percent of total billed charges,,
Creatinine Kinase,,82550,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,UnitedHealthcare,Medicare Advantage,44.1,49,,percent of total billed charges,,
Creatinine Kinase,,82550,CPT,Facility,Inpatient,,,,90,76.5,25.794,90,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Creatinine Kinase,,82550,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,43.2,48,,percent of total billed charges,,100% of DHS outpatient percentage
Creatinine Kinase,,82550,CPT,Facility,Inpatient,,,,90,76.5,25.794,90,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Creatinine Kinase Mb,,82553,CPT,Facility,Both,,,,105,89.25,30.093,105,Aetna,Commercial,96.6,92,,percent of total billed charges,,
Creatinine Kinase Mb,,82553,CPT,Facility,Outpatient,,,,105,89.25,30.093,105,Aetna,Medicare Advantage,51.45,49,,percent of total billed charges,,
Creatinine Kinase Mb,,82553,CPT,Facility,Inpatient,,,,105,89.25,30.093,105,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Creatinine Kinase Mb,,82553,CPT,Facility,Both,,,,105,89.25,30.093,105,Aetna,PPO,97.65,93,,percent of total billed charges,,
Creatinine Kinase Mb,,82553,CPT,Facility,Both,,,,105,89.25,30.093,105,America's PPO,America's PPO,100.8315,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Creatinine Kinase Mb,,82553,CPT,Facility,Both,,,,105,89.25,30.093,105,BlueCross BlueShield Minnesota, Federal Employee Program,103.32,98.4,,percent of total billed charges,,
Creatinine Kinase Mb,,82553,CPT,Facility,Both,,,,105,89.25,30.093,105,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,105,100,,percent of total billed charges,,
Creatinine Kinase Mb,,82553,CPT,Facility,Both,,,,105,89.25,30.093,105,BlueCross BlueShield Minnesota,High Value Network Plan,94.5,90,,percent of total billed charges,,
Creatinine Kinase Mb,,82553,CPT,Facility,Outpatient,,,,105,89.25,30.093,105,BlueCross BlueShield Minnesota,Medicare Advantage,51.45,49,,percent of total billed charges,,
Creatinine Kinase Mb,,82553,CPT,Facility,Inpatient,,,,105,89.25,30.093,105,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Creatinine Kinase Mb,,82553,CPT,Facility,Both,,,,105,89.25,30.093,105,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,92.9985,88.57,,percent of total billed charges,,
Creatinine Kinase Mb,,82553,CPT,Facility,Both,,,,105,89.25,30.093,105,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,30.093,28.66,,percent of total billed charges,,
Creatinine Kinase Mb,,82553,CPT,Facility,Outpatient,,,,105,89.25,30.093,105,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),51.45,49,,percent of total billed charges,,
Creatinine Kinase Mb,,82553,CPT,Facility,Inpatient,,,,105,89.25,30.093,105,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Creatinine Kinase Mb,,82553,CPT,Facility,Both,,,,105,89.25,30.093,105,CorVel,Worker's Compensation,105,100,,percent of total billed charges,,
Creatinine Kinase Mb,,82553,CPT,Facility,Both,,,,105,89.25,30.093,105,First Health Group Corporation,First Health Network,101.85,97,,percent of total billed charges,,
Creatinine Kinase Mb,,82553,CPT,Facility,Both,,,,105,89.25,30.093,105,"Health Partners, Inc.",Commercial,99.33,94.6,,percent of total billed charges,,
Creatinine Kinase Mb,,82553,CPT,Facility,Outpatient,,,,105,89.25,30.093,105,"Health Partners, Inc.",Medicare Advantage,51.45,49,,percent of total billed charges,,
Creatinine Kinase Mb,,82553,CPT,Facility,Inpatient,,,,105,89.25,30.093,105,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Creatinine Kinase Mb,,82553,CPT,Facility,Both,,,,105,89.25,30.093,105,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),63,60,,percent of total billed charges,,
Creatinine Kinase Mb,,82553,CPT,Facility,Both,,,,105,89.25,30.093,105,"Health Partners, Inc.",State of Minnesota Advantage Program,85.575,81.5,,percent of total billed charges,,
Creatinine Kinase Mb,,82553,CPT,Facility,Both,,,,105,89.25,30.093,105,"Health Partners, Inc.",State Public Programs,52.5,50,,percent of total billed charges,,
Creatinine Kinase Mb,,82553,CPT,Facility,Both,,,,105,89.25,30.093,105,Humana Insurance Company,Commercial PPO,99.75,95,,percent of total billed charges,,
Creatinine Kinase Mb,,82553,CPT,Facility,Outpatient,,,,105,89.25,30.093,105,Humana Insurance Company,Medicare PPO,51.45,49,,percent of total billed charges,,
Creatinine Kinase Mb,,82553,CPT,Facility,Inpatient,,,,105,89.25,30.093,105,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Creatinine Kinase Mb,,82553,CPT,Facility,Both,,,,105,89.25,30.093,105,Medica,Individual & Family,104.055,99.1,,percent of total billed charges,,
Creatinine Kinase Mb,,82553,CPT,Facility,Outpatient,,,,105,89.25,30.093,105,Medica,Medica Advantage Solution,52.29,49.8,,percent of total billed charges,,
Creatinine Kinase Mb,,82553,CPT,Facility,Inpatient,,,,105,89.25,30.093,105,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Creatinine Kinase Mb,,82553,CPT,Facility,Outpatient,,,,105,89.25,30.093,105,Medica,Medical Assistance,46.83,44.6,,percent of total billed charges,,
Creatinine Kinase Mb,,82553,CPT,Facility,Inpatient,,,,105,89.25,30.093,105,Medica,Medical Assistance,,,,,Included in per diem rate,
Creatinine Kinase Mb,,82553,CPT,Facility,Outpatient,,,,105,89.25,30.093,105,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,52.29,49.8,,percent of total billed charges,,
Creatinine Kinase Mb,,82553,CPT,Facility,Inpatient,,,,105,89.25,30.093,105,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Creatinine Kinase Mb,,82553,CPT,Facility,Both,,,,105,89.25,30.093,105,"Multiplan, Inc.","Multiplan, Inc.",98.7,94,,percent of total billed charges,,
Creatinine Kinase Mb,,82553,CPT,Facility,Outpatient,,,,105,89.25,30.093,105,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,90.72,86.4,,percent of total billed charges,,
Creatinine Kinase Mb,,82553,CPT,Facility,Inpatient,,,,105,89.25,30.093,105,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Creatinine Kinase Mb,,82553,CPT,Facility,Both,,,,105,89.25,30.093,105,"Preferred One Administrative Services, INC.",PPO,103.53,98.6,,percent of total billed charges,,
Creatinine Kinase Mb,,82553,CPT,Facility,Outpatient,,,,105,89.25,30.093,105,PrimeWest Health,Minnesota Senior Health Options (MSHO),54.0225,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Creatinine Kinase Mb,,82553,CPT,Facility,Inpatient,,,,105,89.25,30.093,105,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Creatinine Kinase Mb,,82553,CPT,Facility,Outpatient,,,,105,89.25,30.093,105,PrimeWest Health,MinnesotaCare,53.928,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Creatinine Kinase Mb,,82553,CPT,Facility,Inpatient,,,,105,89.25,30.093,105,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Creatinine Kinase Mb,,82553,CPT,Facility,Both,,,,105,89.25,30.093,105,Sanford Health Plan,Sanford Health Plan,96.6,92,,percent of total billed charges,,
Creatinine Kinase Mb,,82553,CPT,Facility,Outpatient,,,,105,89.25,30.093,105,"UCare Health, Inc.",Individual & Family Plan,59.1675,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Creatinine Kinase Mb,,82553,CPT,Facility,Inpatient,,,,105,89.25,30.093,105,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Creatinine Kinase Mb,,82553,CPT,Facility,Outpatient,,,,105,89.25,30.093,105,"UCare Health, Inc.",Medical Assistance,52.9935,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Creatinine Kinase Mb,,82553,CPT,Facility,Inpatient,,,,105,89.25,30.093,105,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Creatinine Kinase Mb,,82553,CPT,Facility,Outpatient,,,,105,89.25,30.093,105,"UCare Health, Inc.",Medicare Advantage,52.9935,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Creatinine Kinase Mb,,82553,CPT,Facility,Inpatient,,,,105,89.25,30.093,105,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Creatinine Kinase Mb,,82553,CPT,Facility,Outpatient,,,,105,89.25,30.093,105,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),52.9935,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Creatinine Kinase Mb,,82553,CPT,Facility,Inpatient,,,,105,89.25,30.093,105,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Creatinine Kinase Mb,,82553,CPT,Facility,Both,,,,105,89.25,30.093,105,UnitedHealthcare,Individual & Family,98.7,94,,percent of total billed charges,,
Creatinine Kinase Mb,,82553,CPT,Facility,Outpatient,,,,105,89.25,30.093,105,UnitedHealthcare,Medicare Advantage,51.45,49,,percent of total billed charges,,
Creatinine Kinase Mb,,82553,CPT,Facility,Inpatient,,,,105,89.25,30.093,105,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Creatinine Kinase Mb,,82553,CPT,Facility,Outpatient,,,,105,89.25,30.093,105,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,50.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
Creatinine Kinase Mb,,82553,CPT,Facility,Inpatient,,,,105,89.25,30.093,105,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Creatinine, Serum Or Plasma",,82565,CPT,Facility,Both,,,,72,61.2,20.6352,72,Aetna,Commercial,66.24,92,,percent of total billed charges,,
"Creatinine, Serum Or Plasma",,82565,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,Aetna,Medicare Advantage,35.28,49,,percent of total billed charges,,
"Creatinine, Serum Or Plasma",,82565,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Creatinine, Serum Or Plasma",,82565,CPT,Facility,Both,,,,72,61.2,20.6352,72,Aetna,PPO,66.96,93,,percent of total billed charges,,
"Creatinine, Serum Or Plasma",,82565,CPT,Facility,Both,,,,72,61.2,20.6352,72,America's PPO,America's PPO,69.1416,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Creatinine, Serum Or Plasma",,82565,CPT,Facility,Both,,,,72,61.2,20.6352,72,BlueCross BlueShield Minnesota, Federal Employee Program,70.848,98.4,,percent of total billed charges,,
"Creatinine, Serum Or Plasma",,82565,CPT,Facility,Both,,,,72,61.2,20.6352,72,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,72,100,,percent of total billed charges,,
"Creatinine, Serum Or Plasma",,82565,CPT,Facility,Both,,,,72,61.2,20.6352,72,BlueCross BlueShield Minnesota,High Value Network Plan,64.8,90,,percent of total billed charges,,
"Creatinine, Serum Or Plasma",,82565,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,BlueCross BlueShield Minnesota,Medicare Advantage,35.28,49,,percent of total billed charges,,
"Creatinine, Serum Or Plasma",,82565,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Creatinine, Serum Or Plasma",,82565,CPT,Facility,Both,,,,72,61.2,20.6352,72,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,63.7704,88.57,,percent of total billed charges,,
"Creatinine, Serum Or Plasma",,82565,CPT,Facility,Both,,,,72,61.2,20.6352,72,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,20.6352,28.66,,percent of total billed charges,,
"Creatinine, Serum Or Plasma",,82565,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),35.28,49,,percent of total billed charges,,
"Creatinine, Serum Or Plasma",,82565,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Creatinine, Serum Or Plasma",,82565,CPT,Facility,Both,,,,72,61.2,20.6352,72,CorVel,Worker's Compensation,72,100,,percent of total billed charges,,
"Creatinine, Serum Or Plasma",,82565,CPT,Facility,Both,,,,72,61.2,20.6352,72,First Health Group Corporation,First Health Network,69.84,97,,percent of total billed charges,,
"Creatinine, Serum Or Plasma",,82565,CPT,Facility,Both,,,,72,61.2,20.6352,72,"Health Partners, Inc.",Commercial,68.112,94.6,,percent of total billed charges,,
"Creatinine, Serum Or Plasma",,82565,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,"Health Partners, Inc.",Medicare Advantage,35.28,49,,percent of total billed charges,,
"Creatinine, Serum Or Plasma",,82565,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Creatinine, Serum Or Plasma",,82565,CPT,Facility,Both,,,,72,61.2,20.6352,72,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),43.2,60,,percent of total billed charges,,
"Creatinine, Serum Or Plasma",,82565,CPT,Facility,Both,,,,72,61.2,20.6352,72,"Health Partners, Inc.",State of Minnesota Advantage Program,58.68,81.5,,percent of total billed charges,,
"Creatinine, Serum Or Plasma",,82565,CPT,Facility,Both,,,,72,61.2,20.6352,72,"Health Partners, Inc.",State Public Programs,36,50,,percent of total billed charges,,
"Creatinine, Serum Or Plasma",,82565,CPT,Facility,Both,,,,72,61.2,20.6352,72,Humana Insurance Company,Commercial PPO,68.4,95,,percent of total billed charges,,
"Creatinine, Serum Or Plasma",,82565,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,Humana Insurance Company,Medicare PPO,35.28,49,,percent of total billed charges,,
"Creatinine, Serum Or Plasma",,82565,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Creatinine, Serum Or Plasma",,82565,CPT,Facility,Both,,,,72,61.2,20.6352,72,Medica,Individual & Family,71.352,99.1,,percent of total billed charges,,
"Creatinine, Serum Or Plasma",,82565,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,Medica,Medica Advantage Solution,35.856,49.8,,percent of total billed charges,,
"Creatinine, Serum Or Plasma",,82565,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Creatinine, Serum Or Plasma",,82565,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,Medica,Medical Assistance,32.112,44.6,,percent of total billed charges,,
"Creatinine, Serum Or Plasma",,82565,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,Medica,Medical Assistance,,,,,Included in per diem rate,
"Creatinine, Serum Or Plasma",,82565,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,35.856,49.8,,percent of total billed charges,,
"Creatinine, Serum Or Plasma",,82565,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Creatinine, Serum Or Plasma",,82565,CPT,Facility,Both,,,,72,61.2,20.6352,72,"Multiplan, Inc.","Multiplan, Inc.",67.68,94,,percent of total billed charges,,
"Creatinine, Serum Or Plasma",,82565,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,62.208,86.4,,percent of total billed charges,,
"Creatinine, Serum Or Plasma",,82565,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Creatinine, Serum Or Plasma",,82565,CPT,Facility,Both,,,,72,61.2,20.6352,72,"Preferred One Administrative Services, INC.",PPO,70.992,98.6,,percent of total billed charges,,
"Creatinine, Serum Or Plasma",,82565,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,PrimeWest Health,Minnesota Senior Health Options (MSHO),37.044,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Creatinine, Serum Or Plasma",,82565,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Creatinine, Serum Or Plasma",,82565,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,PrimeWest Health,MinnesotaCare,36.9792,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Creatinine, Serum Or Plasma",,82565,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Creatinine, Serum Or Plasma",,82565,CPT,Facility,Both,,,,72,61.2,20.6352,72,Sanford Health Plan,Sanford Health Plan,66.24,92,,percent of total billed charges,,
"Creatinine, Serum Or Plasma",,82565,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,"UCare Health, Inc.",Individual & Family Plan,40.572,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Creatinine, Serum Or Plasma",,82565,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Creatinine, Serum Or Plasma",,82565,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,"UCare Health, Inc.",Medical Assistance,36.3384,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Creatinine, Serum Or Plasma",,82565,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Creatinine, Serum Or Plasma",,82565,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,"UCare Health, Inc.",Medicare Advantage,36.3384,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Creatinine, Serum Or Plasma",,82565,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Creatinine, Serum Or Plasma",,82565,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),36.3384,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Creatinine, Serum Or Plasma",,82565,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Creatinine, Serum Or Plasma",,82565,CPT,Facility,Both,,,,72,61.2,20.6352,72,UnitedHealthcare,Individual & Family,67.68,94,,percent of total billed charges,,
"Creatinine, Serum Or Plasma",,82565,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,UnitedHealthcare,Medicare Advantage,35.28,49,,percent of total billed charges,,
"Creatinine, Serum Or Plasma",,82565,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Creatinine, Serum Or Plasma",,82565,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,34.56,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Creatinine, Serum Or Plasma",,82565,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Creatinine For Protein/Creatinine Ratio, Urine",,82570,CPT,Facility,Both,,,,72,61.2,20.6352,72,Aetna,Commercial,66.24,92,,percent of total billed charges,,
"Creatinine For Protein/Creatinine Ratio, Urine",,82570,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,Aetna,Medicare Advantage,35.28,49,,percent of total billed charges,,
"Creatinine For Protein/Creatinine Ratio, Urine",,82570,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Creatinine For Protein/Creatinine Ratio, Urine",,82570,CPT,Facility,Both,,,,72,61.2,20.6352,72,Aetna,PPO,66.96,93,,percent of total billed charges,,
"Creatinine For Protein/Creatinine Ratio, Urine",,82570,CPT,Facility,Both,,,,72,61.2,20.6352,72,America's PPO,America's PPO,69.1416,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Creatinine For Protein/Creatinine Ratio, Urine",,82570,CPT,Facility,Both,,,,72,61.2,20.6352,72,BlueCross BlueShield Minnesota, Federal Employee Program,70.848,98.4,,percent of total billed charges,,
"Creatinine For Protein/Creatinine Ratio, Urine",,82570,CPT,Facility,Both,,,,72,61.2,20.6352,72,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,72,100,,percent of total billed charges,,
"Creatinine For Protein/Creatinine Ratio, Urine",,82570,CPT,Facility,Both,,,,72,61.2,20.6352,72,BlueCross BlueShield Minnesota,High Value Network Plan,64.8,90,,percent of total billed charges,,
"Creatinine For Protein/Creatinine Ratio, Urine",,82570,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,BlueCross BlueShield Minnesota,Medicare Advantage,35.28,49,,percent of total billed charges,,
"Creatinine For Protein/Creatinine Ratio, Urine",,82570,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Creatinine For Protein/Creatinine Ratio, Urine",,82570,CPT,Facility,Both,,,,72,61.2,20.6352,72,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,63.7704,88.57,,percent of total billed charges,,
"Creatinine For Protein/Creatinine Ratio, Urine",,82570,CPT,Facility,Both,,,,72,61.2,20.6352,72,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,20.6352,28.66,,percent of total billed charges,,
"Creatinine For Protein/Creatinine Ratio, Urine",,82570,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),35.28,49,,percent of total billed charges,,
"Creatinine For Protein/Creatinine Ratio, Urine",,82570,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Creatinine For Protein/Creatinine Ratio, Urine",,82570,CPT,Facility,Both,,,,72,61.2,20.6352,72,CorVel,Worker's Compensation,72,100,,percent of total billed charges,,
"Creatinine For Protein/Creatinine Ratio, Urine",,82570,CPT,Facility,Both,,,,72,61.2,20.6352,72,First Health Group Corporation,First Health Network,69.84,97,,percent of total billed charges,,
"Creatinine For Protein/Creatinine Ratio, Urine",,82570,CPT,Facility,Both,,,,72,61.2,20.6352,72,"Health Partners, Inc.",Commercial,68.112,94.6,,percent of total billed charges,,
"Creatinine For Protein/Creatinine Ratio, Urine",,82570,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,"Health Partners, Inc.",Medicare Advantage,35.28,49,,percent of total billed charges,,
"Creatinine For Protein/Creatinine Ratio, Urine",,82570,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Creatinine For Protein/Creatinine Ratio, Urine",,82570,CPT,Facility,Both,,,,72,61.2,20.6352,72,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),43.2,60,,percent of total billed charges,,
"Creatinine For Protein/Creatinine Ratio, Urine",,82570,CPT,Facility,Both,,,,72,61.2,20.6352,72,"Health Partners, Inc.",State of Minnesota Advantage Program,58.68,81.5,,percent of total billed charges,,
"Creatinine For Protein/Creatinine Ratio, Urine",,82570,CPT,Facility,Both,,,,72,61.2,20.6352,72,"Health Partners, Inc.",State Public Programs,36,50,,percent of total billed charges,,
"Creatinine For Protein/Creatinine Ratio, Urine",,82570,CPT,Facility,Both,,,,72,61.2,20.6352,72,Humana Insurance Company,Commercial PPO,68.4,95,,percent of total billed charges,,
"Creatinine For Protein/Creatinine Ratio, Urine",,82570,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,Humana Insurance Company,Medicare PPO,35.28,49,,percent of total billed charges,,
"Creatinine For Protein/Creatinine Ratio, Urine",,82570,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Creatinine For Protein/Creatinine Ratio, Urine",,82570,CPT,Facility,Both,,,,72,61.2,20.6352,72,Medica,Individual & Family,71.352,99.1,,percent of total billed charges,,
"Creatinine For Protein/Creatinine Ratio, Urine",,82570,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,Medica,Medica Advantage Solution,35.856,49.8,,percent of total billed charges,,
"Creatinine For Protein/Creatinine Ratio, Urine",,82570,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Creatinine For Protein/Creatinine Ratio, Urine",,82570,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,Medica,Medical Assistance,32.112,44.6,,percent of total billed charges,,
"Creatinine For Protein/Creatinine Ratio, Urine",,82570,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,Medica,Medical Assistance,,,,,Included in per diem rate,
"Creatinine For Protein/Creatinine Ratio, Urine",,82570,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,35.856,49.8,,percent of total billed charges,,
"Creatinine For Protein/Creatinine Ratio, Urine",,82570,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Creatinine For Protein/Creatinine Ratio, Urine",,82570,CPT,Facility,Both,,,,72,61.2,20.6352,72,"Multiplan, Inc.","Multiplan, Inc.",67.68,94,,percent of total billed charges,,
"Creatinine For Protein/Creatinine Ratio, Urine",,82570,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,62.208,86.4,,percent of total billed charges,,
"Creatinine For Protein/Creatinine Ratio, Urine",,82570,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Creatinine For Protein/Creatinine Ratio, Urine",,82570,CPT,Facility,Both,,,,72,61.2,20.6352,72,"Preferred One Administrative Services, INC.",PPO,70.992,98.6,,percent of total billed charges,,
"Creatinine For Protein/Creatinine Ratio, Urine",,82570,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,PrimeWest Health,Minnesota Senior Health Options (MSHO),37.044,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Creatinine For Protein/Creatinine Ratio, Urine",,82570,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Creatinine For Protein/Creatinine Ratio, Urine",,82570,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,PrimeWest Health,MinnesotaCare,36.9792,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Creatinine For Protein/Creatinine Ratio, Urine",,82570,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Creatinine For Protein/Creatinine Ratio, Urine",,82570,CPT,Facility,Both,,,,72,61.2,20.6352,72,Sanford Health Plan,Sanford Health Plan,66.24,92,,percent of total billed charges,,
"Creatinine For Protein/Creatinine Ratio, Urine",,82570,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,"UCare Health, Inc.",Individual & Family Plan,40.572,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Creatinine For Protein/Creatinine Ratio, Urine",,82570,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Creatinine For Protein/Creatinine Ratio, Urine",,82570,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,"UCare Health, Inc.",Medical Assistance,36.3384,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Creatinine For Protein/Creatinine Ratio, Urine",,82570,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Creatinine For Protein/Creatinine Ratio, Urine",,82570,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,"UCare Health, Inc.",Medicare Advantage,36.3384,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Creatinine For Protein/Creatinine Ratio, Urine",,82570,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Creatinine For Protein/Creatinine Ratio, Urine",,82570,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),36.3384,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Creatinine For Protein/Creatinine Ratio, Urine",,82570,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Creatinine For Protein/Creatinine Ratio, Urine",,82570,CPT,Facility,Both,,,,72,61.2,20.6352,72,UnitedHealthcare,Individual & Family,67.68,94,,percent of total billed charges,,
"Creatinine For Protein/Creatinine Ratio, Urine",,82570,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,UnitedHealthcare,Medicare Advantage,35.28,49,,percent of total billed charges,,
"Creatinine For Protein/Creatinine Ratio, Urine",,82570,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Creatinine For Protein/Creatinine Ratio, Urine",,82570,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,34.56,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Creatinine For Protein/Creatinine Ratio, Urine",,82570,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Creatinine, Body Fluid",,82570,CPT,Facility,Both,,,,72,61.2,20.6352,72,Aetna,Commercial,66.24,92,,percent of total billed charges,,
"Creatinine, Body Fluid",,82570,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,Aetna,Medicare Advantage,35.28,49,,percent of total billed charges,,
"Creatinine, Body Fluid",,82570,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Creatinine, Body Fluid",,82570,CPT,Facility,Both,,,,72,61.2,20.6352,72,Aetna,PPO,66.96,93,,percent of total billed charges,,
"Creatinine, Body Fluid",,82570,CPT,Facility,Both,,,,72,61.2,20.6352,72,America's PPO,America's PPO,69.1416,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Creatinine, Body Fluid",,82570,CPT,Facility,Both,,,,72,61.2,20.6352,72,BlueCross BlueShield Minnesota, Federal Employee Program,70.848,98.4,,percent of total billed charges,,
"Creatinine, Body Fluid",,82570,CPT,Facility,Both,,,,72,61.2,20.6352,72,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,72,100,,percent of total billed charges,,
"Creatinine, Body Fluid",,82570,CPT,Facility,Both,,,,72,61.2,20.6352,72,BlueCross BlueShield Minnesota,High Value Network Plan,64.8,90,,percent of total billed charges,,
"Creatinine, Body Fluid",,82570,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,BlueCross BlueShield Minnesota,Medicare Advantage,35.28,49,,percent of total billed charges,,
"Creatinine, Body Fluid",,82570,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Creatinine, Body Fluid",,82570,CPT,Facility,Both,,,,72,61.2,20.6352,72,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,63.7704,88.57,,percent of total billed charges,,
"Creatinine, Body Fluid",,82570,CPT,Facility,Both,,,,72,61.2,20.6352,72,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,20.6352,28.66,,percent of total billed charges,,
"Creatinine, Body Fluid",,82570,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),35.28,49,,percent of total billed charges,,
"Creatinine, Body Fluid",,82570,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Creatinine, Body Fluid",,82570,CPT,Facility,Both,,,,72,61.2,20.6352,72,CorVel,Worker's Compensation,72,100,,percent of total billed charges,,
"Creatinine, Body Fluid",,82570,CPT,Facility,Both,,,,72,61.2,20.6352,72,First Health Group Corporation,First Health Network,69.84,97,,percent of total billed charges,,
"Creatinine, Body Fluid",,82570,CPT,Facility,Both,,,,72,61.2,20.6352,72,"Health Partners, Inc.",Commercial,68.112,94.6,,percent of total billed charges,,
"Creatinine, Body Fluid",,82570,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,"Health Partners, Inc.",Medicare Advantage,35.28,49,,percent of total billed charges,,
"Creatinine, Body Fluid",,82570,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Creatinine, Body Fluid",,82570,CPT,Facility,Both,,,,72,61.2,20.6352,72,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),43.2,60,,percent of total billed charges,,
"Creatinine, Body Fluid",,82570,CPT,Facility,Both,,,,72,61.2,20.6352,72,"Health Partners, Inc.",State of Minnesota Advantage Program,58.68,81.5,,percent of total billed charges,,
"Creatinine, Body Fluid",,82570,CPT,Facility,Both,,,,72,61.2,20.6352,72,"Health Partners, Inc.",State Public Programs,36,50,,percent of total billed charges,,
"Creatinine, Body Fluid",,82570,CPT,Facility,Both,,,,72,61.2,20.6352,72,Humana Insurance Company,Commercial PPO,68.4,95,,percent of total billed charges,,
"Creatinine, Body Fluid",,82570,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,Humana Insurance Company,Medicare PPO,35.28,49,,percent of total billed charges,,
"Creatinine, Body Fluid",,82570,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Creatinine, Body Fluid",,82570,CPT,Facility,Both,,,,72,61.2,20.6352,72,Medica,Individual & Family,71.352,99.1,,percent of total billed charges,,
"Creatinine, Body Fluid",,82570,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,Medica,Medica Advantage Solution,35.856,49.8,,percent of total billed charges,,
"Creatinine, Body Fluid",,82570,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Creatinine, Body Fluid",,82570,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,Medica,Medical Assistance,32.112,44.6,,percent of total billed charges,,
"Creatinine, Body Fluid",,82570,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,Medica,Medical Assistance,,,,,Included in per diem rate,
"Creatinine, Body Fluid",,82570,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,35.856,49.8,,percent of total billed charges,,
"Creatinine, Body Fluid",,82570,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Creatinine, Body Fluid",,82570,CPT,Facility,Both,,,,72,61.2,20.6352,72,"Multiplan, Inc.","Multiplan, Inc.",67.68,94,,percent of total billed charges,,
"Creatinine, Body Fluid",,82570,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,62.208,86.4,,percent of total billed charges,,
"Creatinine, Body Fluid",,82570,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Creatinine, Body Fluid",,82570,CPT,Facility,Both,,,,72,61.2,20.6352,72,"Preferred One Administrative Services, INC.",PPO,70.992,98.6,,percent of total billed charges,,
"Creatinine, Body Fluid",,82570,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,PrimeWest Health,Minnesota Senior Health Options (MSHO),37.044,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Creatinine, Body Fluid",,82570,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Creatinine, Body Fluid",,82570,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,PrimeWest Health,MinnesotaCare,36.9792,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Creatinine, Body Fluid",,82570,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Creatinine, Body Fluid",,82570,CPT,Facility,Both,,,,72,61.2,20.6352,72,Sanford Health Plan,Sanford Health Plan,66.24,92,,percent of total billed charges,,
"Creatinine, Body Fluid",,82570,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,"UCare Health, Inc.",Individual & Family Plan,40.572,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Creatinine, Body Fluid",,82570,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Creatinine, Body Fluid",,82570,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,"UCare Health, Inc.",Medical Assistance,36.3384,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Creatinine, Body Fluid",,82570,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Creatinine, Body Fluid",,82570,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,"UCare Health, Inc.",Medicare Advantage,36.3384,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Creatinine, Body Fluid",,82570,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Creatinine, Body Fluid",,82570,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),36.3384,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Creatinine, Body Fluid",,82570,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Creatinine, Body Fluid",,82570,CPT,Facility,Both,,,,72,61.2,20.6352,72,UnitedHealthcare,Individual & Family,67.68,94,,percent of total billed charges,,
"Creatinine, Body Fluid",,82570,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,UnitedHealthcare,Medicare Advantage,35.28,49,,percent of total billed charges,,
"Creatinine, Body Fluid",,82570,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Creatinine, Body Fluid",,82570,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,34.56,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Creatinine, Body Fluid",,82570,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Creatinine, Urine",,82570,CPT,Facility,Both,,,,72,61.2,20.6352,72,Aetna,Commercial,66.24,92,,percent of total billed charges,,
"Creatinine, Urine",,82570,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,Aetna,Medicare Advantage,35.28,49,,percent of total billed charges,,
"Creatinine, Urine",,82570,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Creatinine, Urine",,82570,CPT,Facility,Both,,,,72,61.2,20.6352,72,Aetna,PPO,66.96,93,,percent of total billed charges,,
"Creatinine, Urine",,82570,CPT,Facility,Both,,,,72,61.2,20.6352,72,America's PPO,America's PPO,69.1416,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Creatinine, Urine",,82570,CPT,Facility,Both,,,,72,61.2,20.6352,72,BlueCross BlueShield Minnesota, Federal Employee Program,70.848,98.4,,percent of total billed charges,,
"Creatinine, Urine",,82570,CPT,Facility,Both,,,,72,61.2,20.6352,72,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,72,100,,percent of total billed charges,,
"Creatinine, Urine",,82570,CPT,Facility,Both,,,,72,61.2,20.6352,72,BlueCross BlueShield Minnesota,High Value Network Plan,64.8,90,,percent of total billed charges,,
"Creatinine, Urine",,82570,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,BlueCross BlueShield Minnesota,Medicare Advantage,35.28,49,,percent of total billed charges,,
"Creatinine, Urine",,82570,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Creatinine, Urine",,82570,CPT,Facility,Both,,,,72,61.2,20.6352,72,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,63.7704,88.57,,percent of total billed charges,,
"Creatinine, Urine",,82570,CPT,Facility,Both,,,,72,61.2,20.6352,72,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,20.6352,28.66,,percent of total billed charges,,
"Creatinine, Urine",,82570,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),35.28,49,,percent of total billed charges,,
"Creatinine, Urine",,82570,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Creatinine, Urine",,82570,CPT,Facility,Both,,,,72,61.2,20.6352,72,CorVel,Worker's Compensation,72,100,,percent of total billed charges,,
"Creatinine, Urine",,82570,CPT,Facility,Both,,,,72,61.2,20.6352,72,First Health Group Corporation,First Health Network,69.84,97,,percent of total billed charges,,
"Creatinine, Urine",,82570,CPT,Facility,Both,,,,72,61.2,20.6352,72,"Health Partners, Inc.",Commercial,68.112,94.6,,percent of total billed charges,,
"Creatinine, Urine",,82570,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,"Health Partners, Inc.",Medicare Advantage,35.28,49,,percent of total billed charges,,
"Creatinine, Urine",,82570,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Creatinine, Urine",,82570,CPT,Facility,Both,,,,72,61.2,20.6352,72,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),43.2,60,,percent of total billed charges,,
"Creatinine, Urine",,82570,CPT,Facility,Both,,,,72,61.2,20.6352,72,"Health Partners, Inc.",State of Minnesota Advantage Program,58.68,81.5,,percent of total billed charges,,
"Creatinine, Urine",,82570,CPT,Facility,Both,,,,72,61.2,20.6352,72,"Health Partners, Inc.",State Public Programs,36,50,,percent of total billed charges,,
"Creatinine, Urine",,82570,CPT,Facility,Both,,,,72,61.2,20.6352,72,Humana Insurance Company,Commercial PPO,68.4,95,,percent of total billed charges,,
"Creatinine, Urine",,82570,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,Humana Insurance Company,Medicare PPO,35.28,49,,percent of total billed charges,,
"Creatinine, Urine",,82570,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Creatinine, Urine",,82570,CPT,Facility,Both,,,,72,61.2,20.6352,72,Medica,Individual & Family,71.352,99.1,,percent of total billed charges,,
"Creatinine, Urine",,82570,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,Medica,Medica Advantage Solution,35.856,49.8,,percent of total billed charges,,
"Creatinine, Urine",,82570,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Creatinine, Urine",,82570,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,Medica,Medical Assistance,32.112,44.6,,percent of total billed charges,,
"Creatinine, Urine",,82570,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,Medica,Medical Assistance,,,,,Included in per diem rate,
"Creatinine, Urine",,82570,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,35.856,49.8,,percent of total billed charges,,
"Creatinine, Urine",,82570,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Creatinine, Urine",,82570,CPT,Facility,Both,,,,72,61.2,20.6352,72,"Multiplan, Inc.","Multiplan, Inc.",67.68,94,,percent of total billed charges,,
"Creatinine, Urine",,82570,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,62.208,86.4,,percent of total billed charges,,
"Creatinine, Urine",,82570,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Creatinine, Urine",,82570,CPT,Facility,Both,,,,72,61.2,20.6352,72,"Preferred One Administrative Services, INC.",PPO,70.992,98.6,,percent of total billed charges,,
"Creatinine, Urine",,82570,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,PrimeWest Health,Minnesota Senior Health Options (MSHO),37.044,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Creatinine, Urine",,82570,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Creatinine, Urine",,82570,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,PrimeWest Health,MinnesotaCare,36.9792,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Creatinine, Urine",,82570,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Creatinine, Urine",,82570,CPT,Facility,Both,,,,72,61.2,20.6352,72,Sanford Health Plan,Sanford Health Plan,66.24,92,,percent of total billed charges,,
"Creatinine, Urine",,82570,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,"UCare Health, Inc.",Individual & Family Plan,40.572,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Creatinine, Urine",,82570,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Creatinine, Urine",,82570,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,"UCare Health, Inc.",Medical Assistance,36.3384,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Creatinine, Urine",,82570,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Creatinine, Urine",,82570,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,"UCare Health, Inc.",Medicare Advantage,36.3384,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Creatinine, Urine",,82570,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Creatinine, Urine",,82570,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),36.3384,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Creatinine, Urine",,82570,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Creatinine, Urine",,82570,CPT,Facility,Both,,,,72,61.2,20.6352,72,UnitedHealthcare,Individual & Family,67.68,94,,percent of total billed charges,,
"Creatinine, Urine",,82570,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,UnitedHealthcare,Medicare Advantage,35.28,49,,percent of total billed charges,,
"Creatinine, Urine",,82570,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Creatinine, Urine",,82570,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,34.56,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Creatinine, Urine",,82570,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Creatinine, Urine, 24 Hr",,82570,CPT,Facility,Both,,,,72,61.2,20.6352,72,Aetna,Commercial,66.24,92,,percent of total billed charges,,
"Creatinine, Urine, 24 Hr",,82570,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,Aetna,Medicare Advantage,35.28,49,,percent of total billed charges,,
"Creatinine, Urine, 24 Hr",,82570,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Creatinine, Urine, 24 Hr",,82570,CPT,Facility,Both,,,,72,61.2,20.6352,72,Aetna,PPO,66.96,93,,percent of total billed charges,,
"Creatinine, Urine, 24 Hr",,82570,CPT,Facility,Both,,,,72,61.2,20.6352,72,America's PPO,America's PPO,69.1416,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Creatinine, Urine, 24 Hr",,82570,CPT,Facility,Both,,,,72,61.2,20.6352,72,BlueCross BlueShield Minnesota, Federal Employee Program,70.848,98.4,,percent of total billed charges,,
"Creatinine, Urine, 24 Hr",,82570,CPT,Facility,Both,,,,72,61.2,20.6352,72,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,72,100,,percent of total billed charges,,
"Creatinine, Urine, 24 Hr",,82570,CPT,Facility,Both,,,,72,61.2,20.6352,72,BlueCross BlueShield Minnesota,High Value Network Plan,64.8,90,,percent of total billed charges,,
"Creatinine, Urine, 24 Hr",,82570,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,BlueCross BlueShield Minnesota,Medicare Advantage,35.28,49,,percent of total billed charges,,
"Creatinine, Urine, 24 Hr",,82570,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Creatinine, Urine, 24 Hr",,82570,CPT,Facility,Both,,,,72,61.2,20.6352,72,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,63.7704,88.57,,percent of total billed charges,,
"Creatinine, Urine, 24 Hr",,82570,CPT,Facility,Both,,,,72,61.2,20.6352,72,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,20.6352,28.66,,percent of total billed charges,,
"Creatinine, Urine, 24 Hr",,82570,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),35.28,49,,percent of total billed charges,,
"Creatinine, Urine, 24 Hr",,82570,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Creatinine, Urine, 24 Hr",,82570,CPT,Facility,Both,,,,72,61.2,20.6352,72,CorVel,Worker's Compensation,72,100,,percent of total billed charges,,
"Creatinine, Urine, 24 Hr",,82570,CPT,Facility,Both,,,,72,61.2,20.6352,72,First Health Group Corporation,First Health Network,69.84,97,,percent of total billed charges,,
"Creatinine, Urine, 24 Hr",,82570,CPT,Facility,Both,,,,72,61.2,20.6352,72,"Health Partners, Inc.",Commercial,68.112,94.6,,percent of total billed charges,,
"Creatinine, Urine, 24 Hr",,82570,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,"Health Partners, Inc.",Medicare Advantage,35.28,49,,percent of total billed charges,,
"Creatinine, Urine, 24 Hr",,82570,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Creatinine, Urine, 24 Hr",,82570,CPT,Facility,Both,,,,72,61.2,20.6352,72,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),43.2,60,,percent of total billed charges,,
"Creatinine, Urine, 24 Hr",,82570,CPT,Facility,Both,,,,72,61.2,20.6352,72,"Health Partners, Inc.",State of Minnesota Advantage Program,58.68,81.5,,percent of total billed charges,,
"Creatinine, Urine, 24 Hr",,82570,CPT,Facility,Both,,,,72,61.2,20.6352,72,"Health Partners, Inc.",State Public Programs,36,50,,percent of total billed charges,,
"Creatinine, Urine, 24 Hr",,82570,CPT,Facility,Both,,,,72,61.2,20.6352,72,Humana Insurance Company,Commercial PPO,68.4,95,,percent of total billed charges,,
"Creatinine, Urine, 24 Hr",,82570,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,Humana Insurance Company,Medicare PPO,35.28,49,,percent of total billed charges,,
"Creatinine, Urine, 24 Hr",,82570,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Creatinine, Urine, 24 Hr",,82570,CPT,Facility,Both,,,,72,61.2,20.6352,72,Medica,Individual & Family,71.352,99.1,,percent of total billed charges,,
"Creatinine, Urine, 24 Hr",,82570,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,Medica,Medica Advantage Solution,35.856,49.8,,percent of total billed charges,,
"Creatinine, Urine, 24 Hr",,82570,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Creatinine, Urine, 24 Hr",,82570,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,Medica,Medical Assistance,32.112,44.6,,percent of total billed charges,,
"Creatinine, Urine, 24 Hr",,82570,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,Medica,Medical Assistance,,,,,Included in per diem rate,
"Creatinine, Urine, 24 Hr",,82570,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,35.856,49.8,,percent of total billed charges,,
"Creatinine, Urine, 24 Hr",,82570,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Creatinine, Urine, 24 Hr",,82570,CPT,Facility,Both,,,,72,61.2,20.6352,72,"Multiplan, Inc.","Multiplan, Inc.",67.68,94,,percent of total billed charges,,
"Creatinine, Urine, 24 Hr",,82570,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,62.208,86.4,,percent of total billed charges,,
"Creatinine, Urine, 24 Hr",,82570,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Creatinine, Urine, 24 Hr",,82570,CPT,Facility,Both,,,,72,61.2,20.6352,72,"Preferred One Administrative Services, INC.",PPO,70.992,98.6,,percent of total billed charges,,
"Creatinine, Urine, 24 Hr",,82570,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,PrimeWest Health,Minnesota Senior Health Options (MSHO),37.044,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Creatinine, Urine, 24 Hr",,82570,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Creatinine, Urine, 24 Hr",,82570,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,PrimeWest Health,MinnesotaCare,36.9792,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Creatinine, Urine, 24 Hr",,82570,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Creatinine, Urine, 24 Hr",,82570,CPT,Facility,Both,,,,72,61.2,20.6352,72,Sanford Health Plan,Sanford Health Plan,66.24,92,,percent of total billed charges,,
"Creatinine, Urine, 24 Hr",,82570,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,"UCare Health, Inc.",Individual & Family Plan,40.572,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Creatinine, Urine, 24 Hr",,82570,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Creatinine, Urine, 24 Hr",,82570,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,"UCare Health, Inc.",Medical Assistance,36.3384,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Creatinine, Urine, 24 Hr",,82570,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Creatinine, Urine, 24 Hr",,82570,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,"UCare Health, Inc.",Medicare Advantage,36.3384,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Creatinine, Urine, 24 Hr",,82570,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Creatinine, Urine, 24 Hr",,82570,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),36.3384,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Creatinine, Urine, 24 Hr",,82570,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Creatinine, Urine, 24 Hr",,82570,CPT,Facility,Both,,,,72,61.2,20.6352,72,UnitedHealthcare,Individual & Family,67.68,94,,percent of total billed charges,,
"Creatinine, Urine, 24 Hr",,82570,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,UnitedHealthcare,Medicare Advantage,35.28,49,,percent of total billed charges,,
"Creatinine, Urine, 24 Hr",,82570,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Creatinine, Urine, 24 Hr",,82570,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,34.56,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Creatinine, Urine, 24 Hr",,82570,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Creatinine Clearance,,82575,CPT,Facility,Both,,,,129,109.65,36.9714,129,Aetna,Commercial,118.68,92,,percent of total billed charges,,
Creatinine Clearance,,82575,CPT,Facility,Outpatient,,,,129,109.65,36.9714,129,Aetna,Medicare Advantage,63.21,49,,percent of total billed charges,,
Creatinine Clearance,,82575,CPT,Facility,Inpatient,,,,129,109.65,36.9714,129,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Creatinine Clearance,,82575,CPT,Facility,Both,,,,129,109.65,36.9714,129,Aetna,PPO,119.97,93,,percent of total billed charges,,
Creatinine Clearance,,82575,CPT,Facility,Both,,,,129,109.65,36.9714,129,America's PPO,America's PPO,123.8787,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Creatinine Clearance,,82575,CPT,Facility,Both,,,,129,109.65,36.9714,129,BlueCross BlueShield Minnesota, Federal Employee Program,126.936,98.4,,percent of total billed charges,,
Creatinine Clearance,,82575,CPT,Facility,Both,,,,129,109.65,36.9714,129,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,129,100,,percent of total billed charges,,
Creatinine Clearance,,82575,CPT,Facility,Both,,,,129,109.65,36.9714,129,BlueCross BlueShield Minnesota,High Value Network Plan,116.1,90,,percent of total billed charges,,
Creatinine Clearance,,82575,CPT,Facility,Outpatient,,,,129,109.65,36.9714,129,BlueCross BlueShield Minnesota,Medicare Advantage,63.21,49,,percent of total billed charges,,
Creatinine Clearance,,82575,CPT,Facility,Inpatient,,,,129,109.65,36.9714,129,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Creatinine Clearance,,82575,CPT,Facility,Both,,,,129,109.65,36.9714,129,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,114.2553,88.57,,percent of total billed charges,,
Creatinine Clearance,,82575,CPT,Facility,Both,,,,129,109.65,36.9714,129,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,36.9714,28.66,,percent of total billed charges,,
Creatinine Clearance,,82575,CPT,Facility,Outpatient,,,,129,109.65,36.9714,129,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),63.21,49,,percent of total billed charges,,
Creatinine Clearance,,82575,CPT,Facility,Inpatient,,,,129,109.65,36.9714,129,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Creatinine Clearance,,82575,CPT,Facility,Both,,,,129,109.65,36.9714,129,CorVel,Worker's Compensation,129,100,,percent of total billed charges,,
Creatinine Clearance,,82575,CPT,Facility,Both,,,,129,109.65,36.9714,129,First Health Group Corporation,First Health Network,125.13,97,,percent of total billed charges,,
Creatinine Clearance,,82575,CPT,Facility,Both,,,,129,109.65,36.9714,129,"Health Partners, Inc.",Commercial,122.034,94.6,,percent of total billed charges,,
Creatinine Clearance,,82575,CPT,Facility,Outpatient,,,,129,109.65,36.9714,129,"Health Partners, Inc.",Medicare Advantage,63.21,49,,percent of total billed charges,,
Creatinine Clearance,,82575,CPT,Facility,Inpatient,,,,129,109.65,36.9714,129,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Creatinine Clearance,,82575,CPT,Facility,Both,,,,129,109.65,36.9714,129,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),77.4,60,,percent of total billed charges,,
Creatinine Clearance,,82575,CPT,Facility,Both,,,,129,109.65,36.9714,129,"Health Partners, Inc.",State of Minnesota Advantage Program,105.135,81.5,,percent of total billed charges,,
Creatinine Clearance,,82575,CPT,Facility,Both,,,,129,109.65,36.9714,129,"Health Partners, Inc.",State Public Programs,64.5,50,,percent of total billed charges,,
Creatinine Clearance,,82575,CPT,Facility,Both,,,,129,109.65,36.9714,129,Humana Insurance Company,Commercial PPO,122.55,95,,percent of total billed charges,,
Creatinine Clearance,,82575,CPT,Facility,Outpatient,,,,129,109.65,36.9714,129,Humana Insurance Company,Medicare PPO,63.21,49,,percent of total billed charges,,
Creatinine Clearance,,82575,CPT,Facility,Inpatient,,,,129,109.65,36.9714,129,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Creatinine Clearance,,82575,CPT,Facility,Both,,,,129,109.65,36.9714,129,Medica,Individual & Family,127.839,99.1,,percent of total billed charges,,
Creatinine Clearance,,82575,CPT,Facility,Outpatient,,,,129,109.65,36.9714,129,Medica,Medica Advantage Solution,64.242,49.8,,percent of total billed charges,,
Creatinine Clearance,,82575,CPT,Facility,Inpatient,,,,129,109.65,36.9714,129,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Creatinine Clearance,,82575,CPT,Facility,Outpatient,,,,129,109.65,36.9714,129,Medica,Medical Assistance,57.534,44.6,,percent of total billed charges,,
Creatinine Clearance,,82575,CPT,Facility,Inpatient,,,,129,109.65,36.9714,129,Medica,Medical Assistance,,,,,Included in per diem rate,
Creatinine Clearance,,82575,CPT,Facility,Outpatient,,,,129,109.65,36.9714,129,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,64.242,49.8,,percent of total billed charges,,
Creatinine Clearance,,82575,CPT,Facility,Inpatient,,,,129,109.65,36.9714,129,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Creatinine Clearance,,82575,CPT,Facility,Both,,,,129,109.65,36.9714,129,"Multiplan, Inc.","Multiplan, Inc.",121.26,94,,percent of total billed charges,,
Creatinine Clearance,,82575,CPT,Facility,Outpatient,,,,129,109.65,36.9714,129,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,111.456,86.4,,percent of total billed charges,,
Creatinine Clearance,,82575,CPT,Facility,Inpatient,,,,129,109.65,36.9714,129,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Creatinine Clearance,,82575,CPT,Facility,Both,,,,129,109.65,36.9714,129,"Preferred One Administrative Services, INC.",PPO,127.194,98.6,,percent of total billed charges,,
Creatinine Clearance,,82575,CPT,Facility,Outpatient,,,,129,109.65,36.9714,129,PrimeWest Health,Minnesota Senior Health Options (MSHO),66.3705,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Creatinine Clearance,,82575,CPT,Facility,Inpatient,,,,129,109.65,36.9714,129,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Creatinine Clearance,,82575,CPT,Facility,Outpatient,,,,129,109.65,36.9714,129,PrimeWest Health,MinnesotaCare,66.2544,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Creatinine Clearance,,82575,CPT,Facility,Inpatient,,,,129,109.65,36.9714,129,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Creatinine Clearance,,82575,CPT,Facility,Both,,,,129,109.65,36.9714,129,Sanford Health Plan,Sanford Health Plan,118.68,92,,percent of total billed charges,,
Creatinine Clearance,,82575,CPT,Facility,Outpatient,,,,129,109.65,36.9714,129,"UCare Health, Inc.",Individual & Family Plan,72.6915,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Creatinine Clearance,,82575,CPT,Facility,Inpatient,,,,129,109.65,36.9714,129,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Creatinine Clearance,,82575,CPT,Facility,Outpatient,,,,129,109.65,36.9714,129,"UCare Health, Inc.",Medical Assistance,65.1063,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Creatinine Clearance,,82575,CPT,Facility,Inpatient,,,,129,109.65,36.9714,129,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Creatinine Clearance,,82575,CPT,Facility,Outpatient,,,,129,109.65,36.9714,129,"UCare Health, Inc.",Medicare Advantage,65.1063,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Creatinine Clearance,,82575,CPT,Facility,Inpatient,,,,129,109.65,36.9714,129,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Creatinine Clearance,,82575,CPT,Facility,Outpatient,,,,129,109.65,36.9714,129,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),65.1063,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Creatinine Clearance,,82575,CPT,Facility,Inpatient,,,,129,109.65,36.9714,129,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Creatinine Clearance,,82575,CPT,Facility,Both,,,,129,109.65,36.9714,129,UnitedHealthcare,Individual & Family,121.26,94,,percent of total billed charges,,
Creatinine Clearance,,82575,CPT,Facility,Outpatient,,,,129,109.65,36.9714,129,UnitedHealthcare,Medicare Advantage,63.21,49,,percent of total billed charges,,
Creatinine Clearance,,82575,CPT,Facility,Inpatient,,,,129,109.65,36.9714,129,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Creatinine Clearance,,82575,CPT,Facility,Outpatient,,,,129,109.65,36.9714,129,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,61.92,48,,percent of total billed charges,,100% of DHS outpatient percentage
Creatinine Clearance,,82575,CPT,Facility,Inpatient,,,,129,109.65,36.9714,129,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Vitamin B12,,82607,CPT,Facility,Both,,,,129,109.65,36.9714,129,Aetna,Commercial,118.68,92,,percent of total billed charges,,
Vitamin B12,,82607,CPT,Facility,Outpatient,,,,129,109.65,36.9714,129,Aetna,Medicare Advantage,63.21,49,,percent of total billed charges,,
Vitamin B12,,82607,CPT,Facility,Inpatient,,,,129,109.65,36.9714,129,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Vitamin B12,,82607,CPT,Facility,Both,,,,129,109.65,36.9714,129,Aetna,PPO,119.97,93,,percent of total billed charges,,
Vitamin B12,,82607,CPT,Facility,Both,,,,129,109.65,36.9714,129,America's PPO,America's PPO,123.8787,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Vitamin B12,,82607,CPT,Facility,Both,,,,129,109.65,36.9714,129,BlueCross BlueShield Minnesota, Federal Employee Program,126.936,98.4,,percent of total billed charges,,
Vitamin B12,,82607,CPT,Facility,Both,,,,129,109.65,36.9714,129,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,129,100,,percent of total billed charges,,
Vitamin B12,,82607,CPT,Facility,Both,,,,129,109.65,36.9714,129,BlueCross BlueShield Minnesota,High Value Network Plan,116.1,90,,percent of total billed charges,,
Vitamin B12,,82607,CPT,Facility,Outpatient,,,,129,109.65,36.9714,129,BlueCross BlueShield Minnesota,Medicare Advantage,63.21,49,,percent of total billed charges,,
Vitamin B12,,82607,CPT,Facility,Inpatient,,,,129,109.65,36.9714,129,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Vitamin B12,,82607,CPT,Facility,Both,,,,129,109.65,36.9714,129,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,114.2553,88.57,,percent of total billed charges,,
Vitamin B12,,82607,CPT,Facility,Both,,,,129,109.65,36.9714,129,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,36.9714,28.66,,percent of total billed charges,,
Vitamin B12,,82607,CPT,Facility,Outpatient,,,,129,109.65,36.9714,129,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),63.21,49,,percent of total billed charges,,
Vitamin B12,,82607,CPT,Facility,Inpatient,,,,129,109.65,36.9714,129,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Vitamin B12,,82607,CPT,Facility,Both,,,,129,109.65,36.9714,129,CorVel,Worker's Compensation,129,100,,percent of total billed charges,,
Vitamin B12,,82607,CPT,Facility,Both,,,,129,109.65,36.9714,129,First Health Group Corporation,First Health Network,125.13,97,,percent of total billed charges,,
Vitamin B12,,82607,CPT,Facility,Both,,,,129,109.65,36.9714,129,"Health Partners, Inc.",Commercial,122.034,94.6,,percent of total billed charges,,
Vitamin B12,,82607,CPT,Facility,Outpatient,,,,129,109.65,36.9714,129,"Health Partners, Inc.",Medicare Advantage,63.21,49,,percent of total billed charges,,
Vitamin B12,,82607,CPT,Facility,Inpatient,,,,129,109.65,36.9714,129,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Vitamin B12,,82607,CPT,Facility,Both,,,,129,109.65,36.9714,129,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),77.4,60,,percent of total billed charges,,
Vitamin B12,,82607,CPT,Facility,Both,,,,129,109.65,36.9714,129,"Health Partners, Inc.",State of Minnesota Advantage Program,105.135,81.5,,percent of total billed charges,,
Vitamin B12,,82607,CPT,Facility,Both,,,,129,109.65,36.9714,129,"Health Partners, Inc.",State Public Programs,64.5,50,,percent of total billed charges,,
Vitamin B12,,82607,CPT,Facility,Both,,,,129,109.65,36.9714,129,Humana Insurance Company,Commercial PPO,122.55,95,,percent of total billed charges,,
Vitamin B12,,82607,CPT,Facility,Outpatient,,,,129,109.65,36.9714,129,Humana Insurance Company,Medicare PPO,63.21,49,,percent of total billed charges,,
Vitamin B12,,82607,CPT,Facility,Inpatient,,,,129,109.65,36.9714,129,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Vitamin B12,,82607,CPT,Facility,Both,,,,129,109.65,36.9714,129,Medica,Individual & Family,127.839,99.1,,percent of total billed charges,,
Vitamin B12,,82607,CPT,Facility,Outpatient,,,,129,109.65,36.9714,129,Medica,Medica Advantage Solution,64.242,49.8,,percent of total billed charges,,
Vitamin B12,,82607,CPT,Facility,Inpatient,,,,129,109.65,36.9714,129,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Vitamin B12,,82607,CPT,Facility,Outpatient,,,,129,109.65,36.9714,129,Medica,Medical Assistance,57.534,44.6,,percent of total billed charges,,
Vitamin B12,,82607,CPT,Facility,Inpatient,,,,129,109.65,36.9714,129,Medica,Medical Assistance,,,,,Included in per diem rate,
Vitamin B12,,82607,CPT,Facility,Outpatient,,,,129,109.65,36.9714,129,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,64.242,49.8,,percent of total billed charges,,
Vitamin B12,,82607,CPT,Facility,Inpatient,,,,129,109.65,36.9714,129,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Vitamin B12,,82607,CPT,Facility,Both,,,,129,109.65,36.9714,129,"Multiplan, Inc.","Multiplan, Inc.",121.26,94,,percent of total billed charges,,
Vitamin B12,,82607,CPT,Facility,Outpatient,,,,129,109.65,36.9714,129,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,111.456,86.4,,percent of total billed charges,,
Vitamin B12,,82607,CPT,Facility,Inpatient,,,,129,109.65,36.9714,129,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Vitamin B12,,82607,CPT,Facility,Both,,,,129,109.65,36.9714,129,"Preferred One Administrative Services, INC.",PPO,127.194,98.6,,percent of total billed charges,,
Vitamin B12,,82607,CPT,Facility,Outpatient,,,,129,109.65,36.9714,129,PrimeWest Health,Minnesota Senior Health Options (MSHO),66.3705,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Vitamin B12,,82607,CPT,Facility,Inpatient,,,,129,109.65,36.9714,129,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Vitamin B12,,82607,CPT,Facility,Outpatient,,,,129,109.65,36.9714,129,PrimeWest Health,MinnesotaCare,66.2544,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Vitamin B12,,82607,CPT,Facility,Inpatient,,,,129,109.65,36.9714,129,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Vitamin B12,,82607,CPT,Facility,Both,,,,129,109.65,36.9714,129,Sanford Health Plan,Sanford Health Plan,118.68,92,,percent of total billed charges,,
Vitamin B12,,82607,CPT,Facility,Outpatient,,,,129,109.65,36.9714,129,"UCare Health, Inc.",Individual & Family Plan,72.6915,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Vitamin B12,,82607,CPT,Facility,Inpatient,,,,129,109.65,36.9714,129,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Vitamin B12,,82607,CPT,Facility,Outpatient,,,,129,109.65,36.9714,129,"UCare Health, Inc.",Medical Assistance,65.1063,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Vitamin B12,,82607,CPT,Facility,Inpatient,,,,129,109.65,36.9714,129,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Vitamin B12,,82607,CPT,Facility,Outpatient,,,,129,109.65,36.9714,129,"UCare Health, Inc.",Medicare Advantage,65.1063,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Vitamin B12,,82607,CPT,Facility,Inpatient,,,,129,109.65,36.9714,129,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Vitamin B12,,82607,CPT,Facility,Outpatient,,,,129,109.65,36.9714,129,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),65.1063,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Vitamin B12,,82607,CPT,Facility,Inpatient,,,,129,109.65,36.9714,129,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Vitamin B12,,82607,CPT,Facility,Both,,,,129,109.65,36.9714,129,UnitedHealthcare,Individual & Family,121.26,94,,percent of total billed charges,,
Vitamin B12,,82607,CPT,Facility,Outpatient,,,,129,109.65,36.9714,129,UnitedHealthcare,Medicare Advantage,63.21,49,,percent of total billed charges,,
Vitamin B12,,82607,CPT,Facility,Inpatient,,,,129,109.65,36.9714,129,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Vitamin B12,,82607,CPT,Facility,Outpatient,,,,129,109.65,36.9714,129,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,61.92,48,,percent of total billed charges,,100% of DHS outpatient percentage
Vitamin B12,,82607,CPT,Facility,Inpatient,,,,129,109.65,36.9714,129,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Estradiol; Total,,82670,CPT,Facility,Both,,,,162,137.7,46.4292,162,Aetna,Commercial,149.04,92,,percent of total billed charges,,
Estradiol; Total,,82670,CPT,Facility,Outpatient,,,,162,137.7,46.4292,162,Aetna,Medicare Advantage,79.38,49,,percent of total billed charges,,
Estradiol; Total,,82670,CPT,Facility,Inpatient,,,,162,137.7,46.4292,162,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Estradiol; Total,,82670,CPT,Facility,Both,,,,162,137.7,46.4292,162,Aetna,PPO,150.66,93,,percent of total billed charges,,
Estradiol; Total,,82670,CPT,Facility,Both,,,,162,137.7,46.4292,162,America's PPO,America's PPO,155.5686,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Estradiol; Total,,82670,CPT,Facility,Both,,,,162,137.7,46.4292,162,BlueCross BlueShield Minnesota, Federal Employee Program,159.408,98.4,,percent of total billed charges,,
Estradiol; Total,,82670,CPT,Facility,Both,,,,162,137.7,46.4292,162,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,162,100,,percent of total billed charges,,
Estradiol; Total,,82670,CPT,Facility,Both,,,,162,137.7,46.4292,162,BlueCross BlueShield Minnesota,High Value Network Plan,145.8,90,,percent of total billed charges,,
Estradiol; Total,,82670,CPT,Facility,Outpatient,,,,162,137.7,46.4292,162,BlueCross BlueShield Minnesota,Medicare Advantage,79.38,49,,percent of total billed charges,,
Estradiol; Total,,82670,CPT,Facility,Inpatient,,,,162,137.7,46.4292,162,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Estradiol; Total,,82670,CPT,Facility,Both,,,,162,137.7,46.4292,162,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,143.4834,88.57,,percent of total billed charges,,
Estradiol; Total,,82670,CPT,Facility,Both,,,,162,137.7,46.4292,162,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,46.4292,28.66,,percent of total billed charges,,
Estradiol; Total,,82670,CPT,Facility,Outpatient,,,,162,137.7,46.4292,162,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),79.38,49,,percent of total billed charges,,
Estradiol; Total,,82670,CPT,Facility,Inpatient,,,,162,137.7,46.4292,162,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Estradiol; Total,,82670,CPT,Facility,Both,,,,162,137.7,46.4292,162,CorVel,Worker's Compensation,162,100,,percent of total billed charges,,
Estradiol; Total,,82670,CPT,Facility,Both,,,,162,137.7,46.4292,162,First Health Group Corporation,First Health Network,157.14,97,,percent of total billed charges,,
Estradiol; Total,,82670,CPT,Facility,Both,,,,162,137.7,46.4292,162,"Health Partners, Inc.",Commercial,153.252,94.6,,percent of total billed charges,,
Estradiol; Total,,82670,CPT,Facility,Outpatient,,,,162,137.7,46.4292,162,"Health Partners, Inc.",Medicare Advantage,79.38,49,,percent of total billed charges,,
Estradiol; Total,,82670,CPT,Facility,Inpatient,,,,162,137.7,46.4292,162,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Estradiol; Total,,82670,CPT,Facility,Both,,,,162,137.7,46.4292,162,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),97.2,60,,percent of total billed charges,,
Estradiol; Total,,82670,CPT,Facility,Both,,,,162,137.7,46.4292,162,"Health Partners, Inc.",State of Minnesota Advantage Program,132.03,81.5,,percent of total billed charges,,
Estradiol; Total,,82670,CPT,Facility,Both,,,,162,137.7,46.4292,162,"Health Partners, Inc.",State Public Programs,81,50,,percent of total billed charges,,
Estradiol; Total,,82670,CPT,Facility,Both,,,,162,137.7,46.4292,162,Humana Insurance Company,Commercial PPO,153.9,95,,percent of total billed charges,,
Estradiol; Total,,82670,CPT,Facility,Outpatient,,,,162,137.7,46.4292,162,Humana Insurance Company,Medicare PPO,79.38,49,,percent of total billed charges,,
Estradiol; Total,,82670,CPT,Facility,Inpatient,,,,162,137.7,46.4292,162,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Estradiol; Total,,82670,CPT,Facility,Both,,,,162,137.7,46.4292,162,Medica,Individual & Family,160.542,99.1,,percent of total billed charges,,
Estradiol; Total,,82670,CPT,Facility,Outpatient,,,,162,137.7,46.4292,162,Medica,Medica Advantage Solution,80.676,49.8,,percent of total billed charges,,
Estradiol; Total,,82670,CPT,Facility,Inpatient,,,,162,137.7,46.4292,162,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Estradiol; Total,,82670,CPT,Facility,Outpatient,,,,162,137.7,46.4292,162,Medica,Medical Assistance,72.252,44.6,,percent of total billed charges,,
Estradiol; Total,,82670,CPT,Facility,Inpatient,,,,162,137.7,46.4292,162,Medica,Medical Assistance,,,,,Included in per diem rate,
Estradiol; Total,,82670,CPT,Facility,Outpatient,,,,162,137.7,46.4292,162,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,80.676,49.8,,percent of total billed charges,,
Estradiol; Total,,82670,CPT,Facility,Inpatient,,,,162,137.7,46.4292,162,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Estradiol; Total,,82670,CPT,Facility,Both,,,,162,137.7,46.4292,162,"Multiplan, Inc.","Multiplan, Inc.",152.28,94,,percent of total billed charges,,
Estradiol; Total,,82670,CPT,Facility,Outpatient,,,,162,137.7,46.4292,162,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,139.968,86.4,,percent of total billed charges,,
Estradiol; Total,,82670,CPT,Facility,Inpatient,,,,162,137.7,46.4292,162,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Estradiol; Total,,82670,CPT,Facility,Both,,,,162,137.7,46.4292,162,"Preferred One Administrative Services, INC.",PPO,159.732,98.6,,percent of total billed charges,,
Estradiol; Total,,82670,CPT,Facility,Outpatient,,,,162,137.7,46.4292,162,PrimeWest Health,Minnesota Senior Health Options (MSHO),83.349,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Estradiol; Total,,82670,CPT,Facility,Inpatient,,,,162,137.7,46.4292,162,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Estradiol; Total,,82670,CPT,Facility,Outpatient,,,,162,137.7,46.4292,162,PrimeWest Health,MinnesotaCare,83.2032,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Estradiol; Total,,82670,CPT,Facility,Inpatient,,,,162,137.7,46.4292,162,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Estradiol; Total,,82670,CPT,Facility,Both,,,,162,137.7,46.4292,162,Sanford Health Plan,Sanford Health Plan,149.04,92,,percent of total billed charges,,
Estradiol; Total,,82670,CPT,Facility,Outpatient,,,,162,137.7,46.4292,162,"UCare Health, Inc.",Individual & Family Plan,91.287,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Estradiol; Total,,82670,CPT,Facility,Inpatient,,,,162,137.7,46.4292,162,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Estradiol; Total,,82670,CPT,Facility,Outpatient,,,,162,137.7,46.4292,162,"UCare Health, Inc.",Medical Assistance,81.7614,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Estradiol; Total,,82670,CPT,Facility,Inpatient,,,,162,137.7,46.4292,162,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Estradiol; Total,,82670,CPT,Facility,Outpatient,,,,162,137.7,46.4292,162,"UCare Health, Inc.",Medicare Advantage,81.7614,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Estradiol; Total,,82670,CPT,Facility,Inpatient,,,,162,137.7,46.4292,162,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Estradiol; Total,,82670,CPT,Facility,Outpatient,,,,162,137.7,46.4292,162,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),81.7614,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Estradiol; Total,,82670,CPT,Facility,Inpatient,,,,162,137.7,46.4292,162,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Estradiol; Total,,82670,CPT,Facility,Both,,,,162,137.7,46.4292,162,UnitedHealthcare,Individual & Family,152.28,94,,percent of total billed charges,,
Estradiol; Total,,82670,CPT,Facility,Outpatient,,,,162,137.7,46.4292,162,UnitedHealthcare,Medicare Advantage,79.38,49,,percent of total billed charges,,
Estradiol; Total,,82670,CPT,Facility,Inpatient,,,,162,137.7,46.4292,162,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Estradiol; Total,,82670,CPT,Facility,Outpatient,,,,162,137.7,46.4292,162,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,77.76,48,,percent of total billed charges,,100% of DHS outpatient percentage
Estradiol; Total,,82670,CPT,Facility,Inpatient,,,,162,137.7,46.4292,162,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Fat Or Lipids, Feces, Qualitative",,82705,CPT,Facility,Both,,,,58,49.3,16.6228,58,Aetna,Commercial,53.36,92,,percent of total billed charges,,
"Fat Or Lipids, Feces, Qualitative",,82705,CPT,Facility,Outpatient,,,,58,49.3,16.6228,58,Aetna,Medicare Advantage,28.42,49,,percent of total billed charges,,
"Fat Or Lipids, Feces, Qualitative",,82705,CPT,Facility,Inpatient,,,,58,49.3,16.6228,58,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Fat Or Lipids, Feces, Qualitative",,82705,CPT,Facility,Both,,,,58,49.3,16.6228,58,Aetna,PPO,53.94,93,,percent of total billed charges,,
"Fat Or Lipids, Feces, Qualitative",,82705,CPT,Facility,Both,,,,58,49.3,16.6228,58,America's PPO,America's PPO,55.6974,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Fat Or Lipids, Feces, Qualitative",,82705,CPT,Facility,Both,,,,58,49.3,16.6228,58,BlueCross BlueShield Minnesota, Federal Employee Program,57.072,98.4,,percent of total billed charges,,
"Fat Or Lipids, Feces, Qualitative",,82705,CPT,Facility,Both,,,,58,49.3,16.6228,58,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,58,100,,percent of total billed charges,,
"Fat Or Lipids, Feces, Qualitative",,82705,CPT,Facility,Both,,,,58,49.3,16.6228,58,BlueCross BlueShield Minnesota,High Value Network Plan,52.2,90,,percent of total billed charges,,
"Fat Or Lipids, Feces, Qualitative",,82705,CPT,Facility,Outpatient,,,,58,49.3,16.6228,58,BlueCross BlueShield Minnesota,Medicare Advantage,28.42,49,,percent of total billed charges,,
"Fat Or Lipids, Feces, Qualitative",,82705,CPT,Facility,Inpatient,,,,58,49.3,16.6228,58,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Fat Or Lipids, Feces, Qualitative",,82705,CPT,Facility,Both,,,,58,49.3,16.6228,58,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,51.3706,88.57,,percent of total billed charges,,
"Fat Or Lipids, Feces, Qualitative",,82705,CPT,Facility,Both,,,,58,49.3,16.6228,58,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,16.6228,28.66,,percent of total billed charges,,
"Fat Or Lipids, Feces, Qualitative",,82705,CPT,Facility,Outpatient,,,,58,49.3,16.6228,58,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),28.42,49,,percent of total billed charges,,
"Fat Or Lipids, Feces, Qualitative",,82705,CPT,Facility,Inpatient,,,,58,49.3,16.6228,58,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Fat Or Lipids, Feces, Qualitative",,82705,CPT,Facility,Both,,,,58,49.3,16.6228,58,CorVel,Worker's Compensation,58,100,,percent of total billed charges,,
"Fat Or Lipids, Feces, Qualitative",,82705,CPT,Facility,Both,,,,58,49.3,16.6228,58,First Health Group Corporation,First Health Network,56.26,97,,percent of total billed charges,,
"Fat Or Lipids, Feces, Qualitative",,82705,CPT,Facility,Both,,,,58,49.3,16.6228,58,"Health Partners, Inc.",Commercial,54.868,94.6,,percent of total billed charges,,
"Fat Or Lipids, Feces, Qualitative",,82705,CPT,Facility,Outpatient,,,,58,49.3,16.6228,58,"Health Partners, Inc.",Medicare Advantage,28.42,49,,percent of total billed charges,,
"Fat Or Lipids, Feces, Qualitative",,82705,CPT,Facility,Inpatient,,,,58,49.3,16.6228,58,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Fat Or Lipids, Feces, Qualitative",,82705,CPT,Facility,Both,,,,58,49.3,16.6228,58,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),34.8,60,,percent of total billed charges,,
"Fat Or Lipids, Feces, Qualitative",,82705,CPT,Facility,Both,,,,58,49.3,16.6228,58,"Health Partners, Inc.",State of Minnesota Advantage Program,47.27,81.5,,percent of total billed charges,,
"Fat Or Lipids, Feces, Qualitative",,82705,CPT,Facility,Both,,,,58,49.3,16.6228,58,"Health Partners, Inc.",State Public Programs,29,50,,percent of total billed charges,,
"Fat Or Lipids, Feces, Qualitative",,82705,CPT,Facility,Both,,,,58,49.3,16.6228,58,Humana Insurance Company,Commercial PPO,55.1,95,,percent of total billed charges,,
"Fat Or Lipids, Feces, Qualitative",,82705,CPT,Facility,Outpatient,,,,58,49.3,16.6228,58,Humana Insurance Company,Medicare PPO,28.42,49,,percent of total billed charges,,
"Fat Or Lipids, Feces, Qualitative",,82705,CPT,Facility,Inpatient,,,,58,49.3,16.6228,58,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Fat Or Lipids, Feces, Qualitative",,82705,CPT,Facility,Both,,,,58,49.3,16.6228,58,Medica,Individual & Family,57.478,99.1,,percent of total billed charges,,
"Fat Or Lipids, Feces, Qualitative",,82705,CPT,Facility,Outpatient,,,,58,49.3,16.6228,58,Medica,Medica Advantage Solution,28.884,49.8,,percent of total billed charges,,
"Fat Or Lipids, Feces, Qualitative",,82705,CPT,Facility,Inpatient,,,,58,49.3,16.6228,58,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Fat Or Lipids, Feces, Qualitative",,82705,CPT,Facility,Outpatient,,,,58,49.3,16.6228,58,Medica,Medical Assistance,25.868,44.6,,percent of total billed charges,,
"Fat Or Lipids, Feces, Qualitative",,82705,CPT,Facility,Inpatient,,,,58,49.3,16.6228,58,Medica,Medical Assistance,,,,,Included in per diem rate,
"Fat Or Lipids, Feces, Qualitative",,82705,CPT,Facility,Outpatient,,,,58,49.3,16.6228,58,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,28.884,49.8,,percent of total billed charges,,
"Fat Or Lipids, Feces, Qualitative",,82705,CPT,Facility,Inpatient,,,,58,49.3,16.6228,58,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Fat Or Lipids, Feces, Qualitative",,82705,CPT,Facility,Both,,,,58,49.3,16.6228,58,"Multiplan, Inc.","Multiplan, Inc.",54.52,94,,percent of total billed charges,,
"Fat Or Lipids, Feces, Qualitative",,82705,CPT,Facility,Outpatient,,,,58,49.3,16.6228,58,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,50.112,86.4,,percent of total billed charges,,
"Fat Or Lipids, Feces, Qualitative",,82705,CPT,Facility,Inpatient,,,,58,49.3,16.6228,58,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Fat Or Lipids, Feces, Qualitative",,82705,CPT,Facility,Both,,,,58,49.3,16.6228,58,"Preferred One Administrative Services, INC.",PPO,57.188,98.6,,percent of total billed charges,,
"Fat Or Lipids, Feces, Qualitative",,82705,CPT,Facility,Outpatient,,,,58,49.3,16.6228,58,PrimeWest Health,Minnesota Senior Health Options (MSHO),29.841,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Fat Or Lipids, Feces, Qualitative",,82705,CPT,Facility,Inpatient,,,,58,49.3,16.6228,58,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Fat Or Lipids, Feces, Qualitative",,82705,CPT,Facility,Outpatient,,,,58,49.3,16.6228,58,PrimeWest Health,MinnesotaCare,29.7888,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Fat Or Lipids, Feces, Qualitative",,82705,CPT,Facility,Inpatient,,,,58,49.3,16.6228,58,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Fat Or Lipids, Feces, Qualitative",,82705,CPT,Facility,Both,,,,58,49.3,16.6228,58,Sanford Health Plan,Sanford Health Plan,53.36,92,,percent of total billed charges,,
"Fat Or Lipids, Feces, Qualitative",,82705,CPT,Facility,Outpatient,,,,58,49.3,16.6228,58,"UCare Health, Inc.",Individual & Family Plan,32.683,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Fat Or Lipids, Feces, Qualitative",,82705,CPT,Facility,Inpatient,,,,58,49.3,16.6228,58,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Fat Or Lipids, Feces, Qualitative",,82705,CPT,Facility,Outpatient,,,,58,49.3,16.6228,58,"UCare Health, Inc.",Medical Assistance,29.2726,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Fat Or Lipids, Feces, Qualitative",,82705,CPT,Facility,Inpatient,,,,58,49.3,16.6228,58,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Fat Or Lipids, Feces, Qualitative",,82705,CPT,Facility,Outpatient,,,,58,49.3,16.6228,58,"UCare Health, Inc.",Medicare Advantage,29.2726,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Fat Or Lipids, Feces, Qualitative",,82705,CPT,Facility,Inpatient,,,,58,49.3,16.6228,58,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Fat Or Lipids, Feces, Qualitative",,82705,CPT,Facility,Outpatient,,,,58,49.3,16.6228,58,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),29.2726,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Fat Or Lipids, Feces, Qualitative",,82705,CPT,Facility,Inpatient,,,,58,49.3,16.6228,58,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Fat Or Lipids, Feces, Qualitative",,82705,CPT,Facility,Both,,,,58,49.3,16.6228,58,UnitedHealthcare,Individual & Family,54.52,94,,percent of total billed charges,,
"Fat Or Lipids, Feces, Qualitative",,82705,CPT,Facility,Outpatient,,,,58,49.3,16.6228,58,UnitedHealthcare,Medicare Advantage,28.42,49,,percent of total billed charges,,
"Fat Or Lipids, Feces, Qualitative",,82705,CPT,Facility,Inpatient,,,,58,49.3,16.6228,58,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Fat Or Lipids, Feces, Qualitative",,82705,CPT,Facility,Outpatient,,,,58,49.3,16.6228,58,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,27.84,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Fat Or Lipids, Feces, Qualitative",,82705,CPT,Facility,Inpatient,,,,58,49.3,16.6228,58,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Ferritin,,82728,CPT,Facility,Both,,,,126,107.1,36.1116,126,Aetna,Commercial,115.92,92,,percent of total billed charges,,
Ferritin,,82728,CPT,Facility,Outpatient,,,,126,107.1,36.1116,126,Aetna,Medicare Advantage,61.74,49,,percent of total billed charges,,
Ferritin,,82728,CPT,Facility,Inpatient,,,,126,107.1,36.1116,126,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Ferritin,,82728,CPT,Facility,Both,,,,126,107.1,36.1116,126,Aetna,PPO,117.18,93,,percent of total billed charges,,
Ferritin,,82728,CPT,Facility,Both,,,,126,107.1,36.1116,126,America's PPO,America's PPO,120.9978,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Ferritin,,82728,CPT,Facility,Both,,,,126,107.1,36.1116,126,BlueCross BlueShield Minnesota, Federal Employee Program,123.984,98.4,,percent of total billed charges,,
Ferritin,,82728,CPT,Facility,Both,,,,126,107.1,36.1116,126,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,126,100,,percent of total billed charges,,
Ferritin,,82728,CPT,Facility,Both,,,,126,107.1,36.1116,126,BlueCross BlueShield Minnesota,High Value Network Plan,113.4,90,,percent of total billed charges,,
Ferritin,,82728,CPT,Facility,Outpatient,,,,126,107.1,36.1116,126,BlueCross BlueShield Minnesota,Medicare Advantage,61.74,49,,percent of total billed charges,,
Ferritin,,82728,CPT,Facility,Inpatient,,,,126,107.1,36.1116,126,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Ferritin,,82728,CPT,Facility,Both,,,,126,107.1,36.1116,126,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,111.5982,88.57,,percent of total billed charges,,
Ferritin,,82728,CPT,Facility,Both,,,,126,107.1,36.1116,126,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,36.1116,28.66,,percent of total billed charges,,
Ferritin,,82728,CPT,Facility,Outpatient,,,,126,107.1,36.1116,126,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),61.74,49,,percent of total billed charges,,
Ferritin,,82728,CPT,Facility,Inpatient,,,,126,107.1,36.1116,126,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Ferritin,,82728,CPT,Facility,Both,,,,126,107.1,36.1116,126,CorVel,Worker's Compensation,126,100,,percent of total billed charges,,
Ferritin,,82728,CPT,Facility,Both,,,,126,107.1,36.1116,126,First Health Group Corporation,First Health Network,122.22,97,,percent of total billed charges,,
Ferritin,,82728,CPT,Facility,Both,,,,126,107.1,36.1116,126,"Health Partners, Inc.",Commercial,119.196,94.6,,percent of total billed charges,,
Ferritin,,82728,CPT,Facility,Outpatient,,,,126,107.1,36.1116,126,"Health Partners, Inc.",Medicare Advantage,61.74,49,,percent of total billed charges,,
Ferritin,,82728,CPT,Facility,Inpatient,,,,126,107.1,36.1116,126,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ferritin,,82728,CPT,Facility,Both,,,,126,107.1,36.1116,126,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),75.6,60,,percent of total billed charges,,
Ferritin,,82728,CPT,Facility,Both,,,,126,107.1,36.1116,126,"Health Partners, Inc.",State of Minnesota Advantage Program,102.69,81.5,,percent of total billed charges,,
Ferritin,,82728,CPT,Facility,Both,,,,126,107.1,36.1116,126,"Health Partners, Inc.",State Public Programs,63,50,,percent of total billed charges,,
Ferritin,,82728,CPT,Facility,Both,,,,126,107.1,36.1116,126,Humana Insurance Company,Commercial PPO,119.7,95,,percent of total billed charges,,
Ferritin,,82728,CPT,Facility,Outpatient,,,,126,107.1,36.1116,126,Humana Insurance Company,Medicare PPO,61.74,49,,percent of total billed charges,,
Ferritin,,82728,CPT,Facility,Inpatient,,,,126,107.1,36.1116,126,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Ferritin,,82728,CPT,Facility,Both,,,,126,107.1,36.1116,126,Medica,Individual & Family,124.866,99.1,,percent of total billed charges,,
Ferritin,,82728,CPT,Facility,Outpatient,,,,126,107.1,36.1116,126,Medica,Medica Advantage Solution,62.748,49.8,,percent of total billed charges,,
Ferritin,,82728,CPT,Facility,Inpatient,,,,126,107.1,36.1116,126,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Ferritin,,82728,CPT,Facility,Outpatient,,,,126,107.1,36.1116,126,Medica,Medical Assistance,56.196,44.6,,percent of total billed charges,,
Ferritin,,82728,CPT,Facility,Inpatient,,,,126,107.1,36.1116,126,Medica,Medical Assistance,,,,,Included in per diem rate,
Ferritin,,82728,CPT,Facility,Outpatient,,,,126,107.1,36.1116,126,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,62.748,49.8,,percent of total billed charges,,
Ferritin,,82728,CPT,Facility,Inpatient,,,,126,107.1,36.1116,126,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Ferritin,,82728,CPT,Facility,Both,,,,126,107.1,36.1116,126,"Multiplan, Inc.","Multiplan, Inc.",118.44,94,,percent of total billed charges,,
Ferritin,,82728,CPT,Facility,Outpatient,,,,126,107.1,36.1116,126,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,108.864,86.4,,percent of total billed charges,,
Ferritin,,82728,CPT,Facility,Inpatient,,,,126,107.1,36.1116,126,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Ferritin,,82728,CPT,Facility,Both,,,,126,107.1,36.1116,126,"Preferred One Administrative Services, INC.",PPO,124.236,98.6,,percent of total billed charges,,
Ferritin,,82728,CPT,Facility,Outpatient,,,,126,107.1,36.1116,126,PrimeWest Health,Minnesota Senior Health Options (MSHO),64.827,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Ferritin,,82728,CPT,Facility,Inpatient,,,,126,107.1,36.1116,126,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ferritin,,82728,CPT,Facility,Outpatient,,,,126,107.1,36.1116,126,PrimeWest Health,MinnesotaCare,64.7136,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Ferritin,,82728,CPT,Facility,Inpatient,,,,126,107.1,36.1116,126,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Ferritin,,82728,CPT,Facility,Both,,,,126,107.1,36.1116,126,Sanford Health Plan,Sanford Health Plan,115.92,92,,percent of total billed charges,,
Ferritin,,82728,CPT,Facility,Outpatient,,,,126,107.1,36.1116,126,"UCare Health, Inc.",Individual & Family Plan,71.001,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Ferritin,,82728,CPT,Facility,Inpatient,,,,126,107.1,36.1116,126,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Ferritin,,82728,CPT,Facility,Outpatient,,,,126,107.1,36.1116,126,"UCare Health, Inc.",Medical Assistance,63.5922,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ferritin,,82728,CPT,Facility,Inpatient,,,,126,107.1,36.1116,126,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Ferritin,,82728,CPT,Facility,Outpatient,,,,126,107.1,36.1116,126,"UCare Health, Inc.",Medicare Advantage,63.5922,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ferritin,,82728,CPT,Facility,Inpatient,,,,126,107.1,36.1116,126,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ferritin,,82728,CPT,Facility,Outpatient,,,,126,107.1,36.1116,126,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),63.5922,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ferritin,,82728,CPT,Facility,Inpatient,,,,126,107.1,36.1116,126,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ferritin,,82728,CPT,Facility,Both,,,,126,107.1,36.1116,126,UnitedHealthcare,Individual & Family,118.44,94,,percent of total billed charges,,
Ferritin,,82728,CPT,Facility,Outpatient,,,,126,107.1,36.1116,126,UnitedHealthcare,Medicare Advantage,61.74,49,,percent of total billed charges,,
Ferritin,,82728,CPT,Facility,Inpatient,,,,126,107.1,36.1116,126,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Ferritin,,82728,CPT,Facility,Outpatient,,,,126,107.1,36.1116,126,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,60.48,48,,percent of total billed charges,,100% of DHS outpatient percentage
Ferritin,,82728,CPT,Facility,Inpatient,,,,126,107.1,36.1116,126,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Fibronectin Fetal,,82731,CPT,Facility,Both,,,,400,340,114.64,400,Aetna,Commercial,368,92,,percent of total billed charges,,
Fibronectin Fetal,,82731,CPT,Facility,Outpatient,,,,400,340,114.64,400,Aetna,Medicare Advantage,196,49,,percent of total billed charges,,
Fibronectin Fetal,,82731,CPT,Facility,Inpatient,,,,400,340,114.64,400,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Fibronectin Fetal,,82731,CPT,Facility,Both,,,,400,340,114.64,400,Aetna,PPO,372,93,,percent of total billed charges,,
Fibronectin Fetal,,82731,CPT,Facility,Both,,,,400,340,114.64,400,America's PPO,America's PPO,384.12,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Fibronectin Fetal,,82731,CPT,Facility,Both,,,,400,340,114.64,400,BlueCross BlueShield Minnesota, Federal Employee Program,393.6,98.4,,percent of total billed charges,,
Fibronectin Fetal,,82731,CPT,Facility,Both,,,,400,340,114.64,400,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,400,100,,percent of total billed charges,,
Fibronectin Fetal,,82731,CPT,Facility,Both,,,,400,340,114.64,400,BlueCross BlueShield Minnesota,High Value Network Plan,360,90,,percent of total billed charges,,
Fibronectin Fetal,,82731,CPT,Facility,Outpatient,,,,400,340,114.64,400,BlueCross BlueShield Minnesota,Medicare Advantage,196,49,,percent of total billed charges,,
Fibronectin Fetal,,82731,CPT,Facility,Inpatient,,,,400,340,114.64,400,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Fibronectin Fetal,,82731,CPT,Facility,Both,,,,400,340,114.64,400,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,354.28,88.57,,percent of total billed charges,,
Fibronectin Fetal,,82731,CPT,Facility,Both,,,,400,340,114.64,400,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,114.64,28.66,,percent of total billed charges,,
Fibronectin Fetal,,82731,CPT,Facility,Outpatient,,,,400,340,114.64,400,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),196,49,,percent of total billed charges,,
Fibronectin Fetal,,82731,CPT,Facility,Inpatient,,,,400,340,114.64,400,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Fibronectin Fetal,,82731,CPT,Facility,Both,,,,400,340,114.64,400,CorVel,Worker's Compensation,400,100,,percent of total billed charges,,
Fibronectin Fetal,,82731,CPT,Facility,Both,,,,400,340,114.64,400,First Health Group Corporation,First Health Network,388,97,,percent of total billed charges,,
Fibronectin Fetal,,82731,CPT,Facility,Both,,,,400,340,114.64,400,"Health Partners, Inc.",Commercial,378.4,94.6,,percent of total billed charges,,
Fibronectin Fetal,,82731,CPT,Facility,Outpatient,,,,400,340,114.64,400,"Health Partners, Inc.",Medicare Advantage,196,49,,percent of total billed charges,,
Fibronectin Fetal,,82731,CPT,Facility,Inpatient,,,,400,340,114.64,400,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Fibronectin Fetal,,82731,CPT,Facility,Both,,,,400,340,114.64,400,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),240,60,,percent of total billed charges,,
Fibronectin Fetal,,82731,CPT,Facility,Both,,,,400,340,114.64,400,"Health Partners, Inc.",State of Minnesota Advantage Program,326,81.5,,percent of total billed charges,,
Fibronectin Fetal,,82731,CPT,Facility,Both,,,,400,340,114.64,400,"Health Partners, Inc.",State Public Programs,200,50,,percent of total billed charges,,
Fibronectin Fetal,,82731,CPT,Facility,Both,,,,400,340,114.64,400,Humana Insurance Company,Commercial PPO,380,95,,percent of total billed charges,,
Fibronectin Fetal,,82731,CPT,Facility,Outpatient,,,,400,340,114.64,400,Humana Insurance Company,Medicare PPO,196,49,,percent of total billed charges,,
Fibronectin Fetal,,82731,CPT,Facility,Inpatient,,,,400,340,114.64,400,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Fibronectin Fetal,,82731,CPT,Facility,Both,,,,400,340,114.64,400,Medica,Individual & Family,396.4,99.1,,percent of total billed charges,,
Fibronectin Fetal,,82731,CPT,Facility,Outpatient,,,,400,340,114.64,400,Medica,Medica Advantage Solution,199.2,49.8,,percent of total billed charges,,
Fibronectin Fetal,,82731,CPT,Facility,Inpatient,,,,400,340,114.64,400,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Fibronectin Fetal,,82731,CPT,Facility,Outpatient,,,,400,340,114.64,400,Medica,Medical Assistance,178.4,44.6,,percent of total billed charges,,
Fibronectin Fetal,,82731,CPT,Facility,Inpatient,,,,400,340,114.64,400,Medica,Medical Assistance,,,,,Included in per diem rate,
Fibronectin Fetal,,82731,CPT,Facility,Outpatient,,,,400,340,114.64,400,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,199.2,49.8,,percent of total billed charges,,
Fibronectin Fetal,,82731,CPT,Facility,Inpatient,,,,400,340,114.64,400,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Fibronectin Fetal,,82731,CPT,Facility,Both,,,,400,340,114.64,400,"Multiplan, Inc.","Multiplan, Inc.",376,94,,percent of total billed charges,,
Fibronectin Fetal,,82731,CPT,Facility,Outpatient,,,,400,340,114.64,400,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,345.6,86.4,,percent of total billed charges,,
Fibronectin Fetal,,82731,CPT,Facility,Inpatient,,,,400,340,114.64,400,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Fibronectin Fetal,,82731,CPT,Facility,Both,,,,400,340,114.64,400,"Preferred One Administrative Services, INC.",PPO,394.4,98.6,,percent of total billed charges,,
Fibronectin Fetal,,82731,CPT,Facility,Outpatient,,,,400,340,114.64,400,PrimeWest Health,Minnesota Senior Health Options (MSHO),205.8,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Fibronectin Fetal,,82731,CPT,Facility,Inpatient,,,,400,340,114.64,400,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Fibronectin Fetal,,82731,CPT,Facility,Outpatient,,,,400,340,114.64,400,PrimeWest Health,MinnesotaCare,205.44,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Fibronectin Fetal,,82731,CPT,Facility,Inpatient,,,,400,340,114.64,400,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Fibronectin Fetal,,82731,CPT,Facility,Both,,,,400,340,114.64,400,Sanford Health Plan,Sanford Health Plan,368,92,,percent of total billed charges,,
Fibronectin Fetal,,82731,CPT,Facility,Outpatient,,,,400,340,114.64,400,"UCare Health, Inc.",Individual & Family Plan,225.4,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Fibronectin Fetal,,82731,CPT,Facility,Inpatient,,,,400,340,114.64,400,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Fibronectin Fetal,,82731,CPT,Facility,Outpatient,,,,400,340,114.64,400,"UCare Health, Inc.",Medical Assistance,201.88,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Fibronectin Fetal,,82731,CPT,Facility,Inpatient,,,,400,340,114.64,400,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Fibronectin Fetal,,82731,CPT,Facility,Outpatient,,,,400,340,114.64,400,"UCare Health, Inc.",Medicare Advantage,201.88,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Fibronectin Fetal,,82731,CPT,Facility,Inpatient,,,,400,340,114.64,400,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Fibronectin Fetal,,82731,CPT,Facility,Outpatient,,,,400,340,114.64,400,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),201.88,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Fibronectin Fetal,,82731,CPT,Facility,Inpatient,,,,400,340,114.64,400,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Fibronectin Fetal,,82731,CPT,Facility,Both,,,,400,340,114.64,400,UnitedHealthcare,Individual & Family,376,94,,percent of total billed charges,,
Fibronectin Fetal,,82731,CPT,Facility,Outpatient,,,,400,340,114.64,400,UnitedHealthcare,Medicare Advantage,196,49,,percent of total billed charges,,
Fibronectin Fetal,,82731,CPT,Facility,Inpatient,,,,400,340,114.64,400,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Fibronectin Fetal,,82731,CPT,Facility,Outpatient,,,,400,340,114.64,400,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,192,48,,percent of total billed charges,,100% of DHS outpatient percentage
Fibronectin Fetal,,82731,CPT,Facility,Inpatient,,,,400,340,114.64,400,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Folate,,82746,CPT,Facility,Both,,,,79,67.15,22.6414,79,Aetna,Commercial,72.68,92,,percent of total billed charges,,
Folate,,82746,CPT,Facility,Outpatient,,,,79,67.15,22.6414,79,Aetna,Medicare Advantage,38.71,49,,percent of total billed charges,,
Folate,,82746,CPT,Facility,Inpatient,,,,79,67.15,22.6414,79,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Folate,,82746,CPT,Facility,Both,,,,79,67.15,22.6414,79,Aetna,PPO,73.47,93,,percent of total billed charges,,
Folate,,82746,CPT,Facility,Both,,,,79,67.15,22.6414,79,America's PPO,America's PPO,75.8637,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Folate,,82746,CPT,Facility,Both,,,,79,67.15,22.6414,79,BlueCross BlueShield Minnesota, Federal Employee Program,77.736,98.4,,percent of total billed charges,,
Folate,,82746,CPT,Facility,Both,,,,79,67.15,22.6414,79,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,79,100,,percent of total billed charges,,
Folate,,82746,CPT,Facility,Both,,,,79,67.15,22.6414,79,BlueCross BlueShield Minnesota,High Value Network Plan,71.1,90,,percent of total billed charges,,
Folate,,82746,CPT,Facility,Outpatient,,,,79,67.15,22.6414,79,BlueCross BlueShield Minnesota,Medicare Advantage,38.71,49,,percent of total billed charges,,
Folate,,82746,CPT,Facility,Inpatient,,,,79,67.15,22.6414,79,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Folate,,82746,CPT,Facility,Both,,,,79,67.15,22.6414,79,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,69.9703,88.57,,percent of total billed charges,,
Folate,,82746,CPT,Facility,Both,,,,79,67.15,22.6414,79,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,22.6414,28.66,,percent of total billed charges,,
Folate,,82746,CPT,Facility,Outpatient,,,,79,67.15,22.6414,79,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),38.71,49,,percent of total billed charges,,
Folate,,82746,CPT,Facility,Inpatient,,,,79,67.15,22.6414,79,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Folate,,82746,CPT,Facility,Both,,,,79,67.15,22.6414,79,CorVel,Worker's Compensation,79,100,,percent of total billed charges,,
Folate,,82746,CPT,Facility,Both,,,,79,67.15,22.6414,79,First Health Group Corporation,First Health Network,76.63,97,,percent of total billed charges,,
Folate,,82746,CPT,Facility,Both,,,,79,67.15,22.6414,79,"Health Partners, Inc.",Commercial,74.734,94.6,,percent of total billed charges,,
Folate,,82746,CPT,Facility,Outpatient,,,,79,67.15,22.6414,79,"Health Partners, Inc.",Medicare Advantage,38.71,49,,percent of total billed charges,,
Folate,,82746,CPT,Facility,Inpatient,,,,79,67.15,22.6414,79,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Folate,,82746,CPT,Facility,Both,,,,79,67.15,22.6414,79,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),47.4,60,,percent of total billed charges,,
Folate,,82746,CPT,Facility,Both,,,,79,67.15,22.6414,79,"Health Partners, Inc.",State of Minnesota Advantage Program,64.385,81.5,,percent of total billed charges,,
Folate,,82746,CPT,Facility,Both,,,,79,67.15,22.6414,79,"Health Partners, Inc.",State Public Programs,39.5,50,,percent of total billed charges,,
Folate,,82746,CPT,Facility,Both,,,,79,67.15,22.6414,79,Humana Insurance Company,Commercial PPO,75.05,95,,percent of total billed charges,,
Folate,,82746,CPT,Facility,Outpatient,,,,79,67.15,22.6414,79,Humana Insurance Company,Medicare PPO,38.71,49,,percent of total billed charges,,
Folate,,82746,CPT,Facility,Inpatient,,,,79,67.15,22.6414,79,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Folate,,82746,CPT,Facility,Both,,,,79,67.15,22.6414,79,Medica,Individual & Family,78.289,99.1,,percent of total billed charges,,
Folate,,82746,CPT,Facility,Outpatient,,,,79,67.15,22.6414,79,Medica,Medica Advantage Solution,39.342,49.8,,percent of total billed charges,,
Folate,,82746,CPT,Facility,Inpatient,,,,79,67.15,22.6414,79,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Folate,,82746,CPT,Facility,Outpatient,,,,79,67.15,22.6414,79,Medica,Medical Assistance,35.234,44.6,,percent of total billed charges,,
Folate,,82746,CPT,Facility,Inpatient,,,,79,67.15,22.6414,79,Medica,Medical Assistance,,,,,Included in per diem rate,
Folate,,82746,CPT,Facility,Outpatient,,,,79,67.15,22.6414,79,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,39.342,49.8,,percent of total billed charges,,
Folate,,82746,CPT,Facility,Inpatient,,,,79,67.15,22.6414,79,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Folate,,82746,CPT,Facility,Both,,,,79,67.15,22.6414,79,"Multiplan, Inc.","Multiplan, Inc.",74.26,94,,percent of total billed charges,,
Folate,,82746,CPT,Facility,Outpatient,,,,79,67.15,22.6414,79,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,68.256,86.4,,percent of total billed charges,,
Folate,,82746,CPT,Facility,Inpatient,,,,79,67.15,22.6414,79,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Folate,,82746,CPT,Facility,Both,,,,79,67.15,22.6414,79,"Preferred One Administrative Services, INC.",PPO,77.894,98.6,,percent of total billed charges,,
Folate,,82746,CPT,Facility,Outpatient,,,,79,67.15,22.6414,79,PrimeWest Health,Minnesota Senior Health Options (MSHO),40.6455,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Folate,,82746,CPT,Facility,Inpatient,,,,79,67.15,22.6414,79,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Folate,,82746,CPT,Facility,Outpatient,,,,79,67.15,22.6414,79,PrimeWest Health,MinnesotaCare,40.5744,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Folate,,82746,CPT,Facility,Inpatient,,,,79,67.15,22.6414,79,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Folate,,82746,CPT,Facility,Both,,,,79,67.15,22.6414,79,Sanford Health Plan,Sanford Health Plan,72.68,92,,percent of total billed charges,,
Folate,,82746,CPT,Facility,Outpatient,,,,79,67.15,22.6414,79,"UCare Health, Inc.",Individual & Family Plan,44.5165,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Folate,,82746,CPT,Facility,Inpatient,,,,79,67.15,22.6414,79,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Folate,,82746,CPT,Facility,Outpatient,,,,79,67.15,22.6414,79,"UCare Health, Inc.",Medical Assistance,39.8713,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Folate,,82746,CPT,Facility,Inpatient,,,,79,67.15,22.6414,79,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Folate,,82746,CPT,Facility,Outpatient,,,,79,67.15,22.6414,79,"UCare Health, Inc.",Medicare Advantage,39.8713,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Folate,,82746,CPT,Facility,Inpatient,,,,79,67.15,22.6414,79,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Folate,,82746,CPT,Facility,Outpatient,,,,79,67.15,22.6414,79,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),39.8713,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Folate,,82746,CPT,Facility,Inpatient,,,,79,67.15,22.6414,79,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Folate,,82746,CPT,Facility,Both,,,,79,67.15,22.6414,79,UnitedHealthcare,Individual & Family,74.26,94,,percent of total billed charges,,
Folate,,82746,CPT,Facility,Outpatient,,,,79,67.15,22.6414,79,UnitedHealthcare,Medicare Advantage,38.71,49,,percent of total billed charges,,
Folate,,82746,CPT,Facility,Inpatient,,,,79,67.15,22.6414,79,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Folate,,82746,CPT,Facility,Outpatient,,,,79,67.15,22.6414,79,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,37.92,48,,percent of total billed charges,,100% of DHS outpatient percentage
Folate,,82746,CPT,Facility,Inpatient,,,,79,67.15,22.6414,79,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Iga,,82784,CPT,Facility,Both,,,,56,47.6,16.0496,56,Aetna,Commercial,51.52,92,,percent of total billed charges,,
Iga,,82784,CPT,Facility,Outpatient,,,,56,47.6,16.0496,56,Aetna,Medicare Advantage,27.44,49,,percent of total billed charges,,
Iga,,82784,CPT,Facility,Inpatient,,,,56,47.6,16.0496,56,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Iga,,82784,CPT,Facility,Both,,,,56,47.6,16.0496,56,Aetna,PPO,52.08,93,,percent of total billed charges,,
Iga,,82784,CPT,Facility,Both,,,,56,47.6,16.0496,56,America's PPO,America's PPO,53.7768,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Iga,,82784,CPT,Facility,Both,,,,56,47.6,16.0496,56,BlueCross BlueShield Minnesota, Federal Employee Program,55.104,98.4,,percent of total billed charges,,
Iga,,82784,CPT,Facility,Both,,,,56,47.6,16.0496,56,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,56,100,,percent of total billed charges,,
Iga,,82784,CPT,Facility,Both,,,,56,47.6,16.0496,56,BlueCross BlueShield Minnesota,High Value Network Plan,50.4,90,,percent of total billed charges,,
Iga,,82784,CPT,Facility,Outpatient,,,,56,47.6,16.0496,56,BlueCross BlueShield Minnesota,Medicare Advantage,27.44,49,,percent of total billed charges,,
Iga,,82784,CPT,Facility,Inpatient,,,,56,47.6,16.0496,56,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Iga,,82784,CPT,Facility,Both,,,,56,47.6,16.0496,56,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,49.5992,88.57,,percent of total billed charges,,
Iga,,82784,CPT,Facility,Both,,,,56,47.6,16.0496,56,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,16.0496,28.66,,percent of total billed charges,,
Iga,,82784,CPT,Facility,Outpatient,,,,56,47.6,16.0496,56,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),27.44,49,,percent of total billed charges,,
Iga,,82784,CPT,Facility,Inpatient,,,,56,47.6,16.0496,56,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Iga,,82784,CPT,Facility,Both,,,,56,47.6,16.0496,56,CorVel,Worker's Compensation,56,100,,percent of total billed charges,,
Iga,,82784,CPT,Facility,Both,,,,56,47.6,16.0496,56,First Health Group Corporation,First Health Network,54.32,97,,percent of total billed charges,,
Iga,,82784,CPT,Facility,Both,,,,56,47.6,16.0496,56,"Health Partners, Inc.",Commercial,52.976,94.6,,percent of total billed charges,,
Iga,,82784,CPT,Facility,Outpatient,,,,56,47.6,16.0496,56,"Health Partners, Inc.",Medicare Advantage,27.44,49,,percent of total billed charges,,
Iga,,82784,CPT,Facility,Inpatient,,,,56,47.6,16.0496,56,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Iga,,82784,CPT,Facility,Both,,,,56,47.6,16.0496,56,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),33.6,60,,percent of total billed charges,,
Iga,,82784,CPT,Facility,Both,,,,56,47.6,16.0496,56,"Health Partners, Inc.",State of Minnesota Advantage Program,45.64,81.5,,percent of total billed charges,,
Iga,,82784,CPT,Facility,Both,,,,56,47.6,16.0496,56,"Health Partners, Inc.",State Public Programs,28,50,,percent of total billed charges,,
Iga,,82784,CPT,Facility,Both,,,,56,47.6,16.0496,56,Humana Insurance Company,Commercial PPO,53.2,95,,percent of total billed charges,,
Iga,,82784,CPT,Facility,Outpatient,,,,56,47.6,16.0496,56,Humana Insurance Company,Medicare PPO,27.44,49,,percent of total billed charges,,
Iga,,82784,CPT,Facility,Inpatient,,,,56,47.6,16.0496,56,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Iga,,82784,CPT,Facility,Both,,,,56,47.6,16.0496,56,Medica,Individual & Family,55.496,99.1,,percent of total billed charges,,
Iga,,82784,CPT,Facility,Outpatient,,,,56,47.6,16.0496,56,Medica,Medica Advantage Solution,27.888,49.8,,percent of total billed charges,,
Iga,,82784,CPT,Facility,Inpatient,,,,56,47.6,16.0496,56,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Iga,,82784,CPT,Facility,Outpatient,,,,56,47.6,16.0496,56,Medica,Medical Assistance,24.976,44.6,,percent of total billed charges,,
Iga,,82784,CPT,Facility,Inpatient,,,,56,47.6,16.0496,56,Medica,Medical Assistance,,,,,Included in per diem rate,
Iga,,82784,CPT,Facility,Outpatient,,,,56,47.6,16.0496,56,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,27.888,49.8,,percent of total billed charges,,
Iga,,82784,CPT,Facility,Inpatient,,,,56,47.6,16.0496,56,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Iga,,82784,CPT,Facility,Both,,,,56,47.6,16.0496,56,"Multiplan, Inc.","Multiplan, Inc.",52.64,94,,percent of total billed charges,,
Iga,,82784,CPT,Facility,Outpatient,,,,56,47.6,16.0496,56,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,48.384,86.4,,percent of total billed charges,,
Iga,,82784,CPT,Facility,Inpatient,,,,56,47.6,16.0496,56,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Iga,,82784,CPT,Facility,Both,,,,56,47.6,16.0496,56,"Preferred One Administrative Services, INC.",PPO,55.216,98.6,,percent of total billed charges,,
Iga,,82784,CPT,Facility,Outpatient,,,,56,47.6,16.0496,56,PrimeWest Health,Minnesota Senior Health Options (MSHO),28.812,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Iga,,82784,CPT,Facility,Inpatient,,,,56,47.6,16.0496,56,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Iga,,82784,CPT,Facility,Outpatient,,,,56,47.6,16.0496,56,PrimeWest Health,MinnesotaCare,28.7616,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Iga,,82784,CPT,Facility,Inpatient,,,,56,47.6,16.0496,56,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Iga,,82784,CPT,Facility,Both,,,,56,47.6,16.0496,56,Sanford Health Plan,Sanford Health Plan,51.52,92,,percent of total billed charges,,
Iga,,82784,CPT,Facility,Outpatient,,,,56,47.6,16.0496,56,"UCare Health, Inc.",Individual & Family Plan,31.556,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Iga,,82784,CPT,Facility,Inpatient,,,,56,47.6,16.0496,56,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Iga,,82784,CPT,Facility,Outpatient,,,,56,47.6,16.0496,56,"UCare Health, Inc.",Medical Assistance,28.2632,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Iga,,82784,CPT,Facility,Inpatient,,,,56,47.6,16.0496,56,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Iga,,82784,CPT,Facility,Outpatient,,,,56,47.6,16.0496,56,"UCare Health, Inc.",Medicare Advantage,28.2632,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Iga,,82784,CPT,Facility,Inpatient,,,,56,47.6,16.0496,56,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Iga,,82784,CPT,Facility,Outpatient,,,,56,47.6,16.0496,56,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),28.2632,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Iga,,82784,CPT,Facility,Inpatient,,,,56,47.6,16.0496,56,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Iga,,82784,CPT,Facility,Both,,,,56,47.6,16.0496,56,UnitedHealthcare,Individual & Family,52.64,94,,percent of total billed charges,,
Iga,,82784,CPT,Facility,Outpatient,,,,56,47.6,16.0496,56,UnitedHealthcare,Medicare Advantage,27.44,49,,percent of total billed charges,,
Iga,,82784,CPT,Facility,Inpatient,,,,56,47.6,16.0496,56,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Iga,,82784,CPT,Facility,Outpatient,,,,56,47.6,16.0496,56,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,26.88,48,,percent of total billed charges,,100% of DHS outpatient percentage
Iga,,82784,CPT,Facility,Inpatient,,,,56,47.6,16.0496,56,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Igg,,82784,CPT,Facility,Both,,,,66,56.1,18.9156,66,Aetna,Commercial,60.72,92,,percent of total billed charges,,
Igg,,82784,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,Aetna,Medicare Advantage,32.34,49,,percent of total billed charges,,
Igg,,82784,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Igg,,82784,CPT,Facility,Both,,,,66,56.1,18.9156,66,Aetna,PPO,61.38,93,,percent of total billed charges,,
Igg,,82784,CPT,Facility,Both,,,,66,56.1,18.9156,66,America's PPO,America's PPO,63.3798,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Igg,,82784,CPT,Facility,Both,,,,66,56.1,18.9156,66,BlueCross BlueShield Minnesota, Federal Employee Program,64.944,98.4,,percent of total billed charges,,
Igg,,82784,CPT,Facility,Both,,,,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,66,100,,percent of total billed charges,,
Igg,,82784,CPT,Facility,Both,,,,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,High Value Network Plan,59.4,90,,percent of total billed charges,,
Igg,,82784,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,Medicare Advantage,32.34,49,,percent of total billed charges,,
Igg,,82784,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Igg,,82784,CPT,Facility,Both,,,,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,58.4562,88.57,,percent of total billed charges,,
Igg,,82784,CPT,Facility,Both,,,,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,18.9156,28.66,,percent of total billed charges,,
Igg,,82784,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),32.34,49,,percent of total billed charges,,
Igg,,82784,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Igg,,82784,CPT,Facility,Both,,,,66,56.1,18.9156,66,CorVel,Worker's Compensation,66,100,,percent of total billed charges,,
Igg,,82784,CPT,Facility,Both,,,,66,56.1,18.9156,66,First Health Group Corporation,First Health Network,64.02,97,,percent of total billed charges,,
Igg,,82784,CPT,Facility,Both,,,,66,56.1,18.9156,66,"Health Partners, Inc.",Commercial,62.436,94.6,,percent of total billed charges,,
Igg,,82784,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,"Health Partners, Inc.",Medicare Advantage,32.34,49,,percent of total billed charges,,
Igg,,82784,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Igg,,82784,CPT,Facility,Both,,,,66,56.1,18.9156,66,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),39.6,60,,percent of total billed charges,,
Igg,,82784,CPT,Facility,Both,,,,66,56.1,18.9156,66,"Health Partners, Inc.",State of Minnesota Advantage Program,53.79,81.5,,percent of total billed charges,,
Igg,,82784,CPT,Facility,Both,,,,66,56.1,18.9156,66,"Health Partners, Inc.",State Public Programs,33,50,,percent of total billed charges,,
Igg,,82784,CPT,Facility,Both,,,,66,56.1,18.9156,66,Humana Insurance Company,Commercial PPO,62.7,95,,percent of total billed charges,,
Igg,,82784,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,Humana Insurance Company,Medicare PPO,32.34,49,,percent of total billed charges,,
Igg,,82784,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Igg,,82784,CPT,Facility,Both,,,,66,56.1,18.9156,66,Medica,Individual & Family,65.406,99.1,,percent of total billed charges,,
Igg,,82784,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,Medica,Medica Advantage Solution,32.868,49.8,,percent of total billed charges,,
Igg,,82784,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Igg,,82784,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,Medica,Medical Assistance,29.436,44.6,,percent of total billed charges,,
Igg,,82784,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,Medica,Medical Assistance,,,,,Included in per diem rate,
Igg,,82784,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,32.868,49.8,,percent of total billed charges,,
Igg,,82784,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Igg,,82784,CPT,Facility,Both,,,,66,56.1,18.9156,66,"Multiplan, Inc.","Multiplan, Inc.",62.04,94,,percent of total billed charges,,
Igg,,82784,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,57.024,86.4,,percent of total billed charges,,
Igg,,82784,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Igg,,82784,CPT,Facility,Both,,,,66,56.1,18.9156,66,"Preferred One Administrative Services, INC.",PPO,65.076,98.6,,percent of total billed charges,,
Igg,,82784,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,PrimeWest Health,Minnesota Senior Health Options (MSHO),33.957,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Igg,,82784,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Igg,,82784,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,PrimeWest Health,MinnesotaCare,33.8976,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Igg,,82784,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Igg,,82784,CPT,Facility,Both,,,,66,56.1,18.9156,66,Sanford Health Plan,Sanford Health Plan,60.72,92,,percent of total billed charges,,
Igg,,82784,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,"UCare Health, Inc.",Individual & Family Plan,37.191,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Igg,,82784,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Igg,,82784,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,"UCare Health, Inc.",Medical Assistance,33.3102,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Igg,,82784,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Igg,,82784,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,"UCare Health, Inc.",Medicare Advantage,33.3102,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Igg,,82784,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Igg,,82784,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),33.3102,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Igg,,82784,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Igg,,82784,CPT,Facility,Both,,,,66,56.1,18.9156,66,UnitedHealthcare,Individual & Family,62.04,94,,percent of total billed charges,,
Igg,,82784,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,UnitedHealthcare,Medicare Advantage,32.34,49,,percent of total billed charges,,
Igg,,82784,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Igg,,82784,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,31.68,48,,percent of total billed charges,,100% of DHS outpatient percentage
Igg,,82784,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Igm,,82784,CPT,Facility,Both,,,,66,56.1,18.9156,66,Aetna,Commercial,60.72,92,,percent of total billed charges,,
Igm,,82784,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,Aetna,Medicare Advantage,32.34,49,,percent of total billed charges,,
Igm,,82784,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Igm,,82784,CPT,Facility,Both,,,,66,56.1,18.9156,66,Aetna,PPO,61.38,93,,percent of total billed charges,,
Igm,,82784,CPT,Facility,Both,,,,66,56.1,18.9156,66,America's PPO,America's PPO,63.3798,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Igm,,82784,CPT,Facility,Both,,,,66,56.1,18.9156,66,BlueCross BlueShield Minnesota, Federal Employee Program,64.944,98.4,,percent of total billed charges,,
Igm,,82784,CPT,Facility,Both,,,,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,66,100,,percent of total billed charges,,
Igm,,82784,CPT,Facility,Both,,,,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,High Value Network Plan,59.4,90,,percent of total billed charges,,
Igm,,82784,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,Medicare Advantage,32.34,49,,percent of total billed charges,,
Igm,,82784,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Igm,,82784,CPT,Facility,Both,,,,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,58.4562,88.57,,percent of total billed charges,,
Igm,,82784,CPT,Facility,Both,,,,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,18.9156,28.66,,percent of total billed charges,,
Igm,,82784,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),32.34,49,,percent of total billed charges,,
Igm,,82784,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Igm,,82784,CPT,Facility,Both,,,,66,56.1,18.9156,66,CorVel,Worker's Compensation,66,100,,percent of total billed charges,,
Igm,,82784,CPT,Facility,Both,,,,66,56.1,18.9156,66,First Health Group Corporation,First Health Network,64.02,97,,percent of total billed charges,,
Igm,,82784,CPT,Facility,Both,,,,66,56.1,18.9156,66,"Health Partners, Inc.",Commercial,62.436,94.6,,percent of total billed charges,,
Igm,,82784,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,"Health Partners, Inc.",Medicare Advantage,32.34,49,,percent of total billed charges,,
Igm,,82784,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Igm,,82784,CPT,Facility,Both,,,,66,56.1,18.9156,66,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),39.6,60,,percent of total billed charges,,
Igm,,82784,CPT,Facility,Both,,,,66,56.1,18.9156,66,"Health Partners, Inc.",State of Minnesota Advantage Program,53.79,81.5,,percent of total billed charges,,
Igm,,82784,CPT,Facility,Both,,,,66,56.1,18.9156,66,"Health Partners, Inc.",State Public Programs,33,50,,percent of total billed charges,,
Igm,,82784,CPT,Facility,Both,,,,66,56.1,18.9156,66,Humana Insurance Company,Commercial PPO,62.7,95,,percent of total billed charges,,
Igm,,82784,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,Humana Insurance Company,Medicare PPO,32.34,49,,percent of total billed charges,,
Igm,,82784,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Igm,,82784,CPT,Facility,Both,,,,66,56.1,18.9156,66,Medica,Individual & Family,65.406,99.1,,percent of total billed charges,,
Igm,,82784,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,Medica,Medica Advantage Solution,32.868,49.8,,percent of total billed charges,,
Igm,,82784,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Igm,,82784,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,Medica,Medical Assistance,29.436,44.6,,percent of total billed charges,,
Igm,,82784,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,Medica,Medical Assistance,,,,,Included in per diem rate,
Igm,,82784,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,32.868,49.8,,percent of total billed charges,,
Igm,,82784,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Igm,,82784,CPT,Facility,Both,,,,66,56.1,18.9156,66,"Multiplan, Inc.","Multiplan, Inc.",62.04,94,,percent of total billed charges,,
Igm,,82784,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,57.024,86.4,,percent of total billed charges,,
Igm,,82784,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Igm,,82784,CPT,Facility,Both,,,,66,56.1,18.9156,66,"Preferred One Administrative Services, INC.",PPO,65.076,98.6,,percent of total billed charges,,
Igm,,82784,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,PrimeWest Health,Minnesota Senior Health Options (MSHO),33.957,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Igm,,82784,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Igm,,82784,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,PrimeWest Health,MinnesotaCare,33.8976,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Igm,,82784,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Igm,,82784,CPT,Facility,Both,,,,66,56.1,18.9156,66,Sanford Health Plan,Sanford Health Plan,60.72,92,,percent of total billed charges,,
Igm,,82784,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,"UCare Health, Inc.",Individual & Family Plan,37.191,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Igm,,82784,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Igm,,82784,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,"UCare Health, Inc.",Medical Assistance,33.3102,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Igm,,82784,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Igm,,82784,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,"UCare Health, Inc.",Medicare Advantage,33.3102,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Igm,,82784,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Igm,,82784,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),33.3102,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Igm,,82784,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Igm,,82784,CPT,Facility,Both,,,,66,56.1,18.9156,66,UnitedHealthcare,Individual & Family,62.04,94,,percent of total billed charges,,
Igm,,82784,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,UnitedHealthcare,Medicare Advantage,32.34,49,,percent of total billed charges,,
Igm,,82784,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Igm,,82784,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,31.68,48,,percent of total billed charges,,100% of DHS outpatient percentage
Igm,,82784,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Immunoglobin Panel,,82784,CPT,Facility,Both,,,,44,37.4,12.6104,44,Aetna,Commercial,40.48,92,,percent of total billed charges,,
Immunoglobin Panel,,82784,CPT,Facility,Outpatient,,,,44,37.4,12.6104,44,Aetna,Medicare Advantage,21.56,49,,percent of total billed charges,,
Immunoglobin Panel,,82784,CPT,Facility,Inpatient,,,,44,37.4,12.6104,44,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Immunoglobin Panel,,82784,CPT,Facility,Both,,,,44,37.4,12.6104,44,Aetna,PPO,40.92,93,,percent of total billed charges,,
Immunoglobin Panel,,82784,CPT,Facility,Both,,,,44,37.4,12.6104,44,America's PPO,America's PPO,42.2532,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Immunoglobin Panel,,82784,CPT,Facility,Both,,,,44,37.4,12.6104,44,BlueCross BlueShield Minnesota, Federal Employee Program,43.296,98.4,,percent of total billed charges,,
Immunoglobin Panel,,82784,CPT,Facility,Both,,,,44,37.4,12.6104,44,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,44,100,,percent of total billed charges,,
Immunoglobin Panel,,82784,CPT,Facility,Both,,,,44,37.4,12.6104,44,BlueCross BlueShield Minnesota,High Value Network Plan,39.6,90,,percent of total billed charges,,
Immunoglobin Panel,,82784,CPT,Facility,Outpatient,,,,44,37.4,12.6104,44,BlueCross BlueShield Minnesota,Medicare Advantage,21.56,49,,percent of total billed charges,,
Immunoglobin Panel,,82784,CPT,Facility,Inpatient,,,,44,37.4,12.6104,44,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Immunoglobin Panel,,82784,CPT,Facility,Both,,,,44,37.4,12.6104,44,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,38.9708,88.57,,percent of total billed charges,,
Immunoglobin Panel,,82784,CPT,Facility,Both,,,,44,37.4,12.6104,44,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,12.6104,28.66,,percent of total billed charges,,
Immunoglobin Panel,,82784,CPT,Facility,Outpatient,,,,44,37.4,12.6104,44,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),21.56,49,,percent of total billed charges,,
Immunoglobin Panel,,82784,CPT,Facility,Inpatient,,,,44,37.4,12.6104,44,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Immunoglobin Panel,,82784,CPT,Facility,Both,,,,44,37.4,12.6104,44,CorVel,Worker's Compensation,44,100,,percent of total billed charges,,
Immunoglobin Panel,,82784,CPT,Facility,Both,,,,44,37.4,12.6104,44,First Health Group Corporation,First Health Network,42.68,97,,percent of total billed charges,,
Immunoglobin Panel,,82784,CPT,Facility,Both,,,,44,37.4,12.6104,44,"Health Partners, Inc.",Commercial,41.624,94.6,,percent of total billed charges,,
Immunoglobin Panel,,82784,CPT,Facility,Outpatient,,,,44,37.4,12.6104,44,"Health Partners, Inc.",Medicare Advantage,21.56,49,,percent of total billed charges,,
Immunoglobin Panel,,82784,CPT,Facility,Inpatient,,,,44,37.4,12.6104,44,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Immunoglobin Panel,,82784,CPT,Facility,Both,,,,44,37.4,12.6104,44,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),26.4,60,,percent of total billed charges,,
Immunoglobin Panel,,82784,CPT,Facility,Both,,,,44,37.4,12.6104,44,"Health Partners, Inc.",State of Minnesota Advantage Program,35.86,81.5,,percent of total billed charges,,
Immunoglobin Panel,,82784,CPT,Facility,Both,,,,44,37.4,12.6104,44,"Health Partners, Inc.",State Public Programs,22,50,,percent of total billed charges,,
Immunoglobin Panel,,82784,CPT,Facility,Both,,,,44,37.4,12.6104,44,Humana Insurance Company,Commercial PPO,41.8,95,,percent of total billed charges,,
Immunoglobin Panel,,82784,CPT,Facility,Outpatient,,,,44,37.4,12.6104,44,Humana Insurance Company,Medicare PPO,21.56,49,,percent of total billed charges,,
Immunoglobin Panel,,82784,CPT,Facility,Inpatient,,,,44,37.4,12.6104,44,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Immunoglobin Panel,,82784,CPT,Facility,Both,,,,44,37.4,12.6104,44,Medica,Individual & Family,43.604,99.1,,percent of total billed charges,,
Immunoglobin Panel,,82784,CPT,Facility,Outpatient,,,,44,37.4,12.6104,44,Medica,Medica Advantage Solution,21.912,49.8,,percent of total billed charges,,
Immunoglobin Panel,,82784,CPT,Facility,Inpatient,,,,44,37.4,12.6104,44,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Immunoglobin Panel,,82784,CPT,Facility,Outpatient,,,,44,37.4,12.6104,44,Medica,Medical Assistance,19.624,44.6,,percent of total billed charges,,
Immunoglobin Panel,,82784,CPT,Facility,Inpatient,,,,44,37.4,12.6104,44,Medica,Medical Assistance,,,,,Included in per diem rate,
Immunoglobin Panel,,82784,CPT,Facility,Outpatient,,,,44,37.4,12.6104,44,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,21.912,49.8,,percent of total billed charges,,
Immunoglobin Panel,,82784,CPT,Facility,Inpatient,,,,44,37.4,12.6104,44,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Immunoglobin Panel,,82784,CPT,Facility,Both,,,,44,37.4,12.6104,44,"Multiplan, Inc.","Multiplan, Inc.",41.36,94,,percent of total billed charges,,
Immunoglobin Panel,,82784,CPT,Facility,Outpatient,,,,44,37.4,12.6104,44,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,38.016,86.4,,percent of total billed charges,,
Immunoglobin Panel,,82784,CPT,Facility,Inpatient,,,,44,37.4,12.6104,44,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Immunoglobin Panel,,82784,CPT,Facility,Both,,,,44,37.4,12.6104,44,"Preferred One Administrative Services, INC.",PPO,43.384,98.6,,percent of total billed charges,,
Immunoglobin Panel,,82784,CPT,Facility,Outpatient,,,,44,37.4,12.6104,44,PrimeWest Health,Minnesota Senior Health Options (MSHO),22.638,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Immunoglobin Panel,,82784,CPT,Facility,Inpatient,,,,44,37.4,12.6104,44,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Immunoglobin Panel,,82784,CPT,Facility,Outpatient,,,,44,37.4,12.6104,44,PrimeWest Health,MinnesotaCare,22.5984,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Immunoglobin Panel,,82784,CPT,Facility,Inpatient,,,,44,37.4,12.6104,44,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Immunoglobin Panel,,82784,CPT,Facility,Both,,,,44,37.4,12.6104,44,Sanford Health Plan,Sanford Health Plan,40.48,92,,percent of total billed charges,,
Immunoglobin Panel,,82784,CPT,Facility,Outpatient,,,,44,37.4,12.6104,44,"UCare Health, Inc.",Individual & Family Plan,24.794,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Immunoglobin Panel,,82784,CPT,Facility,Inpatient,,,,44,37.4,12.6104,44,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Immunoglobin Panel,,82784,CPT,Facility,Outpatient,,,,44,37.4,12.6104,44,"UCare Health, Inc.",Medical Assistance,22.2068,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Immunoglobin Panel,,82784,CPT,Facility,Inpatient,,,,44,37.4,12.6104,44,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Immunoglobin Panel,,82784,CPT,Facility,Outpatient,,,,44,37.4,12.6104,44,"UCare Health, Inc.",Medicare Advantage,22.2068,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Immunoglobin Panel,,82784,CPT,Facility,Inpatient,,,,44,37.4,12.6104,44,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Immunoglobin Panel,,82784,CPT,Facility,Outpatient,,,,44,37.4,12.6104,44,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),22.2068,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Immunoglobin Panel,,82784,CPT,Facility,Inpatient,,,,44,37.4,12.6104,44,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Immunoglobin Panel,,82784,CPT,Facility,Both,,,,44,37.4,12.6104,44,UnitedHealthcare,Individual & Family,41.36,94,,percent of total billed charges,,
Immunoglobin Panel,,82784,CPT,Facility,Outpatient,,,,44,37.4,12.6104,44,UnitedHealthcare,Medicare Advantage,21.56,49,,percent of total billed charges,,
Immunoglobin Panel,,82784,CPT,Facility,Inpatient,,,,44,37.4,12.6104,44,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Immunoglobin Panel,,82784,CPT,Facility,Outpatient,,,,44,37.4,12.6104,44,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,21.12,48,,percent of total billed charges,,100% of DHS outpatient percentage
Immunoglobin Panel,,82784,CPT,Facility,Inpatient,,,,44,37.4,12.6104,44,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Immunoglobulin E,,82785,CPT,Facility,Both,,,,63,53.55,18.0558,63,Aetna,Commercial,57.96,92,,percent of total billed charges,,
Immunoglobulin E,,82785,CPT,Facility,Outpatient,,,,63,53.55,18.0558,63,Aetna,Medicare Advantage,30.87,49,,percent of total billed charges,,
Immunoglobulin E,,82785,CPT,Facility,Inpatient,,,,63,53.55,18.0558,63,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Immunoglobulin E,,82785,CPT,Facility,Both,,,,63,53.55,18.0558,63,Aetna,PPO,58.59,93,,percent of total billed charges,,
Immunoglobulin E,,82785,CPT,Facility,Both,,,,63,53.55,18.0558,63,America's PPO,America's PPO,60.4989,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Immunoglobulin E,,82785,CPT,Facility,Both,,,,63,53.55,18.0558,63,BlueCross BlueShield Minnesota, Federal Employee Program,61.992,98.4,,percent of total billed charges,,
Immunoglobulin E,,82785,CPT,Facility,Both,,,,63,53.55,18.0558,63,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,63,100,,percent of total billed charges,,
Immunoglobulin E,,82785,CPT,Facility,Both,,,,63,53.55,18.0558,63,BlueCross BlueShield Minnesota,High Value Network Plan,56.7,90,,percent of total billed charges,,
Immunoglobulin E,,82785,CPT,Facility,Outpatient,,,,63,53.55,18.0558,63,BlueCross BlueShield Minnesota,Medicare Advantage,30.87,49,,percent of total billed charges,,
Immunoglobulin E,,82785,CPT,Facility,Inpatient,,,,63,53.55,18.0558,63,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Immunoglobulin E,,82785,CPT,Facility,Both,,,,63,53.55,18.0558,63,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,55.7991,88.57,,percent of total billed charges,,
Immunoglobulin E,,82785,CPT,Facility,Both,,,,63,53.55,18.0558,63,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,18.0558,28.66,,percent of total billed charges,,
Immunoglobulin E,,82785,CPT,Facility,Outpatient,,,,63,53.55,18.0558,63,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),30.87,49,,percent of total billed charges,,
Immunoglobulin E,,82785,CPT,Facility,Inpatient,,,,63,53.55,18.0558,63,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Immunoglobulin E,,82785,CPT,Facility,Both,,,,63,53.55,18.0558,63,CorVel,Worker's Compensation,63,100,,percent of total billed charges,,
Immunoglobulin E,,82785,CPT,Facility,Both,,,,63,53.55,18.0558,63,First Health Group Corporation,First Health Network,61.11,97,,percent of total billed charges,,
Immunoglobulin E,,82785,CPT,Facility,Both,,,,63,53.55,18.0558,63,"Health Partners, Inc.",Commercial,59.598,94.6,,percent of total billed charges,,
Immunoglobulin E,,82785,CPT,Facility,Outpatient,,,,63,53.55,18.0558,63,"Health Partners, Inc.",Medicare Advantage,30.87,49,,percent of total billed charges,,
Immunoglobulin E,,82785,CPT,Facility,Inpatient,,,,63,53.55,18.0558,63,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Immunoglobulin E,,82785,CPT,Facility,Both,,,,63,53.55,18.0558,63,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),37.8,60,,percent of total billed charges,,
Immunoglobulin E,,82785,CPT,Facility,Both,,,,63,53.55,18.0558,63,"Health Partners, Inc.",State of Minnesota Advantage Program,51.345,81.5,,percent of total billed charges,,
Immunoglobulin E,,82785,CPT,Facility,Both,,,,63,53.55,18.0558,63,"Health Partners, Inc.",State Public Programs,31.5,50,,percent of total billed charges,,
Immunoglobulin E,,82785,CPT,Facility,Both,,,,63,53.55,18.0558,63,Humana Insurance Company,Commercial PPO,59.85,95,,percent of total billed charges,,
Immunoglobulin E,,82785,CPT,Facility,Outpatient,,,,63,53.55,18.0558,63,Humana Insurance Company,Medicare PPO,30.87,49,,percent of total billed charges,,
Immunoglobulin E,,82785,CPT,Facility,Inpatient,,,,63,53.55,18.0558,63,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Immunoglobulin E,,82785,CPT,Facility,Both,,,,63,53.55,18.0558,63,Medica,Individual & Family,62.433,99.1,,percent of total billed charges,,
Immunoglobulin E,,82785,CPT,Facility,Outpatient,,,,63,53.55,18.0558,63,Medica,Medica Advantage Solution,31.374,49.8,,percent of total billed charges,,
Immunoglobulin E,,82785,CPT,Facility,Inpatient,,,,63,53.55,18.0558,63,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Immunoglobulin E,,82785,CPT,Facility,Outpatient,,,,63,53.55,18.0558,63,Medica,Medical Assistance,28.098,44.6,,percent of total billed charges,,
Immunoglobulin E,,82785,CPT,Facility,Inpatient,,,,63,53.55,18.0558,63,Medica,Medical Assistance,,,,,Included in per diem rate,
Immunoglobulin E,,82785,CPT,Facility,Outpatient,,,,63,53.55,18.0558,63,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,31.374,49.8,,percent of total billed charges,,
Immunoglobulin E,,82785,CPT,Facility,Inpatient,,,,63,53.55,18.0558,63,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Immunoglobulin E,,82785,CPT,Facility,Both,,,,63,53.55,18.0558,63,"Multiplan, Inc.","Multiplan, Inc.",59.22,94,,percent of total billed charges,,
Immunoglobulin E,,82785,CPT,Facility,Outpatient,,,,63,53.55,18.0558,63,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,54.432,86.4,,percent of total billed charges,,
Immunoglobulin E,,82785,CPT,Facility,Inpatient,,,,63,53.55,18.0558,63,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Immunoglobulin E,,82785,CPT,Facility,Both,,,,63,53.55,18.0558,63,"Preferred One Administrative Services, INC.",PPO,62.118,98.6,,percent of total billed charges,,
Immunoglobulin E,,82785,CPT,Facility,Outpatient,,,,63,53.55,18.0558,63,PrimeWest Health,Minnesota Senior Health Options (MSHO),32.4135,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Immunoglobulin E,,82785,CPT,Facility,Inpatient,,,,63,53.55,18.0558,63,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Immunoglobulin E,,82785,CPT,Facility,Outpatient,,,,63,53.55,18.0558,63,PrimeWest Health,MinnesotaCare,32.3568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Immunoglobulin E,,82785,CPT,Facility,Inpatient,,,,63,53.55,18.0558,63,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Immunoglobulin E,,82785,CPT,Facility,Both,,,,63,53.55,18.0558,63,Sanford Health Plan,Sanford Health Plan,57.96,92,,percent of total billed charges,,
Immunoglobulin E,,82785,CPT,Facility,Outpatient,,,,63,53.55,18.0558,63,"UCare Health, Inc.",Individual & Family Plan,35.5005,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Immunoglobulin E,,82785,CPT,Facility,Inpatient,,,,63,53.55,18.0558,63,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Immunoglobulin E,,82785,CPT,Facility,Outpatient,,,,63,53.55,18.0558,63,"UCare Health, Inc.",Medical Assistance,31.7961,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Immunoglobulin E,,82785,CPT,Facility,Inpatient,,,,63,53.55,18.0558,63,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Immunoglobulin E,,82785,CPT,Facility,Outpatient,,,,63,53.55,18.0558,63,"UCare Health, Inc.",Medicare Advantage,31.7961,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Immunoglobulin E,,82785,CPT,Facility,Inpatient,,,,63,53.55,18.0558,63,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Immunoglobulin E,,82785,CPT,Facility,Outpatient,,,,63,53.55,18.0558,63,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),31.7961,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Immunoglobulin E,,82785,CPT,Facility,Inpatient,,,,63,53.55,18.0558,63,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Immunoglobulin E,,82785,CPT,Facility,Both,,,,63,53.55,18.0558,63,UnitedHealthcare,Individual & Family,59.22,94,,percent of total billed charges,,
Immunoglobulin E,,82785,CPT,Facility,Outpatient,,,,63,53.55,18.0558,63,UnitedHealthcare,Medicare Advantage,30.87,49,,percent of total billed charges,,
Immunoglobulin E,,82785,CPT,Facility,Inpatient,,,,63,53.55,18.0558,63,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Immunoglobulin E,,82785,CPT,Facility,Outpatient,,,,63,53.55,18.0558,63,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,30.24,48,,percent of total billed charges,,100% of DHS outpatient percentage
Immunoglobulin E,,82785,CPT,Facility,Inpatient,,,,63,53.55,18.0558,63,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Arterial Blood Gas,,82803,CPT,Facility,Both,,,,245,208.25,70.217,245,Aetna,Commercial,225.4,92,,percent of total billed charges,,
Arterial Blood Gas,,82803,CPT,Facility,Outpatient,,,,245,208.25,70.217,245,Aetna,Medicare Advantage,120.05,49,,percent of total billed charges,,
Arterial Blood Gas,,82803,CPT,Facility,Inpatient,,,,245,208.25,70.217,245,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Arterial Blood Gas,,82803,CPT,Facility,Both,,,,245,208.25,70.217,245,Aetna,PPO,227.85,93,,percent of total billed charges,,
Arterial Blood Gas,,82803,CPT,Facility,Both,,,,245,208.25,70.217,245,America's PPO,America's PPO,235.2735,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Arterial Blood Gas,,82803,CPT,Facility,Both,,,,245,208.25,70.217,245,BlueCross BlueShield Minnesota, Federal Employee Program,241.08,98.4,,percent of total billed charges,,
Arterial Blood Gas,,82803,CPT,Facility,Both,,,,245,208.25,70.217,245,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,245,100,,percent of total billed charges,,
Arterial Blood Gas,,82803,CPT,Facility,Both,,,,245,208.25,70.217,245,BlueCross BlueShield Minnesota,High Value Network Plan,220.5,90,,percent of total billed charges,,
Arterial Blood Gas,,82803,CPT,Facility,Outpatient,,,,245,208.25,70.217,245,BlueCross BlueShield Minnesota,Medicare Advantage,120.05,49,,percent of total billed charges,,
Arterial Blood Gas,,82803,CPT,Facility,Inpatient,,,,245,208.25,70.217,245,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Arterial Blood Gas,,82803,CPT,Facility,Both,,,,245,208.25,70.217,245,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,216.9965,88.57,,percent of total billed charges,,
Arterial Blood Gas,,82803,CPT,Facility,Both,,,,245,208.25,70.217,245,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,70.217,28.66,,percent of total billed charges,,
Arterial Blood Gas,,82803,CPT,Facility,Outpatient,,,,245,208.25,70.217,245,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),120.05,49,,percent of total billed charges,,
Arterial Blood Gas,,82803,CPT,Facility,Inpatient,,,,245,208.25,70.217,245,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Arterial Blood Gas,,82803,CPT,Facility,Both,,,,245,208.25,70.217,245,CorVel,Worker's Compensation,245,100,,percent of total billed charges,,
Arterial Blood Gas,,82803,CPT,Facility,Both,,,,245,208.25,70.217,245,First Health Group Corporation,First Health Network,237.65,97,,percent of total billed charges,,
Arterial Blood Gas,,82803,CPT,Facility,Both,,,,245,208.25,70.217,245,"Health Partners, Inc.",Commercial,231.77,94.6,,percent of total billed charges,,
Arterial Blood Gas,,82803,CPT,Facility,Outpatient,,,,245,208.25,70.217,245,"Health Partners, Inc.",Medicare Advantage,120.05,49,,percent of total billed charges,,
Arterial Blood Gas,,82803,CPT,Facility,Inpatient,,,,245,208.25,70.217,245,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Arterial Blood Gas,,82803,CPT,Facility,Both,,,,245,208.25,70.217,245,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),147,60,,percent of total billed charges,,
Arterial Blood Gas,,82803,CPT,Facility,Both,,,,245,208.25,70.217,245,"Health Partners, Inc.",State of Minnesota Advantage Program,199.675,81.5,,percent of total billed charges,,
Arterial Blood Gas,,82803,CPT,Facility,Both,,,,245,208.25,70.217,245,"Health Partners, Inc.",State Public Programs,122.5,50,,percent of total billed charges,,
Arterial Blood Gas,,82803,CPT,Facility,Both,,,,245,208.25,70.217,245,Humana Insurance Company,Commercial PPO,232.75,95,,percent of total billed charges,,
Arterial Blood Gas,,82803,CPT,Facility,Outpatient,,,,245,208.25,70.217,245,Humana Insurance Company,Medicare PPO,120.05,49,,percent of total billed charges,,
Arterial Blood Gas,,82803,CPT,Facility,Inpatient,,,,245,208.25,70.217,245,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Arterial Blood Gas,,82803,CPT,Facility,Both,,,,245,208.25,70.217,245,Medica,Individual & Family,242.795,99.1,,percent of total billed charges,,
Arterial Blood Gas,,82803,CPT,Facility,Outpatient,,,,245,208.25,70.217,245,Medica,Medica Advantage Solution,122.01,49.8,,percent of total billed charges,,
Arterial Blood Gas,,82803,CPT,Facility,Inpatient,,,,245,208.25,70.217,245,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Arterial Blood Gas,,82803,CPT,Facility,Outpatient,,,,245,208.25,70.217,245,Medica,Medical Assistance,109.27,44.6,,percent of total billed charges,,
Arterial Blood Gas,,82803,CPT,Facility,Inpatient,,,,245,208.25,70.217,245,Medica,Medical Assistance,,,,,Included in per diem rate,
Arterial Blood Gas,,82803,CPT,Facility,Outpatient,,,,245,208.25,70.217,245,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,122.01,49.8,,percent of total billed charges,,
Arterial Blood Gas,,82803,CPT,Facility,Inpatient,,,,245,208.25,70.217,245,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Arterial Blood Gas,,82803,CPT,Facility,Both,,,,245,208.25,70.217,245,"Multiplan, Inc.","Multiplan, Inc.",230.3,94,,percent of total billed charges,,
Arterial Blood Gas,,82803,CPT,Facility,Outpatient,,,,245,208.25,70.217,245,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,211.68,86.4,,percent of total billed charges,,
Arterial Blood Gas,,82803,CPT,Facility,Inpatient,,,,245,208.25,70.217,245,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Arterial Blood Gas,,82803,CPT,Facility,Both,,,,245,208.25,70.217,245,"Preferred One Administrative Services, INC.",PPO,241.57,98.6,,percent of total billed charges,,
Arterial Blood Gas,,82803,CPT,Facility,Outpatient,,,,245,208.25,70.217,245,PrimeWest Health,Minnesota Senior Health Options (MSHO),126.0525,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Arterial Blood Gas,,82803,CPT,Facility,Inpatient,,,,245,208.25,70.217,245,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Arterial Blood Gas,,82803,CPT,Facility,Outpatient,,,,245,208.25,70.217,245,PrimeWest Health,MinnesotaCare,125.832,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Arterial Blood Gas,,82803,CPT,Facility,Inpatient,,,,245,208.25,70.217,245,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Arterial Blood Gas,,82803,CPT,Facility,Both,,,,245,208.25,70.217,245,Sanford Health Plan,Sanford Health Plan,225.4,92,,percent of total billed charges,,
Arterial Blood Gas,,82803,CPT,Facility,Outpatient,,,,245,208.25,70.217,245,"UCare Health, Inc.",Individual & Family Plan,138.0575,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Arterial Blood Gas,,82803,CPT,Facility,Inpatient,,,,245,208.25,70.217,245,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Arterial Blood Gas,,82803,CPT,Facility,Outpatient,,,,245,208.25,70.217,245,"UCare Health, Inc.",Medical Assistance,123.6515,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Arterial Blood Gas,,82803,CPT,Facility,Inpatient,,,,245,208.25,70.217,245,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Arterial Blood Gas,,82803,CPT,Facility,Outpatient,,,,245,208.25,70.217,245,"UCare Health, Inc.",Medicare Advantage,123.6515,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Arterial Blood Gas,,82803,CPT,Facility,Inpatient,,,,245,208.25,70.217,245,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Arterial Blood Gas,,82803,CPT,Facility,Outpatient,,,,245,208.25,70.217,245,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),123.6515,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Arterial Blood Gas,,82803,CPT,Facility,Inpatient,,,,245,208.25,70.217,245,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Arterial Blood Gas,,82803,CPT,Facility,Both,,,,245,208.25,70.217,245,UnitedHealthcare,Individual & Family,230.3,94,,percent of total billed charges,,
Arterial Blood Gas,,82803,CPT,Facility,Outpatient,,,,245,208.25,70.217,245,UnitedHealthcare,Medicare Advantage,120.05,49,,percent of total billed charges,,
Arterial Blood Gas,,82803,CPT,Facility,Inpatient,,,,245,208.25,70.217,245,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Arterial Blood Gas,,82803,CPT,Facility,Outpatient,,,,245,208.25,70.217,245,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,117.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
Arterial Blood Gas,,82803,CPT,Facility,Inpatient,,,,245,208.25,70.217,245,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Arterial Cord Blood Gas,,82803,CPT,Facility,Both,,,,245,208.25,70.217,245,Aetna,Commercial,225.4,92,,percent of total billed charges,,
Arterial Cord Blood Gas,,82803,CPT,Facility,Outpatient,,,,245,208.25,70.217,245,Aetna,Medicare Advantage,120.05,49,,percent of total billed charges,,
Arterial Cord Blood Gas,,82803,CPT,Facility,Inpatient,,,,245,208.25,70.217,245,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Arterial Cord Blood Gas,,82803,CPT,Facility,Both,,,,245,208.25,70.217,245,Aetna,PPO,227.85,93,,percent of total billed charges,,
Arterial Cord Blood Gas,,82803,CPT,Facility,Both,,,,245,208.25,70.217,245,America's PPO,America's PPO,235.2735,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Arterial Cord Blood Gas,,82803,CPT,Facility,Both,,,,245,208.25,70.217,245,BlueCross BlueShield Minnesota, Federal Employee Program,241.08,98.4,,percent of total billed charges,,
Arterial Cord Blood Gas,,82803,CPT,Facility,Both,,,,245,208.25,70.217,245,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,245,100,,percent of total billed charges,,
Arterial Cord Blood Gas,,82803,CPT,Facility,Both,,,,245,208.25,70.217,245,BlueCross BlueShield Minnesota,High Value Network Plan,220.5,90,,percent of total billed charges,,
Arterial Cord Blood Gas,,82803,CPT,Facility,Outpatient,,,,245,208.25,70.217,245,BlueCross BlueShield Minnesota,Medicare Advantage,120.05,49,,percent of total billed charges,,
Arterial Cord Blood Gas,,82803,CPT,Facility,Inpatient,,,,245,208.25,70.217,245,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Arterial Cord Blood Gas,,82803,CPT,Facility,Both,,,,245,208.25,70.217,245,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,216.9965,88.57,,percent of total billed charges,,
Arterial Cord Blood Gas,,82803,CPT,Facility,Both,,,,245,208.25,70.217,245,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,70.217,28.66,,percent of total billed charges,,
Arterial Cord Blood Gas,,82803,CPT,Facility,Outpatient,,,,245,208.25,70.217,245,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),120.05,49,,percent of total billed charges,,
Arterial Cord Blood Gas,,82803,CPT,Facility,Inpatient,,,,245,208.25,70.217,245,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Arterial Cord Blood Gas,,82803,CPT,Facility,Both,,,,245,208.25,70.217,245,CorVel,Worker's Compensation,245,100,,percent of total billed charges,,
Arterial Cord Blood Gas,,82803,CPT,Facility,Both,,,,245,208.25,70.217,245,First Health Group Corporation,First Health Network,237.65,97,,percent of total billed charges,,
Arterial Cord Blood Gas,,82803,CPT,Facility,Both,,,,245,208.25,70.217,245,"Health Partners, Inc.",Commercial,231.77,94.6,,percent of total billed charges,,
Arterial Cord Blood Gas,,82803,CPT,Facility,Outpatient,,,,245,208.25,70.217,245,"Health Partners, Inc.",Medicare Advantage,120.05,49,,percent of total billed charges,,
Arterial Cord Blood Gas,,82803,CPT,Facility,Inpatient,,,,245,208.25,70.217,245,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Arterial Cord Blood Gas,,82803,CPT,Facility,Both,,,,245,208.25,70.217,245,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),147,60,,percent of total billed charges,,
Arterial Cord Blood Gas,,82803,CPT,Facility,Both,,,,245,208.25,70.217,245,"Health Partners, Inc.",State of Minnesota Advantage Program,199.675,81.5,,percent of total billed charges,,
Arterial Cord Blood Gas,,82803,CPT,Facility,Both,,,,245,208.25,70.217,245,"Health Partners, Inc.",State Public Programs,122.5,50,,percent of total billed charges,,
Arterial Cord Blood Gas,,82803,CPT,Facility,Both,,,,245,208.25,70.217,245,Humana Insurance Company,Commercial PPO,232.75,95,,percent of total billed charges,,
Arterial Cord Blood Gas,,82803,CPT,Facility,Outpatient,,,,245,208.25,70.217,245,Humana Insurance Company,Medicare PPO,120.05,49,,percent of total billed charges,,
Arterial Cord Blood Gas,,82803,CPT,Facility,Inpatient,,,,245,208.25,70.217,245,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Arterial Cord Blood Gas,,82803,CPT,Facility,Both,,,,245,208.25,70.217,245,Medica,Individual & Family,242.795,99.1,,percent of total billed charges,,
Arterial Cord Blood Gas,,82803,CPT,Facility,Outpatient,,,,245,208.25,70.217,245,Medica,Medica Advantage Solution,122.01,49.8,,percent of total billed charges,,
Arterial Cord Blood Gas,,82803,CPT,Facility,Inpatient,,,,245,208.25,70.217,245,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Arterial Cord Blood Gas,,82803,CPT,Facility,Outpatient,,,,245,208.25,70.217,245,Medica,Medical Assistance,109.27,44.6,,percent of total billed charges,,
Arterial Cord Blood Gas,,82803,CPT,Facility,Inpatient,,,,245,208.25,70.217,245,Medica,Medical Assistance,,,,,Included in per diem rate,
Arterial Cord Blood Gas,,82803,CPT,Facility,Outpatient,,,,245,208.25,70.217,245,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,122.01,49.8,,percent of total billed charges,,
Arterial Cord Blood Gas,,82803,CPT,Facility,Inpatient,,,,245,208.25,70.217,245,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Arterial Cord Blood Gas,,82803,CPT,Facility,Both,,,,245,208.25,70.217,245,"Multiplan, Inc.","Multiplan, Inc.",230.3,94,,percent of total billed charges,,
Arterial Cord Blood Gas,,82803,CPT,Facility,Outpatient,,,,245,208.25,70.217,245,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,211.68,86.4,,percent of total billed charges,,
Arterial Cord Blood Gas,,82803,CPT,Facility,Inpatient,,,,245,208.25,70.217,245,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Arterial Cord Blood Gas,,82803,CPT,Facility,Both,,,,245,208.25,70.217,245,"Preferred One Administrative Services, INC.",PPO,241.57,98.6,,percent of total billed charges,,
Arterial Cord Blood Gas,,82803,CPT,Facility,Outpatient,,,,245,208.25,70.217,245,PrimeWest Health,Minnesota Senior Health Options (MSHO),126.0525,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Arterial Cord Blood Gas,,82803,CPT,Facility,Inpatient,,,,245,208.25,70.217,245,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Arterial Cord Blood Gas,,82803,CPT,Facility,Outpatient,,,,245,208.25,70.217,245,PrimeWest Health,MinnesotaCare,125.832,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Arterial Cord Blood Gas,,82803,CPT,Facility,Inpatient,,,,245,208.25,70.217,245,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Arterial Cord Blood Gas,,82803,CPT,Facility,Both,,,,245,208.25,70.217,245,Sanford Health Plan,Sanford Health Plan,225.4,92,,percent of total billed charges,,
Arterial Cord Blood Gas,,82803,CPT,Facility,Outpatient,,,,245,208.25,70.217,245,"UCare Health, Inc.",Individual & Family Plan,138.0575,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Arterial Cord Blood Gas,,82803,CPT,Facility,Inpatient,,,,245,208.25,70.217,245,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Arterial Cord Blood Gas,,82803,CPT,Facility,Outpatient,,,,245,208.25,70.217,245,"UCare Health, Inc.",Medical Assistance,123.6515,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Arterial Cord Blood Gas,,82803,CPT,Facility,Inpatient,,,,245,208.25,70.217,245,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Arterial Cord Blood Gas,,82803,CPT,Facility,Outpatient,,,,245,208.25,70.217,245,"UCare Health, Inc.",Medicare Advantage,123.6515,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Arterial Cord Blood Gas,,82803,CPT,Facility,Inpatient,,,,245,208.25,70.217,245,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Arterial Cord Blood Gas,,82803,CPT,Facility,Outpatient,,,,245,208.25,70.217,245,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),123.6515,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Arterial Cord Blood Gas,,82803,CPT,Facility,Inpatient,,,,245,208.25,70.217,245,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Arterial Cord Blood Gas,,82803,CPT,Facility,Both,,,,245,208.25,70.217,245,UnitedHealthcare,Individual & Family,230.3,94,,percent of total billed charges,,
Arterial Cord Blood Gas,,82803,CPT,Facility,Outpatient,,,,245,208.25,70.217,245,UnitedHealthcare,Medicare Advantage,120.05,49,,percent of total billed charges,,
Arterial Cord Blood Gas,,82803,CPT,Facility,Inpatient,,,,245,208.25,70.217,245,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Arterial Cord Blood Gas,,82803,CPT,Facility,Outpatient,,,,245,208.25,70.217,245,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,117.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
Arterial Cord Blood Gas,,82803,CPT,Facility,Inpatient,,,,245,208.25,70.217,245,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Blood Gases, Arterial, Poc",,82803,CPT,Facility,Both,,,,245,208.25,70.217,245,Aetna,Commercial,225.4,92,,percent of total billed charges,,
"Blood Gases, Arterial, Poc",,82803,CPT,Facility,Outpatient,,,,245,208.25,70.217,245,Aetna,Medicare Advantage,120.05,49,,percent of total billed charges,,
"Blood Gases, Arterial, Poc",,82803,CPT,Facility,Inpatient,,,,245,208.25,70.217,245,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Blood Gases, Arterial, Poc",,82803,CPT,Facility,Both,,,,245,208.25,70.217,245,Aetna,PPO,227.85,93,,percent of total billed charges,,
"Blood Gases, Arterial, Poc",,82803,CPT,Facility,Both,,,,245,208.25,70.217,245,America's PPO,America's PPO,235.2735,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Blood Gases, Arterial, Poc",,82803,CPT,Facility,Both,,,,245,208.25,70.217,245,BlueCross BlueShield Minnesota, Federal Employee Program,241.08,98.4,,percent of total billed charges,,
"Blood Gases, Arterial, Poc",,82803,CPT,Facility,Both,,,,245,208.25,70.217,245,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,245,100,,percent of total billed charges,,
"Blood Gases, Arterial, Poc",,82803,CPT,Facility,Both,,,,245,208.25,70.217,245,BlueCross BlueShield Minnesota,High Value Network Plan,220.5,90,,percent of total billed charges,,
"Blood Gases, Arterial, Poc",,82803,CPT,Facility,Outpatient,,,,245,208.25,70.217,245,BlueCross BlueShield Minnesota,Medicare Advantage,120.05,49,,percent of total billed charges,,
"Blood Gases, Arterial, Poc",,82803,CPT,Facility,Inpatient,,,,245,208.25,70.217,245,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Blood Gases, Arterial, Poc",,82803,CPT,Facility,Both,,,,245,208.25,70.217,245,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,216.9965,88.57,,percent of total billed charges,,
"Blood Gases, Arterial, Poc",,82803,CPT,Facility,Both,,,,245,208.25,70.217,245,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,70.217,28.66,,percent of total billed charges,,
"Blood Gases, Arterial, Poc",,82803,CPT,Facility,Outpatient,,,,245,208.25,70.217,245,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),120.05,49,,percent of total billed charges,,
"Blood Gases, Arterial, Poc",,82803,CPT,Facility,Inpatient,,,,245,208.25,70.217,245,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Blood Gases, Arterial, Poc",,82803,CPT,Facility,Both,,,,245,208.25,70.217,245,CorVel,Worker's Compensation,245,100,,percent of total billed charges,,
"Blood Gases, Arterial, Poc",,82803,CPT,Facility,Both,,,,245,208.25,70.217,245,First Health Group Corporation,First Health Network,237.65,97,,percent of total billed charges,,
"Blood Gases, Arterial, Poc",,82803,CPT,Facility,Both,,,,245,208.25,70.217,245,"Health Partners, Inc.",Commercial,231.77,94.6,,percent of total billed charges,,
"Blood Gases, Arterial, Poc",,82803,CPT,Facility,Outpatient,,,,245,208.25,70.217,245,"Health Partners, Inc.",Medicare Advantage,120.05,49,,percent of total billed charges,,
"Blood Gases, Arterial, Poc",,82803,CPT,Facility,Inpatient,,,,245,208.25,70.217,245,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Blood Gases, Arterial, Poc",,82803,CPT,Facility,Both,,,,245,208.25,70.217,245,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),147,60,,percent of total billed charges,,
"Blood Gases, Arterial, Poc",,82803,CPT,Facility,Both,,,,245,208.25,70.217,245,"Health Partners, Inc.",State of Minnesota Advantage Program,199.675,81.5,,percent of total billed charges,,
"Blood Gases, Arterial, Poc",,82803,CPT,Facility,Both,,,,245,208.25,70.217,245,"Health Partners, Inc.",State Public Programs,122.5,50,,percent of total billed charges,,
"Blood Gases, Arterial, Poc",,82803,CPT,Facility,Both,,,,245,208.25,70.217,245,Humana Insurance Company,Commercial PPO,232.75,95,,percent of total billed charges,,
"Blood Gases, Arterial, Poc",,82803,CPT,Facility,Outpatient,,,,245,208.25,70.217,245,Humana Insurance Company,Medicare PPO,120.05,49,,percent of total billed charges,,
"Blood Gases, Arterial, Poc",,82803,CPT,Facility,Inpatient,,,,245,208.25,70.217,245,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Blood Gases, Arterial, Poc",,82803,CPT,Facility,Both,,,,245,208.25,70.217,245,Medica,Individual & Family,242.795,99.1,,percent of total billed charges,,
"Blood Gases, Arterial, Poc",,82803,CPT,Facility,Outpatient,,,,245,208.25,70.217,245,Medica,Medica Advantage Solution,122.01,49.8,,percent of total billed charges,,
"Blood Gases, Arterial, Poc",,82803,CPT,Facility,Inpatient,,,,245,208.25,70.217,245,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Blood Gases, Arterial, Poc",,82803,CPT,Facility,Outpatient,,,,245,208.25,70.217,245,Medica,Medical Assistance,109.27,44.6,,percent of total billed charges,,
"Blood Gases, Arterial, Poc",,82803,CPT,Facility,Inpatient,,,,245,208.25,70.217,245,Medica,Medical Assistance,,,,,Included in per diem rate,
"Blood Gases, Arterial, Poc",,82803,CPT,Facility,Outpatient,,,,245,208.25,70.217,245,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,122.01,49.8,,percent of total billed charges,,
"Blood Gases, Arterial, Poc",,82803,CPT,Facility,Inpatient,,,,245,208.25,70.217,245,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Blood Gases, Arterial, Poc",,82803,CPT,Facility,Both,,,,245,208.25,70.217,245,"Multiplan, Inc.","Multiplan, Inc.",230.3,94,,percent of total billed charges,,
"Blood Gases, Arterial, Poc",,82803,CPT,Facility,Outpatient,,,,245,208.25,70.217,245,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,211.68,86.4,,percent of total billed charges,,
"Blood Gases, Arterial, Poc",,82803,CPT,Facility,Inpatient,,,,245,208.25,70.217,245,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Blood Gases, Arterial, Poc",,82803,CPT,Facility,Both,,,,245,208.25,70.217,245,"Preferred One Administrative Services, INC.",PPO,241.57,98.6,,percent of total billed charges,,
"Blood Gases, Arterial, Poc",,82803,CPT,Facility,Outpatient,,,,245,208.25,70.217,245,PrimeWest Health,Minnesota Senior Health Options (MSHO),126.0525,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Blood Gases, Arterial, Poc",,82803,CPT,Facility,Inpatient,,,,245,208.25,70.217,245,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Blood Gases, Arterial, Poc",,82803,CPT,Facility,Outpatient,,,,245,208.25,70.217,245,PrimeWest Health,MinnesotaCare,125.832,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Blood Gases, Arterial, Poc",,82803,CPT,Facility,Inpatient,,,,245,208.25,70.217,245,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Blood Gases, Arterial, Poc",,82803,CPT,Facility,Both,,,,245,208.25,70.217,245,Sanford Health Plan,Sanford Health Plan,225.4,92,,percent of total billed charges,,
"Blood Gases, Arterial, Poc",,82803,CPT,Facility,Outpatient,,,,245,208.25,70.217,245,"UCare Health, Inc.",Individual & Family Plan,138.0575,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Blood Gases, Arterial, Poc",,82803,CPT,Facility,Inpatient,,,,245,208.25,70.217,245,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Blood Gases, Arterial, Poc",,82803,CPT,Facility,Outpatient,,,,245,208.25,70.217,245,"UCare Health, Inc.",Medical Assistance,123.6515,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Blood Gases, Arterial, Poc",,82803,CPT,Facility,Inpatient,,,,245,208.25,70.217,245,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Blood Gases, Arterial, Poc",,82803,CPT,Facility,Outpatient,,,,245,208.25,70.217,245,"UCare Health, Inc.",Medicare Advantage,123.6515,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Blood Gases, Arterial, Poc",,82803,CPT,Facility,Inpatient,,,,245,208.25,70.217,245,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Blood Gases, Arterial, Poc",,82803,CPT,Facility,Outpatient,,,,245,208.25,70.217,245,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),123.6515,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Blood Gases, Arterial, Poc",,82803,CPT,Facility,Inpatient,,,,245,208.25,70.217,245,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Blood Gases, Arterial, Poc",,82803,CPT,Facility,Both,,,,245,208.25,70.217,245,UnitedHealthcare,Individual & Family,230.3,94,,percent of total billed charges,,
"Blood Gases, Arterial, Poc",,82803,CPT,Facility,Outpatient,,,,245,208.25,70.217,245,UnitedHealthcare,Medicare Advantage,120.05,49,,percent of total billed charges,,
"Blood Gases, Arterial, Poc",,82803,CPT,Facility,Inpatient,,,,245,208.25,70.217,245,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Blood Gases, Arterial, Poc",,82803,CPT,Facility,Outpatient,,,,245,208.25,70.217,245,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,117.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Blood Gases, Arterial, Poc",,82803,CPT,Facility,Inpatient,,,,245,208.25,70.217,245,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Blood Gases, Venous, Poc",,82803,CPT,Facility,Both,,,,245,208.25,70.217,245,Aetna,Commercial,225.4,92,,percent of total billed charges,,
"Blood Gases, Venous, Poc",,82803,CPT,Facility,Outpatient,,,,245,208.25,70.217,245,Aetna,Medicare Advantage,120.05,49,,percent of total billed charges,,
"Blood Gases, Venous, Poc",,82803,CPT,Facility,Inpatient,,,,245,208.25,70.217,245,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Blood Gases, Venous, Poc",,82803,CPT,Facility,Both,,,,245,208.25,70.217,245,Aetna,PPO,227.85,93,,percent of total billed charges,,
"Blood Gases, Venous, Poc",,82803,CPT,Facility,Both,,,,245,208.25,70.217,245,America's PPO,America's PPO,235.2735,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Blood Gases, Venous, Poc",,82803,CPT,Facility,Both,,,,245,208.25,70.217,245,BlueCross BlueShield Minnesota, Federal Employee Program,241.08,98.4,,percent of total billed charges,,
"Blood Gases, Venous, Poc",,82803,CPT,Facility,Both,,,,245,208.25,70.217,245,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,245,100,,percent of total billed charges,,
"Blood Gases, Venous, Poc",,82803,CPT,Facility,Both,,,,245,208.25,70.217,245,BlueCross BlueShield Minnesota,High Value Network Plan,220.5,90,,percent of total billed charges,,
"Blood Gases, Venous, Poc",,82803,CPT,Facility,Outpatient,,,,245,208.25,70.217,245,BlueCross BlueShield Minnesota,Medicare Advantage,120.05,49,,percent of total billed charges,,
"Blood Gases, Venous, Poc",,82803,CPT,Facility,Inpatient,,,,245,208.25,70.217,245,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Blood Gases, Venous, Poc",,82803,CPT,Facility,Both,,,,245,208.25,70.217,245,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,216.9965,88.57,,percent of total billed charges,,
"Blood Gases, Venous, Poc",,82803,CPT,Facility,Both,,,,245,208.25,70.217,245,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,70.217,28.66,,percent of total billed charges,,
"Blood Gases, Venous, Poc",,82803,CPT,Facility,Outpatient,,,,245,208.25,70.217,245,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),120.05,49,,percent of total billed charges,,
"Blood Gases, Venous, Poc",,82803,CPT,Facility,Inpatient,,,,245,208.25,70.217,245,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Blood Gases, Venous, Poc",,82803,CPT,Facility,Both,,,,245,208.25,70.217,245,CorVel,Worker's Compensation,245,100,,percent of total billed charges,,
"Blood Gases, Venous, Poc",,82803,CPT,Facility,Both,,,,245,208.25,70.217,245,First Health Group Corporation,First Health Network,237.65,97,,percent of total billed charges,,
"Blood Gases, Venous, Poc",,82803,CPT,Facility,Both,,,,245,208.25,70.217,245,"Health Partners, Inc.",Commercial,231.77,94.6,,percent of total billed charges,,
"Blood Gases, Venous, Poc",,82803,CPT,Facility,Outpatient,,,,245,208.25,70.217,245,"Health Partners, Inc.",Medicare Advantage,120.05,49,,percent of total billed charges,,
"Blood Gases, Venous, Poc",,82803,CPT,Facility,Inpatient,,,,245,208.25,70.217,245,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Blood Gases, Venous, Poc",,82803,CPT,Facility,Both,,,,245,208.25,70.217,245,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),147,60,,percent of total billed charges,,
"Blood Gases, Venous, Poc",,82803,CPT,Facility,Both,,,,245,208.25,70.217,245,"Health Partners, Inc.",State of Minnesota Advantage Program,199.675,81.5,,percent of total billed charges,,
"Blood Gases, Venous, Poc",,82803,CPT,Facility,Both,,,,245,208.25,70.217,245,"Health Partners, Inc.",State Public Programs,122.5,50,,percent of total billed charges,,
"Blood Gases, Venous, Poc",,82803,CPT,Facility,Both,,,,245,208.25,70.217,245,Humana Insurance Company,Commercial PPO,232.75,95,,percent of total billed charges,,
"Blood Gases, Venous, Poc",,82803,CPT,Facility,Outpatient,,,,245,208.25,70.217,245,Humana Insurance Company,Medicare PPO,120.05,49,,percent of total billed charges,,
"Blood Gases, Venous, Poc",,82803,CPT,Facility,Inpatient,,,,245,208.25,70.217,245,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Blood Gases, Venous, Poc",,82803,CPT,Facility,Both,,,,245,208.25,70.217,245,Medica,Individual & Family,242.795,99.1,,percent of total billed charges,,
"Blood Gases, Venous, Poc",,82803,CPT,Facility,Outpatient,,,,245,208.25,70.217,245,Medica,Medica Advantage Solution,122.01,49.8,,percent of total billed charges,,
"Blood Gases, Venous, Poc",,82803,CPT,Facility,Inpatient,,,,245,208.25,70.217,245,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Blood Gases, Venous, Poc",,82803,CPT,Facility,Outpatient,,,,245,208.25,70.217,245,Medica,Medical Assistance,109.27,44.6,,percent of total billed charges,,
"Blood Gases, Venous, Poc",,82803,CPT,Facility,Inpatient,,,,245,208.25,70.217,245,Medica,Medical Assistance,,,,,Included in per diem rate,
"Blood Gases, Venous, Poc",,82803,CPT,Facility,Outpatient,,,,245,208.25,70.217,245,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,122.01,49.8,,percent of total billed charges,,
"Blood Gases, Venous, Poc",,82803,CPT,Facility,Inpatient,,,,245,208.25,70.217,245,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Blood Gases, Venous, Poc",,82803,CPT,Facility,Both,,,,245,208.25,70.217,245,"Multiplan, Inc.","Multiplan, Inc.",230.3,94,,percent of total billed charges,,
"Blood Gases, Venous, Poc",,82803,CPT,Facility,Outpatient,,,,245,208.25,70.217,245,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,211.68,86.4,,percent of total billed charges,,
"Blood Gases, Venous, Poc",,82803,CPT,Facility,Inpatient,,,,245,208.25,70.217,245,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Blood Gases, Venous, Poc",,82803,CPT,Facility,Both,,,,245,208.25,70.217,245,"Preferred One Administrative Services, INC.",PPO,241.57,98.6,,percent of total billed charges,,
"Blood Gases, Venous, Poc",,82803,CPT,Facility,Outpatient,,,,245,208.25,70.217,245,PrimeWest Health,Minnesota Senior Health Options (MSHO),126.0525,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Blood Gases, Venous, Poc",,82803,CPT,Facility,Inpatient,,,,245,208.25,70.217,245,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Blood Gases, Venous, Poc",,82803,CPT,Facility,Outpatient,,,,245,208.25,70.217,245,PrimeWest Health,MinnesotaCare,125.832,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Blood Gases, Venous, Poc",,82803,CPT,Facility,Inpatient,,,,245,208.25,70.217,245,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Blood Gases, Venous, Poc",,82803,CPT,Facility,Both,,,,245,208.25,70.217,245,Sanford Health Plan,Sanford Health Plan,225.4,92,,percent of total billed charges,,
"Blood Gases, Venous, Poc",,82803,CPT,Facility,Outpatient,,,,245,208.25,70.217,245,"UCare Health, Inc.",Individual & Family Plan,138.0575,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Blood Gases, Venous, Poc",,82803,CPT,Facility,Inpatient,,,,245,208.25,70.217,245,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Blood Gases, Venous, Poc",,82803,CPT,Facility,Outpatient,,,,245,208.25,70.217,245,"UCare Health, Inc.",Medical Assistance,123.6515,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Blood Gases, Venous, Poc",,82803,CPT,Facility,Inpatient,,,,245,208.25,70.217,245,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Blood Gases, Venous, Poc",,82803,CPT,Facility,Outpatient,,,,245,208.25,70.217,245,"UCare Health, Inc.",Medicare Advantage,123.6515,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Blood Gases, Venous, Poc",,82803,CPT,Facility,Inpatient,,,,245,208.25,70.217,245,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Blood Gases, Venous, Poc",,82803,CPT,Facility,Outpatient,,,,245,208.25,70.217,245,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),123.6515,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Blood Gases, Venous, Poc",,82803,CPT,Facility,Inpatient,,,,245,208.25,70.217,245,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Blood Gases, Venous, Poc",,82803,CPT,Facility,Both,,,,245,208.25,70.217,245,UnitedHealthcare,Individual & Family,230.3,94,,percent of total billed charges,,
"Blood Gases, Venous, Poc",,82803,CPT,Facility,Outpatient,,,,245,208.25,70.217,245,UnitedHealthcare,Medicare Advantage,120.05,49,,percent of total billed charges,,
"Blood Gases, Venous, Poc",,82803,CPT,Facility,Inpatient,,,,245,208.25,70.217,245,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Blood Gases, Venous, Poc",,82803,CPT,Facility,Outpatient,,,,245,208.25,70.217,245,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,117.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Blood Gases, Venous, Poc",,82803,CPT,Facility,Inpatient,,,,245,208.25,70.217,245,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Venous Blood Gas,,82803,CPT,Facility,Both,,,,245,208.25,70.217,245,Aetna,Commercial,225.4,92,,percent of total billed charges,,
Venous Blood Gas,,82803,CPT,Facility,Outpatient,,,,245,208.25,70.217,245,Aetna,Medicare Advantage,120.05,49,,percent of total billed charges,,
Venous Blood Gas,,82803,CPT,Facility,Inpatient,,,,245,208.25,70.217,245,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Venous Blood Gas,,82803,CPT,Facility,Both,,,,245,208.25,70.217,245,Aetna,PPO,227.85,93,,percent of total billed charges,,
Venous Blood Gas,,82803,CPT,Facility,Both,,,,245,208.25,70.217,245,America's PPO,America's PPO,235.2735,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Venous Blood Gas,,82803,CPT,Facility,Both,,,,245,208.25,70.217,245,BlueCross BlueShield Minnesota, Federal Employee Program,241.08,98.4,,percent of total billed charges,,
Venous Blood Gas,,82803,CPT,Facility,Both,,,,245,208.25,70.217,245,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,245,100,,percent of total billed charges,,
Venous Blood Gas,,82803,CPT,Facility,Both,,,,245,208.25,70.217,245,BlueCross BlueShield Minnesota,High Value Network Plan,220.5,90,,percent of total billed charges,,
Venous Blood Gas,,82803,CPT,Facility,Outpatient,,,,245,208.25,70.217,245,BlueCross BlueShield Minnesota,Medicare Advantage,120.05,49,,percent of total billed charges,,
Venous Blood Gas,,82803,CPT,Facility,Inpatient,,,,245,208.25,70.217,245,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Venous Blood Gas,,82803,CPT,Facility,Both,,,,245,208.25,70.217,245,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,216.9965,88.57,,percent of total billed charges,,
Venous Blood Gas,,82803,CPT,Facility,Both,,,,245,208.25,70.217,245,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,70.217,28.66,,percent of total billed charges,,
Venous Blood Gas,,82803,CPT,Facility,Outpatient,,,,245,208.25,70.217,245,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),120.05,49,,percent of total billed charges,,
Venous Blood Gas,,82803,CPT,Facility,Inpatient,,,,245,208.25,70.217,245,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Venous Blood Gas,,82803,CPT,Facility,Both,,,,245,208.25,70.217,245,CorVel,Worker's Compensation,245,100,,percent of total billed charges,,
Venous Blood Gas,,82803,CPT,Facility,Both,,,,245,208.25,70.217,245,First Health Group Corporation,First Health Network,237.65,97,,percent of total billed charges,,
Venous Blood Gas,,82803,CPT,Facility,Both,,,,245,208.25,70.217,245,"Health Partners, Inc.",Commercial,231.77,94.6,,percent of total billed charges,,
Venous Blood Gas,,82803,CPT,Facility,Outpatient,,,,245,208.25,70.217,245,"Health Partners, Inc.",Medicare Advantage,120.05,49,,percent of total billed charges,,
Venous Blood Gas,,82803,CPT,Facility,Inpatient,,,,245,208.25,70.217,245,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Venous Blood Gas,,82803,CPT,Facility,Both,,,,245,208.25,70.217,245,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),147,60,,percent of total billed charges,,
Venous Blood Gas,,82803,CPT,Facility,Both,,,,245,208.25,70.217,245,"Health Partners, Inc.",State of Minnesota Advantage Program,199.675,81.5,,percent of total billed charges,,
Venous Blood Gas,,82803,CPT,Facility,Both,,,,245,208.25,70.217,245,"Health Partners, Inc.",State Public Programs,122.5,50,,percent of total billed charges,,
Venous Blood Gas,,82803,CPT,Facility,Both,,,,245,208.25,70.217,245,Humana Insurance Company,Commercial PPO,232.75,95,,percent of total billed charges,,
Venous Blood Gas,,82803,CPT,Facility,Outpatient,,,,245,208.25,70.217,245,Humana Insurance Company,Medicare PPO,120.05,49,,percent of total billed charges,,
Venous Blood Gas,,82803,CPT,Facility,Inpatient,,,,245,208.25,70.217,245,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Venous Blood Gas,,82803,CPT,Facility,Both,,,,245,208.25,70.217,245,Medica,Individual & Family,242.795,99.1,,percent of total billed charges,,
Venous Blood Gas,,82803,CPT,Facility,Outpatient,,,,245,208.25,70.217,245,Medica,Medica Advantage Solution,122.01,49.8,,percent of total billed charges,,
Venous Blood Gas,,82803,CPT,Facility,Inpatient,,,,245,208.25,70.217,245,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Venous Blood Gas,,82803,CPT,Facility,Outpatient,,,,245,208.25,70.217,245,Medica,Medical Assistance,109.27,44.6,,percent of total billed charges,,
Venous Blood Gas,,82803,CPT,Facility,Inpatient,,,,245,208.25,70.217,245,Medica,Medical Assistance,,,,,Included in per diem rate,
Venous Blood Gas,,82803,CPT,Facility,Outpatient,,,,245,208.25,70.217,245,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,122.01,49.8,,percent of total billed charges,,
Venous Blood Gas,,82803,CPT,Facility,Inpatient,,,,245,208.25,70.217,245,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Venous Blood Gas,,82803,CPT,Facility,Both,,,,245,208.25,70.217,245,"Multiplan, Inc.","Multiplan, Inc.",230.3,94,,percent of total billed charges,,
Venous Blood Gas,,82803,CPT,Facility,Outpatient,,,,245,208.25,70.217,245,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,211.68,86.4,,percent of total billed charges,,
Venous Blood Gas,,82803,CPT,Facility,Inpatient,,,,245,208.25,70.217,245,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Venous Blood Gas,,82803,CPT,Facility,Both,,,,245,208.25,70.217,245,"Preferred One Administrative Services, INC.",PPO,241.57,98.6,,percent of total billed charges,,
Venous Blood Gas,,82803,CPT,Facility,Outpatient,,,,245,208.25,70.217,245,PrimeWest Health,Minnesota Senior Health Options (MSHO),126.0525,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Venous Blood Gas,,82803,CPT,Facility,Inpatient,,,,245,208.25,70.217,245,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Venous Blood Gas,,82803,CPT,Facility,Outpatient,,,,245,208.25,70.217,245,PrimeWest Health,MinnesotaCare,125.832,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Venous Blood Gas,,82803,CPT,Facility,Inpatient,,,,245,208.25,70.217,245,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Venous Blood Gas,,82803,CPT,Facility,Both,,,,245,208.25,70.217,245,Sanford Health Plan,Sanford Health Plan,225.4,92,,percent of total billed charges,,
Venous Blood Gas,,82803,CPT,Facility,Outpatient,,,,245,208.25,70.217,245,"UCare Health, Inc.",Individual & Family Plan,138.0575,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Venous Blood Gas,,82803,CPT,Facility,Inpatient,,,,245,208.25,70.217,245,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Venous Blood Gas,,82803,CPT,Facility,Outpatient,,,,245,208.25,70.217,245,"UCare Health, Inc.",Medical Assistance,123.6515,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Venous Blood Gas,,82803,CPT,Facility,Inpatient,,,,245,208.25,70.217,245,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Venous Blood Gas,,82803,CPT,Facility,Outpatient,,,,245,208.25,70.217,245,"UCare Health, Inc.",Medicare Advantage,123.6515,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Venous Blood Gas,,82803,CPT,Facility,Inpatient,,,,245,208.25,70.217,245,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Venous Blood Gas,,82803,CPT,Facility,Outpatient,,,,245,208.25,70.217,245,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),123.6515,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Venous Blood Gas,,82803,CPT,Facility,Inpatient,,,,245,208.25,70.217,245,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Venous Blood Gas,,82803,CPT,Facility,Both,,,,245,208.25,70.217,245,UnitedHealthcare,Individual & Family,230.3,94,,percent of total billed charges,,
Venous Blood Gas,,82803,CPT,Facility,Outpatient,,,,245,208.25,70.217,245,UnitedHealthcare,Medicare Advantage,120.05,49,,percent of total billed charges,,
Venous Blood Gas,,82803,CPT,Facility,Inpatient,,,,245,208.25,70.217,245,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Venous Blood Gas,,82803,CPT,Facility,Outpatient,,,,245,208.25,70.217,245,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,117.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
Venous Blood Gas,,82803,CPT,Facility,Inpatient,,,,245,208.25,70.217,245,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Venous Cord Blood Gas,,82803,CPT,Facility,Both,,,,245,208.25,70.217,245,Aetna,Commercial,225.4,92,,percent of total billed charges,,
Venous Cord Blood Gas,,82803,CPT,Facility,Outpatient,,,,245,208.25,70.217,245,Aetna,Medicare Advantage,120.05,49,,percent of total billed charges,,
Venous Cord Blood Gas,,82803,CPT,Facility,Inpatient,,,,245,208.25,70.217,245,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Venous Cord Blood Gas,,82803,CPT,Facility,Both,,,,245,208.25,70.217,245,Aetna,PPO,227.85,93,,percent of total billed charges,,
Venous Cord Blood Gas,,82803,CPT,Facility,Both,,,,245,208.25,70.217,245,America's PPO,America's PPO,235.2735,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Venous Cord Blood Gas,,82803,CPT,Facility,Both,,,,245,208.25,70.217,245,BlueCross BlueShield Minnesota, Federal Employee Program,241.08,98.4,,percent of total billed charges,,
Venous Cord Blood Gas,,82803,CPT,Facility,Both,,,,245,208.25,70.217,245,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,245,100,,percent of total billed charges,,
Venous Cord Blood Gas,,82803,CPT,Facility,Both,,,,245,208.25,70.217,245,BlueCross BlueShield Minnesota,High Value Network Plan,220.5,90,,percent of total billed charges,,
Venous Cord Blood Gas,,82803,CPT,Facility,Outpatient,,,,245,208.25,70.217,245,BlueCross BlueShield Minnesota,Medicare Advantage,120.05,49,,percent of total billed charges,,
Venous Cord Blood Gas,,82803,CPT,Facility,Inpatient,,,,245,208.25,70.217,245,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Venous Cord Blood Gas,,82803,CPT,Facility,Both,,,,245,208.25,70.217,245,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,216.9965,88.57,,percent of total billed charges,,
Venous Cord Blood Gas,,82803,CPT,Facility,Both,,,,245,208.25,70.217,245,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,70.217,28.66,,percent of total billed charges,,
Venous Cord Blood Gas,,82803,CPT,Facility,Outpatient,,,,245,208.25,70.217,245,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),120.05,49,,percent of total billed charges,,
Venous Cord Blood Gas,,82803,CPT,Facility,Inpatient,,,,245,208.25,70.217,245,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Venous Cord Blood Gas,,82803,CPT,Facility,Both,,,,245,208.25,70.217,245,CorVel,Worker's Compensation,245,100,,percent of total billed charges,,
Venous Cord Blood Gas,,82803,CPT,Facility,Both,,,,245,208.25,70.217,245,First Health Group Corporation,First Health Network,237.65,97,,percent of total billed charges,,
Venous Cord Blood Gas,,82803,CPT,Facility,Both,,,,245,208.25,70.217,245,"Health Partners, Inc.",Commercial,231.77,94.6,,percent of total billed charges,,
Venous Cord Blood Gas,,82803,CPT,Facility,Outpatient,,,,245,208.25,70.217,245,"Health Partners, Inc.",Medicare Advantage,120.05,49,,percent of total billed charges,,
Venous Cord Blood Gas,,82803,CPT,Facility,Inpatient,,,,245,208.25,70.217,245,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Venous Cord Blood Gas,,82803,CPT,Facility,Both,,,,245,208.25,70.217,245,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),147,60,,percent of total billed charges,,
Venous Cord Blood Gas,,82803,CPT,Facility,Both,,,,245,208.25,70.217,245,"Health Partners, Inc.",State of Minnesota Advantage Program,199.675,81.5,,percent of total billed charges,,
Venous Cord Blood Gas,,82803,CPT,Facility,Both,,,,245,208.25,70.217,245,"Health Partners, Inc.",State Public Programs,122.5,50,,percent of total billed charges,,
Venous Cord Blood Gas,,82803,CPT,Facility,Both,,,,245,208.25,70.217,245,Humana Insurance Company,Commercial PPO,232.75,95,,percent of total billed charges,,
Venous Cord Blood Gas,,82803,CPT,Facility,Outpatient,,,,245,208.25,70.217,245,Humana Insurance Company,Medicare PPO,120.05,49,,percent of total billed charges,,
Venous Cord Blood Gas,,82803,CPT,Facility,Inpatient,,,,245,208.25,70.217,245,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Venous Cord Blood Gas,,82803,CPT,Facility,Both,,,,245,208.25,70.217,245,Medica,Individual & Family,242.795,99.1,,percent of total billed charges,,
Venous Cord Blood Gas,,82803,CPT,Facility,Outpatient,,,,245,208.25,70.217,245,Medica,Medica Advantage Solution,122.01,49.8,,percent of total billed charges,,
Venous Cord Blood Gas,,82803,CPT,Facility,Inpatient,,,,245,208.25,70.217,245,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Venous Cord Blood Gas,,82803,CPT,Facility,Outpatient,,,,245,208.25,70.217,245,Medica,Medical Assistance,109.27,44.6,,percent of total billed charges,,
Venous Cord Blood Gas,,82803,CPT,Facility,Inpatient,,,,245,208.25,70.217,245,Medica,Medical Assistance,,,,,Included in per diem rate,
Venous Cord Blood Gas,,82803,CPT,Facility,Outpatient,,,,245,208.25,70.217,245,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,122.01,49.8,,percent of total billed charges,,
Venous Cord Blood Gas,,82803,CPT,Facility,Inpatient,,,,245,208.25,70.217,245,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Venous Cord Blood Gas,,82803,CPT,Facility,Both,,,,245,208.25,70.217,245,"Multiplan, Inc.","Multiplan, Inc.",230.3,94,,percent of total billed charges,,
Venous Cord Blood Gas,,82803,CPT,Facility,Outpatient,,,,245,208.25,70.217,245,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,211.68,86.4,,percent of total billed charges,,
Venous Cord Blood Gas,,82803,CPT,Facility,Inpatient,,,,245,208.25,70.217,245,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Venous Cord Blood Gas,,82803,CPT,Facility,Both,,,,245,208.25,70.217,245,"Preferred One Administrative Services, INC.",PPO,241.57,98.6,,percent of total billed charges,,
Venous Cord Blood Gas,,82803,CPT,Facility,Outpatient,,,,245,208.25,70.217,245,PrimeWest Health,Minnesota Senior Health Options (MSHO),126.0525,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Venous Cord Blood Gas,,82803,CPT,Facility,Inpatient,,,,245,208.25,70.217,245,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Venous Cord Blood Gas,,82803,CPT,Facility,Outpatient,,,,245,208.25,70.217,245,PrimeWest Health,MinnesotaCare,125.832,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Venous Cord Blood Gas,,82803,CPT,Facility,Inpatient,,,,245,208.25,70.217,245,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Venous Cord Blood Gas,,82803,CPT,Facility,Both,,,,245,208.25,70.217,245,Sanford Health Plan,Sanford Health Plan,225.4,92,,percent of total billed charges,,
Venous Cord Blood Gas,,82803,CPT,Facility,Outpatient,,,,245,208.25,70.217,245,"UCare Health, Inc.",Individual & Family Plan,138.0575,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Venous Cord Blood Gas,,82803,CPT,Facility,Inpatient,,,,245,208.25,70.217,245,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Venous Cord Blood Gas,,82803,CPT,Facility,Outpatient,,,,245,208.25,70.217,245,"UCare Health, Inc.",Medical Assistance,123.6515,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Venous Cord Blood Gas,,82803,CPT,Facility,Inpatient,,,,245,208.25,70.217,245,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Venous Cord Blood Gas,,82803,CPT,Facility,Outpatient,,,,245,208.25,70.217,245,"UCare Health, Inc.",Medicare Advantage,123.6515,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Venous Cord Blood Gas,,82803,CPT,Facility,Inpatient,,,,245,208.25,70.217,245,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Venous Cord Blood Gas,,82803,CPT,Facility,Outpatient,,,,245,208.25,70.217,245,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),123.6515,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Venous Cord Blood Gas,,82803,CPT,Facility,Inpatient,,,,245,208.25,70.217,245,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Venous Cord Blood Gas,,82803,CPT,Facility,Both,,,,245,208.25,70.217,245,UnitedHealthcare,Individual & Family,230.3,94,,percent of total billed charges,,
Venous Cord Blood Gas,,82803,CPT,Facility,Outpatient,,,,245,208.25,70.217,245,UnitedHealthcare,Medicare Advantage,120.05,49,,percent of total billed charges,,
Venous Cord Blood Gas,,82803,CPT,Facility,Inpatient,,,,245,208.25,70.217,245,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Venous Cord Blood Gas,,82803,CPT,Facility,Outpatient,,,,245,208.25,70.217,245,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,117.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
Venous Cord Blood Gas,,82803,CPT,Facility,Inpatient,,,,245,208.25,70.217,245,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Blood Gas, Capillary",,82805,CPT,Facility,Both,,,,245,208.25,70.217,245,Aetna,Commercial,225.4,92,,percent of total billed charges,,
"Blood Gas, Capillary",,82805,CPT,Facility,Outpatient,,,,245,208.25,70.217,245,Aetna,Medicare Advantage,120.05,49,,percent of total billed charges,,
"Blood Gas, Capillary",,82805,CPT,Facility,Inpatient,,,,245,208.25,70.217,245,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Blood Gas, Capillary",,82805,CPT,Facility,Both,,,,245,208.25,70.217,245,Aetna,PPO,227.85,93,,percent of total billed charges,,
"Blood Gas, Capillary",,82805,CPT,Facility,Both,,,,245,208.25,70.217,245,America's PPO,America's PPO,235.2735,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Blood Gas, Capillary",,82805,CPT,Facility,Both,,,,245,208.25,70.217,245,BlueCross BlueShield Minnesota, Federal Employee Program,241.08,98.4,,percent of total billed charges,,
"Blood Gas, Capillary",,82805,CPT,Facility,Both,,,,245,208.25,70.217,245,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,245,100,,percent of total billed charges,,
"Blood Gas, Capillary",,82805,CPT,Facility,Both,,,,245,208.25,70.217,245,BlueCross BlueShield Minnesota,High Value Network Plan,220.5,90,,percent of total billed charges,,
"Blood Gas, Capillary",,82805,CPT,Facility,Outpatient,,,,245,208.25,70.217,245,BlueCross BlueShield Minnesota,Medicare Advantage,120.05,49,,percent of total billed charges,,
"Blood Gas, Capillary",,82805,CPT,Facility,Inpatient,,,,245,208.25,70.217,245,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Blood Gas, Capillary",,82805,CPT,Facility,Both,,,,245,208.25,70.217,245,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,216.9965,88.57,,percent of total billed charges,,
"Blood Gas, Capillary",,82805,CPT,Facility,Both,,,,245,208.25,70.217,245,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,70.217,28.66,,percent of total billed charges,,
"Blood Gas, Capillary",,82805,CPT,Facility,Outpatient,,,,245,208.25,70.217,245,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),120.05,49,,percent of total billed charges,,
"Blood Gas, Capillary",,82805,CPT,Facility,Inpatient,,,,245,208.25,70.217,245,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Blood Gas, Capillary",,82805,CPT,Facility,Both,,,,245,208.25,70.217,245,CorVel,Worker's Compensation,245,100,,percent of total billed charges,,
"Blood Gas, Capillary",,82805,CPT,Facility,Both,,,,245,208.25,70.217,245,First Health Group Corporation,First Health Network,237.65,97,,percent of total billed charges,,
"Blood Gas, Capillary",,82805,CPT,Facility,Both,,,,245,208.25,70.217,245,"Health Partners, Inc.",Commercial,231.77,94.6,,percent of total billed charges,,
"Blood Gas, Capillary",,82805,CPT,Facility,Outpatient,,,,245,208.25,70.217,245,"Health Partners, Inc.",Medicare Advantage,120.05,49,,percent of total billed charges,,
"Blood Gas, Capillary",,82805,CPT,Facility,Inpatient,,,,245,208.25,70.217,245,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Blood Gas, Capillary",,82805,CPT,Facility,Both,,,,245,208.25,70.217,245,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),147,60,,percent of total billed charges,,
"Blood Gas, Capillary",,82805,CPT,Facility,Both,,,,245,208.25,70.217,245,"Health Partners, Inc.",State of Minnesota Advantage Program,199.675,81.5,,percent of total billed charges,,
"Blood Gas, Capillary",,82805,CPT,Facility,Both,,,,245,208.25,70.217,245,"Health Partners, Inc.",State Public Programs,122.5,50,,percent of total billed charges,,
"Blood Gas, Capillary",,82805,CPT,Facility,Both,,,,245,208.25,70.217,245,Humana Insurance Company,Commercial PPO,232.75,95,,percent of total billed charges,,
"Blood Gas, Capillary",,82805,CPT,Facility,Outpatient,,,,245,208.25,70.217,245,Humana Insurance Company,Medicare PPO,120.05,49,,percent of total billed charges,,
"Blood Gas, Capillary",,82805,CPT,Facility,Inpatient,,,,245,208.25,70.217,245,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Blood Gas, Capillary",,82805,CPT,Facility,Both,,,,245,208.25,70.217,245,Medica,Individual & Family,242.795,99.1,,percent of total billed charges,,
"Blood Gas, Capillary",,82805,CPT,Facility,Outpatient,,,,245,208.25,70.217,245,Medica,Medica Advantage Solution,122.01,49.8,,percent of total billed charges,,
"Blood Gas, Capillary",,82805,CPT,Facility,Inpatient,,,,245,208.25,70.217,245,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Blood Gas, Capillary",,82805,CPT,Facility,Outpatient,,,,245,208.25,70.217,245,Medica,Medical Assistance,109.27,44.6,,percent of total billed charges,,
"Blood Gas, Capillary",,82805,CPT,Facility,Inpatient,,,,245,208.25,70.217,245,Medica,Medical Assistance,,,,,Included in per diem rate,
"Blood Gas, Capillary",,82805,CPT,Facility,Outpatient,,,,245,208.25,70.217,245,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,122.01,49.8,,percent of total billed charges,,
"Blood Gas, Capillary",,82805,CPT,Facility,Inpatient,,,,245,208.25,70.217,245,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Blood Gas, Capillary",,82805,CPT,Facility,Both,,,,245,208.25,70.217,245,"Multiplan, Inc.","Multiplan, Inc.",230.3,94,,percent of total billed charges,,
"Blood Gas, Capillary",,82805,CPT,Facility,Outpatient,,,,245,208.25,70.217,245,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,211.68,86.4,,percent of total billed charges,,
"Blood Gas, Capillary",,82805,CPT,Facility,Inpatient,,,,245,208.25,70.217,245,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Blood Gas, Capillary",,82805,CPT,Facility,Both,,,,245,208.25,70.217,245,"Preferred One Administrative Services, INC.",PPO,241.57,98.6,,percent of total billed charges,,
"Blood Gas, Capillary",,82805,CPT,Facility,Outpatient,,,,245,208.25,70.217,245,PrimeWest Health,Minnesota Senior Health Options (MSHO),126.0525,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Blood Gas, Capillary",,82805,CPT,Facility,Inpatient,,,,245,208.25,70.217,245,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Blood Gas, Capillary",,82805,CPT,Facility,Outpatient,,,,245,208.25,70.217,245,PrimeWest Health,MinnesotaCare,125.832,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Blood Gas, Capillary",,82805,CPT,Facility,Inpatient,,,,245,208.25,70.217,245,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Blood Gas, Capillary",,82805,CPT,Facility,Both,,,,245,208.25,70.217,245,Sanford Health Plan,Sanford Health Plan,225.4,92,,percent of total billed charges,,
"Blood Gas, Capillary",,82805,CPT,Facility,Outpatient,,,,245,208.25,70.217,245,"UCare Health, Inc.",Individual & Family Plan,138.0575,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Blood Gas, Capillary",,82805,CPT,Facility,Inpatient,,,,245,208.25,70.217,245,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Blood Gas, Capillary",,82805,CPT,Facility,Outpatient,,,,245,208.25,70.217,245,"UCare Health, Inc.",Medical Assistance,123.6515,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Blood Gas, Capillary",,82805,CPT,Facility,Inpatient,,,,245,208.25,70.217,245,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Blood Gas, Capillary",,82805,CPT,Facility,Outpatient,,,,245,208.25,70.217,245,"UCare Health, Inc.",Medicare Advantage,123.6515,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Blood Gas, Capillary",,82805,CPT,Facility,Inpatient,,,,245,208.25,70.217,245,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Blood Gas, Capillary",,82805,CPT,Facility,Outpatient,,,,245,208.25,70.217,245,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),123.6515,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Blood Gas, Capillary",,82805,CPT,Facility,Inpatient,,,,245,208.25,70.217,245,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Blood Gas, Capillary",,82805,CPT,Facility,Both,,,,245,208.25,70.217,245,UnitedHealthcare,Individual & Family,230.3,94,,percent of total billed charges,,
"Blood Gas, Capillary",,82805,CPT,Facility,Outpatient,,,,245,208.25,70.217,245,UnitedHealthcare,Medicare Advantage,120.05,49,,percent of total billed charges,,
"Blood Gas, Capillary",,82805,CPT,Facility,Inpatient,,,,245,208.25,70.217,245,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Blood Gas, Capillary",,82805,CPT,Facility,Outpatient,,,,245,208.25,70.217,245,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,117.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Blood Gas, Capillary",,82805,CPT,Facility,Inpatient,,,,245,208.25,70.217,245,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
ATROPINE 0.1 MG/ML FOR ETT (PEDS),,J0461,HCPCS,Facility,Both,10,mL,,52,44.2,14.9032,52,Aetna,Commercial,47.84,92,,percent of total billed charges,,
ATROPINE 0.1 MG/ML FOR ETT (PEDS),,J0461,HCPCS,Facility,Outpatient,10,mL,,52,44.2,14.9032,52,Aetna,Medicare Advantage,25.48,49,,percent of total billed charges,,
ATROPINE 0.1 MG/ML FOR ETT (PEDS),,J0461,HCPCS,Facility,Inpatient,10,mL,,52,44.2,14.9032,52,Aetna,Medicare Advantage,,,,,Included in per diem rate,
ATROPINE 0.1 MG/ML FOR ETT (PEDS),,J0461,HCPCS,Facility,Both,10,mL,,52,44.2,14.9032,52,Aetna,PPO,48.36,93,,percent of total billed charges,,
ATROPINE 0.1 MG/ML FOR ETT (PEDS),,J0461,HCPCS,Facility,Both,10,mL,,52,44.2,14.9032,52,America's PPO,America's PPO,49.9356,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
ATROPINE 0.1 MG/ML FOR ETT (PEDS),,J0461,HCPCS,Facility,Both,10,mL,,52,44.2,14.9032,52,BlueCross BlueShield Minnesota, Federal Employee Program,51.168,98.4,,percent of total billed charges,,
ATROPINE 0.1 MG/ML FOR ETT (PEDS),,J0461,HCPCS,Facility,Both,10,mL,,52,44.2,14.9032,52,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,52,100,,percent of total billed charges,,
ATROPINE 0.1 MG/ML FOR ETT (PEDS),,J0461,HCPCS,Facility,Both,10,mL,,52,44.2,14.9032,52,BlueCross BlueShield Minnesota,High Value Network Plan,46.8,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
ATROPINE 0.1 MG/ML FOR ETT (PEDS),,J0461,HCPCS,Facility,Outpatient,10,mL,,52,44.2,14.9032,52,BlueCross BlueShield Minnesota,Medicare Advantage,25.48,49,,percent of total billed charges,,
ATROPINE 0.1 MG/ML FOR ETT (PEDS),,J0461,HCPCS,Facility,Inpatient,10,mL,,52,44.2,14.9032,52,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
ATROPINE 0.1 MG/ML FOR ETT (PEDS),,J0461,HCPCS,Facility,Both,10,mL,,52,44.2,14.9032,52,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,46.0564,88.57,,percent of total billed charges,,
ATROPINE 0.1 MG/ML FOR ETT (PEDS),,J0461,HCPCS,Facility,Both,10,mL,,52,44.2,14.9032,52,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,14.9032,28.66,,percent of total billed charges,,
ATROPINE 0.1 MG/ML FOR ETT (PEDS),,J0461,HCPCS,Facility,Outpatient,10,mL,,52,44.2,14.9032,52,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),25.48,49,,percent of total billed charges,,
ATROPINE 0.1 MG/ML FOR ETT (PEDS),,J0461,HCPCS,Facility,Inpatient,10,mL,,52,44.2,14.9032,52,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
ATROPINE 0.1 MG/ML FOR ETT (PEDS),,J0461,HCPCS,Facility,Both,10,mL,,52,44.2,14.9032,52,CorVel,Worker's Compensation,52,100,,percent of total billed charges,,
ATROPINE 0.1 MG/ML FOR ETT (PEDS),,J0461,HCPCS,Facility,Both,10,mL,,52,44.2,14.9032,52,First Health Group Corporation,First Health Network,50.44,97,,percent of total billed charges,,
ATROPINE 0.1 MG/ML FOR ETT (PEDS),,J0461,HCPCS,Facility,Both,10,mL,,52,44.2,14.9032,52,"Health Partners, Inc.",Commercial,49.192,94.6,,percent of total billed charges,,
ATROPINE 0.1 MG/ML FOR ETT (PEDS),,J0461,HCPCS,Facility,Outpatient,10,mL,,52,44.2,14.9032,52,"Health Partners, Inc.",Medicare Advantage,25.48,49,,percent of total billed charges,,
ATROPINE 0.1 MG/ML FOR ETT (PEDS),,J0461,HCPCS,Facility,Inpatient,10,mL,,52,44.2,14.9032,52,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ATROPINE 0.1 MG/ML FOR ETT (PEDS),,J0461,HCPCS,Facility,Both,10,mL,,52,44.2,14.9032,52,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),31.2,60,,percent of total billed charges,,
ATROPINE 0.1 MG/ML FOR ETT (PEDS),,J0461,HCPCS,Facility,Both,10,mL,,52,44.2,14.9032,52,"Health Partners, Inc.",State of Minnesota Advantage Program,42.38,81.5,,percent of total billed charges,,
ATROPINE 0.1 MG/ML FOR ETT (PEDS),,J0461,HCPCS,Facility,Both,10,mL,,52,44.2,14.9032,52,"Health Partners, Inc.",State Public Programs,26,50,,percent of total billed charges,,
ATROPINE 0.1 MG/ML FOR ETT (PEDS),,J0461,HCPCS,Facility,Both,10,mL,,52,44.2,14.9032,52,Humana Insurance Company,Commercial PPO,49.4,95,,percent of total billed charges,,
ATROPINE 0.1 MG/ML FOR ETT (PEDS),,J0461,HCPCS,Facility,Outpatient,10,mL,,52,44.2,14.9032,52,Humana Insurance Company,Medicare PPO,25.48,49,,percent of total billed charges,,
ATROPINE 0.1 MG/ML FOR ETT (PEDS),,J0461,HCPCS,Facility,Inpatient,10,mL,,52,44.2,14.9032,52,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
ATROPINE 0.1 MG/ML FOR ETT (PEDS),,J0461,HCPCS,Facility,Both,10,mL,,52,44.2,14.9032,52,Medica,Individual & Family,51.532,99.1,,percent of total billed charges,,
ATROPINE 0.1 MG/ML FOR ETT (PEDS),,J0461,HCPCS,Facility,Outpatient,10,mL,,52,44.2,14.9032,52,Medica,Medica Advantage Solution,25.896,49.8,,percent of total billed charges,,
ATROPINE 0.1 MG/ML FOR ETT (PEDS),,J0461,HCPCS,Facility,Inpatient,10,mL,,52,44.2,14.9032,52,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
ATROPINE 0.1 MG/ML FOR ETT (PEDS),,J0461,HCPCS,Facility,Outpatient,10,mL,,52,44.2,14.9032,52,Medica,Medical Assistance,23.192,44.6,,percent of total billed charges,,
ATROPINE 0.1 MG/ML FOR ETT (PEDS),,J0461,HCPCS,Facility,Inpatient,10,mL,,52,44.2,14.9032,52,Medica,Medical Assistance,,,,,Included in per diem rate,
ATROPINE 0.1 MG/ML FOR ETT (PEDS),,J0461,HCPCS,Facility,Outpatient,10,mL,,52,44.2,14.9032,52,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,25.896,49.8,,percent of total billed charges,,
ATROPINE 0.1 MG/ML FOR ETT (PEDS),,J0461,HCPCS,Facility,Inpatient,10,mL,,52,44.2,14.9032,52,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
ATROPINE 0.1 MG/ML FOR ETT (PEDS),,J0461,HCPCS,Facility,Both,10,mL,,52,44.2,14.9032,52,"Multiplan, Inc.","Multiplan, Inc.",48.88,94,,percent of total billed charges,,
ATROPINE 0.1 MG/ML FOR ETT (PEDS),,J0461,HCPCS,Facility,Outpatient,10,mL,,52,44.2,14.9032,52,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,46.852,90.1,,percent of total billed charges,,
ATROPINE 0.1 MG/ML FOR ETT (PEDS),,J0461,HCPCS,Facility,Inpatient,10,mL,,52,44.2,14.9032,52,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
ATROPINE 0.1 MG/ML FOR ETT (PEDS),,J0461,HCPCS,Facility,Both,10,mL,,52,44.2,14.9032,52,"Preferred One Administrative Services, INC.",PPO,51.272,98.6,,percent of total billed charges,,
ATROPINE 0.1 MG/ML FOR ETT (PEDS),,J0461,HCPCS,Facility,Outpatient,10,mL,,52,44.2,14.9032,52,PrimeWest Health,Minnesota Senior Health Options (MSHO),26.754,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
ATROPINE 0.1 MG/ML FOR ETT (PEDS),,J0461,HCPCS,Facility,Inpatient,10,mL,,52,44.2,14.9032,52,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ATROPINE 0.1 MG/ML FOR ETT (PEDS),,J0461,HCPCS,Facility,Outpatient,10,mL,,52,44.2,14.9032,52,PrimeWest Health,MinnesotaCare,26.7072,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
ATROPINE 0.1 MG/ML FOR ETT (PEDS),,J0461,HCPCS,Facility,Inpatient,10,mL,,52,44.2,14.9032,52,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
ATROPINE 0.1 MG/ML FOR ETT (PEDS),,J0461,HCPCS,Facility,Both,10,mL,,52,44.2,14.9032,52,Sanford Health Plan,Sanford Health Plan,47.84,92,,percent of total billed charges,,
ATROPINE 0.1 MG/ML FOR ETT (PEDS),,J0461,HCPCS,Facility,Outpatient,10,mL,,52,44.2,14.9032,52,"UCare Health, Inc.",Individual & Family Plan,29.302,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
ATROPINE 0.1 MG/ML FOR ETT (PEDS),,J0461,HCPCS,Facility,Inpatient,10,mL,,52,44.2,14.9032,52,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
ATROPINE 0.1 MG/ML FOR ETT (PEDS),,J0461,HCPCS,Facility,Outpatient,10,mL,,52,44.2,14.9032,52,"UCare Health, Inc.",Medical Assistance,26.2444,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ATROPINE 0.1 MG/ML FOR ETT (PEDS),,J0461,HCPCS,Facility,Inpatient,10,mL,,52,44.2,14.9032,52,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
ATROPINE 0.1 MG/ML FOR ETT (PEDS),,J0461,HCPCS,Facility,Outpatient,10,mL,,52,44.2,14.9032,52,"UCare Health, Inc.",Medicare Advantage,26.2444,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ATROPINE 0.1 MG/ML FOR ETT (PEDS),,J0461,HCPCS,Facility,Inpatient,10,mL,,52,44.2,14.9032,52,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ATROPINE 0.1 MG/ML FOR ETT (PEDS),,J0461,HCPCS,Facility,Outpatient,10,mL,,52,44.2,14.9032,52,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),26.2444,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ATROPINE 0.1 MG/ML FOR ETT (PEDS),,J0461,HCPCS,Facility,Inpatient,10,mL,,52,44.2,14.9032,52,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ATROPINE 0.1 MG/ML FOR ETT (PEDS),,J0461,HCPCS,Facility,Both,10,mL,,52,44.2,14.9032,52,UnitedHealthcare,Individual & Family,48.88,94,,percent of total billed charges,,
ATROPINE 0.1 MG/ML FOR ETT (PEDS),,J0461,HCPCS,Facility,Outpatient,10,mL,,52,44.2,14.9032,52,UnitedHealthcare,Medicare Advantage,25.48,49,,percent of total billed charges,,
ATROPINE 0.1 MG/ML FOR ETT (PEDS),,J0461,HCPCS,Facility,Inpatient,10,mL,,52,44.2,14.9032,52,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
ATROPINE 0.1 MG/ML FOR ETT (PEDS),,J0461,HCPCS,Facility,Outpatient,10,mL,,52,44.2,14.9032,52,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,24.96,48,,percent of total billed charges,,100% of DHS outpatient percentage
ATROPINE 0.1 MG/ML FOR ETT (PEDS),,J0461,HCPCS,Facility,Inpatient,10,mL,,52,44.2,14.9032,52,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Glucose, Body Fluid",,82945,CPT,Facility,Both,,,,21,17.85,6.0186,21,Aetna,Commercial,19.32,92,,percent of total billed charges,,
"Glucose, Body Fluid",,82945,CPT,Facility,Outpatient,,,,21,17.85,6.0186,21,Aetna,Medicare Advantage,10.29,49,,percent of total billed charges,,
"Glucose, Body Fluid",,82945,CPT,Facility,Inpatient,,,,21,17.85,6.0186,21,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Glucose, Body Fluid",,82945,CPT,Facility,Both,,,,21,17.85,6.0186,21,Aetna,PPO,19.53,93,,percent of total billed charges,,
"Glucose, Body Fluid",,82945,CPT,Facility,Both,,,,21,17.85,6.0186,21,America's PPO,America's PPO,20.1663,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Glucose, Body Fluid",,82945,CPT,Facility,Both,,,,21,17.85,6.0186,21,BlueCross BlueShield Minnesota, Federal Employee Program,20.664,98.4,,percent of total billed charges,,
"Glucose, Body Fluid",,82945,CPT,Facility,Both,,,,21,17.85,6.0186,21,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,21,100,,percent of total billed charges,,
"Glucose, Body Fluid",,82945,CPT,Facility,Both,,,,21,17.85,6.0186,21,BlueCross BlueShield Minnesota,High Value Network Plan,18.9,90,,percent of total billed charges,,
"Glucose, Body Fluid",,82945,CPT,Facility,Outpatient,,,,21,17.85,6.0186,21,BlueCross BlueShield Minnesota,Medicare Advantage,10.29,49,,percent of total billed charges,,
"Glucose, Body Fluid",,82945,CPT,Facility,Inpatient,,,,21,17.85,6.0186,21,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Glucose, Body Fluid",,82945,CPT,Facility,Both,,,,21,17.85,6.0186,21,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,18.5997,88.57,,percent of total billed charges,,
"Glucose, Body Fluid",,82945,CPT,Facility,Both,,,,21,17.85,6.0186,21,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,6.0186,28.66,,percent of total billed charges,,
"Glucose, Body Fluid",,82945,CPT,Facility,Outpatient,,,,21,17.85,6.0186,21,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),10.29,49,,percent of total billed charges,,
"Glucose, Body Fluid",,82945,CPT,Facility,Inpatient,,,,21,17.85,6.0186,21,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Glucose, Body Fluid",,82945,CPT,Facility,Both,,,,21,17.85,6.0186,21,CorVel,Worker's Compensation,21,100,,percent of total billed charges,,
"Glucose, Body Fluid",,82945,CPT,Facility,Both,,,,21,17.85,6.0186,21,First Health Group Corporation,First Health Network,20.37,97,,percent of total billed charges,,
"Glucose, Body Fluid",,82945,CPT,Facility,Both,,,,21,17.85,6.0186,21,"Health Partners, Inc.",Commercial,19.866,94.6,,percent of total billed charges,,
"Glucose, Body Fluid",,82945,CPT,Facility,Outpatient,,,,21,17.85,6.0186,21,"Health Partners, Inc.",Medicare Advantage,10.29,49,,percent of total billed charges,,
"Glucose, Body Fluid",,82945,CPT,Facility,Inpatient,,,,21,17.85,6.0186,21,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Glucose, Body Fluid",,82945,CPT,Facility,Both,,,,21,17.85,6.0186,21,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),12.6,60,,percent of total billed charges,,
"Glucose, Body Fluid",,82945,CPT,Facility,Both,,,,21,17.85,6.0186,21,"Health Partners, Inc.",State of Minnesota Advantage Program,17.115,81.5,,percent of total billed charges,,
"Glucose, Body Fluid",,82945,CPT,Facility,Both,,,,21,17.85,6.0186,21,"Health Partners, Inc.",State Public Programs,10.5,50,,percent of total billed charges,,
"Glucose, Body Fluid",,82945,CPT,Facility,Both,,,,21,17.85,6.0186,21,Humana Insurance Company,Commercial PPO,19.95,95,,percent of total billed charges,,
"Glucose, Body Fluid",,82945,CPT,Facility,Outpatient,,,,21,17.85,6.0186,21,Humana Insurance Company,Medicare PPO,10.29,49,,percent of total billed charges,,
"Glucose, Body Fluid",,82945,CPT,Facility,Inpatient,,,,21,17.85,6.0186,21,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Glucose, Body Fluid",,82945,CPT,Facility,Both,,,,21,17.85,6.0186,21,Medica,Individual & Family,20.811,99.1,,percent of total billed charges,,
"Glucose, Body Fluid",,82945,CPT,Facility,Outpatient,,,,21,17.85,6.0186,21,Medica,Medica Advantage Solution,10.458,49.8,,percent of total billed charges,,
"Glucose, Body Fluid",,82945,CPT,Facility,Inpatient,,,,21,17.85,6.0186,21,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Glucose, Body Fluid",,82945,CPT,Facility,Outpatient,,,,21,17.85,6.0186,21,Medica,Medical Assistance,9.366,44.6,,percent of total billed charges,,
"Glucose, Body Fluid",,82945,CPT,Facility,Inpatient,,,,21,17.85,6.0186,21,Medica,Medical Assistance,,,,,Included in per diem rate,
"Glucose, Body Fluid",,82945,CPT,Facility,Outpatient,,,,21,17.85,6.0186,21,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,10.458,49.8,,percent of total billed charges,,
"Glucose, Body Fluid",,82945,CPT,Facility,Inpatient,,,,21,17.85,6.0186,21,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Glucose, Body Fluid",,82945,CPT,Facility,Both,,,,21,17.85,6.0186,21,"Multiplan, Inc.","Multiplan, Inc.",19.74,94,,percent of total billed charges,,
"Glucose, Body Fluid",,82945,CPT,Facility,Outpatient,,,,21,17.85,6.0186,21,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,18.144,86.4,,percent of total billed charges,,
"Glucose, Body Fluid",,82945,CPT,Facility,Inpatient,,,,21,17.85,6.0186,21,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Glucose, Body Fluid",,82945,CPT,Facility,Both,,,,21,17.85,6.0186,21,"Preferred One Administrative Services, INC.",PPO,20.706,98.6,,percent of total billed charges,,
"Glucose, Body Fluid",,82945,CPT,Facility,Outpatient,,,,21,17.85,6.0186,21,PrimeWest Health,Minnesota Senior Health Options (MSHO),10.8045,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Glucose, Body Fluid",,82945,CPT,Facility,Inpatient,,,,21,17.85,6.0186,21,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Glucose, Body Fluid",,82945,CPT,Facility,Outpatient,,,,21,17.85,6.0186,21,PrimeWest Health,MinnesotaCare,10.7856,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Glucose, Body Fluid",,82945,CPT,Facility,Inpatient,,,,21,17.85,6.0186,21,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Glucose, Body Fluid",,82945,CPT,Facility,Both,,,,21,17.85,6.0186,21,Sanford Health Plan,Sanford Health Plan,19.32,92,,percent of total billed charges,,
"Glucose, Body Fluid",,82945,CPT,Facility,Outpatient,,,,21,17.85,6.0186,21,"UCare Health, Inc.",Individual & Family Plan,11.8335,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Glucose, Body Fluid",,82945,CPT,Facility,Inpatient,,,,21,17.85,6.0186,21,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Glucose, Body Fluid",,82945,CPT,Facility,Outpatient,,,,21,17.85,6.0186,21,"UCare Health, Inc.",Medical Assistance,10.5987,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Glucose, Body Fluid",,82945,CPT,Facility,Inpatient,,,,21,17.85,6.0186,21,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Glucose, Body Fluid",,82945,CPT,Facility,Outpatient,,,,21,17.85,6.0186,21,"UCare Health, Inc.",Medicare Advantage,10.5987,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Glucose, Body Fluid",,82945,CPT,Facility,Inpatient,,,,21,17.85,6.0186,21,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Glucose, Body Fluid",,82945,CPT,Facility,Outpatient,,,,21,17.85,6.0186,21,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),10.5987,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Glucose, Body Fluid",,82945,CPT,Facility,Inpatient,,,,21,17.85,6.0186,21,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Glucose, Body Fluid",,82945,CPT,Facility,Both,,,,21,17.85,6.0186,21,UnitedHealthcare,Individual & Family,19.74,94,,percent of total billed charges,,
"Glucose, Body Fluid",,82945,CPT,Facility,Outpatient,,,,21,17.85,6.0186,21,UnitedHealthcare,Medicare Advantage,10.29,49,,percent of total billed charges,,
"Glucose, Body Fluid",,82945,CPT,Facility,Inpatient,,,,21,17.85,6.0186,21,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Glucose, Body Fluid",,82945,CPT,Facility,Outpatient,,,,21,17.85,6.0186,21,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,10.08,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Glucose, Body Fluid",,82945,CPT,Facility,Inpatient,,,,21,17.85,6.0186,21,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Glucose,,82947,CPT,Facility,Both,,,,60,51,17.196,60,Aetna,Commercial,55.2,92,,percent of total billed charges,,
Glucose,,82947,CPT,Facility,Outpatient,,,,60,51,17.196,60,Aetna,Medicare Advantage,29.4,49,,percent of total billed charges,,
Glucose,,82947,CPT,Facility,Inpatient,,,,60,51,17.196,60,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Glucose,,82947,CPT,Facility,Both,,,,60,51,17.196,60,Aetna,PPO,55.8,93,,percent of total billed charges,,
Glucose,,82947,CPT,Facility,Both,,,,60,51,17.196,60,America's PPO,America's PPO,57.618,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Glucose,,82947,CPT,Facility,Both,,,,60,51,17.196,60,BlueCross BlueShield Minnesota, Federal Employee Program,59.04,98.4,,percent of total billed charges,,
Glucose,,82947,CPT,Facility,Both,,,,60,51,17.196,60,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,60,100,,percent of total billed charges,,
Glucose,,82947,CPT,Facility,Both,,,,60,51,17.196,60,BlueCross BlueShield Minnesota,High Value Network Plan,54,90,,percent of total billed charges,,
Glucose,,82947,CPT,Facility,Outpatient,,,,60,51,17.196,60,BlueCross BlueShield Minnesota,Medicare Advantage,29.4,49,,percent of total billed charges,,
Glucose,,82947,CPT,Facility,Inpatient,,,,60,51,17.196,60,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Glucose,,82947,CPT,Facility,Both,,,,60,51,17.196,60,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,53.142,88.57,,percent of total billed charges,,
Glucose,,82947,CPT,Facility,Both,,,,60,51,17.196,60,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,17.196,28.66,,percent of total billed charges,,
Glucose,,82947,CPT,Facility,Outpatient,,,,60,51,17.196,60,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),29.4,49,,percent of total billed charges,,
Glucose,,82947,CPT,Facility,Inpatient,,,,60,51,17.196,60,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Glucose,,82947,CPT,Facility,Both,,,,60,51,17.196,60,CorVel,Worker's Compensation,60,100,,percent of total billed charges,,
Glucose,,82947,CPT,Facility,Both,,,,60,51,17.196,60,First Health Group Corporation,First Health Network,58.2,97,,percent of total billed charges,,
Glucose,,82947,CPT,Facility,Both,,,,60,51,17.196,60,"Health Partners, Inc.",Commercial,56.76,94.6,,percent of total billed charges,,
Glucose,,82947,CPT,Facility,Outpatient,,,,60,51,17.196,60,"Health Partners, Inc.",Medicare Advantage,29.4,49,,percent of total billed charges,,
Glucose,,82947,CPT,Facility,Inpatient,,,,60,51,17.196,60,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Glucose,,82947,CPT,Facility,Both,,,,60,51,17.196,60,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),36,60,,percent of total billed charges,,
Glucose,,82947,CPT,Facility,Both,,,,60,51,17.196,60,"Health Partners, Inc.",State of Minnesota Advantage Program,48.9,81.5,,percent of total billed charges,,
Glucose,,82947,CPT,Facility,Both,,,,60,51,17.196,60,"Health Partners, Inc.",State Public Programs,30,50,,percent of total billed charges,,
Glucose,,82947,CPT,Facility,Both,,,,60,51,17.196,60,Humana Insurance Company,Commercial PPO,57,95,,percent of total billed charges,,
Glucose,,82947,CPT,Facility,Outpatient,,,,60,51,17.196,60,Humana Insurance Company,Medicare PPO,29.4,49,,percent of total billed charges,,
Glucose,,82947,CPT,Facility,Inpatient,,,,60,51,17.196,60,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Glucose,,82947,CPT,Facility,Both,,,,60,51,17.196,60,Medica,Individual & Family,59.46,99.1,,percent of total billed charges,,
Glucose,,82947,CPT,Facility,Outpatient,,,,60,51,17.196,60,Medica,Medica Advantage Solution,29.88,49.8,,percent of total billed charges,,
Glucose,,82947,CPT,Facility,Inpatient,,,,60,51,17.196,60,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Glucose,,82947,CPT,Facility,Outpatient,,,,60,51,17.196,60,Medica,Medical Assistance,26.76,44.6,,percent of total billed charges,,
Glucose,,82947,CPT,Facility,Inpatient,,,,60,51,17.196,60,Medica,Medical Assistance,,,,,Included in per diem rate,
Glucose,,82947,CPT,Facility,Outpatient,,,,60,51,17.196,60,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,29.88,49.8,,percent of total billed charges,,
Glucose,,82947,CPT,Facility,Inpatient,,,,60,51,17.196,60,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Glucose,,82947,CPT,Facility,Both,,,,60,51,17.196,60,"Multiplan, Inc.","Multiplan, Inc.",56.4,94,,percent of total billed charges,,
Glucose,,82947,CPT,Facility,Outpatient,,,,60,51,17.196,60,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,51.84,86.4,,percent of total billed charges,,
Glucose,,82947,CPT,Facility,Inpatient,,,,60,51,17.196,60,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Glucose,,82947,CPT,Facility,Both,,,,60,51,17.196,60,"Preferred One Administrative Services, INC.",PPO,59.16,98.6,,percent of total billed charges,,
Glucose,,82947,CPT,Facility,Outpatient,,,,60,51,17.196,60,PrimeWest Health,Minnesota Senior Health Options (MSHO),30.87,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Glucose,,82947,CPT,Facility,Inpatient,,,,60,51,17.196,60,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Glucose,,82947,CPT,Facility,Outpatient,,,,60,51,17.196,60,PrimeWest Health,MinnesotaCare,30.816,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Glucose,,82947,CPT,Facility,Inpatient,,,,60,51,17.196,60,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Glucose,,82947,CPT,Facility,Both,,,,60,51,17.196,60,Sanford Health Plan,Sanford Health Plan,55.2,92,,percent of total billed charges,,
Glucose,,82947,CPT,Facility,Outpatient,,,,60,51,17.196,60,"UCare Health, Inc.",Individual & Family Plan,33.81,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Glucose,,82947,CPT,Facility,Inpatient,,,,60,51,17.196,60,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Glucose,,82947,CPT,Facility,Outpatient,,,,60,51,17.196,60,"UCare Health, Inc.",Medical Assistance,30.282,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Glucose,,82947,CPT,Facility,Inpatient,,,,60,51,17.196,60,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Glucose,,82947,CPT,Facility,Outpatient,,,,60,51,17.196,60,"UCare Health, Inc.",Medicare Advantage,30.282,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Glucose,,82947,CPT,Facility,Inpatient,,,,60,51,17.196,60,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Glucose,,82947,CPT,Facility,Outpatient,,,,60,51,17.196,60,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),30.282,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Glucose,,82947,CPT,Facility,Inpatient,,,,60,51,17.196,60,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Glucose,,82947,CPT,Facility,Both,,,,60,51,17.196,60,UnitedHealthcare,Individual & Family,56.4,94,,percent of total billed charges,,
Glucose,,82947,CPT,Facility,Outpatient,,,,60,51,17.196,60,UnitedHealthcare,Medicare Advantage,29.4,49,,percent of total billed charges,,
Glucose,,82947,CPT,Facility,Inpatient,,,,60,51,17.196,60,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Glucose,,82947,CPT,Facility,Outpatient,,,,60,51,17.196,60,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,28.8,48,,percent of total billed charges,,100% of DHS outpatient percentage
Glucose,,82947,CPT,Facility,Inpatient,,,,60,51,17.196,60,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Glucose; Post Glucose Dose (Includes Glucose),,82950,CPT,Facility,Both,,,,71,60.35,20.3486,71,Aetna,Commercial,65.32,92,,percent of total billed charges,,
Glucose; Post Glucose Dose (Includes Glucose),,82950,CPT,Facility,Outpatient,,,,71,60.35,20.3486,71,Aetna,Medicare Advantage,34.79,49,,percent of total billed charges,,
Glucose; Post Glucose Dose (Includes Glucose),,82950,CPT,Facility,Inpatient,,,,71,60.35,20.3486,71,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Glucose; Post Glucose Dose (Includes Glucose),,82950,CPT,Facility,Both,,,,71,60.35,20.3486,71,Aetna,PPO,66.03,93,,percent of total billed charges,,
Glucose; Post Glucose Dose (Includes Glucose),,82950,CPT,Facility,Both,,,,71,60.35,20.3486,71,America's PPO,America's PPO,68.1813,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Glucose; Post Glucose Dose (Includes Glucose),,82950,CPT,Facility,Both,,,,71,60.35,20.3486,71,BlueCross BlueShield Minnesota, Federal Employee Program,69.864,98.4,,percent of total billed charges,,
Glucose; Post Glucose Dose (Includes Glucose),,82950,CPT,Facility,Both,,,,71,60.35,20.3486,71,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,71,100,,percent of total billed charges,,
Glucose; Post Glucose Dose (Includes Glucose),,82950,CPT,Facility,Both,,,,71,60.35,20.3486,71,BlueCross BlueShield Minnesota,High Value Network Plan,63.9,90,,percent of total billed charges,,
Glucose; Post Glucose Dose (Includes Glucose),,82950,CPT,Facility,Outpatient,,,,71,60.35,20.3486,71,BlueCross BlueShield Minnesota,Medicare Advantage,34.79,49,,percent of total billed charges,,
Glucose; Post Glucose Dose (Includes Glucose),,82950,CPT,Facility,Inpatient,,,,71,60.35,20.3486,71,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Glucose; Post Glucose Dose (Includes Glucose),,82950,CPT,Facility,Both,,,,71,60.35,20.3486,71,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,62.8847,88.57,,percent of total billed charges,,
Glucose; Post Glucose Dose (Includes Glucose),,82950,CPT,Facility,Both,,,,71,60.35,20.3486,71,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,20.3486,28.66,,percent of total billed charges,,
Glucose; Post Glucose Dose (Includes Glucose),,82950,CPT,Facility,Outpatient,,,,71,60.35,20.3486,71,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),34.79,49,,percent of total billed charges,,
Glucose; Post Glucose Dose (Includes Glucose),,82950,CPT,Facility,Inpatient,,,,71,60.35,20.3486,71,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Glucose; Post Glucose Dose (Includes Glucose),,82950,CPT,Facility,Both,,,,71,60.35,20.3486,71,CorVel,Worker's Compensation,71,100,,percent of total billed charges,,
Glucose; Post Glucose Dose (Includes Glucose),,82950,CPT,Facility,Both,,,,71,60.35,20.3486,71,First Health Group Corporation,First Health Network,68.87,97,,percent of total billed charges,,
Glucose; Post Glucose Dose (Includes Glucose),,82950,CPT,Facility,Both,,,,71,60.35,20.3486,71,"Health Partners, Inc.",Commercial,67.166,94.6,,percent of total billed charges,,
Glucose; Post Glucose Dose (Includes Glucose),,82950,CPT,Facility,Outpatient,,,,71,60.35,20.3486,71,"Health Partners, Inc.",Medicare Advantage,34.79,49,,percent of total billed charges,,
Glucose; Post Glucose Dose (Includes Glucose),,82950,CPT,Facility,Inpatient,,,,71,60.35,20.3486,71,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Glucose; Post Glucose Dose (Includes Glucose),,82950,CPT,Facility,Both,,,,71,60.35,20.3486,71,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),42.6,60,,percent of total billed charges,,
Glucose; Post Glucose Dose (Includes Glucose),,82950,CPT,Facility,Both,,,,71,60.35,20.3486,71,"Health Partners, Inc.",State of Minnesota Advantage Program,57.865,81.5,,percent of total billed charges,,
Glucose; Post Glucose Dose (Includes Glucose),,82950,CPT,Facility,Both,,,,71,60.35,20.3486,71,"Health Partners, Inc.",State Public Programs,35.5,50,,percent of total billed charges,,
Glucose; Post Glucose Dose (Includes Glucose),,82950,CPT,Facility,Both,,,,71,60.35,20.3486,71,Humana Insurance Company,Commercial PPO,67.45,95,,percent of total billed charges,,
Glucose; Post Glucose Dose (Includes Glucose),,82950,CPT,Facility,Outpatient,,,,71,60.35,20.3486,71,Humana Insurance Company,Medicare PPO,34.79,49,,percent of total billed charges,,
Glucose; Post Glucose Dose (Includes Glucose),,82950,CPT,Facility,Inpatient,,,,71,60.35,20.3486,71,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Glucose; Post Glucose Dose (Includes Glucose),,82950,CPT,Facility,Both,,,,71,60.35,20.3486,71,Medica,Individual & Family,70.361,99.1,,percent of total billed charges,,
Glucose; Post Glucose Dose (Includes Glucose),,82950,CPT,Facility,Outpatient,,,,71,60.35,20.3486,71,Medica,Medica Advantage Solution,35.358,49.8,,percent of total billed charges,,
Glucose; Post Glucose Dose (Includes Glucose),,82950,CPT,Facility,Inpatient,,,,71,60.35,20.3486,71,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Glucose; Post Glucose Dose (Includes Glucose),,82950,CPT,Facility,Outpatient,,,,71,60.35,20.3486,71,Medica,Medical Assistance,31.666,44.6,,percent of total billed charges,,
Glucose; Post Glucose Dose (Includes Glucose),,82950,CPT,Facility,Inpatient,,,,71,60.35,20.3486,71,Medica,Medical Assistance,,,,,Included in per diem rate,
Glucose; Post Glucose Dose (Includes Glucose),,82950,CPT,Facility,Outpatient,,,,71,60.35,20.3486,71,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,35.358,49.8,,percent of total billed charges,,
Glucose; Post Glucose Dose (Includes Glucose),,82950,CPT,Facility,Inpatient,,,,71,60.35,20.3486,71,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Glucose; Post Glucose Dose (Includes Glucose),,82950,CPT,Facility,Both,,,,71,60.35,20.3486,71,"Multiplan, Inc.","Multiplan, Inc.",66.74,94,,percent of total billed charges,,
Glucose; Post Glucose Dose (Includes Glucose),,82950,CPT,Facility,Outpatient,,,,71,60.35,20.3486,71,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,61.344,86.4,,percent of total billed charges,,
Glucose; Post Glucose Dose (Includes Glucose),,82950,CPT,Facility,Inpatient,,,,71,60.35,20.3486,71,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Glucose; Post Glucose Dose (Includes Glucose),,82950,CPT,Facility,Both,,,,71,60.35,20.3486,71,"Preferred One Administrative Services, INC.",PPO,70.006,98.6,,percent of total billed charges,,
Glucose; Post Glucose Dose (Includes Glucose),,82950,CPT,Facility,Outpatient,,,,71,60.35,20.3486,71,PrimeWest Health,Minnesota Senior Health Options (MSHO),36.5295,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Glucose; Post Glucose Dose (Includes Glucose),,82950,CPT,Facility,Inpatient,,,,71,60.35,20.3486,71,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Glucose; Post Glucose Dose (Includes Glucose),,82950,CPT,Facility,Outpatient,,,,71,60.35,20.3486,71,PrimeWest Health,MinnesotaCare,36.4656,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Glucose; Post Glucose Dose (Includes Glucose),,82950,CPT,Facility,Inpatient,,,,71,60.35,20.3486,71,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Glucose; Post Glucose Dose (Includes Glucose),,82950,CPT,Facility,Both,,,,71,60.35,20.3486,71,Sanford Health Plan,Sanford Health Plan,65.32,92,,percent of total billed charges,,
Glucose; Post Glucose Dose (Includes Glucose),,82950,CPT,Facility,Outpatient,,,,71,60.35,20.3486,71,"UCare Health, Inc.",Individual & Family Plan,40.0085,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Glucose; Post Glucose Dose (Includes Glucose),,82950,CPT,Facility,Inpatient,,,,71,60.35,20.3486,71,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Glucose; Post Glucose Dose (Includes Glucose),,82950,CPT,Facility,Outpatient,,,,71,60.35,20.3486,71,"UCare Health, Inc.",Medical Assistance,35.8337,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Glucose; Post Glucose Dose (Includes Glucose),,82950,CPT,Facility,Inpatient,,,,71,60.35,20.3486,71,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Glucose; Post Glucose Dose (Includes Glucose),,82950,CPT,Facility,Outpatient,,,,71,60.35,20.3486,71,"UCare Health, Inc.",Medicare Advantage,35.8337,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Glucose; Post Glucose Dose (Includes Glucose),,82950,CPT,Facility,Inpatient,,,,71,60.35,20.3486,71,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Glucose; Post Glucose Dose (Includes Glucose),,82950,CPT,Facility,Outpatient,,,,71,60.35,20.3486,71,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),35.8337,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Glucose; Post Glucose Dose (Includes Glucose),,82950,CPT,Facility,Inpatient,,,,71,60.35,20.3486,71,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Glucose; Post Glucose Dose (Includes Glucose),,82950,CPT,Facility,Both,,,,71,60.35,20.3486,71,UnitedHealthcare,Individual & Family,66.74,94,,percent of total billed charges,,
Glucose; Post Glucose Dose (Includes Glucose),,82950,CPT,Facility,Outpatient,,,,71,60.35,20.3486,71,UnitedHealthcare,Medicare Advantage,34.79,49,,percent of total billed charges,,
Glucose; Post Glucose Dose (Includes Glucose),,82950,CPT,Facility,Inpatient,,,,71,60.35,20.3486,71,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Glucose; Post Glucose Dose (Includes Glucose),,82950,CPT,Facility,Outpatient,,,,71,60.35,20.3486,71,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,34.08,48,,percent of total billed charges,,100% of DHS outpatient percentage
Glucose; Post Glucose Dose (Includes Glucose),,82950,CPT,Facility,Inpatient,,,,71,60.35,20.3486,71,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Glucose; Tolerance Test (Gtt), 3 Specimens (Includes Glucose)",,82951,CPT,Facility,Both,,,,191,162.35,54.7406,191,Aetna,Commercial,175.72,92,,percent of total billed charges,,
"Glucose; Tolerance Test (Gtt), 3 Specimens (Includes Glucose)",,82951,CPT,Facility,Outpatient,,,,191,162.35,54.7406,191,Aetna,Medicare Advantage,93.59,49,,percent of total billed charges,,
"Glucose; Tolerance Test (Gtt), 3 Specimens (Includes Glucose)",,82951,CPT,Facility,Inpatient,,,,191,162.35,54.7406,191,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Glucose; Tolerance Test (Gtt), 3 Specimens (Includes Glucose)",,82951,CPT,Facility,Both,,,,191,162.35,54.7406,191,Aetna,PPO,177.63,93,,percent of total billed charges,,
"Glucose; Tolerance Test (Gtt), 3 Specimens (Includes Glucose)",,82951,CPT,Facility,Both,,,,191,162.35,54.7406,191,America's PPO,America's PPO,183.4173,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Glucose; Tolerance Test (Gtt), 3 Specimens (Includes Glucose)",,82951,CPT,Facility,Both,,,,191,162.35,54.7406,191,BlueCross BlueShield Minnesota, Federal Employee Program,187.944,98.4,,percent of total billed charges,,
"Glucose; Tolerance Test (Gtt), 3 Specimens (Includes Glucose)",,82951,CPT,Facility,Both,,,,191,162.35,54.7406,191,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,191,100,,percent of total billed charges,,
"Glucose; Tolerance Test (Gtt), 3 Specimens (Includes Glucose)",,82951,CPT,Facility,Both,,,,191,162.35,54.7406,191,BlueCross BlueShield Minnesota,High Value Network Plan,171.9,90,,percent of total billed charges,,
"Glucose; Tolerance Test (Gtt), 3 Specimens (Includes Glucose)",,82951,CPT,Facility,Outpatient,,,,191,162.35,54.7406,191,BlueCross BlueShield Minnesota,Medicare Advantage,93.59,49,,percent of total billed charges,,
"Glucose; Tolerance Test (Gtt), 3 Specimens (Includes Glucose)",,82951,CPT,Facility,Inpatient,,,,191,162.35,54.7406,191,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Glucose; Tolerance Test (Gtt), 3 Specimens (Includes Glucose)",,82951,CPT,Facility,Both,,,,191,162.35,54.7406,191,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,169.1687,88.57,,percent of total billed charges,,
"Glucose; Tolerance Test (Gtt), 3 Specimens (Includes Glucose)",,82951,CPT,Facility,Both,,,,191,162.35,54.7406,191,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,54.7406,28.66,,percent of total billed charges,,
"Glucose; Tolerance Test (Gtt), 3 Specimens (Includes Glucose)",,82951,CPT,Facility,Outpatient,,,,191,162.35,54.7406,191,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),93.59,49,,percent of total billed charges,,
"Glucose; Tolerance Test (Gtt), 3 Specimens (Includes Glucose)",,82951,CPT,Facility,Inpatient,,,,191,162.35,54.7406,191,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Glucose; Tolerance Test (Gtt), 3 Specimens (Includes Glucose)",,82951,CPT,Facility,Both,,,,191,162.35,54.7406,191,CorVel,Worker's Compensation,191,100,,percent of total billed charges,,
"Glucose; Tolerance Test (Gtt), 3 Specimens (Includes Glucose)",,82951,CPT,Facility,Both,,,,191,162.35,54.7406,191,First Health Group Corporation,First Health Network,185.27,97,,percent of total billed charges,,
"Glucose; Tolerance Test (Gtt), 3 Specimens (Includes Glucose)",,82951,CPT,Facility,Both,,,,191,162.35,54.7406,191,"Health Partners, Inc.",Commercial,180.686,94.6,,percent of total billed charges,,
"Glucose; Tolerance Test (Gtt), 3 Specimens (Includes Glucose)",,82951,CPT,Facility,Outpatient,,,,191,162.35,54.7406,191,"Health Partners, Inc.",Medicare Advantage,93.59,49,,percent of total billed charges,,
"Glucose; Tolerance Test (Gtt), 3 Specimens (Includes Glucose)",,82951,CPT,Facility,Inpatient,,,,191,162.35,54.7406,191,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Glucose; Tolerance Test (Gtt), 3 Specimens (Includes Glucose)",,82951,CPT,Facility,Both,,,,191,162.35,54.7406,191,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),114.6,60,,percent of total billed charges,,
"Glucose; Tolerance Test (Gtt), 3 Specimens (Includes Glucose)",,82951,CPT,Facility,Both,,,,191,162.35,54.7406,191,"Health Partners, Inc.",State of Minnesota Advantage Program,155.665,81.5,,percent of total billed charges,,
"Glucose; Tolerance Test (Gtt), 3 Specimens (Includes Glucose)",,82951,CPT,Facility,Both,,,,191,162.35,54.7406,191,"Health Partners, Inc.",State Public Programs,95.5,50,,percent of total billed charges,,
"Glucose; Tolerance Test (Gtt), 3 Specimens (Includes Glucose)",,82951,CPT,Facility,Both,,,,191,162.35,54.7406,191,Humana Insurance Company,Commercial PPO,181.45,95,,percent of total billed charges,,
"Glucose; Tolerance Test (Gtt), 3 Specimens (Includes Glucose)",,82951,CPT,Facility,Outpatient,,,,191,162.35,54.7406,191,Humana Insurance Company,Medicare PPO,93.59,49,,percent of total billed charges,,
"Glucose; Tolerance Test (Gtt), 3 Specimens (Includes Glucose)",,82951,CPT,Facility,Inpatient,,,,191,162.35,54.7406,191,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Glucose; Tolerance Test (Gtt), 3 Specimens (Includes Glucose)",,82951,CPT,Facility,Both,,,,191,162.35,54.7406,191,Medica,Individual & Family,189.281,99.1,,percent of total billed charges,,
"Glucose; Tolerance Test (Gtt), 3 Specimens (Includes Glucose)",,82951,CPT,Facility,Outpatient,,,,191,162.35,54.7406,191,Medica,Medica Advantage Solution,95.118,49.8,,percent of total billed charges,,
"Glucose; Tolerance Test (Gtt), 3 Specimens (Includes Glucose)",,82951,CPT,Facility,Inpatient,,,,191,162.35,54.7406,191,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Glucose; Tolerance Test (Gtt), 3 Specimens (Includes Glucose)",,82951,CPT,Facility,Outpatient,,,,191,162.35,54.7406,191,Medica,Medical Assistance,85.186,44.6,,percent of total billed charges,,
"Glucose; Tolerance Test (Gtt), 3 Specimens (Includes Glucose)",,82951,CPT,Facility,Inpatient,,,,191,162.35,54.7406,191,Medica,Medical Assistance,,,,,Included in per diem rate,
"Glucose; Tolerance Test (Gtt), 3 Specimens (Includes Glucose)",,82951,CPT,Facility,Outpatient,,,,191,162.35,54.7406,191,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,95.118,49.8,,percent of total billed charges,,
"Glucose; Tolerance Test (Gtt), 3 Specimens (Includes Glucose)",,82951,CPT,Facility,Inpatient,,,,191,162.35,54.7406,191,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Glucose; Tolerance Test (Gtt), 3 Specimens (Includes Glucose)",,82951,CPT,Facility,Both,,,,191,162.35,54.7406,191,"Multiplan, Inc.","Multiplan, Inc.",179.54,94,,percent of total billed charges,,
"Glucose; Tolerance Test (Gtt), 3 Specimens (Includes Glucose)",,82951,CPT,Facility,Outpatient,,,,191,162.35,54.7406,191,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,165.024,86.4,,percent of total billed charges,,
"Glucose; Tolerance Test (Gtt), 3 Specimens (Includes Glucose)",,82951,CPT,Facility,Inpatient,,,,191,162.35,54.7406,191,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Glucose; Tolerance Test (Gtt), 3 Specimens (Includes Glucose)",,82951,CPT,Facility,Both,,,,191,162.35,54.7406,191,"Preferred One Administrative Services, INC.",PPO,188.326,98.6,,percent of total billed charges,,
"Glucose; Tolerance Test (Gtt), 3 Specimens (Includes Glucose)",,82951,CPT,Facility,Outpatient,,,,191,162.35,54.7406,191,PrimeWest Health,Minnesota Senior Health Options (MSHO),98.2695,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Glucose; Tolerance Test (Gtt), 3 Specimens (Includes Glucose)",,82951,CPT,Facility,Inpatient,,,,191,162.35,54.7406,191,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Glucose; Tolerance Test (Gtt), 3 Specimens (Includes Glucose)",,82951,CPT,Facility,Outpatient,,,,191,162.35,54.7406,191,PrimeWest Health,MinnesotaCare,98.0976,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Glucose; Tolerance Test (Gtt), 3 Specimens (Includes Glucose)",,82951,CPT,Facility,Inpatient,,,,191,162.35,54.7406,191,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Glucose; Tolerance Test (Gtt), 3 Specimens (Includes Glucose)",,82951,CPT,Facility,Both,,,,191,162.35,54.7406,191,Sanford Health Plan,Sanford Health Plan,175.72,92,,percent of total billed charges,,
"Glucose; Tolerance Test (Gtt), 3 Specimens (Includes Glucose)",,82951,CPT,Facility,Outpatient,,,,191,162.35,54.7406,191,"UCare Health, Inc.",Individual & Family Plan,107.6285,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Glucose; Tolerance Test (Gtt), 3 Specimens (Includes Glucose)",,82951,CPT,Facility,Inpatient,,,,191,162.35,54.7406,191,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Glucose; Tolerance Test (Gtt), 3 Specimens (Includes Glucose)",,82951,CPT,Facility,Outpatient,,,,191,162.35,54.7406,191,"UCare Health, Inc.",Medical Assistance,96.3977,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Glucose; Tolerance Test (Gtt), 3 Specimens (Includes Glucose)",,82951,CPT,Facility,Inpatient,,,,191,162.35,54.7406,191,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Glucose; Tolerance Test (Gtt), 3 Specimens (Includes Glucose)",,82951,CPT,Facility,Outpatient,,,,191,162.35,54.7406,191,"UCare Health, Inc.",Medicare Advantage,96.3977,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Glucose; Tolerance Test (Gtt), 3 Specimens (Includes Glucose)",,82951,CPT,Facility,Inpatient,,,,191,162.35,54.7406,191,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Glucose; Tolerance Test (Gtt), 3 Specimens (Includes Glucose)",,82951,CPT,Facility,Outpatient,,,,191,162.35,54.7406,191,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),96.3977,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Glucose; Tolerance Test (Gtt), 3 Specimens (Includes Glucose)",,82951,CPT,Facility,Inpatient,,,,191,162.35,54.7406,191,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Glucose; Tolerance Test (Gtt), 3 Specimens (Includes Glucose)",,82951,CPT,Facility,Both,,,,191,162.35,54.7406,191,UnitedHealthcare,Individual & Family,179.54,94,,percent of total billed charges,,
"Glucose; Tolerance Test (Gtt), 3 Specimens (Includes Glucose)",,82951,CPT,Facility,Outpatient,,,,191,162.35,54.7406,191,UnitedHealthcare,Medicare Advantage,93.59,49,,percent of total billed charges,,
"Glucose; Tolerance Test (Gtt), 3 Specimens (Includes Glucose)",,82951,CPT,Facility,Inpatient,,,,191,162.35,54.7406,191,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Glucose; Tolerance Test (Gtt), 3 Specimens (Includes Glucose)",,82951,CPT,Facility,Outpatient,,,,191,162.35,54.7406,191,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,91.68,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Glucose; Tolerance Test (Gtt), 3 Specimens (Includes Glucose)",,82951,CPT,Facility,Inpatient,,,,191,162.35,54.7406,191,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Glucose; Tolerance Test; Each Addl Specimen Beyond 3,,82952,CPT,Facility,Both,,,,22,18.7,6.3052,22,Aetna,Commercial,20.24,92,,percent of total billed charges,,
Glucose; Tolerance Test; Each Addl Specimen Beyond 3,,82952,CPT,Facility,Outpatient,,,,22,18.7,6.3052,22,Aetna,Medicare Advantage,10.78,49,,percent of total billed charges,,
Glucose; Tolerance Test; Each Addl Specimen Beyond 3,,82952,CPT,Facility,Inpatient,,,,22,18.7,6.3052,22,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Glucose; Tolerance Test; Each Addl Specimen Beyond 3,,82952,CPT,Facility,Both,,,,22,18.7,6.3052,22,Aetna,PPO,20.46,93,,percent of total billed charges,,
Glucose; Tolerance Test; Each Addl Specimen Beyond 3,,82952,CPT,Facility,Both,,,,22,18.7,6.3052,22,America's PPO,America's PPO,21.1266,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Glucose; Tolerance Test; Each Addl Specimen Beyond 3,,82952,CPT,Facility,Both,,,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota, Federal Employee Program,21.648,98.4,,percent of total billed charges,,
Glucose; Tolerance Test; Each Addl Specimen Beyond 3,,82952,CPT,Facility,Both,,,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,22,100,,percent of total billed charges,,
Glucose; Tolerance Test; Each Addl Specimen Beyond 3,,82952,CPT,Facility,Both,,,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota,High Value Network Plan,19.8,90,,percent of total billed charges,,
Glucose; Tolerance Test; Each Addl Specimen Beyond 3,,82952,CPT,Facility,Outpatient,,,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota,Medicare Advantage,10.78,49,,percent of total billed charges,,
Glucose; Tolerance Test; Each Addl Specimen Beyond 3,,82952,CPT,Facility,Inpatient,,,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Glucose; Tolerance Test; Each Addl Specimen Beyond 3,,82952,CPT,Facility,Both,,,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,19.4854,88.57,,percent of total billed charges,,
Glucose; Tolerance Test; Each Addl Specimen Beyond 3,,82952,CPT,Facility,Both,,,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,6.3052,28.66,,percent of total billed charges,,
Glucose; Tolerance Test; Each Addl Specimen Beyond 3,,82952,CPT,Facility,Outpatient,,,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),10.78,49,,percent of total billed charges,,
Glucose; Tolerance Test; Each Addl Specimen Beyond 3,,82952,CPT,Facility,Inpatient,,,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Glucose; Tolerance Test; Each Addl Specimen Beyond 3,,82952,CPT,Facility,Both,,,,22,18.7,6.3052,22,CorVel,Worker's Compensation,22,100,,percent of total billed charges,,
Glucose; Tolerance Test; Each Addl Specimen Beyond 3,,82952,CPT,Facility,Both,,,,22,18.7,6.3052,22,First Health Group Corporation,First Health Network,21.34,97,,percent of total billed charges,,
Glucose; Tolerance Test; Each Addl Specimen Beyond 3,,82952,CPT,Facility,Both,,,,22,18.7,6.3052,22,"Health Partners, Inc.",Commercial,20.812,94.6,,percent of total billed charges,,
Glucose; Tolerance Test; Each Addl Specimen Beyond 3,,82952,CPT,Facility,Outpatient,,,,22,18.7,6.3052,22,"Health Partners, Inc.",Medicare Advantage,10.78,49,,percent of total billed charges,,
Glucose; Tolerance Test; Each Addl Specimen Beyond 3,,82952,CPT,Facility,Inpatient,,,,22,18.7,6.3052,22,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Glucose; Tolerance Test; Each Addl Specimen Beyond 3,,82952,CPT,Facility,Both,,,,22,18.7,6.3052,22,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),13.2,60,,percent of total billed charges,,
Glucose; Tolerance Test; Each Addl Specimen Beyond 3,,82952,CPT,Facility,Both,,,,22,18.7,6.3052,22,"Health Partners, Inc.",State of Minnesota Advantage Program,17.93,81.5,,percent of total billed charges,,
Glucose; Tolerance Test; Each Addl Specimen Beyond 3,,82952,CPT,Facility,Both,,,,22,18.7,6.3052,22,"Health Partners, Inc.",State Public Programs,11,50,,percent of total billed charges,,
Glucose; Tolerance Test; Each Addl Specimen Beyond 3,,82952,CPT,Facility,Both,,,,22,18.7,6.3052,22,Humana Insurance Company,Commercial PPO,20.9,95,,percent of total billed charges,,
Glucose; Tolerance Test; Each Addl Specimen Beyond 3,,82952,CPT,Facility,Outpatient,,,,22,18.7,6.3052,22,Humana Insurance Company,Medicare PPO,10.78,49,,percent of total billed charges,,
Glucose; Tolerance Test; Each Addl Specimen Beyond 3,,82952,CPT,Facility,Inpatient,,,,22,18.7,6.3052,22,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Glucose; Tolerance Test; Each Addl Specimen Beyond 3,,82952,CPT,Facility,Both,,,,22,18.7,6.3052,22,Medica,Individual & Family,21.802,99.1,,percent of total billed charges,,
Glucose; Tolerance Test; Each Addl Specimen Beyond 3,,82952,CPT,Facility,Outpatient,,,,22,18.7,6.3052,22,Medica,Medica Advantage Solution,10.956,49.8,,percent of total billed charges,,
Glucose; Tolerance Test; Each Addl Specimen Beyond 3,,82952,CPT,Facility,Inpatient,,,,22,18.7,6.3052,22,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Glucose; Tolerance Test; Each Addl Specimen Beyond 3,,82952,CPT,Facility,Outpatient,,,,22,18.7,6.3052,22,Medica,Medical Assistance,9.812,44.6,,percent of total billed charges,,
Glucose; Tolerance Test; Each Addl Specimen Beyond 3,,82952,CPT,Facility,Inpatient,,,,22,18.7,6.3052,22,Medica,Medical Assistance,,,,,Included in per diem rate,
Glucose; Tolerance Test; Each Addl Specimen Beyond 3,,82952,CPT,Facility,Outpatient,,,,22,18.7,6.3052,22,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,10.956,49.8,,percent of total billed charges,,
Glucose; Tolerance Test; Each Addl Specimen Beyond 3,,82952,CPT,Facility,Inpatient,,,,22,18.7,6.3052,22,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Glucose; Tolerance Test; Each Addl Specimen Beyond 3,,82952,CPT,Facility,Both,,,,22,18.7,6.3052,22,"Multiplan, Inc.","Multiplan, Inc.",20.68,94,,percent of total billed charges,,
Glucose; Tolerance Test; Each Addl Specimen Beyond 3,,82952,CPT,Facility,Outpatient,,,,22,18.7,6.3052,22,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,19.008,86.4,,percent of total billed charges,,
Glucose; Tolerance Test; Each Addl Specimen Beyond 3,,82952,CPT,Facility,Inpatient,,,,22,18.7,6.3052,22,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Glucose; Tolerance Test; Each Addl Specimen Beyond 3,,82952,CPT,Facility,Both,,,,22,18.7,6.3052,22,"Preferred One Administrative Services, INC.",PPO,21.692,98.6,,percent of total billed charges,,
Glucose; Tolerance Test; Each Addl Specimen Beyond 3,,82952,CPT,Facility,Outpatient,,,,22,18.7,6.3052,22,PrimeWest Health,Minnesota Senior Health Options (MSHO),11.319,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Glucose; Tolerance Test; Each Addl Specimen Beyond 3,,82952,CPT,Facility,Inpatient,,,,22,18.7,6.3052,22,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Glucose; Tolerance Test; Each Addl Specimen Beyond 3,,82952,CPT,Facility,Outpatient,,,,22,18.7,6.3052,22,PrimeWest Health,MinnesotaCare,11.2992,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Glucose; Tolerance Test; Each Addl Specimen Beyond 3,,82952,CPT,Facility,Inpatient,,,,22,18.7,6.3052,22,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Glucose; Tolerance Test; Each Addl Specimen Beyond 3,,82952,CPT,Facility,Both,,,,22,18.7,6.3052,22,Sanford Health Plan,Sanford Health Plan,20.24,92,,percent of total billed charges,,
Glucose; Tolerance Test; Each Addl Specimen Beyond 3,,82952,CPT,Facility,Outpatient,,,,22,18.7,6.3052,22,"UCare Health, Inc.",Individual & Family Plan,12.397,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Glucose; Tolerance Test; Each Addl Specimen Beyond 3,,82952,CPT,Facility,Inpatient,,,,22,18.7,6.3052,22,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Glucose; Tolerance Test; Each Addl Specimen Beyond 3,,82952,CPT,Facility,Outpatient,,,,22,18.7,6.3052,22,"UCare Health, Inc.",Medical Assistance,11.1034,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Glucose; Tolerance Test; Each Addl Specimen Beyond 3,,82952,CPT,Facility,Inpatient,,,,22,18.7,6.3052,22,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Glucose; Tolerance Test; Each Addl Specimen Beyond 3,,82952,CPT,Facility,Outpatient,,,,22,18.7,6.3052,22,"UCare Health, Inc.",Medicare Advantage,11.1034,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Glucose; Tolerance Test; Each Addl Specimen Beyond 3,,82952,CPT,Facility,Inpatient,,,,22,18.7,6.3052,22,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Glucose; Tolerance Test; Each Addl Specimen Beyond 3,,82952,CPT,Facility,Outpatient,,,,22,18.7,6.3052,22,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),11.1034,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Glucose; Tolerance Test; Each Addl Specimen Beyond 3,,82952,CPT,Facility,Inpatient,,,,22,18.7,6.3052,22,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Glucose; Tolerance Test; Each Addl Specimen Beyond 3,,82952,CPT,Facility,Both,,,,22,18.7,6.3052,22,UnitedHealthcare,Individual & Family,20.68,94,,percent of total billed charges,,
Glucose; Tolerance Test; Each Addl Specimen Beyond 3,,82952,CPT,Facility,Outpatient,,,,22,18.7,6.3052,22,UnitedHealthcare,Medicare Advantage,10.78,49,,percent of total billed charges,,
Glucose; Tolerance Test; Each Addl Specimen Beyond 3,,82952,CPT,Facility,Inpatient,,,,22,18.7,6.3052,22,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Glucose; Tolerance Test; Each Addl Specimen Beyond 3,,82952,CPT,Facility,Outpatient,,,,22,18.7,6.3052,22,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,10.56,48,,percent of total billed charges,,100% of DHS outpatient percentage
Glucose; Tolerance Test; Each Addl Specimen Beyond 3,,82952,CPT,Facility,Inpatient,,,,22,18.7,6.3052,22,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Glucose Meter,,82962,CPT,Facility,Both,,,,29,24.65,8.3114,29,Aetna,Commercial,26.68,92,,percent of total billed charges,,
Glucose Meter,,82962,CPT,Facility,Outpatient,,,,29,24.65,8.3114,29,Aetna,Medicare Advantage,14.21,49,,percent of total billed charges,,
Glucose Meter,,82962,CPT,Facility,Inpatient,,,,29,24.65,8.3114,29,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Glucose Meter,,82962,CPT,Facility,Both,,,,29,24.65,8.3114,29,Aetna,PPO,26.97,93,,percent of total billed charges,,
Glucose Meter,,82962,CPT,Facility,Both,,,,29,24.65,8.3114,29,America's PPO,America's PPO,27.8487,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Glucose Meter,,82962,CPT,Facility,Both,,,,29,24.65,8.3114,29,BlueCross BlueShield Minnesota, Federal Employee Program,28.536,98.4,,percent of total billed charges,,
Glucose Meter,,82962,CPT,Facility,Both,,,,29,24.65,8.3114,29,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,29,100,,percent of total billed charges,,
Glucose Meter,,82962,CPT,Facility,Both,,,,29,24.65,8.3114,29,BlueCross BlueShield Minnesota,High Value Network Plan,26.1,90,,percent of total billed charges,,
Glucose Meter,,82962,CPT,Facility,Outpatient,,,,29,24.65,8.3114,29,BlueCross BlueShield Minnesota,Medicare Advantage,14.21,49,,percent of total billed charges,,
Glucose Meter,,82962,CPT,Facility,Inpatient,,,,29,24.65,8.3114,29,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Glucose Meter,,82962,CPT,Facility,Both,,,,29,24.65,8.3114,29,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,25.6853,88.57,,percent of total billed charges,,
Glucose Meter,,82962,CPT,Facility,Both,,,,29,24.65,8.3114,29,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,8.3114,28.66,,percent of total billed charges,,
Glucose Meter,,82962,CPT,Facility,Outpatient,,,,29,24.65,8.3114,29,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),14.21,49,,percent of total billed charges,,
Glucose Meter,,82962,CPT,Facility,Inpatient,,,,29,24.65,8.3114,29,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Glucose Meter,,82962,CPT,Facility,Both,,,,29,24.65,8.3114,29,CorVel,Worker's Compensation,29,100,,percent of total billed charges,,
Glucose Meter,,82962,CPT,Facility,Both,,,,29,24.65,8.3114,29,First Health Group Corporation,First Health Network,28.13,97,,percent of total billed charges,,
Glucose Meter,,82962,CPT,Facility,Both,,,,29,24.65,8.3114,29,"Health Partners, Inc.",Commercial,27.434,94.6,,percent of total billed charges,,
Glucose Meter,,82962,CPT,Facility,Outpatient,,,,29,24.65,8.3114,29,"Health Partners, Inc.",Medicare Advantage,14.21,49,,percent of total billed charges,,
Glucose Meter,,82962,CPT,Facility,Inpatient,,,,29,24.65,8.3114,29,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Glucose Meter,,82962,CPT,Facility,Both,,,,29,24.65,8.3114,29,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),17.4,60,,percent of total billed charges,,
Glucose Meter,,82962,CPT,Facility,Both,,,,29,24.65,8.3114,29,"Health Partners, Inc.",State of Minnesota Advantage Program,23.635,81.5,,percent of total billed charges,,
Glucose Meter,,82962,CPT,Facility,Both,,,,29,24.65,8.3114,29,"Health Partners, Inc.",State Public Programs,14.5,50,,percent of total billed charges,,
Glucose Meter,,82962,CPT,Facility,Both,,,,29,24.65,8.3114,29,Humana Insurance Company,Commercial PPO,27.55,95,,percent of total billed charges,,
Glucose Meter,,82962,CPT,Facility,Outpatient,,,,29,24.65,8.3114,29,Humana Insurance Company,Medicare PPO,14.21,49,,percent of total billed charges,,
Glucose Meter,,82962,CPT,Facility,Inpatient,,,,29,24.65,8.3114,29,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Glucose Meter,,82962,CPT,Facility,Both,,,,29,24.65,8.3114,29,Medica,Individual & Family,28.739,99.1,,percent of total billed charges,,
Glucose Meter,,82962,CPT,Facility,Outpatient,,,,29,24.65,8.3114,29,Medica,Medica Advantage Solution,14.442,49.8,,percent of total billed charges,,
Glucose Meter,,82962,CPT,Facility,Inpatient,,,,29,24.65,8.3114,29,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Glucose Meter,,82962,CPT,Facility,Outpatient,,,,29,24.65,8.3114,29,Medica,Medical Assistance,12.934,44.6,,percent of total billed charges,,
Glucose Meter,,82962,CPT,Facility,Inpatient,,,,29,24.65,8.3114,29,Medica,Medical Assistance,,,,,Included in per diem rate,
Glucose Meter,,82962,CPT,Facility,Outpatient,,,,29,24.65,8.3114,29,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,14.442,49.8,,percent of total billed charges,,
Glucose Meter,,82962,CPT,Facility,Inpatient,,,,29,24.65,8.3114,29,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Glucose Meter,,82962,CPT,Facility,Both,,,,29,24.65,8.3114,29,"Multiplan, Inc.","Multiplan, Inc.",27.26,94,,percent of total billed charges,,
Glucose Meter,,82962,CPT,Facility,Outpatient,,,,29,24.65,8.3114,29,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,25.056,86.4,,percent of total billed charges,,
Glucose Meter,,82962,CPT,Facility,Inpatient,,,,29,24.65,8.3114,29,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Glucose Meter,,82962,CPT,Facility,Both,,,,29,24.65,8.3114,29,"Preferred One Administrative Services, INC.",PPO,28.594,98.6,,percent of total billed charges,,
Glucose Meter,,82962,CPT,Facility,Outpatient,,,,29,24.65,8.3114,29,PrimeWest Health,Minnesota Senior Health Options (MSHO),14.9205,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Glucose Meter,,82962,CPT,Facility,Inpatient,,,,29,24.65,8.3114,29,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Glucose Meter,,82962,CPT,Facility,Outpatient,,,,29,24.65,8.3114,29,PrimeWest Health,MinnesotaCare,14.8944,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Glucose Meter,,82962,CPT,Facility,Inpatient,,,,29,24.65,8.3114,29,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Glucose Meter,,82962,CPT,Facility,Both,,,,29,24.65,8.3114,29,Sanford Health Plan,Sanford Health Plan,26.68,92,,percent of total billed charges,,
Glucose Meter,,82962,CPT,Facility,Outpatient,,,,29,24.65,8.3114,29,"UCare Health, Inc.",Individual & Family Plan,16.3415,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Glucose Meter,,82962,CPT,Facility,Inpatient,,,,29,24.65,8.3114,29,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Glucose Meter,,82962,CPT,Facility,Outpatient,,,,29,24.65,8.3114,29,"UCare Health, Inc.",Medical Assistance,14.6363,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Glucose Meter,,82962,CPT,Facility,Inpatient,,,,29,24.65,8.3114,29,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Glucose Meter,,82962,CPT,Facility,Outpatient,,,,29,24.65,8.3114,29,"UCare Health, Inc.",Medicare Advantage,14.6363,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Glucose Meter,,82962,CPT,Facility,Inpatient,,,,29,24.65,8.3114,29,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Glucose Meter,,82962,CPT,Facility,Outpatient,,,,29,24.65,8.3114,29,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),14.6363,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Glucose Meter,,82962,CPT,Facility,Inpatient,,,,29,24.65,8.3114,29,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Glucose Meter,,82962,CPT,Facility,Both,,,,29,24.65,8.3114,29,UnitedHealthcare,Individual & Family,27.26,94,,percent of total billed charges,,
Glucose Meter,,82962,CPT,Facility,Outpatient,,,,29,24.65,8.3114,29,UnitedHealthcare,Medicare Advantage,14.21,49,,percent of total billed charges,,
Glucose Meter,,82962,CPT,Facility,Inpatient,,,,29,24.65,8.3114,29,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Glucose Meter,,82962,CPT,Facility,Outpatient,,,,29,24.65,8.3114,29,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,13.92,48,,percent of total billed charges,,100% of DHS outpatient percentage
Glucose Meter,,82962,CPT,Facility,Inpatient,,,,29,24.65,8.3114,29,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Gamma Glutamyl Transferase,,82977,CPT,Facility,Both,,,,79,67.15,22.6414,79,Aetna,Commercial,72.68,92,,percent of total billed charges,,
Gamma Glutamyl Transferase,,82977,CPT,Facility,Outpatient,,,,79,67.15,22.6414,79,Aetna,Medicare Advantage,38.71,49,,percent of total billed charges,,
Gamma Glutamyl Transferase,,82977,CPT,Facility,Inpatient,,,,79,67.15,22.6414,79,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Gamma Glutamyl Transferase,,82977,CPT,Facility,Both,,,,79,67.15,22.6414,79,Aetna,PPO,73.47,93,,percent of total billed charges,,
Gamma Glutamyl Transferase,,82977,CPT,Facility,Both,,,,79,67.15,22.6414,79,America's PPO,America's PPO,75.8637,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Gamma Glutamyl Transferase,,82977,CPT,Facility,Both,,,,79,67.15,22.6414,79,BlueCross BlueShield Minnesota, Federal Employee Program,77.736,98.4,,percent of total billed charges,,
Gamma Glutamyl Transferase,,82977,CPT,Facility,Both,,,,79,67.15,22.6414,79,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,79,100,,percent of total billed charges,,
Gamma Glutamyl Transferase,,82977,CPT,Facility,Both,,,,79,67.15,22.6414,79,BlueCross BlueShield Minnesota,High Value Network Plan,71.1,90,,percent of total billed charges,,
Gamma Glutamyl Transferase,,82977,CPT,Facility,Outpatient,,,,79,67.15,22.6414,79,BlueCross BlueShield Minnesota,Medicare Advantage,38.71,49,,percent of total billed charges,,
Gamma Glutamyl Transferase,,82977,CPT,Facility,Inpatient,,,,79,67.15,22.6414,79,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Gamma Glutamyl Transferase,,82977,CPT,Facility,Both,,,,79,67.15,22.6414,79,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,69.9703,88.57,,percent of total billed charges,,
Gamma Glutamyl Transferase,,82977,CPT,Facility,Both,,,,79,67.15,22.6414,79,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,22.6414,28.66,,percent of total billed charges,,
Gamma Glutamyl Transferase,,82977,CPT,Facility,Outpatient,,,,79,67.15,22.6414,79,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),38.71,49,,percent of total billed charges,,
Gamma Glutamyl Transferase,,82977,CPT,Facility,Inpatient,,,,79,67.15,22.6414,79,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Gamma Glutamyl Transferase,,82977,CPT,Facility,Both,,,,79,67.15,22.6414,79,CorVel,Worker's Compensation,79,100,,percent of total billed charges,,
Gamma Glutamyl Transferase,,82977,CPT,Facility,Both,,,,79,67.15,22.6414,79,First Health Group Corporation,First Health Network,76.63,97,,percent of total billed charges,,
Gamma Glutamyl Transferase,,82977,CPT,Facility,Both,,,,79,67.15,22.6414,79,"Health Partners, Inc.",Commercial,74.734,94.6,,percent of total billed charges,,
Gamma Glutamyl Transferase,,82977,CPT,Facility,Outpatient,,,,79,67.15,22.6414,79,"Health Partners, Inc.",Medicare Advantage,38.71,49,,percent of total billed charges,,
Gamma Glutamyl Transferase,,82977,CPT,Facility,Inpatient,,,,79,67.15,22.6414,79,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Gamma Glutamyl Transferase,,82977,CPT,Facility,Both,,,,79,67.15,22.6414,79,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),47.4,60,,percent of total billed charges,,
Gamma Glutamyl Transferase,,82977,CPT,Facility,Both,,,,79,67.15,22.6414,79,"Health Partners, Inc.",State of Minnesota Advantage Program,64.385,81.5,,percent of total billed charges,,
Gamma Glutamyl Transferase,,82977,CPT,Facility,Both,,,,79,67.15,22.6414,79,"Health Partners, Inc.",State Public Programs,39.5,50,,percent of total billed charges,,
Gamma Glutamyl Transferase,,82977,CPT,Facility,Both,,,,79,67.15,22.6414,79,Humana Insurance Company,Commercial PPO,75.05,95,,percent of total billed charges,,
Gamma Glutamyl Transferase,,82977,CPT,Facility,Outpatient,,,,79,67.15,22.6414,79,Humana Insurance Company,Medicare PPO,38.71,49,,percent of total billed charges,,
Gamma Glutamyl Transferase,,82977,CPT,Facility,Inpatient,,,,79,67.15,22.6414,79,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Gamma Glutamyl Transferase,,82977,CPT,Facility,Both,,,,79,67.15,22.6414,79,Medica,Individual & Family,78.289,99.1,,percent of total billed charges,,
Gamma Glutamyl Transferase,,82977,CPT,Facility,Outpatient,,,,79,67.15,22.6414,79,Medica,Medica Advantage Solution,39.342,49.8,,percent of total billed charges,,
Gamma Glutamyl Transferase,,82977,CPT,Facility,Inpatient,,,,79,67.15,22.6414,79,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Gamma Glutamyl Transferase,,82977,CPT,Facility,Outpatient,,,,79,67.15,22.6414,79,Medica,Medical Assistance,35.234,44.6,,percent of total billed charges,,
Gamma Glutamyl Transferase,,82977,CPT,Facility,Inpatient,,,,79,67.15,22.6414,79,Medica,Medical Assistance,,,,,Included in per diem rate,
Gamma Glutamyl Transferase,,82977,CPT,Facility,Outpatient,,,,79,67.15,22.6414,79,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,39.342,49.8,,percent of total billed charges,,
Gamma Glutamyl Transferase,,82977,CPT,Facility,Inpatient,,,,79,67.15,22.6414,79,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Gamma Glutamyl Transferase,,82977,CPT,Facility,Both,,,,79,67.15,22.6414,79,"Multiplan, Inc.","Multiplan, Inc.",74.26,94,,percent of total billed charges,,
Gamma Glutamyl Transferase,,82977,CPT,Facility,Outpatient,,,,79,67.15,22.6414,79,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,68.256,86.4,,percent of total billed charges,,
Gamma Glutamyl Transferase,,82977,CPT,Facility,Inpatient,,,,79,67.15,22.6414,79,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Gamma Glutamyl Transferase,,82977,CPT,Facility,Both,,,,79,67.15,22.6414,79,"Preferred One Administrative Services, INC.",PPO,77.894,98.6,,percent of total billed charges,,
Gamma Glutamyl Transferase,,82977,CPT,Facility,Outpatient,,,,79,67.15,22.6414,79,PrimeWest Health,Minnesota Senior Health Options (MSHO),40.6455,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Gamma Glutamyl Transferase,,82977,CPT,Facility,Inpatient,,,,79,67.15,22.6414,79,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Gamma Glutamyl Transferase,,82977,CPT,Facility,Outpatient,,,,79,67.15,22.6414,79,PrimeWest Health,MinnesotaCare,40.5744,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Gamma Glutamyl Transferase,,82977,CPT,Facility,Inpatient,,,,79,67.15,22.6414,79,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Gamma Glutamyl Transferase,,82977,CPT,Facility,Both,,,,79,67.15,22.6414,79,Sanford Health Plan,Sanford Health Plan,72.68,92,,percent of total billed charges,,
Gamma Glutamyl Transferase,,82977,CPT,Facility,Outpatient,,,,79,67.15,22.6414,79,"UCare Health, Inc.",Individual & Family Plan,44.5165,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Gamma Glutamyl Transferase,,82977,CPT,Facility,Inpatient,,,,79,67.15,22.6414,79,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Gamma Glutamyl Transferase,,82977,CPT,Facility,Outpatient,,,,79,67.15,22.6414,79,"UCare Health, Inc.",Medical Assistance,39.8713,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Gamma Glutamyl Transferase,,82977,CPT,Facility,Inpatient,,,,79,67.15,22.6414,79,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Gamma Glutamyl Transferase,,82977,CPT,Facility,Outpatient,,,,79,67.15,22.6414,79,"UCare Health, Inc.",Medicare Advantage,39.8713,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Gamma Glutamyl Transferase,,82977,CPT,Facility,Inpatient,,,,79,67.15,22.6414,79,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Gamma Glutamyl Transferase,,82977,CPT,Facility,Outpatient,,,,79,67.15,22.6414,79,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),39.8713,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Gamma Glutamyl Transferase,,82977,CPT,Facility,Inpatient,,,,79,67.15,22.6414,79,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Gamma Glutamyl Transferase,,82977,CPT,Facility,Both,,,,79,67.15,22.6414,79,UnitedHealthcare,Individual & Family,74.26,94,,percent of total billed charges,,
Gamma Glutamyl Transferase,,82977,CPT,Facility,Outpatient,,,,79,67.15,22.6414,79,UnitedHealthcare,Medicare Advantage,38.71,49,,percent of total billed charges,,
Gamma Glutamyl Transferase,,82977,CPT,Facility,Inpatient,,,,79,67.15,22.6414,79,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Gamma Glutamyl Transferase,,82977,CPT,Facility,Outpatient,,,,79,67.15,22.6414,79,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,37.92,48,,percent of total billed charges,,100% of DHS outpatient percentage
Gamma Glutamyl Transferase,,82977,CPT,Facility,Inpatient,,,,79,67.15,22.6414,79,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Follicle Stimulating,,83001,CPT,Facility,Both,,,,129,109.65,36.9714,129,Aetna,Commercial,118.68,92,,percent of total billed charges,,
Follicle Stimulating,,83001,CPT,Facility,Outpatient,,,,129,109.65,36.9714,129,Aetna,Medicare Advantage,63.21,49,,percent of total billed charges,,
Follicle Stimulating,,83001,CPT,Facility,Inpatient,,,,129,109.65,36.9714,129,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Follicle Stimulating,,83001,CPT,Facility,Both,,,,129,109.65,36.9714,129,Aetna,PPO,119.97,93,,percent of total billed charges,,
Follicle Stimulating,,83001,CPT,Facility,Both,,,,129,109.65,36.9714,129,America's PPO,America's PPO,123.8787,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Follicle Stimulating,,83001,CPT,Facility,Both,,,,129,109.65,36.9714,129,BlueCross BlueShield Minnesota, Federal Employee Program,126.936,98.4,,percent of total billed charges,,
Follicle Stimulating,,83001,CPT,Facility,Both,,,,129,109.65,36.9714,129,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,129,100,,percent of total billed charges,,
Follicle Stimulating,,83001,CPT,Facility,Both,,,,129,109.65,36.9714,129,BlueCross BlueShield Minnesota,High Value Network Plan,116.1,90,,percent of total billed charges,,
Follicle Stimulating,,83001,CPT,Facility,Outpatient,,,,129,109.65,36.9714,129,BlueCross BlueShield Minnesota,Medicare Advantage,63.21,49,,percent of total billed charges,,
Follicle Stimulating,,83001,CPT,Facility,Inpatient,,,,129,109.65,36.9714,129,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Follicle Stimulating,,83001,CPT,Facility,Both,,,,129,109.65,36.9714,129,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,114.2553,88.57,,percent of total billed charges,,
Follicle Stimulating,,83001,CPT,Facility,Both,,,,129,109.65,36.9714,129,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,36.9714,28.66,,percent of total billed charges,,
Follicle Stimulating,,83001,CPT,Facility,Outpatient,,,,129,109.65,36.9714,129,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),63.21,49,,percent of total billed charges,,
Follicle Stimulating,,83001,CPT,Facility,Inpatient,,,,129,109.65,36.9714,129,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Follicle Stimulating,,83001,CPT,Facility,Both,,,,129,109.65,36.9714,129,CorVel,Worker's Compensation,129,100,,percent of total billed charges,,
Follicle Stimulating,,83001,CPT,Facility,Both,,,,129,109.65,36.9714,129,First Health Group Corporation,First Health Network,125.13,97,,percent of total billed charges,,
Follicle Stimulating,,83001,CPT,Facility,Both,,,,129,109.65,36.9714,129,"Health Partners, Inc.",Commercial,122.034,94.6,,percent of total billed charges,,
Follicle Stimulating,,83001,CPT,Facility,Outpatient,,,,129,109.65,36.9714,129,"Health Partners, Inc.",Medicare Advantage,63.21,49,,percent of total billed charges,,
Follicle Stimulating,,83001,CPT,Facility,Inpatient,,,,129,109.65,36.9714,129,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Follicle Stimulating,,83001,CPT,Facility,Both,,,,129,109.65,36.9714,129,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),77.4,60,,percent of total billed charges,,
Follicle Stimulating,,83001,CPT,Facility,Both,,,,129,109.65,36.9714,129,"Health Partners, Inc.",State of Minnesota Advantage Program,105.135,81.5,,percent of total billed charges,,
Follicle Stimulating,,83001,CPT,Facility,Both,,,,129,109.65,36.9714,129,"Health Partners, Inc.",State Public Programs,64.5,50,,percent of total billed charges,,
Follicle Stimulating,,83001,CPT,Facility,Both,,,,129,109.65,36.9714,129,Humana Insurance Company,Commercial PPO,122.55,95,,percent of total billed charges,,
Follicle Stimulating,,83001,CPT,Facility,Outpatient,,,,129,109.65,36.9714,129,Humana Insurance Company,Medicare PPO,63.21,49,,percent of total billed charges,,
Follicle Stimulating,,83001,CPT,Facility,Inpatient,,,,129,109.65,36.9714,129,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Follicle Stimulating,,83001,CPT,Facility,Both,,,,129,109.65,36.9714,129,Medica,Individual & Family,127.839,99.1,,percent of total billed charges,,
Follicle Stimulating,,83001,CPT,Facility,Outpatient,,,,129,109.65,36.9714,129,Medica,Medica Advantage Solution,64.242,49.8,,percent of total billed charges,,
Follicle Stimulating,,83001,CPT,Facility,Inpatient,,,,129,109.65,36.9714,129,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Follicle Stimulating,,83001,CPT,Facility,Outpatient,,,,129,109.65,36.9714,129,Medica,Medical Assistance,57.534,44.6,,percent of total billed charges,,
Follicle Stimulating,,83001,CPT,Facility,Inpatient,,,,129,109.65,36.9714,129,Medica,Medical Assistance,,,,,Included in per diem rate,
Follicle Stimulating,,83001,CPT,Facility,Outpatient,,,,129,109.65,36.9714,129,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,64.242,49.8,,percent of total billed charges,,
Follicle Stimulating,,83001,CPT,Facility,Inpatient,,,,129,109.65,36.9714,129,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Follicle Stimulating,,83001,CPT,Facility,Both,,,,129,109.65,36.9714,129,"Multiplan, Inc.","Multiplan, Inc.",121.26,94,,percent of total billed charges,,
Follicle Stimulating,,83001,CPT,Facility,Outpatient,,,,129,109.65,36.9714,129,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,111.456,86.4,,percent of total billed charges,,
Follicle Stimulating,,83001,CPT,Facility,Inpatient,,,,129,109.65,36.9714,129,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Follicle Stimulating,,83001,CPT,Facility,Both,,,,129,109.65,36.9714,129,"Preferred One Administrative Services, INC.",PPO,127.194,98.6,,percent of total billed charges,,
Follicle Stimulating,,83001,CPT,Facility,Outpatient,,,,129,109.65,36.9714,129,PrimeWest Health,Minnesota Senior Health Options (MSHO),66.3705,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Follicle Stimulating,,83001,CPT,Facility,Inpatient,,,,129,109.65,36.9714,129,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Follicle Stimulating,,83001,CPT,Facility,Outpatient,,,,129,109.65,36.9714,129,PrimeWest Health,MinnesotaCare,66.2544,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Follicle Stimulating,,83001,CPT,Facility,Inpatient,,,,129,109.65,36.9714,129,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Follicle Stimulating,,83001,CPT,Facility,Both,,,,129,109.65,36.9714,129,Sanford Health Plan,Sanford Health Plan,118.68,92,,percent of total billed charges,,
Follicle Stimulating,,83001,CPT,Facility,Outpatient,,,,129,109.65,36.9714,129,"UCare Health, Inc.",Individual & Family Plan,72.6915,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Follicle Stimulating,,83001,CPT,Facility,Inpatient,,,,129,109.65,36.9714,129,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Follicle Stimulating,,83001,CPT,Facility,Outpatient,,,,129,109.65,36.9714,129,"UCare Health, Inc.",Medical Assistance,65.1063,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Follicle Stimulating,,83001,CPT,Facility,Inpatient,,,,129,109.65,36.9714,129,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Follicle Stimulating,,83001,CPT,Facility,Outpatient,,,,129,109.65,36.9714,129,"UCare Health, Inc.",Medicare Advantage,65.1063,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Follicle Stimulating,,83001,CPT,Facility,Inpatient,,,,129,109.65,36.9714,129,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Follicle Stimulating,,83001,CPT,Facility,Outpatient,,,,129,109.65,36.9714,129,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),65.1063,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Follicle Stimulating,,83001,CPT,Facility,Inpatient,,,,129,109.65,36.9714,129,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Follicle Stimulating,,83001,CPT,Facility,Both,,,,129,109.65,36.9714,129,UnitedHealthcare,Individual & Family,121.26,94,,percent of total billed charges,,
Follicle Stimulating,,83001,CPT,Facility,Outpatient,,,,129,109.65,36.9714,129,UnitedHealthcare,Medicare Advantage,63.21,49,,percent of total billed charges,,
Follicle Stimulating,,83001,CPT,Facility,Inpatient,,,,129,109.65,36.9714,129,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Follicle Stimulating,,83001,CPT,Facility,Outpatient,,,,129,109.65,36.9714,129,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,61.92,48,,percent of total billed charges,,100% of DHS outpatient percentage
Follicle Stimulating,,83001,CPT,Facility,Inpatient,,,,129,109.65,36.9714,129,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Lutropin (Lh),,83002,CPT,Facility,Both,,,,129,109.65,36.9714,129,Aetna,Commercial,118.68,92,,percent of total billed charges,,
Lutropin (Lh),,83002,CPT,Facility,Outpatient,,,,129,109.65,36.9714,129,Aetna,Medicare Advantage,63.21,49,,percent of total billed charges,,
Lutropin (Lh),,83002,CPT,Facility,Inpatient,,,,129,109.65,36.9714,129,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Lutropin (Lh),,83002,CPT,Facility,Both,,,,129,109.65,36.9714,129,Aetna,PPO,119.97,93,,percent of total billed charges,,
Lutropin (Lh),,83002,CPT,Facility,Both,,,,129,109.65,36.9714,129,America's PPO,America's PPO,123.8787,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Lutropin (Lh),,83002,CPT,Facility,Both,,,,129,109.65,36.9714,129,BlueCross BlueShield Minnesota, Federal Employee Program,126.936,98.4,,percent of total billed charges,,
Lutropin (Lh),,83002,CPT,Facility,Both,,,,129,109.65,36.9714,129,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,129,100,,percent of total billed charges,,
Lutropin (Lh),,83002,CPT,Facility,Both,,,,129,109.65,36.9714,129,BlueCross BlueShield Minnesota,High Value Network Plan,116.1,90,,percent of total billed charges,,
Lutropin (Lh),,83002,CPT,Facility,Outpatient,,,,129,109.65,36.9714,129,BlueCross BlueShield Minnesota,Medicare Advantage,63.21,49,,percent of total billed charges,,
Lutropin (Lh),,83002,CPT,Facility,Inpatient,,,,129,109.65,36.9714,129,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Lutropin (Lh),,83002,CPT,Facility,Both,,,,129,109.65,36.9714,129,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,114.2553,88.57,,percent of total billed charges,,
Lutropin (Lh),,83002,CPT,Facility,Both,,,,129,109.65,36.9714,129,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,36.9714,28.66,,percent of total billed charges,,
Lutropin (Lh),,83002,CPT,Facility,Outpatient,,,,129,109.65,36.9714,129,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),63.21,49,,percent of total billed charges,,
Lutropin (Lh),,83002,CPT,Facility,Inpatient,,,,129,109.65,36.9714,129,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Lutropin (Lh),,83002,CPT,Facility,Both,,,,129,109.65,36.9714,129,CorVel,Worker's Compensation,129,100,,percent of total billed charges,,
Lutropin (Lh),,83002,CPT,Facility,Both,,,,129,109.65,36.9714,129,First Health Group Corporation,First Health Network,125.13,97,,percent of total billed charges,,
Lutropin (Lh),,83002,CPT,Facility,Both,,,,129,109.65,36.9714,129,"Health Partners, Inc.",Commercial,122.034,94.6,,percent of total billed charges,,
Lutropin (Lh),,83002,CPT,Facility,Outpatient,,,,129,109.65,36.9714,129,"Health Partners, Inc.",Medicare Advantage,63.21,49,,percent of total billed charges,,
Lutropin (Lh),,83002,CPT,Facility,Inpatient,,,,129,109.65,36.9714,129,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Lutropin (Lh),,83002,CPT,Facility,Both,,,,129,109.65,36.9714,129,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),77.4,60,,percent of total billed charges,,
Lutropin (Lh),,83002,CPT,Facility,Both,,,,129,109.65,36.9714,129,"Health Partners, Inc.",State of Minnesota Advantage Program,105.135,81.5,,percent of total billed charges,,
Lutropin (Lh),,83002,CPT,Facility,Both,,,,129,109.65,36.9714,129,"Health Partners, Inc.",State Public Programs,64.5,50,,percent of total billed charges,,
Lutropin (Lh),,83002,CPT,Facility,Both,,,,129,109.65,36.9714,129,Humana Insurance Company,Commercial PPO,122.55,95,,percent of total billed charges,,
Lutropin (Lh),,83002,CPT,Facility,Outpatient,,,,129,109.65,36.9714,129,Humana Insurance Company,Medicare PPO,63.21,49,,percent of total billed charges,,
Lutropin (Lh),,83002,CPT,Facility,Inpatient,,,,129,109.65,36.9714,129,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Lutropin (Lh),,83002,CPT,Facility,Both,,,,129,109.65,36.9714,129,Medica,Individual & Family,127.839,99.1,,percent of total billed charges,,
Lutropin (Lh),,83002,CPT,Facility,Outpatient,,,,129,109.65,36.9714,129,Medica,Medica Advantage Solution,64.242,49.8,,percent of total billed charges,,
Lutropin (Lh),,83002,CPT,Facility,Inpatient,,,,129,109.65,36.9714,129,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Lutropin (Lh),,83002,CPT,Facility,Outpatient,,,,129,109.65,36.9714,129,Medica,Medical Assistance,57.534,44.6,,percent of total billed charges,,
Lutropin (Lh),,83002,CPT,Facility,Inpatient,,,,129,109.65,36.9714,129,Medica,Medical Assistance,,,,,Included in per diem rate,
Lutropin (Lh),,83002,CPT,Facility,Outpatient,,,,129,109.65,36.9714,129,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,64.242,49.8,,percent of total billed charges,,
Lutropin (Lh),,83002,CPT,Facility,Inpatient,,,,129,109.65,36.9714,129,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Lutropin (Lh),,83002,CPT,Facility,Both,,,,129,109.65,36.9714,129,"Multiplan, Inc.","Multiplan, Inc.",121.26,94,,percent of total billed charges,,
Lutropin (Lh),,83002,CPT,Facility,Outpatient,,,,129,109.65,36.9714,129,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,111.456,86.4,,percent of total billed charges,,
Lutropin (Lh),,83002,CPT,Facility,Inpatient,,,,129,109.65,36.9714,129,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Lutropin (Lh),,83002,CPT,Facility,Both,,,,129,109.65,36.9714,129,"Preferred One Administrative Services, INC.",PPO,127.194,98.6,,percent of total billed charges,,
Lutropin (Lh),,83002,CPT,Facility,Outpatient,,,,129,109.65,36.9714,129,PrimeWest Health,Minnesota Senior Health Options (MSHO),66.3705,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Lutropin (Lh),,83002,CPT,Facility,Inpatient,,,,129,109.65,36.9714,129,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Lutropin (Lh),,83002,CPT,Facility,Outpatient,,,,129,109.65,36.9714,129,PrimeWest Health,MinnesotaCare,66.2544,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Lutropin (Lh),,83002,CPT,Facility,Inpatient,,,,129,109.65,36.9714,129,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Lutropin (Lh),,83002,CPT,Facility,Both,,,,129,109.65,36.9714,129,Sanford Health Plan,Sanford Health Plan,118.68,92,,percent of total billed charges,,
Lutropin (Lh),,83002,CPT,Facility,Outpatient,,,,129,109.65,36.9714,129,"UCare Health, Inc.",Individual & Family Plan,72.6915,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Lutropin (Lh),,83002,CPT,Facility,Inpatient,,,,129,109.65,36.9714,129,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Lutropin (Lh),,83002,CPT,Facility,Outpatient,,,,129,109.65,36.9714,129,"UCare Health, Inc.",Medical Assistance,65.1063,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Lutropin (Lh),,83002,CPT,Facility,Inpatient,,,,129,109.65,36.9714,129,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Lutropin (Lh),,83002,CPT,Facility,Outpatient,,,,129,109.65,36.9714,129,"UCare Health, Inc.",Medicare Advantage,65.1063,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Lutropin (Lh),,83002,CPT,Facility,Inpatient,,,,129,109.65,36.9714,129,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Lutropin (Lh),,83002,CPT,Facility,Outpatient,,,,129,109.65,36.9714,129,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),65.1063,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Lutropin (Lh),,83002,CPT,Facility,Inpatient,,,,129,109.65,36.9714,129,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Lutropin (Lh),,83002,CPT,Facility,Both,,,,129,109.65,36.9714,129,UnitedHealthcare,Individual & Family,121.26,94,,percent of total billed charges,,
Lutropin (Lh),,83002,CPT,Facility,Outpatient,,,,129,109.65,36.9714,129,UnitedHealthcare,Medicare Advantage,63.21,49,,percent of total billed charges,,
Lutropin (Lh),,83002,CPT,Facility,Inpatient,,,,129,109.65,36.9714,129,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Lutropin (Lh),,83002,CPT,Facility,Outpatient,,,,129,109.65,36.9714,129,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,61.92,48,,percent of total billed charges,,100% of DHS outpatient percentage
Lutropin (Lh),,83002,CPT,Facility,Inpatient,,,,129,109.65,36.9714,129,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Haptoglobin,,83010,CPT,Facility,Both,,,,96,81.6,27.5136,96,Aetna,Commercial,88.32,92,,percent of total billed charges,,
Haptoglobin,,83010,CPT,Facility,Outpatient,,,,96,81.6,27.5136,96,Aetna,Medicare Advantage,47.04,49,,percent of total billed charges,,
Haptoglobin,,83010,CPT,Facility,Inpatient,,,,96,81.6,27.5136,96,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Haptoglobin,,83010,CPT,Facility,Both,,,,96,81.6,27.5136,96,Aetna,PPO,89.28,93,,percent of total billed charges,,
Haptoglobin,,83010,CPT,Facility,Both,,,,96,81.6,27.5136,96,America's PPO,America's PPO,92.1888,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Haptoglobin,,83010,CPT,Facility,Both,,,,96,81.6,27.5136,96,BlueCross BlueShield Minnesota, Federal Employee Program,94.464,98.4,,percent of total billed charges,,
Haptoglobin,,83010,CPT,Facility,Both,,,,96,81.6,27.5136,96,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,96,100,,percent of total billed charges,,
Haptoglobin,,83010,CPT,Facility,Both,,,,96,81.6,27.5136,96,BlueCross BlueShield Minnesota,High Value Network Plan,86.4,90,,percent of total billed charges,,
Haptoglobin,,83010,CPT,Facility,Outpatient,,,,96,81.6,27.5136,96,BlueCross BlueShield Minnesota,Medicare Advantage,47.04,49,,percent of total billed charges,,
Haptoglobin,,83010,CPT,Facility,Inpatient,,,,96,81.6,27.5136,96,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Haptoglobin,,83010,CPT,Facility,Both,,,,96,81.6,27.5136,96,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,85.0272,88.57,,percent of total billed charges,,
Haptoglobin,,83010,CPT,Facility,Both,,,,96,81.6,27.5136,96,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,27.5136,28.66,,percent of total billed charges,,
Haptoglobin,,83010,CPT,Facility,Outpatient,,,,96,81.6,27.5136,96,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),47.04,49,,percent of total billed charges,,
Haptoglobin,,83010,CPT,Facility,Inpatient,,,,96,81.6,27.5136,96,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Haptoglobin,,83010,CPT,Facility,Both,,,,96,81.6,27.5136,96,CorVel,Worker's Compensation,96,100,,percent of total billed charges,,
Haptoglobin,,83010,CPT,Facility,Both,,,,96,81.6,27.5136,96,First Health Group Corporation,First Health Network,93.12,97,,percent of total billed charges,,
Haptoglobin,,83010,CPT,Facility,Both,,,,96,81.6,27.5136,96,"Health Partners, Inc.",Commercial,90.816,94.6,,percent of total billed charges,,
Haptoglobin,,83010,CPT,Facility,Outpatient,,,,96,81.6,27.5136,96,"Health Partners, Inc.",Medicare Advantage,47.04,49,,percent of total billed charges,,
Haptoglobin,,83010,CPT,Facility,Inpatient,,,,96,81.6,27.5136,96,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Haptoglobin,,83010,CPT,Facility,Both,,,,96,81.6,27.5136,96,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),57.6,60,,percent of total billed charges,,
Haptoglobin,,83010,CPT,Facility,Both,,,,96,81.6,27.5136,96,"Health Partners, Inc.",State of Minnesota Advantage Program,78.24,81.5,,percent of total billed charges,,
Haptoglobin,,83010,CPT,Facility,Both,,,,96,81.6,27.5136,96,"Health Partners, Inc.",State Public Programs,48,50,,percent of total billed charges,,
Haptoglobin,,83010,CPT,Facility,Both,,,,96,81.6,27.5136,96,Humana Insurance Company,Commercial PPO,91.2,95,,percent of total billed charges,,
Haptoglobin,,83010,CPT,Facility,Outpatient,,,,96,81.6,27.5136,96,Humana Insurance Company,Medicare PPO,47.04,49,,percent of total billed charges,,
Haptoglobin,,83010,CPT,Facility,Inpatient,,,,96,81.6,27.5136,96,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Haptoglobin,,83010,CPT,Facility,Both,,,,96,81.6,27.5136,96,Medica,Individual & Family,95.136,99.1,,percent of total billed charges,,
Haptoglobin,,83010,CPT,Facility,Outpatient,,,,96,81.6,27.5136,96,Medica,Medica Advantage Solution,47.808,49.8,,percent of total billed charges,,
Haptoglobin,,83010,CPT,Facility,Inpatient,,,,96,81.6,27.5136,96,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Haptoglobin,,83010,CPT,Facility,Outpatient,,,,96,81.6,27.5136,96,Medica,Medical Assistance,42.816,44.6,,percent of total billed charges,,
Haptoglobin,,83010,CPT,Facility,Inpatient,,,,96,81.6,27.5136,96,Medica,Medical Assistance,,,,,Included in per diem rate,
Haptoglobin,,83010,CPT,Facility,Outpatient,,,,96,81.6,27.5136,96,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,47.808,49.8,,percent of total billed charges,,
Haptoglobin,,83010,CPT,Facility,Inpatient,,,,96,81.6,27.5136,96,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Haptoglobin,,83010,CPT,Facility,Both,,,,96,81.6,27.5136,96,"Multiplan, Inc.","Multiplan, Inc.",90.24,94,,percent of total billed charges,,
Haptoglobin,,83010,CPT,Facility,Outpatient,,,,96,81.6,27.5136,96,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,82.944,86.4,,percent of total billed charges,,
Haptoglobin,,83010,CPT,Facility,Inpatient,,,,96,81.6,27.5136,96,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Haptoglobin,,83010,CPT,Facility,Both,,,,96,81.6,27.5136,96,"Preferred One Administrative Services, INC.",PPO,94.656,98.6,,percent of total billed charges,,
Haptoglobin,,83010,CPT,Facility,Outpatient,,,,96,81.6,27.5136,96,PrimeWest Health,Minnesota Senior Health Options (MSHO),49.392,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Haptoglobin,,83010,CPT,Facility,Inpatient,,,,96,81.6,27.5136,96,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Haptoglobin,,83010,CPT,Facility,Outpatient,,,,96,81.6,27.5136,96,PrimeWest Health,MinnesotaCare,49.3056,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Haptoglobin,,83010,CPT,Facility,Inpatient,,,,96,81.6,27.5136,96,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Haptoglobin,,83010,CPT,Facility,Both,,,,96,81.6,27.5136,96,Sanford Health Plan,Sanford Health Plan,88.32,92,,percent of total billed charges,,
Haptoglobin,,83010,CPT,Facility,Outpatient,,,,96,81.6,27.5136,96,"UCare Health, Inc.",Individual & Family Plan,54.096,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Haptoglobin,,83010,CPT,Facility,Inpatient,,,,96,81.6,27.5136,96,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Haptoglobin,,83010,CPT,Facility,Outpatient,,,,96,81.6,27.5136,96,"UCare Health, Inc.",Medical Assistance,48.4512,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Haptoglobin,,83010,CPT,Facility,Inpatient,,,,96,81.6,27.5136,96,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Haptoglobin,,83010,CPT,Facility,Outpatient,,,,96,81.6,27.5136,96,"UCare Health, Inc.",Medicare Advantage,48.4512,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Haptoglobin,,83010,CPT,Facility,Inpatient,,,,96,81.6,27.5136,96,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Haptoglobin,,83010,CPT,Facility,Outpatient,,,,96,81.6,27.5136,96,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),48.4512,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Haptoglobin,,83010,CPT,Facility,Inpatient,,,,96,81.6,27.5136,96,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Haptoglobin,,83010,CPT,Facility,Both,,,,96,81.6,27.5136,96,UnitedHealthcare,Individual & Family,90.24,94,,percent of total billed charges,,
Haptoglobin,,83010,CPT,Facility,Outpatient,,,,96,81.6,27.5136,96,UnitedHealthcare,Medicare Advantage,47.04,49,,percent of total billed charges,,
Haptoglobin,,83010,CPT,Facility,Inpatient,,,,96,81.6,27.5136,96,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Haptoglobin,,83010,CPT,Facility,Outpatient,,,,96,81.6,27.5136,96,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,46.08,48,,percent of total billed charges,,100% of DHS outpatient percentage
Haptoglobin,,83010,CPT,Facility,Inpatient,,,,96,81.6,27.5136,96,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Hemoglobin A1C,,83036,CPT,Facility,Both,,,,101,85.85,35.56,101,Aetna,Commercial,92.92,92,,percent of total billed charges,,
Hemoglobin A1C,,83036,CPT,Facility,Outpatient,,,,101,85.85,35.56,101,Aetna,Medicare Advantage,49.49,49,,percent of total billed charges,,
Hemoglobin A1C,,83036,CPT,Facility,Inpatient,,,,101,85.85,35.56,101,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Hemoglobin A1C,,83036,CPT,Facility,Both,,,,101,85.85,35.56,101,Aetna,PPO,93.93,93,,percent of total billed charges,,
Hemoglobin A1C,,83036,CPT,Facility,Both,,,,101,85.85,35.56,101,America's PPO,America's PPO,96.9903,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Hemoglobin A1C,,83036,CPT,Facility,Both,,,,101,85.85,35.56,101,BlueCross BlueShield Minnesota, Federal Employee Program,70,,,Fee schedule,,100% of BCBS commercial commodity fee schedule
Hemoglobin A1C,,83036,CPT,Facility,Both,,,,101,85.85,35.56,101,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,71.12,,,Fee schedule,,"100% of BCBS commercial commodity fee schedule, plus MN Care tax"
Hemoglobin A1C,,83036,CPT,Facility,Both,,,,101,85.85,35.56,101,BlueCross BlueShield Minnesota,High Value Network Plan,64.008,,,Fee schedule,,"90% of BCBS commercial commodity fee schedule, plus MN Care tax; see disclaimer for more information"
Hemoglobin A1C,,83036,CPT,Facility,Outpatient,,,,101,85.85,35.56,101,BlueCross BlueShield Minnesota,Medicare Advantage,49.49,49,,percent of total billed charges,,
Hemoglobin A1C,,83036,CPT,Facility,Inpatient,,,,101,85.85,35.56,101,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Hemoglobin A1C,,83036,CPT,Facility,Both,,,,101,85.85,35.56,101,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,62.990984,,,Fee schedule,,"88.57% of BCBS commercial commodity fee schedule, plus MN Care tax"
Hemoglobin A1C,,83036,CPT,Facility,Both,,,,101,85.85,35.56,101,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,35.56,,,Fee schedule,,"100% of BCBS Medicaid commodity fee schedule, plus MN Care tax"
Hemoglobin A1C,,83036,CPT,Facility,Outpatient,,,,101,85.85,35.56,101,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),49.49,49,,percent of total billed charges,,
Hemoglobin A1C,,83036,CPT,Facility,Inpatient,,,,101,85.85,35.56,101,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Hemoglobin A1C,,83036,CPT,Facility,Both,,,,101,85.85,35.56,101,CorVel,Worker's Compensation,101,100,,percent of total billed charges,,
Hemoglobin A1C,,83036,CPT,Facility,Both,,,,101,85.85,35.56,101,First Health Group Corporation,First Health Network,97.97,97,,percent of total billed charges,,
Hemoglobin A1C,,83036,CPT,Facility,Both,,,,101,85.85,35.56,101,"Health Partners, Inc.",Commercial,95.546,94.6,,percent of total billed charges,,
Hemoglobin A1C,,83036,CPT,Facility,Outpatient,,,,101,85.85,35.56,101,"Health Partners, Inc.",Medicare Advantage,49.49,49,,percent of total billed charges,,
Hemoglobin A1C,,83036,CPT,Facility,Inpatient,,,,101,85.85,35.56,101,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Hemoglobin A1C,,83036,CPT,Facility,Both,,,,101,85.85,35.56,101,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),60.6,60,,percent of total billed charges,,
Hemoglobin A1C,,83036,CPT,Facility,Both,,,,101,85.85,35.56,101,"Health Partners, Inc.",State of Minnesota Advantage Program,82.315,81.5,,percent of total billed charges,,
Hemoglobin A1C,,83036,CPT,Facility,Both,,,,101,85.85,35.56,101,"Health Partners, Inc.",State Public Programs,50.5,50,,percent of total billed charges,,
Hemoglobin A1C,,83036,CPT,Facility,Both,,,,101,85.85,35.56,101,Humana Insurance Company,Commercial PPO,95.95,95,,percent of total billed charges,,
Hemoglobin A1C,,83036,CPT,Facility,Outpatient,,,,101,85.85,35.56,101,Humana Insurance Company,Medicare PPO,49.49,49,,percent of total billed charges,,
Hemoglobin A1C,,83036,CPT,Facility,Inpatient,,,,101,85.85,35.56,101,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Hemoglobin A1C,,83036,CPT,Facility,Both,,,,101,85.85,35.56,101,Medica,Individual & Family,100.091,99.1,,percent of total billed charges,,
Hemoglobin A1C,,83036,CPT,Facility,Outpatient,,,,101,85.85,35.56,101,Medica,Medica Advantage Solution,50.298,49.8,,percent of total billed charges,,
Hemoglobin A1C,,83036,CPT,Facility,Inpatient,,,,101,85.85,35.56,101,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Hemoglobin A1C,,83036,CPT,Facility,Outpatient,,,,101,85.85,35.56,101,Medica,Medical Assistance,45.046,44.6,,percent of total billed charges,,
Hemoglobin A1C,,83036,CPT,Facility,Inpatient,,,,101,85.85,35.56,101,Medica,Medical Assistance,,,,,Included in per diem rate,
Hemoglobin A1C,,83036,CPT,Facility,Outpatient,,,,101,85.85,35.56,101,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,50.298,49.8,,percent of total billed charges,,
Hemoglobin A1C,,83036,CPT,Facility,Inpatient,,,,101,85.85,35.56,101,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Hemoglobin A1C,,83036,CPT,Facility,Both,,,,101,85.85,35.56,101,"Multiplan, Inc.","Multiplan, Inc.",94.94,94,,percent of total billed charges,,
Hemoglobin A1C,,83036,CPT,Facility,Outpatient,,,,101,85.85,35.56,101,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,87.264,86.4,,percent of total billed charges,,
Hemoglobin A1C,,83036,CPT,Facility,Inpatient,,,,101,85.85,35.56,101,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Hemoglobin A1C,,83036,CPT,Facility,Both,,,,101,85.85,35.56,101,"Preferred One Administrative Services, INC.",PPO,99.586,98.6,,percent of total billed charges,,
Hemoglobin A1C,,83036,CPT,Facility,Outpatient,,,,101,85.85,35.56,101,PrimeWest Health,Minnesota Senior Health Options (MSHO),51.9645,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Hemoglobin A1C,,83036,CPT,Facility,Inpatient,,,,101,85.85,35.56,101,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Hemoglobin A1C,,83036,CPT,Facility,Outpatient,,,,101,85.85,35.56,101,PrimeWest Health,MinnesotaCare,51.8736,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Hemoglobin A1C,,83036,CPT,Facility,Inpatient,,,,101,85.85,35.56,101,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Hemoglobin A1C,,83036,CPT,Facility,Both,,,,101,85.85,35.56,101,Sanford Health Plan,Sanford Health Plan,92.92,92,,percent of total billed charges,,
Hemoglobin A1C,,83036,CPT,Facility,Outpatient,,,,101,85.85,35.56,101,"UCare Health, Inc.",Individual & Family Plan,56.9135,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Hemoglobin A1C,,83036,CPT,Facility,Inpatient,,,,101,85.85,35.56,101,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Hemoglobin A1C,,83036,CPT,Facility,Outpatient,,,,101,85.85,35.56,101,"UCare Health, Inc.",Medical Assistance,50.9747,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Hemoglobin A1C,,83036,CPT,Facility,Inpatient,,,,101,85.85,35.56,101,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Hemoglobin A1C,,83036,CPT,Facility,Outpatient,,,,101,85.85,35.56,101,"UCare Health, Inc.",Medicare Advantage,50.9747,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Hemoglobin A1C,,83036,CPT,Facility,Inpatient,,,,101,85.85,35.56,101,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Hemoglobin A1C,,83036,CPT,Facility,Outpatient,,,,101,85.85,35.56,101,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),50.9747,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Hemoglobin A1C,,83036,CPT,Facility,Inpatient,,,,101,85.85,35.56,101,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Hemoglobin A1C,,83036,CPT,Facility,Both,,,,101,85.85,35.56,101,UnitedHealthcare,Individual & Family,94.94,94,,percent of total billed charges,,
Hemoglobin A1C,,83036,CPT,Facility,Outpatient,,,,101,85.85,35.56,101,UnitedHealthcare,Medicare Advantage,49.49,49,,percent of total billed charges,,
Hemoglobin A1C,,83036,CPT,Facility,Inpatient,,,,101,85.85,35.56,101,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Hemoglobin A1C,,83036,CPT,Facility,Outpatient,,,,101,85.85,35.56,101,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,48.48,48,,percent of total billed charges,,100% of DHS outpatient percentage
Hemoglobin A1C,,83036,CPT,Facility,Inpatient,,,,101,85.85,35.56,101,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Centromere Ab, Igg",,83516,CPT,Facility,Both,,,,133,113.05,38.1178,133,Aetna,Commercial,122.36,92,,percent of total billed charges,,
"Centromere Ab, Igg",,83516,CPT,Facility,Outpatient,,,,133,113.05,38.1178,133,Aetna,Medicare Advantage,65.17,49,,percent of total billed charges,,
"Centromere Ab, Igg",,83516,CPT,Facility,Inpatient,,,,133,113.05,38.1178,133,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Centromere Ab, Igg",,83516,CPT,Facility,Both,,,,133,113.05,38.1178,133,Aetna,PPO,123.69,93,,percent of total billed charges,,
"Centromere Ab, Igg",,83516,CPT,Facility,Both,,,,133,113.05,38.1178,133,America's PPO,America's PPO,127.7199,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Centromere Ab, Igg",,83516,CPT,Facility,Both,,,,133,113.05,38.1178,133,BlueCross BlueShield Minnesota, Federal Employee Program,130.872,98.4,,percent of total billed charges,,
"Centromere Ab, Igg",,83516,CPT,Facility,Both,,,,133,113.05,38.1178,133,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,133,100,,percent of total billed charges,,
"Centromere Ab, Igg",,83516,CPT,Facility,Both,,,,133,113.05,38.1178,133,BlueCross BlueShield Minnesota,High Value Network Plan,119.7,90,,percent of total billed charges,,
"Centromere Ab, Igg",,83516,CPT,Facility,Outpatient,,,,133,113.05,38.1178,133,BlueCross BlueShield Minnesota,Medicare Advantage,65.17,49,,percent of total billed charges,,
"Centromere Ab, Igg",,83516,CPT,Facility,Inpatient,,,,133,113.05,38.1178,133,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Centromere Ab, Igg",,83516,CPT,Facility,Both,,,,133,113.05,38.1178,133,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,117.7981,88.57,,percent of total billed charges,,
"Centromere Ab, Igg",,83516,CPT,Facility,Both,,,,133,113.05,38.1178,133,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,38.1178,28.66,,percent of total billed charges,,
"Centromere Ab, Igg",,83516,CPT,Facility,Outpatient,,,,133,113.05,38.1178,133,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),65.17,49,,percent of total billed charges,,
"Centromere Ab, Igg",,83516,CPT,Facility,Inpatient,,,,133,113.05,38.1178,133,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Centromere Ab, Igg",,83516,CPT,Facility,Both,,,,133,113.05,38.1178,133,CorVel,Worker's Compensation,133,100,,percent of total billed charges,,
"Centromere Ab, Igg",,83516,CPT,Facility,Both,,,,133,113.05,38.1178,133,First Health Group Corporation,First Health Network,129.01,97,,percent of total billed charges,,
"Centromere Ab, Igg",,83516,CPT,Facility,Both,,,,133,113.05,38.1178,133,"Health Partners, Inc.",Commercial,125.818,94.6,,percent of total billed charges,,
"Centromere Ab, Igg",,83516,CPT,Facility,Outpatient,,,,133,113.05,38.1178,133,"Health Partners, Inc.",Medicare Advantage,65.17,49,,percent of total billed charges,,
"Centromere Ab, Igg",,83516,CPT,Facility,Inpatient,,,,133,113.05,38.1178,133,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Centromere Ab, Igg",,83516,CPT,Facility,Both,,,,133,113.05,38.1178,133,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),79.8,60,,percent of total billed charges,,
"Centromere Ab, Igg",,83516,CPT,Facility,Both,,,,133,113.05,38.1178,133,"Health Partners, Inc.",State of Minnesota Advantage Program,108.395,81.5,,percent of total billed charges,,
"Centromere Ab, Igg",,83516,CPT,Facility,Both,,,,133,113.05,38.1178,133,"Health Partners, Inc.",State Public Programs,66.5,50,,percent of total billed charges,,
"Centromere Ab, Igg",,83516,CPT,Facility,Both,,,,133,113.05,38.1178,133,Humana Insurance Company,Commercial PPO,126.35,95,,percent of total billed charges,,
"Centromere Ab, Igg",,83516,CPT,Facility,Outpatient,,,,133,113.05,38.1178,133,Humana Insurance Company,Medicare PPO,65.17,49,,percent of total billed charges,,
"Centromere Ab, Igg",,83516,CPT,Facility,Inpatient,,,,133,113.05,38.1178,133,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Centromere Ab, Igg",,83516,CPT,Facility,Both,,,,133,113.05,38.1178,133,Medica,Individual & Family,131.803,99.1,,percent of total billed charges,,
"Centromere Ab, Igg",,83516,CPT,Facility,Outpatient,,,,133,113.05,38.1178,133,Medica,Medica Advantage Solution,66.234,49.8,,percent of total billed charges,,
"Centromere Ab, Igg",,83516,CPT,Facility,Inpatient,,,,133,113.05,38.1178,133,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Centromere Ab, Igg",,83516,CPT,Facility,Outpatient,,,,133,113.05,38.1178,133,Medica,Medical Assistance,59.318,44.6,,percent of total billed charges,,
"Centromere Ab, Igg",,83516,CPT,Facility,Inpatient,,,,133,113.05,38.1178,133,Medica,Medical Assistance,,,,,Included in per diem rate,
"Centromere Ab, Igg",,83516,CPT,Facility,Outpatient,,,,133,113.05,38.1178,133,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,66.234,49.8,,percent of total billed charges,,
"Centromere Ab, Igg",,83516,CPT,Facility,Inpatient,,,,133,113.05,38.1178,133,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Centromere Ab, Igg",,83516,CPT,Facility,Both,,,,133,113.05,38.1178,133,"Multiplan, Inc.","Multiplan, Inc.",125.02,94,,percent of total billed charges,,
"Centromere Ab, Igg",,83516,CPT,Facility,Outpatient,,,,133,113.05,38.1178,133,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,114.912,86.4,,percent of total billed charges,,
"Centromere Ab, Igg",,83516,CPT,Facility,Inpatient,,,,133,113.05,38.1178,133,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Centromere Ab, Igg",,83516,CPT,Facility,Both,,,,133,113.05,38.1178,133,"Preferred One Administrative Services, INC.",PPO,131.138,98.6,,percent of total billed charges,,
"Centromere Ab, Igg",,83516,CPT,Facility,Outpatient,,,,133,113.05,38.1178,133,PrimeWest Health,Minnesota Senior Health Options (MSHO),68.4285,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Centromere Ab, Igg",,83516,CPT,Facility,Inpatient,,,,133,113.05,38.1178,133,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Centromere Ab, Igg",,83516,CPT,Facility,Outpatient,,,,133,113.05,38.1178,133,PrimeWest Health,MinnesotaCare,68.3088,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Centromere Ab, Igg",,83516,CPT,Facility,Inpatient,,,,133,113.05,38.1178,133,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Centromere Ab, Igg",,83516,CPT,Facility,Both,,,,133,113.05,38.1178,133,Sanford Health Plan,Sanford Health Plan,122.36,92,,percent of total billed charges,,
"Centromere Ab, Igg",,83516,CPT,Facility,Outpatient,,,,133,113.05,38.1178,133,"UCare Health, Inc.",Individual & Family Plan,74.9455,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Centromere Ab, Igg",,83516,CPT,Facility,Inpatient,,,,133,113.05,38.1178,133,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Centromere Ab, Igg",,83516,CPT,Facility,Outpatient,,,,133,113.05,38.1178,133,"UCare Health, Inc.",Medical Assistance,67.1251,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Centromere Ab, Igg",,83516,CPT,Facility,Inpatient,,,,133,113.05,38.1178,133,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Centromere Ab, Igg",,83516,CPT,Facility,Outpatient,,,,133,113.05,38.1178,133,"UCare Health, Inc.",Medicare Advantage,67.1251,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Centromere Ab, Igg",,83516,CPT,Facility,Inpatient,,,,133,113.05,38.1178,133,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Centromere Ab, Igg",,83516,CPT,Facility,Outpatient,,,,133,113.05,38.1178,133,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),67.1251,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Centromere Ab, Igg",,83516,CPT,Facility,Inpatient,,,,133,113.05,38.1178,133,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Centromere Ab, Igg",,83516,CPT,Facility,Both,,,,133,113.05,38.1178,133,UnitedHealthcare,Individual & Family,125.02,94,,percent of total billed charges,,
"Centromere Ab, Igg",,83516,CPT,Facility,Outpatient,,,,133,113.05,38.1178,133,UnitedHealthcare,Medicare Advantage,65.17,49,,percent of total billed charges,,
"Centromere Ab, Igg",,83516,CPT,Facility,Inpatient,,,,133,113.05,38.1178,133,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Centromere Ab, Igg",,83516,CPT,Facility,Outpatient,,,,133,113.05,38.1178,133,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,63.84,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Centromere Ab, Igg",,83516,CPT,Facility,Inpatient,,,,133,113.05,38.1178,133,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Gliadin (Deamidated)Ab, Iga",,83516,CPT,Facility,Both,,,,96,81.6,27.5136,96,Aetna,Commercial,88.32,92,,percent of total billed charges,,
"Gliadin (Deamidated)Ab, Iga",,83516,CPT,Facility,Outpatient,,,,96,81.6,27.5136,96,Aetna,Medicare Advantage,47.04,49,,percent of total billed charges,,
"Gliadin (Deamidated)Ab, Iga",,83516,CPT,Facility,Inpatient,,,,96,81.6,27.5136,96,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Gliadin (Deamidated)Ab, Iga",,83516,CPT,Facility,Both,,,,96,81.6,27.5136,96,Aetna,PPO,89.28,93,,percent of total billed charges,,
"Gliadin (Deamidated)Ab, Iga",,83516,CPT,Facility,Both,,,,96,81.6,27.5136,96,America's PPO,America's PPO,92.1888,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Gliadin (Deamidated)Ab, Iga",,83516,CPT,Facility,Both,,,,96,81.6,27.5136,96,BlueCross BlueShield Minnesota, Federal Employee Program,94.464,98.4,,percent of total billed charges,,
"Gliadin (Deamidated)Ab, Iga",,83516,CPT,Facility,Both,,,,96,81.6,27.5136,96,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,96,100,,percent of total billed charges,,
"Gliadin (Deamidated)Ab, Iga",,83516,CPT,Facility,Both,,,,96,81.6,27.5136,96,BlueCross BlueShield Minnesota,High Value Network Plan,86.4,90,,percent of total billed charges,,
"Gliadin (Deamidated)Ab, Iga",,83516,CPT,Facility,Outpatient,,,,96,81.6,27.5136,96,BlueCross BlueShield Minnesota,Medicare Advantage,47.04,49,,percent of total billed charges,,
"Gliadin (Deamidated)Ab, Iga",,83516,CPT,Facility,Inpatient,,,,96,81.6,27.5136,96,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Gliadin (Deamidated)Ab, Iga",,83516,CPT,Facility,Both,,,,96,81.6,27.5136,96,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,85.0272,88.57,,percent of total billed charges,,
"Gliadin (Deamidated)Ab, Iga",,83516,CPT,Facility,Both,,,,96,81.6,27.5136,96,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,27.5136,28.66,,percent of total billed charges,,
"Gliadin (Deamidated)Ab, Iga",,83516,CPT,Facility,Outpatient,,,,96,81.6,27.5136,96,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),47.04,49,,percent of total billed charges,,
"Gliadin (Deamidated)Ab, Iga",,83516,CPT,Facility,Inpatient,,,,96,81.6,27.5136,96,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Gliadin (Deamidated)Ab, Iga",,83516,CPT,Facility,Both,,,,96,81.6,27.5136,96,CorVel,Worker's Compensation,96,100,,percent of total billed charges,,
"Gliadin (Deamidated)Ab, Iga",,83516,CPT,Facility,Both,,,,96,81.6,27.5136,96,First Health Group Corporation,First Health Network,93.12,97,,percent of total billed charges,,
"Gliadin (Deamidated)Ab, Iga",,83516,CPT,Facility,Both,,,,96,81.6,27.5136,96,"Health Partners, Inc.",Commercial,90.816,94.6,,percent of total billed charges,,
"Gliadin (Deamidated)Ab, Iga",,83516,CPT,Facility,Outpatient,,,,96,81.6,27.5136,96,"Health Partners, Inc.",Medicare Advantage,47.04,49,,percent of total billed charges,,
"Gliadin (Deamidated)Ab, Iga",,83516,CPT,Facility,Inpatient,,,,96,81.6,27.5136,96,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Gliadin (Deamidated)Ab, Iga",,83516,CPT,Facility,Both,,,,96,81.6,27.5136,96,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),57.6,60,,percent of total billed charges,,
"Gliadin (Deamidated)Ab, Iga",,83516,CPT,Facility,Both,,,,96,81.6,27.5136,96,"Health Partners, Inc.",State of Minnesota Advantage Program,78.24,81.5,,percent of total billed charges,,
"Gliadin (Deamidated)Ab, Iga",,83516,CPT,Facility,Both,,,,96,81.6,27.5136,96,"Health Partners, Inc.",State Public Programs,48,50,,percent of total billed charges,,
"Gliadin (Deamidated)Ab, Iga",,83516,CPT,Facility,Both,,,,96,81.6,27.5136,96,Humana Insurance Company,Commercial PPO,91.2,95,,percent of total billed charges,,
"Gliadin (Deamidated)Ab, Iga",,83516,CPT,Facility,Outpatient,,,,96,81.6,27.5136,96,Humana Insurance Company,Medicare PPO,47.04,49,,percent of total billed charges,,
"Gliadin (Deamidated)Ab, Iga",,83516,CPT,Facility,Inpatient,,,,96,81.6,27.5136,96,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Gliadin (Deamidated)Ab, Iga",,83516,CPT,Facility,Both,,,,96,81.6,27.5136,96,Medica,Individual & Family,95.136,99.1,,percent of total billed charges,,
"Gliadin (Deamidated)Ab, Iga",,83516,CPT,Facility,Outpatient,,,,96,81.6,27.5136,96,Medica,Medica Advantage Solution,47.808,49.8,,percent of total billed charges,,
"Gliadin (Deamidated)Ab, Iga",,83516,CPT,Facility,Inpatient,,,,96,81.6,27.5136,96,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Gliadin (Deamidated)Ab, Iga",,83516,CPT,Facility,Outpatient,,,,96,81.6,27.5136,96,Medica,Medical Assistance,42.816,44.6,,percent of total billed charges,,
"Gliadin (Deamidated)Ab, Iga",,83516,CPT,Facility,Inpatient,,,,96,81.6,27.5136,96,Medica,Medical Assistance,,,,,Included in per diem rate,
"Gliadin (Deamidated)Ab, Iga",,83516,CPT,Facility,Outpatient,,,,96,81.6,27.5136,96,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,47.808,49.8,,percent of total billed charges,,
"Gliadin (Deamidated)Ab, Iga",,83516,CPT,Facility,Inpatient,,,,96,81.6,27.5136,96,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Gliadin (Deamidated)Ab, Iga",,83516,CPT,Facility,Both,,,,96,81.6,27.5136,96,"Multiplan, Inc.","Multiplan, Inc.",90.24,94,,percent of total billed charges,,
"Gliadin (Deamidated)Ab, Iga",,83516,CPT,Facility,Outpatient,,,,96,81.6,27.5136,96,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,82.944,86.4,,percent of total billed charges,,
"Gliadin (Deamidated)Ab, Iga",,83516,CPT,Facility,Inpatient,,,,96,81.6,27.5136,96,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Gliadin (Deamidated)Ab, Iga",,83516,CPT,Facility,Both,,,,96,81.6,27.5136,96,"Preferred One Administrative Services, INC.",PPO,94.656,98.6,,percent of total billed charges,,
"Gliadin (Deamidated)Ab, Iga",,83516,CPT,Facility,Outpatient,,,,96,81.6,27.5136,96,PrimeWest Health,Minnesota Senior Health Options (MSHO),49.392,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Gliadin (Deamidated)Ab, Iga",,83516,CPT,Facility,Inpatient,,,,96,81.6,27.5136,96,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Gliadin (Deamidated)Ab, Iga",,83516,CPT,Facility,Outpatient,,,,96,81.6,27.5136,96,PrimeWest Health,MinnesotaCare,49.3056,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Gliadin (Deamidated)Ab, Iga",,83516,CPT,Facility,Inpatient,,,,96,81.6,27.5136,96,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Gliadin (Deamidated)Ab, Iga",,83516,CPT,Facility,Both,,,,96,81.6,27.5136,96,Sanford Health Plan,Sanford Health Plan,88.32,92,,percent of total billed charges,,
"Gliadin (Deamidated)Ab, Iga",,83516,CPT,Facility,Outpatient,,,,96,81.6,27.5136,96,"UCare Health, Inc.",Individual & Family Plan,54.096,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Gliadin (Deamidated)Ab, Iga",,83516,CPT,Facility,Inpatient,,,,96,81.6,27.5136,96,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Gliadin (Deamidated)Ab, Iga",,83516,CPT,Facility,Outpatient,,,,96,81.6,27.5136,96,"UCare Health, Inc.",Medical Assistance,48.4512,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Gliadin (Deamidated)Ab, Iga",,83516,CPT,Facility,Inpatient,,,,96,81.6,27.5136,96,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Gliadin (Deamidated)Ab, Iga",,83516,CPT,Facility,Outpatient,,,,96,81.6,27.5136,96,"UCare Health, Inc.",Medicare Advantage,48.4512,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Gliadin (Deamidated)Ab, Iga",,83516,CPT,Facility,Inpatient,,,,96,81.6,27.5136,96,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Gliadin (Deamidated)Ab, Iga",,83516,CPT,Facility,Outpatient,,,,96,81.6,27.5136,96,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),48.4512,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Gliadin (Deamidated)Ab, Iga",,83516,CPT,Facility,Inpatient,,,,96,81.6,27.5136,96,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Gliadin (Deamidated)Ab, Iga",,83516,CPT,Facility,Both,,,,96,81.6,27.5136,96,UnitedHealthcare,Individual & Family,90.24,94,,percent of total billed charges,,
"Gliadin (Deamidated)Ab, Iga",,83516,CPT,Facility,Outpatient,,,,96,81.6,27.5136,96,UnitedHealthcare,Medicare Advantage,47.04,49,,percent of total billed charges,,
"Gliadin (Deamidated)Ab, Iga",,83516,CPT,Facility,Inpatient,,,,96,81.6,27.5136,96,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Gliadin (Deamidated)Ab, Iga",,83516,CPT,Facility,Outpatient,,,,96,81.6,27.5136,96,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,46.08,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Gliadin (Deamidated)Ab, Iga",,83516,CPT,Facility,Inpatient,,,,96,81.6,27.5136,96,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Gliadin (Deamidated)Ab, Igg",,83516,CPT,Facility,Both,,,,96,81.6,27.5136,96,Aetna,Commercial,88.32,92,,percent of total billed charges,,
"Gliadin (Deamidated)Ab, Igg",,83516,CPT,Facility,Outpatient,,,,96,81.6,27.5136,96,Aetna,Medicare Advantage,47.04,49,,percent of total billed charges,,
"Gliadin (Deamidated)Ab, Igg",,83516,CPT,Facility,Inpatient,,,,96,81.6,27.5136,96,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Gliadin (Deamidated)Ab, Igg",,83516,CPT,Facility,Both,,,,96,81.6,27.5136,96,Aetna,PPO,89.28,93,,percent of total billed charges,,
"Gliadin (Deamidated)Ab, Igg",,83516,CPT,Facility,Both,,,,96,81.6,27.5136,96,America's PPO,America's PPO,92.1888,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Gliadin (Deamidated)Ab, Igg",,83516,CPT,Facility,Both,,,,96,81.6,27.5136,96,BlueCross BlueShield Minnesota, Federal Employee Program,94.464,98.4,,percent of total billed charges,,
"Gliadin (Deamidated)Ab, Igg",,83516,CPT,Facility,Both,,,,96,81.6,27.5136,96,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,96,100,,percent of total billed charges,,
"Gliadin (Deamidated)Ab, Igg",,83516,CPT,Facility,Both,,,,96,81.6,27.5136,96,BlueCross BlueShield Minnesota,High Value Network Plan,86.4,90,,percent of total billed charges,,
"Gliadin (Deamidated)Ab, Igg",,83516,CPT,Facility,Outpatient,,,,96,81.6,27.5136,96,BlueCross BlueShield Minnesota,Medicare Advantage,47.04,49,,percent of total billed charges,,
"Gliadin (Deamidated)Ab, Igg",,83516,CPT,Facility,Inpatient,,,,96,81.6,27.5136,96,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Gliadin (Deamidated)Ab, Igg",,83516,CPT,Facility,Both,,,,96,81.6,27.5136,96,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,85.0272,88.57,,percent of total billed charges,,
"Gliadin (Deamidated)Ab, Igg",,83516,CPT,Facility,Both,,,,96,81.6,27.5136,96,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,27.5136,28.66,,percent of total billed charges,,
"Gliadin (Deamidated)Ab, Igg",,83516,CPT,Facility,Outpatient,,,,96,81.6,27.5136,96,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),47.04,49,,percent of total billed charges,,
"Gliadin (Deamidated)Ab, Igg",,83516,CPT,Facility,Inpatient,,,,96,81.6,27.5136,96,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Gliadin (Deamidated)Ab, Igg",,83516,CPT,Facility,Both,,,,96,81.6,27.5136,96,CorVel,Worker's Compensation,96,100,,percent of total billed charges,,
"Gliadin (Deamidated)Ab, Igg",,83516,CPT,Facility,Both,,,,96,81.6,27.5136,96,First Health Group Corporation,First Health Network,93.12,97,,percent of total billed charges,,
"Gliadin (Deamidated)Ab, Igg",,83516,CPT,Facility,Both,,,,96,81.6,27.5136,96,"Health Partners, Inc.",Commercial,90.816,94.6,,percent of total billed charges,,
"Gliadin (Deamidated)Ab, Igg",,83516,CPT,Facility,Outpatient,,,,96,81.6,27.5136,96,"Health Partners, Inc.",Medicare Advantage,47.04,49,,percent of total billed charges,,
"Gliadin (Deamidated)Ab, Igg",,83516,CPT,Facility,Inpatient,,,,96,81.6,27.5136,96,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Gliadin (Deamidated)Ab, Igg",,83516,CPT,Facility,Both,,,,96,81.6,27.5136,96,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),57.6,60,,percent of total billed charges,,
"Gliadin (Deamidated)Ab, Igg",,83516,CPT,Facility,Both,,,,96,81.6,27.5136,96,"Health Partners, Inc.",State of Minnesota Advantage Program,78.24,81.5,,percent of total billed charges,,
"Gliadin (Deamidated)Ab, Igg",,83516,CPT,Facility,Both,,,,96,81.6,27.5136,96,"Health Partners, Inc.",State Public Programs,48,50,,percent of total billed charges,,
"Gliadin (Deamidated)Ab, Igg",,83516,CPT,Facility,Both,,,,96,81.6,27.5136,96,Humana Insurance Company,Commercial PPO,91.2,95,,percent of total billed charges,,
"Gliadin (Deamidated)Ab, Igg",,83516,CPT,Facility,Outpatient,,,,96,81.6,27.5136,96,Humana Insurance Company,Medicare PPO,47.04,49,,percent of total billed charges,,
"Gliadin (Deamidated)Ab, Igg",,83516,CPT,Facility,Inpatient,,,,96,81.6,27.5136,96,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Gliadin (Deamidated)Ab, Igg",,83516,CPT,Facility,Both,,,,96,81.6,27.5136,96,Medica,Individual & Family,95.136,99.1,,percent of total billed charges,,
"Gliadin (Deamidated)Ab, Igg",,83516,CPT,Facility,Outpatient,,,,96,81.6,27.5136,96,Medica,Medica Advantage Solution,47.808,49.8,,percent of total billed charges,,
"Gliadin (Deamidated)Ab, Igg",,83516,CPT,Facility,Inpatient,,,,96,81.6,27.5136,96,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Gliadin (Deamidated)Ab, Igg",,83516,CPT,Facility,Outpatient,,,,96,81.6,27.5136,96,Medica,Medical Assistance,42.816,44.6,,percent of total billed charges,,
"Gliadin (Deamidated)Ab, Igg",,83516,CPT,Facility,Inpatient,,,,96,81.6,27.5136,96,Medica,Medical Assistance,,,,,Included in per diem rate,
"Gliadin (Deamidated)Ab, Igg",,83516,CPT,Facility,Outpatient,,,,96,81.6,27.5136,96,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,47.808,49.8,,percent of total billed charges,,
"Gliadin (Deamidated)Ab, Igg",,83516,CPT,Facility,Inpatient,,,,96,81.6,27.5136,96,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Gliadin (Deamidated)Ab, Igg",,83516,CPT,Facility,Both,,,,96,81.6,27.5136,96,"Multiplan, Inc.","Multiplan, Inc.",90.24,94,,percent of total billed charges,,
"Gliadin (Deamidated)Ab, Igg",,83516,CPT,Facility,Outpatient,,,,96,81.6,27.5136,96,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,82.944,86.4,,percent of total billed charges,,
"Gliadin (Deamidated)Ab, Igg",,83516,CPT,Facility,Inpatient,,,,96,81.6,27.5136,96,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Gliadin (Deamidated)Ab, Igg",,83516,CPT,Facility,Both,,,,96,81.6,27.5136,96,"Preferred One Administrative Services, INC.",PPO,94.656,98.6,,percent of total billed charges,,
"Gliadin (Deamidated)Ab, Igg",,83516,CPT,Facility,Outpatient,,,,96,81.6,27.5136,96,PrimeWest Health,Minnesota Senior Health Options (MSHO),49.392,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Gliadin (Deamidated)Ab, Igg",,83516,CPT,Facility,Inpatient,,,,96,81.6,27.5136,96,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Gliadin (Deamidated)Ab, Igg",,83516,CPT,Facility,Outpatient,,,,96,81.6,27.5136,96,PrimeWest Health,MinnesotaCare,49.3056,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Gliadin (Deamidated)Ab, Igg",,83516,CPT,Facility,Inpatient,,,,96,81.6,27.5136,96,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Gliadin (Deamidated)Ab, Igg",,83516,CPT,Facility,Both,,,,96,81.6,27.5136,96,Sanford Health Plan,Sanford Health Plan,88.32,92,,percent of total billed charges,,
"Gliadin (Deamidated)Ab, Igg",,83516,CPT,Facility,Outpatient,,,,96,81.6,27.5136,96,"UCare Health, Inc.",Individual & Family Plan,54.096,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Gliadin (Deamidated)Ab, Igg",,83516,CPT,Facility,Inpatient,,,,96,81.6,27.5136,96,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Gliadin (Deamidated)Ab, Igg",,83516,CPT,Facility,Outpatient,,,,96,81.6,27.5136,96,"UCare Health, Inc.",Medical Assistance,48.4512,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Gliadin (Deamidated)Ab, Igg",,83516,CPT,Facility,Inpatient,,,,96,81.6,27.5136,96,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Gliadin (Deamidated)Ab, Igg",,83516,CPT,Facility,Outpatient,,,,96,81.6,27.5136,96,"UCare Health, Inc.",Medicare Advantage,48.4512,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Gliadin (Deamidated)Ab, Igg",,83516,CPT,Facility,Inpatient,,,,96,81.6,27.5136,96,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Gliadin (Deamidated)Ab, Igg",,83516,CPT,Facility,Outpatient,,,,96,81.6,27.5136,96,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),48.4512,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Gliadin (Deamidated)Ab, Igg",,83516,CPT,Facility,Inpatient,,,,96,81.6,27.5136,96,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Gliadin (Deamidated)Ab, Igg",,83516,CPT,Facility,Both,,,,96,81.6,27.5136,96,UnitedHealthcare,Individual & Family,90.24,94,,percent of total billed charges,,
"Gliadin (Deamidated)Ab, Igg",,83516,CPT,Facility,Outpatient,,,,96,81.6,27.5136,96,UnitedHealthcare,Medicare Advantage,47.04,49,,percent of total billed charges,,
"Gliadin (Deamidated)Ab, Igg",,83516,CPT,Facility,Inpatient,,,,96,81.6,27.5136,96,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Gliadin (Deamidated)Ab, Igg",,83516,CPT,Facility,Outpatient,,,,96,81.6,27.5136,96,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,46.08,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Gliadin (Deamidated)Ab, Igg",,83516,CPT,Facility,Inpatient,,,,96,81.6,27.5136,96,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Myeloperoxidase Abs,,83516,CPT,Facility,Both,,,,103,87.55,29.5198,103,Aetna,Commercial,94.76,92,,percent of total billed charges,,
Myeloperoxidase Abs,,83516,CPT,Facility,Outpatient,,,,103,87.55,29.5198,103,Aetna,Medicare Advantage,50.47,49,,percent of total billed charges,,
Myeloperoxidase Abs,,83516,CPT,Facility,Inpatient,,,,103,87.55,29.5198,103,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Myeloperoxidase Abs,,83516,CPT,Facility,Both,,,,103,87.55,29.5198,103,Aetna,PPO,95.79,93,,percent of total billed charges,,
Myeloperoxidase Abs,,83516,CPT,Facility,Both,,,,103,87.55,29.5198,103,America's PPO,America's PPO,98.9109,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Myeloperoxidase Abs,,83516,CPT,Facility,Both,,,,103,87.55,29.5198,103,BlueCross BlueShield Minnesota, Federal Employee Program,101.352,98.4,,percent of total billed charges,,
Myeloperoxidase Abs,,83516,CPT,Facility,Both,,,,103,87.55,29.5198,103,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,103,100,,percent of total billed charges,,
Myeloperoxidase Abs,,83516,CPT,Facility,Both,,,,103,87.55,29.5198,103,BlueCross BlueShield Minnesota,High Value Network Plan,92.7,90,,percent of total billed charges,,
Myeloperoxidase Abs,,83516,CPT,Facility,Outpatient,,,,103,87.55,29.5198,103,BlueCross BlueShield Minnesota,Medicare Advantage,50.47,49,,percent of total billed charges,,
Myeloperoxidase Abs,,83516,CPT,Facility,Inpatient,,,,103,87.55,29.5198,103,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Myeloperoxidase Abs,,83516,CPT,Facility,Both,,,,103,87.55,29.5198,103,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,91.2271,88.57,,percent of total billed charges,,
Myeloperoxidase Abs,,83516,CPT,Facility,Both,,,,103,87.55,29.5198,103,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,29.5198,28.66,,percent of total billed charges,,
Myeloperoxidase Abs,,83516,CPT,Facility,Outpatient,,,,103,87.55,29.5198,103,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),50.47,49,,percent of total billed charges,,
Myeloperoxidase Abs,,83516,CPT,Facility,Inpatient,,,,103,87.55,29.5198,103,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Myeloperoxidase Abs,,83516,CPT,Facility,Both,,,,103,87.55,29.5198,103,CorVel,Worker's Compensation,103,100,,percent of total billed charges,,
Myeloperoxidase Abs,,83516,CPT,Facility,Both,,,,103,87.55,29.5198,103,First Health Group Corporation,First Health Network,99.91,97,,percent of total billed charges,,
Myeloperoxidase Abs,,83516,CPT,Facility,Both,,,,103,87.55,29.5198,103,"Health Partners, Inc.",Commercial,97.438,94.6,,percent of total billed charges,,
Myeloperoxidase Abs,,83516,CPT,Facility,Outpatient,,,,103,87.55,29.5198,103,"Health Partners, Inc.",Medicare Advantage,50.47,49,,percent of total billed charges,,
Myeloperoxidase Abs,,83516,CPT,Facility,Inpatient,,,,103,87.55,29.5198,103,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Myeloperoxidase Abs,,83516,CPT,Facility,Both,,,,103,87.55,29.5198,103,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),61.8,60,,percent of total billed charges,,
Myeloperoxidase Abs,,83516,CPT,Facility,Both,,,,103,87.55,29.5198,103,"Health Partners, Inc.",State of Minnesota Advantage Program,83.945,81.5,,percent of total billed charges,,
Myeloperoxidase Abs,,83516,CPT,Facility,Both,,,,103,87.55,29.5198,103,"Health Partners, Inc.",State Public Programs,51.5,50,,percent of total billed charges,,
Myeloperoxidase Abs,,83516,CPT,Facility,Both,,,,103,87.55,29.5198,103,Humana Insurance Company,Commercial PPO,97.85,95,,percent of total billed charges,,
Myeloperoxidase Abs,,83516,CPT,Facility,Outpatient,,,,103,87.55,29.5198,103,Humana Insurance Company,Medicare PPO,50.47,49,,percent of total billed charges,,
Myeloperoxidase Abs,,83516,CPT,Facility,Inpatient,,,,103,87.55,29.5198,103,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Myeloperoxidase Abs,,83516,CPT,Facility,Both,,,,103,87.55,29.5198,103,Medica,Individual & Family,102.073,99.1,,percent of total billed charges,,
Myeloperoxidase Abs,,83516,CPT,Facility,Outpatient,,,,103,87.55,29.5198,103,Medica,Medica Advantage Solution,51.294,49.8,,percent of total billed charges,,
Myeloperoxidase Abs,,83516,CPT,Facility,Inpatient,,,,103,87.55,29.5198,103,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Myeloperoxidase Abs,,83516,CPT,Facility,Outpatient,,,,103,87.55,29.5198,103,Medica,Medical Assistance,45.938,44.6,,percent of total billed charges,,
Myeloperoxidase Abs,,83516,CPT,Facility,Inpatient,,,,103,87.55,29.5198,103,Medica,Medical Assistance,,,,,Included in per diem rate,
Myeloperoxidase Abs,,83516,CPT,Facility,Outpatient,,,,103,87.55,29.5198,103,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,51.294,49.8,,percent of total billed charges,,
Myeloperoxidase Abs,,83516,CPT,Facility,Inpatient,,,,103,87.55,29.5198,103,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Myeloperoxidase Abs,,83516,CPT,Facility,Both,,,,103,87.55,29.5198,103,"Multiplan, Inc.","Multiplan, Inc.",96.82,94,,percent of total billed charges,,
Myeloperoxidase Abs,,83516,CPT,Facility,Outpatient,,,,103,87.55,29.5198,103,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,88.992,86.4,,percent of total billed charges,,
Myeloperoxidase Abs,,83516,CPT,Facility,Inpatient,,,,103,87.55,29.5198,103,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Myeloperoxidase Abs,,83516,CPT,Facility,Both,,,,103,87.55,29.5198,103,"Preferred One Administrative Services, INC.",PPO,101.558,98.6,,percent of total billed charges,,
Myeloperoxidase Abs,,83516,CPT,Facility,Outpatient,,,,103,87.55,29.5198,103,PrimeWest Health,Minnesota Senior Health Options (MSHO),52.9935,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Myeloperoxidase Abs,,83516,CPT,Facility,Inpatient,,,,103,87.55,29.5198,103,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Myeloperoxidase Abs,,83516,CPT,Facility,Outpatient,,,,103,87.55,29.5198,103,PrimeWest Health,MinnesotaCare,52.9008,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Myeloperoxidase Abs,,83516,CPT,Facility,Inpatient,,,,103,87.55,29.5198,103,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Myeloperoxidase Abs,,83516,CPT,Facility,Both,,,,103,87.55,29.5198,103,Sanford Health Plan,Sanford Health Plan,94.76,92,,percent of total billed charges,,
Myeloperoxidase Abs,,83516,CPT,Facility,Outpatient,,,,103,87.55,29.5198,103,"UCare Health, Inc.",Individual & Family Plan,58.0405,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Myeloperoxidase Abs,,83516,CPT,Facility,Inpatient,,,,103,87.55,29.5198,103,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Myeloperoxidase Abs,,83516,CPT,Facility,Outpatient,,,,103,87.55,29.5198,103,"UCare Health, Inc.",Medical Assistance,51.9841,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Myeloperoxidase Abs,,83516,CPT,Facility,Inpatient,,,,103,87.55,29.5198,103,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Myeloperoxidase Abs,,83516,CPT,Facility,Outpatient,,,,103,87.55,29.5198,103,"UCare Health, Inc.",Medicare Advantage,51.9841,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Myeloperoxidase Abs,,83516,CPT,Facility,Inpatient,,,,103,87.55,29.5198,103,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Myeloperoxidase Abs,,83516,CPT,Facility,Outpatient,,,,103,87.55,29.5198,103,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),51.9841,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Myeloperoxidase Abs,,83516,CPT,Facility,Inpatient,,,,103,87.55,29.5198,103,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Myeloperoxidase Abs,,83516,CPT,Facility,Both,,,,103,87.55,29.5198,103,UnitedHealthcare,Individual & Family,96.82,94,,percent of total billed charges,,
Myeloperoxidase Abs,,83516,CPT,Facility,Outpatient,,,,103,87.55,29.5198,103,UnitedHealthcare,Medicare Advantage,50.47,49,,percent of total billed charges,,
Myeloperoxidase Abs,,83516,CPT,Facility,Inpatient,,,,103,87.55,29.5198,103,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Myeloperoxidase Abs,,83516,CPT,Facility,Outpatient,,,,103,87.55,29.5198,103,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,49.44,48,,percent of total billed charges,,100% of DHS outpatient percentage
Myeloperoxidase Abs,,83516,CPT,Facility,Inpatient,,,,103,87.55,29.5198,103,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Proteinase 3 Abs,,83516,CPT,Facility,Both,,,,100,85,28.66,100,Aetna,Commercial,92,92,,percent of total billed charges,,
Proteinase 3 Abs,,83516,CPT,Facility,Outpatient,,,,100,85,28.66,100,Aetna,Medicare Advantage,49,49,,percent of total billed charges,,
Proteinase 3 Abs,,83516,CPT,Facility,Inpatient,,,,100,85,28.66,100,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Proteinase 3 Abs,,83516,CPT,Facility,Both,,,,100,85,28.66,100,Aetna,PPO,93,93,,percent of total billed charges,,
Proteinase 3 Abs,,83516,CPT,Facility,Both,,,,100,85,28.66,100,America's PPO,America's PPO,96.03,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Proteinase 3 Abs,,83516,CPT,Facility,Both,,,,100,85,28.66,100,BlueCross BlueShield Minnesota, Federal Employee Program,98.4,98.4,,percent of total billed charges,,
Proteinase 3 Abs,,83516,CPT,Facility,Both,,,,100,85,28.66,100,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,100,100,,percent of total billed charges,,
Proteinase 3 Abs,,83516,CPT,Facility,Both,,,,100,85,28.66,100,BlueCross BlueShield Minnesota,High Value Network Plan,90,90,,percent of total billed charges,,
Proteinase 3 Abs,,83516,CPT,Facility,Outpatient,,,,100,85,28.66,100,BlueCross BlueShield Minnesota,Medicare Advantage,49,49,,percent of total billed charges,,
Proteinase 3 Abs,,83516,CPT,Facility,Inpatient,,,,100,85,28.66,100,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Proteinase 3 Abs,,83516,CPT,Facility,Both,,,,100,85,28.66,100,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,88.57,88.57,,percent of total billed charges,,
Proteinase 3 Abs,,83516,CPT,Facility,Both,,,,100,85,28.66,100,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,28.66,28.66,,percent of total billed charges,,
Proteinase 3 Abs,,83516,CPT,Facility,Outpatient,,,,100,85,28.66,100,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),49,49,,percent of total billed charges,,
Proteinase 3 Abs,,83516,CPT,Facility,Inpatient,,,,100,85,28.66,100,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Proteinase 3 Abs,,83516,CPT,Facility,Both,,,,100,85,28.66,100,CorVel,Worker's Compensation,100,100,,percent of total billed charges,,
Proteinase 3 Abs,,83516,CPT,Facility,Both,,,,100,85,28.66,100,First Health Group Corporation,First Health Network,97,97,,percent of total billed charges,,
Proteinase 3 Abs,,83516,CPT,Facility,Both,,,,100,85,28.66,100,"Health Partners, Inc.",Commercial,94.6,94.6,,percent of total billed charges,,
Proteinase 3 Abs,,83516,CPT,Facility,Outpatient,,,,100,85,28.66,100,"Health Partners, Inc.",Medicare Advantage,49,49,,percent of total billed charges,,
Proteinase 3 Abs,,83516,CPT,Facility,Inpatient,,,,100,85,28.66,100,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Proteinase 3 Abs,,83516,CPT,Facility,Both,,,,100,85,28.66,100,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),60,60,,percent of total billed charges,,
Proteinase 3 Abs,,83516,CPT,Facility,Both,,,,100,85,28.66,100,"Health Partners, Inc.",State of Minnesota Advantage Program,81.5,81.5,,percent of total billed charges,,
Proteinase 3 Abs,,83516,CPT,Facility,Both,,,,100,85,28.66,100,"Health Partners, Inc.",State Public Programs,50,50,,percent of total billed charges,,
Proteinase 3 Abs,,83516,CPT,Facility,Both,,,,100,85,28.66,100,Humana Insurance Company,Commercial PPO,95,95,,percent of total billed charges,,
Proteinase 3 Abs,,83516,CPT,Facility,Outpatient,,,,100,85,28.66,100,Humana Insurance Company,Medicare PPO,49,49,,percent of total billed charges,,
Proteinase 3 Abs,,83516,CPT,Facility,Inpatient,,,,100,85,28.66,100,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Proteinase 3 Abs,,83516,CPT,Facility,Both,,,,100,85,28.66,100,Medica,Individual & Family,99.1,99.1,,percent of total billed charges,,
Proteinase 3 Abs,,83516,CPT,Facility,Outpatient,,,,100,85,28.66,100,Medica,Medica Advantage Solution,49.8,49.8,,percent of total billed charges,,
Proteinase 3 Abs,,83516,CPT,Facility,Inpatient,,,,100,85,28.66,100,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Proteinase 3 Abs,,83516,CPT,Facility,Outpatient,,,,100,85,28.66,100,Medica,Medical Assistance,44.6,44.6,,percent of total billed charges,,
Proteinase 3 Abs,,83516,CPT,Facility,Inpatient,,,,100,85,28.66,100,Medica,Medical Assistance,,,,,Included in per diem rate,
Proteinase 3 Abs,,83516,CPT,Facility,Outpatient,,,,100,85,28.66,100,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,49.8,49.8,,percent of total billed charges,,
Proteinase 3 Abs,,83516,CPT,Facility,Inpatient,,,,100,85,28.66,100,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Proteinase 3 Abs,,83516,CPT,Facility,Both,,,,100,85,28.66,100,"Multiplan, Inc.","Multiplan, Inc.",94,94,,percent of total billed charges,,
Proteinase 3 Abs,,83516,CPT,Facility,Outpatient,,,,100,85,28.66,100,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,86.4,86.4,,percent of total billed charges,,
Proteinase 3 Abs,,83516,CPT,Facility,Inpatient,,,,100,85,28.66,100,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Proteinase 3 Abs,,83516,CPT,Facility,Both,,,,100,85,28.66,100,"Preferred One Administrative Services, INC.",PPO,98.6,98.6,,percent of total billed charges,,
Proteinase 3 Abs,,83516,CPT,Facility,Outpatient,,,,100,85,28.66,100,PrimeWest Health,Minnesota Senior Health Options (MSHO),51.45,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Proteinase 3 Abs,,83516,CPT,Facility,Inpatient,,,,100,85,28.66,100,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Proteinase 3 Abs,,83516,CPT,Facility,Outpatient,,,,100,85,28.66,100,PrimeWest Health,MinnesotaCare,51.36,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Proteinase 3 Abs,,83516,CPT,Facility,Inpatient,,,,100,85,28.66,100,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Proteinase 3 Abs,,83516,CPT,Facility,Both,,,,100,85,28.66,100,Sanford Health Plan,Sanford Health Plan,92,92,,percent of total billed charges,,
Proteinase 3 Abs,,83516,CPT,Facility,Outpatient,,,,100,85,28.66,100,"UCare Health, Inc.",Individual & Family Plan,56.35,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Proteinase 3 Abs,,83516,CPT,Facility,Inpatient,,,,100,85,28.66,100,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Proteinase 3 Abs,,83516,CPT,Facility,Outpatient,,,,100,85,28.66,100,"UCare Health, Inc.",Medical Assistance,50.47,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Proteinase 3 Abs,,83516,CPT,Facility,Inpatient,,,,100,85,28.66,100,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Proteinase 3 Abs,,83516,CPT,Facility,Outpatient,,,,100,85,28.66,100,"UCare Health, Inc.",Medicare Advantage,50.47,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Proteinase 3 Abs,,83516,CPT,Facility,Inpatient,,,,100,85,28.66,100,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Proteinase 3 Abs,,83516,CPT,Facility,Outpatient,,,,100,85,28.66,100,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),50.47,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Proteinase 3 Abs,,83516,CPT,Facility,Inpatient,,,,100,85,28.66,100,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Proteinase 3 Abs,,83516,CPT,Facility,Both,,,,100,85,28.66,100,UnitedHealthcare,Individual & Family,94,94,,percent of total billed charges,,
Proteinase 3 Abs,,83516,CPT,Facility,Outpatient,,,,100,85,28.66,100,UnitedHealthcare,Medicare Advantage,49,49,,percent of total billed charges,,
Proteinase 3 Abs,,83516,CPT,Facility,Inpatient,,,,100,85,28.66,100,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Proteinase 3 Abs,,83516,CPT,Facility,Outpatient,,,,100,85,28.66,100,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,48,48,,percent of total billed charges,,100% of DHS outpatient percentage
Proteinase 3 Abs,,83516,CPT,Facility,Inpatient,,,,100,85,28.66,100,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Ribosome P Ab, Igg",,83516,CPT,Facility,Both,,,,131,111.35,37.5446,131,Aetna,Commercial,120.52,92,,percent of total billed charges,,
"Ribosome P Ab, Igg",,83516,CPT,Facility,Outpatient,,,,131,111.35,37.5446,131,Aetna,Medicare Advantage,64.19,49,,percent of total billed charges,,
"Ribosome P Ab, Igg",,83516,CPT,Facility,Inpatient,,,,131,111.35,37.5446,131,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Ribosome P Ab, Igg",,83516,CPT,Facility,Both,,,,131,111.35,37.5446,131,Aetna,PPO,121.83,93,,percent of total billed charges,,
"Ribosome P Ab, Igg",,83516,CPT,Facility,Both,,,,131,111.35,37.5446,131,America's PPO,America's PPO,125.7993,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Ribosome P Ab, Igg",,83516,CPT,Facility,Both,,,,131,111.35,37.5446,131,BlueCross BlueShield Minnesota, Federal Employee Program,128.904,98.4,,percent of total billed charges,,
"Ribosome P Ab, Igg",,83516,CPT,Facility,Both,,,,131,111.35,37.5446,131,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,131,100,,percent of total billed charges,,
"Ribosome P Ab, Igg",,83516,CPT,Facility,Both,,,,131,111.35,37.5446,131,BlueCross BlueShield Minnesota,High Value Network Plan,117.9,90,,percent of total billed charges,,
"Ribosome P Ab, Igg",,83516,CPT,Facility,Outpatient,,,,131,111.35,37.5446,131,BlueCross BlueShield Minnesota,Medicare Advantage,64.19,49,,percent of total billed charges,,
"Ribosome P Ab, Igg",,83516,CPT,Facility,Inpatient,,,,131,111.35,37.5446,131,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Ribosome P Ab, Igg",,83516,CPT,Facility,Both,,,,131,111.35,37.5446,131,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,116.0267,88.57,,percent of total billed charges,,
"Ribosome P Ab, Igg",,83516,CPT,Facility,Both,,,,131,111.35,37.5446,131,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,37.5446,28.66,,percent of total billed charges,,
"Ribosome P Ab, Igg",,83516,CPT,Facility,Outpatient,,,,131,111.35,37.5446,131,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),64.19,49,,percent of total billed charges,,
"Ribosome P Ab, Igg",,83516,CPT,Facility,Inpatient,,,,131,111.35,37.5446,131,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Ribosome P Ab, Igg",,83516,CPT,Facility,Both,,,,131,111.35,37.5446,131,CorVel,Worker's Compensation,131,100,,percent of total billed charges,,
"Ribosome P Ab, Igg",,83516,CPT,Facility,Both,,,,131,111.35,37.5446,131,First Health Group Corporation,First Health Network,127.07,97,,percent of total billed charges,,
"Ribosome P Ab, Igg",,83516,CPT,Facility,Both,,,,131,111.35,37.5446,131,"Health Partners, Inc.",Commercial,123.926,94.6,,percent of total billed charges,,
"Ribosome P Ab, Igg",,83516,CPT,Facility,Outpatient,,,,131,111.35,37.5446,131,"Health Partners, Inc.",Medicare Advantage,64.19,49,,percent of total billed charges,,
"Ribosome P Ab, Igg",,83516,CPT,Facility,Inpatient,,,,131,111.35,37.5446,131,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Ribosome P Ab, Igg",,83516,CPT,Facility,Both,,,,131,111.35,37.5446,131,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),78.6,60,,percent of total billed charges,,
"Ribosome P Ab, Igg",,83516,CPT,Facility,Both,,,,131,111.35,37.5446,131,"Health Partners, Inc.",State of Minnesota Advantage Program,106.765,81.5,,percent of total billed charges,,
"Ribosome P Ab, Igg",,83516,CPT,Facility,Both,,,,131,111.35,37.5446,131,"Health Partners, Inc.",State Public Programs,65.5,50,,percent of total billed charges,,
"Ribosome P Ab, Igg",,83516,CPT,Facility,Both,,,,131,111.35,37.5446,131,Humana Insurance Company,Commercial PPO,124.45,95,,percent of total billed charges,,
"Ribosome P Ab, Igg",,83516,CPT,Facility,Outpatient,,,,131,111.35,37.5446,131,Humana Insurance Company,Medicare PPO,64.19,49,,percent of total billed charges,,
"Ribosome P Ab, Igg",,83516,CPT,Facility,Inpatient,,,,131,111.35,37.5446,131,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Ribosome P Ab, Igg",,83516,CPT,Facility,Both,,,,131,111.35,37.5446,131,Medica,Individual & Family,129.821,99.1,,percent of total billed charges,,
"Ribosome P Ab, Igg",,83516,CPT,Facility,Outpatient,,,,131,111.35,37.5446,131,Medica,Medica Advantage Solution,65.238,49.8,,percent of total billed charges,,
"Ribosome P Ab, Igg",,83516,CPT,Facility,Inpatient,,,,131,111.35,37.5446,131,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Ribosome P Ab, Igg",,83516,CPT,Facility,Outpatient,,,,131,111.35,37.5446,131,Medica,Medical Assistance,58.426,44.6,,percent of total billed charges,,
"Ribosome P Ab, Igg",,83516,CPT,Facility,Inpatient,,,,131,111.35,37.5446,131,Medica,Medical Assistance,,,,,Included in per diem rate,
"Ribosome P Ab, Igg",,83516,CPT,Facility,Outpatient,,,,131,111.35,37.5446,131,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,65.238,49.8,,percent of total billed charges,,
"Ribosome P Ab, Igg",,83516,CPT,Facility,Inpatient,,,,131,111.35,37.5446,131,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Ribosome P Ab, Igg",,83516,CPT,Facility,Both,,,,131,111.35,37.5446,131,"Multiplan, Inc.","Multiplan, Inc.",123.14,94,,percent of total billed charges,,
"Ribosome P Ab, Igg",,83516,CPT,Facility,Outpatient,,,,131,111.35,37.5446,131,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,113.184,86.4,,percent of total billed charges,,
"Ribosome P Ab, Igg",,83516,CPT,Facility,Inpatient,,,,131,111.35,37.5446,131,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Ribosome P Ab, Igg",,83516,CPT,Facility,Both,,,,131,111.35,37.5446,131,"Preferred One Administrative Services, INC.",PPO,129.166,98.6,,percent of total billed charges,,
"Ribosome P Ab, Igg",,83516,CPT,Facility,Outpatient,,,,131,111.35,37.5446,131,PrimeWest Health,Minnesota Senior Health Options (MSHO),67.3995,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Ribosome P Ab, Igg",,83516,CPT,Facility,Inpatient,,,,131,111.35,37.5446,131,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Ribosome P Ab, Igg",,83516,CPT,Facility,Outpatient,,,,131,111.35,37.5446,131,PrimeWest Health,MinnesotaCare,67.2816,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Ribosome P Ab, Igg",,83516,CPT,Facility,Inpatient,,,,131,111.35,37.5446,131,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Ribosome P Ab, Igg",,83516,CPT,Facility,Both,,,,131,111.35,37.5446,131,Sanford Health Plan,Sanford Health Plan,120.52,92,,percent of total billed charges,,
"Ribosome P Ab, Igg",,83516,CPT,Facility,Outpatient,,,,131,111.35,37.5446,131,"UCare Health, Inc.",Individual & Family Plan,73.8185,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Ribosome P Ab, Igg",,83516,CPT,Facility,Inpatient,,,,131,111.35,37.5446,131,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Ribosome P Ab, Igg",,83516,CPT,Facility,Outpatient,,,,131,111.35,37.5446,131,"UCare Health, Inc.",Medical Assistance,66.1157,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Ribosome P Ab, Igg",,83516,CPT,Facility,Inpatient,,,,131,111.35,37.5446,131,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Ribosome P Ab, Igg",,83516,CPT,Facility,Outpatient,,,,131,111.35,37.5446,131,"UCare Health, Inc.",Medicare Advantage,66.1157,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Ribosome P Ab, Igg",,83516,CPT,Facility,Inpatient,,,,131,111.35,37.5446,131,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Ribosome P Ab, Igg",,83516,CPT,Facility,Outpatient,,,,131,111.35,37.5446,131,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),66.1157,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Ribosome P Ab, Igg",,83516,CPT,Facility,Inpatient,,,,131,111.35,37.5446,131,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Ribosome P Ab, Igg",,83516,CPT,Facility,Both,,,,131,111.35,37.5446,131,UnitedHealthcare,Individual & Family,123.14,94,,percent of total billed charges,,
"Ribosome P Ab, Igg",,83516,CPT,Facility,Outpatient,,,,131,111.35,37.5446,131,UnitedHealthcare,Medicare Advantage,64.19,49,,percent of total billed charges,,
"Ribosome P Ab, Igg",,83516,CPT,Facility,Inpatient,,,,131,111.35,37.5446,131,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Ribosome P Ab, Igg",,83516,CPT,Facility,Outpatient,,,,131,111.35,37.5446,131,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,62.88,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Ribosome P Ab, Igg",,83516,CPT,Facility,Inpatient,,,,131,111.35,37.5446,131,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Tissue Transglutaminase, Iga",,83516,CPT,Facility,Both,,,,61,51.85,17.4826,61,Aetna,Commercial,56.12,92,,percent of total billed charges,,
"Tissue Transglutaminase, Iga",,83516,CPT,Facility,Outpatient,,,,61,51.85,17.4826,61,Aetna,Medicare Advantage,29.89,49,,percent of total billed charges,,
"Tissue Transglutaminase, Iga",,83516,CPT,Facility,Inpatient,,,,61,51.85,17.4826,61,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Tissue Transglutaminase, Iga",,83516,CPT,Facility,Both,,,,61,51.85,17.4826,61,Aetna,PPO,56.73,93,,percent of total billed charges,,
"Tissue Transglutaminase, Iga",,83516,CPT,Facility,Both,,,,61,51.85,17.4826,61,America's PPO,America's PPO,58.5783,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Tissue Transglutaminase, Iga",,83516,CPT,Facility,Both,,,,61,51.85,17.4826,61,BlueCross BlueShield Minnesota, Federal Employee Program,60.024,98.4,,percent of total billed charges,,
"Tissue Transglutaminase, Iga",,83516,CPT,Facility,Both,,,,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,61,100,,percent of total billed charges,,
"Tissue Transglutaminase, Iga",,83516,CPT,Facility,Both,,,,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,High Value Network Plan,54.9,90,,percent of total billed charges,,
"Tissue Transglutaminase, Iga",,83516,CPT,Facility,Outpatient,,,,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,Medicare Advantage,29.89,49,,percent of total billed charges,,
"Tissue Transglutaminase, Iga",,83516,CPT,Facility,Inpatient,,,,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Tissue Transglutaminase, Iga",,83516,CPT,Facility,Both,,,,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,54.0277,88.57,,percent of total billed charges,,
"Tissue Transglutaminase, Iga",,83516,CPT,Facility,Both,,,,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,17.4826,28.66,,percent of total billed charges,,
"Tissue Transglutaminase, Iga",,83516,CPT,Facility,Outpatient,,,,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),29.89,49,,percent of total billed charges,,
"Tissue Transglutaminase, Iga",,83516,CPT,Facility,Inpatient,,,,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Tissue Transglutaminase, Iga",,83516,CPT,Facility,Both,,,,61,51.85,17.4826,61,CorVel,Worker's Compensation,61,100,,percent of total billed charges,,
"Tissue Transglutaminase, Iga",,83516,CPT,Facility,Both,,,,61,51.85,17.4826,61,First Health Group Corporation,First Health Network,59.17,97,,percent of total billed charges,,
"Tissue Transglutaminase, Iga",,83516,CPT,Facility,Both,,,,61,51.85,17.4826,61,"Health Partners, Inc.",Commercial,57.706,94.6,,percent of total billed charges,,
"Tissue Transglutaminase, Iga",,83516,CPT,Facility,Outpatient,,,,61,51.85,17.4826,61,"Health Partners, Inc.",Medicare Advantage,29.89,49,,percent of total billed charges,,
"Tissue Transglutaminase, Iga",,83516,CPT,Facility,Inpatient,,,,61,51.85,17.4826,61,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Tissue Transglutaminase, Iga",,83516,CPT,Facility,Both,,,,61,51.85,17.4826,61,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),36.6,60,,percent of total billed charges,,
"Tissue Transglutaminase, Iga",,83516,CPT,Facility,Both,,,,61,51.85,17.4826,61,"Health Partners, Inc.",State of Minnesota Advantage Program,49.715,81.5,,percent of total billed charges,,
"Tissue Transglutaminase, Iga",,83516,CPT,Facility,Both,,,,61,51.85,17.4826,61,"Health Partners, Inc.",State Public Programs,30.5,50,,percent of total billed charges,,
"Tissue Transglutaminase, Iga",,83516,CPT,Facility,Both,,,,61,51.85,17.4826,61,Humana Insurance Company,Commercial PPO,57.95,95,,percent of total billed charges,,
"Tissue Transglutaminase, Iga",,83516,CPT,Facility,Outpatient,,,,61,51.85,17.4826,61,Humana Insurance Company,Medicare PPO,29.89,49,,percent of total billed charges,,
"Tissue Transglutaminase, Iga",,83516,CPT,Facility,Inpatient,,,,61,51.85,17.4826,61,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Tissue Transglutaminase, Iga",,83516,CPT,Facility,Both,,,,61,51.85,17.4826,61,Medica,Individual & Family,60.451,99.1,,percent of total billed charges,,
"Tissue Transglutaminase, Iga",,83516,CPT,Facility,Outpatient,,,,61,51.85,17.4826,61,Medica,Medica Advantage Solution,30.378,49.8,,percent of total billed charges,,
"Tissue Transglutaminase, Iga",,83516,CPT,Facility,Inpatient,,,,61,51.85,17.4826,61,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Tissue Transglutaminase, Iga",,83516,CPT,Facility,Outpatient,,,,61,51.85,17.4826,61,Medica,Medical Assistance,27.206,44.6,,percent of total billed charges,,
"Tissue Transglutaminase, Iga",,83516,CPT,Facility,Inpatient,,,,61,51.85,17.4826,61,Medica,Medical Assistance,,,,,Included in per diem rate,
"Tissue Transglutaminase, Iga",,83516,CPT,Facility,Outpatient,,,,61,51.85,17.4826,61,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,30.378,49.8,,percent of total billed charges,,
"Tissue Transglutaminase, Iga",,83516,CPT,Facility,Inpatient,,,,61,51.85,17.4826,61,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Tissue Transglutaminase, Iga",,83516,CPT,Facility,Both,,,,61,51.85,17.4826,61,"Multiplan, Inc.","Multiplan, Inc.",57.34,94,,percent of total billed charges,,
"Tissue Transglutaminase, Iga",,83516,CPT,Facility,Outpatient,,,,61,51.85,17.4826,61,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,52.704,86.4,,percent of total billed charges,,
"Tissue Transglutaminase, Iga",,83516,CPT,Facility,Inpatient,,,,61,51.85,17.4826,61,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Tissue Transglutaminase, Iga",,83516,CPT,Facility,Both,,,,61,51.85,17.4826,61,"Preferred One Administrative Services, INC.",PPO,60.146,98.6,,percent of total billed charges,,
"Tissue Transglutaminase, Iga",,83516,CPT,Facility,Outpatient,,,,61,51.85,17.4826,61,PrimeWest Health,Minnesota Senior Health Options (MSHO),31.3845,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Tissue Transglutaminase, Iga",,83516,CPT,Facility,Inpatient,,,,61,51.85,17.4826,61,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Tissue Transglutaminase, Iga",,83516,CPT,Facility,Outpatient,,,,61,51.85,17.4826,61,PrimeWest Health,MinnesotaCare,31.3296,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Tissue Transglutaminase, Iga",,83516,CPT,Facility,Inpatient,,,,61,51.85,17.4826,61,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Tissue Transglutaminase, Iga",,83516,CPT,Facility,Both,,,,61,51.85,17.4826,61,Sanford Health Plan,Sanford Health Plan,56.12,92,,percent of total billed charges,,
"Tissue Transglutaminase, Iga",,83516,CPT,Facility,Outpatient,,,,61,51.85,17.4826,61,"UCare Health, Inc.",Individual & Family Plan,34.3735,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Tissue Transglutaminase, Iga",,83516,CPT,Facility,Inpatient,,,,61,51.85,17.4826,61,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Tissue Transglutaminase, Iga",,83516,CPT,Facility,Outpatient,,,,61,51.85,17.4826,61,"UCare Health, Inc.",Medical Assistance,30.7867,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Tissue Transglutaminase, Iga",,83516,CPT,Facility,Inpatient,,,,61,51.85,17.4826,61,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Tissue Transglutaminase, Iga",,83516,CPT,Facility,Outpatient,,,,61,51.85,17.4826,61,"UCare Health, Inc.",Medicare Advantage,30.7867,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Tissue Transglutaminase, Iga",,83516,CPT,Facility,Inpatient,,,,61,51.85,17.4826,61,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Tissue Transglutaminase, Iga",,83516,CPT,Facility,Outpatient,,,,61,51.85,17.4826,61,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),30.7867,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Tissue Transglutaminase, Iga",,83516,CPT,Facility,Inpatient,,,,61,51.85,17.4826,61,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Tissue Transglutaminase, Iga",,83516,CPT,Facility,Both,,,,61,51.85,17.4826,61,UnitedHealthcare,Individual & Family,57.34,94,,percent of total billed charges,,
"Tissue Transglutaminase, Iga",,83516,CPT,Facility,Outpatient,,,,61,51.85,17.4826,61,UnitedHealthcare,Medicare Advantage,29.89,49,,percent of total billed charges,,
"Tissue Transglutaminase, Iga",,83516,CPT,Facility,Inpatient,,,,61,51.85,17.4826,61,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Tissue Transglutaminase, Iga",,83516,CPT,Facility,Outpatient,,,,61,51.85,17.4826,61,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,29.28,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Tissue Transglutaminase, Iga",,83516,CPT,Facility,Inpatient,,,,61,51.85,17.4826,61,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Tissue Transglutaminase, Igg",,83516,CPT,Facility,Both,,,,61,51.85,17.4826,61,Aetna,Commercial,56.12,92,,percent of total billed charges,,
"Tissue Transglutaminase, Igg",,83516,CPT,Facility,Outpatient,,,,61,51.85,17.4826,61,Aetna,Medicare Advantage,29.89,49,,percent of total billed charges,,
"Tissue Transglutaminase, Igg",,83516,CPT,Facility,Inpatient,,,,61,51.85,17.4826,61,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Tissue Transglutaminase, Igg",,83516,CPT,Facility,Both,,,,61,51.85,17.4826,61,Aetna,PPO,56.73,93,,percent of total billed charges,,
"Tissue Transglutaminase, Igg",,83516,CPT,Facility,Both,,,,61,51.85,17.4826,61,America's PPO,America's PPO,58.5783,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Tissue Transglutaminase, Igg",,83516,CPT,Facility,Both,,,,61,51.85,17.4826,61,BlueCross BlueShield Minnesota, Federal Employee Program,60.024,98.4,,percent of total billed charges,,
"Tissue Transglutaminase, Igg",,83516,CPT,Facility,Both,,,,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,61,100,,percent of total billed charges,,
"Tissue Transglutaminase, Igg",,83516,CPT,Facility,Both,,,,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,High Value Network Plan,54.9,90,,percent of total billed charges,,
"Tissue Transglutaminase, Igg",,83516,CPT,Facility,Outpatient,,,,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,Medicare Advantage,29.89,49,,percent of total billed charges,,
"Tissue Transglutaminase, Igg",,83516,CPT,Facility,Inpatient,,,,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Tissue Transglutaminase, Igg",,83516,CPT,Facility,Both,,,,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,54.0277,88.57,,percent of total billed charges,,
"Tissue Transglutaminase, Igg",,83516,CPT,Facility,Both,,,,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,17.4826,28.66,,percent of total billed charges,,
"Tissue Transglutaminase, Igg",,83516,CPT,Facility,Outpatient,,,,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),29.89,49,,percent of total billed charges,,
"Tissue Transglutaminase, Igg",,83516,CPT,Facility,Inpatient,,,,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Tissue Transglutaminase, Igg",,83516,CPT,Facility,Both,,,,61,51.85,17.4826,61,CorVel,Worker's Compensation,61,100,,percent of total billed charges,,
"Tissue Transglutaminase, Igg",,83516,CPT,Facility,Both,,,,61,51.85,17.4826,61,First Health Group Corporation,First Health Network,59.17,97,,percent of total billed charges,,
"Tissue Transglutaminase, Igg",,83516,CPT,Facility,Both,,,,61,51.85,17.4826,61,"Health Partners, Inc.",Commercial,57.706,94.6,,percent of total billed charges,,
"Tissue Transglutaminase, Igg",,83516,CPT,Facility,Outpatient,,,,61,51.85,17.4826,61,"Health Partners, Inc.",Medicare Advantage,29.89,49,,percent of total billed charges,,
"Tissue Transglutaminase, Igg",,83516,CPT,Facility,Inpatient,,,,61,51.85,17.4826,61,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Tissue Transglutaminase, Igg",,83516,CPT,Facility,Both,,,,61,51.85,17.4826,61,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),36.6,60,,percent of total billed charges,,
"Tissue Transglutaminase, Igg",,83516,CPT,Facility,Both,,,,61,51.85,17.4826,61,"Health Partners, Inc.",State of Minnesota Advantage Program,49.715,81.5,,percent of total billed charges,,
"Tissue Transglutaminase, Igg",,83516,CPT,Facility,Both,,,,61,51.85,17.4826,61,"Health Partners, Inc.",State Public Programs,30.5,50,,percent of total billed charges,,
"Tissue Transglutaminase, Igg",,83516,CPT,Facility,Both,,,,61,51.85,17.4826,61,Humana Insurance Company,Commercial PPO,57.95,95,,percent of total billed charges,,
"Tissue Transglutaminase, Igg",,83516,CPT,Facility,Outpatient,,,,61,51.85,17.4826,61,Humana Insurance Company,Medicare PPO,29.89,49,,percent of total billed charges,,
"Tissue Transglutaminase, Igg",,83516,CPT,Facility,Inpatient,,,,61,51.85,17.4826,61,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Tissue Transglutaminase, Igg",,83516,CPT,Facility,Both,,,,61,51.85,17.4826,61,Medica,Individual & Family,60.451,99.1,,percent of total billed charges,,
"Tissue Transglutaminase, Igg",,83516,CPT,Facility,Outpatient,,,,61,51.85,17.4826,61,Medica,Medica Advantage Solution,30.378,49.8,,percent of total billed charges,,
"Tissue Transglutaminase, Igg",,83516,CPT,Facility,Inpatient,,,,61,51.85,17.4826,61,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Tissue Transglutaminase, Igg",,83516,CPT,Facility,Outpatient,,,,61,51.85,17.4826,61,Medica,Medical Assistance,27.206,44.6,,percent of total billed charges,,
"Tissue Transglutaminase, Igg",,83516,CPT,Facility,Inpatient,,,,61,51.85,17.4826,61,Medica,Medical Assistance,,,,,Included in per diem rate,
"Tissue Transglutaminase, Igg",,83516,CPT,Facility,Outpatient,,,,61,51.85,17.4826,61,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,30.378,49.8,,percent of total billed charges,,
"Tissue Transglutaminase, Igg",,83516,CPT,Facility,Inpatient,,,,61,51.85,17.4826,61,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Tissue Transglutaminase, Igg",,83516,CPT,Facility,Both,,,,61,51.85,17.4826,61,"Multiplan, Inc.","Multiplan, Inc.",57.34,94,,percent of total billed charges,,
"Tissue Transglutaminase, Igg",,83516,CPT,Facility,Outpatient,,,,61,51.85,17.4826,61,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,52.704,86.4,,percent of total billed charges,,
"Tissue Transglutaminase, Igg",,83516,CPT,Facility,Inpatient,,,,61,51.85,17.4826,61,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Tissue Transglutaminase, Igg",,83516,CPT,Facility,Both,,,,61,51.85,17.4826,61,"Preferred One Administrative Services, INC.",PPO,60.146,98.6,,percent of total billed charges,,
"Tissue Transglutaminase, Igg",,83516,CPT,Facility,Outpatient,,,,61,51.85,17.4826,61,PrimeWest Health,Minnesota Senior Health Options (MSHO),31.3845,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Tissue Transglutaminase, Igg",,83516,CPT,Facility,Inpatient,,,,61,51.85,17.4826,61,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Tissue Transglutaminase, Igg",,83516,CPT,Facility,Outpatient,,,,61,51.85,17.4826,61,PrimeWest Health,MinnesotaCare,31.3296,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Tissue Transglutaminase, Igg",,83516,CPT,Facility,Inpatient,,,,61,51.85,17.4826,61,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Tissue Transglutaminase, Igg",,83516,CPT,Facility,Both,,,,61,51.85,17.4826,61,Sanford Health Plan,Sanford Health Plan,56.12,92,,percent of total billed charges,,
"Tissue Transglutaminase, Igg",,83516,CPT,Facility,Outpatient,,,,61,51.85,17.4826,61,"UCare Health, Inc.",Individual & Family Plan,34.3735,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Tissue Transglutaminase, Igg",,83516,CPT,Facility,Inpatient,,,,61,51.85,17.4826,61,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Tissue Transglutaminase, Igg",,83516,CPT,Facility,Outpatient,,,,61,51.85,17.4826,61,"UCare Health, Inc.",Medical Assistance,30.7867,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Tissue Transglutaminase, Igg",,83516,CPT,Facility,Inpatient,,,,61,51.85,17.4826,61,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Tissue Transglutaminase, Igg",,83516,CPT,Facility,Outpatient,,,,61,51.85,17.4826,61,"UCare Health, Inc.",Medicare Advantage,30.7867,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Tissue Transglutaminase, Igg",,83516,CPT,Facility,Inpatient,,,,61,51.85,17.4826,61,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Tissue Transglutaminase, Igg",,83516,CPT,Facility,Outpatient,,,,61,51.85,17.4826,61,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),30.7867,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Tissue Transglutaminase, Igg",,83516,CPT,Facility,Inpatient,,,,61,51.85,17.4826,61,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Tissue Transglutaminase, Igg",,83516,CPT,Facility,Both,,,,61,51.85,17.4826,61,UnitedHealthcare,Individual & Family,57.34,94,,percent of total billed charges,,
"Tissue Transglutaminase, Igg",,83516,CPT,Facility,Outpatient,,,,61,51.85,17.4826,61,UnitedHealthcare,Medicare Advantage,29.89,49,,percent of total billed charges,,
"Tissue Transglutaminase, Igg",,83516,CPT,Facility,Inpatient,,,,61,51.85,17.4826,61,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Tissue Transglutaminase, Igg",,83516,CPT,Facility,Outpatient,,,,61,51.85,17.4826,61,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,29.28,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Tissue Transglutaminase, Igg",,83516,CPT,Facility,Inpatient,,,,61,51.85,17.4826,61,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Insulin,,83525,CPT,Facility,Both,,,,87,73.95,24.9342,87,Aetna,Commercial,80.04,92,,percent of total billed charges,,
Insulin,,83525,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,Aetna,Medicare Advantage,42.63,49,,percent of total billed charges,,
Insulin,,83525,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Insulin,,83525,CPT,Facility,Both,,,,87,73.95,24.9342,87,Aetna,PPO,80.91,93,,percent of total billed charges,,
Insulin,,83525,CPT,Facility,Both,,,,87,73.95,24.9342,87,America's PPO,America's PPO,83.5461,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Insulin,,83525,CPT,Facility,Both,,,,87,73.95,24.9342,87,BlueCross BlueShield Minnesota, Federal Employee Program,85.608,98.4,,percent of total billed charges,,
Insulin,,83525,CPT,Facility,Both,,,,87,73.95,24.9342,87,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,87,100,,percent of total billed charges,,
Insulin,,83525,CPT,Facility,Both,,,,87,73.95,24.9342,87,BlueCross BlueShield Minnesota,High Value Network Plan,78.3,90,,percent of total billed charges,,
Insulin,,83525,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,BlueCross BlueShield Minnesota,Medicare Advantage,42.63,49,,percent of total billed charges,,
Insulin,,83525,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Insulin,,83525,CPT,Facility,Both,,,,87,73.95,24.9342,87,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,77.0559,88.57,,percent of total billed charges,,
Insulin,,83525,CPT,Facility,Both,,,,87,73.95,24.9342,87,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,24.9342,28.66,,percent of total billed charges,,
Insulin,,83525,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),42.63,49,,percent of total billed charges,,
Insulin,,83525,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Insulin,,83525,CPT,Facility,Both,,,,87,73.95,24.9342,87,CorVel,Worker's Compensation,87,100,,percent of total billed charges,,
Insulin,,83525,CPT,Facility,Both,,,,87,73.95,24.9342,87,First Health Group Corporation,First Health Network,84.39,97,,percent of total billed charges,,
Insulin,,83525,CPT,Facility,Both,,,,87,73.95,24.9342,87,"Health Partners, Inc.",Commercial,82.302,94.6,,percent of total billed charges,,
Insulin,,83525,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,"Health Partners, Inc.",Medicare Advantage,42.63,49,,percent of total billed charges,,
Insulin,,83525,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Insulin,,83525,CPT,Facility,Both,,,,87,73.95,24.9342,87,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),52.2,60,,percent of total billed charges,,
Insulin,,83525,CPT,Facility,Both,,,,87,73.95,24.9342,87,"Health Partners, Inc.",State of Minnesota Advantage Program,70.905,81.5,,percent of total billed charges,,
Insulin,,83525,CPT,Facility,Both,,,,87,73.95,24.9342,87,"Health Partners, Inc.",State Public Programs,43.5,50,,percent of total billed charges,,
Insulin,,83525,CPT,Facility,Both,,,,87,73.95,24.9342,87,Humana Insurance Company,Commercial PPO,82.65,95,,percent of total billed charges,,
Insulin,,83525,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,Humana Insurance Company,Medicare PPO,42.63,49,,percent of total billed charges,,
Insulin,,83525,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Insulin,,83525,CPT,Facility,Both,,,,87,73.95,24.9342,87,Medica,Individual & Family,86.217,99.1,,percent of total billed charges,,
Insulin,,83525,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,Medica,Medica Advantage Solution,43.326,49.8,,percent of total billed charges,,
Insulin,,83525,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Insulin,,83525,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,Medica,Medical Assistance,38.802,44.6,,percent of total billed charges,,
Insulin,,83525,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,Medica,Medical Assistance,,,,,Included in per diem rate,
Insulin,,83525,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,43.326,49.8,,percent of total billed charges,,
Insulin,,83525,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Insulin,,83525,CPT,Facility,Both,,,,87,73.95,24.9342,87,"Multiplan, Inc.","Multiplan, Inc.",81.78,94,,percent of total billed charges,,
Insulin,,83525,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,75.168,86.4,,percent of total billed charges,,
Insulin,,83525,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Insulin,,83525,CPT,Facility,Both,,,,87,73.95,24.9342,87,"Preferred One Administrative Services, INC.",PPO,85.782,98.6,,percent of total billed charges,,
Insulin,,83525,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,PrimeWest Health,Minnesota Senior Health Options (MSHO),44.7615,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Insulin,,83525,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Insulin,,83525,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,PrimeWest Health,MinnesotaCare,44.6832,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Insulin,,83525,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Insulin,,83525,CPT,Facility,Both,,,,87,73.95,24.9342,87,Sanford Health Plan,Sanford Health Plan,80.04,92,,percent of total billed charges,,
Insulin,,83525,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,"UCare Health, Inc.",Individual & Family Plan,49.0245,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Insulin,,83525,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Insulin,,83525,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,"UCare Health, Inc.",Medical Assistance,43.9089,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Insulin,,83525,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Insulin,,83525,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,"UCare Health, Inc.",Medicare Advantage,43.9089,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Insulin,,83525,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Insulin,,83525,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),43.9089,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Insulin,,83525,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Insulin,,83525,CPT,Facility,Both,,,,87,73.95,24.9342,87,UnitedHealthcare,Individual & Family,81.78,94,,percent of total billed charges,,
Insulin,,83525,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,UnitedHealthcare,Medicare Advantage,42.63,49,,percent of total billed charges,,
Insulin,,83525,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Insulin,,83525,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,41.76,48,,percent of total billed charges,,100% of DHS outpatient percentage
Insulin,,83525,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Iron,,83540,CPT,Facility,Both,,,,72,61.2,20.6352,72,Aetna,Commercial,66.24,92,,percent of total billed charges,,
Iron,,83540,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,Aetna,Medicare Advantage,35.28,49,,percent of total billed charges,,
Iron,,83540,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Iron,,83540,CPT,Facility,Both,,,,72,61.2,20.6352,72,Aetna,PPO,66.96,93,,percent of total billed charges,,
Iron,,83540,CPT,Facility,Both,,,,72,61.2,20.6352,72,America's PPO,America's PPO,69.1416,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Iron,,83540,CPT,Facility,Both,,,,72,61.2,20.6352,72,BlueCross BlueShield Minnesota, Federal Employee Program,70.848,98.4,,percent of total billed charges,,
Iron,,83540,CPT,Facility,Both,,,,72,61.2,20.6352,72,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,72,100,,percent of total billed charges,,
Iron,,83540,CPT,Facility,Both,,,,72,61.2,20.6352,72,BlueCross BlueShield Minnesota,High Value Network Plan,64.8,90,,percent of total billed charges,,
Iron,,83540,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,BlueCross BlueShield Minnesota,Medicare Advantage,35.28,49,,percent of total billed charges,,
Iron,,83540,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Iron,,83540,CPT,Facility,Both,,,,72,61.2,20.6352,72,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,63.7704,88.57,,percent of total billed charges,,
Iron,,83540,CPT,Facility,Both,,,,72,61.2,20.6352,72,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,20.6352,28.66,,percent of total billed charges,,
Iron,,83540,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),35.28,49,,percent of total billed charges,,
Iron,,83540,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Iron,,83540,CPT,Facility,Both,,,,72,61.2,20.6352,72,CorVel,Worker's Compensation,72,100,,percent of total billed charges,,
Iron,,83540,CPT,Facility,Both,,,,72,61.2,20.6352,72,First Health Group Corporation,First Health Network,69.84,97,,percent of total billed charges,,
Iron,,83540,CPT,Facility,Both,,,,72,61.2,20.6352,72,"Health Partners, Inc.",Commercial,68.112,94.6,,percent of total billed charges,,
Iron,,83540,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,"Health Partners, Inc.",Medicare Advantage,35.28,49,,percent of total billed charges,,
Iron,,83540,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Iron,,83540,CPT,Facility,Both,,,,72,61.2,20.6352,72,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),43.2,60,,percent of total billed charges,,
Iron,,83540,CPT,Facility,Both,,,,72,61.2,20.6352,72,"Health Partners, Inc.",State of Minnesota Advantage Program,58.68,81.5,,percent of total billed charges,,
Iron,,83540,CPT,Facility,Both,,,,72,61.2,20.6352,72,"Health Partners, Inc.",State Public Programs,36,50,,percent of total billed charges,,
Iron,,83540,CPT,Facility,Both,,,,72,61.2,20.6352,72,Humana Insurance Company,Commercial PPO,68.4,95,,percent of total billed charges,,
Iron,,83540,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,Humana Insurance Company,Medicare PPO,35.28,49,,percent of total billed charges,,
Iron,,83540,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Iron,,83540,CPT,Facility,Both,,,,72,61.2,20.6352,72,Medica,Individual & Family,71.352,99.1,,percent of total billed charges,,
Iron,,83540,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,Medica,Medica Advantage Solution,35.856,49.8,,percent of total billed charges,,
Iron,,83540,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Iron,,83540,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,Medica,Medical Assistance,32.112,44.6,,percent of total billed charges,,
Iron,,83540,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,Medica,Medical Assistance,,,,,Included in per diem rate,
Iron,,83540,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,35.856,49.8,,percent of total billed charges,,
Iron,,83540,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Iron,,83540,CPT,Facility,Both,,,,72,61.2,20.6352,72,"Multiplan, Inc.","Multiplan, Inc.",67.68,94,,percent of total billed charges,,
Iron,,83540,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,62.208,86.4,,percent of total billed charges,,
Iron,,83540,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Iron,,83540,CPT,Facility,Both,,,,72,61.2,20.6352,72,"Preferred One Administrative Services, INC.",PPO,70.992,98.6,,percent of total billed charges,,
Iron,,83540,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,PrimeWest Health,Minnesota Senior Health Options (MSHO),37.044,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Iron,,83540,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Iron,,83540,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,PrimeWest Health,MinnesotaCare,36.9792,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Iron,,83540,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Iron,,83540,CPT,Facility,Both,,,,72,61.2,20.6352,72,Sanford Health Plan,Sanford Health Plan,66.24,92,,percent of total billed charges,,
Iron,,83540,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,"UCare Health, Inc.",Individual & Family Plan,40.572,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Iron,,83540,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Iron,,83540,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,"UCare Health, Inc.",Medical Assistance,36.3384,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Iron,,83540,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Iron,,83540,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,"UCare Health, Inc.",Medicare Advantage,36.3384,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Iron,,83540,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Iron,,83540,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),36.3384,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Iron,,83540,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Iron,,83540,CPT,Facility,Both,,,,72,61.2,20.6352,72,UnitedHealthcare,Individual & Family,67.68,94,,percent of total billed charges,,
Iron,,83540,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,UnitedHealthcare,Medicare Advantage,35.28,49,,percent of total billed charges,,
Iron,,83540,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Iron,,83540,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,34.56,48,,percent of total billed charges,,100% of DHS outpatient percentage
Iron,,83540,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Iron Binding Capacity,,83550,CPT,Facility,Both,,,,66,56.1,18.9156,66,Aetna,Commercial,60.72,92,,percent of total billed charges,,
Iron Binding Capacity,,83550,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,Aetna,Medicare Advantage,32.34,49,,percent of total billed charges,,
Iron Binding Capacity,,83550,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Iron Binding Capacity,,83550,CPT,Facility,Both,,,,66,56.1,18.9156,66,Aetna,PPO,61.38,93,,percent of total billed charges,,
Iron Binding Capacity,,83550,CPT,Facility,Both,,,,66,56.1,18.9156,66,America's PPO,America's PPO,63.3798,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Iron Binding Capacity,,83550,CPT,Facility,Both,,,,66,56.1,18.9156,66,BlueCross BlueShield Minnesota, Federal Employee Program,64.944,98.4,,percent of total billed charges,,
Iron Binding Capacity,,83550,CPT,Facility,Both,,,,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,66,100,,percent of total billed charges,,
Iron Binding Capacity,,83550,CPT,Facility,Both,,,,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,High Value Network Plan,59.4,90,,percent of total billed charges,,
Iron Binding Capacity,,83550,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,Medicare Advantage,32.34,49,,percent of total billed charges,,
Iron Binding Capacity,,83550,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Iron Binding Capacity,,83550,CPT,Facility,Both,,,,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,58.4562,88.57,,percent of total billed charges,,
Iron Binding Capacity,,83550,CPT,Facility,Both,,,,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,18.9156,28.66,,percent of total billed charges,,
Iron Binding Capacity,,83550,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),32.34,49,,percent of total billed charges,,
Iron Binding Capacity,,83550,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Iron Binding Capacity,,83550,CPT,Facility,Both,,,,66,56.1,18.9156,66,CorVel,Worker's Compensation,66,100,,percent of total billed charges,,
Iron Binding Capacity,,83550,CPT,Facility,Both,,,,66,56.1,18.9156,66,First Health Group Corporation,First Health Network,64.02,97,,percent of total billed charges,,
Iron Binding Capacity,,83550,CPT,Facility,Both,,,,66,56.1,18.9156,66,"Health Partners, Inc.",Commercial,62.436,94.6,,percent of total billed charges,,
Iron Binding Capacity,,83550,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,"Health Partners, Inc.",Medicare Advantage,32.34,49,,percent of total billed charges,,
Iron Binding Capacity,,83550,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Iron Binding Capacity,,83550,CPT,Facility,Both,,,,66,56.1,18.9156,66,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),39.6,60,,percent of total billed charges,,
Iron Binding Capacity,,83550,CPT,Facility,Both,,,,66,56.1,18.9156,66,"Health Partners, Inc.",State of Minnesota Advantage Program,53.79,81.5,,percent of total billed charges,,
Iron Binding Capacity,,83550,CPT,Facility,Both,,,,66,56.1,18.9156,66,"Health Partners, Inc.",State Public Programs,33,50,,percent of total billed charges,,
Iron Binding Capacity,,83550,CPT,Facility,Both,,,,66,56.1,18.9156,66,Humana Insurance Company,Commercial PPO,62.7,95,,percent of total billed charges,,
Iron Binding Capacity,,83550,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,Humana Insurance Company,Medicare PPO,32.34,49,,percent of total billed charges,,
Iron Binding Capacity,,83550,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Iron Binding Capacity,,83550,CPT,Facility,Both,,,,66,56.1,18.9156,66,Medica,Individual & Family,65.406,99.1,,percent of total billed charges,,
Iron Binding Capacity,,83550,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,Medica,Medica Advantage Solution,32.868,49.8,,percent of total billed charges,,
Iron Binding Capacity,,83550,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Iron Binding Capacity,,83550,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,Medica,Medical Assistance,29.436,44.6,,percent of total billed charges,,
Iron Binding Capacity,,83550,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,Medica,Medical Assistance,,,,,Included in per diem rate,
Iron Binding Capacity,,83550,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,32.868,49.8,,percent of total billed charges,,
Iron Binding Capacity,,83550,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Iron Binding Capacity,,83550,CPT,Facility,Both,,,,66,56.1,18.9156,66,"Multiplan, Inc.","Multiplan, Inc.",62.04,94,,percent of total billed charges,,
Iron Binding Capacity,,83550,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,57.024,86.4,,percent of total billed charges,,
Iron Binding Capacity,,83550,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Iron Binding Capacity,,83550,CPT,Facility,Both,,,,66,56.1,18.9156,66,"Preferred One Administrative Services, INC.",PPO,65.076,98.6,,percent of total billed charges,,
Iron Binding Capacity,,83550,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,PrimeWest Health,Minnesota Senior Health Options (MSHO),33.957,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Iron Binding Capacity,,83550,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Iron Binding Capacity,,83550,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,PrimeWest Health,MinnesotaCare,33.8976,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Iron Binding Capacity,,83550,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Iron Binding Capacity,,83550,CPT,Facility,Both,,,,66,56.1,18.9156,66,Sanford Health Plan,Sanford Health Plan,60.72,92,,percent of total billed charges,,
Iron Binding Capacity,,83550,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,"UCare Health, Inc.",Individual & Family Plan,37.191,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Iron Binding Capacity,,83550,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Iron Binding Capacity,,83550,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,"UCare Health, Inc.",Medical Assistance,33.3102,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Iron Binding Capacity,,83550,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Iron Binding Capacity,,83550,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,"UCare Health, Inc.",Medicare Advantage,33.3102,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Iron Binding Capacity,,83550,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Iron Binding Capacity,,83550,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),33.3102,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Iron Binding Capacity,,83550,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Iron Binding Capacity,,83550,CPT,Facility,Both,,,,66,56.1,18.9156,66,UnitedHealthcare,Individual & Family,62.04,94,,percent of total billed charges,,
Iron Binding Capacity,,83550,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,UnitedHealthcare,Medicare Advantage,32.34,49,,percent of total billed charges,,
Iron Binding Capacity,,83550,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Iron Binding Capacity,,83550,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,31.68,48,,percent of total billed charges,,100% of DHS outpatient percentage
Iron Binding Capacity,,83550,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Lactate,,83605,CPT,Facility,Both,,,,92,78.2,26.3672,92,Aetna,Commercial,84.64,92,,percent of total billed charges,,
Lactate,,83605,CPT,Facility,Outpatient,,,,92,78.2,26.3672,92,Aetna,Medicare Advantage,45.08,49,,percent of total billed charges,,
Lactate,,83605,CPT,Facility,Inpatient,,,,92,78.2,26.3672,92,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Lactate,,83605,CPT,Facility,Both,,,,92,78.2,26.3672,92,Aetna,PPO,85.56,93,,percent of total billed charges,,
Lactate,,83605,CPT,Facility,Both,,,,92,78.2,26.3672,92,America's PPO,America's PPO,88.3476,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Lactate,,83605,CPT,Facility,Both,,,,92,78.2,26.3672,92,BlueCross BlueShield Minnesota, Federal Employee Program,90.528,98.4,,percent of total billed charges,,
Lactate,,83605,CPT,Facility,Both,,,,92,78.2,26.3672,92,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,92,100,,percent of total billed charges,,
Lactate,,83605,CPT,Facility,Both,,,,92,78.2,26.3672,92,BlueCross BlueShield Minnesota,High Value Network Plan,82.8,90,,percent of total billed charges,,
Lactate,,83605,CPT,Facility,Outpatient,,,,92,78.2,26.3672,92,BlueCross BlueShield Minnesota,Medicare Advantage,45.08,49,,percent of total billed charges,,
Lactate,,83605,CPT,Facility,Inpatient,,,,92,78.2,26.3672,92,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Lactate,,83605,CPT,Facility,Both,,,,92,78.2,26.3672,92,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,81.4844,88.57,,percent of total billed charges,,
Lactate,,83605,CPT,Facility,Both,,,,92,78.2,26.3672,92,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,26.3672,28.66,,percent of total billed charges,,
Lactate,,83605,CPT,Facility,Outpatient,,,,92,78.2,26.3672,92,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),45.08,49,,percent of total billed charges,,
Lactate,,83605,CPT,Facility,Inpatient,,,,92,78.2,26.3672,92,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Lactate,,83605,CPT,Facility,Both,,,,92,78.2,26.3672,92,CorVel,Worker's Compensation,92,100,,percent of total billed charges,,
Lactate,,83605,CPT,Facility,Both,,,,92,78.2,26.3672,92,First Health Group Corporation,First Health Network,89.24,97,,percent of total billed charges,,
Lactate,,83605,CPT,Facility,Both,,,,92,78.2,26.3672,92,"Health Partners, Inc.",Commercial,87.032,94.6,,percent of total billed charges,,
Lactate,,83605,CPT,Facility,Outpatient,,,,92,78.2,26.3672,92,"Health Partners, Inc.",Medicare Advantage,45.08,49,,percent of total billed charges,,
Lactate,,83605,CPT,Facility,Inpatient,,,,92,78.2,26.3672,92,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Lactate,,83605,CPT,Facility,Both,,,,92,78.2,26.3672,92,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),55.2,60,,percent of total billed charges,,
Lactate,,83605,CPT,Facility,Both,,,,92,78.2,26.3672,92,"Health Partners, Inc.",State of Minnesota Advantage Program,74.98,81.5,,percent of total billed charges,,
Lactate,,83605,CPT,Facility,Both,,,,92,78.2,26.3672,92,"Health Partners, Inc.",State Public Programs,46,50,,percent of total billed charges,,
Lactate,,83605,CPT,Facility,Both,,,,92,78.2,26.3672,92,Humana Insurance Company,Commercial PPO,87.4,95,,percent of total billed charges,,
Lactate,,83605,CPT,Facility,Outpatient,,,,92,78.2,26.3672,92,Humana Insurance Company,Medicare PPO,45.08,49,,percent of total billed charges,,
Lactate,,83605,CPT,Facility,Inpatient,,,,92,78.2,26.3672,92,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Lactate,,83605,CPT,Facility,Both,,,,92,78.2,26.3672,92,Medica,Individual & Family,91.172,99.1,,percent of total billed charges,,
Lactate,,83605,CPT,Facility,Outpatient,,,,92,78.2,26.3672,92,Medica,Medica Advantage Solution,45.816,49.8,,percent of total billed charges,,
Lactate,,83605,CPT,Facility,Inpatient,,,,92,78.2,26.3672,92,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Lactate,,83605,CPT,Facility,Outpatient,,,,92,78.2,26.3672,92,Medica,Medical Assistance,41.032,44.6,,percent of total billed charges,,
Lactate,,83605,CPT,Facility,Inpatient,,,,92,78.2,26.3672,92,Medica,Medical Assistance,,,,,Included in per diem rate,
Lactate,,83605,CPT,Facility,Outpatient,,,,92,78.2,26.3672,92,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,45.816,49.8,,percent of total billed charges,,
Lactate,,83605,CPT,Facility,Inpatient,,,,92,78.2,26.3672,92,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Lactate,,83605,CPT,Facility,Both,,,,92,78.2,26.3672,92,"Multiplan, Inc.","Multiplan, Inc.",86.48,94,,percent of total billed charges,,
Lactate,,83605,CPT,Facility,Outpatient,,,,92,78.2,26.3672,92,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,79.488,86.4,,percent of total billed charges,,
Lactate,,83605,CPT,Facility,Inpatient,,,,92,78.2,26.3672,92,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Lactate,,83605,CPT,Facility,Both,,,,92,78.2,26.3672,92,"Preferred One Administrative Services, INC.",PPO,90.712,98.6,,percent of total billed charges,,
Lactate,,83605,CPT,Facility,Outpatient,,,,92,78.2,26.3672,92,PrimeWest Health,Minnesota Senior Health Options (MSHO),47.334,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Lactate,,83605,CPT,Facility,Inpatient,,,,92,78.2,26.3672,92,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Lactate,,83605,CPT,Facility,Outpatient,,,,92,78.2,26.3672,92,PrimeWest Health,MinnesotaCare,47.2512,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Lactate,,83605,CPT,Facility,Inpatient,,,,92,78.2,26.3672,92,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Lactate,,83605,CPT,Facility,Both,,,,92,78.2,26.3672,92,Sanford Health Plan,Sanford Health Plan,84.64,92,,percent of total billed charges,,
Lactate,,83605,CPT,Facility,Outpatient,,,,92,78.2,26.3672,92,"UCare Health, Inc.",Individual & Family Plan,51.842,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Lactate,,83605,CPT,Facility,Inpatient,,,,92,78.2,26.3672,92,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Lactate,,83605,CPT,Facility,Outpatient,,,,92,78.2,26.3672,92,"UCare Health, Inc.",Medical Assistance,46.4324,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Lactate,,83605,CPT,Facility,Inpatient,,,,92,78.2,26.3672,92,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Lactate,,83605,CPT,Facility,Outpatient,,,,92,78.2,26.3672,92,"UCare Health, Inc.",Medicare Advantage,46.4324,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Lactate,,83605,CPT,Facility,Inpatient,,,,92,78.2,26.3672,92,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Lactate,,83605,CPT,Facility,Outpatient,,,,92,78.2,26.3672,92,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),46.4324,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Lactate,,83605,CPT,Facility,Inpatient,,,,92,78.2,26.3672,92,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Lactate,,83605,CPT,Facility,Both,,,,92,78.2,26.3672,92,UnitedHealthcare,Individual & Family,86.48,94,,percent of total billed charges,,
Lactate,,83605,CPT,Facility,Outpatient,,,,92,78.2,26.3672,92,UnitedHealthcare,Medicare Advantage,45.08,49,,percent of total billed charges,,
Lactate,,83605,CPT,Facility,Inpatient,,,,92,78.2,26.3672,92,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Lactate,,83605,CPT,Facility,Outpatient,,,,92,78.2,26.3672,92,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,44.16,48,,percent of total billed charges,,100% of DHS outpatient percentage
Lactate,,83605,CPT,Facility,Inpatient,,,,92,78.2,26.3672,92,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Lactate, Blood, Poc",,83605,CPT,Facility,Both,,,,92,78.2,26.3672,92,Aetna,Commercial,84.64,92,,percent of total billed charges,,
"Lactate, Blood, Poc",,83605,CPT,Facility,Outpatient,,,,92,78.2,26.3672,92,Aetna,Medicare Advantage,45.08,49,,percent of total billed charges,,
"Lactate, Blood, Poc",,83605,CPT,Facility,Inpatient,,,,92,78.2,26.3672,92,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Lactate, Blood, Poc",,83605,CPT,Facility,Both,,,,92,78.2,26.3672,92,Aetna,PPO,85.56,93,,percent of total billed charges,,
"Lactate, Blood, Poc",,83605,CPT,Facility,Both,,,,92,78.2,26.3672,92,America's PPO,America's PPO,88.3476,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Lactate, Blood, Poc",,83605,CPT,Facility,Both,,,,92,78.2,26.3672,92,BlueCross BlueShield Minnesota, Federal Employee Program,90.528,98.4,,percent of total billed charges,,
"Lactate, Blood, Poc",,83605,CPT,Facility,Both,,,,92,78.2,26.3672,92,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,92,100,,percent of total billed charges,,
"Lactate, Blood, Poc",,83605,CPT,Facility,Both,,,,92,78.2,26.3672,92,BlueCross BlueShield Minnesota,High Value Network Plan,82.8,90,,percent of total billed charges,,
"Lactate, Blood, Poc",,83605,CPT,Facility,Outpatient,,,,92,78.2,26.3672,92,BlueCross BlueShield Minnesota,Medicare Advantage,45.08,49,,percent of total billed charges,,
"Lactate, Blood, Poc",,83605,CPT,Facility,Inpatient,,,,92,78.2,26.3672,92,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Lactate, Blood, Poc",,83605,CPT,Facility,Both,,,,92,78.2,26.3672,92,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,81.4844,88.57,,percent of total billed charges,,
"Lactate, Blood, Poc",,83605,CPT,Facility,Both,,,,92,78.2,26.3672,92,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,26.3672,28.66,,percent of total billed charges,,
"Lactate, Blood, Poc",,83605,CPT,Facility,Outpatient,,,,92,78.2,26.3672,92,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),45.08,49,,percent of total billed charges,,
"Lactate, Blood, Poc",,83605,CPT,Facility,Inpatient,,,,92,78.2,26.3672,92,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Lactate, Blood, Poc",,83605,CPT,Facility,Both,,,,92,78.2,26.3672,92,CorVel,Worker's Compensation,92,100,,percent of total billed charges,,
"Lactate, Blood, Poc",,83605,CPT,Facility,Both,,,,92,78.2,26.3672,92,First Health Group Corporation,First Health Network,89.24,97,,percent of total billed charges,,
"Lactate, Blood, Poc",,83605,CPT,Facility,Both,,,,92,78.2,26.3672,92,"Health Partners, Inc.",Commercial,87.032,94.6,,percent of total billed charges,,
"Lactate, Blood, Poc",,83605,CPT,Facility,Outpatient,,,,92,78.2,26.3672,92,"Health Partners, Inc.",Medicare Advantage,45.08,49,,percent of total billed charges,,
"Lactate, Blood, Poc",,83605,CPT,Facility,Inpatient,,,,92,78.2,26.3672,92,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Lactate, Blood, Poc",,83605,CPT,Facility,Both,,,,92,78.2,26.3672,92,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),55.2,60,,percent of total billed charges,,
"Lactate, Blood, Poc",,83605,CPT,Facility,Both,,,,92,78.2,26.3672,92,"Health Partners, Inc.",State of Minnesota Advantage Program,74.98,81.5,,percent of total billed charges,,
"Lactate, Blood, Poc",,83605,CPT,Facility,Both,,,,92,78.2,26.3672,92,"Health Partners, Inc.",State Public Programs,46,50,,percent of total billed charges,,
"Lactate, Blood, Poc",,83605,CPT,Facility,Both,,,,92,78.2,26.3672,92,Humana Insurance Company,Commercial PPO,87.4,95,,percent of total billed charges,,
"Lactate, Blood, Poc",,83605,CPT,Facility,Outpatient,,,,92,78.2,26.3672,92,Humana Insurance Company,Medicare PPO,45.08,49,,percent of total billed charges,,
"Lactate, Blood, Poc",,83605,CPT,Facility,Inpatient,,,,92,78.2,26.3672,92,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Lactate, Blood, Poc",,83605,CPT,Facility,Both,,,,92,78.2,26.3672,92,Medica,Individual & Family,91.172,99.1,,percent of total billed charges,,
"Lactate, Blood, Poc",,83605,CPT,Facility,Outpatient,,,,92,78.2,26.3672,92,Medica,Medica Advantage Solution,45.816,49.8,,percent of total billed charges,,
"Lactate, Blood, Poc",,83605,CPT,Facility,Inpatient,,,,92,78.2,26.3672,92,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Lactate, Blood, Poc",,83605,CPT,Facility,Outpatient,,,,92,78.2,26.3672,92,Medica,Medical Assistance,41.032,44.6,,percent of total billed charges,,
"Lactate, Blood, Poc",,83605,CPT,Facility,Inpatient,,,,92,78.2,26.3672,92,Medica,Medical Assistance,,,,,Included in per diem rate,
"Lactate, Blood, Poc",,83605,CPT,Facility,Outpatient,,,,92,78.2,26.3672,92,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,45.816,49.8,,percent of total billed charges,,
"Lactate, Blood, Poc",,83605,CPT,Facility,Inpatient,,,,92,78.2,26.3672,92,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Lactate, Blood, Poc",,83605,CPT,Facility,Both,,,,92,78.2,26.3672,92,"Multiplan, Inc.","Multiplan, Inc.",86.48,94,,percent of total billed charges,,
"Lactate, Blood, Poc",,83605,CPT,Facility,Outpatient,,,,92,78.2,26.3672,92,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,79.488,86.4,,percent of total billed charges,,
"Lactate, Blood, Poc",,83605,CPT,Facility,Inpatient,,,,92,78.2,26.3672,92,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Lactate, Blood, Poc",,83605,CPT,Facility,Both,,,,92,78.2,26.3672,92,"Preferred One Administrative Services, INC.",PPO,90.712,98.6,,percent of total billed charges,,
"Lactate, Blood, Poc",,83605,CPT,Facility,Outpatient,,,,92,78.2,26.3672,92,PrimeWest Health,Minnesota Senior Health Options (MSHO),47.334,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Lactate, Blood, Poc",,83605,CPT,Facility,Inpatient,,,,92,78.2,26.3672,92,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Lactate, Blood, Poc",,83605,CPT,Facility,Outpatient,,,,92,78.2,26.3672,92,PrimeWest Health,MinnesotaCare,47.2512,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Lactate, Blood, Poc",,83605,CPT,Facility,Inpatient,,,,92,78.2,26.3672,92,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Lactate, Blood, Poc",,83605,CPT,Facility,Both,,,,92,78.2,26.3672,92,Sanford Health Plan,Sanford Health Plan,84.64,92,,percent of total billed charges,,
"Lactate, Blood, Poc",,83605,CPT,Facility,Outpatient,,,,92,78.2,26.3672,92,"UCare Health, Inc.",Individual & Family Plan,51.842,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Lactate, Blood, Poc",,83605,CPT,Facility,Inpatient,,,,92,78.2,26.3672,92,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Lactate, Blood, Poc",,83605,CPT,Facility,Outpatient,,,,92,78.2,26.3672,92,"UCare Health, Inc.",Medical Assistance,46.4324,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Lactate, Blood, Poc",,83605,CPT,Facility,Inpatient,,,,92,78.2,26.3672,92,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Lactate, Blood, Poc",,83605,CPT,Facility,Outpatient,,,,92,78.2,26.3672,92,"UCare Health, Inc.",Medicare Advantage,46.4324,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Lactate, Blood, Poc",,83605,CPT,Facility,Inpatient,,,,92,78.2,26.3672,92,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Lactate, Blood, Poc",,83605,CPT,Facility,Outpatient,,,,92,78.2,26.3672,92,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),46.4324,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Lactate, Blood, Poc",,83605,CPT,Facility,Inpatient,,,,92,78.2,26.3672,92,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Lactate, Blood, Poc",,83605,CPT,Facility,Both,,,,92,78.2,26.3672,92,UnitedHealthcare,Individual & Family,86.48,94,,percent of total billed charges,,
"Lactate, Blood, Poc",,83605,CPT,Facility,Outpatient,,,,92,78.2,26.3672,92,UnitedHealthcare,Medicare Advantage,45.08,49,,percent of total billed charges,,
"Lactate, Blood, Poc",,83605,CPT,Facility,Inpatient,,,,92,78.2,26.3672,92,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Lactate, Blood, Poc",,83605,CPT,Facility,Outpatient,,,,92,78.2,26.3672,92,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,44.16,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Lactate, Blood, Poc",,83605,CPT,Facility,Inpatient,,,,92,78.2,26.3672,92,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Lactate Dehydrogenase,,83615,CPT,Facility,Both,,,,66,56.1,18.9156,66,Aetna,Commercial,60.72,92,,percent of total billed charges,,
Lactate Dehydrogenase,,83615,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,Aetna,Medicare Advantage,32.34,49,,percent of total billed charges,,
Lactate Dehydrogenase,,83615,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Lactate Dehydrogenase,,83615,CPT,Facility,Both,,,,66,56.1,18.9156,66,Aetna,PPO,61.38,93,,percent of total billed charges,,
Lactate Dehydrogenase,,83615,CPT,Facility,Both,,,,66,56.1,18.9156,66,America's PPO,America's PPO,63.3798,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Lactate Dehydrogenase,,83615,CPT,Facility,Both,,,,66,56.1,18.9156,66,BlueCross BlueShield Minnesota, Federal Employee Program,64.944,98.4,,percent of total billed charges,,
Lactate Dehydrogenase,,83615,CPT,Facility,Both,,,,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,66,100,,percent of total billed charges,,
Lactate Dehydrogenase,,83615,CPT,Facility,Both,,,,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,High Value Network Plan,59.4,90,,percent of total billed charges,,
Lactate Dehydrogenase,,83615,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,Medicare Advantage,32.34,49,,percent of total billed charges,,
Lactate Dehydrogenase,,83615,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Lactate Dehydrogenase,,83615,CPT,Facility,Both,,,,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,58.4562,88.57,,percent of total billed charges,,
Lactate Dehydrogenase,,83615,CPT,Facility,Both,,,,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,18.9156,28.66,,percent of total billed charges,,
Lactate Dehydrogenase,,83615,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),32.34,49,,percent of total billed charges,,
Lactate Dehydrogenase,,83615,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Lactate Dehydrogenase,,83615,CPT,Facility,Both,,,,66,56.1,18.9156,66,CorVel,Worker's Compensation,66,100,,percent of total billed charges,,
Lactate Dehydrogenase,,83615,CPT,Facility,Both,,,,66,56.1,18.9156,66,First Health Group Corporation,First Health Network,64.02,97,,percent of total billed charges,,
Lactate Dehydrogenase,,83615,CPT,Facility,Both,,,,66,56.1,18.9156,66,"Health Partners, Inc.",Commercial,62.436,94.6,,percent of total billed charges,,
Lactate Dehydrogenase,,83615,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,"Health Partners, Inc.",Medicare Advantage,32.34,49,,percent of total billed charges,,
Lactate Dehydrogenase,,83615,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Lactate Dehydrogenase,,83615,CPT,Facility,Both,,,,66,56.1,18.9156,66,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),39.6,60,,percent of total billed charges,,
Lactate Dehydrogenase,,83615,CPT,Facility,Both,,,,66,56.1,18.9156,66,"Health Partners, Inc.",State of Minnesota Advantage Program,53.79,81.5,,percent of total billed charges,,
Lactate Dehydrogenase,,83615,CPT,Facility,Both,,,,66,56.1,18.9156,66,"Health Partners, Inc.",State Public Programs,33,50,,percent of total billed charges,,
Lactate Dehydrogenase,,83615,CPT,Facility,Both,,,,66,56.1,18.9156,66,Humana Insurance Company,Commercial PPO,62.7,95,,percent of total billed charges,,
Lactate Dehydrogenase,,83615,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,Humana Insurance Company,Medicare PPO,32.34,49,,percent of total billed charges,,
Lactate Dehydrogenase,,83615,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Lactate Dehydrogenase,,83615,CPT,Facility,Both,,,,66,56.1,18.9156,66,Medica,Individual & Family,65.406,99.1,,percent of total billed charges,,
Lactate Dehydrogenase,,83615,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,Medica,Medica Advantage Solution,32.868,49.8,,percent of total billed charges,,
Lactate Dehydrogenase,,83615,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Lactate Dehydrogenase,,83615,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,Medica,Medical Assistance,29.436,44.6,,percent of total billed charges,,
Lactate Dehydrogenase,,83615,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,Medica,Medical Assistance,,,,,Included in per diem rate,
Lactate Dehydrogenase,,83615,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,32.868,49.8,,percent of total billed charges,,
Lactate Dehydrogenase,,83615,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Lactate Dehydrogenase,,83615,CPT,Facility,Both,,,,66,56.1,18.9156,66,"Multiplan, Inc.","Multiplan, Inc.",62.04,94,,percent of total billed charges,,
Lactate Dehydrogenase,,83615,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,57.024,86.4,,percent of total billed charges,,
Lactate Dehydrogenase,,83615,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Lactate Dehydrogenase,,83615,CPT,Facility,Both,,,,66,56.1,18.9156,66,"Preferred One Administrative Services, INC.",PPO,65.076,98.6,,percent of total billed charges,,
Lactate Dehydrogenase,,83615,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,PrimeWest Health,Minnesota Senior Health Options (MSHO),33.957,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Lactate Dehydrogenase,,83615,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Lactate Dehydrogenase,,83615,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,PrimeWest Health,MinnesotaCare,33.8976,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Lactate Dehydrogenase,,83615,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Lactate Dehydrogenase,,83615,CPT,Facility,Both,,,,66,56.1,18.9156,66,Sanford Health Plan,Sanford Health Plan,60.72,92,,percent of total billed charges,,
Lactate Dehydrogenase,,83615,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,"UCare Health, Inc.",Individual & Family Plan,37.191,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Lactate Dehydrogenase,,83615,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Lactate Dehydrogenase,,83615,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,"UCare Health, Inc.",Medical Assistance,33.3102,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Lactate Dehydrogenase,,83615,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Lactate Dehydrogenase,,83615,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,"UCare Health, Inc.",Medicare Advantage,33.3102,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Lactate Dehydrogenase,,83615,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Lactate Dehydrogenase,,83615,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),33.3102,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Lactate Dehydrogenase,,83615,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Lactate Dehydrogenase,,83615,CPT,Facility,Both,,,,66,56.1,18.9156,66,UnitedHealthcare,Individual & Family,62.04,94,,percent of total billed charges,,
Lactate Dehydrogenase,,83615,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,UnitedHealthcare,Medicare Advantage,32.34,49,,percent of total billed charges,,
Lactate Dehydrogenase,,83615,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Lactate Dehydrogenase,,83615,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,31.68,48,,percent of total billed charges,,100% of DHS outpatient percentage
Lactate Dehydrogenase,,83615,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Ldh, Body Fluid",,83615,CPT,Facility,Both,,,,66,56.1,18.9156,66,Aetna,Commercial,60.72,92,,percent of total billed charges,,
"Ldh, Body Fluid",,83615,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,Aetna,Medicare Advantage,32.34,49,,percent of total billed charges,,
"Ldh, Body Fluid",,83615,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Ldh, Body Fluid",,83615,CPT,Facility,Both,,,,66,56.1,18.9156,66,Aetna,PPO,61.38,93,,percent of total billed charges,,
"Ldh, Body Fluid",,83615,CPT,Facility,Both,,,,66,56.1,18.9156,66,America's PPO,America's PPO,63.3798,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Ldh, Body Fluid",,83615,CPT,Facility,Both,,,,66,56.1,18.9156,66,BlueCross BlueShield Minnesota, Federal Employee Program,64.944,98.4,,percent of total billed charges,,
"Ldh, Body Fluid",,83615,CPT,Facility,Both,,,,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,66,100,,percent of total billed charges,,
"Ldh, Body Fluid",,83615,CPT,Facility,Both,,,,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,High Value Network Plan,59.4,90,,percent of total billed charges,,
"Ldh, Body Fluid",,83615,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,Medicare Advantage,32.34,49,,percent of total billed charges,,
"Ldh, Body Fluid",,83615,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Ldh, Body Fluid",,83615,CPT,Facility,Both,,,,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,58.4562,88.57,,percent of total billed charges,,
"Ldh, Body Fluid",,83615,CPT,Facility,Both,,,,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,18.9156,28.66,,percent of total billed charges,,
"Ldh, Body Fluid",,83615,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),32.34,49,,percent of total billed charges,,
"Ldh, Body Fluid",,83615,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Ldh, Body Fluid",,83615,CPT,Facility,Both,,,,66,56.1,18.9156,66,CorVel,Worker's Compensation,66,100,,percent of total billed charges,,
"Ldh, Body Fluid",,83615,CPT,Facility,Both,,,,66,56.1,18.9156,66,First Health Group Corporation,First Health Network,64.02,97,,percent of total billed charges,,
"Ldh, Body Fluid",,83615,CPT,Facility,Both,,,,66,56.1,18.9156,66,"Health Partners, Inc.",Commercial,62.436,94.6,,percent of total billed charges,,
"Ldh, Body Fluid",,83615,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,"Health Partners, Inc.",Medicare Advantage,32.34,49,,percent of total billed charges,,
"Ldh, Body Fluid",,83615,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Ldh, Body Fluid",,83615,CPT,Facility,Both,,,,66,56.1,18.9156,66,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),39.6,60,,percent of total billed charges,,
"Ldh, Body Fluid",,83615,CPT,Facility,Both,,,,66,56.1,18.9156,66,"Health Partners, Inc.",State of Minnesota Advantage Program,53.79,81.5,,percent of total billed charges,,
"Ldh, Body Fluid",,83615,CPT,Facility,Both,,,,66,56.1,18.9156,66,"Health Partners, Inc.",State Public Programs,33,50,,percent of total billed charges,,
"Ldh, Body Fluid",,83615,CPT,Facility,Both,,,,66,56.1,18.9156,66,Humana Insurance Company,Commercial PPO,62.7,95,,percent of total billed charges,,
"Ldh, Body Fluid",,83615,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,Humana Insurance Company,Medicare PPO,32.34,49,,percent of total billed charges,,
"Ldh, Body Fluid",,83615,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Ldh, Body Fluid",,83615,CPT,Facility,Both,,,,66,56.1,18.9156,66,Medica,Individual & Family,65.406,99.1,,percent of total billed charges,,
"Ldh, Body Fluid",,83615,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,Medica,Medica Advantage Solution,32.868,49.8,,percent of total billed charges,,
"Ldh, Body Fluid",,83615,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Ldh, Body Fluid",,83615,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,Medica,Medical Assistance,29.436,44.6,,percent of total billed charges,,
"Ldh, Body Fluid",,83615,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,Medica,Medical Assistance,,,,,Included in per diem rate,
"Ldh, Body Fluid",,83615,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,32.868,49.8,,percent of total billed charges,,
"Ldh, Body Fluid",,83615,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Ldh, Body Fluid",,83615,CPT,Facility,Both,,,,66,56.1,18.9156,66,"Multiplan, Inc.","Multiplan, Inc.",62.04,94,,percent of total billed charges,,
"Ldh, Body Fluid",,83615,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,57.024,86.4,,percent of total billed charges,,
"Ldh, Body Fluid",,83615,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Ldh, Body Fluid",,83615,CPT,Facility,Both,,,,66,56.1,18.9156,66,"Preferred One Administrative Services, INC.",PPO,65.076,98.6,,percent of total billed charges,,
"Ldh, Body Fluid",,83615,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,PrimeWest Health,Minnesota Senior Health Options (MSHO),33.957,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Ldh, Body Fluid",,83615,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Ldh, Body Fluid",,83615,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,PrimeWest Health,MinnesotaCare,33.8976,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Ldh, Body Fluid",,83615,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Ldh, Body Fluid",,83615,CPT,Facility,Both,,,,66,56.1,18.9156,66,Sanford Health Plan,Sanford Health Plan,60.72,92,,percent of total billed charges,,
"Ldh, Body Fluid",,83615,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,"UCare Health, Inc.",Individual & Family Plan,37.191,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Ldh, Body Fluid",,83615,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Ldh, Body Fluid",,83615,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,"UCare Health, Inc.",Medical Assistance,33.3102,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Ldh, Body Fluid",,83615,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Ldh, Body Fluid",,83615,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,"UCare Health, Inc.",Medicare Advantage,33.3102,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Ldh, Body Fluid",,83615,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Ldh, Body Fluid",,83615,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),33.3102,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Ldh, Body Fluid",,83615,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Ldh, Body Fluid",,83615,CPT,Facility,Both,,,,66,56.1,18.9156,66,UnitedHealthcare,Individual & Family,62.04,94,,percent of total billed charges,,
"Ldh, Body Fluid",,83615,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,UnitedHealthcare,Medicare Advantage,32.34,49,,percent of total billed charges,,
"Ldh, Body Fluid",,83615,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Ldh, Body Fluid",,83615,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,31.68,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Ldh, Body Fluid",,83615,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Lactoferrin, Stool",,83630,CPT,Facility,Both,,,,58,49.3,16.6228,58,Aetna,Commercial,53.36,92,,percent of total billed charges,,
"Lactoferrin, Stool",,83630,CPT,Facility,Outpatient,,,,58,49.3,16.6228,58,Aetna,Medicare Advantage,28.42,49,,percent of total billed charges,,
"Lactoferrin, Stool",,83630,CPT,Facility,Inpatient,,,,58,49.3,16.6228,58,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Lactoferrin, Stool",,83630,CPT,Facility,Both,,,,58,49.3,16.6228,58,Aetna,PPO,53.94,93,,percent of total billed charges,,
"Lactoferrin, Stool",,83630,CPT,Facility,Both,,,,58,49.3,16.6228,58,America's PPO,America's PPO,55.6974,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Lactoferrin, Stool",,83630,CPT,Facility,Both,,,,58,49.3,16.6228,58,BlueCross BlueShield Minnesota, Federal Employee Program,57.072,98.4,,percent of total billed charges,,
"Lactoferrin, Stool",,83630,CPT,Facility,Both,,,,58,49.3,16.6228,58,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,58,100,,percent of total billed charges,,
"Lactoferrin, Stool",,83630,CPT,Facility,Both,,,,58,49.3,16.6228,58,BlueCross BlueShield Minnesota,High Value Network Plan,52.2,90,,percent of total billed charges,,
"Lactoferrin, Stool",,83630,CPT,Facility,Outpatient,,,,58,49.3,16.6228,58,BlueCross BlueShield Minnesota,Medicare Advantage,28.42,49,,percent of total billed charges,,
"Lactoferrin, Stool",,83630,CPT,Facility,Inpatient,,,,58,49.3,16.6228,58,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Lactoferrin, Stool",,83630,CPT,Facility,Both,,,,58,49.3,16.6228,58,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,51.3706,88.57,,percent of total billed charges,,
"Lactoferrin, Stool",,83630,CPT,Facility,Both,,,,58,49.3,16.6228,58,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,16.6228,28.66,,percent of total billed charges,,
"Lactoferrin, Stool",,83630,CPT,Facility,Outpatient,,,,58,49.3,16.6228,58,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),28.42,49,,percent of total billed charges,,
"Lactoferrin, Stool",,83630,CPT,Facility,Inpatient,,,,58,49.3,16.6228,58,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Lactoferrin, Stool",,83630,CPT,Facility,Both,,,,58,49.3,16.6228,58,CorVel,Worker's Compensation,58,100,,percent of total billed charges,,
"Lactoferrin, Stool",,83630,CPT,Facility,Both,,,,58,49.3,16.6228,58,First Health Group Corporation,First Health Network,56.26,97,,percent of total billed charges,,
"Lactoferrin, Stool",,83630,CPT,Facility,Both,,,,58,49.3,16.6228,58,"Health Partners, Inc.",Commercial,54.868,94.6,,percent of total billed charges,,
"Lactoferrin, Stool",,83630,CPT,Facility,Outpatient,,,,58,49.3,16.6228,58,"Health Partners, Inc.",Medicare Advantage,28.42,49,,percent of total billed charges,,
"Lactoferrin, Stool",,83630,CPT,Facility,Inpatient,,,,58,49.3,16.6228,58,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Lactoferrin, Stool",,83630,CPT,Facility,Both,,,,58,49.3,16.6228,58,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),34.8,60,,percent of total billed charges,,
"Lactoferrin, Stool",,83630,CPT,Facility,Both,,,,58,49.3,16.6228,58,"Health Partners, Inc.",State of Minnesota Advantage Program,47.27,81.5,,percent of total billed charges,,
"Lactoferrin, Stool",,83630,CPT,Facility,Both,,,,58,49.3,16.6228,58,"Health Partners, Inc.",State Public Programs,29,50,,percent of total billed charges,,
"Lactoferrin, Stool",,83630,CPT,Facility,Both,,,,58,49.3,16.6228,58,Humana Insurance Company,Commercial PPO,55.1,95,,percent of total billed charges,,
"Lactoferrin, Stool",,83630,CPT,Facility,Outpatient,,,,58,49.3,16.6228,58,Humana Insurance Company,Medicare PPO,28.42,49,,percent of total billed charges,,
"Lactoferrin, Stool",,83630,CPT,Facility,Inpatient,,,,58,49.3,16.6228,58,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Lactoferrin, Stool",,83630,CPT,Facility,Both,,,,58,49.3,16.6228,58,Medica,Individual & Family,57.478,99.1,,percent of total billed charges,,
"Lactoferrin, Stool",,83630,CPT,Facility,Outpatient,,,,58,49.3,16.6228,58,Medica,Medica Advantage Solution,28.884,49.8,,percent of total billed charges,,
"Lactoferrin, Stool",,83630,CPT,Facility,Inpatient,,,,58,49.3,16.6228,58,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Lactoferrin, Stool",,83630,CPT,Facility,Outpatient,,,,58,49.3,16.6228,58,Medica,Medical Assistance,25.868,44.6,,percent of total billed charges,,
"Lactoferrin, Stool",,83630,CPT,Facility,Inpatient,,,,58,49.3,16.6228,58,Medica,Medical Assistance,,,,,Included in per diem rate,
"Lactoferrin, Stool",,83630,CPT,Facility,Outpatient,,,,58,49.3,16.6228,58,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,28.884,49.8,,percent of total billed charges,,
"Lactoferrin, Stool",,83630,CPT,Facility,Inpatient,,,,58,49.3,16.6228,58,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Lactoferrin, Stool",,83630,CPT,Facility,Both,,,,58,49.3,16.6228,58,"Multiplan, Inc.","Multiplan, Inc.",54.52,94,,percent of total billed charges,,
"Lactoferrin, Stool",,83630,CPT,Facility,Outpatient,,,,58,49.3,16.6228,58,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,50.112,86.4,,percent of total billed charges,,
"Lactoferrin, Stool",,83630,CPT,Facility,Inpatient,,,,58,49.3,16.6228,58,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Lactoferrin, Stool",,83630,CPT,Facility,Both,,,,58,49.3,16.6228,58,"Preferred One Administrative Services, INC.",PPO,57.188,98.6,,percent of total billed charges,,
"Lactoferrin, Stool",,83630,CPT,Facility,Outpatient,,,,58,49.3,16.6228,58,PrimeWest Health,Minnesota Senior Health Options (MSHO),29.841,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Lactoferrin, Stool",,83630,CPT,Facility,Inpatient,,,,58,49.3,16.6228,58,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Lactoferrin, Stool",,83630,CPT,Facility,Outpatient,,,,58,49.3,16.6228,58,PrimeWest Health,MinnesotaCare,29.7888,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Lactoferrin, Stool",,83630,CPT,Facility,Inpatient,,,,58,49.3,16.6228,58,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Lactoferrin, Stool",,83630,CPT,Facility,Both,,,,58,49.3,16.6228,58,Sanford Health Plan,Sanford Health Plan,53.36,92,,percent of total billed charges,,
"Lactoferrin, Stool",,83630,CPT,Facility,Outpatient,,,,58,49.3,16.6228,58,"UCare Health, Inc.",Individual & Family Plan,32.683,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Lactoferrin, Stool",,83630,CPT,Facility,Inpatient,,,,58,49.3,16.6228,58,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Lactoferrin, Stool",,83630,CPT,Facility,Outpatient,,,,58,49.3,16.6228,58,"UCare Health, Inc.",Medical Assistance,29.2726,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Lactoferrin, Stool",,83630,CPT,Facility,Inpatient,,,,58,49.3,16.6228,58,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Lactoferrin, Stool",,83630,CPT,Facility,Outpatient,,,,58,49.3,16.6228,58,"UCare Health, Inc.",Medicare Advantage,29.2726,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Lactoferrin, Stool",,83630,CPT,Facility,Inpatient,,,,58,49.3,16.6228,58,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Lactoferrin, Stool",,83630,CPT,Facility,Outpatient,,,,58,49.3,16.6228,58,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),29.2726,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Lactoferrin, Stool",,83630,CPT,Facility,Inpatient,,,,58,49.3,16.6228,58,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Lactoferrin, Stool",,83630,CPT,Facility,Both,,,,58,49.3,16.6228,58,UnitedHealthcare,Individual & Family,54.52,94,,percent of total billed charges,,
"Lactoferrin, Stool",,83630,CPT,Facility,Outpatient,,,,58,49.3,16.6228,58,UnitedHealthcare,Medicare Advantage,28.42,49,,percent of total billed charges,,
"Lactoferrin, Stool",,83630,CPT,Facility,Inpatient,,,,58,49.3,16.6228,58,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Lactoferrin, Stool",,83630,CPT,Facility,Outpatient,,,,58,49.3,16.6228,58,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,27.84,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Lactoferrin, Stool",,83630,CPT,Facility,Inpatient,,,,58,49.3,16.6228,58,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Lead,,83655,CPT,Facility,Both,,,,90,76.5,25.794,90,Aetna,Commercial,82.8,92,,percent of total billed charges,,
Lead,,83655,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,Aetna,Medicare Advantage,44.1,49,,percent of total billed charges,,
Lead,,83655,CPT,Facility,Inpatient,,,,90,76.5,25.794,90,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Lead,,83655,CPT,Facility,Both,,,,90,76.5,25.794,90,Aetna,PPO,83.7,93,,percent of total billed charges,,
Lead,,83655,CPT,Facility,Both,,,,90,76.5,25.794,90,America's PPO,America's PPO,86.427,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Lead,,83655,CPT,Facility,Both,,,,90,76.5,25.794,90,BlueCross BlueShield Minnesota, Federal Employee Program,88.56,98.4,,percent of total billed charges,,
Lead,,83655,CPT,Facility,Both,,,,90,76.5,25.794,90,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,90,100,,percent of total billed charges,,
Lead,,83655,CPT,Facility,Both,,,,90,76.5,25.794,90,BlueCross BlueShield Minnesota,High Value Network Plan,81,90,,percent of total billed charges,,
Lead,,83655,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,BlueCross BlueShield Minnesota,Medicare Advantage,44.1,49,,percent of total billed charges,,
Lead,,83655,CPT,Facility,Inpatient,,,,90,76.5,25.794,90,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Lead,,83655,CPT,Facility,Both,,,,90,76.5,25.794,90,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,79.713,88.57,,percent of total billed charges,,
Lead,,83655,CPT,Facility,Both,,,,90,76.5,25.794,90,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,25.794,28.66,,percent of total billed charges,,
Lead,,83655,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),44.1,49,,percent of total billed charges,,
Lead,,83655,CPT,Facility,Inpatient,,,,90,76.5,25.794,90,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Lead,,83655,CPT,Facility,Both,,,,90,76.5,25.794,90,CorVel,Worker's Compensation,90,100,,percent of total billed charges,,
Lead,,83655,CPT,Facility,Both,,,,90,76.5,25.794,90,First Health Group Corporation,First Health Network,87.3,97,,percent of total billed charges,,
Lead,,83655,CPT,Facility,Both,,,,90,76.5,25.794,90,"Health Partners, Inc.",Commercial,85.14,94.6,,percent of total billed charges,,
Lead,,83655,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,"Health Partners, Inc.",Medicare Advantage,44.1,49,,percent of total billed charges,,
Lead,,83655,CPT,Facility,Inpatient,,,,90,76.5,25.794,90,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Lead,,83655,CPT,Facility,Both,,,,90,76.5,25.794,90,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),54,60,,percent of total billed charges,,
Lead,,83655,CPT,Facility,Both,,,,90,76.5,25.794,90,"Health Partners, Inc.",State of Minnesota Advantage Program,73.35,81.5,,percent of total billed charges,,
Lead,,83655,CPT,Facility,Both,,,,90,76.5,25.794,90,"Health Partners, Inc.",State Public Programs,45,50,,percent of total billed charges,,
Lead,,83655,CPT,Facility,Both,,,,90,76.5,25.794,90,Humana Insurance Company,Commercial PPO,85.5,95,,percent of total billed charges,,
Lead,,83655,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,Humana Insurance Company,Medicare PPO,44.1,49,,percent of total billed charges,,
Lead,,83655,CPT,Facility,Inpatient,,,,90,76.5,25.794,90,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Lead,,83655,CPT,Facility,Both,,,,90,76.5,25.794,90,Medica,Individual & Family,89.19,99.1,,percent of total billed charges,,
Lead,,83655,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,Medica,Medica Advantage Solution,44.82,49.8,,percent of total billed charges,,
Lead,,83655,CPT,Facility,Inpatient,,,,90,76.5,25.794,90,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Lead,,83655,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,Medica,Medical Assistance,40.14,44.6,,percent of total billed charges,,
Lead,,83655,CPT,Facility,Inpatient,,,,90,76.5,25.794,90,Medica,Medical Assistance,,,,,Included in per diem rate,
Lead,,83655,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,44.82,49.8,,percent of total billed charges,,
Lead,,83655,CPT,Facility,Inpatient,,,,90,76.5,25.794,90,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Lead,,83655,CPT,Facility,Both,,,,90,76.5,25.794,90,"Multiplan, Inc.","Multiplan, Inc.",84.6,94,,percent of total billed charges,,
Lead,,83655,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,77.76,86.4,,percent of total billed charges,,
Lead,,83655,CPT,Facility,Inpatient,,,,90,76.5,25.794,90,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Lead,,83655,CPT,Facility,Both,,,,90,76.5,25.794,90,"Preferred One Administrative Services, INC.",PPO,88.74,98.6,,percent of total billed charges,,
Lead,,83655,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,PrimeWest Health,Minnesota Senior Health Options (MSHO),46.305,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Lead,,83655,CPT,Facility,Inpatient,,,,90,76.5,25.794,90,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Lead,,83655,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,PrimeWest Health,MinnesotaCare,46.224,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Lead,,83655,CPT,Facility,Inpatient,,,,90,76.5,25.794,90,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Lead,,83655,CPT,Facility,Both,,,,90,76.5,25.794,90,Sanford Health Plan,Sanford Health Plan,82.8,92,,percent of total billed charges,,
Lead,,83655,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,"UCare Health, Inc.",Individual & Family Plan,50.715,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Lead,,83655,CPT,Facility,Inpatient,,,,90,76.5,25.794,90,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Lead,,83655,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,"UCare Health, Inc.",Medical Assistance,45.423,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Lead,,83655,CPT,Facility,Inpatient,,,,90,76.5,25.794,90,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Lead,,83655,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,"UCare Health, Inc.",Medicare Advantage,45.423,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Lead,,83655,CPT,Facility,Inpatient,,,,90,76.5,25.794,90,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Lead,,83655,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),45.423,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Lead,,83655,CPT,Facility,Inpatient,,,,90,76.5,25.794,90,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Lead,,83655,CPT,Facility,Both,,,,90,76.5,25.794,90,UnitedHealthcare,Individual & Family,84.6,94,,percent of total billed charges,,
Lead,,83655,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,UnitedHealthcare,Medicare Advantage,44.1,49,,percent of total billed charges,,
Lead,,83655,CPT,Facility,Inpatient,,,,90,76.5,25.794,90,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Lead,,83655,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,43.2,48,,percent of total billed charges,,100% of DHS outpatient percentage
Lead,,83655,CPT,Facility,Inpatient,,,,90,76.5,25.794,90,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Lipase,,83690,CPT,Facility,Both,,,,129,109.65,36.9714,129,Aetna,Commercial,118.68,92,,percent of total billed charges,,
Lipase,,83690,CPT,Facility,Outpatient,,,,129,109.65,36.9714,129,Aetna,Medicare Advantage,63.21,49,,percent of total billed charges,,
Lipase,,83690,CPT,Facility,Inpatient,,,,129,109.65,36.9714,129,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Lipase,,83690,CPT,Facility,Both,,,,129,109.65,36.9714,129,Aetna,PPO,119.97,93,,percent of total billed charges,,
Lipase,,83690,CPT,Facility,Both,,,,129,109.65,36.9714,129,America's PPO,America's PPO,123.8787,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Lipase,,83690,CPT,Facility,Both,,,,129,109.65,36.9714,129,BlueCross BlueShield Minnesota, Federal Employee Program,126.936,98.4,,percent of total billed charges,,
Lipase,,83690,CPT,Facility,Both,,,,129,109.65,36.9714,129,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,129,100,,percent of total billed charges,,
Lipase,,83690,CPT,Facility,Both,,,,129,109.65,36.9714,129,BlueCross BlueShield Minnesota,High Value Network Plan,116.1,90,,percent of total billed charges,,
Lipase,,83690,CPT,Facility,Outpatient,,,,129,109.65,36.9714,129,BlueCross BlueShield Minnesota,Medicare Advantage,63.21,49,,percent of total billed charges,,
Lipase,,83690,CPT,Facility,Inpatient,,,,129,109.65,36.9714,129,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Lipase,,83690,CPT,Facility,Both,,,,129,109.65,36.9714,129,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,114.2553,88.57,,percent of total billed charges,,
Lipase,,83690,CPT,Facility,Both,,,,129,109.65,36.9714,129,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,36.9714,28.66,,percent of total billed charges,,
Lipase,,83690,CPT,Facility,Outpatient,,,,129,109.65,36.9714,129,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),63.21,49,,percent of total billed charges,,
Lipase,,83690,CPT,Facility,Inpatient,,,,129,109.65,36.9714,129,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Lipase,,83690,CPT,Facility,Both,,,,129,109.65,36.9714,129,CorVel,Worker's Compensation,129,100,,percent of total billed charges,,
Lipase,,83690,CPT,Facility,Both,,,,129,109.65,36.9714,129,First Health Group Corporation,First Health Network,125.13,97,,percent of total billed charges,,
Lipase,,83690,CPT,Facility,Both,,,,129,109.65,36.9714,129,"Health Partners, Inc.",Commercial,122.034,94.6,,percent of total billed charges,,
Lipase,,83690,CPT,Facility,Outpatient,,,,129,109.65,36.9714,129,"Health Partners, Inc.",Medicare Advantage,63.21,49,,percent of total billed charges,,
Lipase,,83690,CPT,Facility,Inpatient,,,,129,109.65,36.9714,129,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Lipase,,83690,CPT,Facility,Both,,,,129,109.65,36.9714,129,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),77.4,60,,percent of total billed charges,,
Lipase,,83690,CPT,Facility,Both,,,,129,109.65,36.9714,129,"Health Partners, Inc.",State of Minnesota Advantage Program,105.135,81.5,,percent of total billed charges,,
Lipase,,83690,CPT,Facility,Both,,,,129,109.65,36.9714,129,"Health Partners, Inc.",State Public Programs,64.5,50,,percent of total billed charges,,
Lipase,,83690,CPT,Facility,Both,,,,129,109.65,36.9714,129,Humana Insurance Company,Commercial PPO,122.55,95,,percent of total billed charges,,
Lipase,,83690,CPT,Facility,Outpatient,,,,129,109.65,36.9714,129,Humana Insurance Company,Medicare PPO,63.21,49,,percent of total billed charges,,
Lipase,,83690,CPT,Facility,Inpatient,,,,129,109.65,36.9714,129,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Lipase,,83690,CPT,Facility,Both,,,,129,109.65,36.9714,129,Medica,Individual & Family,127.839,99.1,,percent of total billed charges,,
Lipase,,83690,CPT,Facility,Outpatient,,,,129,109.65,36.9714,129,Medica,Medica Advantage Solution,64.242,49.8,,percent of total billed charges,,
Lipase,,83690,CPT,Facility,Inpatient,,,,129,109.65,36.9714,129,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Lipase,,83690,CPT,Facility,Outpatient,,,,129,109.65,36.9714,129,Medica,Medical Assistance,57.534,44.6,,percent of total billed charges,,
Lipase,,83690,CPT,Facility,Inpatient,,,,129,109.65,36.9714,129,Medica,Medical Assistance,,,,,Included in per diem rate,
Lipase,,83690,CPT,Facility,Outpatient,,,,129,109.65,36.9714,129,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,64.242,49.8,,percent of total billed charges,,
Lipase,,83690,CPT,Facility,Inpatient,,,,129,109.65,36.9714,129,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Lipase,,83690,CPT,Facility,Both,,,,129,109.65,36.9714,129,"Multiplan, Inc.","Multiplan, Inc.",121.26,94,,percent of total billed charges,,
Lipase,,83690,CPT,Facility,Outpatient,,,,129,109.65,36.9714,129,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,111.456,86.4,,percent of total billed charges,,
Lipase,,83690,CPT,Facility,Inpatient,,,,129,109.65,36.9714,129,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Lipase,,83690,CPT,Facility,Both,,,,129,109.65,36.9714,129,"Preferred One Administrative Services, INC.",PPO,127.194,98.6,,percent of total billed charges,,
Lipase,,83690,CPT,Facility,Outpatient,,,,129,109.65,36.9714,129,PrimeWest Health,Minnesota Senior Health Options (MSHO),66.3705,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Lipase,,83690,CPT,Facility,Inpatient,,,,129,109.65,36.9714,129,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Lipase,,83690,CPT,Facility,Outpatient,,,,129,109.65,36.9714,129,PrimeWest Health,MinnesotaCare,66.2544,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Lipase,,83690,CPT,Facility,Inpatient,,,,129,109.65,36.9714,129,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Lipase,,83690,CPT,Facility,Both,,,,129,109.65,36.9714,129,Sanford Health Plan,Sanford Health Plan,118.68,92,,percent of total billed charges,,
Lipase,,83690,CPT,Facility,Outpatient,,,,129,109.65,36.9714,129,"UCare Health, Inc.",Individual & Family Plan,72.6915,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Lipase,,83690,CPT,Facility,Inpatient,,,,129,109.65,36.9714,129,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Lipase,,83690,CPT,Facility,Outpatient,,,,129,109.65,36.9714,129,"UCare Health, Inc.",Medical Assistance,65.1063,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Lipase,,83690,CPT,Facility,Inpatient,,,,129,109.65,36.9714,129,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Lipase,,83690,CPT,Facility,Outpatient,,,,129,109.65,36.9714,129,"UCare Health, Inc.",Medicare Advantage,65.1063,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Lipase,,83690,CPT,Facility,Inpatient,,,,129,109.65,36.9714,129,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Lipase,,83690,CPT,Facility,Outpatient,,,,129,109.65,36.9714,129,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),65.1063,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Lipase,,83690,CPT,Facility,Inpatient,,,,129,109.65,36.9714,129,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Lipase,,83690,CPT,Facility,Both,,,,129,109.65,36.9714,129,UnitedHealthcare,Individual & Family,121.26,94,,percent of total billed charges,,
Lipase,,83690,CPT,Facility,Outpatient,,,,129,109.65,36.9714,129,UnitedHealthcare,Medicare Advantage,63.21,49,,percent of total billed charges,,
Lipase,,83690,CPT,Facility,Inpatient,,,,129,109.65,36.9714,129,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Lipase,,83690,CPT,Facility,Outpatient,,,,129,109.65,36.9714,129,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,61.92,48,,percent of total billed charges,,100% of DHS outpatient percentage
Lipase,,83690,CPT,Facility,Inpatient,,,,129,109.65,36.9714,129,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Hdl Cholesterol,,83718,CPT,Facility,Both,,,,63,53.55,18.0558,63,Aetna,Commercial,57.96,92,,percent of total billed charges,,
Hdl Cholesterol,,83718,CPT,Facility,Outpatient,,,,63,53.55,18.0558,63,Aetna,Medicare Advantage,30.87,49,,percent of total billed charges,,
Hdl Cholesterol,,83718,CPT,Facility,Inpatient,,,,63,53.55,18.0558,63,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Hdl Cholesterol,,83718,CPT,Facility,Both,,,,63,53.55,18.0558,63,Aetna,PPO,58.59,93,,percent of total billed charges,,
Hdl Cholesterol,,83718,CPT,Facility,Both,,,,63,53.55,18.0558,63,America's PPO,America's PPO,60.4989,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Hdl Cholesterol,,83718,CPT,Facility,Both,,,,63,53.55,18.0558,63,BlueCross BlueShield Minnesota, Federal Employee Program,61.992,98.4,,percent of total billed charges,,
Hdl Cholesterol,,83718,CPT,Facility,Both,,,,63,53.55,18.0558,63,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,63,100,,percent of total billed charges,,
Hdl Cholesterol,,83718,CPT,Facility,Both,,,,63,53.55,18.0558,63,BlueCross BlueShield Minnesota,High Value Network Plan,56.7,90,,percent of total billed charges,,
Hdl Cholesterol,,83718,CPT,Facility,Outpatient,,,,63,53.55,18.0558,63,BlueCross BlueShield Minnesota,Medicare Advantage,30.87,49,,percent of total billed charges,,
Hdl Cholesterol,,83718,CPT,Facility,Inpatient,,,,63,53.55,18.0558,63,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Hdl Cholesterol,,83718,CPT,Facility,Both,,,,63,53.55,18.0558,63,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,55.7991,88.57,,percent of total billed charges,,
Hdl Cholesterol,,83718,CPT,Facility,Both,,,,63,53.55,18.0558,63,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,18.0558,28.66,,percent of total billed charges,,
Hdl Cholesterol,,83718,CPT,Facility,Outpatient,,,,63,53.55,18.0558,63,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),30.87,49,,percent of total billed charges,,
Hdl Cholesterol,,83718,CPT,Facility,Inpatient,,,,63,53.55,18.0558,63,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Hdl Cholesterol,,83718,CPT,Facility,Both,,,,63,53.55,18.0558,63,CorVel,Worker's Compensation,63,100,,percent of total billed charges,,
Hdl Cholesterol,,83718,CPT,Facility,Both,,,,63,53.55,18.0558,63,First Health Group Corporation,First Health Network,61.11,97,,percent of total billed charges,,
Hdl Cholesterol,,83718,CPT,Facility,Both,,,,63,53.55,18.0558,63,"Health Partners, Inc.",Commercial,59.598,94.6,,percent of total billed charges,,
Hdl Cholesterol,,83718,CPT,Facility,Outpatient,,,,63,53.55,18.0558,63,"Health Partners, Inc.",Medicare Advantage,30.87,49,,percent of total billed charges,,
Hdl Cholesterol,,83718,CPT,Facility,Inpatient,,,,63,53.55,18.0558,63,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Hdl Cholesterol,,83718,CPT,Facility,Both,,,,63,53.55,18.0558,63,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),37.8,60,,percent of total billed charges,,
Hdl Cholesterol,,83718,CPT,Facility,Both,,,,63,53.55,18.0558,63,"Health Partners, Inc.",State of Minnesota Advantage Program,51.345,81.5,,percent of total billed charges,,
Hdl Cholesterol,,83718,CPT,Facility,Both,,,,63,53.55,18.0558,63,"Health Partners, Inc.",State Public Programs,31.5,50,,percent of total billed charges,,
Hdl Cholesterol,,83718,CPT,Facility,Both,,,,63,53.55,18.0558,63,Humana Insurance Company,Commercial PPO,59.85,95,,percent of total billed charges,,
Hdl Cholesterol,,83718,CPT,Facility,Outpatient,,,,63,53.55,18.0558,63,Humana Insurance Company,Medicare PPO,30.87,49,,percent of total billed charges,,
Hdl Cholesterol,,83718,CPT,Facility,Inpatient,,,,63,53.55,18.0558,63,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Hdl Cholesterol,,83718,CPT,Facility,Both,,,,63,53.55,18.0558,63,Medica,Individual & Family,62.433,99.1,,percent of total billed charges,,
Hdl Cholesterol,,83718,CPT,Facility,Outpatient,,,,63,53.55,18.0558,63,Medica,Medica Advantage Solution,31.374,49.8,,percent of total billed charges,,
Hdl Cholesterol,,83718,CPT,Facility,Inpatient,,,,63,53.55,18.0558,63,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Hdl Cholesterol,,83718,CPT,Facility,Outpatient,,,,63,53.55,18.0558,63,Medica,Medical Assistance,28.098,44.6,,percent of total billed charges,,
Hdl Cholesterol,,83718,CPT,Facility,Inpatient,,,,63,53.55,18.0558,63,Medica,Medical Assistance,,,,,Included in per diem rate,
Hdl Cholesterol,,83718,CPT,Facility,Outpatient,,,,63,53.55,18.0558,63,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,31.374,49.8,,percent of total billed charges,,
Hdl Cholesterol,,83718,CPT,Facility,Inpatient,,,,63,53.55,18.0558,63,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Hdl Cholesterol,,83718,CPT,Facility,Both,,,,63,53.55,18.0558,63,"Multiplan, Inc.","Multiplan, Inc.",59.22,94,,percent of total billed charges,,
Hdl Cholesterol,,83718,CPT,Facility,Outpatient,,,,63,53.55,18.0558,63,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,54.432,86.4,,percent of total billed charges,,
Hdl Cholesterol,,83718,CPT,Facility,Inpatient,,,,63,53.55,18.0558,63,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Hdl Cholesterol,,83718,CPT,Facility,Both,,,,63,53.55,18.0558,63,"Preferred One Administrative Services, INC.",PPO,62.118,98.6,,percent of total billed charges,,
Hdl Cholesterol,,83718,CPT,Facility,Outpatient,,,,63,53.55,18.0558,63,PrimeWest Health,Minnesota Senior Health Options (MSHO),32.4135,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Hdl Cholesterol,,83718,CPT,Facility,Inpatient,,,,63,53.55,18.0558,63,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Hdl Cholesterol,,83718,CPT,Facility,Outpatient,,,,63,53.55,18.0558,63,PrimeWest Health,MinnesotaCare,32.3568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Hdl Cholesterol,,83718,CPT,Facility,Inpatient,,,,63,53.55,18.0558,63,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Hdl Cholesterol,,83718,CPT,Facility,Both,,,,63,53.55,18.0558,63,Sanford Health Plan,Sanford Health Plan,57.96,92,,percent of total billed charges,,
Hdl Cholesterol,,83718,CPT,Facility,Outpatient,,,,63,53.55,18.0558,63,"UCare Health, Inc.",Individual & Family Plan,35.5005,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Hdl Cholesterol,,83718,CPT,Facility,Inpatient,,,,63,53.55,18.0558,63,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Hdl Cholesterol,,83718,CPT,Facility,Outpatient,,,,63,53.55,18.0558,63,"UCare Health, Inc.",Medical Assistance,31.7961,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Hdl Cholesterol,,83718,CPT,Facility,Inpatient,,,,63,53.55,18.0558,63,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Hdl Cholesterol,,83718,CPT,Facility,Outpatient,,,,63,53.55,18.0558,63,"UCare Health, Inc.",Medicare Advantage,31.7961,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Hdl Cholesterol,,83718,CPT,Facility,Inpatient,,,,63,53.55,18.0558,63,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Hdl Cholesterol,,83718,CPT,Facility,Outpatient,,,,63,53.55,18.0558,63,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),31.7961,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Hdl Cholesterol,,83718,CPT,Facility,Inpatient,,,,63,53.55,18.0558,63,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Hdl Cholesterol,,83718,CPT,Facility,Both,,,,63,53.55,18.0558,63,UnitedHealthcare,Individual & Family,59.22,94,,percent of total billed charges,,
Hdl Cholesterol,,83718,CPT,Facility,Outpatient,,,,63,53.55,18.0558,63,UnitedHealthcare,Medicare Advantage,30.87,49,,percent of total billed charges,,
Hdl Cholesterol,,83718,CPT,Facility,Inpatient,,,,63,53.55,18.0558,63,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Hdl Cholesterol,,83718,CPT,Facility,Outpatient,,,,63,53.55,18.0558,63,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,30.24,48,,percent of total billed charges,,100% of DHS outpatient percentage
Hdl Cholesterol,,83718,CPT,Facility,Inpatient,,,,63,53.55,18.0558,63,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Ldl, Direct Assay",,83721,CPT,Facility,Both,,,,41,34.85,11.7506,41,Aetna,Commercial,37.72,92,,percent of total billed charges,,
"Ldl, Direct Assay",,83721,CPT,Facility,Outpatient,,,,41,34.85,11.7506,41,Aetna,Medicare Advantage,20.09,49,,percent of total billed charges,,
"Ldl, Direct Assay",,83721,CPT,Facility,Inpatient,,,,41,34.85,11.7506,41,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Ldl, Direct Assay",,83721,CPT,Facility,Both,,,,41,34.85,11.7506,41,Aetna,PPO,38.13,93,,percent of total billed charges,,
"Ldl, Direct Assay",,83721,CPT,Facility,Both,,,,41,34.85,11.7506,41,America's PPO,America's PPO,39.3723,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Ldl, Direct Assay",,83721,CPT,Facility,Both,,,,41,34.85,11.7506,41,BlueCross BlueShield Minnesota, Federal Employee Program,40.344,98.4,,percent of total billed charges,,
"Ldl, Direct Assay",,83721,CPT,Facility,Both,,,,41,34.85,11.7506,41,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,41,100,,percent of total billed charges,,
"Ldl, Direct Assay",,83721,CPT,Facility,Both,,,,41,34.85,11.7506,41,BlueCross BlueShield Minnesota,High Value Network Plan,36.9,90,,percent of total billed charges,,
"Ldl, Direct Assay",,83721,CPT,Facility,Outpatient,,,,41,34.85,11.7506,41,BlueCross BlueShield Minnesota,Medicare Advantage,20.09,49,,percent of total billed charges,,
"Ldl, Direct Assay",,83721,CPT,Facility,Inpatient,,,,41,34.85,11.7506,41,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Ldl, Direct Assay",,83721,CPT,Facility,Both,,,,41,34.85,11.7506,41,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,36.3137,88.57,,percent of total billed charges,,
"Ldl, Direct Assay",,83721,CPT,Facility,Both,,,,41,34.85,11.7506,41,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,11.7506,28.66,,percent of total billed charges,,
"Ldl, Direct Assay",,83721,CPT,Facility,Outpatient,,,,41,34.85,11.7506,41,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),20.09,49,,percent of total billed charges,,
"Ldl, Direct Assay",,83721,CPT,Facility,Inpatient,,,,41,34.85,11.7506,41,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Ldl, Direct Assay",,83721,CPT,Facility,Both,,,,41,34.85,11.7506,41,CorVel,Worker's Compensation,41,100,,percent of total billed charges,,
"Ldl, Direct Assay",,83721,CPT,Facility,Both,,,,41,34.85,11.7506,41,First Health Group Corporation,First Health Network,39.77,97,,percent of total billed charges,,
"Ldl, Direct Assay",,83721,CPT,Facility,Both,,,,41,34.85,11.7506,41,"Health Partners, Inc.",Commercial,38.786,94.6,,percent of total billed charges,,
"Ldl, Direct Assay",,83721,CPT,Facility,Outpatient,,,,41,34.85,11.7506,41,"Health Partners, Inc.",Medicare Advantage,20.09,49,,percent of total billed charges,,
"Ldl, Direct Assay",,83721,CPT,Facility,Inpatient,,,,41,34.85,11.7506,41,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Ldl, Direct Assay",,83721,CPT,Facility,Both,,,,41,34.85,11.7506,41,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),24.6,60,,percent of total billed charges,,
"Ldl, Direct Assay",,83721,CPT,Facility,Both,,,,41,34.85,11.7506,41,"Health Partners, Inc.",State of Minnesota Advantage Program,33.415,81.5,,percent of total billed charges,,
"Ldl, Direct Assay",,83721,CPT,Facility,Both,,,,41,34.85,11.7506,41,"Health Partners, Inc.",State Public Programs,20.5,50,,percent of total billed charges,,
"Ldl, Direct Assay",,83721,CPT,Facility,Both,,,,41,34.85,11.7506,41,Humana Insurance Company,Commercial PPO,38.95,95,,percent of total billed charges,,
"Ldl, Direct Assay",,83721,CPT,Facility,Outpatient,,,,41,34.85,11.7506,41,Humana Insurance Company,Medicare PPO,20.09,49,,percent of total billed charges,,
"Ldl, Direct Assay",,83721,CPT,Facility,Inpatient,,,,41,34.85,11.7506,41,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Ldl, Direct Assay",,83721,CPT,Facility,Both,,,,41,34.85,11.7506,41,Medica,Individual & Family,40.631,99.1,,percent of total billed charges,,
"Ldl, Direct Assay",,83721,CPT,Facility,Outpatient,,,,41,34.85,11.7506,41,Medica,Medica Advantage Solution,20.418,49.8,,percent of total billed charges,,
"Ldl, Direct Assay",,83721,CPT,Facility,Inpatient,,,,41,34.85,11.7506,41,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Ldl, Direct Assay",,83721,CPT,Facility,Outpatient,,,,41,34.85,11.7506,41,Medica,Medical Assistance,18.286,44.6,,percent of total billed charges,,
"Ldl, Direct Assay",,83721,CPT,Facility,Inpatient,,,,41,34.85,11.7506,41,Medica,Medical Assistance,,,,,Included in per diem rate,
"Ldl, Direct Assay",,83721,CPT,Facility,Outpatient,,,,41,34.85,11.7506,41,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,20.418,49.8,,percent of total billed charges,,
"Ldl, Direct Assay",,83721,CPT,Facility,Inpatient,,,,41,34.85,11.7506,41,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Ldl, Direct Assay",,83721,CPT,Facility,Both,,,,41,34.85,11.7506,41,"Multiplan, Inc.","Multiplan, Inc.",38.54,94,,percent of total billed charges,,
"Ldl, Direct Assay",,83721,CPT,Facility,Outpatient,,,,41,34.85,11.7506,41,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,35.424,86.4,,percent of total billed charges,,
"Ldl, Direct Assay",,83721,CPT,Facility,Inpatient,,,,41,34.85,11.7506,41,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Ldl, Direct Assay",,83721,CPT,Facility,Both,,,,41,34.85,11.7506,41,"Preferred One Administrative Services, INC.",PPO,40.426,98.6,,percent of total billed charges,,
"Ldl, Direct Assay",,83721,CPT,Facility,Outpatient,,,,41,34.85,11.7506,41,PrimeWest Health,Minnesota Senior Health Options (MSHO),21.0945,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Ldl, Direct Assay",,83721,CPT,Facility,Inpatient,,,,41,34.85,11.7506,41,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Ldl, Direct Assay",,83721,CPT,Facility,Outpatient,,,,41,34.85,11.7506,41,PrimeWest Health,MinnesotaCare,21.0576,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Ldl, Direct Assay",,83721,CPT,Facility,Inpatient,,,,41,34.85,11.7506,41,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Ldl, Direct Assay",,83721,CPT,Facility,Both,,,,41,34.85,11.7506,41,Sanford Health Plan,Sanford Health Plan,37.72,92,,percent of total billed charges,,
"Ldl, Direct Assay",,83721,CPT,Facility,Outpatient,,,,41,34.85,11.7506,41,"UCare Health, Inc.",Individual & Family Plan,23.1035,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Ldl, Direct Assay",,83721,CPT,Facility,Inpatient,,,,41,34.85,11.7506,41,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Ldl, Direct Assay",,83721,CPT,Facility,Outpatient,,,,41,34.85,11.7506,41,"UCare Health, Inc.",Medical Assistance,20.6927,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Ldl, Direct Assay",,83721,CPT,Facility,Inpatient,,,,41,34.85,11.7506,41,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Ldl, Direct Assay",,83721,CPT,Facility,Outpatient,,,,41,34.85,11.7506,41,"UCare Health, Inc.",Medicare Advantage,20.6927,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Ldl, Direct Assay",,83721,CPT,Facility,Inpatient,,,,41,34.85,11.7506,41,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Ldl, Direct Assay",,83721,CPT,Facility,Outpatient,,,,41,34.85,11.7506,41,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),20.6927,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Ldl, Direct Assay",,83721,CPT,Facility,Inpatient,,,,41,34.85,11.7506,41,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Ldl, Direct Assay",,83721,CPT,Facility,Both,,,,41,34.85,11.7506,41,UnitedHealthcare,Individual & Family,38.54,94,,percent of total billed charges,,
"Ldl, Direct Assay",,83721,CPT,Facility,Outpatient,,,,41,34.85,11.7506,41,UnitedHealthcare,Medicare Advantage,20.09,49,,percent of total billed charges,,
"Ldl, Direct Assay",,83721,CPT,Facility,Inpatient,,,,41,34.85,11.7506,41,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Ldl, Direct Assay",,83721,CPT,Facility,Outpatient,,,,41,34.85,11.7506,41,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,19.68,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Ldl, Direct Assay",,83721,CPT,Facility,Inpatient,,,,41,34.85,11.7506,41,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Magnesium,,83735,CPT,Facility,Both,,,,90,76.5,25.794,90,Aetna,Commercial,82.8,92,,percent of total billed charges,,
Magnesium,,83735,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,Aetna,Medicare Advantage,44.1,49,,percent of total billed charges,,
Magnesium,,83735,CPT,Facility,Inpatient,,,,90,76.5,25.794,90,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Magnesium,,83735,CPT,Facility,Both,,,,90,76.5,25.794,90,Aetna,PPO,83.7,93,,percent of total billed charges,,
Magnesium,,83735,CPT,Facility,Both,,,,90,76.5,25.794,90,America's PPO,America's PPO,86.427,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Magnesium,,83735,CPT,Facility,Both,,,,90,76.5,25.794,90,BlueCross BlueShield Minnesota, Federal Employee Program,88.56,98.4,,percent of total billed charges,,
Magnesium,,83735,CPT,Facility,Both,,,,90,76.5,25.794,90,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,90,100,,percent of total billed charges,,
Magnesium,,83735,CPT,Facility,Both,,,,90,76.5,25.794,90,BlueCross BlueShield Minnesota,High Value Network Plan,81,90,,percent of total billed charges,,
Magnesium,,83735,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,BlueCross BlueShield Minnesota,Medicare Advantage,44.1,49,,percent of total billed charges,,
Magnesium,,83735,CPT,Facility,Inpatient,,,,90,76.5,25.794,90,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Magnesium,,83735,CPT,Facility,Both,,,,90,76.5,25.794,90,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,79.713,88.57,,percent of total billed charges,,
Magnesium,,83735,CPT,Facility,Both,,,,90,76.5,25.794,90,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,25.794,28.66,,percent of total billed charges,,
Magnesium,,83735,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),44.1,49,,percent of total billed charges,,
Magnesium,,83735,CPT,Facility,Inpatient,,,,90,76.5,25.794,90,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Magnesium,,83735,CPT,Facility,Both,,,,90,76.5,25.794,90,CorVel,Worker's Compensation,90,100,,percent of total billed charges,,
Magnesium,,83735,CPT,Facility,Both,,,,90,76.5,25.794,90,First Health Group Corporation,First Health Network,87.3,97,,percent of total billed charges,,
Magnesium,,83735,CPT,Facility,Both,,,,90,76.5,25.794,90,"Health Partners, Inc.",Commercial,85.14,94.6,,percent of total billed charges,,
Magnesium,,83735,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,"Health Partners, Inc.",Medicare Advantage,44.1,49,,percent of total billed charges,,
Magnesium,,83735,CPT,Facility,Inpatient,,,,90,76.5,25.794,90,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Magnesium,,83735,CPT,Facility,Both,,,,90,76.5,25.794,90,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),54,60,,percent of total billed charges,,
Magnesium,,83735,CPT,Facility,Both,,,,90,76.5,25.794,90,"Health Partners, Inc.",State of Minnesota Advantage Program,73.35,81.5,,percent of total billed charges,,
Magnesium,,83735,CPT,Facility,Both,,,,90,76.5,25.794,90,"Health Partners, Inc.",State Public Programs,45,50,,percent of total billed charges,,
Magnesium,,83735,CPT,Facility,Both,,,,90,76.5,25.794,90,Humana Insurance Company,Commercial PPO,85.5,95,,percent of total billed charges,,
Magnesium,,83735,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,Humana Insurance Company,Medicare PPO,44.1,49,,percent of total billed charges,,
Magnesium,,83735,CPT,Facility,Inpatient,,,,90,76.5,25.794,90,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Magnesium,,83735,CPT,Facility,Both,,,,90,76.5,25.794,90,Medica,Individual & Family,89.19,99.1,,percent of total billed charges,,
Magnesium,,83735,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,Medica,Medica Advantage Solution,44.82,49.8,,percent of total billed charges,,
Magnesium,,83735,CPT,Facility,Inpatient,,,,90,76.5,25.794,90,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Magnesium,,83735,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,Medica,Medical Assistance,40.14,44.6,,percent of total billed charges,,
Magnesium,,83735,CPT,Facility,Inpatient,,,,90,76.5,25.794,90,Medica,Medical Assistance,,,,,Included in per diem rate,
Magnesium,,83735,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,44.82,49.8,,percent of total billed charges,,
Magnesium,,83735,CPT,Facility,Inpatient,,,,90,76.5,25.794,90,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Magnesium,,83735,CPT,Facility,Both,,,,90,76.5,25.794,90,"Multiplan, Inc.","Multiplan, Inc.",84.6,94,,percent of total billed charges,,
Magnesium,,83735,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,77.76,86.4,,percent of total billed charges,,
Magnesium,,83735,CPT,Facility,Inpatient,,,,90,76.5,25.794,90,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Magnesium,,83735,CPT,Facility,Both,,,,90,76.5,25.794,90,"Preferred One Administrative Services, INC.",PPO,88.74,98.6,,percent of total billed charges,,
Magnesium,,83735,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,PrimeWest Health,Minnesota Senior Health Options (MSHO),46.305,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Magnesium,,83735,CPT,Facility,Inpatient,,,,90,76.5,25.794,90,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Magnesium,,83735,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,PrimeWest Health,MinnesotaCare,46.224,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Magnesium,,83735,CPT,Facility,Inpatient,,,,90,76.5,25.794,90,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Magnesium,,83735,CPT,Facility,Both,,,,90,76.5,25.794,90,Sanford Health Plan,Sanford Health Plan,82.8,92,,percent of total billed charges,,
Magnesium,,83735,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,"UCare Health, Inc.",Individual & Family Plan,50.715,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Magnesium,,83735,CPT,Facility,Inpatient,,,,90,76.5,25.794,90,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Magnesium,,83735,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,"UCare Health, Inc.",Medical Assistance,45.423,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Magnesium,,83735,CPT,Facility,Inpatient,,,,90,76.5,25.794,90,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Magnesium,,83735,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,"UCare Health, Inc.",Medicare Advantage,45.423,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Magnesium,,83735,CPT,Facility,Inpatient,,,,90,76.5,25.794,90,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Magnesium,,83735,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),45.423,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Magnesium,,83735,CPT,Facility,Inpatient,,,,90,76.5,25.794,90,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Magnesium,,83735,CPT,Facility,Both,,,,90,76.5,25.794,90,UnitedHealthcare,Individual & Family,84.6,94,,percent of total billed charges,,
Magnesium,,83735,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,UnitedHealthcare,Medicare Advantage,44.1,49,,percent of total billed charges,,
Magnesium,,83735,CPT,Facility,Inpatient,,,,90,76.5,25.794,90,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Magnesium,,83735,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,43.2,48,,percent of total billed charges,,100% of DHS outpatient percentage
Magnesium,,83735,CPT,Facility,Inpatient,,,,90,76.5,25.794,90,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Natriuretic Peptide B,,83880,CPT,Facility,Both,,,,184,156.4,52.7344,184,Aetna,Commercial,169.28,92,,percent of total billed charges,,
Natriuretic Peptide B,,83880,CPT,Facility,Outpatient,,,,184,156.4,52.7344,184,Aetna,Medicare Advantage,90.16,49,,percent of total billed charges,,
Natriuretic Peptide B,,83880,CPT,Facility,Inpatient,,,,184,156.4,52.7344,184,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Natriuretic Peptide B,,83880,CPT,Facility,Both,,,,184,156.4,52.7344,184,Aetna,PPO,171.12,93,,percent of total billed charges,,
Natriuretic Peptide B,,83880,CPT,Facility,Both,,,,184,156.4,52.7344,184,America's PPO,America's PPO,176.6952,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Natriuretic Peptide B,,83880,CPT,Facility,Both,,,,184,156.4,52.7344,184,BlueCross BlueShield Minnesota, Federal Employee Program,181.056,98.4,,percent of total billed charges,,
Natriuretic Peptide B,,83880,CPT,Facility,Both,,,,184,156.4,52.7344,184,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,184,100,,percent of total billed charges,,
Natriuretic Peptide B,,83880,CPT,Facility,Both,,,,184,156.4,52.7344,184,BlueCross BlueShield Minnesota,High Value Network Plan,165.6,90,,percent of total billed charges,,
Natriuretic Peptide B,,83880,CPT,Facility,Outpatient,,,,184,156.4,52.7344,184,BlueCross BlueShield Minnesota,Medicare Advantage,90.16,49,,percent of total billed charges,,
Natriuretic Peptide B,,83880,CPT,Facility,Inpatient,,,,184,156.4,52.7344,184,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Natriuretic Peptide B,,83880,CPT,Facility,Both,,,,184,156.4,52.7344,184,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,162.9688,88.57,,percent of total billed charges,,
Natriuretic Peptide B,,83880,CPT,Facility,Both,,,,184,156.4,52.7344,184,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,52.7344,28.66,,percent of total billed charges,,
Natriuretic Peptide B,,83880,CPT,Facility,Outpatient,,,,184,156.4,52.7344,184,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),90.16,49,,percent of total billed charges,,
Natriuretic Peptide B,,83880,CPT,Facility,Inpatient,,,,184,156.4,52.7344,184,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Natriuretic Peptide B,,83880,CPT,Facility,Both,,,,184,156.4,52.7344,184,CorVel,Worker's Compensation,184,100,,percent of total billed charges,,
Natriuretic Peptide B,,83880,CPT,Facility,Both,,,,184,156.4,52.7344,184,First Health Group Corporation,First Health Network,178.48,97,,percent of total billed charges,,
Natriuretic Peptide B,,83880,CPT,Facility,Both,,,,184,156.4,52.7344,184,"Health Partners, Inc.",Commercial,174.064,94.6,,percent of total billed charges,,
Natriuretic Peptide B,,83880,CPT,Facility,Outpatient,,,,184,156.4,52.7344,184,"Health Partners, Inc.",Medicare Advantage,90.16,49,,percent of total billed charges,,
Natriuretic Peptide B,,83880,CPT,Facility,Inpatient,,,,184,156.4,52.7344,184,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Natriuretic Peptide B,,83880,CPT,Facility,Both,,,,184,156.4,52.7344,184,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),110.4,60,,percent of total billed charges,,
Natriuretic Peptide B,,83880,CPT,Facility,Both,,,,184,156.4,52.7344,184,"Health Partners, Inc.",State of Minnesota Advantage Program,149.96,81.5,,percent of total billed charges,,
Natriuretic Peptide B,,83880,CPT,Facility,Both,,,,184,156.4,52.7344,184,"Health Partners, Inc.",State Public Programs,92,50,,percent of total billed charges,,
Natriuretic Peptide B,,83880,CPT,Facility,Both,,,,184,156.4,52.7344,184,Humana Insurance Company,Commercial PPO,174.8,95,,percent of total billed charges,,
Natriuretic Peptide B,,83880,CPT,Facility,Outpatient,,,,184,156.4,52.7344,184,Humana Insurance Company,Medicare PPO,90.16,49,,percent of total billed charges,,
Natriuretic Peptide B,,83880,CPT,Facility,Inpatient,,,,184,156.4,52.7344,184,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Natriuretic Peptide B,,83880,CPT,Facility,Both,,,,184,156.4,52.7344,184,Medica,Individual & Family,182.344,99.1,,percent of total billed charges,,
Natriuretic Peptide B,,83880,CPT,Facility,Outpatient,,,,184,156.4,52.7344,184,Medica,Medica Advantage Solution,91.632,49.8,,percent of total billed charges,,
Natriuretic Peptide B,,83880,CPT,Facility,Inpatient,,,,184,156.4,52.7344,184,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Natriuretic Peptide B,,83880,CPT,Facility,Outpatient,,,,184,156.4,52.7344,184,Medica,Medical Assistance,82.064,44.6,,percent of total billed charges,,
Natriuretic Peptide B,,83880,CPT,Facility,Inpatient,,,,184,156.4,52.7344,184,Medica,Medical Assistance,,,,,Included in per diem rate,
Natriuretic Peptide B,,83880,CPT,Facility,Outpatient,,,,184,156.4,52.7344,184,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,91.632,49.8,,percent of total billed charges,,
Natriuretic Peptide B,,83880,CPT,Facility,Inpatient,,,,184,156.4,52.7344,184,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Natriuretic Peptide B,,83880,CPT,Facility,Both,,,,184,156.4,52.7344,184,"Multiplan, Inc.","Multiplan, Inc.",172.96,94,,percent of total billed charges,,
Natriuretic Peptide B,,83880,CPT,Facility,Outpatient,,,,184,156.4,52.7344,184,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,158.976,86.4,,percent of total billed charges,,
Natriuretic Peptide B,,83880,CPT,Facility,Inpatient,,,,184,156.4,52.7344,184,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Natriuretic Peptide B,,83880,CPT,Facility,Both,,,,184,156.4,52.7344,184,"Preferred One Administrative Services, INC.",PPO,181.424,98.6,,percent of total billed charges,,
Natriuretic Peptide B,,83880,CPT,Facility,Outpatient,,,,184,156.4,52.7344,184,PrimeWest Health,Minnesota Senior Health Options (MSHO),94.668,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Natriuretic Peptide B,,83880,CPT,Facility,Inpatient,,,,184,156.4,52.7344,184,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Natriuretic Peptide B,,83880,CPT,Facility,Outpatient,,,,184,156.4,52.7344,184,PrimeWest Health,MinnesotaCare,94.5024,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Natriuretic Peptide B,,83880,CPT,Facility,Inpatient,,,,184,156.4,52.7344,184,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Natriuretic Peptide B,,83880,CPT,Facility,Both,,,,184,156.4,52.7344,184,Sanford Health Plan,Sanford Health Plan,169.28,92,,percent of total billed charges,,
Natriuretic Peptide B,,83880,CPT,Facility,Outpatient,,,,184,156.4,52.7344,184,"UCare Health, Inc.",Individual & Family Plan,103.684,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Natriuretic Peptide B,,83880,CPT,Facility,Inpatient,,,,184,156.4,52.7344,184,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Natriuretic Peptide B,,83880,CPT,Facility,Outpatient,,,,184,156.4,52.7344,184,"UCare Health, Inc.",Medical Assistance,92.8648,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Natriuretic Peptide B,,83880,CPT,Facility,Inpatient,,,,184,156.4,52.7344,184,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Natriuretic Peptide B,,83880,CPT,Facility,Outpatient,,,,184,156.4,52.7344,184,"UCare Health, Inc.",Medicare Advantage,92.8648,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Natriuretic Peptide B,,83880,CPT,Facility,Inpatient,,,,184,156.4,52.7344,184,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Natriuretic Peptide B,,83880,CPT,Facility,Outpatient,,,,184,156.4,52.7344,184,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),92.8648,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Natriuretic Peptide B,,83880,CPT,Facility,Inpatient,,,,184,156.4,52.7344,184,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Natriuretic Peptide B,,83880,CPT,Facility,Both,,,,184,156.4,52.7344,184,UnitedHealthcare,Individual & Family,172.96,94,,percent of total billed charges,,
Natriuretic Peptide B,,83880,CPT,Facility,Outpatient,,,,184,156.4,52.7344,184,UnitedHealthcare,Medicare Advantage,90.16,49,,percent of total billed charges,,
Natriuretic Peptide B,,83880,CPT,Facility,Inpatient,,,,184,156.4,52.7344,184,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Natriuretic Peptide B,,83880,CPT,Facility,Outpatient,,,,184,156.4,52.7344,184,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,88.32,48,,percent of total billed charges,,100% of DHS outpatient percentage
Natriuretic Peptide B,,83880,CPT,Facility,Inpatient,,,,184,156.4,52.7344,184,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Nt Pro Brain Natriuretic Peptide,,83880,CPT,Facility,Both,,,,184,156.4,52.7344,184,Aetna,Commercial,169.28,92,,percent of total billed charges,,
Nt Pro Brain Natriuretic Peptide,,83880,CPT,Facility,Outpatient,,,,184,156.4,52.7344,184,Aetna,Medicare Advantage,90.16,49,,percent of total billed charges,,
Nt Pro Brain Natriuretic Peptide,,83880,CPT,Facility,Inpatient,,,,184,156.4,52.7344,184,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Nt Pro Brain Natriuretic Peptide,,83880,CPT,Facility,Both,,,,184,156.4,52.7344,184,Aetna,PPO,171.12,93,,percent of total billed charges,,
Nt Pro Brain Natriuretic Peptide,,83880,CPT,Facility,Both,,,,184,156.4,52.7344,184,America's PPO,America's PPO,176.6952,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Nt Pro Brain Natriuretic Peptide,,83880,CPT,Facility,Both,,,,184,156.4,52.7344,184,BlueCross BlueShield Minnesota, Federal Employee Program,181.056,98.4,,percent of total billed charges,,
Nt Pro Brain Natriuretic Peptide,,83880,CPT,Facility,Both,,,,184,156.4,52.7344,184,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,184,100,,percent of total billed charges,,
Nt Pro Brain Natriuretic Peptide,,83880,CPT,Facility,Both,,,,184,156.4,52.7344,184,BlueCross BlueShield Minnesota,High Value Network Plan,165.6,90,,percent of total billed charges,,
Nt Pro Brain Natriuretic Peptide,,83880,CPT,Facility,Outpatient,,,,184,156.4,52.7344,184,BlueCross BlueShield Minnesota,Medicare Advantage,90.16,49,,percent of total billed charges,,
Nt Pro Brain Natriuretic Peptide,,83880,CPT,Facility,Inpatient,,,,184,156.4,52.7344,184,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Nt Pro Brain Natriuretic Peptide,,83880,CPT,Facility,Both,,,,184,156.4,52.7344,184,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,162.9688,88.57,,percent of total billed charges,,
Nt Pro Brain Natriuretic Peptide,,83880,CPT,Facility,Both,,,,184,156.4,52.7344,184,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,52.7344,28.66,,percent of total billed charges,,
Nt Pro Brain Natriuretic Peptide,,83880,CPT,Facility,Outpatient,,,,184,156.4,52.7344,184,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),90.16,49,,percent of total billed charges,,
Nt Pro Brain Natriuretic Peptide,,83880,CPT,Facility,Inpatient,,,,184,156.4,52.7344,184,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Nt Pro Brain Natriuretic Peptide,,83880,CPT,Facility,Both,,,,184,156.4,52.7344,184,CorVel,Worker's Compensation,184,100,,percent of total billed charges,,
Nt Pro Brain Natriuretic Peptide,,83880,CPT,Facility,Both,,,,184,156.4,52.7344,184,First Health Group Corporation,First Health Network,178.48,97,,percent of total billed charges,,
Nt Pro Brain Natriuretic Peptide,,83880,CPT,Facility,Both,,,,184,156.4,52.7344,184,"Health Partners, Inc.",Commercial,174.064,94.6,,percent of total billed charges,,
Nt Pro Brain Natriuretic Peptide,,83880,CPT,Facility,Outpatient,,,,184,156.4,52.7344,184,"Health Partners, Inc.",Medicare Advantage,90.16,49,,percent of total billed charges,,
Nt Pro Brain Natriuretic Peptide,,83880,CPT,Facility,Inpatient,,,,184,156.4,52.7344,184,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Nt Pro Brain Natriuretic Peptide,,83880,CPT,Facility,Both,,,,184,156.4,52.7344,184,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),110.4,60,,percent of total billed charges,,
Nt Pro Brain Natriuretic Peptide,,83880,CPT,Facility,Both,,,,184,156.4,52.7344,184,"Health Partners, Inc.",State of Minnesota Advantage Program,149.96,81.5,,percent of total billed charges,,
Nt Pro Brain Natriuretic Peptide,,83880,CPT,Facility,Both,,,,184,156.4,52.7344,184,"Health Partners, Inc.",State Public Programs,92,50,,percent of total billed charges,,
Nt Pro Brain Natriuretic Peptide,,83880,CPT,Facility,Both,,,,184,156.4,52.7344,184,Humana Insurance Company,Commercial PPO,174.8,95,,percent of total billed charges,,
Nt Pro Brain Natriuretic Peptide,,83880,CPT,Facility,Outpatient,,,,184,156.4,52.7344,184,Humana Insurance Company,Medicare PPO,90.16,49,,percent of total billed charges,,
Nt Pro Brain Natriuretic Peptide,,83880,CPT,Facility,Inpatient,,,,184,156.4,52.7344,184,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Nt Pro Brain Natriuretic Peptide,,83880,CPT,Facility,Both,,,,184,156.4,52.7344,184,Medica,Individual & Family,182.344,99.1,,percent of total billed charges,,
Nt Pro Brain Natriuretic Peptide,,83880,CPT,Facility,Outpatient,,,,184,156.4,52.7344,184,Medica,Medica Advantage Solution,91.632,49.8,,percent of total billed charges,,
Nt Pro Brain Natriuretic Peptide,,83880,CPT,Facility,Inpatient,,,,184,156.4,52.7344,184,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Nt Pro Brain Natriuretic Peptide,,83880,CPT,Facility,Outpatient,,,,184,156.4,52.7344,184,Medica,Medical Assistance,82.064,44.6,,percent of total billed charges,,
Nt Pro Brain Natriuretic Peptide,,83880,CPT,Facility,Inpatient,,,,184,156.4,52.7344,184,Medica,Medical Assistance,,,,,Included in per diem rate,
Nt Pro Brain Natriuretic Peptide,,83880,CPT,Facility,Outpatient,,,,184,156.4,52.7344,184,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,91.632,49.8,,percent of total billed charges,,
Nt Pro Brain Natriuretic Peptide,,83880,CPT,Facility,Inpatient,,,,184,156.4,52.7344,184,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Nt Pro Brain Natriuretic Peptide,,83880,CPT,Facility,Both,,,,184,156.4,52.7344,184,"Multiplan, Inc.","Multiplan, Inc.",172.96,94,,percent of total billed charges,,
Nt Pro Brain Natriuretic Peptide,,83880,CPT,Facility,Outpatient,,,,184,156.4,52.7344,184,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,158.976,86.4,,percent of total billed charges,,
Nt Pro Brain Natriuretic Peptide,,83880,CPT,Facility,Inpatient,,,,184,156.4,52.7344,184,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Nt Pro Brain Natriuretic Peptide,,83880,CPT,Facility,Both,,,,184,156.4,52.7344,184,"Preferred One Administrative Services, INC.",PPO,181.424,98.6,,percent of total billed charges,,
Nt Pro Brain Natriuretic Peptide,,83880,CPT,Facility,Outpatient,,,,184,156.4,52.7344,184,PrimeWest Health,Minnesota Senior Health Options (MSHO),94.668,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Nt Pro Brain Natriuretic Peptide,,83880,CPT,Facility,Inpatient,,,,184,156.4,52.7344,184,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Nt Pro Brain Natriuretic Peptide,,83880,CPT,Facility,Outpatient,,,,184,156.4,52.7344,184,PrimeWest Health,MinnesotaCare,94.5024,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Nt Pro Brain Natriuretic Peptide,,83880,CPT,Facility,Inpatient,,,,184,156.4,52.7344,184,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Nt Pro Brain Natriuretic Peptide,,83880,CPT,Facility,Both,,,,184,156.4,52.7344,184,Sanford Health Plan,Sanford Health Plan,169.28,92,,percent of total billed charges,,
Nt Pro Brain Natriuretic Peptide,,83880,CPT,Facility,Outpatient,,,,184,156.4,52.7344,184,"UCare Health, Inc.",Individual & Family Plan,103.684,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Nt Pro Brain Natriuretic Peptide,,83880,CPT,Facility,Inpatient,,,,184,156.4,52.7344,184,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Nt Pro Brain Natriuretic Peptide,,83880,CPT,Facility,Outpatient,,,,184,156.4,52.7344,184,"UCare Health, Inc.",Medical Assistance,92.8648,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Nt Pro Brain Natriuretic Peptide,,83880,CPT,Facility,Inpatient,,,,184,156.4,52.7344,184,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Nt Pro Brain Natriuretic Peptide,,83880,CPT,Facility,Outpatient,,,,184,156.4,52.7344,184,"UCare Health, Inc.",Medicare Advantage,92.8648,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Nt Pro Brain Natriuretic Peptide,,83880,CPT,Facility,Inpatient,,,,184,156.4,52.7344,184,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Nt Pro Brain Natriuretic Peptide,,83880,CPT,Facility,Outpatient,,,,184,156.4,52.7344,184,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),92.8648,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Nt Pro Brain Natriuretic Peptide,,83880,CPT,Facility,Inpatient,,,,184,156.4,52.7344,184,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Nt Pro Brain Natriuretic Peptide,,83880,CPT,Facility,Both,,,,184,156.4,52.7344,184,UnitedHealthcare,Individual & Family,172.96,94,,percent of total billed charges,,
Nt Pro Brain Natriuretic Peptide,,83880,CPT,Facility,Outpatient,,,,184,156.4,52.7344,184,UnitedHealthcare,Medicare Advantage,90.16,49,,percent of total billed charges,,
Nt Pro Brain Natriuretic Peptide,,83880,CPT,Facility,Inpatient,,,,184,156.4,52.7344,184,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Nt Pro Brain Natriuretic Peptide,,83880,CPT,Facility,Outpatient,,,,184,156.4,52.7344,184,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,88.32,48,,percent of total billed charges,,100% of DHS outpatient percentage
Nt Pro Brain Natriuretic Peptide,,83880,CPT,Facility,Inpatient,,,,184,156.4,52.7344,184,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
ATROPINE 0.1 MG/ML INJ SYRG,,J0461,HCPCS,Facility,Both,10,mL,,88,74.8,25.2208,88,Aetna,Commercial,80.96,92,,percent of total billed charges,,
ATROPINE 0.1 MG/ML INJ SYRG,,J0461,HCPCS,Facility,Both,10,mL,,88,74.8,25.2208,88,Aetna,Commercial,80.96,92,,percent of total billed charges,,
ATROPINE 0.1 MG/ML INJ SYRG,,J0461,HCPCS,Facility,Outpatient,10,mL,,88,74.8,25.2208,88,Aetna,Medicare Advantage,43.12,49,,percent of total billed charges,,
ATROPINE 0.1 MG/ML INJ SYRG,,J0461,HCPCS,Facility,Outpatient,10,mL,,88,74.8,25.2208,88,Aetna,Medicare Advantage,43.12,49,,percent of total billed charges,,
ATROPINE 0.1 MG/ML INJ SYRG,,J0461,HCPCS,Facility,Inpatient,10,mL,,88,74.8,25.2208,88,Aetna,Medicare Advantage,,,,,Included in per diem rate,
ATROPINE 0.1 MG/ML INJ SYRG,,J0461,HCPCS,Facility,Inpatient,10,mL,,88,74.8,25.2208,88,Aetna,Medicare Advantage,,,,,Included in per diem rate,
ATROPINE 0.1 MG/ML INJ SYRG,,J0461,HCPCS,Facility,Both,10,mL,,88,74.8,25.2208,88,Aetna,PPO,81.84,93,,percent of total billed charges,,
ATROPINE 0.1 MG/ML INJ SYRG,,J0461,HCPCS,Facility,Both,10,mL,,88,74.8,25.2208,88,Aetna,PPO,81.84,93,,percent of total billed charges,,
ATROPINE 0.1 MG/ML INJ SYRG,,J0461,HCPCS,Facility,Both,10,mL,,88,74.8,25.2208,88,America's PPO,America's PPO,84.5064,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
ATROPINE 0.1 MG/ML INJ SYRG,,J0461,HCPCS,Facility,Both,10,mL,,88,74.8,25.2208,88,America's PPO,America's PPO,84.5064,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
ATROPINE 0.1 MG/ML INJ SYRG,,J0461,HCPCS,Facility,Both,10,mL,,88,74.8,25.2208,88,BlueCross BlueShield Minnesota, Federal Employee Program,86.592,98.4,,percent of total billed charges,,
ATROPINE 0.1 MG/ML INJ SYRG,,J0461,HCPCS,Facility,Both,10,mL,,88,74.8,25.2208,88,BlueCross BlueShield Minnesota, Federal Employee Program,86.592,98.4,,percent of total billed charges,,
ATROPINE 0.1 MG/ML INJ SYRG,,J0461,HCPCS,Facility,Both,10,mL,,88,74.8,25.2208,88,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,88,100,,percent of total billed charges,,
ATROPINE 0.1 MG/ML INJ SYRG,,J0461,HCPCS,Facility,Both,10,mL,,88,74.8,25.2208,88,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,88,100,,percent of total billed charges,,
ATROPINE 0.1 MG/ML INJ SYRG,,J0461,HCPCS,Facility,Both,10,mL,,88,74.8,25.2208,88,BlueCross BlueShield Minnesota,High Value Network Plan,79.2,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
ATROPINE 0.1 MG/ML INJ SYRG,,J0461,HCPCS,Facility,Both,10,mL,,88,74.8,25.2208,88,BlueCross BlueShield Minnesota,High Value Network Plan,79.2,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
ATROPINE 0.1 MG/ML INJ SYRG,,J0461,HCPCS,Facility,Outpatient,10,mL,,88,74.8,25.2208,88,BlueCross BlueShield Minnesota,Medicare Advantage,43.12,49,,percent of total billed charges,,
ATROPINE 0.1 MG/ML INJ SYRG,,J0461,HCPCS,Facility,Outpatient,10,mL,,88,74.8,25.2208,88,BlueCross BlueShield Minnesota,Medicare Advantage,43.12,49,,percent of total billed charges,,
ATROPINE 0.1 MG/ML INJ SYRG,,J0461,HCPCS,Facility,Inpatient,10,mL,,88,74.8,25.2208,88,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
ATROPINE 0.1 MG/ML INJ SYRG,,J0461,HCPCS,Facility,Inpatient,10,mL,,88,74.8,25.2208,88,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
ATROPINE 0.1 MG/ML INJ SYRG,,J0461,HCPCS,Facility,Both,10,mL,,88,74.8,25.2208,88,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,77.9416,88.57,,percent of total billed charges,,
ATROPINE 0.1 MG/ML INJ SYRG,,J0461,HCPCS,Facility,Both,10,mL,,88,74.8,25.2208,88,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,77.9416,88.57,,percent of total billed charges,,
ATROPINE 0.1 MG/ML INJ SYRG,,J0461,HCPCS,Facility,Both,10,mL,,88,74.8,25.2208,88,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,25.2208,28.66,,percent of total billed charges,,
ATROPINE 0.1 MG/ML INJ SYRG,,J0461,HCPCS,Facility,Both,10,mL,,88,74.8,25.2208,88,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,25.2208,28.66,,percent of total billed charges,,
ATROPINE 0.1 MG/ML INJ SYRG,,J0461,HCPCS,Facility,Outpatient,10,mL,,88,74.8,25.2208,88,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),43.12,49,,percent of total billed charges,,
ATROPINE 0.1 MG/ML INJ SYRG,,J0461,HCPCS,Facility,Outpatient,10,mL,,88,74.8,25.2208,88,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),43.12,49,,percent of total billed charges,,
ATROPINE 0.1 MG/ML INJ SYRG,,J0461,HCPCS,Facility,Inpatient,10,mL,,88,74.8,25.2208,88,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
ATROPINE 0.1 MG/ML INJ SYRG,,J0461,HCPCS,Facility,Inpatient,10,mL,,88,74.8,25.2208,88,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
ATROPINE 0.1 MG/ML INJ SYRG,,J0461,HCPCS,Facility,Both,10,mL,,88,74.8,25.2208,88,CorVel,Worker's Compensation,88,100,,percent of total billed charges,,
ATROPINE 0.1 MG/ML INJ SYRG,,J0461,HCPCS,Facility,Both,10,mL,,88,74.8,25.2208,88,CorVel,Worker's Compensation,88,100,,percent of total billed charges,,
ATROPINE 0.1 MG/ML INJ SYRG,,J0461,HCPCS,Facility,Both,10,mL,,88,74.8,25.2208,88,First Health Group Corporation,First Health Network,85.36,97,,percent of total billed charges,,
ATROPINE 0.1 MG/ML INJ SYRG,,J0461,HCPCS,Facility,Both,10,mL,,88,74.8,25.2208,88,First Health Group Corporation,First Health Network,85.36,97,,percent of total billed charges,,
ATROPINE 0.1 MG/ML INJ SYRG,,J0461,HCPCS,Facility,Both,10,mL,,88,74.8,25.2208,88,"Health Partners, Inc.",Commercial,83.248,94.6,,percent of total billed charges,,
ATROPINE 0.1 MG/ML INJ SYRG,,J0461,HCPCS,Facility,Both,10,mL,,88,74.8,25.2208,88,"Health Partners, Inc.",Commercial,83.248,94.6,,percent of total billed charges,,
ATROPINE 0.1 MG/ML INJ SYRG,,J0461,HCPCS,Facility,Outpatient,10,mL,,88,74.8,25.2208,88,"Health Partners, Inc.",Medicare Advantage,43.12,49,,percent of total billed charges,,
ATROPINE 0.1 MG/ML INJ SYRG,,J0461,HCPCS,Facility,Outpatient,10,mL,,88,74.8,25.2208,88,"Health Partners, Inc.",Medicare Advantage,43.12,49,,percent of total billed charges,,
ATROPINE 0.1 MG/ML INJ SYRG,,J0461,HCPCS,Facility,Inpatient,10,mL,,88,74.8,25.2208,88,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ATROPINE 0.1 MG/ML INJ SYRG,,J0461,HCPCS,Facility,Inpatient,10,mL,,88,74.8,25.2208,88,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ATROPINE 0.1 MG/ML INJ SYRG,,J0461,HCPCS,Facility,Both,10,mL,,88,74.8,25.2208,88,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),52.8,60,,percent of total billed charges,,
ATROPINE 0.1 MG/ML INJ SYRG,,J0461,HCPCS,Facility,Both,10,mL,,88,74.8,25.2208,88,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),52.8,60,,percent of total billed charges,,
ATROPINE 0.1 MG/ML INJ SYRG,,J0461,HCPCS,Facility,Both,10,mL,,88,74.8,25.2208,88,"Health Partners, Inc.",State of Minnesota Advantage Program,71.72,81.5,,percent of total billed charges,,
ATROPINE 0.1 MG/ML INJ SYRG,,J0461,HCPCS,Facility,Both,10,mL,,88,74.8,25.2208,88,"Health Partners, Inc.",State of Minnesota Advantage Program,71.72,81.5,,percent of total billed charges,,
ATROPINE 0.1 MG/ML INJ SYRG,,J0461,HCPCS,Facility,Both,10,mL,,88,74.8,25.2208,88,"Health Partners, Inc.",State Public Programs,44,50,,percent of total billed charges,,
ATROPINE 0.1 MG/ML INJ SYRG,,J0461,HCPCS,Facility,Both,10,mL,,88,74.8,25.2208,88,"Health Partners, Inc.",State Public Programs,44,50,,percent of total billed charges,,
ATROPINE 0.1 MG/ML INJ SYRG,,J0461,HCPCS,Facility,Both,10,mL,,88,74.8,25.2208,88,Humana Insurance Company,Commercial PPO,83.6,95,,percent of total billed charges,,
ATROPINE 0.1 MG/ML INJ SYRG,,J0461,HCPCS,Facility,Both,10,mL,,88,74.8,25.2208,88,Humana Insurance Company,Commercial PPO,83.6,95,,percent of total billed charges,,
ATROPINE 0.1 MG/ML INJ SYRG,,J0461,HCPCS,Facility,Outpatient,10,mL,,88,74.8,25.2208,88,Humana Insurance Company,Medicare PPO,43.12,49,,percent of total billed charges,,
ATROPINE 0.1 MG/ML INJ SYRG,,J0461,HCPCS,Facility,Outpatient,10,mL,,88,74.8,25.2208,88,Humana Insurance Company,Medicare PPO,43.12,49,,percent of total billed charges,,
ATROPINE 0.1 MG/ML INJ SYRG,,J0461,HCPCS,Facility,Inpatient,10,mL,,88,74.8,25.2208,88,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
ATROPINE 0.1 MG/ML INJ SYRG,,J0461,HCPCS,Facility,Inpatient,10,mL,,88,74.8,25.2208,88,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
ATROPINE 0.1 MG/ML INJ SYRG,,J0461,HCPCS,Facility,Both,10,mL,,88,74.8,25.2208,88,Medica,Individual & Family,87.208,99.1,,percent of total billed charges,,
ATROPINE 0.1 MG/ML INJ SYRG,,J0461,HCPCS,Facility,Both,10,mL,,88,74.8,25.2208,88,Medica,Individual & Family,87.208,99.1,,percent of total billed charges,,
ATROPINE 0.1 MG/ML INJ SYRG,,J0461,HCPCS,Facility,Outpatient,10,mL,,88,74.8,25.2208,88,Medica,Medica Advantage Solution,43.824,49.8,,percent of total billed charges,,
ATROPINE 0.1 MG/ML INJ SYRG,,J0461,HCPCS,Facility,Outpatient,10,mL,,88,74.8,25.2208,88,Medica,Medica Advantage Solution,43.824,49.8,,percent of total billed charges,,
Osmolality,,83930,CPT,Facility,Both,,,,90,76.5,25.794,90,Aetna,Commercial,82.8,92,,percent of total billed charges,,
Osmolality,,83930,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,Aetna,Medicare Advantage,44.1,49,,percent of total billed charges,,
Osmolality,,83930,CPT,Facility,Inpatient,,,,90,76.5,25.794,90,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Osmolality,,83930,CPT,Facility,Both,,,,90,76.5,25.794,90,Aetna,PPO,83.7,93,,percent of total billed charges,,
Osmolality,,83930,CPT,Facility,Both,,,,90,76.5,25.794,90,America's PPO,America's PPO,86.427,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Osmolality,,83930,CPT,Facility,Both,,,,90,76.5,25.794,90,BlueCross BlueShield Minnesota, Federal Employee Program,88.56,98.4,,percent of total billed charges,,
Osmolality,,83930,CPT,Facility,Both,,,,90,76.5,25.794,90,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,90,100,,percent of total billed charges,,
Osmolality,,83930,CPT,Facility,Both,,,,90,76.5,25.794,90,BlueCross BlueShield Minnesota,High Value Network Plan,81,90,,percent of total billed charges,,
Osmolality,,83930,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,BlueCross BlueShield Minnesota,Medicare Advantage,44.1,49,,percent of total billed charges,,
Osmolality,,83930,CPT,Facility,Inpatient,,,,90,76.5,25.794,90,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Osmolality,,83930,CPT,Facility,Both,,,,90,76.5,25.794,90,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,79.713,88.57,,percent of total billed charges,,
Osmolality,,83930,CPT,Facility,Both,,,,90,76.5,25.794,90,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,25.794,28.66,,percent of total billed charges,,
Osmolality,,83930,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),44.1,49,,percent of total billed charges,,
Osmolality,,83930,CPT,Facility,Inpatient,,,,90,76.5,25.794,90,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Osmolality,,83930,CPT,Facility,Both,,,,90,76.5,25.794,90,CorVel,Worker's Compensation,90,100,,percent of total billed charges,,
Osmolality,,83930,CPT,Facility,Both,,,,90,76.5,25.794,90,First Health Group Corporation,First Health Network,87.3,97,,percent of total billed charges,,
Osmolality,,83930,CPT,Facility,Both,,,,90,76.5,25.794,90,"Health Partners, Inc.",Commercial,85.14,94.6,,percent of total billed charges,,
Osmolality,,83930,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,"Health Partners, Inc.",Medicare Advantage,44.1,49,,percent of total billed charges,,
Osmolality,,83930,CPT,Facility,Inpatient,,,,90,76.5,25.794,90,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Osmolality,,83930,CPT,Facility,Both,,,,90,76.5,25.794,90,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),54,60,,percent of total billed charges,,
Osmolality,,83930,CPT,Facility,Both,,,,90,76.5,25.794,90,"Health Partners, Inc.",State of Minnesota Advantage Program,73.35,81.5,,percent of total billed charges,,
Osmolality,,83930,CPT,Facility,Both,,,,90,76.5,25.794,90,"Health Partners, Inc.",State Public Programs,45,50,,percent of total billed charges,,
Osmolality,,83930,CPT,Facility,Both,,,,90,76.5,25.794,90,Humana Insurance Company,Commercial PPO,85.5,95,,percent of total billed charges,,
Osmolality,,83930,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,Humana Insurance Company,Medicare PPO,44.1,49,,percent of total billed charges,,
Osmolality,,83930,CPT,Facility,Inpatient,,,,90,76.5,25.794,90,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Osmolality,,83930,CPT,Facility,Both,,,,90,76.5,25.794,90,Medica,Individual & Family,89.19,99.1,,percent of total billed charges,,
Osmolality,,83930,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,Medica,Medica Advantage Solution,44.82,49.8,,percent of total billed charges,,
Osmolality,,83930,CPT,Facility,Inpatient,,,,90,76.5,25.794,90,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Osmolality,,83930,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,Medica,Medical Assistance,40.14,44.6,,percent of total billed charges,,
Osmolality,,83930,CPT,Facility,Inpatient,,,,90,76.5,25.794,90,Medica,Medical Assistance,,,,,Included in per diem rate,
Osmolality,,83930,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,44.82,49.8,,percent of total billed charges,,
Osmolality,,83930,CPT,Facility,Inpatient,,,,90,76.5,25.794,90,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Osmolality,,83930,CPT,Facility,Both,,,,90,76.5,25.794,90,"Multiplan, Inc.","Multiplan, Inc.",84.6,94,,percent of total billed charges,,
Osmolality,,83930,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,77.76,86.4,,percent of total billed charges,,
Osmolality,,83930,CPT,Facility,Inpatient,,,,90,76.5,25.794,90,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Osmolality,,83930,CPT,Facility,Both,,,,90,76.5,25.794,90,"Preferred One Administrative Services, INC.",PPO,88.74,98.6,,percent of total billed charges,,
Osmolality,,83930,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,PrimeWest Health,Minnesota Senior Health Options (MSHO),46.305,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Osmolality,,83930,CPT,Facility,Inpatient,,,,90,76.5,25.794,90,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Osmolality,,83930,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,PrimeWest Health,MinnesotaCare,46.224,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Osmolality,,83930,CPT,Facility,Inpatient,,,,90,76.5,25.794,90,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Osmolality,,83930,CPT,Facility,Both,,,,90,76.5,25.794,90,Sanford Health Plan,Sanford Health Plan,82.8,92,,percent of total billed charges,,
Osmolality,,83930,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,"UCare Health, Inc.",Individual & Family Plan,50.715,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Osmolality,,83930,CPT,Facility,Inpatient,,,,90,76.5,25.794,90,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Osmolality,,83930,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,"UCare Health, Inc.",Medical Assistance,45.423,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Osmolality,,83930,CPT,Facility,Inpatient,,,,90,76.5,25.794,90,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Osmolality,,83930,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,"UCare Health, Inc.",Medicare Advantage,45.423,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Osmolality,,83930,CPT,Facility,Inpatient,,,,90,76.5,25.794,90,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Osmolality,,83930,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),45.423,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Osmolality,,83930,CPT,Facility,Inpatient,,,,90,76.5,25.794,90,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Osmolality,,83930,CPT,Facility,Both,,,,90,76.5,25.794,90,UnitedHealthcare,Individual & Family,84.6,94,,percent of total billed charges,,
Osmolality,,83930,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,UnitedHealthcare,Medicare Advantage,44.1,49,,percent of total billed charges,,
Osmolality,,83930,CPT,Facility,Inpatient,,,,90,76.5,25.794,90,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Osmolality,,83930,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,43.2,48,,percent of total billed charges,,100% of DHS outpatient percentage
Osmolality,,83930,CPT,Facility,Inpatient,,,,90,76.5,25.794,90,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Osmololity, Urine, Random",,83935,CPT,Facility,Both,,,,90,76.5,25.794,90,Aetna,Commercial,82.8,92,,percent of total billed charges,,
"Osmololity, Urine, Random",,83935,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,Aetna,Medicare Advantage,44.1,49,,percent of total billed charges,,
"Osmololity, Urine, Random",,83935,CPT,Facility,Inpatient,,,,90,76.5,25.794,90,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Osmololity, Urine, Random",,83935,CPT,Facility,Both,,,,90,76.5,25.794,90,Aetna,PPO,83.7,93,,percent of total billed charges,,
"Osmololity, Urine, Random",,83935,CPT,Facility,Both,,,,90,76.5,25.794,90,America's PPO,America's PPO,86.427,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Osmololity, Urine, Random",,83935,CPT,Facility,Both,,,,90,76.5,25.794,90,BlueCross BlueShield Minnesota, Federal Employee Program,88.56,98.4,,percent of total billed charges,,
"Osmololity, Urine, Random",,83935,CPT,Facility,Both,,,,90,76.5,25.794,90,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,90,100,,percent of total billed charges,,
"Osmololity, Urine, Random",,83935,CPT,Facility,Both,,,,90,76.5,25.794,90,BlueCross BlueShield Minnesota,High Value Network Plan,81,90,,percent of total billed charges,,
"Osmololity, Urine, Random",,83935,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,BlueCross BlueShield Minnesota,Medicare Advantage,44.1,49,,percent of total billed charges,,
"Osmololity, Urine, Random",,83935,CPT,Facility,Inpatient,,,,90,76.5,25.794,90,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Osmololity, Urine, Random",,83935,CPT,Facility,Both,,,,90,76.5,25.794,90,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,79.713,88.57,,percent of total billed charges,,
"Osmololity, Urine, Random",,83935,CPT,Facility,Both,,,,90,76.5,25.794,90,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,25.794,28.66,,percent of total billed charges,,
"Osmololity, Urine, Random",,83935,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),44.1,49,,percent of total billed charges,,
"Osmololity, Urine, Random",,83935,CPT,Facility,Inpatient,,,,90,76.5,25.794,90,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Osmololity, Urine, Random",,83935,CPT,Facility,Both,,,,90,76.5,25.794,90,CorVel,Worker's Compensation,90,100,,percent of total billed charges,,
"Osmololity, Urine, Random",,83935,CPT,Facility,Both,,,,90,76.5,25.794,90,First Health Group Corporation,First Health Network,87.3,97,,percent of total billed charges,,
"Osmololity, Urine, Random",,83935,CPT,Facility,Both,,,,90,76.5,25.794,90,"Health Partners, Inc.",Commercial,85.14,94.6,,percent of total billed charges,,
"Osmololity, Urine, Random",,83935,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,"Health Partners, Inc.",Medicare Advantage,44.1,49,,percent of total billed charges,,
"Osmololity, Urine, Random",,83935,CPT,Facility,Inpatient,,,,90,76.5,25.794,90,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Osmololity, Urine, Random",,83935,CPT,Facility,Both,,,,90,76.5,25.794,90,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),54,60,,percent of total billed charges,,
"Osmololity, Urine, Random",,83935,CPT,Facility,Both,,,,90,76.5,25.794,90,"Health Partners, Inc.",State of Minnesota Advantage Program,73.35,81.5,,percent of total billed charges,,
"Osmololity, Urine, Random",,83935,CPT,Facility,Both,,,,90,76.5,25.794,90,"Health Partners, Inc.",State Public Programs,45,50,,percent of total billed charges,,
"Osmololity, Urine, Random",,83935,CPT,Facility,Both,,,,90,76.5,25.794,90,Humana Insurance Company,Commercial PPO,85.5,95,,percent of total billed charges,,
"Osmololity, Urine, Random",,83935,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,Humana Insurance Company,Medicare PPO,44.1,49,,percent of total billed charges,,
"Osmololity, Urine, Random",,83935,CPT,Facility,Inpatient,,,,90,76.5,25.794,90,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Osmololity, Urine, Random",,83935,CPT,Facility,Both,,,,90,76.5,25.794,90,Medica,Individual & Family,89.19,99.1,,percent of total billed charges,,
"Osmololity, Urine, Random",,83935,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,Medica,Medica Advantage Solution,44.82,49.8,,percent of total billed charges,,
"Osmololity, Urine, Random",,83935,CPT,Facility,Inpatient,,,,90,76.5,25.794,90,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Osmololity, Urine, Random",,83935,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,Medica,Medical Assistance,40.14,44.6,,percent of total billed charges,,
"Osmololity, Urine, Random",,83935,CPT,Facility,Inpatient,,,,90,76.5,25.794,90,Medica,Medical Assistance,,,,,Included in per diem rate,
"Osmololity, Urine, Random",,83935,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,44.82,49.8,,percent of total billed charges,,
"Osmololity, Urine, Random",,83935,CPT,Facility,Inpatient,,,,90,76.5,25.794,90,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Osmololity, Urine, Random",,83935,CPT,Facility,Both,,,,90,76.5,25.794,90,"Multiplan, Inc.","Multiplan, Inc.",84.6,94,,percent of total billed charges,,
"Osmololity, Urine, Random",,83935,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,77.76,86.4,,percent of total billed charges,,
"Osmololity, Urine, Random",,83935,CPT,Facility,Inpatient,,,,90,76.5,25.794,90,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Osmololity, Urine, Random",,83935,CPT,Facility,Both,,,,90,76.5,25.794,90,"Preferred One Administrative Services, INC.",PPO,88.74,98.6,,percent of total billed charges,,
"Osmololity, Urine, Random",,83935,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,PrimeWest Health,Minnesota Senior Health Options (MSHO),46.305,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Osmololity, Urine, Random",,83935,CPT,Facility,Inpatient,,,,90,76.5,25.794,90,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Osmololity, Urine, Random",,83935,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,PrimeWest Health,MinnesotaCare,46.224,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Osmololity, Urine, Random",,83935,CPT,Facility,Inpatient,,,,90,76.5,25.794,90,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Osmololity, Urine, Random",,83935,CPT,Facility,Both,,,,90,76.5,25.794,90,Sanford Health Plan,Sanford Health Plan,82.8,92,,percent of total billed charges,,
"Osmololity, Urine, Random",,83935,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,"UCare Health, Inc.",Individual & Family Plan,50.715,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Osmololity, Urine, Random",,83935,CPT,Facility,Inpatient,,,,90,76.5,25.794,90,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Osmololity, Urine, Random",,83935,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,"UCare Health, Inc.",Medical Assistance,45.423,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Osmololity, Urine, Random",,83935,CPT,Facility,Inpatient,,,,90,76.5,25.794,90,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Osmololity, Urine, Random",,83935,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,"UCare Health, Inc.",Medicare Advantage,45.423,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Osmololity, Urine, Random",,83935,CPT,Facility,Inpatient,,,,90,76.5,25.794,90,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Osmololity, Urine, Random",,83935,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),45.423,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Osmololity, Urine, Random",,83935,CPT,Facility,Inpatient,,,,90,76.5,25.794,90,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Osmololity, Urine, Random",,83935,CPT,Facility,Both,,,,90,76.5,25.794,90,UnitedHealthcare,Individual & Family,84.6,94,,percent of total billed charges,,
"Osmololity, Urine, Random",,83935,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,UnitedHealthcare,Medicare Advantage,44.1,49,,percent of total billed charges,,
"Osmololity, Urine, Random",,83935,CPT,Facility,Inpatient,,,,90,76.5,25.794,90,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Osmololity, Urine, Random",,83935,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,43.2,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Osmololity, Urine, Random",,83935,CPT,Facility,Inpatient,,,,90,76.5,25.794,90,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Parathyrin Intact,,83970,CPT,Facility,Both,,,,106,90.1,30.3796,106,Aetna,Commercial,97.52,92,,percent of total billed charges,,
Parathyrin Intact,,83970,CPT,Facility,Outpatient,,,,106,90.1,30.3796,106,Aetna,Medicare Advantage,51.94,49,,percent of total billed charges,,
Parathyrin Intact,,83970,CPT,Facility,Inpatient,,,,106,90.1,30.3796,106,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Parathyrin Intact,,83970,CPT,Facility,Both,,,,106,90.1,30.3796,106,Aetna,PPO,98.58,93,,percent of total billed charges,,
Parathyrin Intact,,83970,CPT,Facility,Both,,,,106,90.1,30.3796,106,America's PPO,America's PPO,101.7918,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Parathyrin Intact,,83970,CPT,Facility,Both,,,,106,90.1,30.3796,106,BlueCross BlueShield Minnesota, Federal Employee Program,104.304,98.4,,percent of total billed charges,,
Parathyrin Intact,,83970,CPT,Facility,Both,,,,106,90.1,30.3796,106,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,106,100,,percent of total billed charges,,
Parathyrin Intact,,83970,CPT,Facility,Both,,,,106,90.1,30.3796,106,BlueCross BlueShield Minnesota,High Value Network Plan,95.4,90,,percent of total billed charges,,
Parathyrin Intact,,83970,CPT,Facility,Outpatient,,,,106,90.1,30.3796,106,BlueCross BlueShield Minnesota,Medicare Advantage,51.94,49,,percent of total billed charges,,
Parathyrin Intact,,83970,CPT,Facility,Inpatient,,,,106,90.1,30.3796,106,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Parathyrin Intact,,83970,CPT,Facility,Both,,,,106,90.1,30.3796,106,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,93.8842,88.57,,percent of total billed charges,,
Parathyrin Intact,,83970,CPT,Facility,Both,,,,106,90.1,30.3796,106,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,30.3796,28.66,,percent of total billed charges,,
Parathyrin Intact,,83970,CPT,Facility,Outpatient,,,,106,90.1,30.3796,106,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),51.94,49,,percent of total billed charges,,
Parathyrin Intact,,83970,CPT,Facility,Inpatient,,,,106,90.1,30.3796,106,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Parathyrin Intact,,83970,CPT,Facility,Both,,,,106,90.1,30.3796,106,CorVel,Worker's Compensation,106,100,,percent of total billed charges,,
Parathyrin Intact,,83970,CPT,Facility,Both,,,,106,90.1,30.3796,106,First Health Group Corporation,First Health Network,102.82,97,,percent of total billed charges,,
Parathyrin Intact,,83970,CPT,Facility,Both,,,,106,90.1,30.3796,106,"Health Partners, Inc.",Commercial,100.276,94.6,,percent of total billed charges,,
Parathyrin Intact,,83970,CPT,Facility,Outpatient,,,,106,90.1,30.3796,106,"Health Partners, Inc.",Medicare Advantage,51.94,49,,percent of total billed charges,,
Parathyrin Intact,,83970,CPT,Facility,Inpatient,,,,106,90.1,30.3796,106,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Parathyrin Intact,,83970,CPT,Facility,Both,,,,106,90.1,30.3796,106,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),63.6,60,,percent of total billed charges,,
Parathyrin Intact,,83970,CPT,Facility,Both,,,,106,90.1,30.3796,106,"Health Partners, Inc.",State of Minnesota Advantage Program,86.39,81.5,,percent of total billed charges,,
Parathyrin Intact,,83970,CPT,Facility,Both,,,,106,90.1,30.3796,106,"Health Partners, Inc.",State Public Programs,53,50,,percent of total billed charges,,
Parathyrin Intact,,83970,CPT,Facility,Both,,,,106,90.1,30.3796,106,Humana Insurance Company,Commercial PPO,100.7,95,,percent of total billed charges,,
Parathyrin Intact,,83970,CPT,Facility,Outpatient,,,,106,90.1,30.3796,106,Humana Insurance Company,Medicare PPO,51.94,49,,percent of total billed charges,,
Parathyrin Intact,,83970,CPT,Facility,Inpatient,,,,106,90.1,30.3796,106,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Parathyrin Intact,,83970,CPT,Facility,Both,,,,106,90.1,30.3796,106,Medica,Individual & Family,105.046,99.1,,percent of total billed charges,,
Parathyrin Intact,,83970,CPT,Facility,Outpatient,,,,106,90.1,30.3796,106,Medica,Medica Advantage Solution,52.788,49.8,,percent of total billed charges,,
Parathyrin Intact,,83970,CPT,Facility,Inpatient,,,,106,90.1,30.3796,106,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Parathyrin Intact,,83970,CPT,Facility,Outpatient,,,,106,90.1,30.3796,106,Medica,Medical Assistance,47.276,44.6,,percent of total billed charges,,
Parathyrin Intact,,83970,CPT,Facility,Inpatient,,,,106,90.1,30.3796,106,Medica,Medical Assistance,,,,,Included in per diem rate,
Parathyrin Intact,,83970,CPT,Facility,Outpatient,,,,106,90.1,30.3796,106,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,52.788,49.8,,percent of total billed charges,,
Parathyrin Intact,,83970,CPT,Facility,Inpatient,,,,106,90.1,30.3796,106,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Parathyrin Intact,,83970,CPT,Facility,Both,,,,106,90.1,30.3796,106,"Multiplan, Inc.","Multiplan, Inc.",99.64,94,,percent of total billed charges,,
Parathyrin Intact,,83970,CPT,Facility,Outpatient,,,,106,90.1,30.3796,106,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,91.584,86.4,,percent of total billed charges,,
Parathyrin Intact,,83970,CPT,Facility,Inpatient,,,,106,90.1,30.3796,106,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Parathyrin Intact,,83970,CPT,Facility,Both,,,,106,90.1,30.3796,106,"Preferred One Administrative Services, INC.",PPO,104.516,98.6,,percent of total billed charges,,
Parathyrin Intact,,83970,CPT,Facility,Outpatient,,,,106,90.1,30.3796,106,PrimeWest Health,Minnesota Senior Health Options (MSHO),54.537,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Parathyrin Intact,,83970,CPT,Facility,Inpatient,,,,106,90.1,30.3796,106,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Parathyrin Intact,,83970,CPT,Facility,Outpatient,,,,106,90.1,30.3796,106,PrimeWest Health,MinnesotaCare,54.4416,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Parathyrin Intact,,83970,CPT,Facility,Inpatient,,,,106,90.1,30.3796,106,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Parathyrin Intact,,83970,CPT,Facility,Both,,,,106,90.1,30.3796,106,Sanford Health Plan,Sanford Health Plan,97.52,92,,percent of total billed charges,,
Parathyrin Intact,,83970,CPT,Facility,Outpatient,,,,106,90.1,30.3796,106,"UCare Health, Inc.",Individual & Family Plan,59.731,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Parathyrin Intact,,83970,CPT,Facility,Inpatient,,,,106,90.1,30.3796,106,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Parathyrin Intact,,83970,CPT,Facility,Outpatient,,,,106,90.1,30.3796,106,"UCare Health, Inc.",Medical Assistance,53.4982,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Parathyrin Intact,,83970,CPT,Facility,Inpatient,,,,106,90.1,30.3796,106,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Parathyrin Intact,,83970,CPT,Facility,Outpatient,,,,106,90.1,30.3796,106,"UCare Health, Inc.",Medicare Advantage,53.4982,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Parathyrin Intact,,83970,CPT,Facility,Inpatient,,,,106,90.1,30.3796,106,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Parathyrin Intact,,83970,CPT,Facility,Outpatient,,,,106,90.1,30.3796,106,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),53.4982,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Parathyrin Intact,,83970,CPT,Facility,Inpatient,,,,106,90.1,30.3796,106,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Parathyrin Intact,,83970,CPT,Facility,Both,,,,106,90.1,30.3796,106,UnitedHealthcare,Individual & Family,99.64,94,,percent of total billed charges,,
Parathyrin Intact,,83970,CPT,Facility,Outpatient,,,,106,90.1,30.3796,106,UnitedHealthcare,Medicare Advantage,51.94,49,,percent of total billed charges,,
Parathyrin Intact,,83970,CPT,Facility,Inpatient,,,,106,90.1,30.3796,106,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Parathyrin Intact,,83970,CPT,Facility,Outpatient,,,,106,90.1,30.3796,106,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,50.88,48,,percent of total billed charges,,100% of DHS outpatient percentage
Parathyrin Intact,,83970,CPT,Facility,Inpatient,,,,106,90.1,30.3796,106,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Ph, Body Fluid",,83986,CPT,Facility,Both,,,,47,39.95,13.4702,47,Aetna,Commercial,43.24,92,,percent of total billed charges,,
"Ph, Body Fluid",,83986,CPT,Facility,Outpatient,,,,47,39.95,13.4702,47,Aetna,Medicare Advantage,23.03,49,,percent of total billed charges,,
"Ph, Body Fluid",,83986,CPT,Facility,Inpatient,,,,47,39.95,13.4702,47,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Ph, Body Fluid",,83986,CPT,Facility,Both,,,,47,39.95,13.4702,47,Aetna,PPO,43.71,93,,percent of total billed charges,,
"Ph, Body Fluid",,83986,CPT,Facility,Both,,,,47,39.95,13.4702,47,America's PPO,America's PPO,45.1341,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Ph, Body Fluid",,83986,CPT,Facility,Both,,,,47,39.95,13.4702,47,BlueCross BlueShield Minnesota, Federal Employee Program,46.248,98.4,,percent of total billed charges,,
"Ph, Body Fluid",,83986,CPT,Facility,Both,,,,47,39.95,13.4702,47,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,47,100,,percent of total billed charges,,
"Ph, Body Fluid",,83986,CPT,Facility,Both,,,,47,39.95,13.4702,47,BlueCross BlueShield Minnesota,High Value Network Plan,42.3,90,,percent of total billed charges,,
"Ph, Body Fluid",,83986,CPT,Facility,Outpatient,,,,47,39.95,13.4702,47,BlueCross BlueShield Minnesota,Medicare Advantage,23.03,49,,percent of total billed charges,,
"Ph, Body Fluid",,83986,CPT,Facility,Inpatient,,,,47,39.95,13.4702,47,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Ph, Body Fluid",,83986,CPT,Facility,Both,,,,47,39.95,13.4702,47,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,41.6279,88.57,,percent of total billed charges,,
"Ph, Body Fluid",,83986,CPT,Facility,Both,,,,47,39.95,13.4702,47,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,13.4702,28.66,,percent of total billed charges,,
"Ph, Body Fluid",,83986,CPT,Facility,Outpatient,,,,47,39.95,13.4702,47,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),23.03,49,,percent of total billed charges,,
"Ph, Body Fluid",,83986,CPT,Facility,Inpatient,,,,47,39.95,13.4702,47,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Ph, Body Fluid",,83986,CPT,Facility,Both,,,,47,39.95,13.4702,47,CorVel,Worker's Compensation,47,100,,percent of total billed charges,,
"Ph, Body Fluid",,83986,CPT,Facility,Both,,,,47,39.95,13.4702,47,First Health Group Corporation,First Health Network,45.59,97,,percent of total billed charges,,
"Ph, Body Fluid",,83986,CPT,Facility,Both,,,,47,39.95,13.4702,47,"Health Partners, Inc.",Commercial,44.462,94.6,,percent of total billed charges,,
"Ph, Body Fluid",,83986,CPT,Facility,Outpatient,,,,47,39.95,13.4702,47,"Health Partners, Inc.",Medicare Advantage,23.03,49,,percent of total billed charges,,
"Ph, Body Fluid",,83986,CPT,Facility,Inpatient,,,,47,39.95,13.4702,47,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Ph, Body Fluid",,83986,CPT,Facility,Both,,,,47,39.95,13.4702,47,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),28.2,60,,percent of total billed charges,,
"Ph, Body Fluid",,83986,CPT,Facility,Both,,,,47,39.95,13.4702,47,"Health Partners, Inc.",State of Minnesota Advantage Program,38.305,81.5,,percent of total billed charges,,
"Ph, Body Fluid",,83986,CPT,Facility,Both,,,,47,39.95,13.4702,47,"Health Partners, Inc.",State Public Programs,23.5,50,,percent of total billed charges,,
"Ph, Body Fluid",,83986,CPT,Facility,Both,,,,47,39.95,13.4702,47,Humana Insurance Company,Commercial PPO,44.65,95,,percent of total billed charges,,
"Ph, Body Fluid",,83986,CPT,Facility,Outpatient,,,,47,39.95,13.4702,47,Humana Insurance Company,Medicare PPO,23.03,49,,percent of total billed charges,,
"Ph, Body Fluid",,83986,CPT,Facility,Inpatient,,,,47,39.95,13.4702,47,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Ph, Body Fluid",,83986,CPT,Facility,Both,,,,47,39.95,13.4702,47,Medica,Individual & Family,46.577,99.1,,percent of total billed charges,,
"Ph, Body Fluid",,83986,CPT,Facility,Outpatient,,,,47,39.95,13.4702,47,Medica,Medica Advantage Solution,23.406,49.8,,percent of total billed charges,,
"Ph, Body Fluid",,83986,CPT,Facility,Inpatient,,,,47,39.95,13.4702,47,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Ph, Body Fluid",,83986,CPT,Facility,Outpatient,,,,47,39.95,13.4702,47,Medica,Medical Assistance,20.962,44.6,,percent of total billed charges,,
"Ph, Body Fluid",,83986,CPT,Facility,Inpatient,,,,47,39.95,13.4702,47,Medica,Medical Assistance,,,,,Included in per diem rate,
"Ph, Body Fluid",,83986,CPT,Facility,Outpatient,,,,47,39.95,13.4702,47,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,23.406,49.8,,percent of total billed charges,,
"Ph, Body Fluid",,83986,CPT,Facility,Inpatient,,,,47,39.95,13.4702,47,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Ph, Body Fluid",,83986,CPT,Facility,Both,,,,47,39.95,13.4702,47,"Multiplan, Inc.","Multiplan, Inc.",44.18,94,,percent of total billed charges,,
"Ph, Body Fluid",,83986,CPT,Facility,Outpatient,,,,47,39.95,13.4702,47,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,40.608,86.4,,percent of total billed charges,,
"Ph, Body Fluid",,83986,CPT,Facility,Inpatient,,,,47,39.95,13.4702,47,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Ph, Body Fluid",,83986,CPT,Facility,Both,,,,47,39.95,13.4702,47,"Preferred One Administrative Services, INC.",PPO,46.342,98.6,,percent of total billed charges,,
"Ph, Body Fluid",,83986,CPT,Facility,Outpatient,,,,47,39.95,13.4702,47,PrimeWest Health,Minnesota Senior Health Options (MSHO),24.1815,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Ph, Body Fluid",,83986,CPT,Facility,Inpatient,,,,47,39.95,13.4702,47,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Ph, Body Fluid",,83986,CPT,Facility,Outpatient,,,,47,39.95,13.4702,47,PrimeWest Health,MinnesotaCare,24.1392,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Ph, Body Fluid",,83986,CPT,Facility,Inpatient,,,,47,39.95,13.4702,47,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Ph, Body Fluid",,83986,CPT,Facility,Both,,,,47,39.95,13.4702,47,Sanford Health Plan,Sanford Health Plan,43.24,92,,percent of total billed charges,,
"Ph, Body Fluid",,83986,CPT,Facility,Outpatient,,,,47,39.95,13.4702,47,"UCare Health, Inc.",Individual & Family Plan,26.4845,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Ph, Body Fluid",,83986,CPT,Facility,Inpatient,,,,47,39.95,13.4702,47,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Ph, Body Fluid",,83986,CPT,Facility,Outpatient,,,,47,39.95,13.4702,47,"UCare Health, Inc.",Medical Assistance,23.7209,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Ph, Body Fluid",,83986,CPT,Facility,Inpatient,,,,47,39.95,13.4702,47,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Ph, Body Fluid",,83986,CPT,Facility,Outpatient,,,,47,39.95,13.4702,47,"UCare Health, Inc.",Medicare Advantage,23.7209,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Ph, Body Fluid",,83986,CPT,Facility,Inpatient,,,,47,39.95,13.4702,47,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Ph, Body Fluid",,83986,CPT,Facility,Outpatient,,,,47,39.95,13.4702,47,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),23.7209,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Ph, Body Fluid",,83986,CPT,Facility,Inpatient,,,,47,39.95,13.4702,47,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Ph, Body Fluid",,83986,CPT,Facility,Both,,,,47,39.95,13.4702,47,UnitedHealthcare,Individual & Family,44.18,94,,percent of total billed charges,,
"Ph, Body Fluid",,83986,CPT,Facility,Outpatient,,,,47,39.95,13.4702,47,UnitedHealthcare,Medicare Advantage,23.03,49,,percent of total billed charges,,
"Ph, Body Fluid",,83986,CPT,Facility,Inpatient,,,,47,39.95,13.4702,47,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Ph, Body Fluid",,83986,CPT,Facility,Outpatient,,,,47,39.95,13.4702,47,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,22.56,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Ph, Body Fluid",,83986,CPT,Facility,Inpatient,,,,47,39.95,13.4702,47,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Alkaline Phosphatase,,84075,CPT,Facility,Both,,,,71,60.35,20.3486,71,Aetna,Commercial,65.32,92,,percent of total billed charges,,
Alkaline Phosphatase,,84075,CPT,Facility,Outpatient,,,,71,60.35,20.3486,71,Aetna,Medicare Advantage,34.79,49,,percent of total billed charges,,
Alkaline Phosphatase,,84075,CPT,Facility,Inpatient,,,,71,60.35,20.3486,71,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Alkaline Phosphatase,,84075,CPT,Facility,Both,,,,71,60.35,20.3486,71,Aetna,PPO,66.03,93,,percent of total billed charges,,
Alkaline Phosphatase,,84075,CPT,Facility,Both,,,,71,60.35,20.3486,71,America's PPO,America's PPO,68.1813,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Alkaline Phosphatase,,84075,CPT,Facility,Both,,,,71,60.35,20.3486,71,BlueCross BlueShield Minnesota, Federal Employee Program,69.864,98.4,,percent of total billed charges,,
Alkaline Phosphatase,,84075,CPT,Facility,Both,,,,71,60.35,20.3486,71,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,71,100,,percent of total billed charges,,
Alkaline Phosphatase,,84075,CPT,Facility,Both,,,,71,60.35,20.3486,71,BlueCross BlueShield Minnesota,High Value Network Plan,63.9,90,,percent of total billed charges,,
Alkaline Phosphatase,,84075,CPT,Facility,Outpatient,,,,71,60.35,20.3486,71,BlueCross BlueShield Minnesota,Medicare Advantage,34.79,49,,percent of total billed charges,,
Alkaline Phosphatase,,84075,CPT,Facility,Inpatient,,,,71,60.35,20.3486,71,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Alkaline Phosphatase,,84075,CPT,Facility,Both,,,,71,60.35,20.3486,71,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,62.8847,88.57,,percent of total billed charges,,
Alkaline Phosphatase,,84075,CPT,Facility,Both,,,,71,60.35,20.3486,71,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,20.3486,28.66,,percent of total billed charges,,
Alkaline Phosphatase,,84075,CPT,Facility,Outpatient,,,,71,60.35,20.3486,71,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),34.79,49,,percent of total billed charges,,
Alkaline Phosphatase,,84075,CPT,Facility,Inpatient,,,,71,60.35,20.3486,71,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Alkaline Phosphatase,,84075,CPT,Facility,Both,,,,71,60.35,20.3486,71,CorVel,Worker's Compensation,71,100,,percent of total billed charges,,
Alkaline Phosphatase,,84075,CPT,Facility,Both,,,,71,60.35,20.3486,71,First Health Group Corporation,First Health Network,68.87,97,,percent of total billed charges,,
Alkaline Phosphatase,,84075,CPT,Facility,Both,,,,71,60.35,20.3486,71,"Health Partners, Inc.",Commercial,67.166,94.6,,percent of total billed charges,,
Alkaline Phosphatase,,84075,CPT,Facility,Outpatient,,,,71,60.35,20.3486,71,"Health Partners, Inc.",Medicare Advantage,34.79,49,,percent of total billed charges,,
Alkaline Phosphatase,,84075,CPT,Facility,Inpatient,,,,71,60.35,20.3486,71,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Alkaline Phosphatase,,84075,CPT,Facility,Both,,,,71,60.35,20.3486,71,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),42.6,60,,percent of total billed charges,,
Alkaline Phosphatase,,84075,CPT,Facility,Both,,,,71,60.35,20.3486,71,"Health Partners, Inc.",State of Minnesota Advantage Program,57.865,81.5,,percent of total billed charges,,
Alkaline Phosphatase,,84075,CPT,Facility,Both,,,,71,60.35,20.3486,71,"Health Partners, Inc.",State Public Programs,35.5,50,,percent of total billed charges,,
Alkaline Phosphatase,,84075,CPT,Facility,Both,,,,71,60.35,20.3486,71,Humana Insurance Company,Commercial PPO,67.45,95,,percent of total billed charges,,
Alkaline Phosphatase,,84075,CPT,Facility,Outpatient,,,,71,60.35,20.3486,71,Humana Insurance Company,Medicare PPO,34.79,49,,percent of total billed charges,,
Alkaline Phosphatase,,84075,CPT,Facility,Inpatient,,,,71,60.35,20.3486,71,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Alkaline Phosphatase,,84075,CPT,Facility,Both,,,,71,60.35,20.3486,71,Medica,Individual & Family,70.361,99.1,,percent of total billed charges,,
Alkaline Phosphatase,,84075,CPT,Facility,Outpatient,,,,71,60.35,20.3486,71,Medica,Medica Advantage Solution,35.358,49.8,,percent of total billed charges,,
Alkaline Phosphatase,,84075,CPT,Facility,Inpatient,,,,71,60.35,20.3486,71,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Alkaline Phosphatase,,84075,CPT,Facility,Outpatient,,,,71,60.35,20.3486,71,Medica,Medical Assistance,31.666,44.6,,percent of total billed charges,,
Alkaline Phosphatase,,84075,CPT,Facility,Inpatient,,,,71,60.35,20.3486,71,Medica,Medical Assistance,,,,,Included in per diem rate,
Alkaline Phosphatase,,84075,CPT,Facility,Outpatient,,,,71,60.35,20.3486,71,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,35.358,49.8,,percent of total billed charges,,
Alkaline Phosphatase,,84075,CPT,Facility,Inpatient,,,,71,60.35,20.3486,71,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Alkaline Phosphatase,,84075,CPT,Facility,Both,,,,71,60.35,20.3486,71,"Multiplan, Inc.","Multiplan, Inc.",66.74,94,,percent of total billed charges,,
Alkaline Phosphatase,,84075,CPT,Facility,Outpatient,,,,71,60.35,20.3486,71,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,61.344,86.4,,percent of total billed charges,,
Alkaline Phosphatase,,84075,CPT,Facility,Inpatient,,,,71,60.35,20.3486,71,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Alkaline Phosphatase,,84075,CPT,Facility,Both,,,,71,60.35,20.3486,71,"Preferred One Administrative Services, INC.",PPO,70.006,98.6,,percent of total billed charges,,
Alkaline Phosphatase,,84075,CPT,Facility,Outpatient,,,,71,60.35,20.3486,71,PrimeWest Health,Minnesota Senior Health Options (MSHO),36.5295,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Alkaline Phosphatase,,84075,CPT,Facility,Inpatient,,,,71,60.35,20.3486,71,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Alkaline Phosphatase,,84075,CPT,Facility,Outpatient,,,,71,60.35,20.3486,71,PrimeWest Health,MinnesotaCare,36.4656,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Alkaline Phosphatase,,84075,CPT,Facility,Inpatient,,,,71,60.35,20.3486,71,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Alkaline Phosphatase,,84075,CPT,Facility,Both,,,,71,60.35,20.3486,71,Sanford Health Plan,Sanford Health Plan,65.32,92,,percent of total billed charges,,
Alkaline Phosphatase,,84075,CPT,Facility,Outpatient,,,,71,60.35,20.3486,71,"UCare Health, Inc.",Individual & Family Plan,40.0085,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Alkaline Phosphatase,,84075,CPT,Facility,Inpatient,,,,71,60.35,20.3486,71,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Alkaline Phosphatase,,84075,CPT,Facility,Outpatient,,,,71,60.35,20.3486,71,"UCare Health, Inc.",Medical Assistance,35.8337,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Alkaline Phosphatase,,84075,CPT,Facility,Inpatient,,,,71,60.35,20.3486,71,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Alkaline Phosphatase,,84075,CPT,Facility,Outpatient,,,,71,60.35,20.3486,71,"UCare Health, Inc.",Medicare Advantage,35.8337,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Alkaline Phosphatase,,84075,CPT,Facility,Inpatient,,,,71,60.35,20.3486,71,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Alkaline Phosphatase,,84075,CPT,Facility,Outpatient,,,,71,60.35,20.3486,71,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),35.8337,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Alkaline Phosphatase,,84075,CPT,Facility,Inpatient,,,,71,60.35,20.3486,71,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Alkaline Phosphatase,,84075,CPT,Facility,Both,,,,71,60.35,20.3486,71,UnitedHealthcare,Individual & Family,66.74,94,,percent of total billed charges,,
Alkaline Phosphatase,,84075,CPT,Facility,Outpatient,,,,71,60.35,20.3486,71,UnitedHealthcare,Medicare Advantage,34.79,49,,percent of total billed charges,,
Alkaline Phosphatase,,84075,CPT,Facility,Inpatient,,,,71,60.35,20.3486,71,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Alkaline Phosphatase,,84075,CPT,Facility,Outpatient,,,,71,60.35,20.3486,71,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,34.08,48,,percent of total billed charges,,100% of DHS outpatient percentage
Alkaline Phosphatase,,84075,CPT,Facility,Inpatient,,,,71,60.35,20.3486,71,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Phosphate,,84100,CPT,Facility,Both,,,,67,56.95,19.2022,67,Aetna,Commercial,61.64,92,,percent of total billed charges,,
Phosphate,,84100,CPT,Facility,Outpatient,,,,67,56.95,19.2022,67,Aetna,Medicare Advantage,32.83,49,,percent of total billed charges,,
Phosphate,,84100,CPT,Facility,Inpatient,,,,67,56.95,19.2022,67,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Phosphate,,84100,CPT,Facility,Both,,,,67,56.95,19.2022,67,Aetna,PPO,62.31,93,,percent of total billed charges,,
Phosphate,,84100,CPT,Facility,Both,,,,67,56.95,19.2022,67,America's PPO,America's PPO,64.3401,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Phosphate,,84100,CPT,Facility,Both,,,,67,56.95,19.2022,67,BlueCross BlueShield Minnesota, Federal Employee Program,65.928,98.4,,percent of total billed charges,,
Phosphate,,84100,CPT,Facility,Both,,,,67,56.95,19.2022,67,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,67,100,,percent of total billed charges,,
Phosphate,,84100,CPT,Facility,Both,,,,67,56.95,19.2022,67,BlueCross BlueShield Minnesota,High Value Network Plan,60.3,90,,percent of total billed charges,,
Phosphate,,84100,CPT,Facility,Outpatient,,,,67,56.95,19.2022,67,BlueCross BlueShield Minnesota,Medicare Advantage,32.83,49,,percent of total billed charges,,
Phosphate,,84100,CPT,Facility,Inpatient,,,,67,56.95,19.2022,67,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Phosphate,,84100,CPT,Facility,Both,,,,67,56.95,19.2022,67,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,59.3419,88.57,,percent of total billed charges,,
Phosphate,,84100,CPT,Facility,Both,,,,67,56.95,19.2022,67,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,19.2022,28.66,,percent of total billed charges,,
Phosphate,,84100,CPT,Facility,Outpatient,,,,67,56.95,19.2022,67,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),32.83,49,,percent of total billed charges,,
Phosphate,,84100,CPT,Facility,Inpatient,,,,67,56.95,19.2022,67,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Phosphate,,84100,CPT,Facility,Both,,,,67,56.95,19.2022,67,CorVel,Worker's Compensation,67,100,,percent of total billed charges,,
Phosphate,,84100,CPT,Facility,Both,,,,67,56.95,19.2022,67,First Health Group Corporation,First Health Network,64.99,97,,percent of total billed charges,,
Phosphate,,84100,CPT,Facility,Both,,,,67,56.95,19.2022,67,"Health Partners, Inc.",Commercial,63.382,94.6,,percent of total billed charges,,
Phosphate,,84100,CPT,Facility,Outpatient,,,,67,56.95,19.2022,67,"Health Partners, Inc.",Medicare Advantage,32.83,49,,percent of total billed charges,,
Phosphate,,84100,CPT,Facility,Inpatient,,,,67,56.95,19.2022,67,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Phosphate,,84100,CPT,Facility,Both,,,,67,56.95,19.2022,67,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),40.2,60,,percent of total billed charges,,
Phosphate,,84100,CPT,Facility,Both,,,,67,56.95,19.2022,67,"Health Partners, Inc.",State of Minnesota Advantage Program,54.605,81.5,,percent of total billed charges,,
Phosphate,,84100,CPT,Facility,Both,,,,67,56.95,19.2022,67,"Health Partners, Inc.",State Public Programs,33.5,50,,percent of total billed charges,,
Phosphate,,84100,CPT,Facility,Both,,,,67,56.95,19.2022,67,Humana Insurance Company,Commercial PPO,63.65,95,,percent of total billed charges,,
Phosphate,,84100,CPT,Facility,Outpatient,,,,67,56.95,19.2022,67,Humana Insurance Company,Medicare PPO,32.83,49,,percent of total billed charges,,
Phosphate,,84100,CPT,Facility,Inpatient,,,,67,56.95,19.2022,67,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Phosphate,,84100,CPT,Facility,Both,,,,67,56.95,19.2022,67,Medica,Individual & Family,66.397,99.1,,percent of total billed charges,,
Phosphate,,84100,CPT,Facility,Outpatient,,,,67,56.95,19.2022,67,Medica,Medica Advantage Solution,33.366,49.8,,percent of total billed charges,,
Phosphate,,84100,CPT,Facility,Inpatient,,,,67,56.95,19.2022,67,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Phosphate,,84100,CPT,Facility,Outpatient,,,,67,56.95,19.2022,67,Medica,Medical Assistance,29.882,44.6,,percent of total billed charges,,
Phosphate,,84100,CPT,Facility,Inpatient,,,,67,56.95,19.2022,67,Medica,Medical Assistance,,,,,Included in per diem rate,
Phosphate,,84100,CPT,Facility,Outpatient,,,,67,56.95,19.2022,67,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,33.366,49.8,,percent of total billed charges,,
Phosphate,,84100,CPT,Facility,Inpatient,,,,67,56.95,19.2022,67,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Phosphate,,84100,CPT,Facility,Both,,,,67,56.95,19.2022,67,"Multiplan, Inc.","Multiplan, Inc.",62.98,94,,percent of total billed charges,,
Phosphate,,84100,CPT,Facility,Outpatient,,,,67,56.95,19.2022,67,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,57.888,86.4,,percent of total billed charges,,
Phosphate,,84100,CPT,Facility,Inpatient,,,,67,56.95,19.2022,67,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Phosphate,,84100,CPT,Facility,Both,,,,67,56.95,19.2022,67,"Preferred One Administrative Services, INC.",PPO,66.062,98.6,,percent of total billed charges,,
Phosphate,,84100,CPT,Facility,Outpatient,,,,67,56.95,19.2022,67,PrimeWest Health,Minnesota Senior Health Options (MSHO),34.4715,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Phosphate,,84100,CPT,Facility,Inpatient,,,,67,56.95,19.2022,67,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Phosphate,,84100,CPT,Facility,Outpatient,,,,67,56.95,19.2022,67,PrimeWest Health,MinnesotaCare,34.4112,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Phosphate,,84100,CPT,Facility,Inpatient,,,,67,56.95,19.2022,67,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Phosphate,,84100,CPT,Facility,Both,,,,67,56.95,19.2022,67,Sanford Health Plan,Sanford Health Plan,61.64,92,,percent of total billed charges,,
Phosphate,,84100,CPT,Facility,Outpatient,,,,67,56.95,19.2022,67,"UCare Health, Inc.",Individual & Family Plan,37.7545,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Phosphate,,84100,CPT,Facility,Inpatient,,,,67,56.95,19.2022,67,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Phosphate,,84100,CPT,Facility,Outpatient,,,,67,56.95,19.2022,67,"UCare Health, Inc.",Medical Assistance,33.8149,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Phosphate,,84100,CPT,Facility,Inpatient,,,,67,56.95,19.2022,67,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Phosphate,,84100,CPT,Facility,Outpatient,,,,67,56.95,19.2022,67,"UCare Health, Inc.",Medicare Advantage,33.8149,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Phosphate,,84100,CPT,Facility,Inpatient,,,,67,56.95,19.2022,67,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Phosphate,,84100,CPT,Facility,Outpatient,,,,67,56.95,19.2022,67,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),33.8149,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Phosphate,,84100,CPT,Facility,Inpatient,,,,67,56.95,19.2022,67,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Phosphate,,84100,CPT,Facility,Both,,,,67,56.95,19.2022,67,UnitedHealthcare,Individual & Family,62.98,94,,percent of total billed charges,,
Phosphate,,84100,CPT,Facility,Outpatient,,,,67,56.95,19.2022,67,UnitedHealthcare,Medicare Advantage,32.83,49,,percent of total billed charges,,
Phosphate,,84100,CPT,Facility,Inpatient,,,,67,56.95,19.2022,67,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Phosphate,,84100,CPT,Facility,Outpatient,,,,67,56.95,19.2022,67,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,32.16,48,,percent of total billed charges,,100% of DHS outpatient percentage
Phosphate,,84100,CPT,Facility,Inpatient,,,,67,56.95,19.2022,67,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Potassium,,84132,CPT,Facility,Both,,,,55,46.75,15.763,55,Aetna,Commercial,50.6,92,,percent of total billed charges,,
Potassium,,84132,CPT,Facility,Outpatient,,,,55,46.75,15.763,55,Aetna,Medicare Advantage,26.95,49,,percent of total billed charges,,
Potassium,,84132,CPT,Facility,Inpatient,,,,55,46.75,15.763,55,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Potassium,,84132,CPT,Facility,Both,,,,55,46.75,15.763,55,Aetna,PPO,51.15,93,,percent of total billed charges,,
Potassium,,84132,CPT,Facility,Both,,,,55,46.75,15.763,55,America's PPO,America's PPO,52.8165,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Potassium,,84132,CPT,Facility,Both,,,,55,46.75,15.763,55,BlueCross BlueShield Minnesota, Federal Employee Program,54.12,98.4,,percent of total billed charges,,
Potassium,,84132,CPT,Facility,Both,,,,55,46.75,15.763,55,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,55,100,,percent of total billed charges,,
Potassium,,84132,CPT,Facility,Both,,,,55,46.75,15.763,55,BlueCross BlueShield Minnesota,High Value Network Plan,49.5,90,,percent of total billed charges,,
Potassium,,84132,CPT,Facility,Outpatient,,,,55,46.75,15.763,55,BlueCross BlueShield Minnesota,Medicare Advantage,26.95,49,,percent of total billed charges,,
Potassium,,84132,CPT,Facility,Inpatient,,,,55,46.75,15.763,55,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Potassium,,84132,CPT,Facility,Both,,,,55,46.75,15.763,55,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,48.7135,88.57,,percent of total billed charges,,
Potassium,,84132,CPT,Facility,Both,,,,55,46.75,15.763,55,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,15.763,28.66,,percent of total billed charges,,
Potassium,,84132,CPT,Facility,Outpatient,,,,55,46.75,15.763,55,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),26.95,49,,percent of total billed charges,,
Potassium,,84132,CPT,Facility,Inpatient,,,,55,46.75,15.763,55,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Potassium,,84132,CPT,Facility,Both,,,,55,46.75,15.763,55,CorVel,Worker's Compensation,55,100,,percent of total billed charges,,
Potassium,,84132,CPT,Facility,Both,,,,55,46.75,15.763,55,First Health Group Corporation,First Health Network,53.35,97,,percent of total billed charges,,
Potassium,,84132,CPT,Facility,Both,,,,55,46.75,15.763,55,"Health Partners, Inc.",Commercial,52.03,94.6,,percent of total billed charges,,
Potassium,,84132,CPT,Facility,Outpatient,,,,55,46.75,15.763,55,"Health Partners, Inc.",Medicare Advantage,26.95,49,,percent of total billed charges,,
Potassium,,84132,CPT,Facility,Inpatient,,,,55,46.75,15.763,55,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Potassium,,84132,CPT,Facility,Both,,,,55,46.75,15.763,55,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),33,60,,percent of total billed charges,,
Potassium,,84132,CPT,Facility,Both,,,,55,46.75,15.763,55,"Health Partners, Inc.",State of Minnesota Advantage Program,44.825,81.5,,percent of total billed charges,,
Potassium,,84132,CPT,Facility,Both,,,,55,46.75,15.763,55,"Health Partners, Inc.",State Public Programs,27.5,50,,percent of total billed charges,,
Potassium,,84132,CPT,Facility,Both,,,,55,46.75,15.763,55,Humana Insurance Company,Commercial PPO,52.25,95,,percent of total billed charges,,
Potassium,,84132,CPT,Facility,Outpatient,,,,55,46.75,15.763,55,Humana Insurance Company,Medicare PPO,26.95,49,,percent of total billed charges,,
Potassium,,84132,CPT,Facility,Inpatient,,,,55,46.75,15.763,55,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Potassium,,84132,CPT,Facility,Both,,,,55,46.75,15.763,55,Medica,Individual & Family,54.505,99.1,,percent of total billed charges,,
Potassium,,84132,CPT,Facility,Outpatient,,,,55,46.75,15.763,55,Medica,Medica Advantage Solution,27.39,49.8,,percent of total billed charges,,
Potassium,,84132,CPT,Facility,Inpatient,,,,55,46.75,15.763,55,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Potassium,,84132,CPT,Facility,Outpatient,,,,55,46.75,15.763,55,Medica,Medical Assistance,24.53,44.6,,percent of total billed charges,,
Potassium,,84132,CPT,Facility,Inpatient,,,,55,46.75,15.763,55,Medica,Medical Assistance,,,,,Included in per diem rate,
Potassium,,84132,CPT,Facility,Outpatient,,,,55,46.75,15.763,55,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,27.39,49.8,,percent of total billed charges,,
Potassium,,84132,CPT,Facility,Inpatient,,,,55,46.75,15.763,55,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Potassium,,84132,CPT,Facility,Both,,,,55,46.75,15.763,55,"Multiplan, Inc.","Multiplan, Inc.",51.7,94,,percent of total billed charges,,
Potassium,,84132,CPT,Facility,Outpatient,,,,55,46.75,15.763,55,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,47.52,86.4,,percent of total billed charges,,
Potassium,,84132,CPT,Facility,Inpatient,,,,55,46.75,15.763,55,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Potassium,,84132,CPT,Facility,Both,,,,55,46.75,15.763,55,"Preferred One Administrative Services, INC.",PPO,54.23,98.6,,percent of total billed charges,,
Potassium,,84132,CPT,Facility,Outpatient,,,,55,46.75,15.763,55,PrimeWest Health,Minnesota Senior Health Options (MSHO),28.2975,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Potassium,,84132,CPT,Facility,Inpatient,,,,55,46.75,15.763,55,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Potassium,,84132,CPT,Facility,Outpatient,,,,55,46.75,15.763,55,PrimeWest Health,MinnesotaCare,28.248,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Potassium,,84132,CPT,Facility,Inpatient,,,,55,46.75,15.763,55,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Potassium,,84132,CPT,Facility,Both,,,,55,46.75,15.763,55,Sanford Health Plan,Sanford Health Plan,50.6,92,,percent of total billed charges,,
Potassium,,84132,CPT,Facility,Outpatient,,,,55,46.75,15.763,55,"UCare Health, Inc.",Individual & Family Plan,30.9925,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Potassium,,84132,CPT,Facility,Inpatient,,,,55,46.75,15.763,55,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Potassium,,84132,CPT,Facility,Outpatient,,,,55,46.75,15.763,55,"UCare Health, Inc.",Medical Assistance,27.7585,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Potassium,,84132,CPT,Facility,Inpatient,,,,55,46.75,15.763,55,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Potassium,,84132,CPT,Facility,Outpatient,,,,55,46.75,15.763,55,"UCare Health, Inc.",Medicare Advantage,27.7585,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Potassium,,84132,CPT,Facility,Inpatient,,,,55,46.75,15.763,55,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Potassium,,84132,CPT,Facility,Outpatient,,,,55,46.75,15.763,55,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),27.7585,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Potassium,,84132,CPT,Facility,Inpatient,,,,55,46.75,15.763,55,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Potassium,,84132,CPT,Facility,Both,,,,55,46.75,15.763,55,UnitedHealthcare,Individual & Family,51.7,94,,percent of total billed charges,,
Potassium,,84132,CPT,Facility,Outpatient,,,,55,46.75,15.763,55,UnitedHealthcare,Medicare Advantage,26.95,49,,percent of total billed charges,,
Potassium,,84132,CPT,Facility,Inpatient,,,,55,46.75,15.763,55,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Potassium,,84132,CPT,Facility,Outpatient,,,,55,46.75,15.763,55,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,26.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
Potassium,,84132,CPT,Facility,Inpatient,,,,55,46.75,15.763,55,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Potassium, Urine, Random",,84133,CPT,Facility,Both,,,,55,46.75,15.763,55,Aetna,Commercial,50.6,92,,percent of total billed charges,,
"Potassium, Urine, Random",,84133,CPT,Facility,Outpatient,,,,55,46.75,15.763,55,Aetna,Medicare Advantage,26.95,49,,percent of total billed charges,,
"Potassium, Urine, Random",,84133,CPT,Facility,Inpatient,,,,55,46.75,15.763,55,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Potassium, Urine, Random",,84133,CPT,Facility,Both,,,,55,46.75,15.763,55,Aetna,PPO,51.15,93,,percent of total billed charges,,
"Potassium, Urine, Random",,84133,CPT,Facility,Both,,,,55,46.75,15.763,55,America's PPO,America's PPO,52.8165,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Potassium, Urine, Random",,84133,CPT,Facility,Both,,,,55,46.75,15.763,55,BlueCross BlueShield Minnesota, Federal Employee Program,54.12,98.4,,percent of total billed charges,,
"Potassium, Urine, Random",,84133,CPT,Facility,Both,,,,55,46.75,15.763,55,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,55,100,,percent of total billed charges,,
"Potassium, Urine, Random",,84133,CPT,Facility,Both,,,,55,46.75,15.763,55,BlueCross BlueShield Minnesota,High Value Network Plan,49.5,90,,percent of total billed charges,,
"Potassium, Urine, Random",,84133,CPT,Facility,Outpatient,,,,55,46.75,15.763,55,BlueCross BlueShield Minnesota,Medicare Advantage,26.95,49,,percent of total billed charges,,
"Potassium, Urine, Random",,84133,CPT,Facility,Inpatient,,,,55,46.75,15.763,55,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Potassium, Urine, Random",,84133,CPT,Facility,Both,,,,55,46.75,15.763,55,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,48.7135,88.57,,percent of total billed charges,,
"Potassium, Urine, Random",,84133,CPT,Facility,Both,,,,55,46.75,15.763,55,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,15.763,28.66,,percent of total billed charges,,
"Potassium, Urine, Random",,84133,CPT,Facility,Outpatient,,,,55,46.75,15.763,55,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),26.95,49,,percent of total billed charges,,
"Potassium, Urine, Random",,84133,CPT,Facility,Inpatient,,,,55,46.75,15.763,55,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Potassium, Urine, Random",,84133,CPT,Facility,Both,,,,55,46.75,15.763,55,CorVel,Worker's Compensation,55,100,,percent of total billed charges,,
"Potassium, Urine, Random",,84133,CPT,Facility,Both,,,,55,46.75,15.763,55,First Health Group Corporation,First Health Network,53.35,97,,percent of total billed charges,,
"Potassium, Urine, Random",,84133,CPT,Facility,Both,,,,55,46.75,15.763,55,"Health Partners, Inc.",Commercial,52.03,94.6,,percent of total billed charges,,
"Potassium, Urine, Random",,84133,CPT,Facility,Outpatient,,,,55,46.75,15.763,55,"Health Partners, Inc.",Medicare Advantage,26.95,49,,percent of total billed charges,,
"Potassium, Urine, Random",,84133,CPT,Facility,Inpatient,,,,55,46.75,15.763,55,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Potassium, Urine, Random",,84133,CPT,Facility,Both,,,,55,46.75,15.763,55,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),33,60,,percent of total billed charges,,
"Potassium, Urine, Random",,84133,CPT,Facility,Both,,,,55,46.75,15.763,55,"Health Partners, Inc.",State of Minnesota Advantage Program,44.825,81.5,,percent of total billed charges,,
"Potassium, Urine, Random",,84133,CPT,Facility,Both,,,,55,46.75,15.763,55,"Health Partners, Inc.",State Public Programs,27.5,50,,percent of total billed charges,,
"Potassium, Urine, Random",,84133,CPT,Facility,Both,,,,55,46.75,15.763,55,Humana Insurance Company,Commercial PPO,52.25,95,,percent of total billed charges,,
"Potassium, Urine, Random",,84133,CPT,Facility,Outpatient,,,,55,46.75,15.763,55,Humana Insurance Company,Medicare PPO,26.95,49,,percent of total billed charges,,
"Potassium, Urine, Random",,84133,CPT,Facility,Inpatient,,,,55,46.75,15.763,55,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Potassium, Urine, Random",,84133,CPT,Facility,Both,,,,55,46.75,15.763,55,Medica,Individual & Family,54.505,99.1,,percent of total billed charges,,
"Potassium, Urine, Random",,84133,CPT,Facility,Outpatient,,,,55,46.75,15.763,55,Medica,Medica Advantage Solution,27.39,49.8,,percent of total billed charges,,
"Potassium, Urine, Random",,84133,CPT,Facility,Inpatient,,,,55,46.75,15.763,55,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Potassium, Urine, Random",,84133,CPT,Facility,Outpatient,,,,55,46.75,15.763,55,Medica,Medical Assistance,24.53,44.6,,percent of total billed charges,,
"Potassium, Urine, Random",,84133,CPT,Facility,Inpatient,,,,55,46.75,15.763,55,Medica,Medical Assistance,,,,,Included in per diem rate,
"Potassium, Urine, Random",,84133,CPT,Facility,Outpatient,,,,55,46.75,15.763,55,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,27.39,49.8,,percent of total billed charges,,
"Potassium, Urine, Random",,84133,CPT,Facility,Inpatient,,,,55,46.75,15.763,55,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Potassium, Urine, Random",,84133,CPT,Facility,Both,,,,55,46.75,15.763,55,"Multiplan, Inc.","Multiplan, Inc.",51.7,94,,percent of total billed charges,,
"Potassium, Urine, Random",,84133,CPT,Facility,Outpatient,,,,55,46.75,15.763,55,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,47.52,86.4,,percent of total billed charges,,
"Potassium, Urine, Random",,84133,CPT,Facility,Inpatient,,,,55,46.75,15.763,55,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Potassium, Urine, Random",,84133,CPT,Facility,Both,,,,55,46.75,15.763,55,"Preferred One Administrative Services, INC.",PPO,54.23,98.6,,percent of total billed charges,,
"Potassium, Urine, Random",,84133,CPT,Facility,Outpatient,,,,55,46.75,15.763,55,PrimeWest Health,Minnesota Senior Health Options (MSHO),28.2975,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Potassium, Urine, Random",,84133,CPT,Facility,Inpatient,,,,55,46.75,15.763,55,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Potassium, Urine, Random",,84133,CPT,Facility,Outpatient,,,,55,46.75,15.763,55,PrimeWest Health,MinnesotaCare,28.248,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Potassium, Urine, Random",,84133,CPT,Facility,Inpatient,,,,55,46.75,15.763,55,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Potassium, Urine, Random",,84133,CPT,Facility,Both,,,,55,46.75,15.763,55,Sanford Health Plan,Sanford Health Plan,50.6,92,,percent of total billed charges,,
"Potassium, Urine, Random",,84133,CPT,Facility,Outpatient,,,,55,46.75,15.763,55,"UCare Health, Inc.",Individual & Family Plan,30.9925,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Potassium, Urine, Random",,84133,CPT,Facility,Inpatient,,,,55,46.75,15.763,55,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Potassium, Urine, Random",,84133,CPT,Facility,Outpatient,,,,55,46.75,15.763,55,"UCare Health, Inc.",Medical Assistance,27.7585,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Potassium, Urine, Random",,84133,CPT,Facility,Inpatient,,,,55,46.75,15.763,55,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Potassium, Urine, Random",,84133,CPT,Facility,Outpatient,,,,55,46.75,15.763,55,"UCare Health, Inc.",Medicare Advantage,27.7585,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Potassium, Urine, Random",,84133,CPT,Facility,Inpatient,,,,55,46.75,15.763,55,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Potassium, Urine, Random",,84133,CPT,Facility,Outpatient,,,,55,46.75,15.763,55,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),27.7585,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Potassium, Urine, Random",,84133,CPT,Facility,Inpatient,,,,55,46.75,15.763,55,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Potassium, Urine, Random",,84133,CPT,Facility,Both,,,,55,46.75,15.763,55,UnitedHealthcare,Individual & Family,51.7,94,,percent of total billed charges,,
"Potassium, Urine, Random",,84133,CPT,Facility,Outpatient,,,,55,46.75,15.763,55,UnitedHealthcare,Medicare Advantage,26.95,49,,percent of total billed charges,,
"Potassium, Urine, Random",,84133,CPT,Facility,Inpatient,,,,55,46.75,15.763,55,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Potassium, Urine, Random",,84133,CPT,Facility,Outpatient,,,,55,46.75,15.763,55,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,26.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Potassium, Urine, Random",,84133,CPT,Facility,Inpatient,,,,55,46.75,15.763,55,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Prealbumin,,84134,CPT,Facility,Both,,,,86,73.1,24.6476,86,Aetna,Commercial,79.12,92,,percent of total billed charges,,
Prealbumin,,84134,CPT,Facility,Outpatient,,,,86,73.1,24.6476,86,Aetna,Medicare Advantage,42.14,49,,percent of total billed charges,,
Prealbumin,,84134,CPT,Facility,Inpatient,,,,86,73.1,24.6476,86,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Prealbumin,,84134,CPT,Facility,Both,,,,86,73.1,24.6476,86,Aetna,PPO,79.98,93,,percent of total billed charges,,
Prealbumin,,84134,CPT,Facility,Both,,,,86,73.1,24.6476,86,America's PPO,America's PPO,82.5858,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Prealbumin,,84134,CPT,Facility,Both,,,,86,73.1,24.6476,86,BlueCross BlueShield Minnesota, Federal Employee Program,84.624,98.4,,percent of total billed charges,,
Prealbumin,,84134,CPT,Facility,Both,,,,86,73.1,24.6476,86,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,86,100,,percent of total billed charges,,
Prealbumin,,84134,CPT,Facility,Both,,,,86,73.1,24.6476,86,BlueCross BlueShield Minnesota,High Value Network Plan,77.4,90,,percent of total billed charges,,
Prealbumin,,84134,CPT,Facility,Outpatient,,,,86,73.1,24.6476,86,BlueCross BlueShield Minnesota,Medicare Advantage,42.14,49,,percent of total billed charges,,
Prealbumin,,84134,CPT,Facility,Inpatient,,,,86,73.1,24.6476,86,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Prealbumin,,84134,CPT,Facility,Both,,,,86,73.1,24.6476,86,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,76.1702,88.57,,percent of total billed charges,,
Prealbumin,,84134,CPT,Facility,Both,,,,86,73.1,24.6476,86,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,24.6476,28.66,,percent of total billed charges,,
Prealbumin,,84134,CPT,Facility,Outpatient,,,,86,73.1,24.6476,86,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),42.14,49,,percent of total billed charges,,
Prealbumin,,84134,CPT,Facility,Inpatient,,,,86,73.1,24.6476,86,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Prealbumin,,84134,CPT,Facility,Both,,,,86,73.1,24.6476,86,CorVel,Worker's Compensation,86,100,,percent of total billed charges,,
Prealbumin,,84134,CPT,Facility,Both,,,,86,73.1,24.6476,86,First Health Group Corporation,First Health Network,83.42,97,,percent of total billed charges,,
Prealbumin,,84134,CPT,Facility,Both,,,,86,73.1,24.6476,86,"Health Partners, Inc.",Commercial,81.356,94.6,,percent of total billed charges,,
Prealbumin,,84134,CPT,Facility,Outpatient,,,,86,73.1,24.6476,86,"Health Partners, Inc.",Medicare Advantage,42.14,49,,percent of total billed charges,,
Prealbumin,,84134,CPT,Facility,Inpatient,,,,86,73.1,24.6476,86,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Prealbumin,,84134,CPT,Facility,Both,,,,86,73.1,24.6476,86,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),51.6,60,,percent of total billed charges,,
Prealbumin,,84134,CPT,Facility,Both,,,,86,73.1,24.6476,86,"Health Partners, Inc.",State of Minnesota Advantage Program,70.09,81.5,,percent of total billed charges,,
Prealbumin,,84134,CPT,Facility,Both,,,,86,73.1,24.6476,86,"Health Partners, Inc.",State Public Programs,43,50,,percent of total billed charges,,
Prealbumin,,84134,CPT,Facility,Both,,,,86,73.1,24.6476,86,Humana Insurance Company,Commercial PPO,81.7,95,,percent of total billed charges,,
Prealbumin,,84134,CPT,Facility,Outpatient,,,,86,73.1,24.6476,86,Humana Insurance Company,Medicare PPO,42.14,49,,percent of total billed charges,,
Prealbumin,,84134,CPT,Facility,Inpatient,,,,86,73.1,24.6476,86,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Prealbumin,,84134,CPT,Facility,Both,,,,86,73.1,24.6476,86,Medica,Individual & Family,85.226,99.1,,percent of total billed charges,,
Prealbumin,,84134,CPT,Facility,Outpatient,,,,86,73.1,24.6476,86,Medica,Medica Advantage Solution,42.828,49.8,,percent of total billed charges,,
Prealbumin,,84134,CPT,Facility,Inpatient,,,,86,73.1,24.6476,86,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Prealbumin,,84134,CPT,Facility,Outpatient,,,,86,73.1,24.6476,86,Medica,Medical Assistance,38.356,44.6,,percent of total billed charges,,
Prealbumin,,84134,CPT,Facility,Inpatient,,,,86,73.1,24.6476,86,Medica,Medical Assistance,,,,,Included in per diem rate,
Prealbumin,,84134,CPT,Facility,Outpatient,,,,86,73.1,24.6476,86,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,42.828,49.8,,percent of total billed charges,,
Prealbumin,,84134,CPT,Facility,Inpatient,,,,86,73.1,24.6476,86,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Prealbumin,,84134,CPT,Facility,Both,,,,86,73.1,24.6476,86,"Multiplan, Inc.","Multiplan, Inc.",80.84,94,,percent of total billed charges,,
Prealbumin,,84134,CPT,Facility,Outpatient,,,,86,73.1,24.6476,86,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,74.304,86.4,,percent of total billed charges,,
Prealbumin,,84134,CPT,Facility,Inpatient,,,,86,73.1,24.6476,86,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Prealbumin,,84134,CPT,Facility,Both,,,,86,73.1,24.6476,86,"Preferred One Administrative Services, INC.",PPO,84.796,98.6,,percent of total billed charges,,
Prealbumin,,84134,CPT,Facility,Outpatient,,,,86,73.1,24.6476,86,PrimeWest Health,Minnesota Senior Health Options (MSHO),44.247,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Prealbumin,,84134,CPT,Facility,Inpatient,,,,86,73.1,24.6476,86,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Prealbumin,,84134,CPT,Facility,Outpatient,,,,86,73.1,24.6476,86,PrimeWest Health,MinnesotaCare,44.1696,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Prealbumin,,84134,CPT,Facility,Inpatient,,,,86,73.1,24.6476,86,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Prealbumin,,84134,CPT,Facility,Both,,,,86,73.1,24.6476,86,Sanford Health Plan,Sanford Health Plan,79.12,92,,percent of total billed charges,,
Prealbumin,,84134,CPT,Facility,Outpatient,,,,86,73.1,24.6476,86,"UCare Health, Inc.",Individual & Family Plan,48.461,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Prealbumin,,84134,CPT,Facility,Inpatient,,,,86,73.1,24.6476,86,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Prealbumin,,84134,CPT,Facility,Outpatient,,,,86,73.1,24.6476,86,"UCare Health, Inc.",Medical Assistance,43.4042,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Prealbumin,,84134,CPT,Facility,Inpatient,,,,86,73.1,24.6476,86,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Prealbumin,,84134,CPT,Facility,Outpatient,,,,86,73.1,24.6476,86,"UCare Health, Inc.",Medicare Advantage,43.4042,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Prealbumin,,84134,CPT,Facility,Inpatient,,,,86,73.1,24.6476,86,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Prealbumin,,84134,CPT,Facility,Outpatient,,,,86,73.1,24.6476,86,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),43.4042,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Prealbumin,,84134,CPT,Facility,Inpatient,,,,86,73.1,24.6476,86,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Prealbumin,,84134,CPT,Facility,Both,,,,86,73.1,24.6476,86,UnitedHealthcare,Individual & Family,80.84,94,,percent of total billed charges,,
Prealbumin,,84134,CPT,Facility,Outpatient,,,,86,73.1,24.6476,86,UnitedHealthcare,Medicare Advantage,42.14,49,,percent of total billed charges,,
Prealbumin,,84134,CPT,Facility,Inpatient,,,,86,73.1,24.6476,86,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Prealbumin,,84134,CPT,Facility,Outpatient,,,,86,73.1,24.6476,86,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,41.28,48,,percent of total billed charges,,100% of DHS outpatient percentage
Prealbumin,,84134,CPT,Facility,Inpatient,,,,86,73.1,24.6476,86,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Progesterone,,84144,CPT,Facility,Both,,,,107,90.95,30.6662,107,Aetna,Commercial,98.44,92,,percent of total billed charges,,
Progesterone,,84144,CPT,Facility,Outpatient,,,,107,90.95,30.6662,107,Aetna,Medicare Advantage,52.43,49,,percent of total billed charges,,
Progesterone,,84144,CPT,Facility,Inpatient,,,,107,90.95,30.6662,107,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Progesterone,,84144,CPT,Facility,Both,,,,107,90.95,30.6662,107,Aetna,PPO,99.51,93,,percent of total billed charges,,
Progesterone,,84144,CPT,Facility,Both,,,,107,90.95,30.6662,107,America's PPO,America's PPO,102.7521,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Progesterone,,84144,CPT,Facility,Both,,,,107,90.95,30.6662,107,BlueCross BlueShield Minnesota, Federal Employee Program,105.288,98.4,,percent of total billed charges,,
Progesterone,,84144,CPT,Facility,Both,,,,107,90.95,30.6662,107,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,107,100,,percent of total billed charges,,
Progesterone,,84144,CPT,Facility,Both,,,,107,90.95,30.6662,107,BlueCross BlueShield Minnesota,High Value Network Plan,96.3,90,,percent of total billed charges,,
Progesterone,,84144,CPT,Facility,Outpatient,,,,107,90.95,30.6662,107,BlueCross BlueShield Minnesota,Medicare Advantage,52.43,49,,percent of total billed charges,,
Progesterone,,84144,CPT,Facility,Inpatient,,,,107,90.95,30.6662,107,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Progesterone,,84144,CPT,Facility,Both,,,,107,90.95,30.6662,107,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,94.7699,88.57,,percent of total billed charges,,
Progesterone,,84144,CPT,Facility,Both,,,,107,90.95,30.6662,107,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,30.6662,28.66,,percent of total billed charges,,
Progesterone,,84144,CPT,Facility,Outpatient,,,,107,90.95,30.6662,107,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),52.43,49,,percent of total billed charges,,
Progesterone,,84144,CPT,Facility,Inpatient,,,,107,90.95,30.6662,107,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Progesterone,,84144,CPT,Facility,Both,,,,107,90.95,30.6662,107,CorVel,Worker's Compensation,107,100,,percent of total billed charges,,
Progesterone,,84144,CPT,Facility,Both,,,,107,90.95,30.6662,107,First Health Group Corporation,First Health Network,103.79,97,,percent of total billed charges,,
Progesterone,,84144,CPT,Facility,Both,,,,107,90.95,30.6662,107,"Health Partners, Inc.",Commercial,101.222,94.6,,percent of total billed charges,,
Progesterone,,84144,CPT,Facility,Outpatient,,,,107,90.95,30.6662,107,"Health Partners, Inc.",Medicare Advantage,52.43,49,,percent of total billed charges,,
Progesterone,,84144,CPT,Facility,Inpatient,,,,107,90.95,30.6662,107,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Progesterone,,84144,CPT,Facility,Both,,,,107,90.95,30.6662,107,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),64.2,60,,percent of total billed charges,,
Progesterone,,84144,CPT,Facility,Both,,,,107,90.95,30.6662,107,"Health Partners, Inc.",State of Minnesota Advantage Program,87.205,81.5,,percent of total billed charges,,
Progesterone,,84144,CPT,Facility,Both,,,,107,90.95,30.6662,107,"Health Partners, Inc.",State Public Programs,53.5,50,,percent of total billed charges,,
Progesterone,,84144,CPT,Facility,Both,,,,107,90.95,30.6662,107,Humana Insurance Company,Commercial PPO,101.65,95,,percent of total billed charges,,
Progesterone,,84144,CPT,Facility,Outpatient,,,,107,90.95,30.6662,107,Humana Insurance Company,Medicare PPO,52.43,49,,percent of total billed charges,,
Progesterone,,84144,CPT,Facility,Inpatient,,,,107,90.95,30.6662,107,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Progesterone,,84144,CPT,Facility,Both,,,,107,90.95,30.6662,107,Medica,Individual & Family,106.037,99.1,,percent of total billed charges,,
Progesterone,,84144,CPT,Facility,Outpatient,,,,107,90.95,30.6662,107,Medica,Medica Advantage Solution,53.286,49.8,,percent of total billed charges,,
Progesterone,,84144,CPT,Facility,Inpatient,,,,107,90.95,30.6662,107,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Progesterone,,84144,CPT,Facility,Outpatient,,,,107,90.95,30.6662,107,Medica,Medical Assistance,47.722,44.6,,percent of total billed charges,,
Progesterone,,84144,CPT,Facility,Inpatient,,,,107,90.95,30.6662,107,Medica,Medical Assistance,,,,,Included in per diem rate,
Progesterone,,84144,CPT,Facility,Outpatient,,,,107,90.95,30.6662,107,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,53.286,49.8,,percent of total billed charges,,
Progesterone,,84144,CPT,Facility,Inpatient,,,,107,90.95,30.6662,107,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Progesterone,,84144,CPT,Facility,Both,,,,107,90.95,30.6662,107,"Multiplan, Inc.","Multiplan, Inc.",100.58,94,,percent of total billed charges,,
Progesterone,,84144,CPT,Facility,Outpatient,,,,107,90.95,30.6662,107,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,92.448,86.4,,percent of total billed charges,,
Progesterone,,84144,CPT,Facility,Inpatient,,,,107,90.95,30.6662,107,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Progesterone,,84144,CPT,Facility,Both,,,,107,90.95,30.6662,107,"Preferred One Administrative Services, INC.",PPO,105.502,98.6,,percent of total billed charges,,
Progesterone,,84144,CPT,Facility,Outpatient,,,,107,90.95,30.6662,107,PrimeWest Health,Minnesota Senior Health Options (MSHO),55.0515,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Progesterone,,84144,CPT,Facility,Inpatient,,,,107,90.95,30.6662,107,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Progesterone,,84144,CPT,Facility,Outpatient,,,,107,90.95,30.6662,107,PrimeWest Health,MinnesotaCare,54.9552,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Progesterone,,84144,CPT,Facility,Inpatient,,,,107,90.95,30.6662,107,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Progesterone,,84144,CPT,Facility,Both,,,,107,90.95,30.6662,107,Sanford Health Plan,Sanford Health Plan,98.44,92,,percent of total billed charges,,
Progesterone,,84144,CPT,Facility,Outpatient,,,,107,90.95,30.6662,107,"UCare Health, Inc.",Individual & Family Plan,60.2945,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Progesterone,,84144,CPT,Facility,Inpatient,,,,107,90.95,30.6662,107,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Progesterone,,84144,CPT,Facility,Outpatient,,,,107,90.95,30.6662,107,"UCare Health, Inc.",Medical Assistance,54.0029,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Progesterone,,84144,CPT,Facility,Inpatient,,,,107,90.95,30.6662,107,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Progesterone,,84144,CPT,Facility,Outpatient,,,,107,90.95,30.6662,107,"UCare Health, Inc.",Medicare Advantage,54.0029,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Progesterone,,84144,CPT,Facility,Inpatient,,,,107,90.95,30.6662,107,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Progesterone,,84144,CPT,Facility,Outpatient,,,,107,90.95,30.6662,107,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),54.0029,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Progesterone,,84144,CPT,Facility,Inpatient,,,,107,90.95,30.6662,107,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Progesterone,,84144,CPT,Facility,Both,,,,107,90.95,30.6662,107,UnitedHealthcare,Individual & Family,100.58,94,,percent of total billed charges,,
Progesterone,,84144,CPT,Facility,Outpatient,,,,107,90.95,30.6662,107,UnitedHealthcare,Medicare Advantage,52.43,49,,percent of total billed charges,,
Progesterone,,84144,CPT,Facility,Inpatient,,,,107,90.95,30.6662,107,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Progesterone,,84144,CPT,Facility,Outpatient,,,,107,90.95,30.6662,107,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,51.36,48,,percent of total billed charges,,100% of DHS outpatient percentage
Progesterone,,84144,CPT,Facility,Inpatient,,,,107,90.95,30.6662,107,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Procalcitonin,,84145,CPT,Facility,Both,,,,94,79.9,26.9404,94,Aetna,Commercial,86.48,92,,percent of total billed charges,,
Procalcitonin,,84145,CPT,Facility,Outpatient,,,,94,79.9,26.9404,94,Aetna,Medicare Advantage,46.06,49,,percent of total billed charges,,
Procalcitonin,,84145,CPT,Facility,Inpatient,,,,94,79.9,26.9404,94,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Procalcitonin,,84145,CPT,Facility,Both,,,,94,79.9,26.9404,94,Aetna,PPO,87.42,93,,percent of total billed charges,,
Procalcitonin,,84145,CPT,Facility,Both,,,,94,79.9,26.9404,94,America's PPO,America's PPO,90.2682,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Procalcitonin,,84145,CPT,Facility,Both,,,,94,79.9,26.9404,94,BlueCross BlueShield Minnesota, Federal Employee Program,92.496,98.4,,percent of total billed charges,,
Procalcitonin,,84145,CPT,Facility,Both,,,,94,79.9,26.9404,94,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,94,100,,percent of total billed charges,,
Procalcitonin,,84145,CPT,Facility,Both,,,,94,79.9,26.9404,94,BlueCross BlueShield Minnesota,High Value Network Plan,84.6,90,,percent of total billed charges,,
Procalcitonin,,84145,CPT,Facility,Outpatient,,,,94,79.9,26.9404,94,BlueCross BlueShield Minnesota,Medicare Advantage,46.06,49,,percent of total billed charges,,
Procalcitonin,,84145,CPT,Facility,Inpatient,,,,94,79.9,26.9404,94,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Procalcitonin,,84145,CPT,Facility,Both,,,,94,79.9,26.9404,94,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,83.2558,88.57,,percent of total billed charges,,
Procalcitonin,,84145,CPT,Facility,Both,,,,94,79.9,26.9404,94,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,26.9404,28.66,,percent of total billed charges,,
Procalcitonin,,84145,CPT,Facility,Outpatient,,,,94,79.9,26.9404,94,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),46.06,49,,percent of total billed charges,,
Procalcitonin,,84145,CPT,Facility,Inpatient,,,,94,79.9,26.9404,94,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Procalcitonin,,84145,CPT,Facility,Both,,,,94,79.9,26.9404,94,CorVel,Worker's Compensation,94,100,,percent of total billed charges,,
Procalcitonin,,84145,CPT,Facility,Both,,,,94,79.9,26.9404,94,First Health Group Corporation,First Health Network,91.18,97,,percent of total billed charges,,
Procalcitonin,,84145,CPT,Facility,Both,,,,94,79.9,26.9404,94,"Health Partners, Inc.",Commercial,88.924,94.6,,percent of total billed charges,,
Procalcitonin,,84145,CPT,Facility,Outpatient,,,,94,79.9,26.9404,94,"Health Partners, Inc.",Medicare Advantage,46.06,49,,percent of total billed charges,,
Procalcitonin,,84145,CPT,Facility,Inpatient,,,,94,79.9,26.9404,94,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Procalcitonin,,84145,CPT,Facility,Both,,,,94,79.9,26.9404,94,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),56.4,60,,percent of total billed charges,,
Procalcitonin,,84145,CPT,Facility,Both,,,,94,79.9,26.9404,94,"Health Partners, Inc.",State of Minnesota Advantage Program,76.61,81.5,,percent of total billed charges,,
Procalcitonin,,84145,CPT,Facility,Both,,,,94,79.9,26.9404,94,"Health Partners, Inc.",State Public Programs,47,50,,percent of total billed charges,,
Procalcitonin,,84145,CPT,Facility,Both,,,,94,79.9,26.9404,94,Humana Insurance Company,Commercial PPO,89.3,95,,percent of total billed charges,,
Procalcitonin,,84145,CPT,Facility,Outpatient,,,,94,79.9,26.9404,94,Humana Insurance Company,Medicare PPO,46.06,49,,percent of total billed charges,,
Procalcitonin,,84145,CPT,Facility,Inpatient,,,,94,79.9,26.9404,94,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Procalcitonin,,84145,CPT,Facility,Both,,,,94,79.9,26.9404,94,Medica,Individual & Family,93.154,99.1,,percent of total billed charges,,
Procalcitonin,,84145,CPT,Facility,Outpatient,,,,94,79.9,26.9404,94,Medica,Medica Advantage Solution,46.812,49.8,,percent of total billed charges,,
Procalcitonin,,84145,CPT,Facility,Inpatient,,,,94,79.9,26.9404,94,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Procalcitonin,,84145,CPT,Facility,Outpatient,,,,94,79.9,26.9404,94,Medica,Medical Assistance,41.924,44.6,,percent of total billed charges,,
Procalcitonin,,84145,CPT,Facility,Inpatient,,,,94,79.9,26.9404,94,Medica,Medical Assistance,,,,,Included in per diem rate,
Procalcitonin,,84145,CPT,Facility,Outpatient,,,,94,79.9,26.9404,94,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,46.812,49.8,,percent of total billed charges,,
Procalcitonin,,84145,CPT,Facility,Inpatient,,,,94,79.9,26.9404,94,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Procalcitonin,,84145,CPT,Facility,Both,,,,94,79.9,26.9404,94,"Multiplan, Inc.","Multiplan, Inc.",88.36,94,,percent of total billed charges,,
Procalcitonin,,84145,CPT,Facility,Outpatient,,,,94,79.9,26.9404,94,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,81.216,86.4,,percent of total billed charges,,
Procalcitonin,,84145,CPT,Facility,Inpatient,,,,94,79.9,26.9404,94,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Procalcitonin,,84145,CPT,Facility,Both,,,,94,79.9,26.9404,94,"Preferred One Administrative Services, INC.",PPO,92.684,98.6,,percent of total billed charges,,
Procalcitonin,,84145,CPT,Facility,Outpatient,,,,94,79.9,26.9404,94,PrimeWest Health,Minnesota Senior Health Options (MSHO),48.363,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Procalcitonin,,84145,CPT,Facility,Inpatient,,,,94,79.9,26.9404,94,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Procalcitonin,,84145,CPT,Facility,Outpatient,,,,94,79.9,26.9404,94,PrimeWest Health,MinnesotaCare,48.2784,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Procalcitonin,,84145,CPT,Facility,Inpatient,,,,94,79.9,26.9404,94,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Procalcitonin,,84145,CPT,Facility,Both,,,,94,79.9,26.9404,94,Sanford Health Plan,Sanford Health Plan,86.48,92,,percent of total billed charges,,
Procalcitonin,,84145,CPT,Facility,Outpatient,,,,94,79.9,26.9404,94,"UCare Health, Inc.",Individual & Family Plan,52.969,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Procalcitonin,,84145,CPT,Facility,Inpatient,,,,94,79.9,26.9404,94,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Procalcitonin,,84145,CPT,Facility,Outpatient,,,,94,79.9,26.9404,94,"UCare Health, Inc.",Medical Assistance,47.4418,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Procalcitonin,,84145,CPT,Facility,Inpatient,,,,94,79.9,26.9404,94,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Procalcitonin,,84145,CPT,Facility,Outpatient,,,,94,79.9,26.9404,94,"UCare Health, Inc.",Medicare Advantage,47.4418,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Procalcitonin,,84145,CPT,Facility,Inpatient,,,,94,79.9,26.9404,94,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Procalcitonin,,84145,CPT,Facility,Outpatient,,,,94,79.9,26.9404,94,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),47.4418,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Procalcitonin,,84145,CPT,Facility,Inpatient,,,,94,79.9,26.9404,94,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Procalcitonin,,84145,CPT,Facility,Both,,,,94,79.9,26.9404,94,UnitedHealthcare,Individual & Family,88.36,94,,percent of total billed charges,,
Procalcitonin,,84145,CPT,Facility,Outpatient,,,,94,79.9,26.9404,94,UnitedHealthcare,Medicare Advantage,46.06,49,,percent of total billed charges,,
Procalcitonin,,84145,CPT,Facility,Inpatient,,,,94,79.9,26.9404,94,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Procalcitonin,,84145,CPT,Facility,Outpatient,,,,94,79.9,26.9404,94,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,45.12,48,,percent of total billed charges,,100% of DHS outpatient percentage
Procalcitonin,,84145,CPT,Facility,Inpatient,,,,94,79.9,26.9404,94,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Prolactin,,84146,CPT,Facility,Both,,,,152,129.2,43.5632,152,Aetna,Commercial,139.84,92,,percent of total billed charges,,
Prolactin,,84146,CPT,Facility,Outpatient,,,,152,129.2,43.5632,152,Aetna,Medicare Advantage,74.48,49,,percent of total billed charges,,
Prolactin,,84146,CPT,Facility,Inpatient,,,,152,129.2,43.5632,152,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Prolactin,,84146,CPT,Facility,Both,,,,152,129.2,43.5632,152,Aetna,PPO,141.36,93,,percent of total billed charges,,
Prolactin,,84146,CPT,Facility,Both,,,,152,129.2,43.5632,152,America's PPO,America's PPO,145.9656,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Prolactin,,84146,CPT,Facility,Both,,,,152,129.2,43.5632,152,BlueCross BlueShield Minnesota, Federal Employee Program,149.568,98.4,,percent of total billed charges,,
Prolactin,,84146,CPT,Facility,Both,,,,152,129.2,43.5632,152,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,152,100,,percent of total billed charges,,
Prolactin,,84146,CPT,Facility,Both,,,,152,129.2,43.5632,152,BlueCross BlueShield Minnesota,High Value Network Plan,136.8,90,,percent of total billed charges,,
Prolactin,,84146,CPT,Facility,Outpatient,,,,152,129.2,43.5632,152,BlueCross BlueShield Minnesota,Medicare Advantage,74.48,49,,percent of total billed charges,,
Prolactin,,84146,CPT,Facility,Inpatient,,,,152,129.2,43.5632,152,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Prolactin,,84146,CPT,Facility,Both,,,,152,129.2,43.5632,152,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,134.6264,88.57,,percent of total billed charges,,
Prolactin,,84146,CPT,Facility,Both,,,,152,129.2,43.5632,152,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,43.5632,28.66,,percent of total billed charges,,
Prolactin,,84146,CPT,Facility,Outpatient,,,,152,129.2,43.5632,152,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),74.48,49,,percent of total billed charges,,
Prolactin,,84146,CPT,Facility,Inpatient,,,,152,129.2,43.5632,152,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Prolactin,,84146,CPT,Facility,Both,,,,152,129.2,43.5632,152,CorVel,Worker's Compensation,152,100,,percent of total billed charges,,
Prolactin,,84146,CPT,Facility,Both,,,,152,129.2,43.5632,152,First Health Group Corporation,First Health Network,147.44,97,,percent of total billed charges,,
Prolactin,,84146,CPT,Facility,Both,,,,152,129.2,43.5632,152,"Health Partners, Inc.",Commercial,143.792,94.6,,percent of total billed charges,,
Prolactin,,84146,CPT,Facility,Outpatient,,,,152,129.2,43.5632,152,"Health Partners, Inc.",Medicare Advantage,74.48,49,,percent of total billed charges,,
Prolactin,,84146,CPT,Facility,Inpatient,,,,152,129.2,43.5632,152,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Prolactin,,84146,CPT,Facility,Both,,,,152,129.2,43.5632,152,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),91.2,60,,percent of total billed charges,,
Prolactin,,84146,CPT,Facility,Both,,,,152,129.2,43.5632,152,"Health Partners, Inc.",State of Minnesota Advantage Program,123.88,81.5,,percent of total billed charges,,
Prolactin,,84146,CPT,Facility,Both,,,,152,129.2,43.5632,152,"Health Partners, Inc.",State Public Programs,76,50,,percent of total billed charges,,
Prolactin,,84146,CPT,Facility,Both,,,,152,129.2,43.5632,152,Humana Insurance Company,Commercial PPO,144.4,95,,percent of total billed charges,,
Prolactin,,84146,CPT,Facility,Outpatient,,,,152,129.2,43.5632,152,Humana Insurance Company,Medicare PPO,74.48,49,,percent of total billed charges,,
Prolactin,,84146,CPT,Facility,Inpatient,,,,152,129.2,43.5632,152,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Prolactin,,84146,CPT,Facility,Both,,,,152,129.2,43.5632,152,Medica,Individual & Family,150.632,99.1,,percent of total billed charges,,
Prolactin,,84146,CPT,Facility,Outpatient,,,,152,129.2,43.5632,152,Medica,Medica Advantage Solution,75.696,49.8,,percent of total billed charges,,
Prolactin,,84146,CPT,Facility,Inpatient,,,,152,129.2,43.5632,152,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Prolactin,,84146,CPT,Facility,Outpatient,,,,152,129.2,43.5632,152,Medica,Medical Assistance,67.792,44.6,,percent of total billed charges,,
Prolactin,,84146,CPT,Facility,Inpatient,,,,152,129.2,43.5632,152,Medica,Medical Assistance,,,,,Included in per diem rate,
Prolactin,,84146,CPT,Facility,Outpatient,,,,152,129.2,43.5632,152,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,75.696,49.8,,percent of total billed charges,,
Prolactin,,84146,CPT,Facility,Inpatient,,,,152,129.2,43.5632,152,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Prolactin,,84146,CPT,Facility,Both,,,,152,129.2,43.5632,152,"Multiplan, Inc.","Multiplan, Inc.",142.88,94,,percent of total billed charges,,
Prolactin,,84146,CPT,Facility,Outpatient,,,,152,129.2,43.5632,152,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,131.328,86.4,,percent of total billed charges,,
Prolactin,,84146,CPT,Facility,Inpatient,,,,152,129.2,43.5632,152,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Prolactin,,84146,CPT,Facility,Both,,,,152,129.2,43.5632,152,"Preferred One Administrative Services, INC.",PPO,149.872,98.6,,percent of total billed charges,,
Prolactin,,84146,CPT,Facility,Outpatient,,,,152,129.2,43.5632,152,PrimeWest Health,Minnesota Senior Health Options (MSHO),78.204,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Prolactin,,84146,CPT,Facility,Inpatient,,,,152,129.2,43.5632,152,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Prolactin,,84146,CPT,Facility,Outpatient,,,,152,129.2,43.5632,152,PrimeWest Health,MinnesotaCare,78.0672,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Prolactin,,84146,CPT,Facility,Inpatient,,,,152,129.2,43.5632,152,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Prolactin,,84146,CPT,Facility,Both,,,,152,129.2,43.5632,152,Sanford Health Plan,Sanford Health Plan,139.84,92,,percent of total billed charges,,
Prolactin,,84146,CPT,Facility,Outpatient,,,,152,129.2,43.5632,152,"UCare Health, Inc.",Individual & Family Plan,85.652,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Prolactin,,84146,CPT,Facility,Inpatient,,,,152,129.2,43.5632,152,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Prolactin,,84146,CPT,Facility,Outpatient,,,,152,129.2,43.5632,152,"UCare Health, Inc.",Medical Assistance,76.7144,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Prolactin,,84146,CPT,Facility,Inpatient,,,,152,129.2,43.5632,152,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Prolactin,,84146,CPT,Facility,Outpatient,,,,152,129.2,43.5632,152,"UCare Health, Inc.",Medicare Advantage,76.7144,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Prolactin,,84146,CPT,Facility,Inpatient,,,,152,129.2,43.5632,152,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Prolactin,,84146,CPT,Facility,Outpatient,,,,152,129.2,43.5632,152,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),76.7144,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Prolactin,,84146,CPT,Facility,Inpatient,,,,152,129.2,43.5632,152,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Prolactin,,84146,CPT,Facility,Both,,,,152,129.2,43.5632,152,UnitedHealthcare,Individual & Family,142.88,94,,percent of total billed charges,,
Prolactin,,84146,CPT,Facility,Outpatient,,,,152,129.2,43.5632,152,UnitedHealthcare,Medicare Advantage,74.48,49,,percent of total billed charges,,
Prolactin,,84146,CPT,Facility,Inpatient,,,,152,129.2,43.5632,152,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Prolactin,,84146,CPT,Facility,Outpatient,,,,152,129.2,43.5632,152,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,72.96,48,,percent of total billed charges,,100% of DHS outpatient percentage
Prolactin,,84146,CPT,Facility,Inpatient,,,,152,129.2,43.5632,152,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Psa, Diagnostic",,84153,CPT,Facility,Both,,,,146,124.1,41.8436,146,Aetna,Commercial,134.32,92,,percent of total billed charges,,
"Psa, Diagnostic",,84153,CPT,Facility,Outpatient,,,,146,124.1,41.8436,146,Aetna,Medicare Advantage,71.54,49,,percent of total billed charges,,
"Psa, Diagnostic",,84153,CPT,Facility,Inpatient,,,,146,124.1,41.8436,146,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Psa, Diagnostic",,84153,CPT,Facility,Both,,,,146,124.1,41.8436,146,Aetna,PPO,135.78,93,,percent of total billed charges,,
"Psa, Diagnostic",,84153,CPT,Facility,Both,,,,146,124.1,41.8436,146,America's PPO,America's PPO,140.2038,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Psa, Diagnostic",,84153,CPT,Facility,Both,,,,146,124.1,41.8436,146,BlueCross BlueShield Minnesota, Federal Employee Program,143.664,98.4,,percent of total billed charges,,
"Psa, Diagnostic",,84153,CPT,Facility,Both,,,,146,124.1,41.8436,146,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,146,100,,percent of total billed charges,,
"Psa, Diagnostic",,84153,CPT,Facility,Both,,,,146,124.1,41.8436,146,BlueCross BlueShield Minnesota,High Value Network Plan,131.4,90,,percent of total billed charges,,
"Psa, Diagnostic",,84153,CPT,Facility,Outpatient,,,,146,124.1,41.8436,146,BlueCross BlueShield Minnesota,Medicare Advantage,71.54,49,,percent of total billed charges,,
"Psa, Diagnostic",,84153,CPT,Facility,Inpatient,,,,146,124.1,41.8436,146,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Psa, Diagnostic",,84153,CPT,Facility,Both,,,,146,124.1,41.8436,146,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,129.3122,88.57,,percent of total billed charges,,
"Psa, Diagnostic",,84153,CPT,Facility,Both,,,,146,124.1,41.8436,146,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,41.8436,28.66,,percent of total billed charges,,
"Psa, Diagnostic",,84153,CPT,Facility,Outpatient,,,,146,124.1,41.8436,146,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),71.54,49,,percent of total billed charges,,
"Psa, Diagnostic",,84153,CPT,Facility,Inpatient,,,,146,124.1,41.8436,146,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Psa, Diagnostic",,84153,CPT,Facility,Both,,,,146,124.1,41.8436,146,CorVel,Worker's Compensation,146,100,,percent of total billed charges,,
"Psa, Diagnostic",,84153,CPT,Facility,Both,,,,146,124.1,41.8436,146,First Health Group Corporation,First Health Network,141.62,97,,percent of total billed charges,,
"Psa, Diagnostic",,84153,CPT,Facility,Both,,,,146,124.1,41.8436,146,"Health Partners, Inc.",Commercial,138.116,94.6,,percent of total billed charges,,
"Psa, Diagnostic",,84153,CPT,Facility,Outpatient,,,,146,124.1,41.8436,146,"Health Partners, Inc.",Medicare Advantage,71.54,49,,percent of total billed charges,,
"Psa, Diagnostic",,84153,CPT,Facility,Inpatient,,,,146,124.1,41.8436,146,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Psa, Diagnostic",,84153,CPT,Facility,Both,,,,146,124.1,41.8436,146,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),87.6,60,,percent of total billed charges,,
"Psa, Diagnostic",,84153,CPT,Facility,Both,,,,146,124.1,41.8436,146,"Health Partners, Inc.",State of Minnesota Advantage Program,118.99,81.5,,percent of total billed charges,,
"Psa, Diagnostic",,84153,CPT,Facility,Both,,,,146,124.1,41.8436,146,"Health Partners, Inc.",State Public Programs,73,50,,percent of total billed charges,,
"Psa, Diagnostic",,84153,CPT,Facility,Both,,,,146,124.1,41.8436,146,Humana Insurance Company,Commercial PPO,138.7,95,,percent of total billed charges,,
"Psa, Diagnostic",,84153,CPT,Facility,Outpatient,,,,146,124.1,41.8436,146,Humana Insurance Company,Medicare PPO,71.54,49,,percent of total billed charges,,
"Psa, Diagnostic",,84153,CPT,Facility,Inpatient,,,,146,124.1,41.8436,146,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Psa, Diagnostic",,84153,CPT,Facility,Both,,,,146,124.1,41.8436,146,Medica,Individual & Family,144.686,99.1,,percent of total billed charges,,
"Psa, Diagnostic",,84153,CPT,Facility,Outpatient,,,,146,124.1,41.8436,146,Medica,Medica Advantage Solution,72.708,49.8,,percent of total billed charges,,
"Psa, Diagnostic",,84153,CPT,Facility,Inpatient,,,,146,124.1,41.8436,146,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Psa, Diagnostic",,84153,CPT,Facility,Outpatient,,,,146,124.1,41.8436,146,Medica,Medical Assistance,65.116,44.6,,percent of total billed charges,,
"Psa, Diagnostic",,84153,CPT,Facility,Inpatient,,,,146,124.1,41.8436,146,Medica,Medical Assistance,,,,,Included in per diem rate,
"Psa, Diagnostic",,84153,CPT,Facility,Outpatient,,,,146,124.1,41.8436,146,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,72.708,49.8,,percent of total billed charges,,
"Psa, Diagnostic",,84153,CPT,Facility,Inpatient,,,,146,124.1,41.8436,146,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Psa, Diagnostic",,84153,CPT,Facility,Both,,,,146,124.1,41.8436,146,"Multiplan, Inc.","Multiplan, Inc.",137.24,94,,percent of total billed charges,,
"Psa, Diagnostic",,84153,CPT,Facility,Outpatient,,,,146,124.1,41.8436,146,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,126.144,86.4,,percent of total billed charges,,
"Psa, Diagnostic",,84153,CPT,Facility,Inpatient,,,,146,124.1,41.8436,146,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Psa, Diagnostic",,84153,CPT,Facility,Both,,,,146,124.1,41.8436,146,"Preferred One Administrative Services, INC.",PPO,143.956,98.6,,percent of total billed charges,,
"Psa, Diagnostic",,84153,CPT,Facility,Outpatient,,,,146,124.1,41.8436,146,PrimeWest Health,Minnesota Senior Health Options (MSHO),75.117,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Psa, Diagnostic",,84153,CPT,Facility,Inpatient,,,,146,124.1,41.8436,146,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Psa, Diagnostic",,84153,CPT,Facility,Outpatient,,,,146,124.1,41.8436,146,PrimeWest Health,MinnesotaCare,74.9856,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Psa, Diagnostic",,84153,CPT,Facility,Inpatient,,,,146,124.1,41.8436,146,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Psa, Diagnostic",,84153,CPT,Facility,Both,,,,146,124.1,41.8436,146,Sanford Health Plan,Sanford Health Plan,134.32,92,,percent of total billed charges,,
"Psa, Diagnostic",,84153,CPT,Facility,Outpatient,,,,146,124.1,41.8436,146,"UCare Health, Inc.",Individual & Family Plan,82.271,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Psa, Diagnostic",,84153,CPT,Facility,Inpatient,,,,146,124.1,41.8436,146,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Psa, Diagnostic",,84153,CPT,Facility,Outpatient,,,,146,124.1,41.8436,146,"UCare Health, Inc.",Medical Assistance,73.6862,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Psa, Diagnostic",,84153,CPT,Facility,Inpatient,,,,146,124.1,41.8436,146,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Psa, Diagnostic",,84153,CPT,Facility,Outpatient,,,,146,124.1,41.8436,146,"UCare Health, Inc.",Medicare Advantage,73.6862,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Psa, Diagnostic",,84153,CPT,Facility,Inpatient,,,,146,124.1,41.8436,146,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Psa, Diagnostic",,84153,CPT,Facility,Outpatient,,,,146,124.1,41.8436,146,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),73.6862,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Psa, Diagnostic",,84153,CPT,Facility,Inpatient,,,,146,124.1,41.8436,146,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Psa, Diagnostic",,84153,CPT,Facility,Both,,,,146,124.1,41.8436,146,UnitedHealthcare,Individual & Family,137.24,94,,percent of total billed charges,,
"Psa, Diagnostic",,84153,CPT,Facility,Outpatient,,,,146,124.1,41.8436,146,UnitedHealthcare,Medicare Advantage,71.54,49,,percent of total billed charges,,
"Psa, Diagnostic",,84153,CPT,Facility,Inpatient,,,,146,124.1,41.8436,146,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Psa, Diagnostic",,84153,CPT,Facility,Outpatient,,,,146,124.1,41.8436,146,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,70.08,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Psa, Diagnostic",,84153,CPT,Facility,Inpatient,,,,146,124.1,41.8436,146,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Psa, Screening",,84153,CPT,Facility,Both,,,,146,124.1,41.8436,146,Aetna,Commercial,134.32,92,,percent of total billed charges,,
"Psa, Screening",,84153,CPT,Facility,Outpatient,,,,146,124.1,41.8436,146,Aetna,Medicare Advantage,71.54,49,,percent of total billed charges,,
"Psa, Screening",,84153,CPT,Facility,Inpatient,,,,146,124.1,41.8436,146,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Psa, Screening",,84153,CPT,Facility,Both,,,,146,124.1,41.8436,146,Aetna,PPO,135.78,93,,percent of total billed charges,,
"Psa, Screening",,84153,CPT,Facility,Both,,,,146,124.1,41.8436,146,America's PPO,America's PPO,140.2038,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Psa, Screening",,84153,CPT,Facility,Both,,,,146,124.1,41.8436,146,BlueCross BlueShield Minnesota, Federal Employee Program,143.664,98.4,,percent of total billed charges,,
"Psa, Screening",,84153,CPT,Facility,Both,,,,146,124.1,41.8436,146,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,146,100,,percent of total billed charges,,
"Psa, Screening",,84153,CPT,Facility,Both,,,,146,124.1,41.8436,146,BlueCross BlueShield Minnesota,High Value Network Plan,131.4,90,,percent of total billed charges,,
"Psa, Screening",,84153,CPT,Facility,Outpatient,,,,146,124.1,41.8436,146,BlueCross BlueShield Minnesota,Medicare Advantage,71.54,49,,percent of total billed charges,,
"Psa, Screening",,84153,CPT,Facility,Inpatient,,,,146,124.1,41.8436,146,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Psa, Screening",,84153,CPT,Facility,Both,,,,146,124.1,41.8436,146,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,129.3122,88.57,,percent of total billed charges,,
"Psa, Screening",,84153,CPT,Facility,Both,,,,146,124.1,41.8436,146,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,41.8436,28.66,,percent of total billed charges,,
"Psa, Screening",,84153,CPT,Facility,Outpatient,,,,146,124.1,41.8436,146,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),71.54,49,,percent of total billed charges,,
"Psa, Screening",,84153,CPT,Facility,Inpatient,,,,146,124.1,41.8436,146,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Psa, Screening",,84153,CPT,Facility,Both,,,,146,124.1,41.8436,146,CorVel,Worker's Compensation,146,100,,percent of total billed charges,,
"Psa, Screening",,84153,CPT,Facility,Both,,,,146,124.1,41.8436,146,First Health Group Corporation,First Health Network,141.62,97,,percent of total billed charges,,
"Psa, Screening",,84153,CPT,Facility,Both,,,,146,124.1,41.8436,146,"Health Partners, Inc.",Commercial,138.116,94.6,,percent of total billed charges,,
"Psa, Screening",,84153,CPT,Facility,Outpatient,,,,146,124.1,41.8436,146,"Health Partners, Inc.",Medicare Advantage,71.54,49,,percent of total billed charges,,
"Psa, Screening",,84153,CPT,Facility,Inpatient,,,,146,124.1,41.8436,146,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Psa, Screening",,84153,CPT,Facility,Both,,,,146,124.1,41.8436,146,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),87.6,60,,percent of total billed charges,,
"Psa, Screening",,84153,CPT,Facility,Both,,,,146,124.1,41.8436,146,"Health Partners, Inc.",State of Minnesota Advantage Program,118.99,81.5,,percent of total billed charges,,
"Psa, Screening",,84153,CPT,Facility,Both,,,,146,124.1,41.8436,146,"Health Partners, Inc.",State Public Programs,73,50,,percent of total billed charges,,
"Psa, Screening",,84153,CPT,Facility,Both,,,,146,124.1,41.8436,146,Humana Insurance Company,Commercial PPO,138.7,95,,percent of total billed charges,,
"Psa, Screening",,84153,CPT,Facility,Outpatient,,,,146,124.1,41.8436,146,Humana Insurance Company,Medicare PPO,71.54,49,,percent of total billed charges,,
"Psa, Screening",,84153,CPT,Facility,Inpatient,,,,146,124.1,41.8436,146,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Psa, Screening",,84153,CPT,Facility,Both,,,,146,124.1,41.8436,146,Medica,Individual & Family,144.686,99.1,,percent of total billed charges,,
"Psa, Screening",,84153,CPT,Facility,Outpatient,,,,146,124.1,41.8436,146,Medica,Medica Advantage Solution,72.708,49.8,,percent of total billed charges,,
"Psa, Screening",,84153,CPT,Facility,Inpatient,,,,146,124.1,41.8436,146,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Psa, Screening",,84153,CPT,Facility,Outpatient,,,,146,124.1,41.8436,146,Medica,Medical Assistance,65.116,44.6,,percent of total billed charges,,
"Psa, Screening",,84153,CPT,Facility,Inpatient,,,,146,124.1,41.8436,146,Medica,Medical Assistance,,,,,Included in per diem rate,
"Psa, Screening",,84153,CPT,Facility,Outpatient,,,,146,124.1,41.8436,146,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,72.708,49.8,,percent of total billed charges,,
"Psa, Screening",,84153,CPT,Facility,Inpatient,,,,146,124.1,41.8436,146,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Psa, Screening",,84153,CPT,Facility,Both,,,,146,124.1,41.8436,146,"Multiplan, Inc.","Multiplan, Inc.",137.24,94,,percent of total billed charges,,
"Psa, Screening",,84153,CPT,Facility,Outpatient,,,,146,124.1,41.8436,146,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,126.144,86.4,,percent of total billed charges,,
"Psa, Screening",,84153,CPT,Facility,Inpatient,,,,146,124.1,41.8436,146,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Psa, Screening",,84153,CPT,Facility,Both,,,,146,124.1,41.8436,146,"Preferred One Administrative Services, INC.",PPO,143.956,98.6,,percent of total billed charges,,
"Psa, Screening",,84153,CPT,Facility,Outpatient,,,,146,124.1,41.8436,146,PrimeWest Health,Minnesota Senior Health Options (MSHO),75.117,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Psa, Screening",,84153,CPT,Facility,Inpatient,,,,146,124.1,41.8436,146,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Psa, Screening",,84153,CPT,Facility,Outpatient,,,,146,124.1,41.8436,146,PrimeWest Health,MinnesotaCare,74.9856,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Psa, Screening",,84153,CPT,Facility,Inpatient,,,,146,124.1,41.8436,146,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Psa, Screening",,84153,CPT,Facility,Both,,,,146,124.1,41.8436,146,Sanford Health Plan,Sanford Health Plan,134.32,92,,percent of total billed charges,,
"Psa, Screening",,84153,CPT,Facility,Outpatient,,,,146,124.1,41.8436,146,"UCare Health, Inc.",Individual & Family Plan,82.271,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Psa, Screening",,84153,CPT,Facility,Inpatient,,,,146,124.1,41.8436,146,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Psa, Screening",,84153,CPT,Facility,Outpatient,,,,146,124.1,41.8436,146,"UCare Health, Inc.",Medical Assistance,73.6862,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Psa, Screening",,84153,CPT,Facility,Inpatient,,,,146,124.1,41.8436,146,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Psa, Screening",,84153,CPT,Facility,Outpatient,,,,146,124.1,41.8436,146,"UCare Health, Inc.",Medicare Advantage,73.6862,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Psa, Screening",,84153,CPT,Facility,Inpatient,,,,146,124.1,41.8436,146,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Psa, Screening",,84153,CPT,Facility,Outpatient,,,,146,124.1,41.8436,146,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),73.6862,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Psa, Screening",,84153,CPT,Facility,Inpatient,,,,146,124.1,41.8436,146,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Psa, Screening",,84153,CPT,Facility,Both,,,,146,124.1,41.8436,146,UnitedHealthcare,Individual & Family,137.24,94,,percent of total billed charges,,
"Psa, Screening",,84153,CPT,Facility,Outpatient,,,,146,124.1,41.8436,146,UnitedHealthcare,Medicare Advantage,71.54,49,,percent of total billed charges,,
"Psa, Screening",,84153,CPT,Facility,Inpatient,,,,146,124.1,41.8436,146,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Psa, Screening",,84153,CPT,Facility,Outpatient,,,,146,124.1,41.8436,146,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,70.08,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Psa, Screening",,84153,CPT,Facility,Inpatient,,,,146,124.1,41.8436,146,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Protein,,84155,CPT,Facility,Both,,,,60,51,17.196,60,Aetna,Commercial,55.2,92,,percent of total billed charges,,
Protein,,84155,CPT,Facility,Outpatient,,,,60,51,17.196,60,Aetna,Medicare Advantage,29.4,49,,percent of total billed charges,,
Protein,,84155,CPT,Facility,Inpatient,,,,60,51,17.196,60,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Protein,,84155,CPT,Facility,Both,,,,60,51,17.196,60,Aetna,PPO,55.8,93,,percent of total billed charges,,
Protein,,84155,CPT,Facility,Both,,,,60,51,17.196,60,America's PPO,America's PPO,57.618,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Protein,,84155,CPT,Facility,Both,,,,60,51,17.196,60,BlueCross BlueShield Minnesota, Federal Employee Program,59.04,98.4,,percent of total billed charges,,
Protein,,84155,CPT,Facility,Both,,,,60,51,17.196,60,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,60,100,,percent of total billed charges,,
Protein,,84155,CPT,Facility,Both,,,,60,51,17.196,60,BlueCross BlueShield Minnesota,High Value Network Plan,54,90,,percent of total billed charges,,
Protein,,84155,CPT,Facility,Outpatient,,,,60,51,17.196,60,BlueCross BlueShield Minnesota,Medicare Advantage,29.4,49,,percent of total billed charges,,
Protein,,84155,CPT,Facility,Inpatient,,,,60,51,17.196,60,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Protein,,84155,CPT,Facility,Both,,,,60,51,17.196,60,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,53.142,88.57,,percent of total billed charges,,
Protein,,84155,CPT,Facility,Both,,,,60,51,17.196,60,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,17.196,28.66,,percent of total billed charges,,
Protein,,84155,CPT,Facility,Outpatient,,,,60,51,17.196,60,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),29.4,49,,percent of total billed charges,,
Protein,,84155,CPT,Facility,Inpatient,,,,60,51,17.196,60,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Protein,,84155,CPT,Facility,Both,,,,60,51,17.196,60,CorVel,Worker's Compensation,60,100,,percent of total billed charges,,
Protein,,84155,CPT,Facility,Both,,,,60,51,17.196,60,First Health Group Corporation,First Health Network,58.2,97,,percent of total billed charges,,
Protein,,84155,CPT,Facility,Both,,,,60,51,17.196,60,"Health Partners, Inc.",Commercial,56.76,94.6,,percent of total billed charges,,
Protein,,84155,CPT,Facility,Outpatient,,,,60,51,17.196,60,"Health Partners, Inc.",Medicare Advantage,29.4,49,,percent of total billed charges,,
Protein,,84155,CPT,Facility,Inpatient,,,,60,51,17.196,60,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Protein,,84155,CPT,Facility,Both,,,,60,51,17.196,60,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),36,60,,percent of total billed charges,,
Protein,,84155,CPT,Facility,Both,,,,60,51,17.196,60,"Health Partners, Inc.",State of Minnesota Advantage Program,48.9,81.5,,percent of total billed charges,,
Protein,,84155,CPT,Facility,Both,,,,60,51,17.196,60,"Health Partners, Inc.",State Public Programs,30,50,,percent of total billed charges,,
Protein,,84155,CPT,Facility,Both,,,,60,51,17.196,60,Humana Insurance Company,Commercial PPO,57,95,,percent of total billed charges,,
Protein,,84155,CPT,Facility,Outpatient,,,,60,51,17.196,60,Humana Insurance Company,Medicare PPO,29.4,49,,percent of total billed charges,,
Protein,,84155,CPT,Facility,Inpatient,,,,60,51,17.196,60,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Protein,,84155,CPT,Facility,Both,,,,60,51,17.196,60,Medica,Individual & Family,59.46,99.1,,percent of total billed charges,,
Protein,,84155,CPT,Facility,Outpatient,,,,60,51,17.196,60,Medica,Medica Advantage Solution,29.88,49.8,,percent of total billed charges,,
Protein,,84155,CPT,Facility,Inpatient,,,,60,51,17.196,60,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Protein,,84155,CPT,Facility,Outpatient,,,,60,51,17.196,60,Medica,Medical Assistance,26.76,44.6,,percent of total billed charges,,
Protein,,84155,CPT,Facility,Inpatient,,,,60,51,17.196,60,Medica,Medical Assistance,,,,,Included in per diem rate,
Protein,,84155,CPT,Facility,Outpatient,,,,60,51,17.196,60,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,29.88,49.8,,percent of total billed charges,,
Protein,,84155,CPT,Facility,Inpatient,,,,60,51,17.196,60,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Protein,,84155,CPT,Facility,Both,,,,60,51,17.196,60,"Multiplan, Inc.","Multiplan, Inc.",56.4,94,,percent of total billed charges,,
Protein,,84155,CPT,Facility,Outpatient,,,,60,51,17.196,60,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,51.84,86.4,,percent of total billed charges,,
Protein,,84155,CPT,Facility,Inpatient,,,,60,51,17.196,60,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Protein,,84155,CPT,Facility,Both,,,,60,51,17.196,60,"Preferred One Administrative Services, INC.",PPO,59.16,98.6,,percent of total billed charges,,
Protein,,84155,CPT,Facility,Outpatient,,,,60,51,17.196,60,PrimeWest Health,Minnesota Senior Health Options (MSHO),30.87,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Protein,,84155,CPT,Facility,Inpatient,,,,60,51,17.196,60,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Protein,,84155,CPT,Facility,Outpatient,,,,60,51,17.196,60,PrimeWest Health,MinnesotaCare,30.816,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Protein,,84155,CPT,Facility,Inpatient,,,,60,51,17.196,60,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Protein,,84155,CPT,Facility,Both,,,,60,51,17.196,60,Sanford Health Plan,Sanford Health Plan,55.2,92,,percent of total billed charges,,
Protein,,84155,CPT,Facility,Outpatient,,,,60,51,17.196,60,"UCare Health, Inc.",Individual & Family Plan,33.81,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Protein,,84155,CPT,Facility,Inpatient,,,,60,51,17.196,60,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Protein,,84155,CPT,Facility,Outpatient,,,,60,51,17.196,60,"UCare Health, Inc.",Medical Assistance,30.282,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Protein,,84155,CPT,Facility,Inpatient,,,,60,51,17.196,60,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Protein,,84155,CPT,Facility,Outpatient,,,,60,51,17.196,60,"UCare Health, Inc.",Medicare Advantage,30.282,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Protein,,84155,CPT,Facility,Inpatient,,,,60,51,17.196,60,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Protein,,84155,CPT,Facility,Outpatient,,,,60,51,17.196,60,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),30.282,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Protein,,84155,CPT,Facility,Inpatient,,,,60,51,17.196,60,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Protein,,84155,CPT,Facility,Both,,,,60,51,17.196,60,UnitedHealthcare,Individual & Family,56.4,94,,percent of total billed charges,,
Protein,,84155,CPT,Facility,Outpatient,,,,60,51,17.196,60,UnitedHealthcare,Medicare Advantage,29.4,49,,percent of total billed charges,,
Protein,,84155,CPT,Facility,Inpatient,,,,60,51,17.196,60,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Protein,,84155,CPT,Facility,Outpatient,,,,60,51,17.196,60,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,28.8,48,,percent of total billed charges,,100% of DHS outpatient percentage
Protein,,84155,CPT,Facility,Inpatient,,,,60,51,17.196,60,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Protein, Urine, 24 Hr",,84156,CPT,Facility,Both,,,,70,59.5,20.062,70,Aetna,Commercial,64.4,92,,percent of total billed charges,,
"Protein, Urine, 24 Hr",,84156,CPT,Facility,Outpatient,,,,70,59.5,20.062,70,Aetna,Medicare Advantage,34.3,49,,percent of total billed charges,,
"Protein, Urine, 24 Hr",,84156,CPT,Facility,Inpatient,,,,70,59.5,20.062,70,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Protein, Urine, 24 Hr",,84156,CPT,Facility,Both,,,,70,59.5,20.062,70,Aetna,PPO,65.1,93,,percent of total billed charges,,
"Protein, Urine, 24 Hr",,84156,CPT,Facility,Both,,,,70,59.5,20.062,70,America's PPO,America's PPO,67.221,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Protein, Urine, 24 Hr",,84156,CPT,Facility,Both,,,,70,59.5,20.062,70,BlueCross BlueShield Minnesota, Federal Employee Program,68.88,98.4,,percent of total billed charges,,
"Protein, Urine, 24 Hr",,84156,CPT,Facility,Both,,,,70,59.5,20.062,70,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,70,100,,percent of total billed charges,,
"Protein, Urine, 24 Hr",,84156,CPT,Facility,Both,,,,70,59.5,20.062,70,BlueCross BlueShield Minnesota,High Value Network Plan,63,90,,percent of total billed charges,,
"Protein, Urine, 24 Hr",,84156,CPT,Facility,Outpatient,,,,70,59.5,20.062,70,BlueCross BlueShield Minnesota,Medicare Advantage,34.3,49,,percent of total billed charges,,
"Protein, Urine, 24 Hr",,84156,CPT,Facility,Inpatient,,,,70,59.5,20.062,70,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Protein, Urine, 24 Hr",,84156,CPT,Facility,Both,,,,70,59.5,20.062,70,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,61.999,88.57,,percent of total billed charges,,
"Protein, Urine, 24 Hr",,84156,CPT,Facility,Both,,,,70,59.5,20.062,70,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,20.062,28.66,,percent of total billed charges,,
"Protein, Urine, 24 Hr",,84156,CPT,Facility,Outpatient,,,,70,59.5,20.062,70,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),34.3,49,,percent of total billed charges,,
"Protein, Urine, 24 Hr",,84156,CPT,Facility,Inpatient,,,,70,59.5,20.062,70,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Protein, Urine, 24 Hr",,84156,CPT,Facility,Both,,,,70,59.5,20.062,70,CorVel,Worker's Compensation,70,100,,percent of total billed charges,,
"Protein, Urine, 24 Hr",,84156,CPT,Facility,Both,,,,70,59.5,20.062,70,First Health Group Corporation,First Health Network,67.9,97,,percent of total billed charges,,
"Protein, Urine, 24 Hr",,84156,CPT,Facility,Both,,,,70,59.5,20.062,70,"Health Partners, Inc.",Commercial,66.22,94.6,,percent of total billed charges,,
"Protein, Urine, 24 Hr",,84156,CPT,Facility,Outpatient,,,,70,59.5,20.062,70,"Health Partners, Inc.",Medicare Advantage,34.3,49,,percent of total billed charges,,
"Protein, Urine, 24 Hr",,84156,CPT,Facility,Inpatient,,,,70,59.5,20.062,70,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Protein, Urine, 24 Hr",,84156,CPT,Facility,Both,,,,70,59.5,20.062,70,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),42,60,,percent of total billed charges,,
"Protein, Urine, 24 Hr",,84156,CPT,Facility,Both,,,,70,59.5,20.062,70,"Health Partners, Inc.",State of Minnesota Advantage Program,57.05,81.5,,percent of total billed charges,,
"Protein, Urine, 24 Hr",,84156,CPT,Facility,Both,,,,70,59.5,20.062,70,"Health Partners, Inc.",State Public Programs,35,50,,percent of total billed charges,,
"Protein, Urine, 24 Hr",,84156,CPT,Facility,Both,,,,70,59.5,20.062,70,Humana Insurance Company,Commercial PPO,66.5,95,,percent of total billed charges,,
"Protein, Urine, 24 Hr",,84156,CPT,Facility,Outpatient,,,,70,59.5,20.062,70,Humana Insurance Company,Medicare PPO,34.3,49,,percent of total billed charges,,
"Protein, Urine, 24 Hr",,84156,CPT,Facility,Inpatient,,,,70,59.5,20.062,70,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Protein, Urine, 24 Hr",,84156,CPT,Facility,Both,,,,70,59.5,20.062,70,Medica,Individual & Family,69.37,99.1,,percent of total billed charges,,
"Protein, Urine, 24 Hr",,84156,CPT,Facility,Outpatient,,,,70,59.5,20.062,70,Medica,Medica Advantage Solution,34.86,49.8,,percent of total billed charges,,
"Protein, Urine, 24 Hr",,84156,CPT,Facility,Inpatient,,,,70,59.5,20.062,70,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Protein, Urine, 24 Hr",,84156,CPT,Facility,Outpatient,,,,70,59.5,20.062,70,Medica,Medical Assistance,31.22,44.6,,percent of total billed charges,,
"Protein, Urine, 24 Hr",,84156,CPT,Facility,Inpatient,,,,70,59.5,20.062,70,Medica,Medical Assistance,,,,,Included in per diem rate,
"Protein, Urine, 24 Hr",,84156,CPT,Facility,Outpatient,,,,70,59.5,20.062,70,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,34.86,49.8,,percent of total billed charges,,
"Protein, Urine, 24 Hr",,84156,CPT,Facility,Inpatient,,,,70,59.5,20.062,70,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Protein, Urine, 24 Hr",,84156,CPT,Facility,Both,,,,70,59.5,20.062,70,"Multiplan, Inc.","Multiplan, Inc.",65.8,94,,percent of total billed charges,,
"Protein, Urine, 24 Hr",,84156,CPT,Facility,Outpatient,,,,70,59.5,20.062,70,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,60.48,86.4,,percent of total billed charges,,
"Protein, Urine, 24 Hr",,84156,CPT,Facility,Inpatient,,,,70,59.5,20.062,70,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Protein, Urine, 24 Hr",,84156,CPT,Facility,Both,,,,70,59.5,20.062,70,"Preferred One Administrative Services, INC.",PPO,69.02,98.6,,percent of total billed charges,,
"Protein, Urine, 24 Hr",,84156,CPT,Facility,Outpatient,,,,70,59.5,20.062,70,PrimeWest Health,Minnesota Senior Health Options (MSHO),36.015,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Protein, Urine, 24 Hr",,84156,CPT,Facility,Inpatient,,,,70,59.5,20.062,70,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Protein, Urine, 24 Hr",,84156,CPT,Facility,Outpatient,,,,70,59.5,20.062,70,PrimeWest Health,MinnesotaCare,35.952,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Protein, Urine, 24 Hr",,84156,CPT,Facility,Inpatient,,,,70,59.5,20.062,70,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Protein, Urine, 24 Hr",,84156,CPT,Facility,Both,,,,70,59.5,20.062,70,Sanford Health Plan,Sanford Health Plan,64.4,92,,percent of total billed charges,,
"Protein, Urine, 24 Hr",,84156,CPT,Facility,Outpatient,,,,70,59.5,20.062,70,"UCare Health, Inc.",Individual & Family Plan,39.445,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Protein, Urine, 24 Hr",,84156,CPT,Facility,Inpatient,,,,70,59.5,20.062,70,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Protein, Urine, 24 Hr",,84156,CPT,Facility,Outpatient,,,,70,59.5,20.062,70,"UCare Health, Inc.",Medical Assistance,35.329,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Protein, Urine, 24 Hr",,84156,CPT,Facility,Inpatient,,,,70,59.5,20.062,70,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Protein, Urine, 24 Hr",,84156,CPT,Facility,Outpatient,,,,70,59.5,20.062,70,"UCare Health, Inc.",Medicare Advantage,35.329,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Protein, Urine, 24 Hr",,84156,CPT,Facility,Inpatient,,,,70,59.5,20.062,70,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Protein, Urine, 24 Hr",,84156,CPT,Facility,Outpatient,,,,70,59.5,20.062,70,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),35.329,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Protein, Urine, 24 Hr",,84156,CPT,Facility,Inpatient,,,,70,59.5,20.062,70,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Protein, Urine, 24 Hr",,84156,CPT,Facility,Both,,,,70,59.5,20.062,70,UnitedHealthcare,Individual & Family,65.8,94,,percent of total billed charges,,
"Protein, Urine, 24 Hr",,84156,CPT,Facility,Outpatient,,,,70,59.5,20.062,70,UnitedHealthcare,Medicare Advantage,34.3,49,,percent of total billed charges,,
"Protein, Urine, 24 Hr",,84156,CPT,Facility,Inpatient,,,,70,59.5,20.062,70,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Protein, Urine, 24 Hr",,84156,CPT,Facility,Outpatient,,,,70,59.5,20.062,70,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,33.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Protein, Urine, 24 Hr",,84156,CPT,Facility,Inpatient,,,,70,59.5,20.062,70,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Protein, Urine, Random",,84156,CPT,Facility,Both,,,,54,45.9,15.4764,54,Aetna,Commercial,49.68,92,,percent of total billed charges,,
"Protein, Urine, Random",,84156,CPT,Facility,Outpatient,,,,54,45.9,15.4764,54,Aetna,Medicare Advantage,26.46,49,,percent of total billed charges,,
"Protein, Urine, Random",,84156,CPT,Facility,Inpatient,,,,54,45.9,15.4764,54,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Protein, Urine, Random",,84156,CPT,Facility,Both,,,,54,45.9,15.4764,54,Aetna,PPO,50.22,93,,percent of total billed charges,,
"Protein, Urine, Random",,84156,CPT,Facility,Both,,,,54,45.9,15.4764,54,America's PPO,America's PPO,51.8562,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Protein, Urine, Random",,84156,CPT,Facility,Both,,,,54,45.9,15.4764,54,BlueCross BlueShield Minnesota, Federal Employee Program,53.136,98.4,,percent of total billed charges,,
"Protein, Urine, Random",,84156,CPT,Facility,Both,,,,54,45.9,15.4764,54,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,54,100,,percent of total billed charges,,
"Protein, Urine, Random",,84156,CPT,Facility,Both,,,,54,45.9,15.4764,54,BlueCross BlueShield Minnesota,High Value Network Plan,48.6,90,,percent of total billed charges,,
"Protein, Urine, Random",,84156,CPT,Facility,Outpatient,,,,54,45.9,15.4764,54,BlueCross BlueShield Minnesota,Medicare Advantage,26.46,49,,percent of total billed charges,,
"Protein, Urine, Random",,84156,CPT,Facility,Inpatient,,,,54,45.9,15.4764,54,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Protein, Urine, Random",,84156,CPT,Facility,Both,,,,54,45.9,15.4764,54,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,47.8278,88.57,,percent of total billed charges,,
"Protein, Urine, Random",,84156,CPT,Facility,Both,,,,54,45.9,15.4764,54,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,15.4764,28.66,,percent of total billed charges,,
"Protein, Urine, Random",,84156,CPT,Facility,Outpatient,,,,54,45.9,15.4764,54,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),26.46,49,,percent of total billed charges,,
"Protein, Urine, Random",,84156,CPT,Facility,Inpatient,,,,54,45.9,15.4764,54,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Protein, Urine, Random",,84156,CPT,Facility,Both,,,,54,45.9,15.4764,54,CorVel,Worker's Compensation,54,100,,percent of total billed charges,,
"Protein, Urine, Random",,84156,CPT,Facility,Both,,,,54,45.9,15.4764,54,First Health Group Corporation,First Health Network,52.38,97,,percent of total billed charges,,
"Protein, Urine, Random",,84156,CPT,Facility,Both,,,,54,45.9,15.4764,54,"Health Partners, Inc.",Commercial,51.084,94.6,,percent of total billed charges,,
"Protein, Urine, Random",,84156,CPT,Facility,Outpatient,,,,54,45.9,15.4764,54,"Health Partners, Inc.",Medicare Advantage,26.46,49,,percent of total billed charges,,
"Protein, Urine, Random",,84156,CPT,Facility,Inpatient,,,,54,45.9,15.4764,54,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Protein, Urine, Random",,84156,CPT,Facility,Both,,,,54,45.9,15.4764,54,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),32.4,60,,percent of total billed charges,,
"Protein, Urine, Random",,84156,CPT,Facility,Both,,,,54,45.9,15.4764,54,"Health Partners, Inc.",State of Minnesota Advantage Program,44.01,81.5,,percent of total billed charges,,
"Protein, Urine, Random",,84156,CPT,Facility,Both,,,,54,45.9,15.4764,54,"Health Partners, Inc.",State Public Programs,27,50,,percent of total billed charges,,
"Protein, Urine, Random",,84156,CPT,Facility,Both,,,,54,45.9,15.4764,54,Humana Insurance Company,Commercial PPO,51.3,95,,percent of total billed charges,,
"Protein, Urine, Random",,84156,CPT,Facility,Outpatient,,,,54,45.9,15.4764,54,Humana Insurance Company,Medicare PPO,26.46,49,,percent of total billed charges,,
"Protein, Urine, Random",,84156,CPT,Facility,Inpatient,,,,54,45.9,15.4764,54,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Protein, Urine, Random",,84156,CPT,Facility,Both,,,,54,45.9,15.4764,54,Medica,Individual & Family,53.514,99.1,,percent of total billed charges,,
"Protein, Urine, Random",,84156,CPT,Facility,Outpatient,,,,54,45.9,15.4764,54,Medica,Medica Advantage Solution,26.892,49.8,,percent of total billed charges,,
"Protein, Urine, Random",,84156,CPT,Facility,Inpatient,,,,54,45.9,15.4764,54,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Protein, Urine, Random",,84156,CPT,Facility,Outpatient,,,,54,45.9,15.4764,54,Medica,Medical Assistance,24.084,44.6,,percent of total billed charges,,
"Protein, Urine, Random",,84156,CPT,Facility,Inpatient,,,,54,45.9,15.4764,54,Medica,Medical Assistance,,,,,Included in per diem rate,
"Protein, Urine, Random",,84156,CPT,Facility,Outpatient,,,,54,45.9,15.4764,54,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,26.892,49.8,,percent of total billed charges,,
"Protein, Urine, Random",,84156,CPT,Facility,Inpatient,,,,54,45.9,15.4764,54,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Protein, Urine, Random",,84156,CPT,Facility,Both,,,,54,45.9,15.4764,54,"Multiplan, Inc.","Multiplan, Inc.",50.76,94,,percent of total billed charges,,
"Protein, Urine, Random",,84156,CPT,Facility,Outpatient,,,,54,45.9,15.4764,54,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,46.656,86.4,,percent of total billed charges,,
"Protein, Urine, Random",,84156,CPT,Facility,Inpatient,,,,54,45.9,15.4764,54,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Protein, Urine, Random",,84156,CPT,Facility,Both,,,,54,45.9,15.4764,54,"Preferred One Administrative Services, INC.",PPO,53.244,98.6,,percent of total billed charges,,
"Protein, Urine, Random",,84156,CPT,Facility,Outpatient,,,,54,45.9,15.4764,54,PrimeWest Health,Minnesota Senior Health Options (MSHO),27.783,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Protein, Urine, Random",,84156,CPT,Facility,Inpatient,,,,54,45.9,15.4764,54,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Protein, Urine, Random",,84156,CPT,Facility,Outpatient,,,,54,45.9,15.4764,54,PrimeWest Health,MinnesotaCare,27.7344,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Protein, Urine, Random",,84156,CPT,Facility,Inpatient,,,,54,45.9,15.4764,54,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Protein, Urine, Random",,84156,CPT,Facility,Both,,,,54,45.9,15.4764,54,Sanford Health Plan,Sanford Health Plan,49.68,92,,percent of total billed charges,,
"Protein, Urine, Random",,84156,CPT,Facility,Outpatient,,,,54,45.9,15.4764,54,"UCare Health, Inc.",Individual & Family Plan,30.429,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Protein, Urine, Random",,84156,CPT,Facility,Inpatient,,,,54,45.9,15.4764,54,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Protein, Urine, Random",,84156,CPT,Facility,Outpatient,,,,54,45.9,15.4764,54,"UCare Health, Inc.",Medical Assistance,27.2538,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Protein, Urine, Random",,84156,CPT,Facility,Inpatient,,,,54,45.9,15.4764,54,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Protein, Urine, Random",,84156,CPT,Facility,Outpatient,,,,54,45.9,15.4764,54,"UCare Health, Inc.",Medicare Advantage,27.2538,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Protein, Urine, Random",,84156,CPT,Facility,Inpatient,,,,54,45.9,15.4764,54,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Protein, Urine, Random",,84156,CPT,Facility,Outpatient,,,,54,45.9,15.4764,54,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),27.2538,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Protein, Urine, Random",,84156,CPT,Facility,Inpatient,,,,54,45.9,15.4764,54,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Protein, Urine, Random",,84156,CPT,Facility,Both,,,,54,45.9,15.4764,54,UnitedHealthcare,Individual & Family,50.76,94,,percent of total billed charges,,
"Protein, Urine, Random",,84156,CPT,Facility,Outpatient,,,,54,45.9,15.4764,54,UnitedHealthcare,Medicare Advantage,26.46,49,,percent of total billed charges,,
"Protein, Urine, Random",,84156,CPT,Facility,Inpatient,,,,54,45.9,15.4764,54,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Protein, Urine, Random",,84156,CPT,Facility,Outpatient,,,,54,45.9,15.4764,54,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,25.92,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Protein, Urine, Random",,84156,CPT,Facility,Inpatient,,,,54,45.9,15.4764,54,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Protein, Body Fluid",,84157,CPT,Facility,Both,,,,38,32.3,10.8908,38,Aetna,Commercial,34.96,92,,percent of total billed charges,,
"Protein, Body Fluid",,84157,CPT,Facility,Outpatient,,,,38,32.3,10.8908,38,Aetna,Medicare Advantage,18.62,49,,percent of total billed charges,,
"Protein, Body Fluid",,84157,CPT,Facility,Inpatient,,,,38,32.3,10.8908,38,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Protein, Body Fluid",,84157,CPT,Facility,Both,,,,38,32.3,10.8908,38,Aetna,PPO,35.34,93,,percent of total billed charges,,
"Protein, Body Fluid",,84157,CPT,Facility,Both,,,,38,32.3,10.8908,38,America's PPO,America's PPO,36.4914,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Protein, Body Fluid",,84157,CPT,Facility,Both,,,,38,32.3,10.8908,38,BlueCross BlueShield Minnesota, Federal Employee Program,37.392,98.4,,percent of total billed charges,,
"Protein, Body Fluid",,84157,CPT,Facility,Both,,,,38,32.3,10.8908,38,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,38,100,,percent of total billed charges,,
"Protein, Body Fluid",,84157,CPT,Facility,Both,,,,38,32.3,10.8908,38,BlueCross BlueShield Minnesota,High Value Network Plan,34.2,90,,percent of total billed charges,,
"Protein, Body Fluid",,84157,CPT,Facility,Outpatient,,,,38,32.3,10.8908,38,BlueCross BlueShield Minnesota,Medicare Advantage,18.62,49,,percent of total billed charges,,
"Protein, Body Fluid",,84157,CPT,Facility,Inpatient,,,,38,32.3,10.8908,38,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Protein, Body Fluid",,84157,CPT,Facility,Both,,,,38,32.3,10.8908,38,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,33.6566,88.57,,percent of total billed charges,,
"Protein, Body Fluid",,84157,CPT,Facility,Both,,,,38,32.3,10.8908,38,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,10.8908,28.66,,percent of total billed charges,,
"Protein, Body Fluid",,84157,CPT,Facility,Outpatient,,,,38,32.3,10.8908,38,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),18.62,49,,percent of total billed charges,,
"Protein, Body Fluid",,84157,CPT,Facility,Inpatient,,,,38,32.3,10.8908,38,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Protein, Body Fluid",,84157,CPT,Facility,Both,,,,38,32.3,10.8908,38,CorVel,Worker's Compensation,38,100,,percent of total billed charges,,
"Protein, Body Fluid",,84157,CPT,Facility,Both,,,,38,32.3,10.8908,38,First Health Group Corporation,First Health Network,36.86,97,,percent of total billed charges,,
"Protein, Body Fluid",,84157,CPT,Facility,Both,,,,38,32.3,10.8908,38,"Health Partners, Inc.",Commercial,35.948,94.6,,percent of total billed charges,,
"Protein, Body Fluid",,84157,CPT,Facility,Outpatient,,,,38,32.3,10.8908,38,"Health Partners, Inc.",Medicare Advantage,18.62,49,,percent of total billed charges,,
"Protein, Body Fluid",,84157,CPT,Facility,Inpatient,,,,38,32.3,10.8908,38,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Protein, Body Fluid",,84157,CPT,Facility,Both,,,,38,32.3,10.8908,38,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),22.8,60,,percent of total billed charges,,
"Protein, Body Fluid",,84157,CPT,Facility,Both,,,,38,32.3,10.8908,38,"Health Partners, Inc.",State of Minnesota Advantage Program,30.97,81.5,,percent of total billed charges,,
"Protein, Body Fluid",,84157,CPT,Facility,Both,,,,38,32.3,10.8908,38,"Health Partners, Inc.",State Public Programs,19,50,,percent of total billed charges,,
"Protein, Body Fluid",,84157,CPT,Facility,Both,,,,38,32.3,10.8908,38,Humana Insurance Company,Commercial PPO,36.1,95,,percent of total billed charges,,
"Protein, Body Fluid",,84157,CPT,Facility,Outpatient,,,,38,32.3,10.8908,38,Humana Insurance Company,Medicare PPO,18.62,49,,percent of total billed charges,,
"Protein, Body Fluid",,84157,CPT,Facility,Inpatient,,,,38,32.3,10.8908,38,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Protein, Body Fluid",,84157,CPT,Facility,Both,,,,38,32.3,10.8908,38,Medica,Individual & Family,37.658,99.1,,percent of total billed charges,,
"Protein, Body Fluid",,84157,CPT,Facility,Outpatient,,,,38,32.3,10.8908,38,Medica,Medica Advantage Solution,18.924,49.8,,percent of total billed charges,,
"Protein, Body Fluid",,84157,CPT,Facility,Inpatient,,,,38,32.3,10.8908,38,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Protein, Body Fluid",,84157,CPT,Facility,Outpatient,,,,38,32.3,10.8908,38,Medica,Medical Assistance,16.948,44.6,,percent of total billed charges,,
"Protein, Body Fluid",,84157,CPT,Facility,Inpatient,,,,38,32.3,10.8908,38,Medica,Medical Assistance,,,,,Included in per diem rate,
"Protein, Body Fluid",,84157,CPT,Facility,Outpatient,,,,38,32.3,10.8908,38,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,18.924,49.8,,percent of total billed charges,,
"Protein, Body Fluid",,84157,CPT,Facility,Inpatient,,,,38,32.3,10.8908,38,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Protein, Body Fluid",,84157,CPT,Facility,Both,,,,38,32.3,10.8908,38,"Multiplan, Inc.","Multiplan, Inc.",35.72,94,,percent of total billed charges,,
"Protein, Body Fluid",,84157,CPT,Facility,Outpatient,,,,38,32.3,10.8908,38,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,32.832,86.4,,percent of total billed charges,,
"Protein, Body Fluid",,84157,CPT,Facility,Inpatient,,,,38,32.3,10.8908,38,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Protein, Body Fluid",,84157,CPT,Facility,Both,,,,38,32.3,10.8908,38,"Preferred One Administrative Services, INC.",PPO,37.468,98.6,,percent of total billed charges,,
"Protein, Body Fluid",,84157,CPT,Facility,Outpatient,,,,38,32.3,10.8908,38,PrimeWest Health,Minnesota Senior Health Options (MSHO),19.551,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Protein, Body Fluid",,84157,CPT,Facility,Inpatient,,,,38,32.3,10.8908,38,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Protein, Body Fluid",,84157,CPT,Facility,Outpatient,,,,38,32.3,10.8908,38,PrimeWest Health,MinnesotaCare,19.5168,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Protein, Body Fluid",,84157,CPT,Facility,Inpatient,,,,38,32.3,10.8908,38,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Protein, Body Fluid",,84157,CPT,Facility,Both,,,,38,32.3,10.8908,38,Sanford Health Plan,Sanford Health Plan,34.96,92,,percent of total billed charges,,
"Protein, Body Fluid",,84157,CPT,Facility,Outpatient,,,,38,32.3,10.8908,38,"UCare Health, Inc.",Individual & Family Plan,21.413,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Protein, Body Fluid",,84157,CPT,Facility,Inpatient,,,,38,32.3,10.8908,38,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Protein, Body Fluid",,84157,CPT,Facility,Outpatient,,,,38,32.3,10.8908,38,"UCare Health, Inc.",Medical Assistance,19.1786,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Protein, Body Fluid",,84157,CPT,Facility,Inpatient,,,,38,32.3,10.8908,38,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Protein, Body Fluid",,84157,CPT,Facility,Outpatient,,,,38,32.3,10.8908,38,"UCare Health, Inc.",Medicare Advantage,19.1786,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Protein, Body Fluid",,84157,CPT,Facility,Inpatient,,,,38,32.3,10.8908,38,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Protein, Body Fluid",,84157,CPT,Facility,Outpatient,,,,38,32.3,10.8908,38,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),19.1786,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Protein, Body Fluid",,84157,CPT,Facility,Inpatient,,,,38,32.3,10.8908,38,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Protein, Body Fluid",,84157,CPT,Facility,Both,,,,38,32.3,10.8908,38,UnitedHealthcare,Individual & Family,35.72,94,,percent of total billed charges,,
"Protein, Body Fluid",,84157,CPT,Facility,Outpatient,,,,38,32.3,10.8908,38,UnitedHealthcare,Medicare Advantage,18.62,49,,percent of total billed charges,,
"Protein, Body Fluid",,84157,CPT,Facility,Inpatient,,,,38,32.3,10.8908,38,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Protein, Body Fluid",,84157,CPT,Facility,Outpatient,,,,38,32.3,10.8908,38,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,18.24,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Protein, Body Fluid",,84157,CPT,Facility,Inpatient,,,,38,32.3,10.8908,38,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Protein Electrophoresis,,84165,CPT,Facility,Both,,,,103,87.55,29.5198,103,Aetna,Commercial,94.76,92,,percent of total billed charges,,
Protein Electrophoresis,,84165,CPT,Facility,Outpatient,,,,103,87.55,29.5198,103,Aetna,Medicare Advantage,50.47,49,,percent of total billed charges,,
Protein Electrophoresis,,84165,CPT,Facility,Inpatient,,,,103,87.55,29.5198,103,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Protein Electrophoresis,,84165,CPT,Facility,Both,,,,103,87.55,29.5198,103,Aetna,PPO,95.79,93,,percent of total billed charges,,
Protein Electrophoresis,,84165,CPT,Facility,Both,,,,103,87.55,29.5198,103,America's PPO,America's PPO,98.9109,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Protein Electrophoresis,,84165,CPT,Facility,Both,,,,103,87.55,29.5198,103,BlueCross BlueShield Minnesota, Federal Employee Program,101.352,98.4,,percent of total billed charges,,
Protein Electrophoresis,,84165,CPT,Facility,Both,,,,103,87.55,29.5198,103,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,103,100,,percent of total billed charges,,
Protein Electrophoresis,,84165,CPT,Facility,Both,,,,103,87.55,29.5198,103,BlueCross BlueShield Minnesota,High Value Network Plan,92.7,90,,percent of total billed charges,,
Protein Electrophoresis,,84165,CPT,Facility,Outpatient,,,,103,87.55,29.5198,103,BlueCross BlueShield Minnesota,Medicare Advantage,50.47,49,,percent of total billed charges,,
Protein Electrophoresis,,84165,CPT,Facility,Inpatient,,,,103,87.55,29.5198,103,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Protein Electrophoresis,,84165,CPT,Facility,Both,,,,103,87.55,29.5198,103,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,91.2271,88.57,,percent of total billed charges,,
Protein Electrophoresis,,84165,CPT,Facility,Both,,,,103,87.55,29.5198,103,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,29.5198,28.66,,percent of total billed charges,,
Protein Electrophoresis,,84165,CPT,Facility,Outpatient,,,,103,87.55,29.5198,103,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),50.47,49,,percent of total billed charges,,
Protein Electrophoresis,,84165,CPT,Facility,Inpatient,,,,103,87.55,29.5198,103,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Protein Electrophoresis,,84165,CPT,Facility,Both,,,,103,87.55,29.5198,103,CorVel,Worker's Compensation,103,100,,percent of total billed charges,,
Protein Electrophoresis,,84165,CPT,Facility,Both,,,,103,87.55,29.5198,103,First Health Group Corporation,First Health Network,99.91,97,,percent of total billed charges,,
Protein Electrophoresis,,84165,CPT,Facility,Both,,,,103,87.55,29.5198,103,"Health Partners, Inc.",Commercial,97.438,94.6,,percent of total billed charges,,
Protein Electrophoresis,,84165,CPT,Facility,Outpatient,,,,103,87.55,29.5198,103,"Health Partners, Inc.",Medicare Advantage,50.47,49,,percent of total billed charges,,
Protein Electrophoresis,,84165,CPT,Facility,Inpatient,,,,103,87.55,29.5198,103,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Protein Electrophoresis,,84165,CPT,Facility,Both,,,,103,87.55,29.5198,103,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),61.8,60,,percent of total billed charges,,
Protein Electrophoresis,,84165,CPT,Facility,Both,,,,103,87.55,29.5198,103,"Health Partners, Inc.",State of Minnesota Advantage Program,83.945,81.5,,percent of total billed charges,,
Protein Electrophoresis,,84165,CPT,Facility,Both,,,,103,87.55,29.5198,103,"Health Partners, Inc.",State Public Programs,51.5,50,,percent of total billed charges,,
Protein Electrophoresis,,84165,CPT,Facility,Both,,,,103,87.55,29.5198,103,Humana Insurance Company,Commercial PPO,97.85,95,,percent of total billed charges,,
Protein Electrophoresis,,84165,CPT,Facility,Outpatient,,,,103,87.55,29.5198,103,Humana Insurance Company,Medicare PPO,50.47,49,,percent of total billed charges,,
Protein Electrophoresis,,84165,CPT,Facility,Inpatient,,,,103,87.55,29.5198,103,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Protein Electrophoresis,,84165,CPT,Facility,Both,,,,103,87.55,29.5198,103,Medica,Individual & Family,102.073,99.1,,percent of total billed charges,,
Protein Electrophoresis,,84165,CPT,Facility,Outpatient,,,,103,87.55,29.5198,103,Medica,Medica Advantage Solution,51.294,49.8,,percent of total billed charges,,
Protein Electrophoresis,,84165,CPT,Facility,Inpatient,,,,103,87.55,29.5198,103,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Protein Electrophoresis,,84165,CPT,Facility,Outpatient,,,,103,87.55,29.5198,103,Medica,Medical Assistance,45.938,44.6,,percent of total billed charges,,
Protein Electrophoresis,,84165,CPT,Facility,Inpatient,,,,103,87.55,29.5198,103,Medica,Medical Assistance,,,,,Included in per diem rate,
Protein Electrophoresis,,84165,CPT,Facility,Outpatient,,,,103,87.55,29.5198,103,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,51.294,49.8,,percent of total billed charges,,
Protein Electrophoresis,,84165,CPT,Facility,Inpatient,,,,103,87.55,29.5198,103,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Protein Electrophoresis,,84165,CPT,Facility,Both,,,,103,87.55,29.5198,103,"Multiplan, Inc.","Multiplan, Inc.",96.82,94,,percent of total billed charges,,
Protein Electrophoresis,,84165,CPT,Facility,Outpatient,,,,103,87.55,29.5198,103,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,88.992,86.4,,percent of total billed charges,,
Protein Electrophoresis,,84165,CPT,Facility,Inpatient,,,,103,87.55,29.5198,103,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Protein Electrophoresis,,84165,CPT,Facility,Both,,,,103,87.55,29.5198,103,"Preferred One Administrative Services, INC.",PPO,101.558,98.6,,percent of total billed charges,,
Protein Electrophoresis,,84165,CPT,Facility,Outpatient,,,,103,87.55,29.5198,103,PrimeWest Health,Minnesota Senior Health Options (MSHO),52.9935,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Protein Electrophoresis,,84165,CPT,Facility,Inpatient,,,,103,87.55,29.5198,103,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Protein Electrophoresis,,84165,CPT,Facility,Outpatient,,,,103,87.55,29.5198,103,PrimeWest Health,MinnesotaCare,52.9008,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Protein Electrophoresis,,84165,CPT,Facility,Inpatient,,,,103,87.55,29.5198,103,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Protein Electrophoresis,,84165,CPT,Facility,Both,,,,103,87.55,29.5198,103,Sanford Health Plan,Sanford Health Plan,94.76,92,,percent of total billed charges,,
Protein Electrophoresis,,84165,CPT,Facility,Outpatient,,,,103,87.55,29.5198,103,"UCare Health, Inc.",Individual & Family Plan,58.0405,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Protein Electrophoresis,,84165,CPT,Facility,Inpatient,,,,103,87.55,29.5198,103,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Protein Electrophoresis,,84165,CPT,Facility,Outpatient,,,,103,87.55,29.5198,103,"UCare Health, Inc.",Medical Assistance,51.9841,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Protein Electrophoresis,,84165,CPT,Facility,Inpatient,,,,103,87.55,29.5198,103,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Protein Electrophoresis,,84165,CPT,Facility,Outpatient,,,,103,87.55,29.5198,103,"UCare Health, Inc.",Medicare Advantage,51.9841,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Protein Electrophoresis,,84165,CPT,Facility,Inpatient,,,,103,87.55,29.5198,103,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Protein Electrophoresis,,84165,CPT,Facility,Outpatient,,,,103,87.55,29.5198,103,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),51.9841,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Protein Electrophoresis,,84165,CPT,Facility,Inpatient,,,,103,87.55,29.5198,103,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Protein Electrophoresis,,84165,CPT,Facility,Both,,,,103,87.55,29.5198,103,UnitedHealthcare,Individual & Family,96.82,94,,percent of total billed charges,,
Protein Electrophoresis,,84165,CPT,Facility,Outpatient,,,,103,87.55,29.5198,103,UnitedHealthcare,Medicare Advantage,50.47,49,,percent of total billed charges,,
Protein Electrophoresis,,84165,CPT,Facility,Inpatient,,,,103,87.55,29.5198,103,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Protein Electrophoresis,,84165,CPT,Facility,Outpatient,,,,103,87.55,29.5198,103,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,49.44,48,,percent of total billed charges,,100% of DHS outpatient percentage
Protein Electrophoresis,,84165,CPT,Facility,Inpatient,,,,103,87.55,29.5198,103,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Protein Electrophoresis, Urine, 24 Hr",,84166,CPT,Facility,Both,,,,120,102,34.392,120,Aetna,Commercial,110.4,92,,percent of total billed charges,,
"Protein Electrophoresis, Urine, 24 Hr",,84166,CPT,Facility,Outpatient,,,,120,102,34.392,120,Aetna,Medicare Advantage,58.8,49,,percent of total billed charges,,
"Protein Electrophoresis, Urine, 24 Hr",,84166,CPT,Facility,Inpatient,,,,120,102,34.392,120,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Protein Electrophoresis, Urine, 24 Hr",,84166,CPT,Facility,Both,,,,120,102,34.392,120,Aetna,PPO,111.6,93,,percent of total billed charges,,
"Protein Electrophoresis, Urine, 24 Hr",,84166,CPT,Facility,Both,,,,120,102,34.392,120,America's PPO,America's PPO,115.236,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Protein Electrophoresis, Urine, 24 Hr",,84166,CPT,Facility,Both,,,,120,102,34.392,120,BlueCross BlueShield Minnesota, Federal Employee Program,118.08,98.4,,percent of total billed charges,,
"Protein Electrophoresis, Urine, 24 Hr",,84166,CPT,Facility,Both,,,,120,102,34.392,120,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,120,100,,percent of total billed charges,,
"Protein Electrophoresis, Urine, 24 Hr",,84166,CPT,Facility,Both,,,,120,102,34.392,120,BlueCross BlueShield Minnesota,High Value Network Plan,108,90,,percent of total billed charges,,
"Protein Electrophoresis, Urine, 24 Hr",,84166,CPT,Facility,Outpatient,,,,120,102,34.392,120,BlueCross BlueShield Minnesota,Medicare Advantage,58.8,49,,percent of total billed charges,,
"Protein Electrophoresis, Urine, 24 Hr",,84166,CPT,Facility,Inpatient,,,,120,102,34.392,120,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Protein Electrophoresis, Urine, 24 Hr",,84166,CPT,Facility,Both,,,,120,102,34.392,120,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,106.284,88.57,,percent of total billed charges,,
"Protein Electrophoresis, Urine, 24 Hr",,84166,CPT,Facility,Both,,,,120,102,34.392,120,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,34.392,28.66,,percent of total billed charges,,
"Protein Electrophoresis, Urine, 24 Hr",,84166,CPT,Facility,Outpatient,,,,120,102,34.392,120,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),58.8,49,,percent of total billed charges,,
"Protein Electrophoresis, Urine, 24 Hr",,84166,CPT,Facility,Inpatient,,,,120,102,34.392,120,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Protein Electrophoresis, Urine, 24 Hr",,84166,CPT,Facility,Both,,,,120,102,34.392,120,CorVel,Worker's Compensation,120,100,,percent of total billed charges,,
"Protein Electrophoresis, Urine, 24 Hr",,84166,CPT,Facility,Both,,,,120,102,34.392,120,First Health Group Corporation,First Health Network,116.4,97,,percent of total billed charges,,
"Protein Electrophoresis, Urine, 24 Hr",,84166,CPT,Facility,Both,,,,120,102,34.392,120,"Health Partners, Inc.",Commercial,113.52,94.6,,percent of total billed charges,,
"Protein Electrophoresis, Urine, 24 Hr",,84166,CPT,Facility,Outpatient,,,,120,102,34.392,120,"Health Partners, Inc.",Medicare Advantage,58.8,49,,percent of total billed charges,,
"Protein Electrophoresis, Urine, 24 Hr",,84166,CPT,Facility,Inpatient,,,,120,102,34.392,120,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Protein Electrophoresis, Urine, 24 Hr",,84166,CPT,Facility,Both,,,,120,102,34.392,120,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),72,60,,percent of total billed charges,,
"Protein Electrophoresis, Urine, 24 Hr",,84166,CPT,Facility,Both,,,,120,102,34.392,120,"Health Partners, Inc.",State of Minnesota Advantage Program,97.8,81.5,,percent of total billed charges,,
"Protein Electrophoresis, Urine, 24 Hr",,84166,CPT,Facility,Both,,,,120,102,34.392,120,"Health Partners, Inc.",State Public Programs,60,50,,percent of total billed charges,,
"Protein Electrophoresis, Urine, 24 Hr",,84166,CPT,Facility,Both,,,,120,102,34.392,120,Humana Insurance Company,Commercial PPO,114,95,,percent of total billed charges,,
"Protein Electrophoresis, Urine, 24 Hr",,84166,CPT,Facility,Outpatient,,,,120,102,34.392,120,Humana Insurance Company,Medicare PPO,58.8,49,,percent of total billed charges,,
"Protein Electrophoresis, Urine, 24 Hr",,84166,CPT,Facility,Inpatient,,,,120,102,34.392,120,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Protein Electrophoresis, Urine, 24 Hr",,84166,CPT,Facility,Both,,,,120,102,34.392,120,Medica,Individual & Family,118.92,99.1,,percent of total billed charges,,
"Protein Electrophoresis, Urine, 24 Hr",,84166,CPT,Facility,Outpatient,,,,120,102,34.392,120,Medica,Medica Advantage Solution,59.76,49.8,,percent of total billed charges,,
"Protein Electrophoresis, Urine, 24 Hr",,84166,CPT,Facility,Inpatient,,,,120,102,34.392,120,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Protein Electrophoresis, Urine, 24 Hr",,84166,CPT,Facility,Outpatient,,,,120,102,34.392,120,Medica,Medical Assistance,53.52,44.6,,percent of total billed charges,,
"Protein Electrophoresis, Urine, 24 Hr",,84166,CPT,Facility,Inpatient,,,,120,102,34.392,120,Medica,Medical Assistance,,,,,Included in per diem rate,
"Protein Electrophoresis, Urine, 24 Hr",,84166,CPT,Facility,Outpatient,,,,120,102,34.392,120,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,59.76,49.8,,percent of total billed charges,,
"Protein Electrophoresis, Urine, 24 Hr",,84166,CPT,Facility,Inpatient,,,,120,102,34.392,120,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Protein Electrophoresis, Urine, 24 Hr",,84166,CPT,Facility,Both,,,,120,102,34.392,120,"Multiplan, Inc.","Multiplan, Inc.",112.8,94,,percent of total billed charges,,
"Protein Electrophoresis, Urine, 24 Hr",,84166,CPT,Facility,Outpatient,,,,120,102,34.392,120,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,103.68,86.4,,percent of total billed charges,,
"Protein Electrophoresis, Urine, 24 Hr",,84166,CPT,Facility,Inpatient,,,,120,102,34.392,120,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Protein Electrophoresis, Urine, 24 Hr",,84166,CPT,Facility,Both,,,,120,102,34.392,120,"Preferred One Administrative Services, INC.",PPO,118.32,98.6,,percent of total billed charges,,
"Protein Electrophoresis, Urine, 24 Hr",,84166,CPT,Facility,Outpatient,,,,120,102,34.392,120,PrimeWest Health,Minnesota Senior Health Options (MSHO),61.74,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Protein Electrophoresis, Urine, 24 Hr",,84166,CPT,Facility,Inpatient,,,,120,102,34.392,120,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Protein Electrophoresis, Urine, 24 Hr",,84166,CPT,Facility,Outpatient,,,,120,102,34.392,120,PrimeWest Health,MinnesotaCare,61.632,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Protein Electrophoresis, Urine, 24 Hr",,84166,CPT,Facility,Inpatient,,,,120,102,34.392,120,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Protein Electrophoresis, Urine, 24 Hr",,84166,CPT,Facility,Both,,,,120,102,34.392,120,Sanford Health Plan,Sanford Health Plan,110.4,92,,percent of total billed charges,,
"Protein Electrophoresis, Urine, 24 Hr",,84166,CPT,Facility,Outpatient,,,,120,102,34.392,120,"UCare Health, Inc.",Individual & Family Plan,67.62,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Protein Electrophoresis, Urine, 24 Hr",,84166,CPT,Facility,Inpatient,,,,120,102,34.392,120,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Protein Electrophoresis, Urine, 24 Hr",,84166,CPT,Facility,Outpatient,,,,120,102,34.392,120,"UCare Health, Inc.",Medical Assistance,60.564,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Protein Electrophoresis, Urine, 24 Hr",,84166,CPT,Facility,Inpatient,,,,120,102,34.392,120,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Protein Electrophoresis, Urine, 24 Hr",,84166,CPT,Facility,Outpatient,,,,120,102,34.392,120,"UCare Health, Inc.",Medicare Advantage,60.564,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Protein Electrophoresis, Urine, 24 Hr",,84166,CPT,Facility,Inpatient,,,,120,102,34.392,120,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Protein Electrophoresis, Urine, 24 Hr",,84166,CPT,Facility,Outpatient,,,,120,102,34.392,120,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),60.564,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Protein Electrophoresis, Urine, 24 Hr",,84166,CPT,Facility,Inpatient,,,,120,102,34.392,120,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Protein Electrophoresis, Urine, 24 Hr",,84166,CPT,Facility,Both,,,,120,102,34.392,120,UnitedHealthcare,Individual & Family,112.8,94,,percent of total billed charges,,
"Protein Electrophoresis, Urine, 24 Hr",,84166,CPT,Facility,Outpatient,,,,120,102,34.392,120,UnitedHealthcare,Medicare Advantage,58.8,49,,percent of total billed charges,,
"Protein Electrophoresis, Urine, 24 Hr",,84166,CPT,Facility,Inpatient,,,,120,102,34.392,120,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Protein Electrophoresis, Urine, 24 Hr",,84166,CPT,Facility,Outpatient,,,,120,102,34.392,120,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,57.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Protein Electrophoresis, Urine, 24 Hr",,84166,CPT,Facility,Inpatient,,,,120,102,34.392,120,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Protein Electrophoresis, Urine, Random",,84166,CPT,Facility,Both,,,,120,102,34.392,120,Aetna,Commercial,110.4,92,,percent of total billed charges,,
"Protein Electrophoresis, Urine, Random",,84166,CPT,Facility,Outpatient,,,,120,102,34.392,120,Aetna,Medicare Advantage,58.8,49,,percent of total billed charges,,
"Protein Electrophoresis, Urine, Random",,84166,CPT,Facility,Inpatient,,,,120,102,34.392,120,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Protein Electrophoresis, Urine, Random",,84166,CPT,Facility,Both,,,,120,102,34.392,120,Aetna,PPO,111.6,93,,percent of total billed charges,,
"Protein Electrophoresis, Urine, Random",,84166,CPT,Facility,Both,,,,120,102,34.392,120,America's PPO,America's PPO,115.236,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Protein Electrophoresis, Urine, Random",,84166,CPT,Facility,Both,,,,120,102,34.392,120,BlueCross BlueShield Minnesota, Federal Employee Program,118.08,98.4,,percent of total billed charges,,
"Protein Electrophoresis, Urine, Random",,84166,CPT,Facility,Both,,,,120,102,34.392,120,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,120,100,,percent of total billed charges,,
"Protein Electrophoresis, Urine, Random",,84166,CPT,Facility,Both,,,,120,102,34.392,120,BlueCross BlueShield Minnesota,High Value Network Plan,108,90,,percent of total billed charges,,
"Protein Electrophoresis, Urine, Random",,84166,CPT,Facility,Outpatient,,,,120,102,34.392,120,BlueCross BlueShield Minnesota,Medicare Advantage,58.8,49,,percent of total billed charges,,
"Protein Electrophoresis, Urine, Random",,84166,CPT,Facility,Inpatient,,,,120,102,34.392,120,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Protein Electrophoresis, Urine, Random",,84166,CPT,Facility,Both,,,,120,102,34.392,120,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,106.284,88.57,,percent of total billed charges,,
"Protein Electrophoresis, Urine, Random",,84166,CPT,Facility,Both,,,,120,102,34.392,120,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,34.392,28.66,,percent of total billed charges,,
"Protein Electrophoresis, Urine, Random",,84166,CPT,Facility,Outpatient,,,,120,102,34.392,120,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),58.8,49,,percent of total billed charges,,
"Protein Electrophoresis, Urine, Random",,84166,CPT,Facility,Inpatient,,,,120,102,34.392,120,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Protein Electrophoresis, Urine, Random",,84166,CPT,Facility,Both,,,,120,102,34.392,120,CorVel,Worker's Compensation,120,100,,percent of total billed charges,,
"Protein Electrophoresis, Urine, Random",,84166,CPT,Facility,Both,,,,120,102,34.392,120,First Health Group Corporation,First Health Network,116.4,97,,percent of total billed charges,,
"Protein Electrophoresis, Urine, Random",,84166,CPT,Facility,Both,,,,120,102,34.392,120,"Health Partners, Inc.",Commercial,113.52,94.6,,percent of total billed charges,,
"Protein Electrophoresis, Urine, Random",,84166,CPT,Facility,Outpatient,,,,120,102,34.392,120,"Health Partners, Inc.",Medicare Advantage,58.8,49,,percent of total billed charges,,
"Protein Electrophoresis, Urine, Random",,84166,CPT,Facility,Inpatient,,,,120,102,34.392,120,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Protein Electrophoresis, Urine, Random",,84166,CPT,Facility,Both,,,,120,102,34.392,120,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),72,60,,percent of total billed charges,,
"Protein Electrophoresis, Urine, Random",,84166,CPT,Facility,Both,,,,120,102,34.392,120,"Health Partners, Inc.",State of Minnesota Advantage Program,97.8,81.5,,percent of total billed charges,,
"Protein Electrophoresis, Urine, Random",,84166,CPT,Facility,Both,,,,120,102,34.392,120,"Health Partners, Inc.",State Public Programs,60,50,,percent of total billed charges,,
"Protein Electrophoresis, Urine, Random",,84166,CPT,Facility,Both,,,,120,102,34.392,120,Humana Insurance Company,Commercial PPO,114,95,,percent of total billed charges,,
"Protein Electrophoresis, Urine, Random",,84166,CPT,Facility,Outpatient,,,,120,102,34.392,120,Humana Insurance Company,Medicare PPO,58.8,49,,percent of total billed charges,,
"Protein Electrophoresis, Urine, Random",,84166,CPT,Facility,Inpatient,,,,120,102,34.392,120,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Protein Electrophoresis, Urine, Random",,84166,CPT,Facility,Both,,,,120,102,34.392,120,Medica,Individual & Family,118.92,99.1,,percent of total billed charges,,
"Protein Electrophoresis, Urine, Random",,84166,CPT,Facility,Outpatient,,,,120,102,34.392,120,Medica,Medica Advantage Solution,59.76,49.8,,percent of total billed charges,,
"Protein Electrophoresis, Urine, Random",,84166,CPT,Facility,Inpatient,,,,120,102,34.392,120,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Protein Electrophoresis, Urine, Random",,84166,CPT,Facility,Outpatient,,,,120,102,34.392,120,Medica,Medical Assistance,53.52,44.6,,percent of total billed charges,,
"Protein Electrophoresis, Urine, Random",,84166,CPT,Facility,Inpatient,,,,120,102,34.392,120,Medica,Medical Assistance,,,,,Included in per diem rate,
"Protein Electrophoresis, Urine, Random",,84166,CPT,Facility,Outpatient,,,,120,102,34.392,120,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,59.76,49.8,,percent of total billed charges,,
"Protein Electrophoresis, Urine, Random",,84166,CPT,Facility,Inpatient,,,,120,102,34.392,120,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Protein Electrophoresis, Urine, Random",,84166,CPT,Facility,Both,,,,120,102,34.392,120,"Multiplan, Inc.","Multiplan, Inc.",112.8,94,,percent of total billed charges,,
"Protein Electrophoresis, Urine, Random",,84166,CPT,Facility,Outpatient,,,,120,102,34.392,120,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,103.68,86.4,,percent of total billed charges,,
"Protein Electrophoresis, Urine, Random",,84166,CPT,Facility,Inpatient,,,,120,102,34.392,120,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Protein Electrophoresis, Urine, Random",,84166,CPT,Facility,Both,,,,120,102,34.392,120,"Preferred One Administrative Services, INC.",PPO,118.32,98.6,,percent of total billed charges,,
"Protein Electrophoresis, Urine, Random",,84166,CPT,Facility,Outpatient,,,,120,102,34.392,120,PrimeWest Health,Minnesota Senior Health Options (MSHO),61.74,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Protein Electrophoresis, Urine, Random",,84166,CPT,Facility,Inpatient,,,,120,102,34.392,120,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Protein Electrophoresis, Urine, Random",,84166,CPT,Facility,Outpatient,,,,120,102,34.392,120,PrimeWest Health,MinnesotaCare,61.632,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Protein Electrophoresis, Urine, Random",,84166,CPT,Facility,Inpatient,,,,120,102,34.392,120,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Protein Electrophoresis, Urine, Random",,84166,CPT,Facility,Both,,,,120,102,34.392,120,Sanford Health Plan,Sanford Health Plan,110.4,92,,percent of total billed charges,,
"Protein Electrophoresis, Urine, Random",,84166,CPT,Facility,Outpatient,,,,120,102,34.392,120,"UCare Health, Inc.",Individual & Family Plan,67.62,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Protein Electrophoresis, Urine, Random",,84166,CPT,Facility,Inpatient,,,,120,102,34.392,120,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Protein Electrophoresis, Urine, Random",,84166,CPT,Facility,Outpatient,,,,120,102,34.392,120,"UCare Health, Inc.",Medical Assistance,60.564,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Protein Electrophoresis, Urine, Random",,84166,CPT,Facility,Inpatient,,,,120,102,34.392,120,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Protein Electrophoresis, Urine, Random",,84166,CPT,Facility,Outpatient,,,,120,102,34.392,120,"UCare Health, Inc.",Medicare Advantage,60.564,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Protein Electrophoresis, Urine, Random",,84166,CPT,Facility,Inpatient,,,,120,102,34.392,120,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Protein Electrophoresis, Urine, Random",,84166,CPT,Facility,Outpatient,,,,120,102,34.392,120,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),60.564,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Protein Electrophoresis, Urine, Random",,84166,CPT,Facility,Inpatient,,,,120,102,34.392,120,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Protein Electrophoresis, Urine, Random",,84166,CPT,Facility,Both,,,,120,102,34.392,120,UnitedHealthcare,Individual & Family,112.8,94,,percent of total billed charges,,
"Protein Electrophoresis, Urine, Random",,84166,CPT,Facility,Outpatient,,,,120,102,34.392,120,UnitedHealthcare,Medicare Advantage,58.8,49,,percent of total billed charges,,
"Protein Electrophoresis, Urine, Random",,84166,CPT,Facility,Inpatient,,,,120,102,34.392,120,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Protein Electrophoresis, Urine, Random",,84166,CPT,Facility,Outpatient,,,,120,102,34.392,120,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,57.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Protein Electrophoresis, Urine, Random",,84166,CPT,Facility,Inpatient,,,,120,102,34.392,120,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
ATROPINE 0.1 MG/ML INJ SYRG,,J0461,HCPCS,Facility,Inpatient,10,mL,,88,74.8,25.2208,88,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
ATROPINE 0.1 MG/ML INJ SYRG,,J0461,HCPCS,Facility,Inpatient,10,mL,,88,74.8,25.2208,88,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
ATROPINE 0.1 MG/ML INJ SYRG,,J0461,HCPCS,Facility,Outpatient,10,mL,,88,74.8,25.2208,88,Medica,Medical Assistance,39.248,44.6,,percent of total billed charges,,
ATROPINE 0.1 MG/ML INJ SYRG,,J0461,HCPCS,Facility,Outpatient,10,mL,,88,74.8,25.2208,88,Medica,Medical Assistance,39.248,44.6,,percent of total billed charges,,
ATROPINE 0.1 MG/ML INJ SYRG,,J0461,HCPCS,Facility,Inpatient,10,mL,,88,74.8,25.2208,88,Medica,Medical Assistance,,,,,Included in per diem rate,
ATROPINE 0.1 MG/ML INJ SYRG,,J0461,HCPCS,Facility,Inpatient,10,mL,,88,74.8,25.2208,88,Medica,Medical Assistance,,,,,Included in per diem rate,
ATROPINE 0.1 MG/ML INJ SYRG,,J0461,HCPCS,Facility,Outpatient,10,mL,,88,74.8,25.2208,88,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,43.824,49.8,,percent of total billed charges,,
ATROPINE 0.1 MG/ML INJ SYRG,,J0461,HCPCS,Facility,Outpatient,10,mL,,88,74.8,25.2208,88,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,43.824,49.8,,percent of total billed charges,,
ATROPINE 0.1 MG/ML INJ SYRG,,J0461,HCPCS,Facility,Inpatient,10,mL,,88,74.8,25.2208,88,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
ATROPINE 0.1 MG/ML INJ SYRG,,J0461,HCPCS,Facility,Inpatient,10,mL,,88,74.8,25.2208,88,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
ATROPINE 0.1 MG/ML INJ SYRG,,J0461,HCPCS,Facility,Both,10,mL,,88,74.8,25.2208,88,"Multiplan, Inc.","Multiplan, Inc.",82.72,94,,percent of total billed charges,,
ATROPINE 0.1 MG/ML INJ SYRG,,J0461,HCPCS,Facility,Both,10,mL,,88,74.8,25.2208,88,"Multiplan, Inc.","Multiplan, Inc.",82.72,94,,percent of total billed charges,,
ATROPINE 0.1 MG/ML INJ SYRG,,J0461,HCPCS,Facility,Outpatient,10,mL,,88,74.8,25.2208,88,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,79.288,90.1,,percent of total billed charges,,
ATROPINE 0.1 MG/ML INJ SYRG,,J0461,HCPCS,Facility,Outpatient,10,mL,,88,74.8,25.2208,88,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,79.288,90.1,,percent of total billed charges,,
ATROPINE 0.1 MG/ML INJ SYRG,,J0461,HCPCS,Facility,Inpatient,10,mL,,88,74.8,25.2208,88,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
ATROPINE 0.1 MG/ML INJ SYRG,,J0461,HCPCS,Facility,Inpatient,10,mL,,88,74.8,25.2208,88,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
ATROPINE 0.1 MG/ML INJ SYRG,,J0461,HCPCS,Facility,Both,10,mL,,88,74.8,25.2208,88,"Preferred One Administrative Services, INC.",PPO,86.768,98.6,,percent of total billed charges,,
ATROPINE 0.1 MG/ML INJ SYRG,,J0461,HCPCS,Facility,Both,10,mL,,88,74.8,25.2208,88,"Preferred One Administrative Services, INC.",PPO,86.768,98.6,,percent of total billed charges,,
ATROPINE 0.1 MG/ML INJ SYRG,,J0461,HCPCS,Facility,Outpatient,10,mL,,88,74.8,25.2208,88,PrimeWest Health,Minnesota Senior Health Options (MSHO),45.276,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
ATROPINE 0.1 MG/ML INJ SYRG,,J0461,HCPCS,Facility,Outpatient,10,mL,,88,74.8,25.2208,88,PrimeWest Health,Minnesota Senior Health Options (MSHO),45.276,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
ATROPINE 0.1 MG/ML INJ SYRG,,J0461,HCPCS,Facility,Inpatient,10,mL,,88,74.8,25.2208,88,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ATROPINE 0.1 MG/ML INJ SYRG,,J0461,HCPCS,Facility,Inpatient,10,mL,,88,74.8,25.2208,88,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ATROPINE 0.1 MG/ML INJ SYRG,,J0461,HCPCS,Facility,Outpatient,10,mL,,88,74.8,25.2208,88,PrimeWest Health,MinnesotaCare,45.1968,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
ATROPINE 0.1 MG/ML INJ SYRG,,J0461,HCPCS,Facility,Outpatient,10,mL,,88,74.8,25.2208,88,PrimeWest Health,MinnesotaCare,45.1968,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
ATROPINE 0.1 MG/ML INJ SYRG,,J0461,HCPCS,Facility,Inpatient,10,mL,,88,74.8,25.2208,88,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
ATROPINE 0.1 MG/ML INJ SYRG,,J0461,HCPCS,Facility,Inpatient,10,mL,,88,74.8,25.2208,88,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
ATROPINE 0.1 MG/ML INJ SYRG,,J0461,HCPCS,Facility,Both,10,mL,,88,74.8,25.2208,88,Sanford Health Plan,Sanford Health Plan,80.96,92,,percent of total billed charges,,
ATROPINE 0.1 MG/ML INJ SYRG,,J0461,HCPCS,Facility,Both,10,mL,,88,74.8,25.2208,88,Sanford Health Plan,Sanford Health Plan,80.96,92,,percent of total billed charges,,
ATROPINE 0.1 MG/ML INJ SYRG,,J0461,HCPCS,Facility,Outpatient,10,mL,,88,74.8,25.2208,88,"UCare Health, Inc.",Individual & Family Plan,49.588,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
ATROPINE 0.1 MG/ML INJ SYRG,,J0461,HCPCS,Facility,Outpatient,10,mL,,88,74.8,25.2208,88,"UCare Health, Inc.",Individual & Family Plan,49.588,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
ATROPINE 0.1 MG/ML INJ SYRG,,J0461,HCPCS,Facility,Inpatient,10,mL,,88,74.8,25.2208,88,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
ATROPINE 0.1 MG/ML INJ SYRG,,J0461,HCPCS,Facility,Inpatient,10,mL,,88,74.8,25.2208,88,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
ATROPINE 0.1 MG/ML INJ SYRG,,J0461,HCPCS,Facility,Outpatient,10,mL,,88,74.8,25.2208,88,"UCare Health, Inc.",Medical Assistance,44.4136,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ATROPINE 0.1 MG/ML INJ SYRG,,J0461,HCPCS,Facility,Outpatient,10,mL,,88,74.8,25.2208,88,"UCare Health, Inc.",Medical Assistance,44.4136,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ATROPINE 0.1 MG/ML INJ SYRG,,J0461,HCPCS,Facility,Inpatient,10,mL,,88,74.8,25.2208,88,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
ATROPINE 0.1 MG/ML INJ SYRG,,J0461,HCPCS,Facility,Inpatient,10,mL,,88,74.8,25.2208,88,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
ATROPINE 0.1 MG/ML INJ SYRG,,J0461,HCPCS,Facility,Outpatient,10,mL,,88,74.8,25.2208,88,"UCare Health, Inc.",Medicare Advantage,44.4136,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ATROPINE 0.1 MG/ML INJ SYRG,,J0461,HCPCS,Facility,Outpatient,10,mL,,88,74.8,25.2208,88,"UCare Health, Inc.",Medicare Advantage,44.4136,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ATROPINE 0.1 MG/ML INJ SYRG,,J0461,HCPCS,Facility,Inpatient,10,mL,,88,74.8,25.2208,88,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ATROPINE 0.1 MG/ML INJ SYRG,,J0461,HCPCS,Facility,Inpatient,10,mL,,88,74.8,25.2208,88,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ATROPINE 0.1 MG/ML INJ SYRG,,J0461,HCPCS,Facility,Outpatient,10,mL,,88,74.8,25.2208,88,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),44.4136,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ATROPINE 0.1 MG/ML INJ SYRG,,J0461,HCPCS,Facility,Outpatient,10,mL,,88,74.8,25.2208,88,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),44.4136,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ATROPINE 0.1 MG/ML INJ SYRG,,J0461,HCPCS,Facility,Inpatient,10,mL,,88,74.8,25.2208,88,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ATROPINE 0.1 MG/ML INJ SYRG,,J0461,HCPCS,Facility,Inpatient,10,mL,,88,74.8,25.2208,88,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ATROPINE 0.1 MG/ML INJ SYRG,,J0461,HCPCS,Facility,Both,10,mL,,88,74.8,25.2208,88,UnitedHealthcare,Individual & Family,82.72,94,,percent of total billed charges,,
ATROPINE 0.1 MG/ML INJ SYRG,,J0461,HCPCS,Facility,Both,10,mL,,88,74.8,25.2208,88,UnitedHealthcare,Individual & Family,82.72,94,,percent of total billed charges,,
ATROPINE 0.1 MG/ML INJ SYRG,,J0461,HCPCS,Facility,Outpatient,10,mL,,88,74.8,25.2208,88,UnitedHealthcare,Medicare Advantage,43.12,49,,percent of total billed charges,,
ATROPINE 0.1 MG/ML INJ SYRG,,J0461,HCPCS,Facility,Outpatient,10,mL,,88,74.8,25.2208,88,UnitedHealthcare,Medicare Advantage,43.12,49,,percent of total billed charges,,
ATROPINE 0.1 MG/ML INJ SYRG,,J0461,HCPCS,Facility,Inpatient,10,mL,,88,74.8,25.2208,88,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
ATROPINE 0.1 MG/ML INJ SYRG,,J0461,HCPCS,Facility,Inpatient,10,mL,,88,74.8,25.2208,88,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
ATROPINE 0.1 MG/ML INJ SYRG,,J0461,HCPCS,Facility,Outpatient,10,mL,,88,74.8,25.2208,88,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,42.24,48,,percent of total billed charges,,100% of DHS outpatient percentage
ATROPINE 0.1 MG/ML INJ SYRG,,J0461,HCPCS,Facility,Outpatient,10,mL,,88,74.8,25.2208,88,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,42.24,48,,percent of total billed charges,,100% of DHS outpatient percentage
ATROPINE 0.1 MG/ML INJ SYRG,,J0461,HCPCS,Facility,Inpatient,10,mL,,88,74.8,25.2208,88,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
ATROPINE 0.1 MG/ML INJ SYRG,,J0461,HCPCS,Facility,Inpatient,10,mL,,88,74.8,25.2208,88,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
ATROPINE 0.1 MG/ML INJ SYRG (PEDS 0.5 MG MAX),,J0461,HCPCS,Facility,Both,10,mL,,52,44.2,14.9032,52,Aetna,Commercial,47.84,92,,percent of total billed charges,,
ATROPINE 0.1 MG/ML INJ SYRG (PEDS 0.5 MG MAX),,J0461,HCPCS,Facility,Outpatient,10,mL,,52,44.2,14.9032,52,Aetna,Medicare Advantage,25.48,49,,percent of total billed charges,,
ATROPINE 0.1 MG/ML INJ SYRG (PEDS 0.5 MG MAX),,J0461,HCPCS,Facility,Inpatient,10,mL,,52,44.2,14.9032,52,Aetna,Medicare Advantage,,,,,Included in per diem rate,
ATROPINE 0.1 MG/ML INJ SYRG (PEDS 0.5 MG MAX),,J0461,HCPCS,Facility,Both,10,mL,,52,44.2,14.9032,52,Aetna,PPO,48.36,93,,percent of total billed charges,,
ATROPINE 0.1 MG/ML INJ SYRG (PEDS 0.5 MG MAX),,J0461,HCPCS,Facility,Both,10,mL,,52,44.2,14.9032,52,America's PPO,America's PPO,49.9356,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
ATROPINE 0.1 MG/ML INJ SYRG (PEDS 0.5 MG MAX),,J0461,HCPCS,Facility,Both,10,mL,,52,44.2,14.9032,52,BlueCross BlueShield Minnesota, Federal Employee Program,51.168,98.4,,percent of total billed charges,,
ATROPINE 0.1 MG/ML INJ SYRG (PEDS 0.5 MG MAX),,J0461,HCPCS,Facility,Both,10,mL,,52,44.2,14.9032,52,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,52,100,,percent of total billed charges,,
ATROPINE 0.1 MG/ML INJ SYRG (PEDS 0.5 MG MAX),,J0461,HCPCS,Facility,Both,10,mL,,52,44.2,14.9032,52,BlueCross BlueShield Minnesota,High Value Network Plan,46.8,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
ATROPINE 0.1 MG/ML INJ SYRG (PEDS 0.5 MG MAX),,J0461,HCPCS,Facility,Outpatient,10,mL,,52,44.2,14.9032,52,BlueCross BlueShield Minnesota,Medicare Advantage,25.48,49,,percent of total billed charges,,
ATROPINE 0.1 MG/ML INJ SYRG (PEDS 0.5 MG MAX),,J0461,HCPCS,Facility,Inpatient,10,mL,,52,44.2,14.9032,52,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
ATROPINE 0.1 MG/ML INJ SYRG (PEDS 0.5 MG MAX),,J0461,HCPCS,Facility,Both,10,mL,,52,44.2,14.9032,52,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,46.0564,88.57,,percent of total billed charges,,
ATROPINE 0.1 MG/ML INJ SYRG (PEDS 0.5 MG MAX),,J0461,HCPCS,Facility,Both,10,mL,,52,44.2,14.9032,52,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,14.9032,28.66,,percent of total billed charges,,
ATROPINE 0.1 MG/ML INJ SYRG (PEDS 0.5 MG MAX),,J0461,HCPCS,Facility,Outpatient,10,mL,,52,44.2,14.9032,52,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),25.48,49,,percent of total billed charges,,
ATROPINE 0.1 MG/ML INJ SYRG (PEDS 0.5 MG MAX),,J0461,HCPCS,Facility,Inpatient,10,mL,,52,44.2,14.9032,52,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
ATROPINE 0.1 MG/ML INJ SYRG (PEDS 0.5 MG MAX),,J0461,HCPCS,Facility,Both,10,mL,,52,44.2,14.9032,52,CorVel,Worker's Compensation,52,100,,percent of total billed charges,,
ATROPINE 0.1 MG/ML INJ SYRG (PEDS 0.5 MG MAX),,J0461,HCPCS,Facility,Both,10,mL,,52,44.2,14.9032,52,First Health Group Corporation,First Health Network,50.44,97,,percent of total billed charges,,
ATROPINE 0.1 MG/ML INJ SYRG (PEDS 0.5 MG MAX),,J0461,HCPCS,Facility,Both,10,mL,,52,44.2,14.9032,52,"Health Partners, Inc.",Commercial,49.192,94.6,,percent of total billed charges,,
ATROPINE 0.1 MG/ML INJ SYRG (PEDS 0.5 MG MAX),,J0461,HCPCS,Facility,Outpatient,10,mL,,52,44.2,14.9032,52,"Health Partners, Inc.",Medicare Advantage,25.48,49,,percent of total billed charges,,
ATROPINE 0.1 MG/ML INJ SYRG (PEDS 0.5 MG MAX),,J0461,HCPCS,Facility,Inpatient,10,mL,,52,44.2,14.9032,52,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ATROPINE 0.1 MG/ML INJ SYRG (PEDS 0.5 MG MAX),,J0461,HCPCS,Facility,Both,10,mL,,52,44.2,14.9032,52,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),31.2,60,,percent of total billed charges,,
ATROPINE 0.1 MG/ML INJ SYRG (PEDS 0.5 MG MAX),,J0461,HCPCS,Facility,Both,10,mL,,52,44.2,14.9032,52,"Health Partners, Inc.",State of Minnesota Advantage Program,42.38,81.5,,percent of total billed charges,,
ATROPINE 0.1 MG/ML INJ SYRG (PEDS 0.5 MG MAX),,J0461,HCPCS,Facility,Both,10,mL,,52,44.2,14.9032,52,"Health Partners, Inc.",State Public Programs,26,50,,percent of total billed charges,,
ATROPINE 0.1 MG/ML INJ SYRG (PEDS 0.5 MG MAX),,J0461,HCPCS,Facility,Both,10,mL,,52,44.2,14.9032,52,Humana Insurance Company,Commercial PPO,49.4,95,,percent of total billed charges,,
ATROPINE 0.1 MG/ML INJ SYRG (PEDS 0.5 MG MAX),,J0461,HCPCS,Facility,Outpatient,10,mL,,52,44.2,14.9032,52,Humana Insurance Company,Medicare PPO,25.48,49,,percent of total billed charges,,
ATROPINE 0.1 MG/ML INJ SYRG (PEDS 0.5 MG MAX),,J0461,HCPCS,Facility,Inpatient,10,mL,,52,44.2,14.9032,52,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
ATROPINE 0.1 MG/ML INJ SYRG (PEDS 0.5 MG MAX),,J0461,HCPCS,Facility,Both,10,mL,,52,44.2,14.9032,52,Medica,Individual & Family,51.532,99.1,,percent of total billed charges,,
ATROPINE 0.1 MG/ML INJ SYRG (PEDS 0.5 MG MAX),,J0461,HCPCS,Facility,Outpatient,10,mL,,52,44.2,14.9032,52,Medica,Medica Advantage Solution,25.896,49.8,,percent of total billed charges,,
ATROPINE 0.1 MG/ML INJ SYRG (PEDS 0.5 MG MAX),,J0461,HCPCS,Facility,Inpatient,10,mL,,52,44.2,14.9032,52,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
ATROPINE 0.1 MG/ML INJ SYRG (PEDS 0.5 MG MAX),,J0461,HCPCS,Facility,Outpatient,10,mL,,52,44.2,14.9032,52,Medica,Medical Assistance,23.192,44.6,,percent of total billed charges,,
ATROPINE 0.1 MG/ML INJ SYRG (PEDS 0.5 MG MAX),,J0461,HCPCS,Facility,Inpatient,10,mL,,52,44.2,14.9032,52,Medica,Medical Assistance,,,,,Included in per diem rate,
ATROPINE 0.1 MG/ML INJ SYRG (PEDS 0.5 MG MAX),,J0461,HCPCS,Facility,Outpatient,10,mL,,52,44.2,14.9032,52,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,25.896,49.8,,percent of total billed charges,,
ATROPINE 0.1 MG/ML INJ SYRG (PEDS 0.5 MG MAX),,J0461,HCPCS,Facility,Inpatient,10,mL,,52,44.2,14.9032,52,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
ATROPINE 0.1 MG/ML INJ SYRG (PEDS 0.5 MG MAX),,J0461,HCPCS,Facility,Both,10,mL,,52,44.2,14.9032,52,"Multiplan, Inc.","Multiplan, Inc.",48.88,94,,percent of total billed charges,,
ATROPINE 0.1 MG/ML INJ SYRG (PEDS 0.5 MG MAX),,J0461,HCPCS,Facility,Outpatient,10,mL,,52,44.2,14.9032,52,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,46.852,90.1,,percent of total billed charges,,
ATROPINE 0.1 MG/ML INJ SYRG (PEDS 0.5 MG MAX),,J0461,HCPCS,Facility,Inpatient,10,mL,,52,44.2,14.9032,52,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
ATROPINE 0.1 MG/ML INJ SYRG (PEDS 0.5 MG MAX),,J0461,HCPCS,Facility,Both,10,mL,,52,44.2,14.9032,52,"Preferred One Administrative Services, INC.",PPO,51.272,98.6,,percent of total billed charges,,
ATROPINE 0.1 MG/ML INJ SYRG (PEDS 0.5 MG MAX),,J0461,HCPCS,Facility,Outpatient,10,mL,,52,44.2,14.9032,52,PrimeWest Health,Minnesota Senior Health Options (MSHO),26.754,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
ATROPINE 0.1 MG/ML INJ SYRG (PEDS 0.5 MG MAX),,J0461,HCPCS,Facility,Inpatient,10,mL,,52,44.2,14.9032,52,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ATROPINE 0.1 MG/ML INJ SYRG (PEDS 0.5 MG MAX),,J0461,HCPCS,Facility,Outpatient,10,mL,,52,44.2,14.9032,52,PrimeWest Health,MinnesotaCare,26.7072,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
ATROPINE 0.1 MG/ML INJ SYRG (PEDS 0.5 MG MAX),,J0461,HCPCS,Facility,Inpatient,10,mL,,52,44.2,14.9032,52,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
ATROPINE 0.1 MG/ML INJ SYRG (PEDS 0.5 MG MAX),,J0461,HCPCS,Facility,Both,10,mL,,52,44.2,14.9032,52,Sanford Health Plan,Sanford Health Plan,47.84,92,,percent of total billed charges,,
ATROPINE 0.1 MG/ML INJ SYRG (PEDS 0.5 MG MAX),,J0461,HCPCS,Facility,Outpatient,10,mL,,52,44.2,14.9032,52,"UCare Health, Inc.",Individual & Family Plan,29.302,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
ATROPINE 0.1 MG/ML INJ SYRG (PEDS 0.5 MG MAX),,J0461,HCPCS,Facility,Inpatient,10,mL,,52,44.2,14.9032,52,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
ATROPINE 0.1 MG/ML INJ SYRG (PEDS 0.5 MG MAX),,J0461,HCPCS,Facility,Outpatient,10,mL,,52,44.2,14.9032,52,"UCare Health, Inc.",Medical Assistance,26.2444,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ATROPINE 0.1 MG/ML INJ SYRG (PEDS 0.5 MG MAX),,J0461,HCPCS,Facility,Inpatient,10,mL,,52,44.2,14.9032,52,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
ATROPINE 0.1 MG/ML INJ SYRG (PEDS 0.5 MG MAX),,J0461,HCPCS,Facility,Outpatient,10,mL,,52,44.2,14.9032,52,"UCare Health, Inc.",Medicare Advantage,26.2444,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ATROPINE 0.1 MG/ML INJ SYRG (PEDS 0.5 MG MAX),,J0461,HCPCS,Facility,Inpatient,10,mL,,52,44.2,14.9032,52,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ATROPINE 0.1 MG/ML INJ SYRG (PEDS 0.5 MG MAX),,J0461,HCPCS,Facility,Outpatient,10,mL,,52,44.2,14.9032,52,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),26.2444,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ATROPINE 0.1 MG/ML INJ SYRG (PEDS 0.5 MG MAX),,J0461,HCPCS,Facility,Inpatient,10,mL,,52,44.2,14.9032,52,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ATROPINE 0.1 MG/ML INJ SYRG (PEDS 0.5 MG MAX),,J0461,HCPCS,Facility,Both,10,mL,,52,44.2,14.9032,52,UnitedHealthcare,Individual & Family,48.88,94,,percent of total billed charges,,
ATROPINE 0.1 MG/ML INJ SYRG (PEDS 0.5 MG MAX),,J0461,HCPCS,Facility,Outpatient,10,mL,,52,44.2,14.9032,52,UnitedHealthcare,Medicare Advantage,25.48,49,,percent of total billed charges,,
ATROPINE 0.1 MG/ML INJ SYRG (PEDS 0.5 MG MAX),,J0461,HCPCS,Facility,Inpatient,10,mL,,52,44.2,14.9032,52,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
ATROPINE 0.1 MG/ML INJ SYRG (PEDS 0.5 MG MAX),,J0461,HCPCS,Facility,Outpatient,10,mL,,52,44.2,14.9032,52,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,24.96,48,,percent of total billed charges,,100% of DHS outpatient percentage
ATROPINE 0.1 MG/ML INJ SYRG (PEDS 0.5 MG MAX),,J0461,HCPCS,Facility,Inpatient,10,mL,,52,44.2,14.9032,52,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Sodium,,84295,CPT,Facility,Both,,,,55,46.75,15.763,55,Aetna,Commercial,50.6,92,,percent of total billed charges,,
Sodium,,84295,CPT,Facility,Outpatient,,,,55,46.75,15.763,55,Aetna,Medicare Advantage,26.95,49,,percent of total billed charges,,
Sodium,,84295,CPT,Facility,Inpatient,,,,55,46.75,15.763,55,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Sodium,,84295,CPT,Facility,Both,,,,55,46.75,15.763,55,Aetna,PPO,51.15,93,,percent of total billed charges,,
Sodium,,84295,CPT,Facility,Both,,,,55,46.75,15.763,55,America's PPO,America's PPO,52.8165,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Sodium,,84295,CPT,Facility,Both,,,,55,46.75,15.763,55,BlueCross BlueShield Minnesota, Federal Employee Program,54.12,98.4,,percent of total billed charges,,
Sodium,,84295,CPT,Facility,Both,,,,55,46.75,15.763,55,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,55,100,,percent of total billed charges,,
Sodium,,84295,CPT,Facility,Both,,,,55,46.75,15.763,55,BlueCross BlueShield Minnesota,High Value Network Plan,49.5,90,,percent of total billed charges,,
Sodium,,84295,CPT,Facility,Outpatient,,,,55,46.75,15.763,55,BlueCross BlueShield Minnesota,Medicare Advantage,26.95,49,,percent of total billed charges,,
Sodium,,84295,CPT,Facility,Inpatient,,,,55,46.75,15.763,55,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Sodium,,84295,CPT,Facility,Both,,,,55,46.75,15.763,55,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,48.7135,88.57,,percent of total billed charges,,
Sodium,,84295,CPT,Facility,Both,,,,55,46.75,15.763,55,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,15.763,28.66,,percent of total billed charges,,
Sodium,,84295,CPT,Facility,Outpatient,,,,55,46.75,15.763,55,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),26.95,49,,percent of total billed charges,,
Sodium,,84295,CPT,Facility,Inpatient,,,,55,46.75,15.763,55,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Sodium,,84295,CPT,Facility,Both,,,,55,46.75,15.763,55,CorVel,Worker's Compensation,55,100,,percent of total billed charges,,
Sodium,,84295,CPT,Facility,Both,,,,55,46.75,15.763,55,First Health Group Corporation,First Health Network,53.35,97,,percent of total billed charges,,
Sodium,,84295,CPT,Facility,Both,,,,55,46.75,15.763,55,"Health Partners, Inc.",Commercial,52.03,94.6,,percent of total billed charges,,
Sodium,,84295,CPT,Facility,Outpatient,,,,55,46.75,15.763,55,"Health Partners, Inc.",Medicare Advantage,26.95,49,,percent of total billed charges,,
Sodium,,84295,CPT,Facility,Inpatient,,,,55,46.75,15.763,55,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sodium,,84295,CPT,Facility,Both,,,,55,46.75,15.763,55,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),33,60,,percent of total billed charges,,
Sodium,,84295,CPT,Facility,Both,,,,55,46.75,15.763,55,"Health Partners, Inc.",State of Minnesota Advantage Program,44.825,81.5,,percent of total billed charges,,
Sodium,,84295,CPT,Facility,Both,,,,55,46.75,15.763,55,"Health Partners, Inc.",State Public Programs,27.5,50,,percent of total billed charges,,
Sodium,,84295,CPT,Facility,Both,,,,55,46.75,15.763,55,Humana Insurance Company,Commercial PPO,52.25,95,,percent of total billed charges,,
Sodium,,84295,CPT,Facility,Outpatient,,,,55,46.75,15.763,55,Humana Insurance Company,Medicare PPO,26.95,49,,percent of total billed charges,,
Sodium,,84295,CPT,Facility,Inpatient,,,,55,46.75,15.763,55,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Sodium,,84295,CPT,Facility,Both,,,,55,46.75,15.763,55,Medica,Individual & Family,54.505,99.1,,percent of total billed charges,,
Sodium,,84295,CPT,Facility,Outpatient,,,,55,46.75,15.763,55,Medica,Medica Advantage Solution,27.39,49.8,,percent of total billed charges,,
Sodium,,84295,CPT,Facility,Inpatient,,,,55,46.75,15.763,55,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Sodium,,84295,CPT,Facility,Outpatient,,,,55,46.75,15.763,55,Medica,Medical Assistance,24.53,44.6,,percent of total billed charges,,
Sodium,,84295,CPT,Facility,Inpatient,,,,55,46.75,15.763,55,Medica,Medical Assistance,,,,,Included in per diem rate,
Sodium,,84295,CPT,Facility,Outpatient,,,,55,46.75,15.763,55,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,27.39,49.8,,percent of total billed charges,,
Sodium,,84295,CPT,Facility,Inpatient,,,,55,46.75,15.763,55,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Sodium,,84295,CPT,Facility,Both,,,,55,46.75,15.763,55,"Multiplan, Inc.","Multiplan, Inc.",51.7,94,,percent of total billed charges,,
Sodium,,84295,CPT,Facility,Outpatient,,,,55,46.75,15.763,55,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,47.52,86.4,,percent of total billed charges,,
Sodium,,84295,CPT,Facility,Inpatient,,,,55,46.75,15.763,55,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Sodium,,84295,CPT,Facility,Both,,,,55,46.75,15.763,55,"Preferred One Administrative Services, INC.",PPO,54.23,98.6,,percent of total billed charges,,
Sodium,,84295,CPT,Facility,Outpatient,,,,55,46.75,15.763,55,PrimeWest Health,Minnesota Senior Health Options (MSHO),28.2975,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Sodium,,84295,CPT,Facility,Inpatient,,,,55,46.75,15.763,55,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sodium,,84295,CPT,Facility,Outpatient,,,,55,46.75,15.763,55,PrimeWest Health,MinnesotaCare,28.248,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Sodium,,84295,CPT,Facility,Inpatient,,,,55,46.75,15.763,55,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Sodium,,84295,CPT,Facility,Both,,,,55,46.75,15.763,55,Sanford Health Plan,Sanford Health Plan,50.6,92,,percent of total billed charges,,
Sodium,,84295,CPT,Facility,Outpatient,,,,55,46.75,15.763,55,"UCare Health, Inc.",Individual & Family Plan,30.9925,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Sodium,,84295,CPT,Facility,Inpatient,,,,55,46.75,15.763,55,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Sodium,,84295,CPT,Facility,Outpatient,,,,55,46.75,15.763,55,"UCare Health, Inc.",Medical Assistance,27.7585,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sodium,,84295,CPT,Facility,Inpatient,,,,55,46.75,15.763,55,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Sodium,,84295,CPT,Facility,Outpatient,,,,55,46.75,15.763,55,"UCare Health, Inc.",Medicare Advantage,27.7585,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sodium,,84295,CPT,Facility,Inpatient,,,,55,46.75,15.763,55,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sodium,,84295,CPT,Facility,Outpatient,,,,55,46.75,15.763,55,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),27.7585,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sodium,,84295,CPT,Facility,Inpatient,,,,55,46.75,15.763,55,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sodium,,84295,CPT,Facility,Both,,,,55,46.75,15.763,55,UnitedHealthcare,Individual & Family,51.7,94,,percent of total billed charges,,
Sodium,,84295,CPT,Facility,Outpatient,,,,55,46.75,15.763,55,UnitedHealthcare,Medicare Advantage,26.95,49,,percent of total billed charges,,
Sodium,,84295,CPT,Facility,Inpatient,,,,55,46.75,15.763,55,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Sodium,,84295,CPT,Facility,Outpatient,,,,55,46.75,15.763,55,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,26.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
Sodium,,84295,CPT,Facility,Inpatient,,,,55,46.75,15.763,55,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Sodium, Urine, 24 Hr",,84300,CPT,Facility,Both,,,,55,46.75,15.763,55,Aetna,Commercial,50.6,92,,percent of total billed charges,,
"Sodium, Urine, 24 Hr",,84300,CPT,Facility,Outpatient,,,,55,46.75,15.763,55,Aetna,Medicare Advantage,26.95,49,,percent of total billed charges,,
"Sodium, Urine, 24 Hr",,84300,CPT,Facility,Inpatient,,,,55,46.75,15.763,55,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Sodium, Urine, 24 Hr",,84300,CPT,Facility,Both,,,,55,46.75,15.763,55,Aetna,PPO,51.15,93,,percent of total billed charges,,
"Sodium, Urine, 24 Hr",,84300,CPT,Facility,Both,,,,55,46.75,15.763,55,America's PPO,America's PPO,52.8165,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Sodium, Urine, 24 Hr",,84300,CPT,Facility,Both,,,,55,46.75,15.763,55,BlueCross BlueShield Minnesota, Federal Employee Program,54.12,98.4,,percent of total billed charges,,
"Sodium, Urine, 24 Hr",,84300,CPT,Facility,Both,,,,55,46.75,15.763,55,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,55,100,,percent of total billed charges,,
"Sodium, Urine, 24 Hr",,84300,CPT,Facility,Both,,,,55,46.75,15.763,55,BlueCross BlueShield Minnesota,High Value Network Plan,49.5,90,,percent of total billed charges,,
"Sodium, Urine, 24 Hr",,84300,CPT,Facility,Outpatient,,,,55,46.75,15.763,55,BlueCross BlueShield Minnesota,Medicare Advantage,26.95,49,,percent of total billed charges,,
"Sodium, Urine, 24 Hr",,84300,CPT,Facility,Inpatient,,,,55,46.75,15.763,55,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Sodium, Urine, 24 Hr",,84300,CPT,Facility,Both,,,,55,46.75,15.763,55,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,48.7135,88.57,,percent of total billed charges,,
"Sodium, Urine, 24 Hr",,84300,CPT,Facility,Both,,,,55,46.75,15.763,55,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,15.763,28.66,,percent of total billed charges,,
"Sodium, Urine, 24 Hr",,84300,CPT,Facility,Outpatient,,,,55,46.75,15.763,55,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),26.95,49,,percent of total billed charges,,
"Sodium, Urine, 24 Hr",,84300,CPT,Facility,Inpatient,,,,55,46.75,15.763,55,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Sodium, Urine, 24 Hr",,84300,CPT,Facility,Both,,,,55,46.75,15.763,55,CorVel,Worker's Compensation,55,100,,percent of total billed charges,,
"Sodium, Urine, 24 Hr",,84300,CPT,Facility,Both,,,,55,46.75,15.763,55,First Health Group Corporation,First Health Network,53.35,97,,percent of total billed charges,,
"Sodium, Urine, 24 Hr",,84300,CPT,Facility,Both,,,,55,46.75,15.763,55,"Health Partners, Inc.",Commercial,52.03,94.6,,percent of total billed charges,,
"Sodium, Urine, 24 Hr",,84300,CPT,Facility,Outpatient,,,,55,46.75,15.763,55,"Health Partners, Inc.",Medicare Advantage,26.95,49,,percent of total billed charges,,
"Sodium, Urine, 24 Hr",,84300,CPT,Facility,Inpatient,,,,55,46.75,15.763,55,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Sodium, Urine, 24 Hr",,84300,CPT,Facility,Both,,,,55,46.75,15.763,55,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),33,60,,percent of total billed charges,,
"Sodium, Urine, 24 Hr",,84300,CPT,Facility,Both,,,,55,46.75,15.763,55,"Health Partners, Inc.",State of Minnesota Advantage Program,44.825,81.5,,percent of total billed charges,,
"Sodium, Urine, 24 Hr",,84300,CPT,Facility,Both,,,,55,46.75,15.763,55,"Health Partners, Inc.",State Public Programs,27.5,50,,percent of total billed charges,,
"Sodium, Urine, 24 Hr",,84300,CPT,Facility,Both,,,,55,46.75,15.763,55,Humana Insurance Company,Commercial PPO,52.25,95,,percent of total billed charges,,
"Sodium, Urine, 24 Hr",,84300,CPT,Facility,Outpatient,,,,55,46.75,15.763,55,Humana Insurance Company,Medicare PPO,26.95,49,,percent of total billed charges,,
"Sodium, Urine, 24 Hr",,84300,CPT,Facility,Inpatient,,,,55,46.75,15.763,55,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Sodium, Urine, 24 Hr",,84300,CPT,Facility,Both,,,,55,46.75,15.763,55,Medica,Individual & Family,54.505,99.1,,percent of total billed charges,,
"Sodium, Urine, 24 Hr",,84300,CPT,Facility,Outpatient,,,,55,46.75,15.763,55,Medica,Medica Advantage Solution,27.39,49.8,,percent of total billed charges,,
"Sodium, Urine, 24 Hr",,84300,CPT,Facility,Inpatient,,,,55,46.75,15.763,55,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Sodium, Urine, 24 Hr",,84300,CPT,Facility,Outpatient,,,,55,46.75,15.763,55,Medica,Medical Assistance,24.53,44.6,,percent of total billed charges,,
"Sodium, Urine, 24 Hr",,84300,CPT,Facility,Inpatient,,,,55,46.75,15.763,55,Medica,Medical Assistance,,,,,Included in per diem rate,
"Sodium, Urine, 24 Hr",,84300,CPT,Facility,Outpatient,,,,55,46.75,15.763,55,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,27.39,49.8,,percent of total billed charges,,
"Sodium, Urine, 24 Hr",,84300,CPT,Facility,Inpatient,,,,55,46.75,15.763,55,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Sodium, Urine, 24 Hr",,84300,CPT,Facility,Both,,,,55,46.75,15.763,55,"Multiplan, Inc.","Multiplan, Inc.",51.7,94,,percent of total billed charges,,
"Sodium, Urine, 24 Hr",,84300,CPT,Facility,Outpatient,,,,55,46.75,15.763,55,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,47.52,86.4,,percent of total billed charges,,
"Sodium, Urine, 24 Hr",,84300,CPT,Facility,Inpatient,,,,55,46.75,15.763,55,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Sodium, Urine, 24 Hr",,84300,CPT,Facility,Both,,,,55,46.75,15.763,55,"Preferred One Administrative Services, INC.",PPO,54.23,98.6,,percent of total billed charges,,
"Sodium, Urine, 24 Hr",,84300,CPT,Facility,Outpatient,,,,55,46.75,15.763,55,PrimeWest Health,Minnesota Senior Health Options (MSHO),28.2975,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Sodium, Urine, 24 Hr",,84300,CPT,Facility,Inpatient,,,,55,46.75,15.763,55,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Sodium, Urine, 24 Hr",,84300,CPT,Facility,Outpatient,,,,55,46.75,15.763,55,PrimeWest Health,MinnesotaCare,28.248,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Sodium, Urine, 24 Hr",,84300,CPT,Facility,Inpatient,,,,55,46.75,15.763,55,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Sodium, Urine, 24 Hr",,84300,CPT,Facility,Both,,,,55,46.75,15.763,55,Sanford Health Plan,Sanford Health Plan,50.6,92,,percent of total billed charges,,
"Sodium, Urine, 24 Hr",,84300,CPT,Facility,Outpatient,,,,55,46.75,15.763,55,"UCare Health, Inc.",Individual & Family Plan,30.9925,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Sodium, Urine, 24 Hr",,84300,CPT,Facility,Inpatient,,,,55,46.75,15.763,55,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Sodium, Urine, 24 Hr",,84300,CPT,Facility,Outpatient,,,,55,46.75,15.763,55,"UCare Health, Inc.",Medical Assistance,27.7585,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Sodium, Urine, 24 Hr",,84300,CPT,Facility,Inpatient,,,,55,46.75,15.763,55,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Sodium, Urine, 24 Hr",,84300,CPT,Facility,Outpatient,,,,55,46.75,15.763,55,"UCare Health, Inc.",Medicare Advantage,27.7585,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Sodium, Urine, 24 Hr",,84300,CPT,Facility,Inpatient,,,,55,46.75,15.763,55,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Sodium, Urine, 24 Hr",,84300,CPT,Facility,Outpatient,,,,55,46.75,15.763,55,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),27.7585,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Sodium, Urine, 24 Hr",,84300,CPT,Facility,Inpatient,,,,55,46.75,15.763,55,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Sodium, Urine, 24 Hr",,84300,CPT,Facility,Both,,,,55,46.75,15.763,55,UnitedHealthcare,Individual & Family,51.7,94,,percent of total billed charges,,
"Sodium, Urine, 24 Hr",,84300,CPT,Facility,Outpatient,,,,55,46.75,15.763,55,UnitedHealthcare,Medicare Advantage,26.95,49,,percent of total billed charges,,
"Sodium, Urine, 24 Hr",,84300,CPT,Facility,Inpatient,,,,55,46.75,15.763,55,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Sodium, Urine, 24 Hr",,84300,CPT,Facility,Outpatient,,,,55,46.75,15.763,55,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,26.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Sodium, Urine, 24 Hr",,84300,CPT,Facility,Inpatient,,,,55,46.75,15.763,55,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Sodium, Urine, Random",,84300,CPT,Facility,Both,,,,55,46.75,15.763,55,Aetna,Commercial,50.6,92,,percent of total billed charges,,
"Sodium, Urine, Random",,84300,CPT,Facility,Outpatient,,,,55,46.75,15.763,55,Aetna,Medicare Advantage,26.95,49,,percent of total billed charges,,
"Sodium, Urine, Random",,84300,CPT,Facility,Inpatient,,,,55,46.75,15.763,55,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Sodium, Urine, Random",,84300,CPT,Facility,Both,,,,55,46.75,15.763,55,Aetna,PPO,51.15,93,,percent of total billed charges,,
"Sodium, Urine, Random",,84300,CPT,Facility,Both,,,,55,46.75,15.763,55,America's PPO,America's PPO,52.8165,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Sodium, Urine, Random",,84300,CPT,Facility,Both,,,,55,46.75,15.763,55,BlueCross BlueShield Minnesota, Federal Employee Program,54.12,98.4,,percent of total billed charges,,
"Sodium, Urine, Random",,84300,CPT,Facility,Both,,,,55,46.75,15.763,55,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,55,100,,percent of total billed charges,,
"Sodium, Urine, Random",,84300,CPT,Facility,Both,,,,55,46.75,15.763,55,BlueCross BlueShield Minnesota,High Value Network Plan,49.5,90,,percent of total billed charges,,
"Sodium, Urine, Random",,84300,CPT,Facility,Outpatient,,,,55,46.75,15.763,55,BlueCross BlueShield Minnesota,Medicare Advantage,26.95,49,,percent of total billed charges,,
"Sodium, Urine, Random",,84300,CPT,Facility,Inpatient,,,,55,46.75,15.763,55,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Sodium, Urine, Random",,84300,CPT,Facility,Both,,,,55,46.75,15.763,55,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,48.7135,88.57,,percent of total billed charges,,
"Sodium, Urine, Random",,84300,CPT,Facility,Both,,,,55,46.75,15.763,55,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,15.763,28.66,,percent of total billed charges,,
"Sodium, Urine, Random",,84300,CPT,Facility,Outpatient,,,,55,46.75,15.763,55,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),26.95,49,,percent of total billed charges,,
"Sodium, Urine, Random",,84300,CPT,Facility,Inpatient,,,,55,46.75,15.763,55,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Sodium, Urine, Random",,84300,CPT,Facility,Both,,,,55,46.75,15.763,55,CorVel,Worker's Compensation,55,100,,percent of total billed charges,,
"Sodium, Urine, Random",,84300,CPT,Facility,Both,,,,55,46.75,15.763,55,First Health Group Corporation,First Health Network,53.35,97,,percent of total billed charges,,
"Sodium, Urine, Random",,84300,CPT,Facility,Both,,,,55,46.75,15.763,55,"Health Partners, Inc.",Commercial,52.03,94.6,,percent of total billed charges,,
"Sodium, Urine, Random",,84300,CPT,Facility,Outpatient,,,,55,46.75,15.763,55,"Health Partners, Inc.",Medicare Advantage,26.95,49,,percent of total billed charges,,
"Sodium, Urine, Random",,84300,CPT,Facility,Inpatient,,,,55,46.75,15.763,55,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Sodium, Urine, Random",,84300,CPT,Facility,Both,,,,55,46.75,15.763,55,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),33,60,,percent of total billed charges,,
"Sodium, Urine, Random",,84300,CPT,Facility,Both,,,,55,46.75,15.763,55,"Health Partners, Inc.",State of Minnesota Advantage Program,44.825,81.5,,percent of total billed charges,,
"Sodium, Urine, Random",,84300,CPT,Facility,Both,,,,55,46.75,15.763,55,"Health Partners, Inc.",State Public Programs,27.5,50,,percent of total billed charges,,
"Sodium, Urine, Random",,84300,CPT,Facility,Both,,,,55,46.75,15.763,55,Humana Insurance Company,Commercial PPO,52.25,95,,percent of total billed charges,,
"Sodium, Urine, Random",,84300,CPT,Facility,Outpatient,,,,55,46.75,15.763,55,Humana Insurance Company,Medicare PPO,26.95,49,,percent of total billed charges,,
"Sodium, Urine, Random",,84300,CPT,Facility,Inpatient,,,,55,46.75,15.763,55,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Sodium, Urine, Random",,84300,CPT,Facility,Both,,,,55,46.75,15.763,55,Medica,Individual & Family,54.505,99.1,,percent of total billed charges,,
"Sodium, Urine, Random",,84300,CPT,Facility,Outpatient,,,,55,46.75,15.763,55,Medica,Medica Advantage Solution,27.39,49.8,,percent of total billed charges,,
"Sodium, Urine, Random",,84300,CPT,Facility,Inpatient,,,,55,46.75,15.763,55,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Sodium, Urine, Random",,84300,CPT,Facility,Outpatient,,,,55,46.75,15.763,55,Medica,Medical Assistance,24.53,44.6,,percent of total billed charges,,
"Sodium, Urine, Random",,84300,CPT,Facility,Inpatient,,,,55,46.75,15.763,55,Medica,Medical Assistance,,,,,Included in per diem rate,
"Sodium, Urine, Random",,84300,CPT,Facility,Outpatient,,,,55,46.75,15.763,55,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,27.39,49.8,,percent of total billed charges,,
"Sodium, Urine, Random",,84300,CPT,Facility,Inpatient,,,,55,46.75,15.763,55,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Sodium, Urine, Random",,84300,CPT,Facility,Both,,,,55,46.75,15.763,55,"Multiplan, Inc.","Multiplan, Inc.",51.7,94,,percent of total billed charges,,
"Sodium, Urine, Random",,84300,CPT,Facility,Outpatient,,,,55,46.75,15.763,55,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,47.52,86.4,,percent of total billed charges,,
"Sodium, Urine, Random",,84300,CPT,Facility,Inpatient,,,,55,46.75,15.763,55,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Sodium, Urine, Random",,84300,CPT,Facility,Both,,,,55,46.75,15.763,55,"Preferred One Administrative Services, INC.",PPO,54.23,98.6,,percent of total billed charges,,
"Sodium, Urine, Random",,84300,CPT,Facility,Outpatient,,,,55,46.75,15.763,55,PrimeWest Health,Minnesota Senior Health Options (MSHO),28.2975,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Sodium, Urine, Random",,84300,CPT,Facility,Inpatient,,,,55,46.75,15.763,55,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Sodium, Urine, Random",,84300,CPT,Facility,Outpatient,,,,55,46.75,15.763,55,PrimeWest Health,MinnesotaCare,28.248,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Sodium, Urine, Random",,84300,CPT,Facility,Inpatient,,,,55,46.75,15.763,55,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Sodium, Urine, Random",,84300,CPT,Facility,Both,,,,55,46.75,15.763,55,Sanford Health Plan,Sanford Health Plan,50.6,92,,percent of total billed charges,,
"Sodium, Urine, Random",,84300,CPT,Facility,Outpatient,,,,55,46.75,15.763,55,"UCare Health, Inc.",Individual & Family Plan,30.9925,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Sodium, Urine, Random",,84300,CPT,Facility,Inpatient,,,,55,46.75,15.763,55,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Sodium, Urine, Random",,84300,CPT,Facility,Outpatient,,,,55,46.75,15.763,55,"UCare Health, Inc.",Medical Assistance,27.7585,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Sodium, Urine, Random",,84300,CPT,Facility,Inpatient,,,,55,46.75,15.763,55,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Sodium, Urine, Random",,84300,CPT,Facility,Outpatient,,,,55,46.75,15.763,55,"UCare Health, Inc.",Medicare Advantage,27.7585,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Sodium, Urine, Random",,84300,CPT,Facility,Inpatient,,,,55,46.75,15.763,55,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Sodium, Urine, Random",,84300,CPT,Facility,Outpatient,,,,55,46.75,15.763,55,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),27.7585,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Sodium, Urine, Random",,84300,CPT,Facility,Inpatient,,,,55,46.75,15.763,55,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Sodium, Urine, Random",,84300,CPT,Facility,Both,,,,55,46.75,15.763,55,UnitedHealthcare,Individual & Family,51.7,94,,percent of total billed charges,,
"Sodium, Urine, Random",,84300,CPT,Facility,Outpatient,,,,55,46.75,15.763,55,UnitedHealthcare,Medicare Advantage,26.95,49,,percent of total billed charges,,
"Sodium, Urine, Random",,84300,CPT,Facility,Inpatient,,,,55,46.75,15.763,55,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Sodium, Urine, Random",,84300,CPT,Facility,Outpatient,,,,55,46.75,15.763,55,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,26.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Sodium, Urine, Random",,84300,CPT,Facility,Inpatient,,,,55,46.75,15.763,55,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Cholesterol, Body Fluid",,84311,CPT,Facility,Both,,,,66,56.1,18.9156,66,Aetna,Commercial,60.72,92,,percent of total billed charges,,
"Cholesterol, Body Fluid",,84311,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,Aetna,Medicare Advantage,32.34,49,,percent of total billed charges,,
"Cholesterol, Body Fluid",,84311,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Cholesterol, Body Fluid",,84311,CPT,Facility,Both,,,,66,56.1,18.9156,66,Aetna,PPO,61.38,93,,percent of total billed charges,,
"Cholesterol, Body Fluid",,84311,CPT,Facility,Both,,,,66,56.1,18.9156,66,America's PPO,America's PPO,63.3798,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Cholesterol, Body Fluid",,84311,CPT,Facility,Both,,,,66,56.1,18.9156,66,BlueCross BlueShield Minnesota, Federal Employee Program,64.944,98.4,,percent of total billed charges,,
"Cholesterol, Body Fluid",,84311,CPT,Facility,Both,,,,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,66,100,,percent of total billed charges,,
"Cholesterol, Body Fluid",,84311,CPT,Facility,Both,,,,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,High Value Network Plan,59.4,90,,percent of total billed charges,,
"Cholesterol, Body Fluid",,84311,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,Medicare Advantage,32.34,49,,percent of total billed charges,,
"Cholesterol, Body Fluid",,84311,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Cholesterol, Body Fluid",,84311,CPT,Facility,Both,,,,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,58.4562,88.57,,percent of total billed charges,,
"Cholesterol, Body Fluid",,84311,CPT,Facility,Both,,,,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,18.9156,28.66,,percent of total billed charges,,
"Cholesterol, Body Fluid",,84311,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),32.34,49,,percent of total billed charges,,
"Cholesterol, Body Fluid",,84311,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Cholesterol, Body Fluid",,84311,CPT,Facility,Both,,,,66,56.1,18.9156,66,CorVel,Worker's Compensation,66,100,,percent of total billed charges,,
"Cholesterol, Body Fluid",,84311,CPT,Facility,Both,,,,66,56.1,18.9156,66,First Health Group Corporation,First Health Network,64.02,97,,percent of total billed charges,,
"Cholesterol, Body Fluid",,84311,CPT,Facility,Both,,,,66,56.1,18.9156,66,"Health Partners, Inc.",Commercial,62.436,94.6,,percent of total billed charges,,
"Cholesterol, Body Fluid",,84311,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,"Health Partners, Inc.",Medicare Advantage,32.34,49,,percent of total billed charges,,
"Cholesterol, Body Fluid",,84311,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Cholesterol, Body Fluid",,84311,CPT,Facility,Both,,,,66,56.1,18.9156,66,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),39.6,60,,percent of total billed charges,,
"Cholesterol, Body Fluid",,84311,CPT,Facility,Both,,,,66,56.1,18.9156,66,"Health Partners, Inc.",State of Minnesota Advantage Program,53.79,81.5,,percent of total billed charges,,
"Cholesterol, Body Fluid",,84311,CPT,Facility,Both,,,,66,56.1,18.9156,66,"Health Partners, Inc.",State Public Programs,33,50,,percent of total billed charges,,
"Cholesterol, Body Fluid",,84311,CPT,Facility,Both,,,,66,56.1,18.9156,66,Humana Insurance Company,Commercial PPO,62.7,95,,percent of total billed charges,,
"Cholesterol, Body Fluid",,84311,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,Humana Insurance Company,Medicare PPO,32.34,49,,percent of total billed charges,,
"Cholesterol, Body Fluid",,84311,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Cholesterol, Body Fluid",,84311,CPT,Facility,Both,,,,66,56.1,18.9156,66,Medica,Individual & Family,65.406,99.1,,percent of total billed charges,,
"Cholesterol, Body Fluid",,84311,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,Medica,Medica Advantage Solution,32.868,49.8,,percent of total billed charges,,
"Cholesterol, Body Fluid",,84311,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Cholesterol, Body Fluid",,84311,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,Medica,Medical Assistance,29.436,44.6,,percent of total billed charges,,
"Cholesterol, Body Fluid",,84311,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,Medica,Medical Assistance,,,,,Included in per diem rate,
"Cholesterol, Body Fluid",,84311,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,32.868,49.8,,percent of total billed charges,,
"Cholesterol, Body Fluid",,84311,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Cholesterol, Body Fluid",,84311,CPT,Facility,Both,,,,66,56.1,18.9156,66,"Multiplan, Inc.","Multiplan, Inc.",62.04,94,,percent of total billed charges,,
"Cholesterol, Body Fluid",,84311,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,57.024,86.4,,percent of total billed charges,,
"Cholesterol, Body Fluid",,84311,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Cholesterol, Body Fluid",,84311,CPT,Facility,Both,,,,66,56.1,18.9156,66,"Preferred One Administrative Services, INC.",PPO,65.076,98.6,,percent of total billed charges,,
"Cholesterol, Body Fluid",,84311,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,PrimeWest Health,Minnesota Senior Health Options (MSHO),33.957,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Cholesterol, Body Fluid",,84311,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Cholesterol, Body Fluid",,84311,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,PrimeWest Health,MinnesotaCare,33.8976,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Cholesterol, Body Fluid",,84311,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Cholesterol, Body Fluid",,84311,CPT,Facility,Both,,,,66,56.1,18.9156,66,Sanford Health Plan,Sanford Health Plan,60.72,92,,percent of total billed charges,,
"Cholesterol, Body Fluid",,84311,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,"UCare Health, Inc.",Individual & Family Plan,37.191,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Cholesterol, Body Fluid",,84311,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Cholesterol, Body Fluid",,84311,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,"UCare Health, Inc.",Medical Assistance,33.3102,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Cholesterol, Body Fluid",,84311,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Cholesterol, Body Fluid",,84311,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,"UCare Health, Inc.",Medicare Advantage,33.3102,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Cholesterol, Body Fluid",,84311,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Cholesterol, Body Fluid",,84311,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),33.3102,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Cholesterol, Body Fluid",,84311,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Cholesterol, Body Fluid",,84311,CPT,Facility,Both,,,,66,56.1,18.9156,66,UnitedHealthcare,Individual & Family,62.04,94,,percent of total billed charges,,
"Cholesterol, Body Fluid",,84311,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,UnitedHealthcare,Medicare Advantage,32.34,49,,percent of total billed charges,,
"Cholesterol, Body Fluid",,84311,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Cholesterol, Body Fluid",,84311,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,31.68,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Cholesterol, Body Fluid",,84311,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Specific Gravity, Body Fluid",,84315,CPT,Facility,Both,,,,31,26.35,8.8846,31,Aetna,Commercial,28.52,92,,percent of total billed charges,,
"Specific Gravity, Body Fluid",,84315,CPT,Facility,Outpatient,,,,31,26.35,8.8846,31,Aetna,Medicare Advantage,15.19,49,,percent of total billed charges,,
"Specific Gravity, Body Fluid",,84315,CPT,Facility,Inpatient,,,,31,26.35,8.8846,31,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Specific Gravity, Body Fluid",,84315,CPT,Facility,Both,,,,31,26.35,8.8846,31,Aetna,PPO,28.83,93,,percent of total billed charges,,
"Specific Gravity, Body Fluid",,84315,CPT,Facility,Both,,,,31,26.35,8.8846,31,America's PPO,America's PPO,29.7693,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Specific Gravity, Body Fluid",,84315,CPT,Facility,Both,,,,31,26.35,8.8846,31,BlueCross BlueShield Minnesota, Federal Employee Program,30.504,98.4,,percent of total billed charges,,
"Specific Gravity, Body Fluid",,84315,CPT,Facility,Both,,,,31,26.35,8.8846,31,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,31,100,,percent of total billed charges,,
"Specific Gravity, Body Fluid",,84315,CPT,Facility,Both,,,,31,26.35,8.8846,31,BlueCross BlueShield Minnesota,High Value Network Plan,27.9,90,,percent of total billed charges,,
"Specific Gravity, Body Fluid",,84315,CPT,Facility,Outpatient,,,,31,26.35,8.8846,31,BlueCross BlueShield Minnesota,Medicare Advantage,15.19,49,,percent of total billed charges,,
"Specific Gravity, Body Fluid",,84315,CPT,Facility,Inpatient,,,,31,26.35,8.8846,31,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Specific Gravity, Body Fluid",,84315,CPT,Facility,Both,,,,31,26.35,8.8846,31,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,27.4567,88.57,,percent of total billed charges,,
"Specific Gravity, Body Fluid",,84315,CPT,Facility,Both,,,,31,26.35,8.8846,31,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,8.8846,28.66,,percent of total billed charges,,
"Specific Gravity, Body Fluid",,84315,CPT,Facility,Outpatient,,,,31,26.35,8.8846,31,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),15.19,49,,percent of total billed charges,,
"Specific Gravity, Body Fluid",,84315,CPT,Facility,Inpatient,,,,31,26.35,8.8846,31,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Specific Gravity, Body Fluid",,84315,CPT,Facility,Both,,,,31,26.35,8.8846,31,CorVel,Worker's Compensation,31,100,,percent of total billed charges,,
"Specific Gravity, Body Fluid",,84315,CPT,Facility,Both,,,,31,26.35,8.8846,31,First Health Group Corporation,First Health Network,30.07,97,,percent of total billed charges,,
"Specific Gravity, Body Fluid",,84315,CPT,Facility,Both,,,,31,26.35,8.8846,31,"Health Partners, Inc.",Commercial,29.326,94.6,,percent of total billed charges,,
"Specific Gravity, Body Fluid",,84315,CPT,Facility,Outpatient,,,,31,26.35,8.8846,31,"Health Partners, Inc.",Medicare Advantage,15.19,49,,percent of total billed charges,,
"Specific Gravity, Body Fluid",,84315,CPT,Facility,Inpatient,,,,31,26.35,8.8846,31,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Specific Gravity, Body Fluid",,84315,CPT,Facility,Both,,,,31,26.35,8.8846,31,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),18.6,60,,percent of total billed charges,,
"Specific Gravity, Body Fluid",,84315,CPT,Facility,Both,,,,31,26.35,8.8846,31,"Health Partners, Inc.",State of Minnesota Advantage Program,25.265,81.5,,percent of total billed charges,,
"Specific Gravity, Body Fluid",,84315,CPT,Facility,Both,,,,31,26.35,8.8846,31,"Health Partners, Inc.",State Public Programs,15.5,50,,percent of total billed charges,,
"Specific Gravity, Body Fluid",,84315,CPT,Facility,Both,,,,31,26.35,8.8846,31,Humana Insurance Company,Commercial PPO,29.45,95,,percent of total billed charges,,
"Specific Gravity, Body Fluid",,84315,CPT,Facility,Outpatient,,,,31,26.35,8.8846,31,Humana Insurance Company,Medicare PPO,15.19,49,,percent of total billed charges,,
"Specific Gravity, Body Fluid",,84315,CPT,Facility,Inpatient,,,,31,26.35,8.8846,31,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Specific Gravity, Body Fluid",,84315,CPT,Facility,Both,,,,31,26.35,8.8846,31,Medica,Individual & Family,30.721,99.1,,percent of total billed charges,,
"Specific Gravity, Body Fluid",,84315,CPT,Facility,Outpatient,,,,31,26.35,8.8846,31,Medica,Medica Advantage Solution,15.438,49.8,,percent of total billed charges,,
"Specific Gravity, Body Fluid",,84315,CPT,Facility,Inpatient,,,,31,26.35,8.8846,31,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Specific Gravity, Body Fluid",,84315,CPT,Facility,Outpatient,,,,31,26.35,8.8846,31,Medica,Medical Assistance,13.826,44.6,,percent of total billed charges,,
"Specific Gravity, Body Fluid",,84315,CPT,Facility,Inpatient,,,,31,26.35,8.8846,31,Medica,Medical Assistance,,,,,Included in per diem rate,
"Specific Gravity, Body Fluid",,84315,CPT,Facility,Outpatient,,,,31,26.35,8.8846,31,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,15.438,49.8,,percent of total billed charges,,
"Specific Gravity, Body Fluid",,84315,CPT,Facility,Inpatient,,,,31,26.35,8.8846,31,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Specific Gravity, Body Fluid",,84315,CPT,Facility,Both,,,,31,26.35,8.8846,31,"Multiplan, Inc.","Multiplan, Inc.",29.14,94,,percent of total billed charges,,
"Specific Gravity, Body Fluid",,84315,CPT,Facility,Outpatient,,,,31,26.35,8.8846,31,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,26.784,86.4,,percent of total billed charges,,
"Specific Gravity, Body Fluid",,84315,CPT,Facility,Inpatient,,,,31,26.35,8.8846,31,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Specific Gravity, Body Fluid",,84315,CPT,Facility,Both,,,,31,26.35,8.8846,31,"Preferred One Administrative Services, INC.",PPO,30.566,98.6,,percent of total billed charges,,
"Specific Gravity, Body Fluid",,84315,CPT,Facility,Outpatient,,,,31,26.35,8.8846,31,PrimeWest Health,Minnesota Senior Health Options (MSHO),15.9495,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Specific Gravity, Body Fluid",,84315,CPT,Facility,Inpatient,,,,31,26.35,8.8846,31,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Specific Gravity, Body Fluid",,84315,CPT,Facility,Outpatient,,,,31,26.35,8.8846,31,PrimeWest Health,MinnesotaCare,15.9216,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Specific Gravity, Body Fluid",,84315,CPT,Facility,Inpatient,,,,31,26.35,8.8846,31,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Specific Gravity, Body Fluid",,84315,CPT,Facility,Both,,,,31,26.35,8.8846,31,Sanford Health Plan,Sanford Health Plan,28.52,92,,percent of total billed charges,,
"Specific Gravity, Body Fluid",,84315,CPT,Facility,Outpatient,,,,31,26.35,8.8846,31,"UCare Health, Inc.",Individual & Family Plan,17.4685,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Specific Gravity, Body Fluid",,84315,CPT,Facility,Inpatient,,,,31,26.35,8.8846,31,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Specific Gravity, Body Fluid",,84315,CPT,Facility,Outpatient,,,,31,26.35,8.8846,31,"UCare Health, Inc.",Medical Assistance,15.6457,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Specific Gravity, Body Fluid",,84315,CPT,Facility,Inpatient,,,,31,26.35,8.8846,31,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Specific Gravity, Body Fluid",,84315,CPT,Facility,Outpatient,,,,31,26.35,8.8846,31,"UCare Health, Inc.",Medicare Advantage,15.6457,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Specific Gravity, Body Fluid",,84315,CPT,Facility,Inpatient,,,,31,26.35,8.8846,31,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Specific Gravity, Body Fluid",,84315,CPT,Facility,Outpatient,,,,31,26.35,8.8846,31,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),15.6457,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Specific Gravity, Body Fluid",,84315,CPT,Facility,Inpatient,,,,31,26.35,8.8846,31,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Specific Gravity, Body Fluid",,84315,CPT,Facility,Both,,,,31,26.35,8.8846,31,UnitedHealthcare,Individual & Family,29.14,94,,percent of total billed charges,,
"Specific Gravity, Body Fluid",,84315,CPT,Facility,Outpatient,,,,31,26.35,8.8846,31,UnitedHealthcare,Medicare Advantage,15.19,49,,percent of total billed charges,,
"Specific Gravity, Body Fluid",,84315,CPT,Facility,Inpatient,,,,31,26.35,8.8846,31,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Specific Gravity, Body Fluid",,84315,CPT,Facility,Outpatient,,,,31,26.35,8.8846,31,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,14.88,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Specific Gravity, Body Fluid",,84315,CPT,Facility,Inpatient,,,,31,26.35,8.8846,31,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Testosterone,,84403,CPT,Facility,Both,,,,84,71.4,24.0744,84,Aetna,Commercial,77.28,92,,percent of total billed charges,,
Testosterone,,84403,CPT,Facility,Outpatient,,,,84,71.4,24.0744,84,Aetna,Medicare Advantage,41.16,49,,percent of total billed charges,,
Testosterone,,84403,CPT,Facility,Inpatient,,,,84,71.4,24.0744,84,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Testosterone,,84403,CPT,Facility,Both,,,,84,71.4,24.0744,84,Aetna,PPO,78.12,93,,percent of total billed charges,,
Testosterone,,84403,CPT,Facility,Both,,,,84,71.4,24.0744,84,America's PPO,America's PPO,80.6652,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Testosterone,,84403,CPT,Facility,Both,,,,84,71.4,24.0744,84,BlueCross BlueShield Minnesota, Federal Employee Program,82.656,98.4,,percent of total billed charges,,
Testosterone,,84403,CPT,Facility,Both,,,,84,71.4,24.0744,84,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,84,100,,percent of total billed charges,,
Testosterone,,84403,CPT,Facility,Both,,,,84,71.4,24.0744,84,BlueCross BlueShield Minnesota,High Value Network Plan,75.6,90,,percent of total billed charges,,
Testosterone,,84403,CPT,Facility,Outpatient,,,,84,71.4,24.0744,84,BlueCross BlueShield Minnesota,Medicare Advantage,41.16,49,,percent of total billed charges,,
Testosterone,,84403,CPT,Facility,Inpatient,,,,84,71.4,24.0744,84,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Testosterone,,84403,CPT,Facility,Both,,,,84,71.4,24.0744,84,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,74.3988,88.57,,percent of total billed charges,,
Testosterone,,84403,CPT,Facility,Both,,,,84,71.4,24.0744,84,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,24.0744,28.66,,percent of total billed charges,,
Testosterone,,84403,CPT,Facility,Outpatient,,,,84,71.4,24.0744,84,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),41.16,49,,percent of total billed charges,,
Testosterone,,84403,CPT,Facility,Inpatient,,,,84,71.4,24.0744,84,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Testosterone,,84403,CPT,Facility,Both,,,,84,71.4,24.0744,84,CorVel,Worker's Compensation,84,100,,percent of total billed charges,,
Testosterone,,84403,CPT,Facility,Both,,,,84,71.4,24.0744,84,First Health Group Corporation,First Health Network,81.48,97,,percent of total billed charges,,
Testosterone,,84403,CPT,Facility,Both,,,,84,71.4,24.0744,84,"Health Partners, Inc.",Commercial,79.464,94.6,,percent of total billed charges,,
Testosterone,,84403,CPT,Facility,Outpatient,,,,84,71.4,24.0744,84,"Health Partners, Inc.",Medicare Advantage,41.16,49,,percent of total billed charges,,
Testosterone,,84403,CPT,Facility,Inpatient,,,,84,71.4,24.0744,84,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Testosterone,,84403,CPT,Facility,Both,,,,84,71.4,24.0744,84,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),50.4,60,,percent of total billed charges,,
Testosterone,,84403,CPT,Facility,Both,,,,84,71.4,24.0744,84,"Health Partners, Inc.",State of Minnesota Advantage Program,68.46,81.5,,percent of total billed charges,,
Testosterone,,84403,CPT,Facility,Both,,,,84,71.4,24.0744,84,"Health Partners, Inc.",State Public Programs,42,50,,percent of total billed charges,,
Testosterone,,84403,CPT,Facility,Both,,,,84,71.4,24.0744,84,Humana Insurance Company,Commercial PPO,79.8,95,,percent of total billed charges,,
Testosterone,,84403,CPT,Facility,Outpatient,,,,84,71.4,24.0744,84,Humana Insurance Company,Medicare PPO,41.16,49,,percent of total billed charges,,
Testosterone,,84403,CPT,Facility,Inpatient,,,,84,71.4,24.0744,84,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Testosterone,,84403,CPT,Facility,Both,,,,84,71.4,24.0744,84,Medica,Individual & Family,83.244,99.1,,percent of total billed charges,,
Testosterone,,84403,CPT,Facility,Outpatient,,,,84,71.4,24.0744,84,Medica,Medica Advantage Solution,41.832,49.8,,percent of total billed charges,,
Testosterone,,84403,CPT,Facility,Inpatient,,,,84,71.4,24.0744,84,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Testosterone,,84403,CPT,Facility,Outpatient,,,,84,71.4,24.0744,84,Medica,Medical Assistance,37.464,44.6,,percent of total billed charges,,
Testosterone,,84403,CPT,Facility,Inpatient,,,,84,71.4,24.0744,84,Medica,Medical Assistance,,,,,Included in per diem rate,
Testosterone,,84403,CPT,Facility,Outpatient,,,,84,71.4,24.0744,84,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,41.832,49.8,,percent of total billed charges,,
Testosterone,,84403,CPT,Facility,Inpatient,,,,84,71.4,24.0744,84,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Testosterone,,84403,CPT,Facility,Both,,,,84,71.4,24.0744,84,"Multiplan, Inc.","Multiplan, Inc.",78.96,94,,percent of total billed charges,,
Testosterone,,84403,CPT,Facility,Outpatient,,,,84,71.4,24.0744,84,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,72.576,86.4,,percent of total billed charges,,
Testosterone,,84403,CPT,Facility,Inpatient,,,,84,71.4,24.0744,84,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Testosterone,,84403,CPT,Facility,Both,,,,84,71.4,24.0744,84,"Preferred One Administrative Services, INC.",PPO,82.824,98.6,,percent of total billed charges,,
Testosterone,,84403,CPT,Facility,Outpatient,,,,84,71.4,24.0744,84,PrimeWest Health,Minnesota Senior Health Options (MSHO),43.218,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Testosterone,,84403,CPT,Facility,Inpatient,,,,84,71.4,24.0744,84,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Testosterone,,84403,CPT,Facility,Outpatient,,,,84,71.4,24.0744,84,PrimeWest Health,MinnesotaCare,43.1424,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Testosterone,,84403,CPT,Facility,Inpatient,,,,84,71.4,24.0744,84,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Testosterone,,84403,CPT,Facility,Both,,,,84,71.4,24.0744,84,Sanford Health Plan,Sanford Health Plan,77.28,92,,percent of total billed charges,,
Testosterone,,84403,CPT,Facility,Outpatient,,,,84,71.4,24.0744,84,"UCare Health, Inc.",Individual & Family Plan,47.334,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Testosterone,,84403,CPT,Facility,Inpatient,,,,84,71.4,24.0744,84,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Testosterone,,84403,CPT,Facility,Outpatient,,,,84,71.4,24.0744,84,"UCare Health, Inc.",Medical Assistance,42.3948,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Testosterone,,84403,CPT,Facility,Inpatient,,,,84,71.4,24.0744,84,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Testosterone,,84403,CPT,Facility,Outpatient,,,,84,71.4,24.0744,84,"UCare Health, Inc.",Medicare Advantage,42.3948,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Testosterone,,84403,CPT,Facility,Inpatient,,,,84,71.4,24.0744,84,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Testosterone,,84403,CPT,Facility,Outpatient,,,,84,71.4,24.0744,84,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),42.3948,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Testosterone,,84403,CPT,Facility,Inpatient,,,,84,71.4,24.0744,84,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Testosterone,,84403,CPT,Facility,Both,,,,84,71.4,24.0744,84,UnitedHealthcare,Individual & Family,78.96,94,,percent of total billed charges,,
Testosterone,,84403,CPT,Facility,Outpatient,,,,84,71.4,24.0744,84,UnitedHealthcare,Medicare Advantage,41.16,49,,percent of total billed charges,,
Testosterone,,84403,CPT,Facility,Inpatient,,,,84,71.4,24.0744,84,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Testosterone,,84403,CPT,Facility,Outpatient,,,,84,71.4,24.0744,84,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,40.32,48,,percent of total billed charges,,100% of DHS outpatient percentage
Testosterone,,84403,CPT,Facility,Inpatient,,,,84,71.4,24.0744,84,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Thyroxine,,84436,CPT,Facility,Both,,,,61,51.85,17.4826,61,Aetna,Commercial,56.12,92,,percent of total billed charges,,
Thyroxine,,84436,CPT,Facility,Outpatient,,,,61,51.85,17.4826,61,Aetna,Medicare Advantage,29.89,49,,percent of total billed charges,,
Thyroxine,,84436,CPT,Facility,Inpatient,,,,61,51.85,17.4826,61,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Thyroxine,,84436,CPT,Facility,Both,,,,61,51.85,17.4826,61,Aetna,PPO,56.73,93,,percent of total billed charges,,
Thyroxine,,84436,CPT,Facility,Both,,,,61,51.85,17.4826,61,America's PPO,America's PPO,58.5783,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Thyroxine,,84436,CPT,Facility,Both,,,,61,51.85,17.4826,61,BlueCross BlueShield Minnesota, Federal Employee Program,60.024,98.4,,percent of total billed charges,,
Thyroxine,,84436,CPT,Facility,Both,,,,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,61,100,,percent of total billed charges,,
Thyroxine,,84436,CPT,Facility,Both,,,,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,High Value Network Plan,54.9,90,,percent of total billed charges,,
Thyroxine,,84436,CPT,Facility,Outpatient,,,,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,Medicare Advantage,29.89,49,,percent of total billed charges,,
Thyroxine,,84436,CPT,Facility,Inpatient,,,,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Thyroxine,,84436,CPT,Facility,Both,,,,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,54.0277,88.57,,percent of total billed charges,,
Thyroxine,,84436,CPT,Facility,Both,,,,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,17.4826,28.66,,percent of total billed charges,,
Thyroxine,,84436,CPT,Facility,Outpatient,,,,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),29.89,49,,percent of total billed charges,,
Thyroxine,,84436,CPT,Facility,Inpatient,,,,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Thyroxine,,84436,CPT,Facility,Both,,,,61,51.85,17.4826,61,CorVel,Worker's Compensation,61,100,,percent of total billed charges,,
Thyroxine,,84436,CPT,Facility,Both,,,,61,51.85,17.4826,61,First Health Group Corporation,First Health Network,59.17,97,,percent of total billed charges,,
Thyroxine,,84436,CPT,Facility,Both,,,,61,51.85,17.4826,61,"Health Partners, Inc.",Commercial,57.706,94.6,,percent of total billed charges,,
Thyroxine,,84436,CPT,Facility,Outpatient,,,,61,51.85,17.4826,61,"Health Partners, Inc.",Medicare Advantage,29.89,49,,percent of total billed charges,,
Thyroxine,,84436,CPT,Facility,Inpatient,,,,61,51.85,17.4826,61,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Thyroxine,,84436,CPT,Facility,Both,,,,61,51.85,17.4826,61,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),36.6,60,,percent of total billed charges,,
Thyroxine,,84436,CPT,Facility,Both,,,,61,51.85,17.4826,61,"Health Partners, Inc.",State of Minnesota Advantage Program,49.715,81.5,,percent of total billed charges,,
Thyroxine,,84436,CPT,Facility,Both,,,,61,51.85,17.4826,61,"Health Partners, Inc.",State Public Programs,30.5,50,,percent of total billed charges,,
Thyroxine,,84436,CPT,Facility,Both,,,,61,51.85,17.4826,61,Humana Insurance Company,Commercial PPO,57.95,95,,percent of total billed charges,,
Thyroxine,,84436,CPT,Facility,Outpatient,,,,61,51.85,17.4826,61,Humana Insurance Company,Medicare PPO,29.89,49,,percent of total billed charges,,
Thyroxine,,84436,CPT,Facility,Inpatient,,,,61,51.85,17.4826,61,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Thyroxine,,84436,CPT,Facility,Both,,,,61,51.85,17.4826,61,Medica,Individual & Family,60.451,99.1,,percent of total billed charges,,
Thyroxine,,84436,CPT,Facility,Outpatient,,,,61,51.85,17.4826,61,Medica,Medica Advantage Solution,30.378,49.8,,percent of total billed charges,,
Thyroxine,,84436,CPT,Facility,Inpatient,,,,61,51.85,17.4826,61,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Thyroxine,,84436,CPT,Facility,Outpatient,,,,61,51.85,17.4826,61,Medica,Medical Assistance,27.206,44.6,,percent of total billed charges,,
Thyroxine,,84436,CPT,Facility,Inpatient,,,,61,51.85,17.4826,61,Medica,Medical Assistance,,,,,Included in per diem rate,
Thyroxine,,84436,CPT,Facility,Outpatient,,,,61,51.85,17.4826,61,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,30.378,49.8,,percent of total billed charges,,
Thyroxine,,84436,CPT,Facility,Inpatient,,,,61,51.85,17.4826,61,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Thyroxine,,84436,CPT,Facility,Both,,,,61,51.85,17.4826,61,"Multiplan, Inc.","Multiplan, Inc.",57.34,94,,percent of total billed charges,,
Thyroxine,,84436,CPT,Facility,Outpatient,,,,61,51.85,17.4826,61,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,52.704,86.4,,percent of total billed charges,,
Thyroxine,,84436,CPT,Facility,Inpatient,,,,61,51.85,17.4826,61,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Thyroxine,,84436,CPT,Facility,Both,,,,61,51.85,17.4826,61,"Preferred One Administrative Services, INC.",PPO,60.146,98.6,,percent of total billed charges,,
Thyroxine,,84436,CPT,Facility,Outpatient,,,,61,51.85,17.4826,61,PrimeWest Health,Minnesota Senior Health Options (MSHO),31.3845,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Thyroxine,,84436,CPT,Facility,Inpatient,,,,61,51.85,17.4826,61,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Thyroxine,,84436,CPT,Facility,Outpatient,,,,61,51.85,17.4826,61,PrimeWest Health,MinnesotaCare,31.3296,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Thyroxine,,84436,CPT,Facility,Inpatient,,,,61,51.85,17.4826,61,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Thyroxine,,84436,CPT,Facility,Both,,,,61,51.85,17.4826,61,Sanford Health Plan,Sanford Health Plan,56.12,92,,percent of total billed charges,,
Thyroxine,,84436,CPT,Facility,Outpatient,,,,61,51.85,17.4826,61,"UCare Health, Inc.",Individual & Family Plan,34.3735,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Thyroxine,,84436,CPT,Facility,Inpatient,,,,61,51.85,17.4826,61,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Thyroxine,,84436,CPT,Facility,Outpatient,,,,61,51.85,17.4826,61,"UCare Health, Inc.",Medical Assistance,30.7867,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Thyroxine,,84436,CPT,Facility,Inpatient,,,,61,51.85,17.4826,61,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Thyroxine,,84436,CPT,Facility,Outpatient,,,,61,51.85,17.4826,61,"UCare Health, Inc.",Medicare Advantage,30.7867,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Thyroxine,,84436,CPT,Facility,Inpatient,,,,61,51.85,17.4826,61,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Thyroxine,,84436,CPT,Facility,Outpatient,,,,61,51.85,17.4826,61,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),30.7867,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Thyroxine,,84436,CPT,Facility,Inpatient,,,,61,51.85,17.4826,61,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Thyroxine,,84436,CPT,Facility,Both,,,,61,51.85,17.4826,61,UnitedHealthcare,Individual & Family,57.34,94,,percent of total billed charges,,
Thyroxine,,84436,CPT,Facility,Outpatient,,,,61,51.85,17.4826,61,UnitedHealthcare,Medicare Advantage,29.89,49,,percent of total billed charges,,
Thyroxine,,84436,CPT,Facility,Inpatient,,,,61,51.85,17.4826,61,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Thyroxine,,84436,CPT,Facility,Outpatient,,,,61,51.85,17.4826,61,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,29.28,48,,percent of total billed charges,,100% of DHS outpatient percentage
Thyroxine,,84436,CPT,Facility,Inpatient,,,,61,51.85,17.4826,61,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Thyroxine (T4) Free,,84439,CPT,Facility,Both,,,,90,76.5,25.794,90,Aetna,Commercial,82.8,92,,percent of total billed charges,,
Thyroxine (T4) Free,,84439,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,Aetna,Medicare Advantage,44.1,49,,percent of total billed charges,,
Thyroxine (T4) Free,,84439,CPT,Facility,Inpatient,,,,90,76.5,25.794,90,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Thyroxine (T4) Free,,84439,CPT,Facility,Both,,,,90,76.5,25.794,90,Aetna,PPO,83.7,93,,percent of total billed charges,,
Thyroxine (T4) Free,,84439,CPT,Facility,Both,,,,90,76.5,25.794,90,America's PPO,America's PPO,86.427,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Thyroxine (T4) Free,,84439,CPT,Facility,Both,,,,90,76.5,25.794,90,BlueCross BlueShield Minnesota, Federal Employee Program,88.56,98.4,,percent of total billed charges,,
Thyroxine (T4) Free,,84439,CPT,Facility,Both,,,,90,76.5,25.794,90,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,90,100,,percent of total billed charges,,
Thyroxine (T4) Free,,84439,CPT,Facility,Both,,,,90,76.5,25.794,90,BlueCross BlueShield Minnesota,High Value Network Plan,81,90,,percent of total billed charges,,
Thyroxine (T4) Free,,84439,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,BlueCross BlueShield Minnesota,Medicare Advantage,44.1,49,,percent of total billed charges,,
Thyroxine (T4) Free,,84439,CPT,Facility,Inpatient,,,,90,76.5,25.794,90,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Thyroxine (T4) Free,,84439,CPT,Facility,Both,,,,90,76.5,25.794,90,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,79.713,88.57,,percent of total billed charges,,
Thyroxine (T4) Free,,84439,CPT,Facility,Both,,,,90,76.5,25.794,90,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,25.794,28.66,,percent of total billed charges,,
Thyroxine (T4) Free,,84439,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),44.1,49,,percent of total billed charges,,
Thyroxine (T4) Free,,84439,CPT,Facility,Inpatient,,,,90,76.5,25.794,90,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Thyroxine (T4) Free,,84439,CPT,Facility,Both,,,,90,76.5,25.794,90,CorVel,Worker's Compensation,90,100,,percent of total billed charges,,
Thyroxine (T4) Free,,84439,CPT,Facility,Both,,,,90,76.5,25.794,90,First Health Group Corporation,First Health Network,87.3,97,,percent of total billed charges,,
Thyroxine (T4) Free,,84439,CPT,Facility,Both,,,,90,76.5,25.794,90,"Health Partners, Inc.",Commercial,85.14,94.6,,percent of total billed charges,,
Thyroxine (T4) Free,,84439,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,"Health Partners, Inc.",Medicare Advantage,44.1,49,,percent of total billed charges,,
Thyroxine (T4) Free,,84439,CPT,Facility,Inpatient,,,,90,76.5,25.794,90,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Thyroxine (T4) Free,,84439,CPT,Facility,Both,,,,90,76.5,25.794,90,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),54,60,,percent of total billed charges,,
Thyroxine (T4) Free,,84439,CPT,Facility,Both,,,,90,76.5,25.794,90,"Health Partners, Inc.",State of Minnesota Advantage Program,73.35,81.5,,percent of total billed charges,,
Thyroxine (T4) Free,,84439,CPT,Facility,Both,,,,90,76.5,25.794,90,"Health Partners, Inc.",State Public Programs,45,50,,percent of total billed charges,,
Thyroxine (T4) Free,,84439,CPT,Facility,Both,,,,90,76.5,25.794,90,Humana Insurance Company,Commercial PPO,85.5,95,,percent of total billed charges,,
Thyroxine (T4) Free,,84439,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,Humana Insurance Company,Medicare PPO,44.1,49,,percent of total billed charges,,
Thyroxine (T4) Free,,84439,CPT,Facility,Inpatient,,,,90,76.5,25.794,90,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Thyroxine (T4) Free,,84439,CPT,Facility,Both,,,,90,76.5,25.794,90,Medica,Individual & Family,89.19,99.1,,percent of total billed charges,,
Thyroxine (T4) Free,,84439,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,Medica,Medica Advantage Solution,44.82,49.8,,percent of total billed charges,,
Thyroxine (T4) Free,,84439,CPT,Facility,Inpatient,,,,90,76.5,25.794,90,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Thyroxine (T4) Free,,84439,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,Medica,Medical Assistance,40.14,44.6,,percent of total billed charges,,
Thyroxine (T4) Free,,84439,CPT,Facility,Inpatient,,,,90,76.5,25.794,90,Medica,Medical Assistance,,,,,Included in per diem rate,
Thyroxine (T4) Free,,84439,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,44.82,49.8,,percent of total billed charges,,
Thyroxine (T4) Free,,84439,CPT,Facility,Inpatient,,,,90,76.5,25.794,90,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Thyroxine (T4) Free,,84439,CPT,Facility,Both,,,,90,76.5,25.794,90,"Multiplan, Inc.","Multiplan, Inc.",84.6,94,,percent of total billed charges,,
Thyroxine (T4) Free,,84439,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,77.76,86.4,,percent of total billed charges,,
Thyroxine (T4) Free,,84439,CPT,Facility,Inpatient,,,,90,76.5,25.794,90,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Thyroxine (T4) Free,,84439,CPT,Facility,Both,,,,90,76.5,25.794,90,"Preferred One Administrative Services, INC.",PPO,88.74,98.6,,percent of total billed charges,,
Thyroxine (T4) Free,,84439,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,PrimeWest Health,Minnesota Senior Health Options (MSHO),46.305,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Thyroxine (T4) Free,,84439,CPT,Facility,Inpatient,,,,90,76.5,25.794,90,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Thyroxine (T4) Free,,84439,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,PrimeWest Health,MinnesotaCare,46.224,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Thyroxine (T4) Free,,84439,CPT,Facility,Inpatient,,,,90,76.5,25.794,90,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Thyroxine (T4) Free,,84439,CPT,Facility,Both,,,,90,76.5,25.794,90,Sanford Health Plan,Sanford Health Plan,82.8,92,,percent of total billed charges,,
Thyroxine (T4) Free,,84439,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,"UCare Health, Inc.",Individual & Family Plan,50.715,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Thyroxine (T4) Free,,84439,CPT,Facility,Inpatient,,,,90,76.5,25.794,90,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Thyroxine (T4) Free,,84439,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,"UCare Health, Inc.",Medical Assistance,45.423,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Thyroxine (T4) Free,,84439,CPT,Facility,Inpatient,,,,90,76.5,25.794,90,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Thyroxine (T4) Free,,84439,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,"UCare Health, Inc.",Medicare Advantage,45.423,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Thyroxine (T4) Free,,84439,CPT,Facility,Inpatient,,,,90,76.5,25.794,90,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Thyroxine (T4) Free,,84439,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),45.423,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Thyroxine (T4) Free,,84439,CPT,Facility,Inpatient,,,,90,76.5,25.794,90,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Thyroxine (T4) Free,,84439,CPT,Facility,Both,,,,90,76.5,25.794,90,UnitedHealthcare,Individual & Family,84.6,94,,percent of total billed charges,,
Thyroxine (T4) Free,,84439,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,UnitedHealthcare,Medicare Advantage,44.1,49,,percent of total billed charges,,
Thyroxine (T4) Free,,84439,CPT,Facility,Inpatient,,,,90,76.5,25.794,90,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Thyroxine (T4) Free,,84439,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,43.2,48,,percent of total billed charges,,100% of DHS outpatient percentage
Thyroxine (T4) Free,,84439,CPT,Facility,Inpatient,,,,90,76.5,25.794,90,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Thyroid Stimulating Hormone,,84443,CPT,Facility,Both,,,,135,114.75,45.72,135,Aetna,Commercial,124.2,92,,percent of total billed charges,,
Thyroid Stimulating Hormone,,84443,CPT,Facility,Outpatient,,,,135,114.75,45.72,135,Aetna,Medicare Advantage,66.15,49,,percent of total billed charges,,
Thyroid Stimulating Hormone,,84443,CPT,Facility,Inpatient,,,,135,114.75,45.72,135,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Thyroid Stimulating Hormone,,84443,CPT,Facility,Both,,,,135,114.75,45.72,135,Aetna,PPO,125.55,93,,percent of total billed charges,,
Thyroid Stimulating Hormone,,84443,CPT,Facility,Both,,,,135,114.75,45.72,135,America's PPO,America's PPO,129.6405,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Thyroid Stimulating Hormone,,84443,CPT,Facility,Both,,,,135,114.75,45.72,135,BlueCross BlueShield Minnesota, Federal Employee Program,90,,,Fee schedule,,100% of BCBS commercial commodity fee schedule
Thyroid Stimulating Hormone,,84443,CPT,Facility,Both,,,,135,114.75,45.72,135,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,91.44,,,Fee schedule,,"100% of BCBS commercial commodity fee schedule, plus MN Care tax"
Thyroid Stimulating Hormone,,84443,CPT,Facility,Both,,,,135,114.75,45.72,135,BlueCross BlueShield Minnesota,High Value Network Plan,82.296,,,Fee schedule,,"90% of BCBS commercial commodity fee schedule, plus MN Care tax; see disclaimer for more information"
Thyroid Stimulating Hormone,,84443,CPT,Facility,Outpatient,,,,135,114.75,45.72,135,BlueCross BlueShield Minnesota,Medicare Advantage,66.15,49,,percent of total billed charges,,
Thyroid Stimulating Hormone,,84443,CPT,Facility,Inpatient,,,,135,114.75,45.72,135,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Thyroid Stimulating Hormone,,84443,CPT,Facility,Both,,,,135,114.75,45.72,135,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,80.988408,,,Fee schedule,,"88.57% of BCBS commercial commodity fee schedule, plus MN Care tax"
Thyroid Stimulating Hormone,,84443,CPT,Facility,Both,,,,135,114.75,45.72,135,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,45.72,,,Fee schedule,,"100% of BCBS Medicaid commodity fee schedule, plus MN Care tax"
Thyroid Stimulating Hormone,,84443,CPT,Facility,Outpatient,,,,135,114.75,45.72,135,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),66.15,49,,percent of total billed charges,,
Thyroid Stimulating Hormone,,84443,CPT,Facility,Inpatient,,,,135,114.75,45.72,135,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Thyroid Stimulating Hormone,,84443,CPT,Facility,Both,,,,135,114.75,45.72,135,CorVel,Worker's Compensation,135,100,,percent of total billed charges,,
Thyroid Stimulating Hormone,,84443,CPT,Facility,Both,,,,135,114.75,45.72,135,First Health Group Corporation,First Health Network,130.95,97,,percent of total billed charges,,
Thyroid Stimulating Hormone,,84443,CPT,Facility,Both,,,,135,114.75,45.72,135,"Health Partners, Inc.",Commercial,127.71,94.6,,percent of total billed charges,,
Thyroid Stimulating Hormone,,84443,CPT,Facility,Outpatient,,,,135,114.75,45.72,135,"Health Partners, Inc.",Medicare Advantage,66.15,49,,percent of total billed charges,,
Thyroid Stimulating Hormone,,84443,CPT,Facility,Inpatient,,,,135,114.75,45.72,135,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Thyroid Stimulating Hormone,,84443,CPT,Facility,Both,,,,135,114.75,45.72,135,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),81,60,,percent of total billed charges,,
Thyroid Stimulating Hormone,,84443,CPT,Facility,Both,,,,135,114.75,45.72,135,"Health Partners, Inc.",State of Minnesota Advantage Program,110.025,81.5,,percent of total billed charges,,
Thyroid Stimulating Hormone,,84443,CPT,Facility,Both,,,,135,114.75,45.72,135,"Health Partners, Inc.",State Public Programs,67.5,50,,percent of total billed charges,,
Thyroid Stimulating Hormone,,84443,CPT,Facility,Both,,,,135,114.75,45.72,135,Humana Insurance Company,Commercial PPO,128.25,95,,percent of total billed charges,,
Thyroid Stimulating Hormone,,84443,CPT,Facility,Outpatient,,,,135,114.75,45.72,135,Humana Insurance Company,Medicare PPO,66.15,49,,percent of total billed charges,,
Thyroid Stimulating Hormone,,84443,CPT,Facility,Inpatient,,,,135,114.75,45.72,135,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Thyroid Stimulating Hormone,,84443,CPT,Facility,Both,,,,135,114.75,45.72,135,Medica,Individual & Family,133.785,99.1,,percent of total billed charges,,
Thyroid Stimulating Hormone,,84443,CPT,Facility,Outpatient,,,,135,114.75,45.72,135,Medica,Medica Advantage Solution,67.23,49.8,,percent of total billed charges,,
Thyroid Stimulating Hormone,,84443,CPT,Facility,Inpatient,,,,135,114.75,45.72,135,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Thyroid Stimulating Hormone,,84443,CPT,Facility,Outpatient,,,,135,114.75,45.72,135,Medica,Medical Assistance,60.21,44.6,,percent of total billed charges,,
Thyroid Stimulating Hormone,,84443,CPT,Facility,Inpatient,,,,135,114.75,45.72,135,Medica,Medical Assistance,,,,,Included in per diem rate,
Thyroid Stimulating Hormone,,84443,CPT,Facility,Outpatient,,,,135,114.75,45.72,135,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,67.23,49.8,,percent of total billed charges,,
Thyroid Stimulating Hormone,,84443,CPT,Facility,Inpatient,,,,135,114.75,45.72,135,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Thyroid Stimulating Hormone,,84443,CPT,Facility,Both,,,,135,114.75,45.72,135,"Multiplan, Inc.","Multiplan, Inc.",126.9,94,,percent of total billed charges,,
Thyroid Stimulating Hormone,,84443,CPT,Facility,Outpatient,,,,135,114.75,45.72,135,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,116.64,86.4,,percent of total billed charges,,
Thyroid Stimulating Hormone,,84443,CPT,Facility,Inpatient,,,,135,114.75,45.72,135,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Thyroid Stimulating Hormone,,84443,CPT,Facility,Both,,,,135,114.75,45.72,135,"Preferred One Administrative Services, INC.",PPO,133.11,98.6,,percent of total billed charges,,
Thyroid Stimulating Hormone,,84443,CPT,Facility,Outpatient,,,,135,114.75,45.72,135,PrimeWest Health,Minnesota Senior Health Options (MSHO),69.4575,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Thyroid Stimulating Hormone,,84443,CPT,Facility,Inpatient,,,,135,114.75,45.72,135,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Thyroid Stimulating Hormone,,84443,CPT,Facility,Outpatient,,,,135,114.75,45.72,135,PrimeWest Health,MinnesotaCare,69.336,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Thyroid Stimulating Hormone,,84443,CPT,Facility,Inpatient,,,,135,114.75,45.72,135,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Thyroid Stimulating Hormone,,84443,CPT,Facility,Both,,,,135,114.75,45.72,135,Sanford Health Plan,Sanford Health Plan,124.2,92,,percent of total billed charges,,
Thyroid Stimulating Hormone,,84443,CPT,Facility,Outpatient,,,,135,114.75,45.72,135,"UCare Health, Inc.",Individual & Family Plan,76.0725,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Thyroid Stimulating Hormone,,84443,CPT,Facility,Inpatient,,,,135,114.75,45.72,135,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Thyroid Stimulating Hormone,,84443,CPT,Facility,Outpatient,,,,135,114.75,45.72,135,"UCare Health, Inc.",Medical Assistance,68.1345,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Thyroid Stimulating Hormone,,84443,CPT,Facility,Inpatient,,,,135,114.75,45.72,135,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Thyroid Stimulating Hormone,,84443,CPT,Facility,Outpatient,,,,135,114.75,45.72,135,"UCare Health, Inc.",Medicare Advantage,68.1345,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Thyroid Stimulating Hormone,,84443,CPT,Facility,Inpatient,,,,135,114.75,45.72,135,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Thyroid Stimulating Hormone,,84443,CPT,Facility,Outpatient,,,,135,114.75,45.72,135,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),68.1345,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Thyroid Stimulating Hormone,,84443,CPT,Facility,Inpatient,,,,135,114.75,45.72,135,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Thyroid Stimulating Hormone,,84443,CPT,Facility,Both,,,,135,114.75,45.72,135,UnitedHealthcare,Individual & Family,126.9,94,,percent of total billed charges,,
Thyroid Stimulating Hormone,,84443,CPT,Facility,Outpatient,,,,135,114.75,45.72,135,UnitedHealthcare,Medicare Advantage,66.15,49,,percent of total billed charges,,
Thyroid Stimulating Hormone,,84443,CPT,Facility,Inpatient,,,,135,114.75,45.72,135,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Thyroid Stimulating Hormone,,84443,CPT,Facility,Outpatient,,,,135,114.75,45.72,135,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,64.8,48,,percent of total billed charges,,100% of DHS outpatient percentage
Thyroid Stimulating Hormone,,84443,CPT,Facility,Inpatient,,,,135,114.75,45.72,135,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Aspartimine Aminotransferase (Ast),,84450,CPT,Facility,Both,,,,60,51,17.196,60,Aetna,Commercial,55.2,92,,percent of total billed charges,,
Aspartimine Aminotransferase (Ast),,84450,CPT,Facility,Outpatient,,,,60,51,17.196,60,Aetna,Medicare Advantage,29.4,49,,percent of total billed charges,,
Aspartimine Aminotransferase (Ast),,84450,CPT,Facility,Inpatient,,,,60,51,17.196,60,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Aspartimine Aminotransferase (Ast),,84450,CPT,Facility,Both,,,,60,51,17.196,60,Aetna,PPO,55.8,93,,percent of total billed charges,,
Aspartimine Aminotransferase (Ast),,84450,CPT,Facility,Both,,,,60,51,17.196,60,America's PPO,America's PPO,57.618,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Aspartimine Aminotransferase (Ast),,84450,CPT,Facility,Both,,,,60,51,17.196,60,BlueCross BlueShield Minnesota, Federal Employee Program,59.04,98.4,,percent of total billed charges,,
Aspartimine Aminotransferase (Ast),,84450,CPT,Facility,Both,,,,60,51,17.196,60,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,60,100,,percent of total billed charges,,
Aspartimine Aminotransferase (Ast),,84450,CPT,Facility,Both,,,,60,51,17.196,60,BlueCross BlueShield Minnesota,High Value Network Plan,54,90,,percent of total billed charges,,
Aspartimine Aminotransferase (Ast),,84450,CPT,Facility,Outpatient,,,,60,51,17.196,60,BlueCross BlueShield Minnesota,Medicare Advantage,29.4,49,,percent of total billed charges,,
Aspartimine Aminotransferase (Ast),,84450,CPT,Facility,Inpatient,,,,60,51,17.196,60,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Aspartimine Aminotransferase (Ast),,84450,CPT,Facility,Both,,,,60,51,17.196,60,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,53.142,88.57,,percent of total billed charges,,
Aspartimine Aminotransferase (Ast),,84450,CPT,Facility,Both,,,,60,51,17.196,60,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,17.196,28.66,,percent of total billed charges,,
Aspartimine Aminotransferase (Ast),,84450,CPT,Facility,Outpatient,,,,60,51,17.196,60,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),29.4,49,,percent of total billed charges,,
Aspartimine Aminotransferase (Ast),,84450,CPT,Facility,Inpatient,,,,60,51,17.196,60,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Aspartimine Aminotransferase (Ast),,84450,CPT,Facility,Both,,,,60,51,17.196,60,CorVel,Worker's Compensation,60,100,,percent of total billed charges,,
Aspartimine Aminotransferase (Ast),,84450,CPT,Facility,Both,,,,60,51,17.196,60,First Health Group Corporation,First Health Network,58.2,97,,percent of total billed charges,,
Aspartimine Aminotransferase (Ast),,84450,CPT,Facility,Both,,,,60,51,17.196,60,"Health Partners, Inc.",Commercial,56.76,94.6,,percent of total billed charges,,
Aspartimine Aminotransferase (Ast),,84450,CPT,Facility,Outpatient,,,,60,51,17.196,60,"Health Partners, Inc.",Medicare Advantage,29.4,49,,percent of total billed charges,,
Aspartimine Aminotransferase (Ast),,84450,CPT,Facility,Inpatient,,,,60,51,17.196,60,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Aspartimine Aminotransferase (Ast),,84450,CPT,Facility,Both,,,,60,51,17.196,60,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),36,60,,percent of total billed charges,,
Aspartimine Aminotransferase (Ast),,84450,CPT,Facility,Both,,,,60,51,17.196,60,"Health Partners, Inc.",State of Minnesota Advantage Program,48.9,81.5,,percent of total billed charges,,
Aspartimine Aminotransferase (Ast),,84450,CPT,Facility,Both,,,,60,51,17.196,60,"Health Partners, Inc.",State Public Programs,30,50,,percent of total billed charges,,
Aspartimine Aminotransferase (Ast),,84450,CPT,Facility,Both,,,,60,51,17.196,60,Humana Insurance Company,Commercial PPO,57,95,,percent of total billed charges,,
Aspartimine Aminotransferase (Ast),,84450,CPT,Facility,Outpatient,,,,60,51,17.196,60,Humana Insurance Company,Medicare PPO,29.4,49,,percent of total billed charges,,
Aspartimine Aminotransferase (Ast),,84450,CPT,Facility,Inpatient,,,,60,51,17.196,60,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Aspartimine Aminotransferase (Ast),,84450,CPT,Facility,Both,,,,60,51,17.196,60,Medica,Individual & Family,59.46,99.1,,percent of total billed charges,,
Aspartimine Aminotransferase (Ast),,84450,CPT,Facility,Outpatient,,,,60,51,17.196,60,Medica,Medica Advantage Solution,29.88,49.8,,percent of total billed charges,,
Aspartimine Aminotransferase (Ast),,84450,CPT,Facility,Inpatient,,,,60,51,17.196,60,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Aspartimine Aminotransferase (Ast),,84450,CPT,Facility,Outpatient,,,,60,51,17.196,60,Medica,Medical Assistance,26.76,44.6,,percent of total billed charges,,
Aspartimine Aminotransferase (Ast),,84450,CPT,Facility,Inpatient,,,,60,51,17.196,60,Medica,Medical Assistance,,,,,Included in per diem rate,
Aspartimine Aminotransferase (Ast),,84450,CPT,Facility,Outpatient,,,,60,51,17.196,60,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,29.88,49.8,,percent of total billed charges,,
Aspartimine Aminotransferase (Ast),,84450,CPT,Facility,Inpatient,,,,60,51,17.196,60,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Aspartimine Aminotransferase (Ast),,84450,CPT,Facility,Both,,,,60,51,17.196,60,"Multiplan, Inc.","Multiplan, Inc.",56.4,94,,percent of total billed charges,,
Aspartimine Aminotransferase (Ast),,84450,CPT,Facility,Outpatient,,,,60,51,17.196,60,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,51.84,86.4,,percent of total billed charges,,
Aspartimine Aminotransferase (Ast),,84450,CPT,Facility,Inpatient,,,,60,51,17.196,60,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Aspartimine Aminotransferase (Ast),,84450,CPT,Facility,Both,,,,60,51,17.196,60,"Preferred One Administrative Services, INC.",PPO,59.16,98.6,,percent of total billed charges,,
Aspartimine Aminotransferase (Ast),,84450,CPT,Facility,Outpatient,,,,60,51,17.196,60,PrimeWest Health,Minnesota Senior Health Options (MSHO),30.87,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Aspartimine Aminotransferase (Ast),,84450,CPT,Facility,Inpatient,,,,60,51,17.196,60,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Aspartimine Aminotransferase (Ast),,84450,CPT,Facility,Outpatient,,,,60,51,17.196,60,PrimeWest Health,MinnesotaCare,30.816,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Aspartimine Aminotransferase (Ast),,84450,CPT,Facility,Inpatient,,,,60,51,17.196,60,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Aspartimine Aminotransferase (Ast),,84450,CPT,Facility,Both,,,,60,51,17.196,60,Sanford Health Plan,Sanford Health Plan,55.2,92,,percent of total billed charges,,
Aspartimine Aminotransferase (Ast),,84450,CPT,Facility,Outpatient,,,,60,51,17.196,60,"UCare Health, Inc.",Individual & Family Plan,33.81,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Aspartimine Aminotransferase (Ast),,84450,CPT,Facility,Inpatient,,,,60,51,17.196,60,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Aspartimine Aminotransferase (Ast),,84450,CPT,Facility,Outpatient,,,,60,51,17.196,60,"UCare Health, Inc.",Medical Assistance,30.282,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Aspartimine Aminotransferase (Ast),,84450,CPT,Facility,Inpatient,,,,60,51,17.196,60,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Aspartimine Aminotransferase (Ast),,84450,CPT,Facility,Outpatient,,,,60,51,17.196,60,"UCare Health, Inc.",Medicare Advantage,30.282,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Aspartimine Aminotransferase (Ast),,84450,CPT,Facility,Inpatient,,,,60,51,17.196,60,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Aspartimine Aminotransferase (Ast),,84450,CPT,Facility,Outpatient,,,,60,51,17.196,60,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),30.282,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Aspartimine Aminotransferase (Ast),,84450,CPT,Facility,Inpatient,,,,60,51,17.196,60,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Aspartimine Aminotransferase (Ast),,84450,CPT,Facility,Both,,,,60,51,17.196,60,UnitedHealthcare,Individual & Family,56.4,94,,percent of total billed charges,,
Aspartimine Aminotransferase (Ast),,84450,CPT,Facility,Outpatient,,,,60,51,17.196,60,UnitedHealthcare,Medicare Advantage,29.4,49,,percent of total billed charges,,
Aspartimine Aminotransferase (Ast),,84450,CPT,Facility,Inpatient,,,,60,51,17.196,60,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Aspartimine Aminotransferase (Ast),,84450,CPT,Facility,Outpatient,,,,60,51,17.196,60,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,28.8,48,,percent of total billed charges,,100% of DHS outpatient percentage
Aspartimine Aminotransferase (Ast),,84450,CPT,Facility,Inpatient,,,,60,51,17.196,60,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Alanine Aminotransferase (Alt),,84460,CPT,Facility,Both,,,,60,51,17.196,60,Aetna,Commercial,55.2,92,,percent of total billed charges,,
Alanine Aminotransferase (Alt),,84460,CPT,Facility,Outpatient,,,,60,51,17.196,60,Aetna,Medicare Advantage,29.4,49,,percent of total billed charges,,
Alanine Aminotransferase (Alt),,84460,CPT,Facility,Inpatient,,,,60,51,17.196,60,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Alanine Aminotransferase (Alt),,84460,CPT,Facility,Both,,,,60,51,17.196,60,Aetna,PPO,55.8,93,,percent of total billed charges,,
Alanine Aminotransferase (Alt),,84460,CPT,Facility,Both,,,,60,51,17.196,60,America's PPO,America's PPO,57.618,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Alanine Aminotransferase (Alt),,84460,CPT,Facility,Both,,,,60,51,17.196,60,BlueCross BlueShield Minnesota, Federal Employee Program,59.04,98.4,,percent of total billed charges,,
Alanine Aminotransferase (Alt),,84460,CPT,Facility,Both,,,,60,51,17.196,60,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,60,100,,percent of total billed charges,,
Alanine Aminotransferase (Alt),,84460,CPT,Facility,Both,,,,60,51,17.196,60,BlueCross BlueShield Minnesota,High Value Network Plan,54,90,,percent of total billed charges,,
Alanine Aminotransferase (Alt),,84460,CPT,Facility,Outpatient,,,,60,51,17.196,60,BlueCross BlueShield Minnesota,Medicare Advantage,29.4,49,,percent of total billed charges,,
Alanine Aminotransferase (Alt),,84460,CPT,Facility,Inpatient,,,,60,51,17.196,60,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Alanine Aminotransferase (Alt),,84460,CPT,Facility,Both,,,,60,51,17.196,60,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,53.142,88.57,,percent of total billed charges,,
Alanine Aminotransferase (Alt),,84460,CPT,Facility,Both,,,,60,51,17.196,60,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,17.196,28.66,,percent of total billed charges,,
Alanine Aminotransferase (Alt),,84460,CPT,Facility,Outpatient,,,,60,51,17.196,60,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),29.4,49,,percent of total billed charges,,
Alanine Aminotransferase (Alt),,84460,CPT,Facility,Inpatient,,,,60,51,17.196,60,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Alanine Aminotransferase (Alt),,84460,CPT,Facility,Both,,,,60,51,17.196,60,CorVel,Worker's Compensation,60,100,,percent of total billed charges,,
Alanine Aminotransferase (Alt),,84460,CPT,Facility,Both,,,,60,51,17.196,60,First Health Group Corporation,First Health Network,58.2,97,,percent of total billed charges,,
Alanine Aminotransferase (Alt),,84460,CPT,Facility,Both,,,,60,51,17.196,60,"Health Partners, Inc.",Commercial,56.76,94.6,,percent of total billed charges,,
Alanine Aminotransferase (Alt),,84460,CPT,Facility,Outpatient,,,,60,51,17.196,60,"Health Partners, Inc.",Medicare Advantage,29.4,49,,percent of total billed charges,,
Alanine Aminotransferase (Alt),,84460,CPT,Facility,Inpatient,,,,60,51,17.196,60,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Alanine Aminotransferase (Alt),,84460,CPT,Facility,Both,,,,60,51,17.196,60,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),36,60,,percent of total billed charges,,
Alanine Aminotransferase (Alt),,84460,CPT,Facility,Both,,,,60,51,17.196,60,"Health Partners, Inc.",State of Minnesota Advantage Program,48.9,81.5,,percent of total billed charges,,
Alanine Aminotransferase (Alt),,84460,CPT,Facility,Both,,,,60,51,17.196,60,"Health Partners, Inc.",State Public Programs,30,50,,percent of total billed charges,,
Alanine Aminotransferase (Alt),,84460,CPT,Facility,Both,,,,60,51,17.196,60,Humana Insurance Company,Commercial PPO,57,95,,percent of total billed charges,,
Alanine Aminotransferase (Alt),,84460,CPT,Facility,Outpatient,,,,60,51,17.196,60,Humana Insurance Company,Medicare PPO,29.4,49,,percent of total billed charges,,
Alanine Aminotransferase (Alt),,84460,CPT,Facility,Inpatient,,,,60,51,17.196,60,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Alanine Aminotransferase (Alt),,84460,CPT,Facility,Both,,,,60,51,17.196,60,Medica,Individual & Family,59.46,99.1,,percent of total billed charges,,
Alanine Aminotransferase (Alt),,84460,CPT,Facility,Outpatient,,,,60,51,17.196,60,Medica,Medica Advantage Solution,29.88,49.8,,percent of total billed charges,,
Alanine Aminotransferase (Alt),,84460,CPT,Facility,Inpatient,,,,60,51,17.196,60,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Alanine Aminotransferase (Alt),,84460,CPT,Facility,Outpatient,,,,60,51,17.196,60,Medica,Medical Assistance,26.76,44.6,,percent of total billed charges,,
Alanine Aminotransferase (Alt),,84460,CPT,Facility,Inpatient,,,,60,51,17.196,60,Medica,Medical Assistance,,,,,Included in per diem rate,
Alanine Aminotransferase (Alt),,84460,CPT,Facility,Outpatient,,,,60,51,17.196,60,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,29.88,49.8,,percent of total billed charges,,
Alanine Aminotransferase (Alt),,84460,CPT,Facility,Inpatient,,,,60,51,17.196,60,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Alanine Aminotransferase (Alt),,84460,CPT,Facility,Both,,,,60,51,17.196,60,"Multiplan, Inc.","Multiplan, Inc.",56.4,94,,percent of total billed charges,,
Alanine Aminotransferase (Alt),,84460,CPT,Facility,Outpatient,,,,60,51,17.196,60,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,51.84,86.4,,percent of total billed charges,,
Alanine Aminotransferase (Alt),,84460,CPT,Facility,Inpatient,,,,60,51,17.196,60,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Alanine Aminotransferase (Alt),,84460,CPT,Facility,Both,,,,60,51,17.196,60,"Preferred One Administrative Services, INC.",PPO,59.16,98.6,,percent of total billed charges,,
Alanine Aminotransferase (Alt),,84460,CPT,Facility,Outpatient,,,,60,51,17.196,60,PrimeWest Health,Minnesota Senior Health Options (MSHO),30.87,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Alanine Aminotransferase (Alt),,84460,CPT,Facility,Inpatient,,,,60,51,17.196,60,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Alanine Aminotransferase (Alt),,84460,CPT,Facility,Outpatient,,,,60,51,17.196,60,PrimeWest Health,MinnesotaCare,30.816,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Alanine Aminotransferase (Alt),,84460,CPT,Facility,Inpatient,,,,60,51,17.196,60,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Alanine Aminotransferase (Alt),,84460,CPT,Facility,Both,,,,60,51,17.196,60,Sanford Health Plan,Sanford Health Plan,55.2,92,,percent of total billed charges,,
Alanine Aminotransferase (Alt),,84460,CPT,Facility,Outpatient,,,,60,51,17.196,60,"UCare Health, Inc.",Individual & Family Plan,33.81,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Alanine Aminotransferase (Alt),,84460,CPT,Facility,Inpatient,,,,60,51,17.196,60,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Alanine Aminotransferase (Alt),,84460,CPT,Facility,Outpatient,,,,60,51,17.196,60,"UCare Health, Inc.",Medical Assistance,30.282,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Alanine Aminotransferase (Alt),,84460,CPT,Facility,Inpatient,,,,60,51,17.196,60,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Alanine Aminotransferase (Alt),,84460,CPT,Facility,Outpatient,,,,60,51,17.196,60,"UCare Health, Inc.",Medicare Advantage,30.282,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Alanine Aminotransferase (Alt),,84460,CPT,Facility,Inpatient,,,,60,51,17.196,60,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Alanine Aminotransferase (Alt),,84460,CPT,Facility,Outpatient,,,,60,51,17.196,60,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),30.282,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Alanine Aminotransferase (Alt),,84460,CPT,Facility,Inpatient,,,,60,51,17.196,60,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Alanine Aminotransferase (Alt),,84460,CPT,Facility,Both,,,,60,51,17.196,60,UnitedHealthcare,Individual & Family,56.4,94,,percent of total billed charges,,
Alanine Aminotransferase (Alt),,84460,CPT,Facility,Outpatient,,,,60,51,17.196,60,UnitedHealthcare,Medicare Advantage,29.4,49,,percent of total billed charges,,
Alanine Aminotransferase (Alt),,84460,CPT,Facility,Inpatient,,,,60,51,17.196,60,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Alanine Aminotransferase (Alt),,84460,CPT,Facility,Outpatient,,,,60,51,17.196,60,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,28.8,48,,percent of total billed charges,,100% of DHS outpatient percentage
Alanine Aminotransferase (Alt),,84460,CPT,Facility,Inpatient,,,,60,51,17.196,60,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Transferrin,,84466,CPT,Facility,Both,,,,94,79.9,26.9404,94,Aetna,Commercial,86.48,92,,percent of total billed charges,,
Transferrin,,84466,CPT,Facility,Outpatient,,,,94,79.9,26.9404,94,Aetna,Medicare Advantage,46.06,49,,percent of total billed charges,,
Transferrin,,84466,CPT,Facility,Inpatient,,,,94,79.9,26.9404,94,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Transferrin,,84466,CPT,Facility,Both,,,,94,79.9,26.9404,94,Aetna,PPO,87.42,93,,percent of total billed charges,,
Transferrin,,84466,CPT,Facility,Both,,,,94,79.9,26.9404,94,America's PPO,America's PPO,90.2682,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Transferrin,,84466,CPT,Facility,Both,,,,94,79.9,26.9404,94,BlueCross BlueShield Minnesota, Federal Employee Program,92.496,98.4,,percent of total billed charges,,
Transferrin,,84466,CPT,Facility,Both,,,,94,79.9,26.9404,94,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,94,100,,percent of total billed charges,,
Transferrin,,84466,CPT,Facility,Both,,,,94,79.9,26.9404,94,BlueCross BlueShield Minnesota,High Value Network Plan,84.6,90,,percent of total billed charges,,
Transferrin,,84466,CPT,Facility,Outpatient,,,,94,79.9,26.9404,94,BlueCross BlueShield Minnesota,Medicare Advantage,46.06,49,,percent of total billed charges,,
Transferrin,,84466,CPT,Facility,Inpatient,,,,94,79.9,26.9404,94,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Transferrin,,84466,CPT,Facility,Both,,,,94,79.9,26.9404,94,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,83.2558,88.57,,percent of total billed charges,,
Transferrin,,84466,CPT,Facility,Both,,,,94,79.9,26.9404,94,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,26.9404,28.66,,percent of total billed charges,,
Transferrin,,84466,CPT,Facility,Outpatient,,,,94,79.9,26.9404,94,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),46.06,49,,percent of total billed charges,,
Transferrin,,84466,CPT,Facility,Inpatient,,,,94,79.9,26.9404,94,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Transferrin,,84466,CPT,Facility,Both,,,,94,79.9,26.9404,94,CorVel,Worker's Compensation,94,100,,percent of total billed charges,,
Transferrin,,84466,CPT,Facility,Both,,,,94,79.9,26.9404,94,First Health Group Corporation,First Health Network,91.18,97,,percent of total billed charges,,
Transferrin,,84466,CPT,Facility,Both,,,,94,79.9,26.9404,94,"Health Partners, Inc.",Commercial,88.924,94.6,,percent of total billed charges,,
Transferrin,,84466,CPT,Facility,Outpatient,,,,94,79.9,26.9404,94,"Health Partners, Inc.",Medicare Advantage,46.06,49,,percent of total billed charges,,
Transferrin,,84466,CPT,Facility,Inpatient,,,,94,79.9,26.9404,94,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Transferrin,,84466,CPT,Facility,Both,,,,94,79.9,26.9404,94,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),56.4,60,,percent of total billed charges,,
Transferrin,,84466,CPT,Facility,Both,,,,94,79.9,26.9404,94,"Health Partners, Inc.",State of Minnesota Advantage Program,76.61,81.5,,percent of total billed charges,,
Transferrin,,84466,CPT,Facility,Both,,,,94,79.9,26.9404,94,"Health Partners, Inc.",State Public Programs,47,50,,percent of total billed charges,,
Transferrin,,84466,CPT,Facility,Both,,,,94,79.9,26.9404,94,Humana Insurance Company,Commercial PPO,89.3,95,,percent of total billed charges,,
Transferrin,,84466,CPT,Facility,Outpatient,,,,94,79.9,26.9404,94,Humana Insurance Company,Medicare PPO,46.06,49,,percent of total billed charges,,
Transferrin,,84466,CPT,Facility,Inpatient,,,,94,79.9,26.9404,94,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Transferrin,,84466,CPT,Facility,Both,,,,94,79.9,26.9404,94,Medica,Individual & Family,93.154,99.1,,percent of total billed charges,,
Transferrin,,84466,CPT,Facility,Outpatient,,,,94,79.9,26.9404,94,Medica,Medica Advantage Solution,46.812,49.8,,percent of total billed charges,,
Transferrin,,84466,CPT,Facility,Inpatient,,,,94,79.9,26.9404,94,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Transferrin,,84466,CPT,Facility,Outpatient,,,,94,79.9,26.9404,94,Medica,Medical Assistance,41.924,44.6,,percent of total billed charges,,
Transferrin,,84466,CPT,Facility,Inpatient,,,,94,79.9,26.9404,94,Medica,Medical Assistance,,,,,Included in per diem rate,
Transferrin,,84466,CPT,Facility,Outpatient,,,,94,79.9,26.9404,94,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,46.812,49.8,,percent of total billed charges,,
Transferrin,,84466,CPT,Facility,Inpatient,,,,94,79.9,26.9404,94,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Transferrin,,84466,CPT,Facility,Both,,,,94,79.9,26.9404,94,"Multiplan, Inc.","Multiplan, Inc.",88.36,94,,percent of total billed charges,,
Transferrin,,84466,CPT,Facility,Outpatient,,,,94,79.9,26.9404,94,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,81.216,86.4,,percent of total billed charges,,
Transferrin,,84466,CPT,Facility,Inpatient,,,,94,79.9,26.9404,94,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Transferrin,,84466,CPT,Facility,Both,,,,94,79.9,26.9404,94,"Preferred One Administrative Services, INC.",PPO,92.684,98.6,,percent of total billed charges,,
Transferrin,,84466,CPT,Facility,Outpatient,,,,94,79.9,26.9404,94,PrimeWest Health,Minnesota Senior Health Options (MSHO),48.363,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Transferrin,,84466,CPT,Facility,Inpatient,,,,94,79.9,26.9404,94,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Transferrin,,84466,CPT,Facility,Outpatient,,,,94,79.9,26.9404,94,PrimeWest Health,MinnesotaCare,48.2784,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Transferrin,,84466,CPT,Facility,Inpatient,,,,94,79.9,26.9404,94,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Transferrin,,84466,CPT,Facility,Both,,,,94,79.9,26.9404,94,Sanford Health Plan,Sanford Health Plan,86.48,92,,percent of total billed charges,,
Transferrin,,84466,CPT,Facility,Outpatient,,,,94,79.9,26.9404,94,"UCare Health, Inc.",Individual & Family Plan,52.969,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Transferrin,,84466,CPT,Facility,Inpatient,,,,94,79.9,26.9404,94,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Transferrin,,84466,CPT,Facility,Outpatient,,,,94,79.9,26.9404,94,"UCare Health, Inc.",Medical Assistance,47.4418,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Transferrin,,84466,CPT,Facility,Inpatient,,,,94,79.9,26.9404,94,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Transferrin,,84466,CPT,Facility,Outpatient,,,,94,79.9,26.9404,94,"UCare Health, Inc.",Medicare Advantage,47.4418,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Transferrin,,84466,CPT,Facility,Inpatient,,,,94,79.9,26.9404,94,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Transferrin,,84466,CPT,Facility,Outpatient,,,,94,79.9,26.9404,94,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),47.4418,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Transferrin,,84466,CPT,Facility,Inpatient,,,,94,79.9,26.9404,94,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Transferrin,,84466,CPT,Facility,Both,,,,94,79.9,26.9404,94,UnitedHealthcare,Individual & Family,88.36,94,,percent of total billed charges,,
Transferrin,,84466,CPT,Facility,Outpatient,,,,94,79.9,26.9404,94,UnitedHealthcare,Medicare Advantage,46.06,49,,percent of total billed charges,,
Transferrin,,84466,CPT,Facility,Inpatient,,,,94,79.9,26.9404,94,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Transferrin,,84466,CPT,Facility,Outpatient,,,,94,79.9,26.9404,94,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,45.12,48,,percent of total billed charges,,100% of DHS outpatient percentage
Transferrin,,84466,CPT,Facility,Inpatient,,,,94,79.9,26.9404,94,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Triglyceride,,84478,CPT,Facility,Both,,,,53,45.05,15.1898,53,Aetna,Commercial,48.76,92,,percent of total billed charges,,
Triglyceride,,84478,CPT,Facility,Outpatient,,,,53,45.05,15.1898,53,Aetna,Medicare Advantage,25.97,49,,percent of total billed charges,,
Triglyceride,,84478,CPT,Facility,Inpatient,,,,53,45.05,15.1898,53,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Triglyceride,,84478,CPT,Facility,Both,,,,53,45.05,15.1898,53,Aetna,PPO,49.29,93,,percent of total billed charges,,
Triglyceride,,84478,CPT,Facility,Both,,,,53,45.05,15.1898,53,America's PPO,America's PPO,50.8959,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Triglyceride,,84478,CPT,Facility,Both,,,,53,45.05,15.1898,53,BlueCross BlueShield Minnesota, Federal Employee Program,52.152,98.4,,percent of total billed charges,,
Triglyceride,,84478,CPT,Facility,Both,,,,53,45.05,15.1898,53,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,53,100,,percent of total billed charges,,
Triglyceride,,84478,CPT,Facility,Both,,,,53,45.05,15.1898,53,BlueCross BlueShield Minnesota,High Value Network Plan,47.7,90,,percent of total billed charges,,
Triglyceride,,84478,CPT,Facility,Outpatient,,,,53,45.05,15.1898,53,BlueCross BlueShield Minnesota,Medicare Advantage,25.97,49,,percent of total billed charges,,
Triglyceride,,84478,CPT,Facility,Inpatient,,,,53,45.05,15.1898,53,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Triglyceride,,84478,CPT,Facility,Both,,,,53,45.05,15.1898,53,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,46.9421,88.57,,percent of total billed charges,,
Triglyceride,,84478,CPT,Facility,Both,,,,53,45.05,15.1898,53,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,15.1898,28.66,,percent of total billed charges,,
Triglyceride,,84478,CPT,Facility,Outpatient,,,,53,45.05,15.1898,53,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),25.97,49,,percent of total billed charges,,
Triglyceride,,84478,CPT,Facility,Inpatient,,,,53,45.05,15.1898,53,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Triglyceride,,84478,CPT,Facility,Both,,,,53,45.05,15.1898,53,CorVel,Worker's Compensation,53,100,,percent of total billed charges,,
Triglyceride,,84478,CPT,Facility,Both,,,,53,45.05,15.1898,53,First Health Group Corporation,First Health Network,51.41,97,,percent of total billed charges,,
Triglyceride,,84478,CPT,Facility,Both,,,,53,45.05,15.1898,53,"Health Partners, Inc.",Commercial,50.138,94.6,,percent of total billed charges,,
Triglyceride,,84478,CPT,Facility,Outpatient,,,,53,45.05,15.1898,53,"Health Partners, Inc.",Medicare Advantage,25.97,49,,percent of total billed charges,,
Triglyceride,,84478,CPT,Facility,Inpatient,,,,53,45.05,15.1898,53,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Triglyceride,,84478,CPT,Facility,Both,,,,53,45.05,15.1898,53,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),31.8,60,,percent of total billed charges,,
Triglyceride,,84478,CPT,Facility,Both,,,,53,45.05,15.1898,53,"Health Partners, Inc.",State of Minnesota Advantage Program,43.195,81.5,,percent of total billed charges,,
Triglyceride,,84478,CPT,Facility,Both,,,,53,45.05,15.1898,53,"Health Partners, Inc.",State Public Programs,26.5,50,,percent of total billed charges,,
Triglyceride,,84478,CPT,Facility,Both,,,,53,45.05,15.1898,53,Humana Insurance Company,Commercial PPO,50.35,95,,percent of total billed charges,,
Triglyceride,,84478,CPT,Facility,Outpatient,,,,53,45.05,15.1898,53,Humana Insurance Company,Medicare PPO,25.97,49,,percent of total billed charges,,
Triglyceride,,84478,CPT,Facility,Inpatient,,,,53,45.05,15.1898,53,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Triglyceride,,84478,CPT,Facility,Both,,,,53,45.05,15.1898,53,Medica,Individual & Family,52.523,99.1,,percent of total billed charges,,
Triglyceride,,84478,CPT,Facility,Outpatient,,,,53,45.05,15.1898,53,Medica,Medica Advantage Solution,26.394,49.8,,percent of total billed charges,,
Triglyceride,,84478,CPT,Facility,Inpatient,,,,53,45.05,15.1898,53,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Triglyceride,,84478,CPT,Facility,Outpatient,,,,53,45.05,15.1898,53,Medica,Medical Assistance,23.638,44.6,,percent of total billed charges,,
Triglyceride,,84478,CPT,Facility,Inpatient,,,,53,45.05,15.1898,53,Medica,Medical Assistance,,,,,Included in per diem rate,
Triglyceride,,84478,CPT,Facility,Outpatient,,,,53,45.05,15.1898,53,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,26.394,49.8,,percent of total billed charges,,
Triglyceride,,84478,CPT,Facility,Inpatient,,,,53,45.05,15.1898,53,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Triglyceride,,84478,CPT,Facility,Both,,,,53,45.05,15.1898,53,"Multiplan, Inc.","Multiplan, Inc.",49.82,94,,percent of total billed charges,,
Triglyceride,,84478,CPT,Facility,Outpatient,,,,53,45.05,15.1898,53,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,45.792,86.4,,percent of total billed charges,,
Triglyceride,,84478,CPT,Facility,Inpatient,,,,53,45.05,15.1898,53,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Triglyceride,,84478,CPT,Facility,Both,,,,53,45.05,15.1898,53,"Preferred One Administrative Services, INC.",PPO,52.258,98.6,,percent of total billed charges,,
Triglyceride,,84478,CPT,Facility,Outpatient,,,,53,45.05,15.1898,53,PrimeWest Health,Minnesota Senior Health Options (MSHO),27.2685,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Triglyceride,,84478,CPT,Facility,Inpatient,,,,53,45.05,15.1898,53,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Triglyceride,,84478,CPT,Facility,Outpatient,,,,53,45.05,15.1898,53,PrimeWest Health,MinnesotaCare,27.2208,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Triglyceride,,84478,CPT,Facility,Inpatient,,,,53,45.05,15.1898,53,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Triglyceride,,84478,CPT,Facility,Both,,,,53,45.05,15.1898,53,Sanford Health Plan,Sanford Health Plan,48.76,92,,percent of total billed charges,,
Triglyceride,,84478,CPT,Facility,Outpatient,,,,53,45.05,15.1898,53,"UCare Health, Inc.",Individual & Family Plan,29.8655,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Triglyceride,,84478,CPT,Facility,Inpatient,,,,53,45.05,15.1898,53,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Triglyceride,,84478,CPT,Facility,Outpatient,,,,53,45.05,15.1898,53,"UCare Health, Inc.",Medical Assistance,26.7491,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Triglyceride,,84478,CPT,Facility,Inpatient,,,,53,45.05,15.1898,53,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Triglyceride,,84478,CPT,Facility,Outpatient,,,,53,45.05,15.1898,53,"UCare Health, Inc.",Medicare Advantage,26.7491,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Triglyceride,,84478,CPT,Facility,Inpatient,,,,53,45.05,15.1898,53,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Triglyceride,,84478,CPT,Facility,Outpatient,,,,53,45.05,15.1898,53,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),26.7491,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Triglyceride,,84478,CPT,Facility,Inpatient,,,,53,45.05,15.1898,53,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Triglyceride,,84478,CPT,Facility,Both,,,,53,45.05,15.1898,53,UnitedHealthcare,Individual & Family,49.82,94,,percent of total billed charges,,
Triglyceride,,84478,CPT,Facility,Outpatient,,,,53,45.05,15.1898,53,UnitedHealthcare,Medicare Advantage,25.97,49,,percent of total billed charges,,
Triglyceride,,84478,CPT,Facility,Inpatient,,,,53,45.05,15.1898,53,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Triglyceride,,84478,CPT,Facility,Outpatient,,,,53,45.05,15.1898,53,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,25.44,48,,percent of total billed charges,,100% of DHS outpatient percentage
Triglyceride,,84478,CPT,Facility,Inpatient,,,,53,45.05,15.1898,53,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Triglyceride, Body Fluid",,84478,CPT,Facility,Both,,,,53,45.05,15.1898,53,Aetna,Commercial,48.76,92,,percent of total billed charges,,
"Triglyceride, Body Fluid",,84478,CPT,Facility,Outpatient,,,,53,45.05,15.1898,53,Aetna,Medicare Advantage,25.97,49,,percent of total billed charges,,
"Triglyceride, Body Fluid",,84478,CPT,Facility,Inpatient,,,,53,45.05,15.1898,53,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Triglyceride, Body Fluid",,84478,CPT,Facility,Both,,,,53,45.05,15.1898,53,Aetna,PPO,49.29,93,,percent of total billed charges,,
"Triglyceride, Body Fluid",,84478,CPT,Facility,Both,,,,53,45.05,15.1898,53,America's PPO,America's PPO,50.8959,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Triglyceride, Body Fluid",,84478,CPT,Facility,Both,,,,53,45.05,15.1898,53,BlueCross BlueShield Minnesota, Federal Employee Program,52.152,98.4,,percent of total billed charges,,
"Triglyceride, Body Fluid",,84478,CPT,Facility,Both,,,,53,45.05,15.1898,53,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,53,100,,percent of total billed charges,,
"Triglyceride, Body Fluid",,84478,CPT,Facility,Both,,,,53,45.05,15.1898,53,BlueCross BlueShield Minnesota,High Value Network Plan,47.7,90,,percent of total billed charges,,
"Triglyceride, Body Fluid",,84478,CPT,Facility,Outpatient,,,,53,45.05,15.1898,53,BlueCross BlueShield Minnesota,Medicare Advantage,25.97,49,,percent of total billed charges,,
"Triglyceride, Body Fluid",,84478,CPT,Facility,Inpatient,,,,53,45.05,15.1898,53,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Triglyceride, Body Fluid",,84478,CPT,Facility,Both,,,,53,45.05,15.1898,53,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,46.9421,88.57,,percent of total billed charges,,
"Triglyceride, Body Fluid",,84478,CPT,Facility,Both,,,,53,45.05,15.1898,53,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,15.1898,28.66,,percent of total billed charges,,
"Triglyceride, Body Fluid",,84478,CPT,Facility,Outpatient,,,,53,45.05,15.1898,53,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),25.97,49,,percent of total billed charges,,
"Triglyceride, Body Fluid",,84478,CPT,Facility,Inpatient,,,,53,45.05,15.1898,53,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Triglyceride, Body Fluid",,84478,CPT,Facility,Both,,,,53,45.05,15.1898,53,CorVel,Worker's Compensation,53,100,,percent of total billed charges,,
"Triglyceride, Body Fluid",,84478,CPT,Facility,Both,,,,53,45.05,15.1898,53,First Health Group Corporation,First Health Network,51.41,97,,percent of total billed charges,,
"Triglyceride, Body Fluid",,84478,CPT,Facility,Both,,,,53,45.05,15.1898,53,"Health Partners, Inc.",Commercial,50.138,94.6,,percent of total billed charges,,
"Triglyceride, Body Fluid",,84478,CPT,Facility,Outpatient,,,,53,45.05,15.1898,53,"Health Partners, Inc.",Medicare Advantage,25.97,49,,percent of total billed charges,,
"Triglyceride, Body Fluid",,84478,CPT,Facility,Inpatient,,,,53,45.05,15.1898,53,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Triglyceride, Body Fluid",,84478,CPT,Facility,Both,,,,53,45.05,15.1898,53,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),31.8,60,,percent of total billed charges,,
"Triglyceride, Body Fluid",,84478,CPT,Facility,Both,,,,53,45.05,15.1898,53,"Health Partners, Inc.",State of Minnesota Advantage Program,43.195,81.5,,percent of total billed charges,,
"Triglyceride, Body Fluid",,84478,CPT,Facility,Both,,,,53,45.05,15.1898,53,"Health Partners, Inc.",State Public Programs,26.5,50,,percent of total billed charges,,
"Triglyceride, Body Fluid",,84478,CPT,Facility,Both,,,,53,45.05,15.1898,53,Humana Insurance Company,Commercial PPO,50.35,95,,percent of total billed charges,,
"Triglyceride, Body Fluid",,84478,CPT,Facility,Outpatient,,,,53,45.05,15.1898,53,Humana Insurance Company,Medicare PPO,25.97,49,,percent of total billed charges,,
"Triglyceride, Body Fluid",,84478,CPT,Facility,Inpatient,,,,53,45.05,15.1898,53,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Triglyceride, Body Fluid",,84478,CPT,Facility,Both,,,,53,45.05,15.1898,53,Medica,Individual & Family,52.523,99.1,,percent of total billed charges,,
"Triglyceride, Body Fluid",,84478,CPT,Facility,Outpatient,,,,53,45.05,15.1898,53,Medica,Medica Advantage Solution,26.394,49.8,,percent of total billed charges,,
"Triglyceride, Body Fluid",,84478,CPT,Facility,Inpatient,,,,53,45.05,15.1898,53,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Triglyceride, Body Fluid",,84478,CPT,Facility,Outpatient,,,,53,45.05,15.1898,53,Medica,Medical Assistance,23.638,44.6,,percent of total billed charges,,
"Triglyceride, Body Fluid",,84478,CPT,Facility,Inpatient,,,,53,45.05,15.1898,53,Medica,Medical Assistance,,,,,Included in per diem rate,
"Triglyceride, Body Fluid",,84478,CPT,Facility,Outpatient,,,,53,45.05,15.1898,53,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,26.394,49.8,,percent of total billed charges,,
"Triglyceride, Body Fluid",,84478,CPT,Facility,Inpatient,,,,53,45.05,15.1898,53,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Triglyceride, Body Fluid",,84478,CPT,Facility,Both,,,,53,45.05,15.1898,53,"Multiplan, Inc.","Multiplan, Inc.",49.82,94,,percent of total billed charges,,
"Triglyceride, Body Fluid",,84478,CPT,Facility,Outpatient,,,,53,45.05,15.1898,53,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,45.792,86.4,,percent of total billed charges,,
"Triglyceride, Body Fluid",,84478,CPT,Facility,Inpatient,,,,53,45.05,15.1898,53,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Triglyceride, Body Fluid",,84478,CPT,Facility,Both,,,,53,45.05,15.1898,53,"Preferred One Administrative Services, INC.",PPO,52.258,98.6,,percent of total billed charges,,
"Triglyceride, Body Fluid",,84478,CPT,Facility,Outpatient,,,,53,45.05,15.1898,53,PrimeWest Health,Minnesota Senior Health Options (MSHO),27.2685,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Triglyceride, Body Fluid",,84478,CPT,Facility,Inpatient,,,,53,45.05,15.1898,53,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Triglyceride, Body Fluid",,84478,CPT,Facility,Outpatient,,,,53,45.05,15.1898,53,PrimeWest Health,MinnesotaCare,27.2208,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Triglyceride, Body Fluid",,84478,CPT,Facility,Inpatient,,,,53,45.05,15.1898,53,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Triglyceride, Body Fluid",,84478,CPT,Facility,Both,,,,53,45.05,15.1898,53,Sanford Health Plan,Sanford Health Plan,48.76,92,,percent of total billed charges,,
"Triglyceride, Body Fluid",,84478,CPT,Facility,Outpatient,,,,53,45.05,15.1898,53,"UCare Health, Inc.",Individual & Family Plan,29.8655,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Triglyceride, Body Fluid",,84478,CPT,Facility,Inpatient,,,,53,45.05,15.1898,53,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Triglyceride, Body Fluid",,84478,CPT,Facility,Outpatient,,,,53,45.05,15.1898,53,"UCare Health, Inc.",Medical Assistance,26.7491,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Triglyceride, Body Fluid",,84478,CPT,Facility,Inpatient,,,,53,45.05,15.1898,53,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Triglyceride, Body Fluid",,84478,CPT,Facility,Outpatient,,,,53,45.05,15.1898,53,"UCare Health, Inc.",Medicare Advantage,26.7491,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Triglyceride, Body Fluid",,84478,CPT,Facility,Inpatient,,,,53,45.05,15.1898,53,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Triglyceride, Body Fluid",,84478,CPT,Facility,Outpatient,,,,53,45.05,15.1898,53,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),26.7491,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Triglyceride, Body Fluid",,84478,CPT,Facility,Inpatient,,,,53,45.05,15.1898,53,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Triglyceride, Body Fluid",,84478,CPT,Facility,Both,,,,53,45.05,15.1898,53,UnitedHealthcare,Individual & Family,49.82,94,,percent of total billed charges,,
"Triglyceride, Body Fluid",,84478,CPT,Facility,Outpatient,,,,53,45.05,15.1898,53,UnitedHealthcare,Medicare Advantage,25.97,49,,percent of total billed charges,,
"Triglyceride, Body Fluid",,84478,CPT,Facility,Inpatient,,,,53,45.05,15.1898,53,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Triglyceride, Body Fluid",,84478,CPT,Facility,Outpatient,,,,53,45.05,15.1898,53,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,25.44,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Triglyceride, Body Fluid",,84478,CPT,Facility,Inpatient,,,,53,45.05,15.1898,53,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Triiodothyronine (T3) Free,,84481,CPT,Facility,Both,,,,149,126.65,42.7034,149,Aetna,Commercial,137.08,92,,percent of total billed charges,,
Triiodothyronine (T3) Free,,84481,CPT,Facility,Outpatient,,,,149,126.65,42.7034,149,Aetna,Medicare Advantage,73.01,49,,percent of total billed charges,,
Triiodothyronine (T3) Free,,84481,CPT,Facility,Inpatient,,,,149,126.65,42.7034,149,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Triiodothyronine (T3) Free,,84481,CPT,Facility,Both,,,,149,126.65,42.7034,149,Aetna,PPO,138.57,93,,percent of total billed charges,,
Triiodothyronine (T3) Free,,84481,CPT,Facility,Both,,,,149,126.65,42.7034,149,America's PPO,America's PPO,143.0847,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Triiodothyronine (T3) Free,,84481,CPT,Facility,Both,,,,149,126.65,42.7034,149,BlueCross BlueShield Minnesota, Federal Employee Program,146.616,98.4,,percent of total billed charges,,
Triiodothyronine (T3) Free,,84481,CPT,Facility,Both,,,,149,126.65,42.7034,149,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,149,100,,percent of total billed charges,,
Triiodothyronine (T3) Free,,84481,CPT,Facility,Both,,,,149,126.65,42.7034,149,BlueCross BlueShield Minnesota,High Value Network Plan,134.1,90,,percent of total billed charges,,
Triiodothyronine (T3) Free,,84481,CPT,Facility,Outpatient,,,,149,126.65,42.7034,149,BlueCross BlueShield Minnesota,Medicare Advantage,73.01,49,,percent of total billed charges,,
Triiodothyronine (T3) Free,,84481,CPT,Facility,Inpatient,,,,149,126.65,42.7034,149,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Triiodothyronine (T3) Free,,84481,CPT,Facility,Both,,,,149,126.65,42.7034,149,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,131.9693,88.57,,percent of total billed charges,,
Triiodothyronine (T3) Free,,84481,CPT,Facility,Both,,,,149,126.65,42.7034,149,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,42.7034,28.66,,percent of total billed charges,,
Triiodothyronine (T3) Free,,84481,CPT,Facility,Outpatient,,,,149,126.65,42.7034,149,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),73.01,49,,percent of total billed charges,,
Triiodothyronine (T3) Free,,84481,CPT,Facility,Inpatient,,,,149,126.65,42.7034,149,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Triiodothyronine (T3) Free,,84481,CPT,Facility,Both,,,,149,126.65,42.7034,149,CorVel,Worker's Compensation,149,100,,percent of total billed charges,,
Triiodothyronine (T3) Free,,84481,CPT,Facility,Both,,,,149,126.65,42.7034,149,First Health Group Corporation,First Health Network,144.53,97,,percent of total billed charges,,
Triiodothyronine (T3) Free,,84481,CPT,Facility,Both,,,,149,126.65,42.7034,149,"Health Partners, Inc.",Commercial,140.954,94.6,,percent of total billed charges,,
Triiodothyronine (T3) Free,,84481,CPT,Facility,Outpatient,,,,149,126.65,42.7034,149,"Health Partners, Inc.",Medicare Advantage,73.01,49,,percent of total billed charges,,
Triiodothyronine (T3) Free,,84481,CPT,Facility,Inpatient,,,,149,126.65,42.7034,149,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Triiodothyronine (T3) Free,,84481,CPT,Facility,Both,,,,149,126.65,42.7034,149,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),89.4,60,,percent of total billed charges,,
Triiodothyronine (T3) Free,,84481,CPT,Facility,Both,,,,149,126.65,42.7034,149,"Health Partners, Inc.",State of Minnesota Advantage Program,121.435,81.5,,percent of total billed charges,,
Triiodothyronine (T3) Free,,84481,CPT,Facility,Both,,,,149,126.65,42.7034,149,"Health Partners, Inc.",State Public Programs,74.5,50,,percent of total billed charges,,
Triiodothyronine (T3) Free,,84481,CPT,Facility,Both,,,,149,126.65,42.7034,149,Humana Insurance Company,Commercial PPO,141.55,95,,percent of total billed charges,,
Triiodothyronine (T3) Free,,84481,CPT,Facility,Outpatient,,,,149,126.65,42.7034,149,Humana Insurance Company,Medicare PPO,73.01,49,,percent of total billed charges,,
Triiodothyronine (T3) Free,,84481,CPT,Facility,Inpatient,,,,149,126.65,42.7034,149,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Triiodothyronine (T3) Free,,84481,CPT,Facility,Both,,,,149,126.65,42.7034,149,Medica,Individual & Family,147.659,99.1,,percent of total billed charges,,
Triiodothyronine (T3) Free,,84481,CPT,Facility,Outpatient,,,,149,126.65,42.7034,149,Medica,Medica Advantage Solution,74.202,49.8,,percent of total billed charges,,
Triiodothyronine (T3) Free,,84481,CPT,Facility,Inpatient,,,,149,126.65,42.7034,149,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Triiodothyronine (T3) Free,,84481,CPT,Facility,Outpatient,,,,149,126.65,42.7034,149,Medica,Medical Assistance,66.454,44.6,,percent of total billed charges,,
Triiodothyronine (T3) Free,,84481,CPT,Facility,Inpatient,,,,149,126.65,42.7034,149,Medica,Medical Assistance,,,,,Included in per diem rate,
Triiodothyronine (T3) Free,,84481,CPT,Facility,Outpatient,,,,149,126.65,42.7034,149,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,74.202,49.8,,percent of total billed charges,,
Triiodothyronine (T3) Free,,84481,CPT,Facility,Inpatient,,,,149,126.65,42.7034,149,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Triiodothyronine (T3) Free,,84481,CPT,Facility,Both,,,,149,126.65,42.7034,149,"Multiplan, Inc.","Multiplan, Inc.",140.06,94,,percent of total billed charges,,
Triiodothyronine (T3) Free,,84481,CPT,Facility,Outpatient,,,,149,126.65,42.7034,149,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,128.736,86.4,,percent of total billed charges,,
Triiodothyronine (T3) Free,,84481,CPT,Facility,Inpatient,,,,149,126.65,42.7034,149,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Triiodothyronine (T3) Free,,84481,CPT,Facility,Both,,,,149,126.65,42.7034,149,"Preferred One Administrative Services, INC.",PPO,146.914,98.6,,percent of total billed charges,,
Triiodothyronine (T3) Free,,84481,CPT,Facility,Outpatient,,,,149,126.65,42.7034,149,PrimeWest Health,Minnesota Senior Health Options (MSHO),76.6605,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Triiodothyronine (T3) Free,,84481,CPT,Facility,Inpatient,,,,149,126.65,42.7034,149,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Triiodothyronine (T3) Free,,84481,CPT,Facility,Outpatient,,,,149,126.65,42.7034,149,PrimeWest Health,MinnesotaCare,76.5264,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Triiodothyronine (T3) Free,,84481,CPT,Facility,Inpatient,,,,149,126.65,42.7034,149,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Triiodothyronine (T3) Free,,84481,CPT,Facility,Both,,,,149,126.65,42.7034,149,Sanford Health Plan,Sanford Health Plan,137.08,92,,percent of total billed charges,,
Triiodothyronine (T3) Free,,84481,CPT,Facility,Outpatient,,,,149,126.65,42.7034,149,"UCare Health, Inc.",Individual & Family Plan,83.9615,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Triiodothyronine (T3) Free,,84481,CPT,Facility,Inpatient,,,,149,126.65,42.7034,149,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Triiodothyronine (T3) Free,,84481,CPT,Facility,Outpatient,,,,149,126.65,42.7034,149,"UCare Health, Inc.",Medical Assistance,75.2003,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Triiodothyronine (T3) Free,,84481,CPT,Facility,Inpatient,,,,149,126.65,42.7034,149,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Triiodothyronine (T3) Free,,84481,CPT,Facility,Outpatient,,,,149,126.65,42.7034,149,"UCare Health, Inc.",Medicare Advantage,75.2003,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Triiodothyronine (T3) Free,,84481,CPT,Facility,Inpatient,,,,149,126.65,42.7034,149,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Triiodothyronine (T3) Free,,84481,CPT,Facility,Outpatient,,,,149,126.65,42.7034,149,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),75.2003,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Triiodothyronine (T3) Free,,84481,CPT,Facility,Inpatient,,,,149,126.65,42.7034,149,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Triiodothyronine (T3) Free,,84481,CPT,Facility,Both,,,,149,126.65,42.7034,149,UnitedHealthcare,Individual & Family,140.06,94,,percent of total billed charges,,
Triiodothyronine (T3) Free,,84481,CPT,Facility,Outpatient,,,,149,126.65,42.7034,149,UnitedHealthcare,Medicare Advantage,73.01,49,,percent of total billed charges,,
Triiodothyronine (T3) Free,,84481,CPT,Facility,Inpatient,,,,149,126.65,42.7034,149,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Triiodothyronine (T3) Free,,84481,CPT,Facility,Outpatient,,,,149,126.65,42.7034,149,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,71.52,48,,percent of total billed charges,,100% of DHS outpatient percentage
Triiodothyronine (T3) Free,,84481,CPT,Facility,Inpatient,,,,149,126.65,42.7034,149,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
CALCIUM GLUCONATE 100 MG/ML (10%) IV SOLN,,J0612,HCPCS,Facility,Both,10,mL,,58,49.3,16.6228,58,Aetna,Commercial,53.36,92,,percent of total billed charges,,
CALCIUM GLUCONATE 100 MG/ML (10%) IV SOLN,,J0612,HCPCS,Facility,Outpatient,10,mL,,58,49.3,16.6228,58,Aetna,Medicare Advantage,28.42,49,,percent of total billed charges,,
CALCIUM GLUCONATE 100 MG/ML (10%) IV SOLN,,J0612,HCPCS,Facility,Inpatient,10,mL,,58,49.3,16.6228,58,Aetna,Medicare Advantage,,,,,Included in per diem rate,
CALCIUM GLUCONATE 100 MG/ML (10%) IV SOLN,,J0612,HCPCS,Facility,Both,10,mL,,58,49.3,16.6228,58,Aetna,PPO,53.94,93,,percent of total billed charges,,
CALCIUM GLUCONATE 100 MG/ML (10%) IV SOLN,,J0612,HCPCS,Facility,Both,10,mL,,58,49.3,16.6228,58,America's PPO,America's PPO,55.6974,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
CALCIUM GLUCONATE 100 MG/ML (10%) IV SOLN,,J0612,HCPCS,Facility,Both,10,mL,,58,49.3,16.6228,58,BlueCross BlueShield Minnesota, Federal Employee Program,57.072,98.4,,percent of total billed charges,,
CALCIUM GLUCONATE 100 MG/ML (10%) IV SOLN,,J0612,HCPCS,Facility,Both,10,mL,,58,49.3,16.6228,58,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,58,100,,percent of total billed charges,,
CALCIUM GLUCONATE 100 MG/ML (10%) IV SOLN,,J0612,HCPCS,Facility,Both,10,mL,,58,49.3,16.6228,58,BlueCross BlueShield Minnesota,High Value Network Plan,52.2,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
CALCIUM GLUCONATE 100 MG/ML (10%) IV SOLN,,J0612,HCPCS,Facility,Outpatient,10,mL,,58,49.3,16.6228,58,BlueCross BlueShield Minnesota,Medicare Advantage,28.42,49,,percent of total billed charges,,
CALCIUM GLUCONATE 100 MG/ML (10%) IV SOLN,,J0612,HCPCS,Facility,Inpatient,10,mL,,58,49.3,16.6228,58,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
CALCIUM GLUCONATE 100 MG/ML (10%) IV SOLN,,J0612,HCPCS,Facility,Both,10,mL,,58,49.3,16.6228,58,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,51.3706,88.57,,percent of total billed charges,,
CALCIUM GLUCONATE 100 MG/ML (10%) IV SOLN,,J0612,HCPCS,Facility,Both,10,mL,,58,49.3,16.6228,58,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,16.6228,28.66,,percent of total billed charges,,
CALCIUM GLUCONATE 100 MG/ML (10%) IV SOLN,,J0612,HCPCS,Facility,Outpatient,10,mL,,58,49.3,16.6228,58,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),28.42,49,,percent of total billed charges,,
CALCIUM GLUCONATE 100 MG/ML (10%) IV SOLN,,J0612,HCPCS,Facility,Inpatient,10,mL,,58,49.3,16.6228,58,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
CALCIUM GLUCONATE 100 MG/ML (10%) IV SOLN,,J0612,HCPCS,Facility,Both,10,mL,,58,49.3,16.6228,58,CorVel,Worker's Compensation,58,100,,percent of total billed charges,,
CALCIUM GLUCONATE 100 MG/ML (10%) IV SOLN,,J0612,HCPCS,Facility,Both,10,mL,,58,49.3,16.6228,58,First Health Group Corporation,First Health Network,56.26,97,,percent of total billed charges,,
CALCIUM GLUCONATE 100 MG/ML (10%) IV SOLN,,J0612,HCPCS,Facility,Both,10,mL,,58,49.3,16.6228,58,"Health Partners, Inc.",Commercial,54.868,94.6,,percent of total billed charges,,
CALCIUM GLUCONATE 100 MG/ML (10%) IV SOLN,,J0612,HCPCS,Facility,Outpatient,10,mL,,58,49.3,16.6228,58,"Health Partners, Inc.",Medicare Advantage,28.42,49,,percent of total billed charges,,
CALCIUM GLUCONATE 100 MG/ML (10%) IV SOLN,,J0612,HCPCS,Facility,Inpatient,10,mL,,58,49.3,16.6228,58,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CALCIUM GLUCONATE 100 MG/ML (10%) IV SOLN,,J0612,HCPCS,Facility,Both,10,mL,,58,49.3,16.6228,58,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),34.8,60,,percent of total billed charges,,
CALCIUM GLUCONATE 100 MG/ML (10%) IV SOLN,,J0612,HCPCS,Facility,Both,10,mL,,58,49.3,16.6228,58,"Health Partners, Inc.",State of Minnesota Advantage Program,47.27,81.5,,percent of total billed charges,,
CALCIUM GLUCONATE 100 MG/ML (10%) IV SOLN,,J0612,HCPCS,Facility,Both,10,mL,,58,49.3,16.6228,58,"Health Partners, Inc.",State Public Programs,29,50,,percent of total billed charges,,
CALCIUM GLUCONATE 100 MG/ML (10%) IV SOLN,,J0612,HCPCS,Facility,Both,10,mL,,58,49.3,16.6228,58,Humana Insurance Company,Commercial PPO,55.1,95,,percent of total billed charges,,
CALCIUM GLUCONATE 100 MG/ML (10%) IV SOLN,,J0612,HCPCS,Facility,Outpatient,10,mL,,58,49.3,16.6228,58,Humana Insurance Company,Medicare PPO,28.42,49,,percent of total billed charges,,
CALCIUM GLUCONATE 100 MG/ML (10%) IV SOLN,,J0612,HCPCS,Facility,Inpatient,10,mL,,58,49.3,16.6228,58,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
CALCIUM GLUCONATE 100 MG/ML (10%) IV SOLN,,J0612,HCPCS,Facility,Both,10,mL,,58,49.3,16.6228,58,Medica,Individual & Family,57.478,99.1,,percent of total billed charges,,
CALCIUM GLUCONATE 100 MG/ML (10%) IV SOLN,,J0612,HCPCS,Facility,Outpatient,10,mL,,58,49.3,16.6228,58,Medica,Medica Advantage Solution,28.884,49.8,,percent of total billed charges,,
CALCIUM GLUCONATE 100 MG/ML (10%) IV SOLN,,J0612,HCPCS,Facility,Inpatient,10,mL,,58,49.3,16.6228,58,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
CALCIUM GLUCONATE 100 MG/ML (10%) IV SOLN,,J0612,HCPCS,Facility,Outpatient,10,mL,,58,49.3,16.6228,58,Medica,Medical Assistance,25.868,44.6,,percent of total billed charges,,
CALCIUM GLUCONATE 100 MG/ML (10%) IV SOLN,,J0612,HCPCS,Facility,Inpatient,10,mL,,58,49.3,16.6228,58,Medica,Medical Assistance,,,,,Included in per diem rate,
CALCIUM GLUCONATE 100 MG/ML (10%) IV SOLN,,J0612,HCPCS,Facility,Outpatient,10,mL,,58,49.3,16.6228,58,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,28.884,49.8,,percent of total billed charges,,
CALCIUM GLUCONATE 100 MG/ML (10%) IV SOLN,,J0612,HCPCS,Facility,Inpatient,10,mL,,58,49.3,16.6228,58,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
CALCIUM GLUCONATE 100 MG/ML (10%) IV SOLN,,J0612,HCPCS,Facility,Both,10,mL,,58,49.3,16.6228,58,"Multiplan, Inc.","Multiplan, Inc.",54.52,94,,percent of total billed charges,,
CALCIUM GLUCONATE 100 MG/ML (10%) IV SOLN,,J0612,HCPCS,Facility,Outpatient,10,mL,,58,49.3,16.6228,58,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,52.258,90.1,,percent of total billed charges,,
CALCIUM GLUCONATE 100 MG/ML (10%) IV SOLN,,J0612,HCPCS,Facility,Inpatient,10,mL,,58,49.3,16.6228,58,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
CALCIUM GLUCONATE 100 MG/ML (10%) IV SOLN,,J0612,HCPCS,Facility,Both,10,mL,,58,49.3,16.6228,58,"Preferred One Administrative Services, INC.",PPO,57.188,98.6,,percent of total billed charges,,
CALCIUM GLUCONATE 100 MG/ML (10%) IV SOLN,,J0612,HCPCS,Facility,Outpatient,10,mL,,58,49.3,16.6228,58,PrimeWest Health,Minnesota Senior Health Options (MSHO),29.841,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
CALCIUM GLUCONATE 100 MG/ML (10%) IV SOLN,,J0612,HCPCS,Facility,Inpatient,10,mL,,58,49.3,16.6228,58,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CALCIUM GLUCONATE 100 MG/ML (10%) IV SOLN,,J0612,HCPCS,Facility,Outpatient,10,mL,,58,49.3,16.6228,58,PrimeWest Health,MinnesotaCare,29.7888,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
CALCIUM GLUCONATE 100 MG/ML (10%) IV SOLN,,J0612,HCPCS,Facility,Inpatient,10,mL,,58,49.3,16.6228,58,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
CALCIUM GLUCONATE 100 MG/ML (10%) IV SOLN,,J0612,HCPCS,Facility,Both,10,mL,,58,49.3,16.6228,58,Sanford Health Plan,Sanford Health Plan,53.36,92,,percent of total billed charges,,
CALCIUM GLUCONATE 100 MG/ML (10%) IV SOLN,,J0612,HCPCS,Facility,Outpatient,10,mL,,58,49.3,16.6228,58,"UCare Health, Inc.",Individual & Family Plan,32.683,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
CALCIUM GLUCONATE 100 MG/ML (10%) IV SOLN,,J0612,HCPCS,Facility,Inpatient,10,mL,,58,49.3,16.6228,58,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
CALCIUM GLUCONATE 100 MG/ML (10%) IV SOLN,,J0612,HCPCS,Facility,Outpatient,10,mL,,58,49.3,16.6228,58,"UCare Health, Inc.",Medical Assistance,29.2726,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CALCIUM GLUCONATE 100 MG/ML (10%) IV SOLN,,J0612,HCPCS,Facility,Inpatient,10,mL,,58,49.3,16.6228,58,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
CALCIUM GLUCONATE 100 MG/ML (10%) IV SOLN,,J0612,HCPCS,Facility,Outpatient,10,mL,,58,49.3,16.6228,58,"UCare Health, Inc.",Medicare Advantage,29.2726,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CALCIUM GLUCONATE 100 MG/ML (10%) IV SOLN,,J0612,HCPCS,Facility,Inpatient,10,mL,,58,49.3,16.6228,58,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CALCIUM GLUCONATE 100 MG/ML (10%) IV SOLN,,J0612,HCPCS,Facility,Outpatient,10,mL,,58,49.3,16.6228,58,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),29.2726,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CALCIUM GLUCONATE 100 MG/ML (10%) IV SOLN,,J0612,HCPCS,Facility,Inpatient,10,mL,,58,49.3,16.6228,58,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CALCIUM GLUCONATE 100 MG/ML (10%) IV SOLN,,J0612,HCPCS,Facility,Both,10,mL,,58,49.3,16.6228,58,UnitedHealthcare,Individual & Family,54.52,94,,percent of total billed charges,,
CALCIUM GLUCONATE 100 MG/ML (10%) IV SOLN,,J0612,HCPCS,Facility,Outpatient,10,mL,,58,49.3,16.6228,58,UnitedHealthcare,Medicare Advantage,28.42,49,,percent of total billed charges,,
CALCIUM GLUCONATE 100 MG/ML (10%) IV SOLN,,J0612,HCPCS,Facility,Inpatient,10,mL,,58,49.3,16.6228,58,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
CALCIUM GLUCONATE 100 MG/ML (10%) IV SOLN,,J0612,HCPCS,Facility,Outpatient,10,mL,,58,49.3,16.6228,58,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,27.84,48,,percent of total billed charges,,100% of DHS outpatient percentage
CALCIUM GLUCONATE 100 MG/ML (10%) IV SOLN,,J0612,HCPCS,Facility,Inpatient,10,mL,,58,49.3,16.6228,58,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Troponin I,,84484,CPT,Facility,Both,,,,161,136.85,46.1426,161,Aetna,Commercial,148.12,92,,percent of total billed charges,,
Troponin I,,84484,CPT,Facility,Outpatient,,,,161,136.85,46.1426,161,Aetna,Medicare Advantage,78.89,49,,percent of total billed charges,,
Troponin I,,84484,CPT,Facility,Inpatient,,,,161,136.85,46.1426,161,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Troponin I,,84484,CPT,Facility,Both,,,,161,136.85,46.1426,161,Aetna,PPO,149.73,93,,percent of total billed charges,,
Troponin I,,84484,CPT,Facility,Both,,,,161,136.85,46.1426,161,America's PPO,America's PPO,154.6083,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Troponin I,,84484,CPT,Facility,Both,,,,161,136.85,46.1426,161,BlueCross BlueShield Minnesota, Federal Employee Program,158.424,98.4,,percent of total billed charges,,
Troponin I,,84484,CPT,Facility,Both,,,,161,136.85,46.1426,161,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,161,100,,percent of total billed charges,,
Troponin I,,84484,CPT,Facility,Both,,,,161,136.85,46.1426,161,BlueCross BlueShield Minnesota,High Value Network Plan,144.9,90,,percent of total billed charges,,
Troponin I,,84484,CPT,Facility,Outpatient,,,,161,136.85,46.1426,161,BlueCross BlueShield Minnesota,Medicare Advantage,78.89,49,,percent of total billed charges,,
Troponin I,,84484,CPT,Facility,Inpatient,,,,161,136.85,46.1426,161,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Troponin I,,84484,CPT,Facility,Both,,,,161,136.85,46.1426,161,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,142.5977,88.57,,percent of total billed charges,,
Troponin I,,84484,CPT,Facility,Both,,,,161,136.85,46.1426,161,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,46.1426,28.66,,percent of total billed charges,,
Troponin I,,84484,CPT,Facility,Outpatient,,,,161,136.85,46.1426,161,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),78.89,49,,percent of total billed charges,,
Troponin I,,84484,CPT,Facility,Inpatient,,,,161,136.85,46.1426,161,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Troponin I,,84484,CPT,Facility,Both,,,,161,136.85,46.1426,161,CorVel,Worker's Compensation,161,100,,percent of total billed charges,,
Troponin I,,84484,CPT,Facility,Both,,,,161,136.85,46.1426,161,First Health Group Corporation,First Health Network,156.17,97,,percent of total billed charges,,
Troponin I,,84484,CPT,Facility,Both,,,,161,136.85,46.1426,161,"Health Partners, Inc.",Commercial,152.306,94.6,,percent of total billed charges,,
Troponin I,,84484,CPT,Facility,Outpatient,,,,161,136.85,46.1426,161,"Health Partners, Inc.",Medicare Advantage,78.89,49,,percent of total billed charges,,
Troponin I,,84484,CPT,Facility,Inpatient,,,,161,136.85,46.1426,161,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Troponin I,,84484,CPT,Facility,Both,,,,161,136.85,46.1426,161,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),96.6,60,,percent of total billed charges,,
Troponin I,,84484,CPT,Facility,Both,,,,161,136.85,46.1426,161,"Health Partners, Inc.",State of Minnesota Advantage Program,131.215,81.5,,percent of total billed charges,,
Troponin I,,84484,CPT,Facility,Both,,,,161,136.85,46.1426,161,"Health Partners, Inc.",State Public Programs,80.5,50,,percent of total billed charges,,
Troponin I,,84484,CPT,Facility,Both,,,,161,136.85,46.1426,161,Humana Insurance Company,Commercial PPO,152.95,95,,percent of total billed charges,,
Troponin I,,84484,CPT,Facility,Outpatient,,,,161,136.85,46.1426,161,Humana Insurance Company,Medicare PPO,78.89,49,,percent of total billed charges,,
Troponin I,,84484,CPT,Facility,Inpatient,,,,161,136.85,46.1426,161,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Troponin I,,84484,CPT,Facility,Both,,,,161,136.85,46.1426,161,Medica,Individual & Family,159.551,99.1,,percent of total billed charges,,
Troponin I,,84484,CPT,Facility,Outpatient,,,,161,136.85,46.1426,161,Medica,Medica Advantage Solution,80.178,49.8,,percent of total billed charges,,
Troponin I,,84484,CPT,Facility,Inpatient,,,,161,136.85,46.1426,161,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Troponin I,,84484,CPT,Facility,Outpatient,,,,161,136.85,46.1426,161,Medica,Medical Assistance,71.806,44.6,,percent of total billed charges,,
Troponin I,,84484,CPT,Facility,Inpatient,,,,161,136.85,46.1426,161,Medica,Medical Assistance,,,,,Included in per diem rate,
Troponin I,,84484,CPT,Facility,Outpatient,,,,161,136.85,46.1426,161,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,80.178,49.8,,percent of total billed charges,,
Troponin I,,84484,CPT,Facility,Inpatient,,,,161,136.85,46.1426,161,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Troponin I,,84484,CPT,Facility,Both,,,,161,136.85,46.1426,161,"Multiplan, Inc.","Multiplan, Inc.",151.34,94,,percent of total billed charges,,
Troponin I,,84484,CPT,Facility,Outpatient,,,,161,136.85,46.1426,161,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,139.104,86.4,,percent of total billed charges,,
Troponin I,,84484,CPT,Facility,Inpatient,,,,161,136.85,46.1426,161,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Troponin I,,84484,CPT,Facility,Both,,,,161,136.85,46.1426,161,"Preferred One Administrative Services, INC.",PPO,158.746,98.6,,percent of total billed charges,,
Troponin I,,84484,CPT,Facility,Outpatient,,,,161,136.85,46.1426,161,PrimeWest Health,Minnesota Senior Health Options (MSHO),82.8345,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Troponin I,,84484,CPT,Facility,Inpatient,,,,161,136.85,46.1426,161,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Troponin I,,84484,CPT,Facility,Outpatient,,,,161,136.85,46.1426,161,PrimeWest Health,MinnesotaCare,82.6896,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Troponin I,,84484,CPT,Facility,Inpatient,,,,161,136.85,46.1426,161,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Troponin I,,84484,CPT,Facility,Both,,,,161,136.85,46.1426,161,Sanford Health Plan,Sanford Health Plan,148.12,92,,percent of total billed charges,,
Troponin I,,84484,CPT,Facility,Outpatient,,,,161,136.85,46.1426,161,"UCare Health, Inc.",Individual & Family Plan,90.7235,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Troponin I,,84484,CPT,Facility,Inpatient,,,,161,136.85,46.1426,161,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Troponin I,,84484,CPT,Facility,Outpatient,,,,161,136.85,46.1426,161,"UCare Health, Inc.",Medical Assistance,81.2567,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Troponin I,,84484,CPT,Facility,Inpatient,,,,161,136.85,46.1426,161,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Troponin I,,84484,CPT,Facility,Outpatient,,,,161,136.85,46.1426,161,"UCare Health, Inc.",Medicare Advantage,81.2567,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Troponin I,,84484,CPT,Facility,Inpatient,,,,161,136.85,46.1426,161,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Troponin I,,84484,CPT,Facility,Outpatient,,,,161,136.85,46.1426,161,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),81.2567,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Troponin I,,84484,CPT,Facility,Inpatient,,,,161,136.85,46.1426,161,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Troponin I,,84484,CPT,Facility,Both,,,,161,136.85,46.1426,161,UnitedHealthcare,Individual & Family,151.34,94,,percent of total billed charges,,
Troponin I,,84484,CPT,Facility,Outpatient,,,,161,136.85,46.1426,161,UnitedHealthcare,Medicare Advantage,78.89,49,,percent of total billed charges,,
Troponin I,,84484,CPT,Facility,Inpatient,,,,161,136.85,46.1426,161,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Troponin I,,84484,CPT,Facility,Outpatient,,,,161,136.85,46.1426,161,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,77.28,48,,percent of total billed charges,,100% of DHS outpatient percentage
Troponin I,,84484,CPT,Facility,Inpatient,,,,161,136.85,46.1426,161,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Troponin T,,84484,CPT,Facility,Both,,,,161,136.85,46.1426,161,Aetna,Commercial,148.12,92,,percent of total billed charges,,
Troponin T,,84484,CPT,Facility,Outpatient,,,,161,136.85,46.1426,161,Aetna,Medicare Advantage,78.89,49,,percent of total billed charges,,
Troponin T,,84484,CPT,Facility,Inpatient,,,,161,136.85,46.1426,161,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Troponin T,,84484,CPT,Facility,Both,,,,161,136.85,46.1426,161,Aetna,PPO,149.73,93,,percent of total billed charges,,
Troponin T,,84484,CPT,Facility,Both,,,,161,136.85,46.1426,161,America's PPO,America's PPO,154.6083,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Troponin T,,84484,CPT,Facility,Both,,,,161,136.85,46.1426,161,BlueCross BlueShield Minnesota, Federal Employee Program,158.424,98.4,,percent of total billed charges,,
Troponin T,,84484,CPT,Facility,Both,,,,161,136.85,46.1426,161,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,161,100,,percent of total billed charges,,
Troponin T,,84484,CPT,Facility,Both,,,,161,136.85,46.1426,161,BlueCross BlueShield Minnesota,High Value Network Plan,144.9,90,,percent of total billed charges,,
Troponin T,,84484,CPT,Facility,Outpatient,,,,161,136.85,46.1426,161,BlueCross BlueShield Minnesota,Medicare Advantage,78.89,49,,percent of total billed charges,,
Troponin T,,84484,CPT,Facility,Inpatient,,,,161,136.85,46.1426,161,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Troponin T,,84484,CPT,Facility,Both,,,,161,136.85,46.1426,161,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,142.5977,88.57,,percent of total billed charges,,
Troponin T,,84484,CPT,Facility,Both,,,,161,136.85,46.1426,161,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,46.1426,28.66,,percent of total billed charges,,
Troponin T,,84484,CPT,Facility,Outpatient,,,,161,136.85,46.1426,161,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),78.89,49,,percent of total billed charges,,
Troponin T,,84484,CPT,Facility,Inpatient,,,,161,136.85,46.1426,161,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Troponin T,,84484,CPT,Facility,Both,,,,161,136.85,46.1426,161,CorVel,Worker's Compensation,161,100,,percent of total billed charges,,
Troponin T,,84484,CPT,Facility,Both,,,,161,136.85,46.1426,161,First Health Group Corporation,First Health Network,156.17,97,,percent of total billed charges,,
Troponin T,,84484,CPT,Facility,Both,,,,161,136.85,46.1426,161,"Health Partners, Inc.",Commercial,152.306,94.6,,percent of total billed charges,,
Troponin T,,84484,CPT,Facility,Outpatient,,,,161,136.85,46.1426,161,"Health Partners, Inc.",Medicare Advantage,78.89,49,,percent of total billed charges,,
Troponin T,,84484,CPT,Facility,Inpatient,,,,161,136.85,46.1426,161,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Troponin T,,84484,CPT,Facility,Both,,,,161,136.85,46.1426,161,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),96.6,60,,percent of total billed charges,,
Troponin T,,84484,CPT,Facility,Both,,,,161,136.85,46.1426,161,"Health Partners, Inc.",State of Minnesota Advantage Program,131.215,81.5,,percent of total billed charges,,
Troponin T,,84484,CPT,Facility,Both,,,,161,136.85,46.1426,161,"Health Partners, Inc.",State Public Programs,80.5,50,,percent of total billed charges,,
Troponin T,,84484,CPT,Facility,Both,,,,161,136.85,46.1426,161,Humana Insurance Company,Commercial PPO,152.95,95,,percent of total billed charges,,
Troponin T,,84484,CPT,Facility,Outpatient,,,,161,136.85,46.1426,161,Humana Insurance Company,Medicare PPO,78.89,49,,percent of total billed charges,,
Troponin T,,84484,CPT,Facility,Inpatient,,,,161,136.85,46.1426,161,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Troponin T,,84484,CPT,Facility,Both,,,,161,136.85,46.1426,161,Medica,Individual & Family,159.551,99.1,,percent of total billed charges,,
Troponin T,,84484,CPT,Facility,Outpatient,,,,161,136.85,46.1426,161,Medica,Medica Advantage Solution,80.178,49.8,,percent of total billed charges,,
Troponin T,,84484,CPT,Facility,Inpatient,,,,161,136.85,46.1426,161,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Troponin T,,84484,CPT,Facility,Outpatient,,,,161,136.85,46.1426,161,Medica,Medical Assistance,71.806,44.6,,percent of total billed charges,,
Troponin T,,84484,CPT,Facility,Inpatient,,,,161,136.85,46.1426,161,Medica,Medical Assistance,,,,,Included in per diem rate,
Troponin T,,84484,CPT,Facility,Outpatient,,,,161,136.85,46.1426,161,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,80.178,49.8,,percent of total billed charges,,
Troponin T,,84484,CPT,Facility,Inpatient,,,,161,136.85,46.1426,161,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Troponin T,,84484,CPT,Facility,Both,,,,161,136.85,46.1426,161,"Multiplan, Inc.","Multiplan, Inc.",151.34,94,,percent of total billed charges,,
Troponin T,,84484,CPT,Facility,Outpatient,,,,161,136.85,46.1426,161,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,139.104,86.4,,percent of total billed charges,,
Troponin T,,84484,CPT,Facility,Inpatient,,,,161,136.85,46.1426,161,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Troponin T,,84484,CPT,Facility,Both,,,,161,136.85,46.1426,161,"Preferred One Administrative Services, INC.",PPO,158.746,98.6,,percent of total billed charges,,
Troponin T,,84484,CPT,Facility,Outpatient,,,,161,136.85,46.1426,161,PrimeWest Health,Minnesota Senior Health Options (MSHO),82.8345,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Troponin T,,84484,CPT,Facility,Inpatient,,,,161,136.85,46.1426,161,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Troponin T,,84484,CPT,Facility,Outpatient,,,,161,136.85,46.1426,161,PrimeWest Health,MinnesotaCare,82.6896,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Troponin T,,84484,CPT,Facility,Inpatient,,,,161,136.85,46.1426,161,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Troponin T,,84484,CPT,Facility,Both,,,,161,136.85,46.1426,161,Sanford Health Plan,Sanford Health Plan,148.12,92,,percent of total billed charges,,
Troponin T,,84484,CPT,Facility,Outpatient,,,,161,136.85,46.1426,161,"UCare Health, Inc.",Individual & Family Plan,90.7235,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Troponin T,,84484,CPT,Facility,Inpatient,,,,161,136.85,46.1426,161,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Troponin T,,84484,CPT,Facility,Outpatient,,,,161,136.85,46.1426,161,"UCare Health, Inc.",Medical Assistance,81.2567,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Troponin T,,84484,CPT,Facility,Inpatient,,,,161,136.85,46.1426,161,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Troponin T,,84484,CPT,Facility,Outpatient,,,,161,136.85,46.1426,161,"UCare Health, Inc.",Medicare Advantage,81.2567,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Troponin T,,84484,CPT,Facility,Inpatient,,,,161,136.85,46.1426,161,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Troponin T,,84484,CPT,Facility,Outpatient,,,,161,136.85,46.1426,161,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),81.2567,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Troponin T,,84484,CPT,Facility,Inpatient,,,,161,136.85,46.1426,161,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Troponin T,,84484,CPT,Facility,Both,,,,161,136.85,46.1426,161,UnitedHealthcare,Individual & Family,151.34,94,,percent of total billed charges,,
Troponin T,,84484,CPT,Facility,Outpatient,,,,161,136.85,46.1426,161,UnitedHealthcare,Medicare Advantage,78.89,49,,percent of total billed charges,,
Troponin T,,84484,CPT,Facility,Inpatient,,,,161,136.85,46.1426,161,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Troponin T,,84484,CPT,Facility,Outpatient,,,,161,136.85,46.1426,161,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,77.28,48,,percent of total billed charges,,100% of DHS outpatient percentage
Troponin T,,84484,CPT,Facility,Inpatient,,,,161,136.85,46.1426,161,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Troponin, Quantitative; High Sensitivity",,84484,CPT,Facility,Both,,,,179,152.15,51.3014,179,Aetna,Commercial,164.68,92,,percent of total billed charges,,
"Troponin, Quantitative; High Sensitivity",,84484,CPT,Facility,Outpatient,,,,179,152.15,51.3014,179,Aetna,Medicare Advantage,87.71,49,,percent of total billed charges,,
"Troponin, Quantitative; High Sensitivity",,84484,CPT,Facility,Inpatient,,,,179,152.15,51.3014,179,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Troponin, Quantitative; High Sensitivity",,84484,CPT,Facility,Both,,,,179,152.15,51.3014,179,Aetna,PPO,166.47,93,,percent of total billed charges,,
"Troponin, Quantitative; High Sensitivity",,84484,CPT,Facility,Both,,,,179,152.15,51.3014,179,America's PPO,America's PPO,171.8937,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Troponin, Quantitative; High Sensitivity",,84484,CPT,Facility,Both,,,,179,152.15,51.3014,179,BlueCross BlueShield Minnesota, Federal Employee Program,176.136,98.4,,percent of total billed charges,,
"Troponin, Quantitative; High Sensitivity",,84484,CPT,Facility,Both,,,,179,152.15,51.3014,179,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,179,100,,percent of total billed charges,,
"Troponin, Quantitative; High Sensitivity",,84484,CPT,Facility,Both,,,,179,152.15,51.3014,179,BlueCross BlueShield Minnesota,High Value Network Plan,161.1,90,,percent of total billed charges,,
"Troponin, Quantitative; High Sensitivity",,84484,CPT,Facility,Outpatient,,,,179,152.15,51.3014,179,BlueCross BlueShield Minnesota,Medicare Advantage,87.71,49,,percent of total billed charges,,
"Troponin, Quantitative; High Sensitivity",,84484,CPT,Facility,Inpatient,,,,179,152.15,51.3014,179,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Troponin, Quantitative; High Sensitivity",,84484,CPT,Facility,Both,,,,179,152.15,51.3014,179,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,158.5403,88.57,,percent of total billed charges,,
"Troponin, Quantitative; High Sensitivity",,84484,CPT,Facility,Both,,,,179,152.15,51.3014,179,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,51.3014,28.66,,percent of total billed charges,,
"Troponin, Quantitative; High Sensitivity",,84484,CPT,Facility,Outpatient,,,,179,152.15,51.3014,179,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),87.71,49,,percent of total billed charges,,
"Troponin, Quantitative; High Sensitivity",,84484,CPT,Facility,Inpatient,,,,179,152.15,51.3014,179,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Troponin, Quantitative; High Sensitivity",,84484,CPT,Facility,Both,,,,179,152.15,51.3014,179,CorVel,Worker's Compensation,179,100,,percent of total billed charges,,
"Troponin, Quantitative; High Sensitivity",,84484,CPT,Facility,Both,,,,179,152.15,51.3014,179,First Health Group Corporation,First Health Network,173.63,97,,percent of total billed charges,,
"Troponin, Quantitative; High Sensitivity",,84484,CPT,Facility,Both,,,,179,152.15,51.3014,179,"Health Partners, Inc.",Commercial,169.334,94.6,,percent of total billed charges,,
"Troponin, Quantitative; High Sensitivity",,84484,CPT,Facility,Outpatient,,,,179,152.15,51.3014,179,"Health Partners, Inc.",Medicare Advantage,87.71,49,,percent of total billed charges,,
"Troponin, Quantitative; High Sensitivity",,84484,CPT,Facility,Inpatient,,,,179,152.15,51.3014,179,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Troponin, Quantitative; High Sensitivity",,84484,CPT,Facility,Both,,,,179,152.15,51.3014,179,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),107.4,60,,percent of total billed charges,,
"Troponin, Quantitative; High Sensitivity",,84484,CPT,Facility,Both,,,,179,152.15,51.3014,179,"Health Partners, Inc.",State of Minnesota Advantage Program,145.885,81.5,,percent of total billed charges,,
"Troponin, Quantitative; High Sensitivity",,84484,CPT,Facility,Both,,,,179,152.15,51.3014,179,"Health Partners, Inc.",State Public Programs,89.5,50,,percent of total billed charges,,
"Troponin, Quantitative; High Sensitivity",,84484,CPT,Facility,Both,,,,179,152.15,51.3014,179,Humana Insurance Company,Commercial PPO,170.05,95,,percent of total billed charges,,
"Troponin, Quantitative; High Sensitivity",,84484,CPT,Facility,Outpatient,,,,179,152.15,51.3014,179,Humana Insurance Company,Medicare PPO,87.71,49,,percent of total billed charges,,
"Troponin, Quantitative; High Sensitivity",,84484,CPT,Facility,Inpatient,,,,179,152.15,51.3014,179,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Troponin, Quantitative; High Sensitivity",,84484,CPT,Facility,Both,,,,179,152.15,51.3014,179,Medica,Individual & Family,177.389,99.1,,percent of total billed charges,,
"Troponin, Quantitative; High Sensitivity",,84484,CPT,Facility,Outpatient,,,,179,152.15,51.3014,179,Medica,Medica Advantage Solution,89.142,49.8,,percent of total billed charges,,
"Troponin, Quantitative; High Sensitivity",,84484,CPT,Facility,Inpatient,,,,179,152.15,51.3014,179,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Troponin, Quantitative; High Sensitivity",,84484,CPT,Facility,Outpatient,,,,179,152.15,51.3014,179,Medica,Medical Assistance,79.834,44.6,,percent of total billed charges,,
"Troponin, Quantitative; High Sensitivity",,84484,CPT,Facility,Inpatient,,,,179,152.15,51.3014,179,Medica,Medical Assistance,,,,,Included in per diem rate,
"Troponin, Quantitative; High Sensitivity",,84484,CPT,Facility,Outpatient,,,,179,152.15,51.3014,179,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,89.142,49.8,,percent of total billed charges,,
"Troponin, Quantitative; High Sensitivity",,84484,CPT,Facility,Inpatient,,,,179,152.15,51.3014,179,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Troponin, Quantitative; High Sensitivity",,84484,CPT,Facility,Both,,,,179,152.15,51.3014,179,"Multiplan, Inc.","Multiplan, Inc.",168.26,94,,percent of total billed charges,,
"Troponin, Quantitative; High Sensitivity",,84484,CPT,Facility,Outpatient,,,,179,152.15,51.3014,179,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,154.656,86.4,,percent of total billed charges,,
"Troponin, Quantitative; High Sensitivity",,84484,CPT,Facility,Inpatient,,,,179,152.15,51.3014,179,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Troponin, Quantitative; High Sensitivity",,84484,CPT,Facility,Both,,,,179,152.15,51.3014,179,"Preferred One Administrative Services, INC.",PPO,176.494,98.6,,percent of total billed charges,,
"Troponin, Quantitative; High Sensitivity",,84484,CPT,Facility,Outpatient,,,,179,152.15,51.3014,179,PrimeWest Health,Minnesota Senior Health Options (MSHO),92.0955,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Troponin, Quantitative; High Sensitivity",,84484,CPT,Facility,Inpatient,,,,179,152.15,51.3014,179,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Troponin, Quantitative; High Sensitivity",,84484,CPT,Facility,Outpatient,,,,179,152.15,51.3014,179,PrimeWest Health,MinnesotaCare,91.9344,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Troponin, Quantitative; High Sensitivity",,84484,CPT,Facility,Inpatient,,,,179,152.15,51.3014,179,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Troponin, Quantitative; High Sensitivity",,84484,CPT,Facility,Both,,,,179,152.15,51.3014,179,Sanford Health Plan,Sanford Health Plan,164.68,92,,percent of total billed charges,,
"Troponin, Quantitative; High Sensitivity",,84484,CPT,Facility,Outpatient,,,,179,152.15,51.3014,179,"UCare Health, Inc.",Individual & Family Plan,100.8665,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Troponin, Quantitative; High Sensitivity",,84484,CPT,Facility,Inpatient,,,,179,152.15,51.3014,179,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Troponin, Quantitative; High Sensitivity",,84484,CPT,Facility,Outpatient,,,,179,152.15,51.3014,179,"UCare Health, Inc.",Medical Assistance,90.3413,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Troponin, Quantitative; High Sensitivity",,84484,CPT,Facility,Inpatient,,,,179,152.15,51.3014,179,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Troponin, Quantitative; High Sensitivity",,84484,CPT,Facility,Outpatient,,,,179,152.15,51.3014,179,"UCare Health, Inc.",Medicare Advantage,90.3413,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Troponin, Quantitative; High Sensitivity",,84484,CPT,Facility,Inpatient,,,,179,152.15,51.3014,179,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Troponin, Quantitative; High Sensitivity",,84484,CPT,Facility,Outpatient,,,,179,152.15,51.3014,179,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),90.3413,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Troponin, Quantitative; High Sensitivity",,84484,CPT,Facility,Inpatient,,,,179,152.15,51.3014,179,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Troponin, Quantitative; High Sensitivity",,84484,CPT,Facility,Both,,,,179,152.15,51.3014,179,UnitedHealthcare,Individual & Family,168.26,94,,percent of total billed charges,,
"Troponin, Quantitative; High Sensitivity",,84484,CPT,Facility,Outpatient,,,,179,152.15,51.3014,179,UnitedHealthcare,Medicare Advantage,87.71,49,,percent of total billed charges,,
"Troponin, Quantitative; High Sensitivity",,84484,CPT,Facility,Inpatient,,,,179,152.15,51.3014,179,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Troponin, Quantitative; High Sensitivity",,84484,CPT,Facility,Outpatient,,,,179,152.15,51.3014,179,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,85.92,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Troponin, Quantitative; High Sensitivity",,84484,CPT,Facility,Inpatient,,,,179,152.15,51.3014,179,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Both,10,mL,,11,9.35,3.1526,11,Aetna,Commercial,10.12,92,,percent of total billed charges,,
BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Outpatient,10,mL,,11,9.35,3.1526,11,Aetna,Medicare Advantage,5.39,49,,percent of total billed charges,,
BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Inpatient,10,mL,,11,9.35,3.1526,11,Aetna,Medicare Advantage,,,,,Included in per diem rate,
BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Both,10,mL,,11,9.35,3.1526,11,Aetna,PPO,10.23,93,,percent of total billed charges,,
BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Both,10,mL,,11,9.35,3.1526,11,America's PPO,America's PPO,10.5633,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Both,10,mL,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota, Federal Employee Program,10.824,98.4,,percent of total billed charges,,
BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Both,10,mL,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,11,100,,percent of total billed charges,,
BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Both,10,mL,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,High Value Network Plan,9.9,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Outpatient,10,mL,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,Medicare Advantage,5.39,49,,percent of total billed charges,,
BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Inpatient,10,mL,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Both,10,mL,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,9.7427,88.57,,percent of total billed charges,,
BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Both,10,mL,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,3.1526,28.66,,percent of total billed charges,,
BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Outpatient,10,mL,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),5.39,49,,percent of total billed charges,,
BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Inpatient,10,mL,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Both,10,mL,,11,9.35,3.1526,11,CorVel,Worker's Compensation,11,100,,percent of total billed charges,,
BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Both,10,mL,,11,9.35,3.1526,11,First Health Group Corporation,First Health Network,10.67,97,,percent of total billed charges,,
BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Both,10,mL,,11,9.35,3.1526,11,"Health Partners, Inc.",Commercial,10.406,94.6,,percent of total billed charges,,
BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Outpatient,10,mL,,11,9.35,3.1526,11,"Health Partners, Inc.",Medicare Advantage,5.39,49,,percent of total billed charges,,
BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Inpatient,10,mL,,11,9.35,3.1526,11,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Both,10,mL,,11,9.35,3.1526,11,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),6.6,60,,percent of total billed charges,,
BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Both,10,mL,,11,9.35,3.1526,11,"Health Partners, Inc.",State of Minnesota Advantage Program,8.965,81.5,,percent of total billed charges,,
BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Both,10,mL,,11,9.35,3.1526,11,"Health Partners, Inc.",State Public Programs,5.5,50,,percent of total billed charges,,
BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Both,10,mL,,11,9.35,3.1526,11,Humana Insurance Company,Commercial PPO,10.45,95,,percent of total billed charges,,
BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Outpatient,10,mL,,11,9.35,3.1526,11,Humana Insurance Company,Medicare PPO,5.39,49,,percent of total billed charges,,
BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Inpatient,10,mL,,11,9.35,3.1526,11,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Both,10,mL,,11,9.35,3.1526,11,Medica,Individual & Family,10.901,99.1,,percent of total billed charges,,
BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Outpatient,10,mL,,11,9.35,3.1526,11,Medica,Medica Advantage Solution,5.478,49.8,,percent of total billed charges,,
BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Inpatient,10,mL,,11,9.35,3.1526,11,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Outpatient,10,mL,,11,9.35,3.1526,11,Medica,Medical Assistance,4.906,44.6,,percent of total billed charges,,
BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Inpatient,10,mL,,11,9.35,3.1526,11,Medica,Medical Assistance,,,,,Included in per diem rate,
BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Outpatient,10,mL,,11,9.35,3.1526,11,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,5.478,49.8,,percent of total billed charges,,
BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Inpatient,10,mL,,11,9.35,3.1526,11,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Both,10,mL,,11,9.35,3.1526,11,"Multiplan, Inc.","Multiplan, Inc.",10.34,94,,percent of total billed charges,,
BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Outpatient,10,mL,,11,9.35,3.1526,11,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,9.911,90.1,,percent of total billed charges,,
BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Inpatient,10,mL,,11,9.35,3.1526,11,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Both,10,mL,,11,9.35,3.1526,11,"Preferred One Administrative Services, INC.",PPO,10.846,98.6,,percent of total billed charges,,
BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Outpatient,10,mL,,11,9.35,3.1526,11,PrimeWest Health,Minnesota Senior Health Options (MSHO),5.6595,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Inpatient,10,mL,,11,9.35,3.1526,11,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Outpatient,10,mL,,11,9.35,3.1526,11,PrimeWest Health,MinnesotaCare,5.6496,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Inpatient,10,mL,,11,9.35,3.1526,11,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Both,10,mL,,11,9.35,3.1526,11,Sanford Health Plan,Sanford Health Plan,10.12,92,,percent of total billed charges,,
BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Outpatient,10,mL,,11,9.35,3.1526,11,"UCare Health, Inc.",Individual & Family Plan,6.1985,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Inpatient,10,mL,,11,9.35,3.1526,11,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Outpatient,10,mL,,11,9.35,3.1526,11,"UCare Health, Inc.",Medical Assistance,5.5517,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Inpatient,10,mL,,11,9.35,3.1526,11,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Outpatient,10,mL,,11,9.35,3.1526,11,"UCare Health, Inc.",Medicare Advantage,5.5517,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Inpatient,10,mL,,11,9.35,3.1526,11,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Outpatient,10,mL,,11,9.35,3.1526,11,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),5.5517,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Inpatient,10,mL,,11,9.35,3.1526,11,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Both,10,mL,,11,9.35,3.1526,11,UnitedHealthcare,Individual & Family,10.34,94,,percent of total billed charges,,
BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Outpatient,10,mL,,11,9.35,3.1526,11,UnitedHealthcare,Medicare Advantage,5.39,49,,percent of total billed charges,,
BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Inpatient,10,mL,,11,9.35,3.1526,11,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Outpatient,10,mL,,11,9.35,3.1526,11,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,5.28,48,,percent of total billed charges,,100% of DHS outpatient percentage
BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Inpatient,10,mL,,11,9.35,3.1526,11,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Blood Urea Nitrogen,,84520,CPT,Facility,Both,,,,56,47.6,16.0496,56,Aetna,Commercial,51.52,92,,percent of total billed charges,,
Blood Urea Nitrogen,,84520,CPT,Facility,Outpatient,,,,56,47.6,16.0496,56,Aetna,Medicare Advantage,27.44,49,,percent of total billed charges,,
Blood Urea Nitrogen,,84520,CPT,Facility,Inpatient,,,,56,47.6,16.0496,56,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Blood Urea Nitrogen,,84520,CPT,Facility,Both,,,,56,47.6,16.0496,56,Aetna,PPO,52.08,93,,percent of total billed charges,,
Blood Urea Nitrogen,,84520,CPT,Facility,Both,,,,56,47.6,16.0496,56,America's PPO,America's PPO,53.7768,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Blood Urea Nitrogen,,84520,CPT,Facility,Both,,,,56,47.6,16.0496,56,BlueCross BlueShield Minnesota, Federal Employee Program,55.104,98.4,,percent of total billed charges,,
Blood Urea Nitrogen,,84520,CPT,Facility,Both,,,,56,47.6,16.0496,56,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,56,100,,percent of total billed charges,,
Blood Urea Nitrogen,,84520,CPT,Facility,Both,,,,56,47.6,16.0496,56,BlueCross BlueShield Minnesota,High Value Network Plan,50.4,90,,percent of total billed charges,,
Blood Urea Nitrogen,,84520,CPT,Facility,Outpatient,,,,56,47.6,16.0496,56,BlueCross BlueShield Minnesota,Medicare Advantage,27.44,49,,percent of total billed charges,,
Blood Urea Nitrogen,,84520,CPT,Facility,Inpatient,,,,56,47.6,16.0496,56,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Blood Urea Nitrogen,,84520,CPT,Facility,Both,,,,56,47.6,16.0496,56,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,49.5992,88.57,,percent of total billed charges,,
Blood Urea Nitrogen,,84520,CPT,Facility,Both,,,,56,47.6,16.0496,56,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,16.0496,28.66,,percent of total billed charges,,
Blood Urea Nitrogen,,84520,CPT,Facility,Outpatient,,,,56,47.6,16.0496,56,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),27.44,49,,percent of total billed charges,,
Blood Urea Nitrogen,,84520,CPT,Facility,Inpatient,,,,56,47.6,16.0496,56,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Blood Urea Nitrogen,,84520,CPT,Facility,Both,,,,56,47.6,16.0496,56,CorVel,Worker's Compensation,56,100,,percent of total billed charges,,
Blood Urea Nitrogen,,84520,CPT,Facility,Both,,,,56,47.6,16.0496,56,First Health Group Corporation,First Health Network,54.32,97,,percent of total billed charges,,
Blood Urea Nitrogen,,84520,CPT,Facility,Both,,,,56,47.6,16.0496,56,"Health Partners, Inc.",Commercial,52.976,94.6,,percent of total billed charges,,
Blood Urea Nitrogen,,84520,CPT,Facility,Outpatient,,,,56,47.6,16.0496,56,"Health Partners, Inc.",Medicare Advantage,27.44,49,,percent of total billed charges,,
Blood Urea Nitrogen,,84520,CPT,Facility,Inpatient,,,,56,47.6,16.0496,56,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Blood Urea Nitrogen,,84520,CPT,Facility,Both,,,,56,47.6,16.0496,56,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),33.6,60,,percent of total billed charges,,
Blood Urea Nitrogen,,84520,CPT,Facility,Both,,,,56,47.6,16.0496,56,"Health Partners, Inc.",State of Minnesota Advantage Program,45.64,81.5,,percent of total billed charges,,
Blood Urea Nitrogen,,84520,CPT,Facility,Both,,,,56,47.6,16.0496,56,"Health Partners, Inc.",State Public Programs,28,50,,percent of total billed charges,,
Blood Urea Nitrogen,,84520,CPT,Facility,Both,,,,56,47.6,16.0496,56,Humana Insurance Company,Commercial PPO,53.2,95,,percent of total billed charges,,
Blood Urea Nitrogen,,84520,CPT,Facility,Outpatient,,,,56,47.6,16.0496,56,Humana Insurance Company,Medicare PPO,27.44,49,,percent of total billed charges,,
Blood Urea Nitrogen,,84520,CPT,Facility,Inpatient,,,,56,47.6,16.0496,56,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Blood Urea Nitrogen,,84520,CPT,Facility,Both,,,,56,47.6,16.0496,56,Medica,Individual & Family,55.496,99.1,,percent of total billed charges,,
Blood Urea Nitrogen,,84520,CPT,Facility,Outpatient,,,,56,47.6,16.0496,56,Medica,Medica Advantage Solution,27.888,49.8,,percent of total billed charges,,
Blood Urea Nitrogen,,84520,CPT,Facility,Inpatient,,,,56,47.6,16.0496,56,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Blood Urea Nitrogen,,84520,CPT,Facility,Outpatient,,,,56,47.6,16.0496,56,Medica,Medical Assistance,24.976,44.6,,percent of total billed charges,,
Blood Urea Nitrogen,,84520,CPT,Facility,Inpatient,,,,56,47.6,16.0496,56,Medica,Medical Assistance,,,,,Included in per diem rate,
Blood Urea Nitrogen,,84520,CPT,Facility,Outpatient,,,,56,47.6,16.0496,56,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,27.888,49.8,,percent of total billed charges,,
Blood Urea Nitrogen,,84520,CPT,Facility,Inpatient,,,,56,47.6,16.0496,56,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Blood Urea Nitrogen,,84520,CPT,Facility,Both,,,,56,47.6,16.0496,56,"Multiplan, Inc.","Multiplan, Inc.",52.64,94,,percent of total billed charges,,
Blood Urea Nitrogen,,84520,CPT,Facility,Outpatient,,,,56,47.6,16.0496,56,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,48.384,86.4,,percent of total billed charges,,
Blood Urea Nitrogen,,84520,CPT,Facility,Inpatient,,,,56,47.6,16.0496,56,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Blood Urea Nitrogen,,84520,CPT,Facility,Both,,,,56,47.6,16.0496,56,"Preferred One Administrative Services, INC.",PPO,55.216,98.6,,percent of total billed charges,,
Blood Urea Nitrogen,,84520,CPT,Facility,Outpatient,,,,56,47.6,16.0496,56,PrimeWest Health,Minnesota Senior Health Options (MSHO),28.812,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Blood Urea Nitrogen,,84520,CPT,Facility,Inpatient,,,,56,47.6,16.0496,56,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Blood Urea Nitrogen,,84520,CPT,Facility,Outpatient,,,,56,47.6,16.0496,56,PrimeWest Health,MinnesotaCare,28.7616,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Blood Urea Nitrogen,,84520,CPT,Facility,Inpatient,,,,56,47.6,16.0496,56,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Blood Urea Nitrogen,,84520,CPT,Facility,Both,,,,56,47.6,16.0496,56,Sanford Health Plan,Sanford Health Plan,51.52,92,,percent of total billed charges,,
Blood Urea Nitrogen,,84520,CPT,Facility,Outpatient,,,,56,47.6,16.0496,56,"UCare Health, Inc.",Individual & Family Plan,31.556,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Blood Urea Nitrogen,,84520,CPT,Facility,Inpatient,,,,56,47.6,16.0496,56,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Blood Urea Nitrogen,,84520,CPT,Facility,Outpatient,,,,56,47.6,16.0496,56,"UCare Health, Inc.",Medical Assistance,28.2632,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Blood Urea Nitrogen,,84520,CPT,Facility,Inpatient,,,,56,47.6,16.0496,56,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Blood Urea Nitrogen,,84520,CPT,Facility,Outpatient,,,,56,47.6,16.0496,56,"UCare Health, Inc.",Medicare Advantage,28.2632,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Blood Urea Nitrogen,,84520,CPT,Facility,Inpatient,,,,56,47.6,16.0496,56,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Blood Urea Nitrogen,,84520,CPT,Facility,Outpatient,,,,56,47.6,16.0496,56,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),28.2632,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Blood Urea Nitrogen,,84520,CPT,Facility,Inpatient,,,,56,47.6,16.0496,56,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Blood Urea Nitrogen,,84520,CPT,Facility,Both,,,,56,47.6,16.0496,56,UnitedHealthcare,Individual & Family,52.64,94,,percent of total billed charges,,
Blood Urea Nitrogen,,84520,CPT,Facility,Outpatient,,,,56,47.6,16.0496,56,UnitedHealthcare,Medicare Advantage,27.44,49,,percent of total billed charges,,
Blood Urea Nitrogen,,84520,CPT,Facility,Inpatient,,,,56,47.6,16.0496,56,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Blood Urea Nitrogen,,84520,CPT,Facility,Outpatient,,,,56,47.6,16.0496,56,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,26.88,48,,percent of total billed charges,,100% of DHS outpatient percentage
Blood Urea Nitrogen,,84520,CPT,Facility,Inpatient,,,,56,47.6,16.0496,56,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Uric Acid,,84550,CPT,Facility,Both,,,,72,61.2,20.6352,72,Aetna,Commercial,66.24,92,,percent of total billed charges,,
Uric Acid,,84550,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,Aetna,Medicare Advantage,35.28,49,,percent of total billed charges,,
Uric Acid,,84550,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Uric Acid,,84550,CPT,Facility,Both,,,,72,61.2,20.6352,72,Aetna,PPO,66.96,93,,percent of total billed charges,,
Uric Acid,,84550,CPT,Facility,Both,,,,72,61.2,20.6352,72,America's PPO,America's PPO,69.1416,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Uric Acid,,84550,CPT,Facility,Both,,,,72,61.2,20.6352,72,BlueCross BlueShield Minnesota, Federal Employee Program,70.848,98.4,,percent of total billed charges,,
Uric Acid,,84550,CPT,Facility,Both,,,,72,61.2,20.6352,72,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,72,100,,percent of total billed charges,,
Uric Acid,,84550,CPT,Facility,Both,,,,72,61.2,20.6352,72,BlueCross BlueShield Minnesota,High Value Network Plan,64.8,90,,percent of total billed charges,,
Uric Acid,,84550,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,BlueCross BlueShield Minnesota,Medicare Advantage,35.28,49,,percent of total billed charges,,
Uric Acid,,84550,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Uric Acid,,84550,CPT,Facility,Both,,,,72,61.2,20.6352,72,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,63.7704,88.57,,percent of total billed charges,,
Uric Acid,,84550,CPT,Facility,Both,,,,72,61.2,20.6352,72,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,20.6352,28.66,,percent of total billed charges,,
Uric Acid,,84550,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),35.28,49,,percent of total billed charges,,
Uric Acid,,84550,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Uric Acid,,84550,CPT,Facility,Both,,,,72,61.2,20.6352,72,CorVel,Worker's Compensation,72,100,,percent of total billed charges,,
Uric Acid,,84550,CPT,Facility,Both,,,,72,61.2,20.6352,72,First Health Group Corporation,First Health Network,69.84,97,,percent of total billed charges,,
Uric Acid,,84550,CPT,Facility,Both,,,,72,61.2,20.6352,72,"Health Partners, Inc.",Commercial,68.112,94.6,,percent of total billed charges,,
Uric Acid,,84550,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,"Health Partners, Inc.",Medicare Advantage,35.28,49,,percent of total billed charges,,
Uric Acid,,84550,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Uric Acid,,84550,CPT,Facility,Both,,,,72,61.2,20.6352,72,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),43.2,60,,percent of total billed charges,,
Uric Acid,,84550,CPT,Facility,Both,,,,72,61.2,20.6352,72,"Health Partners, Inc.",State of Minnesota Advantage Program,58.68,81.5,,percent of total billed charges,,
Uric Acid,,84550,CPT,Facility,Both,,,,72,61.2,20.6352,72,"Health Partners, Inc.",State Public Programs,36,50,,percent of total billed charges,,
Uric Acid,,84550,CPT,Facility,Both,,,,72,61.2,20.6352,72,Humana Insurance Company,Commercial PPO,68.4,95,,percent of total billed charges,,
Uric Acid,,84550,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,Humana Insurance Company,Medicare PPO,35.28,49,,percent of total billed charges,,
Uric Acid,,84550,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Uric Acid,,84550,CPT,Facility,Both,,,,72,61.2,20.6352,72,Medica,Individual & Family,71.352,99.1,,percent of total billed charges,,
Uric Acid,,84550,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,Medica,Medica Advantage Solution,35.856,49.8,,percent of total billed charges,,
Uric Acid,,84550,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Uric Acid,,84550,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,Medica,Medical Assistance,32.112,44.6,,percent of total billed charges,,
Uric Acid,,84550,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,Medica,Medical Assistance,,,,,Included in per diem rate,
Uric Acid,,84550,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,35.856,49.8,,percent of total billed charges,,
Uric Acid,,84550,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Uric Acid,,84550,CPT,Facility,Both,,,,72,61.2,20.6352,72,"Multiplan, Inc.","Multiplan, Inc.",67.68,94,,percent of total billed charges,,
Uric Acid,,84550,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,62.208,86.4,,percent of total billed charges,,
Uric Acid,,84550,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Uric Acid,,84550,CPT,Facility,Both,,,,72,61.2,20.6352,72,"Preferred One Administrative Services, INC.",PPO,70.992,98.6,,percent of total billed charges,,
Uric Acid,,84550,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,PrimeWest Health,Minnesota Senior Health Options (MSHO),37.044,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Uric Acid,,84550,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Uric Acid,,84550,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,PrimeWest Health,MinnesotaCare,36.9792,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Uric Acid,,84550,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Uric Acid,,84550,CPT,Facility,Both,,,,72,61.2,20.6352,72,Sanford Health Plan,Sanford Health Plan,66.24,92,,percent of total billed charges,,
Uric Acid,,84550,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,"UCare Health, Inc.",Individual & Family Plan,40.572,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Uric Acid,,84550,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Uric Acid,,84550,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,"UCare Health, Inc.",Medical Assistance,36.3384,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Uric Acid,,84550,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Uric Acid,,84550,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,"UCare Health, Inc.",Medicare Advantage,36.3384,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Uric Acid,,84550,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Uric Acid,,84550,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),36.3384,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Uric Acid,,84550,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Uric Acid,,84550,CPT,Facility,Both,,,,72,61.2,20.6352,72,UnitedHealthcare,Individual & Family,67.68,94,,percent of total billed charges,,
Uric Acid,,84550,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,UnitedHealthcare,Medicare Advantage,35.28,49,,percent of total billed charges,,
Uric Acid,,84550,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Uric Acid,,84550,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,34.56,48,,percent of total billed charges,,100% of DHS outpatient percentage
Uric Acid,,84550,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Uric Acid, Body Fluid",,84560,CPT,Facility,Both,,,,72,61.2,20.6352,72,Aetna,Commercial,66.24,92,,percent of total billed charges,,
"Uric Acid, Body Fluid",,84560,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,Aetna,Medicare Advantage,35.28,49,,percent of total billed charges,,
"Uric Acid, Body Fluid",,84560,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Uric Acid, Body Fluid",,84560,CPT,Facility,Both,,,,72,61.2,20.6352,72,Aetna,PPO,66.96,93,,percent of total billed charges,,
"Uric Acid, Body Fluid",,84560,CPT,Facility,Both,,,,72,61.2,20.6352,72,America's PPO,America's PPO,69.1416,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Uric Acid, Body Fluid",,84560,CPT,Facility,Both,,,,72,61.2,20.6352,72,BlueCross BlueShield Minnesota, Federal Employee Program,70.848,98.4,,percent of total billed charges,,
"Uric Acid, Body Fluid",,84560,CPT,Facility,Both,,,,72,61.2,20.6352,72,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,72,100,,percent of total billed charges,,
"Uric Acid, Body Fluid",,84560,CPT,Facility,Both,,,,72,61.2,20.6352,72,BlueCross BlueShield Minnesota,High Value Network Plan,64.8,90,,percent of total billed charges,,
"Uric Acid, Body Fluid",,84560,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,BlueCross BlueShield Minnesota,Medicare Advantage,35.28,49,,percent of total billed charges,,
"Uric Acid, Body Fluid",,84560,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Uric Acid, Body Fluid",,84560,CPT,Facility,Both,,,,72,61.2,20.6352,72,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,63.7704,88.57,,percent of total billed charges,,
"Uric Acid, Body Fluid",,84560,CPT,Facility,Both,,,,72,61.2,20.6352,72,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,20.6352,28.66,,percent of total billed charges,,
"Uric Acid, Body Fluid",,84560,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),35.28,49,,percent of total billed charges,,
"Uric Acid, Body Fluid",,84560,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Uric Acid, Body Fluid",,84560,CPT,Facility,Both,,,,72,61.2,20.6352,72,CorVel,Worker's Compensation,72,100,,percent of total billed charges,,
"Uric Acid, Body Fluid",,84560,CPT,Facility,Both,,,,72,61.2,20.6352,72,First Health Group Corporation,First Health Network,69.84,97,,percent of total billed charges,,
"Uric Acid, Body Fluid",,84560,CPT,Facility,Both,,,,72,61.2,20.6352,72,"Health Partners, Inc.",Commercial,68.112,94.6,,percent of total billed charges,,
"Uric Acid, Body Fluid",,84560,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,"Health Partners, Inc.",Medicare Advantage,35.28,49,,percent of total billed charges,,
"Uric Acid, Body Fluid",,84560,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Uric Acid, Body Fluid",,84560,CPT,Facility,Both,,,,72,61.2,20.6352,72,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),43.2,60,,percent of total billed charges,,
"Uric Acid, Body Fluid",,84560,CPT,Facility,Both,,,,72,61.2,20.6352,72,"Health Partners, Inc.",State of Minnesota Advantage Program,58.68,81.5,,percent of total billed charges,,
"Uric Acid, Body Fluid",,84560,CPT,Facility,Both,,,,72,61.2,20.6352,72,"Health Partners, Inc.",State Public Programs,36,50,,percent of total billed charges,,
"Uric Acid, Body Fluid",,84560,CPT,Facility,Both,,,,72,61.2,20.6352,72,Humana Insurance Company,Commercial PPO,68.4,95,,percent of total billed charges,,
"Uric Acid, Body Fluid",,84560,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,Humana Insurance Company,Medicare PPO,35.28,49,,percent of total billed charges,,
"Uric Acid, Body Fluid",,84560,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Uric Acid, Body Fluid",,84560,CPT,Facility,Both,,,,72,61.2,20.6352,72,Medica,Individual & Family,71.352,99.1,,percent of total billed charges,,
"Uric Acid, Body Fluid",,84560,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,Medica,Medica Advantage Solution,35.856,49.8,,percent of total billed charges,,
"Uric Acid, Body Fluid",,84560,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Uric Acid, Body Fluid",,84560,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,Medica,Medical Assistance,32.112,44.6,,percent of total billed charges,,
"Uric Acid, Body Fluid",,84560,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,Medica,Medical Assistance,,,,,Included in per diem rate,
"Uric Acid, Body Fluid",,84560,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,35.856,49.8,,percent of total billed charges,,
"Uric Acid, Body Fluid",,84560,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Uric Acid, Body Fluid",,84560,CPT,Facility,Both,,,,72,61.2,20.6352,72,"Multiplan, Inc.","Multiplan, Inc.",67.68,94,,percent of total billed charges,,
"Uric Acid, Body Fluid",,84560,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,62.208,86.4,,percent of total billed charges,,
"Uric Acid, Body Fluid",,84560,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Uric Acid, Body Fluid",,84560,CPT,Facility,Both,,,,72,61.2,20.6352,72,"Preferred One Administrative Services, INC.",PPO,70.992,98.6,,percent of total billed charges,,
"Uric Acid, Body Fluid",,84560,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,PrimeWest Health,Minnesota Senior Health Options (MSHO),37.044,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Uric Acid, Body Fluid",,84560,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Uric Acid, Body Fluid",,84560,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,PrimeWest Health,MinnesotaCare,36.9792,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Uric Acid, Body Fluid",,84560,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Uric Acid, Body Fluid",,84560,CPT,Facility,Both,,,,72,61.2,20.6352,72,Sanford Health Plan,Sanford Health Plan,66.24,92,,percent of total billed charges,,
"Uric Acid, Body Fluid",,84560,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,"UCare Health, Inc.",Individual & Family Plan,40.572,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Uric Acid, Body Fluid",,84560,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Uric Acid, Body Fluid",,84560,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,"UCare Health, Inc.",Medical Assistance,36.3384,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Uric Acid, Body Fluid",,84560,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Uric Acid, Body Fluid",,84560,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,"UCare Health, Inc.",Medicare Advantage,36.3384,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Uric Acid, Body Fluid",,84560,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Uric Acid, Body Fluid",,84560,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),36.3384,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Uric Acid, Body Fluid",,84560,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Uric Acid, Body Fluid",,84560,CPT,Facility,Both,,,,72,61.2,20.6352,72,UnitedHealthcare,Individual & Family,67.68,94,,percent of total billed charges,,
"Uric Acid, Body Fluid",,84560,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,UnitedHealthcare,Medicare Advantage,35.28,49,,percent of total billed charges,,
"Uric Acid, Body Fluid",,84560,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Uric Acid, Body Fluid",,84560,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,34.56,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Uric Acid, Body Fluid",,84560,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Beta-Hcg, Quantitative",,84702,CPT,Facility,Both,,,,168,142.8,48.1488,168,Aetna,Commercial,154.56,92,,percent of total billed charges,,
"Beta-Hcg, Quantitative",,84702,CPT,Facility,Outpatient,,,,168,142.8,48.1488,168,Aetna,Medicare Advantage,82.32,49,,percent of total billed charges,,
"Beta-Hcg, Quantitative",,84702,CPT,Facility,Inpatient,,,,168,142.8,48.1488,168,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Beta-Hcg, Quantitative",,84702,CPT,Facility,Both,,,,168,142.8,48.1488,168,Aetna,PPO,156.24,93,,percent of total billed charges,,
"Beta-Hcg, Quantitative",,84702,CPT,Facility,Both,,,,168,142.8,48.1488,168,America's PPO,America's PPO,161.3304,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Beta-Hcg, Quantitative",,84702,CPT,Facility,Both,,,,168,142.8,48.1488,168,BlueCross BlueShield Minnesota, Federal Employee Program,165.312,98.4,,percent of total billed charges,,
"Beta-Hcg, Quantitative",,84702,CPT,Facility,Both,,,,168,142.8,48.1488,168,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,168,100,,percent of total billed charges,,
"Beta-Hcg, Quantitative",,84702,CPT,Facility,Both,,,,168,142.8,48.1488,168,BlueCross BlueShield Minnesota,High Value Network Plan,151.2,90,,percent of total billed charges,,
"Beta-Hcg, Quantitative",,84702,CPT,Facility,Outpatient,,,,168,142.8,48.1488,168,BlueCross BlueShield Minnesota,Medicare Advantage,82.32,49,,percent of total billed charges,,
"Beta-Hcg, Quantitative",,84702,CPT,Facility,Inpatient,,,,168,142.8,48.1488,168,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Beta-Hcg, Quantitative",,84702,CPT,Facility,Both,,,,168,142.8,48.1488,168,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,148.7976,88.57,,percent of total billed charges,,
"Beta-Hcg, Quantitative",,84702,CPT,Facility,Both,,,,168,142.8,48.1488,168,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,48.1488,28.66,,percent of total billed charges,,
"Beta-Hcg, Quantitative",,84702,CPT,Facility,Outpatient,,,,168,142.8,48.1488,168,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),82.32,49,,percent of total billed charges,,
"Beta-Hcg, Quantitative",,84702,CPT,Facility,Inpatient,,,,168,142.8,48.1488,168,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Beta-Hcg, Quantitative",,84702,CPT,Facility,Both,,,,168,142.8,48.1488,168,CorVel,Worker's Compensation,168,100,,percent of total billed charges,,
"Beta-Hcg, Quantitative",,84702,CPT,Facility,Both,,,,168,142.8,48.1488,168,First Health Group Corporation,First Health Network,162.96,97,,percent of total billed charges,,
"Beta-Hcg, Quantitative",,84702,CPT,Facility,Both,,,,168,142.8,48.1488,168,"Health Partners, Inc.",Commercial,158.928,94.6,,percent of total billed charges,,
"Beta-Hcg, Quantitative",,84702,CPT,Facility,Outpatient,,,,168,142.8,48.1488,168,"Health Partners, Inc.",Medicare Advantage,82.32,49,,percent of total billed charges,,
"Beta-Hcg, Quantitative",,84702,CPT,Facility,Inpatient,,,,168,142.8,48.1488,168,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Beta-Hcg, Quantitative",,84702,CPT,Facility,Both,,,,168,142.8,48.1488,168,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),100.8,60,,percent of total billed charges,,
"Beta-Hcg, Quantitative",,84702,CPT,Facility,Both,,,,168,142.8,48.1488,168,"Health Partners, Inc.",State of Minnesota Advantage Program,136.92,81.5,,percent of total billed charges,,
"Beta-Hcg, Quantitative",,84702,CPT,Facility,Both,,,,168,142.8,48.1488,168,"Health Partners, Inc.",State Public Programs,84,50,,percent of total billed charges,,
"Beta-Hcg, Quantitative",,84702,CPT,Facility,Both,,,,168,142.8,48.1488,168,Humana Insurance Company,Commercial PPO,159.6,95,,percent of total billed charges,,
"Beta-Hcg, Quantitative",,84702,CPT,Facility,Outpatient,,,,168,142.8,48.1488,168,Humana Insurance Company,Medicare PPO,82.32,49,,percent of total billed charges,,
"Beta-Hcg, Quantitative",,84702,CPT,Facility,Inpatient,,,,168,142.8,48.1488,168,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Beta-Hcg, Quantitative",,84702,CPT,Facility,Both,,,,168,142.8,48.1488,168,Medica,Individual & Family,166.488,99.1,,percent of total billed charges,,
"Beta-Hcg, Quantitative",,84702,CPT,Facility,Outpatient,,,,168,142.8,48.1488,168,Medica,Medica Advantage Solution,83.664,49.8,,percent of total billed charges,,
"Beta-Hcg, Quantitative",,84702,CPT,Facility,Inpatient,,,,168,142.8,48.1488,168,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Beta-Hcg, Quantitative",,84702,CPT,Facility,Outpatient,,,,168,142.8,48.1488,168,Medica,Medical Assistance,74.928,44.6,,percent of total billed charges,,
"Beta-Hcg, Quantitative",,84702,CPT,Facility,Inpatient,,,,168,142.8,48.1488,168,Medica,Medical Assistance,,,,,Included in per diem rate,
"Beta-Hcg, Quantitative",,84702,CPT,Facility,Outpatient,,,,168,142.8,48.1488,168,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,83.664,49.8,,percent of total billed charges,,
"Beta-Hcg, Quantitative",,84702,CPT,Facility,Inpatient,,,,168,142.8,48.1488,168,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Beta-Hcg, Quantitative",,84702,CPT,Facility,Both,,,,168,142.8,48.1488,168,"Multiplan, Inc.","Multiplan, Inc.",157.92,94,,percent of total billed charges,,
"Beta-Hcg, Quantitative",,84702,CPT,Facility,Outpatient,,,,168,142.8,48.1488,168,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,145.152,86.4,,percent of total billed charges,,
"Beta-Hcg, Quantitative",,84702,CPT,Facility,Inpatient,,,,168,142.8,48.1488,168,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Beta-Hcg, Quantitative",,84702,CPT,Facility,Both,,,,168,142.8,48.1488,168,"Preferred One Administrative Services, INC.",PPO,165.648,98.6,,percent of total billed charges,,
"Beta-Hcg, Quantitative",,84702,CPT,Facility,Outpatient,,,,168,142.8,48.1488,168,PrimeWest Health,Minnesota Senior Health Options (MSHO),86.436,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Beta-Hcg, Quantitative",,84702,CPT,Facility,Inpatient,,,,168,142.8,48.1488,168,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Beta-Hcg, Quantitative",,84702,CPT,Facility,Outpatient,,,,168,142.8,48.1488,168,PrimeWest Health,MinnesotaCare,86.2848,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Beta-Hcg, Quantitative",,84702,CPT,Facility,Inpatient,,,,168,142.8,48.1488,168,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Beta-Hcg, Quantitative",,84702,CPT,Facility,Both,,,,168,142.8,48.1488,168,Sanford Health Plan,Sanford Health Plan,154.56,92,,percent of total billed charges,,
"Beta-Hcg, Quantitative",,84702,CPT,Facility,Outpatient,,,,168,142.8,48.1488,168,"UCare Health, Inc.",Individual & Family Plan,94.668,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Beta-Hcg, Quantitative",,84702,CPT,Facility,Inpatient,,,,168,142.8,48.1488,168,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Beta-Hcg, Quantitative",,84702,CPT,Facility,Outpatient,,,,168,142.8,48.1488,168,"UCare Health, Inc.",Medical Assistance,84.7896,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Beta-Hcg, Quantitative",,84702,CPT,Facility,Inpatient,,,,168,142.8,48.1488,168,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Beta-Hcg, Quantitative",,84702,CPT,Facility,Outpatient,,,,168,142.8,48.1488,168,"UCare Health, Inc.",Medicare Advantage,84.7896,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Beta-Hcg, Quantitative",,84702,CPT,Facility,Inpatient,,,,168,142.8,48.1488,168,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Beta-Hcg, Quantitative",,84702,CPT,Facility,Outpatient,,,,168,142.8,48.1488,168,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),84.7896,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Beta-Hcg, Quantitative",,84702,CPT,Facility,Inpatient,,,,168,142.8,48.1488,168,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Beta-Hcg, Quantitative",,84702,CPT,Facility,Both,,,,168,142.8,48.1488,168,UnitedHealthcare,Individual & Family,157.92,94,,percent of total billed charges,,
"Beta-Hcg, Quantitative",,84702,CPT,Facility,Outpatient,,,,168,142.8,48.1488,168,UnitedHealthcare,Medicare Advantage,82.32,49,,percent of total billed charges,,
"Beta-Hcg, Quantitative",,84702,CPT,Facility,Inpatient,,,,168,142.8,48.1488,168,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Beta-Hcg, Quantitative",,84702,CPT,Facility,Outpatient,,,,168,142.8,48.1488,168,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,80.64,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Beta-Hcg, Quantitative",,84702,CPT,Facility,Inpatient,,,,168,142.8,48.1488,168,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Hcg, Qualitative, Serum",,84703,CPT,Facility,Both,,,,90,76.5,25.794,90,Aetna,Commercial,82.8,92,,percent of total billed charges,,
"Hcg, Qualitative, Serum",,84703,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,Aetna,Medicare Advantage,44.1,49,,percent of total billed charges,,
"Hcg, Qualitative, Serum",,84703,CPT,Facility,Inpatient,,,,90,76.5,25.794,90,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Hcg, Qualitative, Serum",,84703,CPT,Facility,Both,,,,90,76.5,25.794,90,Aetna,PPO,83.7,93,,percent of total billed charges,,
"Hcg, Qualitative, Serum",,84703,CPT,Facility,Both,,,,90,76.5,25.794,90,America's PPO,America's PPO,86.427,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Hcg, Qualitative, Serum",,84703,CPT,Facility,Both,,,,90,76.5,25.794,90,BlueCross BlueShield Minnesota, Federal Employee Program,88.56,98.4,,percent of total billed charges,,
"Hcg, Qualitative, Serum",,84703,CPT,Facility,Both,,,,90,76.5,25.794,90,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,90,100,,percent of total billed charges,,
"Hcg, Qualitative, Serum",,84703,CPT,Facility,Both,,,,90,76.5,25.794,90,BlueCross BlueShield Minnesota,High Value Network Plan,81,90,,percent of total billed charges,,
"Hcg, Qualitative, Serum",,84703,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,BlueCross BlueShield Minnesota,Medicare Advantage,44.1,49,,percent of total billed charges,,
"Hcg, Qualitative, Serum",,84703,CPT,Facility,Inpatient,,,,90,76.5,25.794,90,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Hcg, Qualitative, Serum",,84703,CPT,Facility,Both,,,,90,76.5,25.794,90,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,79.713,88.57,,percent of total billed charges,,
"Hcg, Qualitative, Serum",,84703,CPT,Facility,Both,,,,90,76.5,25.794,90,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,25.794,28.66,,percent of total billed charges,,
"Hcg, Qualitative, Serum",,84703,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),44.1,49,,percent of total billed charges,,
"Hcg, Qualitative, Serum",,84703,CPT,Facility,Inpatient,,,,90,76.5,25.794,90,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Hcg, Qualitative, Serum",,84703,CPT,Facility,Both,,,,90,76.5,25.794,90,CorVel,Worker's Compensation,90,100,,percent of total billed charges,,
"Hcg, Qualitative, Serum",,84703,CPT,Facility,Both,,,,90,76.5,25.794,90,First Health Group Corporation,First Health Network,87.3,97,,percent of total billed charges,,
"Hcg, Qualitative, Serum",,84703,CPT,Facility,Both,,,,90,76.5,25.794,90,"Health Partners, Inc.",Commercial,85.14,94.6,,percent of total billed charges,,
"Hcg, Qualitative, Serum",,84703,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,"Health Partners, Inc.",Medicare Advantage,44.1,49,,percent of total billed charges,,
"Hcg, Qualitative, Serum",,84703,CPT,Facility,Inpatient,,,,90,76.5,25.794,90,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Hcg, Qualitative, Serum",,84703,CPT,Facility,Both,,,,90,76.5,25.794,90,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),54,60,,percent of total billed charges,,
"Hcg, Qualitative, Serum",,84703,CPT,Facility,Both,,,,90,76.5,25.794,90,"Health Partners, Inc.",State of Minnesota Advantage Program,73.35,81.5,,percent of total billed charges,,
"Hcg, Qualitative, Serum",,84703,CPT,Facility,Both,,,,90,76.5,25.794,90,"Health Partners, Inc.",State Public Programs,45,50,,percent of total billed charges,,
"Hcg, Qualitative, Serum",,84703,CPT,Facility,Both,,,,90,76.5,25.794,90,Humana Insurance Company,Commercial PPO,85.5,95,,percent of total billed charges,,
"Hcg, Qualitative, Serum",,84703,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,Humana Insurance Company,Medicare PPO,44.1,49,,percent of total billed charges,,
"Hcg, Qualitative, Serum",,84703,CPT,Facility,Inpatient,,,,90,76.5,25.794,90,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Hcg, Qualitative, Serum",,84703,CPT,Facility,Both,,,,90,76.5,25.794,90,Medica,Individual & Family,89.19,99.1,,percent of total billed charges,,
"Hcg, Qualitative, Serum",,84703,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,Medica,Medica Advantage Solution,44.82,49.8,,percent of total billed charges,,
"Hcg, Qualitative, Serum",,84703,CPT,Facility,Inpatient,,,,90,76.5,25.794,90,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Hcg, Qualitative, Serum",,84703,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,Medica,Medical Assistance,40.14,44.6,,percent of total billed charges,,
"Hcg, Qualitative, Serum",,84703,CPT,Facility,Inpatient,,,,90,76.5,25.794,90,Medica,Medical Assistance,,,,,Included in per diem rate,
"Hcg, Qualitative, Serum",,84703,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,44.82,49.8,,percent of total billed charges,,
"Hcg, Qualitative, Serum",,84703,CPT,Facility,Inpatient,,,,90,76.5,25.794,90,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Hcg, Qualitative, Serum",,84703,CPT,Facility,Both,,,,90,76.5,25.794,90,"Multiplan, Inc.","Multiplan, Inc.",84.6,94,,percent of total billed charges,,
"Hcg, Qualitative, Serum",,84703,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,77.76,86.4,,percent of total billed charges,,
"Hcg, Qualitative, Serum",,84703,CPT,Facility,Inpatient,,,,90,76.5,25.794,90,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Hcg, Qualitative, Serum",,84703,CPT,Facility,Both,,,,90,76.5,25.794,90,"Preferred One Administrative Services, INC.",PPO,88.74,98.6,,percent of total billed charges,,
"Hcg, Qualitative, Serum",,84703,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,PrimeWest Health,Minnesota Senior Health Options (MSHO),46.305,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Hcg, Qualitative, Serum",,84703,CPT,Facility,Inpatient,,,,90,76.5,25.794,90,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Hcg, Qualitative, Serum",,84703,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,PrimeWest Health,MinnesotaCare,46.224,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Hcg, Qualitative, Serum",,84703,CPT,Facility,Inpatient,,,,90,76.5,25.794,90,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Hcg, Qualitative, Serum",,84703,CPT,Facility,Both,,,,90,76.5,25.794,90,Sanford Health Plan,Sanford Health Plan,82.8,92,,percent of total billed charges,,
"Hcg, Qualitative, Serum",,84703,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,"UCare Health, Inc.",Individual & Family Plan,50.715,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Hcg, Qualitative, Serum",,84703,CPT,Facility,Inpatient,,,,90,76.5,25.794,90,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Hcg, Qualitative, Serum",,84703,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,"UCare Health, Inc.",Medical Assistance,45.423,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Hcg, Qualitative, Serum",,84703,CPT,Facility,Inpatient,,,,90,76.5,25.794,90,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Hcg, Qualitative, Serum",,84703,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,"UCare Health, Inc.",Medicare Advantage,45.423,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Hcg, Qualitative, Serum",,84703,CPT,Facility,Inpatient,,,,90,76.5,25.794,90,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Hcg, Qualitative, Serum",,84703,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),45.423,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Hcg, Qualitative, Serum",,84703,CPT,Facility,Inpatient,,,,90,76.5,25.794,90,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Hcg, Qualitative, Serum",,84703,CPT,Facility,Both,,,,90,76.5,25.794,90,UnitedHealthcare,Individual & Family,84.6,94,,percent of total billed charges,,
"Hcg, Qualitative, Serum",,84703,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,UnitedHealthcare,Medicare Advantage,44.1,49,,percent of total billed charges,,
"Hcg, Qualitative, Serum",,84703,CPT,Facility,Inpatient,,,,90,76.5,25.794,90,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Hcg, Qualitative, Serum",,84703,CPT,Facility,Outpatient,,,,90,76.5,25.794,90,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,43.2,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Hcg, Qualitative, Serum",,84703,CPT,Facility,Inpatient,,,,90,76.5,25.794,90,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Manual Differential,,85007,CPT,Facility,Both,,,,67,56.95,19.2022,67,Aetna,Commercial,61.64,92,,percent of total billed charges,,
Manual Differential,,85007,CPT,Facility,Outpatient,,,,67,56.95,19.2022,67,Aetna,Medicare Advantage,32.83,49,,percent of total billed charges,,
Manual Differential,,85007,CPT,Facility,Inpatient,,,,67,56.95,19.2022,67,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Manual Differential,,85007,CPT,Facility,Both,,,,67,56.95,19.2022,67,Aetna,PPO,62.31,93,,percent of total billed charges,,
Manual Differential,,85007,CPT,Facility,Both,,,,67,56.95,19.2022,67,America's PPO,America's PPO,64.3401,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Manual Differential,,85007,CPT,Facility,Both,,,,67,56.95,19.2022,67,BlueCross BlueShield Minnesota, Federal Employee Program,65.928,98.4,,percent of total billed charges,,
Manual Differential,,85007,CPT,Facility,Both,,,,67,56.95,19.2022,67,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,67,100,,percent of total billed charges,,
Manual Differential,,85007,CPT,Facility,Both,,,,67,56.95,19.2022,67,BlueCross BlueShield Minnesota,High Value Network Plan,60.3,90,,percent of total billed charges,,
Manual Differential,,85007,CPT,Facility,Outpatient,,,,67,56.95,19.2022,67,BlueCross BlueShield Minnesota,Medicare Advantage,32.83,49,,percent of total billed charges,,
Manual Differential,,85007,CPT,Facility,Inpatient,,,,67,56.95,19.2022,67,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Manual Differential,,85007,CPT,Facility,Both,,,,67,56.95,19.2022,67,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,59.3419,88.57,,percent of total billed charges,,
Manual Differential,,85007,CPT,Facility,Both,,,,67,56.95,19.2022,67,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,19.2022,28.66,,percent of total billed charges,,
Manual Differential,,85007,CPT,Facility,Outpatient,,,,67,56.95,19.2022,67,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),32.83,49,,percent of total billed charges,,
Manual Differential,,85007,CPT,Facility,Inpatient,,,,67,56.95,19.2022,67,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Manual Differential,,85007,CPT,Facility,Both,,,,67,56.95,19.2022,67,CorVel,Worker's Compensation,67,100,,percent of total billed charges,,
Manual Differential,,85007,CPT,Facility,Both,,,,67,56.95,19.2022,67,First Health Group Corporation,First Health Network,64.99,97,,percent of total billed charges,,
Manual Differential,,85007,CPT,Facility,Both,,,,67,56.95,19.2022,67,"Health Partners, Inc.",Commercial,63.382,94.6,,percent of total billed charges,,
Manual Differential,,85007,CPT,Facility,Outpatient,,,,67,56.95,19.2022,67,"Health Partners, Inc.",Medicare Advantage,32.83,49,,percent of total billed charges,,
Manual Differential,,85007,CPT,Facility,Inpatient,,,,67,56.95,19.2022,67,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Manual Differential,,85007,CPT,Facility,Both,,,,67,56.95,19.2022,67,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),40.2,60,,percent of total billed charges,,
Manual Differential,,85007,CPT,Facility,Both,,,,67,56.95,19.2022,67,"Health Partners, Inc.",State of Minnesota Advantage Program,54.605,81.5,,percent of total billed charges,,
Manual Differential,,85007,CPT,Facility,Both,,,,67,56.95,19.2022,67,"Health Partners, Inc.",State Public Programs,33.5,50,,percent of total billed charges,,
Manual Differential,,85007,CPT,Facility,Both,,,,67,56.95,19.2022,67,Humana Insurance Company,Commercial PPO,63.65,95,,percent of total billed charges,,
Manual Differential,,85007,CPT,Facility,Outpatient,,,,67,56.95,19.2022,67,Humana Insurance Company,Medicare PPO,32.83,49,,percent of total billed charges,,
Manual Differential,,85007,CPT,Facility,Inpatient,,,,67,56.95,19.2022,67,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Manual Differential,,85007,CPT,Facility,Both,,,,67,56.95,19.2022,67,Medica,Individual & Family,66.397,99.1,,percent of total billed charges,,
Manual Differential,,85007,CPT,Facility,Outpatient,,,,67,56.95,19.2022,67,Medica,Medica Advantage Solution,33.366,49.8,,percent of total billed charges,,
Manual Differential,,85007,CPT,Facility,Inpatient,,,,67,56.95,19.2022,67,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Manual Differential,,85007,CPT,Facility,Outpatient,,,,67,56.95,19.2022,67,Medica,Medical Assistance,29.882,44.6,,percent of total billed charges,,
Manual Differential,,85007,CPT,Facility,Inpatient,,,,67,56.95,19.2022,67,Medica,Medical Assistance,,,,,Included in per diem rate,
Manual Differential,,85007,CPT,Facility,Outpatient,,,,67,56.95,19.2022,67,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,33.366,49.8,,percent of total billed charges,,
Manual Differential,,85007,CPT,Facility,Inpatient,,,,67,56.95,19.2022,67,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Manual Differential,,85007,CPT,Facility,Both,,,,67,56.95,19.2022,67,"Multiplan, Inc.","Multiplan, Inc.",62.98,94,,percent of total billed charges,,
Manual Differential,,85007,CPT,Facility,Outpatient,,,,67,56.95,19.2022,67,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,57.888,86.4,,percent of total billed charges,,
Manual Differential,,85007,CPT,Facility,Inpatient,,,,67,56.95,19.2022,67,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Manual Differential,,85007,CPT,Facility,Both,,,,67,56.95,19.2022,67,"Preferred One Administrative Services, INC.",PPO,66.062,98.6,,percent of total billed charges,,
Manual Differential,,85007,CPT,Facility,Outpatient,,,,67,56.95,19.2022,67,PrimeWest Health,Minnesota Senior Health Options (MSHO),34.4715,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Manual Differential,,85007,CPT,Facility,Inpatient,,,,67,56.95,19.2022,67,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Manual Differential,,85007,CPT,Facility,Outpatient,,,,67,56.95,19.2022,67,PrimeWest Health,MinnesotaCare,34.4112,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Manual Differential,,85007,CPT,Facility,Inpatient,,,,67,56.95,19.2022,67,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Manual Differential,,85007,CPT,Facility,Both,,,,67,56.95,19.2022,67,Sanford Health Plan,Sanford Health Plan,61.64,92,,percent of total billed charges,,
Manual Differential,,85007,CPT,Facility,Outpatient,,,,67,56.95,19.2022,67,"UCare Health, Inc.",Individual & Family Plan,37.7545,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Manual Differential,,85007,CPT,Facility,Inpatient,,,,67,56.95,19.2022,67,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Manual Differential,,85007,CPT,Facility,Outpatient,,,,67,56.95,19.2022,67,"UCare Health, Inc.",Medical Assistance,33.8149,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Manual Differential,,85007,CPT,Facility,Inpatient,,,,67,56.95,19.2022,67,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Manual Differential,,85007,CPT,Facility,Outpatient,,,,67,56.95,19.2022,67,"UCare Health, Inc.",Medicare Advantage,33.8149,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Manual Differential,,85007,CPT,Facility,Inpatient,,,,67,56.95,19.2022,67,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Manual Differential,,85007,CPT,Facility,Outpatient,,,,67,56.95,19.2022,67,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),33.8149,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Manual Differential,,85007,CPT,Facility,Inpatient,,,,67,56.95,19.2022,67,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Manual Differential,,85007,CPT,Facility,Both,,,,67,56.95,19.2022,67,UnitedHealthcare,Individual & Family,62.98,94,,percent of total billed charges,,
Manual Differential,,85007,CPT,Facility,Outpatient,,,,67,56.95,19.2022,67,UnitedHealthcare,Medicare Advantage,32.83,49,,percent of total billed charges,,
Manual Differential,,85007,CPT,Facility,Inpatient,,,,67,56.95,19.2022,67,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Manual Differential,,85007,CPT,Facility,Outpatient,,,,67,56.95,19.2022,67,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,32.16,48,,percent of total billed charges,,100% of DHS outpatient percentage
Manual Differential,,85007,CPT,Facility,Inpatient,,,,67,56.95,19.2022,67,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Hematocrit,,85014,CPT,Facility,Both,,,,45,38.25,12.897,45,Aetna,Commercial,41.4,92,,percent of total billed charges,,
Hematocrit,,85014,CPT,Facility,Outpatient,,,,45,38.25,12.897,45,Aetna,Medicare Advantage,22.05,49,,percent of total billed charges,,
Hematocrit,,85014,CPT,Facility,Inpatient,,,,45,38.25,12.897,45,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Hematocrit,,85014,CPT,Facility,Both,,,,45,38.25,12.897,45,Aetna,PPO,41.85,93,,percent of total billed charges,,
Hematocrit,,85014,CPT,Facility,Both,,,,45,38.25,12.897,45,America's PPO,America's PPO,43.2135,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Hematocrit,,85014,CPT,Facility,Both,,,,45,38.25,12.897,45,BlueCross BlueShield Minnesota, Federal Employee Program,44.28,98.4,,percent of total billed charges,,
Hematocrit,,85014,CPT,Facility,Both,,,,45,38.25,12.897,45,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,45,100,,percent of total billed charges,,
Hematocrit,,85014,CPT,Facility,Both,,,,45,38.25,12.897,45,BlueCross BlueShield Minnesota,High Value Network Plan,40.5,90,,percent of total billed charges,,
Hematocrit,,85014,CPT,Facility,Outpatient,,,,45,38.25,12.897,45,BlueCross BlueShield Minnesota,Medicare Advantage,22.05,49,,percent of total billed charges,,
Hematocrit,,85014,CPT,Facility,Inpatient,,,,45,38.25,12.897,45,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Hematocrit,,85014,CPT,Facility,Both,,,,45,38.25,12.897,45,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,39.8565,88.57,,percent of total billed charges,,
Hematocrit,,85014,CPT,Facility,Both,,,,45,38.25,12.897,45,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,12.897,28.66,,percent of total billed charges,,
Hematocrit,,85014,CPT,Facility,Outpatient,,,,45,38.25,12.897,45,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),22.05,49,,percent of total billed charges,,
Hematocrit,,85014,CPT,Facility,Inpatient,,,,45,38.25,12.897,45,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Hematocrit,,85014,CPT,Facility,Both,,,,45,38.25,12.897,45,CorVel,Worker's Compensation,45,100,,percent of total billed charges,,
Hematocrit,,85014,CPT,Facility,Both,,,,45,38.25,12.897,45,First Health Group Corporation,First Health Network,43.65,97,,percent of total billed charges,,
Hematocrit,,85014,CPT,Facility,Both,,,,45,38.25,12.897,45,"Health Partners, Inc.",Commercial,42.57,94.6,,percent of total billed charges,,
Hematocrit,,85014,CPT,Facility,Outpatient,,,,45,38.25,12.897,45,"Health Partners, Inc.",Medicare Advantage,22.05,49,,percent of total billed charges,,
Hematocrit,,85014,CPT,Facility,Inpatient,,,,45,38.25,12.897,45,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Hematocrit,,85014,CPT,Facility,Both,,,,45,38.25,12.897,45,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),27,60,,percent of total billed charges,,
Hematocrit,,85014,CPT,Facility,Both,,,,45,38.25,12.897,45,"Health Partners, Inc.",State of Minnesota Advantage Program,36.675,81.5,,percent of total billed charges,,
Hematocrit,,85014,CPT,Facility,Both,,,,45,38.25,12.897,45,"Health Partners, Inc.",State Public Programs,22.5,50,,percent of total billed charges,,
Hematocrit,,85014,CPT,Facility,Both,,,,45,38.25,12.897,45,Humana Insurance Company,Commercial PPO,42.75,95,,percent of total billed charges,,
Hematocrit,,85014,CPT,Facility,Outpatient,,,,45,38.25,12.897,45,Humana Insurance Company,Medicare PPO,22.05,49,,percent of total billed charges,,
Hematocrit,,85014,CPT,Facility,Inpatient,,,,45,38.25,12.897,45,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Hematocrit,,85014,CPT,Facility,Both,,,,45,38.25,12.897,45,Medica,Individual & Family,44.595,99.1,,percent of total billed charges,,
Hematocrit,,85014,CPT,Facility,Outpatient,,,,45,38.25,12.897,45,Medica,Medica Advantage Solution,22.41,49.8,,percent of total billed charges,,
Hematocrit,,85014,CPT,Facility,Inpatient,,,,45,38.25,12.897,45,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Hematocrit,,85014,CPT,Facility,Outpatient,,,,45,38.25,12.897,45,Medica,Medical Assistance,20.07,44.6,,percent of total billed charges,,
Hematocrit,,85014,CPT,Facility,Inpatient,,,,45,38.25,12.897,45,Medica,Medical Assistance,,,,,Included in per diem rate,
Hematocrit,,85014,CPT,Facility,Outpatient,,,,45,38.25,12.897,45,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,22.41,49.8,,percent of total billed charges,,
Hematocrit,,85014,CPT,Facility,Inpatient,,,,45,38.25,12.897,45,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Hematocrit,,85014,CPT,Facility,Both,,,,45,38.25,12.897,45,"Multiplan, Inc.","Multiplan, Inc.",42.3,94,,percent of total billed charges,,
Hematocrit,,85014,CPT,Facility,Outpatient,,,,45,38.25,12.897,45,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,38.88,86.4,,percent of total billed charges,,
Hematocrit,,85014,CPT,Facility,Inpatient,,,,45,38.25,12.897,45,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Hematocrit,,85014,CPT,Facility,Both,,,,45,38.25,12.897,45,"Preferred One Administrative Services, INC.",PPO,44.37,98.6,,percent of total billed charges,,
Hematocrit,,85014,CPT,Facility,Outpatient,,,,45,38.25,12.897,45,PrimeWest Health,Minnesota Senior Health Options (MSHO),23.1525,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Hematocrit,,85014,CPT,Facility,Inpatient,,,,45,38.25,12.897,45,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Hematocrit,,85014,CPT,Facility,Outpatient,,,,45,38.25,12.897,45,PrimeWest Health,MinnesotaCare,23.112,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Hematocrit,,85014,CPT,Facility,Inpatient,,,,45,38.25,12.897,45,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Hematocrit,,85014,CPT,Facility,Both,,,,45,38.25,12.897,45,Sanford Health Plan,Sanford Health Plan,41.4,92,,percent of total billed charges,,
Hematocrit,,85014,CPT,Facility,Outpatient,,,,45,38.25,12.897,45,"UCare Health, Inc.",Individual & Family Plan,25.3575,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Hematocrit,,85014,CPT,Facility,Inpatient,,,,45,38.25,12.897,45,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Hematocrit,,85014,CPT,Facility,Outpatient,,,,45,38.25,12.897,45,"UCare Health, Inc.",Medical Assistance,22.7115,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Hematocrit,,85014,CPT,Facility,Inpatient,,,,45,38.25,12.897,45,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Hematocrit,,85014,CPT,Facility,Outpatient,,,,45,38.25,12.897,45,"UCare Health, Inc.",Medicare Advantage,22.7115,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Hematocrit,,85014,CPT,Facility,Inpatient,,,,45,38.25,12.897,45,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Hematocrit,,85014,CPT,Facility,Outpatient,,,,45,38.25,12.897,45,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),22.7115,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Hematocrit,,85014,CPT,Facility,Inpatient,,,,45,38.25,12.897,45,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Hematocrit,,85014,CPT,Facility,Both,,,,45,38.25,12.897,45,UnitedHealthcare,Individual & Family,42.3,94,,percent of total billed charges,,
Hematocrit,,85014,CPT,Facility,Outpatient,,,,45,38.25,12.897,45,UnitedHealthcare,Medicare Advantage,22.05,49,,percent of total billed charges,,
Hematocrit,,85014,CPT,Facility,Inpatient,,,,45,38.25,12.897,45,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Hematocrit,,85014,CPT,Facility,Outpatient,,,,45,38.25,12.897,45,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,21.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
Hematocrit,,85014,CPT,Facility,Inpatient,,,,45,38.25,12.897,45,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Hemoglobin,,85018,CPT,Facility,Both,,,,45,38.25,12.897,45,Aetna,Commercial,41.4,92,,percent of total billed charges,,
Hemoglobin,,85018,CPT,Facility,Outpatient,,,,45,38.25,12.897,45,Aetna,Medicare Advantage,22.05,49,,percent of total billed charges,,
Hemoglobin,,85018,CPT,Facility,Inpatient,,,,45,38.25,12.897,45,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Hemoglobin,,85018,CPT,Facility,Both,,,,45,38.25,12.897,45,Aetna,PPO,41.85,93,,percent of total billed charges,,
Hemoglobin,,85018,CPT,Facility,Both,,,,45,38.25,12.897,45,America's PPO,America's PPO,43.2135,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Hemoglobin,,85018,CPT,Facility,Both,,,,45,38.25,12.897,45,BlueCross BlueShield Minnesota, Federal Employee Program,44.28,98.4,,percent of total billed charges,,
Hemoglobin,,85018,CPT,Facility,Both,,,,45,38.25,12.897,45,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,45,100,,percent of total billed charges,,
Hemoglobin,,85018,CPT,Facility,Both,,,,45,38.25,12.897,45,BlueCross BlueShield Minnesota,High Value Network Plan,40.5,90,,percent of total billed charges,,
Hemoglobin,,85018,CPT,Facility,Outpatient,,,,45,38.25,12.897,45,BlueCross BlueShield Minnesota,Medicare Advantage,22.05,49,,percent of total billed charges,,
Hemoglobin,,85018,CPT,Facility,Inpatient,,,,45,38.25,12.897,45,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Hemoglobin,,85018,CPT,Facility,Both,,,,45,38.25,12.897,45,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,39.8565,88.57,,percent of total billed charges,,
Hemoglobin,,85018,CPT,Facility,Both,,,,45,38.25,12.897,45,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,12.897,28.66,,percent of total billed charges,,
Hemoglobin,,85018,CPT,Facility,Outpatient,,,,45,38.25,12.897,45,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),22.05,49,,percent of total billed charges,,
Hemoglobin,,85018,CPT,Facility,Inpatient,,,,45,38.25,12.897,45,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Hemoglobin,,85018,CPT,Facility,Both,,,,45,38.25,12.897,45,CorVel,Worker's Compensation,45,100,,percent of total billed charges,,
Hemoglobin,,85018,CPT,Facility,Both,,,,45,38.25,12.897,45,First Health Group Corporation,First Health Network,43.65,97,,percent of total billed charges,,
Hemoglobin,,85018,CPT,Facility,Both,,,,45,38.25,12.897,45,"Health Partners, Inc.",Commercial,42.57,94.6,,percent of total billed charges,,
Hemoglobin,,85018,CPT,Facility,Outpatient,,,,45,38.25,12.897,45,"Health Partners, Inc.",Medicare Advantage,22.05,49,,percent of total billed charges,,
Hemoglobin,,85018,CPT,Facility,Inpatient,,,,45,38.25,12.897,45,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Hemoglobin,,85018,CPT,Facility,Both,,,,45,38.25,12.897,45,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),27,60,,percent of total billed charges,,
Hemoglobin,,85018,CPT,Facility,Both,,,,45,38.25,12.897,45,"Health Partners, Inc.",State of Minnesota Advantage Program,36.675,81.5,,percent of total billed charges,,
Hemoglobin,,85018,CPT,Facility,Both,,,,45,38.25,12.897,45,"Health Partners, Inc.",State Public Programs,22.5,50,,percent of total billed charges,,
Hemoglobin,,85018,CPT,Facility,Both,,,,45,38.25,12.897,45,Humana Insurance Company,Commercial PPO,42.75,95,,percent of total billed charges,,
Hemoglobin,,85018,CPT,Facility,Outpatient,,,,45,38.25,12.897,45,Humana Insurance Company,Medicare PPO,22.05,49,,percent of total billed charges,,
Hemoglobin,,85018,CPT,Facility,Inpatient,,,,45,38.25,12.897,45,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Hemoglobin,,85018,CPT,Facility,Both,,,,45,38.25,12.897,45,Medica,Individual & Family,44.595,99.1,,percent of total billed charges,,
Hemoglobin,,85018,CPT,Facility,Outpatient,,,,45,38.25,12.897,45,Medica,Medica Advantage Solution,22.41,49.8,,percent of total billed charges,,
Hemoglobin,,85018,CPT,Facility,Inpatient,,,,45,38.25,12.897,45,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Hemoglobin,,85018,CPT,Facility,Outpatient,,,,45,38.25,12.897,45,Medica,Medical Assistance,20.07,44.6,,percent of total billed charges,,
Hemoglobin,,85018,CPT,Facility,Inpatient,,,,45,38.25,12.897,45,Medica,Medical Assistance,,,,,Included in per diem rate,
Hemoglobin,,85018,CPT,Facility,Outpatient,,,,45,38.25,12.897,45,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,22.41,49.8,,percent of total billed charges,,
Hemoglobin,,85018,CPT,Facility,Inpatient,,,,45,38.25,12.897,45,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Hemoglobin,,85018,CPT,Facility,Both,,,,45,38.25,12.897,45,"Multiplan, Inc.","Multiplan, Inc.",42.3,94,,percent of total billed charges,,
Hemoglobin,,85018,CPT,Facility,Outpatient,,,,45,38.25,12.897,45,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,38.88,86.4,,percent of total billed charges,,
Hemoglobin,,85018,CPT,Facility,Inpatient,,,,45,38.25,12.897,45,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Hemoglobin,,85018,CPT,Facility,Both,,,,45,38.25,12.897,45,"Preferred One Administrative Services, INC.",PPO,44.37,98.6,,percent of total billed charges,,
Hemoglobin,,85018,CPT,Facility,Outpatient,,,,45,38.25,12.897,45,PrimeWest Health,Minnesota Senior Health Options (MSHO),23.1525,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Hemoglobin,,85018,CPT,Facility,Inpatient,,,,45,38.25,12.897,45,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Hemoglobin,,85018,CPT,Facility,Outpatient,,,,45,38.25,12.897,45,PrimeWest Health,MinnesotaCare,23.112,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Hemoglobin,,85018,CPT,Facility,Inpatient,,,,45,38.25,12.897,45,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Hemoglobin,,85018,CPT,Facility,Both,,,,45,38.25,12.897,45,Sanford Health Plan,Sanford Health Plan,41.4,92,,percent of total billed charges,,
Hemoglobin,,85018,CPT,Facility,Outpatient,,,,45,38.25,12.897,45,"UCare Health, Inc.",Individual & Family Plan,25.3575,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Hemoglobin,,85018,CPT,Facility,Inpatient,,,,45,38.25,12.897,45,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Hemoglobin,,85018,CPT,Facility,Outpatient,,,,45,38.25,12.897,45,"UCare Health, Inc.",Medical Assistance,22.7115,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Hemoglobin,,85018,CPT,Facility,Inpatient,,,,45,38.25,12.897,45,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Hemoglobin,,85018,CPT,Facility,Outpatient,,,,45,38.25,12.897,45,"UCare Health, Inc.",Medicare Advantage,22.7115,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Hemoglobin,,85018,CPT,Facility,Inpatient,,,,45,38.25,12.897,45,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Hemoglobin,,85018,CPT,Facility,Outpatient,,,,45,38.25,12.897,45,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),22.7115,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Hemoglobin,,85018,CPT,Facility,Inpatient,,,,45,38.25,12.897,45,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Hemoglobin,,85018,CPT,Facility,Both,,,,45,38.25,12.897,45,UnitedHealthcare,Individual & Family,42.3,94,,percent of total billed charges,,
Hemoglobin,,85018,CPT,Facility,Outpatient,,,,45,38.25,12.897,45,UnitedHealthcare,Medicare Advantage,22.05,49,,percent of total billed charges,,
Hemoglobin,,85018,CPT,Facility,Inpatient,,,,45,38.25,12.897,45,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Hemoglobin,,85018,CPT,Facility,Outpatient,,,,45,38.25,12.897,45,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,21.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
Hemoglobin,,85018,CPT,Facility,Inpatient,,,,45,38.25,12.897,45,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Cbc With Differential And Platelet Count,,85025,CPT,Facility,Both,,,,135,114.75,38.1,135,Aetna,Commercial,124.2,92,,percent of total billed charges,,
Cbc With Differential And Platelet Count,,85025,CPT,Facility,Outpatient,,,,135,114.75,38.1,135,Aetna,Medicare Advantage,66.15,49,,percent of total billed charges,,
Cbc With Differential And Platelet Count,,85025,CPT,Facility,Inpatient,,,,135,114.75,38.1,135,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Cbc With Differential And Platelet Count,,85025,CPT,Facility,Both,,,,135,114.75,38.1,135,Aetna,PPO,125.55,93,,percent of total billed charges,,
Cbc With Differential And Platelet Count,,85025,CPT,Facility,Both,,,,135,114.75,38.1,135,America's PPO,America's PPO,129.6405,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Cbc With Differential And Platelet Count,,85025,CPT,Facility,Both,,,,135,114.75,38.1,135,BlueCross BlueShield Minnesota, Federal Employee Program,75,,,Fee schedule,,100% of BCBS commercial commodity fee schedule
Cbc With Differential And Platelet Count,,85025,CPT,Facility,Both,,,,135,114.75,38.1,135,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,76.2,,,Fee schedule,,"100% of BCBS commercial commodity fee schedule, plus MN Care tax"
Cbc With Differential And Platelet Count,,85025,CPT,Facility,Both,,,,135,114.75,38.1,135,BlueCross BlueShield Minnesota,High Value Network Plan,68.58,,,Fee schedule,,"90% of BCBS commercial commodity fee schedule, plus MN Care tax; see disclaimer for more information"
Cbc With Differential And Platelet Count,,85025,CPT,Facility,Outpatient,,,,135,114.75,38.1,135,BlueCross BlueShield Minnesota,Medicare Advantage,66.15,49,,percent of total billed charges,,
Cbc With Differential And Platelet Count,,85025,CPT,Facility,Inpatient,,,,135,114.75,38.1,135,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Cbc With Differential And Platelet Count,,85025,CPT,Facility,Both,,,,135,114.75,38.1,135,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,67.49034,,,Fee schedule,,"88.57% of BCBS commercial commodity fee schedule, plus MN Care tax"
Cbc With Differential And Platelet Count,,85025,CPT,Facility,Both,,,,135,114.75,38.1,135,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,38.1,,,Fee schedule,,"100% of BCBS Medicaid commodity fee schedule, plus MN Care tax"
Cbc With Differential And Platelet Count,,85025,CPT,Facility,Outpatient,,,,135,114.75,38.1,135,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),66.15,49,,percent of total billed charges,,
Cbc With Differential And Platelet Count,,85025,CPT,Facility,Inpatient,,,,135,114.75,38.1,135,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Cbc With Differential And Platelet Count,,85025,CPT,Facility,Both,,,,135,114.75,38.1,135,CorVel,Worker's Compensation,135,100,,percent of total billed charges,,
Cbc With Differential And Platelet Count,,85025,CPT,Facility,Both,,,,135,114.75,38.1,135,First Health Group Corporation,First Health Network,130.95,97,,percent of total billed charges,,
Cbc With Differential And Platelet Count,,85025,CPT,Facility,Both,,,,135,114.75,38.1,135,"Health Partners, Inc.",Commercial,127.71,94.6,,percent of total billed charges,,
Cbc With Differential And Platelet Count,,85025,CPT,Facility,Outpatient,,,,135,114.75,38.1,135,"Health Partners, Inc.",Medicare Advantage,66.15,49,,percent of total billed charges,,
Cbc With Differential And Platelet Count,,85025,CPT,Facility,Inpatient,,,,135,114.75,38.1,135,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Cbc With Differential And Platelet Count,,85025,CPT,Facility,Both,,,,135,114.75,38.1,135,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),81,60,,percent of total billed charges,,
Cbc With Differential And Platelet Count,,85025,CPT,Facility,Both,,,,135,114.75,38.1,135,"Health Partners, Inc.",State of Minnesota Advantage Program,110.025,81.5,,percent of total billed charges,,
Cbc With Differential And Platelet Count,,85025,CPT,Facility,Both,,,,135,114.75,38.1,135,"Health Partners, Inc.",State Public Programs,67.5,50,,percent of total billed charges,,
Cbc With Differential And Platelet Count,,85025,CPT,Facility,Both,,,,135,114.75,38.1,135,Humana Insurance Company,Commercial PPO,128.25,95,,percent of total billed charges,,
Cbc With Differential And Platelet Count,,85025,CPT,Facility,Outpatient,,,,135,114.75,38.1,135,Humana Insurance Company,Medicare PPO,66.15,49,,percent of total billed charges,,
Cbc With Differential And Platelet Count,,85025,CPT,Facility,Inpatient,,,,135,114.75,38.1,135,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Cbc With Differential And Platelet Count,,85025,CPT,Facility,Both,,,,135,114.75,38.1,135,Medica,Individual & Family,133.785,99.1,,percent of total billed charges,,
Cbc With Differential And Platelet Count,,85025,CPT,Facility,Outpatient,,,,135,114.75,38.1,135,Medica,Medica Advantage Solution,67.23,49.8,,percent of total billed charges,,
Cbc With Differential And Platelet Count,,85025,CPT,Facility,Inpatient,,,,135,114.75,38.1,135,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Cbc With Differential And Platelet Count,,85025,CPT,Facility,Outpatient,,,,135,114.75,38.1,135,Medica,Medical Assistance,60.21,44.6,,percent of total billed charges,,
Cbc With Differential And Platelet Count,,85025,CPT,Facility,Inpatient,,,,135,114.75,38.1,135,Medica,Medical Assistance,,,,,Included in per diem rate,
Cbc With Differential And Platelet Count,,85025,CPT,Facility,Outpatient,,,,135,114.75,38.1,135,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,67.23,49.8,,percent of total billed charges,,
Cbc With Differential And Platelet Count,,85025,CPT,Facility,Inpatient,,,,135,114.75,38.1,135,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Cbc With Differential And Platelet Count,,85025,CPT,Facility,Both,,,,135,114.75,38.1,135,"Multiplan, Inc.","Multiplan, Inc.",126.9,94,,percent of total billed charges,,
Cbc With Differential And Platelet Count,,85025,CPT,Facility,Outpatient,,,,135,114.75,38.1,135,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,116.64,86.4,,percent of total billed charges,,
Cbc With Differential And Platelet Count,,85025,CPT,Facility,Inpatient,,,,135,114.75,38.1,135,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Cbc With Differential And Platelet Count,,85025,CPT,Facility,Both,,,,135,114.75,38.1,135,"Preferred One Administrative Services, INC.",PPO,133.11,98.6,,percent of total billed charges,,
Cbc With Differential And Platelet Count,,85025,CPT,Facility,Outpatient,,,,135,114.75,38.1,135,PrimeWest Health,Minnesota Senior Health Options (MSHO),69.4575,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Cbc With Differential And Platelet Count,,85025,CPT,Facility,Inpatient,,,,135,114.75,38.1,135,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Cbc With Differential And Platelet Count,,85025,CPT,Facility,Outpatient,,,,135,114.75,38.1,135,PrimeWest Health,MinnesotaCare,69.336,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Cbc With Differential And Platelet Count,,85025,CPT,Facility,Inpatient,,,,135,114.75,38.1,135,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Cbc With Differential And Platelet Count,,85025,CPT,Facility,Both,,,,135,114.75,38.1,135,Sanford Health Plan,Sanford Health Plan,124.2,92,,percent of total billed charges,,
Cbc With Differential And Platelet Count,,85025,CPT,Facility,Outpatient,,,,135,114.75,38.1,135,"UCare Health, Inc.",Individual & Family Plan,76.0725,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Cbc With Differential And Platelet Count,,85025,CPT,Facility,Inpatient,,,,135,114.75,38.1,135,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Cbc With Differential And Platelet Count,,85025,CPT,Facility,Outpatient,,,,135,114.75,38.1,135,"UCare Health, Inc.",Medical Assistance,68.1345,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Cbc With Differential And Platelet Count,,85025,CPT,Facility,Inpatient,,,,135,114.75,38.1,135,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Cbc With Differential And Platelet Count,,85025,CPT,Facility,Outpatient,,,,135,114.75,38.1,135,"UCare Health, Inc.",Medicare Advantage,68.1345,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Cbc With Differential And Platelet Count,,85025,CPT,Facility,Inpatient,,,,135,114.75,38.1,135,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Cbc With Differential And Platelet Count,,85025,CPT,Facility,Outpatient,,,,135,114.75,38.1,135,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),68.1345,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Cbc With Differential And Platelet Count,,85025,CPT,Facility,Inpatient,,,,135,114.75,38.1,135,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Cbc With Differential And Platelet Count,,85025,CPT,Facility,Both,,,,135,114.75,38.1,135,UnitedHealthcare,Individual & Family,126.9,94,,percent of total billed charges,,
Cbc With Differential And Platelet Count,,85025,CPT,Facility,Outpatient,,,,135,114.75,38.1,135,UnitedHealthcare,Medicare Advantage,66.15,49,,percent of total billed charges,,
Cbc With Differential And Platelet Count,,85025,CPT,Facility,Inpatient,,,,135,114.75,38.1,135,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Cbc With Differential And Platelet Count,,85025,CPT,Facility,Outpatient,,,,135,114.75,38.1,135,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,64.8,48,,percent of total billed charges,,100% of DHS outpatient percentage
Cbc With Differential And Platelet Count,,85025,CPT,Facility,Inpatient,,,,135,114.75,38.1,135,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Hemogram With Platelet Count,,85027,CPT,Facility,Both,,,,101,85.85,28.9466,101,Aetna,Commercial,92.92,92,,percent of total billed charges,,
Hemogram With Platelet Count,,85027,CPT,Facility,Outpatient,,,,101,85.85,28.9466,101,Aetna,Medicare Advantage,49.49,49,,percent of total billed charges,,
Hemogram With Platelet Count,,85027,CPT,Facility,Inpatient,,,,101,85.85,28.9466,101,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Hemogram With Platelet Count,,85027,CPT,Facility,Both,,,,101,85.85,28.9466,101,Aetna,PPO,93.93,93,,percent of total billed charges,,
Hemogram With Platelet Count,,85027,CPT,Facility,Both,,,,101,85.85,28.9466,101,America's PPO,America's PPO,96.9903,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Hemogram With Platelet Count,,85027,CPT,Facility,Both,,,,101,85.85,28.9466,101,BlueCross BlueShield Minnesota, Federal Employee Program,99.384,98.4,,percent of total billed charges,,
Hemogram With Platelet Count,,85027,CPT,Facility,Both,,,,101,85.85,28.9466,101,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,101,100,,percent of total billed charges,,
Hemogram With Platelet Count,,85027,CPT,Facility,Both,,,,101,85.85,28.9466,101,BlueCross BlueShield Minnesota,High Value Network Plan,90.9,90,,percent of total billed charges,,
Hemogram With Platelet Count,,85027,CPT,Facility,Outpatient,,,,101,85.85,28.9466,101,BlueCross BlueShield Minnesota,Medicare Advantage,49.49,49,,percent of total billed charges,,
Hemogram With Platelet Count,,85027,CPT,Facility,Inpatient,,,,101,85.85,28.9466,101,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Hemogram With Platelet Count,,85027,CPT,Facility,Both,,,,101,85.85,28.9466,101,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,89.4557,88.57,,percent of total billed charges,,
Hemogram With Platelet Count,,85027,CPT,Facility,Both,,,,101,85.85,28.9466,101,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,28.9466,28.66,,percent of total billed charges,,
Hemogram With Platelet Count,,85027,CPT,Facility,Outpatient,,,,101,85.85,28.9466,101,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),49.49,49,,percent of total billed charges,,
Hemogram With Platelet Count,,85027,CPT,Facility,Inpatient,,,,101,85.85,28.9466,101,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Hemogram With Platelet Count,,85027,CPT,Facility,Both,,,,101,85.85,28.9466,101,CorVel,Worker's Compensation,101,100,,percent of total billed charges,,
Hemogram With Platelet Count,,85027,CPT,Facility,Both,,,,101,85.85,28.9466,101,First Health Group Corporation,First Health Network,97.97,97,,percent of total billed charges,,
Hemogram With Platelet Count,,85027,CPT,Facility,Both,,,,101,85.85,28.9466,101,"Health Partners, Inc.",Commercial,95.546,94.6,,percent of total billed charges,,
Hemogram With Platelet Count,,85027,CPT,Facility,Outpatient,,,,101,85.85,28.9466,101,"Health Partners, Inc.",Medicare Advantage,49.49,49,,percent of total billed charges,,
Hemogram With Platelet Count,,85027,CPT,Facility,Inpatient,,,,101,85.85,28.9466,101,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Hemogram With Platelet Count,,85027,CPT,Facility,Both,,,,101,85.85,28.9466,101,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),60.6,60,,percent of total billed charges,,
Hemogram With Platelet Count,,85027,CPT,Facility,Both,,,,101,85.85,28.9466,101,"Health Partners, Inc.",State of Minnesota Advantage Program,82.315,81.5,,percent of total billed charges,,
Hemogram With Platelet Count,,85027,CPT,Facility,Both,,,,101,85.85,28.9466,101,"Health Partners, Inc.",State Public Programs,50.5,50,,percent of total billed charges,,
Hemogram With Platelet Count,,85027,CPT,Facility,Both,,,,101,85.85,28.9466,101,Humana Insurance Company,Commercial PPO,95.95,95,,percent of total billed charges,,
Hemogram With Platelet Count,,85027,CPT,Facility,Outpatient,,,,101,85.85,28.9466,101,Humana Insurance Company,Medicare PPO,49.49,49,,percent of total billed charges,,
Hemogram With Platelet Count,,85027,CPT,Facility,Inpatient,,,,101,85.85,28.9466,101,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Hemogram With Platelet Count,,85027,CPT,Facility,Both,,,,101,85.85,28.9466,101,Medica,Individual & Family,100.091,99.1,,percent of total billed charges,,
Hemogram With Platelet Count,,85027,CPT,Facility,Outpatient,,,,101,85.85,28.9466,101,Medica,Medica Advantage Solution,50.298,49.8,,percent of total billed charges,,
Hemogram With Platelet Count,,85027,CPT,Facility,Inpatient,,,,101,85.85,28.9466,101,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Hemogram With Platelet Count,,85027,CPT,Facility,Outpatient,,,,101,85.85,28.9466,101,Medica,Medical Assistance,45.046,44.6,,percent of total billed charges,,
Hemogram With Platelet Count,,85027,CPT,Facility,Inpatient,,,,101,85.85,28.9466,101,Medica,Medical Assistance,,,,,Included in per diem rate,
Hemogram With Platelet Count,,85027,CPT,Facility,Outpatient,,,,101,85.85,28.9466,101,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,50.298,49.8,,percent of total billed charges,,
Hemogram With Platelet Count,,85027,CPT,Facility,Inpatient,,,,101,85.85,28.9466,101,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Hemogram With Platelet Count,,85027,CPT,Facility,Both,,,,101,85.85,28.9466,101,"Multiplan, Inc.","Multiplan, Inc.",94.94,94,,percent of total billed charges,,
Hemogram With Platelet Count,,85027,CPT,Facility,Outpatient,,,,101,85.85,28.9466,101,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,87.264,86.4,,percent of total billed charges,,
Hemogram With Platelet Count,,85027,CPT,Facility,Inpatient,,,,101,85.85,28.9466,101,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Hemogram With Platelet Count,,85027,CPT,Facility,Both,,,,101,85.85,28.9466,101,"Preferred One Administrative Services, INC.",PPO,99.586,98.6,,percent of total billed charges,,
Hemogram With Platelet Count,,85027,CPT,Facility,Outpatient,,,,101,85.85,28.9466,101,PrimeWest Health,Minnesota Senior Health Options (MSHO),51.9645,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Hemogram With Platelet Count,,85027,CPT,Facility,Inpatient,,,,101,85.85,28.9466,101,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Hemogram With Platelet Count,,85027,CPT,Facility,Outpatient,,,,101,85.85,28.9466,101,PrimeWest Health,MinnesotaCare,51.8736,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Hemogram With Platelet Count,,85027,CPT,Facility,Inpatient,,,,101,85.85,28.9466,101,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Hemogram With Platelet Count,,85027,CPT,Facility,Both,,,,101,85.85,28.9466,101,Sanford Health Plan,Sanford Health Plan,92.92,92,,percent of total billed charges,,
Hemogram With Platelet Count,,85027,CPT,Facility,Outpatient,,,,101,85.85,28.9466,101,"UCare Health, Inc.",Individual & Family Plan,56.9135,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Hemogram With Platelet Count,,85027,CPT,Facility,Inpatient,,,,101,85.85,28.9466,101,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Hemogram With Platelet Count,,85027,CPT,Facility,Outpatient,,,,101,85.85,28.9466,101,"UCare Health, Inc.",Medical Assistance,50.9747,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Hemogram With Platelet Count,,85027,CPT,Facility,Inpatient,,,,101,85.85,28.9466,101,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Hemogram With Platelet Count,,85027,CPT,Facility,Outpatient,,,,101,85.85,28.9466,101,"UCare Health, Inc.",Medicare Advantage,50.9747,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Hemogram With Platelet Count,,85027,CPT,Facility,Inpatient,,,,101,85.85,28.9466,101,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Hemogram With Platelet Count,,85027,CPT,Facility,Outpatient,,,,101,85.85,28.9466,101,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),50.9747,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Hemogram With Platelet Count,,85027,CPT,Facility,Inpatient,,,,101,85.85,28.9466,101,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Hemogram With Platelet Count,,85027,CPT,Facility,Both,,,,101,85.85,28.9466,101,UnitedHealthcare,Individual & Family,94.94,94,,percent of total billed charges,,
Hemogram With Platelet Count,,85027,CPT,Facility,Outpatient,,,,101,85.85,28.9466,101,UnitedHealthcare,Medicare Advantage,49.49,49,,percent of total billed charges,,
Hemogram With Platelet Count,,85027,CPT,Facility,Inpatient,,,,101,85.85,28.9466,101,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Hemogram With Platelet Count,,85027,CPT,Facility,Outpatient,,,,101,85.85,28.9466,101,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,48.48,48,,percent of total billed charges,,100% of DHS outpatient percentage
Hemogram With Platelet Count,,85027,CPT,Facility,Inpatient,,,,101,85.85,28.9466,101,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Reticulocyte Count, Automated",,85045,CPT,Facility,Both,,,,49,41.65,14.0434,49,Aetna,Commercial,45.08,92,,percent of total billed charges,,
"Reticulocyte Count, Automated",,85045,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,Aetna,Medicare Advantage,24.01,49,,percent of total billed charges,,
"Reticulocyte Count, Automated",,85045,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Reticulocyte Count, Automated",,85045,CPT,Facility,Both,,,,49,41.65,14.0434,49,Aetna,PPO,45.57,93,,percent of total billed charges,,
"Reticulocyte Count, Automated",,85045,CPT,Facility,Both,,,,49,41.65,14.0434,49,America's PPO,America's PPO,47.0547,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Reticulocyte Count, Automated",,85045,CPT,Facility,Both,,,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota, Federal Employee Program,48.216,98.4,,percent of total billed charges,,
"Reticulocyte Count, Automated",,85045,CPT,Facility,Both,,,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,49,100,,percent of total billed charges,,
"Reticulocyte Count, Automated",,85045,CPT,Facility,Both,,,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,High Value Network Plan,44.1,90,,percent of total billed charges,,
"Reticulocyte Count, Automated",,85045,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Medicare Advantage,24.01,49,,percent of total billed charges,,
"Reticulocyte Count, Automated",,85045,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Reticulocyte Count, Automated",,85045,CPT,Facility,Both,,,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,43.3993,88.57,,percent of total billed charges,,
"Reticulocyte Count, Automated",,85045,CPT,Facility,Both,,,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,14.0434,28.66,,percent of total billed charges,,
"Reticulocyte Count, Automated",,85045,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),24.01,49,,percent of total billed charges,,
"Reticulocyte Count, Automated",,85045,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Reticulocyte Count, Automated",,85045,CPT,Facility,Both,,,,49,41.65,14.0434,49,CorVel,Worker's Compensation,49,100,,percent of total billed charges,,
"Reticulocyte Count, Automated",,85045,CPT,Facility,Both,,,,49,41.65,14.0434,49,First Health Group Corporation,First Health Network,47.53,97,,percent of total billed charges,,
"Reticulocyte Count, Automated",,85045,CPT,Facility,Both,,,,49,41.65,14.0434,49,"Health Partners, Inc.",Commercial,46.354,94.6,,percent of total billed charges,,
"Reticulocyte Count, Automated",,85045,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,"Health Partners, Inc.",Medicare Advantage,24.01,49,,percent of total billed charges,,
"Reticulocyte Count, Automated",,85045,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Reticulocyte Count, Automated",,85045,CPT,Facility,Both,,,,49,41.65,14.0434,49,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),29.4,60,,percent of total billed charges,,
"Reticulocyte Count, Automated",,85045,CPT,Facility,Both,,,,49,41.65,14.0434,49,"Health Partners, Inc.",State of Minnesota Advantage Program,39.935,81.5,,percent of total billed charges,,
"Reticulocyte Count, Automated",,85045,CPT,Facility,Both,,,,49,41.65,14.0434,49,"Health Partners, Inc.",State Public Programs,24.5,50,,percent of total billed charges,,
"Reticulocyte Count, Automated",,85045,CPT,Facility,Both,,,,49,41.65,14.0434,49,Humana Insurance Company,Commercial PPO,46.55,95,,percent of total billed charges,,
"Reticulocyte Count, Automated",,85045,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,Humana Insurance Company,Medicare PPO,24.01,49,,percent of total billed charges,,
"Reticulocyte Count, Automated",,85045,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Reticulocyte Count, Automated",,85045,CPT,Facility,Both,,,,49,41.65,14.0434,49,Medica,Individual & Family,48.559,99.1,,percent of total billed charges,,
"Reticulocyte Count, Automated",,85045,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,Medica,Medica Advantage Solution,24.402,49.8,,percent of total billed charges,,
"Reticulocyte Count, Automated",,85045,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Reticulocyte Count, Automated",,85045,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,Medica,Medical Assistance,21.854,44.6,,percent of total billed charges,,
"Reticulocyte Count, Automated",,85045,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,Medica,Medical Assistance,,,,,Included in per diem rate,
"Reticulocyte Count, Automated",,85045,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,24.402,49.8,,percent of total billed charges,,
"Reticulocyte Count, Automated",,85045,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Reticulocyte Count, Automated",,85045,CPT,Facility,Both,,,,49,41.65,14.0434,49,"Multiplan, Inc.","Multiplan, Inc.",46.06,94,,percent of total billed charges,,
"Reticulocyte Count, Automated",,85045,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,42.336,86.4,,percent of total billed charges,,
"Reticulocyte Count, Automated",,85045,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Reticulocyte Count, Automated",,85045,CPT,Facility,Both,,,,49,41.65,14.0434,49,"Preferred One Administrative Services, INC.",PPO,48.314,98.6,,percent of total billed charges,,
"Reticulocyte Count, Automated",,85045,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,PrimeWest Health,Minnesota Senior Health Options (MSHO),25.2105,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Reticulocyte Count, Automated",,85045,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Reticulocyte Count, Automated",,85045,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,PrimeWest Health,MinnesotaCare,25.1664,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Reticulocyte Count, Automated",,85045,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Reticulocyte Count, Automated",,85045,CPT,Facility,Both,,,,49,41.65,14.0434,49,Sanford Health Plan,Sanford Health Plan,45.08,92,,percent of total billed charges,,
"Reticulocyte Count, Automated",,85045,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,"UCare Health, Inc.",Individual & Family Plan,27.6115,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Reticulocyte Count, Automated",,85045,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Reticulocyte Count, Automated",,85045,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,"UCare Health, Inc.",Medical Assistance,24.7303,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Reticulocyte Count, Automated",,85045,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Reticulocyte Count, Automated",,85045,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,"UCare Health, Inc.",Medicare Advantage,24.7303,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Reticulocyte Count, Automated",,85045,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Reticulocyte Count, Automated",,85045,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),24.7303,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Reticulocyte Count, Automated",,85045,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Reticulocyte Count, Automated",,85045,CPT,Facility,Both,,,,49,41.65,14.0434,49,UnitedHealthcare,Individual & Family,46.06,94,,percent of total billed charges,,
"Reticulocyte Count, Automated",,85045,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,UnitedHealthcare,Medicare Advantage,24.01,49,,percent of total billed charges,,
"Reticulocyte Count, Automated",,85045,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Reticulocyte Count, Automated",,85045,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,23.52,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Reticulocyte Count, Automated",,85045,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
White Blood Cell Count,,85048,CPT,Facility,Both,,,,66,56.1,18.9156,66,Aetna,Commercial,60.72,92,,percent of total billed charges,,
White Blood Cell Count,,85048,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,Aetna,Medicare Advantage,32.34,49,,percent of total billed charges,,
White Blood Cell Count,,85048,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,Aetna,Medicare Advantage,,,,,Included in per diem rate,
White Blood Cell Count,,85048,CPT,Facility,Both,,,,66,56.1,18.9156,66,Aetna,PPO,61.38,93,,percent of total billed charges,,
White Blood Cell Count,,85048,CPT,Facility,Both,,,,66,56.1,18.9156,66,America's PPO,America's PPO,63.3798,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
White Blood Cell Count,,85048,CPT,Facility,Both,,,,66,56.1,18.9156,66,BlueCross BlueShield Minnesota, Federal Employee Program,64.944,98.4,,percent of total billed charges,,
White Blood Cell Count,,85048,CPT,Facility,Both,,,,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,66,100,,percent of total billed charges,,
White Blood Cell Count,,85048,CPT,Facility,Both,,,,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,High Value Network Plan,59.4,90,,percent of total billed charges,,
White Blood Cell Count,,85048,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,Medicare Advantage,32.34,49,,percent of total billed charges,,
White Blood Cell Count,,85048,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
White Blood Cell Count,,85048,CPT,Facility,Both,,,,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,58.4562,88.57,,percent of total billed charges,,
White Blood Cell Count,,85048,CPT,Facility,Both,,,,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,18.9156,28.66,,percent of total billed charges,,
White Blood Cell Count,,85048,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),32.34,49,,percent of total billed charges,,
White Blood Cell Count,,85048,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
White Blood Cell Count,,85048,CPT,Facility,Both,,,,66,56.1,18.9156,66,CorVel,Worker's Compensation,66,100,,percent of total billed charges,,
White Blood Cell Count,,85048,CPT,Facility,Both,,,,66,56.1,18.9156,66,First Health Group Corporation,First Health Network,64.02,97,,percent of total billed charges,,
White Blood Cell Count,,85048,CPT,Facility,Both,,,,66,56.1,18.9156,66,"Health Partners, Inc.",Commercial,62.436,94.6,,percent of total billed charges,,
White Blood Cell Count,,85048,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,"Health Partners, Inc.",Medicare Advantage,32.34,49,,percent of total billed charges,,
White Blood Cell Count,,85048,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
White Blood Cell Count,,85048,CPT,Facility,Both,,,,66,56.1,18.9156,66,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),39.6,60,,percent of total billed charges,,
White Blood Cell Count,,85048,CPT,Facility,Both,,,,66,56.1,18.9156,66,"Health Partners, Inc.",State of Minnesota Advantage Program,53.79,81.5,,percent of total billed charges,,
White Blood Cell Count,,85048,CPT,Facility,Both,,,,66,56.1,18.9156,66,"Health Partners, Inc.",State Public Programs,33,50,,percent of total billed charges,,
White Blood Cell Count,,85048,CPT,Facility,Both,,,,66,56.1,18.9156,66,Humana Insurance Company,Commercial PPO,62.7,95,,percent of total billed charges,,
White Blood Cell Count,,85048,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,Humana Insurance Company,Medicare PPO,32.34,49,,percent of total billed charges,,
White Blood Cell Count,,85048,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
White Blood Cell Count,,85048,CPT,Facility,Both,,,,66,56.1,18.9156,66,Medica,Individual & Family,65.406,99.1,,percent of total billed charges,,
White Blood Cell Count,,85048,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,Medica,Medica Advantage Solution,32.868,49.8,,percent of total billed charges,,
White Blood Cell Count,,85048,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
White Blood Cell Count,,85048,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,Medica,Medical Assistance,29.436,44.6,,percent of total billed charges,,
White Blood Cell Count,,85048,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,Medica,Medical Assistance,,,,,Included in per diem rate,
White Blood Cell Count,,85048,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,32.868,49.8,,percent of total billed charges,,
White Blood Cell Count,,85048,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
White Blood Cell Count,,85048,CPT,Facility,Both,,,,66,56.1,18.9156,66,"Multiplan, Inc.","Multiplan, Inc.",62.04,94,,percent of total billed charges,,
White Blood Cell Count,,85048,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,57.024,86.4,,percent of total billed charges,,
White Blood Cell Count,,85048,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
White Blood Cell Count,,85048,CPT,Facility,Both,,,,66,56.1,18.9156,66,"Preferred One Administrative Services, INC.",PPO,65.076,98.6,,percent of total billed charges,,
White Blood Cell Count,,85048,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,PrimeWest Health,Minnesota Senior Health Options (MSHO),33.957,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
White Blood Cell Count,,85048,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
White Blood Cell Count,,85048,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,PrimeWest Health,MinnesotaCare,33.8976,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
White Blood Cell Count,,85048,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
White Blood Cell Count,,85048,CPT,Facility,Both,,,,66,56.1,18.9156,66,Sanford Health Plan,Sanford Health Plan,60.72,92,,percent of total billed charges,,
White Blood Cell Count,,85048,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,"UCare Health, Inc.",Individual & Family Plan,37.191,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
White Blood Cell Count,,85048,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
White Blood Cell Count,,85048,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,"UCare Health, Inc.",Medical Assistance,33.3102,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
White Blood Cell Count,,85048,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
White Blood Cell Count,,85048,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,"UCare Health, Inc.",Medicare Advantage,33.3102,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
White Blood Cell Count,,85048,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
White Blood Cell Count,,85048,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),33.3102,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
White Blood Cell Count,,85048,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
White Blood Cell Count,,85048,CPT,Facility,Both,,,,66,56.1,18.9156,66,UnitedHealthcare,Individual & Family,62.04,94,,percent of total billed charges,,
White Blood Cell Count,,85048,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,UnitedHealthcare,Medicare Advantage,32.34,49,,percent of total billed charges,,
White Blood Cell Count,,85048,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
White Blood Cell Count,,85048,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,31.68,48,,percent of total billed charges,,100% of DHS outpatient percentage
White Blood Cell Count,,85048,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Platelet Count,,85049,CPT,Facility,Both,,,,49,41.65,14.0434,49,Aetna,Commercial,45.08,92,,percent of total billed charges,,
Platelet Count,,85049,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,Aetna,Medicare Advantage,24.01,49,,percent of total billed charges,,
Platelet Count,,85049,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Platelet Count,,85049,CPT,Facility,Both,,,,49,41.65,14.0434,49,Aetna,PPO,45.57,93,,percent of total billed charges,,
Platelet Count,,85049,CPT,Facility,Both,,,,49,41.65,14.0434,49,America's PPO,America's PPO,47.0547,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Platelet Count,,85049,CPT,Facility,Both,,,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota, Federal Employee Program,48.216,98.4,,percent of total billed charges,,
Platelet Count,,85049,CPT,Facility,Both,,,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,49,100,,percent of total billed charges,,
Platelet Count,,85049,CPT,Facility,Both,,,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,High Value Network Plan,44.1,90,,percent of total billed charges,,
Platelet Count,,85049,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Medicare Advantage,24.01,49,,percent of total billed charges,,
Platelet Count,,85049,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Platelet Count,,85049,CPT,Facility,Both,,,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,43.3993,88.57,,percent of total billed charges,,
Platelet Count,,85049,CPT,Facility,Both,,,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,14.0434,28.66,,percent of total billed charges,,
Platelet Count,,85049,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),24.01,49,,percent of total billed charges,,
Platelet Count,,85049,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Platelet Count,,85049,CPT,Facility,Both,,,,49,41.65,14.0434,49,CorVel,Worker's Compensation,49,100,,percent of total billed charges,,
Platelet Count,,85049,CPT,Facility,Both,,,,49,41.65,14.0434,49,First Health Group Corporation,First Health Network,47.53,97,,percent of total billed charges,,
Platelet Count,,85049,CPT,Facility,Both,,,,49,41.65,14.0434,49,"Health Partners, Inc.",Commercial,46.354,94.6,,percent of total billed charges,,
Platelet Count,,85049,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,"Health Partners, Inc.",Medicare Advantage,24.01,49,,percent of total billed charges,,
Platelet Count,,85049,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Platelet Count,,85049,CPT,Facility,Both,,,,49,41.65,14.0434,49,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),29.4,60,,percent of total billed charges,,
Platelet Count,,85049,CPT,Facility,Both,,,,49,41.65,14.0434,49,"Health Partners, Inc.",State of Minnesota Advantage Program,39.935,81.5,,percent of total billed charges,,
Platelet Count,,85049,CPT,Facility,Both,,,,49,41.65,14.0434,49,"Health Partners, Inc.",State Public Programs,24.5,50,,percent of total billed charges,,
Platelet Count,,85049,CPT,Facility,Both,,,,49,41.65,14.0434,49,Humana Insurance Company,Commercial PPO,46.55,95,,percent of total billed charges,,
Platelet Count,,85049,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,Humana Insurance Company,Medicare PPO,24.01,49,,percent of total billed charges,,
Platelet Count,,85049,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Platelet Count,,85049,CPT,Facility,Both,,,,49,41.65,14.0434,49,Medica,Individual & Family,48.559,99.1,,percent of total billed charges,,
Platelet Count,,85049,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,Medica,Medica Advantage Solution,24.402,49.8,,percent of total billed charges,,
Platelet Count,,85049,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Platelet Count,,85049,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,Medica,Medical Assistance,21.854,44.6,,percent of total billed charges,,
Platelet Count,,85049,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,Medica,Medical Assistance,,,,,Included in per diem rate,
Platelet Count,,85049,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,24.402,49.8,,percent of total billed charges,,
Platelet Count,,85049,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Platelet Count,,85049,CPT,Facility,Both,,,,49,41.65,14.0434,49,"Multiplan, Inc.","Multiplan, Inc.",46.06,94,,percent of total billed charges,,
Platelet Count,,85049,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,42.336,86.4,,percent of total billed charges,,
Platelet Count,,85049,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Platelet Count,,85049,CPT,Facility,Both,,,,49,41.65,14.0434,49,"Preferred One Administrative Services, INC.",PPO,48.314,98.6,,percent of total billed charges,,
Platelet Count,,85049,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,PrimeWest Health,Minnesota Senior Health Options (MSHO),25.2105,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Platelet Count,,85049,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Platelet Count,,85049,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,PrimeWest Health,MinnesotaCare,25.1664,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Platelet Count,,85049,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Platelet Count,,85049,CPT,Facility,Both,,,,49,41.65,14.0434,49,Sanford Health Plan,Sanford Health Plan,45.08,92,,percent of total billed charges,,
Platelet Count,,85049,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,"UCare Health, Inc.",Individual & Family Plan,27.6115,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Platelet Count,,85049,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Platelet Count,,85049,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,"UCare Health, Inc.",Medical Assistance,24.7303,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Platelet Count,,85049,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Platelet Count,,85049,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,"UCare Health, Inc.",Medicare Advantage,24.7303,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Platelet Count,,85049,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Platelet Count,,85049,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),24.7303,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Platelet Count,,85049,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Platelet Count,,85049,CPT,Facility,Both,,,,49,41.65,14.0434,49,UnitedHealthcare,Individual & Family,46.06,94,,percent of total billed charges,,
Platelet Count,,85049,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,UnitedHealthcare,Medicare Advantage,24.01,49,,percent of total billed charges,,
Platelet Count,,85049,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Platelet Count,,85049,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,23.52,48,,percent of total billed charges,,100% of DHS outpatient percentage
Platelet Count,,85049,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Antithrombin Iii,,85300,CPT,Facility,Both,,,,158,134.3,45.2828,158,Aetna,Commercial,145.36,92,,percent of total billed charges,,
Antithrombin Iii,,85300,CPT,Facility,Outpatient,,,,158,134.3,45.2828,158,Aetna,Medicare Advantage,77.42,49,,percent of total billed charges,,
Antithrombin Iii,,85300,CPT,Facility,Inpatient,,,,158,134.3,45.2828,158,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Antithrombin Iii,,85300,CPT,Facility,Both,,,,158,134.3,45.2828,158,Aetna,PPO,146.94,93,,percent of total billed charges,,
Antithrombin Iii,,85300,CPT,Facility,Both,,,,158,134.3,45.2828,158,America's PPO,America's PPO,151.7274,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Antithrombin Iii,,85300,CPT,Facility,Both,,,,158,134.3,45.2828,158,BlueCross BlueShield Minnesota, Federal Employee Program,155.472,98.4,,percent of total billed charges,,
Antithrombin Iii,,85300,CPT,Facility,Both,,,,158,134.3,45.2828,158,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,158,100,,percent of total billed charges,,
Antithrombin Iii,,85300,CPT,Facility,Both,,,,158,134.3,45.2828,158,BlueCross BlueShield Minnesota,High Value Network Plan,142.2,90,,percent of total billed charges,,
Antithrombin Iii,,85300,CPT,Facility,Outpatient,,,,158,134.3,45.2828,158,BlueCross BlueShield Minnesota,Medicare Advantage,77.42,49,,percent of total billed charges,,
Antithrombin Iii,,85300,CPT,Facility,Inpatient,,,,158,134.3,45.2828,158,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Antithrombin Iii,,85300,CPT,Facility,Both,,,,158,134.3,45.2828,158,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,139.9406,88.57,,percent of total billed charges,,
Antithrombin Iii,,85300,CPT,Facility,Both,,,,158,134.3,45.2828,158,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,45.2828,28.66,,percent of total billed charges,,
Antithrombin Iii,,85300,CPT,Facility,Outpatient,,,,158,134.3,45.2828,158,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),77.42,49,,percent of total billed charges,,
Antithrombin Iii,,85300,CPT,Facility,Inpatient,,,,158,134.3,45.2828,158,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Antithrombin Iii,,85300,CPT,Facility,Both,,,,158,134.3,45.2828,158,CorVel,Worker's Compensation,158,100,,percent of total billed charges,,
Antithrombin Iii,,85300,CPT,Facility,Both,,,,158,134.3,45.2828,158,First Health Group Corporation,First Health Network,153.26,97,,percent of total billed charges,,
Antithrombin Iii,,85300,CPT,Facility,Both,,,,158,134.3,45.2828,158,"Health Partners, Inc.",Commercial,149.468,94.6,,percent of total billed charges,,
Antithrombin Iii,,85300,CPT,Facility,Outpatient,,,,158,134.3,45.2828,158,"Health Partners, Inc.",Medicare Advantage,77.42,49,,percent of total billed charges,,
Antithrombin Iii,,85300,CPT,Facility,Inpatient,,,,158,134.3,45.2828,158,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Antithrombin Iii,,85300,CPT,Facility,Both,,,,158,134.3,45.2828,158,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),94.8,60,,percent of total billed charges,,
Antithrombin Iii,,85300,CPT,Facility,Both,,,,158,134.3,45.2828,158,"Health Partners, Inc.",State of Minnesota Advantage Program,128.77,81.5,,percent of total billed charges,,
Antithrombin Iii,,85300,CPT,Facility,Both,,,,158,134.3,45.2828,158,"Health Partners, Inc.",State Public Programs,79,50,,percent of total billed charges,,
Antithrombin Iii,,85300,CPT,Facility,Both,,,,158,134.3,45.2828,158,Humana Insurance Company,Commercial PPO,150.1,95,,percent of total billed charges,,
Antithrombin Iii,,85300,CPT,Facility,Outpatient,,,,158,134.3,45.2828,158,Humana Insurance Company,Medicare PPO,77.42,49,,percent of total billed charges,,
Antithrombin Iii,,85300,CPT,Facility,Inpatient,,,,158,134.3,45.2828,158,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Antithrombin Iii,,85300,CPT,Facility,Both,,,,158,134.3,45.2828,158,Medica,Individual & Family,156.578,99.1,,percent of total billed charges,,
Antithrombin Iii,,85300,CPT,Facility,Outpatient,,,,158,134.3,45.2828,158,Medica,Medica Advantage Solution,78.684,49.8,,percent of total billed charges,,
Antithrombin Iii,,85300,CPT,Facility,Inpatient,,,,158,134.3,45.2828,158,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Antithrombin Iii,,85300,CPT,Facility,Outpatient,,,,158,134.3,45.2828,158,Medica,Medical Assistance,70.468,44.6,,percent of total billed charges,,
Antithrombin Iii,,85300,CPT,Facility,Inpatient,,,,158,134.3,45.2828,158,Medica,Medical Assistance,,,,,Included in per diem rate,
Antithrombin Iii,,85300,CPT,Facility,Outpatient,,,,158,134.3,45.2828,158,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,78.684,49.8,,percent of total billed charges,,
Antithrombin Iii,,85300,CPT,Facility,Inpatient,,,,158,134.3,45.2828,158,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Antithrombin Iii,,85300,CPT,Facility,Both,,,,158,134.3,45.2828,158,"Multiplan, Inc.","Multiplan, Inc.",148.52,94,,percent of total billed charges,,
Antithrombin Iii,,85300,CPT,Facility,Outpatient,,,,158,134.3,45.2828,158,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,136.512,86.4,,percent of total billed charges,,
Antithrombin Iii,,85300,CPT,Facility,Inpatient,,,,158,134.3,45.2828,158,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Antithrombin Iii,,85300,CPT,Facility,Both,,,,158,134.3,45.2828,158,"Preferred One Administrative Services, INC.",PPO,155.788,98.6,,percent of total billed charges,,
Antithrombin Iii,,85300,CPT,Facility,Outpatient,,,,158,134.3,45.2828,158,PrimeWest Health,Minnesota Senior Health Options (MSHO),81.291,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Antithrombin Iii,,85300,CPT,Facility,Inpatient,,,,158,134.3,45.2828,158,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Antithrombin Iii,,85300,CPT,Facility,Outpatient,,,,158,134.3,45.2828,158,PrimeWest Health,MinnesotaCare,81.1488,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Antithrombin Iii,,85300,CPT,Facility,Inpatient,,,,158,134.3,45.2828,158,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Antithrombin Iii,,85300,CPT,Facility,Both,,,,158,134.3,45.2828,158,Sanford Health Plan,Sanford Health Plan,145.36,92,,percent of total billed charges,,
Antithrombin Iii,,85300,CPT,Facility,Outpatient,,,,158,134.3,45.2828,158,"UCare Health, Inc.",Individual & Family Plan,89.033,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Antithrombin Iii,,85300,CPT,Facility,Inpatient,,,,158,134.3,45.2828,158,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Antithrombin Iii,,85300,CPT,Facility,Outpatient,,,,158,134.3,45.2828,158,"UCare Health, Inc.",Medical Assistance,79.7426,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Antithrombin Iii,,85300,CPT,Facility,Inpatient,,,,158,134.3,45.2828,158,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Antithrombin Iii,,85300,CPT,Facility,Outpatient,,,,158,134.3,45.2828,158,"UCare Health, Inc.",Medicare Advantage,79.7426,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Antithrombin Iii,,85300,CPT,Facility,Inpatient,,,,158,134.3,45.2828,158,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Antithrombin Iii,,85300,CPT,Facility,Outpatient,,,,158,134.3,45.2828,158,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),79.7426,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Antithrombin Iii,,85300,CPT,Facility,Inpatient,,,,158,134.3,45.2828,158,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Antithrombin Iii,,85300,CPT,Facility,Both,,,,158,134.3,45.2828,158,UnitedHealthcare,Individual & Family,148.52,94,,percent of total billed charges,,
Antithrombin Iii,,85300,CPT,Facility,Outpatient,,,,158,134.3,45.2828,158,UnitedHealthcare,Medicare Advantage,77.42,49,,percent of total billed charges,,
Antithrombin Iii,,85300,CPT,Facility,Inpatient,,,,158,134.3,45.2828,158,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Antithrombin Iii,,85300,CPT,Facility,Outpatient,,,,158,134.3,45.2828,158,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,75.84,48,,percent of total billed charges,,100% of DHS outpatient percentage
Antithrombin Iii,,85300,CPT,Facility,Inpatient,,,,158,134.3,45.2828,158,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Protein C,,85303,CPT,Facility,Both,,,,128,108.8,36.6848,128,Aetna,Commercial,117.76,92,,percent of total billed charges,,
Protein C,,85303,CPT,Facility,Outpatient,,,,128,108.8,36.6848,128,Aetna,Medicare Advantage,62.72,49,,percent of total billed charges,,
Protein C,,85303,CPT,Facility,Inpatient,,,,128,108.8,36.6848,128,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Protein C,,85303,CPT,Facility,Both,,,,128,108.8,36.6848,128,Aetna,PPO,119.04,93,,percent of total billed charges,,
Protein C,,85303,CPT,Facility,Both,,,,128,108.8,36.6848,128,America's PPO,America's PPO,122.9184,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Protein C,,85303,CPT,Facility,Both,,,,128,108.8,36.6848,128,BlueCross BlueShield Minnesota, Federal Employee Program,125.952,98.4,,percent of total billed charges,,
Protein C,,85303,CPT,Facility,Both,,,,128,108.8,36.6848,128,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,128,100,,percent of total billed charges,,
Protein C,,85303,CPT,Facility,Both,,,,128,108.8,36.6848,128,BlueCross BlueShield Minnesota,High Value Network Plan,115.2,90,,percent of total billed charges,,
Protein C,,85303,CPT,Facility,Outpatient,,,,128,108.8,36.6848,128,BlueCross BlueShield Minnesota,Medicare Advantage,62.72,49,,percent of total billed charges,,
Protein C,,85303,CPT,Facility,Inpatient,,,,128,108.8,36.6848,128,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Protein C,,85303,CPT,Facility,Both,,,,128,108.8,36.6848,128,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,113.3696,88.57,,percent of total billed charges,,
Protein C,,85303,CPT,Facility,Both,,,,128,108.8,36.6848,128,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,36.6848,28.66,,percent of total billed charges,,
Protein C,,85303,CPT,Facility,Outpatient,,,,128,108.8,36.6848,128,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),62.72,49,,percent of total billed charges,,
Protein C,,85303,CPT,Facility,Inpatient,,,,128,108.8,36.6848,128,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Protein C,,85303,CPT,Facility,Both,,,,128,108.8,36.6848,128,CorVel,Worker's Compensation,128,100,,percent of total billed charges,,
Protein C,,85303,CPT,Facility,Both,,,,128,108.8,36.6848,128,First Health Group Corporation,First Health Network,124.16,97,,percent of total billed charges,,
Protein C,,85303,CPT,Facility,Both,,,,128,108.8,36.6848,128,"Health Partners, Inc.",Commercial,121.088,94.6,,percent of total billed charges,,
Protein C,,85303,CPT,Facility,Outpatient,,,,128,108.8,36.6848,128,"Health Partners, Inc.",Medicare Advantage,62.72,49,,percent of total billed charges,,
Protein C,,85303,CPT,Facility,Inpatient,,,,128,108.8,36.6848,128,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Protein C,,85303,CPT,Facility,Both,,,,128,108.8,36.6848,128,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),76.8,60,,percent of total billed charges,,
Protein C,,85303,CPT,Facility,Both,,,,128,108.8,36.6848,128,"Health Partners, Inc.",State of Minnesota Advantage Program,104.32,81.5,,percent of total billed charges,,
Protein C,,85303,CPT,Facility,Both,,,,128,108.8,36.6848,128,"Health Partners, Inc.",State Public Programs,64,50,,percent of total billed charges,,
Protein C,,85303,CPT,Facility,Both,,,,128,108.8,36.6848,128,Humana Insurance Company,Commercial PPO,121.6,95,,percent of total billed charges,,
Protein C,,85303,CPT,Facility,Outpatient,,,,128,108.8,36.6848,128,Humana Insurance Company,Medicare PPO,62.72,49,,percent of total billed charges,,
Protein C,,85303,CPT,Facility,Inpatient,,,,128,108.8,36.6848,128,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Protein C,,85303,CPT,Facility,Both,,,,128,108.8,36.6848,128,Medica,Individual & Family,126.848,99.1,,percent of total billed charges,,
Protein C,,85303,CPT,Facility,Outpatient,,,,128,108.8,36.6848,128,Medica,Medica Advantage Solution,63.744,49.8,,percent of total billed charges,,
Protein C,,85303,CPT,Facility,Inpatient,,,,128,108.8,36.6848,128,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Protein C,,85303,CPT,Facility,Outpatient,,,,128,108.8,36.6848,128,Medica,Medical Assistance,57.088,44.6,,percent of total billed charges,,
Protein C,,85303,CPT,Facility,Inpatient,,,,128,108.8,36.6848,128,Medica,Medical Assistance,,,,,Included in per diem rate,
Protein C,,85303,CPT,Facility,Outpatient,,,,128,108.8,36.6848,128,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,63.744,49.8,,percent of total billed charges,,
Protein C,,85303,CPT,Facility,Inpatient,,,,128,108.8,36.6848,128,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Protein C,,85303,CPT,Facility,Both,,,,128,108.8,36.6848,128,"Multiplan, Inc.","Multiplan, Inc.",120.32,94,,percent of total billed charges,,
Protein C,,85303,CPT,Facility,Outpatient,,,,128,108.8,36.6848,128,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,110.592,86.4,,percent of total billed charges,,
Protein C,,85303,CPT,Facility,Inpatient,,,,128,108.8,36.6848,128,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Protein C,,85303,CPT,Facility,Both,,,,128,108.8,36.6848,128,"Preferred One Administrative Services, INC.",PPO,126.208,98.6,,percent of total billed charges,,
Protein C,,85303,CPT,Facility,Outpatient,,,,128,108.8,36.6848,128,PrimeWest Health,Minnesota Senior Health Options (MSHO),65.856,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Protein C,,85303,CPT,Facility,Inpatient,,,,128,108.8,36.6848,128,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Protein C,,85303,CPT,Facility,Outpatient,,,,128,108.8,36.6848,128,PrimeWest Health,MinnesotaCare,65.7408,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Protein C,,85303,CPT,Facility,Inpatient,,,,128,108.8,36.6848,128,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Protein C,,85303,CPT,Facility,Both,,,,128,108.8,36.6848,128,Sanford Health Plan,Sanford Health Plan,117.76,92,,percent of total billed charges,,
Protein C,,85303,CPT,Facility,Outpatient,,,,128,108.8,36.6848,128,"UCare Health, Inc.",Individual & Family Plan,72.128,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Protein C,,85303,CPT,Facility,Inpatient,,,,128,108.8,36.6848,128,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Protein C,,85303,CPT,Facility,Outpatient,,,,128,108.8,36.6848,128,"UCare Health, Inc.",Medical Assistance,64.6016,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Protein C,,85303,CPT,Facility,Inpatient,,,,128,108.8,36.6848,128,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Protein C,,85303,CPT,Facility,Outpatient,,,,128,108.8,36.6848,128,"UCare Health, Inc.",Medicare Advantage,64.6016,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Protein C,,85303,CPT,Facility,Inpatient,,,,128,108.8,36.6848,128,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Protein C,,85303,CPT,Facility,Outpatient,,,,128,108.8,36.6848,128,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),64.6016,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Protein C,,85303,CPT,Facility,Inpatient,,,,128,108.8,36.6848,128,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Protein C,,85303,CPT,Facility,Both,,,,128,108.8,36.6848,128,UnitedHealthcare,Individual & Family,120.32,94,,percent of total billed charges,,
Protein C,,85303,CPT,Facility,Outpatient,,,,128,108.8,36.6848,128,UnitedHealthcare,Medicare Advantage,62.72,49,,percent of total billed charges,,
Protein C,,85303,CPT,Facility,Inpatient,,,,128,108.8,36.6848,128,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Protein C,,85303,CPT,Facility,Outpatient,,,,128,108.8,36.6848,128,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,61.44,48,,percent of total billed charges,,100% of DHS outpatient percentage
Protein C,,85303,CPT,Facility,Inpatient,,,,128,108.8,36.6848,128,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Both,10,mL,,32,27.2,9.1712,32,Aetna,Commercial,29.44,92,,percent of total billed charges,,
BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Outpatient,10,mL,,32,27.2,9.1712,32,Aetna,Medicare Advantage,15.68,49,,percent of total billed charges,,
BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Inpatient,10,mL,,32,27.2,9.1712,32,Aetna,Medicare Advantage,,,,,Included in per diem rate,
BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Both,10,mL,,32,27.2,9.1712,32,Aetna,PPO,29.76,93,,percent of total billed charges,,
BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Both,10,mL,,32,27.2,9.1712,32,America's PPO,America's PPO,30.7296,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Both,10,mL,,32,27.2,9.1712,32,BlueCross BlueShield Minnesota, Federal Employee Program,31.488,98.4,,percent of total billed charges,,
BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Both,10,mL,,32,27.2,9.1712,32,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,32,100,,percent of total billed charges,,
BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Both,10,mL,,32,27.2,9.1712,32,BlueCross BlueShield Minnesota,High Value Network Plan,28.8,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Outpatient,10,mL,,32,27.2,9.1712,32,BlueCross BlueShield Minnesota,Medicare Advantage,15.68,49,,percent of total billed charges,,
BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Inpatient,10,mL,,32,27.2,9.1712,32,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Both,10,mL,,32,27.2,9.1712,32,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,28.3424,88.57,,percent of total billed charges,,
BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Both,10,mL,,32,27.2,9.1712,32,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,9.1712,28.66,,percent of total billed charges,,
BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Outpatient,10,mL,,32,27.2,9.1712,32,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),15.68,49,,percent of total billed charges,,
BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Inpatient,10,mL,,32,27.2,9.1712,32,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Both,10,mL,,32,27.2,9.1712,32,CorVel,Worker's Compensation,32,100,,percent of total billed charges,,
BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Both,10,mL,,32,27.2,9.1712,32,First Health Group Corporation,First Health Network,31.04,97,,percent of total billed charges,,
BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Both,10,mL,,32,27.2,9.1712,32,"Health Partners, Inc.",Commercial,30.272,94.6,,percent of total billed charges,,
BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Outpatient,10,mL,,32,27.2,9.1712,32,"Health Partners, Inc.",Medicare Advantage,15.68,49,,percent of total billed charges,,
BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Inpatient,10,mL,,32,27.2,9.1712,32,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Both,10,mL,,32,27.2,9.1712,32,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),19.2,60,,percent of total billed charges,,
BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Both,10,mL,,32,27.2,9.1712,32,"Health Partners, Inc.",State of Minnesota Advantage Program,26.08,81.5,,percent of total billed charges,,
BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Both,10,mL,,32,27.2,9.1712,32,"Health Partners, Inc.",State Public Programs,16,50,,percent of total billed charges,,
BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Both,10,mL,,32,27.2,9.1712,32,Humana Insurance Company,Commercial PPO,30.4,95,,percent of total billed charges,,
BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Outpatient,10,mL,,32,27.2,9.1712,32,Humana Insurance Company,Medicare PPO,15.68,49,,percent of total billed charges,,
BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Inpatient,10,mL,,32,27.2,9.1712,32,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Both,10,mL,,32,27.2,9.1712,32,Medica,Individual & Family,31.712,99.1,,percent of total billed charges,,
BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Outpatient,10,mL,,32,27.2,9.1712,32,Medica,Medica Advantage Solution,15.936,49.8,,percent of total billed charges,,
BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Inpatient,10,mL,,32,27.2,9.1712,32,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Outpatient,10,mL,,32,27.2,9.1712,32,Medica,Medical Assistance,14.272,44.6,,percent of total billed charges,,
BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Inpatient,10,mL,,32,27.2,9.1712,32,Medica,Medical Assistance,,,,,Included in per diem rate,
BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Outpatient,10,mL,,32,27.2,9.1712,32,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,15.936,49.8,,percent of total billed charges,,
BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Inpatient,10,mL,,32,27.2,9.1712,32,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Both,10,mL,,32,27.2,9.1712,32,"Multiplan, Inc.","Multiplan, Inc.",30.08,94,,percent of total billed charges,,
BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Outpatient,10,mL,,32,27.2,9.1712,32,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,28.832,90.1,,percent of total billed charges,,
BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Inpatient,10,mL,,32,27.2,9.1712,32,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Both,10,mL,,32,27.2,9.1712,32,"Preferred One Administrative Services, INC.",PPO,31.552,98.6,,percent of total billed charges,,
BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Outpatient,10,mL,,32,27.2,9.1712,32,PrimeWest Health,Minnesota Senior Health Options (MSHO),16.464,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Inpatient,10,mL,,32,27.2,9.1712,32,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Outpatient,10,mL,,32,27.2,9.1712,32,PrimeWest Health,MinnesotaCare,16.4352,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Inpatient,10,mL,,32,27.2,9.1712,32,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Both,10,mL,,32,27.2,9.1712,32,Sanford Health Plan,Sanford Health Plan,29.44,92,,percent of total billed charges,,
BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Outpatient,10,mL,,32,27.2,9.1712,32,"UCare Health, Inc.",Individual & Family Plan,18.032,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Inpatient,10,mL,,32,27.2,9.1712,32,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Outpatient,10,mL,,32,27.2,9.1712,32,"UCare Health, Inc.",Medical Assistance,16.1504,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Inpatient,10,mL,,32,27.2,9.1712,32,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Outpatient,10,mL,,32,27.2,9.1712,32,"UCare Health, Inc.",Medicare Advantage,16.1504,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Inpatient,10,mL,,32,27.2,9.1712,32,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Outpatient,10,mL,,32,27.2,9.1712,32,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),16.1504,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Inpatient,10,mL,,32,27.2,9.1712,32,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Both,10,mL,,32,27.2,9.1712,32,UnitedHealthcare,Individual & Family,30.08,94,,percent of total billed charges,,
BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Outpatient,10,mL,,32,27.2,9.1712,32,UnitedHealthcare,Medicare Advantage,15.68,49,,percent of total billed charges,,
BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Inpatient,10,mL,,32,27.2,9.1712,32,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Outpatient,10,mL,,32,27.2,9.1712,32,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,15.36,48,,percent of total billed charges,,100% of DHS outpatient percentage
BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Inpatient,10,mL,,32,27.2,9.1712,32,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
D Dimer,,85379,CPT,Facility,Both,,,,168,142.8,48.1488,168,Aetna,Commercial,154.56,92,,percent of total billed charges,,
D Dimer,,85379,CPT,Facility,Outpatient,,,,168,142.8,48.1488,168,Aetna,Medicare Advantage,82.32,49,,percent of total billed charges,,
D Dimer,,85379,CPT,Facility,Inpatient,,,,168,142.8,48.1488,168,Aetna,Medicare Advantage,,,,,Included in per diem rate,
D Dimer,,85379,CPT,Facility,Both,,,,168,142.8,48.1488,168,Aetna,PPO,156.24,93,,percent of total billed charges,,
D Dimer,,85379,CPT,Facility,Both,,,,168,142.8,48.1488,168,America's PPO,America's PPO,161.3304,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
D Dimer,,85379,CPT,Facility,Both,,,,168,142.8,48.1488,168,BlueCross BlueShield Minnesota, Federal Employee Program,165.312,98.4,,percent of total billed charges,,
D Dimer,,85379,CPT,Facility,Both,,,,168,142.8,48.1488,168,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,168,100,,percent of total billed charges,,
D Dimer,,85379,CPT,Facility,Both,,,,168,142.8,48.1488,168,BlueCross BlueShield Minnesota,High Value Network Plan,151.2,90,,percent of total billed charges,,
D Dimer,,85379,CPT,Facility,Outpatient,,,,168,142.8,48.1488,168,BlueCross BlueShield Minnesota,Medicare Advantage,82.32,49,,percent of total billed charges,,
D Dimer,,85379,CPT,Facility,Inpatient,,,,168,142.8,48.1488,168,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
D Dimer,,85379,CPT,Facility,Both,,,,168,142.8,48.1488,168,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,148.7976,88.57,,percent of total billed charges,,
D Dimer,,85379,CPT,Facility,Both,,,,168,142.8,48.1488,168,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,48.1488,28.66,,percent of total billed charges,,
D Dimer,,85379,CPT,Facility,Outpatient,,,,168,142.8,48.1488,168,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),82.32,49,,percent of total billed charges,,
D Dimer,,85379,CPT,Facility,Inpatient,,,,168,142.8,48.1488,168,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
D Dimer,,85379,CPT,Facility,Both,,,,168,142.8,48.1488,168,CorVel,Worker's Compensation,168,100,,percent of total billed charges,,
D Dimer,,85379,CPT,Facility,Both,,,,168,142.8,48.1488,168,First Health Group Corporation,First Health Network,162.96,97,,percent of total billed charges,,
D Dimer,,85379,CPT,Facility,Both,,,,168,142.8,48.1488,168,"Health Partners, Inc.",Commercial,158.928,94.6,,percent of total billed charges,,
D Dimer,,85379,CPT,Facility,Outpatient,,,,168,142.8,48.1488,168,"Health Partners, Inc.",Medicare Advantage,82.32,49,,percent of total billed charges,,
D Dimer,,85379,CPT,Facility,Inpatient,,,,168,142.8,48.1488,168,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
D Dimer,,85379,CPT,Facility,Both,,,,168,142.8,48.1488,168,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),100.8,60,,percent of total billed charges,,
D Dimer,,85379,CPT,Facility,Both,,,,168,142.8,48.1488,168,"Health Partners, Inc.",State of Minnesota Advantage Program,136.92,81.5,,percent of total billed charges,,
D Dimer,,85379,CPT,Facility,Both,,,,168,142.8,48.1488,168,"Health Partners, Inc.",State Public Programs,84,50,,percent of total billed charges,,
D Dimer,,85379,CPT,Facility,Both,,,,168,142.8,48.1488,168,Humana Insurance Company,Commercial PPO,159.6,95,,percent of total billed charges,,
D Dimer,,85379,CPT,Facility,Outpatient,,,,168,142.8,48.1488,168,Humana Insurance Company,Medicare PPO,82.32,49,,percent of total billed charges,,
D Dimer,,85379,CPT,Facility,Inpatient,,,,168,142.8,48.1488,168,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
D Dimer,,85379,CPT,Facility,Both,,,,168,142.8,48.1488,168,Medica,Individual & Family,166.488,99.1,,percent of total billed charges,,
D Dimer,,85379,CPT,Facility,Outpatient,,,,168,142.8,48.1488,168,Medica,Medica Advantage Solution,83.664,49.8,,percent of total billed charges,,
D Dimer,,85379,CPT,Facility,Inpatient,,,,168,142.8,48.1488,168,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
D Dimer,,85379,CPT,Facility,Outpatient,,,,168,142.8,48.1488,168,Medica,Medical Assistance,74.928,44.6,,percent of total billed charges,,
D Dimer,,85379,CPT,Facility,Inpatient,,,,168,142.8,48.1488,168,Medica,Medical Assistance,,,,,Included in per diem rate,
D Dimer,,85379,CPT,Facility,Outpatient,,,,168,142.8,48.1488,168,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,83.664,49.8,,percent of total billed charges,,
D Dimer,,85379,CPT,Facility,Inpatient,,,,168,142.8,48.1488,168,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
D Dimer,,85379,CPT,Facility,Both,,,,168,142.8,48.1488,168,"Multiplan, Inc.","Multiplan, Inc.",157.92,94,,percent of total billed charges,,
D Dimer,,85379,CPT,Facility,Outpatient,,,,168,142.8,48.1488,168,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,145.152,86.4,,percent of total billed charges,,
D Dimer,,85379,CPT,Facility,Inpatient,,,,168,142.8,48.1488,168,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
D Dimer,,85379,CPT,Facility,Both,,,,168,142.8,48.1488,168,"Preferred One Administrative Services, INC.",PPO,165.648,98.6,,percent of total billed charges,,
D Dimer,,85379,CPT,Facility,Outpatient,,,,168,142.8,48.1488,168,PrimeWest Health,Minnesota Senior Health Options (MSHO),86.436,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
D Dimer,,85379,CPT,Facility,Inpatient,,,,168,142.8,48.1488,168,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
D Dimer,,85379,CPT,Facility,Outpatient,,,,168,142.8,48.1488,168,PrimeWest Health,MinnesotaCare,86.2848,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
D Dimer,,85379,CPT,Facility,Inpatient,,,,168,142.8,48.1488,168,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
D Dimer,,85379,CPT,Facility,Both,,,,168,142.8,48.1488,168,Sanford Health Plan,Sanford Health Plan,154.56,92,,percent of total billed charges,,
D Dimer,,85379,CPT,Facility,Outpatient,,,,168,142.8,48.1488,168,"UCare Health, Inc.",Individual & Family Plan,94.668,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
D Dimer,,85379,CPT,Facility,Inpatient,,,,168,142.8,48.1488,168,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
D Dimer,,85379,CPT,Facility,Outpatient,,,,168,142.8,48.1488,168,"UCare Health, Inc.",Medical Assistance,84.7896,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
D Dimer,,85379,CPT,Facility,Inpatient,,,,168,142.8,48.1488,168,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
D Dimer,,85379,CPT,Facility,Outpatient,,,,168,142.8,48.1488,168,"UCare Health, Inc.",Medicare Advantage,84.7896,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
D Dimer,,85379,CPT,Facility,Inpatient,,,,168,142.8,48.1488,168,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
D Dimer,,85379,CPT,Facility,Outpatient,,,,168,142.8,48.1488,168,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),84.7896,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
D Dimer,,85379,CPT,Facility,Inpatient,,,,168,142.8,48.1488,168,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
D Dimer,,85379,CPT,Facility,Both,,,,168,142.8,48.1488,168,UnitedHealthcare,Individual & Family,157.92,94,,percent of total billed charges,,
D Dimer,,85379,CPT,Facility,Outpatient,,,,168,142.8,48.1488,168,UnitedHealthcare,Medicare Advantage,82.32,49,,percent of total billed charges,,
D Dimer,,85379,CPT,Facility,Inpatient,,,,168,142.8,48.1488,168,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
D Dimer,,85379,CPT,Facility,Outpatient,,,,168,142.8,48.1488,168,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,80.64,48,,percent of total billed charges,,100% of DHS outpatient percentage
D Dimer,,85379,CPT,Facility,Inpatient,,,,168,142.8,48.1488,168,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Fibrinogen,,85384,CPT,Facility,Both,,,,84,71.4,24.0744,84,Aetna,Commercial,77.28,92,,percent of total billed charges,,
Fibrinogen,,85384,CPT,Facility,Outpatient,,,,84,71.4,24.0744,84,Aetna,Medicare Advantage,41.16,49,,percent of total billed charges,,
Fibrinogen,,85384,CPT,Facility,Inpatient,,,,84,71.4,24.0744,84,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Fibrinogen,,85384,CPT,Facility,Both,,,,84,71.4,24.0744,84,Aetna,PPO,78.12,93,,percent of total billed charges,,
Fibrinogen,,85384,CPT,Facility,Both,,,,84,71.4,24.0744,84,America's PPO,America's PPO,80.6652,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Fibrinogen,,85384,CPT,Facility,Both,,,,84,71.4,24.0744,84,BlueCross BlueShield Minnesota, Federal Employee Program,82.656,98.4,,percent of total billed charges,,
Fibrinogen,,85384,CPT,Facility,Both,,,,84,71.4,24.0744,84,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,84,100,,percent of total billed charges,,
Fibrinogen,,85384,CPT,Facility,Both,,,,84,71.4,24.0744,84,BlueCross BlueShield Minnesota,High Value Network Plan,75.6,90,,percent of total billed charges,,
Fibrinogen,,85384,CPT,Facility,Outpatient,,,,84,71.4,24.0744,84,BlueCross BlueShield Minnesota,Medicare Advantage,41.16,49,,percent of total billed charges,,
Fibrinogen,,85384,CPT,Facility,Inpatient,,,,84,71.4,24.0744,84,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Fibrinogen,,85384,CPT,Facility,Both,,,,84,71.4,24.0744,84,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,74.3988,88.57,,percent of total billed charges,,
Fibrinogen,,85384,CPT,Facility,Both,,,,84,71.4,24.0744,84,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,24.0744,28.66,,percent of total billed charges,,
Fibrinogen,,85384,CPT,Facility,Outpatient,,,,84,71.4,24.0744,84,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),41.16,49,,percent of total billed charges,,
Fibrinogen,,85384,CPT,Facility,Inpatient,,,,84,71.4,24.0744,84,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Fibrinogen,,85384,CPT,Facility,Both,,,,84,71.4,24.0744,84,CorVel,Worker's Compensation,84,100,,percent of total billed charges,,
Fibrinogen,,85384,CPT,Facility,Both,,,,84,71.4,24.0744,84,First Health Group Corporation,First Health Network,81.48,97,,percent of total billed charges,,
Fibrinogen,,85384,CPT,Facility,Both,,,,84,71.4,24.0744,84,"Health Partners, Inc.",Commercial,79.464,94.6,,percent of total billed charges,,
Fibrinogen,,85384,CPT,Facility,Outpatient,,,,84,71.4,24.0744,84,"Health Partners, Inc.",Medicare Advantage,41.16,49,,percent of total billed charges,,
Fibrinogen,,85384,CPT,Facility,Inpatient,,,,84,71.4,24.0744,84,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Fibrinogen,,85384,CPT,Facility,Both,,,,84,71.4,24.0744,84,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),50.4,60,,percent of total billed charges,,
Fibrinogen,,85384,CPT,Facility,Both,,,,84,71.4,24.0744,84,"Health Partners, Inc.",State of Minnesota Advantage Program,68.46,81.5,,percent of total billed charges,,
Fibrinogen,,85384,CPT,Facility,Both,,,,84,71.4,24.0744,84,"Health Partners, Inc.",State Public Programs,42,50,,percent of total billed charges,,
Fibrinogen,,85384,CPT,Facility,Both,,,,84,71.4,24.0744,84,Humana Insurance Company,Commercial PPO,79.8,95,,percent of total billed charges,,
Fibrinogen,,85384,CPT,Facility,Outpatient,,,,84,71.4,24.0744,84,Humana Insurance Company,Medicare PPO,41.16,49,,percent of total billed charges,,
Fibrinogen,,85384,CPT,Facility,Inpatient,,,,84,71.4,24.0744,84,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Fibrinogen,,85384,CPT,Facility,Both,,,,84,71.4,24.0744,84,Medica,Individual & Family,83.244,99.1,,percent of total billed charges,,
Fibrinogen,,85384,CPT,Facility,Outpatient,,,,84,71.4,24.0744,84,Medica,Medica Advantage Solution,41.832,49.8,,percent of total billed charges,,
Fibrinogen,,85384,CPT,Facility,Inpatient,,,,84,71.4,24.0744,84,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Fibrinogen,,85384,CPT,Facility,Outpatient,,,,84,71.4,24.0744,84,Medica,Medical Assistance,37.464,44.6,,percent of total billed charges,,
Fibrinogen,,85384,CPT,Facility,Inpatient,,,,84,71.4,24.0744,84,Medica,Medical Assistance,,,,,Included in per diem rate,
Fibrinogen,,85384,CPT,Facility,Outpatient,,,,84,71.4,24.0744,84,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,41.832,49.8,,percent of total billed charges,,
Fibrinogen,,85384,CPT,Facility,Inpatient,,,,84,71.4,24.0744,84,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Fibrinogen,,85384,CPT,Facility,Both,,,,84,71.4,24.0744,84,"Multiplan, Inc.","Multiplan, Inc.",78.96,94,,percent of total billed charges,,
Fibrinogen,,85384,CPT,Facility,Outpatient,,,,84,71.4,24.0744,84,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,72.576,86.4,,percent of total billed charges,,
Fibrinogen,,85384,CPT,Facility,Inpatient,,,,84,71.4,24.0744,84,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Fibrinogen,,85384,CPT,Facility,Both,,,,84,71.4,24.0744,84,"Preferred One Administrative Services, INC.",PPO,82.824,98.6,,percent of total billed charges,,
Fibrinogen,,85384,CPT,Facility,Outpatient,,,,84,71.4,24.0744,84,PrimeWest Health,Minnesota Senior Health Options (MSHO),43.218,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Fibrinogen,,85384,CPT,Facility,Inpatient,,,,84,71.4,24.0744,84,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Fibrinogen,,85384,CPT,Facility,Outpatient,,,,84,71.4,24.0744,84,PrimeWest Health,MinnesotaCare,43.1424,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Fibrinogen,,85384,CPT,Facility,Inpatient,,,,84,71.4,24.0744,84,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Fibrinogen,,85384,CPT,Facility,Both,,,,84,71.4,24.0744,84,Sanford Health Plan,Sanford Health Plan,77.28,92,,percent of total billed charges,,
Fibrinogen,,85384,CPT,Facility,Outpatient,,,,84,71.4,24.0744,84,"UCare Health, Inc.",Individual & Family Plan,47.334,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Fibrinogen,,85384,CPT,Facility,Inpatient,,,,84,71.4,24.0744,84,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Fibrinogen,,85384,CPT,Facility,Outpatient,,,,84,71.4,24.0744,84,"UCare Health, Inc.",Medical Assistance,42.3948,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Fibrinogen,,85384,CPT,Facility,Inpatient,,,,84,71.4,24.0744,84,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Fibrinogen,,85384,CPT,Facility,Outpatient,,,,84,71.4,24.0744,84,"UCare Health, Inc.",Medicare Advantage,42.3948,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Fibrinogen,,85384,CPT,Facility,Inpatient,,,,84,71.4,24.0744,84,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Fibrinogen,,85384,CPT,Facility,Outpatient,,,,84,71.4,24.0744,84,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),42.3948,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Fibrinogen,,85384,CPT,Facility,Inpatient,,,,84,71.4,24.0744,84,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Fibrinogen,,85384,CPT,Facility,Both,,,,84,71.4,24.0744,84,UnitedHealthcare,Individual & Family,78.96,94,,percent of total billed charges,,
Fibrinogen,,85384,CPT,Facility,Outpatient,,,,84,71.4,24.0744,84,UnitedHealthcare,Medicare Advantage,41.16,49,,percent of total billed charges,,
Fibrinogen,,85384,CPT,Facility,Inpatient,,,,84,71.4,24.0744,84,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Fibrinogen,,85384,CPT,Facility,Outpatient,,,,84,71.4,24.0744,84,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,40.32,48,,percent of total billed charges,,100% of DHS outpatient percentage
Fibrinogen,,85384,CPT,Facility,Inpatient,,,,84,71.4,24.0744,84,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Hemoglobin Or Rbcs, Fetal, For Fetomaternal Hemorrhage; Rosette (Bb)",,85461,CPT,Facility,Both,,,,59,50.15,16.9094,59,Aetna,Commercial,54.28,92,,percent of total billed charges,,
"Hemoglobin Or Rbcs, Fetal, For Fetomaternal Hemorrhage; Rosette (Bb)",,85461,CPT,Facility,Outpatient,,,,59,50.15,16.9094,59,Aetna,Medicare Advantage,28.91,49,,percent of total billed charges,,
"Hemoglobin Or Rbcs, Fetal, For Fetomaternal Hemorrhage; Rosette (Bb)",,85461,CPT,Facility,Inpatient,,,,59,50.15,16.9094,59,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Hemoglobin Or Rbcs, Fetal, For Fetomaternal Hemorrhage; Rosette (Bb)",,85461,CPT,Facility,Both,,,,59,50.15,16.9094,59,Aetna,PPO,54.87,93,,percent of total billed charges,,
"Hemoglobin Or Rbcs, Fetal, For Fetomaternal Hemorrhage; Rosette (Bb)",,85461,CPT,Facility,Both,,,,59,50.15,16.9094,59,America's PPO,America's PPO,56.6577,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Hemoglobin Or Rbcs, Fetal, For Fetomaternal Hemorrhage; Rosette (Bb)",,85461,CPT,Facility,Both,,,,59,50.15,16.9094,59,BlueCross BlueShield Minnesota, Federal Employee Program,58.056,98.4,,percent of total billed charges,,
"Hemoglobin Or Rbcs, Fetal, For Fetomaternal Hemorrhage; Rosette (Bb)",,85461,CPT,Facility,Both,,,,59,50.15,16.9094,59,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,59,100,,percent of total billed charges,,
"Hemoglobin Or Rbcs, Fetal, For Fetomaternal Hemorrhage; Rosette (Bb)",,85461,CPT,Facility,Both,,,,59,50.15,16.9094,59,BlueCross BlueShield Minnesota,High Value Network Plan,53.1,90,,percent of total billed charges,,
"Hemoglobin Or Rbcs, Fetal, For Fetomaternal Hemorrhage; Rosette (Bb)",,85461,CPT,Facility,Outpatient,,,,59,50.15,16.9094,59,BlueCross BlueShield Minnesota,Medicare Advantage,28.91,49,,percent of total billed charges,,
"Hemoglobin Or Rbcs, Fetal, For Fetomaternal Hemorrhage; Rosette (Bb)",,85461,CPT,Facility,Inpatient,,,,59,50.15,16.9094,59,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Hemoglobin Or Rbcs, Fetal, For Fetomaternal Hemorrhage; Rosette (Bb)",,85461,CPT,Facility,Both,,,,59,50.15,16.9094,59,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,52.2563,88.57,,percent of total billed charges,,
"Hemoglobin Or Rbcs, Fetal, For Fetomaternal Hemorrhage; Rosette (Bb)",,85461,CPT,Facility,Both,,,,59,50.15,16.9094,59,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,16.9094,28.66,,percent of total billed charges,,
"Hemoglobin Or Rbcs, Fetal, For Fetomaternal Hemorrhage; Rosette (Bb)",,85461,CPT,Facility,Outpatient,,,,59,50.15,16.9094,59,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),28.91,49,,percent of total billed charges,,
"Hemoglobin Or Rbcs, Fetal, For Fetomaternal Hemorrhage; Rosette (Bb)",,85461,CPT,Facility,Inpatient,,,,59,50.15,16.9094,59,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Hemoglobin Or Rbcs, Fetal, For Fetomaternal Hemorrhage; Rosette (Bb)",,85461,CPT,Facility,Both,,,,59,50.15,16.9094,59,CorVel,Worker's Compensation,59,100,,percent of total billed charges,,
"Hemoglobin Or Rbcs, Fetal, For Fetomaternal Hemorrhage; Rosette (Bb)",,85461,CPT,Facility,Both,,,,59,50.15,16.9094,59,First Health Group Corporation,First Health Network,57.23,97,,percent of total billed charges,,
"Hemoglobin Or Rbcs, Fetal, For Fetomaternal Hemorrhage; Rosette (Bb)",,85461,CPT,Facility,Both,,,,59,50.15,16.9094,59,"Health Partners, Inc.",Commercial,55.814,94.6,,percent of total billed charges,,
"Hemoglobin Or Rbcs, Fetal, For Fetomaternal Hemorrhage; Rosette (Bb)",,85461,CPT,Facility,Outpatient,,,,59,50.15,16.9094,59,"Health Partners, Inc.",Medicare Advantage,28.91,49,,percent of total billed charges,,
"Hemoglobin Or Rbcs, Fetal, For Fetomaternal Hemorrhage; Rosette (Bb)",,85461,CPT,Facility,Inpatient,,,,59,50.15,16.9094,59,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Hemoglobin Or Rbcs, Fetal, For Fetomaternal Hemorrhage; Rosette (Bb)",,85461,CPT,Facility,Both,,,,59,50.15,16.9094,59,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),35.4,60,,percent of total billed charges,,
"Hemoglobin Or Rbcs, Fetal, For Fetomaternal Hemorrhage; Rosette (Bb)",,85461,CPT,Facility,Both,,,,59,50.15,16.9094,59,"Health Partners, Inc.",State of Minnesota Advantage Program,48.085,81.5,,percent of total billed charges,,
"Hemoglobin Or Rbcs, Fetal, For Fetomaternal Hemorrhage; Rosette (Bb)",,85461,CPT,Facility,Both,,,,59,50.15,16.9094,59,"Health Partners, Inc.",State Public Programs,29.5,50,,percent of total billed charges,,
"Hemoglobin Or Rbcs, Fetal, For Fetomaternal Hemorrhage; Rosette (Bb)",,85461,CPT,Facility,Both,,,,59,50.15,16.9094,59,Humana Insurance Company,Commercial PPO,56.05,95,,percent of total billed charges,,
"Hemoglobin Or Rbcs, Fetal, For Fetomaternal Hemorrhage; Rosette (Bb)",,85461,CPT,Facility,Outpatient,,,,59,50.15,16.9094,59,Humana Insurance Company,Medicare PPO,28.91,49,,percent of total billed charges,,
"Hemoglobin Or Rbcs, Fetal, For Fetomaternal Hemorrhage; Rosette (Bb)",,85461,CPT,Facility,Inpatient,,,,59,50.15,16.9094,59,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Hemoglobin Or Rbcs, Fetal, For Fetomaternal Hemorrhage; Rosette (Bb)",,85461,CPT,Facility,Both,,,,59,50.15,16.9094,59,Medica,Individual & Family,58.469,99.1,,percent of total billed charges,,
"Hemoglobin Or Rbcs, Fetal, For Fetomaternal Hemorrhage; Rosette (Bb)",,85461,CPT,Facility,Outpatient,,,,59,50.15,16.9094,59,Medica,Medica Advantage Solution,29.382,49.8,,percent of total billed charges,,
"Hemoglobin Or Rbcs, Fetal, For Fetomaternal Hemorrhage; Rosette (Bb)",,85461,CPT,Facility,Inpatient,,,,59,50.15,16.9094,59,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Hemoglobin Or Rbcs, Fetal, For Fetomaternal Hemorrhage; Rosette (Bb)",,85461,CPT,Facility,Outpatient,,,,59,50.15,16.9094,59,Medica,Medical Assistance,26.314,44.6,,percent of total billed charges,,
"Hemoglobin Or Rbcs, Fetal, For Fetomaternal Hemorrhage; Rosette (Bb)",,85461,CPT,Facility,Inpatient,,,,59,50.15,16.9094,59,Medica,Medical Assistance,,,,,Included in per diem rate,
"Hemoglobin Or Rbcs, Fetal, For Fetomaternal Hemorrhage; Rosette (Bb)",,85461,CPT,Facility,Outpatient,,,,59,50.15,16.9094,59,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,29.382,49.8,,percent of total billed charges,,
"Hemoglobin Or Rbcs, Fetal, For Fetomaternal Hemorrhage; Rosette (Bb)",,85461,CPT,Facility,Inpatient,,,,59,50.15,16.9094,59,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Hemoglobin Or Rbcs, Fetal, For Fetomaternal Hemorrhage; Rosette (Bb)",,85461,CPT,Facility,Both,,,,59,50.15,16.9094,59,"Multiplan, Inc.","Multiplan, Inc.",55.46,94,,percent of total billed charges,,
"Hemoglobin Or Rbcs, Fetal, For Fetomaternal Hemorrhage; Rosette (Bb)",,85461,CPT,Facility,Outpatient,,,,59,50.15,16.9094,59,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,50.976,86.4,,percent of total billed charges,,
"Hemoglobin Or Rbcs, Fetal, For Fetomaternal Hemorrhage; Rosette (Bb)",,85461,CPT,Facility,Inpatient,,,,59,50.15,16.9094,59,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Hemoglobin Or Rbcs, Fetal, For Fetomaternal Hemorrhage; Rosette (Bb)",,85461,CPT,Facility,Both,,,,59,50.15,16.9094,59,"Preferred One Administrative Services, INC.",PPO,58.174,98.6,,percent of total billed charges,,
"Hemoglobin Or Rbcs, Fetal, For Fetomaternal Hemorrhage; Rosette (Bb)",,85461,CPT,Facility,Outpatient,,,,59,50.15,16.9094,59,PrimeWest Health,Minnesota Senior Health Options (MSHO),30.3555,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Hemoglobin Or Rbcs, Fetal, For Fetomaternal Hemorrhage; Rosette (Bb)",,85461,CPT,Facility,Inpatient,,,,59,50.15,16.9094,59,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Hemoglobin Or Rbcs, Fetal, For Fetomaternal Hemorrhage; Rosette (Bb)",,85461,CPT,Facility,Outpatient,,,,59,50.15,16.9094,59,PrimeWest Health,MinnesotaCare,30.3024,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Hemoglobin Or Rbcs, Fetal, For Fetomaternal Hemorrhage; Rosette (Bb)",,85461,CPT,Facility,Inpatient,,,,59,50.15,16.9094,59,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Hemoglobin Or Rbcs, Fetal, For Fetomaternal Hemorrhage; Rosette (Bb)",,85461,CPT,Facility,Both,,,,59,50.15,16.9094,59,Sanford Health Plan,Sanford Health Plan,54.28,92,,percent of total billed charges,,
"Hemoglobin Or Rbcs, Fetal, For Fetomaternal Hemorrhage; Rosette (Bb)",,85461,CPT,Facility,Outpatient,,,,59,50.15,16.9094,59,"UCare Health, Inc.",Individual & Family Plan,33.2465,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Hemoglobin Or Rbcs, Fetal, For Fetomaternal Hemorrhage; Rosette (Bb)",,85461,CPT,Facility,Inpatient,,,,59,50.15,16.9094,59,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Hemoglobin Or Rbcs, Fetal, For Fetomaternal Hemorrhage; Rosette (Bb)",,85461,CPT,Facility,Outpatient,,,,59,50.15,16.9094,59,"UCare Health, Inc.",Medical Assistance,29.7773,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Hemoglobin Or Rbcs, Fetal, For Fetomaternal Hemorrhage; Rosette (Bb)",,85461,CPT,Facility,Inpatient,,,,59,50.15,16.9094,59,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Hemoglobin Or Rbcs, Fetal, For Fetomaternal Hemorrhage; Rosette (Bb)",,85461,CPT,Facility,Outpatient,,,,59,50.15,16.9094,59,"UCare Health, Inc.",Medicare Advantage,29.7773,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Hemoglobin Or Rbcs, Fetal, For Fetomaternal Hemorrhage; Rosette (Bb)",,85461,CPT,Facility,Inpatient,,,,59,50.15,16.9094,59,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Hemoglobin Or Rbcs, Fetal, For Fetomaternal Hemorrhage; Rosette (Bb)",,85461,CPT,Facility,Outpatient,,,,59,50.15,16.9094,59,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),29.7773,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Hemoglobin Or Rbcs, Fetal, For Fetomaternal Hemorrhage; Rosette (Bb)",,85461,CPT,Facility,Inpatient,,,,59,50.15,16.9094,59,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Hemoglobin Or Rbcs, Fetal, For Fetomaternal Hemorrhage; Rosette (Bb)",,85461,CPT,Facility,Both,,,,59,50.15,16.9094,59,UnitedHealthcare,Individual & Family,55.46,94,,percent of total billed charges,,
"Hemoglobin Or Rbcs, Fetal, For Fetomaternal Hemorrhage; Rosette (Bb)",,85461,CPT,Facility,Outpatient,,,,59,50.15,16.9094,59,UnitedHealthcare,Medicare Advantage,28.91,49,,percent of total billed charges,,
"Hemoglobin Or Rbcs, Fetal, For Fetomaternal Hemorrhage; Rosette (Bb)",,85461,CPT,Facility,Inpatient,,,,59,50.15,16.9094,59,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Hemoglobin Or Rbcs, Fetal, For Fetomaternal Hemorrhage; Rosette (Bb)",,85461,CPT,Facility,Outpatient,,,,59,50.15,16.9094,59,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,28.32,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Hemoglobin Or Rbcs, Fetal, For Fetomaternal Hemorrhage; Rosette (Bb)",,85461,CPT,Facility,Inpatient,,,,59,50.15,16.9094,59,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Prothrombin Time,,85610,CPT,Facility,Both,,,,60,51,17.196,60,Aetna,Commercial,55.2,92,,percent of total billed charges,,
Prothrombin Time,,85610,CPT,Facility,Outpatient,,,,60,51,17.196,60,Aetna,Medicare Advantage,29.4,49,,percent of total billed charges,,
Prothrombin Time,,85610,CPT,Facility,Inpatient,,,,60,51,17.196,60,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Prothrombin Time,,85610,CPT,Facility,Both,,,,60,51,17.196,60,Aetna,PPO,55.8,93,,percent of total billed charges,,
Prothrombin Time,,85610,CPT,Facility,Both,,,,60,51,17.196,60,America's PPO,America's PPO,57.618,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Prothrombin Time,,85610,CPT,Facility,Both,,,,60,51,17.196,60,BlueCross BlueShield Minnesota, Federal Employee Program,59.04,98.4,,percent of total billed charges,,
Prothrombin Time,,85610,CPT,Facility,Both,,,,60,51,17.196,60,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,60,100,,percent of total billed charges,,
Prothrombin Time,,85610,CPT,Facility,Both,,,,60,51,17.196,60,BlueCross BlueShield Minnesota,High Value Network Plan,54,90,,percent of total billed charges,,
Prothrombin Time,,85610,CPT,Facility,Outpatient,,,,60,51,17.196,60,BlueCross BlueShield Minnesota,Medicare Advantage,29.4,49,,percent of total billed charges,,
Prothrombin Time,,85610,CPT,Facility,Inpatient,,,,60,51,17.196,60,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Prothrombin Time,,85610,CPT,Facility,Both,,,,60,51,17.196,60,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,53.142,88.57,,percent of total billed charges,,
Prothrombin Time,,85610,CPT,Facility,Both,,,,60,51,17.196,60,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,17.196,28.66,,percent of total billed charges,,
Prothrombin Time,,85610,CPT,Facility,Outpatient,,,,60,51,17.196,60,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),29.4,49,,percent of total billed charges,,
Prothrombin Time,,85610,CPT,Facility,Inpatient,,,,60,51,17.196,60,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Prothrombin Time,,85610,CPT,Facility,Both,,,,60,51,17.196,60,CorVel,Worker's Compensation,60,100,,percent of total billed charges,,
Prothrombin Time,,85610,CPT,Facility,Both,,,,60,51,17.196,60,First Health Group Corporation,First Health Network,58.2,97,,percent of total billed charges,,
Prothrombin Time,,85610,CPT,Facility,Both,,,,60,51,17.196,60,"Health Partners, Inc.",Commercial,56.76,94.6,,percent of total billed charges,,
Prothrombin Time,,85610,CPT,Facility,Outpatient,,,,60,51,17.196,60,"Health Partners, Inc.",Medicare Advantage,29.4,49,,percent of total billed charges,,
Prothrombin Time,,85610,CPT,Facility,Inpatient,,,,60,51,17.196,60,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Prothrombin Time,,85610,CPT,Facility,Both,,,,60,51,17.196,60,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),36,60,,percent of total billed charges,,
Prothrombin Time,,85610,CPT,Facility,Both,,,,60,51,17.196,60,"Health Partners, Inc.",State of Minnesota Advantage Program,48.9,81.5,,percent of total billed charges,,
Prothrombin Time,,85610,CPT,Facility,Both,,,,60,51,17.196,60,"Health Partners, Inc.",State Public Programs,30,50,,percent of total billed charges,,
Prothrombin Time,,85610,CPT,Facility,Both,,,,60,51,17.196,60,Humana Insurance Company,Commercial PPO,57,95,,percent of total billed charges,,
Prothrombin Time,,85610,CPT,Facility,Outpatient,,,,60,51,17.196,60,Humana Insurance Company,Medicare PPO,29.4,49,,percent of total billed charges,,
Prothrombin Time,,85610,CPT,Facility,Inpatient,,,,60,51,17.196,60,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Prothrombin Time,,85610,CPT,Facility,Both,,,,60,51,17.196,60,Medica,Individual & Family,59.46,99.1,,percent of total billed charges,,
Prothrombin Time,,85610,CPT,Facility,Outpatient,,,,60,51,17.196,60,Medica,Medica Advantage Solution,29.88,49.8,,percent of total billed charges,,
Prothrombin Time,,85610,CPT,Facility,Inpatient,,,,60,51,17.196,60,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Prothrombin Time,,85610,CPT,Facility,Outpatient,,,,60,51,17.196,60,Medica,Medical Assistance,26.76,44.6,,percent of total billed charges,,
Prothrombin Time,,85610,CPT,Facility,Inpatient,,,,60,51,17.196,60,Medica,Medical Assistance,,,,,Included in per diem rate,
Prothrombin Time,,85610,CPT,Facility,Outpatient,,,,60,51,17.196,60,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,29.88,49.8,,percent of total billed charges,,
Prothrombin Time,,85610,CPT,Facility,Inpatient,,,,60,51,17.196,60,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Prothrombin Time,,85610,CPT,Facility,Both,,,,60,51,17.196,60,"Multiplan, Inc.","Multiplan, Inc.",56.4,94,,percent of total billed charges,,
Prothrombin Time,,85610,CPT,Facility,Outpatient,,,,60,51,17.196,60,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,51.84,86.4,,percent of total billed charges,,
Prothrombin Time,,85610,CPT,Facility,Inpatient,,,,60,51,17.196,60,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Prothrombin Time,,85610,CPT,Facility,Both,,,,60,51,17.196,60,"Preferred One Administrative Services, INC.",PPO,59.16,98.6,,percent of total billed charges,,
Prothrombin Time,,85610,CPT,Facility,Outpatient,,,,60,51,17.196,60,PrimeWest Health,Minnesota Senior Health Options (MSHO),30.87,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Prothrombin Time,,85610,CPT,Facility,Inpatient,,,,60,51,17.196,60,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Prothrombin Time,,85610,CPT,Facility,Outpatient,,,,60,51,17.196,60,PrimeWest Health,MinnesotaCare,30.816,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Prothrombin Time,,85610,CPT,Facility,Inpatient,,,,60,51,17.196,60,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Prothrombin Time,,85610,CPT,Facility,Both,,,,60,51,17.196,60,Sanford Health Plan,Sanford Health Plan,55.2,92,,percent of total billed charges,,
Prothrombin Time,,85610,CPT,Facility,Outpatient,,,,60,51,17.196,60,"UCare Health, Inc.",Individual & Family Plan,33.81,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Prothrombin Time,,85610,CPT,Facility,Inpatient,,,,60,51,17.196,60,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Prothrombin Time,,85610,CPT,Facility,Outpatient,,,,60,51,17.196,60,"UCare Health, Inc.",Medical Assistance,30.282,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Prothrombin Time,,85610,CPT,Facility,Inpatient,,,,60,51,17.196,60,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Prothrombin Time,,85610,CPT,Facility,Outpatient,,,,60,51,17.196,60,"UCare Health, Inc.",Medicare Advantage,30.282,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Prothrombin Time,,85610,CPT,Facility,Inpatient,,,,60,51,17.196,60,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Prothrombin Time,,85610,CPT,Facility,Outpatient,,,,60,51,17.196,60,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),30.282,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Prothrombin Time,,85610,CPT,Facility,Inpatient,,,,60,51,17.196,60,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Prothrombin Time,,85610,CPT,Facility,Both,,,,60,51,17.196,60,UnitedHealthcare,Individual & Family,56.4,94,,percent of total billed charges,,
Prothrombin Time,,85610,CPT,Facility,Outpatient,,,,60,51,17.196,60,UnitedHealthcare,Medicare Advantage,29.4,49,,percent of total billed charges,,
Prothrombin Time,,85610,CPT,Facility,Inpatient,,,,60,51,17.196,60,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Prothrombin Time,,85610,CPT,Facility,Outpatient,,,,60,51,17.196,60,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,28.8,48,,percent of total billed charges,,100% of DHS outpatient percentage
Prothrombin Time,,85610,CPT,Facility,Inpatient,,,,60,51,17.196,60,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Erythrocyte Sedimentation Rate, Manual",,85651,CPT,Facility,Both,,,,54,45.9,15.4764,54,Aetna,Commercial,49.68,92,,percent of total billed charges,,
"Erythrocyte Sedimentation Rate, Manual",,85651,CPT,Facility,Outpatient,,,,54,45.9,15.4764,54,Aetna,Medicare Advantage,26.46,49,,percent of total billed charges,,
"Erythrocyte Sedimentation Rate, Manual",,85651,CPT,Facility,Inpatient,,,,54,45.9,15.4764,54,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Erythrocyte Sedimentation Rate, Manual",,85651,CPT,Facility,Both,,,,54,45.9,15.4764,54,Aetna,PPO,50.22,93,,percent of total billed charges,,
"Erythrocyte Sedimentation Rate, Manual",,85651,CPT,Facility,Both,,,,54,45.9,15.4764,54,America's PPO,America's PPO,51.8562,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Erythrocyte Sedimentation Rate, Manual",,85651,CPT,Facility,Both,,,,54,45.9,15.4764,54,BlueCross BlueShield Minnesota, Federal Employee Program,53.136,98.4,,percent of total billed charges,,
"Erythrocyte Sedimentation Rate, Manual",,85651,CPT,Facility,Both,,,,54,45.9,15.4764,54,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,54,100,,percent of total billed charges,,
"Erythrocyte Sedimentation Rate, Manual",,85651,CPT,Facility,Both,,,,54,45.9,15.4764,54,BlueCross BlueShield Minnesota,High Value Network Plan,48.6,90,,percent of total billed charges,,
"Erythrocyte Sedimentation Rate, Manual",,85651,CPT,Facility,Outpatient,,,,54,45.9,15.4764,54,BlueCross BlueShield Minnesota,Medicare Advantage,26.46,49,,percent of total billed charges,,
"Erythrocyte Sedimentation Rate, Manual",,85651,CPT,Facility,Inpatient,,,,54,45.9,15.4764,54,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Erythrocyte Sedimentation Rate, Manual",,85651,CPT,Facility,Both,,,,54,45.9,15.4764,54,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,47.8278,88.57,,percent of total billed charges,,
"Erythrocyte Sedimentation Rate, Manual",,85651,CPT,Facility,Both,,,,54,45.9,15.4764,54,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,15.4764,28.66,,percent of total billed charges,,
"Erythrocyte Sedimentation Rate, Manual",,85651,CPT,Facility,Outpatient,,,,54,45.9,15.4764,54,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),26.46,49,,percent of total billed charges,,
"Erythrocyte Sedimentation Rate, Manual",,85651,CPT,Facility,Inpatient,,,,54,45.9,15.4764,54,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Erythrocyte Sedimentation Rate, Manual",,85651,CPT,Facility,Both,,,,54,45.9,15.4764,54,CorVel,Worker's Compensation,54,100,,percent of total billed charges,,
"Erythrocyte Sedimentation Rate, Manual",,85651,CPT,Facility,Both,,,,54,45.9,15.4764,54,First Health Group Corporation,First Health Network,52.38,97,,percent of total billed charges,,
"Erythrocyte Sedimentation Rate, Manual",,85651,CPT,Facility,Both,,,,54,45.9,15.4764,54,"Health Partners, Inc.",Commercial,51.084,94.6,,percent of total billed charges,,
"Erythrocyte Sedimentation Rate, Manual",,85651,CPT,Facility,Outpatient,,,,54,45.9,15.4764,54,"Health Partners, Inc.",Medicare Advantage,26.46,49,,percent of total billed charges,,
"Erythrocyte Sedimentation Rate, Manual",,85651,CPT,Facility,Inpatient,,,,54,45.9,15.4764,54,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Erythrocyte Sedimentation Rate, Manual",,85651,CPT,Facility,Both,,,,54,45.9,15.4764,54,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),32.4,60,,percent of total billed charges,,
"Erythrocyte Sedimentation Rate, Manual",,85651,CPT,Facility,Both,,,,54,45.9,15.4764,54,"Health Partners, Inc.",State of Minnesota Advantage Program,44.01,81.5,,percent of total billed charges,,
"Erythrocyte Sedimentation Rate, Manual",,85651,CPT,Facility,Both,,,,54,45.9,15.4764,54,"Health Partners, Inc.",State Public Programs,27,50,,percent of total billed charges,,
"Erythrocyte Sedimentation Rate, Manual",,85651,CPT,Facility,Both,,,,54,45.9,15.4764,54,Humana Insurance Company,Commercial PPO,51.3,95,,percent of total billed charges,,
"Erythrocyte Sedimentation Rate, Manual",,85651,CPT,Facility,Outpatient,,,,54,45.9,15.4764,54,Humana Insurance Company,Medicare PPO,26.46,49,,percent of total billed charges,,
"Erythrocyte Sedimentation Rate, Manual",,85651,CPT,Facility,Inpatient,,,,54,45.9,15.4764,54,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Erythrocyte Sedimentation Rate, Manual",,85651,CPT,Facility,Both,,,,54,45.9,15.4764,54,Medica,Individual & Family,53.514,99.1,,percent of total billed charges,,
"Erythrocyte Sedimentation Rate, Manual",,85651,CPT,Facility,Outpatient,,,,54,45.9,15.4764,54,Medica,Medica Advantage Solution,26.892,49.8,,percent of total billed charges,,
"Erythrocyte Sedimentation Rate, Manual",,85651,CPT,Facility,Inpatient,,,,54,45.9,15.4764,54,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Erythrocyte Sedimentation Rate, Manual",,85651,CPT,Facility,Outpatient,,,,54,45.9,15.4764,54,Medica,Medical Assistance,24.084,44.6,,percent of total billed charges,,
"Erythrocyte Sedimentation Rate, Manual",,85651,CPT,Facility,Inpatient,,,,54,45.9,15.4764,54,Medica,Medical Assistance,,,,,Included in per diem rate,
"Erythrocyte Sedimentation Rate, Manual",,85651,CPT,Facility,Outpatient,,,,54,45.9,15.4764,54,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,26.892,49.8,,percent of total billed charges,,
"Erythrocyte Sedimentation Rate, Manual",,85651,CPT,Facility,Inpatient,,,,54,45.9,15.4764,54,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Erythrocyte Sedimentation Rate, Manual",,85651,CPT,Facility,Both,,,,54,45.9,15.4764,54,"Multiplan, Inc.","Multiplan, Inc.",50.76,94,,percent of total billed charges,,
"Erythrocyte Sedimentation Rate, Manual",,85651,CPT,Facility,Outpatient,,,,54,45.9,15.4764,54,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,46.656,86.4,,percent of total billed charges,,
"Erythrocyte Sedimentation Rate, Manual",,85651,CPT,Facility,Inpatient,,,,54,45.9,15.4764,54,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Erythrocyte Sedimentation Rate, Manual",,85651,CPT,Facility,Both,,,,54,45.9,15.4764,54,"Preferred One Administrative Services, INC.",PPO,53.244,98.6,,percent of total billed charges,,
"Erythrocyte Sedimentation Rate, Manual",,85651,CPT,Facility,Outpatient,,,,54,45.9,15.4764,54,PrimeWest Health,Minnesota Senior Health Options (MSHO),27.783,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Erythrocyte Sedimentation Rate, Manual",,85651,CPT,Facility,Inpatient,,,,54,45.9,15.4764,54,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Erythrocyte Sedimentation Rate, Manual",,85651,CPT,Facility,Outpatient,,,,54,45.9,15.4764,54,PrimeWest Health,MinnesotaCare,27.7344,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Erythrocyte Sedimentation Rate, Manual",,85651,CPT,Facility,Inpatient,,,,54,45.9,15.4764,54,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Erythrocyte Sedimentation Rate, Manual",,85651,CPT,Facility,Both,,,,54,45.9,15.4764,54,Sanford Health Plan,Sanford Health Plan,49.68,92,,percent of total billed charges,,
"Erythrocyte Sedimentation Rate, Manual",,85651,CPT,Facility,Outpatient,,,,54,45.9,15.4764,54,"UCare Health, Inc.",Individual & Family Plan,30.429,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Erythrocyte Sedimentation Rate, Manual",,85651,CPT,Facility,Inpatient,,,,54,45.9,15.4764,54,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Erythrocyte Sedimentation Rate, Manual",,85651,CPT,Facility,Outpatient,,,,54,45.9,15.4764,54,"UCare Health, Inc.",Medical Assistance,27.2538,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Erythrocyte Sedimentation Rate, Manual",,85651,CPT,Facility,Inpatient,,,,54,45.9,15.4764,54,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Erythrocyte Sedimentation Rate, Manual",,85651,CPT,Facility,Outpatient,,,,54,45.9,15.4764,54,"UCare Health, Inc.",Medicare Advantage,27.2538,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Erythrocyte Sedimentation Rate, Manual",,85651,CPT,Facility,Inpatient,,,,54,45.9,15.4764,54,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Erythrocyte Sedimentation Rate, Manual",,85651,CPT,Facility,Outpatient,,,,54,45.9,15.4764,54,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),27.2538,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Erythrocyte Sedimentation Rate, Manual",,85651,CPT,Facility,Inpatient,,,,54,45.9,15.4764,54,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Erythrocyte Sedimentation Rate, Manual",,85651,CPT,Facility,Both,,,,54,45.9,15.4764,54,UnitedHealthcare,Individual & Family,50.76,94,,percent of total billed charges,,
"Erythrocyte Sedimentation Rate, Manual",,85651,CPT,Facility,Outpatient,,,,54,45.9,15.4764,54,UnitedHealthcare,Medicare Advantage,26.46,49,,percent of total billed charges,,
"Erythrocyte Sedimentation Rate, Manual",,85651,CPT,Facility,Inpatient,,,,54,45.9,15.4764,54,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Erythrocyte Sedimentation Rate, Manual",,85651,CPT,Facility,Outpatient,,,,54,45.9,15.4764,54,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,25.92,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Erythrocyte Sedimentation Rate, Manual",,85651,CPT,Facility,Inpatient,,,,54,45.9,15.4764,54,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Erythrocyte Sedimentation Rate, Automated",,85652,CPT,Facility,Both,,,,77,65.45,22.0682,77,Aetna,Commercial,70.84,92,,percent of total billed charges,,
"Erythrocyte Sedimentation Rate, Automated",,85652,CPT,Facility,Outpatient,,,,77,65.45,22.0682,77,Aetna,Medicare Advantage,37.73,49,,percent of total billed charges,,
"Erythrocyte Sedimentation Rate, Automated",,85652,CPT,Facility,Inpatient,,,,77,65.45,22.0682,77,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Erythrocyte Sedimentation Rate, Automated",,85652,CPT,Facility,Both,,,,77,65.45,22.0682,77,Aetna,PPO,71.61,93,,percent of total billed charges,,
"Erythrocyte Sedimentation Rate, Automated",,85652,CPT,Facility,Both,,,,77,65.45,22.0682,77,America's PPO,America's PPO,73.9431,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Erythrocyte Sedimentation Rate, Automated",,85652,CPT,Facility,Both,,,,77,65.45,22.0682,77,BlueCross BlueShield Minnesota, Federal Employee Program,75.768,98.4,,percent of total billed charges,,
"Erythrocyte Sedimentation Rate, Automated",,85652,CPT,Facility,Both,,,,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,77,100,,percent of total billed charges,,
"Erythrocyte Sedimentation Rate, Automated",,85652,CPT,Facility,Both,,,,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,High Value Network Plan,69.3,90,,percent of total billed charges,,
"Erythrocyte Sedimentation Rate, Automated",,85652,CPT,Facility,Outpatient,,,,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,Medicare Advantage,37.73,49,,percent of total billed charges,,
"Erythrocyte Sedimentation Rate, Automated",,85652,CPT,Facility,Inpatient,,,,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Erythrocyte Sedimentation Rate, Automated",,85652,CPT,Facility,Both,,,,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,68.1989,88.57,,percent of total billed charges,,
"Erythrocyte Sedimentation Rate, Automated",,85652,CPT,Facility,Both,,,,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,22.0682,28.66,,percent of total billed charges,,
"Erythrocyte Sedimentation Rate, Automated",,85652,CPT,Facility,Outpatient,,,,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),37.73,49,,percent of total billed charges,,
"Erythrocyte Sedimentation Rate, Automated",,85652,CPT,Facility,Inpatient,,,,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Erythrocyte Sedimentation Rate, Automated",,85652,CPT,Facility,Both,,,,77,65.45,22.0682,77,CorVel,Worker's Compensation,77,100,,percent of total billed charges,,
"Erythrocyte Sedimentation Rate, Automated",,85652,CPT,Facility,Both,,,,77,65.45,22.0682,77,First Health Group Corporation,First Health Network,74.69,97,,percent of total billed charges,,
"Erythrocyte Sedimentation Rate, Automated",,85652,CPT,Facility,Both,,,,77,65.45,22.0682,77,"Health Partners, Inc.",Commercial,72.842,94.6,,percent of total billed charges,,
"Erythrocyte Sedimentation Rate, Automated",,85652,CPT,Facility,Outpatient,,,,77,65.45,22.0682,77,"Health Partners, Inc.",Medicare Advantage,37.73,49,,percent of total billed charges,,
"Erythrocyte Sedimentation Rate, Automated",,85652,CPT,Facility,Inpatient,,,,77,65.45,22.0682,77,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Erythrocyte Sedimentation Rate, Automated",,85652,CPT,Facility,Both,,,,77,65.45,22.0682,77,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),46.2,60,,percent of total billed charges,,
"Erythrocyte Sedimentation Rate, Automated",,85652,CPT,Facility,Both,,,,77,65.45,22.0682,77,"Health Partners, Inc.",State of Minnesota Advantage Program,62.755,81.5,,percent of total billed charges,,
"Erythrocyte Sedimentation Rate, Automated",,85652,CPT,Facility,Both,,,,77,65.45,22.0682,77,"Health Partners, Inc.",State Public Programs,38.5,50,,percent of total billed charges,,
"Erythrocyte Sedimentation Rate, Automated",,85652,CPT,Facility,Both,,,,77,65.45,22.0682,77,Humana Insurance Company,Commercial PPO,73.15,95,,percent of total billed charges,,
"Erythrocyte Sedimentation Rate, Automated",,85652,CPT,Facility,Outpatient,,,,77,65.45,22.0682,77,Humana Insurance Company,Medicare PPO,37.73,49,,percent of total billed charges,,
"Erythrocyte Sedimentation Rate, Automated",,85652,CPT,Facility,Inpatient,,,,77,65.45,22.0682,77,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Erythrocyte Sedimentation Rate, Automated",,85652,CPT,Facility,Both,,,,77,65.45,22.0682,77,Medica,Individual & Family,76.307,99.1,,percent of total billed charges,,
"Erythrocyte Sedimentation Rate, Automated",,85652,CPT,Facility,Outpatient,,,,77,65.45,22.0682,77,Medica,Medica Advantage Solution,38.346,49.8,,percent of total billed charges,,
"Erythrocyte Sedimentation Rate, Automated",,85652,CPT,Facility,Inpatient,,,,77,65.45,22.0682,77,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Erythrocyte Sedimentation Rate, Automated",,85652,CPT,Facility,Outpatient,,,,77,65.45,22.0682,77,Medica,Medical Assistance,34.342,44.6,,percent of total billed charges,,
"Erythrocyte Sedimentation Rate, Automated",,85652,CPT,Facility,Inpatient,,,,77,65.45,22.0682,77,Medica,Medical Assistance,,,,,Included in per diem rate,
"Erythrocyte Sedimentation Rate, Automated",,85652,CPT,Facility,Outpatient,,,,77,65.45,22.0682,77,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,38.346,49.8,,percent of total billed charges,,
"Erythrocyte Sedimentation Rate, Automated",,85652,CPT,Facility,Inpatient,,,,77,65.45,22.0682,77,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Erythrocyte Sedimentation Rate, Automated",,85652,CPT,Facility,Both,,,,77,65.45,22.0682,77,"Multiplan, Inc.","Multiplan, Inc.",72.38,94,,percent of total billed charges,,
"Erythrocyte Sedimentation Rate, Automated",,85652,CPT,Facility,Outpatient,,,,77,65.45,22.0682,77,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,66.528,86.4,,percent of total billed charges,,
"Erythrocyte Sedimentation Rate, Automated",,85652,CPT,Facility,Inpatient,,,,77,65.45,22.0682,77,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Erythrocyte Sedimentation Rate, Automated",,85652,CPT,Facility,Both,,,,77,65.45,22.0682,77,"Preferred One Administrative Services, INC.",PPO,75.922,98.6,,percent of total billed charges,,
"Erythrocyte Sedimentation Rate, Automated",,85652,CPT,Facility,Outpatient,,,,77,65.45,22.0682,77,PrimeWest Health,Minnesota Senior Health Options (MSHO),39.6165,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Erythrocyte Sedimentation Rate, Automated",,85652,CPT,Facility,Inpatient,,,,77,65.45,22.0682,77,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Erythrocyte Sedimentation Rate, Automated",,85652,CPT,Facility,Outpatient,,,,77,65.45,22.0682,77,PrimeWest Health,MinnesotaCare,39.5472,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Erythrocyte Sedimentation Rate, Automated",,85652,CPT,Facility,Inpatient,,,,77,65.45,22.0682,77,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Erythrocyte Sedimentation Rate, Automated",,85652,CPT,Facility,Both,,,,77,65.45,22.0682,77,Sanford Health Plan,Sanford Health Plan,70.84,92,,percent of total billed charges,,
"Erythrocyte Sedimentation Rate, Automated",,85652,CPT,Facility,Outpatient,,,,77,65.45,22.0682,77,"UCare Health, Inc.",Individual & Family Plan,43.3895,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Erythrocyte Sedimentation Rate, Automated",,85652,CPT,Facility,Inpatient,,,,77,65.45,22.0682,77,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Erythrocyte Sedimentation Rate, Automated",,85652,CPT,Facility,Outpatient,,,,77,65.45,22.0682,77,"UCare Health, Inc.",Medical Assistance,38.8619,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Erythrocyte Sedimentation Rate, Automated",,85652,CPT,Facility,Inpatient,,,,77,65.45,22.0682,77,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Erythrocyte Sedimentation Rate, Automated",,85652,CPT,Facility,Outpatient,,,,77,65.45,22.0682,77,"UCare Health, Inc.",Medicare Advantage,38.8619,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Erythrocyte Sedimentation Rate, Automated",,85652,CPT,Facility,Inpatient,,,,77,65.45,22.0682,77,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Erythrocyte Sedimentation Rate, Automated",,85652,CPT,Facility,Outpatient,,,,77,65.45,22.0682,77,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),38.8619,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Erythrocyte Sedimentation Rate, Automated",,85652,CPT,Facility,Inpatient,,,,77,65.45,22.0682,77,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Erythrocyte Sedimentation Rate, Automated",,85652,CPT,Facility,Both,,,,77,65.45,22.0682,77,UnitedHealthcare,Individual & Family,72.38,94,,percent of total billed charges,,
"Erythrocyte Sedimentation Rate, Automated",,85652,CPT,Facility,Outpatient,,,,77,65.45,22.0682,77,UnitedHealthcare,Medicare Advantage,37.73,49,,percent of total billed charges,,
"Erythrocyte Sedimentation Rate, Automated",,85652,CPT,Facility,Inpatient,,,,77,65.45,22.0682,77,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Erythrocyte Sedimentation Rate, Automated",,85652,CPT,Facility,Outpatient,,,,77,65.45,22.0682,77,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,36.96,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Erythrocyte Sedimentation Rate, Automated",,85652,CPT,Facility,Inpatient,,,,77,65.45,22.0682,77,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Activated Partial Thromboplastin Time (Aptt),,85730,CPT,Facility,Both,,,,69,58.65,19.7754,69,Aetna,Commercial,63.48,92,,percent of total billed charges,,
Activated Partial Thromboplastin Time (Aptt),,85730,CPT,Facility,Outpatient,,,,69,58.65,19.7754,69,Aetna,Medicare Advantage,33.81,49,,percent of total billed charges,,
Activated Partial Thromboplastin Time (Aptt),,85730,CPT,Facility,Inpatient,,,,69,58.65,19.7754,69,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Activated Partial Thromboplastin Time (Aptt),,85730,CPT,Facility,Both,,,,69,58.65,19.7754,69,Aetna,PPO,64.17,93,,percent of total billed charges,,
Activated Partial Thromboplastin Time (Aptt),,85730,CPT,Facility,Both,,,,69,58.65,19.7754,69,America's PPO,America's PPO,66.2607,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Activated Partial Thromboplastin Time (Aptt),,85730,CPT,Facility,Both,,,,69,58.65,19.7754,69,BlueCross BlueShield Minnesota, Federal Employee Program,67.896,98.4,,percent of total billed charges,,
Activated Partial Thromboplastin Time (Aptt),,85730,CPT,Facility,Both,,,,69,58.65,19.7754,69,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,69,100,,percent of total billed charges,,
Activated Partial Thromboplastin Time (Aptt),,85730,CPT,Facility,Both,,,,69,58.65,19.7754,69,BlueCross BlueShield Minnesota,High Value Network Plan,62.1,90,,percent of total billed charges,,
Activated Partial Thromboplastin Time (Aptt),,85730,CPT,Facility,Outpatient,,,,69,58.65,19.7754,69,BlueCross BlueShield Minnesota,Medicare Advantage,33.81,49,,percent of total billed charges,,
Activated Partial Thromboplastin Time (Aptt),,85730,CPT,Facility,Inpatient,,,,69,58.65,19.7754,69,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Activated Partial Thromboplastin Time (Aptt),,85730,CPT,Facility,Both,,,,69,58.65,19.7754,69,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,61.1133,88.57,,percent of total billed charges,,
Activated Partial Thromboplastin Time (Aptt),,85730,CPT,Facility,Both,,,,69,58.65,19.7754,69,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,19.7754,28.66,,percent of total billed charges,,
Activated Partial Thromboplastin Time (Aptt),,85730,CPT,Facility,Outpatient,,,,69,58.65,19.7754,69,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),33.81,49,,percent of total billed charges,,
Activated Partial Thromboplastin Time (Aptt),,85730,CPT,Facility,Inpatient,,,,69,58.65,19.7754,69,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Activated Partial Thromboplastin Time (Aptt),,85730,CPT,Facility,Both,,,,69,58.65,19.7754,69,CorVel,Worker's Compensation,69,100,,percent of total billed charges,,
Activated Partial Thromboplastin Time (Aptt),,85730,CPT,Facility,Both,,,,69,58.65,19.7754,69,First Health Group Corporation,First Health Network,66.93,97,,percent of total billed charges,,
Activated Partial Thromboplastin Time (Aptt),,85730,CPT,Facility,Both,,,,69,58.65,19.7754,69,"Health Partners, Inc.",Commercial,65.274,94.6,,percent of total billed charges,,
Activated Partial Thromboplastin Time (Aptt),,85730,CPT,Facility,Outpatient,,,,69,58.65,19.7754,69,"Health Partners, Inc.",Medicare Advantage,33.81,49,,percent of total billed charges,,
Activated Partial Thromboplastin Time (Aptt),,85730,CPT,Facility,Inpatient,,,,69,58.65,19.7754,69,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Activated Partial Thromboplastin Time (Aptt),,85730,CPT,Facility,Both,,,,69,58.65,19.7754,69,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),41.4,60,,percent of total billed charges,,
Activated Partial Thromboplastin Time (Aptt),,85730,CPT,Facility,Both,,,,69,58.65,19.7754,69,"Health Partners, Inc.",State of Minnesota Advantage Program,56.235,81.5,,percent of total billed charges,,
Activated Partial Thromboplastin Time (Aptt),,85730,CPT,Facility,Both,,,,69,58.65,19.7754,69,"Health Partners, Inc.",State Public Programs,34.5,50,,percent of total billed charges,,
Activated Partial Thromboplastin Time (Aptt),,85730,CPT,Facility,Both,,,,69,58.65,19.7754,69,Humana Insurance Company,Commercial PPO,65.55,95,,percent of total billed charges,,
Activated Partial Thromboplastin Time (Aptt),,85730,CPT,Facility,Outpatient,,,,69,58.65,19.7754,69,Humana Insurance Company,Medicare PPO,33.81,49,,percent of total billed charges,,
Activated Partial Thromboplastin Time (Aptt),,85730,CPT,Facility,Inpatient,,,,69,58.65,19.7754,69,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Activated Partial Thromboplastin Time (Aptt),,85730,CPT,Facility,Both,,,,69,58.65,19.7754,69,Medica,Individual & Family,68.379,99.1,,percent of total billed charges,,
Activated Partial Thromboplastin Time (Aptt),,85730,CPT,Facility,Outpatient,,,,69,58.65,19.7754,69,Medica,Medica Advantage Solution,34.362,49.8,,percent of total billed charges,,
Activated Partial Thromboplastin Time (Aptt),,85730,CPT,Facility,Inpatient,,,,69,58.65,19.7754,69,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Activated Partial Thromboplastin Time (Aptt),,85730,CPT,Facility,Outpatient,,,,69,58.65,19.7754,69,Medica,Medical Assistance,30.774,44.6,,percent of total billed charges,,
Activated Partial Thromboplastin Time (Aptt),,85730,CPT,Facility,Inpatient,,,,69,58.65,19.7754,69,Medica,Medical Assistance,,,,,Included in per diem rate,
Activated Partial Thromboplastin Time (Aptt),,85730,CPT,Facility,Outpatient,,,,69,58.65,19.7754,69,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,34.362,49.8,,percent of total billed charges,,
Activated Partial Thromboplastin Time (Aptt),,85730,CPT,Facility,Inpatient,,,,69,58.65,19.7754,69,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Activated Partial Thromboplastin Time (Aptt),,85730,CPT,Facility,Both,,,,69,58.65,19.7754,69,"Multiplan, Inc.","Multiplan, Inc.",64.86,94,,percent of total billed charges,,
Activated Partial Thromboplastin Time (Aptt),,85730,CPT,Facility,Outpatient,,,,69,58.65,19.7754,69,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,59.616,86.4,,percent of total billed charges,,
Activated Partial Thromboplastin Time (Aptt),,85730,CPT,Facility,Inpatient,,,,69,58.65,19.7754,69,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Activated Partial Thromboplastin Time (Aptt),,85730,CPT,Facility,Both,,,,69,58.65,19.7754,69,"Preferred One Administrative Services, INC.",PPO,68.034,98.6,,percent of total billed charges,,
Activated Partial Thromboplastin Time (Aptt),,85730,CPT,Facility,Outpatient,,,,69,58.65,19.7754,69,PrimeWest Health,Minnesota Senior Health Options (MSHO),35.5005,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Activated Partial Thromboplastin Time (Aptt),,85730,CPT,Facility,Inpatient,,,,69,58.65,19.7754,69,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Activated Partial Thromboplastin Time (Aptt),,85730,CPT,Facility,Outpatient,,,,69,58.65,19.7754,69,PrimeWest Health,MinnesotaCare,35.4384,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Activated Partial Thromboplastin Time (Aptt),,85730,CPT,Facility,Inpatient,,,,69,58.65,19.7754,69,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Activated Partial Thromboplastin Time (Aptt),,85730,CPT,Facility,Both,,,,69,58.65,19.7754,69,Sanford Health Plan,Sanford Health Plan,63.48,92,,percent of total billed charges,,
Activated Partial Thromboplastin Time (Aptt),,85730,CPT,Facility,Outpatient,,,,69,58.65,19.7754,69,"UCare Health, Inc.",Individual & Family Plan,38.8815,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Activated Partial Thromboplastin Time (Aptt),,85730,CPT,Facility,Inpatient,,,,69,58.65,19.7754,69,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Activated Partial Thromboplastin Time (Aptt),,85730,CPT,Facility,Outpatient,,,,69,58.65,19.7754,69,"UCare Health, Inc.",Medical Assistance,34.8243,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Activated Partial Thromboplastin Time (Aptt),,85730,CPT,Facility,Inpatient,,,,69,58.65,19.7754,69,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Activated Partial Thromboplastin Time (Aptt),,85730,CPT,Facility,Outpatient,,,,69,58.65,19.7754,69,"UCare Health, Inc.",Medicare Advantage,34.8243,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Activated Partial Thromboplastin Time (Aptt),,85730,CPT,Facility,Inpatient,,,,69,58.65,19.7754,69,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Activated Partial Thromboplastin Time (Aptt),,85730,CPT,Facility,Outpatient,,,,69,58.65,19.7754,69,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),34.8243,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Activated Partial Thromboplastin Time (Aptt),,85730,CPT,Facility,Inpatient,,,,69,58.65,19.7754,69,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Activated Partial Thromboplastin Time (Aptt),,85730,CPT,Facility,Both,,,,69,58.65,19.7754,69,UnitedHealthcare,Individual & Family,64.86,94,,percent of total billed charges,,
Activated Partial Thromboplastin Time (Aptt),,85730,CPT,Facility,Outpatient,,,,69,58.65,19.7754,69,UnitedHealthcare,Medicare Advantage,33.81,49,,percent of total billed charges,,
Activated Partial Thromboplastin Time (Aptt),,85730,CPT,Facility,Inpatient,,,,69,58.65,19.7754,69,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Activated Partial Thromboplastin Time (Aptt),,85730,CPT,Facility,Outpatient,,,,69,58.65,19.7754,69,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,33.12,48,,percent of total billed charges,,100% of DHS outpatient percentage
Activated Partial Thromboplastin Time (Aptt),,85730,CPT,Facility,Inpatient,,,,69,58.65,19.7754,69,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
BUPIVACAINE (PF) 0.75 % (7.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Both,10,mL,,33,28.05,9.4578,33,Aetna,Commercial,30.36,92,,percent of total billed charges,,
BUPIVACAINE (PF) 0.75 % (7.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Outpatient,10,mL,,33,28.05,9.4578,33,Aetna,Medicare Advantage,16.17,49,,percent of total billed charges,,
BUPIVACAINE (PF) 0.75 % (7.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Inpatient,10,mL,,33,28.05,9.4578,33,Aetna,Medicare Advantage,,,,,Included in per diem rate,
BUPIVACAINE (PF) 0.75 % (7.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Both,10,mL,,33,28.05,9.4578,33,Aetna,PPO,30.69,93,,percent of total billed charges,,
BUPIVACAINE (PF) 0.75 % (7.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Both,10,mL,,33,28.05,9.4578,33,America's PPO,America's PPO,31.6899,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
BUPIVACAINE (PF) 0.75 % (7.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Both,10,mL,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota, Federal Employee Program,32.472,98.4,,percent of total billed charges,,
BUPIVACAINE (PF) 0.75 % (7.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Both,10,mL,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,33,100,,percent of total billed charges,,
BUPIVACAINE (PF) 0.75 % (7.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Both,10,mL,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota,High Value Network Plan,29.7,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
BUPIVACAINE (PF) 0.75 % (7.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Outpatient,10,mL,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota,Medicare Advantage,16.17,49,,percent of total billed charges,,
BUPIVACAINE (PF) 0.75 % (7.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Inpatient,10,mL,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
BUPIVACAINE (PF) 0.75 % (7.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Both,10,mL,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,29.2281,88.57,,percent of total billed charges,,
BUPIVACAINE (PF) 0.75 % (7.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Both,10,mL,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,9.4578,28.66,,percent of total billed charges,,
BUPIVACAINE (PF) 0.75 % (7.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Outpatient,10,mL,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),16.17,49,,percent of total billed charges,,
BUPIVACAINE (PF) 0.75 % (7.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Inpatient,10,mL,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
BUPIVACAINE (PF) 0.75 % (7.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Both,10,mL,,33,28.05,9.4578,33,CorVel,Worker's Compensation,33,100,,percent of total billed charges,,
BUPIVACAINE (PF) 0.75 % (7.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Both,10,mL,,33,28.05,9.4578,33,First Health Group Corporation,First Health Network,32.01,97,,percent of total billed charges,,
BUPIVACAINE (PF) 0.75 % (7.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Both,10,mL,,33,28.05,9.4578,33,"Health Partners, Inc.",Commercial,31.218,94.6,,percent of total billed charges,,
BUPIVACAINE (PF) 0.75 % (7.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Outpatient,10,mL,,33,28.05,9.4578,33,"Health Partners, Inc.",Medicare Advantage,16.17,49,,percent of total billed charges,,
BUPIVACAINE (PF) 0.75 % (7.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Inpatient,10,mL,,33,28.05,9.4578,33,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
BUPIVACAINE (PF) 0.75 % (7.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Both,10,mL,,33,28.05,9.4578,33,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),19.8,60,,percent of total billed charges,,
BUPIVACAINE (PF) 0.75 % (7.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Both,10,mL,,33,28.05,9.4578,33,"Health Partners, Inc.",State of Minnesota Advantage Program,26.895,81.5,,percent of total billed charges,,
BUPIVACAINE (PF) 0.75 % (7.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Both,10,mL,,33,28.05,9.4578,33,"Health Partners, Inc.",State Public Programs,16.5,50,,percent of total billed charges,,
BUPIVACAINE (PF) 0.75 % (7.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Both,10,mL,,33,28.05,9.4578,33,Humana Insurance Company,Commercial PPO,31.35,95,,percent of total billed charges,,
BUPIVACAINE (PF) 0.75 % (7.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Outpatient,10,mL,,33,28.05,9.4578,33,Humana Insurance Company,Medicare PPO,16.17,49,,percent of total billed charges,,
BUPIVACAINE (PF) 0.75 % (7.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Inpatient,10,mL,,33,28.05,9.4578,33,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
BUPIVACAINE (PF) 0.75 % (7.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Both,10,mL,,33,28.05,9.4578,33,Medica,Individual & Family,32.703,99.1,,percent of total billed charges,,
BUPIVACAINE (PF) 0.75 % (7.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Outpatient,10,mL,,33,28.05,9.4578,33,Medica,Medica Advantage Solution,16.434,49.8,,percent of total billed charges,,
BUPIVACAINE (PF) 0.75 % (7.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Inpatient,10,mL,,33,28.05,9.4578,33,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
BUPIVACAINE (PF) 0.75 % (7.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Outpatient,10,mL,,33,28.05,9.4578,33,Medica,Medical Assistance,14.718,44.6,,percent of total billed charges,,
BUPIVACAINE (PF) 0.75 % (7.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Inpatient,10,mL,,33,28.05,9.4578,33,Medica,Medical Assistance,,,,,Included in per diem rate,
BUPIVACAINE (PF) 0.75 % (7.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Outpatient,10,mL,,33,28.05,9.4578,33,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,16.434,49.8,,percent of total billed charges,,
BUPIVACAINE (PF) 0.75 % (7.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Inpatient,10,mL,,33,28.05,9.4578,33,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
BUPIVACAINE (PF) 0.75 % (7.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Both,10,mL,,33,28.05,9.4578,33,"Multiplan, Inc.","Multiplan, Inc.",31.02,94,,percent of total billed charges,,
BUPIVACAINE (PF) 0.75 % (7.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Outpatient,10,mL,,33,28.05,9.4578,33,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,29.733,90.1,,percent of total billed charges,,
BUPIVACAINE (PF) 0.75 % (7.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Inpatient,10,mL,,33,28.05,9.4578,33,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
BUPIVACAINE (PF) 0.75 % (7.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Both,10,mL,,33,28.05,9.4578,33,"Preferred One Administrative Services, INC.",PPO,32.538,98.6,,percent of total billed charges,,
BUPIVACAINE (PF) 0.75 % (7.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Outpatient,10,mL,,33,28.05,9.4578,33,PrimeWest Health,Minnesota Senior Health Options (MSHO),16.9785,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
BUPIVACAINE (PF) 0.75 % (7.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Inpatient,10,mL,,33,28.05,9.4578,33,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
BUPIVACAINE (PF) 0.75 % (7.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Outpatient,10,mL,,33,28.05,9.4578,33,PrimeWest Health,MinnesotaCare,16.9488,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
BUPIVACAINE (PF) 0.75 % (7.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Inpatient,10,mL,,33,28.05,9.4578,33,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
BUPIVACAINE (PF) 0.75 % (7.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Both,10,mL,,33,28.05,9.4578,33,Sanford Health Plan,Sanford Health Plan,30.36,92,,percent of total billed charges,,
BUPIVACAINE (PF) 0.75 % (7.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Outpatient,10,mL,,33,28.05,9.4578,33,"UCare Health, Inc.",Individual & Family Plan,18.5955,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
BUPIVACAINE (PF) 0.75 % (7.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Inpatient,10,mL,,33,28.05,9.4578,33,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
BUPIVACAINE (PF) 0.75 % (7.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Outpatient,10,mL,,33,28.05,9.4578,33,"UCare Health, Inc.",Medical Assistance,16.6551,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BUPIVACAINE (PF) 0.75 % (7.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Inpatient,10,mL,,33,28.05,9.4578,33,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
BUPIVACAINE (PF) 0.75 % (7.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Outpatient,10,mL,,33,28.05,9.4578,33,"UCare Health, Inc.",Medicare Advantage,16.6551,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BUPIVACAINE (PF) 0.75 % (7.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Inpatient,10,mL,,33,28.05,9.4578,33,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
BUPIVACAINE (PF) 0.75 % (7.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Outpatient,10,mL,,33,28.05,9.4578,33,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),16.6551,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BUPIVACAINE (PF) 0.75 % (7.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Inpatient,10,mL,,33,28.05,9.4578,33,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
BUPIVACAINE (PF) 0.75 % (7.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Both,10,mL,,33,28.05,9.4578,33,UnitedHealthcare,Individual & Family,31.02,94,,percent of total billed charges,,
BUPIVACAINE (PF) 0.75 % (7.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Outpatient,10,mL,,33,28.05,9.4578,33,UnitedHealthcare,Medicare Advantage,16.17,49,,percent of total billed charges,,
BUPIVACAINE (PF) 0.75 % (7.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Inpatient,10,mL,,33,28.05,9.4578,33,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
BUPIVACAINE (PF) 0.75 % (7.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Outpatient,10,mL,,33,28.05,9.4578,33,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,15.84,48,,percent of total billed charges,,100% of DHS outpatient percentage
BUPIVACAINE (PF) 0.75 % (7.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Inpatient,10,mL,,33,28.05,9.4578,33,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
TESTOSTERONE CYPIONATE 200 MG/ML IM OIL,,J1071,HCPCS,Facility,Both,10,mL,,571,485.35,163.6486,571,Aetna,Commercial,525.32,92,,percent of total billed charges,,
TESTOSTERONE CYPIONATE 200 MG/ML IM OIL,,J1071,HCPCS,Facility,Outpatient,10,mL,,571,485.35,163.6486,571,Aetna,Medicare Advantage,279.79,49,,percent of total billed charges,,
TESTOSTERONE CYPIONATE 200 MG/ML IM OIL,,J1071,HCPCS,Facility,Inpatient,10,mL,,571,485.35,163.6486,571,Aetna,Medicare Advantage,,,,,Included in per diem rate,
TESTOSTERONE CYPIONATE 200 MG/ML IM OIL,,J1071,HCPCS,Facility,Both,10,mL,,571,485.35,163.6486,571,Aetna,PPO,531.03,93,,percent of total billed charges,,
TESTOSTERONE CYPIONATE 200 MG/ML IM OIL,,J1071,HCPCS,Facility,Both,10,mL,,571,485.35,163.6486,571,America's PPO,America's PPO,548.3313,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
TESTOSTERONE CYPIONATE 200 MG/ML IM OIL,,J1071,HCPCS,Facility,Both,10,mL,,571,485.35,163.6486,571,BlueCross BlueShield Minnesota, Federal Employee Program,561.864,98.4,,percent of total billed charges,,
TESTOSTERONE CYPIONATE 200 MG/ML IM OIL,,J1071,HCPCS,Facility,Both,10,mL,,571,485.35,163.6486,571,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,571,100,,percent of total billed charges,,
TESTOSTERONE CYPIONATE 200 MG/ML IM OIL,,J1071,HCPCS,Facility,Both,10,mL,,571,485.35,163.6486,571,BlueCross BlueShield Minnesota,High Value Network Plan,513.9,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
TESTOSTERONE CYPIONATE 200 MG/ML IM OIL,,J1071,HCPCS,Facility,Outpatient,10,mL,,571,485.35,163.6486,571,BlueCross BlueShield Minnesota,Medicare Advantage,279.79,49,,percent of total billed charges,,
TESTOSTERONE CYPIONATE 200 MG/ML IM OIL,,J1071,HCPCS,Facility,Inpatient,10,mL,,571,485.35,163.6486,571,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
TESTOSTERONE CYPIONATE 200 MG/ML IM OIL,,J1071,HCPCS,Facility,Both,10,mL,,571,485.35,163.6486,571,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,505.7347,88.57,,percent of total billed charges,,
TESTOSTERONE CYPIONATE 200 MG/ML IM OIL,,J1071,HCPCS,Facility,Both,10,mL,,571,485.35,163.6486,571,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,163.6486,28.66,,percent of total billed charges,,
TESTOSTERONE CYPIONATE 200 MG/ML IM OIL,,J1071,HCPCS,Facility,Outpatient,10,mL,,571,485.35,163.6486,571,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),279.79,49,,percent of total billed charges,,
TESTOSTERONE CYPIONATE 200 MG/ML IM OIL,,J1071,HCPCS,Facility,Inpatient,10,mL,,571,485.35,163.6486,571,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
TESTOSTERONE CYPIONATE 200 MG/ML IM OIL,,J1071,HCPCS,Facility,Both,10,mL,,571,485.35,163.6486,571,CorVel,Worker's Compensation,571,100,,percent of total billed charges,,
TESTOSTERONE CYPIONATE 200 MG/ML IM OIL,,J1071,HCPCS,Facility,Both,10,mL,,571,485.35,163.6486,571,First Health Group Corporation,First Health Network,553.87,97,,percent of total billed charges,,
TESTOSTERONE CYPIONATE 200 MG/ML IM OIL,,J1071,HCPCS,Facility,Both,10,mL,,571,485.35,163.6486,571,"Health Partners, Inc.",Commercial,540.166,94.6,,percent of total billed charges,,
TESTOSTERONE CYPIONATE 200 MG/ML IM OIL,,J1071,HCPCS,Facility,Outpatient,10,mL,,571,485.35,163.6486,571,"Health Partners, Inc.",Medicare Advantage,279.79,49,,percent of total billed charges,,
TESTOSTERONE CYPIONATE 200 MG/ML IM OIL,,J1071,HCPCS,Facility,Inpatient,10,mL,,571,485.35,163.6486,571,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
TESTOSTERONE CYPIONATE 200 MG/ML IM OIL,,J1071,HCPCS,Facility,Both,10,mL,,571,485.35,163.6486,571,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),342.6,60,,percent of total billed charges,,
TESTOSTERONE CYPIONATE 200 MG/ML IM OIL,,J1071,HCPCS,Facility,Both,10,mL,,571,485.35,163.6486,571,"Health Partners, Inc.",State of Minnesota Advantage Program,465.365,81.5,,percent of total billed charges,,
TESTOSTERONE CYPIONATE 200 MG/ML IM OIL,,J1071,HCPCS,Facility,Both,10,mL,,571,485.35,163.6486,571,"Health Partners, Inc.",State Public Programs,285.5,50,,percent of total billed charges,,
TESTOSTERONE CYPIONATE 200 MG/ML IM OIL,,J1071,HCPCS,Facility,Both,10,mL,,571,485.35,163.6486,571,Humana Insurance Company,Commercial PPO,542.45,95,,percent of total billed charges,,
TESTOSTERONE CYPIONATE 200 MG/ML IM OIL,,J1071,HCPCS,Facility,Outpatient,10,mL,,571,485.35,163.6486,571,Humana Insurance Company,Medicare PPO,279.79,49,,percent of total billed charges,,
TESTOSTERONE CYPIONATE 200 MG/ML IM OIL,,J1071,HCPCS,Facility,Inpatient,10,mL,,571,485.35,163.6486,571,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
TESTOSTERONE CYPIONATE 200 MG/ML IM OIL,,J1071,HCPCS,Facility,Both,10,mL,,571,485.35,163.6486,571,Medica,Individual & Family,565.861,99.1,,percent of total billed charges,,
TESTOSTERONE CYPIONATE 200 MG/ML IM OIL,,J1071,HCPCS,Facility,Outpatient,10,mL,,571,485.35,163.6486,571,Medica,Medica Advantage Solution,284.358,49.8,,percent of total billed charges,,
TESTOSTERONE CYPIONATE 200 MG/ML IM OIL,,J1071,HCPCS,Facility,Inpatient,10,mL,,571,485.35,163.6486,571,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
TESTOSTERONE CYPIONATE 200 MG/ML IM OIL,,J1071,HCPCS,Facility,Outpatient,10,mL,,571,485.35,163.6486,571,Medica,Medical Assistance,254.666,44.6,,percent of total billed charges,,
TESTOSTERONE CYPIONATE 200 MG/ML IM OIL,,J1071,HCPCS,Facility,Inpatient,10,mL,,571,485.35,163.6486,571,Medica,Medical Assistance,,,,,Included in per diem rate,
TESTOSTERONE CYPIONATE 200 MG/ML IM OIL,,J1071,HCPCS,Facility,Outpatient,10,mL,,571,485.35,163.6486,571,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,284.358,49.8,,percent of total billed charges,,
TESTOSTERONE CYPIONATE 200 MG/ML IM OIL,,J1071,HCPCS,Facility,Inpatient,10,mL,,571,485.35,163.6486,571,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
TESTOSTERONE CYPIONATE 200 MG/ML IM OIL,,J1071,HCPCS,Facility,Both,10,mL,,571,485.35,163.6486,571,"Multiplan, Inc.","Multiplan, Inc.",536.74,94,,percent of total billed charges,,
TESTOSTERONE CYPIONATE 200 MG/ML IM OIL,,J1071,HCPCS,Facility,Outpatient,10,mL,,571,485.35,163.6486,571,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,514.471,90.1,,percent of total billed charges,,
TESTOSTERONE CYPIONATE 200 MG/ML IM OIL,,J1071,HCPCS,Facility,Inpatient,10,mL,,571,485.35,163.6486,571,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
TESTOSTERONE CYPIONATE 200 MG/ML IM OIL,,J1071,HCPCS,Facility,Both,10,mL,,571,485.35,163.6486,571,"Preferred One Administrative Services, INC.",PPO,563.006,98.6,,percent of total billed charges,,
TESTOSTERONE CYPIONATE 200 MG/ML IM OIL,,J1071,HCPCS,Facility,Outpatient,10,mL,,571,485.35,163.6486,571,PrimeWest Health,Minnesota Senior Health Options (MSHO),293.7795,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
TESTOSTERONE CYPIONATE 200 MG/ML IM OIL,,J1071,HCPCS,Facility,Inpatient,10,mL,,571,485.35,163.6486,571,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
TESTOSTERONE CYPIONATE 200 MG/ML IM OIL,,J1071,HCPCS,Facility,Outpatient,10,mL,,571,485.35,163.6486,571,PrimeWest Health,MinnesotaCare,293.2656,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
TESTOSTERONE CYPIONATE 200 MG/ML IM OIL,,J1071,HCPCS,Facility,Inpatient,10,mL,,571,485.35,163.6486,571,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
TESTOSTERONE CYPIONATE 200 MG/ML IM OIL,,J1071,HCPCS,Facility,Both,10,mL,,571,485.35,163.6486,571,Sanford Health Plan,Sanford Health Plan,525.32,92,,percent of total billed charges,,
TESTOSTERONE CYPIONATE 200 MG/ML IM OIL,,J1071,HCPCS,Facility,Outpatient,10,mL,,571,485.35,163.6486,571,"UCare Health, Inc.",Individual & Family Plan,321.7585,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
TESTOSTERONE CYPIONATE 200 MG/ML IM OIL,,J1071,HCPCS,Facility,Inpatient,10,mL,,571,485.35,163.6486,571,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
TESTOSTERONE CYPIONATE 200 MG/ML IM OIL,,J1071,HCPCS,Facility,Outpatient,10,mL,,571,485.35,163.6486,571,"UCare Health, Inc.",Medical Assistance,288.1837,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TESTOSTERONE CYPIONATE 200 MG/ML IM OIL,,J1071,HCPCS,Facility,Inpatient,10,mL,,571,485.35,163.6486,571,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
TESTOSTERONE CYPIONATE 200 MG/ML IM OIL,,J1071,HCPCS,Facility,Outpatient,10,mL,,571,485.35,163.6486,571,"UCare Health, Inc.",Medicare Advantage,288.1837,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TESTOSTERONE CYPIONATE 200 MG/ML IM OIL,,J1071,HCPCS,Facility,Inpatient,10,mL,,571,485.35,163.6486,571,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
TESTOSTERONE CYPIONATE 200 MG/ML IM OIL,,J1071,HCPCS,Facility,Outpatient,10,mL,,571,485.35,163.6486,571,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),288.1837,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TESTOSTERONE CYPIONATE 200 MG/ML IM OIL,,J1071,HCPCS,Facility,Inpatient,10,mL,,571,485.35,163.6486,571,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
TESTOSTERONE CYPIONATE 200 MG/ML IM OIL,,J1071,HCPCS,Facility,Both,10,mL,,571,485.35,163.6486,571,UnitedHealthcare,Individual & Family,536.74,94,,percent of total billed charges,,
TESTOSTERONE CYPIONATE 200 MG/ML IM OIL,,J1071,HCPCS,Facility,Outpatient,10,mL,,571,485.35,163.6486,571,UnitedHealthcare,Medicare Advantage,279.79,49,,percent of total billed charges,,
TESTOSTERONE CYPIONATE 200 MG/ML IM OIL,,J1071,HCPCS,Facility,Inpatient,10,mL,,571,485.35,163.6486,571,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
TESTOSTERONE CYPIONATE 200 MG/ML IM OIL,,J1071,HCPCS,Facility,Outpatient,10,mL,,571,485.35,163.6486,571,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,274.08,48,,percent of total billed charges,,100% of DHS outpatient percentage
TESTOSTERONE CYPIONATE 200 MG/ML IM OIL,,J1071,HCPCS,Facility,Inpatient,10,mL,,571,485.35,163.6486,571,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Cat Epithelium, Ige",,86003,CPT,Facility,Both,,,,46,39.1,13.1836,46,Aetna,Commercial,42.32,92,,percent of total billed charges,,
"Cat Epithelium, Ige",,86003,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,Aetna,Medicare Advantage,22.54,49,,percent of total billed charges,,
"Cat Epithelium, Ige",,86003,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Cat Epithelium, Ige",,86003,CPT,Facility,Both,,,,46,39.1,13.1836,46,Aetna,PPO,42.78,93,,percent of total billed charges,,
"Cat Epithelium, Ige",,86003,CPT,Facility,Both,,,,46,39.1,13.1836,46,America's PPO,America's PPO,44.1738,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Cat Epithelium, Ige",,86003,CPT,Facility,Both,,,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota, Federal Employee Program,45.264,98.4,,percent of total billed charges,,
"Cat Epithelium, Ige",,86003,CPT,Facility,Both,,,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,46,100,,percent of total billed charges,,
"Cat Epithelium, Ige",,86003,CPT,Facility,Both,,,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,High Value Network Plan,41.4,90,,percent of total billed charges,,
"Cat Epithelium, Ige",,86003,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Medicare Advantage,22.54,49,,percent of total billed charges,,
"Cat Epithelium, Ige",,86003,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Cat Epithelium, Ige",,86003,CPT,Facility,Both,,,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,40.7422,88.57,,percent of total billed charges,,
"Cat Epithelium, Ige",,86003,CPT,Facility,Both,,,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,13.1836,28.66,,percent of total billed charges,,
"Cat Epithelium, Ige",,86003,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),22.54,49,,percent of total billed charges,,
"Cat Epithelium, Ige",,86003,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Cat Epithelium, Ige",,86003,CPT,Facility,Both,,,,46,39.1,13.1836,46,CorVel,Worker's Compensation,46,100,,percent of total billed charges,,
"Cat Epithelium, Ige",,86003,CPT,Facility,Both,,,,46,39.1,13.1836,46,First Health Group Corporation,First Health Network,44.62,97,,percent of total billed charges,,
"Cat Epithelium, Ige",,86003,CPT,Facility,Both,,,,46,39.1,13.1836,46,"Health Partners, Inc.",Commercial,43.516,94.6,,percent of total billed charges,,
"Cat Epithelium, Ige",,86003,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,"Health Partners, Inc.",Medicare Advantage,22.54,49,,percent of total billed charges,,
"Cat Epithelium, Ige",,86003,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Cat Epithelium, Ige",,86003,CPT,Facility,Both,,,,46,39.1,13.1836,46,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),27.6,60,,percent of total billed charges,,
"Cat Epithelium, Ige",,86003,CPT,Facility,Both,,,,46,39.1,13.1836,46,"Health Partners, Inc.",State of Minnesota Advantage Program,37.49,81.5,,percent of total billed charges,,
"Cat Epithelium, Ige",,86003,CPT,Facility,Both,,,,46,39.1,13.1836,46,"Health Partners, Inc.",State Public Programs,23,50,,percent of total billed charges,,
"Cat Epithelium, Ige",,86003,CPT,Facility,Both,,,,46,39.1,13.1836,46,Humana Insurance Company,Commercial PPO,43.7,95,,percent of total billed charges,,
"Cat Epithelium, Ige",,86003,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,Humana Insurance Company,Medicare PPO,22.54,49,,percent of total billed charges,,
"Cat Epithelium, Ige",,86003,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Cat Epithelium, Ige",,86003,CPT,Facility,Both,,,,46,39.1,13.1836,46,Medica,Individual & Family,45.586,99.1,,percent of total billed charges,,
"Cat Epithelium, Ige",,86003,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,Medica,Medica Advantage Solution,22.908,49.8,,percent of total billed charges,,
"Cat Epithelium, Ige",,86003,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Cat Epithelium, Ige",,86003,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,Medica,Medical Assistance,20.516,44.6,,percent of total billed charges,,
"Cat Epithelium, Ige",,86003,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,Medica,Medical Assistance,,,,,Included in per diem rate,
"Cat Epithelium, Ige",,86003,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,22.908,49.8,,percent of total billed charges,,
"Cat Epithelium, Ige",,86003,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Cat Epithelium, Ige",,86003,CPT,Facility,Both,,,,46,39.1,13.1836,46,"Multiplan, Inc.","Multiplan, Inc.",43.24,94,,percent of total billed charges,,
"Cat Epithelium, Ige",,86003,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,39.744,86.4,,percent of total billed charges,,
"Cat Epithelium, Ige",,86003,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Cat Epithelium, Ige",,86003,CPT,Facility,Both,,,,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PPO,45.356,98.6,,percent of total billed charges,,
"Cat Epithelium, Ige",,86003,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,PrimeWest Health,Minnesota Senior Health Options (MSHO),23.667,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Cat Epithelium, Ige",,86003,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Cat Epithelium, Ige",,86003,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,PrimeWest Health,MinnesotaCare,23.6256,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Cat Epithelium, Ige",,86003,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Cat Epithelium, Ige",,86003,CPT,Facility,Both,,,,46,39.1,13.1836,46,Sanford Health Plan,Sanford Health Plan,42.32,92,,percent of total billed charges,,
"Cat Epithelium, Ige",,86003,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,"UCare Health, Inc.",Individual & Family Plan,25.921,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Cat Epithelium, Ige",,86003,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Cat Epithelium, Ige",,86003,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,"UCare Health, Inc.",Medical Assistance,23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Cat Epithelium, Ige",,86003,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Cat Epithelium, Ige",,86003,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,"UCare Health, Inc.",Medicare Advantage,23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Cat Epithelium, Ige",,86003,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Cat Epithelium, Ige",,86003,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Cat Epithelium, Ige",,86003,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Cat Epithelium, Ige",,86003,CPT,Facility,Both,,,,46,39.1,13.1836,46,UnitedHealthcare,Individual & Family,43.24,94,,percent of total billed charges,,
"Cat Epithelium, Ige",,86003,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,UnitedHealthcare,Medicare Advantage,22.54,49,,percent of total billed charges,,
"Cat Epithelium, Ige",,86003,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Cat Epithelium, Ige",,86003,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,22.08,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Cat Epithelium, Ige",,86003,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Cockroach, Ige",,86003,CPT,Facility,Both,,,,46,39.1,13.1836,46,Aetna,Commercial,42.32,92,,percent of total billed charges,,
"Cockroach, Ige",,86003,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,Aetna,Medicare Advantage,22.54,49,,percent of total billed charges,,
"Cockroach, Ige",,86003,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Cockroach, Ige",,86003,CPT,Facility,Both,,,,46,39.1,13.1836,46,Aetna,PPO,42.78,93,,percent of total billed charges,,
"Cockroach, Ige",,86003,CPT,Facility,Both,,,,46,39.1,13.1836,46,America's PPO,America's PPO,44.1738,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Cockroach, Ige",,86003,CPT,Facility,Both,,,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota, Federal Employee Program,45.264,98.4,,percent of total billed charges,,
"Cockroach, Ige",,86003,CPT,Facility,Both,,,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,46,100,,percent of total billed charges,,
"Cockroach, Ige",,86003,CPT,Facility,Both,,,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,High Value Network Plan,41.4,90,,percent of total billed charges,,
"Cockroach, Ige",,86003,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Medicare Advantage,22.54,49,,percent of total billed charges,,
"Cockroach, Ige",,86003,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Cockroach, Ige",,86003,CPT,Facility,Both,,,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,40.7422,88.57,,percent of total billed charges,,
"Cockroach, Ige",,86003,CPT,Facility,Both,,,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,13.1836,28.66,,percent of total billed charges,,
"Cockroach, Ige",,86003,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),22.54,49,,percent of total billed charges,,
"Cockroach, Ige",,86003,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Cockroach, Ige",,86003,CPT,Facility,Both,,,,46,39.1,13.1836,46,CorVel,Worker's Compensation,46,100,,percent of total billed charges,,
"Cockroach, Ige",,86003,CPT,Facility,Both,,,,46,39.1,13.1836,46,First Health Group Corporation,First Health Network,44.62,97,,percent of total billed charges,,
"Cockroach, Ige",,86003,CPT,Facility,Both,,,,46,39.1,13.1836,46,"Health Partners, Inc.",Commercial,43.516,94.6,,percent of total billed charges,,
"Cockroach, Ige",,86003,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,"Health Partners, Inc.",Medicare Advantage,22.54,49,,percent of total billed charges,,
"Cockroach, Ige",,86003,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Cockroach, Ige",,86003,CPT,Facility,Both,,,,46,39.1,13.1836,46,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),27.6,60,,percent of total billed charges,,
"Cockroach, Ige",,86003,CPT,Facility,Both,,,,46,39.1,13.1836,46,"Health Partners, Inc.",State of Minnesota Advantage Program,37.49,81.5,,percent of total billed charges,,
"Cockroach, Ige",,86003,CPT,Facility,Both,,,,46,39.1,13.1836,46,"Health Partners, Inc.",State Public Programs,23,50,,percent of total billed charges,,
"Cockroach, Ige",,86003,CPT,Facility,Both,,,,46,39.1,13.1836,46,Humana Insurance Company,Commercial PPO,43.7,95,,percent of total billed charges,,
"Cockroach, Ige",,86003,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,Humana Insurance Company,Medicare PPO,22.54,49,,percent of total billed charges,,
"Cockroach, Ige",,86003,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Cockroach, Ige",,86003,CPT,Facility,Both,,,,46,39.1,13.1836,46,Medica,Individual & Family,45.586,99.1,,percent of total billed charges,,
"Cockroach, Ige",,86003,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,Medica,Medica Advantage Solution,22.908,49.8,,percent of total billed charges,,
"Cockroach, Ige",,86003,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Cockroach, Ige",,86003,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,Medica,Medical Assistance,20.516,44.6,,percent of total billed charges,,
"Cockroach, Ige",,86003,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,Medica,Medical Assistance,,,,,Included in per diem rate,
"Cockroach, Ige",,86003,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,22.908,49.8,,percent of total billed charges,,
"Cockroach, Ige",,86003,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Cockroach, Ige",,86003,CPT,Facility,Both,,,,46,39.1,13.1836,46,"Multiplan, Inc.","Multiplan, Inc.",43.24,94,,percent of total billed charges,,
"Cockroach, Ige",,86003,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,39.744,86.4,,percent of total billed charges,,
"Cockroach, Ige",,86003,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Cockroach, Ige",,86003,CPT,Facility,Both,,,,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PPO,45.356,98.6,,percent of total billed charges,,
"Cockroach, Ige",,86003,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,PrimeWest Health,Minnesota Senior Health Options (MSHO),23.667,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Cockroach, Ige",,86003,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Cockroach, Ige",,86003,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,PrimeWest Health,MinnesotaCare,23.6256,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Cockroach, Ige",,86003,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Cockroach, Ige",,86003,CPT,Facility,Both,,,,46,39.1,13.1836,46,Sanford Health Plan,Sanford Health Plan,42.32,92,,percent of total billed charges,,
"Cockroach, Ige",,86003,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,"UCare Health, Inc.",Individual & Family Plan,25.921,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Cockroach, Ige",,86003,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Cockroach, Ige",,86003,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,"UCare Health, Inc.",Medical Assistance,23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Cockroach, Ige",,86003,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Cockroach, Ige",,86003,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,"UCare Health, Inc.",Medicare Advantage,23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Cockroach, Ige",,86003,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Cockroach, Ige",,86003,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Cockroach, Ige",,86003,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Cockroach, Ige",,86003,CPT,Facility,Both,,,,46,39.1,13.1836,46,UnitedHealthcare,Individual & Family,43.24,94,,percent of total billed charges,,
"Cockroach, Ige",,86003,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,UnitedHealthcare,Medicare Advantage,22.54,49,,percent of total billed charges,,
"Cockroach, Ige",,86003,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Cockroach, Ige",,86003,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,22.08,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Cockroach, Ige",,86003,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Cottonwood, Ige",,86003,CPT,Facility,Both,,,,49,41.65,14.0434,49,Aetna,Commercial,45.08,92,,percent of total billed charges,,
"Cottonwood, Ige",,86003,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,Aetna,Medicare Advantage,24.01,49,,percent of total billed charges,,
"Cottonwood, Ige",,86003,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Cottonwood, Ige",,86003,CPT,Facility,Both,,,,49,41.65,14.0434,49,Aetna,PPO,45.57,93,,percent of total billed charges,,
"Cottonwood, Ige",,86003,CPT,Facility,Both,,,,49,41.65,14.0434,49,America's PPO,America's PPO,47.0547,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Cottonwood, Ige",,86003,CPT,Facility,Both,,,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota, Federal Employee Program,48.216,98.4,,percent of total billed charges,,
"Cottonwood, Ige",,86003,CPT,Facility,Both,,,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,49,100,,percent of total billed charges,,
"Cottonwood, Ige",,86003,CPT,Facility,Both,,,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,High Value Network Plan,44.1,90,,percent of total billed charges,,
"Cottonwood, Ige",,86003,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Medicare Advantage,24.01,49,,percent of total billed charges,,
"Cottonwood, Ige",,86003,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Cottonwood, Ige",,86003,CPT,Facility,Both,,,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,43.3993,88.57,,percent of total billed charges,,
"Cottonwood, Ige",,86003,CPT,Facility,Both,,,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,14.0434,28.66,,percent of total billed charges,,
"Cottonwood, Ige",,86003,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),24.01,49,,percent of total billed charges,,
"Cottonwood, Ige",,86003,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Cottonwood, Ige",,86003,CPT,Facility,Both,,,,49,41.65,14.0434,49,CorVel,Worker's Compensation,49,100,,percent of total billed charges,,
"Cottonwood, Ige",,86003,CPT,Facility,Both,,,,49,41.65,14.0434,49,First Health Group Corporation,First Health Network,47.53,97,,percent of total billed charges,,
"Cottonwood, Ige",,86003,CPT,Facility,Both,,,,49,41.65,14.0434,49,"Health Partners, Inc.",Commercial,46.354,94.6,,percent of total billed charges,,
"Cottonwood, Ige",,86003,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,"Health Partners, Inc.",Medicare Advantage,24.01,49,,percent of total billed charges,,
"Cottonwood, Ige",,86003,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Cottonwood, Ige",,86003,CPT,Facility,Both,,,,49,41.65,14.0434,49,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),29.4,60,,percent of total billed charges,,
"Cottonwood, Ige",,86003,CPT,Facility,Both,,,,49,41.65,14.0434,49,"Health Partners, Inc.",State of Minnesota Advantage Program,39.935,81.5,,percent of total billed charges,,
"Cottonwood, Ige",,86003,CPT,Facility,Both,,,,49,41.65,14.0434,49,"Health Partners, Inc.",State Public Programs,24.5,50,,percent of total billed charges,,
"Cottonwood, Ige",,86003,CPT,Facility,Both,,,,49,41.65,14.0434,49,Humana Insurance Company,Commercial PPO,46.55,95,,percent of total billed charges,,
"Cottonwood, Ige",,86003,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,Humana Insurance Company,Medicare PPO,24.01,49,,percent of total billed charges,,
"Cottonwood, Ige",,86003,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Cottonwood, Ige",,86003,CPT,Facility,Both,,,,49,41.65,14.0434,49,Medica,Individual & Family,48.559,99.1,,percent of total billed charges,,
"Cottonwood, Ige",,86003,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,Medica,Medica Advantage Solution,24.402,49.8,,percent of total billed charges,,
"Cottonwood, Ige",,86003,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Cottonwood, Ige",,86003,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,Medica,Medical Assistance,21.854,44.6,,percent of total billed charges,,
"Cottonwood, Ige",,86003,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,Medica,Medical Assistance,,,,,Included in per diem rate,
"Cottonwood, Ige",,86003,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,24.402,49.8,,percent of total billed charges,,
"Cottonwood, Ige",,86003,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Cottonwood, Ige",,86003,CPT,Facility,Both,,,,49,41.65,14.0434,49,"Multiplan, Inc.","Multiplan, Inc.",46.06,94,,percent of total billed charges,,
"Cottonwood, Ige",,86003,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,42.336,86.4,,percent of total billed charges,,
"Cottonwood, Ige",,86003,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Cottonwood, Ige",,86003,CPT,Facility,Both,,,,49,41.65,14.0434,49,"Preferred One Administrative Services, INC.",PPO,48.314,98.6,,percent of total billed charges,,
"Cottonwood, Ige",,86003,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,PrimeWest Health,Minnesota Senior Health Options (MSHO),25.2105,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Cottonwood, Ige",,86003,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Cottonwood, Ige",,86003,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,PrimeWest Health,MinnesotaCare,25.1664,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Cottonwood, Ige",,86003,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Cottonwood, Ige",,86003,CPT,Facility,Both,,,,49,41.65,14.0434,49,Sanford Health Plan,Sanford Health Plan,45.08,92,,percent of total billed charges,,
"Cottonwood, Ige",,86003,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,"UCare Health, Inc.",Individual & Family Plan,27.6115,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Cottonwood, Ige",,86003,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Cottonwood, Ige",,86003,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,"UCare Health, Inc.",Medical Assistance,24.7303,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Cottonwood, Ige",,86003,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Cottonwood, Ige",,86003,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,"UCare Health, Inc.",Medicare Advantage,24.7303,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Cottonwood, Ige",,86003,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Cottonwood, Ige",,86003,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),24.7303,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Cottonwood, Ige",,86003,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Cottonwood, Ige",,86003,CPT,Facility,Both,,,,49,41.65,14.0434,49,UnitedHealthcare,Individual & Family,46.06,94,,percent of total billed charges,,
"Cottonwood, Ige",,86003,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,UnitedHealthcare,Medicare Advantage,24.01,49,,percent of total billed charges,,
"Cottonwood, Ige",,86003,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Cottonwood, Ige",,86003,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,23.52,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Cottonwood, Ige",,86003,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Dog Epithelium, Ige",,86003,CPT,Facility,Both,,,,46,39.1,13.1836,46,Aetna,Commercial,42.32,92,,percent of total billed charges,,
"Dog Epithelium, Ige",,86003,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,Aetna,Medicare Advantage,22.54,49,,percent of total billed charges,,
"Dog Epithelium, Ige",,86003,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Dog Epithelium, Ige",,86003,CPT,Facility,Both,,,,46,39.1,13.1836,46,Aetna,PPO,42.78,93,,percent of total billed charges,,
"Dog Epithelium, Ige",,86003,CPT,Facility,Both,,,,46,39.1,13.1836,46,America's PPO,America's PPO,44.1738,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Dog Epithelium, Ige",,86003,CPT,Facility,Both,,,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota, Federal Employee Program,45.264,98.4,,percent of total billed charges,,
"Dog Epithelium, Ige",,86003,CPT,Facility,Both,,,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,46,100,,percent of total billed charges,,
"Dog Epithelium, Ige",,86003,CPT,Facility,Both,,,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,High Value Network Plan,41.4,90,,percent of total billed charges,,
"Dog Epithelium, Ige",,86003,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Medicare Advantage,22.54,49,,percent of total billed charges,,
"Dog Epithelium, Ige",,86003,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Dog Epithelium, Ige",,86003,CPT,Facility,Both,,,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,40.7422,88.57,,percent of total billed charges,,
"Dog Epithelium, Ige",,86003,CPT,Facility,Both,,,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,13.1836,28.66,,percent of total billed charges,,
"Dog Epithelium, Ige",,86003,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),22.54,49,,percent of total billed charges,,
"Dog Epithelium, Ige",,86003,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Dog Epithelium, Ige",,86003,CPT,Facility,Both,,,,46,39.1,13.1836,46,CorVel,Worker's Compensation,46,100,,percent of total billed charges,,
"Dog Epithelium, Ige",,86003,CPT,Facility,Both,,,,46,39.1,13.1836,46,First Health Group Corporation,First Health Network,44.62,97,,percent of total billed charges,,
"Dog Epithelium, Ige",,86003,CPT,Facility,Both,,,,46,39.1,13.1836,46,"Health Partners, Inc.",Commercial,43.516,94.6,,percent of total billed charges,,
"Dog Epithelium, Ige",,86003,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,"Health Partners, Inc.",Medicare Advantage,22.54,49,,percent of total billed charges,,
"Dog Epithelium, Ige",,86003,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Dog Epithelium, Ige",,86003,CPT,Facility,Both,,,,46,39.1,13.1836,46,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),27.6,60,,percent of total billed charges,,
"Dog Epithelium, Ige",,86003,CPT,Facility,Both,,,,46,39.1,13.1836,46,"Health Partners, Inc.",State of Minnesota Advantage Program,37.49,81.5,,percent of total billed charges,,
"Dog Epithelium, Ige",,86003,CPT,Facility,Both,,,,46,39.1,13.1836,46,"Health Partners, Inc.",State Public Programs,23,50,,percent of total billed charges,,
"Dog Epithelium, Ige",,86003,CPT,Facility,Both,,,,46,39.1,13.1836,46,Humana Insurance Company,Commercial PPO,43.7,95,,percent of total billed charges,,
"Dog Epithelium, Ige",,86003,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,Humana Insurance Company,Medicare PPO,22.54,49,,percent of total billed charges,,
"Dog Epithelium, Ige",,86003,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Dog Epithelium, Ige",,86003,CPT,Facility,Both,,,,46,39.1,13.1836,46,Medica,Individual & Family,45.586,99.1,,percent of total billed charges,,
"Dog Epithelium, Ige",,86003,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,Medica,Medica Advantage Solution,22.908,49.8,,percent of total billed charges,,
"Dog Epithelium, Ige",,86003,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Dog Epithelium, Ige",,86003,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,Medica,Medical Assistance,20.516,44.6,,percent of total billed charges,,
"Dog Epithelium, Ige",,86003,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,Medica,Medical Assistance,,,,,Included in per diem rate,
"Dog Epithelium, Ige",,86003,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,22.908,49.8,,percent of total billed charges,,
"Dog Epithelium, Ige",,86003,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Dog Epithelium, Ige",,86003,CPT,Facility,Both,,,,46,39.1,13.1836,46,"Multiplan, Inc.","Multiplan, Inc.",43.24,94,,percent of total billed charges,,
"Dog Epithelium, Ige",,86003,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,39.744,86.4,,percent of total billed charges,,
"Dog Epithelium, Ige",,86003,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Dog Epithelium, Ige",,86003,CPT,Facility,Both,,,,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PPO,45.356,98.6,,percent of total billed charges,,
"Dog Epithelium, Ige",,86003,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,PrimeWest Health,Minnesota Senior Health Options (MSHO),23.667,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Dog Epithelium, Ige",,86003,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Dog Epithelium, Ige",,86003,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,PrimeWest Health,MinnesotaCare,23.6256,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Dog Epithelium, Ige",,86003,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Dog Epithelium, Ige",,86003,CPT,Facility,Both,,,,46,39.1,13.1836,46,Sanford Health Plan,Sanford Health Plan,42.32,92,,percent of total billed charges,,
"Dog Epithelium, Ige",,86003,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,"UCare Health, Inc.",Individual & Family Plan,25.921,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Dog Epithelium, Ige",,86003,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Dog Epithelium, Ige",,86003,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,"UCare Health, Inc.",Medical Assistance,23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Dog Epithelium, Ige",,86003,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Dog Epithelium, Ige",,86003,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,"UCare Health, Inc.",Medicare Advantage,23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Dog Epithelium, Ige",,86003,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Dog Epithelium, Ige",,86003,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Dog Epithelium, Ige",,86003,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Dog Epithelium, Ige",,86003,CPT,Facility,Both,,,,46,39.1,13.1836,46,UnitedHealthcare,Individual & Family,43.24,94,,percent of total billed charges,,
"Dog Epithelium, Ige",,86003,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,UnitedHealthcare,Medicare Advantage,22.54,49,,percent of total billed charges,,
"Dog Epithelium, Ige",,86003,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Dog Epithelium, Ige",,86003,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,22.08,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Dog Epithelium, Ige",,86003,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Oak, Ige",,86003,CPT,Facility,Both,,,,46,39.1,13.1836,46,Aetna,Commercial,42.32,92,,percent of total billed charges,,
"Oak, Ige",,86003,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,Aetna,Medicare Advantage,22.54,49,,percent of total billed charges,,
"Oak, Ige",,86003,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Oak, Ige",,86003,CPT,Facility,Both,,,,46,39.1,13.1836,46,Aetna,PPO,42.78,93,,percent of total billed charges,,
"Oak, Ige",,86003,CPT,Facility,Both,,,,46,39.1,13.1836,46,America's PPO,America's PPO,44.1738,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Oak, Ige",,86003,CPT,Facility,Both,,,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota, Federal Employee Program,45.264,98.4,,percent of total billed charges,,
"Oak, Ige",,86003,CPT,Facility,Both,,,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,46,100,,percent of total billed charges,,
"Oak, Ige",,86003,CPT,Facility,Both,,,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,High Value Network Plan,41.4,90,,percent of total billed charges,,
"Oak, Ige",,86003,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Medicare Advantage,22.54,49,,percent of total billed charges,,
"Oak, Ige",,86003,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Oak, Ige",,86003,CPT,Facility,Both,,,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,40.7422,88.57,,percent of total billed charges,,
"Oak, Ige",,86003,CPT,Facility,Both,,,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,13.1836,28.66,,percent of total billed charges,,
"Oak, Ige",,86003,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),22.54,49,,percent of total billed charges,,
"Oak, Ige",,86003,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Oak, Ige",,86003,CPT,Facility,Both,,,,46,39.1,13.1836,46,CorVel,Worker's Compensation,46,100,,percent of total billed charges,,
"Oak, Ige",,86003,CPT,Facility,Both,,,,46,39.1,13.1836,46,First Health Group Corporation,First Health Network,44.62,97,,percent of total billed charges,,
"Oak, Ige",,86003,CPT,Facility,Both,,,,46,39.1,13.1836,46,"Health Partners, Inc.",Commercial,43.516,94.6,,percent of total billed charges,,
"Oak, Ige",,86003,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,"Health Partners, Inc.",Medicare Advantage,22.54,49,,percent of total billed charges,,
"Oak, Ige",,86003,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Oak, Ige",,86003,CPT,Facility,Both,,,,46,39.1,13.1836,46,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),27.6,60,,percent of total billed charges,,
"Oak, Ige",,86003,CPT,Facility,Both,,,,46,39.1,13.1836,46,"Health Partners, Inc.",State of Minnesota Advantage Program,37.49,81.5,,percent of total billed charges,,
"Oak, Ige",,86003,CPT,Facility,Both,,,,46,39.1,13.1836,46,"Health Partners, Inc.",State Public Programs,23,50,,percent of total billed charges,,
"Oak, Ige",,86003,CPT,Facility,Both,,,,46,39.1,13.1836,46,Humana Insurance Company,Commercial PPO,43.7,95,,percent of total billed charges,,
"Oak, Ige",,86003,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,Humana Insurance Company,Medicare PPO,22.54,49,,percent of total billed charges,,
"Oak, Ige",,86003,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Oak, Ige",,86003,CPT,Facility,Both,,,,46,39.1,13.1836,46,Medica,Individual & Family,45.586,99.1,,percent of total billed charges,,
"Oak, Ige",,86003,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,Medica,Medica Advantage Solution,22.908,49.8,,percent of total billed charges,,
"Oak, Ige",,86003,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Oak, Ige",,86003,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,Medica,Medical Assistance,20.516,44.6,,percent of total billed charges,,
"Oak, Ige",,86003,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,Medica,Medical Assistance,,,,,Included in per diem rate,
"Oak, Ige",,86003,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,22.908,49.8,,percent of total billed charges,,
"Oak, Ige",,86003,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Oak, Ige",,86003,CPT,Facility,Both,,,,46,39.1,13.1836,46,"Multiplan, Inc.","Multiplan, Inc.",43.24,94,,percent of total billed charges,,
"Oak, Ige",,86003,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,39.744,86.4,,percent of total billed charges,,
"Oak, Ige",,86003,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Oak, Ige",,86003,CPT,Facility,Both,,,,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PPO,45.356,98.6,,percent of total billed charges,,
"Oak, Ige",,86003,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,PrimeWest Health,Minnesota Senior Health Options (MSHO),23.667,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Oak, Ige",,86003,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Oak, Ige",,86003,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,PrimeWest Health,MinnesotaCare,23.6256,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Oak, Ige",,86003,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Oak, Ige",,86003,CPT,Facility,Both,,,,46,39.1,13.1836,46,Sanford Health Plan,Sanford Health Plan,42.32,92,,percent of total billed charges,,
"Oak, Ige",,86003,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,"UCare Health, Inc.",Individual & Family Plan,25.921,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Oak, Ige",,86003,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Oak, Ige",,86003,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,"UCare Health, Inc.",Medical Assistance,23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Oak, Ige",,86003,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Oak, Ige",,86003,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,"UCare Health, Inc.",Medicare Advantage,23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Oak, Ige",,86003,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Oak, Ige",,86003,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Oak, Ige",,86003,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Oak, Ige",,86003,CPT,Facility,Both,,,,46,39.1,13.1836,46,UnitedHealthcare,Individual & Family,43.24,94,,percent of total billed charges,,
"Oak, Ige",,86003,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,UnitedHealthcare,Medicare Advantage,22.54,49,,percent of total billed charges,,
"Oak, Ige",,86003,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Oak, Ige",,86003,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,22.08,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Oak, Ige",,86003,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Short Ragweed, Ige",,86003,CPT,Facility,Both,,,,46,39.1,13.1836,46,Aetna,Commercial,42.32,92,,percent of total billed charges,,
"Short Ragweed, Ige",,86003,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,Aetna,Medicare Advantage,22.54,49,,percent of total billed charges,,
"Short Ragweed, Ige",,86003,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Short Ragweed, Ige",,86003,CPT,Facility,Both,,,,46,39.1,13.1836,46,Aetna,PPO,42.78,93,,percent of total billed charges,,
"Short Ragweed, Ige",,86003,CPT,Facility,Both,,,,46,39.1,13.1836,46,America's PPO,America's PPO,44.1738,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Short Ragweed, Ige",,86003,CPT,Facility,Both,,,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota, Federal Employee Program,45.264,98.4,,percent of total billed charges,,
"Short Ragweed, Ige",,86003,CPT,Facility,Both,,,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,46,100,,percent of total billed charges,,
"Short Ragweed, Ige",,86003,CPT,Facility,Both,,,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,High Value Network Plan,41.4,90,,percent of total billed charges,,
"Short Ragweed, Ige",,86003,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Medicare Advantage,22.54,49,,percent of total billed charges,,
"Short Ragweed, Ige",,86003,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Short Ragweed, Ige",,86003,CPT,Facility,Both,,,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,40.7422,88.57,,percent of total billed charges,,
"Short Ragweed, Ige",,86003,CPT,Facility,Both,,,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,13.1836,28.66,,percent of total billed charges,,
"Short Ragweed, Ige",,86003,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),22.54,49,,percent of total billed charges,,
"Short Ragweed, Ige",,86003,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Short Ragweed, Ige",,86003,CPT,Facility,Both,,,,46,39.1,13.1836,46,CorVel,Worker's Compensation,46,100,,percent of total billed charges,,
"Short Ragweed, Ige",,86003,CPT,Facility,Both,,,,46,39.1,13.1836,46,First Health Group Corporation,First Health Network,44.62,97,,percent of total billed charges,,
"Short Ragweed, Ige",,86003,CPT,Facility,Both,,,,46,39.1,13.1836,46,"Health Partners, Inc.",Commercial,43.516,94.6,,percent of total billed charges,,
"Short Ragweed, Ige",,86003,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,"Health Partners, Inc.",Medicare Advantage,22.54,49,,percent of total billed charges,,
"Short Ragweed, Ige",,86003,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Short Ragweed, Ige",,86003,CPT,Facility,Both,,,,46,39.1,13.1836,46,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),27.6,60,,percent of total billed charges,,
"Short Ragweed, Ige",,86003,CPT,Facility,Both,,,,46,39.1,13.1836,46,"Health Partners, Inc.",State of Minnesota Advantage Program,37.49,81.5,,percent of total billed charges,,
"Short Ragweed, Ige",,86003,CPT,Facility,Both,,,,46,39.1,13.1836,46,"Health Partners, Inc.",State Public Programs,23,50,,percent of total billed charges,,
"Short Ragweed, Ige",,86003,CPT,Facility,Both,,,,46,39.1,13.1836,46,Humana Insurance Company,Commercial PPO,43.7,95,,percent of total billed charges,,
"Short Ragweed, Ige",,86003,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,Humana Insurance Company,Medicare PPO,22.54,49,,percent of total billed charges,,
"Short Ragweed, Ige",,86003,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Short Ragweed, Ige",,86003,CPT,Facility,Both,,,,46,39.1,13.1836,46,Medica,Individual & Family,45.586,99.1,,percent of total billed charges,,
"Short Ragweed, Ige",,86003,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,Medica,Medica Advantage Solution,22.908,49.8,,percent of total billed charges,,
"Short Ragweed, Ige",,86003,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Short Ragweed, Ige",,86003,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,Medica,Medical Assistance,20.516,44.6,,percent of total billed charges,,
"Short Ragweed, Ige",,86003,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,Medica,Medical Assistance,,,,,Included in per diem rate,
"Short Ragweed, Ige",,86003,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,22.908,49.8,,percent of total billed charges,,
"Short Ragweed, Ige",,86003,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Short Ragweed, Ige",,86003,CPT,Facility,Both,,,,46,39.1,13.1836,46,"Multiplan, Inc.","Multiplan, Inc.",43.24,94,,percent of total billed charges,,
"Short Ragweed, Ige",,86003,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,39.744,86.4,,percent of total billed charges,,
"Short Ragweed, Ige",,86003,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Short Ragweed, Ige",,86003,CPT,Facility,Both,,,,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PPO,45.356,98.6,,percent of total billed charges,,
"Short Ragweed, Ige",,86003,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,PrimeWest Health,Minnesota Senior Health Options (MSHO),23.667,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Short Ragweed, Ige",,86003,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Short Ragweed, Ige",,86003,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,PrimeWest Health,MinnesotaCare,23.6256,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Short Ragweed, Ige",,86003,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Short Ragweed, Ige",,86003,CPT,Facility,Both,,,,46,39.1,13.1836,46,Sanford Health Plan,Sanford Health Plan,42.32,92,,percent of total billed charges,,
"Short Ragweed, Ige",,86003,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,"UCare Health, Inc.",Individual & Family Plan,25.921,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Short Ragweed, Ige",,86003,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Short Ragweed, Ige",,86003,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,"UCare Health, Inc.",Medical Assistance,23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Short Ragweed, Ige",,86003,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Short Ragweed, Ige",,86003,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,"UCare Health, Inc.",Medicare Advantage,23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Short Ragweed, Ige",,86003,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Short Ragweed, Ige",,86003,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Short Ragweed, Ige",,86003,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Short Ragweed, Ige",,86003,CPT,Facility,Both,,,,46,39.1,13.1836,46,UnitedHealthcare,Individual & Family,43.24,94,,percent of total billed charges,,
"Short Ragweed, Ige",,86003,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,UnitedHealthcare,Medicare Advantage,22.54,49,,percent of total billed charges,,
"Short Ragweed, Ige",,86003,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Short Ragweed, Ige",,86003,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,22.08,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Short Ragweed, Ige",,86003,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Timothy Grass, Ige",,86003,CPT,Facility,Both,,,,46,39.1,13.1836,46,Aetna,Commercial,42.32,92,,percent of total billed charges,,
"Timothy Grass, Ige",,86003,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,Aetna,Medicare Advantage,22.54,49,,percent of total billed charges,,
"Timothy Grass, Ige",,86003,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Timothy Grass, Ige",,86003,CPT,Facility,Both,,,,46,39.1,13.1836,46,Aetna,PPO,42.78,93,,percent of total billed charges,,
"Timothy Grass, Ige",,86003,CPT,Facility,Both,,,,46,39.1,13.1836,46,America's PPO,America's PPO,44.1738,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Timothy Grass, Ige",,86003,CPT,Facility,Both,,,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota, Federal Employee Program,45.264,98.4,,percent of total billed charges,,
"Timothy Grass, Ige",,86003,CPT,Facility,Both,,,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,46,100,,percent of total billed charges,,
"Timothy Grass, Ige",,86003,CPT,Facility,Both,,,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,High Value Network Plan,41.4,90,,percent of total billed charges,,
"Timothy Grass, Ige",,86003,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Medicare Advantage,22.54,49,,percent of total billed charges,,
"Timothy Grass, Ige",,86003,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Timothy Grass, Ige",,86003,CPT,Facility,Both,,,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,40.7422,88.57,,percent of total billed charges,,
"Timothy Grass, Ige",,86003,CPT,Facility,Both,,,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,13.1836,28.66,,percent of total billed charges,,
"Timothy Grass, Ige",,86003,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),22.54,49,,percent of total billed charges,,
"Timothy Grass, Ige",,86003,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Timothy Grass, Ige",,86003,CPT,Facility,Both,,,,46,39.1,13.1836,46,CorVel,Worker's Compensation,46,100,,percent of total billed charges,,
"Timothy Grass, Ige",,86003,CPT,Facility,Both,,,,46,39.1,13.1836,46,First Health Group Corporation,First Health Network,44.62,97,,percent of total billed charges,,
"Timothy Grass, Ige",,86003,CPT,Facility,Both,,,,46,39.1,13.1836,46,"Health Partners, Inc.",Commercial,43.516,94.6,,percent of total billed charges,,
"Timothy Grass, Ige",,86003,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,"Health Partners, Inc.",Medicare Advantage,22.54,49,,percent of total billed charges,,
"Timothy Grass, Ige",,86003,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Timothy Grass, Ige",,86003,CPT,Facility,Both,,,,46,39.1,13.1836,46,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),27.6,60,,percent of total billed charges,,
"Timothy Grass, Ige",,86003,CPT,Facility,Both,,,,46,39.1,13.1836,46,"Health Partners, Inc.",State of Minnesota Advantage Program,37.49,81.5,,percent of total billed charges,,
"Timothy Grass, Ige",,86003,CPT,Facility,Both,,,,46,39.1,13.1836,46,"Health Partners, Inc.",State Public Programs,23,50,,percent of total billed charges,,
"Timothy Grass, Ige",,86003,CPT,Facility,Both,,,,46,39.1,13.1836,46,Humana Insurance Company,Commercial PPO,43.7,95,,percent of total billed charges,,
"Timothy Grass, Ige",,86003,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,Humana Insurance Company,Medicare PPO,22.54,49,,percent of total billed charges,,
"Timothy Grass, Ige",,86003,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Timothy Grass, Ige",,86003,CPT,Facility,Both,,,,46,39.1,13.1836,46,Medica,Individual & Family,45.586,99.1,,percent of total billed charges,,
"Timothy Grass, Ige",,86003,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,Medica,Medica Advantage Solution,22.908,49.8,,percent of total billed charges,,
"Timothy Grass, Ige",,86003,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Timothy Grass, Ige",,86003,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,Medica,Medical Assistance,20.516,44.6,,percent of total billed charges,,
"Timothy Grass, Ige",,86003,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,Medica,Medical Assistance,,,,,Included in per diem rate,
"Timothy Grass, Ige",,86003,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,22.908,49.8,,percent of total billed charges,,
"Timothy Grass, Ige",,86003,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Timothy Grass, Ige",,86003,CPT,Facility,Both,,,,46,39.1,13.1836,46,"Multiplan, Inc.","Multiplan, Inc.",43.24,94,,percent of total billed charges,,
"Timothy Grass, Ige",,86003,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,39.744,86.4,,percent of total billed charges,,
"Timothy Grass, Ige",,86003,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Timothy Grass, Ige",,86003,CPT,Facility,Both,,,,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PPO,45.356,98.6,,percent of total billed charges,,
"Timothy Grass, Ige",,86003,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,PrimeWest Health,Minnesota Senior Health Options (MSHO),23.667,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Timothy Grass, Ige",,86003,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Timothy Grass, Ige",,86003,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,PrimeWest Health,MinnesotaCare,23.6256,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Timothy Grass, Ige",,86003,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Timothy Grass, Ige",,86003,CPT,Facility,Both,,,,46,39.1,13.1836,46,Sanford Health Plan,Sanford Health Plan,42.32,92,,percent of total billed charges,,
"Timothy Grass, Ige",,86003,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,"UCare Health, Inc.",Individual & Family Plan,25.921,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Timothy Grass, Ige",,86003,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Timothy Grass, Ige",,86003,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,"UCare Health, Inc.",Medical Assistance,23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Timothy Grass, Ige",,86003,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Timothy Grass, Ige",,86003,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,"UCare Health, Inc.",Medicare Advantage,23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Timothy Grass, Ige",,86003,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Timothy Grass, Ige",,86003,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Timothy Grass, Ige",,86003,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Timothy Grass, Ige",,86003,CPT,Facility,Both,,,,46,39.1,13.1836,46,UnitedHealthcare,Individual & Family,43.24,94,,percent of total billed charges,,
"Timothy Grass, Ige",,86003,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,UnitedHealthcare,Medicare Advantage,22.54,49,,percent of total billed charges,,
"Timothy Grass, Ige",,86003,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Timothy Grass, Ige",,86003,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,22.08,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Timothy Grass, Ige",,86003,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Antinuclear Ab Screen,,86038,CPT,Facility,Both,,,,129,109.65,36.9714,129,Aetna,Commercial,118.68,92,,percent of total billed charges,,
Antinuclear Ab Screen,,86038,CPT,Facility,Outpatient,,,,129,109.65,36.9714,129,Aetna,Medicare Advantage,63.21,49,,percent of total billed charges,,
Antinuclear Ab Screen,,86038,CPT,Facility,Inpatient,,,,129,109.65,36.9714,129,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Antinuclear Ab Screen,,86038,CPT,Facility,Both,,,,129,109.65,36.9714,129,Aetna,PPO,119.97,93,,percent of total billed charges,,
Antinuclear Ab Screen,,86038,CPT,Facility,Both,,,,129,109.65,36.9714,129,America's PPO,America's PPO,123.8787,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Antinuclear Ab Screen,,86038,CPT,Facility,Both,,,,129,109.65,36.9714,129,BlueCross BlueShield Minnesota, Federal Employee Program,126.936,98.4,,percent of total billed charges,,
Antinuclear Ab Screen,,86038,CPT,Facility,Both,,,,129,109.65,36.9714,129,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,129,100,,percent of total billed charges,,
Antinuclear Ab Screen,,86038,CPT,Facility,Both,,,,129,109.65,36.9714,129,BlueCross BlueShield Minnesota,High Value Network Plan,116.1,90,,percent of total billed charges,,
Antinuclear Ab Screen,,86038,CPT,Facility,Outpatient,,,,129,109.65,36.9714,129,BlueCross BlueShield Minnesota,Medicare Advantage,63.21,49,,percent of total billed charges,,
Antinuclear Ab Screen,,86038,CPT,Facility,Inpatient,,,,129,109.65,36.9714,129,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Antinuclear Ab Screen,,86038,CPT,Facility,Both,,,,129,109.65,36.9714,129,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,114.2553,88.57,,percent of total billed charges,,
Antinuclear Ab Screen,,86038,CPT,Facility,Both,,,,129,109.65,36.9714,129,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,36.9714,28.66,,percent of total billed charges,,
Antinuclear Ab Screen,,86038,CPT,Facility,Outpatient,,,,129,109.65,36.9714,129,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),63.21,49,,percent of total billed charges,,
Antinuclear Ab Screen,,86038,CPT,Facility,Inpatient,,,,129,109.65,36.9714,129,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Antinuclear Ab Screen,,86038,CPT,Facility,Both,,,,129,109.65,36.9714,129,CorVel,Worker's Compensation,129,100,,percent of total billed charges,,
Antinuclear Ab Screen,,86038,CPT,Facility,Both,,,,129,109.65,36.9714,129,First Health Group Corporation,First Health Network,125.13,97,,percent of total billed charges,,
Antinuclear Ab Screen,,86038,CPT,Facility,Both,,,,129,109.65,36.9714,129,"Health Partners, Inc.",Commercial,122.034,94.6,,percent of total billed charges,,
Antinuclear Ab Screen,,86038,CPT,Facility,Outpatient,,,,129,109.65,36.9714,129,"Health Partners, Inc.",Medicare Advantage,63.21,49,,percent of total billed charges,,
Antinuclear Ab Screen,,86038,CPT,Facility,Inpatient,,,,129,109.65,36.9714,129,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Antinuclear Ab Screen,,86038,CPT,Facility,Both,,,,129,109.65,36.9714,129,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),77.4,60,,percent of total billed charges,,
Antinuclear Ab Screen,,86038,CPT,Facility,Both,,,,129,109.65,36.9714,129,"Health Partners, Inc.",State of Minnesota Advantage Program,105.135,81.5,,percent of total billed charges,,
Antinuclear Ab Screen,,86038,CPT,Facility,Both,,,,129,109.65,36.9714,129,"Health Partners, Inc.",State Public Programs,64.5,50,,percent of total billed charges,,
Antinuclear Ab Screen,,86038,CPT,Facility,Both,,,,129,109.65,36.9714,129,Humana Insurance Company,Commercial PPO,122.55,95,,percent of total billed charges,,
Antinuclear Ab Screen,,86038,CPT,Facility,Outpatient,,,,129,109.65,36.9714,129,Humana Insurance Company,Medicare PPO,63.21,49,,percent of total billed charges,,
Antinuclear Ab Screen,,86038,CPT,Facility,Inpatient,,,,129,109.65,36.9714,129,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Antinuclear Ab Screen,,86038,CPT,Facility,Both,,,,129,109.65,36.9714,129,Medica,Individual & Family,127.839,99.1,,percent of total billed charges,,
Antinuclear Ab Screen,,86038,CPT,Facility,Outpatient,,,,129,109.65,36.9714,129,Medica,Medica Advantage Solution,64.242,49.8,,percent of total billed charges,,
Antinuclear Ab Screen,,86038,CPT,Facility,Inpatient,,,,129,109.65,36.9714,129,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Antinuclear Ab Screen,,86038,CPT,Facility,Outpatient,,,,129,109.65,36.9714,129,Medica,Medical Assistance,57.534,44.6,,percent of total billed charges,,
Antinuclear Ab Screen,,86038,CPT,Facility,Inpatient,,,,129,109.65,36.9714,129,Medica,Medical Assistance,,,,,Included in per diem rate,
Antinuclear Ab Screen,,86038,CPT,Facility,Outpatient,,,,129,109.65,36.9714,129,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,64.242,49.8,,percent of total billed charges,,
Antinuclear Ab Screen,,86038,CPT,Facility,Inpatient,,,,129,109.65,36.9714,129,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Antinuclear Ab Screen,,86038,CPT,Facility,Both,,,,129,109.65,36.9714,129,"Multiplan, Inc.","Multiplan, Inc.",121.26,94,,percent of total billed charges,,
Antinuclear Ab Screen,,86038,CPT,Facility,Outpatient,,,,129,109.65,36.9714,129,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,111.456,86.4,,percent of total billed charges,,
Antinuclear Ab Screen,,86038,CPT,Facility,Inpatient,,,,129,109.65,36.9714,129,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Antinuclear Ab Screen,,86038,CPT,Facility,Both,,,,129,109.65,36.9714,129,"Preferred One Administrative Services, INC.",PPO,127.194,98.6,,percent of total billed charges,,
Antinuclear Ab Screen,,86038,CPT,Facility,Outpatient,,,,129,109.65,36.9714,129,PrimeWest Health,Minnesota Senior Health Options (MSHO),66.3705,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Antinuclear Ab Screen,,86038,CPT,Facility,Inpatient,,,,129,109.65,36.9714,129,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Antinuclear Ab Screen,,86038,CPT,Facility,Outpatient,,,,129,109.65,36.9714,129,PrimeWest Health,MinnesotaCare,66.2544,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Antinuclear Ab Screen,,86038,CPT,Facility,Inpatient,,,,129,109.65,36.9714,129,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Antinuclear Ab Screen,,86038,CPT,Facility,Both,,,,129,109.65,36.9714,129,Sanford Health Plan,Sanford Health Plan,118.68,92,,percent of total billed charges,,
Antinuclear Ab Screen,,86038,CPT,Facility,Outpatient,,,,129,109.65,36.9714,129,"UCare Health, Inc.",Individual & Family Plan,72.6915,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Antinuclear Ab Screen,,86038,CPT,Facility,Inpatient,,,,129,109.65,36.9714,129,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Antinuclear Ab Screen,,86038,CPT,Facility,Outpatient,,,,129,109.65,36.9714,129,"UCare Health, Inc.",Medical Assistance,65.1063,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Antinuclear Ab Screen,,86038,CPT,Facility,Inpatient,,,,129,109.65,36.9714,129,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Antinuclear Ab Screen,,86038,CPT,Facility,Outpatient,,,,129,109.65,36.9714,129,"UCare Health, Inc.",Medicare Advantage,65.1063,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Antinuclear Ab Screen,,86038,CPT,Facility,Inpatient,,,,129,109.65,36.9714,129,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Antinuclear Ab Screen,,86038,CPT,Facility,Outpatient,,,,129,109.65,36.9714,129,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),65.1063,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Antinuclear Ab Screen,,86038,CPT,Facility,Inpatient,,,,129,109.65,36.9714,129,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Antinuclear Ab Screen,,86038,CPT,Facility,Both,,,,129,109.65,36.9714,129,UnitedHealthcare,Individual & Family,121.26,94,,percent of total billed charges,,
Antinuclear Ab Screen,,86038,CPT,Facility,Outpatient,,,,129,109.65,36.9714,129,UnitedHealthcare,Medicare Advantage,63.21,49,,percent of total billed charges,,
Antinuclear Ab Screen,,86038,CPT,Facility,Inpatient,,,,129,109.65,36.9714,129,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Antinuclear Ab Screen,,86038,CPT,Facility,Outpatient,,,,129,109.65,36.9714,129,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,61.92,48,,percent of total billed charges,,100% of DHS outpatient percentage
Antinuclear Ab Screen,,86038,CPT,Facility,Inpatient,,,,129,109.65,36.9714,129,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Antinuclear Abs Cascade,,86038,CPT,Facility,Both,,,,129,109.65,36.9714,129,Aetna,Commercial,118.68,92,,percent of total billed charges,,
Antinuclear Abs Cascade,,86038,CPT,Facility,Outpatient,,,,129,109.65,36.9714,129,Aetna,Medicare Advantage,63.21,49,,percent of total billed charges,,
Antinuclear Abs Cascade,,86038,CPT,Facility,Inpatient,,,,129,109.65,36.9714,129,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Antinuclear Abs Cascade,,86038,CPT,Facility,Both,,,,129,109.65,36.9714,129,Aetna,PPO,119.97,93,,percent of total billed charges,,
Antinuclear Abs Cascade,,86038,CPT,Facility,Both,,,,129,109.65,36.9714,129,America's PPO,America's PPO,123.8787,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Antinuclear Abs Cascade,,86038,CPT,Facility,Both,,,,129,109.65,36.9714,129,BlueCross BlueShield Minnesota, Federal Employee Program,126.936,98.4,,percent of total billed charges,,
Antinuclear Abs Cascade,,86038,CPT,Facility,Both,,,,129,109.65,36.9714,129,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,129,100,,percent of total billed charges,,
Antinuclear Abs Cascade,,86038,CPT,Facility,Both,,,,129,109.65,36.9714,129,BlueCross BlueShield Minnesota,High Value Network Plan,116.1,90,,percent of total billed charges,,
Antinuclear Abs Cascade,,86038,CPT,Facility,Outpatient,,,,129,109.65,36.9714,129,BlueCross BlueShield Minnesota,Medicare Advantage,63.21,49,,percent of total billed charges,,
Antinuclear Abs Cascade,,86038,CPT,Facility,Inpatient,,,,129,109.65,36.9714,129,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Antinuclear Abs Cascade,,86038,CPT,Facility,Both,,,,129,109.65,36.9714,129,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,114.2553,88.57,,percent of total billed charges,,
Antinuclear Abs Cascade,,86038,CPT,Facility,Both,,,,129,109.65,36.9714,129,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,36.9714,28.66,,percent of total billed charges,,
Antinuclear Abs Cascade,,86038,CPT,Facility,Outpatient,,,,129,109.65,36.9714,129,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),63.21,49,,percent of total billed charges,,
Antinuclear Abs Cascade,,86038,CPT,Facility,Inpatient,,,,129,109.65,36.9714,129,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Antinuclear Abs Cascade,,86038,CPT,Facility,Both,,,,129,109.65,36.9714,129,CorVel,Worker's Compensation,129,100,,percent of total billed charges,,
Antinuclear Abs Cascade,,86038,CPT,Facility,Both,,,,129,109.65,36.9714,129,First Health Group Corporation,First Health Network,125.13,97,,percent of total billed charges,,
Antinuclear Abs Cascade,,86038,CPT,Facility,Both,,,,129,109.65,36.9714,129,"Health Partners, Inc.",Commercial,122.034,94.6,,percent of total billed charges,,
Antinuclear Abs Cascade,,86038,CPT,Facility,Outpatient,,,,129,109.65,36.9714,129,"Health Partners, Inc.",Medicare Advantage,63.21,49,,percent of total billed charges,,
Antinuclear Abs Cascade,,86038,CPT,Facility,Inpatient,,,,129,109.65,36.9714,129,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Antinuclear Abs Cascade,,86038,CPT,Facility,Both,,,,129,109.65,36.9714,129,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),77.4,60,,percent of total billed charges,,
Antinuclear Abs Cascade,,86038,CPT,Facility,Both,,,,129,109.65,36.9714,129,"Health Partners, Inc.",State of Minnesota Advantage Program,105.135,81.5,,percent of total billed charges,,
Antinuclear Abs Cascade,,86038,CPT,Facility,Both,,,,129,109.65,36.9714,129,"Health Partners, Inc.",State Public Programs,64.5,50,,percent of total billed charges,,
Antinuclear Abs Cascade,,86038,CPT,Facility,Both,,,,129,109.65,36.9714,129,Humana Insurance Company,Commercial PPO,122.55,95,,percent of total billed charges,,
Antinuclear Abs Cascade,,86038,CPT,Facility,Outpatient,,,,129,109.65,36.9714,129,Humana Insurance Company,Medicare PPO,63.21,49,,percent of total billed charges,,
Antinuclear Abs Cascade,,86038,CPT,Facility,Inpatient,,,,129,109.65,36.9714,129,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Antinuclear Abs Cascade,,86038,CPT,Facility,Both,,,,129,109.65,36.9714,129,Medica,Individual & Family,127.839,99.1,,percent of total billed charges,,
Antinuclear Abs Cascade,,86038,CPT,Facility,Outpatient,,,,129,109.65,36.9714,129,Medica,Medica Advantage Solution,64.242,49.8,,percent of total billed charges,,
Antinuclear Abs Cascade,,86038,CPT,Facility,Inpatient,,,,129,109.65,36.9714,129,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Antinuclear Abs Cascade,,86038,CPT,Facility,Outpatient,,,,129,109.65,36.9714,129,Medica,Medical Assistance,57.534,44.6,,percent of total billed charges,,
Antinuclear Abs Cascade,,86038,CPT,Facility,Inpatient,,,,129,109.65,36.9714,129,Medica,Medical Assistance,,,,,Included in per diem rate,
Antinuclear Abs Cascade,,86038,CPT,Facility,Outpatient,,,,129,109.65,36.9714,129,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,64.242,49.8,,percent of total billed charges,,
Antinuclear Abs Cascade,,86038,CPT,Facility,Inpatient,,,,129,109.65,36.9714,129,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Antinuclear Abs Cascade,,86038,CPT,Facility,Both,,,,129,109.65,36.9714,129,"Multiplan, Inc.","Multiplan, Inc.",121.26,94,,percent of total billed charges,,
Antinuclear Abs Cascade,,86038,CPT,Facility,Outpatient,,,,129,109.65,36.9714,129,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,111.456,86.4,,percent of total billed charges,,
Antinuclear Abs Cascade,,86038,CPT,Facility,Inpatient,,,,129,109.65,36.9714,129,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Antinuclear Abs Cascade,,86038,CPT,Facility,Both,,,,129,109.65,36.9714,129,"Preferred One Administrative Services, INC.",PPO,127.194,98.6,,percent of total billed charges,,
Antinuclear Abs Cascade,,86038,CPT,Facility,Outpatient,,,,129,109.65,36.9714,129,PrimeWest Health,Minnesota Senior Health Options (MSHO),66.3705,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Antinuclear Abs Cascade,,86038,CPT,Facility,Inpatient,,,,129,109.65,36.9714,129,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Antinuclear Abs Cascade,,86038,CPT,Facility,Outpatient,,,,129,109.65,36.9714,129,PrimeWest Health,MinnesotaCare,66.2544,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Antinuclear Abs Cascade,,86038,CPT,Facility,Inpatient,,,,129,109.65,36.9714,129,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Antinuclear Abs Cascade,,86038,CPT,Facility,Both,,,,129,109.65,36.9714,129,Sanford Health Plan,Sanford Health Plan,118.68,92,,percent of total billed charges,,
Antinuclear Abs Cascade,,86038,CPT,Facility,Outpatient,,,,129,109.65,36.9714,129,"UCare Health, Inc.",Individual & Family Plan,72.6915,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Antinuclear Abs Cascade,,86038,CPT,Facility,Inpatient,,,,129,109.65,36.9714,129,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Antinuclear Abs Cascade,,86038,CPT,Facility,Outpatient,,,,129,109.65,36.9714,129,"UCare Health, Inc.",Medical Assistance,65.1063,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Antinuclear Abs Cascade,,86038,CPT,Facility,Inpatient,,,,129,109.65,36.9714,129,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Antinuclear Abs Cascade,,86038,CPT,Facility,Outpatient,,,,129,109.65,36.9714,129,"UCare Health, Inc.",Medicare Advantage,65.1063,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Antinuclear Abs Cascade,,86038,CPT,Facility,Inpatient,,,,129,109.65,36.9714,129,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Antinuclear Abs Cascade,,86038,CPT,Facility,Outpatient,,,,129,109.65,36.9714,129,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),65.1063,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Antinuclear Abs Cascade,,86038,CPT,Facility,Inpatient,,,,129,109.65,36.9714,129,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Antinuclear Abs Cascade,,86038,CPT,Facility,Both,,,,129,109.65,36.9714,129,UnitedHealthcare,Individual & Family,121.26,94,,percent of total billed charges,,
Antinuclear Abs Cascade,,86038,CPT,Facility,Outpatient,,,,129,109.65,36.9714,129,UnitedHealthcare,Medicare Advantage,63.21,49,,percent of total billed charges,,
Antinuclear Abs Cascade,,86038,CPT,Facility,Inpatient,,,,129,109.65,36.9714,129,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Antinuclear Abs Cascade,,86038,CPT,Facility,Outpatient,,,,129,109.65,36.9714,129,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,61.92,48,,percent of total billed charges,,100% of DHS outpatient percentage
Antinuclear Abs Cascade,,86038,CPT,Facility,Inpatient,,,,129,109.65,36.9714,129,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Streptolysin O Ab Titer,,86060,CPT,Facility,Both,,,,65,55.25,18.629,65,Aetna,Commercial,59.8,92,,percent of total billed charges,,
Streptolysin O Ab Titer,,86060,CPT,Facility,Outpatient,,,,65,55.25,18.629,65,Aetna,Medicare Advantage,31.85,49,,percent of total billed charges,,
Streptolysin O Ab Titer,,86060,CPT,Facility,Inpatient,,,,65,55.25,18.629,65,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Streptolysin O Ab Titer,,86060,CPT,Facility,Both,,,,65,55.25,18.629,65,Aetna,PPO,60.45,93,,percent of total billed charges,,
Streptolysin O Ab Titer,,86060,CPT,Facility,Both,,,,65,55.25,18.629,65,America's PPO,America's PPO,62.4195,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Streptolysin O Ab Titer,,86060,CPT,Facility,Both,,,,65,55.25,18.629,65,BlueCross BlueShield Minnesota, Federal Employee Program,63.96,98.4,,percent of total billed charges,,
Streptolysin O Ab Titer,,86060,CPT,Facility,Both,,,,65,55.25,18.629,65,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,65,100,,percent of total billed charges,,
Streptolysin O Ab Titer,,86060,CPT,Facility,Both,,,,65,55.25,18.629,65,BlueCross BlueShield Minnesota,High Value Network Plan,58.5,90,,percent of total billed charges,,
Streptolysin O Ab Titer,,86060,CPT,Facility,Outpatient,,,,65,55.25,18.629,65,BlueCross BlueShield Minnesota,Medicare Advantage,31.85,49,,percent of total billed charges,,
Streptolysin O Ab Titer,,86060,CPT,Facility,Inpatient,,,,65,55.25,18.629,65,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Streptolysin O Ab Titer,,86060,CPT,Facility,Both,,,,65,55.25,18.629,65,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,57.5705,88.57,,percent of total billed charges,,
Streptolysin O Ab Titer,,86060,CPT,Facility,Both,,,,65,55.25,18.629,65,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,18.629,28.66,,percent of total billed charges,,
Streptolysin O Ab Titer,,86060,CPT,Facility,Outpatient,,,,65,55.25,18.629,65,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),31.85,49,,percent of total billed charges,,
Streptolysin O Ab Titer,,86060,CPT,Facility,Inpatient,,,,65,55.25,18.629,65,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Streptolysin O Ab Titer,,86060,CPT,Facility,Both,,,,65,55.25,18.629,65,CorVel,Worker's Compensation,65,100,,percent of total billed charges,,
Streptolysin O Ab Titer,,86060,CPT,Facility,Both,,,,65,55.25,18.629,65,First Health Group Corporation,First Health Network,63.05,97,,percent of total billed charges,,
Streptolysin O Ab Titer,,86060,CPT,Facility,Both,,,,65,55.25,18.629,65,"Health Partners, Inc.",Commercial,61.49,94.6,,percent of total billed charges,,
Streptolysin O Ab Titer,,86060,CPT,Facility,Outpatient,,,,65,55.25,18.629,65,"Health Partners, Inc.",Medicare Advantage,31.85,49,,percent of total billed charges,,
Streptolysin O Ab Titer,,86060,CPT,Facility,Inpatient,,,,65,55.25,18.629,65,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Streptolysin O Ab Titer,,86060,CPT,Facility,Both,,,,65,55.25,18.629,65,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),39,60,,percent of total billed charges,,
Streptolysin O Ab Titer,,86060,CPT,Facility,Both,,,,65,55.25,18.629,65,"Health Partners, Inc.",State of Minnesota Advantage Program,52.975,81.5,,percent of total billed charges,,
Streptolysin O Ab Titer,,86060,CPT,Facility,Both,,,,65,55.25,18.629,65,"Health Partners, Inc.",State Public Programs,32.5,50,,percent of total billed charges,,
Streptolysin O Ab Titer,,86060,CPT,Facility,Both,,,,65,55.25,18.629,65,Humana Insurance Company,Commercial PPO,61.75,95,,percent of total billed charges,,
Streptolysin O Ab Titer,,86060,CPT,Facility,Outpatient,,,,65,55.25,18.629,65,Humana Insurance Company,Medicare PPO,31.85,49,,percent of total billed charges,,
Streptolysin O Ab Titer,,86060,CPT,Facility,Inpatient,,,,65,55.25,18.629,65,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Streptolysin O Ab Titer,,86060,CPT,Facility,Both,,,,65,55.25,18.629,65,Medica,Individual & Family,64.415,99.1,,percent of total billed charges,,
Streptolysin O Ab Titer,,86060,CPT,Facility,Outpatient,,,,65,55.25,18.629,65,Medica,Medica Advantage Solution,32.37,49.8,,percent of total billed charges,,
Streptolysin O Ab Titer,,86060,CPT,Facility,Inpatient,,,,65,55.25,18.629,65,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Streptolysin O Ab Titer,,86060,CPT,Facility,Outpatient,,,,65,55.25,18.629,65,Medica,Medical Assistance,28.99,44.6,,percent of total billed charges,,
Streptolysin O Ab Titer,,86060,CPT,Facility,Inpatient,,,,65,55.25,18.629,65,Medica,Medical Assistance,,,,,Included in per diem rate,
Streptolysin O Ab Titer,,86060,CPT,Facility,Outpatient,,,,65,55.25,18.629,65,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,32.37,49.8,,percent of total billed charges,,
Streptolysin O Ab Titer,,86060,CPT,Facility,Inpatient,,,,65,55.25,18.629,65,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Streptolysin O Ab Titer,,86060,CPT,Facility,Both,,,,65,55.25,18.629,65,"Multiplan, Inc.","Multiplan, Inc.",61.1,94,,percent of total billed charges,,
Streptolysin O Ab Titer,,86060,CPT,Facility,Outpatient,,,,65,55.25,18.629,65,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,56.16,86.4,,percent of total billed charges,,
Streptolysin O Ab Titer,,86060,CPT,Facility,Inpatient,,,,65,55.25,18.629,65,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Streptolysin O Ab Titer,,86060,CPT,Facility,Both,,,,65,55.25,18.629,65,"Preferred One Administrative Services, INC.",PPO,64.09,98.6,,percent of total billed charges,,
Streptolysin O Ab Titer,,86060,CPT,Facility,Outpatient,,,,65,55.25,18.629,65,PrimeWest Health,Minnesota Senior Health Options (MSHO),33.4425,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Streptolysin O Ab Titer,,86060,CPT,Facility,Inpatient,,,,65,55.25,18.629,65,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Streptolysin O Ab Titer,,86060,CPT,Facility,Outpatient,,,,65,55.25,18.629,65,PrimeWest Health,MinnesotaCare,33.384,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Streptolysin O Ab Titer,,86060,CPT,Facility,Inpatient,,,,65,55.25,18.629,65,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Streptolysin O Ab Titer,,86060,CPT,Facility,Both,,,,65,55.25,18.629,65,Sanford Health Plan,Sanford Health Plan,59.8,92,,percent of total billed charges,,
Streptolysin O Ab Titer,,86060,CPT,Facility,Outpatient,,,,65,55.25,18.629,65,"UCare Health, Inc.",Individual & Family Plan,36.6275,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Streptolysin O Ab Titer,,86060,CPT,Facility,Inpatient,,,,65,55.25,18.629,65,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Streptolysin O Ab Titer,,86060,CPT,Facility,Outpatient,,,,65,55.25,18.629,65,"UCare Health, Inc.",Medical Assistance,32.8055,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Streptolysin O Ab Titer,,86060,CPT,Facility,Inpatient,,,,65,55.25,18.629,65,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Streptolysin O Ab Titer,,86060,CPT,Facility,Outpatient,,,,65,55.25,18.629,65,"UCare Health, Inc.",Medicare Advantage,32.8055,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Streptolysin O Ab Titer,,86060,CPT,Facility,Inpatient,,,,65,55.25,18.629,65,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Streptolysin O Ab Titer,,86060,CPT,Facility,Outpatient,,,,65,55.25,18.629,65,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),32.8055,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Streptolysin O Ab Titer,,86060,CPT,Facility,Inpatient,,,,65,55.25,18.629,65,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Streptolysin O Ab Titer,,86060,CPT,Facility,Both,,,,65,55.25,18.629,65,UnitedHealthcare,Individual & Family,61.1,94,,percent of total billed charges,,
Streptolysin O Ab Titer,,86060,CPT,Facility,Outpatient,,,,65,55.25,18.629,65,UnitedHealthcare,Medicare Advantage,31.85,49,,percent of total billed charges,,
Streptolysin O Ab Titer,,86060,CPT,Facility,Inpatient,,,,65,55.25,18.629,65,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Streptolysin O Ab Titer,,86060,CPT,Facility,Outpatient,,,,65,55.25,18.629,65,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,31.2,48,,percent of total billed charges,,100% of DHS outpatient percentage
Streptolysin O Ab Titer,,86060,CPT,Facility,Inpatient,,,,65,55.25,18.629,65,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"C Reactive Protein, Inflammatory",,86140,CPT,Facility,Both,,,,104,88.4,29.8064,104,Aetna,Commercial,95.68,92,,percent of total billed charges,,
"C Reactive Protein, Inflammatory",,86140,CPT,Facility,Outpatient,,,,104,88.4,29.8064,104,Aetna,Medicare Advantage,50.96,49,,percent of total billed charges,,
"C Reactive Protein, Inflammatory",,86140,CPT,Facility,Inpatient,,,,104,88.4,29.8064,104,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"C Reactive Protein, Inflammatory",,86140,CPT,Facility,Both,,,,104,88.4,29.8064,104,Aetna,PPO,96.72,93,,percent of total billed charges,,
"C Reactive Protein, Inflammatory",,86140,CPT,Facility,Both,,,,104,88.4,29.8064,104,America's PPO,America's PPO,99.8712,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"C Reactive Protein, Inflammatory",,86140,CPT,Facility,Both,,,,104,88.4,29.8064,104,BlueCross BlueShield Minnesota, Federal Employee Program,102.336,98.4,,percent of total billed charges,,
"C Reactive Protein, Inflammatory",,86140,CPT,Facility,Both,,,,104,88.4,29.8064,104,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,104,100,,percent of total billed charges,,
"C Reactive Protein, Inflammatory",,86140,CPT,Facility,Both,,,,104,88.4,29.8064,104,BlueCross BlueShield Minnesota,High Value Network Plan,93.6,90,,percent of total billed charges,,
"C Reactive Protein, Inflammatory",,86140,CPT,Facility,Outpatient,,,,104,88.4,29.8064,104,BlueCross BlueShield Minnesota,Medicare Advantage,50.96,49,,percent of total billed charges,,
"C Reactive Protein, Inflammatory",,86140,CPT,Facility,Inpatient,,,,104,88.4,29.8064,104,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"C Reactive Protein, Inflammatory",,86140,CPT,Facility,Both,,,,104,88.4,29.8064,104,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,92.1128,88.57,,percent of total billed charges,,
"C Reactive Protein, Inflammatory",,86140,CPT,Facility,Both,,,,104,88.4,29.8064,104,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,29.8064,28.66,,percent of total billed charges,,
"C Reactive Protein, Inflammatory",,86140,CPT,Facility,Outpatient,,,,104,88.4,29.8064,104,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),50.96,49,,percent of total billed charges,,
"C Reactive Protein, Inflammatory",,86140,CPT,Facility,Inpatient,,,,104,88.4,29.8064,104,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"C Reactive Protein, Inflammatory",,86140,CPT,Facility,Both,,,,104,88.4,29.8064,104,CorVel,Worker's Compensation,104,100,,percent of total billed charges,,
"C Reactive Protein, Inflammatory",,86140,CPT,Facility,Both,,,,104,88.4,29.8064,104,First Health Group Corporation,First Health Network,100.88,97,,percent of total billed charges,,
"C Reactive Protein, Inflammatory",,86140,CPT,Facility,Both,,,,104,88.4,29.8064,104,"Health Partners, Inc.",Commercial,98.384,94.6,,percent of total billed charges,,
"C Reactive Protein, Inflammatory",,86140,CPT,Facility,Outpatient,,,,104,88.4,29.8064,104,"Health Partners, Inc.",Medicare Advantage,50.96,49,,percent of total billed charges,,
"C Reactive Protein, Inflammatory",,86140,CPT,Facility,Inpatient,,,,104,88.4,29.8064,104,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"C Reactive Protein, Inflammatory",,86140,CPT,Facility,Both,,,,104,88.4,29.8064,104,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),62.4,60,,percent of total billed charges,,
"C Reactive Protein, Inflammatory",,86140,CPT,Facility,Both,,,,104,88.4,29.8064,104,"Health Partners, Inc.",State of Minnesota Advantage Program,84.76,81.5,,percent of total billed charges,,
"C Reactive Protein, Inflammatory",,86140,CPT,Facility,Both,,,,104,88.4,29.8064,104,"Health Partners, Inc.",State Public Programs,52,50,,percent of total billed charges,,
"C Reactive Protein, Inflammatory",,86140,CPT,Facility,Both,,,,104,88.4,29.8064,104,Humana Insurance Company,Commercial PPO,98.8,95,,percent of total billed charges,,
"C Reactive Protein, Inflammatory",,86140,CPT,Facility,Outpatient,,,,104,88.4,29.8064,104,Humana Insurance Company,Medicare PPO,50.96,49,,percent of total billed charges,,
"C Reactive Protein, Inflammatory",,86140,CPT,Facility,Inpatient,,,,104,88.4,29.8064,104,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"C Reactive Protein, Inflammatory",,86140,CPT,Facility,Both,,,,104,88.4,29.8064,104,Medica,Individual & Family,103.064,99.1,,percent of total billed charges,,
"C Reactive Protein, Inflammatory",,86140,CPT,Facility,Outpatient,,,,104,88.4,29.8064,104,Medica,Medica Advantage Solution,51.792,49.8,,percent of total billed charges,,
"C Reactive Protein, Inflammatory",,86140,CPT,Facility,Inpatient,,,,104,88.4,29.8064,104,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"C Reactive Protein, Inflammatory",,86140,CPT,Facility,Outpatient,,,,104,88.4,29.8064,104,Medica,Medical Assistance,46.384,44.6,,percent of total billed charges,,
"C Reactive Protein, Inflammatory",,86140,CPT,Facility,Inpatient,,,,104,88.4,29.8064,104,Medica,Medical Assistance,,,,,Included in per diem rate,
"C Reactive Protein, Inflammatory",,86140,CPT,Facility,Outpatient,,,,104,88.4,29.8064,104,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,51.792,49.8,,percent of total billed charges,,
"C Reactive Protein, Inflammatory",,86140,CPT,Facility,Inpatient,,,,104,88.4,29.8064,104,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"C Reactive Protein, Inflammatory",,86140,CPT,Facility,Both,,,,104,88.4,29.8064,104,"Multiplan, Inc.","Multiplan, Inc.",97.76,94,,percent of total billed charges,,
"C Reactive Protein, Inflammatory",,86140,CPT,Facility,Outpatient,,,,104,88.4,29.8064,104,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,89.856,86.4,,percent of total billed charges,,
"C Reactive Protein, Inflammatory",,86140,CPT,Facility,Inpatient,,,,104,88.4,29.8064,104,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"C Reactive Protein, Inflammatory",,86140,CPT,Facility,Both,,,,104,88.4,29.8064,104,"Preferred One Administrative Services, INC.",PPO,102.544,98.6,,percent of total billed charges,,
"C Reactive Protein, Inflammatory",,86140,CPT,Facility,Outpatient,,,,104,88.4,29.8064,104,PrimeWest Health,Minnesota Senior Health Options (MSHO),53.508,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"C Reactive Protein, Inflammatory",,86140,CPT,Facility,Inpatient,,,,104,88.4,29.8064,104,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"C Reactive Protein, Inflammatory",,86140,CPT,Facility,Outpatient,,,,104,88.4,29.8064,104,PrimeWest Health,MinnesotaCare,53.4144,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"C Reactive Protein, Inflammatory",,86140,CPT,Facility,Inpatient,,,,104,88.4,29.8064,104,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"C Reactive Protein, Inflammatory",,86140,CPT,Facility,Both,,,,104,88.4,29.8064,104,Sanford Health Plan,Sanford Health Plan,95.68,92,,percent of total billed charges,,
"C Reactive Protein, Inflammatory",,86140,CPT,Facility,Outpatient,,,,104,88.4,29.8064,104,"UCare Health, Inc.",Individual & Family Plan,58.604,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"C Reactive Protein, Inflammatory",,86140,CPT,Facility,Inpatient,,,,104,88.4,29.8064,104,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"C Reactive Protein, Inflammatory",,86140,CPT,Facility,Outpatient,,,,104,88.4,29.8064,104,"UCare Health, Inc.",Medical Assistance,52.4888,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"C Reactive Protein, Inflammatory",,86140,CPT,Facility,Inpatient,,,,104,88.4,29.8064,104,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"C Reactive Protein, Inflammatory",,86140,CPT,Facility,Outpatient,,,,104,88.4,29.8064,104,"UCare Health, Inc.",Medicare Advantage,52.4888,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"C Reactive Protein, Inflammatory",,86140,CPT,Facility,Inpatient,,,,104,88.4,29.8064,104,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"C Reactive Protein, Inflammatory",,86140,CPT,Facility,Outpatient,,,,104,88.4,29.8064,104,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),52.4888,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"C Reactive Protein, Inflammatory",,86140,CPT,Facility,Inpatient,,,,104,88.4,29.8064,104,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"C Reactive Protein, Inflammatory",,86140,CPT,Facility,Both,,,,104,88.4,29.8064,104,UnitedHealthcare,Individual & Family,97.76,94,,percent of total billed charges,,
"C Reactive Protein, Inflammatory",,86140,CPT,Facility,Outpatient,,,,104,88.4,29.8064,104,UnitedHealthcare,Medicare Advantage,50.96,49,,percent of total billed charges,,
"C Reactive Protein, Inflammatory",,86140,CPT,Facility,Inpatient,,,,104,88.4,29.8064,104,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"C Reactive Protein, Inflammatory",,86140,CPT,Facility,Outpatient,,,,104,88.4,29.8064,104,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,49.92,48,,percent of total billed charges,,100% of DHS outpatient percentage
"C Reactive Protein, Inflammatory",,86140,CPT,Facility,Inpatient,,,,104,88.4,29.8064,104,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"C Reactive Protein, Cardiac High Sensitivity",,86141,CPT,Facility,Both,,,,138,117.3,39.5508,138,Aetna,Commercial,126.96,92,,percent of total billed charges,,
"C Reactive Protein, Cardiac High Sensitivity",,86141,CPT,Facility,Outpatient,,,,138,117.3,39.5508,138,Aetna,Medicare Advantage,67.62,49,,percent of total billed charges,,
"C Reactive Protein, Cardiac High Sensitivity",,86141,CPT,Facility,Inpatient,,,,138,117.3,39.5508,138,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"C Reactive Protein, Cardiac High Sensitivity",,86141,CPT,Facility,Both,,,,138,117.3,39.5508,138,Aetna,PPO,128.34,93,,percent of total billed charges,,
"C Reactive Protein, Cardiac High Sensitivity",,86141,CPT,Facility,Both,,,,138,117.3,39.5508,138,America's PPO,America's PPO,132.5214,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"C Reactive Protein, Cardiac High Sensitivity",,86141,CPT,Facility,Both,,,,138,117.3,39.5508,138,BlueCross BlueShield Minnesota, Federal Employee Program,135.792,98.4,,percent of total billed charges,,
"C Reactive Protein, Cardiac High Sensitivity",,86141,CPT,Facility,Both,,,,138,117.3,39.5508,138,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,138,100,,percent of total billed charges,,
"C Reactive Protein, Cardiac High Sensitivity",,86141,CPT,Facility,Both,,,,138,117.3,39.5508,138,BlueCross BlueShield Minnesota,High Value Network Plan,124.2,90,,percent of total billed charges,,
"C Reactive Protein, Cardiac High Sensitivity",,86141,CPT,Facility,Outpatient,,,,138,117.3,39.5508,138,BlueCross BlueShield Minnesota,Medicare Advantage,67.62,49,,percent of total billed charges,,
"C Reactive Protein, Cardiac High Sensitivity",,86141,CPT,Facility,Inpatient,,,,138,117.3,39.5508,138,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"C Reactive Protein, Cardiac High Sensitivity",,86141,CPT,Facility,Both,,,,138,117.3,39.5508,138,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,122.2266,88.57,,percent of total billed charges,,
"C Reactive Protein, Cardiac High Sensitivity",,86141,CPT,Facility,Both,,,,138,117.3,39.5508,138,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,39.5508,28.66,,percent of total billed charges,,
"C Reactive Protein, Cardiac High Sensitivity",,86141,CPT,Facility,Outpatient,,,,138,117.3,39.5508,138,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),67.62,49,,percent of total billed charges,,
"C Reactive Protein, Cardiac High Sensitivity",,86141,CPT,Facility,Inpatient,,,,138,117.3,39.5508,138,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"C Reactive Protein, Cardiac High Sensitivity",,86141,CPT,Facility,Both,,,,138,117.3,39.5508,138,CorVel,Worker's Compensation,138,100,,percent of total billed charges,,
"C Reactive Protein, Cardiac High Sensitivity",,86141,CPT,Facility,Both,,,,138,117.3,39.5508,138,First Health Group Corporation,First Health Network,133.86,97,,percent of total billed charges,,
"C Reactive Protein, Cardiac High Sensitivity",,86141,CPT,Facility,Both,,,,138,117.3,39.5508,138,"Health Partners, Inc.",Commercial,130.548,94.6,,percent of total billed charges,,
"C Reactive Protein, Cardiac High Sensitivity",,86141,CPT,Facility,Outpatient,,,,138,117.3,39.5508,138,"Health Partners, Inc.",Medicare Advantage,67.62,49,,percent of total billed charges,,
"C Reactive Protein, Cardiac High Sensitivity",,86141,CPT,Facility,Inpatient,,,,138,117.3,39.5508,138,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"C Reactive Protein, Cardiac High Sensitivity",,86141,CPT,Facility,Both,,,,138,117.3,39.5508,138,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),82.8,60,,percent of total billed charges,,
"C Reactive Protein, Cardiac High Sensitivity",,86141,CPT,Facility,Both,,,,138,117.3,39.5508,138,"Health Partners, Inc.",State of Minnesota Advantage Program,112.47,81.5,,percent of total billed charges,,
"C Reactive Protein, Cardiac High Sensitivity",,86141,CPT,Facility,Both,,,,138,117.3,39.5508,138,"Health Partners, Inc.",State Public Programs,69,50,,percent of total billed charges,,
"C Reactive Protein, Cardiac High Sensitivity",,86141,CPT,Facility,Both,,,,138,117.3,39.5508,138,Humana Insurance Company,Commercial PPO,131.1,95,,percent of total billed charges,,
"C Reactive Protein, Cardiac High Sensitivity",,86141,CPT,Facility,Outpatient,,,,138,117.3,39.5508,138,Humana Insurance Company,Medicare PPO,67.62,49,,percent of total billed charges,,
"C Reactive Protein, Cardiac High Sensitivity",,86141,CPT,Facility,Inpatient,,,,138,117.3,39.5508,138,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"C Reactive Protein, Cardiac High Sensitivity",,86141,CPT,Facility,Both,,,,138,117.3,39.5508,138,Medica,Individual & Family,136.758,99.1,,percent of total billed charges,,
"C Reactive Protein, Cardiac High Sensitivity",,86141,CPT,Facility,Outpatient,,,,138,117.3,39.5508,138,Medica,Medica Advantage Solution,68.724,49.8,,percent of total billed charges,,
"C Reactive Protein, Cardiac High Sensitivity",,86141,CPT,Facility,Inpatient,,,,138,117.3,39.5508,138,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"C Reactive Protein, Cardiac High Sensitivity",,86141,CPT,Facility,Outpatient,,,,138,117.3,39.5508,138,Medica,Medical Assistance,61.548,44.6,,percent of total billed charges,,
"C Reactive Protein, Cardiac High Sensitivity",,86141,CPT,Facility,Inpatient,,,,138,117.3,39.5508,138,Medica,Medical Assistance,,,,,Included in per diem rate,
"C Reactive Protein, Cardiac High Sensitivity",,86141,CPT,Facility,Outpatient,,,,138,117.3,39.5508,138,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,68.724,49.8,,percent of total billed charges,,
"C Reactive Protein, Cardiac High Sensitivity",,86141,CPT,Facility,Inpatient,,,,138,117.3,39.5508,138,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"C Reactive Protein, Cardiac High Sensitivity",,86141,CPT,Facility,Both,,,,138,117.3,39.5508,138,"Multiplan, Inc.","Multiplan, Inc.",129.72,94,,percent of total billed charges,,
"C Reactive Protein, Cardiac High Sensitivity",,86141,CPT,Facility,Outpatient,,,,138,117.3,39.5508,138,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,119.232,86.4,,percent of total billed charges,,
"C Reactive Protein, Cardiac High Sensitivity",,86141,CPT,Facility,Inpatient,,,,138,117.3,39.5508,138,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"C Reactive Protein, Cardiac High Sensitivity",,86141,CPT,Facility,Both,,,,138,117.3,39.5508,138,"Preferred One Administrative Services, INC.",PPO,136.068,98.6,,percent of total billed charges,,
"C Reactive Protein, Cardiac High Sensitivity",,86141,CPT,Facility,Outpatient,,,,138,117.3,39.5508,138,PrimeWest Health,Minnesota Senior Health Options (MSHO),71.001,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"C Reactive Protein, Cardiac High Sensitivity",,86141,CPT,Facility,Inpatient,,,,138,117.3,39.5508,138,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"C Reactive Protein, Cardiac High Sensitivity",,86141,CPT,Facility,Outpatient,,,,138,117.3,39.5508,138,PrimeWest Health,MinnesotaCare,70.8768,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"C Reactive Protein, Cardiac High Sensitivity",,86141,CPT,Facility,Inpatient,,,,138,117.3,39.5508,138,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"C Reactive Protein, Cardiac High Sensitivity",,86141,CPT,Facility,Both,,,,138,117.3,39.5508,138,Sanford Health Plan,Sanford Health Plan,126.96,92,,percent of total billed charges,,
"C Reactive Protein, Cardiac High Sensitivity",,86141,CPT,Facility,Outpatient,,,,138,117.3,39.5508,138,"UCare Health, Inc.",Individual & Family Plan,77.763,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"C Reactive Protein, Cardiac High Sensitivity",,86141,CPT,Facility,Inpatient,,,,138,117.3,39.5508,138,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"C Reactive Protein, Cardiac High Sensitivity",,86141,CPT,Facility,Outpatient,,,,138,117.3,39.5508,138,"UCare Health, Inc.",Medical Assistance,69.6486,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"C Reactive Protein, Cardiac High Sensitivity",,86141,CPT,Facility,Inpatient,,,,138,117.3,39.5508,138,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"C Reactive Protein, Cardiac High Sensitivity",,86141,CPT,Facility,Outpatient,,,,138,117.3,39.5508,138,"UCare Health, Inc.",Medicare Advantage,69.6486,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"C Reactive Protein, Cardiac High Sensitivity",,86141,CPT,Facility,Inpatient,,,,138,117.3,39.5508,138,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"C Reactive Protein, Cardiac High Sensitivity",,86141,CPT,Facility,Outpatient,,,,138,117.3,39.5508,138,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),69.6486,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"C Reactive Protein, Cardiac High Sensitivity",,86141,CPT,Facility,Inpatient,,,,138,117.3,39.5508,138,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"C Reactive Protein, Cardiac High Sensitivity",,86141,CPT,Facility,Both,,,,138,117.3,39.5508,138,UnitedHealthcare,Individual & Family,129.72,94,,percent of total billed charges,,
"C Reactive Protein, Cardiac High Sensitivity",,86141,CPT,Facility,Outpatient,,,,138,117.3,39.5508,138,UnitedHealthcare,Medicare Advantage,67.62,49,,percent of total billed charges,,
"C Reactive Protein, Cardiac High Sensitivity",,86141,CPT,Facility,Inpatient,,,,138,117.3,39.5508,138,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"C Reactive Protein, Cardiac High Sensitivity",,86141,CPT,Facility,Outpatient,,,,138,117.3,39.5508,138,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,66.24,48,,percent of total billed charges,,100% of DHS outpatient percentage
"C Reactive Protein, Cardiac High Sensitivity",,86141,CPT,Facility,Inpatient,,,,138,117.3,39.5508,138,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Cold Agglutinin,,86157,CPT,Facility,Both,,,,63,53.55,18.0558,63,Aetna,Commercial,57.96,92,,percent of total billed charges,,
Cold Agglutinin,,86157,CPT,Facility,Outpatient,,,,63,53.55,18.0558,63,Aetna,Medicare Advantage,30.87,49,,percent of total billed charges,,
Cold Agglutinin,,86157,CPT,Facility,Inpatient,,,,63,53.55,18.0558,63,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Cold Agglutinin,,86157,CPT,Facility,Both,,,,63,53.55,18.0558,63,Aetna,PPO,58.59,93,,percent of total billed charges,,
Cold Agglutinin,,86157,CPT,Facility,Both,,,,63,53.55,18.0558,63,America's PPO,America's PPO,60.4989,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Cold Agglutinin,,86157,CPT,Facility,Both,,,,63,53.55,18.0558,63,BlueCross BlueShield Minnesota, Federal Employee Program,61.992,98.4,,percent of total billed charges,,
Cold Agglutinin,,86157,CPT,Facility,Both,,,,63,53.55,18.0558,63,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,63,100,,percent of total billed charges,,
Cold Agglutinin,,86157,CPT,Facility,Both,,,,63,53.55,18.0558,63,BlueCross BlueShield Minnesota,High Value Network Plan,56.7,90,,percent of total billed charges,,
Cold Agglutinin,,86157,CPT,Facility,Outpatient,,,,63,53.55,18.0558,63,BlueCross BlueShield Minnesota,Medicare Advantage,30.87,49,,percent of total billed charges,,
Cold Agglutinin,,86157,CPT,Facility,Inpatient,,,,63,53.55,18.0558,63,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Cold Agglutinin,,86157,CPT,Facility,Both,,,,63,53.55,18.0558,63,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,55.7991,88.57,,percent of total billed charges,,
Cold Agglutinin,,86157,CPT,Facility,Both,,,,63,53.55,18.0558,63,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,18.0558,28.66,,percent of total billed charges,,
Cold Agglutinin,,86157,CPT,Facility,Outpatient,,,,63,53.55,18.0558,63,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),30.87,49,,percent of total billed charges,,
Cold Agglutinin,,86157,CPT,Facility,Inpatient,,,,63,53.55,18.0558,63,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Cold Agglutinin,,86157,CPT,Facility,Both,,,,63,53.55,18.0558,63,CorVel,Worker's Compensation,63,100,,percent of total billed charges,,
Cold Agglutinin,,86157,CPT,Facility,Both,,,,63,53.55,18.0558,63,First Health Group Corporation,First Health Network,61.11,97,,percent of total billed charges,,
Cold Agglutinin,,86157,CPT,Facility,Both,,,,63,53.55,18.0558,63,"Health Partners, Inc.",Commercial,59.598,94.6,,percent of total billed charges,,
Cold Agglutinin,,86157,CPT,Facility,Outpatient,,,,63,53.55,18.0558,63,"Health Partners, Inc.",Medicare Advantage,30.87,49,,percent of total billed charges,,
Cold Agglutinin,,86157,CPT,Facility,Inpatient,,,,63,53.55,18.0558,63,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Cold Agglutinin,,86157,CPT,Facility,Both,,,,63,53.55,18.0558,63,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),37.8,60,,percent of total billed charges,,
Cold Agglutinin,,86157,CPT,Facility,Both,,,,63,53.55,18.0558,63,"Health Partners, Inc.",State of Minnesota Advantage Program,51.345,81.5,,percent of total billed charges,,
Cold Agglutinin,,86157,CPT,Facility,Both,,,,63,53.55,18.0558,63,"Health Partners, Inc.",State Public Programs,31.5,50,,percent of total billed charges,,
Cold Agglutinin,,86157,CPT,Facility,Both,,,,63,53.55,18.0558,63,Humana Insurance Company,Commercial PPO,59.85,95,,percent of total billed charges,,
Cold Agglutinin,,86157,CPT,Facility,Outpatient,,,,63,53.55,18.0558,63,Humana Insurance Company,Medicare PPO,30.87,49,,percent of total billed charges,,
Cold Agglutinin,,86157,CPT,Facility,Inpatient,,,,63,53.55,18.0558,63,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Cold Agglutinin,,86157,CPT,Facility,Both,,,,63,53.55,18.0558,63,Medica,Individual & Family,62.433,99.1,,percent of total billed charges,,
Cold Agglutinin,,86157,CPT,Facility,Outpatient,,,,63,53.55,18.0558,63,Medica,Medica Advantage Solution,31.374,49.8,,percent of total billed charges,,
Cold Agglutinin,,86157,CPT,Facility,Inpatient,,,,63,53.55,18.0558,63,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Cold Agglutinin,,86157,CPT,Facility,Outpatient,,,,63,53.55,18.0558,63,Medica,Medical Assistance,28.098,44.6,,percent of total billed charges,,
Cold Agglutinin,,86157,CPT,Facility,Inpatient,,,,63,53.55,18.0558,63,Medica,Medical Assistance,,,,,Included in per diem rate,
Cold Agglutinin,,86157,CPT,Facility,Outpatient,,,,63,53.55,18.0558,63,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,31.374,49.8,,percent of total billed charges,,
Cold Agglutinin,,86157,CPT,Facility,Inpatient,,,,63,53.55,18.0558,63,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Cold Agglutinin,,86157,CPT,Facility,Both,,,,63,53.55,18.0558,63,"Multiplan, Inc.","Multiplan, Inc.",59.22,94,,percent of total billed charges,,
Cold Agglutinin,,86157,CPT,Facility,Outpatient,,,,63,53.55,18.0558,63,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,54.432,86.4,,percent of total billed charges,,
Cold Agglutinin,,86157,CPT,Facility,Inpatient,,,,63,53.55,18.0558,63,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Cold Agglutinin,,86157,CPT,Facility,Both,,,,63,53.55,18.0558,63,"Preferred One Administrative Services, INC.",PPO,62.118,98.6,,percent of total billed charges,,
Cold Agglutinin,,86157,CPT,Facility,Outpatient,,,,63,53.55,18.0558,63,PrimeWest Health,Minnesota Senior Health Options (MSHO),32.4135,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Cold Agglutinin,,86157,CPT,Facility,Inpatient,,,,63,53.55,18.0558,63,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Cold Agglutinin,,86157,CPT,Facility,Outpatient,,,,63,53.55,18.0558,63,PrimeWest Health,MinnesotaCare,32.3568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Cold Agglutinin,,86157,CPT,Facility,Inpatient,,,,63,53.55,18.0558,63,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Cold Agglutinin,,86157,CPT,Facility,Both,,,,63,53.55,18.0558,63,Sanford Health Plan,Sanford Health Plan,57.96,92,,percent of total billed charges,,
Cold Agglutinin,,86157,CPT,Facility,Outpatient,,,,63,53.55,18.0558,63,"UCare Health, Inc.",Individual & Family Plan,35.5005,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Cold Agglutinin,,86157,CPT,Facility,Inpatient,,,,63,53.55,18.0558,63,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Cold Agglutinin,,86157,CPT,Facility,Outpatient,,,,63,53.55,18.0558,63,"UCare Health, Inc.",Medical Assistance,31.7961,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Cold Agglutinin,,86157,CPT,Facility,Inpatient,,,,63,53.55,18.0558,63,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Cold Agglutinin,,86157,CPT,Facility,Outpatient,,,,63,53.55,18.0558,63,"UCare Health, Inc.",Medicare Advantage,31.7961,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Cold Agglutinin,,86157,CPT,Facility,Inpatient,,,,63,53.55,18.0558,63,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Cold Agglutinin,,86157,CPT,Facility,Outpatient,,,,63,53.55,18.0558,63,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),31.7961,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Cold Agglutinin,,86157,CPT,Facility,Inpatient,,,,63,53.55,18.0558,63,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Cold Agglutinin,,86157,CPT,Facility,Both,,,,63,53.55,18.0558,63,UnitedHealthcare,Individual & Family,59.22,94,,percent of total billed charges,,
Cold Agglutinin,,86157,CPT,Facility,Outpatient,,,,63,53.55,18.0558,63,UnitedHealthcare,Medicare Advantage,30.87,49,,percent of total billed charges,,
Cold Agglutinin,,86157,CPT,Facility,Inpatient,,,,63,53.55,18.0558,63,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Cold Agglutinin,,86157,CPT,Facility,Outpatient,,,,63,53.55,18.0558,63,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,30.24,48,,percent of total billed charges,,100% of DHS outpatient percentage
Cold Agglutinin,,86157,CPT,Facility,Inpatient,,,,63,53.55,18.0558,63,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Complement C3,,86160,CPT,Facility,Both,,,,81,68.85,23.2146,81,Aetna,Commercial,74.52,92,,percent of total billed charges,,
Complement C3,,86160,CPT,Facility,Outpatient,,,,81,68.85,23.2146,81,Aetna,Medicare Advantage,39.69,49,,percent of total billed charges,,
Complement C3,,86160,CPT,Facility,Inpatient,,,,81,68.85,23.2146,81,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Complement C3,,86160,CPT,Facility,Both,,,,81,68.85,23.2146,81,Aetna,PPO,75.33,93,,percent of total billed charges,,
Complement C3,,86160,CPT,Facility,Both,,,,81,68.85,23.2146,81,America's PPO,America's PPO,77.7843,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Complement C3,,86160,CPT,Facility,Both,,,,81,68.85,23.2146,81,BlueCross BlueShield Minnesota, Federal Employee Program,79.704,98.4,,percent of total billed charges,,
Complement C3,,86160,CPT,Facility,Both,,,,81,68.85,23.2146,81,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,81,100,,percent of total billed charges,,
Complement C3,,86160,CPT,Facility,Both,,,,81,68.85,23.2146,81,BlueCross BlueShield Minnesota,High Value Network Plan,72.9,90,,percent of total billed charges,,
Complement C3,,86160,CPT,Facility,Outpatient,,,,81,68.85,23.2146,81,BlueCross BlueShield Minnesota,Medicare Advantage,39.69,49,,percent of total billed charges,,
Complement C3,,86160,CPT,Facility,Inpatient,,,,81,68.85,23.2146,81,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Complement C3,,86160,CPT,Facility,Both,,,,81,68.85,23.2146,81,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,71.7417,88.57,,percent of total billed charges,,
Complement C3,,86160,CPT,Facility,Both,,,,81,68.85,23.2146,81,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,23.2146,28.66,,percent of total billed charges,,
Complement C3,,86160,CPT,Facility,Outpatient,,,,81,68.85,23.2146,81,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),39.69,49,,percent of total billed charges,,
Complement C3,,86160,CPT,Facility,Inpatient,,,,81,68.85,23.2146,81,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Complement C3,,86160,CPT,Facility,Both,,,,81,68.85,23.2146,81,CorVel,Worker's Compensation,81,100,,percent of total billed charges,,
Complement C3,,86160,CPT,Facility,Both,,,,81,68.85,23.2146,81,First Health Group Corporation,First Health Network,78.57,97,,percent of total billed charges,,
Complement C3,,86160,CPT,Facility,Both,,,,81,68.85,23.2146,81,"Health Partners, Inc.",Commercial,76.626,94.6,,percent of total billed charges,,
Complement C3,,86160,CPT,Facility,Outpatient,,,,81,68.85,23.2146,81,"Health Partners, Inc.",Medicare Advantage,39.69,49,,percent of total billed charges,,
Complement C3,,86160,CPT,Facility,Inpatient,,,,81,68.85,23.2146,81,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Complement C3,,86160,CPT,Facility,Both,,,,81,68.85,23.2146,81,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),48.6,60,,percent of total billed charges,,
Complement C3,,86160,CPT,Facility,Both,,,,81,68.85,23.2146,81,"Health Partners, Inc.",State of Minnesota Advantage Program,66.015,81.5,,percent of total billed charges,,
Complement C3,,86160,CPT,Facility,Both,,,,81,68.85,23.2146,81,"Health Partners, Inc.",State Public Programs,40.5,50,,percent of total billed charges,,
Complement C3,,86160,CPT,Facility,Both,,,,81,68.85,23.2146,81,Humana Insurance Company,Commercial PPO,76.95,95,,percent of total billed charges,,
Complement C3,,86160,CPT,Facility,Outpatient,,,,81,68.85,23.2146,81,Humana Insurance Company,Medicare PPO,39.69,49,,percent of total billed charges,,
Complement C3,,86160,CPT,Facility,Inpatient,,,,81,68.85,23.2146,81,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Complement C3,,86160,CPT,Facility,Both,,,,81,68.85,23.2146,81,Medica,Individual & Family,80.271,99.1,,percent of total billed charges,,
Complement C3,,86160,CPT,Facility,Outpatient,,,,81,68.85,23.2146,81,Medica,Medica Advantage Solution,40.338,49.8,,percent of total billed charges,,
Complement C3,,86160,CPT,Facility,Inpatient,,,,81,68.85,23.2146,81,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Complement C3,,86160,CPT,Facility,Outpatient,,,,81,68.85,23.2146,81,Medica,Medical Assistance,36.126,44.6,,percent of total billed charges,,
Complement C3,,86160,CPT,Facility,Inpatient,,,,81,68.85,23.2146,81,Medica,Medical Assistance,,,,,Included in per diem rate,
Complement C3,,86160,CPT,Facility,Outpatient,,,,81,68.85,23.2146,81,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,40.338,49.8,,percent of total billed charges,,
Complement C3,,86160,CPT,Facility,Inpatient,,,,81,68.85,23.2146,81,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Complement C3,,86160,CPT,Facility,Both,,,,81,68.85,23.2146,81,"Multiplan, Inc.","Multiplan, Inc.",76.14,94,,percent of total billed charges,,
Complement C3,,86160,CPT,Facility,Outpatient,,,,81,68.85,23.2146,81,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,69.984,86.4,,percent of total billed charges,,
Complement C3,,86160,CPT,Facility,Inpatient,,,,81,68.85,23.2146,81,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Complement C3,,86160,CPT,Facility,Both,,,,81,68.85,23.2146,81,"Preferred One Administrative Services, INC.",PPO,79.866,98.6,,percent of total billed charges,,
Complement C3,,86160,CPT,Facility,Outpatient,,,,81,68.85,23.2146,81,PrimeWest Health,Minnesota Senior Health Options (MSHO),41.6745,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Complement C3,,86160,CPT,Facility,Inpatient,,,,81,68.85,23.2146,81,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Complement C3,,86160,CPT,Facility,Outpatient,,,,81,68.85,23.2146,81,PrimeWest Health,MinnesotaCare,41.6016,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Complement C3,,86160,CPT,Facility,Inpatient,,,,81,68.85,23.2146,81,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Complement C3,,86160,CPT,Facility,Both,,,,81,68.85,23.2146,81,Sanford Health Plan,Sanford Health Plan,74.52,92,,percent of total billed charges,,
Complement C3,,86160,CPT,Facility,Outpatient,,,,81,68.85,23.2146,81,"UCare Health, Inc.",Individual & Family Plan,45.6435,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Complement C3,,86160,CPT,Facility,Inpatient,,,,81,68.85,23.2146,81,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Complement C3,,86160,CPT,Facility,Outpatient,,,,81,68.85,23.2146,81,"UCare Health, Inc.",Medical Assistance,40.8807,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Complement C3,,86160,CPT,Facility,Inpatient,,,,81,68.85,23.2146,81,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Complement C3,,86160,CPT,Facility,Outpatient,,,,81,68.85,23.2146,81,"UCare Health, Inc.",Medicare Advantage,40.8807,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Complement C3,,86160,CPT,Facility,Inpatient,,,,81,68.85,23.2146,81,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Complement C3,,86160,CPT,Facility,Outpatient,,,,81,68.85,23.2146,81,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),40.8807,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Complement C3,,86160,CPT,Facility,Inpatient,,,,81,68.85,23.2146,81,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Complement C3,,86160,CPT,Facility,Both,,,,81,68.85,23.2146,81,UnitedHealthcare,Individual & Family,76.14,94,,percent of total billed charges,,
Complement C3,,86160,CPT,Facility,Outpatient,,,,81,68.85,23.2146,81,UnitedHealthcare,Medicare Advantage,39.69,49,,percent of total billed charges,,
Complement C3,,86160,CPT,Facility,Inpatient,,,,81,68.85,23.2146,81,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Complement C3,,86160,CPT,Facility,Outpatient,,,,81,68.85,23.2146,81,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,38.88,48,,percent of total billed charges,,100% of DHS outpatient percentage
Complement C3,,86160,CPT,Facility,Inpatient,,,,81,68.85,23.2146,81,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Complement C4,,86160,CPT,Facility,Both,,,,81,68.85,23.2146,81,Aetna,Commercial,74.52,92,,percent of total billed charges,,
Complement C4,,86160,CPT,Facility,Outpatient,,,,81,68.85,23.2146,81,Aetna,Medicare Advantage,39.69,49,,percent of total billed charges,,
Complement C4,,86160,CPT,Facility,Inpatient,,,,81,68.85,23.2146,81,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Complement C4,,86160,CPT,Facility,Both,,,,81,68.85,23.2146,81,Aetna,PPO,75.33,93,,percent of total billed charges,,
Complement C4,,86160,CPT,Facility,Both,,,,81,68.85,23.2146,81,America's PPO,America's PPO,77.7843,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Complement C4,,86160,CPT,Facility,Both,,,,81,68.85,23.2146,81,BlueCross BlueShield Minnesota, Federal Employee Program,79.704,98.4,,percent of total billed charges,,
Complement C4,,86160,CPT,Facility,Both,,,,81,68.85,23.2146,81,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,81,100,,percent of total billed charges,,
Complement C4,,86160,CPT,Facility,Both,,,,81,68.85,23.2146,81,BlueCross BlueShield Minnesota,High Value Network Plan,72.9,90,,percent of total billed charges,,
Complement C4,,86160,CPT,Facility,Outpatient,,,,81,68.85,23.2146,81,BlueCross BlueShield Minnesota,Medicare Advantage,39.69,49,,percent of total billed charges,,
Complement C4,,86160,CPT,Facility,Inpatient,,,,81,68.85,23.2146,81,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Complement C4,,86160,CPT,Facility,Both,,,,81,68.85,23.2146,81,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,71.7417,88.57,,percent of total billed charges,,
Complement C4,,86160,CPT,Facility,Both,,,,81,68.85,23.2146,81,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,23.2146,28.66,,percent of total billed charges,,
Complement C4,,86160,CPT,Facility,Outpatient,,,,81,68.85,23.2146,81,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),39.69,49,,percent of total billed charges,,
Complement C4,,86160,CPT,Facility,Inpatient,,,,81,68.85,23.2146,81,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Complement C4,,86160,CPT,Facility,Both,,,,81,68.85,23.2146,81,CorVel,Worker's Compensation,81,100,,percent of total billed charges,,
Complement C4,,86160,CPT,Facility,Both,,,,81,68.85,23.2146,81,First Health Group Corporation,First Health Network,78.57,97,,percent of total billed charges,,
Complement C4,,86160,CPT,Facility,Both,,,,81,68.85,23.2146,81,"Health Partners, Inc.",Commercial,76.626,94.6,,percent of total billed charges,,
Complement C4,,86160,CPT,Facility,Outpatient,,,,81,68.85,23.2146,81,"Health Partners, Inc.",Medicare Advantage,39.69,49,,percent of total billed charges,,
Complement C4,,86160,CPT,Facility,Inpatient,,,,81,68.85,23.2146,81,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Complement C4,,86160,CPT,Facility,Both,,,,81,68.85,23.2146,81,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),48.6,60,,percent of total billed charges,,
Complement C4,,86160,CPT,Facility,Both,,,,81,68.85,23.2146,81,"Health Partners, Inc.",State of Minnesota Advantage Program,66.015,81.5,,percent of total billed charges,,
Complement C4,,86160,CPT,Facility,Both,,,,81,68.85,23.2146,81,"Health Partners, Inc.",State Public Programs,40.5,50,,percent of total billed charges,,
Complement C4,,86160,CPT,Facility,Both,,,,81,68.85,23.2146,81,Humana Insurance Company,Commercial PPO,76.95,95,,percent of total billed charges,,
Complement C4,,86160,CPT,Facility,Outpatient,,,,81,68.85,23.2146,81,Humana Insurance Company,Medicare PPO,39.69,49,,percent of total billed charges,,
Complement C4,,86160,CPT,Facility,Inpatient,,,,81,68.85,23.2146,81,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Complement C4,,86160,CPT,Facility,Both,,,,81,68.85,23.2146,81,Medica,Individual & Family,80.271,99.1,,percent of total billed charges,,
Complement C4,,86160,CPT,Facility,Outpatient,,,,81,68.85,23.2146,81,Medica,Medica Advantage Solution,40.338,49.8,,percent of total billed charges,,
Complement C4,,86160,CPT,Facility,Inpatient,,,,81,68.85,23.2146,81,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Complement C4,,86160,CPT,Facility,Outpatient,,,,81,68.85,23.2146,81,Medica,Medical Assistance,36.126,44.6,,percent of total billed charges,,
Complement C4,,86160,CPT,Facility,Inpatient,,,,81,68.85,23.2146,81,Medica,Medical Assistance,,,,,Included in per diem rate,
Complement C4,,86160,CPT,Facility,Outpatient,,,,81,68.85,23.2146,81,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,40.338,49.8,,percent of total billed charges,,
Complement C4,,86160,CPT,Facility,Inpatient,,,,81,68.85,23.2146,81,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Complement C4,,86160,CPT,Facility,Both,,,,81,68.85,23.2146,81,"Multiplan, Inc.","Multiplan, Inc.",76.14,94,,percent of total billed charges,,
Complement C4,,86160,CPT,Facility,Outpatient,,,,81,68.85,23.2146,81,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,69.984,86.4,,percent of total billed charges,,
Complement C4,,86160,CPT,Facility,Inpatient,,,,81,68.85,23.2146,81,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Complement C4,,86160,CPT,Facility,Both,,,,81,68.85,23.2146,81,"Preferred One Administrative Services, INC.",PPO,79.866,98.6,,percent of total billed charges,,
Complement C4,,86160,CPT,Facility,Outpatient,,,,81,68.85,23.2146,81,PrimeWest Health,Minnesota Senior Health Options (MSHO),41.6745,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Complement C4,,86160,CPT,Facility,Inpatient,,,,81,68.85,23.2146,81,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Complement C4,,86160,CPT,Facility,Outpatient,,,,81,68.85,23.2146,81,PrimeWest Health,MinnesotaCare,41.6016,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Complement C4,,86160,CPT,Facility,Inpatient,,,,81,68.85,23.2146,81,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Complement C4,,86160,CPT,Facility,Both,,,,81,68.85,23.2146,81,Sanford Health Plan,Sanford Health Plan,74.52,92,,percent of total billed charges,,
Complement C4,,86160,CPT,Facility,Outpatient,,,,81,68.85,23.2146,81,"UCare Health, Inc.",Individual & Family Plan,45.6435,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Complement C4,,86160,CPT,Facility,Inpatient,,,,81,68.85,23.2146,81,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Complement C4,,86160,CPT,Facility,Outpatient,,,,81,68.85,23.2146,81,"UCare Health, Inc.",Medical Assistance,40.8807,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Complement C4,,86160,CPT,Facility,Inpatient,,,,81,68.85,23.2146,81,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Complement C4,,86160,CPT,Facility,Outpatient,,,,81,68.85,23.2146,81,"UCare Health, Inc.",Medicare Advantage,40.8807,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Complement C4,,86160,CPT,Facility,Inpatient,,,,81,68.85,23.2146,81,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Complement C4,,86160,CPT,Facility,Outpatient,,,,81,68.85,23.2146,81,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),40.8807,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Complement C4,,86160,CPT,Facility,Inpatient,,,,81,68.85,23.2146,81,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Complement C4,,86160,CPT,Facility,Both,,,,81,68.85,23.2146,81,UnitedHealthcare,Individual & Family,76.14,94,,percent of total billed charges,,
Complement C4,,86160,CPT,Facility,Outpatient,,,,81,68.85,23.2146,81,UnitedHealthcare,Medicare Advantage,39.69,49,,percent of total billed charges,,
Complement C4,,86160,CPT,Facility,Inpatient,,,,81,68.85,23.2146,81,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Complement C4,,86160,CPT,Facility,Outpatient,,,,81,68.85,23.2146,81,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,38.88,48,,percent of total billed charges,,100% of DHS outpatient percentage
Complement C4,,86160,CPT,Facility,Inpatient,,,,81,68.85,23.2146,81,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Cyclic Citrullinated Peptide,,86200,CPT,Facility,Both,,,,122,103.7,34.9652,122,Aetna,Commercial,112.24,92,,percent of total billed charges,,
Cyclic Citrullinated Peptide,,86200,CPT,Facility,Outpatient,,,,122,103.7,34.9652,122,Aetna,Medicare Advantage,59.78,49,,percent of total billed charges,,
Cyclic Citrullinated Peptide,,86200,CPT,Facility,Inpatient,,,,122,103.7,34.9652,122,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Cyclic Citrullinated Peptide,,86200,CPT,Facility,Both,,,,122,103.7,34.9652,122,Aetna,PPO,113.46,93,,percent of total billed charges,,
Cyclic Citrullinated Peptide,,86200,CPT,Facility,Both,,,,122,103.7,34.9652,122,America's PPO,America's PPO,117.1566,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Cyclic Citrullinated Peptide,,86200,CPT,Facility,Both,,,,122,103.7,34.9652,122,BlueCross BlueShield Minnesota, Federal Employee Program,120.048,98.4,,percent of total billed charges,,
Cyclic Citrullinated Peptide,,86200,CPT,Facility,Both,,,,122,103.7,34.9652,122,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,122,100,,percent of total billed charges,,
Cyclic Citrullinated Peptide,,86200,CPT,Facility,Both,,,,122,103.7,34.9652,122,BlueCross BlueShield Minnesota,High Value Network Plan,109.8,90,,percent of total billed charges,,
Cyclic Citrullinated Peptide,,86200,CPT,Facility,Outpatient,,,,122,103.7,34.9652,122,BlueCross BlueShield Minnesota,Medicare Advantage,59.78,49,,percent of total billed charges,,
Cyclic Citrullinated Peptide,,86200,CPT,Facility,Inpatient,,,,122,103.7,34.9652,122,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Cyclic Citrullinated Peptide,,86200,CPT,Facility,Both,,,,122,103.7,34.9652,122,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,108.0554,88.57,,percent of total billed charges,,
Cyclic Citrullinated Peptide,,86200,CPT,Facility,Both,,,,122,103.7,34.9652,122,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,34.9652,28.66,,percent of total billed charges,,
Cyclic Citrullinated Peptide,,86200,CPT,Facility,Outpatient,,,,122,103.7,34.9652,122,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),59.78,49,,percent of total billed charges,,
Cyclic Citrullinated Peptide,,86200,CPT,Facility,Inpatient,,,,122,103.7,34.9652,122,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Cyclic Citrullinated Peptide,,86200,CPT,Facility,Both,,,,122,103.7,34.9652,122,CorVel,Worker's Compensation,122,100,,percent of total billed charges,,
Cyclic Citrullinated Peptide,,86200,CPT,Facility,Both,,,,122,103.7,34.9652,122,First Health Group Corporation,First Health Network,118.34,97,,percent of total billed charges,,
Cyclic Citrullinated Peptide,,86200,CPT,Facility,Both,,,,122,103.7,34.9652,122,"Health Partners, Inc.",Commercial,115.412,94.6,,percent of total billed charges,,
Cyclic Citrullinated Peptide,,86200,CPT,Facility,Outpatient,,,,122,103.7,34.9652,122,"Health Partners, Inc.",Medicare Advantage,59.78,49,,percent of total billed charges,,
Cyclic Citrullinated Peptide,,86200,CPT,Facility,Inpatient,,,,122,103.7,34.9652,122,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Cyclic Citrullinated Peptide,,86200,CPT,Facility,Both,,,,122,103.7,34.9652,122,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),73.2,60,,percent of total billed charges,,
Cyclic Citrullinated Peptide,,86200,CPT,Facility,Both,,,,122,103.7,34.9652,122,"Health Partners, Inc.",State of Minnesota Advantage Program,99.43,81.5,,percent of total billed charges,,
Cyclic Citrullinated Peptide,,86200,CPT,Facility,Both,,,,122,103.7,34.9652,122,"Health Partners, Inc.",State Public Programs,61,50,,percent of total billed charges,,
Cyclic Citrullinated Peptide,,86200,CPT,Facility,Both,,,,122,103.7,34.9652,122,Humana Insurance Company,Commercial PPO,115.9,95,,percent of total billed charges,,
Cyclic Citrullinated Peptide,,86200,CPT,Facility,Outpatient,,,,122,103.7,34.9652,122,Humana Insurance Company,Medicare PPO,59.78,49,,percent of total billed charges,,
Cyclic Citrullinated Peptide,,86200,CPT,Facility,Inpatient,,,,122,103.7,34.9652,122,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Cyclic Citrullinated Peptide,,86200,CPT,Facility,Both,,,,122,103.7,34.9652,122,Medica,Individual & Family,120.902,99.1,,percent of total billed charges,,
Cyclic Citrullinated Peptide,,86200,CPT,Facility,Outpatient,,,,122,103.7,34.9652,122,Medica,Medica Advantage Solution,60.756,49.8,,percent of total billed charges,,
Cyclic Citrullinated Peptide,,86200,CPT,Facility,Inpatient,,,,122,103.7,34.9652,122,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Cyclic Citrullinated Peptide,,86200,CPT,Facility,Outpatient,,,,122,103.7,34.9652,122,Medica,Medical Assistance,54.412,44.6,,percent of total billed charges,,
Cyclic Citrullinated Peptide,,86200,CPT,Facility,Inpatient,,,,122,103.7,34.9652,122,Medica,Medical Assistance,,,,,Included in per diem rate,
Cyclic Citrullinated Peptide,,86200,CPT,Facility,Outpatient,,,,122,103.7,34.9652,122,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,60.756,49.8,,percent of total billed charges,,
Cyclic Citrullinated Peptide,,86200,CPT,Facility,Inpatient,,,,122,103.7,34.9652,122,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Cyclic Citrullinated Peptide,,86200,CPT,Facility,Both,,,,122,103.7,34.9652,122,"Multiplan, Inc.","Multiplan, Inc.",114.68,94,,percent of total billed charges,,
Cyclic Citrullinated Peptide,,86200,CPT,Facility,Outpatient,,,,122,103.7,34.9652,122,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,105.408,86.4,,percent of total billed charges,,
Cyclic Citrullinated Peptide,,86200,CPT,Facility,Inpatient,,,,122,103.7,34.9652,122,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Cyclic Citrullinated Peptide,,86200,CPT,Facility,Both,,,,122,103.7,34.9652,122,"Preferred One Administrative Services, INC.",PPO,120.292,98.6,,percent of total billed charges,,
Cyclic Citrullinated Peptide,,86200,CPT,Facility,Outpatient,,,,122,103.7,34.9652,122,PrimeWest Health,Minnesota Senior Health Options (MSHO),62.769,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Cyclic Citrullinated Peptide,,86200,CPT,Facility,Inpatient,,,,122,103.7,34.9652,122,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Cyclic Citrullinated Peptide,,86200,CPT,Facility,Outpatient,,,,122,103.7,34.9652,122,PrimeWest Health,MinnesotaCare,62.6592,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Cyclic Citrullinated Peptide,,86200,CPT,Facility,Inpatient,,,,122,103.7,34.9652,122,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Cyclic Citrullinated Peptide,,86200,CPT,Facility,Both,,,,122,103.7,34.9652,122,Sanford Health Plan,Sanford Health Plan,112.24,92,,percent of total billed charges,,
Cyclic Citrullinated Peptide,,86200,CPT,Facility,Outpatient,,,,122,103.7,34.9652,122,"UCare Health, Inc.",Individual & Family Plan,68.747,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Cyclic Citrullinated Peptide,,86200,CPT,Facility,Inpatient,,,,122,103.7,34.9652,122,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Cyclic Citrullinated Peptide,,86200,CPT,Facility,Outpatient,,,,122,103.7,34.9652,122,"UCare Health, Inc.",Medical Assistance,61.5734,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Cyclic Citrullinated Peptide,,86200,CPT,Facility,Inpatient,,,,122,103.7,34.9652,122,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Cyclic Citrullinated Peptide,,86200,CPT,Facility,Outpatient,,,,122,103.7,34.9652,122,"UCare Health, Inc.",Medicare Advantage,61.5734,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Cyclic Citrullinated Peptide,,86200,CPT,Facility,Inpatient,,,,122,103.7,34.9652,122,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Cyclic Citrullinated Peptide,,86200,CPT,Facility,Outpatient,,,,122,103.7,34.9652,122,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),61.5734,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Cyclic Citrullinated Peptide,,86200,CPT,Facility,Inpatient,,,,122,103.7,34.9652,122,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Cyclic Citrullinated Peptide,,86200,CPT,Facility,Both,,,,122,103.7,34.9652,122,UnitedHealthcare,Individual & Family,114.68,94,,percent of total billed charges,,
Cyclic Citrullinated Peptide,,86200,CPT,Facility,Outpatient,,,,122,103.7,34.9652,122,UnitedHealthcare,Medicare Advantage,59.78,49,,percent of total billed charges,,
Cyclic Citrullinated Peptide,,86200,CPT,Facility,Inpatient,,,,122,103.7,34.9652,122,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Cyclic Citrullinated Peptide,,86200,CPT,Facility,Outpatient,,,,122,103.7,34.9652,122,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,58.56,48,,percent of total billed charges,,100% of DHS outpatient percentage
Cyclic Citrullinated Peptide,,86200,CPT,Facility,Inpatient,,,,122,103.7,34.9652,122,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Dna Double Stranded Ab, Igg",,86225,CPT,Facility,Both,,,,61,51.85,17.4826,61,Aetna,Commercial,56.12,92,,percent of total billed charges,,
"Dna Double Stranded Ab, Igg",,86225,CPT,Facility,Outpatient,,,,61,51.85,17.4826,61,Aetna,Medicare Advantage,29.89,49,,percent of total billed charges,,
"Dna Double Stranded Ab, Igg",,86225,CPT,Facility,Inpatient,,,,61,51.85,17.4826,61,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Dna Double Stranded Ab, Igg",,86225,CPT,Facility,Both,,,,61,51.85,17.4826,61,Aetna,PPO,56.73,93,,percent of total billed charges,,
"Dna Double Stranded Ab, Igg",,86225,CPT,Facility,Both,,,,61,51.85,17.4826,61,America's PPO,America's PPO,58.5783,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Dna Double Stranded Ab, Igg",,86225,CPT,Facility,Both,,,,61,51.85,17.4826,61,BlueCross BlueShield Minnesota, Federal Employee Program,60.024,98.4,,percent of total billed charges,,
"Dna Double Stranded Ab, Igg",,86225,CPT,Facility,Both,,,,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,61,100,,percent of total billed charges,,
"Dna Double Stranded Ab, Igg",,86225,CPT,Facility,Both,,,,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,High Value Network Plan,54.9,90,,percent of total billed charges,,
"Dna Double Stranded Ab, Igg",,86225,CPT,Facility,Outpatient,,,,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,Medicare Advantage,29.89,49,,percent of total billed charges,,
"Dna Double Stranded Ab, Igg",,86225,CPT,Facility,Inpatient,,,,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Dna Double Stranded Ab, Igg",,86225,CPT,Facility,Both,,,,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,54.0277,88.57,,percent of total billed charges,,
"Dna Double Stranded Ab, Igg",,86225,CPT,Facility,Both,,,,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,17.4826,28.66,,percent of total billed charges,,
"Dna Double Stranded Ab, Igg",,86225,CPT,Facility,Outpatient,,,,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),29.89,49,,percent of total billed charges,,
"Dna Double Stranded Ab, Igg",,86225,CPT,Facility,Inpatient,,,,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Dna Double Stranded Ab, Igg",,86225,CPT,Facility,Both,,,,61,51.85,17.4826,61,CorVel,Worker's Compensation,61,100,,percent of total billed charges,,
"Dna Double Stranded Ab, Igg",,86225,CPT,Facility,Both,,,,61,51.85,17.4826,61,First Health Group Corporation,First Health Network,59.17,97,,percent of total billed charges,,
"Dna Double Stranded Ab, Igg",,86225,CPT,Facility,Both,,,,61,51.85,17.4826,61,"Health Partners, Inc.",Commercial,57.706,94.6,,percent of total billed charges,,
"Dna Double Stranded Ab, Igg",,86225,CPT,Facility,Outpatient,,,,61,51.85,17.4826,61,"Health Partners, Inc.",Medicare Advantage,29.89,49,,percent of total billed charges,,
"Dna Double Stranded Ab, Igg",,86225,CPT,Facility,Inpatient,,,,61,51.85,17.4826,61,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Dna Double Stranded Ab, Igg",,86225,CPT,Facility,Both,,,,61,51.85,17.4826,61,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),36.6,60,,percent of total billed charges,,
"Dna Double Stranded Ab, Igg",,86225,CPT,Facility,Both,,,,61,51.85,17.4826,61,"Health Partners, Inc.",State of Minnesota Advantage Program,49.715,81.5,,percent of total billed charges,,
"Dna Double Stranded Ab, Igg",,86225,CPT,Facility,Both,,,,61,51.85,17.4826,61,"Health Partners, Inc.",State Public Programs,30.5,50,,percent of total billed charges,,
"Dna Double Stranded Ab, Igg",,86225,CPT,Facility,Both,,,,61,51.85,17.4826,61,Humana Insurance Company,Commercial PPO,57.95,95,,percent of total billed charges,,
"Dna Double Stranded Ab, Igg",,86225,CPT,Facility,Outpatient,,,,61,51.85,17.4826,61,Humana Insurance Company,Medicare PPO,29.89,49,,percent of total billed charges,,
"Dna Double Stranded Ab, Igg",,86225,CPT,Facility,Inpatient,,,,61,51.85,17.4826,61,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Dna Double Stranded Ab, Igg",,86225,CPT,Facility,Both,,,,61,51.85,17.4826,61,Medica,Individual & Family,60.451,99.1,,percent of total billed charges,,
"Dna Double Stranded Ab, Igg",,86225,CPT,Facility,Outpatient,,,,61,51.85,17.4826,61,Medica,Medica Advantage Solution,30.378,49.8,,percent of total billed charges,,
"Dna Double Stranded Ab, Igg",,86225,CPT,Facility,Inpatient,,,,61,51.85,17.4826,61,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Dna Double Stranded Ab, Igg",,86225,CPT,Facility,Outpatient,,,,61,51.85,17.4826,61,Medica,Medical Assistance,27.206,44.6,,percent of total billed charges,,
"Dna Double Stranded Ab, Igg",,86225,CPT,Facility,Inpatient,,,,61,51.85,17.4826,61,Medica,Medical Assistance,,,,,Included in per diem rate,
"Dna Double Stranded Ab, Igg",,86225,CPT,Facility,Outpatient,,,,61,51.85,17.4826,61,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,30.378,49.8,,percent of total billed charges,,
"Dna Double Stranded Ab, Igg",,86225,CPT,Facility,Inpatient,,,,61,51.85,17.4826,61,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Dna Double Stranded Ab, Igg",,86225,CPT,Facility,Both,,,,61,51.85,17.4826,61,"Multiplan, Inc.","Multiplan, Inc.",57.34,94,,percent of total billed charges,,
"Dna Double Stranded Ab, Igg",,86225,CPT,Facility,Outpatient,,,,61,51.85,17.4826,61,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,52.704,86.4,,percent of total billed charges,,
"Dna Double Stranded Ab, Igg",,86225,CPT,Facility,Inpatient,,,,61,51.85,17.4826,61,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Dna Double Stranded Ab, Igg",,86225,CPT,Facility,Both,,,,61,51.85,17.4826,61,"Preferred One Administrative Services, INC.",PPO,60.146,98.6,,percent of total billed charges,,
"Dna Double Stranded Ab, Igg",,86225,CPT,Facility,Outpatient,,,,61,51.85,17.4826,61,PrimeWest Health,Minnesota Senior Health Options (MSHO),31.3845,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Dna Double Stranded Ab, Igg",,86225,CPT,Facility,Inpatient,,,,61,51.85,17.4826,61,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Dna Double Stranded Ab, Igg",,86225,CPT,Facility,Outpatient,,,,61,51.85,17.4826,61,PrimeWest Health,MinnesotaCare,31.3296,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Dna Double Stranded Ab, Igg",,86225,CPT,Facility,Inpatient,,,,61,51.85,17.4826,61,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Dna Double Stranded Ab, Igg",,86225,CPT,Facility,Both,,,,61,51.85,17.4826,61,Sanford Health Plan,Sanford Health Plan,56.12,92,,percent of total billed charges,,
"Dna Double Stranded Ab, Igg",,86225,CPT,Facility,Outpatient,,,,61,51.85,17.4826,61,"UCare Health, Inc.",Individual & Family Plan,34.3735,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Dna Double Stranded Ab, Igg",,86225,CPT,Facility,Inpatient,,,,61,51.85,17.4826,61,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Dna Double Stranded Ab, Igg",,86225,CPT,Facility,Outpatient,,,,61,51.85,17.4826,61,"UCare Health, Inc.",Medical Assistance,30.7867,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Dna Double Stranded Ab, Igg",,86225,CPT,Facility,Inpatient,,,,61,51.85,17.4826,61,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Dna Double Stranded Ab, Igg",,86225,CPT,Facility,Outpatient,,,,61,51.85,17.4826,61,"UCare Health, Inc.",Medicare Advantage,30.7867,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Dna Double Stranded Ab, Igg",,86225,CPT,Facility,Inpatient,,,,61,51.85,17.4826,61,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Dna Double Stranded Ab, Igg",,86225,CPT,Facility,Outpatient,,,,61,51.85,17.4826,61,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),30.7867,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Dna Double Stranded Ab, Igg",,86225,CPT,Facility,Inpatient,,,,61,51.85,17.4826,61,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Dna Double Stranded Ab, Igg",,86225,CPT,Facility,Both,,,,61,51.85,17.4826,61,UnitedHealthcare,Individual & Family,57.34,94,,percent of total billed charges,,
"Dna Double Stranded Ab, Igg",,86225,CPT,Facility,Outpatient,,,,61,51.85,17.4826,61,UnitedHealthcare,Medicare Advantage,29.89,49,,percent of total billed charges,,
"Dna Double Stranded Ab, Igg",,86225,CPT,Facility,Inpatient,,,,61,51.85,17.4826,61,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Dna Double Stranded Ab, Igg",,86225,CPT,Facility,Outpatient,,,,61,51.85,17.4826,61,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,29.28,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Dna Double Stranded Ab, Igg",,86225,CPT,Facility,Inpatient,,,,61,51.85,17.4826,61,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Chromatin Antibodies,,86235,CPT,Facility,Both,,,,26,22.1,7.4516,26,Aetna,Commercial,23.92,92,,percent of total billed charges,,
Chromatin Antibodies,,86235,CPT,Facility,Outpatient,,,,26,22.1,7.4516,26,Aetna,Medicare Advantage,12.74,49,,percent of total billed charges,,
Chromatin Antibodies,,86235,CPT,Facility,Inpatient,,,,26,22.1,7.4516,26,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Chromatin Antibodies,,86235,CPT,Facility,Both,,,,26,22.1,7.4516,26,Aetna,PPO,24.18,93,,percent of total billed charges,,
Chromatin Antibodies,,86235,CPT,Facility,Both,,,,26,22.1,7.4516,26,America's PPO,America's PPO,24.9678,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Chromatin Antibodies,,86235,CPT,Facility,Both,,,,26,22.1,7.4516,26,BlueCross BlueShield Minnesota, Federal Employee Program,25.584,98.4,,percent of total billed charges,,
Chromatin Antibodies,,86235,CPT,Facility,Both,,,,26,22.1,7.4516,26,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,26,100,,percent of total billed charges,,
Chromatin Antibodies,,86235,CPT,Facility,Both,,,,26,22.1,7.4516,26,BlueCross BlueShield Minnesota,High Value Network Plan,23.4,90,,percent of total billed charges,,
Chromatin Antibodies,,86235,CPT,Facility,Outpatient,,,,26,22.1,7.4516,26,BlueCross BlueShield Minnesota,Medicare Advantage,12.74,49,,percent of total billed charges,,
Chromatin Antibodies,,86235,CPT,Facility,Inpatient,,,,26,22.1,7.4516,26,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Chromatin Antibodies,,86235,CPT,Facility,Both,,,,26,22.1,7.4516,26,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,23.0282,88.57,,percent of total billed charges,,
Chromatin Antibodies,,86235,CPT,Facility,Both,,,,26,22.1,7.4516,26,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,7.4516,28.66,,percent of total billed charges,,
Chromatin Antibodies,,86235,CPT,Facility,Outpatient,,,,26,22.1,7.4516,26,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),12.74,49,,percent of total billed charges,,
Chromatin Antibodies,,86235,CPT,Facility,Inpatient,,,,26,22.1,7.4516,26,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Chromatin Antibodies,,86235,CPT,Facility,Both,,,,26,22.1,7.4516,26,CorVel,Worker's Compensation,26,100,,percent of total billed charges,,
Chromatin Antibodies,,86235,CPT,Facility,Both,,,,26,22.1,7.4516,26,First Health Group Corporation,First Health Network,25.22,97,,percent of total billed charges,,
Chromatin Antibodies,,86235,CPT,Facility,Both,,,,26,22.1,7.4516,26,"Health Partners, Inc.",Commercial,24.596,94.6,,percent of total billed charges,,
Chromatin Antibodies,,86235,CPT,Facility,Outpatient,,,,26,22.1,7.4516,26,"Health Partners, Inc.",Medicare Advantage,12.74,49,,percent of total billed charges,,
Chromatin Antibodies,,86235,CPT,Facility,Inpatient,,,,26,22.1,7.4516,26,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Chromatin Antibodies,,86235,CPT,Facility,Both,,,,26,22.1,7.4516,26,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),15.6,60,,percent of total billed charges,,
Chromatin Antibodies,,86235,CPT,Facility,Both,,,,26,22.1,7.4516,26,"Health Partners, Inc.",State of Minnesota Advantage Program,21.19,81.5,,percent of total billed charges,,
Chromatin Antibodies,,86235,CPT,Facility,Both,,,,26,22.1,7.4516,26,"Health Partners, Inc.",State Public Programs,13,50,,percent of total billed charges,,
Chromatin Antibodies,,86235,CPT,Facility,Both,,,,26,22.1,7.4516,26,Humana Insurance Company,Commercial PPO,24.7,95,,percent of total billed charges,,
Chromatin Antibodies,,86235,CPT,Facility,Outpatient,,,,26,22.1,7.4516,26,Humana Insurance Company,Medicare PPO,12.74,49,,percent of total billed charges,,
Chromatin Antibodies,,86235,CPT,Facility,Inpatient,,,,26,22.1,7.4516,26,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Chromatin Antibodies,,86235,CPT,Facility,Both,,,,26,22.1,7.4516,26,Medica,Individual & Family,25.766,99.1,,percent of total billed charges,,
Chromatin Antibodies,,86235,CPT,Facility,Outpatient,,,,26,22.1,7.4516,26,Medica,Medica Advantage Solution,12.948,49.8,,percent of total billed charges,,
Chromatin Antibodies,,86235,CPT,Facility,Inpatient,,,,26,22.1,7.4516,26,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Chromatin Antibodies,,86235,CPT,Facility,Outpatient,,,,26,22.1,7.4516,26,Medica,Medical Assistance,11.596,44.6,,percent of total billed charges,,
Chromatin Antibodies,,86235,CPT,Facility,Inpatient,,,,26,22.1,7.4516,26,Medica,Medical Assistance,,,,,Included in per diem rate,
Chromatin Antibodies,,86235,CPT,Facility,Outpatient,,,,26,22.1,7.4516,26,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,12.948,49.8,,percent of total billed charges,,
Chromatin Antibodies,,86235,CPT,Facility,Inpatient,,,,26,22.1,7.4516,26,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Chromatin Antibodies,,86235,CPT,Facility,Both,,,,26,22.1,7.4516,26,"Multiplan, Inc.","Multiplan, Inc.",24.44,94,,percent of total billed charges,,
Chromatin Antibodies,,86235,CPT,Facility,Outpatient,,,,26,22.1,7.4516,26,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,22.464,86.4,,percent of total billed charges,,
Chromatin Antibodies,,86235,CPT,Facility,Inpatient,,,,26,22.1,7.4516,26,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Chromatin Antibodies,,86235,CPT,Facility,Both,,,,26,22.1,7.4516,26,"Preferred One Administrative Services, INC.",PPO,25.636,98.6,,percent of total billed charges,,
Chromatin Antibodies,,86235,CPT,Facility,Outpatient,,,,26,22.1,7.4516,26,PrimeWest Health,Minnesota Senior Health Options (MSHO),13.377,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Chromatin Antibodies,,86235,CPT,Facility,Inpatient,,,,26,22.1,7.4516,26,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Chromatin Antibodies,,86235,CPT,Facility,Outpatient,,,,26,22.1,7.4516,26,PrimeWest Health,MinnesotaCare,13.3536,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Chromatin Antibodies,,86235,CPT,Facility,Inpatient,,,,26,22.1,7.4516,26,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Chromatin Antibodies,,86235,CPT,Facility,Both,,,,26,22.1,7.4516,26,Sanford Health Plan,Sanford Health Plan,23.92,92,,percent of total billed charges,,
Chromatin Antibodies,,86235,CPT,Facility,Outpatient,,,,26,22.1,7.4516,26,"UCare Health, Inc.",Individual & Family Plan,14.651,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Chromatin Antibodies,,86235,CPT,Facility,Inpatient,,,,26,22.1,7.4516,26,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Chromatin Antibodies,,86235,CPT,Facility,Outpatient,,,,26,22.1,7.4516,26,"UCare Health, Inc.",Medical Assistance,13.1222,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Chromatin Antibodies,,86235,CPT,Facility,Inpatient,,,,26,22.1,7.4516,26,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Chromatin Antibodies,,86235,CPT,Facility,Outpatient,,,,26,22.1,7.4516,26,"UCare Health, Inc.",Medicare Advantage,13.1222,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Chromatin Antibodies,,86235,CPT,Facility,Inpatient,,,,26,22.1,7.4516,26,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Chromatin Antibodies,,86235,CPT,Facility,Outpatient,,,,26,22.1,7.4516,26,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),13.1222,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Chromatin Antibodies,,86235,CPT,Facility,Inpatient,,,,26,22.1,7.4516,26,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Chromatin Antibodies,,86235,CPT,Facility,Both,,,,26,22.1,7.4516,26,UnitedHealthcare,Individual & Family,24.44,94,,percent of total billed charges,,
Chromatin Antibodies,,86235,CPT,Facility,Outpatient,,,,26,22.1,7.4516,26,UnitedHealthcare,Medicare Advantage,12.74,49,,percent of total billed charges,,
Chromatin Antibodies,,86235,CPT,Facility,Inpatient,,,,26,22.1,7.4516,26,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Chromatin Antibodies,,86235,CPT,Facility,Outpatient,,,,26,22.1,7.4516,26,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,12.48,48,,percent of total billed charges,,100% of DHS outpatient percentage
Chromatin Antibodies,,86235,CPT,Facility,Inpatient,,,,26,22.1,7.4516,26,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Jo-1 Ena,,86235,CPT,Facility,Both,,,,48,40.8,13.7568,48,Aetna,Commercial,44.16,92,,percent of total billed charges,,
Jo-1 Ena,,86235,CPT,Facility,Outpatient,,,,48,40.8,13.7568,48,Aetna,Medicare Advantage,23.52,49,,percent of total billed charges,,
Jo-1 Ena,,86235,CPT,Facility,Inpatient,,,,48,40.8,13.7568,48,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Jo-1 Ena,,86235,CPT,Facility,Both,,,,48,40.8,13.7568,48,Aetna,PPO,44.64,93,,percent of total billed charges,,
Jo-1 Ena,,86235,CPT,Facility,Both,,,,48,40.8,13.7568,48,America's PPO,America's PPO,46.0944,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Jo-1 Ena,,86235,CPT,Facility,Both,,,,48,40.8,13.7568,48,BlueCross BlueShield Minnesota, Federal Employee Program,47.232,98.4,,percent of total billed charges,,
Jo-1 Ena,,86235,CPT,Facility,Both,,,,48,40.8,13.7568,48,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,48,100,,percent of total billed charges,,
Jo-1 Ena,,86235,CPT,Facility,Both,,,,48,40.8,13.7568,48,BlueCross BlueShield Minnesota,High Value Network Plan,43.2,90,,percent of total billed charges,,
Jo-1 Ena,,86235,CPT,Facility,Outpatient,,,,48,40.8,13.7568,48,BlueCross BlueShield Minnesota,Medicare Advantage,23.52,49,,percent of total billed charges,,
Jo-1 Ena,,86235,CPT,Facility,Inpatient,,,,48,40.8,13.7568,48,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Jo-1 Ena,,86235,CPT,Facility,Both,,,,48,40.8,13.7568,48,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,42.5136,88.57,,percent of total billed charges,,
Jo-1 Ena,,86235,CPT,Facility,Both,,,,48,40.8,13.7568,48,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,13.7568,28.66,,percent of total billed charges,,
Jo-1 Ena,,86235,CPT,Facility,Outpatient,,,,48,40.8,13.7568,48,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),23.52,49,,percent of total billed charges,,
Jo-1 Ena,,86235,CPT,Facility,Inpatient,,,,48,40.8,13.7568,48,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Jo-1 Ena,,86235,CPT,Facility,Both,,,,48,40.8,13.7568,48,CorVel,Worker's Compensation,48,100,,percent of total billed charges,,
Jo-1 Ena,,86235,CPT,Facility,Both,,,,48,40.8,13.7568,48,First Health Group Corporation,First Health Network,46.56,97,,percent of total billed charges,,
Jo-1 Ena,,86235,CPT,Facility,Both,,,,48,40.8,13.7568,48,"Health Partners, Inc.",Commercial,45.408,94.6,,percent of total billed charges,,
Jo-1 Ena,,86235,CPT,Facility,Outpatient,,,,48,40.8,13.7568,48,"Health Partners, Inc.",Medicare Advantage,23.52,49,,percent of total billed charges,,
Jo-1 Ena,,86235,CPT,Facility,Inpatient,,,,48,40.8,13.7568,48,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Jo-1 Ena,,86235,CPT,Facility,Both,,,,48,40.8,13.7568,48,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),28.8,60,,percent of total billed charges,,
Jo-1 Ena,,86235,CPT,Facility,Both,,,,48,40.8,13.7568,48,"Health Partners, Inc.",State of Minnesota Advantage Program,39.12,81.5,,percent of total billed charges,,
Jo-1 Ena,,86235,CPT,Facility,Both,,,,48,40.8,13.7568,48,"Health Partners, Inc.",State Public Programs,24,50,,percent of total billed charges,,
Jo-1 Ena,,86235,CPT,Facility,Both,,,,48,40.8,13.7568,48,Humana Insurance Company,Commercial PPO,45.6,95,,percent of total billed charges,,
Jo-1 Ena,,86235,CPT,Facility,Outpatient,,,,48,40.8,13.7568,48,Humana Insurance Company,Medicare PPO,23.52,49,,percent of total billed charges,,
Jo-1 Ena,,86235,CPT,Facility,Inpatient,,,,48,40.8,13.7568,48,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Jo-1 Ena,,86235,CPT,Facility,Both,,,,48,40.8,13.7568,48,Medica,Individual & Family,47.568,99.1,,percent of total billed charges,,
Jo-1 Ena,,86235,CPT,Facility,Outpatient,,,,48,40.8,13.7568,48,Medica,Medica Advantage Solution,23.904,49.8,,percent of total billed charges,,
Jo-1 Ena,,86235,CPT,Facility,Inpatient,,,,48,40.8,13.7568,48,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Jo-1 Ena,,86235,CPT,Facility,Outpatient,,,,48,40.8,13.7568,48,Medica,Medical Assistance,21.408,44.6,,percent of total billed charges,,
Jo-1 Ena,,86235,CPT,Facility,Inpatient,,,,48,40.8,13.7568,48,Medica,Medical Assistance,,,,,Included in per diem rate,
Jo-1 Ena,,86235,CPT,Facility,Outpatient,,,,48,40.8,13.7568,48,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,23.904,49.8,,percent of total billed charges,,
Jo-1 Ena,,86235,CPT,Facility,Inpatient,,,,48,40.8,13.7568,48,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Jo-1 Ena,,86235,CPT,Facility,Both,,,,48,40.8,13.7568,48,"Multiplan, Inc.","Multiplan, Inc.",45.12,94,,percent of total billed charges,,
Jo-1 Ena,,86235,CPT,Facility,Outpatient,,,,48,40.8,13.7568,48,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,41.472,86.4,,percent of total billed charges,,
Jo-1 Ena,,86235,CPT,Facility,Inpatient,,,,48,40.8,13.7568,48,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Jo-1 Ena,,86235,CPT,Facility,Both,,,,48,40.8,13.7568,48,"Preferred One Administrative Services, INC.",PPO,47.328,98.6,,percent of total billed charges,,
Jo-1 Ena,,86235,CPT,Facility,Outpatient,,,,48,40.8,13.7568,48,PrimeWest Health,Minnesota Senior Health Options (MSHO),24.696,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Jo-1 Ena,,86235,CPT,Facility,Inpatient,,,,48,40.8,13.7568,48,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Jo-1 Ena,,86235,CPT,Facility,Outpatient,,,,48,40.8,13.7568,48,PrimeWest Health,MinnesotaCare,24.6528,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Jo-1 Ena,,86235,CPT,Facility,Inpatient,,,,48,40.8,13.7568,48,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Jo-1 Ena,,86235,CPT,Facility,Both,,,,48,40.8,13.7568,48,Sanford Health Plan,Sanford Health Plan,44.16,92,,percent of total billed charges,,
Jo-1 Ena,,86235,CPT,Facility,Outpatient,,,,48,40.8,13.7568,48,"UCare Health, Inc.",Individual & Family Plan,27.048,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Jo-1 Ena,,86235,CPT,Facility,Inpatient,,,,48,40.8,13.7568,48,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Jo-1 Ena,,86235,CPT,Facility,Outpatient,,,,48,40.8,13.7568,48,"UCare Health, Inc.",Medical Assistance,24.2256,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Jo-1 Ena,,86235,CPT,Facility,Inpatient,,,,48,40.8,13.7568,48,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Jo-1 Ena,,86235,CPT,Facility,Outpatient,,,,48,40.8,13.7568,48,"UCare Health, Inc.",Medicare Advantage,24.2256,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Jo-1 Ena,,86235,CPT,Facility,Inpatient,,,,48,40.8,13.7568,48,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Jo-1 Ena,,86235,CPT,Facility,Outpatient,,,,48,40.8,13.7568,48,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),24.2256,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Jo-1 Ena,,86235,CPT,Facility,Inpatient,,,,48,40.8,13.7568,48,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Jo-1 Ena,,86235,CPT,Facility,Both,,,,48,40.8,13.7568,48,UnitedHealthcare,Individual & Family,45.12,94,,percent of total billed charges,,
Jo-1 Ena,,86235,CPT,Facility,Outpatient,,,,48,40.8,13.7568,48,UnitedHealthcare,Medicare Advantage,23.52,49,,percent of total billed charges,,
Jo-1 Ena,,86235,CPT,Facility,Inpatient,,,,48,40.8,13.7568,48,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Jo-1 Ena,,86235,CPT,Facility,Outpatient,,,,48,40.8,13.7568,48,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,23.04,48,,percent of total billed charges,,100% of DHS outpatient percentage
Jo-1 Ena,,86235,CPT,Facility,Inpatient,,,,48,40.8,13.7568,48,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Scl 70 Abs, Igg",,86235,CPT,Facility,Both,,,,48,40.8,13.7568,48,Aetna,Commercial,44.16,92,,percent of total billed charges,,
"Scl 70 Abs, Igg",,86235,CPT,Facility,Outpatient,,,,48,40.8,13.7568,48,Aetna,Medicare Advantage,23.52,49,,percent of total billed charges,,
"Scl 70 Abs, Igg",,86235,CPT,Facility,Inpatient,,,,48,40.8,13.7568,48,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Scl 70 Abs, Igg",,86235,CPT,Facility,Both,,,,48,40.8,13.7568,48,Aetna,PPO,44.64,93,,percent of total billed charges,,
"Scl 70 Abs, Igg",,86235,CPT,Facility,Both,,,,48,40.8,13.7568,48,America's PPO,America's PPO,46.0944,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Scl 70 Abs, Igg",,86235,CPT,Facility,Both,,,,48,40.8,13.7568,48,BlueCross BlueShield Minnesota, Federal Employee Program,47.232,98.4,,percent of total billed charges,,
"Scl 70 Abs, Igg",,86235,CPT,Facility,Both,,,,48,40.8,13.7568,48,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,48,100,,percent of total billed charges,,
"Scl 70 Abs, Igg",,86235,CPT,Facility,Both,,,,48,40.8,13.7568,48,BlueCross BlueShield Minnesota,High Value Network Plan,43.2,90,,percent of total billed charges,,
"Scl 70 Abs, Igg",,86235,CPT,Facility,Outpatient,,,,48,40.8,13.7568,48,BlueCross BlueShield Minnesota,Medicare Advantage,23.52,49,,percent of total billed charges,,
"Scl 70 Abs, Igg",,86235,CPT,Facility,Inpatient,,,,48,40.8,13.7568,48,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Scl 70 Abs, Igg",,86235,CPT,Facility,Both,,,,48,40.8,13.7568,48,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,42.5136,88.57,,percent of total billed charges,,
"Scl 70 Abs, Igg",,86235,CPT,Facility,Both,,,,48,40.8,13.7568,48,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,13.7568,28.66,,percent of total billed charges,,
"Scl 70 Abs, Igg",,86235,CPT,Facility,Outpatient,,,,48,40.8,13.7568,48,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),23.52,49,,percent of total billed charges,,
"Scl 70 Abs, Igg",,86235,CPT,Facility,Inpatient,,,,48,40.8,13.7568,48,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Scl 70 Abs, Igg",,86235,CPT,Facility,Both,,,,48,40.8,13.7568,48,CorVel,Worker's Compensation,48,100,,percent of total billed charges,,
"Scl 70 Abs, Igg",,86235,CPT,Facility,Both,,,,48,40.8,13.7568,48,First Health Group Corporation,First Health Network,46.56,97,,percent of total billed charges,,
"Scl 70 Abs, Igg",,86235,CPT,Facility,Both,,,,48,40.8,13.7568,48,"Health Partners, Inc.",Commercial,45.408,94.6,,percent of total billed charges,,
"Scl 70 Abs, Igg",,86235,CPT,Facility,Outpatient,,,,48,40.8,13.7568,48,"Health Partners, Inc.",Medicare Advantage,23.52,49,,percent of total billed charges,,
"Scl 70 Abs, Igg",,86235,CPT,Facility,Inpatient,,,,48,40.8,13.7568,48,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Scl 70 Abs, Igg",,86235,CPT,Facility,Both,,,,48,40.8,13.7568,48,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),28.8,60,,percent of total billed charges,,
"Scl 70 Abs, Igg",,86235,CPT,Facility,Both,,,,48,40.8,13.7568,48,"Health Partners, Inc.",State of Minnesota Advantage Program,39.12,81.5,,percent of total billed charges,,
"Scl 70 Abs, Igg",,86235,CPT,Facility,Both,,,,48,40.8,13.7568,48,"Health Partners, Inc.",State Public Programs,24,50,,percent of total billed charges,,
"Scl 70 Abs, Igg",,86235,CPT,Facility,Both,,,,48,40.8,13.7568,48,Humana Insurance Company,Commercial PPO,45.6,95,,percent of total billed charges,,
"Scl 70 Abs, Igg",,86235,CPT,Facility,Outpatient,,,,48,40.8,13.7568,48,Humana Insurance Company,Medicare PPO,23.52,49,,percent of total billed charges,,
"Scl 70 Abs, Igg",,86235,CPT,Facility,Inpatient,,,,48,40.8,13.7568,48,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Scl 70 Abs, Igg",,86235,CPT,Facility,Both,,,,48,40.8,13.7568,48,Medica,Individual & Family,47.568,99.1,,percent of total billed charges,,
"Scl 70 Abs, Igg",,86235,CPT,Facility,Outpatient,,,,48,40.8,13.7568,48,Medica,Medica Advantage Solution,23.904,49.8,,percent of total billed charges,,
"Scl 70 Abs, Igg",,86235,CPT,Facility,Inpatient,,,,48,40.8,13.7568,48,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Scl 70 Abs, Igg",,86235,CPT,Facility,Outpatient,,,,48,40.8,13.7568,48,Medica,Medical Assistance,21.408,44.6,,percent of total billed charges,,
"Scl 70 Abs, Igg",,86235,CPT,Facility,Inpatient,,,,48,40.8,13.7568,48,Medica,Medical Assistance,,,,,Included in per diem rate,
"Scl 70 Abs, Igg",,86235,CPT,Facility,Outpatient,,,,48,40.8,13.7568,48,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,23.904,49.8,,percent of total billed charges,,
"Scl 70 Abs, Igg",,86235,CPT,Facility,Inpatient,,,,48,40.8,13.7568,48,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Scl 70 Abs, Igg",,86235,CPT,Facility,Both,,,,48,40.8,13.7568,48,"Multiplan, Inc.","Multiplan, Inc.",45.12,94,,percent of total billed charges,,
"Scl 70 Abs, Igg",,86235,CPT,Facility,Outpatient,,,,48,40.8,13.7568,48,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,41.472,86.4,,percent of total billed charges,,
"Scl 70 Abs, Igg",,86235,CPT,Facility,Inpatient,,,,48,40.8,13.7568,48,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Scl 70 Abs, Igg",,86235,CPT,Facility,Both,,,,48,40.8,13.7568,48,"Preferred One Administrative Services, INC.",PPO,47.328,98.6,,percent of total billed charges,,
"Scl 70 Abs, Igg",,86235,CPT,Facility,Outpatient,,,,48,40.8,13.7568,48,PrimeWest Health,Minnesota Senior Health Options (MSHO),24.696,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Scl 70 Abs, Igg",,86235,CPT,Facility,Inpatient,,,,48,40.8,13.7568,48,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Scl 70 Abs, Igg",,86235,CPT,Facility,Outpatient,,,,48,40.8,13.7568,48,PrimeWest Health,MinnesotaCare,24.6528,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Scl 70 Abs, Igg",,86235,CPT,Facility,Inpatient,,,,48,40.8,13.7568,48,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Scl 70 Abs, Igg",,86235,CPT,Facility,Both,,,,48,40.8,13.7568,48,Sanford Health Plan,Sanford Health Plan,44.16,92,,percent of total billed charges,,
"Scl 70 Abs, Igg",,86235,CPT,Facility,Outpatient,,,,48,40.8,13.7568,48,"UCare Health, Inc.",Individual & Family Plan,27.048,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Scl 70 Abs, Igg",,86235,CPT,Facility,Inpatient,,,,48,40.8,13.7568,48,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Scl 70 Abs, Igg",,86235,CPT,Facility,Outpatient,,,,48,40.8,13.7568,48,"UCare Health, Inc.",Medical Assistance,24.2256,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Scl 70 Abs, Igg",,86235,CPT,Facility,Inpatient,,,,48,40.8,13.7568,48,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Scl 70 Abs, Igg",,86235,CPT,Facility,Outpatient,,,,48,40.8,13.7568,48,"UCare Health, Inc.",Medicare Advantage,24.2256,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Scl 70 Abs, Igg",,86235,CPT,Facility,Inpatient,,,,48,40.8,13.7568,48,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Scl 70 Abs, Igg",,86235,CPT,Facility,Outpatient,,,,48,40.8,13.7568,48,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),24.2256,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Scl 70 Abs, Igg",,86235,CPT,Facility,Inpatient,,,,48,40.8,13.7568,48,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Scl 70 Abs, Igg",,86235,CPT,Facility,Both,,,,48,40.8,13.7568,48,UnitedHealthcare,Individual & Family,45.12,94,,percent of total billed charges,,
"Scl 70 Abs, Igg",,86235,CPT,Facility,Outpatient,,,,48,40.8,13.7568,48,UnitedHealthcare,Medicare Advantage,23.52,49,,percent of total billed charges,,
"Scl 70 Abs, Igg",,86235,CPT,Facility,Inpatient,,,,48,40.8,13.7568,48,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Scl 70 Abs, Igg",,86235,CPT,Facility,Outpatient,,,,48,40.8,13.7568,48,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,23.04,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Scl 70 Abs, Igg",,86235,CPT,Facility,Inpatient,,,,48,40.8,13.7568,48,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Sm/Rnp Ab,,86235,CPT,Facility,Both,,,,48,40.8,13.7568,48,Aetna,Commercial,44.16,92,,percent of total billed charges,,
Sm/Rnp Ab,,86235,CPT,Facility,Outpatient,,,,48,40.8,13.7568,48,Aetna,Medicare Advantage,23.52,49,,percent of total billed charges,,
Sm/Rnp Ab,,86235,CPT,Facility,Inpatient,,,,48,40.8,13.7568,48,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Sm/Rnp Ab,,86235,CPT,Facility,Both,,,,48,40.8,13.7568,48,Aetna,PPO,44.64,93,,percent of total billed charges,,
Sm/Rnp Ab,,86235,CPT,Facility,Both,,,,48,40.8,13.7568,48,America's PPO,America's PPO,46.0944,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Sm/Rnp Ab,,86235,CPT,Facility,Both,,,,48,40.8,13.7568,48,BlueCross BlueShield Minnesota, Federal Employee Program,47.232,98.4,,percent of total billed charges,,
Sm/Rnp Ab,,86235,CPT,Facility,Both,,,,48,40.8,13.7568,48,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,48,100,,percent of total billed charges,,
Sm/Rnp Ab,,86235,CPT,Facility,Both,,,,48,40.8,13.7568,48,BlueCross BlueShield Minnesota,High Value Network Plan,43.2,90,,percent of total billed charges,,
Sm/Rnp Ab,,86235,CPT,Facility,Outpatient,,,,48,40.8,13.7568,48,BlueCross BlueShield Minnesota,Medicare Advantage,23.52,49,,percent of total billed charges,,
Sm/Rnp Ab,,86235,CPT,Facility,Inpatient,,,,48,40.8,13.7568,48,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Sm/Rnp Ab,,86235,CPT,Facility,Both,,,,48,40.8,13.7568,48,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,42.5136,88.57,,percent of total billed charges,,
Sm/Rnp Ab,,86235,CPT,Facility,Both,,,,48,40.8,13.7568,48,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,13.7568,28.66,,percent of total billed charges,,
Sm/Rnp Ab,,86235,CPT,Facility,Outpatient,,,,48,40.8,13.7568,48,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),23.52,49,,percent of total billed charges,,
Sm/Rnp Ab,,86235,CPT,Facility,Inpatient,,,,48,40.8,13.7568,48,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Sm/Rnp Ab,,86235,CPT,Facility,Both,,,,48,40.8,13.7568,48,CorVel,Worker's Compensation,48,100,,percent of total billed charges,,
Sm/Rnp Ab,,86235,CPT,Facility,Both,,,,48,40.8,13.7568,48,First Health Group Corporation,First Health Network,46.56,97,,percent of total billed charges,,
Sm/Rnp Ab,,86235,CPT,Facility,Both,,,,48,40.8,13.7568,48,"Health Partners, Inc.",Commercial,45.408,94.6,,percent of total billed charges,,
Sm/Rnp Ab,,86235,CPT,Facility,Outpatient,,,,48,40.8,13.7568,48,"Health Partners, Inc.",Medicare Advantage,23.52,49,,percent of total billed charges,,
Sm/Rnp Ab,,86235,CPT,Facility,Inpatient,,,,48,40.8,13.7568,48,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sm/Rnp Ab,,86235,CPT,Facility,Both,,,,48,40.8,13.7568,48,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),28.8,60,,percent of total billed charges,,
Sm/Rnp Ab,,86235,CPT,Facility,Both,,,,48,40.8,13.7568,48,"Health Partners, Inc.",State of Minnesota Advantage Program,39.12,81.5,,percent of total billed charges,,
Sm/Rnp Ab,,86235,CPT,Facility,Both,,,,48,40.8,13.7568,48,"Health Partners, Inc.",State Public Programs,24,50,,percent of total billed charges,,
Sm/Rnp Ab,,86235,CPT,Facility,Both,,,,48,40.8,13.7568,48,Humana Insurance Company,Commercial PPO,45.6,95,,percent of total billed charges,,
Sm/Rnp Ab,,86235,CPT,Facility,Outpatient,,,,48,40.8,13.7568,48,Humana Insurance Company,Medicare PPO,23.52,49,,percent of total billed charges,,
Sm/Rnp Ab,,86235,CPT,Facility,Inpatient,,,,48,40.8,13.7568,48,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Sm/Rnp Ab,,86235,CPT,Facility,Both,,,,48,40.8,13.7568,48,Medica,Individual & Family,47.568,99.1,,percent of total billed charges,,
Sm/Rnp Ab,,86235,CPT,Facility,Outpatient,,,,48,40.8,13.7568,48,Medica,Medica Advantage Solution,23.904,49.8,,percent of total billed charges,,
Sm/Rnp Ab,,86235,CPT,Facility,Inpatient,,,,48,40.8,13.7568,48,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Sm/Rnp Ab,,86235,CPT,Facility,Outpatient,,,,48,40.8,13.7568,48,Medica,Medical Assistance,21.408,44.6,,percent of total billed charges,,
Sm/Rnp Ab,,86235,CPT,Facility,Inpatient,,,,48,40.8,13.7568,48,Medica,Medical Assistance,,,,,Included in per diem rate,
Sm/Rnp Ab,,86235,CPT,Facility,Outpatient,,,,48,40.8,13.7568,48,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,23.904,49.8,,percent of total billed charges,,
Sm/Rnp Ab,,86235,CPT,Facility,Inpatient,,,,48,40.8,13.7568,48,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Sm/Rnp Ab,,86235,CPT,Facility,Both,,,,48,40.8,13.7568,48,"Multiplan, Inc.","Multiplan, Inc.",45.12,94,,percent of total billed charges,,
Sm/Rnp Ab,,86235,CPT,Facility,Outpatient,,,,48,40.8,13.7568,48,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,41.472,86.4,,percent of total billed charges,,
Sm/Rnp Ab,,86235,CPT,Facility,Inpatient,,,,48,40.8,13.7568,48,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Sm/Rnp Ab,,86235,CPT,Facility,Both,,,,48,40.8,13.7568,48,"Preferred One Administrative Services, INC.",PPO,47.328,98.6,,percent of total billed charges,,
Sm/Rnp Ab,,86235,CPT,Facility,Outpatient,,,,48,40.8,13.7568,48,PrimeWest Health,Minnesota Senior Health Options (MSHO),24.696,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Sm/Rnp Ab,,86235,CPT,Facility,Inpatient,,,,48,40.8,13.7568,48,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sm/Rnp Ab,,86235,CPT,Facility,Outpatient,,,,48,40.8,13.7568,48,PrimeWest Health,MinnesotaCare,24.6528,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Sm/Rnp Ab,,86235,CPT,Facility,Inpatient,,,,48,40.8,13.7568,48,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Sm/Rnp Ab,,86235,CPT,Facility,Both,,,,48,40.8,13.7568,48,Sanford Health Plan,Sanford Health Plan,44.16,92,,percent of total billed charges,,
Sm/Rnp Ab,,86235,CPT,Facility,Outpatient,,,,48,40.8,13.7568,48,"UCare Health, Inc.",Individual & Family Plan,27.048,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Sm/Rnp Ab,,86235,CPT,Facility,Inpatient,,,,48,40.8,13.7568,48,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Sm/Rnp Ab,,86235,CPT,Facility,Outpatient,,,,48,40.8,13.7568,48,"UCare Health, Inc.",Medical Assistance,24.2256,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sm/Rnp Ab,,86235,CPT,Facility,Inpatient,,,,48,40.8,13.7568,48,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Sm/Rnp Ab,,86235,CPT,Facility,Outpatient,,,,48,40.8,13.7568,48,"UCare Health, Inc.",Medicare Advantage,24.2256,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sm/Rnp Ab,,86235,CPT,Facility,Inpatient,,,,48,40.8,13.7568,48,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sm/Rnp Ab,,86235,CPT,Facility,Outpatient,,,,48,40.8,13.7568,48,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),24.2256,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sm/Rnp Ab,,86235,CPT,Facility,Inpatient,,,,48,40.8,13.7568,48,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sm/Rnp Ab,,86235,CPT,Facility,Both,,,,48,40.8,13.7568,48,UnitedHealthcare,Individual & Family,45.12,94,,percent of total billed charges,,
Sm/Rnp Ab,,86235,CPT,Facility,Outpatient,,,,48,40.8,13.7568,48,UnitedHealthcare,Medicare Advantage,23.52,49,,percent of total billed charges,,
Sm/Rnp Ab,,86235,CPT,Facility,Inpatient,,,,48,40.8,13.7568,48,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Sm/Rnp Ab,,86235,CPT,Facility,Outpatient,,,,48,40.8,13.7568,48,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,23.04,48,,percent of total billed charges,,100% of DHS outpatient percentage
Sm/Rnp Ab,,86235,CPT,Facility,Inpatient,,,,48,40.8,13.7568,48,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Smith Ena,,86235,CPT,Facility,Both,,,,48,40.8,13.7568,48,Aetna,Commercial,44.16,92,,percent of total billed charges,,
Smith Ena,,86235,CPT,Facility,Outpatient,,,,48,40.8,13.7568,48,Aetna,Medicare Advantage,23.52,49,,percent of total billed charges,,
Smith Ena,,86235,CPT,Facility,Inpatient,,,,48,40.8,13.7568,48,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Smith Ena,,86235,CPT,Facility,Both,,,,48,40.8,13.7568,48,Aetna,PPO,44.64,93,,percent of total billed charges,,
Smith Ena,,86235,CPT,Facility,Both,,,,48,40.8,13.7568,48,America's PPO,America's PPO,46.0944,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Smith Ena,,86235,CPT,Facility,Both,,,,48,40.8,13.7568,48,BlueCross BlueShield Minnesota, Federal Employee Program,47.232,98.4,,percent of total billed charges,,
Smith Ena,,86235,CPT,Facility,Both,,,,48,40.8,13.7568,48,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,48,100,,percent of total billed charges,,
Smith Ena,,86235,CPT,Facility,Both,,,,48,40.8,13.7568,48,BlueCross BlueShield Minnesota,High Value Network Plan,43.2,90,,percent of total billed charges,,
Smith Ena,,86235,CPT,Facility,Outpatient,,,,48,40.8,13.7568,48,BlueCross BlueShield Minnesota,Medicare Advantage,23.52,49,,percent of total billed charges,,
Smith Ena,,86235,CPT,Facility,Inpatient,,,,48,40.8,13.7568,48,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Smith Ena,,86235,CPT,Facility,Both,,,,48,40.8,13.7568,48,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,42.5136,88.57,,percent of total billed charges,,
Smith Ena,,86235,CPT,Facility,Both,,,,48,40.8,13.7568,48,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,13.7568,28.66,,percent of total billed charges,,
Smith Ena,,86235,CPT,Facility,Outpatient,,,,48,40.8,13.7568,48,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),23.52,49,,percent of total billed charges,,
Smith Ena,,86235,CPT,Facility,Inpatient,,,,48,40.8,13.7568,48,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Smith Ena,,86235,CPT,Facility,Both,,,,48,40.8,13.7568,48,CorVel,Worker's Compensation,48,100,,percent of total billed charges,,
Smith Ena,,86235,CPT,Facility,Both,,,,48,40.8,13.7568,48,First Health Group Corporation,First Health Network,46.56,97,,percent of total billed charges,,
Smith Ena,,86235,CPT,Facility,Both,,,,48,40.8,13.7568,48,"Health Partners, Inc.",Commercial,45.408,94.6,,percent of total billed charges,,
Smith Ena,,86235,CPT,Facility,Outpatient,,,,48,40.8,13.7568,48,"Health Partners, Inc.",Medicare Advantage,23.52,49,,percent of total billed charges,,
Smith Ena,,86235,CPT,Facility,Inpatient,,,,48,40.8,13.7568,48,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Smith Ena,,86235,CPT,Facility,Both,,,,48,40.8,13.7568,48,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),28.8,60,,percent of total billed charges,,
Smith Ena,,86235,CPT,Facility,Both,,,,48,40.8,13.7568,48,"Health Partners, Inc.",State of Minnesota Advantage Program,39.12,81.5,,percent of total billed charges,,
Smith Ena,,86235,CPT,Facility,Both,,,,48,40.8,13.7568,48,"Health Partners, Inc.",State Public Programs,24,50,,percent of total billed charges,,
Smith Ena,,86235,CPT,Facility,Both,,,,48,40.8,13.7568,48,Humana Insurance Company,Commercial PPO,45.6,95,,percent of total billed charges,,
Smith Ena,,86235,CPT,Facility,Outpatient,,,,48,40.8,13.7568,48,Humana Insurance Company,Medicare PPO,23.52,49,,percent of total billed charges,,
Smith Ena,,86235,CPT,Facility,Inpatient,,,,48,40.8,13.7568,48,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Smith Ena,,86235,CPT,Facility,Both,,,,48,40.8,13.7568,48,Medica,Individual & Family,47.568,99.1,,percent of total billed charges,,
Smith Ena,,86235,CPT,Facility,Outpatient,,,,48,40.8,13.7568,48,Medica,Medica Advantage Solution,23.904,49.8,,percent of total billed charges,,
Smith Ena,,86235,CPT,Facility,Inpatient,,,,48,40.8,13.7568,48,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Smith Ena,,86235,CPT,Facility,Outpatient,,,,48,40.8,13.7568,48,Medica,Medical Assistance,21.408,44.6,,percent of total billed charges,,
Smith Ena,,86235,CPT,Facility,Inpatient,,,,48,40.8,13.7568,48,Medica,Medical Assistance,,,,,Included in per diem rate,
Smith Ena,,86235,CPT,Facility,Outpatient,,,,48,40.8,13.7568,48,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,23.904,49.8,,percent of total billed charges,,
Smith Ena,,86235,CPT,Facility,Inpatient,,,,48,40.8,13.7568,48,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Smith Ena,,86235,CPT,Facility,Both,,,,48,40.8,13.7568,48,"Multiplan, Inc.","Multiplan, Inc.",45.12,94,,percent of total billed charges,,
Smith Ena,,86235,CPT,Facility,Outpatient,,,,48,40.8,13.7568,48,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,41.472,86.4,,percent of total billed charges,,
Smith Ena,,86235,CPT,Facility,Inpatient,,,,48,40.8,13.7568,48,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Smith Ena,,86235,CPT,Facility,Both,,,,48,40.8,13.7568,48,"Preferred One Administrative Services, INC.",PPO,47.328,98.6,,percent of total billed charges,,
Smith Ena,,86235,CPT,Facility,Outpatient,,,,48,40.8,13.7568,48,PrimeWest Health,Minnesota Senior Health Options (MSHO),24.696,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Smith Ena,,86235,CPT,Facility,Inpatient,,,,48,40.8,13.7568,48,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Smith Ena,,86235,CPT,Facility,Outpatient,,,,48,40.8,13.7568,48,PrimeWest Health,MinnesotaCare,24.6528,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Smith Ena,,86235,CPT,Facility,Inpatient,,,,48,40.8,13.7568,48,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Smith Ena,,86235,CPT,Facility,Both,,,,48,40.8,13.7568,48,Sanford Health Plan,Sanford Health Plan,44.16,92,,percent of total billed charges,,
Smith Ena,,86235,CPT,Facility,Outpatient,,,,48,40.8,13.7568,48,"UCare Health, Inc.",Individual & Family Plan,27.048,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Smith Ena,,86235,CPT,Facility,Inpatient,,,,48,40.8,13.7568,48,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Smith Ena,,86235,CPT,Facility,Outpatient,,,,48,40.8,13.7568,48,"UCare Health, Inc.",Medical Assistance,24.2256,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Smith Ena,,86235,CPT,Facility,Inpatient,,,,48,40.8,13.7568,48,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Smith Ena,,86235,CPT,Facility,Outpatient,,,,48,40.8,13.7568,48,"UCare Health, Inc.",Medicare Advantage,24.2256,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Smith Ena,,86235,CPT,Facility,Inpatient,,,,48,40.8,13.7568,48,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Smith Ena,,86235,CPT,Facility,Outpatient,,,,48,40.8,13.7568,48,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),24.2256,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Smith Ena,,86235,CPT,Facility,Inpatient,,,,48,40.8,13.7568,48,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Smith Ena,,86235,CPT,Facility,Both,,,,48,40.8,13.7568,48,UnitedHealthcare,Individual & Family,45.12,94,,percent of total billed charges,,
Smith Ena,,86235,CPT,Facility,Outpatient,,,,48,40.8,13.7568,48,UnitedHealthcare,Medicare Advantage,23.52,49,,percent of total billed charges,,
Smith Ena,,86235,CPT,Facility,Inpatient,,,,48,40.8,13.7568,48,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Smith Ena,,86235,CPT,Facility,Outpatient,,,,48,40.8,13.7568,48,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,23.04,48,,percent of total billed charges,,100% of DHS outpatient percentage
Smith Ena,,86235,CPT,Facility,Inpatient,,,,48,40.8,13.7568,48,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Ss-A/Ro Ena,,86235,CPT,Facility,Both,,,,48,40.8,13.7568,48,Aetna,Commercial,44.16,92,,percent of total billed charges,,
Ss-A/Ro Ena,,86235,CPT,Facility,Outpatient,,,,48,40.8,13.7568,48,Aetna,Medicare Advantage,23.52,49,,percent of total billed charges,,
Ss-A/Ro Ena,,86235,CPT,Facility,Inpatient,,,,48,40.8,13.7568,48,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Ss-A/Ro Ena,,86235,CPT,Facility,Both,,,,48,40.8,13.7568,48,Aetna,PPO,44.64,93,,percent of total billed charges,,
Ss-A/Ro Ena,,86235,CPT,Facility,Both,,,,48,40.8,13.7568,48,America's PPO,America's PPO,46.0944,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Ss-A/Ro Ena,,86235,CPT,Facility,Both,,,,48,40.8,13.7568,48,BlueCross BlueShield Minnesota, Federal Employee Program,47.232,98.4,,percent of total billed charges,,
Ss-A/Ro Ena,,86235,CPT,Facility,Both,,,,48,40.8,13.7568,48,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,48,100,,percent of total billed charges,,
Ss-A/Ro Ena,,86235,CPT,Facility,Both,,,,48,40.8,13.7568,48,BlueCross BlueShield Minnesota,High Value Network Plan,43.2,90,,percent of total billed charges,,
Ss-A/Ro Ena,,86235,CPT,Facility,Outpatient,,,,48,40.8,13.7568,48,BlueCross BlueShield Minnesota,Medicare Advantage,23.52,49,,percent of total billed charges,,
Ss-A/Ro Ena,,86235,CPT,Facility,Inpatient,,,,48,40.8,13.7568,48,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Ss-A/Ro Ena,,86235,CPT,Facility,Both,,,,48,40.8,13.7568,48,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,42.5136,88.57,,percent of total billed charges,,
Ss-A/Ro Ena,,86235,CPT,Facility,Both,,,,48,40.8,13.7568,48,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,13.7568,28.66,,percent of total billed charges,,
Ss-A/Ro Ena,,86235,CPT,Facility,Outpatient,,,,48,40.8,13.7568,48,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),23.52,49,,percent of total billed charges,,
Ss-A/Ro Ena,,86235,CPT,Facility,Inpatient,,,,48,40.8,13.7568,48,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Ss-A/Ro Ena,,86235,CPT,Facility,Both,,,,48,40.8,13.7568,48,CorVel,Worker's Compensation,48,100,,percent of total billed charges,,
Ss-A/Ro Ena,,86235,CPT,Facility,Both,,,,48,40.8,13.7568,48,First Health Group Corporation,First Health Network,46.56,97,,percent of total billed charges,,
Ss-A/Ro Ena,,86235,CPT,Facility,Both,,,,48,40.8,13.7568,48,"Health Partners, Inc.",Commercial,45.408,94.6,,percent of total billed charges,,
Ss-A/Ro Ena,,86235,CPT,Facility,Outpatient,,,,48,40.8,13.7568,48,"Health Partners, Inc.",Medicare Advantage,23.52,49,,percent of total billed charges,,
Ss-A/Ro Ena,,86235,CPT,Facility,Inpatient,,,,48,40.8,13.7568,48,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ss-A/Ro Ena,,86235,CPT,Facility,Both,,,,48,40.8,13.7568,48,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),28.8,60,,percent of total billed charges,,
Ss-A/Ro Ena,,86235,CPT,Facility,Both,,,,48,40.8,13.7568,48,"Health Partners, Inc.",State of Minnesota Advantage Program,39.12,81.5,,percent of total billed charges,,
Ss-A/Ro Ena,,86235,CPT,Facility,Both,,,,48,40.8,13.7568,48,"Health Partners, Inc.",State Public Programs,24,50,,percent of total billed charges,,
Ss-A/Ro Ena,,86235,CPT,Facility,Both,,,,48,40.8,13.7568,48,Humana Insurance Company,Commercial PPO,45.6,95,,percent of total billed charges,,
Ss-A/Ro Ena,,86235,CPT,Facility,Outpatient,,,,48,40.8,13.7568,48,Humana Insurance Company,Medicare PPO,23.52,49,,percent of total billed charges,,
Ss-A/Ro Ena,,86235,CPT,Facility,Inpatient,,,,48,40.8,13.7568,48,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Ss-A/Ro Ena,,86235,CPT,Facility,Both,,,,48,40.8,13.7568,48,Medica,Individual & Family,47.568,99.1,,percent of total billed charges,,
Ss-A/Ro Ena,,86235,CPT,Facility,Outpatient,,,,48,40.8,13.7568,48,Medica,Medica Advantage Solution,23.904,49.8,,percent of total billed charges,,
Ss-A/Ro Ena,,86235,CPT,Facility,Inpatient,,,,48,40.8,13.7568,48,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Ss-A/Ro Ena,,86235,CPT,Facility,Outpatient,,,,48,40.8,13.7568,48,Medica,Medical Assistance,21.408,44.6,,percent of total billed charges,,
Ss-A/Ro Ena,,86235,CPT,Facility,Inpatient,,,,48,40.8,13.7568,48,Medica,Medical Assistance,,,,,Included in per diem rate,
Ss-A/Ro Ena,,86235,CPT,Facility,Outpatient,,,,48,40.8,13.7568,48,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,23.904,49.8,,percent of total billed charges,,
Ss-A/Ro Ena,,86235,CPT,Facility,Inpatient,,,,48,40.8,13.7568,48,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Ss-A/Ro Ena,,86235,CPT,Facility,Both,,,,48,40.8,13.7568,48,"Multiplan, Inc.","Multiplan, Inc.",45.12,94,,percent of total billed charges,,
Ss-A/Ro Ena,,86235,CPT,Facility,Outpatient,,,,48,40.8,13.7568,48,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,41.472,86.4,,percent of total billed charges,,
Ss-A/Ro Ena,,86235,CPT,Facility,Inpatient,,,,48,40.8,13.7568,48,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Ss-A/Ro Ena,,86235,CPT,Facility,Both,,,,48,40.8,13.7568,48,"Preferred One Administrative Services, INC.",PPO,47.328,98.6,,percent of total billed charges,,
Ss-A/Ro Ena,,86235,CPT,Facility,Outpatient,,,,48,40.8,13.7568,48,PrimeWest Health,Minnesota Senior Health Options (MSHO),24.696,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Ss-A/Ro Ena,,86235,CPT,Facility,Inpatient,,,,48,40.8,13.7568,48,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ss-A/Ro Ena,,86235,CPT,Facility,Outpatient,,,,48,40.8,13.7568,48,PrimeWest Health,MinnesotaCare,24.6528,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Ss-A/Ro Ena,,86235,CPT,Facility,Inpatient,,,,48,40.8,13.7568,48,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Ss-A/Ro Ena,,86235,CPT,Facility,Both,,,,48,40.8,13.7568,48,Sanford Health Plan,Sanford Health Plan,44.16,92,,percent of total billed charges,,
Ss-A/Ro Ena,,86235,CPT,Facility,Outpatient,,,,48,40.8,13.7568,48,"UCare Health, Inc.",Individual & Family Plan,27.048,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Ss-A/Ro Ena,,86235,CPT,Facility,Inpatient,,,,48,40.8,13.7568,48,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Ss-A/Ro Ena,,86235,CPT,Facility,Outpatient,,,,48,40.8,13.7568,48,"UCare Health, Inc.",Medical Assistance,24.2256,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ss-A/Ro Ena,,86235,CPT,Facility,Inpatient,,,,48,40.8,13.7568,48,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Ss-A/Ro Ena,,86235,CPT,Facility,Outpatient,,,,48,40.8,13.7568,48,"UCare Health, Inc.",Medicare Advantage,24.2256,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ss-A/Ro Ena,,86235,CPT,Facility,Inpatient,,,,48,40.8,13.7568,48,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ss-A/Ro Ena,,86235,CPT,Facility,Outpatient,,,,48,40.8,13.7568,48,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),24.2256,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ss-A/Ro Ena,,86235,CPT,Facility,Inpatient,,,,48,40.8,13.7568,48,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ss-A/Ro Ena,,86235,CPT,Facility,Both,,,,48,40.8,13.7568,48,UnitedHealthcare,Individual & Family,45.12,94,,percent of total billed charges,,
Ss-A/Ro Ena,,86235,CPT,Facility,Outpatient,,,,48,40.8,13.7568,48,UnitedHealthcare,Medicare Advantage,23.52,49,,percent of total billed charges,,
Ss-A/Ro Ena,,86235,CPT,Facility,Inpatient,,,,48,40.8,13.7568,48,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Ss-A/Ro Ena,,86235,CPT,Facility,Outpatient,,,,48,40.8,13.7568,48,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,23.04,48,,percent of total billed charges,,100% of DHS outpatient percentage
Ss-A/Ro Ena,,86235,CPT,Facility,Inpatient,,,,48,40.8,13.7568,48,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Ss-B/La Ena,,86235,CPT,Facility,Both,,,,48,40.8,13.7568,48,Aetna,Commercial,44.16,92,,percent of total billed charges,,
Ss-B/La Ena,,86235,CPT,Facility,Outpatient,,,,48,40.8,13.7568,48,Aetna,Medicare Advantage,23.52,49,,percent of total billed charges,,
Ss-B/La Ena,,86235,CPT,Facility,Inpatient,,,,48,40.8,13.7568,48,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Ss-B/La Ena,,86235,CPT,Facility,Both,,,,48,40.8,13.7568,48,Aetna,PPO,44.64,93,,percent of total billed charges,,
Ss-B/La Ena,,86235,CPT,Facility,Both,,,,48,40.8,13.7568,48,America's PPO,America's PPO,46.0944,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Ss-B/La Ena,,86235,CPT,Facility,Both,,,,48,40.8,13.7568,48,BlueCross BlueShield Minnesota, Federal Employee Program,47.232,98.4,,percent of total billed charges,,
Ss-B/La Ena,,86235,CPT,Facility,Both,,,,48,40.8,13.7568,48,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,48,100,,percent of total billed charges,,
Ss-B/La Ena,,86235,CPT,Facility,Both,,,,48,40.8,13.7568,48,BlueCross BlueShield Minnesota,High Value Network Plan,43.2,90,,percent of total billed charges,,
Ss-B/La Ena,,86235,CPT,Facility,Outpatient,,,,48,40.8,13.7568,48,BlueCross BlueShield Minnesota,Medicare Advantage,23.52,49,,percent of total billed charges,,
Ss-B/La Ena,,86235,CPT,Facility,Inpatient,,,,48,40.8,13.7568,48,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Ss-B/La Ena,,86235,CPT,Facility,Both,,,,48,40.8,13.7568,48,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,42.5136,88.57,,percent of total billed charges,,
Ss-B/La Ena,,86235,CPT,Facility,Both,,,,48,40.8,13.7568,48,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,13.7568,28.66,,percent of total billed charges,,
Ss-B/La Ena,,86235,CPT,Facility,Outpatient,,,,48,40.8,13.7568,48,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),23.52,49,,percent of total billed charges,,
Ss-B/La Ena,,86235,CPT,Facility,Inpatient,,,,48,40.8,13.7568,48,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Ss-B/La Ena,,86235,CPT,Facility,Both,,,,48,40.8,13.7568,48,CorVel,Worker's Compensation,48,100,,percent of total billed charges,,
Ss-B/La Ena,,86235,CPT,Facility,Both,,,,48,40.8,13.7568,48,First Health Group Corporation,First Health Network,46.56,97,,percent of total billed charges,,
Ss-B/La Ena,,86235,CPT,Facility,Both,,,,48,40.8,13.7568,48,"Health Partners, Inc.",Commercial,45.408,94.6,,percent of total billed charges,,
Ss-B/La Ena,,86235,CPT,Facility,Outpatient,,,,48,40.8,13.7568,48,"Health Partners, Inc.",Medicare Advantage,23.52,49,,percent of total billed charges,,
Ss-B/La Ena,,86235,CPT,Facility,Inpatient,,,,48,40.8,13.7568,48,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ss-B/La Ena,,86235,CPT,Facility,Both,,,,48,40.8,13.7568,48,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),28.8,60,,percent of total billed charges,,
Ss-B/La Ena,,86235,CPT,Facility,Both,,,,48,40.8,13.7568,48,"Health Partners, Inc.",State of Minnesota Advantage Program,39.12,81.5,,percent of total billed charges,,
Ss-B/La Ena,,86235,CPT,Facility,Both,,,,48,40.8,13.7568,48,"Health Partners, Inc.",State Public Programs,24,50,,percent of total billed charges,,
Ss-B/La Ena,,86235,CPT,Facility,Both,,,,48,40.8,13.7568,48,Humana Insurance Company,Commercial PPO,45.6,95,,percent of total billed charges,,
Ss-B/La Ena,,86235,CPT,Facility,Outpatient,,,,48,40.8,13.7568,48,Humana Insurance Company,Medicare PPO,23.52,49,,percent of total billed charges,,
Ss-B/La Ena,,86235,CPT,Facility,Inpatient,,,,48,40.8,13.7568,48,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Ss-B/La Ena,,86235,CPT,Facility,Both,,,,48,40.8,13.7568,48,Medica,Individual & Family,47.568,99.1,,percent of total billed charges,,
Ss-B/La Ena,,86235,CPT,Facility,Outpatient,,,,48,40.8,13.7568,48,Medica,Medica Advantage Solution,23.904,49.8,,percent of total billed charges,,
Ss-B/La Ena,,86235,CPT,Facility,Inpatient,,,,48,40.8,13.7568,48,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Ss-B/La Ena,,86235,CPT,Facility,Outpatient,,,,48,40.8,13.7568,48,Medica,Medical Assistance,21.408,44.6,,percent of total billed charges,,
Ss-B/La Ena,,86235,CPT,Facility,Inpatient,,,,48,40.8,13.7568,48,Medica,Medical Assistance,,,,,Included in per diem rate,
Ss-B/La Ena,,86235,CPT,Facility,Outpatient,,,,48,40.8,13.7568,48,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,23.904,49.8,,percent of total billed charges,,
Ss-B/La Ena,,86235,CPT,Facility,Inpatient,,,,48,40.8,13.7568,48,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Ss-B/La Ena,,86235,CPT,Facility,Both,,,,48,40.8,13.7568,48,"Multiplan, Inc.","Multiplan, Inc.",45.12,94,,percent of total billed charges,,
Ss-B/La Ena,,86235,CPT,Facility,Outpatient,,,,48,40.8,13.7568,48,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,41.472,86.4,,percent of total billed charges,,
Ss-B/La Ena,,86235,CPT,Facility,Inpatient,,,,48,40.8,13.7568,48,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Ss-B/La Ena,,86235,CPT,Facility,Both,,,,48,40.8,13.7568,48,"Preferred One Administrative Services, INC.",PPO,47.328,98.6,,percent of total billed charges,,
Ss-B/La Ena,,86235,CPT,Facility,Outpatient,,,,48,40.8,13.7568,48,PrimeWest Health,Minnesota Senior Health Options (MSHO),24.696,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Ss-B/La Ena,,86235,CPT,Facility,Inpatient,,,,48,40.8,13.7568,48,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ss-B/La Ena,,86235,CPT,Facility,Outpatient,,,,48,40.8,13.7568,48,PrimeWest Health,MinnesotaCare,24.6528,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Ss-B/La Ena,,86235,CPT,Facility,Inpatient,,,,48,40.8,13.7568,48,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Ss-B/La Ena,,86235,CPT,Facility,Both,,,,48,40.8,13.7568,48,Sanford Health Plan,Sanford Health Plan,44.16,92,,percent of total billed charges,,
Ss-B/La Ena,,86235,CPT,Facility,Outpatient,,,,48,40.8,13.7568,48,"UCare Health, Inc.",Individual & Family Plan,27.048,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Ss-B/La Ena,,86235,CPT,Facility,Inpatient,,,,48,40.8,13.7568,48,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Ss-B/La Ena,,86235,CPT,Facility,Outpatient,,,,48,40.8,13.7568,48,"UCare Health, Inc.",Medical Assistance,24.2256,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ss-B/La Ena,,86235,CPT,Facility,Inpatient,,,,48,40.8,13.7568,48,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Ss-B/La Ena,,86235,CPT,Facility,Outpatient,,,,48,40.8,13.7568,48,"UCare Health, Inc.",Medicare Advantage,24.2256,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ss-B/La Ena,,86235,CPT,Facility,Inpatient,,,,48,40.8,13.7568,48,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ss-B/La Ena,,86235,CPT,Facility,Outpatient,,,,48,40.8,13.7568,48,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),24.2256,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ss-B/La Ena,,86235,CPT,Facility,Inpatient,,,,48,40.8,13.7568,48,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ss-B/La Ena,,86235,CPT,Facility,Both,,,,48,40.8,13.7568,48,UnitedHealthcare,Individual & Family,45.12,94,,percent of total billed charges,,
Ss-B/La Ena,,86235,CPT,Facility,Outpatient,,,,48,40.8,13.7568,48,UnitedHealthcare,Medicare Advantage,23.52,49,,percent of total billed charges,,
Ss-B/La Ena,,86235,CPT,Facility,Inpatient,,,,48,40.8,13.7568,48,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Ss-B/La Ena,,86235,CPT,Facility,Outpatient,,,,48,40.8,13.7568,48,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,23.04,48,,percent of total billed charges,,100% of DHS outpatient percentage
Ss-B/La Ena,,86235,CPT,Facility,Inpatient,,,,48,40.8,13.7568,48,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
U1Rnp Ena,,86235,CPT,Facility,Both,,,,48,40.8,13.7568,48,Aetna,Commercial,44.16,92,,percent of total billed charges,,
U1Rnp Ena,,86235,CPT,Facility,Outpatient,,,,48,40.8,13.7568,48,Aetna,Medicare Advantage,23.52,49,,percent of total billed charges,,
U1Rnp Ena,,86235,CPT,Facility,Inpatient,,,,48,40.8,13.7568,48,Aetna,Medicare Advantage,,,,,Included in per diem rate,
U1Rnp Ena,,86235,CPT,Facility,Both,,,,48,40.8,13.7568,48,Aetna,PPO,44.64,93,,percent of total billed charges,,
U1Rnp Ena,,86235,CPT,Facility,Both,,,,48,40.8,13.7568,48,America's PPO,America's PPO,46.0944,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
U1Rnp Ena,,86235,CPT,Facility,Both,,,,48,40.8,13.7568,48,BlueCross BlueShield Minnesota, Federal Employee Program,47.232,98.4,,percent of total billed charges,,
U1Rnp Ena,,86235,CPT,Facility,Both,,,,48,40.8,13.7568,48,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,48,100,,percent of total billed charges,,
U1Rnp Ena,,86235,CPT,Facility,Both,,,,48,40.8,13.7568,48,BlueCross BlueShield Minnesota,High Value Network Plan,43.2,90,,percent of total billed charges,,
U1Rnp Ena,,86235,CPT,Facility,Outpatient,,,,48,40.8,13.7568,48,BlueCross BlueShield Minnesota,Medicare Advantage,23.52,49,,percent of total billed charges,,
U1Rnp Ena,,86235,CPT,Facility,Inpatient,,,,48,40.8,13.7568,48,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
U1Rnp Ena,,86235,CPT,Facility,Both,,,,48,40.8,13.7568,48,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,42.5136,88.57,,percent of total billed charges,,
U1Rnp Ena,,86235,CPT,Facility,Both,,,,48,40.8,13.7568,48,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,13.7568,28.66,,percent of total billed charges,,
U1Rnp Ena,,86235,CPT,Facility,Outpatient,,,,48,40.8,13.7568,48,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),23.52,49,,percent of total billed charges,,
U1Rnp Ena,,86235,CPT,Facility,Inpatient,,,,48,40.8,13.7568,48,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
U1Rnp Ena,,86235,CPT,Facility,Both,,,,48,40.8,13.7568,48,CorVel,Worker's Compensation,48,100,,percent of total billed charges,,
U1Rnp Ena,,86235,CPT,Facility,Both,,,,48,40.8,13.7568,48,First Health Group Corporation,First Health Network,46.56,97,,percent of total billed charges,,
U1Rnp Ena,,86235,CPT,Facility,Both,,,,48,40.8,13.7568,48,"Health Partners, Inc.",Commercial,45.408,94.6,,percent of total billed charges,,
U1Rnp Ena,,86235,CPT,Facility,Outpatient,,,,48,40.8,13.7568,48,"Health Partners, Inc.",Medicare Advantage,23.52,49,,percent of total billed charges,,
U1Rnp Ena,,86235,CPT,Facility,Inpatient,,,,48,40.8,13.7568,48,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
U1Rnp Ena,,86235,CPT,Facility,Both,,,,48,40.8,13.7568,48,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),28.8,60,,percent of total billed charges,,
U1Rnp Ena,,86235,CPT,Facility,Both,,,,48,40.8,13.7568,48,"Health Partners, Inc.",State of Minnesota Advantage Program,39.12,81.5,,percent of total billed charges,,
U1Rnp Ena,,86235,CPT,Facility,Both,,,,48,40.8,13.7568,48,"Health Partners, Inc.",State Public Programs,24,50,,percent of total billed charges,,
U1Rnp Ena,,86235,CPT,Facility,Both,,,,48,40.8,13.7568,48,Humana Insurance Company,Commercial PPO,45.6,95,,percent of total billed charges,,
U1Rnp Ena,,86235,CPT,Facility,Outpatient,,,,48,40.8,13.7568,48,Humana Insurance Company,Medicare PPO,23.52,49,,percent of total billed charges,,
U1Rnp Ena,,86235,CPT,Facility,Inpatient,,,,48,40.8,13.7568,48,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
U1Rnp Ena,,86235,CPT,Facility,Both,,,,48,40.8,13.7568,48,Medica,Individual & Family,47.568,99.1,,percent of total billed charges,,
U1Rnp Ena,,86235,CPT,Facility,Outpatient,,,,48,40.8,13.7568,48,Medica,Medica Advantage Solution,23.904,49.8,,percent of total billed charges,,
U1Rnp Ena,,86235,CPT,Facility,Inpatient,,,,48,40.8,13.7568,48,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
U1Rnp Ena,,86235,CPT,Facility,Outpatient,,,,48,40.8,13.7568,48,Medica,Medical Assistance,21.408,44.6,,percent of total billed charges,,
U1Rnp Ena,,86235,CPT,Facility,Inpatient,,,,48,40.8,13.7568,48,Medica,Medical Assistance,,,,,Included in per diem rate,
U1Rnp Ena,,86235,CPT,Facility,Outpatient,,,,48,40.8,13.7568,48,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,23.904,49.8,,percent of total billed charges,,
U1Rnp Ena,,86235,CPT,Facility,Inpatient,,,,48,40.8,13.7568,48,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
U1Rnp Ena,,86235,CPT,Facility,Both,,,,48,40.8,13.7568,48,"Multiplan, Inc.","Multiplan, Inc.",45.12,94,,percent of total billed charges,,
U1Rnp Ena,,86235,CPT,Facility,Outpatient,,,,48,40.8,13.7568,48,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,41.472,86.4,,percent of total billed charges,,
U1Rnp Ena,,86235,CPT,Facility,Inpatient,,,,48,40.8,13.7568,48,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
U1Rnp Ena,,86235,CPT,Facility,Both,,,,48,40.8,13.7568,48,"Preferred One Administrative Services, INC.",PPO,47.328,98.6,,percent of total billed charges,,
U1Rnp Ena,,86235,CPT,Facility,Outpatient,,,,48,40.8,13.7568,48,PrimeWest Health,Minnesota Senior Health Options (MSHO),24.696,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
U1Rnp Ena,,86235,CPT,Facility,Inpatient,,,,48,40.8,13.7568,48,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
U1Rnp Ena,,86235,CPT,Facility,Outpatient,,,,48,40.8,13.7568,48,PrimeWest Health,MinnesotaCare,24.6528,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
U1Rnp Ena,,86235,CPT,Facility,Inpatient,,,,48,40.8,13.7568,48,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
U1Rnp Ena,,86235,CPT,Facility,Both,,,,48,40.8,13.7568,48,Sanford Health Plan,Sanford Health Plan,44.16,92,,percent of total billed charges,,
U1Rnp Ena,,86235,CPT,Facility,Outpatient,,,,48,40.8,13.7568,48,"UCare Health, Inc.",Individual & Family Plan,27.048,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
U1Rnp Ena,,86235,CPT,Facility,Inpatient,,,,48,40.8,13.7568,48,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
U1Rnp Ena,,86235,CPT,Facility,Outpatient,,,,48,40.8,13.7568,48,"UCare Health, Inc.",Medical Assistance,24.2256,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
U1Rnp Ena,,86235,CPT,Facility,Inpatient,,,,48,40.8,13.7568,48,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
U1Rnp Ena,,86235,CPT,Facility,Outpatient,,,,48,40.8,13.7568,48,"UCare Health, Inc.",Medicare Advantage,24.2256,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
U1Rnp Ena,,86235,CPT,Facility,Inpatient,,,,48,40.8,13.7568,48,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
U1Rnp Ena,,86235,CPT,Facility,Outpatient,,,,48,40.8,13.7568,48,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),24.2256,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
U1Rnp Ena,,86235,CPT,Facility,Inpatient,,,,48,40.8,13.7568,48,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
U1Rnp Ena,,86235,CPT,Facility,Both,,,,48,40.8,13.7568,48,UnitedHealthcare,Individual & Family,45.12,94,,percent of total billed charges,,
U1Rnp Ena,,86235,CPT,Facility,Outpatient,,,,48,40.8,13.7568,48,UnitedHealthcare,Medicare Advantage,23.52,49,,percent of total billed charges,,
U1Rnp Ena,,86235,CPT,Facility,Inpatient,,,,48,40.8,13.7568,48,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
U1Rnp Ena,,86235,CPT,Facility,Outpatient,,,,48,40.8,13.7568,48,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,23.04,48,,percent of total billed charges,,100% of DHS outpatient percentage
U1Rnp Ena,,86235,CPT,Facility,Inpatient,,,,48,40.8,13.7568,48,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Cancer Ag 15-3,,86300,CPT,Facility,Both,,,,138,117.3,39.5508,138,Aetna,Commercial,126.96,92,,percent of total billed charges,,
Cancer Ag 15-3,,86300,CPT,Facility,Outpatient,,,,138,117.3,39.5508,138,Aetna,Medicare Advantage,67.62,49,,percent of total billed charges,,
Cancer Ag 15-3,,86300,CPT,Facility,Inpatient,,,,138,117.3,39.5508,138,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Cancer Ag 15-3,,86300,CPT,Facility,Both,,,,138,117.3,39.5508,138,Aetna,PPO,128.34,93,,percent of total billed charges,,
Cancer Ag 15-3,,86300,CPT,Facility,Both,,,,138,117.3,39.5508,138,America's PPO,America's PPO,132.5214,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Cancer Ag 15-3,,86300,CPT,Facility,Both,,,,138,117.3,39.5508,138,BlueCross BlueShield Minnesota, Federal Employee Program,135.792,98.4,,percent of total billed charges,,
Cancer Ag 15-3,,86300,CPT,Facility,Both,,,,138,117.3,39.5508,138,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,138,100,,percent of total billed charges,,
Cancer Ag 15-3,,86300,CPT,Facility,Both,,,,138,117.3,39.5508,138,BlueCross BlueShield Minnesota,High Value Network Plan,124.2,90,,percent of total billed charges,,
Cancer Ag 15-3,,86300,CPT,Facility,Outpatient,,,,138,117.3,39.5508,138,BlueCross BlueShield Minnesota,Medicare Advantage,67.62,49,,percent of total billed charges,,
Cancer Ag 15-3,,86300,CPT,Facility,Inpatient,,,,138,117.3,39.5508,138,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Cancer Ag 15-3,,86300,CPT,Facility,Both,,,,138,117.3,39.5508,138,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,122.2266,88.57,,percent of total billed charges,,
Cancer Ag 15-3,,86300,CPT,Facility,Both,,,,138,117.3,39.5508,138,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,39.5508,28.66,,percent of total billed charges,,
Cancer Ag 15-3,,86300,CPT,Facility,Outpatient,,,,138,117.3,39.5508,138,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),67.62,49,,percent of total billed charges,,
Cancer Ag 15-3,,86300,CPT,Facility,Inpatient,,,,138,117.3,39.5508,138,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Cancer Ag 15-3,,86300,CPT,Facility,Both,,,,138,117.3,39.5508,138,CorVel,Worker's Compensation,138,100,,percent of total billed charges,,
Cancer Ag 15-3,,86300,CPT,Facility,Both,,,,138,117.3,39.5508,138,First Health Group Corporation,First Health Network,133.86,97,,percent of total billed charges,,
Cancer Ag 15-3,,86300,CPT,Facility,Both,,,,138,117.3,39.5508,138,"Health Partners, Inc.",Commercial,130.548,94.6,,percent of total billed charges,,
Cancer Ag 15-3,,86300,CPT,Facility,Outpatient,,,,138,117.3,39.5508,138,"Health Partners, Inc.",Medicare Advantage,67.62,49,,percent of total billed charges,,
Cancer Ag 15-3,,86300,CPT,Facility,Inpatient,,,,138,117.3,39.5508,138,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Cancer Ag 15-3,,86300,CPT,Facility,Both,,,,138,117.3,39.5508,138,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),82.8,60,,percent of total billed charges,,
Cancer Ag 15-3,,86300,CPT,Facility,Both,,,,138,117.3,39.5508,138,"Health Partners, Inc.",State of Minnesota Advantage Program,112.47,81.5,,percent of total billed charges,,
Cancer Ag 15-3,,86300,CPT,Facility,Both,,,,138,117.3,39.5508,138,"Health Partners, Inc.",State Public Programs,69,50,,percent of total billed charges,,
Cancer Ag 15-3,,86300,CPT,Facility,Both,,,,138,117.3,39.5508,138,Humana Insurance Company,Commercial PPO,131.1,95,,percent of total billed charges,,
Cancer Ag 15-3,,86300,CPT,Facility,Outpatient,,,,138,117.3,39.5508,138,Humana Insurance Company,Medicare PPO,67.62,49,,percent of total billed charges,,
Cancer Ag 15-3,,86300,CPT,Facility,Inpatient,,,,138,117.3,39.5508,138,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Cancer Ag 15-3,,86300,CPT,Facility,Both,,,,138,117.3,39.5508,138,Medica,Individual & Family,136.758,99.1,,percent of total billed charges,,
Cancer Ag 15-3,,86300,CPT,Facility,Outpatient,,,,138,117.3,39.5508,138,Medica,Medica Advantage Solution,68.724,49.8,,percent of total billed charges,,
Cancer Ag 15-3,,86300,CPT,Facility,Inpatient,,,,138,117.3,39.5508,138,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Cancer Ag 15-3,,86300,CPT,Facility,Outpatient,,,,138,117.3,39.5508,138,Medica,Medical Assistance,61.548,44.6,,percent of total billed charges,,
Cancer Ag 15-3,,86300,CPT,Facility,Inpatient,,,,138,117.3,39.5508,138,Medica,Medical Assistance,,,,,Included in per diem rate,
Cancer Ag 15-3,,86300,CPT,Facility,Outpatient,,,,138,117.3,39.5508,138,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,68.724,49.8,,percent of total billed charges,,
Cancer Ag 15-3,,86300,CPT,Facility,Inpatient,,,,138,117.3,39.5508,138,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Cancer Ag 15-3,,86300,CPT,Facility,Both,,,,138,117.3,39.5508,138,"Multiplan, Inc.","Multiplan, Inc.",129.72,94,,percent of total billed charges,,
Cancer Ag 15-3,,86300,CPT,Facility,Outpatient,,,,138,117.3,39.5508,138,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,119.232,86.4,,percent of total billed charges,,
Cancer Ag 15-3,,86300,CPT,Facility,Inpatient,,,,138,117.3,39.5508,138,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Cancer Ag 15-3,,86300,CPT,Facility,Both,,,,138,117.3,39.5508,138,"Preferred One Administrative Services, INC.",PPO,136.068,98.6,,percent of total billed charges,,
Cancer Ag 15-3,,86300,CPT,Facility,Outpatient,,,,138,117.3,39.5508,138,PrimeWest Health,Minnesota Senior Health Options (MSHO),71.001,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Cancer Ag 15-3,,86300,CPT,Facility,Inpatient,,,,138,117.3,39.5508,138,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Cancer Ag 15-3,,86300,CPT,Facility,Outpatient,,,,138,117.3,39.5508,138,PrimeWest Health,MinnesotaCare,70.8768,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Cancer Ag 15-3,,86300,CPT,Facility,Inpatient,,,,138,117.3,39.5508,138,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Cancer Ag 15-3,,86300,CPT,Facility,Both,,,,138,117.3,39.5508,138,Sanford Health Plan,Sanford Health Plan,126.96,92,,percent of total billed charges,,
Cancer Ag 15-3,,86300,CPT,Facility,Outpatient,,,,138,117.3,39.5508,138,"UCare Health, Inc.",Individual & Family Plan,77.763,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Cancer Ag 15-3,,86300,CPT,Facility,Inpatient,,,,138,117.3,39.5508,138,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Cancer Ag 15-3,,86300,CPT,Facility,Outpatient,,,,138,117.3,39.5508,138,"UCare Health, Inc.",Medical Assistance,69.6486,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Cancer Ag 15-3,,86300,CPT,Facility,Inpatient,,,,138,117.3,39.5508,138,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Cancer Ag 15-3,,86300,CPT,Facility,Outpatient,,,,138,117.3,39.5508,138,"UCare Health, Inc.",Medicare Advantage,69.6486,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Cancer Ag 15-3,,86300,CPT,Facility,Inpatient,,,,138,117.3,39.5508,138,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Cancer Ag 15-3,,86300,CPT,Facility,Outpatient,,,,138,117.3,39.5508,138,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),69.6486,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Cancer Ag 15-3,,86300,CPT,Facility,Inpatient,,,,138,117.3,39.5508,138,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Cancer Ag 15-3,,86300,CPT,Facility,Both,,,,138,117.3,39.5508,138,UnitedHealthcare,Individual & Family,129.72,94,,percent of total billed charges,,
Cancer Ag 15-3,,86300,CPT,Facility,Outpatient,,,,138,117.3,39.5508,138,UnitedHealthcare,Medicare Advantage,67.62,49,,percent of total billed charges,,
Cancer Ag 15-3,,86300,CPT,Facility,Inpatient,,,,138,117.3,39.5508,138,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Cancer Ag 15-3,,86300,CPT,Facility,Outpatient,,,,138,117.3,39.5508,138,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,66.24,48,,percent of total billed charges,,100% of DHS outpatient percentage
Cancer Ag 15-3,,86300,CPT,Facility,Inpatient,,,,138,117.3,39.5508,138,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Cancer Ag 125,,86304,CPT,Facility,Both,,,,81,68.85,23.2146,81,Aetna,Commercial,74.52,92,,percent of total billed charges,,
Cancer Ag 125,,86304,CPT,Facility,Outpatient,,,,81,68.85,23.2146,81,Aetna,Medicare Advantage,39.69,49,,percent of total billed charges,,
Cancer Ag 125,,86304,CPT,Facility,Inpatient,,,,81,68.85,23.2146,81,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Cancer Ag 125,,86304,CPT,Facility,Both,,,,81,68.85,23.2146,81,Aetna,PPO,75.33,93,,percent of total billed charges,,
Cancer Ag 125,,86304,CPT,Facility,Both,,,,81,68.85,23.2146,81,America's PPO,America's PPO,77.7843,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Cancer Ag 125,,86304,CPT,Facility,Both,,,,81,68.85,23.2146,81,BlueCross BlueShield Minnesota, Federal Employee Program,79.704,98.4,,percent of total billed charges,,
Cancer Ag 125,,86304,CPT,Facility,Both,,,,81,68.85,23.2146,81,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,81,100,,percent of total billed charges,,
Cancer Ag 125,,86304,CPT,Facility,Both,,,,81,68.85,23.2146,81,BlueCross BlueShield Minnesota,High Value Network Plan,72.9,90,,percent of total billed charges,,
Cancer Ag 125,,86304,CPT,Facility,Outpatient,,,,81,68.85,23.2146,81,BlueCross BlueShield Minnesota,Medicare Advantage,39.69,49,,percent of total billed charges,,
Cancer Ag 125,,86304,CPT,Facility,Inpatient,,,,81,68.85,23.2146,81,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Cancer Ag 125,,86304,CPT,Facility,Both,,,,81,68.85,23.2146,81,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,71.7417,88.57,,percent of total billed charges,,
Cancer Ag 125,,86304,CPT,Facility,Both,,,,81,68.85,23.2146,81,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,23.2146,28.66,,percent of total billed charges,,
Cancer Ag 125,,86304,CPT,Facility,Outpatient,,,,81,68.85,23.2146,81,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),39.69,49,,percent of total billed charges,,
Cancer Ag 125,,86304,CPT,Facility,Inpatient,,,,81,68.85,23.2146,81,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Cancer Ag 125,,86304,CPT,Facility,Both,,,,81,68.85,23.2146,81,CorVel,Worker's Compensation,81,100,,percent of total billed charges,,
Cancer Ag 125,,86304,CPT,Facility,Both,,,,81,68.85,23.2146,81,First Health Group Corporation,First Health Network,78.57,97,,percent of total billed charges,,
Cancer Ag 125,,86304,CPT,Facility,Both,,,,81,68.85,23.2146,81,"Health Partners, Inc.",Commercial,76.626,94.6,,percent of total billed charges,,
Cancer Ag 125,,86304,CPT,Facility,Outpatient,,,,81,68.85,23.2146,81,"Health Partners, Inc.",Medicare Advantage,39.69,49,,percent of total billed charges,,
Cancer Ag 125,,86304,CPT,Facility,Inpatient,,,,81,68.85,23.2146,81,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Cancer Ag 125,,86304,CPT,Facility,Both,,,,81,68.85,23.2146,81,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),48.6,60,,percent of total billed charges,,
Cancer Ag 125,,86304,CPT,Facility,Both,,,,81,68.85,23.2146,81,"Health Partners, Inc.",State of Minnesota Advantage Program,66.015,81.5,,percent of total billed charges,,
Cancer Ag 125,,86304,CPT,Facility,Both,,,,81,68.85,23.2146,81,"Health Partners, Inc.",State Public Programs,40.5,50,,percent of total billed charges,,
Cancer Ag 125,,86304,CPT,Facility,Both,,,,81,68.85,23.2146,81,Humana Insurance Company,Commercial PPO,76.95,95,,percent of total billed charges,,
Cancer Ag 125,,86304,CPT,Facility,Outpatient,,,,81,68.85,23.2146,81,Humana Insurance Company,Medicare PPO,39.69,49,,percent of total billed charges,,
Cancer Ag 125,,86304,CPT,Facility,Inpatient,,,,81,68.85,23.2146,81,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Cancer Ag 125,,86304,CPT,Facility,Both,,,,81,68.85,23.2146,81,Medica,Individual & Family,80.271,99.1,,percent of total billed charges,,
Cancer Ag 125,,86304,CPT,Facility,Outpatient,,,,81,68.85,23.2146,81,Medica,Medica Advantage Solution,40.338,49.8,,percent of total billed charges,,
Cancer Ag 125,,86304,CPT,Facility,Inpatient,,,,81,68.85,23.2146,81,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Cancer Ag 125,,86304,CPT,Facility,Outpatient,,,,81,68.85,23.2146,81,Medica,Medical Assistance,36.126,44.6,,percent of total billed charges,,
Cancer Ag 125,,86304,CPT,Facility,Inpatient,,,,81,68.85,23.2146,81,Medica,Medical Assistance,,,,,Included in per diem rate,
Cancer Ag 125,,86304,CPT,Facility,Outpatient,,,,81,68.85,23.2146,81,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,40.338,49.8,,percent of total billed charges,,
Cancer Ag 125,,86304,CPT,Facility,Inpatient,,,,81,68.85,23.2146,81,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Cancer Ag 125,,86304,CPT,Facility,Both,,,,81,68.85,23.2146,81,"Multiplan, Inc.","Multiplan, Inc.",76.14,94,,percent of total billed charges,,
Cancer Ag 125,,86304,CPT,Facility,Outpatient,,,,81,68.85,23.2146,81,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,69.984,86.4,,percent of total billed charges,,
Cancer Ag 125,,86304,CPT,Facility,Inpatient,,,,81,68.85,23.2146,81,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Cancer Ag 125,,86304,CPT,Facility,Both,,,,81,68.85,23.2146,81,"Preferred One Administrative Services, INC.",PPO,79.866,98.6,,percent of total billed charges,,
Cancer Ag 125,,86304,CPT,Facility,Outpatient,,,,81,68.85,23.2146,81,PrimeWest Health,Minnesota Senior Health Options (MSHO),41.6745,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Cancer Ag 125,,86304,CPT,Facility,Inpatient,,,,81,68.85,23.2146,81,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Cancer Ag 125,,86304,CPT,Facility,Outpatient,,,,81,68.85,23.2146,81,PrimeWest Health,MinnesotaCare,41.6016,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Cancer Ag 125,,86304,CPT,Facility,Inpatient,,,,81,68.85,23.2146,81,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Cancer Ag 125,,86304,CPT,Facility,Both,,,,81,68.85,23.2146,81,Sanford Health Plan,Sanford Health Plan,74.52,92,,percent of total billed charges,,
Cancer Ag 125,,86304,CPT,Facility,Outpatient,,,,81,68.85,23.2146,81,"UCare Health, Inc.",Individual & Family Plan,45.6435,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Cancer Ag 125,,86304,CPT,Facility,Inpatient,,,,81,68.85,23.2146,81,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Cancer Ag 125,,86304,CPT,Facility,Outpatient,,,,81,68.85,23.2146,81,"UCare Health, Inc.",Medical Assistance,40.8807,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Cancer Ag 125,,86304,CPT,Facility,Inpatient,,,,81,68.85,23.2146,81,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Cancer Ag 125,,86304,CPT,Facility,Outpatient,,,,81,68.85,23.2146,81,"UCare Health, Inc.",Medicare Advantage,40.8807,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Cancer Ag 125,,86304,CPT,Facility,Inpatient,,,,81,68.85,23.2146,81,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Cancer Ag 125,,86304,CPT,Facility,Outpatient,,,,81,68.85,23.2146,81,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),40.8807,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Cancer Ag 125,,86304,CPT,Facility,Inpatient,,,,81,68.85,23.2146,81,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Cancer Ag 125,,86304,CPT,Facility,Both,,,,81,68.85,23.2146,81,UnitedHealthcare,Individual & Family,76.14,94,,percent of total billed charges,,
Cancer Ag 125,,86304,CPT,Facility,Outpatient,,,,81,68.85,23.2146,81,UnitedHealthcare,Medicare Advantage,39.69,49,,percent of total billed charges,,
Cancer Ag 125,,86304,CPT,Facility,Inpatient,,,,81,68.85,23.2146,81,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Cancer Ag 125,,86304,CPT,Facility,Outpatient,,,,81,68.85,23.2146,81,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,38.88,48,,percent of total billed charges,,100% of DHS outpatient percentage
Cancer Ag 125,,86304,CPT,Facility,Inpatient,,,,81,68.85,23.2146,81,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Infectious Mononucleosis Screen,,86308,CPT,Facility,Both,,,,72,61.2,20.6352,72,Aetna,Commercial,66.24,92,,percent of total billed charges,,
Infectious Mononucleosis Screen,,86308,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,Aetna,Medicare Advantage,35.28,49,,percent of total billed charges,,
Infectious Mononucleosis Screen,,86308,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Infectious Mononucleosis Screen,,86308,CPT,Facility,Both,,,,72,61.2,20.6352,72,Aetna,PPO,66.96,93,,percent of total billed charges,,
Infectious Mononucleosis Screen,,86308,CPT,Facility,Both,,,,72,61.2,20.6352,72,America's PPO,America's PPO,69.1416,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Infectious Mononucleosis Screen,,86308,CPT,Facility,Both,,,,72,61.2,20.6352,72,BlueCross BlueShield Minnesota, Federal Employee Program,70.848,98.4,,percent of total billed charges,,
Infectious Mononucleosis Screen,,86308,CPT,Facility,Both,,,,72,61.2,20.6352,72,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,72,100,,percent of total billed charges,,
Infectious Mononucleosis Screen,,86308,CPT,Facility,Both,,,,72,61.2,20.6352,72,BlueCross BlueShield Minnesota,High Value Network Plan,64.8,90,,percent of total billed charges,,
Infectious Mononucleosis Screen,,86308,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,BlueCross BlueShield Minnesota,Medicare Advantage,35.28,49,,percent of total billed charges,,
Infectious Mononucleosis Screen,,86308,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Infectious Mononucleosis Screen,,86308,CPT,Facility,Both,,,,72,61.2,20.6352,72,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,63.7704,88.57,,percent of total billed charges,,
Infectious Mononucleosis Screen,,86308,CPT,Facility,Both,,,,72,61.2,20.6352,72,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,20.6352,28.66,,percent of total billed charges,,
Infectious Mononucleosis Screen,,86308,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),35.28,49,,percent of total billed charges,,
Infectious Mononucleosis Screen,,86308,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Infectious Mononucleosis Screen,,86308,CPT,Facility,Both,,,,72,61.2,20.6352,72,CorVel,Worker's Compensation,72,100,,percent of total billed charges,,
Infectious Mononucleosis Screen,,86308,CPT,Facility,Both,,,,72,61.2,20.6352,72,First Health Group Corporation,First Health Network,69.84,97,,percent of total billed charges,,
Infectious Mononucleosis Screen,,86308,CPT,Facility,Both,,,,72,61.2,20.6352,72,"Health Partners, Inc.",Commercial,68.112,94.6,,percent of total billed charges,,
Infectious Mononucleosis Screen,,86308,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,"Health Partners, Inc.",Medicare Advantage,35.28,49,,percent of total billed charges,,
Infectious Mononucleosis Screen,,86308,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Infectious Mononucleosis Screen,,86308,CPT,Facility,Both,,,,72,61.2,20.6352,72,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),43.2,60,,percent of total billed charges,,
Infectious Mononucleosis Screen,,86308,CPT,Facility,Both,,,,72,61.2,20.6352,72,"Health Partners, Inc.",State of Minnesota Advantage Program,58.68,81.5,,percent of total billed charges,,
Infectious Mononucleosis Screen,,86308,CPT,Facility,Both,,,,72,61.2,20.6352,72,"Health Partners, Inc.",State Public Programs,36,50,,percent of total billed charges,,
Infectious Mononucleosis Screen,,86308,CPT,Facility,Both,,,,72,61.2,20.6352,72,Humana Insurance Company,Commercial PPO,68.4,95,,percent of total billed charges,,
Infectious Mononucleosis Screen,,86308,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,Humana Insurance Company,Medicare PPO,35.28,49,,percent of total billed charges,,
Infectious Mononucleosis Screen,,86308,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Infectious Mononucleosis Screen,,86308,CPT,Facility,Both,,,,72,61.2,20.6352,72,Medica,Individual & Family,71.352,99.1,,percent of total billed charges,,
Infectious Mononucleosis Screen,,86308,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,Medica,Medica Advantage Solution,35.856,49.8,,percent of total billed charges,,
Infectious Mononucleosis Screen,,86308,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Infectious Mononucleosis Screen,,86308,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,Medica,Medical Assistance,32.112,44.6,,percent of total billed charges,,
Infectious Mononucleosis Screen,,86308,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,Medica,Medical Assistance,,,,,Included in per diem rate,
Infectious Mononucleosis Screen,,86308,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,35.856,49.8,,percent of total billed charges,,
Infectious Mononucleosis Screen,,86308,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Infectious Mononucleosis Screen,,86308,CPT,Facility,Both,,,,72,61.2,20.6352,72,"Multiplan, Inc.","Multiplan, Inc.",67.68,94,,percent of total billed charges,,
Infectious Mononucleosis Screen,,86308,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,62.208,86.4,,percent of total billed charges,,
Infectious Mononucleosis Screen,,86308,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Infectious Mononucleosis Screen,,86308,CPT,Facility,Both,,,,72,61.2,20.6352,72,"Preferred One Administrative Services, INC.",PPO,70.992,98.6,,percent of total billed charges,,
Infectious Mononucleosis Screen,,86308,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,PrimeWest Health,Minnesota Senior Health Options (MSHO),37.044,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Infectious Mononucleosis Screen,,86308,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Infectious Mononucleosis Screen,,86308,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,PrimeWest Health,MinnesotaCare,36.9792,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Infectious Mononucleosis Screen,,86308,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Infectious Mononucleosis Screen,,86308,CPT,Facility,Both,,,,72,61.2,20.6352,72,Sanford Health Plan,Sanford Health Plan,66.24,92,,percent of total billed charges,,
Infectious Mononucleosis Screen,,86308,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,"UCare Health, Inc.",Individual & Family Plan,40.572,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Infectious Mononucleosis Screen,,86308,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Infectious Mononucleosis Screen,,86308,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,"UCare Health, Inc.",Medical Assistance,36.3384,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Infectious Mononucleosis Screen,,86308,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Infectious Mononucleosis Screen,,86308,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,"UCare Health, Inc.",Medicare Advantage,36.3384,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Infectious Mononucleosis Screen,,86308,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Infectious Mononucleosis Screen,,86308,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),36.3384,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Infectious Mononucleosis Screen,,86308,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Infectious Mononucleosis Screen,,86308,CPT,Facility,Both,,,,72,61.2,20.6352,72,UnitedHealthcare,Individual & Family,67.68,94,,percent of total billed charges,,
Infectious Mononucleosis Screen,,86308,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,UnitedHealthcare,Medicare Advantage,35.28,49,,percent of total billed charges,,
Infectious Mononucleosis Screen,,86308,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Infectious Mononucleosis Screen,,86308,CPT,Facility,Outpatient,,,,72,61.2,20.6352,72,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,34.56,48,,percent of total billed charges,,100% of DHS outpatient percentage
Infectious Mononucleosis Screen,,86308,CPT,Facility,Inpatient,,,,72,61.2,20.6352,72,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Immunofixation, Serum",,86334,CPT,Facility,Both,,,,306,260.1,87.6996,306,Aetna,Commercial,281.52,92,,percent of total billed charges,,
"Immunofixation, Serum",,86334,CPT,Facility,Outpatient,,,,306,260.1,87.6996,306,Aetna,Medicare Advantage,149.94,49,,percent of total billed charges,,
"Immunofixation, Serum",,86334,CPT,Facility,Inpatient,,,,306,260.1,87.6996,306,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Immunofixation, Serum",,86334,CPT,Facility,Both,,,,306,260.1,87.6996,306,Aetna,PPO,284.58,93,,percent of total billed charges,,
"Immunofixation, Serum",,86334,CPT,Facility,Both,,,,306,260.1,87.6996,306,America's PPO,America's PPO,293.8518,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Immunofixation, Serum",,86334,CPT,Facility,Both,,,,306,260.1,87.6996,306,BlueCross BlueShield Minnesota, Federal Employee Program,301.104,98.4,,percent of total billed charges,,
"Immunofixation, Serum",,86334,CPT,Facility,Both,,,,306,260.1,87.6996,306,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,306,100,,percent of total billed charges,,
"Immunofixation, Serum",,86334,CPT,Facility,Both,,,,306,260.1,87.6996,306,BlueCross BlueShield Minnesota,High Value Network Plan,275.4,90,,percent of total billed charges,,
"Immunofixation, Serum",,86334,CPT,Facility,Outpatient,,,,306,260.1,87.6996,306,BlueCross BlueShield Minnesota,Medicare Advantage,149.94,49,,percent of total billed charges,,
"Immunofixation, Serum",,86334,CPT,Facility,Inpatient,,,,306,260.1,87.6996,306,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Immunofixation, Serum",,86334,CPT,Facility,Both,,,,306,260.1,87.6996,306,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,271.0242,88.57,,percent of total billed charges,,
"Immunofixation, Serum",,86334,CPT,Facility,Both,,,,306,260.1,87.6996,306,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,87.6996,28.66,,percent of total billed charges,,
"Immunofixation, Serum",,86334,CPT,Facility,Outpatient,,,,306,260.1,87.6996,306,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),149.94,49,,percent of total billed charges,,
"Immunofixation, Serum",,86334,CPT,Facility,Inpatient,,,,306,260.1,87.6996,306,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Immunofixation, Serum",,86334,CPT,Facility,Both,,,,306,260.1,87.6996,306,CorVel,Worker's Compensation,306,100,,percent of total billed charges,,
"Immunofixation, Serum",,86334,CPT,Facility,Both,,,,306,260.1,87.6996,306,First Health Group Corporation,First Health Network,296.82,97,,percent of total billed charges,,
"Immunofixation, Serum",,86334,CPT,Facility,Both,,,,306,260.1,87.6996,306,"Health Partners, Inc.",Commercial,289.476,94.6,,percent of total billed charges,,
"Immunofixation, Serum",,86334,CPT,Facility,Outpatient,,,,306,260.1,87.6996,306,"Health Partners, Inc.",Medicare Advantage,149.94,49,,percent of total billed charges,,
"Immunofixation, Serum",,86334,CPT,Facility,Inpatient,,,,306,260.1,87.6996,306,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Immunofixation, Serum",,86334,CPT,Facility,Both,,,,306,260.1,87.6996,306,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),183.6,60,,percent of total billed charges,,
"Immunofixation, Serum",,86334,CPT,Facility,Both,,,,306,260.1,87.6996,306,"Health Partners, Inc.",State of Minnesota Advantage Program,249.39,81.5,,percent of total billed charges,,
"Immunofixation, Serum",,86334,CPT,Facility,Both,,,,306,260.1,87.6996,306,"Health Partners, Inc.",State Public Programs,153,50,,percent of total billed charges,,
"Immunofixation, Serum",,86334,CPT,Facility,Both,,,,306,260.1,87.6996,306,Humana Insurance Company,Commercial PPO,290.7,95,,percent of total billed charges,,
"Immunofixation, Serum",,86334,CPT,Facility,Outpatient,,,,306,260.1,87.6996,306,Humana Insurance Company,Medicare PPO,149.94,49,,percent of total billed charges,,
"Immunofixation, Serum",,86334,CPT,Facility,Inpatient,,,,306,260.1,87.6996,306,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Immunofixation, Serum",,86334,CPT,Facility,Both,,,,306,260.1,87.6996,306,Medica,Individual & Family,303.246,99.1,,percent of total billed charges,,
"Immunofixation, Serum",,86334,CPT,Facility,Outpatient,,,,306,260.1,87.6996,306,Medica,Medica Advantage Solution,152.388,49.8,,percent of total billed charges,,
"Immunofixation, Serum",,86334,CPT,Facility,Inpatient,,,,306,260.1,87.6996,306,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Immunofixation, Serum",,86334,CPT,Facility,Outpatient,,,,306,260.1,87.6996,306,Medica,Medical Assistance,136.476,44.6,,percent of total billed charges,,
"Immunofixation, Serum",,86334,CPT,Facility,Inpatient,,,,306,260.1,87.6996,306,Medica,Medical Assistance,,,,,Included in per diem rate,
"Immunofixation, Serum",,86334,CPT,Facility,Outpatient,,,,306,260.1,87.6996,306,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,152.388,49.8,,percent of total billed charges,,
"Immunofixation, Serum",,86334,CPT,Facility,Inpatient,,,,306,260.1,87.6996,306,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Immunofixation, Serum",,86334,CPT,Facility,Both,,,,306,260.1,87.6996,306,"Multiplan, Inc.","Multiplan, Inc.",287.64,94,,percent of total billed charges,,
"Immunofixation, Serum",,86334,CPT,Facility,Outpatient,,,,306,260.1,87.6996,306,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,264.384,86.4,,percent of total billed charges,,
"Immunofixation, Serum",,86334,CPT,Facility,Inpatient,,,,306,260.1,87.6996,306,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Immunofixation, Serum",,86334,CPT,Facility,Both,,,,306,260.1,87.6996,306,"Preferred One Administrative Services, INC.",PPO,301.716,98.6,,percent of total billed charges,,
"Immunofixation, Serum",,86334,CPT,Facility,Outpatient,,,,306,260.1,87.6996,306,PrimeWest Health,Minnesota Senior Health Options (MSHO),157.437,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Immunofixation, Serum",,86334,CPT,Facility,Inpatient,,,,306,260.1,87.6996,306,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Immunofixation, Serum",,86334,CPT,Facility,Outpatient,,,,306,260.1,87.6996,306,PrimeWest Health,MinnesotaCare,157.1616,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Immunofixation, Serum",,86334,CPT,Facility,Inpatient,,,,306,260.1,87.6996,306,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Immunofixation, Serum",,86334,CPT,Facility,Both,,,,306,260.1,87.6996,306,Sanford Health Plan,Sanford Health Plan,281.52,92,,percent of total billed charges,,
"Immunofixation, Serum",,86334,CPT,Facility,Outpatient,,,,306,260.1,87.6996,306,"UCare Health, Inc.",Individual & Family Plan,172.431,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Immunofixation, Serum",,86334,CPT,Facility,Inpatient,,,,306,260.1,87.6996,306,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Immunofixation, Serum",,86334,CPT,Facility,Outpatient,,,,306,260.1,87.6996,306,"UCare Health, Inc.",Medical Assistance,154.4382,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Immunofixation, Serum",,86334,CPT,Facility,Inpatient,,,,306,260.1,87.6996,306,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Immunofixation, Serum",,86334,CPT,Facility,Outpatient,,,,306,260.1,87.6996,306,"UCare Health, Inc.",Medicare Advantage,154.4382,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Immunofixation, Serum",,86334,CPT,Facility,Inpatient,,,,306,260.1,87.6996,306,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Immunofixation, Serum",,86334,CPT,Facility,Outpatient,,,,306,260.1,87.6996,306,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),154.4382,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Immunofixation, Serum",,86334,CPT,Facility,Inpatient,,,,306,260.1,87.6996,306,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Immunofixation, Serum",,86334,CPT,Facility,Both,,,,306,260.1,87.6996,306,UnitedHealthcare,Individual & Family,287.64,94,,percent of total billed charges,,
"Immunofixation, Serum",,86334,CPT,Facility,Outpatient,,,,306,260.1,87.6996,306,UnitedHealthcare,Medicare Advantage,149.94,49,,percent of total billed charges,,
"Immunofixation, Serum",,86334,CPT,Facility,Inpatient,,,,306,260.1,87.6996,306,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Immunofixation, Serum",,86334,CPT,Facility,Outpatient,,,,306,260.1,87.6996,306,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,146.88,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Immunofixation, Serum",,86334,CPT,Facility,Inpatient,,,,306,260.1,87.6996,306,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Ra(Rheumatoid Factor),,86431,CPT,Facility,Both,,,,58,49.3,16.6228,58,Aetna,Commercial,53.36,92,,percent of total billed charges,,
Ra(Rheumatoid Factor),,86431,CPT,Facility,Outpatient,,,,58,49.3,16.6228,58,Aetna,Medicare Advantage,28.42,49,,percent of total billed charges,,
Ra(Rheumatoid Factor),,86431,CPT,Facility,Inpatient,,,,58,49.3,16.6228,58,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Ra(Rheumatoid Factor),,86431,CPT,Facility,Both,,,,58,49.3,16.6228,58,Aetna,PPO,53.94,93,,percent of total billed charges,,
Ra(Rheumatoid Factor),,86431,CPT,Facility,Both,,,,58,49.3,16.6228,58,America's PPO,America's PPO,55.6974,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Ra(Rheumatoid Factor),,86431,CPT,Facility,Both,,,,58,49.3,16.6228,58,BlueCross BlueShield Minnesota, Federal Employee Program,57.072,98.4,,percent of total billed charges,,
Ra(Rheumatoid Factor),,86431,CPT,Facility,Both,,,,58,49.3,16.6228,58,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,58,100,,percent of total billed charges,,
Ra(Rheumatoid Factor),,86431,CPT,Facility,Both,,,,58,49.3,16.6228,58,BlueCross BlueShield Minnesota,High Value Network Plan,52.2,90,,percent of total billed charges,,
Ra(Rheumatoid Factor),,86431,CPT,Facility,Outpatient,,,,58,49.3,16.6228,58,BlueCross BlueShield Minnesota,Medicare Advantage,28.42,49,,percent of total billed charges,,
Ra(Rheumatoid Factor),,86431,CPT,Facility,Inpatient,,,,58,49.3,16.6228,58,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Ra(Rheumatoid Factor),,86431,CPT,Facility,Both,,,,58,49.3,16.6228,58,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,51.3706,88.57,,percent of total billed charges,,
Ra(Rheumatoid Factor),,86431,CPT,Facility,Both,,,,58,49.3,16.6228,58,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,16.6228,28.66,,percent of total billed charges,,
Ra(Rheumatoid Factor),,86431,CPT,Facility,Outpatient,,,,58,49.3,16.6228,58,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),28.42,49,,percent of total billed charges,,
Ra(Rheumatoid Factor),,86431,CPT,Facility,Inpatient,,,,58,49.3,16.6228,58,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Ra(Rheumatoid Factor),,86431,CPT,Facility,Both,,,,58,49.3,16.6228,58,CorVel,Worker's Compensation,58,100,,percent of total billed charges,,
Ra(Rheumatoid Factor),,86431,CPT,Facility,Both,,,,58,49.3,16.6228,58,First Health Group Corporation,First Health Network,56.26,97,,percent of total billed charges,,
Ra(Rheumatoid Factor),,86431,CPT,Facility,Both,,,,58,49.3,16.6228,58,"Health Partners, Inc.",Commercial,54.868,94.6,,percent of total billed charges,,
Ra(Rheumatoid Factor),,86431,CPT,Facility,Outpatient,,,,58,49.3,16.6228,58,"Health Partners, Inc.",Medicare Advantage,28.42,49,,percent of total billed charges,,
Ra(Rheumatoid Factor),,86431,CPT,Facility,Inpatient,,,,58,49.3,16.6228,58,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ra(Rheumatoid Factor),,86431,CPT,Facility,Both,,,,58,49.3,16.6228,58,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),34.8,60,,percent of total billed charges,,
Ra(Rheumatoid Factor),,86431,CPT,Facility,Both,,,,58,49.3,16.6228,58,"Health Partners, Inc.",State of Minnesota Advantage Program,47.27,81.5,,percent of total billed charges,,
Ra(Rheumatoid Factor),,86431,CPT,Facility,Both,,,,58,49.3,16.6228,58,"Health Partners, Inc.",State Public Programs,29,50,,percent of total billed charges,,
Ra(Rheumatoid Factor),,86431,CPT,Facility,Both,,,,58,49.3,16.6228,58,Humana Insurance Company,Commercial PPO,55.1,95,,percent of total billed charges,,
Ra(Rheumatoid Factor),,86431,CPT,Facility,Outpatient,,,,58,49.3,16.6228,58,Humana Insurance Company,Medicare PPO,28.42,49,,percent of total billed charges,,
Ra(Rheumatoid Factor),,86431,CPT,Facility,Inpatient,,,,58,49.3,16.6228,58,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Ra(Rheumatoid Factor),,86431,CPT,Facility,Both,,,,58,49.3,16.6228,58,Medica,Individual & Family,57.478,99.1,,percent of total billed charges,,
Ra(Rheumatoid Factor),,86431,CPT,Facility,Outpatient,,,,58,49.3,16.6228,58,Medica,Medica Advantage Solution,28.884,49.8,,percent of total billed charges,,
Ra(Rheumatoid Factor),,86431,CPT,Facility,Inpatient,,,,58,49.3,16.6228,58,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Ra(Rheumatoid Factor),,86431,CPT,Facility,Outpatient,,,,58,49.3,16.6228,58,Medica,Medical Assistance,25.868,44.6,,percent of total billed charges,,
Ra(Rheumatoid Factor),,86431,CPT,Facility,Inpatient,,,,58,49.3,16.6228,58,Medica,Medical Assistance,,,,,Included in per diem rate,
Ra(Rheumatoid Factor),,86431,CPT,Facility,Outpatient,,,,58,49.3,16.6228,58,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,28.884,49.8,,percent of total billed charges,,
Ra(Rheumatoid Factor),,86431,CPT,Facility,Inpatient,,,,58,49.3,16.6228,58,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Ra(Rheumatoid Factor),,86431,CPT,Facility,Both,,,,58,49.3,16.6228,58,"Multiplan, Inc.","Multiplan, Inc.",54.52,94,,percent of total billed charges,,
Ra(Rheumatoid Factor),,86431,CPT,Facility,Outpatient,,,,58,49.3,16.6228,58,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,50.112,86.4,,percent of total billed charges,,
Ra(Rheumatoid Factor),,86431,CPT,Facility,Inpatient,,,,58,49.3,16.6228,58,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Ra(Rheumatoid Factor),,86431,CPT,Facility,Both,,,,58,49.3,16.6228,58,"Preferred One Administrative Services, INC.",PPO,57.188,98.6,,percent of total billed charges,,
Ra(Rheumatoid Factor),,86431,CPT,Facility,Outpatient,,,,58,49.3,16.6228,58,PrimeWest Health,Minnesota Senior Health Options (MSHO),29.841,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Ra(Rheumatoid Factor),,86431,CPT,Facility,Inpatient,,,,58,49.3,16.6228,58,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ra(Rheumatoid Factor),,86431,CPT,Facility,Outpatient,,,,58,49.3,16.6228,58,PrimeWest Health,MinnesotaCare,29.7888,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Ra(Rheumatoid Factor),,86431,CPT,Facility,Inpatient,,,,58,49.3,16.6228,58,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Ra(Rheumatoid Factor),,86431,CPT,Facility,Both,,,,58,49.3,16.6228,58,Sanford Health Plan,Sanford Health Plan,53.36,92,,percent of total billed charges,,
Ra(Rheumatoid Factor),,86431,CPT,Facility,Outpatient,,,,58,49.3,16.6228,58,"UCare Health, Inc.",Individual & Family Plan,32.683,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Ra(Rheumatoid Factor),,86431,CPT,Facility,Inpatient,,,,58,49.3,16.6228,58,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Ra(Rheumatoid Factor),,86431,CPT,Facility,Outpatient,,,,58,49.3,16.6228,58,"UCare Health, Inc.",Medical Assistance,29.2726,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ra(Rheumatoid Factor),,86431,CPT,Facility,Inpatient,,,,58,49.3,16.6228,58,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Ra(Rheumatoid Factor),,86431,CPT,Facility,Outpatient,,,,58,49.3,16.6228,58,"UCare Health, Inc.",Medicare Advantage,29.2726,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ra(Rheumatoid Factor),,86431,CPT,Facility,Inpatient,,,,58,49.3,16.6228,58,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ra(Rheumatoid Factor),,86431,CPT,Facility,Outpatient,,,,58,49.3,16.6228,58,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),29.2726,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ra(Rheumatoid Factor),,86431,CPT,Facility,Inpatient,,,,58,49.3,16.6228,58,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ra(Rheumatoid Factor),,86431,CPT,Facility,Both,,,,58,49.3,16.6228,58,UnitedHealthcare,Individual & Family,54.52,94,,percent of total billed charges,,
Ra(Rheumatoid Factor),,86431,CPT,Facility,Outpatient,,,,58,49.3,16.6228,58,UnitedHealthcare,Medicare Advantage,28.42,49,,percent of total billed charges,,
Ra(Rheumatoid Factor),,86431,CPT,Facility,Inpatient,,,,58,49.3,16.6228,58,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Ra(Rheumatoid Factor),,86431,CPT,Facility,Outpatient,,,,58,49.3,16.6228,58,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,27.84,48,,percent of total billed charges,,100% of DHS outpatient percentage
Ra(Rheumatoid Factor),,86431,CPT,Facility,Inpatient,,,,58,49.3,16.6228,58,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Tb Test, Cell Mediated Immunity Antigen Resp Meas; Quantiferon",,86480,CPT,Facility,Both,,,,230,195.5,65.918,230,Aetna,Commercial,211.6,92,,percent of total billed charges,,
"Tb Test, Cell Mediated Immunity Antigen Resp Meas; Quantiferon",,86480,CPT,Facility,Outpatient,,,,230,195.5,65.918,230,Aetna,Medicare Advantage,112.7,49,,percent of total billed charges,,
"Tb Test, Cell Mediated Immunity Antigen Resp Meas; Quantiferon",,86480,CPT,Facility,Inpatient,,,,230,195.5,65.918,230,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Tb Test, Cell Mediated Immunity Antigen Resp Meas; Quantiferon",,86480,CPT,Facility,Both,,,,230,195.5,65.918,230,Aetna,PPO,213.9,93,,percent of total billed charges,,
"Tb Test, Cell Mediated Immunity Antigen Resp Meas; Quantiferon",,86480,CPT,Facility,Both,,,,230,195.5,65.918,230,America's PPO,America's PPO,220.869,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Tb Test, Cell Mediated Immunity Antigen Resp Meas; Quantiferon",,86480,CPT,Facility,Both,,,,230,195.5,65.918,230,BlueCross BlueShield Minnesota, Federal Employee Program,226.32,98.4,,percent of total billed charges,,
"Tb Test, Cell Mediated Immunity Antigen Resp Meas; Quantiferon",,86480,CPT,Facility,Both,,,,230,195.5,65.918,230,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,230,100,,percent of total billed charges,,
"Tb Test, Cell Mediated Immunity Antigen Resp Meas; Quantiferon",,86480,CPT,Facility,Both,,,,230,195.5,65.918,230,BlueCross BlueShield Minnesota,High Value Network Plan,207,90,,percent of total billed charges,,
"Tb Test, Cell Mediated Immunity Antigen Resp Meas; Quantiferon",,86480,CPT,Facility,Outpatient,,,,230,195.5,65.918,230,BlueCross BlueShield Minnesota,Medicare Advantage,112.7,49,,percent of total billed charges,,
"Tb Test, Cell Mediated Immunity Antigen Resp Meas; Quantiferon",,86480,CPT,Facility,Inpatient,,,,230,195.5,65.918,230,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Tb Test, Cell Mediated Immunity Antigen Resp Meas; Quantiferon",,86480,CPT,Facility,Both,,,,230,195.5,65.918,230,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,203.711,88.57,,percent of total billed charges,,
"Tb Test, Cell Mediated Immunity Antigen Resp Meas; Quantiferon",,86480,CPT,Facility,Both,,,,230,195.5,65.918,230,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,65.918,28.66,,percent of total billed charges,,
"Tb Test, Cell Mediated Immunity Antigen Resp Meas; Quantiferon",,86480,CPT,Facility,Outpatient,,,,230,195.5,65.918,230,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),112.7,49,,percent of total billed charges,,
"Tb Test, Cell Mediated Immunity Antigen Resp Meas; Quantiferon",,86480,CPT,Facility,Inpatient,,,,230,195.5,65.918,230,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Tb Test, Cell Mediated Immunity Antigen Resp Meas; Quantiferon",,86480,CPT,Facility,Both,,,,230,195.5,65.918,230,CorVel,Worker's Compensation,230,100,,percent of total billed charges,,
"Tb Test, Cell Mediated Immunity Antigen Resp Meas; Quantiferon",,86480,CPT,Facility,Both,,,,230,195.5,65.918,230,First Health Group Corporation,First Health Network,223.1,97,,percent of total billed charges,,
"Tb Test, Cell Mediated Immunity Antigen Resp Meas; Quantiferon",,86480,CPT,Facility,Both,,,,230,195.5,65.918,230,"Health Partners, Inc.",Commercial,217.58,94.6,,percent of total billed charges,,
"Tb Test, Cell Mediated Immunity Antigen Resp Meas; Quantiferon",,86480,CPT,Facility,Outpatient,,,,230,195.5,65.918,230,"Health Partners, Inc.",Medicare Advantage,112.7,49,,percent of total billed charges,,
"Tb Test, Cell Mediated Immunity Antigen Resp Meas; Quantiferon",,86480,CPT,Facility,Inpatient,,,,230,195.5,65.918,230,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Tb Test, Cell Mediated Immunity Antigen Resp Meas; Quantiferon",,86480,CPT,Facility,Both,,,,230,195.5,65.918,230,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),138,60,,percent of total billed charges,,
"Tb Test, Cell Mediated Immunity Antigen Resp Meas; Quantiferon",,86480,CPT,Facility,Both,,,,230,195.5,65.918,230,"Health Partners, Inc.",State of Minnesota Advantage Program,187.45,81.5,,percent of total billed charges,,
"Tb Test, Cell Mediated Immunity Antigen Resp Meas; Quantiferon",,86480,CPT,Facility,Both,,,,230,195.5,65.918,230,"Health Partners, Inc.",State Public Programs,115,50,,percent of total billed charges,,
"Tb Test, Cell Mediated Immunity Antigen Resp Meas; Quantiferon",,86480,CPT,Facility,Both,,,,230,195.5,65.918,230,Humana Insurance Company,Commercial PPO,218.5,95,,percent of total billed charges,,
"Tb Test, Cell Mediated Immunity Antigen Resp Meas; Quantiferon",,86480,CPT,Facility,Outpatient,,,,230,195.5,65.918,230,Humana Insurance Company,Medicare PPO,112.7,49,,percent of total billed charges,,
"Tb Test, Cell Mediated Immunity Antigen Resp Meas; Quantiferon",,86480,CPT,Facility,Inpatient,,,,230,195.5,65.918,230,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Tb Test, Cell Mediated Immunity Antigen Resp Meas; Quantiferon",,86480,CPT,Facility,Both,,,,230,195.5,65.918,230,Medica,Individual & Family,227.93,99.1,,percent of total billed charges,,
"Tb Test, Cell Mediated Immunity Antigen Resp Meas; Quantiferon",,86480,CPT,Facility,Outpatient,,,,230,195.5,65.918,230,Medica,Medica Advantage Solution,114.54,49.8,,percent of total billed charges,,
"Tb Test, Cell Mediated Immunity Antigen Resp Meas; Quantiferon",,86480,CPT,Facility,Inpatient,,,,230,195.5,65.918,230,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Tb Test, Cell Mediated Immunity Antigen Resp Meas; Quantiferon",,86480,CPT,Facility,Outpatient,,,,230,195.5,65.918,230,Medica,Medical Assistance,102.58,44.6,,percent of total billed charges,,
"Tb Test, Cell Mediated Immunity Antigen Resp Meas; Quantiferon",,86480,CPT,Facility,Inpatient,,,,230,195.5,65.918,230,Medica,Medical Assistance,,,,,Included in per diem rate,
"Tb Test, Cell Mediated Immunity Antigen Resp Meas; Quantiferon",,86480,CPT,Facility,Outpatient,,,,230,195.5,65.918,230,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,114.54,49.8,,percent of total billed charges,,
"Tb Test, Cell Mediated Immunity Antigen Resp Meas; Quantiferon",,86480,CPT,Facility,Inpatient,,,,230,195.5,65.918,230,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Tb Test, Cell Mediated Immunity Antigen Resp Meas; Quantiferon",,86480,CPT,Facility,Both,,,,230,195.5,65.918,230,"Multiplan, Inc.","Multiplan, Inc.",216.2,94,,percent of total billed charges,,
"Tb Test, Cell Mediated Immunity Antigen Resp Meas; Quantiferon",,86480,CPT,Facility,Outpatient,,,,230,195.5,65.918,230,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,198.72,86.4,,percent of total billed charges,,
"Tb Test, Cell Mediated Immunity Antigen Resp Meas; Quantiferon",,86480,CPT,Facility,Inpatient,,,,230,195.5,65.918,230,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Tb Test, Cell Mediated Immunity Antigen Resp Meas; Quantiferon",,86480,CPT,Facility,Both,,,,230,195.5,65.918,230,"Preferred One Administrative Services, INC.",PPO,226.78,98.6,,percent of total billed charges,,
"Tb Test, Cell Mediated Immunity Antigen Resp Meas; Quantiferon",,86480,CPT,Facility,Outpatient,,,,230,195.5,65.918,230,PrimeWest Health,Minnesota Senior Health Options (MSHO),118.335,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Tb Test, Cell Mediated Immunity Antigen Resp Meas; Quantiferon",,86480,CPT,Facility,Inpatient,,,,230,195.5,65.918,230,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Tb Test, Cell Mediated Immunity Antigen Resp Meas; Quantiferon",,86480,CPT,Facility,Outpatient,,,,230,195.5,65.918,230,PrimeWest Health,MinnesotaCare,118.128,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Tb Test, Cell Mediated Immunity Antigen Resp Meas; Quantiferon",,86480,CPT,Facility,Inpatient,,,,230,195.5,65.918,230,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Tb Test, Cell Mediated Immunity Antigen Resp Meas; Quantiferon",,86480,CPT,Facility,Both,,,,230,195.5,65.918,230,Sanford Health Plan,Sanford Health Plan,211.6,92,,percent of total billed charges,,
"Tb Test, Cell Mediated Immunity Antigen Resp Meas; Quantiferon",,86480,CPT,Facility,Outpatient,,,,230,195.5,65.918,230,"UCare Health, Inc.",Individual & Family Plan,129.605,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Tb Test, Cell Mediated Immunity Antigen Resp Meas; Quantiferon",,86480,CPT,Facility,Inpatient,,,,230,195.5,65.918,230,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Tb Test, Cell Mediated Immunity Antigen Resp Meas; Quantiferon",,86480,CPT,Facility,Outpatient,,,,230,195.5,65.918,230,"UCare Health, Inc.",Medical Assistance,116.081,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Tb Test, Cell Mediated Immunity Antigen Resp Meas; Quantiferon",,86480,CPT,Facility,Inpatient,,,,230,195.5,65.918,230,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Tb Test, Cell Mediated Immunity Antigen Resp Meas; Quantiferon",,86480,CPT,Facility,Outpatient,,,,230,195.5,65.918,230,"UCare Health, Inc.",Medicare Advantage,116.081,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Tb Test, Cell Mediated Immunity Antigen Resp Meas; Quantiferon",,86480,CPT,Facility,Inpatient,,,,230,195.5,65.918,230,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Tb Test, Cell Mediated Immunity Antigen Resp Meas; Quantiferon",,86480,CPT,Facility,Outpatient,,,,230,195.5,65.918,230,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),116.081,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Tb Test, Cell Mediated Immunity Antigen Resp Meas; Quantiferon",,86480,CPT,Facility,Inpatient,,,,230,195.5,65.918,230,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Tb Test, Cell Mediated Immunity Antigen Resp Meas; Quantiferon",,86480,CPT,Facility,Both,,,,230,195.5,65.918,230,UnitedHealthcare,Individual & Family,216.2,94,,percent of total billed charges,,
"Tb Test, Cell Mediated Immunity Antigen Resp Meas; Quantiferon",,86480,CPT,Facility,Outpatient,,,,230,195.5,65.918,230,UnitedHealthcare,Medicare Advantage,112.7,49,,percent of total billed charges,,
"Tb Test, Cell Mediated Immunity Antigen Resp Meas; Quantiferon",,86480,CPT,Facility,Inpatient,,,,230,195.5,65.918,230,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Tb Test, Cell Mediated Immunity Antigen Resp Meas; Quantiferon",,86480,CPT,Facility,Outpatient,,,,230,195.5,65.918,230,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,110.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Tb Test, Cell Mediated Immunity Antigen Resp Meas; Quantiferon",,86480,CPT,Facility,Inpatient,,,,230,195.5,65.918,230,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Rapid Plasma Reagin,,86592,CPT,Facility,Both,,,,61,51.85,17.4826,61,Aetna,Commercial,56.12,92,,percent of total billed charges,,
Rapid Plasma Reagin,,86592,CPT,Facility,Outpatient,,,,61,51.85,17.4826,61,Aetna,Medicare Advantage,29.89,49,,percent of total billed charges,,
Rapid Plasma Reagin,,86592,CPT,Facility,Inpatient,,,,61,51.85,17.4826,61,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Rapid Plasma Reagin,,86592,CPT,Facility,Both,,,,61,51.85,17.4826,61,Aetna,PPO,56.73,93,,percent of total billed charges,,
Rapid Plasma Reagin,,86592,CPT,Facility,Both,,,,61,51.85,17.4826,61,America's PPO,America's PPO,58.5783,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Rapid Plasma Reagin,,86592,CPT,Facility,Both,,,,61,51.85,17.4826,61,BlueCross BlueShield Minnesota, Federal Employee Program,60.024,98.4,,percent of total billed charges,,
Rapid Plasma Reagin,,86592,CPT,Facility,Both,,,,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,61,100,,percent of total billed charges,,
Rapid Plasma Reagin,,86592,CPT,Facility,Both,,,,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,High Value Network Plan,54.9,90,,percent of total billed charges,,
Rapid Plasma Reagin,,86592,CPT,Facility,Outpatient,,,,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,Medicare Advantage,29.89,49,,percent of total billed charges,,
Rapid Plasma Reagin,,86592,CPT,Facility,Inpatient,,,,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Rapid Plasma Reagin,,86592,CPT,Facility,Both,,,,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,54.0277,88.57,,percent of total billed charges,,
Rapid Plasma Reagin,,86592,CPT,Facility,Both,,,,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,17.4826,28.66,,percent of total billed charges,,
Rapid Plasma Reagin,,86592,CPT,Facility,Outpatient,,,,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),29.89,49,,percent of total billed charges,,
Rapid Plasma Reagin,,86592,CPT,Facility,Inpatient,,,,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Rapid Plasma Reagin,,86592,CPT,Facility,Both,,,,61,51.85,17.4826,61,CorVel,Worker's Compensation,61,100,,percent of total billed charges,,
Rapid Plasma Reagin,,86592,CPT,Facility,Both,,,,61,51.85,17.4826,61,First Health Group Corporation,First Health Network,59.17,97,,percent of total billed charges,,
Rapid Plasma Reagin,,86592,CPT,Facility,Both,,,,61,51.85,17.4826,61,"Health Partners, Inc.",Commercial,57.706,94.6,,percent of total billed charges,,
Rapid Plasma Reagin,,86592,CPT,Facility,Outpatient,,,,61,51.85,17.4826,61,"Health Partners, Inc.",Medicare Advantage,29.89,49,,percent of total billed charges,,
Rapid Plasma Reagin,,86592,CPT,Facility,Inpatient,,,,61,51.85,17.4826,61,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Rapid Plasma Reagin,,86592,CPT,Facility,Both,,,,61,51.85,17.4826,61,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),36.6,60,,percent of total billed charges,,
Rapid Plasma Reagin,,86592,CPT,Facility,Both,,,,61,51.85,17.4826,61,"Health Partners, Inc.",State of Minnesota Advantage Program,49.715,81.5,,percent of total billed charges,,
Rapid Plasma Reagin,,86592,CPT,Facility,Both,,,,61,51.85,17.4826,61,"Health Partners, Inc.",State Public Programs,30.5,50,,percent of total billed charges,,
Rapid Plasma Reagin,,86592,CPT,Facility,Both,,,,61,51.85,17.4826,61,Humana Insurance Company,Commercial PPO,57.95,95,,percent of total billed charges,,
Rapid Plasma Reagin,,86592,CPT,Facility,Outpatient,,,,61,51.85,17.4826,61,Humana Insurance Company,Medicare PPO,29.89,49,,percent of total billed charges,,
Rapid Plasma Reagin,,86592,CPT,Facility,Inpatient,,,,61,51.85,17.4826,61,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Rapid Plasma Reagin,,86592,CPT,Facility,Both,,,,61,51.85,17.4826,61,Medica,Individual & Family,60.451,99.1,,percent of total billed charges,,
Rapid Plasma Reagin,,86592,CPT,Facility,Outpatient,,,,61,51.85,17.4826,61,Medica,Medica Advantage Solution,30.378,49.8,,percent of total billed charges,,
Rapid Plasma Reagin,,86592,CPT,Facility,Inpatient,,,,61,51.85,17.4826,61,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Rapid Plasma Reagin,,86592,CPT,Facility,Outpatient,,,,61,51.85,17.4826,61,Medica,Medical Assistance,27.206,44.6,,percent of total billed charges,,
Rapid Plasma Reagin,,86592,CPT,Facility,Inpatient,,,,61,51.85,17.4826,61,Medica,Medical Assistance,,,,,Included in per diem rate,
Rapid Plasma Reagin,,86592,CPT,Facility,Outpatient,,,,61,51.85,17.4826,61,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,30.378,49.8,,percent of total billed charges,,
Rapid Plasma Reagin,,86592,CPT,Facility,Inpatient,,,,61,51.85,17.4826,61,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Rapid Plasma Reagin,,86592,CPT,Facility,Both,,,,61,51.85,17.4826,61,"Multiplan, Inc.","Multiplan, Inc.",57.34,94,,percent of total billed charges,,
Rapid Plasma Reagin,,86592,CPT,Facility,Outpatient,,,,61,51.85,17.4826,61,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,52.704,86.4,,percent of total billed charges,,
Rapid Plasma Reagin,,86592,CPT,Facility,Inpatient,,,,61,51.85,17.4826,61,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Rapid Plasma Reagin,,86592,CPT,Facility,Both,,,,61,51.85,17.4826,61,"Preferred One Administrative Services, INC.",PPO,60.146,98.6,,percent of total billed charges,,
Rapid Plasma Reagin,,86592,CPT,Facility,Outpatient,,,,61,51.85,17.4826,61,PrimeWest Health,Minnesota Senior Health Options (MSHO),31.3845,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Rapid Plasma Reagin,,86592,CPT,Facility,Inpatient,,,,61,51.85,17.4826,61,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Rapid Plasma Reagin,,86592,CPT,Facility,Outpatient,,,,61,51.85,17.4826,61,PrimeWest Health,MinnesotaCare,31.3296,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Rapid Plasma Reagin,,86592,CPT,Facility,Inpatient,,,,61,51.85,17.4826,61,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Rapid Plasma Reagin,,86592,CPT,Facility,Both,,,,61,51.85,17.4826,61,Sanford Health Plan,Sanford Health Plan,56.12,92,,percent of total billed charges,,
Rapid Plasma Reagin,,86592,CPT,Facility,Outpatient,,,,61,51.85,17.4826,61,"UCare Health, Inc.",Individual & Family Plan,34.3735,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Rapid Plasma Reagin,,86592,CPT,Facility,Inpatient,,,,61,51.85,17.4826,61,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Rapid Plasma Reagin,,86592,CPT,Facility,Outpatient,,,,61,51.85,17.4826,61,"UCare Health, Inc.",Medical Assistance,30.7867,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Rapid Plasma Reagin,,86592,CPT,Facility,Inpatient,,,,61,51.85,17.4826,61,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Rapid Plasma Reagin,,86592,CPT,Facility,Outpatient,,,,61,51.85,17.4826,61,"UCare Health, Inc.",Medicare Advantage,30.7867,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Rapid Plasma Reagin,,86592,CPT,Facility,Inpatient,,,,61,51.85,17.4826,61,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Rapid Plasma Reagin,,86592,CPT,Facility,Outpatient,,,,61,51.85,17.4826,61,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),30.7867,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Rapid Plasma Reagin,,86592,CPT,Facility,Inpatient,,,,61,51.85,17.4826,61,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Rapid Plasma Reagin,,86592,CPT,Facility,Both,,,,61,51.85,17.4826,61,UnitedHealthcare,Individual & Family,57.34,94,,percent of total billed charges,,
Rapid Plasma Reagin,,86592,CPT,Facility,Outpatient,,,,61,51.85,17.4826,61,UnitedHealthcare,Medicare Advantage,29.89,49,,percent of total billed charges,,
Rapid Plasma Reagin,,86592,CPT,Facility,Inpatient,,,,61,51.85,17.4826,61,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Rapid Plasma Reagin,,86592,CPT,Facility,Outpatient,,,,61,51.85,17.4826,61,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,29.28,48,,percent of total billed charges,,100% of DHS outpatient percentage
Rapid Plasma Reagin,,86592,CPT,Facility,Inpatient,,,,61,51.85,17.4826,61,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Borrelia Burgdorferi Serology, Evaluation With Reflex To Western Blot",,86618,CPT,Facility,Both,,,,123,104.55,35.2518,123,Aetna,Commercial,113.16,92,,percent of total billed charges,,
"Borrelia Burgdorferi Serology, Evaluation With Reflex To Western Blot",,86618,CPT,Facility,Outpatient,,,,123,104.55,35.2518,123,Aetna,Medicare Advantage,60.27,49,,percent of total billed charges,,
"Borrelia Burgdorferi Serology, Evaluation With Reflex To Western Blot",,86618,CPT,Facility,Inpatient,,,,123,104.55,35.2518,123,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Borrelia Burgdorferi Serology, Evaluation With Reflex To Western Blot",,86618,CPT,Facility,Both,,,,123,104.55,35.2518,123,Aetna,PPO,114.39,93,,percent of total billed charges,,
"Borrelia Burgdorferi Serology, Evaluation With Reflex To Western Blot",,86618,CPT,Facility,Both,,,,123,104.55,35.2518,123,America's PPO,America's PPO,118.1169,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Borrelia Burgdorferi Serology, Evaluation With Reflex To Western Blot",,86618,CPT,Facility,Both,,,,123,104.55,35.2518,123,BlueCross BlueShield Minnesota, Federal Employee Program,121.032,98.4,,percent of total billed charges,,
"Borrelia Burgdorferi Serology, Evaluation With Reflex To Western Blot",,86618,CPT,Facility,Both,,,,123,104.55,35.2518,123,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,123,100,,percent of total billed charges,,
"Borrelia Burgdorferi Serology, Evaluation With Reflex To Western Blot",,86618,CPT,Facility,Both,,,,123,104.55,35.2518,123,BlueCross BlueShield Minnesota,High Value Network Plan,110.7,90,,percent of total billed charges,,
"Borrelia Burgdorferi Serology, Evaluation With Reflex To Western Blot",,86618,CPT,Facility,Outpatient,,,,123,104.55,35.2518,123,BlueCross BlueShield Minnesota,Medicare Advantage,60.27,49,,percent of total billed charges,,
"Borrelia Burgdorferi Serology, Evaluation With Reflex To Western Blot",,86618,CPT,Facility,Inpatient,,,,123,104.55,35.2518,123,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Borrelia Burgdorferi Serology, Evaluation With Reflex To Western Blot",,86618,CPT,Facility,Both,,,,123,104.55,35.2518,123,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,108.9411,88.57,,percent of total billed charges,,
"Borrelia Burgdorferi Serology, Evaluation With Reflex To Western Blot",,86618,CPT,Facility,Both,,,,123,104.55,35.2518,123,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,35.2518,28.66,,percent of total billed charges,,
"Borrelia Burgdorferi Serology, Evaluation With Reflex To Western Blot",,86618,CPT,Facility,Outpatient,,,,123,104.55,35.2518,123,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),60.27,49,,percent of total billed charges,,
"Borrelia Burgdorferi Serology, Evaluation With Reflex To Western Blot",,86618,CPT,Facility,Inpatient,,,,123,104.55,35.2518,123,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Borrelia Burgdorferi Serology, Evaluation With Reflex To Western Blot",,86618,CPT,Facility,Both,,,,123,104.55,35.2518,123,CorVel,Worker's Compensation,123,100,,percent of total billed charges,,
"Borrelia Burgdorferi Serology, Evaluation With Reflex To Western Blot",,86618,CPT,Facility,Both,,,,123,104.55,35.2518,123,First Health Group Corporation,First Health Network,119.31,97,,percent of total billed charges,,
"Borrelia Burgdorferi Serology, Evaluation With Reflex To Western Blot",,86618,CPT,Facility,Both,,,,123,104.55,35.2518,123,"Health Partners, Inc.",Commercial,116.358,94.6,,percent of total billed charges,,
"Borrelia Burgdorferi Serology, Evaluation With Reflex To Western Blot",,86618,CPT,Facility,Outpatient,,,,123,104.55,35.2518,123,"Health Partners, Inc.",Medicare Advantage,60.27,49,,percent of total billed charges,,
"Borrelia Burgdorferi Serology, Evaluation With Reflex To Western Blot",,86618,CPT,Facility,Inpatient,,,,123,104.55,35.2518,123,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Borrelia Burgdorferi Serology, Evaluation With Reflex To Western Blot",,86618,CPT,Facility,Both,,,,123,104.55,35.2518,123,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),73.8,60,,percent of total billed charges,,
"Borrelia Burgdorferi Serology, Evaluation With Reflex To Western Blot",,86618,CPT,Facility,Both,,,,123,104.55,35.2518,123,"Health Partners, Inc.",State of Minnesota Advantage Program,100.245,81.5,,percent of total billed charges,,
"Borrelia Burgdorferi Serology, Evaluation With Reflex To Western Blot",,86618,CPT,Facility,Both,,,,123,104.55,35.2518,123,"Health Partners, Inc.",State Public Programs,61.5,50,,percent of total billed charges,,
"Borrelia Burgdorferi Serology, Evaluation With Reflex To Western Blot",,86618,CPT,Facility,Both,,,,123,104.55,35.2518,123,Humana Insurance Company,Commercial PPO,116.85,95,,percent of total billed charges,,
"Borrelia Burgdorferi Serology, Evaluation With Reflex To Western Blot",,86618,CPT,Facility,Outpatient,,,,123,104.55,35.2518,123,Humana Insurance Company,Medicare PPO,60.27,49,,percent of total billed charges,,
"Borrelia Burgdorferi Serology, Evaluation With Reflex To Western Blot",,86618,CPT,Facility,Inpatient,,,,123,104.55,35.2518,123,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Borrelia Burgdorferi Serology, Evaluation With Reflex To Western Blot",,86618,CPT,Facility,Both,,,,123,104.55,35.2518,123,Medica,Individual & Family,121.893,99.1,,percent of total billed charges,,
"Borrelia Burgdorferi Serology, Evaluation With Reflex To Western Blot",,86618,CPT,Facility,Outpatient,,,,123,104.55,35.2518,123,Medica,Medica Advantage Solution,61.254,49.8,,percent of total billed charges,,
"Borrelia Burgdorferi Serology, Evaluation With Reflex To Western Blot",,86618,CPT,Facility,Inpatient,,,,123,104.55,35.2518,123,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Borrelia Burgdorferi Serology, Evaluation With Reflex To Western Blot",,86618,CPT,Facility,Outpatient,,,,123,104.55,35.2518,123,Medica,Medical Assistance,54.858,44.6,,percent of total billed charges,,
"Borrelia Burgdorferi Serology, Evaluation With Reflex To Western Blot",,86618,CPT,Facility,Inpatient,,,,123,104.55,35.2518,123,Medica,Medical Assistance,,,,,Included in per diem rate,
"Borrelia Burgdorferi Serology, Evaluation With Reflex To Western Blot",,86618,CPT,Facility,Outpatient,,,,123,104.55,35.2518,123,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,61.254,49.8,,percent of total billed charges,,
"Borrelia Burgdorferi Serology, Evaluation With Reflex To Western Blot",,86618,CPT,Facility,Inpatient,,,,123,104.55,35.2518,123,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Borrelia Burgdorferi Serology, Evaluation With Reflex To Western Blot",,86618,CPT,Facility,Both,,,,123,104.55,35.2518,123,"Multiplan, Inc.","Multiplan, Inc.",115.62,94,,percent of total billed charges,,
"Borrelia Burgdorferi Serology, Evaluation With Reflex To Western Blot",,86618,CPT,Facility,Outpatient,,,,123,104.55,35.2518,123,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,106.272,86.4,,percent of total billed charges,,
"Borrelia Burgdorferi Serology, Evaluation With Reflex To Western Blot",,86618,CPT,Facility,Inpatient,,,,123,104.55,35.2518,123,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Borrelia Burgdorferi Serology, Evaluation With Reflex To Western Blot",,86618,CPT,Facility,Both,,,,123,104.55,35.2518,123,"Preferred One Administrative Services, INC.",PPO,121.278,98.6,,percent of total billed charges,,
"Borrelia Burgdorferi Serology, Evaluation With Reflex To Western Blot",,86618,CPT,Facility,Outpatient,,,,123,104.55,35.2518,123,PrimeWest Health,Minnesota Senior Health Options (MSHO),63.2835,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Borrelia Burgdorferi Serology, Evaluation With Reflex To Western Blot",,86618,CPT,Facility,Inpatient,,,,123,104.55,35.2518,123,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Borrelia Burgdorferi Serology, Evaluation With Reflex To Western Blot",,86618,CPT,Facility,Outpatient,,,,123,104.55,35.2518,123,PrimeWest Health,MinnesotaCare,63.1728,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Borrelia Burgdorferi Serology, Evaluation With Reflex To Western Blot",,86618,CPT,Facility,Inpatient,,,,123,104.55,35.2518,123,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Borrelia Burgdorferi Serology, Evaluation With Reflex To Western Blot",,86618,CPT,Facility,Both,,,,123,104.55,35.2518,123,Sanford Health Plan,Sanford Health Plan,113.16,92,,percent of total billed charges,,
"Borrelia Burgdorferi Serology, Evaluation With Reflex To Western Blot",,86618,CPT,Facility,Outpatient,,,,123,104.55,35.2518,123,"UCare Health, Inc.",Individual & Family Plan,69.3105,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Borrelia Burgdorferi Serology, Evaluation With Reflex To Western Blot",,86618,CPT,Facility,Inpatient,,,,123,104.55,35.2518,123,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Borrelia Burgdorferi Serology, Evaluation With Reflex To Western Blot",,86618,CPT,Facility,Outpatient,,,,123,104.55,35.2518,123,"UCare Health, Inc.",Medical Assistance,62.0781,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Borrelia Burgdorferi Serology, Evaluation With Reflex To Western Blot",,86618,CPT,Facility,Inpatient,,,,123,104.55,35.2518,123,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Borrelia Burgdorferi Serology, Evaluation With Reflex To Western Blot",,86618,CPT,Facility,Outpatient,,,,123,104.55,35.2518,123,"UCare Health, Inc.",Medicare Advantage,62.0781,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Borrelia Burgdorferi Serology, Evaluation With Reflex To Western Blot",,86618,CPT,Facility,Inpatient,,,,123,104.55,35.2518,123,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Borrelia Burgdorferi Serology, Evaluation With Reflex To Western Blot",,86618,CPT,Facility,Outpatient,,,,123,104.55,35.2518,123,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),62.0781,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Borrelia Burgdorferi Serology, Evaluation With Reflex To Western Blot",,86618,CPT,Facility,Inpatient,,,,123,104.55,35.2518,123,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Borrelia Burgdorferi Serology, Evaluation With Reflex To Western Blot",,86618,CPT,Facility,Both,,,,123,104.55,35.2518,123,UnitedHealthcare,Individual & Family,115.62,94,,percent of total billed charges,,
"Borrelia Burgdorferi Serology, Evaluation With Reflex To Western Blot",,86618,CPT,Facility,Outpatient,,,,123,104.55,35.2518,123,UnitedHealthcare,Medicare Advantage,60.27,49,,percent of total billed charges,,
"Borrelia Burgdorferi Serology, Evaluation With Reflex To Western Blot",,86618,CPT,Facility,Inpatient,,,,123,104.55,35.2518,123,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Borrelia Burgdorferi Serology, Evaluation With Reflex To Western Blot",,86618,CPT,Facility,Outpatient,,,,123,104.55,35.2518,123,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,59.04,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Borrelia Burgdorferi Serology, Evaluation With Reflex To Western Blot",,86618,CPT,Facility,Inpatient,,,,123,104.55,35.2518,123,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Helicobacter Pylori Ab, Igg",,86677,CPT,Facility,Both,,,,128,108.8,36.6848,128,Aetna,Commercial,117.76,92,,percent of total billed charges,,
"Helicobacter Pylori Ab, Igg",,86677,CPT,Facility,Outpatient,,,,128,108.8,36.6848,128,Aetna,Medicare Advantage,62.72,49,,percent of total billed charges,,
"Helicobacter Pylori Ab, Igg",,86677,CPT,Facility,Inpatient,,,,128,108.8,36.6848,128,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Helicobacter Pylori Ab, Igg",,86677,CPT,Facility,Both,,,,128,108.8,36.6848,128,Aetna,PPO,119.04,93,,percent of total billed charges,,
"Helicobacter Pylori Ab, Igg",,86677,CPT,Facility,Both,,,,128,108.8,36.6848,128,America's PPO,America's PPO,122.9184,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Helicobacter Pylori Ab, Igg",,86677,CPT,Facility,Both,,,,128,108.8,36.6848,128,BlueCross BlueShield Minnesota, Federal Employee Program,125.952,98.4,,percent of total billed charges,,
"Helicobacter Pylori Ab, Igg",,86677,CPT,Facility,Both,,,,128,108.8,36.6848,128,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,128,100,,percent of total billed charges,,
"Helicobacter Pylori Ab, Igg",,86677,CPT,Facility,Both,,,,128,108.8,36.6848,128,BlueCross BlueShield Minnesota,High Value Network Plan,115.2,90,,percent of total billed charges,,
"Helicobacter Pylori Ab, Igg",,86677,CPT,Facility,Outpatient,,,,128,108.8,36.6848,128,BlueCross BlueShield Minnesota,Medicare Advantage,62.72,49,,percent of total billed charges,,
"Helicobacter Pylori Ab, Igg",,86677,CPT,Facility,Inpatient,,,,128,108.8,36.6848,128,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Helicobacter Pylori Ab, Igg",,86677,CPT,Facility,Both,,,,128,108.8,36.6848,128,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,113.3696,88.57,,percent of total billed charges,,
"Helicobacter Pylori Ab, Igg",,86677,CPT,Facility,Both,,,,128,108.8,36.6848,128,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,36.6848,28.66,,percent of total billed charges,,
"Helicobacter Pylori Ab, Igg",,86677,CPT,Facility,Outpatient,,,,128,108.8,36.6848,128,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),62.72,49,,percent of total billed charges,,
"Helicobacter Pylori Ab, Igg",,86677,CPT,Facility,Inpatient,,,,128,108.8,36.6848,128,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Helicobacter Pylori Ab, Igg",,86677,CPT,Facility,Both,,,,128,108.8,36.6848,128,CorVel,Worker's Compensation,128,100,,percent of total billed charges,,
"Helicobacter Pylori Ab, Igg",,86677,CPT,Facility,Both,,,,128,108.8,36.6848,128,First Health Group Corporation,First Health Network,124.16,97,,percent of total billed charges,,
"Helicobacter Pylori Ab, Igg",,86677,CPT,Facility,Both,,,,128,108.8,36.6848,128,"Health Partners, Inc.",Commercial,121.088,94.6,,percent of total billed charges,,
"Helicobacter Pylori Ab, Igg",,86677,CPT,Facility,Outpatient,,,,128,108.8,36.6848,128,"Health Partners, Inc.",Medicare Advantage,62.72,49,,percent of total billed charges,,
"Helicobacter Pylori Ab, Igg",,86677,CPT,Facility,Inpatient,,,,128,108.8,36.6848,128,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Helicobacter Pylori Ab, Igg",,86677,CPT,Facility,Both,,,,128,108.8,36.6848,128,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),76.8,60,,percent of total billed charges,,
"Helicobacter Pylori Ab, Igg",,86677,CPT,Facility,Both,,,,128,108.8,36.6848,128,"Health Partners, Inc.",State of Minnesota Advantage Program,104.32,81.5,,percent of total billed charges,,
"Helicobacter Pylori Ab, Igg",,86677,CPT,Facility,Both,,,,128,108.8,36.6848,128,"Health Partners, Inc.",State Public Programs,64,50,,percent of total billed charges,,
"Helicobacter Pylori Ab, Igg",,86677,CPT,Facility,Both,,,,128,108.8,36.6848,128,Humana Insurance Company,Commercial PPO,121.6,95,,percent of total billed charges,,
"Helicobacter Pylori Ab, Igg",,86677,CPT,Facility,Outpatient,,,,128,108.8,36.6848,128,Humana Insurance Company,Medicare PPO,62.72,49,,percent of total billed charges,,
"Helicobacter Pylori Ab, Igg",,86677,CPT,Facility,Inpatient,,,,128,108.8,36.6848,128,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Helicobacter Pylori Ab, Igg",,86677,CPT,Facility,Both,,,,128,108.8,36.6848,128,Medica,Individual & Family,126.848,99.1,,percent of total billed charges,,
"Helicobacter Pylori Ab, Igg",,86677,CPT,Facility,Outpatient,,,,128,108.8,36.6848,128,Medica,Medica Advantage Solution,63.744,49.8,,percent of total billed charges,,
"Helicobacter Pylori Ab, Igg",,86677,CPT,Facility,Inpatient,,,,128,108.8,36.6848,128,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Helicobacter Pylori Ab, Igg",,86677,CPT,Facility,Outpatient,,,,128,108.8,36.6848,128,Medica,Medical Assistance,57.088,44.6,,percent of total billed charges,,
"Helicobacter Pylori Ab, Igg",,86677,CPT,Facility,Inpatient,,,,128,108.8,36.6848,128,Medica,Medical Assistance,,,,,Included in per diem rate,
"Helicobacter Pylori Ab, Igg",,86677,CPT,Facility,Outpatient,,,,128,108.8,36.6848,128,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,63.744,49.8,,percent of total billed charges,,
"Helicobacter Pylori Ab, Igg",,86677,CPT,Facility,Inpatient,,,,128,108.8,36.6848,128,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Helicobacter Pylori Ab, Igg",,86677,CPT,Facility,Both,,,,128,108.8,36.6848,128,"Multiplan, Inc.","Multiplan, Inc.",120.32,94,,percent of total billed charges,,
"Helicobacter Pylori Ab, Igg",,86677,CPT,Facility,Outpatient,,,,128,108.8,36.6848,128,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,110.592,86.4,,percent of total billed charges,,
"Helicobacter Pylori Ab, Igg",,86677,CPT,Facility,Inpatient,,,,128,108.8,36.6848,128,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Helicobacter Pylori Ab, Igg",,86677,CPT,Facility,Both,,,,128,108.8,36.6848,128,"Preferred One Administrative Services, INC.",PPO,126.208,98.6,,percent of total billed charges,,
"Helicobacter Pylori Ab, Igg",,86677,CPT,Facility,Outpatient,,,,128,108.8,36.6848,128,PrimeWest Health,Minnesota Senior Health Options (MSHO),65.856,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Helicobacter Pylori Ab, Igg",,86677,CPT,Facility,Inpatient,,,,128,108.8,36.6848,128,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Helicobacter Pylori Ab, Igg",,86677,CPT,Facility,Outpatient,,,,128,108.8,36.6848,128,PrimeWest Health,MinnesotaCare,65.7408,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Helicobacter Pylori Ab, Igg",,86677,CPT,Facility,Inpatient,,,,128,108.8,36.6848,128,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Helicobacter Pylori Ab, Igg",,86677,CPT,Facility,Both,,,,128,108.8,36.6848,128,Sanford Health Plan,Sanford Health Plan,117.76,92,,percent of total billed charges,,
"Helicobacter Pylori Ab, Igg",,86677,CPT,Facility,Outpatient,,,,128,108.8,36.6848,128,"UCare Health, Inc.",Individual & Family Plan,72.128,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Helicobacter Pylori Ab, Igg",,86677,CPT,Facility,Inpatient,,,,128,108.8,36.6848,128,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Helicobacter Pylori Ab, Igg",,86677,CPT,Facility,Outpatient,,,,128,108.8,36.6848,128,"UCare Health, Inc.",Medical Assistance,64.6016,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Helicobacter Pylori Ab, Igg",,86677,CPT,Facility,Inpatient,,,,128,108.8,36.6848,128,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Helicobacter Pylori Ab, Igg",,86677,CPT,Facility,Outpatient,,,,128,108.8,36.6848,128,"UCare Health, Inc.",Medicare Advantage,64.6016,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Helicobacter Pylori Ab, Igg",,86677,CPT,Facility,Inpatient,,,,128,108.8,36.6848,128,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Helicobacter Pylori Ab, Igg",,86677,CPT,Facility,Outpatient,,,,128,108.8,36.6848,128,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),64.6016,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Helicobacter Pylori Ab, Igg",,86677,CPT,Facility,Inpatient,,,,128,108.8,36.6848,128,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Helicobacter Pylori Ab, Igg",,86677,CPT,Facility,Both,,,,128,108.8,36.6848,128,UnitedHealthcare,Individual & Family,120.32,94,,percent of total billed charges,,
"Helicobacter Pylori Ab, Igg",,86677,CPT,Facility,Outpatient,,,,128,108.8,36.6848,128,UnitedHealthcare,Medicare Advantage,62.72,49,,percent of total billed charges,,
"Helicobacter Pylori Ab, Igg",,86677,CPT,Facility,Inpatient,,,,128,108.8,36.6848,128,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Helicobacter Pylori Ab, Igg",,86677,CPT,Facility,Outpatient,,,,128,108.8,36.6848,128,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,61.44,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Helicobacter Pylori Ab, Igg",,86677,CPT,Facility,Inpatient,,,,128,108.8,36.6848,128,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Hep B Core Aby Total,,86704,CPT,Facility,Both,,,,115,97.75,32.959,115,Aetna,Commercial,105.8,92,,percent of total billed charges,,
Hep B Core Aby Total,,86704,CPT,Facility,Outpatient,,,,115,97.75,32.959,115,Aetna,Medicare Advantage,56.35,49,,percent of total billed charges,,
Hep B Core Aby Total,,86704,CPT,Facility,Inpatient,,,,115,97.75,32.959,115,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Hep B Core Aby Total,,86704,CPT,Facility,Both,,,,115,97.75,32.959,115,Aetna,PPO,106.95,93,,percent of total billed charges,,
Hep B Core Aby Total,,86704,CPT,Facility,Both,,,,115,97.75,32.959,115,America's PPO,America's PPO,110.4345,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Hep B Core Aby Total,,86704,CPT,Facility,Both,,,,115,97.75,32.959,115,BlueCross BlueShield Minnesota, Federal Employee Program,113.16,98.4,,percent of total billed charges,,
Hep B Core Aby Total,,86704,CPT,Facility,Both,,,,115,97.75,32.959,115,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,115,100,,percent of total billed charges,,
Hep B Core Aby Total,,86704,CPT,Facility,Both,,,,115,97.75,32.959,115,BlueCross BlueShield Minnesota,High Value Network Plan,103.5,90,,percent of total billed charges,,
Hep B Core Aby Total,,86704,CPT,Facility,Outpatient,,,,115,97.75,32.959,115,BlueCross BlueShield Minnesota,Medicare Advantage,56.35,49,,percent of total billed charges,,
Hep B Core Aby Total,,86704,CPT,Facility,Inpatient,,,,115,97.75,32.959,115,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Hep B Core Aby Total,,86704,CPT,Facility,Both,,,,115,97.75,32.959,115,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,101.8555,88.57,,percent of total billed charges,,
Hep B Core Aby Total,,86704,CPT,Facility,Both,,,,115,97.75,32.959,115,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,32.959,28.66,,percent of total billed charges,,
Hep B Core Aby Total,,86704,CPT,Facility,Outpatient,,,,115,97.75,32.959,115,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),56.35,49,,percent of total billed charges,,
Hep B Core Aby Total,,86704,CPT,Facility,Inpatient,,,,115,97.75,32.959,115,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Hep B Core Aby Total,,86704,CPT,Facility,Both,,,,115,97.75,32.959,115,CorVel,Worker's Compensation,115,100,,percent of total billed charges,,
Hep B Core Aby Total,,86704,CPT,Facility,Both,,,,115,97.75,32.959,115,First Health Group Corporation,First Health Network,111.55,97,,percent of total billed charges,,
Hep B Core Aby Total,,86704,CPT,Facility,Both,,,,115,97.75,32.959,115,"Health Partners, Inc.",Commercial,108.79,94.6,,percent of total billed charges,,
Hep B Core Aby Total,,86704,CPT,Facility,Outpatient,,,,115,97.75,32.959,115,"Health Partners, Inc.",Medicare Advantage,56.35,49,,percent of total billed charges,,
Hep B Core Aby Total,,86704,CPT,Facility,Inpatient,,,,115,97.75,32.959,115,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Hep B Core Aby Total,,86704,CPT,Facility,Both,,,,115,97.75,32.959,115,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),69,60,,percent of total billed charges,,
Hep B Core Aby Total,,86704,CPT,Facility,Both,,,,115,97.75,32.959,115,"Health Partners, Inc.",State of Minnesota Advantage Program,93.725,81.5,,percent of total billed charges,,
Hep B Core Aby Total,,86704,CPT,Facility,Both,,,,115,97.75,32.959,115,"Health Partners, Inc.",State Public Programs,57.5,50,,percent of total billed charges,,
Hep B Core Aby Total,,86704,CPT,Facility,Both,,,,115,97.75,32.959,115,Humana Insurance Company,Commercial PPO,109.25,95,,percent of total billed charges,,
Hep B Core Aby Total,,86704,CPT,Facility,Outpatient,,,,115,97.75,32.959,115,Humana Insurance Company,Medicare PPO,56.35,49,,percent of total billed charges,,
Hep B Core Aby Total,,86704,CPT,Facility,Inpatient,,,,115,97.75,32.959,115,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Hep B Core Aby Total,,86704,CPT,Facility,Both,,,,115,97.75,32.959,115,Medica,Individual & Family,113.965,99.1,,percent of total billed charges,,
Hep B Core Aby Total,,86704,CPT,Facility,Outpatient,,,,115,97.75,32.959,115,Medica,Medica Advantage Solution,57.27,49.8,,percent of total billed charges,,
Hep B Core Aby Total,,86704,CPT,Facility,Inpatient,,,,115,97.75,32.959,115,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Hep B Core Aby Total,,86704,CPT,Facility,Outpatient,,,,115,97.75,32.959,115,Medica,Medical Assistance,51.29,44.6,,percent of total billed charges,,
Hep B Core Aby Total,,86704,CPT,Facility,Inpatient,,,,115,97.75,32.959,115,Medica,Medical Assistance,,,,,Included in per diem rate,
Hep B Core Aby Total,,86704,CPT,Facility,Outpatient,,,,115,97.75,32.959,115,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,57.27,49.8,,percent of total billed charges,,
Hep B Core Aby Total,,86704,CPT,Facility,Inpatient,,,,115,97.75,32.959,115,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Hep B Core Aby Total,,86704,CPT,Facility,Both,,,,115,97.75,32.959,115,"Multiplan, Inc.","Multiplan, Inc.",108.1,94,,percent of total billed charges,,
Hep B Core Aby Total,,86704,CPT,Facility,Outpatient,,,,115,97.75,32.959,115,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,99.36,86.4,,percent of total billed charges,,
Hep B Core Aby Total,,86704,CPT,Facility,Inpatient,,,,115,97.75,32.959,115,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Hep B Core Aby Total,,86704,CPT,Facility,Both,,,,115,97.75,32.959,115,"Preferred One Administrative Services, INC.",PPO,113.39,98.6,,percent of total billed charges,,
Hep B Core Aby Total,,86704,CPT,Facility,Outpatient,,,,115,97.75,32.959,115,PrimeWest Health,Minnesota Senior Health Options (MSHO),59.1675,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Hep B Core Aby Total,,86704,CPT,Facility,Inpatient,,,,115,97.75,32.959,115,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Hep B Core Aby Total,,86704,CPT,Facility,Outpatient,,,,115,97.75,32.959,115,PrimeWest Health,MinnesotaCare,59.064,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Hep B Core Aby Total,,86704,CPT,Facility,Inpatient,,,,115,97.75,32.959,115,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Hep B Core Aby Total,,86704,CPT,Facility,Both,,,,115,97.75,32.959,115,Sanford Health Plan,Sanford Health Plan,105.8,92,,percent of total billed charges,,
Hep B Core Aby Total,,86704,CPT,Facility,Outpatient,,,,115,97.75,32.959,115,"UCare Health, Inc.",Individual & Family Plan,64.8025,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Hep B Core Aby Total,,86704,CPT,Facility,Inpatient,,,,115,97.75,32.959,115,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Hep B Core Aby Total,,86704,CPT,Facility,Outpatient,,,,115,97.75,32.959,115,"UCare Health, Inc.",Medical Assistance,58.0405,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Hep B Core Aby Total,,86704,CPT,Facility,Inpatient,,,,115,97.75,32.959,115,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Hep B Core Aby Total,,86704,CPT,Facility,Outpatient,,,,115,97.75,32.959,115,"UCare Health, Inc.",Medicare Advantage,58.0405,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Hep B Core Aby Total,,86704,CPT,Facility,Inpatient,,,,115,97.75,32.959,115,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Hep B Core Aby Total,,86704,CPT,Facility,Outpatient,,,,115,97.75,32.959,115,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),58.0405,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Hep B Core Aby Total,,86704,CPT,Facility,Inpatient,,,,115,97.75,32.959,115,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Hep B Core Aby Total,,86704,CPT,Facility,Both,,,,115,97.75,32.959,115,UnitedHealthcare,Individual & Family,108.1,94,,percent of total billed charges,,
Hep B Core Aby Total,,86704,CPT,Facility,Outpatient,,,,115,97.75,32.959,115,UnitedHealthcare,Medicare Advantage,56.35,49,,percent of total billed charges,,
Hep B Core Aby Total,,86704,CPT,Facility,Inpatient,,,,115,97.75,32.959,115,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Hep B Core Aby Total,,86704,CPT,Facility,Outpatient,,,,115,97.75,32.959,115,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,55.2,48,,percent of total billed charges,,100% of DHS outpatient percentage
Hep B Core Aby Total,,86704,CPT,Facility,Inpatient,,,,115,97.75,32.959,115,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Hepatitis B Virus Core Igm Ab,,86705,CPT,Facility,Both,,,,115,97.75,32.959,115,Aetna,Commercial,105.8,92,,percent of total billed charges,,
Hepatitis B Virus Core Igm Ab,,86705,CPT,Facility,Outpatient,,,,115,97.75,32.959,115,Aetna,Medicare Advantage,56.35,49,,percent of total billed charges,,
Hepatitis B Virus Core Igm Ab,,86705,CPT,Facility,Inpatient,,,,115,97.75,32.959,115,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Hepatitis B Virus Core Igm Ab,,86705,CPT,Facility,Both,,,,115,97.75,32.959,115,Aetna,PPO,106.95,93,,percent of total billed charges,,
Hepatitis B Virus Core Igm Ab,,86705,CPT,Facility,Both,,,,115,97.75,32.959,115,America's PPO,America's PPO,110.4345,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Hepatitis B Virus Core Igm Ab,,86705,CPT,Facility,Both,,,,115,97.75,32.959,115,BlueCross BlueShield Minnesota, Federal Employee Program,113.16,98.4,,percent of total billed charges,,
Hepatitis B Virus Core Igm Ab,,86705,CPT,Facility,Both,,,,115,97.75,32.959,115,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,115,100,,percent of total billed charges,,
Hepatitis B Virus Core Igm Ab,,86705,CPT,Facility,Both,,,,115,97.75,32.959,115,BlueCross BlueShield Minnesota,High Value Network Plan,103.5,90,,percent of total billed charges,,
Hepatitis B Virus Core Igm Ab,,86705,CPT,Facility,Outpatient,,,,115,97.75,32.959,115,BlueCross BlueShield Minnesota,Medicare Advantage,56.35,49,,percent of total billed charges,,
Hepatitis B Virus Core Igm Ab,,86705,CPT,Facility,Inpatient,,,,115,97.75,32.959,115,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Hepatitis B Virus Core Igm Ab,,86705,CPT,Facility,Both,,,,115,97.75,32.959,115,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,101.8555,88.57,,percent of total billed charges,,
Hepatitis B Virus Core Igm Ab,,86705,CPT,Facility,Both,,,,115,97.75,32.959,115,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,32.959,28.66,,percent of total billed charges,,
Hepatitis B Virus Core Igm Ab,,86705,CPT,Facility,Outpatient,,,,115,97.75,32.959,115,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),56.35,49,,percent of total billed charges,,
Hepatitis B Virus Core Igm Ab,,86705,CPT,Facility,Inpatient,,,,115,97.75,32.959,115,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Hepatitis B Virus Core Igm Ab,,86705,CPT,Facility,Both,,,,115,97.75,32.959,115,CorVel,Worker's Compensation,115,100,,percent of total billed charges,,
Hepatitis B Virus Core Igm Ab,,86705,CPT,Facility,Both,,,,115,97.75,32.959,115,First Health Group Corporation,First Health Network,111.55,97,,percent of total billed charges,,
Hepatitis B Virus Core Igm Ab,,86705,CPT,Facility,Both,,,,115,97.75,32.959,115,"Health Partners, Inc.",Commercial,108.79,94.6,,percent of total billed charges,,
Hepatitis B Virus Core Igm Ab,,86705,CPT,Facility,Outpatient,,,,115,97.75,32.959,115,"Health Partners, Inc.",Medicare Advantage,56.35,49,,percent of total billed charges,,
Hepatitis B Virus Core Igm Ab,,86705,CPT,Facility,Inpatient,,,,115,97.75,32.959,115,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Hepatitis B Virus Core Igm Ab,,86705,CPT,Facility,Both,,,,115,97.75,32.959,115,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),69,60,,percent of total billed charges,,
Hepatitis B Virus Core Igm Ab,,86705,CPT,Facility,Both,,,,115,97.75,32.959,115,"Health Partners, Inc.",State of Minnesota Advantage Program,93.725,81.5,,percent of total billed charges,,
Hepatitis B Virus Core Igm Ab,,86705,CPT,Facility,Both,,,,115,97.75,32.959,115,"Health Partners, Inc.",State Public Programs,57.5,50,,percent of total billed charges,,
Hepatitis B Virus Core Igm Ab,,86705,CPT,Facility,Both,,,,115,97.75,32.959,115,Humana Insurance Company,Commercial PPO,109.25,95,,percent of total billed charges,,
Hepatitis B Virus Core Igm Ab,,86705,CPT,Facility,Outpatient,,,,115,97.75,32.959,115,Humana Insurance Company,Medicare PPO,56.35,49,,percent of total billed charges,,
Hepatitis B Virus Core Igm Ab,,86705,CPT,Facility,Inpatient,,,,115,97.75,32.959,115,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Hepatitis B Virus Core Igm Ab,,86705,CPT,Facility,Both,,,,115,97.75,32.959,115,Medica,Individual & Family,113.965,99.1,,percent of total billed charges,,
Hepatitis B Virus Core Igm Ab,,86705,CPT,Facility,Outpatient,,,,115,97.75,32.959,115,Medica,Medica Advantage Solution,57.27,49.8,,percent of total billed charges,,
Hepatitis B Virus Core Igm Ab,,86705,CPT,Facility,Inpatient,,,,115,97.75,32.959,115,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Hepatitis B Virus Core Igm Ab,,86705,CPT,Facility,Outpatient,,,,115,97.75,32.959,115,Medica,Medical Assistance,51.29,44.6,,percent of total billed charges,,
Hepatitis B Virus Core Igm Ab,,86705,CPT,Facility,Inpatient,,,,115,97.75,32.959,115,Medica,Medical Assistance,,,,,Included in per diem rate,
Hepatitis B Virus Core Igm Ab,,86705,CPT,Facility,Outpatient,,,,115,97.75,32.959,115,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,57.27,49.8,,percent of total billed charges,,
Hepatitis B Virus Core Igm Ab,,86705,CPT,Facility,Inpatient,,,,115,97.75,32.959,115,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Hepatitis B Virus Core Igm Ab,,86705,CPT,Facility,Both,,,,115,97.75,32.959,115,"Multiplan, Inc.","Multiplan, Inc.",108.1,94,,percent of total billed charges,,
Hepatitis B Virus Core Igm Ab,,86705,CPT,Facility,Outpatient,,,,115,97.75,32.959,115,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,99.36,86.4,,percent of total billed charges,,
Hepatitis B Virus Core Igm Ab,,86705,CPT,Facility,Inpatient,,,,115,97.75,32.959,115,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Hepatitis B Virus Core Igm Ab,,86705,CPT,Facility,Both,,,,115,97.75,32.959,115,"Preferred One Administrative Services, INC.",PPO,113.39,98.6,,percent of total billed charges,,
Hepatitis B Virus Core Igm Ab,,86705,CPT,Facility,Outpatient,,,,115,97.75,32.959,115,PrimeWest Health,Minnesota Senior Health Options (MSHO),59.1675,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Hepatitis B Virus Core Igm Ab,,86705,CPT,Facility,Inpatient,,,,115,97.75,32.959,115,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Hepatitis B Virus Core Igm Ab,,86705,CPT,Facility,Outpatient,,,,115,97.75,32.959,115,PrimeWest Health,MinnesotaCare,59.064,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Hepatitis B Virus Core Igm Ab,,86705,CPT,Facility,Inpatient,,,,115,97.75,32.959,115,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Hepatitis B Virus Core Igm Ab,,86705,CPT,Facility,Both,,,,115,97.75,32.959,115,Sanford Health Plan,Sanford Health Plan,105.8,92,,percent of total billed charges,,
Hepatitis B Virus Core Igm Ab,,86705,CPT,Facility,Outpatient,,,,115,97.75,32.959,115,"UCare Health, Inc.",Individual & Family Plan,64.8025,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Hepatitis B Virus Core Igm Ab,,86705,CPT,Facility,Inpatient,,,,115,97.75,32.959,115,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Hepatitis B Virus Core Igm Ab,,86705,CPT,Facility,Outpatient,,,,115,97.75,32.959,115,"UCare Health, Inc.",Medical Assistance,58.0405,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Hepatitis B Virus Core Igm Ab,,86705,CPT,Facility,Inpatient,,,,115,97.75,32.959,115,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Hepatitis B Virus Core Igm Ab,,86705,CPT,Facility,Outpatient,,,,115,97.75,32.959,115,"UCare Health, Inc.",Medicare Advantage,58.0405,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Hepatitis B Virus Core Igm Ab,,86705,CPT,Facility,Inpatient,,,,115,97.75,32.959,115,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Hepatitis B Virus Core Igm Ab,,86705,CPT,Facility,Outpatient,,,,115,97.75,32.959,115,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),58.0405,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Hepatitis B Virus Core Igm Ab,,86705,CPT,Facility,Inpatient,,,,115,97.75,32.959,115,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Hepatitis B Virus Core Igm Ab,,86705,CPT,Facility,Both,,,,115,97.75,32.959,115,UnitedHealthcare,Individual & Family,108.1,94,,percent of total billed charges,,
Hepatitis B Virus Core Igm Ab,,86705,CPT,Facility,Outpatient,,,,115,97.75,32.959,115,UnitedHealthcare,Medicare Advantage,56.35,49,,percent of total billed charges,,
Hepatitis B Virus Core Igm Ab,,86705,CPT,Facility,Inpatient,,,,115,97.75,32.959,115,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Hepatitis B Virus Core Igm Ab,,86705,CPT,Facility,Outpatient,,,,115,97.75,32.959,115,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,55.2,48,,percent of total billed charges,,100% of DHS outpatient percentage
Hepatitis B Virus Core Igm Ab,,86705,CPT,Facility,Inpatient,,,,115,97.75,32.959,115,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Hepatitis B Virus Surface Ab,,86706,CPT,Facility,Both,,,,38,32.3,10.8908,38,Aetna,Commercial,34.96,92,,percent of total billed charges,,
Hepatitis B Virus Surface Ab,,86706,CPT,Facility,Outpatient,,,,38,32.3,10.8908,38,Aetna,Medicare Advantage,18.62,49,,percent of total billed charges,,
Hepatitis B Virus Surface Ab,,86706,CPT,Facility,Inpatient,,,,38,32.3,10.8908,38,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Hepatitis B Virus Surface Ab,,86706,CPT,Facility,Both,,,,38,32.3,10.8908,38,Aetna,PPO,35.34,93,,percent of total billed charges,,
Hepatitis B Virus Surface Ab,,86706,CPT,Facility,Both,,,,38,32.3,10.8908,38,America's PPO,America's PPO,36.4914,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Hepatitis B Virus Surface Ab,,86706,CPT,Facility,Both,,,,38,32.3,10.8908,38,BlueCross BlueShield Minnesota, Federal Employee Program,37.392,98.4,,percent of total billed charges,,
Hepatitis B Virus Surface Ab,,86706,CPT,Facility,Both,,,,38,32.3,10.8908,38,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,38,100,,percent of total billed charges,,
Hepatitis B Virus Surface Ab,,86706,CPT,Facility,Both,,,,38,32.3,10.8908,38,BlueCross BlueShield Minnesota,High Value Network Plan,34.2,90,,percent of total billed charges,,
Hepatitis B Virus Surface Ab,,86706,CPT,Facility,Outpatient,,,,38,32.3,10.8908,38,BlueCross BlueShield Minnesota,Medicare Advantage,18.62,49,,percent of total billed charges,,
Hepatitis B Virus Surface Ab,,86706,CPT,Facility,Inpatient,,,,38,32.3,10.8908,38,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Hepatitis B Virus Surface Ab,,86706,CPT,Facility,Both,,,,38,32.3,10.8908,38,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,33.6566,88.57,,percent of total billed charges,,
Hepatitis B Virus Surface Ab,,86706,CPT,Facility,Both,,,,38,32.3,10.8908,38,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,10.8908,28.66,,percent of total billed charges,,
Hepatitis B Virus Surface Ab,,86706,CPT,Facility,Outpatient,,,,38,32.3,10.8908,38,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),18.62,49,,percent of total billed charges,,
Hepatitis B Virus Surface Ab,,86706,CPT,Facility,Inpatient,,,,38,32.3,10.8908,38,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Hepatitis B Virus Surface Ab,,86706,CPT,Facility,Both,,,,38,32.3,10.8908,38,CorVel,Worker's Compensation,38,100,,percent of total billed charges,,
Hepatitis B Virus Surface Ab,,86706,CPT,Facility,Both,,,,38,32.3,10.8908,38,First Health Group Corporation,First Health Network,36.86,97,,percent of total billed charges,,
Hepatitis B Virus Surface Ab,,86706,CPT,Facility,Both,,,,38,32.3,10.8908,38,"Health Partners, Inc.",Commercial,35.948,94.6,,percent of total billed charges,,
Hepatitis B Virus Surface Ab,,86706,CPT,Facility,Outpatient,,,,38,32.3,10.8908,38,"Health Partners, Inc.",Medicare Advantage,18.62,49,,percent of total billed charges,,
Hepatitis B Virus Surface Ab,,86706,CPT,Facility,Inpatient,,,,38,32.3,10.8908,38,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Hepatitis B Virus Surface Ab,,86706,CPT,Facility,Both,,,,38,32.3,10.8908,38,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),22.8,60,,percent of total billed charges,,
Hepatitis B Virus Surface Ab,,86706,CPT,Facility,Both,,,,38,32.3,10.8908,38,"Health Partners, Inc.",State of Minnesota Advantage Program,30.97,81.5,,percent of total billed charges,,
Hepatitis B Virus Surface Ab,,86706,CPT,Facility,Both,,,,38,32.3,10.8908,38,"Health Partners, Inc.",State Public Programs,19,50,,percent of total billed charges,,
Hepatitis B Virus Surface Ab,,86706,CPT,Facility,Both,,,,38,32.3,10.8908,38,Humana Insurance Company,Commercial PPO,36.1,95,,percent of total billed charges,,
Hepatitis B Virus Surface Ab,,86706,CPT,Facility,Outpatient,,,,38,32.3,10.8908,38,Humana Insurance Company,Medicare PPO,18.62,49,,percent of total billed charges,,
Hepatitis B Virus Surface Ab,,86706,CPT,Facility,Inpatient,,,,38,32.3,10.8908,38,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Hepatitis B Virus Surface Ab,,86706,CPT,Facility,Both,,,,38,32.3,10.8908,38,Medica,Individual & Family,37.658,99.1,,percent of total billed charges,,
Hepatitis B Virus Surface Ab,,86706,CPT,Facility,Outpatient,,,,38,32.3,10.8908,38,Medica,Medica Advantage Solution,18.924,49.8,,percent of total billed charges,,
Hepatitis B Virus Surface Ab,,86706,CPT,Facility,Inpatient,,,,38,32.3,10.8908,38,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Hepatitis B Virus Surface Ab,,86706,CPT,Facility,Outpatient,,,,38,32.3,10.8908,38,Medica,Medical Assistance,16.948,44.6,,percent of total billed charges,,
Hepatitis B Virus Surface Ab,,86706,CPT,Facility,Inpatient,,,,38,32.3,10.8908,38,Medica,Medical Assistance,,,,,Included in per diem rate,
Hepatitis B Virus Surface Ab,,86706,CPT,Facility,Outpatient,,,,38,32.3,10.8908,38,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,18.924,49.8,,percent of total billed charges,,
Hepatitis B Virus Surface Ab,,86706,CPT,Facility,Inpatient,,,,38,32.3,10.8908,38,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Hepatitis B Virus Surface Ab,,86706,CPT,Facility,Both,,,,38,32.3,10.8908,38,"Multiplan, Inc.","Multiplan, Inc.",35.72,94,,percent of total billed charges,,
Hepatitis B Virus Surface Ab,,86706,CPT,Facility,Outpatient,,,,38,32.3,10.8908,38,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,32.832,86.4,,percent of total billed charges,,
Hepatitis B Virus Surface Ab,,86706,CPT,Facility,Inpatient,,,,38,32.3,10.8908,38,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Hepatitis B Virus Surface Ab,,86706,CPT,Facility,Both,,,,38,32.3,10.8908,38,"Preferred One Administrative Services, INC.",PPO,37.468,98.6,,percent of total billed charges,,
Hepatitis B Virus Surface Ab,,86706,CPT,Facility,Outpatient,,,,38,32.3,10.8908,38,PrimeWest Health,Minnesota Senior Health Options (MSHO),19.551,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Hepatitis B Virus Surface Ab,,86706,CPT,Facility,Inpatient,,,,38,32.3,10.8908,38,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Hepatitis B Virus Surface Ab,,86706,CPT,Facility,Outpatient,,,,38,32.3,10.8908,38,PrimeWest Health,MinnesotaCare,19.5168,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Hepatitis B Virus Surface Ab,,86706,CPT,Facility,Inpatient,,,,38,32.3,10.8908,38,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Hepatitis B Virus Surface Ab,,86706,CPT,Facility,Both,,,,38,32.3,10.8908,38,Sanford Health Plan,Sanford Health Plan,34.96,92,,percent of total billed charges,,
Hepatitis B Virus Surface Ab,,86706,CPT,Facility,Outpatient,,,,38,32.3,10.8908,38,"UCare Health, Inc.",Individual & Family Plan,21.413,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Hepatitis B Virus Surface Ab,,86706,CPT,Facility,Inpatient,,,,38,32.3,10.8908,38,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Hepatitis B Virus Surface Ab,,86706,CPT,Facility,Outpatient,,,,38,32.3,10.8908,38,"UCare Health, Inc.",Medical Assistance,19.1786,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Hepatitis B Virus Surface Ab,,86706,CPT,Facility,Inpatient,,,,38,32.3,10.8908,38,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Hepatitis B Virus Surface Ab,,86706,CPT,Facility,Outpatient,,,,38,32.3,10.8908,38,"UCare Health, Inc.",Medicare Advantage,19.1786,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Hepatitis B Virus Surface Ab,,86706,CPT,Facility,Inpatient,,,,38,32.3,10.8908,38,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Hepatitis B Virus Surface Ab,,86706,CPT,Facility,Outpatient,,,,38,32.3,10.8908,38,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),19.1786,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Hepatitis B Virus Surface Ab,,86706,CPT,Facility,Inpatient,,,,38,32.3,10.8908,38,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Hepatitis B Virus Surface Ab,,86706,CPT,Facility,Both,,,,38,32.3,10.8908,38,UnitedHealthcare,Individual & Family,35.72,94,,percent of total billed charges,,
Hepatitis B Virus Surface Ab,,86706,CPT,Facility,Outpatient,,,,38,32.3,10.8908,38,UnitedHealthcare,Medicare Advantage,18.62,49,,percent of total billed charges,,
Hepatitis B Virus Surface Ab,,86706,CPT,Facility,Inpatient,,,,38,32.3,10.8908,38,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Hepatitis B Virus Surface Ab,,86706,CPT,Facility,Outpatient,,,,38,32.3,10.8908,38,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,18.24,48,,percent of total billed charges,,100% of DHS outpatient percentage
Hepatitis B Virus Surface Ab,,86706,CPT,Facility,Inpatient,,,,38,32.3,10.8908,38,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Hepatitis A Virus Igm Ab,,86709,CPT,Facility,Both,,,,135,114.75,38.691,135,Aetna,Commercial,124.2,92,,percent of total billed charges,,
Hepatitis A Virus Igm Ab,,86709,CPT,Facility,Outpatient,,,,135,114.75,38.691,135,Aetna,Medicare Advantage,66.15,49,,percent of total billed charges,,
Hepatitis A Virus Igm Ab,,86709,CPT,Facility,Inpatient,,,,135,114.75,38.691,135,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Hepatitis A Virus Igm Ab,,86709,CPT,Facility,Both,,,,135,114.75,38.691,135,Aetna,PPO,125.55,93,,percent of total billed charges,,
Hepatitis A Virus Igm Ab,,86709,CPT,Facility,Both,,,,135,114.75,38.691,135,America's PPO,America's PPO,129.6405,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Hepatitis A Virus Igm Ab,,86709,CPT,Facility,Both,,,,135,114.75,38.691,135,BlueCross BlueShield Minnesota, Federal Employee Program,132.84,98.4,,percent of total billed charges,,
Hepatitis A Virus Igm Ab,,86709,CPT,Facility,Both,,,,135,114.75,38.691,135,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,135,100,,percent of total billed charges,,
Hepatitis A Virus Igm Ab,,86709,CPT,Facility,Both,,,,135,114.75,38.691,135,BlueCross BlueShield Minnesota,High Value Network Plan,121.5,90,,percent of total billed charges,,
Hepatitis A Virus Igm Ab,,86709,CPT,Facility,Outpatient,,,,135,114.75,38.691,135,BlueCross BlueShield Minnesota,Medicare Advantage,66.15,49,,percent of total billed charges,,
Hepatitis A Virus Igm Ab,,86709,CPT,Facility,Inpatient,,,,135,114.75,38.691,135,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Hepatitis A Virus Igm Ab,,86709,CPT,Facility,Both,,,,135,114.75,38.691,135,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,119.5695,88.57,,percent of total billed charges,,
Hepatitis A Virus Igm Ab,,86709,CPT,Facility,Both,,,,135,114.75,38.691,135,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,38.691,28.66,,percent of total billed charges,,
Hepatitis A Virus Igm Ab,,86709,CPT,Facility,Outpatient,,,,135,114.75,38.691,135,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),66.15,49,,percent of total billed charges,,
Hepatitis A Virus Igm Ab,,86709,CPT,Facility,Inpatient,,,,135,114.75,38.691,135,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Hepatitis A Virus Igm Ab,,86709,CPT,Facility,Both,,,,135,114.75,38.691,135,CorVel,Worker's Compensation,135,100,,percent of total billed charges,,
Hepatitis A Virus Igm Ab,,86709,CPT,Facility,Both,,,,135,114.75,38.691,135,First Health Group Corporation,First Health Network,130.95,97,,percent of total billed charges,,
Hepatitis A Virus Igm Ab,,86709,CPT,Facility,Both,,,,135,114.75,38.691,135,"Health Partners, Inc.",Commercial,127.71,94.6,,percent of total billed charges,,
Hepatitis A Virus Igm Ab,,86709,CPT,Facility,Outpatient,,,,135,114.75,38.691,135,"Health Partners, Inc.",Medicare Advantage,66.15,49,,percent of total billed charges,,
Hepatitis A Virus Igm Ab,,86709,CPT,Facility,Inpatient,,,,135,114.75,38.691,135,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Hepatitis A Virus Igm Ab,,86709,CPT,Facility,Both,,,,135,114.75,38.691,135,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),81,60,,percent of total billed charges,,
Hepatitis A Virus Igm Ab,,86709,CPT,Facility,Both,,,,135,114.75,38.691,135,"Health Partners, Inc.",State of Minnesota Advantage Program,110.025,81.5,,percent of total billed charges,,
Hepatitis A Virus Igm Ab,,86709,CPT,Facility,Both,,,,135,114.75,38.691,135,"Health Partners, Inc.",State Public Programs,67.5,50,,percent of total billed charges,,
Hepatitis A Virus Igm Ab,,86709,CPT,Facility,Both,,,,135,114.75,38.691,135,Humana Insurance Company,Commercial PPO,128.25,95,,percent of total billed charges,,
Hepatitis A Virus Igm Ab,,86709,CPT,Facility,Outpatient,,,,135,114.75,38.691,135,Humana Insurance Company,Medicare PPO,66.15,49,,percent of total billed charges,,
Hepatitis A Virus Igm Ab,,86709,CPT,Facility,Inpatient,,,,135,114.75,38.691,135,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Hepatitis A Virus Igm Ab,,86709,CPT,Facility,Both,,,,135,114.75,38.691,135,Medica,Individual & Family,133.785,99.1,,percent of total billed charges,,
Hepatitis A Virus Igm Ab,,86709,CPT,Facility,Outpatient,,,,135,114.75,38.691,135,Medica,Medica Advantage Solution,67.23,49.8,,percent of total billed charges,,
Hepatitis A Virus Igm Ab,,86709,CPT,Facility,Inpatient,,,,135,114.75,38.691,135,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Hepatitis A Virus Igm Ab,,86709,CPT,Facility,Outpatient,,,,135,114.75,38.691,135,Medica,Medical Assistance,60.21,44.6,,percent of total billed charges,,
Hepatitis A Virus Igm Ab,,86709,CPT,Facility,Inpatient,,,,135,114.75,38.691,135,Medica,Medical Assistance,,,,,Included in per diem rate,
Hepatitis A Virus Igm Ab,,86709,CPT,Facility,Outpatient,,,,135,114.75,38.691,135,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,67.23,49.8,,percent of total billed charges,,
Hepatitis A Virus Igm Ab,,86709,CPT,Facility,Inpatient,,,,135,114.75,38.691,135,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Hepatitis A Virus Igm Ab,,86709,CPT,Facility,Both,,,,135,114.75,38.691,135,"Multiplan, Inc.","Multiplan, Inc.",126.9,94,,percent of total billed charges,,
Hepatitis A Virus Igm Ab,,86709,CPT,Facility,Outpatient,,,,135,114.75,38.691,135,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,116.64,86.4,,percent of total billed charges,,
Hepatitis A Virus Igm Ab,,86709,CPT,Facility,Inpatient,,,,135,114.75,38.691,135,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Hepatitis A Virus Igm Ab,,86709,CPT,Facility,Both,,,,135,114.75,38.691,135,"Preferred One Administrative Services, INC.",PPO,133.11,98.6,,percent of total billed charges,,
Hepatitis A Virus Igm Ab,,86709,CPT,Facility,Outpatient,,,,135,114.75,38.691,135,PrimeWest Health,Minnesota Senior Health Options (MSHO),69.4575,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Hepatitis A Virus Igm Ab,,86709,CPT,Facility,Inpatient,,,,135,114.75,38.691,135,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Hepatitis A Virus Igm Ab,,86709,CPT,Facility,Outpatient,,,,135,114.75,38.691,135,PrimeWest Health,MinnesotaCare,69.336,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Hepatitis A Virus Igm Ab,,86709,CPT,Facility,Inpatient,,,,135,114.75,38.691,135,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Hepatitis A Virus Igm Ab,,86709,CPT,Facility,Both,,,,135,114.75,38.691,135,Sanford Health Plan,Sanford Health Plan,124.2,92,,percent of total billed charges,,
Hepatitis A Virus Igm Ab,,86709,CPT,Facility,Outpatient,,,,135,114.75,38.691,135,"UCare Health, Inc.",Individual & Family Plan,76.0725,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Hepatitis A Virus Igm Ab,,86709,CPT,Facility,Inpatient,,,,135,114.75,38.691,135,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Hepatitis A Virus Igm Ab,,86709,CPT,Facility,Outpatient,,,,135,114.75,38.691,135,"UCare Health, Inc.",Medical Assistance,68.1345,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Hepatitis A Virus Igm Ab,,86709,CPT,Facility,Inpatient,,,,135,114.75,38.691,135,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Hepatitis A Virus Igm Ab,,86709,CPT,Facility,Outpatient,,,,135,114.75,38.691,135,"UCare Health, Inc.",Medicare Advantage,68.1345,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Hepatitis A Virus Igm Ab,,86709,CPT,Facility,Inpatient,,,,135,114.75,38.691,135,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Hepatitis A Virus Igm Ab,,86709,CPT,Facility,Outpatient,,,,135,114.75,38.691,135,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),68.1345,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Hepatitis A Virus Igm Ab,,86709,CPT,Facility,Inpatient,,,,135,114.75,38.691,135,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Hepatitis A Virus Igm Ab,,86709,CPT,Facility,Both,,,,135,114.75,38.691,135,UnitedHealthcare,Individual & Family,126.9,94,,percent of total billed charges,,
Hepatitis A Virus Igm Ab,,86709,CPT,Facility,Outpatient,,,,135,114.75,38.691,135,UnitedHealthcare,Medicare Advantage,66.15,49,,percent of total billed charges,,
Hepatitis A Virus Igm Ab,,86709,CPT,Facility,Inpatient,,,,135,114.75,38.691,135,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Hepatitis A Virus Igm Ab,,86709,CPT,Facility,Outpatient,,,,135,114.75,38.691,135,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,64.8,48,,percent of total billed charges,,100% of DHS outpatient percentage
Hepatitis A Virus Igm Ab,,86709,CPT,Facility,Inpatient,,,,135,114.75,38.691,135,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Mumps Virus Igg Ab,,86735,CPT,Facility,Both,,,,69,58.65,19.7754,69,Aetna,Commercial,63.48,92,,percent of total billed charges,,
Mumps Virus Igg Ab,,86735,CPT,Facility,Outpatient,,,,69,58.65,19.7754,69,Aetna,Medicare Advantage,33.81,49,,percent of total billed charges,,
Mumps Virus Igg Ab,,86735,CPT,Facility,Inpatient,,,,69,58.65,19.7754,69,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Mumps Virus Igg Ab,,86735,CPT,Facility,Both,,,,69,58.65,19.7754,69,Aetna,PPO,64.17,93,,percent of total billed charges,,
Mumps Virus Igg Ab,,86735,CPT,Facility,Both,,,,69,58.65,19.7754,69,America's PPO,America's PPO,66.2607,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Mumps Virus Igg Ab,,86735,CPT,Facility,Both,,,,69,58.65,19.7754,69,BlueCross BlueShield Minnesota, Federal Employee Program,67.896,98.4,,percent of total billed charges,,
Mumps Virus Igg Ab,,86735,CPT,Facility,Both,,,,69,58.65,19.7754,69,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,69,100,,percent of total billed charges,,
Mumps Virus Igg Ab,,86735,CPT,Facility,Both,,,,69,58.65,19.7754,69,BlueCross BlueShield Minnesota,High Value Network Plan,62.1,90,,percent of total billed charges,,
Mumps Virus Igg Ab,,86735,CPT,Facility,Outpatient,,,,69,58.65,19.7754,69,BlueCross BlueShield Minnesota,Medicare Advantage,33.81,49,,percent of total billed charges,,
Mumps Virus Igg Ab,,86735,CPT,Facility,Inpatient,,,,69,58.65,19.7754,69,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Mumps Virus Igg Ab,,86735,CPT,Facility,Both,,,,69,58.65,19.7754,69,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,61.1133,88.57,,percent of total billed charges,,
Mumps Virus Igg Ab,,86735,CPT,Facility,Both,,,,69,58.65,19.7754,69,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,19.7754,28.66,,percent of total billed charges,,
Mumps Virus Igg Ab,,86735,CPT,Facility,Outpatient,,,,69,58.65,19.7754,69,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),33.81,49,,percent of total billed charges,,
Mumps Virus Igg Ab,,86735,CPT,Facility,Inpatient,,,,69,58.65,19.7754,69,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Mumps Virus Igg Ab,,86735,CPT,Facility,Both,,,,69,58.65,19.7754,69,CorVel,Worker's Compensation,69,100,,percent of total billed charges,,
Mumps Virus Igg Ab,,86735,CPT,Facility,Both,,,,69,58.65,19.7754,69,First Health Group Corporation,First Health Network,66.93,97,,percent of total billed charges,,
Mumps Virus Igg Ab,,86735,CPT,Facility,Both,,,,69,58.65,19.7754,69,"Health Partners, Inc.",Commercial,65.274,94.6,,percent of total billed charges,,
Mumps Virus Igg Ab,,86735,CPT,Facility,Outpatient,,,,69,58.65,19.7754,69,"Health Partners, Inc.",Medicare Advantage,33.81,49,,percent of total billed charges,,
Mumps Virus Igg Ab,,86735,CPT,Facility,Inpatient,,,,69,58.65,19.7754,69,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mumps Virus Igg Ab,,86735,CPT,Facility,Both,,,,69,58.65,19.7754,69,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),41.4,60,,percent of total billed charges,,
Mumps Virus Igg Ab,,86735,CPT,Facility,Both,,,,69,58.65,19.7754,69,"Health Partners, Inc.",State of Minnesota Advantage Program,56.235,81.5,,percent of total billed charges,,
Mumps Virus Igg Ab,,86735,CPT,Facility,Both,,,,69,58.65,19.7754,69,"Health Partners, Inc.",State Public Programs,34.5,50,,percent of total billed charges,,
Mumps Virus Igg Ab,,86735,CPT,Facility,Both,,,,69,58.65,19.7754,69,Humana Insurance Company,Commercial PPO,65.55,95,,percent of total billed charges,,
Mumps Virus Igg Ab,,86735,CPT,Facility,Outpatient,,,,69,58.65,19.7754,69,Humana Insurance Company,Medicare PPO,33.81,49,,percent of total billed charges,,
Mumps Virus Igg Ab,,86735,CPT,Facility,Inpatient,,,,69,58.65,19.7754,69,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Mumps Virus Igg Ab,,86735,CPT,Facility,Both,,,,69,58.65,19.7754,69,Medica,Individual & Family,68.379,99.1,,percent of total billed charges,,
Mumps Virus Igg Ab,,86735,CPT,Facility,Outpatient,,,,69,58.65,19.7754,69,Medica,Medica Advantage Solution,34.362,49.8,,percent of total billed charges,,
Mumps Virus Igg Ab,,86735,CPT,Facility,Inpatient,,,,69,58.65,19.7754,69,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Mumps Virus Igg Ab,,86735,CPT,Facility,Outpatient,,,,69,58.65,19.7754,69,Medica,Medical Assistance,30.774,44.6,,percent of total billed charges,,
Mumps Virus Igg Ab,,86735,CPT,Facility,Inpatient,,,,69,58.65,19.7754,69,Medica,Medical Assistance,,,,,Included in per diem rate,
Mumps Virus Igg Ab,,86735,CPT,Facility,Outpatient,,,,69,58.65,19.7754,69,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,34.362,49.8,,percent of total billed charges,,
Mumps Virus Igg Ab,,86735,CPT,Facility,Inpatient,,,,69,58.65,19.7754,69,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Mumps Virus Igg Ab,,86735,CPT,Facility,Both,,,,69,58.65,19.7754,69,"Multiplan, Inc.","Multiplan, Inc.",64.86,94,,percent of total billed charges,,
Mumps Virus Igg Ab,,86735,CPT,Facility,Outpatient,,,,69,58.65,19.7754,69,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,59.616,86.4,,percent of total billed charges,,
Mumps Virus Igg Ab,,86735,CPT,Facility,Inpatient,,,,69,58.65,19.7754,69,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Mumps Virus Igg Ab,,86735,CPT,Facility,Both,,,,69,58.65,19.7754,69,"Preferred One Administrative Services, INC.",PPO,68.034,98.6,,percent of total billed charges,,
Mumps Virus Igg Ab,,86735,CPT,Facility,Outpatient,,,,69,58.65,19.7754,69,PrimeWest Health,Minnesota Senior Health Options (MSHO),35.5005,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Mumps Virus Igg Ab,,86735,CPT,Facility,Inpatient,,,,69,58.65,19.7754,69,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mumps Virus Igg Ab,,86735,CPT,Facility,Outpatient,,,,69,58.65,19.7754,69,PrimeWest Health,MinnesotaCare,35.4384,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Mumps Virus Igg Ab,,86735,CPT,Facility,Inpatient,,,,69,58.65,19.7754,69,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Mumps Virus Igg Ab,,86735,CPT,Facility,Both,,,,69,58.65,19.7754,69,Sanford Health Plan,Sanford Health Plan,63.48,92,,percent of total billed charges,,
Mumps Virus Igg Ab,,86735,CPT,Facility,Outpatient,,,,69,58.65,19.7754,69,"UCare Health, Inc.",Individual & Family Plan,38.8815,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Mumps Virus Igg Ab,,86735,CPT,Facility,Inpatient,,,,69,58.65,19.7754,69,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Mumps Virus Igg Ab,,86735,CPT,Facility,Outpatient,,,,69,58.65,19.7754,69,"UCare Health, Inc.",Medical Assistance,34.8243,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mumps Virus Igg Ab,,86735,CPT,Facility,Inpatient,,,,69,58.65,19.7754,69,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Mumps Virus Igg Ab,,86735,CPT,Facility,Outpatient,,,,69,58.65,19.7754,69,"UCare Health, Inc.",Medicare Advantage,34.8243,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mumps Virus Igg Ab,,86735,CPT,Facility,Inpatient,,,,69,58.65,19.7754,69,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mumps Virus Igg Ab,,86735,CPT,Facility,Outpatient,,,,69,58.65,19.7754,69,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),34.8243,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mumps Virus Igg Ab,,86735,CPT,Facility,Inpatient,,,,69,58.65,19.7754,69,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mumps Virus Igg Ab,,86735,CPT,Facility,Both,,,,69,58.65,19.7754,69,UnitedHealthcare,Individual & Family,64.86,94,,percent of total billed charges,,
Mumps Virus Igg Ab,,86735,CPT,Facility,Outpatient,,,,69,58.65,19.7754,69,UnitedHealthcare,Medicare Advantage,33.81,49,,percent of total billed charges,,
Mumps Virus Igg Ab,,86735,CPT,Facility,Inpatient,,,,69,58.65,19.7754,69,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Mumps Virus Igg Ab,,86735,CPT,Facility,Outpatient,,,,69,58.65,19.7754,69,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,33.12,48,,percent of total billed charges,,100% of DHS outpatient percentage
Mumps Virus Igg Ab,,86735,CPT,Facility,Inpatient,,,,69,58.65,19.7754,69,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Rubella Ab, Igg",,86762,CPT,Facility,Both,,,,42,35.7,12.0372,42,Aetna,Commercial,38.64,92,,percent of total billed charges,,
"Rubella Ab, Igg",,86762,CPT,Facility,Outpatient,,,,42,35.7,12.0372,42,Aetna,Medicare Advantage,20.58,49,,percent of total billed charges,,
"Rubella Ab, Igg",,86762,CPT,Facility,Inpatient,,,,42,35.7,12.0372,42,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Rubella Ab, Igg",,86762,CPT,Facility,Both,,,,42,35.7,12.0372,42,Aetna,PPO,39.06,93,,percent of total billed charges,,
"Rubella Ab, Igg",,86762,CPT,Facility,Both,,,,42,35.7,12.0372,42,America's PPO,America's PPO,40.3326,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Rubella Ab, Igg",,86762,CPT,Facility,Both,,,,42,35.7,12.0372,42,BlueCross BlueShield Minnesota, Federal Employee Program,41.328,98.4,,percent of total billed charges,,
"Rubella Ab, Igg",,86762,CPT,Facility,Both,,,,42,35.7,12.0372,42,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,42,100,,percent of total billed charges,,
"Rubella Ab, Igg",,86762,CPT,Facility,Both,,,,42,35.7,12.0372,42,BlueCross BlueShield Minnesota,High Value Network Plan,37.8,90,,percent of total billed charges,,
"Rubella Ab, Igg",,86762,CPT,Facility,Outpatient,,,,42,35.7,12.0372,42,BlueCross BlueShield Minnesota,Medicare Advantage,20.58,49,,percent of total billed charges,,
"Rubella Ab, Igg",,86762,CPT,Facility,Inpatient,,,,42,35.7,12.0372,42,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Rubella Ab, Igg",,86762,CPT,Facility,Both,,,,42,35.7,12.0372,42,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,37.1994,88.57,,percent of total billed charges,,
"Rubella Ab, Igg",,86762,CPT,Facility,Both,,,,42,35.7,12.0372,42,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,12.0372,28.66,,percent of total billed charges,,
"Rubella Ab, Igg",,86762,CPT,Facility,Outpatient,,,,42,35.7,12.0372,42,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),20.58,49,,percent of total billed charges,,
"Rubella Ab, Igg",,86762,CPT,Facility,Inpatient,,,,42,35.7,12.0372,42,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Rubella Ab, Igg",,86762,CPT,Facility,Both,,,,42,35.7,12.0372,42,CorVel,Worker's Compensation,42,100,,percent of total billed charges,,
"Rubella Ab, Igg",,86762,CPT,Facility,Both,,,,42,35.7,12.0372,42,First Health Group Corporation,First Health Network,40.74,97,,percent of total billed charges,,
"Rubella Ab, Igg",,86762,CPT,Facility,Both,,,,42,35.7,12.0372,42,"Health Partners, Inc.",Commercial,39.732,94.6,,percent of total billed charges,,
"Rubella Ab, Igg",,86762,CPT,Facility,Outpatient,,,,42,35.7,12.0372,42,"Health Partners, Inc.",Medicare Advantage,20.58,49,,percent of total billed charges,,
"Rubella Ab, Igg",,86762,CPT,Facility,Inpatient,,,,42,35.7,12.0372,42,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Rubella Ab, Igg",,86762,CPT,Facility,Both,,,,42,35.7,12.0372,42,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),25.2,60,,percent of total billed charges,,
"Rubella Ab, Igg",,86762,CPT,Facility,Both,,,,42,35.7,12.0372,42,"Health Partners, Inc.",State of Minnesota Advantage Program,34.23,81.5,,percent of total billed charges,,
"Rubella Ab, Igg",,86762,CPT,Facility,Both,,,,42,35.7,12.0372,42,"Health Partners, Inc.",State Public Programs,21,50,,percent of total billed charges,,
"Rubella Ab, Igg",,86762,CPT,Facility,Both,,,,42,35.7,12.0372,42,Humana Insurance Company,Commercial PPO,39.9,95,,percent of total billed charges,,
"Rubella Ab, Igg",,86762,CPT,Facility,Outpatient,,,,42,35.7,12.0372,42,Humana Insurance Company,Medicare PPO,20.58,49,,percent of total billed charges,,
"Rubella Ab, Igg",,86762,CPT,Facility,Inpatient,,,,42,35.7,12.0372,42,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Rubella Ab, Igg",,86762,CPT,Facility,Both,,,,42,35.7,12.0372,42,Medica,Individual & Family,41.622,99.1,,percent of total billed charges,,
"Rubella Ab, Igg",,86762,CPT,Facility,Outpatient,,,,42,35.7,12.0372,42,Medica,Medica Advantage Solution,20.916,49.8,,percent of total billed charges,,
"Rubella Ab, Igg",,86762,CPT,Facility,Inpatient,,,,42,35.7,12.0372,42,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Rubella Ab, Igg",,86762,CPT,Facility,Outpatient,,,,42,35.7,12.0372,42,Medica,Medical Assistance,18.732,44.6,,percent of total billed charges,,
"Rubella Ab, Igg",,86762,CPT,Facility,Inpatient,,,,42,35.7,12.0372,42,Medica,Medical Assistance,,,,,Included in per diem rate,
"Rubella Ab, Igg",,86762,CPT,Facility,Outpatient,,,,42,35.7,12.0372,42,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,20.916,49.8,,percent of total billed charges,,
"Rubella Ab, Igg",,86762,CPT,Facility,Inpatient,,,,42,35.7,12.0372,42,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Rubella Ab, Igg",,86762,CPT,Facility,Both,,,,42,35.7,12.0372,42,"Multiplan, Inc.","Multiplan, Inc.",39.48,94,,percent of total billed charges,,
"Rubella Ab, Igg",,86762,CPT,Facility,Outpatient,,,,42,35.7,12.0372,42,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,36.288,86.4,,percent of total billed charges,,
"Rubella Ab, Igg",,86762,CPT,Facility,Inpatient,,,,42,35.7,12.0372,42,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Rubella Ab, Igg",,86762,CPT,Facility,Both,,,,42,35.7,12.0372,42,"Preferred One Administrative Services, INC.",PPO,41.412,98.6,,percent of total billed charges,,
"Rubella Ab, Igg",,86762,CPT,Facility,Outpatient,,,,42,35.7,12.0372,42,PrimeWest Health,Minnesota Senior Health Options (MSHO),21.609,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Rubella Ab, Igg",,86762,CPT,Facility,Inpatient,,,,42,35.7,12.0372,42,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Rubella Ab, Igg",,86762,CPT,Facility,Outpatient,,,,42,35.7,12.0372,42,PrimeWest Health,MinnesotaCare,21.5712,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Rubella Ab, Igg",,86762,CPT,Facility,Inpatient,,,,42,35.7,12.0372,42,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Rubella Ab, Igg",,86762,CPT,Facility,Both,,,,42,35.7,12.0372,42,Sanford Health Plan,Sanford Health Plan,38.64,92,,percent of total billed charges,,
"Rubella Ab, Igg",,86762,CPT,Facility,Outpatient,,,,42,35.7,12.0372,42,"UCare Health, Inc.",Individual & Family Plan,23.667,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Rubella Ab, Igg",,86762,CPT,Facility,Inpatient,,,,42,35.7,12.0372,42,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Rubella Ab, Igg",,86762,CPT,Facility,Outpatient,,,,42,35.7,12.0372,42,"UCare Health, Inc.",Medical Assistance,21.1974,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Rubella Ab, Igg",,86762,CPT,Facility,Inpatient,,,,42,35.7,12.0372,42,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Rubella Ab, Igg",,86762,CPT,Facility,Outpatient,,,,42,35.7,12.0372,42,"UCare Health, Inc.",Medicare Advantage,21.1974,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Rubella Ab, Igg",,86762,CPT,Facility,Inpatient,,,,42,35.7,12.0372,42,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Rubella Ab, Igg",,86762,CPT,Facility,Outpatient,,,,42,35.7,12.0372,42,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),21.1974,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Rubella Ab, Igg",,86762,CPT,Facility,Inpatient,,,,42,35.7,12.0372,42,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Rubella Ab, Igg",,86762,CPT,Facility,Both,,,,42,35.7,12.0372,42,UnitedHealthcare,Individual & Family,39.48,94,,percent of total billed charges,,
"Rubella Ab, Igg",,86762,CPT,Facility,Outpatient,,,,42,35.7,12.0372,42,UnitedHealthcare,Medicare Advantage,20.58,49,,percent of total billed charges,,
"Rubella Ab, Igg",,86762,CPT,Facility,Inpatient,,,,42,35.7,12.0372,42,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Rubella Ab, Igg",,86762,CPT,Facility,Outpatient,,,,42,35.7,12.0372,42,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,20.16,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Rubella Ab, Igg",,86762,CPT,Facility,Inpatient,,,,42,35.7,12.0372,42,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Measles Virus Igg Ab,,86765,CPT,Facility,Both,,,,49,41.65,14.0434,49,Aetna,Commercial,45.08,92,,percent of total billed charges,,
Measles Virus Igg Ab,,86765,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,Aetna,Medicare Advantage,24.01,49,,percent of total billed charges,,
Measles Virus Igg Ab,,86765,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Measles Virus Igg Ab,,86765,CPT,Facility,Both,,,,49,41.65,14.0434,49,Aetna,PPO,45.57,93,,percent of total billed charges,,
Measles Virus Igg Ab,,86765,CPT,Facility,Both,,,,49,41.65,14.0434,49,America's PPO,America's PPO,47.0547,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Measles Virus Igg Ab,,86765,CPT,Facility,Both,,,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota, Federal Employee Program,48.216,98.4,,percent of total billed charges,,
Measles Virus Igg Ab,,86765,CPT,Facility,Both,,,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,49,100,,percent of total billed charges,,
Measles Virus Igg Ab,,86765,CPT,Facility,Both,,,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,High Value Network Plan,44.1,90,,percent of total billed charges,,
Measles Virus Igg Ab,,86765,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Medicare Advantage,24.01,49,,percent of total billed charges,,
Measles Virus Igg Ab,,86765,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Measles Virus Igg Ab,,86765,CPT,Facility,Both,,,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,43.3993,88.57,,percent of total billed charges,,
Measles Virus Igg Ab,,86765,CPT,Facility,Both,,,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,14.0434,28.66,,percent of total billed charges,,
Measles Virus Igg Ab,,86765,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),24.01,49,,percent of total billed charges,,
Measles Virus Igg Ab,,86765,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Measles Virus Igg Ab,,86765,CPT,Facility,Both,,,,49,41.65,14.0434,49,CorVel,Worker's Compensation,49,100,,percent of total billed charges,,
Measles Virus Igg Ab,,86765,CPT,Facility,Both,,,,49,41.65,14.0434,49,First Health Group Corporation,First Health Network,47.53,97,,percent of total billed charges,,
Measles Virus Igg Ab,,86765,CPT,Facility,Both,,,,49,41.65,14.0434,49,"Health Partners, Inc.",Commercial,46.354,94.6,,percent of total billed charges,,
Measles Virus Igg Ab,,86765,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,"Health Partners, Inc.",Medicare Advantage,24.01,49,,percent of total billed charges,,
Measles Virus Igg Ab,,86765,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Measles Virus Igg Ab,,86765,CPT,Facility,Both,,,,49,41.65,14.0434,49,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),29.4,60,,percent of total billed charges,,
Measles Virus Igg Ab,,86765,CPT,Facility,Both,,,,49,41.65,14.0434,49,"Health Partners, Inc.",State of Minnesota Advantage Program,39.935,81.5,,percent of total billed charges,,
Measles Virus Igg Ab,,86765,CPT,Facility,Both,,,,49,41.65,14.0434,49,"Health Partners, Inc.",State Public Programs,24.5,50,,percent of total billed charges,,
Measles Virus Igg Ab,,86765,CPT,Facility,Both,,,,49,41.65,14.0434,49,Humana Insurance Company,Commercial PPO,46.55,95,,percent of total billed charges,,
Measles Virus Igg Ab,,86765,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,Humana Insurance Company,Medicare PPO,24.01,49,,percent of total billed charges,,
Measles Virus Igg Ab,,86765,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Measles Virus Igg Ab,,86765,CPT,Facility,Both,,,,49,41.65,14.0434,49,Medica,Individual & Family,48.559,99.1,,percent of total billed charges,,
Measles Virus Igg Ab,,86765,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,Medica,Medica Advantage Solution,24.402,49.8,,percent of total billed charges,,
Measles Virus Igg Ab,,86765,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Measles Virus Igg Ab,,86765,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,Medica,Medical Assistance,21.854,44.6,,percent of total billed charges,,
Measles Virus Igg Ab,,86765,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,Medica,Medical Assistance,,,,,Included in per diem rate,
Measles Virus Igg Ab,,86765,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,24.402,49.8,,percent of total billed charges,,
Measles Virus Igg Ab,,86765,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Measles Virus Igg Ab,,86765,CPT,Facility,Both,,,,49,41.65,14.0434,49,"Multiplan, Inc.","Multiplan, Inc.",46.06,94,,percent of total billed charges,,
Measles Virus Igg Ab,,86765,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,42.336,86.4,,percent of total billed charges,,
Measles Virus Igg Ab,,86765,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Measles Virus Igg Ab,,86765,CPT,Facility,Both,,,,49,41.65,14.0434,49,"Preferred One Administrative Services, INC.",PPO,48.314,98.6,,percent of total billed charges,,
Measles Virus Igg Ab,,86765,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,PrimeWest Health,Minnesota Senior Health Options (MSHO),25.2105,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Measles Virus Igg Ab,,86765,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Measles Virus Igg Ab,,86765,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,PrimeWest Health,MinnesotaCare,25.1664,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Measles Virus Igg Ab,,86765,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Measles Virus Igg Ab,,86765,CPT,Facility,Both,,,,49,41.65,14.0434,49,Sanford Health Plan,Sanford Health Plan,45.08,92,,percent of total billed charges,,
Measles Virus Igg Ab,,86765,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,"UCare Health, Inc.",Individual & Family Plan,27.6115,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Measles Virus Igg Ab,,86765,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Measles Virus Igg Ab,,86765,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,"UCare Health, Inc.",Medical Assistance,24.7303,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Measles Virus Igg Ab,,86765,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Measles Virus Igg Ab,,86765,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,"UCare Health, Inc.",Medicare Advantage,24.7303,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Measles Virus Igg Ab,,86765,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Measles Virus Igg Ab,,86765,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),24.7303,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Measles Virus Igg Ab,,86765,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Measles Virus Igg Ab,,86765,CPT,Facility,Both,,,,49,41.65,14.0434,49,UnitedHealthcare,Individual & Family,46.06,94,,percent of total billed charges,,
Measles Virus Igg Ab,,86765,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,UnitedHealthcare,Medicare Advantage,24.01,49,,percent of total billed charges,,
Measles Virus Igg Ab,,86765,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Measles Virus Igg Ab,,86765,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,23.52,48,,percent of total billed charges,,100% of DHS outpatient percentage
Measles Virus Igg Ab,,86765,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Syphilis Screen, Treponema Ab, Igg, Igm",,86780,CPT,Facility,Both,,,,51,43.35,14.6166,51,Aetna,Commercial,46.92,92,,percent of total billed charges,,
"Syphilis Screen, Treponema Ab, Igg, Igm",,86780,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,Aetna,Medicare Advantage,24.99,49,,percent of total billed charges,,
"Syphilis Screen, Treponema Ab, Igg, Igm",,86780,CPT,Facility,Inpatient,,,,51,43.35,14.6166,51,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Syphilis Screen, Treponema Ab, Igg, Igm",,86780,CPT,Facility,Both,,,,51,43.35,14.6166,51,Aetna,PPO,47.43,93,,percent of total billed charges,,
"Syphilis Screen, Treponema Ab, Igg, Igm",,86780,CPT,Facility,Both,,,,51,43.35,14.6166,51,America's PPO,America's PPO,48.9753,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Syphilis Screen, Treponema Ab, Igg, Igm",,86780,CPT,Facility,Both,,,,51,43.35,14.6166,51,BlueCross BlueShield Minnesota, Federal Employee Program,50.184,98.4,,percent of total billed charges,,
"Syphilis Screen, Treponema Ab, Igg, Igm",,86780,CPT,Facility,Both,,,,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,51,100,,percent of total billed charges,,
"Syphilis Screen, Treponema Ab, Igg, Igm",,86780,CPT,Facility,Both,,,,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,High Value Network Plan,45.9,90,,percent of total billed charges,,
"Syphilis Screen, Treponema Ab, Igg, Igm",,86780,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,Medicare Advantage,24.99,49,,percent of total billed charges,,
"Syphilis Screen, Treponema Ab, Igg, Igm",,86780,CPT,Facility,Inpatient,,,,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Syphilis Screen, Treponema Ab, Igg, Igm",,86780,CPT,Facility,Both,,,,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,45.1707,88.57,,percent of total billed charges,,
"Syphilis Screen, Treponema Ab, Igg, Igm",,86780,CPT,Facility,Both,,,,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,14.6166,28.66,,percent of total billed charges,,
"Syphilis Screen, Treponema Ab, Igg, Igm",,86780,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),24.99,49,,percent of total billed charges,,
"Syphilis Screen, Treponema Ab, Igg, Igm",,86780,CPT,Facility,Inpatient,,,,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Syphilis Screen, Treponema Ab, Igg, Igm",,86780,CPT,Facility,Both,,,,51,43.35,14.6166,51,CorVel,Worker's Compensation,51,100,,percent of total billed charges,,
"Syphilis Screen, Treponema Ab, Igg, Igm",,86780,CPT,Facility,Both,,,,51,43.35,14.6166,51,First Health Group Corporation,First Health Network,49.47,97,,percent of total billed charges,,
"Syphilis Screen, Treponema Ab, Igg, Igm",,86780,CPT,Facility,Both,,,,51,43.35,14.6166,51,"Health Partners, Inc.",Commercial,48.246,94.6,,percent of total billed charges,,
"Syphilis Screen, Treponema Ab, Igg, Igm",,86780,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,"Health Partners, Inc.",Medicare Advantage,24.99,49,,percent of total billed charges,,
"Syphilis Screen, Treponema Ab, Igg, Igm",,86780,CPT,Facility,Inpatient,,,,51,43.35,14.6166,51,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Syphilis Screen, Treponema Ab, Igg, Igm",,86780,CPT,Facility,Both,,,,51,43.35,14.6166,51,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),30.6,60,,percent of total billed charges,,
"Syphilis Screen, Treponema Ab, Igg, Igm",,86780,CPT,Facility,Both,,,,51,43.35,14.6166,51,"Health Partners, Inc.",State of Minnesota Advantage Program,41.565,81.5,,percent of total billed charges,,
"Syphilis Screen, Treponema Ab, Igg, Igm",,86780,CPT,Facility,Both,,,,51,43.35,14.6166,51,"Health Partners, Inc.",State Public Programs,25.5,50,,percent of total billed charges,,
"Syphilis Screen, Treponema Ab, Igg, Igm",,86780,CPT,Facility,Both,,,,51,43.35,14.6166,51,Humana Insurance Company,Commercial PPO,48.45,95,,percent of total billed charges,,
"Syphilis Screen, Treponema Ab, Igg, Igm",,86780,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,Humana Insurance Company,Medicare PPO,24.99,49,,percent of total billed charges,,
"Syphilis Screen, Treponema Ab, Igg, Igm",,86780,CPT,Facility,Inpatient,,,,51,43.35,14.6166,51,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Syphilis Screen, Treponema Ab, Igg, Igm",,86780,CPT,Facility,Both,,,,51,43.35,14.6166,51,Medica,Individual & Family,50.541,99.1,,percent of total billed charges,,
"Syphilis Screen, Treponema Ab, Igg, Igm",,86780,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,Medica,Medica Advantage Solution,25.398,49.8,,percent of total billed charges,,
"Syphilis Screen, Treponema Ab, Igg, Igm",,86780,CPT,Facility,Inpatient,,,,51,43.35,14.6166,51,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Syphilis Screen, Treponema Ab, Igg, Igm",,86780,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,Medica,Medical Assistance,22.746,44.6,,percent of total billed charges,,
"Syphilis Screen, Treponema Ab, Igg, Igm",,86780,CPT,Facility,Inpatient,,,,51,43.35,14.6166,51,Medica,Medical Assistance,,,,,Included in per diem rate,
"Syphilis Screen, Treponema Ab, Igg, Igm",,86780,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,25.398,49.8,,percent of total billed charges,,
"Syphilis Screen, Treponema Ab, Igg, Igm",,86780,CPT,Facility,Inpatient,,,,51,43.35,14.6166,51,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Syphilis Screen, Treponema Ab, Igg, Igm",,86780,CPT,Facility,Both,,,,51,43.35,14.6166,51,"Multiplan, Inc.","Multiplan, Inc.",47.94,94,,percent of total billed charges,,
"Syphilis Screen, Treponema Ab, Igg, Igm",,86780,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,44.064,86.4,,percent of total billed charges,,
"Syphilis Screen, Treponema Ab, Igg, Igm",,86780,CPT,Facility,Inpatient,,,,51,43.35,14.6166,51,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Syphilis Screen, Treponema Ab, Igg, Igm",,86780,CPT,Facility,Both,,,,51,43.35,14.6166,51,"Preferred One Administrative Services, INC.",PPO,50.286,98.6,,percent of total billed charges,,
"Syphilis Screen, Treponema Ab, Igg, Igm",,86780,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,PrimeWest Health,Minnesota Senior Health Options (MSHO),26.2395,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Syphilis Screen, Treponema Ab, Igg, Igm",,86780,CPT,Facility,Inpatient,,,,51,43.35,14.6166,51,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Syphilis Screen, Treponema Ab, Igg, Igm",,86780,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,PrimeWest Health,MinnesotaCare,26.1936,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Syphilis Screen, Treponema Ab, Igg, Igm",,86780,CPT,Facility,Inpatient,,,,51,43.35,14.6166,51,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Syphilis Screen, Treponema Ab, Igg, Igm",,86780,CPT,Facility,Both,,,,51,43.35,14.6166,51,Sanford Health Plan,Sanford Health Plan,46.92,92,,percent of total billed charges,,
"Syphilis Screen, Treponema Ab, Igg, Igm",,86780,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,"UCare Health, Inc.",Individual & Family Plan,28.7385,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Syphilis Screen, Treponema Ab, Igg, Igm",,86780,CPT,Facility,Inpatient,,,,51,43.35,14.6166,51,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Syphilis Screen, Treponema Ab, Igg, Igm",,86780,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,"UCare Health, Inc.",Medical Assistance,25.7397,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Syphilis Screen, Treponema Ab, Igg, Igm",,86780,CPT,Facility,Inpatient,,,,51,43.35,14.6166,51,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Syphilis Screen, Treponema Ab, Igg, Igm",,86780,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,"UCare Health, Inc.",Medicare Advantage,25.7397,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Syphilis Screen, Treponema Ab, Igg, Igm",,86780,CPT,Facility,Inpatient,,,,51,43.35,14.6166,51,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Syphilis Screen, Treponema Ab, Igg, Igm",,86780,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),25.7397,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Syphilis Screen, Treponema Ab, Igg, Igm",,86780,CPT,Facility,Inpatient,,,,51,43.35,14.6166,51,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Syphilis Screen, Treponema Ab, Igg, Igm",,86780,CPT,Facility,Both,,,,51,43.35,14.6166,51,UnitedHealthcare,Individual & Family,47.94,94,,percent of total billed charges,,
"Syphilis Screen, Treponema Ab, Igg, Igm",,86780,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,UnitedHealthcare,Medicare Advantage,24.99,49,,percent of total billed charges,,
"Syphilis Screen, Treponema Ab, Igg, Igm",,86780,CPT,Facility,Inpatient,,,,51,43.35,14.6166,51,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Syphilis Screen, Treponema Ab, Igg, Igm",,86780,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,24.48,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Syphilis Screen, Treponema Ab, Igg, Igm",,86780,CPT,Facility,Inpatient,,,,51,43.35,14.6166,51,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Varicella Aby Igg,,86787,CPT,Facility,Both,,,,114,96.9,32.6724,114,Aetna,Commercial,104.88,92,,percent of total billed charges,,
Varicella Aby Igg,,86787,CPT,Facility,Outpatient,,,,114,96.9,32.6724,114,Aetna,Medicare Advantage,55.86,49,,percent of total billed charges,,
Varicella Aby Igg,,86787,CPT,Facility,Inpatient,,,,114,96.9,32.6724,114,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Varicella Aby Igg,,86787,CPT,Facility,Both,,,,114,96.9,32.6724,114,Aetna,PPO,106.02,93,,percent of total billed charges,,
Varicella Aby Igg,,86787,CPT,Facility,Both,,,,114,96.9,32.6724,114,America's PPO,America's PPO,109.4742,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Varicella Aby Igg,,86787,CPT,Facility,Both,,,,114,96.9,32.6724,114,BlueCross BlueShield Minnesota, Federal Employee Program,112.176,98.4,,percent of total billed charges,,
Varicella Aby Igg,,86787,CPT,Facility,Both,,,,114,96.9,32.6724,114,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,114,100,,percent of total billed charges,,
Varicella Aby Igg,,86787,CPT,Facility,Both,,,,114,96.9,32.6724,114,BlueCross BlueShield Minnesota,High Value Network Plan,102.6,90,,percent of total billed charges,,
Varicella Aby Igg,,86787,CPT,Facility,Outpatient,,,,114,96.9,32.6724,114,BlueCross BlueShield Minnesota,Medicare Advantage,55.86,49,,percent of total billed charges,,
Varicella Aby Igg,,86787,CPT,Facility,Inpatient,,,,114,96.9,32.6724,114,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Varicella Aby Igg,,86787,CPT,Facility,Both,,,,114,96.9,32.6724,114,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,100.9698,88.57,,percent of total billed charges,,
Varicella Aby Igg,,86787,CPT,Facility,Both,,,,114,96.9,32.6724,114,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,32.6724,28.66,,percent of total billed charges,,
Varicella Aby Igg,,86787,CPT,Facility,Outpatient,,,,114,96.9,32.6724,114,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),55.86,49,,percent of total billed charges,,
Varicella Aby Igg,,86787,CPT,Facility,Inpatient,,,,114,96.9,32.6724,114,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Varicella Aby Igg,,86787,CPT,Facility,Both,,,,114,96.9,32.6724,114,CorVel,Worker's Compensation,114,100,,percent of total billed charges,,
Varicella Aby Igg,,86787,CPT,Facility,Both,,,,114,96.9,32.6724,114,First Health Group Corporation,First Health Network,110.58,97,,percent of total billed charges,,
Varicella Aby Igg,,86787,CPT,Facility,Both,,,,114,96.9,32.6724,114,"Health Partners, Inc.",Commercial,107.844,94.6,,percent of total billed charges,,
Varicella Aby Igg,,86787,CPT,Facility,Outpatient,,,,114,96.9,32.6724,114,"Health Partners, Inc.",Medicare Advantage,55.86,49,,percent of total billed charges,,
Varicella Aby Igg,,86787,CPT,Facility,Inpatient,,,,114,96.9,32.6724,114,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Varicella Aby Igg,,86787,CPT,Facility,Both,,,,114,96.9,32.6724,114,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),68.4,60,,percent of total billed charges,,
Varicella Aby Igg,,86787,CPT,Facility,Both,,,,114,96.9,32.6724,114,"Health Partners, Inc.",State of Minnesota Advantage Program,92.91,81.5,,percent of total billed charges,,
Varicella Aby Igg,,86787,CPT,Facility,Both,,,,114,96.9,32.6724,114,"Health Partners, Inc.",State Public Programs,57,50,,percent of total billed charges,,
Varicella Aby Igg,,86787,CPT,Facility,Both,,,,114,96.9,32.6724,114,Humana Insurance Company,Commercial PPO,108.3,95,,percent of total billed charges,,
Varicella Aby Igg,,86787,CPT,Facility,Outpatient,,,,114,96.9,32.6724,114,Humana Insurance Company,Medicare PPO,55.86,49,,percent of total billed charges,,
Varicella Aby Igg,,86787,CPT,Facility,Inpatient,,,,114,96.9,32.6724,114,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Varicella Aby Igg,,86787,CPT,Facility,Both,,,,114,96.9,32.6724,114,Medica,Individual & Family,112.974,99.1,,percent of total billed charges,,
Varicella Aby Igg,,86787,CPT,Facility,Outpatient,,,,114,96.9,32.6724,114,Medica,Medica Advantage Solution,56.772,49.8,,percent of total billed charges,,
Varicella Aby Igg,,86787,CPT,Facility,Inpatient,,,,114,96.9,32.6724,114,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Varicella Aby Igg,,86787,CPT,Facility,Outpatient,,,,114,96.9,32.6724,114,Medica,Medical Assistance,50.844,44.6,,percent of total billed charges,,
Varicella Aby Igg,,86787,CPT,Facility,Inpatient,,,,114,96.9,32.6724,114,Medica,Medical Assistance,,,,,Included in per diem rate,
Varicella Aby Igg,,86787,CPT,Facility,Outpatient,,,,114,96.9,32.6724,114,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,56.772,49.8,,percent of total billed charges,,
Varicella Aby Igg,,86787,CPT,Facility,Inpatient,,,,114,96.9,32.6724,114,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Varicella Aby Igg,,86787,CPT,Facility,Both,,,,114,96.9,32.6724,114,"Multiplan, Inc.","Multiplan, Inc.",107.16,94,,percent of total billed charges,,
Varicella Aby Igg,,86787,CPT,Facility,Outpatient,,,,114,96.9,32.6724,114,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,98.496,86.4,,percent of total billed charges,,
Varicella Aby Igg,,86787,CPT,Facility,Inpatient,,,,114,96.9,32.6724,114,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Varicella Aby Igg,,86787,CPT,Facility,Both,,,,114,96.9,32.6724,114,"Preferred One Administrative Services, INC.",PPO,112.404,98.6,,percent of total billed charges,,
Varicella Aby Igg,,86787,CPT,Facility,Outpatient,,,,114,96.9,32.6724,114,PrimeWest Health,Minnesota Senior Health Options (MSHO),58.653,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Varicella Aby Igg,,86787,CPT,Facility,Inpatient,,,,114,96.9,32.6724,114,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Varicella Aby Igg,,86787,CPT,Facility,Outpatient,,,,114,96.9,32.6724,114,PrimeWest Health,MinnesotaCare,58.5504,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Varicella Aby Igg,,86787,CPT,Facility,Inpatient,,,,114,96.9,32.6724,114,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Varicella Aby Igg,,86787,CPT,Facility,Both,,,,114,96.9,32.6724,114,Sanford Health Plan,Sanford Health Plan,104.88,92,,percent of total billed charges,,
Varicella Aby Igg,,86787,CPT,Facility,Outpatient,,,,114,96.9,32.6724,114,"UCare Health, Inc.",Individual & Family Plan,64.239,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Varicella Aby Igg,,86787,CPT,Facility,Inpatient,,,,114,96.9,32.6724,114,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Varicella Aby Igg,,86787,CPT,Facility,Outpatient,,,,114,96.9,32.6724,114,"UCare Health, Inc.",Medical Assistance,57.5358,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Varicella Aby Igg,,86787,CPT,Facility,Inpatient,,,,114,96.9,32.6724,114,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Varicella Aby Igg,,86787,CPT,Facility,Outpatient,,,,114,96.9,32.6724,114,"UCare Health, Inc.",Medicare Advantage,57.5358,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Varicella Aby Igg,,86787,CPT,Facility,Inpatient,,,,114,96.9,32.6724,114,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Varicella Aby Igg,,86787,CPT,Facility,Outpatient,,,,114,96.9,32.6724,114,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),57.5358,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Varicella Aby Igg,,86787,CPT,Facility,Inpatient,,,,114,96.9,32.6724,114,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Varicella Aby Igg,,86787,CPT,Facility,Both,,,,114,96.9,32.6724,114,UnitedHealthcare,Individual & Family,107.16,94,,percent of total billed charges,,
Varicella Aby Igg,,86787,CPT,Facility,Outpatient,,,,114,96.9,32.6724,114,UnitedHealthcare,Medicare Advantage,55.86,49,,percent of total billed charges,,
Varicella Aby Igg,,86787,CPT,Facility,Inpatient,,,,114,96.9,32.6724,114,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Varicella Aby Igg,,86787,CPT,Facility,Outpatient,,,,114,96.9,32.6724,114,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,54.72,48,,percent of total billed charges,,100% of DHS outpatient percentage
Varicella Aby Igg,,86787,CPT,Facility,Inpatient,,,,114,96.9,32.6724,114,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Hepatitis C Virus Ab,,86803,CPT,Facility,Both,,,,83,70.55,23.7878,83,Aetna,Commercial,76.36,92,,percent of total billed charges,,
Hepatitis C Virus Ab,,86803,CPT,Facility,Outpatient,,,,83,70.55,23.7878,83,Aetna,Medicare Advantage,40.67,49,,percent of total billed charges,,
Hepatitis C Virus Ab,,86803,CPT,Facility,Inpatient,,,,83,70.55,23.7878,83,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Hepatitis C Virus Ab,,86803,CPT,Facility,Both,,,,83,70.55,23.7878,83,Aetna,PPO,77.19,93,,percent of total billed charges,,
Hepatitis C Virus Ab,,86803,CPT,Facility,Both,,,,83,70.55,23.7878,83,America's PPO,America's PPO,79.7049,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Hepatitis C Virus Ab,,86803,CPT,Facility,Both,,,,83,70.55,23.7878,83,BlueCross BlueShield Minnesota, Federal Employee Program,81.672,98.4,,percent of total billed charges,,
Hepatitis C Virus Ab,,86803,CPT,Facility,Both,,,,83,70.55,23.7878,83,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,83,100,,percent of total billed charges,,
Hepatitis C Virus Ab,,86803,CPT,Facility,Both,,,,83,70.55,23.7878,83,BlueCross BlueShield Minnesota,High Value Network Plan,74.7,90,,percent of total billed charges,,
Hepatitis C Virus Ab,,86803,CPT,Facility,Outpatient,,,,83,70.55,23.7878,83,BlueCross BlueShield Minnesota,Medicare Advantage,40.67,49,,percent of total billed charges,,
Hepatitis C Virus Ab,,86803,CPT,Facility,Inpatient,,,,83,70.55,23.7878,83,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Hepatitis C Virus Ab,,86803,CPT,Facility,Both,,,,83,70.55,23.7878,83,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,73.5131,88.57,,percent of total billed charges,,
Hepatitis C Virus Ab,,86803,CPT,Facility,Both,,,,83,70.55,23.7878,83,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,23.7878,28.66,,percent of total billed charges,,
Hepatitis C Virus Ab,,86803,CPT,Facility,Outpatient,,,,83,70.55,23.7878,83,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),40.67,49,,percent of total billed charges,,
Hepatitis C Virus Ab,,86803,CPT,Facility,Inpatient,,,,83,70.55,23.7878,83,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Hepatitis C Virus Ab,,86803,CPT,Facility,Both,,,,83,70.55,23.7878,83,CorVel,Worker's Compensation,83,100,,percent of total billed charges,,
Hepatitis C Virus Ab,,86803,CPT,Facility,Both,,,,83,70.55,23.7878,83,First Health Group Corporation,First Health Network,80.51,97,,percent of total billed charges,,
Hepatitis C Virus Ab,,86803,CPT,Facility,Both,,,,83,70.55,23.7878,83,"Health Partners, Inc.",Commercial,78.518,94.6,,percent of total billed charges,,
Hepatitis C Virus Ab,,86803,CPT,Facility,Outpatient,,,,83,70.55,23.7878,83,"Health Partners, Inc.",Medicare Advantage,40.67,49,,percent of total billed charges,,
Hepatitis C Virus Ab,,86803,CPT,Facility,Inpatient,,,,83,70.55,23.7878,83,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Hepatitis C Virus Ab,,86803,CPT,Facility,Both,,,,83,70.55,23.7878,83,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),49.8,60,,percent of total billed charges,,
Hepatitis C Virus Ab,,86803,CPT,Facility,Both,,,,83,70.55,23.7878,83,"Health Partners, Inc.",State of Minnesota Advantage Program,67.645,81.5,,percent of total billed charges,,
Hepatitis C Virus Ab,,86803,CPT,Facility,Both,,,,83,70.55,23.7878,83,"Health Partners, Inc.",State Public Programs,41.5,50,,percent of total billed charges,,
Hepatitis C Virus Ab,,86803,CPT,Facility,Both,,,,83,70.55,23.7878,83,Humana Insurance Company,Commercial PPO,78.85,95,,percent of total billed charges,,
Hepatitis C Virus Ab,,86803,CPT,Facility,Outpatient,,,,83,70.55,23.7878,83,Humana Insurance Company,Medicare PPO,40.67,49,,percent of total billed charges,,
Hepatitis C Virus Ab,,86803,CPT,Facility,Inpatient,,,,83,70.55,23.7878,83,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Hepatitis C Virus Ab,,86803,CPT,Facility,Both,,,,83,70.55,23.7878,83,Medica,Individual & Family,82.253,99.1,,percent of total billed charges,,
Hepatitis C Virus Ab,,86803,CPT,Facility,Outpatient,,,,83,70.55,23.7878,83,Medica,Medica Advantage Solution,41.334,49.8,,percent of total billed charges,,
Hepatitis C Virus Ab,,86803,CPT,Facility,Inpatient,,,,83,70.55,23.7878,83,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Hepatitis C Virus Ab,,86803,CPT,Facility,Outpatient,,,,83,70.55,23.7878,83,Medica,Medical Assistance,37.018,44.6,,percent of total billed charges,,
Hepatitis C Virus Ab,,86803,CPT,Facility,Inpatient,,,,83,70.55,23.7878,83,Medica,Medical Assistance,,,,,Included in per diem rate,
Hepatitis C Virus Ab,,86803,CPT,Facility,Outpatient,,,,83,70.55,23.7878,83,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,41.334,49.8,,percent of total billed charges,,
Hepatitis C Virus Ab,,86803,CPT,Facility,Inpatient,,,,83,70.55,23.7878,83,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Hepatitis C Virus Ab,,86803,CPT,Facility,Both,,,,83,70.55,23.7878,83,"Multiplan, Inc.","Multiplan, Inc.",78.02,94,,percent of total billed charges,,
Hepatitis C Virus Ab,,86803,CPT,Facility,Outpatient,,,,83,70.55,23.7878,83,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,71.712,86.4,,percent of total billed charges,,
Hepatitis C Virus Ab,,86803,CPT,Facility,Inpatient,,,,83,70.55,23.7878,83,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Hepatitis C Virus Ab,,86803,CPT,Facility,Both,,,,83,70.55,23.7878,83,"Preferred One Administrative Services, INC.",PPO,81.838,98.6,,percent of total billed charges,,
Hepatitis C Virus Ab,,86803,CPT,Facility,Outpatient,,,,83,70.55,23.7878,83,PrimeWest Health,Minnesota Senior Health Options (MSHO),42.7035,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Hepatitis C Virus Ab,,86803,CPT,Facility,Inpatient,,,,83,70.55,23.7878,83,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Hepatitis C Virus Ab,,86803,CPT,Facility,Outpatient,,,,83,70.55,23.7878,83,PrimeWest Health,MinnesotaCare,42.6288,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Hepatitis C Virus Ab,,86803,CPT,Facility,Inpatient,,,,83,70.55,23.7878,83,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Hepatitis C Virus Ab,,86803,CPT,Facility,Both,,,,83,70.55,23.7878,83,Sanford Health Plan,Sanford Health Plan,76.36,92,,percent of total billed charges,,
Hepatitis C Virus Ab,,86803,CPT,Facility,Outpatient,,,,83,70.55,23.7878,83,"UCare Health, Inc.",Individual & Family Plan,46.7705,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Hepatitis C Virus Ab,,86803,CPT,Facility,Inpatient,,,,83,70.55,23.7878,83,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Hepatitis C Virus Ab,,86803,CPT,Facility,Outpatient,,,,83,70.55,23.7878,83,"UCare Health, Inc.",Medical Assistance,41.8901,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Hepatitis C Virus Ab,,86803,CPT,Facility,Inpatient,,,,83,70.55,23.7878,83,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Hepatitis C Virus Ab,,86803,CPT,Facility,Outpatient,,,,83,70.55,23.7878,83,"UCare Health, Inc.",Medicare Advantage,41.8901,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Hepatitis C Virus Ab,,86803,CPT,Facility,Inpatient,,,,83,70.55,23.7878,83,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Hepatitis C Virus Ab,,86803,CPT,Facility,Outpatient,,,,83,70.55,23.7878,83,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),41.8901,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Hepatitis C Virus Ab,,86803,CPT,Facility,Inpatient,,,,83,70.55,23.7878,83,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Hepatitis C Virus Ab,,86803,CPT,Facility,Both,,,,83,70.55,23.7878,83,UnitedHealthcare,Individual & Family,78.02,94,,percent of total billed charges,,
Hepatitis C Virus Ab,,86803,CPT,Facility,Outpatient,,,,83,70.55,23.7878,83,UnitedHealthcare,Medicare Advantage,40.67,49,,percent of total billed charges,,
Hepatitis C Virus Ab,,86803,CPT,Facility,Inpatient,,,,83,70.55,23.7878,83,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Hepatitis C Virus Ab,,86803,CPT,Facility,Outpatient,,,,83,70.55,23.7878,83,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,39.84,48,,percent of total billed charges,,100% of DHS outpatient percentage
Hepatitis C Virus Ab,,86803,CPT,Facility,Inpatient,,,,83,70.55,23.7878,83,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Antibody Screen, Rbc, Each Serum Technique (Bb)",,86850,CPT,Facility,Both,,,,97,82.45,27.8002,97,Aetna,Commercial,89.24,92,,percent of total billed charges,,
"Antibody Screen, Rbc, Each Serum Technique (Bb)",,86850,CPT,Facility,Outpatient,,,,97,82.45,27.8002,97,Aetna,Medicare Advantage,47.53,49,,percent of total billed charges,,
"Antibody Screen, Rbc, Each Serum Technique (Bb)",,86850,CPT,Facility,Inpatient,,,,97,82.45,27.8002,97,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Antibody Screen, Rbc, Each Serum Technique (Bb)",,86850,CPT,Facility,Both,,,,97,82.45,27.8002,97,Aetna,PPO,90.21,93,,percent of total billed charges,,
"Antibody Screen, Rbc, Each Serum Technique (Bb)",,86850,CPT,Facility,Both,,,,97,82.45,27.8002,97,America's PPO,America's PPO,93.1491,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Antibody Screen, Rbc, Each Serum Technique (Bb)",,86850,CPT,Facility,Both,,,,97,82.45,27.8002,97,BlueCross BlueShield Minnesota, Federal Employee Program,95.448,98.4,,percent of total billed charges,,
"Antibody Screen, Rbc, Each Serum Technique (Bb)",,86850,CPT,Facility,Both,,,,97,82.45,27.8002,97,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,97,100,,percent of total billed charges,,
"Antibody Screen, Rbc, Each Serum Technique (Bb)",,86850,CPT,Facility,Both,,,,97,82.45,27.8002,97,BlueCross BlueShield Minnesota,High Value Network Plan,87.3,90,,percent of total billed charges,,
"Antibody Screen, Rbc, Each Serum Technique (Bb)",,86850,CPT,Facility,Outpatient,,,,97,82.45,27.8002,97,BlueCross BlueShield Minnesota,Medicare Advantage,47.53,49,,percent of total billed charges,,
"Antibody Screen, Rbc, Each Serum Technique (Bb)",,86850,CPT,Facility,Inpatient,,,,97,82.45,27.8002,97,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Antibody Screen, Rbc, Each Serum Technique (Bb)",,86850,CPT,Facility,Both,,,,97,82.45,27.8002,97,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,85.9129,88.57,,percent of total billed charges,,
"Antibody Screen, Rbc, Each Serum Technique (Bb)",,86850,CPT,Facility,Both,,,,97,82.45,27.8002,97,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,27.8002,28.66,,percent of total billed charges,,
"Antibody Screen, Rbc, Each Serum Technique (Bb)",,86850,CPT,Facility,Outpatient,,,,97,82.45,27.8002,97,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),47.53,49,,percent of total billed charges,,
"Antibody Screen, Rbc, Each Serum Technique (Bb)",,86850,CPT,Facility,Inpatient,,,,97,82.45,27.8002,97,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Antibody Screen, Rbc, Each Serum Technique (Bb)",,86850,CPT,Facility,Both,,,,97,82.45,27.8002,97,CorVel,Worker's Compensation,97,100,,percent of total billed charges,,
"Antibody Screen, Rbc, Each Serum Technique (Bb)",,86850,CPT,Facility,Both,,,,97,82.45,27.8002,97,First Health Group Corporation,First Health Network,94.09,97,,percent of total billed charges,,
"Antibody Screen, Rbc, Each Serum Technique (Bb)",,86850,CPT,Facility,Both,,,,97,82.45,27.8002,97,"Health Partners, Inc.",Commercial,91.762,94.6,,percent of total billed charges,,
"Antibody Screen, Rbc, Each Serum Technique (Bb)",,86850,CPT,Facility,Outpatient,,,,97,82.45,27.8002,97,"Health Partners, Inc.",Medicare Advantage,47.53,49,,percent of total billed charges,,
"Antibody Screen, Rbc, Each Serum Technique (Bb)",,86850,CPT,Facility,Inpatient,,,,97,82.45,27.8002,97,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Antibody Screen, Rbc, Each Serum Technique (Bb)",,86850,CPT,Facility,Both,,,,97,82.45,27.8002,97,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),58.2,60,,percent of total billed charges,,
"Antibody Screen, Rbc, Each Serum Technique (Bb)",,86850,CPT,Facility,Both,,,,97,82.45,27.8002,97,"Health Partners, Inc.",State of Minnesota Advantage Program,79.055,81.5,,percent of total billed charges,,
"Antibody Screen, Rbc, Each Serum Technique (Bb)",,86850,CPT,Facility,Both,,,,97,82.45,27.8002,97,"Health Partners, Inc.",State Public Programs,48.5,50,,percent of total billed charges,,
"Antibody Screen, Rbc, Each Serum Technique (Bb)",,86850,CPT,Facility,Both,,,,97,82.45,27.8002,97,Humana Insurance Company,Commercial PPO,92.15,95,,percent of total billed charges,,
"Antibody Screen, Rbc, Each Serum Technique (Bb)",,86850,CPT,Facility,Outpatient,,,,97,82.45,27.8002,97,Humana Insurance Company,Medicare PPO,47.53,49,,percent of total billed charges,,
"Antibody Screen, Rbc, Each Serum Technique (Bb)",,86850,CPT,Facility,Inpatient,,,,97,82.45,27.8002,97,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Antibody Screen, Rbc, Each Serum Technique (Bb)",,86850,CPT,Facility,Both,,,,97,82.45,27.8002,97,Medica,Individual & Family,96.127,99.1,,percent of total billed charges,,
"Antibody Screen, Rbc, Each Serum Technique (Bb)",,86850,CPT,Facility,Outpatient,,,,97,82.45,27.8002,97,Medica,Medica Advantage Solution,48.306,49.8,,percent of total billed charges,,
"Antibody Screen, Rbc, Each Serum Technique (Bb)",,86850,CPT,Facility,Inpatient,,,,97,82.45,27.8002,97,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Antibody Screen, Rbc, Each Serum Technique (Bb)",,86850,CPT,Facility,Outpatient,,,,97,82.45,27.8002,97,Medica,Medical Assistance,43.262,44.6,,percent of total billed charges,,
"Antibody Screen, Rbc, Each Serum Technique (Bb)",,86850,CPT,Facility,Inpatient,,,,97,82.45,27.8002,97,Medica,Medical Assistance,,,,,Included in per diem rate,
"Antibody Screen, Rbc, Each Serum Technique (Bb)",,86850,CPT,Facility,Outpatient,,,,97,82.45,27.8002,97,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,48.306,49.8,,percent of total billed charges,,
"Antibody Screen, Rbc, Each Serum Technique (Bb)",,86850,CPT,Facility,Inpatient,,,,97,82.45,27.8002,97,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Antibody Screen, Rbc, Each Serum Technique (Bb)",,86850,CPT,Facility,Both,,,,97,82.45,27.8002,97,"Multiplan, Inc.","Multiplan, Inc.",91.18,94,,percent of total billed charges,,
"Antibody Screen, Rbc, Each Serum Technique (Bb)",,86850,CPT,Facility,Outpatient,,,,97,82.45,27.8002,97,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,83.808,86.4,,percent of total billed charges,,
"Antibody Screen, Rbc, Each Serum Technique (Bb)",,86850,CPT,Facility,Inpatient,,,,97,82.45,27.8002,97,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Antibody Screen, Rbc, Each Serum Technique (Bb)",,86850,CPT,Facility,Both,,,,97,82.45,27.8002,97,"Preferred One Administrative Services, INC.",PPO,95.642,98.6,,percent of total billed charges,,
"Antibody Screen, Rbc, Each Serum Technique (Bb)",,86850,CPT,Facility,Outpatient,,,,97,82.45,27.8002,97,PrimeWest Health,Minnesota Senior Health Options (MSHO),49.9065,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Antibody Screen, Rbc, Each Serum Technique (Bb)",,86850,CPT,Facility,Inpatient,,,,97,82.45,27.8002,97,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Antibody Screen, Rbc, Each Serum Technique (Bb)",,86850,CPT,Facility,Outpatient,,,,97,82.45,27.8002,97,PrimeWest Health,MinnesotaCare,49.8192,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Antibody Screen, Rbc, Each Serum Technique (Bb)",,86850,CPT,Facility,Inpatient,,,,97,82.45,27.8002,97,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Antibody Screen, Rbc, Each Serum Technique (Bb)",,86850,CPT,Facility,Both,,,,97,82.45,27.8002,97,Sanford Health Plan,Sanford Health Plan,89.24,92,,percent of total billed charges,,
"Antibody Screen, Rbc, Each Serum Technique (Bb)",,86850,CPT,Facility,Outpatient,,,,97,82.45,27.8002,97,"UCare Health, Inc.",Individual & Family Plan,54.6595,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Antibody Screen, Rbc, Each Serum Technique (Bb)",,86850,CPT,Facility,Inpatient,,,,97,82.45,27.8002,97,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Antibody Screen, Rbc, Each Serum Technique (Bb)",,86850,CPT,Facility,Outpatient,,,,97,82.45,27.8002,97,"UCare Health, Inc.",Medical Assistance,48.9559,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Antibody Screen, Rbc, Each Serum Technique (Bb)",,86850,CPT,Facility,Inpatient,,,,97,82.45,27.8002,97,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Antibody Screen, Rbc, Each Serum Technique (Bb)",,86850,CPT,Facility,Outpatient,,,,97,82.45,27.8002,97,"UCare Health, Inc.",Medicare Advantage,48.9559,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Antibody Screen, Rbc, Each Serum Technique (Bb)",,86850,CPT,Facility,Inpatient,,,,97,82.45,27.8002,97,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Antibody Screen, Rbc, Each Serum Technique (Bb)",,86850,CPT,Facility,Outpatient,,,,97,82.45,27.8002,97,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),48.9559,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Antibody Screen, Rbc, Each Serum Technique (Bb)",,86850,CPT,Facility,Inpatient,,,,97,82.45,27.8002,97,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Antibody Screen, Rbc, Each Serum Technique (Bb)",,86850,CPT,Facility,Both,,,,97,82.45,27.8002,97,UnitedHealthcare,Individual & Family,91.18,94,,percent of total billed charges,,
"Antibody Screen, Rbc, Each Serum Technique (Bb)",,86850,CPT,Facility,Outpatient,,,,97,82.45,27.8002,97,UnitedHealthcare,Medicare Advantage,47.53,49,,percent of total billed charges,,
"Antibody Screen, Rbc, Each Serum Technique (Bb)",,86850,CPT,Facility,Inpatient,,,,97,82.45,27.8002,97,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Antibody Screen, Rbc, Each Serum Technique (Bb)",,86850,CPT,Facility,Outpatient,,,,97,82.45,27.8002,97,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,46.56,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Antibody Screen, Rbc, Each Serum Technique (Bb)",,86850,CPT,Facility,Inpatient,,,,97,82.45,27.8002,97,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Antibody Elution (Rbc), Each Elution (Bb)",,86860,CPT,Facility,Both,,,,101,85.85,28.9466,101,Aetna,Commercial,92.92,92,,percent of total billed charges,,
"Antibody Elution (Rbc), Each Elution (Bb)",,86860,CPT,Facility,Outpatient,,,,101,85.85,28.9466,101,Aetna,Medicare Advantage,49.49,49,,percent of total billed charges,,
"Antibody Elution (Rbc), Each Elution (Bb)",,86860,CPT,Facility,Inpatient,,,,101,85.85,28.9466,101,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Antibody Elution (Rbc), Each Elution (Bb)",,86860,CPT,Facility,Both,,,,101,85.85,28.9466,101,Aetna,PPO,93.93,93,,percent of total billed charges,,
"Antibody Elution (Rbc), Each Elution (Bb)",,86860,CPT,Facility,Both,,,,101,85.85,28.9466,101,America's PPO,America's PPO,96.9903,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Antibody Elution (Rbc), Each Elution (Bb)",,86860,CPT,Facility,Both,,,,101,85.85,28.9466,101,BlueCross BlueShield Minnesota, Federal Employee Program,99.384,98.4,,percent of total billed charges,,
"Antibody Elution (Rbc), Each Elution (Bb)",,86860,CPT,Facility,Both,,,,101,85.85,28.9466,101,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,101,100,,percent of total billed charges,,
"Antibody Elution (Rbc), Each Elution (Bb)",,86860,CPT,Facility,Both,,,,101,85.85,28.9466,101,BlueCross BlueShield Minnesota,High Value Network Plan,90.9,90,,percent of total billed charges,,
"Antibody Elution (Rbc), Each Elution (Bb)",,86860,CPT,Facility,Outpatient,,,,101,85.85,28.9466,101,BlueCross BlueShield Minnesota,Medicare Advantage,49.49,49,,percent of total billed charges,,
"Antibody Elution (Rbc), Each Elution (Bb)",,86860,CPT,Facility,Inpatient,,,,101,85.85,28.9466,101,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Antibody Elution (Rbc), Each Elution (Bb)",,86860,CPT,Facility,Both,,,,101,85.85,28.9466,101,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,89.4557,88.57,,percent of total billed charges,,
"Antibody Elution (Rbc), Each Elution (Bb)",,86860,CPT,Facility,Both,,,,101,85.85,28.9466,101,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,28.9466,28.66,,percent of total billed charges,,
"Antibody Elution (Rbc), Each Elution (Bb)",,86860,CPT,Facility,Outpatient,,,,101,85.85,28.9466,101,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),49.49,49,,percent of total billed charges,,
"Antibody Elution (Rbc), Each Elution (Bb)",,86860,CPT,Facility,Inpatient,,,,101,85.85,28.9466,101,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Antibody Elution (Rbc), Each Elution (Bb)",,86860,CPT,Facility,Both,,,,101,85.85,28.9466,101,CorVel,Worker's Compensation,101,100,,percent of total billed charges,,
"Antibody Elution (Rbc), Each Elution (Bb)",,86860,CPT,Facility,Both,,,,101,85.85,28.9466,101,First Health Group Corporation,First Health Network,97.97,97,,percent of total billed charges,,
"Antibody Elution (Rbc), Each Elution (Bb)",,86860,CPT,Facility,Both,,,,101,85.85,28.9466,101,"Health Partners, Inc.",Commercial,95.546,94.6,,percent of total billed charges,,
"Antibody Elution (Rbc), Each Elution (Bb)",,86860,CPT,Facility,Outpatient,,,,101,85.85,28.9466,101,"Health Partners, Inc.",Medicare Advantage,49.49,49,,percent of total billed charges,,
"Antibody Elution (Rbc), Each Elution (Bb)",,86860,CPT,Facility,Inpatient,,,,101,85.85,28.9466,101,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Antibody Elution (Rbc), Each Elution (Bb)",,86860,CPT,Facility,Both,,,,101,85.85,28.9466,101,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),60.6,60,,percent of total billed charges,,
"Antibody Elution (Rbc), Each Elution (Bb)",,86860,CPT,Facility,Both,,,,101,85.85,28.9466,101,"Health Partners, Inc.",State of Minnesota Advantage Program,82.315,81.5,,percent of total billed charges,,
"Antibody Elution (Rbc), Each Elution (Bb)",,86860,CPT,Facility,Both,,,,101,85.85,28.9466,101,"Health Partners, Inc.",State Public Programs,50.5,50,,percent of total billed charges,,
"Antibody Elution (Rbc), Each Elution (Bb)",,86860,CPT,Facility,Both,,,,101,85.85,28.9466,101,Humana Insurance Company,Commercial PPO,95.95,95,,percent of total billed charges,,
"Antibody Elution (Rbc), Each Elution (Bb)",,86860,CPT,Facility,Outpatient,,,,101,85.85,28.9466,101,Humana Insurance Company,Medicare PPO,49.49,49,,percent of total billed charges,,
"Antibody Elution (Rbc), Each Elution (Bb)",,86860,CPT,Facility,Inpatient,,,,101,85.85,28.9466,101,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Antibody Elution (Rbc), Each Elution (Bb)",,86860,CPT,Facility,Both,,,,101,85.85,28.9466,101,Medica,Individual & Family,100.091,99.1,,percent of total billed charges,,
"Antibody Elution (Rbc), Each Elution (Bb)",,86860,CPT,Facility,Outpatient,,,,101,85.85,28.9466,101,Medica,Medica Advantage Solution,50.298,49.8,,percent of total billed charges,,
"Antibody Elution (Rbc), Each Elution (Bb)",,86860,CPT,Facility,Inpatient,,,,101,85.85,28.9466,101,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Antibody Elution (Rbc), Each Elution (Bb)",,86860,CPT,Facility,Outpatient,,,,101,85.85,28.9466,101,Medica,Medical Assistance,45.046,44.6,,percent of total billed charges,,
"Antibody Elution (Rbc), Each Elution (Bb)",,86860,CPT,Facility,Inpatient,,,,101,85.85,28.9466,101,Medica,Medical Assistance,,,,,Included in per diem rate,
"Antibody Elution (Rbc), Each Elution (Bb)",,86860,CPT,Facility,Outpatient,,,,101,85.85,28.9466,101,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,50.298,49.8,,percent of total billed charges,,
"Antibody Elution (Rbc), Each Elution (Bb)",,86860,CPT,Facility,Inpatient,,,,101,85.85,28.9466,101,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Antibody Elution (Rbc), Each Elution (Bb)",,86860,CPT,Facility,Both,,,,101,85.85,28.9466,101,"Multiplan, Inc.","Multiplan, Inc.",94.94,94,,percent of total billed charges,,
"Antibody Elution (Rbc), Each Elution (Bb)",,86860,CPT,Facility,Outpatient,,,,101,85.85,28.9466,101,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,87.264,86.4,,percent of total billed charges,,
"Antibody Elution (Rbc), Each Elution (Bb)",,86860,CPT,Facility,Inpatient,,,,101,85.85,28.9466,101,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Antibody Elution (Rbc), Each Elution (Bb)",,86860,CPT,Facility,Both,,,,101,85.85,28.9466,101,"Preferred One Administrative Services, INC.",PPO,99.586,98.6,,percent of total billed charges,,
"Antibody Elution (Rbc), Each Elution (Bb)",,86860,CPT,Facility,Outpatient,,,,101,85.85,28.9466,101,PrimeWest Health,Minnesota Senior Health Options (MSHO),51.9645,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Antibody Elution (Rbc), Each Elution (Bb)",,86860,CPT,Facility,Inpatient,,,,101,85.85,28.9466,101,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Antibody Elution (Rbc), Each Elution (Bb)",,86860,CPT,Facility,Outpatient,,,,101,85.85,28.9466,101,PrimeWest Health,MinnesotaCare,51.8736,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Antibody Elution (Rbc), Each Elution (Bb)",,86860,CPT,Facility,Inpatient,,,,101,85.85,28.9466,101,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Antibody Elution (Rbc), Each Elution (Bb)",,86860,CPT,Facility,Both,,,,101,85.85,28.9466,101,Sanford Health Plan,Sanford Health Plan,92.92,92,,percent of total billed charges,,
"Antibody Elution (Rbc), Each Elution (Bb)",,86860,CPT,Facility,Outpatient,,,,101,85.85,28.9466,101,"UCare Health, Inc.",Individual & Family Plan,56.9135,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Antibody Elution (Rbc), Each Elution (Bb)",,86860,CPT,Facility,Inpatient,,,,101,85.85,28.9466,101,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Antibody Elution (Rbc), Each Elution (Bb)",,86860,CPT,Facility,Outpatient,,,,101,85.85,28.9466,101,"UCare Health, Inc.",Medical Assistance,50.9747,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Antibody Elution (Rbc), Each Elution (Bb)",,86860,CPT,Facility,Inpatient,,,,101,85.85,28.9466,101,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Antibody Elution (Rbc), Each Elution (Bb)",,86860,CPT,Facility,Outpatient,,,,101,85.85,28.9466,101,"UCare Health, Inc.",Medicare Advantage,50.9747,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Antibody Elution (Rbc), Each Elution (Bb)",,86860,CPT,Facility,Inpatient,,,,101,85.85,28.9466,101,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Antibody Elution (Rbc), Each Elution (Bb)",,86860,CPT,Facility,Outpatient,,,,101,85.85,28.9466,101,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),50.9747,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Antibody Elution (Rbc), Each Elution (Bb)",,86860,CPT,Facility,Inpatient,,,,101,85.85,28.9466,101,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Antibody Elution (Rbc), Each Elution (Bb)",,86860,CPT,Facility,Both,,,,101,85.85,28.9466,101,UnitedHealthcare,Individual & Family,94.94,94,,percent of total billed charges,,
"Antibody Elution (Rbc), Each Elution (Bb)",,86860,CPT,Facility,Outpatient,,,,101,85.85,28.9466,101,UnitedHealthcare,Medicare Advantage,49.49,49,,percent of total billed charges,,
"Antibody Elution (Rbc), Each Elution (Bb)",,86860,CPT,Facility,Inpatient,,,,101,85.85,28.9466,101,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Antibody Elution (Rbc), Each Elution (Bb)",,86860,CPT,Facility,Outpatient,,,,101,85.85,28.9466,101,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,48.48,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Antibody Elution (Rbc), Each Elution (Bb)",,86860,CPT,Facility,Inpatient,,,,101,85.85,28.9466,101,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Antibody Identification, Rbc Antibodies, Each Panel For Each Serum Technique (Bb)",,86870,CPT,Facility,Both,,,,150,127.5,42.99,150,Aetna,Commercial,138,92,,percent of total billed charges,,
"Antibody Identification, Rbc Antibodies, Each Panel For Each Serum Technique (Bb)",,86870,CPT,Facility,Outpatient,,,,150,127.5,42.99,150,Aetna,Medicare Advantage,73.5,49,,percent of total billed charges,,
"Antibody Identification, Rbc Antibodies, Each Panel For Each Serum Technique (Bb)",,86870,CPT,Facility,Inpatient,,,,150,127.5,42.99,150,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Antibody Identification, Rbc Antibodies, Each Panel For Each Serum Technique (Bb)",,86870,CPT,Facility,Both,,,,150,127.5,42.99,150,Aetna,PPO,139.5,93,,percent of total billed charges,,
"Antibody Identification, Rbc Antibodies, Each Panel For Each Serum Technique (Bb)",,86870,CPT,Facility,Both,,,,150,127.5,42.99,150,America's PPO,America's PPO,144.045,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Antibody Identification, Rbc Antibodies, Each Panel For Each Serum Technique (Bb)",,86870,CPT,Facility,Both,,,,150,127.5,42.99,150,BlueCross BlueShield Minnesota, Federal Employee Program,147.6,98.4,,percent of total billed charges,,
"Antibody Identification, Rbc Antibodies, Each Panel For Each Serum Technique (Bb)",,86870,CPT,Facility,Both,,,,150,127.5,42.99,150,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,150,100,,percent of total billed charges,,
"Antibody Identification, Rbc Antibodies, Each Panel For Each Serum Technique (Bb)",,86870,CPT,Facility,Both,,,,150,127.5,42.99,150,BlueCross BlueShield Minnesota,High Value Network Plan,135,90,,percent of total billed charges,,
"Antibody Identification, Rbc Antibodies, Each Panel For Each Serum Technique (Bb)",,86870,CPT,Facility,Outpatient,,,,150,127.5,42.99,150,BlueCross BlueShield Minnesota,Medicare Advantage,73.5,49,,percent of total billed charges,,
"Antibody Identification, Rbc Antibodies, Each Panel For Each Serum Technique (Bb)",,86870,CPT,Facility,Inpatient,,,,150,127.5,42.99,150,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Antibody Identification, Rbc Antibodies, Each Panel For Each Serum Technique (Bb)",,86870,CPT,Facility,Both,,,,150,127.5,42.99,150,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,132.855,88.57,,percent of total billed charges,,
"Antibody Identification, Rbc Antibodies, Each Panel For Each Serum Technique (Bb)",,86870,CPT,Facility,Both,,,,150,127.5,42.99,150,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,42.99,28.66,,percent of total billed charges,,
"Antibody Identification, Rbc Antibodies, Each Panel For Each Serum Technique (Bb)",,86870,CPT,Facility,Outpatient,,,,150,127.5,42.99,150,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),73.5,49,,percent of total billed charges,,
"Antibody Identification, Rbc Antibodies, Each Panel For Each Serum Technique (Bb)",,86870,CPT,Facility,Inpatient,,,,150,127.5,42.99,150,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Antibody Identification, Rbc Antibodies, Each Panel For Each Serum Technique (Bb)",,86870,CPT,Facility,Both,,,,150,127.5,42.99,150,CorVel,Worker's Compensation,150,100,,percent of total billed charges,,
"Antibody Identification, Rbc Antibodies, Each Panel For Each Serum Technique (Bb)",,86870,CPT,Facility,Both,,,,150,127.5,42.99,150,First Health Group Corporation,First Health Network,145.5,97,,percent of total billed charges,,
"Antibody Identification, Rbc Antibodies, Each Panel For Each Serum Technique (Bb)",,86870,CPT,Facility,Both,,,,150,127.5,42.99,150,"Health Partners, Inc.",Commercial,141.9,94.6,,percent of total billed charges,,
"Antibody Identification, Rbc Antibodies, Each Panel For Each Serum Technique (Bb)",,86870,CPT,Facility,Outpatient,,,,150,127.5,42.99,150,"Health Partners, Inc.",Medicare Advantage,73.5,49,,percent of total billed charges,,
"Antibody Identification, Rbc Antibodies, Each Panel For Each Serum Technique (Bb)",,86870,CPT,Facility,Inpatient,,,,150,127.5,42.99,150,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Antibody Identification, Rbc Antibodies, Each Panel For Each Serum Technique (Bb)",,86870,CPT,Facility,Both,,,,150,127.5,42.99,150,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),90,60,,percent of total billed charges,,
"Antibody Identification, Rbc Antibodies, Each Panel For Each Serum Technique (Bb)",,86870,CPT,Facility,Both,,,,150,127.5,42.99,150,"Health Partners, Inc.",State of Minnesota Advantage Program,122.25,81.5,,percent of total billed charges,,
"Antibody Identification, Rbc Antibodies, Each Panel For Each Serum Technique (Bb)",,86870,CPT,Facility,Both,,,,150,127.5,42.99,150,"Health Partners, Inc.",State Public Programs,75,50,,percent of total billed charges,,
"Antibody Identification, Rbc Antibodies, Each Panel For Each Serum Technique (Bb)",,86870,CPT,Facility,Both,,,,150,127.5,42.99,150,Humana Insurance Company,Commercial PPO,142.5,95,,percent of total billed charges,,
"Antibody Identification, Rbc Antibodies, Each Panel For Each Serum Technique (Bb)",,86870,CPT,Facility,Outpatient,,,,150,127.5,42.99,150,Humana Insurance Company,Medicare PPO,73.5,49,,percent of total billed charges,,
"Antibody Identification, Rbc Antibodies, Each Panel For Each Serum Technique (Bb)",,86870,CPT,Facility,Inpatient,,,,150,127.5,42.99,150,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Antibody Identification, Rbc Antibodies, Each Panel For Each Serum Technique (Bb)",,86870,CPT,Facility,Both,,,,150,127.5,42.99,150,Medica,Individual & Family,148.65,99.1,,percent of total billed charges,,
"Antibody Identification, Rbc Antibodies, Each Panel For Each Serum Technique (Bb)",,86870,CPT,Facility,Outpatient,,,,150,127.5,42.99,150,Medica,Medica Advantage Solution,74.7,49.8,,percent of total billed charges,,
"Antibody Identification, Rbc Antibodies, Each Panel For Each Serum Technique (Bb)",,86870,CPT,Facility,Inpatient,,,,150,127.5,42.99,150,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Antibody Identification, Rbc Antibodies, Each Panel For Each Serum Technique (Bb)",,86870,CPT,Facility,Outpatient,,,,150,127.5,42.99,150,Medica,Medical Assistance,66.9,44.6,,percent of total billed charges,,
"Antibody Identification, Rbc Antibodies, Each Panel For Each Serum Technique (Bb)",,86870,CPT,Facility,Inpatient,,,,150,127.5,42.99,150,Medica,Medical Assistance,,,,,Included in per diem rate,
"Antibody Identification, Rbc Antibodies, Each Panel For Each Serum Technique (Bb)",,86870,CPT,Facility,Outpatient,,,,150,127.5,42.99,150,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,74.7,49.8,,percent of total billed charges,,
"Antibody Identification, Rbc Antibodies, Each Panel For Each Serum Technique (Bb)",,86870,CPT,Facility,Inpatient,,,,150,127.5,42.99,150,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Antibody Identification, Rbc Antibodies, Each Panel For Each Serum Technique (Bb)",,86870,CPT,Facility,Both,,,,150,127.5,42.99,150,"Multiplan, Inc.","Multiplan, Inc.",141,94,,percent of total billed charges,,
"Antibody Identification, Rbc Antibodies, Each Panel For Each Serum Technique (Bb)",,86870,CPT,Facility,Outpatient,,,,150,127.5,42.99,150,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,129.6,86.4,,percent of total billed charges,,
"Antibody Identification, Rbc Antibodies, Each Panel For Each Serum Technique (Bb)",,86870,CPT,Facility,Inpatient,,,,150,127.5,42.99,150,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Antibody Identification, Rbc Antibodies, Each Panel For Each Serum Technique (Bb)",,86870,CPT,Facility,Both,,,,150,127.5,42.99,150,"Preferred One Administrative Services, INC.",PPO,147.9,98.6,,percent of total billed charges,,
"Antibody Identification, Rbc Antibodies, Each Panel For Each Serum Technique (Bb)",,86870,CPT,Facility,Outpatient,,,,150,127.5,42.99,150,PrimeWest Health,Minnesota Senior Health Options (MSHO),77.175,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Antibody Identification, Rbc Antibodies, Each Panel For Each Serum Technique (Bb)",,86870,CPT,Facility,Inpatient,,,,150,127.5,42.99,150,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Antibody Identification, Rbc Antibodies, Each Panel For Each Serum Technique (Bb)",,86870,CPT,Facility,Outpatient,,,,150,127.5,42.99,150,PrimeWest Health,MinnesotaCare,77.04,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Antibody Identification, Rbc Antibodies, Each Panel For Each Serum Technique (Bb)",,86870,CPT,Facility,Inpatient,,,,150,127.5,42.99,150,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Antibody Identification, Rbc Antibodies, Each Panel For Each Serum Technique (Bb)",,86870,CPT,Facility,Both,,,,150,127.5,42.99,150,Sanford Health Plan,Sanford Health Plan,138,92,,percent of total billed charges,,
"Antibody Identification, Rbc Antibodies, Each Panel For Each Serum Technique (Bb)",,86870,CPT,Facility,Outpatient,,,,150,127.5,42.99,150,"UCare Health, Inc.",Individual & Family Plan,84.525,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Antibody Identification, Rbc Antibodies, Each Panel For Each Serum Technique (Bb)",,86870,CPT,Facility,Inpatient,,,,150,127.5,42.99,150,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Antibody Identification, Rbc Antibodies, Each Panel For Each Serum Technique (Bb)",,86870,CPT,Facility,Outpatient,,,,150,127.5,42.99,150,"UCare Health, Inc.",Medical Assistance,75.705,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Antibody Identification, Rbc Antibodies, Each Panel For Each Serum Technique (Bb)",,86870,CPT,Facility,Inpatient,,,,150,127.5,42.99,150,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Antibody Identification, Rbc Antibodies, Each Panel For Each Serum Technique (Bb)",,86870,CPT,Facility,Outpatient,,,,150,127.5,42.99,150,"UCare Health, Inc.",Medicare Advantage,75.705,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Antibody Identification, Rbc Antibodies, Each Panel For Each Serum Technique (Bb)",,86870,CPT,Facility,Inpatient,,,,150,127.5,42.99,150,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Antibody Identification, Rbc Antibodies, Each Panel For Each Serum Technique (Bb)",,86870,CPT,Facility,Outpatient,,,,150,127.5,42.99,150,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),75.705,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Antibody Identification, Rbc Antibodies, Each Panel For Each Serum Technique (Bb)",,86870,CPT,Facility,Inpatient,,,,150,127.5,42.99,150,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Antibody Identification, Rbc Antibodies, Each Panel For Each Serum Technique (Bb)",,86870,CPT,Facility,Both,,,,150,127.5,42.99,150,UnitedHealthcare,Individual & Family,141,94,,percent of total billed charges,,
"Antibody Identification, Rbc Antibodies, Each Panel For Each Serum Technique (Bb)",,86870,CPT,Facility,Outpatient,,,,150,127.5,42.99,150,UnitedHealthcare,Medicare Advantage,73.5,49,,percent of total billed charges,,
"Antibody Identification, Rbc Antibodies, Each Panel For Each Serum Technique (Bb)",,86870,CPT,Facility,Inpatient,,,,150,127.5,42.99,150,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Antibody Identification, Rbc Antibodies, Each Panel For Each Serum Technique (Bb)",,86870,CPT,Facility,Outpatient,,,,150,127.5,42.99,150,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,72,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Antibody Identification, Rbc Antibodies, Each Panel For Each Serum Technique (Bb)",,86870,CPT,Facility,Inpatient,,,,150,127.5,42.99,150,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Direct Coombs--C3 (Bb),,86880,CPT,Facility,Both,,,,49,41.65,14.0434,49,Aetna,Commercial,45.08,92,,percent of total billed charges,,
Direct Coombs--C3 (Bb),,86880,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,Aetna,Medicare Advantage,24.01,49,,percent of total billed charges,,
Direct Coombs--C3 (Bb),,86880,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Direct Coombs--C3 (Bb),,86880,CPT,Facility,Both,,,,49,41.65,14.0434,49,Aetna,PPO,45.57,93,,percent of total billed charges,,
Direct Coombs--C3 (Bb),,86880,CPT,Facility,Both,,,,49,41.65,14.0434,49,America's PPO,America's PPO,47.0547,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Direct Coombs--C3 (Bb),,86880,CPT,Facility,Both,,,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota, Federal Employee Program,48.216,98.4,,percent of total billed charges,,
Direct Coombs--C3 (Bb),,86880,CPT,Facility,Both,,,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,49,100,,percent of total billed charges,,
Direct Coombs--C3 (Bb),,86880,CPT,Facility,Both,,,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,High Value Network Plan,44.1,90,,percent of total billed charges,,
Direct Coombs--C3 (Bb),,86880,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Medicare Advantage,24.01,49,,percent of total billed charges,,
Direct Coombs--C3 (Bb),,86880,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Direct Coombs--C3 (Bb),,86880,CPT,Facility,Both,,,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,43.3993,88.57,,percent of total billed charges,,
Direct Coombs--C3 (Bb),,86880,CPT,Facility,Both,,,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,14.0434,28.66,,percent of total billed charges,,
Direct Coombs--C3 (Bb),,86880,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),24.01,49,,percent of total billed charges,,
Direct Coombs--C3 (Bb),,86880,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Direct Coombs--C3 (Bb),,86880,CPT,Facility,Both,,,,49,41.65,14.0434,49,CorVel,Worker's Compensation,49,100,,percent of total billed charges,,
Direct Coombs--C3 (Bb),,86880,CPT,Facility,Both,,,,49,41.65,14.0434,49,First Health Group Corporation,First Health Network,47.53,97,,percent of total billed charges,,
Direct Coombs--C3 (Bb),,86880,CPT,Facility,Both,,,,49,41.65,14.0434,49,"Health Partners, Inc.",Commercial,46.354,94.6,,percent of total billed charges,,
Direct Coombs--C3 (Bb),,86880,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,"Health Partners, Inc.",Medicare Advantage,24.01,49,,percent of total billed charges,,
Direct Coombs--C3 (Bb),,86880,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Direct Coombs--C3 (Bb),,86880,CPT,Facility,Both,,,,49,41.65,14.0434,49,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),29.4,60,,percent of total billed charges,,
Direct Coombs--C3 (Bb),,86880,CPT,Facility,Both,,,,49,41.65,14.0434,49,"Health Partners, Inc.",State of Minnesota Advantage Program,39.935,81.5,,percent of total billed charges,,
Direct Coombs--C3 (Bb),,86880,CPT,Facility,Both,,,,49,41.65,14.0434,49,"Health Partners, Inc.",State Public Programs,24.5,50,,percent of total billed charges,,
Direct Coombs--C3 (Bb),,86880,CPT,Facility,Both,,,,49,41.65,14.0434,49,Humana Insurance Company,Commercial PPO,46.55,95,,percent of total billed charges,,
Direct Coombs--C3 (Bb),,86880,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,Humana Insurance Company,Medicare PPO,24.01,49,,percent of total billed charges,,
Direct Coombs--C3 (Bb),,86880,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Direct Coombs--C3 (Bb),,86880,CPT,Facility,Both,,,,49,41.65,14.0434,49,Medica,Individual & Family,48.559,99.1,,percent of total billed charges,,
Direct Coombs--C3 (Bb),,86880,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,Medica,Medica Advantage Solution,24.402,49.8,,percent of total billed charges,,
Direct Coombs--C3 (Bb),,86880,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Direct Coombs--C3 (Bb),,86880,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,Medica,Medical Assistance,21.854,44.6,,percent of total billed charges,,
Direct Coombs--C3 (Bb),,86880,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,Medica,Medical Assistance,,,,,Included in per diem rate,
Direct Coombs--C3 (Bb),,86880,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,24.402,49.8,,percent of total billed charges,,
Direct Coombs--C3 (Bb),,86880,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Direct Coombs--C3 (Bb),,86880,CPT,Facility,Both,,,,49,41.65,14.0434,49,"Multiplan, Inc.","Multiplan, Inc.",46.06,94,,percent of total billed charges,,
Direct Coombs--C3 (Bb),,86880,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,42.336,86.4,,percent of total billed charges,,
Direct Coombs--C3 (Bb),,86880,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Direct Coombs--C3 (Bb),,86880,CPT,Facility,Both,,,,49,41.65,14.0434,49,"Preferred One Administrative Services, INC.",PPO,48.314,98.6,,percent of total billed charges,,
Direct Coombs--C3 (Bb),,86880,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,PrimeWest Health,Minnesota Senior Health Options (MSHO),25.2105,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Direct Coombs--C3 (Bb),,86880,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Direct Coombs--C3 (Bb),,86880,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,PrimeWest Health,MinnesotaCare,25.1664,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Direct Coombs--C3 (Bb),,86880,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Direct Coombs--C3 (Bb),,86880,CPT,Facility,Both,,,,49,41.65,14.0434,49,Sanford Health Plan,Sanford Health Plan,45.08,92,,percent of total billed charges,,
Direct Coombs--C3 (Bb),,86880,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,"UCare Health, Inc.",Individual & Family Plan,27.6115,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Direct Coombs--C3 (Bb),,86880,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Direct Coombs--C3 (Bb),,86880,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,"UCare Health, Inc.",Medical Assistance,24.7303,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Direct Coombs--C3 (Bb),,86880,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Direct Coombs--C3 (Bb),,86880,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,"UCare Health, Inc.",Medicare Advantage,24.7303,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Direct Coombs--C3 (Bb),,86880,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Direct Coombs--C3 (Bb),,86880,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),24.7303,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Direct Coombs--C3 (Bb),,86880,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Direct Coombs--C3 (Bb),,86880,CPT,Facility,Both,,,,49,41.65,14.0434,49,UnitedHealthcare,Individual & Family,46.06,94,,percent of total billed charges,,
Direct Coombs--C3 (Bb),,86880,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,UnitedHealthcare,Medicare Advantage,24.01,49,,percent of total billed charges,,
Direct Coombs--C3 (Bb),,86880,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Direct Coombs--C3 (Bb),,86880,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,23.52,48,,percent of total billed charges,,100% of DHS outpatient percentage
Direct Coombs--C3 (Bb),,86880,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Direct Coombs--Igg (Bb),,86880,CPT,Facility,Both,,,,49,41.65,14.0434,49,Aetna,Commercial,45.08,92,,percent of total billed charges,,
Direct Coombs--Igg (Bb),,86880,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,Aetna,Medicare Advantage,24.01,49,,percent of total billed charges,,
Direct Coombs--Igg (Bb),,86880,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Direct Coombs--Igg (Bb),,86880,CPT,Facility,Both,,,,49,41.65,14.0434,49,Aetna,PPO,45.57,93,,percent of total billed charges,,
Direct Coombs--Igg (Bb),,86880,CPT,Facility,Both,,,,49,41.65,14.0434,49,America's PPO,America's PPO,47.0547,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Direct Coombs--Igg (Bb),,86880,CPT,Facility,Both,,,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota, Federal Employee Program,48.216,98.4,,percent of total billed charges,,
Direct Coombs--Igg (Bb),,86880,CPT,Facility,Both,,,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,49,100,,percent of total billed charges,,
Direct Coombs--Igg (Bb),,86880,CPT,Facility,Both,,,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,High Value Network Plan,44.1,90,,percent of total billed charges,,
Direct Coombs--Igg (Bb),,86880,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Medicare Advantage,24.01,49,,percent of total billed charges,,
Direct Coombs--Igg (Bb),,86880,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Direct Coombs--Igg (Bb),,86880,CPT,Facility,Both,,,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,43.3993,88.57,,percent of total billed charges,,
Direct Coombs--Igg (Bb),,86880,CPT,Facility,Both,,,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,14.0434,28.66,,percent of total billed charges,,
Direct Coombs--Igg (Bb),,86880,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),24.01,49,,percent of total billed charges,,
Direct Coombs--Igg (Bb),,86880,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Direct Coombs--Igg (Bb),,86880,CPT,Facility,Both,,,,49,41.65,14.0434,49,CorVel,Worker's Compensation,49,100,,percent of total billed charges,,
Direct Coombs--Igg (Bb),,86880,CPT,Facility,Both,,,,49,41.65,14.0434,49,First Health Group Corporation,First Health Network,47.53,97,,percent of total billed charges,,
Direct Coombs--Igg (Bb),,86880,CPT,Facility,Both,,,,49,41.65,14.0434,49,"Health Partners, Inc.",Commercial,46.354,94.6,,percent of total billed charges,,
Direct Coombs--Igg (Bb),,86880,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,"Health Partners, Inc.",Medicare Advantage,24.01,49,,percent of total billed charges,,
Direct Coombs--Igg (Bb),,86880,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Direct Coombs--Igg (Bb),,86880,CPT,Facility,Both,,,,49,41.65,14.0434,49,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),29.4,60,,percent of total billed charges,,
Direct Coombs--Igg (Bb),,86880,CPT,Facility,Both,,,,49,41.65,14.0434,49,"Health Partners, Inc.",State of Minnesota Advantage Program,39.935,81.5,,percent of total billed charges,,
Direct Coombs--Igg (Bb),,86880,CPT,Facility,Both,,,,49,41.65,14.0434,49,"Health Partners, Inc.",State Public Programs,24.5,50,,percent of total billed charges,,
Direct Coombs--Igg (Bb),,86880,CPT,Facility,Both,,,,49,41.65,14.0434,49,Humana Insurance Company,Commercial PPO,46.55,95,,percent of total billed charges,,
Direct Coombs--Igg (Bb),,86880,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,Humana Insurance Company,Medicare PPO,24.01,49,,percent of total billed charges,,
Direct Coombs--Igg (Bb),,86880,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Direct Coombs--Igg (Bb),,86880,CPT,Facility,Both,,,,49,41.65,14.0434,49,Medica,Individual & Family,48.559,99.1,,percent of total billed charges,,
Direct Coombs--Igg (Bb),,86880,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,Medica,Medica Advantage Solution,24.402,49.8,,percent of total billed charges,,
Direct Coombs--Igg (Bb),,86880,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Direct Coombs--Igg (Bb),,86880,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,Medica,Medical Assistance,21.854,44.6,,percent of total billed charges,,
Direct Coombs--Igg (Bb),,86880,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,Medica,Medical Assistance,,,,,Included in per diem rate,
Direct Coombs--Igg (Bb),,86880,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,24.402,49.8,,percent of total billed charges,,
Direct Coombs--Igg (Bb),,86880,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Direct Coombs--Igg (Bb),,86880,CPT,Facility,Both,,,,49,41.65,14.0434,49,"Multiplan, Inc.","Multiplan, Inc.",46.06,94,,percent of total billed charges,,
Direct Coombs--Igg (Bb),,86880,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,42.336,86.4,,percent of total billed charges,,
Direct Coombs--Igg (Bb),,86880,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Direct Coombs--Igg (Bb),,86880,CPT,Facility,Both,,,,49,41.65,14.0434,49,"Preferred One Administrative Services, INC.",PPO,48.314,98.6,,percent of total billed charges,,
Direct Coombs--Igg (Bb),,86880,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,PrimeWest Health,Minnesota Senior Health Options (MSHO),25.2105,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Direct Coombs--Igg (Bb),,86880,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Direct Coombs--Igg (Bb),,86880,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,PrimeWest Health,MinnesotaCare,25.1664,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Direct Coombs--Igg (Bb),,86880,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Direct Coombs--Igg (Bb),,86880,CPT,Facility,Both,,,,49,41.65,14.0434,49,Sanford Health Plan,Sanford Health Plan,45.08,92,,percent of total billed charges,,
Direct Coombs--Igg (Bb),,86880,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,"UCare Health, Inc.",Individual & Family Plan,27.6115,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Direct Coombs--Igg (Bb),,86880,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Direct Coombs--Igg (Bb),,86880,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,"UCare Health, Inc.",Medical Assistance,24.7303,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Direct Coombs--Igg (Bb),,86880,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Direct Coombs--Igg (Bb),,86880,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,"UCare Health, Inc.",Medicare Advantage,24.7303,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Direct Coombs--Igg (Bb),,86880,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Direct Coombs--Igg (Bb),,86880,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),24.7303,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Direct Coombs--Igg (Bb),,86880,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Direct Coombs--Igg (Bb),,86880,CPT,Facility,Both,,,,49,41.65,14.0434,49,UnitedHealthcare,Individual & Family,46.06,94,,percent of total billed charges,,
Direct Coombs--Igg (Bb),,86880,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,UnitedHealthcare,Medicare Advantage,24.01,49,,percent of total billed charges,,
Direct Coombs--Igg (Bb),,86880,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Direct Coombs--Igg (Bb),,86880,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,23.52,48,,percent of total billed charges,,100% of DHS outpatient percentage
Direct Coombs--Igg (Bb),,86880,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Direct Coombs--Poly (Bb),,86880,CPT,Facility,Both,,,,49,41.65,14.0434,49,Aetna,Commercial,45.08,92,,percent of total billed charges,,
Direct Coombs--Poly (Bb),,86880,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,Aetna,Medicare Advantage,24.01,49,,percent of total billed charges,,
Direct Coombs--Poly (Bb),,86880,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Direct Coombs--Poly (Bb),,86880,CPT,Facility,Both,,,,49,41.65,14.0434,49,Aetna,PPO,45.57,93,,percent of total billed charges,,
Direct Coombs--Poly (Bb),,86880,CPT,Facility,Both,,,,49,41.65,14.0434,49,America's PPO,America's PPO,47.0547,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Direct Coombs--Poly (Bb),,86880,CPT,Facility,Both,,,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota, Federal Employee Program,48.216,98.4,,percent of total billed charges,,
Direct Coombs--Poly (Bb),,86880,CPT,Facility,Both,,,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,49,100,,percent of total billed charges,,
Direct Coombs--Poly (Bb),,86880,CPT,Facility,Both,,,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,High Value Network Plan,44.1,90,,percent of total billed charges,,
Direct Coombs--Poly (Bb),,86880,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Medicare Advantage,24.01,49,,percent of total billed charges,,
Direct Coombs--Poly (Bb),,86880,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Direct Coombs--Poly (Bb),,86880,CPT,Facility,Both,,,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,43.3993,88.57,,percent of total billed charges,,
Direct Coombs--Poly (Bb),,86880,CPT,Facility,Both,,,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,14.0434,28.66,,percent of total billed charges,,
Direct Coombs--Poly (Bb),,86880,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),24.01,49,,percent of total billed charges,,
Direct Coombs--Poly (Bb),,86880,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Direct Coombs--Poly (Bb),,86880,CPT,Facility,Both,,,,49,41.65,14.0434,49,CorVel,Worker's Compensation,49,100,,percent of total billed charges,,
Direct Coombs--Poly (Bb),,86880,CPT,Facility,Both,,,,49,41.65,14.0434,49,First Health Group Corporation,First Health Network,47.53,97,,percent of total billed charges,,
Direct Coombs--Poly (Bb),,86880,CPT,Facility,Both,,,,49,41.65,14.0434,49,"Health Partners, Inc.",Commercial,46.354,94.6,,percent of total billed charges,,
Direct Coombs--Poly (Bb),,86880,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,"Health Partners, Inc.",Medicare Advantage,24.01,49,,percent of total billed charges,,
Direct Coombs--Poly (Bb),,86880,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Direct Coombs--Poly (Bb),,86880,CPT,Facility,Both,,,,49,41.65,14.0434,49,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),29.4,60,,percent of total billed charges,,
Direct Coombs--Poly (Bb),,86880,CPT,Facility,Both,,,,49,41.65,14.0434,49,"Health Partners, Inc.",State of Minnesota Advantage Program,39.935,81.5,,percent of total billed charges,,
Direct Coombs--Poly (Bb),,86880,CPT,Facility,Both,,,,49,41.65,14.0434,49,"Health Partners, Inc.",State Public Programs,24.5,50,,percent of total billed charges,,
Direct Coombs--Poly (Bb),,86880,CPT,Facility,Both,,,,49,41.65,14.0434,49,Humana Insurance Company,Commercial PPO,46.55,95,,percent of total billed charges,,
Direct Coombs--Poly (Bb),,86880,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,Humana Insurance Company,Medicare PPO,24.01,49,,percent of total billed charges,,
Direct Coombs--Poly (Bb),,86880,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Direct Coombs--Poly (Bb),,86880,CPT,Facility,Both,,,,49,41.65,14.0434,49,Medica,Individual & Family,48.559,99.1,,percent of total billed charges,,
Direct Coombs--Poly (Bb),,86880,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,Medica,Medica Advantage Solution,24.402,49.8,,percent of total billed charges,,
Direct Coombs--Poly (Bb),,86880,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Direct Coombs--Poly (Bb),,86880,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,Medica,Medical Assistance,21.854,44.6,,percent of total billed charges,,
Direct Coombs--Poly (Bb),,86880,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,Medica,Medical Assistance,,,,,Included in per diem rate,
Direct Coombs--Poly (Bb),,86880,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,24.402,49.8,,percent of total billed charges,,
Direct Coombs--Poly (Bb),,86880,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Direct Coombs--Poly (Bb),,86880,CPT,Facility,Both,,,,49,41.65,14.0434,49,"Multiplan, Inc.","Multiplan, Inc.",46.06,94,,percent of total billed charges,,
Direct Coombs--Poly (Bb),,86880,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,42.336,86.4,,percent of total billed charges,,
Direct Coombs--Poly (Bb),,86880,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Direct Coombs--Poly (Bb),,86880,CPT,Facility,Both,,,,49,41.65,14.0434,49,"Preferred One Administrative Services, INC.",PPO,48.314,98.6,,percent of total billed charges,,
Direct Coombs--Poly (Bb),,86880,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,PrimeWest Health,Minnesota Senior Health Options (MSHO),25.2105,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Direct Coombs--Poly (Bb),,86880,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Direct Coombs--Poly (Bb),,86880,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,PrimeWest Health,MinnesotaCare,25.1664,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Direct Coombs--Poly (Bb),,86880,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Direct Coombs--Poly (Bb),,86880,CPT,Facility,Both,,,,49,41.65,14.0434,49,Sanford Health Plan,Sanford Health Plan,45.08,92,,percent of total billed charges,,
Direct Coombs--Poly (Bb),,86880,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,"UCare Health, Inc.",Individual & Family Plan,27.6115,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Direct Coombs--Poly (Bb),,86880,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Direct Coombs--Poly (Bb),,86880,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,"UCare Health, Inc.",Medical Assistance,24.7303,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Direct Coombs--Poly (Bb),,86880,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Direct Coombs--Poly (Bb),,86880,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,"UCare Health, Inc.",Medicare Advantage,24.7303,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Direct Coombs--Poly (Bb),,86880,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Direct Coombs--Poly (Bb),,86880,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),24.7303,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Direct Coombs--Poly (Bb),,86880,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Direct Coombs--Poly (Bb),,86880,CPT,Facility,Both,,,,49,41.65,14.0434,49,UnitedHealthcare,Individual & Family,46.06,94,,percent of total billed charges,,
Direct Coombs--Poly (Bb),,86880,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,UnitedHealthcare,Medicare Advantage,24.01,49,,percent of total billed charges,,
Direct Coombs--Poly (Bb),,86880,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Direct Coombs--Poly (Bb),,86880,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,23.52,48,,percent of total billed charges,,100% of DHS outpatient percentage
Direct Coombs--Poly (Bb),,86880,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Blood Typing, Serologic; Abo (Bb)",,86900,CPT,Facility,Both,,,,91,77.35,26.0806,91,Aetna,Commercial,83.72,92,,percent of total billed charges,,
"Blood Typing, Serologic; Abo (Bb)",,86900,CPT,Facility,Outpatient,,,,91,77.35,26.0806,91,Aetna,Medicare Advantage,44.59,49,,percent of total billed charges,,
"Blood Typing, Serologic; Abo (Bb)",,86900,CPT,Facility,Inpatient,,,,91,77.35,26.0806,91,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Blood Typing, Serologic; Abo (Bb)",,86900,CPT,Facility,Both,,,,91,77.35,26.0806,91,Aetna,PPO,84.63,93,,percent of total billed charges,,
"Blood Typing, Serologic; Abo (Bb)",,86900,CPT,Facility,Both,,,,91,77.35,26.0806,91,America's PPO,America's PPO,87.3873,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Blood Typing, Serologic; Abo (Bb)",,86900,CPT,Facility,Both,,,,91,77.35,26.0806,91,BlueCross BlueShield Minnesota, Federal Employee Program,89.544,98.4,,percent of total billed charges,,
"Blood Typing, Serologic; Abo (Bb)",,86900,CPT,Facility,Both,,,,91,77.35,26.0806,91,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,91,100,,percent of total billed charges,,
"Blood Typing, Serologic; Abo (Bb)",,86900,CPT,Facility,Both,,,,91,77.35,26.0806,91,BlueCross BlueShield Minnesota,High Value Network Plan,81.9,90,,percent of total billed charges,,
"Blood Typing, Serologic; Abo (Bb)",,86900,CPT,Facility,Outpatient,,,,91,77.35,26.0806,91,BlueCross BlueShield Minnesota,Medicare Advantage,44.59,49,,percent of total billed charges,,
"Blood Typing, Serologic; Abo (Bb)",,86900,CPT,Facility,Inpatient,,,,91,77.35,26.0806,91,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Blood Typing, Serologic; Abo (Bb)",,86900,CPT,Facility,Both,,,,91,77.35,26.0806,91,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,80.5987,88.57,,percent of total billed charges,,
"Blood Typing, Serologic; Abo (Bb)",,86900,CPT,Facility,Both,,,,91,77.35,26.0806,91,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,26.0806,28.66,,percent of total billed charges,,
"Blood Typing, Serologic; Abo (Bb)",,86900,CPT,Facility,Outpatient,,,,91,77.35,26.0806,91,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),44.59,49,,percent of total billed charges,,
"Blood Typing, Serologic; Abo (Bb)",,86900,CPT,Facility,Inpatient,,,,91,77.35,26.0806,91,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Blood Typing, Serologic; Abo (Bb)",,86900,CPT,Facility,Both,,,,91,77.35,26.0806,91,CorVel,Worker's Compensation,91,100,,percent of total billed charges,,
"Blood Typing, Serologic; Abo (Bb)",,86900,CPT,Facility,Both,,,,91,77.35,26.0806,91,First Health Group Corporation,First Health Network,88.27,97,,percent of total billed charges,,
"Blood Typing, Serologic; Abo (Bb)",,86900,CPT,Facility,Both,,,,91,77.35,26.0806,91,"Health Partners, Inc.",Commercial,86.086,94.6,,percent of total billed charges,,
"Blood Typing, Serologic; Abo (Bb)",,86900,CPT,Facility,Outpatient,,,,91,77.35,26.0806,91,"Health Partners, Inc.",Medicare Advantage,44.59,49,,percent of total billed charges,,
"Blood Typing, Serologic; Abo (Bb)",,86900,CPT,Facility,Inpatient,,,,91,77.35,26.0806,91,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Blood Typing, Serologic; Abo (Bb)",,86900,CPT,Facility,Both,,,,91,77.35,26.0806,91,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),54.6,60,,percent of total billed charges,,
"Blood Typing, Serologic; Abo (Bb)",,86900,CPT,Facility,Both,,,,91,77.35,26.0806,91,"Health Partners, Inc.",State of Minnesota Advantage Program,74.165,81.5,,percent of total billed charges,,
"Blood Typing, Serologic; Abo (Bb)",,86900,CPT,Facility,Both,,,,91,77.35,26.0806,91,"Health Partners, Inc.",State Public Programs,45.5,50,,percent of total billed charges,,
"Blood Typing, Serologic; Abo (Bb)",,86900,CPT,Facility,Both,,,,91,77.35,26.0806,91,Humana Insurance Company,Commercial PPO,86.45,95,,percent of total billed charges,,
"Blood Typing, Serologic; Abo (Bb)",,86900,CPT,Facility,Outpatient,,,,91,77.35,26.0806,91,Humana Insurance Company,Medicare PPO,44.59,49,,percent of total billed charges,,
"Blood Typing, Serologic; Abo (Bb)",,86900,CPT,Facility,Inpatient,,,,91,77.35,26.0806,91,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Blood Typing, Serologic; Abo (Bb)",,86900,CPT,Facility,Both,,,,91,77.35,26.0806,91,Medica,Individual & Family,90.181,99.1,,percent of total billed charges,,
"Blood Typing, Serologic; Abo (Bb)",,86900,CPT,Facility,Outpatient,,,,91,77.35,26.0806,91,Medica,Medica Advantage Solution,45.318,49.8,,percent of total billed charges,,
"Blood Typing, Serologic; Abo (Bb)",,86900,CPT,Facility,Inpatient,,,,91,77.35,26.0806,91,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Blood Typing, Serologic; Abo (Bb)",,86900,CPT,Facility,Outpatient,,,,91,77.35,26.0806,91,Medica,Medical Assistance,40.586,44.6,,percent of total billed charges,,
"Blood Typing, Serologic; Abo (Bb)",,86900,CPT,Facility,Inpatient,,,,91,77.35,26.0806,91,Medica,Medical Assistance,,,,,Included in per diem rate,
"Blood Typing, Serologic; Abo (Bb)",,86900,CPT,Facility,Outpatient,,,,91,77.35,26.0806,91,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,45.318,49.8,,percent of total billed charges,,
"Blood Typing, Serologic; Abo (Bb)",,86900,CPT,Facility,Inpatient,,,,91,77.35,26.0806,91,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Blood Typing, Serologic; Abo (Bb)",,86900,CPT,Facility,Both,,,,91,77.35,26.0806,91,"Multiplan, Inc.","Multiplan, Inc.",85.54,94,,percent of total billed charges,,
"Blood Typing, Serologic; Abo (Bb)",,86900,CPT,Facility,Outpatient,,,,91,77.35,26.0806,91,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,78.624,86.4,,percent of total billed charges,,
"Blood Typing, Serologic; Abo (Bb)",,86900,CPT,Facility,Inpatient,,,,91,77.35,26.0806,91,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Blood Typing, Serologic; Abo (Bb)",,86900,CPT,Facility,Both,,,,91,77.35,26.0806,91,"Preferred One Administrative Services, INC.",PPO,89.726,98.6,,percent of total billed charges,,
"Blood Typing, Serologic; Abo (Bb)",,86900,CPT,Facility,Outpatient,,,,91,77.35,26.0806,91,PrimeWest Health,Minnesota Senior Health Options (MSHO),46.8195,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Blood Typing, Serologic; Abo (Bb)",,86900,CPT,Facility,Inpatient,,,,91,77.35,26.0806,91,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Blood Typing, Serologic; Abo (Bb)",,86900,CPT,Facility,Outpatient,,,,91,77.35,26.0806,91,PrimeWest Health,MinnesotaCare,46.7376,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Blood Typing, Serologic; Abo (Bb)",,86900,CPT,Facility,Inpatient,,,,91,77.35,26.0806,91,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Blood Typing, Serologic; Abo (Bb)",,86900,CPT,Facility,Both,,,,91,77.35,26.0806,91,Sanford Health Plan,Sanford Health Plan,83.72,92,,percent of total billed charges,,
"Blood Typing, Serologic; Abo (Bb)",,86900,CPT,Facility,Outpatient,,,,91,77.35,26.0806,91,"UCare Health, Inc.",Individual & Family Plan,51.2785,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Blood Typing, Serologic; Abo (Bb)",,86900,CPT,Facility,Inpatient,,,,91,77.35,26.0806,91,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Blood Typing, Serologic; Abo (Bb)",,86900,CPT,Facility,Outpatient,,,,91,77.35,26.0806,91,"UCare Health, Inc.",Medical Assistance,45.9277,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Blood Typing, Serologic; Abo (Bb)",,86900,CPT,Facility,Inpatient,,,,91,77.35,26.0806,91,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Blood Typing, Serologic; Abo (Bb)",,86900,CPT,Facility,Outpatient,,,,91,77.35,26.0806,91,"UCare Health, Inc.",Medicare Advantage,45.9277,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Blood Typing, Serologic; Abo (Bb)",,86900,CPT,Facility,Inpatient,,,,91,77.35,26.0806,91,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Blood Typing, Serologic; Abo (Bb)",,86900,CPT,Facility,Outpatient,,,,91,77.35,26.0806,91,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),45.9277,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Blood Typing, Serologic; Abo (Bb)",,86900,CPT,Facility,Inpatient,,,,91,77.35,26.0806,91,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Blood Typing, Serologic; Abo (Bb)",,86900,CPT,Facility,Both,,,,91,77.35,26.0806,91,UnitedHealthcare,Individual & Family,85.54,94,,percent of total billed charges,,
"Blood Typing, Serologic; Abo (Bb)",,86900,CPT,Facility,Outpatient,,,,91,77.35,26.0806,91,UnitedHealthcare,Medicare Advantage,44.59,49,,percent of total billed charges,,
"Blood Typing, Serologic; Abo (Bb)",,86900,CPT,Facility,Inpatient,,,,91,77.35,26.0806,91,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Blood Typing, Serologic; Abo (Bb)",,86900,CPT,Facility,Outpatient,,,,91,77.35,26.0806,91,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,43.68,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Blood Typing, Serologic; Abo (Bb)",,86900,CPT,Facility,Inpatient,,,,91,77.35,26.0806,91,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Blood Typing, Serologic; Rh (D) (Bb)",,86901,CPT,Facility,Both,,,,46,39.1,13.1836,46,Aetna,Commercial,42.32,92,,percent of total billed charges,,
"Blood Typing, Serologic; Rh (D) (Bb)",,86901,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,Aetna,Medicare Advantage,22.54,49,,percent of total billed charges,,
"Blood Typing, Serologic; Rh (D) (Bb)",,86901,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Blood Typing, Serologic; Rh (D) (Bb)",,86901,CPT,Facility,Both,,,,46,39.1,13.1836,46,Aetna,PPO,42.78,93,,percent of total billed charges,,
"Blood Typing, Serologic; Rh (D) (Bb)",,86901,CPT,Facility,Both,,,,46,39.1,13.1836,46,America's PPO,America's PPO,44.1738,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Blood Typing, Serologic; Rh (D) (Bb)",,86901,CPT,Facility,Both,,,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota, Federal Employee Program,45.264,98.4,,percent of total billed charges,,
"Blood Typing, Serologic; Rh (D) (Bb)",,86901,CPT,Facility,Both,,,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,46,100,,percent of total billed charges,,
"Blood Typing, Serologic; Rh (D) (Bb)",,86901,CPT,Facility,Both,,,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,High Value Network Plan,41.4,90,,percent of total billed charges,,
"Blood Typing, Serologic; Rh (D) (Bb)",,86901,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Medicare Advantage,22.54,49,,percent of total billed charges,,
"Blood Typing, Serologic; Rh (D) (Bb)",,86901,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Blood Typing, Serologic; Rh (D) (Bb)",,86901,CPT,Facility,Both,,,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,40.7422,88.57,,percent of total billed charges,,
"Blood Typing, Serologic; Rh (D) (Bb)",,86901,CPT,Facility,Both,,,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,13.1836,28.66,,percent of total billed charges,,
"Blood Typing, Serologic; Rh (D) (Bb)",,86901,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),22.54,49,,percent of total billed charges,,
"Blood Typing, Serologic; Rh (D) (Bb)",,86901,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Blood Typing, Serologic; Rh (D) (Bb)",,86901,CPT,Facility,Both,,,,46,39.1,13.1836,46,CorVel,Worker's Compensation,46,100,,percent of total billed charges,,
"Blood Typing, Serologic; Rh (D) (Bb)",,86901,CPT,Facility,Both,,,,46,39.1,13.1836,46,First Health Group Corporation,First Health Network,44.62,97,,percent of total billed charges,,
"Blood Typing, Serologic; Rh (D) (Bb)",,86901,CPT,Facility,Both,,,,46,39.1,13.1836,46,"Health Partners, Inc.",Commercial,43.516,94.6,,percent of total billed charges,,
"Blood Typing, Serologic; Rh (D) (Bb)",,86901,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,"Health Partners, Inc.",Medicare Advantage,22.54,49,,percent of total billed charges,,
"Blood Typing, Serologic; Rh (D) (Bb)",,86901,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Blood Typing, Serologic; Rh (D) (Bb)",,86901,CPT,Facility,Both,,,,46,39.1,13.1836,46,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),27.6,60,,percent of total billed charges,,
"Blood Typing, Serologic; Rh (D) (Bb)",,86901,CPT,Facility,Both,,,,46,39.1,13.1836,46,"Health Partners, Inc.",State of Minnesota Advantage Program,37.49,81.5,,percent of total billed charges,,
"Blood Typing, Serologic; Rh (D) (Bb)",,86901,CPT,Facility,Both,,,,46,39.1,13.1836,46,"Health Partners, Inc.",State Public Programs,23,50,,percent of total billed charges,,
"Blood Typing, Serologic; Rh (D) (Bb)",,86901,CPT,Facility,Both,,,,46,39.1,13.1836,46,Humana Insurance Company,Commercial PPO,43.7,95,,percent of total billed charges,,
"Blood Typing, Serologic; Rh (D) (Bb)",,86901,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,Humana Insurance Company,Medicare PPO,22.54,49,,percent of total billed charges,,
"Blood Typing, Serologic; Rh (D) (Bb)",,86901,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Blood Typing, Serologic; Rh (D) (Bb)",,86901,CPT,Facility,Both,,,,46,39.1,13.1836,46,Medica,Individual & Family,45.586,99.1,,percent of total billed charges,,
"Blood Typing, Serologic; Rh (D) (Bb)",,86901,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,Medica,Medica Advantage Solution,22.908,49.8,,percent of total billed charges,,
"Blood Typing, Serologic; Rh (D) (Bb)",,86901,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Blood Typing, Serologic; Rh (D) (Bb)",,86901,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,Medica,Medical Assistance,20.516,44.6,,percent of total billed charges,,
"Blood Typing, Serologic; Rh (D) (Bb)",,86901,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,Medica,Medical Assistance,,,,,Included in per diem rate,
"Blood Typing, Serologic; Rh (D) (Bb)",,86901,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,22.908,49.8,,percent of total billed charges,,
"Blood Typing, Serologic; Rh (D) (Bb)",,86901,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Blood Typing, Serologic; Rh (D) (Bb)",,86901,CPT,Facility,Both,,,,46,39.1,13.1836,46,"Multiplan, Inc.","Multiplan, Inc.",43.24,94,,percent of total billed charges,,
"Blood Typing, Serologic; Rh (D) (Bb)",,86901,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,39.744,86.4,,percent of total billed charges,,
"Blood Typing, Serologic; Rh (D) (Bb)",,86901,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Blood Typing, Serologic; Rh (D) (Bb)",,86901,CPT,Facility,Both,,,,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PPO,45.356,98.6,,percent of total billed charges,,
"Blood Typing, Serologic; Rh (D) (Bb)",,86901,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,PrimeWest Health,Minnesota Senior Health Options (MSHO),23.667,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Blood Typing, Serologic; Rh (D) (Bb)",,86901,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Blood Typing, Serologic; Rh (D) (Bb)",,86901,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,PrimeWest Health,MinnesotaCare,23.6256,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Blood Typing, Serologic; Rh (D) (Bb)",,86901,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Blood Typing, Serologic; Rh (D) (Bb)",,86901,CPT,Facility,Both,,,,46,39.1,13.1836,46,Sanford Health Plan,Sanford Health Plan,42.32,92,,percent of total billed charges,,
"Blood Typing, Serologic; Rh (D) (Bb)",,86901,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,"UCare Health, Inc.",Individual & Family Plan,25.921,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Blood Typing, Serologic; Rh (D) (Bb)",,86901,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Blood Typing, Serologic; Rh (D) (Bb)",,86901,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,"UCare Health, Inc.",Medical Assistance,23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Blood Typing, Serologic; Rh (D) (Bb)",,86901,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Blood Typing, Serologic; Rh (D) (Bb)",,86901,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,"UCare Health, Inc.",Medicare Advantage,23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Blood Typing, Serologic; Rh (D) (Bb)",,86901,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Blood Typing, Serologic; Rh (D) (Bb)",,86901,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Blood Typing, Serologic; Rh (D) (Bb)",,86901,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Blood Typing, Serologic; Rh (D) (Bb)",,86901,CPT,Facility,Both,,,,46,39.1,13.1836,46,UnitedHealthcare,Individual & Family,43.24,94,,percent of total billed charges,,
"Blood Typing, Serologic; Rh (D) (Bb)",,86901,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,UnitedHealthcare,Medicare Advantage,22.54,49,,percent of total billed charges,,
"Blood Typing, Serologic; Rh (D) (Bb)",,86901,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Blood Typing, Serologic; Rh (D) (Bb)",,86901,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,22.08,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Blood Typing, Serologic; Rh (D) (Bb)",,86901,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Blood Typing, Serologic; Antigen Testing Of Donor Blood Using Reagent Serum, Each Antigen Test (Bb)",,86902,CPT,Facility,Both,,,,89,75.65,25.5074,89,Aetna,Commercial,81.88,92,,percent of total billed charges,,
"Blood Typing, Serologic; Antigen Testing Of Donor Blood Using Reagent Serum, Each Antigen Test (Bb)",,86902,CPT,Facility,Outpatient,,,,89,75.65,25.5074,89,Aetna,Medicare Advantage,43.61,49,,percent of total billed charges,,
"Blood Typing, Serologic; Antigen Testing Of Donor Blood Using Reagent Serum, Each Antigen Test (Bb)",,86902,CPT,Facility,Inpatient,,,,89,75.65,25.5074,89,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Blood Typing, Serologic; Antigen Testing Of Donor Blood Using Reagent Serum, Each Antigen Test (Bb)",,86902,CPT,Facility,Both,,,,89,75.65,25.5074,89,Aetna,PPO,82.77,93,,percent of total billed charges,,
"Blood Typing, Serologic; Antigen Testing Of Donor Blood Using Reagent Serum, Each Antigen Test (Bb)",,86902,CPT,Facility,Both,,,,89,75.65,25.5074,89,America's PPO,America's PPO,85.4667,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Blood Typing, Serologic; Antigen Testing Of Donor Blood Using Reagent Serum, Each Antigen Test (Bb)",,86902,CPT,Facility,Both,,,,89,75.65,25.5074,89,BlueCross BlueShield Minnesota, Federal Employee Program,87.576,98.4,,percent of total billed charges,,
"Blood Typing, Serologic; Antigen Testing Of Donor Blood Using Reagent Serum, Each Antigen Test (Bb)",,86902,CPT,Facility,Both,,,,89,75.65,25.5074,89,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,89,100,,percent of total billed charges,,
"Blood Typing, Serologic; Antigen Testing Of Donor Blood Using Reagent Serum, Each Antigen Test (Bb)",,86902,CPT,Facility,Both,,,,89,75.65,25.5074,89,BlueCross BlueShield Minnesota,High Value Network Plan,80.1,90,,percent of total billed charges,,
"Blood Typing, Serologic; Antigen Testing Of Donor Blood Using Reagent Serum, Each Antigen Test (Bb)",,86902,CPT,Facility,Outpatient,,,,89,75.65,25.5074,89,BlueCross BlueShield Minnesota,Medicare Advantage,43.61,49,,percent of total billed charges,,
"Blood Typing, Serologic; Antigen Testing Of Donor Blood Using Reagent Serum, Each Antigen Test (Bb)",,86902,CPT,Facility,Inpatient,,,,89,75.65,25.5074,89,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Blood Typing, Serologic; Antigen Testing Of Donor Blood Using Reagent Serum, Each Antigen Test (Bb)",,86902,CPT,Facility,Both,,,,89,75.65,25.5074,89,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,78.8273,88.57,,percent of total billed charges,,
"Blood Typing, Serologic; Antigen Testing Of Donor Blood Using Reagent Serum, Each Antigen Test (Bb)",,86902,CPT,Facility,Both,,,,89,75.65,25.5074,89,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,25.5074,28.66,,percent of total billed charges,,
"Blood Typing, Serologic; Antigen Testing Of Donor Blood Using Reagent Serum, Each Antigen Test (Bb)",,86902,CPT,Facility,Outpatient,,,,89,75.65,25.5074,89,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),43.61,49,,percent of total billed charges,,
"Blood Typing, Serologic; Antigen Testing Of Donor Blood Using Reagent Serum, Each Antigen Test (Bb)",,86902,CPT,Facility,Inpatient,,,,89,75.65,25.5074,89,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Blood Typing, Serologic; Antigen Testing Of Donor Blood Using Reagent Serum, Each Antigen Test (Bb)",,86902,CPT,Facility,Both,,,,89,75.65,25.5074,89,CorVel,Worker's Compensation,89,100,,percent of total billed charges,,
"Blood Typing, Serologic; Antigen Testing Of Donor Blood Using Reagent Serum, Each Antigen Test (Bb)",,86902,CPT,Facility,Both,,,,89,75.65,25.5074,89,First Health Group Corporation,First Health Network,86.33,97,,percent of total billed charges,,
"Blood Typing, Serologic; Antigen Testing Of Donor Blood Using Reagent Serum, Each Antigen Test (Bb)",,86902,CPT,Facility,Both,,,,89,75.65,25.5074,89,"Health Partners, Inc.",Commercial,84.194,94.6,,percent of total billed charges,,
"Blood Typing, Serologic; Antigen Testing Of Donor Blood Using Reagent Serum, Each Antigen Test (Bb)",,86902,CPT,Facility,Outpatient,,,,89,75.65,25.5074,89,"Health Partners, Inc.",Medicare Advantage,43.61,49,,percent of total billed charges,,
"Blood Typing, Serologic; Antigen Testing Of Donor Blood Using Reagent Serum, Each Antigen Test (Bb)",,86902,CPT,Facility,Inpatient,,,,89,75.65,25.5074,89,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Blood Typing, Serologic; Antigen Testing Of Donor Blood Using Reagent Serum, Each Antigen Test (Bb)",,86902,CPT,Facility,Both,,,,89,75.65,25.5074,89,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),53.4,60,,percent of total billed charges,,
"Blood Typing, Serologic; Antigen Testing Of Donor Blood Using Reagent Serum, Each Antigen Test (Bb)",,86902,CPT,Facility,Both,,,,89,75.65,25.5074,89,"Health Partners, Inc.",State of Minnesota Advantage Program,72.535,81.5,,percent of total billed charges,,
"Blood Typing, Serologic; Antigen Testing Of Donor Blood Using Reagent Serum, Each Antigen Test (Bb)",,86902,CPT,Facility,Both,,,,89,75.65,25.5074,89,"Health Partners, Inc.",State Public Programs,44.5,50,,percent of total billed charges,,
"Blood Typing, Serologic; Antigen Testing Of Donor Blood Using Reagent Serum, Each Antigen Test (Bb)",,86902,CPT,Facility,Both,,,,89,75.65,25.5074,89,Humana Insurance Company,Commercial PPO,84.55,95,,percent of total billed charges,,
"Blood Typing, Serologic; Antigen Testing Of Donor Blood Using Reagent Serum, Each Antigen Test (Bb)",,86902,CPT,Facility,Outpatient,,,,89,75.65,25.5074,89,Humana Insurance Company,Medicare PPO,43.61,49,,percent of total billed charges,,
"Blood Typing, Serologic; Antigen Testing Of Donor Blood Using Reagent Serum, Each Antigen Test (Bb)",,86902,CPT,Facility,Inpatient,,,,89,75.65,25.5074,89,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Blood Typing, Serologic; Antigen Testing Of Donor Blood Using Reagent Serum, Each Antigen Test (Bb)",,86902,CPT,Facility,Both,,,,89,75.65,25.5074,89,Medica,Individual & Family,88.199,99.1,,percent of total billed charges,,
"Blood Typing, Serologic; Antigen Testing Of Donor Blood Using Reagent Serum, Each Antigen Test (Bb)",,86902,CPT,Facility,Outpatient,,,,89,75.65,25.5074,89,Medica,Medica Advantage Solution,44.322,49.8,,percent of total billed charges,,
"Blood Typing, Serologic; Antigen Testing Of Donor Blood Using Reagent Serum, Each Antigen Test (Bb)",,86902,CPT,Facility,Inpatient,,,,89,75.65,25.5074,89,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Blood Typing, Serologic; Antigen Testing Of Donor Blood Using Reagent Serum, Each Antigen Test (Bb)",,86902,CPT,Facility,Outpatient,,,,89,75.65,25.5074,89,Medica,Medical Assistance,39.694,44.6,,percent of total billed charges,,
"Blood Typing, Serologic; Antigen Testing Of Donor Blood Using Reagent Serum, Each Antigen Test (Bb)",,86902,CPT,Facility,Inpatient,,,,89,75.65,25.5074,89,Medica,Medical Assistance,,,,,Included in per diem rate,
"Blood Typing, Serologic; Antigen Testing Of Donor Blood Using Reagent Serum, Each Antigen Test (Bb)",,86902,CPT,Facility,Outpatient,,,,89,75.65,25.5074,89,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,44.322,49.8,,percent of total billed charges,,
"Blood Typing, Serologic; Antigen Testing Of Donor Blood Using Reagent Serum, Each Antigen Test (Bb)",,86902,CPT,Facility,Inpatient,,,,89,75.65,25.5074,89,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Blood Typing, Serologic; Antigen Testing Of Donor Blood Using Reagent Serum, Each Antigen Test (Bb)",,86902,CPT,Facility,Both,,,,89,75.65,25.5074,89,"Multiplan, Inc.","Multiplan, Inc.",83.66,94,,percent of total billed charges,,
"Blood Typing, Serologic; Antigen Testing Of Donor Blood Using Reagent Serum, Each Antigen Test (Bb)",,86902,CPT,Facility,Outpatient,,,,89,75.65,25.5074,89,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,76.896,86.4,,percent of total billed charges,,
"Blood Typing, Serologic; Antigen Testing Of Donor Blood Using Reagent Serum, Each Antigen Test (Bb)",,86902,CPT,Facility,Inpatient,,,,89,75.65,25.5074,89,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Blood Typing, Serologic; Antigen Testing Of Donor Blood Using Reagent Serum, Each Antigen Test (Bb)",,86902,CPT,Facility,Both,,,,89,75.65,25.5074,89,"Preferred One Administrative Services, INC.",PPO,87.754,98.6,,percent of total billed charges,,
"Blood Typing, Serologic; Antigen Testing Of Donor Blood Using Reagent Serum, Each Antigen Test (Bb)",,86902,CPT,Facility,Outpatient,,,,89,75.65,25.5074,89,PrimeWest Health,Minnesota Senior Health Options (MSHO),45.7905,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Blood Typing, Serologic; Antigen Testing Of Donor Blood Using Reagent Serum, Each Antigen Test (Bb)",,86902,CPT,Facility,Inpatient,,,,89,75.65,25.5074,89,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Blood Typing, Serologic; Antigen Testing Of Donor Blood Using Reagent Serum, Each Antigen Test (Bb)",,86902,CPT,Facility,Outpatient,,,,89,75.65,25.5074,89,PrimeWest Health,MinnesotaCare,45.7104,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Blood Typing, Serologic; Antigen Testing Of Donor Blood Using Reagent Serum, Each Antigen Test (Bb)",,86902,CPT,Facility,Inpatient,,,,89,75.65,25.5074,89,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Blood Typing, Serologic; Antigen Testing Of Donor Blood Using Reagent Serum, Each Antigen Test (Bb)",,86902,CPT,Facility,Both,,,,89,75.65,25.5074,89,Sanford Health Plan,Sanford Health Plan,81.88,92,,percent of total billed charges,,
"Blood Typing, Serologic; Antigen Testing Of Donor Blood Using Reagent Serum, Each Antigen Test (Bb)",,86902,CPT,Facility,Outpatient,,,,89,75.65,25.5074,89,"UCare Health, Inc.",Individual & Family Plan,50.1515,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Blood Typing, Serologic; Antigen Testing Of Donor Blood Using Reagent Serum, Each Antigen Test (Bb)",,86902,CPT,Facility,Inpatient,,,,89,75.65,25.5074,89,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Blood Typing, Serologic; Antigen Testing Of Donor Blood Using Reagent Serum, Each Antigen Test (Bb)",,86902,CPT,Facility,Outpatient,,,,89,75.65,25.5074,89,"UCare Health, Inc.",Medical Assistance,44.9183,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Blood Typing, Serologic; Antigen Testing Of Donor Blood Using Reagent Serum, Each Antigen Test (Bb)",,86902,CPT,Facility,Inpatient,,,,89,75.65,25.5074,89,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Blood Typing, Serologic; Antigen Testing Of Donor Blood Using Reagent Serum, Each Antigen Test (Bb)",,86902,CPT,Facility,Outpatient,,,,89,75.65,25.5074,89,"UCare Health, Inc.",Medicare Advantage,44.9183,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Blood Typing, Serologic; Antigen Testing Of Donor Blood Using Reagent Serum, Each Antigen Test (Bb)",,86902,CPT,Facility,Inpatient,,,,89,75.65,25.5074,89,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Blood Typing, Serologic; Antigen Testing Of Donor Blood Using Reagent Serum, Each Antigen Test (Bb)",,86902,CPT,Facility,Outpatient,,,,89,75.65,25.5074,89,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),44.9183,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Blood Typing, Serologic; Antigen Testing Of Donor Blood Using Reagent Serum, Each Antigen Test (Bb)",,86902,CPT,Facility,Inpatient,,,,89,75.65,25.5074,89,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Blood Typing, Serologic; Antigen Testing Of Donor Blood Using Reagent Serum, Each Antigen Test (Bb)",,86902,CPT,Facility,Both,,,,89,75.65,25.5074,89,UnitedHealthcare,Individual & Family,83.66,94,,percent of total billed charges,,
"Blood Typing, Serologic; Antigen Testing Of Donor Blood Using Reagent Serum, Each Antigen Test (Bb)",,86902,CPT,Facility,Outpatient,,,,89,75.65,25.5074,89,UnitedHealthcare,Medicare Advantage,43.61,49,,percent of total billed charges,,
"Blood Typing, Serologic; Antigen Testing Of Donor Blood Using Reagent Serum, Each Antigen Test (Bb)",,86902,CPT,Facility,Inpatient,,,,89,75.65,25.5074,89,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Blood Typing, Serologic; Antigen Testing Of Donor Blood Using Reagent Serum, Each Antigen Test (Bb)",,86902,CPT,Facility,Outpatient,,,,89,75.65,25.5074,89,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,42.72,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Blood Typing, Serologic; Antigen Testing Of Donor Blood Using Reagent Serum, Each Antigen Test (Bb)",,86902,CPT,Facility,Inpatient,,,,89,75.65,25.5074,89,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Blood Typing, Serologic; Rbc Antigens, Other Than Abo Or Rh (D), Each (Bb)",,86905,CPT,Facility,Both,,,,82,69.7,23.5012,82,Aetna,Commercial,75.44,92,,percent of total billed charges,,
"Blood Typing, Serologic; Rbc Antigens, Other Than Abo Or Rh (D), Each (Bb)",,86905,CPT,Facility,Outpatient,,,,82,69.7,23.5012,82,Aetna,Medicare Advantage,40.18,49,,percent of total billed charges,,
"Blood Typing, Serologic; Rbc Antigens, Other Than Abo Or Rh (D), Each (Bb)",,86905,CPT,Facility,Inpatient,,,,82,69.7,23.5012,82,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Blood Typing, Serologic; Rbc Antigens, Other Than Abo Or Rh (D), Each (Bb)",,86905,CPT,Facility,Both,,,,82,69.7,23.5012,82,Aetna,PPO,76.26,93,,percent of total billed charges,,
"Blood Typing, Serologic; Rbc Antigens, Other Than Abo Or Rh (D), Each (Bb)",,86905,CPT,Facility,Both,,,,82,69.7,23.5012,82,America's PPO,America's PPO,78.7446,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Blood Typing, Serologic; Rbc Antigens, Other Than Abo Or Rh (D), Each (Bb)",,86905,CPT,Facility,Both,,,,82,69.7,23.5012,82,BlueCross BlueShield Minnesota, Federal Employee Program,80.688,98.4,,percent of total billed charges,,
"Blood Typing, Serologic; Rbc Antigens, Other Than Abo Or Rh (D), Each (Bb)",,86905,CPT,Facility,Both,,,,82,69.7,23.5012,82,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,82,100,,percent of total billed charges,,
"Blood Typing, Serologic; Rbc Antigens, Other Than Abo Or Rh (D), Each (Bb)",,86905,CPT,Facility,Both,,,,82,69.7,23.5012,82,BlueCross BlueShield Minnesota,High Value Network Plan,73.8,90,,percent of total billed charges,,
"Blood Typing, Serologic; Rbc Antigens, Other Than Abo Or Rh (D), Each (Bb)",,86905,CPT,Facility,Outpatient,,,,82,69.7,23.5012,82,BlueCross BlueShield Minnesota,Medicare Advantage,40.18,49,,percent of total billed charges,,
"Blood Typing, Serologic; Rbc Antigens, Other Than Abo Or Rh (D), Each (Bb)",,86905,CPT,Facility,Inpatient,,,,82,69.7,23.5012,82,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Blood Typing, Serologic; Rbc Antigens, Other Than Abo Or Rh (D), Each (Bb)",,86905,CPT,Facility,Both,,,,82,69.7,23.5012,82,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,72.6274,88.57,,percent of total billed charges,,
"Blood Typing, Serologic; Rbc Antigens, Other Than Abo Or Rh (D), Each (Bb)",,86905,CPT,Facility,Both,,,,82,69.7,23.5012,82,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,23.5012,28.66,,percent of total billed charges,,
"Blood Typing, Serologic; Rbc Antigens, Other Than Abo Or Rh (D), Each (Bb)",,86905,CPT,Facility,Outpatient,,,,82,69.7,23.5012,82,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),40.18,49,,percent of total billed charges,,
"Blood Typing, Serologic; Rbc Antigens, Other Than Abo Or Rh (D), Each (Bb)",,86905,CPT,Facility,Inpatient,,,,82,69.7,23.5012,82,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Blood Typing, Serologic; Rbc Antigens, Other Than Abo Or Rh (D), Each (Bb)",,86905,CPT,Facility,Both,,,,82,69.7,23.5012,82,CorVel,Worker's Compensation,82,100,,percent of total billed charges,,
"Blood Typing, Serologic; Rbc Antigens, Other Than Abo Or Rh (D), Each (Bb)",,86905,CPT,Facility,Both,,,,82,69.7,23.5012,82,First Health Group Corporation,First Health Network,79.54,97,,percent of total billed charges,,
"Blood Typing, Serologic; Rbc Antigens, Other Than Abo Or Rh (D), Each (Bb)",,86905,CPT,Facility,Both,,,,82,69.7,23.5012,82,"Health Partners, Inc.",Commercial,77.572,94.6,,percent of total billed charges,,
"Blood Typing, Serologic; Rbc Antigens, Other Than Abo Or Rh (D), Each (Bb)",,86905,CPT,Facility,Outpatient,,,,82,69.7,23.5012,82,"Health Partners, Inc.",Medicare Advantage,40.18,49,,percent of total billed charges,,
"Blood Typing, Serologic; Rbc Antigens, Other Than Abo Or Rh (D), Each (Bb)",,86905,CPT,Facility,Inpatient,,,,82,69.7,23.5012,82,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Blood Typing, Serologic; Rbc Antigens, Other Than Abo Or Rh (D), Each (Bb)",,86905,CPT,Facility,Both,,,,82,69.7,23.5012,82,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),49.2,60,,percent of total billed charges,,
"Blood Typing, Serologic; Rbc Antigens, Other Than Abo Or Rh (D), Each (Bb)",,86905,CPT,Facility,Both,,,,82,69.7,23.5012,82,"Health Partners, Inc.",State of Minnesota Advantage Program,66.83,81.5,,percent of total billed charges,,
"Blood Typing, Serologic; Rbc Antigens, Other Than Abo Or Rh (D), Each (Bb)",,86905,CPT,Facility,Both,,,,82,69.7,23.5012,82,"Health Partners, Inc.",State Public Programs,41,50,,percent of total billed charges,,
"Blood Typing, Serologic; Rbc Antigens, Other Than Abo Or Rh (D), Each (Bb)",,86905,CPT,Facility,Both,,,,82,69.7,23.5012,82,Humana Insurance Company,Commercial PPO,77.9,95,,percent of total billed charges,,
"Blood Typing, Serologic; Rbc Antigens, Other Than Abo Or Rh (D), Each (Bb)",,86905,CPT,Facility,Outpatient,,,,82,69.7,23.5012,82,Humana Insurance Company,Medicare PPO,40.18,49,,percent of total billed charges,,
"Blood Typing, Serologic; Rbc Antigens, Other Than Abo Or Rh (D), Each (Bb)",,86905,CPT,Facility,Inpatient,,,,82,69.7,23.5012,82,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Blood Typing, Serologic; Rbc Antigens, Other Than Abo Or Rh (D), Each (Bb)",,86905,CPT,Facility,Both,,,,82,69.7,23.5012,82,Medica,Individual & Family,81.262,99.1,,percent of total billed charges,,
"Blood Typing, Serologic; Rbc Antigens, Other Than Abo Or Rh (D), Each (Bb)",,86905,CPT,Facility,Outpatient,,,,82,69.7,23.5012,82,Medica,Medica Advantage Solution,40.836,49.8,,percent of total billed charges,,
"Blood Typing, Serologic; Rbc Antigens, Other Than Abo Or Rh (D), Each (Bb)",,86905,CPT,Facility,Inpatient,,,,82,69.7,23.5012,82,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Blood Typing, Serologic; Rbc Antigens, Other Than Abo Or Rh (D), Each (Bb)",,86905,CPT,Facility,Outpatient,,,,82,69.7,23.5012,82,Medica,Medical Assistance,36.572,44.6,,percent of total billed charges,,
"Blood Typing, Serologic; Rbc Antigens, Other Than Abo Or Rh (D), Each (Bb)",,86905,CPT,Facility,Inpatient,,,,82,69.7,23.5012,82,Medica,Medical Assistance,,,,,Included in per diem rate,
"Blood Typing, Serologic; Rbc Antigens, Other Than Abo Or Rh (D), Each (Bb)",,86905,CPT,Facility,Outpatient,,,,82,69.7,23.5012,82,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,40.836,49.8,,percent of total billed charges,,
"Blood Typing, Serologic; Rbc Antigens, Other Than Abo Or Rh (D), Each (Bb)",,86905,CPT,Facility,Inpatient,,,,82,69.7,23.5012,82,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Blood Typing, Serologic; Rbc Antigens, Other Than Abo Or Rh (D), Each (Bb)",,86905,CPT,Facility,Both,,,,82,69.7,23.5012,82,"Multiplan, Inc.","Multiplan, Inc.",77.08,94,,percent of total billed charges,,
"Blood Typing, Serologic; Rbc Antigens, Other Than Abo Or Rh (D), Each (Bb)",,86905,CPT,Facility,Outpatient,,,,82,69.7,23.5012,82,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,70.848,86.4,,percent of total billed charges,,
"Blood Typing, Serologic; Rbc Antigens, Other Than Abo Or Rh (D), Each (Bb)",,86905,CPT,Facility,Inpatient,,,,82,69.7,23.5012,82,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Blood Typing, Serologic; Rbc Antigens, Other Than Abo Or Rh (D), Each (Bb)",,86905,CPT,Facility,Both,,,,82,69.7,23.5012,82,"Preferred One Administrative Services, INC.",PPO,80.852,98.6,,percent of total billed charges,,
"Blood Typing, Serologic; Rbc Antigens, Other Than Abo Or Rh (D), Each (Bb)",,86905,CPT,Facility,Outpatient,,,,82,69.7,23.5012,82,PrimeWest Health,Minnesota Senior Health Options (MSHO),42.189,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Blood Typing, Serologic; Rbc Antigens, Other Than Abo Or Rh (D), Each (Bb)",,86905,CPT,Facility,Inpatient,,,,82,69.7,23.5012,82,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Blood Typing, Serologic; Rbc Antigens, Other Than Abo Or Rh (D), Each (Bb)",,86905,CPT,Facility,Outpatient,,,,82,69.7,23.5012,82,PrimeWest Health,MinnesotaCare,42.1152,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Blood Typing, Serologic; Rbc Antigens, Other Than Abo Or Rh (D), Each (Bb)",,86905,CPT,Facility,Inpatient,,,,82,69.7,23.5012,82,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Blood Typing, Serologic; Rbc Antigens, Other Than Abo Or Rh (D), Each (Bb)",,86905,CPT,Facility,Both,,,,82,69.7,23.5012,82,Sanford Health Plan,Sanford Health Plan,75.44,92,,percent of total billed charges,,
"Blood Typing, Serologic; Rbc Antigens, Other Than Abo Or Rh (D), Each (Bb)",,86905,CPT,Facility,Outpatient,,,,82,69.7,23.5012,82,"UCare Health, Inc.",Individual & Family Plan,46.207,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Blood Typing, Serologic; Rbc Antigens, Other Than Abo Or Rh (D), Each (Bb)",,86905,CPT,Facility,Inpatient,,,,82,69.7,23.5012,82,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Blood Typing, Serologic; Rbc Antigens, Other Than Abo Or Rh (D), Each (Bb)",,86905,CPT,Facility,Outpatient,,,,82,69.7,23.5012,82,"UCare Health, Inc.",Medical Assistance,41.3854,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Blood Typing, Serologic; Rbc Antigens, Other Than Abo Or Rh (D), Each (Bb)",,86905,CPT,Facility,Inpatient,,,,82,69.7,23.5012,82,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Blood Typing, Serologic; Rbc Antigens, Other Than Abo Or Rh (D), Each (Bb)",,86905,CPT,Facility,Outpatient,,,,82,69.7,23.5012,82,"UCare Health, Inc.",Medicare Advantage,41.3854,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Blood Typing, Serologic; Rbc Antigens, Other Than Abo Or Rh (D), Each (Bb)",,86905,CPT,Facility,Inpatient,,,,82,69.7,23.5012,82,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Blood Typing, Serologic; Rbc Antigens, Other Than Abo Or Rh (D), Each (Bb)",,86905,CPT,Facility,Outpatient,,,,82,69.7,23.5012,82,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),41.3854,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Blood Typing, Serologic; Rbc Antigens, Other Than Abo Or Rh (D), Each (Bb)",,86905,CPT,Facility,Inpatient,,,,82,69.7,23.5012,82,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Blood Typing, Serologic; Rbc Antigens, Other Than Abo Or Rh (D), Each (Bb)",,86905,CPT,Facility,Both,,,,82,69.7,23.5012,82,UnitedHealthcare,Individual & Family,77.08,94,,percent of total billed charges,,
"Blood Typing, Serologic; Rbc Antigens, Other Than Abo Or Rh (D), Each (Bb)",,86905,CPT,Facility,Outpatient,,,,82,69.7,23.5012,82,UnitedHealthcare,Medicare Advantage,40.18,49,,percent of total billed charges,,
"Blood Typing, Serologic; Rbc Antigens, Other Than Abo Or Rh (D), Each (Bb)",,86905,CPT,Facility,Inpatient,,,,82,69.7,23.5012,82,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Blood Typing, Serologic; Rbc Antigens, Other Than Abo Or Rh (D), Each (Bb)",,86905,CPT,Facility,Outpatient,,,,82,69.7,23.5012,82,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,39.36,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Blood Typing, Serologic; Rbc Antigens, Other Than Abo Or Rh (D), Each (Bb)",,86905,CPT,Facility,Inpatient,,,,82,69.7,23.5012,82,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Compatibility Test Each Unit; Immediate Spin Technique (Bb),,86920,CPT,Facility,Both,,,,120,102,34.392,120,Aetna,Commercial,110.4,92,,percent of total billed charges,,
Compatibility Test Each Unit; Immediate Spin Technique (Bb),,86920,CPT,Facility,Outpatient,,,,120,102,34.392,120,Aetna,Medicare Advantage,58.8,49,,percent of total billed charges,,
Compatibility Test Each Unit; Immediate Spin Technique (Bb),,86920,CPT,Facility,Inpatient,,,,120,102,34.392,120,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Compatibility Test Each Unit; Immediate Spin Technique (Bb),,86920,CPT,Facility,Both,,,,120,102,34.392,120,Aetna,PPO,111.6,93,,percent of total billed charges,,
Compatibility Test Each Unit; Immediate Spin Technique (Bb),,86920,CPT,Facility,Both,,,,120,102,34.392,120,America's PPO,America's PPO,115.236,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Compatibility Test Each Unit; Immediate Spin Technique (Bb),,86920,CPT,Facility,Both,,,,120,102,34.392,120,BlueCross BlueShield Minnesota, Federal Employee Program,118.08,98.4,,percent of total billed charges,,
Compatibility Test Each Unit; Immediate Spin Technique (Bb),,86920,CPT,Facility,Both,,,,120,102,34.392,120,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,120,100,,percent of total billed charges,,
Compatibility Test Each Unit; Immediate Spin Technique (Bb),,86920,CPT,Facility,Both,,,,120,102,34.392,120,BlueCross BlueShield Minnesota,High Value Network Plan,108,90,,percent of total billed charges,,
Compatibility Test Each Unit; Immediate Spin Technique (Bb),,86920,CPT,Facility,Outpatient,,,,120,102,34.392,120,BlueCross BlueShield Minnesota,Medicare Advantage,58.8,49,,percent of total billed charges,,
Compatibility Test Each Unit; Immediate Spin Technique (Bb),,86920,CPT,Facility,Inpatient,,,,120,102,34.392,120,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Compatibility Test Each Unit; Immediate Spin Technique (Bb),,86920,CPT,Facility,Both,,,,120,102,34.392,120,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,106.284,88.57,,percent of total billed charges,,
Compatibility Test Each Unit; Immediate Spin Technique (Bb),,86920,CPT,Facility,Both,,,,120,102,34.392,120,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,34.392,28.66,,percent of total billed charges,,
Compatibility Test Each Unit; Immediate Spin Technique (Bb),,86920,CPT,Facility,Outpatient,,,,120,102,34.392,120,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),58.8,49,,percent of total billed charges,,
Compatibility Test Each Unit; Immediate Spin Technique (Bb),,86920,CPT,Facility,Inpatient,,,,120,102,34.392,120,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Compatibility Test Each Unit; Immediate Spin Technique (Bb),,86920,CPT,Facility,Both,,,,120,102,34.392,120,CorVel,Worker's Compensation,120,100,,percent of total billed charges,,
Compatibility Test Each Unit; Immediate Spin Technique (Bb),,86920,CPT,Facility,Both,,,,120,102,34.392,120,First Health Group Corporation,First Health Network,116.4,97,,percent of total billed charges,,
Compatibility Test Each Unit; Immediate Spin Technique (Bb),,86920,CPT,Facility,Both,,,,120,102,34.392,120,"Health Partners, Inc.",Commercial,113.52,94.6,,percent of total billed charges,,
Compatibility Test Each Unit; Immediate Spin Technique (Bb),,86920,CPT,Facility,Outpatient,,,,120,102,34.392,120,"Health Partners, Inc.",Medicare Advantage,58.8,49,,percent of total billed charges,,
Compatibility Test Each Unit; Immediate Spin Technique (Bb),,86920,CPT,Facility,Inpatient,,,,120,102,34.392,120,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Compatibility Test Each Unit; Immediate Spin Technique (Bb),,86920,CPT,Facility,Both,,,,120,102,34.392,120,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),72,60,,percent of total billed charges,,
Compatibility Test Each Unit; Immediate Spin Technique (Bb),,86920,CPT,Facility,Both,,,,120,102,34.392,120,"Health Partners, Inc.",State of Minnesota Advantage Program,97.8,81.5,,percent of total billed charges,,
Compatibility Test Each Unit; Immediate Spin Technique (Bb),,86920,CPT,Facility,Both,,,,120,102,34.392,120,"Health Partners, Inc.",State Public Programs,60,50,,percent of total billed charges,,
Compatibility Test Each Unit; Immediate Spin Technique (Bb),,86920,CPT,Facility,Both,,,,120,102,34.392,120,Humana Insurance Company,Commercial PPO,114,95,,percent of total billed charges,,
Compatibility Test Each Unit; Immediate Spin Technique (Bb),,86920,CPT,Facility,Outpatient,,,,120,102,34.392,120,Humana Insurance Company,Medicare PPO,58.8,49,,percent of total billed charges,,
Compatibility Test Each Unit; Immediate Spin Technique (Bb),,86920,CPT,Facility,Inpatient,,,,120,102,34.392,120,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Compatibility Test Each Unit; Immediate Spin Technique (Bb),,86920,CPT,Facility,Both,,,,120,102,34.392,120,Medica,Individual & Family,118.92,99.1,,percent of total billed charges,,
Compatibility Test Each Unit; Immediate Spin Technique (Bb),,86920,CPT,Facility,Outpatient,,,,120,102,34.392,120,Medica,Medica Advantage Solution,59.76,49.8,,percent of total billed charges,,
Compatibility Test Each Unit; Immediate Spin Technique (Bb),,86920,CPT,Facility,Inpatient,,,,120,102,34.392,120,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Compatibility Test Each Unit; Immediate Spin Technique (Bb),,86920,CPT,Facility,Outpatient,,,,120,102,34.392,120,Medica,Medical Assistance,53.52,44.6,,percent of total billed charges,,
Compatibility Test Each Unit; Immediate Spin Technique (Bb),,86920,CPT,Facility,Inpatient,,,,120,102,34.392,120,Medica,Medical Assistance,,,,,Included in per diem rate,
Compatibility Test Each Unit; Immediate Spin Technique (Bb),,86920,CPT,Facility,Outpatient,,,,120,102,34.392,120,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,59.76,49.8,,percent of total billed charges,,
Compatibility Test Each Unit; Immediate Spin Technique (Bb),,86920,CPT,Facility,Inpatient,,,,120,102,34.392,120,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Compatibility Test Each Unit; Immediate Spin Technique (Bb),,86920,CPT,Facility,Both,,,,120,102,34.392,120,"Multiplan, Inc.","Multiplan, Inc.",112.8,94,,percent of total billed charges,,
Compatibility Test Each Unit; Immediate Spin Technique (Bb),,86920,CPT,Facility,Outpatient,,,,120,102,34.392,120,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,103.68,86.4,,percent of total billed charges,,
Compatibility Test Each Unit; Immediate Spin Technique (Bb),,86920,CPT,Facility,Inpatient,,,,120,102,34.392,120,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Compatibility Test Each Unit; Immediate Spin Technique (Bb),,86920,CPT,Facility,Both,,,,120,102,34.392,120,"Preferred One Administrative Services, INC.",PPO,118.32,98.6,,percent of total billed charges,,
Compatibility Test Each Unit; Immediate Spin Technique (Bb),,86920,CPT,Facility,Outpatient,,,,120,102,34.392,120,PrimeWest Health,Minnesota Senior Health Options (MSHO),61.74,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Compatibility Test Each Unit; Immediate Spin Technique (Bb),,86920,CPT,Facility,Inpatient,,,,120,102,34.392,120,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Compatibility Test Each Unit; Immediate Spin Technique (Bb),,86920,CPT,Facility,Outpatient,,,,120,102,34.392,120,PrimeWest Health,MinnesotaCare,61.632,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Compatibility Test Each Unit; Immediate Spin Technique (Bb),,86920,CPT,Facility,Inpatient,,,,120,102,34.392,120,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Compatibility Test Each Unit; Immediate Spin Technique (Bb),,86920,CPT,Facility,Both,,,,120,102,34.392,120,Sanford Health Plan,Sanford Health Plan,110.4,92,,percent of total billed charges,,
Compatibility Test Each Unit; Immediate Spin Technique (Bb),,86920,CPT,Facility,Outpatient,,,,120,102,34.392,120,"UCare Health, Inc.",Individual & Family Plan,67.62,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Compatibility Test Each Unit; Immediate Spin Technique (Bb),,86920,CPT,Facility,Inpatient,,,,120,102,34.392,120,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Compatibility Test Each Unit; Immediate Spin Technique (Bb),,86920,CPT,Facility,Outpatient,,,,120,102,34.392,120,"UCare Health, Inc.",Medical Assistance,60.564,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Compatibility Test Each Unit; Immediate Spin Technique (Bb),,86920,CPT,Facility,Inpatient,,,,120,102,34.392,120,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Compatibility Test Each Unit; Immediate Spin Technique (Bb),,86920,CPT,Facility,Outpatient,,,,120,102,34.392,120,"UCare Health, Inc.",Medicare Advantage,60.564,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Compatibility Test Each Unit; Immediate Spin Technique (Bb),,86920,CPT,Facility,Inpatient,,,,120,102,34.392,120,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Compatibility Test Each Unit; Immediate Spin Technique (Bb),,86920,CPT,Facility,Outpatient,,,,120,102,34.392,120,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),60.564,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Compatibility Test Each Unit; Immediate Spin Technique (Bb),,86920,CPT,Facility,Inpatient,,,,120,102,34.392,120,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Compatibility Test Each Unit; Immediate Spin Technique (Bb),,86920,CPT,Facility,Both,,,,120,102,34.392,120,UnitedHealthcare,Individual & Family,112.8,94,,percent of total billed charges,,
Compatibility Test Each Unit; Immediate Spin Technique (Bb),,86920,CPT,Facility,Outpatient,,,,120,102,34.392,120,UnitedHealthcare,Medicare Advantage,58.8,49,,percent of total billed charges,,
Compatibility Test Each Unit; Immediate Spin Technique (Bb),,86920,CPT,Facility,Inpatient,,,,120,102,34.392,120,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Compatibility Test Each Unit; Immediate Spin Technique (Bb),,86920,CPT,Facility,Outpatient,,,,120,102,34.392,120,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,57.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
Compatibility Test Each Unit; Immediate Spin Technique (Bb),,86920,CPT,Facility,Inpatient,,,,120,102,34.392,120,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Crossmatch Albumin (Bb),,86921,CPT,Facility,Both,,,,129,109.65,36.9714,129,Aetna,Commercial,118.68,92,,percent of total billed charges,,
Crossmatch Albumin (Bb),,86921,CPT,Facility,Outpatient,,,,129,109.65,36.9714,129,Aetna,Medicare Advantage,63.21,49,,percent of total billed charges,,
Crossmatch Albumin (Bb),,86921,CPT,Facility,Inpatient,,,,129,109.65,36.9714,129,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Crossmatch Albumin (Bb),,86921,CPT,Facility,Both,,,,129,109.65,36.9714,129,Aetna,PPO,119.97,93,,percent of total billed charges,,
Crossmatch Albumin (Bb),,86921,CPT,Facility,Both,,,,129,109.65,36.9714,129,America's PPO,America's PPO,123.8787,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Crossmatch Albumin (Bb),,86921,CPT,Facility,Both,,,,129,109.65,36.9714,129,BlueCross BlueShield Minnesota, Federal Employee Program,126.936,98.4,,percent of total billed charges,,
Crossmatch Albumin (Bb),,86921,CPT,Facility,Both,,,,129,109.65,36.9714,129,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,129,100,,percent of total billed charges,,
Crossmatch Albumin (Bb),,86921,CPT,Facility,Both,,,,129,109.65,36.9714,129,BlueCross BlueShield Minnesota,High Value Network Plan,116.1,90,,percent of total billed charges,,
Crossmatch Albumin (Bb),,86921,CPT,Facility,Outpatient,,,,129,109.65,36.9714,129,BlueCross BlueShield Minnesota,Medicare Advantage,63.21,49,,percent of total billed charges,,
Crossmatch Albumin (Bb),,86921,CPT,Facility,Inpatient,,,,129,109.65,36.9714,129,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Crossmatch Albumin (Bb),,86921,CPT,Facility,Both,,,,129,109.65,36.9714,129,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,114.2553,88.57,,percent of total billed charges,,
Crossmatch Albumin (Bb),,86921,CPT,Facility,Both,,,,129,109.65,36.9714,129,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,36.9714,28.66,,percent of total billed charges,,
Crossmatch Albumin (Bb),,86921,CPT,Facility,Outpatient,,,,129,109.65,36.9714,129,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),63.21,49,,percent of total billed charges,,
Crossmatch Albumin (Bb),,86921,CPT,Facility,Inpatient,,,,129,109.65,36.9714,129,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Crossmatch Albumin (Bb),,86921,CPT,Facility,Both,,,,129,109.65,36.9714,129,CorVel,Worker's Compensation,129,100,,percent of total billed charges,,
Crossmatch Albumin (Bb),,86921,CPT,Facility,Both,,,,129,109.65,36.9714,129,First Health Group Corporation,First Health Network,125.13,97,,percent of total billed charges,,
Crossmatch Albumin (Bb),,86921,CPT,Facility,Both,,,,129,109.65,36.9714,129,"Health Partners, Inc.",Commercial,122.034,94.6,,percent of total billed charges,,
Crossmatch Albumin (Bb),,86921,CPT,Facility,Outpatient,,,,129,109.65,36.9714,129,"Health Partners, Inc.",Medicare Advantage,63.21,49,,percent of total billed charges,,
Crossmatch Albumin (Bb),,86921,CPT,Facility,Inpatient,,,,129,109.65,36.9714,129,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Crossmatch Albumin (Bb),,86921,CPT,Facility,Both,,,,129,109.65,36.9714,129,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),77.4,60,,percent of total billed charges,,
Crossmatch Albumin (Bb),,86921,CPT,Facility,Both,,,,129,109.65,36.9714,129,"Health Partners, Inc.",State of Minnesota Advantage Program,105.135,81.5,,percent of total billed charges,,
Crossmatch Albumin (Bb),,86921,CPT,Facility,Both,,,,129,109.65,36.9714,129,"Health Partners, Inc.",State Public Programs,64.5,50,,percent of total billed charges,,
Crossmatch Albumin (Bb),,86921,CPT,Facility,Both,,,,129,109.65,36.9714,129,Humana Insurance Company,Commercial PPO,122.55,95,,percent of total billed charges,,
Crossmatch Albumin (Bb),,86921,CPT,Facility,Outpatient,,,,129,109.65,36.9714,129,Humana Insurance Company,Medicare PPO,63.21,49,,percent of total billed charges,,
Crossmatch Albumin (Bb),,86921,CPT,Facility,Inpatient,,,,129,109.65,36.9714,129,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Crossmatch Albumin (Bb),,86921,CPT,Facility,Both,,,,129,109.65,36.9714,129,Medica,Individual & Family,127.839,99.1,,percent of total billed charges,,
Crossmatch Albumin (Bb),,86921,CPT,Facility,Outpatient,,,,129,109.65,36.9714,129,Medica,Medica Advantage Solution,64.242,49.8,,percent of total billed charges,,
Crossmatch Albumin (Bb),,86921,CPT,Facility,Inpatient,,,,129,109.65,36.9714,129,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Crossmatch Albumin (Bb),,86921,CPT,Facility,Outpatient,,,,129,109.65,36.9714,129,Medica,Medical Assistance,57.534,44.6,,percent of total billed charges,,
Crossmatch Albumin (Bb),,86921,CPT,Facility,Inpatient,,,,129,109.65,36.9714,129,Medica,Medical Assistance,,,,,Included in per diem rate,
Crossmatch Albumin (Bb),,86921,CPT,Facility,Outpatient,,,,129,109.65,36.9714,129,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,64.242,49.8,,percent of total billed charges,,
Crossmatch Albumin (Bb),,86921,CPT,Facility,Inpatient,,,,129,109.65,36.9714,129,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Crossmatch Albumin (Bb),,86921,CPT,Facility,Both,,,,129,109.65,36.9714,129,"Multiplan, Inc.","Multiplan, Inc.",121.26,94,,percent of total billed charges,,
Crossmatch Albumin (Bb),,86921,CPT,Facility,Outpatient,,,,129,109.65,36.9714,129,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,111.456,86.4,,percent of total billed charges,,
Crossmatch Albumin (Bb),,86921,CPT,Facility,Inpatient,,,,129,109.65,36.9714,129,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Crossmatch Albumin (Bb),,86921,CPT,Facility,Both,,,,129,109.65,36.9714,129,"Preferred One Administrative Services, INC.",PPO,127.194,98.6,,percent of total billed charges,,
Crossmatch Albumin (Bb),,86921,CPT,Facility,Outpatient,,,,129,109.65,36.9714,129,PrimeWest Health,Minnesota Senior Health Options (MSHO),66.3705,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Crossmatch Albumin (Bb),,86921,CPT,Facility,Inpatient,,,,129,109.65,36.9714,129,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Crossmatch Albumin (Bb),,86921,CPT,Facility,Outpatient,,,,129,109.65,36.9714,129,PrimeWest Health,MinnesotaCare,66.2544,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Crossmatch Albumin (Bb),,86921,CPT,Facility,Inpatient,,,,129,109.65,36.9714,129,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Crossmatch Albumin (Bb),,86921,CPT,Facility,Both,,,,129,109.65,36.9714,129,Sanford Health Plan,Sanford Health Plan,118.68,92,,percent of total billed charges,,
Crossmatch Albumin (Bb),,86921,CPT,Facility,Outpatient,,,,129,109.65,36.9714,129,"UCare Health, Inc.",Individual & Family Plan,72.6915,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Crossmatch Albumin (Bb),,86921,CPT,Facility,Inpatient,,,,129,109.65,36.9714,129,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Crossmatch Albumin (Bb),,86921,CPT,Facility,Outpatient,,,,129,109.65,36.9714,129,"UCare Health, Inc.",Medical Assistance,65.1063,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Crossmatch Albumin (Bb),,86921,CPT,Facility,Inpatient,,,,129,109.65,36.9714,129,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Crossmatch Albumin (Bb),,86921,CPT,Facility,Outpatient,,,,129,109.65,36.9714,129,"UCare Health, Inc.",Medicare Advantage,65.1063,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Crossmatch Albumin (Bb),,86921,CPT,Facility,Inpatient,,,,129,109.65,36.9714,129,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Crossmatch Albumin (Bb),,86921,CPT,Facility,Outpatient,,,,129,109.65,36.9714,129,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),65.1063,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Crossmatch Albumin (Bb),,86921,CPT,Facility,Inpatient,,,,129,109.65,36.9714,129,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Crossmatch Albumin (Bb),,86921,CPT,Facility,Both,,,,129,109.65,36.9714,129,UnitedHealthcare,Individual & Family,121.26,94,,percent of total billed charges,,
Crossmatch Albumin (Bb),,86921,CPT,Facility,Outpatient,,,,129,109.65,36.9714,129,UnitedHealthcare,Medicare Advantage,63.21,49,,percent of total billed charges,,
Crossmatch Albumin (Bb),,86921,CPT,Facility,Inpatient,,,,129,109.65,36.9714,129,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Crossmatch Albumin (Bb),,86921,CPT,Facility,Outpatient,,,,129,109.65,36.9714,129,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,61.92,48,,percent of total billed charges,,100% of DHS outpatient percentage
Crossmatch Albumin (Bb),,86921,CPT,Facility,Inpatient,,,,129,109.65,36.9714,129,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Compatibility Test Each Unit; Antiglobulin Technique (Bb),,86922,CPT,Facility,Both,,,,150,127.5,42.99,150,Aetna,Commercial,138,92,,percent of total billed charges,,
Compatibility Test Each Unit; Antiglobulin Technique (Bb),,86922,CPT,Facility,Outpatient,,,,150,127.5,42.99,150,Aetna,Medicare Advantage,73.5,49,,percent of total billed charges,,
Compatibility Test Each Unit; Antiglobulin Technique (Bb),,86922,CPT,Facility,Inpatient,,,,150,127.5,42.99,150,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Compatibility Test Each Unit; Antiglobulin Technique (Bb),,86922,CPT,Facility,Both,,,,150,127.5,42.99,150,Aetna,PPO,139.5,93,,percent of total billed charges,,
Compatibility Test Each Unit; Antiglobulin Technique (Bb),,86922,CPT,Facility,Both,,,,150,127.5,42.99,150,America's PPO,America's PPO,144.045,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Compatibility Test Each Unit; Antiglobulin Technique (Bb),,86922,CPT,Facility,Both,,,,150,127.5,42.99,150,BlueCross BlueShield Minnesota, Federal Employee Program,147.6,98.4,,percent of total billed charges,,
Compatibility Test Each Unit; Antiglobulin Technique (Bb),,86922,CPT,Facility,Both,,,,150,127.5,42.99,150,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,150,100,,percent of total billed charges,,
Compatibility Test Each Unit; Antiglobulin Technique (Bb),,86922,CPT,Facility,Both,,,,150,127.5,42.99,150,BlueCross BlueShield Minnesota,High Value Network Plan,135,90,,percent of total billed charges,,
Compatibility Test Each Unit; Antiglobulin Technique (Bb),,86922,CPT,Facility,Outpatient,,,,150,127.5,42.99,150,BlueCross BlueShield Minnesota,Medicare Advantage,73.5,49,,percent of total billed charges,,
Compatibility Test Each Unit; Antiglobulin Technique (Bb),,86922,CPT,Facility,Inpatient,,,,150,127.5,42.99,150,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Compatibility Test Each Unit; Antiglobulin Technique (Bb),,86922,CPT,Facility,Both,,,,150,127.5,42.99,150,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,132.855,88.57,,percent of total billed charges,,
Compatibility Test Each Unit; Antiglobulin Technique (Bb),,86922,CPT,Facility,Both,,,,150,127.5,42.99,150,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,42.99,28.66,,percent of total billed charges,,
Compatibility Test Each Unit; Antiglobulin Technique (Bb),,86922,CPT,Facility,Outpatient,,,,150,127.5,42.99,150,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),73.5,49,,percent of total billed charges,,
Compatibility Test Each Unit; Antiglobulin Technique (Bb),,86922,CPT,Facility,Inpatient,,,,150,127.5,42.99,150,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Compatibility Test Each Unit; Antiglobulin Technique (Bb),,86922,CPT,Facility,Both,,,,150,127.5,42.99,150,CorVel,Worker's Compensation,150,100,,percent of total billed charges,,
Compatibility Test Each Unit; Antiglobulin Technique (Bb),,86922,CPT,Facility,Both,,,,150,127.5,42.99,150,First Health Group Corporation,First Health Network,145.5,97,,percent of total billed charges,,
Compatibility Test Each Unit; Antiglobulin Technique (Bb),,86922,CPT,Facility,Both,,,,150,127.5,42.99,150,"Health Partners, Inc.",Commercial,141.9,94.6,,percent of total billed charges,,
Compatibility Test Each Unit; Antiglobulin Technique (Bb),,86922,CPT,Facility,Outpatient,,,,150,127.5,42.99,150,"Health Partners, Inc.",Medicare Advantage,73.5,49,,percent of total billed charges,,
Compatibility Test Each Unit; Antiglobulin Technique (Bb),,86922,CPT,Facility,Inpatient,,,,150,127.5,42.99,150,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Compatibility Test Each Unit; Antiglobulin Technique (Bb),,86922,CPT,Facility,Both,,,,150,127.5,42.99,150,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),90,60,,percent of total billed charges,,
Compatibility Test Each Unit; Antiglobulin Technique (Bb),,86922,CPT,Facility,Both,,,,150,127.5,42.99,150,"Health Partners, Inc.",State of Minnesota Advantage Program,122.25,81.5,,percent of total billed charges,,
Compatibility Test Each Unit; Antiglobulin Technique (Bb),,86922,CPT,Facility,Both,,,,150,127.5,42.99,150,"Health Partners, Inc.",State Public Programs,75,50,,percent of total billed charges,,
Compatibility Test Each Unit; Antiglobulin Technique (Bb),,86922,CPT,Facility,Both,,,,150,127.5,42.99,150,Humana Insurance Company,Commercial PPO,142.5,95,,percent of total billed charges,,
Compatibility Test Each Unit; Antiglobulin Technique (Bb),,86922,CPT,Facility,Outpatient,,,,150,127.5,42.99,150,Humana Insurance Company,Medicare PPO,73.5,49,,percent of total billed charges,,
Compatibility Test Each Unit; Antiglobulin Technique (Bb),,86922,CPT,Facility,Inpatient,,,,150,127.5,42.99,150,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Compatibility Test Each Unit; Antiglobulin Technique (Bb),,86922,CPT,Facility,Both,,,,150,127.5,42.99,150,Medica,Individual & Family,148.65,99.1,,percent of total billed charges,,
Compatibility Test Each Unit; Antiglobulin Technique (Bb),,86922,CPT,Facility,Outpatient,,,,150,127.5,42.99,150,Medica,Medica Advantage Solution,74.7,49.8,,percent of total billed charges,,
Compatibility Test Each Unit; Antiglobulin Technique (Bb),,86922,CPT,Facility,Inpatient,,,,150,127.5,42.99,150,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Compatibility Test Each Unit; Antiglobulin Technique (Bb),,86922,CPT,Facility,Outpatient,,,,150,127.5,42.99,150,Medica,Medical Assistance,66.9,44.6,,percent of total billed charges,,
Compatibility Test Each Unit; Antiglobulin Technique (Bb),,86922,CPT,Facility,Inpatient,,,,150,127.5,42.99,150,Medica,Medical Assistance,,,,,Included in per diem rate,
Compatibility Test Each Unit; Antiglobulin Technique (Bb),,86922,CPT,Facility,Outpatient,,,,150,127.5,42.99,150,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,74.7,49.8,,percent of total billed charges,,
Compatibility Test Each Unit; Antiglobulin Technique (Bb),,86922,CPT,Facility,Inpatient,,,,150,127.5,42.99,150,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Compatibility Test Each Unit; Antiglobulin Technique (Bb),,86922,CPT,Facility,Both,,,,150,127.5,42.99,150,"Multiplan, Inc.","Multiplan, Inc.",141,94,,percent of total billed charges,,
Compatibility Test Each Unit; Antiglobulin Technique (Bb),,86922,CPT,Facility,Outpatient,,,,150,127.5,42.99,150,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,129.6,86.4,,percent of total billed charges,,
Compatibility Test Each Unit; Antiglobulin Technique (Bb),,86922,CPT,Facility,Inpatient,,,,150,127.5,42.99,150,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Compatibility Test Each Unit; Antiglobulin Technique (Bb),,86922,CPT,Facility,Both,,,,150,127.5,42.99,150,"Preferred One Administrative Services, INC.",PPO,147.9,98.6,,percent of total billed charges,,
Compatibility Test Each Unit; Antiglobulin Technique (Bb),,86922,CPT,Facility,Outpatient,,,,150,127.5,42.99,150,PrimeWest Health,Minnesota Senior Health Options (MSHO),77.175,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Compatibility Test Each Unit; Antiglobulin Technique (Bb),,86922,CPT,Facility,Inpatient,,,,150,127.5,42.99,150,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Compatibility Test Each Unit; Antiglobulin Technique (Bb),,86922,CPT,Facility,Outpatient,,,,150,127.5,42.99,150,PrimeWest Health,MinnesotaCare,77.04,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Compatibility Test Each Unit; Antiglobulin Technique (Bb),,86922,CPT,Facility,Inpatient,,,,150,127.5,42.99,150,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Compatibility Test Each Unit; Antiglobulin Technique (Bb),,86922,CPT,Facility,Both,,,,150,127.5,42.99,150,Sanford Health Plan,Sanford Health Plan,138,92,,percent of total billed charges,,
Compatibility Test Each Unit; Antiglobulin Technique (Bb),,86922,CPT,Facility,Outpatient,,,,150,127.5,42.99,150,"UCare Health, Inc.",Individual & Family Plan,84.525,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Compatibility Test Each Unit; Antiglobulin Technique (Bb),,86922,CPT,Facility,Inpatient,,,,150,127.5,42.99,150,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Compatibility Test Each Unit; Antiglobulin Technique (Bb),,86922,CPT,Facility,Outpatient,,,,150,127.5,42.99,150,"UCare Health, Inc.",Medical Assistance,75.705,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Compatibility Test Each Unit; Antiglobulin Technique (Bb),,86922,CPT,Facility,Inpatient,,,,150,127.5,42.99,150,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Compatibility Test Each Unit; Antiglobulin Technique (Bb),,86922,CPT,Facility,Outpatient,,,,150,127.5,42.99,150,"UCare Health, Inc.",Medicare Advantage,75.705,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Compatibility Test Each Unit; Antiglobulin Technique (Bb),,86922,CPT,Facility,Inpatient,,,,150,127.5,42.99,150,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Compatibility Test Each Unit; Antiglobulin Technique (Bb),,86922,CPT,Facility,Outpatient,,,,150,127.5,42.99,150,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),75.705,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Compatibility Test Each Unit; Antiglobulin Technique (Bb),,86922,CPT,Facility,Inpatient,,,,150,127.5,42.99,150,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Compatibility Test Each Unit; Antiglobulin Technique (Bb),,86922,CPT,Facility,Both,,,,150,127.5,42.99,150,UnitedHealthcare,Individual & Family,141,94,,percent of total billed charges,,
Compatibility Test Each Unit; Antiglobulin Technique (Bb),,86922,CPT,Facility,Outpatient,,,,150,127.5,42.99,150,UnitedHealthcare,Medicare Advantage,73.5,49,,percent of total billed charges,,
Compatibility Test Each Unit; Antiglobulin Technique (Bb),,86922,CPT,Facility,Inpatient,,,,150,127.5,42.99,150,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Compatibility Test Each Unit; Antiglobulin Technique (Bb),,86922,CPT,Facility,Outpatient,,,,150,127.5,42.99,150,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,72,48,,percent of total billed charges,,100% of DHS outpatient percentage
Compatibility Test Each Unit; Antiglobulin Technique (Bb),,86922,CPT,Facility,Inpatient,,,,150,127.5,42.99,150,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Irradiation Of Blood Product, Each Unit (Bb)",,86945,CPT,Facility,Both,,,,51,43.35,14.6166,51,Aetna,Commercial,46.92,92,,percent of total billed charges,,
"Irradiation Of Blood Product, Each Unit (Bb)",,86945,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,Aetna,Medicare Advantage,24.99,49,,percent of total billed charges,,
"Irradiation Of Blood Product, Each Unit (Bb)",,86945,CPT,Facility,Inpatient,,,,51,43.35,14.6166,51,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Irradiation Of Blood Product, Each Unit (Bb)",,86945,CPT,Facility,Both,,,,51,43.35,14.6166,51,Aetna,PPO,47.43,93,,percent of total billed charges,,
"Irradiation Of Blood Product, Each Unit (Bb)",,86945,CPT,Facility,Both,,,,51,43.35,14.6166,51,America's PPO,America's PPO,48.9753,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Irradiation Of Blood Product, Each Unit (Bb)",,86945,CPT,Facility,Both,,,,51,43.35,14.6166,51,BlueCross BlueShield Minnesota, Federal Employee Program,50.184,98.4,,percent of total billed charges,,
"Irradiation Of Blood Product, Each Unit (Bb)",,86945,CPT,Facility,Both,,,,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,51,100,,percent of total billed charges,,
"Irradiation Of Blood Product, Each Unit (Bb)",,86945,CPT,Facility,Both,,,,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,High Value Network Plan,45.9,90,,percent of total billed charges,,
"Irradiation Of Blood Product, Each Unit (Bb)",,86945,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,Medicare Advantage,24.99,49,,percent of total billed charges,,
"Irradiation Of Blood Product, Each Unit (Bb)",,86945,CPT,Facility,Inpatient,,,,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Irradiation Of Blood Product, Each Unit (Bb)",,86945,CPT,Facility,Both,,,,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,45.1707,88.57,,percent of total billed charges,,
"Irradiation Of Blood Product, Each Unit (Bb)",,86945,CPT,Facility,Both,,,,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,14.6166,28.66,,percent of total billed charges,,
"Irradiation Of Blood Product, Each Unit (Bb)",,86945,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),24.99,49,,percent of total billed charges,,
"Irradiation Of Blood Product, Each Unit (Bb)",,86945,CPT,Facility,Inpatient,,,,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Irradiation Of Blood Product, Each Unit (Bb)",,86945,CPT,Facility,Both,,,,51,43.35,14.6166,51,CorVel,Worker's Compensation,51,100,,percent of total billed charges,,
"Irradiation Of Blood Product, Each Unit (Bb)",,86945,CPT,Facility,Both,,,,51,43.35,14.6166,51,First Health Group Corporation,First Health Network,49.47,97,,percent of total billed charges,,
"Irradiation Of Blood Product, Each Unit (Bb)",,86945,CPT,Facility,Both,,,,51,43.35,14.6166,51,"Health Partners, Inc.",Commercial,48.246,94.6,,percent of total billed charges,,
"Irradiation Of Blood Product, Each Unit (Bb)",,86945,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,"Health Partners, Inc.",Medicare Advantage,24.99,49,,percent of total billed charges,,
"Irradiation Of Blood Product, Each Unit (Bb)",,86945,CPT,Facility,Inpatient,,,,51,43.35,14.6166,51,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Irradiation Of Blood Product, Each Unit (Bb)",,86945,CPT,Facility,Both,,,,51,43.35,14.6166,51,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),30.6,60,,percent of total billed charges,,
"Irradiation Of Blood Product, Each Unit (Bb)",,86945,CPT,Facility,Both,,,,51,43.35,14.6166,51,"Health Partners, Inc.",State of Minnesota Advantage Program,41.565,81.5,,percent of total billed charges,,
"Irradiation Of Blood Product, Each Unit (Bb)",,86945,CPT,Facility,Both,,,,51,43.35,14.6166,51,"Health Partners, Inc.",State Public Programs,25.5,50,,percent of total billed charges,,
"Irradiation Of Blood Product, Each Unit (Bb)",,86945,CPT,Facility,Both,,,,51,43.35,14.6166,51,Humana Insurance Company,Commercial PPO,48.45,95,,percent of total billed charges,,
"Irradiation Of Blood Product, Each Unit (Bb)",,86945,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,Humana Insurance Company,Medicare PPO,24.99,49,,percent of total billed charges,,
"Irradiation Of Blood Product, Each Unit (Bb)",,86945,CPT,Facility,Inpatient,,,,51,43.35,14.6166,51,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Irradiation Of Blood Product, Each Unit (Bb)",,86945,CPT,Facility,Both,,,,51,43.35,14.6166,51,Medica,Individual & Family,50.541,99.1,,percent of total billed charges,,
"Irradiation Of Blood Product, Each Unit (Bb)",,86945,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,Medica,Medica Advantage Solution,25.398,49.8,,percent of total billed charges,,
"Irradiation Of Blood Product, Each Unit (Bb)",,86945,CPT,Facility,Inpatient,,,,51,43.35,14.6166,51,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Irradiation Of Blood Product, Each Unit (Bb)",,86945,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,Medica,Medical Assistance,22.746,44.6,,percent of total billed charges,,
"Irradiation Of Blood Product, Each Unit (Bb)",,86945,CPT,Facility,Inpatient,,,,51,43.35,14.6166,51,Medica,Medical Assistance,,,,,Included in per diem rate,
"Irradiation Of Blood Product, Each Unit (Bb)",,86945,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,25.398,49.8,,percent of total billed charges,,
"Irradiation Of Blood Product, Each Unit (Bb)",,86945,CPT,Facility,Inpatient,,,,51,43.35,14.6166,51,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Irradiation Of Blood Product, Each Unit (Bb)",,86945,CPT,Facility,Both,,,,51,43.35,14.6166,51,"Multiplan, Inc.","Multiplan, Inc.",47.94,94,,percent of total billed charges,,
"Irradiation Of Blood Product, Each Unit (Bb)",,86945,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,44.064,86.4,,percent of total billed charges,,
"Irradiation Of Blood Product, Each Unit (Bb)",,86945,CPT,Facility,Inpatient,,,,51,43.35,14.6166,51,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Irradiation Of Blood Product, Each Unit (Bb)",,86945,CPT,Facility,Both,,,,51,43.35,14.6166,51,"Preferred One Administrative Services, INC.",PPO,50.286,98.6,,percent of total billed charges,,
"Irradiation Of Blood Product, Each Unit (Bb)",,86945,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,PrimeWest Health,Minnesota Senior Health Options (MSHO),26.2395,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Irradiation Of Blood Product, Each Unit (Bb)",,86945,CPT,Facility,Inpatient,,,,51,43.35,14.6166,51,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Irradiation Of Blood Product, Each Unit (Bb)",,86945,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,PrimeWest Health,MinnesotaCare,26.1936,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Irradiation Of Blood Product, Each Unit (Bb)",,86945,CPT,Facility,Inpatient,,,,51,43.35,14.6166,51,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Irradiation Of Blood Product, Each Unit (Bb)",,86945,CPT,Facility,Both,,,,51,43.35,14.6166,51,Sanford Health Plan,Sanford Health Plan,46.92,92,,percent of total billed charges,,
"Irradiation Of Blood Product, Each Unit (Bb)",,86945,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,"UCare Health, Inc.",Individual & Family Plan,28.7385,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Irradiation Of Blood Product, Each Unit (Bb)",,86945,CPT,Facility,Inpatient,,,,51,43.35,14.6166,51,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Irradiation Of Blood Product, Each Unit (Bb)",,86945,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,"UCare Health, Inc.",Medical Assistance,25.7397,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Irradiation Of Blood Product, Each Unit (Bb)",,86945,CPT,Facility,Inpatient,,,,51,43.35,14.6166,51,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Irradiation Of Blood Product, Each Unit (Bb)",,86945,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,"UCare Health, Inc.",Medicare Advantage,25.7397,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Irradiation Of Blood Product, Each Unit (Bb)",,86945,CPT,Facility,Inpatient,,,,51,43.35,14.6166,51,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Irradiation Of Blood Product, Each Unit (Bb)",,86945,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),25.7397,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Irradiation Of Blood Product, Each Unit (Bb)",,86945,CPT,Facility,Inpatient,,,,51,43.35,14.6166,51,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Irradiation Of Blood Product, Each Unit (Bb)",,86945,CPT,Facility,Both,,,,51,43.35,14.6166,51,UnitedHealthcare,Individual & Family,47.94,94,,percent of total billed charges,,
"Irradiation Of Blood Product, Each Unit (Bb)",,86945,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,UnitedHealthcare,Medicare Advantage,24.99,49,,percent of total billed charges,,
"Irradiation Of Blood Product, Each Unit (Bb)",,86945,CPT,Facility,Inpatient,,,,51,43.35,14.6166,51,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Irradiation Of Blood Product, Each Unit (Bb)",,86945,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,24.48,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Irradiation Of Blood Product, Each Unit (Bb)",,86945,CPT,Facility,Inpatient,,,,51,43.35,14.6166,51,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
HALOPERIDOL LACTATE 5 MG/ML INJ SOLN,,J1630,HCPCS,Facility,Both,10,mL,,290,246.5,83.114,290,Aetna,Commercial,266.8,92,,percent of total billed charges,,
HALOPERIDOL LACTATE 5 MG/ML INJ SOLN,,J1630,HCPCS,Facility,Outpatient,10,mL,,290,246.5,83.114,290,Aetna,Medicare Advantage,142.1,49,,percent of total billed charges,,
HALOPERIDOL LACTATE 5 MG/ML INJ SOLN,,J1630,HCPCS,Facility,Inpatient,10,mL,,290,246.5,83.114,290,Aetna,Medicare Advantage,,,,,Included in per diem rate,
HALOPERIDOL LACTATE 5 MG/ML INJ SOLN,,J1630,HCPCS,Facility,Both,10,mL,,290,246.5,83.114,290,Aetna,PPO,269.7,93,,percent of total billed charges,,
HALOPERIDOL LACTATE 5 MG/ML INJ SOLN,,J1630,HCPCS,Facility,Both,10,mL,,290,246.5,83.114,290,America's PPO,America's PPO,278.487,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
HALOPERIDOL LACTATE 5 MG/ML INJ SOLN,,J1630,HCPCS,Facility,Both,10,mL,,290,246.5,83.114,290,BlueCross BlueShield Minnesota, Federal Employee Program,285.36,98.4,,percent of total billed charges,,
HALOPERIDOL LACTATE 5 MG/ML INJ SOLN,,J1630,HCPCS,Facility,Both,10,mL,,290,246.5,83.114,290,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,290,100,,percent of total billed charges,,
HALOPERIDOL LACTATE 5 MG/ML INJ SOLN,,J1630,HCPCS,Facility,Both,10,mL,,290,246.5,83.114,290,BlueCross BlueShield Minnesota,High Value Network Plan,261,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
HALOPERIDOL LACTATE 5 MG/ML INJ SOLN,,J1630,HCPCS,Facility,Outpatient,10,mL,,290,246.5,83.114,290,BlueCross BlueShield Minnesota,Medicare Advantage,142.1,49,,percent of total billed charges,,
HALOPERIDOL LACTATE 5 MG/ML INJ SOLN,,J1630,HCPCS,Facility,Inpatient,10,mL,,290,246.5,83.114,290,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
HALOPERIDOL LACTATE 5 MG/ML INJ SOLN,,J1630,HCPCS,Facility,Both,10,mL,,290,246.5,83.114,290,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,256.853,88.57,,percent of total billed charges,,
HALOPERIDOL LACTATE 5 MG/ML INJ SOLN,,J1630,HCPCS,Facility,Both,10,mL,,290,246.5,83.114,290,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,83.114,28.66,,percent of total billed charges,,
HALOPERIDOL LACTATE 5 MG/ML INJ SOLN,,J1630,HCPCS,Facility,Outpatient,10,mL,,290,246.5,83.114,290,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),142.1,49,,percent of total billed charges,,
HALOPERIDOL LACTATE 5 MG/ML INJ SOLN,,J1630,HCPCS,Facility,Inpatient,10,mL,,290,246.5,83.114,290,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
HALOPERIDOL LACTATE 5 MG/ML INJ SOLN,,J1630,HCPCS,Facility,Both,10,mL,,290,246.5,83.114,290,CorVel,Worker's Compensation,290,100,,percent of total billed charges,,
HALOPERIDOL LACTATE 5 MG/ML INJ SOLN,,J1630,HCPCS,Facility,Both,10,mL,,290,246.5,83.114,290,First Health Group Corporation,First Health Network,281.3,97,,percent of total billed charges,,
HALOPERIDOL LACTATE 5 MG/ML INJ SOLN,,J1630,HCPCS,Facility,Both,10,mL,,290,246.5,83.114,290,"Health Partners, Inc.",Commercial,274.34,94.6,,percent of total billed charges,,
HALOPERIDOL LACTATE 5 MG/ML INJ SOLN,,J1630,HCPCS,Facility,Outpatient,10,mL,,290,246.5,83.114,290,"Health Partners, Inc.",Medicare Advantage,142.1,49,,percent of total billed charges,,
HALOPERIDOL LACTATE 5 MG/ML INJ SOLN,,J1630,HCPCS,Facility,Inpatient,10,mL,,290,246.5,83.114,290,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
HALOPERIDOL LACTATE 5 MG/ML INJ SOLN,,J1630,HCPCS,Facility,Both,10,mL,,290,246.5,83.114,290,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),174,60,,percent of total billed charges,,
HALOPERIDOL LACTATE 5 MG/ML INJ SOLN,,J1630,HCPCS,Facility,Both,10,mL,,290,246.5,83.114,290,"Health Partners, Inc.",State of Minnesota Advantage Program,236.35,81.5,,percent of total billed charges,,
HALOPERIDOL LACTATE 5 MG/ML INJ SOLN,,J1630,HCPCS,Facility,Both,10,mL,,290,246.5,83.114,290,"Health Partners, Inc.",State Public Programs,145,50,,percent of total billed charges,,
HALOPERIDOL LACTATE 5 MG/ML INJ SOLN,,J1630,HCPCS,Facility,Both,10,mL,,290,246.5,83.114,290,Humana Insurance Company,Commercial PPO,275.5,95,,percent of total billed charges,,
HALOPERIDOL LACTATE 5 MG/ML INJ SOLN,,J1630,HCPCS,Facility,Outpatient,10,mL,,290,246.5,83.114,290,Humana Insurance Company,Medicare PPO,142.1,49,,percent of total billed charges,,
HALOPERIDOL LACTATE 5 MG/ML INJ SOLN,,J1630,HCPCS,Facility,Inpatient,10,mL,,290,246.5,83.114,290,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
HALOPERIDOL LACTATE 5 MG/ML INJ SOLN,,J1630,HCPCS,Facility,Both,10,mL,,290,246.5,83.114,290,Medica,Individual & Family,287.39,99.1,,percent of total billed charges,,
HALOPERIDOL LACTATE 5 MG/ML INJ SOLN,,J1630,HCPCS,Facility,Outpatient,10,mL,,290,246.5,83.114,290,Medica,Medica Advantage Solution,144.42,49.8,,percent of total billed charges,,
HALOPERIDOL LACTATE 5 MG/ML INJ SOLN,,J1630,HCPCS,Facility,Inpatient,10,mL,,290,246.5,83.114,290,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
HALOPERIDOL LACTATE 5 MG/ML INJ SOLN,,J1630,HCPCS,Facility,Outpatient,10,mL,,290,246.5,83.114,290,Medica,Medical Assistance,129.34,44.6,,percent of total billed charges,,
HALOPERIDOL LACTATE 5 MG/ML INJ SOLN,,J1630,HCPCS,Facility,Inpatient,10,mL,,290,246.5,83.114,290,Medica,Medical Assistance,,,,,Included in per diem rate,
HALOPERIDOL LACTATE 5 MG/ML INJ SOLN,,J1630,HCPCS,Facility,Outpatient,10,mL,,290,246.5,83.114,290,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,144.42,49.8,,percent of total billed charges,,
HALOPERIDOL LACTATE 5 MG/ML INJ SOLN,,J1630,HCPCS,Facility,Inpatient,10,mL,,290,246.5,83.114,290,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
HALOPERIDOL LACTATE 5 MG/ML INJ SOLN,,J1630,HCPCS,Facility,Both,10,mL,,290,246.5,83.114,290,"Multiplan, Inc.","Multiplan, Inc.",272.6,94,,percent of total billed charges,,
HALOPERIDOL LACTATE 5 MG/ML INJ SOLN,,J1630,HCPCS,Facility,Outpatient,10,mL,,290,246.5,83.114,290,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,261.29,90.1,,percent of total billed charges,,
HALOPERIDOL LACTATE 5 MG/ML INJ SOLN,,J1630,HCPCS,Facility,Inpatient,10,mL,,290,246.5,83.114,290,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
HALOPERIDOL LACTATE 5 MG/ML INJ SOLN,,J1630,HCPCS,Facility,Both,10,mL,,290,246.5,83.114,290,"Preferred One Administrative Services, INC.",PPO,285.94,98.6,,percent of total billed charges,,
HALOPERIDOL LACTATE 5 MG/ML INJ SOLN,,J1630,HCPCS,Facility,Outpatient,10,mL,,290,246.5,83.114,290,PrimeWest Health,Minnesota Senior Health Options (MSHO),149.205,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
HALOPERIDOL LACTATE 5 MG/ML INJ SOLN,,J1630,HCPCS,Facility,Inpatient,10,mL,,290,246.5,83.114,290,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
HALOPERIDOL LACTATE 5 MG/ML INJ SOLN,,J1630,HCPCS,Facility,Outpatient,10,mL,,290,246.5,83.114,290,PrimeWest Health,MinnesotaCare,148.944,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
HALOPERIDOL LACTATE 5 MG/ML INJ SOLN,,J1630,HCPCS,Facility,Inpatient,10,mL,,290,246.5,83.114,290,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
HALOPERIDOL LACTATE 5 MG/ML INJ SOLN,,J1630,HCPCS,Facility,Both,10,mL,,290,246.5,83.114,290,Sanford Health Plan,Sanford Health Plan,266.8,92,,percent of total billed charges,,
HALOPERIDOL LACTATE 5 MG/ML INJ SOLN,,J1630,HCPCS,Facility,Outpatient,10,mL,,290,246.5,83.114,290,"UCare Health, Inc.",Individual & Family Plan,163.415,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
HALOPERIDOL LACTATE 5 MG/ML INJ SOLN,,J1630,HCPCS,Facility,Inpatient,10,mL,,290,246.5,83.114,290,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
HALOPERIDOL LACTATE 5 MG/ML INJ SOLN,,J1630,HCPCS,Facility,Outpatient,10,mL,,290,246.5,83.114,290,"UCare Health, Inc.",Medical Assistance,146.363,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
HALOPERIDOL LACTATE 5 MG/ML INJ SOLN,,J1630,HCPCS,Facility,Inpatient,10,mL,,290,246.5,83.114,290,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
HALOPERIDOL LACTATE 5 MG/ML INJ SOLN,,J1630,HCPCS,Facility,Outpatient,10,mL,,290,246.5,83.114,290,"UCare Health, Inc.",Medicare Advantage,146.363,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
HALOPERIDOL LACTATE 5 MG/ML INJ SOLN,,J1630,HCPCS,Facility,Inpatient,10,mL,,290,246.5,83.114,290,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
HALOPERIDOL LACTATE 5 MG/ML INJ SOLN,,J1630,HCPCS,Facility,Outpatient,10,mL,,290,246.5,83.114,290,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),146.363,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
HALOPERIDOL LACTATE 5 MG/ML INJ SOLN,,J1630,HCPCS,Facility,Inpatient,10,mL,,290,246.5,83.114,290,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
HALOPERIDOL LACTATE 5 MG/ML INJ SOLN,,J1630,HCPCS,Facility,Both,10,mL,,290,246.5,83.114,290,UnitedHealthcare,Individual & Family,272.6,94,,percent of total billed charges,,
HALOPERIDOL LACTATE 5 MG/ML INJ SOLN,,J1630,HCPCS,Facility,Outpatient,10,mL,,290,246.5,83.114,290,UnitedHealthcare,Medicare Advantage,142.1,49,,percent of total billed charges,,
HALOPERIDOL LACTATE 5 MG/ML INJ SOLN,,J1630,HCPCS,Facility,Inpatient,10,mL,,290,246.5,83.114,290,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
HALOPERIDOL LACTATE 5 MG/ML INJ SOLN,,J1630,HCPCS,Facility,Outpatient,10,mL,,290,246.5,83.114,290,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,139.2,48,,percent of total billed charges,,100% of DHS outpatient percentage
HALOPERIDOL LACTATE 5 MG/ML INJ SOLN,,J1630,HCPCS,Facility,Inpatient,10,mL,,290,246.5,83.114,290,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Blood Culture,,87040,CPT,Facility,Both,,,,138,117.3,39.5508,138,Aetna,Commercial,126.96,92,,percent of total billed charges,,
Blood Culture,,87040,CPT,Facility,Outpatient,,,,138,117.3,39.5508,138,Aetna,Medicare Advantage,67.62,49,,percent of total billed charges,,
Blood Culture,,87040,CPT,Facility,Inpatient,,,,138,117.3,39.5508,138,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Blood Culture,,87040,CPT,Facility,Both,,,,138,117.3,39.5508,138,Aetna,PPO,128.34,93,,percent of total billed charges,,
Blood Culture,,87040,CPT,Facility,Both,,,,138,117.3,39.5508,138,America's PPO,America's PPO,132.5214,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Blood Culture,,87040,CPT,Facility,Both,,,,138,117.3,39.5508,138,BlueCross BlueShield Minnesota, Federal Employee Program,135.792,98.4,,percent of total billed charges,,
Blood Culture,,87040,CPT,Facility,Both,,,,138,117.3,39.5508,138,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,138,100,,percent of total billed charges,,
Blood Culture,,87040,CPT,Facility,Both,,,,138,117.3,39.5508,138,BlueCross BlueShield Minnesota,High Value Network Plan,124.2,90,,percent of total billed charges,,
Blood Culture,,87040,CPT,Facility,Outpatient,,,,138,117.3,39.5508,138,BlueCross BlueShield Minnesota,Medicare Advantage,67.62,49,,percent of total billed charges,,
Blood Culture,,87040,CPT,Facility,Inpatient,,,,138,117.3,39.5508,138,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Blood Culture,,87040,CPT,Facility,Both,,,,138,117.3,39.5508,138,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,122.2266,88.57,,percent of total billed charges,,
Blood Culture,,87040,CPT,Facility,Both,,,,138,117.3,39.5508,138,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,39.5508,28.66,,percent of total billed charges,,
Blood Culture,,87040,CPT,Facility,Outpatient,,,,138,117.3,39.5508,138,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),67.62,49,,percent of total billed charges,,
Blood Culture,,87040,CPT,Facility,Inpatient,,,,138,117.3,39.5508,138,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Blood Culture,,87040,CPT,Facility,Both,,,,138,117.3,39.5508,138,CorVel,Worker's Compensation,138,100,,percent of total billed charges,,
Blood Culture,,87040,CPT,Facility,Both,,,,138,117.3,39.5508,138,First Health Group Corporation,First Health Network,133.86,97,,percent of total billed charges,,
Blood Culture,,87040,CPT,Facility,Both,,,,138,117.3,39.5508,138,"Health Partners, Inc.",Commercial,130.548,94.6,,percent of total billed charges,,
Blood Culture,,87040,CPT,Facility,Outpatient,,,,138,117.3,39.5508,138,"Health Partners, Inc.",Medicare Advantage,67.62,49,,percent of total billed charges,,
Blood Culture,,87040,CPT,Facility,Inpatient,,,,138,117.3,39.5508,138,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Blood Culture,,87040,CPT,Facility,Both,,,,138,117.3,39.5508,138,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),82.8,60,,percent of total billed charges,,
Blood Culture,,87040,CPT,Facility,Both,,,,138,117.3,39.5508,138,"Health Partners, Inc.",State of Minnesota Advantage Program,112.47,81.5,,percent of total billed charges,,
Blood Culture,,87040,CPT,Facility,Both,,,,138,117.3,39.5508,138,"Health Partners, Inc.",State Public Programs,69,50,,percent of total billed charges,,
Blood Culture,,87040,CPT,Facility,Both,,,,138,117.3,39.5508,138,Humana Insurance Company,Commercial PPO,131.1,95,,percent of total billed charges,,
Blood Culture,,87040,CPT,Facility,Outpatient,,,,138,117.3,39.5508,138,Humana Insurance Company,Medicare PPO,67.62,49,,percent of total billed charges,,
Blood Culture,,87040,CPT,Facility,Inpatient,,,,138,117.3,39.5508,138,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Blood Culture,,87040,CPT,Facility,Both,,,,138,117.3,39.5508,138,Medica,Individual & Family,136.758,99.1,,percent of total billed charges,,
Blood Culture,,87040,CPT,Facility,Outpatient,,,,138,117.3,39.5508,138,Medica,Medica Advantage Solution,68.724,49.8,,percent of total billed charges,,
Blood Culture,,87040,CPT,Facility,Inpatient,,,,138,117.3,39.5508,138,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Blood Culture,,87040,CPT,Facility,Outpatient,,,,138,117.3,39.5508,138,Medica,Medical Assistance,61.548,44.6,,percent of total billed charges,,
Blood Culture,,87040,CPT,Facility,Inpatient,,,,138,117.3,39.5508,138,Medica,Medical Assistance,,,,,Included in per diem rate,
Blood Culture,,87040,CPT,Facility,Outpatient,,,,138,117.3,39.5508,138,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,68.724,49.8,,percent of total billed charges,,
Blood Culture,,87040,CPT,Facility,Inpatient,,,,138,117.3,39.5508,138,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Blood Culture,,87040,CPT,Facility,Both,,,,138,117.3,39.5508,138,"Multiplan, Inc.","Multiplan, Inc.",129.72,94,,percent of total billed charges,,
Blood Culture,,87040,CPT,Facility,Outpatient,,,,138,117.3,39.5508,138,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,119.232,86.4,,percent of total billed charges,,
Blood Culture,,87040,CPT,Facility,Inpatient,,,,138,117.3,39.5508,138,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Blood Culture,,87040,CPT,Facility,Both,,,,138,117.3,39.5508,138,"Preferred One Administrative Services, INC.",PPO,136.068,98.6,,percent of total billed charges,,
Blood Culture,,87040,CPT,Facility,Outpatient,,,,138,117.3,39.5508,138,PrimeWest Health,Minnesota Senior Health Options (MSHO),71.001,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Blood Culture,,87040,CPT,Facility,Inpatient,,,,138,117.3,39.5508,138,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Blood Culture,,87040,CPT,Facility,Outpatient,,,,138,117.3,39.5508,138,PrimeWest Health,MinnesotaCare,70.8768,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Blood Culture,,87040,CPT,Facility,Inpatient,,,,138,117.3,39.5508,138,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Blood Culture,,87040,CPT,Facility,Both,,,,138,117.3,39.5508,138,Sanford Health Plan,Sanford Health Plan,126.96,92,,percent of total billed charges,,
Blood Culture,,87040,CPT,Facility,Outpatient,,,,138,117.3,39.5508,138,"UCare Health, Inc.",Individual & Family Plan,77.763,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Blood Culture,,87040,CPT,Facility,Inpatient,,,,138,117.3,39.5508,138,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Blood Culture,,87040,CPT,Facility,Outpatient,,,,138,117.3,39.5508,138,"UCare Health, Inc.",Medical Assistance,69.6486,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Blood Culture,,87040,CPT,Facility,Inpatient,,,,138,117.3,39.5508,138,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Blood Culture,,87040,CPT,Facility,Outpatient,,,,138,117.3,39.5508,138,"UCare Health, Inc.",Medicare Advantage,69.6486,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Blood Culture,,87040,CPT,Facility,Inpatient,,,,138,117.3,39.5508,138,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Blood Culture,,87040,CPT,Facility,Outpatient,,,,138,117.3,39.5508,138,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),69.6486,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Blood Culture,,87040,CPT,Facility,Inpatient,,,,138,117.3,39.5508,138,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Blood Culture,,87040,CPT,Facility,Both,,,,138,117.3,39.5508,138,UnitedHealthcare,Individual & Family,129.72,94,,percent of total billed charges,,
Blood Culture,,87040,CPT,Facility,Outpatient,,,,138,117.3,39.5508,138,UnitedHealthcare,Medicare Advantage,67.62,49,,percent of total billed charges,,
Blood Culture,,87040,CPT,Facility,Inpatient,,,,138,117.3,39.5508,138,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Blood Culture,,87040,CPT,Facility,Outpatient,,,,138,117.3,39.5508,138,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,66.24,48,,percent of total billed charges,,100% of DHS outpatient percentage
Blood Culture,,87040,CPT,Facility,Inpatient,,,,138,117.3,39.5508,138,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Aerobic Culture,,87070,CPT,Facility,Both,,,,87,73.95,24.9342,87,Aetna,Commercial,80.04,92,,percent of total billed charges,,
Aerobic Culture,,87070,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,Aetna,Medicare Advantage,42.63,49,,percent of total billed charges,,
Aerobic Culture,,87070,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Aerobic Culture,,87070,CPT,Facility,Both,,,,87,73.95,24.9342,87,Aetna,PPO,80.91,93,,percent of total billed charges,,
Aerobic Culture,,87070,CPT,Facility,Both,,,,87,73.95,24.9342,87,America's PPO,America's PPO,83.5461,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Aerobic Culture,,87070,CPT,Facility,Both,,,,87,73.95,24.9342,87,BlueCross BlueShield Minnesota, Federal Employee Program,85.608,98.4,,percent of total billed charges,,
Aerobic Culture,,87070,CPT,Facility,Both,,,,87,73.95,24.9342,87,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,87,100,,percent of total billed charges,,
Aerobic Culture,,87070,CPT,Facility,Both,,,,87,73.95,24.9342,87,BlueCross BlueShield Minnesota,High Value Network Plan,78.3,90,,percent of total billed charges,,
Aerobic Culture,,87070,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,BlueCross BlueShield Minnesota,Medicare Advantage,42.63,49,,percent of total billed charges,,
Aerobic Culture,,87070,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Aerobic Culture,,87070,CPT,Facility,Both,,,,87,73.95,24.9342,87,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,77.0559,88.57,,percent of total billed charges,,
Aerobic Culture,,87070,CPT,Facility,Both,,,,87,73.95,24.9342,87,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,24.9342,28.66,,percent of total billed charges,,
Aerobic Culture,,87070,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),42.63,49,,percent of total billed charges,,
Aerobic Culture,,87070,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Aerobic Culture,,87070,CPT,Facility,Both,,,,87,73.95,24.9342,87,CorVel,Worker's Compensation,87,100,,percent of total billed charges,,
Aerobic Culture,,87070,CPT,Facility,Both,,,,87,73.95,24.9342,87,First Health Group Corporation,First Health Network,84.39,97,,percent of total billed charges,,
Aerobic Culture,,87070,CPT,Facility,Both,,,,87,73.95,24.9342,87,"Health Partners, Inc.",Commercial,82.302,94.6,,percent of total billed charges,,
Aerobic Culture,,87070,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,"Health Partners, Inc.",Medicare Advantage,42.63,49,,percent of total billed charges,,
Aerobic Culture,,87070,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Aerobic Culture,,87070,CPT,Facility,Both,,,,87,73.95,24.9342,87,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),52.2,60,,percent of total billed charges,,
Aerobic Culture,,87070,CPT,Facility,Both,,,,87,73.95,24.9342,87,"Health Partners, Inc.",State of Minnesota Advantage Program,70.905,81.5,,percent of total billed charges,,
Aerobic Culture,,87070,CPT,Facility,Both,,,,87,73.95,24.9342,87,"Health Partners, Inc.",State Public Programs,43.5,50,,percent of total billed charges,,
Aerobic Culture,,87070,CPT,Facility,Both,,,,87,73.95,24.9342,87,Humana Insurance Company,Commercial PPO,82.65,95,,percent of total billed charges,,
Aerobic Culture,,87070,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,Humana Insurance Company,Medicare PPO,42.63,49,,percent of total billed charges,,
Aerobic Culture,,87070,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Aerobic Culture,,87070,CPT,Facility,Both,,,,87,73.95,24.9342,87,Medica,Individual & Family,86.217,99.1,,percent of total billed charges,,
Aerobic Culture,,87070,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,Medica,Medica Advantage Solution,43.326,49.8,,percent of total billed charges,,
Aerobic Culture,,87070,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Aerobic Culture,,87070,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,Medica,Medical Assistance,38.802,44.6,,percent of total billed charges,,
Aerobic Culture,,87070,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,Medica,Medical Assistance,,,,,Included in per diem rate,
Aerobic Culture,,87070,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,43.326,49.8,,percent of total billed charges,,
Aerobic Culture,,87070,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Aerobic Culture,,87070,CPT,Facility,Both,,,,87,73.95,24.9342,87,"Multiplan, Inc.","Multiplan, Inc.",81.78,94,,percent of total billed charges,,
Aerobic Culture,,87070,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,75.168,86.4,,percent of total billed charges,,
Aerobic Culture,,87070,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Aerobic Culture,,87070,CPT,Facility,Both,,,,87,73.95,24.9342,87,"Preferred One Administrative Services, INC.",PPO,85.782,98.6,,percent of total billed charges,,
Aerobic Culture,,87070,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,PrimeWest Health,Minnesota Senior Health Options (MSHO),44.7615,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Aerobic Culture,,87070,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Aerobic Culture,,87070,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,PrimeWest Health,MinnesotaCare,44.6832,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Aerobic Culture,,87070,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Aerobic Culture,,87070,CPT,Facility,Both,,,,87,73.95,24.9342,87,Sanford Health Plan,Sanford Health Plan,80.04,92,,percent of total billed charges,,
Aerobic Culture,,87070,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,"UCare Health, Inc.",Individual & Family Plan,49.0245,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Aerobic Culture,,87070,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Aerobic Culture,,87070,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,"UCare Health, Inc.",Medical Assistance,43.9089,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Aerobic Culture,,87070,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Aerobic Culture,,87070,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,"UCare Health, Inc.",Medicare Advantage,43.9089,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Aerobic Culture,,87070,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Aerobic Culture,,87070,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),43.9089,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Aerobic Culture,,87070,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Aerobic Culture,,87070,CPT,Facility,Both,,,,87,73.95,24.9342,87,UnitedHealthcare,Individual & Family,81.78,94,,percent of total billed charges,,
Aerobic Culture,,87070,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,UnitedHealthcare,Medicare Advantage,42.63,49,,percent of total billed charges,,
Aerobic Culture,,87070,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Aerobic Culture,,87070,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,41.76,48,,percent of total billed charges,,100% of DHS outpatient percentage
Aerobic Culture,,87070,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Body Fluid Culture With Gram Stain,,87070,CPT,Facility,Both,,,,138,117.3,39.5508,138,Aetna,Commercial,126.96,92,,percent of total billed charges,,
Body Fluid Culture With Gram Stain,,87070,CPT,Facility,Outpatient,,,,138,117.3,39.5508,138,Aetna,Medicare Advantage,67.62,49,,percent of total billed charges,,
Body Fluid Culture With Gram Stain,,87070,CPT,Facility,Inpatient,,,,138,117.3,39.5508,138,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Body Fluid Culture With Gram Stain,,87070,CPT,Facility,Both,,,,138,117.3,39.5508,138,Aetna,PPO,128.34,93,,percent of total billed charges,,
Body Fluid Culture With Gram Stain,,87070,CPT,Facility,Both,,,,138,117.3,39.5508,138,America's PPO,America's PPO,132.5214,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Body Fluid Culture With Gram Stain,,87070,CPT,Facility,Both,,,,138,117.3,39.5508,138,BlueCross BlueShield Minnesota, Federal Employee Program,135.792,98.4,,percent of total billed charges,,
Body Fluid Culture With Gram Stain,,87070,CPT,Facility,Both,,,,138,117.3,39.5508,138,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,138,100,,percent of total billed charges,,
Body Fluid Culture With Gram Stain,,87070,CPT,Facility,Both,,,,138,117.3,39.5508,138,BlueCross BlueShield Minnesota,High Value Network Plan,124.2,90,,percent of total billed charges,,
Body Fluid Culture With Gram Stain,,87070,CPT,Facility,Outpatient,,,,138,117.3,39.5508,138,BlueCross BlueShield Minnesota,Medicare Advantage,67.62,49,,percent of total billed charges,,
Body Fluid Culture With Gram Stain,,87070,CPT,Facility,Inpatient,,,,138,117.3,39.5508,138,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Body Fluid Culture With Gram Stain,,87070,CPT,Facility,Both,,,,138,117.3,39.5508,138,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,122.2266,88.57,,percent of total billed charges,,
Body Fluid Culture With Gram Stain,,87070,CPT,Facility,Both,,,,138,117.3,39.5508,138,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,39.5508,28.66,,percent of total billed charges,,
Body Fluid Culture With Gram Stain,,87070,CPT,Facility,Outpatient,,,,138,117.3,39.5508,138,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),67.62,49,,percent of total billed charges,,
Body Fluid Culture With Gram Stain,,87070,CPT,Facility,Inpatient,,,,138,117.3,39.5508,138,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Body Fluid Culture With Gram Stain,,87070,CPT,Facility,Both,,,,138,117.3,39.5508,138,CorVel,Worker's Compensation,138,100,,percent of total billed charges,,
Body Fluid Culture With Gram Stain,,87070,CPT,Facility,Both,,,,138,117.3,39.5508,138,First Health Group Corporation,First Health Network,133.86,97,,percent of total billed charges,,
Body Fluid Culture With Gram Stain,,87070,CPT,Facility,Both,,,,138,117.3,39.5508,138,"Health Partners, Inc.",Commercial,130.548,94.6,,percent of total billed charges,,
Body Fluid Culture With Gram Stain,,87070,CPT,Facility,Outpatient,,,,138,117.3,39.5508,138,"Health Partners, Inc.",Medicare Advantage,67.62,49,,percent of total billed charges,,
Body Fluid Culture With Gram Stain,,87070,CPT,Facility,Inpatient,,,,138,117.3,39.5508,138,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Body Fluid Culture With Gram Stain,,87070,CPT,Facility,Both,,,,138,117.3,39.5508,138,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),82.8,60,,percent of total billed charges,,
Body Fluid Culture With Gram Stain,,87070,CPT,Facility,Both,,,,138,117.3,39.5508,138,"Health Partners, Inc.",State of Minnesota Advantage Program,112.47,81.5,,percent of total billed charges,,
Body Fluid Culture With Gram Stain,,87070,CPT,Facility,Both,,,,138,117.3,39.5508,138,"Health Partners, Inc.",State Public Programs,69,50,,percent of total billed charges,,
Body Fluid Culture With Gram Stain,,87070,CPT,Facility,Both,,,,138,117.3,39.5508,138,Humana Insurance Company,Commercial PPO,131.1,95,,percent of total billed charges,,
Body Fluid Culture With Gram Stain,,87070,CPT,Facility,Outpatient,,,,138,117.3,39.5508,138,Humana Insurance Company,Medicare PPO,67.62,49,,percent of total billed charges,,
Body Fluid Culture With Gram Stain,,87070,CPT,Facility,Inpatient,,,,138,117.3,39.5508,138,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Body Fluid Culture With Gram Stain,,87070,CPT,Facility,Both,,,,138,117.3,39.5508,138,Medica,Individual & Family,136.758,99.1,,percent of total billed charges,,
Body Fluid Culture With Gram Stain,,87070,CPT,Facility,Outpatient,,,,138,117.3,39.5508,138,Medica,Medica Advantage Solution,68.724,49.8,,percent of total billed charges,,
Body Fluid Culture With Gram Stain,,87070,CPT,Facility,Inpatient,,,,138,117.3,39.5508,138,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Body Fluid Culture With Gram Stain,,87070,CPT,Facility,Outpatient,,,,138,117.3,39.5508,138,Medica,Medical Assistance,61.548,44.6,,percent of total billed charges,,
Body Fluid Culture With Gram Stain,,87070,CPT,Facility,Inpatient,,,,138,117.3,39.5508,138,Medica,Medical Assistance,,,,,Included in per diem rate,
Body Fluid Culture With Gram Stain,,87070,CPT,Facility,Outpatient,,,,138,117.3,39.5508,138,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,68.724,49.8,,percent of total billed charges,,
Body Fluid Culture With Gram Stain,,87070,CPT,Facility,Inpatient,,,,138,117.3,39.5508,138,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Body Fluid Culture With Gram Stain,,87070,CPT,Facility,Both,,,,138,117.3,39.5508,138,"Multiplan, Inc.","Multiplan, Inc.",129.72,94,,percent of total billed charges,,
Body Fluid Culture With Gram Stain,,87070,CPT,Facility,Outpatient,,,,138,117.3,39.5508,138,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,119.232,86.4,,percent of total billed charges,,
Body Fluid Culture With Gram Stain,,87070,CPT,Facility,Inpatient,,,,138,117.3,39.5508,138,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Body Fluid Culture With Gram Stain,,87070,CPT,Facility,Both,,,,138,117.3,39.5508,138,"Preferred One Administrative Services, INC.",PPO,136.068,98.6,,percent of total billed charges,,
Body Fluid Culture With Gram Stain,,87070,CPT,Facility,Outpatient,,,,138,117.3,39.5508,138,PrimeWest Health,Minnesota Senior Health Options (MSHO),71.001,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Body Fluid Culture With Gram Stain,,87070,CPT,Facility,Inpatient,,,,138,117.3,39.5508,138,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Body Fluid Culture With Gram Stain,,87070,CPT,Facility,Outpatient,,,,138,117.3,39.5508,138,PrimeWest Health,MinnesotaCare,70.8768,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Body Fluid Culture With Gram Stain,,87070,CPT,Facility,Inpatient,,,,138,117.3,39.5508,138,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Body Fluid Culture With Gram Stain,,87070,CPT,Facility,Both,,,,138,117.3,39.5508,138,Sanford Health Plan,Sanford Health Plan,126.96,92,,percent of total billed charges,,
Body Fluid Culture With Gram Stain,,87070,CPT,Facility,Outpatient,,,,138,117.3,39.5508,138,"UCare Health, Inc.",Individual & Family Plan,77.763,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Body Fluid Culture With Gram Stain,,87070,CPT,Facility,Inpatient,,,,138,117.3,39.5508,138,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Body Fluid Culture With Gram Stain,,87070,CPT,Facility,Outpatient,,,,138,117.3,39.5508,138,"UCare Health, Inc.",Medical Assistance,69.6486,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Body Fluid Culture With Gram Stain,,87070,CPT,Facility,Inpatient,,,,138,117.3,39.5508,138,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Body Fluid Culture With Gram Stain,,87070,CPT,Facility,Outpatient,,,,138,117.3,39.5508,138,"UCare Health, Inc.",Medicare Advantage,69.6486,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Body Fluid Culture With Gram Stain,,87070,CPT,Facility,Inpatient,,,,138,117.3,39.5508,138,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Body Fluid Culture With Gram Stain,,87070,CPT,Facility,Outpatient,,,,138,117.3,39.5508,138,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),69.6486,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Body Fluid Culture With Gram Stain,,87070,CPT,Facility,Inpatient,,,,138,117.3,39.5508,138,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Body Fluid Culture With Gram Stain,,87070,CPT,Facility,Both,,,,138,117.3,39.5508,138,UnitedHealthcare,Individual & Family,129.72,94,,percent of total billed charges,,
Body Fluid Culture With Gram Stain,,87070,CPT,Facility,Outpatient,,,,138,117.3,39.5508,138,UnitedHealthcare,Medicare Advantage,67.62,49,,percent of total billed charges,,
Body Fluid Culture With Gram Stain,,87070,CPT,Facility,Inpatient,,,,138,117.3,39.5508,138,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Body Fluid Culture With Gram Stain,,87070,CPT,Facility,Outpatient,,,,138,117.3,39.5508,138,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,66.24,48,,percent of total billed charges,,100% of DHS outpatient percentage
Body Fluid Culture With Gram Stain,,87070,CPT,Facility,Inpatient,,,,138,117.3,39.5508,138,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Genital Culture,,87070,CPT,Facility,Both,,,,87,73.95,24.9342,87,Aetna,Commercial,80.04,92,,percent of total billed charges,,
Genital Culture,,87070,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,Aetna,Medicare Advantage,42.63,49,,percent of total billed charges,,
Genital Culture,,87070,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Genital Culture,,87070,CPT,Facility,Both,,,,87,73.95,24.9342,87,Aetna,PPO,80.91,93,,percent of total billed charges,,
Genital Culture,,87070,CPT,Facility,Both,,,,87,73.95,24.9342,87,America's PPO,America's PPO,83.5461,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Genital Culture,,87070,CPT,Facility,Both,,,,87,73.95,24.9342,87,BlueCross BlueShield Minnesota, Federal Employee Program,85.608,98.4,,percent of total billed charges,,
Genital Culture,,87070,CPT,Facility,Both,,,,87,73.95,24.9342,87,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,87,100,,percent of total billed charges,,
Genital Culture,,87070,CPT,Facility,Both,,,,87,73.95,24.9342,87,BlueCross BlueShield Minnesota,High Value Network Plan,78.3,90,,percent of total billed charges,,
Genital Culture,,87070,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,BlueCross BlueShield Minnesota,Medicare Advantage,42.63,49,,percent of total billed charges,,
Genital Culture,,87070,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Genital Culture,,87070,CPT,Facility,Both,,,,87,73.95,24.9342,87,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,77.0559,88.57,,percent of total billed charges,,
Genital Culture,,87070,CPT,Facility,Both,,,,87,73.95,24.9342,87,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,24.9342,28.66,,percent of total billed charges,,
Genital Culture,,87070,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),42.63,49,,percent of total billed charges,,
Genital Culture,,87070,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Genital Culture,,87070,CPT,Facility,Both,,,,87,73.95,24.9342,87,CorVel,Worker's Compensation,87,100,,percent of total billed charges,,
Genital Culture,,87070,CPT,Facility,Both,,,,87,73.95,24.9342,87,First Health Group Corporation,First Health Network,84.39,97,,percent of total billed charges,,
Genital Culture,,87070,CPT,Facility,Both,,,,87,73.95,24.9342,87,"Health Partners, Inc.",Commercial,82.302,94.6,,percent of total billed charges,,
Genital Culture,,87070,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,"Health Partners, Inc.",Medicare Advantage,42.63,49,,percent of total billed charges,,
Genital Culture,,87070,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Genital Culture,,87070,CPT,Facility,Both,,,,87,73.95,24.9342,87,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),52.2,60,,percent of total billed charges,,
Genital Culture,,87070,CPT,Facility,Both,,,,87,73.95,24.9342,87,"Health Partners, Inc.",State of Minnesota Advantage Program,70.905,81.5,,percent of total billed charges,,
Genital Culture,,87070,CPT,Facility,Both,,,,87,73.95,24.9342,87,"Health Partners, Inc.",State Public Programs,43.5,50,,percent of total billed charges,,
Genital Culture,,87070,CPT,Facility,Both,,,,87,73.95,24.9342,87,Humana Insurance Company,Commercial PPO,82.65,95,,percent of total billed charges,,
Genital Culture,,87070,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,Humana Insurance Company,Medicare PPO,42.63,49,,percent of total billed charges,,
Genital Culture,,87070,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Genital Culture,,87070,CPT,Facility,Both,,,,87,73.95,24.9342,87,Medica,Individual & Family,86.217,99.1,,percent of total billed charges,,
Genital Culture,,87070,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,Medica,Medica Advantage Solution,43.326,49.8,,percent of total billed charges,,
Genital Culture,,87070,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Genital Culture,,87070,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,Medica,Medical Assistance,38.802,44.6,,percent of total billed charges,,
Genital Culture,,87070,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,Medica,Medical Assistance,,,,,Included in per diem rate,
Genital Culture,,87070,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,43.326,49.8,,percent of total billed charges,,
Genital Culture,,87070,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Genital Culture,,87070,CPT,Facility,Both,,,,87,73.95,24.9342,87,"Multiplan, Inc.","Multiplan, Inc.",81.78,94,,percent of total billed charges,,
Genital Culture,,87070,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,75.168,86.4,,percent of total billed charges,,
Genital Culture,,87070,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Genital Culture,,87070,CPT,Facility,Both,,,,87,73.95,24.9342,87,"Preferred One Administrative Services, INC.",PPO,85.782,98.6,,percent of total billed charges,,
Genital Culture,,87070,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,PrimeWest Health,Minnesota Senior Health Options (MSHO),44.7615,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Genital Culture,,87070,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Genital Culture,,87070,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,PrimeWest Health,MinnesotaCare,44.6832,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Genital Culture,,87070,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Genital Culture,,87070,CPT,Facility,Both,,,,87,73.95,24.9342,87,Sanford Health Plan,Sanford Health Plan,80.04,92,,percent of total billed charges,,
Genital Culture,,87070,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,"UCare Health, Inc.",Individual & Family Plan,49.0245,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Genital Culture,,87070,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Genital Culture,,87070,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,"UCare Health, Inc.",Medical Assistance,43.9089,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Genital Culture,,87070,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Genital Culture,,87070,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,"UCare Health, Inc.",Medicare Advantage,43.9089,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Genital Culture,,87070,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Genital Culture,,87070,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),43.9089,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Genital Culture,,87070,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Genital Culture,,87070,CPT,Facility,Both,,,,87,73.95,24.9342,87,UnitedHealthcare,Individual & Family,81.78,94,,percent of total billed charges,,
Genital Culture,,87070,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,UnitedHealthcare,Medicare Advantage,42.63,49,,percent of total billed charges,,
Genital Culture,,87070,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Genital Culture,,87070,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,41.76,48,,percent of total billed charges,,100% of DHS outpatient percentage
Genital Culture,,87070,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Group A Beta Streptococcus Culture,,87070,CPT,Facility,Both,,,,31,26.35,8.8846,31,Aetna,Commercial,28.52,92,,percent of total billed charges,,
Group A Beta Streptococcus Culture,,87070,CPT,Facility,Outpatient,,,,31,26.35,8.8846,31,Aetna,Medicare Advantage,15.19,49,,percent of total billed charges,,
Group A Beta Streptococcus Culture,,87070,CPT,Facility,Inpatient,,,,31,26.35,8.8846,31,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Group A Beta Streptococcus Culture,,87070,CPT,Facility,Both,,,,31,26.35,8.8846,31,Aetna,PPO,28.83,93,,percent of total billed charges,,
Group A Beta Streptococcus Culture,,87070,CPT,Facility,Both,,,,31,26.35,8.8846,31,America's PPO,America's PPO,29.7693,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Group A Beta Streptococcus Culture,,87070,CPT,Facility,Both,,,,31,26.35,8.8846,31,BlueCross BlueShield Minnesota, Federal Employee Program,30.504,98.4,,percent of total billed charges,,
Group A Beta Streptococcus Culture,,87070,CPT,Facility,Both,,,,31,26.35,8.8846,31,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,31,100,,percent of total billed charges,,
Group A Beta Streptococcus Culture,,87070,CPT,Facility,Both,,,,31,26.35,8.8846,31,BlueCross BlueShield Minnesota,High Value Network Plan,27.9,90,,percent of total billed charges,,
Group A Beta Streptococcus Culture,,87070,CPT,Facility,Outpatient,,,,31,26.35,8.8846,31,BlueCross BlueShield Minnesota,Medicare Advantage,15.19,49,,percent of total billed charges,,
Group A Beta Streptococcus Culture,,87070,CPT,Facility,Inpatient,,,,31,26.35,8.8846,31,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Group A Beta Streptococcus Culture,,87070,CPT,Facility,Both,,,,31,26.35,8.8846,31,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,27.4567,88.57,,percent of total billed charges,,
Group A Beta Streptococcus Culture,,87070,CPT,Facility,Both,,,,31,26.35,8.8846,31,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,8.8846,28.66,,percent of total billed charges,,
Group A Beta Streptococcus Culture,,87070,CPT,Facility,Outpatient,,,,31,26.35,8.8846,31,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),15.19,49,,percent of total billed charges,,
Group A Beta Streptococcus Culture,,87070,CPT,Facility,Inpatient,,,,31,26.35,8.8846,31,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Group A Beta Streptococcus Culture,,87070,CPT,Facility,Both,,,,31,26.35,8.8846,31,CorVel,Worker's Compensation,31,100,,percent of total billed charges,,
Group A Beta Streptococcus Culture,,87070,CPT,Facility,Both,,,,31,26.35,8.8846,31,First Health Group Corporation,First Health Network,30.07,97,,percent of total billed charges,,
Group A Beta Streptococcus Culture,,87070,CPT,Facility,Both,,,,31,26.35,8.8846,31,"Health Partners, Inc.",Commercial,29.326,94.6,,percent of total billed charges,,
Group A Beta Streptococcus Culture,,87070,CPT,Facility,Outpatient,,,,31,26.35,8.8846,31,"Health Partners, Inc.",Medicare Advantage,15.19,49,,percent of total billed charges,,
Group A Beta Streptococcus Culture,,87070,CPT,Facility,Inpatient,,,,31,26.35,8.8846,31,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Group A Beta Streptococcus Culture,,87070,CPT,Facility,Both,,,,31,26.35,8.8846,31,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),18.6,60,,percent of total billed charges,,
Group A Beta Streptococcus Culture,,87070,CPT,Facility,Both,,,,31,26.35,8.8846,31,"Health Partners, Inc.",State of Minnesota Advantage Program,25.265,81.5,,percent of total billed charges,,
Group A Beta Streptococcus Culture,,87070,CPT,Facility,Both,,,,31,26.35,8.8846,31,"Health Partners, Inc.",State Public Programs,15.5,50,,percent of total billed charges,,
Group A Beta Streptococcus Culture,,87070,CPT,Facility,Both,,,,31,26.35,8.8846,31,Humana Insurance Company,Commercial PPO,29.45,95,,percent of total billed charges,,
Group A Beta Streptococcus Culture,,87070,CPT,Facility,Outpatient,,,,31,26.35,8.8846,31,Humana Insurance Company,Medicare PPO,15.19,49,,percent of total billed charges,,
Group A Beta Streptococcus Culture,,87070,CPT,Facility,Inpatient,,,,31,26.35,8.8846,31,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Group A Beta Streptococcus Culture,,87070,CPT,Facility,Both,,,,31,26.35,8.8846,31,Medica,Individual & Family,30.721,99.1,,percent of total billed charges,,
Group A Beta Streptococcus Culture,,87070,CPT,Facility,Outpatient,,,,31,26.35,8.8846,31,Medica,Medica Advantage Solution,15.438,49.8,,percent of total billed charges,,
Group A Beta Streptococcus Culture,,87070,CPT,Facility,Inpatient,,,,31,26.35,8.8846,31,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Group A Beta Streptococcus Culture,,87070,CPT,Facility,Outpatient,,,,31,26.35,8.8846,31,Medica,Medical Assistance,13.826,44.6,,percent of total billed charges,,
Group A Beta Streptococcus Culture,,87070,CPT,Facility,Inpatient,,,,31,26.35,8.8846,31,Medica,Medical Assistance,,,,,Included in per diem rate,
Group A Beta Streptococcus Culture,,87070,CPT,Facility,Outpatient,,,,31,26.35,8.8846,31,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,15.438,49.8,,percent of total billed charges,,
Group A Beta Streptococcus Culture,,87070,CPT,Facility,Inpatient,,,,31,26.35,8.8846,31,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Group A Beta Streptococcus Culture,,87070,CPT,Facility,Both,,,,31,26.35,8.8846,31,"Multiplan, Inc.","Multiplan, Inc.",29.14,94,,percent of total billed charges,,
Group A Beta Streptococcus Culture,,87070,CPT,Facility,Outpatient,,,,31,26.35,8.8846,31,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,26.784,86.4,,percent of total billed charges,,
Group A Beta Streptococcus Culture,,87070,CPT,Facility,Inpatient,,,,31,26.35,8.8846,31,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Group A Beta Streptococcus Culture,,87070,CPT,Facility,Both,,,,31,26.35,8.8846,31,"Preferred One Administrative Services, INC.",PPO,30.566,98.6,,percent of total billed charges,,
Group A Beta Streptococcus Culture,,87070,CPT,Facility,Outpatient,,,,31,26.35,8.8846,31,PrimeWest Health,Minnesota Senior Health Options (MSHO),15.9495,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Group A Beta Streptococcus Culture,,87070,CPT,Facility,Inpatient,,,,31,26.35,8.8846,31,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Group A Beta Streptococcus Culture,,87070,CPT,Facility,Outpatient,,,,31,26.35,8.8846,31,PrimeWest Health,MinnesotaCare,15.9216,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Group A Beta Streptococcus Culture,,87070,CPT,Facility,Inpatient,,,,31,26.35,8.8846,31,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Group A Beta Streptococcus Culture,,87070,CPT,Facility,Both,,,,31,26.35,8.8846,31,Sanford Health Plan,Sanford Health Plan,28.52,92,,percent of total billed charges,,
Group A Beta Streptococcus Culture,,87070,CPT,Facility,Outpatient,,,,31,26.35,8.8846,31,"UCare Health, Inc.",Individual & Family Plan,17.4685,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Group A Beta Streptococcus Culture,,87070,CPT,Facility,Inpatient,,,,31,26.35,8.8846,31,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Group A Beta Streptococcus Culture,,87070,CPT,Facility,Outpatient,,,,31,26.35,8.8846,31,"UCare Health, Inc.",Medical Assistance,15.6457,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Group A Beta Streptococcus Culture,,87070,CPT,Facility,Inpatient,,,,31,26.35,8.8846,31,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Group A Beta Streptococcus Culture,,87070,CPT,Facility,Outpatient,,,,31,26.35,8.8846,31,"UCare Health, Inc.",Medicare Advantage,15.6457,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Group A Beta Streptococcus Culture,,87070,CPT,Facility,Inpatient,,,,31,26.35,8.8846,31,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Group A Beta Streptococcus Culture,,87070,CPT,Facility,Outpatient,,,,31,26.35,8.8846,31,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),15.6457,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Group A Beta Streptococcus Culture,,87070,CPT,Facility,Inpatient,,,,31,26.35,8.8846,31,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Group A Beta Streptococcus Culture,,87070,CPT,Facility,Both,,,,31,26.35,8.8846,31,UnitedHealthcare,Individual & Family,29.14,94,,percent of total billed charges,,
Group A Beta Streptococcus Culture,,87070,CPT,Facility,Outpatient,,,,31,26.35,8.8846,31,UnitedHealthcare,Medicare Advantage,15.19,49,,percent of total billed charges,,
Group A Beta Streptococcus Culture,,87070,CPT,Facility,Inpatient,,,,31,26.35,8.8846,31,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Group A Beta Streptococcus Culture,,87070,CPT,Facility,Outpatient,,,,31,26.35,8.8846,31,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,14.88,48,,percent of total billed charges,,100% of DHS outpatient percentage
Group A Beta Streptococcus Culture,,87070,CPT,Facility,Inpatient,,,,31,26.35,8.8846,31,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Group B Streptococcus Culture, Rectal And Vaginal",,87070,CPT,Facility,Both,,,,87,73.95,24.9342,87,Aetna,Commercial,80.04,92,,percent of total billed charges,,
"Group B Streptococcus Culture, Rectal And Vaginal",,87070,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,Aetna,Medicare Advantage,42.63,49,,percent of total billed charges,,
"Group B Streptococcus Culture, Rectal And Vaginal",,87070,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Group B Streptococcus Culture, Rectal And Vaginal",,87070,CPT,Facility,Both,,,,87,73.95,24.9342,87,Aetna,PPO,80.91,93,,percent of total billed charges,,
"Group B Streptococcus Culture, Rectal And Vaginal",,87070,CPT,Facility,Both,,,,87,73.95,24.9342,87,America's PPO,America's PPO,83.5461,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Group B Streptococcus Culture, Rectal And Vaginal",,87070,CPT,Facility,Both,,,,87,73.95,24.9342,87,BlueCross BlueShield Minnesota, Federal Employee Program,85.608,98.4,,percent of total billed charges,,
"Group B Streptococcus Culture, Rectal And Vaginal",,87070,CPT,Facility,Both,,,,87,73.95,24.9342,87,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,87,100,,percent of total billed charges,,
"Group B Streptococcus Culture, Rectal And Vaginal",,87070,CPT,Facility,Both,,,,87,73.95,24.9342,87,BlueCross BlueShield Minnesota,High Value Network Plan,78.3,90,,percent of total billed charges,,
"Group B Streptococcus Culture, Rectal And Vaginal",,87070,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,BlueCross BlueShield Minnesota,Medicare Advantage,42.63,49,,percent of total billed charges,,
"Group B Streptococcus Culture, Rectal And Vaginal",,87070,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Group B Streptococcus Culture, Rectal And Vaginal",,87070,CPT,Facility,Both,,,,87,73.95,24.9342,87,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,77.0559,88.57,,percent of total billed charges,,
"Group B Streptococcus Culture, Rectal And Vaginal",,87070,CPT,Facility,Both,,,,87,73.95,24.9342,87,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,24.9342,28.66,,percent of total billed charges,,
"Group B Streptococcus Culture, Rectal And Vaginal",,87070,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),42.63,49,,percent of total billed charges,,
"Group B Streptococcus Culture, Rectal And Vaginal",,87070,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Group B Streptococcus Culture, Rectal And Vaginal",,87070,CPT,Facility,Both,,,,87,73.95,24.9342,87,CorVel,Worker's Compensation,87,100,,percent of total billed charges,,
"Group B Streptococcus Culture, Rectal And Vaginal",,87070,CPT,Facility,Both,,,,87,73.95,24.9342,87,First Health Group Corporation,First Health Network,84.39,97,,percent of total billed charges,,
"Group B Streptococcus Culture, Rectal And Vaginal",,87070,CPT,Facility,Both,,,,87,73.95,24.9342,87,"Health Partners, Inc.",Commercial,82.302,94.6,,percent of total billed charges,,
"Group B Streptococcus Culture, Rectal And Vaginal",,87070,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,"Health Partners, Inc.",Medicare Advantage,42.63,49,,percent of total billed charges,,
"Group B Streptococcus Culture, Rectal And Vaginal",,87070,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Group B Streptococcus Culture, Rectal And Vaginal",,87070,CPT,Facility,Both,,,,87,73.95,24.9342,87,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),52.2,60,,percent of total billed charges,,
"Group B Streptococcus Culture, Rectal And Vaginal",,87070,CPT,Facility,Both,,,,87,73.95,24.9342,87,"Health Partners, Inc.",State of Minnesota Advantage Program,70.905,81.5,,percent of total billed charges,,
"Group B Streptococcus Culture, Rectal And Vaginal",,87070,CPT,Facility,Both,,,,87,73.95,24.9342,87,"Health Partners, Inc.",State Public Programs,43.5,50,,percent of total billed charges,,
"Group B Streptococcus Culture, Rectal And Vaginal",,87070,CPT,Facility,Both,,,,87,73.95,24.9342,87,Humana Insurance Company,Commercial PPO,82.65,95,,percent of total billed charges,,
"Group B Streptococcus Culture, Rectal And Vaginal",,87070,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,Humana Insurance Company,Medicare PPO,42.63,49,,percent of total billed charges,,
"Group B Streptococcus Culture, Rectal And Vaginal",,87070,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Group B Streptococcus Culture, Rectal And Vaginal",,87070,CPT,Facility,Both,,,,87,73.95,24.9342,87,Medica,Individual & Family,86.217,99.1,,percent of total billed charges,,
"Group B Streptococcus Culture, Rectal And Vaginal",,87070,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,Medica,Medica Advantage Solution,43.326,49.8,,percent of total billed charges,,
"Group B Streptococcus Culture, Rectal And Vaginal",,87070,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Group B Streptococcus Culture, Rectal And Vaginal",,87070,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,Medica,Medical Assistance,38.802,44.6,,percent of total billed charges,,
"Group B Streptococcus Culture, Rectal And Vaginal",,87070,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,Medica,Medical Assistance,,,,,Included in per diem rate,
"Group B Streptococcus Culture, Rectal And Vaginal",,87070,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,43.326,49.8,,percent of total billed charges,,
"Group B Streptococcus Culture, Rectal And Vaginal",,87070,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Group B Streptococcus Culture, Rectal And Vaginal",,87070,CPT,Facility,Both,,,,87,73.95,24.9342,87,"Multiplan, Inc.","Multiplan, Inc.",81.78,94,,percent of total billed charges,,
"Group B Streptococcus Culture, Rectal And Vaginal",,87070,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,75.168,86.4,,percent of total billed charges,,
"Group B Streptococcus Culture, Rectal And Vaginal",,87070,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Group B Streptococcus Culture, Rectal And Vaginal",,87070,CPT,Facility,Both,,,,87,73.95,24.9342,87,"Preferred One Administrative Services, INC.",PPO,85.782,98.6,,percent of total billed charges,,
"Group B Streptococcus Culture, Rectal And Vaginal",,87070,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,PrimeWest Health,Minnesota Senior Health Options (MSHO),44.7615,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Group B Streptococcus Culture, Rectal And Vaginal",,87070,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Group B Streptococcus Culture, Rectal And Vaginal",,87070,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,PrimeWest Health,MinnesotaCare,44.6832,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Group B Streptococcus Culture, Rectal And Vaginal",,87070,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Group B Streptococcus Culture, Rectal And Vaginal",,87070,CPT,Facility,Both,,,,87,73.95,24.9342,87,Sanford Health Plan,Sanford Health Plan,80.04,92,,percent of total billed charges,,
"Group B Streptococcus Culture, Rectal And Vaginal",,87070,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,"UCare Health, Inc.",Individual & Family Plan,49.0245,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Group B Streptococcus Culture, Rectal And Vaginal",,87070,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Group B Streptococcus Culture, Rectal And Vaginal",,87070,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,"UCare Health, Inc.",Medical Assistance,43.9089,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Group B Streptococcus Culture, Rectal And Vaginal",,87070,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Group B Streptococcus Culture, Rectal And Vaginal",,87070,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,"UCare Health, Inc.",Medicare Advantage,43.9089,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Group B Streptococcus Culture, Rectal And Vaginal",,87070,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Group B Streptococcus Culture, Rectal And Vaginal",,87070,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),43.9089,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Group B Streptococcus Culture, Rectal And Vaginal",,87070,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Group B Streptococcus Culture, Rectal And Vaginal",,87070,CPT,Facility,Both,,,,87,73.95,24.9342,87,UnitedHealthcare,Individual & Family,81.78,94,,percent of total billed charges,,
"Group B Streptococcus Culture, Rectal And Vaginal",,87070,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,UnitedHealthcare,Medicare Advantage,42.63,49,,percent of total billed charges,,
"Group B Streptococcus Culture, Rectal And Vaginal",,87070,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Group B Streptococcus Culture, Rectal And Vaginal",,87070,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,41.76,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Group B Streptococcus Culture, Rectal And Vaginal",,87070,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Sputum Culture With Gram Stain,,87070,CPT,Facility,Both,,,,87,73.95,24.9342,87,Aetna,Commercial,80.04,92,,percent of total billed charges,,
Sputum Culture With Gram Stain,,87070,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,Aetna,Medicare Advantage,42.63,49,,percent of total billed charges,,
Sputum Culture With Gram Stain,,87070,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Sputum Culture With Gram Stain,,87070,CPT,Facility,Both,,,,87,73.95,24.9342,87,Aetna,PPO,80.91,93,,percent of total billed charges,,
Sputum Culture With Gram Stain,,87070,CPT,Facility,Both,,,,87,73.95,24.9342,87,America's PPO,America's PPO,83.5461,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Sputum Culture With Gram Stain,,87070,CPT,Facility,Both,,,,87,73.95,24.9342,87,BlueCross BlueShield Minnesota, Federal Employee Program,85.608,98.4,,percent of total billed charges,,
Sputum Culture With Gram Stain,,87070,CPT,Facility,Both,,,,87,73.95,24.9342,87,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,87,100,,percent of total billed charges,,
Sputum Culture With Gram Stain,,87070,CPT,Facility,Both,,,,87,73.95,24.9342,87,BlueCross BlueShield Minnesota,High Value Network Plan,78.3,90,,percent of total billed charges,,
Sputum Culture With Gram Stain,,87070,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,BlueCross BlueShield Minnesota,Medicare Advantage,42.63,49,,percent of total billed charges,,
Sputum Culture With Gram Stain,,87070,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Sputum Culture With Gram Stain,,87070,CPT,Facility,Both,,,,87,73.95,24.9342,87,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,77.0559,88.57,,percent of total billed charges,,
Sputum Culture With Gram Stain,,87070,CPT,Facility,Both,,,,87,73.95,24.9342,87,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,24.9342,28.66,,percent of total billed charges,,
Sputum Culture With Gram Stain,,87070,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),42.63,49,,percent of total billed charges,,
Sputum Culture With Gram Stain,,87070,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Sputum Culture With Gram Stain,,87070,CPT,Facility,Both,,,,87,73.95,24.9342,87,CorVel,Worker's Compensation,87,100,,percent of total billed charges,,
Sputum Culture With Gram Stain,,87070,CPT,Facility,Both,,,,87,73.95,24.9342,87,First Health Group Corporation,First Health Network,84.39,97,,percent of total billed charges,,
Sputum Culture With Gram Stain,,87070,CPT,Facility,Both,,,,87,73.95,24.9342,87,"Health Partners, Inc.",Commercial,82.302,94.6,,percent of total billed charges,,
Sputum Culture With Gram Stain,,87070,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,"Health Partners, Inc.",Medicare Advantage,42.63,49,,percent of total billed charges,,
Sputum Culture With Gram Stain,,87070,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sputum Culture With Gram Stain,,87070,CPT,Facility,Both,,,,87,73.95,24.9342,87,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),52.2,60,,percent of total billed charges,,
Sputum Culture With Gram Stain,,87070,CPT,Facility,Both,,,,87,73.95,24.9342,87,"Health Partners, Inc.",State of Minnesota Advantage Program,70.905,81.5,,percent of total billed charges,,
Sputum Culture With Gram Stain,,87070,CPT,Facility,Both,,,,87,73.95,24.9342,87,"Health Partners, Inc.",State Public Programs,43.5,50,,percent of total billed charges,,
Sputum Culture With Gram Stain,,87070,CPT,Facility,Both,,,,87,73.95,24.9342,87,Humana Insurance Company,Commercial PPO,82.65,95,,percent of total billed charges,,
Sputum Culture With Gram Stain,,87070,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,Humana Insurance Company,Medicare PPO,42.63,49,,percent of total billed charges,,
Sputum Culture With Gram Stain,,87070,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Sputum Culture With Gram Stain,,87070,CPT,Facility,Both,,,,87,73.95,24.9342,87,Medica,Individual & Family,86.217,99.1,,percent of total billed charges,,
Sputum Culture With Gram Stain,,87070,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,Medica,Medica Advantage Solution,43.326,49.8,,percent of total billed charges,,
Sputum Culture With Gram Stain,,87070,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Sputum Culture With Gram Stain,,87070,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,Medica,Medical Assistance,38.802,44.6,,percent of total billed charges,,
Sputum Culture With Gram Stain,,87070,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,Medica,Medical Assistance,,,,,Included in per diem rate,
Sputum Culture With Gram Stain,,87070,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,43.326,49.8,,percent of total billed charges,,
Sputum Culture With Gram Stain,,87070,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Sputum Culture With Gram Stain,,87070,CPT,Facility,Both,,,,87,73.95,24.9342,87,"Multiplan, Inc.","Multiplan, Inc.",81.78,94,,percent of total billed charges,,
Sputum Culture With Gram Stain,,87070,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,75.168,86.4,,percent of total billed charges,,
Sputum Culture With Gram Stain,,87070,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Sputum Culture With Gram Stain,,87070,CPT,Facility,Both,,,,87,73.95,24.9342,87,"Preferred One Administrative Services, INC.",PPO,85.782,98.6,,percent of total billed charges,,
Sputum Culture With Gram Stain,,87070,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,PrimeWest Health,Minnesota Senior Health Options (MSHO),44.7615,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Sputum Culture With Gram Stain,,87070,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sputum Culture With Gram Stain,,87070,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,PrimeWest Health,MinnesotaCare,44.6832,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Sputum Culture With Gram Stain,,87070,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Sputum Culture With Gram Stain,,87070,CPT,Facility,Both,,,,87,73.95,24.9342,87,Sanford Health Plan,Sanford Health Plan,80.04,92,,percent of total billed charges,,
Sputum Culture With Gram Stain,,87070,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,"UCare Health, Inc.",Individual & Family Plan,49.0245,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Sputum Culture With Gram Stain,,87070,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Sputum Culture With Gram Stain,,87070,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,"UCare Health, Inc.",Medical Assistance,43.9089,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sputum Culture With Gram Stain,,87070,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Sputum Culture With Gram Stain,,87070,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,"UCare Health, Inc.",Medicare Advantage,43.9089,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sputum Culture With Gram Stain,,87070,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sputum Culture With Gram Stain,,87070,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),43.9089,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sputum Culture With Gram Stain,,87070,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sputum Culture With Gram Stain,,87070,CPT,Facility,Both,,,,87,73.95,24.9342,87,UnitedHealthcare,Individual & Family,81.78,94,,percent of total billed charges,,
Sputum Culture With Gram Stain,,87070,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,UnitedHealthcare,Medicare Advantage,42.63,49,,percent of total billed charges,,
Sputum Culture With Gram Stain,,87070,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Sputum Culture With Gram Stain,,87070,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,41.76,48,,percent of total billed charges,,100% of DHS outpatient percentage
Sputum Culture With Gram Stain,,87070,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Anaerobic Culture,,87075,CPT,Facility,Both,,,,87,73.95,24.9342,87,Aetna,Commercial,80.04,92,,percent of total billed charges,,
Anaerobic Culture,,87075,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,Aetna,Medicare Advantage,42.63,49,,percent of total billed charges,,
Anaerobic Culture,,87075,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Anaerobic Culture,,87075,CPT,Facility,Both,,,,87,73.95,24.9342,87,Aetna,PPO,80.91,93,,percent of total billed charges,,
Anaerobic Culture,,87075,CPT,Facility,Both,,,,87,73.95,24.9342,87,America's PPO,America's PPO,83.5461,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Anaerobic Culture,,87075,CPT,Facility,Both,,,,87,73.95,24.9342,87,BlueCross BlueShield Minnesota, Federal Employee Program,85.608,98.4,,percent of total billed charges,,
Anaerobic Culture,,87075,CPT,Facility,Both,,,,87,73.95,24.9342,87,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,87,100,,percent of total billed charges,,
Anaerobic Culture,,87075,CPT,Facility,Both,,,,87,73.95,24.9342,87,BlueCross BlueShield Minnesota,High Value Network Plan,78.3,90,,percent of total billed charges,,
Anaerobic Culture,,87075,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,BlueCross BlueShield Minnesota,Medicare Advantage,42.63,49,,percent of total billed charges,,
Anaerobic Culture,,87075,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Anaerobic Culture,,87075,CPT,Facility,Both,,,,87,73.95,24.9342,87,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,77.0559,88.57,,percent of total billed charges,,
Anaerobic Culture,,87075,CPT,Facility,Both,,,,87,73.95,24.9342,87,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,24.9342,28.66,,percent of total billed charges,,
Anaerobic Culture,,87075,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),42.63,49,,percent of total billed charges,,
Anaerobic Culture,,87075,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Anaerobic Culture,,87075,CPT,Facility,Both,,,,87,73.95,24.9342,87,CorVel,Worker's Compensation,87,100,,percent of total billed charges,,
Anaerobic Culture,,87075,CPT,Facility,Both,,,,87,73.95,24.9342,87,First Health Group Corporation,First Health Network,84.39,97,,percent of total billed charges,,
Anaerobic Culture,,87075,CPT,Facility,Both,,,,87,73.95,24.9342,87,"Health Partners, Inc.",Commercial,82.302,94.6,,percent of total billed charges,,
Anaerobic Culture,,87075,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,"Health Partners, Inc.",Medicare Advantage,42.63,49,,percent of total billed charges,,
Anaerobic Culture,,87075,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Anaerobic Culture,,87075,CPT,Facility,Both,,,,87,73.95,24.9342,87,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),52.2,60,,percent of total billed charges,,
Anaerobic Culture,,87075,CPT,Facility,Both,,,,87,73.95,24.9342,87,"Health Partners, Inc.",State of Minnesota Advantage Program,70.905,81.5,,percent of total billed charges,,
Anaerobic Culture,,87075,CPT,Facility,Both,,,,87,73.95,24.9342,87,"Health Partners, Inc.",State Public Programs,43.5,50,,percent of total billed charges,,
Anaerobic Culture,,87075,CPT,Facility,Both,,,,87,73.95,24.9342,87,Humana Insurance Company,Commercial PPO,82.65,95,,percent of total billed charges,,
Anaerobic Culture,,87075,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,Humana Insurance Company,Medicare PPO,42.63,49,,percent of total billed charges,,
Anaerobic Culture,,87075,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Anaerobic Culture,,87075,CPT,Facility,Both,,,,87,73.95,24.9342,87,Medica,Individual & Family,86.217,99.1,,percent of total billed charges,,
Anaerobic Culture,,87075,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,Medica,Medica Advantage Solution,43.326,49.8,,percent of total billed charges,,
Anaerobic Culture,,87075,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Anaerobic Culture,,87075,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,Medica,Medical Assistance,38.802,44.6,,percent of total billed charges,,
Anaerobic Culture,,87075,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,Medica,Medical Assistance,,,,,Included in per diem rate,
Anaerobic Culture,,87075,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,43.326,49.8,,percent of total billed charges,,
Anaerobic Culture,,87075,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Anaerobic Culture,,87075,CPT,Facility,Both,,,,87,73.95,24.9342,87,"Multiplan, Inc.","Multiplan, Inc.",81.78,94,,percent of total billed charges,,
Anaerobic Culture,,87075,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,75.168,86.4,,percent of total billed charges,,
Anaerobic Culture,,87075,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Anaerobic Culture,,87075,CPT,Facility,Both,,,,87,73.95,24.9342,87,"Preferred One Administrative Services, INC.",PPO,85.782,98.6,,percent of total billed charges,,
Anaerobic Culture,,87075,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,PrimeWest Health,Minnesota Senior Health Options (MSHO),44.7615,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Anaerobic Culture,,87075,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Anaerobic Culture,,87075,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,PrimeWest Health,MinnesotaCare,44.6832,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Anaerobic Culture,,87075,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Anaerobic Culture,,87075,CPT,Facility,Both,,,,87,73.95,24.9342,87,Sanford Health Plan,Sanford Health Plan,80.04,92,,percent of total billed charges,,
Anaerobic Culture,,87075,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,"UCare Health, Inc.",Individual & Family Plan,49.0245,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Anaerobic Culture,,87075,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Anaerobic Culture,,87075,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,"UCare Health, Inc.",Medical Assistance,43.9089,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Anaerobic Culture,,87075,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Anaerobic Culture,,87075,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,"UCare Health, Inc.",Medicare Advantage,43.9089,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Anaerobic Culture,,87075,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Anaerobic Culture,,87075,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),43.9089,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Anaerobic Culture,,87075,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Anaerobic Culture,,87075,CPT,Facility,Both,,,,87,73.95,24.9342,87,UnitedHealthcare,Individual & Family,81.78,94,,percent of total billed charges,,
Anaerobic Culture,,87075,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,UnitedHealthcare,Medicare Advantage,42.63,49,,percent of total billed charges,,
Anaerobic Culture,,87075,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Anaerobic Culture,,87075,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,41.76,48,,percent of total billed charges,,100% of DHS outpatient percentage
Anaerobic Culture,,87075,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Anaerobic Identification,,87076,CPT,Facility,Both,,,,46,39.1,13.1836,46,Aetna,Commercial,42.32,92,,percent of total billed charges,,
Anaerobic Identification,,87076,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,Aetna,Medicare Advantage,22.54,49,,percent of total billed charges,,
Anaerobic Identification,,87076,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Anaerobic Identification,,87076,CPT,Facility,Both,,,,46,39.1,13.1836,46,Aetna,PPO,42.78,93,,percent of total billed charges,,
Anaerobic Identification,,87076,CPT,Facility,Both,,,,46,39.1,13.1836,46,America's PPO,America's PPO,44.1738,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Anaerobic Identification,,87076,CPT,Facility,Both,,,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota, Federal Employee Program,45.264,98.4,,percent of total billed charges,,
Anaerobic Identification,,87076,CPT,Facility,Both,,,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,46,100,,percent of total billed charges,,
Anaerobic Identification,,87076,CPT,Facility,Both,,,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,High Value Network Plan,41.4,90,,percent of total billed charges,,
Anaerobic Identification,,87076,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Medicare Advantage,22.54,49,,percent of total billed charges,,
Anaerobic Identification,,87076,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Anaerobic Identification,,87076,CPT,Facility,Both,,,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,40.7422,88.57,,percent of total billed charges,,
Anaerobic Identification,,87076,CPT,Facility,Both,,,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,13.1836,28.66,,percent of total billed charges,,
Anaerobic Identification,,87076,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),22.54,49,,percent of total billed charges,,
Anaerobic Identification,,87076,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Anaerobic Identification,,87076,CPT,Facility,Both,,,,46,39.1,13.1836,46,CorVel,Worker's Compensation,46,100,,percent of total billed charges,,
Anaerobic Identification,,87076,CPT,Facility,Both,,,,46,39.1,13.1836,46,First Health Group Corporation,First Health Network,44.62,97,,percent of total billed charges,,
Anaerobic Identification,,87076,CPT,Facility,Both,,,,46,39.1,13.1836,46,"Health Partners, Inc.",Commercial,43.516,94.6,,percent of total billed charges,,
Anaerobic Identification,,87076,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,"Health Partners, Inc.",Medicare Advantage,22.54,49,,percent of total billed charges,,
Anaerobic Identification,,87076,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Anaerobic Identification,,87076,CPT,Facility,Both,,,,46,39.1,13.1836,46,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),27.6,60,,percent of total billed charges,,
Anaerobic Identification,,87076,CPT,Facility,Both,,,,46,39.1,13.1836,46,"Health Partners, Inc.",State of Minnesota Advantage Program,37.49,81.5,,percent of total billed charges,,
Anaerobic Identification,,87076,CPT,Facility,Both,,,,46,39.1,13.1836,46,"Health Partners, Inc.",State Public Programs,23,50,,percent of total billed charges,,
Anaerobic Identification,,87076,CPT,Facility,Both,,,,46,39.1,13.1836,46,Humana Insurance Company,Commercial PPO,43.7,95,,percent of total billed charges,,
Anaerobic Identification,,87076,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,Humana Insurance Company,Medicare PPO,22.54,49,,percent of total billed charges,,
Anaerobic Identification,,87076,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Anaerobic Identification,,87076,CPT,Facility,Both,,,,46,39.1,13.1836,46,Medica,Individual & Family,45.586,99.1,,percent of total billed charges,,
Anaerobic Identification,,87076,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,Medica,Medica Advantage Solution,22.908,49.8,,percent of total billed charges,,
Anaerobic Identification,,87076,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Anaerobic Identification,,87076,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,Medica,Medical Assistance,20.516,44.6,,percent of total billed charges,,
Anaerobic Identification,,87076,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,Medica,Medical Assistance,,,,,Included in per diem rate,
Anaerobic Identification,,87076,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,22.908,49.8,,percent of total billed charges,,
Anaerobic Identification,,87076,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Anaerobic Identification,,87076,CPT,Facility,Both,,,,46,39.1,13.1836,46,"Multiplan, Inc.","Multiplan, Inc.",43.24,94,,percent of total billed charges,,
Anaerobic Identification,,87076,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,39.744,86.4,,percent of total billed charges,,
Anaerobic Identification,,87076,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Anaerobic Identification,,87076,CPT,Facility,Both,,,,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PPO,45.356,98.6,,percent of total billed charges,,
Anaerobic Identification,,87076,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,PrimeWest Health,Minnesota Senior Health Options (MSHO),23.667,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Anaerobic Identification,,87076,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Anaerobic Identification,,87076,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,PrimeWest Health,MinnesotaCare,23.6256,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Anaerobic Identification,,87076,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Anaerobic Identification,,87076,CPT,Facility,Both,,,,46,39.1,13.1836,46,Sanford Health Plan,Sanford Health Plan,42.32,92,,percent of total billed charges,,
Anaerobic Identification,,87076,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,"UCare Health, Inc.",Individual & Family Plan,25.921,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Anaerobic Identification,,87076,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Anaerobic Identification,,87076,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,"UCare Health, Inc.",Medical Assistance,23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Anaerobic Identification,,87076,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Anaerobic Identification,,87076,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,"UCare Health, Inc.",Medicare Advantage,23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Anaerobic Identification,,87076,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Anaerobic Identification,,87076,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Anaerobic Identification,,87076,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Anaerobic Identification,,87076,CPT,Facility,Both,,,,46,39.1,13.1836,46,UnitedHealthcare,Individual & Family,43.24,94,,percent of total billed charges,,
Anaerobic Identification,,87076,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,UnitedHealthcare,Medicare Advantage,22.54,49,,percent of total billed charges,,
Anaerobic Identification,,87076,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Anaerobic Identification,,87076,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,22.08,48,,percent of total billed charges,,100% of DHS outpatient percentage
Anaerobic Identification,,87076,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Subculture, Anaerobe",,87076,CPT,Facility,Both,,,,71,60.35,20.3486,71,Aetna,Commercial,65.32,92,,percent of total billed charges,,
"Subculture, Anaerobe",,87076,CPT,Facility,Outpatient,,,,71,60.35,20.3486,71,Aetna,Medicare Advantage,34.79,49,,percent of total billed charges,,
"Subculture, Anaerobe",,87076,CPT,Facility,Inpatient,,,,71,60.35,20.3486,71,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Subculture, Anaerobe",,87076,CPT,Facility,Both,,,,71,60.35,20.3486,71,Aetna,PPO,66.03,93,,percent of total billed charges,,
"Subculture, Anaerobe",,87076,CPT,Facility,Both,,,,71,60.35,20.3486,71,America's PPO,America's PPO,68.1813,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Subculture, Anaerobe",,87076,CPT,Facility,Both,,,,71,60.35,20.3486,71,BlueCross BlueShield Minnesota, Federal Employee Program,69.864,98.4,,percent of total billed charges,,
"Subculture, Anaerobe",,87076,CPT,Facility,Both,,,,71,60.35,20.3486,71,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,71,100,,percent of total billed charges,,
"Subculture, Anaerobe",,87076,CPT,Facility,Both,,,,71,60.35,20.3486,71,BlueCross BlueShield Minnesota,High Value Network Plan,63.9,90,,percent of total billed charges,,
"Subculture, Anaerobe",,87076,CPT,Facility,Outpatient,,,,71,60.35,20.3486,71,BlueCross BlueShield Minnesota,Medicare Advantage,34.79,49,,percent of total billed charges,,
"Subculture, Anaerobe",,87076,CPT,Facility,Inpatient,,,,71,60.35,20.3486,71,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Subculture, Anaerobe",,87076,CPT,Facility,Both,,,,71,60.35,20.3486,71,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,62.8847,88.57,,percent of total billed charges,,
"Subculture, Anaerobe",,87076,CPT,Facility,Both,,,,71,60.35,20.3486,71,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,20.3486,28.66,,percent of total billed charges,,
"Subculture, Anaerobe",,87076,CPT,Facility,Outpatient,,,,71,60.35,20.3486,71,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),34.79,49,,percent of total billed charges,,
"Subculture, Anaerobe",,87076,CPT,Facility,Inpatient,,,,71,60.35,20.3486,71,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Subculture, Anaerobe",,87076,CPT,Facility,Both,,,,71,60.35,20.3486,71,CorVel,Worker's Compensation,71,100,,percent of total billed charges,,
"Subculture, Anaerobe",,87076,CPT,Facility,Both,,,,71,60.35,20.3486,71,First Health Group Corporation,First Health Network,68.87,97,,percent of total billed charges,,
"Subculture, Anaerobe",,87076,CPT,Facility,Both,,,,71,60.35,20.3486,71,"Health Partners, Inc.",Commercial,67.166,94.6,,percent of total billed charges,,
"Subculture, Anaerobe",,87076,CPT,Facility,Outpatient,,,,71,60.35,20.3486,71,"Health Partners, Inc.",Medicare Advantage,34.79,49,,percent of total billed charges,,
"Subculture, Anaerobe",,87076,CPT,Facility,Inpatient,,,,71,60.35,20.3486,71,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Subculture, Anaerobe",,87076,CPT,Facility,Both,,,,71,60.35,20.3486,71,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),42.6,60,,percent of total billed charges,,
"Subculture, Anaerobe",,87076,CPT,Facility,Both,,,,71,60.35,20.3486,71,"Health Partners, Inc.",State of Minnesota Advantage Program,57.865,81.5,,percent of total billed charges,,
"Subculture, Anaerobe",,87076,CPT,Facility,Both,,,,71,60.35,20.3486,71,"Health Partners, Inc.",State Public Programs,35.5,50,,percent of total billed charges,,
"Subculture, Anaerobe",,87076,CPT,Facility,Both,,,,71,60.35,20.3486,71,Humana Insurance Company,Commercial PPO,67.45,95,,percent of total billed charges,,
"Subculture, Anaerobe",,87076,CPT,Facility,Outpatient,,,,71,60.35,20.3486,71,Humana Insurance Company,Medicare PPO,34.79,49,,percent of total billed charges,,
"Subculture, Anaerobe",,87076,CPT,Facility,Inpatient,,,,71,60.35,20.3486,71,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Subculture, Anaerobe",,87076,CPT,Facility,Both,,,,71,60.35,20.3486,71,Medica,Individual & Family,70.361,99.1,,percent of total billed charges,,
"Subculture, Anaerobe",,87076,CPT,Facility,Outpatient,,,,71,60.35,20.3486,71,Medica,Medica Advantage Solution,35.358,49.8,,percent of total billed charges,,
"Subculture, Anaerobe",,87076,CPT,Facility,Inpatient,,,,71,60.35,20.3486,71,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Subculture, Anaerobe",,87076,CPT,Facility,Outpatient,,,,71,60.35,20.3486,71,Medica,Medical Assistance,31.666,44.6,,percent of total billed charges,,
"Subculture, Anaerobe",,87076,CPT,Facility,Inpatient,,,,71,60.35,20.3486,71,Medica,Medical Assistance,,,,,Included in per diem rate,
"Subculture, Anaerobe",,87076,CPT,Facility,Outpatient,,,,71,60.35,20.3486,71,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,35.358,49.8,,percent of total billed charges,,
"Subculture, Anaerobe",,87076,CPT,Facility,Inpatient,,,,71,60.35,20.3486,71,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Subculture, Anaerobe",,87076,CPT,Facility,Both,,,,71,60.35,20.3486,71,"Multiplan, Inc.","Multiplan, Inc.",66.74,94,,percent of total billed charges,,
"Subculture, Anaerobe",,87076,CPT,Facility,Outpatient,,,,71,60.35,20.3486,71,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,61.344,86.4,,percent of total billed charges,,
"Subculture, Anaerobe",,87076,CPT,Facility,Inpatient,,,,71,60.35,20.3486,71,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Subculture, Anaerobe",,87076,CPT,Facility,Both,,,,71,60.35,20.3486,71,"Preferred One Administrative Services, INC.",PPO,70.006,98.6,,percent of total billed charges,,
"Subculture, Anaerobe",,87076,CPT,Facility,Outpatient,,,,71,60.35,20.3486,71,PrimeWest Health,Minnesota Senior Health Options (MSHO),36.5295,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Subculture, Anaerobe",,87076,CPT,Facility,Inpatient,,,,71,60.35,20.3486,71,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Subculture, Anaerobe",,87076,CPT,Facility,Outpatient,,,,71,60.35,20.3486,71,PrimeWest Health,MinnesotaCare,36.4656,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Subculture, Anaerobe",,87076,CPT,Facility,Inpatient,,,,71,60.35,20.3486,71,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Subculture, Anaerobe",,87076,CPT,Facility,Both,,,,71,60.35,20.3486,71,Sanford Health Plan,Sanford Health Plan,65.32,92,,percent of total billed charges,,
"Subculture, Anaerobe",,87076,CPT,Facility,Outpatient,,,,71,60.35,20.3486,71,"UCare Health, Inc.",Individual & Family Plan,40.0085,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Subculture, Anaerobe",,87076,CPT,Facility,Inpatient,,,,71,60.35,20.3486,71,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Subculture, Anaerobe",,87076,CPT,Facility,Outpatient,,,,71,60.35,20.3486,71,"UCare Health, Inc.",Medical Assistance,35.8337,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Subculture, Anaerobe",,87076,CPT,Facility,Inpatient,,,,71,60.35,20.3486,71,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Subculture, Anaerobe",,87076,CPT,Facility,Outpatient,,,,71,60.35,20.3486,71,"UCare Health, Inc.",Medicare Advantage,35.8337,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Subculture, Anaerobe",,87076,CPT,Facility,Inpatient,,,,71,60.35,20.3486,71,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Subculture, Anaerobe",,87076,CPT,Facility,Outpatient,,,,71,60.35,20.3486,71,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),35.8337,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Subculture, Anaerobe",,87076,CPT,Facility,Inpatient,,,,71,60.35,20.3486,71,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Subculture, Anaerobe",,87076,CPT,Facility,Both,,,,71,60.35,20.3486,71,UnitedHealthcare,Individual & Family,66.74,94,,percent of total billed charges,,
"Subculture, Anaerobe",,87076,CPT,Facility,Outpatient,,,,71,60.35,20.3486,71,UnitedHealthcare,Medicare Advantage,34.79,49,,percent of total billed charges,,
"Subculture, Anaerobe",,87076,CPT,Facility,Inpatient,,,,71,60.35,20.3486,71,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Subculture, Anaerobe",,87076,CPT,Facility,Outpatient,,,,71,60.35,20.3486,71,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,34.08,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Subculture, Anaerobe",,87076,CPT,Facility,Inpatient,,,,71,60.35,20.3486,71,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Aerobic Identification,,87077,CPT,Facility,Both,,,,71,60.35,20.3486,71,Aetna,Commercial,65.32,92,,percent of total billed charges,,
Aerobic Identification,,87077,CPT,Facility,Outpatient,,,,71,60.35,20.3486,71,Aetna,Medicare Advantage,34.79,49,,percent of total billed charges,,
Aerobic Identification,,87077,CPT,Facility,Inpatient,,,,71,60.35,20.3486,71,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Aerobic Identification,,87077,CPT,Facility,Both,,,,71,60.35,20.3486,71,Aetna,PPO,66.03,93,,percent of total billed charges,,
Aerobic Identification,,87077,CPT,Facility,Both,,,,71,60.35,20.3486,71,America's PPO,America's PPO,68.1813,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Aerobic Identification,,87077,CPT,Facility,Both,,,,71,60.35,20.3486,71,BlueCross BlueShield Minnesota, Federal Employee Program,69.864,98.4,,percent of total billed charges,,
Aerobic Identification,,87077,CPT,Facility,Both,,,,71,60.35,20.3486,71,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,71,100,,percent of total billed charges,,
Aerobic Identification,,87077,CPT,Facility,Both,,,,71,60.35,20.3486,71,BlueCross BlueShield Minnesota,High Value Network Plan,63.9,90,,percent of total billed charges,,
Aerobic Identification,,87077,CPT,Facility,Outpatient,,,,71,60.35,20.3486,71,BlueCross BlueShield Minnesota,Medicare Advantage,34.79,49,,percent of total billed charges,,
Aerobic Identification,,87077,CPT,Facility,Inpatient,,,,71,60.35,20.3486,71,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Aerobic Identification,,87077,CPT,Facility,Both,,,,71,60.35,20.3486,71,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,62.8847,88.57,,percent of total billed charges,,
Aerobic Identification,,87077,CPT,Facility,Both,,,,71,60.35,20.3486,71,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,20.3486,28.66,,percent of total billed charges,,
Aerobic Identification,,87077,CPT,Facility,Outpatient,,,,71,60.35,20.3486,71,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),34.79,49,,percent of total billed charges,,
Aerobic Identification,,87077,CPT,Facility,Inpatient,,,,71,60.35,20.3486,71,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Aerobic Identification,,87077,CPT,Facility,Both,,,,71,60.35,20.3486,71,CorVel,Worker's Compensation,71,100,,percent of total billed charges,,
Aerobic Identification,,87077,CPT,Facility,Both,,,,71,60.35,20.3486,71,First Health Group Corporation,First Health Network,68.87,97,,percent of total billed charges,,
Aerobic Identification,,87077,CPT,Facility,Both,,,,71,60.35,20.3486,71,"Health Partners, Inc.",Commercial,67.166,94.6,,percent of total billed charges,,
Aerobic Identification,,87077,CPT,Facility,Outpatient,,,,71,60.35,20.3486,71,"Health Partners, Inc.",Medicare Advantage,34.79,49,,percent of total billed charges,,
Aerobic Identification,,87077,CPT,Facility,Inpatient,,,,71,60.35,20.3486,71,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Aerobic Identification,,87077,CPT,Facility,Both,,,,71,60.35,20.3486,71,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),42.6,60,,percent of total billed charges,,
Aerobic Identification,,87077,CPT,Facility,Both,,,,71,60.35,20.3486,71,"Health Partners, Inc.",State of Minnesota Advantage Program,57.865,81.5,,percent of total billed charges,,
Aerobic Identification,,87077,CPT,Facility,Both,,,,71,60.35,20.3486,71,"Health Partners, Inc.",State Public Programs,35.5,50,,percent of total billed charges,,
Aerobic Identification,,87077,CPT,Facility,Both,,,,71,60.35,20.3486,71,Humana Insurance Company,Commercial PPO,67.45,95,,percent of total billed charges,,
Aerobic Identification,,87077,CPT,Facility,Outpatient,,,,71,60.35,20.3486,71,Humana Insurance Company,Medicare PPO,34.79,49,,percent of total billed charges,,
Aerobic Identification,,87077,CPT,Facility,Inpatient,,,,71,60.35,20.3486,71,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Aerobic Identification,,87077,CPT,Facility,Both,,,,71,60.35,20.3486,71,Medica,Individual & Family,70.361,99.1,,percent of total billed charges,,
Aerobic Identification,,87077,CPT,Facility,Outpatient,,,,71,60.35,20.3486,71,Medica,Medica Advantage Solution,35.358,49.8,,percent of total billed charges,,
Aerobic Identification,,87077,CPT,Facility,Inpatient,,,,71,60.35,20.3486,71,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Aerobic Identification,,87077,CPT,Facility,Outpatient,,,,71,60.35,20.3486,71,Medica,Medical Assistance,31.666,44.6,,percent of total billed charges,,
Aerobic Identification,,87077,CPT,Facility,Inpatient,,,,71,60.35,20.3486,71,Medica,Medical Assistance,,,,,Included in per diem rate,
Aerobic Identification,,87077,CPT,Facility,Outpatient,,,,71,60.35,20.3486,71,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,35.358,49.8,,percent of total billed charges,,
Aerobic Identification,,87077,CPT,Facility,Inpatient,,,,71,60.35,20.3486,71,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Aerobic Identification,,87077,CPT,Facility,Both,,,,71,60.35,20.3486,71,"Multiplan, Inc.","Multiplan, Inc.",66.74,94,,percent of total billed charges,,
Aerobic Identification,,87077,CPT,Facility,Outpatient,,,,71,60.35,20.3486,71,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,61.344,86.4,,percent of total billed charges,,
Aerobic Identification,,87077,CPT,Facility,Inpatient,,,,71,60.35,20.3486,71,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Aerobic Identification,,87077,CPT,Facility,Both,,,,71,60.35,20.3486,71,"Preferred One Administrative Services, INC.",PPO,70.006,98.6,,percent of total billed charges,,
Aerobic Identification,,87077,CPT,Facility,Outpatient,,,,71,60.35,20.3486,71,PrimeWest Health,Minnesota Senior Health Options (MSHO),36.5295,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Aerobic Identification,,87077,CPT,Facility,Inpatient,,,,71,60.35,20.3486,71,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Aerobic Identification,,87077,CPT,Facility,Outpatient,,,,71,60.35,20.3486,71,PrimeWest Health,MinnesotaCare,36.4656,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Aerobic Identification,,87077,CPT,Facility,Inpatient,,,,71,60.35,20.3486,71,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Aerobic Identification,,87077,CPT,Facility,Both,,,,71,60.35,20.3486,71,Sanford Health Plan,Sanford Health Plan,65.32,92,,percent of total billed charges,,
Aerobic Identification,,87077,CPT,Facility,Outpatient,,,,71,60.35,20.3486,71,"UCare Health, Inc.",Individual & Family Plan,40.0085,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Aerobic Identification,,87077,CPT,Facility,Inpatient,,,,71,60.35,20.3486,71,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Aerobic Identification,,87077,CPT,Facility,Outpatient,,,,71,60.35,20.3486,71,"UCare Health, Inc.",Medical Assistance,35.8337,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Aerobic Identification,,87077,CPT,Facility,Inpatient,,,,71,60.35,20.3486,71,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Aerobic Identification,,87077,CPT,Facility,Outpatient,,,,71,60.35,20.3486,71,"UCare Health, Inc.",Medicare Advantage,35.8337,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Aerobic Identification,,87077,CPT,Facility,Inpatient,,,,71,60.35,20.3486,71,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Aerobic Identification,,87077,CPT,Facility,Outpatient,,,,71,60.35,20.3486,71,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),35.8337,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Aerobic Identification,,87077,CPT,Facility,Inpatient,,,,71,60.35,20.3486,71,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Aerobic Identification,,87077,CPT,Facility,Both,,,,71,60.35,20.3486,71,UnitedHealthcare,Individual & Family,66.74,94,,percent of total billed charges,,
Aerobic Identification,,87077,CPT,Facility,Outpatient,,,,71,60.35,20.3486,71,UnitedHealthcare,Medicare Advantage,34.79,49,,percent of total billed charges,,
Aerobic Identification,,87077,CPT,Facility,Inpatient,,,,71,60.35,20.3486,71,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Aerobic Identification,,87077,CPT,Facility,Outpatient,,,,71,60.35,20.3486,71,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,34.08,48,,percent of total billed charges,,100% of DHS outpatient percentage
Aerobic Identification,,87077,CPT,Facility,Inpatient,,,,71,60.35,20.3486,71,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Subculture, Aerobe",,87077,CPT,Facility,Both,,,,71,60.35,20.3486,71,Aetna,Commercial,65.32,92,,percent of total billed charges,,
"Subculture, Aerobe",,87077,CPT,Facility,Outpatient,,,,71,60.35,20.3486,71,Aetna,Medicare Advantage,34.79,49,,percent of total billed charges,,
"Subculture, Aerobe",,87077,CPT,Facility,Inpatient,,,,71,60.35,20.3486,71,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Subculture, Aerobe",,87077,CPT,Facility,Both,,,,71,60.35,20.3486,71,Aetna,PPO,66.03,93,,percent of total billed charges,,
"Subculture, Aerobe",,87077,CPT,Facility,Both,,,,71,60.35,20.3486,71,America's PPO,America's PPO,68.1813,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Subculture, Aerobe",,87077,CPT,Facility,Both,,,,71,60.35,20.3486,71,BlueCross BlueShield Minnesota, Federal Employee Program,69.864,98.4,,percent of total billed charges,,
"Subculture, Aerobe",,87077,CPT,Facility,Both,,,,71,60.35,20.3486,71,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,71,100,,percent of total billed charges,,
"Subculture, Aerobe",,87077,CPT,Facility,Both,,,,71,60.35,20.3486,71,BlueCross BlueShield Minnesota,High Value Network Plan,63.9,90,,percent of total billed charges,,
"Subculture, Aerobe",,87077,CPT,Facility,Outpatient,,,,71,60.35,20.3486,71,BlueCross BlueShield Minnesota,Medicare Advantage,34.79,49,,percent of total billed charges,,
"Subculture, Aerobe",,87077,CPT,Facility,Inpatient,,,,71,60.35,20.3486,71,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Subculture, Aerobe",,87077,CPT,Facility,Both,,,,71,60.35,20.3486,71,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,62.8847,88.57,,percent of total billed charges,,
"Subculture, Aerobe",,87077,CPT,Facility,Both,,,,71,60.35,20.3486,71,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,20.3486,28.66,,percent of total billed charges,,
"Subculture, Aerobe",,87077,CPT,Facility,Outpatient,,,,71,60.35,20.3486,71,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),34.79,49,,percent of total billed charges,,
"Subculture, Aerobe",,87077,CPT,Facility,Inpatient,,,,71,60.35,20.3486,71,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Subculture, Aerobe",,87077,CPT,Facility,Both,,,,71,60.35,20.3486,71,CorVel,Worker's Compensation,71,100,,percent of total billed charges,,
"Subculture, Aerobe",,87077,CPT,Facility,Both,,,,71,60.35,20.3486,71,First Health Group Corporation,First Health Network,68.87,97,,percent of total billed charges,,
"Subculture, Aerobe",,87077,CPT,Facility,Both,,,,71,60.35,20.3486,71,"Health Partners, Inc.",Commercial,67.166,94.6,,percent of total billed charges,,
"Subculture, Aerobe",,87077,CPT,Facility,Outpatient,,,,71,60.35,20.3486,71,"Health Partners, Inc.",Medicare Advantage,34.79,49,,percent of total billed charges,,
"Subculture, Aerobe",,87077,CPT,Facility,Inpatient,,,,71,60.35,20.3486,71,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Subculture, Aerobe",,87077,CPT,Facility,Both,,,,71,60.35,20.3486,71,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),42.6,60,,percent of total billed charges,,
"Subculture, Aerobe",,87077,CPT,Facility,Both,,,,71,60.35,20.3486,71,"Health Partners, Inc.",State of Minnesota Advantage Program,57.865,81.5,,percent of total billed charges,,
"Subculture, Aerobe",,87077,CPT,Facility,Both,,,,71,60.35,20.3486,71,"Health Partners, Inc.",State Public Programs,35.5,50,,percent of total billed charges,,
"Subculture, Aerobe",,87077,CPT,Facility,Both,,,,71,60.35,20.3486,71,Humana Insurance Company,Commercial PPO,67.45,95,,percent of total billed charges,,
"Subculture, Aerobe",,87077,CPT,Facility,Outpatient,,,,71,60.35,20.3486,71,Humana Insurance Company,Medicare PPO,34.79,49,,percent of total billed charges,,
"Subculture, Aerobe",,87077,CPT,Facility,Inpatient,,,,71,60.35,20.3486,71,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Subculture, Aerobe",,87077,CPT,Facility,Both,,,,71,60.35,20.3486,71,Medica,Individual & Family,70.361,99.1,,percent of total billed charges,,
"Subculture, Aerobe",,87077,CPT,Facility,Outpatient,,,,71,60.35,20.3486,71,Medica,Medica Advantage Solution,35.358,49.8,,percent of total billed charges,,
"Subculture, Aerobe",,87077,CPT,Facility,Inpatient,,,,71,60.35,20.3486,71,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Subculture, Aerobe",,87077,CPT,Facility,Outpatient,,,,71,60.35,20.3486,71,Medica,Medical Assistance,31.666,44.6,,percent of total billed charges,,
"Subculture, Aerobe",,87077,CPT,Facility,Inpatient,,,,71,60.35,20.3486,71,Medica,Medical Assistance,,,,,Included in per diem rate,
"Subculture, Aerobe",,87077,CPT,Facility,Outpatient,,,,71,60.35,20.3486,71,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,35.358,49.8,,percent of total billed charges,,
"Subculture, Aerobe",,87077,CPT,Facility,Inpatient,,,,71,60.35,20.3486,71,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Subculture, Aerobe",,87077,CPT,Facility,Both,,,,71,60.35,20.3486,71,"Multiplan, Inc.","Multiplan, Inc.",66.74,94,,percent of total billed charges,,
"Subculture, Aerobe",,87077,CPT,Facility,Outpatient,,,,71,60.35,20.3486,71,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,61.344,86.4,,percent of total billed charges,,
"Subculture, Aerobe",,87077,CPT,Facility,Inpatient,,,,71,60.35,20.3486,71,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Subculture, Aerobe",,87077,CPT,Facility,Both,,,,71,60.35,20.3486,71,"Preferred One Administrative Services, INC.",PPO,70.006,98.6,,percent of total billed charges,,
"Subculture, Aerobe",,87077,CPT,Facility,Outpatient,,,,71,60.35,20.3486,71,PrimeWest Health,Minnesota Senior Health Options (MSHO),36.5295,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Subculture, Aerobe",,87077,CPT,Facility,Inpatient,,,,71,60.35,20.3486,71,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Subculture, Aerobe",,87077,CPT,Facility,Outpatient,,,,71,60.35,20.3486,71,PrimeWest Health,MinnesotaCare,36.4656,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Subculture, Aerobe",,87077,CPT,Facility,Inpatient,,,,71,60.35,20.3486,71,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Subculture, Aerobe",,87077,CPT,Facility,Both,,,,71,60.35,20.3486,71,Sanford Health Plan,Sanford Health Plan,65.32,92,,percent of total billed charges,,
"Subculture, Aerobe",,87077,CPT,Facility,Outpatient,,,,71,60.35,20.3486,71,"UCare Health, Inc.",Individual & Family Plan,40.0085,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Subculture, Aerobe",,87077,CPT,Facility,Inpatient,,,,71,60.35,20.3486,71,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Subculture, Aerobe",,87077,CPT,Facility,Outpatient,,,,71,60.35,20.3486,71,"UCare Health, Inc.",Medical Assistance,35.8337,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Subculture, Aerobe",,87077,CPT,Facility,Inpatient,,,,71,60.35,20.3486,71,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Subculture, Aerobe",,87077,CPT,Facility,Outpatient,,,,71,60.35,20.3486,71,"UCare Health, Inc.",Medicare Advantage,35.8337,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Subculture, Aerobe",,87077,CPT,Facility,Inpatient,,,,71,60.35,20.3486,71,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Subculture, Aerobe",,87077,CPT,Facility,Outpatient,,,,71,60.35,20.3486,71,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),35.8337,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Subculture, Aerobe",,87077,CPT,Facility,Inpatient,,,,71,60.35,20.3486,71,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Subculture, Aerobe",,87077,CPT,Facility,Both,,,,71,60.35,20.3486,71,UnitedHealthcare,Individual & Family,66.74,94,,percent of total billed charges,,
"Subculture, Aerobe",,87077,CPT,Facility,Outpatient,,,,71,60.35,20.3486,71,UnitedHealthcare,Medicare Advantage,34.79,49,,percent of total billed charges,,
"Subculture, Aerobe",,87077,CPT,Facility,Inpatient,,,,71,60.35,20.3486,71,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Subculture, Aerobe",,87077,CPT,Facility,Outpatient,,,,71,60.35,20.3486,71,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,34.08,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Subculture, Aerobe",,87077,CPT,Facility,Inpatient,,,,71,60.35,20.3486,71,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Group B Streptococcus Culture, Rectal And Vaginal, Screen",,87081,CPT,Facility,Both,,,,87,73.95,24.9342,87,Aetna,Commercial,80.04,92,,percent of total billed charges,,
"Group B Streptococcus Culture, Rectal And Vaginal, Screen",,87081,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,Aetna,Medicare Advantage,42.63,49,,percent of total billed charges,,
"Group B Streptococcus Culture, Rectal And Vaginal, Screen",,87081,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Group B Streptococcus Culture, Rectal And Vaginal, Screen",,87081,CPT,Facility,Both,,,,87,73.95,24.9342,87,Aetna,PPO,80.91,93,,percent of total billed charges,,
"Group B Streptococcus Culture, Rectal And Vaginal, Screen",,87081,CPT,Facility,Both,,,,87,73.95,24.9342,87,America's PPO,America's PPO,83.5461,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Group B Streptococcus Culture, Rectal And Vaginal, Screen",,87081,CPT,Facility,Both,,,,87,73.95,24.9342,87,BlueCross BlueShield Minnesota, Federal Employee Program,85.608,98.4,,percent of total billed charges,,
"Group B Streptococcus Culture, Rectal And Vaginal, Screen",,87081,CPT,Facility,Both,,,,87,73.95,24.9342,87,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,87,100,,percent of total billed charges,,
"Group B Streptococcus Culture, Rectal And Vaginal, Screen",,87081,CPT,Facility,Both,,,,87,73.95,24.9342,87,BlueCross BlueShield Minnesota,High Value Network Plan,78.3,90,,percent of total billed charges,,
"Group B Streptococcus Culture, Rectal And Vaginal, Screen",,87081,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,BlueCross BlueShield Minnesota,Medicare Advantage,42.63,49,,percent of total billed charges,,
"Group B Streptococcus Culture, Rectal And Vaginal, Screen",,87081,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Group B Streptococcus Culture, Rectal And Vaginal, Screen",,87081,CPT,Facility,Both,,,,87,73.95,24.9342,87,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,77.0559,88.57,,percent of total billed charges,,
"Group B Streptococcus Culture, Rectal And Vaginal, Screen",,87081,CPT,Facility,Both,,,,87,73.95,24.9342,87,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,24.9342,28.66,,percent of total billed charges,,
"Group B Streptococcus Culture, Rectal And Vaginal, Screen",,87081,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),42.63,49,,percent of total billed charges,,
"Group B Streptococcus Culture, Rectal And Vaginal, Screen",,87081,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Group B Streptococcus Culture, Rectal And Vaginal, Screen",,87081,CPT,Facility,Both,,,,87,73.95,24.9342,87,CorVel,Worker's Compensation,87,100,,percent of total billed charges,,
"Group B Streptococcus Culture, Rectal And Vaginal, Screen",,87081,CPT,Facility,Both,,,,87,73.95,24.9342,87,First Health Group Corporation,First Health Network,84.39,97,,percent of total billed charges,,
"Group B Streptococcus Culture, Rectal And Vaginal, Screen",,87081,CPT,Facility,Both,,,,87,73.95,24.9342,87,"Health Partners, Inc.",Commercial,82.302,94.6,,percent of total billed charges,,
"Group B Streptococcus Culture, Rectal And Vaginal, Screen",,87081,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,"Health Partners, Inc.",Medicare Advantage,42.63,49,,percent of total billed charges,,
"Group B Streptococcus Culture, Rectal And Vaginal, Screen",,87081,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Group B Streptococcus Culture, Rectal And Vaginal, Screen",,87081,CPT,Facility,Both,,,,87,73.95,24.9342,87,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),52.2,60,,percent of total billed charges,,
"Group B Streptococcus Culture, Rectal And Vaginal, Screen",,87081,CPT,Facility,Both,,,,87,73.95,24.9342,87,"Health Partners, Inc.",State of Minnesota Advantage Program,70.905,81.5,,percent of total billed charges,,
"Group B Streptococcus Culture, Rectal And Vaginal, Screen",,87081,CPT,Facility,Both,,,,87,73.95,24.9342,87,"Health Partners, Inc.",State Public Programs,43.5,50,,percent of total billed charges,,
"Group B Streptococcus Culture, Rectal And Vaginal, Screen",,87081,CPT,Facility,Both,,,,87,73.95,24.9342,87,Humana Insurance Company,Commercial PPO,82.65,95,,percent of total billed charges,,
"Group B Streptococcus Culture, Rectal And Vaginal, Screen",,87081,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,Humana Insurance Company,Medicare PPO,42.63,49,,percent of total billed charges,,
"Group B Streptococcus Culture, Rectal And Vaginal, Screen",,87081,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Group B Streptococcus Culture, Rectal And Vaginal, Screen",,87081,CPT,Facility,Both,,,,87,73.95,24.9342,87,Medica,Individual & Family,86.217,99.1,,percent of total billed charges,,
"Group B Streptococcus Culture, Rectal And Vaginal, Screen",,87081,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,Medica,Medica Advantage Solution,43.326,49.8,,percent of total billed charges,,
"Group B Streptococcus Culture, Rectal And Vaginal, Screen",,87081,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Group B Streptococcus Culture, Rectal And Vaginal, Screen",,87081,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,Medica,Medical Assistance,38.802,44.6,,percent of total billed charges,,
"Group B Streptococcus Culture, Rectal And Vaginal, Screen",,87081,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,Medica,Medical Assistance,,,,,Included in per diem rate,
"Group B Streptococcus Culture, Rectal And Vaginal, Screen",,87081,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,43.326,49.8,,percent of total billed charges,,
"Group B Streptococcus Culture, Rectal And Vaginal, Screen",,87081,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Group B Streptococcus Culture, Rectal And Vaginal, Screen",,87081,CPT,Facility,Both,,,,87,73.95,24.9342,87,"Multiplan, Inc.","Multiplan, Inc.",81.78,94,,percent of total billed charges,,
"Group B Streptococcus Culture, Rectal And Vaginal, Screen",,87081,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,75.168,86.4,,percent of total billed charges,,
"Group B Streptococcus Culture, Rectal And Vaginal, Screen",,87081,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Group B Streptococcus Culture, Rectal And Vaginal, Screen",,87081,CPT,Facility,Both,,,,87,73.95,24.9342,87,"Preferred One Administrative Services, INC.",PPO,85.782,98.6,,percent of total billed charges,,
"Group B Streptococcus Culture, Rectal And Vaginal, Screen",,87081,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,PrimeWest Health,Minnesota Senior Health Options (MSHO),44.7615,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Group B Streptococcus Culture, Rectal And Vaginal, Screen",,87081,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Group B Streptococcus Culture, Rectal And Vaginal, Screen",,87081,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,PrimeWest Health,MinnesotaCare,44.6832,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Group B Streptococcus Culture, Rectal And Vaginal, Screen",,87081,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Group B Streptococcus Culture, Rectal And Vaginal, Screen",,87081,CPT,Facility,Both,,,,87,73.95,24.9342,87,Sanford Health Plan,Sanford Health Plan,80.04,92,,percent of total billed charges,,
"Group B Streptococcus Culture, Rectal And Vaginal, Screen",,87081,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,"UCare Health, Inc.",Individual & Family Plan,49.0245,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Group B Streptococcus Culture, Rectal And Vaginal, Screen",,87081,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Group B Streptococcus Culture, Rectal And Vaginal, Screen",,87081,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,"UCare Health, Inc.",Medical Assistance,43.9089,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Group B Streptococcus Culture, Rectal And Vaginal, Screen",,87081,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Group B Streptococcus Culture, Rectal And Vaginal, Screen",,87081,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,"UCare Health, Inc.",Medicare Advantage,43.9089,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Group B Streptococcus Culture, Rectal And Vaginal, Screen",,87081,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Group B Streptococcus Culture, Rectal And Vaginal, Screen",,87081,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),43.9089,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Group B Streptococcus Culture, Rectal And Vaginal, Screen",,87081,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Group B Streptococcus Culture, Rectal And Vaginal, Screen",,87081,CPT,Facility,Both,,,,87,73.95,24.9342,87,UnitedHealthcare,Individual & Family,81.78,94,,percent of total billed charges,,
"Group B Streptococcus Culture, Rectal And Vaginal, Screen",,87081,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,UnitedHealthcare,Medicare Advantage,42.63,49,,percent of total billed charges,,
"Group B Streptococcus Culture, Rectal And Vaginal, Screen",,87081,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Group B Streptococcus Culture, Rectal And Vaginal, Screen",,87081,CPT,Facility,Outpatient,,,,87,73.95,24.9342,87,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,41.76,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Group B Streptococcus Culture, Rectal And Vaginal, Screen",,87081,CPT,Facility,Inpatient,,,,87,73.95,24.9342,87,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Methicillin Resistant Staphylococcus Aureus Culture, Screening Only",,87081,CPT,Facility,Both,,,,255,216.75,73.083,255,Aetna,Commercial,234.6,92,,percent of total billed charges,,
"Methicillin Resistant Staphylococcus Aureus Culture, Screening Only",,87081,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,Aetna,Medicare Advantage,124.95,49,,percent of total billed charges,,
"Methicillin Resistant Staphylococcus Aureus Culture, Screening Only",,87081,CPT,Facility,Inpatient,,,,255,216.75,73.083,255,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Methicillin Resistant Staphylococcus Aureus Culture, Screening Only",,87081,CPT,Facility,Both,,,,255,216.75,73.083,255,Aetna,PPO,237.15,93,,percent of total billed charges,,
"Methicillin Resistant Staphylococcus Aureus Culture, Screening Only",,87081,CPT,Facility,Both,,,,255,216.75,73.083,255,America's PPO,America's PPO,244.8765,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Methicillin Resistant Staphylococcus Aureus Culture, Screening Only",,87081,CPT,Facility,Both,,,,255,216.75,73.083,255,BlueCross BlueShield Minnesota, Federal Employee Program,250.92,98.4,,percent of total billed charges,,
"Methicillin Resistant Staphylococcus Aureus Culture, Screening Only",,87081,CPT,Facility,Both,,,,255,216.75,73.083,255,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,255,100,,percent of total billed charges,,
"Methicillin Resistant Staphylococcus Aureus Culture, Screening Only",,87081,CPT,Facility,Both,,,,255,216.75,73.083,255,BlueCross BlueShield Minnesota,High Value Network Plan,229.5,90,,percent of total billed charges,,
"Methicillin Resistant Staphylococcus Aureus Culture, Screening Only",,87081,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,BlueCross BlueShield Minnesota,Medicare Advantage,124.95,49,,percent of total billed charges,,
"Methicillin Resistant Staphylococcus Aureus Culture, Screening Only",,87081,CPT,Facility,Inpatient,,,,255,216.75,73.083,255,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Methicillin Resistant Staphylococcus Aureus Culture, Screening Only",,87081,CPT,Facility,Both,,,,255,216.75,73.083,255,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,225.8535,88.57,,percent of total billed charges,,
"Methicillin Resistant Staphylococcus Aureus Culture, Screening Only",,87081,CPT,Facility,Both,,,,255,216.75,73.083,255,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,73.083,28.66,,percent of total billed charges,,
"Methicillin Resistant Staphylococcus Aureus Culture, Screening Only",,87081,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),124.95,49,,percent of total billed charges,,
"Methicillin Resistant Staphylococcus Aureus Culture, Screening Only",,87081,CPT,Facility,Inpatient,,,,255,216.75,73.083,255,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Methicillin Resistant Staphylococcus Aureus Culture, Screening Only",,87081,CPT,Facility,Both,,,,255,216.75,73.083,255,CorVel,Worker's Compensation,255,100,,percent of total billed charges,,
"Methicillin Resistant Staphylococcus Aureus Culture, Screening Only",,87081,CPT,Facility,Both,,,,255,216.75,73.083,255,First Health Group Corporation,First Health Network,247.35,97,,percent of total billed charges,,
"Methicillin Resistant Staphylococcus Aureus Culture, Screening Only",,87081,CPT,Facility,Both,,,,255,216.75,73.083,255,"Health Partners, Inc.",Commercial,241.23,94.6,,percent of total billed charges,,
"Methicillin Resistant Staphylococcus Aureus Culture, Screening Only",,87081,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,"Health Partners, Inc.",Medicare Advantage,124.95,49,,percent of total billed charges,,
"Methicillin Resistant Staphylococcus Aureus Culture, Screening Only",,87081,CPT,Facility,Inpatient,,,,255,216.75,73.083,255,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Methicillin Resistant Staphylococcus Aureus Culture, Screening Only",,87081,CPT,Facility,Both,,,,255,216.75,73.083,255,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),153,60,,percent of total billed charges,,
"Methicillin Resistant Staphylococcus Aureus Culture, Screening Only",,87081,CPT,Facility,Both,,,,255,216.75,73.083,255,"Health Partners, Inc.",State of Minnesota Advantage Program,207.825,81.5,,percent of total billed charges,,
"Methicillin Resistant Staphylococcus Aureus Culture, Screening Only",,87081,CPT,Facility,Both,,,,255,216.75,73.083,255,"Health Partners, Inc.",State Public Programs,127.5,50,,percent of total billed charges,,
"Methicillin Resistant Staphylococcus Aureus Culture, Screening Only",,87081,CPT,Facility,Both,,,,255,216.75,73.083,255,Humana Insurance Company,Commercial PPO,242.25,95,,percent of total billed charges,,
"Methicillin Resistant Staphylococcus Aureus Culture, Screening Only",,87081,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,Humana Insurance Company,Medicare PPO,124.95,49,,percent of total billed charges,,
"Methicillin Resistant Staphylococcus Aureus Culture, Screening Only",,87081,CPT,Facility,Inpatient,,,,255,216.75,73.083,255,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Methicillin Resistant Staphylococcus Aureus Culture, Screening Only",,87081,CPT,Facility,Both,,,,255,216.75,73.083,255,Medica,Individual & Family,252.705,99.1,,percent of total billed charges,,
"Methicillin Resistant Staphylococcus Aureus Culture, Screening Only",,87081,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,Medica,Medica Advantage Solution,126.99,49.8,,percent of total billed charges,,
"Methicillin Resistant Staphylococcus Aureus Culture, Screening Only",,87081,CPT,Facility,Inpatient,,,,255,216.75,73.083,255,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Methicillin Resistant Staphylococcus Aureus Culture, Screening Only",,87081,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,Medica,Medical Assistance,113.73,44.6,,percent of total billed charges,,
"Methicillin Resistant Staphylococcus Aureus Culture, Screening Only",,87081,CPT,Facility,Inpatient,,,,255,216.75,73.083,255,Medica,Medical Assistance,,,,,Included in per diem rate,
"Methicillin Resistant Staphylococcus Aureus Culture, Screening Only",,87081,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,126.99,49.8,,percent of total billed charges,,
"Methicillin Resistant Staphylococcus Aureus Culture, Screening Only",,87081,CPT,Facility,Inpatient,,,,255,216.75,73.083,255,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Methicillin Resistant Staphylococcus Aureus Culture, Screening Only",,87081,CPT,Facility,Both,,,,255,216.75,73.083,255,"Multiplan, Inc.","Multiplan, Inc.",239.7,94,,percent of total billed charges,,
"Methicillin Resistant Staphylococcus Aureus Culture, Screening Only",,87081,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,220.32,86.4,,percent of total billed charges,,
"Methicillin Resistant Staphylococcus Aureus Culture, Screening Only",,87081,CPT,Facility,Inpatient,,,,255,216.75,73.083,255,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Methicillin Resistant Staphylococcus Aureus Culture, Screening Only",,87081,CPT,Facility,Both,,,,255,216.75,73.083,255,"Preferred One Administrative Services, INC.",PPO,251.43,98.6,,percent of total billed charges,,
"Methicillin Resistant Staphylococcus Aureus Culture, Screening Only",,87081,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,PrimeWest Health,Minnesota Senior Health Options (MSHO),131.1975,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Methicillin Resistant Staphylococcus Aureus Culture, Screening Only",,87081,CPT,Facility,Inpatient,,,,255,216.75,73.083,255,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Methicillin Resistant Staphylococcus Aureus Culture, Screening Only",,87081,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,PrimeWest Health,MinnesotaCare,130.968,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Methicillin Resistant Staphylococcus Aureus Culture, Screening Only",,87081,CPT,Facility,Inpatient,,,,255,216.75,73.083,255,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Methicillin Resistant Staphylococcus Aureus Culture, Screening Only",,87081,CPT,Facility,Both,,,,255,216.75,73.083,255,Sanford Health Plan,Sanford Health Plan,234.6,92,,percent of total billed charges,,
"Methicillin Resistant Staphylococcus Aureus Culture, Screening Only",,87081,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,"UCare Health, Inc.",Individual & Family Plan,143.6925,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Methicillin Resistant Staphylococcus Aureus Culture, Screening Only",,87081,CPT,Facility,Inpatient,,,,255,216.75,73.083,255,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Methicillin Resistant Staphylococcus Aureus Culture, Screening Only",,87081,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,"UCare Health, Inc.",Medical Assistance,128.6985,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Methicillin Resistant Staphylococcus Aureus Culture, Screening Only",,87081,CPT,Facility,Inpatient,,,,255,216.75,73.083,255,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Methicillin Resistant Staphylococcus Aureus Culture, Screening Only",,87081,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,"UCare Health, Inc.",Medicare Advantage,128.6985,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Methicillin Resistant Staphylococcus Aureus Culture, Screening Only",,87081,CPT,Facility,Inpatient,,,,255,216.75,73.083,255,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Methicillin Resistant Staphylococcus Aureus Culture, Screening Only",,87081,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),128.6985,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Methicillin Resistant Staphylococcus Aureus Culture, Screening Only",,87081,CPT,Facility,Inpatient,,,,255,216.75,73.083,255,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Methicillin Resistant Staphylococcus Aureus Culture, Screening Only",,87081,CPT,Facility,Both,,,,255,216.75,73.083,255,UnitedHealthcare,Individual & Family,239.7,94,,percent of total billed charges,,
"Methicillin Resistant Staphylococcus Aureus Culture, Screening Only",,87081,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,UnitedHealthcare,Medicare Advantage,124.95,49,,percent of total billed charges,,
"Methicillin Resistant Staphylococcus Aureus Culture, Screening Only",,87081,CPT,Facility,Inpatient,,,,255,216.75,73.083,255,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Methicillin Resistant Staphylococcus Aureus Culture, Screening Only",,87081,CPT,Facility,Outpatient,,,,255,216.75,73.083,255,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,122.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Methicillin Resistant Staphylococcus Aureus Culture, Screening Only",,87081,CPT,Facility,Inpatient,,,,255,216.75,73.083,255,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Culture, Urine",,87086,CPT,Facility,Both,,,,88,74.8,25.2208,88,Aetna,Commercial,80.96,92,,percent of total billed charges,,
"Culture, Urine",,87086,CPT,Facility,Outpatient,,,,88,74.8,25.2208,88,Aetna,Medicare Advantage,43.12,49,,percent of total billed charges,,
"Culture, Urine",,87086,CPT,Facility,Inpatient,,,,88,74.8,25.2208,88,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Culture, Urine",,87086,CPT,Facility,Both,,,,88,74.8,25.2208,88,Aetna,PPO,81.84,93,,percent of total billed charges,,
"Culture, Urine",,87086,CPT,Facility,Both,,,,88,74.8,25.2208,88,America's PPO,America's PPO,84.5064,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Culture, Urine",,87086,CPT,Facility,Both,,,,88,74.8,25.2208,88,BlueCross BlueShield Minnesota, Federal Employee Program,86.592,98.4,,percent of total billed charges,,
"Culture, Urine",,87086,CPT,Facility,Both,,,,88,74.8,25.2208,88,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,88,100,,percent of total billed charges,,
"Culture, Urine",,87086,CPT,Facility,Both,,,,88,74.8,25.2208,88,BlueCross BlueShield Minnesota,High Value Network Plan,79.2,90,,percent of total billed charges,,
"Culture, Urine",,87086,CPT,Facility,Outpatient,,,,88,74.8,25.2208,88,BlueCross BlueShield Minnesota,Medicare Advantage,43.12,49,,percent of total billed charges,,
"Culture, Urine",,87086,CPT,Facility,Inpatient,,,,88,74.8,25.2208,88,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Culture, Urine",,87086,CPT,Facility,Both,,,,88,74.8,25.2208,88,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,77.9416,88.57,,percent of total billed charges,,
"Culture, Urine",,87086,CPT,Facility,Both,,,,88,74.8,25.2208,88,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,25.2208,28.66,,percent of total billed charges,,
"Culture, Urine",,87086,CPT,Facility,Outpatient,,,,88,74.8,25.2208,88,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),43.12,49,,percent of total billed charges,,
"Culture, Urine",,87086,CPT,Facility,Inpatient,,,,88,74.8,25.2208,88,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Culture, Urine",,87086,CPT,Facility,Both,,,,88,74.8,25.2208,88,CorVel,Worker's Compensation,88,100,,percent of total billed charges,,
"Culture, Urine",,87086,CPT,Facility,Both,,,,88,74.8,25.2208,88,First Health Group Corporation,First Health Network,85.36,97,,percent of total billed charges,,
"Culture, Urine",,87086,CPT,Facility,Both,,,,88,74.8,25.2208,88,"Health Partners, Inc.",Commercial,83.248,94.6,,percent of total billed charges,,
"Culture, Urine",,87086,CPT,Facility,Outpatient,,,,88,74.8,25.2208,88,"Health Partners, Inc.",Medicare Advantage,43.12,49,,percent of total billed charges,,
"Culture, Urine",,87086,CPT,Facility,Inpatient,,,,88,74.8,25.2208,88,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Culture, Urine",,87086,CPT,Facility,Both,,,,88,74.8,25.2208,88,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),52.8,60,,percent of total billed charges,,
"Culture, Urine",,87086,CPT,Facility,Both,,,,88,74.8,25.2208,88,"Health Partners, Inc.",State of Minnesota Advantage Program,71.72,81.5,,percent of total billed charges,,
"Culture, Urine",,87086,CPT,Facility,Both,,,,88,74.8,25.2208,88,"Health Partners, Inc.",State Public Programs,44,50,,percent of total billed charges,,
"Culture, Urine",,87086,CPT,Facility,Both,,,,88,74.8,25.2208,88,Humana Insurance Company,Commercial PPO,83.6,95,,percent of total billed charges,,
"Culture, Urine",,87086,CPT,Facility,Outpatient,,,,88,74.8,25.2208,88,Humana Insurance Company,Medicare PPO,43.12,49,,percent of total billed charges,,
"Culture, Urine",,87086,CPT,Facility,Inpatient,,,,88,74.8,25.2208,88,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Culture, Urine",,87086,CPT,Facility,Both,,,,88,74.8,25.2208,88,Medica,Individual & Family,87.208,99.1,,percent of total billed charges,,
"Culture, Urine",,87086,CPT,Facility,Outpatient,,,,88,74.8,25.2208,88,Medica,Medica Advantage Solution,43.824,49.8,,percent of total billed charges,,
"Culture, Urine",,87086,CPT,Facility,Inpatient,,,,88,74.8,25.2208,88,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Culture, Urine",,87086,CPT,Facility,Outpatient,,,,88,74.8,25.2208,88,Medica,Medical Assistance,39.248,44.6,,percent of total billed charges,,
"Culture, Urine",,87086,CPT,Facility,Inpatient,,,,88,74.8,25.2208,88,Medica,Medical Assistance,,,,,Included in per diem rate,
"Culture, Urine",,87086,CPT,Facility,Outpatient,,,,88,74.8,25.2208,88,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,43.824,49.8,,percent of total billed charges,,
"Culture, Urine",,87086,CPT,Facility,Inpatient,,,,88,74.8,25.2208,88,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Culture, Urine",,87086,CPT,Facility,Both,,,,88,74.8,25.2208,88,"Multiplan, Inc.","Multiplan, Inc.",82.72,94,,percent of total billed charges,,
"Culture, Urine",,87086,CPT,Facility,Outpatient,,,,88,74.8,25.2208,88,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,76.032,86.4,,percent of total billed charges,,
"Culture, Urine",,87086,CPT,Facility,Inpatient,,,,88,74.8,25.2208,88,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Culture, Urine",,87086,CPT,Facility,Both,,,,88,74.8,25.2208,88,"Preferred One Administrative Services, INC.",PPO,86.768,98.6,,percent of total billed charges,,
"Culture, Urine",,87086,CPT,Facility,Outpatient,,,,88,74.8,25.2208,88,PrimeWest Health,Minnesota Senior Health Options (MSHO),45.276,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Culture, Urine",,87086,CPT,Facility,Inpatient,,,,88,74.8,25.2208,88,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Culture, Urine",,87086,CPT,Facility,Outpatient,,,,88,74.8,25.2208,88,PrimeWest Health,MinnesotaCare,45.1968,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Culture, Urine",,87086,CPT,Facility,Inpatient,,,,88,74.8,25.2208,88,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Culture, Urine",,87086,CPT,Facility,Both,,,,88,74.8,25.2208,88,Sanford Health Plan,Sanford Health Plan,80.96,92,,percent of total billed charges,,
"Culture, Urine",,87086,CPT,Facility,Outpatient,,,,88,74.8,25.2208,88,"UCare Health, Inc.",Individual & Family Plan,49.588,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Culture, Urine",,87086,CPT,Facility,Inpatient,,,,88,74.8,25.2208,88,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Culture, Urine",,87086,CPT,Facility,Outpatient,,,,88,74.8,25.2208,88,"UCare Health, Inc.",Medical Assistance,44.4136,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Culture, Urine",,87086,CPT,Facility,Inpatient,,,,88,74.8,25.2208,88,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Culture, Urine",,87086,CPT,Facility,Outpatient,,,,88,74.8,25.2208,88,"UCare Health, Inc.",Medicare Advantage,44.4136,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Culture, Urine",,87086,CPT,Facility,Inpatient,,,,88,74.8,25.2208,88,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Culture, Urine",,87086,CPT,Facility,Outpatient,,,,88,74.8,25.2208,88,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),44.4136,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Culture, Urine",,87086,CPT,Facility,Inpatient,,,,88,74.8,25.2208,88,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Culture, Urine",,87086,CPT,Facility,Both,,,,88,74.8,25.2208,88,UnitedHealthcare,Individual & Family,82.72,94,,percent of total billed charges,,
"Culture, Urine",,87086,CPT,Facility,Outpatient,,,,88,74.8,25.2208,88,UnitedHealthcare,Medicare Advantage,43.12,49,,percent of total billed charges,,
"Culture, Urine",,87086,CPT,Facility,Inpatient,,,,88,74.8,25.2208,88,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Culture, Urine",,87086,CPT,Facility,Outpatient,,,,88,74.8,25.2208,88,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,42.24,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Culture, Urine",,87086,CPT,Facility,Inpatient,,,,88,74.8,25.2208,88,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Fungal Culture, Skin",,87101,CPT,Facility,Both,,,,110,93.5,31.526,110,Aetna,Commercial,101.2,92,,percent of total billed charges,,
"Fungal Culture, Skin",,87101,CPT,Facility,Outpatient,,,,110,93.5,31.526,110,Aetna,Medicare Advantage,53.9,49,,percent of total billed charges,,
"Fungal Culture, Skin",,87101,CPT,Facility,Inpatient,,,,110,93.5,31.526,110,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Fungal Culture, Skin",,87101,CPT,Facility,Both,,,,110,93.5,31.526,110,Aetna,PPO,102.3,93,,percent of total billed charges,,
"Fungal Culture, Skin",,87101,CPT,Facility,Both,,,,110,93.5,31.526,110,America's PPO,America's PPO,105.633,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Fungal Culture, Skin",,87101,CPT,Facility,Both,,,,110,93.5,31.526,110,BlueCross BlueShield Minnesota, Federal Employee Program,108.24,98.4,,percent of total billed charges,,
"Fungal Culture, Skin",,87101,CPT,Facility,Both,,,,110,93.5,31.526,110,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,110,100,,percent of total billed charges,,
"Fungal Culture, Skin",,87101,CPT,Facility,Both,,,,110,93.5,31.526,110,BlueCross BlueShield Minnesota,High Value Network Plan,99,90,,percent of total billed charges,,
"Fungal Culture, Skin",,87101,CPT,Facility,Outpatient,,,,110,93.5,31.526,110,BlueCross BlueShield Minnesota,Medicare Advantage,53.9,49,,percent of total billed charges,,
"Fungal Culture, Skin",,87101,CPT,Facility,Inpatient,,,,110,93.5,31.526,110,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Fungal Culture, Skin",,87101,CPT,Facility,Both,,,,110,93.5,31.526,110,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,97.427,88.57,,percent of total billed charges,,
"Fungal Culture, Skin",,87101,CPT,Facility,Both,,,,110,93.5,31.526,110,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,31.526,28.66,,percent of total billed charges,,
"Fungal Culture, Skin",,87101,CPT,Facility,Outpatient,,,,110,93.5,31.526,110,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),53.9,49,,percent of total billed charges,,
"Fungal Culture, Skin",,87101,CPT,Facility,Inpatient,,,,110,93.5,31.526,110,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Fungal Culture, Skin",,87101,CPT,Facility,Both,,,,110,93.5,31.526,110,CorVel,Worker's Compensation,110,100,,percent of total billed charges,,
"Fungal Culture, Skin",,87101,CPT,Facility,Both,,,,110,93.5,31.526,110,First Health Group Corporation,First Health Network,106.7,97,,percent of total billed charges,,
"Fungal Culture, Skin",,87101,CPT,Facility,Both,,,,110,93.5,31.526,110,"Health Partners, Inc.",Commercial,104.06,94.6,,percent of total billed charges,,
"Fungal Culture, Skin",,87101,CPT,Facility,Outpatient,,,,110,93.5,31.526,110,"Health Partners, Inc.",Medicare Advantage,53.9,49,,percent of total billed charges,,
"Fungal Culture, Skin",,87101,CPT,Facility,Inpatient,,,,110,93.5,31.526,110,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Fungal Culture, Skin",,87101,CPT,Facility,Both,,,,110,93.5,31.526,110,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),66,60,,percent of total billed charges,,
"Fungal Culture, Skin",,87101,CPT,Facility,Both,,,,110,93.5,31.526,110,"Health Partners, Inc.",State of Minnesota Advantage Program,89.65,81.5,,percent of total billed charges,,
"Fungal Culture, Skin",,87101,CPT,Facility,Both,,,,110,93.5,31.526,110,"Health Partners, Inc.",State Public Programs,55,50,,percent of total billed charges,,
"Fungal Culture, Skin",,87101,CPT,Facility,Both,,,,110,93.5,31.526,110,Humana Insurance Company,Commercial PPO,104.5,95,,percent of total billed charges,,
"Fungal Culture, Skin",,87101,CPT,Facility,Outpatient,,,,110,93.5,31.526,110,Humana Insurance Company,Medicare PPO,53.9,49,,percent of total billed charges,,
"Fungal Culture, Skin",,87101,CPT,Facility,Inpatient,,,,110,93.5,31.526,110,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Fungal Culture, Skin",,87101,CPT,Facility,Both,,,,110,93.5,31.526,110,Medica,Individual & Family,109.01,99.1,,percent of total billed charges,,
"Fungal Culture, Skin",,87101,CPT,Facility,Outpatient,,,,110,93.5,31.526,110,Medica,Medica Advantage Solution,54.78,49.8,,percent of total billed charges,,
"Fungal Culture, Skin",,87101,CPT,Facility,Inpatient,,,,110,93.5,31.526,110,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Fungal Culture, Skin",,87101,CPT,Facility,Outpatient,,,,110,93.5,31.526,110,Medica,Medical Assistance,49.06,44.6,,percent of total billed charges,,
"Fungal Culture, Skin",,87101,CPT,Facility,Inpatient,,,,110,93.5,31.526,110,Medica,Medical Assistance,,,,,Included in per diem rate,
"Fungal Culture, Skin",,87101,CPT,Facility,Outpatient,,,,110,93.5,31.526,110,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,54.78,49.8,,percent of total billed charges,,
"Fungal Culture, Skin",,87101,CPT,Facility,Inpatient,,,,110,93.5,31.526,110,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Fungal Culture, Skin",,87101,CPT,Facility,Both,,,,110,93.5,31.526,110,"Multiplan, Inc.","Multiplan, Inc.",103.4,94,,percent of total billed charges,,
"Fungal Culture, Skin",,87101,CPT,Facility,Outpatient,,,,110,93.5,31.526,110,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,95.04,86.4,,percent of total billed charges,,
"Fungal Culture, Skin",,87101,CPT,Facility,Inpatient,,,,110,93.5,31.526,110,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Fungal Culture, Skin",,87101,CPT,Facility,Both,,,,110,93.5,31.526,110,"Preferred One Administrative Services, INC.",PPO,108.46,98.6,,percent of total billed charges,,
"Fungal Culture, Skin",,87101,CPT,Facility,Outpatient,,,,110,93.5,31.526,110,PrimeWest Health,Minnesota Senior Health Options (MSHO),56.595,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Fungal Culture, Skin",,87101,CPT,Facility,Inpatient,,,,110,93.5,31.526,110,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Fungal Culture, Skin",,87101,CPT,Facility,Outpatient,,,,110,93.5,31.526,110,PrimeWest Health,MinnesotaCare,56.496,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Fungal Culture, Skin",,87101,CPT,Facility,Inpatient,,,,110,93.5,31.526,110,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Fungal Culture, Skin",,87101,CPT,Facility,Both,,,,110,93.5,31.526,110,Sanford Health Plan,Sanford Health Plan,101.2,92,,percent of total billed charges,,
"Fungal Culture, Skin",,87101,CPT,Facility,Outpatient,,,,110,93.5,31.526,110,"UCare Health, Inc.",Individual & Family Plan,61.985,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Fungal Culture, Skin",,87101,CPT,Facility,Inpatient,,,,110,93.5,31.526,110,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Fungal Culture, Skin",,87101,CPT,Facility,Outpatient,,,,110,93.5,31.526,110,"UCare Health, Inc.",Medical Assistance,55.517,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Fungal Culture, Skin",,87101,CPT,Facility,Inpatient,,,,110,93.5,31.526,110,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Fungal Culture, Skin",,87101,CPT,Facility,Outpatient,,,,110,93.5,31.526,110,"UCare Health, Inc.",Medicare Advantage,55.517,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Fungal Culture, Skin",,87101,CPT,Facility,Inpatient,,,,110,93.5,31.526,110,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Fungal Culture, Skin",,87101,CPT,Facility,Outpatient,,,,110,93.5,31.526,110,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),55.517,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Fungal Culture, Skin",,87101,CPT,Facility,Inpatient,,,,110,93.5,31.526,110,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Fungal Culture, Skin",,87101,CPT,Facility,Both,,,,110,93.5,31.526,110,UnitedHealthcare,Individual & Family,103.4,94,,percent of total billed charges,,
"Fungal Culture, Skin",,87101,CPT,Facility,Outpatient,,,,110,93.5,31.526,110,UnitedHealthcare,Medicare Advantage,53.9,49,,percent of total billed charges,,
"Fungal Culture, Skin",,87101,CPT,Facility,Inpatient,,,,110,93.5,31.526,110,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Fungal Culture, Skin",,87101,CPT,Facility,Outpatient,,,,110,93.5,31.526,110,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,52.8,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Fungal Culture, Skin",,87101,CPT,Facility,Inpatient,,,,110,93.5,31.526,110,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Fungal Culture,,87102,CPT,Facility,Both,,,,110,93.5,31.526,110,Aetna,Commercial,101.2,92,,percent of total billed charges,,
Fungal Culture,,87102,CPT,Facility,Outpatient,,,,110,93.5,31.526,110,Aetna,Medicare Advantage,53.9,49,,percent of total billed charges,,
Fungal Culture,,87102,CPT,Facility,Inpatient,,,,110,93.5,31.526,110,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Fungal Culture,,87102,CPT,Facility,Both,,,,110,93.5,31.526,110,Aetna,PPO,102.3,93,,percent of total billed charges,,
Fungal Culture,,87102,CPT,Facility,Both,,,,110,93.5,31.526,110,America's PPO,America's PPO,105.633,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Fungal Culture,,87102,CPT,Facility,Both,,,,110,93.5,31.526,110,BlueCross BlueShield Minnesota, Federal Employee Program,108.24,98.4,,percent of total billed charges,,
Fungal Culture,,87102,CPT,Facility,Both,,,,110,93.5,31.526,110,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,110,100,,percent of total billed charges,,
Fungal Culture,,87102,CPT,Facility,Both,,,,110,93.5,31.526,110,BlueCross BlueShield Minnesota,High Value Network Plan,99,90,,percent of total billed charges,,
Fungal Culture,,87102,CPT,Facility,Outpatient,,,,110,93.5,31.526,110,BlueCross BlueShield Minnesota,Medicare Advantage,53.9,49,,percent of total billed charges,,
Fungal Culture,,87102,CPT,Facility,Inpatient,,,,110,93.5,31.526,110,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Fungal Culture,,87102,CPT,Facility,Both,,,,110,93.5,31.526,110,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,97.427,88.57,,percent of total billed charges,,
Fungal Culture,,87102,CPT,Facility,Both,,,,110,93.5,31.526,110,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,31.526,28.66,,percent of total billed charges,,
Fungal Culture,,87102,CPT,Facility,Outpatient,,,,110,93.5,31.526,110,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),53.9,49,,percent of total billed charges,,
Fungal Culture,,87102,CPT,Facility,Inpatient,,,,110,93.5,31.526,110,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Fungal Culture,,87102,CPT,Facility,Both,,,,110,93.5,31.526,110,CorVel,Worker's Compensation,110,100,,percent of total billed charges,,
Fungal Culture,,87102,CPT,Facility,Both,,,,110,93.5,31.526,110,First Health Group Corporation,First Health Network,106.7,97,,percent of total billed charges,,
Fungal Culture,,87102,CPT,Facility,Both,,,,110,93.5,31.526,110,"Health Partners, Inc.",Commercial,104.06,94.6,,percent of total billed charges,,
Fungal Culture,,87102,CPT,Facility,Outpatient,,,,110,93.5,31.526,110,"Health Partners, Inc.",Medicare Advantage,53.9,49,,percent of total billed charges,,
Fungal Culture,,87102,CPT,Facility,Inpatient,,,,110,93.5,31.526,110,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Fungal Culture,,87102,CPT,Facility,Both,,,,110,93.5,31.526,110,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),66,60,,percent of total billed charges,,
Fungal Culture,,87102,CPT,Facility,Both,,,,110,93.5,31.526,110,"Health Partners, Inc.",State of Minnesota Advantage Program,89.65,81.5,,percent of total billed charges,,
Fungal Culture,,87102,CPT,Facility,Both,,,,110,93.5,31.526,110,"Health Partners, Inc.",State Public Programs,55,50,,percent of total billed charges,,
Fungal Culture,,87102,CPT,Facility,Both,,,,110,93.5,31.526,110,Humana Insurance Company,Commercial PPO,104.5,95,,percent of total billed charges,,
Fungal Culture,,87102,CPT,Facility,Outpatient,,,,110,93.5,31.526,110,Humana Insurance Company,Medicare PPO,53.9,49,,percent of total billed charges,,
Fungal Culture,,87102,CPT,Facility,Inpatient,,,,110,93.5,31.526,110,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Fungal Culture,,87102,CPT,Facility,Both,,,,110,93.5,31.526,110,Medica,Individual & Family,109.01,99.1,,percent of total billed charges,,
Fungal Culture,,87102,CPT,Facility,Outpatient,,,,110,93.5,31.526,110,Medica,Medica Advantage Solution,54.78,49.8,,percent of total billed charges,,
Fungal Culture,,87102,CPT,Facility,Inpatient,,,,110,93.5,31.526,110,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Fungal Culture,,87102,CPT,Facility,Outpatient,,,,110,93.5,31.526,110,Medica,Medical Assistance,49.06,44.6,,percent of total billed charges,,
Fungal Culture,,87102,CPT,Facility,Inpatient,,,,110,93.5,31.526,110,Medica,Medical Assistance,,,,,Included in per diem rate,
Fungal Culture,,87102,CPT,Facility,Outpatient,,,,110,93.5,31.526,110,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,54.78,49.8,,percent of total billed charges,,
Fungal Culture,,87102,CPT,Facility,Inpatient,,,,110,93.5,31.526,110,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Fungal Culture,,87102,CPT,Facility,Both,,,,110,93.5,31.526,110,"Multiplan, Inc.","Multiplan, Inc.",103.4,94,,percent of total billed charges,,
Fungal Culture,,87102,CPT,Facility,Outpatient,,,,110,93.5,31.526,110,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,95.04,86.4,,percent of total billed charges,,
Fungal Culture,,87102,CPT,Facility,Inpatient,,,,110,93.5,31.526,110,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Fungal Culture,,87102,CPT,Facility,Both,,,,110,93.5,31.526,110,"Preferred One Administrative Services, INC.",PPO,108.46,98.6,,percent of total billed charges,,
Fungal Culture,,87102,CPT,Facility,Outpatient,,,,110,93.5,31.526,110,PrimeWest Health,Minnesota Senior Health Options (MSHO),56.595,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Fungal Culture,,87102,CPT,Facility,Inpatient,,,,110,93.5,31.526,110,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Fungal Culture,,87102,CPT,Facility,Outpatient,,,,110,93.5,31.526,110,PrimeWest Health,MinnesotaCare,56.496,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Fungal Culture,,87102,CPT,Facility,Inpatient,,,,110,93.5,31.526,110,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Fungal Culture,,87102,CPT,Facility,Both,,,,110,93.5,31.526,110,Sanford Health Plan,Sanford Health Plan,101.2,92,,percent of total billed charges,,
Fungal Culture,,87102,CPT,Facility,Outpatient,,,,110,93.5,31.526,110,"UCare Health, Inc.",Individual & Family Plan,61.985,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Fungal Culture,,87102,CPT,Facility,Inpatient,,,,110,93.5,31.526,110,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Fungal Culture,,87102,CPT,Facility,Outpatient,,,,110,93.5,31.526,110,"UCare Health, Inc.",Medical Assistance,55.517,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Fungal Culture,,87102,CPT,Facility,Inpatient,,,,110,93.5,31.526,110,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Fungal Culture,,87102,CPT,Facility,Outpatient,,,,110,93.5,31.526,110,"UCare Health, Inc.",Medicare Advantage,55.517,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Fungal Culture,,87102,CPT,Facility,Inpatient,,,,110,93.5,31.526,110,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Fungal Culture,,87102,CPT,Facility,Outpatient,,,,110,93.5,31.526,110,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),55.517,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Fungal Culture,,87102,CPT,Facility,Inpatient,,,,110,93.5,31.526,110,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Fungal Culture,,87102,CPT,Facility,Both,,,,110,93.5,31.526,110,UnitedHealthcare,Individual & Family,103.4,94,,percent of total billed charges,,
Fungal Culture,,87102,CPT,Facility,Outpatient,,,,110,93.5,31.526,110,UnitedHealthcare,Medicare Advantage,53.9,49,,percent of total billed charges,,
Fungal Culture,,87102,CPT,Facility,Inpatient,,,,110,93.5,31.526,110,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Fungal Culture,,87102,CPT,Facility,Outpatient,,,,110,93.5,31.526,110,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,52.8,48,,percent of total billed charges,,100% of DHS outpatient percentage
Fungal Culture,,87102,CPT,Facility,Inpatient,,,,110,93.5,31.526,110,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Yeast Identification,,87106,CPT,Facility,Both,,,,70,59.5,20.062,70,Aetna,Commercial,64.4,92,,percent of total billed charges,,
Yeast Identification,,87106,CPT,Facility,Outpatient,,,,70,59.5,20.062,70,Aetna,Medicare Advantage,34.3,49,,percent of total billed charges,,
Yeast Identification,,87106,CPT,Facility,Inpatient,,,,70,59.5,20.062,70,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Yeast Identification,,87106,CPT,Facility,Both,,,,70,59.5,20.062,70,Aetna,PPO,65.1,93,,percent of total billed charges,,
Yeast Identification,,87106,CPT,Facility,Both,,,,70,59.5,20.062,70,America's PPO,America's PPO,67.221,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Yeast Identification,,87106,CPT,Facility,Both,,,,70,59.5,20.062,70,BlueCross BlueShield Minnesota, Federal Employee Program,68.88,98.4,,percent of total billed charges,,
Yeast Identification,,87106,CPT,Facility,Both,,,,70,59.5,20.062,70,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,70,100,,percent of total billed charges,,
Yeast Identification,,87106,CPT,Facility,Both,,,,70,59.5,20.062,70,BlueCross BlueShield Minnesota,High Value Network Plan,63,90,,percent of total billed charges,,
Yeast Identification,,87106,CPT,Facility,Outpatient,,,,70,59.5,20.062,70,BlueCross BlueShield Minnesota,Medicare Advantage,34.3,49,,percent of total billed charges,,
Yeast Identification,,87106,CPT,Facility,Inpatient,,,,70,59.5,20.062,70,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Yeast Identification,,87106,CPT,Facility,Both,,,,70,59.5,20.062,70,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,61.999,88.57,,percent of total billed charges,,
Yeast Identification,,87106,CPT,Facility,Both,,,,70,59.5,20.062,70,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,20.062,28.66,,percent of total billed charges,,
Yeast Identification,,87106,CPT,Facility,Outpatient,,,,70,59.5,20.062,70,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),34.3,49,,percent of total billed charges,,
Yeast Identification,,87106,CPT,Facility,Inpatient,,,,70,59.5,20.062,70,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Yeast Identification,,87106,CPT,Facility,Both,,,,70,59.5,20.062,70,CorVel,Worker's Compensation,70,100,,percent of total billed charges,,
Yeast Identification,,87106,CPT,Facility,Both,,,,70,59.5,20.062,70,First Health Group Corporation,First Health Network,67.9,97,,percent of total billed charges,,
Yeast Identification,,87106,CPT,Facility,Both,,,,70,59.5,20.062,70,"Health Partners, Inc.",Commercial,66.22,94.6,,percent of total billed charges,,
Yeast Identification,,87106,CPT,Facility,Outpatient,,,,70,59.5,20.062,70,"Health Partners, Inc.",Medicare Advantage,34.3,49,,percent of total billed charges,,
Yeast Identification,,87106,CPT,Facility,Inpatient,,,,70,59.5,20.062,70,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Yeast Identification,,87106,CPT,Facility,Both,,,,70,59.5,20.062,70,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),42,60,,percent of total billed charges,,
Yeast Identification,,87106,CPT,Facility,Both,,,,70,59.5,20.062,70,"Health Partners, Inc.",State of Minnesota Advantage Program,57.05,81.5,,percent of total billed charges,,
Yeast Identification,,87106,CPT,Facility,Both,,,,70,59.5,20.062,70,"Health Partners, Inc.",State Public Programs,35,50,,percent of total billed charges,,
Yeast Identification,,87106,CPT,Facility,Both,,,,70,59.5,20.062,70,Humana Insurance Company,Commercial PPO,66.5,95,,percent of total billed charges,,
Yeast Identification,,87106,CPT,Facility,Outpatient,,,,70,59.5,20.062,70,Humana Insurance Company,Medicare PPO,34.3,49,,percent of total billed charges,,
Yeast Identification,,87106,CPT,Facility,Inpatient,,,,70,59.5,20.062,70,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Yeast Identification,,87106,CPT,Facility,Both,,,,70,59.5,20.062,70,Medica,Individual & Family,69.37,99.1,,percent of total billed charges,,
Yeast Identification,,87106,CPT,Facility,Outpatient,,,,70,59.5,20.062,70,Medica,Medica Advantage Solution,34.86,49.8,,percent of total billed charges,,
Yeast Identification,,87106,CPT,Facility,Inpatient,,,,70,59.5,20.062,70,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Yeast Identification,,87106,CPT,Facility,Outpatient,,,,70,59.5,20.062,70,Medica,Medical Assistance,31.22,44.6,,percent of total billed charges,,
Yeast Identification,,87106,CPT,Facility,Inpatient,,,,70,59.5,20.062,70,Medica,Medical Assistance,,,,,Included in per diem rate,
Yeast Identification,,87106,CPT,Facility,Outpatient,,,,70,59.5,20.062,70,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,34.86,49.8,,percent of total billed charges,,
Yeast Identification,,87106,CPT,Facility,Inpatient,,,,70,59.5,20.062,70,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Yeast Identification,,87106,CPT,Facility,Both,,,,70,59.5,20.062,70,"Multiplan, Inc.","Multiplan, Inc.",65.8,94,,percent of total billed charges,,
Yeast Identification,,87106,CPT,Facility,Outpatient,,,,70,59.5,20.062,70,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,60.48,86.4,,percent of total billed charges,,
Yeast Identification,,87106,CPT,Facility,Inpatient,,,,70,59.5,20.062,70,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Yeast Identification,,87106,CPT,Facility,Both,,,,70,59.5,20.062,70,"Preferred One Administrative Services, INC.",PPO,69.02,98.6,,percent of total billed charges,,
Yeast Identification,,87106,CPT,Facility,Outpatient,,,,70,59.5,20.062,70,PrimeWest Health,Minnesota Senior Health Options (MSHO),36.015,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Yeast Identification,,87106,CPT,Facility,Inpatient,,,,70,59.5,20.062,70,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Yeast Identification,,87106,CPT,Facility,Outpatient,,,,70,59.5,20.062,70,PrimeWest Health,MinnesotaCare,35.952,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Yeast Identification,,87106,CPT,Facility,Inpatient,,,,70,59.5,20.062,70,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Yeast Identification,,87106,CPT,Facility,Both,,,,70,59.5,20.062,70,Sanford Health Plan,Sanford Health Plan,64.4,92,,percent of total billed charges,,
Yeast Identification,,87106,CPT,Facility,Outpatient,,,,70,59.5,20.062,70,"UCare Health, Inc.",Individual & Family Plan,39.445,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Yeast Identification,,87106,CPT,Facility,Inpatient,,,,70,59.5,20.062,70,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Yeast Identification,,87106,CPT,Facility,Outpatient,,,,70,59.5,20.062,70,"UCare Health, Inc.",Medical Assistance,35.329,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Yeast Identification,,87106,CPT,Facility,Inpatient,,,,70,59.5,20.062,70,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Yeast Identification,,87106,CPT,Facility,Outpatient,,,,70,59.5,20.062,70,"UCare Health, Inc.",Medicare Advantage,35.329,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Yeast Identification,,87106,CPT,Facility,Inpatient,,,,70,59.5,20.062,70,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Yeast Identification,,87106,CPT,Facility,Outpatient,,,,70,59.5,20.062,70,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),35.329,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Yeast Identification,,87106,CPT,Facility,Inpatient,,,,70,59.5,20.062,70,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Yeast Identification,,87106,CPT,Facility,Both,,,,70,59.5,20.062,70,UnitedHealthcare,Individual & Family,65.8,94,,percent of total billed charges,,
Yeast Identification,,87106,CPT,Facility,Outpatient,,,,70,59.5,20.062,70,UnitedHealthcare,Medicare Advantage,34.3,49,,percent of total billed charges,,
Yeast Identification,,87106,CPT,Facility,Inpatient,,,,70,59.5,20.062,70,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Yeast Identification,,87106,CPT,Facility,Outpatient,,,,70,59.5,20.062,70,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,33.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
Yeast Identification,,87106,CPT,Facility,Inpatient,,,,70,59.5,20.062,70,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Fungal Identification,,87107,CPT,Facility,Both,,,,84,71.4,24.0744,84,Aetna,Commercial,77.28,92,,percent of total billed charges,,
Fungal Identification,,87107,CPT,Facility,Outpatient,,,,84,71.4,24.0744,84,Aetna,Medicare Advantage,41.16,49,,percent of total billed charges,,
Fungal Identification,,87107,CPT,Facility,Inpatient,,,,84,71.4,24.0744,84,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Fungal Identification,,87107,CPT,Facility,Both,,,,84,71.4,24.0744,84,Aetna,PPO,78.12,93,,percent of total billed charges,,
Fungal Identification,,87107,CPT,Facility,Both,,,,84,71.4,24.0744,84,America's PPO,America's PPO,80.6652,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Fungal Identification,,87107,CPT,Facility,Both,,,,84,71.4,24.0744,84,BlueCross BlueShield Minnesota, Federal Employee Program,82.656,98.4,,percent of total billed charges,,
Fungal Identification,,87107,CPT,Facility,Both,,,,84,71.4,24.0744,84,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,84,100,,percent of total billed charges,,
Fungal Identification,,87107,CPT,Facility,Both,,,,84,71.4,24.0744,84,BlueCross BlueShield Minnesota,High Value Network Plan,75.6,90,,percent of total billed charges,,
Fungal Identification,,87107,CPT,Facility,Outpatient,,,,84,71.4,24.0744,84,BlueCross BlueShield Minnesota,Medicare Advantage,41.16,49,,percent of total billed charges,,
Fungal Identification,,87107,CPT,Facility,Inpatient,,,,84,71.4,24.0744,84,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Fungal Identification,,87107,CPT,Facility,Both,,,,84,71.4,24.0744,84,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,74.3988,88.57,,percent of total billed charges,,
Fungal Identification,,87107,CPT,Facility,Both,,,,84,71.4,24.0744,84,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,24.0744,28.66,,percent of total billed charges,,
Fungal Identification,,87107,CPT,Facility,Outpatient,,,,84,71.4,24.0744,84,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),41.16,49,,percent of total billed charges,,
Fungal Identification,,87107,CPT,Facility,Inpatient,,,,84,71.4,24.0744,84,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Fungal Identification,,87107,CPT,Facility,Both,,,,84,71.4,24.0744,84,CorVel,Worker's Compensation,84,100,,percent of total billed charges,,
Fungal Identification,,87107,CPT,Facility,Both,,,,84,71.4,24.0744,84,First Health Group Corporation,First Health Network,81.48,97,,percent of total billed charges,,
Fungal Identification,,87107,CPT,Facility,Both,,,,84,71.4,24.0744,84,"Health Partners, Inc.",Commercial,79.464,94.6,,percent of total billed charges,,
Fungal Identification,,87107,CPT,Facility,Outpatient,,,,84,71.4,24.0744,84,"Health Partners, Inc.",Medicare Advantage,41.16,49,,percent of total billed charges,,
Fungal Identification,,87107,CPT,Facility,Inpatient,,,,84,71.4,24.0744,84,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Fungal Identification,,87107,CPT,Facility,Both,,,,84,71.4,24.0744,84,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),50.4,60,,percent of total billed charges,,
Fungal Identification,,87107,CPT,Facility,Both,,,,84,71.4,24.0744,84,"Health Partners, Inc.",State of Minnesota Advantage Program,68.46,81.5,,percent of total billed charges,,
Fungal Identification,,87107,CPT,Facility,Both,,,,84,71.4,24.0744,84,"Health Partners, Inc.",State Public Programs,42,50,,percent of total billed charges,,
Fungal Identification,,87107,CPT,Facility,Both,,,,84,71.4,24.0744,84,Humana Insurance Company,Commercial PPO,79.8,95,,percent of total billed charges,,
Fungal Identification,,87107,CPT,Facility,Outpatient,,,,84,71.4,24.0744,84,Humana Insurance Company,Medicare PPO,41.16,49,,percent of total billed charges,,
Fungal Identification,,87107,CPT,Facility,Inpatient,,,,84,71.4,24.0744,84,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Fungal Identification,,87107,CPT,Facility,Both,,,,84,71.4,24.0744,84,Medica,Individual & Family,83.244,99.1,,percent of total billed charges,,
Fungal Identification,,87107,CPT,Facility,Outpatient,,,,84,71.4,24.0744,84,Medica,Medica Advantage Solution,41.832,49.8,,percent of total billed charges,,
Fungal Identification,,87107,CPT,Facility,Inpatient,,,,84,71.4,24.0744,84,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Fungal Identification,,87107,CPT,Facility,Outpatient,,,,84,71.4,24.0744,84,Medica,Medical Assistance,37.464,44.6,,percent of total billed charges,,
Fungal Identification,,87107,CPT,Facility,Inpatient,,,,84,71.4,24.0744,84,Medica,Medical Assistance,,,,,Included in per diem rate,
Fungal Identification,,87107,CPT,Facility,Outpatient,,,,84,71.4,24.0744,84,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,41.832,49.8,,percent of total billed charges,,
Fungal Identification,,87107,CPT,Facility,Inpatient,,,,84,71.4,24.0744,84,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Fungal Identification,,87107,CPT,Facility,Both,,,,84,71.4,24.0744,84,"Multiplan, Inc.","Multiplan, Inc.",78.96,94,,percent of total billed charges,,
Fungal Identification,,87107,CPT,Facility,Outpatient,,,,84,71.4,24.0744,84,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,72.576,86.4,,percent of total billed charges,,
Fungal Identification,,87107,CPT,Facility,Inpatient,,,,84,71.4,24.0744,84,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Fungal Identification,,87107,CPT,Facility,Both,,,,84,71.4,24.0744,84,"Preferred One Administrative Services, INC.",PPO,82.824,98.6,,percent of total billed charges,,
Fungal Identification,,87107,CPT,Facility,Outpatient,,,,84,71.4,24.0744,84,PrimeWest Health,Minnesota Senior Health Options (MSHO),43.218,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Fungal Identification,,87107,CPT,Facility,Inpatient,,,,84,71.4,24.0744,84,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Fungal Identification,,87107,CPT,Facility,Outpatient,,,,84,71.4,24.0744,84,PrimeWest Health,MinnesotaCare,43.1424,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Fungal Identification,,87107,CPT,Facility,Inpatient,,,,84,71.4,24.0744,84,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Fungal Identification,,87107,CPT,Facility,Both,,,,84,71.4,24.0744,84,Sanford Health Plan,Sanford Health Plan,77.28,92,,percent of total billed charges,,
Fungal Identification,,87107,CPT,Facility,Outpatient,,,,84,71.4,24.0744,84,"UCare Health, Inc.",Individual & Family Plan,47.334,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Fungal Identification,,87107,CPT,Facility,Inpatient,,,,84,71.4,24.0744,84,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Fungal Identification,,87107,CPT,Facility,Outpatient,,,,84,71.4,24.0744,84,"UCare Health, Inc.",Medical Assistance,42.3948,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Fungal Identification,,87107,CPT,Facility,Inpatient,,,,84,71.4,24.0744,84,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Fungal Identification,,87107,CPT,Facility,Outpatient,,,,84,71.4,24.0744,84,"UCare Health, Inc.",Medicare Advantage,42.3948,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Fungal Identification,,87107,CPT,Facility,Inpatient,,,,84,71.4,24.0744,84,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Fungal Identification,,87107,CPT,Facility,Outpatient,,,,84,71.4,24.0744,84,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),42.3948,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Fungal Identification,,87107,CPT,Facility,Inpatient,,,,84,71.4,24.0744,84,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Fungal Identification,,87107,CPT,Facility,Both,,,,84,71.4,24.0744,84,UnitedHealthcare,Individual & Family,78.96,94,,percent of total billed charges,,
Fungal Identification,,87107,CPT,Facility,Outpatient,,,,84,71.4,24.0744,84,UnitedHealthcare,Medicare Advantage,41.16,49,,percent of total billed charges,,
Fungal Identification,,87107,CPT,Facility,Inpatient,,,,84,71.4,24.0744,84,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Fungal Identification,,87107,CPT,Facility,Outpatient,,,,84,71.4,24.0744,84,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,40.32,48,,percent of total billed charges,,100% of DHS outpatient percentage
Fungal Identification,,87107,CPT,Facility,Inpatient,,,,84,71.4,24.0744,84,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Macroscopic Parasite Exam, Arthropod/Tick",,87168,CPT,Facility,Both,,,,33,28.05,9.4578,33,Aetna,Commercial,30.36,92,,percent of total billed charges,,
"Macroscopic Parasite Exam, Arthropod/Tick",,87168,CPT,Facility,Outpatient,,,,33,28.05,9.4578,33,Aetna,Medicare Advantage,16.17,49,,percent of total billed charges,,
"Macroscopic Parasite Exam, Arthropod/Tick",,87168,CPT,Facility,Inpatient,,,,33,28.05,9.4578,33,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Macroscopic Parasite Exam, Arthropod/Tick",,87168,CPT,Facility,Both,,,,33,28.05,9.4578,33,Aetna,PPO,30.69,93,,percent of total billed charges,,
"Macroscopic Parasite Exam, Arthropod/Tick",,87168,CPT,Facility,Both,,,,33,28.05,9.4578,33,America's PPO,America's PPO,31.6899,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Macroscopic Parasite Exam, Arthropod/Tick",,87168,CPT,Facility,Both,,,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota, Federal Employee Program,32.472,98.4,,percent of total billed charges,,
"Macroscopic Parasite Exam, Arthropod/Tick",,87168,CPT,Facility,Both,,,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,33,100,,percent of total billed charges,,
"Macroscopic Parasite Exam, Arthropod/Tick",,87168,CPT,Facility,Both,,,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota,High Value Network Plan,29.7,90,,percent of total billed charges,,
"Macroscopic Parasite Exam, Arthropod/Tick",,87168,CPT,Facility,Outpatient,,,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota,Medicare Advantage,16.17,49,,percent of total billed charges,,
"Macroscopic Parasite Exam, Arthropod/Tick",,87168,CPT,Facility,Inpatient,,,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Macroscopic Parasite Exam, Arthropod/Tick",,87168,CPT,Facility,Both,,,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,29.2281,88.57,,percent of total billed charges,,
"Macroscopic Parasite Exam, Arthropod/Tick",,87168,CPT,Facility,Both,,,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,9.4578,28.66,,percent of total billed charges,,
"Macroscopic Parasite Exam, Arthropod/Tick",,87168,CPT,Facility,Outpatient,,,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),16.17,49,,percent of total billed charges,,
"Macroscopic Parasite Exam, Arthropod/Tick",,87168,CPT,Facility,Inpatient,,,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Macroscopic Parasite Exam, Arthropod/Tick",,87168,CPT,Facility,Both,,,,33,28.05,9.4578,33,CorVel,Worker's Compensation,33,100,,percent of total billed charges,,
"Macroscopic Parasite Exam, Arthropod/Tick",,87168,CPT,Facility,Both,,,,33,28.05,9.4578,33,First Health Group Corporation,First Health Network,32.01,97,,percent of total billed charges,,
"Macroscopic Parasite Exam, Arthropod/Tick",,87168,CPT,Facility,Both,,,,33,28.05,9.4578,33,"Health Partners, Inc.",Commercial,31.218,94.6,,percent of total billed charges,,
"Macroscopic Parasite Exam, Arthropod/Tick",,87168,CPT,Facility,Outpatient,,,,33,28.05,9.4578,33,"Health Partners, Inc.",Medicare Advantage,16.17,49,,percent of total billed charges,,
"Macroscopic Parasite Exam, Arthropod/Tick",,87168,CPT,Facility,Inpatient,,,,33,28.05,9.4578,33,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Macroscopic Parasite Exam, Arthropod/Tick",,87168,CPT,Facility,Both,,,,33,28.05,9.4578,33,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),19.8,60,,percent of total billed charges,,
"Macroscopic Parasite Exam, Arthropod/Tick",,87168,CPT,Facility,Both,,,,33,28.05,9.4578,33,"Health Partners, Inc.",State of Minnesota Advantage Program,26.895,81.5,,percent of total billed charges,,
"Macroscopic Parasite Exam, Arthropod/Tick",,87168,CPT,Facility,Both,,,,33,28.05,9.4578,33,"Health Partners, Inc.",State Public Programs,16.5,50,,percent of total billed charges,,
"Macroscopic Parasite Exam, Arthropod/Tick",,87168,CPT,Facility,Both,,,,33,28.05,9.4578,33,Humana Insurance Company,Commercial PPO,31.35,95,,percent of total billed charges,,
"Macroscopic Parasite Exam, Arthropod/Tick",,87168,CPT,Facility,Outpatient,,,,33,28.05,9.4578,33,Humana Insurance Company,Medicare PPO,16.17,49,,percent of total billed charges,,
"Macroscopic Parasite Exam, Arthropod/Tick",,87168,CPT,Facility,Inpatient,,,,33,28.05,9.4578,33,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Macroscopic Parasite Exam, Arthropod/Tick",,87168,CPT,Facility,Both,,,,33,28.05,9.4578,33,Medica,Individual & Family,32.703,99.1,,percent of total billed charges,,
"Macroscopic Parasite Exam, Arthropod/Tick",,87168,CPT,Facility,Outpatient,,,,33,28.05,9.4578,33,Medica,Medica Advantage Solution,16.434,49.8,,percent of total billed charges,,
"Macroscopic Parasite Exam, Arthropod/Tick",,87168,CPT,Facility,Inpatient,,,,33,28.05,9.4578,33,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Macroscopic Parasite Exam, Arthropod/Tick",,87168,CPT,Facility,Outpatient,,,,33,28.05,9.4578,33,Medica,Medical Assistance,14.718,44.6,,percent of total billed charges,,
"Macroscopic Parasite Exam, Arthropod/Tick",,87168,CPT,Facility,Inpatient,,,,33,28.05,9.4578,33,Medica,Medical Assistance,,,,,Included in per diem rate,
"Macroscopic Parasite Exam, Arthropod/Tick",,87168,CPT,Facility,Outpatient,,,,33,28.05,9.4578,33,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,16.434,49.8,,percent of total billed charges,,
"Macroscopic Parasite Exam, Arthropod/Tick",,87168,CPT,Facility,Inpatient,,,,33,28.05,9.4578,33,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Macroscopic Parasite Exam, Arthropod/Tick",,87168,CPT,Facility,Both,,,,33,28.05,9.4578,33,"Multiplan, Inc.","Multiplan, Inc.",31.02,94,,percent of total billed charges,,
"Macroscopic Parasite Exam, Arthropod/Tick",,87168,CPT,Facility,Outpatient,,,,33,28.05,9.4578,33,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,28.512,86.4,,percent of total billed charges,,
"Macroscopic Parasite Exam, Arthropod/Tick",,87168,CPT,Facility,Inpatient,,,,33,28.05,9.4578,33,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Macroscopic Parasite Exam, Arthropod/Tick",,87168,CPT,Facility,Both,,,,33,28.05,9.4578,33,"Preferred One Administrative Services, INC.",PPO,32.538,98.6,,percent of total billed charges,,
"Macroscopic Parasite Exam, Arthropod/Tick",,87168,CPT,Facility,Outpatient,,,,33,28.05,9.4578,33,PrimeWest Health,Minnesota Senior Health Options (MSHO),16.9785,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Macroscopic Parasite Exam, Arthropod/Tick",,87168,CPT,Facility,Inpatient,,,,33,28.05,9.4578,33,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Macroscopic Parasite Exam, Arthropod/Tick",,87168,CPT,Facility,Outpatient,,,,33,28.05,9.4578,33,PrimeWest Health,MinnesotaCare,16.9488,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Macroscopic Parasite Exam, Arthropod/Tick",,87168,CPT,Facility,Inpatient,,,,33,28.05,9.4578,33,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Macroscopic Parasite Exam, Arthropod/Tick",,87168,CPT,Facility,Both,,,,33,28.05,9.4578,33,Sanford Health Plan,Sanford Health Plan,30.36,92,,percent of total billed charges,,
"Macroscopic Parasite Exam, Arthropod/Tick",,87168,CPT,Facility,Outpatient,,,,33,28.05,9.4578,33,"UCare Health, Inc.",Individual & Family Plan,18.5955,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Macroscopic Parasite Exam, Arthropod/Tick",,87168,CPT,Facility,Inpatient,,,,33,28.05,9.4578,33,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Macroscopic Parasite Exam, Arthropod/Tick",,87168,CPT,Facility,Outpatient,,,,33,28.05,9.4578,33,"UCare Health, Inc.",Medical Assistance,16.6551,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Macroscopic Parasite Exam, Arthropod/Tick",,87168,CPT,Facility,Inpatient,,,,33,28.05,9.4578,33,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Macroscopic Parasite Exam, Arthropod/Tick",,87168,CPT,Facility,Outpatient,,,,33,28.05,9.4578,33,"UCare Health, Inc.",Medicare Advantage,16.6551,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Macroscopic Parasite Exam, Arthropod/Tick",,87168,CPT,Facility,Inpatient,,,,33,28.05,9.4578,33,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Macroscopic Parasite Exam, Arthropod/Tick",,87168,CPT,Facility,Outpatient,,,,33,28.05,9.4578,33,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),16.6551,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Macroscopic Parasite Exam, Arthropod/Tick",,87168,CPT,Facility,Inpatient,,,,33,28.05,9.4578,33,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Macroscopic Parasite Exam, Arthropod/Tick",,87168,CPT,Facility,Both,,,,33,28.05,9.4578,33,UnitedHealthcare,Individual & Family,31.02,94,,percent of total billed charges,,
"Macroscopic Parasite Exam, Arthropod/Tick",,87168,CPT,Facility,Outpatient,,,,33,28.05,9.4578,33,UnitedHealthcare,Medicare Advantage,16.17,49,,percent of total billed charges,,
"Macroscopic Parasite Exam, Arthropod/Tick",,87168,CPT,Facility,Inpatient,,,,33,28.05,9.4578,33,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Macroscopic Parasite Exam, Arthropod/Tick",,87168,CPT,Facility,Outpatient,,,,33,28.05,9.4578,33,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,15.84,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Macroscopic Parasite Exam, Arthropod/Tick",,87168,CPT,Facility,Inpatient,,,,33,28.05,9.4578,33,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Ova And Parasites,,87177,CPT,Facility,Both,,,,98,83.3,28.0868,98,Aetna,Commercial,90.16,92,,percent of total billed charges,,
Ova And Parasites,,87177,CPT,Facility,Outpatient,,,,98,83.3,28.0868,98,Aetna,Medicare Advantage,48.02,49,,percent of total billed charges,,
Ova And Parasites,,87177,CPT,Facility,Inpatient,,,,98,83.3,28.0868,98,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Ova And Parasites,,87177,CPT,Facility,Both,,,,98,83.3,28.0868,98,Aetna,PPO,91.14,93,,percent of total billed charges,,
Ova And Parasites,,87177,CPT,Facility,Both,,,,98,83.3,28.0868,98,America's PPO,America's PPO,94.1094,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Ova And Parasites,,87177,CPT,Facility,Both,,,,98,83.3,28.0868,98,BlueCross BlueShield Minnesota, Federal Employee Program,96.432,98.4,,percent of total billed charges,,
Ova And Parasites,,87177,CPT,Facility,Both,,,,98,83.3,28.0868,98,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,98,100,,percent of total billed charges,,
Ova And Parasites,,87177,CPT,Facility,Both,,,,98,83.3,28.0868,98,BlueCross BlueShield Minnesota,High Value Network Plan,88.2,90,,percent of total billed charges,,
Ova And Parasites,,87177,CPT,Facility,Outpatient,,,,98,83.3,28.0868,98,BlueCross BlueShield Minnesota,Medicare Advantage,48.02,49,,percent of total billed charges,,
Ova And Parasites,,87177,CPT,Facility,Inpatient,,,,98,83.3,28.0868,98,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Ova And Parasites,,87177,CPT,Facility,Both,,,,98,83.3,28.0868,98,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,86.7986,88.57,,percent of total billed charges,,
Ova And Parasites,,87177,CPT,Facility,Both,,,,98,83.3,28.0868,98,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,28.0868,28.66,,percent of total billed charges,,
Ova And Parasites,,87177,CPT,Facility,Outpatient,,,,98,83.3,28.0868,98,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),48.02,49,,percent of total billed charges,,
Ova And Parasites,,87177,CPT,Facility,Inpatient,,,,98,83.3,28.0868,98,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Ova And Parasites,,87177,CPT,Facility,Both,,,,98,83.3,28.0868,98,CorVel,Worker's Compensation,98,100,,percent of total billed charges,,
Ova And Parasites,,87177,CPT,Facility,Both,,,,98,83.3,28.0868,98,First Health Group Corporation,First Health Network,95.06,97,,percent of total billed charges,,
Ova And Parasites,,87177,CPT,Facility,Both,,,,98,83.3,28.0868,98,"Health Partners, Inc.",Commercial,92.708,94.6,,percent of total billed charges,,
Ova And Parasites,,87177,CPT,Facility,Outpatient,,,,98,83.3,28.0868,98,"Health Partners, Inc.",Medicare Advantage,48.02,49,,percent of total billed charges,,
Ova And Parasites,,87177,CPT,Facility,Inpatient,,,,98,83.3,28.0868,98,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ova And Parasites,,87177,CPT,Facility,Both,,,,98,83.3,28.0868,98,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),58.8,60,,percent of total billed charges,,
Ova And Parasites,,87177,CPT,Facility,Both,,,,98,83.3,28.0868,98,"Health Partners, Inc.",State of Minnesota Advantage Program,79.87,81.5,,percent of total billed charges,,
Ova And Parasites,,87177,CPT,Facility,Both,,,,98,83.3,28.0868,98,"Health Partners, Inc.",State Public Programs,49,50,,percent of total billed charges,,
Ova And Parasites,,87177,CPT,Facility,Both,,,,98,83.3,28.0868,98,Humana Insurance Company,Commercial PPO,93.1,95,,percent of total billed charges,,
Ova And Parasites,,87177,CPT,Facility,Outpatient,,,,98,83.3,28.0868,98,Humana Insurance Company,Medicare PPO,48.02,49,,percent of total billed charges,,
Ova And Parasites,,87177,CPT,Facility,Inpatient,,,,98,83.3,28.0868,98,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Ova And Parasites,,87177,CPT,Facility,Both,,,,98,83.3,28.0868,98,Medica,Individual & Family,97.118,99.1,,percent of total billed charges,,
Ova And Parasites,,87177,CPT,Facility,Outpatient,,,,98,83.3,28.0868,98,Medica,Medica Advantage Solution,48.804,49.8,,percent of total billed charges,,
Ova And Parasites,,87177,CPT,Facility,Inpatient,,,,98,83.3,28.0868,98,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Ova And Parasites,,87177,CPT,Facility,Outpatient,,,,98,83.3,28.0868,98,Medica,Medical Assistance,43.708,44.6,,percent of total billed charges,,
Ova And Parasites,,87177,CPT,Facility,Inpatient,,,,98,83.3,28.0868,98,Medica,Medical Assistance,,,,,Included in per diem rate,
Ova And Parasites,,87177,CPT,Facility,Outpatient,,,,98,83.3,28.0868,98,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,48.804,49.8,,percent of total billed charges,,
Ova And Parasites,,87177,CPT,Facility,Inpatient,,,,98,83.3,28.0868,98,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Ova And Parasites,,87177,CPT,Facility,Both,,,,98,83.3,28.0868,98,"Multiplan, Inc.","Multiplan, Inc.",92.12,94,,percent of total billed charges,,
Ova And Parasites,,87177,CPT,Facility,Outpatient,,,,98,83.3,28.0868,98,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,84.672,86.4,,percent of total billed charges,,
Ova And Parasites,,87177,CPT,Facility,Inpatient,,,,98,83.3,28.0868,98,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Ova And Parasites,,87177,CPT,Facility,Both,,,,98,83.3,28.0868,98,"Preferred One Administrative Services, INC.",PPO,96.628,98.6,,percent of total billed charges,,
Ova And Parasites,,87177,CPT,Facility,Outpatient,,,,98,83.3,28.0868,98,PrimeWest Health,Minnesota Senior Health Options (MSHO),50.421,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Ova And Parasites,,87177,CPT,Facility,Inpatient,,,,98,83.3,28.0868,98,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ova And Parasites,,87177,CPT,Facility,Outpatient,,,,98,83.3,28.0868,98,PrimeWest Health,MinnesotaCare,50.3328,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Ova And Parasites,,87177,CPT,Facility,Inpatient,,,,98,83.3,28.0868,98,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Ova And Parasites,,87177,CPT,Facility,Both,,,,98,83.3,28.0868,98,Sanford Health Plan,Sanford Health Plan,90.16,92,,percent of total billed charges,,
Ova And Parasites,,87177,CPT,Facility,Outpatient,,,,98,83.3,28.0868,98,"UCare Health, Inc.",Individual & Family Plan,55.223,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Ova And Parasites,,87177,CPT,Facility,Inpatient,,,,98,83.3,28.0868,98,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Ova And Parasites,,87177,CPT,Facility,Outpatient,,,,98,83.3,28.0868,98,"UCare Health, Inc.",Medical Assistance,49.4606,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ova And Parasites,,87177,CPT,Facility,Inpatient,,,,98,83.3,28.0868,98,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Ova And Parasites,,87177,CPT,Facility,Outpatient,,,,98,83.3,28.0868,98,"UCare Health, Inc.",Medicare Advantage,49.4606,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ova And Parasites,,87177,CPT,Facility,Inpatient,,,,98,83.3,28.0868,98,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ova And Parasites,,87177,CPT,Facility,Outpatient,,,,98,83.3,28.0868,98,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),49.4606,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ova And Parasites,,87177,CPT,Facility,Inpatient,,,,98,83.3,28.0868,98,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ova And Parasites,,87177,CPT,Facility,Both,,,,98,83.3,28.0868,98,UnitedHealthcare,Individual & Family,92.12,94,,percent of total billed charges,,
Ova And Parasites,,87177,CPT,Facility,Outpatient,,,,98,83.3,28.0868,98,UnitedHealthcare,Medicare Advantage,48.02,49,,percent of total billed charges,,
Ova And Parasites,,87177,CPT,Facility,Inpatient,,,,98,83.3,28.0868,98,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Ova And Parasites,,87177,CPT,Facility,Outpatient,,,,98,83.3,28.0868,98,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,47.04,48,,percent of total billed charges,,100% of DHS outpatient percentage
Ova And Parasites,,87177,CPT,Facility,Inpatient,,,,98,83.3,28.0868,98,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
D Test,,87184,CPT,Facility,Both,,,,53,45.05,15.1898,53,Aetna,Commercial,48.76,92,,percent of total billed charges,,
D Test,,87184,CPT,Facility,Outpatient,,,,53,45.05,15.1898,53,Aetna,Medicare Advantage,25.97,49,,percent of total billed charges,,
D Test,,87184,CPT,Facility,Inpatient,,,,53,45.05,15.1898,53,Aetna,Medicare Advantage,,,,,Included in per diem rate,
D Test,,87184,CPT,Facility,Both,,,,53,45.05,15.1898,53,Aetna,PPO,49.29,93,,percent of total billed charges,,
D Test,,87184,CPT,Facility,Both,,,,53,45.05,15.1898,53,America's PPO,America's PPO,50.8959,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
D Test,,87184,CPT,Facility,Both,,,,53,45.05,15.1898,53,BlueCross BlueShield Minnesota, Federal Employee Program,52.152,98.4,,percent of total billed charges,,
D Test,,87184,CPT,Facility,Both,,,,53,45.05,15.1898,53,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,53,100,,percent of total billed charges,,
D Test,,87184,CPT,Facility,Both,,,,53,45.05,15.1898,53,BlueCross BlueShield Minnesota,High Value Network Plan,47.7,90,,percent of total billed charges,,
D Test,,87184,CPT,Facility,Outpatient,,,,53,45.05,15.1898,53,BlueCross BlueShield Minnesota,Medicare Advantage,25.97,49,,percent of total billed charges,,
D Test,,87184,CPT,Facility,Inpatient,,,,53,45.05,15.1898,53,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
D Test,,87184,CPT,Facility,Both,,,,53,45.05,15.1898,53,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,46.9421,88.57,,percent of total billed charges,,
D Test,,87184,CPT,Facility,Both,,,,53,45.05,15.1898,53,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,15.1898,28.66,,percent of total billed charges,,
D Test,,87184,CPT,Facility,Outpatient,,,,53,45.05,15.1898,53,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),25.97,49,,percent of total billed charges,,
D Test,,87184,CPT,Facility,Inpatient,,,,53,45.05,15.1898,53,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
D Test,,87184,CPT,Facility,Both,,,,53,45.05,15.1898,53,CorVel,Worker's Compensation,53,100,,percent of total billed charges,,
D Test,,87184,CPT,Facility,Both,,,,53,45.05,15.1898,53,First Health Group Corporation,First Health Network,51.41,97,,percent of total billed charges,,
D Test,,87184,CPT,Facility,Both,,,,53,45.05,15.1898,53,"Health Partners, Inc.",Commercial,50.138,94.6,,percent of total billed charges,,
D Test,,87184,CPT,Facility,Outpatient,,,,53,45.05,15.1898,53,"Health Partners, Inc.",Medicare Advantage,25.97,49,,percent of total billed charges,,
D Test,,87184,CPT,Facility,Inpatient,,,,53,45.05,15.1898,53,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
D Test,,87184,CPT,Facility,Both,,,,53,45.05,15.1898,53,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),31.8,60,,percent of total billed charges,,
D Test,,87184,CPT,Facility,Both,,,,53,45.05,15.1898,53,"Health Partners, Inc.",State of Minnesota Advantage Program,43.195,81.5,,percent of total billed charges,,
D Test,,87184,CPT,Facility,Both,,,,53,45.05,15.1898,53,"Health Partners, Inc.",State Public Programs,26.5,50,,percent of total billed charges,,
D Test,,87184,CPT,Facility,Both,,,,53,45.05,15.1898,53,Humana Insurance Company,Commercial PPO,50.35,95,,percent of total billed charges,,
D Test,,87184,CPT,Facility,Outpatient,,,,53,45.05,15.1898,53,Humana Insurance Company,Medicare PPO,25.97,49,,percent of total billed charges,,
D Test,,87184,CPT,Facility,Inpatient,,,,53,45.05,15.1898,53,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
D Test,,87184,CPT,Facility,Both,,,,53,45.05,15.1898,53,Medica,Individual & Family,52.523,99.1,,percent of total billed charges,,
D Test,,87184,CPT,Facility,Outpatient,,,,53,45.05,15.1898,53,Medica,Medica Advantage Solution,26.394,49.8,,percent of total billed charges,,
D Test,,87184,CPT,Facility,Inpatient,,,,53,45.05,15.1898,53,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
D Test,,87184,CPT,Facility,Outpatient,,,,53,45.05,15.1898,53,Medica,Medical Assistance,23.638,44.6,,percent of total billed charges,,
D Test,,87184,CPT,Facility,Inpatient,,,,53,45.05,15.1898,53,Medica,Medical Assistance,,,,,Included in per diem rate,
D Test,,87184,CPT,Facility,Outpatient,,,,53,45.05,15.1898,53,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,26.394,49.8,,percent of total billed charges,,
D Test,,87184,CPT,Facility,Inpatient,,,,53,45.05,15.1898,53,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
D Test,,87184,CPT,Facility,Both,,,,53,45.05,15.1898,53,"Multiplan, Inc.","Multiplan, Inc.",49.82,94,,percent of total billed charges,,
D Test,,87184,CPT,Facility,Outpatient,,,,53,45.05,15.1898,53,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,45.792,86.4,,percent of total billed charges,,
D Test,,87184,CPT,Facility,Inpatient,,,,53,45.05,15.1898,53,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
D Test,,87184,CPT,Facility,Both,,,,53,45.05,15.1898,53,"Preferred One Administrative Services, INC.",PPO,52.258,98.6,,percent of total billed charges,,
D Test,,87184,CPT,Facility,Outpatient,,,,53,45.05,15.1898,53,PrimeWest Health,Minnesota Senior Health Options (MSHO),27.2685,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
D Test,,87184,CPT,Facility,Inpatient,,,,53,45.05,15.1898,53,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
D Test,,87184,CPT,Facility,Outpatient,,,,53,45.05,15.1898,53,PrimeWest Health,MinnesotaCare,27.2208,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
D Test,,87184,CPT,Facility,Inpatient,,,,53,45.05,15.1898,53,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
D Test,,87184,CPT,Facility,Both,,,,53,45.05,15.1898,53,Sanford Health Plan,Sanford Health Plan,48.76,92,,percent of total billed charges,,
D Test,,87184,CPT,Facility,Outpatient,,,,53,45.05,15.1898,53,"UCare Health, Inc.",Individual & Family Plan,29.8655,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
D Test,,87184,CPT,Facility,Inpatient,,,,53,45.05,15.1898,53,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
D Test,,87184,CPT,Facility,Outpatient,,,,53,45.05,15.1898,53,"UCare Health, Inc.",Medical Assistance,26.7491,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
D Test,,87184,CPT,Facility,Inpatient,,,,53,45.05,15.1898,53,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
D Test,,87184,CPT,Facility,Outpatient,,,,53,45.05,15.1898,53,"UCare Health, Inc.",Medicare Advantage,26.7491,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
D Test,,87184,CPT,Facility,Inpatient,,,,53,45.05,15.1898,53,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
D Test,,87184,CPT,Facility,Outpatient,,,,53,45.05,15.1898,53,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),26.7491,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
D Test,,87184,CPT,Facility,Inpatient,,,,53,45.05,15.1898,53,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
D Test,,87184,CPT,Facility,Both,,,,53,45.05,15.1898,53,UnitedHealthcare,Individual & Family,49.82,94,,percent of total billed charges,,
D Test,,87184,CPT,Facility,Outpatient,,,,53,45.05,15.1898,53,UnitedHealthcare,Medicare Advantage,25.97,49,,percent of total billed charges,,
D Test,,87184,CPT,Facility,Inpatient,,,,53,45.05,15.1898,53,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
D Test,,87184,CPT,Facility,Outpatient,,,,53,45.05,15.1898,53,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,25.44,48,,percent of total billed charges,,100% of DHS outpatient percentage
D Test,,87184,CPT,Facility,Inpatient,,,,53,45.05,15.1898,53,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Beta Lactamase,,87185,CPT,Facility,Both,,,,45,38.25,12.897,45,Aetna,Commercial,41.4,92,,percent of total billed charges,,
Beta Lactamase,,87185,CPT,Facility,Outpatient,,,,45,38.25,12.897,45,Aetna,Medicare Advantage,22.05,49,,percent of total billed charges,,
Beta Lactamase,,87185,CPT,Facility,Inpatient,,,,45,38.25,12.897,45,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Beta Lactamase,,87185,CPT,Facility,Both,,,,45,38.25,12.897,45,Aetna,PPO,41.85,93,,percent of total billed charges,,
Beta Lactamase,,87185,CPT,Facility,Both,,,,45,38.25,12.897,45,America's PPO,America's PPO,43.2135,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Beta Lactamase,,87185,CPT,Facility,Both,,,,45,38.25,12.897,45,BlueCross BlueShield Minnesota, Federal Employee Program,44.28,98.4,,percent of total billed charges,,
Beta Lactamase,,87185,CPT,Facility,Both,,,,45,38.25,12.897,45,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,45,100,,percent of total billed charges,,
Beta Lactamase,,87185,CPT,Facility,Both,,,,45,38.25,12.897,45,BlueCross BlueShield Minnesota,High Value Network Plan,40.5,90,,percent of total billed charges,,
Beta Lactamase,,87185,CPT,Facility,Outpatient,,,,45,38.25,12.897,45,BlueCross BlueShield Minnesota,Medicare Advantage,22.05,49,,percent of total billed charges,,
Beta Lactamase,,87185,CPT,Facility,Inpatient,,,,45,38.25,12.897,45,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Beta Lactamase,,87185,CPT,Facility,Both,,,,45,38.25,12.897,45,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,39.8565,88.57,,percent of total billed charges,,
Beta Lactamase,,87185,CPT,Facility,Both,,,,45,38.25,12.897,45,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,12.897,28.66,,percent of total billed charges,,
Beta Lactamase,,87185,CPT,Facility,Outpatient,,,,45,38.25,12.897,45,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),22.05,49,,percent of total billed charges,,
Beta Lactamase,,87185,CPT,Facility,Inpatient,,,,45,38.25,12.897,45,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Beta Lactamase,,87185,CPT,Facility,Both,,,,45,38.25,12.897,45,CorVel,Worker's Compensation,45,100,,percent of total billed charges,,
Beta Lactamase,,87185,CPT,Facility,Both,,,,45,38.25,12.897,45,First Health Group Corporation,First Health Network,43.65,97,,percent of total billed charges,,
Beta Lactamase,,87185,CPT,Facility,Both,,,,45,38.25,12.897,45,"Health Partners, Inc.",Commercial,42.57,94.6,,percent of total billed charges,,
Beta Lactamase,,87185,CPT,Facility,Outpatient,,,,45,38.25,12.897,45,"Health Partners, Inc.",Medicare Advantage,22.05,49,,percent of total billed charges,,
Beta Lactamase,,87185,CPT,Facility,Inpatient,,,,45,38.25,12.897,45,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Beta Lactamase,,87185,CPT,Facility,Both,,,,45,38.25,12.897,45,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),27,60,,percent of total billed charges,,
Beta Lactamase,,87185,CPT,Facility,Both,,,,45,38.25,12.897,45,"Health Partners, Inc.",State of Minnesota Advantage Program,36.675,81.5,,percent of total billed charges,,
Beta Lactamase,,87185,CPT,Facility,Both,,,,45,38.25,12.897,45,"Health Partners, Inc.",State Public Programs,22.5,50,,percent of total billed charges,,
Beta Lactamase,,87185,CPT,Facility,Both,,,,45,38.25,12.897,45,Humana Insurance Company,Commercial PPO,42.75,95,,percent of total billed charges,,
Beta Lactamase,,87185,CPT,Facility,Outpatient,,,,45,38.25,12.897,45,Humana Insurance Company,Medicare PPO,22.05,49,,percent of total billed charges,,
Beta Lactamase,,87185,CPT,Facility,Inpatient,,,,45,38.25,12.897,45,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Beta Lactamase,,87185,CPT,Facility,Both,,,,45,38.25,12.897,45,Medica,Individual & Family,44.595,99.1,,percent of total billed charges,,
Beta Lactamase,,87185,CPT,Facility,Outpatient,,,,45,38.25,12.897,45,Medica,Medica Advantage Solution,22.41,49.8,,percent of total billed charges,,
Beta Lactamase,,87185,CPT,Facility,Inpatient,,,,45,38.25,12.897,45,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Beta Lactamase,,87185,CPT,Facility,Outpatient,,,,45,38.25,12.897,45,Medica,Medical Assistance,20.07,44.6,,percent of total billed charges,,
Beta Lactamase,,87185,CPT,Facility,Inpatient,,,,45,38.25,12.897,45,Medica,Medical Assistance,,,,,Included in per diem rate,
Beta Lactamase,,87185,CPT,Facility,Outpatient,,,,45,38.25,12.897,45,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,22.41,49.8,,percent of total billed charges,,
Beta Lactamase,,87185,CPT,Facility,Inpatient,,,,45,38.25,12.897,45,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Beta Lactamase,,87185,CPT,Facility,Both,,,,45,38.25,12.897,45,"Multiplan, Inc.","Multiplan, Inc.",42.3,94,,percent of total billed charges,,
Beta Lactamase,,87185,CPT,Facility,Outpatient,,,,45,38.25,12.897,45,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,38.88,86.4,,percent of total billed charges,,
Beta Lactamase,,87185,CPT,Facility,Inpatient,,,,45,38.25,12.897,45,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Beta Lactamase,,87185,CPT,Facility,Both,,,,45,38.25,12.897,45,"Preferred One Administrative Services, INC.",PPO,44.37,98.6,,percent of total billed charges,,
Beta Lactamase,,87185,CPT,Facility,Outpatient,,,,45,38.25,12.897,45,PrimeWest Health,Minnesota Senior Health Options (MSHO),23.1525,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Beta Lactamase,,87185,CPT,Facility,Inpatient,,,,45,38.25,12.897,45,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Beta Lactamase,,87185,CPT,Facility,Outpatient,,,,45,38.25,12.897,45,PrimeWest Health,MinnesotaCare,23.112,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Beta Lactamase,,87185,CPT,Facility,Inpatient,,,,45,38.25,12.897,45,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Beta Lactamase,,87185,CPT,Facility,Both,,,,45,38.25,12.897,45,Sanford Health Plan,Sanford Health Plan,41.4,92,,percent of total billed charges,,
Beta Lactamase,,87185,CPT,Facility,Outpatient,,,,45,38.25,12.897,45,"UCare Health, Inc.",Individual & Family Plan,25.3575,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Beta Lactamase,,87185,CPT,Facility,Inpatient,,,,45,38.25,12.897,45,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Beta Lactamase,,87185,CPT,Facility,Outpatient,,,,45,38.25,12.897,45,"UCare Health, Inc.",Medical Assistance,22.7115,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Beta Lactamase,,87185,CPT,Facility,Inpatient,,,,45,38.25,12.897,45,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Beta Lactamase,,87185,CPT,Facility,Outpatient,,,,45,38.25,12.897,45,"UCare Health, Inc.",Medicare Advantage,22.7115,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Beta Lactamase,,87185,CPT,Facility,Inpatient,,,,45,38.25,12.897,45,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Beta Lactamase,,87185,CPT,Facility,Outpatient,,,,45,38.25,12.897,45,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),22.7115,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Beta Lactamase,,87185,CPT,Facility,Inpatient,,,,45,38.25,12.897,45,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Beta Lactamase,,87185,CPT,Facility,Both,,,,45,38.25,12.897,45,UnitedHealthcare,Individual & Family,42.3,94,,percent of total billed charges,,
Beta Lactamase,,87185,CPT,Facility,Outpatient,,,,45,38.25,12.897,45,UnitedHealthcare,Medicare Advantage,22.05,49,,percent of total billed charges,,
Beta Lactamase,,87185,CPT,Facility,Inpatient,,,,45,38.25,12.897,45,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Beta Lactamase,,87185,CPT,Facility,Outpatient,,,,45,38.25,12.897,45,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,21.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
Beta Lactamase,,87185,CPT,Facility,Inpatient,,,,45,38.25,12.897,45,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Antimicrobial Agent, Susceptibility Studies, Microdilution/Agar Dilution, Per Plate",,87186,CPT,Facility,Both,,,,125,106.25,35.825,125,Aetna,Commercial,115,92,,percent of total billed charges,,
"Antimicrobial Agent, Susceptibility Studies, Microdilution/Agar Dilution, Per Plate",,87186,CPT,Facility,Outpatient,,,,125,106.25,35.825,125,Aetna,Medicare Advantage,61.25,49,,percent of total billed charges,,
"Antimicrobial Agent, Susceptibility Studies, Microdilution/Agar Dilution, Per Plate",,87186,CPT,Facility,Inpatient,,,,125,106.25,35.825,125,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Antimicrobial Agent, Susceptibility Studies, Microdilution/Agar Dilution, Per Plate",,87186,CPT,Facility,Both,,,,125,106.25,35.825,125,Aetna,PPO,116.25,93,,percent of total billed charges,,
"Antimicrobial Agent, Susceptibility Studies, Microdilution/Agar Dilution, Per Plate",,87186,CPT,Facility,Both,,,,125,106.25,35.825,125,America's PPO,America's PPO,120.0375,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Antimicrobial Agent, Susceptibility Studies, Microdilution/Agar Dilution, Per Plate",,87186,CPT,Facility,Both,,,,125,106.25,35.825,125,BlueCross BlueShield Minnesota, Federal Employee Program,123,98.4,,percent of total billed charges,,
"Antimicrobial Agent, Susceptibility Studies, Microdilution/Agar Dilution, Per Plate",,87186,CPT,Facility,Both,,,,125,106.25,35.825,125,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,125,100,,percent of total billed charges,,
"Antimicrobial Agent, Susceptibility Studies, Microdilution/Agar Dilution, Per Plate",,87186,CPT,Facility,Both,,,,125,106.25,35.825,125,BlueCross BlueShield Minnesota,High Value Network Plan,112.5,90,,percent of total billed charges,,
"Antimicrobial Agent, Susceptibility Studies, Microdilution/Agar Dilution, Per Plate",,87186,CPT,Facility,Outpatient,,,,125,106.25,35.825,125,BlueCross BlueShield Minnesota,Medicare Advantage,61.25,49,,percent of total billed charges,,
"Antimicrobial Agent, Susceptibility Studies, Microdilution/Agar Dilution, Per Plate",,87186,CPT,Facility,Inpatient,,,,125,106.25,35.825,125,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Antimicrobial Agent, Susceptibility Studies, Microdilution/Agar Dilution, Per Plate",,87186,CPT,Facility,Both,,,,125,106.25,35.825,125,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,110.7125,88.57,,percent of total billed charges,,
"Antimicrobial Agent, Susceptibility Studies, Microdilution/Agar Dilution, Per Plate",,87186,CPT,Facility,Both,,,,125,106.25,35.825,125,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,35.825,28.66,,percent of total billed charges,,
"Antimicrobial Agent, Susceptibility Studies, Microdilution/Agar Dilution, Per Plate",,87186,CPT,Facility,Outpatient,,,,125,106.25,35.825,125,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),61.25,49,,percent of total billed charges,,
"Antimicrobial Agent, Susceptibility Studies, Microdilution/Agar Dilution, Per Plate",,87186,CPT,Facility,Inpatient,,,,125,106.25,35.825,125,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Antimicrobial Agent, Susceptibility Studies, Microdilution/Agar Dilution, Per Plate",,87186,CPT,Facility,Both,,,,125,106.25,35.825,125,CorVel,Worker's Compensation,125,100,,percent of total billed charges,,
"Antimicrobial Agent, Susceptibility Studies, Microdilution/Agar Dilution, Per Plate",,87186,CPT,Facility,Both,,,,125,106.25,35.825,125,First Health Group Corporation,First Health Network,121.25,97,,percent of total billed charges,,
"Antimicrobial Agent, Susceptibility Studies, Microdilution/Agar Dilution, Per Plate",,87186,CPT,Facility,Both,,,,125,106.25,35.825,125,"Health Partners, Inc.",Commercial,118.25,94.6,,percent of total billed charges,,
"Antimicrobial Agent, Susceptibility Studies, Microdilution/Agar Dilution, Per Plate",,87186,CPT,Facility,Outpatient,,,,125,106.25,35.825,125,"Health Partners, Inc.",Medicare Advantage,61.25,49,,percent of total billed charges,,
"Antimicrobial Agent, Susceptibility Studies, Microdilution/Agar Dilution, Per Plate",,87186,CPT,Facility,Inpatient,,,,125,106.25,35.825,125,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Antimicrobial Agent, Susceptibility Studies, Microdilution/Agar Dilution, Per Plate",,87186,CPT,Facility,Both,,,,125,106.25,35.825,125,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),75,60,,percent of total billed charges,,
"Antimicrobial Agent, Susceptibility Studies, Microdilution/Agar Dilution, Per Plate",,87186,CPT,Facility,Both,,,,125,106.25,35.825,125,"Health Partners, Inc.",State of Minnesota Advantage Program,101.875,81.5,,percent of total billed charges,,
"Antimicrobial Agent, Susceptibility Studies, Microdilution/Agar Dilution, Per Plate",,87186,CPT,Facility,Both,,,,125,106.25,35.825,125,"Health Partners, Inc.",State Public Programs,62.5,50,,percent of total billed charges,,
"Antimicrobial Agent, Susceptibility Studies, Microdilution/Agar Dilution, Per Plate",,87186,CPT,Facility,Both,,,,125,106.25,35.825,125,Humana Insurance Company,Commercial PPO,118.75,95,,percent of total billed charges,,
"Antimicrobial Agent, Susceptibility Studies, Microdilution/Agar Dilution, Per Plate",,87186,CPT,Facility,Outpatient,,,,125,106.25,35.825,125,Humana Insurance Company,Medicare PPO,61.25,49,,percent of total billed charges,,
"Antimicrobial Agent, Susceptibility Studies, Microdilution/Agar Dilution, Per Plate",,87186,CPT,Facility,Inpatient,,,,125,106.25,35.825,125,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Antimicrobial Agent, Susceptibility Studies, Microdilution/Agar Dilution, Per Plate",,87186,CPT,Facility,Both,,,,125,106.25,35.825,125,Medica,Individual & Family,123.875,99.1,,percent of total billed charges,,
"Antimicrobial Agent, Susceptibility Studies, Microdilution/Agar Dilution, Per Plate",,87186,CPT,Facility,Outpatient,,,,125,106.25,35.825,125,Medica,Medica Advantage Solution,62.25,49.8,,percent of total billed charges,,
"Antimicrobial Agent, Susceptibility Studies, Microdilution/Agar Dilution, Per Plate",,87186,CPT,Facility,Inpatient,,,,125,106.25,35.825,125,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Antimicrobial Agent, Susceptibility Studies, Microdilution/Agar Dilution, Per Plate",,87186,CPT,Facility,Outpatient,,,,125,106.25,35.825,125,Medica,Medical Assistance,55.75,44.6,,percent of total billed charges,,
"Antimicrobial Agent, Susceptibility Studies, Microdilution/Agar Dilution, Per Plate",,87186,CPT,Facility,Inpatient,,,,125,106.25,35.825,125,Medica,Medical Assistance,,,,,Included in per diem rate,
"Antimicrobial Agent, Susceptibility Studies, Microdilution/Agar Dilution, Per Plate",,87186,CPT,Facility,Outpatient,,,,125,106.25,35.825,125,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,62.25,49.8,,percent of total billed charges,,
"Antimicrobial Agent, Susceptibility Studies, Microdilution/Agar Dilution, Per Plate",,87186,CPT,Facility,Inpatient,,,,125,106.25,35.825,125,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Antimicrobial Agent, Susceptibility Studies, Microdilution/Agar Dilution, Per Plate",,87186,CPT,Facility,Both,,,,125,106.25,35.825,125,"Multiplan, Inc.","Multiplan, Inc.",117.5,94,,percent of total billed charges,,
"Antimicrobial Agent, Susceptibility Studies, Microdilution/Agar Dilution, Per Plate",,87186,CPT,Facility,Outpatient,,,,125,106.25,35.825,125,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,108,86.4,,percent of total billed charges,,
"Antimicrobial Agent, Susceptibility Studies, Microdilution/Agar Dilution, Per Plate",,87186,CPT,Facility,Inpatient,,,,125,106.25,35.825,125,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Antimicrobial Agent, Susceptibility Studies, Microdilution/Agar Dilution, Per Plate",,87186,CPT,Facility,Both,,,,125,106.25,35.825,125,"Preferred One Administrative Services, INC.",PPO,123.25,98.6,,percent of total billed charges,,
"Antimicrobial Agent, Susceptibility Studies, Microdilution/Agar Dilution, Per Plate",,87186,CPT,Facility,Outpatient,,,,125,106.25,35.825,125,PrimeWest Health,Minnesota Senior Health Options (MSHO),64.3125,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Antimicrobial Agent, Susceptibility Studies, Microdilution/Agar Dilution, Per Plate",,87186,CPT,Facility,Inpatient,,,,125,106.25,35.825,125,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Antimicrobial Agent, Susceptibility Studies, Microdilution/Agar Dilution, Per Plate",,87186,CPT,Facility,Outpatient,,,,125,106.25,35.825,125,PrimeWest Health,MinnesotaCare,64.2,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Antimicrobial Agent, Susceptibility Studies, Microdilution/Agar Dilution, Per Plate",,87186,CPT,Facility,Inpatient,,,,125,106.25,35.825,125,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Antimicrobial Agent, Susceptibility Studies, Microdilution/Agar Dilution, Per Plate",,87186,CPT,Facility,Both,,,,125,106.25,35.825,125,Sanford Health Plan,Sanford Health Plan,115,92,,percent of total billed charges,,
"Antimicrobial Agent, Susceptibility Studies, Microdilution/Agar Dilution, Per Plate",,87186,CPT,Facility,Outpatient,,,,125,106.25,35.825,125,"UCare Health, Inc.",Individual & Family Plan,70.4375,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Antimicrobial Agent, Susceptibility Studies, Microdilution/Agar Dilution, Per Plate",,87186,CPT,Facility,Inpatient,,,,125,106.25,35.825,125,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Antimicrobial Agent, Susceptibility Studies, Microdilution/Agar Dilution, Per Plate",,87186,CPT,Facility,Outpatient,,,,125,106.25,35.825,125,"UCare Health, Inc.",Medical Assistance,63.0875,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Antimicrobial Agent, Susceptibility Studies, Microdilution/Agar Dilution, Per Plate",,87186,CPT,Facility,Inpatient,,,,125,106.25,35.825,125,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Antimicrobial Agent, Susceptibility Studies, Microdilution/Agar Dilution, Per Plate",,87186,CPT,Facility,Outpatient,,,,125,106.25,35.825,125,"UCare Health, Inc.",Medicare Advantage,63.0875,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Antimicrobial Agent, Susceptibility Studies, Microdilution/Agar Dilution, Per Plate",,87186,CPT,Facility,Inpatient,,,,125,106.25,35.825,125,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Antimicrobial Agent, Susceptibility Studies, Microdilution/Agar Dilution, Per Plate",,87186,CPT,Facility,Outpatient,,,,125,106.25,35.825,125,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),63.0875,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Antimicrobial Agent, Susceptibility Studies, Microdilution/Agar Dilution, Per Plate",,87186,CPT,Facility,Inpatient,,,,125,106.25,35.825,125,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Antimicrobial Agent, Susceptibility Studies, Microdilution/Agar Dilution, Per Plate",,87186,CPT,Facility,Both,,,,125,106.25,35.825,125,UnitedHealthcare,Individual & Family,117.5,94,,percent of total billed charges,,
"Antimicrobial Agent, Susceptibility Studies, Microdilution/Agar Dilution, Per Plate",,87186,CPT,Facility,Outpatient,,,,125,106.25,35.825,125,UnitedHealthcare,Medicare Advantage,61.25,49,,percent of total billed charges,,
"Antimicrobial Agent, Susceptibility Studies, Microdilution/Agar Dilution, Per Plate",,87186,CPT,Facility,Inpatient,,,,125,106.25,35.825,125,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Antimicrobial Agent, Susceptibility Studies, Microdilution/Agar Dilution, Per Plate",,87186,CPT,Facility,Outpatient,,,,125,106.25,35.825,125,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,60,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Antimicrobial Agent, Susceptibility Studies, Microdilution/Agar Dilution, Per Plate",,87186,CPT,Facility,Inpatient,,,,125,106.25,35.825,125,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Gram Stain,,87205,CPT,Facility,Both,,,,66,56.1,18.9156,66,Aetna,Commercial,60.72,92,,percent of total billed charges,,
Gram Stain,,87205,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,Aetna,Medicare Advantage,32.34,49,,percent of total billed charges,,
Gram Stain,,87205,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Gram Stain,,87205,CPT,Facility,Both,,,,66,56.1,18.9156,66,Aetna,PPO,61.38,93,,percent of total billed charges,,
Gram Stain,,87205,CPT,Facility,Both,,,,66,56.1,18.9156,66,America's PPO,America's PPO,63.3798,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Gram Stain,,87205,CPT,Facility,Both,,,,66,56.1,18.9156,66,BlueCross BlueShield Minnesota, Federal Employee Program,64.944,98.4,,percent of total billed charges,,
Gram Stain,,87205,CPT,Facility,Both,,,,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,66,100,,percent of total billed charges,,
Gram Stain,,87205,CPT,Facility,Both,,,,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,High Value Network Plan,59.4,90,,percent of total billed charges,,
Gram Stain,,87205,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,Medicare Advantage,32.34,49,,percent of total billed charges,,
Gram Stain,,87205,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Gram Stain,,87205,CPT,Facility,Both,,,,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,58.4562,88.57,,percent of total billed charges,,
Gram Stain,,87205,CPT,Facility,Both,,,,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,18.9156,28.66,,percent of total billed charges,,
Gram Stain,,87205,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),32.34,49,,percent of total billed charges,,
Gram Stain,,87205,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Gram Stain,,87205,CPT,Facility,Both,,,,66,56.1,18.9156,66,CorVel,Worker's Compensation,66,100,,percent of total billed charges,,
Gram Stain,,87205,CPT,Facility,Both,,,,66,56.1,18.9156,66,First Health Group Corporation,First Health Network,64.02,97,,percent of total billed charges,,
Gram Stain,,87205,CPT,Facility,Both,,,,66,56.1,18.9156,66,"Health Partners, Inc.",Commercial,62.436,94.6,,percent of total billed charges,,
Gram Stain,,87205,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,"Health Partners, Inc.",Medicare Advantage,32.34,49,,percent of total billed charges,,
Gram Stain,,87205,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Gram Stain,,87205,CPT,Facility,Both,,,,66,56.1,18.9156,66,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),39.6,60,,percent of total billed charges,,
Gram Stain,,87205,CPT,Facility,Both,,,,66,56.1,18.9156,66,"Health Partners, Inc.",State of Minnesota Advantage Program,53.79,81.5,,percent of total billed charges,,
Gram Stain,,87205,CPT,Facility,Both,,,,66,56.1,18.9156,66,"Health Partners, Inc.",State Public Programs,33,50,,percent of total billed charges,,
Gram Stain,,87205,CPT,Facility,Both,,,,66,56.1,18.9156,66,Humana Insurance Company,Commercial PPO,62.7,95,,percent of total billed charges,,
Gram Stain,,87205,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,Humana Insurance Company,Medicare PPO,32.34,49,,percent of total billed charges,,
Gram Stain,,87205,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Gram Stain,,87205,CPT,Facility,Both,,,,66,56.1,18.9156,66,Medica,Individual & Family,65.406,99.1,,percent of total billed charges,,
Gram Stain,,87205,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,Medica,Medica Advantage Solution,32.868,49.8,,percent of total billed charges,,
Gram Stain,,87205,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Gram Stain,,87205,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,Medica,Medical Assistance,29.436,44.6,,percent of total billed charges,,
Gram Stain,,87205,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,Medica,Medical Assistance,,,,,Included in per diem rate,
Gram Stain,,87205,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,32.868,49.8,,percent of total billed charges,,
Gram Stain,,87205,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Gram Stain,,87205,CPT,Facility,Both,,,,66,56.1,18.9156,66,"Multiplan, Inc.","Multiplan, Inc.",62.04,94,,percent of total billed charges,,
Gram Stain,,87205,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,57.024,86.4,,percent of total billed charges,,
Gram Stain,,87205,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Gram Stain,,87205,CPT,Facility,Both,,,,66,56.1,18.9156,66,"Preferred One Administrative Services, INC.",PPO,65.076,98.6,,percent of total billed charges,,
Gram Stain,,87205,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,PrimeWest Health,Minnesota Senior Health Options (MSHO),33.957,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Gram Stain,,87205,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Gram Stain,,87205,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,PrimeWest Health,MinnesotaCare,33.8976,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Gram Stain,,87205,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Gram Stain,,87205,CPT,Facility,Both,,,,66,56.1,18.9156,66,Sanford Health Plan,Sanford Health Plan,60.72,92,,percent of total billed charges,,
Gram Stain,,87205,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,"UCare Health, Inc.",Individual & Family Plan,37.191,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Gram Stain,,87205,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Gram Stain,,87205,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,"UCare Health, Inc.",Medical Assistance,33.3102,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Gram Stain,,87205,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Gram Stain,,87205,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,"UCare Health, Inc.",Medicare Advantage,33.3102,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Gram Stain,,87205,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Gram Stain,,87205,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),33.3102,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Gram Stain,,87205,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Gram Stain,,87205,CPT,Facility,Both,,,,66,56.1,18.9156,66,UnitedHealthcare,Individual & Family,62.04,94,,percent of total billed charges,,
Gram Stain,,87205,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,UnitedHealthcare,Medicare Advantage,32.34,49,,percent of total billed charges,,
Gram Stain,,87205,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Gram Stain,,87205,CPT,Facility,Outpatient,,,,66,56.1,18.9156,66,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,31.68,48,,percent of total billed charges,,100% of DHS outpatient percentage
Gram Stain,,87205,CPT,Facility,Inpatient,,,,66,56.1,18.9156,66,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Fern Test,,87210,CPT,Facility,Both,,,,77,65.45,22.0682,77,Aetna,Commercial,70.84,92,,percent of total billed charges,,
Fern Test,,87210,CPT,Facility,Outpatient,,,,77,65.45,22.0682,77,Aetna,Medicare Advantage,37.73,49,,percent of total billed charges,,
Fern Test,,87210,CPT,Facility,Inpatient,,,,77,65.45,22.0682,77,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Fern Test,,87210,CPT,Facility,Both,,,,77,65.45,22.0682,77,Aetna,PPO,71.61,93,,percent of total billed charges,,
Fern Test,,87210,CPT,Facility,Both,,,,77,65.45,22.0682,77,America's PPO,America's PPO,73.9431,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Fern Test,,87210,CPT,Facility,Both,,,,77,65.45,22.0682,77,BlueCross BlueShield Minnesota, Federal Employee Program,75.768,98.4,,percent of total billed charges,,
Fern Test,,87210,CPT,Facility,Both,,,,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,77,100,,percent of total billed charges,,
Fern Test,,87210,CPT,Facility,Both,,,,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,High Value Network Plan,69.3,90,,percent of total billed charges,,
Fern Test,,87210,CPT,Facility,Outpatient,,,,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,Medicare Advantage,37.73,49,,percent of total billed charges,,
Fern Test,,87210,CPT,Facility,Inpatient,,,,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Fern Test,,87210,CPT,Facility,Both,,,,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,68.1989,88.57,,percent of total billed charges,,
Fern Test,,87210,CPT,Facility,Both,,,,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,22.0682,28.66,,percent of total billed charges,,
Fern Test,,87210,CPT,Facility,Outpatient,,,,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),37.73,49,,percent of total billed charges,,
Fern Test,,87210,CPT,Facility,Inpatient,,,,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Fern Test,,87210,CPT,Facility,Both,,,,77,65.45,22.0682,77,CorVel,Worker's Compensation,77,100,,percent of total billed charges,,
Fern Test,,87210,CPT,Facility,Both,,,,77,65.45,22.0682,77,First Health Group Corporation,First Health Network,74.69,97,,percent of total billed charges,,
Fern Test,,87210,CPT,Facility,Both,,,,77,65.45,22.0682,77,"Health Partners, Inc.",Commercial,72.842,94.6,,percent of total billed charges,,
Fern Test,,87210,CPT,Facility,Outpatient,,,,77,65.45,22.0682,77,"Health Partners, Inc.",Medicare Advantage,37.73,49,,percent of total billed charges,,
Fern Test,,87210,CPT,Facility,Inpatient,,,,77,65.45,22.0682,77,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Fern Test,,87210,CPT,Facility,Both,,,,77,65.45,22.0682,77,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),46.2,60,,percent of total billed charges,,
Fern Test,,87210,CPT,Facility,Both,,,,77,65.45,22.0682,77,"Health Partners, Inc.",State of Minnesota Advantage Program,62.755,81.5,,percent of total billed charges,,
Fern Test,,87210,CPT,Facility,Both,,,,77,65.45,22.0682,77,"Health Partners, Inc.",State Public Programs,38.5,50,,percent of total billed charges,,
Fern Test,,87210,CPT,Facility,Both,,,,77,65.45,22.0682,77,Humana Insurance Company,Commercial PPO,73.15,95,,percent of total billed charges,,
Fern Test,,87210,CPT,Facility,Outpatient,,,,77,65.45,22.0682,77,Humana Insurance Company,Medicare PPO,37.73,49,,percent of total billed charges,,
Fern Test,,87210,CPT,Facility,Inpatient,,,,77,65.45,22.0682,77,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Fern Test,,87210,CPT,Facility,Both,,,,77,65.45,22.0682,77,Medica,Individual & Family,76.307,99.1,,percent of total billed charges,,
Fern Test,,87210,CPT,Facility,Outpatient,,,,77,65.45,22.0682,77,Medica,Medica Advantage Solution,38.346,49.8,,percent of total billed charges,,
Fern Test,,87210,CPT,Facility,Inpatient,,,,77,65.45,22.0682,77,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Fern Test,,87210,CPT,Facility,Outpatient,,,,77,65.45,22.0682,77,Medica,Medical Assistance,34.342,44.6,,percent of total billed charges,,
Fern Test,,87210,CPT,Facility,Inpatient,,,,77,65.45,22.0682,77,Medica,Medical Assistance,,,,,Included in per diem rate,
Fern Test,,87210,CPT,Facility,Outpatient,,,,77,65.45,22.0682,77,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,38.346,49.8,,percent of total billed charges,,
Fern Test,,87210,CPT,Facility,Inpatient,,,,77,65.45,22.0682,77,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Fern Test,,87210,CPT,Facility,Both,,,,77,65.45,22.0682,77,"Multiplan, Inc.","Multiplan, Inc.",72.38,94,,percent of total billed charges,,
Fern Test,,87210,CPT,Facility,Outpatient,,,,77,65.45,22.0682,77,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,66.528,86.4,,percent of total billed charges,,
Fern Test,,87210,CPT,Facility,Inpatient,,,,77,65.45,22.0682,77,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Fern Test,,87210,CPT,Facility,Both,,,,77,65.45,22.0682,77,"Preferred One Administrative Services, INC.",PPO,75.922,98.6,,percent of total billed charges,,
Fern Test,,87210,CPT,Facility,Outpatient,,,,77,65.45,22.0682,77,PrimeWest Health,Minnesota Senior Health Options (MSHO),39.6165,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Fern Test,,87210,CPT,Facility,Inpatient,,,,77,65.45,22.0682,77,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Fern Test,,87210,CPT,Facility,Outpatient,,,,77,65.45,22.0682,77,PrimeWest Health,MinnesotaCare,39.5472,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Fern Test,,87210,CPT,Facility,Inpatient,,,,77,65.45,22.0682,77,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Fern Test,,87210,CPT,Facility,Both,,,,77,65.45,22.0682,77,Sanford Health Plan,Sanford Health Plan,70.84,92,,percent of total billed charges,,
Fern Test,,87210,CPT,Facility,Outpatient,,,,77,65.45,22.0682,77,"UCare Health, Inc.",Individual & Family Plan,43.3895,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Fern Test,,87210,CPT,Facility,Inpatient,,,,77,65.45,22.0682,77,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Fern Test,,87210,CPT,Facility,Outpatient,,,,77,65.45,22.0682,77,"UCare Health, Inc.",Medical Assistance,38.8619,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Fern Test,,87210,CPT,Facility,Inpatient,,,,77,65.45,22.0682,77,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Fern Test,,87210,CPT,Facility,Outpatient,,,,77,65.45,22.0682,77,"UCare Health, Inc.",Medicare Advantage,38.8619,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Fern Test,,87210,CPT,Facility,Inpatient,,,,77,65.45,22.0682,77,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Fern Test,,87210,CPT,Facility,Outpatient,,,,77,65.45,22.0682,77,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),38.8619,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Fern Test,,87210,CPT,Facility,Inpatient,,,,77,65.45,22.0682,77,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Fern Test,,87210,CPT,Facility,Both,,,,77,65.45,22.0682,77,UnitedHealthcare,Individual & Family,72.38,94,,percent of total billed charges,,
Fern Test,,87210,CPT,Facility,Outpatient,,,,77,65.45,22.0682,77,UnitedHealthcare,Medicare Advantage,37.73,49,,percent of total billed charges,,
Fern Test,,87210,CPT,Facility,Inpatient,,,,77,65.45,22.0682,77,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Fern Test,,87210,CPT,Facility,Outpatient,,,,77,65.45,22.0682,77,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,36.96,48,,percent of total billed charges,,100% of DHS outpatient percentage
Fern Test,,87210,CPT,Facility,Inpatient,,,,77,65.45,22.0682,77,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Wet Preparation,,87210,CPT,Facility,Both,,,,42,35.7,12.0372,42,Aetna,Commercial,38.64,92,,percent of total billed charges,,
Wet Preparation,,87210,CPT,Facility,Outpatient,,,,42,35.7,12.0372,42,Aetna,Medicare Advantage,20.58,49,,percent of total billed charges,,
Wet Preparation,,87210,CPT,Facility,Inpatient,,,,42,35.7,12.0372,42,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Wet Preparation,,87210,CPT,Facility,Both,,,,42,35.7,12.0372,42,Aetna,PPO,39.06,93,,percent of total billed charges,,
Wet Preparation,,87210,CPT,Facility,Both,,,,42,35.7,12.0372,42,America's PPO,America's PPO,40.3326,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Wet Preparation,,87210,CPT,Facility,Both,,,,42,35.7,12.0372,42,BlueCross BlueShield Minnesota, Federal Employee Program,41.328,98.4,,percent of total billed charges,,
Wet Preparation,,87210,CPT,Facility,Both,,,,42,35.7,12.0372,42,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,42,100,,percent of total billed charges,,
Wet Preparation,,87210,CPT,Facility,Both,,,,42,35.7,12.0372,42,BlueCross BlueShield Minnesota,High Value Network Plan,37.8,90,,percent of total billed charges,,
Wet Preparation,,87210,CPT,Facility,Outpatient,,,,42,35.7,12.0372,42,BlueCross BlueShield Minnesota,Medicare Advantage,20.58,49,,percent of total billed charges,,
Wet Preparation,,87210,CPT,Facility,Inpatient,,,,42,35.7,12.0372,42,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Wet Preparation,,87210,CPT,Facility,Both,,,,42,35.7,12.0372,42,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,37.1994,88.57,,percent of total billed charges,,
Wet Preparation,,87210,CPT,Facility,Both,,,,42,35.7,12.0372,42,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,12.0372,28.66,,percent of total billed charges,,
Wet Preparation,,87210,CPT,Facility,Outpatient,,,,42,35.7,12.0372,42,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),20.58,49,,percent of total billed charges,,
Wet Preparation,,87210,CPT,Facility,Inpatient,,,,42,35.7,12.0372,42,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Wet Preparation,,87210,CPT,Facility,Both,,,,42,35.7,12.0372,42,CorVel,Worker's Compensation,42,100,,percent of total billed charges,,
Wet Preparation,,87210,CPT,Facility,Both,,,,42,35.7,12.0372,42,First Health Group Corporation,First Health Network,40.74,97,,percent of total billed charges,,
Wet Preparation,,87210,CPT,Facility,Both,,,,42,35.7,12.0372,42,"Health Partners, Inc.",Commercial,39.732,94.6,,percent of total billed charges,,
Wet Preparation,,87210,CPT,Facility,Outpatient,,,,42,35.7,12.0372,42,"Health Partners, Inc.",Medicare Advantage,20.58,49,,percent of total billed charges,,
Wet Preparation,,87210,CPT,Facility,Inpatient,,,,42,35.7,12.0372,42,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Wet Preparation,,87210,CPT,Facility,Both,,,,42,35.7,12.0372,42,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),25.2,60,,percent of total billed charges,,
Wet Preparation,,87210,CPT,Facility,Both,,,,42,35.7,12.0372,42,"Health Partners, Inc.",State of Minnesota Advantage Program,34.23,81.5,,percent of total billed charges,,
Wet Preparation,,87210,CPT,Facility,Both,,,,42,35.7,12.0372,42,"Health Partners, Inc.",State Public Programs,21,50,,percent of total billed charges,,
Wet Preparation,,87210,CPT,Facility,Both,,,,42,35.7,12.0372,42,Humana Insurance Company,Commercial PPO,39.9,95,,percent of total billed charges,,
Wet Preparation,,87210,CPT,Facility,Outpatient,,,,42,35.7,12.0372,42,Humana Insurance Company,Medicare PPO,20.58,49,,percent of total billed charges,,
Wet Preparation,,87210,CPT,Facility,Inpatient,,,,42,35.7,12.0372,42,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Wet Preparation,,87210,CPT,Facility,Both,,,,42,35.7,12.0372,42,Medica,Individual & Family,41.622,99.1,,percent of total billed charges,,
Wet Preparation,,87210,CPT,Facility,Outpatient,,,,42,35.7,12.0372,42,Medica,Medica Advantage Solution,20.916,49.8,,percent of total billed charges,,
Wet Preparation,,87210,CPT,Facility,Inpatient,,,,42,35.7,12.0372,42,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Wet Preparation,,87210,CPT,Facility,Outpatient,,,,42,35.7,12.0372,42,Medica,Medical Assistance,18.732,44.6,,percent of total billed charges,,
Wet Preparation,,87210,CPT,Facility,Inpatient,,,,42,35.7,12.0372,42,Medica,Medical Assistance,,,,,Included in per diem rate,
Wet Preparation,,87210,CPT,Facility,Outpatient,,,,42,35.7,12.0372,42,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,20.916,49.8,,percent of total billed charges,,
Wet Preparation,,87210,CPT,Facility,Inpatient,,,,42,35.7,12.0372,42,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Wet Preparation,,87210,CPT,Facility,Both,,,,42,35.7,12.0372,42,"Multiplan, Inc.","Multiplan, Inc.",39.48,94,,percent of total billed charges,,
Wet Preparation,,87210,CPT,Facility,Outpatient,,,,42,35.7,12.0372,42,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,36.288,86.4,,percent of total billed charges,,
Wet Preparation,,87210,CPT,Facility,Inpatient,,,,42,35.7,12.0372,42,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Wet Preparation,,87210,CPT,Facility,Both,,,,42,35.7,12.0372,42,"Preferred One Administrative Services, INC.",PPO,41.412,98.6,,percent of total billed charges,,
Wet Preparation,,87210,CPT,Facility,Outpatient,,,,42,35.7,12.0372,42,PrimeWest Health,Minnesota Senior Health Options (MSHO),21.609,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Wet Preparation,,87210,CPT,Facility,Inpatient,,,,42,35.7,12.0372,42,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Wet Preparation,,87210,CPT,Facility,Outpatient,,,,42,35.7,12.0372,42,PrimeWest Health,MinnesotaCare,21.5712,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Wet Preparation,,87210,CPT,Facility,Inpatient,,,,42,35.7,12.0372,42,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Wet Preparation,,87210,CPT,Facility,Both,,,,42,35.7,12.0372,42,Sanford Health Plan,Sanford Health Plan,38.64,92,,percent of total billed charges,,
Wet Preparation,,87210,CPT,Facility,Outpatient,,,,42,35.7,12.0372,42,"UCare Health, Inc.",Individual & Family Plan,23.667,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Wet Preparation,,87210,CPT,Facility,Inpatient,,,,42,35.7,12.0372,42,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Wet Preparation,,87210,CPT,Facility,Outpatient,,,,42,35.7,12.0372,42,"UCare Health, Inc.",Medical Assistance,21.1974,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Wet Preparation,,87210,CPT,Facility,Inpatient,,,,42,35.7,12.0372,42,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Wet Preparation,,87210,CPT,Facility,Outpatient,,,,42,35.7,12.0372,42,"UCare Health, Inc.",Medicare Advantage,21.1974,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Wet Preparation,,87210,CPT,Facility,Inpatient,,,,42,35.7,12.0372,42,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Wet Preparation,,87210,CPT,Facility,Outpatient,,,,42,35.7,12.0372,42,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),21.1974,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Wet Preparation,,87210,CPT,Facility,Inpatient,,,,42,35.7,12.0372,42,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Wet Preparation,,87210,CPT,Facility,Both,,,,42,35.7,12.0372,42,UnitedHealthcare,Individual & Family,39.48,94,,percent of total billed charges,,
Wet Preparation,,87210,CPT,Facility,Outpatient,,,,42,35.7,12.0372,42,UnitedHealthcare,Medicare Advantage,20.58,49,,percent of total billed charges,,
Wet Preparation,,87210,CPT,Facility,Inpatient,,,,42,35.7,12.0372,42,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Wet Preparation,,87210,CPT,Facility,Outpatient,,,,42,35.7,12.0372,42,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,20.16,48,,percent of total billed charges,,100% of DHS outpatient percentage
Wet Preparation,,87210,CPT,Facility,Inpatient,,,,42,35.7,12.0372,42,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Tissue Exam; Skin, Hair Or Nails For Koh For Ectoparasite, Ova, Or Mites (Scabies)",,87220,CPT,Facility,Both,,,,42,35.7,12.0372,42,Aetna,Commercial,38.64,92,,percent of total billed charges,,
"Tissue Exam; Skin, Hair Or Nails For Koh For Ectoparasite, Ova, Or Mites (Scabies)",,87220,CPT,Facility,Outpatient,,,,42,35.7,12.0372,42,Aetna,Medicare Advantage,20.58,49,,percent of total billed charges,,
"Tissue Exam; Skin, Hair Or Nails For Koh For Ectoparasite, Ova, Or Mites (Scabies)",,87220,CPT,Facility,Inpatient,,,,42,35.7,12.0372,42,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Tissue Exam; Skin, Hair Or Nails For Koh For Ectoparasite, Ova, Or Mites (Scabies)",,87220,CPT,Facility,Both,,,,42,35.7,12.0372,42,Aetna,PPO,39.06,93,,percent of total billed charges,,
"Tissue Exam; Skin, Hair Or Nails For Koh For Ectoparasite, Ova, Or Mites (Scabies)",,87220,CPT,Facility,Both,,,,42,35.7,12.0372,42,America's PPO,America's PPO,40.3326,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Tissue Exam; Skin, Hair Or Nails For Koh For Ectoparasite, Ova, Or Mites (Scabies)",,87220,CPT,Facility,Both,,,,42,35.7,12.0372,42,BlueCross BlueShield Minnesota, Federal Employee Program,41.328,98.4,,percent of total billed charges,,
"Tissue Exam; Skin, Hair Or Nails For Koh For Ectoparasite, Ova, Or Mites (Scabies)",,87220,CPT,Facility,Both,,,,42,35.7,12.0372,42,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,42,100,,percent of total billed charges,,
"Tissue Exam; Skin, Hair Or Nails For Koh For Ectoparasite, Ova, Or Mites (Scabies)",,87220,CPT,Facility,Both,,,,42,35.7,12.0372,42,BlueCross BlueShield Minnesota,High Value Network Plan,37.8,90,,percent of total billed charges,,
"Tissue Exam; Skin, Hair Or Nails For Koh For Ectoparasite, Ova, Or Mites (Scabies)",,87220,CPT,Facility,Outpatient,,,,42,35.7,12.0372,42,BlueCross BlueShield Minnesota,Medicare Advantage,20.58,49,,percent of total billed charges,,
"Tissue Exam; Skin, Hair Or Nails For Koh For Ectoparasite, Ova, Or Mites (Scabies)",,87220,CPT,Facility,Inpatient,,,,42,35.7,12.0372,42,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Tissue Exam; Skin, Hair Or Nails For Koh For Ectoparasite, Ova, Or Mites (Scabies)",,87220,CPT,Facility,Both,,,,42,35.7,12.0372,42,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,37.1994,88.57,,percent of total billed charges,,
"Tissue Exam; Skin, Hair Or Nails For Koh For Ectoparasite, Ova, Or Mites (Scabies)",,87220,CPT,Facility,Both,,,,42,35.7,12.0372,42,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,12.0372,28.66,,percent of total billed charges,,
"Tissue Exam; Skin, Hair Or Nails For Koh For Ectoparasite, Ova, Or Mites (Scabies)",,87220,CPT,Facility,Outpatient,,,,42,35.7,12.0372,42,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),20.58,49,,percent of total billed charges,,
"Tissue Exam; Skin, Hair Or Nails For Koh For Ectoparasite, Ova, Or Mites (Scabies)",,87220,CPT,Facility,Inpatient,,,,42,35.7,12.0372,42,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Tissue Exam; Skin, Hair Or Nails For Koh For Ectoparasite, Ova, Or Mites (Scabies)",,87220,CPT,Facility,Both,,,,42,35.7,12.0372,42,CorVel,Worker's Compensation,42,100,,percent of total billed charges,,
"Tissue Exam; Skin, Hair Or Nails For Koh For Ectoparasite, Ova, Or Mites (Scabies)",,87220,CPT,Facility,Both,,,,42,35.7,12.0372,42,First Health Group Corporation,First Health Network,40.74,97,,percent of total billed charges,,
"Tissue Exam; Skin, Hair Or Nails For Koh For Ectoparasite, Ova, Or Mites (Scabies)",,87220,CPT,Facility,Both,,,,42,35.7,12.0372,42,"Health Partners, Inc.",Commercial,39.732,94.6,,percent of total billed charges,,
"Tissue Exam; Skin, Hair Or Nails For Koh For Ectoparasite, Ova, Or Mites (Scabies)",,87220,CPT,Facility,Outpatient,,,,42,35.7,12.0372,42,"Health Partners, Inc.",Medicare Advantage,20.58,49,,percent of total billed charges,,
"Tissue Exam; Skin, Hair Or Nails For Koh For Ectoparasite, Ova, Or Mites (Scabies)",,87220,CPT,Facility,Inpatient,,,,42,35.7,12.0372,42,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Tissue Exam; Skin, Hair Or Nails For Koh For Ectoparasite, Ova, Or Mites (Scabies)",,87220,CPT,Facility,Both,,,,42,35.7,12.0372,42,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),25.2,60,,percent of total billed charges,,
"Tissue Exam; Skin, Hair Or Nails For Koh For Ectoparasite, Ova, Or Mites (Scabies)",,87220,CPT,Facility,Both,,,,42,35.7,12.0372,42,"Health Partners, Inc.",State of Minnesota Advantage Program,34.23,81.5,,percent of total billed charges,,
"Tissue Exam; Skin, Hair Or Nails For Koh For Ectoparasite, Ova, Or Mites (Scabies)",,87220,CPT,Facility,Both,,,,42,35.7,12.0372,42,"Health Partners, Inc.",State Public Programs,21,50,,percent of total billed charges,,
"Tissue Exam; Skin, Hair Or Nails For Koh For Ectoparasite, Ova, Or Mites (Scabies)",,87220,CPT,Facility,Both,,,,42,35.7,12.0372,42,Humana Insurance Company,Commercial PPO,39.9,95,,percent of total billed charges,,
"Tissue Exam; Skin, Hair Or Nails For Koh For Ectoparasite, Ova, Or Mites (Scabies)",,87220,CPT,Facility,Outpatient,,,,42,35.7,12.0372,42,Humana Insurance Company,Medicare PPO,20.58,49,,percent of total billed charges,,
"Tissue Exam; Skin, Hair Or Nails For Koh For Ectoparasite, Ova, Or Mites (Scabies)",,87220,CPT,Facility,Inpatient,,,,42,35.7,12.0372,42,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Tissue Exam; Skin, Hair Or Nails For Koh For Ectoparasite, Ova, Or Mites (Scabies)",,87220,CPT,Facility,Both,,,,42,35.7,12.0372,42,Medica,Individual & Family,41.622,99.1,,percent of total billed charges,,
"Tissue Exam; Skin, Hair Or Nails For Koh For Ectoparasite, Ova, Or Mites (Scabies)",,87220,CPT,Facility,Outpatient,,,,42,35.7,12.0372,42,Medica,Medica Advantage Solution,20.916,49.8,,percent of total billed charges,,
"Tissue Exam; Skin, Hair Or Nails For Koh For Ectoparasite, Ova, Or Mites (Scabies)",,87220,CPT,Facility,Inpatient,,,,42,35.7,12.0372,42,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Tissue Exam; Skin, Hair Or Nails For Koh For Ectoparasite, Ova, Or Mites (Scabies)",,87220,CPT,Facility,Outpatient,,,,42,35.7,12.0372,42,Medica,Medical Assistance,18.732,44.6,,percent of total billed charges,,
"Tissue Exam; Skin, Hair Or Nails For Koh For Ectoparasite, Ova, Or Mites (Scabies)",,87220,CPT,Facility,Inpatient,,,,42,35.7,12.0372,42,Medica,Medical Assistance,,,,,Included in per diem rate,
"Tissue Exam; Skin, Hair Or Nails For Koh For Ectoparasite, Ova, Or Mites (Scabies)",,87220,CPT,Facility,Outpatient,,,,42,35.7,12.0372,42,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,20.916,49.8,,percent of total billed charges,,
"Tissue Exam; Skin, Hair Or Nails For Koh For Ectoparasite, Ova, Or Mites (Scabies)",,87220,CPT,Facility,Inpatient,,,,42,35.7,12.0372,42,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Tissue Exam; Skin, Hair Or Nails For Koh For Ectoparasite, Ova, Or Mites (Scabies)",,87220,CPT,Facility,Both,,,,42,35.7,12.0372,42,"Multiplan, Inc.","Multiplan, Inc.",39.48,94,,percent of total billed charges,,
"Tissue Exam; Skin, Hair Or Nails For Koh For Ectoparasite, Ova, Or Mites (Scabies)",,87220,CPT,Facility,Outpatient,,,,42,35.7,12.0372,42,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,36.288,86.4,,percent of total billed charges,,
"Tissue Exam; Skin, Hair Or Nails For Koh For Ectoparasite, Ova, Or Mites (Scabies)",,87220,CPT,Facility,Inpatient,,,,42,35.7,12.0372,42,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Tissue Exam; Skin, Hair Or Nails For Koh For Ectoparasite, Ova, Or Mites (Scabies)",,87220,CPT,Facility,Both,,,,42,35.7,12.0372,42,"Preferred One Administrative Services, INC.",PPO,41.412,98.6,,percent of total billed charges,,
"Tissue Exam; Skin, Hair Or Nails For Koh For Ectoparasite, Ova, Or Mites (Scabies)",,87220,CPT,Facility,Outpatient,,,,42,35.7,12.0372,42,PrimeWest Health,Minnesota Senior Health Options (MSHO),21.609,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Tissue Exam; Skin, Hair Or Nails For Koh For Ectoparasite, Ova, Or Mites (Scabies)",,87220,CPT,Facility,Inpatient,,,,42,35.7,12.0372,42,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Tissue Exam; Skin, Hair Or Nails For Koh For Ectoparasite, Ova, Or Mites (Scabies)",,87220,CPT,Facility,Outpatient,,,,42,35.7,12.0372,42,PrimeWest Health,MinnesotaCare,21.5712,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Tissue Exam; Skin, Hair Or Nails For Koh For Ectoparasite, Ova, Or Mites (Scabies)",,87220,CPT,Facility,Inpatient,,,,42,35.7,12.0372,42,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Tissue Exam; Skin, Hair Or Nails For Koh For Ectoparasite, Ova, Or Mites (Scabies)",,87220,CPT,Facility,Both,,,,42,35.7,12.0372,42,Sanford Health Plan,Sanford Health Plan,38.64,92,,percent of total billed charges,,
"Tissue Exam; Skin, Hair Or Nails For Koh For Ectoparasite, Ova, Or Mites (Scabies)",,87220,CPT,Facility,Outpatient,,,,42,35.7,12.0372,42,"UCare Health, Inc.",Individual & Family Plan,23.667,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Tissue Exam; Skin, Hair Or Nails For Koh For Ectoparasite, Ova, Or Mites (Scabies)",,87220,CPT,Facility,Inpatient,,,,42,35.7,12.0372,42,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Tissue Exam; Skin, Hair Or Nails For Koh For Ectoparasite, Ova, Or Mites (Scabies)",,87220,CPT,Facility,Outpatient,,,,42,35.7,12.0372,42,"UCare Health, Inc.",Medical Assistance,21.1974,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Tissue Exam; Skin, Hair Or Nails For Koh For Ectoparasite, Ova, Or Mites (Scabies)",,87220,CPT,Facility,Inpatient,,,,42,35.7,12.0372,42,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Tissue Exam; Skin, Hair Or Nails For Koh For Ectoparasite, Ova, Or Mites (Scabies)",,87220,CPT,Facility,Outpatient,,,,42,35.7,12.0372,42,"UCare Health, Inc.",Medicare Advantage,21.1974,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Tissue Exam; Skin, Hair Or Nails For Koh For Ectoparasite, Ova, Or Mites (Scabies)",,87220,CPT,Facility,Inpatient,,,,42,35.7,12.0372,42,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Tissue Exam; Skin, Hair Or Nails For Koh For Ectoparasite, Ova, Or Mites (Scabies)",,87220,CPT,Facility,Outpatient,,,,42,35.7,12.0372,42,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),21.1974,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Tissue Exam; Skin, Hair Or Nails For Koh For Ectoparasite, Ova, Or Mites (Scabies)",,87220,CPT,Facility,Inpatient,,,,42,35.7,12.0372,42,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Tissue Exam; Skin, Hair Or Nails For Koh For Ectoparasite, Ova, Or Mites (Scabies)",,87220,CPT,Facility,Both,,,,42,35.7,12.0372,42,UnitedHealthcare,Individual & Family,39.48,94,,percent of total billed charges,,
"Tissue Exam; Skin, Hair Or Nails For Koh For Ectoparasite, Ova, Or Mites (Scabies)",,87220,CPT,Facility,Outpatient,,,,42,35.7,12.0372,42,UnitedHealthcare,Medicare Advantage,20.58,49,,percent of total billed charges,,
"Tissue Exam; Skin, Hair Or Nails For Koh For Ectoparasite, Ova, Or Mites (Scabies)",,87220,CPT,Facility,Inpatient,,,,42,35.7,12.0372,42,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Tissue Exam; Skin, Hair Or Nails For Koh For Ectoparasite, Ova, Or Mites (Scabies)",,87220,CPT,Facility,Outpatient,,,,42,35.7,12.0372,42,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,20.16,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Tissue Exam; Skin, Hair Or Nails For Koh For Ectoparasite, Ova, Or Mites (Scabies)",,87220,CPT,Facility,Inpatient,,,,42,35.7,12.0372,42,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Clostridium Difficile Screen,,87324,CPT,Facility,Both,,,,199,169.15,57.0334,199,Aetna,Commercial,183.08,92,,percent of total billed charges,,
Clostridium Difficile Screen,,87324,CPT,Facility,Outpatient,,,,199,169.15,57.0334,199,Aetna,Medicare Advantage,97.51,49,,percent of total billed charges,,
Clostridium Difficile Screen,,87324,CPT,Facility,Inpatient,,,,199,169.15,57.0334,199,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Clostridium Difficile Screen,,87324,CPT,Facility,Both,,,,199,169.15,57.0334,199,Aetna,PPO,185.07,93,,percent of total billed charges,,
Clostridium Difficile Screen,,87324,CPT,Facility,Both,,,,199,169.15,57.0334,199,America's PPO,America's PPO,191.0997,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Clostridium Difficile Screen,,87324,CPT,Facility,Both,,,,199,169.15,57.0334,199,BlueCross BlueShield Minnesota, Federal Employee Program,195.816,98.4,,percent of total billed charges,,
Clostridium Difficile Screen,,87324,CPT,Facility,Both,,,,199,169.15,57.0334,199,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,199,100,,percent of total billed charges,,
Clostridium Difficile Screen,,87324,CPT,Facility,Both,,,,199,169.15,57.0334,199,BlueCross BlueShield Minnesota,High Value Network Plan,179.1,90,,percent of total billed charges,,
Clostridium Difficile Screen,,87324,CPT,Facility,Outpatient,,,,199,169.15,57.0334,199,BlueCross BlueShield Minnesota,Medicare Advantage,97.51,49,,percent of total billed charges,,
Clostridium Difficile Screen,,87324,CPT,Facility,Inpatient,,,,199,169.15,57.0334,199,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Clostridium Difficile Screen,,87324,CPT,Facility,Both,,,,199,169.15,57.0334,199,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,176.2543,88.57,,percent of total billed charges,,
Clostridium Difficile Screen,,87324,CPT,Facility,Both,,,,199,169.15,57.0334,199,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,57.0334,28.66,,percent of total billed charges,,
Clostridium Difficile Screen,,87324,CPT,Facility,Outpatient,,,,199,169.15,57.0334,199,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),97.51,49,,percent of total billed charges,,
Clostridium Difficile Screen,,87324,CPT,Facility,Inpatient,,,,199,169.15,57.0334,199,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Clostridium Difficile Screen,,87324,CPT,Facility,Both,,,,199,169.15,57.0334,199,CorVel,Worker's Compensation,199,100,,percent of total billed charges,,
Clostridium Difficile Screen,,87324,CPT,Facility,Both,,,,199,169.15,57.0334,199,First Health Group Corporation,First Health Network,193.03,97,,percent of total billed charges,,
Clostridium Difficile Screen,,87324,CPT,Facility,Both,,,,199,169.15,57.0334,199,"Health Partners, Inc.",Commercial,188.254,94.6,,percent of total billed charges,,
Clostridium Difficile Screen,,87324,CPT,Facility,Outpatient,,,,199,169.15,57.0334,199,"Health Partners, Inc.",Medicare Advantage,97.51,49,,percent of total billed charges,,
Clostridium Difficile Screen,,87324,CPT,Facility,Inpatient,,,,199,169.15,57.0334,199,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Clostridium Difficile Screen,,87324,CPT,Facility,Both,,,,199,169.15,57.0334,199,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),119.4,60,,percent of total billed charges,,
Clostridium Difficile Screen,,87324,CPT,Facility,Both,,,,199,169.15,57.0334,199,"Health Partners, Inc.",State of Minnesota Advantage Program,162.185,81.5,,percent of total billed charges,,
Clostridium Difficile Screen,,87324,CPT,Facility,Both,,,,199,169.15,57.0334,199,"Health Partners, Inc.",State Public Programs,99.5,50,,percent of total billed charges,,
Clostridium Difficile Screen,,87324,CPT,Facility,Both,,,,199,169.15,57.0334,199,Humana Insurance Company,Commercial PPO,189.05,95,,percent of total billed charges,,
Clostridium Difficile Screen,,87324,CPT,Facility,Outpatient,,,,199,169.15,57.0334,199,Humana Insurance Company,Medicare PPO,97.51,49,,percent of total billed charges,,
Clostridium Difficile Screen,,87324,CPT,Facility,Inpatient,,,,199,169.15,57.0334,199,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Clostridium Difficile Screen,,87324,CPT,Facility,Both,,,,199,169.15,57.0334,199,Medica,Individual & Family,197.209,99.1,,percent of total billed charges,,
Clostridium Difficile Screen,,87324,CPT,Facility,Outpatient,,,,199,169.15,57.0334,199,Medica,Medica Advantage Solution,99.102,49.8,,percent of total billed charges,,
Clostridium Difficile Screen,,87324,CPT,Facility,Inpatient,,,,199,169.15,57.0334,199,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Clostridium Difficile Screen,,87324,CPT,Facility,Outpatient,,,,199,169.15,57.0334,199,Medica,Medical Assistance,88.754,44.6,,percent of total billed charges,,
Clostridium Difficile Screen,,87324,CPT,Facility,Inpatient,,,,199,169.15,57.0334,199,Medica,Medical Assistance,,,,,Included in per diem rate,
Clostridium Difficile Screen,,87324,CPT,Facility,Outpatient,,,,199,169.15,57.0334,199,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,99.102,49.8,,percent of total billed charges,,
Clostridium Difficile Screen,,87324,CPT,Facility,Inpatient,,,,199,169.15,57.0334,199,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Clostridium Difficile Screen,,87324,CPT,Facility,Both,,,,199,169.15,57.0334,199,"Multiplan, Inc.","Multiplan, Inc.",187.06,94,,percent of total billed charges,,
Clostridium Difficile Screen,,87324,CPT,Facility,Outpatient,,,,199,169.15,57.0334,199,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,171.936,86.4,,percent of total billed charges,,
Clostridium Difficile Screen,,87324,CPT,Facility,Inpatient,,,,199,169.15,57.0334,199,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Clostridium Difficile Screen,,87324,CPT,Facility,Both,,,,199,169.15,57.0334,199,"Preferred One Administrative Services, INC.",PPO,196.214,98.6,,percent of total billed charges,,
Clostridium Difficile Screen,,87324,CPT,Facility,Outpatient,,,,199,169.15,57.0334,199,PrimeWest Health,Minnesota Senior Health Options (MSHO),102.3855,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Clostridium Difficile Screen,,87324,CPT,Facility,Inpatient,,,,199,169.15,57.0334,199,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Clostridium Difficile Screen,,87324,CPT,Facility,Outpatient,,,,199,169.15,57.0334,199,PrimeWest Health,MinnesotaCare,102.2064,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Clostridium Difficile Screen,,87324,CPT,Facility,Inpatient,,,,199,169.15,57.0334,199,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Clostridium Difficile Screen,,87324,CPT,Facility,Both,,,,199,169.15,57.0334,199,Sanford Health Plan,Sanford Health Plan,183.08,92,,percent of total billed charges,,
Clostridium Difficile Screen,,87324,CPT,Facility,Outpatient,,,,199,169.15,57.0334,199,"UCare Health, Inc.",Individual & Family Plan,112.1365,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Clostridium Difficile Screen,,87324,CPT,Facility,Inpatient,,,,199,169.15,57.0334,199,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Clostridium Difficile Screen,,87324,CPT,Facility,Outpatient,,,,199,169.15,57.0334,199,"UCare Health, Inc.",Medical Assistance,100.4353,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Clostridium Difficile Screen,,87324,CPT,Facility,Inpatient,,,,199,169.15,57.0334,199,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Clostridium Difficile Screen,,87324,CPT,Facility,Outpatient,,,,199,169.15,57.0334,199,"UCare Health, Inc.",Medicare Advantage,100.4353,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Clostridium Difficile Screen,,87324,CPT,Facility,Inpatient,,,,199,169.15,57.0334,199,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Clostridium Difficile Screen,,87324,CPT,Facility,Outpatient,,,,199,169.15,57.0334,199,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),100.4353,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Clostridium Difficile Screen,,87324,CPT,Facility,Inpatient,,,,199,169.15,57.0334,199,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Clostridium Difficile Screen,,87324,CPT,Facility,Both,,,,199,169.15,57.0334,199,UnitedHealthcare,Individual & Family,187.06,94,,percent of total billed charges,,
Clostridium Difficile Screen,,87324,CPT,Facility,Outpatient,,,,199,169.15,57.0334,199,UnitedHealthcare,Medicare Advantage,97.51,49,,percent of total billed charges,,
Clostridium Difficile Screen,,87324,CPT,Facility,Inpatient,,,,199,169.15,57.0334,199,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Clostridium Difficile Screen,,87324,CPT,Facility,Outpatient,,,,199,169.15,57.0334,199,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,95.52,48,,percent of total billed charges,,100% of DHS outpatient percentage
Clostridium Difficile Screen,,87324,CPT,Facility,Inpatient,,,,199,169.15,57.0334,199,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Helicobacter Pylori Ag, Stool",,87338,CPT,Facility,Both,,,,169,143.65,48.4354,169,Aetna,Commercial,155.48,92,,percent of total billed charges,,
"Helicobacter Pylori Ag, Stool",,87338,CPT,Facility,Outpatient,,,,169,143.65,48.4354,169,Aetna,Medicare Advantage,82.81,49,,percent of total billed charges,,
"Helicobacter Pylori Ag, Stool",,87338,CPT,Facility,Inpatient,,,,169,143.65,48.4354,169,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Helicobacter Pylori Ag, Stool",,87338,CPT,Facility,Both,,,,169,143.65,48.4354,169,Aetna,PPO,157.17,93,,percent of total billed charges,,
"Helicobacter Pylori Ag, Stool",,87338,CPT,Facility,Both,,,,169,143.65,48.4354,169,America's PPO,America's PPO,162.2907,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Helicobacter Pylori Ag, Stool",,87338,CPT,Facility,Both,,,,169,143.65,48.4354,169,BlueCross BlueShield Minnesota, Federal Employee Program,166.296,98.4,,percent of total billed charges,,
"Helicobacter Pylori Ag, Stool",,87338,CPT,Facility,Both,,,,169,143.65,48.4354,169,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,169,100,,percent of total billed charges,,
"Helicobacter Pylori Ag, Stool",,87338,CPT,Facility,Both,,,,169,143.65,48.4354,169,BlueCross BlueShield Minnesota,High Value Network Plan,152.1,90,,percent of total billed charges,,
"Helicobacter Pylori Ag, Stool",,87338,CPT,Facility,Outpatient,,,,169,143.65,48.4354,169,BlueCross BlueShield Minnesota,Medicare Advantage,82.81,49,,percent of total billed charges,,
"Helicobacter Pylori Ag, Stool",,87338,CPT,Facility,Inpatient,,,,169,143.65,48.4354,169,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Helicobacter Pylori Ag, Stool",,87338,CPT,Facility,Both,,,,169,143.65,48.4354,169,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,149.6833,88.57,,percent of total billed charges,,
"Helicobacter Pylori Ag, Stool",,87338,CPT,Facility,Both,,,,169,143.65,48.4354,169,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,48.4354,28.66,,percent of total billed charges,,
"Helicobacter Pylori Ag, Stool",,87338,CPT,Facility,Outpatient,,,,169,143.65,48.4354,169,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),82.81,49,,percent of total billed charges,,
"Helicobacter Pylori Ag, Stool",,87338,CPT,Facility,Inpatient,,,,169,143.65,48.4354,169,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Helicobacter Pylori Ag, Stool",,87338,CPT,Facility,Both,,,,169,143.65,48.4354,169,CorVel,Worker's Compensation,169,100,,percent of total billed charges,,
"Helicobacter Pylori Ag, Stool",,87338,CPT,Facility,Both,,,,169,143.65,48.4354,169,First Health Group Corporation,First Health Network,163.93,97,,percent of total billed charges,,
"Helicobacter Pylori Ag, Stool",,87338,CPT,Facility,Both,,,,169,143.65,48.4354,169,"Health Partners, Inc.",Commercial,159.874,94.6,,percent of total billed charges,,
"Helicobacter Pylori Ag, Stool",,87338,CPT,Facility,Outpatient,,,,169,143.65,48.4354,169,"Health Partners, Inc.",Medicare Advantage,82.81,49,,percent of total billed charges,,
"Helicobacter Pylori Ag, Stool",,87338,CPT,Facility,Inpatient,,,,169,143.65,48.4354,169,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Helicobacter Pylori Ag, Stool",,87338,CPT,Facility,Both,,,,169,143.65,48.4354,169,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),101.4,60,,percent of total billed charges,,
"Helicobacter Pylori Ag, Stool",,87338,CPT,Facility,Both,,,,169,143.65,48.4354,169,"Health Partners, Inc.",State of Minnesota Advantage Program,137.735,81.5,,percent of total billed charges,,
"Helicobacter Pylori Ag, Stool",,87338,CPT,Facility,Both,,,,169,143.65,48.4354,169,"Health Partners, Inc.",State Public Programs,84.5,50,,percent of total billed charges,,
"Helicobacter Pylori Ag, Stool",,87338,CPT,Facility,Both,,,,169,143.65,48.4354,169,Humana Insurance Company,Commercial PPO,160.55,95,,percent of total billed charges,,
"Helicobacter Pylori Ag, Stool",,87338,CPT,Facility,Outpatient,,,,169,143.65,48.4354,169,Humana Insurance Company,Medicare PPO,82.81,49,,percent of total billed charges,,
"Helicobacter Pylori Ag, Stool",,87338,CPT,Facility,Inpatient,,,,169,143.65,48.4354,169,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Helicobacter Pylori Ag, Stool",,87338,CPT,Facility,Both,,,,169,143.65,48.4354,169,Medica,Individual & Family,167.479,99.1,,percent of total billed charges,,
"Helicobacter Pylori Ag, Stool",,87338,CPT,Facility,Outpatient,,,,169,143.65,48.4354,169,Medica,Medica Advantage Solution,84.162,49.8,,percent of total billed charges,,
"Helicobacter Pylori Ag, Stool",,87338,CPT,Facility,Inpatient,,,,169,143.65,48.4354,169,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Helicobacter Pylori Ag, Stool",,87338,CPT,Facility,Outpatient,,,,169,143.65,48.4354,169,Medica,Medical Assistance,75.374,44.6,,percent of total billed charges,,
"Helicobacter Pylori Ag, Stool",,87338,CPT,Facility,Inpatient,,,,169,143.65,48.4354,169,Medica,Medical Assistance,,,,,Included in per diem rate,
"Helicobacter Pylori Ag, Stool",,87338,CPT,Facility,Outpatient,,,,169,143.65,48.4354,169,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,84.162,49.8,,percent of total billed charges,,
"Helicobacter Pylori Ag, Stool",,87338,CPT,Facility,Inpatient,,,,169,143.65,48.4354,169,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Helicobacter Pylori Ag, Stool",,87338,CPT,Facility,Both,,,,169,143.65,48.4354,169,"Multiplan, Inc.","Multiplan, Inc.",158.86,94,,percent of total billed charges,,
"Helicobacter Pylori Ag, Stool",,87338,CPT,Facility,Outpatient,,,,169,143.65,48.4354,169,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,146.016,86.4,,percent of total billed charges,,
"Helicobacter Pylori Ag, Stool",,87338,CPT,Facility,Inpatient,,,,169,143.65,48.4354,169,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Helicobacter Pylori Ag, Stool",,87338,CPT,Facility,Both,,,,169,143.65,48.4354,169,"Preferred One Administrative Services, INC.",PPO,166.634,98.6,,percent of total billed charges,,
"Helicobacter Pylori Ag, Stool",,87338,CPT,Facility,Outpatient,,,,169,143.65,48.4354,169,PrimeWest Health,Minnesota Senior Health Options (MSHO),86.9505,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Helicobacter Pylori Ag, Stool",,87338,CPT,Facility,Inpatient,,,,169,143.65,48.4354,169,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Helicobacter Pylori Ag, Stool",,87338,CPT,Facility,Outpatient,,,,169,143.65,48.4354,169,PrimeWest Health,MinnesotaCare,86.7984,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Helicobacter Pylori Ag, Stool",,87338,CPT,Facility,Inpatient,,,,169,143.65,48.4354,169,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Helicobacter Pylori Ag, Stool",,87338,CPT,Facility,Both,,,,169,143.65,48.4354,169,Sanford Health Plan,Sanford Health Plan,155.48,92,,percent of total billed charges,,
"Helicobacter Pylori Ag, Stool",,87338,CPT,Facility,Outpatient,,,,169,143.65,48.4354,169,"UCare Health, Inc.",Individual & Family Plan,95.2315,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Helicobacter Pylori Ag, Stool",,87338,CPT,Facility,Inpatient,,,,169,143.65,48.4354,169,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Helicobacter Pylori Ag, Stool",,87338,CPT,Facility,Outpatient,,,,169,143.65,48.4354,169,"UCare Health, Inc.",Medical Assistance,85.2943,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Helicobacter Pylori Ag, Stool",,87338,CPT,Facility,Inpatient,,,,169,143.65,48.4354,169,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Helicobacter Pylori Ag, Stool",,87338,CPT,Facility,Outpatient,,,,169,143.65,48.4354,169,"UCare Health, Inc.",Medicare Advantage,85.2943,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Helicobacter Pylori Ag, Stool",,87338,CPT,Facility,Inpatient,,,,169,143.65,48.4354,169,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Helicobacter Pylori Ag, Stool",,87338,CPT,Facility,Outpatient,,,,169,143.65,48.4354,169,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),85.2943,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Helicobacter Pylori Ag, Stool",,87338,CPT,Facility,Inpatient,,,,169,143.65,48.4354,169,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Helicobacter Pylori Ag, Stool",,87338,CPT,Facility,Both,,,,169,143.65,48.4354,169,UnitedHealthcare,Individual & Family,158.86,94,,percent of total billed charges,,
"Helicobacter Pylori Ag, Stool",,87338,CPT,Facility,Outpatient,,,,169,143.65,48.4354,169,UnitedHealthcare,Medicare Advantage,82.81,49,,percent of total billed charges,,
"Helicobacter Pylori Ag, Stool",,87338,CPT,Facility,Inpatient,,,,169,143.65,48.4354,169,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Helicobacter Pylori Ag, Stool",,87338,CPT,Facility,Outpatient,,,,169,143.65,48.4354,169,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,81.12,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Helicobacter Pylori Ag, Stool",,87338,CPT,Facility,Inpatient,,,,169,143.65,48.4354,169,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Hepatitis B Virus Surface Ag,,87340,CPT,Facility,Both,,,,84,71.4,24.0744,84,Aetna,Commercial,77.28,92,,percent of total billed charges,,
Hepatitis B Virus Surface Ag,,87340,CPT,Facility,Outpatient,,,,84,71.4,24.0744,84,Aetna,Medicare Advantage,41.16,49,,percent of total billed charges,,
Hepatitis B Virus Surface Ag,,87340,CPT,Facility,Inpatient,,,,84,71.4,24.0744,84,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Hepatitis B Virus Surface Ag,,87340,CPT,Facility,Both,,,,84,71.4,24.0744,84,Aetna,PPO,78.12,93,,percent of total billed charges,,
Hepatitis B Virus Surface Ag,,87340,CPT,Facility,Both,,,,84,71.4,24.0744,84,America's PPO,America's PPO,80.6652,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Hepatitis B Virus Surface Ag,,87340,CPT,Facility,Both,,,,84,71.4,24.0744,84,BlueCross BlueShield Minnesota, Federal Employee Program,82.656,98.4,,percent of total billed charges,,
Hepatitis B Virus Surface Ag,,87340,CPT,Facility,Both,,,,84,71.4,24.0744,84,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,84,100,,percent of total billed charges,,
Hepatitis B Virus Surface Ag,,87340,CPT,Facility,Both,,,,84,71.4,24.0744,84,BlueCross BlueShield Minnesota,High Value Network Plan,75.6,90,,percent of total billed charges,,
Hepatitis B Virus Surface Ag,,87340,CPT,Facility,Outpatient,,,,84,71.4,24.0744,84,BlueCross BlueShield Minnesota,Medicare Advantage,41.16,49,,percent of total billed charges,,
Hepatitis B Virus Surface Ag,,87340,CPT,Facility,Inpatient,,,,84,71.4,24.0744,84,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Hepatitis B Virus Surface Ag,,87340,CPT,Facility,Both,,,,84,71.4,24.0744,84,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,74.3988,88.57,,percent of total billed charges,,
Hepatitis B Virus Surface Ag,,87340,CPT,Facility,Both,,,,84,71.4,24.0744,84,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,24.0744,28.66,,percent of total billed charges,,
Hepatitis B Virus Surface Ag,,87340,CPT,Facility,Outpatient,,,,84,71.4,24.0744,84,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),41.16,49,,percent of total billed charges,,
Hepatitis B Virus Surface Ag,,87340,CPT,Facility,Inpatient,,,,84,71.4,24.0744,84,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Hepatitis B Virus Surface Ag,,87340,CPT,Facility,Both,,,,84,71.4,24.0744,84,CorVel,Worker's Compensation,84,100,,percent of total billed charges,,
Hepatitis B Virus Surface Ag,,87340,CPT,Facility,Both,,,,84,71.4,24.0744,84,First Health Group Corporation,First Health Network,81.48,97,,percent of total billed charges,,
Hepatitis B Virus Surface Ag,,87340,CPT,Facility,Both,,,,84,71.4,24.0744,84,"Health Partners, Inc.",Commercial,79.464,94.6,,percent of total billed charges,,
Hepatitis B Virus Surface Ag,,87340,CPT,Facility,Outpatient,,,,84,71.4,24.0744,84,"Health Partners, Inc.",Medicare Advantage,41.16,49,,percent of total billed charges,,
Hepatitis B Virus Surface Ag,,87340,CPT,Facility,Inpatient,,,,84,71.4,24.0744,84,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Hepatitis B Virus Surface Ag,,87340,CPT,Facility,Both,,,,84,71.4,24.0744,84,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),50.4,60,,percent of total billed charges,,
Hepatitis B Virus Surface Ag,,87340,CPT,Facility,Both,,,,84,71.4,24.0744,84,"Health Partners, Inc.",State of Minnesota Advantage Program,68.46,81.5,,percent of total billed charges,,
Hepatitis B Virus Surface Ag,,87340,CPT,Facility,Both,,,,84,71.4,24.0744,84,"Health Partners, Inc.",State Public Programs,42,50,,percent of total billed charges,,
Hepatitis B Virus Surface Ag,,87340,CPT,Facility,Both,,,,84,71.4,24.0744,84,Humana Insurance Company,Commercial PPO,79.8,95,,percent of total billed charges,,
Hepatitis B Virus Surface Ag,,87340,CPT,Facility,Outpatient,,,,84,71.4,24.0744,84,Humana Insurance Company,Medicare PPO,41.16,49,,percent of total billed charges,,
Hepatitis B Virus Surface Ag,,87340,CPT,Facility,Inpatient,,,,84,71.4,24.0744,84,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Hepatitis B Virus Surface Ag,,87340,CPT,Facility,Both,,,,84,71.4,24.0744,84,Medica,Individual & Family,83.244,99.1,,percent of total billed charges,,
Hepatitis B Virus Surface Ag,,87340,CPT,Facility,Outpatient,,,,84,71.4,24.0744,84,Medica,Medica Advantage Solution,41.832,49.8,,percent of total billed charges,,
Hepatitis B Virus Surface Ag,,87340,CPT,Facility,Inpatient,,,,84,71.4,24.0744,84,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Hepatitis B Virus Surface Ag,,87340,CPT,Facility,Outpatient,,,,84,71.4,24.0744,84,Medica,Medical Assistance,37.464,44.6,,percent of total billed charges,,
Hepatitis B Virus Surface Ag,,87340,CPT,Facility,Inpatient,,,,84,71.4,24.0744,84,Medica,Medical Assistance,,,,,Included in per diem rate,
Hepatitis B Virus Surface Ag,,87340,CPT,Facility,Outpatient,,,,84,71.4,24.0744,84,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,41.832,49.8,,percent of total billed charges,,
Hepatitis B Virus Surface Ag,,87340,CPT,Facility,Inpatient,,,,84,71.4,24.0744,84,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Hepatitis B Virus Surface Ag,,87340,CPT,Facility,Both,,,,84,71.4,24.0744,84,"Multiplan, Inc.","Multiplan, Inc.",78.96,94,,percent of total billed charges,,
Hepatitis B Virus Surface Ag,,87340,CPT,Facility,Outpatient,,,,84,71.4,24.0744,84,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,72.576,86.4,,percent of total billed charges,,
Hepatitis B Virus Surface Ag,,87340,CPT,Facility,Inpatient,,,,84,71.4,24.0744,84,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Hepatitis B Virus Surface Ag,,87340,CPT,Facility,Both,,,,84,71.4,24.0744,84,"Preferred One Administrative Services, INC.",PPO,82.824,98.6,,percent of total billed charges,,
Hepatitis B Virus Surface Ag,,87340,CPT,Facility,Outpatient,,,,84,71.4,24.0744,84,PrimeWest Health,Minnesota Senior Health Options (MSHO),43.218,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Hepatitis B Virus Surface Ag,,87340,CPT,Facility,Inpatient,,,,84,71.4,24.0744,84,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Hepatitis B Virus Surface Ag,,87340,CPT,Facility,Outpatient,,,,84,71.4,24.0744,84,PrimeWest Health,MinnesotaCare,43.1424,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Hepatitis B Virus Surface Ag,,87340,CPT,Facility,Inpatient,,,,84,71.4,24.0744,84,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Hepatitis B Virus Surface Ag,,87340,CPT,Facility,Both,,,,84,71.4,24.0744,84,Sanford Health Plan,Sanford Health Plan,77.28,92,,percent of total billed charges,,
Hepatitis B Virus Surface Ag,,87340,CPT,Facility,Outpatient,,,,84,71.4,24.0744,84,"UCare Health, Inc.",Individual & Family Plan,47.334,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Hepatitis B Virus Surface Ag,,87340,CPT,Facility,Inpatient,,,,84,71.4,24.0744,84,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Hepatitis B Virus Surface Ag,,87340,CPT,Facility,Outpatient,,,,84,71.4,24.0744,84,"UCare Health, Inc.",Medical Assistance,42.3948,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Hepatitis B Virus Surface Ag,,87340,CPT,Facility,Inpatient,,,,84,71.4,24.0744,84,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Hepatitis B Virus Surface Ag,,87340,CPT,Facility,Outpatient,,,,84,71.4,24.0744,84,"UCare Health, Inc.",Medicare Advantage,42.3948,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Hepatitis B Virus Surface Ag,,87340,CPT,Facility,Inpatient,,,,84,71.4,24.0744,84,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Hepatitis B Virus Surface Ag,,87340,CPT,Facility,Outpatient,,,,84,71.4,24.0744,84,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),42.3948,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Hepatitis B Virus Surface Ag,,87340,CPT,Facility,Inpatient,,,,84,71.4,24.0744,84,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Hepatitis B Virus Surface Ag,,87340,CPT,Facility,Both,,,,84,71.4,24.0744,84,UnitedHealthcare,Individual & Family,78.96,94,,percent of total billed charges,,
Hepatitis B Virus Surface Ag,,87340,CPT,Facility,Outpatient,,,,84,71.4,24.0744,84,UnitedHealthcare,Medicare Advantage,41.16,49,,percent of total billed charges,,
Hepatitis B Virus Surface Ag,,87340,CPT,Facility,Inpatient,,,,84,71.4,24.0744,84,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Hepatitis B Virus Surface Ag,,87340,CPT,Facility,Outpatient,,,,84,71.4,24.0744,84,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,40.32,48,,percent of total billed charges,,100% of DHS outpatient percentage
Hepatitis B Virus Surface Ag,,87340,CPT,Facility,Inpatient,,,,84,71.4,24.0744,84,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Hiv 1/2 Ab/Hiv 1/2 Ag,,87389,CPT,Facility,Both,,,,179,152.15,51.3014,179,Aetna,Commercial,164.68,92,,percent of total billed charges,,
Hiv 1/2 Ab/Hiv 1/2 Ag,,87389,CPT,Facility,Outpatient,,,,179,152.15,51.3014,179,Aetna,Medicare Advantage,87.71,49,,percent of total billed charges,,
Hiv 1/2 Ab/Hiv 1/2 Ag,,87389,CPT,Facility,Inpatient,,,,179,152.15,51.3014,179,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Hiv 1/2 Ab/Hiv 1/2 Ag,,87389,CPT,Facility,Both,,,,179,152.15,51.3014,179,Aetna,PPO,166.47,93,,percent of total billed charges,,
Hiv 1/2 Ab/Hiv 1/2 Ag,,87389,CPT,Facility,Both,,,,179,152.15,51.3014,179,America's PPO,America's PPO,171.8937,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Hiv 1/2 Ab/Hiv 1/2 Ag,,87389,CPT,Facility,Both,,,,179,152.15,51.3014,179,BlueCross BlueShield Minnesota, Federal Employee Program,176.136,98.4,,percent of total billed charges,,
Hiv 1/2 Ab/Hiv 1/2 Ag,,87389,CPT,Facility,Both,,,,179,152.15,51.3014,179,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,179,100,,percent of total billed charges,,
Hiv 1/2 Ab/Hiv 1/2 Ag,,87389,CPT,Facility,Both,,,,179,152.15,51.3014,179,BlueCross BlueShield Minnesota,High Value Network Plan,161.1,90,,percent of total billed charges,,
Hiv 1/2 Ab/Hiv 1/2 Ag,,87389,CPT,Facility,Outpatient,,,,179,152.15,51.3014,179,BlueCross BlueShield Minnesota,Medicare Advantage,87.71,49,,percent of total billed charges,,
Hiv 1/2 Ab/Hiv 1/2 Ag,,87389,CPT,Facility,Inpatient,,,,179,152.15,51.3014,179,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Hiv 1/2 Ab/Hiv 1/2 Ag,,87389,CPT,Facility,Both,,,,179,152.15,51.3014,179,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,158.5403,88.57,,percent of total billed charges,,
Hiv 1/2 Ab/Hiv 1/2 Ag,,87389,CPT,Facility,Both,,,,179,152.15,51.3014,179,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,51.3014,28.66,,percent of total billed charges,,
Hiv 1/2 Ab/Hiv 1/2 Ag,,87389,CPT,Facility,Outpatient,,,,179,152.15,51.3014,179,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),87.71,49,,percent of total billed charges,,
Hiv 1/2 Ab/Hiv 1/2 Ag,,87389,CPT,Facility,Inpatient,,,,179,152.15,51.3014,179,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Hiv 1/2 Ab/Hiv 1/2 Ag,,87389,CPT,Facility,Both,,,,179,152.15,51.3014,179,CorVel,Worker's Compensation,179,100,,percent of total billed charges,,
Hiv 1/2 Ab/Hiv 1/2 Ag,,87389,CPT,Facility,Both,,,,179,152.15,51.3014,179,First Health Group Corporation,First Health Network,173.63,97,,percent of total billed charges,,
Hiv 1/2 Ab/Hiv 1/2 Ag,,87389,CPT,Facility,Both,,,,179,152.15,51.3014,179,"Health Partners, Inc.",Commercial,169.334,94.6,,percent of total billed charges,,
Hiv 1/2 Ab/Hiv 1/2 Ag,,87389,CPT,Facility,Outpatient,,,,179,152.15,51.3014,179,"Health Partners, Inc.",Medicare Advantage,87.71,49,,percent of total billed charges,,
Hiv 1/2 Ab/Hiv 1/2 Ag,,87389,CPT,Facility,Inpatient,,,,179,152.15,51.3014,179,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Hiv 1/2 Ab/Hiv 1/2 Ag,,87389,CPT,Facility,Both,,,,179,152.15,51.3014,179,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),107.4,60,,percent of total billed charges,,
Hiv 1/2 Ab/Hiv 1/2 Ag,,87389,CPT,Facility,Both,,,,179,152.15,51.3014,179,"Health Partners, Inc.",State of Minnesota Advantage Program,145.885,81.5,,percent of total billed charges,,
Hiv 1/2 Ab/Hiv 1/2 Ag,,87389,CPT,Facility,Both,,,,179,152.15,51.3014,179,"Health Partners, Inc.",State Public Programs,89.5,50,,percent of total billed charges,,
Hiv 1/2 Ab/Hiv 1/2 Ag,,87389,CPT,Facility,Both,,,,179,152.15,51.3014,179,Humana Insurance Company,Commercial PPO,170.05,95,,percent of total billed charges,,
Hiv 1/2 Ab/Hiv 1/2 Ag,,87389,CPT,Facility,Outpatient,,,,179,152.15,51.3014,179,Humana Insurance Company,Medicare PPO,87.71,49,,percent of total billed charges,,
Hiv 1/2 Ab/Hiv 1/2 Ag,,87389,CPT,Facility,Inpatient,,,,179,152.15,51.3014,179,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Hiv 1/2 Ab/Hiv 1/2 Ag,,87389,CPT,Facility,Both,,,,179,152.15,51.3014,179,Medica,Individual & Family,177.389,99.1,,percent of total billed charges,,
Hiv 1/2 Ab/Hiv 1/2 Ag,,87389,CPT,Facility,Outpatient,,,,179,152.15,51.3014,179,Medica,Medica Advantage Solution,89.142,49.8,,percent of total billed charges,,
Hiv 1/2 Ab/Hiv 1/2 Ag,,87389,CPT,Facility,Inpatient,,,,179,152.15,51.3014,179,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Hiv 1/2 Ab/Hiv 1/2 Ag,,87389,CPT,Facility,Outpatient,,,,179,152.15,51.3014,179,Medica,Medical Assistance,79.834,44.6,,percent of total billed charges,,
Hiv 1/2 Ab/Hiv 1/2 Ag,,87389,CPT,Facility,Inpatient,,,,179,152.15,51.3014,179,Medica,Medical Assistance,,,,,Included in per diem rate,
Hiv 1/2 Ab/Hiv 1/2 Ag,,87389,CPT,Facility,Outpatient,,,,179,152.15,51.3014,179,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,89.142,49.8,,percent of total billed charges,,
Hiv 1/2 Ab/Hiv 1/2 Ag,,87389,CPT,Facility,Inpatient,,,,179,152.15,51.3014,179,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Hiv 1/2 Ab/Hiv 1/2 Ag,,87389,CPT,Facility,Both,,,,179,152.15,51.3014,179,"Multiplan, Inc.","Multiplan, Inc.",168.26,94,,percent of total billed charges,,
Hiv 1/2 Ab/Hiv 1/2 Ag,,87389,CPT,Facility,Outpatient,,,,179,152.15,51.3014,179,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,154.656,86.4,,percent of total billed charges,,
Hiv 1/2 Ab/Hiv 1/2 Ag,,87389,CPT,Facility,Inpatient,,,,179,152.15,51.3014,179,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Hiv 1/2 Ab/Hiv 1/2 Ag,,87389,CPT,Facility,Both,,,,179,152.15,51.3014,179,"Preferred One Administrative Services, INC.",PPO,176.494,98.6,,percent of total billed charges,,
Hiv 1/2 Ab/Hiv 1/2 Ag,,87389,CPT,Facility,Outpatient,,,,179,152.15,51.3014,179,PrimeWest Health,Minnesota Senior Health Options (MSHO),92.0955,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Hiv 1/2 Ab/Hiv 1/2 Ag,,87389,CPT,Facility,Inpatient,,,,179,152.15,51.3014,179,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Hiv 1/2 Ab/Hiv 1/2 Ag,,87389,CPT,Facility,Outpatient,,,,179,152.15,51.3014,179,PrimeWest Health,MinnesotaCare,91.9344,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Hiv 1/2 Ab/Hiv 1/2 Ag,,87389,CPT,Facility,Inpatient,,,,179,152.15,51.3014,179,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Hiv 1/2 Ab/Hiv 1/2 Ag,,87389,CPT,Facility,Both,,,,179,152.15,51.3014,179,Sanford Health Plan,Sanford Health Plan,164.68,92,,percent of total billed charges,,
Hiv 1/2 Ab/Hiv 1/2 Ag,,87389,CPT,Facility,Outpatient,,,,179,152.15,51.3014,179,"UCare Health, Inc.",Individual & Family Plan,100.8665,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Hiv 1/2 Ab/Hiv 1/2 Ag,,87389,CPT,Facility,Inpatient,,,,179,152.15,51.3014,179,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Hiv 1/2 Ab/Hiv 1/2 Ag,,87389,CPT,Facility,Outpatient,,,,179,152.15,51.3014,179,"UCare Health, Inc.",Medical Assistance,90.3413,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Hiv 1/2 Ab/Hiv 1/2 Ag,,87389,CPT,Facility,Inpatient,,,,179,152.15,51.3014,179,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Hiv 1/2 Ab/Hiv 1/2 Ag,,87389,CPT,Facility,Outpatient,,,,179,152.15,51.3014,179,"UCare Health, Inc.",Medicare Advantage,90.3413,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Hiv 1/2 Ab/Hiv 1/2 Ag,,87389,CPT,Facility,Inpatient,,,,179,152.15,51.3014,179,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Hiv 1/2 Ab/Hiv 1/2 Ag,,87389,CPT,Facility,Outpatient,,,,179,152.15,51.3014,179,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),90.3413,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Hiv 1/2 Ab/Hiv 1/2 Ag,,87389,CPT,Facility,Inpatient,,,,179,152.15,51.3014,179,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Hiv 1/2 Ab/Hiv 1/2 Ag,,87389,CPT,Facility,Both,,,,179,152.15,51.3014,179,UnitedHealthcare,Individual & Family,168.26,94,,percent of total billed charges,,
Hiv 1/2 Ab/Hiv 1/2 Ag,,87389,CPT,Facility,Outpatient,,,,179,152.15,51.3014,179,UnitedHealthcare,Medicare Advantage,87.71,49,,percent of total billed charges,,
Hiv 1/2 Ab/Hiv 1/2 Ag,,87389,CPT,Facility,Inpatient,,,,179,152.15,51.3014,179,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Hiv 1/2 Ab/Hiv 1/2 Ag,,87389,CPT,Facility,Outpatient,,,,179,152.15,51.3014,179,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,85.92,48,,percent of total billed charges,,100% of DHS outpatient percentage
Hiv 1/2 Ab/Hiv 1/2 Ag,,87389,CPT,Facility,Inpatient,,,,179,152.15,51.3014,179,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Respiratory Syncytial Virus Ag,,87420,CPT,Facility,Both,,,,142,120.7,40.6972,142,Aetna,Commercial,130.64,92,,percent of total billed charges,,
Respiratory Syncytial Virus Ag,,87420,CPT,Facility,Outpatient,,,,142,120.7,40.6972,142,Aetna,Medicare Advantage,69.58,49,,percent of total billed charges,,
Respiratory Syncytial Virus Ag,,87420,CPT,Facility,Inpatient,,,,142,120.7,40.6972,142,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Respiratory Syncytial Virus Ag,,87420,CPT,Facility,Both,,,,142,120.7,40.6972,142,Aetna,PPO,132.06,93,,percent of total billed charges,,
Respiratory Syncytial Virus Ag,,87420,CPT,Facility,Both,,,,142,120.7,40.6972,142,America's PPO,America's PPO,136.3626,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Respiratory Syncytial Virus Ag,,87420,CPT,Facility,Both,,,,142,120.7,40.6972,142,BlueCross BlueShield Minnesota, Federal Employee Program,139.728,98.4,,percent of total billed charges,,
Respiratory Syncytial Virus Ag,,87420,CPT,Facility,Both,,,,142,120.7,40.6972,142,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,142,100,,percent of total billed charges,,
Respiratory Syncytial Virus Ag,,87420,CPT,Facility,Both,,,,142,120.7,40.6972,142,BlueCross BlueShield Minnesota,High Value Network Plan,127.8,90,,percent of total billed charges,,
Respiratory Syncytial Virus Ag,,87420,CPT,Facility,Outpatient,,,,142,120.7,40.6972,142,BlueCross BlueShield Minnesota,Medicare Advantage,69.58,49,,percent of total billed charges,,
Respiratory Syncytial Virus Ag,,87420,CPT,Facility,Inpatient,,,,142,120.7,40.6972,142,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Respiratory Syncytial Virus Ag,,87420,CPT,Facility,Both,,,,142,120.7,40.6972,142,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,125.7694,88.57,,percent of total billed charges,,
Respiratory Syncytial Virus Ag,,87420,CPT,Facility,Both,,,,142,120.7,40.6972,142,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,40.6972,28.66,,percent of total billed charges,,
Respiratory Syncytial Virus Ag,,87420,CPT,Facility,Outpatient,,,,142,120.7,40.6972,142,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),69.58,49,,percent of total billed charges,,
Respiratory Syncytial Virus Ag,,87420,CPT,Facility,Inpatient,,,,142,120.7,40.6972,142,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Respiratory Syncytial Virus Ag,,87420,CPT,Facility,Both,,,,142,120.7,40.6972,142,CorVel,Worker's Compensation,142,100,,percent of total billed charges,,
Respiratory Syncytial Virus Ag,,87420,CPT,Facility,Both,,,,142,120.7,40.6972,142,First Health Group Corporation,First Health Network,137.74,97,,percent of total billed charges,,
Respiratory Syncytial Virus Ag,,87420,CPT,Facility,Both,,,,142,120.7,40.6972,142,"Health Partners, Inc.",Commercial,134.332,94.6,,percent of total billed charges,,
Respiratory Syncytial Virus Ag,,87420,CPT,Facility,Outpatient,,,,142,120.7,40.6972,142,"Health Partners, Inc.",Medicare Advantage,69.58,49,,percent of total billed charges,,
Respiratory Syncytial Virus Ag,,87420,CPT,Facility,Inpatient,,,,142,120.7,40.6972,142,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Respiratory Syncytial Virus Ag,,87420,CPT,Facility,Both,,,,142,120.7,40.6972,142,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),85.2,60,,percent of total billed charges,,
Respiratory Syncytial Virus Ag,,87420,CPT,Facility,Both,,,,142,120.7,40.6972,142,"Health Partners, Inc.",State of Minnesota Advantage Program,115.73,81.5,,percent of total billed charges,,
Respiratory Syncytial Virus Ag,,87420,CPT,Facility,Both,,,,142,120.7,40.6972,142,"Health Partners, Inc.",State Public Programs,71,50,,percent of total billed charges,,
Respiratory Syncytial Virus Ag,,87420,CPT,Facility,Both,,,,142,120.7,40.6972,142,Humana Insurance Company,Commercial PPO,134.9,95,,percent of total billed charges,,
Respiratory Syncytial Virus Ag,,87420,CPT,Facility,Outpatient,,,,142,120.7,40.6972,142,Humana Insurance Company,Medicare PPO,69.58,49,,percent of total billed charges,,
Respiratory Syncytial Virus Ag,,87420,CPT,Facility,Inpatient,,,,142,120.7,40.6972,142,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Respiratory Syncytial Virus Ag,,87420,CPT,Facility,Both,,,,142,120.7,40.6972,142,Medica,Individual & Family,140.722,99.1,,percent of total billed charges,,
Respiratory Syncytial Virus Ag,,87420,CPT,Facility,Outpatient,,,,142,120.7,40.6972,142,Medica,Medica Advantage Solution,70.716,49.8,,percent of total billed charges,,
Respiratory Syncytial Virus Ag,,87420,CPT,Facility,Inpatient,,,,142,120.7,40.6972,142,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Respiratory Syncytial Virus Ag,,87420,CPT,Facility,Outpatient,,,,142,120.7,40.6972,142,Medica,Medical Assistance,63.332,44.6,,percent of total billed charges,,
Respiratory Syncytial Virus Ag,,87420,CPT,Facility,Inpatient,,,,142,120.7,40.6972,142,Medica,Medical Assistance,,,,,Included in per diem rate,
Respiratory Syncytial Virus Ag,,87420,CPT,Facility,Outpatient,,,,142,120.7,40.6972,142,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,70.716,49.8,,percent of total billed charges,,
Respiratory Syncytial Virus Ag,,87420,CPT,Facility,Inpatient,,,,142,120.7,40.6972,142,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Respiratory Syncytial Virus Ag,,87420,CPT,Facility,Both,,,,142,120.7,40.6972,142,"Multiplan, Inc.","Multiplan, Inc.",133.48,94,,percent of total billed charges,,
Respiratory Syncytial Virus Ag,,87420,CPT,Facility,Outpatient,,,,142,120.7,40.6972,142,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,122.688,86.4,,percent of total billed charges,,
Respiratory Syncytial Virus Ag,,87420,CPT,Facility,Inpatient,,,,142,120.7,40.6972,142,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Respiratory Syncytial Virus Ag,,87420,CPT,Facility,Both,,,,142,120.7,40.6972,142,"Preferred One Administrative Services, INC.",PPO,140.012,98.6,,percent of total billed charges,,
Respiratory Syncytial Virus Ag,,87420,CPT,Facility,Outpatient,,,,142,120.7,40.6972,142,PrimeWest Health,Minnesota Senior Health Options (MSHO),73.059,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Respiratory Syncytial Virus Ag,,87420,CPT,Facility,Inpatient,,,,142,120.7,40.6972,142,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Respiratory Syncytial Virus Ag,,87420,CPT,Facility,Outpatient,,,,142,120.7,40.6972,142,PrimeWest Health,MinnesotaCare,72.9312,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Respiratory Syncytial Virus Ag,,87420,CPT,Facility,Inpatient,,,,142,120.7,40.6972,142,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Respiratory Syncytial Virus Ag,,87420,CPT,Facility,Both,,,,142,120.7,40.6972,142,Sanford Health Plan,Sanford Health Plan,130.64,92,,percent of total billed charges,,
Respiratory Syncytial Virus Ag,,87420,CPT,Facility,Outpatient,,,,142,120.7,40.6972,142,"UCare Health, Inc.",Individual & Family Plan,80.017,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Respiratory Syncytial Virus Ag,,87420,CPT,Facility,Inpatient,,,,142,120.7,40.6972,142,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Respiratory Syncytial Virus Ag,,87420,CPT,Facility,Outpatient,,,,142,120.7,40.6972,142,"UCare Health, Inc.",Medical Assistance,71.6674,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Respiratory Syncytial Virus Ag,,87420,CPT,Facility,Inpatient,,,,142,120.7,40.6972,142,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Respiratory Syncytial Virus Ag,,87420,CPT,Facility,Outpatient,,,,142,120.7,40.6972,142,"UCare Health, Inc.",Medicare Advantage,71.6674,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Respiratory Syncytial Virus Ag,,87420,CPT,Facility,Inpatient,,,,142,120.7,40.6972,142,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Respiratory Syncytial Virus Ag,,87420,CPT,Facility,Outpatient,,,,142,120.7,40.6972,142,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),71.6674,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Respiratory Syncytial Virus Ag,,87420,CPT,Facility,Inpatient,,,,142,120.7,40.6972,142,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Respiratory Syncytial Virus Ag,,87420,CPT,Facility,Both,,,,142,120.7,40.6972,142,UnitedHealthcare,Individual & Family,133.48,94,,percent of total billed charges,,
Respiratory Syncytial Virus Ag,,87420,CPT,Facility,Outpatient,,,,142,120.7,40.6972,142,UnitedHealthcare,Medicare Advantage,69.58,49,,percent of total billed charges,,
Respiratory Syncytial Virus Ag,,87420,CPT,Facility,Inpatient,,,,142,120.7,40.6972,142,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Respiratory Syncytial Virus Ag,,87420,CPT,Facility,Outpatient,,,,142,120.7,40.6972,142,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,68.16,48,,percent of total billed charges,,100% of DHS outpatient percentage
Respiratory Syncytial Virus Ag,,87420,CPT,Facility,Inpatient,,,,142,120.7,40.6972,142,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Infectious Agent Antigen Detect Immunoassay, Qualitative Or Semiquantitative; Sars Antigen Fia",,87426,CPT,Facility,Both,,,,82,69.7,23.5012,82,Aetna,Commercial,75.44,92,,percent of total billed charges,,
"Infectious Agent Antigen Detect Immunoassay, Qualitative Or Semiquantitative; Sars Antigen Fia",,87426,CPT,Facility,Outpatient,,,,82,69.7,23.5012,82,Aetna,Medicare Advantage,40.18,49,,percent of total billed charges,,
"Infectious Agent Antigen Detect Immunoassay, Qualitative Or Semiquantitative; Sars Antigen Fia",,87426,CPT,Facility,Inpatient,,,,82,69.7,23.5012,82,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Infectious Agent Antigen Detect Immunoassay, Qualitative Or Semiquantitative; Sars Antigen Fia",,87426,CPT,Facility,Both,,,,82,69.7,23.5012,82,Aetna,PPO,76.26,93,,percent of total billed charges,,
"Infectious Agent Antigen Detect Immunoassay, Qualitative Or Semiquantitative; Sars Antigen Fia",,87426,CPT,Facility,Both,,,,82,69.7,23.5012,82,America's PPO,America's PPO,78.7446,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Infectious Agent Antigen Detect Immunoassay, Qualitative Or Semiquantitative; Sars Antigen Fia",,87426,CPT,Facility,Both,,,,82,69.7,23.5012,82,BlueCross BlueShield Minnesota, Federal Employee Program,80.688,98.4,,percent of total billed charges,,
"Infectious Agent Antigen Detect Immunoassay, Qualitative Or Semiquantitative; Sars Antigen Fia",,87426,CPT,Facility,Both,,,,82,69.7,23.5012,82,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,82,100,,percent of total billed charges,,
"Infectious Agent Antigen Detect Immunoassay, Qualitative Or Semiquantitative; Sars Antigen Fia",,87426,CPT,Facility,Both,,,,82,69.7,23.5012,82,BlueCross BlueShield Minnesota,High Value Network Plan,73.8,90,,percent of total billed charges,,
"Infectious Agent Antigen Detect Immunoassay, Qualitative Or Semiquantitative; Sars Antigen Fia",,87426,CPT,Facility,Outpatient,,,,82,69.7,23.5012,82,BlueCross BlueShield Minnesota,Medicare Advantage,40.18,49,,percent of total billed charges,,
"Infectious Agent Antigen Detect Immunoassay, Qualitative Or Semiquantitative; Sars Antigen Fia",,87426,CPT,Facility,Inpatient,,,,82,69.7,23.5012,82,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Infectious Agent Antigen Detect Immunoassay, Qualitative Or Semiquantitative; Sars Antigen Fia",,87426,CPT,Facility,Both,,,,82,69.7,23.5012,82,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,72.6274,88.57,,percent of total billed charges,,
"Infectious Agent Antigen Detect Immunoassay, Qualitative Or Semiquantitative; Sars Antigen Fia",,87426,CPT,Facility,Both,,,,82,69.7,23.5012,82,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,23.5012,28.66,,percent of total billed charges,,
"Infectious Agent Antigen Detect Immunoassay, Qualitative Or Semiquantitative; Sars Antigen Fia",,87426,CPT,Facility,Outpatient,,,,82,69.7,23.5012,82,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),40.18,49,,percent of total billed charges,,
"Infectious Agent Antigen Detect Immunoassay, Qualitative Or Semiquantitative; Sars Antigen Fia",,87426,CPT,Facility,Inpatient,,,,82,69.7,23.5012,82,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Infectious Agent Antigen Detect Immunoassay, Qualitative Or Semiquantitative; Sars Antigen Fia",,87426,CPT,Facility,Both,,,,82,69.7,23.5012,82,CorVel,Worker's Compensation,82,100,,percent of total billed charges,,
"Infectious Agent Antigen Detect Immunoassay, Qualitative Or Semiquantitative; Sars Antigen Fia",,87426,CPT,Facility,Both,,,,82,69.7,23.5012,82,First Health Group Corporation,First Health Network,79.54,97,,percent of total billed charges,,
"Infectious Agent Antigen Detect Immunoassay, Qualitative Or Semiquantitative; Sars Antigen Fia",,87426,CPT,Facility,Both,,,,82,69.7,23.5012,82,"Health Partners, Inc.",Commercial,77.572,94.6,,percent of total billed charges,,
"Infectious Agent Antigen Detect Immunoassay, Qualitative Or Semiquantitative; Sars Antigen Fia",,87426,CPT,Facility,Outpatient,,,,82,69.7,23.5012,82,"Health Partners, Inc.",Medicare Advantage,40.18,49,,percent of total billed charges,,
"Infectious Agent Antigen Detect Immunoassay, Qualitative Or Semiquantitative; Sars Antigen Fia",,87426,CPT,Facility,Inpatient,,,,82,69.7,23.5012,82,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Infectious Agent Antigen Detect Immunoassay, Qualitative Or Semiquantitative; Sars Antigen Fia",,87426,CPT,Facility,Both,,,,82,69.7,23.5012,82,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),49.2,60,,percent of total billed charges,,
"Infectious Agent Antigen Detect Immunoassay, Qualitative Or Semiquantitative; Sars Antigen Fia",,87426,CPT,Facility,Both,,,,82,69.7,23.5012,82,"Health Partners, Inc.",State of Minnesota Advantage Program,66.83,81.5,,percent of total billed charges,,
"Infectious Agent Antigen Detect Immunoassay, Qualitative Or Semiquantitative; Sars Antigen Fia",,87426,CPT,Facility,Both,,,,82,69.7,23.5012,82,"Health Partners, Inc.",State Public Programs,41,50,,percent of total billed charges,,
"Infectious Agent Antigen Detect Immunoassay, Qualitative Or Semiquantitative; Sars Antigen Fia",,87426,CPT,Facility,Both,,,,82,69.7,23.5012,82,Humana Insurance Company,Commercial PPO,77.9,95,,percent of total billed charges,,
"Infectious Agent Antigen Detect Immunoassay, Qualitative Or Semiquantitative; Sars Antigen Fia",,87426,CPT,Facility,Outpatient,,,,82,69.7,23.5012,82,Humana Insurance Company,Medicare PPO,40.18,49,,percent of total billed charges,,
"Infectious Agent Antigen Detect Immunoassay, Qualitative Or Semiquantitative; Sars Antigen Fia",,87426,CPT,Facility,Inpatient,,,,82,69.7,23.5012,82,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Infectious Agent Antigen Detect Immunoassay, Qualitative Or Semiquantitative; Sars Antigen Fia",,87426,CPT,Facility,Both,,,,82,69.7,23.5012,82,Medica,Individual & Family,81.262,99.1,,percent of total billed charges,,
"Infectious Agent Antigen Detect Immunoassay, Qualitative Or Semiquantitative; Sars Antigen Fia",,87426,CPT,Facility,Outpatient,,,,82,69.7,23.5012,82,Medica,Medica Advantage Solution,40.836,49.8,,percent of total billed charges,,
"Infectious Agent Antigen Detect Immunoassay, Qualitative Or Semiquantitative; Sars Antigen Fia",,87426,CPT,Facility,Inpatient,,,,82,69.7,23.5012,82,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Infectious Agent Antigen Detect Immunoassay, Qualitative Or Semiquantitative; Sars Antigen Fia",,87426,CPT,Facility,Outpatient,,,,82,69.7,23.5012,82,Medica,Medical Assistance,36.572,44.6,,percent of total billed charges,,
"Infectious Agent Antigen Detect Immunoassay, Qualitative Or Semiquantitative; Sars Antigen Fia",,87426,CPT,Facility,Inpatient,,,,82,69.7,23.5012,82,Medica,Medical Assistance,,,,,Included in per diem rate,
"Infectious Agent Antigen Detect Immunoassay, Qualitative Or Semiquantitative; Sars Antigen Fia",,87426,CPT,Facility,Outpatient,,,,82,69.7,23.5012,82,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,40.836,49.8,,percent of total billed charges,,
"Infectious Agent Antigen Detect Immunoassay, Qualitative Or Semiquantitative; Sars Antigen Fia",,87426,CPT,Facility,Inpatient,,,,82,69.7,23.5012,82,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Infectious Agent Antigen Detect Immunoassay, Qualitative Or Semiquantitative; Sars Antigen Fia",,87426,CPT,Facility,Both,,,,82,69.7,23.5012,82,"Multiplan, Inc.","Multiplan, Inc.",77.08,94,,percent of total billed charges,,
"Infectious Agent Antigen Detect Immunoassay, Qualitative Or Semiquantitative; Sars Antigen Fia",,87426,CPT,Facility,Outpatient,,,,82,69.7,23.5012,82,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,70.848,86.4,,percent of total billed charges,,
"Infectious Agent Antigen Detect Immunoassay, Qualitative Or Semiquantitative; Sars Antigen Fia",,87426,CPT,Facility,Inpatient,,,,82,69.7,23.5012,82,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Infectious Agent Antigen Detect Immunoassay, Qualitative Or Semiquantitative; Sars Antigen Fia",,87426,CPT,Facility,Both,,,,82,69.7,23.5012,82,"Preferred One Administrative Services, INC.",PPO,80.852,98.6,,percent of total billed charges,,
"Infectious Agent Antigen Detect Immunoassay, Qualitative Or Semiquantitative; Sars Antigen Fia",,87426,CPT,Facility,Outpatient,,,,82,69.7,23.5012,82,PrimeWest Health,Minnesota Senior Health Options (MSHO),42.189,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Infectious Agent Antigen Detect Immunoassay, Qualitative Or Semiquantitative; Sars Antigen Fia",,87426,CPT,Facility,Inpatient,,,,82,69.7,23.5012,82,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Infectious Agent Antigen Detect Immunoassay, Qualitative Or Semiquantitative; Sars Antigen Fia",,87426,CPT,Facility,Outpatient,,,,82,69.7,23.5012,82,PrimeWest Health,MinnesotaCare,42.1152,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Infectious Agent Antigen Detect Immunoassay, Qualitative Or Semiquantitative; Sars Antigen Fia",,87426,CPT,Facility,Inpatient,,,,82,69.7,23.5012,82,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Infectious Agent Antigen Detect Immunoassay, Qualitative Or Semiquantitative; Sars Antigen Fia",,87426,CPT,Facility,Both,,,,82,69.7,23.5012,82,Sanford Health Plan,Sanford Health Plan,75.44,92,,percent of total billed charges,,
"Infectious Agent Antigen Detect Immunoassay, Qualitative Or Semiquantitative; Sars Antigen Fia",,87426,CPT,Facility,Outpatient,,,,82,69.7,23.5012,82,"UCare Health, Inc.",Individual & Family Plan,46.207,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Infectious Agent Antigen Detect Immunoassay, Qualitative Or Semiquantitative; Sars Antigen Fia",,87426,CPT,Facility,Inpatient,,,,82,69.7,23.5012,82,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Infectious Agent Antigen Detect Immunoassay, Qualitative Or Semiquantitative; Sars Antigen Fia",,87426,CPT,Facility,Outpatient,,,,82,69.7,23.5012,82,"UCare Health, Inc.",Medical Assistance,41.3854,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Infectious Agent Antigen Detect Immunoassay, Qualitative Or Semiquantitative; Sars Antigen Fia",,87426,CPT,Facility,Inpatient,,,,82,69.7,23.5012,82,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Infectious Agent Antigen Detect Immunoassay, Qualitative Or Semiquantitative; Sars Antigen Fia",,87426,CPT,Facility,Outpatient,,,,82,69.7,23.5012,82,"UCare Health, Inc.",Medicare Advantage,41.3854,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Infectious Agent Antigen Detect Immunoassay, Qualitative Or Semiquantitative; Sars Antigen Fia",,87426,CPT,Facility,Inpatient,,,,82,69.7,23.5012,82,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Infectious Agent Antigen Detect Immunoassay, Qualitative Or Semiquantitative; Sars Antigen Fia",,87426,CPT,Facility,Outpatient,,,,82,69.7,23.5012,82,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),41.3854,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Infectious Agent Antigen Detect Immunoassay, Qualitative Or Semiquantitative; Sars Antigen Fia",,87426,CPT,Facility,Inpatient,,,,82,69.7,23.5012,82,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Infectious Agent Antigen Detect Immunoassay, Qualitative Or Semiquantitative; Sars Antigen Fia",,87426,CPT,Facility,Both,,,,82,69.7,23.5012,82,UnitedHealthcare,Individual & Family,77.08,94,,percent of total billed charges,,
"Infectious Agent Antigen Detect Immunoassay, Qualitative Or Semiquantitative; Sars Antigen Fia",,87426,CPT,Facility,Outpatient,,,,82,69.7,23.5012,82,UnitedHealthcare,Medicare Advantage,40.18,49,,percent of total billed charges,,
"Infectious Agent Antigen Detect Immunoassay, Qualitative Or Semiquantitative; Sars Antigen Fia",,87426,CPT,Facility,Inpatient,,,,82,69.7,23.5012,82,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Infectious Agent Antigen Detect Immunoassay, Qualitative Or Semiquantitative; Sars Antigen Fia",,87426,CPT,Facility,Outpatient,,,,82,69.7,23.5012,82,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,39.36,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Infectious Agent Antigen Detect Immunoassay, Qualitative Or Semiquantitative; Sars Antigen Fia",,87426,CPT,Facility,Inpatient,,,,82,69.7,23.5012,82,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Group A Streptococcus Screen,,87430,CPT,Facility,Both,,,,122,103.7,34.9652,122,Aetna,Commercial,112.24,92,,percent of total billed charges,,
Group A Streptococcus Screen,,87430,CPT,Facility,Outpatient,,,,122,103.7,34.9652,122,Aetna,Medicare Advantage,59.78,49,,percent of total billed charges,,
Group A Streptococcus Screen,,87430,CPT,Facility,Inpatient,,,,122,103.7,34.9652,122,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Group A Streptococcus Screen,,87430,CPT,Facility,Both,,,,122,103.7,34.9652,122,Aetna,PPO,113.46,93,,percent of total billed charges,,
Group A Streptococcus Screen,,87430,CPT,Facility,Both,,,,122,103.7,34.9652,122,America's PPO,America's PPO,117.1566,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Group A Streptococcus Screen,,87430,CPT,Facility,Both,,,,122,103.7,34.9652,122,BlueCross BlueShield Minnesota, Federal Employee Program,120.048,98.4,,percent of total billed charges,,
Group A Streptococcus Screen,,87430,CPT,Facility,Both,,,,122,103.7,34.9652,122,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,122,100,,percent of total billed charges,,
Group A Streptococcus Screen,,87430,CPT,Facility,Both,,,,122,103.7,34.9652,122,BlueCross BlueShield Minnesota,High Value Network Plan,109.8,90,,percent of total billed charges,,
Group A Streptococcus Screen,,87430,CPT,Facility,Outpatient,,,,122,103.7,34.9652,122,BlueCross BlueShield Minnesota,Medicare Advantage,59.78,49,,percent of total billed charges,,
Group A Streptococcus Screen,,87430,CPT,Facility,Inpatient,,,,122,103.7,34.9652,122,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Group A Streptococcus Screen,,87430,CPT,Facility,Both,,,,122,103.7,34.9652,122,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,108.0554,88.57,,percent of total billed charges,,
Group A Streptococcus Screen,,87430,CPT,Facility,Both,,,,122,103.7,34.9652,122,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,34.9652,28.66,,percent of total billed charges,,
Group A Streptococcus Screen,,87430,CPT,Facility,Outpatient,,,,122,103.7,34.9652,122,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),59.78,49,,percent of total billed charges,,
Group A Streptococcus Screen,,87430,CPT,Facility,Inpatient,,,,122,103.7,34.9652,122,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Group A Streptococcus Screen,,87430,CPT,Facility,Both,,,,122,103.7,34.9652,122,CorVel,Worker's Compensation,122,100,,percent of total billed charges,,
Group A Streptococcus Screen,,87430,CPT,Facility,Both,,,,122,103.7,34.9652,122,First Health Group Corporation,First Health Network,118.34,97,,percent of total billed charges,,
Group A Streptococcus Screen,,87430,CPT,Facility,Both,,,,122,103.7,34.9652,122,"Health Partners, Inc.",Commercial,115.412,94.6,,percent of total billed charges,,
Group A Streptococcus Screen,,87430,CPT,Facility,Outpatient,,,,122,103.7,34.9652,122,"Health Partners, Inc.",Medicare Advantage,59.78,49,,percent of total billed charges,,
Group A Streptococcus Screen,,87430,CPT,Facility,Inpatient,,,,122,103.7,34.9652,122,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Group A Streptococcus Screen,,87430,CPT,Facility,Both,,,,122,103.7,34.9652,122,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),73.2,60,,percent of total billed charges,,
Group A Streptococcus Screen,,87430,CPT,Facility,Both,,,,122,103.7,34.9652,122,"Health Partners, Inc.",State of Minnesota Advantage Program,99.43,81.5,,percent of total billed charges,,
Group A Streptococcus Screen,,87430,CPT,Facility,Both,,,,122,103.7,34.9652,122,"Health Partners, Inc.",State Public Programs,61,50,,percent of total billed charges,,
Group A Streptococcus Screen,,87430,CPT,Facility,Both,,,,122,103.7,34.9652,122,Humana Insurance Company,Commercial PPO,115.9,95,,percent of total billed charges,,
Group A Streptococcus Screen,,87430,CPT,Facility,Outpatient,,,,122,103.7,34.9652,122,Humana Insurance Company,Medicare PPO,59.78,49,,percent of total billed charges,,
Group A Streptococcus Screen,,87430,CPT,Facility,Inpatient,,,,122,103.7,34.9652,122,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Group A Streptococcus Screen,,87430,CPT,Facility,Both,,,,122,103.7,34.9652,122,Medica,Individual & Family,120.902,99.1,,percent of total billed charges,,
Group A Streptococcus Screen,,87430,CPT,Facility,Outpatient,,,,122,103.7,34.9652,122,Medica,Medica Advantage Solution,60.756,49.8,,percent of total billed charges,,
Group A Streptococcus Screen,,87430,CPT,Facility,Inpatient,,,,122,103.7,34.9652,122,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Group A Streptococcus Screen,,87430,CPT,Facility,Outpatient,,,,122,103.7,34.9652,122,Medica,Medical Assistance,54.412,44.6,,percent of total billed charges,,
Group A Streptococcus Screen,,87430,CPT,Facility,Inpatient,,,,122,103.7,34.9652,122,Medica,Medical Assistance,,,,,Included in per diem rate,
Group A Streptococcus Screen,,87430,CPT,Facility,Outpatient,,,,122,103.7,34.9652,122,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,60.756,49.8,,percent of total billed charges,,
Group A Streptococcus Screen,,87430,CPT,Facility,Inpatient,,,,122,103.7,34.9652,122,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Group A Streptococcus Screen,,87430,CPT,Facility,Both,,,,122,103.7,34.9652,122,"Multiplan, Inc.","Multiplan, Inc.",114.68,94,,percent of total billed charges,,
Group A Streptococcus Screen,,87430,CPT,Facility,Outpatient,,,,122,103.7,34.9652,122,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,105.408,86.4,,percent of total billed charges,,
Group A Streptococcus Screen,,87430,CPT,Facility,Inpatient,,,,122,103.7,34.9652,122,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Group A Streptococcus Screen,,87430,CPT,Facility,Both,,,,122,103.7,34.9652,122,"Preferred One Administrative Services, INC.",PPO,120.292,98.6,,percent of total billed charges,,
Group A Streptococcus Screen,,87430,CPT,Facility,Outpatient,,,,122,103.7,34.9652,122,PrimeWest Health,Minnesota Senior Health Options (MSHO),62.769,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Group A Streptococcus Screen,,87430,CPT,Facility,Inpatient,,,,122,103.7,34.9652,122,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Group A Streptococcus Screen,,87430,CPT,Facility,Outpatient,,,,122,103.7,34.9652,122,PrimeWest Health,MinnesotaCare,62.6592,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Group A Streptococcus Screen,,87430,CPT,Facility,Inpatient,,,,122,103.7,34.9652,122,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Group A Streptococcus Screen,,87430,CPT,Facility,Both,,,,122,103.7,34.9652,122,Sanford Health Plan,Sanford Health Plan,112.24,92,,percent of total billed charges,,
Group A Streptococcus Screen,,87430,CPT,Facility,Outpatient,,,,122,103.7,34.9652,122,"UCare Health, Inc.",Individual & Family Plan,68.747,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Group A Streptococcus Screen,,87430,CPT,Facility,Inpatient,,,,122,103.7,34.9652,122,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Group A Streptococcus Screen,,87430,CPT,Facility,Outpatient,,,,122,103.7,34.9652,122,"UCare Health, Inc.",Medical Assistance,61.5734,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Group A Streptococcus Screen,,87430,CPT,Facility,Inpatient,,,,122,103.7,34.9652,122,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Group A Streptococcus Screen,,87430,CPT,Facility,Outpatient,,,,122,103.7,34.9652,122,"UCare Health, Inc.",Medicare Advantage,61.5734,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Group A Streptococcus Screen,,87430,CPT,Facility,Inpatient,,,,122,103.7,34.9652,122,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Group A Streptococcus Screen,,87430,CPT,Facility,Outpatient,,,,122,103.7,34.9652,122,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),61.5734,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Group A Streptococcus Screen,,87430,CPT,Facility,Inpatient,,,,122,103.7,34.9652,122,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Group A Streptococcus Screen,,87430,CPT,Facility,Both,,,,122,103.7,34.9652,122,UnitedHealthcare,Individual & Family,114.68,94,,percent of total billed charges,,
Group A Streptococcus Screen,,87430,CPT,Facility,Outpatient,,,,122,103.7,34.9652,122,UnitedHealthcare,Medicare Advantage,59.78,49,,percent of total billed charges,,
Group A Streptococcus Screen,,87430,CPT,Facility,Inpatient,,,,122,103.7,34.9652,122,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Group A Streptococcus Screen,,87430,CPT,Facility,Outpatient,,,,122,103.7,34.9652,122,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,58.56,48,,percent of total billed charges,,100% of DHS outpatient percentage
Group A Streptococcus Screen,,87430,CPT,Facility,Inpatient,,,,122,103.7,34.9652,122,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Iaad Ia Not Otherwise Specified Each Organism,,87449,CPT,Facility,Both,,,,75,63.75,21.495,75,Aetna,Commercial,69,92,,percent of total billed charges,,
Iaad Ia Not Otherwise Specified Each Organism,,87449,CPT,Facility,Outpatient,,,,75,63.75,21.495,75,Aetna,Medicare Advantage,36.75,49,,percent of total billed charges,,
Iaad Ia Not Otherwise Specified Each Organism,,87449,CPT,Facility,Inpatient,,,,75,63.75,21.495,75,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Iaad Ia Not Otherwise Specified Each Organism,,87449,CPT,Facility,Both,,,,75,63.75,21.495,75,Aetna,PPO,69.75,93,,percent of total billed charges,,
Iaad Ia Not Otherwise Specified Each Organism,,87449,CPT,Facility,Both,,,,75,63.75,21.495,75,America's PPO,America's PPO,72.0225,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Iaad Ia Not Otherwise Specified Each Organism,,87449,CPT,Facility,Both,,,,75,63.75,21.495,75,BlueCross BlueShield Minnesota, Federal Employee Program,73.8,98.4,,percent of total billed charges,,
Iaad Ia Not Otherwise Specified Each Organism,,87449,CPT,Facility,Both,,,,75,63.75,21.495,75,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,75,100,,percent of total billed charges,,
Iaad Ia Not Otherwise Specified Each Organism,,87449,CPT,Facility,Both,,,,75,63.75,21.495,75,BlueCross BlueShield Minnesota,High Value Network Plan,67.5,90,,percent of total billed charges,,
Iaad Ia Not Otherwise Specified Each Organism,,87449,CPT,Facility,Outpatient,,,,75,63.75,21.495,75,BlueCross BlueShield Minnesota,Medicare Advantage,36.75,49,,percent of total billed charges,,
Iaad Ia Not Otherwise Specified Each Organism,,87449,CPT,Facility,Inpatient,,,,75,63.75,21.495,75,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Iaad Ia Not Otherwise Specified Each Organism,,87449,CPT,Facility,Both,,,,75,63.75,21.495,75,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,66.4275,88.57,,percent of total billed charges,,
Iaad Ia Not Otherwise Specified Each Organism,,87449,CPT,Facility,Both,,,,75,63.75,21.495,75,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,21.495,28.66,,percent of total billed charges,,
Iaad Ia Not Otherwise Specified Each Organism,,87449,CPT,Facility,Outpatient,,,,75,63.75,21.495,75,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),36.75,49,,percent of total billed charges,,
Iaad Ia Not Otherwise Specified Each Organism,,87449,CPT,Facility,Inpatient,,,,75,63.75,21.495,75,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Iaad Ia Not Otherwise Specified Each Organism,,87449,CPT,Facility,Both,,,,75,63.75,21.495,75,CorVel,Worker's Compensation,75,100,,percent of total billed charges,,
Iaad Ia Not Otherwise Specified Each Organism,,87449,CPT,Facility,Both,,,,75,63.75,21.495,75,First Health Group Corporation,First Health Network,72.75,97,,percent of total billed charges,,
Iaad Ia Not Otherwise Specified Each Organism,,87449,CPT,Facility,Both,,,,75,63.75,21.495,75,"Health Partners, Inc.",Commercial,70.95,94.6,,percent of total billed charges,,
Iaad Ia Not Otherwise Specified Each Organism,,87449,CPT,Facility,Outpatient,,,,75,63.75,21.495,75,"Health Partners, Inc.",Medicare Advantage,36.75,49,,percent of total billed charges,,
Iaad Ia Not Otherwise Specified Each Organism,,87449,CPT,Facility,Inpatient,,,,75,63.75,21.495,75,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Iaad Ia Not Otherwise Specified Each Organism,,87449,CPT,Facility,Both,,,,75,63.75,21.495,75,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),45,60,,percent of total billed charges,,
Iaad Ia Not Otherwise Specified Each Organism,,87449,CPT,Facility,Both,,,,75,63.75,21.495,75,"Health Partners, Inc.",State of Minnesota Advantage Program,61.125,81.5,,percent of total billed charges,,
Iaad Ia Not Otherwise Specified Each Organism,,87449,CPT,Facility,Both,,,,75,63.75,21.495,75,"Health Partners, Inc.",State Public Programs,37.5,50,,percent of total billed charges,,
Iaad Ia Not Otherwise Specified Each Organism,,87449,CPT,Facility,Both,,,,75,63.75,21.495,75,Humana Insurance Company,Commercial PPO,71.25,95,,percent of total billed charges,,
Iaad Ia Not Otherwise Specified Each Organism,,87449,CPT,Facility,Outpatient,,,,75,63.75,21.495,75,Humana Insurance Company,Medicare PPO,36.75,49,,percent of total billed charges,,
Iaad Ia Not Otherwise Specified Each Organism,,87449,CPT,Facility,Inpatient,,,,75,63.75,21.495,75,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Iaad Ia Not Otherwise Specified Each Organism,,87449,CPT,Facility,Both,,,,75,63.75,21.495,75,Medica,Individual & Family,74.325,99.1,,percent of total billed charges,,
Iaad Ia Not Otherwise Specified Each Organism,,87449,CPT,Facility,Outpatient,,,,75,63.75,21.495,75,Medica,Medica Advantage Solution,37.35,49.8,,percent of total billed charges,,
Iaad Ia Not Otherwise Specified Each Organism,,87449,CPT,Facility,Inpatient,,,,75,63.75,21.495,75,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Iaad Ia Not Otherwise Specified Each Organism,,87449,CPT,Facility,Outpatient,,,,75,63.75,21.495,75,Medica,Medical Assistance,33.45,44.6,,percent of total billed charges,,
Iaad Ia Not Otherwise Specified Each Organism,,87449,CPT,Facility,Inpatient,,,,75,63.75,21.495,75,Medica,Medical Assistance,,,,,Included in per diem rate,
Iaad Ia Not Otherwise Specified Each Organism,,87449,CPT,Facility,Outpatient,,,,75,63.75,21.495,75,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,37.35,49.8,,percent of total billed charges,,
Iaad Ia Not Otherwise Specified Each Organism,,87449,CPT,Facility,Inpatient,,,,75,63.75,21.495,75,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Iaad Ia Not Otherwise Specified Each Organism,,87449,CPT,Facility,Both,,,,75,63.75,21.495,75,"Multiplan, Inc.","Multiplan, Inc.",70.5,94,,percent of total billed charges,,
Iaad Ia Not Otherwise Specified Each Organism,,87449,CPT,Facility,Outpatient,,,,75,63.75,21.495,75,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,64.8,86.4,,percent of total billed charges,,
Iaad Ia Not Otherwise Specified Each Organism,,87449,CPT,Facility,Inpatient,,,,75,63.75,21.495,75,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Iaad Ia Not Otherwise Specified Each Organism,,87449,CPT,Facility,Both,,,,75,63.75,21.495,75,"Preferred One Administrative Services, INC.",PPO,73.95,98.6,,percent of total billed charges,,
Iaad Ia Not Otherwise Specified Each Organism,,87449,CPT,Facility,Outpatient,,,,75,63.75,21.495,75,PrimeWest Health,Minnesota Senior Health Options (MSHO),38.5875,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Iaad Ia Not Otherwise Specified Each Organism,,87449,CPT,Facility,Inpatient,,,,75,63.75,21.495,75,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Iaad Ia Not Otherwise Specified Each Organism,,87449,CPT,Facility,Outpatient,,,,75,63.75,21.495,75,PrimeWest Health,MinnesotaCare,38.52,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Iaad Ia Not Otherwise Specified Each Organism,,87449,CPT,Facility,Inpatient,,,,75,63.75,21.495,75,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Iaad Ia Not Otherwise Specified Each Organism,,87449,CPT,Facility,Both,,,,75,63.75,21.495,75,Sanford Health Plan,Sanford Health Plan,69,92,,percent of total billed charges,,
Iaad Ia Not Otherwise Specified Each Organism,,87449,CPT,Facility,Outpatient,,,,75,63.75,21.495,75,"UCare Health, Inc.",Individual & Family Plan,42.2625,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Iaad Ia Not Otherwise Specified Each Organism,,87449,CPT,Facility,Inpatient,,,,75,63.75,21.495,75,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Iaad Ia Not Otherwise Specified Each Organism,,87449,CPT,Facility,Outpatient,,,,75,63.75,21.495,75,"UCare Health, Inc.",Medical Assistance,37.8525,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Iaad Ia Not Otherwise Specified Each Organism,,87449,CPT,Facility,Inpatient,,,,75,63.75,21.495,75,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Iaad Ia Not Otherwise Specified Each Organism,,87449,CPT,Facility,Outpatient,,,,75,63.75,21.495,75,"UCare Health, Inc.",Medicare Advantage,37.8525,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Iaad Ia Not Otherwise Specified Each Organism,,87449,CPT,Facility,Inpatient,,,,75,63.75,21.495,75,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Iaad Ia Not Otherwise Specified Each Organism,,87449,CPT,Facility,Outpatient,,,,75,63.75,21.495,75,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),37.8525,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Iaad Ia Not Otherwise Specified Each Organism,,87449,CPT,Facility,Inpatient,,,,75,63.75,21.495,75,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Iaad Ia Not Otherwise Specified Each Organism,,87449,CPT,Facility,Both,,,,75,63.75,21.495,75,UnitedHealthcare,Individual & Family,70.5,94,,percent of total billed charges,,
Iaad Ia Not Otherwise Specified Each Organism,,87449,CPT,Facility,Outpatient,,,,75,63.75,21.495,75,UnitedHealthcare,Medicare Advantage,36.75,49,,percent of total billed charges,,
Iaad Ia Not Otherwise Specified Each Organism,,87449,CPT,Facility,Inpatient,,,,75,63.75,21.495,75,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Iaad Ia Not Otherwise Specified Each Organism,,87449,CPT,Facility,Outpatient,,,,75,63.75,21.495,75,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,36,48,,percent of total billed charges,,100% of DHS outpatient percentage
Iaad Ia Not Otherwise Specified Each Organism,,87449,CPT,Facility,Inpatient,,,,75,63.75,21.495,75,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Urine Legionella Antigen,,87449,CPT,Facility,Both,,,,162,137.7,46.4292,162,Aetna,Commercial,149.04,92,,percent of total billed charges,,
Urine Legionella Antigen,,87449,CPT,Facility,Outpatient,,,,162,137.7,46.4292,162,Aetna,Medicare Advantage,79.38,49,,percent of total billed charges,,
Urine Legionella Antigen,,87449,CPT,Facility,Inpatient,,,,162,137.7,46.4292,162,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Urine Legionella Antigen,,87449,CPT,Facility,Both,,,,162,137.7,46.4292,162,Aetna,PPO,150.66,93,,percent of total billed charges,,
Urine Legionella Antigen,,87449,CPT,Facility,Both,,,,162,137.7,46.4292,162,America's PPO,America's PPO,155.5686,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Urine Legionella Antigen,,87449,CPT,Facility,Both,,,,162,137.7,46.4292,162,BlueCross BlueShield Minnesota, Federal Employee Program,159.408,98.4,,percent of total billed charges,,
Urine Legionella Antigen,,87449,CPT,Facility,Both,,,,162,137.7,46.4292,162,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,162,100,,percent of total billed charges,,
Urine Legionella Antigen,,87449,CPT,Facility,Both,,,,162,137.7,46.4292,162,BlueCross BlueShield Minnesota,High Value Network Plan,145.8,90,,percent of total billed charges,,
Urine Legionella Antigen,,87449,CPT,Facility,Outpatient,,,,162,137.7,46.4292,162,BlueCross BlueShield Minnesota,Medicare Advantage,79.38,49,,percent of total billed charges,,
Urine Legionella Antigen,,87449,CPT,Facility,Inpatient,,,,162,137.7,46.4292,162,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Urine Legionella Antigen,,87449,CPT,Facility,Both,,,,162,137.7,46.4292,162,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,143.4834,88.57,,percent of total billed charges,,
Urine Legionella Antigen,,87449,CPT,Facility,Both,,,,162,137.7,46.4292,162,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,46.4292,28.66,,percent of total billed charges,,
Urine Legionella Antigen,,87449,CPT,Facility,Outpatient,,,,162,137.7,46.4292,162,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),79.38,49,,percent of total billed charges,,
Urine Legionella Antigen,,87449,CPT,Facility,Inpatient,,,,162,137.7,46.4292,162,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Urine Legionella Antigen,,87449,CPT,Facility,Both,,,,162,137.7,46.4292,162,CorVel,Worker's Compensation,162,100,,percent of total billed charges,,
Urine Legionella Antigen,,87449,CPT,Facility,Both,,,,162,137.7,46.4292,162,First Health Group Corporation,First Health Network,157.14,97,,percent of total billed charges,,
Urine Legionella Antigen,,87449,CPT,Facility,Both,,,,162,137.7,46.4292,162,"Health Partners, Inc.",Commercial,153.252,94.6,,percent of total billed charges,,
Urine Legionella Antigen,,87449,CPT,Facility,Outpatient,,,,162,137.7,46.4292,162,"Health Partners, Inc.",Medicare Advantage,79.38,49,,percent of total billed charges,,
Urine Legionella Antigen,,87449,CPT,Facility,Inpatient,,,,162,137.7,46.4292,162,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Urine Legionella Antigen,,87449,CPT,Facility,Both,,,,162,137.7,46.4292,162,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),97.2,60,,percent of total billed charges,,
Urine Legionella Antigen,,87449,CPT,Facility,Both,,,,162,137.7,46.4292,162,"Health Partners, Inc.",State of Minnesota Advantage Program,132.03,81.5,,percent of total billed charges,,
Urine Legionella Antigen,,87449,CPT,Facility,Both,,,,162,137.7,46.4292,162,"Health Partners, Inc.",State Public Programs,81,50,,percent of total billed charges,,
Urine Legionella Antigen,,87449,CPT,Facility,Both,,,,162,137.7,46.4292,162,Humana Insurance Company,Commercial PPO,153.9,95,,percent of total billed charges,,
Urine Legionella Antigen,,87449,CPT,Facility,Outpatient,,,,162,137.7,46.4292,162,Humana Insurance Company,Medicare PPO,79.38,49,,percent of total billed charges,,
Urine Legionella Antigen,,87449,CPT,Facility,Inpatient,,,,162,137.7,46.4292,162,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Urine Legionella Antigen,,87449,CPT,Facility,Both,,,,162,137.7,46.4292,162,Medica,Individual & Family,160.542,99.1,,percent of total billed charges,,
Urine Legionella Antigen,,87449,CPT,Facility,Outpatient,,,,162,137.7,46.4292,162,Medica,Medica Advantage Solution,80.676,49.8,,percent of total billed charges,,
Urine Legionella Antigen,,87449,CPT,Facility,Inpatient,,,,162,137.7,46.4292,162,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Urine Legionella Antigen,,87449,CPT,Facility,Outpatient,,,,162,137.7,46.4292,162,Medica,Medical Assistance,72.252,44.6,,percent of total billed charges,,
Urine Legionella Antigen,,87449,CPT,Facility,Inpatient,,,,162,137.7,46.4292,162,Medica,Medical Assistance,,,,,Included in per diem rate,
Urine Legionella Antigen,,87449,CPT,Facility,Outpatient,,,,162,137.7,46.4292,162,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,80.676,49.8,,percent of total billed charges,,
Urine Legionella Antigen,,87449,CPT,Facility,Inpatient,,,,162,137.7,46.4292,162,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Urine Legionella Antigen,,87449,CPT,Facility,Both,,,,162,137.7,46.4292,162,"Multiplan, Inc.","Multiplan, Inc.",152.28,94,,percent of total billed charges,,
Urine Legionella Antigen,,87449,CPT,Facility,Outpatient,,,,162,137.7,46.4292,162,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,139.968,86.4,,percent of total billed charges,,
Urine Legionella Antigen,,87449,CPT,Facility,Inpatient,,,,162,137.7,46.4292,162,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Urine Legionella Antigen,,87449,CPT,Facility,Both,,,,162,137.7,46.4292,162,"Preferred One Administrative Services, INC.",PPO,159.732,98.6,,percent of total billed charges,,
Urine Legionella Antigen,,87449,CPT,Facility,Outpatient,,,,162,137.7,46.4292,162,PrimeWest Health,Minnesota Senior Health Options (MSHO),83.349,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Urine Legionella Antigen,,87449,CPT,Facility,Inpatient,,,,162,137.7,46.4292,162,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Urine Legionella Antigen,,87449,CPT,Facility,Outpatient,,,,162,137.7,46.4292,162,PrimeWest Health,MinnesotaCare,83.2032,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Urine Legionella Antigen,,87449,CPT,Facility,Inpatient,,,,162,137.7,46.4292,162,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Urine Legionella Antigen,,87449,CPT,Facility,Both,,,,162,137.7,46.4292,162,Sanford Health Plan,Sanford Health Plan,149.04,92,,percent of total billed charges,,
Urine Legionella Antigen,,87449,CPT,Facility,Outpatient,,,,162,137.7,46.4292,162,"UCare Health, Inc.",Individual & Family Plan,91.287,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Urine Legionella Antigen,,87449,CPT,Facility,Inpatient,,,,162,137.7,46.4292,162,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Urine Legionella Antigen,,87449,CPT,Facility,Outpatient,,,,162,137.7,46.4292,162,"UCare Health, Inc.",Medical Assistance,81.7614,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Urine Legionella Antigen,,87449,CPT,Facility,Inpatient,,,,162,137.7,46.4292,162,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Urine Legionella Antigen,,87449,CPT,Facility,Outpatient,,,,162,137.7,46.4292,162,"UCare Health, Inc.",Medicare Advantage,81.7614,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Urine Legionella Antigen,,87449,CPT,Facility,Inpatient,,,,162,137.7,46.4292,162,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Urine Legionella Antigen,,87449,CPT,Facility,Outpatient,,,,162,137.7,46.4292,162,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),81.7614,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Urine Legionella Antigen,,87449,CPT,Facility,Inpatient,,,,162,137.7,46.4292,162,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Urine Legionella Antigen,,87449,CPT,Facility,Both,,,,162,137.7,46.4292,162,UnitedHealthcare,Individual & Family,152.28,94,,percent of total billed charges,,
Urine Legionella Antigen,,87449,CPT,Facility,Outpatient,,,,162,137.7,46.4292,162,UnitedHealthcare,Medicare Advantage,79.38,49,,percent of total billed charges,,
Urine Legionella Antigen,,87449,CPT,Facility,Inpatient,,,,162,137.7,46.4292,162,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Urine Legionella Antigen,,87449,CPT,Facility,Outpatient,,,,162,137.7,46.4292,162,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,77.76,48,,percent of total billed charges,,100% of DHS outpatient percentage
Urine Legionella Antigen,,87449,CPT,Facility,Inpatient,,,,162,137.7,46.4292,162,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Infectious Agent Detection By Nucleic Acid; Chlamydia Pneumoniae, Amplified Probe",,87486,CPT,Facility,Both,,,,51,43.35,14.6166,51,Aetna,Commercial,46.92,92,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid; Chlamydia Pneumoniae, Amplified Probe",,87486,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,Aetna,Medicare Advantage,24.99,49,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid; Chlamydia Pneumoniae, Amplified Probe",,87486,CPT,Facility,Inpatient,,,,51,43.35,14.6166,51,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Infectious Agent Detection By Nucleic Acid; Chlamydia Pneumoniae, Amplified Probe",,87486,CPT,Facility,Both,,,,51,43.35,14.6166,51,Aetna,PPO,47.43,93,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid; Chlamydia Pneumoniae, Amplified Probe",,87486,CPT,Facility,Both,,,,51,43.35,14.6166,51,America's PPO,America's PPO,48.9753,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Infectious Agent Detection By Nucleic Acid; Chlamydia Pneumoniae, Amplified Probe",,87486,CPT,Facility,Both,,,,51,43.35,14.6166,51,BlueCross BlueShield Minnesota, Federal Employee Program,50.184,98.4,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid; Chlamydia Pneumoniae, Amplified Probe",,87486,CPT,Facility,Both,,,,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,51,100,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid; Chlamydia Pneumoniae, Amplified Probe",,87486,CPT,Facility,Both,,,,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,High Value Network Plan,45.9,90,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid; Chlamydia Pneumoniae, Amplified Probe",,87486,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,Medicare Advantage,24.99,49,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid; Chlamydia Pneumoniae, Amplified Probe",,87486,CPT,Facility,Inpatient,,,,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Infectious Agent Detection By Nucleic Acid; Chlamydia Pneumoniae, Amplified Probe",,87486,CPT,Facility,Both,,,,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,45.1707,88.57,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid; Chlamydia Pneumoniae, Amplified Probe",,87486,CPT,Facility,Both,,,,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,14.6166,28.66,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid; Chlamydia Pneumoniae, Amplified Probe",,87486,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),24.99,49,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid; Chlamydia Pneumoniae, Amplified Probe",,87486,CPT,Facility,Inpatient,,,,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Infectious Agent Detection By Nucleic Acid; Chlamydia Pneumoniae, Amplified Probe",,87486,CPT,Facility,Both,,,,51,43.35,14.6166,51,CorVel,Worker's Compensation,51,100,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid; Chlamydia Pneumoniae, Amplified Probe",,87486,CPT,Facility,Both,,,,51,43.35,14.6166,51,First Health Group Corporation,First Health Network,49.47,97,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid; Chlamydia Pneumoniae, Amplified Probe",,87486,CPT,Facility,Both,,,,51,43.35,14.6166,51,"Health Partners, Inc.",Commercial,48.246,94.6,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid; Chlamydia Pneumoniae, Amplified Probe",,87486,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,"Health Partners, Inc.",Medicare Advantage,24.99,49,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid; Chlamydia Pneumoniae, Amplified Probe",,87486,CPT,Facility,Inpatient,,,,51,43.35,14.6166,51,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Infectious Agent Detection By Nucleic Acid; Chlamydia Pneumoniae, Amplified Probe",,87486,CPT,Facility,Both,,,,51,43.35,14.6166,51,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),30.6,60,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid; Chlamydia Pneumoniae, Amplified Probe",,87486,CPT,Facility,Both,,,,51,43.35,14.6166,51,"Health Partners, Inc.",State of Minnesota Advantage Program,41.565,81.5,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid; Chlamydia Pneumoniae, Amplified Probe",,87486,CPT,Facility,Both,,,,51,43.35,14.6166,51,"Health Partners, Inc.",State Public Programs,25.5,50,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid; Chlamydia Pneumoniae, Amplified Probe",,87486,CPT,Facility,Both,,,,51,43.35,14.6166,51,Humana Insurance Company,Commercial PPO,48.45,95,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid; Chlamydia Pneumoniae, Amplified Probe",,87486,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,Humana Insurance Company,Medicare PPO,24.99,49,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid; Chlamydia Pneumoniae, Amplified Probe",,87486,CPT,Facility,Inpatient,,,,51,43.35,14.6166,51,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Infectious Agent Detection By Nucleic Acid; Chlamydia Pneumoniae, Amplified Probe",,87486,CPT,Facility,Both,,,,51,43.35,14.6166,51,Medica,Individual & Family,50.541,99.1,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid; Chlamydia Pneumoniae, Amplified Probe",,87486,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,Medica,Medica Advantage Solution,25.398,49.8,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid; Chlamydia Pneumoniae, Amplified Probe",,87486,CPT,Facility,Inpatient,,,,51,43.35,14.6166,51,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Infectious Agent Detection By Nucleic Acid; Chlamydia Pneumoniae, Amplified Probe",,87486,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,Medica,Medical Assistance,22.746,44.6,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid; Chlamydia Pneumoniae, Amplified Probe",,87486,CPT,Facility,Inpatient,,,,51,43.35,14.6166,51,Medica,Medical Assistance,,,,,Included in per diem rate,
"Infectious Agent Detection By Nucleic Acid; Chlamydia Pneumoniae, Amplified Probe",,87486,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,25.398,49.8,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid; Chlamydia Pneumoniae, Amplified Probe",,87486,CPT,Facility,Inpatient,,,,51,43.35,14.6166,51,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Infectious Agent Detection By Nucleic Acid; Chlamydia Pneumoniae, Amplified Probe",,87486,CPT,Facility,Both,,,,51,43.35,14.6166,51,"Multiplan, Inc.","Multiplan, Inc.",47.94,94,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid; Chlamydia Pneumoniae, Amplified Probe",,87486,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,44.064,86.4,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid; Chlamydia Pneumoniae, Amplified Probe",,87486,CPT,Facility,Inpatient,,,,51,43.35,14.6166,51,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Infectious Agent Detection By Nucleic Acid; Chlamydia Pneumoniae, Amplified Probe",,87486,CPT,Facility,Both,,,,51,43.35,14.6166,51,"Preferred One Administrative Services, INC.",PPO,50.286,98.6,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid; Chlamydia Pneumoniae, Amplified Probe",,87486,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,PrimeWest Health,Minnesota Senior Health Options (MSHO),26.2395,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Infectious Agent Detection By Nucleic Acid; Chlamydia Pneumoniae, Amplified Probe",,87486,CPT,Facility,Inpatient,,,,51,43.35,14.6166,51,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Infectious Agent Detection By Nucleic Acid; Chlamydia Pneumoniae, Amplified Probe",,87486,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,PrimeWest Health,MinnesotaCare,26.1936,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Infectious Agent Detection By Nucleic Acid; Chlamydia Pneumoniae, Amplified Probe",,87486,CPT,Facility,Inpatient,,,,51,43.35,14.6166,51,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Infectious Agent Detection By Nucleic Acid; Chlamydia Pneumoniae, Amplified Probe",,87486,CPT,Facility,Both,,,,51,43.35,14.6166,51,Sanford Health Plan,Sanford Health Plan,46.92,92,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid; Chlamydia Pneumoniae, Amplified Probe",,87486,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,"UCare Health, Inc.",Individual & Family Plan,28.7385,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Infectious Agent Detection By Nucleic Acid; Chlamydia Pneumoniae, Amplified Probe",,87486,CPT,Facility,Inpatient,,,,51,43.35,14.6166,51,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Infectious Agent Detection By Nucleic Acid; Chlamydia Pneumoniae, Amplified Probe",,87486,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,"UCare Health, Inc.",Medical Assistance,25.7397,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Infectious Agent Detection By Nucleic Acid; Chlamydia Pneumoniae, Amplified Probe",,87486,CPT,Facility,Inpatient,,,,51,43.35,14.6166,51,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Infectious Agent Detection By Nucleic Acid; Chlamydia Pneumoniae, Amplified Probe",,87486,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,"UCare Health, Inc.",Medicare Advantage,25.7397,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Infectious Agent Detection By Nucleic Acid; Chlamydia Pneumoniae, Amplified Probe",,87486,CPT,Facility,Inpatient,,,,51,43.35,14.6166,51,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Infectious Agent Detection By Nucleic Acid; Chlamydia Pneumoniae, Amplified Probe",,87486,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),25.7397,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Infectious Agent Detection By Nucleic Acid; Chlamydia Pneumoniae, Amplified Probe",,87486,CPT,Facility,Inpatient,,,,51,43.35,14.6166,51,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Infectious Agent Detection By Nucleic Acid; Chlamydia Pneumoniae, Amplified Probe",,87486,CPT,Facility,Both,,,,51,43.35,14.6166,51,UnitedHealthcare,Individual & Family,47.94,94,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid; Chlamydia Pneumoniae, Amplified Probe",,87486,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,UnitedHealthcare,Medicare Advantage,24.99,49,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid; Chlamydia Pneumoniae, Amplified Probe",,87486,CPT,Facility,Inpatient,,,,51,43.35,14.6166,51,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Infectious Agent Detection By Nucleic Acid; Chlamydia Pneumoniae, Amplified Probe",,87486,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,24.48,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Infectious Agent Detection By Nucleic Acid; Chlamydia Pneumoniae, Amplified Probe",,87486,CPT,Facility,Inpatient,,,,51,43.35,14.6166,51,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Chlamydia Trachomatis And Neisseria Gonorrhoeae, Genital And Urine Sources, Naat",,87491,CPT,Facility,Both,,,,134,113.9,38.4044,134,Aetna,Commercial,123.28,92,,percent of total billed charges,,
"Chlamydia Trachomatis And Neisseria Gonorrhoeae, Genital And Urine Sources, Naat",,87491,CPT,Facility,Outpatient,,,,134,113.9,38.4044,134,Aetna,Medicare Advantage,65.66,49,,percent of total billed charges,,
"Chlamydia Trachomatis And Neisseria Gonorrhoeae, Genital And Urine Sources, Naat",,87491,CPT,Facility,Inpatient,,,,134,113.9,38.4044,134,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Chlamydia Trachomatis And Neisseria Gonorrhoeae, Genital And Urine Sources, Naat",,87491,CPT,Facility,Both,,,,134,113.9,38.4044,134,Aetna,PPO,124.62,93,,percent of total billed charges,,
"Chlamydia Trachomatis And Neisseria Gonorrhoeae, Genital And Urine Sources, Naat",,87491,CPT,Facility,Both,,,,134,113.9,38.4044,134,America's PPO,America's PPO,128.6802,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Chlamydia Trachomatis And Neisseria Gonorrhoeae, Genital And Urine Sources, Naat",,87491,CPT,Facility,Both,,,,134,113.9,38.4044,134,BlueCross BlueShield Minnesota, Federal Employee Program,131.856,98.4,,percent of total billed charges,,
"Chlamydia Trachomatis And Neisseria Gonorrhoeae, Genital And Urine Sources, Naat",,87491,CPT,Facility,Both,,,,134,113.9,38.4044,134,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,134,100,,percent of total billed charges,,
"Chlamydia Trachomatis And Neisseria Gonorrhoeae, Genital And Urine Sources, Naat",,87491,CPT,Facility,Both,,,,134,113.9,38.4044,134,BlueCross BlueShield Minnesota,High Value Network Plan,120.6,90,,percent of total billed charges,,
"Chlamydia Trachomatis And Neisseria Gonorrhoeae, Genital And Urine Sources, Naat",,87491,CPT,Facility,Outpatient,,,,134,113.9,38.4044,134,BlueCross BlueShield Minnesota,Medicare Advantage,65.66,49,,percent of total billed charges,,
"Chlamydia Trachomatis And Neisseria Gonorrhoeae, Genital And Urine Sources, Naat",,87491,CPT,Facility,Inpatient,,,,134,113.9,38.4044,134,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Chlamydia Trachomatis And Neisseria Gonorrhoeae, Genital And Urine Sources, Naat",,87491,CPT,Facility,Both,,,,134,113.9,38.4044,134,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,118.6838,88.57,,percent of total billed charges,,
"Chlamydia Trachomatis And Neisseria Gonorrhoeae, Genital And Urine Sources, Naat",,87491,CPT,Facility,Both,,,,134,113.9,38.4044,134,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,38.4044,28.66,,percent of total billed charges,,
"Chlamydia Trachomatis And Neisseria Gonorrhoeae, Genital And Urine Sources, Naat",,87491,CPT,Facility,Outpatient,,,,134,113.9,38.4044,134,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),65.66,49,,percent of total billed charges,,
"Chlamydia Trachomatis And Neisseria Gonorrhoeae, Genital And Urine Sources, Naat",,87491,CPT,Facility,Inpatient,,,,134,113.9,38.4044,134,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Chlamydia Trachomatis And Neisseria Gonorrhoeae, Genital And Urine Sources, Naat",,87491,CPT,Facility,Both,,,,134,113.9,38.4044,134,CorVel,Worker's Compensation,134,100,,percent of total billed charges,,
"Chlamydia Trachomatis And Neisseria Gonorrhoeae, Genital And Urine Sources, Naat",,87491,CPT,Facility,Both,,,,134,113.9,38.4044,134,First Health Group Corporation,First Health Network,129.98,97,,percent of total billed charges,,
"Chlamydia Trachomatis And Neisseria Gonorrhoeae, Genital And Urine Sources, Naat",,87491,CPT,Facility,Both,,,,134,113.9,38.4044,134,"Health Partners, Inc.",Commercial,126.764,94.6,,percent of total billed charges,,
"Chlamydia Trachomatis And Neisseria Gonorrhoeae, Genital And Urine Sources, Naat",,87491,CPT,Facility,Outpatient,,,,134,113.9,38.4044,134,"Health Partners, Inc.",Medicare Advantage,65.66,49,,percent of total billed charges,,
"Chlamydia Trachomatis And Neisseria Gonorrhoeae, Genital And Urine Sources, Naat",,87491,CPT,Facility,Inpatient,,,,134,113.9,38.4044,134,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Chlamydia Trachomatis And Neisseria Gonorrhoeae, Genital And Urine Sources, Naat",,87491,CPT,Facility,Both,,,,134,113.9,38.4044,134,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),80.4,60,,percent of total billed charges,,
"Chlamydia Trachomatis And Neisseria Gonorrhoeae, Genital And Urine Sources, Naat",,87491,CPT,Facility,Both,,,,134,113.9,38.4044,134,"Health Partners, Inc.",State of Minnesota Advantage Program,109.21,81.5,,percent of total billed charges,,
"Chlamydia Trachomatis And Neisseria Gonorrhoeae, Genital And Urine Sources, Naat",,87491,CPT,Facility,Both,,,,134,113.9,38.4044,134,"Health Partners, Inc.",State Public Programs,67,50,,percent of total billed charges,,
"Chlamydia Trachomatis And Neisseria Gonorrhoeae, Genital And Urine Sources, Naat",,87491,CPT,Facility,Both,,,,134,113.9,38.4044,134,Humana Insurance Company,Commercial PPO,127.3,95,,percent of total billed charges,,
"Chlamydia Trachomatis And Neisseria Gonorrhoeae, Genital And Urine Sources, Naat",,87491,CPT,Facility,Outpatient,,,,134,113.9,38.4044,134,Humana Insurance Company,Medicare PPO,65.66,49,,percent of total billed charges,,
"Chlamydia Trachomatis And Neisseria Gonorrhoeae, Genital And Urine Sources, Naat",,87491,CPT,Facility,Inpatient,,,,134,113.9,38.4044,134,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Chlamydia Trachomatis And Neisseria Gonorrhoeae, Genital And Urine Sources, Naat",,87491,CPT,Facility,Both,,,,134,113.9,38.4044,134,Medica,Individual & Family,132.794,99.1,,percent of total billed charges,,
"Chlamydia Trachomatis And Neisseria Gonorrhoeae, Genital And Urine Sources, Naat",,87491,CPT,Facility,Outpatient,,,,134,113.9,38.4044,134,Medica,Medica Advantage Solution,66.732,49.8,,percent of total billed charges,,
"Chlamydia Trachomatis And Neisseria Gonorrhoeae, Genital And Urine Sources, Naat",,87491,CPT,Facility,Inpatient,,,,134,113.9,38.4044,134,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Chlamydia Trachomatis And Neisseria Gonorrhoeae, Genital And Urine Sources, Naat",,87491,CPT,Facility,Outpatient,,,,134,113.9,38.4044,134,Medica,Medical Assistance,59.764,44.6,,percent of total billed charges,,
"Chlamydia Trachomatis And Neisseria Gonorrhoeae, Genital And Urine Sources, Naat",,87491,CPT,Facility,Inpatient,,,,134,113.9,38.4044,134,Medica,Medical Assistance,,,,,Included in per diem rate,
"Chlamydia Trachomatis And Neisseria Gonorrhoeae, Genital And Urine Sources, Naat",,87491,CPT,Facility,Outpatient,,,,134,113.9,38.4044,134,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,66.732,49.8,,percent of total billed charges,,
"Chlamydia Trachomatis And Neisseria Gonorrhoeae, Genital And Urine Sources, Naat",,87491,CPT,Facility,Inpatient,,,,134,113.9,38.4044,134,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Chlamydia Trachomatis And Neisseria Gonorrhoeae, Genital And Urine Sources, Naat",,87491,CPT,Facility,Both,,,,134,113.9,38.4044,134,"Multiplan, Inc.","Multiplan, Inc.",125.96,94,,percent of total billed charges,,
"Chlamydia Trachomatis And Neisseria Gonorrhoeae, Genital And Urine Sources, Naat",,87491,CPT,Facility,Outpatient,,,,134,113.9,38.4044,134,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,115.776,86.4,,percent of total billed charges,,
"Chlamydia Trachomatis And Neisseria Gonorrhoeae, Genital And Urine Sources, Naat",,87491,CPT,Facility,Inpatient,,,,134,113.9,38.4044,134,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Chlamydia Trachomatis And Neisseria Gonorrhoeae, Genital And Urine Sources, Naat",,87491,CPT,Facility,Both,,,,134,113.9,38.4044,134,"Preferred One Administrative Services, INC.",PPO,132.124,98.6,,percent of total billed charges,,
"Chlamydia Trachomatis And Neisseria Gonorrhoeae, Genital And Urine Sources, Naat",,87491,CPT,Facility,Outpatient,,,,134,113.9,38.4044,134,PrimeWest Health,Minnesota Senior Health Options (MSHO),68.943,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Chlamydia Trachomatis And Neisseria Gonorrhoeae, Genital And Urine Sources, Naat",,87491,CPT,Facility,Inpatient,,,,134,113.9,38.4044,134,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Chlamydia Trachomatis And Neisseria Gonorrhoeae, Genital And Urine Sources, Naat",,87491,CPT,Facility,Outpatient,,,,134,113.9,38.4044,134,PrimeWest Health,MinnesotaCare,68.8224,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Chlamydia Trachomatis And Neisseria Gonorrhoeae, Genital And Urine Sources, Naat",,87491,CPT,Facility,Inpatient,,,,134,113.9,38.4044,134,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Chlamydia Trachomatis And Neisseria Gonorrhoeae, Genital And Urine Sources, Naat",,87491,CPT,Facility,Both,,,,134,113.9,38.4044,134,Sanford Health Plan,Sanford Health Plan,123.28,92,,percent of total billed charges,,
"Chlamydia Trachomatis And Neisseria Gonorrhoeae, Genital And Urine Sources, Naat",,87491,CPT,Facility,Outpatient,,,,134,113.9,38.4044,134,"UCare Health, Inc.",Individual & Family Plan,75.509,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Chlamydia Trachomatis And Neisseria Gonorrhoeae, Genital And Urine Sources, Naat",,87491,CPT,Facility,Inpatient,,,,134,113.9,38.4044,134,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Chlamydia Trachomatis And Neisseria Gonorrhoeae, Genital And Urine Sources, Naat",,87491,CPT,Facility,Outpatient,,,,134,113.9,38.4044,134,"UCare Health, Inc.",Medical Assistance,67.6298,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Chlamydia Trachomatis And Neisseria Gonorrhoeae, Genital And Urine Sources, Naat",,87491,CPT,Facility,Inpatient,,,,134,113.9,38.4044,134,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Chlamydia Trachomatis And Neisseria Gonorrhoeae, Genital And Urine Sources, Naat",,87491,CPT,Facility,Outpatient,,,,134,113.9,38.4044,134,"UCare Health, Inc.",Medicare Advantage,67.6298,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Chlamydia Trachomatis And Neisseria Gonorrhoeae, Genital And Urine Sources, Naat",,87491,CPT,Facility,Inpatient,,,,134,113.9,38.4044,134,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Chlamydia Trachomatis And Neisseria Gonorrhoeae, Genital And Urine Sources, Naat",,87491,CPT,Facility,Outpatient,,,,134,113.9,38.4044,134,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),67.6298,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Chlamydia Trachomatis And Neisseria Gonorrhoeae, Genital And Urine Sources, Naat",,87491,CPT,Facility,Inpatient,,,,134,113.9,38.4044,134,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Chlamydia Trachomatis And Neisseria Gonorrhoeae, Genital And Urine Sources, Naat",,87491,CPT,Facility,Both,,,,134,113.9,38.4044,134,UnitedHealthcare,Individual & Family,125.96,94,,percent of total billed charges,,
"Chlamydia Trachomatis And Neisseria Gonorrhoeae, Genital And Urine Sources, Naat",,87491,CPT,Facility,Outpatient,,,,134,113.9,38.4044,134,UnitedHealthcare,Medicare Advantage,65.66,49,,percent of total billed charges,,
"Chlamydia Trachomatis And Neisseria Gonorrhoeae, Genital And Urine Sources, Naat",,87491,CPT,Facility,Inpatient,,,,134,113.9,38.4044,134,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Chlamydia Trachomatis And Neisseria Gonorrhoeae, Genital And Urine Sources, Naat",,87491,CPT,Facility,Outpatient,,,,134,113.9,38.4044,134,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,64.32,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Chlamydia Trachomatis And Neisseria Gonorrhoeae, Genital And Urine Sources, Naat",,87491,CPT,Facility,Inpatient,,,,134,113.9,38.4044,134,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Chlamydia Trachomatis,  Genital And Urine Sources, Naat",,87491,CPT,Facility,Both,,,,136,115.6,38.9776,136,Aetna,Commercial,125.12,92,,percent of total billed charges,,
"Chlamydia Trachomatis,  Genital And Urine Sources, Naat",,87491,CPT,Facility,Outpatient,,,,136,115.6,38.9776,136,Aetna,Medicare Advantage,66.64,49,,percent of total billed charges,,
"Chlamydia Trachomatis,  Genital And Urine Sources, Naat",,87491,CPT,Facility,Inpatient,,,,136,115.6,38.9776,136,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Chlamydia Trachomatis,  Genital And Urine Sources, Naat",,87491,CPT,Facility,Both,,,,136,115.6,38.9776,136,Aetna,PPO,126.48,93,,percent of total billed charges,,
"Chlamydia Trachomatis,  Genital And Urine Sources, Naat",,87491,CPT,Facility,Both,,,,136,115.6,38.9776,136,America's PPO,America's PPO,130.6008,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Chlamydia Trachomatis,  Genital And Urine Sources, Naat",,87491,CPT,Facility,Both,,,,136,115.6,38.9776,136,BlueCross BlueShield Minnesota, Federal Employee Program,133.824,98.4,,percent of total billed charges,,
"Chlamydia Trachomatis,  Genital And Urine Sources, Naat",,87491,CPT,Facility,Both,,,,136,115.6,38.9776,136,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,136,100,,percent of total billed charges,,
"Chlamydia Trachomatis,  Genital And Urine Sources, Naat",,87491,CPT,Facility,Both,,,,136,115.6,38.9776,136,BlueCross BlueShield Minnesota,High Value Network Plan,122.4,90,,percent of total billed charges,,
"Chlamydia Trachomatis,  Genital And Urine Sources, Naat",,87491,CPT,Facility,Outpatient,,,,136,115.6,38.9776,136,BlueCross BlueShield Minnesota,Medicare Advantage,66.64,49,,percent of total billed charges,,
"Chlamydia Trachomatis,  Genital And Urine Sources, Naat",,87491,CPT,Facility,Inpatient,,,,136,115.6,38.9776,136,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Chlamydia Trachomatis,  Genital And Urine Sources, Naat",,87491,CPT,Facility,Both,,,,136,115.6,38.9776,136,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,120.4552,88.57,,percent of total billed charges,,
"Chlamydia Trachomatis,  Genital And Urine Sources, Naat",,87491,CPT,Facility,Both,,,,136,115.6,38.9776,136,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,38.9776,28.66,,percent of total billed charges,,
"Chlamydia Trachomatis,  Genital And Urine Sources, Naat",,87491,CPT,Facility,Outpatient,,,,136,115.6,38.9776,136,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),66.64,49,,percent of total billed charges,,
"Chlamydia Trachomatis,  Genital And Urine Sources, Naat",,87491,CPT,Facility,Inpatient,,,,136,115.6,38.9776,136,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Chlamydia Trachomatis,  Genital And Urine Sources, Naat",,87491,CPT,Facility,Both,,,,136,115.6,38.9776,136,CorVel,Worker's Compensation,136,100,,percent of total billed charges,,
"Chlamydia Trachomatis,  Genital And Urine Sources, Naat",,87491,CPT,Facility,Both,,,,136,115.6,38.9776,136,First Health Group Corporation,First Health Network,131.92,97,,percent of total billed charges,,
"Chlamydia Trachomatis,  Genital And Urine Sources, Naat",,87491,CPT,Facility,Both,,,,136,115.6,38.9776,136,"Health Partners, Inc.",Commercial,128.656,94.6,,percent of total billed charges,,
"Chlamydia Trachomatis,  Genital And Urine Sources, Naat",,87491,CPT,Facility,Outpatient,,,,136,115.6,38.9776,136,"Health Partners, Inc.",Medicare Advantage,66.64,49,,percent of total billed charges,,
"Chlamydia Trachomatis,  Genital And Urine Sources, Naat",,87491,CPT,Facility,Inpatient,,,,136,115.6,38.9776,136,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Chlamydia Trachomatis,  Genital And Urine Sources, Naat",,87491,CPT,Facility,Both,,,,136,115.6,38.9776,136,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),81.6,60,,percent of total billed charges,,
"Chlamydia Trachomatis,  Genital And Urine Sources, Naat",,87491,CPT,Facility,Both,,,,136,115.6,38.9776,136,"Health Partners, Inc.",State of Minnesota Advantage Program,110.84,81.5,,percent of total billed charges,,
"Chlamydia Trachomatis,  Genital And Urine Sources, Naat",,87491,CPT,Facility,Both,,,,136,115.6,38.9776,136,"Health Partners, Inc.",State Public Programs,68,50,,percent of total billed charges,,
"Chlamydia Trachomatis,  Genital And Urine Sources, Naat",,87491,CPT,Facility,Both,,,,136,115.6,38.9776,136,Humana Insurance Company,Commercial PPO,129.2,95,,percent of total billed charges,,
"Chlamydia Trachomatis,  Genital And Urine Sources, Naat",,87491,CPT,Facility,Outpatient,,,,136,115.6,38.9776,136,Humana Insurance Company,Medicare PPO,66.64,49,,percent of total billed charges,,
"Chlamydia Trachomatis,  Genital And Urine Sources, Naat",,87491,CPT,Facility,Inpatient,,,,136,115.6,38.9776,136,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Chlamydia Trachomatis,  Genital And Urine Sources, Naat",,87491,CPT,Facility,Both,,,,136,115.6,38.9776,136,Medica,Individual & Family,134.776,99.1,,percent of total billed charges,,
"Chlamydia Trachomatis,  Genital And Urine Sources, Naat",,87491,CPT,Facility,Outpatient,,,,136,115.6,38.9776,136,Medica,Medica Advantage Solution,67.728,49.8,,percent of total billed charges,,
"Chlamydia Trachomatis,  Genital And Urine Sources, Naat",,87491,CPT,Facility,Inpatient,,,,136,115.6,38.9776,136,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Chlamydia Trachomatis,  Genital And Urine Sources, Naat",,87491,CPT,Facility,Outpatient,,,,136,115.6,38.9776,136,Medica,Medical Assistance,60.656,44.6,,percent of total billed charges,,
"Chlamydia Trachomatis,  Genital And Urine Sources, Naat",,87491,CPT,Facility,Inpatient,,,,136,115.6,38.9776,136,Medica,Medical Assistance,,,,,Included in per diem rate,
"Chlamydia Trachomatis,  Genital And Urine Sources, Naat",,87491,CPT,Facility,Outpatient,,,,136,115.6,38.9776,136,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,67.728,49.8,,percent of total billed charges,,
"Chlamydia Trachomatis,  Genital And Urine Sources, Naat",,87491,CPT,Facility,Inpatient,,,,136,115.6,38.9776,136,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Chlamydia Trachomatis,  Genital And Urine Sources, Naat",,87491,CPT,Facility,Both,,,,136,115.6,38.9776,136,"Multiplan, Inc.","Multiplan, Inc.",127.84,94,,percent of total billed charges,,
"Chlamydia Trachomatis,  Genital And Urine Sources, Naat",,87491,CPT,Facility,Outpatient,,,,136,115.6,38.9776,136,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,117.504,86.4,,percent of total billed charges,,
"Chlamydia Trachomatis,  Genital And Urine Sources, Naat",,87491,CPT,Facility,Inpatient,,,,136,115.6,38.9776,136,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Chlamydia Trachomatis,  Genital And Urine Sources, Naat",,87491,CPT,Facility,Both,,,,136,115.6,38.9776,136,"Preferred One Administrative Services, INC.",PPO,134.096,98.6,,percent of total billed charges,,
"Chlamydia Trachomatis,  Genital And Urine Sources, Naat",,87491,CPT,Facility,Outpatient,,,,136,115.6,38.9776,136,PrimeWest Health,Minnesota Senior Health Options (MSHO),69.972,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Chlamydia Trachomatis,  Genital And Urine Sources, Naat",,87491,CPT,Facility,Inpatient,,,,136,115.6,38.9776,136,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Chlamydia Trachomatis,  Genital And Urine Sources, Naat",,87491,CPT,Facility,Outpatient,,,,136,115.6,38.9776,136,PrimeWest Health,MinnesotaCare,69.8496,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Chlamydia Trachomatis,  Genital And Urine Sources, Naat",,87491,CPT,Facility,Inpatient,,,,136,115.6,38.9776,136,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Chlamydia Trachomatis,  Genital And Urine Sources, Naat",,87491,CPT,Facility,Both,,,,136,115.6,38.9776,136,Sanford Health Plan,Sanford Health Plan,125.12,92,,percent of total billed charges,,
"Chlamydia Trachomatis,  Genital And Urine Sources, Naat",,87491,CPT,Facility,Outpatient,,,,136,115.6,38.9776,136,"UCare Health, Inc.",Individual & Family Plan,76.636,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Chlamydia Trachomatis,  Genital And Urine Sources, Naat",,87491,CPT,Facility,Inpatient,,,,136,115.6,38.9776,136,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Chlamydia Trachomatis,  Genital And Urine Sources, Naat",,87491,CPT,Facility,Outpatient,,,,136,115.6,38.9776,136,"UCare Health, Inc.",Medical Assistance,68.6392,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Chlamydia Trachomatis,  Genital And Urine Sources, Naat",,87491,CPT,Facility,Inpatient,,,,136,115.6,38.9776,136,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Chlamydia Trachomatis,  Genital And Urine Sources, Naat",,87491,CPT,Facility,Outpatient,,,,136,115.6,38.9776,136,"UCare Health, Inc.",Medicare Advantage,68.6392,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Chlamydia Trachomatis,  Genital And Urine Sources, Naat",,87491,CPT,Facility,Inpatient,,,,136,115.6,38.9776,136,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Chlamydia Trachomatis,  Genital And Urine Sources, Naat",,87491,CPT,Facility,Outpatient,,,,136,115.6,38.9776,136,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),68.6392,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Chlamydia Trachomatis,  Genital And Urine Sources, Naat",,87491,CPT,Facility,Inpatient,,,,136,115.6,38.9776,136,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Chlamydia Trachomatis,  Genital And Urine Sources, Naat",,87491,CPT,Facility,Both,,,,136,115.6,38.9776,136,UnitedHealthcare,Individual & Family,127.84,94,,percent of total billed charges,,
"Chlamydia Trachomatis,  Genital And Urine Sources, Naat",,87491,CPT,Facility,Outpatient,,,,136,115.6,38.9776,136,UnitedHealthcare,Medicare Advantage,66.64,49,,percent of total billed charges,,
"Chlamydia Trachomatis,  Genital And Urine Sources, Naat",,87491,CPT,Facility,Inpatient,,,,136,115.6,38.9776,136,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Chlamydia Trachomatis,  Genital And Urine Sources, Naat",,87491,CPT,Facility,Outpatient,,,,136,115.6,38.9776,136,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,65.28,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Chlamydia Trachomatis,  Genital And Urine Sources, Naat",,87491,CPT,Facility,Inpatient,,,,136,115.6,38.9776,136,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Clostridium Difficile, Pcr",,87493,CPT,Facility,Both,,,,107,90.95,30.6662,107,Aetna,Commercial,98.44,92,,percent of total billed charges,,
"Clostridium Difficile, Pcr",,87493,CPT,Facility,Outpatient,,,,107,90.95,30.6662,107,Aetna,Medicare Advantage,52.43,49,,percent of total billed charges,,
"Clostridium Difficile, Pcr",,87493,CPT,Facility,Inpatient,,,,107,90.95,30.6662,107,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Clostridium Difficile, Pcr",,87493,CPT,Facility,Both,,,,107,90.95,30.6662,107,Aetna,PPO,99.51,93,,percent of total billed charges,,
"Clostridium Difficile, Pcr",,87493,CPT,Facility,Both,,,,107,90.95,30.6662,107,America's PPO,America's PPO,102.7521,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Clostridium Difficile, Pcr",,87493,CPT,Facility,Both,,,,107,90.95,30.6662,107,BlueCross BlueShield Minnesota, Federal Employee Program,105.288,98.4,,percent of total billed charges,,
"Clostridium Difficile, Pcr",,87493,CPT,Facility,Both,,,,107,90.95,30.6662,107,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,107,100,,percent of total billed charges,,
"Clostridium Difficile, Pcr",,87493,CPT,Facility,Both,,,,107,90.95,30.6662,107,BlueCross BlueShield Minnesota,High Value Network Plan,96.3,90,,percent of total billed charges,,
"Clostridium Difficile, Pcr",,87493,CPT,Facility,Outpatient,,,,107,90.95,30.6662,107,BlueCross BlueShield Minnesota,Medicare Advantage,52.43,49,,percent of total billed charges,,
"Clostridium Difficile, Pcr",,87493,CPT,Facility,Inpatient,,,,107,90.95,30.6662,107,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Clostridium Difficile, Pcr",,87493,CPT,Facility,Both,,,,107,90.95,30.6662,107,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,94.7699,88.57,,percent of total billed charges,,
"Clostridium Difficile, Pcr",,87493,CPT,Facility,Both,,,,107,90.95,30.6662,107,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,30.6662,28.66,,percent of total billed charges,,
"Clostridium Difficile, Pcr",,87493,CPT,Facility,Outpatient,,,,107,90.95,30.6662,107,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),52.43,49,,percent of total billed charges,,
"Clostridium Difficile, Pcr",,87493,CPT,Facility,Inpatient,,,,107,90.95,30.6662,107,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Clostridium Difficile, Pcr",,87493,CPT,Facility,Both,,,,107,90.95,30.6662,107,CorVel,Worker's Compensation,107,100,,percent of total billed charges,,
"Clostridium Difficile, Pcr",,87493,CPT,Facility,Both,,,,107,90.95,30.6662,107,First Health Group Corporation,First Health Network,103.79,97,,percent of total billed charges,,
"Clostridium Difficile, Pcr",,87493,CPT,Facility,Both,,,,107,90.95,30.6662,107,"Health Partners, Inc.",Commercial,101.222,94.6,,percent of total billed charges,,
"Clostridium Difficile, Pcr",,87493,CPT,Facility,Outpatient,,,,107,90.95,30.6662,107,"Health Partners, Inc.",Medicare Advantage,52.43,49,,percent of total billed charges,,
"Clostridium Difficile, Pcr",,87493,CPT,Facility,Inpatient,,,,107,90.95,30.6662,107,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Clostridium Difficile, Pcr",,87493,CPT,Facility,Both,,,,107,90.95,30.6662,107,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),64.2,60,,percent of total billed charges,,
"Clostridium Difficile, Pcr",,87493,CPT,Facility,Both,,,,107,90.95,30.6662,107,"Health Partners, Inc.",State of Minnesota Advantage Program,87.205,81.5,,percent of total billed charges,,
"Clostridium Difficile, Pcr",,87493,CPT,Facility,Both,,,,107,90.95,30.6662,107,"Health Partners, Inc.",State Public Programs,53.5,50,,percent of total billed charges,,
"Clostridium Difficile, Pcr",,87493,CPT,Facility,Both,,,,107,90.95,30.6662,107,Humana Insurance Company,Commercial PPO,101.65,95,,percent of total billed charges,,
"Clostridium Difficile, Pcr",,87493,CPT,Facility,Outpatient,,,,107,90.95,30.6662,107,Humana Insurance Company,Medicare PPO,52.43,49,,percent of total billed charges,,
"Clostridium Difficile, Pcr",,87493,CPT,Facility,Inpatient,,,,107,90.95,30.6662,107,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Clostridium Difficile, Pcr",,87493,CPT,Facility,Both,,,,107,90.95,30.6662,107,Medica,Individual & Family,106.037,99.1,,percent of total billed charges,,
"Clostridium Difficile, Pcr",,87493,CPT,Facility,Outpatient,,,,107,90.95,30.6662,107,Medica,Medica Advantage Solution,53.286,49.8,,percent of total billed charges,,
"Clostridium Difficile, Pcr",,87493,CPT,Facility,Inpatient,,,,107,90.95,30.6662,107,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Clostridium Difficile, Pcr",,87493,CPT,Facility,Outpatient,,,,107,90.95,30.6662,107,Medica,Medical Assistance,47.722,44.6,,percent of total billed charges,,
"Clostridium Difficile, Pcr",,87493,CPT,Facility,Inpatient,,,,107,90.95,30.6662,107,Medica,Medical Assistance,,,,,Included in per diem rate,
"Clostridium Difficile, Pcr",,87493,CPT,Facility,Outpatient,,,,107,90.95,30.6662,107,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,53.286,49.8,,percent of total billed charges,,
"Clostridium Difficile, Pcr",,87493,CPT,Facility,Inpatient,,,,107,90.95,30.6662,107,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Clostridium Difficile, Pcr",,87493,CPT,Facility,Both,,,,107,90.95,30.6662,107,"Multiplan, Inc.","Multiplan, Inc.",100.58,94,,percent of total billed charges,,
"Clostridium Difficile, Pcr",,87493,CPT,Facility,Outpatient,,,,107,90.95,30.6662,107,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,92.448,86.4,,percent of total billed charges,,
"Clostridium Difficile, Pcr",,87493,CPT,Facility,Inpatient,,,,107,90.95,30.6662,107,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Clostridium Difficile, Pcr",,87493,CPT,Facility,Both,,,,107,90.95,30.6662,107,"Preferred One Administrative Services, INC.",PPO,105.502,98.6,,percent of total billed charges,,
"Clostridium Difficile, Pcr",,87493,CPT,Facility,Outpatient,,,,107,90.95,30.6662,107,PrimeWest Health,Minnesota Senior Health Options (MSHO),55.0515,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Clostridium Difficile, Pcr",,87493,CPT,Facility,Inpatient,,,,107,90.95,30.6662,107,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Clostridium Difficile, Pcr",,87493,CPT,Facility,Outpatient,,,,107,90.95,30.6662,107,PrimeWest Health,MinnesotaCare,54.9552,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Clostridium Difficile, Pcr",,87493,CPT,Facility,Inpatient,,,,107,90.95,30.6662,107,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Clostridium Difficile, Pcr",,87493,CPT,Facility,Both,,,,107,90.95,30.6662,107,Sanford Health Plan,Sanford Health Plan,98.44,92,,percent of total billed charges,,
"Clostridium Difficile, Pcr",,87493,CPT,Facility,Outpatient,,,,107,90.95,30.6662,107,"UCare Health, Inc.",Individual & Family Plan,60.2945,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Clostridium Difficile, Pcr",,87493,CPT,Facility,Inpatient,,,,107,90.95,30.6662,107,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Clostridium Difficile, Pcr",,87493,CPT,Facility,Outpatient,,,,107,90.95,30.6662,107,"UCare Health, Inc.",Medical Assistance,54.0029,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Clostridium Difficile, Pcr",,87493,CPT,Facility,Inpatient,,,,107,90.95,30.6662,107,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Clostridium Difficile, Pcr",,87493,CPT,Facility,Outpatient,,,,107,90.95,30.6662,107,"UCare Health, Inc.",Medicare Advantage,54.0029,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Clostridium Difficile, Pcr",,87493,CPT,Facility,Inpatient,,,,107,90.95,30.6662,107,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Clostridium Difficile, Pcr",,87493,CPT,Facility,Outpatient,,,,107,90.95,30.6662,107,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),54.0029,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Clostridium Difficile, Pcr",,87493,CPT,Facility,Inpatient,,,,107,90.95,30.6662,107,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Clostridium Difficile, Pcr",,87493,CPT,Facility,Both,,,,107,90.95,30.6662,107,UnitedHealthcare,Individual & Family,100.58,94,,percent of total billed charges,,
"Clostridium Difficile, Pcr",,87493,CPT,Facility,Outpatient,,,,107,90.95,30.6662,107,UnitedHealthcare,Medicare Advantage,52.43,49,,percent of total billed charges,,
"Clostridium Difficile, Pcr",,87493,CPT,Facility,Inpatient,,,,107,90.95,30.6662,107,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Clostridium Difficile, Pcr",,87493,CPT,Facility,Outpatient,,,,107,90.95,30.6662,107,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,51.36,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Clostridium Difficile, Pcr",,87493,CPT,Facility,Inpatient,,,,107,90.95,30.6662,107,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Enteric Pathogens Profile, Pcr, Stool, 6-11 Targets",,87506,CPT,Facility,Both,,,,490,416.5,140.434,490,Aetna,Commercial,450.8,92,,percent of total billed charges,,
"Enteric Pathogens Profile, Pcr, Stool, 6-11 Targets",,87506,CPT,Facility,Outpatient,,,,490,416.5,140.434,490,Aetna,Medicare Advantage,240.1,49,,percent of total billed charges,,
"Enteric Pathogens Profile, Pcr, Stool, 6-11 Targets",,87506,CPT,Facility,Inpatient,,,,490,416.5,140.434,490,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Enteric Pathogens Profile, Pcr, Stool, 6-11 Targets",,87506,CPT,Facility,Both,,,,490,416.5,140.434,490,Aetna,PPO,455.7,93,,percent of total billed charges,,
"Enteric Pathogens Profile, Pcr, Stool, 6-11 Targets",,87506,CPT,Facility,Both,,,,490,416.5,140.434,490,America's PPO,America's PPO,470.547,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Enteric Pathogens Profile, Pcr, Stool, 6-11 Targets",,87506,CPT,Facility,Both,,,,490,416.5,140.434,490,BlueCross BlueShield Minnesota, Federal Employee Program,482.16,98.4,,percent of total billed charges,,
"Enteric Pathogens Profile, Pcr, Stool, 6-11 Targets",,87506,CPT,Facility,Both,,,,490,416.5,140.434,490,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,490,100,,percent of total billed charges,,
"Enteric Pathogens Profile, Pcr, Stool, 6-11 Targets",,87506,CPT,Facility,Both,,,,490,416.5,140.434,490,BlueCross BlueShield Minnesota,High Value Network Plan,441,90,,percent of total billed charges,,
"Enteric Pathogens Profile, Pcr, Stool, 6-11 Targets",,87506,CPT,Facility,Outpatient,,,,490,416.5,140.434,490,BlueCross BlueShield Minnesota,Medicare Advantage,240.1,49,,percent of total billed charges,,
"Enteric Pathogens Profile, Pcr, Stool, 6-11 Targets",,87506,CPT,Facility,Inpatient,,,,490,416.5,140.434,490,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Enteric Pathogens Profile, Pcr, Stool, 6-11 Targets",,87506,CPT,Facility,Both,,,,490,416.5,140.434,490,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,433.993,88.57,,percent of total billed charges,,
"Enteric Pathogens Profile, Pcr, Stool, 6-11 Targets",,87506,CPT,Facility,Both,,,,490,416.5,140.434,490,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,140.434,28.66,,percent of total billed charges,,
"Enteric Pathogens Profile, Pcr, Stool, 6-11 Targets",,87506,CPT,Facility,Outpatient,,,,490,416.5,140.434,490,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),240.1,49,,percent of total billed charges,,
"Enteric Pathogens Profile, Pcr, Stool, 6-11 Targets",,87506,CPT,Facility,Inpatient,,,,490,416.5,140.434,490,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Enteric Pathogens Profile, Pcr, Stool, 6-11 Targets",,87506,CPT,Facility,Both,,,,490,416.5,140.434,490,CorVel,Worker's Compensation,490,100,,percent of total billed charges,,
"Enteric Pathogens Profile, Pcr, Stool, 6-11 Targets",,87506,CPT,Facility,Both,,,,490,416.5,140.434,490,First Health Group Corporation,First Health Network,475.3,97,,percent of total billed charges,,
"Enteric Pathogens Profile, Pcr, Stool, 6-11 Targets",,87506,CPT,Facility,Both,,,,490,416.5,140.434,490,"Health Partners, Inc.",Commercial,463.54,94.6,,percent of total billed charges,,
"Enteric Pathogens Profile, Pcr, Stool, 6-11 Targets",,87506,CPT,Facility,Outpatient,,,,490,416.5,140.434,490,"Health Partners, Inc.",Medicare Advantage,240.1,49,,percent of total billed charges,,
"Enteric Pathogens Profile, Pcr, Stool, 6-11 Targets",,87506,CPT,Facility,Inpatient,,,,490,416.5,140.434,490,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Enteric Pathogens Profile, Pcr, Stool, 6-11 Targets",,87506,CPT,Facility,Both,,,,490,416.5,140.434,490,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),294,60,,percent of total billed charges,,
"Enteric Pathogens Profile, Pcr, Stool, 6-11 Targets",,87506,CPT,Facility,Both,,,,490,416.5,140.434,490,"Health Partners, Inc.",State of Minnesota Advantage Program,399.35,81.5,,percent of total billed charges,,
"Enteric Pathogens Profile, Pcr, Stool, 6-11 Targets",,87506,CPT,Facility,Both,,,,490,416.5,140.434,490,"Health Partners, Inc.",State Public Programs,245,50,,percent of total billed charges,,
"Enteric Pathogens Profile, Pcr, Stool, 6-11 Targets",,87506,CPT,Facility,Both,,,,490,416.5,140.434,490,Humana Insurance Company,Commercial PPO,465.5,95,,percent of total billed charges,,
"Enteric Pathogens Profile, Pcr, Stool, 6-11 Targets",,87506,CPT,Facility,Outpatient,,,,490,416.5,140.434,490,Humana Insurance Company,Medicare PPO,240.1,49,,percent of total billed charges,,
"Enteric Pathogens Profile, Pcr, Stool, 6-11 Targets",,87506,CPT,Facility,Inpatient,,,,490,416.5,140.434,490,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Enteric Pathogens Profile, Pcr, Stool, 6-11 Targets",,87506,CPT,Facility,Both,,,,490,416.5,140.434,490,Medica,Individual & Family,485.59,99.1,,percent of total billed charges,,
"Enteric Pathogens Profile, Pcr, Stool, 6-11 Targets",,87506,CPT,Facility,Outpatient,,,,490,416.5,140.434,490,Medica,Medica Advantage Solution,244.02,49.8,,percent of total billed charges,,
"Enteric Pathogens Profile, Pcr, Stool, 6-11 Targets",,87506,CPT,Facility,Inpatient,,,,490,416.5,140.434,490,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Enteric Pathogens Profile, Pcr, Stool, 6-11 Targets",,87506,CPT,Facility,Outpatient,,,,490,416.5,140.434,490,Medica,Medical Assistance,218.54,44.6,,percent of total billed charges,,
"Enteric Pathogens Profile, Pcr, Stool, 6-11 Targets",,87506,CPT,Facility,Inpatient,,,,490,416.5,140.434,490,Medica,Medical Assistance,,,,,Included in per diem rate,
"Enteric Pathogens Profile, Pcr, Stool, 6-11 Targets",,87506,CPT,Facility,Outpatient,,,,490,416.5,140.434,490,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,244.02,49.8,,percent of total billed charges,,
"Enteric Pathogens Profile, Pcr, Stool, 6-11 Targets",,87506,CPT,Facility,Inpatient,,,,490,416.5,140.434,490,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Enteric Pathogens Profile, Pcr, Stool, 6-11 Targets",,87506,CPT,Facility,Both,,,,490,416.5,140.434,490,"Multiplan, Inc.","Multiplan, Inc.",460.6,94,,percent of total billed charges,,
"Enteric Pathogens Profile, Pcr, Stool, 6-11 Targets",,87506,CPT,Facility,Outpatient,,,,490,416.5,140.434,490,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,423.36,86.4,,percent of total billed charges,,
"Enteric Pathogens Profile, Pcr, Stool, 6-11 Targets",,87506,CPT,Facility,Inpatient,,,,490,416.5,140.434,490,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Enteric Pathogens Profile, Pcr, Stool, 6-11 Targets",,87506,CPT,Facility,Both,,,,490,416.5,140.434,490,"Preferred One Administrative Services, INC.",PPO,483.14,98.6,,percent of total billed charges,,
"Enteric Pathogens Profile, Pcr, Stool, 6-11 Targets",,87506,CPT,Facility,Outpatient,,,,490,416.5,140.434,490,PrimeWest Health,Minnesota Senior Health Options (MSHO),252.105,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Enteric Pathogens Profile, Pcr, Stool, 6-11 Targets",,87506,CPT,Facility,Inpatient,,,,490,416.5,140.434,490,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Enteric Pathogens Profile, Pcr, Stool, 6-11 Targets",,87506,CPT,Facility,Outpatient,,,,490,416.5,140.434,490,PrimeWest Health,MinnesotaCare,251.664,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Enteric Pathogens Profile, Pcr, Stool, 6-11 Targets",,87506,CPT,Facility,Inpatient,,,,490,416.5,140.434,490,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Enteric Pathogens Profile, Pcr, Stool, 6-11 Targets",,87506,CPT,Facility,Both,,,,490,416.5,140.434,490,Sanford Health Plan,Sanford Health Plan,450.8,92,,percent of total billed charges,,
"Enteric Pathogens Profile, Pcr, Stool, 6-11 Targets",,87506,CPT,Facility,Outpatient,,,,490,416.5,140.434,490,"UCare Health, Inc.",Individual & Family Plan,276.115,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Enteric Pathogens Profile, Pcr, Stool, 6-11 Targets",,87506,CPT,Facility,Inpatient,,,,490,416.5,140.434,490,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Enteric Pathogens Profile, Pcr, Stool, 6-11 Targets",,87506,CPT,Facility,Outpatient,,,,490,416.5,140.434,490,"UCare Health, Inc.",Medical Assistance,247.303,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Enteric Pathogens Profile, Pcr, Stool, 6-11 Targets",,87506,CPT,Facility,Inpatient,,,,490,416.5,140.434,490,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Enteric Pathogens Profile, Pcr, Stool, 6-11 Targets",,87506,CPT,Facility,Outpatient,,,,490,416.5,140.434,490,"UCare Health, Inc.",Medicare Advantage,247.303,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Enteric Pathogens Profile, Pcr, Stool, 6-11 Targets",,87506,CPT,Facility,Inpatient,,,,490,416.5,140.434,490,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Enteric Pathogens Profile, Pcr, Stool, 6-11 Targets",,87506,CPT,Facility,Outpatient,,,,490,416.5,140.434,490,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),247.303,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Enteric Pathogens Profile, Pcr, Stool, 6-11 Targets",,87506,CPT,Facility,Inpatient,,,,490,416.5,140.434,490,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Enteric Pathogens Profile, Pcr, Stool, 6-11 Targets",,87506,CPT,Facility,Both,,,,490,416.5,140.434,490,UnitedHealthcare,Individual & Family,460.6,94,,percent of total billed charges,,
"Enteric Pathogens Profile, Pcr, Stool, 6-11 Targets",,87506,CPT,Facility,Outpatient,,,,490,416.5,140.434,490,UnitedHealthcare,Medicare Advantage,240.1,49,,percent of total billed charges,,
"Enteric Pathogens Profile, Pcr, Stool, 6-11 Targets",,87506,CPT,Facility,Inpatient,,,,490,416.5,140.434,490,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Enteric Pathogens Profile, Pcr, Stool, 6-11 Targets",,87506,CPT,Facility,Outpatient,,,,490,416.5,140.434,490,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,235.2,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Enteric Pathogens Profile, Pcr, Stool, 6-11 Targets",,87506,CPT,Facility,Inpatient,,,,490,416.5,140.434,490,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Enteric Pathogens Profile, Pcr, Stool, 12-25 Targets",,87507,CPT,Facility,Both,,,,490,416.5,140.434,490,Aetna,Commercial,450.8,92,,percent of total billed charges,,
"Enteric Pathogens Profile, Pcr, Stool, 12-25 Targets",,87507,CPT,Facility,Outpatient,,,,490,416.5,140.434,490,Aetna,Medicare Advantage,240.1,49,,percent of total billed charges,,
"Enteric Pathogens Profile, Pcr, Stool, 12-25 Targets",,87507,CPT,Facility,Inpatient,,,,490,416.5,140.434,490,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Enteric Pathogens Profile, Pcr, Stool, 12-25 Targets",,87507,CPT,Facility,Both,,,,490,416.5,140.434,490,Aetna,PPO,455.7,93,,percent of total billed charges,,
"Enteric Pathogens Profile, Pcr, Stool, 12-25 Targets",,87507,CPT,Facility,Both,,,,490,416.5,140.434,490,America's PPO,America's PPO,470.547,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Enteric Pathogens Profile, Pcr, Stool, 12-25 Targets",,87507,CPT,Facility,Both,,,,490,416.5,140.434,490,BlueCross BlueShield Minnesota, Federal Employee Program,482.16,98.4,,percent of total billed charges,,
"Enteric Pathogens Profile, Pcr, Stool, 12-25 Targets",,87507,CPT,Facility,Both,,,,490,416.5,140.434,490,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,490,100,,percent of total billed charges,,
"Enteric Pathogens Profile, Pcr, Stool, 12-25 Targets",,87507,CPT,Facility,Both,,,,490,416.5,140.434,490,BlueCross BlueShield Minnesota,High Value Network Plan,441,90,,percent of total billed charges,,
"Enteric Pathogens Profile, Pcr, Stool, 12-25 Targets",,87507,CPT,Facility,Outpatient,,,,490,416.5,140.434,490,BlueCross BlueShield Minnesota,Medicare Advantage,240.1,49,,percent of total billed charges,,
"Enteric Pathogens Profile, Pcr, Stool, 12-25 Targets",,87507,CPT,Facility,Inpatient,,,,490,416.5,140.434,490,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Enteric Pathogens Profile, Pcr, Stool, 12-25 Targets",,87507,CPT,Facility,Both,,,,490,416.5,140.434,490,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,433.993,88.57,,percent of total billed charges,,
"Enteric Pathogens Profile, Pcr, Stool, 12-25 Targets",,87507,CPT,Facility,Both,,,,490,416.5,140.434,490,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,140.434,28.66,,percent of total billed charges,,
"Enteric Pathogens Profile, Pcr, Stool, 12-25 Targets",,87507,CPT,Facility,Outpatient,,,,490,416.5,140.434,490,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),240.1,49,,percent of total billed charges,,
"Enteric Pathogens Profile, Pcr, Stool, 12-25 Targets",,87507,CPT,Facility,Inpatient,,,,490,416.5,140.434,490,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Enteric Pathogens Profile, Pcr, Stool, 12-25 Targets",,87507,CPT,Facility,Both,,,,490,416.5,140.434,490,CorVel,Worker's Compensation,490,100,,percent of total billed charges,,
"Enteric Pathogens Profile, Pcr, Stool, 12-25 Targets",,87507,CPT,Facility,Both,,,,490,416.5,140.434,490,First Health Group Corporation,First Health Network,475.3,97,,percent of total billed charges,,
"Enteric Pathogens Profile, Pcr, Stool, 12-25 Targets",,87507,CPT,Facility,Both,,,,490,416.5,140.434,490,"Health Partners, Inc.",Commercial,463.54,94.6,,percent of total billed charges,,
"Enteric Pathogens Profile, Pcr, Stool, 12-25 Targets",,87507,CPT,Facility,Outpatient,,,,490,416.5,140.434,490,"Health Partners, Inc.",Medicare Advantage,240.1,49,,percent of total billed charges,,
"Enteric Pathogens Profile, Pcr, Stool, 12-25 Targets",,87507,CPT,Facility,Inpatient,,,,490,416.5,140.434,490,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Enteric Pathogens Profile, Pcr, Stool, 12-25 Targets",,87507,CPT,Facility,Both,,,,490,416.5,140.434,490,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),294,60,,percent of total billed charges,,
"Enteric Pathogens Profile, Pcr, Stool, 12-25 Targets",,87507,CPT,Facility,Both,,,,490,416.5,140.434,490,"Health Partners, Inc.",State of Minnesota Advantage Program,399.35,81.5,,percent of total billed charges,,
"Enteric Pathogens Profile, Pcr, Stool, 12-25 Targets",,87507,CPT,Facility,Both,,,,490,416.5,140.434,490,"Health Partners, Inc.",State Public Programs,245,50,,percent of total billed charges,,
"Enteric Pathogens Profile, Pcr, Stool, 12-25 Targets",,87507,CPT,Facility,Both,,,,490,416.5,140.434,490,Humana Insurance Company,Commercial PPO,465.5,95,,percent of total billed charges,,
"Enteric Pathogens Profile, Pcr, Stool, 12-25 Targets",,87507,CPT,Facility,Outpatient,,,,490,416.5,140.434,490,Humana Insurance Company,Medicare PPO,240.1,49,,percent of total billed charges,,
"Enteric Pathogens Profile, Pcr, Stool, 12-25 Targets",,87507,CPT,Facility,Inpatient,,,,490,416.5,140.434,490,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Enteric Pathogens Profile, Pcr, Stool, 12-25 Targets",,87507,CPT,Facility,Both,,,,490,416.5,140.434,490,Medica,Individual & Family,485.59,99.1,,percent of total billed charges,,
"Enteric Pathogens Profile, Pcr, Stool, 12-25 Targets",,87507,CPT,Facility,Outpatient,,,,490,416.5,140.434,490,Medica,Medica Advantage Solution,244.02,49.8,,percent of total billed charges,,
"Enteric Pathogens Profile, Pcr, Stool, 12-25 Targets",,87507,CPT,Facility,Inpatient,,,,490,416.5,140.434,490,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Enteric Pathogens Profile, Pcr, Stool, 12-25 Targets",,87507,CPT,Facility,Outpatient,,,,490,416.5,140.434,490,Medica,Medical Assistance,218.54,44.6,,percent of total billed charges,,
"Enteric Pathogens Profile, Pcr, Stool, 12-25 Targets",,87507,CPT,Facility,Inpatient,,,,490,416.5,140.434,490,Medica,Medical Assistance,,,,,Included in per diem rate,
"Enteric Pathogens Profile, Pcr, Stool, 12-25 Targets",,87507,CPT,Facility,Outpatient,,,,490,416.5,140.434,490,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,244.02,49.8,,percent of total billed charges,,
"Enteric Pathogens Profile, Pcr, Stool, 12-25 Targets",,87507,CPT,Facility,Inpatient,,,,490,416.5,140.434,490,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Enteric Pathogens Profile, Pcr, Stool, 12-25 Targets",,87507,CPT,Facility,Both,,,,490,416.5,140.434,490,"Multiplan, Inc.","Multiplan, Inc.",460.6,94,,percent of total billed charges,,
"Enteric Pathogens Profile, Pcr, Stool, 12-25 Targets",,87507,CPT,Facility,Outpatient,,,,490,416.5,140.434,490,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,423.36,86.4,,percent of total billed charges,,
"Enteric Pathogens Profile, Pcr, Stool, 12-25 Targets",,87507,CPT,Facility,Inpatient,,,,490,416.5,140.434,490,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Enteric Pathogens Profile, Pcr, Stool, 12-25 Targets",,87507,CPT,Facility,Both,,,,490,416.5,140.434,490,"Preferred One Administrative Services, INC.",PPO,483.14,98.6,,percent of total billed charges,,
"Enteric Pathogens Profile, Pcr, Stool, 12-25 Targets",,87507,CPT,Facility,Outpatient,,,,490,416.5,140.434,490,PrimeWest Health,Minnesota Senior Health Options (MSHO),252.105,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Enteric Pathogens Profile, Pcr, Stool, 12-25 Targets",,87507,CPT,Facility,Inpatient,,,,490,416.5,140.434,490,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Enteric Pathogens Profile, Pcr, Stool, 12-25 Targets",,87507,CPT,Facility,Outpatient,,,,490,416.5,140.434,490,PrimeWest Health,MinnesotaCare,251.664,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Enteric Pathogens Profile, Pcr, Stool, 12-25 Targets",,87507,CPT,Facility,Inpatient,,,,490,416.5,140.434,490,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Enteric Pathogens Profile, Pcr, Stool, 12-25 Targets",,87507,CPT,Facility,Both,,,,490,416.5,140.434,490,Sanford Health Plan,Sanford Health Plan,450.8,92,,percent of total billed charges,,
"Enteric Pathogens Profile, Pcr, Stool, 12-25 Targets",,87507,CPT,Facility,Outpatient,,,,490,416.5,140.434,490,"UCare Health, Inc.",Individual & Family Plan,276.115,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Enteric Pathogens Profile, Pcr, Stool, 12-25 Targets",,87507,CPT,Facility,Inpatient,,,,490,416.5,140.434,490,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Enteric Pathogens Profile, Pcr, Stool, 12-25 Targets",,87507,CPT,Facility,Outpatient,,,,490,416.5,140.434,490,"UCare Health, Inc.",Medical Assistance,247.303,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Enteric Pathogens Profile, Pcr, Stool, 12-25 Targets",,87507,CPT,Facility,Inpatient,,,,490,416.5,140.434,490,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Enteric Pathogens Profile, Pcr, Stool, 12-25 Targets",,87507,CPT,Facility,Outpatient,,,,490,416.5,140.434,490,"UCare Health, Inc.",Medicare Advantage,247.303,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Enteric Pathogens Profile, Pcr, Stool, 12-25 Targets",,87507,CPT,Facility,Inpatient,,,,490,416.5,140.434,490,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Enteric Pathogens Profile, Pcr, Stool, 12-25 Targets",,87507,CPT,Facility,Outpatient,,,,490,416.5,140.434,490,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),247.303,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Enteric Pathogens Profile, Pcr, Stool, 12-25 Targets",,87507,CPT,Facility,Inpatient,,,,490,416.5,140.434,490,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Enteric Pathogens Profile, Pcr, Stool, 12-25 Targets",,87507,CPT,Facility,Both,,,,490,416.5,140.434,490,UnitedHealthcare,Individual & Family,460.6,94,,percent of total billed charges,,
"Enteric Pathogens Profile, Pcr, Stool, 12-25 Targets",,87507,CPT,Facility,Outpatient,,,,490,416.5,140.434,490,UnitedHealthcare,Medicare Advantage,240.1,49,,percent of total billed charges,,
"Enteric Pathogens Profile, Pcr, Stool, 12-25 Targets",,87507,CPT,Facility,Inpatient,,,,490,416.5,140.434,490,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Enteric Pathogens Profile, Pcr, Stool, 12-25 Targets",,87507,CPT,Facility,Outpatient,,,,490,416.5,140.434,490,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,235.2,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Enteric Pathogens Profile, Pcr, Stool, 12-25 Targets",,87507,CPT,Facility,Inpatient,,,,490,416.5,140.434,490,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Infectious Agent Detection By Nucleic Acid; Legionella Pneumophila, Amplified Probe",,87541,CPT,Facility,Both,,,,51,43.35,14.6166,51,Aetna,Commercial,46.92,92,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid; Legionella Pneumophila, Amplified Probe",,87541,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,Aetna,Medicare Advantage,24.99,49,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid; Legionella Pneumophila, Amplified Probe",,87541,CPT,Facility,Inpatient,,,,51,43.35,14.6166,51,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Infectious Agent Detection By Nucleic Acid; Legionella Pneumophila, Amplified Probe",,87541,CPT,Facility,Both,,,,51,43.35,14.6166,51,Aetna,PPO,47.43,93,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid; Legionella Pneumophila, Amplified Probe",,87541,CPT,Facility,Both,,,,51,43.35,14.6166,51,America's PPO,America's PPO,48.9753,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Infectious Agent Detection By Nucleic Acid; Legionella Pneumophila, Amplified Probe",,87541,CPT,Facility,Both,,,,51,43.35,14.6166,51,BlueCross BlueShield Minnesota, Federal Employee Program,50.184,98.4,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid; Legionella Pneumophila, Amplified Probe",,87541,CPT,Facility,Both,,,,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,51,100,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid; Legionella Pneumophila, Amplified Probe",,87541,CPT,Facility,Both,,,,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,High Value Network Plan,45.9,90,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid; Legionella Pneumophila, Amplified Probe",,87541,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,Medicare Advantage,24.99,49,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid; Legionella Pneumophila, Amplified Probe",,87541,CPT,Facility,Inpatient,,,,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Infectious Agent Detection By Nucleic Acid; Legionella Pneumophila, Amplified Probe",,87541,CPT,Facility,Both,,,,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,45.1707,88.57,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid; Legionella Pneumophila, Amplified Probe",,87541,CPT,Facility,Both,,,,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,14.6166,28.66,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid; Legionella Pneumophila, Amplified Probe",,87541,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),24.99,49,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid; Legionella Pneumophila, Amplified Probe",,87541,CPT,Facility,Inpatient,,,,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Infectious Agent Detection By Nucleic Acid; Legionella Pneumophila, Amplified Probe",,87541,CPT,Facility,Both,,,,51,43.35,14.6166,51,CorVel,Worker's Compensation,51,100,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid; Legionella Pneumophila, Amplified Probe",,87541,CPT,Facility,Both,,,,51,43.35,14.6166,51,First Health Group Corporation,First Health Network,49.47,97,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid; Legionella Pneumophila, Amplified Probe",,87541,CPT,Facility,Both,,,,51,43.35,14.6166,51,"Health Partners, Inc.",Commercial,48.246,94.6,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid; Legionella Pneumophila, Amplified Probe",,87541,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,"Health Partners, Inc.",Medicare Advantage,24.99,49,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid; Legionella Pneumophila, Amplified Probe",,87541,CPT,Facility,Inpatient,,,,51,43.35,14.6166,51,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Infectious Agent Detection By Nucleic Acid; Legionella Pneumophila, Amplified Probe",,87541,CPT,Facility,Both,,,,51,43.35,14.6166,51,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),30.6,60,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid; Legionella Pneumophila, Amplified Probe",,87541,CPT,Facility,Both,,,,51,43.35,14.6166,51,"Health Partners, Inc.",State of Minnesota Advantage Program,41.565,81.5,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid; Legionella Pneumophila, Amplified Probe",,87541,CPT,Facility,Both,,,,51,43.35,14.6166,51,"Health Partners, Inc.",State Public Programs,25.5,50,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid; Legionella Pneumophila, Amplified Probe",,87541,CPT,Facility,Both,,,,51,43.35,14.6166,51,Humana Insurance Company,Commercial PPO,48.45,95,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid; Legionella Pneumophila, Amplified Probe",,87541,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,Humana Insurance Company,Medicare PPO,24.99,49,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid; Legionella Pneumophila, Amplified Probe",,87541,CPT,Facility,Inpatient,,,,51,43.35,14.6166,51,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Infectious Agent Detection By Nucleic Acid; Legionella Pneumophila, Amplified Probe",,87541,CPT,Facility,Both,,,,51,43.35,14.6166,51,Medica,Individual & Family,50.541,99.1,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid; Legionella Pneumophila, Amplified Probe",,87541,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,Medica,Medica Advantage Solution,25.398,49.8,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid; Legionella Pneumophila, Amplified Probe",,87541,CPT,Facility,Inpatient,,,,51,43.35,14.6166,51,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Infectious Agent Detection By Nucleic Acid; Legionella Pneumophila, Amplified Probe",,87541,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,Medica,Medical Assistance,22.746,44.6,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid; Legionella Pneumophila, Amplified Probe",,87541,CPT,Facility,Inpatient,,,,51,43.35,14.6166,51,Medica,Medical Assistance,,,,,Included in per diem rate,
"Infectious Agent Detection By Nucleic Acid; Legionella Pneumophila, Amplified Probe",,87541,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,25.398,49.8,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid; Legionella Pneumophila, Amplified Probe",,87541,CPT,Facility,Inpatient,,,,51,43.35,14.6166,51,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Infectious Agent Detection By Nucleic Acid; Legionella Pneumophila, Amplified Probe",,87541,CPT,Facility,Both,,,,51,43.35,14.6166,51,"Multiplan, Inc.","Multiplan, Inc.",47.94,94,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid; Legionella Pneumophila, Amplified Probe",,87541,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,44.064,86.4,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid; Legionella Pneumophila, Amplified Probe",,87541,CPT,Facility,Inpatient,,,,51,43.35,14.6166,51,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Infectious Agent Detection By Nucleic Acid; Legionella Pneumophila, Amplified Probe",,87541,CPT,Facility,Both,,,,51,43.35,14.6166,51,"Preferred One Administrative Services, INC.",PPO,50.286,98.6,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid; Legionella Pneumophila, Amplified Probe",,87541,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,PrimeWest Health,Minnesota Senior Health Options (MSHO),26.2395,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Infectious Agent Detection By Nucleic Acid; Legionella Pneumophila, Amplified Probe",,87541,CPT,Facility,Inpatient,,,,51,43.35,14.6166,51,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Infectious Agent Detection By Nucleic Acid; Legionella Pneumophila, Amplified Probe",,87541,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,PrimeWest Health,MinnesotaCare,26.1936,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Infectious Agent Detection By Nucleic Acid; Legionella Pneumophila, Amplified Probe",,87541,CPT,Facility,Inpatient,,,,51,43.35,14.6166,51,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Infectious Agent Detection By Nucleic Acid; Legionella Pneumophila, Amplified Probe",,87541,CPT,Facility,Both,,,,51,43.35,14.6166,51,Sanford Health Plan,Sanford Health Plan,46.92,92,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid; Legionella Pneumophila, Amplified Probe",,87541,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,"UCare Health, Inc.",Individual & Family Plan,28.7385,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Infectious Agent Detection By Nucleic Acid; Legionella Pneumophila, Amplified Probe",,87541,CPT,Facility,Inpatient,,,,51,43.35,14.6166,51,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Infectious Agent Detection By Nucleic Acid; Legionella Pneumophila, Amplified Probe",,87541,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,"UCare Health, Inc.",Medical Assistance,25.7397,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Infectious Agent Detection By Nucleic Acid; Legionella Pneumophila, Amplified Probe",,87541,CPT,Facility,Inpatient,,,,51,43.35,14.6166,51,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Infectious Agent Detection By Nucleic Acid; Legionella Pneumophila, Amplified Probe",,87541,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,"UCare Health, Inc.",Medicare Advantage,25.7397,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Infectious Agent Detection By Nucleic Acid; Legionella Pneumophila, Amplified Probe",,87541,CPT,Facility,Inpatient,,,,51,43.35,14.6166,51,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Infectious Agent Detection By Nucleic Acid; Legionella Pneumophila, Amplified Probe",,87541,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),25.7397,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Infectious Agent Detection By Nucleic Acid; Legionella Pneumophila, Amplified Probe",,87541,CPT,Facility,Inpatient,,,,51,43.35,14.6166,51,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Infectious Agent Detection By Nucleic Acid; Legionella Pneumophila, Amplified Probe",,87541,CPT,Facility,Both,,,,51,43.35,14.6166,51,UnitedHealthcare,Individual & Family,47.94,94,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid; Legionella Pneumophila, Amplified Probe",,87541,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,UnitedHealthcare,Medicare Advantage,24.99,49,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid; Legionella Pneumophila, Amplified Probe",,87541,CPT,Facility,Inpatient,,,,51,43.35,14.6166,51,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Infectious Agent Detection By Nucleic Acid; Legionella Pneumophila, Amplified Probe",,87541,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,24.48,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Infectious Agent Detection By Nucleic Acid; Legionella Pneumophila, Amplified Probe",,87541,CPT,Facility,Inpatient,,,,51,43.35,14.6166,51,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Infectious Agent Detection By Nucleic Acid; Mycoplasma Pneumoniae, Amplified Probe",,87581,CPT,Facility,Both,,,,51,43.35,14.6166,51,Aetna,Commercial,46.92,92,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid; Mycoplasma Pneumoniae, Amplified Probe",,87581,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,Aetna,Medicare Advantage,24.99,49,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid; Mycoplasma Pneumoniae, Amplified Probe",,87581,CPT,Facility,Inpatient,,,,51,43.35,14.6166,51,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Infectious Agent Detection By Nucleic Acid; Mycoplasma Pneumoniae, Amplified Probe",,87581,CPT,Facility,Both,,,,51,43.35,14.6166,51,Aetna,PPO,47.43,93,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid; Mycoplasma Pneumoniae, Amplified Probe",,87581,CPT,Facility,Both,,,,51,43.35,14.6166,51,America's PPO,America's PPO,48.9753,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Infectious Agent Detection By Nucleic Acid; Mycoplasma Pneumoniae, Amplified Probe",,87581,CPT,Facility,Both,,,,51,43.35,14.6166,51,BlueCross BlueShield Minnesota, Federal Employee Program,50.184,98.4,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid; Mycoplasma Pneumoniae, Amplified Probe",,87581,CPT,Facility,Both,,,,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,51,100,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid; Mycoplasma Pneumoniae, Amplified Probe",,87581,CPT,Facility,Both,,,,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,High Value Network Plan,45.9,90,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid; Mycoplasma Pneumoniae, Amplified Probe",,87581,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,Medicare Advantage,24.99,49,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid; Mycoplasma Pneumoniae, Amplified Probe",,87581,CPT,Facility,Inpatient,,,,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Infectious Agent Detection By Nucleic Acid; Mycoplasma Pneumoniae, Amplified Probe",,87581,CPT,Facility,Both,,,,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,45.1707,88.57,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid; Mycoplasma Pneumoniae, Amplified Probe",,87581,CPT,Facility,Both,,,,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,14.6166,28.66,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid; Mycoplasma Pneumoniae, Amplified Probe",,87581,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),24.99,49,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid; Mycoplasma Pneumoniae, Amplified Probe",,87581,CPT,Facility,Inpatient,,,,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Infectious Agent Detection By Nucleic Acid; Mycoplasma Pneumoniae, Amplified Probe",,87581,CPT,Facility,Both,,,,51,43.35,14.6166,51,CorVel,Worker's Compensation,51,100,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid; Mycoplasma Pneumoniae, Amplified Probe",,87581,CPT,Facility,Both,,,,51,43.35,14.6166,51,First Health Group Corporation,First Health Network,49.47,97,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid; Mycoplasma Pneumoniae, Amplified Probe",,87581,CPT,Facility,Both,,,,51,43.35,14.6166,51,"Health Partners, Inc.",Commercial,48.246,94.6,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid; Mycoplasma Pneumoniae, Amplified Probe",,87581,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,"Health Partners, Inc.",Medicare Advantage,24.99,49,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid; Mycoplasma Pneumoniae, Amplified Probe",,87581,CPT,Facility,Inpatient,,,,51,43.35,14.6166,51,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Infectious Agent Detection By Nucleic Acid; Mycoplasma Pneumoniae, Amplified Probe",,87581,CPT,Facility,Both,,,,51,43.35,14.6166,51,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),30.6,60,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid; Mycoplasma Pneumoniae, Amplified Probe",,87581,CPT,Facility,Both,,,,51,43.35,14.6166,51,"Health Partners, Inc.",State of Minnesota Advantage Program,41.565,81.5,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid; Mycoplasma Pneumoniae, Amplified Probe",,87581,CPT,Facility,Both,,,,51,43.35,14.6166,51,"Health Partners, Inc.",State Public Programs,25.5,50,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid; Mycoplasma Pneumoniae, Amplified Probe",,87581,CPT,Facility,Both,,,,51,43.35,14.6166,51,Humana Insurance Company,Commercial PPO,48.45,95,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid; Mycoplasma Pneumoniae, Amplified Probe",,87581,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,Humana Insurance Company,Medicare PPO,24.99,49,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid; Mycoplasma Pneumoniae, Amplified Probe",,87581,CPT,Facility,Inpatient,,,,51,43.35,14.6166,51,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Infectious Agent Detection By Nucleic Acid; Mycoplasma Pneumoniae, Amplified Probe",,87581,CPT,Facility,Both,,,,51,43.35,14.6166,51,Medica,Individual & Family,50.541,99.1,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid; Mycoplasma Pneumoniae, Amplified Probe",,87581,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,Medica,Medica Advantage Solution,25.398,49.8,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid; Mycoplasma Pneumoniae, Amplified Probe",,87581,CPT,Facility,Inpatient,,,,51,43.35,14.6166,51,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Infectious Agent Detection By Nucleic Acid; Mycoplasma Pneumoniae, Amplified Probe",,87581,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,Medica,Medical Assistance,22.746,44.6,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid; Mycoplasma Pneumoniae, Amplified Probe",,87581,CPT,Facility,Inpatient,,,,51,43.35,14.6166,51,Medica,Medical Assistance,,,,,Included in per diem rate,
"Infectious Agent Detection By Nucleic Acid; Mycoplasma Pneumoniae, Amplified Probe",,87581,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,25.398,49.8,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid; Mycoplasma Pneumoniae, Amplified Probe",,87581,CPT,Facility,Inpatient,,,,51,43.35,14.6166,51,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Infectious Agent Detection By Nucleic Acid; Mycoplasma Pneumoniae, Amplified Probe",,87581,CPT,Facility,Both,,,,51,43.35,14.6166,51,"Multiplan, Inc.","Multiplan, Inc.",47.94,94,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid; Mycoplasma Pneumoniae, Amplified Probe",,87581,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,44.064,86.4,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid; Mycoplasma Pneumoniae, Amplified Probe",,87581,CPT,Facility,Inpatient,,,,51,43.35,14.6166,51,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Infectious Agent Detection By Nucleic Acid; Mycoplasma Pneumoniae, Amplified Probe",,87581,CPT,Facility,Both,,,,51,43.35,14.6166,51,"Preferred One Administrative Services, INC.",PPO,50.286,98.6,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid; Mycoplasma Pneumoniae, Amplified Probe",,87581,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,PrimeWest Health,Minnesota Senior Health Options (MSHO),26.2395,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Infectious Agent Detection By Nucleic Acid; Mycoplasma Pneumoniae, Amplified Probe",,87581,CPT,Facility,Inpatient,,,,51,43.35,14.6166,51,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Infectious Agent Detection By Nucleic Acid; Mycoplasma Pneumoniae, Amplified Probe",,87581,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,PrimeWest Health,MinnesotaCare,26.1936,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Infectious Agent Detection By Nucleic Acid; Mycoplasma Pneumoniae, Amplified Probe",,87581,CPT,Facility,Inpatient,,,,51,43.35,14.6166,51,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Infectious Agent Detection By Nucleic Acid; Mycoplasma Pneumoniae, Amplified Probe",,87581,CPT,Facility,Both,,,,51,43.35,14.6166,51,Sanford Health Plan,Sanford Health Plan,46.92,92,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid; Mycoplasma Pneumoniae, Amplified Probe",,87581,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,"UCare Health, Inc.",Individual & Family Plan,28.7385,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Infectious Agent Detection By Nucleic Acid; Mycoplasma Pneumoniae, Amplified Probe",,87581,CPT,Facility,Inpatient,,,,51,43.35,14.6166,51,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Infectious Agent Detection By Nucleic Acid; Mycoplasma Pneumoniae, Amplified Probe",,87581,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,"UCare Health, Inc.",Medical Assistance,25.7397,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Infectious Agent Detection By Nucleic Acid; Mycoplasma Pneumoniae, Amplified Probe",,87581,CPT,Facility,Inpatient,,,,51,43.35,14.6166,51,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Infectious Agent Detection By Nucleic Acid; Mycoplasma Pneumoniae, Amplified Probe",,87581,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,"UCare Health, Inc.",Medicare Advantage,25.7397,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Infectious Agent Detection By Nucleic Acid; Mycoplasma Pneumoniae, Amplified Probe",,87581,CPT,Facility,Inpatient,,,,51,43.35,14.6166,51,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Infectious Agent Detection By Nucleic Acid; Mycoplasma Pneumoniae, Amplified Probe",,87581,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),25.7397,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Infectious Agent Detection By Nucleic Acid; Mycoplasma Pneumoniae, Amplified Probe",,87581,CPT,Facility,Inpatient,,,,51,43.35,14.6166,51,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Infectious Agent Detection By Nucleic Acid; Mycoplasma Pneumoniae, Amplified Probe",,87581,CPT,Facility,Both,,,,51,43.35,14.6166,51,UnitedHealthcare,Individual & Family,47.94,94,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid; Mycoplasma Pneumoniae, Amplified Probe",,87581,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,UnitedHealthcare,Medicare Advantage,24.99,49,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid; Mycoplasma Pneumoniae, Amplified Probe",,87581,CPT,Facility,Inpatient,,,,51,43.35,14.6166,51,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Infectious Agent Detection By Nucleic Acid; Mycoplasma Pneumoniae, Amplified Probe",,87581,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,24.48,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Infectious Agent Detection By Nucleic Acid; Mycoplasma Pneumoniae, Amplified Probe",,87581,CPT,Facility,Inpatient,,,,51,43.35,14.6166,51,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Neisseria Gonorrhoeae, Naat",,87591,CPT,Facility,Both,,,,126,107.1,36.1116,126,Aetna,Commercial,115.92,92,,percent of total billed charges,,
"Neisseria Gonorrhoeae, Naat",,87591,CPT,Facility,Outpatient,,,,126,107.1,36.1116,126,Aetna,Medicare Advantage,61.74,49,,percent of total billed charges,,
"Neisseria Gonorrhoeae, Naat",,87591,CPT,Facility,Inpatient,,,,126,107.1,36.1116,126,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Neisseria Gonorrhoeae, Naat",,87591,CPT,Facility,Both,,,,126,107.1,36.1116,126,Aetna,PPO,117.18,93,,percent of total billed charges,,
"Neisseria Gonorrhoeae, Naat",,87591,CPT,Facility,Both,,,,126,107.1,36.1116,126,America's PPO,America's PPO,120.9978,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Neisseria Gonorrhoeae, Naat",,87591,CPT,Facility,Both,,,,126,107.1,36.1116,126,BlueCross BlueShield Minnesota, Federal Employee Program,123.984,98.4,,percent of total billed charges,,
"Neisseria Gonorrhoeae, Naat",,87591,CPT,Facility,Both,,,,126,107.1,36.1116,126,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,126,100,,percent of total billed charges,,
"Neisseria Gonorrhoeae, Naat",,87591,CPT,Facility,Both,,,,126,107.1,36.1116,126,BlueCross BlueShield Minnesota,High Value Network Plan,113.4,90,,percent of total billed charges,,
"Neisseria Gonorrhoeae, Naat",,87591,CPT,Facility,Outpatient,,,,126,107.1,36.1116,126,BlueCross BlueShield Minnesota,Medicare Advantage,61.74,49,,percent of total billed charges,,
"Neisseria Gonorrhoeae, Naat",,87591,CPT,Facility,Inpatient,,,,126,107.1,36.1116,126,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Neisseria Gonorrhoeae, Naat",,87591,CPT,Facility,Both,,,,126,107.1,36.1116,126,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,111.5982,88.57,,percent of total billed charges,,
"Neisseria Gonorrhoeae, Naat",,87591,CPT,Facility,Both,,,,126,107.1,36.1116,126,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,36.1116,28.66,,percent of total billed charges,,
"Neisseria Gonorrhoeae, Naat",,87591,CPT,Facility,Outpatient,,,,126,107.1,36.1116,126,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),61.74,49,,percent of total billed charges,,
"Neisseria Gonorrhoeae, Naat",,87591,CPT,Facility,Inpatient,,,,126,107.1,36.1116,126,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Neisseria Gonorrhoeae, Naat",,87591,CPT,Facility,Both,,,,126,107.1,36.1116,126,CorVel,Worker's Compensation,126,100,,percent of total billed charges,,
"Neisseria Gonorrhoeae, Naat",,87591,CPT,Facility,Both,,,,126,107.1,36.1116,126,First Health Group Corporation,First Health Network,122.22,97,,percent of total billed charges,,
"Neisseria Gonorrhoeae, Naat",,87591,CPT,Facility,Both,,,,126,107.1,36.1116,126,"Health Partners, Inc.",Commercial,119.196,94.6,,percent of total billed charges,,
"Neisseria Gonorrhoeae, Naat",,87591,CPT,Facility,Outpatient,,,,126,107.1,36.1116,126,"Health Partners, Inc.",Medicare Advantage,61.74,49,,percent of total billed charges,,
"Neisseria Gonorrhoeae, Naat",,87591,CPT,Facility,Inpatient,,,,126,107.1,36.1116,126,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Neisseria Gonorrhoeae, Naat",,87591,CPT,Facility,Both,,,,126,107.1,36.1116,126,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),75.6,60,,percent of total billed charges,,
"Neisseria Gonorrhoeae, Naat",,87591,CPT,Facility,Both,,,,126,107.1,36.1116,126,"Health Partners, Inc.",State of Minnesota Advantage Program,102.69,81.5,,percent of total billed charges,,
"Neisseria Gonorrhoeae, Naat",,87591,CPT,Facility,Both,,,,126,107.1,36.1116,126,"Health Partners, Inc.",State Public Programs,63,50,,percent of total billed charges,,
"Neisseria Gonorrhoeae, Naat",,87591,CPT,Facility,Both,,,,126,107.1,36.1116,126,Humana Insurance Company,Commercial PPO,119.7,95,,percent of total billed charges,,
"Neisseria Gonorrhoeae, Naat",,87591,CPT,Facility,Outpatient,,,,126,107.1,36.1116,126,Humana Insurance Company,Medicare PPO,61.74,49,,percent of total billed charges,,
"Neisseria Gonorrhoeae, Naat",,87591,CPT,Facility,Inpatient,,,,126,107.1,36.1116,126,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Neisseria Gonorrhoeae, Naat",,87591,CPT,Facility,Both,,,,126,107.1,36.1116,126,Medica,Individual & Family,124.866,99.1,,percent of total billed charges,,
"Neisseria Gonorrhoeae, Naat",,87591,CPT,Facility,Outpatient,,,,126,107.1,36.1116,126,Medica,Medica Advantage Solution,62.748,49.8,,percent of total billed charges,,
"Neisseria Gonorrhoeae, Naat",,87591,CPT,Facility,Inpatient,,,,126,107.1,36.1116,126,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Neisseria Gonorrhoeae, Naat",,87591,CPT,Facility,Outpatient,,,,126,107.1,36.1116,126,Medica,Medical Assistance,56.196,44.6,,percent of total billed charges,,
"Neisseria Gonorrhoeae, Naat",,87591,CPT,Facility,Inpatient,,,,126,107.1,36.1116,126,Medica,Medical Assistance,,,,,Included in per diem rate,
"Neisseria Gonorrhoeae, Naat",,87591,CPT,Facility,Outpatient,,,,126,107.1,36.1116,126,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,62.748,49.8,,percent of total billed charges,,
"Neisseria Gonorrhoeae, Naat",,87591,CPT,Facility,Inpatient,,,,126,107.1,36.1116,126,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Neisseria Gonorrhoeae, Naat",,87591,CPT,Facility,Both,,,,126,107.1,36.1116,126,"Multiplan, Inc.","Multiplan, Inc.",118.44,94,,percent of total billed charges,,
"Neisseria Gonorrhoeae, Naat",,87591,CPT,Facility,Outpatient,,,,126,107.1,36.1116,126,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,108.864,86.4,,percent of total billed charges,,
"Neisseria Gonorrhoeae, Naat",,87591,CPT,Facility,Inpatient,,,,126,107.1,36.1116,126,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Neisseria Gonorrhoeae, Naat",,87591,CPT,Facility,Both,,,,126,107.1,36.1116,126,"Preferred One Administrative Services, INC.",PPO,124.236,98.6,,percent of total billed charges,,
"Neisseria Gonorrhoeae, Naat",,87591,CPT,Facility,Outpatient,,,,126,107.1,36.1116,126,PrimeWest Health,Minnesota Senior Health Options (MSHO),64.827,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Neisseria Gonorrhoeae, Naat",,87591,CPT,Facility,Inpatient,,,,126,107.1,36.1116,126,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Neisseria Gonorrhoeae, Naat",,87591,CPT,Facility,Outpatient,,,,126,107.1,36.1116,126,PrimeWest Health,MinnesotaCare,64.7136,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Neisseria Gonorrhoeae, Naat",,87591,CPT,Facility,Inpatient,,,,126,107.1,36.1116,126,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Neisseria Gonorrhoeae, Naat",,87591,CPT,Facility,Both,,,,126,107.1,36.1116,126,Sanford Health Plan,Sanford Health Plan,115.92,92,,percent of total billed charges,,
"Neisseria Gonorrhoeae, Naat",,87591,CPT,Facility,Outpatient,,,,126,107.1,36.1116,126,"UCare Health, Inc.",Individual & Family Plan,71.001,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Neisseria Gonorrhoeae, Naat",,87591,CPT,Facility,Inpatient,,,,126,107.1,36.1116,126,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Neisseria Gonorrhoeae, Naat",,87591,CPT,Facility,Outpatient,,,,126,107.1,36.1116,126,"UCare Health, Inc.",Medical Assistance,63.5922,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Neisseria Gonorrhoeae, Naat",,87591,CPT,Facility,Inpatient,,,,126,107.1,36.1116,126,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Neisseria Gonorrhoeae, Naat",,87591,CPT,Facility,Outpatient,,,,126,107.1,36.1116,126,"UCare Health, Inc.",Medicare Advantage,63.5922,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Neisseria Gonorrhoeae, Naat",,87591,CPT,Facility,Inpatient,,,,126,107.1,36.1116,126,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Neisseria Gonorrhoeae, Naat",,87591,CPT,Facility,Outpatient,,,,126,107.1,36.1116,126,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),63.5922,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Neisseria Gonorrhoeae, Naat",,87591,CPT,Facility,Inpatient,,,,126,107.1,36.1116,126,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Neisseria Gonorrhoeae, Naat",,87591,CPT,Facility,Both,,,,126,107.1,36.1116,126,UnitedHealthcare,Individual & Family,118.44,94,,percent of total billed charges,,
"Neisseria Gonorrhoeae, Naat",,87591,CPT,Facility,Outpatient,,,,126,107.1,36.1116,126,UnitedHealthcare,Medicare Advantage,61.74,49,,percent of total billed charges,,
"Neisseria Gonorrhoeae, Naat",,87591,CPT,Facility,Inpatient,,,,126,107.1,36.1116,126,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Neisseria Gonorrhoeae, Naat",,87591,CPT,Facility,Outpatient,,,,126,107.1,36.1116,126,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,60.48,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Neisseria Gonorrhoeae, Naat",,87591,CPT,Facility,Inpatient,,,,126,107.1,36.1116,126,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Hpv High Risk,,87624,CPT,Facility,Both,,,,173,147.05,49.5818,173,Aetna,Commercial,159.16,92,,percent of total billed charges,,
Hpv High Risk,,87624,CPT,Facility,Outpatient,,,,173,147.05,49.5818,173,Aetna,Medicare Advantage,84.77,49,,percent of total billed charges,,
Hpv High Risk,,87624,CPT,Facility,Inpatient,,,,173,147.05,49.5818,173,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Hpv High Risk,,87624,CPT,Facility,Both,,,,173,147.05,49.5818,173,Aetna,PPO,160.89,93,,percent of total billed charges,,
Hpv High Risk,,87624,CPT,Facility,Both,,,,173,147.05,49.5818,173,America's PPO,America's PPO,166.1319,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Hpv High Risk,,87624,CPT,Facility,Both,,,,173,147.05,49.5818,173,BlueCross BlueShield Minnesota, Federal Employee Program,170.232,98.4,,percent of total billed charges,,
Hpv High Risk,,87624,CPT,Facility,Both,,,,173,147.05,49.5818,173,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,173,100,,percent of total billed charges,,
Hpv High Risk,,87624,CPT,Facility,Both,,,,173,147.05,49.5818,173,BlueCross BlueShield Minnesota,High Value Network Plan,155.7,90,,percent of total billed charges,,
Hpv High Risk,,87624,CPT,Facility,Outpatient,,,,173,147.05,49.5818,173,BlueCross BlueShield Minnesota,Medicare Advantage,84.77,49,,percent of total billed charges,,
Hpv High Risk,,87624,CPT,Facility,Inpatient,,,,173,147.05,49.5818,173,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Hpv High Risk,,87624,CPT,Facility,Both,,,,173,147.05,49.5818,173,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,153.2261,88.57,,percent of total billed charges,,
Hpv High Risk,,87624,CPT,Facility,Both,,,,173,147.05,49.5818,173,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,49.5818,28.66,,percent of total billed charges,,
Hpv High Risk,,87624,CPT,Facility,Outpatient,,,,173,147.05,49.5818,173,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),84.77,49,,percent of total billed charges,,
Hpv High Risk,,87624,CPT,Facility,Inpatient,,,,173,147.05,49.5818,173,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Hpv High Risk,,87624,CPT,Facility,Both,,,,173,147.05,49.5818,173,CorVel,Worker's Compensation,173,100,,percent of total billed charges,,
Hpv High Risk,,87624,CPT,Facility,Both,,,,173,147.05,49.5818,173,First Health Group Corporation,First Health Network,167.81,97,,percent of total billed charges,,
Hpv High Risk,,87624,CPT,Facility,Both,,,,173,147.05,49.5818,173,"Health Partners, Inc.",Commercial,163.658,94.6,,percent of total billed charges,,
Hpv High Risk,,87624,CPT,Facility,Outpatient,,,,173,147.05,49.5818,173,"Health Partners, Inc.",Medicare Advantage,84.77,49,,percent of total billed charges,,
Hpv High Risk,,87624,CPT,Facility,Inpatient,,,,173,147.05,49.5818,173,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Hpv High Risk,,87624,CPT,Facility,Both,,,,173,147.05,49.5818,173,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),103.8,60,,percent of total billed charges,,
Hpv High Risk,,87624,CPT,Facility,Both,,,,173,147.05,49.5818,173,"Health Partners, Inc.",State of Minnesota Advantage Program,140.995,81.5,,percent of total billed charges,,
Hpv High Risk,,87624,CPT,Facility,Both,,,,173,147.05,49.5818,173,"Health Partners, Inc.",State Public Programs,86.5,50,,percent of total billed charges,,
Hpv High Risk,,87624,CPT,Facility,Both,,,,173,147.05,49.5818,173,Humana Insurance Company,Commercial PPO,164.35,95,,percent of total billed charges,,
Hpv High Risk,,87624,CPT,Facility,Outpatient,,,,173,147.05,49.5818,173,Humana Insurance Company,Medicare PPO,84.77,49,,percent of total billed charges,,
Hpv High Risk,,87624,CPT,Facility,Inpatient,,,,173,147.05,49.5818,173,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Hpv High Risk,,87624,CPT,Facility,Both,,,,173,147.05,49.5818,173,Medica,Individual & Family,171.443,99.1,,percent of total billed charges,,
Hpv High Risk,,87624,CPT,Facility,Outpatient,,,,173,147.05,49.5818,173,Medica,Medica Advantage Solution,86.154,49.8,,percent of total billed charges,,
Hpv High Risk,,87624,CPT,Facility,Inpatient,,,,173,147.05,49.5818,173,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Hpv High Risk,,87624,CPT,Facility,Outpatient,,,,173,147.05,49.5818,173,Medica,Medical Assistance,77.158,44.6,,percent of total billed charges,,
Hpv High Risk,,87624,CPT,Facility,Inpatient,,,,173,147.05,49.5818,173,Medica,Medical Assistance,,,,,Included in per diem rate,
Hpv High Risk,,87624,CPT,Facility,Outpatient,,,,173,147.05,49.5818,173,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,86.154,49.8,,percent of total billed charges,,
Hpv High Risk,,87624,CPT,Facility,Inpatient,,,,173,147.05,49.5818,173,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Hpv High Risk,,87624,CPT,Facility,Both,,,,173,147.05,49.5818,173,"Multiplan, Inc.","Multiplan, Inc.",162.62,94,,percent of total billed charges,,
Hpv High Risk,,87624,CPT,Facility,Outpatient,,,,173,147.05,49.5818,173,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,149.472,86.4,,percent of total billed charges,,
Hpv High Risk,,87624,CPT,Facility,Inpatient,,,,173,147.05,49.5818,173,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Hpv High Risk,,87624,CPT,Facility,Both,,,,173,147.05,49.5818,173,"Preferred One Administrative Services, INC.",PPO,170.578,98.6,,percent of total billed charges,,
Hpv High Risk,,87624,CPT,Facility,Outpatient,,,,173,147.05,49.5818,173,PrimeWest Health,Minnesota Senior Health Options (MSHO),89.0085,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Hpv High Risk,,87624,CPT,Facility,Inpatient,,,,173,147.05,49.5818,173,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Hpv High Risk,,87624,CPT,Facility,Outpatient,,,,173,147.05,49.5818,173,PrimeWest Health,MinnesotaCare,88.8528,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Hpv High Risk,,87624,CPT,Facility,Inpatient,,,,173,147.05,49.5818,173,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Hpv High Risk,,87624,CPT,Facility,Both,,,,173,147.05,49.5818,173,Sanford Health Plan,Sanford Health Plan,159.16,92,,percent of total billed charges,,
Hpv High Risk,,87624,CPT,Facility,Outpatient,,,,173,147.05,49.5818,173,"UCare Health, Inc.",Individual & Family Plan,97.4855,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Hpv High Risk,,87624,CPT,Facility,Inpatient,,,,173,147.05,49.5818,173,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Hpv High Risk,,87624,CPT,Facility,Outpatient,,,,173,147.05,49.5818,173,"UCare Health, Inc.",Medical Assistance,87.3131,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Hpv High Risk,,87624,CPT,Facility,Inpatient,,,,173,147.05,49.5818,173,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Hpv High Risk,,87624,CPT,Facility,Outpatient,,,,173,147.05,49.5818,173,"UCare Health, Inc.",Medicare Advantage,87.3131,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Hpv High Risk,,87624,CPT,Facility,Inpatient,,,,173,147.05,49.5818,173,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Hpv High Risk,,87624,CPT,Facility,Outpatient,,,,173,147.05,49.5818,173,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),87.3131,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Hpv High Risk,,87624,CPT,Facility,Inpatient,,,,173,147.05,49.5818,173,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Hpv High Risk,,87624,CPT,Facility,Both,,,,173,147.05,49.5818,173,UnitedHealthcare,Individual & Family,162.62,94,,percent of total billed charges,,
Hpv High Risk,,87624,CPT,Facility,Outpatient,,,,173,147.05,49.5818,173,UnitedHealthcare,Medicare Advantage,84.77,49,,percent of total billed charges,,
Hpv High Risk,,87624,CPT,Facility,Inpatient,,,,173,147.05,49.5818,173,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Hpv High Risk,,87624,CPT,Facility,Outpatient,,,,173,147.05,49.5818,173,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,83.04,48,,percent of total billed charges,,100% of DHS outpatient percentage
Hpv High Risk,,87624,CPT,Facility,Inpatient,,,,173,147.05,49.5818,173,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Hpv High Risk Rmh,,87624,CPT,Facility,Both,,,,173,147.05,49.5818,173,Aetna,Commercial,159.16,92,,percent of total billed charges,,
Hpv High Risk Rmh,,87624,CPT,Facility,Outpatient,,,,173,147.05,49.5818,173,Aetna,Medicare Advantage,84.77,49,,percent of total billed charges,,
Hpv High Risk Rmh,,87624,CPT,Facility,Inpatient,,,,173,147.05,49.5818,173,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Hpv High Risk Rmh,,87624,CPT,Facility,Both,,,,173,147.05,49.5818,173,Aetna,PPO,160.89,93,,percent of total billed charges,,
Hpv High Risk Rmh,,87624,CPT,Facility,Both,,,,173,147.05,49.5818,173,America's PPO,America's PPO,166.1319,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Hpv High Risk Rmh,,87624,CPT,Facility,Both,,,,173,147.05,49.5818,173,BlueCross BlueShield Minnesota, Federal Employee Program,170.232,98.4,,percent of total billed charges,,
Hpv High Risk Rmh,,87624,CPT,Facility,Both,,,,173,147.05,49.5818,173,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,173,100,,percent of total billed charges,,
Hpv High Risk Rmh,,87624,CPT,Facility,Both,,,,173,147.05,49.5818,173,BlueCross BlueShield Minnesota,High Value Network Plan,155.7,90,,percent of total billed charges,,
Hpv High Risk Rmh,,87624,CPT,Facility,Outpatient,,,,173,147.05,49.5818,173,BlueCross BlueShield Minnesota,Medicare Advantage,84.77,49,,percent of total billed charges,,
Hpv High Risk Rmh,,87624,CPT,Facility,Inpatient,,,,173,147.05,49.5818,173,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Hpv High Risk Rmh,,87624,CPT,Facility,Both,,,,173,147.05,49.5818,173,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,153.2261,88.57,,percent of total billed charges,,
Hpv High Risk Rmh,,87624,CPT,Facility,Both,,,,173,147.05,49.5818,173,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,49.5818,28.66,,percent of total billed charges,,
Hpv High Risk Rmh,,87624,CPT,Facility,Outpatient,,,,173,147.05,49.5818,173,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),84.77,49,,percent of total billed charges,,
Hpv High Risk Rmh,,87624,CPT,Facility,Inpatient,,,,173,147.05,49.5818,173,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Hpv High Risk Rmh,,87624,CPT,Facility,Both,,,,173,147.05,49.5818,173,CorVel,Worker's Compensation,173,100,,percent of total billed charges,,
Hpv High Risk Rmh,,87624,CPT,Facility,Both,,,,173,147.05,49.5818,173,First Health Group Corporation,First Health Network,167.81,97,,percent of total billed charges,,
Hpv High Risk Rmh,,87624,CPT,Facility,Both,,,,173,147.05,49.5818,173,"Health Partners, Inc.",Commercial,163.658,94.6,,percent of total billed charges,,
Hpv High Risk Rmh,,87624,CPT,Facility,Outpatient,,,,173,147.05,49.5818,173,"Health Partners, Inc.",Medicare Advantage,84.77,49,,percent of total billed charges,,
Hpv High Risk Rmh,,87624,CPT,Facility,Inpatient,,,,173,147.05,49.5818,173,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Hpv High Risk Rmh,,87624,CPT,Facility,Both,,,,173,147.05,49.5818,173,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),103.8,60,,percent of total billed charges,,
Hpv High Risk Rmh,,87624,CPT,Facility,Both,,,,173,147.05,49.5818,173,"Health Partners, Inc.",State of Minnesota Advantage Program,140.995,81.5,,percent of total billed charges,,
Hpv High Risk Rmh,,87624,CPT,Facility,Both,,,,173,147.05,49.5818,173,"Health Partners, Inc.",State Public Programs,86.5,50,,percent of total billed charges,,
Hpv High Risk Rmh,,87624,CPT,Facility,Both,,,,173,147.05,49.5818,173,Humana Insurance Company,Commercial PPO,164.35,95,,percent of total billed charges,,
Hpv High Risk Rmh,,87624,CPT,Facility,Outpatient,,,,173,147.05,49.5818,173,Humana Insurance Company,Medicare PPO,84.77,49,,percent of total billed charges,,
Hpv High Risk Rmh,,87624,CPT,Facility,Inpatient,,,,173,147.05,49.5818,173,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Hpv High Risk Rmh,,87624,CPT,Facility,Both,,,,173,147.05,49.5818,173,Medica,Individual & Family,171.443,99.1,,percent of total billed charges,,
Hpv High Risk Rmh,,87624,CPT,Facility,Outpatient,,,,173,147.05,49.5818,173,Medica,Medica Advantage Solution,86.154,49.8,,percent of total billed charges,,
Hpv High Risk Rmh,,87624,CPT,Facility,Inpatient,,,,173,147.05,49.5818,173,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Hpv High Risk Rmh,,87624,CPT,Facility,Outpatient,,,,173,147.05,49.5818,173,Medica,Medical Assistance,77.158,44.6,,percent of total billed charges,,
Hpv High Risk Rmh,,87624,CPT,Facility,Inpatient,,,,173,147.05,49.5818,173,Medica,Medical Assistance,,,,,Included in per diem rate,
Hpv High Risk Rmh,,87624,CPT,Facility,Outpatient,,,,173,147.05,49.5818,173,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,86.154,49.8,,percent of total billed charges,,
Hpv High Risk Rmh,,87624,CPT,Facility,Inpatient,,,,173,147.05,49.5818,173,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Hpv High Risk Rmh,,87624,CPT,Facility,Both,,,,173,147.05,49.5818,173,"Multiplan, Inc.","Multiplan, Inc.",162.62,94,,percent of total billed charges,,
Hpv High Risk Rmh,,87624,CPT,Facility,Outpatient,,,,173,147.05,49.5818,173,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,149.472,86.4,,percent of total billed charges,,
Hpv High Risk Rmh,,87624,CPT,Facility,Inpatient,,,,173,147.05,49.5818,173,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Hpv High Risk Rmh,,87624,CPT,Facility,Both,,,,173,147.05,49.5818,173,"Preferred One Administrative Services, INC.",PPO,170.578,98.6,,percent of total billed charges,,
Hpv High Risk Rmh,,87624,CPT,Facility,Outpatient,,,,173,147.05,49.5818,173,PrimeWest Health,Minnesota Senior Health Options (MSHO),89.0085,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Hpv High Risk Rmh,,87624,CPT,Facility,Inpatient,,,,173,147.05,49.5818,173,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Hpv High Risk Rmh,,87624,CPT,Facility,Outpatient,,,,173,147.05,49.5818,173,PrimeWest Health,MinnesotaCare,88.8528,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Hpv High Risk Rmh,,87624,CPT,Facility,Inpatient,,,,173,147.05,49.5818,173,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Hpv High Risk Rmh,,87624,CPT,Facility,Both,,,,173,147.05,49.5818,173,Sanford Health Plan,Sanford Health Plan,159.16,92,,percent of total billed charges,,
Hpv High Risk Rmh,,87624,CPT,Facility,Outpatient,,,,173,147.05,49.5818,173,"UCare Health, Inc.",Individual & Family Plan,97.4855,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Hpv High Risk Rmh,,87624,CPT,Facility,Inpatient,,,,173,147.05,49.5818,173,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Hpv High Risk Rmh,,87624,CPT,Facility,Outpatient,,,,173,147.05,49.5818,173,"UCare Health, Inc.",Medical Assistance,87.3131,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Hpv High Risk Rmh,,87624,CPT,Facility,Inpatient,,,,173,147.05,49.5818,173,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Hpv High Risk Rmh,,87624,CPT,Facility,Outpatient,,,,173,147.05,49.5818,173,"UCare Health, Inc.",Medicare Advantage,87.3131,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Hpv High Risk Rmh,,87624,CPT,Facility,Inpatient,,,,173,147.05,49.5818,173,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Hpv High Risk Rmh,,87624,CPT,Facility,Outpatient,,,,173,147.05,49.5818,173,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),87.3131,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Hpv High Risk Rmh,,87624,CPT,Facility,Inpatient,,,,173,147.05,49.5818,173,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Hpv High Risk Rmh,,87624,CPT,Facility,Both,,,,173,147.05,49.5818,173,UnitedHealthcare,Individual & Family,162.62,94,,percent of total billed charges,,
Hpv High Risk Rmh,,87624,CPT,Facility,Outpatient,,,,173,147.05,49.5818,173,UnitedHealthcare,Medicare Advantage,84.77,49,,percent of total billed charges,,
Hpv High Risk Rmh,,87624,CPT,Facility,Inpatient,,,,173,147.05,49.5818,173,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Hpv High Risk Rmh,,87624,CPT,Facility,Outpatient,,,,173,147.05,49.5818,173,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,83.04,48,,percent of total billed charges,,100% of DHS outpatient percentage
Hpv High Risk Rmh,,87624,CPT,Facility,Inpatient,,,,173,147.05,49.5818,173,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Respiratory Syncytial And Influenza Virus, Pcr",,87631,CPT,Facility,Both,,,,173,147.05,49.5818,173,Aetna,Commercial,159.16,92,,percent of total billed charges,,
"Respiratory Syncytial And Influenza Virus, Pcr",,87631,CPT,Facility,Outpatient,,,,173,147.05,49.5818,173,Aetna,Medicare Advantage,84.77,49,,percent of total billed charges,,
"Respiratory Syncytial And Influenza Virus, Pcr",,87631,CPT,Facility,Inpatient,,,,173,147.05,49.5818,173,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Respiratory Syncytial And Influenza Virus, Pcr",,87631,CPT,Facility,Both,,,,173,147.05,49.5818,173,Aetna,PPO,160.89,93,,percent of total billed charges,,
"Respiratory Syncytial And Influenza Virus, Pcr",,87631,CPT,Facility,Both,,,,173,147.05,49.5818,173,America's PPO,America's PPO,166.1319,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Respiratory Syncytial And Influenza Virus, Pcr",,87631,CPT,Facility,Both,,,,173,147.05,49.5818,173,BlueCross BlueShield Minnesota, Federal Employee Program,170.232,98.4,,percent of total billed charges,,
"Respiratory Syncytial And Influenza Virus, Pcr",,87631,CPT,Facility,Both,,,,173,147.05,49.5818,173,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,173,100,,percent of total billed charges,,
"Respiratory Syncytial And Influenza Virus, Pcr",,87631,CPT,Facility,Both,,,,173,147.05,49.5818,173,BlueCross BlueShield Minnesota,High Value Network Plan,155.7,90,,percent of total billed charges,,
"Respiratory Syncytial And Influenza Virus, Pcr",,87631,CPT,Facility,Outpatient,,,,173,147.05,49.5818,173,BlueCross BlueShield Minnesota,Medicare Advantage,84.77,49,,percent of total billed charges,,
"Respiratory Syncytial And Influenza Virus, Pcr",,87631,CPT,Facility,Inpatient,,,,173,147.05,49.5818,173,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Respiratory Syncytial And Influenza Virus, Pcr",,87631,CPT,Facility,Both,,,,173,147.05,49.5818,173,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,153.2261,88.57,,percent of total billed charges,,
"Respiratory Syncytial And Influenza Virus, Pcr",,87631,CPT,Facility,Both,,,,173,147.05,49.5818,173,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,49.5818,28.66,,percent of total billed charges,,
"Respiratory Syncytial And Influenza Virus, Pcr",,87631,CPT,Facility,Outpatient,,,,173,147.05,49.5818,173,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),84.77,49,,percent of total billed charges,,
"Respiratory Syncytial And Influenza Virus, Pcr",,87631,CPT,Facility,Inpatient,,,,173,147.05,49.5818,173,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Respiratory Syncytial And Influenza Virus, Pcr",,87631,CPT,Facility,Both,,,,173,147.05,49.5818,173,CorVel,Worker's Compensation,173,100,,percent of total billed charges,,
"Respiratory Syncytial And Influenza Virus, Pcr",,87631,CPT,Facility,Both,,,,173,147.05,49.5818,173,First Health Group Corporation,First Health Network,167.81,97,,percent of total billed charges,,
"Respiratory Syncytial And Influenza Virus, Pcr",,87631,CPT,Facility,Both,,,,173,147.05,49.5818,173,"Health Partners, Inc.",Commercial,163.658,94.6,,percent of total billed charges,,
"Respiratory Syncytial And Influenza Virus, Pcr",,87631,CPT,Facility,Outpatient,,,,173,147.05,49.5818,173,"Health Partners, Inc.",Medicare Advantage,84.77,49,,percent of total billed charges,,
"Respiratory Syncytial And Influenza Virus, Pcr",,87631,CPT,Facility,Inpatient,,,,173,147.05,49.5818,173,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Respiratory Syncytial And Influenza Virus, Pcr",,87631,CPT,Facility,Both,,,,173,147.05,49.5818,173,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),103.8,60,,percent of total billed charges,,
"Respiratory Syncytial And Influenza Virus, Pcr",,87631,CPT,Facility,Both,,,,173,147.05,49.5818,173,"Health Partners, Inc.",State of Minnesota Advantage Program,140.995,81.5,,percent of total billed charges,,
"Respiratory Syncytial And Influenza Virus, Pcr",,87631,CPT,Facility,Both,,,,173,147.05,49.5818,173,"Health Partners, Inc.",State Public Programs,86.5,50,,percent of total billed charges,,
"Respiratory Syncytial And Influenza Virus, Pcr",,87631,CPT,Facility,Both,,,,173,147.05,49.5818,173,Humana Insurance Company,Commercial PPO,164.35,95,,percent of total billed charges,,
"Respiratory Syncytial And Influenza Virus, Pcr",,87631,CPT,Facility,Outpatient,,,,173,147.05,49.5818,173,Humana Insurance Company,Medicare PPO,84.77,49,,percent of total billed charges,,
"Respiratory Syncytial And Influenza Virus, Pcr",,87631,CPT,Facility,Inpatient,,,,173,147.05,49.5818,173,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Respiratory Syncytial And Influenza Virus, Pcr",,87631,CPT,Facility,Both,,,,173,147.05,49.5818,173,Medica,Individual & Family,171.443,99.1,,percent of total billed charges,,
"Respiratory Syncytial And Influenza Virus, Pcr",,87631,CPT,Facility,Outpatient,,,,173,147.05,49.5818,173,Medica,Medica Advantage Solution,86.154,49.8,,percent of total billed charges,,
"Respiratory Syncytial And Influenza Virus, Pcr",,87631,CPT,Facility,Inpatient,,,,173,147.05,49.5818,173,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Respiratory Syncytial And Influenza Virus, Pcr",,87631,CPT,Facility,Outpatient,,,,173,147.05,49.5818,173,Medica,Medical Assistance,77.158,44.6,,percent of total billed charges,,
"Respiratory Syncytial And Influenza Virus, Pcr",,87631,CPT,Facility,Inpatient,,,,173,147.05,49.5818,173,Medica,Medical Assistance,,,,,Included in per diem rate,
"Respiratory Syncytial And Influenza Virus, Pcr",,87631,CPT,Facility,Outpatient,,,,173,147.05,49.5818,173,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,86.154,49.8,,percent of total billed charges,,
"Respiratory Syncytial And Influenza Virus, Pcr",,87631,CPT,Facility,Inpatient,,,,173,147.05,49.5818,173,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Respiratory Syncytial And Influenza Virus, Pcr",,87631,CPT,Facility,Both,,,,173,147.05,49.5818,173,"Multiplan, Inc.","Multiplan, Inc.",162.62,94,,percent of total billed charges,,
"Respiratory Syncytial And Influenza Virus, Pcr",,87631,CPT,Facility,Outpatient,,,,173,147.05,49.5818,173,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,149.472,86.4,,percent of total billed charges,,
"Respiratory Syncytial And Influenza Virus, Pcr",,87631,CPT,Facility,Inpatient,,,,173,147.05,49.5818,173,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Respiratory Syncytial And Influenza Virus, Pcr",,87631,CPT,Facility,Both,,,,173,147.05,49.5818,173,"Preferred One Administrative Services, INC.",PPO,170.578,98.6,,percent of total billed charges,,
"Respiratory Syncytial And Influenza Virus, Pcr",,87631,CPT,Facility,Outpatient,,,,173,147.05,49.5818,173,PrimeWest Health,Minnesota Senior Health Options (MSHO),89.0085,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Respiratory Syncytial And Influenza Virus, Pcr",,87631,CPT,Facility,Inpatient,,,,173,147.05,49.5818,173,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Respiratory Syncytial And Influenza Virus, Pcr",,87631,CPT,Facility,Outpatient,,,,173,147.05,49.5818,173,PrimeWest Health,MinnesotaCare,88.8528,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Respiratory Syncytial And Influenza Virus, Pcr",,87631,CPT,Facility,Inpatient,,,,173,147.05,49.5818,173,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Respiratory Syncytial And Influenza Virus, Pcr",,87631,CPT,Facility,Both,,,,173,147.05,49.5818,173,Sanford Health Plan,Sanford Health Plan,159.16,92,,percent of total billed charges,,
"Respiratory Syncytial And Influenza Virus, Pcr",,87631,CPT,Facility,Outpatient,,,,173,147.05,49.5818,173,"UCare Health, Inc.",Individual & Family Plan,97.4855,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Respiratory Syncytial And Influenza Virus, Pcr",,87631,CPT,Facility,Inpatient,,,,173,147.05,49.5818,173,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Respiratory Syncytial And Influenza Virus, Pcr",,87631,CPT,Facility,Outpatient,,,,173,147.05,49.5818,173,"UCare Health, Inc.",Medical Assistance,87.3131,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Respiratory Syncytial And Influenza Virus, Pcr",,87631,CPT,Facility,Inpatient,,,,173,147.05,49.5818,173,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Respiratory Syncytial And Influenza Virus, Pcr",,87631,CPT,Facility,Outpatient,,,,173,147.05,49.5818,173,"UCare Health, Inc.",Medicare Advantage,87.3131,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Respiratory Syncytial And Influenza Virus, Pcr",,87631,CPT,Facility,Inpatient,,,,173,147.05,49.5818,173,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Respiratory Syncytial And Influenza Virus, Pcr",,87631,CPT,Facility,Outpatient,,,,173,147.05,49.5818,173,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),87.3131,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Respiratory Syncytial And Influenza Virus, Pcr",,87631,CPT,Facility,Inpatient,,,,173,147.05,49.5818,173,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Respiratory Syncytial And Influenza Virus, Pcr",,87631,CPT,Facility,Both,,,,173,147.05,49.5818,173,UnitedHealthcare,Individual & Family,162.62,94,,percent of total billed charges,,
"Respiratory Syncytial And Influenza Virus, Pcr",,87631,CPT,Facility,Outpatient,,,,173,147.05,49.5818,173,UnitedHealthcare,Medicare Advantage,84.77,49,,percent of total billed charges,,
"Respiratory Syncytial And Influenza Virus, Pcr",,87631,CPT,Facility,Inpatient,,,,173,147.05,49.5818,173,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Respiratory Syncytial And Influenza Virus, Pcr",,87631,CPT,Facility,Outpatient,,,,173,147.05,49.5818,173,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,83.04,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Respiratory Syncytial And Influenza Virus, Pcr",,87631,CPT,Facility,Inpatient,,,,173,147.05,49.5818,173,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Infectious Agent Detection By Nucleic Acid; Respiratory Virus, Amplified Probe, 6-11 Targets",,87632,CPT,Facility,Both,,,,224,190.4,64.1984,224,Aetna,Commercial,206.08,92,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid; Respiratory Virus, Amplified Probe, 6-11 Targets",,87632,CPT,Facility,Outpatient,,,,224,190.4,64.1984,224,Aetna,Medicare Advantage,109.76,49,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid; Respiratory Virus, Amplified Probe, 6-11 Targets",,87632,CPT,Facility,Inpatient,,,,224,190.4,64.1984,224,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Infectious Agent Detection By Nucleic Acid; Respiratory Virus, Amplified Probe, 6-11 Targets",,87632,CPT,Facility,Both,,,,224,190.4,64.1984,224,Aetna,PPO,208.32,93,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid; Respiratory Virus, Amplified Probe, 6-11 Targets",,87632,CPT,Facility,Both,,,,224,190.4,64.1984,224,America's PPO,America's PPO,215.1072,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Infectious Agent Detection By Nucleic Acid; Respiratory Virus, Amplified Probe, 6-11 Targets",,87632,CPT,Facility,Both,,,,224,190.4,64.1984,224,BlueCross BlueShield Minnesota, Federal Employee Program,220.416,98.4,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid; Respiratory Virus, Amplified Probe, 6-11 Targets",,87632,CPT,Facility,Both,,,,224,190.4,64.1984,224,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,224,100,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid; Respiratory Virus, Amplified Probe, 6-11 Targets",,87632,CPT,Facility,Both,,,,224,190.4,64.1984,224,BlueCross BlueShield Minnesota,High Value Network Plan,201.6,90,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid; Respiratory Virus, Amplified Probe, 6-11 Targets",,87632,CPT,Facility,Outpatient,,,,224,190.4,64.1984,224,BlueCross BlueShield Minnesota,Medicare Advantage,109.76,49,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid; Respiratory Virus, Amplified Probe, 6-11 Targets",,87632,CPT,Facility,Inpatient,,,,224,190.4,64.1984,224,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Infectious Agent Detection By Nucleic Acid; Respiratory Virus, Amplified Probe, 6-11 Targets",,87632,CPT,Facility,Both,,,,224,190.4,64.1984,224,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,198.3968,88.57,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid; Respiratory Virus, Amplified Probe, 6-11 Targets",,87632,CPT,Facility,Both,,,,224,190.4,64.1984,224,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,64.1984,28.66,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid; Respiratory Virus, Amplified Probe, 6-11 Targets",,87632,CPT,Facility,Outpatient,,,,224,190.4,64.1984,224,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),109.76,49,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid; Respiratory Virus, Amplified Probe, 6-11 Targets",,87632,CPT,Facility,Inpatient,,,,224,190.4,64.1984,224,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Infectious Agent Detection By Nucleic Acid; Respiratory Virus, Amplified Probe, 6-11 Targets",,87632,CPT,Facility,Both,,,,224,190.4,64.1984,224,CorVel,Worker's Compensation,224,100,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid; Respiratory Virus, Amplified Probe, 6-11 Targets",,87632,CPT,Facility,Both,,,,224,190.4,64.1984,224,First Health Group Corporation,First Health Network,217.28,97,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid; Respiratory Virus, Amplified Probe, 6-11 Targets",,87632,CPT,Facility,Both,,,,224,190.4,64.1984,224,"Health Partners, Inc.",Commercial,211.904,94.6,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid; Respiratory Virus, Amplified Probe, 6-11 Targets",,87632,CPT,Facility,Outpatient,,,,224,190.4,64.1984,224,"Health Partners, Inc.",Medicare Advantage,109.76,49,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid; Respiratory Virus, Amplified Probe, 6-11 Targets",,87632,CPT,Facility,Inpatient,,,,224,190.4,64.1984,224,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Infectious Agent Detection By Nucleic Acid; Respiratory Virus, Amplified Probe, 6-11 Targets",,87632,CPT,Facility,Both,,,,224,190.4,64.1984,224,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),134.4,60,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid; Respiratory Virus, Amplified Probe, 6-11 Targets",,87632,CPT,Facility,Both,,,,224,190.4,64.1984,224,"Health Partners, Inc.",State of Minnesota Advantage Program,182.56,81.5,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid; Respiratory Virus, Amplified Probe, 6-11 Targets",,87632,CPT,Facility,Both,,,,224,190.4,64.1984,224,"Health Partners, Inc.",State Public Programs,112,50,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid; Respiratory Virus, Amplified Probe, 6-11 Targets",,87632,CPT,Facility,Both,,,,224,190.4,64.1984,224,Humana Insurance Company,Commercial PPO,212.8,95,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid; Respiratory Virus, Amplified Probe, 6-11 Targets",,87632,CPT,Facility,Outpatient,,,,224,190.4,64.1984,224,Humana Insurance Company,Medicare PPO,109.76,49,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid; Respiratory Virus, Amplified Probe, 6-11 Targets",,87632,CPT,Facility,Inpatient,,,,224,190.4,64.1984,224,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Infectious Agent Detection By Nucleic Acid; Respiratory Virus, Amplified Probe, 6-11 Targets",,87632,CPT,Facility,Both,,,,224,190.4,64.1984,224,Medica,Individual & Family,221.984,99.1,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid; Respiratory Virus, Amplified Probe, 6-11 Targets",,87632,CPT,Facility,Outpatient,,,,224,190.4,64.1984,224,Medica,Medica Advantage Solution,111.552,49.8,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid; Respiratory Virus, Amplified Probe, 6-11 Targets",,87632,CPT,Facility,Inpatient,,,,224,190.4,64.1984,224,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Infectious Agent Detection By Nucleic Acid; Respiratory Virus, Amplified Probe, 6-11 Targets",,87632,CPT,Facility,Outpatient,,,,224,190.4,64.1984,224,Medica,Medical Assistance,99.904,44.6,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid; Respiratory Virus, Amplified Probe, 6-11 Targets",,87632,CPT,Facility,Inpatient,,,,224,190.4,64.1984,224,Medica,Medical Assistance,,,,,Included in per diem rate,
"Infectious Agent Detection By Nucleic Acid; Respiratory Virus, Amplified Probe, 6-11 Targets",,87632,CPT,Facility,Outpatient,,,,224,190.4,64.1984,224,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,111.552,49.8,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid; Respiratory Virus, Amplified Probe, 6-11 Targets",,87632,CPT,Facility,Inpatient,,,,224,190.4,64.1984,224,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Infectious Agent Detection By Nucleic Acid; Respiratory Virus, Amplified Probe, 6-11 Targets",,87632,CPT,Facility,Both,,,,224,190.4,64.1984,224,"Multiplan, Inc.","Multiplan, Inc.",210.56,94,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid; Respiratory Virus, Amplified Probe, 6-11 Targets",,87632,CPT,Facility,Outpatient,,,,224,190.4,64.1984,224,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,193.536,86.4,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid; Respiratory Virus, Amplified Probe, 6-11 Targets",,87632,CPT,Facility,Inpatient,,,,224,190.4,64.1984,224,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Infectious Agent Detection By Nucleic Acid; Respiratory Virus, Amplified Probe, 6-11 Targets",,87632,CPT,Facility,Both,,,,224,190.4,64.1984,224,"Preferred One Administrative Services, INC.",PPO,220.864,98.6,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid; Respiratory Virus, Amplified Probe, 6-11 Targets",,87632,CPT,Facility,Outpatient,,,,224,190.4,64.1984,224,PrimeWest Health,Minnesota Senior Health Options (MSHO),115.248,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Infectious Agent Detection By Nucleic Acid; Respiratory Virus, Amplified Probe, 6-11 Targets",,87632,CPT,Facility,Inpatient,,,,224,190.4,64.1984,224,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Infectious Agent Detection By Nucleic Acid; Respiratory Virus, Amplified Probe, 6-11 Targets",,87632,CPT,Facility,Outpatient,,,,224,190.4,64.1984,224,PrimeWest Health,MinnesotaCare,115.0464,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Infectious Agent Detection By Nucleic Acid; Respiratory Virus, Amplified Probe, 6-11 Targets",,87632,CPT,Facility,Inpatient,,,,224,190.4,64.1984,224,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Infectious Agent Detection By Nucleic Acid; Respiratory Virus, Amplified Probe, 6-11 Targets",,87632,CPT,Facility,Both,,,,224,190.4,64.1984,224,Sanford Health Plan,Sanford Health Plan,206.08,92,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid; Respiratory Virus, Amplified Probe, 6-11 Targets",,87632,CPT,Facility,Outpatient,,,,224,190.4,64.1984,224,"UCare Health, Inc.",Individual & Family Plan,126.224,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Infectious Agent Detection By Nucleic Acid; Respiratory Virus, Amplified Probe, 6-11 Targets",,87632,CPT,Facility,Inpatient,,,,224,190.4,64.1984,224,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Infectious Agent Detection By Nucleic Acid; Respiratory Virus, Amplified Probe, 6-11 Targets",,87632,CPT,Facility,Outpatient,,,,224,190.4,64.1984,224,"UCare Health, Inc.",Medical Assistance,113.0528,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Infectious Agent Detection By Nucleic Acid; Respiratory Virus, Amplified Probe, 6-11 Targets",,87632,CPT,Facility,Inpatient,,,,224,190.4,64.1984,224,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Infectious Agent Detection By Nucleic Acid; Respiratory Virus, Amplified Probe, 6-11 Targets",,87632,CPT,Facility,Outpatient,,,,224,190.4,64.1984,224,"UCare Health, Inc.",Medicare Advantage,113.0528,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Infectious Agent Detection By Nucleic Acid; Respiratory Virus, Amplified Probe, 6-11 Targets",,87632,CPT,Facility,Inpatient,,,,224,190.4,64.1984,224,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Infectious Agent Detection By Nucleic Acid; Respiratory Virus, Amplified Probe, 6-11 Targets",,87632,CPT,Facility,Outpatient,,,,224,190.4,64.1984,224,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),113.0528,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Infectious Agent Detection By Nucleic Acid; Respiratory Virus, Amplified Probe, 6-11 Targets",,87632,CPT,Facility,Inpatient,,,,224,190.4,64.1984,224,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Infectious Agent Detection By Nucleic Acid; Respiratory Virus, Amplified Probe, 6-11 Targets",,87632,CPT,Facility,Both,,,,224,190.4,64.1984,224,UnitedHealthcare,Individual & Family,210.56,94,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid; Respiratory Virus, Amplified Probe, 6-11 Targets",,87632,CPT,Facility,Outpatient,,,,224,190.4,64.1984,224,UnitedHealthcare,Medicare Advantage,109.76,49,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid; Respiratory Virus, Amplified Probe, 6-11 Targets",,87632,CPT,Facility,Inpatient,,,,224,190.4,64.1984,224,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Infectious Agent Detection By Nucleic Acid; Respiratory Virus, Amplified Probe, 6-11 Targets",,87632,CPT,Facility,Outpatient,,,,224,190.4,64.1984,224,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,107.52,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Infectious Agent Detection By Nucleic Acid; Respiratory Virus, Amplified Probe, 6-11 Targets",,87632,CPT,Facility,Inpatient,,,,224,190.4,64.1984,224,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Respiratory Pathogen Profile,,87633,CPT,Facility,Both,,,,439,373.15,125.8174,439,Aetna,Commercial,403.88,92,,percent of total billed charges,,
Respiratory Pathogen Profile,,87633,CPT,Facility,Outpatient,,,,439,373.15,125.8174,439,Aetna,Medicare Advantage,215.11,49,,percent of total billed charges,,
Respiratory Pathogen Profile,,87633,CPT,Facility,Inpatient,,,,439,373.15,125.8174,439,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Respiratory Pathogen Profile,,87633,CPT,Facility,Both,,,,439,373.15,125.8174,439,Aetna,PPO,408.27,93,,percent of total billed charges,,
Respiratory Pathogen Profile,,87633,CPT,Facility,Both,,,,439,373.15,125.8174,439,America's PPO,America's PPO,421.5717,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Respiratory Pathogen Profile,,87633,CPT,Facility,Both,,,,439,373.15,125.8174,439,BlueCross BlueShield Minnesota, Federal Employee Program,431.976,98.4,,percent of total billed charges,,
Respiratory Pathogen Profile,,87633,CPT,Facility,Both,,,,439,373.15,125.8174,439,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,439,100,,percent of total billed charges,,
Respiratory Pathogen Profile,,87633,CPT,Facility,Both,,,,439,373.15,125.8174,439,BlueCross BlueShield Minnesota,High Value Network Plan,395.1,90,,percent of total billed charges,,
Respiratory Pathogen Profile,,87633,CPT,Facility,Outpatient,,,,439,373.15,125.8174,439,BlueCross BlueShield Minnesota,Medicare Advantage,215.11,49,,percent of total billed charges,,
Respiratory Pathogen Profile,,87633,CPT,Facility,Inpatient,,,,439,373.15,125.8174,439,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Respiratory Pathogen Profile,,87633,CPT,Facility,Both,,,,439,373.15,125.8174,439,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,388.8223,88.57,,percent of total billed charges,,
Respiratory Pathogen Profile,,87633,CPT,Facility,Both,,,,439,373.15,125.8174,439,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,125.8174,28.66,,percent of total billed charges,,
Respiratory Pathogen Profile,,87633,CPT,Facility,Outpatient,,,,439,373.15,125.8174,439,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),215.11,49,,percent of total billed charges,,
Respiratory Pathogen Profile,,87633,CPT,Facility,Inpatient,,,,439,373.15,125.8174,439,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Respiratory Pathogen Profile,,87633,CPT,Facility,Both,,,,439,373.15,125.8174,439,CorVel,Worker's Compensation,439,100,,percent of total billed charges,,
Respiratory Pathogen Profile,,87633,CPT,Facility,Both,,,,439,373.15,125.8174,439,First Health Group Corporation,First Health Network,425.83,97,,percent of total billed charges,,
Respiratory Pathogen Profile,,87633,CPT,Facility,Both,,,,439,373.15,125.8174,439,"Health Partners, Inc.",Commercial,415.294,94.6,,percent of total billed charges,,
Respiratory Pathogen Profile,,87633,CPT,Facility,Outpatient,,,,439,373.15,125.8174,439,"Health Partners, Inc.",Medicare Advantage,215.11,49,,percent of total billed charges,,
Respiratory Pathogen Profile,,87633,CPT,Facility,Inpatient,,,,439,373.15,125.8174,439,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Respiratory Pathogen Profile,,87633,CPT,Facility,Both,,,,439,373.15,125.8174,439,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),263.4,60,,percent of total billed charges,,
Respiratory Pathogen Profile,,87633,CPT,Facility,Both,,,,439,373.15,125.8174,439,"Health Partners, Inc.",State of Minnesota Advantage Program,357.785,81.5,,percent of total billed charges,,
Respiratory Pathogen Profile,,87633,CPT,Facility,Both,,,,439,373.15,125.8174,439,"Health Partners, Inc.",State Public Programs,219.5,50,,percent of total billed charges,,
Respiratory Pathogen Profile,,87633,CPT,Facility,Both,,,,439,373.15,125.8174,439,Humana Insurance Company,Commercial PPO,417.05,95,,percent of total billed charges,,
Respiratory Pathogen Profile,,87633,CPT,Facility,Outpatient,,,,439,373.15,125.8174,439,Humana Insurance Company,Medicare PPO,215.11,49,,percent of total billed charges,,
Respiratory Pathogen Profile,,87633,CPT,Facility,Inpatient,,,,439,373.15,125.8174,439,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Respiratory Pathogen Profile,,87633,CPT,Facility,Both,,,,439,373.15,125.8174,439,Medica,Individual & Family,435.049,99.1,,percent of total billed charges,,
Respiratory Pathogen Profile,,87633,CPT,Facility,Outpatient,,,,439,373.15,125.8174,439,Medica,Medica Advantage Solution,218.622,49.8,,percent of total billed charges,,
Respiratory Pathogen Profile,,87633,CPT,Facility,Inpatient,,,,439,373.15,125.8174,439,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Respiratory Pathogen Profile,,87633,CPT,Facility,Outpatient,,,,439,373.15,125.8174,439,Medica,Medical Assistance,195.794,44.6,,percent of total billed charges,,
Respiratory Pathogen Profile,,87633,CPT,Facility,Inpatient,,,,439,373.15,125.8174,439,Medica,Medical Assistance,,,,,Included in per diem rate,
Respiratory Pathogen Profile,,87633,CPT,Facility,Outpatient,,,,439,373.15,125.8174,439,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,218.622,49.8,,percent of total billed charges,,
Respiratory Pathogen Profile,,87633,CPT,Facility,Inpatient,,,,439,373.15,125.8174,439,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Respiratory Pathogen Profile,,87633,CPT,Facility,Both,,,,439,373.15,125.8174,439,"Multiplan, Inc.","Multiplan, Inc.",412.66,94,,percent of total billed charges,,
Respiratory Pathogen Profile,,87633,CPT,Facility,Outpatient,,,,439,373.15,125.8174,439,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,379.296,86.4,,percent of total billed charges,,
Respiratory Pathogen Profile,,87633,CPT,Facility,Inpatient,,,,439,373.15,125.8174,439,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Respiratory Pathogen Profile,,87633,CPT,Facility,Both,,,,439,373.15,125.8174,439,"Preferred One Administrative Services, INC.",PPO,432.854,98.6,,percent of total billed charges,,
Respiratory Pathogen Profile,,87633,CPT,Facility,Outpatient,,,,439,373.15,125.8174,439,PrimeWest Health,Minnesota Senior Health Options (MSHO),225.8655,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Respiratory Pathogen Profile,,87633,CPT,Facility,Inpatient,,,,439,373.15,125.8174,439,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Respiratory Pathogen Profile,,87633,CPT,Facility,Outpatient,,,,439,373.15,125.8174,439,PrimeWest Health,MinnesotaCare,225.4704,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Respiratory Pathogen Profile,,87633,CPT,Facility,Inpatient,,,,439,373.15,125.8174,439,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Respiratory Pathogen Profile,,87633,CPT,Facility,Both,,,,439,373.15,125.8174,439,Sanford Health Plan,Sanford Health Plan,403.88,92,,percent of total billed charges,,
Respiratory Pathogen Profile,,87633,CPT,Facility,Outpatient,,,,439,373.15,125.8174,439,"UCare Health, Inc.",Individual & Family Plan,247.3765,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Respiratory Pathogen Profile,,87633,CPT,Facility,Inpatient,,,,439,373.15,125.8174,439,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Respiratory Pathogen Profile,,87633,CPT,Facility,Outpatient,,,,439,373.15,125.8174,439,"UCare Health, Inc.",Medical Assistance,221.5633,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Respiratory Pathogen Profile,,87633,CPT,Facility,Inpatient,,,,439,373.15,125.8174,439,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Respiratory Pathogen Profile,,87633,CPT,Facility,Outpatient,,,,439,373.15,125.8174,439,"UCare Health, Inc.",Medicare Advantage,221.5633,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Respiratory Pathogen Profile,,87633,CPT,Facility,Inpatient,,,,439,373.15,125.8174,439,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Respiratory Pathogen Profile,,87633,CPT,Facility,Outpatient,,,,439,373.15,125.8174,439,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),221.5633,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Respiratory Pathogen Profile,,87633,CPT,Facility,Inpatient,,,,439,373.15,125.8174,439,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Respiratory Pathogen Profile,,87633,CPT,Facility,Both,,,,439,373.15,125.8174,439,UnitedHealthcare,Individual & Family,412.66,94,,percent of total billed charges,,
Respiratory Pathogen Profile,,87633,CPT,Facility,Outpatient,,,,439,373.15,125.8174,439,UnitedHealthcare,Medicare Advantage,215.11,49,,percent of total billed charges,,
Respiratory Pathogen Profile,,87633,CPT,Facility,Inpatient,,,,439,373.15,125.8174,439,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Respiratory Pathogen Profile,,87633,CPT,Facility,Outpatient,,,,439,373.15,125.8174,439,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,210.72,48,,percent of total billed charges,,100% of DHS outpatient percentage
Respiratory Pathogen Profile,,87633,CPT,Facility,Inpatient,,,,439,373.15,125.8174,439,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Covid-19/Sars-Cov2, Naat",,87635,CPT,Facility,Both,,,,172,146.2,60.96,172,Aetna,Commercial,158.24,92,,percent of total billed charges,,
"Covid-19/Sars-Cov2, Naat",,87635,CPT,Facility,Outpatient,,,,172,146.2,60.96,172,Aetna,Medicare Advantage,84.28,49,,percent of total billed charges,,
"Covid-19/Sars-Cov2, Naat",,87635,CPT,Facility,Inpatient,,,,172,146.2,60.96,172,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Covid-19/Sars-Cov2, Naat",,87635,CPT,Facility,Both,,,,172,146.2,60.96,172,Aetna,PPO,159.96,93,,percent of total billed charges,,
"Covid-19/Sars-Cov2, Naat",,87635,CPT,Facility,Both,,,,172,146.2,60.96,172,America's PPO,America's PPO,165.1716,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Covid-19/Sars-Cov2, Naat",,87635,CPT,Facility,Both,,,,172,146.2,60.96,172,BlueCross BlueShield Minnesota, Federal Employee Program,120,,,Fee schedule,,100% of BCBS commercial commodity fee schedule
"Covid-19/Sars-Cov2, Naat",,87635,CPT,Facility,Both,,,,172,146.2,60.96,172,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,121.92,,,Fee schedule,,"100% of BCBS commercial commodity fee schedule, plus MN Care tax"
"Covid-19/Sars-Cov2, Naat",,87635,CPT,Facility,Both,,,,172,146.2,60.96,172,BlueCross BlueShield Minnesota,High Value Network Plan,109.728,,,Fee schedule,,"90% of BCBS commercial commodity fee schedule, plus MN Care tax; see disclaimer for more information"
"Covid-19/Sars-Cov2, Naat",,87635,CPT,Facility,Outpatient,,,,172,146.2,60.96,172,BlueCross BlueShield Minnesota,Medicare Advantage,84.28,49,,percent of total billed charges,,
"Covid-19/Sars-Cov2, Naat",,87635,CPT,Facility,Inpatient,,,,172,146.2,60.96,172,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Covid-19/Sars-Cov2, Naat",,87635,CPT,Facility,Both,,,,172,146.2,60.96,172,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,107.984544,,,Fee schedule,,"88.57% of BCBS commercial commodity fee schedule, plus MN Care tax"
"Covid-19/Sars-Cov2, Naat",,87635,CPT,Facility,Both,,,,172,146.2,60.96,172,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,60.96,,,Fee schedule,,"100% of BCBS Medicaid commodity fee schedule, plus MN Care tax"
"Covid-19/Sars-Cov2, Naat",,87635,CPT,Facility,Outpatient,,,,172,146.2,60.96,172,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),84.28,49,,percent of total billed charges,,
"Covid-19/Sars-Cov2, Naat",,87635,CPT,Facility,Inpatient,,,,172,146.2,60.96,172,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Covid-19/Sars-Cov2, Naat",,87635,CPT,Facility,Both,,,,172,146.2,60.96,172,CorVel,Worker's Compensation,172,100,,percent of total billed charges,,
"Covid-19/Sars-Cov2, Naat",,87635,CPT,Facility,Both,,,,172,146.2,60.96,172,First Health Group Corporation,First Health Network,166.84,97,,percent of total billed charges,,
"Covid-19/Sars-Cov2, Naat",,87635,CPT,Facility,Both,,,,172,146.2,60.96,172,"Health Partners, Inc.",Commercial,162.712,94.6,,percent of total billed charges,,
"Covid-19/Sars-Cov2, Naat",,87635,CPT,Facility,Outpatient,,,,172,146.2,60.96,172,"Health Partners, Inc.",Medicare Advantage,84.28,49,,percent of total billed charges,,
"Covid-19/Sars-Cov2, Naat",,87635,CPT,Facility,Inpatient,,,,172,146.2,60.96,172,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Covid-19/Sars-Cov2, Naat",,87635,CPT,Facility,Both,,,,172,146.2,60.96,172,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),103.2,60,,percent of total billed charges,,
"Covid-19/Sars-Cov2, Naat",,87635,CPT,Facility,Both,,,,172,146.2,60.96,172,"Health Partners, Inc.",State of Minnesota Advantage Program,140.18,81.5,,percent of total billed charges,,
"Covid-19/Sars-Cov2, Naat",,87635,CPT,Facility,Both,,,,172,146.2,60.96,172,"Health Partners, Inc.",State Public Programs,86,50,,percent of total billed charges,,
"Covid-19/Sars-Cov2, Naat",,87635,CPT,Facility,Both,,,,172,146.2,60.96,172,Humana Insurance Company,Commercial PPO,163.4,95,,percent of total billed charges,,
"Covid-19/Sars-Cov2, Naat",,87635,CPT,Facility,Outpatient,,,,172,146.2,60.96,172,Humana Insurance Company,Medicare PPO,84.28,49,,percent of total billed charges,,
"Covid-19/Sars-Cov2, Naat",,87635,CPT,Facility,Inpatient,,,,172,146.2,60.96,172,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Covid-19/Sars-Cov2, Naat",,87635,CPT,Facility,Both,,,,172,146.2,60.96,172,Medica,Individual & Family,170.452,99.1,,percent of total billed charges,,
"Covid-19/Sars-Cov2, Naat",,87635,CPT,Facility,Outpatient,,,,172,146.2,60.96,172,Medica,Medica Advantage Solution,85.656,49.8,,percent of total billed charges,,
"Covid-19/Sars-Cov2, Naat",,87635,CPT,Facility,Inpatient,,,,172,146.2,60.96,172,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Covid-19/Sars-Cov2, Naat",,87635,CPT,Facility,Outpatient,,,,172,146.2,60.96,172,Medica,Medical Assistance,76.712,44.6,,percent of total billed charges,,
"Covid-19/Sars-Cov2, Naat",,87635,CPT,Facility,Inpatient,,,,172,146.2,60.96,172,Medica,Medical Assistance,,,,,Included in per diem rate,
"Covid-19/Sars-Cov2, Naat",,87635,CPT,Facility,Outpatient,,,,172,146.2,60.96,172,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,85.656,49.8,,percent of total billed charges,,
"Covid-19/Sars-Cov2, Naat",,87635,CPT,Facility,Inpatient,,,,172,146.2,60.96,172,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Covid-19/Sars-Cov2, Naat",,87635,CPT,Facility,Both,,,,172,146.2,60.96,172,"Multiplan, Inc.","Multiplan, Inc.",161.68,94,,percent of total billed charges,,
"Covid-19/Sars-Cov2, Naat",,87635,CPT,Facility,Outpatient,,,,172,146.2,60.96,172,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,148.608,86.4,,percent of total billed charges,,
"Covid-19/Sars-Cov2, Naat",,87635,CPT,Facility,Inpatient,,,,172,146.2,60.96,172,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Covid-19/Sars-Cov2, Naat",,87635,CPT,Facility,Both,,,,172,146.2,60.96,172,"Preferred One Administrative Services, INC.",PPO,169.592,98.6,,percent of total billed charges,,
"Covid-19/Sars-Cov2, Naat",,87635,CPT,Facility,Outpatient,,,,172,146.2,60.96,172,PrimeWest Health,Minnesota Senior Health Options (MSHO),88.494,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Covid-19/Sars-Cov2, Naat",,87635,CPT,Facility,Inpatient,,,,172,146.2,60.96,172,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Covid-19/Sars-Cov2, Naat",,87635,CPT,Facility,Outpatient,,,,172,146.2,60.96,172,PrimeWest Health,MinnesotaCare,88.3392,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Covid-19/Sars-Cov2, Naat",,87635,CPT,Facility,Inpatient,,,,172,146.2,60.96,172,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Covid-19/Sars-Cov2, Naat",,87635,CPT,Facility,Both,,,,172,146.2,60.96,172,Sanford Health Plan,Sanford Health Plan,158.24,92,,percent of total billed charges,,
"Covid-19/Sars-Cov2, Naat",,87635,CPT,Facility,Outpatient,,,,172,146.2,60.96,172,"UCare Health, Inc.",Individual & Family Plan,96.922,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Covid-19/Sars-Cov2, Naat",,87635,CPT,Facility,Inpatient,,,,172,146.2,60.96,172,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Covid-19/Sars-Cov2, Naat",,87635,CPT,Facility,Outpatient,,,,172,146.2,60.96,172,"UCare Health, Inc.",Medical Assistance,86.8084,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Covid-19/Sars-Cov2, Naat",,87635,CPT,Facility,Inpatient,,,,172,146.2,60.96,172,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Covid-19/Sars-Cov2, Naat",,87635,CPT,Facility,Outpatient,,,,172,146.2,60.96,172,"UCare Health, Inc.",Medicare Advantage,86.8084,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Covid-19/Sars-Cov2, Naat",,87635,CPT,Facility,Inpatient,,,,172,146.2,60.96,172,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Covid-19/Sars-Cov2, Naat",,87635,CPT,Facility,Outpatient,,,,172,146.2,60.96,172,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),86.8084,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Covid-19/Sars-Cov2, Naat",,87635,CPT,Facility,Inpatient,,,,172,146.2,60.96,172,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Covid-19/Sars-Cov2, Naat",,87635,CPT,Facility,Both,,,,172,146.2,60.96,172,UnitedHealthcare,Individual & Family,161.68,94,,percent of total billed charges,,
"Covid-19/Sars-Cov2, Naat",,87635,CPT,Facility,Outpatient,,,,172,146.2,60.96,172,UnitedHealthcare,Medicare Advantage,84.28,49,,percent of total billed charges,,
"Covid-19/Sars-Cov2, Naat",,87635,CPT,Facility,Inpatient,,,,172,146.2,60.96,172,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Covid-19/Sars-Cov2, Naat",,87635,CPT,Facility,Outpatient,,,,172,146.2,60.96,172,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,82.56,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Covid-19/Sars-Cov2, Naat",,87635,CPT,Facility,Inpatient,,,,172,146.2,60.96,172,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Group A Streptococcus, Naat",,87651,CPT,Facility,Both,,,,122,103.7,34.9652,122,Aetna,Commercial,112.24,92,,percent of total billed charges,,
"Group A Streptococcus, Naat",,87651,CPT,Facility,Outpatient,,,,122,103.7,34.9652,122,Aetna,Medicare Advantage,59.78,49,,percent of total billed charges,,
"Group A Streptococcus, Naat",,87651,CPT,Facility,Inpatient,,,,122,103.7,34.9652,122,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Group A Streptococcus, Naat",,87651,CPT,Facility,Both,,,,122,103.7,34.9652,122,Aetna,PPO,113.46,93,,percent of total billed charges,,
"Group A Streptococcus, Naat",,87651,CPT,Facility,Both,,,,122,103.7,34.9652,122,America's PPO,America's PPO,117.1566,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Group A Streptococcus, Naat",,87651,CPT,Facility,Both,,,,122,103.7,34.9652,122,BlueCross BlueShield Minnesota, Federal Employee Program,120.048,98.4,,percent of total billed charges,,
"Group A Streptococcus, Naat",,87651,CPT,Facility,Both,,,,122,103.7,34.9652,122,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,122,100,,percent of total billed charges,,
"Group A Streptococcus, Naat",,87651,CPT,Facility,Both,,,,122,103.7,34.9652,122,BlueCross BlueShield Minnesota,High Value Network Plan,109.8,90,,percent of total billed charges,,
"Group A Streptococcus, Naat",,87651,CPT,Facility,Outpatient,,,,122,103.7,34.9652,122,BlueCross BlueShield Minnesota,Medicare Advantage,59.78,49,,percent of total billed charges,,
"Group A Streptococcus, Naat",,87651,CPT,Facility,Inpatient,,,,122,103.7,34.9652,122,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Group A Streptococcus, Naat",,87651,CPT,Facility,Both,,,,122,103.7,34.9652,122,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,108.0554,88.57,,percent of total billed charges,,
"Group A Streptococcus, Naat",,87651,CPT,Facility,Both,,,,122,103.7,34.9652,122,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,34.9652,28.66,,percent of total billed charges,,
"Group A Streptococcus, Naat",,87651,CPT,Facility,Outpatient,,,,122,103.7,34.9652,122,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),59.78,49,,percent of total billed charges,,
"Group A Streptococcus, Naat",,87651,CPT,Facility,Inpatient,,,,122,103.7,34.9652,122,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Group A Streptococcus, Naat",,87651,CPT,Facility,Both,,,,122,103.7,34.9652,122,CorVel,Worker's Compensation,122,100,,percent of total billed charges,,
"Group A Streptococcus, Naat",,87651,CPT,Facility,Both,,,,122,103.7,34.9652,122,First Health Group Corporation,First Health Network,118.34,97,,percent of total billed charges,,
"Group A Streptococcus, Naat",,87651,CPT,Facility,Both,,,,122,103.7,34.9652,122,"Health Partners, Inc.",Commercial,115.412,94.6,,percent of total billed charges,,
"Group A Streptococcus, Naat",,87651,CPT,Facility,Outpatient,,,,122,103.7,34.9652,122,"Health Partners, Inc.",Medicare Advantage,59.78,49,,percent of total billed charges,,
"Group A Streptococcus, Naat",,87651,CPT,Facility,Inpatient,,,,122,103.7,34.9652,122,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Group A Streptococcus, Naat",,87651,CPT,Facility,Both,,,,122,103.7,34.9652,122,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),73.2,60,,percent of total billed charges,,
"Group A Streptococcus, Naat",,87651,CPT,Facility,Both,,,,122,103.7,34.9652,122,"Health Partners, Inc.",State of Minnesota Advantage Program,99.43,81.5,,percent of total billed charges,,
"Group A Streptococcus, Naat",,87651,CPT,Facility,Both,,,,122,103.7,34.9652,122,"Health Partners, Inc.",State Public Programs,61,50,,percent of total billed charges,,
"Group A Streptococcus, Naat",,87651,CPT,Facility,Both,,,,122,103.7,34.9652,122,Humana Insurance Company,Commercial PPO,115.9,95,,percent of total billed charges,,
"Group A Streptococcus, Naat",,87651,CPT,Facility,Outpatient,,,,122,103.7,34.9652,122,Humana Insurance Company,Medicare PPO,59.78,49,,percent of total billed charges,,
"Group A Streptococcus, Naat",,87651,CPT,Facility,Inpatient,,,,122,103.7,34.9652,122,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Group A Streptococcus, Naat",,87651,CPT,Facility,Both,,,,122,103.7,34.9652,122,Medica,Individual & Family,120.902,99.1,,percent of total billed charges,,
"Group A Streptococcus, Naat",,87651,CPT,Facility,Outpatient,,,,122,103.7,34.9652,122,Medica,Medica Advantage Solution,60.756,49.8,,percent of total billed charges,,
"Group A Streptococcus, Naat",,87651,CPT,Facility,Inpatient,,,,122,103.7,34.9652,122,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Group A Streptococcus, Naat",,87651,CPT,Facility,Outpatient,,,,122,103.7,34.9652,122,Medica,Medical Assistance,54.412,44.6,,percent of total billed charges,,
"Group A Streptococcus, Naat",,87651,CPT,Facility,Inpatient,,,,122,103.7,34.9652,122,Medica,Medical Assistance,,,,,Included in per diem rate,
"Group A Streptococcus, Naat",,87651,CPT,Facility,Outpatient,,,,122,103.7,34.9652,122,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,60.756,49.8,,percent of total billed charges,,
"Group A Streptococcus, Naat",,87651,CPT,Facility,Inpatient,,,,122,103.7,34.9652,122,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Group A Streptococcus, Naat",,87651,CPT,Facility,Both,,,,122,103.7,34.9652,122,"Multiplan, Inc.","Multiplan, Inc.",114.68,94,,percent of total billed charges,,
"Group A Streptococcus, Naat",,87651,CPT,Facility,Outpatient,,,,122,103.7,34.9652,122,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,105.408,86.4,,percent of total billed charges,,
"Group A Streptococcus, Naat",,87651,CPT,Facility,Inpatient,,,,122,103.7,34.9652,122,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Group A Streptococcus, Naat",,87651,CPT,Facility,Both,,,,122,103.7,34.9652,122,"Preferred One Administrative Services, INC.",PPO,120.292,98.6,,percent of total billed charges,,
"Group A Streptococcus, Naat",,87651,CPT,Facility,Outpatient,,,,122,103.7,34.9652,122,PrimeWest Health,Minnesota Senior Health Options (MSHO),62.769,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Group A Streptococcus, Naat",,87651,CPT,Facility,Inpatient,,,,122,103.7,34.9652,122,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Group A Streptococcus, Naat",,87651,CPT,Facility,Outpatient,,,,122,103.7,34.9652,122,PrimeWest Health,MinnesotaCare,62.6592,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Group A Streptococcus, Naat",,87651,CPT,Facility,Inpatient,,,,122,103.7,34.9652,122,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Group A Streptococcus, Naat",,87651,CPT,Facility,Both,,,,122,103.7,34.9652,122,Sanford Health Plan,Sanford Health Plan,112.24,92,,percent of total billed charges,,
"Group A Streptococcus, Naat",,87651,CPT,Facility,Outpatient,,,,122,103.7,34.9652,122,"UCare Health, Inc.",Individual & Family Plan,68.747,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Group A Streptococcus, Naat",,87651,CPT,Facility,Inpatient,,,,122,103.7,34.9652,122,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Group A Streptococcus, Naat",,87651,CPT,Facility,Outpatient,,,,122,103.7,34.9652,122,"UCare Health, Inc.",Medical Assistance,61.5734,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Group A Streptococcus, Naat",,87651,CPT,Facility,Inpatient,,,,122,103.7,34.9652,122,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Group A Streptococcus, Naat",,87651,CPT,Facility,Outpatient,,,,122,103.7,34.9652,122,"UCare Health, Inc.",Medicare Advantage,61.5734,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Group A Streptococcus, Naat",,87651,CPT,Facility,Inpatient,,,,122,103.7,34.9652,122,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Group A Streptococcus, Naat",,87651,CPT,Facility,Outpatient,,,,122,103.7,34.9652,122,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),61.5734,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Group A Streptococcus, Naat",,87651,CPT,Facility,Inpatient,,,,122,103.7,34.9652,122,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Group A Streptococcus, Naat",,87651,CPT,Facility,Both,,,,122,103.7,34.9652,122,UnitedHealthcare,Individual & Family,114.68,94,,percent of total billed charges,,
"Group A Streptococcus, Naat",,87651,CPT,Facility,Outpatient,,,,122,103.7,34.9652,122,UnitedHealthcare,Medicare Advantage,59.78,49,,percent of total billed charges,,
"Group A Streptococcus, Naat",,87651,CPT,Facility,Inpatient,,,,122,103.7,34.9652,122,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Group A Streptococcus, Naat",,87651,CPT,Facility,Outpatient,,,,122,103.7,34.9652,122,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,58.56,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Group A Streptococcus, Naat",,87651,CPT,Facility,Inpatient,,,,122,103.7,34.9652,122,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Group B Streptococcus, Pcr",,87653,CPT,Facility,Both,,,,163,138.55,46.7158,163,Aetna,Commercial,149.96,92,,percent of total billed charges,,
"Group B Streptococcus, Pcr",,87653,CPT,Facility,Outpatient,,,,163,138.55,46.7158,163,Aetna,Medicare Advantage,79.87,49,,percent of total billed charges,,
"Group B Streptococcus, Pcr",,87653,CPT,Facility,Inpatient,,,,163,138.55,46.7158,163,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Group B Streptococcus, Pcr",,87653,CPT,Facility,Both,,,,163,138.55,46.7158,163,Aetna,PPO,151.59,93,,percent of total billed charges,,
"Group B Streptococcus, Pcr",,87653,CPT,Facility,Both,,,,163,138.55,46.7158,163,America's PPO,America's PPO,156.5289,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Group B Streptococcus, Pcr",,87653,CPT,Facility,Both,,,,163,138.55,46.7158,163,BlueCross BlueShield Minnesota, Federal Employee Program,160.392,98.4,,percent of total billed charges,,
"Group B Streptococcus, Pcr",,87653,CPT,Facility,Both,,,,163,138.55,46.7158,163,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,163,100,,percent of total billed charges,,
"Group B Streptococcus, Pcr",,87653,CPT,Facility,Both,,,,163,138.55,46.7158,163,BlueCross BlueShield Minnesota,High Value Network Plan,146.7,90,,percent of total billed charges,,
"Group B Streptococcus, Pcr",,87653,CPT,Facility,Outpatient,,,,163,138.55,46.7158,163,BlueCross BlueShield Minnesota,Medicare Advantage,79.87,49,,percent of total billed charges,,
"Group B Streptococcus, Pcr",,87653,CPT,Facility,Inpatient,,,,163,138.55,46.7158,163,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Group B Streptococcus, Pcr",,87653,CPT,Facility,Both,,,,163,138.55,46.7158,163,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,144.3691,88.57,,percent of total billed charges,,
"Group B Streptococcus, Pcr",,87653,CPT,Facility,Both,,,,163,138.55,46.7158,163,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,46.7158,28.66,,percent of total billed charges,,
"Group B Streptococcus, Pcr",,87653,CPT,Facility,Outpatient,,,,163,138.55,46.7158,163,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),79.87,49,,percent of total billed charges,,
"Group B Streptococcus, Pcr",,87653,CPT,Facility,Inpatient,,,,163,138.55,46.7158,163,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Group B Streptococcus, Pcr",,87653,CPT,Facility,Both,,,,163,138.55,46.7158,163,CorVel,Worker's Compensation,163,100,,percent of total billed charges,,
"Group B Streptococcus, Pcr",,87653,CPT,Facility,Both,,,,163,138.55,46.7158,163,First Health Group Corporation,First Health Network,158.11,97,,percent of total billed charges,,
"Group B Streptococcus, Pcr",,87653,CPT,Facility,Both,,,,163,138.55,46.7158,163,"Health Partners, Inc.",Commercial,154.198,94.6,,percent of total billed charges,,
"Group B Streptococcus, Pcr",,87653,CPT,Facility,Outpatient,,,,163,138.55,46.7158,163,"Health Partners, Inc.",Medicare Advantage,79.87,49,,percent of total billed charges,,
"Group B Streptococcus, Pcr",,87653,CPT,Facility,Inpatient,,,,163,138.55,46.7158,163,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Group B Streptococcus, Pcr",,87653,CPT,Facility,Both,,,,163,138.55,46.7158,163,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),97.8,60,,percent of total billed charges,,
"Group B Streptococcus, Pcr",,87653,CPT,Facility,Both,,,,163,138.55,46.7158,163,"Health Partners, Inc.",State of Minnesota Advantage Program,132.845,81.5,,percent of total billed charges,,
"Group B Streptococcus, Pcr",,87653,CPT,Facility,Both,,,,163,138.55,46.7158,163,"Health Partners, Inc.",State Public Programs,81.5,50,,percent of total billed charges,,
"Group B Streptococcus, Pcr",,87653,CPT,Facility,Both,,,,163,138.55,46.7158,163,Humana Insurance Company,Commercial PPO,154.85,95,,percent of total billed charges,,
"Group B Streptococcus, Pcr",,87653,CPT,Facility,Outpatient,,,,163,138.55,46.7158,163,Humana Insurance Company,Medicare PPO,79.87,49,,percent of total billed charges,,
"Group B Streptococcus, Pcr",,87653,CPT,Facility,Inpatient,,,,163,138.55,46.7158,163,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Group B Streptococcus, Pcr",,87653,CPT,Facility,Both,,,,163,138.55,46.7158,163,Medica,Individual & Family,161.533,99.1,,percent of total billed charges,,
"Group B Streptococcus, Pcr",,87653,CPT,Facility,Outpatient,,,,163,138.55,46.7158,163,Medica,Medica Advantage Solution,81.174,49.8,,percent of total billed charges,,
"Group B Streptococcus, Pcr",,87653,CPT,Facility,Inpatient,,,,163,138.55,46.7158,163,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Group B Streptococcus, Pcr",,87653,CPT,Facility,Outpatient,,,,163,138.55,46.7158,163,Medica,Medical Assistance,72.698,44.6,,percent of total billed charges,,
"Group B Streptococcus, Pcr",,87653,CPT,Facility,Inpatient,,,,163,138.55,46.7158,163,Medica,Medical Assistance,,,,,Included in per diem rate,
"Group B Streptococcus, Pcr",,87653,CPT,Facility,Outpatient,,,,163,138.55,46.7158,163,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,81.174,49.8,,percent of total billed charges,,
"Group B Streptococcus, Pcr",,87653,CPT,Facility,Inpatient,,,,163,138.55,46.7158,163,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Group B Streptococcus, Pcr",,87653,CPT,Facility,Both,,,,163,138.55,46.7158,163,"Multiplan, Inc.","Multiplan, Inc.",153.22,94,,percent of total billed charges,,
"Group B Streptococcus, Pcr",,87653,CPT,Facility,Outpatient,,,,163,138.55,46.7158,163,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,140.832,86.4,,percent of total billed charges,,
"Group B Streptococcus, Pcr",,87653,CPT,Facility,Inpatient,,,,163,138.55,46.7158,163,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Group B Streptococcus, Pcr",,87653,CPT,Facility,Both,,,,163,138.55,46.7158,163,"Preferred One Administrative Services, INC.",PPO,160.718,98.6,,percent of total billed charges,,
"Group B Streptococcus, Pcr",,87653,CPT,Facility,Outpatient,,,,163,138.55,46.7158,163,PrimeWest Health,Minnesota Senior Health Options (MSHO),83.8635,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Group B Streptococcus, Pcr",,87653,CPT,Facility,Inpatient,,,,163,138.55,46.7158,163,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Group B Streptococcus, Pcr",,87653,CPT,Facility,Outpatient,,,,163,138.55,46.7158,163,PrimeWest Health,MinnesotaCare,83.7168,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Group B Streptococcus, Pcr",,87653,CPT,Facility,Inpatient,,,,163,138.55,46.7158,163,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Group B Streptococcus, Pcr",,87653,CPT,Facility,Both,,,,163,138.55,46.7158,163,Sanford Health Plan,Sanford Health Plan,149.96,92,,percent of total billed charges,,
"Group B Streptococcus, Pcr",,87653,CPT,Facility,Outpatient,,,,163,138.55,46.7158,163,"UCare Health, Inc.",Individual & Family Plan,91.8505,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Group B Streptococcus, Pcr",,87653,CPT,Facility,Inpatient,,,,163,138.55,46.7158,163,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Group B Streptococcus, Pcr",,87653,CPT,Facility,Outpatient,,,,163,138.55,46.7158,163,"UCare Health, Inc.",Medical Assistance,82.2661,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Group B Streptococcus, Pcr",,87653,CPT,Facility,Inpatient,,,,163,138.55,46.7158,163,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Group B Streptococcus, Pcr",,87653,CPT,Facility,Outpatient,,,,163,138.55,46.7158,163,"UCare Health, Inc.",Medicare Advantage,82.2661,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Group B Streptococcus, Pcr",,87653,CPT,Facility,Inpatient,,,,163,138.55,46.7158,163,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Group B Streptococcus, Pcr",,87653,CPT,Facility,Outpatient,,,,163,138.55,46.7158,163,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),82.2661,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Group B Streptococcus, Pcr",,87653,CPT,Facility,Inpatient,,,,163,138.55,46.7158,163,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Group B Streptococcus, Pcr",,87653,CPT,Facility,Both,,,,163,138.55,46.7158,163,UnitedHealthcare,Individual & Family,153.22,94,,percent of total billed charges,,
"Group B Streptococcus, Pcr",,87653,CPT,Facility,Outpatient,,,,163,138.55,46.7158,163,UnitedHealthcare,Medicare Advantage,79.87,49,,percent of total billed charges,,
"Group B Streptococcus, Pcr",,87653,CPT,Facility,Inpatient,,,,163,138.55,46.7158,163,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Group B Streptococcus, Pcr",,87653,CPT,Facility,Outpatient,,,,163,138.55,46.7158,163,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,78.24,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Group B Streptococcus, Pcr",,87653,CPT,Facility,Inpatient,,,,163,138.55,46.7158,163,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Infectious Agent Detection By Nucleic Acid Nos, Each Organism",,87798,CPT,Facility,Both,,,,31,26.35,8.8846,31,Aetna,Commercial,28.52,92,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid Nos, Each Organism",,87798,CPT,Facility,Outpatient,,,,31,26.35,8.8846,31,Aetna,Medicare Advantage,15.19,49,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid Nos, Each Organism",,87798,CPT,Facility,Inpatient,,,,31,26.35,8.8846,31,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Infectious Agent Detection By Nucleic Acid Nos, Each Organism",,87798,CPT,Facility,Both,,,,31,26.35,8.8846,31,Aetna,PPO,28.83,93,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid Nos, Each Organism",,87798,CPT,Facility,Both,,,,31,26.35,8.8846,31,America's PPO,America's PPO,29.7693,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Infectious Agent Detection By Nucleic Acid Nos, Each Organism",,87798,CPT,Facility,Both,,,,31,26.35,8.8846,31,BlueCross BlueShield Minnesota, Federal Employee Program,30.504,98.4,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid Nos, Each Organism",,87798,CPT,Facility,Both,,,,31,26.35,8.8846,31,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,31,100,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid Nos, Each Organism",,87798,CPT,Facility,Both,,,,31,26.35,8.8846,31,BlueCross BlueShield Minnesota,High Value Network Plan,27.9,90,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid Nos, Each Organism",,87798,CPT,Facility,Outpatient,,,,31,26.35,8.8846,31,BlueCross BlueShield Minnesota,Medicare Advantage,15.19,49,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid Nos, Each Organism",,87798,CPT,Facility,Inpatient,,,,31,26.35,8.8846,31,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Infectious Agent Detection By Nucleic Acid Nos, Each Organism",,87798,CPT,Facility,Both,,,,31,26.35,8.8846,31,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,27.4567,88.57,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid Nos, Each Organism",,87798,CPT,Facility,Both,,,,31,26.35,8.8846,31,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,8.8846,28.66,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid Nos, Each Organism",,87798,CPT,Facility,Outpatient,,,,31,26.35,8.8846,31,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),15.19,49,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid Nos, Each Organism",,87798,CPT,Facility,Inpatient,,,,31,26.35,8.8846,31,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Infectious Agent Detection By Nucleic Acid Nos, Each Organism",,87798,CPT,Facility,Both,,,,31,26.35,8.8846,31,CorVel,Worker's Compensation,31,100,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid Nos, Each Organism",,87798,CPT,Facility,Both,,,,31,26.35,8.8846,31,First Health Group Corporation,First Health Network,30.07,97,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid Nos, Each Organism",,87798,CPT,Facility,Both,,,,31,26.35,8.8846,31,"Health Partners, Inc.",Commercial,29.326,94.6,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid Nos, Each Organism",,87798,CPT,Facility,Outpatient,,,,31,26.35,8.8846,31,"Health Partners, Inc.",Medicare Advantage,15.19,49,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid Nos, Each Organism",,87798,CPT,Facility,Inpatient,,,,31,26.35,8.8846,31,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Infectious Agent Detection By Nucleic Acid Nos, Each Organism",,87798,CPT,Facility,Both,,,,31,26.35,8.8846,31,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),18.6,60,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid Nos, Each Organism",,87798,CPT,Facility,Both,,,,31,26.35,8.8846,31,"Health Partners, Inc.",State of Minnesota Advantage Program,25.265,81.5,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid Nos, Each Organism",,87798,CPT,Facility,Both,,,,31,26.35,8.8846,31,"Health Partners, Inc.",State Public Programs,15.5,50,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid Nos, Each Organism",,87798,CPT,Facility,Both,,,,31,26.35,8.8846,31,Humana Insurance Company,Commercial PPO,29.45,95,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid Nos, Each Organism",,87798,CPT,Facility,Outpatient,,,,31,26.35,8.8846,31,Humana Insurance Company,Medicare PPO,15.19,49,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid Nos, Each Organism",,87798,CPT,Facility,Inpatient,,,,31,26.35,8.8846,31,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Infectious Agent Detection By Nucleic Acid Nos, Each Organism",,87798,CPT,Facility,Both,,,,31,26.35,8.8846,31,Medica,Individual & Family,30.721,99.1,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid Nos, Each Organism",,87798,CPT,Facility,Outpatient,,,,31,26.35,8.8846,31,Medica,Medica Advantage Solution,15.438,49.8,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid Nos, Each Organism",,87798,CPT,Facility,Inpatient,,,,31,26.35,8.8846,31,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Infectious Agent Detection By Nucleic Acid Nos, Each Organism",,87798,CPT,Facility,Outpatient,,,,31,26.35,8.8846,31,Medica,Medical Assistance,13.826,44.6,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid Nos, Each Organism",,87798,CPT,Facility,Inpatient,,,,31,26.35,8.8846,31,Medica,Medical Assistance,,,,,Included in per diem rate,
"Infectious Agent Detection By Nucleic Acid Nos, Each Organism",,87798,CPT,Facility,Outpatient,,,,31,26.35,8.8846,31,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,15.438,49.8,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid Nos, Each Organism",,87798,CPT,Facility,Inpatient,,,,31,26.35,8.8846,31,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Infectious Agent Detection By Nucleic Acid Nos, Each Organism",,87798,CPT,Facility,Both,,,,31,26.35,8.8846,31,"Multiplan, Inc.","Multiplan, Inc.",29.14,94,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid Nos, Each Organism",,87798,CPT,Facility,Outpatient,,,,31,26.35,8.8846,31,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,26.784,86.4,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid Nos, Each Organism",,87798,CPT,Facility,Inpatient,,,,31,26.35,8.8846,31,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Infectious Agent Detection By Nucleic Acid Nos, Each Organism",,87798,CPT,Facility,Both,,,,31,26.35,8.8846,31,"Preferred One Administrative Services, INC.",PPO,30.566,98.6,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid Nos, Each Organism",,87798,CPT,Facility,Outpatient,,,,31,26.35,8.8846,31,PrimeWest Health,Minnesota Senior Health Options (MSHO),15.9495,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Infectious Agent Detection By Nucleic Acid Nos, Each Organism",,87798,CPT,Facility,Inpatient,,,,31,26.35,8.8846,31,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Infectious Agent Detection By Nucleic Acid Nos, Each Organism",,87798,CPT,Facility,Outpatient,,,,31,26.35,8.8846,31,PrimeWest Health,MinnesotaCare,15.9216,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Infectious Agent Detection By Nucleic Acid Nos, Each Organism",,87798,CPT,Facility,Inpatient,,,,31,26.35,8.8846,31,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Infectious Agent Detection By Nucleic Acid Nos, Each Organism",,87798,CPT,Facility,Both,,,,31,26.35,8.8846,31,Sanford Health Plan,Sanford Health Plan,28.52,92,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid Nos, Each Organism",,87798,CPT,Facility,Outpatient,,,,31,26.35,8.8846,31,"UCare Health, Inc.",Individual & Family Plan,17.4685,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Infectious Agent Detection By Nucleic Acid Nos, Each Organism",,87798,CPT,Facility,Inpatient,,,,31,26.35,8.8846,31,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Infectious Agent Detection By Nucleic Acid Nos, Each Organism",,87798,CPT,Facility,Outpatient,,,,31,26.35,8.8846,31,"UCare Health, Inc.",Medical Assistance,15.6457,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Infectious Agent Detection By Nucleic Acid Nos, Each Organism",,87798,CPT,Facility,Inpatient,,,,31,26.35,8.8846,31,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Infectious Agent Detection By Nucleic Acid Nos, Each Organism",,87798,CPT,Facility,Outpatient,,,,31,26.35,8.8846,31,"UCare Health, Inc.",Medicare Advantage,15.6457,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Infectious Agent Detection By Nucleic Acid Nos, Each Organism",,87798,CPT,Facility,Inpatient,,,,31,26.35,8.8846,31,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Infectious Agent Detection By Nucleic Acid Nos, Each Organism",,87798,CPT,Facility,Outpatient,,,,31,26.35,8.8846,31,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),15.6457,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Infectious Agent Detection By Nucleic Acid Nos, Each Organism",,87798,CPT,Facility,Inpatient,,,,31,26.35,8.8846,31,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Infectious Agent Detection By Nucleic Acid Nos, Each Organism",,87798,CPT,Facility,Both,,,,31,26.35,8.8846,31,UnitedHealthcare,Individual & Family,29.14,94,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid Nos, Each Organism",,87798,CPT,Facility,Outpatient,,,,31,26.35,8.8846,31,UnitedHealthcare,Medicare Advantage,15.19,49,,percent of total billed charges,,
"Infectious Agent Detection By Nucleic Acid Nos, Each Organism",,87798,CPT,Facility,Inpatient,,,,31,26.35,8.8846,31,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Infectious Agent Detection By Nucleic Acid Nos, Each Organism",,87798,CPT,Facility,Outpatient,,,,31,26.35,8.8846,31,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,14.88,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Infectious Agent Detection By Nucleic Acid Nos, Each Organism",,87798,CPT,Facility,Inpatient,,,,31,26.35,8.8846,31,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Influenza A And B Ag,,87804,CPT,Facility,Both,,,,91,77.35,26.0806,91,Aetna,Commercial,83.72,92,,percent of total billed charges,,
Influenza A And B Ag,,87804,CPT,Facility,Outpatient,,,,91,77.35,26.0806,91,Aetna,Medicare Advantage,44.59,49,,percent of total billed charges,,
Influenza A And B Ag,,87804,CPT,Facility,Inpatient,,,,91,77.35,26.0806,91,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Influenza A And B Ag,,87804,CPT,Facility,Both,,,,91,77.35,26.0806,91,Aetna,PPO,84.63,93,,percent of total billed charges,,
Influenza A And B Ag,,87804,CPT,Facility,Both,,,,91,77.35,26.0806,91,America's PPO,America's PPO,87.3873,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Influenza A And B Ag,,87804,CPT,Facility,Both,,,,91,77.35,26.0806,91,BlueCross BlueShield Minnesota, Federal Employee Program,89.544,98.4,,percent of total billed charges,,
Influenza A And B Ag,,87804,CPT,Facility,Both,,,,91,77.35,26.0806,91,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,91,100,,percent of total billed charges,,
Influenza A And B Ag,,87804,CPT,Facility,Both,,,,91,77.35,26.0806,91,BlueCross BlueShield Minnesota,High Value Network Plan,81.9,90,,percent of total billed charges,,
Influenza A And B Ag,,87804,CPT,Facility,Outpatient,,,,91,77.35,26.0806,91,BlueCross BlueShield Minnesota,Medicare Advantage,44.59,49,,percent of total billed charges,,
Influenza A And B Ag,,87804,CPT,Facility,Inpatient,,,,91,77.35,26.0806,91,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Influenza A And B Ag,,87804,CPT,Facility,Both,,,,91,77.35,26.0806,91,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,80.5987,88.57,,percent of total billed charges,,
Influenza A And B Ag,,87804,CPT,Facility,Both,,,,91,77.35,26.0806,91,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,26.0806,28.66,,percent of total billed charges,,
Influenza A And B Ag,,87804,CPT,Facility,Outpatient,,,,91,77.35,26.0806,91,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),44.59,49,,percent of total billed charges,,
Influenza A And B Ag,,87804,CPT,Facility,Inpatient,,,,91,77.35,26.0806,91,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Influenza A And B Ag,,87804,CPT,Facility,Both,,,,91,77.35,26.0806,91,CorVel,Worker's Compensation,91,100,,percent of total billed charges,,
Influenza A And B Ag,,87804,CPT,Facility,Both,,,,91,77.35,26.0806,91,First Health Group Corporation,First Health Network,88.27,97,,percent of total billed charges,,
Influenza A And B Ag,,87804,CPT,Facility,Both,,,,91,77.35,26.0806,91,"Health Partners, Inc.",Commercial,86.086,94.6,,percent of total billed charges,,
Influenza A And B Ag,,87804,CPT,Facility,Outpatient,,,,91,77.35,26.0806,91,"Health Partners, Inc.",Medicare Advantage,44.59,49,,percent of total billed charges,,
Influenza A And B Ag,,87804,CPT,Facility,Inpatient,,,,91,77.35,26.0806,91,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Influenza A And B Ag,,87804,CPT,Facility,Both,,,,91,77.35,26.0806,91,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),54.6,60,,percent of total billed charges,,
Influenza A And B Ag,,87804,CPT,Facility,Both,,,,91,77.35,26.0806,91,"Health Partners, Inc.",State of Minnesota Advantage Program,74.165,81.5,,percent of total billed charges,,
Influenza A And B Ag,,87804,CPT,Facility,Both,,,,91,77.35,26.0806,91,"Health Partners, Inc.",State Public Programs,45.5,50,,percent of total billed charges,,
Influenza A And B Ag,,87804,CPT,Facility,Both,,,,91,77.35,26.0806,91,Humana Insurance Company,Commercial PPO,86.45,95,,percent of total billed charges,,
Influenza A And B Ag,,87804,CPT,Facility,Outpatient,,,,91,77.35,26.0806,91,Humana Insurance Company,Medicare PPO,44.59,49,,percent of total billed charges,,
Influenza A And B Ag,,87804,CPT,Facility,Inpatient,,,,91,77.35,26.0806,91,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Influenza A And B Ag,,87804,CPT,Facility,Both,,,,91,77.35,26.0806,91,Medica,Individual & Family,90.181,99.1,,percent of total billed charges,,
Influenza A And B Ag,,87804,CPT,Facility,Outpatient,,,,91,77.35,26.0806,91,Medica,Medica Advantage Solution,45.318,49.8,,percent of total billed charges,,
Influenza A And B Ag,,87804,CPT,Facility,Inpatient,,,,91,77.35,26.0806,91,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Influenza A And B Ag,,87804,CPT,Facility,Outpatient,,,,91,77.35,26.0806,91,Medica,Medical Assistance,40.586,44.6,,percent of total billed charges,,
Influenza A And B Ag,,87804,CPT,Facility,Inpatient,,,,91,77.35,26.0806,91,Medica,Medical Assistance,,,,,Included in per diem rate,
Influenza A And B Ag,,87804,CPT,Facility,Outpatient,,,,91,77.35,26.0806,91,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,45.318,49.8,,percent of total billed charges,,
Influenza A And B Ag,,87804,CPT,Facility,Inpatient,,,,91,77.35,26.0806,91,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Influenza A And B Ag,,87804,CPT,Facility,Both,,,,91,77.35,26.0806,91,"Multiplan, Inc.","Multiplan, Inc.",85.54,94,,percent of total billed charges,,
Influenza A And B Ag,,87804,CPT,Facility,Outpatient,,,,91,77.35,26.0806,91,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,78.624,86.4,,percent of total billed charges,,
Influenza A And B Ag,,87804,CPT,Facility,Inpatient,,,,91,77.35,26.0806,91,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Influenza A And B Ag,,87804,CPT,Facility,Both,,,,91,77.35,26.0806,91,"Preferred One Administrative Services, INC.",PPO,89.726,98.6,,percent of total billed charges,,
Influenza A And B Ag,,87804,CPT,Facility,Outpatient,,,,91,77.35,26.0806,91,PrimeWest Health,Minnesota Senior Health Options (MSHO),46.8195,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Influenza A And B Ag,,87804,CPT,Facility,Inpatient,,,,91,77.35,26.0806,91,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Influenza A And B Ag,,87804,CPT,Facility,Outpatient,,,,91,77.35,26.0806,91,PrimeWest Health,MinnesotaCare,46.7376,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Influenza A And B Ag,,87804,CPT,Facility,Inpatient,,,,91,77.35,26.0806,91,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Influenza A And B Ag,,87804,CPT,Facility,Both,,,,91,77.35,26.0806,91,Sanford Health Plan,Sanford Health Plan,83.72,92,,percent of total billed charges,,
Influenza A And B Ag,,87804,CPT,Facility,Outpatient,,,,91,77.35,26.0806,91,"UCare Health, Inc.",Individual & Family Plan,51.2785,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Influenza A And B Ag,,87804,CPT,Facility,Inpatient,,,,91,77.35,26.0806,91,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Influenza A And B Ag,,87804,CPT,Facility,Outpatient,,,,91,77.35,26.0806,91,"UCare Health, Inc.",Medical Assistance,45.9277,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Influenza A And B Ag,,87804,CPT,Facility,Inpatient,,,,91,77.35,26.0806,91,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Influenza A And B Ag,,87804,CPT,Facility,Outpatient,,,,91,77.35,26.0806,91,"UCare Health, Inc.",Medicare Advantage,45.9277,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Influenza A And B Ag,,87804,CPT,Facility,Inpatient,,,,91,77.35,26.0806,91,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Influenza A And B Ag,,87804,CPT,Facility,Outpatient,,,,91,77.35,26.0806,91,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),45.9277,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Influenza A And B Ag,,87804,CPT,Facility,Inpatient,,,,91,77.35,26.0806,91,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Influenza A And B Ag,,87804,CPT,Facility,Both,,,,91,77.35,26.0806,91,UnitedHealthcare,Individual & Family,85.54,94,,percent of total billed charges,,
Influenza A And B Ag,,87804,CPT,Facility,Outpatient,,,,91,77.35,26.0806,91,UnitedHealthcare,Medicare Advantage,44.59,49,,percent of total billed charges,,
Influenza A And B Ag,,87804,CPT,Facility,Inpatient,,,,91,77.35,26.0806,91,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Influenza A And B Ag,,87804,CPT,Facility,Outpatient,,,,91,77.35,26.0806,91,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,43.68,48,,percent of total billed charges,,100% of DHS outpatient percentage
Influenza A And B Ag,,87804,CPT,Facility,Inpatient,,,,91,77.35,26.0806,91,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Respiratory Syncytial Virus (Rsv),,87807,CPT,Facility,Both,,,,142,120.7,40.6972,142,Aetna,Commercial,130.64,92,,percent of total billed charges,,
Respiratory Syncytial Virus (Rsv),,87807,CPT,Facility,Outpatient,,,,142,120.7,40.6972,142,Aetna,Medicare Advantage,69.58,49,,percent of total billed charges,,
Respiratory Syncytial Virus (Rsv),,87807,CPT,Facility,Inpatient,,,,142,120.7,40.6972,142,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Respiratory Syncytial Virus (Rsv),,87807,CPT,Facility,Both,,,,142,120.7,40.6972,142,Aetna,PPO,132.06,93,,percent of total billed charges,,
Respiratory Syncytial Virus (Rsv),,87807,CPT,Facility,Both,,,,142,120.7,40.6972,142,America's PPO,America's PPO,136.3626,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Respiratory Syncytial Virus (Rsv),,87807,CPT,Facility,Both,,,,142,120.7,40.6972,142,BlueCross BlueShield Minnesota, Federal Employee Program,139.728,98.4,,percent of total billed charges,,
Respiratory Syncytial Virus (Rsv),,87807,CPT,Facility,Both,,,,142,120.7,40.6972,142,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,142,100,,percent of total billed charges,,
Respiratory Syncytial Virus (Rsv),,87807,CPT,Facility,Both,,,,142,120.7,40.6972,142,BlueCross BlueShield Minnesota,High Value Network Plan,127.8,90,,percent of total billed charges,,
Respiratory Syncytial Virus (Rsv),,87807,CPT,Facility,Outpatient,,,,142,120.7,40.6972,142,BlueCross BlueShield Minnesota,Medicare Advantage,69.58,49,,percent of total billed charges,,
Respiratory Syncytial Virus (Rsv),,87807,CPT,Facility,Inpatient,,,,142,120.7,40.6972,142,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Respiratory Syncytial Virus (Rsv),,87807,CPT,Facility,Both,,,,142,120.7,40.6972,142,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,125.7694,88.57,,percent of total billed charges,,
Respiratory Syncytial Virus (Rsv),,87807,CPT,Facility,Both,,,,142,120.7,40.6972,142,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,40.6972,28.66,,percent of total billed charges,,
Respiratory Syncytial Virus (Rsv),,87807,CPT,Facility,Outpatient,,,,142,120.7,40.6972,142,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),69.58,49,,percent of total billed charges,,
Respiratory Syncytial Virus (Rsv),,87807,CPT,Facility,Inpatient,,,,142,120.7,40.6972,142,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Respiratory Syncytial Virus (Rsv),,87807,CPT,Facility,Both,,,,142,120.7,40.6972,142,CorVel,Worker's Compensation,142,100,,percent of total billed charges,,
Respiratory Syncytial Virus (Rsv),,87807,CPT,Facility,Both,,,,142,120.7,40.6972,142,First Health Group Corporation,First Health Network,137.74,97,,percent of total billed charges,,
Respiratory Syncytial Virus (Rsv),,87807,CPT,Facility,Both,,,,142,120.7,40.6972,142,"Health Partners, Inc.",Commercial,134.332,94.6,,percent of total billed charges,,
Respiratory Syncytial Virus (Rsv),,87807,CPT,Facility,Outpatient,,,,142,120.7,40.6972,142,"Health Partners, Inc.",Medicare Advantage,69.58,49,,percent of total billed charges,,
Respiratory Syncytial Virus (Rsv),,87807,CPT,Facility,Inpatient,,,,142,120.7,40.6972,142,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Respiratory Syncytial Virus (Rsv),,87807,CPT,Facility,Both,,,,142,120.7,40.6972,142,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),85.2,60,,percent of total billed charges,,
Respiratory Syncytial Virus (Rsv),,87807,CPT,Facility,Both,,,,142,120.7,40.6972,142,"Health Partners, Inc.",State of Minnesota Advantage Program,115.73,81.5,,percent of total billed charges,,
Respiratory Syncytial Virus (Rsv),,87807,CPT,Facility,Both,,,,142,120.7,40.6972,142,"Health Partners, Inc.",State Public Programs,71,50,,percent of total billed charges,,
Respiratory Syncytial Virus (Rsv),,87807,CPT,Facility,Both,,,,142,120.7,40.6972,142,Humana Insurance Company,Commercial PPO,134.9,95,,percent of total billed charges,,
Respiratory Syncytial Virus (Rsv),,87807,CPT,Facility,Outpatient,,,,142,120.7,40.6972,142,Humana Insurance Company,Medicare PPO,69.58,49,,percent of total billed charges,,
Respiratory Syncytial Virus (Rsv),,87807,CPT,Facility,Inpatient,,,,142,120.7,40.6972,142,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Respiratory Syncytial Virus (Rsv),,87807,CPT,Facility,Both,,,,142,120.7,40.6972,142,Medica,Individual & Family,140.722,99.1,,percent of total billed charges,,
Respiratory Syncytial Virus (Rsv),,87807,CPT,Facility,Outpatient,,,,142,120.7,40.6972,142,Medica,Medica Advantage Solution,70.716,49.8,,percent of total billed charges,,
Respiratory Syncytial Virus (Rsv),,87807,CPT,Facility,Inpatient,,,,142,120.7,40.6972,142,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Respiratory Syncytial Virus (Rsv),,87807,CPT,Facility,Outpatient,,,,142,120.7,40.6972,142,Medica,Medical Assistance,63.332,44.6,,percent of total billed charges,,
Respiratory Syncytial Virus (Rsv),,87807,CPT,Facility,Inpatient,,,,142,120.7,40.6972,142,Medica,Medical Assistance,,,,,Included in per diem rate,
Respiratory Syncytial Virus (Rsv),,87807,CPT,Facility,Outpatient,,,,142,120.7,40.6972,142,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,70.716,49.8,,percent of total billed charges,,
Respiratory Syncytial Virus (Rsv),,87807,CPT,Facility,Inpatient,,,,142,120.7,40.6972,142,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Respiratory Syncytial Virus (Rsv),,87807,CPT,Facility,Both,,,,142,120.7,40.6972,142,"Multiplan, Inc.","Multiplan, Inc.",133.48,94,,percent of total billed charges,,
Respiratory Syncytial Virus (Rsv),,87807,CPT,Facility,Outpatient,,,,142,120.7,40.6972,142,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,122.688,86.4,,percent of total billed charges,,
Respiratory Syncytial Virus (Rsv),,87807,CPT,Facility,Inpatient,,,,142,120.7,40.6972,142,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Respiratory Syncytial Virus (Rsv),,87807,CPT,Facility,Both,,,,142,120.7,40.6972,142,"Preferred One Administrative Services, INC.",PPO,140.012,98.6,,percent of total billed charges,,
Respiratory Syncytial Virus (Rsv),,87807,CPT,Facility,Outpatient,,,,142,120.7,40.6972,142,PrimeWest Health,Minnesota Senior Health Options (MSHO),73.059,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Respiratory Syncytial Virus (Rsv),,87807,CPT,Facility,Inpatient,,,,142,120.7,40.6972,142,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Respiratory Syncytial Virus (Rsv),,87807,CPT,Facility,Outpatient,,,,142,120.7,40.6972,142,PrimeWest Health,MinnesotaCare,72.9312,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Respiratory Syncytial Virus (Rsv),,87807,CPT,Facility,Inpatient,,,,142,120.7,40.6972,142,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Respiratory Syncytial Virus (Rsv),,87807,CPT,Facility,Both,,,,142,120.7,40.6972,142,Sanford Health Plan,Sanford Health Plan,130.64,92,,percent of total billed charges,,
Respiratory Syncytial Virus (Rsv),,87807,CPT,Facility,Outpatient,,,,142,120.7,40.6972,142,"UCare Health, Inc.",Individual & Family Plan,80.017,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Respiratory Syncytial Virus (Rsv),,87807,CPT,Facility,Inpatient,,,,142,120.7,40.6972,142,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Respiratory Syncytial Virus (Rsv),,87807,CPT,Facility,Outpatient,,,,142,120.7,40.6972,142,"UCare Health, Inc.",Medical Assistance,71.6674,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Respiratory Syncytial Virus (Rsv),,87807,CPT,Facility,Inpatient,,,,142,120.7,40.6972,142,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Respiratory Syncytial Virus (Rsv),,87807,CPT,Facility,Outpatient,,,,142,120.7,40.6972,142,"UCare Health, Inc.",Medicare Advantage,71.6674,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Respiratory Syncytial Virus (Rsv),,87807,CPT,Facility,Inpatient,,,,142,120.7,40.6972,142,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Respiratory Syncytial Virus (Rsv),,87807,CPT,Facility,Outpatient,,,,142,120.7,40.6972,142,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),71.6674,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Respiratory Syncytial Virus (Rsv),,87807,CPT,Facility,Inpatient,,,,142,120.7,40.6972,142,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Respiratory Syncytial Virus (Rsv),,87807,CPT,Facility,Both,,,,142,120.7,40.6972,142,UnitedHealthcare,Individual & Family,133.48,94,,percent of total billed charges,,
Respiratory Syncytial Virus (Rsv),,87807,CPT,Facility,Outpatient,,,,142,120.7,40.6972,142,UnitedHealthcare,Medicare Advantage,69.58,49,,percent of total billed charges,,
Respiratory Syncytial Virus (Rsv),,87807,CPT,Facility,Inpatient,,,,142,120.7,40.6972,142,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Respiratory Syncytial Virus (Rsv),,87807,CPT,Facility,Outpatient,,,,142,120.7,40.6972,142,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,68.16,48,,percent of total billed charges,,100% of DHS outpatient percentage
Respiratory Syncytial Virus (Rsv),,87807,CPT,Facility,Inpatient,,,,142,120.7,40.6972,142,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Covid Antigen (Screening),,87811,CPT,Facility,Both,,,,82,69.7,23.5012,82,Aetna,Commercial,75.44,92,,percent of total billed charges,,
Covid Antigen (Screening),,87811,CPT,Facility,Outpatient,,,,82,69.7,23.5012,82,Aetna,Medicare Advantage,40.18,49,,percent of total billed charges,,
Covid Antigen (Screening),,87811,CPT,Facility,Inpatient,,,,82,69.7,23.5012,82,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Covid Antigen (Screening),,87811,CPT,Facility,Both,,,,82,69.7,23.5012,82,Aetna,PPO,76.26,93,,percent of total billed charges,,
Covid Antigen (Screening),,87811,CPT,Facility,Both,,,,82,69.7,23.5012,82,America's PPO,America's PPO,78.7446,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Covid Antigen (Screening),,87811,CPT,Facility,Both,,,,82,69.7,23.5012,82,BlueCross BlueShield Minnesota, Federal Employee Program,80.688,98.4,,percent of total billed charges,,
Covid Antigen (Screening),,87811,CPT,Facility,Both,,,,82,69.7,23.5012,82,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,82,100,,percent of total billed charges,,
Covid Antigen (Screening),,87811,CPT,Facility,Both,,,,82,69.7,23.5012,82,BlueCross BlueShield Minnesota,High Value Network Plan,73.8,90,,percent of total billed charges,,
Covid Antigen (Screening),,87811,CPT,Facility,Outpatient,,,,82,69.7,23.5012,82,BlueCross BlueShield Minnesota,Medicare Advantage,40.18,49,,percent of total billed charges,,
Covid Antigen (Screening),,87811,CPT,Facility,Inpatient,,,,82,69.7,23.5012,82,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Covid Antigen (Screening),,87811,CPT,Facility,Both,,,,82,69.7,23.5012,82,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,72.6274,88.57,,percent of total billed charges,,
Covid Antigen (Screening),,87811,CPT,Facility,Both,,,,82,69.7,23.5012,82,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,23.5012,28.66,,percent of total billed charges,,
Covid Antigen (Screening),,87811,CPT,Facility,Outpatient,,,,82,69.7,23.5012,82,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),40.18,49,,percent of total billed charges,,
Covid Antigen (Screening),,87811,CPT,Facility,Inpatient,,,,82,69.7,23.5012,82,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Covid Antigen (Screening),,87811,CPT,Facility,Both,,,,82,69.7,23.5012,82,CorVel,Worker's Compensation,82,100,,percent of total billed charges,,
Covid Antigen (Screening),,87811,CPT,Facility,Both,,,,82,69.7,23.5012,82,First Health Group Corporation,First Health Network,79.54,97,,percent of total billed charges,,
Covid Antigen (Screening),,87811,CPT,Facility,Both,,,,82,69.7,23.5012,82,"Health Partners, Inc.",Commercial,77.572,94.6,,percent of total billed charges,,
Covid Antigen (Screening),,87811,CPT,Facility,Outpatient,,,,82,69.7,23.5012,82,"Health Partners, Inc.",Medicare Advantage,40.18,49,,percent of total billed charges,,
Covid Antigen (Screening),,87811,CPT,Facility,Inpatient,,,,82,69.7,23.5012,82,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Covid Antigen (Screening),,87811,CPT,Facility,Both,,,,82,69.7,23.5012,82,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),49.2,60,,percent of total billed charges,,
Covid Antigen (Screening),,87811,CPT,Facility,Both,,,,82,69.7,23.5012,82,"Health Partners, Inc.",State of Minnesota Advantage Program,66.83,81.5,,percent of total billed charges,,
Covid Antigen (Screening),,87811,CPT,Facility,Both,,,,82,69.7,23.5012,82,"Health Partners, Inc.",State Public Programs,41,50,,percent of total billed charges,,
Covid Antigen (Screening),,87811,CPT,Facility,Both,,,,82,69.7,23.5012,82,Humana Insurance Company,Commercial PPO,77.9,95,,percent of total billed charges,,
Covid Antigen (Screening),,87811,CPT,Facility,Outpatient,,,,82,69.7,23.5012,82,Humana Insurance Company,Medicare PPO,40.18,49,,percent of total billed charges,,
Covid Antigen (Screening),,87811,CPT,Facility,Inpatient,,,,82,69.7,23.5012,82,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Covid Antigen (Screening),,87811,CPT,Facility,Both,,,,82,69.7,23.5012,82,Medica,Individual & Family,81.262,99.1,,percent of total billed charges,,
Covid Antigen (Screening),,87811,CPT,Facility,Outpatient,,,,82,69.7,23.5012,82,Medica,Medica Advantage Solution,40.836,49.8,,percent of total billed charges,,
Covid Antigen (Screening),,87811,CPT,Facility,Inpatient,,,,82,69.7,23.5012,82,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Covid Antigen (Screening),,87811,CPT,Facility,Outpatient,,,,82,69.7,23.5012,82,Medica,Medical Assistance,36.572,44.6,,percent of total billed charges,,
Covid Antigen (Screening),,87811,CPT,Facility,Inpatient,,,,82,69.7,23.5012,82,Medica,Medical Assistance,,,,,Included in per diem rate,
Covid Antigen (Screening),,87811,CPT,Facility,Outpatient,,,,82,69.7,23.5012,82,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,40.836,49.8,,percent of total billed charges,,
Covid Antigen (Screening),,87811,CPT,Facility,Inpatient,,,,82,69.7,23.5012,82,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Covid Antigen (Screening),,87811,CPT,Facility,Both,,,,82,69.7,23.5012,82,"Multiplan, Inc.","Multiplan, Inc.",77.08,94,,percent of total billed charges,,
Covid Antigen (Screening),,87811,CPT,Facility,Outpatient,,,,82,69.7,23.5012,82,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,70.848,86.4,,percent of total billed charges,,
Covid Antigen (Screening),,87811,CPT,Facility,Inpatient,,,,82,69.7,23.5012,82,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Covid Antigen (Screening),,87811,CPT,Facility,Both,,,,82,69.7,23.5012,82,"Preferred One Administrative Services, INC.",PPO,80.852,98.6,,percent of total billed charges,,
Covid Antigen (Screening),,87811,CPT,Facility,Outpatient,,,,82,69.7,23.5012,82,PrimeWest Health,Minnesota Senior Health Options (MSHO),42.189,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Covid Antigen (Screening),,87811,CPT,Facility,Inpatient,,,,82,69.7,23.5012,82,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Covid Antigen (Screening),,87811,CPT,Facility,Outpatient,,,,82,69.7,23.5012,82,PrimeWest Health,MinnesotaCare,42.1152,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Covid Antigen (Screening),,87811,CPT,Facility,Inpatient,,,,82,69.7,23.5012,82,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Covid Antigen (Screening),,87811,CPT,Facility,Both,,,,82,69.7,23.5012,82,Sanford Health Plan,Sanford Health Plan,75.44,92,,percent of total billed charges,,
Covid Antigen (Screening),,87811,CPT,Facility,Outpatient,,,,82,69.7,23.5012,82,"UCare Health, Inc.",Individual & Family Plan,46.207,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Covid Antigen (Screening),,87811,CPT,Facility,Inpatient,,,,82,69.7,23.5012,82,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Covid Antigen (Screening),,87811,CPT,Facility,Outpatient,,,,82,69.7,23.5012,82,"UCare Health, Inc.",Medical Assistance,41.3854,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Covid Antigen (Screening),,87811,CPT,Facility,Inpatient,,,,82,69.7,23.5012,82,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Covid Antigen (Screening),,87811,CPT,Facility,Outpatient,,,,82,69.7,23.5012,82,"UCare Health, Inc.",Medicare Advantage,41.3854,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Covid Antigen (Screening),,87811,CPT,Facility,Inpatient,,,,82,69.7,23.5012,82,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Covid Antigen (Screening),,87811,CPT,Facility,Outpatient,,,,82,69.7,23.5012,82,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),41.3854,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Covid Antigen (Screening),,87811,CPT,Facility,Inpatient,,,,82,69.7,23.5012,82,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Covid Antigen (Screening),,87811,CPT,Facility,Both,,,,82,69.7,23.5012,82,UnitedHealthcare,Individual & Family,77.08,94,,percent of total billed charges,,
Covid Antigen (Screening),,87811,CPT,Facility,Outpatient,,,,82,69.7,23.5012,82,UnitedHealthcare,Medicare Advantage,40.18,49,,percent of total billed charges,,
Covid Antigen (Screening),,87811,CPT,Facility,Inpatient,,,,82,69.7,23.5012,82,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Covid Antigen (Screening),,87811,CPT,Facility,Outpatient,,,,82,69.7,23.5012,82,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,39.36,48,,percent of total billed charges,,100% of DHS outpatient percentage
Covid Antigen (Screening),,87811,CPT,Facility,Inpatient,,,,82,69.7,23.5012,82,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Urine Strep Pneumonia Antigen,,87899,CPT,Facility,Both,,,,139,118.15,39.8374,139,Aetna,Commercial,127.88,92,,percent of total billed charges,,
Urine Strep Pneumonia Antigen,,87899,CPT,Facility,Outpatient,,,,139,118.15,39.8374,139,Aetna,Medicare Advantage,68.11,49,,percent of total billed charges,,
Urine Strep Pneumonia Antigen,,87899,CPT,Facility,Inpatient,,,,139,118.15,39.8374,139,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Urine Strep Pneumonia Antigen,,87899,CPT,Facility,Both,,,,139,118.15,39.8374,139,Aetna,PPO,129.27,93,,percent of total billed charges,,
Urine Strep Pneumonia Antigen,,87899,CPT,Facility,Both,,,,139,118.15,39.8374,139,America's PPO,America's PPO,133.4817,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Urine Strep Pneumonia Antigen,,87899,CPT,Facility,Both,,,,139,118.15,39.8374,139,BlueCross BlueShield Minnesota, Federal Employee Program,136.776,98.4,,percent of total billed charges,,
Urine Strep Pneumonia Antigen,,87899,CPT,Facility,Both,,,,139,118.15,39.8374,139,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,139,100,,percent of total billed charges,,
Urine Strep Pneumonia Antigen,,87899,CPT,Facility,Both,,,,139,118.15,39.8374,139,BlueCross BlueShield Minnesota,High Value Network Plan,125.1,90,,percent of total billed charges,,
Urine Strep Pneumonia Antigen,,87899,CPT,Facility,Outpatient,,,,139,118.15,39.8374,139,BlueCross BlueShield Minnesota,Medicare Advantage,68.11,49,,percent of total billed charges,,
Urine Strep Pneumonia Antigen,,87899,CPT,Facility,Inpatient,,,,139,118.15,39.8374,139,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Urine Strep Pneumonia Antigen,,87899,CPT,Facility,Both,,,,139,118.15,39.8374,139,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,123.1123,88.57,,percent of total billed charges,,
Urine Strep Pneumonia Antigen,,87899,CPT,Facility,Both,,,,139,118.15,39.8374,139,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,39.8374,28.66,,percent of total billed charges,,
Urine Strep Pneumonia Antigen,,87899,CPT,Facility,Outpatient,,,,139,118.15,39.8374,139,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),68.11,49,,percent of total billed charges,,
Urine Strep Pneumonia Antigen,,87899,CPT,Facility,Inpatient,,,,139,118.15,39.8374,139,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Urine Strep Pneumonia Antigen,,87899,CPT,Facility,Both,,,,139,118.15,39.8374,139,CorVel,Worker's Compensation,139,100,,percent of total billed charges,,
Urine Strep Pneumonia Antigen,,87899,CPT,Facility,Both,,,,139,118.15,39.8374,139,First Health Group Corporation,First Health Network,134.83,97,,percent of total billed charges,,
Urine Strep Pneumonia Antigen,,87899,CPT,Facility,Both,,,,139,118.15,39.8374,139,"Health Partners, Inc.",Commercial,131.494,94.6,,percent of total billed charges,,
Urine Strep Pneumonia Antigen,,87899,CPT,Facility,Outpatient,,,,139,118.15,39.8374,139,"Health Partners, Inc.",Medicare Advantage,68.11,49,,percent of total billed charges,,
Urine Strep Pneumonia Antigen,,87899,CPT,Facility,Inpatient,,,,139,118.15,39.8374,139,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Urine Strep Pneumonia Antigen,,87899,CPT,Facility,Both,,,,139,118.15,39.8374,139,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),83.4,60,,percent of total billed charges,,
Urine Strep Pneumonia Antigen,,87899,CPT,Facility,Both,,,,139,118.15,39.8374,139,"Health Partners, Inc.",State of Minnesota Advantage Program,113.285,81.5,,percent of total billed charges,,
Urine Strep Pneumonia Antigen,,87899,CPT,Facility,Both,,,,139,118.15,39.8374,139,"Health Partners, Inc.",State Public Programs,69.5,50,,percent of total billed charges,,
Urine Strep Pneumonia Antigen,,87899,CPT,Facility,Both,,,,139,118.15,39.8374,139,Humana Insurance Company,Commercial PPO,132.05,95,,percent of total billed charges,,
Urine Strep Pneumonia Antigen,,87899,CPT,Facility,Outpatient,,,,139,118.15,39.8374,139,Humana Insurance Company,Medicare PPO,68.11,49,,percent of total billed charges,,
Urine Strep Pneumonia Antigen,,87899,CPT,Facility,Inpatient,,,,139,118.15,39.8374,139,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Urine Strep Pneumonia Antigen,,87899,CPT,Facility,Both,,,,139,118.15,39.8374,139,Medica,Individual & Family,137.749,99.1,,percent of total billed charges,,
Urine Strep Pneumonia Antigen,,87899,CPT,Facility,Outpatient,,,,139,118.15,39.8374,139,Medica,Medica Advantage Solution,69.222,49.8,,percent of total billed charges,,
Urine Strep Pneumonia Antigen,,87899,CPT,Facility,Inpatient,,,,139,118.15,39.8374,139,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Urine Strep Pneumonia Antigen,,87899,CPT,Facility,Outpatient,,,,139,118.15,39.8374,139,Medica,Medical Assistance,61.994,44.6,,percent of total billed charges,,
Urine Strep Pneumonia Antigen,,87899,CPT,Facility,Inpatient,,,,139,118.15,39.8374,139,Medica,Medical Assistance,,,,,Included in per diem rate,
Urine Strep Pneumonia Antigen,,87899,CPT,Facility,Outpatient,,,,139,118.15,39.8374,139,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,69.222,49.8,,percent of total billed charges,,
Urine Strep Pneumonia Antigen,,87899,CPT,Facility,Inpatient,,,,139,118.15,39.8374,139,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Urine Strep Pneumonia Antigen,,87899,CPT,Facility,Both,,,,139,118.15,39.8374,139,"Multiplan, Inc.","Multiplan, Inc.",130.66,94,,percent of total billed charges,,
Urine Strep Pneumonia Antigen,,87899,CPT,Facility,Outpatient,,,,139,118.15,39.8374,139,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,120.096,86.4,,percent of total billed charges,,
Urine Strep Pneumonia Antigen,,87899,CPT,Facility,Inpatient,,,,139,118.15,39.8374,139,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Urine Strep Pneumonia Antigen,,87899,CPT,Facility,Both,,,,139,118.15,39.8374,139,"Preferred One Administrative Services, INC.",PPO,137.054,98.6,,percent of total billed charges,,
Urine Strep Pneumonia Antigen,,87899,CPT,Facility,Outpatient,,,,139,118.15,39.8374,139,PrimeWest Health,Minnesota Senior Health Options (MSHO),71.5155,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Urine Strep Pneumonia Antigen,,87899,CPT,Facility,Inpatient,,,,139,118.15,39.8374,139,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Urine Strep Pneumonia Antigen,,87899,CPT,Facility,Outpatient,,,,139,118.15,39.8374,139,PrimeWest Health,MinnesotaCare,71.3904,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Urine Strep Pneumonia Antigen,,87899,CPT,Facility,Inpatient,,,,139,118.15,39.8374,139,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Urine Strep Pneumonia Antigen,,87899,CPT,Facility,Both,,,,139,118.15,39.8374,139,Sanford Health Plan,Sanford Health Plan,127.88,92,,percent of total billed charges,,
Urine Strep Pneumonia Antigen,,87899,CPT,Facility,Outpatient,,,,139,118.15,39.8374,139,"UCare Health, Inc.",Individual & Family Plan,78.3265,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Urine Strep Pneumonia Antigen,,87899,CPT,Facility,Inpatient,,,,139,118.15,39.8374,139,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Urine Strep Pneumonia Antigen,,87899,CPT,Facility,Outpatient,,,,139,118.15,39.8374,139,"UCare Health, Inc.",Medical Assistance,70.1533,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Urine Strep Pneumonia Antigen,,87899,CPT,Facility,Inpatient,,,,139,118.15,39.8374,139,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Urine Strep Pneumonia Antigen,,87899,CPT,Facility,Outpatient,,,,139,118.15,39.8374,139,"UCare Health, Inc.",Medicare Advantage,70.1533,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Urine Strep Pneumonia Antigen,,87899,CPT,Facility,Inpatient,,,,139,118.15,39.8374,139,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Urine Strep Pneumonia Antigen,,87899,CPT,Facility,Outpatient,,,,139,118.15,39.8374,139,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),70.1533,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Urine Strep Pneumonia Antigen,,87899,CPT,Facility,Inpatient,,,,139,118.15,39.8374,139,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Urine Strep Pneumonia Antigen,,87899,CPT,Facility,Both,,,,139,118.15,39.8374,139,UnitedHealthcare,Individual & Family,130.66,94,,percent of total billed charges,,
Urine Strep Pneumonia Antigen,,87899,CPT,Facility,Outpatient,,,,139,118.15,39.8374,139,UnitedHealthcare,Medicare Advantage,68.11,49,,percent of total billed charges,,
Urine Strep Pneumonia Antigen,,87899,CPT,Facility,Inpatient,,,,139,118.15,39.8374,139,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Urine Strep Pneumonia Antigen,,87899,CPT,Facility,Outpatient,,,,139,118.15,39.8374,139,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,66.72,48,,percent of total billed charges,,100% of DHS outpatient percentage
Urine Strep Pneumonia Antigen,,87899,CPT,Facility,Inpatient,,,,139,118.15,39.8374,139,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
HALOPERIDOL LACTATE 5 MG/ML IV INJ,,J1630,HCPCS,Facility,Both,10,mL,,162,137.7,46.4292,162,Aetna,Commercial,149.04,92,,percent of total billed charges,,
HALOPERIDOL LACTATE 5 MG/ML IV INJ,,J1630,HCPCS,Facility,Outpatient,10,mL,,162,137.7,46.4292,162,Aetna,Medicare Advantage,79.38,49,,percent of total billed charges,,
HALOPERIDOL LACTATE 5 MG/ML IV INJ,,J1630,HCPCS,Facility,Inpatient,10,mL,,162,137.7,46.4292,162,Aetna,Medicare Advantage,,,,,Included in per diem rate,
HALOPERIDOL LACTATE 5 MG/ML IV INJ,,J1630,HCPCS,Facility,Both,10,mL,,162,137.7,46.4292,162,Aetna,PPO,150.66,93,,percent of total billed charges,,
HALOPERIDOL LACTATE 5 MG/ML IV INJ,,J1630,HCPCS,Facility,Both,10,mL,,162,137.7,46.4292,162,America's PPO,America's PPO,155.5686,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
HALOPERIDOL LACTATE 5 MG/ML IV INJ,,J1630,HCPCS,Facility,Both,10,mL,,162,137.7,46.4292,162,BlueCross BlueShield Minnesota, Federal Employee Program,159.408,98.4,,percent of total billed charges,,
HALOPERIDOL LACTATE 5 MG/ML IV INJ,,J1630,HCPCS,Facility,Both,10,mL,,162,137.7,46.4292,162,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,162,100,,percent of total billed charges,,
HALOPERIDOL LACTATE 5 MG/ML IV INJ,,J1630,HCPCS,Facility,Both,10,mL,,162,137.7,46.4292,162,BlueCross BlueShield Minnesota,High Value Network Plan,145.8,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
HALOPERIDOL LACTATE 5 MG/ML IV INJ,,J1630,HCPCS,Facility,Outpatient,10,mL,,162,137.7,46.4292,162,BlueCross BlueShield Minnesota,Medicare Advantage,79.38,49,,percent of total billed charges,,
HALOPERIDOL LACTATE 5 MG/ML IV INJ,,J1630,HCPCS,Facility,Inpatient,10,mL,,162,137.7,46.4292,162,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
HALOPERIDOL LACTATE 5 MG/ML IV INJ,,J1630,HCPCS,Facility,Both,10,mL,,162,137.7,46.4292,162,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,143.4834,88.57,,percent of total billed charges,,
HALOPERIDOL LACTATE 5 MG/ML IV INJ,,J1630,HCPCS,Facility,Both,10,mL,,162,137.7,46.4292,162,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,46.4292,28.66,,percent of total billed charges,,
HALOPERIDOL LACTATE 5 MG/ML IV INJ,,J1630,HCPCS,Facility,Outpatient,10,mL,,162,137.7,46.4292,162,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),79.38,49,,percent of total billed charges,,
HALOPERIDOL LACTATE 5 MG/ML IV INJ,,J1630,HCPCS,Facility,Inpatient,10,mL,,162,137.7,46.4292,162,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
HALOPERIDOL LACTATE 5 MG/ML IV INJ,,J1630,HCPCS,Facility,Both,10,mL,,162,137.7,46.4292,162,CorVel,Worker's Compensation,162,100,,percent of total billed charges,,
HALOPERIDOL LACTATE 5 MG/ML IV INJ,,J1630,HCPCS,Facility,Both,10,mL,,162,137.7,46.4292,162,First Health Group Corporation,First Health Network,157.14,97,,percent of total billed charges,,
HALOPERIDOL LACTATE 5 MG/ML IV INJ,,J1630,HCPCS,Facility,Both,10,mL,,162,137.7,46.4292,162,"Health Partners, Inc.",Commercial,153.252,94.6,,percent of total billed charges,,
HALOPERIDOL LACTATE 5 MG/ML IV INJ,,J1630,HCPCS,Facility,Outpatient,10,mL,,162,137.7,46.4292,162,"Health Partners, Inc.",Medicare Advantage,79.38,49,,percent of total billed charges,,
HALOPERIDOL LACTATE 5 MG/ML IV INJ,,J1630,HCPCS,Facility,Inpatient,10,mL,,162,137.7,46.4292,162,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
HALOPERIDOL LACTATE 5 MG/ML IV INJ,,J1630,HCPCS,Facility,Both,10,mL,,162,137.7,46.4292,162,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),97.2,60,,percent of total billed charges,,
HALOPERIDOL LACTATE 5 MG/ML IV INJ,,J1630,HCPCS,Facility,Both,10,mL,,162,137.7,46.4292,162,"Health Partners, Inc.",State of Minnesota Advantage Program,132.03,81.5,,percent of total billed charges,,
HALOPERIDOL LACTATE 5 MG/ML IV INJ,,J1630,HCPCS,Facility,Both,10,mL,,162,137.7,46.4292,162,"Health Partners, Inc.",State Public Programs,81,50,,percent of total billed charges,,
HALOPERIDOL LACTATE 5 MG/ML IV INJ,,J1630,HCPCS,Facility,Both,10,mL,,162,137.7,46.4292,162,Humana Insurance Company,Commercial PPO,153.9,95,,percent of total billed charges,,
HALOPERIDOL LACTATE 5 MG/ML IV INJ,,J1630,HCPCS,Facility,Outpatient,10,mL,,162,137.7,46.4292,162,Humana Insurance Company,Medicare PPO,79.38,49,,percent of total billed charges,,
HALOPERIDOL LACTATE 5 MG/ML IV INJ,,J1630,HCPCS,Facility,Inpatient,10,mL,,162,137.7,46.4292,162,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
HALOPERIDOL LACTATE 5 MG/ML IV INJ,,J1630,HCPCS,Facility,Both,10,mL,,162,137.7,46.4292,162,Medica,Individual & Family,160.542,99.1,,percent of total billed charges,,
HALOPERIDOL LACTATE 5 MG/ML IV INJ,,J1630,HCPCS,Facility,Outpatient,10,mL,,162,137.7,46.4292,162,Medica,Medica Advantage Solution,80.676,49.8,,percent of total billed charges,,
HALOPERIDOL LACTATE 5 MG/ML IV INJ,,J1630,HCPCS,Facility,Inpatient,10,mL,,162,137.7,46.4292,162,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
HALOPERIDOL LACTATE 5 MG/ML IV INJ,,J1630,HCPCS,Facility,Outpatient,10,mL,,162,137.7,46.4292,162,Medica,Medical Assistance,72.252,44.6,,percent of total billed charges,,
HALOPERIDOL LACTATE 5 MG/ML IV INJ,,J1630,HCPCS,Facility,Inpatient,10,mL,,162,137.7,46.4292,162,Medica,Medical Assistance,,,,,Included in per diem rate,
HALOPERIDOL LACTATE 5 MG/ML IV INJ,,J1630,HCPCS,Facility,Outpatient,10,mL,,162,137.7,46.4292,162,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,80.676,49.8,,percent of total billed charges,,
HALOPERIDOL LACTATE 5 MG/ML IV INJ,,J1630,HCPCS,Facility,Inpatient,10,mL,,162,137.7,46.4292,162,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
HALOPERIDOL LACTATE 5 MG/ML IV INJ,,J1630,HCPCS,Facility,Both,10,mL,,162,137.7,46.4292,162,"Multiplan, Inc.","Multiplan, Inc.",152.28,94,,percent of total billed charges,,
HALOPERIDOL LACTATE 5 MG/ML IV INJ,,J1630,HCPCS,Facility,Outpatient,10,mL,,162,137.7,46.4292,162,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,145.962,90.1,,percent of total billed charges,,
HALOPERIDOL LACTATE 5 MG/ML IV INJ,,J1630,HCPCS,Facility,Inpatient,10,mL,,162,137.7,46.4292,162,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
HALOPERIDOL LACTATE 5 MG/ML IV INJ,,J1630,HCPCS,Facility,Both,10,mL,,162,137.7,46.4292,162,"Preferred One Administrative Services, INC.",PPO,159.732,98.6,,percent of total billed charges,,
HALOPERIDOL LACTATE 5 MG/ML IV INJ,,J1630,HCPCS,Facility,Outpatient,10,mL,,162,137.7,46.4292,162,PrimeWest Health,Minnesota Senior Health Options (MSHO),83.349,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
HALOPERIDOL LACTATE 5 MG/ML IV INJ,,J1630,HCPCS,Facility,Inpatient,10,mL,,162,137.7,46.4292,162,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
HALOPERIDOL LACTATE 5 MG/ML IV INJ,,J1630,HCPCS,Facility,Outpatient,10,mL,,162,137.7,46.4292,162,PrimeWest Health,MinnesotaCare,83.2032,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
HALOPERIDOL LACTATE 5 MG/ML IV INJ,,J1630,HCPCS,Facility,Inpatient,10,mL,,162,137.7,46.4292,162,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
HALOPERIDOL LACTATE 5 MG/ML IV INJ,,J1630,HCPCS,Facility,Both,10,mL,,162,137.7,46.4292,162,Sanford Health Plan,Sanford Health Plan,149.04,92,,percent of total billed charges,,
HALOPERIDOL LACTATE 5 MG/ML IV INJ,,J1630,HCPCS,Facility,Outpatient,10,mL,,162,137.7,46.4292,162,"UCare Health, Inc.",Individual & Family Plan,91.287,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
HALOPERIDOL LACTATE 5 MG/ML IV INJ,,J1630,HCPCS,Facility,Inpatient,10,mL,,162,137.7,46.4292,162,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
HALOPERIDOL LACTATE 5 MG/ML IV INJ,,J1630,HCPCS,Facility,Outpatient,10,mL,,162,137.7,46.4292,162,"UCare Health, Inc.",Medical Assistance,81.7614,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
HALOPERIDOL LACTATE 5 MG/ML IV INJ,,J1630,HCPCS,Facility,Inpatient,10,mL,,162,137.7,46.4292,162,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
HALOPERIDOL LACTATE 5 MG/ML IV INJ,,J1630,HCPCS,Facility,Outpatient,10,mL,,162,137.7,46.4292,162,"UCare Health, Inc.",Medicare Advantage,81.7614,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
HALOPERIDOL LACTATE 5 MG/ML IV INJ,,J1630,HCPCS,Facility,Inpatient,10,mL,,162,137.7,46.4292,162,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
HALOPERIDOL LACTATE 5 MG/ML IV INJ,,J1630,HCPCS,Facility,Outpatient,10,mL,,162,137.7,46.4292,162,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),81.7614,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
HALOPERIDOL LACTATE 5 MG/ML IV INJ,,J1630,HCPCS,Facility,Inpatient,10,mL,,162,137.7,46.4292,162,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
HALOPERIDOL LACTATE 5 MG/ML IV INJ,,J1630,HCPCS,Facility,Both,10,mL,,162,137.7,46.4292,162,UnitedHealthcare,Individual & Family,152.28,94,,percent of total billed charges,,
HALOPERIDOL LACTATE 5 MG/ML IV INJ,,J1630,HCPCS,Facility,Outpatient,10,mL,,162,137.7,46.4292,162,UnitedHealthcare,Medicare Advantage,79.38,49,,percent of total billed charges,,
HALOPERIDOL LACTATE 5 MG/ML IV INJ,,J1630,HCPCS,Facility,Inpatient,10,mL,,162,137.7,46.4292,162,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
HALOPERIDOL LACTATE 5 MG/ML IV INJ,,J1630,HCPCS,Facility,Outpatient,10,mL,,162,137.7,46.4292,162,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,77.76,48,,percent of total billed charges,,100% of DHS outpatient percentage
HALOPERIDOL LACTATE 5 MG/ML IV INJ,,J1630,HCPCS,Facility,Inpatient,10,mL,,162,137.7,46.4292,162,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
IRON SUCROSE 200 MG IRON/10 ML IV SOLN,,J1756,HCPCS,Facility,Both,10,mL,,573,487.05,164.2218,573,Aetna,Commercial,527.16,92,,percent of total billed charges,,
IRON SUCROSE 200 MG IRON/10 ML IV SOLN,,J1756,HCPCS,Facility,Outpatient,10,mL,,573,487.05,164.2218,573,Aetna,Medicare Advantage,280.77,49,,percent of total billed charges,,
IRON SUCROSE 200 MG IRON/10 ML IV SOLN,,J1756,HCPCS,Facility,Inpatient,10,mL,,573,487.05,164.2218,573,Aetna,Medicare Advantage,,,,,Included in per diem rate,
IRON SUCROSE 200 MG IRON/10 ML IV SOLN,,J1756,HCPCS,Facility,Both,10,mL,,573,487.05,164.2218,573,Aetna,PPO,532.89,93,,percent of total billed charges,,
IRON SUCROSE 200 MG IRON/10 ML IV SOLN,,J1756,HCPCS,Facility,Both,10,mL,,573,487.05,164.2218,573,America's PPO,America's PPO,550.2519,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
IRON SUCROSE 200 MG IRON/10 ML IV SOLN,,J1756,HCPCS,Facility,Both,10,mL,,573,487.05,164.2218,573,BlueCross BlueShield Minnesota, Federal Employee Program,563.832,98.4,,percent of total billed charges,,
IRON SUCROSE 200 MG IRON/10 ML IV SOLN,,J1756,HCPCS,Facility,Both,10,mL,,573,487.05,164.2218,573,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,573,100,,percent of total billed charges,,
IRON SUCROSE 200 MG IRON/10 ML IV SOLN,,J1756,HCPCS,Facility,Both,10,mL,,573,487.05,164.2218,573,BlueCross BlueShield Minnesota,High Value Network Plan,515.7,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
IRON SUCROSE 200 MG IRON/10 ML IV SOLN,,J1756,HCPCS,Facility,Outpatient,10,mL,,573,487.05,164.2218,573,BlueCross BlueShield Minnesota,Medicare Advantage,280.77,49,,percent of total billed charges,,
IRON SUCROSE 200 MG IRON/10 ML IV SOLN,,J1756,HCPCS,Facility,Inpatient,10,mL,,573,487.05,164.2218,573,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
IRON SUCROSE 200 MG IRON/10 ML IV SOLN,,J1756,HCPCS,Facility,Both,10,mL,,573,487.05,164.2218,573,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,507.5061,88.57,,percent of total billed charges,,
IRON SUCROSE 200 MG IRON/10 ML IV SOLN,,J1756,HCPCS,Facility,Both,10,mL,,573,487.05,164.2218,573,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,164.2218,28.66,,percent of total billed charges,,
IRON SUCROSE 200 MG IRON/10 ML IV SOLN,,J1756,HCPCS,Facility,Outpatient,10,mL,,573,487.05,164.2218,573,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),280.77,49,,percent of total billed charges,,
IRON SUCROSE 200 MG IRON/10 ML IV SOLN,,J1756,HCPCS,Facility,Inpatient,10,mL,,573,487.05,164.2218,573,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
IRON SUCROSE 200 MG IRON/10 ML IV SOLN,,J1756,HCPCS,Facility,Both,10,mL,,573,487.05,164.2218,573,CorVel,Worker's Compensation,573,100,,percent of total billed charges,,
IRON SUCROSE 200 MG IRON/10 ML IV SOLN,,J1756,HCPCS,Facility,Both,10,mL,,573,487.05,164.2218,573,First Health Group Corporation,First Health Network,555.81,97,,percent of total billed charges,,
IRON SUCROSE 200 MG IRON/10 ML IV SOLN,,J1756,HCPCS,Facility,Both,10,mL,,573,487.05,164.2218,573,"Health Partners, Inc.",Commercial,542.058,94.6,,percent of total billed charges,,
IRON SUCROSE 200 MG IRON/10 ML IV SOLN,,J1756,HCPCS,Facility,Outpatient,10,mL,,573,487.05,164.2218,573,"Health Partners, Inc.",Medicare Advantage,280.77,49,,percent of total billed charges,,
IRON SUCROSE 200 MG IRON/10 ML IV SOLN,,J1756,HCPCS,Facility,Inpatient,10,mL,,573,487.05,164.2218,573,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
IRON SUCROSE 200 MG IRON/10 ML IV SOLN,,J1756,HCPCS,Facility,Both,10,mL,,573,487.05,164.2218,573,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),343.8,60,,percent of total billed charges,,
IRON SUCROSE 200 MG IRON/10 ML IV SOLN,,J1756,HCPCS,Facility,Both,10,mL,,573,487.05,164.2218,573,"Health Partners, Inc.",State of Minnesota Advantage Program,466.995,81.5,,percent of total billed charges,,
IRON SUCROSE 200 MG IRON/10 ML IV SOLN,,J1756,HCPCS,Facility,Both,10,mL,,573,487.05,164.2218,573,"Health Partners, Inc.",State Public Programs,286.5,50,,percent of total billed charges,,
IRON SUCROSE 200 MG IRON/10 ML IV SOLN,,J1756,HCPCS,Facility,Both,10,mL,,573,487.05,164.2218,573,Humana Insurance Company,Commercial PPO,544.35,95,,percent of total billed charges,,
IRON SUCROSE 200 MG IRON/10 ML IV SOLN,,J1756,HCPCS,Facility,Outpatient,10,mL,,573,487.05,164.2218,573,Humana Insurance Company,Medicare PPO,280.77,49,,percent of total billed charges,,
IRON SUCROSE 200 MG IRON/10 ML IV SOLN,,J1756,HCPCS,Facility,Inpatient,10,mL,,573,487.05,164.2218,573,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
IRON SUCROSE 200 MG IRON/10 ML IV SOLN,,J1756,HCPCS,Facility,Both,10,mL,,573,487.05,164.2218,573,Medica,Individual & Family,567.843,99.1,,percent of total billed charges,,
IRON SUCROSE 200 MG IRON/10 ML IV SOLN,,J1756,HCPCS,Facility,Outpatient,10,mL,,573,487.05,164.2218,573,Medica,Medica Advantage Solution,285.354,49.8,,percent of total billed charges,,
IRON SUCROSE 200 MG IRON/10 ML IV SOLN,,J1756,HCPCS,Facility,Inpatient,10,mL,,573,487.05,164.2218,573,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
IRON SUCROSE 200 MG IRON/10 ML IV SOLN,,J1756,HCPCS,Facility,Outpatient,10,mL,,573,487.05,164.2218,573,Medica,Medical Assistance,255.558,44.6,,percent of total billed charges,,
IRON SUCROSE 200 MG IRON/10 ML IV SOLN,,J1756,HCPCS,Facility,Inpatient,10,mL,,573,487.05,164.2218,573,Medica,Medical Assistance,,,,,Included in per diem rate,
IRON SUCROSE 200 MG IRON/10 ML IV SOLN,,J1756,HCPCS,Facility,Outpatient,10,mL,,573,487.05,164.2218,573,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,285.354,49.8,,percent of total billed charges,,
IRON SUCROSE 200 MG IRON/10 ML IV SOLN,,J1756,HCPCS,Facility,Inpatient,10,mL,,573,487.05,164.2218,573,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
IRON SUCROSE 200 MG IRON/10 ML IV SOLN,,J1756,HCPCS,Facility,Both,10,mL,,573,487.05,164.2218,573,"Multiplan, Inc.","Multiplan, Inc.",538.62,94,,percent of total billed charges,,
IRON SUCROSE 200 MG IRON/10 ML IV SOLN,,J1756,HCPCS,Facility,Outpatient,10,mL,,573,487.05,164.2218,573,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,516.273,90.1,,percent of total billed charges,,
IRON SUCROSE 200 MG IRON/10 ML IV SOLN,,J1756,HCPCS,Facility,Inpatient,10,mL,,573,487.05,164.2218,573,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
IRON SUCROSE 200 MG IRON/10 ML IV SOLN,,J1756,HCPCS,Facility,Both,10,mL,,573,487.05,164.2218,573,"Preferred One Administrative Services, INC.",PPO,564.978,98.6,,percent of total billed charges,,
IRON SUCROSE 200 MG IRON/10 ML IV SOLN,,J1756,HCPCS,Facility,Outpatient,10,mL,,573,487.05,164.2218,573,PrimeWest Health,Minnesota Senior Health Options (MSHO),294.8085,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
IRON SUCROSE 200 MG IRON/10 ML IV SOLN,,J1756,HCPCS,Facility,Inpatient,10,mL,,573,487.05,164.2218,573,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
IRON SUCROSE 200 MG IRON/10 ML IV SOLN,,J1756,HCPCS,Facility,Outpatient,10,mL,,573,487.05,164.2218,573,PrimeWest Health,MinnesotaCare,294.2928,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
IRON SUCROSE 200 MG IRON/10 ML IV SOLN,,J1756,HCPCS,Facility,Inpatient,10,mL,,573,487.05,164.2218,573,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
IRON SUCROSE 200 MG IRON/10 ML IV SOLN,,J1756,HCPCS,Facility,Both,10,mL,,573,487.05,164.2218,573,Sanford Health Plan,Sanford Health Plan,527.16,92,,percent of total billed charges,,
IRON SUCROSE 200 MG IRON/10 ML IV SOLN,,J1756,HCPCS,Facility,Outpatient,10,mL,,573,487.05,164.2218,573,"UCare Health, Inc.",Individual & Family Plan,322.8855,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
IRON SUCROSE 200 MG IRON/10 ML IV SOLN,,J1756,HCPCS,Facility,Inpatient,10,mL,,573,487.05,164.2218,573,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
IRON SUCROSE 200 MG IRON/10 ML IV SOLN,,J1756,HCPCS,Facility,Outpatient,10,mL,,573,487.05,164.2218,573,"UCare Health, Inc.",Medical Assistance,289.1931,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
IRON SUCROSE 200 MG IRON/10 ML IV SOLN,,J1756,HCPCS,Facility,Inpatient,10,mL,,573,487.05,164.2218,573,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
IRON SUCROSE 200 MG IRON/10 ML IV SOLN,,J1756,HCPCS,Facility,Outpatient,10,mL,,573,487.05,164.2218,573,"UCare Health, Inc.",Medicare Advantage,289.1931,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
IRON SUCROSE 200 MG IRON/10 ML IV SOLN,,J1756,HCPCS,Facility,Inpatient,10,mL,,573,487.05,164.2218,573,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
IRON SUCROSE 200 MG IRON/10 ML IV SOLN,,J1756,HCPCS,Facility,Outpatient,10,mL,,573,487.05,164.2218,573,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),289.1931,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
IRON SUCROSE 200 MG IRON/10 ML IV SOLN,,J1756,HCPCS,Facility,Inpatient,10,mL,,573,487.05,164.2218,573,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
IRON SUCROSE 200 MG IRON/10 ML IV SOLN,,J1756,HCPCS,Facility,Both,10,mL,,573,487.05,164.2218,573,UnitedHealthcare,Individual & Family,538.62,94,,percent of total billed charges,,
IRON SUCROSE 200 MG IRON/10 ML IV SOLN,,J1756,HCPCS,Facility,Outpatient,10,mL,,573,487.05,164.2218,573,UnitedHealthcare,Medicare Advantage,280.77,49,,percent of total billed charges,,
IRON SUCROSE 200 MG IRON/10 ML IV SOLN,,J1756,HCPCS,Facility,Inpatient,10,mL,,573,487.05,164.2218,573,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
IRON SUCROSE 200 MG IRON/10 ML IV SOLN,,J1756,HCPCS,Facility,Outpatient,10,mL,,573,487.05,164.2218,573,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,275.04,48,,percent of total billed charges,,100% of DHS outpatient percentage
IRON SUCROSE 200 MG IRON/10 ML IV SOLN,,J1756,HCPCS,Facility,Inpatient,10,mL,,573,487.05,164.2218,573,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Cytopathology, Concentration Technique, Smears And Interpretation (Path)",,88108,CPT,Facility,Both,,,,101,85.85,28.9466,101,Aetna,Commercial,92.92,92,,percent of total billed charges,,
"Cytopathology, Concentration Technique, Smears And Interpretation (Path)",,88108,CPT,Facility,Outpatient,,,,101,85.85,28.9466,101,Aetna,Medicare Advantage,49.49,49,,percent of total billed charges,,
"Cytopathology, Concentration Technique, Smears And Interpretation (Path)",,88108,CPT,Facility,Inpatient,,,,101,85.85,28.9466,101,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Cytopathology, Concentration Technique, Smears And Interpretation (Path)",,88108,CPT,Facility,Both,,,,101,85.85,28.9466,101,Aetna,PPO,93.93,93,,percent of total billed charges,,
"Cytopathology, Concentration Technique, Smears And Interpretation (Path)",,88108,CPT,Facility,Both,,,,101,85.85,28.9466,101,America's PPO,America's PPO,96.9903,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Cytopathology, Concentration Technique, Smears And Interpretation (Path)",,88108,CPT,Facility,Both,,,,101,85.85,28.9466,101,BlueCross BlueShield Minnesota, Federal Employee Program,99.384,98.4,,percent of total billed charges,,
"Cytopathology, Concentration Technique, Smears And Interpretation (Path)",,88108,CPT,Facility,Both,,,,101,85.85,28.9466,101,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,101,100,,percent of total billed charges,,
"Cytopathology, Concentration Technique, Smears And Interpretation (Path)",,88108,CPT,Facility,Both,,,,101,85.85,28.9466,101,BlueCross BlueShield Minnesota,High Value Network Plan,90.9,90,,percent of total billed charges,,
"Cytopathology, Concentration Technique, Smears And Interpretation (Path)",,88108,CPT,Facility,Outpatient,,,,101,85.85,28.9466,101,BlueCross BlueShield Minnesota,Medicare Advantage,49.49,49,,percent of total billed charges,,
"Cytopathology, Concentration Technique, Smears And Interpretation (Path)",,88108,CPT,Facility,Inpatient,,,,101,85.85,28.9466,101,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Cytopathology, Concentration Technique, Smears And Interpretation (Path)",,88108,CPT,Facility,Both,,,,101,85.85,28.9466,101,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,89.4557,88.57,,percent of total billed charges,,
"Cytopathology, Concentration Technique, Smears And Interpretation (Path)",,88108,CPT,Facility,Both,,,,101,85.85,28.9466,101,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,28.9466,28.66,,percent of total billed charges,,
"Cytopathology, Concentration Technique, Smears And Interpretation (Path)",,88108,CPT,Facility,Outpatient,,,,101,85.85,28.9466,101,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),49.49,49,,percent of total billed charges,,
"Cytopathology, Concentration Technique, Smears And Interpretation (Path)",,88108,CPT,Facility,Inpatient,,,,101,85.85,28.9466,101,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Cytopathology, Concentration Technique, Smears And Interpretation (Path)",,88108,CPT,Facility,Both,,,,101,85.85,28.9466,101,CorVel,Worker's Compensation,101,100,,percent of total billed charges,,
"Cytopathology, Concentration Technique, Smears And Interpretation (Path)",,88108,CPT,Facility,Both,,,,101,85.85,28.9466,101,First Health Group Corporation,First Health Network,97.97,97,,percent of total billed charges,,
"Cytopathology, Concentration Technique, Smears And Interpretation (Path)",,88108,CPT,Facility,Both,,,,101,85.85,28.9466,101,"Health Partners, Inc.",Commercial,95.546,94.6,,percent of total billed charges,,
"Cytopathology, Concentration Technique, Smears And Interpretation (Path)",,88108,CPT,Facility,Outpatient,,,,101,85.85,28.9466,101,"Health Partners, Inc.",Medicare Advantage,49.49,49,,percent of total billed charges,,
"Cytopathology, Concentration Technique, Smears And Interpretation (Path)",,88108,CPT,Facility,Inpatient,,,,101,85.85,28.9466,101,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Cytopathology, Concentration Technique, Smears And Interpretation (Path)",,88108,CPT,Facility,Both,,,,101,85.85,28.9466,101,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),60.6,60,,percent of total billed charges,,
"Cytopathology, Concentration Technique, Smears And Interpretation (Path)",,88108,CPT,Facility,Both,,,,101,85.85,28.9466,101,"Health Partners, Inc.",State of Minnesota Advantage Program,82.315,81.5,,percent of total billed charges,,
"Cytopathology, Concentration Technique, Smears And Interpretation (Path)",,88108,CPT,Facility,Both,,,,101,85.85,28.9466,101,"Health Partners, Inc.",State Public Programs,50.5,50,,percent of total billed charges,,
"Cytopathology, Concentration Technique, Smears And Interpretation (Path)",,88108,CPT,Facility,Both,,,,101,85.85,28.9466,101,Humana Insurance Company,Commercial PPO,95.95,95,,percent of total billed charges,,
"Cytopathology, Concentration Technique, Smears And Interpretation (Path)",,88108,CPT,Facility,Outpatient,,,,101,85.85,28.9466,101,Humana Insurance Company,Medicare PPO,49.49,49,,percent of total billed charges,,
"Cytopathology, Concentration Technique, Smears And Interpretation (Path)",,88108,CPT,Facility,Inpatient,,,,101,85.85,28.9466,101,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Cytopathology, Concentration Technique, Smears And Interpretation (Path)",,88108,CPT,Facility,Both,,,,101,85.85,28.9466,101,Medica,Individual & Family,100.091,99.1,,percent of total billed charges,,
"Cytopathology, Concentration Technique, Smears And Interpretation (Path)",,88108,CPT,Facility,Outpatient,,,,101,85.85,28.9466,101,Medica,Medica Advantage Solution,50.298,49.8,,percent of total billed charges,,
"Cytopathology, Concentration Technique, Smears And Interpretation (Path)",,88108,CPT,Facility,Inpatient,,,,101,85.85,28.9466,101,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Cytopathology, Concentration Technique, Smears And Interpretation (Path)",,88108,CPT,Facility,Outpatient,,,,101,85.85,28.9466,101,Medica,Medical Assistance,45.046,44.6,,percent of total billed charges,,
"Cytopathology, Concentration Technique, Smears And Interpretation (Path)",,88108,CPT,Facility,Inpatient,,,,101,85.85,28.9466,101,Medica,Medical Assistance,,,,,Included in per diem rate,
"Cytopathology, Concentration Technique, Smears And Interpretation (Path)",,88108,CPT,Facility,Outpatient,,,,101,85.85,28.9466,101,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,50.298,49.8,,percent of total billed charges,,
"Cytopathology, Concentration Technique, Smears And Interpretation (Path)",,88108,CPT,Facility,Inpatient,,,,101,85.85,28.9466,101,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Cytopathology, Concentration Technique, Smears And Interpretation (Path)",,88108,CPT,Facility,Both,,,,101,85.85,28.9466,101,"Multiplan, Inc.","Multiplan, Inc.",94.94,94,,percent of total billed charges,,
"Cytopathology, Concentration Technique, Smears And Interpretation (Path)",,88108,CPT,Facility,Outpatient,,,,101,85.85,28.9466,101,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,91.001,90.1,,percent of total billed charges,,
"Cytopathology, Concentration Technique, Smears And Interpretation (Path)",,88108,CPT,Facility,Inpatient,,,,101,85.85,28.9466,101,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Cytopathology, Concentration Technique, Smears And Interpretation (Path)",,88108,CPT,Facility,Both,,,,101,85.85,28.9466,101,"Preferred One Administrative Services, INC.",PPO,99.586,98.6,,percent of total billed charges,,
"Cytopathology, Concentration Technique, Smears And Interpretation (Path)",,88108,CPT,Facility,Outpatient,,,,101,85.85,28.9466,101,PrimeWest Health,Minnesota Senior Health Options (MSHO),51.9645,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Cytopathology, Concentration Technique, Smears And Interpretation (Path)",,88108,CPT,Facility,Inpatient,,,,101,85.85,28.9466,101,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Cytopathology, Concentration Technique, Smears And Interpretation (Path)",,88108,CPT,Facility,Outpatient,,,,101,85.85,28.9466,101,PrimeWest Health,MinnesotaCare,51.8736,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Cytopathology, Concentration Technique, Smears And Interpretation (Path)",,88108,CPT,Facility,Inpatient,,,,101,85.85,28.9466,101,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Cytopathology, Concentration Technique, Smears And Interpretation (Path)",,88108,CPT,Facility,Both,,,,101,85.85,28.9466,101,Sanford Health Plan,Sanford Health Plan,92.92,92,,percent of total billed charges,,
"Cytopathology, Concentration Technique, Smears And Interpretation (Path)",,88108,CPT,Facility,Outpatient,,,,101,85.85,28.9466,101,"UCare Health, Inc.",Individual & Family Plan,56.9135,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Cytopathology, Concentration Technique, Smears And Interpretation (Path)",,88108,CPT,Facility,Inpatient,,,,101,85.85,28.9466,101,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Cytopathology, Concentration Technique, Smears And Interpretation (Path)",,88108,CPT,Facility,Outpatient,,,,101,85.85,28.9466,101,"UCare Health, Inc.",Medical Assistance,50.9747,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Cytopathology, Concentration Technique, Smears And Interpretation (Path)",,88108,CPT,Facility,Inpatient,,,,101,85.85,28.9466,101,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Cytopathology, Concentration Technique, Smears And Interpretation (Path)",,88108,CPT,Facility,Outpatient,,,,101,85.85,28.9466,101,"UCare Health, Inc.",Medicare Advantage,50.9747,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Cytopathology, Concentration Technique, Smears And Interpretation (Path)",,88108,CPT,Facility,Inpatient,,,,101,85.85,28.9466,101,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Cytopathology, Concentration Technique, Smears And Interpretation (Path)",,88108,CPT,Facility,Outpatient,,,,101,85.85,28.9466,101,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),50.9747,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Cytopathology, Concentration Technique, Smears And Interpretation (Path)",,88108,CPT,Facility,Inpatient,,,,101,85.85,28.9466,101,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Cytopathology, Concentration Technique, Smears And Interpretation (Path)",,88108,CPT,Facility,Both,,,,101,85.85,28.9466,101,UnitedHealthcare,Individual & Family,94.94,94,,percent of total billed charges,,
"Cytopathology, Concentration Technique, Smears And Interpretation (Path)",,88108,CPT,Facility,Outpatient,,,,101,85.85,28.9466,101,UnitedHealthcare,Medicare Advantage,49.49,49,,percent of total billed charges,,
"Cytopathology, Concentration Technique, Smears And Interpretation (Path)",,88108,CPT,Facility,Inpatient,,,,101,85.85,28.9466,101,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Cytopathology, Concentration Technique, Smears And Interpretation (Path)",,88108,CPT,Facility,Outpatient,,,,101,85.85,28.9466,101,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,48.48,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Cytopathology, Concentration Technique, Smears And Interpretation (Path)",,88108,CPT,Facility,Inpatient,,,,101,85.85,28.9466,101,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Cytopathology, Selective Cellular Enhancement Technique W/Interp, Except Cervical Or Vaginal (Path)",,88112,CPT,Facility,Both,,,,108,91.8,30.9528,108,Aetna,Commercial,99.36,92,,percent of total billed charges,,
"Cytopathology, Selective Cellular Enhancement Technique W/Interp, Except Cervical Or Vaginal (Path)",,88112,CPT,Facility,Outpatient,,,,108,91.8,30.9528,108,Aetna,Medicare Advantage,52.92,49,,percent of total billed charges,,
"Cytopathology, Selective Cellular Enhancement Technique W/Interp, Except Cervical Or Vaginal (Path)",,88112,CPT,Facility,Inpatient,,,,108,91.8,30.9528,108,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Cytopathology, Selective Cellular Enhancement Technique W/Interp, Except Cervical Or Vaginal (Path)",,88112,CPT,Facility,Both,,,,108,91.8,30.9528,108,Aetna,PPO,100.44,93,,percent of total billed charges,,
"Cytopathology, Selective Cellular Enhancement Technique W/Interp, Except Cervical Or Vaginal (Path)",,88112,CPT,Facility,Both,,,,108,91.8,30.9528,108,America's PPO,America's PPO,103.7124,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Cytopathology, Selective Cellular Enhancement Technique W/Interp, Except Cervical Or Vaginal (Path)",,88112,CPT,Facility,Both,,,,108,91.8,30.9528,108,BlueCross BlueShield Minnesota, Federal Employee Program,106.272,98.4,,percent of total billed charges,,
"Cytopathology, Selective Cellular Enhancement Technique W/Interp, Except Cervical Or Vaginal (Path)",,88112,CPT,Facility,Both,,,,108,91.8,30.9528,108,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,108,100,,percent of total billed charges,,
"Cytopathology, Selective Cellular Enhancement Technique W/Interp, Except Cervical Or Vaginal (Path)",,88112,CPT,Facility,Both,,,,108,91.8,30.9528,108,BlueCross BlueShield Minnesota,High Value Network Plan,97.2,90,,percent of total billed charges,,
"Cytopathology, Selective Cellular Enhancement Technique W/Interp, Except Cervical Or Vaginal (Path)",,88112,CPT,Facility,Outpatient,,,,108,91.8,30.9528,108,BlueCross BlueShield Minnesota,Medicare Advantage,52.92,49,,percent of total billed charges,,
"Cytopathology, Selective Cellular Enhancement Technique W/Interp, Except Cervical Or Vaginal (Path)",,88112,CPT,Facility,Inpatient,,,,108,91.8,30.9528,108,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Cytopathology, Selective Cellular Enhancement Technique W/Interp, Except Cervical Or Vaginal (Path)",,88112,CPT,Facility,Both,,,,108,91.8,30.9528,108,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,95.6556,88.57,,percent of total billed charges,,
"Cytopathology, Selective Cellular Enhancement Technique W/Interp, Except Cervical Or Vaginal (Path)",,88112,CPT,Facility,Both,,,,108,91.8,30.9528,108,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,30.9528,28.66,,percent of total billed charges,,
"Cytopathology, Selective Cellular Enhancement Technique W/Interp, Except Cervical Or Vaginal (Path)",,88112,CPT,Facility,Outpatient,,,,108,91.8,30.9528,108,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),52.92,49,,percent of total billed charges,,
"Cytopathology, Selective Cellular Enhancement Technique W/Interp, Except Cervical Or Vaginal (Path)",,88112,CPT,Facility,Inpatient,,,,108,91.8,30.9528,108,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Cytopathology, Selective Cellular Enhancement Technique W/Interp, Except Cervical Or Vaginal (Path)",,88112,CPT,Facility,Both,,,,108,91.8,30.9528,108,CorVel,Worker's Compensation,108,100,,percent of total billed charges,,
"Cytopathology, Selective Cellular Enhancement Technique W/Interp, Except Cervical Or Vaginal (Path)",,88112,CPT,Facility,Both,,,,108,91.8,30.9528,108,First Health Group Corporation,First Health Network,104.76,97,,percent of total billed charges,,
"Cytopathology, Selective Cellular Enhancement Technique W/Interp, Except Cervical Or Vaginal (Path)",,88112,CPT,Facility,Both,,,,108,91.8,30.9528,108,"Health Partners, Inc.",Commercial,102.168,94.6,,percent of total billed charges,,
"Cytopathology, Selective Cellular Enhancement Technique W/Interp, Except Cervical Or Vaginal (Path)",,88112,CPT,Facility,Outpatient,,,,108,91.8,30.9528,108,"Health Partners, Inc.",Medicare Advantage,52.92,49,,percent of total billed charges,,
"Cytopathology, Selective Cellular Enhancement Technique W/Interp, Except Cervical Or Vaginal (Path)",,88112,CPT,Facility,Inpatient,,,,108,91.8,30.9528,108,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Cytopathology, Selective Cellular Enhancement Technique W/Interp, Except Cervical Or Vaginal (Path)",,88112,CPT,Facility,Both,,,,108,91.8,30.9528,108,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),64.8,60,,percent of total billed charges,,
"Cytopathology, Selective Cellular Enhancement Technique W/Interp, Except Cervical Or Vaginal (Path)",,88112,CPT,Facility,Both,,,,108,91.8,30.9528,108,"Health Partners, Inc.",State of Minnesota Advantage Program,88.02,81.5,,percent of total billed charges,,
"Cytopathology, Selective Cellular Enhancement Technique W/Interp, Except Cervical Or Vaginal (Path)",,88112,CPT,Facility,Both,,,,108,91.8,30.9528,108,"Health Partners, Inc.",State Public Programs,54,50,,percent of total billed charges,,
"Cytopathology, Selective Cellular Enhancement Technique W/Interp, Except Cervical Or Vaginal (Path)",,88112,CPT,Facility,Both,,,,108,91.8,30.9528,108,Humana Insurance Company,Commercial PPO,102.6,95,,percent of total billed charges,,
"Cytopathology, Selective Cellular Enhancement Technique W/Interp, Except Cervical Or Vaginal (Path)",,88112,CPT,Facility,Outpatient,,,,108,91.8,30.9528,108,Humana Insurance Company,Medicare PPO,52.92,49,,percent of total billed charges,,
"Cytopathology, Selective Cellular Enhancement Technique W/Interp, Except Cervical Or Vaginal (Path)",,88112,CPT,Facility,Inpatient,,,,108,91.8,30.9528,108,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Cytopathology, Selective Cellular Enhancement Technique W/Interp, Except Cervical Or Vaginal (Path)",,88112,CPT,Facility,Both,,,,108,91.8,30.9528,108,Medica,Individual & Family,107.028,99.1,,percent of total billed charges,,
"Cytopathology, Selective Cellular Enhancement Technique W/Interp, Except Cervical Or Vaginal (Path)",,88112,CPT,Facility,Outpatient,,,,108,91.8,30.9528,108,Medica,Medica Advantage Solution,53.784,49.8,,percent of total billed charges,,
"Cytopathology, Selective Cellular Enhancement Technique W/Interp, Except Cervical Or Vaginal (Path)",,88112,CPT,Facility,Inpatient,,,,108,91.8,30.9528,108,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Cytopathology, Selective Cellular Enhancement Technique W/Interp, Except Cervical Or Vaginal (Path)",,88112,CPT,Facility,Outpatient,,,,108,91.8,30.9528,108,Medica,Medical Assistance,48.168,44.6,,percent of total billed charges,,
"Cytopathology, Selective Cellular Enhancement Technique W/Interp, Except Cervical Or Vaginal (Path)",,88112,CPT,Facility,Inpatient,,,,108,91.8,30.9528,108,Medica,Medical Assistance,,,,,Included in per diem rate,
"Cytopathology, Selective Cellular Enhancement Technique W/Interp, Except Cervical Or Vaginal (Path)",,88112,CPT,Facility,Outpatient,,,,108,91.8,30.9528,108,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,53.784,49.8,,percent of total billed charges,,
"Cytopathology, Selective Cellular Enhancement Technique W/Interp, Except Cervical Or Vaginal (Path)",,88112,CPT,Facility,Inpatient,,,,108,91.8,30.9528,108,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Cytopathology, Selective Cellular Enhancement Technique W/Interp, Except Cervical Or Vaginal (Path)",,88112,CPT,Facility,Both,,,,108,91.8,30.9528,108,"Multiplan, Inc.","Multiplan, Inc.",101.52,94,,percent of total billed charges,,
"Cytopathology, Selective Cellular Enhancement Technique W/Interp, Except Cervical Or Vaginal (Path)",,88112,CPT,Facility,Outpatient,,,,108,91.8,30.9528,108,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,97.308,90.1,,percent of total billed charges,,
"Cytopathology, Selective Cellular Enhancement Technique W/Interp, Except Cervical Or Vaginal (Path)",,88112,CPT,Facility,Inpatient,,,,108,91.8,30.9528,108,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Cytopathology, Selective Cellular Enhancement Technique W/Interp, Except Cervical Or Vaginal (Path)",,88112,CPT,Facility,Both,,,,108,91.8,30.9528,108,"Preferred One Administrative Services, INC.",PPO,106.488,98.6,,percent of total billed charges,,
"Cytopathology, Selective Cellular Enhancement Technique W/Interp, Except Cervical Or Vaginal (Path)",,88112,CPT,Facility,Outpatient,,,,108,91.8,30.9528,108,PrimeWest Health,Minnesota Senior Health Options (MSHO),55.566,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Cytopathology, Selective Cellular Enhancement Technique W/Interp, Except Cervical Or Vaginal (Path)",,88112,CPT,Facility,Inpatient,,,,108,91.8,30.9528,108,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Cytopathology, Selective Cellular Enhancement Technique W/Interp, Except Cervical Or Vaginal (Path)",,88112,CPT,Facility,Outpatient,,,,108,91.8,30.9528,108,PrimeWest Health,MinnesotaCare,55.4688,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Cytopathology, Selective Cellular Enhancement Technique W/Interp, Except Cervical Or Vaginal (Path)",,88112,CPT,Facility,Inpatient,,,,108,91.8,30.9528,108,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Cytopathology, Selective Cellular Enhancement Technique W/Interp, Except Cervical Or Vaginal (Path)",,88112,CPT,Facility,Both,,,,108,91.8,30.9528,108,Sanford Health Plan,Sanford Health Plan,99.36,92,,percent of total billed charges,,
"Cytopathology, Selective Cellular Enhancement Technique W/Interp, Except Cervical Or Vaginal (Path)",,88112,CPT,Facility,Outpatient,,,,108,91.8,30.9528,108,"UCare Health, Inc.",Individual & Family Plan,60.858,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Cytopathology, Selective Cellular Enhancement Technique W/Interp, Except Cervical Or Vaginal (Path)",,88112,CPT,Facility,Inpatient,,,,108,91.8,30.9528,108,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Cytopathology, Selective Cellular Enhancement Technique W/Interp, Except Cervical Or Vaginal (Path)",,88112,CPT,Facility,Outpatient,,,,108,91.8,30.9528,108,"UCare Health, Inc.",Medical Assistance,54.5076,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Cytopathology, Selective Cellular Enhancement Technique W/Interp, Except Cervical Or Vaginal (Path)",,88112,CPT,Facility,Inpatient,,,,108,91.8,30.9528,108,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Cytopathology, Selective Cellular Enhancement Technique W/Interp, Except Cervical Or Vaginal (Path)",,88112,CPT,Facility,Outpatient,,,,108,91.8,30.9528,108,"UCare Health, Inc.",Medicare Advantage,54.5076,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Cytopathology, Selective Cellular Enhancement Technique W/Interp, Except Cervical Or Vaginal (Path)",,88112,CPT,Facility,Inpatient,,,,108,91.8,30.9528,108,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Cytopathology, Selective Cellular Enhancement Technique W/Interp, Except Cervical Or Vaginal (Path)",,88112,CPT,Facility,Outpatient,,,,108,91.8,30.9528,108,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),54.5076,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Cytopathology, Selective Cellular Enhancement Technique W/Interp, Except Cervical Or Vaginal (Path)",,88112,CPT,Facility,Inpatient,,,,108,91.8,30.9528,108,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Cytopathology, Selective Cellular Enhancement Technique W/Interp, Except Cervical Or Vaginal (Path)",,88112,CPT,Facility,Both,,,,108,91.8,30.9528,108,UnitedHealthcare,Individual & Family,101.52,94,,percent of total billed charges,,
"Cytopathology, Selective Cellular Enhancement Technique W/Interp, Except Cervical Or Vaginal (Path)",,88112,CPT,Facility,Outpatient,,,,108,91.8,30.9528,108,UnitedHealthcare,Medicare Advantage,52.92,49,,percent of total billed charges,,
"Cytopathology, Selective Cellular Enhancement Technique W/Interp, Except Cervical Or Vaginal (Path)",,88112,CPT,Facility,Inpatient,,,,108,91.8,30.9528,108,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Cytopathology, Selective Cellular Enhancement Technique W/Interp, Except Cervical Or Vaginal (Path)",,88112,CPT,Facility,Outpatient,,,,108,91.8,30.9528,108,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,51.84,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Cytopathology, Selective Cellular Enhancement Technique W/Interp, Except Cervical Or Vaginal (Path)",,88112,CPT,Facility,Inpatient,,,,108,91.8,30.9528,108,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Cytopathology, Evaluation Of Fine Needle Aspirate; Interpretation And Report (Path)",,88173,CPT,Facility,Both,,,,184,156.4,52.7344,184,Aetna,Commercial,169.28,92,,percent of total billed charges,,
"Cytopathology, Evaluation Of Fine Needle Aspirate; Interpretation And Report (Path)",,88173,CPT,Facility,Outpatient,,,,184,156.4,52.7344,184,Aetna,Medicare Advantage,90.16,49,,percent of total billed charges,,
"Cytopathology, Evaluation Of Fine Needle Aspirate; Interpretation And Report (Path)",,88173,CPT,Facility,Inpatient,,,,184,156.4,52.7344,184,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Cytopathology, Evaluation Of Fine Needle Aspirate; Interpretation And Report (Path)",,88173,CPT,Facility,Both,,,,184,156.4,52.7344,184,Aetna,PPO,171.12,93,,percent of total billed charges,,
"Cytopathology, Evaluation Of Fine Needle Aspirate; Interpretation And Report (Path)",,88173,CPT,Facility,Both,,,,184,156.4,52.7344,184,America's PPO,America's PPO,176.6952,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Cytopathology, Evaluation Of Fine Needle Aspirate; Interpretation And Report (Path)",,88173,CPT,Facility,Both,,,,184,156.4,52.7344,184,BlueCross BlueShield Minnesota, Federal Employee Program,181.056,98.4,,percent of total billed charges,,
"Cytopathology, Evaluation Of Fine Needle Aspirate; Interpretation And Report (Path)",,88173,CPT,Facility,Both,,,,184,156.4,52.7344,184,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,184,100,,percent of total billed charges,,
"Cytopathology, Evaluation Of Fine Needle Aspirate; Interpretation And Report (Path)",,88173,CPT,Facility,Both,,,,184,156.4,52.7344,184,BlueCross BlueShield Minnesota,High Value Network Plan,165.6,90,,percent of total billed charges,,
"Cytopathology, Evaluation Of Fine Needle Aspirate; Interpretation And Report (Path)",,88173,CPT,Facility,Outpatient,,,,184,156.4,52.7344,184,BlueCross BlueShield Minnesota,Medicare Advantage,90.16,49,,percent of total billed charges,,
"Cytopathology, Evaluation Of Fine Needle Aspirate; Interpretation And Report (Path)",,88173,CPT,Facility,Inpatient,,,,184,156.4,52.7344,184,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Cytopathology, Evaluation Of Fine Needle Aspirate; Interpretation And Report (Path)",,88173,CPT,Facility,Both,,,,184,156.4,52.7344,184,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,162.9688,88.57,,percent of total billed charges,,
"Cytopathology, Evaluation Of Fine Needle Aspirate; Interpretation And Report (Path)",,88173,CPT,Facility,Both,,,,184,156.4,52.7344,184,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,52.7344,28.66,,percent of total billed charges,,
"Cytopathology, Evaluation Of Fine Needle Aspirate; Interpretation And Report (Path)",,88173,CPT,Facility,Outpatient,,,,184,156.4,52.7344,184,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),90.16,49,,percent of total billed charges,,
"Cytopathology, Evaluation Of Fine Needle Aspirate; Interpretation And Report (Path)",,88173,CPT,Facility,Inpatient,,,,184,156.4,52.7344,184,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Cytopathology, Evaluation Of Fine Needle Aspirate; Interpretation And Report (Path)",,88173,CPT,Facility,Both,,,,184,156.4,52.7344,184,CorVel,Worker's Compensation,184,100,,percent of total billed charges,,
"Cytopathology, Evaluation Of Fine Needle Aspirate; Interpretation And Report (Path)",,88173,CPT,Facility,Both,,,,184,156.4,52.7344,184,First Health Group Corporation,First Health Network,178.48,97,,percent of total billed charges,,
"Cytopathology, Evaluation Of Fine Needle Aspirate; Interpretation And Report (Path)",,88173,CPT,Facility,Both,,,,184,156.4,52.7344,184,"Health Partners, Inc.",Commercial,174.064,94.6,,percent of total billed charges,,
"Cytopathology, Evaluation Of Fine Needle Aspirate; Interpretation And Report (Path)",,88173,CPT,Facility,Outpatient,,,,184,156.4,52.7344,184,"Health Partners, Inc.",Medicare Advantage,90.16,49,,percent of total billed charges,,
"Cytopathology, Evaluation Of Fine Needle Aspirate; Interpretation And Report (Path)",,88173,CPT,Facility,Inpatient,,,,184,156.4,52.7344,184,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Cytopathology, Evaluation Of Fine Needle Aspirate; Interpretation And Report (Path)",,88173,CPT,Facility,Both,,,,184,156.4,52.7344,184,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),110.4,60,,percent of total billed charges,,
"Cytopathology, Evaluation Of Fine Needle Aspirate; Interpretation And Report (Path)",,88173,CPT,Facility,Both,,,,184,156.4,52.7344,184,"Health Partners, Inc.",State of Minnesota Advantage Program,149.96,81.5,,percent of total billed charges,,
"Cytopathology, Evaluation Of Fine Needle Aspirate; Interpretation And Report (Path)",,88173,CPT,Facility,Both,,,,184,156.4,52.7344,184,"Health Partners, Inc.",State Public Programs,92,50,,percent of total billed charges,,
"Cytopathology, Evaluation Of Fine Needle Aspirate; Interpretation And Report (Path)",,88173,CPT,Facility,Both,,,,184,156.4,52.7344,184,Humana Insurance Company,Commercial PPO,174.8,95,,percent of total billed charges,,
"Cytopathology, Evaluation Of Fine Needle Aspirate; Interpretation And Report (Path)",,88173,CPT,Facility,Outpatient,,,,184,156.4,52.7344,184,Humana Insurance Company,Medicare PPO,90.16,49,,percent of total billed charges,,
"Cytopathology, Evaluation Of Fine Needle Aspirate; Interpretation And Report (Path)",,88173,CPT,Facility,Inpatient,,,,184,156.4,52.7344,184,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Cytopathology, Evaluation Of Fine Needle Aspirate; Interpretation And Report (Path)",,88173,CPT,Facility,Both,,,,184,156.4,52.7344,184,Medica,Individual & Family,182.344,99.1,,percent of total billed charges,,
"Cytopathology, Evaluation Of Fine Needle Aspirate; Interpretation And Report (Path)",,88173,CPT,Facility,Outpatient,,,,184,156.4,52.7344,184,Medica,Medica Advantage Solution,91.632,49.8,,percent of total billed charges,,
"Cytopathology, Evaluation Of Fine Needle Aspirate; Interpretation And Report (Path)",,88173,CPT,Facility,Inpatient,,,,184,156.4,52.7344,184,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Cytopathology, Evaluation Of Fine Needle Aspirate; Interpretation And Report (Path)",,88173,CPT,Facility,Outpatient,,,,184,156.4,52.7344,184,Medica,Medical Assistance,82.064,44.6,,percent of total billed charges,,
"Cytopathology, Evaluation Of Fine Needle Aspirate; Interpretation And Report (Path)",,88173,CPT,Facility,Inpatient,,,,184,156.4,52.7344,184,Medica,Medical Assistance,,,,,Included in per diem rate,
"Cytopathology, Evaluation Of Fine Needle Aspirate; Interpretation And Report (Path)",,88173,CPT,Facility,Outpatient,,,,184,156.4,52.7344,184,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,91.632,49.8,,percent of total billed charges,,
"Cytopathology, Evaluation Of Fine Needle Aspirate; Interpretation And Report (Path)",,88173,CPT,Facility,Inpatient,,,,184,156.4,52.7344,184,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Cytopathology, Evaluation Of Fine Needle Aspirate; Interpretation And Report (Path)",,88173,CPT,Facility,Both,,,,184,156.4,52.7344,184,"Multiplan, Inc.","Multiplan, Inc.",172.96,94,,percent of total billed charges,,
"Cytopathology, Evaluation Of Fine Needle Aspirate; Interpretation And Report (Path)",,88173,CPT,Facility,Outpatient,,,,184,156.4,52.7344,184,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,165.784,90.1,,percent of total billed charges,,
"Cytopathology, Evaluation Of Fine Needle Aspirate; Interpretation And Report (Path)",,88173,CPT,Facility,Inpatient,,,,184,156.4,52.7344,184,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Cytopathology, Evaluation Of Fine Needle Aspirate; Interpretation And Report (Path)",,88173,CPT,Facility,Both,,,,184,156.4,52.7344,184,"Preferred One Administrative Services, INC.",PPO,181.424,98.6,,percent of total billed charges,,
"Cytopathology, Evaluation Of Fine Needle Aspirate; Interpretation And Report (Path)",,88173,CPT,Facility,Outpatient,,,,184,156.4,52.7344,184,PrimeWest Health,Minnesota Senior Health Options (MSHO),94.668,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Cytopathology, Evaluation Of Fine Needle Aspirate; Interpretation And Report (Path)",,88173,CPT,Facility,Inpatient,,,,184,156.4,52.7344,184,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Cytopathology, Evaluation Of Fine Needle Aspirate; Interpretation And Report (Path)",,88173,CPT,Facility,Outpatient,,,,184,156.4,52.7344,184,PrimeWest Health,MinnesotaCare,94.5024,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Cytopathology, Evaluation Of Fine Needle Aspirate; Interpretation And Report (Path)",,88173,CPT,Facility,Inpatient,,,,184,156.4,52.7344,184,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Cytopathology, Evaluation Of Fine Needle Aspirate; Interpretation And Report (Path)",,88173,CPT,Facility,Both,,,,184,156.4,52.7344,184,Sanford Health Plan,Sanford Health Plan,169.28,92,,percent of total billed charges,,
"Cytopathology, Evaluation Of Fine Needle Aspirate; Interpretation And Report (Path)",,88173,CPT,Facility,Outpatient,,,,184,156.4,52.7344,184,"UCare Health, Inc.",Individual & Family Plan,103.684,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Cytopathology, Evaluation Of Fine Needle Aspirate; Interpretation And Report (Path)",,88173,CPT,Facility,Inpatient,,,,184,156.4,52.7344,184,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Cytopathology, Evaluation Of Fine Needle Aspirate; Interpretation And Report (Path)",,88173,CPT,Facility,Outpatient,,,,184,156.4,52.7344,184,"UCare Health, Inc.",Medical Assistance,92.8648,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Cytopathology, Evaluation Of Fine Needle Aspirate; Interpretation And Report (Path)",,88173,CPT,Facility,Inpatient,,,,184,156.4,52.7344,184,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Cytopathology, Evaluation Of Fine Needle Aspirate; Interpretation And Report (Path)",,88173,CPT,Facility,Outpatient,,,,184,156.4,52.7344,184,"UCare Health, Inc.",Medicare Advantage,92.8648,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Cytopathology, Evaluation Of Fine Needle Aspirate; Interpretation And Report (Path)",,88173,CPT,Facility,Inpatient,,,,184,156.4,52.7344,184,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Cytopathology, Evaluation Of Fine Needle Aspirate; Interpretation And Report (Path)",,88173,CPT,Facility,Outpatient,,,,184,156.4,52.7344,184,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),92.8648,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Cytopathology, Evaluation Of Fine Needle Aspirate; Interpretation And Report (Path)",,88173,CPT,Facility,Inpatient,,,,184,156.4,52.7344,184,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Cytopathology, Evaluation Of Fine Needle Aspirate; Interpretation And Report (Path)",,88173,CPT,Facility,Both,,,,184,156.4,52.7344,184,UnitedHealthcare,Individual & Family,172.96,94,,percent of total billed charges,,
"Cytopathology, Evaluation Of Fine Needle Aspirate; Interpretation And Report (Path)",,88173,CPT,Facility,Outpatient,,,,184,156.4,52.7344,184,UnitedHealthcare,Medicare Advantage,90.16,49,,percent of total billed charges,,
"Cytopathology, Evaluation Of Fine Needle Aspirate; Interpretation And Report (Path)",,88173,CPT,Facility,Inpatient,,,,184,156.4,52.7344,184,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Cytopathology, Evaluation Of Fine Needle Aspirate; Interpretation And Report (Path)",,88173,CPT,Facility,Outpatient,,,,184,156.4,52.7344,184,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,88.32,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Cytopathology, Evaluation Of Fine Needle Aspirate; Interpretation And Report (Path)",,88173,CPT,Facility,Inpatient,,,,184,156.4,52.7344,184,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Cytopathology, Cervical Or Vaginal,  Preserve Fld, Thin Prep; Auto System Phys Supervision (Path)",,88175,CPT,Facility,Both,,,,81,68.85,23.2146,81,Aetna,Commercial,74.52,92,,percent of total billed charges,,
"Cytopathology, Cervical Or Vaginal,  Preserve Fld, Thin Prep; Auto System Phys Supervision (Path)",,88175,CPT,Facility,Outpatient,,,,81,68.85,23.2146,81,Aetna,Medicare Advantage,39.69,49,,percent of total billed charges,,
"Cytopathology, Cervical Or Vaginal,  Preserve Fld, Thin Prep; Auto System Phys Supervision (Path)",,88175,CPT,Facility,Inpatient,,,,81,68.85,23.2146,81,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Cytopathology, Cervical Or Vaginal,  Preserve Fld, Thin Prep; Auto System Phys Supervision (Path)",,88175,CPT,Facility,Both,,,,81,68.85,23.2146,81,Aetna,PPO,75.33,93,,percent of total billed charges,,
"Cytopathology, Cervical Or Vaginal,  Preserve Fld, Thin Prep; Auto System Phys Supervision (Path)",,88175,CPT,Facility,Both,,,,81,68.85,23.2146,81,America's PPO,America's PPO,77.7843,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Cytopathology, Cervical Or Vaginal,  Preserve Fld, Thin Prep; Auto System Phys Supervision (Path)",,88175,CPT,Facility,Both,,,,81,68.85,23.2146,81,BlueCross BlueShield Minnesota, Federal Employee Program,79.704,98.4,,percent of total billed charges,,
"Cytopathology, Cervical Or Vaginal,  Preserve Fld, Thin Prep; Auto System Phys Supervision (Path)",,88175,CPT,Facility,Both,,,,81,68.85,23.2146,81,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,81,100,,percent of total billed charges,,
"Cytopathology, Cervical Or Vaginal,  Preserve Fld, Thin Prep; Auto System Phys Supervision (Path)",,88175,CPT,Facility,Both,,,,81,68.85,23.2146,81,BlueCross BlueShield Minnesota,High Value Network Plan,72.9,90,,percent of total billed charges,,
"Cytopathology, Cervical Or Vaginal,  Preserve Fld, Thin Prep; Auto System Phys Supervision (Path)",,88175,CPT,Facility,Outpatient,,,,81,68.85,23.2146,81,BlueCross BlueShield Minnesota,Medicare Advantage,39.69,49,,percent of total billed charges,,
"Cytopathology, Cervical Or Vaginal,  Preserve Fld, Thin Prep; Auto System Phys Supervision (Path)",,88175,CPT,Facility,Inpatient,,,,81,68.85,23.2146,81,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Cytopathology, Cervical Or Vaginal,  Preserve Fld, Thin Prep; Auto System Phys Supervision (Path)",,88175,CPT,Facility,Both,,,,81,68.85,23.2146,81,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,71.7417,88.57,,percent of total billed charges,,
"Cytopathology, Cervical Or Vaginal,  Preserve Fld, Thin Prep; Auto System Phys Supervision (Path)",,88175,CPT,Facility,Both,,,,81,68.85,23.2146,81,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,23.2146,28.66,,percent of total billed charges,,
"Cytopathology, Cervical Or Vaginal,  Preserve Fld, Thin Prep; Auto System Phys Supervision (Path)",,88175,CPT,Facility,Outpatient,,,,81,68.85,23.2146,81,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),39.69,49,,percent of total billed charges,,
"Cytopathology, Cervical Or Vaginal,  Preserve Fld, Thin Prep; Auto System Phys Supervision (Path)",,88175,CPT,Facility,Inpatient,,,,81,68.85,23.2146,81,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Cytopathology, Cervical Or Vaginal,  Preserve Fld, Thin Prep; Auto System Phys Supervision (Path)",,88175,CPT,Facility,Both,,,,81,68.85,23.2146,81,CorVel,Worker's Compensation,81,100,,percent of total billed charges,,
"Cytopathology, Cervical Or Vaginal,  Preserve Fld, Thin Prep; Auto System Phys Supervision (Path)",,88175,CPT,Facility,Both,,,,81,68.85,23.2146,81,First Health Group Corporation,First Health Network,78.57,97,,percent of total billed charges,,
"Cytopathology, Cervical Or Vaginal,  Preserve Fld, Thin Prep; Auto System Phys Supervision (Path)",,88175,CPT,Facility,Both,,,,81,68.85,23.2146,81,"Health Partners, Inc.",Commercial,76.626,94.6,,percent of total billed charges,,
"Cytopathology, Cervical Or Vaginal,  Preserve Fld, Thin Prep; Auto System Phys Supervision (Path)",,88175,CPT,Facility,Outpatient,,,,81,68.85,23.2146,81,"Health Partners, Inc.",Medicare Advantage,39.69,49,,percent of total billed charges,,
"Cytopathology, Cervical Or Vaginal,  Preserve Fld, Thin Prep; Auto System Phys Supervision (Path)",,88175,CPT,Facility,Inpatient,,,,81,68.85,23.2146,81,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Cytopathology, Cervical Or Vaginal,  Preserve Fld, Thin Prep; Auto System Phys Supervision (Path)",,88175,CPT,Facility,Both,,,,81,68.85,23.2146,81,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),48.6,60,,percent of total billed charges,,
"Cytopathology, Cervical Or Vaginal,  Preserve Fld, Thin Prep; Auto System Phys Supervision (Path)",,88175,CPT,Facility,Both,,,,81,68.85,23.2146,81,"Health Partners, Inc.",State of Minnesota Advantage Program,66.015,81.5,,percent of total billed charges,,
"Cytopathology, Cervical Or Vaginal,  Preserve Fld, Thin Prep; Auto System Phys Supervision (Path)",,88175,CPT,Facility,Both,,,,81,68.85,23.2146,81,"Health Partners, Inc.",State Public Programs,40.5,50,,percent of total billed charges,,
"Cytopathology, Cervical Or Vaginal,  Preserve Fld, Thin Prep; Auto System Phys Supervision (Path)",,88175,CPT,Facility,Both,,,,81,68.85,23.2146,81,Humana Insurance Company,Commercial PPO,76.95,95,,percent of total billed charges,,
"Cytopathology, Cervical Or Vaginal,  Preserve Fld, Thin Prep; Auto System Phys Supervision (Path)",,88175,CPT,Facility,Outpatient,,,,81,68.85,23.2146,81,Humana Insurance Company,Medicare PPO,39.69,49,,percent of total billed charges,,
"Cytopathology, Cervical Or Vaginal,  Preserve Fld, Thin Prep; Auto System Phys Supervision (Path)",,88175,CPT,Facility,Inpatient,,,,81,68.85,23.2146,81,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Cytopathology, Cervical Or Vaginal,  Preserve Fld, Thin Prep; Auto System Phys Supervision (Path)",,88175,CPT,Facility,Both,,,,81,68.85,23.2146,81,Medica,Individual & Family,80.271,99.1,,percent of total billed charges,,
"Cytopathology, Cervical Or Vaginal,  Preserve Fld, Thin Prep; Auto System Phys Supervision (Path)",,88175,CPT,Facility,Outpatient,,,,81,68.85,23.2146,81,Medica,Medica Advantage Solution,40.338,49.8,,percent of total billed charges,,
"Cytopathology, Cervical Or Vaginal,  Preserve Fld, Thin Prep; Auto System Phys Supervision (Path)",,88175,CPT,Facility,Inpatient,,,,81,68.85,23.2146,81,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Cytopathology, Cervical Or Vaginal,  Preserve Fld, Thin Prep; Auto System Phys Supervision (Path)",,88175,CPT,Facility,Outpatient,,,,81,68.85,23.2146,81,Medica,Medical Assistance,36.126,44.6,,percent of total billed charges,,
"Cytopathology, Cervical Or Vaginal,  Preserve Fld, Thin Prep; Auto System Phys Supervision (Path)",,88175,CPT,Facility,Inpatient,,,,81,68.85,23.2146,81,Medica,Medical Assistance,,,,,Included in per diem rate,
"Cytopathology, Cervical Or Vaginal,  Preserve Fld, Thin Prep; Auto System Phys Supervision (Path)",,88175,CPT,Facility,Outpatient,,,,81,68.85,23.2146,81,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,40.338,49.8,,percent of total billed charges,,
"Cytopathology, Cervical Or Vaginal,  Preserve Fld, Thin Prep; Auto System Phys Supervision (Path)",,88175,CPT,Facility,Inpatient,,,,81,68.85,23.2146,81,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Cytopathology, Cervical Or Vaginal,  Preserve Fld, Thin Prep; Auto System Phys Supervision (Path)",,88175,CPT,Facility,Both,,,,81,68.85,23.2146,81,"Multiplan, Inc.","Multiplan, Inc.",76.14,94,,percent of total billed charges,,
"Cytopathology, Cervical Or Vaginal,  Preserve Fld, Thin Prep; Auto System Phys Supervision (Path)",,88175,CPT,Facility,Outpatient,,,,81,68.85,23.2146,81,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,72.981,90.1,,percent of total billed charges,,
"Cytopathology, Cervical Or Vaginal,  Preserve Fld, Thin Prep; Auto System Phys Supervision (Path)",,88175,CPT,Facility,Inpatient,,,,81,68.85,23.2146,81,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Cytopathology, Cervical Or Vaginal,  Preserve Fld, Thin Prep; Auto System Phys Supervision (Path)",,88175,CPT,Facility,Both,,,,81,68.85,23.2146,81,"Preferred One Administrative Services, INC.",PPO,79.866,98.6,,percent of total billed charges,,
"Cytopathology, Cervical Or Vaginal,  Preserve Fld, Thin Prep; Auto System Phys Supervision (Path)",,88175,CPT,Facility,Outpatient,,,,81,68.85,23.2146,81,PrimeWest Health,Minnesota Senior Health Options (MSHO),41.6745,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Cytopathology, Cervical Or Vaginal,  Preserve Fld, Thin Prep; Auto System Phys Supervision (Path)",,88175,CPT,Facility,Inpatient,,,,81,68.85,23.2146,81,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Cytopathology, Cervical Or Vaginal,  Preserve Fld, Thin Prep; Auto System Phys Supervision (Path)",,88175,CPT,Facility,Outpatient,,,,81,68.85,23.2146,81,PrimeWest Health,MinnesotaCare,41.6016,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Cytopathology, Cervical Or Vaginal,  Preserve Fld, Thin Prep; Auto System Phys Supervision (Path)",,88175,CPT,Facility,Inpatient,,,,81,68.85,23.2146,81,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Cytopathology, Cervical Or Vaginal,  Preserve Fld, Thin Prep; Auto System Phys Supervision (Path)",,88175,CPT,Facility,Both,,,,81,68.85,23.2146,81,Sanford Health Plan,Sanford Health Plan,74.52,92,,percent of total billed charges,,
"Cytopathology, Cervical Or Vaginal,  Preserve Fld, Thin Prep; Auto System Phys Supervision (Path)",,88175,CPT,Facility,Outpatient,,,,81,68.85,23.2146,81,"UCare Health, Inc.",Individual & Family Plan,45.6435,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Cytopathology, Cervical Or Vaginal,  Preserve Fld, Thin Prep; Auto System Phys Supervision (Path)",,88175,CPT,Facility,Inpatient,,,,81,68.85,23.2146,81,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Cytopathology, Cervical Or Vaginal,  Preserve Fld, Thin Prep; Auto System Phys Supervision (Path)",,88175,CPT,Facility,Outpatient,,,,81,68.85,23.2146,81,"UCare Health, Inc.",Medical Assistance,40.8807,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Cytopathology, Cervical Or Vaginal,  Preserve Fld, Thin Prep; Auto System Phys Supervision (Path)",,88175,CPT,Facility,Inpatient,,,,81,68.85,23.2146,81,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Cytopathology, Cervical Or Vaginal,  Preserve Fld, Thin Prep; Auto System Phys Supervision (Path)",,88175,CPT,Facility,Outpatient,,,,81,68.85,23.2146,81,"UCare Health, Inc.",Medicare Advantage,40.8807,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Cytopathology, Cervical Or Vaginal,  Preserve Fld, Thin Prep; Auto System Phys Supervision (Path)",,88175,CPT,Facility,Inpatient,,,,81,68.85,23.2146,81,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Cytopathology, Cervical Or Vaginal,  Preserve Fld, Thin Prep; Auto System Phys Supervision (Path)",,88175,CPT,Facility,Outpatient,,,,81,68.85,23.2146,81,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),40.8807,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Cytopathology, Cervical Or Vaginal,  Preserve Fld, Thin Prep; Auto System Phys Supervision (Path)",,88175,CPT,Facility,Inpatient,,,,81,68.85,23.2146,81,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Cytopathology, Cervical Or Vaginal,  Preserve Fld, Thin Prep; Auto System Phys Supervision (Path)",,88175,CPT,Facility,Both,,,,81,68.85,23.2146,81,UnitedHealthcare,Individual & Family,76.14,94,,percent of total billed charges,,
"Cytopathology, Cervical Or Vaginal,  Preserve Fld, Thin Prep; Auto System Phys Supervision (Path)",,88175,CPT,Facility,Outpatient,,,,81,68.85,23.2146,81,UnitedHealthcare,Medicare Advantage,39.69,49,,percent of total billed charges,,
"Cytopathology, Cervical Or Vaginal,  Preserve Fld, Thin Prep; Auto System Phys Supervision (Path)",,88175,CPT,Facility,Inpatient,,,,81,68.85,23.2146,81,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Cytopathology, Cervical Or Vaginal,  Preserve Fld, Thin Prep; Auto System Phys Supervision (Path)",,88175,CPT,Facility,Outpatient,,,,81,68.85,23.2146,81,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,38.88,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Cytopathology, Cervical Or Vaginal,  Preserve Fld, Thin Prep; Auto System Phys Supervision (Path)",,88175,CPT,Facility,Inpatient,,,,81,68.85,23.2146,81,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
INSULIN ASP PRT-INSULIN ASPART 100 UNIT/ML (70-30) SUBQ SOLN,,J1815,HCPCS,Facility,Both,10,mL,,1297,1102.45,371.7202,1297,Aetna,Commercial,1193.24,92,,percent of total billed charges,,
INSULIN ASP PRT-INSULIN ASPART 100 UNIT/ML (70-30) SUBQ SOLN,,J1815,HCPCS,Facility,Outpatient,10,mL,,1297,1102.45,371.7202,1297,Aetna,Medicare Advantage,635.53,49,,percent of total billed charges,,
INSULIN ASP PRT-INSULIN ASPART 100 UNIT/ML (70-30) SUBQ SOLN,,J1815,HCPCS,Facility,Inpatient,10,mL,,1297,1102.45,371.7202,1297,Aetna,Medicare Advantage,,,,,Included in per diem rate,
INSULIN ASP PRT-INSULIN ASPART 100 UNIT/ML (70-30) SUBQ SOLN,,J1815,HCPCS,Facility,Both,10,mL,,1297,1102.45,371.7202,1297,Aetna,PPO,1206.21,93,,percent of total billed charges,,
INSULIN ASP PRT-INSULIN ASPART 100 UNIT/ML (70-30) SUBQ SOLN,,J1815,HCPCS,Facility,Both,10,mL,,1297,1102.45,371.7202,1297,America's PPO,America's PPO,1245.5091,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
INSULIN ASP PRT-INSULIN ASPART 100 UNIT/ML (70-30) SUBQ SOLN,,J1815,HCPCS,Facility,Both,10,mL,,1297,1102.45,371.7202,1297,BlueCross BlueShield Minnesota, Federal Employee Program,1276.248,98.4,,percent of total billed charges,,
INSULIN ASP PRT-INSULIN ASPART 100 UNIT/ML (70-30) SUBQ SOLN,,J1815,HCPCS,Facility,Both,10,mL,,1297,1102.45,371.7202,1297,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1297,100,,percent of total billed charges,,
INSULIN ASP PRT-INSULIN ASPART 100 UNIT/ML (70-30) SUBQ SOLN,,J1815,HCPCS,Facility,Both,10,mL,,1297,1102.45,371.7202,1297,BlueCross BlueShield Minnesota,High Value Network Plan,1167.3,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
INSULIN ASP PRT-INSULIN ASPART 100 UNIT/ML (70-30) SUBQ SOLN,,J1815,HCPCS,Facility,Outpatient,10,mL,,1297,1102.45,371.7202,1297,BlueCross BlueShield Minnesota,Medicare Advantage,635.53,49,,percent of total billed charges,,
INSULIN ASP PRT-INSULIN ASPART 100 UNIT/ML (70-30) SUBQ SOLN,,J1815,HCPCS,Facility,Inpatient,10,mL,,1297,1102.45,371.7202,1297,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
INSULIN ASP PRT-INSULIN ASPART 100 UNIT/ML (70-30) SUBQ SOLN,,J1815,HCPCS,Facility,Both,10,mL,,1297,1102.45,371.7202,1297,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1148.7529,88.57,,percent of total billed charges,,
INSULIN ASP PRT-INSULIN ASPART 100 UNIT/ML (70-30) SUBQ SOLN,,J1815,HCPCS,Facility,Both,10,mL,,1297,1102.45,371.7202,1297,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,371.7202,28.66,,percent of total billed charges,,
INSULIN ASP PRT-INSULIN ASPART 100 UNIT/ML (70-30) SUBQ SOLN,,J1815,HCPCS,Facility,Outpatient,10,mL,,1297,1102.45,371.7202,1297,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),635.53,49,,percent of total billed charges,,
INSULIN ASP PRT-INSULIN ASPART 100 UNIT/ML (70-30) SUBQ SOLN,,J1815,HCPCS,Facility,Inpatient,10,mL,,1297,1102.45,371.7202,1297,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
INSULIN ASP PRT-INSULIN ASPART 100 UNIT/ML (70-30) SUBQ SOLN,,J1815,HCPCS,Facility,Both,10,mL,,1297,1102.45,371.7202,1297,CorVel,Worker's Compensation,1297,100,,percent of total billed charges,,
INSULIN ASP PRT-INSULIN ASPART 100 UNIT/ML (70-30) SUBQ SOLN,,J1815,HCPCS,Facility,Both,10,mL,,1297,1102.45,371.7202,1297,First Health Group Corporation,First Health Network,1258.09,97,,percent of total billed charges,,
INSULIN ASP PRT-INSULIN ASPART 100 UNIT/ML (70-30) SUBQ SOLN,,J1815,HCPCS,Facility,Both,10,mL,,1297,1102.45,371.7202,1297,"Health Partners, Inc.",Commercial,1226.962,94.6,,percent of total billed charges,,
INSULIN ASP PRT-INSULIN ASPART 100 UNIT/ML (70-30) SUBQ SOLN,,J1815,HCPCS,Facility,Outpatient,10,mL,,1297,1102.45,371.7202,1297,"Health Partners, Inc.",Medicare Advantage,635.53,49,,percent of total billed charges,,
INSULIN ASP PRT-INSULIN ASPART 100 UNIT/ML (70-30) SUBQ SOLN,,J1815,HCPCS,Facility,Inpatient,10,mL,,1297,1102.45,371.7202,1297,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
INSULIN ASP PRT-INSULIN ASPART 100 UNIT/ML (70-30) SUBQ SOLN,,J1815,HCPCS,Facility,Both,10,mL,,1297,1102.45,371.7202,1297,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),778.2,60,,percent of total billed charges,,
INSULIN ASP PRT-INSULIN ASPART 100 UNIT/ML (70-30) SUBQ SOLN,,J1815,HCPCS,Facility,Both,10,mL,,1297,1102.45,371.7202,1297,"Health Partners, Inc.",State of Minnesota Advantage Program,1057.055,81.5,,percent of total billed charges,,
INSULIN ASP PRT-INSULIN ASPART 100 UNIT/ML (70-30) SUBQ SOLN,,J1815,HCPCS,Facility,Both,10,mL,,1297,1102.45,371.7202,1297,"Health Partners, Inc.",State Public Programs,648.5,50,,percent of total billed charges,,
INSULIN ASP PRT-INSULIN ASPART 100 UNIT/ML (70-30) SUBQ SOLN,,J1815,HCPCS,Facility,Both,10,mL,,1297,1102.45,371.7202,1297,Humana Insurance Company,Commercial PPO,1232.15,95,,percent of total billed charges,,
INSULIN ASP PRT-INSULIN ASPART 100 UNIT/ML (70-30) SUBQ SOLN,,J1815,HCPCS,Facility,Outpatient,10,mL,,1297,1102.45,371.7202,1297,Humana Insurance Company,Medicare PPO,635.53,49,,percent of total billed charges,,
INSULIN ASP PRT-INSULIN ASPART 100 UNIT/ML (70-30) SUBQ SOLN,,J1815,HCPCS,Facility,Inpatient,10,mL,,1297,1102.45,371.7202,1297,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
INSULIN ASP PRT-INSULIN ASPART 100 UNIT/ML (70-30) SUBQ SOLN,,J1815,HCPCS,Facility,Both,10,mL,,1297,1102.45,371.7202,1297,Medica,Individual & Family,1285.327,99.1,,percent of total billed charges,,
INSULIN ASP PRT-INSULIN ASPART 100 UNIT/ML (70-30) SUBQ SOLN,,J1815,HCPCS,Facility,Outpatient,10,mL,,1297,1102.45,371.7202,1297,Medica,Medica Advantage Solution,645.906,49.8,,percent of total billed charges,,
INSULIN ASP PRT-INSULIN ASPART 100 UNIT/ML (70-30) SUBQ SOLN,,J1815,HCPCS,Facility,Inpatient,10,mL,,1297,1102.45,371.7202,1297,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
INSULIN ASP PRT-INSULIN ASPART 100 UNIT/ML (70-30) SUBQ SOLN,,J1815,HCPCS,Facility,Outpatient,10,mL,,1297,1102.45,371.7202,1297,Medica,Medical Assistance,578.462,44.6,,percent of total billed charges,,
INSULIN ASP PRT-INSULIN ASPART 100 UNIT/ML (70-30) SUBQ SOLN,,J1815,HCPCS,Facility,Inpatient,10,mL,,1297,1102.45,371.7202,1297,Medica,Medical Assistance,,,,,Included in per diem rate,
INSULIN ASP PRT-INSULIN ASPART 100 UNIT/ML (70-30) SUBQ SOLN,,J1815,HCPCS,Facility,Outpatient,10,mL,,1297,1102.45,371.7202,1297,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,645.906,49.8,,percent of total billed charges,,
INSULIN ASP PRT-INSULIN ASPART 100 UNIT/ML (70-30) SUBQ SOLN,,J1815,HCPCS,Facility,Inpatient,10,mL,,1297,1102.45,371.7202,1297,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
INSULIN ASP PRT-INSULIN ASPART 100 UNIT/ML (70-30) SUBQ SOLN,,J1815,HCPCS,Facility,Both,10,mL,,1297,1102.45,371.7202,1297,"Multiplan, Inc.","Multiplan, Inc.",1219.18,94,,percent of total billed charges,,
INSULIN ASP PRT-INSULIN ASPART 100 UNIT/ML (70-30) SUBQ SOLN,,J1815,HCPCS,Facility,Outpatient,10,mL,,1297,1102.45,371.7202,1297,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1168.597,90.1,,percent of total billed charges,,
INSULIN ASP PRT-INSULIN ASPART 100 UNIT/ML (70-30) SUBQ SOLN,,J1815,HCPCS,Facility,Inpatient,10,mL,,1297,1102.45,371.7202,1297,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
INSULIN ASP PRT-INSULIN ASPART 100 UNIT/ML (70-30) SUBQ SOLN,,J1815,HCPCS,Facility,Both,10,mL,,1297,1102.45,371.7202,1297,"Preferred One Administrative Services, INC.",PPO,1278.842,98.6,,percent of total billed charges,,
INSULIN ASP PRT-INSULIN ASPART 100 UNIT/ML (70-30) SUBQ SOLN,,J1815,HCPCS,Facility,Outpatient,10,mL,,1297,1102.45,371.7202,1297,PrimeWest Health,Minnesota Senior Health Options (MSHO),667.3065,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
INSULIN ASP PRT-INSULIN ASPART 100 UNIT/ML (70-30) SUBQ SOLN,,J1815,HCPCS,Facility,Inpatient,10,mL,,1297,1102.45,371.7202,1297,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
INSULIN ASP PRT-INSULIN ASPART 100 UNIT/ML (70-30) SUBQ SOLN,,J1815,HCPCS,Facility,Outpatient,10,mL,,1297,1102.45,371.7202,1297,PrimeWest Health,MinnesotaCare,666.1392,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
INSULIN ASP PRT-INSULIN ASPART 100 UNIT/ML (70-30) SUBQ SOLN,,J1815,HCPCS,Facility,Inpatient,10,mL,,1297,1102.45,371.7202,1297,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
INSULIN ASP PRT-INSULIN ASPART 100 UNIT/ML (70-30) SUBQ SOLN,,J1815,HCPCS,Facility,Both,10,mL,,1297,1102.45,371.7202,1297,Sanford Health Plan,Sanford Health Plan,1193.24,92,,percent of total billed charges,,
INSULIN ASP PRT-INSULIN ASPART 100 UNIT/ML (70-30) SUBQ SOLN,,J1815,HCPCS,Facility,Outpatient,10,mL,,1297,1102.45,371.7202,1297,"UCare Health, Inc.",Individual & Family Plan,730.8595,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
INSULIN ASP PRT-INSULIN ASPART 100 UNIT/ML (70-30) SUBQ SOLN,,J1815,HCPCS,Facility,Inpatient,10,mL,,1297,1102.45,371.7202,1297,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
INSULIN ASP PRT-INSULIN ASPART 100 UNIT/ML (70-30) SUBQ SOLN,,J1815,HCPCS,Facility,Outpatient,10,mL,,1297,1102.45,371.7202,1297,"UCare Health, Inc.",Medical Assistance,654.5959,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
INSULIN ASP PRT-INSULIN ASPART 100 UNIT/ML (70-30) SUBQ SOLN,,J1815,HCPCS,Facility,Inpatient,10,mL,,1297,1102.45,371.7202,1297,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
INSULIN ASP PRT-INSULIN ASPART 100 UNIT/ML (70-30) SUBQ SOLN,,J1815,HCPCS,Facility,Outpatient,10,mL,,1297,1102.45,371.7202,1297,"UCare Health, Inc.",Medicare Advantage,654.5959,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
INSULIN ASP PRT-INSULIN ASPART 100 UNIT/ML (70-30) SUBQ SOLN,,J1815,HCPCS,Facility,Inpatient,10,mL,,1297,1102.45,371.7202,1297,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
INSULIN ASP PRT-INSULIN ASPART 100 UNIT/ML (70-30) SUBQ SOLN,,J1815,HCPCS,Facility,Outpatient,10,mL,,1297,1102.45,371.7202,1297,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),654.5959,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
INSULIN ASP PRT-INSULIN ASPART 100 UNIT/ML (70-30) SUBQ SOLN,,J1815,HCPCS,Facility,Inpatient,10,mL,,1297,1102.45,371.7202,1297,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
INSULIN ASP PRT-INSULIN ASPART 100 UNIT/ML (70-30) SUBQ SOLN,,J1815,HCPCS,Facility,Both,10,mL,,1297,1102.45,371.7202,1297,UnitedHealthcare,Individual & Family,1219.18,94,,percent of total billed charges,,
INSULIN ASP PRT-INSULIN ASPART 100 UNIT/ML (70-30) SUBQ SOLN,,J1815,HCPCS,Facility,Outpatient,10,mL,,1297,1102.45,371.7202,1297,UnitedHealthcare,Medicare Advantage,635.53,49,,percent of total billed charges,,
INSULIN ASP PRT-INSULIN ASPART 100 UNIT/ML (70-30) SUBQ SOLN,,J1815,HCPCS,Facility,Inpatient,10,mL,,1297,1102.45,371.7202,1297,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
INSULIN ASP PRT-INSULIN ASPART 100 UNIT/ML (70-30) SUBQ SOLN,,J1815,HCPCS,Facility,Outpatient,10,mL,,1297,1102.45,371.7202,1297,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,622.56,48,,percent of total billed charges,,100% of DHS outpatient percentage
INSULIN ASP PRT-INSULIN ASPART 100 UNIT/ML (70-30) SUBQ SOLN,,J1815,HCPCS,Facility,Inpatient,10,mL,,1297,1102.45,371.7202,1297,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Level I - Surgical Pathology, Gross Examination Only (Path)",,88300,CPT,Facility,Both,,,,49,41.65,14.0434,49,Aetna,Commercial,45.08,92,,percent of total billed charges,,
"Level I - Surgical Pathology, Gross Examination Only (Path)",,88300,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,Aetna,Medicare Advantage,24.01,49,,percent of total billed charges,,
"Level I - Surgical Pathology, Gross Examination Only (Path)",,88300,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Level I - Surgical Pathology, Gross Examination Only (Path)",,88300,CPT,Facility,Both,,,,49,41.65,14.0434,49,Aetna,PPO,45.57,93,,percent of total billed charges,,
"Level I - Surgical Pathology, Gross Examination Only (Path)",,88300,CPT,Facility,Both,,,,49,41.65,14.0434,49,America's PPO,America's PPO,47.0547,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Level I - Surgical Pathology, Gross Examination Only (Path)",,88300,CPT,Facility,Both,,,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota, Federal Employee Program,48.216,98.4,,percent of total billed charges,,
"Level I - Surgical Pathology, Gross Examination Only (Path)",,88300,CPT,Facility,Both,,,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,49,100,,percent of total billed charges,,
"Level I - Surgical Pathology, Gross Examination Only (Path)",,88300,CPT,Facility,Both,,,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,High Value Network Plan,44.1,90,,percent of total billed charges,,
"Level I - Surgical Pathology, Gross Examination Only (Path)",,88300,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Medicare Advantage,24.01,49,,percent of total billed charges,,
"Level I - Surgical Pathology, Gross Examination Only (Path)",,88300,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Level I - Surgical Pathology, Gross Examination Only (Path)",,88300,CPT,Facility,Both,,,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,43.3993,88.57,,percent of total billed charges,,
"Level I - Surgical Pathology, Gross Examination Only (Path)",,88300,CPT,Facility,Both,,,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,14.0434,28.66,,percent of total billed charges,,
"Level I - Surgical Pathology, Gross Examination Only (Path)",,88300,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),24.01,49,,percent of total billed charges,,
"Level I - Surgical Pathology, Gross Examination Only (Path)",,88300,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Level I - Surgical Pathology, Gross Examination Only (Path)",,88300,CPT,Facility,Both,,,,49,41.65,14.0434,49,CorVel,Worker's Compensation,49,100,,percent of total billed charges,,
"Level I - Surgical Pathology, Gross Examination Only (Path)",,88300,CPT,Facility,Both,,,,49,41.65,14.0434,49,First Health Group Corporation,First Health Network,47.53,97,,percent of total billed charges,,
"Level I - Surgical Pathology, Gross Examination Only (Path)",,88300,CPT,Facility,Both,,,,49,41.65,14.0434,49,"Health Partners, Inc.",Commercial,46.354,94.6,,percent of total billed charges,,
"Level I - Surgical Pathology, Gross Examination Only (Path)",,88300,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,"Health Partners, Inc.",Medicare Advantage,24.01,49,,percent of total billed charges,,
"Level I - Surgical Pathology, Gross Examination Only (Path)",,88300,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Level I - Surgical Pathology, Gross Examination Only (Path)",,88300,CPT,Facility,Both,,,,49,41.65,14.0434,49,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),29.4,60,,percent of total billed charges,,
"Level I - Surgical Pathology, Gross Examination Only (Path)",,88300,CPT,Facility,Both,,,,49,41.65,14.0434,49,"Health Partners, Inc.",State of Minnesota Advantage Program,39.935,81.5,,percent of total billed charges,,
"Level I - Surgical Pathology, Gross Examination Only (Path)",,88300,CPT,Facility,Both,,,,49,41.65,14.0434,49,"Health Partners, Inc.",State Public Programs,24.5,50,,percent of total billed charges,,
"Level I - Surgical Pathology, Gross Examination Only (Path)",,88300,CPT,Facility,Both,,,,49,41.65,14.0434,49,Humana Insurance Company,Commercial PPO,46.55,95,,percent of total billed charges,,
"Level I - Surgical Pathology, Gross Examination Only (Path)",,88300,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,Humana Insurance Company,Medicare PPO,24.01,49,,percent of total billed charges,,
"Level I - Surgical Pathology, Gross Examination Only (Path)",,88300,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Level I - Surgical Pathology, Gross Examination Only (Path)",,88300,CPT,Facility,Both,,,,49,41.65,14.0434,49,Medica,Individual & Family,48.559,99.1,,percent of total billed charges,,
"Level I - Surgical Pathology, Gross Examination Only (Path)",,88300,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,Medica,Medica Advantage Solution,24.402,49.8,,percent of total billed charges,,
"Level I - Surgical Pathology, Gross Examination Only (Path)",,88300,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Level I - Surgical Pathology, Gross Examination Only (Path)",,88300,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,Medica,Medical Assistance,21.854,44.6,,percent of total billed charges,,
"Level I - Surgical Pathology, Gross Examination Only (Path)",,88300,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,Medica,Medical Assistance,,,,,Included in per diem rate,
"Level I - Surgical Pathology, Gross Examination Only (Path)",,88300,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,24.402,49.8,,percent of total billed charges,,
"Level I - Surgical Pathology, Gross Examination Only (Path)",,88300,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Level I - Surgical Pathology, Gross Examination Only (Path)",,88300,CPT,Facility,Both,,,,49,41.65,14.0434,49,"Multiplan, Inc.","Multiplan, Inc.",46.06,94,,percent of total billed charges,,
"Level I - Surgical Pathology, Gross Examination Only (Path)",,88300,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,44.149,90.1,,percent of total billed charges,,
"Level I - Surgical Pathology, Gross Examination Only (Path)",,88300,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Level I - Surgical Pathology, Gross Examination Only (Path)",,88300,CPT,Facility,Both,,,,49,41.65,14.0434,49,"Preferred One Administrative Services, INC.",PPO,48.314,98.6,,percent of total billed charges,,
"Level I - Surgical Pathology, Gross Examination Only (Path)",,88300,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,PrimeWest Health,Minnesota Senior Health Options (MSHO),25.2105,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Level I - Surgical Pathology, Gross Examination Only (Path)",,88300,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Level I - Surgical Pathology, Gross Examination Only (Path)",,88300,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,PrimeWest Health,MinnesotaCare,25.1664,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Level I - Surgical Pathology, Gross Examination Only (Path)",,88300,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Level I - Surgical Pathology, Gross Examination Only (Path)",,88300,CPT,Facility,Both,,,,49,41.65,14.0434,49,Sanford Health Plan,Sanford Health Plan,45.08,92,,percent of total billed charges,,
"Level I - Surgical Pathology, Gross Examination Only (Path)",,88300,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,"UCare Health, Inc.",Individual & Family Plan,27.6115,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Level I - Surgical Pathology, Gross Examination Only (Path)",,88300,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Level I - Surgical Pathology, Gross Examination Only (Path)",,88300,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,"UCare Health, Inc.",Medical Assistance,24.7303,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Level I - Surgical Pathology, Gross Examination Only (Path)",,88300,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Level I - Surgical Pathology, Gross Examination Only (Path)",,88300,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,"UCare Health, Inc.",Medicare Advantage,24.7303,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Level I - Surgical Pathology, Gross Examination Only (Path)",,88300,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Level I - Surgical Pathology, Gross Examination Only (Path)",,88300,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),24.7303,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Level I - Surgical Pathology, Gross Examination Only (Path)",,88300,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Level I - Surgical Pathology, Gross Examination Only (Path)",,88300,CPT,Facility,Both,,,,49,41.65,14.0434,49,UnitedHealthcare,Individual & Family,46.06,94,,percent of total billed charges,,
"Level I - Surgical Pathology, Gross Examination Only (Path)",,88300,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,UnitedHealthcare,Medicare Advantage,24.01,49,,percent of total billed charges,,
"Level I - Surgical Pathology, Gross Examination Only (Path)",,88300,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Level I - Surgical Pathology, Gross Examination Only (Path)",,88300,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,23.52,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Level I - Surgical Pathology, Gross Examination Only (Path)",,88300,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Level Ii - Surgical Pathology, Gross And Microscopic Examination  (Path)",,88302,CPT,Facility,Both,,,,51,43.35,14.6166,51,Aetna,Commercial,46.92,92,,percent of total billed charges,,
"Level Ii - Surgical Pathology, Gross And Microscopic Examination  (Path)",,88302,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,Aetna,Medicare Advantage,24.99,49,,percent of total billed charges,,
"Level Ii - Surgical Pathology, Gross And Microscopic Examination  (Path)",,88302,CPT,Facility,Inpatient,,,,51,43.35,14.6166,51,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Level Ii - Surgical Pathology, Gross And Microscopic Examination  (Path)",,88302,CPT,Facility,Both,,,,51,43.35,14.6166,51,Aetna,PPO,47.43,93,,percent of total billed charges,,
"Level Ii - Surgical Pathology, Gross And Microscopic Examination  (Path)",,88302,CPT,Facility,Both,,,,51,43.35,14.6166,51,America's PPO,America's PPO,48.9753,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Level Ii - Surgical Pathology, Gross And Microscopic Examination  (Path)",,88302,CPT,Facility,Both,,,,51,43.35,14.6166,51,BlueCross BlueShield Minnesota, Federal Employee Program,50.184,98.4,,percent of total billed charges,,
"Level Ii - Surgical Pathology, Gross And Microscopic Examination  (Path)",,88302,CPT,Facility,Both,,,,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,51,100,,percent of total billed charges,,
"Level Ii - Surgical Pathology, Gross And Microscopic Examination  (Path)",,88302,CPT,Facility,Both,,,,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,High Value Network Plan,45.9,90,,percent of total billed charges,,
"Level Ii - Surgical Pathology, Gross And Microscopic Examination  (Path)",,88302,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,Medicare Advantage,24.99,49,,percent of total billed charges,,
"Level Ii - Surgical Pathology, Gross And Microscopic Examination  (Path)",,88302,CPT,Facility,Inpatient,,,,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Level Ii - Surgical Pathology, Gross And Microscopic Examination  (Path)",,88302,CPT,Facility,Both,,,,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,45.1707,88.57,,percent of total billed charges,,
"Level Ii - Surgical Pathology, Gross And Microscopic Examination  (Path)",,88302,CPT,Facility,Both,,,,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,14.6166,28.66,,percent of total billed charges,,
"Level Ii - Surgical Pathology, Gross And Microscopic Examination  (Path)",,88302,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),24.99,49,,percent of total billed charges,,
"Level Ii - Surgical Pathology, Gross And Microscopic Examination  (Path)",,88302,CPT,Facility,Inpatient,,,,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Level Ii - Surgical Pathology, Gross And Microscopic Examination  (Path)",,88302,CPT,Facility,Both,,,,51,43.35,14.6166,51,CorVel,Worker's Compensation,51,100,,percent of total billed charges,,
"Level Ii - Surgical Pathology, Gross And Microscopic Examination  (Path)",,88302,CPT,Facility,Both,,,,51,43.35,14.6166,51,First Health Group Corporation,First Health Network,49.47,97,,percent of total billed charges,,
"Level Ii - Surgical Pathology, Gross And Microscopic Examination  (Path)",,88302,CPT,Facility,Both,,,,51,43.35,14.6166,51,"Health Partners, Inc.",Commercial,48.246,94.6,,percent of total billed charges,,
"Level Ii - Surgical Pathology, Gross And Microscopic Examination  (Path)",,88302,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,"Health Partners, Inc.",Medicare Advantage,24.99,49,,percent of total billed charges,,
"Level Ii - Surgical Pathology, Gross And Microscopic Examination  (Path)",,88302,CPT,Facility,Inpatient,,,,51,43.35,14.6166,51,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Level Ii - Surgical Pathology, Gross And Microscopic Examination  (Path)",,88302,CPT,Facility,Both,,,,51,43.35,14.6166,51,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),30.6,60,,percent of total billed charges,,
"Level Ii - Surgical Pathology, Gross And Microscopic Examination  (Path)",,88302,CPT,Facility,Both,,,,51,43.35,14.6166,51,"Health Partners, Inc.",State of Minnesota Advantage Program,41.565,81.5,,percent of total billed charges,,
"Level Ii - Surgical Pathology, Gross And Microscopic Examination  (Path)",,88302,CPT,Facility,Both,,,,51,43.35,14.6166,51,"Health Partners, Inc.",State Public Programs,25.5,50,,percent of total billed charges,,
"Level Ii - Surgical Pathology, Gross And Microscopic Examination  (Path)",,88302,CPT,Facility,Both,,,,51,43.35,14.6166,51,Humana Insurance Company,Commercial PPO,48.45,95,,percent of total billed charges,,
"Level Ii - Surgical Pathology, Gross And Microscopic Examination  (Path)",,88302,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,Humana Insurance Company,Medicare PPO,24.99,49,,percent of total billed charges,,
"Level Ii - Surgical Pathology, Gross And Microscopic Examination  (Path)",,88302,CPT,Facility,Inpatient,,,,51,43.35,14.6166,51,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Level Ii - Surgical Pathology, Gross And Microscopic Examination  (Path)",,88302,CPT,Facility,Both,,,,51,43.35,14.6166,51,Medica,Individual & Family,50.541,99.1,,percent of total billed charges,,
"Level Ii - Surgical Pathology, Gross And Microscopic Examination  (Path)",,88302,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,Medica,Medica Advantage Solution,25.398,49.8,,percent of total billed charges,,
"Level Ii - Surgical Pathology, Gross And Microscopic Examination  (Path)",,88302,CPT,Facility,Inpatient,,,,51,43.35,14.6166,51,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Level Ii - Surgical Pathology, Gross And Microscopic Examination  (Path)",,88302,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,Medica,Medical Assistance,22.746,44.6,,percent of total billed charges,,
"Level Ii - Surgical Pathology, Gross And Microscopic Examination  (Path)",,88302,CPT,Facility,Inpatient,,,,51,43.35,14.6166,51,Medica,Medical Assistance,,,,,Included in per diem rate,
"Level Ii - Surgical Pathology, Gross And Microscopic Examination  (Path)",,88302,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,25.398,49.8,,percent of total billed charges,,
"Level Ii - Surgical Pathology, Gross And Microscopic Examination  (Path)",,88302,CPT,Facility,Inpatient,,,,51,43.35,14.6166,51,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Level Ii - Surgical Pathology, Gross And Microscopic Examination  (Path)",,88302,CPT,Facility,Both,,,,51,43.35,14.6166,51,"Multiplan, Inc.","Multiplan, Inc.",47.94,94,,percent of total billed charges,,
"Level Ii - Surgical Pathology, Gross And Microscopic Examination  (Path)",,88302,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,45.951,90.1,,percent of total billed charges,,
"Level Ii - Surgical Pathology, Gross And Microscopic Examination  (Path)",,88302,CPT,Facility,Inpatient,,,,51,43.35,14.6166,51,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Level Ii - Surgical Pathology, Gross And Microscopic Examination  (Path)",,88302,CPT,Facility,Both,,,,51,43.35,14.6166,51,"Preferred One Administrative Services, INC.",PPO,50.286,98.6,,percent of total billed charges,,
"Level Ii - Surgical Pathology, Gross And Microscopic Examination  (Path)",,88302,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,PrimeWest Health,Minnesota Senior Health Options (MSHO),26.2395,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Level Ii - Surgical Pathology, Gross And Microscopic Examination  (Path)",,88302,CPT,Facility,Inpatient,,,,51,43.35,14.6166,51,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Level Ii - Surgical Pathology, Gross And Microscopic Examination  (Path)",,88302,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,PrimeWest Health,MinnesotaCare,26.1936,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Level Ii - Surgical Pathology, Gross And Microscopic Examination  (Path)",,88302,CPT,Facility,Inpatient,,,,51,43.35,14.6166,51,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Level Ii - Surgical Pathology, Gross And Microscopic Examination  (Path)",,88302,CPT,Facility,Both,,,,51,43.35,14.6166,51,Sanford Health Plan,Sanford Health Plan,46.92,92,,percent of total billed charges,,
"Level Ii - Surgical Pathology, Gross And Microscopic Examination  (Path)",,88302,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,"UCare Health, Inc.",Individual & Family Plan,28.7385,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Level Ii - Surgical Pathology, Gross And Microscopic Examination  (Path)",,88302,CPT,Facility,Inpatient,,,,51,43.35,14.6166,51,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Level Ii - Surgical Pathology, Gross And Microscopic Examination  (Path)",,88302,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,"UCare Health, Inc.",Medical Assistance,25.7397,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Level Ii - Surgical Pathology, Gross And Microscopic Examination  (Path)",,88302,CPT,Facility,Inpatient,,,,51,43.35,14.6166,51,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Level Ii - Surgical Pathology, Gross And Microscopic Examination  (Path)",,88302,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,"UCare Health, Inc.",Medicare Advantage,25.7397,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Level Ii - Surgical Pathology, Gross And Microscopic Examination  (Path)",,88302,CPT,Facility,Inpatient,,,,51,43.35,14.6166,51,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Level Ii - Surgical Pathology, Gross And Microscopic Examination  (Path)",,88302,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),25.7397,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Level Ii - Surgical Pathology, Gross And Microscopic Examination  (Path)",,88302,CPT,Facility,Inpatient,,,,51,43.35,14.6166,51,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Level Ii - Surgical Pathology, Gross And Microscopic Examination  (Path)",,88302,CPT,Facility,Both,,,,51,43.35,14.6166,51,UnitedHealthcare,Individual & Family,47.94,94,,percent of total billed charges,,
"Level Ii - Surgical Pathology, Gross And Microscopic Examination  (Path)",,88302,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,UnitedHealthcare,Medicare Advantage,24.99,49,,percent of total billed charges,,
"Level Ii - Surgical Pathology, Gross And Microscopic Examination  (Path)",,88302,CPT,Facility,Inpatient,,,,51,43.35,14.6166,51,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Level Ii - Surgical Pathology, Gross And Microscopic Examination  (Path)",,88302,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,24.48,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Level Ii - Surgical Pathology, Gross And Microscopic Examination  (Path)",,88302,CPT,Facility,Inpatient,,,,51,43.35,14.6166,51,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Level Iii - Surgical Pathology, Gross And Microscopic Examination (Path)",,88304,CPT,Facility,Both,,,,156,132.6,44.7096,156,Aetna,Commercial,143.52,92,,percent of total billed charges,,
"Level Iii - Surgical Pathology, Gross And Microscopic Examination (Path)",,88304,CPT,Facility,Outpatient,,,,156,132.6,44.7096,156,Aetna,Medicare Advantage,76.44,49,,percent of total billed charges,,
"Level Iii - Surgical Pathology, Gross And Microscopic Examination (Path)",,88304,CPT,Facility,Inpatient,,,,156,132.6,44.7096,156,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Level Iii - Surgical Pathology, Gross And Microscopic Examination (Path)",,88304,CPT,Facility,Both,,,,156,132.6,44.7096,156,Aetna,PPO,145.08,93,,percent of total billed charges,,
"Level Iii - Surgical Pathology, Gross And Microscopic Examination (Path)",,88304,CPT,Facility,Both,,,,156,132.6,44.7096,156,America's PPO,America's PPO,149.8068,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Level Iii - Surgical Pathology, Gross And Microscopic Examination (Path)",,88304,CPT,Facility,Both,,,,156,132.6,44.7096,156,BlueCross BlueShield Minnesota, Federal Employee Program,153.504,98.4,,percent of total billed charges,,
"Level Iii - Surgical Pathology, Gross And Microscopic Examination (Path)",,88304,CPT,Facility,Both,,,,156,132.6,44.7096,156,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,156,100,,percent of total billed charges,,
"Level Iii - Surgical Pathology, Gross And Microscopic Examination (Path)",,88304,CPT,Facility,Both,,,,156,132.6,44.7096,156,BlueCross BlueShield Minnesota,High Value Network Plan,140.4,90,,percent of total billed charges,,
"Level Iii - Surgical Pathology, Gross And Microscopic Examination (Path)",,88304,CPT,Facility,Outpatient,,,,156,132.6,44.7096,156,BlueCross BlueShield Minnesota,Medicare Advantage,76.44,49,,percent of total billed charges,,
"Level Iii - Surgical Pathology, Gross And Microscopic Examination (Path)",,88304,CPT,Facility,Inpatient,,,,156,132.6,44.7096,156,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Level Iii - Surgical Pathology, Gross And Microscopic Examination (Path)",,88304,CPT,Facility,Both,,,,156,132.6,44.7096,156,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,138.1692,88.57,,percent of total billed charges,,
"Level Iii - Surgical Pathology, Gross And Microscopic Examination (Path)",,88304,CPT,Facility,Both,,,,156,132.6,44.7096,156,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,44.7096,28.66,,percent of total billed charges,,
"Level Iii - Surgical Pathology, Gross And Microscopic Examination (Path)",,88304,CPT,Facility,Outpatient,,,,156,132.6,44.7096,156,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),76.44,49,,percent of total billed charges,,
"Level Iii - Surgical Pathology, Gross And Microscopic Examination (Path)",,88304,CPT,Facility,Inpatient,,,,156,132.6,44.7096,156,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Level Iii - Surgical Pathology, Gross And Microscopic Examination (Path)",,88304,CPT,Facility,Both,,,,156,132.6,44.7096,156,CorVel,Worker's Compensation,156,100,,percent of total billed charges,,
"Level Iii - Surgical Pathology, Gross And Microscopic Examination (Path)",,88304,CPT,Facility,Both,,,,156,132.6,44.7096,156,First Health Group Corporation,First Health Network,151.32,97,,percent of total billed charges,,
"Level Iii - Surgical Pathology, Gross And Microscopic Examination (Path)",,88304,CPT,Facility,Both,,,,156,132.6,44.7096,156,"Health Partners, Inc.",Commercial,147.576,94.6,,percent of total billed charges,,
"Level Iii - Surgical Pathology, Gross And Microscopic Examination (Path)",,88304,CPT,Facility,Outpatient,,,,156,132.6,44.7096,156,"Health Partners, Inc.",Medicare Advantage,76.44,49,,percent of total billed charges,,
"Level Iii - Surgical Pathology, Gross And Microscopic Examination (Path)",,88304,CPT,Facility,Inpatient,,,,156,132.6,44.7096,156,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Level Iii - Surgical Pathology, Gross And Microscopic Examination (Path)",,88304,CPT,Facility,Both,,,,156,132.6,44.7096,156,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),93.6,60,,percent of total billed charges,,
"Level Iii - Surgical Pathology, Gross And Microscopic Examination (Path)",,88304,CPT,Facility,Both,,,,156,132.6,44.7096,156,"Health Partners, Inc.",State of Minnesota Advantage Program,127.14,81.5,,percent of total billed charges,,
"Level Iii - Surgical Pathology, Gross And Microscopic Examination (Path)",,88304,CPT,Facility,Both,,,,156,132.6,44.7096,156,"Health Partners, Inc.",State Public Programs,78,50,,percent of total billed charges,,
"Level Iii - Surgical Pathology, Gross And Microscopic Examination (Path)",,88304,CPT,Facility,Both,,,,156,132.6,44.7096,156,Humana Insurance Company,Commercial PPO,148.2,95,,percent of total billed charges,,
"Level Iii - Surgical Pathology, Gross And Microscopic Examination (Path)",,88304,CPT,Facility,Outpatient,,,,156,132.6,44.7096,156,Humana Insurance Company,Medicare PPO,76.44,49,,percent of total billed charges,,
"Level Iii - Surgical Pathology, Gross And Microscopic Examination (Path)",,88304,CPT,Facility,Inpatient,,,,156,132.6,44.7096,156,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Level Iii - Surgical Pathology, Gross And Microscopic Examination (Path)",,88304,CPT,Facility,Both,,,,156,132.6,44.7096,156,Medica,Individual & Family,154.596,99.1,,percent of total billed charges,,
"Level Iii - Surgical Pathology, Gross And Microscopic Examination (Path)",,88304,CPT,Facility,Outpatient,,,,156,132.6,44.7096,156,Medica,Medica Advantage Solution,77.688,49.8,,percent of total billed charges,,
"Level Iii - Surgical Pathology, Gross And Microscopic Examination (Path)",,88304,CPT,Facility,Inpatient,,,,156,132.6,44.7096,156,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Level Iii - Surgical Pathology, Gross And Microscopic Examination (Path)",,88304,CPT,Facility,Outpatient,,,,156,132.6,44.7096,156,Medica,Medical Assistance,69.576,44.6,,percent of total billed charges,,
"Level Iii - Surgical Pathology, Gross And Microscopic Examination (Path)",,88304,CPT,Facility,Inpatient,,,,156,132.6,44.7096,156,Medica,Medical Assistance,,,,,Included in per diem rate,
"Level Iii - Surgical Pathology, Gross And Microscopic Examination (Path)",,88304,CPT,Facility,Outpatient,,,,156,132.6,44.7096,156,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,77.688,49.8,,percent of total billed charges,,
"Level Iii - Surgical Pathology, Gross And Microscopic Examination (Path)",,88304,CPT,Facility,Inpatient,,,,156,132.6,44.7096,156,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Level Iii - Surgical Pathology, Gross And Microscopic Examination (Path)",,88304,CPT,Facility,Both,,,,156,132.6,44.7096,156,"Multiplan, Inc.","Multiplan, Inc.",146.64,94,,percent of total billed charges,,
"Level Iii - Surgical Pathology, Gross And Microscopic Examination (Path)",,88304,CPT,Facility,Outpatient,,,,156,132.6,44.7096,156,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,140.556,90.1,,percent of total billed charges,,
"Level Iii - Surgical Pathology, Gross And Microscopic Examination (Path)",,88304,CPT,Facility,Inpatient,,,,156,132.6,44.7096,156,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Level Iii - Surgical Pathology, Gross And Microscopic Examination (Path)",,88304,CPT,Facility,Both,,,,156,132.6,44.7096,156,"Preferred One Administrative Services, INC.",PPO,153.816,98.6,,percent of total billed charges,,
"Level Iii - Surgical Pathology, Gross And Microscopic Examination (Path)",,88304,CPT,Facility,Outpatient,,,,156,132.6,44.7096,156,PrimeWest Health,Minnesota Senior Health Options (MSHO),80.262,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Level Iii - Surgical Pathology, Gross And Microscopic Examination (Path)",,88304,CPT,Facility,Inpatient,,,,156,132.6,44.7096,156,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Level Iii - Surgical Pathology, Gross And Microscopic Examination (Path)",,88304,CPT,Facility,Outpatient,,,,156,132.6,44.7096,156,PrimeWest Health,MinnesotaCare,80.1216,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Level Iii - Surgical Pathology, Gross And Microscopic Examination (Path)",,88304,CPT,Facility,Inpatient,,,,156,132.6,44.7096,156,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Level Iii - Surgical Pathology, Gross And Microscopic Examination (Path)",,88304,CPT,Facility,Both,,,,156,132.6,44.7096,156,Sanford Health Plan,Sanford Health Plan,143.52,92,,percent of total billed charges,,
"Level Iii - Surgical Pathology, Gross And Microscopic Examination (Path)",,88304,CPT,Facility,Outpatient,,,,156,132.6,44.7096,156,"UCare Health, Inc.",Individual & Family Plan,87.906,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Level Iii - Surgical Pathology, Gross And Microscopic Examination (Path)",,88304,CPT,Facility,Inpatient,,,,156,132.6,44.7096,156,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Level Iii - Surgical Pathology, Gross And Microscopic Examination (Path)",,88304,CPT,Facility,Outpatient,,,,156,132.6,44.7096,156,"UCare Health, Inc.",Medical Assistance,78.7332,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Level Iii - Surgical Pathology, Gross And Microscopic Examination (Path)",,88304,CPT,Facility,Inpatient,,,,156,132.6,44.7096,156,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Level Iii - Surgical Pathology, Gross And Microscopic Examination (Path)",,88304,CPT,Facility,Outpatient,,,,156,132.6,44.7096,156,"UCare Health, Inc.",Medicare Advantage,78.7332,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Level Iii - Surgical Pathology, Gross And Microscopic Examination (Path)",,88304,CPT,Facility,Inpatient,,,,156,132.6,44.7096,156,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Level Iii - Surgical Pathology, Gross And Microscopic Examination (Path)",,88304,CPT,Facility,Outpatient,,,,156,132.6,44.7096,156,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),78.7332,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Level Iii - Surgical Pathology, Gross And Microscopic Examination (Path)",,88304,CPT,Facility,Inpatient,,,,156,132.6,44.7096,156,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Level Iii - Surgical Pathology, Gross And Microscopic Examination (Path)",,88304,CPT,Facility,Both,,,,156,132.6,44.7096,156,UnitedHealthcare,Individual & Family,146.64,94,,percent of total billed charges,,
"Level Iii - Surgical Pathology, Gross And Microscopic Examination (Path)",,88304,CPT,Facility,Outpatient,,,,156,132.6,44.7096,156,UnitedHealthcare,Medicare Advantage,76.44,49,,percent of total billed charges,,
"Level Iii - Surgical Pathology, Gross And Microscopic Examination (Path)",,88304,CPT,Facility,Inpatient,,,,156,132.6,44.7096,156,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Level Iii - Surgical Pathology, Gross And Microscopic Examination (Path)",,88304,CPT,Facility,Outpatient,,,,156,132.6,44.7096,156,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,74.88,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Level Iii - Surgical Pathology, Gross And Microscopic Examination (Path)",,88304,CPT,Facility,Inpatient,,,,156,132.6,44.7096,156,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Level Iv - Surgical Pathology, Gross And Microscopic Examination (Path)",,88305,CPT,Facility,Both,,,,244,207.4,73.66,244,Aetna,Commercial,224.48,92,,percent of total billed charges,,
"Level Iv - Surgical Pathology, Gross And Microscopic Examination (Path)",,88305,CPT,Facility,Outpatient,,,,244,207.4,73.66,244,Aetna,Medicare Advantage,119.56,49,,percent of total billed charges,,
"Level Iv - Surgical Pathology, Gross And Microscopic Examination (Path)",,88305,CPT,Facility,Inpatient,,,,244,207.4,73.66,244,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Level Iv - Surgical Pathology, Gross And Microscopic Examination (Path)",,88305,CPT,Facility,Both,,,,244,207.4,73.66,244,Aetna,PPO,226.92,93,,percent of total billed charges,,
"Level Iv - Surgical Pathology, Gross And Microscopic Examination (Path)",,88305,CPT,Facility,Both,,,,244,207.4,73.66,244,America's PPO,America's PPO,234.3132,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Level Iv - Surgical Pathology, Gross And Microscopic Examination (Path)",,88305,CPT,Facility,Both,,,,244,207.4,73.66,244,BlueCross BlueShield Minnesota, Federal Employee Program,145,,,Fee schedule,,100% of BCBS commercial commodity fee schedule
"Level Iv - Surgical Pathology, Gross And Microscopic Examination (Path)",,88305,CPT,Facility,Both,,,,244,207.4,73.66,244,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,147.32,,,Fee schedule,,"100% of BCBS commercial commodity fee schedule, plus MN Care tax"
"Level Iv - Surgical Pathology, Gross And Microscopic Examination (Path)",,88305,CPT,Facility,Both,,,,244,207.4,73.66,244,BlueCross BlueShield Minnesota,High Value Network Plan,132.588,,,Fee schedule,,"90% of BCBS commercial commodity fee schedule, plus MN Care tax; see disclaimer for more information"
"Level Iv - Surgical Pathology, Gross And Microscopic Examination (Path)",,88305,CPT,Facility,Outpatient,,,,244,207.4,73.66,244,BlueCross BlueShield Minnesota,Medicare Advantage,119.56,49,,percent of total billed charges,,
"Level Iv - Surgical Pathology, Gross And Microscopic Examination (Path)",,88305,CPT,Facility,Inpatient,,,,244,207.4,73.66,244,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Level Iv - Surgical Pathology, Gross And Microscopic Examination (Path)",,88305,CPT,Facility,Both,,,,244,207.4,73.66,244,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,130.481324,,,Fee schedule,,"88.57% of BCBS commercial commodity fee schedule, plus MN Care tax"
"Level Iv - Surgical Pathology, Gross And Microscopic Examination (Path)",,88305,CPT,Facility,Both,,,,244,207.4,73.66,244,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,73.66,,,Fee schedule,,"100% of BCBS Medicaid commodity fee schedule, plus MN Care tax"
"Level Iv - Surgical Pathology, Gross And Microscopic Examination (Path)",,88305,CPT,Facility,Outpatient,,,,244,207.4,73.66,244,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),119.56,49,,percent of total billed charges,,
"Level Iv - Surgical Pathology, Gross And Microscopic Examination (Path)",,88305,CPT,Facility,Inpatient,,,,244,207.4,73.66,244,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Level Iv - Surgical Pathology, Gross And Microscopic Examination (Path)",,88305,CPT,Facility,Both,,,,244,207.4,73.66,244,CorVel,Worker's Compensation,244,100,,percent of total billed charges,,
"Level Iv - Surgical Pathology, Gross And Microscopic Examination (Path)",,88305,CPT,Facility,Both,,,,244,207.4,73.66,244,First Health Group Corporation,First Health Network,236.68,97,,percent of total billed charges,,
"Level Iv - Surgical Pathology, Gross And Microscopic Examination (Path)",,88305,CPT,Facility,Both,,,,244,207.4,73.66,244,"Health Partners, Inc.",Commercial,230.824,94.6,,percent of total billed charges,,
"Level Iv - Surgical Pathology, Gross And Microscopic Examination (Path)",,88305,CPT,Facility,Outpatient,,,,244,207.4,73.66,244,"Health Partners, Inc.",Medicare Advantage,119.56,49,,percent of total billed charges,,
"Level Iv - Surgical Pathology, Gross And Microscopic Examination (Path)",,88305,CPT,Facility,Inpatient,,,,244,207.4,73.66,244,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Level Iv - Surgical Pathology, Gross And Microscopic Examination (Path)",,88305,CPT,Facility,Both,,,,244,207.4,73.66,244,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),146.4,60,,percent of total billed charges,,
"Level Iv - Surgical Pathology, Gross And Microscopic Examination (Path)",,88305,CPT,Facility,Both,,,,244,207.4,73.66,244,"Health Partners, Inc.",State of Minnesota Advantage Program,198.86,81.5,,percent of total billed charges,,
"Level Iv - Surgical Pathology, Gross And Microscopic Examination (Path)",,88305,CPT,Facility,Both,,,,244,207.4,73.66,244,"Health Partners, Inc.",State Public Programs,122,50,,percent of total billed charges,,
"Level Iv - Surgical Pathology, Gross And Microscopic Examination (Path)",,88305,CPT,Facility,Both,,,,244,207.4,73.66,244,Humana Insurance Company,Commercial PPO,231.8,95,,percent of total billed charges,,
"Level Iv - Surgical Pathology, Gross And Microscopic Examination (Path)",,88305,CPT,Facility,Outpatient,,,,244,207.4,73.66,244,Humana Insurance Company,Medicare PPO,119.56,49,,percent of total billed charges,,
"Level Iv - Surgical Pathology, Gross And Microscopic Examination (Path)",,88305,CPT,Facility,Inpatient,,,,244,207.4,73.66,244,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Level Iv - Surgical Pathology, Gross And Microscopic Examination (Path)",,88305,CPT,Facility,Both,,,,244,207.4,73.66,244,Medica,Individual & Family,241.804,99.1,,percent of total billed charges,,
"Level Iv - Surgical Pathology, Gross And Microscopic Examination (Path)",,88305,CPT,Facility,Outpatient,,,,244,207.4,73.66,244,Medica,Medica Advantage Solution,121.512,49.8,,percent of total billed charges,,
"Level Iv - Surgical Pathology, Gross And Microscopic Examination (Path)",,88305,CPT,Facility,Inpatient,,,,244,207.4,73.66,244,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Level Iv - Surgical Pathology, Gross And Microscopic Examination (Path)",,88305,CPT,Facility,Outpatient,,,,244,207.4,73.66,244,Medica,Medical Assistance,108.824,44.6,,percent of total billed charges,,
"Level Iv - Surgical Pathology, Gross And Microscopic Examination (Path)",,88305,CPT,Facility,Inpatient,,,,244,207.4,73.66,244,Medica,Medical Assistance,,,,,Included in per diem rate,
"Level Iv - Surgical Pathology, Gross And Microscopic Examination (Path)",,88305,CPT,Facility,Outpatient,,,,244,207.4,73.66,244,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,121.512,49.8,,percent of total billed charges,,
"Level Iv - Surgical Pathology, Gross And Microscopic Examination (Path)",,88305,CPT,Facility,Inpatient,,,,244,207.4,73.66,244,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Level Iv - Surgical Pathology, Gross And Microscopic Examination (Path)",,88305,CPT,Facility,Both,,,,244,207.4,73.66,244,"Multiplan, Inc.","Multiplan, Inc.",229.36,94,,percent of total billed charges,,
"Level Iv - Surgical Pathology, Gross And Microscopic Examination (Path)",,88305,CPT,Facility,Outpatient,,,,244,207.4,73.66,244,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,219.844,90.1,,percent of total billed charges,,
"Level Iv - Surgical Pathology, Gross And Microscopic Examination (Path)",,88305,CPT,Facility,Inpatient,,,,244,207.4,73.66,244,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Level Iv - Surgical Pathology, Gross And Microscopic Examination (Path)",,88305,CPT,Facility,Both,,,,244,207.4,73.66,244,"Preferred One Administrative Services, INC.",PPO,240.584,98.6,,percent of total billed charges,,
"Level Iv - Surgical Pathology, Gross And Microscopic Examination (Path)",,88305,CPT,Facility,Outpatient,,,,244,207.4,73.66,244,PrimeWest Health,Minnesota Senior Health Options (MSHO),125.538,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Level Iv - Surgical Pathology, Gross And Microscopic Examination (Path)",,88305,CPT,Facility,Inpatient,,,,244,207.4,73.66,244,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Level Iv - Surgical Pathology, Gross And Microscopic Examination (Path)",,88305,CPT,Facility,Outpatient,,,,244,207.4,73.66,244,PrimeWest Health,MinnesotaCare,125.3184,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Level Iv - Surgical Pathology, Gross And Microscopic Examination (Path)",,88305,CPT,Facility,Inpatient,,,,244,207.4,73.66,244,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Level Iv - Surgical Pathology, Gross And Microscopic Examination (Path)",,88305,CPT,Facility,Both,,,,244,207.4,73.66,244,Sanford Health Plan,Sanford Health Plan,224.48,92,,percent of total billed charges,,
"Level Iv - Surgical Pathology, Gross And Microscopic Examination (Path)",,88305,CPT,Facility,Outpatient,,,,244,207.4,73.66,244,"UCare Health, Inc.",Individual & Family Plan,137.494,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Level Iv - Surgical Pathology, Gross And Microscopic Examination (Path)",,88305,CPT,Facility,Inpatient,,,,244,207.4,73.66,244,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Level Iv - Surgical Pathology, Gross And Microscopic Examination (Path)",,88305,CPT,Facility,Outpatient,,,,244,207.4,73.66,244,"UCare Health, Inc.",Medical Assistance,123.1468,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Level Iv - Surgical Pathology, Gross And Microscopic Examination (Path)",,88305,CPT,Facility,Inpatient,,,,244,207.4,73.66,244,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Level Iv - Surgical Pathology, Gross And Microscopic Examination (Path)",,88305,CPT,Facility,Outpatient,,,,244,207.4,73.66,244,"UCare Health, Inc.",Medicare Advantage,123.1468,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Level Iv - Surgical Pathology, Gross And Microscopic Examination (Path)",,88305,CPT,Facility,Inpatient,,,,244,207.4,73.66,244,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Level Iv - Surgical Pathology, Gross And Microscopic Examination (Path)",,88305,CPT,Facility,Outpatient,,,,244,207.4,73.66,244,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),123.1468,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Level Iv - Surgical Pathology, Gross And Microscopic Examination (Path)",,88305,CPT,Facility,Inpatient,,,,244,207.4,73.66,244,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Level Iv - Surgical Pathology, Gross And Microscopic Examination (Path)",,88305,CPT,Facility,Both,,,,244,207.4,73.66,244,UnitedHealthcare,Individual & Family,229.36,94,,percent of total billed charges,,
"Level Iv - Surgical Pathology, Gross And Microscopic Examination (Path)",,88305,CPT,Facility,Outpatient,,,,244,207.4,73.66,244,UnitedHealthcare,Medicare Advantage,119.56,49,,percent of total billed charges,,
"Level Iv - Surgical Pathology, Gross And Microscopic Examination (Path)",,88305,CPT,Facility,Inpatient,,,,244,207.4,73.66,244,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Level Iv - Surgical Pathology, Gross And Microscopic Examination (Path)",,88305,CPT,Facility,Outpatient,,,,244,207.4,73.66,244,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,117.12,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Level Iv - Surgical Pathology, Gross And Microscopic Examination (Path)",,88305,CPT,Facility,Inpatient,,,,244,207.4,73.66,244,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Level V - Surgical Pathology, Gross And Microscopic Examination (Path)",,88307,CPT,Facility,Both,,,,281,238.85,80.5346,281,Aetna,Commercial,258.52,92,,percent of total billed charges,,
"Level V - Surgical Pathology, Gross And Microscopic Examination (Path)",,88307,CPT,Facility,Outpatient,,,,281,238.85,80.5346,281,Aetna,Medicare Advantage,137.69,49,,percent of total billed charges,,
"Level V - Surgical Pathology, Gross And Microscopic Examination (Path)",,88307,CPT,Facility,Inpatient,,,,281,238.85,80.5346,281,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Level V - Surgical Pathology, Gross And Microscopic Examination (Path)",,88307,CPT,Facility,Both,,,,281,238.85,80.5346,281,Aetna,PPO,261.33,93,,percent of total billed charges,,
"Level V - Surgical Pathology, Gross And Microscopic Examination (Path)",,88307,CPT,Facility,Both,,,,281,238.85,80.5346,281,America's PPO,America's PPO,269.8443,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Level V - Surgical Pathology, Gross And Microscopic Examination (Path)",,88307,CPT,Facility,Both,,,,281,238.85,80.5346,281,BlueCross BlueShield Minnesota, Federal Employee Program,276.504,98.4,,percent of total billed charges,,
"Level V - Surgical Pathology, Gross And Microscopic Examination (Path)",,88307,CPT,Facility,Both,,,,281,238.85,80.5346,281,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,281,100,,percent of total billed charges,,
"Level V - Surgical Pathology, Gross And Microscopic Examination (Path)",,88307,CPT,Facility,Both,,,,281,238.85,80.5346,281,BlueCross BlueShield Minnesota,High Value Network Plan,252.9,90,,percent of total billed charges,,
"Level V - Surgical Pathology, Gross And Microscopic Examination (Path)",,88307,CPT,Facility,Outpatient,,,,281,238.85,80.5346,281,BlueCross BlueShield Minnesota,Medicare Advantage,137.69,49,,percent of total billed charges,,
"Level V - Surgical Pathology, Gross And Microscopic Examination (Path)",,88307,CPT,Facility,Inpatient,,,,281,238.85,80.5346,281,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Level V - Surgical Pathology, Gross And Microscopic Examination (Path)",,88307,CPT,Facility,Both,,,,281,238.85,80.5346,281,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,248.8817,88.57,,percent of total billed charges,,
"Level V - Surgical Pathology, Gross And Microscopic Examination (Path)",,88307,CPT,Facility,Both,,,,281,238.85,80.5346,281,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,80.5346,28.66,,percent of total billed charges,,
"Level V - Surgical Pathology, Gross And Microscopic Examination (Path)",,88307,CPT,Facility,Outpatient,,,,281,238.85,80.5346,281,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),137.69,49,,percent of total billed charges,,
"Level V - Surgical Pathology, Gross And Microscopic Examination (Path)",,88307,CPT,Facility,Inpatient,,,,281,238.85,80.5346,281,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Level V - Surgical Pathology, Gross And Microscopic Examination (Path)",,88307,CPT,Facility,Both,,,,281,238.85,80.5346,281,CorVel,Worker's Compensation,281,100,,percent of total billed charges,,
"Level V - Surgical Pathology, Gross And Microscopic Examination (Path)",,88307,CPT,Facility,Both,,,,281,238.85,80.5346,281,First Health Group Corporation,First Health Network,272.57,97,,percent of total billed charges,,
"Level V - Surgical Pathology, Gross And Microscopic Examination (Path)",,88307,CPT,Facility,Both,,,,281,238.85,80.5346,281,"Health Partners, Inc.",Commercial,265.826,94.6,,percent of total billed charges,,
"Level V - Surgical Pathology, Gross And Microscopic Examination (Path)",,88307,CPT,Facility,Outpatient,,,,281,238.85,80.5346,281,"Health Partners, Inc.",Medicare Advantage,137.69,49,,percent of total billed charges,,
"Level V - Surgical Pathology, Gross And Microscopic Examination (Path)",,88307,CPT,Facility,Inpatient,,,,281,238.85,80.5346,281,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Level V - Surgical Pathology, Gross And Microscopic Examination (Path)",,88307,CPT,Facility,Both,,,,281,238.85,80.5346,281,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),168.6,60,,percent of total billed charges,,
"Level V - Surgical Pathology, Gross And Microscopic Examination (Path)",,88307,CPT,Facility,Both,,,,281,238.85,80.5346,281,"Health Partners, Inc.",State of Minnesota Advantage Program,229.015,81.5,,percent of total billed charges,,
"Level V - Surgical Pathology, Gross And Microscopic Examination (Path)",,88307,CPT,Facility,Both,,,,281,238.85,80.5346,281,"Health Partners, Inc.",State Public Programs,140.5,50,,percent of total billed charges,,
"Level V - Surgical Pathology, Gross And Microscopic Examination (Path)",,88307,CPT,Facility,Both,,,,281,238.85,80.5346,281,Humana Insurance Company,Commercial PPO,266.95,95,,percent of total billed charges,,
"Level V - Surgical Pathology, Gross And Microscopic Examination (Path)",,88307,CPT,Facility,Outpatient,,,,281,238.85,80.5346,281,Humana Insurance Company,Medicare PPO,137.69,49,,percent of total billed charges,,
"Level V - Surgical Pathology, Gross And Microscopic Examination (Path)",,88307,CPT,Facility,Inpatient,,,,281,238.85,80.5346,281,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Level V - Surgical Pathology, Gross And Microscopic Examination (Path)",,88307,CPT,Facility,Both,,,,281,238.85,80.5346,281,Medica,Individual & Family,278.471,99.1,,percent of total billed charges,,
"Level V - Surgical Pathology, Gross And Microscopic Examination (Path)",,88307,CPT,Facility,Outpatient,,,,281,238.85,80.5346,281,Medica,Medica Advantage Solution,139.938,49.8,,percent of total billed charges,,
"Level V - Surgical Pathology, Gross And Microscopic Examination (Path)",,88307,CPT,Facility,Inpatient,,,,281,238.85,80.5346,281,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Level V - Surgical Pathology, Gross And Microscopic Examination (Path)",,88307,CPT,Facility,Outpatient,,,,281,238.85,80.5346,281,Medica,Medical Assistance,125.326,44.6,,percent of total billed charges,,
"Level V - Surgical Pathology, Gross And Microscopic Examination (Path)",,88307,CPT,Facility,Inpatient,,,,281,238.85,80.5346,281,Medica,Medical Assistance,,,,,Included in per diem rate,
"Level V - Surgical Pathology, Gross And Microscopic Examination (Path)",,88307,CPT,Facility,Outpatient,,,,281,238.85,80.5346,281,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,139.938,49.8,,percent of total billed charges,,
"Level V - Surgical Pathology, Gross And Microscopic Examination (Path)",,88307,CPT,Facility,Inpatient,,,,281,238.85,80.5346,281,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Level V - Surgical Pathology, Gross And Microscopic Examination (Path)",,88307,CPT,Facility,Both,,,,281,238.85,80.5346,281,"Multiplan, Inc.","Multiplan, Inc.",264.14,94,,percent of total billed charges,,
"Level V - Surgical Pathology, Gross And Microscopic Examination (Path)",,88307,CPT,Facility,Outpatient,,,,281,238.85,80.5346,281,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,253.181,90.1,,percent of total billed charges,,
"Level V - Surgical Pathology, Gross And Microscopic Examination (Path)",,88307,CPT,Facility,Inpatient,,,,281,238.85,80.5346,281,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Level V - Surgical Pathology, Gross And Microscopic Examination (Path)",,88307,CPT,Facility,Both,,,,281,238.85,80.5346,281,"Preferred One Administrative Services, INC.",PPO,277.066,98.6,,percent of total billed charges,,
"Level V - Surgical Pathology, Gross And Microscopic Examination (Path)",,88307,CPT,Facility,Outpatient,,,,281,238.85,80.5346,281,PrimeWest Health,Minnesota Senior Health Options (MSHO),144.5745,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Level V - Surgical Pathology, Gross And Microscopic Examination (Path)",,88307,CPT,Facility,Inpatient,,,,281,238.85,80.5346,281,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Level V - Surgical Pathology, Gross And Microscopic Examination (Path)",,88307,CPT,Facility,Outpatient,,,,281,238.85,80.5346,281,PrimeWest Health,MinnesotaCare,144.3216,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Level V - Surgical Pathology, Gross And Microscopic Examination (Path)",,88307,CPT,Facility,Inpatient,,,,281,238.85,80.5346,281,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Level V - Surgical Pathology, Gross And Microscopic Examination (Path)",,88307,CPT,Facility,Both,,,,281,238.85,80.5346,281,Sanford Health Plan,Sanford Health Plan,258.52,92,,percent of total billed charges,,
"Level V - Surgical Pathology, Gross And Microscopic Examination (Path)",,88307,CPT,Facility,Outpatient,,,,281,238.85,80.5346,281,"UCare Health, Inc.",Individual & Family Plan,158.3435,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Level V - Surgical Pathology, Gross And Microscopic Examination (Path)",,88307,CPT,Facility,Inpatient,,,,281,238.85,80.5346,281,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Level V - Surgical Pathology, Gross And Microscopic Examination (Path)",,88307,CPT,Facility,Outpatient,,,,281,238.85,80.5346,281,"UCare Health, Inc.",Medical Assistance,141.8207,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Level V - Surgical Pathology, Gross And Microscopic Examination (Path)",,88307,CPT,Facility,Inpatient,,,,281,238.85,80.5346,281,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Level V - Surgical Pathology, Gross And Microscopic Examination (Path)",,88307,CPT,Facility,Outpatient,,,,281,238.85,80.5346,281,"UCare Health, Inc.",Medicare Advantage,141.8207,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Level V - Surgical Pathology, Gross And Microscopic Examination (Path)",,88307,CPT,Facility,Inpatient,,,,281,238.85,80.5346,281,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Level V - Surgical Pathology, Gross And Microscopic Examination (Path)",,88307,CPT,Facility,Outpatient,,,,281,238.85,80.5346,281,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),141.8207,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Level V - Surgical Pathology, Gross And Microscopic Examination (Path)",,88307,CPT,Facility,Inpatient,,,,281,238.85,80.5346,281,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Level V - Surgical Pathology, Gross And Microscopic Examination (Path)",,88307,CPT,Facility,Both,,,,281,238.85,80.5346,281,UnitedHealthcare,Individual & Family,264.14,94,,percent of total billed charges,,
"Level V - Surgical Pathology, Gross And Microscopic Examination (Path)",,88307,CPT,Facility,Outpatient,,,,281,238.85,80.5346,281,UnitedHealthcare,Medicare Advantage,137.69,49,,percent of total billed charges,,
"Level V - Surgical Pathology, Gross And Microscopic Examination (Path)",,88307,CPT,Facility,Inpatient,,,,281,238.85,80.5346,281,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Level V - Surgical Pathology, Gross And Microscopic Examination (Path)",,88307,CPT,Facility,Outpatient,,,,281,238.85,80.5346,281,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,134.88,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Level V - Surgical Pathology, Gross And Microscopic Examination (Path)",,88307,CPT,Facility,Inpatient,,,,281,238.85,80.5346,281,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Decalcification Procedure (Path),,88311,CPT,Facility,Both,,,,33,28.05,9.4578,33,Aetna,Commercial,30.36,92,,percent of total billed charges,,
Decalcification Procedure (Path),,88311,CPT,Facility,Outpatient,,,,33,28.05,9.4578,33,Aetna,Medicare Advantage,16.17,49,,percent of total billed charges,,
Decalcification Procedure (Path),,88311,CPT,Facility,Inpatient,,,,33,28.05,9.4578,33,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Decalcification Procedure (Path),,88311,CPT,Facility,Both,,,,33,28.05,9.4578,33,Aetna,PPO,30.69,93,,percent of total billed charges,,
Decalcification Procedure (Path),,88311,CPT,Facility,Both,,,,33,28.05,9.4578,33,America's PPO,America's PPO,31.6899,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Decalcification Procedure (Path),,88311,CPT,Facility,Both,,,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota, Federal Employee Program,32.472,98.4,,percent of total billed charges,,
Decalcification Procedure (Path),,88311,CPT,Facility,Both,,,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,33,100,,percent of total billed charges,,
Decalcification Procedure (Path),,88311,CPT,Facility,Both,,,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota,High Value Network Plan,29.7,90,,percent of total billed charges,,
Decalcification Procedure (Path),,88311,CPT,Facility,Outpatient,,,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota,Medicare Advantage,16.17,49,,percent of total billed charges,,
Decalcification Procedure (Path),,88311,CPT,Facility,Inpatient,,,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Decalcification Procedure (Path),,88311,CPT,Facility,Both,,,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,29.2281,88.57,,percent of total billed charges,,
Decalcification Procedure (Path),,88311,CPT,Facility,Both,,,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,9.4578,28.66,,percent of total billed charges,,
Decalcification Procedure (Path),,88311,CPT,Facility,Outpatient,,,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),16.17,49,,percent of total billed charges,,
Decalcification Procedure (Path),,88311,CPT,Facility,Inpatient,,,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Decalcification Procedure (Path),,88311,CPT,Facility,Both,,,,33,28.05,9.4578,33,CorVel,Worker's Compensation,33,100,,percent of total billed charges,,
Decalcification Procedure (Path),,88311,CPT,Facility,Both,,,,33,28.05,9.4578,33,First Health Group Corporation,First Health Network,32.01,97,,percent of total billed charges,,
Decalcification Procedure (Path),,88311,CPT,Facility,Both,,,,33,28.05,9.4578,33,"Health Partners, Inc.",Commercial,31.218,94.6,,percent of total billed charges,,
Decalcification Procedure (Path),,88311,CPT,Facility,Outpatient,,,,33,28.05,9.4578,33,"Health Partners, Inc.",Medicare Advantage,16.17,49,,percent of total billed charges,,
Decalcification Procedure (Path),,88311,CPT,Facility,Inpatient,,,,33,28.05,9.4578,33,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Decalcification Procedure (Path),,88311,CPT,Facility,Both,,,,33,28.05,9.4578,33,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),19.8,60,,percent of total billed charges,,
Decalcification Procedure (Path),,88311,CPT,Facility,Both,,,,33,28.05,9.4578,33,"Health Partners, Inc.",State of Minnesota Advantage Program,26.895,81.5,,percent of total billed charges,,
Decalcification Procedure (Path),,88311,CPT,Facility,Both,,,,33,28.05,9.4578,33,"Health Partners, Inc.",State Public Programs,16.5,50,,percent of total billed charges,,
Decalcification Procedure (Path),,88311,CPT,Facility,Both,,,,33,28.05,9.4578,33,Humana Insurance Company,Commercial PPO,31.35,95,,percent of total billed charges,,
Decalcification Procedure (Path),,88311,CPT,Facility,Outpatient,,,,33,28.05,9.4578,33,Humana Insurance Company,Medicare PPO,16.17,49,,percent of total billed charges,,
Decalcification Procedure (Path),,88311,CPT,Facility,Inpatient,,,,33,28.05,9.4578,33,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Decalcification Procedure (Path),,88311,CPT,Facility,Both,,,,33,28.05,9.4578,33,Medica,Individual & Family,32.703,99.1,,percent of total billed charges,,
Decalcification Procedure (Path),,88311,CPT,Facility,Outpatient,,,,33,28.05,9.4578,33,Medica,Medica Advantage Solution,16.434,49.8,,percent of total billed charges,,
Decalcification Procedure (Path),,88311,CPT,Facility,Inpatient,,,,33,28.05,9.4578,33,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Decalcification Procedure (Path),,88311,CPT,Facility,Outpatient,,,,33,28.05,9.4578,33,Medica,Medical Assistance,14.718,44.6,,percent of total billed charges,,
Decalcification Procedure (Path),,88311,CPT,Facility,Inpatient,,,,33,28.05,9.4578,33,Medica,Medical Assistance,,,,,Included in per diem rate,
Decalcification Procedure (Path),,88311,CPT,Facility,Outpatient,,,,33,28.05,9.4578,33,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,16.434,49.8,,percent of total billed charges,,
Decalcification Procedure (Path),,88311,CPT,Facility,Inpatient,,,,33,28.05,9.4578,33,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Decalcification Procedure (Path),,88311,CPT,Facility,Both,,,,33,28.05,9.4578,33,"Multiplan, Inc.","Multiplan, Inc.",31.02,94,,percent of total billed charges,,
Decalcification Procedure (Path),,88311,CPT,Facility,Outpatient,,,,33,28.05,9.4578,33,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,29.733,90.1,,percent of total billed charges,,
Decalcification Procedure (Path),,88311,CPT,Facility,Inpatient,,,,33,28.05,9.4578,33,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Decalcification Procedure (Path),,88311,CPT,Facility,Both,,,,33,28.05,9.4578,33,"Preferred One Administrative Services, INC.",PPO,32.538,98.6,,percent of total billed charges,,
Decalcification Procedure (Path),,88311,CPT,Facility,Outpatient,,,,33,28.05,9.4578,33,PrimeWest Health,Minnesota Senior Health Options (MSHO),16.9785,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Decalcification Procedure (Path),,88311,CPT,Facility,Inpatient,,,,33,28.05,9.4578,33,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Decalcification Procedure (Path),,88311,CPT,Facility,Outpatient,,,,33,28.05,9.4578,33,PrimeWest Health,MinnesotaCare,16.9488,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Decalcification Procedure (Path),,88311,CPT,Facility,Inpatient,,,,33,28.05,9.4578,33,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Decalcification Procedure (Path),,88311,CPT,Facility,Both,,,,33,28.05,9.4578,33,Sanford Health Plan,Sanford Health Plan,30.36,92,,percent of total billed charges,,
Decalcification Procedure (Path),,88311,CPT,Facility,Outpatient,,,,33,28.05,9.4578,33,"UCare Health, Inc.",Individual & Family Plan,18.5955,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Decalcification Procedure (Path),,88311,CPT,Facility,Inpatient,,,,33,28.05,9.4578,33,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Decalcification Procedure (Path),,88311,CPT,Facility,Outpatient,,,,33,28.05,9.4578,33,"UCare Health, Inc.",Medical Assistance,16.6551,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Decalcification Procedure (Path),,88311,CPT,Facility,Inpatient,,,,33,28.05,9.4578,33,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Decalcification Procedure (Path),,88311,CPT,Facility,Outpatient,,,,33,28.05,9.4578,33,"UCare Health, Inc.",Medicare Advantage,16.6551,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Decalcification Procedure (Path),,88311,CPT,Facility,Inpatient,,,,33,28.05,9.4578,33,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Decalcification Procedure (Path),,88311,CPT,Facility,Outpatient,,,,33,28.05,9.4578,33,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),16.6551,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Decalcification Procedure (Path),,88311,CPT,Facility,Inpatient,,,,33,28.05,9.4578,33,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Decalcification Procedure (Path),,88311,CPT,Facility,Both,,,,33,28.05,9.4578,33,UnitedHealthcare,Individual & Family,31.02,94,,percent of total billed charges,,
Decalcification Procedure (Path),,88311,CPT,Facility,Outpatient,,,,33,28.05,9.4578,33,UnitedHealthcare,Medicare Advantage,16.17,49,,percent of total billed charges,,
Decalcification Procedure (Path),,88311,CPT,Facility,Inpatient,,,,33,28.05,9.4578,33,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Decalcification Procedure (Path),,88311,CPT,Facility,Outpatient,,,,33,28.05,9.4578,33,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,15.84,48,,percent of total billed charges,,100% of DHS outpatient percentage
Decalcification Procedure (Path),,88311,CPT,Facility,Inpatient,,,,33,28.05,9.4578,33,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Special Stain Including Interpretation And Report; Group I For Microorganisms (Path),,88312,CPT,Facility,Both,,,,78,66.3,22.3548,78,Aetna,Commercial,71.76,92,,percent of total billed charges,,
Special Stain Including Interpretation And Report; Group I For Microorganisms (Path),,88312,CPT,Facility,Outpatient,,,,78,66.3,22.3548,78,Aetna,Medicare Advantage,38.22,49,,percent of total billed charges,,
Special Stain Including Interpretation And Report; Group I For Microorganisms (Path),,88312,CPT,Facility,Inpatient,,,,78,66.3,22.3548,78,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Special Stain Including Interpretation And Report; Group I For Microorganisms (Path),,88312,CPT,Facility,Both,,,,78,66.3,22.3548,78,Aetna,PPO,72.54,93,,percent of total billed charges,,
Special Stain Including Interpretation And Report; Group I For Microorganisms (Path),,88312,CPT,Facility,Both,,,,78,66.3,22.3548,78,America's PPO,America's PPO,74.9034,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Special Stain Including Interpretation And Report; Group I For Microorganisms (Path),,88312,CPT,Facility,Both,,,,78,66.3,22.3548,78,BlueCross BlueShield Minnesota, Federal Employee Program,76.752,98.4,,percent of total billed charges,,
Special Stain Including Interpretation And Report; Group I For Microorganisms (Path),,88312,CPT,Facility,Both,,,,78,66.3,22.3548,78,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,78,100,,percent of total billed charges,,
Special Stain Including Interpretation And Report; Group I For Microorganisms (Path),,88312,CPT,Facility,Both,,,,78,66.3,22.3548,78,BlueCross BlueShield Minnesota,High Value Network Plan,70.2,90,,percent of total billed charges,,
Special Stain Including Interpretation And Report; Group I For Microorganisms (Path),,88312,CPT,Facility,Outpatient,,,,78,66.3,22.3548,78,BlueCross BlueShield Minnesota,Medicare Advantage,38.22,49,,percent of total billed charges,,
Special Stain Including Interpretation And Report; Group I For Microorganisms (Path),,88312,CPT,Facility,Inpatient,,,,78,66.3,22.3548,78,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Special Stain Including Interpretation And Report; Group I For Microorganisms (Path),,88312,CPT,Facility,Both,,,,78,66.3,22.3548,78,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,69.0846,88.57,,percent of total billed charges,,
Special Stain Including Interpretation And Report; Group I For Microorganisms (Path),,88312,CPT,Facility,Both,,,,78,66.3,22.3548,78,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,22.3548,28.66,,percent of total billed charges,,
Special Stain Including Interpretation And Report; Group I For Microorganisms (Path),,88312,CPT,Facility,Outpatient,,,,78,66.3,22.3548,78,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),38.22,49,,percent of total billed charges,,
Special Stain Including Interpretation And Report; Group I For Microorganisms (Path),,88312,CPT,Facility,Inpatient,,,,78,66.3,22.3548,78,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Special Stain Including Interpretation And Report; Group I For Microorganisms (Path),,88312,CPT,Facility,Both,,,,78,66.3,22.3548,78,CorVel,Worker's Compensation,78,100,,percent of total billed charges,,
Special Stain Including Interpretation And Report; Group I For Microorganisms (Path),,88312,CPT,Facility,Both,,,,78,66.3,22.3548,78,First Health Group Corporation,First Health Network,75.66,97,,percent of total billed charges,,
Special Stain Including Interpretation And Report; Group I For Microorganisms (Path),,88312,CPT,Facility,Both,,,,78,66.3,22.3548,78,"Health Partners, Inc.",Commercial,73.788,94.6,,percent of total billed charges,,
Special Stain Including Interpretation And Report; Group I For Microorganisms (Path),,88312,CPT,Facility,Outpatient,,,,78,66.3,22.3548,78,"Health Partners, Inc.",Medicare Advantage,38.22,49,,percent of total billed charges,,
Special Stain Including Interpretation And Report; Group I For Microorganisms (Path),,88312,CPT,Facility,Inpatient,,,,78,66.3,22.3548,78,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Special Stain Including Interpretation And Report; Group I For Microorganisms (Path),,88312,CPT,Facility,Both,,,,78,66.3,22.3548,78,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),46.8,60,,percent of total billed charges,,
Special Stain Including Interpretation And Report; Group I For Microorganisms (Path),,88312,CPT,Facility,Both,,,,78,66.3,22.3548,78,"Health Partners, Inc.",State of Minnesota Advantage Program,63.57,81.5,,percent of total billed charges,,
Special Stain Including Interpretation And Report; Group I For Microorganisms (Path),,88312,CPT,Facility,Both,,,,78,66.3,22.3548,78,"Health Partners, Inc.",State Public Programs,39,50,,percent of total billed charges,,
Special Stain Including Interpretation And Report; Group I For Microorganisms (Path),,88312,CPT,Facility,Both,,,,78,66.3,22.3548,78,Humana Insurance Company,Commercial PPO,74.1,95,,percent of total billed charges,,
Special Stain Including Interpretation And Report; Group I For Microorganisms (Path),,88312,CPT,Facility,Outpatient,,,,78,66.3,22.3548,78,Humana Insurance Company,Medicare PPO,38.22,49,,percent of total billed charges,,
Special Stain Including Interpretation And Report; Group I For Microorganisms (Path),,88312,CPT,Facility,Inpatient,,,,78,66.3,22.3548,78,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Special Stain Including Interpretation And Report; Group I For Microorganisms (Path),,88312,CPT,Facility,Both,,,,78,66.3,22.3548,78,Medica,Individual & Family,77.298,99.1,,percent of total billed charges,,
Special Stain Including Interpretation And Report; Group I For Microorganisms (Path),,88312,CPT,Facility,Outpatient,,,,78,66.3,22.3548,78,Medica,Medica Advantage Solution,38.844,49.8,,percent of total billed charges,,
Special Stain Including Interpretation And Report; Group I For Microorganisms (Path),,88312,CPT,Facility,Inpatient,,,,78,66.3,22.3548,78,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Special Stain Including Interpretation And Report; Group I For Microorganisms (Path),,88312,CPT,Facility,Outpatient,,,,78,66.3,22.3548,78,Medica,Medical Assistance,34.788,44.6,,percent of total billed charges,,
Special Stain Including Interpretation And Report; Group I For Microorganisms (Path),,88312,CPT,Facility,Inpatient,,,,78,66.3,22.3548,78,Medica,Medical Assistance,,,,,Included in per diem rate,
Special Stain Including Interpretation And Report; Group I For Microorganisms (Path),,88312,CPT,Facility,Outpatient,,,,78,66.3,22.3548,78,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,38.844,49.8,,percent of total billed charges,,
Special Stain Including Interpretation And Report; Group I For Microorganisms (Path),,88312,CPT,Facility,Inpatient,,,,78,66.3,22.3548,78,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Special Stain Including Interpretation And Report; Group I For Microorganisms (Path),,88312,CPT,Facility,Both,,,,78,66.3,22.3548,78,"Multiplan, Inc.","Multiplan, Inc.",73.32,94,,percent of total billed charges,,
Special Stain Including Interpretation And Report; Group I For Microorganisms (Path),,88312,CPT,Facility,Outpatient,,,,78,66.3,22.3548,78,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,70.278,90.1,,percent of total billed charges,,
Special Stain Including Interpretation And Report; Group I For Microorganisms (Path),,88312,CPT,Facility,Inpatient,,,,78,66.3,22.3548,78,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Special Stain Including Interpretation And Report; Group I For Microorganisms (Path),,88312,CPT,Facility,Both,,,,78,66.3,22.3548,78,"Preferred One Administrative Services, INC.",PPO,76.908,98.6,,percent of total billed charges,,
Special Stain Including Interpretation And Report; Group I For Microorganisms (Path),,88312,CPT,Facility,Outpatient,,,,78,66.3,22.3548,78,PrimeWest Health,Minnesota Senior Health Options (MSHO),40.131,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Special Stain Including Interpretation And Report; Group I For Microorganisms (Path),,88312,CPT,Facility,Inpatient,,,,78,66.3,22.3548,78,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Special Stain Including Interpretation And Report; Group I For Microorganisms (Path),,88312,CPT,Facility,Outpatient,,,,78,66.3,22.3548,78,PrimeWest Health,MinnesotaCare,40.0608,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Special Stain Including Interpretation And Report; Group I For Microorganisms (Path),,88312,CPT,Facility,Inpatient,,,,78,66.3,22.3548,78,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Special Stain Including Interpretation And Report; Group I For Microorganisms (Path),,88312,CPT,Facility,Both,,,,78,66.3,22.3548,78,Sanford Health Plan,Sanford Health Plan,71.76,92,,percent of total billed charges,,
Special Stain Including Interpretation And Report; Group I For Microorganisms (Path),,88312,CPT,Facility,Outpatient,,,,78,66.3,22.3548,78,"UCare Health, Inc.",Individual & Family Plan,43.953,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Special Stain Including Interpretation And Report; Group I For Microorganisms (Path),,88312,CPT,Facility,Inpatient,,,,78,66.3,22.3548,78,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Special Stain Including Interpretation And Report; Group I For Microorganisms (Path),,88312,CPT,Facility,Outpatient,,,,78,66.3,22.3548,78,"UCare Health, Inc.",Medical Assistance,39.3666,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Special Stain Including Interpretation And Report; Group I For Microorganisms (Path),,88312,CPT,Facility,Inpatient,,,,78,66.3,22.3548,78,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Special Stain Including Interpretation And Report; Group I For Microorganisms (Path),,88312,CPT,Facility,Outpatient,,,,78,66.3,22.3548,78,"UCare Health, Inc.",Medicare Advantage,39.3666,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Special Stain Including Interpretation And Report; Group I For Microorganisms (Path),,88312,CPT,Facility,Inpatient,,,,78,66.3,22.3548,78,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Special Stain Including Interpretation And Report; Group I For Microorganisms (Path),,88312,CPT,Facility,Outpatient,,,,78,66.3,22.3548,78,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),39.3666,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Special Stain Including Interpretation And Report; Group I For Microorganisms (Path),,88312,CPT,Facility,Inpatient,,,,78,66.3,22.3548,78,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Special Stain Including Interpretation And Report; Group I For Microorganisms (Path),,88312,CPT,Facility,Both,,,,78,66.3,22.3548,78,UnitedHealthcare,Individual & Family,73.32,94,,percent of total billed charges,,
Special Stain Including Interpretation And Report; Group I For Microorganisms (Path),,88312,CPT,Facility,Outpatient,,,,78,66.3,22.3548,78,UnitedHealthcare,Medicare Advantage,38.22,49,,percent of total billed charges,,
Special Stain Including Interpretation And Report; Group I For Microorganisms (Path),,88312,CPT,Facility,Inpatient,,,,78,66.3,22.3548,78,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Special Stain Including Interpretation And Report; Group I For Microorganisms (Path),,88312,CPT,Facility,Outpatient,,,,78,66.3,22.3548,78,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,37.44,48,,percent of total billed charges,,100% of DHS outpatient percentage
Special Stain Including Interpretation And Report; Group I For Microorganisms (Path),,88312,CPT,Facility,Inpatient,,,,78,66.3,22.3548,78,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Special Stain Including Interp And Report; Group Ii (Path),,88313,CPT,Facility,Both,,,,64,54.4,18.3424,64,Aetna,Commercial,58.88,92,,percent of total billed charges,,
Special Stain Including Interp And Report; Group Ii (Path),,88313,CPT,Facility,Outpatient,,,,64,54.4,18.3424,64,Aetna,Medicare Advantage,31.36,49,,percent of total billed charges,,
Special Stain Including Interp And Report; Group Ii (Path),,88313,CPT,Facility,Inpatient,,,,64,54.4,18.3424,64,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Special Stain Including Interp And Report; Group Ii (Path),,88313,CPT,Facility,Both,,,,64,54.4,18.3424,64,Aetna,PPO,59.52,93,,percent of total billed charges,,
Special Stain Including Interp And Report; Group Ii (Path),,88313,CPT,Facility,Both,,,,64,54.4,18.3424,64,America's PPO,America's PPO,61.4592,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Special Stain Including Interp And Report; Group Ii (Path),,88313,CPT,Facility,Both,,,,64,54.4,18.3424,64,BlueCross BlueShield Minnesota, Federal Employee Program,62.976,98.4,,percent of total billed charges,,
Special Stain Including Interp And Report; Group Ii (Path),,88313,CPT,Facility,Both,,,,64,54.4,18.3424,64,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,64,100,,percent of total billed charges,,
Special Stain Including Interp And Report; Group Ii (Path),,88313,CPT,Facility,Both,,,,64,54.4,18.3424,64,BlueCross BlueShield Minnesota,High Value Network Plan,57.6,90,,percent of total billed charges,,
Special Stain Including Interp And Report; Group Ii (Path),,88313,CPT,Facility,Outpatient,,,,64,54.4,18.3424,64,BlueCross BlueShield Minnesota,Medicare Advantage,31.36,49,,percent of total billed charges,,
Special Stain Including Interp And Report; Group Ii (Path),,88313,CPT,Facility,Inpatient,,,,64,54.4,18.3424,64,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Special Stain Including Interp And Report; Group Ii (Path),,88313,CPT,Facility,Both,,,,64,54.4,18.3424,64,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,56.6848,88.57,,percent of total billed charges,,
Special Stain Including Interp And Report; Group Ii (Path),,88313,CPT,Facility,Both,,,,64,54.4,18.3424,64,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,18.3424,28.66,,percent of total billed charges,,
Special Stain Including Interp And Report; Group Ii (Path),,88313,CPT,Facility,Outpatient,,,,64,54.4,18.3424,64,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),31.36,49,,percent of total billed charges,,
Special Stain Including Interp And Report; Group Ii (Path),,88313,CPT,Facility,Inpatient,,,,64,54.4,18.3424,64,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Special Stain Including Interp And Report; Group Ii (Path),,88313,CPT,Facility,Both,,,,64,54.4,18.3424,64,CorVel,Worker's Compensation,64,100,,percent of total billed charges,,
Special Stain Including Interp And Report; Group Ii (Path),,88313,CPT,Facility,Both,,,,64,54.4,18.3424,64,First Health Group Corporation,First Health Network,62.08,97,,percent of total billed charges,,
Special Stain Including Interp And Report; Group Ii (Path),,88313,CPT,Facility,Both,,,,64,54.4,18.3424,64,"Health Partners, Inc.",Commercial,60.544,94.6,,percent of total billed charges,,
Special Stain Including Interp And Report; Group Ii (Path),,88313,CPT,Facility,Outpatient,,,,64,54.4,18.3424,64,"Health Partners, Inc.",Medicare Advantage,31.36,49,,percent of total billed charges,,
Special Stain Including Interp And Report; Group Ii (Path),,88313,CPT,Facility,Inpatient,,,,64,54.4,18.3424,64,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Special Stain Including Interp And Report; Group Ii (Path),,88313,CPT,Facility,Both,,,,64,54.4,18.3424,64,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),38.4,60,,percent of total billed charges,,
Special Stain Including Interp And Report; Group Ii (Path),,88313,CPT,Facility,Both,,,,64,54.4,18.3424,64,"Health Partners, Inc.",State of Minnesota Advantage Program,52.16,81.5,,percent of total billed charges,,
Special Stain Including Interp And Report; Group Ii (Path),,88313,CPT,Facility,Both,,,,64,54.4,18.3424,64,"Health Partners, Inc.",State Public Programs,32,50,,percent of total billed charges,,
Special Stain Including Interp And Report; Group Ii (Path),,88313,CPT,Facility,Both,,,,64,54.4,18.3424,64,Humana Insurance Company,Commercial PPO,60.8,95,,percent of total billed charges,,
Special Stain Including Interp And Report; Group Ii (Path),,88313,CPT,Facility,Outpatient,,,,64,54.4,18.3424,64,Humana Insurance Company,Medicare PPO,31.36,49,,percent of total billed charges,,
Special Stain Including Interp And Report; Group Ii (Path),,88313,CPT,Facility,Inpatient,,,,64,54.4,18.3424,64,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Special Stain Including Interp And Report; Group Ii (Path),,88313,CPT,Facility,Both,,,,64,54.4,18.3424,64,Medica,Individual & Family,63.424,99.1,,percent of total billed charges,,
Special Stain Including Interp And Report; Group Ii (Path),,88313,CPT,Facility,Outpatient,,,,64,54.4,18.3424,64,Medica,Medica Advantage Solution,31.872,49.8,,percent of total billed charges,,
Special Stain Including Interp And Report; Group Ii (Path),,88313,CPT,Facility,Inpatient,,,,64,54.4,18.3424,64,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Special Stain Including Interp And Report; Group Ii (Path),,88313,CPT,Facility,Outpatient,,,,64,54.4,18.3424,64,Medica,Medical Assistance,28.544,44.6,,percent of total billed charges,,
Special Stain Including Interp And Report; Group Ii (Path),,88313,CPT,Facility,Inpatient,,,,64,54.4,18.3424,64,Medica,Medical Assistance,,,,,Included in per diem rate,
Special Stain Including Interp And Report; Group Ii (Path),,88313,CPT,Facility,Outpatient,,,,64,54.4,18.3424,64,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,31.872,49.8,,percent of total billed charges,,
Special Stain Including Interp And Report; Group Ii (Path),,88313,CPT,Facility,Inpatient,,,,64,54.4,18.3424,64,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Special Stain Including Interp And Report; Group Ii (Path),,88313,CPT,Facility,Both,,,,64,54.4,18.3424,64,"Multiplan, Inc.","Multiplan, Inc.",60.16,94,,percent of total billed charges,,
Special Stain Including Interp And Report; Group Ii (Path),,88313,CPT,Facility,Outpatient,,,,64,54.4,18.3424,64,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,57.664,90.1,,percent of total billed charges,,
Special Stain Including Interp And Report; Group Ii (Path),,88313,CPT,Facility,Inpatient,,,,64,54.4,18.3424,64,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Special Stain Including Interp And Report; Group Ii (Path),,88313,CPT,Facility,Both,,,,64,54.4,18.3424,64,"Preferred One Administrative Services, INC.",PPO,63.104,98.6,,percent of total billed charges,,
Special Stain Including Interp And Report; Group Ii (Path),,88313,CPT,Facility,Outpatient,,,,64,54.4,18.3424,64,PrimeWest Health,Minnesota Senior Health Options (MSHO),32.928,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Special Stain Including Interp And Report; Group Ii (Path),,88313,CPT,Facility,Inpatient,,,,64,54.4,18.3424,64,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Special Stain Including Interp And Report; Group Ii (Path),,88313,CPT,Facility,Outpatient,,,,64,54.4,18.3424,64,PrimeWest Health,MinnesotaCare,32.8704,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Special Stain Including Interp And Report; Group Ii (Path),,88313,CPT,Facility,Inpatient,,,,64,54.4,18.3424,64,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Special Stain Including Interp And Report; Group Ii (Path),,88313,CPT,Facility,Both,,,,64,54.4,18.3424,64,Sanford Health Plan,Sanford Health Plan,58.88,92,,percent of total billed charges,,
Special Stain Including Interp And Report; Group Ii (Path),,88313,CPT,Facility,Outpatient,,,,64,54.4,18.3424,64,"UCare Health, Inc.",Individual & Family Plan,36.064,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Special Stain Including Interp And Report; Group Ii (Path),,88313,CPT,Facility,Inpatient,,,,64,54.4,18.3424,64,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Special Stain Including Interp And Report; Group Ii (Path),,88313,CPT,Facility,Outpatient,,,,64,54.4,18.3424,64,"UCare Health, Inc.",Medical Assistance,32.3008,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Special Stain Including Interp And Report; Group Ii (Path),,88313,CPT,Facility,Inpatient,,,,64,54.4,18.3424,64,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Special Stain Including Interp And Report; Group Ii (Path),,88313,CPT,Facility,Outpatient,,,,64,54.4,18.3424,64,"UCare Health, Inc.",Medicare Advantage,32.3008,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Special Stain Including Interp And Report; Group Ii (Path),,88313,CPT,Facility,Inpatient,,,,64,54.4,18.3424,64,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Special Stain Including Interp And Report; Group Ii (Path),,88313,CPT,Facility,Outpatient,,,,64,54.4,18.3424,64,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),32.3008,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Special Stain Including Interp And Report; Group Ii (Path),,88313,CPT,Facility,Inpatient,,,,64,54.4,18.3424,64,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Special Stain Including Interp And Report; Group Ii (Path),,88313,CPT,Facility,Both,,,,64,54.4,18.3424,64,UnitedHealthcare,Individual & Family,60.16,94,,percent of total billed charges,,
Special Stain Including Interp And Report; Group Ii (Path),,88313,CPT,Facility,Outpatient,,,,64,54.4,18.3424,64,UnitedHealthcare,Medicare Advantage,31.36,49,,percent of total billed charges,,
Special Stain Including Interp And Report; Group Ii (Path),,88313,CPT,Facility,Inpatient,,,,64,54.4,18.3424,64,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Special Stain Including Interp And Report; Group Ii (Path),,88313,CPT,Facility,Outpatient,,,,64,54.4,18.3424,64,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,30.72,48,,percent of total billed charges,,100% of DHS outpatient percentage
Special Stain Including Interp And Report; Group Ii (Path),,88313,CPT,Facility,Inpatient,,,,64,54.4,18.3424,64,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Consultation And Report On Referred Material Requiring Preparation Of Slides (Path),,88323,CPT,Facility,Both,,,,371,315.35,106.3286,371,Aetna,Commercial,341.32,92,,percent of total billed charges,,
Consultation And Report On Referred Material Requiring Preparation Of Slides (Path),,88323,CPT,Facility,Outpatient,,,,371,315.35,106.3286,371,Aetna,Medicare Advantage,181.79,49,,percent of total billed charges,,
Consultation And Report On Referred Material Requiring Preparation Of Slides (Path),,88323,CPT,Facility,Inpatient,,,,371,315.35,106.3286,371,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Consultation And Report On Referred Material Requiring Preparation Of Slides (Path),,88323,CPT,Facility,Both,,,,371,315.35,106.3286,371,Aetna,PPO,345.03,93,,percent of total billed charges,,
Consultation And Report On Referred Material Requiring Preparation Of Slides (Path),,88323,CPT,Facility,Both,,,,371,315.35,106.3286,371,America's PPO,America's PPO,356.2713,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Consultation And Report On Referred Material Requiring Preparation Of Slides (Path),,88323,CPT,Facility,Both,,,,371,315.35,106.3286,371,BlueCross BlueShield Minnesota, Federal Employee Program,365.064,98.4,,percent of total billed charges,,
Consultation And Report On Referred Material Requiring Preparation Of Slides (Path),,88323,CPT,Facility,Both,,,,371,315.35,106.3286,371,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,371,100,,percent of total billed charges,,
Consultation And Report On Referred Material Requiring Preparation Of Slides (Path),,88323,CPT,Facility,Both,,,,371,315.35,106.3286,371,BlueCross BlueShield Minnesota,High Value Network Plan,333.9,90,,percent of total billed charges,,
Consultation And Report On Referred Material Requiring Preparation Of Slides (Path),,88323,CPT,Facility,Outpatient,,,,371,315.35,106.3286,371,BlueCross BlueShield Minnesota,Medicare Advantage,181.79,49,,percent of total billed charges,,
Consultation And Report On Referred Material Requiring Preparation Of Slides (Path),,88323,CPT,Facility,Inpatient,,,,371,315.35,106.3286,371,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Consultation And Report On Referred Material Requiring Preparation Of Slides (Path),,88323,CPT,Facility,Both,,,,371,315.35,106.3286,371,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,328.5947,88.57,,percent of total billed charges,,
Consultation And Report On Referred Material Requiring Preparation Of Slides (Path),,88323,CPT,Facility,Both,,,,371,315.35,106.3286,371,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,106.3286,28.66,,percent of total billed charges,,
Consultation And Report On Referred Material Requiring Preparation Of Slides (Path),,88323,CPT,Facility,Outpatient,,,,371,315.35,106.3286,371,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),181.79,49,,percent of total billed charges,,
Consultation And Report On Referred Material Requiring Preparation Of Slides (Path),,88323,CPT,Facility,Inpatient,,,,371,315.35,106.3286,371,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Consultation And Report On Referred Material Requiring Preparation Of Slides (Path),,88323,CPT,Facility,Both,,,,371,315.35,106.3286,371,CorVel,Worker's Compensation,371,100,,percent of total billed charges,,
Consultation And Report On Referred Material Requiring Preparation Of Slides (Path),,88323,CPT,Facility,Both,,,,371,315.35,106.3286,371,First Health Group Corporation,First Health Network,359.87,97,,percent of total billed charges,,
Consultation And Report On Referred Material Requiring Preparation Of Slides (Path),,88323,CPT,Facility,Both,,,,371,315.35,106.3286,371,"Health Partners, Inc.",Commercial,350.966,94.6,,percent of total billed charges,,
Consultation And Report On Referred Material Requiring Preparation Of Slides (Path),,88323,CPT,Facility,Outpatient,,,,371,315.35,106.3286,371,"Health Partners, Inc.",Medicare Advantage,181.79,49,,percent of total billed charges,,
Consultation And Report On Referred Material Requiring Preparation Of Slides (Path),,88323,CPT,Facility,Inpatient,,,,371,315.35,106.3286,371,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Consultation And Report On Referred Material Requiring Preparation Of Slides (Path),,88323,CPT,Facility,Both,,,,371,315.35,106.3286,371,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),222.6,60,,percent of total billed charges,,
Consultation And Report On Referred Material Requiring Preparation Of Slides (Path),,88323,CPT,Facility,Both,,,,371,315.35,106.3286,371,"Health Partners, Inc.",State of Minnesota Advantage Program,302.365,81.5,,percent of total billed charges,,
Consultation And Report On Referred Material Requiring Preparation Of Slides (Path),,88323,CPT,Facility,Both,,,,371,315.35,106.3286,371,"Health Partners, Inc.",State Public Programs,185.5,50,,percent of total billed charges,,
Consultation And Report On Referred Material Requiring Preparation Of Slides (Path),,88323,CPT,Facility,Both,,,,371,315.35,106.3286,371,Humana Insurance Company,Commercial PPO,352.45,95,,percent of total billed charges,,
Consultation And Report On Referred Material Requiring Preparation Of Slides (Path),,88323,CPT,Facility,Outpatient,,,,371,315.35,106.3286,371,Humana Insurance Company,Medicare PPO,181.79,49,,percent of total billed charges,,
Consultation And Report On Referred Material Requiring Preparation Of Slides (Path),,88323,CPT,Facility,Inpatient,,,,371,315.35,106.3286,371,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Consultation And Report On Referred Material Requiring Preparation Of Slides (Path),,88323,CPT,Facility,Both,,,,371,315.35,106.3286,371,Medica,Individual & Family,367.661,99.1,,percent of total billed charges,,
Consultation And Report On Referred Material Requiring Preparation Of Slides (Path),,88323,CPT,Facility,Outpatient,,,,371,315.35,106.3286,371,Medica,Medica Advantage Solution,184.758,49.8,,percent of total billed charges,,
Consultation And Report On Referred Material Requiring Preparation Of Slides (Path),,88323,CPT,Facility,Inpatient,,,,371,315.35,106.3286,371,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Consultation And Report On Referred Material Requiring Preparation Of Slides (Path),,88323,CPT,Facility,Outpatient,,,,371,315.35,106.3286,371,Medica,Medical Assistance,165.466,44.6,,percent of total billed charges,,
Consultation And Report On Referred Material Requiring Preparation Of Slides (Path),,88323,CPT,Facility,Inpatient,,,,371,315.35,106.3286,371,Medica,Medical Assistance,,,,,Included in per diem rate,
Consultation And Report On Referred Material Requiring Preparation Of Slides (Path),,88323,CPT,Facility,Outpatient,,,,371,315.35,106.3286,371,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,184.758,49.8,,percent of total billed charges,,
Consultation And Report On Referred Material Requiring Preparation Of Slides (Path),,88323,CPT,Facility,Inpatient,,,,371,315.35,106.3286,371,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Consultation And Report On Referred Material Requiring Preparation Of Slides (Path),,88323,CPT,Facility,Both,,,,371,315.35,106.3286,371,"Multiplan, Inc.","Multiplan, Inc.",348.74,94,,percent of total billed charges,,
Consultation And Report On Referred Material Requiring Preparation Of Slides (Path),,88323,CPT,Facility,Outpatient,,,,371,315.35,106.3286,371,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,334.271,90.1,,percent of total billed charges,,
Consultation And Report On Referred Material Requiring Preparation Of Slides (Path),,88323,CPT,Facility,Inpatient,,,,371,315.35,106.3286,371,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Consultation And Report On Referred Material Requiring Preparation Of Slides (Path),,88323,CPT,Facility,Both,,,,371,315.35,106.3286,371,"Preferred One Administrative Services, INC.",PPO,365.806,98.6,,percent of total billed charges,,
Consultation And Report On Referred Material Requiring Preparation Of Slides (Path),,88323,CPT,Facility,Outpatient,,,,371,315.35,106.3286,371,PrimeWest Health,Minnesota Senior Health Options (MSHO),190.8795,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Consultation And Report On Referred Material Requiring Preparation Of Slides (Path),,88323,CPT,Facility,Inpatient,,,,371,315.35,106.3286,371,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Consultation And Report On Referred Material Requiring Preparation Of Slides (Path),,88323,CPT,Facility,Outpatient,,,,371,315.35,106.3286,371,PrimeWest Health,MinnesotaCare,190.5456,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Consultation And Report On Referred Material Requiring Preparation Of Slides (Path),,88323,CPT,Facility,Inpatient,,,,371,315.35,106.3286,371,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Consultation And Report On Referred Material Requiring Preparation Of Slides (Path),,88323,CPT,Facility,Both,,,,371,315.35,106.3286,371,Sanford Health Plan,Sanford Health Plan,341.32,92,,percent of total billed charges,,
Consultation And Report On Referred Material Requiring Preparation Of Slides (Path),,88323,CPT,Facility,Outpatient,,,,371,315.35,106.3286,371,"UCare Health, Inc.",Individual & Family Plan,209.0585,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Consultation And Report On Referred Material Requiring Preparation Of Slides (Path),,88323,CPT,Facility,Inpatient,,,,371,315.35,106.3286,371,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Consultation And Report On Referred Material Requiring Preparation Of Slides (Path),,88323,CPT,Facility,Outpatient,,,,371,315.35,106.3286,371,"UCare Health, Inc.",Medical Assistance,187.2437,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Consultation And Report On Referred Material Requiring Preparation Of Slides (Path),,88323,CPT,Facility,Inpatient,,,,371,315.35,106.3286,371,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Consultation And Report On Referred Material Requiring Preparation Of Slides (Path),,88323,CPT,Facility,Outpatient,,,,371,315.35,106.3286,371,"UCare Health, Inc.",Medicare Advantage,187.2437,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Consultation And Report On Referred Material Requiring Preparation Of Slides (Path),,88323,CPT,Facility,Inpatient,,,,371,315.35,106.3286,371,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Consultation And Report On Referred Material Requiring Preparation Of Slides (Path),,88323,CPT,Facility,Outpatient,,,,371,315.35,106.3286,371,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),187.2437,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Consultation And Report On Referred Material Requiring Preparation Of Slides (Path),,88323,CPT,Facility,Inpatient,,,,371,315.35,106.3286,371,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Consultation And Report On Referred Material Requiring Preparation Of Slides (Path),,88323,CPT,Facility,Both,,,,371,315.35,106.3286,371,UnitedHealthcare,Individual & Family,348.74,94,,percent of total billed charges,,
Consultation And Report On Referred Material Requiring Preparation Of Slides (Path),,88323,CPT,Facility,Outpatient,,,,371,315.35,106.3286,371,UnitedHealthcare,Medicare Advantage,181.79,49,,percent of total billed charges,,
Consultation And Report On Referred Material Requiring Preparation Of Slides (Path),,88323,CPT,Facility,Inpatient,,,,371,315.35,106.3286,371,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Consultation And Report On Referred Material Requiring Preparation Of Slides (Path),,88323,CPT,Facility,Outpatient,,,,371,315.35,106.3286,371,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,178.08,48,,percent of total billed charges,,100% of DHS outpatient percentage
Consultation And Report On Referred Material Requiring Preparation Of Slides (Path),,88323,CPT,Facility,Inpatient,,,,371,315.35,106.3286,371,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Pathology Consultation During Surgery; Cytologic Examination, Initial Site (Path)",,88333,CPT,Facility,Both,,,,54,45.9,15.4764,54,Aetna,Commercial,49.68,92,,percent of total billed charges,,
"Pathology Consultation During Surgery; Cytologic Examination, Initial Site (Path)",,88333,CPT,Facility,Outpatient,,,,54,45.9,15.4764,54,Aetna,Medicare Advantage,26.46,49,,percent of total billed charges,,
"Pathology Consultation During Surgery; Cytologic Examination, Initial Site (Path)",,88333,CPT,Facility,Inpatient,,,,54,45.9,15.4764,54,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Pathology Consultation During Surgery; Cytologic Examination, Initial Site (Path)",,88333,CPT,Facility,Both,,,,54,45.9,15.4764,54,Aetna,PPO,50.22,93,,percent of total billed charges,,
"Pathology Consultation During Surgery; Cytologic Examination, Initial Site (Path)",,88333,CPT,Facility,Both,,,,54,45.9,15.4764,54,America's PPO,America's PPO,51.8562,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Pathology Consultation During Surgery; Cytologic Examination, Initial Site (Path)",,88333,CPT,Facility,Both,,,,54,45.9,15.4764,54,BlueCross BlueShield Minnesota, Federal Employee Program,53.136,98.4,,percent of total billed charges,,
"Pathology Consultation During Surgery; Cytologic Examination, Initial Site (Path)",,88333,CPT,Facility,Both,,,,54,45.9,15.4764,54,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,54,100,,percent of total billed charges,,
"Pathology Consultation During Surgery; Cytologic Examination, Initial Site (Path)",,88333,CPT,Facility,Both,,,,54,45.9,15.4764,54,BlueCross BlueShield Minnesota,High Value Network Plan,48.6,90,,percent of total billed charges,,
"Pathology Consultation During Surgery; Cytologic Examination, Initial Site (Path)",,88333,CPT,Facility,Outpatient,,,,54,45.9,15.4764,54,BlueCross BlueShield Minnesota,Medicare Advantage,26.46,49,,percent of total billed charges,,
"Pathology Consultation During Surgery; Cytologic Examination, Initial Site (Path)",,88333,CPT,Facility,Inpatient,,,,54,45.9,15.4764,54,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Pathology Consultation During Surgery; Cytologic Examination, Initial Site (Path)",,88333,CPT,Facility,Both,,,,54,45.9,15.4764,54,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,47.8278,88.57,,percent of total billed charges,,
"Pathology Consultation During Surgery; Cytologic Examination, Initial Site (Path)",,88333,CPT,Facility,Both,,,,54,45.9,15.4764,54,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,15.4764,28.66,,percent of total billed charges,,
"Pathology Consultation During Surgery; Cytologic Examination, Initial Site (Path)",,88333,CPT,Facility,Outpatient,,,,54,45.9,15.4764,54,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),26.46,49,,percent of total billed charges,,
"Pathology Consultation During Surgery; Cytologic Examination, Initial Site (Path)",,88333,CPT,Facility,Inpatient,,,,54,45.9,15.4764,54,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Pathology Consultation During Surgery; Cytologic Examination, Initial Site (Path)",,88333,CPT,Facility,Both,,,,54,45.9,15.4764,54,CorVel,Worker's Compensation,54,100,,percent of total billed charges,,
"Pathology Consultation During Surgery; Cytologic Examination, Initial Site (Path)",,88333,CPT,Facility,Both,,,,54,45.9,15.4764,54,First Health Group Corporation,First Health Network,52.38,97,,percent of total billed charges,,
"Pathology Consultation During Surgery; Cytologic Examination, Initial Site (Path)",,88333,CPT,Facility,Both,,,,54,45.9,15.4764,54,"Health Partners, Inc.",Commercial,51.084,94.6,,percent of total billed charges,,
"Pathology Consultation During Surgery; Cytologic Examination, Initial Site (Path)",,88333,CPT,Facility,Outpatient,,,,54,45.9,15.4764,54,"Health Partners, Inc.",Medicare Advantage,26.46,49,,percent of total billed charges,,
"Pathology Consultation During Surgery; Cytologic Examination, Initial Site (Path)",,88333,CPT,Facility,Inpatient,,,,54,45.9,15.4764,54,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Pathology Consultation During Surgery; Cytologic Examination, Initial Site (Path)",,88333,CPT,Facility,Both,,,,54,45.9,15.4764,54,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),32.4,60,,percent of total billed charges,,
"Pathology Consultation During Surgery; Cytologic Examination, Initial Site (Path)",,88333,CPT,Facility,Both,,,,54,45.9,15.4764,54,"Health Partners, Inc.",State of Minnesota Advantage Program,44.01,81.5,,percent of total billed charges,,
"Pathology Consultation During Surgery; Cytologic Examination, Initial Site (Path)",,88333,CPT,Facility,Both,,,,54,45.9,15.4764,54,"Health Partners, Inc.",State Public Programs,27,50,,percent of total billed charges,,
"Pathology Consultation During Surgery; Cytologic Examination, Initial Site (Path)",,88333,CPT,Facility,Both,,,,54,45.9,15.4764,54,Humana Insurance Company,Commercial PPO,51.3,95,,percent of total billed charges,,
"Pathology Consultation During Surgery; Cytologic Examination, Initial Site (Path)",,88333,CPT,Facility,Outpatient,,,,54,45.9,15.4764,54,Humana Insurance Company,Medicare PPO,26.46,49,,percent of total billed charges,,
"Pathology Consultation During Surgery; Cytologic Examination, Initial Site (Path)",,88333,CPT,Facility,Inpatient,,,,54,45.9,15.4764,54,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Pathology Consultation During Surgery; Cytologic Examination, Initial Site (Path)",,88333,CPT,Facility,Both,,,,54,45.9,15.4764,54,Medica,Individual & Family,53.514,99.1,,percent of total billed charges,,
"Pathology Consultation During Surgery; Cytologic Examination, Initial Site (Path)",,88333,CPT,Facility,Outpatient,,,,54,45.9,15.4764,54,Medica,Medica Advantage Solution,26.892,49.8,,percent of total billed charges,,
"Pathology Consultation During Surgery; Cytologic Examination, Initial Site (Path)",,88333,CPT,Facility,Inpatient,,,,54,45.9,15.4764,54,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Pathology Consultation During Surgery; Cytologic Examination, Initial Site (Path)",,88333,CPT,Facility,Outpatient,,,,54,45.9,15.4764,54,Medica,Medical Assistance,24.084,44.6,,percent of total billed charges,,
"Pathology Consultation During Surgery; Cytologic Examination, Initial Site (Path)",,88333,CPT,Facility,Inpatient,,,,54,45.9,15.4764,54,Medica,Medical Assistance,,,,,Included in per diem rate,
"Pathology Consultation During Surgery; Cytologic Examination, Initial Site (Path)",,88333,CPT,Facility,Outpatient,,,,54,45.9,15.4764,54,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,26.892,49.8,,percent of total billed charges,,
"Pathology Consultation During Surgery; Cytologic Examination, Initial Site (Path)",,88333,CPT,Facility,Inpatient,,,,54,45.9,15.4764,54,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Pathology Consultation During Surgery; Cytologic Examination, Initial Site (Path)",,88333,CPT,Facility,Both,,,,54,45.9,15.4764,54,"Multiplan, Inc.","Multiplan, Inc.",50.76,94,,percent of total billed charges,,
"Pathology Consultation During Surgery; Cytologic Examination, Initial Site (Path)",,88333,CPT,Facility,Outpatient,,,,54,45.9,15.4764,54,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,48.654,90.1,,percent of total billed charges,,
"Pathology Consultation During Surgery; Cytologic Examination, Initial Site (Path)",,88333,CPT,Facility,Inpatient,,,,54,45.9,15.4764,54,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Pathology Consultation During Surgery; Cytologic Examination, Initial Site (Path)",,88333,CPT,Facility,Both,,,,54,45.9,15.4764,54,"Preferred One Administrative Services, INC.",PPO,53.244,98.6,,percent of total billed charges,,
"Pathology Consultation During Surgery; Cytologic Examination, Initial Site (Path)",,88333,CPT,Facility,Outpatient,,,,54,45.9,15.4764,54,PrimeWest Health,Minnesota Senior Health Options (MSHO),27.783,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Pathology Consultation During Surgery; Cytologic Examination, Initial Site (Path)",,88333,CPT,Facility,Inpatient,,,,54,45.9,15.4764,54,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Pathology Consultation During Surgery; Cytologic Examination, Initial Site (Path)",,88333,CPT,Facility,Outpatient,,,,54,45.9,15.4764,54,PrimeWest Health,MinnesotaCare,27.7344,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Pathology Consultation During Surgery; Cytologic Examination, Initial Site (Path)",,88333,CPT,Facility,Inpatient,,,,54,45.9,15.4764,54,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Pathology Consultation During Surgery; Cytologic Examination, Initial Site (Path)",,88333,CPT,Facility,Both,,,,54,45.9,15.4764,54,Sanford Health Plan,Sanford Health Plan,49.68,92,,percent of total billed charges,,
"Pathology Consultation During Surgery; Cytologic Examination, Initial Site (Path)",,88333,CPT,Facility,Outpatient,,,,54,45.9,15.4764,54,"UCare Health, Inc.",Individual & Family Plan,30.429,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Pathology Consultation During Surgery; Cytologic Examination, Initial Site (Path)",,88333,CPT,Facility,Inpatient,,,,54,45.9,15.4764,54,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Pathology Consultation During Surgery; Cytologic Examination, Initial Site (Path)",,88333,CPT,Facility,Outpatient,,,,54,45.9,15.4764,54,"UCare Health, Inc.",Medical Assistance,27.2538,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Pathology Consultation During Surgery; Cytologic Examination, Initial Site (Path)",,88333,CPT,Facility,Inpatient,,,,54,45.9,15.4764,54,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Pathology Consultation During Surgery; Cytologic Examination, Initial Site (Path)",,88333,CPT,Facility,Outpatient,,,,54,45.9,15.4764,54,"UCare Health, Inc.",Medicare Advantage,27.2538,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Pathology Consultation During Surgery; Cytologic Examination, Initial Site (Path)",,88333,CPT,Facility,Inpatient,,,,54,45.9,15.4764,54,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Pathology Consultation During Surgery; Cytologic Examination, Initial Site (Path)",,88333,CPT,Facility,Outpatient,,,,54,45.9,15.4764,54,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),27.2538,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Pathology Consultation During Surgery; Cytologic Examination, Initial Site (Path)",,88333,CPT,Facility,Inpatient,,,,54,45.9,15.4764,54,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Pathology Consultation During Surgery; Cytologic Examination, Initial Site (Path)",,88333,CPT,Facility,Both,,,,54,45.9,15.4764,54,UnitedHealthcare,Individual & Family,50.76,94,,percent of total billed charges,,
"Pathology Consultation During Surgery; Cytologic Examination, Initial Site (Path)",,88333,CPT,Facility,Outpatient,,,,54,45.9,15.4764,54,UnitedHealthcare,Medicare Advantage,26.46,49,,percent of total billed charges,,
"Pathology Consultation During Surgery; Cytologic Examination, Initial Site (Path)",,88333,CPT,Facility,Inpatient,,,,54,45.9,15.4764,54,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Pathology Consultation During Surgery; Cytologic Examination, Initial Site (Path)",,88333,CPT,Facility,Outpatient,,,,54,45.9,15.4764,54,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,25.92,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Pathology Consultation During Surgery; Cytologic Examination, Initial Site (Path)",,88333,CPT,Facility,Inpatient,,,,54,45.9,15.4764,54,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Immunohistochemistry Or Immunocytochemistry, Per Specimen; Ea Multiplex Antibody Stain Proc (Path)",,88344,CPT,Facility,Both,,,,275,233.75,78.815,275,Aetna,Commercial,253,92,,percent of total billed charges,,
"Immunohistochemistry Or Immunocytochemistry, Per Specimen; Ea Multiplex Antibody Stain Proc (Path)",,88344,CPT,Facility,Outpatient,,,,275,233.75,78.815,275,Aetna,Medicare Advantage,134.75,49,,percent of total billed charges,,
"Immunohistochemistry Or Immunocytochemistry, Per Specimen; Ea Multiplex Antibody Stain Proc (Path)",,88344,CPT,Facility,Inpatient,,,,275,233.75,78.815,275,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Immunohistochemistry Or Immunocytochemistry, Per Specimen; Ea Multiplex Antibody Stain Proc (Path)",,88344,CPT,Facility,Both,,,,275,233.75,78.815,275,Aetna,PPO,255.75,93,,percent of total billed charges,,
"Immunohistochemistry Or Immunocytochemistry, Per Specimen; Ea Multiplex Antibody Stain Proc (Path)",,88344,CPT,Facility,Both,,,,275,233.75,78.815,275,America's PPO,America's PPO,264.0825,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Immunohistochemistry Or Immunocytochemistry, Per Specimen; Ea Multiplex Antibody Stain Proc (Path)",,88344,CPT,Facility,Both,,,,275,233.75,78.815,275,BlueCross BlueShield Minnesota, Federal Employee Program,270.6,98.4,,percent of total billed charges,,
"Immunohistochemistry Or Immunocytochemistry, Per Specimen; Ea Multiplex Antibody Stain Proc (Path)",,88344,CPT,Facility,Both,,,,275,233.75,78.815,275,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,275,100,,percent of total billed charges,,
"Immunohistochemistry Or Immunocytochemistry, Per Specimen; Ea Multiplex Antibody Stain Proc (Path)",,88344,CPT,Facility,Both,,,,275,233.75,78.815,275,BlueCross BlueShield Minnesota,High Value Network Plan,247.5,90,,percent of total billed charges,,
"Immunohistochemistry Or Immunocytochemistry, Per Specimen; Ea Multiplex Antibody Stain Proc (Path)",,88344,CPT,Facility,Outpatient,,,,275,233.75,78.815,275,BlueCross BlueShield Minnesota,Medicare Advantage,134.75,49,,percent of total billed charges,,
"Immunohistochemistry Or Immunocytochemistry, Per Specimen; Ea Multiplex Antibody Stain Proc (Path)",,88344,CPT,Facility,Inpatient,,,,275,233.75,78.815,275,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Immunohistochemistry Or Immunocytochemistry, Per Specimen; Ea Multiplex Antibody Stain Proc (Path)",,88344,CPT,Facility,Both,,,,275,233.75,78.815,275,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,243.5675,88.57,,percent of total billed charges,,
"Immunohistochemistry Or Immunocytochemistry, Per Specimen; Ea Multiplex Antibody Stain Proc (Path)",,88344,CPT,Facility,Both,,,,275,233.75,78.815,275,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,78.815,28.66,,percent of total billed charges,,
"Immunohistochemistry Or Immunocytochemistry, Per Specimen; Ea Multiplex Antibody Stain Proc (Path)",,88344,CPT,Facility,Outpatient,,,,275,233.75,78.815,275,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),134.75,49,,percent of total billed charges,,
"Immunohistochemistry Or Immunocytochemistry, Per Specimen; Ea Multiplex Antibody Stain Proc (Path)",,88344,CPT,Facility,Inpatient,,,,275,233.75,78.815,275,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Immunohistochemistry Or Immunocytochemistry, Per Specimen; Ea Multiplex Antibody Stain Proc (Path)",,88344,CPT,Facility,Both,,,,275,233.75,78.815,275,CorVel,Worker's Compensation,275,100,,percent of total billed charges,,
"Immunohistochemistry Or Immunocytochemistry, Per Specimen; Ea Multiplex Antibody Stain Proc (Path)",,88344,CPT,Facility,Both,,,,275,233.75,78.815,275,First Health Group Corporation,First Health Network,266.75,97,,percent of total billed charges,,
"Immunohistochemistry Or Immunocytochemistry, Per Specimen; Ea Multiplex Antibody Stain Proc (Path)",,88344,CPT,Facility,Both,,,,275,233.75,78.815,275,"Health Partners, Inc.",Commercial,260.15,94.6,,percent of total billed charges,,
"Immunohistochemistry Or Immunocytochemistry, Per Specimen; Ea Multiplex Antibody Stain Proc (Path)",,88344,CPT,Facility,Outpatient,,,,275,233.75,78.815,275,"Health Partners, Inc.",Medicare Advantage,134.75,49,,percent of total billed charges,,
"Immunohistochemistry Or Immunocytochemistry, Per Specimen; Ea Multiplex Antibody Stain Proc (Path)",,88344,CPT,Facility,Inpatient,,,,275,233.75,78.815,275,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Immunohistochemistry Or Immunocytochemistry, Per Specimen; Ea Multiplex Antibody Stain Proc (Path)",,88344,CPT,Facility,Both,,,,275,233.75,78.815,275,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),165,60,,percent of total billed charges,,
"Immunohistochemistry Or Immunocytochemistry, Per Specimen; Ea Multiplex Antibody Stain Proc (Path)",,88344,CPT,Facility,Both,,,,275,233.75,78.815,275,"Health Partners, Inc.",State of Minnesota Advantage Program,224.125,81.5,,percent of total billed charges,,
"Immunohistochemistry Or Immunocytochemistry, Per Specimen; Ea Multiplex Antibody Stain Proc (Path)",,88344,CPT,Facility,Both,,,,275,233.75,78.815,275,"Health Partners, Inc.",State Public Programs,137.5,50,,percent of total billed charges,,
"Immunohistochemistry Or Immunocytochemistry, Per Specimen; Ea Multiplex Antibody Stain Proc (Path)",,88344,CPT,Facility,Both,,,,275,233.75,78.815,275,Humana Insurance Company,Commercial PPO,261.25,95,,percent of total billed charges,,
"Immunohistochemistry Or Immunocytochemistry, Per Specimen; Ea Multiplex Antibody Stain Proc (Path)",,88344,CPT,Facility,Outpatient,,,,275,233.75,78.815,275,Humana Insurance Company,Medicare PPO,134.75,49,,percent of total billed charges,,
"Immunohistochemistry Or Immunocytochemistry, Per Specimen; Ea Multiplex Antibody Stain Proc (Path)",,88344,CPT,Facility,Inpatient,,,,275,233.75,78.815,275,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Immunohistochemistry Or Immunocytochemistry, Per Specimen; Ea Multiplex Antibody Stain Proc (Path)",,88344,CPT,Facility,Both,,,,275,233.75,78.815,275,Medica,Individual & Family,272.525,99.1,,percent of total billed charges,,
"Immunohistochemistry Or Immunocytochemistry, Per Specimen; Ea Multiplex Antibody Stain Proc (Path)",,88344,CPT,Facility,Outpatient,,,,275,233.75,78.815,275,Medica,Medica Advantage Solution,136.95,49.8,,percent of total billed charges,,
"Immunohistochemistry Or Immunocytochemistry, Per Specimen; Ea Multiplex Antibody Stain Proc (Path)",,88344,CPT,Facility,Inpatient,,,,275,233.75,78.815,275,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Immunohistochemistry Or Immunocytochemistry, Per Specimen; Ea Multiplex Antibody Stain Proc (Path)",,88344,CPT,Facility,Outpatient,,,,275,233.75,78.815,275,Medica,Medical Assistance,122.65,44.6,,percent of total billed charges,,
"Immunohistochemistry Or Immunocytochemistry, Per Specimen; Ea Multiplex Antibody Stain Proc (Path)",,88344,CPT,Facility,Inpatient,,,,275,233.75,78.815,275,Medica,Medical Assistance,,,,,Included in per diem rate,
"Immunohistochemistry Or Immunocytochemistry, Per Specimen; Ea Multiplex Antibody Stain Proc (Path)",,88344,CPT,Facility,Outpatient,,,,275,233.75,78.815,275,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,136.95,49.8,,percent of total billed charges,,
"Immunohistochemistry Or Immunocytochemistry, Per Specimen; Ea Multiplex Antibody Stain Proc (Path)",,88344,CPT,Facility,Inpatient,,,,275,233.75,78.815,275,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Immunohistochemistry Or Immunocytochemistry, Per Specimen; Ea Multiplex Antibody Stain Proc (Path)",,88344,CPT,Facility,Both,,,,275,233.75,78.815,275,"Multiplan, Inc.","Multiplan, Inc.",258.5,94,,percent of total billed charges,,
"Immunohistochemistry Or Immunocytochemistry, Per Specimen; Ea Multiplex Antibody Stain Proc (Path)",,88344,CPT,Facility,Outpatient,,,,275,233.75,78.815,275,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,247.775,90.1,,percent of total billed charges,,
"Immunohistochemistry Or Immunocytochemistry, Per Specimen; Ea Multiplex Antibody Stain Proc (Path)",,88344,CPT,Facility,Inpatient,,,,275,233.75,78.815,275,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Immunohistochemistry Or Immunocytochemistry, Per Specimen; Ea Multiplex Antibody Stain Proc (Path)",,88344,CPT,Facility,Both,,,,275,233.75,78.815,275,"Preferred One Administrative Services, INC.",PPO,271.15,98.6,,percent of total billed charges,,
"Immunohistochemistry Or Immunocytochemistry, Per Specimen; Ea Multiplex Antibody Stain Proc (Path)",,88344,CPT,Facility,Outpatient,,,,275,233.75,78.815,275,PrimeWest Health,Minnesota Senior Health Options (MSHO),141.4875,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Immunohistochemistry Or Immunocytochemistry, Per Specimen; Ea Multiplex Antibody Stain Proc (Path)",,88344,CPT,Facility,Inpatient,,,,275,233.75,78.815,275,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Immunohistochemistry Or Immunocytochemistry, Per Specimen; Ea Multiplex Antibody Stain Proc (Path)",,88344,CPT,Facility,Outpatient,,,,275,233.75,78.815,275,PrimeWest Health,MinnesotaCare,141.24,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Immunohistochemistry Or Immunocytochemistry, Per Specimen; Ea Multiplex Antibody Stain Proc (Path)",,88344,CPT,Facility,Inpatient,,,,275,233.75,78.815,275,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Immunohistochemistry Or Immunocytochemistry, Per Specimen; Ea Multiplex Antibody Stain Proc (Path)",,88344,CPT,Facility,Both,,,,275,233.75,78.815,275,Sanford Health Plan,Sanford Health Plan,253,92,,percent of total billed charges,,
"Immunohistochemistry Or Immunocytochemistry, Per Specimen; Ea Multiplex Antibody Stain Proc (Path)",,88344,CPT,Facility,Outpatient,,,,275,233.75,78.815,275,"UCare Health, Inc.",Individual & Family Plan,154.9625,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Immunohistochemistry Or Immunocytochemistry, Per Specimen; Ea Multiplex Antibody Stain Proc (Path)",,88344,CPT,Facility,Inpatient,,,,275,233.75,78.815,275,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Immunohistochemistry Or Immunocytochemistry, Per Specimen; Ea Multiplex Antibody Stain Proc (Path)",,88344,CPT,Facility,Outpatient,,,,275,233.75,78.815,275,"UCare Health, Inc.",Medical Assistance,138.7925,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Immunohistochemistry Or Immunocytochemistry, Per Specimen; Ea Multiplex Antibody Stain Proc (Path)",,88344,CPT,Facility,Inpatient,,,,275,233.75,78.815,275,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Immunohistochemistry Or Immunocytochemistry, Per Specimen; Ea Multiplex Antibody Stain Proc (Path)",,88344,CPT,Facility,Outpatient,,,,275,233.75,78.815,275,"UCare Health, Inc.",Medicare Advantage,138.7925,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Immunohistochemistry Or Immunocytochemistry, Per Specimen; Ea Multiplex Antibody Stain Proc (Path)",,88344,CPT,Facility,Inpatient,,,,275,233.75,78.815,275,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Immunohistochemistry Or Immunocytochemistry, Per Specimen; Ea Multiplex Antibody Stain Proc (Path)",,88344,CPT,Facility,Outpatient,,,,275,233.75,78.815,275,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),138.7925,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Immunohistochemistry Or Immunocytochemistry, Per Specimen; Ea Multiplex Antibody Stain Proc (Path)",,88344,CPT,Facility,Inpatient,,,,275,233.75,78.815,275,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Immunohistochemistry Or Immunocytochemistry, Per Specimen; Ea Multiplex Antibody Stain Proc (Path)",,88344,CPT,Facility,Both,,,,275,233.75,78.815,275,UnitedHealthcare,Individual & Family,258.5,94,,percent of total billed charges,,
"Immunohistochemistry Or Immunocytochemistry, Per Specimen; Ea Multiplex Antibody Stain Proc (Path)",,88344,CPT,Facility,Outpatient,,,,275,233.75,78.815,275,UnitedHealthcare,Medicare Advantage,134.75,49,,percent of total billed charges,,
"Immunohistochemistry Or Immunocytochemistry, Per Specimen; Ea Multiplex Antibody Stain Proc (Path)",,88344,CPT,Facility,Inpatient,,,,275,233.75,78.815,275,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Immunohistochemistry Or Immunocytochemistry, Per Specimen; Ea Multiplex Antibody Stain Proc (Path)",,88344,CPT,Facility,Outpatient,,,,275,233.75,78.815,275,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,132,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Immunohistochemistry Or Immunocytochemistry, Per Specimen; Ea Multiplex Antibody Stain Proc (Path)",,88344,CPT,Facility,Inpatient,,,,275,233.75,78.815,275,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Morphometric Analysis, Tumor Immunohist, Quant Semiquant, Per Specimen, Ea Antibody; Manual (Path)",,88360,CPT,Facility,Both,,,,341,289.85,97.7306,341,Aetna,Commercial,313.72,92,,percent of total billed charges,,
"Morphometric Analysis, Tumor Immunohist, Quant Semiquant, Per Specimen, Ea Antibody; Manual (Path)",,88360,CPT,Facility,Outpatient,,,,341,289.85,97.7306,341,Aetna,Medicare Advantage,167.09,49,,percent of total billed charges,,
"Morphometric Analysis, Tumor Immunohist, Quant Semiquant, Per Specimen, Ea Antibody; Manual (Path)",,88360,CPT,Facility,Inpatient,,,,341,289.85,97.7306,341,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Morphometric Analysis, Tumor Immunohist, Quant Semiquant, Per Specimen, Ea Antibody; Manual (Path)",,88360,CPT,Facility,Both,,,,341,289.85,97.7306,341,Aetna,PPO,317.13,93,,percent of total billed charges,,
"Morphometric Analysis, Tumor Immunohist, Quant Semiquant, Per Specimen, Ea Antibody; Manual (Path)",,88360,CPT,Facility,Both,,,,341,289.85,97.7306,341,America's PPO,America's PPO,327.4623,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Morphometric Analysis, Tumor Immunohist, Quant Semiquant, Per Specimen, Ea Antibody; Manual (Path)",,88360,CPT,Facility,Both,,,,341,289.85,97.7306,341,BlueCross BlueShield Minnesota, Federal Employee Program,335.544,98.4,,percent of total billed charges,,
"Morphometric Analysis, Tumor Immunohist, Quant Semiquant, Per Specimen, Ea Antibody; Manual (Path)",,88360,CPT,Facility,Both,,,,341,289.85,97.7306,341,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,341,100,,percent of total billed charges,,
"Morphometric Analysis, Tumor Immunohist, Quant Semiquant, Per Specimen, Ea Antibody; Manual (Path)",,88360,CPT,Facility,Both,,,,341,289.85,97.7306,341,BlueCross BlueShield Minnesota,High Value Network Plan,306.9,90,,percent of total billed charges,,
"Morphometric Analysis, Tumor Immunohist, Quant Semiquant, Per Specimen, Ea Antibody; Manual (Path)",,88360,CPT,Facility,Outpatient,,,,341,289.85,97.7306,341,BlueCross BlueShield Minnesota,Medicare Advantage,167.09,49,,percent of total billed charges,,
"Morphometric Analysis, Tumor Immunohist, Quant Semiquant, Per Specimen, Ea Antibody; Manual (Path)",,88360,CPT,Facility,Inpatient,,,,341,289.85,97.7306,341,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Morphometric Analysis, Tumor Immunohist, Quant Semiquant, Per Specimen, Ea Antibody; Manual (Path)",,88360,CPT,Facility,Both,,,,341,289.85,97.7306,341,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,302.0237,88.57,,percent of total billed charges,,
"Morphometric Analysis, Tumor Immunohist, Quant Semiquant, Per Specimen, Ea Antibody; Manual (Path)",,88360,CPT,Facility,Both,,,,341,289.85,97.7306,341,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,97.7306,28.66,,percent of total billed charges,,
"Morphometric Analysis, Tumor Immunohist, Quant Semiquant, Per Specimen, Ea Antibody; Manual (Path)",,88360,CPT,Facility,Outpatient,,,,341,289.85,97.7306,341,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),167.09,49,,percent of total billed charges,,
"Morphometric Analysis, Tumor Immunohist, Quant Semiquant, Per Specimen, Ea Antibody; Manual (Path)",,88360,CPT,Facility,Inpatient,,,,341,289.85,97.7306,341,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Morphometric Analysis, Tumor Immunohist, Quant Semiquant, Per Specimen, Ea Antibody; Manual (Path)",,88360,CPT,Facility,Both,,,,341,289.85,97.7306,341,CorVel,Worker's Compensation,341,100,,percent of total billed charges,,
"Morphometric Analysis, Tumor Immunohist, Quant Semiquant, Per Specimen, Ea Antibody; Manual (Path)",,88360,CPT,Facility,Both,,,,341,289.85,97.7306,341,First Health Group Corporation,First Health Network,330.77,97,,percent of total billed charges,,
"Morphometric Analysis, Tumor Immunohist, Quant Semiquant, Per Specimen, Ea Antibody; Manual (Path)",,88360,CPT,Facility,Both,,,,341,289.85,97.7306,341,"Health Partners, Inc.",Commercial,322.586,94.6,,percent of total billed charges,,
"Morphometric Analysis, Tumor Immunohist, Quant Semiquant, Per Specimen, Ea Antibody; Manual (Path)",,88360,CPT,Facility,Outpatient,,,,341,289.85,97.7306,341,"Health Partners, Inc.",Medicare Advantage,167.09,49,,percent of total billed charges,,
"Morphometric Analysis, Tumor Immunohist, Quant Semiquant, Per Specimen, Ea Antibody; Manual (Path)",,88360,CPT,Facility,Inpatient,,,,341,289.85,97.7306,341,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Morphometric Analysis, Tumor Immunohist, Quant Semiquant, Per Specimen, Ea Antibody; Manual (Path)",,88360,CPT,Facility,Both,,,,341,289.85,97.7306,341,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),204.6,60,,percent of total billed charges,,
"Morphometric Analysis, Tumor Immunohist, Quant Semiquant, Per Specimen, Ea Antibody; Manual (Path)",,88360,CPT,Facility,Both,,,,341,289.85,97.7306,341,"Health Partners, Inc.",State of Minnesota Advantage Program,277.915,81.5,,percent of total billed charges,,
"Morphometric Analysis, Tumor Immunohist, Quant Semiquant, Per Specimen, Ea Antibody; Manual (Path)",,88360,CPT,Facility,Both,,,,341,289.85,97.7306,341,"Health Partners, Inc.",State Public Programs,170.5,50,,percent of total billed charges,,
"Morphometric Analysis, Tumor Immunohist, Quant Semiquant, Per Specimen, Ea Antibody; Manual (Path)",,88360,CPT,Facility,Both,,,,341,289.85,97.7306,341,Humana Insurance Company,Commercial PPO,323.95,95,,percent of total billed charges,,
"Morphometric Analysis, Tumor Immunohist, Quant Semiquant, Per Specimen, Ea Antibody; Manual (Path)",,88360,CPT,Facility,Outpatient,,,,341,289.85,97.7306,341,Humana Insurance Company,Medicare PPO,167.09,49,,percent of total billed charges,,
"Morphometric Analysis, Tumor Immunohist, Quant Semiquant, Per Specimen, Ea Antibody; Manual (Path)",,88360,CPT,Facility,Inpatient,,,,341,289.85,97.7306,341,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Morphometric Analysis, Tumor Immunohist, Quant Semiquant, Per Specimen, Ea Antibody; Manual (Path)",,88360,CPT,Facility,Both,,,,341,289.85,97.7306,341,Medica,Individual & Family,337.931,99.1,,percent of total billed charges,,
"Morphometric Analysis, Tumor Immunohist, Quant Semiquant, Per Specimen, Ea Antibody; Manual (Path)",,88360,CPT,Facility,Outpatient,,,,341,289.85,97.7306,341,Medica,Medica Advantage Solution,169.818,49.8,,percent of total billed charges,,
"Morphometric Analysis, Tumor Immunohist, Quant Semiquant, Per Specimen, Ea Antibody; Manual (Path)",,88360,CPT,Facility,Inpatient,,,,341,289.85,97.7306,341,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Morphometric Analysis, Tumor Immunohist, Quant Semiquant, Per Specimen, Ea Antibody; Manual (Path)",,88360,CPT,Facility,Outpatient,,,,341,289.85,97.7306,341,Medica,Medical Assistance,152.086,44.6,,percent of total billed charges,,
"Morphometric Analysis, Tumor Immunohist, Quant Semiquant, Per Specimen, Ea Antibody; Manual (Path)",,88360,CPT,Facility,Inpatient,,,,341,289.85,97.7306,341,Medica,Medical Assistance,,,,,Included in per diem rate,
"Morphometric Analysis, Tumor Immunohist, Quant Semiquant, Per Specimen, Ea Antibody; Manual (Path)",,88360,CPT,Facility,Outpatient,,,,341,289.85,97.7306,341,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,169.818,49.8,,percent of total billed charges,,
"Morphometric Analysis, Tumor Immunohist, Quant Semiquant, Per Specimen, Ea Antibody; Manual (Path)",,88360,CPT,Facility,Inpatient,,,,341,289.85,97.7306,341,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Morphometric Analysis, Tumor Immunohist, Quant Semiquant, Per Specimen, Ea Antibody; Manual (Path)",,88360,CPT,Facility,Both,,,,341,289.85,97.7306,341,"Multiplan, Inc.","Multiplan, Inc.",320.54,94,,percent of total billed charges,,
"Morphometric Analysis, Tumor Immunohist, Quant Semiquant, Per Specimen, Ea Antibody; Manual (Path)",,88360,CPT,Facility,Outpatient,,,,341,289.85,97.7306,341,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,307.241,90.1,,percent of total billed charges,,
"Morphometric Analysis, Tumor Immunohist, Quant Semiquant, Per Specimen, Ea Antibody; Manual (Path)",,88360,CPT,Facility,Inpatient,,,,341,289.85,97.7306,341,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Morphometric Analysis, Tumor Immunohist, Quant Semiquant, Per Specimen, Ea Antibody; Manual (Path)",,88360,CPT,Facility,Both,,,,341,289.85,97.7306,341,"Preferred One Administrative Services, INC.",PPO,336.226,98.6,,percent of total billed charges,,
"Morphometric Analysis, Tumor Immunohist, Quant Semiquant, Per Specimen, Ea Antibody; Manual (Path)",,88360,CPT,Facility,Outpatient,,,,341,289.85,97.7306,341,PrimeWest Health,Minnesota Senior Health Options (MSHO),175.4445,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Morphometric Analysis, Tumor Immunohist, Quant Semiquant, Per Specimen, Ea Antibody; Manual (Path)",,88360,CPT,Facility,Inpatient,,,,341,289.85,97.7306,341,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Morphometric Analysis, Tumor Immunohist, Quant Semiquant, Per Specimen, Ea Antibody; Manual (Path)",,88360,CPT,Facility,Outpatient,,,,341,289.85,97.7306,341,PrimeWest Health,MinnesotaCare,175.1376,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Morphometric Analysis, Tumor Immunohist, Quant Semiquant, Per Specimen, Ea Antibody; Manual (Path)",,88360,CPT,Facility,Inpatient,,,,341,289.85,97.7306,341,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Morphometric Analysis, Tumor Immunohist, Quant Semiquant, Per Specimen, Ea Antibody; Manual (Path)",,88360,CPT,Facility,Both,,,,341,289.85,97.7306,341,Sanford Health Plan,Sanford Health Plan,313.72,92,,percent of total billed charges,,
"Morphometric Analysis, Tumor Immunohist, Quant Semiquant, Per Specimen, Ea Antibody; Manual (Path)",,88360,CPT,Facility,Outpatient,,,,341,289.85,97.7306,341,"UCare Health, Inc.",Individual & Family Plan,192.1535,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Morphometric Analysis, Tumor Immunohist, Quant Semiquant, Per Specimen, Ea Antibody; Manual (Path)",,88360,CPT,Facility,Inpatient,,,,341,289.85,97.7306,341,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Morphometric Analysis, Tumor Immunohist, Quant Semiquant, Per Specimen, Ea Antibody; Manual (Path)",,88360,CPT,Facility,Outpatient,,,,341,289.85,97.7306,341,"UCare Health, Inc.",Medical Assistance,172.1027,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Morphometric Analysis, Tumor Immunohist, Quant Semiquant, Per Specimen, Ea Antibody; Manual (Path)",,88360,CPT,Facility,Inpatient,,,,341,289.85,97.7306,341,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Morphometric Analysis, Tumor Immunohist, Quant Semiquant, Per Specimen, Ea Antibody; Manual (Path)",,88360,CPT,Facility,Outpatient,,,,341,289.85,97.7306,341,"UCare Health, Inc.",Medicare Advantage,172.1027,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Morphometric Analysis, Tumor Immunohist, Quant Semiquant, Per Specimen, Ea Antibody; Manual (Path)",,88360,CPT,Facility,Inpatient,,,,341,289.85,97.7306,341,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Morphometric Analysis, Tumor Immunohist, Quant Semiquant, Per Specimen, Ea Antibody; Manual (Path)",,88360,CPT,Facility,Outpatient,,,,341,289.85,97.7306,341,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),172.1027,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Morphometric Analysis, Tumor Immunohist, Quant Semiquant, Per Specimen, Ea Antibody; Manual (Path)",,88360,CPT,Facility,Inpatient,,,,341,289.85,97.7306,341,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Morphometric Analysis, Tumor Immunohist, Quant Semiquant, Per Specimen, Ea Antibody; Manual (Path)",,88360,CPT,Facility,Both,,,,341,289.85,97.7306,341,UnitedHealthcare,Individual & Family,320.54,94,,percent of total billed charges,,
"Morphometric Analysis, Tumor Immunohist, Quant Semiquant, Per Specimen, Ea Antibody; Manual (Path)",,88360,CPT,Facility,Outpatient,,,,341,289.85,97.7306,341,UnitedHealthcare,Medicare Advantage,167.09,49,,percent of total billed charges,,
"Morphometric Analysis, Tumor Immunohist, Quant Semiquant, Per Specimen, Ea Antibody; Manual (Path)",,88360,CPT,Facility,Inpatient,,,,341,289.85,97.7306,341,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Morphometric Analysis, Tumor Immunohist, Quant Semiquant, Per Specimen, Ea Antibody; Manual (Path)",,88360,CPT,Facility,Outpatient,,,,341,289.85,97.7306,341,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,163.68,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Morphometric Analysis, Tumor Immunohist, Quant Semiquant, Per Specimen, Ea Antibody; Manual (Path)",,88360,CPT,Facility,Inpatient,,,,341,289.85,97.7306,341,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Morphometric Analysis, Tumor Immunohistochem, Quant, Per Specimen, Ea Antibody Computerassist (Path)",,88361,CPT,Facility,Both,,,,341,289.85,97.7306,341,Aetna,Commercial,313.72,92,,percent of total billed charges,,
"Morphometric Analysis, Tumor Immunohistochem, Quant, Per Specimen, Ea Antibody Computerassist (Path)",,88361,CPT,Facility,Outpatient,,,,341,289.85,97.7306,341,Aetna,Medicare Advantage,167.09,49,,percent of total billed charges,,
"Morphometric Analysis, Tumor Immunohistochem, Quant, Per Specimen, Ea Antibody Computerassist (Path)",,88361,CPT,Facility,Inpatient,,,,341,289.85,97.7306,341,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Morphometric Analysis, Tumor Immunohistochem, Quant, Per Specimen, Ea Antibody Computerassist (Path)",,88361,CPT,Facility,Both,,,,341,289.85,97.7306,341,Aetna,PPO,317.13,93,,percent of total billed charges,,
"Morphometric Analysis, Tumor Immunohistochem, Quant, Per Specimen, Ea Antibody Computerassist (Path)",,88361,CPT,Facility,Both,,,,341,289.85,97.7306,341,America's PPO,America's PPO,327.4623,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Morphometric Analysis, Tumor Immunohistochem, Quant, Per Specimen, Ea Antibody Computerassist (Path)",,88361,CPT,Facility,Both,,,,341,289.85,97.7306,341,BlueCross BlueShield Minnesota, Federal Employee Program,335.544,98.4,,percent of total billed charges,,
"Morphometric Analysis, Tumor Immunohistochem, Quant, Per Specimen, Ea Antibody Computerassist (Path)",,88361,CPT,Facility,Both,,,,341,289.85,97.7306,341,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,341,100,,percent of total billed charges,,
"Morphometric Analysis, Tumor Immunohistochem, Quant, Per Specimen, Ea Antibody Computerassist (Path)",,88361,CPT,Facility,Both,,,,341,289.85,97.7306,341,BlueCross BlueShield Minnesota,High Value Network Plan,306.9,90,,percent of total billed charges,,
"Morphometric Analysis, Tumor Immunohistochem, Quant, Per Specimen, Ea Antibody Computerassist (Path)",,88361,CPT,Facility,Outpatient,,,,341,289.85,97.7306,341,BlueCross BlueShield Minnesota,Medicare Advantage,167.09,49,,percent of total billed charges,,
"Morphometric Analysis, Tumor Immunohistochem, Quant, Per Specimen, Ea Antibody Computerassist (Path)",,88361,CPT,Facility,Inpatient,,,,341,289.85,97.7306,341,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Morphometric Analysis, Tumor Immunohistochem, Quant, Per Specimen, Ea Antibody Computerassist (Path)",,88361,CPT,Facility,Both,,,,341,289.85,97.7306,341,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,302.0237,88.57,,percent of total billed charges,,
"Morphometric Analysis, Tumor Immunohistochem, Quant, Per Specimen, Ea Antibody Computerassist (Path)",,88361,CPT,Facility,Both,,,,341,289.85,97.7306,341,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,97.7306,28.66,,percent of total billed charges,,
"Morphometric Analysis, Tumor Immunohistochem, Quant, Per Specimen, Ea Antibody Computerassist (Path)",,88361,CPT,Facility,Outpatient,,,,341,289.85,97.7306,341,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),167.09,49,,percent of total billed charges,,
"Morphometric Analysis, Tumor Immunohistochem, Quant, Per Specimen, Ea Antibody Computerassist (Path)",,88361,CPT,Facility,Inpatient,,,,341,289.85,97.7306,341,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Morphometric Analysis, Tumor Immunohistochem, Quant, Per Specimen, Ea Antibody Computerassist (Path)",,88361,CPT,Facility,Both,,,,341,289.85,97.7306,341,CorVel,Worker's Compensation,341,100,,percent of total billed charges,,
"Morphometric Analysis, Tumor Immunohistochem, Quant, Per Specimen, Ea Antibody Computerassist (Path)",,88361,CPT,Facility,Both,,,,341,289.85,97.7306,341,First Health Group Corporation,First Health Network,330.77,97,,percent of total billed charges,,
"Morphometric Analysis, Tumor Immunohistochem, Quant, Per Specimen, Ea Antibody Computerassist (Path)",,88361,CPT,Facility,Both,,,,341,289.85,97.7306,341,"Health Partners, Inc.",Commercial,322.586,94.6,,percent of total billed charges,,
"Morphometric Analysis, Tumor Immunohistochem, Quant, Per Specimen, Ea Antibody Computerassist (Path)",,88361,CPT,Facility,Outpatient,,,,341,289.85,97.7306,341,"Health Partners, Inc.",Medicare Advantage,167.09,49,,percent of total billed charges,,
"Morphometric Analysis, Tumor Immunohistochem, Quant, Per Specimen, Ea Antibody Computerassist (Path)",,88361,CPT,Facility,Inpatient,,,,341,289.85,97.7306,341,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Morphometric Analysis, Tumor Immunohistochem, Quant, Per Specimen, Ea Antibody Computerassist (Path)",,88361,CPT,Facility,Both,,,,341,289.85,97.7306,341,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),204.6,60,,percent of total billed charges,,
"Morphometric Analysis, Tumor Immunohistochem, Quant, Per Specimen, Ea Antibody Computerassist (Path)",,88361,CPT,Facility,Both,,,,341,289.85,97.7306,341,"Health Partners, Inc.",State of Minnesota Advantage Program,277.915,81.5,,percent of total billed charges,,
"Morphometric Analysis, Tumor Immunohistochem, Quant, Per Specimen, Ea Antibody Computerassist (Path)",,88361,CPT,Facility,Both,,,,341,289.85,97.7306,341,"Health Partners, Inc.",State Public Programs,170.5,50,,percent of total billed charges,,
"Morphometric Analysis, Tumor Immunohistochem, Quant, Per Specimen, Ea Antibody Computerassist (Path)",,88361,CPT,Facility,Both,,,,341,289.85,97.7306,341,Humana Insurance Company,Commercial PPO,323.95,95,,percent of total billed charges,,
"Morphometric Analysis, Tumor Immunohistochem, Quant, Per Specimen, Ea Antibody Computerassist (Path)",,88361,CPT,Facility,Outpatient,,,,341,289.85,97.7306,341,Humana Insurance Company,Medicare PPO,167.09,49,,percent of total billed charges,,
"Morphometric Analysis, Tumor Immunohistochem, Quant, Per Specimen, Ea Antibody Computerassist (Path)",,88361,CPT,Facility,Inpatient,,,,341,289.85,97.7306,341,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Morphometric Analysis, Tumor Immunohistochem, Quant, Per Specimen, Ea Antibody Computerassist (Path)",,88361,CPT,Facility,Both,,,,341,289.85,97.7306,341,Medica,Individual & Family,337.931,99.1,,percent of total billed charges,,
"Morphometric Analysis, Tumor Immunohistochem, Quant, Per Specimen, Ea Antibody Computerassist (Path)",,88361,CPT,Facility,Outpatient,,,,341,289.85,97.7306,341,Medica,Medica Advantage Solution,169.818,49.8,,percent of total billed charges,,
"Morphometric Analysis, Tumor Immunohistochem, Quant, Per Specimen, Ea Antibody Computerassist (Path)",,88361,CPT,Facility,Inpatient,,,,341,289.85,97.7306,341,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Morphometric Analysis, Tumor Immunohistochem, Quant, Per Specimen, Ea Antibody Computerassist (Path)",,88361,CPT,Facility,Outpatient,,,,341,289.85,97.7306,341,Medica,Medical Assistance,152.086,44.6,,percent of total billed charges,,
"Morphometric Analysis, Tumor Immunohistochem, Quant, Per Specimen, Ea Antibody Computerassist (Path)",,88361,CPT,Facility,Inpatient,,,,341,289.85,97.7306,341,Medica,Medical Assistance,,,,,Included in per diem rate,
"Morphometric Analysis, Tumor Immunohistochem, Quant, Per Specimen, Ea Antibody Computerassist (Path)",,88361,CPT,Facility,Outpatient,,,,341,289.85,97.7306,341,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,169.818,49.8,,percent of total billed charges,,
"Morphometric Analysis, Tumor Immunohistochem, Quant, Per Specimen, Ea Antibody Computerassist (Path)",,88361,CPT,Facility,Inpatient,,,,341,289.85,97.7306,341,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Morphometric Analysis, Tumor Immunohistochem, Quant, Per Specimen, Ea Antibody Computerassist (Path)",,88361,CPT,Facility,Both,,,,341,289.85,97.7306,341,"Multiplan, Inc.","Multiplan, Inc.",320.54,94,,percent of total billed charges,,
"Morphometric Analysis, Tumor Immunohistochem, Quant, Per Specimen, Ea Antibody Computerassist (Path)",,88361,CPT,Facility,Outpatient,,,,341,289.85,97.7306,341,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,307.241,90.1,,percent of total billed charges,,
"Morphometric Analysis, Tumor Immunohistochem, Quant, Per Specimen, Ea Antibody Computerassist (Path)",,88361,CPT,Facility,Inpatient,,,,341,289.85,97.7306,341,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Morphometric Analysis, Tumor Immunohistochem, Quant, Per Specimen, Ea Antibody Computerassist (Path)",,88361,CPT,Facility,Both,,,,341,289.85,97.7306,341,"Preferred One Administrative Services, INC.",PPO,336.226,98.6,,percent of total billed charges,,
"Morphometric Analysis, Tumor Immunohistochem, Quant, Per Specimen, Ea Antibody Computerassist (Path)",,88361,CPT,Facility,Outpatient,,,,341,289.85,97.7306,341,PrimeWest Health,Minnesota Senior Health Options (MSHO),175.4445,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Morphometric Analysis, Tumor Immunohistochem, Quant, Per Specimen, Ea Antibody Computerassist (Path)",,88361,CPT,Facility,Inpatient,,,,341,289.85,97.7306,341,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Morphometric Analysis, Tumor Immunohistochem, Quant, Per Specimen, Ea Antibody Computerassist (Path)",,88361,CPT,Facility,Outpatient,,,,341,289.85,97.7306,341,PrimeWest Health,MinnesotaCare,175.1376,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Morphometric Analysis, Tumor Immunohistochem, Quant, Per Specimen, Ea Antibody Computerassist (Path)",,88361,CPT,Facility,Inpatient,,,,341,289.85,97.7306,341,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Morphometric Analysis, Tumor Immunohistochem, Quant, Per Specimen, Ea Antibody Computerassist (Path)",,88361,CPT,Facility,Both,,,,341,289.85,97.7306,341,Sanford Health Plan,Sanford Health Plan,313.72,92,,percent of total billed charges,,
"Morphometric Analysis, Tumor Immunohistochem, Quant, Per Specimen, Ea Antibody Computerassist (Path)",,88361,CPT,Facility,Outpatient,,,,341,289.85,97.7306,341,"UCare Health, Inc.",Individual & Family Plan,192.1535,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Morphometric Analysis, Tumor Immunohistochem, Quant, Per Specimen, Ea Antibody Computerassist (Path)",,88361,CPT,Facility,Inpatient,,,,341,289.85,97.7306,341,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Morphometric Analysis, Tumor Immunohistochem, Quant, Per Specimen, Ea Antibody Computerassist (Path)",,88361,CPT,Facility,Outpatient,,,,341,289.85,97.7306,341,"UCare Health, Inc.",Medical Assistance,172.1027,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Morphometric Analysis, Tumor Immunohistochem, Quant, Per Specimen, Ea Antibody Computerassist (Path)",,88361,CPT,Facility,Inpatient,,,,341,289.85,97.7306,341,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Morphometric Analysis, Tumor Immunohistochem, Quant, Per Specimen, Ea Antibody Computerassist (Path)",,88361,CPT,Facility,Outpatient,,,,341,289.85,97.7306,341,"UCare Health, Inc.",Medicare Advantage,172.1027,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Morphometric Analysis, Tumor Immunohistochem, Quant, Per Specimen, Ea Antibody Computerassist (Path)",,88361,CPT,Facility,Inpatient,,,,341,289.85,97.7306,341,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Morphometric Analysis, Tumor Immunohistochem, Quant, Per Specimen, Ea Antibody Computerassist (Path)",,88361,CPT,Facility,Outpatient,,,,341,289.85,97.7306,341,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),172.1027,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Morphometric Analysis, Tumor Immunohistochem, Quant, Per Specimen, Ea Antibody Computerassist (Path)",,88361,CPT,Facility,Inpatient,,,,341,289.85,97.7306,341,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Morphometric Analysis, Tumor Immunohistochem, Quant, Per Specimen, Ea Antibody Computerassist (Path)",,88361,CPT,Facility,Both,,,,341,289.85,97.7306,341,UnitedHealthcare,Individual & Family,320.54,94,,percent of total billed charges,,
"Morphometric Analysis, Tumor Immunohistochem, Quant, Per Specimen, Ea Antibody Computerassist (Path)",,88361,CPT,Facility,Outpatient,,,,341,289.85,97.7306,341,UnitedHealthcare,Medicare Advantage,167.09,49,,percent of total billed charges,,
"Morphometric Analysis, Tumor Immunohistochem, Quant, Per Specimen, Ea Antibody Computerassist (Path)",,88361,CPT,Facility,Inpatient,,,,341,289.85,97.7306,341,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Morphometric Analysis, Tumor Immunohistochem, Quant, Per Specimen, Ea Antibody Computerassist (Path)",,88361,CPT,Facility,Outpatient,,,,341,289.85,97.7306,341,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,163.68,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Morphometric Analysis, Tumor Immunohistochem, Quant, Per Specimen, Ea Antibody Computerassist (Path)",,88361,CPT,Facility,Inpatient,,,,341,289.85,97.7306,341,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Cell Count W/O Differential, Body Fluid",,89050,CPT,Facility,Both,,,,33,28.05,9.4578,33,Aetna,Commercial,30.36,92,,percent of total billed charges,,
"Cell Count W/O Differential, Body Fluid",,89050,CPT,Facility,Outpatient,,,,33,28.05,9.4578,33,Aetna,Medicare Advantage,16.17,49,,percent of total billed charges,,
"Cell Count W/O Differential, Body Fluid",,89050,CPT,Facility,Inpatient,,,,33,28.05,9.4578,33,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Cell Count W/O Differential, Body Fluid",,89050,CPT,Facility,Both,,,,33,28.05,9.4578,33,Aetna,PPO,30.69,93,,percent of total billed charges,,
"Cell Count W/O Differential, Body Fluid",,89050,CPT,Facility,Both,,,,33,28.05,9.4578,33,America's PPO,America's PPO,31.6899,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Cell Count W/O Differential, Body Fluid",,89050,CPT,Facility,Both,,,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota, Federal Employee Program,32.472,98.4,,percent of total billed charges,,
"Cell Count W/O Differential, Body Fluid",,89050,CPT,Facility,Both,,,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,33,100,,percent of total billed charges,,
"Cell Count W/O Differential, Body Fluid",,89050,CPT,Facility,Both,,,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota,High Value Network Plan,29.7,90,,percent of total billed charges,,
"Cell Count W/O Differential, Body Fluid",,89050,CPT,Facility,Outpatient,,,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota,Medicare Advantage,16.17,49,,percent of total billed charges,,
"Cell Count W/O Differential, Body Fluid",,89050,CPT,Facility,Inpatient,,,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Cell Count W/O Differential, Body Fluid",,89050,CPT,Facility,Both,,,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,29.2281,88.57,,percent of total billed charges,,
"Cell Count W/O Differential, Body Fluid",,89050,CPT,Facility,Both,,,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,9.4578,28.66,,percent of total billed charges,,
"Cell Count W/O Differential, Body Fluid",,89050,CPT,Facility,Outpatient,,,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),16.17,49,,percent of total billed charges,,
"Cell Count W/O Differential, Body Fluid",,89050,CPT,Facility,Inpatient,,,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Cell Count W/O Differential, Body Fluid",,89050,CPT,Facility,Both,,,,33,28.05,9.4578,33,CorVel,Worker's Compensation,33,100,,percent of total billed charges,,
"Cell Count W/O Differential, Body Fluid",,89050,CPT,Facility,Both,,,,33,28.05,9.4578,33,First Health Group Corporation,First Health Network,32.01,97,,percent of total billed charges,,
"Cell Count W/O Differential, Body Fluid",,89050,CPT,Facility,Both,,,,33,28.05,9.4578,33,"Health Partners, Inc.",Commercial,31.218,94.6,,percent of total billed charges,,
"Cell Count W/O Differential, Body Fluid",,89050,CPT,Facility,Outpatient,,,,33,28.05,9.4578,33,"Health Partners, Inc.",Medicare Advantage,16.17,49,,percent of total billed charges,,
"Cell Count W/O Differential, Body Fluid",,89050,CPT,Facility,Inpatient,,,,33,28.05,9.4578,33,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Cell Count W/O Differential, Body Fluid",,89050,CPT,Facility,Both,,,,33,28.05,9.4578,33,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),19.8,60,,percent of total billed charges,,
"Cell Count W/O Differential, Body Fluid",,89050,CPT,Facility,Both,,,,33,28.05,9.4578,33,"Health Partners, Inc.",State of Minnesota Advantage Program,26.895,81.5,,percent of total billed charges,,
"Cell Count W/O Differential, Body Fluid",,89050,CPT,Facility,Both,,,,33,28.05,9.4578,33,"Health Partners, Inc.",State Public Programs,16.5,50,,percent of total billed charges,,
"Cell Count W/O Differential, Body Fluid",,89050,CPT,Facility,Both,,,,33,28.05,9.4578,33,Humana Insurance Company,Commercial PPO,31.35,95,,percent of total billed charges,,
"Cell Count W/O Differential, Body Fluid",,89050,CPT,Facility,Outpatient,,,,33,28.05,9.4578,33,Humana Insurance Company,Medicare PPO,16.17,49,,percent of total billed charges,,
"Cell Count W/O Differential, Body Fluid",,89050,CPT,Facility,Inpatient,,,,33,28.05,9.4578,33,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Cell Count W/O Differential, Body Fluid",,89050,CPT,Facility,Both,,,,33,28.05,9.4578,33,Medica,Individual & Family,32.703,99.1,,percent of total billed charges,,
"Cell Count W/O Differential, Body Fluid",,89050,CPT,Facility,Outpatient,,,,33,28.05,9.4578,33,Medica,Medica Advantage Solution,16.434,49.8,,percent of total billed charges,,
"Cell Count W/O Differential, Body Fluid",,89050,CPT,Facility,Inpatient,,,,33,28.05,9.4578,33,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Cell Count W/O Differential, Body Fluid",,89050,CPT,Facility,Outpatient,,,,33,28.05,9.4578,33,Medica,Medical Assistance,14.718,44.6,,percent of total billed charges,,
"Cell Count W/O Differential, Body Fluid",,89050,CPT,Facility,Inpatient,,,,33,28.05,9.4578,33,Medica,Medical Assistance,,,,,Included in per diem rate,
"Cell Count W/O Differential, Body Fluid",,89050,CPT,Facility,Outpatient,,,,33,28.05,9.4578,33,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,16.434,49.8,,percent of total billed charges,,
"Cell Count W/O Differential, Body Fluid",,89050,CPT,Facility,Inpatient,,,,33,28.05,9.4578,33,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Cell Count W/O Differential, Body Fluid",,89050,CPT,Facility,Both,,,,33,28.05,9.4578,33,"Multiplan, Inc.","Multiplan, Inc.",31.02,94,,percent of total billed charges,,
"Cell Count W/O Differential, Body Fluid",,89050,CPT,Facility,Outpatient,,,,33,28.05,9.4578,33,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,28.512,86.4,,percent of total billed charges,,
"Cell Count W/O Differential, Body Fluid",,89050,CPT,Facility,Inpatient,,,,33,28.05,9.4578,33,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Cell Count W/O Differential, Body Fluid",,89050,CPT,Facility,Both,,,,33,28.05,9.4578,33,"Preferred One Administrative Services, INC.",PPO,32.538,98.6,,percent of total billed charges,,
"Cell Count W/O Differential, Body Fluid",,89050,CPT,Facility,Outpatient,,,,33,28.05,9.4578,33,PrimeWest Health,Minnesota Senior Health Options (MSHO),16.9785,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Cell Count W/O Differential, Body Fluid",,89050,CPT,Facility,Inpatient,,,,33,28.05,9.4578,33,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Cell Count W/O Differential, Body Fluid",,89050,CPT,Facility,Outpatient,,,,33,28.05,9.4578,33,PrimeWest Health,MinnesotaCare,16.9488,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Cell Count W/O Differential, Body Fluid",,89050,CPT,Facility,Inpatient,,,,33,28.05,9.4578,33,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Cell Count W/O Differential, Body Fluid",,89050,CPT,Facility,Both,,,,33,28.05,9.4578,33,Sanford Health Plan,Sanford Health Plan,30.36,92,,percent of total billed charges,,
"Cell Count W/O Differential, Body Fluid",,89050,CPT,Facility,Outpatient,,,,33,28.05,9.4578,33,"UCare Health, Inc.",Individual & Family Plan,18.5955,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Cell Count W/O Differential, Body Fluid",,89050,CPT,Facility,Inpatient,,,,33,28.05,9.4578,33,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Cell Count W/O Differential, Body Fluid",,89050,CPT,Facility,Outpatient,,,,33,28.05,9.4578,33,"UCare Health, Inc.",Medical Assistance,16.6551,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Cell Count W/O Differential, Body Fluid",,89050,CPT,Facility,Inpatient,,,,33,28.05,9.4578,33,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Cell Count W/O Differential, Body Fluid",,89050,CPT,Facility,Outpatient,,,,33,28.05,9.4578,33,"UCare Health, Inc.",Medicare Advantage,16.6551,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Cell Count W/O Differential, Body Fluid",,89050,CPT,Facility,Inpatient,,,,33,28.05,9.4578,33,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Cell Count W/O Differential, Body Fluid",,89050,CPT,Facility,Outpatient,,,,33,28.05,9.4578,33,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),16.6551,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Cell Count W/O Differential, Body Fluid",,89050,CPT,Facility,Inpatient,,,,33,28.05,9.4578,33,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Cell Count W/O Differential, Body Fluid",,89050,CPT,Facility,Both,,,,33,28.05,9.4578,33,UnitedHealthcare,Individual & Family,31.02,94,,percent of total billed charges,,
"Cell Count W/O Differential, Body Fluid",,89050,CPT,Facility,Outpatient,,,,33,28.05,9.4578,33,UnitedHealthcare,Medicare Advantage,16.17,49,,percent of total billed charges,,
"Cell Count W/O Differential, Body Fluid",,89050,CPT,Facility,Inpatient,,,,33,28.05,9.4578,33,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Cell Count W/O Differential, Body Fluid",,89050,CPT,Facility,Outpatient,,,,33,28.05,9.4578,33,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,15.84,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Cell Count W/O Differential, Body Fluid",,89050,CPT,Facility,Inpatient,,,,33,28.05,9.4578,33,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Cell Count W/O Differential, Cerebral Spinal Fluid",,89050,CPT,Facility,Both,,,,33,28.05,9.4578,33,Aetna,Commercial,30.36,92,,percent of total billed charges,,
"Cell Count W/O Differential, Cerebral Spinal Fluid",,89050,CPT,Facility,Outpatient,,,,33,28.05,9.4578,33,Aetna,Medicare Advantage,16.17,49,,percent of total billed charges,,
"Cell Count W/O Differential, Cerebral Spinal Fluid",,89050,CPT,Facility,Inpatient,,,,33,28.05,9.4578,33,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Cell Count W/O Differential, Cerebral Spinal Fluid",,89050,CPT,Facility,Both,,,,33,28.05,9.4578,33,Aetna,PPO,30.69,93,,percent of total billed charges,,
"Cell Count W/O Differential, Cerebral Spinal Fluid",,89050,CPT,Facility,Both,,,,33,28.05,9.4578,33,America's PPO,America's PPO,31.6899,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Cell Count W/O Differential, Cerebral Spinal Fluid",,89050,CPT,Facility,Both,,,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota, Federal Employee Program,32.472,98.4,,percent of total billed charges,,
"Cell Count W/O Differential, Cerebral Spinal Fluid",,89050,CPT,Facility,Both,,,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,33,100,,percent of total billed charges,,
"Cell Count W/O Differential, Cerebral Spinal Fluid",,89050,CPT,Facility,Both,,,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota,High Value Network Plan,29.7,90,,percent of total billed charges,,
"Cell Count W/O Differential, Cerebral Spinal Fluid",,89050,CPT,Facility,Outpatient,,,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota,Medicare Advantage,16.17,49,,percent of total billed charges,,
"Cell Count W/O Differential, Cerebral Spinal Fluid",,89050,CPT,Facility,Inpatient,,,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Cell Count W/O Differential, Cerebral Spinal Fluid",,89050,CPT,Facility,Both,,,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,29.2281,88.57,,percent of total billed charges,,
"Cell Count W/O Differential, Cerebral Spinal Fluid",,89050,CPT,Facility,Both,,,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,9.4578,28.66,,percent of total billed charges,,
"Cell Count W/O Differential, Cerebral Spinal Fluid",,89050,CPT,Facility,Outpatient,,,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),16.17,49,,percent of total billed charges,,
"Cell Count W/O Differential, Cerebral Spinal Fluid",,89050,CPT,Facility,Inpatient,,,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Cell Count W/O Differential, Cerebral Spinal Fluid",,89050,CPT,Facility,Both,,,,33,28.05,9.4578,33,CorVel,Worker's Compensation,33,100,,percent of total billed charges,,
"Cell Count W/O Differential, Cerebral Spinal Fluid",,89050,CPT,Facility,Both,,,,33,28.05,9.4578,33,First Health Group Corporation,First Health Network,32.01,97,,percent of total billed charges,,
"Cell Count W/O Differential, Cerebral Spinal Fluid",,89050,CPT,Facility,Both,,,,33,28.05,9.4578,33,"Health Partners, Inc.",Commercial,31.218,94.6,,percent of total billed charges,,
"Cell Count W/O Differential, Cerebral Spinal Fluid",,89050,CPT,Facility,Outpatient,,,,33,28.05,9.4578,33,"Health Partners, Inc.",Medicare Advantage,16.17,49,,percent of total billed charges,,
"Cell Count W/O Differential, Cerebral Spinal Fluid",,89050,CPT,Facility,Inpatient,,,,33,28.05,9.4578,33,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Cell Count W/O Differential, Cerebral Spinal Fluid",,89050,CPT,Facility,Both,,,,33,28.05,9.4578,33,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),19.8,60,,percent of total billed charges,,
"Cell Count W/O Differential, Cerebral Spinal Fluid",,89050,CPT,Facility,Both,,,,33,28.05,9.4578,33,"Health Partners, Inc.",State of Minnesota Advantage Program,26.895,81.5,,percent of total billed charges,,
"Cell Count W/O Differential, Cerebral Spinal Fluid",,89050,CPT,Facility,Both,,,,33,28.05,9.4578,33,"Health Partners, Inc.",State Public Programs,16.5,50,,percent of total billed charges,,
"Cell Count W/O Differential, Cerebral Spinal Fluid",,89050,CPT,Facility,Both,,,,33,28.05,9.4578,33,Humana Insurance Company,Commercial PPO,31.35,95,,percent of total billed charges,,
"Cell Count W/O Differential, Cerebral Spinal Fluid",,89050,CPT,Facility,Outpatient,,,,33,28.05,9.4578,33,Humana Insurance Company,Medicare PPO,16.17,49,,percent of total billed charges,,
"Cell Count W/O Differential, Cerebral Spinal Fluid",,89050,CPT,Facility,Inpatient,,,,33,28.05,9.4578,33,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Cell Count W/O Differential, Cerebral Spinal Fluid",,89050,CPT,Facility,Both,,,,33,28.05,9.4578,33,Medica,Individual & Family,32.703,99.1,,percent of total billed charges,,
"Cell Count W/O Differential, Cerebral Spinal Fluid",,89050,CPT,Facility,Outpatient,,,,33,28.05,9.4578,33,Medica,Medica Advantage Solution,16.434,49.8,,percent of total billed charges,,
"Cell Count W/O Differential, Cerebral Spinal Fluid",,89050,CPT,Facility,Inpatient,,,,33,28.05,9.4578,33,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Cell Count W/O Differential, Cerebral Spinal Fluid",,89050,CPT,Facility,Outpatient,,,,33,28.05,9.4578,33,Medica,Medical Assistance,14.718,44.6,,percent of total billed charges,,
"Cell Count W/O Differential, Cerebral Spinal Fluid",,89050,CPT,Facility,Inpatient,,,,33,28.05,9.4578,33,Medica,Medical Assistance,,,,,Included in per diem rate,
"Cell Count W/O Differential, Cerebral Spinal Fluid",,89050,CPT,Facility,Outpatient,,,,33,28.05,9.4578,33,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,16.434,49.8,,percent of total billed charges,,
"Cell Count W/O Differential, Cerebral Spinal Fluid",,89050,CPT,Facility,Inpatient,,,,33,28.05,9.4578,33,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Cell Count W/O Differential, Cerebral Spinal Fluid",,89050,CPT,Facility,Both,,,,33,28.05,9.4578,33,"Multiplan, Inc.","Multiplan, Inc.",31.02,94,,percent of total billed charges,,
"Cell Count W/O Differential, Cerebral Spinal Fluid",,89050,CPT,Facility,Outpatient,,,,33,28.05,9.4578,33,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,28.512,86.4,,percent of total billed charges,,
"Cell Count W/O Differential, Cerebral Spinal Fluid",,89050,CPT,Facility,Inpatient,,,,33,28.05,9.4578,33,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Cell Count W/O Differential, Cerebral Spinal Fluid",,89050,CPT,Facility,Both,,,,33,28.05,9.4578,33,"Preferred One Administrative Services, INC.",PPO,32.538,98.6,,percent of total billed charges,,
"Cell Count W/O Differential, Cerebral Spinal Fluid",,89050,CPT,Facility,Outpatient,,,,33,28.05,9.4578,33,PrimeWest Health,Minnesota Senior Health Options (MSHO),16.9785,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Cell Count W/O Differential, Cerebral Spinal Fluid",,89050,CPT,Facility,Inpatient,,,,33,28.05,9.4578,33,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Cell Count W/O Differential, Cerebral Spinal Fluid",,89050,CPT,Facility,Outpatient,,,,33,28.05,9.4578,33,PrimeWest Health,MinnesotaCare,16.9488,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Cell Count W/O Differential, Cerebral Spinal Fluid",,89050,CPT,Facility,Inpatient,,,,33,28.05,9.4578,33,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Cell Count W/O Differential, Cerebral Spinal Fluid",,89050,CPT,Facility,Both,,,,33,28.05,9.4578,33,Sanford Health Plan,Sanford Health Plan,30.36,92,,percent of total billed charges,,
"Cell Count W/O Differential, Cerebral Spinal Fluid",,89050,CPT,Facility,Outpatient,,,,33,28.05,9.4578,33,"UCare Health, Inc.",Individual & Family Plan,18.5955,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Cell Count W/O Differential, Cerebral Spinal Fluid",,89050,CPT,Facility,Inpatient,,,,33,28.05,9.4578,33,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Cell Count W/O Differential, Cerebral Spinal Fluid",,89050,CPT,Facility,Outpatient,,,,33,28.05,9.4578,33,"UCare Health, Inc.",Medical Assistance,16.6551,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Cell Count W/O Differential, Cerebral Spinal Fluid",,89050,CPT,Facility,Inpatient,,,,33,28.05,9.4578,33,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Cell Count W/O Differential, Cerebral Spinal Fluid",,89050,CPT,Facility,Outpatient,,,,33,28.05,9.4578,33,"UCare Health, Inc.",Medicare Advantage,16.6551,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Cell Count W/O Differential, Cerebral Spinal Fluid",,89050,CPT,Facility,Inpatient,,,,33,28.05,9.4578,33,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Cell Count W/O Differential, Cerebral Spinal Fluid",,89050,CPT,Facility,Outpatient,,,,33,28.05,9.4578,33,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),16.6551,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Cell Count W/O Differential, Cerebral Spinal Fluid",,89050,CPT,Facility,Inpatient,,,,33,28.05,9.4578,33,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Cell Count W/O Differential, Cerebral Spinal Fluid",,89050,CPT,Facility,Both,,,,33,28.05,9.4578,33,UnitedHealthcare,Individual & Family,31.02,94,,percent of total billed charges,,
"Cell Count W/O Differential, Cerebral Spinal Fluid",,89050,CPT,Facility,Outpatient,,,,33,28.05,9.4578,33,UnitedHealthcare,Medicare Advantage,16.17,49,,percent of total billed charges,,
"Cell Count W/O Differential, Cerebral Spinal Fluid",,89050,CPT,Facility,Inpatient,,,,33,28.05,9.4578,33,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Cell Count W/O Differential, Cerebral Spinal Fluid",,89050,CPT,Facility,Outpatient,,,,33,28.05,9.4578,33,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,15.84,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Cell Count W/O Differential, Cerebral Spinal Fluid",,89050,CPT,Facility,Inpatient,,,,33,28.05,9.4578,33,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Cell Count W/O Differential, Synovial Fluid",,89050,CPT,Facility,Both,,,,33,28.05,9.4578,33,Aetna,Commercial,30.36,92,,percent of total billed charges,,
"Cell Count W/O Differential, Synovial Fluid",,89050,CPT,Facility,Outpatient,,,,33,28.05,9.4578,33,Aetna,Medicare Advantage,16.17,49,,percent of total billed charges,,
"Cell Count W/O Differential, Synovial Fluid",,89050,CPT,Facility,Inpatient,,,,33,28.05,9.4578,33,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Cell Count W/O Differential, Synovial Fluid",,89050,CPT,Facility,Both,,,,33,28.05,9.4578,33,Aetna,PPO,30.69,93,,percent of total billed charges,,
"Cell Count W/O Differential, Synovial Fluid",,89050,CPT,Facility,Both,,,,33,28.05,9.4578,33,America's PPO,America's PPO,31.6899,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Cell Count W/O Differential, Synovial Fluid",,89050,CPT,Facility,Both,,,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota, Federal Employee Program,32.472,98.4,,percent of total billed charges,,
"Cell Count W/O Differential, Synovial Fluid",,89050,CPT,Facility,Both,,,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,33,100,,percent of total billed charges,,
"Cell Count W/O Differential, Synovial Fluid",,89050,CPT,Facility,Both,,,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota,High Value Network Plan,29.7,90,,percent of total billed charges,,
"Cell Count W/O Differential, Synovial Fluid",,89050,CPT,Facility,Outpatient,,,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota,Medicare Advantage,16.17,49,,percent of total billed charges,,
"Cell Count W/O Differential, Synovial Fluid",,89050,CPT,Facility,Inpatient,,,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Cell Count W/O Differential, Synovial Fluid",,89050,CPT,Facility,Both,,,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,29.2281,88.57,,percent of total billed charges,,
"Cell Count W/O Differential, Synovial Fluid",,89050,CPT,Facility,Both,,,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,9.4578,28.66,,percent of total billed charges,,
"Cell Count W/O Differential, Synovial Fluid",,89050,CPT,Facility,Outpatient,,,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),16.17,49,,percent of total billed charges,,
"Cell Count W/O Differential, Synovial Fluid",,89050,CPT,Facility,Inpatient,,,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Cell Count W/O Differential, Synovial Fluid",,89050,CPT,Facility,Both,,,,33,28.05,9.4578,33,CorVel,Worker's Compensation,33,100,,percent of total billed charges,,
"Cell Count W/O Differential, Synovial Fluid",,89050,CPT,Facility,Both,,,,33,28.05,9.4578,33,First Health Group Corporation,First Health Network,32.01,97,,percent of total billed charges,,
"Cell Count W/O Differential, Synovial Fluid",,89050,CPT,Facility,Both,,,,33,28.05,9.4578,33,"Health Partners, Inc.",Commercial,31.218,94.6,,percent of total billed charges,,
"Cell Count W/O Differential, Synovial Fluid",,89050,CPT,Facility,Outpatient,,,,33,28.05,9.4578,33,"Health Partners, Inc.",Medicare Advantage,16.17,49,,percent of total billed charges,,
"Cell Count W/O Differential, Synovial Fluid",,89050,CPT,Facility,Inpatient,,,,33,28.05,9.4578,33,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Cell Count W/O Differential, Synovial Fluid",,89050,CPT,Facility,Both,,,,33,28.05,9.4578,33,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),19.8,60,,percent of total billed charges,,
"Cell Count W/O Differential, Synovial Fluid",,89050,CPT,Facility,Both,,,,33,28.05,9.4578,33,"Health Partners, Inc.",State of Minnesota Advantage Program,26.895,81.5,,percent of total billed charges,,
"Cell Count W/O Differential, Synovial Fluid",,89050,CPT,Facility,Both,,,,33,28.05,9.4578,33,"Health Partners, Inc.",State Public Programs,16.5,50,,percent of total billed charges,,
"Cell Count W/O Differential, Synovial Fluid",,89050,CPT,Facility,Both,,,,33,28.05,9.4578,33,Humana Insurance Company,Commercial PPO,31.35,95,,percent of total billed charges,,
"Cell Count W/O Differential, Synovial Fluid",,89050,CPT,Facility,Outpatient,,,,33,28.05,9.4578,33,Humana Insurance Company,Medicare PPO,16.17,49,,percent of total billed charges,,
"Cell Count W/O Differential, Synovial Fluid",,89050,CPT,Facility,Inpatient,,,,33,28.05,9.4578,33,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Cell Count W/O Differential, Synovial Fluid",,89050,CPT,Facility,Both,,,,33,28.05,9.4578,33,Medica,Individual & Family,32.703,99.1,,percent of total billed charges,,
"Cell Count W/O Differential, Synovial Fluid",,89050,CPT,Facility,Outpatient,,,,33,28.05,9.4578,33,Medica,Medica Advantage Solution,16.434,49.8,,percent of total billed charges,,
"Cell Count W/O Differential, Synovial Fluid",,89050,CPT,Facility,Inpatient,,,,33,28.05,9.4578,33,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Cell Count W/O Differential, Synovial Fluid",,89050,CPT,Facility,Outpatient,,,,33,28.05,9.4578,33,Medica,Medical Assistance,14.718,44.6,,percent of total billed charges,,
"Cell Count W/O Differential, Synovial Fluid",,89050,CPT,Facility,Inpatient,,,,33,28.05,9.4578,33,Medica,Medical Assistance,,,,,Included in per diem rate,
"Cell Count W/O Differential, Synovial Fluid",,89050,CPT,Facility,Outpatient,,,,33,28.05,9.4578,33,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,16.434,49.8,,percent of total billed charges,,
"Cell Count W/O Differential, Synovial Fluid",,89050,CPT,Facility,Inpatient,,,,33,28.05,9.4578,33,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Cell Count W/O Differential, Synovial Fluid",,89050,CPT,Facility,Both,,,,33,28.05,9.4578,33,"Multiplan, Inc.","Multiplan, Inc.",31.02,94,,percent of total billed charges,,
"Cell Count W/O Differential, Synovial Fluid",,89050,CPT,Facility,Outpatient,,,,33,28.05,9.4578,33,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,28.512,86.4,,percent of total billed charges,,
"Cell Count W/O Differential, Synovial Fluid",,89050,CPT,Facility,Inpatient,,,,33,28.05,9.4578,33,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Cell Count W/O Differential, Synovial Fluid",,89050,CPT,Facility,Both,,,,33,28.05,9.4578,33,"Preferred One Administrative Services, INC.",PPO,32.538,98.6,,percent of total billed charges,,
"Cell Count W/O Differential, Synovial Fluid",,89050,CPT,Facility,Outpatient,,,,33,28.05,9.4578,33,PrimeWest Health,Minnesota Senior Health Options (MSHO),16.9785,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Cell Count W/O Differential, Synovial Fluid",,89050,CPT,Facility,Inpatient,,,,33,28.05,9.4578,33,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Cell Count W/O Differential, Synovial Fluid",,89050,CPT,Facility,Outpatient,,,,33,28.05,9.4578,33,PrimeWest Health,MinnesotaCare,16.9488,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Cell Count W/O Differential, Synovial Fluid",,89050,CPT,Facility,Inpatient,,,,33,28.05,9.4578,33,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Cell Count W/O Differential, Synovial Fluid",,89050,CPT,Facility,Both,,,,33,28.05,9.4578,33,Sanford Health Plan,Sanford Health Plan,30.36,92,,percent of total billed charges,,
"Cell Count W/O Differential, Synovial Fluid",,89050,CPT,Facility,Outpatient,,,,33,28.05,9.4578,33,"UCare Health, Inc.",Individual & Family Plan,18.5955,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Cell Count W/O Differential, Synovial Fluid",,89050,CPT,Facility,Inpatient,,,,33,28.05,9.4578,33,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Cell Count W/O Differential, Synovial Fluid",,89050,CPT,Facility,Outpatient,,,,33,28.05,9.4578,33,"UCare Health, Inc.",Medical Assistance,16.6551,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Cell Count W/O Differential, Synovial Fluid",,89050,CPT,Facility,Inpatient,,,,33,28.05,9.4578,33,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Cell Count W/O Differential, Synovial Fluid",,89050,CPT,Facility,Outpatient,,,,33,28.05,9.4578,33,"UCare Health, Inc.",Medicare Advantage,16.6551,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Cell Count W/O Differential, Synovial Fluid",,89050,CPT,Facility,Inpatient,,,,33,28.05,9.4578,33,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Cell Count W/O Differential, Synovial Fluid",,89050,CPT,Facility,Outpatient,,,,33,28.05,9.4578,33,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),16.6551,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Cell Count W/O Differential, Synovial Fluid",,89050,CPT,Facility,Inpatient,,,,33,28.05,9.4578,33,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Cell Count W/O Differential, Synovial Fluid",,89050,CPT,Facility,Both,,,,33,28.05,9.4578,33,UnitedHealthcare,Individual & Family,31.02,94,,percent of total billed charges,,
"Cell Count W/O Differential, Synovial Fluid",,89050,CPT,Facility,Outpatient,,,,33,28.05,9.4578,33,UnitedHealthcare,Medicare Advantage,16.17,49,,percent of total billed charges,,
"Cell Count W/O Differential, Synovial Fluid",,89050,CPT,Facility,Inpatient,,,,33,28.05,9.4578,33,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Cell Count W/O Differential, Synovial Fluid",,89050,CPT,Facility,Outpatient,,,,33,28.05,9.4578,33,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,15.84,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Cell Count W/O Differential, Synovial Fluid",,89050,CPT,Facility,Inpatient,,,,33,28.05,9.4578,33,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Eosinophils, Stool",,89050,CPT,Facility,Both,,,,26,22.1,7.4516,26,Aetna,Commercial,23.92,92,,percent of total billed charges,,
"Eosinophils, Stool",,89050,CPT,Facility,Outpatient,,,,26,22.1,7.4516,26,Aetna,Medicare Advantage,12.74,49,,percent of total billed charges,,
"Eosinophils, Stool",,89050,CPT,Facility,Inpatient,,,,26,22.1,7.4516,26,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Eosinophils, Stool",,89050,CPT,Facility,Both,,,,26,22.1,7.4516,26,Aetna,PPO,24.18,93,,percent of total billed charges,,
"Eosinophils, Stool",,89050,CPT,Facility,Both,,,,26,22.1,7.4516,26,America's PPO,America's PPO,24.9678,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Eosinophils, Stool",,89050,CPT,Facility,Both,,,,26,22.1,7.4516,26,BlueCross BlueShield Minnesota, Federal Employee Program,25.584,98.4,,percent of total billed charges,,
"Eosinophils, Stool",,89050,CPT,Facility,Both,,,,26,22.1,7.4516,26,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,26,100,,percent of total billed charges,,
"Eosinophils, Stool",,89050,CPT,Facility,Both,,,,26,22.1,7.4516,26,BlueCross BlueShield Minnesota,High Value Network Plan,23.4,90,,percent of total billed charges,,
"Eosinophils, Stool",,89050,CPT,Facility,Outpatient,,,,26,22.1,7.4516,26,BlueCross BlueShield Minnesota,Medicare Advantage,12.74,49,,percent of total billed charges,,
"Eosinophils, Stool",,89050,CPT,Facility,Inpatient,,,,26,22.1,7.4516,26,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Eosinophils, Stool",,89050,CPT,Facility,Both,,,,26,22.1,7.4516,26,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,23.0282,88.57,,percent of total billed charges,,
"Eosinophils, Stool",,89050,CPT,Facility,Both,,,,26,22.1,7.4516,26,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,7.4516,28.66,,percent of total billed charges,,
"Eosinophils, Stool",,89050,CPT,Facility,Outpatient,,,,26,22.1,7.4516,26,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),12.74,49,,percent of total billed charges,,
"Eosinophils, Stool",,89050,CPT,Facility,Inpatient,,,,26,22.1,7.4516,26,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Eosinophils, Stool",,89050,CPT,Facility,Both,,,,26,22.1,7.4516,26,CorVel,Worker's Compensation,26,100,,percent of total billed charges,,
"Eosinophils, Stool",,89050,CPT,Facility,Both,,,,26,22.1,7.4516,26,First Health Group Corporation,First Health Network,25.22,97,,percent of total billed charges,,
"Eosinophils, Stool",,89050,CPT,Facility,Both,,,,26,22.1,7.4516,26,"Health Partners, Inc.",Commercial,24.596,94.6,,percent of total billed charges,,
"Eosinophils, Stool",,89050,CPT,Facility,Outpatient,,,,26,22.1,7.4516,26,"Health Partners, Inc.",Medicare Advantage,12.74,49,,percent of total billed charges,,
"Eosinophils, Stool",,89050,CPT,Facility,Inpatient,,,,26,22.1,7.4516,26,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Eosinophils, Stool",,89050,CPT,Facility,Both,,,,26,22.1,7.4516,26,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),15.6,60,,percent of total billed charges,,
"Eosinophils, Stool",,89050,CPT,Facility,Both,,,,26,22.1,7.4516,26,"Health Partners, Inc.",State of Minnesota Advantage Program,21.19,81.5,,percent of total billed charges,,
"Eosinophils, Stool",,89050,CPT,Facility,Both,,,,26,22.1,7.4516,26,"Health Partners, Inc.",State Public Programs,13,50,,percent of total billed charges,,
"Eosinophils, Stool",,89050,CPT,Facility,Both,,,,26,22.1,7.4516,26,Humana Insurance Company,Commercial PPO,24.7,95,,percent of total billed charges,,
"Eosinophils, Stool",,89050,CPT,Facility,Outpatient,,,,26,22.1,7.4516,26,Humana Insurance Company,Medicare PPO,12.74,49,,percent of total billed charges,,
"Eosinophils, Stool",,89050,CPT,Facility,Inpatient,,,,26,22.1,7.4516,26,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Eosinophils, Stool",,89050,CPT,Facility,Both,,,,26,22.1,7.4516,26,Medica,Individual & Family,25.766,99.1,,percent of total billed charges,,
"Eosinophils, Stool",,89050,CPT,Facility,Outpatient,,,,26,22.1,7.4516,26,Medica,Medica Advantage Solution,12.948,49.8,,percent of total billed charges,,
"Eosinophils, Stool",,89050,CPT,Facility,Inpatient,,,,26,22.1,7.4516,26,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Eosinophils, Stool",,89050,CPT,Facility,Outpatient,,,,26,22.1,7.4516,26,Medica,Medical Assistance,11.596,44.6,,percent of total billed charges,,
"Eosinophils, Stool",,89050,CPT,Facility,Inpatient,,,,26,22.1,7.4516,26,Medica,Medical Assistance,,,,,Included in per diem rate,
"Eosinophils, Stool",,89050,CPT,Facility,Outpatient,,,,26,22.1,7.4516,26,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,12.948,49.8,,percent of total billed charges,,
"Eosinophils, Stool",,89050,CPT,Facility,Inpatient,,,,26,22.1,7.4516,26,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Eosinophils, Stool",,89050,CPT,Facility,Both,,,,26,22.1,7.4516,26,"Multiplan, Inc.","Multiplan, Inc.",24.44,94,,percent of total billed charges,,
"Eosinophils, Stool",,89050,CPT,Facility,Outpatient,,,,26,22.1,7.4516,26,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,22.464,86.4,,percent of total billed charges,,
"Eosinophils, Stool",,89050,CPT,Facility,Inpatient,,,,26,22.1,7.4516,26,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Eosinophils, Stool",,89050,CPT,Facility,Both,,,,26,22.1,7.4516,26,"Preferred One Administrative Services, INC.",PPO,25.636,98.6,,percent of total billed charges,,
"Eosinophils, Stool",,89050,CPT,Facility,Outpatient,,,,26,22.1,7.4516,26,PrimeWest Health,Minnesota Senior Health Options (MSHO),13.377,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Eosinophils, Stool",,89050,CPT,Facility,Inpatient,,,,26,22.1,7.4516,26,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Eosinophils, Stool",,89050,CPT,Facility,Outpatient,,,,26,22.1,7.4516,26,PrimeWest Health,MinnesotaCare,13.3536,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Eosinophils, Stool",,89050,CPT,Facility,Inpatient,,,,26,22.1,7.4516,26,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Eosinophils, Stool",,89050,CPT,Facility,Both,,,,26,22.1,7.4516,26,Sanford Health Plan,Sanford Health Plan,23.92,92,,percent of total billed charges,,
"Eosinophils, Stool",,89050,CPT,Facility,Outpatient,,,,26,22.1,7.4516,26,"UCare Health, Inc.",Individual & Family Plan,14.651,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Eosinophils, Stool",,89050,CPT,Facility,Inpatient,,,,26,22.1,7.4516,26,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Eosinophils, Stool",,89050,CPT,Facility,Outpatient,,,,26,22.1,7.4516,26,"UCare Health, Inc.",Medical Assistance,13.1222,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Eosinophils, Stool",,89050,CPT,Facility,Inpatient,,,,26,22.1,7.4516,26,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Eosinophils, Stool",,89050,CPT,Facility,Outpatient,,,,26,22.1,7.4516,26,"UCare Health, Inc.",Medicare Advantage,13.1222,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Eosinophils, Stool",,89050,CPT,Facility,Inpatient,,,,26,22.1,7.4516,26,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Eosinophils, Stool",,89050,CPT,Facility,Outpatient,,,,26,22.1,7.4516,26,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),13.1222,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Eosinophils, Stool",,89050,CPT,Facility,Inpatient,,,,26,22.1,7.4516,26,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Eosinophils, Stool",,89050,CPT,Facility,Both,,,,26,22.1,7.4516,26,UnitedHealthcare,Individual & Family,24.44,94,,percent of total billed charges,,
"Eosinophils, Stool",,89050,CPT,Facility,Outpatient,,,,26,22.1,7.4516,26,UnitedHealthcare,Medicare Advantage,12.74,49,,percent of total billed charges,,
"Eosinophils, Stool",,89050,CPT,Facility,Inpatient,,,,26,22.1,7.4516,26,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Eosinophils, Stool",,89050,CPT,Facility,Outpatient,,,,26,22.1,7.4516,26,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,12.48,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Eosinophils, Stool",,89050,CPT,Facility,Inpatient,,,,26,22.1,7.4516,26,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Cell Count And Differential, Body Fluid",,89051,CPT,Facility,Both,,,,61,51.85,17.4826,61,Aetna,Commercial,56.12,92,,percent of total billed charges,,
"Cell Count And Differential, Body Fluid",,89051,CPT,Facility,Outpatient,,,,61,51.85,17.4826,61,Aetna,Medicare Advantage,29.89,49,,percent of total billed charges,,
"Cell Count And Differential, Body Fluid",,89051,CPT,Facility,Inpatient,,,,61,51.85,17.4826,61,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Cell Count And Differential, Body Fluid",,89051,CPT,Facility,Both,,,,61,51.85,17.4826,61,Aetna,PPO,56.73,93,,percent of total billed charges,,
"Cell Count And Differential, Body Fluid",,89051,CPT,Facility,Both,,,,61,51.85,17.4826,61,America's PPO,America's PPO,58.5783,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Cell Count And Differential, Body Fluid",,89051,CPT,Facility,Both,,,,61,51.85,17.4826,61,BlueCross BlueShield Minnesota, Federal Employee Program,60.024,98.4,,percent of total billed charges,,
"Cell Count And Differential, Body Fluid",,89051,CPT,Facility,Both,,,,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,61,100,,percent of total billed charges,,
"Cell Count And Differential, Body Fluid",,89051,CPT,Facility,Both,,,,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,High Value Network Plan,54.9,90,,percent of total billed charges,,
"Cell Count And Differential, Body Fluid",,89051,CPT,Facility,Outpatient,,,,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,Medicare Advantage,29.89,49,,percent of total billed charges,,
"Cell Count And Differential, Body Fluid",,89051,CPT,Facility,Inpatient,,,,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Cell Count And Differential, Body Fluid",,89051,CPT,Facility,Both,,,,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,54.0277,88.57,,percent of total billed charges,,
"Cell Count And Differential, Body Fluid",,89051,CPT,Facility,Both,,,,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,17.4826,28.66,,percent of total billed charges,,
"Cell Count And Differential, Body Fluid",,89051,CPT,Facility,Outpatient,,,,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),29.89,49,,percent of total billed charges,,
"Cell Count And Differential, Body Fluid",,89051,CPT,Facility,Inpatient,,,,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Cell Count And Differential, Body Fluid",,89051,CPT,Facility,Both,,,,61,51.85,17.4826,61,CorVel,Worker's Compensation,61,100,,percent of total billed charges,,
"Cell Count And Differential, Body Fluid",,89051,CPT,Facility,Both,,,,61,51.85,17.4826,61,First Health Group Corporation,First Health Network,59.17,97,,percent of total billed charges,,
"Cell Count And Differential, Body Fluid",,89051,CPT,Facility,Both,,,,61,51.85,17.4826,61,"Health Partners, Inc.",Commercial,57.706,94.6,,percent of total billed charges,,
"Cell Count And Differential, Body Fluid",,89051,CPT,Facility,Outpatient,,,,61,51.85,17.4826,61,"Health Partners, Inc.",Medicare Advantage,29.89,49,,percent of total billed charges,,
"Cell Count And Differential, Body Fluid",,89051,CPT,Facility,Inpatient,,,,61,51.85,17.4826,61,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Cell Count And Differential, Body Fluid",,89051,CPT,Facility,Both,,,,61,51.85,17.4826,61,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),36.6,60,,percent of total billed charges,,
"Cell Count And Differential, Body Fluid",,89051,CPT,Facility,Both,,,,61,51.85,17.4826,61,"Health Partners, Inc.",State of Minnesota Advantage Program,49.715,81.5,,percent of total billed charges,,
"Cell Count And Differential, Body Fluid",,89051,CPT,Facility,Both,,,,61,51.85,17.4826,61,"Health Partners, Inc.",State Public Programs,30.5,50,,percent of total billed charges,,
"Cell Count And Differential, Body Fluid",,89051,CPT,Facility,Both,,,,61,51.85,17.4826,61,Humana Insurance Company,Commercial PPO,57.95,95,,percent of total billed charges,,
"Cell Count And Differential, Body Fluid",,89051,CPT,Facility,Outpatient,,,,61,51.85,17.4826,61,Humana Insurance Company,Medicare PPO,29.89,49,,percent of total billed charges,,
"Cell Count And Differential, Body Fluid",,89051,CPT,Facility,Inpatient,,,,61,51.85,17.4826,61,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Cell Count And Differential, Body Fluid",,89051,CPT,Facility,Both,,,,61,51.85,17.4826,61,Medica,Individual & Family,60.451,99.1,,percent of total billed charges,,
"Cell Count And Differential, Body Fluid",,89051,CPT,Facility,Outpatient,,,,61,51.85,17.4826,61,Medica,Medica Advantage Solution,30.378,49.8,,percent of total billed charges,,
"Cell Count And Differential, Body Fluid",,89051,CPT,Facility,Inpatient,,,,61,51.85,17.4826,61,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Cell Count And Differential, Body Fluid",,89051,CPT,Facility,Outpatient,,,,61,51.85,17.4826,61,Medica,Medical Assistance,27.206,44.6,,percent of total billed charges,,
"Cell Count And Differential, Body Fluid",,89051,CPT,Facility,Inpatient,,,,61,51.85,17.4826,61,Medica,Medical Assistance,,,,,Included in per diem rate,
"Cell Count And Differential, Body Fluid",,89051,CPT,Facility,Outpatient,,,,61,51.85,17.4826,61,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,30.378,49.8,,percent of total billed charges,,
"Cell Count And Differential, Body Fluid",,89051,CPT,Facility,Inpatient,,,,61,51.85,17.4826,61,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Cell Count And Differential, Body Fluid",,89051,CPT,Facility,Both,,,,61,51.85,17.4826,61,"Multiplan, Inc.","Multiplan, Inc.",57.34,94,,percent of total billed charges,,
"Cell Count And Differential, Body Fluid",,89051,CPT,Facility,Outpatient,,,,61,51.85,17.4826,61,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,52.704,86.4,,percent of total billed charges,,
"Cell Count And Differential, Body Fluid",,89051,CPT,Facility,Inpatient,,,,61,51.85,17.4826,61,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Cell Count And Differential, Body Fluid",,89051,CPT,Facility,Both,,,,61,51.85,17.4826,61,"Preferred One Administrative Services, INC.",PPO,60.146,98.6,,percent of total billed charges,,
"Cell Count And Differential, Body Fluid",,89051,CPT,Facility,Outpatient,,,,61,51.85,17.4826,61,PrimeWest Health,Minnesota Senior Health Options (MSHO),31.3845,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Cell Count And Differential, Body Fluid",,89051,CPT,Facility,Inpatient,,,,61,51.85,17.4826,61,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Cell Count And Differential, Body Fluid",,89051,CPT,Facility,Outpatient,,,,61,51.85,17.4826,61,PrimeWest Health,MinnesotaCare,31.3296,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Cell Count And Differential, Body Fluid",,89051,CPT,Facility,Inpatient,,,,61,51.85,17.4826,61,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Cell Count And Differential, Body Fluid",,89051,CPT,Facility,Both,,,,61,51.85,17.4826,61,Sanford Health Plan,Sanford Health Plan,56.12,92,,percent of total billed charges,,
"Cell Count And Differential, Body Fluid",,89051,CPT,Facility,Outpatient,,,,61,51.85,17.4826,61,"UCare Health, Inc.",Individual & Family Plan,34.3735,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Cell Count And Differential, Body Fluid",,89051,CPT,Facility,Inpatient,,,,61,51.85,17.4826,61,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Cell Count And Differential, Body Fluid",,89051,CPT,Facility,Outpatient,,,,61,51.85,17.4826,61,"UCare Health, Inc.",Medical Assistance,30.7867,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Cell Count And Differential, Body Fluid",,89051,CPT,Facility,Inpatient,,,,61,51.85,17.4826,61,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Cell Count And Differential, Body Fluid",,89051,CPT,Facility,Outpatient,,,,61,51.85,17.4826,61,"UCare Health, Inc.",Medicare Advantage,30.7867,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Cell Count And Differential, Body Fluid",,89051,CPT,Facility,Inpatient,,,,61,51.85,17.4826,61,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Cell Count And Differential, Body Fluid",,89051,CPT,Facility,Outpatient,,,,61,51.85,17.4826,61,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),30.7867,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Cell Count And Differential, Body Fluid",,89051,CPT,Facility,Inpatient,,,,61,51.85,17.4826,61,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Cell Count And Differential, Body Fluid",,89051,CPT,Facility,Both,,,,61,51.85,17.4826,61,UnitedHealthcare,Individual & Family,57.34,94,,percent of total billed charges,,
"Cell Count And Differential, Body Fluid",,89051,CPT,Facility,Outpatient,,,,61,51.85,17.4826,61,UnitedHealthcare,Medicare Advantage,29.89,49,,percent of total billed charges,,
"Cell Count And Differential, Body Fluid",,89051,CPT,Facility,Inpatient,,,,61,51.85,17.4826,61,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Cell Count And Differential, Body Fluid",,89051,CPT,Facility,Outpatient,,,,61,51.85,17.4826,61,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,29.28,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Cell Count And Differential, Body Fluid",,89051,CPT,Facility,Inpatient,,,,61,51.85,17.4826,61,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Cell Count And Differential, Cerebral Spinal Fluid",,89051,CPT,Facility,Both,,,,61,51.85,17.4826,61,Aetna,Commercial,56.12,92,,percent of total billed charges,,
"Cell Count And Differential, Cerebral Spinal Fluid",,89051,CPT,Facility,Outpatient,,,,61,51.85,17.4826,61,Aetna,Medicare Advantage,29.89,49,,percent of total billed charges,,
"Cell Count And Differential, Cerebral Spinal Fluid",,89051,CPT,Facility,Inpatient,,,,61,51.85,17.4826,61,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Cell Count And Differential, Cerebral Spinal Fluid",,89051,CPT,Facility,Both,,,,61,51.85,17.4826,61,Aetna,PPO,56.73,93,,percent of total billed charges,,
"Cell Count And Differential, Cerebral Spinal Fluid",,89051,CPT,Facility,Both,,,,61,51.85,17.4826,61,America's PPO,America's PPO,58.5783,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Cell Count And Differential, Cerebral Spinal Fluid",,89051,CPT,Facility,Both,,,,61,51.85,17.4826,61,BlueCross BlueShield Minnesota, Federal Employee Program,60.024,98.4,,percent of total billed charges,,
"Cell Count And Differential, Cerebral Spinal Fluid",,89051,CPT,Facility,Both,,,,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,61,100,,percent of total billed charges,,
"Cell Count And Differential, Cerebral Spinal Fluid",,89051,CPT,Facility,Both,,,,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,High Value Network Plan,54.9,90,,percent of total billed charges,,
"Cell Count And Differential, Cerebral Spinal Fluid",,89051,CPT,Facility,Outpatient,,,,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,Medicare Advantage,29.89,49,,percent of total billed charges,,
"Cell Count And Differential, Cerebral Spinal Fluid",,89051,CPT,Facility,Inpatient,,,,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Cell Count And Differential, Cerebral Spinal Fluid",,89051,CPT,Facility,Both,,,,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,54.0277,88.57,,percent of total billed charges,,
"Cell Count And Differential, Cerebral Spinal Fluid",,89051,CPT,Facility,Both,,,,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,17.4826,28.66,,percent of total billed charges,,
"Cell Count And Differential, Cerebral Spinal Fluid",,89051,CPT,Facility,Outpatient,,,,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),29.89,49,,percent of total billed charges,,
"Cell Count And Differential, Cerebral Spinal Fluid",,89051,CPT,Facility,Inpatient,,,,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Cell Count And Differential, Cerebral Spinal Fluid",,89051,CPT,Facility,Both,,,,61,51.85,17.4826,61,CorVel,Worker's Compensation,61,100,,percent of total billed charges,,
"Cell Count And Differential, Cerebral Spinal Fluid",,89051,CPT,Facility,Both,,,,61,51.85,17.4826,61,First Health Group Corporation,First Health Network,59.17,97,,percent of total billed charges,,
"Cell Count And Differential, Cerebral Spinal Fluid",,89051,CPT,Facility,Both,,,,61,51.85,17.4826,61,"Health Partners, Inc.",Commercial,57.706,94.6,,percent of total billed charges,,
"Cell Count And Differential, Cerebral Spinal Fluid",,89051,CPT,Facility,Outpatient,,,,61,51.85,17.4826,61,"Health Partners, Inc.",Medicare Advantage,29.89,49,,percent of total billed charges,,
"Cell Count And Differential, Cerebral Spinal Fluid",,89051,CPT,Facility,Inpatient,,,,61,51.85,17.4826,61,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Cell Count And Differential, Cerebral Spinal Fluid",,89051,CPT,Facility,Both,,,,61,51.85,17.4826,61,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),36.6,60,,percent of total billed charges,,
"Cell Count And Differential, Cerebral Spinal Fluid",,89051,CPT,Facility,Both,,,,61,51.85,17.4826,61,"Health Partners, Inc.",State of Minnesota Advantage Program,49.715,81.5,,percent of total billed charges,,
"Cell Count And Differential, Cerebral Spinal Fluid",,89051,CPT,Facility,Both,,,,61,51.85,17.4826,61,"Health Partners, Inc.",State Public Programs,30.5,50,,percent of total billed charges,,
"Cell Count And Differential, Cerebral Spinal Fluid",,89051,CPT,Facility,Both,,,,61,51.85,17.4826,61,Humana Insurance Company,Commercial PPO,57.95,95,,percent of total billed charges,,
"Cell Count And Differential, Cerebral Spinal Fluid",,89051,CPT,Facility,Outpatient,,,,61,51.85,17.4826,61,Humana Insurance Company,Medicare PPO,29.89,49,,percent of total billed charges,,
"Cell Count And Differential, Cerebral Spinal Fluid",,89051,CPT,Facility,Inpatient,,,,61,51.85,17.4826,61,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Cell Count And Differential, Cerebral Spinal Fluid",,89051,CPT,Facility,Both,,,,61,51.85,17.4826,61,Medica,Individual & Family,60.451,99.1,,percent of total billed charges,,
"Cell Count And Differential, Cerebral Spinal Fluid",,89051,CPT,Facility,Outpatient,,,,61,51.85,17.4826,61,Medica,Medica Advantage Solution,30.378,49.8,,percent of total billed charges,,
"Cell Count And Differential, Cerebral Spinal Fluid",,89051,CPT,Facility,Inpatient,,,,61,51.85,17.4826,61,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Cell Count And Differential, Cerebral Spinal Fluid",,89051,CPT,Facility,Outpatient,,,,61,51.85,17.4826,61,Medica,Medical Assistance,27.206,44.6,,percent of total billed charges,,
"Cell Count And Differential, Cerebral Spinal Fluid",,89051,CPT,Facility,Inpatient,,,,61,51.85,17.4826,61,Medica,Medical Assistance,,,,,Included in per diem rate,
"Cell Count And Differential, Cerebral Spinal Fluid",,89051,CPT,Facility,Outpatient,,,,61,51.85,17.4826,61,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,30.378,49.8,,percent of total billed charges,,
"Cell Count And Differential, Cerebral Spinal Fluid",,89051,CPT,Facility,Inpatient,,,,61,51.85,17.4826,61,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Cell Count And Differential, Cerebral Spinal Fluid",,89051,CPT,Facility,Both,,,,61,51.85,17.4826,61,"Multiplan, Inc.","Multiplan, Inc.",57.34,94,,percent of total billed charges,,
"Cell Count And Differential, Cerebral Spinal Fluid",,89051,CPT,Facility,Outpatient,,,,61,51.85,17.4826,61,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,52.704,86.4,,percent of total billed charges,,
"Cell Count And Differential, Cerebral Spinal Fluid",,89051,CPT,Facility,Inpatient,,,,61,51.85,17.4826,61,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Cell Count And Differential, Cerebral Spinal Fluid",,89051,CPT,Facility,Both,,,,61,51.85,17.4826,61,"Preferred One Administrative Services, INC.",PPO,60.146,98.6,,percent of total billed charges,,
"Cell Count And Differential, Cerebral Spinal Fluid",,89051,CPT,Facility,Outpatient,,,,61,51.85,17.4826,61,PrimeWest Health,Minnesota Senior Health Options (MSHO),31.3845,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Cell Count And Differential, Cerebral Spinal Fluid",,89051,CPT,Facility,Inpatient,,,,61,51.85,17.4826,61,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Cell Count And Differential, Cerebral Spinal Fluid",,89051,CPT,Facility,Outpatient,,,,61,51.85,17.4826,61,PrimeWest Health,MinnesotaCare,31.3296,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Cell Count And Differential, Cerebral Spinal Fluid",,89051,CPT,Facility,Inpatient,,,,61,51.85,17.4826,61,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Cell Count And Differential, Cerebral Spinal Fluid",,89051,CPT,Facility,Both,,,,61,51.85,17.4826,61,Sanford Health Plan,Sanford Health Plan,56.12,92,,percent of total billed charges,,
"Cell Count And Differential, Cerebral Spinal Fluid",,89051,CPT,Facility,Outpatient,,,,61,51.85,17.4826,61,"UCare Health, Inc.",Individual & Family Plan,34.3735,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Cell Count And Differential, Cerebral Spinal Fluid",,89051,CPT,Facility,Inpatient,,,,61,51.85,17.4826,61,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Cell Count And Differential, Cerebral Spinal Fluid",,89051,CPT,Facility,Outpatient,,,,61,51.85,17.4826,61,"UCare Health, Inc.",Medical Assistance,30.7867,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Cell Count And Differential, Cerebral Spinal Fluid",,89051,CPT,Facility,Inpatient,,,,61,51.85,17.4826,61,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Cell Count And Differential, Cerebral Spinal Fluid",,89051,CPT,Facility,Outpatient,,,,61,51.85,17.4826,61,"UCare Health, Inc.",Medicare Advantage,30.7867,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Cell Count And Differential, Cerebral Spinal Fluid",,89051,CPT,Facility,Inpatient,,,,61,51.85,17.4826,61,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Cell Count And Differential, Cerebral Spinal Fluid",,89051,CPT,Facility,Outpatient,,,,61,51.85,17.4826,61,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),30.7867,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Cell Count And Differential, Cerebral Spinal Fluid",,89051,CPT,Facility,Inpatient,,,,61,51.85,17.4826,61,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Cell Count And Differential, Cerebral Spinal Fluid",,89051,CPT,Facility,Both,,,,61,51.85,17.4826,61,UnitedHealthcare,Individual & Family,57.34,94,,percent of total billed charges,,
"Cell Count And Differential, Cerebral Spinal Fluid",,89051,CPT,Facility,Outpatient,,,,61,51.85,17.4826,61,UnitedHealthcare,Medicare Advantage,29.89,49,,percent of total billed charges,,
"Cell Count And Differential, Cerebral Spinal Fluid",,89051,CPT,Facility,Inpatient,,,,61,51.85,17.4826,61,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Cell Count And Differential, Cerebral Spinal Fluid",,89051,CPT,Facility,Outpatient,,,,61,51.85,17.4826,61,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,29.28,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Cell Count And Differential, Cerebral Spinal Fluid",,89051,CPT,Facility,Inpatient,,,,61,51.85,17.4826,61,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Cell Count And Differential, Synovial Fluid",,89051,CPT,Facility,Both,,,,61,51.85,17.4826,61,Aetna,Commercial,56.12,92,,percent of total billed charges,,
"Cell Count And Differential, Synovial Fluid",,89051,CPT,Facility,Outpatient,,,,61,51.85,17.4826,61,Aetna,Medicare Advantage,29.89,49,,percent of total billed charges,,
"Cell Count And Differential, Synovial Fluid",,89051,CPT,Facility,Inpatient,,,,61,51.85,17.4826,61,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Cell Count And Differential, Synovial Fluid",,89051,CPT,Facility,Both,,,,61,51.85,17.4826,61,Aetna,PPO,56.73,93,,percent of total billed charges,,
"Cell Count And Differential, Synovial Fluid",,89051,CPT,Facility,Both,,,,61,51.85,17.4826,61,America's PPO,America's PPO,58.5783,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Cell Count And Differential, Synovial Fluid",,89051,CPT,Facility,Both,,,,61,51.85,17.4826,61,BlueCross BlueShield Minnesota, Federal Employee Program,60.024,98.4,,percent of total billed charges,,
"Cell Count And Differential, Synovial Fluid",,89051,CPT,Facility,Both,,,,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,61,100,,percent of total billed charges,,
"Cell Count And Differential, Synovial Fluid",,89051,CPT,Facility,Both,,,,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,High Value Network Plan,54.9,90,,percent of total billed charges,,
"Cell Count And Differential, Synovial Fluid",,89051,CPT,Facility,Outpatient,,,,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,Medicare Advantage,29.89,49,,percent of total billed charges,,
"Cell Count And Differential, Synovial Fluid",,89051,CPT,Facility,Inpatient,,,,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Cell Count And Differential, Synovial Fluid",,89051,CPT,Facility,Both,,,,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,54.0277,88.57,,percent of total billed charges,,
"Cell Count And Differential, Synovial Fluid",,89051,CPT,Facility,Both,,,,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,17.4826,28.66,,percent of total billed charges,,
"Cell Count And Differential, Synovial Fluid",,89051,CPT,Facility,Outpatient,,,,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),29.89,49,,percent of total billed charges,,
"Cell Count And Differential, Synovial Fluid",,89051,CPT,Facility,Inpatient,,,,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Cell Count And Differential, Synovial Fluid",,89051,CPT,Facility,Both,,,,61,51.85,17.4826,61,CorVel,Worker's Compensation,61,100,,percent of total billed charges,,
"Cell Count And Differential, Synovial Fluid",,89051,CPT,Facility,Both,,,,61,51.85,17.4826,61,First Health Group Corporation,First Health Network,59.17,97,,percent of total billed charges,,
"Cell Count And Differential, Synovial Fluid",,89051,CPT,Facility,Both,,,,61,51.85,17.4826,61,"Health Partners, Inc.",Commercial,57.706,94.6,,percent of total billed charges,,
"Cell Count And Differential, Synovial Fluid",,89051,CPT,Facility,Outpatient,,,,61,51.85,17.4826,61,"Health Partners, Inc.",Medicare Advantage,29.89,49,,percent of total billed charges,,
"Cell Count And Differential, Synovial Fluid",,89051,CPT,Facility,Inpatient,,,,61,51.85,17.4826,61,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Cell Count And Differential, Synovial Fluid",,89051,CPT,Facility,Both,,,,61,51.85,17.4826,61,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),36.6,60,,percent of total billed charges,,
"Cell Count And Differential, Synovial Fluid",,89051,CPT,Facility,Both,,,,61,51.85,17.4826,61,"Health Partners, Inc.",State of Minnesota Advantage Program,49.715,81.5,,percent of total billed charges,,
"Cell Count And Differential, Synovial Fluid",,89051,CPT,Facility,Both,,,,61,51.85,17.4826,61,"Health Partners, Inc.",State Public Programs,30.5,50,,percent of total billed charges,,
"Cell Count And Differential, Synovial Fluid",,89051,CPT,Facility,Both,,,,61,51.85,17.4826,61,Humana Insurance Company,Commercial PPO,57.95,95,,percent of total billed charges,,
"Cell Count And Differential, Synovial Fluid",,89051,CPT,Facility,Outpatient,,,,61,51.85,17.4826,61,Humana Insurance Company,Medicare PPO,29.89,49,,percent of total billed charges,,
"Cell Count And Differential, Synovial Fluid",,89051,CPT,Facility,Inpatient,,,,61,51.85,17.4826,61,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Cell Count And Differential, Synovial Fluid",,89051,CPT,Facility,Both,,,,61,51.85,17.4826,61,Medica,Individual & Family,60.451,99.1,,percent of total billed charges,,
"Cell Count And Differential, Synovial Fluid",,89051,CPT,Facility,Outpatient,,,,61,51.85,17.4826,61,Medica,Medica Advantage Solution,30.378,49.8,,percent of total billed charges,,
"Cell Count And Differential, Synovial Fluid",,89051,CPT,Facility,Inpatient,,,,61,51.85,17.4826,61,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Cell Count And Differential, Synovial Fluid",,89051,CPT,Facility,Outpatient,,,,61,51.85,17.4826,61,Medica,Medical Assistance,27.206,44.6,,percent of total billed charges,,
"Cell Count And Differential, Synovial Fluid",,89051,CPT,Facility,Inpatient,,,,61,51.85,17.4826,61,Medica,Medical Assistance,,,,,Included in per diem rate,
"Cell Count And Differential, Synovial Fluid",,89051,CPT,Facility,Outpatient,,,,61,51.85,17.4826,61,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,30.378,49.8,,percent of total billed charges,,
"Cell Count And Differential, Synovial Fluid",,89051,CPT,Facility,Inpatient,,,,61,51.85,17.4826,61,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Cell Count And Differential, Synovial Fluid",,89051,CPT,Facility,Both,,,,61,51.85,17.4826,61,"Multiplan, Inc.","Multiplan, Inc.",57.34,94,,percent of total billed charges,,
"Cell Count And Differential, Synovial Fluid",,89051,CPT,Facility,Outpatient,,,,61,51.85,17.4826,61,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,52.704,86.4,,percent of total billed charges,,
"Cell Count And Differential, Synovial Fluid",,89051,CPT,Facility,Inpatient,,,,61,51.85,17.4826,61,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Cell Count And Differential, Synovial Fluid",,89051,CPT,Facility,Both,,,,61,51.85,17.4826,61,"Preferred One Administrative Services, INC.",PPO,60.146,98.6,,percent of total billed charges,,
"Cell Count And Differential, Synovial Fluid",,89051,CPT,Facility,Outpatient,,,,61,51.85,17.4826,61,PrimeWest Health,Minnesota Senior Health Options (MSHO),31.3845,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Cell Count And Differential, Synovial Fluid",,89051,CPT,Facility,Inpatient,,,,61,51.85,17.4826,61,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Cell Count And Differential, Synovial Fluid",,89051,CPT,Facility,Outpatient,,,,61,51.85,17.4826,61,PrimeWest Health,MinnesotaCare,31.3296,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Cell Count And Differential, Synovial Fluid",,89051,CPT,Facility,Inpatient,,,,61,51.85,17.4826,61,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Cell Count And Differential, Synovial Fluid",,89051,CPT,Facility,Both,,,,61,51.85,17.4826,61,Sanford Health Plan,Sanford Health Plan,56.12,92,,percent of total billed charges,,
"Cell Count And Differential, Synovial Fluid",,89051,CPT,Facility,Outpatient,,,,61,51.85,17.4826,61,"UCare Health, Inc.",Individual & Family Plan,34.3735,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Cell Count And Differential, Synovial Fluid",,89051,CPT,Facility,Inpatient,,,,61,51.85,17.4826,61,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Cell Count And Differential, Synovial Fluid",,89051,CPT,Facility,Outpatient,,,,61,51.85,17.4826,61,"UCare Health, Inc.",Medical Assistance,30.7867,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Cell Count And Differential, Synovial Fluid",,89051,CPT,Facility,Inpatient,,,,61,51.85,17.4826,61,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Cell Count And Differential, Synovial Fluid",,89051,CPT,Facility,Outpatient,,,,61,51.85,17.4826,61,"UCare Health, Inc.",Medicare Advantage,30.7867,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Cell Count And Differential, Synovial Fluid",,89051,CPT,Facility,Inpatient,,,,61,51.85,17.4826,61,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Cell Count And Differential, Synovial Fluid",,89051,CPT,Facility,Outpatient,,,,61,51.85,17.4826,61,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),30.7867,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Cell Count And Differential, Synovial Fluid",,89051,CPT,Facility,Inpatient,,,,61,51.85,17.4826,61,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Cell Count And Differential, Synovial Fluid",,89051,CPT,Facility,Both,,,,61,51.85,17.4826,61,UnitedHealthcare,Individual & Family,57.34,94,,percent of total billed charges,,
"Cell Count And Differential, Synovial Fluid",,89051,CPT,Facility,Outpatient,,,,61,51.85,17.4826,61,UnitedHealthcare,Medicare Advantage,29.89,49,,percent of total billed charges,,
"Cell Count And Differential, Synovial Fluid",,89051,CPT,Facility,Inpatient,,,,61,51.85,17.4826,61,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Cell Count And Differential, Synovial Fluid",,89051,CPT,Facility,Outpatient,,,,61,51.85,17.4826,61,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,29.28,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Cell Count And Differential, Synovial Fluid",,89051,CPT,Facility,Inpatient,,,,61,51.85,17.4826,61,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Crystal Id, Synovial Fluid",,89060,CPT,Facility,Both,,,,49,41.65,14.0434,49,Aetna,Commercial,45.08,92,,percent of total billed charges,,
"Crystal Id, Synovial Fluid",,89060,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,Aetna,Medicare Advantage,24.01,49,,percent of total billed charges,,
"Crystal Id, Synovial Fluid",,89060,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Crystal Id, Synovial Fluid",,89060,CPT,Facility,Both,,,,49,41.65,14.0434,49,Aetna,PPO,45.57,93,,percent of total billed charges,,
"Crystal Id, Synovial Fluid",,89060,CPT,Facility,Both,,,,49,41.65,14.0434,49,America's PPO,America's PPO,47.0547,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Crystal Id, Synovial Fluid",,89060,CPT,Facility,Both,,,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota, Federal Employee Program,48.216,98.4,,percent of total billed charges,,
"Crystal Id, Synovial Fluid",,89060,CPT,Facility,Both,,,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,49,100,,percent of total billed charges,,
"Crystal Id, Synovial Fluid",,89060,CPT,Facility,Both,,,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,High Value Network Plan,44.1,90,,percent of total billed charges,,
"Crystal Id, Synovial Fluid",,89060,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Medicare Advantage,24.01,49,,percent of total billed charges,,
"Crystal Id, Synovial Fluid",,89060,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Crystal Id, Synovial Fluid",,89060,CPT,Facility,Both,,,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,43.3993,88.57,,percent of total billed charges,,
"Crystal Id, Synovial Fluid",,89060,CPT,Facility,Both,,,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,14.0434,28.66,,percent of total billed charges,,
"Crystal Id, Synovial Fluid",,89060,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),24.01,49,,percent of total billed charges,,
"Crystal Id, Synovial Fluid",,89060,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Crystal Id, Synovial Fluid",,89060,CPT,Facility,Both,,,,49,41.65,14.0434,49,CorVel,Worker's Compensation,49,100,,percent of total billed charges,,
"Crystal Id, Synovial Fluid",,89060,CPT,Facility,Both,,,,49,41.65,14.0434,49,First Health Group Corporation,First Health Network,47.53,97,,percent of total billed charges,,
"Crystal Id, Synovial Fluid",,89060,CPT,Facility,Both,,,,49,41.65,14.0434,49,"Health Partners, Inc.",Commercial,46.354,94.6,,percent of total billed charges,,
"Crystal Id, Synovial Fluid",,89060,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,"Health Partners, Inc.",Medicare Advantage,24.01,49,,percent of total billed charges,,
"Crystal Id, Synovial Fluid",,89060,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Crystal Id, Synovial Fluid",,89060,CPT,Facility,Both,,,,49,41.65,14.0434,49,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),29.4,60,,percent of total billed charges,,
"Crystal Id, Synovial Fluid",,89060,CPT,Facility,Both,,,,49,41.65,14.0434,49,"Health Partners, Inc.",State of Minnesota Advantage Program,39.935,81.5,,percent of total billed charges,,
"Crystal Id, Synovial Fluid",,89060,CPT,Facility,Both,,,,49,41.65,14.0434,49,"Health Partners, Inc.",State Public Programs,24.5,50,,percent of total billed charges,,
"Crystal Id, Synovial Fluid",,89060,CPT,Facility,Both,,,,49,41.65,14.0434,49,Humana Insurance Company,Commercial PPO,46.55,95,,percent of total billed charges,,
"Crystal Id, Synovial Fluid",,89060,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,Humana Insurance Company,Medicare PPO,24.01,49,,percent of total billed charges,,
"Crystal Id, Synovial Fluid",,89060,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Crystal Id, Synovial Fluid",,89060,CPT,Facility,Both,,,,49,41.65,14.0434,49,Medica,Individual & Family,48.559,99.1,,percent of total billed charges,,
"Crystal Id, Synovial Fluid",,89060,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,Medica,Medica Advantage Solution,24.402,49.8,,percent of total billed charges,,
"Crystal Id, Synovial Fluid",,89060,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Crystal Id, Synovial Fluid",,89060,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,Medica,Medical Assistance,21.854,44.6,,percent of total billed charges,,
"Crystal Id, Synovial Fluid",,89060,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,Medica,Medical Assistance,,,,,Included in per diem rate,
"Crystal Id, Synovial Fluid",,89060,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,24.402,49.8,,percent of total billed charges,,
"Crystal Id, Synovial Fluid",,89060,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Crystal Id, Synovial Fluid",,89060,CPT,Facility,Both,,,,49,41.65,14.0434,49,"Multiplan, Inc.","Multiplan, Inc.",46.06,94,,percent of total billed charges,,
"Crystal Id, Synovial Fluid",,89060,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,42.336,86.4,,percent of total billed charges,,
"Crystal Id, Synovial Fluid",,89060,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Crystal Id, Synovial Fluid",,89060,CPT,Facility,Both,,,,49,41.65,14.0434,49,"Preferred One Administrative Services, INC.",PPO,48.314,98.6,,percent of total billed charges,,
"Crystal Id, Synovial Fluid",,89060,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,PrimeWest Health,Minnesota Senior Health Options (MSHO),25.2105,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Crystal Id, Synovial Fluid",,89060,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Crystal Id, Synovial Fluid",,89060,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,PrimeWest Health,MinnesotaCare,25.1664,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Crystal Id, Synovial Fluid",,89060,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Crystal Id, Synovial Fluid",,89060,CPT,Facility,Both,,,,49,41.65,14.0434,49,Sanford Health Plan,Sanford Health Plan,45.08,92,,percent of total billed charges,,
"Crystal Id, Synovial Fluid",,89060,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,"UCare Health, Inc.",Individual & Family Plan,27.6115,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Crystal Id, Synovial Fluid",,89060,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Crystal Id, Synovial Fluid",,89060,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,"UCare Health, Inc.",Medical Assistance,24.7303,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Crystal Id, Synovial Fluid",,89060,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Crystal Id, Synovial Fluid",,89060,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,"UCare Health, Inc.",Medicare Advantage,24.7303,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Crystal Id, Synovial Fluid",,89060,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Crystal Id, Synovial Fluid",,89060,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),24.7303,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Crystal Id, Synovial Fluid",,89060,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Crystal Id, Synovial Fluid",,89060,CPT,Facility,Both,,,,49,41.65,14.0434,49,UnitedHealthcare,Individual & Family,46.06,94,,percent of total billed charges,,
"Crystal Id, Synovial Fluid",,89060,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,UnitedHealthcare,Medicare Advantage,24.01,49,,percent of total billed charges,,
"Crystal Id, Synovial Fluid",,89060,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Crystal Id, Synovial Fluid",,89060,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,23.52,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Crystal Id, Synovial Fluid",,89060,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Post Vasectomy Semen Analysis; Sperm Presence And Motility,,89321,CPT,Facility,Both,,,,173,147.05,49.5818,173,Aetna,Commercial,159.16,92,,percent of total billed charges,,
Post Vasectomy Semen Analysis; Sperm Presence And Motility,,89321,CPT,Facility,Outpatient,,,,173,147.05,49.5818,173,Aetna,Medicare Advantage,84.77,49,,percent of total billed charges,,
Post Vasectomy Semen Analysis; Sperm Presence And Motility,,89321,CPT,Facility,Inpatient,,,,173,147.05,49.5818,173,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Post Vasectomy Semen Analysis; Sperm Presence And Motility,,89321,CPT,Facility,Both,,,,173,147.05,49.5818,173,Aetna,PPO,160.89,93,,percent of total billed charges,,
Post Vasectomy Semen Analysis; Sperm Presence And Motility,,89321,CPT,Facility,Both,,,,173,147.05,49.5818,173,America's PPO,America's PPO,166.1319,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Post Vasectomy Semen Analysis; Sperm Presence And Motility,,89321,CPT,Facility,Both,,,,173,147.05,49.5818,173,BlueCross BlueShield Minnesota, Federal Employee Program,170.232,98.4,,percent of total billed charges,,
Post Vasectomy Semen Analysis; Sperm Presence And Motility,,89321,CPT,Facility,Both,,,,173,147.05,49.5818,173,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,173,100,,percent of total billed charges,,
Post Vasectomy Semen Analysis; Sperm Presence And Motility,,89321,CPT,Facility,Both,,,,173,147.05,49.5818,173,BlueCross BlueShield Minnesota,High Value Network Plan,155.7,90,,percent of total billed charges,,
Post Vasectomy Semen Analysis; Sperm Presence And Motility,,89321,CPT,Facility,Outpatient,,,,173,147.05,49.5818,173,BlueCross BlueShield Minnesota,Medicare Advantage,84.77,49,,percent of total billed charges,,
Post Vasectomy Semen Analysis; Sperm Presence And Motility,,89321,CPT,Facility,Inpatient,,,,173,147.05,49.5818,173,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Post Vasectomy Semen Analysis; Sperm Presence And Motility,,89321,CPT,Facility,Both,,,,173,147.05,49.5818,173,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,153.2261,88.57,,percent of total billed charges,,
Post Vasectomy Semen Analysis; Sperm Presence And Motility,,89321,CPT,Facility,Both,,,,173,147.05,49.5818,173,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,49.5818,28.66,,percent of total billed charges,,
Post Vasectomy Semen Analysis; Sperm Presence And Motility,,89321,CPT,Facility,Outpatient,,,,173,147.05,49.5818,173,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),84.77,49,,percent of total billed charges,,
Post Vasectomy Semen Analysis; Sperm Presence And Motility,,89321,CPT,Facility,Inpatient,,,,173,147.05,49.5818,173,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Post Vasectomy Semen Analysis; Sperm Presence And Motility,,89321,CPT,Facility,Both,,,,173,147.05,49.5818,173,CorVel,Worker's Compensation,173,100,,percent of total billed charges,,
Post Vasectomy Semen Analysis; Sperm Presence And Motility,,89321,CPT,Facility,Both,,,,173,147.05,49.5818,173,First Health Group Corporation,First Health Network,167.81,97,,percent of total billed charges,,
Post Vasectomy Semen Analysis; Sperm Presence And Motility,,89321,CPT,Facility,Both,,,,173,147.05,49.5818,173,"Health Partners, Inc.",Commercial,163.658,94.6,,percent of total billed charges,,
Post Vasectomy Semen Analysis; Sperm Presence And Motility,,89321,CPT,Facility,Outpatient,,,,173,147.05,49.5818,173,"Health Partners, Inc.",Medicare Advantage,84.77,49,,percent of total billed charges,,
Post Vasectomy Semen Analysis; Sperm Presence And Motility,,89321,CPT,Facility,Inpatient,,,,173,147.05,49.5818,173,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Post Vasectomy Semen Analysis; Sperm Presence And Motility,,89321,CPT,Facility,Both,,,,173,147.05,49.5818,173,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),103.8,60,,percent of total billed charges,,
Post Vasectomy Semen Analysis; Sperm Presence And Motility,,89321,CPT,Facility,Both,,,,173,147.05,49.5818,173,"Health Partners, Inc.",State of Minnesota Advantage Program,140.995,81.5,,percent of total billed charges,,
Post Vasectomy Semen Analysis; Sperm Presence And Motility,,89321,CPT,Facility,Both,,,,173,147.05,49.5818,173,"Health Partners, Inc.",State Public Programs,86.5,50,,percent of total billed charges,,
Post Vasectomy Semen Analysis; Sperm Presence And Motility,,89321,CPT,Facility,Both,,,,173,147.05,49.5818,173,Humana Insurance Company,Commercial PPO,164.35,95,,percent of total billed charges,,
Post Vasectomy Semen Analysis; Sperm Presence And Motility,,89321,CPT,Facility,Outpatient,,,,173,147.05,49.5818,173,Humana Insurance Company,Medicare PPO,84.77,49,,percent of total billed charges,,
Post Vasectomy Semen Analysis; Sperm Presence And Motility,,89321,CPT,Facility,Inpatient,,,,173,147.05,49.5818,173,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Post Vasectomy Semen Analysis; Sperm Presence And Motility,,89321,CPT,Facility,Both,,,,173,147.05,49.5818,173,Medica,Individual & Family,171.443,99.1,,percent of total billed charges,,
Post Vasectomy Semen Analysis; Sperm Presence And Motility,,89321,CPT,Facility,Outpatient,,,,173,147.05,49.5818,173,Medica,Medica Advantage Solution,86.154,49.8,,percent of total billed charges,,
Post Vasectomy Semen Analysis; Sperm Presence And Motility,,89321,CPT,Facility,Inpatient,,,,173,147.05,49.5818,173,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Post Vasectomy Semen Analysis; Sperm Presence And Motility,,89321,CPT,Facility,Outpatient,,,,173,147.05,49.5818,173,Medica,Medical Assistance,77.158,44.6,,percent of total billed charges,,
Post Vasectomy Semen Analysis; Sperm Presence And Motility,,89321,CPT,Facility,Inpatient,,,,173,147.05,49.5818,173,Medica,Medical Assistance,,,,,Included in per diem rate,
Post Vasectomy Semen Analysis; Sperm Presence And Motility,,89321,CPT,Facility,Outpatient,,,,173,147.05,49.5818,173,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,86.154,49.8,,percent of total billed charges,,
Post Vasectomy Semen Analysis; Sperm Presence And Motility,,89321,CPT,Facility,Inpatient,,,,173,147.05,49.5818,173,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Post Vasectomy Semen Analysis; Sperm Presence And Motility,,89321,CPT,Facility,Both,,,,173,147.05,49.5818,173,"Multiplan, Inc.","Multiplan, Inc.",162.62,94,,percent of total billed charges,,
Post Vasectomy Semen Analysis; Sperm Presence And Motility,,89321,CPT,Facility,Outpatient,,,,173,147.05,49.5818,173,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,149.472,86.4,,percent of total billed charges,,
Post Vasectomy Semen Analysis; Sperm Presence And Motility,,89321,CPT,Facility,Inpatient,,,,173,147.05,49.5818,173,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Post Vasectomy Semen Analysis; Sperm Presence And Motility,,89321,CPT,Facility,Both,,,,173,147.05,49.5818,173,"Preferred One Administrative Services, INC.",PPO,170.578,98.6,,percent of total billed charges,,
Post Vasectomy Semen Analysis; Sperm Presence And Motility,,89321,CPT,Facility,Outpatient,,,,173,147.05,49.5818,173,PrimeWest Health,Minnesota Senior Health Options (MSHO),89.0085,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Post Vasectomy Semen Analysis; Sperm Presence And Motility,,89321,CPT,Facility,Inpatient,,,,173,147.05,49.5818,173,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Post Vasectomy Semen Analysis; Sperm Presence And Motility,,89321,CPT,Facility,Outpatient,,,,173,147.05,49.5818,173,PrimeWest Health,MinnesotaCare,88.8528,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Post Vasectomy Semen Analysis; Sperm Presence And Motility,,89321,CPT,Facility,Inpatient,,,,173,147.05,49.5818,173,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Post Vasectomy Semen Analysis; Sperm Presence And Motility,,89321,CPT,Facility,Both,,,,173,147.05,49.5818,173,Sanford Health Plan,Sanford Health Plan,159.16,92,,percent of total billed charges,,
Post Vasectomy Semen Analysis; Sperm Presence And Motility,,89321,CPT,Facility,Outpatient,,,,173,147.05,49.5818,173,"UCare Health, Inc.",Individual & Family Plan,97.4855,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Post Vasectomy Semen Analysis; Sperm Presence And Motility,,89321,CPT,Facility,Inpatient,,,,173,147.05,49.5818,173,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Post Vasectomy Semen Analysis; Sperm Presence And Motility,,89321,CPT,Facility,Outpatient,,,,173,147.05,49.5818,173,"UCare Health, Inc.",Medical Assistance,87.3131,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Post Vasectomy Semen Analysis; Sperm Presence And Motility,,89321,CPT,Facility,Inpatient,,,,173,147.05,49.5818,173,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Post Vasectomy Semen Analysis; Sperm Presence And Motility,,89321,CPT,Facility,Outpatient,,,,173,147.05,49.5818,173,"UCare Health, Inc.",Medicare Advantage,87.3131,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Post Vasectomy Semen Analysis; Sperm Presence And Motility,,89321,CPT,Facility,Inpatient,,,,173,147.05,49.5818,173,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Post Vasectomy Semen Analysis; Sperm Presence And Motility,,89321,CPT,Facility,Outpatient,,,,173,147.05,49.5818,173,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),87.3131,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Post Vasectomy Semen Analysis; Sperm Presence And Motility,,89321,CPT,Facility,Inpatient,,,,173,147.05,49.5818,173,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Post Vasectomy Semen Analysis; Sperm Presence And Motility,,89321,CPT,Facility,Both,,,,173,147.05,49.5818,173,UnitedHealthcare,Individual & Family,162.62,94,,percent of total billed charges,,
Post Vasectomy Semen Analysis; Sperm Presence And Motility,,89321,CPT,Facility,Outpatient,,,,173,147.05,49.5818,173,UnitedHealthcare,Medicare Advantage,84.77,49,,percent of total billed charges,,
Post Vasectomy Semen Analysis; Sperm Presence And Motility,,89321,CPT,Facility,Inpatient,,,,173,147.05,49.5818,173,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Post Vasectomy Semen Analysis; Sperm Presence And Motility,,89321,CPT,Facility,Outpatient,,,,173,147.05,49.5818,173,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,83.04,48,,percent of total billed charges,,100% of DHS outpatient percentage
Post Vasectomy Semen Analysis; Sperm Presence And Motility,,89321,CPT,Facility,Inpatient,,,,173,147.05,49.5818,173,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
INSULIN ASPART U-100 100 UNIT/ML SUBQ SOLN,,J1815,HCPCS,Facility,Both,10,mL,,1251,1063.35,358.5366,1251,Aetna,Commercial,1150.92,92,,percent of total billed charges,,
INSULIN ASPART U-100 100 UNIT/ML SUBQ SOLN,,J1815,HCPCS,Facility,Outpatient,10,mL,,1251,1063.35,358.5366,1251,Aetna,Medicare Advantage,612.99,49,,percent of total billed charges,,
INSULIN ASPART U-100 100 UNIT/ML SUBQ SOLN,,J1815,HCPCS,Facility,Inpatient,10,mL,,1251,1063.35,358.5366,1251,Aetna,Medicare Advantage,,,,,Included in per diem rate,
INSULIN ASPART U-100 100 UNIT/ML SUBQ SOLN,,J1815,HCPCS,Facility,Both,10,mL,,1251,1063.35,358.5366,1251,Aetna,PPO,1163.43,93,,percent of total billed charges,,
INSULIN ASPART U-100 100 UNIT/ML SUBQ SOLN,,J1815,HCPCS,Facility,Both,10,mL,,1251,1063.35,358.5366,1251,America's PPO,America's PPO,1201.3353,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
INSULIN ASPART U-100 100 UNIT/ML SUBQ SOLN,,J1815,HCPCS,Facility,Both,10,mL,,1251,1063.35,358.5366,1251,BlueCross BlueShield Minnesota, Federal Employee Program,1230.984,98.4,,percent of total billed charges,,
INSULIN ASPART U-100 100 UNIT/ML SUBQ SOLN,,J1815,HCPCS,Facility,Both,10,mL,,1251,1063.35,358.5366,1251,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1251,100,,percent of total billed charges,,
INSULIN ASPART U-100 100 UNIT/ML SUBQ SOLN,,J1815,HCPCS,Facility,Both,10,mL,,1251,1063.35,358.5366,1251,BlueCross BlueShield Minnesota,High Value Network Plan,1125.9,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
INSULIN ASPART U-100 100 UNIT/ML SUBQ SOLN,,J1815,HCPCS,Facility,Outpatient,10,mL,,1251,1063.35,358.5366,1251,BlueCross BlueShield Minnesota,Medicare Advantage,612.99,49,,percent of total billed charges,,
INSULIN ASPART U-100 100 UNIT/ML SUBQ SOLN,,J1815,HCPCS,Facility,Inpatient,10,mL,,1251,1063.35,358.5366,1251,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
INSULIN ASPART U-100 100 UNIT/ML SUBQ SOLN,,J1815,HCPCS,Facility,Both,10,mL,,1251,1063.35,358.5366,1251,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1108.0107,88.57,,percent of total billed charges,,
INSULIN ASPART U-100 100 UNIT/ML SUBQ SOLN,,J1815,HCPCS,Facility,Both,10,mL,,1251,1063.35,358.5366,1251,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,358.5366,28.66,,percent of total billed charges,,
INSULIN ASPART U-100 100 UNIT/ML SUBQ SOLN,,J1815,HCPCS,Facility,Outpatient,10,mL,,1251,1063.35,358.5366,1251,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),612.99,49,,percent of total billed charges,,
INSULIN ASPART U-100 100 UNIT/ML SUBQ SOLN,,J1815,HCPCS,Facility,Inpatient,10,mL,,1251,1063.35,358.5366,1251,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
INSULIN ASPART U-100 100 UNIT/ML SUBQ SOLN,,J1815,HCPCS,Facility,Both,10,mL,,1251,1063.35,358.5366,1251,CorVel,Worker's Compensation,1251,100,,percent of total billed charges,,
INSULIN ASPART U-100 100 UNIT/ML SUBQ SOLN,,J1815,HCPCS,Facility,Both,10,mL,,1251,1063.35,358.5366,1251,First Health Group Corporation,First Health Network,1213.47,97,,percent of total billed charges,,
INSULIN ASPART U-100 100 UNIT/ML SUBQ SOLN,,J1815,HCPCS,Facility,Both,10,mL,,1251,1063.35,358.5366,1251,"Health Partners, Inc.",Commercial,1183.446,94.6,,percent of total billed charges,,
INSULIN ASPART U-100 100 UNIT/ML SUBQ SOLN,,J1815,HCPCS,Facility,Outpatient,10,mL,,1251,1063.35,358.5366,1251,"Health Partners, Inc.",Medicare Advantage,612.99,49,,percent of total billed charges,,
INSULIN ASPART U-100 100 UNIT/ML SUBQ SOLN,,J1815,HCPCS,Facility,Inpatient,10,mL,,1251,1063.35,358.5366,1251,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
INSULIN ASPART U-100 100 UNIT/ML SUBQ SOLN,,J1815,HCPCS,Facility,Both,10,mL,,1251,1063.35,358.5366,1251,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),750.6,60,,percent of total billed charges,,
INSULIN ASPART U-100 100 UNIT/ML SUBQ SOLN,,J1815,HCPCS,Facility,Both,10,mL,,1251,1063.35,358.5366,1251,"Health Partners, Inc.",State of Minnesota Advantage Program,1019.565,81.5,,percent of total billed charges,,
INSULIN ASPART U-100 100 UNIT/ML SUBQ SOLN,,J1815,HCPCS,Facility,Both,10,mL,,1251,1063.35,358.5366,1251,"Health Partners, Inc.",State Public Programs,625.5,50,,percent of total billed charges,,
INSULIN ASPART U-100 100 UNIT/ML SUBQ SOLN,,J1815,HCPCS,Facility,Both,10,mL,,1251,1063.35,358.5366,1251,Humana Insurance Company,Commercial PPO,1188.45,95,,percent of total billed charges,,
INSULIN ASPART U-100 100 UNIT/ML SUBQ SOLN,,J1815,HCPCS,Facility,Outpatient,10,mL,,1251,1063.35,358.5366,1251,Humana Insurance Company,Medicare PPO,612.99,49,,percent of total billed charges,,
INSULIN ASPART U-100 100 UNIT/ML SUBQ SOLN,,J1815,HCPCS,Facility,Inpatient,10,mL,,1251,1063.35,358.5366,1251,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
INSULIN ASPART U-100 100 UNIT/ML SUBQ SOLN,,J1815,HCPCS,Facility,Both,10,mL,,1251,1063.35,358.5366,1251,Medica,Individual & Family,1239.741,99.1,,percent of total billed charges,,
INSULIN ASPART U-100 100 UNIT/ML SUBQ SOLN,,J1815,HCPCS,Facility,Outpatient,10,mL,,1251,1063.35,358.5366,1251,Medica,Medica Advantage Solution,622.998,49.8,,percent of total billed charges,,
INSULIN ASPART U-100 100 UNIT/ML SUBQ SOLN,,J1815,HCPCS,Facility,Inpatient,10,mL,,1251,1063.35,358.5366,1251,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
INSULIN ASPART U-100 100 UNIT/ML SUBQ SOLN,,J1815,HCPCS,Facility,Outpatient,10,mL,,1251,1063.35,358.5366,1251,Medica,Medical Assistance,557.946,44.6,,percent of total billed charges,,
INSULIN ASPART U-100 100 UNIT/ML SUBQ SOLN,,J1815,HCPCS,Facility,Inpatient,10,mL,,1251,1063.35,358.5366,1251,Medica,Medical Assistance,,,,,Included in per diem rate,
INSULIN ASPART U-100 100 UNIT/ML SUBQ SOLN,,J1815,HCPCS,Facility,Outpatient,10,mL,,1251,1063.35,358.5366,1251,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,622.998,49.8,,percent of total billed charges,,
INSULIN ASPART U-100 100 UNIT/ML SUBQ SOLN,,J1815,HCPCS,Facility,Inpatient,10,mL,,1251,1063.35,358.5366,1251,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
INSULIN ASPART U-100 100 UNIT/ML SUBQ SOLN,,J1815,HCPCS,Facility,Both,10,mL,,1251,1063.35,358.5366,1251,"Multiplan, Inc.","Multiplan, Inc.",1175.94,94,,percent of total billed charges,,
INSULIN ASPART U-100 100 UNIT/ML SUBQ SOLN,,J1815,HCPCS,Facility,Outpatient,10,mL,,1251,1063.35,358.5366,1251,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1127.151,90.1,,percent of total billed charges,,
INSULIN ASPART U-100 100 UNIT/ML SUBQ SOLN,,J1815,HCPCS,Facility,Inpatient,10,mL,,1251,1063.35,358.5366,1251,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
INSULIN ASPART U-100 100 UNIT/ML SUBQ SOLN,,J1815,HCPCS,Facility,Both,10,mL,,1251,1063.35,358.5366,1251,"Preferred One Administrative Services, INC.",PPO,1233.486,98.6,,percent of total billed charges,,
INSULIN ASPART U-100 100 UNIT/ML SUBQ SOLN,,J1815,HCPCS,Facility,Outpatient,10,mL,,1251,1063.35,358.5366,1251,PrimeWest Health,Minnesota Senior Health Options (MSHO),643.6395,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
INSULIN ASPART U-100 100 UNIT/ML SUBQ SOLN,,J1815,HCPCS,Facility,Inpatient,10,mL,,1251,1063.35,358.5366,1251,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
INSULIN ASPART U-100 100 UNIT/ML SUBQ SOLN,,J1815,HCPCS,Facility,Outpatient,10,mL,,1251,1063.35,358.5366,1251,PrimeWest Health,MinnesotaCare,642.5136,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
INSULIN ASPART U-100 100 UNIT/ML SUBQ SOLN,,J1815,HCPCS,Facility,Inpatient,10,mL,,1251,1063.35,358.5366,1251,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
INSULIN ASPART U-100 100 UNIT/ML SUBQ SOLN,,J1815,HCPCS,Facility,Both,10,mL,,1251,1063.35,358.5366,1251,Sanford Health Plan,Sanford Health Plan,1150.92,92,,percent of total billed charges,,
INSULIN ASPART U-100 100 UNIT/ML SUBQ SOLN,,J1815,HCPCS,Facility,Outpatient,10,mL,,1251,1063.35,358.5366,1251,"UCare Health, Inc.",Individual & Family Plan,704.9385,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
INSULIN ASPART U-100 100 UNIT/ML SUBQ SOLN,,J1815,HCPCS,Facility,Inpatient,10,mL,,1251,1063.35,358.5366,1251,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
INSULIN ASPART U-100 100 UNIT/ML SUBQ SOLN,,J1815,HCPCS,Facility,Outpatient,10,mL,,1251,1063.35,358.5366,1251,"UCare Health, Inc.",Medical Assistance,631.3797,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
INSULIN ASPART U-100 100 UNIT/ML SUBQ SOLN,,J1815,HCPCS,Facility,Inpatient,10,mL,,1251,1063.35,358.5366,1251,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
INSULIN ASPART U-100 100 UNIT/ML SUBQ SOLN,,J1815,HCPCS,Facility,Outpatient,10,mL,,1251,1063.35,358.5366,1251,"UCare Health, Inc.",Medicare Advantage,631.3797,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
INSULIN ASPART U-100 100 UNIT/ML SUBQ SOLN,,J1815,HCPCS,Facility,Inpatient,10,mL,,1251,1063.35,358.5366,1251,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
INSULIN ASPART U-100 100 UNIT/ML SUBQ SOLN,,J1815,HCPCS,Facility,Outpatient,10,mL,,1251,1063.35,358.5366,1251,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),631.3797,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
INSULIN ASPART U-100 100 UNIT/ML SUBQ SOLN,,J1815,HCPCS,Facility,Inpatient,10,mL,,1251,1063.35,358.5366,1251,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
INSULIN ASPART U-100 100 UNIT/ML SUBQ SOLN,,J1815,HCPCS,Facility,Both,10,mL,,1251,1063.35,358.5366,1251,UnitedHealthcare,Individual & Family,1175.94,94,,percent of total billed charges,,
INSULIN ASPART U-100 100 UNIT/ML SUBQ SOLN,,J1815,HCPCS,Facility,Outpatient,10,mL,,1251,1063.35,358.5366,1251,UnitedHealthcare,Medicare Advantage,612.99,49,,percent of total billed charges,,
INSULIN ASPART U-100 100 UNIT/ML SUBQ SOLN,,J1815,HCPCS,Facility,Inpatient,10,mL,,1251,1063.35,358.5366,1251,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
INSULIN ASPART U-100 100 UNIT/ML SUBQ SOLN,,J1815,HCPCS,Facility,Outpatient,10,mL,,1251,1063.35,358.5366,1251,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,600.48,48,,percent of total billed charges,,100% of DHS outpatient percentage
INSULIN ASPART U-100 100 UNIT/ML SUBQ SOLN,,J1815,HCPCS,Facility,Inpatient,10,mL,,1251,1063.35,358.5366,1251,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
INSULIN LISPRO PROTAMIN-LISPRO 100 UNIT/ML (50-50) SUBQ SUSP,,J1815,HCPCS,Facility,Both,10,mL,,1230,1045.5,352.518,1230,Aetna,Commercial,1131.6,92,,percent of total billed charges,,
INSULIN LISPRO PROTAMIN-LISPRO 100 UNIT/ML (50-50) SUBQ SUSP,,J1815,HCPCS,Facility,Outpatient,10,mL,,1230,1045.5,352.518,1230,Aetna,Medicare Advantage,602.7,49,,percent of total billed charges,,
INSULIN LISPRO PROTAMIN-LISPRO 100 UNIT/ML (50-50) SUBQ SUSP,,J1815,HCPCS,Facility,Inpatient,10,mL,,1230,1045.5,352.518,1230,Aetna,Medicare Advantage,,,,,Included in per diem rate,
INSULIN LISPRO PROTAMIN-LISPRO 100 UNIT/ML (50-50) SUBQ SUSP,,J1815,HCPCS,Facility,Both,10,mL,,1230,1045.5,352.518,1230,Aetna,PPO,1143.9,93,,percent of total billed charges,,
INSULIN LISPRO PROTAMIN-LISPRO 100 UNIT/ML (50-50) SUBQ SUSP,,J1815,HCPCS,Facility,Both,10,mL,,1230,1045.5,352.518,1230,America's PPO,America's PPO,1181.169,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
INSULIN LISPRO PROTAMIN-LISPRO 100 UNIT/ML (50-50) SUBQ SUSP,,J1815,HCPCS,Facility,Both,10,mL,,1230,1045.5,352.518,1230,BlueCross BlueShield Minnesota, Federal Employee Program,1210.32,98.4,,percent of total billed charges,,
INSULIN LISPRO PROTAMIN-LISPRO 100 UNIT/ML (50-50) SUBQ SUSP,,J1815,HCPCS,Facility,Both,10,mL,,1230,1045.5,352.518,1230,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1230,100,,percent of total billed charges,,
INSULIN LISPRO PROTAMIN-LISPRO 100 UNIT/ML (50-50) SUBQ SUSP,,J1815,HCPCS,Facility,Both,10,mL,,1230,1045.5,352.518,1230,BlueCross BlueShield Minnesota,High Value Network Plan,1107,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
INSULIN LISPRO PROTAMIN-LISPRO 100 UNIT/ML (50-50) SUBQ SUSP,,J1815,HCPCS,Facility,Outpatient,10,mL,,1230,1045.5,352.518,1230,BlueCross BlueShield Minnesota,Medicare Advantage,602.7,49,,percent of total billed charges,,
INSULIN LISPRO PROTAMIN-LISPRO 100 UNIT/ML (50-50) SUBQ SUSP,,J1815,HCPCS,Facility,Inpatient,10,mL,,1230,1045.5,352.518,1230,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
INSULIN LISPRO PROTAMIN-LISPRO 100 UNIT/ML (50-50) SUBQ SUSP,,J1815,HCPCS,Facility,Both,10,mL,,1230,1045.5,352.518,1230,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1089.411,88.57,,percent of total billed charges,,
INSULIN LISPRO PROTAMIN-LISPRO 100 UNIT/ML (50-50) SUBQ SUSP,,J1815,HCPCS,Facility,Both,10,mL,,1230,1045.5,352.518,1230,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,352.518,28.66,,percent of total billed charges,,
INSULIN LISPRO PROTAMIN-LISPRO 100 UNIT/ML (50-50) SUBQ SUSP,,J1815,HCPCS,Facility,Outpatient,10,mL,,1230,1045.5,352.518,1230,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),602.7,49,,percent of total billed charges,,
INSULIN LISPRO PROTAMIN-LISPRO 100 UNIT/ML (50-50) SUBQ SUSP,,J1815,HCPCS,Facility,Inpatient,10,mL,,1230,1045.5,352.518,1230,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
INSULIN LISPRO PROTAMIN-LISPRO 100 UNIT/ML (50-50) SUBQ SUSP,,J1815,HCPCS,Facility,Both,10,mL,,1230,1045.5,352.518,1230,CorVel,Worker's Compensation,1230,100,,percent of total billed charges,,
INSULIN LISPRO PROTAMIN-LISPRO 100 UNIT/ML (50-50) SUBQ SUSP,,J1815,HCPCS,Facility,Both,10,mL,,1230,1045.5,352.518,1230,First Health Group Corporation,First Health Network,1193.1,97,,percent of total billed charges,,
INSULIN LISPRO PROTAMIN-LISPRO 100 UNIT/ML (50-50) SUBQ SUSP,,J1815,HCPCS,Facility,Both,10,mL,,1230,1045.5,352.518,1230,"Health Partners, Inc.",Commercial,1163.58,94.6,,percent of total billed charges,,
INSULIN LISPRO PROTAMIN-LISPRO 100 UNIT/ML (50-50) SUBQ SUSP,,J1815,HCPCS,Facility,Outpatient,10,mL,,1230,1045.5,352.518,1230,"Health Partners, Inc.",Medicare Advantage,602.7,49,,percent of total billed charges,,
INSULIN LISPRO PROTAMIN-LISPRO 100 UNIT/ML (50-50) SUBQ SUSP,,J1815,HCPCS,Facility,Inpatient,10,mL,,1230,1045.5,352.518,1230,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
INSULIN LISPRO PROTAMIN-LISPRO 100 UNIT/ML (50-50) SUBQ SUSP,,J1815,HCPCS,Facility,Both,10,mL,,1230,1045.5,352.518,1230,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),738,60,,percent of total billed charges,,
INSULIN LISPRO PROTAMIN-LISPRO 100 UNIT/ML (50-50) SUBQ SUSP,,J1815,HCPCS,Facility,Both,10,mL,,1230,1045.5,352.518,1230,"Health Partners, Inc.",State of Minnesota Advantage Program,1002.45,81.5,,percent of total billed charges,,
INSULIN LISPRO PROTAMIN-LISPRO 100 UNIT/ML (50-50) SUBQ SUSP,,J1815,HCPCS,Facility,Both,10,mL,,1230,1045.5,352.518,1230,"Health Partners, Inc.",State Public Programs,615,50,,percent of total billed charges,,
INSULIN LISPRO PROTAMIN-LISPRO 100 UNIT/ML (50-50) SUBQ SUSP,,J1815,HCPCS,Facility,Both,10,mL,,1230,1045.5,352.518,1230,Humana Insurance Company,Commercial PPO,1168.5,95,,percent of total billed charges,,
INSULIN LISPRO PROTAMIN-LISPRO 100 UNIT/ML (50-50) SUBQ SUSP,,J1815,HCPCS,Facility,Outpatient,10,mL,,1230,1045.5,352.518,1230,Humana Insurance Company,Medicare PPO,602.7,49,,percent of total billed charges,,
INSULIN LISPRO PROTAMIN-LISPRO 100 UNIT/ML (50-50) SUBQ SUSP,,J1815,HCPCS,Facility,Inpatient,10,mL,,1230,1045.5,352.518,1230,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
INSULIN LISPRO PROTAMIN-LISPRO 100 UNIT/ML (50-50) SUBQ SUSP,,J1815,HCPCS,Facility,Both,10,mL,,1230,1045.5,352.518,1230,Medica,Individual & Family,1218.93,99.1,,percent of total billed charges,,
INSULIN LISPRO PROTAMIN-LISPRO 100 UNIT/ML (50-50) SUBQ SUSP,,J1815,HCPCS,Facility,Outpatient,10,mL,,1230,1045.5,352.518,1230,Medica,Medica Advantage Solution,612.54,49.8,,percent of total billed charges,,
INSULIN LISPRO PROTAMIN-LISPRO 100 UNIT/ML (50-50) SUBQ SUSP,,J1815,HCPCS,Facility,Inpatient,10,mL,,1230,1045.5,352.518,1230,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
INSULIN LISPRO PROTAMIN-LISPRO 100 UNIT/ML (50-50) SUBQ SUSP,,J1815,HCPCS,Facility,Outpatient,10,mL,,1230,1045.5,352.518,1230,Medica,Medical Assistance,548.58,44.6,,percent of total billed charges,,
INSULIN LISPRO PROTAMIN-LISPRO 100 UNIT/ML (50-50) SUBQ SUSP,,J1815,HCPCS,Facility,Inpatient,10,mL,,1230,1045.5,352.518,1230,Medica,Medical Assistance,,,,,Included in per diem rate,
INSULIN LISPRO PROTAMIN-LISPRO 100 UNIT/ML (50-50) SUBQ SUSP,,J1815,HCPCS,Facility,Outpatient,10,mL,,1230,1045.5,352.518,1230,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,612.54,49.8,,percent of total billed charges,,
INSULIN LISPRO PROTAMIN-LISPRO 100 UNIT/ML (50-50) SUBQ SUSP,,J1815,HCPCS,Facility,Inpatient,10,mL,,1230,1045.5,352.518,1230,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
INSULIN LISPRO PROTAMIN-LISPRO 100 UNIT/ML (50-50) SUBQ SUSP,,J1815,HCPCS,Facility,Both,10,mL,,1230,1045.5,352.518,1230,"Multiplan, Inc.","Multiplan, Inc.",1156.2,94,,percent of total billed charges,,
INSULIN LISPRO PROTAMIN-LISPRO 100 UNIT/ML (50-50) SUBQ SUSP,,J1815,HCPCS,Facility,Outpatient,10,mL,,1230,1045.5,352.518,1230,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1108.23,90.1,,percent of total billed charges,,
INSULIN LISPRO PROTAMIN-LISPRO 100 UNIT/ML (50-50) SUBQ SUSP,,J1815,HCPCS,Facility,Inpatient,10,mL,,1230,1045.5,352.518,1230,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
INSULIN LISPRO PROTAMIN-LISPRO 100 UNIT/ML (50-50) SUBQ SUSP,,J1815,HCPCS,Facility,Both,10,mL,,1230,1045.5,352.518,1230,"Preferred One Administrative Services, INC.",PPO,1212.78,98.6,,percent of total billed charges,,
INSULIN LISPRO PROTAMIN-LISPRO 100 UNIT/ML (50-50) SUBQ SUSP,,J1815,HCPCS,Facility,Outpatient,10,mL,,1230,1045.5,352.518,1230,PrimeWest Health,Minnesota Senior Health Options (MSHO),632.835,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
INSULIN LISPRO PROTAMIN-LISPRO 100 UNIT/ML (50-50) SUBQ SUSP,,J1815,HCPCS,Facility,Inpatient,10,mL,,1230,1045.5,352.518,1230,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
INSULIN LISPRO PROTAMIN-LISPRO 100 UNIT/ML (50-50) SUBQ SUSP,,J1815,HCPCS,Facility,Outpatient,10,mL,,1230,1045.5,352.518,1230,PrimeWest Health,MinnesotaCare,631.728,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
INSULIN LISPRO PROTAMIN-LISPRO 100 UNIT/ML (50-50) SUBQ SUSP,,J1815,HCPCS,Facility,Inpatient,10,mL,,1230,1045.5,352.518,1230,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
INSULIN LISPRO PROTAMIN-LISPRO 100 UNIT/ML (50-50) SUBQ SUSP,,J1815,HCPCS,Facility,Both,10,mL,,1230,1045.5,352.518,1230,Sanford Health Plan,Sanford Health Plan,1131.6,92,,percent of total billed charges,,
INSULIN LISPRO PROTAMIN-LISPRO 100 UNIT/ML (50-50) SUBQ SUSP,,J1815,HCPCS,Facility,Outpatient,10,mL,,1230,1045.5,352.518,1230,"UCare Health, Inc.",Individual & Family Plan,693.105,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
INSULIN LISPRO PROTAMIN-LISPRO 100 UNIT/ML (50-50) SUBQ SUSP,,J1815,HCPCS,Facility,Inpatient,10,mL,,1230,1045.5,352.518,1230,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
INSULIN LISPRO PROTAMIN-LISPRO 100 UNIT/ML (50-50) SUBQ SUSP,,J1815,HCPCS,Facility,Outpatient,10,mL,,1230,1045.5,352.518,1230,"UCare Health, Inc.",Medical Assistance,620.781,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
INSULIN LISPRO PROTAMIN-LISPRO 100 UNIT/ML (50-50) SUBQ SUSP,,J1815,HCPCS,Facility,Inpatient,10,mL,,1230,1045.5,352.518,1230,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
INSULIN LISPRO PROTAMIN-LISPRO 100 UNIT/ML (50-50) SUBQ SUSP,,J1815,HCPCS,Facility,Outpatient,10,mL,,1230,1045.5,352.518,1230,"UCare Health, Inc.",Medicare Advantage,620.781,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
INSULIN LISPRO PROTAMIN-LISPRO 100 UNIT/ML (50-50) SUBQ SUSP,,J1815,HCPCS,Facility,Inpatient,10,mL,,1230,1045.5,352.518,1230,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
INSULIN LISPRO PROTAMIN-LISPRO 100 UNIT/ML (50-50) SUBQ SUSP,,J1815,HCPCS,Facility,Outpatient,10,mL,,1230,1045.5,352.518,1230,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),620.781,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
INSULIN LISPRO PROTAMIN-LISPRO 100 UNIT/ML (50-50) SUBQ SUSP,,J1815,HCPCS,Facility,Inpatient,10,mL,,1230,1045.5,352.518,1230,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
INSULIN LISPRO PROTAMIN-LISPRO 100 UNIT/ML (50-50) SUBQ SUSP,,J1815,HCPCS,Facility,Both,10,mL,,1230,1045.5,352.518,1230,UnitedHealthcare,Individual & Family,1156.2,94,,percent of total billed charges,,
INSULIN LISPRO PROTAMIN-LISPRO 100 UNIT/ML (50-50) SUBQ SUSP,,J1815,HCPCS,Facility,Outpatient,10,mL,,1230,1045.5,352.518,1230,UnitedHealthcare,Medicare Advantage,602.7,49,,percent of total billed charges,,
INSULIN LISPRO PROTAMIN-LISPRO 100 UNIT/ML (50-50) SUBQ SUSP,,J1815,HCPCS,Facility,Inpatient,10,mL,,1230,1045.5,352.518,1230,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
INSULIN LISPRO PROTAMIN-LISPRO 100 UNIT/ML (50-50) SUBQ SUSP,,J1815,HCPCS,Facility,Outpatient,10,mL,,1230,1045.5,352.518,1230,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,590.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
INSULIN LISPRO PROTAMIN-LISPRO 100 UNIT/ML (50-50) SUBQ SUSP,,J1815,HCPCS,Facility,Inpatient,10,mL,,1230,1045.5,352.518,1230,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
INSULIN LISPRO PROTAMIN-LISPRO 100 UNIT/ML (75-25) SUBQ SUSP,,J1815,HCPCS,Facility,Both,10,mL,,1230,1045.5,352.518,1230,Aetna,Commercial,1131.6,92,,percent of total billed charges,,
INSULIN LISPRO PROTAMIN-LISPRO 100 UNIT/ML (75-25) SUBQ SUSP,,J1815,HCPCS,Facility,Outpatient,10,mL,,1230,1045.5,352.518,1230,Aetna,Medicare Advantage,602.7,49,,percent of total billed charges,,
INSULIN LISPRO PROTAMIN-LISPRO 100 UNIT/ML (75-25) SUBQ SUSP,,J1815,HCPCS,Facility,Inpatient,10,mL,,1230,1045.5,352.518,1230,Aetna,Medicare Advantage,,,,,Included in per diem rate,
INSULIN LISPRO PROTAMIN-LISPRO 100 UNIT/ML (75-25) SUBQ SUSP,,J1815,HCPCS,Facility,Both,10,mL,,1230,1045.5,352.518,1230,Aetna,PPO,1143.9,93,,percent of total billed charges,,
INSULIN LISPRO PROTAMIN-LISPRO 100 UNIT/ML (75-25) SUBQ SUSP,,J1815,HCPCS,Facility,Both,10,mL,,1230,1045.5,352.518,1230,America's PPO,America's PPO,1181.169,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
INSULIN LISPRO PROTAMIN-LISPRO 100 UNIT/ML (75-25) SUBQ SUSP,,J1815,HCPCS,Facility,Both,10,mL,,1230,1045.5,352.518,1230,BlueCross BlueShield Minnesota, Federal Employee Program,1210.32,98.4,,percent of total billed charges,,
INSULIN LISPRO PROTAMIN-LISPRO 100 UNIT/ML (75-25) SUBQ SUSP,,J1815,HCPCS,Facility,Both,10,mL,,1230,1045.5,352.518,1230,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1230,100,,percent of total billed charges,,
INSULIN LISPRO PROTAMIN-LISPRO 100 UNIT/ML (75-25) SUBQ SUSP,,J1815,HCPCS,Facility,Both,10,mL,,1230,1045.5,352.518,1230,BlueCross BlueShield Minnesota,High Value Network Plan,1107,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
INSULIN LISPRO PROTAMIN-LISPRO 100 UNIT/ML (75-25) SUBQ SUSP,,J1815,HCPCS,Facility,Outpatient,10,mL,,1230,1045.5,352.518,1230,BlueCross BlueShield Minnesota,Medicare Advantage,602.7,49,,percent of total billed charges,,
INSULIN LISPRO PROTAMIN-LISPRO 100 UNIT/ML (75-25) SUBQ SUSP,,J1815,HCPCS,Facility,Inpatient,10,mL,,1230,1045.5,352.518,1230,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
INSULIN LISPRO PROTAMIN-LISPRO 100 UNIT/ML (75-25) SUBQ SUSP,,J1815,HCPCS,Facility,Both,10,mL,,1230,1045.5,352.518,1230,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1089.411,88.57,,percent of total billed charges,,
INSULIN LISPRO PROTAMIN-LISPRO 100 UNIT/ML (75-25) SUBQ SUSP,,J1815,HCPCS,Facility,Both,10,mL,,1230,1045.5,352.518,1230,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,352.518,28.66,,percent of total billed charges,,
INSULIN LISPRO PROTAMIN-LISPRO 100 UNIT/ML (75-25) SUBQ SUSP,,J1815,HCPCS,Facility,Outpatient,10,mL,,1230,1045.5,352.518,1230,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),602.7,49,,percent of total billed charges,,
INSULIN LISPRO PROTAMIN-LISPRO 100 UNIT/ML (75-25) SUBQ SUSP,,J1815,HCPCS,Facility,Inpatient,10,mL,,1230,1045.5,352.518,1230,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
INSULIN LISPRO PROTAMIN-LISPRO 100 UNIT/ML (75-25) SUBQ SUSP,,J1815,HCPCS,Facility,Both,10,mL,,1230,1045.5,352.518,1230,CorVel,Worker's Compensation,1230,100,,percent of total billed charges,,
INSULIN LISPRO PROTAMIN-LISPRO 100 UNIT/ML (75-25) SUBQ SUSP,,J1815,HCPCS,Facility,Both,10,mL,,1230,1045.5,352.518,1230,First Health Group Corporation,First Health Network,1193.1,97,,percent of total billed charges,,
INSULIN LISPRO PROTAMIN-LISPRO 100 UNIT/ML (75-25) SUBQ SUSP,,J1815,HCPCS,Facility,Both,10,mL,,1230,1045.5,352.518,1230,"Health Partners, Inc.",Commercial,1163.58,94.6,,percent of total billed charges,,
INSULIN LISPRO PROTAMIN-LISPRO 100 UNIT/ML (75-25) SUBQ SUSP,,J1815,HCPCS,Facility,Outpatient,10,mL,,1230,1045.5,352.518,1230,"Health Partners, Inc.",Medicare Advantage,602.7,49,,percent of total billed charges,,
INSULIN LISPRO PROTAMIN-LISPRO 100 UNIT/ML (75-25) SUBQ SUSP,,J1815,HCPCS,Facility,Inpatient,10,mL,,1230,1045.5,352.518,1230,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
INSULIN LISPRO PROTAMIN-LISPRO 100 UNIT/ML (75-25) SUBQ SUSP,,J1815,HCPCS,Facility,Both,10,mL,,1230,1045.5,352.518,1230,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),738,60,,percent of total billed charges,,
INSULIN LISPRO PROTAMIN-LISPRO 100 UNIT/ML (75-25) SUBQ SUSP,,J1815,HCPCS,Facility,Both,10,mL,,1230,1045.5,352.518,1230,"Health Partners, Inc.",State of Minnesota Advantage Program,1002.45,81.5,,percent of total billed charges,,
INSULIN LISPRO PROTAMIN-LISPRO 100 UNIT/ML (75-25) SUBQ SUSP,,J1815,HCPCS,Facility,Both,10,mL,,1230,1045.5,352.518,1230,"Health Partners, Inc.",State Public Programs,615,50,,percent of total billed charges,,
INSULIN LISPRO PROTAMIN-LISPRO 100 UNIT/ML (75-25) SUBQ SUSP,,J1815,HCPCS,Facility,Both,10,mL,,1230,1045.5,352.518,1230,Humana Insurance Company,Commercial PPO,1168.5,95,,percent of total billed charges,,
INSULIN LISPRO PROTAMIN-LISPRO 100 UNIT/ML (75-25) SUBQ SUSP,,J1815,HCPCS,Facility,Outpatient,10,mL,,1230,1045.5,352.518,1230,Humana Insurance Company,Medicare PPO,602.7,49,,percent of total billed charges,,
INSULIN LISPRO PROTAMIN-LISPRO 100 UNIT/ML (75-25) SUBQ SUSP,,J1815,HCPCS,Facility,Inpatient,10,mL,,1230,1045.5,352.518,1230,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
INSULIN LISPRO PROTAMIN-LISPRO 100 UNIT/ML (75-25) SUBQ SUSP,,J1815,HCPCS,Facility,Both,10,mL,,1230,1045.5,352.518,1230,Medica,Individual & Family,1218.93,99.1,,percent of total billed charges,,
INSULIN LISPRO PROTAMIN-LISPRO 100 UNIT/ML (75-25) SUBQ SUSP,,J1815,HCPCS,Facility,Outpatient,10,mL,,1230,1045.5,352.518,1230,Medica,Medica Advantage Solution,612.54,49.8,,percent of total billed charges,,
INSULIN LISPRO PROTAMIN-LISPRO 100 UNIT/ML (75-25) SUBQ SUSP,,J1815,HCPCS,Facility,Inpatient,10,mL,,1230,1045.5,352.518,1230,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
INSULIN LISPRO PROTAMIN-LISPRO 100 UNIT/ML (75-25) SUBQ SUSP,,J1815,HCPCS,Facility,Outpatient,10,mL,,1230,1045.5,352.518,1230,Medica,Medical Assistance,548.58,44.6,,percent of total billed charges,,
INSULIN LISPRO PROTAMIN-LISPRO 100 UNIT/ML (75-25) SUBQ SUSP,,J1815,HCPCS,Facility,Inpatient,10,mL,,1230,1045.5,352.518,1230,Medica,Medical Assistance,,,,,Included in per diem rate,
INSULIN LISPRO PROTAMIN-LISPRO 100 UNIT/ML (75-25) SUBQ SUSP,,J1815,HCPCS,Facility,Outpatient,10,mL,,1230,1045.5,352.518,1230,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,612.54,49.8,,percent of total billed charges,,
INSULIN LISPRO PROTAMIN-LISPRO 100 UNIT/ML (75-25) SUBQ SUSP,,J1815,HCPCS,Facility,Inpatient,10,mL,,1230,1045.5,352.518,1230,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
INSULIN LISPRO PROTAMIN-LISPRO 100 UNIT/ML (75-25) SUBQ SUSP,,J1815,HCPCS,Facility,Both,10,mL,,1230,1045.5,352.518,1230,"Multiplan, Inc.","Multiplan, Inc.",1156.2,94,,percent of total billed charges,,
INSULIN LISPRO PROTAMIN-LISPRO 100 UNIT/ML (75-25) SUBQ SUSP,,J1815,HCPCS,Facility,Outpatient,10,mL,,1230,1045.5,352.518,1230,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1108.23,90.1,,percent of total billed charges,,
INSULIN LISPRO PROTAMIN-LISPRO 100 UNIT/ML (75-25) SUBQ SUSP,,J1815,HCPCS,Facility,Inpatient,10,mL,,1230,1045.5,352.518,1230,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
INSULIN LISPRO PROTAMIN-LISPRO 100 UNIT/ML (75-25) SUBQ SUSP,,J1815,HCPCS,Facility,Both,10,mL,,1230,1045.5,352.518,1230,"Preferred One Administrative Services, INC.",PPO,1212.78,98.6,,percent of total billed charges,,
INSULIN LISPRO PROTAMIN-LISPRO 100 UNIT/ML (75-25) SUBQ SUSP,,J1815,HCPCS,Facility,Outpatient,10,mL,,1230,1045.5,352.518,1230,PrimeWest Health,Minnesota Senior Health Options (MSHO),632.835,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
INSULIN LISPRO PROTAMIN-LISPRO 100 UNIT/ML (75-25) SUBQ SUSP,,J1815,HCPCS,Facility,Inpatient,10,mL,,1230,1045.5,352.518,1230,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
INSULIN LISPRO PROTAMIN-LISPRO 100 UNIT/ML (75-25) SUBQ SUSP,,J1815,HCPCS,Facility,Outpatient,10,mL,,1230,1045.5,352.518,1230,PrimeWest Health,MinnesotaCare,631.728,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
INSULIN LISPRO PROTAMIN-LISPRO 100 UNIT/ML (75-25) SUBQ SUSP,,J1815,HCPCS,Facility,Inpatient,10,mL,,1230,1045.5,352.518,1230,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
INSULIN LISPRO PROTAMIN-LISPRO 100 UNIT/ML (75-25) SUBQ SUSP,,J1815,HCPCS,Facility,Both,10,mL,,1230,1045.5,352.518,1230,Sanford Health Plan,Sanford Health Plan,1131.6,92,,percent of total billed charges,,
INSULIN LISPRO PROTAMIN-LISPRO 100 UNIT/ML (75-25) SUBQ SUSP,,J1815,HCPCS,Facility,Outpatient,10,mL,,1230,1045.5,352.518,1230,"UCare Health, Inc.",Individual & Family Plan,693.105,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
INSULIN LISPRO PROTAMIN-LISPRO 100 UNIT/ML (75-25) SUBQ SUSP,,J1815,HCPCS,Facility,Inpatient,10,mL,,1230,1045.5,352.518,1230,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
INSULIN LISPRO PROTAMIN-LISPRO 100 UNIT/ML (75-25) SUBQ SUSP,,J1815,HCPCS,Facility,Outpatient,10,mL,,1230,1045.5,352.518,1230,"UCare Health, Inc.",Medical Assistance,620.781,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
INSULIN LISPRO PROTAMIN-LISPRO 100 UNIT/ML (75-25) SUBQ SUSP,,J1815,HCPCS,Facility,Inpatient,10,mL,,1230,1045.5,352.518,1230,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
INSULIN LISPRO PROTAMIN-LISPRO 100 UNIT/ML (75-25) SUBQ SUSP,,J1815,HCPCS,Facility,Outpatient,10,mL,,1230,1045.5,352.518,1230,"UCare Health, Inc.",Medicare Advantage,620.781,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
INSULIN LISPRO PROTAMIN-LISPRO 100 UNIT/ML (75-25) SUBQ SUSP,,J1815,HCPCS,Facility,Inpatient,10,mL,,1230,1045.5,352.518,1230,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
INSULIN LISPRO PROTAMIN-LISPRO 100 UNIT/ML (75-25) SUBQ SUSP,,J1815,HCPCS,Facility,Outpatient,10,mL,,1230,1045.5,352.518,1230,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),620.781,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
INSULIN LISPRO PROTAMIN-LISPRO 100 UNIT/ML (75-25) SUBQ SUSP,,J1815,HCPCS,Facility,Inpatient,10,mL,,1230,1045.5,352.518,1230,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
INSULIN LISPRO PROTAMIN-LISPRO 100 UNIT/ML (75-25) SUBQ SUSP,,J1815,HCPCS,Facility,Both,10,mL,,1230,1045.5,352.518,1230,UnitedHealthcare,Individual & Family,1156.2,94,,percent of total billed charges,,
INSULIN LISPRO PROTAMIN-LISPRO 100 UNIT/ML (75-25) SUBQ SUSP,,J1815,HCPCS,Facility,Outpatient,10,mL,,1230,1045.5,352.518,1230,UnitedHealthcare,Medicare Advantage,602.7,49,,percent of total billed charges,,
INSULIN LISPRO PROTAMIN-LISPRO 100 UNIT/ML (75-25) SUBQ SUSP,,J1815,HCPCS,Facility,Inpatient,10,mL,,1230,1045.5,352.518,1230,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
INSULIN LISPRO PROTAMIN-LISPRO 100 UNIT/ML (75-25) SUBQ SUSP,,J1815,HCPCS,Facility,Outpatient,10,mL,,1230,1045.5,352.518,1230,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,590.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
INSULIN LISPRO PROTAMIN-LISPRO 100 UNIT/ML (75-25) SUBQ SUSP,,J1815,HCPCS,Facility,Inpatient,10,mL,,1230,1045.5,352.518,1230,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Administration Influenza Vaccine,,90471,CPT,Facility,Both,,,,25,21.25,7.165,25,Aetna,Commercial,23,92,,percent of total billed charges,,
Administration Influenza Vaccine,,90471,CPT,Facility,Outpatient,,,,25,21.25,7.165,25,Aetna,Medicare Advantage,12.25,49,,percent of total billed charges,,
Administration Influenza Vaccine,,90471,CPT,Facility,Inpatient,,,,25,21.25,7.165,25,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Administration Influenza Vaccine,,90471,CPT,Facility,Both,,,,25,21.25,7.165,25,Aetna,PPO,23.25,93,,percent of total billed charges,,
Administration Influenza Vaccine,,90471,CPT,Facility,Both,,,,25,21.25,7.165,25,America's PPO,America's PPO,24.0075,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Administration Influenza Vaccine,,90471,CPT,Facility,Both,,,,25,21.25,7.165,25,BlueCross BlueShield Minnesota, Federal Employee Program,24.6,98.4,,percent of total billed charges,,
Administration Influenza Vaccine,,90471,CPT,Facility,Both,,,,25,21.25,7.165,25,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,25,100,,percent of total billed charges,,
Administration Influenza Vaccine,,90471,CPT,Facility,Both,,,,25,21.25,7.165,25,BlueCross BlueShield Minnesota,High Value Network Plan,22.5,90,,percent of total billed charges,,
Administration Influenza Vaccine,,90471,CPT,Facility,Outpatient,,,,25,21.25,7.165,25,BlueCross BlueShield Minnesota,Medicare Advantage,12.25,49,,percent of total billed charges,,
Administration Influenza Vaccine,,90471,CPT,Facility,Inpatient,,,,25,21.25,7.165,25,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Administration Influenza Vaccine,,90471,CPT,Facility,Both,,,,25,21.25,7.165,25,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,22.1425,88.57,,percent of total billed charges,,
Administration Influenza Vaccine,,90471,CPT,Facility,Both,,,,25,21.25,7.165,25,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,7.165,28.66,,percent of total billed charges,,
Administration Influenza Vaccine,,90471,CPT,Facility,Outpatient,,,,25,21.25,7.165,25,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),12.25,49,,percent of total billed charges,,
Administration Influenza Vaccine,,90471,CPT,Facility,Inpatient,,,,25,21.25,7.165,25,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Administration Influenza Vaccine,,90471,CPT,Facility,Both,,,,25,21.25,7.165,25,CorVel,Worker's Compensation,25,100,,percent of total billed charges,,
Administration Influenza Vaccine,,90471,CPT,Facility,Both,,,,25,21.25,7.165,25,First Health Group Corporation,First Health Network,24.25,97,,percent of total billed charges,,
Administration Influenza Vaccine,,90471,CPT,Facility,Both,,,,25,21.25,7.165,25,"Health Partners, Inc.",Commercial,23.65,94.6,,percent of total billed charges,,
Administration Influenza Vaccine,,90471,CPT,Facility,Outpatient,,,,25,21.25,7.165,25,"Health Partners, Inc.",Medicare Advantage,12.25,49,,percent of total billed charges,,
Administration Influenza Vaccine,,90471,CPT,Facility,Inpatient,,,,25,21.25,7.165,25,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Administration Influenza Vaccine,,90471,CPT,Facility,Both,,,,25,21.25,7.165,25,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),15,60,,percent of total billed charges,,
Administration Influenza Vaccine,,90471,CPT,Facility,Both,,,,25,21.25,7.165,25,"Health Partners, Inc.",State of Minnesota Advantage Program,20.375,81.5,,percent of total billed charges,,
Administration Influenza Vaccine,,90471,CPT,Facility,Both,,,,25,21.25,7.165,25,"Health Partners, Inc.",State Public Programs,12.5,50,,percent of total billed charges,,
Administration Influenza Vaccine,,90471,CPT,Facility,Both,,,,25,21.25,7.165,25,Humana Insurance Company,Commercial PPO,23.75,95,,percent of total billed charges,,
Administration Influenza Vaccine,,90471,CPT,Facility,Outpatient,,,,25,21.25,7.165,25,Humana Insurance Company,Medicare PPO,12.25,49,,percent of total billed charges,,
Administration Influenza Vaccine,,90471,CPT,Facility,Inpatient,,,,25,21.25,7.165,25,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Administration Influenza Vaccine,,90471,CPT,Facility,Both,,,,25,21.25,7.165,25,Medica,Individual & Family,24.775,99.1,,percent of total billed charges,,
Administration Influenza Vaccine,,90471,CPT,Facility,Outpatient,,,,25,21.25,7.165,25,Medica,Medica Advantage Solution,12.45,49.8,,percent of total billed charges,,
Administration Influenza Vaccine,,90471,CPT,Facility,Inpatient,,,,25,21.25,7.165,25,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Administration Influenza Vaccine,,90471,CPT,Facility,Outpatient,,,,25,21.25,7.165,25,Medica,Medical Assistance,11.15,44.6,,percent of total billed charges,,
Administration Influenza Vaccine,,90471,CPT,Facility,Inpatient,,,,25,21.25,7.165,25,Medica,Medical Assistance,,,,,Included in per diem rate,
Administration Influenza Vaccine,,90471,CPT,Facility,Outpatient,,,,25,21.25,7.165,25,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,12.45,49.8,,percent of total billed charges,,
Administration Influenza Vaccine,,90471,CPT,Facility,Inpatient,,,,25,21.25,7.165,25,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Administration Influenza Vaccine,,90471,CPT,Facility,Both,,,,25,21.25,7.165,25,"Multiplan, Inc.","Multiplan, Inc.",23.5,94,,percent of total billed charges,,
Administration Influenza Vaccine,,90471,CPT,Facility,Outpatient,,,,25,21.25,7.165,25,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,22.525,90.1,,percent of total billed charges,,
Administration Influenza Vaccine,,90471,CPT,Facility,Inpatient,,,,25,21.25,7.165,25,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Administration Influenza Vaccine,,90471,CPT,Facility,Both,,,,25,21.25,7.165,25,"Preferred One Administrative Services, INC.",PPO,24.65,98.6,,percent of total billed charges,,
Administration Influenza Vaccine,,90471,CPT,Facility,Outpatient,,,,25,21.25,7.165,25,PrimeWest Health,Minnesota Senior Health Options (MSHO),12.8625,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Administration Influenza Vaccine,,90471,CPT,Facility,Inpatient,,,,25,21.25,7.165,25,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Administration Influenza Vaccine,,90471,CPT,Facility,Outpatient,,,,25,21.25,7.165,25,PrimeWest Health,MinnesotaCare,12.84,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Administration Influenza Vaccine,,90471,CPT,Facility,Inpatient,,,,25,21.25,7.165,25,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Administration Influenza Vaccine,,90471,CPT,Facility,Both,,,,25,21.25,7.165,25,Sanford Health Plan,Sanford Health Plan,23,92,,percent of total billed charges,,
Administration Influenza Vaccine,,90471,CPT,Facility,Outpatient,,,,25,21.25,7.165,25,"UCare Health, Inc.",Individual & Family Plan,14.0875,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Administration Influenza Vaccine,,90471,CPT,Facility,Inpatient,,,,25,21.25,7.165,25,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Administration Influenza Vaccine,,90471,CPT,Facility,Outpatient,,,,25,21.25,7.165,25,"UCare Health, Inc.",Medical Assistance,12.6175,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Administration Influenza Vaccine,,90471,CPT,Facility,Inpatient,,,,25,21.25,7.165,25,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Administration Influenza Vaccine,,90471,CPT,Facility,Outpatient,,,,25,21.25,7.165,25,"UCare Health, Inc.",Medicare Advantage,12.6175,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Administration Influenza Vaccine,,90471,CPT,Facility,Inpatient,,,,25,21.25,7.165,25,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Administration Influenza Vaccine,,90471,CPT,Facility,Outpatient,,,,25,21.25,7.165,25,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),12.6175,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Administration Influenza Vaccine,,90471,CPT,Facility,Inpatient,,,,25,21.25,7.165,25,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Administration Influenza Vaccine,,90471,CPT,Facility,Both,,,,25,21.25,7.165,25,UnitedHealthcare,Individual & Family,23.5,94,,percent of total billed charges,,
Administration Influenza Vaccine,,90471,CPT,Facility,Outpatient,,,,25,21.25,7.165,25,UnitedHealthcare,Medicare Advantage,12.25,49,,percent of total billed charges,,
Administration Influenza Vaccine,,90471,CPT,Facility,Inpatient,,,,25,21.25,7.165,25,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Administration Influenza Vaccine,,90471,CPT,Facility,Outpatient,,,,25,21.25,7.165,25,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,12,48,,percent of total billed charges,,100% of DHS outpatient percentage
Administration Influenza Vaccine,,90471,CPT,Facility,Inpatient,,,,25,21.25,7.165,25,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Administration Pneumococcal Vaccine,,90471,CPT,Facility,Both,,,,25,21.25,7.165,25,Aetna,Commercial,23,92,,percent of total billed charges,,
Administration Pneumococcal Vaccine,,90471,CPT,Facility,Outpatient,,,,25,21.25,7.165,25,Aetna,Medicare Advantage,12.25,49,,percent of total billed charges,,
Administration Pneumococcal Vaccine,,90471,CPT,Facility,Inpatient,,,,25,21.25,7.165,25,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Administration Pneumococcal Vaccine,,90471,CPT,Facility,Both,,,,25,21.25,7.165,25,Aetna,PPO,23.25,93,,percent of total billed charges,,
Administration Pneumococcal Vaccine,,90471,CPT,Facility,Both,,,,25,21.25,7.165,25,America's PPO,America's PPO,24.0075,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Administration Pneumococcal Vaccine,,90471,CPT,Facility,Both,,,,25,21.25,7.165,25,BlueCross BlueShield Minnesota, Federal Employee Program,24.6,98.4,,percent of total billed charges,,
Administration Pneumococcal Vaccine,,90471,CPT,Facility,Both,,,,25,21.25,7.165,25,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,25,100,,percent of total billed charges,,
Administration Pneumococcal Vaccine,,90471,CPT,Facility,Both,,,,25,21.25,7.165,25,BlueCross BlueShield Minnesota,High Value Network Plan,22.5,90,,percent of total billed charges,,
Administration Pneumococcal Vaccine,,90471,CPT,Facility,Outpatient,,,,25,21.25,7.165,25,BlueCross BlueShield Minnesota,Medicare Advantage,12.25,49,,percent of total billed charges,,
Administration Pneumococcal Vaccine,,90471,CPT,Facility,Inpatient,,,,25,21.25,7.165,25,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Administration Pneumococcal Vaccine,,90471,CPT,Facility,Both,,,,25,21.25,7.165,25,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,22.1425,88.57,,percent of total billed charges,,
Administration Pneumococcal Vaccine,,90471,CPT,Facility,Both,,,,25,21.25,7.165,25,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,7.165,28.66,,percent of total billed charges,,
Administration Pneumococcal Vaccine,,90471,CPT,Facility,Outpatient,,,,25,21.25,7.165,25,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),12.25,49,,percent of total billed charges,,
Administration Pneumococcal Vaccine,,90471,CPT,Facility,Inpatient,,,,25,21.25,7.165,25,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Administration Pneumococcal Vaccine,,90471,CPT,Facility,Both,,,,25,21.25,7.165,25,CorVel,Worker's Compensation,25,100,,percent of total billed charges,,
Administration Pneumococcal Vaccine,,90471,CPT,Facility,Both,,,,25,21.25,7.165,25,First Health Group Corporation,First Health Network,24.25,97,,percent of total billed charges,,
Administration Pneumococcal Vaccine,,90471,CPT,Facility,Both,,,,25,21.25,7.165,25,"Health Partners, Inc.",Commercial,23.65,94.6,,percent of total billed charges,,
Administration Pneumococcal Vaccine,,90471,CPT,Facility,Outpatient,,,,25,21.25,7.165,25,"Health Partners, Inc.",Medicare Advantage,12.25,49,,percent of total billed charges,,
Administration Pneumococcal Vaccine,,90471,CPT,Facility,Inpatient,,,,25,21.25,7.165,25,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Administration Pneumococcal Vaccine,,90471,CPT,Facility,Both,,,,25,21.25,7.165,25,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),15,60,,percent of total billed charges,,
Administration Pneumococcal Vaccine,,90471,CPT,Facility,Both,,,,25,21.25,7.165,25,"Health Partners, Inc.",State of Minnesota Advantage Program,20.375,81.5,,percent of total billed charges,,
Administration Pneumococcal Vaccine,,90471,CPT,Facility,Both,,,,25,21.25,7.165,25,"Health Partners, Inc.",State Public Programs,12.5,50,,percent of total billed charges,,
Administration Pneumococcal Vaccine,,90471,CPT,Facility,Both,,,,25,21.25,7.165,25,Humana Insurance Company,Commercial PPO,23.75,95,,percent of total billed charges,,
Administration Pneumococcal Vaccine,,90471,CPT,Facility,Outpatient,,,,25,21.25,7.165,25,Humana Insurance Company,Medicare PPO,12.25,49,,percent of total billed charges,,
Administration Pneumococcal Vaccine,,90471,CPT,Facility,Inpatient,,,,25,21.25,7.165,25,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Administration Pneumococcal Vaccine,,90471,CPT,Facility,Both,,,,25,21.25,7.165,25,Medica,Individual & Family,24.775,99.1,,percent of total billed charges,,
Administration Pneumococcal Vaccine,,90471,CPT,Facility,Outpatient,,,,25,21.25,7.165,25,Medica,Medica Advantage Solution,12.45,49.8,,percent of total billed charges,,
Administration Pneumococcal Vaccine,,90471,CPT,Facility,Inpatient,,,,25,21.25,7.165,25,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Administration Pneumococcal Vaccine,,90471,CPT,Facility,Outpatient,,,,25,21.25,7.165,25,Medica,Medical Assistance,11.15,44.6,,percent of total billed charges,,
Administration Pneumococcal Vaccine,,90471,CPT,Facility,Inpatient,,,,25,21.25,7.165,25,Medica,Medical Assistance,,,,,Included in per diem rate,
Administration Pneumococcal Vaccine,,90471,CPT,Facility,Outpatient,,,,25,21.25,7.165,25,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,12.45,49.8,,percent of total billed charges,,
Administration Pneumococcal Vaccine,,90471,CPT,Facility,Inpatient,,,,25,21.25,7.165,25,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Administration Pneumococcal Vaccine,,90471,CPT,Facility,Both,,,,25,21.25,7.165,25,"Multiplan, Inc.","Multiplan, Inc.",23.5,94,,percent of total billed charges,,
Administration Pneumococcal Vaccine,,90471,CPT,Facility,Outpatient,,,,25,21.25,7.165,25,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,22.525,90.1,,percent of total billed charges,,
Administration Pneumococcal Vaccine,,90471,CPT,Facility,Inpatient,,,,25,21.25,7.165,25,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Administration Pneumococcal Vaccine,,90471,CPT,Facility,Both,,,,25,21.25,7.165,25,"Preferred One Administrative Services, INC.",PPO,24.65,98.6,,percent of total billed charges,,
Administration Pneumococcal Vaccine,,90471,CPT,Facility,Outpatient,,,,25,21.25,7.165,25,PrimeWest Health,Minnesota Senior Health Options (MSHO),12.8625,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Administration Pneumococcal Vaccine,,90471,CPT,Facility,Inpatient,,,,25,21.25,7.165,25,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Administration Pneumococcal Vaccine,,90471,CPT,Facility,Outpatient,,,,25,21.25,7.165,25,PrimeWest Health,MinnesotaCare,12.84,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Administration Pneumococcal Vaccine,,90471,CPT,Facility,Inpatient,,,,25,21.25,7.165,25,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Administration Pneumococcal Vaccine,,90471,CPT,Facility,Both,,,,25,21.25,7.165,25,Sanford Health Plan,Sanford Health Plan,23,92,,percent of total billed charges,,
Administration Pneumococcal Vaccine,,90471,CPT,Facility,Outpatient,,,,25,21.25,7.165,25,"UCare Health, Inc.",Individual & Family Plan,14.0875,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Administration Pneumococcal Vaccine,,90471,CPT,Facility,Inpatient,,,,25,21.25,7.165,25,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Administration Pneumococcal Vaccine,,90471,CPT,Facility,Outpatient,,,,25,21.25,7.165,25,"UCare Health, Inc.",Medical Assistance,12.6175,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Administration Pneumococcal Vaccine,,90471,CPT,Facility,Inpatient,,,,25,21.25,7.165,25,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Administration Pneumococcal Vaccine,,90471,CPT,Facility,Outpatient,,,,25,21.25,7.165,25,"UCare Health, Inc.",Medicare Advantage,12.6175,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Administration Pneumococcal Vaccine,,90471,CPT,Facility,Inpatient,,,,25,21.25,7.165,25,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Administration Pneumococcal Vaccine,,90471,CPT,Facility,Outpatient,,,,25,21.25,7.165,25,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),12.6175,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Administration Pneumococcal Vaccine,,90471,CPT,Facility,Inpatient,,,,25,21.25,7.165,25,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Administration Pneumococcal Vaccine,,90471,CPT,Facility,Both,,,,25,21.25,7.165,25,UnitedHealthcare,Individual & Family,23.5,94,,percent of total billed charges,,
Administration Pneumococcal Vaccine,,90471,CPT,Facility,Outpatient,,,,25,21.25,7.165,25,UnitedHealthcare,Medicare Advantage,12.25,49,,percent of total billed charges,,
Administration Pneumococcal Vaccine,,90471,CPT,Facility,Inpatient,,,,25,21.25,7.165,25,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Administration Pneumococcal Vaccine,,90471,CPT,Facility,Outpatient,,,,25,21.25,7.165,25,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,12,48,,percent of total billed charges,,100% of DHS outpatient percentage
Administration Pneumococcal Vaccine,,90471,CPT,Facility,Inpatient,,,,25,21.25,7.165,25,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Administration Vaccine,,90471,CPT,Facility,Both,,,,28,23.8,8.0248,28,Aetna,Commercial,25.76,92,,percent of total billed charges,,
Administration Vaccine,,90471,CPT,Facility,Outpatient,,,,28,23.8,8.0248,28,Aetna,Medicare Advantage,13.72,49,,percent of total billed charges,,
Administration Vaccine,,90471,CPT,Facility,Inpatient,,,,28,23.8,8.0248,28,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Administration Vaccine,,90471,CPT,Facility,Both,,,,28,23.8,8.0248,28,Aetna,PPO,26.04,93,,percent of total billed charges,,
Administration Vaccine,,90471,CPT,Facility,Both,,,,28,23.8,8.0248,28,America's PPO,America's PPO,26.8884,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Administration Vaccine,,90471,CPT,Facility,Both,,,,28,23.8,8.0248,28,BlueCross BlueShield Minnesota, Federal Employee Program,27.552,98.4,,percent of total billed charges,,
Administration Vaccine,,90471,CPT,Facility,Both,,,,28,23.8,8.0248,28,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,28,100,,percent of total billed charges,,
Administration Vaccine,,90471,CPT,Facility,Both,,,,28,23.8,8.0248,28,BlueCross BlueShield Minnesota,High Value Network Plan,25.2,90,,percent of total billed charges,,
Administration Vaccine,,90471,CPT,Facility,Outpatient,,,,28,23.8,8.0248,28,BlueCross BlueShield Minnesota,Medicare Advantage,13.72,49,,percent of total billed charges,,
Administration Vaccine,,90471,CPT,Facility,Inpatient,,,,28,23.8,8.0248,28,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Administration Vaccine,,90471,CPT,Facility,Both,,,,28,23.8,8.0248,28,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,24.7996,88.57,,percent of total billed charges,,
Administration Vaccine,,90471,CPT,Facility,Both,,,,28,23.8,8.0248,28,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,8.0248,28.66,,percent of total billed charges,,
Administration Vaccine,,90471,CPT,Facility,Outpatient,,,,28,23.8,8.0248,28,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),13.72,49,,percent of total billed charges,,
Administration Vaccine,,90471,CPT,Facility,Inpatient,,,,28,23.8,8.0248,28,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Administration Vaccine,,90471,CPT,Facility,Both,,,,28,23.8,8.0248,28,CorVel,Worker's Compensation,28,100,,percent of total billed charges,,
Administration Vaccine,,90471,CPT,Facility,Both,,,,28,23.8,8.0248,28,First Health Group Corporation,First Health Network,27.16,97,,percent of total billed charges,,
Administration Vaccine,,90471,CPT,Facility,Both,,,,28,23.8,8.0248,28,"Health Partners, Inc.",Commercial,26.488,94.6,,percent of total billed charges,,
Administration Vaccine,,90471,CPT,Facility,Outpatient,,,,28,23.8,8.0248,28,"Health Partners, Inc.",Medicare Advantage,13.72,49,,percent of total billed charges,,
Administration Vaccine,,90471,CPT,Facility,Inpatient,,,,28,23.8,8.0248,28,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Administration Vaccine,,90471,CPT,Facility,Both,,,,28,23.8,8.0248,28,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),16.8,60,,percent of total billed charges,,
Administration Vaccine,,90471,CPT,Facility,Both,,,,28,23.8,8.0248,28,"Health Partners, Inc.",State of Minnesota Advantage Program,22.82,81.5,,percent of total billed charges,,
Administration Vaccine,,90471,CPT,Facility,Both,,,,28,23.8,8.0248,28,"Health Partners, Inc.",State Public Programs,14,50,,percent of total billed charges,,
Administration Vaccine,,90471,CPT,Facility,Both,,,,28,23.8,8.0248,28,Humana Insurance Company,Commercial PPO,26.6,95,,percent of total billed charges,,
Administration Vaccine,,90471,CPT,Facility,Outpatient,,,,28,23.8,8.0248,28,Humana Insurance Company,Medicare PPO,13.72,49,,percent of total billed charges,,
Administration Vaccine,,90471,CPT,Facility,Inpatient,,,,28,23.8,8.0248,28,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Administration Vaccine,,90471,CPT,Facility,Both,,,,28,23.8,8.0248,28,Medica,Individual & Family,27.748,99.1,,percent of total billed charges,,
Administration Vaccine,,90471,CPT,Facility,Outpatient,,,,28,23.8,8.0248,28,Medica,Medica Advantage Solution,13.944,49.8,,percent of total billed charges,,
Administration Vaccine,,90471,CPT,Facility,Inpatient,,,,28,23.8,8.0248,28,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Administration Vaccine,,90471,CPT,Facility,Outpatient,,,,28,23.8,8.0248,28,Medica,Medical Assistance,12.488,44.6,,percent of total billed charges,,
Administration Vaccine,,90471,CPT,Facility,Inpatient,,,,28,23.8,8.0248,28,Medica,Medical Assistance,,,,,Included in per diem rate,
Administration Vaccine,,90471,CPT,Facility,Outpatient,,,,28,23.8,8.0248,28,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,13.944,49.8,,percent of total billed charges,,
Administration Vaccine,,90471,CPT,Facility,Inpatient,,,,28,23.8,8.0248,28,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Administration Vaccine,,90471,CPT,Facility,Both,,,,28,23.8,8.0248,28,"Multiplan, Inc.","Multiplan, Inc.",26.32,94,,percent of total billed charges,,
Administration Vaccine,,90471,CPT,Facility,Outpatient,,,,28,23.8,8.0248,28,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,25.228,90.1,,percent of total billed charges,,
Administration Vaccine,,90471,CPT,Facility,Inpatient,,,,28,23.8,8.0248,28,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Administration Vaccine,,90471,CPT,Facility,Both,,,,28,23.8,8.0248,28,"Preferred One Administrative Services, INC.",PPO,27.608,98.6,,percent of total billed charges,,
Administration Vaccine,,90471,CPT,Facility,Outpatient,,,,28,23.8,8.0248,28,PrimeWest Health,Minnesota Senior Health Options (MSHO),14.406,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Administration Vaccine,,90471,CPT,Facility,Inpatient,,,,28,23.8,8.0248,28,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Administration Vaccine,,90471,CPT,Facility,Outpatient,,,,28,23.8,8.0248,28,PrimeWest Health,MinnesotaCare,14.3808,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Administration Vaccine,,90471,CPT,Facility,Inpatient,,,,28,23.8,8.0248,28,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Administration Vaccine,,90471,CPT,Facility,Both,,,,28,23.8,8.0248,28,Sanford Health Plan,Sanford Health Plan,25.76,92,,percent of total billed charges,,
Administration Vaccine,,90471,CPT,Facility,Outpatient,,,,28,23.8,8.0248,28,"UCare Health, Inc.",Individual & Family Plan,15.778,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Administration Vaccine,,90471,CPT,Facility,Inpatient,,,,28,23.8,8.0248,28,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Administration Vaccine,,90471,CPT,Facility,Outpatient,,,,28,23.8,8.0248,28,"UCare Health, Inc.",Medical Assistance,14.1316,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Administration Vaccine,,90471,CPT,Facility,Inpatient,,,,28,23.8,8.0248,28,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Administration Vaccine,,90471,CPT,Facility,Outpatient,,,,28,23.8,8.0248,28,"UCare Health, Inc.",Medicare Advantage,14.1316,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Administration Vaccine,,90471,CPT,Facility,Inpatient,,,,28,23.8,8.0248,28,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Administration Vaccine,,90471,CPT,Facility,Outpatient,,,,28,23.8,8.0248,28,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),14.1316,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Administration Vaccine,,90471,CPT,Facility,Inpatient,,,,28,23.8,8.0248,28,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Administration Vaccine,,90471,CPT,Facility,Both,,,,28,23.8,8.0248,28,UnitedHealthcare,Individual & Family,26.32,94,,percent of total billed charges,,
Administration Vaccine,,90471,CPT,Facility,Outpatient,,,,28,23.8,8.0248,28,UnitedHealthcare,Medicare Advantage,13.72,49,,percent of total billed charges,,
Administration Vaccine,,90471,CPT,Facility,Inpatient,,,,28,23.8,8.0248,28,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Administration Vaccine,,90471,CPT,Facility,Outpatient,,,,28,23.8,8.0248,28,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,13.44,48,,percent of total billed charges,,100% of DHS outpatient percentage
Administration Vaccine,,90471,CPT,Facility,Inpatient,,,,28,23.8,8.0248,28,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Administration Vaccine - Ea Additional Vaccine,,90472,CPT,Facility,Both,,,,28,23.8,8.0248,28,Aetna,Commercial,25.76,92,,percent of total billed charges,,
Administration Vaccine - Ea Additional Vaccine,,90472,CPT,Facility,Outpatient,,,,28,23.8,8.0248,28,Aetna,Medicare Advantage,13.72,49,,percent of total billed charges,,
Administration Vaccine - Ea Additional Vaccine,,90472,CPT,Facility,Inpatient,,,,28,23.8,8.0248,28,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Administration Vaccine - Ea Additional Vaccine,,90472,CPT,Facility,Both,,,,28,23.8,8.0248,28,Aetna,PPO,26.04,93,,percent of total billed charges,,
Administration Vaccine - Ea Additional Vaccine,,90472,CPT,Facility,Both,,,,28,23.8,8.0248,28,America's PPO,America's PPO,26.8884,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Administration Vaccine - Ea Additional Vaccine,,90472,CPT,Facility,Both,,,,28,23.8,8.0248,28,BlueCross BlueShield Minnesota, Federal Employee Program,27.552,98.4,,percent of total billed charges,,
Administration Vaccine - Ea Additional Vaccine,,90472,CPT,Facility,Both,,,,28,23.8,8.0248,28,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,28,100,,percent of total billed charges,,
Administration Vaccine - Ea Additional Vaccine,,90472,CPT,Facility,Both,,,,28,23.8,8.0248,28,BlueCross BlueShield Minnesota,High Value Network Plan,25.2,90,,percent of total billed charges,,
Administration Vaccine - Ea Additional Vaccine,,90472,CPT,Facility,Outpatient,,,,28,23.8,8.0248,28,BlueCross BlueShield Minnesota,Medicare Advantage,13.72,49,,percent of total billed charges,,
Administration Vaccine - Ea Additional Vaccine,,90472,CPT,Facility,Inpatient,,,,28,23.8,8.0248,28,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Administration Vaccine - Ea Additional Vaccine,,90472,CPT,Facility,Both,,,,28,23.8,8.0248,28,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,24.7996,88.57,,percent of total billed charges,,
Administration Vaccine - Ea Additional Vaccine,,90472,CPT,Facility,Both,,,,28,23.8,8.0248,28,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,8.0248,28.66,,percent of total billed charges,,
Administration Vaccine - Ea Additional Vaccine,,90472,CPT,Facility,Outpatient,,,,28,23.8,8.0248,28,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),13.72,49,,percent of total billed charges,,
Administration Vaccine - Ea Additional Vaccine,,90472,CPT,Facility,Inpatient,,,,28,23.8,8.0248,28,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Administration Vaccine - Ea Additional Vaccine,,90472,CPT,Facility,Both,,,,28,23.8,8.0248,28,CorVel,Worker's Compensation,28,100,,percent of total billed charges,,
Administration Vaccine - Ea Additional Vaccine,,90472,CPT,Facility,Both,,,,28,23.8,8.0248,28,First Health Group Corporation,First Health Network,27.16,97,,percent of total billed charges,,
Administration Vaccine - Ea Additional Vaccine,,90472,CPT,Facility,Both,,,,28,23.8,8.0248,28,"Health Partners, Inc.",Commercial,26.488,94.6,,percent of total billed charges,,
Administration Vaccine - Ea Additional Vaccine,,90472,CPT,Facility,Outpatient,,,,28,23.8,8.0248,28,"Health Partners, Inc.",Medicare Advantage,13.72,49,,percent of total billed charges,,
Administration Vaccine - Ea Additional Vaccine,,90472,CPT,Facility,Inpatient,,,,28,23.8,8.0248,28,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Administration Vaccine - Ea Additional Vaccine,,90472,CPT,Facility,Both,,,,28,23.8,8.0248,28,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),16.8,60,,percent of total billed charges,,
Administration Vaccine - Ea Additional Vaccine,,90472,CPT,Facility,Both,,,,28,23.8,8.0248,28,"Health Partners, Inc.",State of Minnesota Advantage Program,22.82,81.5,,percent of total billed charges,,
Administration Vaccine - Ea Additional Vaccine,,90472,CPT,Facility,Both,,,,28,23.8,8.0248,28,"Health Partners, Inc.",State Public Programs,14,50,,percent of total billed charges,,
Administration Vaccine - Ea Additional Vaccine,,90472,CPT,Facility,Both,,,,28,23.8,8.0248,28,Humana Insurance Company,Commercial PPO,26.6,95,,percent of total billed charges,,
Administration Vaccine - Ea Additional Vaccine,,90472,CPT,Facility,Outpatient,,,,28,23.8,8.0248,28,Humana Insurance Company,Medicare PPO,13.72,49,,percent of total billed charges,,
Administration Vaccine - Ea Additional Vaccine,,90472,CPT,Facility,Inpatient,,,,28,23.8,8.0248,28,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Administration Vaccine - Ea Additional Vaccine,,90472,CPT,Facility,Both,,,,28,23.8,8.0248,28,Medica,Individual & Family,27.748,99.1,,percent of total billed charges,,
Administration Vaccine - Ea Additional Vaccine,,90472,CPT,Facility,Outpatient,,,,28,23.8,8.0248,28,Medica,Medica Advantage Solution,13.944,49.8,,percent of total billed charges,,
Administration Vaccine - Ea Additional Vaccine,,90472,CPT,Facility,Inpatient,,,,28,23.8,8.0248,28,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Administration Vaccine - Ea Additional Vaccine,,90472,CPT,Facility,Outpatient,,,,28,23.8,8.0248,28,Medica,Medical Assistance,12.488,44.6,,percent of total billed charges,,
Administration Vaccine - Ea Additional Vaccine,,90472,CPT,Facility,Inpatient,,,,28,23.8,8.0248,28,Medica,Medical Assistance,,,,,Included in per diem rate,
Administration Vaccine - Ea Additional Vaccine,,90472,CPT,Facility,Outpatient,,,,28,23.8,8.0248,28,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,13.944,49.8,,percent of total billed charges,,
Administration Vaccine - Ea Additional Vaccine,,90472,CPT,Facility,Inpatient,,,,28,23.8,8.0248,28,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Administration Vaccine - Ea Additional Vaccine,,90472,CPT,Facility,Both,,,,28,23.8,8.0248,28,"Multiplan, Inc.","Multiplan, Inc.",26.32,94,,percent of total billed charges,,
Administration Vaccine - Ea Additional Vaccine,,90472,CPT,Facility,Outpatient,,,,28,23.8,8.0248,28,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,25.228,90.1,,percent of total billed charges,,
Administration Vaccine - Ea Additional Vaccine,,90472,CPT,Facility,Inpatient,,,,28,23.8,8.0248,28,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Administration Vaccine - Ea Additional Vaccine,,90472,CPT,Facility,Both,,,,28,23.8,8.0248,28,"Preferred One Administrative Services, INC.",PPO,27.608,98.6,,percent of total billed charges,,
Administration Vaccine - Ea Additional Vaccine,,90472,CPT,Facility,Outpatient,,,,28,23.8,8.0248,28,PrimeWest Health,Minnesota Senior Health Options (MSHO),14.406,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Administration Vaccine - Ea Additional Vaccine,,90472,CPT,Facility,Inpatient,,,,28,23.8,8.0248,28,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Administration Vaccine - Ea Additional Vaccine,,90472,CPT,Facility,Outpatient,,,,28,23.8,8.0248,28,PrimeWest Health,MinnesotaCare,14.3808,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Administration Vaccine - Ea Additional Vaccine,,90472,CPT,Facility,Inpatient,,,,28,23.8,8.0248,28,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Administration Vaccine - Ea Additional Vaccine,,90472,CPT,Facility,Both,,,,28,23.8,8.0248,28,Sanford Health Plan,Sanford Health Plan,25.76,92,,percent of total billed charges,,
Administration Vaccine - Ea Additional Vaccine,,90472,CPT,Facility,Outpatient,,,,28,23.8,8.0248,28,"UCare Health, Inc.",Individual & Family Plan,15.778,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Administration Vaccine - Ea Additional Vaccine,,90472,CPT,Facility,Inpatient,,,,28,23.8,8.0248,28,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Administration Vaccine - Ea Additional Vaccine,,90472,CPT,Facility,Outpatient,,,,28,23.8,8.0248,28,"UCare Health, Inc.",Medical Assistance,14.1316,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Administration Vaccine - Ea Additional Vaccine,,90472,CPT,Facility,Inpatient,,,,28,23.8,8.0248,28,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Administration Vaccine - Ea Additional Vaccine,,90472,CPT,Facility,Outpatient,,,,28,23.8,8.0248,28,"UCare Health, Inc.",Medicare Advantage,14.1316,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Administration Vaccine - Ea Additional Vaccine,,90472,CPT,Facility,Inpatient,,,,28,23.8,8.0248,28,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Administration Vaccine - Ea Additional Vaccine,,90472,CPT,Facility,Outpatient,,,,28,23.8,8.0248,28,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),14.1316,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Administration Vaccine - Ea Additional Vaccine,,90472,CPT,Facility,Inpatient,,,,28,23.8,8.0248,28,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Administration Vaccine - Ea Additional Vaccine,,90472,CPT,Facility,Both,,,,28,23.8,8.0248,28,UnitedHealthcare,Individual & Family,26.32,94,,percent of total billed charges,,
Administration Vaccine - Ea Additional Vaccine,,90472,CPT,Facility,Outpatient,,,,28,23.8,8.0248,28,UnitedHealthcare,Medicare Advantage,13.72,49,,percent of total billed charges,,
Administration Vaccine - Ea Additional Vaccine,,90472,CPT,Facility,Inpatient,,,,28,23.8,8.0248,28,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Administration Vaccine - Ea Additional Vaccine,,90472,CPT,Facility,Outpatient,,,,28,23.8,8.0248,28,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,13.44,48,,percent of total billed charges,,100% of DHS outpatient percentage
Administration Vaccine - Ea Additional Vaccine,,90472,CPT,Facility,Inpatient,,,,28,23.8,8.0248,28,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
INSULIN NPH ISOPH U-100 HUMAN 100 UNIT/ML SUBQ SUSP,,J1815,HCPCS,Facility,Both,10,mL,,645,548.25,184.857,645,Aetna,Commercial,593.4,92,,percent of total billed charges,,
INSULIN NPH ISOPH U-100 HUMAN 100 UNIT/ML SUBQ SUSP,,J1815,HCPCS,Facility,Outpatient,10,mL,,645,548.25,184.857,645,Aetna,Medicare Advantage,316.05,49,,percent of total billed charges,,
INSULIN NPH ISOPH U-100 HUMAN 100 UNIT/ML SUBQ SUSP,,J1815,HCPCS,Facility,Inpatient,10,mL,,645,548.25,184.857,645,Aetna,Medicare Advantage,,,,,Included in per diem rate,
INSULIN NPH ISOPH U-100 HUMAN 100 UNIT/ML SUBQ SUSP,,J1815,HCPCS,Facility,Both,10,mL,,645,548.25,184.857,645,Aetna,PPO,599.85,93,,percent of total billed charges,,
INSULIN NPH ISOPH U-100 HUMAN 100 UNIT/ML SUBQ SUSP,,J1815,HCPCS,Facility,Both,10,mL,,645,548.25,184.857,645,America's PPO,America's PPO,619.3935,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
INSULIN NPH ISOPH U-100 HUMAN 100 UNIT/ML SUBQ SUSP,,J1815,HCPCS,Facility,Both,10,mL,,645,548.25,184.857,645,BlueCross BlueShield Minnesota, Federal Employee Program,634.68,98.4,,percent of total billed charges,,
INSULIN NPH ISOPH U-100 HUMAN 100 UNIT/ML SUBQ SUSP,,J1815,HCPCS,Facility,Both,10,mL,,645,548.25,184.857,645,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,645,100,,percent of total billed charges,,
INSULIN NPH ISOPH U-100 HUMAN 100 UNIT/ML SUBQ SUSP,,J1815,HCPCS,Facility,Both,10,mL,,645,548.25,184.857,645,BlueCross BlueShield Minnesota,High Value Network Plan,580.5,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
INSULIN NPH ISOPH U-100 HUMAN 100 UNIT/ML SUBQ SUSP,,J1815,HCPCS,Facility,Outpatient,10,mL,,645,548.25,184.857,645,BlueCross BlueShield Minnesota,Medicare Advantage,316.05,49,,percent of total billed charges,,
INSULIN NPH ISOPH U-100 HUMAN 100 UNIT/ML SUBQ SUSP,,J1815,HCPCS,Facility,Inpatient,10,mL,,645,548.25,184.857,645,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
INSULIN NPH ISOPH U-100 HUMAN 100 UNIT/ML SUBQ SUSP,,J1815,HCPCS,Facility,Both,10,mL,,645,548.25,184.857,645,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,571.2765,88.57,,percent of total billed charges,,
INSULIN NPH ISOPH U-100 HUMAN 100 UNIT/ML SUBQ SUSP,,J1815,HCPCS,Facility,Both,10,mL,,645,548.25,184.857,645,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,184.857,28.66,,percent of total billed charges,,
INSULIN NPH ISOPH U-100 HUMAN 100 UNIT/ML SUBQ SUSP,,J1815,HCPCS,Facility,Outpatient,10,mL,,645,548.25,184.857,645,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),316.05,49,,percent of total billed charges,,
INSULIN NPH ISOPH U-100 HUMAN 100 UNIT/ML SUBQ SUSP,,J1815,HCPCS,Facility,Inpatient,10,mL,,645,548.25,184.857,645,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
INSULIN NPH ISOPH U-100 HUMAN 100 UNIT/ML SUBQ SUSP,,J1815,HCPCS,Facility,Both,10,mL,,645,548.25,184.857,645,CorVel,Worker's Compensation,645,100,,percent of total billed charges,,
INSULIN NPH ISOPH U-100 HUMAN 100 UNIT/ML SUBQ SUSP,,J1815,HCPCS,Facility,Both,10,mL,,645,548.25,184.857,645,First Health Group Corporation,First Health Network,625.65,97,,percent of total billed charges,,
INSULIN NPH ISOPH U-100 HUMAN 100 UNIT/ML SUBQ SUSP,,J1815,HCPCS,Facility,Both,10,mL,,645,548.25,184.857,645,"Health Partners, Inc.",Commercial,610.17,94.6,,percent of total billed charges,,
INSULIN NPH ISOPH U-100 HUMAN 100 UNIT/ML SUBQ SUSP,,J1815,HCPCS,Facility,Outpatient,10,mL,,645,548.25,184.857,645,"Health Partners, Inc.",Medicare Advantage,316.05,49,,percent of total billed charges,,
INSULIN NPH ISOPH U-100 HUMAN 100 UNIT/ML SUBQ SUSP,,J1815,HCPCS,Facility,Inpatient,10,mL,,645,548.25,184.857,645,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
INSULIN NPH ISOPH U-100 HUMAN 100 UNIT/ML SUBQ SUSP,,J1815,HCPCS,Facility,Both,10,mL,,645,548.25,184.857,645,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),387,60,,percent of total billed charges,,
INSULIN NPH ISOPH U-100 HUMAN 100 UNIT/ML SUBQ SUSP,,J1815,HCPCS,Facility,Both,10,mL,,645,548.25,184.857,645,"Health Partners, Inc.",State of Minnesota Advantage Program,525.675,81.5,,percent of total billed charges,,
INSULIN NPH ISOPH U-100 HUMAN 100 UNIT/ML SUBQ SUSP,,J1815,HCPCS,Facility,Both,10,mL,,645,548.25,184.857,645,"Health Partners, Inc.",State Public Programs,322.5,50,,percent of total billed charges,,
INSULIN NPH ISOPH U-100 HUMAN 100 UNIT/ML SUBQ SUSP,,J1815,HCPCS,Facility,Both,10,mL,,645,548.25,184.857,645,Humana Insurance Company,Commercial PPO,612.75,95,,percent of total billed charges,,
INSULIN NPH ISOPH U-100 HUMAN 100 UNIT/ML SUBQ SUSP,,J1815,HCPCS,Facility,Outpatient,10,mL,,645,548.25,184.857,645,Humana Insurance Company,Medicare PPO,316.05,49,,percent of total billed charges,,
INSULIN NPH ISOPH U-100 HUMAN 100 UNIT/ML SUBQ SUSP,,J1815,HCPCS,Facility,Inpatient,10,mL,,645,548.25,184.857,645,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
INSULIN NPH ISOPH U-100 HUMAN 100 UNIT/ML SUBQ SUSP,,J1815,HCPCS,Facility,Both,10,mL,,645,548.25,184.857,645,Medica,Individual & Family,639.195,99.1,,percent of total billed charges,,
INSULIN NPH ISOPH U-100 HUMAN 100 UNIT/ML SUBQ SUSP,,J1815,HCPCS,Facility,Outpatient,10,mL,,645,548.25,184.857,645,Medica,Medica Advantage Solution,321.21,49.8,,percent of total billed charges,,
INSULIN NPH ISOPH U-100 HUMAN 100 UNIT/ML SUBQ SUSP,,J1815,HCPCS,Facility,Inpatient,10,mL,,645,548.25,184.857,645,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
INSULIN NPH ISOPH U-100 HUMAN 100 UNIT/ML SUBQ SUSP,,J1815,HCPCS,Facility,Outpatient,10,mL,,645,548.25,184.857,645,Medica,Medical Assistance,287.67,44.6,,percent of total billed charges,,
INSULIN NPH ISOPH U-100 HUMAN 100 UNIT/ML SUBQ SUSP,,J1815,HCPCS,Facility,Inpatient,10,mL,,645,548.25,184.857,645,Medica,Medical Assistance,,,,,Included in per diem rate,
INSULIN NPH ISOPH U-100 HUMAN 100 UNIT/ML SUBQ SUSP,,J1815,HCPCS,Facility,Outpatient,10,mL,,645,548.25,184.857,645,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,321.21,49.8,,percent of total billed charges,,
INSULIN NPH ISOPH U-100 HUMAN 100 UNIT/ML SUBQ SUSP,,J1815,HCPCS,Facility,Inpatient,10,mL,,645,548.25,184.857,645,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
INSULIN NPH ISOPH U-100 HUMAN 100 UNIT/ML SUBQ SUSP,,J1815,HCPCS,Facility,Both,10,mL,,645,548.25,184.857,645,"Multiplan, Inc.","Multiplan, Inc.",606.3,94,,percent of total billed charges,,
INSULIN NPH ISOPH U-100 HUMAN 100 UNIT/ML SUBQ SUSP,,J1815,HCPCS,Facility,Outpatient,10,mL,,645,548.25,184.857,645,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,581.145,90.1,,percent of total billed charges,,
INSULIN NPH ISOPH U-100 HUMAN 100 UNIT/ML SUBQ SUSP,,J1815,HCPCS,Facility,Inpatient,10,mL,,645,548.25,184.857,645,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
INSULIN NPH ISOPH U-100 HUMAN 100 UNIT/ML SUBQ SUSP,,J1815,HCPCS,Facility,Both,10,mL,,645,548.25,184.857,645,"Preferred One Administrative Services, INC.",PPO,635.97,98.6,,percent of total billed charges,,
INSULIN NPH ISOPH U-100 HUMAN 100 UNIT/ML SUBQ SUSP,,J1815,HCPCS,Facility,Outpatient,10,mL,,645,548.25,184.857,645,PrimeWest Health,Minnesota Senior Health Options (MSHO),331.8525,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
INSULIN NPH ISOPH U-100 HUMAN 100 UNIT/ML SUBQ SUSP,,J1815,HCPCS,Facility,Inpatient,10,mL,,645,548.25,184.857,645,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
INSULIN NPH ISOPH U-100 HUMAN 100 UNIT/ML SUBQ SUSP,,J1815,HCPCS,Facility,Outpatient,10,mL,,645,548.25,184.857,645,PrimeWest Health,MinnesotaCare,331.272,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
INSULIN NPH ISOPH U-100 HUMAN 100 UNIT/ML SUBQ SUSP,,J1815,HCPCS,Facility,Inpatient,10,mL,,645,548.25,184.857,645,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
INSULIN NPH ISOPH U-100 HUMAN 100 UNIT/ML SUBQ SUSP,,J1815,HCPCS,Facility,Both,10,mL,,645,548.25,184.857,645,Sanford Health Plan,Sanford Health Plan,593.4,92,,percent of total billed charges,,
INSULIN NPH ISOPH U-100 HUMAN 100 UNIT/ML SUBQ SUSP,,J1815,HCPCS,Facility,Outpatient,10,mL,,645,548.25,184.857,645,"UCare Health, Inc.",Individual & Family Plan,363.4575,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
INSULIN NPH ISOPH U-100 HUMAN 100 UNIT/ML SUBQ SUSP,,J1815,HCPCS,Facility,Inpatient,10,mL,,645,548.25,184.857,645,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
INSULIN NPH ISOPH U-100 HUMAN 100 UNIT/ML SUBQ SUSP,,J1815,HCPCS,Facility,Outpatient,10,mL,,645,548.25,184.857,645,"UCare Health, Inc.",Medical Assistance,325.5315,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
INSULIN NPH ISOPH U-100 HUMAN 100 UNIT/ML SUBQ SUSP,,J1815,HCPCS,Facility,Inpatient,10,mL,,645,548.25,184.857,645,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
INSULIN NPH ISOPH U-100 HUMAN 100 UNIT/ML SUBQ SUSP,,J1815,HCPCS,Facility,Outpatient,10,mL,,645,548.25,184.857,645,"UCare Health, Inc.",Medicare Advantage,325.5315,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
INSULIN NPH ISOPH U-100 HUMAN 100 UNIT/ML SUBQ SUSP,,J1815,HCPCS,Facility,Inpatient,10,mL,,645,548.25,184.857,645,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
INSULIN NPH ISOPH U-100 HUMAN 100 UNIT/ML SUBQ SUSP,,J1815,HCPCS,Facility,Outpatient,10,mL,,645,548.25,184.857,645,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),325.5315,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
INSULIN NPH ISOPH U-100 HUMAN 100 UNIT/ML SUBQ SUSP,,J1815,HCPCS,Facility,Inpatient,10,mL,,645,548.25,184.857,645,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
INSULIN NPH ISOPH U-100 HUMAN 100 UNIT/ML SUBQ SUSP,,J1815,HCPCS,Facility,Both,10,mL,,645,548.25,184.857,645,UnitedHealthcare,Individual & Family,606.3,94,,percent of total billed charges,,
INSULIN NPH ISOPH U-100 HUMAN 100 UNIT/ML SUBQ SUSP,,J1815,HCPCS,Facility,Outpatient,10,mL,,645,548.25,184.857,645,UnitedHealthcare,Medicare Advantage,316.05,49,,percent of total billed charges,,
INSULIN NPH ISOPH U-100 HUMAN 100 UNIT/ML SUBQ SUSP,,J1815,HCPCS,Facility,Inpatient,10,mL,,645,548.25,184.857,645,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
INSULIN NPH ISOPH U-100 HUMAN 100 UNIT/ML SUBQ SUSP,,J1815,HCPCS,Facility,Outpatient,10,mL,,645,548.25,184.857,645,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,309.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
INSULIN NPH ISOPH U-100 HUMAN 100 UNIT/ML SUBQ SUSP,,J1815,HCPCS,Facility,Inpatient,10,mL,,645,548.25,184.857,645,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
INSULIN REGULAR HUMAN 100 UNIT/ML INJ SOLN,,J1815,HCPCS,Facility,Both,10,mL,,696,591.6,199.4736,696,Aetna,Commercial,640.32,92,,percent of total billed charges,,
INSULIN REGULAR HUMAN 100 UNIT/ML INJ SOLN,,J1815,HCPCS,Facility,Outpatient,10,mL,,696,591.6,199.4736,696,Aetna,Medicare Advantage,341.04,49,,percent of total billed charges,,
INSULIN REGULAR HUMAN 100 UNIT/ML INJ SOLN,,J1815,HCPCS,Facility,Inpatient,10,mL,,696,591.6,199.4736,696,Aetna,Medicare Advantage,,,,,Included in per diem rate,
INSULIN REGULAR HUMAN 100 UNIT/ML INJ SOLN,,J1815,HCPCS,Facility,Both,10,mL,,696,591.6,199.4736,696,Aetna,PPO,647.28,93,,percent of total billed charges,,
INSULIN REGULAR HUMAN 100 UNIT/ML INJ SOLN,,J1815,HCPCS,Facility,Both,10,mL,,696,591.6,199.4736,696,America's PPO,America's PPO,668.3688,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
INSULIN REGULAR HUMAN 100 UNIT/ML INJ SOLN,,J1815,HCPCS,Facility,Both,10,mL,,696,591.6,199.4736,696,BlueCross BlueShield Minnesota, Federal Employee Program,684.864,98.4,,percent of total billed charges,,
INSULIN REGULAR HUMAN 100 UNIT/ML INJ SOLN,,J1815,HCPCS,Facility,Both,10,mL,,696,591.6,199.4736,696,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,696,100,,percent of total billed charges,,
INSULIN REGULAR HUMAN 100 UNIT/ML INJ SOLN,,J1815,HCPCS,Facility,Both,10,mL,,696,591.6,199.4736,696,BlueCross BlueShield Minnesota,High Value Network Plan,626.4,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
INSULIN REGULAR HUMAN 100 UNIT/ML INJ SOLN,,J1815,HCPCS,Facility,Outpatient,10,mL,,696,591.6,199.4736,696,BlueCross BlueShield Minnesota,Medicare Advantage,341.04,49,,percent of total billed charges,,
INSULIN REGULAR HUMAN 100 UNIT/ML INJ SOLN,,J1815,HCPCS,Facility,Inpatient,10,mL,,696,591.6,199.4736,696,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
INSULIN REGULAR HUMAN 100 UNIT/ML INJ SOLN,,J1815,HCPCS,Facility,Both,10,mL,,696,591.6,199.4736,696,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,616.4472,88.57,,percent of total billed charges,,
INSULIN REGULAR HUMAN 100 UNIT/ML INJ SOLN,,J1815,HCPCS,Facility,Both,10,mL,,696,591.6,199.4736,696,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,199.4736,28.66,,percent of total billed charges,,
INSULIN REGULAR HUMAN 100 UNIT/ML INJ SOLN,,J1815,HCPCS,Facility,Outpatient,10,mL,,696,591.6,199.4736,696,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),341.04,49,,percent of total billed charges,,
INSULIN REGULAR HUMAN 100 UNIT/ML INJ SOLN,,J1815,HCPCS,Facility,Inpatient,10,mL,,696,591.6,199.4736,696,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
INSULIN REGULAR HUMAN 100 UNIT/ML INJ SOLN,,J1815,HCPCS,Facility,Both,10,mL,,696,591.6,199.4736,696,CorVel,Worker's Compensation,696,100,,percent of total billed charges,,
INSULIN REGULAR HUMAN 100 UNIT/ML INJ SOLN,,J1815,HCPCS,Facility,Both,10,mL,,696,591.6,199.4736,696,First Health Group Corporation,First Health Network,675.12,97,,percent of total billed charges,,
INSULIN REGULAR HUMAN 100 UNIT/ML INJ SOLN,,J1815,HCPCS,Facility,Both,10,mL,,696,591.6,199.4736,696,"Health Partners, Inc.",Commercial,658.416,94.6,,percent of total billed charges,,
INSULIN REGULAR HUMAN 100 UNIT/ML INJ SOLN,,J1815,HCPCS,Facility,Outpatient,10,mL,,696,591.6,199.4736,696,"Health Partners, Inc.",Medicare Advantage,341.04,49,,percent of total billed charges,,
INSULIN REGULAR HUMAN 100 UNIT/ML INJ SOLN,,J1815,HCPCS,Facility,Inpatient,10,mL,,696,591.6,199.4736,696,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
INSULIN REGULAR HUMAN 100 UNIT/ML INJ SOLN,,J1815,HCPCS,Facility,Both,10,mL,,696,591.6,199.4736,696,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),417.6,60,,percent of total billed charges,,
INSULIN REGULAR HUMAN 100 UNIT/ML INJ SOLN,,J1815,HCPCS,Facility,Both,10,mL,,696,591.6,199.4736,696,"Health Partners, Inc.",State of Minnesota Advantage Program,567.24,81.5,,percent of total billed charges,,
INSULIN REGULAR HUMAN 100 UNIT/ML INJ SOLN,,J1815,HCPCS,Facility,Both,10,mL,,696,591.6,199.4736,696,"Health Partners, Inc.",State Public Programs,348,50,,percent of total billed charges,,
INSULIN REGULAR HUMAN 100 UNIT/ML INJ SOLN,,J1815,HCPCS,Facility,Both,10,mL,,696,591.6,199.4736,696,Humana Insurance Company,Commercial PPO,661.2,95,,percent of total billed charges,,
INSULIN REGULAR HUMAN 100 UNIT/ML INJ SOLN,,J1815,HCPCS,Facility,Outpatient,10,mL,,696,591.6,199.4736,696,Humana Insurance Company,Medicare PPO,341.04,49,,percent of total billed charges,,
INSULIN REGULAR HUMAN 100 UNIT/ML INJ SOLN,,J1815,HCPCS,Facility,Inpatient,10,mL,,696,591.6,199.4736,696,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
INSULIN REGULAR HUMAN 100 UNIT/ML INJ SOLN,,J1815,HCPCS,Facility,Both,10,mL,,696,591.6,199.4736,696,Medica,Individual & Family,689.736,99.1,,percent of total billed charges,,
INSULIN REGULAR HUMAN 100 UNIT/ML INJ SOLN,,J1815,HCPCS,Facility,Outpatient,10,mL,,696,591.6,199.4736,696,Medica,Medica Advantage Solution,346.608,49.8,,percent of total billed charges,,
INSULIN REGULAR HUMAN 100 UNIT/ML INJ SOLN,,J1815,HCPCS,Facility,Inpatient,10,mL,,696,591.6,199.4736,696,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
INSULIN REGULAR HUMAN 100 UNIT/ML INJ SOLN,,J1815,HCPCS,Facility,Outpatient,10,mL,,696,591.6,199.4736,696,Medica,Medical Assistance,310.416,44.6,,percent of total billed charges,,
INSULIN REGULAR HUMAN 100 UNIT/ML INJ SOLN,,J1815,HCPCS,Facility,Inpatient,10,mL,,696,591.6,199.4736,696,Medica,Medical Assistance,,,,,Included in per diem rate,
INSULIN REGULAR HUMAN 100 UNIT/ML INJ SOLN,,J1815,HCPCS,Facility,Outpatient,10,mL,,696,591.6,199.4736,696,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,346.608,49.8,,percent of total billed charges,,
INSULIN REGULAR HUMAN 100 UNIT/ML INJ SOLN,,J1815,HCPCS,Facility,Inpatient,10,mL,,696,591.6,199.4736,696,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
INSULIN REGULAR HUMAN 100 UNIT/ML INJ SOLN,,J1815,HCPCS,Facility,Both,10,mL,,696,591.6,199.4736,696,"Multiplan, Inc.","Multiplan, Inc.",654.24,94,,percent of total billed charges,,
INSULIN REGULAR HUMAN 100 UNIT/ML INJ SOLN,,J1815,HCPCS,Facility,Outpatient,10,mL,,696,591.6,199.4736,696,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,627.096,90.1,,percent of total billed charges,,
INSULIN REGULAR HUMAN 100 UNIT/ML INJ SOLN,,J1815,HCPCS,Facility,Inpatient,10,mL,,696,591.6,199.4736,696,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
INSULIN REGULAR HUMAN 100 UNIT/ML INJ SOLN,,J1815,HCPCS,Facility,Both,10,mL,,696,591.6,199.4736,696,"Preferred One Administrative Services, INC.",PPO,686.256,98.6,,percent of total billed charges,,
INSULIN REGULAR HUMAN 100 UNIT/ML INJ SOLN,,J1815,HCPCS,Facility,Outpatient,10,mL,,696,591.6,199.4736,696,PrimeWest Health,Minnesota Senior Health Options (MSHO),358.092,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
INSULIN REGULAR HUMAN 100 UNIT/ML INJ SOLN,,J1815,HCPCS,Facility,Inpatient,10,mL,,696,591.6,199.4736,696,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
INSULIN REGULAR HUMAN 100 UNIT/ML INJ SOLN,,J1815,HCPCS,Facility,Outpatient,10,mL,,696,591.6,199.4736,696,PrimeWest Health,MinnesotaCare,357.4656,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
INSULIN REGULAR HUMAN 100 UNIT/ML INJ SOLN,,J1815,HCPCS,Facility,Inpatient,10,mL,,696,591.6,199.4736,696,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
INSULIN REGULAR HUMAN 100 UNIT/ML INJ SOLN,,J1815,HCPCS,Facility,Both,10,mL,,696,591.6,199.4736,696,Sanford Health Plan,Sanford Health Plan,640.32,92,,percent of total billed charges,,
INSULIN REGULAR HUMAN 100 UNIT/ML INJ SOLN,,J1815,HCPCS,Facility,Outpatient,10,mL,,696,591.6,199.4736,696,"UCare Health, Inc.",Individual & Family Plan,392.196,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
INSULIN REGULAR HUMAN 100 UNIT/ML INJ SOLN,,J1815,HCPCS,Facility,Inpatient,10,mL,,696,591.6,199.4736,696,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
INSULIN REGULAR HUMAN 100 UNIT/ML INJ SOLN,,J1815,HCPCS,Facility,Outpatient,10,mL,,696,591.6,199.4736,696,"UCare Health, Inc.",Medical Assistance,351.2712,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
INSULIN REGULAR HUMAN 100 UNIT/ML INJ SOLN,,J1815,HCPCS,Facility,Inpatient,10,mL,,696,591.6,199.4736,696,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
INSULIN REGULAR HUMAN 100 UNIT/ML INJ SOLN,,J1815,HCPCS,Facility,Outpatient,10,mL,,696,591.6,199.4736,696,"UCare Health, Inc.",Medicare Advantage,351.2712,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
INSULIN REGULAR HUMAN 100 UNIT/ML INJ SOLN,,J1815,HCPCS,Facility,Inpatient,10,mL,,696,591.6,199.4736,696,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
INSULIN REGULAR HUMAN 100 UNIT/ML INJ SOLN,,J1815,HCPCS,Facility,Outpatient,10,mL,,696,591.6,199.4736,696,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),351.2712,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
INSULIN REGULAR HUMAN 100 UNIT/ML INJ SOLN,,J1815,HCPCS,Facility,Inpatient,10,mL,,696,591.6,199.4736,696,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
INSULIN REGULAR HUMAN 100 UNIT/ML INJ SOLN,,J1815,HCPCS,Facility,Both,10,mL,,696,591.6,199.4736,696,UnitedHealthcare,Individual & Family,654.24,94,,percent of total billed charges,,
INSULIN REGULAR HUMAN 100 UNIT/ML INJ SOLN,,J1815,HCPCS,Facility,Outpatient,10,mL,,696,591.6,199.4736,696,UnitedHealthcare,Medicare Advantage,341.04,49,,percent of total billed charges,,
INSULIN REGULAR HUMAN 100 UNIT/ML INJ SOLN,,J1815,HCPCS,Facility,Inpatient,10,mL,,696,591.6,199.4736,696,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
INSULIN REGULAR HUMAN 100 UNIT/ML INJ SOLN,,J1815,HCPCS,Facility,Outpatient,10,mL,,696,591.6,199.4736,696,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,334.08,48,,percent of total billed charges,,100% of DHS outpatient percentage
INSULIN REGULAR HUMAN 100 UNIT/ML INJ SOLN,,J1815,HCPCS,Facility,Inpatient,10,mL,,696,591.6,199.4736,696,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
FUROSEMIDE 10 MG/ML INJ SOLN,,J1940,HCPCS,Facility,Both,10,mL,,19,16.15,5.4454,19,Aetna,Commercial,17.48,92,,percent of total billed charges,,
FUROSEMIDE 10 MG/ML INJ SOLN,,J1940,HCPCS,Facility,Outpatient,10,mL,,19,16.15,5.4454,19,Aetna,Medicare Advantage,9.31,49,,percent of total billed charges,,
FUROSEMIDE 10 MG/ML INJ SOLN,,J1940,HCPCS,Facility,Inpatient,10,mL,,19,16.15,5.4454,19,Aetna,Medicare Advantage,,,,,Included in per diem rate,
FUROSEMIDE 10 MG/ML INJ SOLN,,J1940,HCPCS,Facility,Both,10,mL,,19,16.15,5.4454,19,Aetna,PPO,17.67,93,,percent of total billed charges,,
FUROSEMIDE 10 MG/ML INJ SOLN,,J1940,HCPCS,Facility,Both,10,mL,,19,16.15,5.4454,19,America's PPO,America's PPO,18.2457,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
FUROSEMIDE 10 MG/ML INJ SOLN,,J1940,HCPCS,Facility,Both,10,mL,,19,16.15,5.4454,19,BlueCross BlueShield Minnesota, Federal Employee Program,18.696,98.4,,percent of total billed charges,,
FUROSEMIDE 10 MG/ML INJ SOLN,,J1940,HCPCS,Facility,Both,10,mL,,19,16.15,5.4454,19,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,19,100,,percent of total billed charges,,
FUROSEMIDE 10 MG/ML INJ SOLN,,J1940,HCPCS,Facility,Both,10,mL,,19,16.15,5.4454,19,BlueCross BlueShield Minnesota,High Value Network Plan,17.1,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
FUROSEMIDE 10 MG/ML INJ SOLN,,J1940,HCPCS,Facility,Outpatient,10,mL,,19,16.15,5.4454,19,BlueCross BlueShield Minnesota,Medicare Advantage,9.31,49,,percent of total billed charges,,
FUROSEMIDE 10 MG/ML INJ SOLN,,J1940,HCPCS,Facility,Inpatient,10,mL,,19,16.15,5.4454,19,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
FUROSEMIDE 10 MG/ML INJ SOLN,,J1940,HCPCS,Facility,Both,10,mL,,19,16.15,5.4454,19,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,16.8283,88.57,,percent of total billed charges,,
FUROSEMIDE 10 MG/ML INJ SOLN,,J1940,HCPCS,Facility,Both,10,mL,,19,16.15,5.4454,19,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,5.4454,28.66,,percent of total billed charges,,
FUROSEMIDE 10 MG/ML INJ SOLN,,J1940,HCPCS,Facility,Outpatient,10,mL,,19,16.15,5.4454,19,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),9.31,49,,percent of total billed charges,,
FUROSEMIDE 10 MG/ML INJ SOLN,,J1940,HCPCS,Facility,Inpatient,10,mL,,19,16.15,5.4454,19,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
FUROSEMIDE 10 MG/ML INJ SOLN,,J1940,HCPCS,Facility,Both,10,mL,,19,16.15,5.4454,19,CorVel,Worker's Compensation,19,100,,percent of total billed charges,,
FUROSEMIDE 10 MG/ML INJ SOLN,,J1940,HCPCS,Facility,Both,10,mL,,19,16.15,5.4454,19,First Health Group Corporation,First Health Network,18.43,97,,percent of total billed charges,,
FUROSEMIDE 10 MG/ML INJ SOLN,,J1940,HCPCS,Facility,Both,10,mL,,19,16.15,5.4454,19,"Health Partners, Inc.",Commercial,17.974,94.6,,percent of total billed charges,,
FUROSEMIDE 10 MG/ML INJ SOLN,,J1940,HCPCS,Facility,Outpatient,10,mL,,19,16.15,5.4454,19,"Health Partners, Inc.",Medicare Advantage,9.31,49,,percent of total billed charges,,
FUROSEMIDE 10 MG/ML INJ SOLN,,J1940,HCPCS,Facility,Inpatient,10,mL,,19,16.15,5.4454,19,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
FUROSEMIDE 10 MG/ML INJ SOLN,,J1940,HCPCS,Facility,Both,10,mL,,19,16.15,5.4454,19,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),11.4,60,,percent of total billed charges,,
FUROSEMIDE 10 MG/ML INJ SOLN,,J1940,HCPCS,Facility,Both,10,mL,,19,16.15,5.4454,19,"Health Partners, Inc.",State of Minnesota Advantage Program,15.485,81.5,,percent of total billed charges,,
FUROSEMIDE 10 MG/ML INJ SOLN,,J1940,HCPCS,Facility,Both,10,mL,,19,16.15,5.4454,19,"Health Partners, Inc.",State Public Programs,9.5,50,,percent of total billed charges,,
FUROSEMIDE 10 MG/ML INJ SOLN,,J1940,HCPCS,Facility,Both,10,mL,,19,16.15,5.4454,19,Humana Insurance Company,Commercial PPO,18.05,95,,percent of total billed charges,,
FUROSEMIDE 10 MG/ML INJ SOLN,,J1940,HCPCS,Facility,Outpatient,10,mL,,19,16.15,5.4454,19,Humana Insurance Company,Medicare PPO,9.31,49,,percent of total billed charges,,
FUROSEMIDE 10 MG/ML INJ SOLN,,J1940,HCPCS,Facility,Inpatient,10,mL,,19,16.15,5.4454,19,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
FUROSEMIDE 10 MG/ML INJ SOLN,,J1940,HCPCS,Facility,Both,10,mL,,19,16.15,5.4454,19,Medica,Individual & Family,18.829,99.1,,percent of total billed charges,,
FUROSEMIDE 10 MG/ML INJ SOLN,,J1940,HCPCS,Facility,Outpatient,10,mL,,19,16.15,5.4454,19,Medica,Medica Advantage Solution,9.462,49.8,,percent of total billed charges,,
FUROSEMIDE 10 MG/ML INJ SOLN,,J1940,HCPCS,Facility,Inpatient,10,mL,,19,16.15,5.4454,19,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
FUROSEMIDE 10 MG/ML INJ SOLN,,J1940,HCPCS,Facility,Outpatient,10,mL,,19,16.15,5.4454,19,Medica,Medical Assistance,8.474,44.6,,percent of total billed charges,,
FUROSEMIDE 10 MG/ML INJ SOLN,,J1940,HCPCS,Facility,Inpatient,10,mL,,19,16.15,5.4454,19,Medica,Medical Assistance,,,,,Included in per diem rate,
FUROSEMIDE 10 MG/ML INJ SOLN,,J1940,HCPCS,Facility,Outpatient,10,mL,,19,16.15,5.4454,19,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,9.462,49.8,,percent of total billed charges,,
FUROSEMIDE 10 MG/ML INJ SOLN,,J1940,HCPCS,Facility,Inpatient,10,mL,,19,16.15,5.4454,19,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
FUROSEMIDE 10 MG/ML INJ SOLN,,J1940,HCPCS,Facility,Both,10,mL,,19,16.15,5.4454,19,"Multiplan, Inc.","Multiplan, Inc.",17.86,94,,percent of total billed charges,,
FUROSEMIDE 10 MG/ML INJ SOLN,,J1940,HCPCS,Facility,Outpatient,10,mL,,19,16.15,5.4454,19,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,17.119,90.1,,percent of total billed charges,,
FUROSEMIDE 10 MG/ML INJ SOLN,,J1940,HCPCS,Facility,Inpatient,10,mL,,19,16.15,5.4454,19,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
FUROSEMIDE 10 MG/ML INJ SOLN,,J1940,HCPCS,Facility,Both,10,mL,,19,16.15,5.4454,19,"Preferred One Administrative Services, INC.",PPO,18.734,98.6,,percent of total billed charges,,
FUROSEMIDE 10 MG/ML INJ SOLN,,J1940,HCPCS,Facility,Outpatient,10,mL,,19,16.15,5.4454,19,PrimeWest Health,Minnesota Senior Health Options (MSHO),9.7755,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
FUROSEMIDE 10 MG/ML INJ SOLN,,J1940,HCPCS,Facility,Inpatient,10,mL,,19,16.15,5.4454,19,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
FUROSEMIDE 10 MG/ML INJ SOLN,,J1940,HCPCS,Facility,Outpatient,10,mL,,19,16.15,5.4454,19,PrimeWest Health,MinnesotaCare,9.7584,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
FUROSEMIDE 10 MG/ML INJ SOLN,,J1940,HCPCS,Facility,Inpatient,10,mL,,19,16.15,5.4454,19,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
FUROSEMIDE 10 MG/ML INJ SOLN,,J1940,HCPCS,Facility,Both,10,mL,,19,16.15,5.4454,19,Sanford Health Plan,Sanford Health Plan,17.48,92,,percent of total billed charges,,
FUROSEMIDE 10 MG/ML INJ SOLN,,J1940,HCPCS,Facility,Outpatient,10,mL,,19,16.15,5.4454,19,"UCare Health, Inc.",Individual & Family Plan,10.7065,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
FUROSEMIDE 10 MG/ML INJ SOLN,,J1940,HCPCS,Facility,Inpatient,10,mL,,19,16.15,5.4454,19,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
FUROSEMIDE 10 MG/ML INJ SOLN,,J1940,HCPCS,Facility,Outpatient,10,mL,,19,16.15,5.4454,19,"UCare Health, Inc.",Medical Assistance,9.5893,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FUROSEMIDE 10 MG/ML INJ SOLN,,J1940,HCPCS,Facility,Inpatient,10,mL,,19,16.15,5.4454,19,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
FUROSEMIDE 10 MG/ML INJ SOLN,,J1940,HCPCS,Facility,Outpatient,10,mL,,19,16.15,5.4454,19,"UCare Health, Inc.",Medicare Advantage,9.5893,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FUROSEMIDE 10 MG/ML INJ SOLN,,J1940,HCPCS,Facility,Inpatient,10,mL,,19,16.15,5.4454,19,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
FUROSEMIDE 10 MG/ML INJ SOLN,,J1940,HCPCS,Facility,Outpatient,10,mL,,19,16.15,5.4454,19,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),9.5893,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FUROSEMIDE 10 MG/ML INJ SOLN,,J1940,HCPCS,Facility,Inpatient,10,mL,,19,16.15,5.4454,19,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
FUROSEMIDE 10 MG/ML INJ SOLN,,J1940,HCPCS,Facility,Both,10,mL,,19,16.15,5.4454,19,UnitedHealthcare,Individual & Family,17.86,94,,percent of total billed charges,,
FUROSEMIDE 10 MG/ML INJ SOLN,,J1940,HCPCS,Facility,Outpatient,10,mL,,19,16.15,5.4454,19,UnitedHealthcare,Medicare Advantage,9.31,49,,percent of total billed charges,,
FUROSEMIDE 10 MG/ML INJ SOLN,,J1940,HCPCS,Facility,Inpatient,10,mL,,19,16.15,5.4454,19,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
FUROSEMIDE 10 MG/ML INJ SOLN,,J1940,HCPCS,Facility,Outpatient,10,mL,,19,16.15,5.4454,19,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,9.12,48,,percent of total billed charges,,100% of DHS outpatient percentage
FUROSEMIDE 10 MG/ML INJ SOLN,,J1940,HCPCS,Facility,Inpatient,10,mL,,19,16.15,5.4454,19,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
MIDAZOLAM 5 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Both,10,mL,,36,30.6,10.3176,36,Aetna,Commercial,33.12,92,,percent of total billed charges,,
MIDAZOLAM 5 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Outpatient,10,mL,,36,30.6,10.3176,36,Aetna,Medicare Advantage,17.64,49,,percent of total billed charges,,
MIDAZOLAM 5 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Inpatient,10,mL,,36,30.6,10.3176,36,Aetna,Medicare Advantage,,,,,Included in per diem rate,
MIDAZOLAM 5 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Both,10,mL,,36,30.6,10.3176,36,Aetna,PPO,33.48,93,,percent of total billed charges,,
MIDAZOLAM 5 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Both,10,mL,,36,30.6,10.3176,36,America's PPO,America's PPO,34.5708,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
MIDAZOLAM 5 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Both,10,mL,,36,30.6,10.3176,36,BlueCross BlueShield Minnesota, Federal Employee Program,35.424,98.4,,percent of total billed charges,,
MIDAZOLAM 5 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Both,10,mL,,36,30.6,10.3176,36,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,36,100,,percent of total billed charges,,
MIDAZOLAM 5 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Both,10,mL,,36,30.6,10.3176,36,BlueCross BlueShield Minnesota,High Value Network Plan,32.4,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
MIDAZOLAM 5 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Outpatient,10,mL,,36,30.6,10.3176,36,BlueCross BlueShield Minnesota,Medicare Advantage,17.64,49,,percent of total billed charges,,
MIDAZOLAM 5 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Inpatient,10,mL,,36,30.6,10.3176,36,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
MIDAZOLAM 5 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Both,10,mL,,36,30.6,10.3176,36,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,31.8852,88.57,,percent of total billed charges,,
MIDAZOLAM 5 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Both,10,mL,,36,30.6,10.3176,36,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,10.3176,28.66,,percent of total billed charges,,
MIDAZOLAM 5 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Outpatient,10,mL,,36,30.6,10.3176,36,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),17.64,49,,percent of total billed charges,,
MIDAZOLAM 5 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Inpatient,10,mL,,36,30.6,10.3176,36,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
MIDAZOLAM 5 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Both,10,mL,,36,30.6,10.3176,36,CorVel,Worker's Compensation,36,100,,percent of total billed charges,,
MIDAZOLAM 5 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Both,10,mL,,36,30.6,10.3176,36,First Health Group Corporation,First Health Network,34.92,97,,percent of total billed charges,,
MIDAZOLAM 5 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Both,10,mL,,36,30.6,10.3176,36,"Health Partners, Inc.",Commercial,34.056,94.6,,percent of total billed charges,,
MIDAZOLAM 5 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Outpatient,10,mL,,36,30.6,10.3176,36,"Health Partners, Inc.",Medicare Advantage,17.64,49,,percent of total billed charges,,
MIDAZOLAM 5 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Inpatient,10,mL,,36,30.6,10.3176,36,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
MIDAZOLAM 5 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Both,10,mL,,36,30.6,10.3176,36,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),21.6,60,,percent of total billed charges,,
MIDAZOLAM 5 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Both,10,mL,,36,30.6,10.3176,36,"Health Partners, Inc.",State of Minnesota Advantage Program,29.34,81.5,,percent of total billed charges,,
MIDAZOLAM 5 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Both,10,mL,,36,30.6,10.3176,36,"Health Partners, Inc.",State Public Programs,18,50,,percent of total billed charges,,
MIDAZOLAM 5 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Both,10,mL,,36,30.6,10.3176,36,Humana Insurance Company,Commercial PPO,34.2,95,,percent of total billed charges,,
MIDAZOLAM 5 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Outpatient,10,mL,,36,30.6,10.3176,36,Humana Insurance Company,Medicare PPO,17.64,49,,percent of total billed charges,,
MIDAZOLAM 5 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Inpatient,10,mL,,36,30.6,10.3176,36,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
MIDAZOLAM 5 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Both,10,mL,,36,30.6,10.3176,36,Medica,Individual & Family,35.676,99.1,,percent of total billed charges,,
MIDAZOLAM 5 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Outpatient,10,mL,,36,30.6,10.3176,36,Medica,Medica Advantage Solution,17.928,49.8,,percent of total billed charges,,
MIDAZOLAM 5 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Inpatient,10,mL,,36,30.6,10.3176,36,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
MIDAZOLAM 5 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Outpatient,10,mL,,36,30.6,10.3176,36,Medica,Medical Assistance,16.056,44.6,,percent of total billed charges,,
MIDAZOLAM 5 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Inpatient,10,mL,,36,30.6,10.3176,36,Medica,Medical Assistance,,,,,Included in per diem rate,
MIDAZOLAM 5 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Outpatient,10,mL,,36,30.6,10.3176,36,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,17.928,49.8,,percent of total billed charges,,
MIDAZOLAM 5 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Inpatient,10,mL,,36,30.6,10.3176,36,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
MIDAZOLAM 5 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Both,10,mL,,36,30.6,10.3176,36,"Multiplan, Inc.","Multiplan, Inc.",33.84,94,,percent of total billed charges,,
MIDAZOLAM 5 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Outpatient,10,mL,,36,30.6,10.3176,36,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,32.436,90.1,,percent of total billed charges,,
MIDAZOLAM 5 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Inpatient,10,mL,,36,30.6,10.3176,36,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
MIDAZOLAM 5 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Both,10,mL,,36,30.6,10.3176,36,"Preferred One Administrative Services, INC.",PPO,35.496,98.6,,percent of total billed charges,,
MIDAZOLAM 5 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Outpatient,10,mL,,36,30.6,10.3176,36,PrimeWest Health,Minnesota Senior Health Options (MSHO),18.522,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
MIDAZOLAM 5 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Inpatient,10,mL,,36,30.6,10.3176,36,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
MIDAZOLAM 5 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Outpatient,10,mL,,36,30.6,10.3176,36,PrimeWest Health,MinnesotaCare,18.4896,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
MIDAZOLAM 5 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Inpatient,10,mL,,36,30.6,10.3176,36,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
MIDAZOLAM 5 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Both,10,mL,,36,30.6,10.3176,36,Sanford Health Plan,Sanford Health Plan,33.12,92,,percent of total billed charges,,
MIDAZOLAM 5 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Outpatient,10,mL,,36,30.6,10.3176,36,"UCare Health, Inc.",Individual & Family Plan,20.286,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
MIDAZOLAM 5 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Inpatient,10,mL,,36,30.6,10.3176,36,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
MIDAZOLAM 5 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Outpatient,10,mL,,36,30.6,10.3176,36,"UCare Health, Inc.",Medical Assistance,18.1692,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MIDAZOLAM 5 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Inpatient,10,mL,,36,30.6,10.3176,36,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
MIDAZOLAM 5 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Outpatient,10,mL,,36,30.6,10.3176,36,"UCare Health, Inc.",Medicare Advantage,18.1692,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MIDAZOLAM 5 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Inpatient,10,mL,,36,30.6,10.3176,36,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
MIDAZOLAM 5 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Outpatient,10,mL,,36,30.6,10.3176,36,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),18.1692,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MIDAZOLAM 5 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Inpatient,10,mL,,36,30.6,10.3176,36,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
MIDAZOLAM 5 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Both,10,mL,,36,30.6,10.3176,36,UnitedHealthcare,Individual & Family,33.84,94,,percent of total billed charges,,
MIDAZOLAM 5 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Outpatient,10,mL,,36,30.6,10.3176,36,UnitedHealthcare,Medicare Advantage,17.64,49,,percent of total billed charges,,
MIDAZOLAM 5 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Inpatient,10,mL,,36,30.6,10.3176,36,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
MIDAZOLAM 5 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Outpatient,10,mL,,36,30.6,10.3176,36,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,17.28,48,,percent of total billed charges,,100% of DHS outpatient percentage
MIDAZOLAM 5 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Inpatient,10,mL,,36,30.6,10.3176,36,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
MORPHINE (PF) 0.5 MG/ML INJ SOLN,,J2270,HCPCS,Facility,Both,10,mL,,157,133.45,44.9962,157,Aetna,Commercial,144.44,92,,percent of total billed charges,,
MORPHINE (PF) 0.5 MG/ML INJ SOLN,,J2270,HCPCS,Facility,Outpatient,10,mL,,157,133.45,44.9962,157,Aetna,Medicare Advantage,76.93,49,,percent of total billed charges,,
MORPHINE (PF) 0.5 MG/ML INJ SOLN,,J2270,HCPCS,Facility,Inpatient,10,mL,,157,133.45,44.9962,157,Aetna,Medicare Advantage,,,,,Included in per diem rate,
MORPHINE (PF) 0.5 MG/ML INJ SOLN,,J2270,HCPCS,Facility,Both,10,mL,,157,133.45,44.9962,157,Aetna,PPO,146.01,93,,percent of total billed charges,,
MORPHINE (PF) 0.5 MG/ML INJ SOLN,,J2270,HCPCS,Facility,Both,10,mL,,157,133.45,44.9962,157,America's PPO,America's PPO,150.7671,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
MORPHINE (PF) 0.5 MG/ML INJ SOLN,,J2270,HCPCS,Facility,Both,10,mL,,157,133.45,44.9962,157,BlueCross BlueShield Minnesota, Federal Employee Program,154.488,98.4,,percent of total billed charges,,
MORPHINE (PF) 0.5 MG/ML INJ SOLN,,J2270,HCPCS,Facility,Both,10,mL,,157,133.45,44.9962,157,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,157,100,,percent of total billed charges,,
MORPHINE (PF) 0.5 MG/ML INJ SOLN,,J2270,HCPCS,Facility,Both,10,mL,,157,133.45,44.9962,157,BlueCross BlueShield Minnesota,High Value Network Plan,141.3,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
MORPHINE (PF) 0.5 MG/ML INJ SOLN,,J2270,HCPCS,Facility,Outpatient,10,mL,,157,133.45,44.9962,157,BlueCross BlueShield Minnesota,Medicare Advantage,76.93,49,,percent of total billed charges,,
MORPHINE (PF) 0.5 MG/ML INJ SOLN,,J2270,HCPCS,Facility,Inpatient,10,mL,,157,133.45,44.9962,157,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
MORPHINE (PF) 0.5 MG/ML INJ SOLN,,J2270,HCPCS,Facility,Both,10,mL,,157,133.45,44.9962,157,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,139.0549,88.57,,percent of total billed charges,,
MORPHINE (PF) 0.5 MG/ML INJ SOLN,,J2270,HCPCS,Facility,Both,10,mL,,157,133.45,44.9962,157,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,44.9962,28.66,,percent of total billed charges,,
MORPHINE (PF) 0.5 MG/ML INJ SOLN,,J2270,HCPCS,Facility,Outpatient,10,mL,,157,133.45,44.9962,157,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),76.93,49,,percent of total billed charges,,
MORPHINE (PF) 0.5 MG/ML INJ SOLN,,J2270,HCPCS,Facility,Inpatient,10,mL,,157,133.45,44.9962,157,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
MORPHINE (PF) 0.5 MG/ML INJ SOLN,,J2270,HCPCS,Facility,Both,10,mL,,157,133.45,44.9962,157,CorVel,Worker's Compensation,157,100,,percent of total billed charges,,
MORPHINE (PF) 0.5 MG/ML INJ SOLN,,J2270,HCPCS,Facility,Both,10,mL,,157,133.45,44.9962,157,First Health Group Corporation,First Health Network,152.29,97,,percent of total billed charges,,
MORPHINE (PF) 0.5 MG/ML INJ SOLN,,J2270,HCPCS,Facility,Both,10,mL,,157,133.45,44.9962,157,"Health Partners, Inc.",Commercial,148.522,94.6,,percent of total billed charges,,
MORPHINE (PF) 0.5 MG/ML INJ SOLN,,J2270,HCPCS,Facility,Outpatient,10,mL,,157,133.45,44.9962,157,"Health Partners, Inc.",Medicare Advantage,76.93,49,,percent of total billed charges,,
MORPHINE (PF) 0.5 MG/ML INJ SOLN,,J2270,HCPCS,Facility,Inpatient,10,mL,,157,133.45,44.9962,157,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
MORPHINE (PF) 0.5 MG/ML INJ SOLN,,J2270,HCPCS,Facility,Both,10,mL,,157,133.45,44.9962,157,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),94.2,60,,percent of total billed charges,,
MORPHINE (PF) 0.5 MG/ML INJ SOLN,,J2270,HCPCS,Facility,Both,10,mL,,157,133.45,44.9962,157,"Health Partners, Inc.",State of Minnesota Advantage Program,127.955,81.5,,percent of total billed charges,,
MORPHINE (PF) 0.5 MG/ML INJ SOLN,,J2270,HCPCS,Facility,Both,10,mL,,157,133.45,44.9962,157,"Health Partners, Inc.",State Public Programs,78.5,50,,percent of total billed charges,,
MORPHINE (PF) 0.5 MG/ML INJ SOLN,,J2270,HCPCS,Facility,Both,10,mL,,157,133.45,44.9962,157,Humana Insurance Company,Commercial PPO,149.15,95,,percent of total billed charges,,
MORPHINE (PF) 0.5 MG/ML INJ SOLN,,J2270,HCPCS,Facility,Outpatient,10,mL,,157,133.45,44.9962,157,Humana Insurance Company,Medicare PPO,76.93,49,,percent of total billed charges,,
MORPHINE (PF) 0.5 MG/ML INJ SOLN,,J2270,HCPCS,Facility,Inpatient,10,mL,,157,133.45,44.9962,157,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
MORPHINE (PF) 0.5 MG/ML INJ SOLN,,J2270,HCPCS,Facility,Both,10,mL,,157,133.45,44.9962,157,Medica,Individual & Family,155.587,99.1,,percent of total billed charges,,
MORPHINE (PF) 0.5 MG/ML INJ SOLN,,J2270,HCPCS,Facility,Outpatient,10,mL,,157,133.45,44.9962,157,Medica,Medica Advantage Solution,78.186,49.8,,percent of total billed charges,,
MORPHINE (PF) 0.5 MG/ML INJ SOLN,,J2270,HCPCS,Facility,Inpatient,10,mL,,157,133.45,44.9962,157,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
MORPHINE (PF) 0.5 MG/ML INJ SOLN,,J2270,HCPCS,Facility,Outpatient,10,mL,,157,133.45,44.9962,157,Medica,Medical Assistance,70.022,44.6,,percent of total billed charges,,
MORPHINE (PF) 0.5 MG/ML INJ SOLN,,J2270,HCPCS,Facility,Inpatient,10,mL,,157,133.45,44.9962,157,Medica,Medical Assistance,,,,,Included in per diem rate,
MORPHINE (PF) 0.5 MG/ML INJ SOLN,,J2270,HCPCS,Facility,Outpatient,10,mL,,157,133.45,44.9962,157,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,78.186,49.8,,percent of total billed charges,,
MORPHINE (PF) 0.5 MG/ML INJ SOLN,,J2270,HCPCS,Facility,Inpatient,10,mL,,157,133.45,44.9962,157,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
MORPHINE (PF) 0.5 MG/ML INJ SOLN,,J2270,HCPCS,Facility,Both,10,mL,,157,133.45,44.9962,157,"Multiplan, Inc.","Multiplan, Inc.",147.58,94,,percent of total billed charges,,
MORPHINE (PF) 0.5 MG/ML INJ SOLN,,J2270,HCPCS,Facility,Outpatient,10,mL,,157,133.45,44.9962,157,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,141.457,90.1,,percent of total billed charges,,
MORPHINE (PF) 0.5 MG/ML INJ SOLN,,J2270,HCPCS,Facility,Inpatient,10,mL,,157,133.45,44.9962,157,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
MORPHINE (PF) 0.5 MG/ML INJ SOLN,,J2270,HCPCS,Facility,Both,10,mL,,157,133.45,44.9962,157,"Preferred One Administrative Services, INC.",PPO,154.802,98.6,,percent of total billed charges,,
MORPHINE (PF) 0.5 MG/ML INJ SOLN,,J2270,HCPCS,Facility,Outpatient,10,mL,,157,133.45,44.9962,157,PrimeWest Health,Minnesota Senior Health Options (MSHO),80.7765,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
MORPHINE (PF) 0.5 MG/ML INJ SOLN,,J2270,HCPCS,Facility,Inpatient,10,mL,,157,133.45,44.9962,157,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
MORPHINE (PF) 0.5 MG/ML INJ SOLN,,J2270,HCPCS,Facility,Outpatient,10,mL,,157,133.45,44.9962,157,PrimeWest Health,MinnesotaCare,80.6352,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
MORPHINE (PF) 0.5 MG/ML INJ SOLN,,J2270,HCPCS,Facility,Inpatient,10,mL,,157,133.45,44.9962,157,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
MORPHINE (PF) 0.5 MG/ML INJ SOLN,,J2270,HCPCS,Facility,Both,10,mL,,157,133.45,44.9962,157,Sanford Health Plan,Sanford Health Plan,144.44,92,,percent of total billed charges,,
MORPHINE (PF) 0.5 MG/ML INJ SOLN,,J2270,HCPCS,Facility,Outpatient,10,mL,,157,133.45,44.9962,157,"UCare Health, Inc.",Individual & Family Plan,88.4695,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
MORPHINE (PF) 0.5 MG/ML INJ SOLN,,J2270,HCPCS,Facility,Inpatient,10,mL,,157,133.45,44.9962,157,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
MORPHINE (PF) 0.5 MG/ML INJ SOLN,,J2270,HCPCS,Facility,Outpatient,10,mL,,157,133.45,44.9962,157,"UCare Health, Inc.",Medical Assistance,79.2379,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MORPHINE (PF) 0.5 MG/ML INJ SOLN,,J2270,HCPCS,Facility,Inpatient,10,mL,,157,133.45,44.9962,157,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
MORPHINE (PF) 0.5 MG/ML INJ SOLN,,J2270,HCPCS,Facility,Outpatient,10,mL,,157,133.45,44.9962,157,"UCare Health, Inc.",Medicare Advantage,79.2379,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MORPHINE (PF) 0.5 MG/ML INJ SOLN,,J2270,HCPCS,Facility,Inpatient,10,mL,,157,133.45,44.9962,157,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
MORPHINE (PF) 0.5 MG/ML INJ SOLN,,J2270,HCPCS,Facility,Outpatient,10,mL,,157,133.45,44.9962,157,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),79.2379,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MORPHINE (PF) 0.5 MG/ML INJ SOLN,,J2270,HCPCS,Facility,Inpatient,10,mL,,157,133.45,44.9962,157,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
MORPHINE (PF) 0.5 MG/ML INJ SOLN,,J2270,HCPCS,Facility,Both,10,mL,,157,133.45,44.9962,157,UnitedHealthcare,Individual & Family,147.58,94,,percent of total billed charges,,
MORPHINE (PF) 0.5 MG/ML INJ SOLN,,J2270,HCPCS,Facility,Outpatient,10,mL,,157,133.45,44.9962,157,UnitedHealthcare,Medicare Advantage,76.93,49,,percent of total billed charges,,
MORPHINE (PF) 0.5 MG/ML INJ SOLN,,J2270,HCPCS,Facility,Inpatient,10,mL,,157,133.45,44.9962,157,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
MORPHINE (PF) 0.5 MG/ML INJ SOLN,,J2270,HCPCS,Facility,Outpatient,10,mL,,157,133.45,44.9962,157,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,75.36,48,,percent of total billed charges,,100% of DHS outpatient percentage
MORPHINE (PF) 0.5 MG/ML INJ SOLN,,J2270,HCPCS,Facility,Inpatient,10,mL,,157,133.45,44.9962,157,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
PROCAINAMIDE 100 MG/ML IV SYRG,,J2690,HCPCS,Facility,Both,10,mL,,398,338.3,114.0668,398,Aetna,Commercial,366.16,92,,percent of total billed charges,,
PROCAINAMIDE 100 MG/ML IV SYRG,,J2690,HCPCS,Facility,Outpatient,10,mL,,398,338.3,114.0668,398,Aetna,Medicare Advantage,195.02,49,,percent of total billed charges,,
PROCAINAMIDE 100 MG/ML IV SYRG,,J2690,HCPCS,Facility,Inpatient,10,mL,,398,338.3,114.0668,398,Aetna,Medicare Advantage,,,,,Included in per diem rate,
PROCAINAMIDE 100 MG/ML IV SYRG,,J2690,HCPCS,Facility,Both,10,mL,,398,338.3,114.0668,398,Aetna,PPO,370.14,93,,percent of total billed charges,,
PROCAINAMIDE 100 MG/ML IV SYRG,,J2690,HCPCS,Facility,Both,10,mL,,398,338.3,114.0668,398,America's PPO,America's PPO,382.1994,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
PROCAINAMIDE 100 MG/ML IV SYRG,,J2690,HCPCS,Facility,Both,10,mL,,398,338.3,114.0668,398,BlueCross BlueShield Minnesota, Federal Employee Program,391.632,98.4,,percent of total billed charges,,
PROCAINAMIDE 100 MG/ML IV SYRG,,J2690,HCPCS,Facility,Both,10,mL,,398,338.3,114.0668,398,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,398,100,,percent of total billed charges,,
PROCAINAMIDE 100 MG/ML IV SYRG,,J2690,HCPCS,Facility,Both,10,mL,,398,338.3,114.0668,398,BlueCross BlueShield Minnesota,High Value Network Plan,358.2,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
PROCAINAMIDE 100 MG/ML IV SYRG,,J2690,HCPCS,Facility,Outpatient,10,mL,,398,338.3,114.0668,398,BlueCross BlueShield Minnesota,Medicare Advantage,195.02,49,,percent of total billed charges,,
PROCAINAMIDE 100 MG/ML IV SYRG,,J2690,HCPCS,Facility,Inpatient,10,mL,,398,338.3,114.0668,398,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
PROCAINAMIDE 100 MG/ML IV SYRG,,J2690,HCPCS,Facility,Both,10,mL,,398,338.3,114.0668,398,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,352.5086,88.57,,percent of total billed charges,,
PROCAINAMIDE 100 MG/ML IV SYRG,,J2690,HCPCS,Facility,Both,10,mL,,398,338.3,114.0668,398,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,114.0668,28.66,,percent of total billed charges,,
PROCAINAMIDE 100 MG/ML IV SYRG,,J2690,HCPCS,Facility,Outpatient,10,mL,,398,338.3,114.0668,398,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),195.02,49,,percent of total billed charges,,
PROCAINAMIDE 100 MG/ML IV SYRG,,J2690,HCPCS,Facility,Inpatient,10,mL,,398,338.3,114.0668,398,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
PROCAINAMIDE 100 MG/ML IV SYRG,,J2690,HCPCS,Facility,Both,10,mL,,398,338.3,114.0668,398,CorVel,Worker's Compensation,398,100,,percent of total billed charges,,
PROCAINAMIDE 100 MG/ML IV SYRG,,J2690,HCPCS,Facility,Both,10,mL,,398,338.3,114.0668,398,First Health Group Corporation,First Health Network,386.06,97,,percent of total billed charges,,
PROCAINAMIDE 100 MG/ML IV SYRG,,J2690,HCPCS,Facility,Both,10,mL,,398,338.3,114.0668,398,"Health Partners, Inc.",Commercial,376.508,94.6,,percent of total billed charges,,
PROCAINAMIDE 100 MG/ML IV SYRG,,J2690,HCPCS,Facility,Outpatient,10,mL,,398,338.3,114.0668,398,"Health Partners, Inc.",Medicare Advantage,195.02,49,,percent of total billed charges,,
PROCAINAMIDE 100 MG/ML IV SYRG,,J2690,HCPCS,Facility,Inpatient,10,mL,,398,338.3,114.0668,398,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PROCAINAMIDE 100 MG/ML IV SYRG,,J2690,HCPCS,Facility,Both,10,mL,,398,338.3,114.0668,398,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),238.8,60,,percent of total billed charges,,
PROCAINAMIDE 100 MG/ML IV SYRG,,J2690,HCPCS,Facility,Both,10,mL,,398,338.3,114.0668,398,"Health Partners, Inc.",State of Minnesota Advantage Program,324.37,81.5,,percent of total billed charges,,
PROCAINAMIDE 100 MG/ML IV SYRG,,J2690,HCPCS,Facility,Both,10,mL,,398,338.3,114.0668,398,"Health Partners, Inc.",State Public Programs,199,50,,percent of total billed charges,,
PROCAINAMIDE 100 MG/ML IV SYRG,,J2690,HCPCS,Facility,Both,10,mL,,398,338.3,114.0668,398,Humana Insurance Company,Commercial PPO,378.1,95,,percent of total billed charges,,
PROCAINAMIDE 100 MG/ML IV SYRG,,J2690,HCPCS,Facility,Outpatient,10,mL,,398,338.3,114.0668,398,Humana Insurance Company,Medicare PPO,195.02,49,,percent of total billed charges,,
PROCAINAMIDE 100 MG/ML IV SYRG,,J2690,HCPCS,Facility,Inpatient,10,mL,,398,338.3,114.0668,398,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
PROCAINAMIDE 100 MG/ML IV SYRG,,J2690,HCPCS,Facility,Both,10,mL,,398,338.3,114.0668,398,Medica,Individual & Family,394.418,99.1,,percent of total billed charges,,
PROCAINAMIDE 100 MG/ML IV SYRG,,J2690,HCPCS,Facility,Outpatient,10,mL,,398,338.3,114.0668,398,Medica,Medica Advantage Solution,198.204,49.8,,percent of total billed charges,,
PROCAINAMIDE 100 MG/ML IV SYRG,,J2690,HCPCS,Facility,Inpatient,10,mL,,398,338.3,114.0668,398,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
PROCAINAMIDE 100 MG/ML IV SYRG,,J2690,HCPCS,Facility,Outpatient,10,mL,,398,338.3,114.0668,398,Medica,Medical Assistance,177.508,44.6,,percent of total billed charges,,
PROCAINAMIDE 100 MG/ML IV SYRG,,J2690,HCPCS,Facility,Inpatient,10,mL,,398,338.3,114.0668,398,Medica,Medical Assistance,,,,,Included in per diem rate,
PROCAINAMIDE 100 MG/ML IV SYRG,,J2690,HCPCS,Facility,Outpatient,10,mL,,398,338.3,114.0668,398,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,198.204,49.8,,percent of total billed charges,,
PROCAINAMIDE 100 MG/ML IV SYRG,,J2690,HCPCS,Facility,Inpatient,10,mL,,398,338.3,114.0668,398,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
PROCAINAMIDE 100 MG/ML IV SYRG,,J2690,HCPCS,Facility,Both,10,mL,,398,338.3,114.0668,398,"Multiplan, Inc.","Multiplan, Inc.",374.12,94,,percent of total billed charges,,
PROCAINAMIDE 100 MG/ML IV SYRG,,J2690,HCPCS,Facility,Outpatient,10,mL,,398,338.3,114.0668,398,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,358.598,90.1,,percent of total billed charges,,
PROCAINAMIDE 100 MG/ML IV SYRG,,J2690,HCPCS,Facility,Inpatient,10,mL,,398,338.3,114.0668,398,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
PROCAINAMIDE 100 MG/ML IV SYRG,,J2690,HCPCS,Facility,Both,10,mL,,398,338.3,114.0668,398,"Preferred One Administrative Services, INC.",PPO,392.428,98.6,,percent of total billed charges,,
PROCAINAMIDE 100 MG/ML IV SYRG,,J2690,HCPCS,Facility,Outpatient,10,mL,,398,338.3,114.0668,398,PrimeWest Health,Minnesota Senior Health Options (MSHO),204.771,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
PROCAINAMIDE 100 MG/ML IV SYRG,,J2690,HCPCS,Facility,Inpatient,10,mL,,398,338.3,114.0668,398,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PROCAINAMIDE 100 MG/ML IV SYRG,,J2690,HCPCS,Facility,Outpatient,10,mL,,398,338.3,114.0668,398,PrimeWest Health,MinnesotaCare,204.4128,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
PROCAINAMIDE 100 MG/ML IV SYRG,,J2690,HCPCS,Facility,Inpatient,10,mL,,398,338.3,114.0668,398,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
PROCAINAMIDE 100 MG/ML IV SYRG,,J2690,HCPCS,Facility,Both,10,mL,,398,338.3,114.0668,398,Sanford Health Plan,Sanford Health Plan,366.16,92,,percent of total billed charges,,
PROCAINAMIDE 100 MG/ML IV SYRG,,J2690,HCPCS,Facility,Outpatient,10,mL,,398,338.3,114.0668,398,"UCare Health, Inc.",Individual & Family Plan,224.273,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
PROCAINAMIDE 100 MG/ML IV SYRG,,J2690,HCPCS,Facility,Inpatient,10,mL,,398,338.3,114.0668,398,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
PROCAINAMIDE 100 MG/ML IV SYRG,,J2690,HCPCS,Facility,Outpatient,10,mL,,398,338.3,114.0668,398,"UCare Health, Inc.",Medical Assistance,200.8706,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PROCAINAMIDE 100 MG/ML IV SYRG,,J2690,HCPCS,Facility,Inpatient,10,mL,,398,338.3,114.0668,398,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
PROCAINAMIDE 100 MG/ML IV SYRG,,J2690,HCPCS,Facility,Outpatient,10,mL,,398,338.3,114.0668,398,"UCare Health, Inc.",Medicare Advantage,200.8706,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PROCAINAMIDE 100 MG/ML IV SYRG,,J2690,HCPCS,Facility,Inpatient,10,mL,,398,338.3,114.0668,398,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PROCAINAMIDE 100 MG/ML IV SYRG,,J2690,HCPCS,Facility,Outpatient,10,mL,,398,338.3,114.0668,398,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),200.8706,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PROCAINAMIDE 100 MG/ML IV SYRG,,J2690,HCPCS,Facility,Inpatient,10,mL,,398,338.3,114.0668,398,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PROCAINAMIDE 100 MG/ML IV SYRG,,J2690,HCPCS,Facility,Both,10,mL,,398,338.3,114.0668,398,UnitedHealthcare,Individual & Family,374.12,94,,percent of total billed charges,,
PROCAINAMIDE 100 MG/ML IV SYRG,,J2690,HCPCS,Facility,Outpatient,10,mL,,398,338.3,114.0668,398,UnitedHealthcare,Medicare Advantage,195.02,49,,percent of total billed charges,,
PROCAINAMIDE 100 MG/ML IV SYRG,,J2690,HCPCS,Facility,Inpatient,10,mL,,398,338.3,114.0668,398,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
PROCAINAMIDE 100 MG/ML IV SYRG,,J2690,HCPCS,Facility,Outpatient,10,mL,,398,338.3,114.0668,398,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,191.04,48,,percent of total billed charges,,100% of DHS outpatient percentage
PROCAINAMIDE 100 MG/ML IV SYRG,,J2690,HCPCS,Facility,Inpatient,10,mL,,398,338.3,114.0668,398,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
NEOSTIGMINE METHYLSULFATE 1 MG/ML IV SOLN,,J2710,HCPCS,Facility,Both,10,mL,,98,83.3,28.0868,98,Aetna,Commercial,90.16,92,,percent of total billed charges,,
NEOSTIGMINE METHYLSULFATE 1 MG/ML IV SOLN,,J2710,HCPCS,Facility,Outpatient,10,mL,,98,83.3,28.0868,98,Aetna,Medicare Advantage,48.02,49,,percent of total billed charges,,
NEOSTIGMINE METHYLSULFATE 1 MG/ML IV SOLN,,J2710,HCPCS,Facility,Inpatient,10,mL,,98,83.3,28.0868,98,Aetna,Medicare Advantage,,,,,Included in per diem rate,
NEOSTIGMINE METHYLSULFATE 1 MG/ML IV SOLN,,J2710,HCPCS,Facility,Both,10,mL,,98,83.3,28.0868,98,Aetna,PPO,91.14,93,,percent of total billed charges,,
NEOSTIGMINE METHYLSULFATE 1 MG/ML IV SOLN,,J2710,HCPCS,Facility,Both,10,mL,,98,83.3,28.0868,98,America's PPO,America's PPO,94.1094,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
NEOSTIGMINE METHYLSULFATE 1 MG/ML IV SOLN,,J2710,HCPCS,Facility,Both,10,mL,,98,83.3,28.0868,98,BlueCross BlueShield Minnesota, Federal Employee Program,96.432,98.4,,percent of total billed charges,,
NEOSTIGMINE METHYLSULFATE 1 MG/ML IV SOLN,,J2710,HCPCS,Facility,Both,10,mL,,98,83.3,28.0868,98,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,98,100,,percent of total billed charges,,
NEOSTIGMINE METHYLSULFATE 1 MG/ML IV SOLN,,J2710,HCPCS,Facility,Both,10,mL,,98,83.3,28.0868,98,BlueCross BlueShield Minnesota,High Value Network Plan,88.2,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
NEOSTIGMINE METHYLSULFATE 1 MG/ML IV SOLN,,J2710,HCPCS,Facility,Outpatient,10,mL,,98,83.3,28.0868,98,BlueCross BlueShield Minnesota,Medicare Advantage,48.02,49,,percent of total billed charges,,
NEOSTIGMINE METHYLSULFATE 1 MG/ML IV SOLN,,J2710,HCPCS,Facility,Inpatient,10,mL,,98,83.3,28.0868,98,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
NEOSTIGMINE METHYLSULFATE 1 MG/ML IV SOLN,,J2710,HCPCS,Facility,Both,10,mL,,98,83.3,28.0868,98,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,86.7986,88.57,,percent of total billed charges,,
NEOSTIGMINE METHYLSULFATE 1 MG/ML IV SOLN,,J2710,HCPCS,Facility,Both,10,mL,,98,83.3,28.0868,98,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,28.0868,28.66,,percent of total billed charges,,
NEOSTIGMINE METHYLSULFATE 1 MG/ML IV SOLN,,J2710,HCPCS,Facility,Outpatient,10,mL,,98,83.3,28.0868,98,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),48.02,49,,percent of total billed charges,,
NEOSTIGMINE METHYLSULFATE 1 MG/ML IV SOLN,,J2710,HCPCS,Facility,Inpatient,10,mL,,98,83.3,28.0868,98,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
NEOSTIGMINE METHYLSULFATE 1 MG/ML IV SOLN,,J2710,HCPCS,Facility,Both,10,mL,,98,83.3,28.0868,98,CorVel,Worker's Compensation,98,100,,percent of total billed charges,,
NEOSTIGMINE METHYLSULFATE 1 MG/ML IV SOLN,,J2710,HCPCS,Facility,Both,10,mL,,98,83.3,28.0868,98,First Health Group Corporation,First Health Network,95.06,97,,percent of total billed charges,,
NEOSTIGMINE METHYLSULFATE 1 MG/ML IV SOLN,,J2710,HCPCS,Facility,Both,10,mL,,98,83.3,28.0868,98,"Health Partners, Inc.",Commercial,92.708,94.6,,percent of total billed charges,,
NEOSTIGMINE METHYLSULFATE 1 MG/ML IV SOLN,,J2710,HCPCS,Facility,Outpatient,10,mL,,98,83.3,28.0868,98,"Health Partners, Inc.",Medicare Advantage,48.02,49,,percent of total billed charges,,
NEOSTIGMINE METHYLSULFATE 1 MG/ML IV SOLN,,J2710,HCPCS,Facility,Inpatient,10,mL,,98,83.3,28.0868,98,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
NEOSTIGMINE METHYLSULFATE 1 MG/ML IV SOLN,,J2710,HCPCS,Facility,Both,10,mL,,98,83.3,28.0868,98,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),58.8,60,,percent of total billed charges,,
NEOSTIGMINE METHYLSULFATE 1 MG/ML IV SOLN,,J2710,HCPCS,Facility,Both,10,mL,,98,83.3,28.0868,98,"Health Partners, Inc.",State of Minnesota Advantage Program,79.87,81.5,,percent of total billed charges,,
NEOSTIGMINE METHYLSULFATE 1 MG/ML IV SOLN,,J2710,HCPCS,Facility,Both,10,mL,,98,83.3,28.0868,98,"Health Partners, Inc.",State Public Programs,49,50,,percent of total billed charges,,
NEOSTIGMINE METHYLSULFATE 1 MG/ML IV SOLN,,J2710,HCPCS,Facility,Both,10,mL,,98,83.3,28.0868,98,Humana Insurance Company,Commercial PPO,93.1,95,,percent of total billed charges,,
NEOSTIGMINE METHYLSULFATE 1 MG/ML IV SOLN,,J2710,HCPCS,Facility,Outpatient,10,mL,,98,83.3,28.0868,98,Humana Insurance Company,Medicare PPO,48.02,49,,percent of total billed charges,,
NEOSTIGMINE METHYLSULFATE 1 MG/ML IV SOLN,,J2710,HCPCS,Facility,Inpatient,10,mL,,98,83.3,28.0868,98,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
NEOSTIGMINE METHYLSULFATE 1 MG/ML IV SOLN,,J2710,HCPCS,Facility,Both,10,mL,,98,83.3,28.0868,98,Medica,Individual & Family,97.118,99.1,,percent of total billed charges,,
NEOSTIGMINE METHYLSULFATE 1 MG/ML IV SOLN,,J2710,HCPCS,Facility,Outpatient,10,mL,,98,83.3,28.0868,98,Medica,Medica Advantage Solution,48.804,49.8,,percent of total billed charges,,
NEOSTIGMINE METHYLSULFATE 1 MG/ML IV SOLN,,J2710,HCPCS,Facility,Inpatient,10,mL,,98,83.3,28.0868,98,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
NEOSTIGMINE METHYLSULFATE 1 MG/ML IV SOLN,,J2710,HCPCS,Facility,Outpatient,10,mL,,98,83.3,28.0868,98,Medica,Medical Assistance,43.708,44.6,,percent of total billed charges,,
NEOSTIGMINE METHYLSULFATE 1 MG/ML IV SOLN,,J2710,HCPCS,Facility,Inpatient,10,mL,,98,83.3,28.0868,98,Medica,Medical Assistance,,,,,Included in per diem rate,
NEOSTIGMINE METHYLSULFATE 1 MG/ML IV SOLN,,J2710,HCPCS,Facility,Outpatient,10,mL,,98,83.3,28.0868,98,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,48.804,49.8,,percent of total billed charges,,
NEOSTIGMINE METHYLSULFATE 1 MG/ML IV SOLN,,J2710,HCPCS,Facility,Inpatient,10,mL,,98,83.3,28.0868,98,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
NEOSTIGMINE METHYLSULFATE 1 MG/ML IV SOLN,,J2710,HCPCS,Facility,Both,10,mL,,98,83.3,28.0868,98,"Multiplan, Inc.","Multiplan, Inc.",92.12,94,,percent of total billed charges,,
NEOSTIGMINE METHYLSULFATE 1 MG/ML IV SOLN,,J2710,HCPCS,Facility,Outpatient,10,mL,,98,83.3,28.0868,98,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,88.298,90.1,,percent of total billed charges,,
NEOSTIGMINE METHYLSULFATE 1 MG/ML IV SOLN,,J2710,HCPCS,Facility,Inpatient,10,mL,,98,83.3,28.0868,98,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
NEOSTIGMINE METHYLSULFATE 1 MG/ML IV SOLN,,J2710,HCPCS,Facility,Both,10,mL,,98,83.3,28.0868,98,"Preferred One Administrative Services, INC.",PPO,96.628,98.6,,percent of total billed charges,,
NEOSTIGMINE METHYLSULFATE 1 MG/ML IV SOLN,,J2710,HCPCS,Facility,Outpatient,10,mL,,98,83.3,28.0868,98,PrimeWest Health,Minnesota Senior Health Options (MSHO),50.421,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
NEOSTIGMINE METHYLSULFATE 1 MG/ML IV SOLN,,J2710,HCPCS,Facility,Inpatient,10,mL,,98,83.3,28.0868,98,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
NEOSTIGMINE METHYLSULFATE 1 MG/ML IV SOLN,,J2710,HCPCS,Facility,Outpatient,10,mL,,98,83.3,28.0868,98,PrimeWest Health,MinnesotaCare,50.3328,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
NEOSTIGMINE METHYLSULFATE 1 MG/ML IV SOLN,,J2710,HCPCS,Facility,Inpatient,10,mL,,98,83.3,28.0868,98,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
NEOSTIGMINE METHYLSULFATE 1 MG/ML IV SOLN,,J2710,HCPCS,Facility,Both,10,mL,,98,83.3,28.0868,98,Sanford Health Plan,Sanford Health Plan,90.16,92,,percent of total billed charges,,
NEOSTIGMINE METHYLSULFATE 1 MG/ML IV SOLN,,J2710,HCPCS,Facility,Outpatient,10,mL,,98,83.3,28.0868,98,"UCare Health, Inc.",Individual & Family Plan,55.223,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
NEOSTIGMINE METHYLSULFATE 1 MG/ML IV SOLN,,J2710,HCPCS,Facility,Inpatient,10,mL,,98,83.3,28.0868,98,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
NEOSTIGMINE METHYLSULFATE 1 MG/ML IV SOLN,,J2710,HCPCS,Facility,Outpatient,10,mL,,98,83.3,28.0868,98,"UCare Health, Inc.",Medical Assistance,49.4606,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
NEOSTIGMINE METHYLSULFATE 1 MG/ML IV SOLN,,J2710,HCPCS,Facility,Inpatient,10,mL,,98,83.3,28.0868,98,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
NEOSTIGMINE METHYLSULFATE 1 MG/ML IV SOLN,,J2710,HCPCS,Facility,Outpatient,10,mL,,98,83.3,28.0868,98,"UCare Health, Inc.",Medicare Advantage,49.4606,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
NEOSTIGMINE METHYLSULFATE 1 MG/ML IV SOLN,,J2710,HCPCS,Facility,Inpatient,10,mL,,98,83.3,28.0868,98,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
NEOSTIGMINE METHYLSULFATE 1 MG/ML IV SOLN,,J2710,HCPCS,Facility,Outpatient,10,mL,,98,83.3,28.0868,98,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),49.4606,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
NEOSTIGMINE METHYLSULFATE 1 MG/ML IV SOLN,,J2710,HCPCS,Facility,Inpatient,10,mL,,98,83.3,28.0868,98,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
NEOSTIGMINE METHYLSULFATE 1 MG/ML IV SOLN,,J2710,HCPCS,Facility,Both,10,mL,,98,83.3,28.0868,98,UnitedHealthcare,Individual & Family,92.12,94,,percent of total billed charges,,
NEOSTIGMINE METHYLSULFATE 1 MG/ML IV SOLN,,J2710,HCPCS,Facility,Outpatient,10,mL,,98,83.3,28.0868,98,UnitedHealthcare,Medicare Advantage,48.02,49,,percent of total billed charges,,
NEOSTIGMINE METHYLSULFATE 1 MG/ML IV SOLN,,J2710,HCPCS,Facility,Inpatient,10,mL,,98,83.3,28.0868,98,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
NEOSTIGMINE METHYLSULFATE 1 MG/ML IV SOLN,,J2710,HCPCS,Facility,Outpatient,10,mL,,98,83.3,28.0868,98,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,47.04,48,,percent of total billed charges,,100% of DHS outpatient percentage
NEOSTIGMINE METHYLSULFATE 1 MG/ML IV SOLN,,J2710,HCPCS,Facility,Inpatient,10,mL,,98,83.3,28.0868,98,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
ROPIVACAINE (PF) 2 MG/ML (0.2 %) INJ SOLN,,J2795,HCPCS,Facility,Both,10,mL,,11,9.35,3.1526,11,Aetna,Commercial,10.12,92,,percent of total billed charges,,
ROPIVACAINE (PF) 2 MG/ML (0.2 %) INJ SOLN,,J2795,HCPCS,Facility,Outpatient,10,mL,,11,9.35,3.1526,11,Aetna,Medicare Advantage,5.39,49,,percent of total billed charges,,
ROPIVACAINE (PF) 2 MG/ML (0.2 %) INJ SOLN,,J2795,HCPCS,Facility,Inpatient,10,mL,,11,9.35,3.1526,11,Aetna,Medicare Advantage,,,,,Included in per diem rate,
ROPIVACAINE (PF) 2 MG/ML (0.2 %) INJ SOLN,,J2795,HCPCS,Facility,Both,10,mL,,11,9.35,3.1526,11,Aetna,PPO,10.23,93,,percent of total billed charges,,
ROPIVACAINE (PF) 2 MG/ML (0.2 %) INJ SOLN,,J2795,HCPCS,Facility,Both,10,mL,,11,9.35,3.1526,11,America's PPO,America's PPO,10.5633,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
ROPIVACAINE (PF) 2 MG/ML (0.2 %) INJ SOLN,,J2795,HCPCS,Facility,Both,10,mL,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota, Federal Employee Program,10.824,98.4,,percent of total billed charges,,
ROPIVACAINE (PF) 2 MG/ML (0.2 %) INJ SOLN,,J2795,HCPCS,Facility,Both,10,mL,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,11,100,,percent of total billed charges,,
ROPIVACAINE (PF) 2 MG/ML (0.2 %) INJ SOLN,,J2795,HCPCS,Facility,Both,10,mL,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,High Value Network Plan,9.9,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
ROPIVACAINE (PF) 2 MG/ML (0.2 %) INJ SOLN,,J2795,HCPCS,Facility,Outpatient,10,mL,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,Medicare Advantage,5.39,49,,percent of total billed charges,,
ROPIVACAINE (PF) 2 MG/ML (0.2 %) INJ SOLN,,J2795,HCPCS,Facility,Inpatient,10,mL,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
ROPIVACAINE (PF) 2 MG/ML (0.2 %) INJ SOLN,,J2795,HCPCS,Facility,Both,10,mL,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,9.7427,88.57,,percent of total billed charges,,
ROPIVACAINE (PF) 2 MG/ML (0.2 %) INJ SOLN,,J2795,HCPCS,Facility,Both,10,mL,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,3.1526,28.66,,percent of total billed charges,,
ROPIVACAINE (PF) 2 MG/ML (0.2 %) INJ SOLN,,J2795,HCPCS,Facility,Outpatient,10,mL,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),5.39,49,,percent of total billed charges,,
ROPIVACAINE (PF) 2 MG/ML (0.2 %) INJ SOLN,,J2795,HCPCS,Facility,Inpatient,10,mL,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
ROPIVACAINE (PF) 2 MG/ML (0.2 %) INJ SOLN,,J2795,HCPCS,Facility,Both,10,mL,,11,9.35,3.1526,11,CorVel,Worker's Compensation,11,100,,percent of total billed charges,,
ROPIVACAINE (PF) 2 MG/ML (0.2 %) INJ SOLN,,J2795,HCPCS,Facility,Both,10,mL,,11,9.35,3.1526,11,First Health Group Corporation,First Health Network,10.67,97,,percent of total billed charges,,
ROPIVACAINE (PF) 2 MG/ML (0.2 %) INJ SOLN,,J2795,HCPCS,Facility,Both,10,mL,,11,9.35,3.1526,11,"Health Partners, Inc.",Commercial,10.406,94.6,,percent of total billed charges,,
ROPIVACAINE (PF) 2 MG/ML (0.2 %) INJ SOLN,,J2795,HCPCS,Facility,Outpatient,10,mL,,11,9.35,3.1526,11,"Health Partners, Inc.",Medicare Advantage,5.39,49,,percent of total billed charges,,
ROPIVACAINE (PF) 2 MG/ML (0.2 %) INJ SOLN,,J2795,HCPCS,Facility,Inpatient,10,mL,,11,9.35,3.1526,11,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ROPIVACAINE (PF) 2 MG/ML (0.2 %) INJ SOLN,,J2795,HCPCS,Facility,Both,10,mL,,11,9.35,3.1526,11,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),6.6,60,,percent of total billed charges,,
ROPIVACAINE (PF) 2 MG/ML (0.2 %) INJ SOLN,,J2795,HCPCS,Facility,Both,10,mL,,11,9.35,3.1526,11,"Health Partners, Inc.",State of Minnesota Advantage Program,8.965,81.5,,percent of total billed charges,,
ROPIVACAINE (PF) 2 MG/ML (0.2 %) INJ SOLN,,J2795,HCPCS,Facility,Both,10,mL,,11,9.35,3.1526,11,"Health Partners, Inc.",State Public Programs,5.5,50,,percent of total billed charges,,
ROPIVACAINE (PF) 2 MG/ML (0.2 %) INJ SOLN,,J2795,HCPCS,Facility,Both,10,mL,,11,9.35,3.1526,11,Humana Insurance Company,Commercial PPO,10.45,95,,percent of total billed charges,,
ROPIVACAINE (PF) 2 MG/ML (0.2 %) INJ SOLN,,J2795,HCPCS,Facility,Outpatient,10,mL,,11,9.35,3.1526,11,Humana Insurance Company,Medicare PPO,5.39,49,,percent of total billed charges,,
ROPIVACAINE (PF) 2 MG/ML (0.2 %) INJ SOLN,,J2795,HCPCS,Facility,Inpatient,10,mL,,11,9.35,3.1526,11,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
ROPIVACAINE (PF) 2 MG/ML (0.2 %) INJ SOLN,,J2795,HCPCS,Facility,Both,10,mL,,11,9.35,3.1526,11,Medica,Individual & Family,10.901,99.1,,percent of total billed charges,,
ROPIVACAINE (PF) 2 MG/ML (0.2 %) INJ SOLN,,J2795,HCPCS,Facility,Outpatient,10,mL,,11,9.35,3.1526,11,Medica,Medica Advantage Solution,5.478,49.8,,percent of total billed charges,,
ROPIVACAINE (PF) 2 MG/ML (0.2 %) INJ SOLN,,J2795,HCPCS,Facility,Inpatient,10,mL,,11,9.35,3.1526,11,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
ROPIVACAINE (PF) 2 MG/ML (0.2 %) INJ SOLN,,J2795,HCPCS,Facility,Outpatient,10,mL,,11,9.35,3.1526,11,Medica,Medical Assistance,4.906,44.6,,percent of total billed charges,,
ROPIVACAINE (PF) 2 MG/ML (0.2 %) INJ SOLN,,J2795,HCPCS,Facility,Inpatient,10,mL,,11,9.35,3.1526,11,Medica,Medical Assistance,,,,,Included in per diem rate,
ROPIVACAINE (PF) 2 MG/ML (0.2 %) INJ SOLN,,J2795,HCPCS,Facility,Outpatient,10,mL,,11,9.35,3.1526,11,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,5.478,49.8,,percent of total billed charges,,
ROPIVACAINE (PF) 2 MG/ML (0.2 %) INJ SOLN,,J2795,HCPCS,Facility,Inpatient,10,mL,,11,9.35,3.1526,11,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
ROPIVACAINE (PF) 2 MG/ML (0.2 %) INJ SOLN,,J2795,HCPCS,Facility,Both,10,mL,,11,9.35,3.1526,11,"Multiplan, Inc.","Multiplan, Inc.",10.34,94,,percent of total billed charges,,
ROPIVACAINE (PF) 2 MG/ML (0.2 %) INJ SOLN,,J2795,HCPCS,Facility,Outpatient,10,mL,,11,9.35,3.1526,11,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,9.911,90.1,,percent of total billed charges,,
ROPIVACAINE (PF) 2 MG/ML (0.2 %) INJ SOLN,,J2795,HCPCS,Facility,Inpatient,10,mL,,11,9.35,3.1526,11,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
ROPIVACAINE (PF) 2 MG/ML (0.2 %) INJ SOLN,,J2795,HCPCS,Facility,Both,10,mL,,11,9.35,3.1526,11,"Preferred One Administrative Services, INC.",PPO,10.846,98.6,,percent of total billed charges,,
ROPIVACAINE (PF) 2 MG/ML (0.2 %) INJ SOLN,,J2795,HCPCS,Facility,Outpatient,10,mL,,11,9.35,3.1526,11,PrimeWest Health,Minnesota Senior Health Options (MSHO),5.6595,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
ROPIVACAINE (PF) 2 MG/ML (0.2 %) INJ SOLN,,J2795,HCPCS,Facility,Inpatient,10,mL,,11,9.35,3.1526,11,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ROPIVACAINE (PF) 2 MG/ML (0.2 %) INJ SOLN,,J2795,HCPCS,Facility,Outpatient,10,mL,,11,9.35,3.1526,11,PrimeWest Health,MinnesotaCare,5.6496,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
ROPIVACAINE (PF) 2 MG/ML (0.2 %) INJ SOLN,,J2795,HCPCS,Facility,Inpatient,10,mL,,11,9.35,3.1526,11,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
ROPIVACAINE (PF) 2 MG/ML (0.2 %) INJ SOLN,,J2795,HCPCS,Facility,Both,10,mL,,11,9.35,3.1526,11,Sanford Health Plan,Sanford Health Plan,10.12,92,,percent of total billed charges,,
ROPIVACAINE (PF) 2 MG/ML (0.2 %) INJ SOLN,,J2795,HCPCS,Facility,Outpatient,10,mL,,11,9.35,3.1526,11,"UCare Health, Inc.",Individual & Family Plan,6.1985,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
ROPIVACAINE (PF) 2 MG/ML (0.2 %) INJ SOLN,,J2795,HCPCS,Facility,Inpatient,10,mL,,11,9.35,3.1526,11,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
ROPIVACAINE (PF) 2 MG/ML (0.2 %) INJ SOLN,,J2795,HCPCS,Facility,Outpatient,10,mL,,11,9.35,3.1526,11,"UCare Health, Inc.",Medical Assistance,5.5517,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ROPIVACAINE (PF) 2 MG/ML (0.2 %) INJ SOLN,,J2795,HCPCS,Facility,Inpatient,10,mL,,11,9.35,3.1526,11,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
ROPIVACAINE (PF) 2 MG/ML (0.2 %) INJ SOLN,,J2795,HCPCS,Facility,Outpatient,10,mL,,11,9.35,3.1526,11,"UCare Health, Inc.",Medicare Advantage,5.5517,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ROPIVACAINE (PF) 2 MG/ML (0.2 %) INJ SOLN,,J2795,HCPCS,Facility,Inpatient,10,mL,,11,9.35,3.1526,11,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ROPIVACAINE (PF) 2 MG/ML (0.2 %) INJ SOLN,,J2795,HCPCS,Facility,Outpatient,10,mL,,11,9.35,3.1526,11,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),5.5517,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ROPIVACAINE (PF) 2 MG/ML (0.2 %) INJ SOLN,,J2795,HCPCS,Facility,Inpatient,10,mL,,11,9.35,3.1526,11,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ROPIVACAINE (PF) 2 MG/ML (0.2 %) INJ SOLN,,J2795,HCPCS,Facility,Both,10,mL,,11,9.35,3.1526,11,UnitedHealthcare,Individual & Family,10.34,94,,percent of total billed charges,,
ROPIVACAINE (PF) 2 MG/ML (0.2 %) INJ SOLN,,J2795,HCPCS,Facility,Outpatient,10,mL,,11,9.35,3.1526,11,UnitedHealthcare,Medicare Advantage,5.39,49,,percent of total billed charges,,
ROPIVACAINE (PF) 2 MG/ML (0.2 %) INJ SOLN,,J2795,HCPCS,Facility,Inpatient,10,mL,,11,9.35,3.1526,11,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
ROPIVACAINE (PF) 2 MG/ML (0.2 %) INJ SOLN,,J2795,HCPCS,Facility,Outpatient,10,mL,,11,9.35,3.1526,11,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,5.28,48,,percent of total billed charges,,100% of DHS outpatient percentage
ROPIVACAINE (PF) 2 MG/ML (0.2 %) INJ SOLN,,J2795,HCPCS,Facility,Inpatient,10,mL,,11,9.35,3.1526,11,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJ SOLN,,J3475,HCPCS,Facility,Both,10,mL,,13,11.05,3.7258,13,Aetna,Commercial,11.96,92,,percent of total billed charges,,
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJ SOLN,,J3475,HCPCS,Facility,Outpatient,10,mL,,13,11.05,3.7258,13,Aetna,Medicare Advantage,6.37,49,,percent of total billed charges,,
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJ SOLN,,J3475,HCPCS,Facility,Inpatient,10,mL,,13,11.05,3.7258,13,Aetna,Medicare Advantage,,,,,Included in per diem rate,
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJ SOLN,,J3475,HCPCS,Facility,Both,10,mL,,13,11.05,3.7258,13,Aetna,PPO,12.09,93,,percent of total billed charges,,
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJ SOLN,,J3475,HCPCS,Facility,Both,10,mL,,13,11.05,3.7258,13,America's PPO,America's PPO,12.4839,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJ SOLN,,J3475,HCPCS,Facility,Both,10,mL,,13,11.05,3.7258,13,BlueCross BlueShield Minnesota, Federal Employee Program,12.792,98.4,,percent of total billed charges,,
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJ SOLN,,J3475,HCPCS,Facility,Both,10,mL,,13,11.05,3.7258,13,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,13,100,,percent of total billed charges,,
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJ SOLN,,J3475,HCPCS,Facility,Both,10,mL,,13,11.05,3.7258,13,BlueCross BlueShield Minnesota,High Value Network Plan,11.7,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJ SOLN,,J3475,HCPCS,Facility,Outpatient,10,mL,,13,11.05,3.7258,13,BlueCross BlueShield Minnesota,Medicare Advantage,6.37,49,,percent of total billed charges,,
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJ SOLN,,J3475,HCPCS,Facility,Inpatient,10,mL,,13,11.05,3.7258,13,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJ SOLN,,J3475,HCPCS,Facility,Both,10,mL,,13,11.05,3.7258,13,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,11.5141,88.57,,percent of total billed charges,,
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJ SOLN,,J3475,HCPCS,Facility,Both,10,mL,,13,11.05,3.7258,13,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,3.7258,28.66,,percent of total billed charges,,
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJ SOLN,,J3475,HCPCS,Facility,Outpatient,10,mL,,13,11.05,3.7258,13,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),6.37,49,,percent of total billed charges,,
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJ SOLN,,J3475,HCPCS,Facility,Inpatient,10,mL,,13,11.05,3.7258,13,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJ SOLN,,J3475,HCPCS,Facility,Both,10,mL,,13,11.05,3.7258,13,CorVel,Worker's Compensation,13,100,,percent of total billed charges,,
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJ SOLN,,J3475,HCPCS,Facility,Both,10,mL,,13,11.05,3.7258,13,First Health Group Corporation,First Health Network,12.61,97,,percent of total billed charges,,
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJ SOLN,,J3475,HCPCS,Facility,Both,10,mL,,13,11.05,3.7258,13,"Health Partners, Inc.",Commercial,12.298,94.6,,percent of total billed charges,,
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJ SOLN,,J3475,HCPCS,Facility,Outpatient,10,mL,,13,11.05,3.7258,13,"Health Partners, Inc.",Medicare Advantage,6.37,49,,percent of total billed charges,,
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJ SOLN,,J3475,HCPCS,Facility,Inpatient,10,mL,,13,11.05,3.7258,13,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJ SOLN,,J3475,HCPCS,Facility,Both,10,mL,,13,11.05,3.7258,13,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),7.8,60,,percent of total billed charges,,
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJ SOLN,,J3475,HCPCS,Facility,Both,10,mL,,13,11.05,3.7258,13,"Health Partners, Inc.",State of Minnesota Advantage Program,10.595,81.5,,percent of total billed charges,,
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJ SOLN,,J3475,HCPCS,Facility,Both,10,mL,,13,11.05,3.7258,13,"Health Partners, Inc.",State Public Programs,6.5,50,,percent of total billed charges,,
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJ SOLN,,J3475,HCPCS,Facility,Both,10,mL,,13,11.05,3.7258,13,Humana Insurance Company,Commercial PPO,12.35,95,,percent of total billed charges,,
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJ SOLN,,J3475,HCPCS,Facility,Outpatient,10,mL,,13,11.05,3.7258,13,Humana Insurance Company,Medicare PPO,6.37,49,,percent of total billed charges,,
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJ SOLN,,J3475,HCPCS,Facility,Inpatient,10,mL,,13,11.05,3.7258,13,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJ SOLN,,J3475,HCPCS,Facility,Both,10,mL,,13,11.05,3.7258,13,Medica,Individual & Family,12.883,99.1,,percent of total billed charges,,
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJ SOLN,,J3475,HCPCS,Facility,Outpatient,10,mL,,13,11.05,3.7258,13,Medica,Medica Advantage Solution,6.474,49.8,,percent of total billed charges,,
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJ SOLN,,J3475,HCPCS,Facility,Inpatient,10,mL,,13,11.05,3.7258,13,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJ SOLN,,J3475,HCPCS,Facility,Outpatient,10,mL,,13,11.05,3.7258,13,Medica,Medical Assistance,5.798,44.6,,percent of total billed charges,,
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJ SOLN,,J3475,HCPCS,Facility,Inpatient,10,mL,,13,11.05,3.7258,13,Medica,Medical Assistance,,,,,Included in per diem rate,
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJ SOLN,,J3475,HCPCS,Facility,Outpatient,10,mL,,13,11.05,3.7258,13,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,6.474,49.8,,percent of total billed charges,,
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJ SOLN,,J3475,HCPCS,Facility,Inpatient,10,mL,,13,11.05,3.7258,13,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJ SOLN,,J3475,HCPCS,Facility,Both,10,mL,,13,11.05,3.7258,13,"Multiplan, Inc.","Multiplan, Inc.",12.22,94,,percent of total billed charges,,
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJ SOLN,,J3475,HCPCS,Facility,Outpatient,10,mL,,13,11.05,3.7258,13,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,11.713,90.1,,percent of total billed charges,,
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJ SOLN,,J3475,HCPCS,Facility,Inpatient,10,mL,,13,11.05,3.7258,13,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJ SOLN,,J3475,HCPCS,Facility,Both,10,mL,,13,11.05,3.7258,13,"Preferred One Administrative Services, INC.",PPO,12.818,98.6,,percent of total billed charges,,
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJ SOLN,,J3475,HCPCS,Facility,Outpatient,10,mL,,13,11.05,3.7258,13,PrimeWest Health,Minnesota Senior Health Options (MSHO),6.6885,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJ SOLN,,J3475,HCPCS,Facility,Inpatient,10,mL,,13,11.05,3.7258,13,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJ SOLN,,J3475,HCPCS,Facility,Outpatient,10,mL,,13,11.05,3.7258,13,PrimeWest Health,MinnesotaCare,6.6768,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJ SOLN,,J3475,HCPCS,Facility,Inpatient,10,mL,,13,11.05,3.7258,13,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJ SOLN,,J3475,HCPCS,Facility,Both,10,mL,,13,11.05,3.7258,13,Sanford Health Plan,Sanford Health Plan,11.96,92,,percent of total billed charges,,
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJ SOLN,,J3475,HCPCS,Facility,Outpatient,10,mL,,13,11.05,3.7258,13,"UCare Health, Inc.",Individual & Family Plan,7.3255,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJ SOLN,,J3475,HCPCS,Facility,Inpatient,10,mL,,13,11.05,3.7258,13,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJ SOLN,,J3475,HCPCS,Facility,Outpatient,10,mL,,13,11.05,3.7258,13,"UCare Health, Inc.",Medical Assistance,6.5611,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJ SOLN,,J3475,HCPCS,Facility,Inpatient,10,mL,,13,11.05,3.7258,13,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJ SOLN,,J3475,HCPCS,Facility,Outpatient,10,mL,,13,11.05,3.7258,13,"UCare Health, Inc.",Medicare Advantage,6.5611,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJ SOLN,,J3475,HCPCS,Facility,Inpatient,10,mL,,13,11.05,3.7258,13,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJ SOLN,,J3475,HCPCS,Facility,Outpatient,10,mL,,13,11.05,3.7258,13,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),6.5611,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJ SOLN,,J3475,HCPCS,Facility,Inpatient,10,mL,,13,11.05,3.7258,13,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJ SOLN,,J3475,HCPCS,Facility,Both,10,mL,,13,11.05,3.7258,13,UnitedHealthcare,Individual & Family,12.22,94,,percent of total billed charges,,
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJ SOLN,,J3475,HCPCS,Facility,Outpatient,10,mL,,13,11.05,3.7258,13,UnitedHealthcare,Medicare Advantage,6.37,49,,percent of total billed charges,,
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJ SOLN,,J3475,HCPCS,Facility,Inpatient,10,mL,,13,11.05,3.7258,13,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJ SOLN,,J3475,HCPCS,Facility,Outpatient,10,mL,,13,11.05,3.7258,13,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,6.24,48,,percent of total billed charges,,100% of DHS outpatient percentage
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJ SOLN,,J3475,HCPCS,Facility,Inpatient,10,mL,,13,11.05,3.7258,13,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJ SOLN (ADULT),,J3475,HCPCS,Facility,Both,10,mL,,11,9.35,3.1526,11,Aetna,Commercial,10.12,92,,percent of total billed charges,,
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJ SOLN (ADULT),,J3475,HCPCS,Facility,Outpatient,10,mL,,11,9.35,3.1526,11,Aetna,Medicare Advantage,5.39,49,,percent of total billed charges,,
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJ SOLN (ADULT),,J3475,HCPCS,Facility,Inpatient,10,mL,,11,9.35,3.1526,11,Aetna,Medicare Advantage,,,,,Included in per diem rate,
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJ SOLN (ADULT),,J3475,HCPCS,Facility,Both,10,mL,,11,9.35,3.1526,11,Aetna,PPO,10.23,93,,percent of total billed charges,,
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJ SOLN (ADULT),,J3475,HCPCS,Facility,Both,10,mL,,11,9.35,3.1526,11,America's PPO,America's PPO,10.5633,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJ SOLN (ADULT),,J3475,HCPCS,Facility,Both,10,mL,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota, Federal Employee Program,10.824,98.4,,percent of total billed charges,,
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJ SOLN (ADULT),,J3475,HCPCS,Facility,Both,10,mL,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,11,100,,percent of total billed charges,,
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJ SOLN (ADULT),,J3475,HCPCS,Facility,Both,10,mL,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,High Value Network Plan,9.9,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJ SOLN (ADULT),,J3475,HCPCS,Facility,Outpatient,10,mL,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,Medicare Advantage,5.39,49,,percent of total billed charges,,
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJ SOLN (ADULT),,J3475,HCPCS,Facility,Inpatient,10,mL,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJ SOLN (ADULT),,J3475,HCPCS,Facility,Both,10,mL,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,9.7427,88.57,,percent of total billed charges,,
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJ SOLN (ADULT),,J3475,HCPCS,Facility,Both,10,mL,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,3.1526,28.66,,percent of total billed charges,,
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJ SOLN (ADULT),,J3475,HCPCS,Facility,Outpatient,10,mL,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),5.39,49,,percent of total billed charges,,
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJ SOLN (ADULT),,J3475,HCPCS,Facility,Inpatient,10,mL,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJ SOLN (ADULT),,J3475,HCPCS,Facility,Both,10,mL,,11,9.35,3.1526,11,CorVel,Worker's Compensation,11,100,,percent of total billed charges,,
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJ SOLN (ADULT),,J3475,HCPCS,Facility,Both,10,mL,,11,9.35,3.1526,11,First Health Group Corporation,First Health Network,10.67,97,,percent of total billed charges,,
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJ SOLN (ADULT),,J3475,HCPCS,Facility,Both,10,mL,,11,9.35,3.1526,11,"Health Partners, Inc.",Commercial,10.406,94.6,,percent of total billed charges,,
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJ SOLN (ADULT),,J3475,HCPCS,Facility,Outpatient,10,mL,,11,9.35,3.1526,11,"Health Partners, Inc.",Medicare Advantage,5.39,49,,percent of total billed charges,,
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJ SOLN (ADULT),,J3475,HCPCS,Facility,Inpatient,10,mL,,11,9.35,3.1526,11,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJ SOLN (ADULT),,J3475,HCPCS,Facility,Both,10,mL,,11,9.35,3.1526,11,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),6.6,60,,percent of total billed charges,,
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJ SOLN (ADULT),,J3475,HCPCS,Facility,Both,10,mL,,11,9.35,3.1526,11,"Health Partners, Inc.",State of Minnesota Advantage Program,8.965,81.5,,percent of total billed charges,,
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJ SOLN (ADULT),,J3475,HCPCS,Facility,Both,10,mL,,11,9.35,3.1526,11,"Health Partners, Inc.",State Public Programs,5.5,50,,percent of total billed charges,,
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJ SOLN (ADULT),,J3475,HCPCS,Facility,Both,10,mL,,11,9.35,3.1526,11,Humana Insurance Company,Commercial PPO,10.45,95,,percent of total billed charges,,
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJ SOLN (ADULT),,J3475,HCPCS,Facility,Outpatient,10,mL,,11,9.35,3.1526,11,Humana Insurance Company,Medicare PPO,5.39,49,,percent of total billed charges,,
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJ SOLN (ADULT),,J3475,HCPCS,Facility,Inpatient,10,mL,,11,9.35,3.1526,11,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJ SOLN (ADULT),,J3475,HCPCS,Facility,Both,10,mL,,11,9.35,3.1526,11,Medica,Individual & Family,10.901,99.1,,percent of total billed charges,,
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJ SOLN (ADULT),,J3475,HCPCS,Facility,Outpatient,10,mL,,11,9.35,3.1526,11,Medica,Medica Advantage Solution,5.478,49.8,,percent of total billed charges,,
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJ SOLN (ADULT),,J3475,HCPCS,Facility,Inpatient,10,mL,,11,9.35,3.1526,11,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJ SOLN (ADULT),,J3475,HCPCS,Facility,Outpatient,10,mL,,11,9.35,3.1526,11,Medica,Medical Assistance,4.906,44.6,,percent of total billed charges,,
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJ SOLN (ADULT),,J3475,HCPCS,Facility,Inpatient,10,mL,,11,9.35,3.1526,11,Medica,Medical Assistance,,,,,Included in per diem rate,
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJ SOLN (ADULT),,J3475,HCPCS,Facility,Outpatient,10,mL,,11,9.35,3.1526,11,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,5.478,49.8,,percent of total billed charges,,
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJ SOLN (ADULT),,J3475,HCPCS,Facility,Inpatient,10,mL,,11,9.35,3.1526,11,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJ SOLN (ADULT),,J3475,HCPCS,Facility,Both,10,mL,,11,9.35,3.1526,11,"Multiplan, Inc.","Multiplan, Inc.",10.34,94,,percent of total billed charges,,
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJ SOLN (ADULT),,J3475,HCPCS,Facility,Outpatient,10,mL,,11,9.35,3.1526,11,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,9.911,90.1,,percent of total billed charges,,
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJ SOLN (ADULT),,J3475,HCPCS,Facility,Inpatient,10,mL,,11,9.35,3.1526,11,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJ SOLN (ADULT),,J3475,HCPCS,Facility,Both,10,mL,,11,9.35,3.1526,11,"Preferred One Administrative Services, INC.",PPO,10.846,98.6,,percent of total billed charges,,
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJ SOLN (ADULT),,J3475,HCPCS,Facility,Outpatient,10,mL,,11,9.35,3.1526,11,PrimeWest Health,Minnesota Senior Health Options (MSHO),5.6595,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJ SOLN (ADULT),,J3475,HCPCS,Facility,Inpatient,10,mL,,11,9.35,3.1526,11,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJ SOLN (ADULT),,J3475,HCPCS,Facility,Outpatient,10,mL,,11,9.35,3.1526,11,PrimeWest Health,MinnesotaCare,5.6496,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJ SOLN (ADULT),,J3475,HCPCS,Facility,Inpatient,10,mL,,11,9.35,3.1526,11,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJ SOLN (ADULT),,J3475,HCPCS,Facility,Both,10,mL,,11,9.35,3.1526,11,Sanford Health Plan,Sanford Health Plan,10.12,92,,percent of total billed charges,,
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJ SOLN (ADULT),,J3475,HCPCS,Facility,Outpatient,10,mL,,11,9.35,3.1526,11,"UCare Health, Inc.",Individual & Family Plan,6.1985,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJ SOLN (ADULT),,J3475,HCPCS,Facility,Inpatient,10,mL,,11,9.35,3.1526,11,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJ SOLN (ADULT),,J3475,HCPCS,Facility,Outpatient,10,mL,,11,9.35,3.1526,11,"UCare Health, Inc.",Medical Assistance,5.5517,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJ SOLN (ADULT),,J3475,HCPCS,Facility,Inpatient,10,mL,,11,9.35,3.1526,11,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJ SOLN (ADULT),,J3475,HCPCS,Facility,Outpatient,10,mL,,11,9.35,3.1526,11,"UCare Health, Inc.",Medicare Advantage,5.5517,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJ SOLN (ADULT),,J3475,HCPCS,Facility,Inpatient,10,mL,,11,9.35,3.1526,11,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJ SOLN (ADULT),,J3475,HCPCS,Facility,Outpatient,10,mL,,11,9.35,3.1526,11,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),5.5517,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJ SOLN (ADULT),,J3475,HCPCS,Facility,Inpatient,10,mL,,11,9.35,3.1526,11,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJ SOLN (ADULT),,J3475,HCPCS,Facility,Both,10,mL,,11,9.35,3.1526,11,UnitedHealthcare,Individual & Family,10.34,94,,percent of total billed charges,,
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJ SOLN (ADULT),,J3475,HCPCS,Facility,Outpatient,10,mL,,11,9.35,3.1526,11,UnitedHealthcare,Medicare Advantage,5.39,49,,percent of total billed charges,,
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJ SOLN (ADULT),,J3475,HCPCS,Facility,Inpatient,10,mL,,11,9.35,3.1526,11,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJ SOLN (ADULT),,J3475,HCPCS,Facility,Outpatient,10,mL,,11,9.35,3.1526,11,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,5.28,48,,percent of total billed charges,,100% of DHS outpatient percentage
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJ SOLN (ADULT),,J3475,HCPCS,Facility,Inpatient,10,mL,,11,9.35,3.1526,11,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJ SOLN (PEDS 2 GM MAX),,J3475,HCPCS,Facility,Both,10,mL,,11,9.35,3.1526,11,Aetna,Commercial,10.12,92,,percent of total billed charges,,
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJ SOLN (PEDS 2 GM MAX),,J3475,HCPCS,Facility,Outpatient,10,mL,,11,9.35,3.1526,11,Aetna,Medicare Advantage,5.39,49,,percent of total billed charges,,
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJ SOLN (PEDS 2 GM MAX),,J3475,HCPCS,Facility,Inpatient,10,mL,,11,9.35,3.1526,11,Aetna,Medicare Advantage,,,,,Included in per diem rate,
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJ SOLN (PEDS 2 GM MAX),,J3475,HCPCS,Facility,Both,10,mL,,11,9.35,3.1526,11,Aetna,PPO,10.23,93,,percent of total billed charges,,
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJ SOLN (PEDS 2 GM MAX),,J3475,HCPCS,Facility,Both,10,mL,,11,9.35,3.1526,11,America's PPO,America's PPO,10.5633,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJ SOLN (PEDS 2 GM MAX),,J3475,HCPCS,Facility,Both,10,mL,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota, Federal Employee Program,10.824,98.4,,percent of total billed charges,,
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJ SOLN (PEDS 2 GM MAX),,J3475,HCPCS,Facility,Both,10,mL,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,11,100,,percent of total billed charges,,
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJ SOLN (PEDS 2 GM MAX),,J3475,HCPCS,Facility,Both,10,mL,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,High Value Network Plan,9.9,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJ SOLN (PEDS 2 GM MAX),,J3475,HCPCS,Facility,Outpatient,10,mL,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,Medicare Advantage,5.39,49,,percent of total billed charges,,
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJ SOLN (PEDS 2 GM MAX),,J3475,HCPCS,Facility,Inpatient,10,mL,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJ SOLN (PEDS 2 GM MAX),,J3475,HCPCS,Facility,Both,10,mL,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,9.7427,88.57,,percent of total billed charges,,
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJ SOLN (PEDS 2 GM MAX),,J3475,HCPCS,Facility,Both,10,mL,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,3.1526,28.66,,percent of total billed charges,,
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJ SOLN (PEDS 2 GM MAX),,J3475,HCPCS,Facility,Outpatient,10,mL,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),5.39,49,,percent of total billed charges,,
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJ SOLN (PEDS 2 GM MAX),,J3475,HCPCS,Facility,Inpatient,10,mL,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJ SOLN (PEDS 2 GM MAX),,J3475,HCPCS,Facility,Both,10,mL,,11,9.35,3.1526,11,CorVel,Worker's Compensation,11,100,,percent of total billed charges,,
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJ SOLN (PEDS 2 GM MAX),,J3475,HCPCS,Facility,Both,10,mL,,11,9.35,3.1526,11,First Health Group Corporation,First Health Network,10.67,97,,percent of total billed charges,,
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJ SOLN (PEDS 2 GM MAX),,J3475,HCPCS,Facility,Both,10,mL,,11,9.35,3.1526,11,"Health Partners, Inc.",Commercial,10.406,94.6,,percent of total billed charges,,
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJ SOLN (PEDS 2 GM MAX),,J3475,HCPCS,Facility,Outpatient,10,mL,,11,9.35,3.1526,11,"Health Partners, Inc.",Medicare Advantage,5.39,49,,percent of total billed charges,,
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJ SOLN (PEDS 2 GM MAX),,J3475,HCPCS,Facility,Inpatient,10,mL,,11,9.35,3.1526,11,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJ SOLN (PEDS 2 GM MAX),,J3475,HCPCS,Facility,Both,10,mL,,11,9.35,3.1526,11,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),6.6,60,,percent of total billed charges,,
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJ SOLN (PEDS 2 GM MAX),,J3475,HCPCS,Facility,Both,10,mL,,11,9.35,3.1526,11,"Health Partners, Inc.",State of Minnesota Advantage Program,8.965,81.5,,percent of total billed charges,,
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJ SOLN (PEDS 2 GM MAX),,J3475,HCPCS,Facility,Both,10,mL,,11,9.35,3.1526,11,"Health Partners, Inc.",State Public Programs,5.5,50,,percent of total billed charges,,
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJ SOLN (PEDS 2 GM MAX),,J3475,HCPCS,Facility,Both,10,mL,,11,9.35,3.1526,11,Humana Insurance Company,Commercial PPO,10.45,95,,percent of total billed charges,,
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJ SOLN (PEDS 2 GM MAX),,J3475,HCPCS,Facility,Outpatient,10,mL,,11,9.35,3.1526,11,Humana Insurance Company,Medicare PPO,5.39,49,,percent of total billed charges,,
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJ SOLN (PEDS 2 GM MAX),,J3475,HCPCS,Facility,Inpatient,10,mL,,11,9.35,3.1526,11,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJ SOLN (PEDS 2 GM MAX),,J3475,HCPCS,Facility,Both,10,mL,,11,9.35,3.1526,11,Medica,Individual & Family,10.901,99.1,,percent of total billed charges,,
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJ SOLN (PEDS 2 GM MAX),,J3475,HCPCS,Facility,Outpatient,10,mL,,11,9.35,3.1526,11,Medica,Medica Advantage Solution,5.478,49.8,,percent of total billed charges,,
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJ SOLN (PEDS 2 GM MAX),,J3475,HCPCS,Facility,Inpatient,10,mL,,11,9.35,3.1526,11,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJ SOLN (PEDS 2 GM MAX),,J3475,HCPCS,Facility,Outpatient,10,mL,,11,9.35,3.1526,11,Medica,Medical Assistance,4.906,44.6,,percent of total billed charges,,
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJ SOLN (PEDS 2 GM MAX),,J3475,HCPCS,Facility,Inpatient,10,mL,,11,9.35,3.1526,11,Medica,Medical Assistance,,,,,Included in per diem rate,
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJ SOLN (PEDS 2 GM MAX),,J3475,HCPCS,Facility,Outpatient,10,mL,,11,9.35,3.1526,11,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,5.478,49.8,,percent of total billed charges,,
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJ SOLN (PEDS 2 GM MAX),,J3475,HCPCS,Facility,Inpatient,10,mL,,11,9.35,3.1526,11,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJ SOLN (PEDS 2 GM MAX),,J3475,HCPCS,Facility,Both,10,mL,,11,9.35,3.1526,11,"Multiplan, Inc.","Multiplan, Inc.",10.34,94,,percent of total billed charges,,
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJ SOLN (PEDS 2 GM MAX),,J3475,HCPCS,Facility,Outpatient,10,mL,,11,9.35,3.1526,11,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,9.911,90.1,,percent of total billed charges,,
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJ SOLN (PEDS 2 GM MAX),,J3475,HCPCS,Facility,Inpatient,10,mL,,11,9.35,3.1526,11,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJ SOLN (PEDS 2 GM MAX),,J3475,HCPCS,Facility,Both,10,mL,,11,9.35,3.1526,11,"Preferred One Administrative Services, INC.",PPO,10.846,98.6,,percent of total billed charges,,
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJ SOLN (PEDS 2 GM MAX),,J3475,HCPCS,Facility,Outpatient,10,mL,,11,9.35,3.1526,11,PrimeWest Health,Minnesota Senior Health Options (MSHO),5.6595,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJ SOLN (PEDS 2 GM MAX),,J3475,HCPCS,Facility,Inpatient,10,mL,,11,9.35,3.1526,11,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJ SOLN (PEDS 2 GM MAX),,J3475,HCPCS,Facility,Outpatient,10,mL,,11,9.35,3.1526,11,PrimeWest Health,MinnesotaCare,5.6496,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJ SOLN (PEDS 2 GM MAX),,J3475,HCPCS,Facility,Inpatient,10,mL,,11,9.35,3.1526,11,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJ SOLN (PEDS 2 GM MAX),,J3475,HCPCS,Facility,Both,10,mL,,11,9.35,3.1526,11,Sanford Health Plan,Sanford Health Plan,10.12,92,,percent of total billed charges,,
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJ SOLN (PEDS 2 GM MAX),,J3475,HCPCS,Facility,Outpatient,10,mL,,11,9.35,3.1526,11,"UCare Health, Inc.",Individual & Family Plan,6.1985,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJ SOLN (PEDS 2 GM MAX),,J3475,HCPCS,Facility,Inpatient,10,mL,,11,9.35,3.1526,11,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJ SOLN (PEDS 2 GM MAX),,J3475,HCPCS,Facility,Outpatient,10,mL,,11,9.35,3.1526,11,"UCare Health, Inc.",Medical Assistance,5.5517,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJ SOLN (PEDS 2 GM MAX),,J3475,HCPCS,Facility,Inpatient,10,mL,,11,9.35,3.1526,11,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJ SOLN (PEDS 2 GM MAX),,J3475,HCPCS,Facility,Outpatient,10,mL,,11,9.35,3.1526,11,"UCare Health, Inc.",Medicare Advantage,5.5517,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJ SOLN (PEDS 2 GM MAX),,J3475,HCPCS,Facility,Inpatient,10,mL,,11,9.35,3.1526,11,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJ SOLN (PEDS 2 GM MAX),,J3475,HCPCS,Facility,Outpatient,10,mL,,11,9.35,3.1526,11,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),5.5517,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJ SOLN (PEDS 2 GM MAX),,J3475,HCPCS,Facility,Inpatient,10,mL,,11,9.35,3.1526,11,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJ SOLN (PEDS 2 GM MAX),,J3475,HCPCS,Facility,Both,10,mL,,11,9.35,3.1526,11,UnitedHealthcare,Individual & Family,10.34,94,,percent of total billed charges,,
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJ SOLN (PEDS 2 GM MAX),,J3475,HCPCS,Facility,Outpatient,10,mL,,11,9.35,3.1526,11,UnitedHealthcare,Medicare Advantage,5.39,49,,percent of total billed charges,,
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJ SOLN (PEDS 2 GM MAX),,J3475,HCPCS,Facility,Inpatient,10,mL,,11,9.35,3.1526,11,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJ SOLN (PEDS 2 GM MAX),,J3475,HCPCS,Facility,Outpatient,10,mL,,11,9.35,3.1526,11,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,5.28,48,,percent of total billed charges,,100% of DHS outpatient percentage
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJ SOLN (PEDS 2 GM MAX),,J3475,HCPCS,Facility,Inpatient,10,mL,,11,9.35,3.1526,11,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
POTASSIUM CHLORIDE 2 MEQ/ML IV SOLN,,J3480,HCPCS,Facility,Both,10,mL,,22,18.7,6.3052,22,Aetna,Commercial,20.24,92,,percent of total billed charges,,
POTASSIUM CHLORIDE 2 MEQ/ML IV SOLN,,J3480,HCPCS,Facility,Both,10,mL,,22,18.7,6.3052,22,Aetna,Commercial,20.24,92,,percent of total billed charges,,
POTASSIUM CHLORIDE 2 MEQ/ML IV SOLN,,J3480,HCPCS,Facility,Outpatient,10,mL,,22,18.7,6.3052,22,Aetna,Medicare Advantage,10.78,49,,percent of total billed charges,,
POTASSIUM CHLORIDE 2 MEQ/ML IV SOLN,,J3480,HCPCS,Facility,Outpatient,10,mL,,22,18.7,6.3052,22,Aetna,Medicare Advantage,10.78,49,,percent of total billed charges,,
POTASSIUM CHLORIDE 2 MEQ/ML IV SOLN,,J3480,HCPCS,Facility,Inpatient,10,mL,,22,18.7,6.3052,22,Aetna,Medicare Advantage,,,,,Included in per diem rate,
POTASSIUM CHLORIDE 2 MEQ/ML IV SOLN,,J3480,HCPCS,Facility,Inpatient,10,mL,,22,18.7,6.3052,22,Aetna,Medicare Advantage,,,,,Included in per diem rate,
POTASSIUM CHLORIDE 2 MEQ/ML IV SOLN,,J3480,HCPCS,Facility,Both,10,mL,,22,18.7,6.3052,22,Aetna,PPO,20.46,93,,percent of total billed charges,,
POTASSIUM CHLORIDE 2 MEQ/ML IV SOLN,,J3480,HCPCS,Facility,Both,10,mL,,22,18.7,6.3052,22,Aetna,PPO,20.46,93,,percent of total billed charges,,
POTASSIUM CHLORIDE 2 MEQ/ML IV SOLN,,J3480,HCPCS,Facility,Both,10,mL,,22,18.7,6.3052,22,America's PPO,America's PPO,21.1266,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
POTASSIUM CHLORIDE 2 MEQ/ML IV SOLN,,J3480,HCPCS,Facility,Both,10,mL,,22,18.7,6.3052,22,America's PPO,America's PPO,21.1266,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
POTASSIUM CHLORIDE 2 MEQ/ML IV SOLN,,J3480,HCPCS,Facility,Both,10,mL,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota, Federal Employee Program,21.648,98.4,,percent of total billed charges,,
POTASSIUM CHLORIDE 2 MEQ/ML IV SOLN,,J3480,HCPCS,Facility,Both,10,mL,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota, Federal Employee Program,21.648,98.4,,percent of total billed charges,,
POTASSIUM CHLORIDE 2 MEQ/ML IV SOLN,,J3480,HCPCS,Facility,Both,10,mL,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,22,100,,percent of total billed charges,,
POTASSIUM CHLORIDE 2 MEQ/ML IV SOLN,,J3480,HCPCS,Facility,Both,10,mL,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,22,100,,percent of total billed charges,,
POTASSIUM CHLORIDE 2 MEQ/ML IV SOLN,,J3480,HCPCS,Facility,Both,10,mL,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota,High Value Network Plan,19.8,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
POTASSIUM CHLORIDE 2 MEQ/ML IV SOLN,,J3480,HCPCS,Facility,Both,10,mL,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota,High Value Network Plan,19.8,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
POTASSIUM CHLORIDE 2 MEQ/ML IV SOLN,,J3480,HCPCS,Facility,Outpatient,10,mL,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota,Medicare Advantage,10.78,49,,percent of total billed charges,,
POTASSIUM CHLORIDE 2 MEQ/ML IV SOLN,,J3480,HCPCS,Facility,Outpatient,10,mL,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota,Medicare Advantage,10.78,49,,percent of total billed charges,,
POTASSIUM CHLORIDE 2 MEQ/ML IV SOLN,,J3480,HCPCS,Facility,Inpatient,10,mL,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
POTASSIUM CHLORIDE 2 MEQ/ML IV SOLN,,J3480,HCPCS,Facility,Inpatient,10,mL,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
POTASSIUM CHLORIDE 2 MEQ/ML IV SOLN,,J3480,HCPCS,Facility,Both,10,mL,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,19.4854,88.57,,percent of total billed charges,,
POTASSIUM CHLORIDE 2 MEQ/ML IV SOLN,,J3480,HCPCS,Facility,Both,10,mL,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,19.4854,88.57,,percent of total billed charges,,
POTASSIUM CHLORIDE 2 MEQ/ML IV SOLN,,J3480,HCPCS,Facility,Both,10,mL,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,6.3052,28.66,,percent of total billed charges,,
POTASSIUM CHLORIDE 2 MEQ/ML IV SOLN,,J3480,HCPCS,Facility,Both,10,mL,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,6.3052,28.66,,percent of total billed charges,,
POTASSIUM CHLORIDE 2 MEQ/ML IV SOLN,,J3480,HCPCS,Facility,Outpatient,10,mL,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),10.78,49,,percent of total billed charges,,
POTASSIUM CHLORIDE 2 MEQ/ML IV SOLN,,J3480,HCPCS,Facility,Outpatient,10,mL,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),10.78,49,,percent of total billed charges,,
POTASSIUM CHLORIDE 2 MEQ/ML IV SOLN,,J3480,HCPCS,Facility,Inpatient,10,mL,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
POTASSIUM CHLORIDE 2 MEQ/ML IV SOLN,,J3480,HCPCS,Facility,Inpatient,10,mL,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
POTASSIUM CHLORIDE 2 MEQ/ML IV SOLN,,J3480,HCPCS,Facility,Both,10,mL,,22,18.7,6.3052,22,CorVel,Worker's Compensation,22,100,,percent of total billed charges,,
POTASSIUM CHLORIDE 2 MEQ/ML IV SOLN,,J3480,HCPCS,Facility,Both,10,mL,,22,18.7,6.3052,22,CorVel,Worker's Compensation,22,100,,percent of total billed charges,,
POTASSIUM CHLORIDE 2 MEQ/ML IV SOLN,,J3480,HCPCS,Facility,Both,10,mL,,22,18.7,6.3052,22,First Health Group Corporation,First Health Network,21.34,97,,percent of total billed charges,,
POTASSIUM CHLORIDE 2 MEQ/ML IV SOLN,,J3480,HCPCS,Facility,Both,10,mL,,22,18.7,6.3052,22,First Health Group Corporation,First Health Network,21.34,97,,percent of total billed charges,,
POTASSIUM CHLORIDE 2 MEQ/ML IV SOLN,,J3480,HCPCS,Facility,Both,10,mL,,22,18.7,6.3052,22,"Health Partners, Inc.",Commercial,20.812,94.6,,percent of total billed charges,,
POTASSIUM CHLORIDE 2 MEQ/ML IV SOLN,,J3480,HCPCS,Facility,Both,10,mL,,22,18.7,6.3052,22,"Health Partners, Inc.",Commercial,20.812,94.6,,percent of total billed charges,,
POTASSIUM CHLORIDE 2 MEQ/ML IV SOLN,,J3480,HCPCS,Facility,Outpatient,10,mL,,22,18.7,6.3052,22,"Health Partners, Inc.",Medicare Advantage,10.78,49,,percent of total billed charges,,
POTASSIUM CHLORIDE 2 MEQ/ML IV SOLN,,J3480,HCPCS,Facility,Outpatient,10,mL,,22,18.7,6.3052,22,"Health Partners, Inc.",Medicare Advantage,10.78,49,,percent of total billed charges,,
POTASSIUM CHLORIDE 2 MEQ/ML IV SOLN,,J3480,HCPCS,Facility,Inpatient,10,mL,,22,18.7,6.3052,22,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
POTASSIUM CHLORIDE 2 MEQ/ML IV SOLN,,J3480,HCPCS,Facility,Inpatient,10,mL,,22,18.7,6.3052,22,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
POTASSIUM CHLORIDE 2 MEQ/ML IV SOLN,,J3480,HCPCS,Facility,Both,10,mL,,22,18.7,6.3052,22,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),13.2,60,,percent of total billed charges,,
POTASSIUM CHLORIDE 2 MEQ/ML IV SOLN,,J3480,HCPCS,Facility,Both,10,mL,,22,18.7,6.3052,22,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),13.2,60,,percent of total billed charges,,
POTASSIUM CHLORIDE 2 MEQ/ML IV SOLN,,J3480,HCPCS,Facility,Both,10,mL,,22,18.7,6.3052,22,"Health Partners, Inc.",State of Minnesota Advantage Program,17.93,81.5,,percent of total billed charges,,
POTASSIUM CHLORIDE 2 MEQ/ML IV SOLN,,J3480,HCPCS,Facility,Both,10,mL,,22,18.7,6.3052,22,"Health Partners, Inc.",State of Minnesota Advantage Program,17.93,81.5,,percent of total billed charges,,
POTASSIUM CHLORIDE 2 MEQ/ML IV SOLN,,J3480,HCPCS,Facility,Both,10,mL,,22,18.7,6.3052,22,"Health Partners, Inc.",State Public Programs,11,50,,percent of total billed charges,,
POTASSIUM CHLORIDE 2 MEQ/ML IV SOLN,,J3480,HCPCS,Facility,Both,10,mL,,22,18.7,6.3052,22,"Health Partners, Inc.",State Public Programs,11,50,,percent of total billed charges,,
POTASSIUM CHLORIDE 2 MEQ/ML IV SOLN,,J3480,HCPCS,Facility,Both,10,mL,,22,18.7,6.3052,22,Humana Insurance Company,Commercial PPO,20.9,95,,percent of total billed charges,,
POTASSIUM CHLORIDE 2 MEQ/ML IV SOLN,,J3480,HCPCS,Facility,Both,10,mL,,22,18.7,6.3052,22,Humana Insurance Company,Commercial PPO,20.9,95,,percent of total billed charges,,
POTASSIUM CHLORIDE 2 MEQ/ML IV SOLN,,J3480,HCPCS,Facility,Outpatient,10,mL,,22,18.7,6.3052,22,Humana Insurance Company,Medicare PPO,10.78,49,,percent of total billed charges,,
POTASSIUM CHLORIDE 2 MEQ/ML IV SOLN,,J3480,HCPCS,Facility,Outpatient,10,mL,,22,18.7,6.3052,22,Humana Insurance Company,Medicare PPO,10.78,49,,percent of total billed charges,,
POTASSIUM CHLORIDE 2 MEQ/ML IV SOLN,,J3480,HCPCS,Facility,Inpatient,10,mL,,22,18.7,6.3052,22,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
POTASSIUM CHLORIDE 2 MEQ/ML IV SOLN,,J3480,HCPCS,Facility,Inpatient,10,mL,,22,18.7,6.3052,22,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
POTASSIUM CHLORIDE 2 MEQ/ML IV SOLN,,J3480,HCPCS,Facility,Both,10,mL,,22,18.7,6.3052,22,Medica,Individual & Family,21.802,99.1,,percent of total billed charges,,
POTASSIUM CHLORIDE 2 MEQ/ML IV SOLN,,J3480,HCPCS,Facility,Both,10,mL,,22,18.7,6.3052,22,Medica,Individual & Family,21.802,99.1,,percent of total billed charges,,
POTASSIUM CHLORIDE 2 MEQ/ML IV SOLN,,J3480,HCPCS,Facility,Outpatient,10,mL,,22,18.7,6.3052,22,Medica,Medica Advantage Solution,10.956,49.8,,percent of total billed charges,,
POTASSIUM CHLORIDE 2 MEQ/ML IV SOLN,,J3480,HCPCS,Facility,Outpatient,10,mL,,22,18.7,6.3052,22,Medica,Medica Advantage Solution,10.956,49.8,,percent of total billed charges,,
POTASSIUM CHLORIDE 2 MEQ/ML IV SOLN,,J3480,HCPCS,Facility,Inpatient,10,mL,,22,18.7,6.3052,22,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
POTASSIUM CHLORIDE 2 MEQ/ML IV SOLN,,J3480,HCPCS,Facility,Inpatient,10,mL,,22,18.7,6.3052,22,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
POTASSIUM CHLORIDE 2 MEQ/ML IV SOLN,,J3480,HCPCS,Facility,Outpatient,10,mL,,22,18.7,6.3052,22,Medica,Medical Assistance,9.812,44.6,,percent of total billed charges,,
POTASSIUM CHLORIDE 2 MEQ/ML IV SOLN,,J3480,HCPCS,Facility,Outpatient,10,mL,,22,18.7,6.3052,22,Medica,Medical Assistance,9.812,44.6,,percent of total billed charges,,
POTASSIUM CHLORIDE 2 MEQ/ML IV SOLN,,J3480,HCPCS,Facility,Inpatient,10,mL,,22,18.7,6.3052,22,Medica,Medical Assistance,,,,,Included in per diem rate,
POTASSIUM CHLORIDE 2 MEQ/ML IV SOLN,,J3480,HCPCS,Facility,Inpatient,10,mL,,22,18.7,6.3052,22,Medica,Medical Assistance,,,,,Included in per diem rate,
POTASSIUM CHLORIDE 2 MEQ/ML IV SOLN,,J3480,HCPCS,Facility,Outpatient,10,mL,,22,18.7,6.3052,22,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,10.956,49.8,,percent of total billed charges,,
POTASSIUM CHLORIDE 2 MEQ/ML IV SOLN,,J3480,HCPCS,Facility,Outpatient,10,mL,,22,18.7,6.3052,22,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,10.956,49.8,,percent of total billed charges,,
POTASSIUM CHLORIDE 2 MEQ/ML IV SOLN,,J3480,HCPCS,Facility,Inpatient,10,mL,,22,18.7,6.3052,22,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
POTASSIUM CHLORIDE 2 MEQ/ML IV SOLN,,J3480,HCPCS,Facility,Inpatient,10,mL,,22,18.7,6.3052,22,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
POTASSIUM CHLORIDE 2 MEQ/ML IV SOLN,,J3480,HCPCS,Facility,Both,10,mL,,22,18.7,6.3052,22,"Multiplan, Inc.","Multiplan, Inc.",20.68,94,,percent of total billed charges,,
POTASSIUM CHLORIDE 2 MEQ/ML IV SOLN,,J3480,HCPCS,Facility,Both,10,mL,,22,18.7,6.3052,22,"Multiplan, Inc.","Multiplan, Inc.",20.68,94,,percent of total billed charges,,
POTASSIUM CHLORIDE 2 MEQ/ML IV SOLN,,J3480,HCPCS,Facility,Outpatient,10,mL,,22,18.7,6.3052,22,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,19.822,90.1,,percent of total billed charges,,
POTASSIUM CHLORIDE 2 MEQ/ML IV SOLN,,J3480,HCPCS,Facility,Outpatient,10,mL,,22,18.7,6.3052,22,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,19.822,90.1,,percent of total billed charges,,
POTASSIUM CHLORIDE 2 MEQ/ML IV SOLN,,J3480,HCPCS,Facility,Inpatient,10,mL,,22,18.7,6.3052,22,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
POTASSIUM CHLORIDE 2 MEQ/ML IV SOLN,,J3480,HCPCS,Facility,Inpatient,10,mL,,22,18.7,6.3052,22,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
POTASSIUM CHLORIDE 2 MEQ/ML IV SOLN,,J3480,HCPCS,Facility,Both,10,mL,,22,18.7,6.3052,22,"Preferred One Administrative Services, INC.",PPO,21.692,98.6,,percent of total billed charges,,
POTASSIUM CHLORIDE 2 MEQ/ML IV SOLN,,J3480,HCPCS,Facility,Both,10,mL,,22,18.7,6.3052,22,"Preferred One Administrative Services, INC.",PPO,21.692,98.6,,percent of total billed charges,,
POTASSIUM CHLORIDE 2 MEQ/ML IV SOLN,,J3480,HCPCS,Facility,Outpatient,10,mL,,22,18.7,6.3052,22,PrimeWest Health,Minnesota Senior Health Options (MSHO),11.319,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
POTASSIUM CHLORIDE 2 MEQ/ML IV SOLN,,J3480,HCPCS,Facility,Outpatient,10,mL,,22,18.7,6.3052,22,PrimeWest Health,Minnesota Senior Health Options (MSHO),11.319,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
POTASSIUM CHLORIDE 2 MEQ/ML IV SOLN,,J3480,HCPCS,Facility,Inpatient,10,mL,,22,18.7,6.3052,22,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
POTASSIUM CHLORIDE 2 MEQ/ML IV SOLN,,J3480,HCPCS,Facility,Inpatient,10,mL,,22,18.7,6.3052,22,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
POTASSIUM CHLORIDE 2 MEQ/ML IV SOLN,,J3480,HCPCS,Facility,Outpatient,10,mL,,22,18.7,6.3052,22,PrimeWest Health,MinnesotaCare,11.2992,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
POTASSIUM CHLORIDE 2 MEQ/ML IV SOLN,,J3480,HCPCS,Facility,Outpatient,10,mL,,22,18.7,6.3052,22,PrimeWest Health,MinnesotaCare,11.2992,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
POTASSIUM CHLORIDE 2 MEQ/ML IV SOLN,,J3480,HCPCS,Facility,Inpatient,10,mL,,22,18.7,6.3052,22,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
POTASSIUM CHLORIDE 2 MEQ/ML IV SOLN,,J3480,HCPCS,Facility,Inpatient,10,mL,,22,18.7,6.3052,22,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
POTASSIUM CHLORIDE 2 MEQ/ML IV SOLN,,J3480,HCPCS,Facility,Both,10,mL,,22,18.7,6.3052,22,Sanford Health Plan,Sanford Health Plan,20.24,92,,percent of total billed charges,,
POTASSIUM CHLORIDE 2 MEQ/ML IV SOLN,,J3480,HCPCS,Facility,Both,10,mL,,22,18.7,6.3052,22,Sanford Health Plan,Sanford Health Plan,20.24,92,,percent of total billed charges,,
POTASSIUM CHLORIDE 2 MEQ/ML IV SOLN,,J3480,HCPCS,Facility,Outpatient,10,mL,,22,18.7,6.3052,22,"UCare Health, Inc.",Individual & Family Plan,12.397,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
POTASSIUM CHLORIDE 2 MEQ/ML IV SOLN,,J3480,HCPCS,Facility,Outpatient,10,mL,,22,18.7,6.3052,22,"UCare Health, Inc.",Individual & Family Plan,12.397,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
POTASSIUM CHLORIDE 2 MEQ/ML IV SOLN,,J3480,HCPCS,Facility,Inpatient,10,mL,,22,18.7,6.3052,22,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
POTASSIUM CHLORIDE 2 MEQ/ML IV SOLN,,J3480,HCPCS,Facility,Inpatient,10,mL,,22,18.7,6.3052,22,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
POTASSIUM CHLORIDE 2 MEQ/ML IV SOLN,,J3480,HCPCS,Facility,Outpatient,10,mL,,22,18.7,6.3052,22,"UCare Health, Inc.",Medical Assistance,11.1034,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
POTASSIUM CHLORIDE 2 MEQ/ML IV SOLN,,J3480,HCPCS,Facility,Outpatient,10,mL,,22,18.7,6.3052,22,"UCare Health, Inc.",Medical Assistance,11.1034,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
POTASSIUM CHLORIDE 2 MEQ/ML IV SOLN,,J3480,HCPCS,Facility,Inpatient,10,mL,,22,18.7,6.3052,22,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
POTASSIUM CHLORIDE 2 MEQ/ML IV SOLN,,J3480,HCPCS,Facility,Inpatient,10,mL,,22,18.7,6.3052,22,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
POTASSIUM CHLORIDE 2 MEQ/ML IV SOLN,,J3480,HCPCS,Facility,Outpatient,10,mL,,22,18.7,6.3052,22,"UCare Health, Inc.",Medicare Advantage,11.1034,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
POTASSIUM CHLORIDE 2 MEQ/ML IV SOLN,,J3480,HCPCS,Facility,Outpatient,10,mL,,22,18.7,6.3052,22,"UCare Health, Inc.",Medicare Advantage,11.1034,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
POTASSIUM CHLORIDE 2 MEQ/ML IV SOLN,,J3480,HCPCS,Facility,Inpatient,10,mL,,22,18.7,6.3052,22,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
POTASSIUM CHLORIDE 2 MEQ/ML IV SOLN,,J3480,HCPCS,Facility,Inpatient,10,mL,,22,18.7,6.3052,22,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
POTASSIUM CHLORIDE 2 MEQ/ML IV SOLN,,J3480,HCPCS,Facility,Outpatient,10,mL,,22,18.7,6.3052,22,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),11.1034,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
POTASSIUM CHLORIDE 2 MEQ/ML IV SOLN,,J3480,HCPCS,Facility,Outpatient,10,mL,,22,18.7,6.3052,22,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),11.1034,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
POTASSIUM CHLORIDE 2 MEQ/ML IV SOLN,,J3480,HCPCS,Facility,Inpatient,10,mL,,22,18.7,6.3052,22,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
POTASSIUM CHLORIDE 2 MEQ/ML IV SOLN,,J3480,HCPCS,Facility,Inpatient,10,mL,,22,18.7,6.3052,22,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
POTASSIUM CHLORIDE 2 MEQ/ML IV SOLN,,J3480,HCPCS,Facility,Both,10,mL,,22,18.7,6.3052,22,UnitedHealthcare,Individual & Family,20.68,94,,percent of total billed charges,,
POTASSIUM CHLORIDE 2 MEQ/ML IV SOLN,,J3480,HCPCS,Facility,Both,10,mL,,22,18.7,6.3052,22,UnitedHealthcare,Individual & Family,20.68,94,,percent of total billed charges,,
POTASSIUM CHLORIDE 2 MEQ/ML IV SOLN,,J3480,HCPCS,Facility,Outpatient,10,mL,,22,18.7,6.3052,22,UnitedHealthcare,Medicare Advantage,10.78,49,,percent of total billed charges,,
POTASSIUM CHLORIDE 2 MEQ/ML IV SOLN,,J3480,HCPCS,Facility,Outpatient,10,mL,,22,18.7,6.3052,22,UnitedHealthcare,Medicare Advantage,10.78,49,,percent of total billed charges,,
POTASSIUM CHLORIDE 2 MEQ/ML IV SOLN,,J3480,HCPCS,Facility,Inpatient,10,mL,,22,18.7,6.3052,22,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
POTASSIUM CHLORIDE 2 MEQ/ML IV SOLN,,J3480,HCPCS,Facility,Inpatient,10,mL,,22,18.7,6.3052,22,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
POTASSIUM CHLORIDE 2 MEQ/ML IV SOLN,,J3480,HCPCS,Facility,Outpatient,10,mL,,22,18.7,6.3052,22,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,10.56,48,,percent of total billed charges,,100% of DHS outpatient percentage
POTASSIUM CHLORIDE 2 MEQ/ML IV SOLN,,J3480,HCPCS,Facility,Outpatient,10,mL,,22,18.7,6.3052,22,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,10.56,48,,percent of total billed charges,,100% of DHS outpatient percentage
POTASSIUM CHLORIDE 2 MEQ/ML IV SOLN,,J3480,HCPCS,Facility,Inpatient,10,mL,,22,18.7,6.3052,22,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
POTASSIUM CHLORIDE 2 MEQ/ML IV SOLN,,J3480,HCPCS,Facility,Inpatient,10,mL,,22,18.7,6.3052,22,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
BUMETANIDE 0.25 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Both,10,mL,,20,17,5.732,20,Aetna,Commercial,18.4,92,,percent of total billed charges,,
BUMETANIDE 0.25 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Outpatient,10,mL,,20,17,5.732,20,Aetna,Medicare Advantage,9.8,49,,percent of total billed charges,,
BUMETANIDE 0.25 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Inpatient,10,mL,,20,17,5.732,20,Aetna,Medicare Advantage,,,,,Included in per diem rate,
BUMETANIDE 0.25 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Both,10,mL,,20,17,5.732,20,Aetna,PPO,18.6,93,,percent of total billed charges,,
BUMETANIDE 0.25 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Both,10,mL,,20,17,5.732,20,America's PPO,America's PPO,19.206,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
BUMETANIDE 0.25 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Both,10,mL,,20,17,5.732,20,BlueCross BlueShield Minnesota, Federal Employee Program,19.68,98.4,,percent of total billed charges,,
BUMETANIDE 0.25 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Both,10,mL,,20,17,5.732,20,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,20,100,,percent of total billed charges,,
BUMETANIDE 0.25 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Both,10,mL,,20,17,5.732,20,BlueCross BlueShield Minnesota,High Value Network Plan,18,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
BUMETANIDE 0.25 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Outpatient,10,mL,,20,17,5.732,20,BlueCross BlueShield Minnesota,Medicare Advantage,9.8,49,,percent of total billed charges,,
BUMETANIDE 0.25 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Inpatient,10,mL,,20,17,5.732,20,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
BUMETANIDE 0.25 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Both,10,mL,,20,17,5.732,20,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,17.714,88.57,,percent of total billed charges,,
BUMETANIDE 0.25 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Both,10,mL,,20,17,5.732,20,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,5.732,28.66,,percent of total billed charges,,
BUMETANIDE 0.25 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Outpatient,10,mL,,20,17,5.732,20,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),9.8,49,,percent of total billed charges,,
BUMETANIDE 0.25 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Inpatient,10,mL,,20,17,5.732,20,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
BUMETANIDE 0.25 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Both,10,mL,,20,17,5.732,20,CorVel,Worker's Compensation,20,100,,percent of total billed charges,,
BUMETANIDE 0.25 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Both,10,mL,,20,17,5.732,20,First Health Group Corporation,First Health Network,19.4,97,,percent of total billed charges,,
BUMETANIDE 0.25 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Both,10,mL,,20,17,5.732,20,"Health Partners, Inc.",Commercial,18.92,94.6,,percent of total billed charges,,
BUMETANIDE 0.25 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Outpatient,10,mL,,20,17,5.732,20,"Health Partners, Inc.",Medicare Advantage,9.8,49,,percent of total billed charges,,
BUMETANIDE 0.25 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Inpatient,10,mL,,20,17,5.732,20,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
BUMETANIDE 0.25 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Both,10,mL,,20,17,5.732,20,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),12,60,,percent of total billed charges,,
BUMETANIDE 0.25 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Both,10,mL,,20,17,5.732,20,"Health Partners, Inc.",State of Minnesota Advantage Program,16.3,81.5,,percent of total billed charges,,
BUMETANIDE 0.25 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Both,10,mL,,20,17,5.732,20,"Health Partners, Inc.",State Public Programs,10,50,,percent of total billed charges,,
BUMETANIDE 0.25 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Both,10,mL,,20,17,5.732,20,Humana Insurance Company,Commercial PPO,19,95,,percent of total billed charges,,
BUMETANIDE 0.25 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Outpatient,10,mL,,20,17,5.732,20,Humana Insurance Company,Medicare PPO,9.8,49,,percent of total billed charges,,
BUMETANIDE 0.25 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Inpatient,10,mL,,20,17,5.732,20,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
BUMETANIDE 0.25 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Both,10,mL,,20,17,5.732,20,Medica,Individual & Family,19.82,99.1,,percent of total billed charges,,
BUMETANIDE 0.25 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Outpatient,10,mL,,20,17,5.732,20,Medica,Medica Advantage Solution,9.96,49.8,,percent of total billed charges,,
BUMETANIDE 0.25 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Inpatient,10,mL,,20,17,5.732,20,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
BUMETANIDE 0.25 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Outpatient,10,mL,,20,17,5.732,20,Medica,Medical Assistance,8.92,44.6,,percent of total billed charges,,
BUMETANIDE 0.25 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Inpatient,10,mL,,20,17,5.732,20,Medica,Medical Assistance,,,,,Included in per diem rate,
BUMETANIDE 0.25 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Outpatient,10,mL,,20,17,5.732,20,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,9.96,49.8,,percent of total billed charges,,
BUMETANIDE 0.25 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Inpatient,10,mL,,20,17,5.732,20,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
BUMETANIDE 0.25 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Both,10,mL,,20,17,5.732,20,"Multiplan, Inc.","Multiplan, Inc.",18.8,94,,percent of total billed charges,,
BUMETANIDE 0.25 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Outpatient,10,mL,,20,17,5.732,20,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,18.02,90.1,,percent of total billed charges,,
BUMETANIDE 0.25 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Inpatient,10,mL,,20,17,5.732,20,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
BUMETANIDE 0.25 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Both,10,mL,,20,17,5.732,20,"Preferred One Administrative Services, INC.",PPO,19.72,98.6,,percent of total billed charges,,
BUMETANIDE 0.25 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Outpatient,10,mL,,20,17,5.732,20,PrimeWest Health,Minnesota Senior Health Options (MSHO),10.29,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
BUMETANIDE 0.25 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Inpatient,10,mL,,20,17,5.732,20,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
BUMETANIDE 0.25 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Outpatient,10,mL,,20,17,5.732,20,PrimeWest Health,MinnesotaCare,10.272,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
BUMETANIDE 0.25 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Inpatient,10,mL,,20,17,5.732,20,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
BUMETANIDE 0.25 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Both,10,mL,,20,17,5.732,20,Sanford Health Plan,Sanford Health Plan,18.4,92,,percent of total billed charges,,
BUMETANIDE 0.25 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Outpatient,10,mL,,20,17,5.732,20,"UCare Health, Inc.",Individual & Family Plan,11.27,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
BUMETANIDE 0.25 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Inpatient,10,mL,,20,17,5.732,20,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
BUMETANIDE 0.25 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Outpatient,10,mL,,20,17,5.732,20,"UCare Health, Inc.",Medical Assistance,10.094,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BUMETANIDE 0.25 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Inpatient,10,mL,,20,17,5.732,20,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
BUMETANIDE 0.25 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Outpatient,10,mL,,20,17,5.732,20,"UCare Health, Inc.",Medicare Advantage,10.094,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BUMETANIDE 0.25 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Inpatient,10,mL,,20,17,5.732,20,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
BUMETANIDE 0.25 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Outpatient,10,mL,,20,17,5.732,20,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),10.094,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BUMETANIDE 0.25 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Inpatient,10,mL,,20,17,5.732,20,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
BUMETANIDE 0.25 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Both,10,mL,,20,17,5.732,20,UnitedHealthcare,Individual & Family,18.8,94,,percent of total billed charges,,
BUMETANIDE 0.25 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Outpatient,10,mL,,20,17,5.732,20,UnitedHealthcare,Medicare Advantage,9.8,49,,percent of total billed charges,,
BUMETANIDE 0.25 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Inpatient,10,mL,,20,17,5.732,20,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
BUMETANIDE 0.25 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Outpatient,10,mL,,20,17,5.732,20,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,9.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
BUMETANIDE 0.25 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Inpatient,10,mL,,20,17,5.732,20,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
DILTIAZEM HCL 5 MG/ML IV SOLN,,J3490,HCPCS,Facility,Both,10,mL,,24,20.4,6.8784,24,Aetna,Commercial,22.08,92,,percent of total billed charges,,
DILTIAZEM HCL 5 MG/ML IV SOLN,,J3490,HCPCS,Facility,Outpatient,10,mL,,24,20.4,6.8784,24,Aetna,Medicare Advantage,11.76,49,,percent of total billed charges,,
DILTIAZEM HCL 5 MG/ML IV SOLN,,J3490,HCPCS,Facility,Inpatient,10,mL,,24,20.4,6.8784,24,Aetna,Medicare Advantage,,,,,Included in per diem rate,
DILTIAZEM HCL 5 MG/ML IV SOLN,,J3490,HCPCS,Facility,Both,10,mL,,24,20.4,6.8784,24,Aetna,PPO,22.32,93,,percent of total billed charges,,
DILTIAZEM HCL 5 MG/ML IV SOLN,,J3490,HCPCS,Facility,Both,10,mL,,24,20.4,6.8784,24,America's PPO,America's PPO,23.0472,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
DILTIAZEM HCL 5 MG/ML IV SOLN,,J3490,HCPCS,Facility,Both,10,mL,,24,20.4,6.8784,24,BlueCross BlueShield Minnesota, Federal Employee Program,23.616,98.4,,percent of total billed charges,,
DILTIAZEM HCL 5 MG/ML IV SOLN,,J3490,HCPCS,Facility,Both,10,mL,,24,20.4,6.8784,24,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,24,100,,percent of total billed charges,,
DILTIAZEM HCL 5 MG/ML IV SOLN,,J3490,HCPCS,Facility,Both,10,mL,,24,20.4,6.8784,24,BlueCross BlueShield Minnesota,High Value Network Plan,21.6,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
DILTIAZEM HCL 5 MG/ML IV SOLN,,J3490,HCPCS,Facility,Outpatient,10,mL,,24,20.4,6.8784,24,BlueCross BlueShield Minnesota,Medicare Advantage,11.76,49,,percent of total billed charges,,
DILTIAZEM HCL 5 MG/ML IV SOLN,,J3490,HCPCS,Facility,Inpatient,10,mL,,24,20.4,6.8784,24,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
DILTIAZEM HCL 5 MG/ML IV SOLN,,J3490,HCPCS,Facility,Both,10,mL,,24,20.4,6.8784,24,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,21.2568,88.57,,percent of total billed charges,,
DILTIAZEM HCL 5 MG/ML IV SOLN,,J3490,HCPCS,Facility,Both,10,mL,,24,20.4,6.8784,24,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,6.8784,28.66,,percent of total billed charges,,
DILTIAZEM HCL 5 MG/ML IV SOLN,,J3490,HCPCS,Facility,Outpatient,10,mL,,24,20.4,6.8784,24,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),11.76,49,,percent of total billed charges,,
DILTIAZEM HCL 5 MG/ML IV SOLN,,J3490,HCPCS,Facility,Inpatient,10,mL,,24,20.4,6.8784,24,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
DILTIAZEM HCL 5 MG/ML IV SOLN,,J3490,HCPCS,Facility,Both,10,mL,,24,20.4,6.8784,24,CorVel,Worker's Compensation,24,100,,percent of total billed charges,,
DILTIAZEM HCL 5 MG/ML IV SOLN,,J3490,HCPCS,Facility,Both,10,mL,,24,20.4,6.8784,24,First Health Group Corporation,First Health Network,23.28,97,,percent of total billed charges,,
DILTIAZEM HCL 5 MG/ML IV SOLN,,J3490,HCPCS,Facility,Both,10,mL,,24,20.4,6.8784,24,"Health Partners, Inc.",Commercial,22.704,94.6,,percent of total billed charges,,
DILTIAZEM HCL 5 MG/ML IV SOLN,,J3490,HCPCS,Facility,Outpatient,10,mL,,24,20.4,6.8784,24,"Health Partners, Inc.",Medicare Advantage,11.76,49,,percent of total billed charges,,
DILTIAZEM HCL 5 MG/ML IV SOLN,,J3490,HCPCS,Facility,Inpatient,10,mL,,24,20.4,6.8784,24,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DILTIAZEM HCL 5 MG/ML IV SOLN,,J3490,HCPCS,Facility,Both,10,mL,,24,20.4,6.8784,24,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),14.4,60,,percent of total billed charges,,
DILTIAZEM HCL 5 MG/ML IV SOLN,,J3490,HCPCS,Facility,Both,10,mL,,24,20.4,6.8784,24,"Health Partners, Inc.",State of Minnesota Advantage Program,19.56,81.5,,percent of total billed charges,,
DILTIAZEM HCL 5 MG/ML IV SOLN,,J3490,HCPCS,Facility,Both,10,mL,,24,20.4,6.8784,24,"Health Partners, Inc.",State Public Programs,12,50,,percent of total billed charges,,
DILTIAZEM HCL 5 MG/ML IV SOLN,,J3490,HCPCS,Facility,Both,10,mL,,24,20.4,6.8784,24,Humana Insurance Company,Commercial PPO,22.8,95,,percent of total billed charges,,
DILTIAZEM HCL 5 MG/ML IV SOLN,,J3490,HCPCS,Facility,Outpatient,10,mL,,24,20.4,6.8784,24,Humana Insurance Company,Medicare PPO,11.76,49,,percent of total billed charges,,
DILTIAZEM HCL 5 MG/ML IV SOLN,,J3490,HCPCS,Facility,Inpatient,10,mL,,24,20.4,6.8784,24,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
DILTIAZEM HCL 5 MG/ML IV SOLN,,J3490,HCPCS,Facility,Both,10,mL,,24,20.4,6.8784,24,Medica,Individual & Family,23.784,99.1,,percent of total billed charges,,
DILTIAZEM HCL 5 MG/ML IV SOLN,,J3490,HCPCS,Facility,Outpatient,10,mL,,24,20.4,6.8784,24,Medica,Medica Advantage Solution,11.952,49.8,,percent of total billed charges,,
DILTIAZEM HCL 5 MG/ML IV SOLN,,J3490,HCPCS,Facility,Inpatient,10,mL,,24,20.4,6.8784,24,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
DILTIAZEM HCL 5 MG/ML IV SOLN,,J3490,HCPCS,Facility,Outpatient,10,mL,,24,20.4,6.8784,24,Medica,Medical Assistance,10.704,44.6,,percent of total billed charges,,
DILTIAZEM HCL 5 MG/ML IV SOLN,,J3490,HCPCS,Facility,Inpatient,10,mL,,24,20.4,6.8784,24,Medica,Medical Assistance,,,,,Included in per diem rate,
DILTIAZEM HCL 5 MG/ML IV SOLN,,J3490,HCPCS,Facility,Outpatient,10,mL,,24,20.4,6.8784,24,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,11.952,49.8,,percent of total billed charges,,
DILTIAZEM HCL 5 MG/ML IV SOLN,,J3490,HCPCS,Facility,Inpatient,10,mL,,24,20.4,6.8784,24,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
DILTIAZEM HCL 5 MG/ML IV SOLN,,J3490,HCPCS,Facility,Both,10,mL,,24,20.4,6.8784,24,"Multiplan, Inc.","Multiplan, Inc.",22.56,94,,percent of total billed charges,,
DILTIAZEM HCL 5 MG/ML IV SOLN,,J3490,HCPCS,Facility,Outpatient,10,mL,,24,20.4,6.8784,24,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,21.624,90.1,,percent of total billed charges,,
DILTIAZEM HCL 5 MG/ML IV SOLN,,J3490,HCPCS,Facility,Inpatient,10,mL,,24,20.4,6.8784,24,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
DILTIAZEM HCL 5 MG/ML IV SOLN,,J3490,HCPCS,Facility,Both,10,mL,,24,20.4,6.8784,24,"Preferred One Administrative Services, INC.",PPO,23.664,98.6,,percent of total billed charges,,
DILTIAZEM HCL 5 MG/ML IV SOLN,,J3490,HCPCS,Facility,Outpatient,10,mL,,24,20.4,6.8784,24,PrimeWest Health,Minnesota Senior Health Options (MSHO),12.348,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
DILTIAZEM HCL 5 MG/ML IV SOLN,,J3490,HCPCS,Facility,Inpatient,10,mL,,24,20.4,6.8784,24,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DILTIAZEM HCL 5 MG/ML IV SOLN,,J3490,HCPCS,Facility,Outpatient,10,mL,,24,20.4,6.8784,24,PrimeWest Health,MinnesotaCare,12.3264,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
DILTIAZEM HCL 5 MG/ML IV SOLN,,J3490,HCPCS,Facility,Inpatient,10,mL,,24,20.4,6.8784,24,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
DILTIAZEM HCL 5 MG/ML IV SOLN,,J3490,HCPCS,Facility,Both,10,mL,,24,20.4,6.8784,24,Sanford Health Plan,Sanford Health Plan,22.08,92,,percent of total billed charges,,
DILTIAZEM HCL 5 MG/ML IV SOLN,,J3490,HCPCS,Facility,Outpatient,10,mL,,24,20.4,6.8784,24,"UCare Health, Inc.",Individual & Family Plan,13.524,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
DILTIAZEM HCL 5 MG/ML IV SOLN,,J3490,HCPCS,Facility,Inpatient,10,mL,,24,20.4,6.8784,24,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
DILTIAZEM HCL 5 MG/ML IV SOLN,,J3490,HCPCS,Facility,Outpatient,10,mL,,24,20.4,6.8784,24,"UCare Health, Inc.",Medical Assistance,12.1128,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DILTIAZEM HCL 5 MG/ML IV SOLN,,J3490,HCPCS,Facility,Inpatient,10,mL,,24,20.4,6.8784,24,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
DILTIAZEM HCL 5 MG/ML IV SOLN,,J3490,HCPCS,Facility,Outpatient,10,mL,,24,20.4,6.8784,24,"UCare Health, Inc.",Medicare Advantage,12.1128,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DILTIAZEM HCL 5 MG/ML IV SOLN,,J3490,HCPCS,Facility,Inpatient,10,mL,,24,20.4,6.8784,24,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DILTIAZEM HCL 5 MG/ML IV SOLN,,J3490,HCPCS,Facility,Outpatient,10,mL,,24,20.4,6.8784,24,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),12.1128,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DILTIAZEM HCL 5 MG/ML IV SOLN,,J3490,HCPCS,Facility,Inpatient,10,mL,,24,20.4,6.8784,24,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DILTIAZEM HCL 5 MG/ML IV SOLN,,J3490,HCPCS,Facility,Both,10,mL,,24,20.4,6.8784,24,UnitedHealthcare,Individual & Family,22.56,94,,percent of total billed charges,,
DILTIAZEM HCL 5 MG/ML IV SOLN,,J3490,HCPCS,Facility,Outpatient,10,mL,,24,20.4,6.8784,24,UnitedHealthcare,Medicare Advantage,11.76,49,,percent of total billed charges,,
DILTIAZEM HCL 5 MG/ML IV SOLN,,J3490,HCPCS,Facility,Inpatient,10,mL,,24,20.4,6.8784,24,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
DILTIAZEM HCL 5 MG/ML IV SOLN,,J3490,HCPCS,Facility,Outpatient,10,mL,,24,20.4,6.8784,24,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,11.52,48,,percent of total billed charges,,100% of DHS outpatient percentage
DILTIAZEM HCL 5 MG/ML IV SOLN,,J3490,HCPCS,Facility,Inpatient,10,mL,,24,20.4,6.8784,24,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
ETOMIDATE 2 MG/ML IV SOLN,,J3490,HCPCS,Facility,Both,10,mL,,38,32.3,10.8908,38,Aetna,Commercial,34.96,92,,percent of total billed charges,,
ETOMIDATE 2 MG/ML IV SOLN,,J3490,HCPCS,Facility,Outpatient,10,mL,,38,32.3,10.8908,38,Aetna,Medicare Advantage,18.62,49,,percent of total billed charges,,
ETOMIDATE 2 MG/ML IV SOLN,,J3490,HCPCS,Facility,Inpatient,10,mL,,38,32.3,10.8908,38,Aetna,Medicare Advantage,,,,,Included in per diem rate,
ETOMIDATE 2 MG/ML IV SOLN,,J3490,HCPCS,Facility,Both,10,mL,,38,32.3,10.8908,38,Aetna,PPO,35.34,93,,percent of total billed charges,,
ETOMIDATE 2 MG/ML IV SOLN,,J3490,HCPCS,Facility,Both,10,mL,,38,32.3,10.8908,38,America's PPO,America's PPO,36.4914,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
ETOMIDATE 2 MG/ML IV SOLN,,J3490,HCPCS,Facility,Both,10,mL,,38,32.3,10.8908,38,BlueCross BlueShield Minnesota, Federal Employee Program,37.392,98.4,,percent of total billed charges,,
ETOMIDATE 2 MG/ML IV SOLN,,J3490,HCPCS,Facility,Both,10,mL,,38,32.3,10.8908,38,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,38,100,,percent of total billed charges,,
ETOMIDATE 2 MG/ML IV SOLN,,J3490,HCPCS,Facility,Both,10,mL,,38,32.3,10.8908,38,BlueCross BlueShield Minnesota,High Value Network Plan,34.2,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
ETOMIDATE 2 MG/ML IV SOLN,,J3490,HCPCS,Facility,Outpatient,10,mL,,38,32.3,10.8908,38,BlueCross BlueShield Minnesota,Medicare Advantage,18.62,49,,percent of total billed charges,,
ETOMIDATE 2 MG/ML IV SOLN,,J3490,HCPCS,Facility,Inpatient,10,mL,,38,32.3,10.8908,38,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
ETOMIDATE 2 MG/ML IV SOLN,,J3490,HCPCS,Facility,Both,10,mL,,38,32.3,10.8908,38,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,33.6566,88.57,,percent of total billed charges,,
ETOMIDATE 2 MG/ML IV SOLN,,J3490,HCPCS,Facility,Both,10,mL,,38,32.3,10.8908,38,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,10.8908,28.66,,percent of total billed charges,,
ETOMIDATE 2 MG/ML IV SOLN,,J3490,HCPCS,Facility,Outpatient,10,mL,,38,32.3,10.8908,38,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),18.62,49,,percent of total billed charges,,
ETOMIDATE 2 MG/ML IV SOLN,,J3490,HCPCS,Facility,Inpatient,10,mL,,38,32.3,10.8908,38,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
ETOMIDATE 2 MG/ML IV SOLN,,J3490,HCPCS,Facility,Both,10,mL,,38,32.3,10.8908,38,CorVel,Worker's Compensation,38,100,,percent of total billed charges,,
ETOMIDATE 2 MG/ML IV SOLN,,J3490,HCPCS,Facility,Both,10,mL,,38,32.3,10.8908,38,First Health Group Corporation,First Health Network,36.86,97,,percent of total billed charges,,
ETOMIDATE 2 MG/ML IV SOLN,,J3490,HCPCS,Facility,Both,10,mL,,38,32.3,10.8908,38,"Health Partners, Inc.",Commercial,35.948,94.6,,percent of total billed charges,,
ETOMIDATE 2 MG/ML IV SOLN,,J3490,HCPCS,Facility,Outpatient,10,mL,,38,32.3,10.8908,38,"Health Partners, Inc.",Medicare Advantage,18.62,49,,percent of total billed charges,,
ETOMIDATE 2 MG/ML IV SOLN,,J3490,HCPCS,Facility,Inpatient,10,mL,,38,32.3,10.8908,38,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ETOMIDATE 2 MG/ML IV SOLN,,J3490,HCPCS,Facility,Both,10,mL,,38,32.3,10.8908,38,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),22.8,60,,percent of total billed charges,,
ETOMIDATE 2 MG/ML IV SOLN,,J3490,HCPCS,Facility,Both,10,mL,,38,32.3,10.8908,38,"Health Partners, Inc.",State of Minnesota Advantage Program,30.97,81.5,,percent of total billed charges,,
ETOMIDATE 2 MG/ML IV SOLN,,J3490,HCPCS,Facility,Both,10,mL,,38,32.3,10.8908,38,"Health Partners, Inc.",State Public Programs,19,50,,percent of total billed charges,,
ETOMIDATE 2 MG/ML IV SOLN,,J3490,HCPCS,Facility,Both,10,mL,,38,32.3,10.8908,38,Humana Insurance Company,Commercial PPO,36.1,95,,percent of total billed charges,,
ETOMIDATE 2 MG/ML IV SOLN,,J3490,HCPCS,Facility,Outpatient,10,mL,,38,32.3,10.8908,38,Humana Insurance Company,Medicare PPO,18.62,49,,percent of total billed charges,,
ETOMIDATE 2 MG/ML IV SOLN,,J3490,HCPCS,Facility,Inpatient,10,mL,,38,32.3,10.8908,38,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
ETOMIDATE 2 MG/ML IV SOLN,,J3490,HCPCS,Facility,Both,10,mL,,38,32.3,10.8908,38,Medica,Individual & Family,37.658,99.1,,percent of total billed charges,,
ETOMIDATE 2 MG/ML IV SOLN,,J3490,HCPCS,Facility,Outpatient,10,mL,,38,32.3,10.8908,38,Medica,Medica Advantage Solution,18.924,49.8,,percent of total billed charges,,
ETOMIDATE 2 MG/ML IV SOLN,,J3490,HCPCS,Facility,Inpatient,10,mL,,38,32.3,10.8908,38,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
ETOMIDATE 2 MG/ML IV SOLN,,J3490,HCPCS,Facility,Outpatient,10,mL,,38,32.3,10.8908,38,Medica,Medical Assistance,16.948,44.6,,percent of total billed charges,,
ETOMIDATE 2 MG/ML IV SOLN,,J3490,HCPCS,Facility,Inpatient,10,mL,,38,32.3,10.8908,38,Medica,Medical Assistance,,,,,Included in per diem rate,
ETOMIDATE 2 MG/ML IV SOLN,,J3490,HCPCS,Facility,Outpatient,10,mL,,38,32.3,10.8908,38,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,18.924,49.8,,percent of total billed charges,,
ETOMIDATE 2 MG/ML IV SOLN,,J3490,HCPCS,Facility,Inpatient,10,mL,,38,32.3,10.8908,38,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
ETOMIDATE 2 MG/ML IV SOLN,,J3490,HCPCS,Facility,Both,10,mL,,38,32.3,10.8908,38,"Multiplan, Inc.","Multiplan, Inc.",35.72,94,,percent of total billed charges,,
ETOMIDATE 2 MG/ML IV SOLN,,J3490,HCPCS,Facility,Outpatient,10,mL,,38,32.3,10.8908,38,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,34.238,90.1,,percent of total billed charges,,
ETOMIDATE 2 MG/ML IV SOLN,,J3490,HCPCS,Facility,Inpatient,10,mL,,38,32.3,10.8908,38,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
ETOMIDATE 2 MG/ML IV SOLN,,J3490,HCPCS,Facility,Both,10,mL,,38,32.3,10.8908,38,"Preferred One Administrative Services, INC.",PPO,37.468,98.6,,percent of total billed charges,,
ETOMIDATE 2 MG/ML IV SOLN,,J3490,HCPCS,Facility,Outpatient,10,mL,,38,32.3,10.8908,38,PrimeWest Health,Minnesota Senior Health Options (MSHO),19.551,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
ETOMIDATE 2 MG/ML IV SOLN,,J3490,HCPCS,Facility,Inpatient,10,mL,,38,32.3,10.8908,38,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ETOMIDATE 2 MG/ML IV SOLN,,J3490,HCPCS,Facility,Outpatient,10,mL,,38,32.3,10.8908,38,PrimeWest Health,MinnesotaCare,19.5168,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
ETOMIDATE 2 MG/ML IV SOLN,,J3490,HCPCS,Facility,Inpatient,10,mL,,38,32.3,10.8908,38,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
ETOMIDATE 2 MG/ML IV SOLN,,J3490,HCPCS,Facility,Both,10,mL,,38,32.3,10.8908,38,Sanford Health Plan,Sanford Health Plan,34.96,92,,percent of total billed charges,,
ETOMIDATE 2 MG/ML IV SOLN,,J3490,HCPCS,Facility,Outpatient,10,mL,,38,32.3,10.8908,38,"UCare Health, Inc.",Individual & Family Plan,21.413,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
ETOMIDATE 2 MG/ML IV SOLN,,J3490,HCPCS,Facility,Inpatient,10,mL,,38,32.3,10.8908,38,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
ETOMIDATE 2 MG/ML IV SOLN,,J3490,HCPCS,Facility,Outpatient,10,mL,,38,32.3,10.8908,38,"UCare Health, Inc.",Medical Assistance,19.1786,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ETOMIDATE 2 MG/ML IV SOLN,,J3490,HCPCS,Facility,Inpatient,10,mL,,38,32.3,10.8908,38,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
ETOMIDATE 2 MG/ML IV SOLN,,J3490,HCPCS,Facility,Outpatient,10,mL,,38,32.3,10.8908,38,"UCare Health, Inc.",Medicare Advantage,19.1786,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ETOMIDATE 2 MG/ML IV SOLN,,J3490,HCPCS,Facility,Inpatient,10,mL,,38,32.3,10.8908,38,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ETOMIDATE 2 MG/ML IV SOLN,,J3490,HCPCS,Facility,Outpatient,10,mL,,38,32.3,10.8908,38,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),19.1786,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ETOMIDATE 2 MG/ML IV SOLN,,J3490,HCPCS,Facility,Inpatient,10,mL,,38,32.3,10.8908,38,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ETOMIDATE 2 MG/ML IV SOLN,,J3490,HCPCS,Facility,Both,10,mL,,38,32.3,10.8908,38,UnitedHealthcare,Individual & Family,35.72,94,,percent of total billed charges,,
ETOMIDATE 2 MG/ML IV SOLN,,J3490,HCPCS,Facility,Outpatient,10,mL,,38,32.3,10.8908,38,UnitedHealthcare,Medicare Advantage,18.62,49,,percent of total billed charges,,
ETOMIDATE 2 MG/ML IV SOLN,,J3490,HCPCS,Facility,Inpatient,10,mL,,38,32.3,10.8908,38,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
ETOMIDATE 2 MG/ML IV SOLN,,J3490,HCPCS,Facility,Outpatient,10,mL,,38,32.3,10.8908,38,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,18.24,48,,percent of total billed charges,,100% of DHS outpatient percentage
ETOMIDATE 2 MG/ML IV SOLN,,J3490,HCPCS,Facility,Inpatient,10,mL,,38,32.3,10.8908,38,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
FOLIC ACID 5 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Both,10,mL,,248,210.8,71.0768,248,Aetna,Commercial,228.16,92,,percent of total billed charges,,
FOLIC ACID 5 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Outpatient,10,mL,,248,210.8,71.0768,248,Aetna,Medicare Advantage,121.52,49,,percent of total billed charges,,
FOLIC ACID 5 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Inpatient,10,mL,,248,210.8,71.0768,248,Aetna,Medicare Advantage,,,,,Included in per diem rate,
FOLIC ACID 5 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Both,10,mL,,248,210.8,71.0768,248,Aetna,PPO,230.64,93,,percent of total billed charges,,
FOLIC ACID 5 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Both,10,mL,,248,210.8,71.0768,248,America's PPO,America's PPO,238.1544,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
FOLIC ACID 5 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Both,10,mL,,248,210.8,71.0768,248,BlueCross BlueShield Minnesota, Federal Employee Program,244.032,98.4,,percent of total billed charges,,
FOLIC ACID 5 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Both,10,mL,,248,210.8,71.0768,248,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,248,100,,percent of total billed charges,,
FOLIC ACID 5 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Both,10,mL,,248,210.8,71.0768,248,BlueCross BlueShield Minnesota,High Value Network Plan,223.2,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
FOLIC ACID 5 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Outpatient,10,mL,,248,210.8,71.0768,248,BlueCross BlueShield Minnesota,Medicare Advantage,121.52,49,,percent of total billed charges,,
FOLIC ACID 5 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Inpatient,10,mL,,248,210.8,71.0768,248,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
FOLIC ACID 5 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Both,10,mL,,248,210.8,71.0768,248,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,219.6536,88.57,,percent of total billed charges,,
FOLIC ACID 5 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Both,10,mL,,248,210.8,71.0768,248,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,71.0768,28.66,,percent of total billed charges,,
FOLIC ACID 5 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Outpatient,10,mL,,248,210.8,71.0768,248,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),121.52,49,,percent of total billed charges,,
FOLIC ACID 5 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Inpatient,10,mL,,248,210.8,71.0768,248,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
FOLIC ACID 5 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Both,10,mL,,248,210.8,71.0768,248,CorVel,Worker's Compensation,248,100,,percent of total billed charges,,
FOLIC ACID 5 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Both,10,mL,,248,210.8,71.0768,248,First Health Group Corporation,First Health Network,240.56,97,,percent of total billed charges,,
FOLIC ACID 5 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Both,10,mL,,248,210.8,71.0768,248,"Health Partners, Inc.",Commercial,234.608,94.6,,percent of total billed charges,,
FOLIC ACID 5 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Outpatient,10,mL,,248,210.8,71.0768,248,"Health Partners, Inc.",Medicare Advantage,121.52,49,,percent of total billed charges,,
FOLIC ACID 5 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Inpatient,10,mL,,248,210.8,71.0768,248,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
FOLIC ACID 5 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Both,10,mL,,248,210.8,71.0768,248,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),148.8,60,,percent of total billed charges,,
FOLIC ACID 5 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Both,10,mL,,248,210.8,71.0768,248,"Health Partners, Inc.",State of Minnesota Advantage Program,202.12,81.5,,percent of total billed charges,,
FOLIC ACID 5 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Both,10,mL,,248,210.8,71.0768,248,"Health Partners, Inc.",State Public Programs,124,50,,percent of total billed charges,,
FOLIC ACID 5 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Both,10,mL,,248,210.8,71.0768,248,Humana Insurance Company,Commercial PPO,235.6,95,,percent of total billed charges,,
FOLIC ACID 5 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Outpatient,10,mL,,248,210.8,71.0768,248,Humana Insurance Company,Medicare PPO,121.52,49,,percent of total billed charges,,
FOLIC ACID 5 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Inpatient,10,mL,,248,210.8,71.0768,248,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
FOLIC ACID 5 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Both,10,mL,,248,210.8,71.0768,248,Medica,Individual & Family,245.768,99.1,,percent of total billed charges,,
FOLIC ACID 5 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Outpatient,10,mL,,248,210.8,71.0768,248,Medica,Medica Advantage Solution,123.504,49.8,,percent of total billed charges,,
FOLIC ACID 5 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Inpatient,10,mL,,248,210.8,71.0768,248,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
FOLIC ACID 5 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Outpatient,10,mL,,248,210.8,71.0768,248,Medica,Medical Assistance,110.608,44.6,,percent of total billed charges,,
FOLIC ACID 5 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Inpatient,10,mL,,248,210.8,71.0768,248,Medica,Medical Assistance,,,,,Included in per diem rate,
FOLIC ACID 5 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Outpatient,10,mL,,248,210.8,71.0768,248,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,123.504,49.8,,percent of total billed charges,,
FOLIC ACID 5 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Inpatient,10,mL,,248,210.8,71.0768,248,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
FOLIC ACID 5 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Both,10,mL,,248,210.8,71.0768,248,"Multiplan, Inc.","Multiplan, Inc.",233.12,94,,percent of total billed charges,,
FOLIC ACID 5 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Outpatient,10,mL,,248,210.8,71.0768,248,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,223.448,90.1,,percent of total billed charges,,
FOLIC ACID 5 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Inpatient,10,mL,,248,210.8,71.0768,248,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
FOLIC ACID 5 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Both,10,mL,,248,210.8,71.0768,248,"Preferred One Administrative Services, INC.",PPO,244.528,98.6,,percent of total billed charges,,
FOLIC ACID 5 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Outpatient,10,mL,,248,210.8,71.0768,248,PrimeWest Health,Minnesota Senior Health Options (MSHO),127.596,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
FOLIC ACID 5 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Inpatient,10,mL,,248,210.8,71.0768,248,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
FOLIC ACID 5 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Outpatient,10,mL,,248,210.8,71.0768,248,PrimeWest Health,MinnesotaCare,127.3728,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
FOLIC ACID 5 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Inpatient,10,mL,,248,210.8,71.0768,248,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
FOLIC ACID 5 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Both,10,mL,,248,210.8,71.0768,248,Sanford Health Plan,Sanford Health Plan,228.16,92,,percent of total billed charges,,
FOLIC ACID 5 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Outpatient,10,mL,,248,210.8,71.0768,248,"UCare Health, Inc.",Individual & Family Plan,139.748,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
FOLIC ACID 5 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Inpatient,10,mL,,248,210.8,71.0768,248,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
FOLIC ACID 5 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Outpatient,10,mL,,248,210.8,71.0768,248,"UCare Health, Inc.",Medical Assistance,125.1656,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FOLIC ACID 5 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Inpatient,10,mL,,248,210.8,71.0768,248,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
FOLIC ACID 5 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Outpatient,10,mL,,248,210.8,71.0768,248,"UCare Health, Inc.",Medicare Advantage,125.1656,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FOLIC ACID 5 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Inpatient,10,mL,,248,210.8,71.0768,248,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
FOLIC ACID 5 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Outpatient,10,mL,,248,210.8,71.0768,248,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),125.1656,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FOLIC ACID 5 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Inpatient,10,mL,,248,210.8,71.0768,248,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
FOLIC ACID 5 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Both,10,mL,,248,210.8,71.0768,248,UnitedHealthcare,Individual & Family,233.12,94,,percent of total billed charges,,
FOLIC ACID 5 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Outpatient,10,mL,,248,210.8,71.0768,248,UnitedHealthcare,Medicare Advantage,121.52,49,,percent of total billed charges,,
FOLIC ACID 5 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Inpatient,10,mL,,248,210.8,71.0768,248,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
FOLIC ACID 5 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Outpatient,10,mL,,248,210.8,71.0768,248,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,119.04,48,,percent of total billed charges,,100% of DHS outpatient percentage
FOLIC ACID 5 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Inpatient,10,mL,,248,210.8,71.0768,248,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Eye Exam & Eval W Initiation Of Dx And Tx Program; Intermediate, New Patient (Pro Cah)",,92002,CPT,Professional,Both,,,,143,121.55,29.22,143,Aetna,Commercial,121.55,85,,percent of total billed charges,,
"Eye Exam & Eval W Initiation Of Dx And Tx Program; Intermediate, New Patient (Pro Cah)",,92002,CPT,Professional,Both,,,,143,121.55,29.22,143,Aetna,Medicare Advantage,46.75,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Eye Exam & Eval W Initiation Of Dx And Tx Program; Intermediate, New Patient (Pro Cah)",,92002,CPT,Professional,Both,,,,143,121.55,29.22,143,Aetna,PPO,132.99,93,,percent of total billed charges,,
"Eye Exam & Eval W Initiation Of Dx And Tx Program; Intermediate, New Patient (Pro Cah)",,92002,CPT,Professional,Both,,,,143,121.55,29.22,143,America's PPO,America's PPO,122.1792,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Eye Exam & Eval W Initiation Of Dx And Tx Program; Intermediate, New Patient (Pro Cah)",,92002,CPT,Professional,Both,,,,143,121.55,29.22,143,BlueCross BlueShield Minnesota, Federal Employee Program,58.04,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Eye Exam & Eval W Initiation Of Dx And Tx Program; Intermediate, New Patient (Pro Cah)",,92002,CPT,Professional,Both,,,,143,121.55,29.22,143,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,58.96864,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Eye Exam & Eval W Initiation Of Dx And Tx Program; Intermediate, New Patient (Pro Cah)",,92002,CPT,Professional,Both,,,,143,121.55,29.22,143,BlueCross BlueShield Minnesota,High Value Network Plan,58.96864,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Eye Exam & Eval W Initiation Of Dx And Tx Program; Intermediate, New Patient (Pro Cah)",,92002,CPT,Professional,Both,,,,143,121.55,29.22,143,BlueCross BlueShield Minnesota,Medicare Advantage,52.417,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Eye Exam & Eval W Initiation Of Dx And Tx Program; Intermediate, New Patient (Pro Cah)",,92002,CPT,Professional,Both,,,,143,121.55,29.22,143,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,58.96864,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Eye Exam & Eval W Initiation Of Dx And Tx Program; Intermediate, New Patient (Pro Cah)",,92002,CPT,Professional,Both,,,,143,121.55,29.22,143,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,33.74136,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Eye Exam & Eval W Initiation Of Dx And Tx Program; Intermediate, New Patient (Pro Cah)",,92002,CPT,Professional,Both,,,,143,121.55,29.22,143,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),52.417,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Eye Exam & Eval W Initiation Of Dx And Tx Program; Intermediate, New Patient (Pro Cah)",,92002,CPT,Professional,Both,,,,143,121.55,29.22,143,CorVel,Worker's Compensation,89.9970528,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Eye Exam & Eval W Initiation Of Dx And Tx Program; Intermediate, New Patient (Pro Cah)",,92002,CPT,Professional,Both,,,,143,121.55,29.22,143,First Health Group Corporation,First Health Network,138.71,97,,percent of total billed charges,,
"Eye Exam & Eval W Initiation Of Dx And Tx Program; Intermediate, New Patient (Pro Cah)",,92002,CPT,Professional,Both,,,,143,121.55,29.22,143,"Health Partners, Inc.",Commercial,97.22,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Eye Exam & Eval W Initiation Of Dx And Tx Program; Intermediate, New Patient (Pro Cah)",,92002,CPT,Professional,Both,,,,143,121.55,29.22,143,"Health Partners, Inc.",Medicare Advantage,52.417,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Eye Exam & Eval W Initiation Of Dx And Tx Program; Intermediate, New Patient (Pro Cah)",,92002,CPT,Professional,Both,,,,143,121.55,29.22,143,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),45.75,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Eye Exam & Eval W Initiation Of Dx And Tx Program; Intermediate, New Patient (Pro Cah)",,92002,CPT,Professional,Both,,,,143,121.55,29.22,143,"Health Partners, Inc.",State of Minnesota Advantage Program,83.75503,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Eye Exam & Eval W Initiation Of Dx And Tx Program; Intermediate, New Patient (Pro Cah)",,92002,CPT,Professional,Both,,,,143,121.55,29.22,143,"Health Partners, Inc.",State Public Programs,29.22,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Eye Exam & Eval W Initiation Of Dx And Tx Program; Intermediate, New Patient (Pro Cah)",,92002,CPT,Professional,Both,,,,143,121.55,29.22,143,Humana Insurance Company,Commercial PPO,45.58,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Eye Exam & Eval W Initiation Of Dx And Tx Program; Intermediate, New Patient (Pro Cah)",,92002,CPT,Professional,Both,,,,143,121.55,29.22,143,Humana Insurance Company,Medicare PPO,143,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Eye Exam & Eval W Initiation Of Dx And Tx Program; Intermediate, New Patient (Pro Cah)",,92002,CPT,Professional,Both,,,,143,121.55,29.22,143,Medica,Individual & Family,121.264,84.8,,percent of total billed charges,,
"Eye Exam & Eval W Initiation Of Dx And Tx Program; Intermediate, New Patient (Pro Cah)",,92002,CPT,Professional,Both,,,,143,121.55,29.22,143,Medica,Medica Advantage Solution,71.214,49.8,,percent of total billed charges,,
"Eye Exam & Eval W Initiation Of Dx And Tx Program; Intermediate, New Patient (Pro Cah)",,92002,CPT,Professional,Both,,,,143,121.55,29.22,143,Medica,Medical Assistance,33.74,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Eye Exam & Eval W Initiation Of Dx And Tx Program; Intermediate, New Patient (Pro Cah)",,92002,CPT,Professional,Both,,,,143,121.55,29.22,143,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,45.58,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Eye Exam & Eval W Initiation Of Dx And Tx Program; Intermediate, New Patient (Pro Cah)",,92002,CPT,Professional,Both,,,,143,121.55,29.22,143,"Multiplan, Inc.","Multiplan, Inc.",134.42,94,,percent of total billed charges,,
"Eye Exam & Eval W Initiation Of Dx And Tx Program; Intermediate, New Patient (Pro Cah)",,92002,CPT,Professional,Both,,,,143,121.55,29.22,143,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,128.843,90.1,,percent of total billed charges,,
"Eye Exam & Eval W Initiation Of Dx And Tx Program; Intermediate, New Patient (Pro Cah)",,92002,CPT,Professional,Both,,,,143,121.55,29.22,143,"Preferred One Administrative Services, INC.",PPO,140.998,98.6,,percent of total billed charges,,
"Eye Exam & Eval W Initiation Of Dx And Tx Program; Intermediate, New Patient (Pro Cah)",,92002,CPT,Professional,Both,,,,143,121.55,29.22,143,PrimeWest Health,Minnesota Senior Health Options (MSHO),52.417,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Eye Exam & Eval W Initiation Of Dx And Tx Program; Intermediate, New Patient (Pro Cah)",,92002,CPT,Professional,Both,,,,143,121.55,29.22,143,PrimeWest Health,MinnesotaCare,36.1032552,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Eye Exam & Eval W Initiation Of Dx And Tx Program; Intermediate, New Patient (Pro Cah)",,92002,CPT,Professional,Both,,,,143,121.55,29.22,143,Sanford Health Plan,Sanford Health Plan,125.84,88,,percent of total billed charges,,
"Eye Exam & Eval W Initiation Of Dx And Tx Program; Intermediate, New Patient (Pro Cah)",,92002,CPT,Professional,Both,,,,143,121.55,29.22,143,"UCare Health, Inc.",Individual & Family Plan,74.094848,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Eye Exam & Eval W Initiation Of Dx And Tx Program; Intermediate, New Patient (Pro Cah)",,92002,CPT,Professional,Both,,,,143,121.55,29.22,143,"UCare Health, Inc.",Medical Assistance,37.115496,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Eye Exam & Eval W Initiation Of Dx And Tx Program; Intermediate, New Patient (Pro Cah)",,92002,CPT,Professional,Both,,,,143,121.55,29.22,143,"UCare Health, Inc.",Medicare Advantage,52.417,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Eye Exam & Eval W Initiation Of Dx And Tx Program; Intermediate, New Patient (Pro Cah)",,92002,CPT,Professional,Both,,,,143,121.55,29.22,143,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),41.9336,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Eye Exam & Eval W Initiation Of Dx And Tx Program; Intermediate, New Patient (Pro Cah)",,92002,CPT,Professional,Both,,,,143,121.55,29.22,143,UnitedHealthcare,Individual & Family,143,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Eye Exam & Eval W Initiation Of Dx And Tx Program; Intermediate, New Patient (Pro Cah)",,92002,CPT,Professional,Both,,,,143,121.55,29.22,143,UnitedHealthcare,Medicare Advantage,52.417,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Eye Exam & Eval W Initiation Of Dx And Tx Program; Intermediate, New Patient (Pro Cah)",,92002,CPT,Professional,Both,,,,143,121.55,29.22,143,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,33.74136,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Eye Exam; Intermediate, New Patient",,92002,CPT,Facility,Both,,,,92,78.2,26.3672,92,Aetna,Commercial,84.64,92,,percent of total billed charges,,
"Eye Exam; Intermediate, New Patient",,92002,CPT,Facility,Outpatient,,,,92,78.2,26.3672,92,Aetna,Medicare Advantage,45.08,49,,percent of total billed charges,,
"Eye Exam; Intermediate, New Patient",,92002,CPT,Facility,Inpatient,,,,92,78.2,26.3672,92,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Eye Exam; Intermediate, New Patient",,92002,CPT,Facility,Both,,,,92,78.2,26.3672,92,Aetna,PPO,85.56,93,,percent of total billed charges,,
"Eye Exam; Intermediate, New Patient",,92002,CPT,Facility,Both,,,,92,78.2,26.3672,92,America's PPO,America's PPO,88.3476,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Eye Exam; Intermediate, New Patient",,92002,CPT,Facility,Both,,,,92,78.2,26.3672,92,BlueCross BlueShield Minnesota, Federal Employee Program,90.528,98.4,,percent of total billed charges,,
"Eye Exam; Intermediate, New Patient",,92002,CPT,Facility,Both,,,,92,78.2,26.3672,92,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,92,100,,percent of total billed charges,,
"Eye Exam; Intermediate, New Patient",,92002,CPT,Facility,Both,,,,92,78.2,26.3672,92,BlueCross BlueShield Minnesota,High Value Network Plan,82.8,90,,percent of total billed charges,,
"Eye Exam; Intermediate, New Patient",,92002,CPT,Facility,Outpatient,,,,92,78.2,26.3672,92,BlueCross BlueShield Minnesota,Medicare Advantage,45.08,49,,percent of total billed charges,,
"Eye Exam; Intermediate, New Patient",,92002,CPT,Facility,Inpatient,,,,92,78.2,26.3672,92,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Eye Exam; Intermediate, New Patient",,92002,CPT,Facility,Both,,,,92,78.2,26.3672,92,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,81.4844,88.57,,percent of total billed charges,,
"Eye Exam; Intermediate, New Patient",,92002,CPT,Facility,Both,,,,92,78.2,26.3672,92,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,26.3672,28.66,,percent of total billed charges,,
"Eye Exam; Intermediate, New Patient",,92002,CPT,Facility,Outpatient,,,,92,78.2,26.3672,92,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),45.08,49,,percent of total billed charges,,
"Eye Exam; Intermediate, New Patient",,92002,CPT,Facility,Inpatient,,,,92,78.2,26.3672,92,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Eye Exam; Intermediate, New Patient",,92002,CPT,Facility,Both,,,,92,78.2,26.3672,92,CorVel,Worker's Compensation,92,100,,percent of total billed charges,,
"Eye Exam; Intermediate, New Patient",,92002,CPT,Facility,Both,,,,92,78.2,26.3672,92,First Health Group Corporation,First Health Network,89.24,97,,percent of total billed charges,,
"Eye Exam; Intermediate, New Patient",,92002,CPT,Facility,Both,,,,92,78.2,26.3672,92,"Health Partners, Inc.",Commercial,87.032,94.6,,percent of total billed charges,,
"Eye Exam; Intermediate, New Patient",,92002,CPT,Facility,Outpatient,,,,92,78.2,26.3672,92,"Health Partners, Inc.",Medicare Advantage,45.08,49,,percent of total billed charges,,
"Eye Exam; Intermediate, New Patient",,92002,CPT,Facility,Inpatient,,,,92,78.2,26.3672,92,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Eye Exam; Intermediate, New Patient",,92002,CPT,Facility,Both,,,,92,78.2,26.3672,92,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),55.2,60,,percent of total billed charges,,
"Eye Exam; Intermediate, New Patient",,92002,CPT,Facility,Both,,,,92,78.2,26.3672,92,"Health Partners, Inc.",State of Minnesota Advantage Program,74.98,81.5,,percent of total billed charges,,
"Eye Exam; Intermediate, New Patient",,92002,CPT,Facility,Both,,,,92,78.2,26.3672,92,"Health Partners, Inc.",State Public Programs,46,50,,percent of total billed charges,,
"Eye Exam; Intermediate, New Patient",,92002,CPT,Facility,Both,,,,92,78.2,26.3672,92,Humana Insurance Company,Commercial PPO,87.4,95,,percent of total billed charges,,
"Eye Exam; Intermediate, New Patient",,92002,CPT,Facility,Outpatient,,,,92,78.2,26.3672,92,Humana Insurance Company,Medicare PPO,45.08,49,,percent of total billed charges,,
"Eye Exam; Intermediate, New Patient",,92002,CPT,Facility,Inpatient,,,,92,78.2,26.3672,92,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Eye Exam; Intermediate, New Patient",,92002,CPT,Facility,Both,,,,92,78.2,26.3672,92,Medica,Individual & Family,91.172,99.1,,percent of total billed charges,,
"Eye Exam; Intermediate, New Patient",,92002,CPT,Facility,Outpatient,,,,92,78.2,26.3672,92,Medica,Medica Advantage Solution,45.816,49.8,,percent of total billed charges,,
"Eye Exam; Intermediate, New Patient",,92002,CPT,Facility,Inpatient,,,,92,78.2,26.3672,92,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Eye Exam; Intermediate, New Patient",,92002,CPT,Facility,Outpatient,,,,92,78.2,26.3672,92,Medica,Medical Assistance,41.032,44.6,,percent of total billed charges,,
"Eye Exam; Intermediate, New Patient",,92002,CPT,Facility,Inpatient,,,,92,78.2,26.3672,92,Medica,Medical Assistance,,,,,Included in per diem rate,
"Eye Exam; Intermediate, New Patient",,92002,CPT,Facility,Outpatient,,,,92,78.2,26.3672,92,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,45.816,49.8,,percent of total billed charges,,
"Eye Exam; Intermediate, New Patient",,92002,CPT,Facility,Inpatient,,,,92,78.2,26.3672,92,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Eye Exam; Intermediate, New Patient",,92002,CPT,Facility,Both,,,,92,78.2,26.3672,92,"Multiplan, Inc.","Multiplan, Inc.",86.48,94,,percent of total billed charges,,
"Eye Exam; Intermediate, New Patient",,92002,CPT,Facility,Outpatient,,,,92,78.2,26.3672,92,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,82.892,90.1,,percent of total billed charges,,
"Eye Exam; Intermediate, New Patient",,92002,CPT,Facility,Inpatient,,,,92,78.2,26.3672,92,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Eye Exam; Intermediate, New Patient",,92002,CPT,Facility,Both,,,,92,78.2,26.3672,92,"Preferred One Administrative Services, INC.",PPO,90.712,98.6,,percent of total billed charges,,
"Eye Exam; Intermediate, New Patient",,92002,CPT,Facility,Outpatient,,,,92,78.2,26.3672,92,PrimeWest Health,Minnesota Senior Health Options (MSHO),47.334,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Eye Exam; Intermediate, New Patient",,92002,CPT,Facility,Inpatient,,,,92,78.2,26.3672,92,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Eye Exam; Intermediate, New Patient",,92002,CPT,Facility,Outpatient,,,,92,78.2,26.3672,92,PrimeWest Health,MinnesotaCare,47.2512,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Eye Exam; Intermediate, New Patient",,92002,CPT,Facility,Inpatient,,,,92,78.2,26.3672,92,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Eye Exam; Intermediate, New Patient",,92002,CPT,Facility,Both,,,,92,78.2,26.3672,92,Sanford Health Plan,Sanford Health Plan,84.64,92,,percent of total billed charges,,
"Eye Exam; Intermediate, New Patient",,92002,CPT,Facility,Outpatient,,,,92,78.2,26.3672,92,"UCare Health, Inc.",Individual & Family Plan,51.842,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Eye Exam; Intermediate, New Patient",,92002,CPT,Facility,Inpatient,,,,92,78.2,26.3672,92,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Eye Exam; Intermediate, New Patient",,92002,CPT,Facility,Outpatient,,,,92,78.2,26.3672,92,"UCare Health, Inc.",Medical Assistance,46.4324,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Eye Exam; Intermediate, New Patient",,92002,CPT,Facility,Inpatient,,,,92,78.2,26.3672,92,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Eye Exam; Intermediate, New Patient",,92002,CPT,Facility,Outpatient,,,,92,78.2,26.3672,92,"UCare Health, Inc.",Medicare Advantage,46.4324,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Eye Exam; Intermediate, New Patient",,92002,CPT,Facility,Inpatient,,,,92,78.2,26.3672,92,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Eye Exam; Intermediate, New Patient",,92002,CPT,Facility,Outpatient,,,,92,78.2,26.3672,92,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),46.4324,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Eye Exam; Intermediate, New Patient",,92002,CPT,Facility,Inpatient,,,,92,78.2,26.3672,92,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Eye Exam; Intermediate, New Patient",,92002,CPT,Facility,Both,,,,92,78.2,26.3672,92,UnitedHealthcare,Individual & Family,86.48,94,,percent of total billed charges,,
"Eye Exam; Intermediate, New Patient",,92002,CPT,Facility,Outpatient,,,,92,78.2,26.3672,92,UnitedHealthcare,Medicare Advantage,45.08,49,,percent of total billed charges,,
"Eye Exam; Intermediate, New Patient",,92002,CPT,Facility,Inpatient,,,,92,78.2,26.3672,92,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Eye Exam; Intermediate, New Patient",,92002,CPT,Facility,Outpatient,,,,92,78.2,26.3672,92,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,44.16,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Eye Exam; Intermediate, New Patient",,92002,CPT,Facility,Inpatient,,,,92,78.2,26.3672,92,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Eye Exam & Eval W Initiation Of Dx And Tx Program; Comprehensive New Patient 1+ Visits (Pro Cah),,92004,CPT,Professional,Both,,,,230,195.5,60.21,230,Aetna,Commercial,195.5,85,,percent of total billed charges,,
Eye Exam & Eval W Initiation Of Dx And Tx Program; Comprehensive New Patient 1+ Visits (Pro Cah),,92004,CPT,Professional,Both,,,,230,195.5,60.21,230,Aetna,Medicare Advantage,95.93,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Eye Exam & Eval W Initiation Of Dx And Tx Program; Comprehensive New Patient 1+ Visits (Pro Cah),,92004,CPT,Professional,Both,,,,230,195.5,60.21,230,Aetna,PPO,213.9,93,,percent of total billed charges,,
Eye Exam & Eval W Initiation Of Dx And Tx Program; Comprehensive New Patient 1+ Visits (Pro Cah),,92004,CPT,Professional,Both,,,,230,195.5,60.21,230,America's PPO,America's PPO,196.512,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Eye Exam & Eval W Initiation Of Dx And Tx Program; Comprehensive New Patient 1+ Visits (Pro Cah),,92004,CPT,Professional,Both,,,,230,195.5,60.21,230,BlueCross BlueShield Minnesota, Federal Employee Program,119.08,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Eye Exam & Eval W Initiation Of Dx And Tx Program; Comprehensive New Patient 1+ Visits (Pro Cah),,92004,CPT,Professional,Both,,,,230,195.5,60.21,230,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,120.98528,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Eye Exam & Eval W Initiation Of Dx And Tx Program; Comprehensive New Patient 1+ Visits (Pro Cah),,92004,CPT,Professional,Both,,,,230,195.5,60.21,230,BlueCross BlueShield Minnesota,High Value Network Plan,120.98528,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Eye Exam & Eval W Initiation Of Dx And Tx Program; Comprehensive New Patient 1+ Visits (Pro Cah),,92004,CPT,Professional,Both,,,,230,195.5,60.21,230,BlueCross BlueShield Minnesota,Medicare Advantage,107.571,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Eye Exam & Eval W Initiation Of Dx And Tx Program; Comprehensive New Patient 1+ Visits (Pro Cah),,92004,CPT,Professional,Both,,,,230,195.5,60.21,230,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,120.98528,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Eye Exam & Eval W Initiation Of Dx And Tx Program; Comprehensive New Patient 1+ Visits (Pro Cah),,92004,CPT,Professional,Both,,,,230,195.5,60.21,230,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,69.51472,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Eye Exam & Eval W Initiation Of Dx And Tx Program; Comprehensive New Patient 1+ Visits (Pro Cah),,92004,CPT,Professional,Both,,,,230,195.5,60.21,230,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),107.571,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Eye Exam & Eval W Initiation Of Dx And Tx Program; Comprehensive New Patient 1+ Visits (Pro Cah),,92004,CPT,Professional,Both,,,,230,195.5,60.21,230,CorVel,Worker's Compensation,184.6738395,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Eye Exam & Eval W Initiation Of Dx And Tx Program; Comprehensive New Patient 1+ Visits (Pro Cah),,92004,CPT,Professional,Both,,,,230,195.5,60.21,230,First Health Group Corporation,First Health Network,223.1,97,,percent of total billed charges,,
Eye Exam & Eval W Initiation Of Dx And Tx Program; Comprehensive New Patient 1+ Visits (Pro Cah),,92004,CPT,Professional,Both,,,,230,195.5,60.21,230,"Health Partners, Inc.",Commercial,199.52,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Eye Exam & Eval W Initiation Of Dx And Tx Program; Comprehensive New Patient 1+ Visits (Pro Cah),,92004,CPT,Professional,Both,,,,230,195.5,60.21,230,"Health Partners, Inc.",Medicare Advantage,107.571,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Eye Exam & Eval W Initiation Of Dx And Tx Program; Comprehensive New Patient 1+ Visits (Pro Cah),,92004,CPT,Professional,Both,,,,230,195.5,60.21,230,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),93.53,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Eye Exam & Eval W Initiation Of Dx And Tx Program; Comprehensive New Patient 1+ Visits (Pro Cah),,92004,CPT,Professional,Both,,,,230,195.5,60.21,230,"Health Partners, Inc.",State of Minnesota Advantage Program,171.88648,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Eye Exam & Eval W Initiation Of Dx And Tx Program; Comprehensive New Patient 1+ Visits (Pro Cah),,92004,CPT,Professional,Both,,,,230,195.5,60.21,230,"Health Partners, Inc.",State Public Programs,60.21,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Eye Exam & Eval W Initiation Of Dx And Tx Program; Comprehensive New Patient 1+ Visits (Pro Cah),,92004,CPT,Professional,Both,,,,230,195.5,60.21,230,Humana Insurance Company,Commercial PPO,93.54,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Eye Exam & Eval W Initiation Of Dx And Tx Program; Comprehensive New Patient 1+ Visits (Pro Cah),,92004,CPT,Professional,Both,,,,230,195.5,60.21,230,Humana Insurance Company,Medicare PPO,230,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Eye Exam & Eval W Initiation Of Dx And Tx Program; Comprehensive New Patient 1+ Visits (Pro Cah),,92004,CPT,Professional,Both,,,,230,195.5,60.21,230,Medica,Individual & Family,195.04,84.8,,percent of total billed charges,,
Eye Exam & Eval W Initiation Of Dx And Tx Program; Comprehensive New Patient 1+ Visits (Pro Cah),,92004,CPT,Professional,Both,,,,230,195.5,60.21,230,Medica,Medica Advantage Solution,114.54,49.8,,percent of total billed charges,,
Eye Exam & Eval W Initiation Of Dx And Tx Program; Comprehensive New Patient 1+ Visits (Pro Cah),,92004,CPT,Professional,Both,,,,230,195.5,60.21,230,Medica,Medical Assistance,69.51,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Eye Exam & Eval W Initiation Of Dx And Tx Program; Comprehensive New Patient 1+ Visits (Pro Cah),,92004,CPT,Professional,Both,,,,230,195.5,60.21,230,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,93.54,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Eye Exam & Eval W Initiation Of Dx And Tx Program; Comprehensive New Patient 1+ Visits (Pro Cah),,92004,CPT,Professional,Both,,,,230,195.5,60.21,230,"Multiplan, Inc.","Multiplan, Inc.",216.2,94,,percent of total billed charges,,
Eye Exam & Eval W Initiation Of Dx And Tx Program; Comprehensive New Patient 1+ Visits (Pro Cah),,92004,CPT,Professional,Both,,,,230,195.5,60.21,230,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,207.23,90.1,,percent of total billed charges,,
Eye Exam & Eval W Initiation Of Dx And Tx Program; Comprehensive New Patient 1+ Visits (Pro Cah),,92004,CPT,Professional,Both,,,,230,195.5,60.21,230,"Preferred One Administrative Services, INC.",PPO,226.78,98.6,,percent of total billed charges,,
Eye Exam & Eval W Initiation Of Dx And Tx Program; Comprehensive New Patient 1+ Visits (Pro Cah),,92004,CPT,Professional,Both,,,,230,195.5,60.21,230,PrimeWest Health,Minnesota Senior Health Options (MSHO),107.571,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Eye Exam & Eval W Initiation Of Dx And Tx Program; Comprehensive New Patient 1+ Visits (Pro Cah),,92004,CPT,Professional,Both,,,,230,195.5,60.21,230,PrimeWest Health,MinnesotaCare,74.3807504,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Eye Exam & Eval W Initiation Of Dx And Tx Program; Comprehensive New Patient 1+ Visits (Pro Cah),,92004,CPT,Professional,Both,,,,230,195.5,60.21,230,Sanford Health Plan,Sanford Health Plan,202.4,88,,percent of total billed charges,,
Eye Exam & Eval W Initiation Of Dx And Tx Program; Comprehensive New Patient 1+ Visits (Pro Cah),,92004,CPT,Professional,Both,,,,230,195.5,60.21,230,"UCare Health, Inc.",Individual & Family Plan,152.058624,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Eye Exam & Eval W Initiation Of Dx And Tx Program; Comprehensive New Patient 1+ Visits (Pro Cah),,92004,CPT,Professional,Both,,,,230,195.5,60.21,230,"UCare Health, Inc.",Medical Assistance,76.466192,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Eye Exam & Eval W Initiation Of Dx And Tx Program; Comprehensive New Patient 1+ Visits (Pro Cah),,92004,CPT,Professional,Both,,,,230,195.5,60.21,230,"UCare Health, Inc.",Medicare Advantage,107.571,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Eye Exam & Eval W Initiation Of Dx And Tx Program; Comprehensive New Patient 1+ Visits (Pro Cah),,92004,CPT,Professional,Both,,,,230,195.5,60.21,230,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),86.0568,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Eye Exam & Eval W Initiation Of Dx And Tx Program; Comprehensive New Patient 1+ Visits (Pro Cah),,92004,CPT,Professional,Both,,,,230,195.5,60.21,230,UnitedHealthcare,Individual & Family,230,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Eye Exam & Eval W Initiation Of Dx And Tx Program; Comprehensive New Patient 1+ Visits (Pro Cah),,92004,CPT,Professional,Both,,,,230,195.5,60.21,230,UnitedHealthcare,Medicare Advantage,107.571,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Eye Exam & Eval W Initiation Of Dx And Tx Program; Comprehensive New Patient 1+ Visits (Pro Cah),,92004,CPT,Professional,Both,,,,230,195.5,60.21,230,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,69.51472,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Eye Exam; Comprehensive New Patient 1+ Visits,,92004,CPT,Facility,Both,,,,153,130.05,43.8498,153,Aetna,Commercial,140.76,92,,percent of total billed charges,,
Eye Exam; Comprehensive New Patient 1+ Visits,,92004,CPT,Facility,Outpatient,,,,153,130.05,43.8498,153,Aetna,Medicare Advantage,74.97,49,,percent of total billed charges,,
Eye Exam; Comprehensive New Patient 1+ Visits,,92004,CPT,Facility,Inpatient,,,,153,130.05,43.8498,153,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Eye Exam; Comprehensive New Patient 1+ Visits,,92004,CPT,Facility,Both,,,,153,130.05,43.8498,153,Aetna,PPO,142.29,93,,percent of total billed charges,,
Eye Exam; Comprehensive New Patient 1+ Visits,,92004,CPT,Facility,Both,,,,153,130.05,43.8498,153,America's PPO,America's PPO,146.9259,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Eye Exam; Comprehensive New Patient 1+ Visits,,92004,CPT,Facility,Both,,,,153,130.05,43.8498,153,BlueCross BlueShield Minnesota, Federal Employee Program,150.552,98.4,,percent of total billed charges,,
Eye Exam; Comprehensive New Patient 1+ Visits,,92004,CPT,Facility,Both,,,,153,130.05,43.8498,153,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,153,100,,percent of total billed charges,,
Eye Exam; Comprehensive New Patient 1+ Visits,,92004,CPT,Facility,Both,,,,153,130.05,43.8498,153,BlueCross BlueShield Minnesota,High Value Network Plan,137.7,90,,percent of total billed charges,,
Eye Exam; Comprehensive New Patient 1+ Visits,,92004,CPT,Facility,Outpatient,,,,153,130.05,43.8498,153,BlueCross BlueShield Minnesota,Medicare Advantage,74.97,49,,percent of total billed charges,,
Eye Exam; Comprehensive New Patient 1+ Visits,,92004,CPT,Facility,Inpatient,,,,153,130.05,43.8498,153,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Eye Exam; Comprehensive New Patient 1+ Visits,,92004,CPT,Facility,Both,,,,153,130.05,43.8498,153,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,135.5121,88.57,,percent of total billed charges,,
Eye Exam; Comprehensive New Patient 1+ Visits,,92004,CPT,Facility,Both,,,,153,130.05,43.8498,153,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,43.8498,28.66,,percent of total billed charges,,
Eye Exam; Comprehensive New Patient 1+ Visits,,92004,CPT,Facility,Outpatient,,,,153,130.05,43.8498,153,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),74.97,49,,percent of total billed charges,,
Eye Exam; Comprehensive New Patient 1+ Visits,,92004,CPT,Facility,Inpatient,,,,153,130.05,43.8498,153,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Eye Exam; Comprehensive New Patient 1+ Visits,,92004,CPT,Facility,Both,,,,153,130.05,43.8498,153,CorVel,Worker's Compensation,153,100,,percent of total billed charges,,
Eye Exam; Comprehensive New Patient 1+ Visits,,92004,CPT,Facility,Both,,,,153,130.05,43.8498,153,First Health Group Corporation,First Health Network,148.41,97,,percent of total billed charges,,
Eye Exam; Comprehensive New Patient 1+ Visits,,92004,CPT,Facility,Both,,,,153,130.05,43.8498,153,"Health Partners, Inc.",Commercial,144.738,94.6,,percent of total billed charges,,
Eye Exam; Comprehensive New Patient 1+ Visits,,92004,CPT,Facility,Outpatient,,,,153,130.05,43.8498,153,"Health Partners, Inc.",Medicare Advantage,74.97,49,,percent of total billed charges,,
Eye Exam; Comprehensive New Patient 1+ Visits,,92004,CPT,Facility,Inpatient,,,,153,130.05,43.8498,153,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Eye Exam; Comprehensive New Patient 1+ Visits,,92004,CPT,Facility,Both,,,,153,130.05,43.8498,153,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),91.8,60,,percent of total billed charges,,
Eye Exam; Comprehensive New Patient 1+ Visits,,92004,CPT,Facility,Both,,,,153,130.05,43.8498,153,"Health Partners, Inc.",State of Minnesota Advantage Program,124.695,81.5,,percent of total billed charges,,
Eye Exam; Comprehensive New Patient 1+ Visits,,92004,CPT,Facility,Both,,,,153,130.05,43.8498,153,"Health Partners, Inc.",State Public Programs,76.5,50,,percent of total billed charges,,
Eye Exam; Comprehensive New Patient 1+ Visits,,92004,CPT,Facility,Both,,,,153,130.05,43.8498,153,Humana Insurance Company,Commercial PPO,145.35,95,,percent of total billed charges,,
Eye Exam; Comprehensive New Patient 1+ Visits,,92004,CPT,Facility,Outpatient,,,,153,130.05,43.8498,153,Humana Insurance Company,Medicare PPO,74.97,49,,percent of total billed charges,,
Eye Exam; Comprehensive New Patient 1+ Visits,,92004,CPT,Facility,Inpatient,,,,153,130.05,43.8498,153,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Eye Exam; Comprehensive New Patient 1+ Visits,,92004,CPT,Facility,Both,,,,153,130.05,43.8498,153,Medica,Individual & Family,151.623,99.1,,percent of total billed charges,,
Eye Exam; Comprehensive New Patient 1+ Visits,,92004,CPT,Facility,Outpatient,,,,153,130.05,43.8498,153,Medica,Medica Advantage Solution,76.194,49.8,,percent of total billed charges,,
Eye Exam; Comprehensive New Patient 1+ Visits,,92004,CPT,Facility,Inpatient,,,,153,130.05,43.8498,153,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Eye Exam; Comprehensive New Patient 1+ Visits,,92004,CPT,Facility,Outpatient,,,,153,130.05,43.8498,153,Medica,Medical Assistance,68.238,44.6,,percent of total billed charges,,
Eye Exam; Comprehensive New Patient 1+ Visits,,92004,CPT,Facility,Inpatient,,,,153,130.05,43.8498,153,Medica,Medical Assistance,,,,,Included in per diem rate,
Eye Exam; Comprehensive New Patient 1+ Visits,,92004,CPT,Facility,Outpatient,,,,153,130.05,43.8498,153,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,76.194,49.8,,percent of total billed charges,,
Eye Exam; Comprehensive New Patient 1+ Visits,,92004,CPT,Facility,Inpatient,,,,153,130.05,43.8498,153,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Eye Exam; Comprehensive New Patient 1+ Visits,,92004,CPT,Facility,Both,,,,153,130.05,43.8498,153,"Multiplan, Inc.","Multiplan, Inc.",143.82,94,,percent of total billed charges,,
Eye Exam; Comprehensive New Patient 1+ Visits,,92004,CPT,Facility,Outpatient,,,,153,130.05,43.8498,153,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,137.853,90.1,,percent of total billed charges,,
Eye Exam; Comprehensive New Patient 1+ Visits,,92004,CPT,Facility,Inpatient,,,,153,130.05,43.8498,153,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Eye Exam; Comprehensive New Patient 1+ Visits,,92004,CPT,Facility,Both,,,,153,130.05,43.8498,153,"Preferred One Administrative Services, INC.",PPO,150.858,98.6,,percent of total billed charges,,
Eye Exam; Comprehensive New Patient 1+ Visits,,92004,CPT,Facility,Outpatient,,,,153,130.05,43.8498,153,PrimeWest Health,Minnesota Senior Health Options (MSHO),78.7185,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Eye Exam; Comprehensive New Patient 1+ Visits,,92004,CPT,Facility,Inpatient,,,,153,130.05,43.8498,153,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Eye Exam; Comprehensive New Patient 1+ Visits,,92004,CPT,Facility,Outpatient,,,,153,130.05,43.8498,153,PrimeWest Health,MinnesotaCare,78.5808,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Eye Exam; Comprehensive New Patient 1+ Visits,,92004,CPT,Facility,Inpatient,,,,153,130.05,43.8498,153,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Eye Exam; Comprehensive New Patient 1+ Visits,,92004,CPT,Facility,Both,,,,153,130.05,43.8498,153,Sanford Health Plan,Sanford Health Plan,140.76,92,,percent of total billed charges,,
Eye Exam; Comprehensive New Patient 1+ Visits,,92004,CPT,Facility,Outpatient,,,,153,130.05,43.8498,153,"UCare Health, Inc.",Individual & Family Plan,86.2155,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Eye Exam; Comprehensive New Patient 1+ Visits,,92004,CPT,Facility,Inpatient,,,,153,130.05,43.8498,153,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Eye Exam; Comprehensive New Patient 1+ Visits,,92004,CPT,Facility,Outpatient,,,,153,130.05,43.8498,153,"UCare Health, Inc.",Medical Assistance,77.2191,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Eye Exam; Comprehensive New Patient 1+ Visits,,92004,CPT,Facility,Inpatient,,,,153,130.05,43.8498,153,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Eye Exam; Comprehensive New Patient 1+ Visits,,92004,CPT,Facility,Outpatient,,,,153,130.05,43.8498,153,"UCare Health, Inc.",Medicare Advantage,77.2191,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Eye Exam; Comprehensive New Patient 1+ Visits,,92004,CPT,Facility,Inpatient,,,,153,130.05,43.8498,153,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Eye Exam; Comprehensive New Patient 1+ Visits,,92004,CPT,Facility,Outpatient,,,,153,130.05,43.8498,153,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),77.2191,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Eye Exam; Comprehensive New Patient 1+ Visits,,92004,CPT,Facility,Inpatient,,,,153,130.05,43.8498,153,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Eye Exam; Comprehensive New Patient 1+ Visits,,92004,CPT,Facility,Both,,,,153,130.05,43.8498,153,UnitedHealthcare,Individual & Family,143.82,94,,percent of total billed charges,,
Eye Exam; Comprehensive New Patient 1+ Visits,,92004,CPT,Facility,Outpatient,,,,153,130.05,43.8498,153,UnitedHealthcare,Medicare Advantage,74.97,49,,percent of total billed charges,,
Eye Exam; Comprehensive New Patient 1+ Visits,,92004,CPT,Facility,Inpatient,,,,153,130.05,43.8498,153,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Eye Exam; Comprehensive New Patient 1+ Visits,,92004,CPT,Facility,Outpatient,,,,153,130.05,43.8498,153,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,73.44,48,,percent of total billed charges,,100% of DHS outpatient percentage
Eye Exam; Comprehensive New Patient 1+ Visits,,92004,CPT,Facility,Inpatient,,,,153,130.05,43.8498,153,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Eye Exam & Eval W Continuation Of Dx And Tx Plan, Intermediate, Establish Patient (Pro Cah)",,92012,CPT,Professional,Both,,,,153,130.05,32.07,153,Aetna,Commercial,130.05,85,,percent of total billed charges,,
"Eye Exam & Eval W Continuation Of Dx And Tx Plan, Intermediate, Establish Patient (Pro Cah)",,92012,CPT,Professional,Both,,,,153,130.05,32.07,153,Aetna,Medicare Advantage,50.97,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Eye Exam & Eval W Continuation Of Dx And Tx Plan, Intermediate, Establish Patient (Pro Cah)",,92012,CPT,Professional,Both,,,,153,130.05,32.07,153,Aetna,PPO,142.29,93,,percent of total billed charges,,
"Eye Exam & Eval W Continuation Of Dx And Tx Plan, Intermediate, Establish Patient (Pro Cah)",,92012,CPT,Professional,Both,,,,153,130.05,32.07,153,America's PPO,America's PPO,130.7232,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Eye Exam & Eval W Continuation Of Dx And Tx Plan, Intermediate, Establish Patient (Pro Cah)",,92012,CPT,Professional,Both,,,,153,130.05,32.07,153,BlueCross BlueShield Minnesota, Federal Employee Program,64.06,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Eye Exam & Eval W Continuation Of Dx And Tx Plan, Intermediate, Establish Patient (Pro Cah)",,92012,CPT,Professional,Both,,,,153,130.05,32.07,153,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,65.08496,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Eye Exam & Eval W Continuation Of Dx And Tx Plan, Intermediate, Establish Patient (Pro Cah)",,92012,CPT,Professional,Both,,,,153,130.05,32.07,153,BlueCross BlueShield Minnesota,High Value Network Plan,65.08496,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Eye Exam & Eval W Continuation Of Dx And Tx Plan, Intermediate, Establish Patient (Pro Cah)",,92012,CPT,Professional,Both,,,,153,130.05,32.07,153,BlueCross BlueShield Minnesota,Medicare Advantage,57.408,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Eye Exam & Eval W Continuation Of Dx And Tx Plan, Intermediate, Establish Patient (Pro Cah)",,92012,CPT,Professional,Both,,,,153,130.05,32.07,153,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,65.08496,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Eye Exam & Eval W Continuation Of Dx And Tx Plan, Intermediate, Establish Patient (Pro Cah)",,92012,CPT,Professional,Both,,,,153,130.05,32.07,153,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,37.02304,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Eye Exam & Eval W Continuation Of Dx And Tx Plan, Intermediate, Establish Patient (Pro Cah)",,92012,CPT,Professional,Both,,,,153,130.05,32.07,153,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),57.408,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Eye Exam & Eval W Continuation Of Dx And Tx Plan, Intermediate, Establish Patient (Pro Cah)",,92012,CPT,Professional,Both,,,,153,130.05,32.07,153,CorVel,Worker's Compensation,98.1273096,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Eye Exam & Eval W Continuation Of Dx And Tx Plan, Intermediate, Establish Patient (Pro Cah)",,92012,CPT,Professional,Both,,,,153,130.05,32.07,153,First Health Group Corporation,First Health Network,148.41,97,,percent of total billed charges,,
"Eye Exam & Eval W Continuation Of Dx And Tx Plan, Intermediate, Establish Patient (Pro Cah)",,92012,CPT,Professional,Both,,,,153,130.05,32.07,153,"Health Partners, Inc.",Commercial,105.93,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Eye Exam & Eval W Continuation Of Dx And Tx Plan, Intermediate, Establish Patient (Pro Cah)",,92012,CPT,Professional,Both,,,,153,130.05,32.07,153,"Health Partners, Inc.",Medicare Advantage,57.408,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Eye Exam & Eval W Continuation Of Dx And Tx Plan, Intermediate, Establish Patient (Pro Cah)",,92012,CPT,Professional,Both,,,,153,130.05,32.07,153,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),49.81,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Eye Exam & Eval W Continuation Of Dx And Tx Plan, Intermediate, Establish Patient (Pro Cah)",,92012,CPT,Professional,Both,,,,153,130.05,32.07,153,"Health Partners, Inc.",State of Minnesota Advantage Program,91.258695,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Eye Exam & Eval W Continuation Of Dx And Tx Plan, Intermediate, Establish Patient (Pro Cah)",,92012,CPT,Professional,Both,,,,153,130.05,32.07,153,"Health Partners, Inc.",State Public Programs,32.07,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Eye Exam & Eval W Continuation Of Dx And Tx Plan, Intermediate, Establish Patient (Pro Cah)",,92012,CPT,Professional,Both,,,,153,130.05,32.07,153,Humana Insurance Company,Commercial PPO,49.92,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Eye Exam & Eval W Continuation Of Dx And Tx Plan, Intermediate, Establish Patient (Pro Cah)",,92012,CPT,Professional,Both,,,,153,130.05,32.07,153,Humana Insurance Company,Medicare PPO,153,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Eye Exam & Eval W Continuation Of Dx And Tx Plan, Intermediate, Establish Patient (Pro Cah)",,92012,CPT,Professional,Both,,,,153,130.05,32.07,153,Medica,Individual & Family,129.744,84.8,,percent of total billed charges,,
"Eye Exam & Eval W Continuation Of Dx And Tx Plan, Intermediate, Establish Patient (Pro Cah)",,92012,CPT,Professional,Both,,,,153,130.05,32.07,153,Medica,Medica Advantage Solution,76.194,49.8,,percent of total billed charges,,
"Eye Exam & Eval W Continuation Of Dx And Tx Plan, Intermediate, Establish Patient (Pro Cah)",,92012,CPT,Professional,Both,,,,153,130.05,32.07,153,Medica,Medical Assistance,37.02,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Eye Exam & Eval W Continuation Of Dx And Tx Plan, Intermediate, Establish Patient (Pro Cah)",,92012,CPT,Professional,Both,,,,153,130.05,32.07,153,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,49.92,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Eye Exam & Eval W Continuation Of Dx And Tx Plan, Intermediate, Establish Patient (Pro Cah)",,92012,CPT,Professional,Both,,,,153,130.05,32.07,153,"Multiplan, Inc.","Multiplan, Inc.",143.82,94,,percent of total billed charges,,
"Eye Exam & Eval W Continuation Of Dx And Tx Plan, Intermediate, Establish Patient (Pro Cah)",,92012,CPT,Professional,Both,,,,153,130.05,32.07,153,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,137.853,90.1,,percent of total billed charges,,
"Eye Exam & Eval W Continuation Of Dx And Tx Plan, Intermediate, Establish Patient (Pro Cah)",,92012,CPT,Professional,Both,,,,153,130.05,32.07,153,"Preferred One Administrative Services, INC.",PPO,150.858,98.6,,percent of total billed charges,,
"Eye Exam & Eval W Continuation Of Dx And Tx Plan, Intermediate, Establish Patient (Pro Cah)",,92012,CPT,Professional,Both,,,,153,130.05,32.07,153,PrimeWest Health,Minnesota Senior Health Options (MSHO),57.408,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Eye Exam & Eval W Continuation Of Dx And Tx Plan, Intermediate, Establish Patient (Pro Cah)",,92012,CPT,Professional,Both,,,,153,130.05,32.07,153,PrimeWest Health,MinnesotaCare,39.6146528,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Eye Exam & Eval W Continuation Of Dx And Tx Plan, Intermediate, Establish Patient (Pro Cah)",,92012,CPT,Professional,Both,,,,153,130.05,32.07,153,Sanford Health Plan,Sanford Health Plan,134.64,88,,percent of total billed charges,,
"Eye Exam & Eval W Continuation Of Dx And Tx Plan, Intermediate, Establish Patient (Pro Cah)",,92012,CPT,Professional,Both,,,,153,130.05,32.07,153,"UCare Health, Inc.",Individual & Family Plan,81.149952,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Eye Exam & Eval W Continuation Of Dx And Tx Plan, Intermediate, Establish Patient (Pro Cah)",,92012,CPT,Professional,Both,,,,153,130.05,32.07,153,"UCare Health, Inc.",Medical Assistance,40.725344,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Eye Exam & Eval W Continuation Of Dx And Tx Plan, Intermediate, Establish Patient (Pro Cah)",,92012,CPT,Professional,Both,,,,153,130.05,32.07,153,"UCare Health, Inc.",Medicare Advantage,57.408,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Eye Exam & Eval W Continuation Of Dx And Tx Plan, Intermediate, Establish Patient (Pro Cah)",,92012,CPT,Professional,Both,,,,153,130.05,32.07,153,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),45.9264,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Eye Exam & Eval W Continuation Of Dx And Tx Plan, Intermediate, Establish Patient (Pro Cah)",,92012,CPT,Professional,Both,,,,153,130.05,32.07,153,UnitedHealthcare,Individual & Family,153,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Eye Exam & Eval W Continuation Of Dx And Tx Plan, Intermediate, Establish Patient (Pro Cah)",,92012,CPT,Professional,Both,,,,153,130.05,32.07,153,UnitedHealthcare,Medicare Advantage,57.408,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Eye Exam & Eval W Continuation Of Dx And Tx Plan, Intermediate, Establish Patient (Pro Cah)",,92012,CPT,Professional,Both,,,,153,130.05,32.07,153,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,37.02304,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Eye Exam W Continuation Of Dx And Tx Plan, Intermediate, Establish Patient",,92012,CPT,Facility,Both,,,,97,82.45,27.8002,97,Aetna,Commercial,89.24,92,,percent of total billed charges,,
"Eye Exam W Continuation Of Dx And Tx Plan, Intermediate, Establish Patient",,92012,CPT,Facility,Outpatient,,,,97,82.45,27.8002,97,Aetna,Medicare Advantage,47.53,49,,percent of total billed charges,,
"Eye Exam W Continuation Of Dx And Tx Plan, Intermediate, Establish Patient",,92012,CPT,Facility,Inpatient,,,,97,82.45,27.8002,97,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Eye Exam W Continuation Of Dx And Tx Plan, Intermediate, Establish Patient",,92012,CPT,Facility,Both,,,,97,82.45,27.8002,97,Aetna,PPO,90.21,93,,percent of total billed charges,,
"Eye Exam W Continuation Of Dx And Tx Plan, Intermediate, Establish Patient",,92012,CPT,Facility,Both,,,,97,82.45,27.8002,97,America's PPO,America's PPO,93.1491,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Eye Exam W Continuation Of Dx And Tx Plan, Intermediate, Establish Patient",,92012,CPT,Facility,Both,,,,97,82.45,27.8002,97,BlueCross BlueShield Minnesota, Federal Employee Program,95.448,98.4,,percent of total billed charges,,
"Eye Exam W Continuation Of Dx And Tx Plan, Intermediate, Establish Patient",,92012,CPT,Facility,Both,,,,97,82.45,27.8002,97,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,97,100,,percent of total billed charges,,
"Eye Exam W Continuation Of Dx And Tx Plan, Intermediate, Establish Patient",,92012,CPT,Facility,Both,,,,97,82.45,27.8002,97,BlueCross BlueShield Minnesota,High Value Network Plan,87.3,90,,percent of total billed charges,,
"Eye Exam W Continuation Of Dx And Tx Plan, Intermediate, Establish Patient",,92012,CPT,Facility,Outpatient,,,,97,82.45,27.8002,97,BlueCross BlueShield Minnesota,Medicare Advantage,47.53,49,,percent of total billed charges,,
"Eye Exam W Continuation Of Dx And Tx Plan, Intermediate, Establish Patient",,92012,CPT,Facility,Inpatient,,,,97,82.45,27.8002,97,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Eye Exam W Continuation Of Dx And Tx Plan, Intermediate, Establish Patient",,92012,CPT,Facility,Both,,,,97,82.45,27.8002,97,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,85.9129,88.57,,percent of total billed charges,,
"Eye Exam W Continuation Of Dx And Tx Plan, Intermediate, Establish Patient",,92012,CPT,Facility,Both,,,,97,82.45,27.8002,97,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,27.8002,28.66,,percent of total billed charges,,
"Eye Exam W Continuation Of Dx And Tx Plan, Intermediate, Establish Patient",,92012,CPT,Facility,Outpatient,,,,97,82.45,27.8002,97,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),47.53,49,,percent of total billed charges,,
"Eye Exam W Continuation Of Dx And Tx Plan, Intermediate, Establish Patient",,92012,CPT,Facility,Inpatient,,,,97,82.45,27.8002,97,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Eye Exam W Continuation Of Dx And Tx Plan, Intermediate, Establish Patient",,92012,CPT,Facility,Both,,,,97,82.45,27.8002,97,CorVel,Worker's Compensation,97,100,,percent of total billed charges,,
"Eye Exam W Continuation Of Dx And Tx Plan, Intermediate, Establish Patient",,92012,CPT,Facility,Both,,,,97,82.45,27.8002,97,First Health Group Corporation,First Health Network,94.09,97,,percent of total billed charges,,
"Eye Exam W Continuation Of Dx And Tx Plan, Intermediate, Establish Patient",,92012,CPT,Facility,Both,,,,97,82.45,27.8002,97,"Health Partners, Inc.",Commercial,91.762,94.6,,percent of total billed charges,,
"Eye Exam W Continuation Of Dx And Tx Plan, Intermediate, Establish Patient",,92012,CPT,Facility,Outpatient,,,,97,82.45,27.8002,97,"Health Partners, Inc.",Medicare Advantage,47.53,49,,percent of total billed charges,,
"Eye Exam W Continuation Of Dx And Tx Plan, Intermediate, Establish Patient",,92012,CPT,Facility,Inpatient,,,,97,82.45,27.8002,97,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Eye Exam W Continuation Of Dx And Tx Plan, Intermediate, Establish Patient",,92012,CPT,Facility,Both,,,,97,82.45,27.8002,97,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),58.2,60,,percent of total billed charges,,
"Eye Exam W Continuation Of Dx And Tx Plan, Intermediate, Establish Patient",,92012,CPT,Facility,Both,,,,97,82.45,27.8002,97,"Health Partners, Inc.",State of Minnesota Advantage Program,79.055,81.5,,percent of total billed charges,,
"Eye Exam W Continuation Of Dx And Tx Plan, Intermediate, Establish Patient",,92012,CPT,Facility,Both,,,,97,82.45,27.8002,97,"Health Partners, Inc.",State Public Programs,48.5,50,,percent of total billed charges,,
"Eye Exam W Continuation Of Dx And Tx Plan, Intermediate, Establish Patient",,92012,CPT,Facility,Both,,,,97,82.45,27.8002,97,Humana Insurance Company,Commercial PPO,92.15,95,,percent of total billed charges,,
"Eye Exam W Continuation Of Dx And Tx Plan, Intermediate, Establish Patient",,92012,CPT,Facility,Outpatient,,,,97,82.45,27.8002,97,Humana Insurance Company,Medicare PPO,47.53,49,,percent of total billed charges,,
"Eye Exam W Continuation Of Dx And Tx Plan, Intermediate, Establish Patient",,92012,CPT,Facility,Inpatient,,,,97,82.45,27.8002,97,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Eye Exam W Continuation Of Dx And Tx Plan, Intermediate, Establish Patient",,92012,CPT,Facility,Both,,,,97,82.45,27.8002,97,Medica,Individual & Family,96.127,99.1,,percent of total billed charges,,
"Eye Exam W Continuation Of Dx And Tx Plan, Intermediate, Establish Patient",,92012,CPT,Facility,Outpatient,,,,97,82.45,27.8002,97,Medica,Medica Advantage Solution,48.306,49.8,,percent of total billed charges,,
"Eye Exam W Continuation Of Dx And Tx Plan, Intermediate, Establish Patient",,92012,CPT,Facility,Inpatient,,,,97,82.45,27.8002,97,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Eye Exam W Continuation Of Dx And Tx Plan, Intermediate, Establish Patient",,92012,CPT,Facility,Outpatient,,,,97,82.45,27.8002,97,Medica,Medical Assistance,43.262,44.6,,percent of total billed charges,,
"Eye Exam W Continuation Of Dx And Tx Plan, Intermediate, Establish Patient",,92012,CPT,Facility,Inpatient,,,,97,82.45,27.8002,97,Medica,Medical Assistance,,,,,Included in per diem rate,
"Eye Exam W Continuation Of Dx And Tx Plan, Intermediate, Establish Patient",,92012,CPT,Facility,Outpatient,,,,97,82.45,27.8002,97,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,48.306,49.8,,percent of total billed charges,,
"Eye Exam W Continuation Of Dx And Tx Plan, Intermediate, Establish Patient",,92012,CPT,Facility,Inpatient,,,,97,82.45,27.8002,97,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Eye Exam W Continuation Of Dx And Tx Plan, Intermediate, Establish Patient",,92012,CPT,Facility,Both,,,,97,82.45,27.8002,97,"Multiplan, Inc.","Multiplan, Inc.",91.18,94,,percent of total billed charges,,
"Eye Exam W Continuation Of Dx And Tx Plan, Intermediate, Establish Patient",,92012,CPT,Facility,Outpatient,,,,97,82.45,27.8002,97,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,87.397,90.1,,percent of total billed charges,,
"Eye Exam W Continuation Of Dx And Tx Plan, Intermediate, Establish Patient",,92012,CPT,Facility,Inpatient,,,,97,82.45,27.8002,97,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Eye Exam W Continuation Of Dx And Tx Plan, Intermediate, Establish Patient",,92012,CPT,Facility,Both,,,,97,82.45,27.8002,97,"Preferred One Administrative Services, INC.",PPO,95.642,98.6,,percent of total billed charges,,
"Eye Exam W Continuation Of Dx And Tx Plan, Intermediate, Establish Patient",,92012,CPT,Facility,Outpatient,,,,97,82.45,27.8002,97,PrimeWest Health,Minnesota Senior Health Options (MSHO),49.9065,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Eye Exam W Continuation Of Dx And Tx Plan, Intermediate, Establish Patient",,92012,CPT,Facility,Inpatient,,,,97,82.45,27.8002,97,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Eye Exam W Continuation Of Dx And Tx Plan, Intermediate, Establish Patient",,92012,CPT,Facility,Outpatient,,,,97,82.45,27.8002,97,PrimeWest Health,MinnesotaCare,49.8192,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Eye Exam W Continuation Of Dx And Tx Plan, Intermediate, Establish Patient",,92012,CPT,Facility,Inpatient,,,,97,82.45,27.8002,97,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Eye Exam W Continuation Of Dx And Tx Plan, Intermediate, Establish Patient",,92012,CPT,Facility,Both,,,,97,82.45,27.8002,97,Sanford Health Plan,Sanford Health Plan,89.24,92,,percent of total billed charges,,
"Eye Exam W Continuation Of Dx And Tx Plan, Intermediate, Establish Patient",,92012,CPT,Facility,Outpatient,,,,97,82.45,27.8002,97,"UCare Health, Inc.",Individual & Family Plan,54.6595,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Eye Exam W Continuation Of Dx And Tx Plan, Intermediate, Establish Patient",,92012,CPT,Facility,Inpatient,,,,97,82.45,27.8002,97,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Eye Exam W Continuation Of Dx And Tx Plan, Intermediate, Establish Patient",,92012,CPT,Facility,Outpatient,,,,97,82.45,27.8002,97,"UCare Health, Inc.",Medical Assistance,48.9559,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Eye Exam W Continuation Of Dx And Tx Plan, Intermediate, Establish Patient",,92012,CPT,Facility,Inpatient,,,,97,82.45,27.8002,97,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Eye Exam W Continuation Of Dx And Tx Plan, Intermediate, Establish Patient",,92012,CPT,Facility,Outpatient,,,,97,82.45,27.8002,97,"UCare Health, Inc.",Medicare Advantage,48.9559,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Eye Exam W Continuation Of Dx And Tx Plan, Intermediate, Establish Patient",,92012,CPT,Facility,Inpatient,,,,97,82.45,27.8002,97,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Eye Exam W Continuation Of Dx And Tx Plan, Intermediate, Establish Patient",,92012,CPT,Facility,Outpatient,,,,97,82.45,27.8002,97,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),48.9559,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Eye Exam W Continuation Of Dx And Tx Plan, Intermediate, Establish Patient",,92012,CPT,Facility,Inpatient,,,,97,82.45,27.8002,97,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Eye Exam W Continuation Of Dx And Tx Plan, Intermediate, Establish Patient",,92012,CPT,Facility,Both,,,,97,82.45,27.8002,97,UnitedHealthcare,Individual & Family,91.18,94,,percent of total billed charges,,
"Eye Exam W Continuation Of Dx And Tx Plan, Intermediate, Establish Patient",,92012,CPT,Facility,Outpatient,,,,97,82.45,27.8002,97,UnitedHealthcare,Medicare Advantage,47.53,49,,percent of total billed charges,,
"Eye Exam W Continuation Of Dx And Tx Plan, Intermediate, Establish Patient",,92012,CPT,Facility,Inpatient,,,,97,82.45,27.8002,97,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Eye Exam W Continuation Of Dx And Tx Plan, Intermediate, Establish Patient",,92012,CPT,Facility,Outpatient,,,,97,82.45,27.8002,97,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,46.56,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Eye Exam W Continuation Of Dx And Tx Plan, Intermediate, Establish Patient",,92012,CPT,Facility,Inpatient,,,,97,82.45,27.8002,97,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Eye Exam & Eval W Continuation Of Dx And Tx Plan, Comprehensive Establish Patient 1+ Visits (Pro Cah)",,92014,CPT,Professional,Both,,,,199,169.15,48.43,199,Aetna,Commercial,169.15,85,,percent of total billed charges,,
"Eye Exam & Eval W Continuation Of Dx And Tx Plan, Comprehensive Establish Patient 1+ Visits (Pro Cah)",,92014,CPT,Professional,Both,,,,199,169.15,48.43,199,Aetna,Medicare Advantage,77.03,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Eye Exam & Eval W Continuation Of Dx And Tx Plan, Comprehensive Establish Patient 1+ Visits (Pro Cah)",,92014,CPT,Professional,Both,,,,199,169.15,48.43,199,Aetna,PPO,185.07,93,,percent of total billed charges,,
"Eye Exam & Eval W Continuation Of Dx And Tx Plan, Comprehensive Establish Patient 1+ Visits (Pro Cah)",,92014,CPT,Professional,Both,,,,199,169.15,48.43,199,America's PPO,America's PPO,170.0256,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Eye Exam & Eval W Continuation Of Dx And Tx Plan, Comprehensive Establish Patient 1+ Visits (Pro Cah)",,92014,CPT,Professional,Both,,,,199,169.15,48.43,199,BlueCross BlueShield Minnesota, Federal Employee Program,96.3,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Eye Exam & Eval W Continuation Of Dx And Tx Plan, Comprehensive Establish Patient 1+ Visits (Pro Cah)",,92014,CPT,Professional,Both,,,,199,169.15,48.43,199,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,97.8408,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Eye Exam & Eval W Continuation Of Dx And Tx Plan, Comprehensive Establish Patient 1+ Visits (Pro Cah)",,92014,CPT,Professional,Both,,,,199,169.15,48.43,199,BlueCross BlueShield Minnesota,High Value Network Plan,97.8408,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Eye Exam & Eval W Continuation Of Dx And Tx Plan, Comprehensive Establish Patient 1+ Visits (Pro Cah)",,92014,CPT,Professional,Both,,,,199,169.15,48.43,199,BlueCross BlueShield Minnesota,Medicare Advantage,86.825,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Eye Exam & Eval W Continuation Of Dx And Tx Plan, Comprehensive Establish Patient 1+ Visits (Pro Cah)",,92014,CPT,Professional,Both,,,,199,169.15,48.43,199,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,97.8408,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Eye Exam & Eval W Continuation Of Dx And Tx Plan, Comprehensive Establish Patient 1+ Visits (Pro Cah)",,92014,CPT,Professional,Both,,,,199,169.15,48.43,199,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,55.91048,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Eye Exam & Eval W Continuation Of Dx And Tx Plan, Comprehensive Establish Patient 1+ Visits (Pro Cah)",,92014,CPT,Professional,Both,,,,199,169.15,48.43,199,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),86.825,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Eye Exam & Eval W Continuation Of Dx And Tx Plan, Comprehensive Establish Patient 1+ Visits (Pro Cah)",,92014,CPT,Professional,Both,,,,199,169.15,48.43,199,CorVel,Worker's Compensation,148.2797901,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Eye Exam & Eval W Continuation Of Dx And Tx Plan, Comprehensive Establish Patient 1+ Visits (Pro Cah)",,92014,CPT,Professional,Both,,,,199,169.15,48.43,199,First Health Group Corporation,First Health Network,193.03,97,,percent of total billed charges,,
"Eye Exam & Eval W Continuation Of Dx And Tx Plan, Comprehensive Establish Patient 1+ Visits (Pro Cah)",,92014,CPT,Professional,Both,,,,199,169.15,48.43,199,"Health Partners, Inc.",Commercial,160.35,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Eye Exam & Eval W Continuation Of Dx And Tx Plan, Comprehensive Establish Patient 1+ Visits (Pro Cah)",,92014,CPT,Professional,Both,,,,199,169.15,48.43,199,"Health Partners, Inc.",Medicare Advantage,86.825,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Eye Exam & Eval W Continuation Of Dx And Tx Plan, Comprehensive Establish Patient 1+ Visits (Pro Cah)",,92014,CPT,Professional,Both,,,,199,169.15,48.43,199,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),75.23,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Eye Exam & Eval W Continuation Of Dx And Tx Plan, Comprehensive Establish Patient 1+ Visits (Pro Cah)",,92014,CPT,Professional,Both,,,,199,169.15,48.43,199,"Health Partners, Inc.",State of Minnesota Advantage Program,138.141525,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Eye Exam & Eval W Continuation Of Dx And Tx Plan, Comprehensive Establish Patient 1+ Visits (Pro Cah)",,92014,CPT,Professional,Both,,,,199,169.15,48.43,199,"Health Partners, Inc.",State Public Programs,48.43,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Eye Exam & Eval W Continuation Of Dx And Tx Plan, Comprehensive Establish Patient 1+ Visits (Pro Cah)",,92014,CPT,Professional,Both,,,,199,169.15,48.43,199,Humana Insurance Company,Commercial PPO,75.5,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Eye Exam & Eval W Continuation Of Dx And Tx Plan, Comprehensive Establish Patient 1+ Visits (Pro Cah)",,92014,CPT,Professional,Both,,,,199,169.15,48.43,199,Humana Insurance Company,Medicare PPO,199,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Eye Exam & Eval W Continuation Of Dx And Tx Plan, Comprehensive Establish Patient 1+ Visits (Pro Cah)",,92014,CPT,Professional,Both,,,,199,169.15,48.43,199,Medica,Individual & Family,168.752,84.8,,percent of total billed charges,,
"Eye Exam & Eval W Continuation Of Dx And Tx Plan, Comprehensive Establish Patient 1+ Visits (Pro Cah)",,92014,CPT,Professional,Both,,,,199,169.15,48.43,199,Medica,Medica Advantage Solution,99.102,49.8,,percent of total billed charges,,
"Eye Exam & Eval W Continuation Of Dx And Tx Plan, Comprehensive Establish Patient 1+ Visits (Pro Cah)",,92014,CPT,Professional,Both,,,,199,169.15,48.43,199,Medica,Medical Assistance,55.91,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Eye Exam & Eval W Continuation Of Dx And Tx Plan, Comprehensive Establish Patient 1+ Visits (Pro Cah)",,92014,CPT,Professional,Both,,,,199,169.15,48.43,199,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,75.5,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Eye Exam & Eval W Continuation Of Dx And Tx Plan, Comprehensive Establish Patient 1+ Visits (Pro Cah)",,92014,CPT,Professional,Both,,,,199,169.15,48.43,199,"Multiplan, Inc.","Multiplan, Inc.",187.06,94,,percent of total billed charges,,
"Eye Exam & Eval W Continuation Of Dx And Tx Plan, Comprehensive Establish Patient 1+ Visits (Pro Cah)",,92014,CPT,Professional,Both,,,,199,169.15,48.43,199,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,179.299,90.1,,percent of total billed charges,,
"Eye Exam & Eval W Continuation Of Dx And Tx Plan, Comprehensive Establish Patient 1+ Visits (Pro Cah)",,92014,CPT,Professional,Both,,,,199,169.15,48.43,199,"Preferred One Administrative Services, INC.",PPO,196.214,98.6,,percent of total billed charges,,
"Eye Exam & Eval W Continuation Of Dx And Tx Plan, Comprehensive Establish Patient 1+ Visits (Pro Cah)",,92014,CPT,Professional,Both,,,,199,169.15,48.43,199,PrimeWest Health,Minnesota Senior Health Options (MSHO),86.825,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Eye Exam & Eval W Continuation Of Dx And Tx Plan, Comprehensive Establish Patient 1+ Visits (Pro Cah)",,92014,CPT,Professional,Both,,,,199,169.15,48.43,199,PrimeWest Health,MinnesotaCare,59.8242136,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Eye Exam & Eval W Continuation Of Dx And Tx Plan, Comprehensive Establish Patient 1+ Visits (Pro Cah)",,92014,CPT,Professional,Both,,,,199,169.15,48.43,199,Sanford Health Plan,Sanford Health Plan,175.12,88,,percent of total billed charges,,
"Eye Exam & Eval W Continuation Of Dx And Tx Plan, Comprehensive Establish Patient 1+ Visits (Pro Cah)",,92014,CPT,Professional,Both,,,,199,169.15,48.43,199,"UCare Health, Inc.",Individual & Family Plan,122.7328,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Eye Exam & Eval W Continuation Of Dx And Tx Plan, Comprehensive Establish Patient 1+ Visits (Pro Cah)",,92014,CPT,Professional,Both,,,,199,169.15,48.43,199,"UCare Health, Inc.",Medical Assistance,61.501528,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Eye Exam & Eval W Continuation Of Dx And Tx Plan, Comprehensive Establish Patient 1+ Visits (Pro Cah)",,92014,CPT,Professional,Both,,,,199,169.15,48.43,199,"UCare Health, Inc.",Medicare Advantage,86.825,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Eye Exam & Eval W Continuation Of Dx And Tx Plan, Comprehensive Establish Patient 1+ Visits (Pro Cah)",,92014,CPT,Professional,Both,,,,199,169.15,48.43,199,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),69.46,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Eye Exam & Eval W Continuation Of Dx And Tx Plan, Comprehensive Establish Patient 1+ Visits (Pro Cah)",,92014,CPT,Professional,Both,,,,199,169.15,48.43,199,UnitedHealthcare,Individual & Family,199,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Eye Exam & Eval W Continuation Of Dx And Tx Plan, Comprehensive Establish Patient 1+ Visits (Pro Cah)",,92014,CPT,Professional,Both,,,,199,169.15,48.43,199,UnitedHealthcare,Medicare Advantage,86.825,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Eye Exam & Eval W Continuation Of Dx And Tx Plan, Comprehensive Establish Patient 1+ Visits (Pro Cah)",,92014,CPT,Professional,Both,,,,199,169.15,48.43,199,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,55.91048,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Eye Exam W Continuation Of Dx And Tx Plan, Comprehensive Establish Patient 1+ Visits",,92014,CPT,Facility,Both,,,,133,113.05,38.1178,133,Aetna,Commercial,122.36,92,,percent of total billed charges,,
"Eye Exam W Continuation Of Dx And Tx Plan, Comprehensive Establish Patient 1+ Visits",,92014,CPT,Facility,Outpatient,,,,133,113.05,38.1178,133,Aetna,Medicare Advantage,65.17,49,,percent of total billed charges,,
"Eye Exam W Continuation Of Dx And Tx Plan, Comprehensive Establish Patient 1+ Visits",,92014,CPT,Facility,Inpatient,,,,133,113.05,38.1178,133,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Eye Exam W Continuation Of Dx And Tx Plan, Comprehensive Establish Patient 1+ Visits",,92014,CPT,Facility,Both,,,,133,113.05,38.1178,133,Aetna,PPO,123.69,93,,percent of total billed charges,,
"Eye Exam W Continuation Of Dx And Tx Plan, Comprehensive Establish Patient 1+ Visits",,92014,CPT,Facility,Both,,,,133,113.05,38.1178,133,America's PPO,America's PPO,127.7199,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Eye Exam W Continuation Of Dx And Tx Plan, Comprehensive Establish Patient 1+ Visits",,92014,CPT,Facility,Both,,,,133,113.05,38.1178,133,BlueCross BlueShield Minnesota, Federal Employee Program,130.872,98.4,,percent of total billed charges,,
"Eye Exam W Continuation Of Dx And Tx Plan, Comprehensive Establish Patient 1+ Visits",,92014,CPT,Facility,Both,,,,133,113.05,38.1178,133,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,133,100,,percent of total billed charges,,
"Eye Exam W Continuation Of Dx And Tx Plan, Comprehensive Establish Patient 1+ Visits",,92014,CPT,Facility,Both,,,,133,113.05,38.1178,133,BlueCross BlueShield Minnesota,High Value Network Plan,119.7,90,,percent of total billed charges,,
"Eye Exam W Continuation Of Dx And Tx Plan, Comprehensive Establish Patient 1+ Visits",,92014,CPT,Facility,Outpatient,,,,133,113.05,38.1178,133,BlueCross BlueShield Minnesota,Medicare Advantage,65.17,49,,percent of total billed charges,,
"Eye Exam W Continuation Of Dx And Tx Plan, Comprehensive Establish Patient 1+ Visits",,92014,CPT,Facility,Inpatient,,,,133,113.05,38.1178,133,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Eye Exam W Continuation Of Dx And Tx Plan, Comprehensive Establish Patient 1+ Visits",,92014,CPT,Facility,Both,,,,133,113.05,38.1178,133,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,117.7981,88.57,,percent of total billed charges,,
"Eye Exam W Continuation Of Dx And Tx Plan, Comprehensive Establish Patient 1+ Visits",,92014,CPT,Facility,Both,,,,133,113.05,38.1178,133,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,38.1178,28.66,,percent of total billed charges,,
"Eye Exam W Continuation Of Dx And Tx Plan, Comprehensive Establish Patient 1+ Visits",,92014,CPT,Facility,Outpatient,,,,133,113.05,38.1178,133,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),65.17,49,,percent of total billed charges,,
"Eye Exam W Continuation Of Dx And Tx Plan, Comprehensive Establish Patient 1+ Visits",,92014,CPT,Facility,Inpatient,,,,133,113.05,38.1178,133,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Eye Exam W Continuation Of Dx And Tx Plan, Comprehensive Establish Patient 1+ Visits",,92014,CPT,Facility,Both,,,,133,113.05,38.1178,133,CorVel,Worker's Compensation,133,100,,percent of total billed charges,,
"Eye Exam W Continuation Of Dx And Tx Plan, Comprehensive Establish Patient 1+ Visits",,92014,CPT,Facility,Both,,,,133,113.05,38.1178,133,First Health Group Corporation,First Health Network,129.01,97,,percent of total billed charges,,
"Eye Exam W Continuation Of Dx And Tx Plan, Comprehensive Establish Patient 1+ Visits",,92014,CPT,Facility,Both,,,,133,113.05,38.1178,133,"Health Partners, Inc.",Commercial,125.818,94.6,,percent of total billed charges,,
"Eye Exam W Continuation Of Dx And Tx Plan, Comprehensive Establish Patient 1+ Visits",,92014,CPT,Facility,Outpatient,,,,133,113.05,38.1178,133,"Health Partners, Inc.",Medicare Advantage,65.17,49,,percent of total billed charges,,
"Eye Exam W Continuation Of Dx And Tx Plan, Comprehensive Establish Patient 1+ Visits",,92014,CPT,Facility,Inpatient,,,,133,113.05,38.1178,133,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Eye Exam W Continuation Of Dx And Tx Plan, Comprehensive Establish Patient 1+ Visits",,92014,CPT,Facility,Both,,,,133,113.05,38.1178,133,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),79.8,60,,percent of total billed charges,,
"Eye Exam W Continuation Of Dx And Tx Plan, Comprehensive Establish Patient 1+ Visits",,92014,CPT,Facility,Both,,,,133,113.05,38.1178,133,"Health Partners, Inc.",State of Minnesota Advantage Program,108.395,81.5,,percent of total billed charges,,
"Eye Exam W Continuation Of Dx And Tx Plan, Comprehensive Establish Patient 1+ Visits",,92014,CPT,Facility,Both,,,,133,113.05,38.1178,133,"Health Partners, Inc.",State Public Programs,66.5,50,,percent of total billed charges,,
"Eye Exam W Continuation Of Dx And Tx Plan, Comprehensive Establish Patient 1+ Visits",,92014,CPT,Facility,Both,,,,133,113.05,38.1178,133,Humana Insurance Company,Commercial PPO,126.35,95,,percent of total billed charges,,
"Eye Exam W Continuation Of Dx And Tx Plan, Comprehensive Establish Patient 1+ Visits",,92014,CPT,Facility,Outpatient,,,,133,113.05,38.1178,133,Humana Insurance Company,Medicare PPO,65.17,49,,percent of total billed charges,,
"Eye Exam W Continuation Of Dx And Tx Plan, Comprehensive Establish Patient 1+ Visits",,92014,CPT,Facility,Inpatient,,,,133,113.05,38.1178,133,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Eye Exam W Continuation Of Dx And Tx Plan, Comprehensive Establish Patient 1+ Visits",,92014,CPT,Facility,Both,,,,133,113.05,38.1178,133,Medica,Individual & Family,131.803,99.1,,percent of total billed charges,,
"Eye Exam W Continuation Of Dx And Tx Plan, Comprehensive Establish Patient 1+ Visits",,92014,CPT,Facility,Outpatient,,,,133,113.05,38.1178,133,Medica,Medica Advantage Solution,66.234,49.8,,percent of total billed charges,,
"Eye Exam W Continuation Of Dx And Tx Plan, Comprehensive Establish Patient 1+ Visits",,92014,CPT,Facility,Inpatient,,,,133,113.05,38.1178,133,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Eye Exam W Continuation Of Dx And Tx Plan, Comprehensive Establish Patient 1+ Visits",,92014,CPT,Facility,Outpatient,,,,133,113.05,38.1178,133,Medica,Medical Assistance,59.318,44.6,,percent of total billed charges,,
"Eye Exam W Continuation Of Dx And Tx Plan, Comprehensive Establish Patient 1+ Visits",,92014,CPT,Facility,Inpatient,,,,133,113.05,38.1178,133,Medica,Medical Assistance,,,,,Included in per diem rate,
"Eye Exam W Continuation Of Dx And Tx Plan, Comprehensive Establish Patient 1+ Visits",,92014,CPT,Facility,Outpatient,,,,133,113.05,38.1178,133,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,66.234,49.8,,percent of total billed charges,,
"Eye Exam W Continuation Of Dx And Tx Plan, Comprehensive Establish Patient 1+ Visits",,92014,CPT,Facility,Inpatient,,,,133,113.05,38.1178,133,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Eye Exam W Continuation Of Dx And Tx Plan, Comprehensive Establish Patient 1+ Visits",,92014,CPT,Facility,Both,,,,133,113.05,38.1178,133,"Multiplan, Inc.","Multiplan, Inc.",125.02,94,,percent of total billed charges,,
"Eye Exam W Continuation Of Dx And Tx Plan, Comprehensive Establish Patient 1+ Visits",,92014,CPT,Facility,Outpatient,,,,133,113.05,38.1178,133,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,119.833,90.1,,percent of total billed charges,,
"Eye Exam W Continuation Of Dx And Tx Plan, Comprehensive Establish Patient 1+ Visits",,92014,CPT,Facility,Inpatient,,,,133,113.05,38.1178,133,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Eye Exam W Continuation Of Dx And Tx Plan, Comprehensive Establish Patient 1+ Visits",,92014,CPT,Facility,Both,,,,133,113.05,38.1178,133,"Preferred One Administrative Services, INC.",PPO,131.138,98.6,,percent of total billed charges,,
"Eye Exam W Continuation Of Dx And Tx Plan, Comprehensive Establish Patient 1+ Visits",,92014,CPT,Facility,Outpatient,,,,133,113.05,38.1178,133,PrimeWest Health,Minnesota Senior Health Options (MSHO),68.4285,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Eye Exam W Continuation Of Dx And Tx Plan, Comprehensive Establish Patient 1+ Visits",,92014,CPT,Facility,Inpatient,,,,133,113.05,38.1178,133,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Eye Exam W Continuation Of Dx And Tx Plan, Comprehensive Establish Patient 1+ Visits",,92014,CPT,Facility,Outpatient,,,,133,113.05,38.1178,133,PrimeWest Health,MinnesotaCare,68.3088,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Eye Exam W Continuation Of Dx And Tx Plan, Comprehensive Establish Patient 1+ Visits",,92014,CPT,Facility,Inpatient,,,,133,113.05,38.1178,133,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Eye Exam W Continuation Of Dx And Tx Plan, Comprehensive Establish Patient 1+ Visits",,92014,CPT,Facility,Both,,,,133,113.05,38.1178,133,Sanford Health Plan,Sanford Health Plan,122.36,92,,percent of total billed charges,,
"Eye Exam W Continuation Of Dx And Tx Plan, Comprehensive Establish Patient 1+ Visits",,92014,CPT,Facility,Outpatient,,,,133,113.05,38.1178,133,"UCare Health, Inc.",Individual & Family Plan,74.9455,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Eye Exam W Continuation Of Dx And Tx Plan, Comprehensive Establish Patient 1+ Visits",,92014,CPT,Facility,Inpatient,,,,133,113.05,38.1178,133,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Eye Exam W Continuation Of Dx And Tx Plan, Comprehensive Establish Patient 1+ Visits",,92014,CPT,Facility,Outpatient,,,,133,113.05,38.1178,133,"UCare Health, Inc.",Medical Assistance,67.1251,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Eye Exam W Continuation Of Dx And Tx Plan, Comprehensive Establish Patient 1+ Visits",,92014,CPT,Facility,Inpatient,,,,133,113.05,38.1178,133,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Eye Exam W Continuation Of Dx And Tx Plan, Comprehensive Establish Patient 1+ Visits",,92014,CPT,Facility,Outpatient,,,,133,113.05,38.1178,133,"UCare Health, Inc.",Medicare Advantage,67.1251,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Eye Exam W Continuation Of Dx And Tx Plan, Comprehensive Establish Patient 1+ Visits",,92014,CPT,Facility,Inpatient,,,,133,113.05,38.1178,133,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Eye Exam W Continuation Of Dx And Tx Plan, Comprehensive Establish Patient 1+ Visits",,92014,CPT,Facility,Outpatient,,,,133,113.05,38.1178,133,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),67.1251,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Eye Exam W Continuation Of Dx And Tx Plan, Comprehensive Establish Patient 1+ Visits",,92014,CPT,Facility,Inpatient,,,,133,113.05,38.1178,133,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Eye Exam W Continuation Of Dx And Tx Plan, Comprehensive Establish Patient 1+ Visits",,92014,CPT,Facility,Both,,,,133,113.05,38.1178,133,UnitedHealthcare,Individual & Family,125.02,94,,percent of total billed charges,,
"Eye Exam W Continuation Of Dx And Tx Plan, Comprehensive Establish Patient 1+ Visits",,92014,CPT,Facility,Outpatient,,,,133,113.05,38.1178,133,UnitedHealthcare,Medicare Advantage,65.17,49,,percent of total billed charges,,
"Eye Exam W Continuation Of Dx And Tx Plan, Comprehensive Establish Patient 1+ Visits",,92014,CPT,Facility,Inpatient,,,,133,113.05,38.1178,133,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Eye Exam W Continuation Of Dx And Tx Plan, Comprehensive Establish Patient 1+ Visits",,92014,CPT,Facility,Outpatient,,,,133,113.05,38.1178,133,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,63.84,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Eye Exam W Continuation Of Dx And Tx Plan, Comprehensive Establish Patient 1+ Visits",,92014,CPT,Facility,Inpatient,,,,133,113.05,38.1178,133,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Gonioscopy (Pro Cah),,92020,CPT,Professional,Both,,,,82,69.7,12.87,82,Aetna,Commercial,69.7,85,,percent of total billed charges,,
Gonioscopy (Pro Cah),,92020,CPT,Professional,Both,,,,82,69.7,12.87,82,Aetna,Medicare Advantage,20.46,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Gonioscopy (Pro Cah),,92020,CPT,Professional,Both,,,,82,69.7,12.87,82,Aetna,PPO,76.26,93,,percent of total billed charges,,
Gonioscopy (Pro Cah),,92020,CPT,Professional,Both,,,,82,69.7,12.87,82,America's PPO,America's PPO,70.0608,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Gonioscopy (Pro Cah),,92020,CPT,Professional,Both,,,,82,69.7,12.87,82,BlueCross BlueShield Minnesota, Federal Employee Program,35.01,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Gonioscopy (Pro Cah),,92020,CPT,Professional,Both,,,,82,69.7,12.87,82,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,35.57016,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Gonioscopy (Pro Cah),,92020,CPT,Professional,Both,,,,82,69.7,12.87,82,BlueCross BlueShield Minnesota,High Value Network Plan,35.57016,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Gonioscopy (Pro Cah),,92020,CPT,Professional,Both,,,,82,69.7,12.87,82,BlueCross BlueShield Minnesota,Medicare Advantage,23.2875,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Gonioscopy (Pro Cah),,92020,CPT,Professional,Both,,,,82,69.7,12.87,82,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,35.57016,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Gonioscopy (Pro Cah),,92020,CPT,Professional,Both,,,,82,69.7,12.87,82,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,14.85392,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Gonioscopy (Pro Cah),,92020,CPT,Professional,Both,,,,82,69.7,12.87,82,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),23.2875,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Gonioscopy (Pro Cah),,92020,CPT,Professional,Both,,,,82,69.7,12.87,82,CorVel,Worker's Compensation,39.3790842,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Gonioscopy (Pro Cah),,92020,CPT,Professional,Both,,,,82,69.7,12.87,82,First Health Group Corporation,First Health Network,79.54,97,,percent of total billed charges,,
Gonioscopy (Pro Cah),,92020,CPT,Professional,Both,,,,82,69.7,12.87,82,"Health Partners, Inc.",Commercial,42.08,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Gonioscopy (Pro Cah),,92020,CPT,Professional,Both,,,,82,69.7,12.87,82,"Health Partners, Inc.",Medicare Advantage,23.2875,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Gonioscopy (Pro Cah),,92020,CPT,Professional,Both,,,,82,69.7,12.87,82,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),19.99,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Gonioscopy (Pro Cah),,92020,CPT,Professional,Both,,,,82,69.7,12.87,82,"Health Partners, Inc.",State of Minnesota Advantage Program,36.25192,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Gonioscopy (Pro Cah),,92020,CPT,Professional,Both,,,,82,69.7,12.87,82,"Health Partners, Inc.",State Public Programs,12.87,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Gonioscopy (Pro Cah),,92020,CPT,Professional,Both,,,,82,69.7,12.87,82,Humana Insurance Company,Commercial PPO,20.25,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Gonioscopy (Pro Cah),,92020,CPT,Professional,Both,,,,82,69.7,12.87,82,Humana Insurance Company,Medicare PPO,82,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Gonioscopy (Pro Cah),,92020,CPT,Professional,Both,,,,82,69.7,12.87,82,Medica,Individual & Family,69.536,84.8,,percent of total billed charges,,
Gonioscopy (Pro Cah),,92020,CPT,Professional,Both,,,,82,69.7,12.87,82,Medica,Medica Advantage Solution,40.836,49.8,,percent of total billed charges,,
Gonioscopy (Pro Cah),,92020,CPT,Professional,Both,,,,82,69.7,12.87,82,Medica,Medical Assistance,14.85,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Gonioscopy (Pro Cah),,92020,CPT,Professional,Both,,,,82,69.7,12.87,82,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,20.25,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Gonioscopy (Pro Cah),,92020,CPT,Professional,Both,,,,82,69.7,12.87,82,"Multiplan, Inc.","Multiplan, Inc.",77.08,94,,percent of total billed charges,,
Gonioscopy (Pro Cah),,92020,CPT,Professional,Both,,,,82,69.7,12.87,82,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,73.882,90.1,,percent of total billed charges,,
Gonioscopy (Pro Cah),,92020,CPT,Professional,Both,,,,82,69.7,12.87,82,"Preferred One Administrative Services, INC.",PPO,80.852,98.6,,percent of total billed charges,,
Gonioscopy (Pro Cah),,92020,CPT,Professional,Both,,,,82,69.7,12.87,82,PrimeWest Health,Minnesota Senior Health Options (MSHO),23.2875,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Gonioscopy (Pro Cah),,92020,CPT,Professional,Both,,,,82,69.7,12.87,82,PrimeWest Health,MinnesotaCare,15.8936944,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Gonioscopy (Pro Cah),,92020,CPT,Professional,Both,,,,82,69.7,12.87,82,Sanford Health Plan,Sanford Health Plan,72.16,88,,percent of total billed charges,,
Gonioscopy (Pro Cah),,92020,CPT,Professional,Both,,,,82,69.7,12.87,82,"UCare Health, Inc.",Individual & Family Plan,32.9184,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Gonioscopy (Pro Cah),,92020,CPT,Professional,Both,,,,82,69.7,12.87,82,"UCare Health, Inc.",Medical Assistance,16.339312,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Gonioscopy (Pro Cah),,92020,CPT,Professional,Both,,,,82,69.7,12.87,82,"UCare Health, Inc.",Medicare Advantage,23.2875,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Gonioscopy (Pro Cah),,92020,CPT,Professional,Both,,,,82,69.7,12.87,82,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),18.63,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Gonioscopy (Pro Cah),,92020,CPT,Professional,Both,,,,82,69.7,12.87,82,UnitedHealthcare,Individual & Family,82,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Gonioscopy (Pro Cah),,92020,CPT,Professional,Both,,,,82,69.7,12.87,82,UnitedHealthcare,Medicare Advantage,23.2875,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Gonioscopy (Pro Cah),,92020,CPT,Professional,Both,,,,82,69.7,12.87,82,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,14.85392,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Computerized Corneal Topography, Unilateral Or Bilateral, With Interpretation And Report (Pro Cah)",,92025,CPT,Professional,Both,,,,117,99.45,14.10208,117,Aetna,Commercial,99.45,85,,percent of total billed charges,,
"Computerized Corneal Topography, Unilateral Or Bilateral, With Interpretation And Report (Pro Cah)",,92025,CPT,Professional,Both,,,,117,99.45,14.10208,117,Aetna,Medicare Advantage,37.2,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Computerized Corneal Topography, Unilateral Or Bilateral, With Interpretation And Report (Pro Cah)",,92025,CPT,Professional,Both,,,,117,99.45,14.10208,117,Aetna,PPO,108.81,93,,percent of total billed charges,,
"Computerized Corneal Topography, Unilateral Or Bilateral, With Interpretation And Report (Pro Cah)",,92025,CPT,Professional,Both,,,,117,99.45,14.10208,117,America's PPO,America's PPO,99.9648,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Computerized Corneal Topography, Unilateral Or Bilateral, With Interpretation And Report (Pro Cah)",,92025,CPT,Professional,Both,,,,117,99.45,14.10208,117,BlueCross BlueShield Minnesota, Federal Employee Program,63.02,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Computerized Corneal Topography, Unilateral Or Bilateral, With Interpretation And Report (Pro Cah)",,92025,CPT,Professional,Both,,,,117,99.45,14.10208,117,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,64.02832,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Computerized Corneal Topography, Unilateral Or Bilateral, With Interpretation And Report (Pro Cah)",,92025,CPT,Professional,Both,,,,117,99.45,14.10208,117,BlueCross BlueShield Minnesota,High Value Network Plan,64.02832,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Computerized Corneal Topography, Unilateral Or Bilateral, With Interpretation And Report (Pro Cah)",,92025,CPT,Professional,Both,,,,117,99.45,14.10208,117,BlueCross BlueShield Minnesota,Medicare Advantage,42.09,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Computerized Corneal Topography, Unilateral Or Bilateral, With Interpretation And Report (Pro Cah)",,92025,CPT,Professional,Both,,,,117,99.45,14.10208,117,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,64.02832,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Computerized Corneal Topography, Unilateral Or Bilateral, With Interpretation And Report (Pro Cah)",,92025,CPT,Professional,Both,,,,117,99.45,14.10208,117,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,14.10208,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Computerized Corneal Topography, Unilateral Or Bilateral, With Interpretation And Report (Pro Cah)",,92025,CPT,Professional,Both,,,,117,99.45,14.10208,117,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),42.09,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Computerized Corneal Topography, Unilateral Or Bilateral, With Interpretation And Report (Pro Cah)",,92025,CPT,Professional,Both,,,,117,99.45,14.10208,117,CorVel,Worker's Compensation,70.9335351,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Computerized Corneal Topography, Unilateral Or Bilateral, With Interpretation And Report (Pro Cah)",,92025,CPT,Professional,Both,,,,117,99.45,14.10208,117,First Health Group Corporation,First Health Network,113.49,97,,percent of total billed charges,,
"Computerized Corneal Topography, Unilateral Or Bilateral, With Interpretation And Report (Pro Cah)",,92025,CPT,Professional,Both,,,,117,99.45,14.10208,117,"Health Partners, Inc.",Commercial,76.18,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Computerized Corneal Topography, Unilateral Or Bilateral, With Interpretation And Report (Pro Cah)",,92025,CPT,Professional,Both,,,,117,99.45,14.10208,117,"Health Partners, Inc.",Medicare Advantage,42.09,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Computerized Corneal Topography, Unilateral Or Bilateral, With Interpretation And Report (Pro Cah)",,92025,CPT,Professional,Both,,,,117,99.45,14.10208,117,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),36.6,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Computerized Corneal Topography, Unilateral Or Bilateral, With Interpretation And Report (Pro Cah)",,92025,CPT,Professional,Both,,,,117,99.45,14.10208,117,"Health Partners, Inc.",State of Minnesota Advantage Program,65.62907,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Computerized Corneal Topography, Unilateral Or Bilateral, With Interpretation And Report (Pro Cah)",,92025,CPT,Professional,Both,,,,117,99.45,14.10208,117,"Health Partners, Inc.",State Public Programs,23.56,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Computerized Corneal Topography, Unilateral Or Bilateral, With Interpretation And Report (Pro Cah)",,92025,CPT,Professional,Both,,,,117,99.45,14.10208,117,Humana Insurance Company,Commercial PPO,36.6,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Computerized Corneal Topography, Unilateral Or Bilateral, With Interpretation And Report (Pro Cah)",,92025,CPT,Professional,Both,,,,117,99.45,14.10208,117,Humana Insurance Company,Medicare PPO,117,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Computerized Corneal Topography, Unilateral Or Bilateral, With Interpretation And Report (Pro Cah)",,92025,CPT,Professional,Both,,,,117,99.45,14.10208,117,Medica,Individual & Family,99.216,84.8,,percent of total billed charges,,
"Computerized Corneal Topography, Unilateral Or Bilateral, With Interpretation And Report (Pro Cah)",,92025,CPT,Professional,Both,,,,117,99.45,14.10208,117,Medica,Medica Advantage Solution,58.266,49.8,,percent of total billed charges,,
"Computerized Corneal Topography, Unilateral Or Bilateral, With Interpretation And Report (Pro Cah)",,92025,CPT,Professional,Both,,,,117,99.45,14.10208,117,Medica,Medical Assistance,27.2,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Computerized Corneal Topography, Unilateral Or Bilateral, With Interpretation And Report (Pro Cah)",,92025,CPT,Professional,Both,,,,117,99.45,14.10208,117,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,36.6,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Computerized Corneal Topography, Unilateral Or Bilateral, With Interpretation And Report (Pro Cah)",,92025,CPT,Professional,Both,,,,117,99.45,14.10208,117,"Multiplan, Inc.","Multiplan, Inc.",109.98,94,,percent of total billed charges,,
"Computerized Corneal Topography, Unilateral Or Bilateral, With Interpretation And Report (Pro Cah)",,92025,CPT,Professional,Both,,,,117,99.45,14.10208,117,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,105.417,90.1,,percent of total billed charges,,
"Computerized Corneal Topography, Unilateral Or Bilateral, With Interpretation And Report (Pro Cah)",,92025,CPT,Professional,Both,,,,117,99.45,14.10208,117,"Preferred One Administrative Services, INC.",PPO,115.362,98.6,,percent of total billed charges,,
"Computerized Corneal Topography, Unilateral Or Bilateral, With Interpretation And Report (Pro Cah)",,92025,CPT,Professional,Both,,,,117,99.45,14.10208,117,PrimeWest Health,Minnesota Senior Health Options (MSHO),42.09,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Computerized Corneal Topography, Unilateral Or Bilateral, With Interpretation And Report (Pro Cah)",,92025,CPT,Professional,Both,,,,117,99.45,14.10208,117,PrimeWest Health,MinnesotaCare,15.0892256,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Computerized Corneal Topography, Unilateral Or Bilateral, With Interpretation And Report (Pro Cah)",,92025,CPT,Professional,Both,,,,117,99.45,14.10208,117,Sanford Health Plan,Sanford Health Plan,102.96,88,,percent of total billed charges,,
"Computerized Corneal Topography, Unilateral Or Bilateral, With Interpretation And Report (Pro Cah)",,92025,CPT,Professional,Both,,,,117,99.45,14.10208,117,"UCare Health, Inc.",Individual & Family Plan,59.49696,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Computerized Corneal Topography, Unilateral Or Bilateral, With Interpretation And Report (Pro Cah)",,92025,CPT,Professional,Both,,,,117,99.45,14.10208,117,"UCare Health, Inc.",Medical Assistance,15.512288,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Computerized Corneal Topography, Unilateral Or Bilateral, With Interpretation And Report (Pro Cah)",,92025,CPT,Professional,Both,,,,117,99.45,14.10208,117,"UCare Health, Inc.",Medicare Advantage,42.09,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Computerized Corneal Topography, Unilateral Or Bilateral, With Interpretation And Report (Pro Cah)",,92025,CPT,Professional,Both,,,,117,99.45,14.10208,117,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),33.672,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Computerized Corneal Topography, Unilateral Or Bilateral, With Interpretation And Report (Pro Cah)",,92025,CPT,Professional,Both,,,,117,99.45,14.10208,117,UnitedHealthcare,Individual & Family,117,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Computerized Corneal Topography, Unilateral Or Bilateral, With Interpretation And Report (Pro Cah)",,92025,CPT,Professional,Both,,,,117,99.45,14.10208,117,UnitedHealthcare,Medicare Advantage,42.09,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Computerized Corneal Topography, Unilateral Or Bilateral, With Interpretation And Report (Pro Cah)",,92025,CPT,Professional,Both,,,,117,99.45,14.10208,117,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,14.10208,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Fitting Of Contact Lens For Treatment Of Ocular Surface Disease (Pro Cah),,92071,CPT,Professional,Both,,,,102,86.7,22.6,102,Aetna,Commercial,86.7,85,,percent of total billed charges,,
Fitting Of Contact Lens For Treatment Of Ocular Surface Disease (Pro Cah),,92071,CPT,Professional,Both,,,,102,86.7,22.6,102,Aetna,Medicare Advantage,32.49,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Fitting Of Contact Lens For Treatment Of Ocular Surface Disease (Pro Cah),,92071,CPT,Professional,Both,,,,102,86.7,22.6,102,Aetna,PPO,94.86,93,,percent of total billed charges,,
Fitting Of Contact Lens For Treatment Of Ocular Surface Disease (Pro Cah),,92071,CPT,Professional,Both,,,,102,86.7,22.6,102,America's PPO,America's PPO,87.1488,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Fitting Of Contact Lens For Treatment Of Ocular Surface Disease (Pro Cah),,92071,CPT,Professional,Both,,,,102,86.7,22.6,102,BlueCross BlueShield Minnesota, Federal Employee Program,55.43,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Fitting Of Contact Lens For Treatment Of Ocular Surface Disease (Pro Cah),,92071,CPT,Professional,Both,,,,102,86.7,22.6,102,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,56.31688,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Fitting Of Contact Lens For Treatment Of Ocular Surface Disease (Pro Cah),,92071,CPT,Professional,Both,,,,102,86.7,22.6,102,BlueCross BlueShield Minnesota,High Value Network Plan,56.31688,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Fitting Of Contact Lens For Treatment Of Ocular Surface Disease (Pro Cah),,92071,CPT,Professional,Both,,,,102,86.7,22.6,102,BlueCross BlueShield Minnesota,Medicare Advantage,36.731,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Fitting Of Contact Lens For Treatment Of Ocular Surface Disease (Pro Cah),,92071,CPT,Professional,Both,,,,102,86.7,22.6,102,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,56.31688,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Fitting Of Contact Lens For Treatment Of Ocular Surface Disease (Pro Cah),,92071,CPT,Professional,Both,,,,102,86.7,22.6,102,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,23.6728,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Fitting Of Contact Lens For Treatment Of Ocular Surface Disease (Pro Cah),,92071,CPT,Professional,Both,,,,102,86.7,22.6,102,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),36.731,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Fitting Of Contact Lens For Treatment Of Ocular Surface Disease (Pro Cah),,92071,CPT,Professional,Both,,,,102,86.7,22.6,102,CorVel,Worker's Compensation,62.5413153,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Fitting Of Contact Lens For Treatment Of Ocular Surface Disease (Pro Cah),,92071,CPT,Professional,Both,,,,102,86.7,22.6,102,First Health Group Corporation,First Health Network,98.94,97,,percent of total billed charges,,
Fitting Of Contact Lens For Treatment Of Ocular Surface Disease (Pro Cah),,92071,CPT,Professional,Both,,,,102,86.7,22.6,102,"Health Partners, Inc.",Commercial,67.47,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Fitting Of Contact Lens For Treatment Of Ocular Surface Disease (Pro Cah),,92071,CPT,Professional,Both,,,,102,86.7,22.6,102,"Health Partners, Inc.",Medicare Advantage,36.731,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Fitting Of Contact Lens For Treatment Of Ocular Surface Disease (Pro Cah),,92071,CPT,Professional,Both,,,,102,86.7,22.6,102,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),32.19,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Fitting Of Contact Lens For Treatment Of Ocular Surface Disease (Pro Cah),,92071,CPT,Professional,Both,,,,102,86.7,22.6,102,"Health Partners, Inc.",State of Minnesota Advantage Program,58.125405,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Fitting Of Contact Lens For Treatment Of Ocular Surface Disease (Pro Cah),,92071,CPT,Professional,Both,,,,102,86.7,22.6,102,"Health Partners, Inc.",State Public Programs,22.6,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Fitting Of Contact Lens For Treatment Of Ocular Surface Disease (Pro Cah),,92071,CPT,Professional,Both,,,,102,86.7,22.6,102,Humana Insurance Company,Commercial PPO,31.94,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Fitting Of Contact Lens For Treatment Of Ocular Surface Disease (Pro Cah),,92071,CPT,Professional,Both,,,,102,86.7,22.6,102,Humana Insurance Company,Medicare PPO,102,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Fitting Of Contact Lens For Treatment Of Ocular Surface Disease (Pro Cah),,92071,CPT,Professional,Both,,,,102,86.7,22.6,102,Medica,Individual & Family,86.496,84.8,,percent of total billed charges,,
Fitting Of Contact Lens For Treatment Of Ocular Surface Disease (Pro Cah),,92071,CPT,Professional,Both,,,,102,86.7,22.6,102,Medica,Medica Advantage Solution,50.796,49.8,,percent of total billed charges,,
Fitting Of Contact Lens For Treatment Of Ocular Surface Disease (Pro Cah),,92071,CPT,Professional,Both,,,,102,86.7,22.6,102,Medica,Medical Assistance,23.67,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Fitting Of Contact Lens For Treatment Of Ocular Surface Disease (Pro Cah),,92071,CPT,Professional,Both,,,,102,86.7,22.6,102,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,31.94,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Fitting Of Contact Lens For Treatment Of Ocular Surface Disease (Pro Cah),,92071,CPT,Professional,Both,,,,102,86.7,22.6,102,"Multiplan, Inc.","Multiplan, Inc.",95.88,94,,percent of total billed charges,,
Fitting Of Contact Lens For Treatment Of Ocular Surface Disease (Pro Cah),,92071,CPT,Professional,Both,,,,102,86.7,22.6,102,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,91.902,90.1,,percent of total billed charges,,
Fitting Of Contact Lens For Treatment Of Ocular Surface Disease (Pro Cah),,92071,CPT,Professional,Both,,,,102,86.7,22.6,102,"Preferred One Administrative Services, INC.",PPO,100.572,98.6,,percent of total billed charges,,
Fitting Of Contact Lens For Treatment Of Ocular Surface Disease (Pro Cah),,92071,CPT,Professional,Both,,,,102,86.7,22.6,102,PrimeWest Health,Minnesota Senior Health Options (MSHO),36.731,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Fitting Of Contact Lens For Treatment Of Ocular Surface Disease (Pro Cah),,92071,CPT,Professional,Both,,,,102,86.7,22.6,102,PrimeWest Health,MinnesotaCare,25.329896,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Fitting Of Contact Lens For Treatment Of Ocular Surface Disease (Pro Cah),,92071,CPT,Professional,Both,,,,102,86.7,22.6,102,Sanford Health Plan,Sanford Health Plan,89.76,88,,percent of total billed charges,,
Fitting Of Contact Lens For Treatment Of Ocular Surface Disease (Pro Cah),,92071,CPT,Professional,Both,,,,102,86.7,22.6,102,"UCare Health, Inc.",Individual & Family Plan,51.921664,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Fitting Of Contact Lens For Treatment Of Ocular Surface Disease (Pro Cah),,92071,CPT,Professional,Both,,,,102,86.7,22.6,102,"UCare Health, Inc.",Medical Assistance,26.04008,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Fitting Of Contact Lens For Treatment Of Ocular Surface Disease (Pro Cah),,92071,CPT,Professional,Both,,,,102,86.7,22.6,102,"UCare Health, Inc.",Medicare Advantage,36.731,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Fitting Of Contact Lens For Treatment Of Ocular Surface Disease (Pro Cah),,92071,CPT,Professional,Both,,,,102,86.7,22.6,102,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),29.3848,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Fitting Of Contact Lens For Treatment Of Ocular Surface Disease (Pro Cah),,92071,CPT,Professional,Both,,,,102,86.7,22.6,102,UnitedHealthcare,Individual & Family,102,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Fitting Of Contact Lens For Treatment Of Ocular Surface Disease (Pro Cah),,92071,CPT,Professional,Both,,,,102,86.7,22.6,102,UnitedHealthcare,Medicare Advantage,36.731,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Fitting Of Contact Lens For Treatment Of Ocular Surface Disease (Pro Cah),,92071,CPT,Professional,Both,,,,102,86.7,22.6,102,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,23.6728,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Visual Field Examination, Unilateral Or Bilateral W Interpt & Report; Limited Exam (Procah)",,92082,CPT,Professional,Both,,,,133,113.05,15.10792,133,Aetna,Commercial,113.05,85,,percent of total billed charges,,
"Visual Field Examination, Unilateral Or Bilateral W Interpt & Report; Limited Exam (Procah)",,92082,CPT,Professional,Both,,,,133,113.05,15.10792,133,Aetna,Medicare Advantage,48.14,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Visual Field Examination, Unilateral Or Bilateral W Interpt & Report; Limited Exam (Procah)",,92082,CPT,Professional,Both,,,,133,113.05,15.10792,133,Aetna,PPO,123.69,93,,percent of total billed charges,,
"Visual Field Examination, Unilateral Or Bilateral W Interpt & Report; Limited Exam (Procah)",,92082,CPT,Professional,Both,,,,133,113.05,15.10792,133,America's PPO,America's PPO,113.6352,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Visual Field Examination, Unilateral Or Bilateral W Interpt & Report; Limited Exam (Procah)",,92082,CPT,Professional,Both,,,,133,113.05,15.10792,133,BlueCross BlueShield Minnesota, Federal Employee Program,81.11,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Visual Field Examination, Unilateral Or Bilateral W Interpt & Report; Limited Exam (Procah)",,92082,CPT,Professional,Both,,,,133,113.05,15.10792,133,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,82.40776,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Visual Field Examination, Unilateral Or Bilateral W Interpt & Report; Limited Exam (Procah)",,92082,CPT,Professional,Both,,,,133,113.05,15.10792,133,BlueCross BlueShield Minnesota,High Value Network Plan,82.40776,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Visual Field Examination, Unilateral Or Bilateral W Interpt & Report; Limited Exam (Procah)",,92082,CPT,Professional,Both,,,,133,113.05,15.10792,133,BlueCross BlueShield Minnesota,Medicare Advantage,54.3605,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Visual Field Examination, Unilateral Or Bilateral W Interpt & Report; Limited Exam (Procah)",,92082,CPT,Professional,Both,,,,133,113.05,15.10792,133,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,82.40776,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Visual Field Examination, Unilateral Or Bilateral W Interpt & Report; Limited Exam (Procah)",,92082,CPT,Professional,Both,,,,133,113.05,15.10792,133,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,15.10792,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Visual Field Examination, Unilateral Or Bilateral W Interpt & Report; Limited Exam (Procah)",,92082,CPT,Professional,Both,,,,133,113.05,15.10792,133,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),54.3605,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Visual Field Examination, Unilateral Or Bilateral W Interpt & Report; Limited Exam (Procah)",,92082,CPT,Professional,Both,,,,133,113.05,15.10792,133,CorVel,Worker's Compensation,91.3028376,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Visual Field Examination, Unilateral Or Bilateral W Interpt & Report; Limited Exam (Procah)",,92082,CPT,Professional,Both,,,,133,113.05,15.10792,133,First Health Group Corporation,First Health Network,129.01,97,,percent of total billed charges,,
"Visual Field Examination, Unilateral Or Bilateral W Interpt & Report; Limited Exam (Procah)",,92082,CPT,Professional,Both,,,,133,113.05,15.10792,133,"Health Partners, Inc.",Commercial,97.94,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Visual Field Examination, Unilateral Or Bilateral W Interpt & Report; Limited Exam (Procah)",,92082,CPT,Professional,Both,,,,133,113.05,15.10792,133,"Health Partners, Inc.",Medicare Advantage,54.3605,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Visual Field Examination, Unilateral Or Bilateral W Interpt & Report; Limited Exam (Procah)",,92082,CPT,Professional,Both,,,,133,113.05,15.10792,133,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),47.44,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Visual Field Examination, Unilateral Or Bilateral W Interpt & Report; Limited Exam (Procah)",,92082,CPT,Professional,Both,,,,133,113.05,15.10792,133,"Health Partners, Inc.",State of Minnesota Advantage Program,84.37531,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Visual Field Examination, Unilateral Or Bilateral W Interpt & Report; Limited Exam (Procah)",,92082,CPT,Professional,Both,,,,133,113.05,15.10792,133,"Health Partners, Inc.",State Public Programs,30.32,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Visual Field Examination, Unilateral Or Bilateral W Interpt & Report; Limited Exam (Procah)",,92082,CPT,Professional,Both,,,,133,113.05,15.10792,133,Humana Insurance Company,Commercial PPO,47.27,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Visual Field Examination, Unilateral Or Bilateral W Interpt & Report; Limited Exam (Procah)",,92082,CPT,Professional,Both,,,,133,113.05,15.10792,133,Humana Insurance Company,Medicare PPO,133,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Visual Field Examination, Unilateral Or Bilateral W Interpt & Report; Limited Exam (Procah)",,92082,CPT,Professional,Both,,,,133,113.05,15.10792,133,Medica,Individual & Family,112.784,84.8,,percent of total billed charges,,
"Visual Field Examination, Unilateral Or Bilateral W Interpt & Report; Limited Exam (Procah)",,92082,CPT,Professional,Both,,,,133,113.05,15.10792,133,Medica,Medica Advantage Solution,66.234,49.8,,percent of total billed charges,,
"Visual Field Examination, Unilateral Or Bilateral W Interpt & Report; Limited Exam (Procah)",,92082,CPT,Professional,Both,,,,133,113.05,15.10792,133,Medica,Medical Assistance,35,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Visual Field Examination, Unilateral Or Bilateral W Interpt & Report; Limited Exam (Procah)",,92082,CPT,Professional,Both,,,,133,113.05,15.10792,133,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,47.27,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Visual Field Examination, Unilateral Or Bilateral W Interpt & Report; Limited Exam (Procah)",,92082,CPT,Professional,Both,,,,133,113.05,15.10792,133,"Multiplan, Inc.","Multiplan, Inc.",125.02,94,,percent of total billed charges,,
"Visual Field Examination, Unilateral Or Bilateral W Interpt & Report; Limited Exam (Procah)",,92082,CPT,Professional,Both,,,,133,113.05,15.10792,133,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,119.833,90.1,,percent of total billed charges,,
"Visual Field Examination, Unilateral Or Bilateral W Interpt & Report; Limited Exam (Procah)",,92082,CPT,Professional,Both,,,,133,113.05,15.10792,133,"Preferred One Administrative Services, INC.",PPO,131.138,98.6,,percent of total billed charges,,
"Visual Field Examination, Unilateral Or Bilateral W Interpt & Report; Limited Exam (Procah)",,92082,CPT,Professional,Both,,,,133,113.05,15.10792,133,PrimeWest Health,Minnesota Senior Health Options (MSHO),54.3605,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Visual Field Examination, Unilateral Or Bilateral W Interpt & Report; Limited Exam (Procah)",,92082,CPT,Professional,Both,,,,133,113.05,15.10792,133,PrimeWest Health,MinnesotaCare,16.1654744,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Visual Field Examination, Unilateral Or Bilateral W Interpt & Report; Limited Exam (Procah)",,92082,CPT,Professional,Both,,,,133,113.05,15.10792,133,Sanford Health Plan,Sanford Health Plan,117.04,88,,percent of total billed charges,,
"Visual Field Examination, Unilateral Or Bilateral W Interpt & Report; Limited Exam (Procah)",,92082,CPT,Professional,Both,,,,133,113.05,15.10792,133,"UCare Health, Inc.",Individual & Family Plan,76.842112,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Visual Field Examination, Unilateral Or Bilateral W Interpt & Report; Limited Exam (Procah)",,92082,CPT,Professional,Both,,,,133,113.05,15.10792,133,"UCare Health, Inc.",Medical Assistance,16.618712,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Visual Field Examination, Unilateral Or Bilateral W Interpt & Report; Limited Exam (Procah)",,92082,CPT,Professional,Both,,,,133,113.05,15.10792,133,"UCare Health, Inc.",Medicare Advantage,54.3605,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Visual Field Examination, Unilateral Or Bilateral W Interpt & Report; Limited Exam (Procah)",,92082,CPT,Professional,Both,,,,133,113.05,15.10792,133,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),43.4884,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Visual Field Examination, Unilateral Or Bilateral W Interpt & Report; Limited Exam (Procah)",,92082,CPT,Professional,Both,,,,133,113.05,15.10792,133,UnitedHealthcare,Individual & Family,133,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Visual Field Examination, Unilateral Or Bilateral W Interpt & Report; Limited Exam (Procah)",,92082,CPT,Professional,Both,,,,133,113.05,15.10792,133,UnitedHealthcare,Medicare Advantage,54.3605,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Visual Field Examination, Unilateral Or Bilateral W Interpt & Report; Limited Exam (Procah)",,92082,CPT,Professional,Both,,,,133,113.05,15.10792,133,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,15.10792,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Visual Field Examination, Unilateral Or Bilateral W Interpt & Report; Extended Exam (Pro Cah)",,92083,CPT,Professional,Both,,,,189,160.65,19.63928,189,Aetna,Commercial,160.65,85,,percent of total billed charges,,
"Visual Field Examination, Unilateral Or Bilateral W Interpt & Report; Extended Exam (Pro Cah)",,92083,CPT,Professional,Both,,,,189,160.65,19.63928,189,Aetna,Medicare Advantage,64.35,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Visual Field Examination, Unilateral Or Bilateral W Interpt & Report; Extended Exam (Pro Cah)",,92083,CPT,Professional,Both,,,,189,160.65,19.63928,189,Aetna,PPO,175.77,93,,percent of total billed charges,,
"Visual Field Examination, Unilateral Or Bilateral W Interpt & Report; Extended Exam (Pro Cah)",,92083,CPT,Professional,Both,,,,189,160.65,19.63928,189,America's PPO,America's PPO,161.4816,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Visual Field Examination, Unilateral Or Bilateral W Interpt & Report; Extended Exam (Pro Cah)",,92083,CPT,Professional,Both,,,,189,160.65,19.63928,189,BlueCross BlueShield Minnesota, Federal Employee Program,108.53,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Visual Field Examination, Unilateral Or Bilateral W Interpt & Report; Extended Exam (Pro Cah)",,92083,CPT,Professional,Both,,,,189,160.65,19.63928,189,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,110.26648,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Visual Field Examination, Unilateral Or Bilateral W Interpt & Report; Extended Exam (Pro Cah)",,92083,CPT,Professional,Both,,,,189,160.65,19.63928,189,BlueCross BlueShield Minnesota,High Value Network Plan,110.26648,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Visual Field Examination, Unilateral Or Bilateral W Interpt & Report; Extended Exam (Pro Cah)",,92083,CPT,Professional,Both,,,,189,160.65,19.63928,189,BlueCross BlueShield Minnesota,Medicare Advantage,72.956,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Visual Field Examination, Unilateral Or Bilateral W Interpt & Report; Extended Exam (Pro Cah)",,92083,CPT,Professional,Both,,,,189,160.65,19.63928,189,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,110.26648,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Visual Field Examination, Unilateral Or Bilateral W Interpt & Report; Extended Exam (Pro Cah)",,92083,CPT,Professional,Both,,,,189,160.65,19.63928,189,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,19.63928,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Visual Field Examination, Unilateral Or Bilateral W Interpt & Report; Extended Exam (Pro Cah)",,92083,CPT,Professional,Both,,,,189,160.65,19.63928,189,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),72.956,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Visual Field Examination, Unilateral Or Bilateral W Interpt & Report; Extended Exam (Pro Cah)",,92083,CPT,Professional,Both,,,,189,160.65,19.63928,189,CorVel,Worker's Compensation,123.8762574,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Visual Field Examination, Unilateral Or Bilateral W Interpt & Report; Extended Exam (Pro Cah)",,92083,CPT,Professional,Both,,,,189,160.65,19.63928,189,First Health Group Corporation,First Health Network,183.33,97,,percent of total billed charges,,
"Visual Field Examination, Unilateral Or Bilateral W Interpt & Report; Extended Exam (Pro Cah)",,92083,CPT,Professional,Both,,,,189,160.65,19.63928,189,"Health Partners, Inc.",Commercial,132.77,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Visual Field Examination, Unilateral Or Bilateral W Interpt & Report; Extended Exam (Pro Cah)",,92083,CPT,Professional,Both,,,,189,160.65,19.63928,189,"Health Partners, Inc.",Medicare Advantage,72.956,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Visual Field Examination, Unilateral Or Bilateral W Interpt & Report; Extended Exam (Pro Cah)",,92083,CPT,Professional,Both,,,,189,160.65,19.63928,189,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),63.71,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Visual Field Examination, Unilateral Or Bilateral W Interpt & Report; Extended Exam (Pro Cah)",,92083,CPT,Professional,Both,,,,189,160.65,19.63928,189,"Health Partners, Inc.",State of Minnesota Advantage Program,114.381355,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Visual Field Examination, Unilateral Or Bilateral W Interpt & Report; Extended Exam (Pro Cah)",,92083,CPT,Professional,Both,,,,189,160.65,19.63928,189,"Health Partners, Inc.",State Public Programs,40.79,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Visual Field Examination, Unilateral Or Bilateral W Interpt & Report; Extended Exam (Pro Cah)",,92083,CPT,Professional,Both,,,,189,160.65,19.63928,189,Humana Insurance Company,Commercial PPO,63.44,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Visual Field Examination, Unilateral Or Bilateral W Interpt & Report; Extended Exam (Pro Cah)",,92083,CPT,Professional,Both,,,,189,160.65,19.63928,189,Humana Insurance Company,Medicare PPO,189,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Visual Field Examination, Unilateral Or Bilateral W Interpt & Report; Extended Exam (Pro Cah)",,92083,CPT,Professional,Both,,,,189,160.65,19.63928,189,Medica,Individual & Family,160.272,84.8,,percent of total billed charges,,
"Visual Field Examination, Unilateral Or Bilateral W Interpt & Report; Extended Exam (Pro Cah)",,92083,CPT,Professional,Both,,,,189,160.65,19.63928,189,Medica,Medica Advantage Solution,94.122,49.8,,percent of total billed charges,,
"Visual Field Examination, Unilateral Or Bilateral W Interpt & Report; Extended Exam (Pro Cah)",,92083,CPT,Professional,Both,,,,189,160.65,19.63928,189,Medica,Medical Assistance,47.09,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Visual Field Examination, Unilateral Or Bilateral W Interpt & Report; Extended Exam (Pro Cah)",,92083,CPT,Professional,Both,,,,189,160.65,19.63928,189,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,63.44,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Visual Field Examination, Unilateral Or Bilateral W Interpt & Report; Extended Exam (Pro Cah)",,92083,CPT,Professional,Both,,,,189,160.65,19.63928,189,"Multiplan, Inc.","Multiplan, Inc.",177.66,94,,percent of total billed charges,,
"Visual Field Examination, Unilateral Or Bilateral W Interpt & Report; Extended Exam (Pro Cah)",,92083,CPT,Professional,Both,,,,189,160.65,19.63928,189,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,170.289,90.1,,percent of total billed charges,,
"Visual Field Examination, Unilateral Or Bilateral W Interpt & Report; Extended Exam (Pro Cah)",,92083,CPT,Professional,Both,,,,189,160.65,19.63928,189,"Preferred One Administrative Services, INC.",PPO,186.354,98.6,,percent of total billed charges,,
"Visual Field Examination, Unilateral Or Bilateral W Interpt & Report; Extended Exam (Pro Cah)",,92083,CPT,Professional,Both,,,,189,160.65,19.63928,189,PrimeWest Health,Minnesota Senior Health Options (MSHO),72.956,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Visual Field Examination, Unilateral Or Bilateral W Interpt & Report; Extended Exam (Pro Cah)",,92083,CPT,Professional,Both,,,,189,160.65,19.63928,189,PrimeWest Health,MinnesotaCare,21.0140296,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Visual Field Examination, Unilateral Or Bilateral W Interpt & Report; Extended Exam (Pro Cah)",,92083,CPT,Professional,Both,,,,189,160.65,19.63928,189,Sanford Health Plan,Sanford Health Plan,166.32,88,,percent of total billed charges,,
"Visual Field Examination, Unilateral Or Bilateral W Interpt & Report; Extended Exam (Pro Cah)",,92083,CPT,Professional,Both,,,,189,160.65,19.63928,189,"UCare Health, Inc.",Individual & Family Plan,103.128064,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Visual Field Examination, Unilateral Or Bilateral W Interpt & Report; Extended Exam (Pro Cah)",,92083,CPT,Professional,Both,,,,189,160.65,19.63928,189,"UCare Health, Inc.",Medical Assistance,21.603208,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Visual Field Examination, Unilateral Or Bilateral W Interpt & Report; Extended Exam (Pro Cah)",,92083,CPT,Professional,Both,,,,189,160.65,19.63928,189,"UCare Health, Inc.",Medicare Advantage,72.956,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Visual Field Examination, Unilateral Or Bilateral W Interpt & Report; Extended Exam (Pro Cah)",,92083,CPT,Professional,Both,,,,189,160.65,19.63928,189,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),58.3648,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Visual Field Examination, Unilateral Or Bilateral W Interpt & Report; Extended Exam (Pro Cah)",,92083,CPT,Professional,Both,,,,189,160.65,19.63928,189,UnitedHealthcare,Individual & Family,189,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Visual Field Examination, Unilateral Or Bilateral W Interpt & Report; Extended Exam (Pro Cah)",,92083,CPT,Professional,Both,,,,189,160.65,19.63928,189,UnitedHealthcare,Medicare Advantage,72.956,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Visual Field Examination, Unilateral Or Bilateral W Interpt & Report; Extended Exam (Pro Cah)",,92083,CPT,Professional,Both,,,,189,160.65,19.63928,189,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,19.63928,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
SULFAMETHOXAZOLE-TRIMETHOPRIM 400-80 MG/5 ML IV SOLN,,J3490,HCPCS,Facility,Both,10,mL,,73,62.05,20.9218,73,Aetna,Commercial,67.16,92,,percent of total billed charges,,
SULFAMETHOXAZOLE-TRIMETHOPRIM 400-80 MG/5 ML IV SOLN,,J3490,HCPCS,Facility,Outpatient,10,mL,,73,62.05,20.9218,73,Aetna,Medicare Advantage,35.77,49,,percent of total billed charges,,
SULFAMETHOXAZOLE-TRIMETHOPRIM 400-80 MG/5 ML IV SOLN,,J3490,HCPCS,Facility,Inpatient,10,mL,,73,62.05,20.9218,73,Aetna,Medicare Advantage,,,,,Included in per diem rate,
SULFAMETHOXAZOLE-TRIMETHOPRIM 400-80 MG/5 ML IV SOLN,,J3490,HCPCS,Facility,Both,10,mL,,73,62.05,20.9218,73,Aetna,PPO,67.89,93,,percent of total billed charges,,
SULFAMETHOXAZOLE-TRIMETHOPRIM 400-80 MG/5 ML IV SOLN,,J3490,HCPCS,Facility,Both,10,mL,,73,62.05,20.9218,73,America's PPO,America's PPO,70.1019,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SULFAMETHOXAZOLE-TRIMETHOPRIM 400-80 MG/5 ML IV SOLN,,J3490,HCPCS,Facility,Both,10,mL,,73,62.05,20.9218,73,BlueCross BlueShield Minnesota, Federal Employee Program,71.832,98.4,,percent of total billed charges,,
SULFAMETHOXAZOLE-TRIMETHOPRIM 400-80 MG/5 ML IV SOLN,,J3490,HCPCS,Facility,Both,10,mL,,73,62.05,20.9218,73,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,73,100,,percent of total billed charges,,
SULFAMETHOXAZOLE-TRIMETHOPRIM 400-80 MG/5 ML IV SOLN,,J3490,HCPCS,Facility,Both,10,mL,,73,62.05,20.9218,73,BlueCross BlueShield Minnesota,High Value Network Plan,65.7,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
SULFAMETHOXAZOLE-TRIMETHOPRIM 400-80 MG/5 ML IV SOLN,,J3490,HCPCS,Facility,Outpatient,10,mL,,73,62.05,20.9218,73,BlueCross BlueShield Minnesota,Medicare Advantage,35.77,49,,percent of total billed charges,,
SULFAMETHOXAZOLE-TRIMETHOPRIM 400-80 MG/5 ML IV SOLN,,J3490,HCPCS,Facility,Inpatient,10,mL,,73,62.05,20.9218,73,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
SULFAMETHOXAZOLE-TRIMETHOPRIM 400-80 MG/5 ML IV SOLN,,J3490,HCPCS,Facility,Both,10,mL,,73,62.05,20.9218,73,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,64.6561,88.57,,percent of total billed charges,,
SULFAMETHOXAZOLE-TRIMETHOPRIM 400-80 MG/5 ML IV SOLN,,J3490,HCPCS,Facility,Both,10,mL,,73,62.05,20.9218,73,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,20.9218,28.66,,percent of total billed charges,,
SULFAMETHOXAZOLE-TRIMETHOPRIM 400-80 MG/5 ML IV SOLN,,J3490,HCPCS,Facility,Outpatient,10,mL,,73,62.05,20.9218,73,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),35.77,49,,percent of total billed charges,,
SULFAMETHOXAZOLE-TRIMETHOPRIM 400-80 MG/5 ML IV SOLN,,J3490,HCPCS,Facility,Inpatient,10,mL,,73,62.05,20.9218,73,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
SULFAMETHOXAZOLE-TRIMETHOPRIM 400-80 MG/5 ML IV SOLN,,J3490,HCPCS,Facility,Both,10,mL,,73,62.05,20.9218,73,CorVel,Worker's Compensation,73,100,,percent of total billed charges,,
SULFAMETHOXAZOLE-TRIMETHOPRIM 400-80 MG/5 ML IV SOLN,,J3490,HCPCS,Facility,Both,10,mL,,73,62.05,20.9218,73,First Health Group Corporation,First Health Network,70.81,97,,percent of total billed charges,,
SULFAMETHOXAZOLE-TRIMETHOPRIM 400-80 MG/5 ML IV SOLN,,J3490,HCPCS,Facility,Both,10,mL,,73,62.05,20.9218,73,"Health Partners, Inc.",Commercial,69.058,94.6,,percent of total billed charges,,
SULFAMETHOXAZOLE-TRIMETHOPRIM 400-80 MG/5 ML IV SOLN,,J3490,HCPCS,Facility,Outpatient,10,mL,,73,62.05,20.9218,73,"Health Partners, Inc.",Medicare Advantage,35.77,49,,percent of total billed charges,,
SULFAMETHOXAZOLE-TRIMETHOPRIM 400-80 MG/5 ML IV SOLN,,J3490,HCPCS,Facility,Inpatient,10,mL,,73,62.05,20.9218,73,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SULFAMETHOXAZOLE-TRIMETHOPRIM 400-80 MG/5 ML IV SOLN,,J3490,HCPCS,Facility,Both,10,mL,,73,62.05,20.9218,73,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),43.8,60,,percent of total billed charges,,
SULFAMETHOXAZOLE-TRIMETHOPRIM 400-80 MG/5 ML IV SOLN,,J3490,HCPCS,Facility,Both,10,mL,,73,62.05,20.9218,73,"Health Partners, Inc.",State of Minnesota Advantage Program,59.495,81.5,,percent of total billed charges,,
SULFAMETHOXAZOLE-TRIMETHOPRIM 400-80 MG/5 ML IV SOLN,,J3490,HCPCS,Facility,Both,10,mL,,73,62.05,20.9218,73,"Health Partners, Inc.",State Public Programs,36.5,50,,percent of total billed charges,,
SULFAMETHOXAZOLE-TRIMETHOPRIM 400-80 MG/5 ML IV SOLN,,J3490,HCPCS,Facility,Both,10,mL,,73,62.05,20.9218,73,Humana Insurance Company,Commercial PPO,69.35,95,,percent of total billed charges,,
SULFAMETHOXAZOLE-TRIMETHOPRIM 400-80 MG/5 ML IV SOLN,,J3490,HCPCS,Facility,Outpatient,10,mL,,73,62.05,20.9218,73,Humana Insurance Company,Medicare PPO,35.77,49,,percent of total billed charges,,
SULFAMETHOXAZOLE-TRIMETHOPRIM 400-80 MG/5 ML IV SOLN,,J3490,HCPCS,Facility,Inpatient,10,mL,,73,62.05,20.9218,73,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
SULFAMETHOXAZOLE-TRIMETHOPRIM 400-80 MG/5 ML IV SOLN,,J3490,HCPCS,Facility,Both,10,mL,,73,62.05,20.9218,73,Medica,Individual & Family,72.343,99.1,,percent of total billed charges,,
SULFAMETHOXAZOLE-TRIMETHOPRIM 400-80 MG/5 ML IV SOLN,,J3490,HCPCS,Facility,Outpatient,10,mL,,73,62.05,20.9218,73,Medica,Medica Advantage Solution,36.354,49.8,,percent of total billed charges,,
SULFAMETHOXAZOLE-TRIMETHOPRIM 400-80 MG/5 ML IV SOLN,,J3490,HCPCS,Facility,Inpatient,10,mL,,73,62.05,20.9218,73,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
SULFAMETHOXAZOLE-TRIMETHOPRIM 400-80 MG/5 ML IV SOLN,,J3490,HCPCS,Facility,Outpatient,10,mL,,73,62.05,20.9218,73,Medica,Medical Assistance,32.558,44.6,,percent of total billed charges,,
SULFAMETHOXAZOLE-TRIMETHOPRIM 400-80 MG/5 ML IV SOLN,,J3490,HCPCS,Facility,Inpatient,10,mL,,73,62.05,20.9218,73,Medica,Medical Assistance,,,,,Included in per diem rate,
SULFAMETHOXAZOLE-TRIMETHOPRIM 400-80 MG/5 ML IV SOLN,,J3490,HCPCS,Facility,Outpatient,10,mL,,73,62.05,20.9218,73,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,36.354,49.8,,percent of total billed charges,,
SULFAMETHOXAZOLE-TRIMETHOPRIM 400-80 MG/5 ML IV SOLN,,J3490,HCPCS,Facility,Inpatient,10,mL,,73,62.05,20.9218,73,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
SULFAMETHOXAZOLE-TRIMETHOPRIM 400-80 MG/5 ML IV SOLN,,J3490,HCPCS,Facility,Both,10,mL,,73,62.05,20.9218,73,"Multiplan, Inc.","Multiplan, Inc.",68.62,94,,percent of total billed charges,,
SULFAMETHOXAZOLE-TRIMETHOPRIM 400-80 MG/5 ML IV SOLN,,J3490,HCPCS,Facility,Outpatient,10,mL,,73,62.05,20.9218,73,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,65.773,90.1,,percent of total billed charges,,
SULFAMETHOXAZOLE-TRIMETHOPRIM 400-80 MG/5 ML IV SOLN,,J3490,HCPCS,Facility,Inpatient,10,mL,,73,62.05,20.9218,73,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
SULFAMETHOXAZOLE-TRIMETHOPRIM 400-80 MG/5 ML IV SOLN,,J3490,HCPCS,Facility,Both,10,mL,,73,62.05,20.9218,73,"Preferred One Administrative Services, INC.",PPO,71.978,98.6,,percent of total billed charges,,
SULFAMETHOXAZOLE-TRIMETHOPRIM 400-80 MG/5 ML IV SOLN,,J3490,HCPCS,Facility,Outpatient,10,mL,,73,62.05,20.9218,73,PrimeWest Health,Minnesota Senior Health Options (MSHO),37.5585,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
SULFAMETHOXAZOLE-TRIMETHOPRIM 400-80 MG/5 ML IV SOLN,,J3490,HCPCS,Facility,Inpatient,10,mL,,73,62.05,20.9218,73,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SULFAMETHOXAZOLE-TRIMETHOPRIM 400-80 MG/5 ML IV SOLN,,J3490,HCPCS,Facility,Outpatient,10,mL,,73,62.05,20.9218,73,PrimeWest Health,MinnesotaCare,37.4928,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
SULFAMETHOXAZOLE-TRIMETHOPRIM 400-80 MG/5 ML IV SOLN,,J3490,HCPCS,Facility,Inpatient,10,mL,,73,62.05,20.9218,73,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
SULFAMETHOXAZOLE-TRIMETHOPRIM 400-80 MG/5 ML IV SOLN,,J3490,HCPCS,Facility,Both,10,mL,,73,62.05,20.9218,73,Sanford Health Plan,Sanford Health Plan,67.16,92,,percent of total billed charges,,
SULFAMETHOXAZOLE-TRIMETHOPRIM 400-80 MG/5 ML IV SOLN,,J3490,HCPCS,Facility,Outpatient,10,mL,,73,62.05,20.9218,73,"UCare Health, Inc.",Individual & Family Plan,41.1355,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
SULFAMETHOXAZOLE-TRIMETHOPRIM 400-80 MG/5 ML IV SOLN,,J3490,HCPCS,Facility,Inpatient,10,mL,,73,62.05,20.9218,73,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
SULFAMETHOXAZOLE-TRIMETHOPRIM 400-80 MG/5 ML IV SOLN,,J3490,HCPCS,Facility,Outpatient,10,mL,,73,62.05,20.9218,73,"UCare Health, Inc.",Medical Assistance,36.8431,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SULFAMETHOXAZOLE-TRIMETHOPRIM 400-80 MG/5 ML IV SOLN,,J3490,HCPCS,Facility,Inpatient,10,mL,,73,62.05,20.9218,73,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
SULFAMETHOXAZOLE-TRIMETHOPRIM 400-80 MG/5 ML IV SOLN,,J3490,HCPCS,Facility,Outpatient,10,mL,,73,62.05,20.9218,73,"UCare Health, Inc.",Medicare Advantage,36.8431,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SULFAMETHOXAZOLE-TRIMETHOPRIM 400-80 MG/5 ML IV SOLN,,J3490,HCPCS,Facility,Inpatient,10,mL,,73,62.05,20.9218,73,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SULFAMETHOXAZOLE-TRIMETHOPRIM 400-80 MG/5 ML IV SOLN,,J3490,HCPCS,Facility,Outpatient,10,mL,,73,62.05,20.9218,73,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),36.8431,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SULFAMETHOXAZOLE-TRIMETHOPRIM 400-80 MG/5 ML IV SOLN,,J3490,HCPCS,Facility,Inpatient,10,mL,,73,62.05,20.9218,73,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SULFAMETHOXAZOLE-TRIMETHOPRIM 400-80 MG/5 ML IV SOLN,,J3490,HCPCS,Facility,Both,10,mL,,73,62.05,20.9218,73,UnitedHealthcare,Individual & Family,68.62,94,,percent of total billed charges,,
SULFAMETHOXAZOLE-TRIMETHOPRIM 400-80 MG/5 ML IV SOLN,,J3490,HCPCS,Facility,Outpatient,10,mL,,73,62.05,20.9218,73,UnitedHealthcare,Medicare Advantage,35.77,49,,percent of total billed charges,,
SULFAMETHOXAZOLE-TRIMETHOPRIM 400-80 MG/5 ML IV SOLN,,J3490,HCPCS,Facility,Inpatient,10,mL,,73,62.05,20.9218,73,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
SULFAMETHOXAZOLE-TRIMETHOPRIM 400-80 MG/5 ML IV SOLN,,J3490,HCPCS,Facility,Outpatient,10,mL,,73,62.05,20.9218,73,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,35.04,48,,percent of total billed charges,,100% of DHS outpatient percentage
SULFAMETHOXAZOLE-TRIMETHOPRIM 400-80 MG/5 ML IV SOLN,,J3490,HCPCS,Facility,Inpatient,10,mL,,73,62.05,20.9218,73,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Computerized Ophth Dx Imaging, Post Segment, Retina",,92134,CPT,Facility,Both,,,,107,90.95,30.6662,107,Aetna,Commercial,98.44,92,,percent of total billed charges,,
"Computerized Ophth Dx Imaging, Post Segment, Retina",,92134,CPT,Facility,Outpatient,,,,107,90.95,30.6662,107,Aetna,Medicare Advantage,52.43,49,,percent of total billed charges,,
"Computerized Ophth Dx Imaging, Post Segment, Retina",,92134,CPT,Facility,Inpatient,,,,107,90.95,30.6662,107,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Computerized Ophth Dx Imaging, Post Segment, Retina",,92134,CPT,Facility,Both,,,,107,90.95,30.6662,107,Aetna,PPO,99.51,93,,percent of total billed charges,,
"Computerized Ophth Dx Imaging, Post Segment, Retina",,92134,CPT,Facility,Both,,,,107,90.95,30.6662,107,America's PPO,America's PPO,102.7521,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Computerized Ophth Dx Imaging, Post Segment, Retina",,92134,CPT,Facility,Both,,,,107,90.95,30.6662,107,BlueCross BlueShield Minnesota, Federal Employee Program,105.288,98.4,,percent of total billed charges,,
"Computerized Ophth Dx Imaging, Post Segment, Retina",,92134,CPT,Facility,Both,,,,107,90.95,30.6662,107,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,107,100,,percent of total billed charges,,
"Computerized Ophth Dx Imaging, Post Segment, Retina",,92134,CPT,Facility,Both,,,,107,90.95,30.6662,107,BlueCross BlueShield Minnesota,High Value Network Plan,96.3,90,,percent of total billed charges,,
"Computerized Ophth Dx Imaging, Post Segment, Retina",,92134,CPT,Facility,Outpatient,,,,107,90.95,30.6662,107,BlueCross BlueShield Minnesota,Medicare Advantage,52.43,49,,percent of total billed charges,,
"Computerized Ophth Dx Imaging, Post Segment, Retina",,92134,CPT,Facility,Inpatient,,,,107,90.95,30.6662,107,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Computerized Ophth Dx Imaging, Post Segment, Retina",,92134,CPT,Facility,Both,,,,107,90.95,30.6662,107,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,94.7699,88.57,,percent of total billed charges,,
"Computerized Ophth Dx Imaging, Post Segment, Retina",,92134,CPT,Facility,Both,,,,107,90.95,30.6662,107,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,30.6662,28.66,,percent of total billed charges,,
"Computerized Ophth Dx Imaging, Post Segment, Retina",,92134,CPT,Facility,Outpatient,,,,107,90.95,30.6662,107,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),52.43,49,,percent of total billed charges,,
"Computerized Ophth Dx Imaging, Post Segment, Retina",,92134,CPT,Facility,Inpatient,,,,107,90.95,30.6662,107,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Computerized Ophth Dx Imaging, Post Segment, Retina",,92134,CPT,Facility,Both,,,,107,90.95,30.6662,107,CorVel,Worker's Compensation,107,100,,percent of total billed charges,,
"Computerized Ophth Dx Imaging, Post Segment, Retina",,92134,CPT,Facility,Both,,,,107,90.95,30.6662,107,First Health Group Corporation,First Health Network,103.79,97,,percent of total billed charges,,
"Computerized Ophth Dx Imaging, Post Segment, Retina",,92134,CPT,Facility,Both,,,,107,90.95,30.6662,107,"Health Partners, Inc.",Commercial,101.222,94.6,,percent of total billed charges,,
"Computerized Ophth Dx Imaging, Post Segment, Retina",,92134,CPT,Facility,Outpatient,,,,107,90.95,30.6662,107,"Health Partners, Inc.",Medicare Advantage,52.43,49,,percent of total billed charges,,
"Computerized Ophth Dx Imaging, Post Segment, Retina",,92134,CPT,Facility,Inpatient,,,,107,90.95,30.6662,107,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Computerized Ophth Dx Imaging, Post Segment, Retina",,92134,CPT,Facility,Both,,,,107,90.95,30.6662,107,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),64.2,60,,percent of total billed charges,,
"Computerized Ophth Dx Imaging, Post Segment, Retina",,92134,CPT,Facility,Both,,,,107,90.95,30.6662,107,"Health Partners, Inc.",State of Minnesota Advantage Program,87.205,81.5,,percent of total billed charges,,
"Computerized Ophth Dx Imaging, Post Segment, Retina",,92134,CPT,Facility,Both,,,,107,90.95,30.6662,107,"Health Partners, Inc.",State Public Programs,53.5,50,,percent of total billed charges,,
"Computerized Ophth Dx Imaging, Post Segment, Retina",,92134,CPT,Facility,Both,,,,107,90.95,30.6662,107,Humana Insurance Company,Commercial PPO,101.65,95,,percent of total billed charges,,
"Computerized Ophth Dx Imaging, Post Segment, Retina",,92134,CPT,Facility,Outpatient,,,,107,90.95,30.6662,107,Humana Insurance Company,Medicare PPO,52.43,49,,percent of total billed charges,,
"Computerized Ophth Dx Imaging, Post Segment, Retina",,92134,CPT,Facility,Inpatient,,,,107,90.95,30.6662,107,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Computerized Ophth Dx Imaging, Post Segment, Retina",,92134,CPT,Facility,Both,,,,107,90.95,30.6662,107,Medica,Individual & Family,106.037,99.1,,percent of total billed charges,,
"Computerized Ophth Dx Imaging, Post Segment, Retina",,92134,CPT,Facility,Outpatient,,,,107,90.95,30.6662,107,Medica,Medica Advantage Solution,53.286,49.8,,percent of total billed charges,,
"Computerized Ophth Dx Imaging, Post Segment, Retina",,92134,CPT,Facility,Inpatient,,,,107,90.95,30.6662,107,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Computerized Ophth Dx Imaging, Post Segment, Retina",,92134,CPT,Facility,Outpatient,,,,107,90.95,30.6662,107,Medica,Medical Assistance,47.722,44.6,,percent of total billed charges,,
"Computerized Ophth Dx Imaging, Post Segment, Retina",,92134,CPT,Facility,Inpatient,,,,107,90.95,30.6662,107,Medica,Medical Assistance,,,,,Included in per diem rate,
"Computerized Ophth Dx Imaging, Post Segment, Retina",,92134,CPT,Facility,Outpatient,,,,107,90.95,30.6662,107,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,53.286,49.8,,percent of total billed charges,,
"Computerized Ophth Dx Imaging, Post Segment, Retina",,92134,CPT,Facility,Inpatient,,,,107,90.95,30.6662,107,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Computerized Ophth Dx Imaging, Post Segment, Retina",,92134,CPT,Facility,Both,,,,107,90.95,30.6662,107,"Multiplan, Inc.","Multiplan, Inc.",100.58,94,,percent of total billed charges,,
"Computerized Ophth Dx Imaging, Post Segment, Retina",,92134,CPT,Facility,Outpatient,,,,107,90.95,30.6662,107,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,96.407,90.1,,percent of total billed charges,,
"Computerized Ophth Dx Imaging, Post Segment, Retina",,92134,CPT,Facility,Inpatient,,,,107,90.95,30.6662,107,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Computerized Ophth Dx Imaging, Post Segment, Retina",,92134,CPT,Facility,Both,,,,107,90.95,30.6662,107,"Preferred One Administrative Services, INC.",PPO,105.502,98.6,,percent of total billed charges,,
"Computerized Ophth Dx Imaging, Post Segment, Retina",,92134,CPT,Facility,Outpatient,,,,107,90.95,30.6662,107,PrimeWest Health,Minnesota Senior Health Options (MSHO),55.0515,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Computerized Ophth Dx Imaging, Post Segment, Retina",,92134,CPT,Facility,Inpatient,,,,107,90.95,30.6662,107,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Computerized Ophth Dx Imaging, Post Segment, Retina",,92134,CPT,Facility,Outpatient,,,,107,90.95,30.6662,107,PrimeWest Health,MinnesotaCare,54.9552,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Computerized Ophth Dx Imaging, Post Segment, Retina",,92134,CPT,Facility,Inpatient,,,,107,90.95,30.6662,107,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Computerized Ophth Dx Imaging, Post Segment, Retina",,92134,CPT,Facility,Both,,,,107,90.95,30.6662,107,Sanford Health Plan,Sanford Health Plan,98.44,92,,percent of total billed charges,,
"Computerized Ophth Dx Imaging, Post Segment, Retina",,92134,CPT,Facility,Outpatient,,,,107,90.95,30.6662,107,"UCare Health, Inc.",Individual & Family Plan,60.2945,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Computerized Ophth Dx Imaging, Post Segment, Retina",,92134,CPT,Facility,Inpatient,,,,107,90.95,30.6662,107,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Computerized Ophth Dx Imaging, Post Segment, Retina",,92134,CPT,Facility,Outpatient,,,,107,90.95,30.6662,107,"UCare Health, Inc.",Medical Assistance,54.0029,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Computerized Ophth Dx Imaging, Post Segment, Retina",,92134,CPT,Facility,Inpatient,,,,107,90.95,30.6662,107,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Computerized Ophth Dx Imaging, Post Segment, Retina",,92134,CPT,Facility,Outpatient,,,,107,90.95,30.6662,107,"UCare Health, Inc.",Medicare Advantage,54.0029,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Computerized Ophth Dx Imaging, Post Segment, Retina",,92134,CPT,Facility,Inpatient,,,,107,90.95,30.6662,107,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Computerized Ophth Dx Imaging, Post Segment, Retina",,92134,CPT,Facility,Outpatient,,,,107,90.95,30.6662,107,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),54.0029,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Computerized Ophth Dx Imaging, Post Segment, Retina",,92134,CPT,Facility,Inpatient,,,,107,90.95,30.6662,107,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Computerized Ophth Dx Imaging, Post Segment, Retina",,92134,CPT,Facility,Both,,,,107,90.95,30.6662,107,UnitedHealthcare,Individual & Family,100.58,94,,percent of total billed charges,,
"Computerized Ophth Dx Imaging, Post Segment, Retina",,92134,CPT,Facility,Outpatient,,,,107,90.95,30.6662,107,UnitedHealthcare,Medicare Advantage,52.43,49,,percent of total billed charges,,
"Computerized Ophth Dx Imaging, Post Segment, Retina",,92134,CPT,Facility,Inpatient,,,,107,90.95,30.6662,107,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Computerized Ophth Dx Imaging, Post Segment, Retina",,92134,CPT,Facility,Outpatient,,,,107,90.95,30.6662,107,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,51.36,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Computerized Ophth Dx Imaging, Post Segment, Retina",,92134,CPT,Facility,Inpatient,,,,107,90.95,30.6662,107,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Fluorescein Angiography With Interpretation And Report, Unilateral Or Bilateral (Pro Cah)",,92235,CPT,Professional,Both,,,,342,290.7,31.22168,342,Aetna,Commercial,290.7,85,,percent of total billed charges,,
"Fluorescein Angiography With Interpretation And Report, Unilateral Or Bilateral (Pro Cah)",,92235,CPT,Professional,Both,,,,342,290.7,31.22168,342,Aetna,Medicare Advantage,120.08,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Fluorescein Angiography With Interpretation And Report, Unilateral Or Bilateral (Pro Cah)",,92235,CPT,Professional,Both,,,,342,290.7,31.22168,342,Aetna,PPO,318.06,93,,percent of total billed charges,,
"Fluorescein Angiography With Interpretation And Report, Unilateral Or Bilateral (Pro Cah)",,92235,CPT,Professional,Both,,,,342,290.7,31.22168,342,America's PPO,America's PPO,292.2048,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Fluorescein Angiography With Interpretation And Report, Unilateral Or Bilateral (Pro Cah)",,92235,CPT,Professional,Both,,,,342,290.7,31.22168,342,BlueCross BlueShield Minnesota, Federal Employee Program,238.65,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Fluorescein Angiography With Interpretation And Report, Unilateral Or Bilateral (Pro Cah)",,92235,CPT,Professional,Both,,,,342,290.7,31.22168,342,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,242.4684,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Fluorescein Angiography With Interpretation And Report, Unilateral Or Bilateral (Pro Cah)",,92235,CPT,Professional,Both,,,,342,290.7,31.22168,342,BlueCross BlueShield Minnesota,High Value Network Plan,242.4684,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Fluorescein Angiography With Interpretation And Report, Unilateral Or Bilateral (Pro Cah)",,92235,CPT,Professional,Both,,,,342,290.7,31.22168,342,BlueCross BlueShield Minnesota,Medicare Advantage,161.322,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Fluorescein Angiography With Interpretation And Report, Unilateral Or Bilateral (Pro Cah)",,92235,CPT,Professional,Both,,,,342,290.7,31.22168,342,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,242.4684,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Fluorescein Angiography With Interpretation And Report, Unilateral Or Bilateral (Pro Cah)",,92235,CPT,Professional,Both,,,,342,290.7,31.22168,342,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,31.22168,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Fluorescein Angiography With Interpretation And Report, Unilateral Or Bilateral (Pro Cah)",,92235,CPT,Professional,Both,,,,342,290.7,31.22168,342,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),161.322,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Fluorescein Angiography With Interpretation And Report, Unilateral Or Bilateral (Pro Cah)",,92235,CPT,Professional,Both,,,,342,290.7,31.22168,342,CorVel,Worker's Compensation,249.5378934,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Fluorescein Angiography With Interpretation And Report, Unilateral Or Bilateral (Pro Cah)",,92235,CPT,Professional,Both,,,,342,290.7,31.22168,342,First Health Group Corporation,First Health Network,331.74,97,,percent of total billed charges,,
"Fluorescein Angiography With Interpretation And Report, Unilateral Or Bilateral (Pro Cah)",,92235,CPT,Professional,Both,,,,342,290.7,31.22168,342,"Health Partners, Inc.",Commercial,269.17,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Fluorescein Angiography With Interpretation And Report, Unilateral Or Bilateral (Pro Cah)",,92235,CPT,Professional,Both,,,,342,290.7,31.22168,342,"Health Partners, Inc.",Medicare Advantage,161.322,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Fluorescein Angiography With Interpretation And Report, Unilateral Or Bilateral (Pro Cah)",,92235,CPT,Professional,Both,,,,342,290.7,31.22168,342,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),140.29,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Fluorescein Angiography With Interpretation And Report, Unilateral Or Bilateral (Pro Cah)",,92235,CPT,Professional,Both,,,,342,290.7,31.22168,342,"Health Partners, Inc.",State of Minnesota Advantage Program,231.889955,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Fluorescein Angiography With Interpretation And Report, Unilateral Or Bilateral (Pro Cah)",,92235,CPT,Professional,Both,,,,342,290.7,31.22168,342,"Health Partners, Inc.",State Public Programs,90.09,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Fluorescein Angiography With Interpretation And Report, Unilateral Or Bilateral (Pro Cah)",,92235,CPT,Professional,Both,,,,342,290.7,31.22168,342,Humana Insurance Company,Commercial PPO,140.28,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Fluorescein Angiography With Interpretation And Report, Unilateral Or Bilateral (Pro Cah)",,92235,CPT,Professional,Both,,,,342,290.7,31.22168,342,Humana Insurance Company,Medicare PPO,342,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Fluorescein Angiography With Interpretation And Report, Unilateral Or Bilateral (Pro Cah)",,92235,CPT,Professional,Both,,,,342,290.7,31.22168,342,Medica,Individual & Family,290.016,84.8,,percent of total billed charges,,
"Fluorescein Angiography With Interpretation And Report, Unilateral Or Bilateral (Pro Cah)",,92235,CPT,Professional,Both,,,,342,290.7,31.22168,342,Medica,Medica Advantage Solution,170.316,49.8,,percent of total billed charges,,
"Fluorescein Angiography With Interpretation And Report, Unilateral Or Bilateral (Pro Cah)",,92235,CPT,Professional,Both,,,,342,290.7,31.22168,342,Medica,Medical Assistance,104.02,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Fluorescein Angiography With Interpretation And Report, Unilateral Or Bilateral (Pro Cah)",,92235,CPT,Professional,Both,,,,342,290.7,31.22168,342,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,140.28,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Fluorescein Angiography With Interpretation And Report, Unilateral Or Bilateral (Pro Cah)",,92235,CPT,Professional,Both,,,,342,290.7,31.22168,342,"Multiplan, Inc.","Multiplan, Inc.",321.48,94,,percent of total billed charges,,
"Fluorescein Angiography With Interpretation And Report, Unilateral Or Bilateral (Pro Cah)",,92235,CPT,Professional,Both,,,,342,290.7,31.22168,342,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,308.142,90.1,,percent of total billed charges,,
"Fluorescein Angiography With Interpretation And Report, Unilateral Or Bilateral (Pro Cah)",,92235,CPT,Professional,Both,,,,342,290.7,31.22168,342,"Preferred One Administrative Services, INC.",PPO,337.212,98.6,,percent of total billed charges,,
"Fluorescein Angiography With Interpretation And Report, Unilateral Or Bilateral (Pro Cah)",,92235,CPT,Professional,Both,,,,342,290.7,31.22168,342,PrimeWest Health,Minnesota Senior Health Options (MSHO),161.322,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Fluorescein Angiography With Interpretation And Report, Unilateral Or Bilateral (Pro Cah)",,92235,CPT,Professional,Both,,,,342,290.7,31.22168,342,PrimeWest Health,MinnesotaCare,33.4071976,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Fluorescein Angiography With Interpretation And Report, Unilateral Or Bilateral (Pro Cah)",,92235,CPT,Professional,Both,,,,342,290.7,31.22168,342,Sanford Health Plan,Sanford Health Plan,300.96,88,,percent of total billed charges,,
"Fluorescein Angiography With Interpretation And Report, Unilateral Or Bilateral (Pro Cah)",,92235,CPT,Professional,Both,,,,342,290.7,31.22168,342,"UCare Health, Inc.",Individual & Family Plan,228.039168,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Fluorescein Angiography With Interpretation And Report, Unilateral Or Bilateral (Pro Cah)",,92235,CPT,Professional,Both,,,,342,290.7,31.22168,342,"UCare Health, Inc.",Medical Assistance,34.343848,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Fluorescein Angiography With Interpretation And Report, Unilateral Or Bilateral (Pro Cah)",,92235,CPT,Professional,Both,,,,342,290.7,31.22168,342,"UCare Health, Inc.",Medicare Advantage,161.322,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Fluorescein Angiography With Interpretation And Report, Unilateral Or Bilateral (Pro Cah)",,92235,CPT,Professional,Both,,,,342,290.7,31.22168,342,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),129.0576,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Fluorescein Angiography With Interpretation And Report, Unilateral Or Bilateral (Pro Cah)",,92235,CPT,Professional,Both,,,,342,290.7,31.22168,342,UnitedHealthcare,Individual & Family,342,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Fluorescein Angiography With Interpretation And Report, Unilateral Or Bilateral (Pro Cah)",,92235,CPT,Professional,Both,,,,342,290.7,31.22168,342,UnitedHealthcare,Medicare Advantage,161.322,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Fluorescein Angiography With Interpretation And Report, Unilateral Or Bilateral (Pro Cah)",,92235,CPT,Professional,Both,,,,342,290.7,31.22168,342,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,31.22168,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Pure Tone Audiometry (Threshold); Air Only (Pro Cah),,92552,CPT,Professional,Both,,,,79,67.15,23.34,79,Aetna,Commercial,67.15,85,,percent of total billed charges,,
Pure Tone Audiometry (Threshold); Air Only (Pro Cah),,92552,CPT,Professional,Both,,,,79,67.15,23.34,79,Aetna,Medicare Advantage,33,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Pure Tone Audiometry (Threshold); Air Only (Pro Cah),,92552,CPT,Professional,Both,,,,79,67.15,23.34,79,Aetna,PPO,73.47,93,,percent of total billed charges,,
Pure Tone Audiometry (Threshold); Air Only (Pro Cah),,92552,CPT,Professional,Both,,,,79,67.15,23.34,79,America's PPO,America's PPO,67.4976,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Pure Tone Audiometry (Threshold); Air Only (Pro Cah),,92552,CPT,Professional,Both,,,,79,67.15,23.34,79,BlueCross BlueShield Minnesota, Federal Employee Program,61.85,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Pure Tone Audiometry (Threshold); Air Only (Pro Cah),,92552,CPT,Professional,Both,,,,79,67.15,23.34,79,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,62.8396,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Pure Tone Audiometry (Threshold); Air Only (Pro Cah),,92552,CPT,Professional,Both,,,,79,67.15,23.34,79,BlueCross BlueShield Minnesota,High Value Network Plan,62.8396,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Pure Tone Audiometry (Threshold); Air Only (Pro Cah),,92552,CPT,Professional,Both,,,,79,67.15,23.34,79,BlueCross BlueShield Minnesota,Medicare Advantage,41.8255,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Pure Tone Audiometry (Threshold); Air Only (Pro Cah),,92552,CPT,Professional,Both,,,,79,67.15,23.34,79,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,62.8396,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Pure Tone Audiometry (Threshold); Air Only (Pro Cah),,92552,CPT,Professional,Both,,,,79,67.15,23.34,79,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,26.94432,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Pure Tone Audiometry (Threshold); Air Only (Pro Cah),,92552,CPT,Professional,Both,,,,79,67.15,23.34,79,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),41.8255,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Pure Tone Audiometry (Threshold); Air Only (Pro Cah),,92552,CPT,Professional,Both,,,,79,67.15,23.34,79,CorVel,Worker's Compensation,66.9194559,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Pure Tone Audiometry (Threshold); Air Only (Pro Cah),,92552,CPT,Professional,Both,,,,79,67.15,23.34,79,First Health Group Corporation,First Health Network,76.63,97,,percent of total billed charges,,
Pure Tone Audiometry (Threshold); Air Only (Pro Cah),,92552,CPT,Professional,Both,,,,79,67.15,23.34,79,"Health Partners, Inc.",Commercial,71.83,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Pure Tone Audiometry (Threshold); Air Only (Pro Cah),,92552,CPT,Professional,Both,,,,79,67.15,23.34,79,"Health Partners, Inc.",Medicare Advantage,41.8255,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Pure Tone Audiometry (Threshold); Air Only (Pro Cah),,92552,CPT,Professional,Both,,,,79,67.15,23.34,79,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),36.26,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Pure Tone Audiometry (Threshold); Air Only (Pro Cah),,92552,CPT,Professional,Both,,,,79,67.15,23.34,79,"Health Partners, Inc.",State of Minnesota Advantage Program,61.881545,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Pure Tone Audiometry (Threshold); Air Only (Pro Cah),,92552,CPT,Professional,Both,,,,79,67.15,23.34,79,"Health Partners, Inc.",State Public Programs,23.34,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Pure Tone Audiometry (Threshold); Air Only (Pro Cah),,92552,CPT,Professional,Both,,,,79,67.15,23.34,79,Humana Insurance Company,Commercial PPO,36.37,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Pure Tone Audiometry (Threshold); Air Only (Pro Cah),,92552,CPT,Professional,Both,,,,79,67.15,23.34,79,Humana Insurance Company,Medicare PPO,79,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Pure Tone Audiometry (Threshold); Air Only (Pro Cah),,92552,CPT,Professional,Both,,,,79,67.15,23.34,79,Medica,Individual & Family,66.992,84.8,,percent of total billed charges,,
Pure Tone Audiometry (Threshold); Air Only (Pro Cah),,92552,CPT,Professional,Both,,,,79,67.15,23.34,79,Medica,Medica Advantage Solution,39.342,49.8,,percent of total billed charges,,
Pure Tone Audiometry (Threshold); Air Only (Pro Cah),,92552,CPT,Professional,Both,,,,79,67.15,23.34,79,Medica,Medical Assistance,26.94,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Pure Tone Audiometry (Threshold); Air Only (Pro Cah),,92552,CPT,Professional,Both,,,,79,67.15,23.34,79,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,36.37,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Pure Tone Audiometry (Threshold); Air Only (Pro Cah),,92552,CPT,Professional,Both,,,,79,67.15,23.34,79,"Multiplan, Inc.","Multiplan, Inc.",74.26,94,,percent of total billed charges,,
Pure Tone Audiometry (Threshold); Air Only (Pro Cah),,92552,CPT,Professional,Both,,,,79,67.15,23.34,79,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,71.179,90.1,,percent of total billed charges,,
Pure Tone Audiometry (Threshold); Air Only (Pro Cah),,92552,CPT,Professional,Both,,,,79,67.15,23.34,79,"Preferred One Administrative Services, INC.",PPO,77.894,98.6,,percent of total billed charges,,
Pure Tone Audiometry (Threshold); Air Only (Pro Cah),,92552,CPT,Professional,Both,,,,79,67.15,23.34,79,PrimeWest Health,Minnesota Senior Health Options (MSHO),41.8255,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Pure Tone Audiometry (Threshold); Air Only (Pro Cah),,92552,CPT,Professional,Both,,,,79,67.15,23.34,79,PrimeWest Health,MinnesotaCare,28.8304224,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Pure Tone Audiometry (Threshold); Air Only (Pro Cah),,92552,CPT,Professional,Both,,,,79,67.15,23.34,79,Sanford Health Plan,Sanford Health Plan,69.52,88,,percent of total billed charges,,
Pure Tone Audiometry (Threshold); Air Only (Pro Cah),,92552,CPT,Professional,Both,,,,79,67.15,23.34,79,"UCare Health, Inc.",Individual & Family Plan,59.123072,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Pure Tone Audiometry (Threshold); Air Only (Pro Cah),,92552,CPT,Professional,Both,,,,79,67.15,23.34,79,"UCare Health, Inc.",Medical Assistance,29.638752,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Pure Tone Audiometry (Threshold); Air Only (Pro Cah),,92552,CPT,Professional,Both,,,,79,67.15,23.34,79,"UCare Health, Inc.",Medicare Advantage,41.8255,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Pure Tone Audiometry (Threshold); Air Only (Pro Cah),,92552,CPT,Professional,Both,,,,79,67.15,23.34,79,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),33.4604,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Pure Tone Audiometry (Threshold); Air Only (Pro Cah),,92552,CPT,Professional,Both,,,,79,67.15,23.34,79,UnitedHealthcare,Individual & Family,79,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Pure Tone Audiometry (Threshold); Air Only (Pro Cah),,92552,CPT,Professional,Both,,,,79,67.15,23.34,79,UnitedHealthcare,Medicare Advantage,41.8255,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Pure Tone Audiometry (Threshold); Air Only (Pro Cah),,92552,CPT,Professional,Both,,,,79,67.15,23.34,79,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,26.94432,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Pure Tone Audiometry (Threshold); Air And Bone (Pro Cah),,92553,CPT,Professional,Both,,,,90,76.5,28.57,90,Aetna,Commercial,76.5,85,,percent of total billed charges,,
Pure Tone Audiometry (Threshold); Air And Bone (Pro Cah),,92553,CPT,Professional,Both,,,,90,76.5,28.57,90,Aetna,Medicare Advantage,40.42,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Pure Tone Audiometry (Threshold); Air And Bone (Pro Cah),,92553,CPT,Professional,Both,,,,90,76.5,28.57,90,Aetna,PPO,83.7,93,,percent of total billed charges,,
Pure Tone Audiometry (Threshold); Air And Bone (Pro Cah),,92553,CPT,Professional,Both,,,,90,76.5,28.57,90,America's PPO,America's PPO,76.896,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Pure Tone Audiometry (Threshold); Air And Bone (Pro Cah),,92553,CPT,Professional,Both,,,,90,76.5,28.57,90,BlueCross BlueShield Minnesota, Federal Employee Program,75.86,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Pure Tone Audiometry (Threshold); Air And Bone (Pro Cah),,92553,CPT,Professional,Both,,,,90,76.5,28.57,90,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,77.07376,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Pure Tone Audiometry (Threshold); Air And Bone (Pro Cah),,92553,CPT,Professional,Both,,,,90,76.5,28.57,90,BlueCross BlueShield Minnesota,High Value Network Plan,77.07376,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Pure Tone Audiometry (Threshold); Air And Bone (Pro Cah),,92553,CPT,Professional,Both,,,,90,76.5,28.57,90,BlueCross BlueShield Minnesota,Medicare Advantage,51.359,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Pure Tone Audiometry (Threshold); Air And Bone (Pro Cah),,92553,CPT,Professional,Both,,,,90,76.5,28.57,90,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,77.07376,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Pure Tone Audiometry (Threshold); Air And Bone (Pro Cah),,92553,CPT,Professional,Both,,,,90,76.5,28.57,90,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,32.98952,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Pure Tone Audiometry (Threshold); Air And Bone (Pro Cah),,92553,CPT,Professional,Both,,,,90,76.5,28.57,90,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),51.359,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Pure Tone Audiometry (Threshold); Air And Bone (Pro Cah),,92553,CPT,Professional,Both,,,,90,76.5,28.57,90,CorVel,Worker's Compensation,81.20853,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Pure Tone Audiometry (Threshold); Air And Bone (Pro Cah),,92553,CPT,Professional,Both,,,,90,76.5,28.57,90,First Health Group Corporation,First Health Network,87.3,97,,percent of total billed charges,,
Pure Tone Audiometry (Threshold); Air And Bone (Pro Cah),,92553,CPT,Professional,Both,,,,90,76.5,28.57,90,"Health Partners, Inc.",Commercial,87.79,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Pure Tone Audiometry (Threshold); Air And Bone (Pro Cah),,92553,CPT,Professional,Both,,,,90,76.5,28.57,90,"Health Partners, Inc.",Medicare Advantage,51.359,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Pure Tone Audiometry (Threshold); Air And Bone (Pro Cah),,92553,CPT,Professional,Both,,,,90,76.5,28.57,90,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),44.39,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Pure Tone Audiometry (Threshold); Air And Bone (Pro Cah),,92553,CPT,Professional,Both,,,,90,76.5,28.57,90,"Health Partners, Inc.",State of Minnesota Advantage Program,75.631085,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Pure Tone Audiometry (Threshold); Air And Bone (Pro Cah),,92553,CPT,Professional,Both,,,,90,76.5,28.57,90,"Health Partners, Inc.",State Public Programs,28.57,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Pure Tone Audiometry (Threshold); Air And Bone (Pro Cah),,92553,CPT,Professional,Both,,,,90,76.5,28.57,90,Humana Insurance Company,Commercial PPO,44.66,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Pure Tone Audiometry (Threshold); Air And Bone (Pro Cah),,92553,CPT,Professional,Both,,,,90,76.5,28.57,90,Humana Insurance Company,Medicare PPO,90,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Pure Tone Audiometry (Threshold); Air And Bone (Pro Cah),,92553,CPT,Professional,Both,,,,90,76.5,28.57,90,Medica,Individual & Family,76.32,84.8,,percent of total billed charges,,
Pure Tone Audiometry (Threshold); Air And Bone (Pro Cah),,92553,CPT,Professional,Both,,,,90,76.5,28.57,90,Medica,Medica Advantage Solution,44.82,49.8,,percent of total billed charges,,
Pure Tone Audiometry (Threshold); Air And Bone (Pro Cah),,92553,CPT,Professional,Both,,,,90,76.5,28.57,90,Medica,Medical Assistance,32.99,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Pure Tone Audiometry (Threshold); Air And Bone (Pro Cah),,92553,CPT,Professional,Both,,,,90,76.5,28.57,90,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,44.66,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Pure Tone Audiometry (Threshold); Air And Bone (Pro Cah),,92553,CPT,Professional,Both,,,,90,76.5,28.57,90,"Multiplan, Inc.","Multiplan, Inc.",84.6,94,,percent of total billed charges,,
Pure Tone Audiometry (Threshold); Air And Bone (Pro Cah),,92553,CPT,Professional,Both,,,,90,76.5,28.57,90,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,81.09,90.1,,percent of total billed charges,,
Pure Tone Audiometry (Threshold); Air And Bone (Pro Cah),,92553,CPT,Professional,Both,,,,90,76.5,28.57,90,"Preferred One Administrative Services, INC.",PPO,88.74,98.6,,percent of total billed charges,,
Pure Tone Audiometry (Threshold); Air And Bone (Pro Cah),,92553,CPT,Professional,Both,,,,90,76.5,28.57,90,PrimeWest Health,Minnesota Senior Health Options (MSHO),51.359,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Pure Tone Audiometry (Threshold); Air And Bone (Pro Cah),,92553,CPT,Professional,Both,,,,90,76.5,28.57,90,PrimeWest Health,MinnesotaCare,35.2987864,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Pure Tone Audiometry (Threshold); Air And Bone (Pro Cah),,92553,CPT,Professional,Both,,,,90,76.5,28.57,90,Sanford Health Plan,Sanford Health Plan,79.2,88,,percent of total billed charges,,
Pure Tone Audiometry (Threshold); Air And Bone (Pro Cah),,92553,CPT,Professional,Both,,,,90,76.5,28.57,90,"UCare Health, Inc.",Individual & Family Plan,72.599296,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Pure Tone Audiometry (Threshold); Air And Bone (Pro Cah),,92553,CPT,Professional,Both,,,,90,76.5,28.57,90,"UCare Health, Inc.",Medical Assistance,36.288472,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Pure Tone Audiometry (Threshold); Air And Bone (Pro Cah),,92553,CPT,Professional,Both,,,,90,76.5,28.57,90,"UCare Health, Inc.",Medicare Advantage,51.359,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Pure Tone Audiometry (Threshold); Air And Bone (Pro Cah),,92553,CPT,Professional,Both,,,,90,76.5,28.57,90,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),41.0872,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Pure Tone Audiometry (Threshold); Air And Bone (Pro Cah),,92553,CPT,Professional,Both,,,,90,76.5,28.57,90,UnitedHealthcare,Individual & Family,90,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Pure Tone Audiometry (Threshold); Air And Bone (Pro Cah),,92553,CPT,Professional,Both,,,,90,76.5,28.57,90,UnitedHealthcare,Medicare Advantage,51.359,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Pure Tone Audiometry (Threshold); Air And Bone (Pro Cah),,92553,CPT,Professional,Both,,,,90,76.5,28.57,90,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,32.98952,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Speech Audiometry Threshold (Pro Cah),,92555,CPT,Professional,Both,,,,41,34.85,17.88,41,Aetna,Commercial,34.85,85,,percent of total billed charges,,
Speech Audiometry Threshold (Pro Cah),,92555,CPT,Professional,Both,,,,41,34.85,17.88,41,Aetna,Medicare Advantage,25.22,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Speech Audiometry Threshold (Pro Cah),,92555,CPT,Professional,Both,,,,41,34.85,17.88,41,Aetna,PPO,38.13,93,,percent of total billed charges,,
Speech Audiometry Threshold (Pro Cah),,92555,CPT,Professional,Both,,,,41,34.85,17.88,41,America's PPO,America's PPO,35.0304,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Speech Audiometry Threshold (Pro Cah),,92555,CPT,Professional,Both,,,,41,34.85,17.88,41,BlueCross BlueShield Minnesota, Federal Employee Program,41,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Speech Audiometry Threshold (Pro Cah),,92555,CPT,Professional,Both,,,,41,34.85,17.88,41,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,41,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Speech Audiometry Threshold (Pro Cah),,92555,CPT,Professional,Both,,,,41,34.85,17.88,41,BlueCross BlueShield Minnesota,High Value Network Plan,41,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Speech Audiometry Threshold (Pro Cah),,92555,CPT,Professional,Both,,,,41,34.85,17.88,41,BlueCross BlueShield Minnesota,Medicare Advantage,32.292,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Speech Audiometry Threshold (Pro Cah),,92555,CPT,Professional,Both,,,,41,34.85,17.88,41,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,41,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Speech Audiometry Threshold (Pro Cah),,92555,CPT,Professional,Both,,,,41,34.85,17.88,41,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,20.64512,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Speech Audiometry Threshold (Pro Cah),,92555,CPT,Professional,Both,,,,41,34.85,17.88,41,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),32.292,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Speech Audiometry Threshold (Pro Cah),,92555,CPT,Professional,Both,,,,41,34.85,17.88,41,CorVel,Worker's Compensation,41,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Speech Audiometry Threshold (Pro Cah),,92555,CPT,Professional,Both,,,,41,34.85,17.88,41,First Health Group Corporation,First Health Network,39.77,97,,percent of total billed charges,,
Speech Audiometry Threshold (Pro Cah),,92555,CPT,Professional,Both,,,,41,34.85,17.88,41,"Health Partners, Inc.",Commercial,41,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Speech Audiometry Threshold (Pro Cah),,92555,CPT,Professional,Both,,,,41,34.85,17.88,41,"Health Partners, Inc.",Medicare Advantage,32.292,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Speech Audiometry Threshold (Pro Cah),,92555,CPT,Professional,Both,,,,41,34.85,17.88,41,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),28.13,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Speech Audiometry Threshold (Pro Cah),,92555,CPT,Professional,Both,,,,41,34.85,17.88,41,"Health Partners, Inc.",State of Minnesota Advantage Program,41,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Speech Audiometry Threshold (Pro Cah),,92555,CPT,Professional,Both,,,,41,34.85,17.88,41,"Health Partners, Inc.",State Public Programs,17.88,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Speech Audiometry Threshold (Pro Cah),,92555,CPT,Professional,Both,,,,41,34.85,17.88,41,Humana Insurance Company,Commercial PPO,28.08,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Speech Audiometry Threshold (Pro Cah),,92555,CPT,Professional,Both,,,,41,34.85,17.88,41,Humana Insurance Company,Medicare PPO,41,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Speech Audiometry Threshold (Pro Cah),,92555,CPT,Professional,Both,,,,41,34.85,17.88,41,Medica,Individual & Family,34.768,84.8,,percent of total billed charges,,
Speech Audiometry Threshold (Pro Cah),,92555,CPT,Professional,Both,,,,41,34.85,17.88,41,Medica,Medica Advantage Solution,20.418,49.8,,percent of total billed charges,,
Speech Audiometry Threshold (Pro Cah),,92555,CPT,Professional,Both,,,,41,34.85,17.88,41,Medica,Medical Assistance,20.65,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Speech Audiometry Threshold (Pro Cah),,92555,CPT,Professional,Both,,,,41,34.85,17.88,41,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,28.08,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Speech Audiometry Threshold (Pro Cah),,92555,CPT,Professional,Both,,,,41,34.85,17.88,41,"Multiplan, Inc.","Multiplan, Inc.",38.54,94,,percent of total billed charges,,
Speech Audiometry Threshold (Pro Cah),,92555,CPT,Professional,Both,,,,41,34.85,17.88,41,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,36.941,90.1,,percent of total billed charges,,
Speech Audiometry Threshold (Pro Cah),,92555,CPT,Professional,Both,,,,41,34.85,17.88,41,"Preferred One Administrative Services, INC.",PPO,40.426,98.6,,percent of total billed charges,,
Speech Audiometry Threshold (Pro Cah),,92555,CPT,Professional,Both,,,,41,34.85,17.88,41,PrimeWest Health,Minnesota Senior Health Options (MSHO),32.292,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Speech Audiometry Threshold (Pro Cah),,92555,CPT,Professional,Both,,,,41,34.85,17.88,41,PrimeWest Health,MinnesotaCare,22.0902784,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Speech Audiometry Threshold (Pro Cah),,92555,CPT,Professional,Both,,,,41,34.85,17.88,41,Sanford Health Plan,Sanford Health Plan,36.08,88,,percent of total billed charges,,
Speech Audiometry Threshold (Pro Cah),,92555,CPT,Professional,Both,,,,41,34.85,17.88,41,"UCare Health, Inc.",Individual & Family Plan,41,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Speech Audiometry Threshold (Pro Cah),,92555,CPT,Professional,Both,,,,41,34.85,17.88,41,"UCare Health, Inc.",Medical Assistance,22.709632,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Speech Audiometry Threshold (Pro Cah),,92555,CPT,Professional,Both,,,,41,34.85,17.88,41,"UCare Health, Inc.",Medicare Advantage,32.292,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Speech Audiometry Threshold (Pro Cah),,92555,CPT,Professional,Both,,,,41,34.85,17.88,41,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),25.8336,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Speech Audiometry Threshold (Pro Cah),,92555,CPT,Professional,Both,,,,41,34.85,17.88,41,UnitedHealthcare,Individual & Family,41,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Speech Audiometry Threshold (Pro Cah),,92555,CPT,Professional,Both,,,,41,34.85,17.88,41,UnitedHealthcare,Medicare Advantage,32.292,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Speech Audiometry Threshold (Pro Cah),,92555,CPT,Professional,Both,,,,41,34.85,17.88,41,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,20.64512,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Comprehensive Audiometry Threshold Eval And Speech Recognition (Pro Cah),,92557,CPT,Professional,Both,,,,157,133.45,20.28,157,Aetna,Commercial,133.45,85,,percent of total billed charges,,
Comprehensive Audiometry Threshold Eval And Speech Recognition (Pro Cah),,92557,CPT,Professional,Both,,,,157,133.45,20.28,157,Aetna,Medicare Advantage,32.39,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Comprehensive Audiometry Threshold Eval And Speech Recognition (Pro Cah),,92557,CPT,Professional,Both,,,,157,133.45,20.28,157,Aetna,PPO,146.01,93,,percent of total billed charges,,
Comprehensive Audiometry Threshold Eval And Speech Recognition (Pro Cah),,92557,CPT,Professional,Both,,,,157,133.45,20.28,157,America's PPO,America's PPO,134.1408,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Comprehensive Audiometry Threshold Eval And Speech Recognition (Pro Cah),,92557,CPT,Professional,Both,,,,157,133.45,20.28,157,BlueCross BlueShield Minnesota, Federal Employee Program,54.85,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Comprehensive Audiometry Threshold Eval And Speech Recognition (Pro Cah),,92557,CPT,Professional,Both,,,,157,133.45,20.28,157,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,55.7276,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Comprehensive Audiometry Threshold Eval And Speech Recognition (Pro Cah),,92557,CPT,Professional,Both,,,,157,133.45,20.28,157,BlueCross BlueShield Minnesota,High Value Network Plan,55.7276,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Comprehensive Audiometry Threshold Eval And Speech Recognition (Pro Cah),,92557,CPT,Professional,Both,,,,157,133.45,20.28,157,BlueCross BlueShield Minnesota,Medicare Advantage,36.34,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Comprehensive Audiometry Threshold Eval And Speech Recognition (Pro Cah),,92557,CPT,Professional,Both,,,,157,133.45,20.28,157,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,55.7276,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Comprehensive Audiometry Threshold Eval And Speech Recognition (Pro Cah),,92557,CPT,Professional,Both,,,,157,133.45,20.28,157,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,23.4188,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Comprehensive Audiometry Threshold Eval And Speech Recognition (Pro Cah),,92557,CPT,Professional,Both,,,,157,133.45,20.28,157,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),36.34,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Comprehensive Audiometry Threshold Eval And Speech Recognition (Pro Cah),,92557,CPT,Professional,Both,,,,157,133.45,20.28,157,CorVel,Worker's Compensation,62.3438355,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Comprehensive Audiometry Threshold Eval And Speech Recognition (Pro Cah),,92557,CPT,Professional,Both,,,,157,133.45,20.28,157,First Health Group Corporation,First Health Network,152.29,97,,percent of total billed charges,,
Comprehensive Audiometry Threshold Eval And Speech Recognition (Pro Cah),,92557,CPT,Professional,Both,,,,157,133.45,20.28,157,"Health Partners, Inc.",Commercial,66.75,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Comprehensive Audiometry Threshold Eval And Speech Recognition (Pro Cah),,92557,CPT,Professional,Both,,,,157,133.45,20.28,157,"Health Partners, Inc.",Medicare Advantage,36.34,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Comprehensive Audiometry Threshold Eval And Speech Recognition (Pro Cah),,92557,CPT,Professional,Both,,,,157,133.45,20.28,157,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),31.85,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Comprehensive Audiometry Threshold Eval And Speech Recognition (Pro Cah),,92557,CPT,Professional,Both,,,,157,133.45,20.28,157,"Health Partners, Inc.",State of Minnesota Advantage Program,57.505125,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Comprehensive Audiometry Threshold Eval And Speech Recognition (Pro Cah),,92557,CPT,Professional,Both,,,,157,133.45,20.28,157,"Health Partners, Inc.",State Public Programs,20.28,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Comprehensive Audiometry Threshold Eval And Speech Recognition (Pro Cah),,92557,CPT,Professional,Both,,,,157,133.45,20.28,157,Humana Insurance Company,Commercial PPO,37.13,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Comprehensive Audiometry Threshold Eval And Speech Recognition (Pro Cah),,92557,CPT,Professional,Both,,,,157,133.45,20.28,157,Humana Insurance Company,Medicare PPO,157,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Comprehensive Audiometry Threshold Eval And Speech Recognition (Pro Cah),,92557,CPT,Professional,Both,,,,157,133.45,20.28,157,Medica,Individual & Family,133.136,84.8,,percent of total billed charges,,
Comprehensive Audiometry Threshold Eval And Speech Recognition (Pro Cah),,92557,CPT,Professional,Both,,,,157,133.45,20.28,157,Medica,Medica Advantage Solution,78.186,49.8,,percent of total billed charges,,
Comprehensive Audiometry Threshold Eval And Speech Recognition (Pro Cah),,92557,CPT,Professional,Both,,,,157,133.45,20.28,157,Medica,Medical Assistance,23.42,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Comprehensive Audiometry Threshold Eval And Speech Recognition (Pro Cah),,92557,CPT,Professional,Both,,,,157,133.45,20.28,157,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,31.6,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Comprehensive Audiometry Threshold Eval And Speech Recognition (Pro Cah),,92557,CPT,Professional,Both,,,,157,133.45,20.28,157,"Multiplan, Inc.","Multiplan, Inc.",147.58,94,,percent of total billed charges,,
Comprehensive Audiometry Threshold Eval And Speech Recognition (Pro Cah),,92557,CPT,Professional,Both,,,,157,133.45,20.28,157,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,141.457,90.1,,percent of total billed charges,,
Comprehensive Audiometry Threshold Eval And Speech Recognition (Pro Cah),,92557,CPT,Professional,Both,,,,157,133.45,20.28,157,"Preferred One Administrative Services, INC.",PPO,154.802,98.6,,percent of total billed charges,,
Comprehensive Audiometry Threshold Eval And Speech Recognition (Pro Cah),,92557,CPT,Professional,Both,,,,157,133.45,20.28,157,PrimeWest Health,Minnesota Senior Health Options (MSHO),36.34,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Comprehensive Audiometry Threshold Eval And Speech Recognition (Pro Cah),,92557,CPT,Professional,Both,,,,157,133.45,20.28,157,PrimeWest Health,MinnesotaCare,25.058116,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Comprehensive Audiometry Threshold Eval And Speech Recognition (Pro Cah),,92557,CPT,Professional,Both,,,,157,133.45,20.28,157,Sanford Health Plan,Sanford Health Plan,138.16,88,,percent of total billed charges,,
Comprehensive Audiometry Threshold Eval And Speech Recognition (Pro Cah),,92557,CPT,Professional,Both,,,,157,133.45,20.28,157,"UCare Health, Inc.",Individual & Family Plan,51.36896,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Comprehensive Audiometry Threshold Eval And Speech Recognition (Pro Cah),,92557,CPT,Professional,Both,,,,157,133.45,20.28,157,"UCare Health, Inc.",Medical Assistance,25.76068,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Comprehensive Audiometry Threshold Eval And Speech Recognition (Pro Cah),,92557,CPT,Professional,Both,,,,157,133.45,20.28,157,"UCare Health, Inc.",Medicare Advantage,36.34,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Comprehensive Audiometry Threshold Eval And Speech Recognition (Pro Cah),,92557,CPT,Professional,Both,,,,157,133.45,20.28,157,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),29.072,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Comprehensive Audiometry Threshold Eval And Speech Recognition (Pro Cah),,92557,CPT,Professional,Both,,,,157,133.45,20.28,157,UnitedHealthcare,Individual & Family,157,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Comprehensive Audiometry Threshold Eval And Speech Recognition (Pro Cah),,92557,CPT,Professional,Both,,,,157,133.45,20.28,157,UnitedHealthcare,Medicare Advantage,36.34,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Comprehensive Audiometry Threshold Eval And Speech Recognition (Pro Cah),,92557,CPT,Professional,Both,,,,157,133.45,20.28,157,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,23.4188,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Evoked Otoacoustic Emissions, Screening (Qualitative), Automated Analysis",,92558,CPT,Facility,Both,,,,183,155.55,52.4478,183,Aetna,Commercial,168.36,92,,percent of total billed charges,,
"Evoked Otoacoustic Emissions, Screening (Qualitative), Automated Analysis",,92558,CPT,Facility,Outpatient,,,,183,155.55,52.4478,183,Aetna,Medicare Advantage,89.67,49,,percent of total billed charges,,
"Evoked Otoacoustic Emissions, Screening (Qualitative), Automated Analysis",,92558,CPT,Facility,Inpatient,,,,183,155.55,52.4478,183,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Evoked Otoacoustic Emissions, Screening (Qualitative), Automated Analysis",,92558,CPT,Facility,Both,,,,183,155.55,52.4478,183,Aetna,PPO,170.19,93,,percent of total billed charges,,
"Evoked Otoacoustic Emissions, Screening (Qualitative), Automated Analysis",,92558,CPT,Facility,Both,,,,183,155.55,52.4478,183,America's PPO,America's PPO,175.7349,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Evoked Otoacoustic Emissions, Screening (Qualitative), Automated Analysis",,92558,CPT,Facility,Both,,,,183,155.55,52.4478,183,BlueCross BlueShield Minnesota, Federal Employee Program,180.072,98.4,,percent of total billed charges,,
"Evoked Otoacoustic Emissions, Screening (Qualitative), Automated Analysis",,92558,CPT,Facility,Both,,,,183,155.55,52.4478,183,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,183,100,,percent of total billed charges,,
"Evoked Otoacoustic Emissions, Screening (Qualitative), Automated Analysis",,92558,CPT,Facility,Both,,,,183,155.55,52.4478,183,BlueCross BlueShield Minnesota,High Value Network Plan,164.7,90,,percent of total billed charges,,
"Evoked Otoacoustic Emissions, Screening (Qualitative), Automated Analysis",,92558,CPT,Facility,Outpatient,,,,183,155.55,52.4478,183,BlueCross BlueShield Minnesota,Medicare Advantage,89.67,49,,percent of total billed charges,,
"Evoked Otoacoustic Emissions, Screening (Qualitative), Automated Analysis",,92558,CPT,Facility,Inpatient,,,,183,155.55,52.4478,183,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Evoked Otoacoustic Emissions, Screening (Qualitative), Automated Analysis",,92558,CPT,Facility,Both,,,,183,155.55,52.4478,183,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,162.0831,88.57,,percent of total billed charges,,
"Evoked Otoacoustic Emissions, Screening (Qualitative), Automated Analysis",,92558,CPT,Facility,Both,,,,183,155.55,52.4478,183,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,52.4478,28.66,,percent of total billed charges,,
"Evoked Otoacoustic Emissions, Screening (Qualitative), Automated Analysis",,92558,CPT,Facility,Outpatient,,,,183,155.55,52.4478,183,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),89.67,49,,percent of total billed charges,,
"Evoked Otoacoustic Emissions, Screening (Qualitative), Automated Analysis",,92558,CPT,Facility,Inpatient,,,,183,155.55,52.4478,183,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Evoked Otoacoustic Emissions, Screening (Qualitative), Automated Analysis",,92558,CPT,Facility,Both,,,,183,155.55,52.4478,183,CorVel,Worker's Compensation,183,100,,percent of total billed charges,,
"Evoked Otoacoustic Emissions, Screening (Qualitative), Automated Analysis",,92558,CPT,Facility,Both,,,,183,155.55,52.4478,183,First Health Group Corporation,First Health Network,177.51,97,,percent of total billed charges,,
"Evoked Otoacoustic Emissions, Screening (Qualitative), Automated Analysis",,92558,CPT,Facility,Both,,,,183,155.55,52.4478,183,"Health Partners, Inc.",Commercial,173.118,94.6,,percent of total billed charges,,
"Evoked Otoacoustic Emissions, Screening (Qualitative), Automated Analysis",,92558,CPT,Facility,Outpatient,,,,183,155.55,52.4478,183,"Health Partners, Inc.",Medicare Advantage,89.67,49,,percent of total billed charges,,
"Evoked Otoacoustic Emissions, Screening (Qualitative), Automated Analysis",,92558,CPT,Facility,Inpatient,,,,183,155.55,52.4478,183,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Evoked Otoacoustic Emissions, Screening (Qualitative), Automated Analysis",,92558,CPT,Facility,Both,,,,183,155.55,52.4478,183,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),109.8,60,,percent of total billed charges,,
"Evoked Otoacoustic Emissions, Screening (Qualitative), Automated Analysis",,92558,CPT,Facility,Both,,,,183,155.55,52.4478,183,"Health Partners, Inc.",State of Minnesota Advantage Program,149.145,81.5,,percent of total billed charges,,
"Evoked Otoacoustic Emissions, Screening (Qualitative), Automated Analysis",,92558,CPT,Facility,Both,,,,183,155.55,52.4478,183,"Health Partners, Inc.",State Public Programs,91.5,50,,percent of total billed charges,,
"Evoked Otoacoustic Emissions, Screening (Qualitative), Automated Analysis",,92558,CPT,Facility,Both,,,,183,155.55,52.4478,183,Humana Insurance Company,Commercial PPO,173.85,95,,percent of total billed charges,,
"Evoked Otoacoustic Emissions, Screening (Qualitative), Automated Analysis",,92558,CPT,Facility,Outpatient,,,,183,155.55,52.4478,183,Humana Insurance Company,Medicare PPO,89.67,49,,percent of total billed charges,,
"Evoked Otoacoustic Emissions, Screening (Qualitative), Automated Analysis",,92558,CPT,Facility,Inpatient,,,,183,155.55,52.4478,183,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Evoked Otoacoustic Emissions, Screening (Qualitative), Automated Analysis",,92558,CPT,Facility,Both,,,,183,155.55,52.4478,183,Medica,Individual & Family,181.353,99.1,,percent of total billed charges,,
"Evoked Otoacoustic Emissions, Screening (Qualitative), Automated Analysis",,92558,CPT,Facility,Outpatient,,,,183,155.55,52.4478,183,Medica,Medica Advantage Solution,91.134,49.8,,percent of total billed charges,,
"Evoked Otoacoustic Emissions, Screening (Qualitative), Automated Analysis",,92558,CPT,Facility,Inpatient,,,,183,155.55,52.4478,183,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Evoked Otoacoustic Emissions, Screening (Qualitative), Automated Analysis",,92558,CPT,Facility,Outpatient,,,,183,155.55,52.4478,183,Medica,Medical Assistance,81.618,44.6,,percent of total billed charges,,
"Evoked Otoacoustic Emissions, Screening (Qualitative), Automated Analysis",,92558,CPT,Facility,Inpatient,,,,183,155.55,52.4478,183,Medica,Medical Assistance,,,,,Included in per diem rate,
"Evoked Otoacoustic Emissions, Screening (Qualitative), Automated Analysis",,92558,CPT,Facility,Outpatient,,,,183,155.55,52.4478,183,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,91.134,49.8,,percent of total billed charges,,
"Evoked Otoacoustic Emissions, Screening (Qualitative), Automated Analysis",,92558,CPT,Facility,Inpatient,,,,183,155.55,52.4478,183,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Evoked Otoacoustic Emissions, Screening (Qualitative), Automated Analysis",,92558,CPT,Facility,Both,,,,183,155.55,52.4478,183,"Multiplan, Inc.","Multiplan, Inc.",172.02,94,,percent of total billed charges,,
"Evoked Otoacoustic Emissions, Screening (Qualitative), Automated Analysis",,92558,CPT,Facility,Outpatient,,,,183,155.55,52.4478,183,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,164.883,90.1,,percent of total billed charges,,
"Evoked Otoacoustic Emissions, Screening (Qualitative), Automated Analysis",,92558,CPT,Facility,Inpatient,,,,183,155.55,52.4478,183,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Evoked Otoacoustic Emissions, Screening (Qualitative), Automated Analysis",,92558,CPT,Facility,Both,,,,183,155.55,52.4478,183,"Preferred One Administrative Services, INC.",PPO,180.438,98.6,,percent of total billed charges,,
"Evoked Otoacoustic Emissions, Screening (Qualitative), Automated Analysis",,92558,CPT,Facility,Outpatient,,,,183,155.55,52.4478,183,PrimeWest Health,Minnesota Senior Health Options (MSHO),94.1535,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Evoked Otoacoustic Emissions, Screening (Qualitative), Automated Analysis",,92558,CPT,Facility,Inpatient,,,,183,155.55,52.4478,183,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Evoked Otoacoustic Emissions, Screening (Qualitative), Automated Analysis",,92558,CPT,Facility,Outpatient,,,,183,155.55,52.4478,183,PrimeWest Health,MinnesotaCare,93.9888,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Evoked Otoacoustic Emissions, Screening (Qualitative), Automated Analysis",,92558,CPT,Facility,Inpatient,,,,183,155.55,52.4478,183,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Evoked Otoacoustic Emissions, Screening (Qualitative), Automated Analysis",,92558,CPT,Facility,Both,,,,183,155.55,52.4478,183,Sanford Health Plan,Sanford Health Plan,168.36,92,,percent of total billed charges,,
"Evoked Otoacoustic Emissions, Screening (Qualitative), Automated Analysis",,92558,CPT,Facility,Outpatient,,,,183,155.55,52.4478,183,"UCare Health, Inc.",Individual & Family Plan,103.1205,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Evoked Otoacoustic Emissions, Screening (Qualitative), Automated Analysis",,92558,CPT,Facility,Inpatient,,,,183,155.55,52.4478,183,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Evoked Otoacoustic Emissions, Screening (Qualitative), Automated Analysis",,92558,CPT,Facility,Outpatient,,,,183,155.55,52.4478,183,"UCare Health, Inc.",Medical Assistance,92.3601,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Evoked Otoacoustic Emissions, Screening (Qualitative), Automated Analysis",,92558,CPT,Facility,Inpatient,,,,183,155.55,52.4478,183,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Evoked Otoacoustic Emissions, Screening (Qualitative), Automated Analysis",,92558,CPT,Facility,Outpatient,,,,183,155.55,52.4478,183,"UCare Health, Inc.",Medicare Advantage,92.3601,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Evoked Otoacoustic Emissions, Screening (Qualitative), Automated Analysis",,92558,CPT,Facility,Inpatient,,,,183,155.55,52.4478,183,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Evoked Otoacoustic Emissions, Screening (Qualitative), Automated Analysis",,92558,CPT,Facility,Outpatient,,,,183,155.55,52.4478,183,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),92.3601,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Evoked Otoacoustic Emissions, Screening (Qualitative), Automated Analysis",,92558,CPT,Facility,Inpatient,,,,183,155.55,52.4478,183,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Evoked Otoacoustic Emissions, Screening (Qualitative), Automated Analysis",,92558,CPT,Facility,Both,,,,183,155.55,52.4478,183,UnitedHealthcare,Individual & Family,172.02,94,,percent of total billed charges,,
"Evoked Otoacoustic Emissions, Screening (Qualitative), Automated Analysis",,92558,CPT,Facility,Outpatient,,,,183,155.55,52.4478,183,UnitedHealthcare,Medicare Advantage,89.67,49,,percent of total billed charges,,
"Evoked Otoacoustic Emissions, Screening (Qualitative), Automated Analysis",,92558,CPT,Facility,Inpatient,,,,183,155.55,52.4478,183,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Evoked Otoacoustic Emissions, Screening (Qualitative), Automated Analysis",,92558,CPT,Facility,Outpatient,,,,183,155.55,52.4478,183,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,87.84,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Evoked Otoacoustic Emissions, Screening (Qualitative), Automated Analysis",,92558,CPT,Facility,Inpatient,,,,183,155.55,52.4478,183,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Tone Decay Test (Pro Cah),,92563,CPT,Professional,Both,,,,64,54.4,21.82,64,Aetna,Commercial,54.4,85,,percent of total billed charges,,
Tone Decay Test (Pro Cah),,92563,CPT,Professional,Both,,,,64,54.4,21.82,64,Aetna,Medicare Advantage,31.94,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Tone Decay Test (Pro Cah),,92563,CPT,Professional,Both,,,,64,54.4,21.82,64,Aetna,PPO,59.52,93,,percent of total billed charges,,
Tone Decay Test (Pro Cah),,92563,CPT,Professional,Both,,,,64,54.4,21.82,64,America's PPO,America's PPO,54.6816,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Tone Decay Test (Pro Cah),,92563,CPT,Professional,Both,,,,64,54.4,21.82,64,BlueCross BlueShield Minnesota, Federal Employee Program,57.77,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Tone Decay Test (Pro Cah),,92563,CPT,Professional,Both,,,,64,54.4,21.82,64,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,58.69432,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Tone Decay Test (Pro Cah),,92563,CPT,Professional,Both,,,,64,54.4,21.82,64,BlueCross BlueShield Minnesota,High Value Network Plan,58.69432,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Tone Decay Test (Pro Cah),,92563,CPT,Professional,Both,,,,64,54.4,21.82,64,BlueCross BlueShield Minnesota,Medicare Advantage,39.0425,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Tone Decay Test (Pro Cah),,92563,CPT,Professional,Both,,,,64,54.4,21.82,64,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,58.69432,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Tone Decay Test (Pro Cah),,92563,CPT,Professional,Both,,,,64,54.4,21.82,64,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,25.18664,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Tone Decay Test (Pro Cah),,92563,CPT,Professional,Both,,,,64,54.4,21.82,64,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),39.0425,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Tone Decay Test (Pro Cah),,92563,CPT,Professional,Both,,,,64,54.4,21.82,64,CorVel,Worker's Compensation,63.5172954,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Tone Decay Test (Pro Cah),,92563,CPT,Professional,Both,,,,64,54.4,21.82,64,First Health Group Corporation,First Health Network,62.08,97,,percent of total billed charges,,
Tone Decay Test (Pro Cah),,92563,CPT,Professional,Both,,,,64,54.4,21.82,64,"Health Partners, Inc.",Commercial,64,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Tone Decay Test (Pro Cah),,92563,CPT,Professional,Both,,,,64,54.4,21.82,64,"Health Partners, Inc.",Medicare Advantage,39.0425,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Tone Decay Test (Pro Cah),,92563,CPT,Professional,Both,,,,64,54.4,21.82,64,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),33.89,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Tone Decay Test (Pro Cah),,92563,CPT,Professional,Both,,,,64,54.4,21.82,64,"Health Partners, Inc.",State of Minnesota Advantage Program,58.7543,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Tone Decay Test (Pro Cah),,92563,CPT,Professional,Both,,,,64,54.4,21.82,64,"Health Partners, Inc.",State Public Programs,21.82,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Tone Decay Test (Pro Cah),,92563,CPT,Professional,Both,,,,64,54.4,21.82,64,Humana Insurance Company,Commercial PPO,33.95,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Tone Decay Test (Pro Cah),,92563,CPT,Professional,Both,,,,64,54.4,21.82,64,Humana Insurance Company,Medicare PPO,64,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Tone Decay Test (Pro Cah),,92563,CPT,Professional,Both,,,,64,54.4,21.82,64,Medica,Individual & Family,54.272,84.8,,percent of total billed charges,,
Tone Decay Test (Pro Cah),,92563,CPT,Professional,Both,,,,64,54.4,21.82,64,Medica,Medica Advantage Solution,31.872,49.8,,percent of total billed charges,,
Tone Decay Test (Pro Cah),,92563,CPT,Professional,Both,,,,64,54.4,21.82,64,Medica,Medical Assistance,25.19,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Tone Decay Test (Pro Cah),,92563,CPT,Professional,Both,,,,64,54.4,21.82,64,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,33.95,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Tone Decay Test (Pro Cah),,92563,CPT,Professional,Both,,,,64,54.4,21.82,64,"Multiplan, Inc.","Multiplan, Inc.",60.16,94,,percent of total billed charges,,
Tone Decay Test (Pro Cah),,92563,CPT,Professional,Both,,,,64,54.4,21.82,64,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,57.664,90.1,,percent of total billed charges,,
Tone Decay Test (Pro Cah),,92563,CPT,Professional,Both,,,,64,54.4,21.82,64,"Preferred One Administrative Services, INC.",PPO,63.104,98.6,,percent of total billed charges,,
Tone Decay Test (Pro Cah),,92563,CPT,Professional,Both,,,,64,54.4,21.82,64,PrimeWest Health,Minnesota Senior Health Options (MSHO),39.0425,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Tone Decay Test (Pro Cah),,92563,CPT,Professional,Both,,,,64,54.4,21.82,64,PrimeWest Health,MinnesotaCare,26.9497048,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Tone Decay Test (Pro Cah),,92563,CPT,Professional,Both,,,,64,54.4,21.82,64,Sanford Health Plan,Sanford Health Plan,56.32,88,,percent of total billed charges,,
Tone Decay Test (Pro Cah),,92563,CPT,Professional,Both,,,,64,54.4,21.82,64,"UCare Health, Inc.",Individual & Family Plan,55.18912,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Tone Decay Test (Pro Cah),,92563,CPT,Professional,Both,,,,64,54.4,21.82,64,"UCare Health, Inc.",Medical Assistance,27.705304,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Tone Decay Test (Pro Cah),,92563,CPT,Professional,Both,,,,64,54.4,21.82,64,"UCare Health, Inc.",Medicare Advantage,39.0425,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Tone Decay Test (Pro Cah),,92563,CPT,Professional,Both,,,,64,54.4,21.82,64,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),31.234,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Tone Decay Test (Pro Cah),,92563,CPT,Professional,Both,,,,64,54.4,21.82,64,UnitedHealthcare,Individual & Family,64,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Tone Decay Test (Pro Cah),,92563,CPT,Professional,Both,,,,64,54.4,21.82,64,UnitedHealthcare,Medicare Advantage,39.0425,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Tone Decay Test (Pro Cah),,92563,CPT,Professional,Both,,,,64,54.4,21.82,64,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,25.18664,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Tympanometry (Impedance Testing) (Pro Cah),,92567,CPT,Professional,Both,,,,65,55.25,6.76,65,Aetna,Commercial,55.25,85,,percent of total billed charges,,
Tympanometry (Impedance Testing) (Pro Cah),,92567,CPT,Professional,Both,,,,65,55.25,6.76,65,Aetna,Medicare Advantage,10.64,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Tympanometry (Impedance Testing) (Pro Cah),,92567,CPT,Professional,Both,,,,65,55.25,6.76,65,Aetna,PPO,60.45,93,,percent of total billed charges,,
Tympanometry (Impedance Testing) (Pro Cah),,92567,CPT,Professional,Both,,,,65,55.25,6.76,65,America's PPO,America's PPO,55.536,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Tympanometry (Impedance Testing) (Pro Cah),,92567,CPT,Professional,Both,,,,65,55.25,6.76,65,BlueCross BlueShield Minnesota, Federal Employee Program,18.67,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Tympanometry (Impedance Testing) (Pro Cah),,92567,CPT,Professional,Both,,,,65,55.25,6.76,65,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,18.96872,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Tympanometry (Impedance Testing) (Pro Cah),,92567,CPT,Professional,Both,,,,65,55.25,6.76,65,BlueCross BlueShield Minnesota,High Value Network Plan,18.96872,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Tympanometry (Impedance Testing) (Pro Cah),,92567,CPT,Professional,Both,,,,65,55.25,6.76,65,BlueCross BlueShield Minnesota,Medicare Advantage,12.2935,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Tympanometry (Impedance Testing) (Pro Cah),,92567,CPT,Professional,Both,,,,65,55.25,6.76,65,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,18.96872,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Tympanometry (Impedance Testing) (Pro Cah),,92567,CPT,Professional,Both,,,,65,55.25,6.76,65,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,7.80288,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Tympanometry (Impedance Testing) (Pro Cah),,92567,CPT,Professional,Both,,,,65,55.25,6.76,65,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),12.2935,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Tympanometry (Impedance Testing) (Pro Cah),,92567,CPT,Professional,Both,,,,65,55.25,6.76,65,CorVel,Worker's Compensation,20.4754311,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Tympanometry (Impedance Testing) (Pro Cah),,92567,CPT,Professional,Both,,,,65,55.25,6.76,65,First Health Group Corporation,First Health Network,63.05,97,,percent of total billed charges,,
Tympanometry (Impedance Testing) (Pro Cah),,92567,CPT,Professional,Both,,,,65,55.25,6.76,65,"Health Partners, Inc.",Commercial,21.76,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Tympanometry (Impedance Testing) (Pro Cah),,92567,CPT,Professional,Both,,,,65,55.25,6.76,65,"Health Partners, Inc.",Medicare Advantage,12.2935,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Tympanometry (Impedance Testing) (Pro Cah),,92567,CPT,Professional,Both,,,,65,55.25,6.76,65,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),10.51,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Tympanometry (Impedance Testing) (Pro Cah),,92567,CPT,Professional,Both,,,,65,55.25,6.76,65,"Health Partners, Inc.",State of Minnesota Advantage Program,18.74624,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Tympanometry (Impedance Testing) (Pro Cah),,92567,CPT,Professional,Both,,,,65,55.25,6.76,65,"Health Partners, Inc.",State Public Programs,6.76,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Tympanometry (Impedance Testing) (Pro Cah),,92567,CPT,Professional,Both,,,,65,55.25,6.76,65,Humana Insurance Company,Commercial PPO,16.56,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Tympanometry (Impedance Testing) (Pro Cah),,92567,CPT,Professional,Both,,,,65,55.25,6.76,65,Humana Insurance Company,Medicare PPO,65,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Tympanometry (Impedance Testing) (Pro Cah),,92567,CPT,Professional,Both,,,,65,55.25,6.76,65,Medica,Individual & Family,55.12,84.8,,percent of total billed charges,,
Tympanometry (Impedance Testing) (Pro Cah),,92567,CPT,Professional,Both,,,,65,55.25,6.76,65,Medica,Medica Advantage Solution,32.37,49.8,,percent of total billed charges,,
Tympanometry (Impedance Testing) (Pro Cah),,92567,CPT,Professional,Both,,,,65,55.25,6.76,65,Medica,Medical Assistance,7.8,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Tympanometry (Impedance Testing) (Pro Cah),,92567,CPT,Professional,Both,,,,65,55.25,6.76,65,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,10.69,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Tympanometry (Impedance Testing) (Pro Cah),,92567,CPT,Professional,Both,,,,65,55.25,6.76,65,"Multiplan, Inc.","Multiplan, Inc.",61.1,94,,percent of total billed charges,,
Tympanometry (Impedance Testing) (Pro Cah),,92567,CPT,Professional,Both,,,,65,55.25,6.76,65,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,58.565,90.1,,percent of total billed charges,,
Tympanometry (Impedance Testing) (Pro Cah),,92567,CPT,Professional,Both,,,,65,55.25,6.76,65,"Preferred One Administrative Services, INC.",PPO,64.09,98.6,,percent of total billed charges,,
Tympanometry (Impedance Testing) (Pro Cah),,92567,CPT,Professional,Both,,,,65,55.25,6.76,65,PrimeWest Health,Minnesota Senior Health Options (MSHO),12.2935,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Tympanometry (Impedance Testing) (Pro Cah),,92567,CPT,Professional,Both,,,,65,55.25,6.76,65,PrimeWest Health,MinnesotaCare,8.3490816,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Tympanometry (Impedance Testing) (Pro Cah),,92567,CPT,Professional,Both,,,,65,55.25,6.76,65,Sanford Health Plan,Sanford Health Plan,57.2,88,,percent of total billed charges,,
Tympanometry (Impedance Testing) (Pro Cah),,92567,CPT,Professional,Both,,,,65,55.25,6.76,65,"UCare Health, Inc.",Individual & Family Plan,17.377664,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Tympanometry (Impedance Testing) (Pro Cah),,92567,CPT,Professional,Both,,,,65,55.25,6.76,65,"UCare Health, Inc.",Medical Assistance,8.583168,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Tympanometry (Impedance Testing) (Pro Cah),,92567,CPT,Professional,Both,,,,65,55.25,6.76,65,"UCare Health, Inc.",Medicare Advantage,12.2935,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Tympanometry (Impedance Testing) (Pro Cah),,92567,CPT,Professional,Both,,,,65,55.25,6.76,65,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),9.8348,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Tympanometry (Impedance Testing) (Pro Cah),,92567,CPT,Professional,Both,,,,65,55.25,6.76,65,UnitedHealthcare,Individual & Family,65,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Tympanometry (Impedance Testing) (Pro Cah),,92567,CPT,Professional,Both,,,,65,55.25,6.76,65,UnitedHealthcare,Medicare Advantage,12.2935,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Tympanometry (Impedance Testing) (Pro Cah),,92567,CPT,Professional,Both,,,,65,55.25,6.76,65,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,7.80288,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Acoustic Reflex Testing, Threshold (Pro Cah)",,92568,CPT,Professional,Both,,,,59,50.15,9.37,59,Aetna,Commercial,50.15,85,,percent of total billed charges,,
"Acoustic Reflex Testing, Threshold (Pro Cah)",,92568,CPT,Professional,Both,,,,59,50.15,9.37,59,Aetna,Medicare Advantage,14.96,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Acoustic Reflex Testing, Threshold (Pro Cah)",,92568,CPT,Professional,Both,,,,59,50.15,9.37,59,Aetna,PPO,54.87,93,,percent of total billed charges,,
"Acoustic Reflex Testing, Threshold (Pro Cah)",,92568,CPT,Professional,Both,,,,59,50.15,9.37,59,America's PPO,America's PPO,50.4096,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Acoustic Reflex Testing, Threshold (Pro Cah)",,92568,CPT,Professional,Both,,,,59,50.15,9.37,59,BlueCross BlueShield Minnesota, Federal Employee Program,26.26,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Acoustic Reflex Testing, Threshold (Pro Cah)",,92568,CPT,Professional,Both,,,,59,50.15,9.37,59,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,26.68016,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Acoustic Reflex Testing, Threshold (Pro Cah)",,92568,CPT,Professional,Both,,,,59,50.15,9.37,59,BlueCross BlueShield Minnesota,High Value Network Plan,26.68016,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Acoustic Reflex Testing, Threshold (Pro Cah)",,92568,CPT,Professional,Both,,,,59,50.15,9.37,59,BlueCross BlueShield Minnesota,Medicare Advantage,17.112,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Acoustic Reflex Testing, Threshold (Pro Cah)",,92568,CPT,Professional,Both,,,,59,50.15,9.37,59,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,26.68016,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Acoustic Reflex Testing, Threshold (Pro Cah)",,92568,CPT,Professional,Both,,,,59,50.15,9.37,59,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,10.8204,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Acoustic Reflex Testing, Threshold (Pro Cah)",,92568,CPT,Professional,Both,,,,59,50.15,9.37,59,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),17.112,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Acoustic Reflex Testing, Threshold (Pro Cah)",,92568,CPT,Professional,Both,,,,59,50.15,9.37,59,CorVel,Worker's Compensation,29.4795696,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Acoustic Reflex Testing, Threshold (Pro Cah)",,92568,CPT,Professional,Both,,,,59,50.15,9.37,59,First Health Group Corporation,First Health Network,57.23,97,,percent of total billed charges,,
"Acoustic Reflex Testing, Threshold (Pro Cah)",,92568,CPT,Professional,Both,,,,59,50.15,9.37,59,"Health Partners, Inc.",Commercial,31.92,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Acoustic Reflex Testing, Threshold (Pro Cah)",,92568,CPT,Professional,Both,,,,59,50.15,9.37,59,"Health Partners, Inc.",Medicare Advantage,17.112,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Acoustic Reflex Testing, Threshold (Pro Cah)",,92568,CPT,Professional,Both,,,,59,50.15,9.37,59,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),14.91,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Acoustic Reflex Testing, Threshold (Pro Cah)",,92568,CPT,Professional,Both,,,,59,50.15,9.37,59,"Health Partners, Inc.",State of Minnesota Advantage Program,27.49908,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Acoustic Reflex Testing, Threshold (Pro Cah)",,92568,CPT,Professional,Both,,,,59,50.15,9.37,59,"Health Partners, Inc.",State Public Programs,9.37,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Acoustic Reflex Testing, Threshold (Pro Cah)",,92568,CPT,Professional,Both,,,,59,50.15,9.37,59,Humana Insurance Company,Commercial PPO,15.23,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Acoustic Reflex Testing, Threshold (Pro Cah)",,92568,CPT,Professional,Both,,,,59,50.15,9.37,59,Humana Insurance Company,Medicare PPO,59,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Acoustic Reflex Testing, Threshold (Pro Cah)",,92568,CPT,Professional,Both,,,,59,50.15,9.37,59,Medica,Individual & Family,50.032,84.8,,percent of total billed charges,,
"Acoustic Reflex Testing, Threshold (Pro Cah)",,92568,CPT,Professional,Both,,,,59,50.15,9.37,59,Medica,Medica Advantage Solution,29.382,49.8,,percent of total billed charges,,
"Acoustic Reflex Testing, Threshold (Pro Cah)",,92568,CPT,Professional,Both,,,,59,50.15,9.37,59,Medica,Medical Assistance,10.82,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Acoustic Reflex Testing, Threshold (Pro Cah)",,92568,CPT,Professional,Both,,,,59,50.15,9.37,59,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,14.88,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Acoustic Reflex Testing, Threshold (Pro Cah)",,92568,CPT,Professional,Both,,,,59,50.15,9.37,59,"Multiplan, Inc.","Multiplan, Inc.",55.46,94,,percent of total billed charges,,
"Acoustic Reflex Testing, Threshold (Pro Cah)",,92568,CPT,Professional,Both,,,,59,50.15,9.37,59,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,53.159,90.1,,percent of total billed charges,,
"Acoustic Reflex Testing, Threshold (Pro Cah)",,92568,CPT,Professional,Both,,,,59,50.15,9.37,59,"Preferred One Administrative Services, INC.",PPO,58.174,98.6,,percent of total billed charges,,
"Acoustic Reflex Testing, Threshold (Pro Cah)",,92568,CPT,Professional,Both,,,,59,50.15,9.37,59,PrimeWest Health,Minnesota Senior Health Options (MSHO),17.112,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Acoustic Reflex Testing, Threshold (Pro Cah)",,92568,CPT,Professional,Both,,,,59,50.15,9.37,59,PrimeWest Health,MinnesotaCare,11.577828,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Acoustic Reflex Testing, Threshold (Pro Cah)",,92568,CPT,Professional,Both,,,,59,50.15,9.37,59,Sanford Health Plan,Sanford Health Plan,51.92,88,,percent of total billed charges,,
"Acoustic Reflex Testing, Threshold (Pro Cah)",,92568,CPT,Professional,Both,,,,59,50.15,9.37,59,"UCare Health, Inc.",Individual & Family Plan,24.188928,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Acoustic Reflex Testing, Threshold (Pro Cah)",,92568,CPT,Professional,Both,,,,59,50.15,9.37,59,"UCare Health, Inc.",Medical Assistance,11.90244,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Acoustic Reflex Testing, Threshold (Pro Cah)",,92568,CPT,Professional,Both,,,,59,50.15,9.37,59,"UCare Health, Inc.",Medicare Advantage,17.112,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Acoustic Reflex Testing, Threshold (Pro Cah)",,92568,CPT,Professional,Both,,,,59,50.15,9.37,59,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),13.6896,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Acoustic Reflex Testing, Threshold (Pro Cah)",,92568,CPT,Professional,Both,,,,59,50.15,9.37,59,UnitedHealthcare,Individual & Family,59,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Acoustic Reflex Testing, Threshold (Pro Cah)",,92568,CPT,Professional,Both,,,,59,50.15,9.37,59,UnitedHealthcare,Medicare Advantage,17.112,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Acoustic Reflex Testing, Threshold (Pro Cah)",,92568,CPT,Professional,Both,,,,59,50.15,9.37,59,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,10.8204,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Acoustic Immittance Testing, Incl Tympanometry Reflex Decay Testing (Pro Cah)",,92570,CPT,Professional,Both,,,,54,45.9,18.54,54,Aetna,Commercial,45.9,85,,percent of total billed charges,,
"Acoustic Immittance Testing, Incl Tympanometry Reflex Decay Testing (Pro Cah)",,92570,CPT,Professional,Both,,,,54,45.9,18.54,54,Aetna,Medicare Advantage,29.58,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Acoustic Immittance Testing, Incl Tympanometry Reflex Decay Testing (Pro Cah)",,92570,CPT,Professional,Both,,,,54,45.9,18.54,54,Aetna,PPO,50.22,93,,percent of total billed charges,,
"Acoustic Immittance Testing, Incl Tympanometry Reflex Decay Testing (Pro Cah)",,92570,CPT,Professional,Both,,,,54,45.9,18.54,54,America's PPO,America's PPO,46.1376,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Acoustic Immittance Testing, Incl Tympanometry Reflex Decay Testing (Pro Cah)",,92570,CPT,Professional,Both,,,,54,45.9,18.54,54,BlueCross BlueShield Minnesota, Federal Employee Program,50.18,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Acoustic Immittance Testing, Incl Tympanometry Reflex Decay Testing (Pro Cah)",,92570,CPT,Professional,Both,,,,54,45.9,18.54,54,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,50.98288,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Acoustic Immittance Testing, Incl Tympanometry Reflex Decay Testing (Pro Cah)",,92570,CPT,Professional,Both,,,,54,45.9,18.54,54,BlueCross BlueShield Minnesota,High Value Network Plan,50.98288,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Acoustic Immittance Testing, Incl Tympanometry Reflex Decay Testing (Pro Cah)",,92570,CPT,Professional,Both,,,,54,45.9,18.54,54,BlueCross BlueShield Minnesota,Medicare Advantage,33.2005,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Acoustic Immittance Testing, Incl Tympanometry Reflex Decay Testing (Pro Cah)",,92570,CPT,Professional,Both,,,,54,45.9,18.54,54,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,50.98288,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Acoustic Immittance Testing, Incl Tympanometry Reflex Decay Testing (Pro Cah)",,92570,CPT,Professional,Both,,,,54,45.9,18.54,54,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,21.40712,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Acoustic Immittance Testing, Incl Tympanometry Reflex Decay Testing (Pro Cah)",,92570,CPT,Professional,Both,,,,54,45.9,18.54,54,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),33.2005,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Acoustic Immittance Testing, Incl Tympanometry Reflex Decay Testing (Pro Cah)",,92570,CPT,Professional,Both,,,,54,45.9,18.54,54,CorVel,Worker's Compensation,54,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Acoustic Immittance Testing, Incl Tympanometry Reflex Decay Testing (Pro Cah)",,92570,CPT,Professional,Both,,,,54,45.9,18.54,54,First Health Group Corporation,First Health Network,52.38,97,,percent of total billed charges,,
"Acoustic Immittance Testing, Incl Tympanometry Reflex Decay Testing (Pro Cah)",,92570,CPT,Professional,Both,,,,54,45.9,18.54,54,"Health Partners, Inc.",Commercial,54,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Acoustic Immittance Testing, Incl Tympanometry Reflex Decay Testing (Pro Cah)",,92570,CPT,Professional,Both,,,,54,45.9,18.54,54,"Health Partners, Inc.",Medicare Advantage,33.2005,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Acoustic Immittance Testing, Incl Tympanometry Reflex Decay Testing (Pro Cah)",,92570,CPT,Professional,Both,,,,54,45.9,18.54,54,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),29.14,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Acoustic Immittance Testing, Incl Tympanometry Reflex Decay Testing (Pro Cah)",,92570,CPT,Professional,Both,,,,54,45.9,18.54,54,"Health Partners, Inc.",State of Minnesota Advantage Program,52.49981,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Acoustic Immittance Testing, Incl Tympanometry Reflex Decay Testing (Pro Cah)",,92570,CPT,Professional,Both,,,,54,45.9,18.54,54,"Health Partners, Inc.",State Public Programs,18.54,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Acoustic Immittance Testing, Incl Tympanometry Reflex Decay Testing (Pro Cah)",,92570,CPT,Professional,Both,,,,54,45.9,18.54,54,Humana Insurance Company,Commercial PPO,32.33,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Acoustic Immittance Testing, Incl Tympanometry Reflex Decay Testing (Pro Cah)",,92570,CPT,Professional,Both,,,,54,45.9,18.54,54,Humana Insurance Company,Medicare PPO,54,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Acoustic Immittance Testing, Incl Tympanometry Reflex Decay Testing (Pro Cah)",,92570,CPT,Professional,Both,,,,54,45.9,18.54,54,Medica,Individual & Family,45.792,84.8,,percent of total billed charges,,
"Acoustic Immittance Testing, Incl Tympanometry Reflex Decay Testing (Pro Cah)",,92570,CPT,Professional,Both,,,,54,45.9,18.54,54,Medica,Medica Advantage Solution,26.892,49.8,,percent of total billed charges,,
"Acoustic Immittance Testing, Incl Tympanometry Reflex Decay Testing (Pro Cah)",,92570,CPT,Professional,Both,,,,54,45.9,18.54,54,Medica,Medical Assistance,21.41,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Acoustic Immittance Testing, Incl Tympanometry Reflex Decay Testing (Pro Cah)",,92570,CPT,Professional,Both,,,,54,45.9,18.54,54,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,28.87,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Acoustic Immittance Testing, Incl Tympanometry Reflex Decay Testing (Pro Cah)",,92570,CPT,Professional,Both,,,,54,45.9,18.54,54,"Multiplan, Inc.","Multiplan, Inc.",50.76,94,,percent of total billed charges,,
"Acoustic Immittance Testing, Incl Tympanometry Reflex Decay Testing (Pro Cah)",,92570,CPT,Professional,Both,,,,54,45.9,18.54,54,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,48.654,90.1,,percent of total billed charges,,
"Acoustic Immittance Testing, Incl Tympanometry Reflex Decay Testing (Pro Cah)",,92570,CPT,Professional,Both,,,,54,45.9,18.54,54,"Preferred One Administrative Services, INC.",PPO,53.244,98.6,,percent of total billed charges,,
"Acoustic Immittance Testing, Incl Tympanometry Reflex Decay Testing (Pro Cah)",,92570,CPT,Professional,Both,,,,54,45.9,18.54,54,PrimeWest Health,Minnesota Senior Health Options (MSHO),33.2005,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Acoustic Immittance Testing, Incl Tympanometry Reflex Decay Testing (Pro Cah)",,92570,CPT,Professional,Both,,,,54,45.9,18.54,54,PrimeWest Health,MinnesotaCare,22.9056184,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Acoustic Immittance Testing, Incl Tympanometry Reflex Decay Testing (Pro Cah)",,92570,CPT,Professional,Both,,,,54,45.9,18.54,54,Sanford Health Plan,Sanford Health Plan,47.52,88,,percent of total billed charges,,
"Acoustic Immittance Testing, Incl Tympanometry Reflex Decay Testing (Pro Cah)",,92570,CPT,Professional,Both,,,,54,45.9,18.54,54,"UCare Health, Inc.",Individual & Family Plan,46.931072,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Acoustic Immittance Testing, Incl Tympanometry Reflex Decay Testing (Pro Cah)",,92570,CPT,Professional,Both,,,,54,45.9,18.54,54,"UCare Health, Inc.",Medical Assistance,23.547832,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Acoustic Immittance Testing, Incl Tympanometry Reflex Decay Testing (Pro Cah)",,92570,CPT,Professional,Both,,,,54,45.9,18.54,54,"UCare Health, Inc.",Medicare Advantage,33.2005,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Acoustic Immittance Testing, Incl Tympanometry Reflex Decay Testing (Pro Cah)",,92570,CPT,Professional,Both,,,,54,45.9,18.54,54,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),26.5604,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Acoustic Immittance Testing, Incl Tympanometry Reflex Decay Testing (Pro Cah)",,92570,CPT,Professional,Both,,,,54,45.9,18.54,54,UnitedHealthcare,Individual & Family,54,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Acoustic Immittance Testing, Incl Tympanometry Reflex Decay Testing (Pro Cah)",,92570,CPT,Professional,Both,,,,54,45.9,18.54,54,UnitedHealthcare,Medicare Advantage,33.2005,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Acoustic Immittance Testing, Incl Tympanometry Reflex Decay Testing (Pro Cah)",,92570,CPT,Professional,Both,,,,54,45.9,18.54,54,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,21.40712,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Conditioning Play Audiometry (Pro Cah),,92582,CPT,Professional,Both,,,,158,134.3,54.09,158,Aetna,Commercial,134.3,85,,percent of total billed charges,,
Conditioning Play Audiometry (Pro Cah),,92582,CPT,Professional,Both,,,,158,134.3,54.09,158,Aetna,Medicare Advantage,76.95,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Conditioning Play Audiometry (Pro Cah),,92582,CPT,Professional,Both,,,,158,134.3,54.09,158,Aetna,PPO,146.94,93,,percent of total billed charges,,
Conditioning Play Audiometry (Pro Cah),,92582,CPT,Professional,Both,,,,158,134.3,54.09,158,America's PPO,America's PPO,134.9952,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Conditioning Play Audiometry (Pro Cah),,92582,CPT,Professional,Both,,,,158,134.3,54.09,158,BlueCross BlueShield Minnesota, Federal Employee Program,142.96,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Conditioning Play Audiometry (Pro Cah),,92582,CPT,Professional,Both,,,,158,134.3,54.09,158,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,145.24736,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Conditioning Play Audiometry (Pro Cah),,92582,CPT,Professional,Both,,,,158,134.3,54.09,158,BlueCross BlueShield Minnesota,High Value Network Plan,145.24736,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Conditioning Play Audiometry (Pro Cah),,92582,CPT,Professional,Both,,,,158,134.3,54.09,158,BlueCross BlueShield Minnesota,Medicare Advantage,97.0255,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Conditioning Play Audiometry (Pro Cah),,92582,CPT,Professional,Both,,,,158,134.3,54.09,158,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,145.24736,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Conditioning Play Audiometry (Pro Cah),,92582,CPT,Professional,Both,,,,158,134.3,54.09,158,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,62.45352,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Conditioning Play Audiometry (Pro Cah),,92582,CPT,Professional,Both,,,,158,134.3,54.09,158,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),97.0255,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Conditioning Play Audiometry (Pro Cah),,92582,CPT,Professional,Both,,,,158,134.3,54.09,158,CorVel,Worker's Compensation,154.2518748,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Conditioning Play Audiometry (Pro Cah),,92582,CPT,Professional,Both,,,,158,134.3,54.09,158,First Health Group Corporation,First Health Network,153.26,97,,percent of total billed charges,,
Conditioning Play Audiometry (Pro Cah),,92582,CPT,Professional,Both,,,,158,134.3,54.09,158,"Health Partners, Inc.",Commercial,158,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Conditioning Play Audiometry (Pro Cah),,92582,CPT,Professional,Both,,,,158,134.3,54.09,158,"Health Partners, Inc.",Medicare Advantage,97.0255,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Conditioning Play Audiometry (Pro Cah),,92582,CPT,Professional,Both,,,,158,134.3,54.09,158,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),84.38,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Conditioning Play Audiometry (Pro Cah),,92582,CPT,Professional,Both,,,,158,134.3,54.09,158,"Health Partners, Inc.",State of Minnesota Advantage Program,143.758505,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Conditioning Play Audiometry (Pro Cah),,92582,CPT,Professional,Both,,,,158,134.3,54.09,158,"Health Partners, Inc.",State Public Programs,54.09,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Conditioning Play Audiometry (Pro Cah),,92582,CPT,Professional,Both,,,,158,134.3,54.09,158,Humana Insurance Company,Commercial PPO,84.37,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Conditioning Play Audiometry (Pro Cah),,92582,CPT,Professional,Both,,,,158,134.3,54.09,158,Humana Insurance Company,Medicare PPO,158,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Conditioning Play Audiometry (Pro Cah),,92582,CPT,Professional,Both,,,,158,134.3,54.09,158,Medica,Individual & Family,133.984,84.8,,percent of total billed charges,,
Conditioning Play Audiometry (Pro Cah),,92582,CPT,Professional,Both,,,,158,134.3,54.09,158,Medica,Medica Advantage Solution,78.684,49.8,,percent of total billed charges,,
Conditioning Play Audiometry (Pro Cah),,92582,CPT,Professional,Both,,,,158,134.3,54.09,158,Medica,Medical Assistance,62.45,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Conditioning Play Audiometry (Pro Cah),,92582,CPT,Professional,Both,,,,158,134.3,54.09,158,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,84.37,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Conditioning Play Audiometry (Pro Cah),,92582,CPT,Professional,Both,,,,158,134.3,54.09,158,"Multiplan, Inc.","Multiplan, Inc.",148.52,94,,percent of total billed charges,,
Conditioning Play Audiometry (Pro Cah),,92582,CPT,Professional,Both,,,,158,134.3,54.09,158,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,142.358,90.1,,percent of total billed charges,,
Conditioning Play Audiometry (Pro Cah),,92582,CPT,Professional,Both,,,,158,134.3,54.09,158,"Preferred One Administrative Services, INC.",PPO,155.788,98.6,,percent of total billed charges,,
Conditioning Play Audiometry (Pro Cah),,92582,CPT,Professional,Both,,,,158,134.3,54.09,158,PrimeWest Health,Minnesota Senior Health Options (MSHO),97.0255,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Conditioning Play Audiometry (Pro Cah),,92582,CPT,Professional,Both,,,,158,134.3,54.09,158,PrimeWest Health,MinnesotaCare,66.8252664,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Conditioning Play Audiometry (Pro Cah),,92582,CPT,Professional,Both,,,,158,134.3,54.09,158,Sanford Health Plan,Sanford Health Plan,139.04,88,,percent of total billed charges,,
Conditioning Play Audiometry (Pro Cah),,92582,CPT,Professional,Both,,,,158,134.3,54.09,158,"UCare Health, Inc.",Individual & Family Plan,137.151872,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Conditioning Play Audiometry (Pro Cah),,92582,CPT,Professional,Both,,,,158,134.3,54.09,158,"UCare Health, Inc.",Medical Assistance,68.698872,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Conditioning Play Audiometry (Pro Cah),,92582,CPT,Professional,Both,,,,158,134.3,54.09,158,"UCare Health, Inc.",Medicare Advantage,97.0255,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Conditioning Play Audiometry (Pro Cah),,92582,CPT,Professional,Both,,,,158,134.3,54.09,158,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),77.6204,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Conditioning Play Audiometry (Pro Cah),,92582,CPT,Professional,Both,,,,158,134.3,54.09,158,UnitedHealthcare,Individual & Family,158,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Conditioning Play Audiometry (Pro Cah),,92582,CPT,Professional,Both,,,,158,134.3,54.09,158,UnitedHealthcare,Medicare Advantage,97.0255,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Conditioning Play Audiometry (Pro Cah),,92582,CPT,Professional,Both,,,,158,134.3,54.09,158,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,62.45352,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Distortion Product Evoked Otoacoustic Emissions; Ltd Eval (Pro Cah),,92587,CPT,Professional,Both,,,,143,121.55,13.09624,143,Aetna,Commercial,121.55,85,,percent of total billed charges,,
Distortion Product Evoked Otoacoustic Emissions; Ltd Eval (Pro Cah),,92587,CPT,Professional,Both,,,,143,121.55,13.09624,143,Aetna,Medicare Advantage,22.36,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Distortion Product Evoked Otoacoustic Emissions; Ltd Eval (Pro Cah),,92587,CPT,Professional,Both,,,,143,121.55,13.09624,143,Aetna,PPO,132.99,93,,percent of total billed charges,,
Distortion Product Evoked Otoacoustic Emissions; Ltd Eval (Pro Cah),,92587,CPT,Professional,Both,,,,143,121.55,13.09624,143,America's PPO,America's PPO,122.1792,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Distortion Product Evoked Otoacoustic Emissions; Ltd Eval (Pro Cah),,92587,CPT,Professional,Both,,,,143,121.55,13.09624,143,BlueCross BlueShield Minnesota, Federal Employee Program,37.93,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Distortion Product Evoked Otoacoustic Emissions; Ltd Eval (Pro Cah),,92587,CPT,Professional,Both,,,,143,121.55,13.09624,143,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,38.53688,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Distortion Product Evoked Otoacoustic Emissions; Ltd Eval (Pro Cah),,92587,CPT,Professional,Both,,,,143,121.55,13.09624,143,BlueCross BlueShield Minnesota,High Value Network Plan,38.53688,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Distortion Product Evoked Otoacoustic Emissions; Ltd Eval (Pro Cah),,92587,CPT,Professional,Both,,,,143,121.55,13.09624,143,BlueCross BlueShield Minnesota,Medicare Advantage,25.0125,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Distortion Product Evoked Otoacoustic Emissions; Ltd Eval (Pro Cah),,92587,CPT,Professional,Both,,,,143,121.55,13.09624,143,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,38.53688,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Distortion Product Evoked Otoacoustic Emissions; Ltd Eval (Pro Cah),,92587,CPT,Professional,Both,,,,143,121.55,13.09624,143,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,13.09624,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Distortion Product Evoked Otoacoustic Emissions; Ltd Eval (Pro Cah),,92587,CPT,Professional,Both,,,,143,121.55,13.09624,143,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),25.0125,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Distortion Product Evoked Otoacoustic Emissions; Ltd Eval (Pro Cah),,92587,CPT,Professional,Both,,,,143,121.55,13.09624,143,CorVel,Worker's Compensation,43.035819,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Distortion Product Evoked Otoacoustic Emissions; Ltd Eval (Pro Cah),,92587,CPT,Professional,Both,,,,143,121.55,13.09624,143,First Health Group Corporation,First Health Network,138.71,97,,percent of total billed charges,,
Distortion Product Evoked Otoacoustic Emissions; Ltd Eval (Pro Cah),,92587,CPT,Professional,Both,,,,143,121.55,13.09624,143,"Health Partners, Inc.",Commercial,45.71,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Distortion Product Evoked Otoacoustic Emissions; Ltd Eval (Pro Cah),,92587,CPT,Professional,Both,,,,143,121.55,13.09624,143,"Health Partners, Inc.",Medicare Advantage,25.0125,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Distortion Product Evoked Otoacoustic Emissions; Ltd Eval (Pro Cah),,92587,CPT,Professional,Both,,,,143,121.55,13.09624,143,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),22.03,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Distortion Product Evoked Otoacoustic Emissions; Ltd Eval (Pro Cah),,92587,CPT,Professional,Both,,,,143,121.55,13.09624,143,"Health Partners, Inc.",State of Minnesota Advantage Program,39.379165,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Distortion Product Evoked Otoacoustic Emissions; Ltd Eval (Pro Cah),,92587,CPT,Professional,Both,,,,143,121.55,13.09624,143,"Health Partners, Inc.",State Public Programs,13.96,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Distortion Product Evoked Otoacoustic Emissions; Ltd Eval (Pro Cah),,92587,CPT,Professional,Both,,,,143,121.55,13.09624,143,Humana Insurance Company,Commercial PPO,21.75,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Distortion Product Evoked Otoacoustic Emissions; Ltd Eval (Pro Cah),,92587,CPT,Professional,Both,,,,143,121.55,13.09624,143,Humana Insurance Company,Medicare PPO,143,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Distortion Product Evoked Otoacoustic Emissions; Ltd Eval (Pro Cah),,92587,CPT,Professional,Both,,,,143,121.55,13.09624,143,Medica,Individual & Family,121.264,84.8,,percent of total billed charges,,
Distortion Product Evoked Otoacoustic Emissions; Ltd Eval (Pro Cah),,92587,CPT,Professional,Both,,,,143,121.55,13.09624,143,Medica,Medica Advantage Solution,71.214,49.8,,percent of total billed charges,,
Distortion Product Evoked Otoacoustic Emissions; Ltd Eval (Pro Cah),,92587,CPT,Professional,Both,,,,143,121.55,13.09624,143,Medica,Medical Assistance,16.11,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Distortion Product Evoked Otoacoustic Emissions; Ltd Eval (Pro Cah),,92587,CPT,Professional,Both,,,,143,121.55,13.09624,143,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,21.75,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Distortion Product Evoked Otoacoustic Emissions; Ltd Eval (Pro Cah),,92587,CPT,Professional,Both,,,,143,121.55,13.09624,143,"Multiplan, Inc.","Multiplan, Inc.",134.42,94,,percent of total billed charges,,
Distortion Product Evoked Otoacoustic Emissions; Ltd Eval (Pro Cah),,92587,CPT,Professional,Both,,,,143,121.55,13.09624,143,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,128.843,90.1,,percent of total billed charges,,
Distortion Product Evoked Otoacoustic Emissions; Ltd Eval (Pro Cah),,92587,CPT,Professional,Both,,,,143,121.55,13.09624,143,"Preferred One Administrative Services, INC.",PPO,140.998,98.6,,percent of total billed charges,,
Distortion Product Evoked Otoacoustic Emissions; Ltd Eval (Pro Cah),,92587,CPT,Professional,Both,,,,143,121.55,13.09624,143,PrimeWest Health,Minnesota Senior Health Options (MSHO),25.0125,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Distortion Product Evoked Otoacoustic Emissions; Ltd Eval (Pro Cah),,92587,CPT,Professional,Both,,,,143,121.55,13.09624,143,PrimeWest Health,MinnesotaCare,14.0129768,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Distortion Product Evoked Otoacoustic Emissions; Ltd Eval (Pro Cah),,92587,CPT,Professional,Both,,,,143,121.55,13.09624,143,Sanford Health Plan,Sanford Health Plan,125.84,88,,percent of total billed charges,,
Distortion Product Evoked Otoacoustic Emissions; Ltd Eval (Pro Cah),,92587,CPT,Professional,Both,,,,143,121.55,13.09624,143,"UCare Health, Inc.",Individual & Family Plan,35.3568,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Distortion Product Evoked Otoacoustic Emissions; Ltd Eval (Pro Cah),,92587,CPT,Professional,Both,,,,143,121.55,13.09624,143,"UCare Health, Inc.",Medical Assistance,14.405864,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Distortion Product Evoked Otoacoustic Emissions; Ltd Eval (Pro Cah),,92587,CPT,Professional,Both,,,,143,121.55,13.09624,143,"UCare Health, Inc.",Medicare Advantage,25.0125,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Distortion Product Evoked Otoacoustic Emissions; Ltd Eval (Pro Cah),,92587,CPT,Professional,Both,,,,143,121.55,13.09624,143,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),20.01,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Distortion Product Evoked Otoacoustic Emissions; Ltd Eval (Pro Cah),,92587,CPT,Professional,Both,,,,143,121.55,13.09624,143,UnitedHealthcare,Individual & Family,143,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Distortion Product Evoked Otoacoustic Emissions; Ltd Eval (Pro Cah),,92587,CPT,Professional,Both,,,,143,121.55,13.09624,143,UnitedHealthcare,Medicare Advantage,25.0125,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Distortion Product Evoked Otoacoustic Emissions; Ltd Eval (Pro Cah),,92587,CPT,Professional,Both,,,,143,121.55,13.09624,143,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,13.09624,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
FOSPHENYTOIN 500 MG PE/10 ML INJ SOLN,,Q2009,HCPCS,Facility,Both,10,mL,,413,351.05,118.3658,413,Aetna,Commercial,379.96,92,,percent of total billed charges,,
FOSPHENYTOIN 500 MG PE/10 ML INJ SOLN,,Q2009,HCPCS,Facility,Outpatient,10,mL,,413,351.05,118.3658,413,Aetna,Medicare Advantage,202.37,49,,percent of total billed charges,,
FOSPHENYTOIN 500 MG PE/10 ML INJ SOLN,,Q2009,HCPCS,Facility,Inpatient,10,mL,,413,351.05,118.3658,413,Aetna,Medicare Advantage,,,,,Included in per diem rate,
FOSPHENYTOIN 500 MG PE/10 ML INJ SOLN,,Q2009,HCPCS,Facility,Both,10,mL,,413,351.05,118.3658,413,Aetna,PPO,384.09,93,,percent of total billed charges,,
FOSPHENYTOIN 500 MG PE/10 ML INJ SOLN,,Q2009,HCPCS,Facility,Both,10,mL,,413,351.05,118.3658,413,America's PPO,America's PPO,396.6039,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
FOSPHENYTOIN 500 MG PE/10 ML INJ SOLN,,Q2009,HCPCS,Facility,Both,10,mL,,413,351.05,118.3658,413,BlueCross BlueShield Minnesota, Federal Employee Program,406.392,98.4,,percent of total billed charges,,
FOSPHENYTOIN 500 MG PE/10 ML INJ SOLN,,Q2009,HCPCS,Facility,Both,10,mL,,413,351.05,118.3658,413,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,413,100,,percent of total billed charges,,
FOSPHENYTOIN 500 MG PE/10 ML INJ SOLN,,Q2009,HCPCS,Facility,Both,10,mL,,413,351.05,118.3658,413,BlueCross BlueShield Minnesota,High Value Network Plan,371.7,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
FOSPHENYTOIN 500 MG PE/10 ML INJ SOLN,,Q2009,HCPCS,Facility,Outpatient,10,mL,,413,351.05,118.3658,413,BlueCross BlueShield Minnesota,Medicare Advantage,202.37,49,,percent of total billed charges,,
FOSPHENYTOIN 500 MG PE/10 ML INJ SOLN,,Q2009,HCPCS,Facility,Inpatient,10,mL,,413,351.05,118.3658,413,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
FOSPHENYTOIN 500 MG PE/10 ML INJ SOLN,,Q2009,HCPCS,Facility,Both,10,mL,,413,351.05,118.3658,413,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,365.7941,88.57,,percent of total billed charges,,
FOSPHENYTOIN 500 MG PE/10 ML INJ SOLN,,Q2009,HCPCS,Facility,Both,10,mL,,413,351.05,118.3658,413,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,118.3658,28.66,,percent of total billed charges,,
FOSPHENYTOIN 500 MG PE/10 ML INJ SOLN,,Q2009,HCPCS,Facility,Outpatient,10,mL,,413,351.05,118.3658,413,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),202.37,49,,percent of total billed charges,,
FOSPHENYTOIN 500 MG PE/10 ML INJ SOLN,,Q2009,HCPCS,Facility,Inpatient,10,mL,,413,351.05,118.3658,413,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
FOSPHENYTOIN 500 MG PE/10 ML INJ SOLN,,Q2009,HCPCS,Facility,Both,10,mL,,413,351.05,118.3658,413,CorVel,Worker's Compensation,413,100,,percent of total billed charges,,
FOSPHENYTOIN 500 MG PE/10 ML INJ SOLN,,Q2009,HCPCS,Facility,Both,10,mL,,413,351.05,118.3658,413,First Health Group Corporation,First Health Network,400.61,97,,percent of total billed charges,,
FOSPHENYTOIN 500 MG PE/10 ML INJ SOLN,,Q2009,HCPCS,Facility,Both,10,mL,,413,351.05,118.3658,413,"Health Partners, Inc.",Commercial,390.698,94.6,,percent of total billed charges,,
FOSPHENYTOIN 500 MG PE/10 ML INJ SOLN,,Q2009,HCPCS,Facility,Outpatient,10,mL,,413,351.05,118.3658,413,"Health Partners, Inc.",Medicare Advantage,202.37,49,,percent of total billed charges,,
FOSPHENYTOIN 500 MG PE/10 ML INJ SOLN,,Q2009,HCPCS,Facility,Inpatient,10,mL,,413,351.05,118.3658,413,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
FOSPHENYTOIN 500 MG PE/10 ML INJ SOLN,,Q2009,HCPCS,Facility,Both,10,mL,,413,351.05,118.3658,413,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),247.8,60,,percent of total billed charges,,
FOSPHENYTOIN 500 MG PE/10 ML INJ SOLN,,Q2009,HCPCS,Facility,Both,10,mL,,413,351.05,118.3658,413,"Health Partners, Inc.",State of Minnesota Advantage Program,336.595,81.5,,percent of total billed charges,,
FOSPHENYTOIN 500 MG PE/10 ML INJ SOLN,,Q2009,HCPCS,Facility,Both,10,mL,,413,351.05,118.3658,413,"Health Partners, Inc.",State Public Programs,206.5,50,,percent of total billed charges,,
FOSPHENYTOIN 500 MG PE/10 ML INJ SOLN,,Q2009,HCPCS,Facility,Both,10,mL,,413,351.05,118.3658,413,Humana Insurance Company,Commercial PPO,392.35,95,,percent of total billed charges,,
FOSPHENYTOIN 500 MG PE/10 ML INJ SOLN,,Q2009,HCPCS,Facility,Outpatient,10,mL,,413,351.05,118.3658,413,Humana Insurance Company,Medicare PPO,202.37,49,,percent of total billed charges,,
FOSPHENYTOIN 500 MG PE/10 ML INJ SOLN,,Q2009,HCPCS,Facility,Inpatient,10,mL,,413,351.05,118.3658,413,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
FOSPHENYTOIN 500 MG PE/10 ML INJ SOLN,,Q2009,HCPCS,Facility,Both,10,mL,,413,351.05,118.3658,413,Medica,Individual & Family,409.283,99.1,,percent of total billed charges,,
FOSPHENYTOIN 500 MG PE/10 ML INJ SOLN,,Q2009,HCPCS,Facility,Outpatient,10,mL,,413,351.05,118.3658,413,Medica,Medica Advantage Solution,205.674,49.8,,percent of total billed charges,,
FOSPHENYTOIN 500 MG PE/10 ML INJ SOLN,,Q2009,HCPCS,Facility,Inpatient,10,mL,,413,351.05,118.3658,413,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
FOSPHENYTOIN 500 MG PE/10 ML INJ SOLN,,Q2009,HCPCS,Facility,Outpatient,10,mL,,413,351.05,118.3658,413,Medica,Medical Assistance,184.198,44.6,,percent of total billed charges,,
FOSPHENYTOIN 500 MG PE/10 ML INJ SOLN,,Q2009,HCPCS,Facility,Inpatient,10,mL,,413,351.05,118.3658,413,Medica,Medical Assistance,,,,,Included in per diem rate,
FOSPHENYTOIN 500 MG PE/10 ML INJ SOLN,,Q2009,HCPCS,Facility,Outpatient,10,mL,,413,351.05,118.3658,413,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,205.674,49.8,,percent of total billed charges,,
FOSPHENYTOIN 500 MG PE/10 ML INJ SOLN,,Q2009,HCPCS,Facility,Inpatient,10,mL,,413,351.05,118.3658,413,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
FOSPHENYTOIN 500 MG PE/10 ML INJ SOLN,,Q2009,HCPCS,Facility,Both,10,mL,,413,351.05,118.3658,413,"Multiplan, Inc.","Multiplan, Inc.",388.22,94,,percent of total billed charges,,
FOSPHENYTOIN 500 MG PE/10 ML INJ SOLN,,Q2009,HCPCS,Facility,Outpatient,10,mL,,413,351.05,118.3658,413,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,372.113,90.1,,percent of total billed charges,,
FOSPHENYTOIN 500 MG PE/10 ML INJ SOLN,,Q2009,HCPCS,Facility,Inpatient,10,mL,,413,351.05,118.3658,413,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
FOSPHENYTOIN 500 MG PE/10 ML INJ SOLN,,Q2009,HCPCS,Facility,Both,10,mL,,413,351.05,118.3658,413,"Preferred One Administrative Services, INC.",PPO,407.218,98.6,,percent of total billed charges,,
FOSPHENYTOIN 500 MG PE/10 ML INJ SOLN,,Q2009,HCPCS,Facility,Outpatient,10,mL,,413,351.05,118.3658,413,PrimeWest Health,Minnesota Senior Health Options (MSHO),212.4885,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
FOSPHENYTOIN 500 MG PE/10 ML INJ SOLN,,Q2009,HCPCS,Facility,Inpatient,10,mL,,413,351.05,118.3658,413,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
FOSPHENYTOIN 500 MG PE/10 ML INJ SOLN,,Q2009,HCPCS,Facility,Outpatient,10,mL,,413,351.05,118.3658,413,PrimeWest Health,MinnesotaCare,212.1168,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
FOSPHENYTOIN 500 MG PE/10 ML INJ SOLN,,Q2009,HCPCS,Facility,Inpatient,10,mL,,413,351.05,118.3658,413,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
FOSPHENYTOIN 500 MG PE/10 ML INJ SOLN,,Q2009,HCPCS,Facility,Both,10,mL,,413,351.05,118.3658,413,Sanford Health Plan,Sanford Health Plan,379.96,92,,percent of total billed charges,,
FOSPHENYTOIN 500 MG PE/10 ML INJ SOLN,,Q2009,HCPCS,Facility,Outpatient,10,mL,,413,351.05,118.3658,413,"UCare Health, Inc.",Individual & Family Plan,232.7255,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
FOSPHENYTOIN 500 MG PE/10 ML INJ SOLN,,Q2009,HCPCS,Facility,Inpatient,10,mL,,413,351.05,118.3658,413,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
FOSPHENYTOIN 500 MG PE/10 ML INJ SOLN,,Q2009,HCPCS,Facility,Outpatient,10,mL,,413,351.05,118.3658,413,"UCare Health, Inc.",Medical Assistance,208.4411,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FOSPHENYTOIN 500 MG PE/10 ML INJ SOLN,,Q2009,HCPCS,Facility,Inpatient,10,mL,,413,351.05,118.3658,413,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
FOSPHENYTOIN 500 MG PE/10 ML INJ SOLN,,Q2009,HCPCS,Facility,Outpatient,10,mL,,413,351.05,118.3658,413,"UCare Health, Inc.",Medicare Advantage,208.4411,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FOSPHENYTOIN 500 MG PE/10 ML INJ SOLN,,Q2009,HCPCS,Facility,Inpatient,10,mL,,413,351.05,118.3658,413,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
FOSPHENYTOIN 500 MG PE/10 ML INJ SOLN,,Q2009,HCPCS,Facility,Outpatient,10,mL,,413,351.05,118.3658,413,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),208.4411,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FOSPHENYTOIN 500 MG PE/10 ML INJ SOLN,,Q2009,HCPCS,Facility,Inpatient,10,mL,,413,351.05,118.3658,413,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
FOSPHENYTOIN 500 MG PE/10 ML INJ SOLN,,Q2009,HCPCS,Facility,Both,10,mL,,413,351.05,118.3658,413,UnitedHealthcare,Individual & Family,388.22,94,,percent of total billed charges,,
FOSPHENYTOIN 500 MG PE/10 ML INJ SOLN,,Q2009,HCPCS,Facility,Outpatient,10,mL,,413,351.05,118.3658,413,UnitedHealthcare,Medicare Advantage,202.37,49,,percent of total billed charges,,
FOSPHENYTOIN 500 MG PE/10 ML INJ SOLN,,Q2009,HCPCS,Facility,Inpatient,10,mL,,413,351.05,118.3658,413,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
FOSPHENYTOIN 500 MG PE/10 ML INJ SOLN,,Q2009,HCPCS,Facility,Outpatient,10,mL,,413,351.05,118.3658,413,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,198.24,48,,percent of total billed charges,,100% of DHS outpatient percentage
FOSPHENYTOIN 500 MG PE/10 ML INJ SOLN,,Q2009,HCPCS,Facility,Inpatient,10,mL,,413,351.05,118.3658,413,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
METHYLENE BLUE (ANTIDOTE) 1 % (10 MG/ML) IV SOLN,,Q9968,HCPCS,Facility,Both,10,mL,,975,828.75,279.435,975,Aetna,Commercial,897,92,,percent of total billed charges,,
METHYLENE BLUE (ANTIDOTE) 1 % (10 MG/ML) IV SOLN,,Q9968,HCPCS,Facility,Outpatient,10,mL,,975,828.75,279.435,975,Aetna,Medicare Advantage,477.75,49,,percent of total billed charges,,
METHYLENE BLUE (ANTIDOTE) 1 % (10 MG/ML) IV SOLN,,Q9968,HCPCS,Facility,Inpatient,10,mL,,975,828.75,279.435,975,Aetna,Medicare Advantage,,,,,Included in per diem rate,
METHYLENE BLUE (ANTIDOTE) 1 % (10 MG/ML) IV SOLN,,Q9968,HCPCS,Facility,Both,10,mL,,975,828.75,279.435,975,Aetna,PPO,906.75,93,,percent of total billed charges,,
METHYLENE BLUE (ANTIDOTE) 1 % (10 MG/ML) IV SOLN,,Q9968,HCPCS,Facility,Both,10,mL,,975,828.75,279.435,975,America's PPO,America's PPO,936.2925,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
METHYLENE BLUE (ANTIDOTE) 1 % (10 MG/ML) IV SOLN,,Q9968,HCPCS,Facility,Both,10,mL,,975,828.75,279.435,975,BlueCross BlueShield Minnesota, Federal Employee Program,959.4,98.4,,percent of total billed charges,,
METHYLENE BLUE (ANTIDOTE) 1 % (10 MG/ML) IV SOLN,,Q9968,HCPCS,Facility,Both,10,mL,,975,828.75,279.435,975,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,975,100,,percent of total billed charges,,
METHYLENE BLUE (ANTIDOTE) 1 % (10 MG/ML) IV SOLN,,Q9968,HCPCS,Facility,Both,10,mL,,975,828.75,279.435,975,BlueCross BlueShield Minnesota,High Value Network Plan,877.5,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
METHYLENE BLUE (ANTIDOTE) 1 % (10 MG/ML) IV SOLN,,Q9968,HCPCS,Facility,Outpatient,10,mL,,975,828.75,279.435,975,BlueCross BlueShield Minnesota,Medicare Advantage,477.75,49,,percent of total billed charges,,
METHYLENE BLUE (ANTIDOTE) 1 % (10 MG/ML) IV SOLN,,Q9968,HCPCS,Facility,Inpatient,10,mL,,975,828.75,279.435,975,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
METHYLENE BLUE (ANTIDOTE) 1 % (10 MG/ML) IV SOLN,,Q9968,HCPCS,Facility,Both,10,mL,,975,828.75,279.435,975,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,863.5575,88.57,,percent of total billed charges,,
METHYLENE BLUE (ANTIDOTE) 1 % (10 MG/ML) IV SOLN,,Q9968,HCPCS,Facility,Both,10,mL,,975,828.75,279.435,975,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,279.435,28.66,,percent of total billed charges,,
METHYLENE BLUE (ANTIDOTE) 1 % (10 MG/ML) IV SOLN,,Q9968,HCPCS,Facility,Outpatient,10,mL,,975,828.75,279.435,975,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),477.75,49,,percent of total billed charges,,
METHYLENE BLUE (ANTIDOTE) 1 % (10 MG/ML) IV SOLN,,Q9968,HCPCS,Facility,Inpatient,10,mL,,975,828.75,279.435,975,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
METHYLENE BLUE (ANTIDOTE) 1 % (10 MG/ML) IV SOLN,,Q9968,HCPCS,Facility,Both,10,mL,,975,828.75,279.435,975,CorVel,Worker's Compensation,975,100,,percent of total billed charges,,
METHYLENE BLUE (ANTIDOTE) 1 % (10 MG/ML) IV SOLN,,Q9968,HCPCS,Facility,Both,10,mL,,975,828.75,279.435,975,First Health Group Corporation,First Health Network,945.75,97,,percent of total billed charges,,
METHYLENE BLUE (ANTIDOTE) 1 % (10 MG/ML) IV SOLN,,Q9968,HCPCS,Facility,Both,10,mL,,975,828.75,279.435,975,"Health Partners, Inc.",Commercial,922.35,94.6,,percent of total billed charges,,
METHYLENE BLUE (ANTIDOTE) 1 % (10 MG/ML) IV SOLN,,Q9968,HCPCS,Facility,Outpatient,10,mL,,975,828.75,279.435,975,"Health Partners, Inc.",Medicare Advantage,477.75,49,,percent of total billed charges,,
METHYLENE BLUE (ANTIDOTE) 1 % (10 MG/ML) IV SOLN,,Q9968,HCPCS,Facility,Inpatient,10,mL,,975,828.75,279.435,975,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
METHYLENE BLUE (ANTIDOTE) 1 % (10 MG/ML) IV SOLN,,Q9968,HCPCS,Facility,Both,10,mL,,975,828.75,279.435,975,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),585,60,,percent of total billed charges,,
METHYLENE BLUE (ANTIDOTE) 1 % (10 MG/ML) IV SOLN,,Q9968,HCPCS,Facility,Both,10,mL,,975,828.75,279.435,975,"Health Partners, Inc.",State of Minnesota Advantage Program,794.625,81.5,,percent of total billed charges,,
METHYLENE BLUE (ANTIDOTE) 1 % (10 MG/ML) IV SOLN,,Q9968,HCPCS,Facility,Both,10,mL,,975,828.75,279.435,975,"Health Partners, Inc.",State Public Programs,487.5,50,,percent of total billed charges,,
METHYLENE BLUE (ANTIDOTE) 1 % (10 MG/ML) IV SOLN,,Q9968,HCPCS,Facility,Both,10,mL,,975,828.75,279.435,975,Humana Insurance Company,Commercial PPO,926.25,95,,percent of total billed charges,,
METHYLENE BLUE (ANTIDOTE) 1 % (10 MG/ML) IV SOLN,,Q9968,HCPCS,Facility,Outpatient,10,mL,,975,828.75,279.435,975,Humana Insurance Company,Medicare PPO,477.75,49,,percent of total billed charges,,
METHYLENE BLUE (ANTIDOTE) 1 % (10 MG/ML) IV SOLN,,Q9968,HCPCS,Facility,Inpatient,10,mL,,975,828.75,279.435,975,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
METHYLENE BLUE (ANTIDOTE) 1 % (10 MG/ML) IV SOLN,,Q9968,HCPCS,Facility,Both,10,mL,,975,828.75,279.435,975,Medica,Individual & Family,966.225,99.1,,percent of total billed charges,,
METHYLENE BLUE (ANTIDOTE) 1 % (10 MG/ML) IV SOLN,,Q9968,HCPCS,Facility,Outpatient,10,mL,,975,828.75,279.435,975,Medica,Medica Advantage Solution,485.55,49.8,,percent of total billed charges,,
METHYLENE BLUE (ANTIDOTE) 1 % (10 MG/ML) IV SOLN,,Q9968,HCPCS,Facility,Inpatient,10,mL,,975,828.75,279.435,975,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
METHYLENE BLUE (ANTIDOTE) 1 % (10 MG/ML) IV SOLN,,Q9968,HCPCS,Facility,Outpatient,10,mL,,975,828.75,279.435,975,Medica,Medical Assistance,434.85,44.6,,percent of total billed charges,,
METHYLENE BLUE (ANTIDOTE) 1 % (10 MG/ML) IV SOLN,,Q9968,HCPCS,Facility,Inpatient,10,mL,,975,828.75,279.435,975,Medica,Medical Assistance,,,,,Included in per diem rate,
METHYLENE BLUE (ANTIDOTE) 1 % (10 MG/ML) IV SOLN,,Q9968,HCPCS,Facility,Outpatient,10,mL,,975,828.75,279.435,975,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,485.55,49.8,,percent of total billed charges,,
METHYLENE BLUE (ANTIDOTE) 1 % (10 MG/ML) IV SOLN,,Q9968,HCPCS,Facility,Inpatient,10,mL,,975,828.75,279.435,975,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
METHYLENE BLUE (ANTIDOTE) 1 % (10 MG/ML) IV SOLN,,Q9968,HCPCS,Facility,Both,10,mL,,975,828.75,279.435,975,"Multiplan, Inc.","Multiplan, Inc.",916.5,94,,percent of total billed charges,,
METHYLENE BLUE (ANTIDOTE) 1 % (10 MG/ML) IV SOLN,,Q9968,HCPCS,Facility,Outpatient,10,mL,,975,828.75,279.435,975,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,878.475,90.1,,percent of total billed charges,,
METHYLENE BLUE (ANTIDOTE) 1 % (10 MG/ML) IV SOLN,,Q9968,HCPCS,Facility,Inpatient,10,mL,,975,828.75,279.435,975,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
METHYLENE BLUE (ANTIDOTE) 1 % (10 MG/ML) IV SOLN,,Q9968,HCPCS,Facility,Both,10,mL,,975,828.75,279.435,975,"Preferred One Administrative Services, INC.",PPO,961.35,98.6,,percent of total billed charges,,
METHYLENE BLUE (ANTIDOTE) 1 % (10 MG/ML) IV SOLN,,Q9968,HCPCS,Facility,Outpatient,10,mL,,975,828.75,279.435,975,PrimeWest Health,Minnesota Senior Health Options (MSHO),501.6375,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
METHYLENE BLUE (ANTIDOTE) 1 % (10 MG/ML) IV SOLN,,Q9968,HCPCS,Facility,Inpatient,10,mL,,975,828.75,279.435,975,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
METHYLENE BLUE (ANTIDOTE) 1 % (10 MG/ML) IV SOLN,,Q9968,HCPCS,Facility,Outpatient,10,mL,,975,828.75,279.435,975,PrimeWest Health,MinnesotaCare,500.76,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
METHYLENE BLUE (ANTIDOTE) 1 % (10 MG/ML) IV SOLN,,Q9968,HCPCS,Facility,Inpatient,10,mL,,975,828.75,279.435,975,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
METHYLENE BLUE (ANTIDOTE) 1 % (10 MG/ML) IV SOLN,,Q9968,HCPCS,Facility,Both,10,mL,,975,828.75,279.435,975,Sanford Health Plan,Sanford Health Plan,897,92,,percent of total billed charges,,
METHYLENE BLUE (ANTIDOTE) 1 % (10 MG/ML) IV SOLN,,Q9968,HCPCS,Facility,Outpatient,10,mL,,975,828.75,279.435,975,"UCare Health, Inc.",Individual & Family Plan,549.4125,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
METHYLENE BLUE (ANTIDOTE) 1 % (10 MG/ML) IV SOLN,,Q9968,HCPCS,Facility,Inpatient,10,mL,,975,828.75,279.435,975,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
METHYLENE BLUE (ANTIDOTE) 1 % (10 MG/ML) IV SOLN,,Q9968,HCPCS,Facility,Outpatient,10,mL,,975,828.75,279.435,975,"UCare Health, Inc.",Medical Assistance,492.0825,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
METHYLENE BLUE (ANTIDOTE) 1 % (10 MG/ML) IV SOLN,,Q9968,HCPCS,Facility,Inpatient,10,mL,,975,828.75,279.435,975,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
METHYLENE BLUE (ANTIDOTE) 1 % (10 MG/ML) IV SOLN,,Q9968,HCPCS,Facility,Outpatient,10,mL,,975,828.75,279.435,975,"UCare Health, Inc.",Medicare Advantage,492.0825,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
METHYLENE BLUE (ANTIDOTE) 1 % (10 MG/ML) IV SOLN,,Q9968,HCPCS,Facility,Inpatient,10,mL,,975,828.75,279.435,975,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
METHYLENE BLUE (ANTIDOTE) 1 % (10 MG/ML) IV SOLN,,Q9968,HCPCS,Facility,Outpatient,10,mL,,975,828.75,279.435,975,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),492.0825,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
METHYLENE BLUE (ANTIDOTE) 1 % (10 MG/ML) IV SOLN,,Q9968,HCPCS,Facility,Inpatient,10,mL,,975,828.75,279.435,975,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
METHYLENE BLUE (ANTIDOTE) 1 % (10 MG/ML) IV SOLN,,Q9968,HCPCS,Facility,Both,10,mL,,975,828.75,279.435,975,UnitedHealthcare,Individual & Family,916.5,94,,percent of total billed charges,,
METHYLENE BLUE (ANTIDOTE) 1 % (10 MG/ML) IV SOLN,,Q9968,HCPCS,Facility,Outpatient,10,mL,,975,828.75,279.435,975,UnitedHealthcare,Medicare Advantage,477.75,49,,percent of total billed charges,,
METHYLENE BLUE (ANTIDOTE) 1 % (10 MG/ML) IV SOLN,,Q9968,HCPCS,Facility,Inpatient,10,mL,,975,828.75,279.435,975,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
METHYLENE BLUE (ANTIDOTE) 1 % (10 MG/ML) IV SOLN,,Q9968,HCPCS,Facility,Outpatient,10,mL,,975,828.75,279.435,975,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,468,48,,percent of total billed charges,,100% of DHS outpatient percentage
METHYLENE BLUE (ANTIDOTE) 1 % (10 MG/ML) IV SOLN,,Q9968,HCPCS,Facility,Inpatient,10,mL,,975,828.75,279.435,975,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Cardiopulmonary Resuscitation,,92950,CPT,Facility,Both,,,,408,346.8,116.9328,408,Aetna,Commercial,375.36,92,,percent of total billed charges,,
Cardiopulmonary Resuscitation,,92950,CPT,Facility,Outpatient,,,,408,346.8,116.9328,408,Aetna,Medicare Advantage,199.92,49,,percent of total billed charges,,
Cardiopulmonary Resuscitation,,92950,CPT,Facility,Inpatient,,,,408,346.8,116.9328,408,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Cardiopulmonary Resuscitation,,92950,CPT,Facility,Both,,,,408,346.8,116.9328,408,Aetna,PPO,379.44,93,,percent of total billed charges,,
Cardiopulmonary Resuscitation,,92950,CPT,Facility,Both,,,,408,346.8,116.9328,408,America's PPO,America's PPO,391.8024,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Cardiopulmonary Resuscitation,,92950,CPT,Facility,Both,,,,408,346.8,116.9328,408,BlueCross BlueShield Minnesota, Federal Employee Program,401.472,98.4,,percent of total billed charges,,
Cardiopulmonary Resuscitation,,92950,CPT,Facility,Both,,,,408,346.8,116.9328,408,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,408,100,,percent of total billed charges,,
Cardiopulmonary Resuscitation,,92950,CPT,Facility,Both,,,,408,346.8,116.9328,408,BlueCross BlueShield Minnesota,High Value Network Plan,367.2,90,,percent of total billed charges,,
Cardiopulmonary Resuscitation,,92950,CPT,Facility,Outpatient,,,,408,346.8,116.9328,408,BlueCross BlueShield Minnesota,Medicare Advantage,199.92,49,,percent of total billed charges,,
Cardiopulmonary Resuscitation,,92950,CPT,Facility,Inpatient,,,,408,346.8,116.9328,408,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Cardiopulmonary Resuscitation,,92950,CPT,Facility,Both,,,,408,346.8,116.9328,408,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,361.3656,88.57,,percent of total billed charges,,
Cardiopulmonary Resuscitation,,92950,CPT,Facility,Both,,,,408,346.8,116.9328,408,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,116.9328,28.66,,percent of total billed charges,,
Cardiopulmonary Resuscitation,,92950,CPT,Facility,Outpatient,,,,408,346.8,116.9328,408,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),199.92,49,,percent of total billed charges,,
Cardiopulmonary Resuscitation,,92950,CPT,Facility,Inpatient,,,,408,346.8,116.9328,408,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Cardiopulmonary Resuscitation,,92950,CPT,Facility,Both,,,,408,346.8,116.9328,408,CorVel,Worker's Compensation,408,100,,percent of total billed charges,,
Cardiopulmonary Resuscitation,,92950,CPT,Facility,Both,,,,408,346.8,116.9328,408,First Health Group Corporation,First Health Network,395.76,97,,percent of total billed charges,,
Cardiopulmonary Resuscitation,,92950,CPT,Facility,Both,,,,408,346.8,116.9328,408,"Health Partners, Inc.",Commercial,385.968,94.6,,percent of total billed charges,,
Cardiopulmonary Resuscitation,,92950,CPT,Facility,Outpatient,,,,408,346.8,116.9328,408,"Health Partners, Inc.",Medicare Advantage,199.92,49,,percent of total billed charges,,
Cardiopulmonary Resuscitation,,92950,CPT,Facility,Inpatient,,,,408,346.8,116.9328,408,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Cardiopulmonary Resuscitation,,92950,CPT,Facility,Both,,,,408,346.8,116.9328,408,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),244.8,60,,percent of total billed charges,,
Cardiopulmonary Resuscitation,,92950,CPT,Facility,Both,,,,408,346.8,116.9328,408,"Health Partners, Inc.",State of Minnesota Advantage Program,332.52,81.5,,percent of total billed charges,,
Cardiopulmonary Resuscitation,,92950,CPT,Facility,Both,,,,408,346.8,116.9328,408,"Health Partners, Inc.",State Public Programs,204,50,,percent of total billed charges,,
Cardiopulmonary Resuscitation,,92950,CPT,Facility,Both,,,,408,346.8,116.9328,408,Humana Insurance Company,Commercial PPO,387.6,95,,percent of total billed charges,,
Cardiopulmonary Resuscitation,,92950,CPT,Facility,Outpatient,,,,408,346.8,116.9328,408,Humana Insurance Company,Medicare PPO,199.92,49,,percent of total billed charges,,
Cardiopulmonary Resuscitation,,92950,CPT,Facility,Inpatient,,,,408,346.8,116.9328,408,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Cardiopulmonary Resuscitation,,92950,CPT,Facility,Both,,,,408,346.8,116.9328,408,Medica,Individual & Family,404.328,99.1,,percent of total billed charges,,
Cardiopulmonary Resuscitation,,92950,CPT,Facility,Outpatient,,,,408,346.8,116.9328,408,Medica,Medica Advantage Solution,203.184,49.8,,percent of total billed charges,,
Cardiopulmonary Resuscitation,,92950,CPT,Facility,Inpatient,,,,408,346.8,116.9328,408,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Cardiopulmonary Resuscitation,,92950,CPT,Facility,Outpatient,,,,408,346.8,116.9328,408,Medica,Medical Assistance,181.968,44.6,,percent of total billed charges,,
Cardiopulmonary Resuscitation,,92950,CPT,Facility,Inpatient,,,,408,346.8,116.9328,408,Medica,Medical Assistance,,,,,Included in per diem rate,
Cardiopulmonary Resuscitation,,92950,CPT,Facility,Outpatient,,,,408,346.8,116.9328,408,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,203.184,49.8,,percent of total billed charges,,
Cardiopulmonary Resuscitation,,92950,CPT,Facility,Inpatient,,,,408,346.8,116.9328,408,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Cardiopulmonary Resuscitation,,92950,CPT,Facility,Both,,,,408,346.8,116.9328,408,"Multiplan, Inc.","Multiplan, Inc.",383.52,94,,percent of total billed charges,,
Cardiopulmonary Resuscitation,,92950,CPT,Facility,Outpatient,,,,408,346.8,116.9328,408,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,367.608,90.1,,percent of total billed charges,,
Cardiopulmonary Resuscitation,,92950,CPT,Facility,Inpatient,,,,408,346.8,116.9328,408,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Cardiopulmonary Resuscitation,,92950,CPT,Facility,Both,,,,408,346.8,116.9328,408,"Preferred One Administrative Services, INC.",PPO,402.288,98.6,,percent of total billed charges,,
Cardiopulmonary Resuscitation,,92950,CPT,Facility,Outpatient,,,,408,346.8,116.9328,408,PrimeWest Health,Minnesota Senior Health Options (MSHO),209.916,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Cardiopulmonary Resuscitation,,92950,CPT,Facility,Inpatient,,,,408,346.8,116.9328,408,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Cardiopulmonary Resuscitation,,92950,CPT,Facility,Outpatient,,,,408,346.8,116.9328,408,PrimeWest Health,MinnesotaCare,209.5488,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Cardiopulmonary Resuscitation,,92950,CPT,Facility,Inpatient,,,,408,346.8,116.9328,408,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Cardiopulmonary Resuscitation,,92950,CPT,Facility,Both,,,,408,346.8,116.9328,408,Sanford Health Plan,Sanford Health Plan,375.36,92,,percent of total billed charges,,
Cardiopulmonary Resuscitation,,92950,CPT,Facility,Outpatient,,,,408,346.8,116.9328,408,"UCare Health, Inc.",Individual & Family Plan,229.908,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Cardiopulmonary Resuscitation,,92950,CPT,Facility,Inpatient,,,,408,346.8,116.9328,408,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Cardiopulmonary Resuscitation,,92950,CPT,Facility,Outpatient,,,,408,346.8,116.9328,408,"UCare Health, Inc.",Medical Assistance,205.9176,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Cardiopulmonary Resuscitation,,92950,CPT,Facility,Inpatient,,,,408,346.8,116.9328,408,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Cardiopulmonary Resuscitation,,92950,CPT,Facility,Outpatient,,,,408,346.8,116.9328,408,"UCare Health, Inc.",Medicare Advantage,205.9176,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Cardiopulmonary Resuscitation,,92950,CPT,Facility,Inpatient,,,,408,346.8,116.9328,408,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Cardiopulmonary Resuscitation,,92950,CPT,Facility,Outpatient,,,,408,346.8,116.9328,408,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),205.9176,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Cardiopulmonary Resuscitation,,92950,CPT,Facility,Inpatient,,,,408,346.8,116.9328,408,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Cardiopulmonary Resuscitation,,92950,CPT,Facility,Both,,,,408,346.8,116.9328,408,UnitedHealthcare,Individual & Family,383.52,94,,percent of total billed charges,,
Cardiopulmonary Resuscitation,,92950,CPT,Facility,Outpatient,,,,408,346.8,116.9328,408,UnitedHealthcare,Medicare Advantage,199.92,49,,percent of total billed charges,,
Cardiopulmonary Resuscitation,,92950,CPT,Facility,Inpatient,,,,408,346.8,116.9328,408,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Cardiopulmonary Resuscitation,,92950,CPT,Facility,Outpatient,,,,408,346.8,116.9328,408,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,195.84,48,,percent of total billed charges,,100% of DHS outpatient percentage
Cardiopulmonary Resuscitation,,92950,CPT,Facility,Inpatient,,,,408,346.8,116.9328,408,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Cpr (Pro Cah),,92950,CPT,Professional,Both,,,,332,282.2,112.13,332,Aetna,Commercial,282.2,85,,percent of total billed charges,,
Cpr (Pro Cah),,92950,CPT,Professional,Both,,,,332,282.2,112.13,332,Aetna,Medicare Advantage,179.02,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Cpr (Pro Cah),,92950,CPT,Professional,Both,,,,332,282.2,112.13,332,Aetna,PPO,308.76,93,,percent of total billed charges,,
Cpr (Pro Cah),,92950,CPT,Professional,Both,,,,332,282.2,112.13,332,America's PPO,America's PPO,283.6608,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Cpr (Pro Cah),,92950,CPT,Professional,Both,,,,332,282.2,112.13,332,BlueCross BlueShield Minnesota, Federal Employee Program,313.92,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Cpr (Pro Cah),,92950,CPT,Professional,Both,,,,332,282.2,112.13,332,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,318.94272,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Cpr (Pro Cah),,92950,CPT,Professional,Both,,,,332,282.2,112.13,332,BlueCross BlueShield Minnesota,High Value Network Plan,318.94272,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Cpr (Pro Cah),,92950,CPT,Professional,Both,,,,332,282.2,112.13,332,BlueCross BlueShield Minnesota,Medicare Advantage,200.422,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Cpr (Pro Cah),,92950,CPT,Professional,Both,,,,332,282.2,112.13,332,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,318.94272,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Cpr (Pro Cah),,92950,CPT,Professional,Both,,,,332,282.2,112.13,332,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,129.45872,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Cpr (Pro Cah),,92950,CPT,Professional,Both,,,,332,282.2,112.13,332,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),200.422,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Cpr (Pro Cah),,92950,CPT,Professional,Both,,,,332,282.2,112.13,332,CorVel,Worker's Compensation,332,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Cpr (Pro Cah),,92950,CPT,Professional,Both,,,,332,282.2,112.13,332,First Health Group Corporation,First Health Network,322.04,97,,percent of total billed charges,,
Cpr (Pro Cah),,92950,CPT,Professional,Both,,,,332,282.2,112.13,332,"Health Partners, Inc.",Commercial,332,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Cpr (Pro Cah),,92950,CPT,Professional,Both,,,,332,282.2,112.13,332,"Health Partners, Inc.",Medicare Advantage,200.422,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Cpr (Pro Cah),,92950,CPT,Professional,Both,,,,332,282.2,112.13,332,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),174.18,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Cpr (Pro Cah),,92950,CPT,Professional,Both,,,,332,282.2,112.13,332,"Health Partners, Inc.",State of Minnesota Advantage Program,321.27058,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Cpr (Pro Cah),,92950,CPT,Professional,Both,,,,332,282.2,112.13,332,"Health Partners, Inc.",State Public Programs,112.13,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Cpr (Pro Cah),,92950,CPT,Professional,Both,,,,332,282.2,112.13,332,Humana Insurance Company,Commercial PPO,174.28,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Cpr (Pro Cah),,92950,CPT,Professional,Both,,,,332,282.2,112.13,332,Humana Insurance Company,Medicare PPO,332,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Cpr (Pro Cah),,92950,CPT,Professional,Both,,,,332,282.2,112.13,332,Medica,Individual & Family,281.536,84.8,,percent of total billed charges,,
Cpr (Pro Cah),,92950,CPT,Professional,Both,,,,332,282.2,112.13,332,Medica,Medica Advantage Solution,165.336,49.8,,percent of total billed charges,,
Cpr (Pro Cah),,92950,CPT,Professional,Both,,,,332,282.2,112.13,332,Medica,Medical Assistance,129.46,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Cpr (Pro Cah),,92950,CPT,Professional,Both,,,,332,282.2,112.13,332,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,174.28,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Cpr (Pro Cah),,92950,CPT,Professional,Both,,,,332,282.2,112.13,332,"Multiplan, Inc.","Multiplan, Inc.",312.08,94,,percent of total billed charges,,
Cpr (Pro Cah),,92950,CPT,Professional,Both,,,,332,282.2,112.13,332,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,299.132,90.1,,percent of total billed charges,,
Cpr (Pro Cah),,92950,CPT,Professional,Both,,,,332,282.2,112.13,332,"Preferred One Administrative Services, INC.",PPO,327.352,98.6,,percent of total billed charges,,
Cpr (Pro Cah),,92950,CPT,Professional,Both,,,,332,282.2,112.13,332,PrimeWest Health,Minnesota Senior Health Options (MSHO),200.422,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Cpr (Pro Cah),,92950,CPT,Professional,Both,,,,332,282.2,112.13,332,PrimeWest Health,MinnesotaCare,138.5208304,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Cpr (Pro Cah),,92950,CPT,Professional,Both,,,,332,282.2,112.13,332,Sanford Health Plan,Sanford Health Plan,292.16,88,,percent of total billed charges,,
Cpr (Pro Cah),,92950,CPT,Professional,Both,,,,332,282.2,112.13,332,"UCare Health, Inc.",Individual & Family Plan,283.309568,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Cpr (Pro Cah),,92950,CPT,Professional,Both,,,,332,282.2,112.13,332,"UCare Health, Inc.",Medical Assistance,142.404592,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Cpr (Pro Cah),,92950,CPT,Professional,Both,,,,332,282.2,112.13,332,"UCare Health, Inc.",Medicare Advantage,200.422,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Cpr (Pro Cah),,92950,CPT,Professional,Both,,,,332,282.2,112.13,332,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),160.3376,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Cpr (Pro Cah),,92950,CPT,Professional,Both,,,,332,282.2,112.13,332,UnitedHealthcare,Individual & Family,332,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Cpr (Pro Cah),,92950,CPT,Professional,Both,,,,332,282.2,112.13,332,UnitedHealthcare,Medicare Advantage,200.422,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Cpr (Pro Cah),,92950,CPT,Professional,Both,,,,332,282.2,112.13,332,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,129.45872,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Temporary External Pacing,,92953,CPT,Facility,Both,,,,408,346.8,116.9328,408,Aetna,Commercial,375.36,92,,percent of total billed charges,,
Temporary External Pacing,,92953,CPT,Facility,Outpatient,,,,408,346.8,116.9328,408,Aetna,Medicare Advantage,199.92,49,,percent of total billed charges,,
Temporary External Pacing,,92953,CPT,Facility,Inpatient,,,,408,346.8,116.9328,408,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Temporary External Pacing,,92953,CPT,Facility,Both,,,,408,346.8,116.9328,408,Aetna,PPO,379.44,93,,percent of total billed charges,,
Temporary External Pacing,,92953,CPT,Facility,Both,,,,408,346.8,116.9328,408,America's PPO,America's PPO,391.8024,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Temporary External Pacing,,92953,CPT,Facility,Both,,,,408,346.8,116.9328,408,BlueCross BlueShield Minnesota, Federal Employee Program,401.472,98.4,,percent of total billed charges,,
Temporary External Pacing,,92953,CPT,Facility,Both,,,,408,346.8,116.9328,408,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,408,100,,percent of total billed charges,,
Temporary External Pacing,,92953,CPT,Facility,Both,,,,408,346.8,116.9328,408,BlueCross BlueShield Minnesota,High Value Network Plan,367.2,90,,percent of total billed charges,,
Temporary External Pacing,,92953,CPT,Facility,Outpatient,,,,408,346.8,116.9328,408,BlueCross BlueShield Minnesota,Medicare Advantage,199.92,49,,percent of total billed charges,,
Temporary External Pacing,,92953,CPT,Facility,Inpatient,,,,408,346.8,116.9328,408,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Temporary External Pacing,,92953,CPT,Facility,Both,,,,408,346.8,116.9328,408,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,361.3656,88.57,,percent of total billed charges,,
Temporary External Pacing,,92953,CPT,Facility,Both,,,,408,346.8,116.9328,408,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,116.9328,28.66,,percent of total billed charges,,
Temporary External Pacing,,92953,CPT,Facility,Outpatient,,,,408,346.8,116.9328,408,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),199.92,49,,percent of total billed charges,,
Temporary External Pacing,,92953,CPT,Facility,Inpatient,,,,408,346.8,116.9328,408,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Temporary External Pacing,,92953,CPT,Facility,Both,,,,408,346.8,116.9328,408,CorVel,Worker's Compensation,408,100,,percent of total billed charges,,
Temporary External Pacing,,92953,CPT,Facility,Both,,,,408,346.8,116.9328,408,First Health Group Corporation,First Health Network,395.76,97,,percent of total billed charges,,
Temporary External Pacing,,92953,CPT,Facility,Both,,,,408,346.8,116.9328,408,"Health Partners, Inc.",Commercial,385.968,94.6,,percent of total billed charges,,
Temporary External Pacing,,92953,CPT,Facility,Outpatient,,,,408,346.8,116.9328,408,"Health Partners, Inc.",Medicare Advantage,199.92,49,,percent of total billed charges,,
Temporary External Pacing,,92953,CPT,Facility,Inpatient,,,,408,346.8,116.9328,408,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Temporary External Pacing,,92953,CPT,Facility,Both,,,,408,346.8,116.9328,408,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),244.8,60,,percent of total billed charges,,
Temporary External Pacing,,92953,CPT,Facility,Both,,,,408,346.8,116.9328,408,"Health Partners, Inc.",State of Minnesota Advantage Program,332.52,81.5,,percent of total billed charges,,
Temporary External Pacing,,92953,CPT,Facility,Both,,,,408,346.8,116.9328,408,"Health Partners, Inc.",State Public Programs,204,50,,percent of total billed charges,,
Temporary External Pacing,,92953,CPT,Facility,Both,,,,408,346.8,116.9328,408,Humana Insurance Company,Commercial PPO,387.6,95,,percent of total billed charges,,
Temporary External Pacing,,92953,CPT,Facility,Outpatient,,,,408,346.8,116.9328,408,Humana Insurance Company,Medicare PPO,199.92,49,,percent of total billed charges,,
Temporary External Pacing,,92953,CPT,Facility,Inpatient,,,,408,346.8,116.9328,408,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Temporary External Pacing,,92953,CPT,Facility,Both,,,,408,346.8,116.9328,408,Medica,Individual & Family,404.328,99.1,,percent of total billed charges,,
Temporary External Pacing,,92953,CPT,Facility,Outpatient,,,,408,346.8,116.9328,408,Medica,Medica Advantage Solution,203.184,49.8,,percent of total billed charges,,
Temporary External Pacing,,92953,CPT,Facility,Inpatient,,,,408,346.8,116.9328,408,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Temporary External Pacing,,92953,CPT,Facility,Outpatient,,,,408,346.8,116.9328,408,Medica,Medical Assistance,181.968,44.6,,percent of total billed charges,,
Temporary External Pacing,,92953,CPT,Facility,Inpatient,,,,408,346.8,116.9328,408,Medica,Medical Assistance,,,,,Included in per diem rate,
Temporary External Pacing,,92953,CPT,Facility,Outpatient,,,,408,346.8,116.9328,408,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,203.184,49.8,,percent of total billed charges,,
Temporary External Pacing,,92953,CPT,Facility,Inpatient,,,,408,346.8,116.9328,408,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Temporary External Pacing,,92953,CPT,Facility,Both,,,,408,346.8,116.9328,408,"Multiplan, Inc.","Multiplan, Inc.",383.52,94,,percent of total billed charges,,
Temporary External Pacing,,92953,CPT,Facility,Outpatient,,,,408,346.8,116.9328,408,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,367.608,90.1,,percent of total billed charges,,
Temporary External Pacing,,92953,CPT,Facility,Inpatient,,,,408,346.8,116.9328,408,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Temporary External Pacing,,92953,CPT,Facility,Both,,,,408,346.8,116.9328,408,"Preferred One Administrative Services, INC.",PPO,402.288,98.6,,percent of total billed charges,,
Temporary External Pacing,,92953,CPT,Facility,Outpatient,,,,408,346.8,116.9328,408,PrimeWest Health,Minnesota Senior Health Options (MSHO),209.916,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Temporary External Pacing,,92953,CPT,Facility,Inpatient,,,,408,346.8,116.9328,408,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Temporary External Pacing,,92953,CPT,Facility,Outpatient,,,,408,346.8,116.9328,408,PrimeWest Health,MinnesotaCare,209.5488,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Temporary External Pacing,,92953,CPT,Facility,Inpatient,,,,408,346.8,116.9328,408,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Temporary External Pacing,,92953,CPT,Facility,Both,,,,408,346.8,116.9328,408,Sanford Health Plan,Sanford Health Plan,375.36,92,,percent of total billed charges,,
Temporary External Pacing,,92953,CPT,Facility,Outpatient,,,,408,346.8,116.9328,408,"UCare Health, Inc.",Individual & Family Plan,229.908,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Temporary External Pacing,,92953,CPT,Facility,Inpatient,,,,408,346.8,116.9328,408,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Temporary External Pacing,,92953,CPT,Facility,Outpatient,,,,408,346.8,116.9328,408,"UCare Health, Inc.",Medical Assistance,205.9176,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Temporary External Pacing,,92953,CPT,Facility,Inpatient,,,,408,346.8,116.9328,408,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Temporary External Pacing,,92953,CPT,Facility,Outpatient,,,,408,346.8,116.9328,408,"UCare Health, Inc.",Medicare Advantage,205.9176,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Temporary External Pacing,,92953,CPT,Facility,Inpatient,,,,408,346.8,116.9328,408,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Temporary External Pacing,,92953,CPT,Facility,Outpatient,,,,408,346.8,116.9328,408,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),205.9176,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Temporary External Pacing,,92953,CPT,Facility,Inpatient,,,,408,346.8,116.9328,408,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Temporary External Pacing,,92953,CPT,Facility,Both,,,,408,346.8,116.9328,408,UnitedHealthcare,Individual & Family,383.52,94,,percent of total billed charges,,
Temporary External Pacing,,92953,CPT,Facility,Outpatient,,,,408,346.8,116.9328,408,UnitedHealthcare,Medicare Advantage,199.92,49,,percent of total billed charges,,
Temporary External Pacing,,92953,CPT,Facility,Inpatient,,,,408,346.8,116.9328,408,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Temporary External Pacing,,92953,CPT,Facility,Outpatient,,,,408,346.8,116.9328,408,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,195.84,48,,percent of total billed charges,,100% of DHS outpatient percentage
Temporary External Pacing,,92953,CPT,Facility,Inpatient,,,,408,346.8,116.9328,408,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Cardioversion,,92960,CPT,Facility,Both,,,,857,728.45,245.6162,857,Aetna,Commercial,788.44,92,,percent of total billed charges,,
Cardioversion,,92960,CPT,Facility,Outpatient,,,,857,728.45,245.6162,857,Aetna,Medicare Advantage,419.93,49,,percent of total billed charges,,
Cardioversion,,92960,CPT,Facility,Inpatient,,,,857,728.45,245.6162,857,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Cardioversion,,92960,CPT,Facility,Both,,,,857,728.45,245.6162,857,Aetna,PPO,797.01,93,,percent of total billed charges,,
Cardioversion,,92960,CPT,Facility,Both,,,,857,728.45,245.6162,857,America's PPO,America's PPO,822.9771,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Cardioversion,,92960,CPT,Facility,Both,,,,857,728.45,245.6162,857,BlueCross BlueShield Minnesota, Federal Employee Program,843.288,98.4,,percent of total billed charges,,
Cardioversion,,92960,CPT,Facility,Both,,,,857,728.45,245.6162,857,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,857,100,,percent of total billed charges,,
Cardioversion,,92960,CPT,Facility,Both,,,,857,728.45,245.6162,857,BlueCross BlueShield Minnesota,High Value Network Plan,771.3,90,,percent of total billed charges,,
Cardioversion,,92960,CPT,Facility,Outpatient,,,,857,728.45,245.6162,857,BlueCross BlueShield Minnesota,Medicare Advantage,419.93,49,,percent of total billed charges,,
Cardioversion,,92960,CPT,Facility,Inpatient,,,,857,728.45,245.6162,857,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Cardioversion,,92960,CPT,Facility,Both,,,,857,728.45,245.6162,857,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,759.0449,88.57,,percent of total billed charges,,
Cardioversion,,92960,CPT,Facility,Both,,,,857,728.45,245.6162,857,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,245.6162,28.66,,percent of total billed charges,,
Cardioversion,,92960,CPT,Facility,Outpatient,,,,857,728.45,245.6162,857,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),419.93,49,,percent of total billed charges,,
Cardioversion,,92960,CPT,Facility,Inpatient,,,,857,728.45,245.6162,857,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Cardioversion,,92960,CPT,Facility,Both,,,,857,728.45,245.6162,857,CorVel,Worker's Compensation,857,100,,percent of total billed charges,,
Cardioversion,,92960,CPT,Facility,Both,,,,857,728.45,245.6162,857,First Health Group Corporation,First Health Network,831.29,97,,percent of total billed charges,,
Cardioversion,,92960,CPT,Facility,Both,,,,857,728.45,245.6162,857,"Health Partners, Inc.",Commercial,810.722,94.6,,percent of total billed charges,,
Cardioversion,,92960,CPT,Facility,Outpatient,,,,857,728.45,245.6162,857,"Health Partners, Inc.",Medicare Advantage,419.93,49,,percent of total billed charges,,
Cardioversion,,92960,CPT,Facility,Inpatient,,,,857,728.45,245.6162,857,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Cardioversion,,92960,CPT,Facility,Both,,,,857,728.45,245.6162,857,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),514.2,60,,percent of total billed charges,,
Cardioversion,,92960,CPT,Facility,Both,,,,857,728.45,245.6162,857,"Health Partners, Inc.",State of Minnesota Advantage Program,698.455,81.5,,percent of total billed charges,,
Cardioversion,,92960,CPT,Facility,Both,,,,857,728.45,245.6162,857,"Health Partners, Inc.",State Public Programs,428.5,50,,percent of total billed charges,,
Cardioversion,,92960,CPT,Facility,Both,,,,857,728.45,245.6162,857,Humana Insurance Company,Commercial PPO,814.15,95,,percent of total billed charges,,
Cardioversion,,92960,CPT,Facility,Outpatient,,,,857,728.45,245.6162,857,Humana Insurance Company,Medicare PPO,419.93,49,,percent of total billed charges,,
Cardioversion,,92960,CPT,Facility,Inpatient,,,,857,728.45,245.6162,857,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Cardioversion,,92960,CPT,Facility,Both,,,,857,728.45,245.6162,857,Medica,Individual & Family,849.287,99.1,,percent of total billed charges,,
Cardioversion,,92960,CPT,Facility,Outpatient,,,,857,728.45,245.6162,857,Medica,Medica Advantage Solution,426.786,49.8,,percent of total billed charges,,
Cardioversion,,92960,CPT,Facility,Inpatient,,,,857,728.45,245.6162,857,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Cardioversion,,92960,CPT,Facility,Outpatient,,,,857,728.45,245.6162,857,Medica,Medical Assistance,382.222,44.6,,percent of total billed charges,,
Cardioversion,,92960,CPT,Facility,Inpatient,,,,857,728.45,245.6162,857,Medica,Medical Assistance,,,,,Included in per diem rate,
Cardioversion,,92960,CPT,Facility,Outpatient,,,,857,728.45,245.6162,857,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,426.786,49.8,,percent of total billed charges,,
Cardioversion,,92960,CPT,Facility,Inpatient,,,,857,728.45,245.6162,857,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Cardioversion,,92960,CPT,Facility,Both,,,,857,728.45,245.6162,857,"Multiplan, Inc.","Multiplan, Inc.",805.58,94,,percent of total billed charges,,
Cardioversion,,92960,CPT,Facility,Outpatient,,,,857,728.45,245.6162,857,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,772.157,90.1,,percent of total billed charges,,
Cardioversion,,92960,CPT,Facility,Inpatient,,,,857,728.45,245.6162,857,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Cardioversion,,92960,CPT,Facility,Both,,,,857,728.45,245.6162,857,"Preferred One Administrative Services, INC.",PPO,845.002,98.6,,percent of total billed charges,,
Cardioversion,,92960,CPT,Facility,Outpatient,,,,857,728.45,245.6162,857,PrimeWest Health,Minnesota Senior Health Options (MSHO),440.9265,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Cardioversion,,92960,CPT,Facility,Inpatient,,,,857,728.45,245.6162,857,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Cardioversion,,92960,CPT,Facility,Outpatient,,,,857,728.45,245.6162,857,PrimeWest Health,MinnesotaCare,440.1552,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Cardioversion,,92960,CPT,Facility,Inpatient,,,,857,728.45,245.6162,857,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Cardioversion,,92960,CPT,Facility,Both,,,,857,728.45,245.6162,857,Sanford Health Plan,Sanford Health Plan,788.44,92,,percent of total billed charges,,
Cardioversion,,92960,CPT,Facility,Outpatient,,,,857,728.45,245.6162,857,"UCare Health, Inc.",Individual & Family Plan,482.9195,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Cardioversion,,92960,CPT,Facility,Inpatient,,,,857,728.45,245.6162,857,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Cardioversion,,92960,CPT,Facility,Outpatient,,,,857,728.45,245.6162,857,"UCare Health, Inc.",Medical Assistance,432.5279,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Cardioversion,,92960,CPT,Facility,Inpatient,,,,857,728.45,245.6162,857,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Cardioversion,,92960,CPT,Facility,Outpatient,,,,857,728.45,245.6162,857,"UCare Health, Inc.",Medicare Advantage,432.5279,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Cardioversion,,92960,CPT,Facility,Inpatient,,,,857,728.45,245.6162,857,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Cardioversion,,92960,CPT,Facility,Outpatient,,,,857,728.45,245.6162,857,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),432.5279,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Cardioversion,,92960,CPT,Facility,Inpatient,,,,857,728.45,245.6162,857,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Cardioversion,,92960,CPT,Facility,Both,,,,857,728.45,245.6162,857,UnitedHealthcare,Individual & Family,805.58,94,,percent of total billed charges,,
Cardioversion,,92960,CPT,Facility,Outpatient,,,,857,728.45,245.6162,857,UnitedHealthcare,Medicare Advantage,419.93,49,,percent of total billed charges,,
Cardioversion,,92960,CPT,Facility,Inpatient,,,,857,728.45,245.6162,857,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Cardioversion,,92960,CPT,Facility,Outpatient,,,,857,728.45,245.6162,857,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,411.36,48,,percent of total billed charges,,100% of DHS outpatient percentage
Cardioversion,,92960,CPT,Facility,Inpatient,,,,857,728.45,245.6162,857,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Cardioversion (Pro Cah),,92960,CPT,Professional,Both,,,,545,463.25,67.41,545,Aetna,Commercial,463.25,85,,percent of total billed charges,,
Cardioversion (Pro Cah),,92960,CPT,Professional,Both,,,,545,463.25,67.41,545,Aetna,Medicare Advantage,107.33,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Cardioversion (Pro Cah),,92960,CPT,Professional,Both,,,,545,463.25,67.41,545,Aetna,PPO,506.85,93,,percent of total billed charges,,
Cardioversion (Pro Cah),,92960,CPT,Professional,Both,,,,545,463.25,67.41,545,America's PPO,America's PPO,465.648,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Cardioversion (Pro Cah),,92960,CPT,Professional,Both,,,,545,463.25,67.41,545,BlueCross BlueShield Minnesota, Federal Employee Program,186.14,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Cardioversion (Pro Cah),,92960,CPT,Professional,Both,,,,545,463.25,67.41,545,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,189.11824,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Cardioversion (Pro Cah),,92960,CPT,Professional,Both,,,,545,463.25,67.41,545,BlueCross BlueShield Minnesota,High Value Network Plan,189.11824,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Cardioversion (Pro Cah),,92960,CPT,Professional,Both,,,,545,463.25,67.41,545,BlueCross BlueShield Minnesota,Medicare Advantage,120.6005,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Cardioversion (Pro Cah),,92960,CPT,Professional,Both,,,,545,463.25,67.41,545,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,189.11824,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Cardioversion (Pro Cah),,92960,CPT,Professional,Both,,,,545,463.25,67.41,545,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,77.8256,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Cardioversion (Pro Cah),,92960,CPT,Professional,Both,,,,545,463.25,67.41,545,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),120.6005,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Cardioversion (Pro Cah),,92960,CPT,Professional,Both,,,,545,463.25,67.41,545,CorVel,Worker's Compensation,207.0636156,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Cardioversion (Pro Cah),,92960,CPT,Professional,Both,,,,545,463.25,67.41,545,First Health Group Corporation,First Health Network,528.65,97,,percent of total billed charges,,
Cardioversion (Pro Cah),,92960,CPT,Professional,Both,,,,545,463.25,67.41,545,"Health Partners, Inc.",Commercial,223.46,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Cardioversion (Pro Cah),,92960,CPT,Professional,Both,,,,545,463.25,67.41,545,"Health Partners, Inc.",Medicare Advantage,120.6005,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Cardioversion (Pro Cah),,92960,CPT,Professional,Both,,,,545,463.25,67.41,545,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),105.05,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Cardioversion (Pro Cah),,92960,CPT,Professional,Both,,,,545,463.25,67.41,545,"Health Partners, Inc.",State of Minnesota Advantage Program,192.51079,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Cardioversion (Pro Cah),,92960,CPT,Professional,Both,,,,545,463.25,67.41,545,"Health Partners, Inc.",State Public Programs,67.41,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Cardioversion (Pro Cah),,92960,CPT,Professional,Both,,,,545,463.25,67.41,545,Humana Insurance Company,Commercial PPO,104.87,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Cardioversion (Pro Cah),,92960,CPT,Professional,Both,,,,545,463.25,67.41,545,Humana Insurance Company,Medicare PPO,545,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Cardioversion (Pro Cah),,92960,CPT,Professional,Both,,,,545,463.25,67.41,545,Medica,Individual & Family,462.16,84.8,,percent of total billed charges,,
Cardioversion (Pro Cah),,92960,CPT,Professional,Both,,,,545,463.25,67.41,545,Medica,Medica Advantage Solution,271.41,49.8,,percent of total billed charges,,
Cardioversion (Pro Cah),,92960,CPT,Professional,Both,,,,545,463.25,67.41,545,Medica,Medical Assistance,77.83,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Cardioversion (Pro Cah),,92960,CPT,Professional,Both,,,,545,463.25,67.41,545,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,104.87,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Cardioversion (Pro Cah),,92960,CPT,Professional,Both,,,,545,463.25,67.41,545,"Multiplan, Inc.","Multiplan, Inc.",512.3,94,,percent of total billed charges,,
Cardioversion (Pro Cah),,92960,CPT,Professional,Both,,,,545,463.25,67.41,545,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,491.045,90.1,,percent of total billed charges,,
Cardioversion (Pro Cah),,92960,CPT,Professional,Both,,,,545,463.25,67.41,545,"Preferred One Administrative Services, INC.",PPO,537.37,98.6,,percent of total billed charges,,
Cardioversion (Pro Cah),,92960,CPT,Professional,Both,,,,545,463.25,67.41,545,PrimeWest Health,Minnesota Senior Health Options (MSHO),120.6005,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Cardioversion (Pro Cah),,92960,CPT,Professional,Both,,,,545,463.25,67.41,545,PrimeWest Health,MinnesotaCare,83.273392,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Cardioversion (Pro Cah),,92960,CPT,Professional,Both,,,,545,463.25,67.41,545,Sanford Health Plan,Sanford Health Plan,479.6,88,,percent of total billed charges,,
Cardioversion (Pro Cah),,92960,CPT,Professional,Both,,,,545,463.25,67.41,545,"UCare Health, Inc.",Individual & Family Plan,170.476672,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Cardioversion (Pro Cah),,92960,CPT,Professional,Both,,,,545,463.25,67.41,545,"UCare Health, Inc.",Medical Assistance,85.60816,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Cardioversion (Pro Cah),,92960,CPT,Professional,Both,,,,545,463.25,67.41,545,"UCare Health, Inc.",Medicare Advantage,120.6005,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Cardioversion (Pro Cah),,92960,CPT,Professional,Both,,,,545,463.25,67.41,545,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),96.4804,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Cardioversion (Pro Cah),,92960,CPT,Professional,Both,,,,545,463.25,67.41,545,UnitedHealthcare,Individual & Family,545,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Cardioversion (Pro Cah),,92960,CPT,Professional,Both,,,,545,463.25,67.41,545,UnitedHealthcare,Medicare Advantage,120.6005,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Cardioversion (Pro Cah),,92960,CPT,Professional,Both,,,,545,463.25,67.41,545,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,77.8256,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Ekg Tracing,,93005,CPT,Facility,Both,,,,204,173.4,73.66,204,Aetna,Commercial,187.68,92,,percent of total billed charges,,
Ekg Tracing,,93005,CPT,Facility,Outpatient,,,,204,173.4,73.66,204,Aetna,Medicare Advantage,99.96,49,,percent of total billed charges,,
Ekg Tracing,,93005,CPT,Facility,Inpatient,,,,204,173.4,73.66,204,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Ekg Tracing,,93005,CPT,Facility,Both,,,,204,173.4,73.66,204,Aetna,PPO,189.72,93,,percent of total billed charges,,
Ekg Tracing,,93005,CPT,Facility,Both,,,,204,173.4,73.66,204,America's PPO,America's PPO,195.9012,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Ekg Tracing,,93005,CPT,Facility,Both,,,,204,173.4,73.66,204,BlueCross BlueShield Minnesota, Federal Employee Program,145,,,Fee schedule,,100% of BCBS commercial commodity fee schedule
Ekg Tracing,,93005,CPT,Facility,Both,,,,204,173.4,73.66,204,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,147.32,,,Fee schedule,,"100% of BCBS commercial commodity fee schedule, plus MN Care tax"
Ekg Tracing,,93005,CPT,Facility,Both,,,,204,173.4,73.66,204,BlueCross BlueShield Minnesota,High Value Network Plan,132.588,,,Fee schedule,,"90% of BCBS commercial commodity fee schedule, plus MN Care tax; see disclaimer for more information"
Ekg Tracing,,93005,CPT,Facility,Outpatient,,,,204,173.4,73.66,204,BlueCross BlueShield Minnesota,Medicare Advantage,99.96,49,,percent of total billed charges,,
Ekg Tracing,,93005,CPT,Facility,Inpatient,,,,204,173.4,73.66,204,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Ekg Tracing,,93005,CPT,Facility,Both,,,,204,173.4,73.66,204,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,130.481324,,,Fee schedule,,"88.57% of BCBS commercial commodity fee schedule, plus MN Care tax"
Ekg Tracing,,93005,CPT,Facility,Both,,,,204,173.4,73.66,204,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,73.66,,,Fee schedule,,"100% of BCBS Medicaid commodity fee schedule, plus MN Care tax"
Ekg Tracing,,93005,CPT,Facility,Outpatient,,,,204,173.4,73.66,204,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),99.96,49,,percent of total billed charges,,
Ekg Tracing,,93005,CPT,Facility,Inpatient,,,,204,173.4,73.66,204,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Ekg Tracing,,93005,CPT,Facility,Both,,,,204,173.4,73.66,204,CorVel,Worker's Compensation,204,100,,percent of total billed charges,,
Ekg Tracing,,93005,CPT,Facility,Both,,,,204,173.4,73.66,204,First Health Group Corporation,First Health Network,197.88,97,,percent of total billed charges,,
Ekg Tracing,,93005,CPT,Facility,Both,,,,204,173.4,73.66,204,"Health Partners, Inc.",Commercial,192.984,94.6,,percent of total billed charges,,
Ekg Tracing,,93005,CPT,Facility,Outpatient,,,,204,173.4,73.66,204,"Health Partners, Inc.",Medicare Advantage,99.96,49,,percent of total billed charges,,
Ekg Tracing,,93005,CPT,Facility,Inpatient,,,,204,173.4,73.66,204,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ekg Tracing,,93005,CPT,Facility,Both,,,,204,173.4,73.66,204,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),122.4,60,,percent of total billed charges,,
Ekg Tracing,,93005,CPT,Facility,Both,,,,204,173.4,73.66,204,"Health Partners, Inc.",State of Minnesota Advantage Program,166.26,81.5,,percent of total billed charges,,
Ekg Tracing,,93005,CPT,Facility,Both,,,,204,173.4,73.66,204,"Health Partners, Inc.",State Public Programs,102,50,,percent of total billed charges,,
Ekg Tracing,,93005,CPT,Facility,Both,,,,204,173.4,73.66,204,Humana Insurance Company,Commercial PPO,193.8,95,,percent of total billed charges,,
Ekg Tracing,,93005,CPT,Facility,Outpatient,,,,204,173.4,73.66,204,Humana Insurance Company,Medicare PPO,99.96,49,,percent of total billed charges,,
Ekg Tracing,,93005,CPT,Facility,Inpatient,,,,204,173.4,73.66,204,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Ekg Tracing,,93005,CPT,Facility,Both,,,,204,173.4,73.66,204,Medica,Individual & Family,202.164,99.1,,percent of total billed charges,,
Ekg Tracing,,93005,CPT,Facility,Outpatient,,,,204,173.4,73.66,204,Medica,Medica Advantage Solution,101.592,49.8,,percent of total billed charges,,
Ekg Tracing,,93005,CPT,Facility,Inpatient,,,,204,173.4,73.66,204,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Ekg Tracing,,93005,CPT,Facility,Outpatient,,,,204,173.4,73.66,204,Medica,Medical Assistance,90.984,44.6,,percent of total billed charges,,
Ekg Tracing,,93005,CPT,Facility,Inpatient,,,,204,173.4,73.66,204,Medica,Medical Assistance,,,,,Included in per diem rate,
Ekg Tracing,,93005,CPT,Facility,Outpatient,,,,204,173.4,73.66,204,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,101.592,49.8,,percent of total billed charges,,
Ekg Tracing,,93005,CPT,Facility,Inpatient,,,,204,173.4,73.66,204,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Ekg Tracing,,93005,CPT,Facility,Both,,,,204,173.4,73.66,204,"Multiplan, Inc.","Multiplan, Inc.",191.76,94,,percent of total billed charges,,
Ekg Tracing,,93005,CPT,Facility,Outpatient,,,,204,173.4,73.66,204,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,183.804,90.1,,percent of total billed charges,,
Ekg Tracing,,93005,CPT,Facility,Inpatient,,,,204,173.4,73.66,204,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Ekg Tracing,,93005,CPT,Facility,Both,,,,204,173.4,73.66,204,"Preferred One Administrative Services, INC.",PPO,201.144,98.6,,percent of total billed charges,,
Ekg Tracing,,93005,CPT,Facility,Outpatient,,,,204,173.4,73.66,204,PrimeWest Health,Minnesota Senior Health Options (MSHO),104.958,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Ekg Tracing,,93005,CPT,Facility,Inpatient,,,,204,173.4,73.66,204,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ekg Tracing,,93005,CPT,Facility,Outpatient,,,,204,173.4,73.66,204,PrimeWest Health,MinnesotaCare,104.7744,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Ekg Tracing,,93005,CPT,Facility,Inpatient,,,,204,173.4,73.66,204,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Ekg Tracing,,93005,CPT,Facility,Both,,,,204,173.4,73.66,204,Sanford Health Plan,Sanford Health Plan,187.68,92,,percent of total billed charges,,
Ekg Tracing,,93005,CPT,Facility,Outpatient,,,,204,173.4,73.66,204,"UCare Health, Inc.",Individual & Family Plan,114.954,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Ekg Tracing,,93005,CPT,Facility,Inpatient,,,,204,173.4,73.66,204,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Ekg Tracing,,93005,CPT,Facility,Outpatient,,,,204,173.4,73.66,204,"UCare Health, Inc.",Medical Assistance,102.9588,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ekg Tracing,,93005,CPT,Facility,Inpatient,,,,204,173.4,73.66,204,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Ekg Tracing,,93005,CPT,Facility,Outpatient,,,,204,173.4,73.66,204,"UCare Health, Inc.",Medicare Advantage,102.9588,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ekg Tracing,,93005,CPT,Facility,Inpatient,,,,204,173.4,73.66,204,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ekg Tracing,,93005,CPT,Facility,Outpatient,,,,204,173.4,73.66,204,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),102.9588,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ekg Tracing,,93005,CPT,Facility,Inpatient,,,,204,173.4,73.66,204,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ekg Tracing,,93005,CPT,Facility,Both,,,,204,173.4,73.66,204,UnitedHealthcare,Individual & Family,191.76,94,,percent of total billed charges,,
Ekg Tracing,,93005,CPT,Facility,Outpatient,,,,204,173.4,73.66,204,UnitedHealthcare,Medicare Advantage,99.96,49,,percent of total billed charges,,
Ekg Tracing,,93005,CPT,Facility,Inpatient,,,,204,173.4,73.66,204,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Ekg Tracing,,93005,CPT,Facility,Outpatient,,,,204,173.4,73.66,204,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,97.92,48,,percent of total billed charges,,100% of DHS outpatient percentage
Ekg Tracing,,93005,CPT,Facility,Inpatient,,,,204,173.4,73.66,204,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Ecg-Interpretation Only (Pro Cah),,93010,CPT,Professional,Both,,,,51,43.35,5.02,51,Aetna,Commercial,43.35,85,,percent of total billed charges,,
Ecg-Interpretation Only (Pro Cah),,93010,CPT,Professional,Both,,,,51,43.35,5.02,51,Aetna,Medicare Advantage,8.18,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ecg-Interpretation Only (Pro Cah),,93010,CPT,Professional,Both,,,,51,43.35,5.02,51,Aetna,PPO,47.43,93,,percent of total billed charges,,
Ecg-Interpretation Only (Pro Cah),,93010,CPT,Professional,Both,,,,51,43.35,5.02,51,America's PPO,America's PPO,43.5744,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Ecg-Interpretation Only (Pro Cah),,93010,CPT,Professional,Both,,,,51,43.35,5.02,51,BlueCross BlueShield Minnesota, Federal Employee Program,14,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Ecg-Interpretation Only (Pro Cah),,93010,CPT,Professional,Both,,,,51,43.35,5.02,51,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,14.224,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Ecg-Interpretation Only (Pro Cah),,93010,CPT,Professional,Both,,,,51,43.35,5.02,51,BlueCross BlueShield Minnesota,High Value Network Plan,14.224,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Ecg-Interpretation Only (Pro Cah),,93010,CPT,Professional,Both,,,,51,43.35,5.02,51,BlueCross BlueShield Minnesota,Medicare Advantage,9.131,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ecg-Interpretation Only (Pro Cah),,93010,CPT,Professional,Both,,,,51,43.35,5.02,51,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,14.224,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Ecg-Interpretation Only (Pro Cah),,93010,CPT,Professional,Both,,,,51,43.35,5.02,51,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,5.7912,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Ecg-Interpretation Only (Pro Cah),,93010,CPT,Professional,Both,,,,51,43.35,5.02,51,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),9.131,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ecg-Interpretation Only (Pro Cah),,93010,CPT,Professional,Both,,,,51,43.35,5.02,51,CorVel,Worker's Compensation,15.7386027,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Ecg-Interpretation Only (Pro Cah),,93010,CPT,Professional,Both,,,,51,43.35,5.02,51,First Health Group Corporation,First Health Network,49.47,97,,percent of total billed charges,,
Ecg-Interpretation Only (Pro Cah),,93010,CPT,Professional,Both,,,,51,43.35,5.02,51,"Health Partners, Inc.",Commercial,16.68,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Ecg-Interpretation Only (Pro Cah),,93010,CPT,Professional,Both,,,,51,43.35,5.02,51,"Health Partners, Inc.",Medicare Advantage,9.131,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ecg-Interpretation Only (Pro Cah),,93010,CPT,Professional,Both,,,,51,43.35,5.02,51,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),7.79,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Ecg-Interpretation Only (Pro Cah),,93010,CPT,Professional,Both,,,,51,43.35,5.02,51,"Health Partners, Inc.",State of Minnesota Advantage Program,14.36982,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Ecg-Interpretation Only (Pro Cah),,93010,CPT,Professional,Both,,,,51,43.35,5.02,51,"Health Partners, Inc.",State Public Programs,5.02,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Ecg-Interpretation Only (Pro Cah),,93010,CPT,Professional,Both,,,,51,43.35,5.02,51,Humana Insurance Company,Commercial PPO,7.94,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Ecg-Interpretation Only (Pro Cah),,93010,CPT,Professional,Both,,,,51,43.35,5.02,51,Humana Insurance Company,Medicare PPO,51,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Ecg-Interpretation Only (Pro Cah),,93010,CPT,Professional,Both,,,,51,43.35,5.02,51,Medica,Individual & Family,43.248,84.8,,percent of total billed charges,,
Ecg-Interpretation Only (Pro Cah),,93010,CPT,Professional,Both,,,,51,43.35,5.02,51,Medica,Medica Advantage Solution,25.398,49.8,,percent of total billed charges,,
Ecg-Interpretation Only (Pro Cah),,93010,CPT,Professional,Both,,,,51,43.35,5.02,51,Medica,Medical Assistance,5.79,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Ecg-Interpretation Only (Pro Cah),,93010,CPT,Professional,Both,,,,51,43.35,5.02,51,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,7.94,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Ecg-Interpretation Only (Pro Cah),,93010,CPT,Professional,Both,,,,51,43.35,5.02,51,"Multiplan, Inc.","Multiplan, Inc.",47.94,94,,percent of total billed charges,,
Ecg-Interpretation Only (Pro Cah),,93010,CPT,Professional,Both,,,,51,43.35,5.02,51,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,45.951,90.1,,percent of total billed charges,,
Ecg-Interpretation Only (Pro Cah),,93010,CPT,Professional,Both,,,,51,43.35,5.02,51,"Preferred One Administrative Services, INC.",PPO,50.286,98.6,,percent of total billed charges,,
Ecg-Interpretation Only (Pro Cah),,93010,CPT,Professional,Both,,,,51,43.35,5.02,51,PrimeWest Health,Minnesota Senior Health Options (MSHO),9.131,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ecg-Interpretation Only (Pro Cah),,93010,CPT,Professional,Both,,,,51,43.35,5.02,51,PrimeWest Health,MinnesotaCare,6.196584,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Ecg-Interpretation Only (Pro Cah),,93010,CPT,Professional,Both,,,,51,43.35,5.02,51,Sanford Health Plan,Sanford Health Plan,44.88,88,,percent of total billed charges,,
Ecg-Interpretation Only (Pro Cah),,93010,CPT,Professional,Both,,,,51,43.35,5.02,51,"UCare Health, Inc.",Individual & Family Plan,12.907264,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Ecg-Interpretation Only (Pro Cah),,93010,CPT,Professional,Both,,,,51,43.35,5.02,51,"UCare Health, Inc.",Medical Assistance,6.37032,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Ecg-Interpretation Only (Pro Cah),,93010,CPT,Professional,Both,,,,51,43.35,5.02,51,"UCare Health, Inc.",Medicare Advantage,9.131,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Ecg-Interpretation Only (Pro Cah),,93010,CPT,Professional,Both,,,,51,43.35,5.02,51,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),7.3048,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Ecg-Interpretation Only (Pro Cah),,93010,CPT,Professional,Both,,,,51,43.35,5.02,51,UnitedHealthcare,Individual & Family,51,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Ecg-Interpretation Only (Pro Cah),,93010,CPT,Professional,Both,,,,51,43.35,5.02,51,UnitedHealthcare,Medicare Advantage,9.131,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Ecg-Interpretation Only (Pro Cah),,93010,CPT,Professional,Both,,,,51,43.35,5.02,51,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,5.7912,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Stress Test,,93017,CPT,Facility,Both,,,,816,693.6,233.8656,816,Aetna,Commercial,750.72,92,,percent of total billed charges,,
Stress Test,,93017,CPT,Facility,Outpatient,,,,816,693.6,233.8656,816,Aetna,Medicare Advantage,399.84,49,,percent of total billed charges,,
Stress Test,,93017,CPT,Facility,Inpatient,,,,816,693.6,233.8656,816,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Stress Test,,93017,CPT,Facility,Both,,,,816,693.6,233.8656,816,Aetna,PPO,758.88,93,,percent of total billed charges,,
Stress Test,,93017,CPT,Facility,Both,,,,816,693.6,233.8656,816,America's PPO,America's PPO,783.6048,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Stress Test,,93017,CPT,Facility,Both,,,,816,693.6,233.8656,816,BlueCross BlueShield Minnesota, Federal Employee Program,802.944,98.4,,percent of total billed charges,,
Stress Test,,93017,CPT,Facility,Both,,,,816,693.6,233.8656,816,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,816,100,,percent of total billed charges,,
Stress Test,,93017,CPT,Facility,Both,,,,816,693.6,233.8656,816,BlueCross BlueShield Minnesota,High Value Network Plan,734.4,90,,percent of total billed charges,,
Stress Test,,93017,CPT,Facility,Outpatient,,,,816,693.6,233.8656,816,BlueCross BlueShield Minnesota,Medicare Advantage,399.84,49,,percent of total billed charges,,
Stress Test,,93017,CPT,Facility,Inpatient,,,,816,693.6,233.8656,816,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Stress Test,,93017,CPT,Facility,Both,,,,816,693.6,233.8656,816,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,722.7312,88.57,,percent of total billed charges,,
Stress Test,,93017,CPT,Facility,Both,,,,816,693.6,233.8656,816,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,233.8656,28.66,,percent of total billed charges,,
Stress Test,,93017,CPT,Facility,Outpatient,,,,816,693.6,233.8656,816,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),399.84,49,,percent of total billed charges,,
Stress Test,,93017,CPT,Facility,Inpatient,,,,816,693.6,233.8656,816,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Stress Test,,93017,CPT,Facility,Both,,,,816,693.6,233.8656,816,CorVel,Worker's Compensation,816,100,,percent of total billed charges,,
Stress Test,,93017,CPT,Facility,Both,,,,816,693.6,233.8656,816,First Health Group Corporation,First Health Network,791.52,97,,percent of total billed charges,,
Stress Test,,93017,CPT,Facility,Both,,,,816,693.6,233.8656,816,"Health Partners, Inc.",Commercial,771.936,94.6,,percent of total billed charges,,
Stress Test,,93017,CPT,Facility,Outpatient,,,,816,693.6,233.8656,816,"Health Partners, Inc.",Medicare Advantage,399.84,49,,percent of total billed charges,,
Stress Test,,93017,CPT,Facility,Inpatient,,,,816,693.6,233.8656,816,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Stress Test,,93017,CPT,Facility,Both,,,,816,693.6,233.8656,816,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),489.6,60,,percent of total billed charges,,
Stress Test,,93017,CPT,Facility,Both,,,,816,693.6,233.8656,816,"Health Partners, Inc.",State of Minnesota Advantage Program,665.04,81.5,,percent of total billed charges,,
Stress Test,,93017,CPT,Facility,Both,,,,816,693.6,233.8656,816,"Health Partners, Inc.",State Public Programs,408,50,,percent of total billed charges,,
Stress Test,,93017,CPT,Facility,Both,,,,816,693.6,233.8656,816,Humana Insurance Company,Commercial PPO,775.2,95,,percent of total billed charges,,
Stress Test,,93017,CPT,Facility,Outpatient,,,,816,693.6,233.8656,816,Humana Insurance Company,Medicare PPO,399.84,49,,percent of total billed charges,,
Stress Test,,93017,CPT,Facility,Inpatient,,,,816,693.6,233.8656,816,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Stress Test,,93017,CPT,Facility,Both,,,,816,693.6,233.8656,816,Medica,Individual & Family,808.656,99.1,,percent of total billed charges,,
Stress Test,,93017,CPT,Facility,Outpatient,,,,816,693.6,233.8656,816,Medica,Medica Advantage Solution,406.368,49.8,,percent of total billed charges,,
Stress Test,,93017,CPT,Facility,Inpatient,,,,816,693.6,233.8656,816,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Stress Test,,93017,CPT,Facility,Outpatient,,,,816,693.6,233.8656,816,Medica,Medical Assistance,363.936,44.6,,percent of total billed charges,,
Stress Test,,93017,CPT,Facility,Inpatient,,,,816,693.6,233.8656,816,Medica,Medical Assistance,,,,,Included in per diem rate,
Stress Test,,93017,CPT,Facility,Outpatient,,,,816,693.6,233.8656,816,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,406.368,49.8,,percent of total billed charges,,
Stress Test,,93017,CPT,Facility,Inpatient,,,,816,693.6,233.8656,816,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Stress Test,,93017,CPT,Facility,Both,,,,816,693.6,233.8656,816,"Multiplan, Inc.","Multiplan, Inc.",767.04,94,,percent of total billed charges,,
Stress Test,,93017,CPT,Facility,Outpatient,,,,816,693.6,233.8656,816,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,735.216,90.1,,percent of total billed charges,,
Stress Test,,93017,CPT,Facility,Inpatient,,,,816,693.6,233.8656,816,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Stress Test,,93017,CPT,Facility,Both,,,,816,693.6,233.8656,816,"Preferred One Administrative Services, INC.",PPO,804.576,98.6,,percent of total billed charges,,
Stress Test,,93017,CPT,Facility,Outpatient,,,,816,693.6,233.8656,816,PrimeWest Health,Minnesota Senior Health Options (MSHO),419.832,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Stress Test,,93017,CPT,Facility,Inpatient,,,,816,693.6,233.8656,816,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Stress Test,,93017,CPT,Facility,Outpatient,,,,816,693.6,233.8656,816,PrimeWest Health,MinnesotaCare,419.0976,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Stress Test,,93017,CPT,Facility,Inpatient,,,,816,693.6,233.8656,816,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Stress Test,,93017,CPT,Facility,Both,,,,816,693.6,233.8656,816,Sanford Health Plan,Sanford Health Plan,750.72,92,,percent of total billed charges,,
Stress Test,,93017,CPT,Facility,Outpatient,,,,816,693.6,233.8656,816,"UCare Health, Inc.",Individual & Family Plan,459.816,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Stress Test,,93017,CPT,Facility,Inpatient,,,,816,693.6,233.8656,816,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Stress Test,,93017,CPT,Facility,Outpatient,,,,816,693.6,233.8656,816,"UCare Health, Inc.",Medical Assistance,411.8352,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Stress Test,,93017,CPT,Facility,Inpatient,,,,816,693.6,233.8656,816,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Stress Test,,93017,CPT,Facility,Outpatient,,,,816,693.6,233.8656,816,"UCare Health, Inc.",Medicare Advantage,411.8352,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Stress Test,,93017,CPT,Facility,Inpatient,,,,816,693.6,233.8656,816,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Stress Test,,93017,CPT,Facility,Outpatient,,,,816,693.6,233.8656,816,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),411.8352,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Stress Test,,93017,CPT,Facility,Inpatient,,,,816,693.6,233.8656,816,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Stress Test,,93017,CPT,Facility,Both,,,,816,693.6,233.8656,816,UnitedHealthcare,Individual & Family,767.04,94,,percent of total billed charges,,
Stress Test,,93017,CPT,Facility,Outpatient,,,,816,693.6,233.8656,816,UnitedHealthcare,Medicare Advantage,399.84,49,,percent of total billed charges,,
Stress Test,,93017,CPT,Facility,Inpatient,,,,816,693.6,233.8656,816,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Stress Test,,93017,CPT,Facility,Outpatient,,,,816,693.6,233.8656,816,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,391.68,48,,percent of total billed charges,,100% of DHS outpatient percentage
Stress Test,,93017,CPT,Facility,Inpatient,,,,816,693.6,233.8656,816,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Stress Test-Interp (Pro Cah),,93018,CPT,Professional,Both,,,,179,152.15,8.72,179,Aetna,Commercial,152.15,85,,percent of total billed charges,,
Stress Test-Interp (Pro Cah),,93018,CPT,Professional,Both,,,,179,152.15,8.72,179,Aetna,Medicare Advantage,14.48,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Stress Test-Interp (Pro Cah),,93018,CPT,Professional,Both,,,,179,152.15,8.72,179,Aetna,PPO,166.47,93,,percent of total billed charges,,
Stress Test-Interp (Pro Cah),,93018,CPT,Professional,Both,,,,179,152.15,8.72,179,America's PPO,America's PPO,152.9376,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Stress Test-Interp (Pro Cah),,93018,CPT,Professional,Both,,,,179,152.15,8.72,179,BlueCross BlueShield Minnesota, Federal Employee Program,23.92,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Stress Test-Interp (Pro Cah),,93018,CPT,Professional,Both,,,,179,152.15,8.72,179,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,24.30272,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Stress Test-Interp (Pro Cah),,93018,CPT,Professional,Both,,,,179,152.15,8.72,179,BlueCross BlueShield Minnesota,High Value Network Plan,24.30272,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Stress Test-Interp (Pro Cah),,93018,CPT,Professional,Both,,,,179,152.15,8.72,179,BlueCross BlueShield Minnesota,Medicare Advantage,15.7895,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Stress Test-Interp (Pro Cah),,93018,CPT,Professional,Both,,,,179,152.15,8.72,179,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,24.30272,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Stress Test-Interp (Pro Cah),,93018,CPT,Professional,Both,,,,179,152.15,8.72,179,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,10.06856,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Stress Test-Interp (Pro Cah),,93018,CPT,Professional,Both,,,,179,152.15,8.72,179,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),15.7895,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Stress Test-Interp (Pro Cah),,93018,CPT,Professional,Both,,,,179,152.15,8.72,179,CorVel,Worker's Compensation,27.8728632,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Stress Test-Interp (Pro Cah),,93018,CPT,Professional,Both,,,,179,152.15,8.72,179,First Health Group Corporation,First Health Network,173.63,97,,percent of total billed charges,,
Stress Test-Interp (Pro Cah),,93018,CPT,Professional,Both,,,,179,152.15,8.72,179,"Health Partners, Inc.",Commercial,29.75,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Stress Test-Interp (Pro Cah),,93018,CPT,Professional,Both,,,,179,152.15,8.72,179,"Health Partners, Inc.",Medicare Advantage,15.7895,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Stress Test-Interp (Pro Cah),,93018,CPT,Professional,Both,,,,179,152.15,8.72,179,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),13.55,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Stress Test-Interp (Pro Cah),,93018,CPT,Professional,Both,,,,179,152.15,8.72,179,"Health Partners, Inc.",State of Minnesota Advantage Program,25.629625,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Stress Test-Interp (Pro Cah),,93018,CPT,Professional,Both,,,,179,152.15,8.72,179,"Health Partners, Inc.",State Public Programs,8.72,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Stress Test-Interp (Pro Cah),,93018,CPT,Professional,Both,,,,179,152.15,8.72,179,Humana Insurance Company,Commercial PPO,13.73,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Stress Test-Interp (Pro Cah),,93018,CPT,Professional,Both,,,,179,152.15,8.72,179,Humana Insurance Company,Medicare PPO,179,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Stress Test-Interp (Pro Cah),,93018,CPT,Professional,Both,,,,179,152.15,8.72,179,Medica,Individual & Family,151.792,84.8,,percent of total billed charges,,
Stress Test-Interp (Pro Cah),,93018,CPT,Professional,Both,,,,179,152.15,8.72,179,Medica,Medica Advantage Solution,89.142,49.8,,percent of total billed charges,,
Stress Test-Interp (Pro Cah),,93018,CPT,Professional,Both,,,,179,152.15,8.72,179,Medica,Medical Assistance,10.07,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Stress Test-Interp (Pro Cah),,93018,CPT,Professional,Both,,,,179,152.15,8.72,179,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,13.73,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Stress Test-Interp (Pro Cah),,93018,CPT,Professional,Both,,,,179,152.15,8.72,179,"Multiplan, Inc.","Multiplan, Inc.",168.26,94,,percent of total billed charges,,
Stress Test-Interp (Pro Cah),,93018,CPT,Professional,Both,,,,179,152.15,8.72,179,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,161.279,90.1,,percent of total billed charges,,
Stress Test-Interp (Pro Cah),,93018,CPT,Professional,Both,,,,179,152.15,8.72,179,"Preferred One Administrative Services, INC.",PPO,176.494,98.6,,percent of total billed charges,,
Stress Test-Interp (Pro Cah),,93018,CPT,Professional,Both,,,,179,152.15,8.72,179,PrimeWest Health,Minnesota Senior Health Options (MSHO),15.7895,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Stress Test-Interp (Pro Cah),,93018,CPT,Professional,Both,,,,179,152.15,8.72,179,PrimeWest Health,MinnesotaCare,10.7733592,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Stress Test-Interp (Pro Cah),,93018,CPT,Professional,Both,,,,179,152.15,8.72,179,Sanford Health Plan,Sanford Health Plan,157.52,88,,percent of total billed charges,,
Stress Test-Interp (Pro Cah),,93018,CPT,Professional,Both,,,,179,152.15,8.72,179,"UCare Health, Inc.",Individual & Family Plan,22.319488,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Stress Test-Interp (Pro Cah),,93018,CPT,Professional,Both,,,,179,152.15,8.72,179,"UCare Health, Inc.",Medical Assistance,11.075416,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Stress Test-Interp (Pro Cah),,93018,CPT,Professional,Both,,,,179,152.15,8.72,179,"UCare Health, Inc.",Medicare Advantage,15.7895,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Stress Test-Interp (Pro Cah),,93018,CPT,Professional,Both,,,,179,152.15,8.72,179,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),12.6316,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Stress Test-Interp (Pro Cah),,93018,CPT,Professional,Both,,,,179,152.15,8.72,179,UnitedHealthcare,Individual & Family,179,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Stress Test-Interp (Pro Cah),,93018,CPT,Professional,Both,,,,179,152.15,8.72,179,UnitedHealthcare,Medicare Advantage,15.7895,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Stress Test-Interp (Pro Cah),,93018,CPT,Professional,Both,,,,179,152.15,8.72,179,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,10.06856,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
METHYLENE BLUE (ANTIDOTE) 5 MG/ML IV SOLN,,Q9968,HCPCS,Facility,Both,10,mL,,1126,957.1,322.7116,1126,Aetna,Commercial,1035.92,92,,percent of total billed charges,,
METHYLENE BLUE (ANTIDOTE) 5 MG/ML IV SOLN,,Q9968,HCPCS,Facility,Outpatient,10,mL,,1126,957.1,322.7116,1126,Aetna,Medicare Advantage,551.74,49,,percent of total billed charges,,
METHYLENE BLUE (ANTIDOTE) 5 MG/ML IV SOLN,,Q9968,HCPCS,Facility,Inpatient,10,mL,,1126,957.1,322.7116,1126,Aetna,Medicare Advantage,,,,,Included in per diem rate,
METHYLENE BLUE (ANTIDOTE) 5 MG/ML IV SOLN,,Q9968,HCPCS,Facility,Both,10,mL,,1126,957.1,322.7116,1126,Aetna,PPO,1047.18,93,,percent of total billed charges,,
METHYLENE BLUE (ANTIDOTE) 5 MG/ML IV SOLN,,Q9968,HCPCS,Facility,Both,10,mL,,1126,957.1,322.7116,1126,America's PPO,America's PPO,1081.2978,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
METHYLENE BLUE (ANTIDOTE) 5 MG/ML IV SOLN,,Q9968,HCPCS,Facility,Both,10,mL,,1126,957.1,322.7116,1126,BlueCross BlueShield Minnesota, Federal Employee Program,1107.984,98.4,,percent of total billed charges,,
METHYLENE BLUE (ANTIDOTE) 5 MG/ML IV SOLN,,Q9968,HCPCS,Facility,Both,10,mL,,1126,957.1,322.7116,1126,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1126,100,,percent of total billed charges,,
METHYLENE BLUE (ANTIDOTE) 5 MG/ML IV SOLN,,Q9968,HCPCS,Facility,Both,10,mL,,1126,957.1,322.7116,1126,BlueCross BlueShield Minnesota,High Value Network Plan,1013.4,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
METHYLENE BLUE (ANTIDOTE) 5 MG/ML IV SOLN,,Q9968,HCPCS,Facility,Outpatient,10,mL,,1126,957.1,322.7116,1126,BlueCross BlueShield Minnesota,Medicare Advantage,551.74,49,,percent of total billed charges,,
METHYLENE BLUE (ANTIDOTE) 5 MG/ML IV SOLN,,Q9968,HCPCS,Facility,Inpatient,10,mL,,1126,957.1,322.7116,1126,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
METHYLENE BLUE (ANTIDOTE) 5 MG/ML IV SOLN,,Q9968,HCPCS,Facility,Both,10,mL,,1126,957.1,322.7116,1126,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,997.2982,88.57,,percent of total billed charges,,
METHYLENE BLUE (ANTIDOTE) 5 MG/ML IV SOLN,,Q9968,HCPCS,Facility,Both,10,mL,,1126,957.1,322.7116,1126,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,322.7116,28.66,,percent of total billed charges,,
METHYLENE BLUE (ANTIDOTE) 5 MG/ML IV SOLN,,Q9968,HCPCS,Facility,Outpatient,10,mL,,1126,957.1,322.7116,1126,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),551.74,49,,percent of total billed charges,,
METHYLENE BLUE (ANTIDOTE) 5 MG/ML IV SOLN,,Q9968,HCPCS,Facility,Inpatient,10,mL,,1126,957.1,322.7116,1126,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
METHYLENE BLUE (ANTIDOTE) 5 MG/ML IV SOLN,,Q9968,HCPCS,Facility,Both,10,mL,,1126,957.1,322.7116,1126,CorVel,Worker's Compensation,1126,100,,percent of total billed charges,,
METHYLENE BLUE (ANTIDOTE) 5 MG/ML IV SOLN,,Q9968,HCPCS,Facility,Both,10,mL,,1126,957.1,322.7116,1126,First Health Group Corporation,First Health Network,1092.22,97,,percent of total billed charges,,
METHYLENE BLUE (ANTIDOTE) 5 MG/ML IV SOLN,,Q9968,HCPCS,Facility,Both,10,mL,,1126,957.1,322.7116,1126,"Health Partners, Inc.",Commercial,1065.196,94.6,,percent of total billed charges,,
METHYLENE BLUE (ANTIDOTE) 5 MG/ML IV SOLN,,Q9968,HCPCS,Facility,Outpatient,10,mL,,1126,957.1,322.7116,1126,"Health Partners, Inc.",Medicare Advantage,551.74,49,,percent of total billed charges,,
METHYLENE BLUE (ANTIDOTE) 5 MG/ML IV SOLN,,Q9968,HCPCS,Facility,Inpatient,10,mL,,1126,957.1,322.7116,1126,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
METHYLENE BLUE (ANTIDOTE) 5 MG/ML IV SOLN,,Q9968,HCPCS,Facility,Both,10,mL,,1126,957.1,322.7116,1126,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),675.6,60,,percent of total billed charges,,
METHYLENE BLUE (ANTIDOTE) 5 MG/ML IV SOLN,,Q9968,HCPCS,Facility,Both,10,mL,,1126,957.1,322.7116,1126,"Health Partners, Inc.",State of Minnesota Advantage Program,917.69,81.5,,percent of total billed charges,,
METHYLENE BLUE (ANTIDOTE) 5 MG/ML IV SOLN,,Q9968,HCPCS,Facility,Both,10,mL,,1126,957.1,322.7116,1126,"Health Partners, Inc.",State Public Programs,563,50,,percent of total billed charges,,
METHYLENE BLUE (ANTIDOTE) 5 MG/ML IV SOLN,,Q9968,HCPCS,Facility,Both,10,mL,,1126,957.1,322.7116,1126,Humana Insurance Company,Commercial PPO,1069.7,95,,percent of total billed charges,,
METHYLENE BLUE (ANTIDOTE) 5 MG/ML IV SOLN,,Q9968,HCPCS,Facility,Outpatient,10,mL,,1126,957.1,322.7116,1126,Humana Insurance Company,Medicare PPO,551.74,49,,percent of total billed charges,,
METHYLENE BLUE (ANTIDOTE) 5 MG/ML IV SOLN,,Q9968,HCPCS,Facility,Inpatient,10,mL,,1126,957.1,322.7116,1126,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
METHYLENE BLUE (ANTIDOTE) 5 MG/ML IV SOLN,,Q9968,HCPCS,Facility,Both,10,mL,,1126,957.1,322.7116,1126,Medica,Individual & Family,1115.866,99.1,,percent of total billed charges,,
METHYLENE BLUE (ANTIDOTE) 5 MG/ML IV SOLN,,Q9968,HCPCS,Facility,Outpatient,10,mL,,1126,957.1,322.7116,1126,Medica,Medica Advantage Solution,560.748,49.8,,percent of total billed charges,,
METHYLENE BLUE (ANTIDOTE) 5 MG/ML IV SOLN,,Q9968,HCPCS,Facility,Inpatient,10,mL,,1126,957.1,322.7116,1126,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
METHYLENE BLUE (ANTIDOTE) 5 MG/ML IV SOLN,,Q9968,HCPCS,Facility,Outpatient,10,mL,,1126,957.1,322.7116,1126,Medica,Medical Assistance,502.196,44.6,,percent of total billed charges,,
METHYLENE BLUE (ANTIDOTE) 5 MG/ML IV SOLN,,Q9968,HCPCS,Facility,Inpatient,10,mL,,1126,957.1,322.7116,1126,Medica,Medical Assistance,,,,,Included in per diem rate,
METHYLENE BLUE (ANTIDOTE) 5 MG/ML IV SOLN,,Q9968,HCPCS,Facility,Outpatient,10,mL,,1126,957.1,322.7116,1126,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,560.748,49.8,,percent of total billed charges,,
METHYLENE BLUE (ANTIDOTE) 5 MG/ML IV SOLN,,Q9968,HCPCS,Facility,Inpatient,10,mL,,1126,957.1,322.7116,1126,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
METHYLENE BLUE (ANTIDOTE) 5 MG/ML IV SOLN,,Q9968,HCPCS,Facility,Both,10,mL,,1126,957.1,322.7116,1126,"Multiplan, Inc.","Multiplan, Inc.",1058.44,94,,percent of total billed charges,,
METHYLENE BLUE (ANTIDOTE) 5 MG/ML IV SOLN,,Q9968,HCPCS,Facility,Outpatient,10,mL,,1126,957.1,322.7116,1126,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1014.526,90.1,,percent of total billed charges,,
METHYLENE BLUE (ANTIDOTE) 5 MG/ML IV SOLN,,Q9968,HCPCS,Facility,Inpatient,10,mL,,1126,957.1,322.7116,1126,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
METHYLENE BLUE (ANTIDOTE) 5 MG/ML IV SOLN,,Q9968,HCPCS,Facility,Both,10,mL,,1126,957.1,322.7116,1126,"Preferred One Administrative Services, INC.",PPO,1110.236,98.6,,percent of total billed charges,,
METHYLENE BLUE (ANTIDOTE) 5 MG/ML IV SOLN,,Q9968,HCPCS,Facility,Outpatient,10,mL,,1126,957.1,322.7116,1126,PrimeWest Health,Minnesota Senior Health Options (MSHO),579.327,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
METHYLENE BLUE (ANTIDOTE) 5 MG/ML IV SOLN,,Q9968,HCPCS,Facility,Inpatient,10,mL,,1126,957.1,322.7116,1126,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
METHYLENE BLUE (ANTIDOTE) 5 MG/ML IV SOLN,,Q9968,HCPCS,Facility,Outpatient,10,mL,,1126,957.1,322.7116,1126,PrimeWest Health,MinnesotaCare,578.3136,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
METHYLENE BLUE (ANTIDOTE) 5 MG/ML IV SOLN,,Q9968,HCPCS,Facility,Inpatient,10,mL,,1126,957.1,322.7116,1126,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
METHYLENE BLUE (ANTIDOTE) 5 MG/ML IV SOLN,,Q9968,HCPCS,Facility,Both,10,mL,,1126,957.1,322.7116,1126,Sanford Health Plan,Sanford Health Plan,1035.92,92,,percent of total billed charges,,
METHYLENE BLUE (ANTIDOTE) 5 MG/ML IV SOLN,,Q9968,HCPCS,Facility,Outpatient,10,mL,,1126,957.1,322.7116,1126,"UCare Health, Inc.",Individual & Family Plan,634.501,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
METHYLENE BLUE (ANTIDOTE) 5 MG/ML IV SOLN,,Q9968,HCPCS,Facility,Inpatient,10,mL,,1126,957.1,322.7116,1126,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
METHYLENE BLUE (ANTIDOTE) 5 MG/ML IV SOLN,,Q9968,HCPCS,Facility,Outpatient,10,mL,,1126,957.1,322.7116,1126,"UCare Health, Inc.",Medical Assistance,568.2922,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
METHYLENE BLUE (ANTIDOTE) 5 MG/ML IV SOLN,,Q9968,HCPCS,Facility,Inpatient,10,mL,,1126,957.1,322.7116,1126,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
METHYLENE BLUE (ANTIDOTE) 5 MG/ML IV SOLN,,Q9968,HCPCS,Facility,Outpatient,10,mL,,1126,957.1,322.7116,1126,"UCare Health, Inc.",Medicare Advantage,568.2922,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
METHYLENE BLUE (ANTIDOTE) 5 MG/ML IV SOLN,,Q9968,HCPCS,Facility,Inpatient,10,mL,,1126,957.1,322.7116,1126,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
METHYLENE BLUE (ANTIDOTE) 5 MG/ML IV SOLN,,Q9968,HCPCS,Facility,Outpatient,10,mL,,1126,957.1,322.7116,1126,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),568.2922,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
METHYLENE BLUE (ANTIDOTE) 5 MG/ML IV SOLN,,Q9968,HCPCS,Facility,Inpatient,10,mL,,1126,957.1,322.7116,1126,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
METHYLENE BLUE (ANTIDOTE) 5 MG/ML IV SOLN,,Q9968,HCPCS,Facility,Both,10,mL,,1126,957.1,322.7116,1126,UnitedHealthcare,Individual & Family,1058.44,94,,percent of total billed charges,,
METHYLENE BLUE (ANTIDOTE) 5 MG/ML IV SOLN,,Q9968,HCPCS,Facility,Outpatient,10,mL,,1126,957.1,322.7116,1126,UnitedHealthcare,Medicare Advantage,551.74,49,,percent of total billed charges,,
METHYLENE BLUE (ANTIDOTE) 5 MG/ML IV SOLN,,Q9968,HCPCS,Facility,Inpatient,10,mL,,1126,957.1,322.7116,1126,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
METHYLENE BLUE (ANTIDOTE) 5 MG/ML IV SOLN,,Q9968,HCPCS,Facility,Outpatient,10,mL,,1126,957.1,322.7116,1126,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,540.48,48,,percent of total billed charges,,100% of DHS outpatient percentage
METHYLENE BLUE (ANTIDOTE) 5 MG/ML IV SOLN,,Q9968,HCPCS,Facility,Inpatient,10,mL,,1126,957.1,322.7116,1126,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Holter Monitor/Connect/Instruct,,93225,CPT,Facility,Both,,,,380,323,108.908,380,Aetna,Commercial,349.6,92,,percent of total billed charges,,
Holter Monitor/Connect/Instruct,,93225,CPT,Facility,Outpatient,,,,380,323,108.908,380,Aetna,Medicare Advantage,186.2,49,,percent of total billed charges,,
Holter Monitor/Connect/Instruct,,93225,CPT,Facility,Inpatient,,,,380,323,108.908,380,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Holter Monitor/Connect/Instruct,,93225,CPT,Facility,Both,,,,380,323,108.908,380,Aetna,PPO,353.4,93,,percent of total billed charges,,
Holter Monitor/Connect/Instruct,,93225,CPT,Facility,Both,,,,380,323,108.908,380,America's PPO,America's PPO,364.914,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Holter Monitor/Connect/Instruct,,93225,CPT,Facility,Both,,,,380,323,108.908,380,BlueCross BlueShield Minnesota, Federal Employee Program,373.92,98.4,,percent of total billed charges,,
Holter Monitor/Connect/Instruct,,93225,CPT,Facility,Both,,,,380,323,108.908,380,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,380,100,,percent of total billed charges,,
Holter Monitor/Connect/Instruct,,93225,CPT,Facility,Both,,,,380,323,108.908,380,BlueCross BlueShield Minnesota,High Value Network Plan,342,90,,percent of total billed charges,,
Holter Monitor/Connect/Instruct,,93225,CPT,Facility,Outpatient,,,,380,323,108.908,380,BlueCross BlueShield Minnesota,Medicare Advantage,186.2,49,,percent of total billed charges,,
Holter Monitor/Connect/Instruct,,93225,CPT,Facility,Inpatient,,,,380,323,108.908,380,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Holter Monitor/Connect/Instruct,,93225,CPT,Facility,Both,,,,380,323,108.908,380,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,336.566,88.57,,percent of total billed charges,,
Holter Monitor/Connect/Instruct,,93225,CPT,Facility,Both,,,,380,323,108.908,380,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,108.908,28.66,,percent of total billed charges,,
Holter Monitor/Connect/Instruct,,93225,CPT,Facility,Outpatient,,,,380,323,108.908,380,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),186.2,49,,percent of total billed charges,,
Holter Monitor/Connect/Instruct,,93225,CPT,Facility,Inpatient,,,,380,323,108.908,380,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Holter Monitor/Connect/Instruct,,93225,CPT,Facility,Both,,,,380,323,108.908,380,CorVel,Worker's Compensation,380,100,,percent of total billed charges,,
Holter Monitor/Connect/Instruct,,93225,CPT,Facility,Both,,,,380,323,108.908,380,First Health Group Corporation,First Health Network,368.6,97,,percent of total billed charges,,
Holter Monitor/Connect/Instruct,,93225,CPT,Facility,Both,,,,380,323,108.908,380,"Health Partners, Inc.",Commercial,359.48,94.6,,percent of total billed charges,,
Holter Monitor/Connect/Instruct,,93225,CPT,Facility,Outpatient,,,,380,323,108.908,380,"Health Partners, Inc.",Medicare Advantage,186.2,49,,percent of total billed charges,,
Holter Monitor/Connect/Instruct,,93225,CPT,Facility,Inpatient,,,,380,323,108.908,380,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Holter Monitor/Connect/Instruct,,93225,CPT,Facility,Both,,,,380,323,108.908,380,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),228,60,,percent of total billed charges,,
Holter Monitor/Connect/Instruct,,93225,CPT,Facility,Both,,,,380,323,108.908,380,"Health Partners, Inc.",State of Minnesota Advantage Program,309.7,81.5,,percent of total billed charges,,
Holter Monitor/Connect/Instruct,,93225,CPT,Facility,Both,,,,380,323,108.908,380,"Health Partners, Inc.",State Public Programs,190,50,,percent of total billed charges,,
Holter Monitor/Connect/Instruct,,93225,CPT,Facility,Both,,,,380,323,108.908,380,Humana Insurance Company,Commercial PPO,361,95,,percent of total billed charges,,
Holter Monitor/Connect/Instruct,,93225,CPT,Facility,Outpatient,,,,380,323,108.908,380,Humana Insurance Company,Medicare PPO,186.2,49,,percent of total billed charges,,
Holter Monitor/Connect/Instruct,,93225,CPT,Facility,Inpatient,,,,380,323,108.908,380,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Holter Monitor/Connect/Instruct,,93225,CPT,Facility,Both,,,,380,323,108.908,380,Medica,Individual & Family,376.58,99.1,,percent of total billed charges,,
Holter Monitor/Connect/Instruct,,93225,CPT,Facility,Outpatient,,,,380,323,108.908,380,Medica,Medica Advantage Solution,189.24,49.8,,percent of total billed charges,,
Holter Monitor/Connect/Instruct,,93225,CPT,Facility,Inpatient,,,,380,323,108.908,380,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Holter Monitor/Connect/Instruct,,93225,CPT,Facility,Outpatient,,,,380,323,108.908,380,Medica,Medical Assistance,169.48,44.6,,percent of total billed charges,,
Holter Monitor/Connect/Instruct,,93225,CPT,Facility,Inpatient,,,,380,323,108.908,380,Medica,Medical Assistance,,,,,Included in per diem rate,
Holter Monitor/Connect/Instruct,,93225,CPT,Facility,Outpatient,,,,380,323,108.908,380,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,189.24,49.8,,percent of total billed charges,,
Holter Monitor/Connect/Instruct,,93225,CPT,Facility,Inpatient,,,,380,323,108.908,380,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Holter Monitor/Connect/Instruct,,93225,CPT,Facility,Both,,,,380,323,108.908,380,"Multiplan, Inc.","Multiplan, Inc.",357.2,94,,percent of total billed charges,,
Holter Monitor/Connect/Instruct,,93225,CPT,Facility,Outpatient,,,,380,323,108.908,380,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,342.38,90.1,,percent of total billed charges,,
Holter Monitor/Connect/Instruct,,93225,CPT,Facility,Inpatient,,,,380,323,108.908,380,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Holter Monitor/Connect/Instruct,,93225,CPT,Facility,Both,,,,380,323,108.908,380,"Preferred One Administrative Services, INC.",PPO,374.68,98.6,,percent of total billed charges,,
Holter Monitor/Connect/Instruct,,93225,CPT,Facility,Outpatient,,,,380,323,108.908,380,PrimeWest Health,Minnesota Senior Health Options (MSHO),195.51,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Holter Monitor/Connect/Instruct,,93225,CPT,Facility,Inpatient,,,,380,323,108.908,380,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Holter Monitor/Connect/Instruct,,93225,CPT,Facility,Outpatient,,,,380,323,108.908,380,PrimeWest Health,MinnesotaCare,195.168,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Holter Monitor/Connect/Instruct,,93225,CPT,Facility,Inpatient,,,,380,323,108.908,380,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Holter Monitor/Connect/Instruct,,93225,CPT,Facility,Both,,,,380,323,108.908,380,Sanford Health Plan,Sanford Health Plan,349.6,92,,percent of total billed charges,,
Holter Monitor/Connect/Instruct,,93225,CPT,Facility,Outpatient,,,,380,323,108.908,380,"UCare Health, Inc.",Individual & Family Plan,214.13,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Holter Monitor/Connect/Instruct,,93225,CPT,Facility,Inpatient,,,,380,323,108.908,380,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Holter Monitor/Connect/Instruct,,93225,CPT,Facility,Outpatient,,,,380,323,108.908,380,"UCare Health, Inc.",Medical Assistance,191.786,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Holter Monitor/Connect/Instruct,,93225,CPT,Facility,Inpatient,,,,380,323,108.908,380,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Holter Monitor/Connect/Instruct,,93225,CPT,Facility,Outpatient,,,,380,323,108.908,380,"UCare Health, Inc.",Medicare Advantage,191.786,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Holter Monitor/Connect/Instruct,,93225,CPT,Facility,Inpatient,,,,380,323,108.908,380,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Holter Monitor/Connect/Instruct,,93225,CPT,Facility,Outpatient,,,,380,323,108.908,380,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),191.786,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Holter Monitor/Connect/Instruct,,93225,CPT,Facility,Inpatient,,,,380,323,108.908,380,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Holter Monitor/Connect/Instruct,,93225,CPT,Facility,Both,,,,380,323,108.908,380,UnitedHealthcare,Individual & Family,357.2,94,,percent of total billed charges,,
Holter Monitor/Connect/Instruct,,93225,CPT,Facility,Outpatient,,,,380,323,108.908,380,UnitedHealthcare,Medicare Advantage,186.2,49,,percent of total billed charges,,
Holter Monitor/Connect/Instruct,,93225,CPT,Facility,Inpatient,,,,380,323,108.908,380,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Holter Monitor/Connect/Instruct,,93225,CPT,Facility,Outpatient,,,,380,323,108.908,380,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,182.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
Holter Monitor/Connect/Instruct,,93225,CPT,Facility,Inpatient,,,,380,323,108.908,380,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Arrhythmia Monitor/Instruct,,93270,CPT,Facility,Both,,,,393,334.05,112.6338,393,Aetna,Commercial,361.56,92,,percent of total billed charges,,
Arrhythmia Monitor/Instruct,,93270,CPT,Facility,Outpatient,,,,393,334.05,112.6338,393,Aetna,Medicare Advantage,192.57,49,,percent of total billed charges,,
Arrhythmia Monitor/Instruct,,93270,CPT,Facility,Inpatient,,,,393,334.05,112.6338,393,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Arrhythmia Monitor/Instruct,,93270,CPT,Facility,Both,,,,393,334.05,112.6338,393,Aetna,PPO,365.49,93,,percent of total billed charges,,
Arrhythmia Monitor/Instruct,,93270,CPT,Facility,Both,,,,393,334.05,112.6338,393,America's PPO,America's PPO,377.3979,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Arrhythmia Monitor/Instruct,,93270,CPT,Facility,Both,,,,393,334.05,112.6338,393,BlueCross BlueShield Minnesota, Federal Employee Program,386.712,98.4,,percent of total billed charges,,
Arrhythmia Monitor/Instruct,,93270,CPT,Facility,Both,,,,393,334.05,112.6338,393,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,393,100,,percent of total billed charges,,
Arrhythmia Monitor/Instruct,,93270,CPT,Facility,Both,,,,393,334.05,112.6338,393,BlueCross BlueShield Minnesota,High Value Network Plan,353.7,90,,percent of total billed charges,,
Arrhythmia Monitor/Instruct,,93270,CPT,Facility,Outpatient,,,,393,334.05,112.6338,393,BlueCross BlueShield Minnesota,Medicare Advantage,192.57,49,,percent of total billed charges,,
Arrhythmia Monitor/Instruct,,93270,CPT,Facility,Inpatient,,,,393,334.05,112.6338,393,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Arrhythmia Monitor/Instruct,,93270,CPT,Facility,Both,,,,393,334.05,112.6338,393,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,348.0801,88.57,,percent of total billed charges,,
Arrhythmia Monitor/Instruct,,93270,CPT,Facility,Both,,,,393,334.05,112.6338,393,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,112.6338,28.66,,percent of total billed charges,,
Arrhythmia Monitor/Instruct,,93270,CPT,Facility,Outpatient,,,,393,334.05,112.6338,393,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),192.57,49,,percent of total billed charges,,
Arrhythmia Monitor/Instruct,,93270,CPT,Facility,Inpatient,,,,393,334.05,112.6338,393,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Arrhythmia Monitor/Instruct,,93270,CPT,Facility,Both,,,,393,334.05,112.6338,393,CorVel,Worker's Compensation,393,100,,percent of total billed charges,,
Arrhythmia Monitor/Instruct,,93270,CPT,Facility,Both,,,,393,334.05,112.6338,393,First Health Group Corporation,First Health Network,381.21,97,,percent of total billed charges,,
Arrhythmia Monitor/Instruct,,93270,CPT,Facility,Both,,,,393,334.05,112.6338,393,"Health Partners, Inc.",Commercial,371.778,94.6,,percent of total billed charges,,
Arrhythmia Monitor/Instruct,,93270,CPT,Facility,Outpatient,,,,393,334.05,112.6338,393,"Health Partners, Inc.",Medicare Advantage,192.57,49,,percent of total billed charges,,
Arrhythmia Monitor/Instruct,,93270,CPT,Facility,Inpatient,,,,393,334.05,112.6338,393,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Arrhythmia Monitor/Instruct,,93270,CPT,Facility,Both,,,,393,334.05,112.6338,393,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),235.8,60,,percent of total billed charges,,
Arrhythmia Monitor/Instruct,,93270,CPT,Facility,Both,,,,393,334.05,112.6338,393,"Health Partners, Inc.",State of Minnesota Advantage Program,320.295,81.5,,percent of total billed charges,,
Arrhythmia Monitor/Instruct,,93270,CPT,Facility,Both,,,,393,334.05,112.6338,393,"Health Partners, Inc.",State Public Programs,196.5,50,,percent of total billed charges,,
Arrhythmia Monitor/Instruct,,93270,CPT,Facility,Both,,,,393,334.05,112.6338,393,Humana Insurance Company,Commercial PPO,373.35,95,,percent of total billed charges,,
Arrhythmia Monitor/Instruct,,93270,CPT,Facility,Outpatient,,,,393,334.05,112.6338,393,Humana Insurance Company,Medicare PPO,192.57,49,,percent of total billed charges,,
Arrhythmia Monitor/Instruct,,93270,CPT,Facility,Inpatient,,,,393,334.05,112.6338,393,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Arrhythmia Monitor/Instruct,,93270,CPT,Facility,Both,,,,393,334.05,112.6338,393,Medica,Individual & Family,389.463,99.1,,percent of total billed charges,,
Arrhythmia Monitor/Instruct,,93270,CPT,Facility,Outpatient,,,,393,334.05,112.6338,393,Medica,Medica Advantage Solution,195.714,49.8,,percent of total billed charges,,
Arrhythmia Monitor/Instruct,,93270,CPT,Facility,Inpatient,,,,393,334.05,112.6338,393,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Arrhythmia Monitor/Instruct,,93270,CPT,Facility,Outpatient,,,,393,334.05,112.6338,393,Medica,Medical Assistance,175.278,44.6,,percent of total billed charges,,
Arrhythmia Monitor/Instruct,,93270,CPT,Facility,Inpatient,,,,393,334.05,112.6338,393,Medica,Medical Assistance,,,,,Included in per diem rate,
Arrhythmia Monitor/Instruct,,93270,CPT,Facility,Outpatient,,,,393,334.05,112.6338,393,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,195.714,49.8,,percent of total billed charges,,
Arrhythmia Monitor/Instruct,,93270,CPT,Facility,Inpatient,,,,393,334.05,112.6338,393,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Arrhythmia Monitor/Instruct,,93270,CPT,Facility,Both,,,,393,334.05,112.6338,393,"Multiplan, Inc.","Multiplan, Inc.",369.42,94,,percent of total billed charges,,
Arrhythmia Monitor/Instruct,,93270,CPT,Facility,Outpatient,,,,393,334.05,112.6338,393,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,354.093,90.1,,percent of total billed charges,,
Arrhythmia Monitor/Instruct,,93270,CPT,Facility,Inpatient,,,,393,334.05,112.6338,393,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Arrhythmia Monitor/Instruct,,93270,CPT,Facility,Both,,,,393,334.05,112.6338,393,"Preferred One Administrative Services, INC.",PPO,387.498,98.6,,percent of total billed charges,,
Arrhythmia Monitor/Instruct,,93270,CPT,Facility,Outpatient,,,,393,334.05,112.6338,393,PrimeWest Health,Minnesota Senior Health Options (MSHO),202.1985,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Arrhythmia Monitor/Instruct,,93270,CPT,Facility,Inpatient,,,,393,334.05,112.6338,393,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Arrhythmia Monitor/Instruct,,93270,CPT,Facility,Outpatient,,,,393,334.05,112.6338,393,PrimeWest Health,MinnesotaCare,201.8448,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Arrhythmia Monitor/Instruct,,93270,CPT,Facility,Inpatient,,,,393,334.05,112.6338,393,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Arrhythmia Monitor/Instruct,,93270,CPT,Facility,Both,,,,393,334.05,112.6338,393,Sanford Health Plan,Sanford Health Plan,361.56,92,,percent of total billed charges,,
Arrhythmia Monitor/Instruct,,93270,CPT,Facility,Outpatient,,,,393,334.05,112.6338,393,"UCare Health, Inc.",Individual & Family Plan,221.4555,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Arrhythmia Monitor/Instruct,,93270,CPT,Facility,Inpatient,,,,393,334.05,112.6338,393,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Arrhythmia Monitor/Instruct,,93270,CPT,Facility,Outpatient,,,,393,334.05,112.6338,393,"UCare Health, Inc.",Medical Assistance,198.3471,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Arrhythmia Monitor/Instruct,,93270,CPT,Facility,Inpatient,,,,393,334.05,112.6338,393,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Arrhythmia Monitor/Instruct,,93270,CPT,Facility,Outpatient,,,,393,334.05,112.6338,393,"UCare Health, Inc.",Medicare Advantage,198.3471,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Arrhythmia Monitor/Instruct,,93270,CPT,Facility,Inpatient,,,,393,334.05,112.6338,393,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Arrhythmia Monitor/Instruct,,93270,CPT,Facility,Outpatient,,,,393,334.05,112.6338,393,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),198.3471,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Arrhythmia Monitor/Instruct,,93270,CPT,Facility,Inpatient,,,,393,334.05,112.6338,393,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Arrhythmia Monitor/Instruct,,93270,CPT,Facility,Both,,,,393,334.05,112.6338,393,UnitedHealthcare,Individual & Family,369.42,94,,percent of total billed charges,,
Arrhythmia Monitor/Instruct,,93270,CPT,Facility,Outpatient,,,,393,334.05,112.6338,393,UnitedHealthcare,Medicare Advantage,192.57,49,,percent of total billed charges,,
Arrhythmia Monitor/Instruct,,93270,CPT,Facility,Inpatient,,,,393,334.05,112.6338,393,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Arrhythmia Monitor/Instruct,,93270,CPT,Facility,Outpatient,,,,393,334.05,112.6338,393,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,188.64,48,,percent of total billed charges,,100% of DHS outpatient percentage
Arrhythmia Monitor/Instruct,,93270,CPT,Facility,Inpatient,,,,393,334.05,112.6338,393,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Complete Echo (2D/C/D),,93306,CPT,Facility,Both,,,,1697,1442.45,756.862,1697,Aetna,Commercial,1561.24,92,,percent of total billed charges,,
Complete Echo (2D/C/D),,93306,CPT,Facility,Outpatient,,,,1697,1442.45,756.862,1697,Aetna,Medicare Advantage,831.53,49,,percent of total billed charges,,
Complete Echo (2D/C/D),,93306,CPT,Facility,Inpatient,,,,1697,1442.45,756.862,1697,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Complete Echo (2D/C/D),,93306,CPT,Facility,Both,,,,1697,1442.45,756.862,1697,Aetna,PPO,1578.21,93,,percent of total billed charges,,
Complete Echo (2D/C/D),,93306,CPT,Facility,Both,,,,1697,1442.45,756.862,1697,America's PPO,America's PPO,1629.6291,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Complete Echo (2D/C/D),,93306,CPT,Facility,Both,,,,1697,1442.45,756.862,1697,BlueCross BlueShield Minnesota, Federal Employee Program,1545,,,Fee schedule,,100% of BCBS commercial commodity fee schedule
Complete Echo (2D/C/D),,93306,CPT,Facility,Both,,,,1697,1442.45,756.862,1697,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1569.72,,,Fee schedule,,"100% of BCBS commercial commodity fee schedule, plus MN Care tax"
Complete Echo (2D/C/D),,93306,CPT,Facility,Both,,,,1697,1442.45,756.862,1697,BlueCross BlueShield Minnesota,High Value Network Plan,1412.748,,,Fee schedule,,"90% of BCBS commercial commodity fee schedule, plus MN Care tax; see disclaimer for more information"
Complete Echo (2D/C/D),,93306,CPT,Facility,Outpatient,,,,1697,1442.45,756.862,1697,BlueCross BlueShield Minnesota,Medicare Advantage,831.53,49,,percent of total billed charges,,
Complete Echo (2D/C/D),,93306,CPT,Facility,Inpatient,,,,1697,1442.45,756.862,1697,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Complete Echo (2D/C/D),,93306,CPT,Facility,Both,,,,1697,1442.45,756.862,1697,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1390.301004,,,Fee schedule,,"88.57% of BCBS commercial commodity fee schedule, plus MN Care tax"
Complete Echo (2D/C/D),,93306,CPT,Facility,Both,,,,1697,1442.45,756.862,1697,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,784.86,,,Fee schedule,,"100% of BCBS Medicaid commodity fee schedule, plus MN Care tax"
Complete Echo (2D/C/D),,93306,CPT,Facility,Outpatient,,,,1697,1442.45,756.862,1697,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),831.53,49,,percent of total billed charges,,
Complete Echo (2D/C/D),,93306,CPT,Facility,Inpatient,,,,1697,1442.45,756.862,1697,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Complete Echo (2D/C/D),,93306,CPT,Facility,Both,,,,1697,1442.45,756.862,1697,CorVel,Worker's Compensation,1697,100,,percent of total billed charges,,
Complete Echo (2D/C/D),,93306,CPT,Facility,Both,,,,1697,1442.45,756.862,1697,First Health Group Corporation,First Health Network,1646.09,97,,percent of total billed charges,,
Complete Echo (2D/C/D),,93306,CPT,Facility,Both,,,,1697,1442.45,756.862,1697,"Health Partners, Inc.",Commercial,1605.362,94.6,,percent of total billed charges,,
Complete Echo (2D/C/D),,93306,CPT,Facility,Outpatient,,,,1697,1442.45,756.862,1697,"Health Partners, Inc.",Medicare Advantage,831.53,49,,percent of total billed charges,,
Complete Echo (2D/C/D),,93306,CPT,Facility,Inpatient,,,,1697,1442.45,756.862,1697,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Complete Echo (2D/C/D),,93306,CPT,Facility,Both,,,,1697,1442.45,756.862,1697,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1018.2,60,,percent of total billed charges,,
Complete Echo (2D/C/D),,93306,CPT,Facility,Both,,,,1697,1442.45,756.862,1697,"Health Partners, Inc.",State of Minnesota Advantage Program,1383.055,81.5,,percent of total billed charges,,
Complete Echo (2D/C/D),,93306,CPT,Facility,Both,,,,1697,1442.45,756.862,1697,"Health Partners, Inc.",State Public Programs,848.5,50,,percent of total billed charges,,
Complete Echo (2D/C/D),,93306,CPT,Facility,Both,,,,1697,1442.45,756.862,1697,Humana Insurance Company,Commercial PPO,1612.15,95,,percent of total billed charges,,
Complete Echo (2D/C/D),,93306,CPT,Facility,Outpatient,,,,1697,1442.45,756.862,1697,Humana Insurance Company,Medicare PPO,831.53,49,,percent of total billed charges,,
Complete Echo (2D/C/D),,93306,CPT,Facility,Inpatient,,,,1697,1442.45,756.862,1697,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Complete Echo (2D/C/D),,93306,CPT,Facility,Both,,,,1697,1442.45,756.862,1697,Medica,Individual & Family,1681.727,99.1,,percent of total billed charges,,
Complete Echo (2D/C/D),,93306,CPT,Facility,Outpatient,,,,1697,1442.45,756.862,1697,Medica,Medica Advantage Solution,845.106,49.8,,percent of total billed charges,,
Complete Echo (2D/C/D),,93306,CPT,Facility,Inpatient,,,,1697,1442.45,756.862,1697,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Complete Echo (2D/C/D),,93306,CPT,Facility,Outpatient,,,,1697,1442.45,756.862,1697,Medica,Medical Assistance,756.862,44.6,,percent of total billed charges,,
Complete Echo (2D/C/D),,93306,CPT,Facility,Inpatient,,,,1697,1442.45,756.862,1697,Medica,Medical Assistance,,,,,Included in per diem rate,
Complete Echo (2D/C/D),,93306,CPT,Facility,Outpatient,,,,1697,1442.45,756.862,1697,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,845.106,49.8,,percent of total billed charges,,
Complete Echo (2D/C/D),,93306,CPT,Facility,Inpatient,,,,1697,1442.45,756.862,1697,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Complete Echo (2D/C/D),,93306,CPT,Facility,Both,,,,1697,1442.45,756.862,1697,"Multiplan, Inc.","Multiplan, Inc.",1595.18,94,,percent of total billed charges,,
Complete Echo (2D/C/D),,93306,CPT,Facility,Outpatient,,,,1697,1442.45,756.862,1697,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1528.997,90.1,,percent of total billed charges,,
Complete Echo (2D/C/D),,93306,CPT,Facility,Inpatient,,,,1697,1442.45,756.862,1697,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Complete Echo (2D/C/D),,93306,CPT,Facility,Both,,,,1697,1442.45,756.862,1697,"Preferred One Administrative Services, INC.",PPO,1673.242,98.6,,percent of total billed charges,,
Complete Echo (2D/C/D),,93306,CPT,Facility,Outpatient,,,,1697,1442.45,756.862,1697,PrimeWest Health,Minnesota Senior Health Options (MSHO),873.1065,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Complete Echo (2D/C/D),,93306,CPT,Facility,Inpatient,,,,1697,1442.45,756.862,1697,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Complete Echo (2D/C/D),,93306,CPT,Facility,Outpatient,,,,1697,1442.45,756.862,1697,PrimeWest Health,MinnesotaCare,871.5792,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Complete Echo (2D/C/D),,93306,CPT,Facility,Inpatient,,,,1697,1442.45,756.862,1697,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Complete Echo (2D/C/D),,93306,CPT,Facility,Both,,,,1697,1442.45,756.862,1697,Sanford Health Plan,Sanford Health Plan,1561.24,92,,percent of total billed charges,,
Complete Echo (2D/C/D),,93306,CPT,Facility,Outpatient,,,,1697,1442.45,756.862,1697,"UCare Health, Inc.",Individual & Family Plan,956.2595,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Complete Echo (2D/C/D),,93306,CPT,Facility,Inpatient,,,,1697,1442.45,756.862,1697,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Complete Echo (2D/C/D),,93306,CPT,Facility,Outpatient,,,,1697,1442.45,756.862,1697,"UCare Health, Inc.",Medical Assistance,856.4759,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Complete Echo (2D/C/D),,93306,CPT,Facility,Inpatient,,,,1697,1442.45,756.862,1697,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Complete Echo (2D/C/D),,93306,CPT,Facility,Outpatient,,,,1697,1442.45,756.862,1697,"UCare Health, Inc.",Medicare Advantage,856.4759,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Complete Echo (2D/C/D),,93306,CPT,Facility,Inpatient,,,,1697,1442.45,756.862,1697,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Complete Echo (2D/C/D),,93306,CPT,Facility,Outpatient,,,,1697,1442.45,756.862,1697,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),856.4759,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Complete Echo (2D/C/D),,93306,CPT,Facility,Inpatient,,,,1697,1442.45,756.862,1697,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Complete Echo (2D/C/D),,93306,CPT,Facility,Both,,,,1697,1442.45,756.862,1697,UnitedHealthcare,Individual & Family,1595.18,94,,percent of total billed charges,,
Complete Echo (2D/C/D),,93306,CPT,Facility,Outpatient,,,,1697,1442.45,756.862,1697,UnitedHealthcare,Medicare Advantage,831.53,49,,percent of total billed charges,,
Complete Echo (2D/C/D),,93306,CPT,Facility,Inpatient,,,,1697,1442.45,756.862,1697,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Complete Echo (2D/C/D),,93306,CPT,Facility,Outpatient,,,,1697,1442.45,756.862,1697,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,814.56,48,,percent of total billed charges,,100% of DHS outpatient percentage
Complete Echo (2D/C/D),,93306,CPT,Facility,Inpatient,,,,1697,1442.45,756.862,1697,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Echocardiogram, Pediatric",,93306,CPT,Facility,Both,,,,1797,1527.45,784.86,1797,Aetna,Commercial,1653.24,92,,percent of total billed charges,,
"Echocardiogram, Pediatric",,93306,CPT,Facility,Outpatient,,,,1797,1527.45,784.86,1797,Aetna,Medicare Advantage,880.53,49,,percent of total billed charges,,
"Echocardiogram, Pediatric",,93306,CPT,Facility,Inpatient,,,,1797,1527.45,784.86,1797,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Echocardiogram, Pediatric",,93306,CPT,Facility,Both,,,,1797,1527.45,784.86,1797,Aetna,PPO,1671.21,93,,percent of total billed charges,,
"Echocardiogram, Pediatric",,93306,CPT,Facility,Both,,,,1797,1527.45,784.86,1797,America's PPO,America's PPO,1725.6591,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Echocardiogram, Pediatric",,93306,CPT,Facility,Both,,,,1797,1527.45,784.86,1797,BlueCross BlueShield Minnesota, Federal Employee Program,1545,,,Fee schedule,,100% of BCBS commercial commodity fee schedule
"Echocardiogram, Pediatric",,93306,CPT,Facility,Both,,,,1797,1527.45,784.86,1797,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1569.72,,,Fee schedule,,"100% of BCBS commercial commodity fee schedule, plus MN Care tax"
"Echocardiogram, Pediatric",,93306,CPT,Facility,Both,,,,1797,1527.45,784.86,1797,BlueCross BlueShield Minnesota,High Value Network Plan,1412.748,,,Fee schedule,,"90% of BCBS commercial commodity fee schedule, plus MN Care tax; see disclaimer for more information"
"Echocardiogram, Pediatric",,93306,CPT,Facility,Outpatient,,,,1797,1527.45,784.86,1797,BlueCross BlueShield Minnesota,Medicare Advantage,880.53,49,,percent of total billed charges,,
"Echocardiogram, Pediatric",,93306,CPT,Facility,Inpatient,,,,1797,1527.45,784.86,1797,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Echocardiogram, Pediatric",,93306,CPT,Facility,Both,,,,1797,1527.45,784.86,1797,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1390.301004,,,Fee schedule,,"88.57% of BCBS commercial commodity fee schedule, plus MN Care tax"
"Echocardiogram, Pediatric",,93306,CPT,Facility,Both,,,,1797,1527.45,784.86,1797,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,784.86,,,Fee schedule,,"100% of BCBS Medicaid commodity fee schedule, plus MN Care tax"
"Echocardiogram, Pediatric",,93306,CPT,Facility,Outpatient,,,,1797,1527.45,784.86,1797,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),880.53,49,,percent of total billed charges,,
"Echocardiogram, Pediatric",,93306,CPT,Facility,Inpatient,,,,1797,1527.45,784.86,1797,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Echocardiogram, Pediatric",,93306,CPT,Facility,Both,,,,1797,1527.45,784.86,1797,CorVel,Worker's Compensation,1797,100,,percent of total billed charges,,
"Echocardiogram, Pediatric",,93306,CPT,Facility,Both,,,,1797,1527.45,784.86,1797,First Health Group Corporation,First Health Network,1743.09,97,,percent of total billed charges,,
"Echocardiogram, Pediatric",,93306,CPT,Facility,Both,,,,1797,1527.45,784.86,1797,"Health Partners, Inc.",Commercial,1699.962,94.6,,percent of total billed charges,,
"Echocardiogram, Pediatric",,93306,CPT,Facility,Outpatient,,,,1797,1527.45,784.86,1797,"Health Partners, Inc.",Medicare Advantage,880.53,49,,percent of total billed charges,,
"Echocardiogram, Pediatric",,93306,CPT,Facility,Inpatient,,,,1797,1527.45,784.86,1797,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Echocardiogram, Pediatric",,93306,CPT,Facility,Both,,,,1797,1527.45,784.86,1797,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1078.2,60,,percent of total billed charges,,
"Echocardiogram, Pediatric",,93306,CPT,Facility,Both,,,,1797,1527.45,784.86,1797,"Health Partners, Inc.",State of Minnesota Advantage Program,1464.555,81.5,,percent of total billed charges,,
"Echocardiogram, Pediatric",,93306,CPT,Facility,Both,,,,1797,1527.45,784.86,1797,"Health Partners, Inc.",State Public Programs,898.5,50,,percent of total billed charges,,
"Echocardiogram, Pediatric",,93306,CPT,Facility,Both,,,,1797,1527.45,784.86,1797,Humana Insurance Company,Commercial PPO,1707.15,95,,percent of total billed charges,,
"Echocardiogram, Pediatric",,93306,CPT,Facility,Outpatient,,,,1797,1527.45,784.86,1797,Humana Insurance Company,Medicare PPO,880.53,49,,percent of total billed charges,,
"Echocardiogram, Pediatric",,93306,CPT,Facility,Inpatient,,,,1797,1527.45,784.86,1797,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Echocardiogram, Pediatric",,93306,CPT,Facility,Both,,,,1797,1527.45,784.86,1797,Medica,Individual & Family,1780.827,99.1,,percent of total billed charges,,
"Echocardiogram, Pediatric",,93306,CPT,Facility,Outpatient,,,,1797,1527.45,784.86,1797,Medica,Medica Advantage Solution,894.906,49.8,,percent of total billed charges,,
"Echocardiogram, Pediatric",,93306,CPT,Facility,Inpatient,,,,1797,1527.45,784.86,1797,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Echocardiogram, Pediatric",,93306,CPT,Facility,Outpatient,,,,1797,1527.45,784.86,1797,Medica,Medical Assistance,801.462,44.6,,percent of total billed charges,,
"Echocardiogram, Pediatric",,93306,CPT,Facility,Inpatient,,,,1797,1527.45,784.86,1797,Medica,Medical Assistance,,,,,Included in per diem rate,
"Echocardiogram, Pediatric",,93306,CPT,Facility,Outpatient,,,,1797,1527.45,784.86,1797,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,894.906,49.8,,percent of total billed charges,,
"Echocardiogram, Pediatric",,93306,CPT,Facility,Inpatient,,,,1797,1527.45,784.86,1797,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Echocardiogram, Pediatric",,93306,CPT,Facility,Both,,,,1797,1527.45,784.86,1797,"Multiplan, Inc.","Multiplan, Inc.",1689.18,94,,percent of total billed charges,,
"Echocardiogram, Pediatric",,93306,CPT,Facility,Outpatient,,,,1797,1527.45,784.86,1797,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1619.097,90.1,,percent of total billed charges,,
"Echocardiogram, Pediatric",,93306,CPT,Facility,Inpatient,,,,1797,1527.45,784.86,1797,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Echocardiogram, Pediatric",,93306,CPT,Facility,Both,,,,1797,1527.45,784.86,1797,"Preferred One Administrative Services, INC.",PPO,1771.842,98.6,,percent of total billed charges,,
"Echocardiogram, Pediatric",,93306,CPT,Facility,Outpatient,,,,1797,1527.45,784.86,1797,PrimeWest Health,Minnesota Senior Health Options (MSHO),924.5565,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Echocardiogram, Pediatric",,93306,CPT,Facility,Inpatient,,,,1797,1527.45,784.86,1797,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Echocardiogram, Pediatric",,93306,CPT,Facility,Outpatient,,,,1797,1527.45,784.86,1797,PrimeWest Health,MinnesotaCare,922.9392,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Echocardiogram, Pediatric",,93306,CPT,Facility,Inpatient,,,,1797,1527.45,784.86,1797,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Echocardiogram, Pediatric",,93306,CPT,Facility,Both,,,,1797,1527.45,784.86,1797,Sanford Health Plan,Sanford Health Plan,1653.24,92,,percent of total billed charges,,
"Echocardiogram, Pediatric",,93306,CPT,Facility,Outpatient,,,,1797,1527.45,784.86,1797,"UCare Health, Inc.",Individual & Family Plan,1012.6095,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Echocardiogram, Pediatric",,93306,CPT,Facility,Inpatient,,,,1797,1527.45,784.86,1797,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Echocardiogram, Pediatric",,93306,CPT,Facility,Outpatient,,,,1797,1527.45,784.86,1797,"UCare Health, Inc.",Medical Assistance,906.9459,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Echocardiogram, Pediatric",,93306,CPT,Facility,Inpatient,,,,1797,1527.45,784.86,1797,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Echocardiogram, Pediatric",,93306,CPT,Facility,Outpatient,,,,1797,1527.45,784.86,1797,"UCare Health, Inc.",Medicare Advantage,906.9459,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Echocardiogram, Pediatric",,93306,CPT,Facility,Inpatient,,,,1797,1527.45,784.86,1797,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Echocardiogram, Pediatric",,93306,CPT,Facility,Outpatient,,,,1797,1527.45,784.86,1797,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),906.9459,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Echocardiogram, Pediatric",,93306,CPT,Facility,Inpatient,,,,1797,1527.45,784.86,1797,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Echocardiogram, Pediatric",,93306,CPT,Facility,Both,,,,1797,1527.45,784.86,1797,UnitedHealthcare,Individual & Family,1689.18,94,,percent of total billed charges,,
"Echocardiogram, Pediatric",,93306,CPT,Facility,Outpatient,,,,1797,1527.45,784.86,1797,UnitedHealthcare,Medicare Advantage,880.53,49,,percent of total billed charges,,
"Echocardiogram, Pediatric",,93306,CPT,Facility,Inpatient,,,,1797,1527.45,784.86,1797,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Echocardiogram, Pediatric",,93306,CPT,Facility,Outpatient,,,,1797,1527.45,784.86,1797,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,862.56,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Echocardiogram, Pediatric",,93306,CPT,Facility,Inpatient,,,,1797,1527.45,784.86,1797,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Echo Limited,,93308,CPT,Facility,Both,,,,879,747.15,251.9214,879,Aetna,Commercial,808.68,92,,percent of total billed charges,,
Echo Limited,,93308,CPT,Facility,Outpatient,,,,879,747.15,251.9214,879,Aetna,Medicare Advantage,430.71,49,,percent of total billed charges,,
Echo Limited,,93308,CPT,Facility,Inpatient,,,,879,747.15,251.9214,879,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Echo Limited,,93308,CPT,Facility,Both,,,,879,747.15,251.9214,879,Aetna,PPO,817.47,93,,percent of total billed charges,,
Echo Limited,,93308,CPT,Facility,Both,,,,879,747.15,251.9214,879,America's PPO,America's PPO,844.1037,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Echo Limited,,93308,CPT,Facility,Both,,,,879,747.15,251.9214,879,BlueCross BlueShield Minnesota, Federal Employee Program,864.936,98.4,,percent of total billed charges,,
Echo Limited,,93308,CPT,Facility,Both,,,,879,747.15,251.9214,879,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,879,100,,percent of total billed charges,,
Echo Limited,,93308,CPT,Facility,Both,,,,879,747.15,251.9214,879,BlueCross BlueShield Minnesota,High Value Network Plan,791.1,90,,percent of total billed charges,,
Echo Limited,,93308,CPT,Facility,Outpatient,,,,879,747.15,251.9214,879,BlueCross BlueShield Minnesota,Medicare Advantage,430.71,49,,percent of total billed charges,,
Echo Limited,,93308,CPT,Facility,Inpatient,,,,879,747.15,251.9214,879,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Echo Limited,,93308,CPT,Facility,Both,,,,879,747.15,251.9214,879,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,778.5303,88.57,,percent of total billed charges,,
Echo Limited,,93308,CPT,Facility,Both,,,,879,747.15,251.9214,879,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,251.9214,28.66,,percent of total billed charges,,
Echo Limited,,93308,CPT,Facility,Outpatient,,,,879,747.15,251.9214,879,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),430.71,49,,percent of total billed charges,,
Echo Limited,,93308,CPT,Facility,Inpatient,,,,879,747.15,251.9214,879,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Echo Limited,,93308,CPT,Facility,Both,,,,879,747.15,251.9214,879,CorVel,Worker's Compensation,879,100,,percent of total billed charges,,
Echo Limited,,93308,CPT,Facility,Both,,,,879,747.15,251.9214,879,First Health Group Corporation,First Health Network,852.63,97,,percent of total billed charges,,
Echo Limited,,93308,CPT,Facility,Both,,,,879,747.15,251.9214,879,"Health Partners, Inc.",Commercial,831.534,94.6,,percent of total billed charges,,
Echo Limited,,93308,CPT,Facility,Outpatient,,,,879,747.15,251.9214,879,"Health Partners, Inc.",Medicare Advantage,430.71,49,,percent of total billed charges,,
Echo Limited,,93308,CPT,Facility,Inpatient,,,,879,747.15,251.9214,879,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Echo Limited,,93308,CPT,Facility,Both,,,,879,747.15,251.9214,879,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),527.4,60,,percent of total billed charges,,
Echo Limited,,93308,CPT,Facility,Both,,,,879,747.15,251.9214,879,"Health Partners, Inc.",State of Minnesota Advantage Program,716.385,81.5,,percent of total billed charges,,
Echo Limited,,93308,CPT,Facility,Both,,,,879,747.15,251.9214,879,"Health Partners, Inc.",State Public Programs,439.5,50,,percent of total billed charges,,
Echo Limited,,93308,CPT,Facility,Both,,,,879,747.15,251.9214,879,Humana Insurance Company,Commercial PPO,835.05,95,,percent of total billed charges,,
Echo Limited,,93308,CPT,Facility,Outpatient,,,,879,747.15,251.9214,879,Humana Insurance Company,Medicare PPO,430.71,49,,percent of total billed charges,,
Echo Limited,,93308,CPT,Facility,Inpatient,,,,879,747.15,251.9214,879,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Echo Limited,,93308,CPT,Facility,Both,,,,879,747.15,251.9214,879,Medica,Individual & Family,871.089,99.1,,percent of total billed charges,,
Echo Limited,,93308,CPT,Facility,Outpatient,,,,879,747.15,251.9214,879,Medica,Medica Advantage Solution,437.742,49.8,,percent of total billed charges,,
Echo Limited,,93308,CPT,Facility,Inpatient,,,,879,747.15,251.9214,879,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Echo Limited,,93308,CPT,Facility,Outpatient,,,,879,747.15,251.9214,879,Medica,Medical Assistance,392.034,44.6,,percent of total billed charges,,
Echo Limited,,93308,CPT,Facility,Inpatient,,,,879,747.15,251.9214,879,Medica,Medical Assistance,,,,,Included in per diem rate,
Echo Limited,,93308,CPT,Facility,Outpatient,,,,879,747.15,251.9214,879,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,437.742,49.8,,percent of total billed charges,,
Echo Limited,,93308,CPT,Facility,Inpatient,,,,879,747.15,251.9214,879,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Echo Limited,,93308,CPT,Facility,Both,,,,879,747.15,251.9214,879,"Multiplan, Inc.","Multiplan, Inc.",826.26,94,,percent of total billed charges,,
Echo Limited,,93308,CPT,Facility,Outpatient,,,,879,747.15,251.9214,879,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,791.979,90.1,,percent of total billed charges,,
Echo Limited,,93308,CPT,Facility,Inpatient,,,,879,747.15,251.9214,879,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Echo Limited,,93308,CPT,Facility,Both,,,,879,747.15,251.9214,879,"Preferred One Administrative Services, INC.",PPO,866.694,98.6,,percent of total billed charges,,
Echo Limited,,93308,CPT,Facility,Outpatient,,,,879,747.15,251.9214,879,PrimeWest Health,Minnesota Senior Health Options (MSHO),452.2455,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Echo Limited,,93308,CPT,Facility,Inpatient,,,,879,747.15,251.9214,879,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Echo Limited,,93308,CPT,Facility,Outpatient,,,,879,747.15,251.9214,879,PrimeWest Health,MinnesotaCare,451.4544,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Echo Limited,,93308,CPT,Facility,Inpatient,,,,879,747.15,251.9214,879,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Echo Limited,,93308,CPT,Facility,Both,,,,879,747.15,251.9214,879,Sanford Health Plan,Sanford Health Plan,808.68,92,,percent of total billed charges,,
Echo Limited,,93308,CPT,Facility,Outpatient,,,,879,747.15,251.9214,879,"UCare Health, Inc.",Individual & Family Plan,495.3165,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Echo Limited,,93308,CPT,Facility,Inpatient,,,,879,747.15,251.9214,879,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Echo Limited,,93308,CPT,Facility,Outpatient,,,,879,747.15,251.9214,879,"UCare Health, Inc.",Medical Assistance,443.6313,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Echo Limited,,93308,CPT,Facility,Inpatient,,,,879,747.15,251.9214,879,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Echo Limited,,93308,CPT,Facility,Outpatient,,,,879,747.15,251.9214,879,"UCare Health, Inc.",Medicare Advantage,443.6313,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Echo Limited,,93308,CPT,Facility,Inpatient,,,,879,747.15,251.9214,879,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Echo Limited,,93308,CPT,Facility,Outpatient,,,,879,747.15,251.9214,879,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),443.6313,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Echo Limited,,93308,CPT,Facility,Inpatient,,,,879,747.15,251.9214,879,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Echo Limited,,93308,CPT,Facility,Both,,,,879,747.15,251.9214,879,UnitedHealthcare,Individual & Family,826.26,94,,percent of total billed charges,,
Echo Limited,,93308,CPT,Facility,Outpatient,,,,879,747.15,251.9214,879,UnitedHealthcare,Medicare Advantage,430.71,49,,percent of total billed charges,,
Echo Limited,,93308,CPT,Facility,Inpatient,,,,879,747.15,251.9214,879,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Echo Limited,,93308,CPT,Facility,Outpatient,,,,879,747.15,251.9214,879,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,421.92,48,,percent of total billed charges,,100% of DHS outpatient percentage
Echo Limited,,93308,CPT,Facility,Inpatient,,,,879,747.15,251.9214,879,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Stress Echocardiography Test,,93350,CPT,Facility,Both,,,,851,723.35,243.8966,851,Aetna,Commercial,782.92,92,,percent of total billed charges,,
Stress Echocardiography Test,,93350,CPT,Facility,Outpatient,,,,851,723.35,243.8966,851,Aetna,Medicare Advantage,416.99,49,,percent of total billed charges,,
Stress Echocardiography Test,,93350,CPT,Facility,Inpatient,,,,851,723.35,243.8966,851,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Stress Echocardiography Test,,93350,CPT,Facility,Both,,,,851,723.35,243.8966,851,Aetna,PPO,791.43,93,,percent of total billed charges,,
Stress Echocardiography Test,,93350,CPT,Facility,Both,,,,851,723.35,243.8966,851,America's PPO,America's PPO,817.2153,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Stress Echocardiography Test,,93350,CPT,Facility,Both,,,,851,723.35,243.8966,851,BlueCross BlueShield Minnesota, Federal Employee Program,837.384,98.4,,percent of total billed charges,,
Stress Echocardiography Test,,93350,CPT,Facility,Both,,,,851,723.35,243.8966,851,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,851,100,,percent of total billed charges,,
Stress Echocardiography Test,,93350,CPT,Facility,Both,,,,851,723.35,243.8966,851,BlueCross BlueShield Minnesota,High Value Network Plan,765.9,90,,percent of total billed charges,,
Stress Echocardiography Test,,93350,CPT,Facility,Outpatient,,,,851,723.35,243.8966,851,BlueCross BlueShield Minnesota,Medicare Advantage,416.99,49,,percent of total billed charges,,
Stress Echocardiography Test,,93350,CPT,Facility,Inpatient,,,,851,723.35,243.8966,851,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Stress Echocardiography Test,,93350,CPT,Facility,Both,,,,851,723.35,243.8966,851,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,753.7307,88.57,,percent of total billed charges,,
Stress Echocardiography Test,,93350,CPT,Facility,Both,,,,851,723.35,243.8966,851,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,243.8966,28.66,,percent of total billed charges,,
Stress Echocardiography Test,,93350,CPT,Facility,Outpatient,,,,851,723.35,243.8966,851,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),416.99,49,,percent of total billed charges,,
Stress Echocardiography Test,,93350,CPT,Facility,Inpatient,,,,851,723.35,243.8966,851,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Stress Echocardiography Test,,93350,CPT,Facility,Both,,,,851,723.35,243.8966,851,CorVel,Worker's Compensation,851,100,,percent of total billed charges,,
Stress Echocardiography Test,,93350,CPT,Facility,Both,,,,851,723.35,243.8966,851,First Health Group Corporation,First Health Network,825.47,97,,percent of total billed charges,,
Stress Echocardiography Test,,93350,CPT,Facility,Both,,,,851,723.35,243.8966,851,"Health Partners, Inc.",Commercial,805.046,94.6,,percent of total billed charges,,
Stress Echocardiography Test,,93350,CPT,Facility,Outpatient,,,,851,723.35,243.8966,851,"Health Partners, Inc.",Medicare Advantage,416.99,49,,percent of total billed charges,,
Stress Echocardiography Test,,93350,CPT,Facility,Inpatient,,,,851,723.35,243.8966,851,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Stress Echocardiography Test,,93350,CPT,Facility,Both,,,,851,723.35,243.8966,851,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),510.6,60,,percent of total billed charges,,
Stress Echocardiography Test,,93350,CPT,Facility,Both,,,,851,723.35,243.8966,851,"Health Partners, Inc.",State of Minnesota Advantage Program,693.565,81.5,,percent of total billed charges,,
Stress Echocardiography Test,,93350,CPT,Facility,Both,,,,851,723.35,243.8966,851,"Health Partners, Inc.",State Public Programs,425.5,50,,percent of total billed charges,,
Stress Echocardiography Test,,93350,CPT,Facility,Both,,,,851,723.35,243.8966,851,Humana Insurance Company,Commercial PPO,808.45,95,,percent of total billed charges,,
Stress Echocardiography Test,,93350,CPT,Facility,Outpatient,,,,851,723.35,243.8966,851,Humana Insurance Company,Medicare PPO,416.99,49,,percent of total billed charges,,
Stress Echocardiography Test,,93350,CPT,Facility,Inpatient,,,,851,723.35,243.8966,851,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Stress Echocardiography Test,,93350,CPT,Facility,Both,,,,851,723.35,243.8966,851,Medica,Individual & Family,843.341,99.1,,percent of total billed charges,,
Stress Echocardiography Test,,93350,CPT,Facility,Outpatient,,,,851,723.35,243.8966,851,Medica,Medica Advantage Solution,423.798,49.8,,percent of total billed charges,,
Stress Echocardiography Test,,93350,CPT,Facility,Inpatient,,,,851,723.35,243.8966,851,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Stress Echocardiography Test,,93350,CPT,Facility,Outpatient,,,,851,723.35,243.8966,851,Medica,Medical Assistance,379.546,44.6,,percent of total billed charges,,
Stress Echocardiography Test,,93350,CPT,Facility,Inpatient,,,,851,723.35,243.8966,851,Medica,Medical Assistance,,,,,Included in per diem rate,
Stress Echocardiography Test,,93350,CPT,Facility,Outpatient,,,,851,723.35,243.8966,851,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,423.798,49.8,,percent of total billed charges,,
Stress Echocardiography Test,,93350,CPT,Facility,Inpatient,,,,851,723.35,243.8966,851,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Stress Echocardiography Test,,93350,CPT,Facility,Both,,,,851,723.35,243.8966,851,"Multiplan, Inc.","Multiplan, Inc.",799.94,94,,percent of total billed charges,,
Stress Echocardiography Test,,93350,CPT,Facility,Outpatient,,,,851,723.35,243.8966,851,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,766.751,90.1,,percent of total billed charges,,
Stress Echocardiography Test,,93350,CPT,Facility,Inpatient,,,,851,723.35,243.8966,851,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Stress Echocardiography Test,,93350,CPT,Facility,Both,,,,851,723.35,243.8966,851,"Preferred One Administrative Services, INC.",PPO,839.086,98.6,,percent of total billed charges,,
Stress Echocardiography Test,,93350,CPT,Facility,Outpatient,,,,851,723.35,243.8966,851,PrimeWest Health,Minnesota Senior Health Options (MSHO),437.8395,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Stress Echocardiography Test,,93350,CPT,Facility,Inpatient,,,,851,723.35,243.8966,851,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Stress Echocardiography Test,,93350,CPT,Facility,Outpatient,,,,851,723.35,243.8966,851,PrimeWest Health,MinnesotaCare,437.0736,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Stress Echocardiography Test,,93350,CPT,Facility,Inpatient,,,,851,723.35,243.8966,851,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Stress Echocardiography Test,,93350,CPT,Facility,Both,,,,851,723.35,243.8966,851,Sanford Health Plan,Sanford Health Plan,782.92,92,,percent of total billed charges,,
Stress Echocardiography Test,,93350,CPT,Facility,Outpatient,,,,851,723.35,243.8966,851,"UCare Health, Inc.",Individual & Family Plan,479.5385,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Stress Echocardiography Test,,93350,CPT,Facility,Inpatient,,,,851,723.35,243.8966,851,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Stress Echocardiography Test,,93350,CPT,Facility,Outpatient,,,,851,723.35,243.8966,851,"UCare Health, Inc.",Medical Assistance,429.4997,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Stress Echocardiography Test,,93350,CPT,Facility,Inpatient,,,,851,723.35,243.8966,851,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Stress Echocardiography Test,,93350,CPT,Facility,Outpatient,,,,851,723.35,243.8966,851,"UCare Health, Inc.",Medicare Advantage,429.4997,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Stress Echocardiography Test,,93350,CPT,Facility,Inpatient,,,,851,723.35,243.8966,851,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Stress Echocardiography Test,,93350,CPT,Facility,Outpatient,,,,851,723.35,243.8966,851,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),429.4997,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Stress Echocardiography Test,,93350,CPT,Facility,Inpatient,,,,851,723.35,243.8966,851,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Stress Echocardiography Test,,93350,CPT,Facility,Both,,,,851,723.35,243.8966,851,UnitedHealthcare,Individual & Family,799.94,94,,percent of total billed charges,,
Stress Echocardiography Test,,93350,CPT,Facility,Outpatient,,,,851,723.35,243.8966,851,UnitedHealthcare,Medicare Advantage,416.99,49,,percent of total billed charges,,
Stress Echocardiography Test,,93350,CPT,Facility,Inpatient,,,,851,723.35,243.8966,851,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Stress Echocardiography Test,,93350,CPT,Facility,Outpatient,,,,851,723.35,243.8966,851,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,408.48,48,,percent of total billed charges,,100% of DHS outpatient percentage
Stress Echocardiography Test,,93350,CPT,Facility,Inpatient,,,,851,723.35,243.8966,851,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Phase 2 Cardiac Rehab,,93798,CPT,Facility,Both,,,,245,208.25,109.27,269.24,Aetna,Commercial,225.4,92,,percent of total billed charges,,
Phase 2 Cardiac Rehab,,93798,CPT,Facility,Outpatient,,,,245,208.25,109.27,269.24,Aetna,Medicare Advantage,120.05,49,,percent of total billed charges,,
Phase 2 Cardiac Rehab,,93798,CPT,Facility,Inpatient,,,,245,208.25,109.27,269.24,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Phase 2 Cardiac Rehab,,93798,CPT,Facility,Both,,,,245,208.25,109.27,269.24,Aetna,PPO,227.85,93,,percent of total billed charges,,
Phase 2 Cardiac Rehab,,93798,CPT,Facility,Both,,,,245,208.25,109.27,269.24,America's PPO,America's PPO,235.2735,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Phase 2 Cardiac Rehab,,93798,CPT,Facility,Both,,,,245,208.25,109.27,269.24,BlueCross BlueShield Minnesota, Federal Employee Program,265,,,Fee schedule,,100% of BCBS commercial commodity fee schedule
Phase 2 Cardiac Rehab,,93798,CPT,Facility,Both,,,,245,208.25,109.27,269.24,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,269.24,,,Fee schedule,,"100% of BCBS commercial commodity fee schedule, plus MN Care tax"
Phase 2 Cardiac Rehab,,93798,CPT,Facility,Both,,,,245,208.25,109.27,269.24,BlueCross BlueShield Minnesota,High Value Network Plan,242.316,,,Fee schedule,,"90% of BCBS commercial commodity fee schedule, plus MN Care tax; see disclaimer for more information"
Phase 2 Cardiac Rehab,,93798,CPT,Facility,Outpatient,,,,245,208.25,109.27,269.24,BlueCross BlueShield Minnesota,Medicare Advantage,120.05,49,,percent of total billed charges,,
Phase 2 Cardiac Rehab,,93798,CPT,Facility,Inpatient,,,,245,208.25,109.27,269.24,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Phase 2 Cardiac Rehab,,93798,CPT,Facility,Both,,,,245,208.25,109.27,269.24,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,238.465868,,,Fee schedule,,"88.57% of BCBS commercial commodity fee schedule, plus MN Care tax"
Phase 2 Cardiac Rehab,,93798,CPT,Facility,Both,,,,245,208.25,109.27,269.24,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,134.62,,,Fee schedule,,"100% of BCBS Medicaid commodity fee schedule, plus MN Care tax"
Phase 2 Cardiac Rehab,,93798,CPT,Facility,Outpatient,,,,245,208.25,109.27,269.24,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),120.05,49,,percent of total billed charges,,
Phase 2 Cardiac Rehab,,93798,CPT,Facility,Inpatient,,,,245,208.25,109.27,269.24,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Phase 2 Cardiac Rehab,,93798,CPT,Facility,Both,,,,245,208.25,109.27,269.24,CorVel,Worker's Compensation,245,100,,percent of total billed charges,,
Phase 2 Cardiac Rehab,,93798,CPT,Facility,Both,,,,245,208.25,109.27,269.24,First Health Group Corporation,First Health Network,237.65,97,,percent of total billed charges,,
Phase 2 Cardiac Rehab,,93798,CPT,Facility,Both,,,,245,208.25,109.27,269.24,"Health Partners, Inc.",Commercial,231.77,94.6,,percent of total billed charges,,
Phase 2 Cardiac Rehab,,93798,CPT,Facility,Outpatient,,,,245,208.25,109.27,269.24,"Health Partners, Inc.",Medicare Advantage,120.05,49,,percent of total billed charges,,
Phase 2 Cardiac Rehab,,93798,CPT,Facility,Inpatient,,,,245,208.25,109.27,269.24,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Phase 2 Cardiac Rehab,,93798,CPT,Facility,Both,,,,245,208.25,109.27,269.24,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),147,60,,percent of total billed charges,,
Phase 2 Cardiac Rehab,,93798,CPT,Facility,Both,,,,245,208.25,109.27,269.24,"Health Partners, Inc.",State of Minnesota Advantage Program,199.675,81.5,,percent of total billed charges,,
Phase 2 Cardiac Rehab,,93798,CPT,Facility,Both,,,,245,208.25,109.27,269.24,"Health Partners, Inc.",State Public Programs,122.5,50,,percent of total billed charges,,
Phase 2 Cardiac Rehab,,93798,CPT,Facility,Both,,,,245,208.25,109.27,269.24,Humana Insurance Company,Commercial PPO,232.75,95,,percent of total billed charges,,
Phase 2 Cardiac Rehab,,93798,CPT,Facility,Outpatient,,,,245,208.25,109.27,269.24,Humana Insurance Company,Medicare PPO,120.05,49,,percent of total billed charges,,
Phase 2 Cardiac Rehab,,93798,CPT,Facility,Inpatient,,,,245,208.25,109.27,269.24,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Phase 2 Cardiac Rehab,,93798,CPT,Facility,Both,,,,245,208.25,109.27,269.24,Medica,Individual & Family,242.795,99.1,,percent of total billed charges,,
Phase 2 Cardiac Rehab,,93798,CPT,Facility,Outpatient,,,,245,208.25,109.27,269.24,Medica,Medica Advantage Solution,122.01,49.8,,percent of total billed charges,,
Phase 2 Cardiac Rehab,,93798,CPT,Facility,Inpatient,,,,245,208.25,109.27,269.24,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Phase 2 Cardiac Rehab,,93798,CPT,Facility,Outpatient,,,,245,208.25,109.27,269.24,Medica,Medical Assistance,109.27,44.6,,percent of total billed charges,,
Phase 2 Cardiac Rehab,,93798,CPT,Facility,Inpatient,,,,245,208.25,109.27,269.24,Medica,Medical Assistance,,,,,Included in per diem rate,
Phase 2 Cardiac Rehab,,93798,CPT,Facility,Outpatient,,,,245,208.25,109.27,269.24,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,122.01,49.8,,percent of total billed charges,,
Phase 2 Cardiac Rehab,,93798,CPT,Facility,Inpatient,,,,245,208.25,109.27,269.24,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Phase 2 Cardiac Rehab,,93798,CPT,Facility,Both,,,,245,208.25,109.27,269.24,"Multiplan, Inc.","Multiplan, Inc.",230.3,94,,percent of total billed charges,,
Phase 2 Cardiac Rehab,,93798,CPT,Facility,Outpatient,,,,245,208.25,109.27,269.24,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,220.745,90.1,,percent of total billed charges,,
Phase 2 Cardiac Rehab,,93798,CPT,Facility,Inpatient,,,,245,208.25,109.27,269.24,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Phase 2 Cardiac Rehab,,93798,CPT,Facility,Both,,,,245,208.25,109.27,269.24,"Preferred One Administrative Services, INC.",PPO,241.57,98.6,,percent of total billed charges,,
Phase 2 Cardiac Rehab,,93798,CPT,Facility,Outpatient,,,,245,208.25,109.27,269.24,PrimeWest Health,Minnesota Senior Health Options (MSHO),126.0525,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Phase 2 Cardiac Rehab,,93798,CPT,Facility,Inpatient,,,,245,208.25,109.27,269.24,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Phase 2 Cardiac Rehab,,93798,CPT,Facility,Outpatient,,,,245,208.25,109.27,269.24,PrimeWest Health,MinnesotaCare,125.832,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Phase 2 Cardiac Rehab,,93798,CPT,Facility,Inpatient,,,,245,208.25,109.27,269.24,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Phase 2 Cardiac Rehab,,93798,CPT,Facility,Both,,,,245,208.25,109.27,269.24,Sanford Health Plan,Sanford Health Plan,225.4,92,,percent of total billed charges,,
Phase 2 Cardiac Rehab,,93798,CPT,Facility,Outpatient,,,,245,208.25,109.27,269.24,"UCare Health, Inc.",Individual & Family Plan,138.0575,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Phase 2 Cardiac Rehab,,93798,CPT,Facility,Inpatient,,,,245,208.25,109.27,269.24,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Phase 2 Cardiac Rehab,,93798,CPT,Facility,Outpatient,,,,245,208.25,109.27,269.24,"UCare Health, Inc.",Medical Assistance,123.6515,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Phase 2 Cardiac Rehab,,93798,CPT,Facility,Inpatient,,,,245,208.25,109.27,269.24,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Phase 2 Cardiac Rehab,,93798,CPT,Facility,Outpatient,,,,245,208.25,109.27,269.24,"UCare Health, Inc.",Medicare Advantage,123.6515,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Phase 2 Cardiac Rehab,,93798,CPT,Facility,Inpatient,,,,245,208.25,109.27,269.24,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Phase 2 Cardiac Rehab,,93798,CPT,Facility,Outpatient,,,,245,208.25,109.27,269.24,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),123.6515,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Phase 2 Cardiac Rehab,,93798,CPT,Facility,Inpatient,,,,245,208.25,109.27,269.24,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Phase 2 Cardiac Rehab,,93798,CPT,Facility,Both,,,,245,208.25,109.27,269.24,UnitedHealthcare,Individual & Family,230.3,94,,percent of total billed charges,,
Phase 2 Cardiac Rehab,,93798,CPT,Facility,Outpatient,,,,245,208.25,109.27,269.24,UnitedHealthcare,Medicare Advantage,120.05,49,,percent of total billed charges,,
Phase 2 Cardiac Rehab,,93798,CPT,Facility,Inpatient,,,,245,208.25,109.27,269.24,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Phase 2 Cardiac Rehab,,93798,CPT,Facility,Outpatient,,,,245,208.25,109.27,269.24,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,117.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
Phase 2 Cardiac Rehab,,93798,CPT,Facility,Inpatient,,,,245,208.25,109.27,269.24,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Us Carotid Bilateral Routine,,93880,CPT,Facility,Both,,,,802,681.7,229.8532,802,Aetna,Commercial,737.84,92,,percent of total billed charges,,
Us Carotid Bilateral Routine,,93880,CPT,Facility,Outpatient,,,,802,681.7,229.8532,802,Aetna,Medicare Advantage,392.98,49,,percent of total billed charges,,
Us Carotid Bilateral Routine,,93880,CPT,Facility,Inpatient,,,,802,681.7,229.8532,802,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Us Carotid Bilateral Routine,,93880,CPT,Facility,Both,,,,802,681.7,229.8532,802,Aetna,PPO,745.86,93,,percent of total billed charges,,
Us Carotid Bilateral Routine,,93880,CPT,Facility,Both,,,,802,681.7,229.8532,802,America's PPO,America's PPO,770.1606,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Us Carotid Bilateral Routine,,93880,CPT,Facility,Both,,,,802,681.7,229.8532,802,BlueCross BlueShield Minnesota, Federal Employee Program,789.168,98.4,,percent of total billed charges,,
Us Carotid Bilateral Routine,,93880,CPT,Facility,Both,,,,802,681.7,229.8532,802,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,802,100,,percent of total billed charges,,
Us Carotid Bilateral Routine,,93880,CPT,Facility,Both,,,,802,681.7,229.8532,802,BlueCross BlueShield Minnesota,High Value Network Plan,721.8,90,,percent of total billed charges,,
Us Carotid Bilateral Routine,,93880,CPT,Facility,Outpatient,,,,802,681.7,229.8532,802,BlueCross BlueShield Minnesota,Medicare Advantage,392.98,49,,percent of total billed charges,,
Us Carotid Bilateral Routine,,93880,CPT,Facility,Inpatient,,,,802,681.7,229.8532,802,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Us Carotid Bilateral Routine,,93880,CPT,Facility,Both,,,,802,681.7,229.8532,802,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,710.3314,88.57,,percent of total billed charges,,
Us Carotid Bilateral Routine,,93880,CPT,Facility,Both,,,,802,681.7,229.8532,802,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,229.8532,28.66,,percent of total billed charges,,
Us Carotid Bilateral Routine,,93880,CPT,Facility,Outpatient,,,,802,681.7,229.8532,802,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),392.98,49,,percent of total billed charges,,
Us Carotid Bilateral Routine,,93880,CPT,Facility,Inpatient,,,,802,681.7,229.8532,802,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Us Carotid Bilateral Routine,,93880,CPT,Facility,Both,,,,802,681.7,229.8532,802,CorVel,Worker's Compensation,802,100,,percent of total billed charges,,
Us Carotid Bilateral Routine,,93880,CPT,Facility,Both,,,,802,681.7,229.8532,802,First Health Group Corporation,First Health Network,777.94,97,,percent of total billed charges,,
Us Carotid Bilateral Routine,,93880,CPT,Facility,Both,,,,802,681.7,229.8532,802,"Health Partners, Inc.",Commercial,758.692,94.6,,percent of total billed charges,,
Us Carotid Bilateral Routine,,93880,CPT,Facility,Outpatient,,,,802,681.7,229.8532,802,"Health Partners, Inc.",Medicare Advantage,392.98,49,,percent of total billed charges,,
Us Carotid Bilateral Routine,,93880,CPT,Facility,Inpatient,,,,802,681.7,229.8532,802,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Us Carotid Bilateral Routine,,93880,CPT,Facility,Both,,,,802,681.7,229.8532,802,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),481.2,60,,percent of total billed charges,,
Us Carotid Bilateral Routine,,93880,CPT,Facility,Both,,,,802,681.7,229.8532,802,"Health Partners, Inc.",State of Minnesota Advantage Program,653.63,81.5,,percent of total billed charges,,
Us Carotid Bilateral Routine,,93880,CPT,Facility,Both,,,,802,681.7,229.8532,802,"Health Partners, Inc.",State Public Programs,401,50,,percent of total billed charges,,
Us Carotid Bilateral Routine,,93880,CPT,Facility,Both,,,,802,681.7,229.8532,802,Humana Insurance Company,Commercial PPO,761.9,95,,percent of total billed charges,,
Us Carotid Bilateral Routine,,93880,CPT,Facility,Outpatient,,,,802,681.7,229.8532,802,Humana Insurance Company,Medicare PPO,392.98,49,,percent of total billed charges,,
Us Carotid Bilateral Routine,,93880,CPT,Facility,Inpatient,,,,802,681.7,229.8532,802,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Us Carotid Bilateral Routine,,93880,CPT,Facility,Both,,,,802,681.7,229.8532,802,Medica,Individual & Family,794.782,99.1,,percent of total billed charges,,
Us Carotid Bilateral Routine,,93880,CPT,Facility,Outpatient,,,,802,681.7,229.8532,802,Medica,Medica Advantage Solution,399.396,49.8,,percent of total billed charges,,
Us Carotid Bilateral Routine,,93880,CPT,Facility,Inpatient,,,,802,681.7,229.8532,802,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Us Carotid Bilateral Routine,,93880,CPT,Facility,Outpatient,,,,802,681.7,229.8532,802,Medica,Medical Assistance,357.692,44.6,,percent of total billed charges,,
Us Carotid Bilateral Routine,,93880,CPT,Facility,Inpatient,,,,802,681.7,229.8532,802,Medica,Medical Assistance,,,,,Included in per diem rate,
Us Carotid Bilateral Routine,,93880,CPT,Facility,Outpatient,,,,802,681.7,229.8532,802,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,399.396,49.8,,percent of total billed charges,,
Us Carotid Bilateral Routine,,93880,CPT,Facility,Inpatient,,,,802,681.7,229.8532,802,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Us Carotid Bilateral Routine,,93880,CPT,Facility,Both,,,,802,681.7,229.8532,802,"Multiplan, Inc.","Multiplan, Inc.",753.88,94,,percent of total billed charges,,
Us Carotid Bilateral Routine,,93880,CPT,Facility,Outpatient,,,,802,681.7,229.8532,802,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,722.602,90.1,,percent of total billed charges,,
Us Carotid Bilateral Routine,,93880,CPT,Facility,Inpatient,,,,802,681.7,229.8532,802,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Us Carotid Bilateral Routine,,93880,CPT,Facility,Both,,,,802,681.7,229.8532,802,"Preferred One Administrative Services, INC.",PPO,790.772,98.6,,percent of total billed charges,,
Us Carotid Bilateral Routine,,93880,CPT,Facility,Outpatient,,,,802,681.7,229.8532,802,PrimeWest Health,Minnesota Senior Health Options (MSHO),412.629,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Us Carotid Bilateral Routine,,93880,CPT,Facility,Inpatient,,,,802,681.7,229.8532,802,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Us Carotid Bilateral Routine,,93880,CPT,Facility,Outpatient,,,,802,681.7,229.8532,802,PrimeWest Health,MinnesotaCare,411.9072,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Us Carotid Bilateral Routine,,93880,CPT,Facility,Inpatient,,,,802,681.7,229.8532,802,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Us Carotid Bilateral Routine,,93880,CPT,Facility,Both,,,,802,681.7,229.8532,802,Sanford Health Plan,Sanford Health Plan,737.84,92,,percent of total billed charges,,
Us Carotid Bilateral Routine,,93880,CPT,Facility,Outpatient,,,,802,681.7,229.8532,802,"UCare Health, Inc.",Individual & Family Plan,451.927,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Us Carotid Bilateral Routine,,93880,CPT,Facility,Inpatient,,,,802,681.7,229.8532,802,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Us Carotid Bilateral Routine,,93880,CPT,Facility,Outpatient,,,,802,681.7,229.8532,802,"UCare Health, Inc.",Medical Assistance,404.7694,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Carotid Bilateral Routine,,93880,CPT,Facility,Inpatient,,,,802,681.7,229.8532,802,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Us Carotid Bilateral Routine,,93880,CPT,Facility,Outpatient,,,,802,681.7,229.8532,802,"UCare Health, Inc.",Medicare Advantage,404.7694,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Carotid Bilateral Routine,,93880,CPT,Facility,Inpatient,,,,802,681.7,229.8532,802,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Us Carotid Bilateral Routine,,93880,CPT,Facility,Outpatient,,,,802,681.7,229.8532,802,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),404.7694,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Carotid Bilateral Routine,,93880,CPT,Facility,Inpatient,,,,802,681.7,229.8532,802,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Us Carotid Bilateral Routine,,93880,CPT,Facility,Both,,,,802,681.7,229.8532,802,UnitedHealthcare,Individual & Family,753.88,94,,percent of total billed charges,,
Us Carotid Bilateral Routine,,93880,CPT,Facility,Outpatient,,,,802,681.7,229.8532,802,UnitedHealthcare,Medicare Advantage,392.98,49,,percent of total billed charges,,
Us Carotid Bilateral Routine,,93880,CPT,Facility,Inpatient,,,,802,681.7,229.8532,802,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Us Carotid Bilateral Routine,,93880,CPT,Facility,Outpatient,,,,802,681.7,229.8532,802,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,384.96,48,,percent of total billed charges,,100% of DHS outpatient percentage
Us Carotid Bilateral Routine,,93880,CPT,Facility,Inpatient,,,,802,681.7,229.8532,802,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Us Dop Extracranial Ltd,,93882,CPT,Facility,Both,,,,598,508.3,171.3868,598,Aetna,Commercial,550.16,92,,percent of total billed charges,,
Us Dop Extracranial Ltd,,93882,CPT,Facility,Outpatient,,,,598,508.3,171.3868,598,Aetna,Medicare Advantage,293.02,49,,percent of total billed charges,,
Us Dop Extracranial Ltd,,93882,CPT,Facility,Inpatient,,,,598,508.3,171.3868,598,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Us Dop Extracranial Ltd,,93882,CPT,Facility,Both,,,,598,508.3,171.3868,598,Aetna,PPO,556.14,93,,percent of total billed charges,,
Us Dop Extracranial Ltd,,93882,CPT,Facility,Both,,,,598,508.3,171.3868,598,America's PPO,America's PPO,574.2594,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Us Dop Extracranial Ltd,,93882,CPT,Facility,Both,,,,598,508.3,171.3868,598,BlueCross BlueShield Minnesota, Federal Employee Program,588.432,98.4,,percent of total billed charges,,
Us Dop Extracranial Ltd,,93882,CPT,Facility,Both,,,,598,508.3,171.3868,598,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,598,100,,percent of total billed charges,,
Us Dop Extracranial Ltd,,93882,CPT,Facility,Both,,,,598,508.3,171.3868,598,BlueCross BlueShield Minnesota,High Value Network Plan,538.2,90,,percent of total billed charges,,
Us Dop Extracranial Ltd,,93882,CPT,Facility,Outpatient,,,,598,508.3,171.3868,598,BlueCross BlueShield Minnesota,Medicare Advantage,293.02,49,,percent of total billed charges,,
Us Dop Extracranial Ltd,,93882,CPT,Facility,Inpatient,,,,598,508.3,171.3868,598,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Us Dop Extracranial Ltd,,93882,CPT,Facility,Both,,,,598,508.3,171.3868,598,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,529.6486,88.57,,percent of total billed charges,,
Us Dop Extracranial Ltd,,93882,CPT,Facility,Both,,,,598,508.3,171.3868,598,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,171.3868,28.66,,percent of total billed charges,,
Us Dop Extracranial Ltd,,93882,CPT,Facility,Outpatient,,,,598,508.3,171.3868,598,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),293.02,49,,percent of total billed charges,,
Us Dop Extracranial Ltd,,93882,CPT,Facility,Inpatient,,,,598,508.3,171.3868,598,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Us Dop Extracranial Ltd,,93882,CPT,Facility,Both,,,,598,508.3,171.3868,598,CorVel,Worker's Compensation,598,100,,percent of total billed charges,,
Us Dop Extracranial Ltd,,93882,CPT,Facility,Both,,,,598,508.3,171.3868,598,First Health Group Corporation,First Health Network,580.06,97,,percent of total billed charges,,
Us Dop Extracranial Ltd,,93882,CPT,Facility,Both,,,,598,508.3,171.3868,598,"Health Partners, Inc.",Commercial,565.708,94.6,,percent of total billed charges,,
Us Dop Extracranial Ltd,,93882,CPT,Facility,Outpatient,,,,598,508.3,171.3868,598,"Health Partners, Inc.",Medicare Advantage,293.02,49,,percent of total billed charges,,
Us Dop Extracranial Ltd,,93882,CPT,Facility,Inpatient,,,,598,508.3,171.3868,598,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Us Dop Extracranial Ltd,,93882,CPT,Facility,Both,,,,598,508.3,171.3868,598,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),358.8,60,,percent of total billed charges,,
Us Dop Extracranial Ltd,,93882,CPT,Facility,Both,,,,598,508.3,171.3868,598,"Health Partners, Inc.",State of Minnesota Advantage Program,487.37,81.5,,percent of total billed charges,,
Us Dop Extracranial Ltd,,93882,CPT,Facility,Both,,,,598,508.3,171.3868,598,"Health Partners, Inc.",State Public Programs,299,50,,percent of total billed charges,,
Us Dop Extracranial Ltd,,93882,CPT,Facility,Both,,,,598,508.3,171.3868,598,Humana Insurance Company,Commercial PPO,568.1,95,,percent of total billed charges,,
Us Dop Extracranial Ltd,,93882,CPT,Facility,Outpatient,,,,598,508.3,171.3868,598,Humana Insurance Company,Medicare PPO,293.02,49,,percent of total billed charges,,
Us Dop Extracranial Ltd,,93882,CPT,Facility,Inpatient,,,,598,508.3,171.3868,598,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Us Dop Extracranial Ltd,,93882,CPT,Facility,Both,,,,598,508.3,171.3868,598,Medica,Individual & Family,592.618,99.1,,percent of total billed charges,,
Us Dop Extracranial Ltd,,93882,CPT,Facility,Outpatient,,,,598,508.3,171.3868,598,Medica,Medica Advantage Solution,297.804,49.8,,percent of total billed charges,,
Us Dop Extracranial Ltd,,93882,CPT,Facility,Inpatient,,,,598,508.3,171.3868,598,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Us Dop Extracranial Ltd,,93882,CPT,Facility,Outpatient,,,,598,508.3,171.3868,598,Medica,Medical Assistance,266.708,44.6,,percent of total billed charges,,
Us Dop Extracranial Ltd,,93882,CPT,Facility,Inpatient,,,,598,508.3,171.3868,598,Medica,Medical Assistance,,,,,Included in per diem rate,
Us Dop Extracranial Ltd,,93882,CPT,Facility,Outpatient,,,,598,508.3,171.3868,598,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,297.804,49.8,,percent of total billed charges,,
Us Dop Extracranial Ltd,,93882,CPT,Facility,Inpatient,,,,598,508.3,171.3868,598,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Us Dop Extracranial Ltd,,93882,CPT,Facility,Both,,,,598,508.3,171.3868,598,"Multiplan, Inc.","Multiplan, Inc.",562.12,94,,percent of total billed charges,,
Us Dop Extracranial Ltd,,93882,CPT,Facility,Outpatient,,,,598,508.3,171.3868,598,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,538.798,90.1,,percent of total billed charges,,
Us Dop Extracranial Ltd,,93882,CPT,Facility,Inpatient,,,,598,508.3,171.3868,598,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Us Dop Extracranial Ltd,,93882,CPT,Facility,Both,,,,598,508.3,171.3868,598,"Preferred One Administrative Services, INC.",PPO,589.628,98.6,,percent of total billed charges,,
Us Dop Extracranial Ltd,,93882,CPT,Facility,Outpatient,,,,598,508.3,171.3868,598,PrimeWest Health,Minnesota Senior Health Options (MSHO),307.671,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Us Dop Extracranial Ltd,,93882,CPT,Facility,Inpatient,,,,598,508.3,171.3868,598,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Us Dop Extracranial Ltd,,93882,CPT,Facility,Outpatient,,,,598,508.3,171.3868,598,PrimeWest Health,MinnesotaCare,307.1328,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Us Dop Extracranial Ltd,,93882,CPT,Facility,Inpatient,,,,598,508.3,171.3868,598,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Us Dop Extracranial Ltd,,93882,CPT,Facility,Both,,,,598,508.3,171.3868,598,Sanford Health Plan,Sanford Health Plan,550.16,92,,percent of total billed charges,,
Us Dop Extracranial Ltd,,93882,CPT,Facility,Outpatient,,,,598,508.3,171.3868,598,"UCare Health, Inc.",Individual & Family Plan,336.973,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Us Dop Extracranial Ltd,,93882,CPT,Facility,Inpatient,,,,598,508.3,171.3868,598,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Us Dop Extracranial Ltd,,93882,CPT,Facility,Outpatient,,,,598,508.3,171.3868,598,"UCare Health, Inc.",Medical Assistance,301.8106,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Dop Extracranial Ltd,,93882,CPT,Facility,Inpatient,,,,598,508.3,171.3868,598,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Us Dop Extracranial Ltd,,93882,CPT,Facility,Outpatient,,,,598,508.3,171.3868,598,"UCare Health, Inc.",Medicare Advantage,301.8106,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Dop Extracranial Ltd,,93882,CPT,Facility,Inpatient,,,,598,508.3,171.3868,598,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Us Dop Extracranial Ltd,,93882,CPT,Facility,Outpatient,,,,598,508.3,171.3868,598,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),301.8106,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Dop Extracranial Ltd,,93882,CPT,Facility,Inpatient,,,,598,508.3,171.3868,598,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Us Dop Extracranial Ltd,,93882,CPT,Facility,Both,,,,598,508.3,171.3868,598,UnitedHealthcare,Individual & Family,562.12,94,,percent of total billed charges,,
Us Dop Extracranial Ltd,,93882,CPT,Facility,Outpatient,,,,598,508.3,171.3868,598,UnitedHealthcare,Medicare Advantage,293.02,49,,percent of total billed charges,,
Us Dop Extracranial Ltd,,93882,CPT,Facility,Inpatient,,,,598,508.3,171.3868,598,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Us Dop Extracranial Ltd,,93882,CPT,Facility,Outpatient,,,,598,508.3,171.3868,598,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,287.04,48,,percent of total billed charges,,100% of DHS outpatient percentage
Us Dop Extracranial Ltd,,93882,CPT,Facility,Inpatient,,,,598,508.3,171.3868,598,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Us Dop Ankle Brachial Index,,93922,CPT,Facility,Both,,,,449,381.65,128.6834,449,Aetna,Commercial,413.08,92,,percent of total billed charges,,
Us Dop Ankle Brachial Index,,93922,CPT,Facility,Outpatient,,,,449,381.65,128.6834,449,Aetna,Medicare Advantage,220.01,49,,percent of total billed charges,,
Us Dop Ankle Brachial Index,,93922,CPT,Facility,Inpatient,,,,449,381.65,128.6834,449,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Us Dop Ankle Brachial Index,,93922,CPT,Facility,Both,,,,449,381.65,128.6834,449,Aetna,PPO,417.57,93,,percent of total billed charges,,
Us Dop Ankle Brachial Index,,93922,CPT,Facility,Both,,,,449,381.65,128.6834,449,America's PPO,America's PPO,431.1747,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Us Dop Ankle Brachial Index,,93922,CPT,Facility,Both,,,,449,381.65,128.6834,449,BlueCross BlueShield Minnesota, Federal Employee Program,441.816,98.4,,percent of total billed charges,,
Us Dop Ankle Brachial Index,,93922,CPT,Facility,Both,,,,449,381.65,128.6834,449,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,449,100,,percent of total billed charges,,
Us Dop Ankle Brachial Index,,93922,CPT,Facility,Both,,,,449,381.65,128.6834,449,BlueCross BlueShield Minnesota,High Value Network Plan,404.1,90,,percent of total billed charges,,
Us Dop Ankle Brachial Index,,93922,CPT,Facility,Outpatient,,,,449,381.65,128.6834,449,BlueCross BlueShield Minnesota,Medicare Advantage,220.01,49,,percent of total billed charges,,
Us Dop Ankle Brachial Index,,93922,CPT,Facility,Inpatient,,,,449,381.65,128.6834,449,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Us Dop Ankle Brachial Index,,93922,CPT,Facility,Both,,,,449,381.65,128.6834,449,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,397.6793,88.57,,percent of total billed charges,,
Us Dop Ankle Brachial Index,,93922,CPT,Facility,Both,,,,449,381.65,128.6834,449,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,128.6834,28.66,,percent of total billed charges,,
Us Dop Ankle Brachial Index,,93922,CPT,Facility,Outpatient,,,,449,381.65,128.6834,449,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),220.01,49,,percent of total billed charges,,
Us Dop Ankle Brachial Index,,93922,CPT,Facility,Inpatient,,,,449,381.65,128.6834,449,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Us Dop Ankle Brachial Index,,93922,CPT,Facility,Both,,,,449,381.65,128.6834,449,CorVel,Worker's Compensation,449,100,,percent of total billed charges,,
Us Dop Ankle Brachial Index,,93922,CPT,Facility,Both,,,,449,381.65,128.6834,449,First Health Group Corporation,First Health Network,435.53,97,,percent of total billed charges,,
Us Dop Ankle Brachial Index,,93922,CPT,Facility,Both,,,,449,381.65,128.6834,449,"Health Partners, Inc.",Commercial,424.754,94.6,,percent of total billed charges,,
Us Dop Ankle Brachial Index,,93922,CPT,Facility,Outpatient,,,,449,381.65,128.6834,449,"Health Partners, Inc.",Medicare Advantage,220.01,49,,percent of total billed charges,,
Us Dop Ankle Brachial Index,,93922,CPT,Facility,Inpatient,,,,449,381.65,128.6834,449,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Us Dop Ankle Brachial Index,,93922,CPT,Facility,Both,,,,449,381.65,128.6834,449,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),269.4,60,,percent of total billed charges,,
Us Dop Ankle Brachial Index,,93922,CPT,Facility,Both,,,,449,381.65,128.6834,449,"Health Partners, Inc.",State of Minnesota Advantage Program,365.935,81.5,,percent of total billed charges,,
Us Dop Ankle Brachial Index,,93922,CPT,Facility,Both,,,,449,381.65,128.6834,449,"Health Partners, Inc.",State Public Programs,224.5,50,,percent of total billed charges,,
Us Dop Ankle Brachial Index,,93922,CPT,Facility,Both,,,,449,381.65,128.6834,449,Humana Insurance Company,Commercial PPO,426.55,95,,percent of total billed charges,,
Us Dop Ankle Brachial Index,,93922,CPT,Facility,Outpatient,,,,449,381.65,128.6834,449,Humana Insurance Company,Medicare PPO,220.01,49,,percent of total billed charges,,
Us Dop Ankle Brachial Index,,93922,CPT,Facility,Inpatient,,,,449,381.65,128.6834,449,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Us Dop Ankle Brachial Index,,93922,CPT,Facility,Both,,,,449,381.65,128.6834,449,Medica,Individual & Family,444.959,99.1,,percent of total billed charges,,
Us Dop Ankle Brachial Index,,93922,CPT,Facility,Outpatient,,,,449,381.65,128.6834,449,Medica,Medica Advantage Solution,223.602,49.8,,percent of total billed charges,,
Us Dop Ankle Brachial Index,,93922,CPT,Facility,Inpatient,,,,449,381.65,128.6834,449,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Us Dop Ankle Brachial Index,,93922,CPT,Facility,Outpatient,,,,449,381.65,128.6834,449,Medica,Medical Assistance,200.254,44.6,,percent of total billed charges,,
Us Dop Ankle Brachial Index,,93922,CPT,Facility,Inpatient,,,,449,381.65,128.6834,449,Medica,Medical Assistance,,,,,Included in per diem rate,
Us Dop Ankle Brachial Index,,93922,CPT,Facility,Outpatient,,,,449,381.65,128.6834,449,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,223.602,49.8,,percent of total billed charges,,
Us Dop Ankle Brachial Index,,93922,CPT,Facility,Inpatient,,,,449,381.65,128.6834,449,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Us Dop Ankle Brachial Index,,93922,CPT,Facility,Both,,,,449,381.65,128.6834,449,"Multiplan, Inc.","Multiplan, Inc.",422.06,94,,percent of total billed charges,,
Us Dop Ankle Brachial Index,,93922,CPT,Facility,Outpatient,,,,449,381.65,128.6834,449,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,404.549,90.1,,percent of total billed charges,,
Us Dop Ankle Brachial Index,,93922,CPT,Facility,Inpatient,,,,449,381.65,128.6834,449,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Us Dop Ankle Brachial Index,,93922,CPT,Facility,Both,,,,449,381.65,128.6834,449,"Preferred One Administrative Services, INC.",PPO,442.714,98.6,,percent of total billed charges,,
Us Dop Ankle Brachial Index,,93922,CPT,Facility,Outpatient,,,,449,381.65,128.6834,449,PrimeWest Health,Minnesota Senior Health Options (MSHO),231.0105,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Us Dop Ankle Brachial Index,,93922,CPT,Facility,Inpatient,,,,449,381.65,128.6834,449,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Us Dop Ankle Brachial Index,,93922,CPT,Facility,Outpatient,,,,449,381.65,128.6834,449,PrimeWest Health,MinnesotaCare,230.6064,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Us Dop Ankle Brachial Index,,93922,CPT,Facility,Inpatient,,,,449,381.65,128.6834,449,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Us Dop Ankle Brachial Index,,93922,CPT,Facility,Both,,,,449,381.65,128.6834,449,Sanford Health Plan,Sanford Health Plan,413.08,92,,percent of total billed charges,,
Us Dop Ankle Brachial Index,,93922,CPT,Facility,Outpatient,,,,449,381.65,128.6834,449,"UCare Health, Inc.",Individual & Family Plan,253.0115,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Us Dop Ankle Brachial Index,,93922,CPT,Facility,Inpatient,,,,449,381.65,128.6834,449,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Us Dop Ankle Brachial Index,,93922,CPT,Facility,Outpatient,,,,449,381.65,128.6834,449,"UCare Health, Inc.",Medical Assistance,226.6103,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Dop Ankle Brachial Index,,93922,CPT,Facility,Inpatient,,,,449,381.65,128.6834,449,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Us Dop Ankle Brachial Index,,93922,CPT,Facility,Outpatient,,,,449,381.65,128.6834,449,"UCare Health, Inc.",Medicare Advantage,226.6103,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Dop Ankle Brachial Index,,93922,CPT,Facility,Inpatient,,,,449,381.65,128.6834,449,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Us Dop Ankle Brachial Index,,93922,CPT,Facility,Outpatient,,,,449,381.65,128.6834,449,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),226.6103,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Dop Ankle Brachial Index,,93922,CPT,Facility,Inpatient,,,,449,381.65,128.6834,449,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Us Dop Ankle Brachial Index,,93922,CPT,Facility,Both,,,,449,381.65,128.6834,449,UnitedHealthcare,Individual & Family,422.06,94,,percent of total billed charges,,
Us Dop Ankle Brachial Index,,93922,CPT,Facility,Outpatient,,,,449,381.65,128.6834,449,UnitedHealthcare,Medicare Advantage,220.01,49,,percent of total billed charges,,
Us Dop Ankle Brachial Index,,93922,CPT,Facility,Inpatient,,,,449,381.65,128.6834,449,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Us Dop Ankle Brachial Index,,93922,CPT,Facility,Outpatient,,,,449,381.65,128.6834,449,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,215.52,48,,percent of total billed charges,,100% of DHS outpatient percentage
Us Dop Ankle Brachial Index,,93922,CPT,Facility,Inpatient,,,,449,381.65,128.6834,449,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Us Dop Pvr Seg Pressure Arm,,93923,CPT,Facility,Both,,,,602,511.7,172.5332,602,Aetna,Commercial,553.84,92,,percent of total billed charges,,
Us Dop Pvr Seg Pressure Arm,,93923,CPT,Facility,Outpatient,,,,602,511.7,172.5332,602,Aetna,Medicare Advantage,294.98,49,,percent of total billed charges,,
Us Dop Pvr Seg Pressure Arm,,93923,CPT,Facility,Inpatient,,,,602,511.7,172.5332,602,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Us Dop Pvr Seg Pressure Arm,,93923,CPT,Facility,Both,,,,602,511.7,172.5332,602,Aetna,PPO,559.86,93,,percent of total billed charges,,
Us Dop Pvr Seg Pressure Arm,,93923,CPT,Facility,Both,,,,602,511.7,172.5332,602,America's PPO,America's PPO,578.1006,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Us Dop Pvr Seg Pressure Arm,,93923,CPT,Facility,Both,,,,602,511.7,172.5332,602,BlueCross BlueShield Minnesota, Federal Employee Program,592.368,98.4,,percent of total billed charges,,
Us Dop Pvr Seg Pressure Arm,,93923,CPT,Facility,Both,,,,602,511.7,172.5332,602,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,602,100,,percent of total billed charges,,
Us Dop Pvr Seg Pressure Arm,,93923,CPT,Facility,Both,,,,602,511.7,172.5332,602,BlueCross BlueShield Minnesota,High Value Network Plan,541.8,90,,percent of total billed charges,,
Us Dop Pvr Seg Pressure Arm,,93923,CPT,Facility,Outpatient,,,,602,511.7,172.5332,602,BlueCross BlueShield Minnesota,Medicare Advantage,294.98,49,,percent of total billed charges,,
Us Dop Pvr Seg Pressure Arm,,93923,CPT,Facility,Inpatient,,,,602,511.7,172.5332,602,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Us Dop Pvr Seg Pressure Arm,,93923,CPT,Facility,Both,,,,602,511.7,172.5332,602,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,533.1914,88.57,,percent of total billed charges,,
Us Dop Pvr Seg Pressure Arm,,93923,CPT,Facility,Both,,,,602,511.7,172.5332,602,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,172.5332,28.66,,percent of total billed charges,,
Us Dop Pvr Seg Pressure Arm,,93923,CPT,Facility,Outpatient,,,,602,511.7,172.5332,602,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),294.98,49,,percent of total billed charges,,
Us Dop Pvr Seg Pressure Arm,,93923,CPT,Facility,Inpatient,,,,602,511.7,172.5332,602,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Us Dop Pvr Seg Pressure Arm,,93923,CPT,Facility,Both,,,,602,511.7,172.5332,602,CorVel,Worker's Compensation,602,100,,percent of total billed charges,,
Us Dop Pvr Seg Pressure Arm,,93923,CPT,Facility,Both,,,,602,511.7,172.5332,602,First Health Group Corporation,First Health Network,583.94,97,,percent of total billed charges,,
Us Dop Pvr Seg Pressure Arm,,93923,CPT,Facility,Both,,,,602,511.7,172.5332,602,"Health Partners, Inc.",Commercial,569.492,94.6,,percent of total billed charges,,
Us Dop Pvr Seg Pressure Arm,,93923,CPT,Facility,Outpatient,,,,602,511.7,172.5332,602,"Health Partners, Inc.",Medicare Advantage,294.98,49,,percent of total billed charges,,
Us Dop Pvr Seg Pressure Arm,,93923,CPT,Facility,Inpatient,,,,602,511.7,172.5332,602,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Us Dop Pvr Seg Pressure Arm,,93923,CPT,Facility,Both,,,,602,511.7,172.5332,602,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),361.2,60,,percent of total billed charges,,
Us Dop Pvr Seg Pressure Arm,,93923,CPT,Facility,Both,,,,602,511.7,172.5332,602,"Health Partners, Inc.",State of Minnesota Advantage Program,490.63,81.5,,percent of total billed charges,,
Us Dop Pvr Seg Pressure Arm,,93923,CPT,Facility,Both,,,,602,511.7,172.5332,602,"Health Partners, Inc.",State Public Programs,301,50,,percent of total billed charges,,
Us Dop Pvr Seg Pressure Arm,,93923,CPT,Facility,Both,,,,602,511.7,172.5332,602,Humana Insurance Company,Commercial PPO,571.9,95,,percent of total billed charges,,
Us Dop Pvr Seg Pressure Arm,,93923,CPT,Facility,Outpatient,,,,602,511.7,172.5332,602,Humana Insurance Company,Medicare PPO,294.98,49,,percent of total billed charges,,
Us Dop Pvr Seg Pressure Arm,,93923,CPT,Facility,Inpatient,,,,602,511.7,172.5332,602,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Us Dop Pvr Seg Pressure Arm,,93923,CPT,Facility,Both,,,,602,511.7,172.5332,602,Medica,Individual & Family,596.582,99.1,,percent of total billed charges,,
Us Dop Pvr Seg Pressure Arm,,93923,CPT,Facility,Outpatient,,,,602,511.7,172.5332,602,Medica,Medica Advantage Solution,299.796,49.8,,percent of total billed charges,,
Us Dop Pvr Seg Pressure Arm,,93923,CPT,Facility,Inpatient,,,,602,511.7,172.5332,602,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Us Dop Pvr Seg Pressure Arm,,93923,CPT,Facility,Outpatient,,,,602,511.7,172.5332,602,Medica,Medical Assistance,268.492,44.6,,percent of total billed charges,,
Us Dop Pvr Seg Pressure Arm,,93923,CPT,Facility,Inpatient,,,,602,511.7,172.5332,602,Medica,Medical Assistance,,,,,Included in per diem rate,
Us Dop Pvr Seg Pressure Arm,,93923,CPT,Facility,Outpatient,,,,602,511.7,172.5332,602,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,299.796,49.8,,percent of total billed charges,,
Us Dop Pvr Seg Pressure Arm,,93923,CPT,Facility,Inpatient,,,,602,511.7,172.5332,602,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Us Dop Pvr Seg Pressure Arm,,93923,CPT,Facility,Both,,,,602,511.7,172.5332,602,"Multiplan, Inc.","Multiplan, Inc.",565.88,94,,percent of total billed charges,,
Us Dop Pvr Seg Pressure Arm,,93923,CPT,Facility,Outpatient,,,,602,511.7,172.5332,602,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,542.402,90.1,,percent of total billed charges,,
Us Dop Pvr Seg Pressure Arm,,93923,CPT,Facility,Inpatient,,,,602,511.7,172.5332,602,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Us Dop Pvr Seg Pressure Arm,,93923,CPT,Facility,Both,,,,602,511.7,172.5332,602,"Preferred One Administrative Services, INC.",PPO,593.572,98.6,,percent of total billed charges,,
Us Dop Pvr Seg Pressure Arm,,93923,CPT,Facility,Outpatient,,,,602,511.7,172.5332,602,PrimeWest Health,Minnesota Senior Health Options (MSHO),309.729,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Us Dop Pvr Seg Pressure Arm,,93923,CPT,Facility,Inpatient,,,,602,511.7,172.5332,602,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Us Dop Pvr Seg Pressure Arm,,93923,CPT,Facility,Outpatient,,,,602,511.7,172.5332,602,PrimeWest Health,MinnesotaCare,309.1872,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Us Dop Pvr Seg Pressure Arm,,93923,CPT,Facility,Inpatient,,,,602,511.7,172.5332,602,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Us Dop Pvr Seg Pressure Arm,,93923,CPT,Facility,Both,,,,602,511.7,172.5332,602,Sanford Health Plan,Sanford Health Plan,553.84,92,,percent of total billed charges,,
Us Dop Pvr Seg Pressure Arm,,93923,CPT,Facility,Outpatient,,,,602,511.7,172.5332,602,"UCare Health, Inc.",Individual & Family Plan,339.227,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Us Dop Pvr Seg Pressure Arm,,93923,CPT,Facility,Inpatient,,,,602,511.7,172.5332,602,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Us Dop Pvr Seg Pressure Arm,,93923,CPT,Facility,Outpatient,,,,602,511.7,172.5332,602,"UCare Health, Inc.",Medical Assistance,303.8294,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Dop Pvr Seg Pressure Arm,,93923,CPT,Facility,Inpatient,,,,602,511.7,172.5332,602,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Us Dop Pvr Seg Pressure Arm,,93923,CPT,Facility,Outpatient,,,,602,511.7,172.5332,602,"UCare Health, Inc.",Medicare Advantage,303.8294,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Dop Pvr Seg Pressure Arm,,93923,CPT,Facility,Inpatient,,,,602,511.7,172.5332,602,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Us Dop Pvr Seg Pressure Arm,,93923,CPT,Facility,Outpatient,,,,602,511.7,172.5332,602,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),303.8294,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Dop Pvr Seg Pressure Arm,,93923,CPT,Facility,Inpatient,,,,602,511.7,172.5332,602,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Us Dop Pvr Seg Pressure Arm,,93923,CPT,Facility,Both,,,,602,511.7,172.5332,602,UnitedHealthcare,Individual & Family,565.88,94,,percent of total billed charges,,
Us Dop Pvr Seg Pressure Arm,,93923,CPT,Facility,Outpatient,,,,602,511.7,172.5332,602,UnitedHealthcare,Medicare Advantage,294.98,49,,percent of total billed charges,,
Us Dop Pvr Seg Pressure Arm,,93923,CPT,Facility,Inpatient,,,,602,511.7,172.5332,602,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Us Dop Pvr Seg Pressure Arm,,93923,CPT,Facility,Outpatient,,,,602,511.7,172.5332,602,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,288.96,48,,percent of total billed charges,,100% of DHS outpatient percentage
Us Dop Pvr Seg Pressure Arm,,93923,CPT,Facility,Inpatient,,,,602,511.7,172.5332,602,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Us Dop Pvr Seg Pressure Leg,,93923,CPT,Facility,Both,,,,602,511.7,172.5332,602,Aetna,Commercial,553.84,92,,percent of total billed charges,,
Us Dop Pvr Seg Pressure Leg,,93923,CPT,Facility,Outpatient,,,,602,511.7,172.5332,602,Aetna,Medicare Advantage,294.98,49,,percent of total billed charges,,
Us Dop Pvr Seg Pressure Leg,,93923,CPT,Facility,Inpatient,,,,602,511.7,172.5332,602,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Us Dop Pvr Seg Pressure Leg,,93923,CPT,Facility,Both,,,,602,511.7,172.5332,602,Aetna,PPO,559.86,93,,percent of total billed charges,,
Us Dop Pvr Seg Pressure Leg,,93923,CPT,Facility,Both,,,,602,511.7,172.5332,602,America's PPO,America's PPO,578.1006,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Us Dop Pvr Seg Pressure Leg,,93923,CPT,Facility,Both,,,,602,511.7,172.5332,602,BlueCross BlueShield Minnesota, Federal Employee Program,592.368,98.4,,percent of total billed charges,,
Us Dop Pvr Seg Pressure Leg,,93923,CPT,Facility,Both,,,,602,511.7,172.5332,602,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,602,100,,percent of total billed charges,,
Us Dop Pvr Seg Pressure Leg,,93923,CPT,Facility,Both,,,,602,511.7,172.5332,602,BlueCross BlueShield Minnesota,High Value Network Plan,541.8,90,,percent of total billed charges,,
Us Dop Pvr Seg Pressure Leg,,93923,CPT,Facility,Outpatient,,,,602,511.7,172.5332,602,BlueCross BlueShield Minnesota,Medicare Advantage,294.98,49,,percent of total billed charges,,
Us Dop Pvr Seg Pressure Leg,,93923,CPT,Facility,Inpatient,,,,602,511.7,172.5332,602,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Us Dop Pvr Seg Pressure Leg,,93923,CPT,Facility,Both,,,,602,511.7,172.5332,602,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,533.1914,88.57,,percent of total billed charges,,
Us Dop Pvr Seg Pressure Leg,,93923,CPT,Facility,Both,,,,602,511.7,172.5332,602,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,172.5332,28.66,,percent of total billed charges,,
Us Dop Pvr Seg Pressure Leg,,93923,CPT,Facility,Outpatient,,,,602,511.7,172.5332,602,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),294.98,49,,percent of total billed charges,,
Us Dop Pvr Seg Pressure Leg,,93923,CPT,Facility,Inpatient,,,,602,511.7,172.5332,602,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Us Dop Pvr Seg Pressure Leg,,93923,CPT,Facility,Both,,,,602,511.7,172.5332,602,CorVel,Worker's Compensation,602,100,,percent of total billed charges,,
Us Dop Pvr Seg Pressure Leg,,93923,CPT,Facility,Both,,,,602,511.7,172.5332,602,First Health Group Corporation,First Health Network,583.94,97,,percent of total billed charges,,
Us Dop Pvr Seg Pressure Leg,,93923,CPT,Facility,Both,,,,602,511.7,172.5332,602,"Health Partners, Inc.",Commercial,569.492,94.6,,percent of total billed charges,,
Us Dop Pvr Seg Pressure Leg,,93923,CPT,Facility,Outpatient,,,,602,511.7,172.5332,602,"Health Partners, Inc.",Medicare Advantage,294.98,49,,percent of total billed charges,,
Us Dop Pvr Seg Pressure Leg,,93923,CPT,Facility,Inpatient,,,,602,511.7,172.5332,602,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Us Dop Pvr Seg Pressure Leg,,93923,CPT,Facility,Both,,,,602,511.7,172.5332,602,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),361.2,60,,percent of total billed charges,,
Us Dop Pvr Seg Pressure Leg,,93923,CPT,Facility,Both,,,,602,511.7,172.5332,602,"Health Partners, Inc.",State of Minnesota Advantage Program,490.63,81.5,,percent of total billed charges,,
Us Dop Pvr Seg Pressure Leg,,93923,CPT,Facility,Both,,,,602,511.7,172.5332,602,"Health Partners, Inc.",State Public Programs,301,50,,percent of total billed charges,,
Us Dop Pvr Seg Pressure Leg,,93923,CPT,Facility,Both,,,,602,511.7,172.5332,602,Humana Insurance Company,Commercial PPO,571.9,95,,percent of total billed charges,,
Us Dop Pvr Seg Pressure Leg,,93923,CPT,Facility,Outpatient,,,,602,511.7,172.5332,602,Humana Insurance Company,Medicare PPO,294.98,49,,percent of total billed charges,,
Us Dop Pvr Seg Pressure Leg,,93923,CPT,Facility,Inpatient,,,,602,511.7,172.5332,602,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Us Dop Pvr Seg Pressure Leg,,93923,CPT,Facility,Both,,,,602,511.7,172.5332,602,Medica,Individual & Family,596.582,99.1,,percent of total billed charges,,
Us Dop Pvr Seg Pressure Leg,,93923,CPT,Facility,Outpatient,,,,602,511.7,172.5332,602,Medica,Medica Advantage Solution,299.796,49.8,,percent of total billed charges,,
Us Dop Pvr Seg Pressure Leg,,93923,CPT,Facility,Inpatient,,,,602,511.7,172.5332,602,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Us Dop Pvr Seg Pressure Leg,,93923,CPT,Facility,Outpatient,,,,602,511.7,172.5332,602,Medica,Medical Assistance,268.492,44.6,,percent of total billed charges,,
Us Dop Pvr Seg Pressure Leg,,93923,CPT,Facility,Inpatient,,,,602,511.7,172.5332,602,Medica,Medical Assistance,,,,,Included in per diem rate,
Us Dop Pvr Seg Pressure Leg,,93923,CPT,Facility,Outpatient,,,,602,511.7,172.5332,602,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,299.796,49.8,,percent of total billed charges,,
Us Dop Pvr Seg Pressure Leg,,93923,CPT,Facility,Inpatient,,,,602,511.7,172.5332,602,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Us Dop Pvr Seg Pressure Leg,,93923,CPT,Facility,Both,,,,602,511.7,172.5332,602,"Multiplan, Inc.","Multiplan, Inc.",565.88,94,,percent of total billed charges,,
Us Dop Pvr Seg Pressure Leg,,93923,CPT,Facility,Outpatient,,,,602,511.7,172.5332,602,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,542.402,90.1,,percent of total billed charges,,
Us Dop Pvr Seg Pressure Leg,,93923,CPT,Facility,Inpatient,,,,602,511.7,172.5332,602,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Us Dop Pvr Seg Pressure Leg,,93923,CPT,Facility,Both,,,,602,511.7,172.5332,602,"Preferred One Administrative Services, INC.",PPO,593.572,98.6,,percent of total billed charges,,
Us Dop Pvr Seg Pressure Leg,,93923,CPT,Facility,Outpatient,,,,602,511.7,172.5332,602,PrimeWest Health,Minnesota Senior Health Options (MSHO),309.729,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Us Dop Pvr Seg Pressure Leg,,93923,CPT,Facility,Inpatient,,,,602,511.7,172.5332,602,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Us Dop Pvr Seg Pressure Leg,,93923,CPT,Facility,Outpatient,,,,602,511.7,172.5332,602,PrimeWest Health,MinnesotaCare,309.1872,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Us Dop Pvr Seg Pressure Leg,,93923,CPT,Facility,Inpatient,,,,602,511.7,172.5332,602,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Us Dop Pvr Seg Pressure Leg,,93923,CPT,Facility,Both,,,,602,511.7,172.5332,602,Sanford Health Plan,Sanford Health Plan,553.84,92,,percent of total billed charges,,
Us Dop Pvr Seg Pressure Leg,,93923,CPT,Facility,Outpatient,,,,602,511.7,172.5332,602,"UCare Health, Inc.",Individual & Family Plan,339.227,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Us Dop Pvr Seg Pressure Leg,,93923,CPT,Facility,Inpatient,,,,602,511.7,172.5332,602,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Us Dop Pvr Seg Pressure Leg,,93923,CPT,Facility,Outpatient,,,,602,511.7,172.5332,602,"UCare Health, Inc.",Medical Assistance,303.8294,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Dop Pvr Seg Pressure Leg,,93923,CPT,Facility,Inpatient,,,,602,511.7,172.5332,602,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Us Dop Pvr Seg Pressure Leg,,93923,CPT,Facility,Outpatient,,,,602,511.7,172.5332,602,"UCare Health, Inc.",Medicare Advantage,303.8294,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Dop Pvr Seg Pressure Leg,,93923,CPT,Facility,Inpatient,,,,602,511.7,172.5332,602,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Us Dop Pvr Seg Pressure Leg,,93923,CPT,Facility,Outpatient,,,,602,511.7,172.5332,602,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),303.8294,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Dop Pvr Seg Pressure Leg,,93923,CPT,Facility,Inpatient,,,,602,511.7,172.5332,602,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Us Dop Pvr Seg Pressure Leg,,93923,CPT,Facility,Both,,,,602,511.7,172.5332,602,UnitedHealthcare,Individual & Family,565.88,94,,percent of total billed charges,,
Us Dop Pvr Seg Pressure Leg,,93923,CPT,Facility,Outpatient,,,,602,511.7,172.5332,602,UnitedHealthcare,Medicare Advantage,294.98,49,,percent of total billed charges,,
Us Dop Pvr Seg Pressure Leg,,93923,CPT,Facility,Inpatient,,,,602,511.7,172.5332,602,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Us Dop Pvr Seg Pressure Leg,,93923,CPT,Facility,Outpatient,,,,602,511.7,172.5332,602,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,288.96,48,,percent of total billed charges,,100% of DHS outpatient percentage
Us Dop Pvr Seg Pressure Leg,,93923,CPT,Facility,Inpatient,,,,602,511.7,172.5332,602,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Us Dop Artery Leg Bil,,93925,CPT,Facility,Both,,,,978,831.3,280.2948,978,Aetna,Commercial,899.76,92,,percent of total billed charges,,
Us Dop Artery Leg Bil,,93925,CPT,Facility,Outpatient,,,,978,831.3,280.2948,978,Aetna,Medicare Advantage,479.22,49,,percent of total billed charges,,
Us Dop Artery Leg Bil,,93925,CPT,Facility,Inpatient,,,,978,831.3,280.2948,978,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Us Dop Artery Leg Bil,,93925,CPT,Facility,Both,,,,978,831.3,280.2948,978,Aetna,PPO,909.54,93,,percent of total billed charges,,
Us Dop Artery Leg Bil,,93925,CPT,Facility,Both,,,,978,831.3,280.2948,978,America's PPO,America's PPO,939.1734,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Us Dop Artery Leg Bil,,93925,CPT,Facility,Both,,,,978,831.3,280.2948,978,BlueCross BlueShield Minnesota, Federal Employee Program,962.352,98.4,,percent of total billed charges,,
Us Dop Artery Leg Bil,,93925,CPT,Facility,Both,,,,978,831.3,280.2948,978,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,978,100,,percent of total billed charges,,
Us Dop Artery Leg Bil,,93925,CPT,Facility,Both,,,,978,831.3,280.2948,978,BlueCross BlueShield Minnesota,High Value Network Plan,880.2,90,,percent of total billed charges,,
Us Dop Artery Leg Bil,,93925,CPT,Facility,Outpatient,,,,978,831.3,280.2948,978,BlueCross BlueShield Minnesota,Medicare Advantage,479.22,49,,percent of total billed charges,,
Us Dop Artery Leg Bil,,93925,CPT,Facility,Inpatient,,,,978,831.3,280.2948,978,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Us Dop Artery Leg Bil,,93925,CPT,Facility,Both,,,,978,831.3,280.2948,978,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,866.2146,88.57,,percent of total billed charges,,
Us Dop Artery Leg Bil,,93925,CPT,Facility,Both,,,,978,831.3,280.2948,978,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,280.2948,28.66,,percent of total billed charges,,
Us Dop Artery Leg Bil,,93925,CPT,Facility,Outpatient,,,,978,831.3,280.2948,978,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),479.22,49,,percent of total billed charges,,
Us Dop Artery Leg Bil,,93925,CPT,Facility,Inpatient,,,,978,831.3,280.2948,978,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Us Dop Artery Leg Bil,,93925,CPT,Facility,Both,,,,978,831.3,280.2948,978,CorVel,Worker's Compensation,978,100,,percent of total billed charges,,
Us Dop Artery Leg Bil,,93925,CPT,Facility,Both,,,,978,831.3,280.2948,978,First Health Group Corporation,First Health Network,948.66,97,,percent of total billed charges,,
Us Dop Artery Leg Bil,,93925,CPT,Facility,Both,,,,978,831.3,280.2948,978,"Health Partners, Inc.",Commercial,925.188,94.6,,percent of total billed charges,,
Us Dop Artery Leg Bil,,93925,CPT,Facility,Outpatient,,,,978,831.3,280.2948,978,"Health Partners, Inc.",Medicare Advantage,479.22,49,,percent of total billed charges,,
Us Dop Artery Leg Bil,,93925,CPT,Facility,Inpatient,,,,978,831.3,280.2948,978,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Us Dop Artery Leg Bil,,93925,CPT,Facility,Both,,,,978,831.3,280.2948,978,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),586.8,60,,percent of total billed charges,,
Us Dop Artery Leg Bil,,93925,CPT,Facility,Both,,,,978,831.3,280.2948,978,"Health Partners, Inc.",State of Minnesota Advantage Program,797.07,81.5,,percent of total billed charges,,
Us Dop Artery Leg Bil,,93925,CPT,Facility,Both,,,,978,831.3,280.2948,978,"Health Partners, Inc.",State Public Programs,489,50,,percent of total billed charges,,
Us Dop Artery Leg Bil,,93925,CPT,Facility,Both,,,,978,831.3,280.2948,978,Humana Insurance Company,Commercial PPO,929.1,95,,percent of total billed charges,,
Us Dop Artery Leg Bil,,93925,CPT,Facility,Outpatient,,,,978,831.3,280.2948,978,Humana Insurance Company,Medicare PPO,479.22,49,,percent of total billed charges,,
Us Dop Artery Leg Bil,,93925,CPT,Facility,Inpatient,,,,978,831.3,280.2948,978,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Us Dop Artery Leg Bil,,93925,CPT,Facility,Both,,,,978,831.3,280.2948,978,Medica,Individual & Family,969.198,99.1,,percent of total billed charges,,
Us Dop Artery Leg Bil,,93925,CPT,Facility,Outpatient,,,,978,831.3,280.2948,978,Medica,Medica Advantage Solution,487.044,49.8,,percent of total billed charges,,
Us Dop Artery Leg Bil,,93925,CPT,Facility,Inpatient,,,,978,831.3,280.2948,978,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Us Dop Artery Leg Bil,,93925,CPT,Facility,Outpatient,,,,978,831.3,280.2948,978,Medica,Medical Assistance,436.188,44.6,,percent of total billed charges,,
Us Dop Artery Leg Bil,,93925,CPT,Facility,Inpatient,,,,978,831.3,280.2948,978,Medica,Medical Assistance,,,,,Included in per diem rate,
Us Dop Artery Leg Bil,,93925,CPT,Facility,Outpatient,,,,978,831.3,280.2948,978,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,487.044,49.8,,percent of total billed charges,,
Us Dop Artery Leg Bil,,93925,CPT,Facility,Inpatient,,,,978,831.3,280.2948,978,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Us Dop Artery Leg Bil,,93925,CPT,Facility,Both,,,,978,831.3,280.2948,978,"Multiplan, Inc.","Multiplan, Inc.",919.32,94,,percent of total billed charges,,
Us Dop Artery Leg Bil,,93925,CPT,Facility,Outpatient,,,,978,831.3,280.2948,978,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,881.178,90.1,,percent of total billed charges,,
Us Dop Artery Leg Bil,,93925,CPT,Facility,Inpatient,,,,978,831.3,280.2948,978,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Us Dop Artery Leg Bil,,93925,CPT,Facility,Both,,,,978,831.3,280.2948,978,"Preferred One Administrative Services, INC.",PPO,964.308,98.6,,percent of total billed charges,,
Us Dop Artery Leg Bil,,93925,CPT,Facility,Outpatient,,,,978,831.3,280.2948,978,PrimeWest Health,Minnesota Senior Health Options (MSHO),503.181,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Us Dop Artery Leg Bil,,93925,CPT,Facility,Inpatient,,,,978,831.3,280.2948,978,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Us Dop Artery Leg Bil,,93925,CPT,Facility,Outpatient,,,,978,831.3,280.2948,978,PrimeWest Health,MinnesotaCare,502.3008,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Us Dop Artery Leg Bil,,93925,CPT,Facility,Inpatient,,,,978,831.3,280.2948,978,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Us Dop Artery Leg Bil,,93925,CPT,Facility,Both,,,,978,831.3,280.2948,978,Sanford Health Plan,Sanford Health Plan,899.76,92,,percent of total billed charges,,
Us Dop Artery Leg Bil,,93925,CPT,Facility,Outpatient,,,,978,831.3,280.2948,978,"UCare Health, Inc.",Individual & Family Plan,551.103,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Us Dop Artery Leg Bil,,93925,CPT,Facility,Inpatient,,,,978,831.3,280.2948,978,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Us Dop Artery Leg Bil,,93925,CPT,Facility,Outpatient,,,,978,831.3,280.2948,978,"UCare Health, Inc.",Medical Assistance,493.5966,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Dop Artery Leg Bil,,93925,CPT,Facility,Inpatient,,,,978,831.3,280.2948,978,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Us Dop Artery Leg Bil,,93925,CPT,Facility,Outpatient,,,,978,831.3,280.2948,978,"UCare Health, Inc.",Medicare Advantage,493.5966,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Dop Artery Leg Bil,,93925,CPT,Facility,Inpatient,,,,978,831.3,280.2948,978,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Us Dop Artery Leg Bil,,93925,CPT,Facility,Outpatient,,,,978,831.3,280.2948,978,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),493.5966,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Dop Artery Leg Bil,,93925,CPT,Facility,Inpatient,,,,978,831.3,280.2948,978,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Us Dop Artery Leg Bil,,93925,CPT,Facility,Both,,,,978,831.3,280.2948,978,UnitedHealthcare,Individual & Family,919.32,94,,percent of total billed charges,,
Us Dop Artery Leg Bil,,93925,CPT,Facility,Outpatient,,,,978,831.3,280.2948,978,UnitedHealthcare,Medicare Advantage,479.22,49,,percent of total billed charges,,
Us Dop Artery Leg Bil,,93925,CPT,Facility,Inpatient,,,,978,831.3,280.2948,978,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Us Dop Artery Leg Bil,,93925,CPT,Facility,Outpatient,,,,978,831.3,280.2948,978,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,469.44,48,,percent of total billed charges,,100% of DHS outpatient percentage
Us Dop Artery Leg Bil,,93925,CPT,Facility,Inpatient,,,,978,831.3,280.2948,978,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Us Dop Artery Leg Ltd,,93926,CPT,Facility,Both,,,,636,540.6,182.2776,636,Aetna,Commercial,585.12,92,,percent of total billed charges,,
Us Dop Artery Leg Ltd,,93926,CPT,Facility,Outpatient,,,,636,540.6,182.2776,636,Aetna,Medicare Advantage,311.64,49,,percent of total billed charges,,
Us Dop Artery Leg Ltd,,93926,CPT,Facility,Inpatient,,,,636,540.6,182.2776,636,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Us Dop Artery Leg Ltd,,93926,CPT,Facility,Both,,,,636,540.6,182.2776,636,Aetna,PPO,591.48,93,,percent of total billed charges,,
Us Dop Artery Leg Ltd,,93926,CPT,Facility,Both,,,,636,540.6,182.2776,636,America's PPO,America's PPO,610.7508,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Us Dop Artery Leg Ltd,,93926,CPT,Facility,Both,,,,636,540.6,182.2776,636,BlueCross BlueShield Minnesota, Federal Employee Program,625.824,98.4,,percent of total billed charges,,
Us Dop Artery Leg Ltd,,93926,CPT,Facility,Both,,,,636,540.6,182.2776,636,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,636,100,,percent of total billed charges,,
Us Dop Artery Leg Ltd,,93926,CPT,Facility,Both,,,,636,540.6,182.2776,636,BlueCross BlueShield Minnesota,High Value Network Plan,572.4,90,,percent of total billed charges,,
Us Dop Artery Leg Ltd,,93926,CPT,Facility,Outpatient,,,,636,540.6,182.2776,636,BlueCross BlueShield Minnesota,Medicare Advantage,311.64,49,,percent of total billed charges,,
Us Dop Artery Leg Ltd,,93926,CPT,Facility,Inpatient,,,,636,540.6,182.2776,636,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Us Dop Artery Leg Ltd,,93926,CPT,Facility,Both,,,,636,540.6,182.2776,636,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,563.3052,88.57,,percent of total billed charges,,
Us Dop Artery Leg Ltd,,93926,CPT,Facility,Both,,,,636,540.6,182.2776,636,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,182.2776,28.66,,percent of total billed charges,,
Us Dop Artery Leg Ltd,,93926,CPT,Facility,Outpatient,,,,636,540.6,182.2776,636,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),311.64,49,,percent of total billed charges,,
Us Dop Artery Leg Ltd,,93926,CPT,Facility,Inpatient,,,,636,540.6,182.2776,636,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Us Dop Artery Leg Ltd,,93926,CPT,Facility,Both,,,,636,540.6,182.2776,636,CorVel,Worker's Compensation,636,100,,percent of total billed charges,,
Us Dop Artery Leg Ltd,,93926,CPT,Facility,Both,,,,636,540.6,182.2776,636,First Health Group Corporation,First Health Network,616.92,97,,percent of total billed charges,,
Us Dop Artery Leg Ltd,,93926,CPT,Facility,Both,,,,636,540.6,182.2776,636,"Health Partners, Inc.",Commercial,601.656,94.6,,percent of total billed charges,,
Us Dop Artery Leg Ltd,,93926,CPT,Facility,Outpatient,,,,636,540.6,182.2776,636,"Health Partners, Inc.",Medicare Advantage,311.64,49,,percent of total billed charges,,
Us Dop Artery Leg Ltd,,93926,CPT,Facility,Inpatient,,,,636,540.6,182.2776,636,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Us Dop Artery Leg Ltd,,93926,CPT,Facility,Both,,,,636,540.6,182.2776,636,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),381.6,60,,percent of total billed charges,,
Us Dop Artery Leg Ltd,,93926,CPT,Facility,Both,,,,636,540.6,182.2776,636,"Health Partners, Inc.",State of Minnesota Advantage Program,518.34,81.5,,percent of total billed charges,,
Us Dop Artery Leg Ltd,,93926,CPT,Facility,Both,,,,636,540.6,182.2776,636,"Health Partners, Inc.",State Public Programs,318,50,,percent of total billed charges,,
Us Dop Artery Leg Ltd,,93926,CPT,Facility,Both,,,,636,540.6,182.2776,636,Humana Insurance Company,Commercial PPO,604.2,95,,percent of total billed charges,,
Us Dop Artery Leg Ltd,,93926,CPT,Facility,Outpatient,,,,636,540.6,182.2776,636,Humana Insurance Company,Medicare PPO,311.64,49,,percent of total billed charges,,
Us Dop Artery Leg Ltd,,93926,CPT,Facility,Inpatient,,,,636,540.6,182.2776,636,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Us Dop Artery Leg Ltd,,93926,CPT,Facility,Both,,,,636,540.6,182.2776,636,Medica,Individual & Family,630.276,99.1,,percent of total billed charges,,
Us Dop Artery Leg Ltd,,93926,CPT,Facility,Outpatient,,,,636,540.6,182.2776,636,Medica,Medica Advantage Solution,316.728,49.8,,percent of total billed charges,,
Us Dop Artery Leg Ltd,,93926,CPT,Facility,Inpatient,,,,636,540.6,182.2776,636,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Us Dop Artery Leg Ltd,,93926,CPT,Facility,Outpatient,,,,636,540.6,182.2776,636,Medica,Medical Assistance,283.656,44.6,,percent of total billed charges,,
Us Dop Artery Leg Ltd,,93926,CPT,Facility,Inpatient,,,,636,540.6,182.2776,636,Medica,Medical Assistance,,,,,Included in per diem rate,
Us Dop Artery Leg Ltd,,93926,CPT,Facility,Outpatient,,,,636,540.6,182.2776,636,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,316.728,49.8,,percent of total billed charges,,
Us Dop Artery Leg Ltd,,93926,CPT,Facility,Inpatient,,,,636,540.6,182.2776,636,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Us Dop Artery Leg Ltd,,93926,CPT,Facility,Both,,,,636,540.6,182.2776,636,"Multiplan, Inc.","Multiplan, Inc.",597.84,94,,percent of total billed charges,,
Us Dop Artery Leg Ltd,,93926,CPT,Facility,Outpatient,,,,636,540.6,182.2776,636,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,573.036,90.1,,percent of total billed charges,,
Us Dop Artery Leg Ltd,,93926,CPT,Facility,Inpatient,,,,636,540.6,182.2776,636,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Us Dop Artery Leg Ltd,,93926,CPT,Facility,Both,,,,636,540.6,182.2776,636,"Preferred One Administrative Services, INC.",PPO,627.096,98.6,,percent of total billed charges,,
Us Dop Artery Leg Ltd,,93926,CPT,Facility,Outpatient,,,,636,540.6,182.2776,636,PrimeWest Health,Minnesota Senior Health Options (MSHO),327.222,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Us Dop Artery Leg Ltd,,93926,CPT,Facility,Inpatient,,,,636,540.6,182.2776,636,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Us Dop Artery Leg Ltd,,93926,CPT,Facility,Outpatient,,,,636,540.6,182.2776,636,PrimeWest Health,MinnesotaCare,326.6496,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Us Dop Artery Leg Ltd,,93926,CPT,Facility,Inpatient,,,,636,540.6,182.2776,636,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Us Dop Artery Leg Ltd,,93926,CPT,Facility,Both,,,,636,540.6,182.2776,636,Sanford Health Plan,Sanford Health Plan,585.12,92,,percent of total billed charges,,
Us Dop Artery Leg Ltd,,93926,CPT,Facility,Outpatient,,,,636,540.6,182.2776,636,"UCare Health, Inc.",Individual & Family Plan,358.386,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Us Dop Artery Leg Ltd,,93926,CPT,Facility,Inpatient,,,,636,540.6,182.2776,636,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Us Dop Artery Leg Ltd,,93926,CPT,Facility,Outpatient,,,,636,540.6,182.2776,636,"UCare Health, Inc.",Medical Assistance,320.9892,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Dop Artery Leg Ltd,,93926,CPT,Facility,Inpatient,,,,636,540.6,182.2776,636,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Us Dop Artery Leg Ltd,,93926,CPT,Facility,Outpatient,,,,636,540.6,182.2776,636,"UCare Health, Inc.",Medicare Advantage,320.9892,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Dop Artery Leg Ltd,,93926,CPT,Facility,Inpatient,,,,636,540.6,182.2776,636,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Us Dop Artery Leg Ltd,,93926,CPT,Facility,Outpatient,,,,636,540.6,182.2776,636,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),320.9892,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Dop Artery Leg Ltd,,93926,CPT,Facility,Inpatient,,,,636,540.6,182.2776,636,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Us Dop Artery Leg Ltd,,93926,CPT,Facility,Both,,,,636,540.6,182.2776,636,UnitedHealthcare,Individual & Family,597.84,94,,percent of total billed charges,,
Us Dop Artery Leg Ltd,,93926,CPT,Facility,Outpatient,,,,636,540.6,182.2776,636,UnitedHealthcare,Medicare Advantage,311.64,49,,percent of total billed charges,,
Us Dop Artery Leg Ltd,,93926,CPT,Facility,Inpatient,,,,636,540.6,182.2776,636,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Us Dop Artery Leg Ltd,,93926,CPT,Facility,Outpatient,,,,636,540.6,182.2776,636,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,305.28,48,,percent of total billed charges,,100% of DHS outpatient percentage
Us Dop Artery Leg Ltd,,93926,CPT,Facility,Inpatient,,,,636,540.6,182.2776,636,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Us Dop Artery Arm Bil,,93930,CPT,Facility,Both,,,,797,677.45,228.4202,797,Aetna,Commercial,733.24,92,,percent of total billed charges,,
Us Dop Artery Arm Bil,,93930,CPT,Facility,Outpatient,,,,797,677.45,228.4202,797,Aetna,Medicare Advantage,390.53,49,,percent of total billed charges,,
Us Dop Artery Arm Bil,,93930,CPT,Facility,Inpatient,,,,797,677.45,228.4202,797,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Us Dop Artery Arm Bil,,93930,CPT,Facility,Both,,,,797,677.45,228.4202,797,Aetna,PPO,741.21,93,,percent of total billed charges,,
Us Dop Artery Arm Bil,,93930,CPT,Facility,Both,,,,797,677.45,228.4202,797,America's PPO,America's PPO,765.3591,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Us Dop Artery Arm Bil,,93930,CPT,Facility,Both,,,,797,677.45,228.4202,797,BlueCross BlueShield Minnesota, Federal Employee Program,784.248,98.4,,percent of total billed charges,,
Us Dop Artery Arm Bil,,93930,CPT,Facility,Both,,,,797,677.45,228.4202,797,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,797,100,,percent of total billed charges,,
Us Dop Artery Arm Bil,,93930,CPT,Facility,Both,,,,797,677.45,228.4202,797,BlueCross BlueShield Minnesota,High Value Network Plan,717.3,90,,percent of total billed charges,,
Us Dop Artery Arm Bil,,93930,CPT,Facility,Outpatient,,,,797,677.45,228.4202,797,BlueCross BlueShield Minnesota,Medicare Advantage,390.53,49,,percent of total billed charges,,
Us Dop Artery Arm Bil,,93930,CPT,Facility,Inpatient,,,,797,677.45,228.4202,797,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Us Dop Artery Arm Bil,,93930,CPT,Facility,Both,,,,797,677.45,228.4202,797,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,705.9029,88.57,,percent of total billed charges,,
Us Dop Artery Arm Bil,,93930,CPT,Facility,Both,,,,797,677.45,228.4202,797,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,228.4202,28.66,,percent of total billed charges,,
Us Dop Artery Arm Bil,,93930,CPT,Facility,Outpatient,,,,797,677.45,228.4202,797,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),390.53,49,,percent of total billed charges,,
Us Dop Artery Arm Bil,,93930,CPT,Facility,Inpatient,,,,797,677.45,228.4202,797,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Us Dop Artery Arm Bil,,93930,CPT,Facility,Both,,,,797,677.45,228.4202,797,CorVel,Worker's Compensation,797,100,,percent of total billed charges,,
Us Dop Artery Arm Bil,,93930,CPT,Facility,Both,,,,797,677.45,228.4202,797,First Health Group Corporation,First Health Network,773.09,97,,percent of total billed charges,,
Us Dop Artery Arm Bil,,93930,CPT,Facility,Both,,,,797,677.45,228.4202,797,"Health Partners, Inc.",Commercial,753.962,94.6,,percent of total billed charges,,
Us Dop Artery Arm Bil,,93930,CPT,Facility,Outpatient,,,,797,677.45,228.4202,797,"Health Partners, Inc.",Medicare Advantage,390.53,49,,percent of total billed charges,,
Us Dop Artery Arm Bil,,93930,CPT,Facility,Inpatient,,,,797,677.45,228.4202,797,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Us Dop Artery Arm Bil,,93930,CPT,Facility,Both,,,,797,677.45,228.4202,797,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),478.2,60,,percent of total billed charges,,
Us Dop Artery Arm Bil,,93930,CPT,Facility,Both,,,,797,677.45,228.4202,797,"Health Partners, Inc.",State of Minnesota Advantage Program,649.555,81.5,,percent of total billed charges,,
Us Dop Artery Arm Bil,,93930,CPT,Facility,Both,,,,797,677.45,228.4202,797,"Health Partners, Inc.",State Public Programs,398.5,50,,percent of total billed charges,,
Us Dop Artery Arm Bil,,93930,CPT,Facility,Both,,,,797,677.45,228.4202,797,Humana Insurance Company,Commercial PPO,757.15,95,,percent of total billed charges,,
Us Dop Artery Arm Bil,,93930,CPT,Facility,Outpatient,,,,797,677.45,228.4202,797,Humana Insurance Company,Medicare PPO,390.53,49,,percent of total billed charges,,
Us Dop Artery Arm Bil,,93930,CPT,Facility,Inpatient,,,,797,677.45,228.4202,797,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Us Dop Artery Arm Bil,,93930,CPT,Facility,Both,,,,797,677.45,228.4202,797,Medica,Individual & Family,789.827,99.1,,percent of total billed charges,,
Us Dop Artery Arm Bil,,93930,CPT,Facility,Outpatient,,,,797,677.45,228.4202,797,Medica,Medica Advantage Solution,396.906,49.8,,percent of total billed charges,,
Us Dop Artery Arm Bil,,93930,CPT,Facility,Inpatient,,,,797,677.45,228.4202,797,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Us Dop Artery Arm Bil,,93930,CPT,Facility,Outpatient,,,,797,677.45,228.4202,797,Medica,Medical Assistance,355.462,44.6,,percent of total billed charges,,
Us Dop Artery Arm Bil,,93930,CPT,Facility,Inpatient,,,,797,677.45,228.4202,797,Medica,Medical Assistance,,,,,Included in per diem rate,
Us Dop Artery Arm Bil,,93930,CPT,Facility,Outpatient,,,,797,677.45,228.4202,797,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,396.906,49.8,,percent of total billed charges,,
Us Dop Artery Arm Bil,,93930,CPT,Facility,Inpatient,,,,797,677.45,228.4202,797,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Us Dop Artery Arm Bil,,93930,CPT,Facility,Both,,,,797,677.45,228.4202,797,"Multiplan, Inc.","Multiplan, Inc.",749.18,94,,percent of total billed charges,,
Us Dop Artery Arm Bil,,93930,CPT,Facility,Outpatient,,,,797,677.45,228.4202,797,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,718.097,90.1,,percent of total billed charges,,
Us Dop Artery Arm Bil,,93930,CPT,Facility,Inpatient,,,,797,677.45,228.4202,797,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Us Dop Artery Arm Bil,,93930,CPT,Facility,Both,,,,797,677.45,228.4202,797,"Preferred One Administrative Services, INC.",PPO,785.842,98.6,,percent of total billed charges,,
Us Dop Artery Arm Bil,,93930,CPT,Facility,Outpatient,,,,797,677.45,228.4202,797,PrimeWest Health,Minnesota Senior Health Options (MSHO),410.0565,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Us Dop Artery Arm Bil,,93930,CPT,Facility,Inpatient,,,,797,677.45,228.4202,797,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Us Dop Artery Arm Bil,,93930,CPT,Facility,Outpatient,,,,797,677.45,228.4202,797,PrimeWest Health,MinnesotaCare,409.3392,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Us Dop Artery Arm Bil,,93930,CPT,Facility,Inpatient,,,,797,677.45,228.4202,797,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Us Dop Artery Arm Bil,,93930,CPT,Facility,Both,,,,797,677.45,228.4202,797,Sanford Health Plan,Sanford Health Plan,733.24,92,,percent of total billed charges,,
Us Dop Artery Arm Bil,,93930,CPT,Facility,Outpatient,,,,797,677.45,228.4202,797,"UCare Health, Inc.",Individual & Family Plan,449.1095,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Us Dop Artery Arm Bil,,93930,CPT,Facility,Inpatient,,,,797,677.45,228.4202,797,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Us Dop Artery Arm Bil,,93930,CPT,Facility,Outpatient,,,,797,677.45,228.4202,797,"UCare Health, Inc.",Medical Assistance,402.2459,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Dop Artery Arm Bil,,93930,CPT,Facility,Inpatient,,,,797,677.45,228.4202,797,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Us Dop Artery Arm Bil,,93930,CPT,Facility,Outpatient,,,,797,677.45,228.4202,797,"UCare Health, Inc.",Medicare Advantage,402.2459,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Dop Artery Arm Bil,,93930,CPT,Facility,Inpatient,,,,797,677.45,228.4202,797,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Us Dop Artery Arm Bil,,93930,CPT,Facility,Outpatient,,,,797,677.45,228.4202,797,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),402.2459,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Dop Artery Arm Bil,,93930,CPT,Facility,Inpatient,,,,797,677.45,228.4202,797,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Us Dop Artery Arm Bil,,93930,CPT,Facility,Both,,,,797,677.45,228.4202,797,UnitedHealthcare,Individual & Family,749.18,94,,percent of total billed charges,,
Us Dop Artery Arm Bil,,93930,CPT,Facility,Outpatient,,,,797,677.45,228.4202,797,UnitedHealthcare,Medicare Advantage,390.53,49,,percent of total billed charges,,
Us Dop Artery Arm Bil,,93930,CPT,Facility,Inpatient,,,,797,677.45,228.4202,797,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Us Dop Artery Arm Bil,,93930,CPT,Facility,Outpatient,,,,797,677.45,228.4202,797,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,382.56,48,,percent of total billed charges,,100% of DHS outpatient percentage
Us Dop Artery Arm Bil,,93930,CPT,Facility,Inpatient,,,,797,677.45,228.4202,797,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Us Dop Artery Arm Ltd,,93931,CPT,Facility,Both,,,,606,515.1,173.6796,606,Aetna,Commercial,557.52,92,,percent of total billed charges,,
Us Dop Artery Arm Ltd,,93931,CPT,Facility,Outpatient,,,,606,515.1,173.6796,606,Aetna,Medicare Advantage,296.94,49,,percent of total billed charges,,
Us Dop Artery Arm Ltd,,93931,CPT,Facility,Inpatient,,,,606,515.1,173.6796,606,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Us Dop Artery Arm Ltd,,93931,CPT,Facility,Both,,,,606,515.1,173.6796,606,Aetna,PPO,563.58,93,,percent of total billed charges,,
Us Dop Artery Arm Ltd,,93931,CPT,Facility,Both,,,,606,515.1,173.6796,606,America's PPO,America's PPO,581.9418,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Us Dop Artery Arm Ltd,,93931,CPT,Facility,Both,,,,606,515.1,173.6796,606,BlueCross BlueShield Minnesota, Federal Employee Program,596.304,98.4,,percent of total billed charges,,
Us Dop Artery Arm Ltd,,93931,CPT,Facility,Both,,,,606,515.1,173.6796,606,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,606,100,,percent of total billed charges,,
Us Dop Artery Arm Ltd,,93931,CPT,Facility,Both,,,,606,515.1,173.6796,606,BlueCross BlueShield Minnesota,High Value Network Plan,545.4,90,,percent of total billed charges,,
Us Dop Artery Arm Ltd,,93931,CPT,Facility,Outpatient,,,,606,515.1,173.6796,606,BlueCross BlueShield Minnesota,Medicare Advantage,296.94,49,,percent of total billed charges,,
Us Dop Artery Arm Ltd,,93931,CPT,Facility,Inpatient,,,,606,515.1,173.6796,606,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Us Dop Artery Arm Ltd,,93931,CPT,Facility,Both,,,,606,515.1,173.6796,606,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,536.7342,88.57,,percent of total billed charges,,
Us Dop Artery Arm Ltd,,93931,CPT,Facility,Both,,,,606,515.1,173.6796,606,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,173.6796,28.66,,percent of total billed charges,,
Us Dop Artery Arm Ltd,,93931,CPT,Facility,Outpatient,,,,606,515.1,173.6796,606,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),296.94,49,,percent of total billed charges,,
Us Dop Artery Arm Ltd,,93931,CPT,Facility,Inpatient,,,,606,515.1,173.6796,606,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Us Dop Artery Arm Ltd,,93931,CPT,Facility,Both,,,,606,515.1,173.6796,606,CorVel,Worker's Compensation,606,100,,percent of total billed charges,,
Us Dop Artery Arm Ltd,,93931,CPT,Facility,Both,,,,606,515.1,173.6796,606,First Health Group Corporation,First Health Network,587.82,97,,percent of total billed charges,,
Us Dop Artery Arm Ltd,,93931,CPT,Facility,Both,,,,606,515.1,173.6796,606,"Health Partners, Inc.",Commercial,573.276,94.6,,percent of total billed charges,,
Us Dop Artery Arm Ltd,,93931,CPT,Facility,Outpatient,,,,606,515.1,173.6796,606,"Health Partners, Inc.",Medicare Advantage,296.94,49,,percent of total billed charges,,
Us Dop Artery Arm Ltd,,93931,CPT,Facility,Inpatient,,,,606,515.1,173.6796,606,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Us Dop Artery Arm Ltd,,93931,CPT,Facility,Both,,,,606,515.1,173.6796,606,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),363.6,60,,percent of total billed charges,,
Us Dop Artery Arm Ltd,,93931,CPT,Facility,Both,,,,606,515.1,173.6796,606,"Health Partners, Inc.",State of Minnesota Advantage Program,493.89,81.5,,percent of total billed charges,,
Us Dop Artery Arm Ltd,,93931,CPT,Facility,Both,,,,606,515.1,173.6796,606,"Health Partners, Inc.",State Public Programs,303,50,,percent of total billed charges,,
Us Dop Artery Arm Ltd,,93931,CPT,Facility,Both,,,,606,515.1,173.6796,606,Humana Insurance Company,Commercial PPO,575.7,95,,percent of total billed charges,,
Us Dop Artery Arm Ltd,,93931,CPT,Facility,Outpatient,,,,606,515.1,173.6796,606,Humana Insurance Company,Medicare PPO,296.94,49,,percent of total billed charges,,
Us Dop Artery Arm Ltd,,93931,CPT,Facility,Inpatient,,,,606,515.1,173.6796,606,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Us Dop Artery Arm Ltd,,93931,CPT,Facility,Both,,,,606,515.1,173.6796,606,Medica,Individual & Family,600.546,99.1,,percent of total billed charges,,
Us Dop Artery Arm Ltd,,93931,CPT,Facility,Outpatient,,,,606,515.1,173.6796,606,Medica,Medica Advantage Solution,301.788,49.8,,percent of total billed charges,,
Us Dop Artery Arm Ltd,,93931,CPT,Facility,Inpatient,,,,606,515.1,173.6796,606,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Us Dop Artery Arm Ltd,,93931,CPT,Facility,Outpatient,,,,606,515.1,173.6796,606,Medica,Medical Assistance,270.276,44.6,,percent of total billed charges,,
Us Dop Artery Arm Ltd,,93931,CPT,Facility,Inpatient,,,,606,515.1,173.6796,606,Medica,Medical Assistance,,,,,Included in per diem rate,
Us Dop Artery Arm Ltd,,93931,CPT,Facility,Outpatient,,,,606,515.1,173.6796,606,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,301.788,49.8,,percent of total billed charges,,
Us Dop Artery Arm Ltd,,93931,CPT,Facility,Inpatient,,,,606,515.1,173.6796,606,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Us Dop Artery Arm Ltd,,93931,CPT,Facility,Both,,,,606,515.1,173.6796,606,"Multiplan, Inc.","Multiplan, Inc.",569.64,94,,percent of total billed charges,,
Us Dop Artery Arm Ltd,,93931,CPT,Facility,Outpatient,,,,606,515.1,173.6796,606,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,546.006,90.1,,percent of total billed charges,,
Us Dop Artery Arm Ltd,,93931,CPT,Facility,Inpatient,,,,606,515.1,173.6796,606,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Us Dop Artery Arm Ltd,,93931,CPT,Facility,Both,,,,606,515.1,173.6796,606,"Preferred One Administrative Services, INC.",PPO,597.516,98.6,,percent of total billed charges,,
Us Dop Artery Arm Ltd,,93931,CPT,Facility,Outpatient,,,,606,515.1,173.6796,606,PrimeWest Health,Minnesota Senior Health Options (MSHO),311.787,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Us Dop Artery Arm Ltd,,93931,CPT,Facility,Inpatient,,,,606,515.1,173.6796,606,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Us Dop Artery Arm Ltd,,93931,CPT,Facility,Outpatient,,,,606,515.1,173.6796,606,PrimeWest Health,MinnesotaCare,311.2416,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Us Dop Artery Arm Ltd,,93931,CPT,Facility,Inpatient,,,,606,515.1,173.6796,606,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Us Dop Artery Arm Ltd,,93931,CPT,Facility,Both,,,,606,515.1,173.6796,606,Sanford Health Plan,Sanford Health Plan,557.52,92,,percent of total billed charges,,
Us Dop Artery Arm Ltd,,93931,CPT,Facility,Outpatient,,,,606,515.1,173.6796,606,"UCare Health, Inc.",Individual & Family Plan,341.481,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Us Dop Artery Arm Ltd,,93931,CPT,Facility,Inpatient,,,,606,515.1,173.6796,606,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Us Dop Artery Arm Ltd,,93931,CPT,Facility,Outpatient,,,,606,515.1,173.6796,606,"UCare Health, Inc.",Medical Assistance,305.8482,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Dop Artery Arm Ltd,,93931,CPT,Facility,Inpatient,,,,606,515.1,173.6796,606,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Us Dop Artery Arm Ltd,,93931,CPT,Facility,Outpatient,,,,606,515.1,173.6796,606,"UCare Health, Inc.",Medicare Advantage,305.8482,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Dop Artery Arm Ltd,,93931,CPT,Facility,Inpatient,,,,606,515.1,173.6796,606,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Us Dop Artery Arm Ltd,,93931,CPT,Facility,Outpatient,,,,606,515.1,173.6796,606,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),305.8482,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Dop Artery Arm Ltd,,93931,CPT,Facility,Inpatient,,,,606,515.1,173.6796,606,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Us Dop Artery Arm Ltd,,93931,CPT,Facility,Both,,,,606,515.1,173.6796,606,UnitedHealthcare,Individual & Family,569.64,94,,percent of total billed charges,,
Us Dop Artery Arm Ltd,,93931,CPT,Facility,Outpatient,,,,606,515.1,173.6796,606,UnitedHealthcare,Medicare Advantage,296.94,49,,percent of total billed charges,,
Us Dop Artery Arm Ltd,,93931,CPT,Facility,Inpatient,,,,606,515.1,173.6796,606,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Us Dop Artery Arm Ltd,,93931,CPT,Facility,Outpatient,,,,606,515.1,173.6796,606,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,290.88,48,,percent of total billed charges,,100% of DHS outpatient percentage
Us Dop Artery Arm Ltd,,93931,CPT,Facility,Inpatient,,,,606,515.1,173.6796,606,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Us Dop Vein Arm Bil,,93970,CPT,Facility,Both,,,,932,792.2,267.1112,932,Aetna,Commercial,857.44,92,,percent of total billed charges,,
Us Dop Vein Arm Bil,,93970,CPT,Facility,Outpatient,,,,932,792.2,267.1112,932,Aetna,Medicare Advantage,456.68,49,,percent of total billed charges,,
Us Dop Vein Arm Bil,,93970,CPT,Facility,Inpatient,,,,932,792.2,267.1112,932,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Us Dop Vein Arm Bil,,93970,CPT,Facility,Both,,,,932,792.2,267.1112,932,Aetna,PPO,866.76,93,,percent of total billed charges,,
Us Dop Vein Arm Bil,,93970,CPT,Facility,Both,,,,932,792.2,267.1112,932,America's PPO,America's PPO,894.9996,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Us Dop Vein Arm Bil,,93970,CPT,Facility,Both,,,,932,792.2,267.1112,932,BlueCross BlueShield Minnesota, Federal Employee Program,917.088,98.4,,percent of total billed charges,,
Us Dop Vein Arm Bil,,93970,CPT,Facility,Both,,,,932,792.2,267.1112,932,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,932,100,,percent of total billed charges,,
Us Dop Vein Arm Bil,,93970,CPT,Facility,Both,,,,932,792.2,267.1112,932,BlueCross BlueShield Minnesota,High Value Network Plan,838.8,90,,percent of total billed charges,,
Us Dop Vein Arm Bil,,93970,CPT,Facility,Outpatient,,,,932,792.2,267.1112,932,BlueCross BlueShield Minnesota,Medicare Advantage,456.68,49,,percent of total billed charges,,
Us Dop Vein Arm Bil,,93970,CPT,Facility,Inpatient,,,,932,792.2,267.1112,932,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Us Dop Vein Arm Bil,,93970,CPT,Facility,Both,,,,932,792.2,267.1112,932,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,825.4724,88.57,,percent of total billed charges,,
Us Dop Vein Arm Bil,,93970,CPT,Facility,Both,,,,932,792.2,267.1112,932,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,267.1112,28.66,,percent of total billed charges,,
Us Dop Vein Arm Bil,,93970,CPT,Facility,Outpatient,,,,932,792.2,267.1112,932,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),456.68,49,,percent of total billed charges,,
Us Dop Vein Arm Bil,,93970,CPT,Facility,Inpatient,,,,932,792.2,267.1112,932,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Us Dop Vein Arm Bil,,93970,CPT,Facility,Both,,,,932,792.2,267.1112,932,CorVel,Worker's Compensation,932,100,,percent of total billed charges,,
Us Dop Vein Arm Bil,,93970,CPT,Facility,Both,,,,932,792.2,267.1112,932,First Health Group Corporation,First Health Network,904.04,97,,percent of total billed charges,,
Us Dop Vein Arm Bil,,93970,CPT,Facility,Both,,,,932,792.2,267.1112,932,"Health Partners, Inc.",Commercial,881.672,94.6,,percent of total billed charges,,
Us Dop Vein Arm Bil,,93970,CPT,Facility,Outpatient,,,,932,792.2,267.1112,932,"Health Partners, Inc.",Medicare Advantage,456.68,49,,percent of total billed charges,,
Us Dop Vein Arm Bil,,93970,CPT,Facility,Inpatient,,,,932,792.2,267.1112,932,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Us Dop Vein Arm Bil,,93970,CPT,Facility,Both,,,,932,792.2,267.1112,932,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),559.2,60,,percent of total billed charges,,
Us Dop Vein Arm Bil,,93970,CPT,Facility,Both,,,,932,792.2,267.1112,932,"Health Partners, Inc.",State of Minnesota Advantage Program,759.58,81.5,,percent of total billed charges,,
Us Dop Vein Arm Bil,,93970,CPT,Facility,Both,,,,932,792.2,267.1112,932,"Health Partners, Inc.",State Public Programs,466,50,,percent of total billed charges,,
Us Dop Vein Arm Bil,,93970,CPT,Facility,Both,,,,932,792.2,267.1112,932,Humana Insurance Company,Commercial PPO,885.4,95,,percent of total billed charges,,
Us Dop Vein Arm Bil,,93970,CPT,Facility,Outpatient,,,,932,792.2,267.1112,932,Humana Insurance Company,Medicare PPO,456.68,49,,percent of total billed charges,,
Us Dop Vein Arm Bil,,93970,CPT,Facility,Inpatient,,,,932,792.2,267.1112,932,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Us Dop Vein Arm Bil,,93970,CPT,Facility,Both,,,,932,792.2,267.1112,932,Medica,Individual & Family,923.612,99.1,,percent of total billed charges,,
Us Dop Vein Arm Bil,,93970,CPT,Facility,Outpatient,,,,932,792.2,267.1112,932,Medica,Medica Advantage Solution,464.136,49.8,,percent of total billed charges,,
Us Dop Vein Arm Bil,,93970,CPT,Facility,Inpatient,,,,932,792.2,267.1112,932,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Us Dop Vein Arm Bil,,93970,CPT,Facility,Outpatient,,,,932,792.2,267.1112,932,Medica,Medical Assistance,415.672,44.6,,percent of total billed charges,,
Us Dop Vein Arm Bil,,93970,CPT,Facility,Inpatient,,,,932,792.2,267.1112,932,Medica,Medical Assistance,,,,,Included in per diem rate,
Us Dop Vein Arm Bil,,93970,CPT,Facility,Outpatient,,,,932,792.2,267.1112,932,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,464.136,49.8,,percent of total billed charges,,
Us Dop Vein Arm Bil,,93970,CPT,Facility,Inpatient,,,,932,792.2,267.1112,932,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Us Dop Vein Arm Bil,,93970,CPT,Facility,Both,,,,932,792.2,267.1112,932,"Multiplan, Inc.","Multiplan, Inc.",876.08,94,,percent of total billed charges,,
Us Dop Vein Arm Bil,,93970,CPT,Facility,Outpatient,,,,932,792.2,267.1112,932,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,839.732,90.1,,percent of total billed charges,,
Us Dop Vein Arm Bil,,93970,CPT,Facility,Inpatient,,,,932,792.2,267.1112,932,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Us Dop Vein Arm Bil,,93970,CPT,Facility,Both,,,,932,792.2,267.1112,932,"Preferred One Administrative Services, INC.",PPO,918.952,98.6,,percent of total billed charges,,
Us Dop Vein Arm Bil,,93970,CPT,Facility,Outpatient,,,,932,792.2,267.1112,932,PrimeWest Health,Minnesota Senior Health Options (MSHO),479.514,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Us Dop Vein Arm Bil,,93970,CPT,Facility,Inpatient,,,,932,792.2,267.1112,932,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Us Dop Vein Arm Bil,,93970,CPT,Facility,Outpatient,,,,932,792.2,267.1112,932,PrimeWest Health,MinnesotaCare,478.6752,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Us Dop Vein Arm Bil,,93970,CPT,Facility,Inpatient,,,,932,792.2,267.1112,932,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Us Dop Vein Arm Bil,,93970,CPT,Facility,Both,,,,932,792.2,267.1112,932,Sanford Health Plan,Sanford Health Plan,857.44,92,,percent of total billed charges,,
Us Dop Vein Arm Bil,,93970,CPT,Facility,Outpatient,,,,932,792.2,267.1112,932,"UCare Health, Inc.",Individual & Family Plan,525.182,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Us Dop Vein Arm Bil,,93970,CPT,Facility,Inpatient,,,,932,792.2,267.1112,932,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Us Dop Vein Arm Bil,,93970,CPT,Facility,Outpatient,,,,932,792.2,267.1112,932,"UCare Health, Inc.",Medical Assistance,470.3804,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Dop Vein Arm Bil,,93970,CPT,Facility,Inpatient,,,,932,792.2,267.1112,932,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Us Dop Vein Arm Bil,,93970,CPT,Facility,Outpatient,,,,932,792.2,267.1112,932,"UCare Health, Inc.",Medicare Advantage,470.3804,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Dop Vein Arm Bil,,93970,CPT,Facility,Inpatient,,,,932,792.2,267.1112,932,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Us Dop Vein Arm Bil,,93970,CPT,Facility,Outpatient,,,,932,792.2,267.1112,932,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),470.3804,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Dop Vein Arm Bil,,93970,CPT,Facility,Inpatient,,,,932,792.2,267.1112,932,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Us Dop Vein Arm Bil,,93970,CPT,Facility,Both,,,,932,792.2,267.1112,932,UnitedHealthcare,Individual & Family,876.08,94,,percent of total billed charges,,
Us Dop Vein Arm Bil,,93970,CPT,Facility,Outpatient,,,,932,792.2,267.1112,932,UnitedHealthcare,Medicare Advantage,456.68,49,,percent of total billed charges,,
Us Dop Vein Arm Bil,,93970,CPT,Facility,Inpatient,,,,932,792.2,267.1112,932,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Us Dop Vein Arm Bil,,93970,CPT,Facility,Outpatient,,,,932,792.2,267.1112,932,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,447.36,48,,percent of total billed charges,,100% of DHS outpatient percentage
Us Dop Vein Arm Bil,,93970,CPT,Facility,Inpatient,,,,932,792.2,267.1112,932,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Us Dop Vein Competence Study Bil,,93970,CPT,Facility,Both,,,,932,792.2,267.1112,932,Aetna,Commercial,857.44,92,,percent of total billed charges,,
Us Dop Vein Competence Study Bil,,93970,CPT,Facility,Outpatient,,,,932,792.2,267.1112,932,Aetna,Medicare Advantage,456.68,49,,percent of total billed charges,,
Us Dop Vein Competence Study Bil,,93970,CPT,Facility,Inpatient,,,,932,792.2,267.1112,932,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Us Dop Vein Competence Study Bil,,93970,CPT,Facility,Both,,,,932,792.2,267.1112,932,Aetna,PPO,866.76,93,,percent of total billed charges,,
Us Dop Vein Competence Study Bil,,93970,CPT,Facility,Both,,,,932,792.2,267.1112,932,America's PPO,America's PPO,894.9996,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Us Dop Vein Competence Study Bil,,93970,CPT,Facility,Both,,,,932,792.2,267.1112,932,BlueCross BlueShield Minnesota, Federal Employee Program,917.088,98.4,,percent of total billed charges,,
Us Dop Vein Competence Study Bil,,93970,CPT,Facility,Both,,,,932,792.2,267.1112,932,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,932,100,,percent of total billed charges,,
Us Dop Vein Competence Study Bil,,93970,CPT,Facility,Both,,,,932,792.2,267.1112,932,BlueCross BlueShield Minnesota,High Value Network Plan,838.8,90,,percent of total billed charges,,
Us Dop Vein Competence Study Bil,,93970,CPT,Facility,Outpatient,,,,932,792.2,267.1112,932,BlueCross BlueShield Minnesota,Medicare Advantage,456.68,49,,percent of total billed charges,,
Us Dop Vein Competence Study Bil,,93970,CPT,Facility,Inpatient,,,,932,792.2,267.1112,932,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Us Dop Vein Competence Study Bil,,93970,CPT,Facility,Both,,,,932,792.2,267.1112,932,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,825.4724,88.57,,percent of total billed charges,,
Us Dop Vein Competence Study Bil,,93970,CPT,Facility,Both,,,,932,792.2,267.1112,932,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,267.1112,28.66,,percent of total billed charges,,
Us Dop Vein Competence Study Bil,,93970,CPT,Facility,Outpatient,,,,932,792.2,267.1112,932,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),456.68,49,,percent of total billed charges,,
Us Dop Vein Competence Study Bil,,93970,CPT,Facility,Inpatient,,,,932,792.2,267.1112,932,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Us Dop Vein Competence Study Bil,,93970,CPT,Facility,Both,,,,932,792.2,267.1112,932,CorVel,Worker's Compensation,932,100,,percent of total billed charges,,
Us Dop Vein Competence Study Bil,,93970,CPT,Facility,Both,,,,932,792.2,267.1112,932,First Health Group Corporation,First Health Network,904.04,97,,percent of total billed charges,,
Us Dop Vein Competence Study Bil,,93970,CPT,Facility,Both,,,,932,792.2,267.1112,932,"Health Partners, Inc.",Commercial,881.672,94.6,,percent of total billed charges,,
Us Dop Vein Competence Study Bil,,93970,CPT,Facility,Outpatient,,,,932,792.2,267.1112,932,"Health Partners, Inc.",Medicare Advantage,456.68,49,,percent of total billed charges,,
Us Dop Vein Competence Study Bil,,93970,CPT,Facility,Inpatient,,,,932,792.2,267.1112,932,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Us Dop Vein Competence Study Bil,,93970,CPT,Facility,Both,,,,932,792.2,267.1112,932,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),559.2,60,,percent of total billed charges,,
Us Dop Vein Competence Study Bil,,93970,CPT,Facility,Both,,,,932,792.2,267.1112,932,"Health Partners, Inc.",State of Minnesota Advantage Program,759.58,81.5,,percent of total billed charges,,
Us Dop Vein Competence Study Bil,,93970,CPT,Facility,Both,,,,932,792.2,267.1112,932,"Health Partners, Inc.",State Public Programs,466,50,,percent of total billed charges,,
Us Dop Vein Competence Study Bil,,93970,CPT,Facility,Both,,,,932,792.2,267.1112,932,Humana Insurance Company,Commercial PPO,885.4,95,,percent of total billed charges,,
Us Dop Vein Competence Study Bil,,93970,CPT,Facility,Outpatient,,,,932,792.2,267.1112,932,Humana Insurance Company,Medicare PPO,456.68,49,,percent of total billed charges,,
Us Dop Vein Competence Study Bil,,93970,CPT,Facility,Inpatient,,,,932,792.2,267.1112,932,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Us Dop Vein Competence Study Bil,,93970,CPT,Facility,Both,,,,932,792.2,267.1112,932,Medica,Individual & Family,923.612,99.1,,percent of total billed charges,,
Us Dop Vein Competence Study Bil,,93970,CPT,Facility,Outpatient,,,,932,792.2,267.1112,932,Medica,Medica Advantage Solution,464.136,49.8,,percent of total billed charges,,
Us Dop Vein Competence Study Bil,,93970,CPT,Facility,Inpatient,,,,932,792.2,267.1112,932,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Us Dop Vein Competence Study Bil,,93970,CPT,Facility,Outpatient,,,,932,792.2,267.1112,932,Medica,Medical Assistance,415.672,44.6,,percent of total billed charges,,
Us Dop Vein Competence Study Bil,,93970,CPT,Facility,Inpatient,,,,932,792.2,267.1112,932,Medica,Medical Assistance,,,,,Included in per diem rate,
Us Dop Vein Competence Study Bil,,93970,CPT,Facility,Outpatient,,,,932,792.2,267.1112,932,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,464.136,49.8,,percent of total billed charges,,
Us Dop Vein Competence Study Bil,,93970,CPT,Facility,Inpatient,,,,932,792.2,267.1112,932,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Us Dop Vein Competence Study Bil,,93970,CPT,Facility,Both,,,,932,792.2,267.1112,932,"Multiplan, Inc.","Multiplan, Inc.",876.08,94,,percent of total billed charges,,
Us Dop Vein Competence Study Bil,,93970,CPT,Facility,Outpatient,,,,932,792.2,267.1112,932,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,839.732,90.1,,percent of total billed charges,,
Us Dop Vein Competence Study Bil,,93970,CPT,Facility,Inpatient,,,,932,792.2,267.1112,932,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Us Dop Vein Competence Study Bil,,93970,CPT,Facility,Both,,,,932,792.2,267.1112,932,"Preferred One Administrative Services, INC.",PPO,918.952,98.6,,percent of total billed charges,,
Us Dop Vein Competence Study Bil,,93970,CPT,Facility,Outpatient,,,,932,792.2,267.1112,932,PrimeWest Health,Minnesota Senior Health Options (MSHO),479.514,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Us Dop Vein Competence Study Bil,,93970,CPT,Facility,Inpatient,,,,932,792.2,267.1112,932,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Us Dop Vein Competence Study Bil,,93970,CPT,Facility,Outpatient,,,,932,792.2,267.1112,932,PrimeWest Health,MinnesotaCare,478.6752,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Us Dop Vein Competence Study Bil,,93970,CPT,Facility,Inpatient,,,,932,792.2,267.1112,932,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Us Dop Vein Competence Study Bil,,93970,CPT,Facility,Both,,,,932,792.2,267.1112,932,Sanford Health Plan,Sanford Health Plan,857.44,92,,percent of total billed charges,,
Us Dop Vein Competence Study Bil,,93970,CPT,Facility,Outpatient,,,,932,792.2,267.1112,932,"UCare Health, Inc.",Individual & Family Plan,525.182,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Us Dop Vein Competence Study Bil,,93970,CPT,Facility,Inpatient,,,,932,792.2,267.1112,932,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Us Dop Vein Competence Study Bil,,93970,CPT,Facility,Outpatient,,,,932,792.2,267.1112,932,"UCare Health, Inc.",Medical Assistance,470.3804,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Dop Vein Competence Study Bil,,93970,CPT,Facility,Inpatient,,,,932,792.2,267.1112,932,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Us Dop Vein Competence Study Bil,,93970,CPT,Facility,Outpatient,,,,932,792.2,267.1112,932,"UCare Health, Inc.",Medicare Advantage,470.3804,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Dop Vein Competence Study Bil,,93970,CPT,Facility,Inpatient,,,,932,792.2,267.1112,932,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Us Dop Vein Competence Study Bil,,93970,CPT,Facility,Outpatient,,,,932,792.2,267.1112,932,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),470.3804,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Dop Vein Competence Study Bil,,93970,CPT,Facility,Inpatient,,,,932,792.2,267.1112,932,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Us Dop Vein Competence Study Bil,,93970,CPT,Facility,Both,,,,932,792.2,267.1112,932,UnitedHealthcare,Individual & Family,876.08,94,,percent of total billed charges,,
Us Dop Vein Competence Study Bil,,93970,CPT,Facility,Outpatient,,,,932,792.2,267.1112,932,UnitedHealthcare,Medicare Advantage,456.68,49,,percent of total billed charges,,
Us Dop Vein Competence Study Bil,,93970,CPT,Facility,Inpatient,,,,932,792.2,267.1112,932,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Us Dop Vein Competence Study Bil,,93970,CPT,Facility,Outpatient,,,,932,792.2,267.1112,932,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,447.36,48,,percent of total billed charges,,100% of DHS outpatient percentage
Us Dop Vein Competence Study Bil,,93970,CPT,Facility,Inpatient,,,,932,792.2,267.1112,932,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Us Dop Vein Leg Bil,,93970,CPT,Facility,Both,,,,932,792.2,267.1112,932,Aetna,Commercial,857.44,92,,percent of total billed charges,,
Us Dop Vein Leg Bil,,93970,CPT,Facility,Outpatient,,,,932,792.2,267.1112,932,Aetna,Medicare Advantage,456.68,49,,percent of total billed charges,,
Us Dop Vein Leg Bil,,93970,CPT,Facility,Inpatient,,,,932,792.2,267.1112,932,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Us Dop Vein Leg Bil,,93970,CPT,Facility,Both,,,,932,792.2,267.1112,932,Aetna,PPO,866.76,93,,percent of total billed charges,,
Us Dop Vein Leg Bil,,93970,CPT,Facility,Both,,,,932,792.2,267.1112,932,America's PPO,America's PPO,894.9996,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Us Dop Vein Leg Bil,,93970,CPT,Facility,Both,,,,932,792.2,267.1112,932,BlueCross BlueShield Minnesota, Federal Employee Program,917.088,98.4,,percent of total billed charges,,
Us Dop Vein Leg Bil,,93970,CPT,Facility,Both,,,,932,792.2,267.1112,932,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,932,100,,percent of total billed charges,,
Us Dop Vein Leg Bil,,93970,CPT,Facility,Both,,,,932,792.2,267.1112,932,BlueCross BlueShield Minnesota,High Value Network Plan,838.8,90,,percent of total billed charges,,
Us Dop Vein Leg Bil,,93970,CPT,Facility,Outpatient,,,,932,792.2,267.1112,932,BlueCross BlueShield Minnesota,Medicare Advantage,456.68,49,,percent of total billed charges,,
Us Dop Vein Leg Bil,,93970,CPT,Facility,Inpatient,,,,932,792.2,267.1112,932,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Us Dop Vein Leg Bil,,93970,CPT,Facility,Both,,,,932,792.2,267.1112,932,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,825.4724,88.57,,percent of total billed charges,,
Us Dop Vein Leg Bil,,93970,CPT,Facility,Both,,,,932,792.2,267.1112,932,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,267.1112,28.66,,percent of total billed charges,,
Us Dop Vein Leg Bil,,93970,CPT,Facility,Outpatient,,,,932,792.2,267.1112,932,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),456.68,49,,percent of total billed charges,,
Us Dop Vein Leg Bil,,93970,CPT,Facility,Inpatient,,,,932,792.2,267.1112,932,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Us Dop Vein Leg Bil,,93970,CPT,Facility,Both,,,,932,792.2,267.1112,932,CorVel,Worker's Compensation,932,100,,percent of total billed charges,,
Us Dop Vein Leg Bil,,93970,CPT,Facility,Both,,,,932,792.2,267.1112,932,First Health Group Corporation,First Health Network,904.04,97,,percent of total billed charges,,
Us Dop Vein Leg Bil,,93970,CPT,Facility,Both,,,,932,792.2,267.1112,932,"Health Partners, Inc.",Commercial,881.672,94.6,,percent of total billed charges,,
Us Dop Vein Leg Bil,,93970,CPT,Facility,Outpatient,,,,932,792.2,267.1112,932,"Health Partners, Inc.",Medicare Advantage,456.68,49,,percent of total billed charges,,
Us Dop Vein Leg Bil,,93970,CPT,Facility,Inpatient,,,,932,792.2,267.1112,932,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Us Dop Vein Leg Bil,,93970,CPT,Facility,Both,,,,932,792.2,267.1112,932,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),559.2,60,,percent of total billed charges,,
Us Dop Vein Leg Bil,,93970,CPT,Facility,Both,,,,932,792.2,267.1112,932,"Health Partners, Inc.",State of Minnesota Advantage Program,759.58,81.5,,percent of total billed charges,,
Us Dop Vein Leg Bil,,93970,CPT,Facility,Both,,,,932,792.2,267.1112,932,"Health Partners, Inc.",State Public Programs,466,50,,percent of total billed charges,,
Us Dop Vein Leg Bil,,93970,CPT,Facility,Both,,,,932,792.2,267.1112,932,Humana Insurance Company,Commercial PPO,885.4,95,,percent of total billed charges,,
Us Dop Vein Leg Bil,,93970,CPT,Facility,Outpatient,,,,932,792.2,267.1112,932,Humana Insurance Company,Medicare PPO,456.68,49,,percent of total billed charges,,
Us Dop Vein Leg Bil,,93970,CPT,Facility,Inpatient,,,,932,792.2,267.1112,932,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Us Dop Vein Leg Bil,,93970,CPT,Facility,Both,,,,932,792.2,267.1112,932,Medica,Individual & Family,923.612,99.1,,percent of total billed charges,,
Us Dop Vein Leg Bil,,93970,CPT,Facility,Outpatient,,,,932,792.2,267.1112,932,Medica,Medica Advantage Solution,464.136,49.8,,percent of total billed charges,,
Us Dop Vein Leg Bil,,93970,CPT,Facility,Inpatient,,,,932,792.2,267.1112,932,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Us Dop Vein Leg Bil,,93970,CPT,Facility,Outpatient,,,,932,792.2,267.1112,932,Medica,Medical Assistance,415.672,44.6,,percent of total billed charges,,
Us Dop Vein Leg Bil,,93970,CPT,Facility,Inpatient,,,,932,792.2,267.1112,932,Medica,Medical Assistance,,,,,Included in per diem rate,
Us Dop Vein Leg Bil,,93970,CPT,Facility,Outpatient,,,,932,792.2,267.1112,932,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,464.136,49.8,,percent of total billed charges,,
Us Dop Vein Leg Bil,,93970,CPT,Facility,Inpatient,,,,932,792.2,267.1112,932,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Us Dop Vein Leg Bil,,93970,CPT,Facility,Both,,,,932,792.2,267.1112,932,"Multiplan, Inc.","Multiplan, Inc.",876.08,94,,percent of total billed charges,,
Us Dop Vein Leg Bil,,93970,CPT,Facility,Outpatient,,,,932,792.2,267.1112,932,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,839.732,90.1,,percent of total billed charges,,
Us Dop Vein Leg Bil,,93970,CPT,Facility,Inpatient,,,,932,792.2,267.1112,932,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Us Dop Vein Leg Bil,,93970,CPT,Facility,Both,,,,932,792.2,267.1112,932,"Preferred One Administrative Services, INC.",PPO,918.952,98.6,,percent of total billed charges,,
Us Dop Vein Leg Bil,,93970,CPT,Facility,Outpatient,,,,932,792.2,267.1112,932,PrimeWest Health,Minnesota Senior Health Options (MSHO),479.514,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Us Dop Vein Leg Bil,,93970,CPT,Facility,Inpatient,,,,932,792.2,267.1112,932,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Us Dop Vein Leg Bil,,93970,CPT,Facility,Outpatient,,,,932,792.2,267.1112,932,PrimeWest Health,MinnesotaCare,478.6752,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Us Dop Vein Leg Bil,,93970,CPT,Facility,Inpatient,,,,932,792.2,267.1112,932,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Us Dop Vein Leg Bil,,93970,CPT,Facility,Both,,,,932,792.2,267.1112,932,Sanford Health Plan,Sanford Health Plan,857.44,92,,percent of total billed charges,,
Us Dop Vein Leg Bil,,93970,CPT,Facility,Outpatient,,,,932,792.2,267.1112,932,"UCare Health, Inc.",Individual & Family Plan,525.182,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Us Dop Vein Leg Bil,,93970,CPT,Facility,Inpatient,,,,932,792.2,267.1112,932,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Us Dop Vein Leg Bil,,93970,CPT,Facility,Outpatient,,,,932,792.2,267.1112,932,"UCare Health, Inc.",Medical Assistance,470.3804,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Dop Vein Leg Bil,,93970,CPT,Facility,Inpatient,,,,932,792.2,267.1112,932,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Us Dop Vein Leg Bil,,93970,CPT,Facility,Outpatient,,,,932,792.2,267.1112,932,"UCare Health, Inc.",Medicare Advantage,470.3804,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Dop Vein Leg Bil,,93970,CPT,Facility,Inpatient,,,,932,792.2,267.1112,932,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Us Dop Vein Leg Bil,,93970,CPT,Facility,Outpatient,,,,932,792.2,267.1112,932,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),470.3804,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Dop Vein Leg Bil,,93970,CPT,Facility,Inpatient,,,,932,792.2,267.1112,932,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Us Dop Vein Leg Bil,,93970,CPT,Facility,Both,,,,932,792.2,267.1112,932,UnitedHealthcare,Individual & Family,876.08,94,,percent of total billed charges,,
Us Dop Vein Leg Bil,,93970,CPT,Facility,Outpatient,,,,932,792.2,267.1112,932,UnitedHealthcare,Medicare Advantage,456.68,49,,percent of total billed charges,,
Us Dop Vein Leg Bil,,93970,CPT,Facility,Inpatient,,,,932,792.2,267.1112,932,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Us Dop Vein Leg Bil,,93970,CPT,Facility,Outpatient,,,,932,792.2,267.1112,932,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,447.36,48,,percent of total billed charges,,100% of DHS outpatient percentage
Us Dop Vein Leg Bil,,93970,CPT,Facility,Inpatient,,,,932,792.2,267.1112,932,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Us Vein Meas And Or Map Arm Bil,,93970,CPT,Facility,Both,,,,932,792.2,267.1112,932,Aetna,Commercial,857.44,92,,percent of total billed charges,,
Us Vein Meas And Or Map Arm Bil,,93970,CPT,Facility,Outpatient,,,,932,792.2,267.1112,932,Aetna,Medicare Advantage,456.68,49,,percent of total billed charges,,
Us Vein Meas And Or Map Arm Bil,,93970,CPT,Facility,Inpatient,,,,932,792.2,267.1112,932,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Us Vein Meas And Or Map Arm Bil,,93970,CPT,Facility,Both,,,,932,792.2,267.1112,932,Aetna,PPO,866.76,93,,percent of total billed charges,,
Us Vein Meas And Or Map Arm Bil,,93970,CPT,Facility,Both,,,,932,792.2,267.1112,932,America's PPO,America's PPO,894.9996,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Us Vein Meas And Or Map Arm Bil,,93970,CPT,Facility,Both,,,,932,792.2,267.1112,932,BlueCross BlueShield Minnesota, Federal Employee Program,917.088,98.4,,percent of total billed charges,,
Us Vein Meas And Or Map Arm Bil,,93970,CPT,Facility,Both,,,,932,792.2,267.1112,932,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,932,100,,percent of total billed charges,,
Us Vein Meas And Or Map Arm Bil,,93970,CPT,Facility,Both,,,,932,792.2,267.1112,932,BlueCross BlueShield Minnesota,High Value Network Plan,838.8,90,,percent of total billed charges,,
Us Vein Meas And Or Map Arm Bil,,93970,CPT,Facility,Outpatient,,,,932,792.2,267.1112,932,BlueCross BlueShield Minnesota,Medicare Advantage,456.68,49,,percent of total billed charges,,
Us Vein Meas And Or Map Arm Bil,,93970,CPT,Facility,Inpatient,,,,932,792.2,267.1112,932,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Us Vein Meas And Or Map Arm Bil,,93970,CPT,Facility,Both,,,,932,792.2,267.1112,932,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,825.4724,88.57,,percent of total billed charges,,
Us Vein Meas And Or Map Arm Bil,,93970,CPT,Facility,Both,,,,932,792.2,267.1112,932,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,267.1112,28.66,,percent of total billed charges,,
Us Vein Meas And Or Map Arm Bil,,93970,CPT,Facility,Outpatient,,,,932,792.2,267.1112,932,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),456.68,49,,percent of total billed charges,,
Us Vein Meas And Or Map Arm Bil,,93970,CPT,Facility,Inpatient,,,,932,792.2,267.1112,932,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Us Vein Meas And Or Map Arm Bil,,93970,CPT,Facility,Both,,,,932,792.2,267.1112,932,CorVel,Worker's Compensation,932,100,,percent of total billed charges,,
Us Vein Meas And Or Map Arm Bil,,93970,CPT,Facility,Both,,,,932,792.2,267.1112,932,First Health Group Corporation,First Health Network,904.04,97,,percent of total billed charges,,
Us Vein Meas And Or Map Arm Bil,,93970,CPT,Facility,Both,,,,932,792.2,267.1112,932,"Health Partners, Inc.",Commercial,881.672,94.6,,percent of total billed charges,,
Us Vein Meas And Or Map Arm Bil,,93970,CPT,Facility,Outpatient,,,,932,792.2,267.1112,932,"Health Partners, Inc.",Medicare Advantage,456.68,49,,percent of total billed charges,,
Us Vein Meas And Or Map Arm Bil,,93970,CPT,Facility,Inpatient,,,,932,792.2,267.1112,932,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Us Vein Meas And Or Map Arm Bil,,93970,CPT,Facility,Both,,,,932,792.2,267.1112,932,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),559.2,60,,percent of total billed charges,,
Us Vein Meas And Or Map Arm Bil,,93970,CPT,Facility,Both,,,,932,792.2,267.1112,932,"Health Partners, Inc.",State of Minnesota Advantage Program,759.58,81.5,,percent of total billed charges,,
Us Vein Meas And Or Map Arm Bil,,93970,CPT,Facility,Both,,,,932,792.2,267.1112,932,"Health Partners, Inc.",State Public Programs,466,50,,percent of total billed charges,,
Us Vein Meas And Or Map Arm Bil,,93970,CPT,Facility,Both,,,,932,792.2,267.1112,932,Humana Insurance Company,Commercial PPO,885.4,95,,percent of total billed charges,,
Us Vein Meas And Or Map Arm Bil,,93970,CPT,Facility,Outpatient,,,,932,792.2,267.1112,932,Humana Insurance Company,Medicare PPO,456.68,49,,percent of total billed charges,,
Us Vein Meas And Or Map Arm Bil,,93970,CPT,Facility,Inpatient,,,,932,792.2,267.1112,932,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Us Vein Meas And Or Map Arm Bil,,93970,CPT,Facility,Both,,,,932,792.2,267.1112,932,Medica,Individual & Family,923.612,99.1,,percent of total billed charges,,
Us Vein Meas And Or Map Arm Bil,,93970,CPT,Facility,Outpatient,,,,932,792.2,267.1112,932,Medica,Medica Advantage Solution,464.136,49.8,,percent of total billed charges,,
Us Vein Meas And Or Map Arm Bil,,93970,CPT,Facility,Inpatient,,,,932,792.2,267.1112,932,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Us Vein Meas And Or Map Arm Bil,,93970,CPT,Facility,Outpatient,,,,932,792.2,267.1112,932,Medica,Medical Assistance,415.672,44.6,,percent of total billed charges,,
Us Vein Meas And Or Map Arm Bil,,93970,CPT,Facility,Inpatient,,,,932,792.2,267.1112,932,Medica,Medical Assistance,,,,,Included in per diem rate,
Us Vein Meas And Or Map Arm Bil,,93970,CPT,Facility,Outpatient,,,,932,792.2,267.1112,932,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,464.136,49.8,,percent of total billed charges,,
Us Vein Meas And Or Map Arm Bil,,93970,CPT,Facility,Inpatient,,,,932,792.2,267.1112,932,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Us Vein Meas And Or Map Arm Bil,,93970,CPT,Facility,Both,,,,932,792.2,267.1112,932,"Multiplan, Inc.","Multiplan, Inc.",876.08,94,,percent of total billed charges,,
Us Vein Meas And Or Map Arm Bil,,93970,CPT,Facility,Outpatient,,,,932,792.2,267.1112,932,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,839.732,90.1,,percent of total billed charges,,
Us Vein Meas And Or Map Arm Bil,,93970,CPT,Facility,Inpatient,,,,932,792.2,267.1112,932,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Us Vein Meas And Or Map Arm Bil,,93970,CPT,Facility,Both,,,,932,792.2,267.1112,932,"Preferred One Administrative Services, INC.",PPO,918.952,98.6,,percent of total billed charges,,
Us Vein Meas And Or Map Arm Bil,,93970,CPT,Facility,Outpatient,,,,932,792.2,267.1112,932,PrimeWest Health,Minnesota Senior Health Options (MSHO),479.514,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Us Vein Meas And Or Map Arm Bil,,93970,CPT,Facility,Inpatient,,,,932,792.2,267.1112,932,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Us Vein Meas And Or Map Arm Bil,,93970,CPT,Facility,Outpatient,,,,932,792.2,267.1112,932,PrimeWest Health,MinnesotaCare,478.6752,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Us Vein Meas And Or Map Arm Bil,,93970,CPT,Facility,Inpatient,,,,932,792.2,267.1112,932,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Us Vein Meas And Or Map Arm Bil,,93970,CPT,Facility,Both,,,,932,792.2,267.1112,932,Sanford Health Plan,Sanford Health Plan,857.44,92,,percent of total billed charges,,
Us Vein Meas And Or Map Arm Bil,,93970,CPT,Facility,Outpatient,,,,932,792.2,267.1112,932,"UCare Health, Inc.",Individual & Family Plan,525.182,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Us Vein Meas And Or Map Arm Bil,,93970,CPT,Facility,Inpatient,,,,932,792.2,267.1112,932,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Us Vein Meas And Or Map Arm Bil,,93970,CPT,Facility,Outpatient,,,,932,792.2,267.1112,932,"UCare Health, Inc.",Medical Assistance,470.3804,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Vein Meas And Or Map Arm Bil,,93970,CPT,Facility,Inpatient,,,,932,792.2,267.1112,932,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Us Vein Meas And Or Map Arm Bil,,93970,CPT,Facility,Outpatient,,,,932,792.2,267.1112,932,"UCare Health, Inc.",Medicare Advantage,470.3804,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Vein Meas And Or Map Arm Bil,,93970,CPT,Facility,Inpatient,,,,932,792.2,267.1112,932,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Us Vein Meas And Or Map Arm Bil,,93970,CPT,Facility,Outpatient,,,,932,792.2,267.1112,932,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),470.3804,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Vein Meas And Or Map Arm Bil,,93970,CPT,Facility,Inpatient,,,,932,792.2,267.1112,932,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Us Vein Meas And Or Map Arm Bil,,93970,CPT,Facility,Both,,,,932,792.2,267.1112,932,UnitedHealthcare,Individual & Family,876.08,94,,percent of total billed charges,,
Us Vein Meas And Or Map Arm Bil,,93970,CPT,Facility,Outpatient,,,,932,792.2,267.1112,932,UnitedHealthcare,Medicare Advantage,456.68,49,,percent of total billed charges,,
Us Vein Meas And Or Map Arm Bil,,93970,CPT,Facility,Inpatient,,,,932,792.2,267.1112,932,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Us Vein Meas And Or Map Arm Bil,,93970,CPT,Facility,Outpatient,,,,932,792.2,267.1112,932,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,447.36,48,,percent of total billed charges,,100% of DHS outpatient percentage
Us Vein Meas And Or Map Arm Bil,,93970,CPT,Facility,Inpatient,,,,932,792.2,267.1112,932,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Us Vein Meas And Or Map Leg Bil,,93970,CPT,Facility,Both,,,,932,792.2,267.1112,932,Aetna,Commercial,857.44,92,,percent of total billed charges,,
Us Vein Meas And Or Map Leg Bil,,93970,CPT,Facility,Outpatient,,,,932,792.2,267.1112,932,Aetna,Medicare Advantage,456.68,49,,percent of total billed charges,,
Us Vein Meas And Or Map Leg Bil,,93970,CPT,Facility,Inpatient,,,,932,792.2,267.1112,932,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Us Vein Meas And Or Map Leg Bil,,93970,CPT,Facility,Both,,,,932,792.2,267.1112,932,Aetna,PPO,866.76,93,,percent of total billed charges,,
Us Vein Meas And Or Map Leg Bil,,93970,CPT,Facility,Both,,,,932,792.2,267.1112,932,America's PPO,America's PPO,894.9996,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Us Vein Meas And Or Map Leg Bil,,93970,CPT,Facility,Both,,,,932,792.2,267.1112,932,BlueCross BlueShield Minnesota, Federal Employee Program,917.088,98.4,,percent of total billed charges,,
Us Vein Meas And Or Map Leg Bil,,93970,CPT,Facility,Both,,,,932,792.2,267.1112,932,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,932,100,,percent of total billed charges,,
Us Vein Meas And Or Map Leg Bil,,93970,CPT,Facility,Both,,,,932,792.2,267.1112,932,BlueCross BlueShield Minnesota,High Value Network Plan,838.8,90,,percent of total billed charges,,
Us Vein Meas And Or Map Leg Bil,,93970,CPT,Facility,Outpatient,,,,932,792.2,267.1112,932,BlueCross BlueShield Minnesota,Medicare Advantage,456.68,49,,percent of total billed charges,,
Us Vein Meas And Or Map Leg Bil,,93970,CPT,Facility,Inpatient,,,,932,792.2,267.1112,932,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Us Vein Meas And Or Map Leg Bil,,93970,CPT,Facility,Both,,,,932,792.2,267.1112,932,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,825.4724,88.57,,percent of total billed charges,,
Us Vein Meas And Or Map Leg Bil,,93970,CPT,Facility,Both,,,,932,792.2,267.1112,932,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,267.1112,28.66,,percent of total billed charges,,
Us Vein Meas And Or Map Leg Bil,,93970,CPT,Facility,Outpatient,,,,932,792.2,267.1112,932,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),456.68,49,,percent of total billed charges,,
Us Vein Meas And Or Map Leg Bil,,93970,CPT,Facility,Inpatient,,,,932,792.2,267.1112,932,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Us Vein Meas And Or Map Leg Bil,,93970,CPT,Facility,Both,,,,932,792.2,267.1112,932,CorVel,Worker's Compensation,932,100,,percent of total billed charges,,
Us Vein Meas And Or Map Leg Bil,,93970,CPT,Facility,Both,,,,932,792.2,267.1112,932,First Health Group Corporation,First Health Network,904.04,97,,percent of total billed charges,,
Us Vein Meas And Or Map Leg Bil,,93970,CPT,Facility,Both,,,,932,792.2,267.1112,932,"Health Partners, Inc.",Commercial,881.672,94.6,,percent of total billed charges,,
Us Vein Meas And Or Map Leg Bil,,93970,CPT,Facility,Outpatient,,,,932,792.2,267.1112,932,"Health Partners, Inc.",Medicare Advantage,456.68,49,,percent of total billed charges,,
Us Vein Meas And Or Map Leg Bil,,93970,CPT,Facility,Inpatient,,,,932,792.2,267.1112,932,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Us Vein Meas And Or Map Leg Bil,,93970,CPT,Facility,Both,,,,932,792.2,267.1112,932,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),559.2,60,,percent of total billed charges,,
Us Vein Meas And Or Map Leg Bil,,93970,CPT,Facility,Both,,,,932,792.2,267.1112,932,"Health Partners, Inc.",State of Minnesota Advantage Program,759.58,81.5,,percent of total billed charges,,
Us Vein Meas And Or Map Leg Bil,,93970,CPT,Facility,Both,,,,932,792.2,267.1112,932,"Health Partners, Inc.",State Public Programs,466,50,,percent of total billed charges,,
Us Vein Meas And Or Map Leg Bil,,93970,CPT,Facility,Both,,,,932,792.2,267.1112,932,Humana Insurance Company,Commercial PPO,885.4,95,,percent of total billed charges,,
Us Vein Meas And Or Map Leg Bil,,93970,CPT,Facility,Outpatient,,,,932,792.2,267.1112,932,Humana Insurance Company,Medicare PPO,456.68,49,,percent of total billed charges,,
Us Vein Meas And Or Map Leg Bil,,93970,CPT,Facility,Inpatient,,,,932,792.2,267.1112,932,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Us Vein Meas And Or Map Leg Bil,,93970,CPT,Facility,Both,,,,932,792.2,267.1112,932,Medica,Individual & Family,923.612,99.1,,percent of total billed charges,,
Us Vein Meas And Or Map Leg Bil,,93970,CPT,Facility,Outpatient,,,,932,792.2,267.1112,932,Medica,Medica Advantage Solution,464.136,49.8,,percent of total billed charges,,
Us Vein Meas And Or Map Leg Bil,,93970,CPT,Facility,Inpatient,,,,932,792.2,267.1112,932,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Us Vein Meas And Or Map Leg Bil,,93970,CPT,Facility,Outpatient,,,,932,792.2,267.1112,932,Medica,Medical Assistance,415.672,44.6,,percent of total billed charges,,
Us Vein Meas And Or Map Leg Bil,,93970,CPT,Facility,Inpatient,,,,932,792.2,267.1112,932,Medica,Medical Assistance,,,,,Included in per diem rate,
Us Vein Meas And Or Map Leg Bil,,93970,CPT,Facility,Outpatient,,,,932,792.2,267.1112,932,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,464.136,49.8,,percent of total billed charges,,
Us Vein Meas And Or Map Leg Bil,,93970,CPT,Facility,Inpatient,,,,932,792.2,267.1112,932,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Us Vein Meas And Or Map Leg Bil,,93970,CPT,Facility,Both,,,,932,792.2,267.1112,932,"Multiplan, Inc.","Multiplan, Inc.",876.08,94,,percent of total billed charges,,
Us Vein Meas And Or Map Leg Bil,,93970,CPT,Facility,Outpatient,,,,932,792.2,267.1112,932,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,839.732,90.1,,percent of total billed charges,,
Us Vein Meas And Or Map Leg Bil,,93970,CPT,Facility,Inpatient,,,,932,792.2,267.1112,932,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Us Vein Meas And Or Map Leg Bil,,93970,CPT,Facility,Both,,,,932,792.2,267.1112,932,"Preferred One Administrative Services, INC.",PPO,918.952,98.6,,percent of total billed charges,,
Us Vein Meas And Or Map Leg Bil,,93970,CPT,Facility,Outpatient,,,,932,792.2,267.1112,932,PrimeWest Health,Minnesota Senior Health Options (MSHO),479.514,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Us Vein Meas And Or Map Leg Bil,,93970,CPT,Facility,Inpatient,,,,932,792.2,267.1112,932,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Us Vein Meas And Or Map Leg Bil,,93970,CPT,Facility,Outpatient,,,,932,792.2,267.1112,932,PrimeWest Health,MinnesotaCare,478.6752,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Us Vein Meas And Or Map Leg Bil,,93970,CPT,Facility,Inpatient,,,,932,792.2,267.1112,932,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Us Vein Meas And Or Map Leg Bil,,93970,CPT,Facility,Both,,,,932,792.2,267.1112,932,Sanford Health Plan,Sanford Health Plan,857.44,92,,percent of total billed charges,,
Us Vein Meas And Or Map Leg Bil,,93970,CPT,Facility,Outpatient,,,,932,792.2,267.1112,932,"UCare Health, Inc.",Individual & Family Plan,525.182,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Us Vein Meas And Or Map Leg Bil,,93970,CPT,Facility,Inpatient,,,,932,792.2,267.1112,932,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Us Vein Meas And Or Map Leg Bil,,93970,CPT,Facility,Outpatient,,,,932,792.2,267.1112,932,"UCare Health, Inc.",Medical Assistance,470.3804,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Vein Meas And Or Map Leg Bil,,93970,CPT,Facility,Inpatient,,,,932,792.2,267.1112,932,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Us Vein Meas And Or Map Leg Bil,,93970,CPT,Facility,Outpatient,,,,932,792.2,267.1112,932,"UCare Health, Inc.",Medicare Advantage,470.3804,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Vein Meas And Or Map Leg Bil,,93970,CPT,Facility,Inpatient,,,,932,792.2,267.1112,932,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Us Vein Meas And Or Map Leg Bil,,93970,CPT,Facility,Outpatient,,,,932,792.2,267.1112,932,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),470.3804,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Vein Meas And Or Map Leg Bil,,93970,CPT,Facility,Inpatient,,,,932,792.2,267.1112,932,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Us Vein Meas And Or Map Leg Bil,,93970,CPT,Facility,Both,,,,932,792.2,267.1112,932,UnitedHealthcare,Individual & Family,876.08,94,,percent of total billed charges,,
Us Vein Meas And Or Map Leg Bil,,93970,CPT,Facility,Outpatient,,,,932,792.2,267.1112,932,UnitedHealthcare,Medicare Advantage,456.68,49,,percent of total billed charges,,
Us Vein Meas And Or Map Leg Bil,,93970,CPT,Facility,Inpatient,,,,932,792.2,267.1112,932,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Us Vein Meas And Or Map Leg Bil,,93970,CPT,Facility,Outpatient,,,,932,792.2,267.1112,932,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,447.36,48,,percent of total billed charges,,100% of DHS outpatient percentage
Us Vein Meas And Or Map Leg Bil,,93970,CPT,Facility,Inpatient,,,,932,792.2,267.1112,932,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Us Dop Vein Ltd Upper Extremity,,93971,CPT,Facility,Both,,,,626,532.1,179.4116,626,Aetna,Commercial,575.92,92,,percent of total billed charges,,
Us Dop Vein Ltd Upper Extremity,,93971,CPT,Facility,Outpatient,,,,626,532.1,179.4116,626,Aetna,Medicare Advantage,306.74,49,,percent of total billed charges,,
Us Dop Vein Ltd Upper Extremity,,93971,CPT,Facility,Inpatient,,,,626,532.1,179.4116,626,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Us Dop Vein Ltd Upper Extremity,,93971,CPT,Facility,Both,,,,626,532.1,179.4116,626,Aetna,PPO,582.18,93,,percent of total billed charges,,
Us Dop Vein Ltd Upper Extremity,,93971,CPT,Facility,Both,,,,626,532.1,179.4116,626,America's PPO,America's PPO,601.1478,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Us Dop Vein Ltd Upper Extremity,,93971,CPT,Facility,Both,,,,626,532.1,179.4116,626,BlueCross BlueShield Minnesota, Federal Employee Program,615.984,98.4,,percent of total billed charges,,
Us Dop Vein Ltd Upper Extremity,,93971,CPT,Facility,Both,,,,626,532.1,179.4116,626,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,626,100,,percent of total billed charges,,
Us Dop Vein Ltd Upper Extremity,,93971,CPT,Facility,Both,,,,626,532.1,179.4116,626,BlueCross BlueShield Minnesota,High Value Network Plan,563.4,90,,percent of total billed charges,,
Us Dop Vein Ltd Upper Extremity,,93971,CPT,Facility,Outpatient,,,,626,532.1,179.4116,626,BlueCross BlueShield Minnesota,Medicare Advantage,306.74,49,,percent of total billed charges,,
Us Dop Vein Ltd Upper Extremity,,93971,CPT,Facility,Inpatient,,,,626,532.1,179.4116,626,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Us Dop Vein Ltd Upper Extremity,,93971,CPT,Facility,Both,,,,626,532.1,179.4116,626,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,554.4482,88.57,,percent of total billed charges,,
Us Dop Vein Ltd Upper Extremity,,93971,CPT,Facility,Both,,,,626,532.1,179.4116,626,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,179.4116,28.66,,percent of total billed charges,,
Us Dop Vein Ltd Upper Extremity,,93971,CPT,Facility,Outpatient,,,,626,532.1,179.4116,626,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),306.74,49,,percent of total billed charges,,
Us Dop Vein Ltd Upper Extremity,,93971,CPT,Facility,Inpatient,,,,626,532.1,179.4116,626,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Us Dop Vein Ltd Upper Extremity,,93971,CPT,Facility,Both,,,,626,532.1,179.4116,626,CorVel,Worker's Compensation,626,100,,percent of total billed charges,,
Us Dop Vein Ltd Upper Extremity,,93971,CPT,Facility,Both,,,,626,532.1,179.4116,626,First Health Group Corporation,First Health Network,607.22,97,,percent of total billed charges,,
Us Dop Vein Ltd Upper Extremity,,93971,CPT,Facility,Both,,,,626,532.1,179.4116,626,"Health Partners, Inc.",Commercial,592.196,94.6,,percent of total billed charges,,
Us Dop Vein Ltd Upper Extremity,,93971,CPT,Facility,Outpatient,,,,626,532.1,179.4116,626,"Health Partners, Inc.",Medicare Advantage,306.74,49,,percent of total billed charges,,
Us Dop Vein Ltd Upper Extremity,,93971,CPT,Facility,Inpatient,,,,626,532.1,179.4116,626,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Us Dop Vein Ltd Upper Extremity,,93971,CPT,Facility,Both,,,,626,532.1,179.4116,626,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),375.6,60,,percent of total billed charges,,
Us Dop Vein Ltd Upper Extremity,,93971,CPT,Facility,Both,,,,626,532.1,179.4116,626,"Health Partners, Inc.",State of Minnesota Advantage Program,510.19,81.5,,percent of total billed charges,,
Us Dop Vein Ltd Upper Extremity,,93971,CPT,Facility,Both,,,,626,532.1,179.4116,626,"Health Partners, Inc.",State Public Programs,313,50,,percent of total billed charges,,
Us Dop Vein Ltd Upper Extremity,,93971,CPT,Facility,Both,,,,626,532.1,179.4116,626,Humana Insurance Company,Commercial PPO,594.7,95,,percent of total billed charges,,
Us Dop Vein Ltd Upper Extremity,,93971,CPT,Facility,Outpatient,,,,626,532.1,179.4116,626,Humana Insurance Company,Medicare PPO,306.74,49,,percent of total billed charges,,
Us Dop Vein Ltd Upper Extremity,,93971,CPT,Facility,Inpatient,,,,626,532.1,179.4116,626,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Us Dop Vein Ltd Upper Extremity,,93971,CPT,Facility,Both,,,,626,532.1,179.4116,626,Medica,Individual & Family,620.366,99.1,,percent of total billed charges,,
Us Dop Vein Ltd Upper Extremity,,93971,CPT,Facility,Outpatient,,,,626,532.1,179.4116,626,Medica,Medica Advantage Solution,311.748,49.8,,percent of total billed charges,,
Us Dop Vein Ltd Upper Extremity,,93971,CPT,Facility,Inpatient,,,,626,532.1,179.4116,626,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Us Dop Vein Ltd Upper Extremity,,93971,CPT,Facility,Outpatient,,,,626,532.1,179.4116,626,Medica,Medical Assistance,279.196,44.6,,percent of total billed charges,,
Us Dop Vein Ltd Upper Extremity,,93971,CPT,Facility,Inpatient,,,,626,532.1,179.4116,626,Medica,Medical Assistance,,,,,Included in per diem rate,
Us Dop Vein Ltd Upper Extremity,,93971,CPT,Facility,Outpatient,,,,626,532.1,179.4116,626,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,311.748,49.8,,percent of total billed charges,,
Us Dop Vein Ltd Upper Extremity,,93971,CPT,Facility,Inpatient,,,,626,532.1,179.4116,626,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Us Dop Vein Ltd Upper Extremity,,93971,CPT,Facility,Both,,,,626,532.1,179.4116,626,"Multiplan, Inc.","Multiplan, Inc.",588.44,94,,percent of total billed charges,,
Us Dop Vein Ltd Upper Extremity,,93971,CPT,Facility,Outpatient,,,,626,532.1,179.4116,626,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,564.026,90.1,,percent of total billed charges,,
Us Dop Vein Ltd Upper Extremity,,93971,CPT,Facility,Inpatient,,,,626,532.1,179.4116,626,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Us Dop Vein Ltd Upper Extremity,,93971,CPT,Facility,Both,,,,626,532.1,179.4116,626,"Preferred One Administrative Services, INC.",PPO,617.236,98.6,,percent of total billed charges,,
Us Dop Vein Ltd Upper Extremity,,93971,CPT,Facility,Outpatient,,,,626,532.1,179.4116,626,PrimeWest Health,Minnesota Senior Health Options (MSHO),322.077,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Us Dop Vein Ltd Upper Extremity,,93971,CPT,Facility,Inpatient,,,,626,532.1,179.4116,626,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Us Dop Vein Ltd Upper Extremity,,93971,CPT,Facility,Outpatient,,,,626,532.1,179.4116,626,PrimeWest Health,MinnesotaCare,321.5136,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Us Dop Vein Ltd Upper Extremity,,93971,CPT,Facility,Inpatient,,,,626,532.1,179.4116,626,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Us Dop Vein Ltd Upper Extremity,,93971,CPT,Facility,Both,,,,626,532.1,179.4116,626,Sanford Health Plan,Sanford Health Plan,575.92,92,,percent of total billed charges,,
Us Dop Vein Ltd Upper Extremity,,93971,CPT,Facility,Outpatient,,,,626,532.1,179.4116,626,"UCare Health, Inc.",Individual & Family Plan,352.751,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Us Dop Vein Ltd Upper Extremity,,93971,CPT,Facility,Inpatient,,,,626,532.1,179.4116,626,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Us Dop Vein Ltd Upper Extremity,,93971,CPT,Facility,Outpatient,,,,626,532.1,179.4116,626,"UCare Health, Inc.",Medical Assistance,315.9422,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Dop Vein Ltd Upper Extremity,,93971,CPT,Facility,Inpatient,,,,626,532.1,179.4116,626,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Us Dop Vein Ltd Upper Extremity,,93971,CPT,Facility,Outpatient,,,,626,532.1,179.4116,626,"UCare Health, Inc.",Medicare Advantage,315.9422,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Dop Vein Ltd Upper Extremity,,93971,CPT,Facility,Inpatient,,,,626,532.1,179.4116,626,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Us Dop Vein Ltd Upper Extremity,,93971,CPT,Facility,Outpatient,,,,626,532.1,179.4116,626,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),315.9422,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Dop Vein Ltd Upper Extremity,,93971,CPT,Facility,Inpatient,,,,626,532.1,179.4116,626,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Us Dop Vein Ltd Upper Extremity,,93971,CPT,Facility,Both,,,,626,532.1,179.4116,626,UnitedHealthcare,Individual & Family,588.44,94,,percent of total billed charges,,
Us Dop Vein Ltd Upper Extremity,,93971,CPT,Facility,Outpatient,,,,626,532.1,179.4116,626,UnitedHealthcare,Medicare Advantage,306.74,49,,percent of total billed charges,,
Us Dop Vein Ltd Upper Extremity,,93971,CPT,Facility,Inpatient,,,,626,532.1,179.4116,626,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Us Dop Vein Ltd Upper Extremity,,93971,CPT,Facility,Outpatient,,,,626,532.1,179.4116,626,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,300.48,48,,percent of total billed charges,,100% of DHS outpatient percentage
Us Dop Vein Ltd Upper Extremity,,93971,CPT,Facility,Inpatient,,,,626,532.1,179.4116,626,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Us Abd Port Hep Slen Vasc,,93975,CPT,Facility,Both,,,,1359,1155.15,389.4894,1359,Aetna,Commercial,1250.28,92,,percent of total billed charges,,
Us Abd Port Hep Slen Vasc,,93975,CPT,Facility,Outpatient,,,,1359,1155.15,389.4894,1359,Aetna,Medicare Advantage,665.91,49,,percent of total billed charges,,
Us Abd Port Hep Slen Vasc,,93975,CPT,Facility,Inpatient,,,,1359,1155.15,389.4894,1359,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Us Abd Port Hep Slen Vasc,,93975,CPT,Facility,Both,,,,1359,1155.15,389.4894,1359,Aetna,PPO,1263.87,93,,percent of total billed charges,,
Us Abd Port Hep Slen Vasc,,93975,CPT,Facility,Both,,,,1359,1155.15,389.4894,1359,America's PPO,America's PPO,1305.0477,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Us Abd Port Hep Slen Vasc,,93975,CPT,Facility,Both,,,,1359,1155.15,389.4894,1359,BlueCross BlueShield Minnesota, Federal Employee Program,1337.256,98.4,,percent of total billed charges,,
Us Abd Port Hep Slen Vasc,,93975,CPT,Facility,Both,,,,1359,1155.15,389.4894,1359,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1359,100,,percent of total billed charges,,
Us Abd Port Hep Slen Vasc,,93975,CPT,Facility,Both,,,,1359,1155.15,389.4894,1359,BlueCross BlueShield Minnesota,High Value Network Plan,1223.1,90,,percent of total billed charges,,
Us Abd Port Hep Slen Vasc,,93975,CPT,Facility,Outpatient,,,,1359,1155.15,389.4894,1359,BlueCross BlueShield Minnesota,Medicare Advantage,665.91,49,,percent of total billed charges,,
Us Abd Port Hep Slen Vasc,,93975,CPT,Facility,Inpatient,,,,1359,1155.15,389.4894,1359,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Us Abd Port Hep Slen Vasc,,93975,CPT,Facility,Both,,,,1359,1155.15,389.4894,1359,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1203.6663,88.57,,percent of total billed charges,,
Us Abd Port Hep Slen Vasc,,93975,CPT,Facility,Both,,,,1359,1155.15,389.4894,1359,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,389.4894,28.66,,percent of total billed charges,,
Us Abd Port Hep Slen Vasc,,93975,CPT,Facility,Outpatient,,,,1359,1155.15,389.4894,1359,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),665.91,49,,percent of total billed charges,,
Us Abd Port Hep Slen Vasc,,93975,CPT,Facility,Inpatient,,,,1359,1155.15,389.4894,1359,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Us Abd Port Hep Slen Vasc,,93975,CPT,Facility,Both,,,,1359,1155.15,389.4894,1359,CorVel,Worker's Compensation,1359,100,,percent of total billed charges,,
Us Abd Port Hep Slen Vasc,,93975,CPT,Facility,Both,,,,1359,1155.15,389.4894,1359,First Health Group Corporation,First Health Network,1318.23,97,,percent of total billed charges,,
Us Abd Port Hep Slen Vasc,,93975,CPT,Facility,Both,,,,1359,1155.15,389.4894,1359,"Health Partners, Inc.",Commercial,1285.614,94.6,,percent of total billed charges,,
Us Abd Port Hep Slen Vasc,,93975,CPT,Facility,Outpatient,,,,1359,1155.15,389.4894,1359,"Health Partners, Inc.",Medicare Advantage,665.91,49,,percent of total billed charges,,
Us Abd Port Hep Slen Vasc,,93975,CPT,Facility,Inpatient,,,,1359,1155.15,389.4894,1359,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Us Abd Port Hep Slen Vasc,,93975,CPT,Facility,Both,,,,1359,1155.15,389.4894,1359,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),815.4,60,,percent of total billed charges,,
Us Abd Port Hep Slen Vasc,,93975,CPT,Facility,Both,,,,1359,1155.15,389.4894,1359,"Health Partners, Inc.",State of Minnesota Advantage Program,1107.585,81.5,,percent of total billed charges,,
Us Abd Port Hep Slen Vasc,,93975,CPT,Facility,Both,,,,1359,1155.15,389.4894,1359,"Health Partners, Inc.",State Public Programs,679.5,50,,percent of total billed charges,,
Us Abd Port Hep Slen Vasc,,93975,CPT,Facility,Both,,,,1359,1155.15,389.4894,1359,Humana Insurance Company,Commercial PPO,1291.05,95,,percent of total billed charges,,
Us Abd Port Hep Slen Vasc,,93975,CPT,Facility,Outpatient,,,,1359,1155.15,389.4894,1359,Humana Insurance Company,Medicare PPO,665.91,49,,percent of total billed charges,,
Us Abd Port Hep Slen Vasc,,93975,CPT,Facility,Inpatient,,,,1359,1155.15,389.4894,1359,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Us Abd Port Hep Slen Vasc,,93975,CPT,Facility,Both,,,,1359,1155.15,389.4894,1359,Medica,Individual & Family,1346.769,99.1,,percent of total billed charges,,
Us Abd Port Hep Slen Vasc,,93975,CPT,Facility,Outpatient,,,,1359,1155.15,389.4894,1359,Medica,Medica Advantage Solution,676.782,49.8,,percent of total billed charges,,
Us Abd Port Hep Slen Vasc,,93975,CPT,Facility,Inpatient,,,,1359,1155.15,389.4894,1359,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Us Abd Port Hep Slen Vasc,,93975,CPT,Facility,Outpatient,,,,1359,1155.15,389.4894,1359,Medica,Medical Assistance,606.114,44.6,,percent of total billed charges,,
Us Abd Port Hep Slen Vasc,,93975,CPT,Facility,Inpatient,,,,1359,1155.15,389.4894,1359,Medica,Medical Assistance,,,,,Included in per diem rate,
Us Abd Port Hep Slen Vasc,,93975,CPT,Facility,Outpatient,,,,1359,1155.15,389.4894,1359,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,676.782,49.8,,percent of total billed charges,,
Us Abd Port Hep Slen Vasc,,93975,CPT,Facility,Inpatient,,,,1359,1155.15,389.4894,1359,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Us Abd Port Hep Slen Vasc,,93975,CPT,Facility,Both,,,,1359,1155.15,389.4894,1359,"Multiplan, Inc.","Multiplan, Inc.",1277.46,94,,percent of total billed charges,,
Us Abd Port Hep Slen Vasc,,93975,CPT,Facility,Outpatient,,,,1359,1155.15,389.4894,1359,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1224.459,90.1,,percent of total billed charges,,
Us Abd Port Hep Slen Vasc,,93975,CPT,Facility,Inpatient,,,,1359,1155.15,389.4894,1359,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Us Abd Port Hep Slen Vasc,,93975,CPT,Facility,Both,,,,1359,1155.15,389.4894,1359,"Preferred One Administrative Services, INC.",PPO,1339.974,98.6,,percent of total billed charges,,
Us Abd Port Hep Slen Vasc,,93975,CPT,Facility,Outpatient,,,,1359,1155.15,389.4894,1359,PrimeWest Health,Minnesota Senior Health Options (MSHO),699.2055,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Us Abd Port Hep Slen Vasc,,93975,CPT,Facility,Inpatient,,,,1359,1155.15,389.4894,1359,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Us Abd Port Hep Slen Vasc,,93975,CPT,Facility,Outpatient,,,,1359,1155.15,389.4894,1359,PrimeWest Health,MinnesotaCare,697.9824,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Us Abd Port Hep Slen Vasc,,93975,CPT,Facility,Inpatient,,,,1359,1155.15,389.4894,1359,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Us Abd Port Hep Slen Vasc,,93975,CPT,Facility,Both,,,,1359,1155.15,389.4894,1359,Sanford Health Plan,Sanford Health Plan,1250.28,92,,percent of total billed charges,,
Us Abd Port Hep Slen Vasc,,93975,CPT,Facility,Outpatient,,,,1359,1155.15,389.4894,1359,"UCare Health, Inc.",Individual & Family Plan,765.7965,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Us Abd Port Hep Slen Vasc,,93975,CPT,Facility,Inpatient,,,,1359,1155.15,389.4894,1359,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Us Abd Port Hep Slen Vasc,,93975,CPT,Facility,Outpatient,,,,1359,1155.15,389.4894,1359,"UCare Health, Inc.",Medical Assistance,685.8873,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Abd Port Hep Slen Vasc,,93975,CPT,Facility,Inpatient,,,,1359,1155.15,389.4894,1359,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Us Abd Port Hep Slen Vasc,,93975,CPT,Facility,Outpatient,,,,1359,1155.15,389.4894,1359,"UCare Health, Inc.",Medicare Advantage,685.8873,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Abd Port Hep Slen Vasc,,93975,CPT,Facility,Inpatient,,,,1359,1155.15,389.4894,1359,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Us Abd Port Hep Slen Vasc,,93975,CPT,Facility,Outpatient,,,,1359,1155.15,389.4894,1359,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),685.8873,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Abd Port Hep Slen Vasc,,93975,CPT,Facility,Inpatient,,,,1359,1155.15,389.4894,1359,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Us Abd Port Hep Slen Vasc,,93975,CPT,Facility,Both,,,,1359,1155.15,389.4894,1359,UnitedHealthcare,Individual & Family,1277.46,94,,percent of total billed charges,,
Us Abd Port Hep Slen Vasc,,93975,CPT,Facility,Outpatient,,,,1359,1155.15,389.4894,1359,UnitedHealthcare,Medicare Advantage,665.91,49,,percent of total billed charges,,
Us Abd Port Hep Slen Vasc,,93975,CPT,Facility,Inpatient,,,,1359,1155.15,389.4894,1359,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Us Abd Port Hep Slen Vasc,,93975,CPT,Facility,Outpatient,,,,1359,1155.15,389.4894,1359,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,652.32,48,,percent of total billed charges,,100% of DHS outpatient percentage
Us Abd Port Hep Slen Vasc,,93975,CPT,Facility,Inpatient,,,,1359,1155.15,389.4894,1359,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Us Dop Organs Complete,,93975,CPT,Facility,Both,,,,1359,1155.15,389.4894,1359,Aetna,Commercial,1250.28,92,,percent of total billed charges,,
Us Dop Organs Complete,,93975,CPT,Facility,Outpatient,,,,1359,1155.15,389.4894,1359,Aetna,Medicare Advantage,665.91,49,,percent of total billed charges,,
Us Dop Organs Complete,,93975,CPT,Facility,Inpatient,,,,1359,1155.15,389.4894,1359,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Us Dop Organs Complete,,93975,CPT,Facility,Both,,,,1359,1155.15,389.4894,1359,Aetna,PPO,1263.87,93,,percent of total billed charges,,
Us Dop Organs Complete,,93975,CPT,Facility,Both,,,,1359,1155.15,389.4894,1359,America's PPO,America's PPO,1305.0477,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Us Dop Organs Complete,,93975,CPT,Facility,Both,,,,1359,1155.15,389.4894,1359,BlueCross BlueShield Minnesota, Federal Employee Program,1337.256,98.4,,percent of total billed charges,,
Us Dop Organs Complete,,93975,CPT,Facility,Both,,,,1359,1155.15,389.4894,1359,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1359,100,,percent of total billed charges,,
Us Dop Organs Complete,,93975,CPT,Facility,Both,,,,1359,1155.15,389.4894,1359,BlueCross BlueShield Minnesota,High Value Network Plan,1223.1,90,,percent of total billed charges,,
Us Dop Organs Complete,,93975,CPT,Facility,Outpatient,,,,1359,1155.15,389.4894,1359,BlueCross BlueShield Minnesota,Medicare Advantage,665.91,49,,percent of total billed charges,,
Us Dop Organs Complete,,93975,CPT,Facility,Inpatient,,,,1359,1155.15,389.4894,1359,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Us Dop Organs Complete,,93975,CPT,Facility,Both,,,,1359,1155.15,389.4894,1359,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1203.6663,88.57,,percent of total billed charges,,
Us Dop Organs Complete,,93975,CPT,Facility,Both,,,,1359,1155.15,389.4894,1359,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,389.4894,28.66,,percent of total billed charges,,
Us Dop Organs Complete,,93975,CPT,Facility,Outpatient,,,,1359,1155.15,389.4894,1359,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),665.91,49,,percent of total billed charges,,
Us Dop Organs Complete,,93975,CPT,Facility,Inpatient,,,,1359,1155.15,389.4894,1359,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Us Dop Organs Complete,,93975,CPT,Facility,Both,,,,1359,1155.15,389.4894,1359,CorVel,Worker's Compensation,1359,100,,percent of total billed charges,,
Us Dop Organs Complete,,93975,CPT,Facility,Both,,,,1359,1155.15,389.4894,1359,First Health Group Corporation,First Health Network,1318.23,97,,percent of total billed charges,,
Us Dop Organs Complete,,93975,CPT,Facility,Both,,,,1359,1155.15,389.4894,1359,"Health Partners, Inc.",Commercial,1285.614,94.6,,percent of total billed charges,,
Us Dop Organs Complete,,93975,CPT,Facility,Outpatient,,,,1359,1155.15,389.4894,1359,"Health Partners, Inc.",Medicare Advantage,665.91,49,,percent of total billed charges,,
Us Dop Organs Complete,,93975,CPT,Facility,Inpatient,,,,1359,1155.15,389.4894,1359,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Us Dop Organs Complete,,93975,CPT,Facility,Both,,,,1359,1155.15,389.4894,1359,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),815.4,60,,percent of total billed charges,,
Us Dop Organs Complete,,93975,CPT,Facility,Both,,,,1359,1155.15,389.4894,1359,"Health Partners, Inc.",State of Minnesota Advantage Program,1107.585,81.5,,percent of total billed charges,,
Us Dop Organs Complete,,93975,CPT,Facility,Both,,,,1359,1155.15,389.4894,1359,"Health Partners, Inc.",State Public Programs,679.5,50,,percent of total billed charges,,
Us Dop Organs Complete,,93975,CPT,Facility,Both,,,,1359,1155.15,389.4894,1359,Humana Insurance Company,Commercial PPO,1291.05,95,,percent of total billed charges,,
Us Dop Organs Complete,,93975,CPT,Facility,Outpatient,,,,1359,1155.15,389.4894,1359,Humana Insurance Company,Medicare PPO,665.91,49,,percent of total billed charges,,
Us Dop Organs Complete,,93975,CPT,Facility,Inpatient,,,,1359,1155.15,389.4894,1359,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Us Dop Organs Complete,,93975,CPT,Facility,Both,,,,1359,1155.15,389.4894,1359,Medica,Individual & Family,1346.769,99.1,,percent of total billed charges,,
Us Dop Organs Complete,,93975,CPT,Facility,Outpatient,,,,1359,1155.15,389.4894,1359,Medica,Medica Advantage Solution,676.782,49.8,,percent of total billed charges,,
Us Dop Organs Complete,,93975,CPT,Facility,Inpatient,,,,1359,1155.15,389.4894,1359,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Us Dop Organs Complete,,93975,CPT,Facility,Outpatient,,,,1359,1155.15,389.4894,1359,Medica,Medical Assistance,606.114,44.6,,percent of total billed charges,,
Us Dop Organs Complete,,93975,CPT,Facility,Inpatient,,,,1359,1155.15,389.4894,1359,Medica,Medical Assistance,,,,,Included in per diem rate,
Us Dop Organs Complete,,93975,CPT,Facility,Outpatient,,,,1359,1155.15,389.4894,1359,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,676.782,49.8,,percent of total billed charges,,
Us Dop Organs Complete,,93975,CPT,Facility,Inpatient,,,,1359,1155.15,389.4894,1359,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Us Dop Organs Complete,,93975,CPT,Facility,Both,,,,1359,1155.15,389.4894,1359,"Multiplan, Inc.","Multiplan, Inc.",1277.46,94,,percent of total billed charges,,
Us Dop Organs Complete,,93975,CPT,Facility,Outpatient,,,,1359,1155.15,389.4894,1359,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1224.459,90.1,,percent of total billed charges,,
Us Dop Organs Complete,,93975,CPT,Facility,Inpatient,,,,1359,1155.15,389.4894,1359,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Us Dop Organs Complete,,93975,CPT,Facility,Both,,,,1359,1155.15,389.4894,1359,"Preferred One Administrative Services, INC.",PPO,1339.974,98.6,,percent of total billed charges,,
Us Dop Organs Complete,,93975,CPT,Facility,Outpatient,,,,1359,1155.15,389.4894,1359,PrimeWest Health,Minnesota Senior Health Options (MSHO),699.2055,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Us Dop Organs Complete,,93975,CPT,Facility,Inpatient,,,,1359,1155.15,389.4894,1359,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Us Dop Organs Complete,,93975,CPT,Facility,Outpatient,,,,1359,1155.15,389.4894,1359,PrimeWest Health,MinnesotaCare,697.9824,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Us Dop Organs Complete,,93975,CPT,Facility,Inpatient,,,,1359,1155.15,389.4894,1359,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Us Dop Organs Complete,,93975,CPT,Facility,Both,,,,1359,1155.15,389.4894,1359,Sanford Health Plan,Sanford Health Plan,1250.28,92,,percent of total billed charges,,
Us Dop Organs Complete,,93975,CPT,Facility,Outpatient,,,,1359,1155.15,389.4894,1359,"UCare Health, Inc.",Individual & Family Plan,765.7965,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Us Dop Organs Complete,,93975,CPT,Facility,Inpatient,,,,1359,1155.15,389.4894,1359,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Us Dop Organs Complete,,93975,CPT,Facility,Outpatient,,,,1359,1155.15,389.4894,1359,"UCare Health, Inc.",Medical Assistance,685.8873,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Dop Organs Complete,,93975,CPT,Facility,Inpatient,,,,1359,1155.15,389.4894,1359,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Us Dop Organs Complete,,93975,CPT,Facility,Outpatient,,,,1359,1155.15,389.4894,1359,"UCare Health, Inc.",Medicare Advantage,685.8873,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Dop Organs Complete,,93975,CPT,Facility,Inpatient,,,,1359,1155.15,389.4894,1359,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Us Dop Organs Complete,,93975,CPT,Facility,Outpatient,,,,1359,1155.15,389.4894,1359,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),685.8873,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Dop Organs Complete,,93975,CPT,Facility,Inpatient,,,,1359,1155.15,389.4894,1359,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Us Dop Organs Complete,,93975,CPT,Facility,Both,,,,1359,1155.15,389.4894,1359,UnitedHealthcare,Individual & Family,1277.46,94,,percent of total billed charges,,
Us Dop Organs Complete,,93975,CPT,Facility,Outpatient,,,,1359,1155.15,389.4894,1359,UnitedHealthcare,Medicare Advantage,665.91,49,,percent of total billed charges,,
Us Dop Organs Complete,,93975,CPT,Facility,Inpatient,,,,1359,1155.15,389.4894,1359,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Us Dop Organs Complete,,93975,CPT,Facility,Outpatient,,,,1359,1155.15,389.4894,1359,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,652.32,48,,percent of total billed charges,,100% of DHS outpatient percentage
Us Dop Organs Complete,,93975,CPT,Facility,Inpatient,,,,1359,1155.15,389.4894,1359,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Us Renal Artery Complete Study,,93975,CPT,Facility,Both,,,,1359,1155.15,389.4894,1359,Aetna,Commercial,1250.28,92,,percent of total billed charges,,
Us Renal Artery Complete Study,,93975,CPT,Facility,Outpatient,,,,1359,1155.15,389.4894,1359,Aetna,Medicare Advantage,665.91,49,,percent of total billed charges,,
Us Renal Artery Complete Study,,93975,CPT,Facility,Inpatient,,,,1359,1155.15,389.4894,1359,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Us Renal Artery Complete Study,,93975,CPT,Facility,Both,,,,1359,1155.15,389.4894,1359,Aetna,PPO,1263.87,93,,percent of total billed charges,,
Us Renal Artery Complete Study,,93975,CPT,Facility,Both,,,,1359,1155.15,389.4894,1359,America's PPO,America's PPO,1305.0477,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Us Renal Artery Complete Study,,93975,CPT,Facility,Both,,,,1359,1155.15,389.4894,1359,BlueCross BlueShield Minnesota, Federal Employee Program,1337.256,98.4,,percent of total billed charges,,
Us Renal Artery Complete Study,,93975,CPT,Facility,Both,,,,1359,1155.15,389.4894,1359,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1359,100,,percent of total billed charges,,
Us Renal Artery Complete Study,,93975,CPT,Facility,Both,,,,1359,1155.15,389.4894,1359,BlueCross BlueShield Minnesota,High Value Network Plan,1223.1,90,,percent of total billed charges,,
Us Renal Artery Complete Study,,93975,CPT,Facility,Outpatient,,,,1359,1155.15,389.4894,1359,BlueCross BlueShield Minnesota,Medicare Advantage,665.91,49,,percent of total billed charges,,
Us Renal Artery Complete Study,,93975,CPT,Facility,Inpatient,,,,1359,1155.15,389.4894,1359,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Us Renal Artery Complete Study,,93975,CPT,Facility,Both,,,,1359,1155.15,389.4894,1359,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1203.6663,88.57,,percent of total billed charges,,
Us Renal Artery Complete Study,,93975,CPT,Facility,Both,,,,1359,1155.15,389.4894,1359,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,389.4894,28.66,,percent of total billed charges,,
Us Renal Artery Complete Study,,93975,CPT,Facility,Outpatient,,,,1359,1155.15,389.4894,1359,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),665.91,49,,percent of total billed charges,,
Us Renal Artery Complete Study,,93975,CPT,Facility,Inpatient,,,,1359,1155.15,389.4894,1359,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Us Renal Artery Complete Study,,93975,CPT,Facility,Both,,,,1359,1155.15,389.4894,1359,CorVel,Worker's Compensation,1359,100,,percent of total billed charges,,
Us Renal Artery Complete Study,,93975,CPT,Facility,Both,,,,1359,1155.15,389.4894,1359,First Health Group Corporation,First Health Network,1318.23,97,,percent of total billed charges,,
Us Renal Artery Complete Study,,93975,CPT,Facility,Both,,,,1359,1155.15,389.4894,1359,"Health Partners, Inc.",Commercial,1285.614,94.6,,percent of total billed charges,,
Us Renal Artery Complete Study,,93975,CPT,Facility,Outpatient,,,,1359,1155.15,389.4894,1359,"Health Partners, Inc.",Medicare Advantage,665.91,49,,percent of total billed charges,,
Us Renal Artery Complete Study,,93975,CPT,Facility,Inpatient,,,,1359,1155.15,389.4894,1359,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Us Renal Artery Complete Study,,93975,CPT,Facility,Both,,,,1359,1155.15,389.4894,1359,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),815.4,60,,percent of total billed charges,,
Us Renal Artery Complete Study,,93975,CPT,Facility,Both,,,,1359,1155.15,389.4894,1359,"Health Partners, Inc.",State of Minnesota Advantage Program,1107.585,81.5,,percent of total billed charges,,
Us Renal Artery Complete Study,,93975,CPT,Facility,Both,,,,1359,1155.15,389.4894,1359,"Health Partners, Inc.",State Public Programs,679.5,50,,percent of total billed charges,,
Us Renal Artery Complete Study,,93975,CPT,Facility,Both,,,,1359,1155.15,389.4894,1359,Humana Insurance Company,Commercial PPO,1291.05,95,,percent of total billed charges,,
Us Renal Artery Complete Study,,93975,CPT,Facility,Outpatient,,,,1359,1155.15,389.4894,1359,Humana Insurance Company,Medicare PPO,665.91,49,,percent of total billed charges,,
Us Renal Artery Complete Study,,93975,CPT,Facility,Inpatient,,,,1359,1155.15,389.4894,1359,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Us Renal Artery Complete Study,,93975,CPT,Facility,Both,,,,1359,1155.15,389.4894,1359,Medica,Individual & Family,1346.769,99.1,,percent of total billed charges,,
Us Renal Artery Complete Study,,93975,CPT,Facility,Outpatient,,,,1359,1155.15,389.4894,1359,Medica,Medica Advantage Solution,676.782,49.8,,percent of total billed charges,,
Us Renal Artery Complete Study,,93975,CPT,Facility,Inpatient,,,,1359,1155.15,389.4894,1359,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Us Renal Artery Complete Study,,93975,CPT,Facility,Outpatient,,,,1359,1155.15,389.4894,1359,Medica,Medical Assistance,606.114,44.6,,percent of total billed charges,,
Us Renal Artery Complete Study,,93975,CPT,Facility,Inpatient,,,,1359,1155.15,389.4894,1359,Medica,Medical Assistance,,,,,Included in per diem rate,
Us Renal Artery Complete Study,,93975,CPT,Facility,Outpatient,,,,1359,1155.15,389.4894,1359,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,676.782,49.8,,percent of total billed charges,,
Us Renal Artery Complete Study,,93975,CPT,Facility,Inpatient,,,,1359,1155.15,389.4894,1359,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Us Renal Artery Complete Study,,93975,CPT,Facility,Both,,,,1359,1155.15,389.4894,1359,"Multiplan, Inc.","Multiplan, Inc.",1277.46,94,,percent of total billed charges,,
Us Renal Artery Complete Study,,93975,CPT,Facility,Outpatient,,,,1359,1155.15,389.4894,1359,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1224.459,90.1,,percent of total billed charges,,
Us Renal Artery Complete Study,,93975,CPT,Facility,Inpatient,,,,1359,1155.15,389.4894,1359,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Us Renal Artery Complete Study,,93975,CPT,Facility,Both,,,,1359,1155.15,389.4894,1359,"Preferred One Administrative Services, INC.",PPO,1339.974,98.6,,percent of total billed charges,,
Us Renal Artery Complete Study,,93975,CPT,Facility,Outpatient,,,,1359,1155.15,389.4894,1359,PrimeWest Health,Minnesota Senior Health Options (MSHO),699.2055,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Us Renal Artery Complete Study,,93975,CPT,Facility,Inpatient,,,,1359,1155.15,389.4894,1359,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Us Renal Artery Complete Study,,93975,CPT,Facility,Outpatient,,,,1359,1155.15,389.4894,1359,PrimeWest Health,MinnesotaCare,697.9824,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Us Renal Artery Complete Study,,93975,CPT,Facility,Inpatient,,,,1359,1155.15,389.4894,1359,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Us Renal Artery Complete Study,,93975,CPT,Facility,Both,,,,1359,1155.15,389.4894,1359,Sanford Health Plan,Sanford Health Plan,1250.28,92,,percent of total billed charges,,
Us Renal Artery Complete Study,,93975,CPT,Facility,Outpatient,,,,1359,1155.15,389.4894,1359,"UCare Health, Inc.",Individual & Family Plan,765.7965,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Us Renal Artery Complete Study,,93975,CPT,Facility,Inpatient,,,,1359,1155.15,389.4894,1359,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Us Renal Artery Complete Study,,93975,CPT,Facility,Outpatient,,,,1359,1155.15,389.4894,1359,"UCare Health, Inc.",Medical Assistance,685.8873,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Renal Artery Complete Study,,93975,CPT,Facility,Inpatient,,,,1359,1155.15,389.4894,1359,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Us Renal Artery Complete Study,,93975,CPT,Facility,Outpatient,,,,1359,1155.15,389.4894,1359,"UCare Health, Inc.",Medicare Advantage,685.8873,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Renal Artery Complete Study,,93975,CPT,Facility,Inpatient,,,,1359,1155.15,389.4894,1359,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Us Renal Artery Complete Study,,93975,CPT,Facility,Outpatient,,,,1359,1155.15,389.4894,1359,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),685.8873,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Renal Artery Complete Study,,93975,CPT,Facility,Inpatient,,,,1359,1155.15,389.4894,1359,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Us Renal Artery Complete Study,,93975,CPT,Facility,Both,,,,1359,1155.15,389.4894,1359,UnitedHealthcare,Individual & Family,1277.46,94,,percent of total billed charges,,
Us Renal Artery Complete Study,,93975,CPT,Facility,Outpatient,,,,1359,1155.15,389.4894,1359,UnitedHealthcare,Medicare Advantage,665.91,49,,percent of total billed charges,,
Us Renal Artery Complete Study,,93975,CPT,Facility,Inpatient,,,,1359,1155.15,389.4894,1359,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Us Renal Artery Complete Study,,93975,CPT,Facility,Outpatient,,,,1359,1155.15,389.4894,1359,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,652.32,48,,percent of total billed charges,,100% of DHS outpatient percentage
Us Renal Artery Complete Study,,93975,CPT,Facility,Inpatient,,,,1359,1155.15,389.4894,1359,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Us Abd Mesenteric Arterial System,,93976,CPT,Facility,Both,,,,786,668.1,225.2676,786,Aetna,Commercial,723.12,92,,percent of total billed charges,,
Us Abd Mesenteric Arterial System,,93976,CPT,Facility,Outpatient,,,,786,668.1,225.2676,786,Aetna,Medicare Advantage,385.14,49,,percent of total billed charges,,
Us Abd Mesenteric Arterial System,,93976,CPT,Facility,Inpatient,,,,786,668.1,225.2676,786,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Us Abd Mesenteric Arterial System,,93976,CPT,Facility,Both,,,,786,668.1,225.2676,786,Aetna,PPO,730.98,93,,percent of total billed charges,,
Us Abd Mesenteric Arterial System,,93976,CPT,Facility,Both,,,,786,668.1,225.2676,786,America's PPO,America's PPO,754.7958,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Us Abd Mesenteric Arterial System,,93976,CPT,Facility,Both,,,,786,668.1,225.2676,786,BlueCross BlueShield Minnesota, Federal Employee Program,773.424,98.4,,percent of total billed charges,,
Us Abd Mesenteric Arterial System,,93976,CPT,Facility,Both,,,,786,668.1,225.2676,786,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,786,100,,percent of total billed charges,,
Us Abd Mesenteric Arterial System,,93976,CPT,Facility,Both,,,,786,668.1,225.2676,786,BlueCross BlueShield Minnesota,High Value Network Plan,707.4,90,,percent of total billed charges,,
Us Abd Mesenteric Arterial System,,93976,CPT,Facility,Outpatient,,,,786,668.1,225.2676,786,BlueCross BlueShield Minnesota,Medicare Advantage,385.14,49,,percent of total billed charges,,
Us Abd Mesenteric Arterial System,,93976,CPT,Facility,Inpatient,,,,786,668.1,225.2676,786,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Us Abd Mesenteric Arterial System,,93976,CPT,Facility,Both,,,,786,668.1,225.2676,786,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,696.1602,88.57,,percent of total billed charges,,
Us Abd Mesenteric Arterial System,,93976,CPT,Facility,Both,,,,786,668.1,225.2676,786,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,225.2676,28.66,,percent of total billed charges,,
Us Abd Mesenteric Arterial System,,93976,CPT,Facility,Outpatient,,,,786,668.1,225.2676,786,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),385.14,49,,percent of total billed charges,,
Us Abd Mesenteric Arterial System,,93976,CPT,Facility,Inpatient,,,,786,668.1,225.2676,786,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Us Abd Mesenteric Arterial System,,93976,CPT,Facility,Both,,,,786,668.1,225.2676,786,CorVel,Worker's Compensation,786,100,,percent of total billed charges,,
Us Abd Mesenteric Arterial System,,93976,CPT,Facility,Both,,,,786,668.1,225.2676,786,First Health Group Corporation,First Health Network,762.42,97,,percent of total billed charges,,
Us Abd Mesenteric Arterial System,,93976,CPT,Facility,Both,,,,786,668.1,225.2676,786,"Health Partners, Inc.",Commercial,743.556,94.6,,percent of total billed charges,,
Us Abd Mesenteric Arterial System,,93976,CPT,Facility,Outpatient,,,,786,668.1,225.2676,786,"Health Partners, Inc.",Medicare Advantage,385.14,49,,percent of total billed charges,,
Us Abd Mesenteric Arterial System,,93976,CPT,Facility,Inpatient,,,,786,668.1,225.2676,786,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Us Abd Mesenteric Arterial System,,93976,CPT,Facility,Both,,,,786,668.1,225.2676,786,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),471.6,60,,percent of total billed charges,,
Us Abd Mesenteric Arterial System,,93976,CPT,Facility,Both,,,,786,668.1,225.2676,786,"Health Partners, Inc.",State of Minnesota Advantage Program,640.59,81.5,,percent of total billed charges,,
Us Abd Mesenteric Arterial System,,93976,CPT,Facility,Both,,,,786,668.1,225.2676,786,"Health Partners, Inc.",State Public Programs,393,50,,percent of total billed charges,,
Us Abd Mesenteric Arterial System,,93976,CPT,Facility,Both,,,,786,668.1,225.2676,786,Humana Insurance Company,Commercial PPO,746.7,95,,percent of total billed charges,,
Us Abd Mesenteric Arterial System,,93976,CPT,Facility,Outpatient,,,,786,668.1,225.2676,786,Humana Insurance Company,Medicare PPO,385.14,49,,percent of total billed charges,,
Us Abd Mesenteric Arterial System,,93976,CPT,Facility,Inpatient,,,,786,668.1,225.2676,786,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Us Abd Mesenteric Arterial System,,93976,CPT,Facility,Both,,,,786,668.1,225.2676,786,Medica,Individual & Family,778.926,99.1,,percent of total billed charges,,
Us Abd Mesenteric Arterial System,,93976,CPT,Facility,Outpatient,,,,786,668.1,225.2676,786,Medica,Medica Advantage Solution,391.428,49.8,,percent of total billed charges,,
Us Abd Mesenteric Arterial System,,93976,CPT,Facility,Inpatient,,,,786,668.1,225.2676,786,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Us Abd Mesenteric Arterial System,,93976,CPT,Facility,Outpatient,,,,786,668.1,225.2676,786,Medica,Medical Assistance,350.556,44.6,,percent of total billed charges,,
Us Abd Mesenteric Arterial System,,93976,CPT,Facility,Inpatient,,,,786,668.1,225.2676,786,Medica,Medical Assistance,,,,,Included in per diem rate,
Us Abd Mesenteric Arterial System,,93976,CPT,Facility,Outpatient,,,,786,668.1,225.2676,786,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,391.428,49.8,,percent of total billed charges,,
Us Abd Mesenteric Arterial System,,93976,CPT,Facility,Inpatient,,,,786,668.1,225.2676,786,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Us Abd Mesenteric Arterial System,,93976,CPT,Facility,Both,,,,786,668.1,225.2676,786,"Multiplan, Inc.","Multiplan, Inc.",738.84,94,,percent of total billed charges,,
Us Abd Mesenteric Arterial System,,93976,CPT,Facility,Outpatient,,,,786,668.1,225.2676,786,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,708.186,90.1,,percent of total billed charges,,
Us Abd Mesenteric Arterial System,,93976,CPT,Facility,Inpatient,,,,786,668.1,225.2676,786,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Us Abd Mesenteric Arterial System,,93976,CPT,Facility,Both,,,,786,668.1,225.2676,786,"Preferred One Administrative Services, INC.",PPO,774.996,98.6,,percent of total billed charges,,
Us Abd Mesenteric Arterial System,,93976,CPT,Facility,Outpatient,,,,786,668.1,225.2676,786,PrimeWest Health,Minnesota Senior Health Options (MSHO),404.397,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Us Abd Mesenteric Arterial System,,93976,CPT,Facility,Inpatient,,,,786,668.1,225.2676,786,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Us Abd Mesenteric Arterial System,,93976,CPT,Facility,Outpatient,,,,786,668.1,225.2676,786,PrimeWest Health,MinnesotaCare,403.6896,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Us Abd Mesenteric Arterial System,,93976,CPT,Facility,Inpatient,,,,786,668.1,225.2676,786,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Us Abd Mesenteric Arterial System,,93976,CPT,Facility,Both,,,,786,668.1,225.2676,786,Sanford Health Plan,Sanford Health Plan,723.12,92,,percent of total billed charges,,
Us Abd Mesenteric Arterial System,,93976,CPT,Facility,Outpatient,,,,786,668.1,225.2676,786,"UCare Health, Inc.",Individual & Family Plan,442.911,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Us Abd Mesenteric Arterial System,,93976,CPT,Facility,Inpatient,,,,786,668.1,225.2676,786,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Us Abd Mesenteric Arterial System,,93976,CPT,Facility,Outpatient,,,,786,668.1,225.2676,786,"UCare Health, Inc.",Medical Assistance,396.6942,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Abd Mesenteric Arterial System,,93976,CPT,Facility,Inpatient,,,,786,668.1,225.2676,786,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Us Abd Mesenteric Arterial System,,93976,CPT,Facility,Outpatient,,,,786,668.1,225.2676,786,"UCare Health, Inc.",Medicare Advantage,396.6942,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Abd Mesenteric Arterial System,,93976,CPT,Facility,Inpatient,,,,786,668.1,225.2676,786,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Us Abd Mesenteric Arterial System,,93976,CPT,Facility,Outpatient,,,,786,668.1,225.2676,786,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),396.6942,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Abd Mesenteric Arterial System,,93976,CPT,Facility,Inpatient,,,,786,668.1,225.2676,786,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Us Abd Mesenteric Arterial System,,93976,CPT,Facility,Both,,,,786,668.1,225.2676,786,UnitedHealthcare,Individual & Family,738.84,94,,percent of total billed charges,,
Us Abd Mesenteric Arterial System,,93976,CPT,Facility,Outpatient,,,,786,668.1,225.2676,786,UnitedHealthcare,Medicare Advantage,385.14,49,,percent of total billed charges,,
Us Abd Mesenteric Arterial System,,93976,CPT,Facility,Inpatient,,,,786,668.1,225.2676,786,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Us Abd Mesenteric Arterial System,,93976,CPT,Facility,Outpatient,,,,786,668.1,225.2676,786,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,377.28,48,,percent of total billed charges,,100% of DHS outpatient percentage
Us Abd Mesenteric Arterial System,,93976,CPT,Facility,Inpatient,,,,786,668.1,225.2676,786,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Us Dop Organs Ltd,,93976,CPT,Facility,Both,,,,786,668.1,225.2676,786,Aetna,Commercial,723.12,92,,percent of total billed charges,,
Us Dop Organs Ltd,,93976,CPT,Facility,Outpatient,,,,786,668.1,225.2676,786,Aetna,Medicare Advantage,385.14,49,,percent of total billed charges,,
Us Dop Organs Ltd,,93976,CPT,Facility,Inpatient,,,,786,668.1,225.2676,786,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Us Dop Organs Ltd,,93976,CPT,Facility,Both,,,,786,668.1,225.2676,786,Aetna,PPO,730.98,93,,percent of total billed charges,,
Us Dop Organs Ltd,,93976,CPT,Facility,Both,,,,786,668.1,225.2676,786,America's PPO,America's PPO,754.7958,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Us Dop Organs Ltd,,93976,CPT,Facility,Both,,,,786,668.1,225.2676,786,BlueCross BlueShield Minnesota, Federal Employee Program,773.424,98.4,,percent of total billed charges,,
Us Dop Organs Ltd,,93976,CPT,Facility,Both,,,,786,668.1,225.2676,786,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,786,100,,percent of total billed charges,,
Us Dop Organs Ltd,,93976,CPT,Facility,Both,,,,786,668.1,225.2676,786,BlueCross BlueShield Minnesota,High Value Network Plan,707.4,90,,percent of total billed charges,,
Us Dop Organs Ltd,,93976,CPT,Facility,Outpatient,,,,786,668.1,225.2676,786,BlueCross BlueShield Minnesota,Medicare Advantage,385.14,49,,percent of total billed charges,,
Us Dop Organs Ltd,,93976,CPT,Facility,Inpatient,,,,786,668.1,225.2676,786,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Us Dop Organs Ltd,,93976,CPT,Facility,Both,,,,786,668.1,225.2676,786,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,696.1602,88.57,,percent of total billed charges,,
Us Dop Organs Ltd,,93976,CPT,Facility,Both,,,,786,668.1,225.2676,786,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,225.2676,28.66,,percent of total billed charges,,
Us Dop Organs Ltd,,93976,CPT,Facility,Outpatient,,,,786,668.1,225.2676,786,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),385.14,49,,percent of total billed charges,,
Us Dop Organs Ltd,,93976,CPT,Facility,Inpatient,,,,786,668.1,225.2676,786,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Us Dop Organs Ltd,,93976,CPT,Facility,Both,,,,786,668.1,225.2676,786,CorVel,Worker's Compensation,786,100,,percent of total billed charges,,
Us Dop Organs Ltd,,93976,CPT,Facility,Both,,,,786,668.1,225.2676,786,First Health Group Corporation,First Health Network,762.42,97,,percent of total billed charges,,
Us Dop Organs Ltd,,93976,CPT,Facility,Both,,,,786,668.1,225.2676,786,"Health Partners, Inc.",Commercial,743.556,94.6,,percent of total billed charges,,
Us Dop Organs Ltd,,93976,CPT,Facility,Outpatient,,,,786,668.1,225.2676,786,"Health Partners, Inc.",Medicare Advantage,385.14,49,,percent of total billed charges,,
Us Dop Organs Ltd,,93976,CPT,Facility,Inpatient,,,,786,668.1,225.2676,786,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Us Dop Organs Ltd,,93976,CPT,Facility,Both,,,,786,668.1,225.2676,786,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),471.6,60,,percent of total billed charges,,
Us Dop Organs Ltd,,93976,CPT,Facility,Both,,,,786,668.1,225.2676,786,"Health Partners, Inc.",State of Minnesota Advantage Program,640.59,81.5,,percent of total billed charges,,
Us Dop Organs Ltd,,93976,CPT,Facility,Both,,,,786,668.1,225.2676,786,"Health Partners, Inc.",State Public Programs,393,50,,percent of total billed charges,,
Us Dop Organs Ltd,,93976,CPT,Facility,Both,,,,786,668.1,225.2676,786,Humana Insurance Company,Commercial PPO,746.7,95,,percent of total billed charges,,
Us Dop Organs Ltd,,93976,CPT,Facility,Outpatient,,,,786,668.1,225.2676,786,Humana Insurance Company,Medicare PPO,385.14,49,,percent of total billed charges,,
Us Dop Organs Ltd,,93976,CPT,Facility,Inpatient,,,,786,668.1,225.2676,786,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Us Dop Organs Ltd,,93976,CPT,Facility,Both,,,,786,668.1,225.2676,786,Medica,Individual & Family,778.926,99.1,,percent of total billed charges,,
Us Dop Organs Ltd,,93976,CPT,Facility,Outpatient,,,,786,668.1,225.2676,786,Medica,Medica Advantage Solution,391.428,49.8,,percent of total billed charges,,
Us Dop Organs Ltd,,93976,CPT,Facility,Inpatient,,,,786,668.1,225.2676,786,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Us Dop Organs Ltd,,93976,CPT,Facility,Outpatient,,,,786,668.1,225.2676,786,Medica,Medical Assistance,350.556,44.6,,percent of total billed charges,,
Us Dop Organs Ltd,,93976,CPT,Facility,Inpatient,,,,786,668.1,225.2676,786,Medica,Medical Assistance,,,,,Included in per diem rate,
Us Dop Organs Ltd,,93976,CPT,Facility,Outpatient,,,,786,668.1,225.2676,786,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,391.428,49.8,,percent of total billed charges,,
Us Dop Organs Ltd,,93976,CPT,Facility,Inpatient,,,,786,668.1,225.2676,786,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Us Dop Organs Ltd,,93976,CPT,Facility,Both,,,,786,668.1,225.2676,786,"Multiplan, Inc.","Multiplan, Inc.",738.84,94,,percent of total billed charges,,
Us Dop Organs Ltd,,93976,CPT,Facility,Outpatient,,,,786,668.1,225.2676,786,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,708.186,90.1,,percent of total billed charges,,
Us Dop Organs Ltd,,93976,CPT,Facility,Inpatient,,,,786,668.1,225.2676,786,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Us Dop Organs Ltd,,93976,CPT,Facility,Both,,,,786,668.1,225.2676,786,"Preferred One Administrative Services, INC.",PPO,774.996,98.6,,percent of total billed charges,,
Us Dop Organs Ltd,,93976,CPT,Facility,Outpatient,,,,786,668.1,225.2676,786,PrimeWest Health,Minnesota Senior Health Options (MSHO),404.397,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Us Dop Organs Ltd,,93976,CPT,Facility,Inpatient,,,,786,668.1,225.2676,786,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Us Dop Organs Ltd,,93976,CPT,Facility,Outpatient,,,,786,668.1,225.2676,786,PrimeWest Health,MinnesotaCare,403.6896,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Us Dop Organs Ltd,,93976,CPT,Facility,Inpatient,,,,786,668.1,225.2676,786,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Us Dop Organs Ltd,,93976,CPT,Facility,Both,,,,786,668.1,225.2676,786,Sanford Health Plan,Sanford Health Plan,723.12,92,,percent of total billed charges,,
Us Dop Organs Ltd,,93976,CPT,Facility,Outpatient,,,,786,668.1,225.2676,786,"UCare Health, Inc.",Individual & Family Plan,442.911,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Us Dop Organs Ltd,,93976,CPT,Facility,Inpatient,,,,786,668.1,225.2676,786,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Us Dop Organs Ltd,,93976,CPT,Facility,Outpatient,,,,786,668.1,225.2676,786,"UCare Health, Inc.",Medical Assistance,396.6942,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Dop Organs Ltd,,93976,CPT,Facility,Inpatient,,,,786,668.1,225.2676,786,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Us Dop Organs Ltd,,93976,CPT,Facility,Outpatient,,,,786,668.1,225.2676,786,"UCare Health, Inc.",Medicare Advantage,396.6942,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Dop Organs Ltd,,93976,CPT,Facility,Inpatient,,,,786,668.1,225.2676,786,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Us Dop Organs Ltd,,93976,CPT,Facility,Outpatient,,,,786,668.1,225.2676,786,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),396.6942,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Dop Organs Ltd,,93976,CPT,Facility,Inpatient,,,,786,668.1,225.2676,786,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Us Dop Organs Ltd,,93976,CPT,Facility,Both,,,,786,668.1,225.2676,786,UnitedHealthcare,Individual & Family,738.84,94,,percent of total billed charges,,
Us Dop Organs Ltd,,93976,CPT,Facility,Outpatient,,,,786,668.1,225.2676,786,UnitedHealthcare,Medicare Advantage,385.14,49,,percent of total billed charges,,
Us Dop Organs Ltd,,93976,CPT,Facility,Inpatient,,,,786,668.1,225.2676,786,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Us Dop Organs Ltd,,93976,CPT,Facility,Outpatient,,,,786,668.1,225.2676,786,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,377.28,48,,percent of total billed charges,,100% of DHS outpatient percentage
Us Dop Organs Ltd,,93976,CPT,Facility,Inpatient,,,,786,668.1,225.2676,786,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Us Renal Artery Limited Study,,93976,CPT,Facility,Both,,,,786,668.1,225.2676,786,Aetna,Commercial,723.12,92,,percent of total billed charges,,
Us Renal Artery Limited Study,,93976,CPT,Facility,Outpatient,,,,786,668.1,225.2676,786,Aetna,Medicare Advantage,385.14,49,,percent of total billed charges,,
Us Renal Artery Limited Study,,93976,CPT,Facility,Inpatient,,,,786,668.1,225.2676,786,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Us Renal Artery Limited Study,,93976,CPT,Facility,Both,,,,786,668.1,225.2676,786,Aetna,PPO,730.98,93,,percent of total billed charges,,
Us Renal Artery Limited Study,,93976,CPT,Facility,Both,,,,786,668.1,225.2676,786,America's PPO,America's PPO,754.7958,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Us Renal Artery Limited Study,,93976,CPT,Facility,Both,,,,786,668.1,225.2676,786,BlueCross BlueShield Minnesota, Federal Employee Program,773.424,98.4,,percent of total billed charges,,
Us Renal Artery Limited Study,,93976,CPT,Facility,Both,,,,786,668.1,225.2676,786,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,786,100,,percent of total billed charges,,
Us Renal Artery Limited Study,,93976,CPT,Facility,Both,,,,786,668.1,225.2676,786,BlueCross BlueShield Minnesota,High Value Network Plan,707.4,90,,percent of total billed charges,,
Us Renal Artery Limited Study,,93976,CPT,Facility,Outpatient,,,,786,668.1,225.2676,786,BlueCross BlueShield Minnesota,Medicare Advantage,385.14,49,,percent of total billed charges,,
Us Renal Artery Limited Study,,93976,CPT,Facility,Inpatient,,,,786,668.1,225.2676,786,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Us Renal Artery Limited Study,,93976,CPT,Facility,Both,,,,786,668.1,225.2676,786,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,696.1602,88.57,,percent of total billed charges,,
Us Renal Artery Limited Study,,93976,CPT,Facility,Both,,,,786,668.1,225.2676,786,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,225.2676,28.66,,percent of total billed charges,,
Us Renal Artery Limited Study,,93976,CPT,Facility,Outpatient,,,,786,668.1,225.2676,786,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),385.14,49,,percent of total billed charges,,
Us Renal Artery Limited Study,,93976,CPT,Facility,Inpatient,,,,786,668.1,225.2676,786,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Us Renal Artery Limited Study,,93976,CPT,Facility,Both,,,,786,668.1,225.2676,786,CorVel,Worker's Compensation,786,100,,percent of total billed charges,,
Us Renal Artery Limited Study,,93976,CPT,Facility,Both,,,,786,668.1,225.2676,786,First Health Group Corporation,First Health Network,762.42,97,,percent of total billed charges,,
Us Renal Artery Limited Study,,93976,CPT,Facility,Both,,,,786,668.1,225.2676,786,"Health Partners, Inc.",Commercial,743.556,94.6,,percent of total billed charges,,
Us Renal Artery Limited Study,,93976,CPT,Facility,Outpatient,,,,786,668.1,225.2676,786,"Health Partners, Inc.",Medicare Advantage,385.14,49,,percent of total billed charges,,
Us Renal Artery Limited Study,,93976,CPT,Facility,Inpatient,,,,786,668.1,225.2676,786,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Us Renal Artery Limited Study,,93976,CPT,Facility,Both,,,,786,668.1,225.2676,786,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),471.6,60,,percent of total billed charges,,
Us Renal Artery Limited Study,,93976,CPT,Facility,Both,,,,786,668.1,225.2676,786,"Health Partners, Inc.",State of Minnesota Advantage Program,640.59,81.5,,percent of total billed charges,,
Us Renal Artery Limited Study,,93976,CPT,Facility,Both,,,,786,668.1,225.2676,786,"Health Partners, Inc.",State Public Programs,393,50,,percent of total billed charges,,
Us Renal Artery Limited Study,,93976,CPT,Facility,Both,,,,786,668.1,225.2676,786,Humana Insurance Company,Commercial PPO,746.7,95,,percent of total billed charges,,
Us Renal Artery Limited Study,,93976,CPT,Facility,Outpatient,,,,786,668.1,225.2676,786,Humana Insurance Company,Medicare PPO,385.14,49,,percent of total billed charges,,
Us Renal Artery Limited Study,,93976,CPT,Facility,Inpatient,,,,786,668.1,225.2676,786,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Us Renal Artery Limited Study,,93976,CPT,Facility,Both,,,,786,668.1,225.2676,786,Medica,Individual & Family,778.926,99.1,,percent of total billed charges,,
Us Renal Artery Limited Study,,93976,CPT,Facility,Outpatient,,,,786,668.1,225.2676,786,Medica,Medica Advantage Solution,391.428,49.8,,percent of total billed charges,,
Us Renal Artery Limited Study,,93976,CPT,Facility,Inpatient,,,,786,668.1,225.2676,786,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Us Renal Artery Limited Study,,93976,CPT,Facility,Outpatient,,,,786,668.1,225.2676,786,Medica,Medical Assistance,350.556,44.6,,percent of total billed charges,,
Us Renal Artery Limited Study,,93976,CPT,Facility,Inpatient,,,,786,668.1,225.2676,786,Medica,Medical Assistance,,,,,Included in per diem rate,
Us Renal Artery Limited Study,,93976,CPT,Facility,Outpatient,,,,786,668.1,225.2676,786,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,391.428,49.8,,percent of total billed charges,,
Us Renal Artery Limited Study,,93976,CPT,Facility,Inpatient,,,,786,668.1,225.2676,786,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Us Renal Artery Limited Study,,93976,CPT,Facility,Both,,,,786,668.1,225.2676,786,"Multiplan, Inc.","Multiplan, Inc.",738.84,94,,percent of total billed charges,,
Us Renal Artery Limited Study,,93976,CPT,Facility,Outpatient,,,,786,668.1,225.2676,786,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,708.186,90.1,,percent of total billed charges,,
Us Renal Artery Limited Study,,93976,CPT,Facility,Inpatient,,,,786,668.1,225.2676,786,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Us Renal Artery Limited Study,,93976,CPT,Facility,Both,,,,786,668.1,225.2676,786,"Preferred One Administrative Services, INC.",PPO,774.996,98.6,,percent of total billed charges,,
Us Renal Artery Limited Study,,93976,CPT,Facility,Outpatient,,,,786,668.1,225.2676,786,PrimeWest Health,Minnesota Senior Health Options (MSHO),404.397,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Us Renal Artery Limited Study,,93976,CPT,Facility,Inpatient,,,,786,668.1,225.2676,786,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Us Renal Artery Limited Study,,93976,CPT,Facility,Outpatient,,,,786,668.1,225.2676,786,PrimeWest Health,MinnesotaCare,403.6896,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Us Renal Artery Limited Study,,93976,CPT,Facility,Inpatient,,,,786,668.1,225.2676,786,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Us Renal Artery Limited Study,,93976,CPT,Facility,Both,,,,786,668.1,225.2676,786,Sanford Health Plan,Sanford Health Plan,723.12,92,,percent of total billed charges,,
Us Renal Artery Limited Study,,93976,CPT,Facility,Outpatient,,,,786,668.1,225.2676,786,"UCare Health, Inc.",Individual & Family Plan,442.911,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Us Renal Artery Limited Study,,93976,CPT,Facility,Inpatient,,,,786,668.1,225.2676,786,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Us Renal Artery Limited Study,,93976,CPT,Facility,Outpatient,,,,786,668.1,225.2676,786,"UCare Health, Inc.",Medical Assistance,396.6942,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Renal Artery Limited Study,,93976,CPT,Facility,Inpatient,,,,786,668.1,225.2676,786,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Us Renal Artery Limited Study,,93976,CPT,Facility,Outpatient,,,,786,668.1,225.2676,786,"UCare Health, Inc.",Medicare Advantage,396.6942,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Renal Artery Limited Study,,93976,CPT,Facility,Inpatient,,,,786,668.1,225.2676,786,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Us Renal Artery Limited Study,,93976,CPT,Facility,Outpatient,,,,786,668.1,225.2676,786,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),396.6942,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Renal Artery Limited Study,,93976,CPT,Facility,Inpatient,,,,786,668.1,225.2676,786,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Us Renal Artery Limited Study,,93976,CPT,Facility,Both,,,,786,668.1,225.2676,786,UnitedHealthcare,Individual & Family,738.84,94,,percent of total billed charges,,
Us Renal Artery Limited Study,,93976,CPT,Facility,Outpatient,,,,786,668.1,225.2676,786,UnitedHealthcare,Medicare Advantage,385.14,49,,percent of total billed charges,,
Us Renal Artery Limited Study,,93976,CPT,Facility,Inpatient,,,,786,668.1,225.2676,786,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Us Renal Artery Limited Study,,93976,CPT,Facility,Outpatient,,,,786,668.1,225.2676,786,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,377.28,48,,percent of total billed charges,,100% of DHS outpatient percentage
Us Renal Artery Limited Study,,93976,CPT,Facility,Inpatient,,,,786,668.1,225.2676,786,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Us Dop Artery Aorta Iliac,,93978,CPT,Facility,Both,,,,822,698.7,235.5852,822,Aetna,Commercial,756.24,92,,percent of total billed charges,,
Us Dop Artery Aorta Iliac,,93978,CPT,Facility,Outpatient,,,,822,698.7,235.5852,822,Aetna,Medicare Advantage,402.78,49,,percent of total billed charges,,
Us Dop Artery Aorta Iliac,,93978,CPT,Facility,Inpatient,,,,822,698.7,235.5852,822,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Us Dop Artery Aorta Iliac,,93978,CPT,Facility,Both,,,,822,698.7,235.5852,822,Aetna,PPO,764.46,93,,percent of total billed charges,,
Us Dop Artery Aorta Iliac,,93978,CPT,Facility,Both,,,,822,698.7,235.5852,822,America's PPO,America's PPO,789.3666,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Us Dop Artery Aorta Iliac,,93978,CPT,Facility,Both,,,,822,698.7,235.5852,822,BlueCross BlueShield Minnesota, Federal Employee Program,808.848,98.4,,percent of total billed charges,,
Us Dop Artery Aorta Iliac,,93978,CPT,Facility,Both,,,,822,698.7,235.5852,822,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,822,100,,percent of total billed charges,,
Us Dop Artery Aorta Iliac,,93978,CPT,Facility,Both,,,,822,698.7,235.5852,822,BlueCross BlueShield Minnesota,High Value Network Plan,739.8,90,,percent of total billed charges,,
Us Dop Artery Aorta Iliac,,93978,CPT,Facility,Outpatient,,,,822,698.7,235.5852,822,BlueCross BlueShield Minnesota,Medicare Advantage,402.78,49,,percent of total billed charges,,
Us Dop Artery Aorta Iliac,,93978,CPT,Facility,Inpatient,,,,822,698.7,235.5852,822,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Us Dop Artery Aorta Iliac,,93978,CPT,Facility,Both,,,,822,698.7,235.5852,822,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,728.0454,88.57,,percent of total billed charges,,
Us Dop Artery Aorta Iliac,,93978,CPT,Facility,Both,,,,822,698.7,235.5852,822,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,235.5852,28.66,,percent of total billed charges,,
Us Dop Artery Aorta Iliac,,93978,CPT,Facility,Outpatient,,,,822,698.7,235.5852,822,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),402.78,49,,percent of total billed charges,,
Us Dop Artery Aorta Iliac,,93978,CPT,Facility,Inpatient,,,,822,698.7,235.5852,822,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Us Dop Artery Aorta Iliac,,93978,CPT,Facility,Both,,,,822,698.7,235.5852,822,CorVel,Worker's Compensation,822,100,,percent of total billed charges,,
Us Dop Artery Aorta Iliac,,93978,CPT,Facility,Both,,,,822,698.7,235.5852,822,First Health Group Corporation,First Health Network,797.34,97,,percent of total billed charges,,
Us Dop Artery Aorta Iliac,,93978,CPT,Facility,Both,,,,822,698.7,235.5852,822,"Health Partners, Inc.",Commercial,777.612,94.6,,percent of total billed charges,,
Us Dop Artery Aorta Iliac,,93978,CPT,Facility,Outpatient,,,,822,698.7,235.5852,822,"Health Partners, Inc.",Medicare Advantage,402.78,49,,percent of total billed charges,,
Us Dop Artery Aorta Iliac,,93978,CPT,Facility,Inpatient,,,,822,698.7,235.5852,822,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Us Dop Artery Aorta Iliac,,93978,CPT,Facility,Both,,,,822,698.7,235.5852,822,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),493.2,60,,percent of total billed charges,,
Us Dop Artery Aorta Iliac,,93978,CPT,Facility,Both,,,,822,698.7,235.5852,822,"Health Partners, Inc.",State of Minnesota Advantage Program,669.93,81.5,,percent of total billed charges,,
Us Dop Artery Aorta Iliac,,93978,CPT,Facility,Both,,,,822,698.7,235.5852,822,"Health Partners, Inc.",State Public Programs,411,50,,percent of total billed charges,,
Us Dop Artery Aorta Iliac,,93978,CPT,Facility,Both,,,,822,698.7,235.5852,822,Humana Insurance Company,Commercial PPO,780.9,95,,percent of total billed charges,,
Us Dop Artery Aorta Iliac,,93978,CPT,Facility,Outpatient,,,,822,698.7,235.5852,822,Humana Insurance Company,Medicare PPO,402.78,49,,percent of total billed charges,,
Us Dop Artery Aorta Iliac,,93978,CPT,Facility,Inpatient,,,,822,698.7,235.5852,822,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Us Dop Artery Aorta Iliac,,93978,CPT,Facility,Both,,,,822,698.7,235.5852,822,Medica,Individual & Family,814.602,99.1,,percent of total billed charges,,
Us Dop Artery Aorta Iliac,,93978,CPT,Facility,Outpatient,,,,822,698.7,235.5852,822,Medica,Medica Advantage Solution,409.356,49.8,,percent of total billed charges,,
Us Dop Artery Aorta Iliac,,93978,CPT,Facility,Inpatient,,,,822,698.7,235.5852,822,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Us Dop Artery Aorta Iliac,,93978,CPT,Facility,Outpatient,,,,822,698.7,235.5852,822,Medica,Medical Assistance,366.612,44.6,,percent of total billed charges,,
Us Dop Artery Aorta Iliac,,93978,CPT,Facility,Inpatient,,,,822,698.7,235.5852,822,Medica,Medical Assistance,,,,,Included in per diem rate,
Us Dop Artery Aorta Iliac,,93978,CPT,Facility,Outpatient,,,,822,698.7,235.5852,822,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,409.356,49.8,,percent of total billed charges,,
Us Dop Artery Aorta Iliac,,93978,CPT,Facility,Inpatient,,,,822,698.7,235.5852,822,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Us Dop Artery Aorta Iliac,,93978,CPT,Facility,Both,,,,822,698.7,235.5852,822,"Multiplan, Inc.","Multiplan, Inc.",772.68,94,,percent of total billed charges,,
Us Dop Artery Aorta Iliac,,93978,CPT,Facility,Outpatient,,,,822,698.7,235.5852,822,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,740.622,90.1,,percent of total billed charges,,
Us Dop Artery Aorta Iliac,,93978,CPT,Facility,Inpatient,,,,822,698.7,235.5852,822,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Us Dop Artery Aorta Iliac,,93978,CPT,Facility,Both,,,,822,698.7,235.5852,822,"Preferred One Administrative Services, INC.",PPO,810.492,98.6,,percent of total billed charges,,
Us Dop Artery Aorta Iliac,,93978,CPT,Facility,Outpatient,,,,822,698.7,235.5852,822,PrimeWest Health,Minnesota Senior Health Options (MSHO),422.919,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Us Dop Artery Aorta Iliac,,93978,CPT,Facility,Inpatient,,,,822,698.7,235.5852,822,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Us Dop Artery Aorta Iliac,,93978,CPT,Facility,Outpatient,,,,822,698.7,235.5852,822,PrimeWest Health,MinnesotaCare,422.1792,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Us Dop Artery Aorta Iliac,,93978,CPT,Facility,Inpatient,,,,822,698.7,235.5852,822,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Us Dop Artery Aorta Iliac,,93978,CPT,Facility,Both,,,,822,698.7,235.5852,822,Sanford Health Plan,Sanford Health Plan,756.24,92,,percent of total billed charges,,
Us Dop Artery Aorta Iliac,,93978,CPT,Facility,Outpatient,,,,822,698.7,235.5852,822,"UCare Health, Inc.",Individual & Family Plan,463.197,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Us Dop Artery Aorta Iliac,,93978,CPT,Facility,Inpatient,,,,822,698.7,235.5852,822,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Us Dop Artery Aorta Iliac,,93978,CPT,Facility,Outpatient,,,,822,698.7,235.5852,822,"UCare Health, Inc.",Medical Assistance,414.8634,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Dop Artery Aorta Iliac,,93978,CPT,Facility,Inpatient,,,,822,698.7,235.5852,822,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Us Dop Artery Aorta Iliac,,93978,CPT,Facility,Outpatient,,,,822,698.7,235.5852,822,"UCare Health, Inc.",Medicare Advantage,414.8634,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Dop Artery Aorta Iliac,,93978,CPT,Facility,Inpatient,,,,822,698.7,235.5852,822,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Us Dop Artery Aorta Iliac,,93978,CPT,Facility,Outpatient,,,,822,698.7,235.5852,822,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),414.8634,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Dop Artery Aorta Iliac,,93978,CPT,Facility,Inpatient,,,,822,698.7,235.5852,822,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Us Dop Artery Aorta Iliac,,93978,CPT,Facility,Both,,,,822,698.7,235.5852,822,UnitedHealthcare,Individual & Family,772.68,94,,percent of total billed charges,,
Us Dop Artery Aorta Iliac,,93978,CPT,Facility,Outpatient,,,,822,698.7,235.5852,822,UnitedHealthcare,Medicare Advantage,402.78,49,,percent of total billed charges,,
Us Dop Artery Aorta Iliac,,93978,CPT,Facility,Inpatient,,,,822,698.7,235.5852,822,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Us Dop Artery Aorta Iliac,,93978,CPT,Facility,Outpatient,,,,822,698.7,235.5852,822,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,394.56,48,,percent of total billed charges,,100% of DHS outpatient percentage
Us Dop Artery Aorta Iliac,,93978,CPT,Facility,Inpatient,,,,822,698.7,235.5852,822,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Us Dop Vein Ivc Iliac,,93978,CPT,Facility,Both,,,,822,698.7,235.5852,822,Aetna,Commercial,756.24,92,,percent of total billed charges,,
Us Dop Vein Ivc Iliac,,93978,CPT,Facility,Outpatient,,,,822,698.7,235.5852,822,Aetna,Medicare Advantage,402.78,49,,percent of total billed charges,,
Us Dop Vein Ivc Iliac,,93978,CPT,Facility,Inpatient,,,,822,698.7,235.5852,822,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Us Dop Vein Ivc Iliac,,93978,CPT,Facility,Both,,,,822,698.7,235.5852,822,Aetna,PPO,764.46,93,,percent of total billed charges,,
Us Dop Vein Ivc Iliac,,93978,CPT,Facility,Both,,,,822,698.7,235.5852,822,America's PPO,America's PPO,789.3666,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Us Dop Vein Ivc Iliac,,93978,CPT,Facility,Both,,,,822,698.7,235.5852,822,BlueCross BlueShield Minnesota, Federal Employee Program,808.848,98.4,,percent of total billed charges,,
Us Dop Vein Ivc Iliac,,93978,CPT,Facility,Both,,,,822,698.7,235.5852,822,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,822,100,,percent of total billed charges,,
Us Dop Vein Ivc Iliac,,93978,CPT,Facility,Both,,,,822,698.7,235.5852,822,BlueCross BlueShield Minnesota,High Value Network Plan,739.8,90,,percent of total billed charges,,
Us Dop Vein Ivc Iliac,,93978,CPT,Facility,Outpatient,,,,822,698.7,235.5852,822,BlueCross BlueShield Minnesota,Medicare Advantage,402.78,49,,percent of total billed charges,,
Us Dop Vein Ivc Iliac,,93978,CPT,Facility,Inpatient,,,,822,698.7,235.5852,822,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Us Dop Vein Ivc Iliac,,93978,CPT,Facility,Both,,,,822,698.7,235.5852,822,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,728.0454,88.57,,percent of total billed charges,,
Us Dop Vein Ivc Iliac,,93978,CPT,Facility,Both,,,,822,698.7,235.5852,822,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,235.5852,28.66,,percent of total billed charges,,
Us Dop Vein Ivc Iliac,,93978,CPT,Facility,Outpatient,,,,822,698.7,235.5852,822,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),402.78,49,,percent of total billed charges,,
Us Dop Vein Ivc Iliac,,93978,CPT,Facility,Inpatient,,,,822,698.7,235.5852,822,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Us Dop Vein Ivc Iliac,,93978,CPT,Facility,Both,,,,822,698.7,235.5852,822,CorVel,Worker's Compensation,822,100,,percent of total billed charges,,
Us Dop Vein Ivc Iliac,,93978,CPT,Facility,Both,,,,822,698.7,235.5852,822,First Health Group Corporation,First Health Network,797.34,97,,percent of total billed charges,,
Us Dop Vein Ivc Iliac,,93978,CPT,Facility,Both,,,,822,698.7,235.5852,822,"Health Partners, Inc.",Commercial,777.612,94.6,,percent of total billed charges,,
Us Dop Vein Ivc Iliac,,93978,CPT,Facility,Outpatient,,,,822,698.7,235.5852,822,"Health Partners, Inc.",Medicare Advantage,402.78,49,,percent of total billed charges,,
Us Dop Vein Ivc Iliac,,93978,CPT,Facility,Inpatient,,,,822,698.7,235.5852,822,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Us Dop Vein Ivc Iliac,,93978,CPT,Facility,Both,,,,822,698.7,235.5852,822,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),493.2,60,,percent of total billed charges,,
Us Dop Vein Ivc Iliac,,93978,CPT,Facility,Both,,,,822,698.7,235.5852,822,"Health Partners, Inc.",State of Minnesota Advantage Program,669.93,81.5,,percent of total billed charges,,
Us Dop Vein Ivc Iliac,,93978,CPT,Facility,Both,,,,822,698.7,235.5852,822,"Health Partners, Inc.",State Public Programs,411,50,,percent of total billed charges,,
Us Dop Vein Ivc Iliac,,93978,CPT,Facility,Both,,,,822,698.7,235.5852,822,Humana Insurance Company,Commercial PPO,780.9,95,,percent of total billed charges,,
Us Dop Vein Ivc Iliac,,93978,CPT,Facility,Outpatient,,,,822,698.7,235.5852,822,Humana Insurance Company,Medicare PPO,402.78,49,,percent of total billed charges,,
Us Dop Vein Ivc Iliac,,93978,CPT,Facility,Inpatient,,,,822,698.7,235.5852,822,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Us Dop Vein Ivc Iliac,,93978,CPT,Facility,Both,,,,822,698.7,235.5852,822,Medica,Individual & Family,814.602,99.1,,percent of total billed charges,,
Us Dop Vein Ivc Iliac,,93978,CPT,Facility,Outpatient,,,,822,698.7,235.5852,822,Medica,Medica Advantage Solution,409.356,49.8,,percent of total billed charges,,
Us Dop Vein Ivc Iliac,,93978,CPT,Facility,Inpatient,,,,822,698.7,235.5852,822,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Us Dop Vein Ivc Iliac,,93978,CPT,Facility,Outpatient,,,,822,698.7,235.5852,822,Medica,Medical Assistance,366.612,44.6,,percent of total billed charges,,
Us Dop Vein Ivc Iliac,,93978,CPT,Facility,Inpatient,,,,822,698.7,235.5852,822,Medica,Medical Assistance,,,,,Included in per diem rate,
Us Dop Vein Ivc Iliac,,93978,CPT,Facility,Outpatient,,,,822,698.7,235.5852,822,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,409.356,49.8,,percent of total billed charges,,
Us Dop Vein Ivc Iliac,,93978,CPT,Facility,Inpatient,,,,822,698.7,235.5852,822,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Us Dop Vein Ivc Iliac,,93978,CPT,Facility,Both,,,,822,698.7,235.5852,822,"Multiplan, Inc.","Multiplan, Inc.",772.68,94,,percent of total billed charges,,
Us Dop Vein Ivc Iliac,,93978,CPT,Facility,Outpatient,,,,822,698.7,235.5852,822,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,740.622,90.1,,percent of total billed charges,,
Us Dop Vein Ivc Iliac,,93978,CPT,Facility,Inpatient,,,,822,698.7,235.5852,822,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Us Dop Vein Ivc Iliac,,93978,CPT,Facility,Both,,,,822,698.7,235.5852,822,"Preferred One Administrative Services, INC.",PPO,810.492,98.6,,percent of total billed charges,,
Us Dop Vein Ivc Iliac,,93978,CPT,Facility,Outpatient,,,,822,698.7,235.5852,822,PrimeWest Health,Minnesota Senior Health Options (MSHO),422.919,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Us Dop Vein Ivc Iliac,,93978,CPT,Facility,Inpatient,,,,822,698.7,235.5852,822,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Us Dop Vein Ivc Iliac,,93978,CPT,Facility,Outpatient,,,,822,698.7,235.5852,822,PrimeWest Health,MinnesotaCare,422.1792,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Us Dop Vein Ivc Iliac,,93978,CPT,Facility,Inpatient,,,,822,698.7,235.5852,822,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Us Dop Vein Ivc Iliac,,93978,CPT,Facility,Both,,,,822,698.7,235.5852,822,Sanford Health Plan,Sanford Health Plan,756.24,92,,percent of total billed charges,,
Us Dop Vein Ivc Iliac,,93978,CPT,Facility,Outpatient,,,,822,698.7,235.5852,822,"UCare Health, Inc.",Individual & Family Plan,463.197,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Us Dop Vein Ivc Iliac,,93978,CPT,Facility,Inpatient,,,,822,698.7,235.5852,822,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Us Dop Vein Ivc Iliac,,93978,CPT,Facility,Outpatient,,,,822,698.7,235.5852,822,"UCare Health, Inc.",Medical Assistance,414.8634,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Dop Vein Ivc Iliac,,93978,CPT,Facility,Inpatient,,,,822,698.7,235.5852,822,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Us Dop Vein Ivc Iliac,,93978,CPT,Facility,Outpatient,,,,822,698.7,235.5852,822,"UCare Health, Inc.",Medicare Advantage,414.8634,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Dop Vein Ivc Iliac,,93978,CPT,Facility,Inpatient,,,,822,698.7,235.5852,822,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Us Dop Vein Ivc Iliac,,93978,CPT,Facility,Outpatient,,,,822,698.7,235.5852,822,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),414.8634,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Us Dop Vein Ivc Iliac,,93978,CPT,Facility,Inpatient,,,,822,698.7,235.5852,822,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Us Dop Vein Ivc Iliac,,93978,CPT,Facility,Both,,,,822,698.7,235.5852,822,UnitedHealthcare,Individual & Family,772.68,94,,percent of total billed charges,,
Us Dop Vein Ivc Iliac,,93978,CPT,Facility,Outpatient,,,,822,698.7,235.5852,822,UnitedHealthcare,Medicare Advantage,402.78,49,,percent of total billed charges,,
Us Dop Vein Ivc Iliac,,93978,CPT,Facility,Inpatient,,,,822,698.7,235.5852,822,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Us Dop Vein Ivc Iliac,,93978,CPT,Facility,Outpatient,,,,822,698.7,235.5852,822,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,394.56,48,,percent of total billed charges,,100% of DHS outpatient percentage
Us Dop Vein Ivc Iliac,,93978,CPT,Facility,Inpatient,,,,822,698.7,235.5852,822,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Spirometry Screen Pulmonary,,94010,CPT,Facility,Both,,,,168,142.8,48.1488,168,Aetna,Commercial,154.56,92,,percent of total billed charges,,
Spirometry Screen Pulmonary,,94010,CPT,Facility,Outpatient,,,,168,142.8,48.1488,168,Aetna,Medicare Advantage,82.32,49,,percent of total billed charges,,
Spirometry Screen Pulmonary,,94010,CPT,Facility,Inpatient,,,,168,142.8,48.1488,168,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Spirometry Screen Pulmonary,,94010,CPT,Facility,Both,,,,168,142.8,48.1488,168,Aetna,PPO,156.24,93,,percent of total billed charges,,
Spirometry Screen Pulmonary,,94010,CPT,Facility,Both,,,,168,142.8,48.1488,168,America's PPO,America's PPO,161.3304,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Spirometry Screen Pulmonary,,94010,CPT,Facility,Both,,,,168,142.8,48.1488,168,BlueCross BlueShield Minnesota, Federal Employee Program,165.312,98.4,,percent of total billed charges,,
Spirometry Screen Pulmonary,,94010,CPT,Facility,Both,,,,168,142.8,48.1488,168,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,168,100,,percent of total billed charges,,
Spirometry Screen Pulmonary,,94010,CPT,Facility,Both,,,,168,142.8,48.1488,168,BlueCross BlueShield Minnesota,High Value Network Plan,151.2,90,,percent of total billed charges,,
Spirometry Screen Pulmonary,,94010,CPT,Facility,Outpatient,,,,168,142.8,48.1488,168,BlueCross BlueShield Minnesota,Medicare Advantage,82.32,49,,percent of total billed charges,,
Spirometry Screen Pulmonary,,94010,CPT,Facility,Inpatient,,,,168,142.8,48.1488,168,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Spirometry Screen Pulmonary,,94010,CPT,Facility,Both,,,,168,142.8,48.1488,168,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,148.7976,88.57,,percent of total billed charges,,
Spirometry Screen Pulmonary,,94010,CPT,Facility,Both,,,,168,142.8,48.1488,168,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,48.1488,28.66,,percent of total billed charges,,
Spirometry Screen Pulmonary,,94010,CPT,Facility,Outpatient,,,,168,142.8,48.1488,168,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),82.32,49,,percent of total billed charges,,
Spirometry Screen Pulmonary,,94010,CPT,Facility,Inpatient,,,,168,142.8,48.1488,168,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Spirometry Screen Pulmonary,,94010,CPT,Facility,Both,,,,168,142.8,48.1488,168,CorVel,Worker's Compensation,168,100,,percent of total billed charges,,
Spirometry Screen Pulmonary,,94010,CPT,Facility,Both,,,,168,142.8,48.1488,168,First Health Group Corporation,First Health Network,162.96,97,,percent of total billed charges,,
Spirometry Screen Pulmonary,,94010,CPT,Facility,Both,,,,168,142.8,48.1488,168,"Health Partners, Inc.",Commercial,158.928,94.6,,percent of total billed charges,,
Spirometry Screen Pulmonary,,94010,CPT,Facility,Outpatient,,,,168,142.8,48.1488,168,"Health Partners, Inc.",Medicare Advantage,82.32,49,,percent of total billed charges,,
Spirometry Screen Pulmonary,,94010,CPT,Facility,Inpatient,,,,168,142.8,48.1488,168,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Spirometry Screen Pulmonary,,94010,CPT,Facility,Both,,,,168,142.8,48.1488,168,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),100.8,60,,percent of total billed charges,,
Spirometry Screen Pulmonary,,94010,CPT,Facility,Both,,,,168,142.8,48.1488,168,"Health Partners, Inc.",State of Minnesota Advantage Program,136.92,81.5,,percent of total billed charges,,
Spirometry Screen Pulmonary,,94010,CPT,Facility,Both,,,,168,142.8,48.1488,168,"Health Partners, Inc.",State Public Programs,84,50,,percent of total billed charges,,
Spirometry Screen Pulmonary,,94010,CPT,Facility,Both,,,,168,142.8,48.1488,168,Humana Insurance Company,Commercial PPO,159.6,95,,percent of total billed charges,,
Spirometry Screen Pulmonary,,94010,CPT,Facility,Outpatient,,,,168,142.8,48.1488,168,Humana Insurance Company,Medicare PPO,82.32,49,,percent of total billed charges,,
Spirometry Screen Pulmonary,,94010,CPT,Facility,Inpatient,,,,168,142.8,48.1488,168,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Spirometry Screen Pulmonary,,94010,CPT,Facility,Both,,,,168,142.8,48.1488,168,Medica,Individual & Family,166.488,99.1,,percent of total billed charges,,
Spirometry Screen Pulmonary,,94010,CPT,Facility,Outpatient,,,,168,142.8,48.1488,168,Medica,Medica Advantage Solution,83.664,49.8,,percent of total billed charges,,
Spirometry Screen Pulmonary,,94010,CPT,Facility,Inpatient,,,,168,142.8,48.1488,168,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Spirometry Screen Pulmonary,,94010,CPT,Facility,Outpatient,,,,168,142.8,48.1488,168,Medica,Medical Assistance,74.928,44.6,,percent of total billed charges,,
Spirometry Screen Pulmonary,,94010,CPT,Facility,Inpatient,,,,168,142.8,48.1488,168,Medica,Medical Assistance,,,,,Included in per diem rate,
Spirometry Screen Pulmonary,,94010,CPT,Facility,Outpatient,,,,168,142.8,48.1488,168,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,83.664,49.8,,percent of total billed charges,,
Spirometry Screen Pulmonary,,94010,CPT,Facility,Inpatient,,,,168,142.8,48.1488,168,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Spirometry Screen Pulmonary,,94010,CPT,Facility,Both,,,,168,142.8,48.1488,168,"Multiplan, Inc.","Multiplan, Inc.",157.92,94,,percent of total billed charges,,
Spirometry Screen Pulmonary,,94010,CPT,Facility,Outpatient,,,,168,142.8,48.1488,168,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,151.368,90.1,,percent of total billed charges,,
Spirometry Screen Pulmonary,,94010,CPT,Facility,Inpatient,,,,168,142.8,48.1488,168,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Spirometry Screen Pulmonary,,94010,CPT,Facility,Both,,,,168,142.8,48.1488,168,"Preferred One Administrative Services, INC.",PPO,165.648,98.6,,percent of total billed charges,,
Spirometry Screen Pulmonary,,94010,CPT,Facility,Outpatient,,,,168,142.8,48.1488,168,PrimeWest Health,Minnesota Senior Health Options (MSHO),86.436,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Spirometry Screen Pulmonary,,94010,CPT,Facility,Inpatient,,,,168,142.8,48.1488,168,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Spirometry Screen Pulmonary,,94010,CPT,Facility,Outpatient,,,,168,142.8,48.1488,168,PrimeWest Health,MinnesotaCare,86.2848,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Spirometry Screen Pulmonary,,94010,CPT,Facility,Inpatient,,,,168,142.8,48.1488,168,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Spirometry Screen Pulmonary,,94010,CPT,Facility,Both,,,,168,142.8,48.1488,168,Sanford Health Plan,Sanford Health Plan,154.56,92,,percent of total billed charges,,
Spirometry Screen Pulmonary,,94010,CPT,Facility,Outpatient,,,,168,142.8,48.1488,168,"UCare Health, Inc.",Individual & Family Plan,94.668,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Spirometry Screen Pulmonary,,94010,CPT,Facility,Inpatient,,,,168,142.8,48.1488,168,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Spirometry Screen Pulmonary,,94010,CPT,Facility,Outpatient,,,,168,142.8,48.1488,168,"UCare Health, Inc.",Medical Assistance,84.7896,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Spirometry Screen Pulmonary,,94010,CPT,Facility,Inpatient,,,,168,142.8,48.1488,168,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Spirometry Screen Pulmonary,,94010,CPT,Facility,Outpatient,,,,168,142.8,48.1488,168,"UCare Health, Inc.",Medicare Advantage,84.7896,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Spirometry Screen Pulmonary,,94010,CPT,Facility,Inpatient,,,,168,142.8,48.1488,168,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Spirometry Screen Pulmonary,,94010,CPT,Facility,Outpatient,,,,168,142.8,48.1488,168,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),84.7896,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Spirometry Screen Pulmonary,,94010,CPT,Facility,Inpatient,,,,168,142.8,48.1488,168,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Spirometry Screen Pulmonary,,94010,CPT,Facility,Both,,,,168,142.8,48.1488,168,UnitedHealthcare,Individual & Family,157.92,94,,percent of total billed charges,,
Spirometry Screen Pulmonary,,94010,CPT,Facility,Outpatient,,,,168,142.8,48.1488,168,UnitedHealthcare,Medicare Advantage,82.32,49,,percent of total billed charges,,
Spirometry Screen Pulmonary,,94010,CPT,Facility,Inpatient,,,,168,142.8,48.1488,168,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Spirometry Screen Pulmonary,,94010,CPT,Facility,Outpatient,,,,168,142.8,48.1488,168,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,80.64,48,,percent of total billed charges,,100% of DHS outpatient percentage
Spirometry Screen Pulmonary,,94010,CPT,Facility,Inpatient,,,,168,142.8,48.1488,168,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Spirometry Pre And Post Bronchodilation,,94060,CPT,Facility,Both,,,,270,229.5,77.382,270,Aetna,Commercial,248.4,92,,percent of total billed charges,,
Spirometry Pre And Post Bronchodilation,,94060,CPT,Facility,Outpatient,,,,270,229.5,77.382,270,Aetna,Medicare Advantage,132.3,49,,percent of total billed charges,,
Spirometry Pre And Post Bronchodilation,,94060,CPT,Facility,Inpatient,,,,270,229.5,77.382,270,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Spirometry Pre And Post Bronchodilation,,94060,CPT,Facility,Both,,,,270,229.5,77.382,270,Aetna,PPO,251.1,93,,percent of total billed charges,,
Spirometry Pre And Post Bronchodilation,,94060,CPT,Facility,Both,,,,270,229.5,77.382,270,America's PPO,America's PPO,259.281,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Spirometry Pre And Post Bronchodilation,,94060,CPT,Facility,Both,,,,270,229.5,77.382,270,BlueCross BlueShield Minnesota, Federal Employee Program,265.68,98.4,,percent of total billed charges,,
Spirometry Pre And Post Bronchodilation,,94060,CPT,Facility,Both,,,,270,229.5,77.382,270,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,270,100,,percent of total billed charges,,
Spirometry Pre And Post Bronchodilation,,94060,CPT,Facility,Both,,,,270,229.5,77.382,270,BlueCross BlueShield Minnesota,High Value Network Plan,243,90,,percent of total billed charges,,
Spirometry Pre And Post Bronchodilation,,94060,CPT,Facility,Outpatient,,,,270,229.5,77.382,270,BlueCross BlueShield Minnesota,Medicare Advantage,132.3,49,,percent of total billed charges,,
Spirometry Pre And Post Bronchodilation,,94060,CPT,Facility,Inpatient,,,,270,229.5,77.382,270,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Spirometry Pre And Post Bronchodilation,,94060,CPT,Facility,Both,,,,270,229.5,77.382,270,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,239.139,88.57,,percent of total billed charges,,
Spirometry Pre And Post Bronchodilation,,94060,CPT,Facility,Both,,,,270,229.5,77.382,270,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,77.382,28.66,,percent of total billed charges,,
Spirometry Pre And Post Bronchodilation,,94060,CPT,Facility,Outpatient,,,,270,229.5,77.382,270,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),132.3,49,,percent of total billed charges,,
Spirometry Pre And Post Bronchodilation,,94060,CPT,Facility,Inpatient,,,,270,229.5,77.382,270,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Spirometry Pre And Post Bronchodilation,,94060,CPT,Facility,Both,,,,270,229.5,77.382,270,CorVel,Worker's Compensation,270,100,,percent of total billed charges,,
Spirometry Pre And Post Bronchodilation,,94060,CPT,Facility,Both,,,,270,229.5,77.382,270,First Health Group Corporation,First Health Network,261.9,97,,percent of total billed charges,,
Spirometry Pre And Post Bronchodilation,,94060,CPT,Facility,Both,,,,270,229.5,77.382,270,"Health Partners, Inc.",Commercial,255.42,94.6,,percent of total billed charges,,
Spirometry Pre And Post Bronchodilation,,94060,CPT,Facility,Outpatient,,,,270,229.5,77.382,270,"Health Partners, Inc.",Medicare Advantage,132.3,49,,percent of total billed charges,,
Spirometry Pre And Post Bronchodilation,,94060,CPT,Facility,Inpatient,,,,270,229.5,77.382,270,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Spirometry Pre And Post Bronchodilation,,94060,CPT,Facility,Both,,,,270,229.5,77.382,270,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),162,60,,percent of total billed charges,,
Spirometry Pre And Post Bronchodilation,,94060,CPT,Facility,Both,,,,270,229.5,77.382,270,"Health Partners, Inc.",State of Minnesota Advantage Program,220.05,81.5,,percent of total billed charges,,
Spirometry Pre And Post Bronchodilation,,94060,CPT,Facility,Both,,,,270,229.5,77.382,270,"Health Partners, Inc.",State Public Programs,135,50,,percent of total billed charges,,
Spirometry Pre And Post Bronchodilation,,94060,CPT,Facility,Both,,,,270,229.5,77.382,270,Humana Insurance Company,Commercial PPO,256.5,95,,percent of total billed charges,,
Spirometry Pre And Post Bronchodilation,,94060,CPT,Facility,Outpatient,,,,270,229.5,77.382,270,Humana Insurance Company,Medicare PPO,132.3,49,,percent of total billed charges,,
Spirometry Pre And Post Bronchodilation,,94060,CPT,Facility,Inpatient,,,,270,229.5,77.382,270,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Spirometry Pre And Post Bronchodilation,,94060,CPT,Facility,Both,,,,270,229.5,77.382,270,Medica,Individual & Family,267.57,99.1,,percent of total billed charges,,
Spirometry Pre And Post Bronchodilation,,94060,CPT,Facility,Outpatient,,,,270,229.5,77.382,270,Medica,Medica Advantage Solution,134.46,49.8,,percent of total billed charges,,
Spirometry Pre And Post Bronchodilation,,94060,CPT,Facility,Inpatient,,,,270,229.5,77.382,270,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Spirometry Pre And Post Bronchodilation,,94060,CPT,Facility,Outpatient,,,,270,229.5,77.382,270,Medica,Medical Assistance,120.42,44.6,,percent of total billed charges,,
Spirometry Pre And Post Bronchodilation,,94060,CPT,Facility,Inpatient,,,,270,229.5,77.382,270,Medica,Medical Assistance,,,,,Included in per diem rate,
Spirometry Pre And Post Bronchodilation,,94060,CPT,Facility,Outpatient,,,,270,229.5,77.382,270,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,134.46,49.8,,percent of total billed charges,,
Spirometry Pre And Post Bronchodilation,,94060,CPT,Facility,Inpatient,,,,270,229.5,77.382,270,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Spirometry Pre And Post Bronchodilation,,94060,CPT,Facility,Both,,,,270,229.5,77.382,270,"Multiplan, Inc.","Multiplan, Inc.",253.8,94,,percent of total billed charges,,
Spirometry Pre And Post Bronchodilation,,94060,CPT,Facility,Outpatient,,,,270,229.5,77.382,270,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,243.27,90.1,,percent of total billed charges,,
Spirometry Pre And Post Bronchodilation,,94060,CPT,Facility,Inpatient,,,,270,229.5,77.382,270,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Spirometry Pre And Post Bronchodilation,,94060,CPT,Facility,Both,,,,270,229.5,77.382,270,"Preferred One Administrative Services, INC.",PPO,266.22,98.6,,percent of total billed charges,,
Spirometry Pre And Post Bronchodilation,,94060,CPT,Facility,Outpatient,,,,270,229.5,77.382,270,PrimeWest Health,Minnesota Senior Health Options (MSHO),138.915,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Spirometry Pre And Post Bronchodilation,,94060,CPT,Facility,Inpatient,,,,270,229.5,77.382,270,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Spirometry Pre And Post Bronchodilation,,94060,CPT,Facility,Outpatient,,,,270,229.5,77.382,270,PrimeWest Health,MinnesotaCare,138.672,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Spirometry Pre And Post Bronchodilation,,94060,CPT,Facility,Inpatient,,,,270,229.5,77.382,270,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Spirometry Pre And Post Bronchodilation,,94060,CPT,Facility,Both,,,,270,229.5,77.382,270,Sanford Health Plan,Sanford Health Plan,248.4,92,,percent of total billed charges,,
Spirometry Pre And Post Bronchodilation,,94060,CPT,Facility,Outpatient,,,,270,229.5,77.382,270,"UCare Health, Inc.",Individual & Family Plan,152.145,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Spirometry Pre And Post Bronchodilation,,94060,CPT,Facility,Inpatient,,,,270,229.5,77.382,270,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Spirometry Pre And Post Bronchodilation,,94060,CPT,Facility,Outpatient,,,,270,229.5,77.382,270,"UCare Health, Inc.",Medical Assistance,136.269,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Spirometry Pre And Post Bronchodilation,,94060,CPT,Facility,Inpatient,,,,270,229.5,77.382,270,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Spirometry Pre And Post Bronchodilation,,94060,CPT,Facility,Outpatient,,,,270,229.5,77.382,270,"UCare Health, Inc.",Medicare Advantage,136.269,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Spirometry Pre And Post Bronchodilation,,94060,CPT,Facility,Inpatient,,,,270,229.5,77.382,270,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Spirometry Pre And Post Bronchodilation,,94060,CPT,Facility,Outpatient,,,,270,229.5,77.382,270,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),136.269,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Spirometry Pre And Post Bronchodilation,,94060,CPT,Facility,Inpatient,,,,270,229.5,77.382,270,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Spirometry Pre And Post Bronchodilation,,94060,CPT,Facility,Both,,,,270,229.5,77.382,270,UnitedHealthcare,Individual & Family,253.8,94,,percent of total billed charges,,
Spirometry Pre And Post Bronchodilation,,94060,CPT,Facility,Outpatient,,,,270,229.5,77.382,270,UnitedHealthcare,Medicare Advantage,132.3,49,,percent of total billed charges,,
Spirometry Pre And Post Bronchodilation,,94060,CPT,Facility,Inpatient,,,,270,229.5,77.382,270,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Spirometry Pre And Post Bronchodilation,,94060,CPT,Facility,Outpatient,,,,270,229.5,77.382,270,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,129.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
Spirometry Pre And Post Bronchodilation,,94060,CPT,Facility,Inpatient,,,,270,229.5,77.382,270,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Cont Glucose Monitoring Services - Patient Supplied Sensor,,95249,CPT,Facility,Both,,,,210,178.5,60.186,210,Aetna,Commercial,193.2,92,,percent of total billed charges,,
Cont Glucose Monitoring Services - Patient Supplied Sensor,,95249,CPT,Facility,Outpatient,,,,210,178.5,60.186,210,Aetna,Medicare Advantage,102.9,49,,percent of total billed charges,,
Cont Glucose Monitoring Services - Patient Supplied Sensor,,95249,CPT,Facility,Inpatient,,,,210,178.5,60.186,210,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Cont Glucose Monitoring Services - Patient Supplied Sensor,,95249,CPT,Facility,Both,,,,210,178.5,60.186,210,Aetna,PPO,195.3,93,,percent of total billed charges,,
Cont Glucose Monitoring Services - Patient Supplied Sensor,,95249,CPT,Facility,Both,,,,210,178.5,60.186,210,America's PPO,America's PPO,201.663,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Cont Glucose Monitoring Services - Patient Supplied Sensor,,95249,CPT,Facility,Both,,,,210,178.5,60.186,210,BlueCross BlueShield Minnesota, Federal Employee Program,206.64,98.4,,percent of total billed charges,,
Cont Glucose Monitoring Services - Patient Supplied Sensor,,95249,CPT,Facility,Both,,,,210,178.5,60.186,210,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,210,100,,percent of total billed charges,,
Cont Glucose Monitoring Services - Patient Supplied Sensor,,95249,CPT,Facility,Both,,,,210,178.5,60.186,210,BlueCross BlueShield Minnesota,High Value Network Plan,189,90,,percent of total billed charges,,
Cont Glucose Monitoring Services - Patient Supplied Sensor,,95249,CPT,Facility,Outpatient,,,,210,178.5,60.186,210,BlueCross BlueShield Minnesota,Medicare Advantage,102.9,49,,percent of total billed charges,,
Cont Glucose Monitoring Services - Patient Supplied Sensor,,95249,CPT,Facility,Inpatient,,,,210,178.5,60.186,210,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Cont Glucose Monitoring Services - Patient Supplied Sensor,,95249,CPT,Facility,Both,,,,210,178.5,60.186,210,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,185.997,88.57,,percent of total billed charges,,
Cont Glucose Monitoring Services - Patient Supplied Sensor,,95249,CPT,Facility,Both,,,,210,178.5,60.186,210,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,60.186,28.66,,percent of total billed charges,,
Cont Glucose Monitoring Services - Patient Supplied Sensor,,95249,CPT,Facility,Outpatient,,,,210,178.5,60.186,210,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),102.9,49,,percent of total billed charges,,
Cont Glucose Monitoring Services - Patient Supplied Sensor,,95249,CPT,Facility,Inpatient,,,,210,178.5,60.186,210,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Cont Glucose Monitoring Services - Patient Supplied Sensor,,95249,CPT,Facility,Both,,,,210,178.5,60.186,210,CorVel,Worker's Compensation,210,100,,percent of total billed charges,,
Cont Glucose Monitoring Services - Patient Supplied Sensor,,95249,CPT,Facility,Both,,,,210,178.5,60.186,210,First Health Group Corporation,First Health Network,203.7,97,,percent of total billed charges,,
Cont Glucose Monitoring Services - Patient Supplied Sensor,,95249,CPT,Facility,Both,,,,210,178.5,60.186,210,"Health Partners, Inc.",Commercial,198.66,94.6,,percent of total billed charges,,
Cont Glucose Monitoring Services - Patient Supplied Sensor,,95249,CPT,Facility,Outpatient,,,,210,178.5,60.186,210,"Health Partners, Inc.",Medicare Advantage,102.9,49,,percent of total billed charges,,
Cont Glucose Monitoring Services - Patient Supplied Sensor,,95249,CPT,Facility,Inpatient,,,,210,178.5,60.186,210,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Cont Glucose Monitoring Services - Patient Supplied Sensor,,95249,CPT,Facility,Both,,,,210,178.5,60.186,210,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),126,60,,percent of total billed charges,,
Cont Glucose Monitoring Services - Patient Supplied Sensor,,95249,CPT,Facility,Both,,,,210,178.5,60.186,210,"Health Partners, Inc.",State of Minnesota Advantage Program,171.15,81.5,,percent of total billed charges,,
Cont Glucose Monitoring Services - Patient Supplied Sensor,,95249,CPT,Facility,Both,,,,210,178.5,60.186,210,"Health Partners, Inc.",State Public Programs,105,50,,percent of total billed charges,,
Cont Glucose Monitoring Services - Patient Supplied Sensor,,95249,CPT,Facility,Both,,,,210,178.5,60.186,210,Humana Insurance Company,Commercial PPO,199.5,95,,percent of total billed charges,,
Cont Glucose Monitoring Services - Patient Supplied Sensor,,95249,CPT,Facility,Outpatient,,,,210,178.5,60.186,210,Humana Insurance Company,Medicare PPO,102.9,49,,percent of total billed charges,,
Cont Glucose Monitoring Services - Patient Supplied Sensor,,95249,CPT,Facility,Inpatient,,,,210,178.5,60.186,210,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Cont Glucose Monitoring Services - Patient Supplied Sensor,,95249,CPT,Facility,Both,,,,210,178.5,60.186,210,Medica,Individual & Family,208.11,99.1,,percent of total billed charges,,
Cont Glucose Monitoring Services - Patient Supplied Sensor,,95249,CPT,Facility,Outpatient,,,,210,178.5,60.186,210,Medica,Medica Advantage Solution,104.58,49.8,,percent of total billed charges,,
Cont Glucose Monitoring Services - Patient Supplied Sensor,,95249,CPT,Facility,Inpatient,,,,210,178.5,60.186,210,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Cont Glucose Monitoring Services - Patient Supplied Sensor,,95249,CPT,Facility,Outpatient,,,,210,178.5,60.186,210,Medica,Medical Assistance,93.66,44.6,,percent of total billed charges,,
Cont Glucose Monitoring Services - Patient Supplied Sensor,,95249,CPT,Facility,Inpatient,,,,210,178.5,60.186,210,Medica,Medical Assistance,,,,,Included in per diem rate,
Cont Glucose Monitoring Services - Patient Supplied Sensor,,95249,CPT,Facility,Outpatient,,,,210,178.5,60.186,210,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,104.58,49.8,,percent of total billed charges,,
Cont Glucose Monitoring Services - Patient Supplied Sensor,,95249,CPT,Facility,Inpatient,,,,210,178.5,60.186,210,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Cont Glucose Monitoring Services - Patient Supplied Sensor,,95249,CPT,Facility,Both,,,,210,178.5,60.186,210,"Multiplan, Inc.","Multiplan, Inc.",197.4,94,,percent of total billed charges,,
Cont Glucose Monitoring Services - Patient Supplied Sensor,,95249,CPT,Facility,Outpatient,,,,210,178.5,60.186,210,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,189.21,90.1,,percent of total billed charges,,
Cont Glucose Monitoring Services - Patient Supplied Sensor,,95249,CPT,Facility,Inpatient,,,,210,178.5,60.186,210,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Cont Glucose Monitoring Services - Patient Supplied Sensor,,95249,CPT,Facility,Both,,,,210,178.5,60.186,210,"Preferred One Administrative Services, INC.",PPO,207.06,98.6,,percent of total billed charges,,
Cont Glucose Monitoring Services - Patient Supplied Sensor,,95249,CPT,Facility,Outpatient,,,,210,178.5,60.186,210,PrimeWest Health,Minnesota Senior Health Options (MSHO),108.045,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Cont Glucose Monitoring Services - Patient Supplied Sensor,,95249,CPT,Facility,Inpatient,,,,210,178.5,60.186,210,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Cont Glucose Monitoring Services - Patient Supplied Sensor,,95249,CPT,Facility,Outpatient,,,,210,178.5,60.186,210,PrimeWest Health,MinnesotaCare,107.856,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Cont Glucose Monitoring Services - Patient Supplied Sensor,,95249,CPT,Facility,Inpatient,,,,210,178.5,60.186,210,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Cont Glucose Monitoring Services - Patient Supplied Sensor,,95249,CPT,Facility,Both,,,,210,178.5,60.186,210,Sanford Health Plan,Sanford Health Plan,193.2,92,,percent of total billed charges,,
Cont Glucose Monitoring Services - Patient Supplied Sensor,,95249,CPT,Facility,Outpatient,,,,210,178.5,60.186,210,"UCare Health, Inc.",Individual & Family Plan,118.335,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Cont Glucose Monitoring Services - Patient Supplied Sensor,,95249,CPT,Facility,Inpatient,,,,210,178.5,60.186,210,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Cont Glucose Monitoring Services - Patient Supplied Sensor,,95249,CPT,Facility,Outpatient,,,,210,178.5,60.186,210,"UCare Health, Inc.",Medical Assistance,105.987,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Cont Glucose Monitoring Services - Patient Supplied Sensor,,95249,CPT,Facility,Inpatient,,,,210,178.5,60.186,210,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Cont Glucose Monitoring Services - Patient Supplied Sensor,,95249,CPT,Facility,Outpatient,,,,210,178.5,60.186,210,"UCare Health, Inc.",Medicare Advantage,105.987,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Cont Glucose Monitoring Services - Patient Supplied Sensor,,95249,CPT,Facility,Inpatient,,,,210,178.5,60.186,210,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Cont Glucose Monitoring Services - Patient Supplied Sensor,,95249,CPT,Facility,Outpatient,,,,210,178.5,60.186,210,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),105.987,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Cont Glucose Monitoring Services - Patient Supplied Sensor,,95249,CPT,Facility,Inpatient,,,,210,178.5,60.186,210,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Cont Glucose Monitoring Services - Patient Supplied Sensor,,95249,CPT,Facility,Both,,,,210,178.5,60.186,210,UnitedHealthcare,Individual & Family,197.4,94,,percent of total billed charges,,
Cont Glucose Monitoring Services - Patient Supplied Sensor,,95249,CPT,Facility,Outpatient,,,,210,178.5,60.186,210,UnitedHealthcare,Medicare Advantage,102.9,49,,percent of total billed charges,,
Cont Glucose Monitoring Services - Patient Supplied Sensor,,95249,CPT,Facility,Inpatient,,,,210,178.5,60.186,210,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Cont Glucose Monitoring Services - Patient Supplied Sensor,,95249,CPT,Facility,Outpatient,,,,210,178.5,60.186,210,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,100.8,48,,percent of total billed charges,,100% of DHS outpatient percentage
Cont Glucose Monitoring Services - Patient Supplied Sensor,,95249,CPT,Facility,Inpatient,,,,210,178.5,60.186,210,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Cgms (Cont Glucose Monitoring Services),,95250,CPT,Facility,Both,,,,395,335.75,113.207,395,Aetna,Commercial,363.4,92,,percent of total billed charges,,
Cgms (Cont Glucose Monitoring Services),,95250,CPT,Facility,Outpatient,,,,395,335.75,113.207,395,Aetna,Medicare Advantage,193.55,49,,percent of total billed charges,,
Cgms (Cont Glucose Monitoring Services),,95250,CPT,Facility,Inpatient,,,,395,335.75,113.207,395,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Cgms (Cont Glucose Monitoring Services),,95250,CPT,Facility,Both,,,,395,335.75,113.207,395,Aetna,PPO,367.35,93,,percent of total billed charges,,
Cgms (Cont Glucose Monitoring Services),,95250,CPT,Facility,Both,,,,395,335.75,113.207,395,America's PPO,America's PPO,379.3185,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Cgms (Cont Glucose Monitoring Services),,95250,CPT,Facility,Both,,,,395,335.75,113.207,395,BlueCross BlueShield Minnesota, Federal Employee Program,388.68,98.4,,percent of total billed charges,,
Cgms (Cont Glucose Monitoring Services),,95250,CPT,Facility,Both,,,,395,335.75,113.207,395,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,395,100,,percent of total billed charges,,
Cgms (Cont Glucose Monitoring Services),,95250,CPT,Facility,Both,,,,395,335.75,113.207,395,BlueCross BlueShield Minnesota,High Value Network Plan,355.5,90,,percent of total billed charges,,
Cgms (Cont Glucose Monitoring Services),,95250,CPT,Facility,Outpatient,,,,395,335.75,113.207,395,BlueCross BlueShield Minnesota,Medicare Advantage,193.55,49,,percent of total billed charges,,
Cgms (Cont Glucose Monitoring Services),,95250,CPT,Facility,Inpatient,,,,395,335.75,113.207,395,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Cgms (Cont Glucose Monitoring Services),,95250,CPT,Facility,Both,,,,395,335.75,113.207,395,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,349.8515,88.57,,percent of total billed charges,,
Cgms (Cont Glucose Monitoring Services),,95250,CPT,Facility,Both,,,,395,335.75,113.207,395,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,113.207,28.66,,percent of total billed charges,,
Cgms (Cont Glucose Monitoring Services),,95250,CPT,Facility,Outpatient,,,,395,335.75,113.207,395,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),193.55,49,,percent of total billed charges,,
Cgms (Cont Glucose Monitoring Services),,95250,CPT,Facility,Inpatient,,,,395,335.75,113.207,395,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Cgms (Cont Glucose Monitoring Services),,95250,CPT,Facility,Both,,,,395,335.75,113.207,395,CorVel,Worker's Compensation,395,100,,percent of total billed charges,,
Cgms (Cont Glucose Monitoring Services),,95250,CPT,Facility,Both,,,,395,335.75,113.207,395,First Health Group Corporation,First Health Network,383.15,97,,percent of total billed charges,,
Cgms (Cont Glucose Monitoring Services),,95250,CPT,Facility,Both,,,,395,335.75,113.207,395,"Health Partners, Inc.",Commercial,373.67,94.6,,percent of total billed charges,,
Cgms (Cont Glucose Monitoring Services),,95250,CPT,Facility,Outpatient,,,,395,335.75,113.207,395,"Health Partners, Inc.",Medicare Advantage,193.55,49,,percent of total billed charges,,
Cgms (Cont Glucose Monitoring Services),,95250,CPT,Facility,Inpatient,,,,395,335.75,113.207,395,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Cgms (Cont Glucose Monitoring Services),,95250,CPT,Facility,Both,,,,395,335.75,113.207,395,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),237,60,,percent of total billed charges,,
Cgms (Cont Glucose Monitoring Services),,95250,CPT,Facility,Both,,,,395,335.75,113.207,395,"Health Partners, Inc.",State of Minnesota Advantage Program,321.925,81.5,,percent of total billed charges,,
Cgms (Cont Glucose Monitoring Services),,95250,CPT,Facility,Both,,,,395,335.75,113.207,395,"Health Partners, Inc.",State Public Programs,197.5,50,,percent of total billed charges,,
Cgms (Cont Glucose Monitoring Services),,95250,CPT,Facility,Both,,,,395,335.75,113.207,395,Humana Insurance Company,Commercial PPO,375.25,95,,percent of total billed charges,,
Cgms (Cont Glucose Monitoring Services),,95250,CPT,Facility,Outpatient,,,,395,335.75,113.207,395,Humana Insurance Company,Medicare PPO,193.55,49,,percent of total billed charges,,
Cgms (Cont Glucose Monitoring Services),,95250,CPT,Facility,Inpatient,,,,395,335.75,113.207,395,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Cgms (Cont Glucose Monitoring Services),,95250,CPT,Facility,Both,,,,395,335.75,113.207,395,Medica,Individual & Family,391.445,99.1,,percent of total billed charges,,
Cgms (Cont Glucose Monitoring Services),,95250,CPT,Facility,Outpatient,,,,395,335.75,113.207,395,Medica,Medica Advantage Solution,196.71,49.8,,percent of total billed charges,,
Cgms (Cont Glucose Monitoring Services),,95250,CPT,Facility,Inpatient,,,,395,335.75,113.207,395,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Cgms (Cont Glucose Monitoring Services),,95250,CPT,Facility,Outpatient,,,,395,335.75,113.207,395,Medica,Medical Assistance,176.17,44.6,,percent of total billed charges,,
Cgms (Cont Glucose Monitoring Services),,95250,CPT,Facility,Inpatient,,,,395,335.75,113.207,395,Medica,Medical Assistance,,,,,Included in per diem rate,
Cgms (Cont Glucose Monitoring Services),,95250,CPT,Facility,Outpatient,,,,395,335.75,113.207,395,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,196.71,49.8,,percent of total billed charges,,
Cgms (Cont Glucose Monitoring Services),,95250,CPT,Facility,Inpatient,,,,395,335.75,113.207,395,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Cgms (Cont Glucose Monitoring Services),,95250,CPT,Facility,Both,,,,395,335.75,113.207,395,"Multiplan, Inc.","Multiplan, Inc.",371.3,94,,percent of total billed charges,,
Cgms (Cont Glucose Monitoring Services),,95250,CPT,Facility,Outpatient,,,,395,335.75,113.207,395,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,355.895,90.1,,percent of total billed charges,,
Cgms (Cont Glucose Monitoring Services),,95250,CPT,Facility,Inpatient,,,,395,335.75,113.207,395,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Cgms (Cont Glucose Monitoring Services),,95250,CPT,Facility,Both,,,,395,335.75,113.207,395,"Preferred One Administrative Services, INC.",PPO,389.47,98.6,,percent of total billed charges,,
Cgms (Cont Glucose Monitoring Services),,95250,CPT,Facility,Outpatient,,,,395,335.75,113.207,395,PrimeWest Health,Minnesota Senior Health Options (MSHO),203.2275,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Cgms (Cont Glucose Monitoring Services),,95250,CPT,Facility,Inpatient,,,,395,335.75,113.207,395,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Cgms (Cont Glucose Monitoring Services),,95250,CPT,Facility,Outpatient,,,,395,335.75,113.207,395,PrimeWest Health,MinnesotaCare,202.872,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Cgms (Cont Glucose Monitoring Services),,95250,CPT,Facility,Inpatient,,,,395,335.75,113.207,395,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Cgms (Cont Glucose Monitoring Services),,95250,CPT,Facility,Both,,,,395,335.75,113.207,395,Sanford Health Plan,Sanford Health Plan,363.4,92,,percent of total billed charges,,
Cgms (Cont Glucose Monitoring Services),,95250,CPT,Facility,Outpatient,,,,395,335.75,113.207,395,"UCare Health, Inc.",Individual & Family Plan,222.5825,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Cgms (Cont Glucose Monitoring Services),,95250,CPT,Facility,Inpatient,,,,395,335.75,113.207,395,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Cgms (Cont Glucose Monitoring Services),,95250,CPT,Facility,Outpatient,,,,395,335.75,113.207,395,"UCare Health, Inc.",Medical Assistance,199.3565,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Cgms (Cont Glucose Monitoring Services),,95250,CPT,Facility,Inpatient,,,,395,335.75,113.207,395,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Cgms (Cont Glucose Monitoring Services),,95250,CPT,Facility,Outpatient,,,,395,335.75,113.207,395,"UCare Health, Inc.",Medicare Advantage,199.3565,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Cgms (Cont Glucose Monitoring Services),,95250,CPT,Facility,Inpatient,,,,395,335.75,113.207,395,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Cgms (Cont Glucose Monitoring Services),,95250,CPT,Facility,Outpatient,,,,395,335.75,113.207,395,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),199.3565,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Cgms (Cont Glucose Monitoring Services),,95250,CPT,Facility,Inpatient,,,,395,335.75,113.207,395,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Cgms (Cont Glucose Monitoring Services),,95250,CPT,Facility,Both,,,,395,335.75,113.207,395,UnitedHealthcare,Individual & Family,371.3,94,,percent of total billed charges,,
Cgms (Cont Glucose Monitoring Services),,95250,CPT,Facility,Outpatient,,,,395,335.75,113.207,395,UnitedHealthcare,Medicare Advantage,193.55,49,,percent of total billed charges,,
Cgms (Cont Glucose Monitoring Services),,95250,CPT,Facility,Inpatient,,,,395,335.75,113.207,395,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Cgms (Cont Glucose Monitoring Services),,95250,CPT,Facility,Outpatient,,,,395,335.75,113.207,395,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,189.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
Cgms (Cont Glucose Monitoring Services),,95250,CPT,Facility,Inpatient,,,,395,335.75,113.207,395,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Mslt (Mult Sleep Latency Testing),,95805,CPT,Facility,Both,,,,2321,1972.85,665.1986,2321,Aetna,Commercial,2135.32,92,,percent of total billed charges,,
Mslt (Mult Sleep Latency Testing),,95805,CPT,Facility,Outpatient,,,,2321,1972.85,665.1986,2321,Aetna,Medicare Advantage,1137.29,49,,percent of total billed charges,,
Mslt (Mult Sleep Latency Testing),,95805,CPT,Facility,Inpatient,,,,2321,1972.85,665.1986,2321,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Mslt (Mult Sleep Latency Testing),,95805,CPT,Facility,Both,,,,2321,1972.85,665.1986,2321,Aetna,PPO,2158.53,93,,percent of total billed charges,,
Mslt (Mult Sleep Latency Testing),,95805,CPT,Facility,Both,,,,2321,1972.85,665.1986,2321,America's PPO,America's PPO,2228.8563,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Mslt (Mult Sleep Latency Testing),,95805,CPT,Facility,Both,,,,2321,1972.85,665.1986,2321,BlueCross BlueShield Minnesota, Federal Employee Program,2283.864,98.4,,percent of total billed charges,,
Mslt (Mult Sleep Latency Testing),,95805,CPT,Facility,Both,,,,2321,1972.85,665.1986,2321,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,2321,100,,percent of total billed charges,,
Mslt (Mult Sleep Latency Testing),,95805,CPT,Facility,Both,,,,2321,1972.85,665.1986,2321,BlueCross BlueShield Minnesota,High Value Network Plan,2088.9,90,,percent of total billed charges,,
Mslt (Mult Sleep Latency Testing),,95805,CPT,Facility,Outpatient,,,,2321,1972.85,665.1986,2321,BlueCross BlueShield Minnesota,Medicare Advantage,1137.29,49,,percent of total billed charges,,
Mslt (Mult Sleep Latency Testing),,95805,CPT,Facility,Inpatient,,,,2321,1972.85,665.1986,2321,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Mslt (Mult Sleep Latency Testing),,95805,CPT,Facility,Both,,,,2321,1972.85,665.1986,2321,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,2055.7097,88.57,,percent of total billed charges,,
Mslt (Mult Sleep Latency Testing),,95805,CPT,Facility,Both,,,,2321,1972.85,665.1986,2321,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,665.1986,28.66,,percent of total billed charges,,
Mslt (Mult Sleep Latency Testing),,95805,CPT,Facility,Outpatient,,,,2321,1972.85,665.1986,2321,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1137.29,49,,percent of total billed charges,,
Mslt (Mult Sleep Latency Testing),,95805,CPT,Facility,Inpatient,,,,2321,1972.85,665.1986,2321,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Mslt (Mult Sleep Latency Testing),,95805,CPT,Facility,Both,,,,2321,1972.85,665.1986,2321,CorVel,Worker's Compensation,2321,100,,percent of total billed charges,,
Mslt (Mult Sleep Latency Testing),,95805,CPT,Facility,Both,,,,2321,1972.85,665.1986,2321,First Health Group Corporation,First Health Network,2251.37,97,,percent of total billed charges,,
Mslt (Mult Sleep Latency Testing),,95805,CPT,Facility,Both,,,,2321,1972.85,665.1986,2321,"Health Partners, Inc.",Commercial,2195.666,94.6,,percent of total billed charges,,
Mslt (Mult Sleep Latency Testing),,95805,CPT,Facility,Outpatient,,,,2321,1972.85,665.1986,2321,"Health Partners, Inc.",Medicare Advantage,1137.29,49,,percent of total billed charges,,
Mslt (Mult Sleep Latency Testing),,95805,CPT,Facility,Inpatient,,,,2321,1972.85,665.1986,2321,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mslt (Mult Sleep Latency Testing),,95805,CPT,Facility,Both,,,,2321,1972.85,665.1986,2321,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1392.6,60,,percent of total billed charges,,
Mslt (Mult Sleep Latency Testing),,95805,CPT,Facility,Both,,,,2321,1972.85,665.1986,2321,"Health Partners, Inc.",State of Minnesota Advantage Program,1891.615,81.5,,percent of total billed charges,,
Mslt (Mult Sleep Latency Testing),,95805,CPT,Facility,Both,,,,2321,1972.85,665.1986,2321,"Health Partners, Inc.",State Public Programs,1160.5,50,,percent of total billed charges,,
Mslt (Mult Sleep Latency Testing),,95805,CPT,Facility,Both,,,,2321,1972.85,665.1986,2321,Humana Insurance Company,Commercial PPO,2204.95,95,,percent of total billed charges,,
Mslt (Mult Sleep Latency Testing),,95805,CPT,Facility,Outpatient,,,,2321,1972.85,665.1986,2321,Humana Insurance Company,Medicare PPO,1137.29,49,,percent of total billed charges,,
Mslt (Mult Sleep Latency Testing),,95805,CPT,Facility,Inpatient,,,,2321,1972.85,665.1986,2321,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Mslt (Mult Sleep Latency Testing),,95805,CPT,Facility,Both,,,,2321,1972.85,665.1986,2321,Medica,Individual & Family,2300.111,99.1,,percent of total billed charges,,
Mslt (Mult Sleep Latency Testing),,95805,CPT,Facility,Outpatient,,,,2321,1972.85,665.1986,2321,Medica,Medica Advantage Solution,1155.858,49.8,,percent of total billed charges,,
Mslt (Mult Sleep Latency Testing),,95805,CPT,Facility,Inpatient,,,,2321,1972.85,665.1986,2321,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Mslt (Mult Sleep Latency Testing),,95805,CPT,Facility,Outpatient,,,,2321,1972.85,665.1986,2321,Medica,Medical Assistance,1035.166,44.6,,percent of total billed charges,,
Mslt (Mult Sleep Latency Testing),,95805,CPT,Facility,Inpatient,,,,2321,1972.85,665.1986,2321,Medica,Medical Assistance,,,,,Included in per diem rate,
Mslt (Mult Sleep Latency Testing),,95805,CPT,Facility,Outpatient,,,,2321,1972.85,665.1986,2321,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1155.858,49.8,,percent of total billed charges,,
Mslt (Mult Sleep Latency Testing),,95805,CPT,Facility,Inpatient,,,,2321,1972.85,665.1986,2321,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Mslt (Mult Sleep Latency Testing),,95805,CPT,Facility,Both,,,,2321,1972.85,665.1986,2321,"Multiplan, Inc.","Multiplan, Inc.",2181.74,94,,percent of total billed charges,,
Mslt (Mult Sleep Latency Testing),,95805,CPT,Facility,Outpatient,,,,2321,1972.85,665.1986,2321,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,2091.221,90.1,,percent of total billed charges,,
Mslt (Mult Sleep Latency Testing),,95805,CPT,Facility,Inpatient,,,,2321,1972.85,665.1986,2321,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Mslt (Mult Sleep Latency Testing),,95805,CPT,Facility,Both,,,,2321,1972.85,665.1986,2321,"Preferred One Administrative Services, INC.",PPO,2288.506,98.6,,percent of total billed charges,,
Mslt (Mult Sleep Latency Testing),,95805,CPT,Facility,Outpatient,,,,2321,1972.85,665.1986,2321,PrimeWest Health,Minnesota Senior Health Options (MSHO),1194.1545,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Mslt (Mult Sleep Latency Testing),,95805,CPT,Facility,Inpatient,,,,2321,1972.85,665.1986,2321,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mslt (Mult Sleep Latency Testing),,95805,CPT,Facility,Outpatient,,,,2321,1972.85,665.1986,2321,PrimeWest Health,MinnesotaCare,1192.0656,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Mslt (Mult Sleep Latency Testing),,95805,CPT,Facility,Inpatient,,,,2321,1972.85,665.1986,2321,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Mslt (Mult Sleep Latency Testing),,95805,CPT,Facility,Both,,,,2321,1972.85,665.1986,2321,Sanford Health Plan,Sanford Health Plan,2135.32,92,,percent of total billed charges,,
Mslt (Mult Sleep Latency Testing),,95805,CPT,Facility,Outpatient,,,,2321,1972.85,665.1986,2321,"UCare Health, Inc.",Individual & Family Plan,1307.8835,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Mslt (Mult Sleep Latency Testing),,95805,CPT,Facility,Inpatient,,,,2321,1972.85,665.1986,2321,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Mslt (Mult Sleep Latency Testing),,95805,CPT,Facility,Outpatient,,,,2321,1972.85,665.1986,2321,"UCare Health, Inc.",Medical Assistance,1171.4087,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mslt (Mult Sleep Latency Testing),,95805,CPT,Facility,Inpatient,,,,2321,1972.85,665.1986,2321,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Mslt (Mult Sleep Latency Testing),,95805,CPT,Facility,Outpatient,,,,2321,1972.85,665.1986,2321,"UCare Health, Inc.",Medicare Advantage,1171.4087,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mslt (Mult Sleep Latency Testing),,95805,CPT,Facility,Inpatient,,,,2321,1972.85,665.1986,2321,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mslt (Mult Sleep Latency Testing),,95805,CPT,Facility,Outpatient,,,,2321,1972.85,665.1986,2321,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1171.4087,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mslt (Mult Sleep Latency Testing),,95805,CPT,Facility,Inpatient,,,,2321,1972.85,665.1986,2321,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mslt (Mult Sleep Latency Testing),,95805,CPT,Facility,Both,,,,2321,1972.85,665.1986,2321,UnitedHealthcare,Individual & Family,2181.74,94,,percent of total billed charges,,
Mslt (Mult Sleep Latency Testing),,95805,CPT,Facility,Outpatient,,,,2321,1972.85,665.1986,2321,UnitedHealthcare,Medicare Advantage,1137.29,49,,percent of total billed charges,,
Mslt (Mult Sleep Latency Testing),,95805,CPT,Facility,Inpatient,,,,2321,1972.85,665.1986,2321,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Mslt (Mult Sleep Latency Testing),,95805,CPT,Facility,Outpatient,,,,2321,1972.85,665.1986,2321,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1114.08,48,,percent of total billed charges,,100% of DHS outpatient percentage
Mslt (Mult Sleep Latency Testing),,95805,CPT,Facility,Inpatient,,,,2321,1972.85,665.1986,2321,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Polysomnography,,95810,CPT,Facility,Both,,,,4794,4074.9,1373.9604,4794,Aetna,Commercial,4410.48,92,,percent of total billed charges,,
Polysomnography,,95810,CPT,Facility,Outpatient,,,,4794,4074.9,1373.9604,4794,Aetna,Medicare Advantage,2349.06,49,,percent of total billed charges,,
Polysomnography,,95810,CPT,Facility,Inpatient,,,,4794,4074.9,1373.9604,4794,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Polysomnography,,95810,CPT,Facility,Both,,,,4794,4074.9,1373.9604,4794,Aetna,PPO,4458.42,93,,percent of total billed charges,,
Polysomnography,,95810,CPT,Facility,Both,,,,4794,4074.9,1373.9604,4794,America's PPO,America's PPO,4603.6782,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Polysomnography,,95810,CPT,Facility,Both,,,,4794,4074.9,1373.9604,4794,BlueCross BlueShield Minnesota, Federal Employee Program,4717.296,98.4,,percent of total billed charges,,
Polysomnography,,95810,CPT,Facility,Both,,,,4794,4074.9,1373.9604,4794,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,4794,100,,percent of total billed charges,,
Polysomnography,,95810,CPT,Facility,Both,,,,4794,4074.9,1373.9604,4794,BlueCross BlueShield Minnesota,High Value Network Plan,4314.6,90,,percent of total billed charges,,
Polysomnography,,95810,CPT,Facility,Outpatient,,,,4794,4074.9,1373.9604,4794,BlueCross BlueShield Minnesota,Medicare Advantage,2349.06,49,,percent of total billed charges,,
Polysomnography,,95810,CPT,Facility,Inpatient,,,,4794,4074.9,1373.9604,4794,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Polysomnography,,95810,CPT,Facility,Both,,,,4794,4074.9,1373.9604,4794,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4246.0458,88.57,,percent of total billed charges,,
Polysomnography,,95810,CPT,Facility,Both,,,,4794,4074.9,1373.9604,4794,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1373.9604,28.66,,percent of total billed charges,,
Polysomnography,,95810,CPT,Facility,Outpatient,,,,4794,4074.9,1373.9604,4794,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2349.06,49,,percent of total billed charges,,
Polysomnography,,95810,CPT,Facility,Inpatient,,,,4794,4074.9,1373.9604,4794,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Polysomnography,,95810,CPT,Facility,Both,,,,4794,4074.9,1373.9604,4794,CorVel,Worker's Compensation,4794,100,,percent of total billed charges,,
Polysomnography,,95810,CPT,Facility,Both,,,,4794,4074.9,1373.9604,4794,First Health Group Corporation,First Health Network,4650.18,97,,percent of total billed charges,,
Polysomnography,,95810,CPT,Facility,Both,,,,4794,4074.9,1373.9604,4794,"Health Partners, Inc.",Commercial,4535.124,94.6,,percent of total billed charges,,
Polysomnography,,95810,CPT,Facility,Outpatient,,,,4794,4074.9,1373.9604,4794,"Health Partners, Inc.",Medicare Advantage,2349.06,49,,percent of total billed charges,,
Polysomnography,,95810,CPT,Facility,Inpatient,,,,4794,4074.9,1373.9604,4794,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Polysomnography,,95810,CPT,Facility,Both,,,,4794,4074.9,1373.9604,4794,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),2876.4,60,,percent of total billed charges,,
Polysomnography,,95810,CPT,Facility,Both,,,,4794,4074.9,1373.9604,4794,"Health Partners, Inc.",State of Minnesota Advantage Program,3907.11,81.5,,percent of total billed charges,,
Polysomnography,,95810,CPT,Facility,Both,,,,4794,4074.9,1373.9604,4794,"Health Partners, Inc.",State Public Programs,2397,50,,percent of total billed charges,,
Polysomnography,,95810,CPT,Facility,Both,,,,4794,4074.9,1373.9604,4794,Humana Insurance Company,Commercial PPO,4554.3,95,,percent of total billed charges,,
Polysomnography,,95810,CPT,Facility,Outpatient,,,,4794,4074.9,1373.9604,4794,Humana Insurance Company,Medicare PPO,2349.06,49,,percent of total billed charges,,
Polysomnography,,95810,CPT,Facility,Inpatient,,,,4794,4074.9,1373.9604,4794,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Polysomnography,,95810,CPT,Facility,Both,,,,4794,4074.9,1373.9604,4794,Medica,Individual & Family,4750.854,99.1,,percent of total billed charges,,
Polysomnography,,95810,CPT,Facility,Outpatient,,,,4794,4074.9,1373.9604,4794,Medica,Medica Advantage Solution,2387.412,49.8,,percent of total billed charges,,
Polysomnography,,95810,CPT,Facility,Inpatient,,,,4794,4074.9,1373.9604,4794,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Polysomnography,,95810,CPT,Facility,Outpatient,,,,4794,4074.9,1373.9604,4794,Medica,Medical Assistance,2138.124,44.6,,percent of total billed charges,,
Polysomnography,,95810,CPT,Facility,Inpatient,,,,4794,4074.9,1373.9604,4794,Medica,Medical Assistance,,,,,Included in per diem rate,
Polysomnography,,95810,CPT,Facility,Outpatient,,,,4794,4074.9,1373.9604,4794,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2387.412,49.8,,percent of total billed charges,,
Polysomnography,,95810,CPT,Facility,Inpatient,,,,4794,4074.9,1373.9604,4794,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Polysomnography,,95810,CPT,Facility,Both,,,,4794,4074.9,1373.9604,4794,"Multiplan, Inc.","Multiplan, Inc.",4506.36,94,,percent of total billed charges,,
Polysomnography,,95810,CPT,Facility,Outpatient,,,,4794,4074.9,1373.9604,4794,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4319.394,90.1,,percent of total billed charges,,
Polysomnography,,95810,CPT,Facility,Inpatient,,,,4794,4074.9,1373.9604,4794,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Polysomnography,,95810,CPT,Facility,Both,,,,4794,4074.9,1373.9604,4794,"Preferred One Administrative Services, INC.",PPO,4726.884,98.6,,percent of total billed charges,,
Polysomnography,,95810,CPT,Facility,Outpatient,,,,4794,4074.9,1373.9604,4794,PrimeWest Health,Minnesota Senior Health Options (MSHO),2466.513,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Polysomnography,,95810,CPT,Facility,Inpatient,,,,4794,4074.9,1373.9604,4794,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Polysomnography,,95810,CPT,Facility,Outpatient,,,,4794,4074.9,1373.9604,4794,PrimeWest Health,MinnesotaCare,2462.1984,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Polysomnography,,95810,CPT,Facility,Inpatient,,,,4794,4074.9,1373.9604,4794,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Polysomnography,,95810,CPT,Facility,Both,,,,4794,4074.9,1373.9604,4794,Sanford Health Plan,Sanford Health Plan,4410.48,92,,percent of total billed charges,,
Polysomnography,,95810,CPT,Facility,Outpatient,,,,4794,4074.9,1373.9604,4794,"UCare Health, Inc.",Individual & Family Plan,2701.419,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Polysomnography,,95810,CPT,Facility,Inpatient,,,,4794,4074.9,1373.9604,4794,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Polysomnography,,95810,CPT,Facility,Outpatient,,,,4794,4074.9,1373.9604,4794,"UCare Health, Inc.",Medical Assistance,2419.5318,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Polysomnography,,95810,CPT,Facility,Inpatient,,,,4794,4074.9,1373.9604,4794,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Polysomnography,,95810,CPT,Facility,Outpatient,,,,4794,4074.9,1373.9604,4794,"UCare Health, Inc.",Medicare Advantage,2419.5318,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Polysomnography,,95810,CPT,Facility,Inpatient,,,,4794,4074.9,1373.9604,4794,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Polysomnography,,95810,CPT,Facility,Outpatient,,,,4794,4074.9,1373.9604,4794,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2419.5318,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Polysomnography,,95810,CPT,Facility,Inpatient,,,,4794,4074.9,1373.9604,4794,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Polysomnography,,95810,CPT,Facility,Both,,,,4794,4074.9,1373.9604,4794,UnitedHealthcare,Individual & Family,4506.36,94,,percent of total billed charges,,
Polysomnography,,95810,CPT,Facility,Outpatient,,,,4794,4074.9,1373.9604,4794,UnitedHealthcare,Medicare Advantage,2349.06,49,,percent of total billed charges,,
Polysomnography,,95810,CPT,Facility,Inpatient,,,,4794,4074.9,1373.9604,4794,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Polysomnography,,95810,CPT,Facility,Outpatient,,,,4794,4074.9,1373.9604,4794,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2301.12,48,,percent of total billed charges,,100% of DHS outpatient percentage
Polysomnography,,95810,CPT,Facility,Inpatient,,,,4794,4074.9,1373.9604,4794,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Poly/Split,,95811,CPT,Facility,Both,,,,5202,4421.7,1490.8932,5202,Aetna,Commercial,4785.84,92,,percent of total billed charges,,
Poly/Split,,95811,CPT,Facility,Outpatient,,,,5202,4421.7,1490.8932,5202,Aetna,Medicare Advantage,2548.98,49,,percent of total billed charges,,
Poly/Split,,95811,CPT,Facility,Inpatient,,,,5202,4421.7,1490.8932,5202,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Poly/Split,,95811,CPT,Facility,Both,,,,5202,4421.7,1490.8932,5202,Aetna,PPO,4837.86,93,,percent of total billed charges,,
Poly/Split,,95811,CPT,Facility,Both,,,,5202,4421.7,1490.8932,5202,America's PPO,America's PPO,4995.4806,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Poly/Split,,95811,CPT,Facility,Both,,,,5202,4421.7,1490.8932,5202,BlueCross BlueShield Minnesota, Federal Employee Program,5118.768,98.4,,percent of total billed charges,,
Poly/Split,,95811,CPT,Facility,Both,,,,5202,4421.7,1490.8932,5202,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5202,100,,percent of total billed charges,,
Poly/Split,,95811,CPT,Facility,Both,,,,5202,4421.7,1490.8932,5202,BlueCross BlueShield Minnesota,High Value Network Plan,4681.8,90,,percent of total billed charges,,
Poly/Split,,95811,CPT,Facility,Outpatient,,,,5202,4421.7,1490.8932,5202,BlueCross BlueShield Minnesota,Medicare Advantage,2548.98,49,,percent of total billed charges,,
Poly/Split,,95811,CPT,Facility,Inpatient,,,,5202,4421.7,1490.8932,5202,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Poly/Split,,95811,CPT,Facility,Both,,,,5202,4421.7,1490.8932,5202,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4607.4114,88.57,,percent of total billed charges,,
Poly/Split,,95811,CPT,Facility,Both,,,,5202,4421.7,1490.8932,5202,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1490.8932,28.66,,percent of total billed charges,,
Poly/Split,,95811,CPT,Facility,Outpatient,,,,5202,4421.7,1490.8932,5202,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2548.98,49,,percent of total billed charges,,
Poly/Split,,95811,CPT,Facility,Inpatient,,,,5202,4421.7,1490.8932,5202,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Poly/Split,,95811,CPT,Facility,Both,,,,5202,4421.7,1490.8932,5202,CorVel,Worker's Compensation,5202,100,,percent of total billed charges,,
Poly/Split,,95811,CPT,Facility,Both,,,,5202,4421.7,1490.8932,5202,First Health Group Corporation,First Health Network,5045.94,97,,percent of total billed charges,,
Poly/Split,,95811,CPT,Facility,Both,,,,5202,4421.7,1490.8932,5202,"Health Partners, Inc.",Commercial,4921.092,94.6,,percent of total billed charges,,
Poly/Split,,95811,CPT,Facility,Outpatient,,,,5202,4421.7,1490.8932,5202,"Health Partners, Inc.",Medicare Advantage,2548.98,49,,percent of total billed charges,,
Poly/Split,,95811,CPT,Facility,Inpatient,,,,5202,4421.7,1490.8932,5202,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Poly/Split,,95811,CPT,Facility,Both,,,,5202,4421.7,1490.8932,5202,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3121.2,60,,percent of total billed charges,,
Poly/Split,,95811,CPT,Facility,Both,,,,5202,4421.7,1490.8932,5202,"Health Partners, Inc.",State of Minnesota Advantage Program,4239.63,81.5,,percent of total billed charges,,
Poly/Split,,95811,CPT,Facility,Both,,,,5202,4421.7,1490.8932,5202,"Health Partners, Inc.",State Public Programs,2601,50,,percent of total billed charges,,
Poly/Split,,95811,CPT,Facility,Both,,,,5202,4421.7,1490.8932,5202,Humana Insurance Company,Commercial PPO,4941.9,95,,percent of total billed charges,,
Poly/Split,,95811,CPT,Facility,Outpatient,,,,5202,4421.7,1490.8932,5202,Humana Insurance Company,Medicare PPO,2548.98,49,,percent of total billed charges,,
Poly/Split,,95811,CPT,Facility,Inpatient,,,,5202,4421.7,1490.8932,5202,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Poly/Split,,95811,CPT,Facility,Both,,,,5202,4421.7,1490.8932,5202,Medica,Individual & Family,5155.182,99.1,,percent of total billed charges,,
Poly/Split,,95811,CPT,Facility,Outpatient,,,,5202,4421.7,1490.8932,5202,Medica,Medica Advantage Solution,2590.596,49.8,,percent of total billed charges,,
Poly/Split,,95811,CPT,Facility,Inpatient,,,,5202,4421.7,1490.8932,5202,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Poly/Split,,95811,CPT,Facility,Outpatient,,,,5202,4421.7,1490.8932,5202,Medica,Medical Assistance,2320.092,44.6,,percent of total billed charges,,
Poly/Split,,95811,CPT,Facility,Inpatient,,,,5202,4421.7,1490.8932,5202,Medica,Medical Assistance,,,,,Included in per diem rate,
Poly/Split,,95811,CPT,Facility,Outpatient,,,,5202,4421.7,1490.8932,5202,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2590.596,49.8,,percent of total billed charges,,
Poly/Split,,95811,CPT,Facility,Inpatient,,,,5202,4421.7,1490.8932,5202,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Poly/Split,,95811,CPT,Facility,Both,,,,5202,4421.7,1490.8932,5202,"Multiplan, Inc.","Multiplan, Inc.",4889.88,94,,percent of total billed charges,,
Poly/Split,,95811,CPT,Facility,Outpatient,,,,5202,4421.7,1490.8932,5202,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4687.002,90.1,,percent of total billed charges,,
Poly/Split,,95811,CPT,Facility,Inpatient,,,,5202,4421.7,1490.8932,5202,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Poly/Split,,95811,CPT,Facility,Both,,,,5202,4421.7,1490.8932,5202,"Preferred One Administrative Services, INC.",PPO,5129.172,98.6,,percent of total billed charges,,
Poly/Split,,95811,CPT,Facility,Outpatient,,,,5202,4421.7,1490.8932,5202,PrimeWest Health,Minnesota Senior Health Options (MSHO),2676.429,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Poly/Split,,95811,CPT,Facility,Inpatient,,,,5202,4421.7,1490.8932,5202,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Poly/Split,,95811,CPT,Facility,Outpatient,,,,5202,4421.7,1490.8932,5202,PrimeWest Health,MinnesotaCare,2671.7472,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Poly/Split,,95811,CPT,Facility,Inpatient,,,,5202,4421.7,1490.8932,5202,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Poly/Split,,95811,CPT,Facility,Both,,,,5202,4421.7,1490.8932,5202,Sanford Health Plan,Sanford Health Plan,4785.84,92,,percent of total billed charges,,
Poly/Split,,95811,CPT,Facility,Outpatient,,,,5202,4421.7,1490.8932,5202,"UCare Health, Inc.",Individual & Family Plan,2931.327,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Poly/Split,,95811,CPT,Facility,Inpatient,,,,5202,4421.7,1490.8932,5202,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Poly/Split,,95811,CPT,Facility,Outpatient,,,,5202,4421.7,1490.8932,5202,"UCare Health, Inc.",Medical Assistance,2625.4494,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Poly/Split,,95811,CPT,Facility,Inpatient,,,,5202,4421.7,1490.8932,5202,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Poly/Split,,95811,CPT,Facility,Outpatient,,,,5202,4421.7,1490.8932,5202,"UCare Health, Inc.",Medicare Advantage,2625.4494,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Poly/Split,,95811,CPT,Facility,Inpatient,,,,5202,4421.7,1490.8932,5202,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Poly/Split,,95811,CPT,Facility,Outpatient,,,,5202,4421.7,1490.8932,5202,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2625.4494,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Poly/Split,,95811,CPT,Facility,Inpatient,,,,5202,4421.7,1490.8932,5202,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Poly/Split,,95811,CPT,Facility,Both,,,,5202,4421.7,1490.8932,5202,UnitedHealthcare,Individual & Family,4889.88,94,,percent of total billed charges,,
Poly/Split,,95811,CPT,Facility,Outpatient,,,,5202,4421.7,1490.8932,5202,UnitedHealthcare,Medicare Advantage,2548.98,49,,percent of total billed charges,,
Poly/Split,,95811,CPT,Facility,Inpatient,,,,5202,4421.7,1490.8932,5202,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Poly/Split,,95811,CPT,Facility,Outpatient,,,,5202,4421.7,1490.8932,5202,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2496.96,48,,percent of total billed charges,,100% of DHS outpatient percentage
Poly/Split,,95811,CPT,Facility,Inpatient,,,,5202,4421.7,1490.8932,5202,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Emg Motor And Or Sensory Nerve W/ F Wave,,95905,CPT,Facility,Both,,,,357,303.45,102.3162,357,Aetna,Commercial,328.44,92,,percent of total billed charges,,
Emg Motor And Or Sensory Nerve W/ F Wave,,95905,CPT,Facility,Outpatient,,,,357,303.45,102.3162,357,Aetna,Medicare Advantage,174.93,49,,percent of total billed charges,,
Emg Motor And Or Sensory Nerve W/ F Wave,,95905,CPT,Facility,Inpatient,,,,357,303.45,102.3162,357,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Emg Motor And Or Sensory Nerve W/ F Wave,,95905,CPT,Facility,Both,,,,357,303.45,102.3162,357,Aetna,PPO,332.01,93,,percent of total billed charges,,
Emg Motor And Or Sensory Nerve W/ F Wave,,95905,CPT,Facility,Both,,,,357,303.45,102.3162,357,America's PPO,America's PPO,342.8271,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Emg Motor And Or Sensory Nerve W/ F Wave,,95905,CPT,Facility,Both,,,,357,303.45,102.3162,357,BlueCross BlueShield Minnesota, Federal Employee Program,351.288,98.4,,percent of total billed charges,,
Emg Motor And Or Sensory Nerve W/ F Wave,,95905,CPT,Facility,Both,,,,357,303.45,102.3162,357,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,357,100,,percent of total billed charges,,
Emg Motor And Or Sensory Nerve W/ F Wave,,95905,CPT,Facility,Both,,,,357,303.45,102.3162,357,BlueCross BlueShield Minnesota,High Value Network Plan,321.3,90,,percent of total billed charges,,
Emg Motor And Or Sensory Nerve W/ F Wave,,95905,CPT,Facility,Outpatient,,,,357,303.45,102.3162,357,BlueCross BlueShield Minnesota,Medicare Advantage,174.93,49,,percent of total billed charges,,
Emg Motor And Or Sensory Nerve W/ F Wave,,95905,CPT,Facility,Inpatient,,,,357,303.45,102.3162,357,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Emg Motor And Or Sensory Nerve W/ F Wave,,95905,CPT,Facility,Both,,,,357,303.45,102.3162,357,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,316.1949,88.57,,percent of total billed charges,,
Emg Motor And Or Sensory Nerve W/ F Wave,,95905,CPT,Facility,Both,,,,357,303.45,102.3162,357,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,102.3162,28.66,,percent of total billed charges,,
Emg Motor And Or Sensory Nerve W/ F Wave,,95905,CPT,Facility,Outpatient,,,,357,303.45,102.3162,357,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),174.93,49,,percent of total billed charges,,
Emg Motor And Or Sensory Nerve W/ F Wave,,95905,CPT,Facility,Inpatient,,,,357,303.45,102.3162,357,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Emg Motor And Or Sensory Nerve W/ F Wave,,95905,CPT,Facility,Both,,,,357,303.45,102.3162,357,CorVel,Worker's Compensation,357,100,,percent of total billed charges,,
Emg Motor And Or Sensory Nerve W/ F Wave,,95905,CPT,Facility,Both,,,,357,303.45,102.3162,357,First Health Group Corporation,First Health Network,346.29,97,,percent of total billed charges,,
Emg Motor And Or Sensory Nerve W/ F Wave,,95905,CPT,Facility,Both,,,,357,303.45,102.3162,357,"Health Partners, Inc.",Commercial,337.722,94.6,,percent of total billed charges,,
Emg Motor And Or Sensory Nerve W/ F Wave,,95905,CPT,Facility,Outpatient,,,,357,303.45,102.3162,357,"Health Partners, Inc.",Medicare Advantage,174.93,49,,percent of total billed charges,,
Emg Motor And Or Sensory Nerve W/ F Wave,,95905,CPT,Facility,Inpatient,,,,357,303.45,102.3162,357,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Emg Motor And Or Sensory Nerve W/ F Wave,,95905,CPT,Facility,Both,,,,357,303.45,102.3162,357,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),214.2,60,,percent of total billed charges,,
Emg Motor And Or Sensory Nerve W/ F Wave,,95905,CPT,Facility,Both,,,,357,303.45,102.3162,357,"Health Partners, Inc.",State of Minnesota Advantage Program,290.955,81.5,,percent of total billed charges,,
Emg Motor And Or Sensory Nerve W/ F Wave,,95905,CPT,Facility,Both,,,,357,303.45,102.3162,357,"Health Partners, Inc.",State Public Programs,178.5,50,,percent of total billed charges,,
Emg Motor And Or Sensory Nerve W/ F Wave,,95905,CPT,Facility,Both,,,,357,303.45,102.3162,357,Humana Insurance Company,Commercial PPO,339.15,95,,percent of total billed charges,,
Emg Motor And Or Sensory Nerve W/ F Wave,,95905,CPT,Facility,Outpatient,,,,357,303.45,102.3162,357,Humana Insurance Company,Medicare PPO,174.93,49,,percent of total billed charges,,
Emg Motor And Or Sensory Nerve W/ F Wave,,95905,CPT,Facility,Inpatient,,,,357,303.45,102.3162,357,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Emg Motor And Or Sensory Nerve W/ F Wave,,95905,CPT,Facility,Both,,,,357,303.45,102.3162,357,Medica,Individual & Family,353.787,99.1,,percent of total billed charges,,
Emg Motor And Or Sensory Nerve W/ F Wave,,95905,CPT,Facility,Outpatient,,,,357,303.45,102.3162,357,Medica,Medica Advantage Solution,177.786,49.8,,percent of total billed charges,,
Emg Motor And Or Sensory Nerve W/ F Wave,,95905,CPT,Facility,Inpatient,,,,357,303.45,102.3162,357,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Emg Motor And Or Sensory Nerve W/ F Wave,,95905,CPT,Facility,Outpatient,,,,357,303.45,102.3162,357,Medica,Medical Assistance,159.222,44.6,,percent of total billed charges,,
Emg Motor And Or Sensory Nerve W/ F Wave,,95905,CPT,Facility,Inpatient,,,,357,303.45,102.3162,357,Medica,Medical Assistance,,,,,Included in per diem rate,
Emg Motor And Or Sensory Nerve W/ F Wave,,95905,CPT,Facility,Outpatient,,,,357,303.45,102.3162,357,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,177.786,49.8,,percent of total billed charges,,
Emg Motor And Or Sensory Nerve W/ F Wave,,95905,CPT,Facility,Inpatient,,,,357,303.45,102.3162,357,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Emg Motor And Or Sensory Nerve W/ F Wave,,95905,CPT,Facility,Both,,,,357,303.45,102.3162,357,"Multiplan, Inc.","Multiplan, Inc.",335.58,94,,percent of total billed charges,,
Emg Motor And Or Sensory Nerve W/ F Wave,,95905,CPT,Facility,Outpatient,,,,357,303.45,102.3162,357,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,321.657,90.1,,percent of total billed charges,,
Emg Motor And Or Sensory Nerve W/ F Wave,,95905,CPT,Facility,Inpatient,,,,357,303.45,102.3162,357,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Emg Motor And Or Sensory Nerve W/ F Wave,,95905,CPT,Facility,Both,,,,357,303.45,102.3162,357,"Preferred One Administrative Services, INC.",PPO,352.002,98.6,,percent of total billed charges,,
Emg Motor And Or Sensory Nerve W/ F Wave,,95905,CPT,Facility,Outpatient,,,,357,303.45,102.3162,357,PrimeWest Health,Minnesota Senior Health Options (MSHO),183.6765,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Emg Motor And Or Sensory Nerve W/ F Wave,,95905,CPT,Facility,Inpatient,,,,357,303.45,102.3162,357,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Emg Motor And Or Sensory Nerve W/ F Wave,,95905,CPT,Facility,Outpatient,,,,357,303.45,102.3162,357,PrimeWest Health,MinnesotaCare,183.3552,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Emg Motor And Or Sensory Nerve W/ F Wave,,95905,CPT,Facility,Inpatient,,,,357,303.45,102.3162,357,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Emg Motor And Or Sensory Nerve W/ F Wave,,95905,CPT,Facility,Both,,,,357,303.45,102.3162,357,Sanford Health Plan,Sanford Health Plan,328.44,92,,percent of total billed charges,,
Emg Motor And Or Sensory Nerve W/ F Wave,,95905,CPT,Facility,Outpatient,,,,357,303.45,102.3162,357,"UCare Health, Inc.",Individual & Family Plan,201.1695,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Emg Motor And Or Sensory Nerve W/ F Wave,,95905,CPT,Facility,Inpatient,,,,357,303.45,102.3162,357,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Emg Motor And Or Sensory Nerve W/ F Wave,,95905,CPT,Facility,Outpatient,,,,357,303.45,102.3162,357,"UCare Health, Inc.",Medical Assistance,180.1779,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Emg Motor And Or Sensory Nerve W/ F Wave,,95905,CPT,Facility,Inpatient,,,,357,303.45,102.3162,357,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Emg Motor And Or Sensory Nerve W/ F Wave,,95905,CPT,Facility,Outpatient,,,,357,303.45,102.3162,357,"UCare Health, Inc.",Medicare Advantage,180.1779,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Emg Motor And Or Sensory Nerve W/ F Wave,,95905,CPT,Facility,Inpatient,,,,357,303.45,102.3162,357,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Emg Motor And Or Sensory Nerve W/ F Wave,,95905,CPT,Facility,Outpatient,,,,357,303.45,102.3162,357,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),180.1779,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Emg Motor And Or Sensory Nerve W/ F Wave,,95905,CPT,Facility,Inpatient,,,,357,303.45,102.3162,357,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Emg Motor And Or Sensory Nerve W/ F Wave,,95905,CPT,Facility,Both,,,,357,303.45,102.3162,357,UnitedHealthcare,Individual & Family,335.58,94,,percent of total billed charges,,
Emg Motor And Or Sensory Nerve W/ F Wave,,95905,CPT,Facility,Outpatient,,,,357,303.45,102.3162,357,UnitedHealthcare,Medicare Advantage,174.93,49,,percent of total billed charges,,
Emg Motor And Or Sensory Nerve W/ F Wave,,95905,CPT,Facility,Inpatient,,,,357,303.45,102.3162,357,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Emg Motor And Or Sensory Nerve W/ F Wave,,95905,CPT,Facility,Outpatient,,,,357,303.45,102.3162,357,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,171.36,48,,percent of total billed charges,,100% of DHS outpatient percentage
Emg Motor And Or Sensory Nerve W/ F Wave,,95905,CPT,Facility,Inpatient,,,,357,303.45,102.3162,357,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Canalith Repositioning Procedure(S), Per Day (Pro Cah)",,95992,CPT,Professional,Both,,,,143,121.55,22.69,143,Aetna,Commercial,121.55,85,,percent of total billed charges,,
"Canalith Repositioning Procedure(S), Per Day (Pro Cah)",,95992,CPT,Professional,Both,,,,143,121.55,22.69,143,Aetna,Medicare Advantage,36.56,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Canalith Repositioning Procedure(S), Per Day (Pro Cah)",,95992,CPT,Professional,Both,,,,143,121.55,22.69,143,Aetna,PPO,132.99,93,,percent of total billed charges,,
"Canalith Repositioning Procedure(S), Per Day (Pro Cah)",,95992,CPT,Professional,Both,,,,143,121.55,22.69,143,America's PPO,America's PPO,122.1792,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Canalith Repositioning Procedure(S), Per Day (Pro Cah)",,95992,CPT,Professional,Both,,,,143,121.55,22.69,143,BlueCross BlueShield Minnesota, Federal Employee Program,62.43,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Canalith Repositioning Procedure(S), Per Day (Pro Cah)",,95992,CPT,Professional,Both,,,,143,121.55,22.69,143,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,63.42888,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Canalith Repositioning Procedure(S), Per Day (Pro Cah)",,95992,CPT,Professional,Both,,,,143,121.55,22.69,143,BlueCross BlueShield Minnesota,High Value Network Plan,63.42888,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Canalith Repositioning Procedure(S), Per Day (Pro Cah)",,95992,CPT,Professional,Both,,,,143,121.55,22.69,143,BlueCross BlueShield Minnesota,Medicare Advantage,40.8595,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Canalith Repositioning Procedure(S), Per Day (Pro Cah)",,95992,CPT,Professional,Both,,,,143,121.55,22.69,143,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,63.42888,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Canalith Repositioning Procedure(S), Per Day (Pro Cah)",,95992,CPT,Professional,Both,,,,143,121.55,22.69,143,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,26.19248,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Canalith Repositioning Procedure(S), Per Day (Pro Cah)",,95992,CPT,Professional,Both,,,,143,121.55,22.69,143,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),40.8595,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Canalith Repositioning Procedure(S), Per Day (Pro Cah)",,95992,CPT,Professional,Both,,,,143,121.55,22.69,143,CorVel,Worker's Compensation,70.3780392,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Canalith Repositioning Procedure(S), Per Day (Pro Cah)",,95992,CPT,Professional,Both,,,,143,121.55,22.69,143,First Health Group Corporation,First Health Network,138.71,97,,percent of total billed charges,,
"Canalith Repositioning Procedure(S), Per Day (Pro Cah)",,95992,CPT,Professional,Both,,,,143,121.55,22.69,143,"Health Partners, Inc.",Commercial,75.46,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Canalith Repositioning Procedure(S), Per Day (Pro Cah)",,95992,CPT,Professional,Both,,,,143,121.55,22.69,143,"Health Partners, Inc.",Medicare Advantage,40.8595,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Canalith Repositioning Procedure(S), Per Day (Pro Cah)",,95992,CPT,Professional,Both,,,,143,121.55,22.69,143,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),35.58,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Canalith Repositioning Procedure(S), Per Day (Pro Cah)",,95992,CPT,Professional,Both,,,,143,121.55,22.69,143,"Health Partners, Inc.",State of Minnesota Advantage Program,65.00879,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Canalith Repositioning Procedure(S), Per Day (Pro Cah)",,95992,CPT,Professional,Both,,,,143,121.55,22.69,143,"Health Partners, Inc.",State Public Programs,22.69,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Canalith Repositioning Procedure(S), Per Day (Pro Cah)",,95992,CPT,Professional,Both,,,,143,121.55,22.69,143,Humana Insurance Company,Commercial PPO,35.53,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Canalith Repositioning Procedure(S), Per Day (Pro Cah)",,95992,CPT,Professional,Both,,,,143,121.55,22.69,143,Humana Insurance Company,Medicare PPO,143,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Canalith Repositioning Procedure(S), Per Day (Pro Cah)",,95992,CPT,Professional,Both,,,,143,121.55,22.69,143,Medica,Individual & Family,121.264,84.8,,percent of total billed charges,,
"Canalith Repositioning Procedure(S), Per Day (Pro Cah)",,95992,CPT,Professional,Both,,,,143,121.55,22.69,143,Medica,Medica Advantage Solution,71.214,49.8,,percent of total billed charges,,
"Canalith Repositioning Procedure(S), Per Day (Pro Cah)",,95992,CPT,Professional,Both,,,,143,121.55,22.69,143,Medica,Medical Assistance,26.19,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Canalith Repositioning Procedure(S), Per Day (Pro Cah)",,95992,CPT,Professional,Both,,,,143,121.55,22.69,143,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,35.53,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Canalith Repositioning Procedure(S), Per Day (Pro Cah)",,95992,CPT,Professional,Both,,,,143,121.55,22.69,143,"Multiplan, Inc.","Multiplan, Inc.",134.42,94,,percent of total billed charges,,
"Canalith Repositioning Procedure(S), Per Day (Pro Cah)",,95992,CPT,Professional,Both,,,,143,121.55,22.69,143,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,128.843,90.1,,percent of total billed charges,,
"Canalith Repositioning Procedure(S), Per Day (Pro Cah)",,95992,CPT,Professional,Both,,,,143,121.55,22.69,143,"Preferred One Administrative Services, INC.",PPO,140.998,98.6,,percent of total billed charges,,
"Canalith Repositioning Procedure(S), Per Day (Pro Cah)",,95992,CPT,Professional,Both,,,,143,121.55,22.69,143,PrimeWest Health,Minnesota Senior Health Options (MSHO),40.8595,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Canalith Repositioning Procedure(S), Per Day (Pro Cah)",,95992,CPT,Professional,Both,,,,143,121.55,22.69,143,PrimeWest Health,MinnesotaCare,28.0259536,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Canalith Repositioning Procedure(S), Per Day (Pro Cah)",,95992,CPT,Professional,Both,,,,143,121.55,22.69,143,Sanford Health Plan,Sanford Health Plan,125.84,88,,percent of total billed charges,,
"Canalith Repositioning Procedure(S), Per Day (Pro Cah)",,95992,CPT,Professional,Both,,,,143,121.55,22.69,143,"UCare Health, Inc.",Individual & Family Plan,57.757568,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Canalith Repositioning Procedure(S), Per Day (Pro Cah)",,95992,CPT,Professional,Both,,,,143,121.55,22.69,143,"UCare Health, Inc.",Medical Assistance,28.811728,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Canalith Repositioning Procedure(S), Per Day (Pro Cah)",,95992,CPT,Professional,Both,,,,143,121.55,22.69,143,"UCare Health, Inc.",Medicare Advantage,40.8595,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Canalith Repositioning Procedure(S), Per Day (Pro Cah)",,95992,CPT,Professional,Both,,,,143,121.55,22.69,143,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),32.6876,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Canalith Repositioning Procedure(S), Per Day (Pro Cah)",,95992,CPT,Professional,Both,,,,143,121.55,22.69,143,UnitedHealthcare,Individual & Family,143,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Canalith Repositioning Procedure(S), Per Day (Pro Cah)",,95992,CPT,Professional,Both,,,,143,121.55,22.69,143,UnitedHealthcare,Medicare Advantage,40.8595,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Canalith Repositioning Procedure(S), Per Day (Pro Cah)",,95992,CPT,Professional,Both,,,,143,121.55,22.69,143,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,26.19248,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Iv Infusion Hydration Primary Up To 1 Hour,,96360,CPT,Facility,Both,,,,364,309.4,104.3224,364,Aetna,Commercial,334.88,92,,percent of total billed charges,,
Iv Infusion Hydration Primary Up To 1 Hour,,96360,CPT,Facility,Outpatient,,,,364,309.4,104.3224,364,Aetna,Medicare Advantage,178.36,49,,percent of total billed charges,,
Iv Infusion Hydration Primary Up To 1 Hour,,96360,CPT,Facility,Inpatient,,,,364,309.4,104.3224,364,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Iv Infusion Hydration Primary Up To 1 Hour,,96360,CPT,Facility,Both,,,,364,309.4,104.3224,364,Aetna,PPO,338.52,93,,percent of total billed charges,,
Iv Infusion Hydration Primary Up To 1 Hour,,96360,CPT,Facility,Both,,,,364,309.4,104.3224,364,America's PPO,America's PPO,349.5492,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Iv Infusion Hydration Primary Up To 1 Hour,,96360,CPT,Facility,Both,,,,364,309.4,104.3224,364,BlueCross BlueShield Minnesota, Federal Employee Program,358.176,98.4,,percent of total billed charges,,
Iv Infusion Hydration Primary Up To 1 Hour,,96360,CPT,Facility,Both,,,,364,309.4,104.3224,364,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,364,100,,percent of total billed charges,,
Iv Infusion Hydration Primary Up To 1 Hour,,96360,CPT,Facility,Both,,,,364,309.4,104.3224,364,BlueCross BlueShield Minnesota,High Value Network Plan,327.6,90,,percent of total billed charges,,
Iv Infusion Hydration Primary Up To 1 Hour,,96360,CPT,Facility,Outpatient,,,,364,309.4,104.3224,364,BlueCross BlueShield Minnesota,Medicare Advantage,178.36,49,,percent of total billed charges,,
Iv Infusion Hydration Primary Up To 1 Hour,,96360,CPT,Facility,Inpatient,,,,364,309.4,104.3224,364,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Iv Infusion Hydration Primary Up To 1 Hour,,96360,CPT,Facility,Both,,,,364,309.4,104.3224,364,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,322.3948,88.57,,percent of total billed charges,,
Iv Infusion Hydration Primary Up To 1 Hour,,96360,CPT,Facility,Both,,,,364,309.4,104.3224,364,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,104.3224,28.66,,percent of total billed charges,,
Iv Infusion Hydration Primary Up To 1 Hour,,96360,CPT,Facility,Outpatient,,,,364,309.4,104.3224,364,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),178.36,49,,percent of total billed charges,,
Iv Infusion Hydration Primary Up To 1 Hour,,96360,CPT,Facility,Inpatient,,,,364,309.4,104.3224,364,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Iv Infusion Hydration Primary Up To 1 Hour,,96360,CPT,Facility,Both,,,,364,309.4,104.3224,364,CorVel,Worker's Compensation,364,100,,percent of total billed charges,,
Iv Infusion Hydration Primary Up To 1 Hour,,96360,CPT,Facility,Both,,,,364,309.4,104.3224,364,First Health Group Corporation,First Health Network,353.08,97,,percent of total billed charges,,
Iv Infusion Hydration Primary Up To 1 Hour,,96360,CPT,Facility,Both,,,,364,309.4,104.3224,364,"Health Partners, Inc.",Commercial,344.344,94.6,,percent of total billed charges,,
Iv Infusion Hydration Primary Up To 1 Hour,,96360,CPT,Facility,Outpatient,,,,364,309.4,104.3224,364,"Health Partners, Inc.",Medicare Advantage,178.36,49,,percent of total billed charges,,
Iv Infusion Hydration Primary Up To 1 Hour,,96360,CPT,Facility,Inpatient,,,,364,309.4,104.3224,364,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Iv Infusion Hydration Primary Up To 1 Hour,,96360,CPT,Facility,Both,,,,364,309.4,104.3224,364,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),218.4,60,,percent of total billed charges,,
Iv Infusion Hydration Primary Up To 1 Hour,,96360,CPT,Facility,Both,,,,364,309.4,104.3224,364,"Health Partners, Inc.",State of Minnesota Advantage Program,296.66,81.5,,percent of total billed charges,,
Iv Infusion Hydration Primary Up To 1 Hour,,96360,CPT,Facility,Both,,,,364,309.4,104.3224,364,"Health Partners, Inc.",State Public Programs,182,50,,percent of total billed charges,,
Iv Infusion Hydration Primary Up To 1 Hour,,96360,CPT,Facility,Both,,,,364,309.4,104.3224,364,Humana Insurance Company,Commercial PPO,345.8,95,,percent of total billed charges,,
Iv Infusion Hydration Primary Up To 1 Hour,,96360,CPT,Facility,Outpatient,,,,364,309.4,104.3224,364,Humana Insurance Company,Medicare PPO,178.36,49,,percent of total billed charges,,
Iv Infusion Hydration Primary Up To 1 Hour,,96360,CPT,Facility,Inpatient,,,,364,309.4,104.3224,364,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Iv Infusion Hydration Primary Up To 1 Hour,,96360,CPT,Facility,Both,,,,364,309.4,104.3224,364,Medica,Individual & Family,360.724,99.1,,percent of total billed charges,,
Iv Infusion Hydration Primary Up To 1 Hour,,96360,CPT,Facility,Outpatient,,,,364,309.4,104.3224,364,Medica,Medica Advantage Solution,181.272,49.8,,percent of total billed charges,,
Iv Infusion Hydration Primary Up To 1 Hour,,96360,CPT,Facility,Inpatient,,,,364,309.4,104.3224,364,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Iv Infusion Hydration Primary Up To 1 Hour,,96360,CPT,Facility,Outpatient,,,,364,309.4,104.3224,364,Medica,Medical Assistance,162.344,44.6,,percent of total billed charges,,
Iv Infusion Hydration Primary Up To 1 Hour,,96360,CPT,Facility,Inpatient,,,,364,309.4,104.3224,364,Medica,Medical Assistance,,,,,Included in per diem rate,
Iv Infusion Hydration Primary Up To 1 Hour,,96360,CPT,Facility,Outpatient,,,,364,309.4,104.3224,364,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,181.272,49.8,,percent of total billed charges,,
Iv Infusion Hydration Primary Up To 1 Hour,,96360,CPT,Facility,Inpatient,,,,364,309.4,104.3224,364,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Iv Infusion Hydration Primary Up To 1 Hour,,96360,CPT,Facility,Both,,,,364,309.4,104.3224,364,"Multiplan, Inc.","Multiplan, Inc.",342.16,94,,percent of total billed charges,,
Iv Infusion Hydration Primary Up To 1 Hour,,96360,CPT,Facility,Outpatient,,,,364,309.4,104.3224,364,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,327.964,90.1,,percent of total billed charges,,
Iv Infusion Hydration Primary Up To 1 Hour,,96360,CPT,Facility,Inpatient,,,,364,309.4,104.3224,364,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Iv Infusion Hydration Primary Up To 1 Hour,,96360,CPT,Facility,Both,,,,364,309.4,104.3224,364,"Preferred One Administrative Services, INC.",PPO,358.904,98.6,,percent of total billed charges,,
Iv Infusion Hydration Primary Up To 1 Hour,,96360,CPT,Facility,Outpatient,,,,364,309.4,104.3224,364,PrimeWest Health,Minnesota Senior Health Options (MSHO),187.278,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Iv Infusion Hydration Primary Up To 1 Hour,,96360,CPT,Facility,Inpatient,,,,364,309.4,104.3224,364,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Iv Infusion Hydration Primary Up To 1 Hour,,96360,CPT,Facility,Outpatient,,,,364,309.4,104.3224,364,PrimeWest Health,MinnesotaCare,186.9504,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Iv Infusion Hydration Primary Up To 1 Hour,,96360,CPT,Facility,Inpatient,,,,364,309.4,104.3224,364,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Iv Infusion Hydration Primary Up To 1 Hour,,96360,CPT,Facility,Both,,,,364,309.4,104.3224,364,Sanford Health Plan,Sanford Health Plan,334.88,92,,percent of total billed charges,,
Iv Infusion Hydration Primary Up To 1 Hour,,96360,CPT,Facility,Outpatient,,,,364,309.4,104.3224,364,"UCare Health, Inc.",Individual & Family Plan,205.114,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Iv Infusion Hydration Primary Up To 1 Hour,,96360,CPT,Facility,Inpatient,,,,364,309.4,104.3224,364,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Iv Infusion Hydration Primary Up To 1 Hour,,96360,CPT,Facility,Outpatient,,,,364,309.4,104.3224,364,"UCare Health, Inc.",Medical Assistance,183.7108,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Iv Infusion Hydration Primary Up To 1 Hour,,96360,CPT,Facility,Inpatient,,,,364,309.4,104.3224,364,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Iv Infusion Hydration Primary Up To 1 Hour,,96360,CPT,Facility,Outpatient,,,,364,309.4,104.3224,364,"UCare Health, Inc.",Medicare Advantage,183.7108,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Iv Infusion Hydration Primary Up To 1 Hour,,96360,CPT,Facility,Inpatient,,,,364,309.4,104.3224,364,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Iv Infusion Hydration Primary Up To 1 Hour,,96360,CPT,Facility,Outpatient,,,,364,309.4,104.3224,364,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),183.7108,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Iv Infusion Hydration Primary Up To 1 Hour,,96360,CPT,Facility,Inpatient,,,,364,309.4,104.3224,364,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Iv Infusion Hydration Primary Up To 1 Hour,,96360,CPT,Facility,Both,,,,364,309.4,104.3224,364,UnitedHealthcare,Individual & Family,342.16,94,,percent of total billed charges,,
Iv Infusion Hydration Primary Up To 1 Hour,,96360,CPT,Facility,Outpatient,,,,364,309.4,104.3224,364,UnitedHealthcare,Medicare Advantage,178.36,49,,percent of total billed charges,,
Iv Infusion Hydration Primary Up To 1 Hour,,96360,CPT,Facility,Inpatient,,,,364,309.4,104.3224,364,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Iv Infusion Hydration Primary Up To 1 Hour,,96360,CPT,Facility,Outpatient,,,,364,309.4,104.3224,364,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,174.72,48,,percent of total billed charges,,100% of DHS outpatient percentage
Iv Infusion Hydration Primary Up To 1 Hour,,96360,CPT,Facility,Inpatient,,,,364,309.4,104.3224,364,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Iv Infusion Hydration Each Additional Hour,,96361,CPT,Facility,Both,,,,92,78.2,26.3672,92,Aetna,Commercial,84.64,92,,percent of total billed charges,,
Iv Infusion Hydration Each Additional Hour,,96361,CPT,Facility,Outpatient,,,,92,78.2,26.3672,92,Aetna,Medicare Advantage,45.08,49,,percent of total billed charges,,
Iv Infusion Hydration Each Additional Hour,,96361,CPT,Facility,Inpatient,,,,92,78.2,26.3672,92,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Iv Infusion Hydration Each Additional Hour,,96361,CPT,Facility,Both,,,,92,78.2,26.3672,92,Aetna,PPO,85.56,93,,percent of total billed charges,,
Iv Infusion Hydration Each Additional Hour,,96361,CPT,Facility,Both,,,,92,78.2,26.3672,92,America's PPO,America's PPO,88.3476,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Iv Infusion Hydration Each Additional Hour,,96361,CPT,Facility,Both,,,,92,78.2,26.3672,92,BlueCross BlueShield Minnesota, Federal Employee Program,90.528,98.4,,percent of total billed charges,,
Iv Infusion Hydration Each Additional Hour,,96361,CPT,Facility,Both,,,,92,78.2,26.3672,92,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,92,100,,percent of total billed charges,,
Iv Infusion Hydration Each Additional Hour,,96361,CPT,Facility,Both,,,,92,78.2,26.3672,92,BlueCross BlueShield Minnesota,High Value Network Plan,82.8,90,,percent of total billed charges,,
Iv Infusion Hydration Each Additional Hour,,96361,CPT,Facility,Outpatient,,,,92,78.2,26.3672,92,BlueCross BlueShield Minnesota,Medicare Advantage,45.08,49,,percent of total billed charges,,
Iv Infusion Hydration Each Additional Hour,,96361,CPT,Facility,Inpatient,,,,92,78.2,26.3672,92,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Iv Infusion Hydration Each Additional Hour,,96361,CPT,Facility,Both,,,,92,78.2,26.3672,92,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,81.4844,88.57,,percent of total billed charges,,
Iv Infusion Hydration Each Additional Hour,,96361,CPT,Facility,Both,,,,92,78.2,26.3672,92,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,26.3672,28.66,,percent of total billed charges,,
Iv Infusion Hydration Each Additional Hour,,96361,CPT,Facility,Outpatient,,,,92,78.2,26.3672,92,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),45.08,49,,percent of total billed charges,,
Iv Infusion Hydration Each Additional Hour,,96361,CPT,Facility,Inpatient,,,,92,78.2,26.3672,92,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Iv Infusion Hydration Each Additional Hour,,96361,CPT,Facility,Both,,,,92,78.2,26.3672,92,CorVel,Worker's Compensation,92,100,,percent of total billed charges,,
Iv Infusion Hydration Each Additional Hour,,96361,CPT,Facility,Both,,,,92,78.2,26.3672,92,First Health Group Corporation,First Health Network,89.24,97,,percent of total billed charges,,
Iv Infusion Hydration Each Additional Hour,,96361,CPT,Facility,Both,,,,92,78.2,26.3672,92,"Health Partners, Inc.",Commercial,87.032,94.6,,percent of total billed charges,,
Iv Infusion Hydration Each Additional Hour,,96361,CPT,Facility,Outpatient,,,,92,78.2,26.3672,92,"Health Partners, Inc.",Medicare Advantage,45.08,49,,percent of total billed charges,,
Iv Infusion Hydration Each Additional Hour,,96361,CPT,Facility,Inpatient,,,,92,78.2,26.3672,92,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Iv Infusion Hydration Each Additional Hour,,96361,CPT,Facility,Both,,,,92,78.2,26.3672,92,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),55.2,60,,percent of total billed charges,,
Iv Infusion Hydration Each Additional Hour,,96361,CPT,Facility,Both,,,,92,78.2,26.3672,92,"Health Partners, Inc.",State of Minnesota Advantage Program,74.98,81.5,,percent of total billed charges,,
Iv Infusion Hydration Each Additional Hour,,96361,CPT,Facility,Both,,,,92,78.2,26.3672,92,"Health Partners, Inc.",State Public Programs,46,50,,percent of total billed charges,,
Iv Infusion Hydration Each Additional Hour,,96361,CPT,Facility,Both,,,,92,78.2,26.3672,92,Humana Insurance Company,Commercial PPO,87.4,95,,percent of total billed charges,,
Iv Infusion Hydration Each Additional Hour,,96361,CPT,Facility,Outpatient,,,,92,78.2,26.3672,92,Humana Insurance Company,Medicare PPO,45.08,49,,percent of total billed charges,,
Iv Infusion Hydration Each Additional Hour,,96361,CPT,Facility,Inpatient,,,,92,78.2,26.3672,92,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Iv Infusion Hydration Each Additional Hour,,96361,CPT,Facility,Both,,,,92,78.2,26.3672,92,Medica,Individual & Family,91.172,99.1,,percent of total billed charges,,
Iv Infusion Hydration Each Additional Hour,,96361,CPT,Facility,Outpatient,,,,92,78.2,26.3672,92,Medica,Medica Advantage Solution,45.816,49.8,,percent of total billed charges,,
Iv Infusion Hydration Each Additional Hour,,96361,CPT,Facility,Inpatient,,,,92,78.2,26.3672,92,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Iv Infusion Hydration Each Additional Hour,,96361,CPT,Facility,Outpatient,,,,92,78.2,26.3672,92,Medica,Medical Assistance,41.032,44.6,,percent of total billed charges,,
Iv Infusion Hydration Each Additional Hour,,96361,CPT,Facility,Inpatient,,,,92,78.2,26.3672,92,Medica,Medical Assistance,,,,,Included in per diem rate,
Iv Infusion Hydration Each Additional Hour,,96361,CPT,Facility,Outpatient,,,,92,78.2,26.3672,92,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,45.816,49.8,,percent of total billed charges,,
Iv Infusion Hydration Each Additional Hour,,96361,CPT,Facility,Inpatient,,,,92,78.2,26.3672,92,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Iv Infusion Hydration Each Additional Hour,,96361,CPT,Facility,Both,,,,92,78.2,26.3672,92,"Multiplan, Inc.","Multiplan, Inc.",86.48,94,,percent of total billed charges,,
Iv Infusion Hydration Each Additional Hour,,96361,CPT,Facility,Outpatient,,,,92,78.2,26.3672,92,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,82.892,90.1,,percent of total billed charges,,
Iv Infusion Hydration Each Additional Hour,,96361,CPT,Facility,Inpatient,,,,92,78.2,26.3672,92,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Iv Infusion Hydration Each Additional Hour,,96361,CPT,Facility,Both,,,,92,78.2,26.3672,92,"Preferred One Administrative Services, INC.",PPO,90.712,98.6,,percent of total billed charges,,
Iv Infusion Hydration Each Additional Hour,,96361,CPT,Facility,Outpatient,,,,92,78.2,26.3672,92,PrimeWest Health,Minnesota Senior Health Options (MSHO),47.334,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Iv Infusion Hydration Each Additional Hour,,96361,CPT,Facility,Inpatient,,,,92,78.2,26.3672,92,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Iv Infusion Hydration Each Additional Hour,,96361,CPT,Facility,Outpatient,,,,92,78.2,26.3672,92,PrimeWest Health,MinnesotaCare,47.2512,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Iv Infusion Hydration Each Additional Hour,,96361,CPT,Facility,Inpatient,,,,92,78.2,26.3672,92,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Iv Infusion Hydration Each Additional Hour,,96361,CPT,Facility,Both,,,,92,78.2,26.3672,92,Sanford Health Plan,Sanford Health Plan,84.64,92,,percent of total billed charges,,
Iv Infusion Hydration Each Additional Hour,,96361,CPT,Facility,Outpatient,,,,92,78.2,26.3672,92,"UCare Health, Inc.",Individual & Family Plan,51.842,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Iv Infusion Hydration Each Additional Hour,,96361,CPT,Facility,Inpatient,,,,92,78.2,26.3672,92,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Iv Infusion Hydration Each Additional Hour,,96361,CPT,Facility,Outpatient,,,,92,78.2,26.3672,92,"UCare Health, Inc.",Medical Assistance,46.4324,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Iv Infusion Hydration Each Additional Hour,,96361,CPT,Facility,Inpatient,,,,92,78.2,26.3672,92,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Iv Infusion Hydration Each Additional Hour,,96361,CPT,Facility,Outpatient,,,,92,78.2,26.3672,92,"UCare Health, Inc.",Medicare Advantage,46.4324,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Iv Infusion Hydration Each Additional Hour,,96361,CPT,Facility,Inpatient,,,,92,78.2,26.3672,92,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Iv Infusion Hydration Each Additional Hour,,96361,CPT,Facility,Outpatient,,,,92,78.2,26.3672,92,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),46.4324,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Iv Infusion Hydration Each Additional Hour,,96361,CPT,Facility,Inpatient,,,,92,78.2,26.3672,92,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Iv Infusion Hydration Each Additional Hour,,96361,CPT,Facility,Both,,,,92,78.2,26.3672,92,UnitedHealthcare,Individual & Family,86.48,94,,percent of total billed charges,,
Iv Infusion Hydration Each Additional Hour,,96361,CPT,Facility,Outpatient,,,,92,78.2,26.3672,92,UnitedHealthcare,Medicare Advantage,45.08,49,,percent of total billed charges,,
Iv Infusion Hydration Each Additional Hour,,96361,CPT,Facility,Inpatient,,,,92,78.2,26.3672,92,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Iv Infusion Hydration Each Additional Hour,,96361,CPT,Facility,Outpatient,,,,92,78.2,26.3672,92,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,44.16,48,,percent of total billed charges,,100% of DHS outpatient percentage
Iv Infusion Hydration Each Additional Hour,,96361,CPT,Facility,Inpatient,,,,92,78.2,26.3672,92,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Iv Infusion Therapy Primary Up To 1 Hour,,96365,CPT,Facility,Both,,,,364,309.4,104.3224,364,Aetna,Commercial,334.88,92,,percent of total billed charges,,
Iv Infusion Therapy Primary Up To 1 Hour,,96365,CPT,Facility,Outpatient,,,,364,309.4,104.3224,364,Aetna,Medicare Advantage,178.36,49,,percent of total billed charges,,
Iv Infusion Therapy Primary Up To 1 Hour,,96365,CPT,Facility,Inpatient,,,,364,309.4,104.3224,364,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Iv Infusion Therapy Primary Up To 1 Hour,,96365,CPT,Facility,Both,,,,364,309.4,104.3224,364,Aetna,PPO,338.52,93,,percent of total billed charges,,
Iv Infusion Therapy Primary Up To 1 Hour,,96365,CPT,Facility,Both,,,,364,309.4,104.3224,364,America's PPO,America's PPO,349.5492,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Iv Infusion Therapy Primary Up To 1 Hour,,96365,CPT,Facility,Both,,,,364,309.4,104.3224,364,BlueCross BlueShield Minnesota, Federal Employee Program,358.176,98.4,,percent of total billed charges,,
Iv Infusion Therapy Primary Up To 1 Hour,,96365,CPT,Facility,Both,,,,364,309.4,104.3224,364,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,364,100,,percent of total billed charges,,
Iv Infusion Therapy Primary Up To 1 Hour,,96365,CPT,Facility,Both,,,,364,309.4,104.3224,364,BlueCross BlueShield Minnesota,High Value Network Plan,327.6,90,,percent of total billed charges,,
Iv Infusion Therapy Primary Up To 1 Hour,,96365,CPT,Facility,Outpatient,,,,364,309.4,104.3224,364,BlueCross BlueShield Minnesota,Medicare Advantage,178.36,49,,percent of total billed charges,,
Iv Infusion Therapy Primary Up To 1 Hour,,96365,CPT,Facility,Inpatient,,,,364,309.4,104.3224,364,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Iv Infusion Therapy Primary Up To 1 Hour,,96365,CPT,Facility,Both,,,,364,309.4,104.3224,364,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,322.3948,88.57,,percent of total billed charges,,
Iv Infusion Therapy Primary Up To 1 Hour,,96365,CPT,Facility,Both,,,,364,309.4,104.3224,364,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,104.3224,28.66,,percent of total billed charges,,
Iv Infusion Therapy Primary Up To 1 Hour,,96365,CPT,Facility,Outpatient,,,,364,309.4,104.3224,364,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),178.36,49,,percent of total billed charges,,
Iv Infusion Therapy Primary Up To 1 Hour,,96365,CPT,Facility,Inpatient,,,,364,309.4,104.3224,364,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Iv Infusion Therapy Primary Up To 1 Hour,,96365,CPT,Facility,Both,,,,364,309.4,104.3224,364,CorVel,Worker's Compensation,364,100,,percent of total billed charges,,
Iv Infusion Therapy Primary Up To 1 Hour,,96365,CPT,Facility,Both,,,,364,309.4,104.3224,364,First Health Group Corporation,First Health Network,353.08,97,,percent of total billed charges,,
Iv Infusion Therapy Primary Up To 1 Hour,,96365,CPT,Facility,Both,,,,364,309.4,104.3224,364,"Health Partners, Inc.",Commercial,344.344,94.6,,percent of total billed charges,,
Iv Infusion Therapy Primary Up To 1 Hour,,96365,CPT,Facility,Outpatient,,,,364,309.4,104.3224,364,"Health Partners, Inc.",Medicare Advantage,178.36,49,,percent of total billed charges,,
Iv Infusion Therapy Primary Up To 1 Hour,,96365,CPT,Facility,Inpatient,,,,364,309.4,104.3224,364,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Iv Infusion Therapy Primary Up To 1 Hour,,96365,CPT,Facility,Both,,,,364,309.4,104.3224,364,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),218.4,60,,percent of total billed charges,,
Iv Infusion Therapy Primary Up To 1 Hour,,96365,CPT,Facility,Both,,,,364,309.4,104.3224,364,"Health Partners, Inc.",State of Minnesota Advantage Program,296.66,81.5,,percent of total billed charges,,
Iv Infusion Therapy Primary Up To 1 Hour,,96365,CPT,Facility,Both,,,,364,309.4,104.3224,364,"Health Partners, Inc.",State Public Programs,182,50,,percent of total billed charges,,
Iv Infusion Therapy Primary Up To 1 Hour,,96365,CPT,Facility,Both,,,,364,309.4,104.3224,364,Humana Insurance Company,Commercial PPO,345.8,95,,percent of total billed charges,,
Iv Infusion Therapy Primary Up To 1 Hour,,96365,CPT,Facility,Outpatient,,,,364,309.4,104.3224,364,Humana Insurance Company,Medicare PPO,178.36,49,,percent of total billed charges,,
Iv Infusion Therapy Primary Up To 1 Hour,,96365,CPT,Facility,Inpatient,,,,364,309.4,104.3224,364,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Iv Infusion Therapy Primary Up To 1 Hour,,96365,CPT,Facility,Both,,,,364,309.4,104.3224,364,Medica,Individual & Family,360.724,99.1,,percent of total billed charges,,
Iv Infusion Therapy Primary Up To 1 Hour,,96365,CPT,Facility,Outpatient,,,,364,309.4,104.3224,364,Medica,Medica Advantage Solution,181.272,49.8,,percent of total billed charges,,
Iv Infusion Therapy Primary Up To 1 Hour,,96365,CPT,Facility,Inpatient,,,,364,309.4,104.3224,364,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Iv Infusion Therapy Primary Up To 1 Hour,,96365,CPT,Facility,Outpatient,,,,364,309.4,104.3224,364,Medica,Medical Assistance,162.344,44.6,,percent of total billed charges,,
Iv Infusion Therapy Primary Up To 1 Hour,,96365,CPT,Facility,Inpatient,,,,364,309.4,104.3224,364,Medica,Medical Assistance,,,,,Included in per diem rate,
Iv Infusion Therapy Primary Up To 1 Hour,,96365,CPT,Facility,Outpatient,,,,364,309.4,104.3224,364,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,181.272,49.8,,percent of total billed charges,,
Iv Infusion Therapy Primary Up To 1 Hour,,96365,CPT,Facility,Inpatient,,,,364,309.4,104.3224,364,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Iv Infusion Therapy Primary Up To 1 Hour,,96365,CPT,Facility,Both,,,,364,309.4,104.3224,364,"Multiplan, Inc.","Multiplan, Inc.",342.16,94,,percent of total billed charges,,
Iv Infusion Therapy Primary Up To 1 Hour,,96365,CPT,Facility,Outpatient,,,,364,309.4,104.3224,364,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,327.964,90.1,,percent of total billed charges,,
Iv Infusion Therapy Primary Up To 1 Hour,,96365,CPT,Facility,Inpatient,,,,364,309.4,104.3224,364,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Iv Infusion Therapy Primary Up To 1 Hour,,96365,CPT,Facility,Both,,,,364,309.4,104.3224,364,"Preferred One Administrative Services, INC.",PPO,358.904,98.6,,percent of total billed charges,,
Iv Infusion Therapy Primary Up To 1 Hour,,96365,CPT,Facility,Outpatient,,,,364,309.4,104.3224,364,PrimeWest Health,Minnesota Senior Health Options (MSHO),187.278,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Iv Infusion Therapy Primary Up To 1 Hour,,96365,CPT,Facility,Inpatient,,,,364,309.4,104.3224,364,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Iv Infusion Therapy Primary Up To 1 Hour,,96365,CPT,Facility,Outpatient,,,,364,309.4,104.3224,364,PrimeWest Health,MinnesotaCare,186.9504,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Iv Infusion Therapy Primary Up To 1 Hour,,96365,CPT,Facility,Inpatient,,,,364,309.4,104.3224,364,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Iv Infusion Therapy Primary Up To 1 Hour,,96365,CPT,Facility,Both,,,,364,309.4,104.3224,364,Sanford Health Plan,Sanford Health Plan,334.88,92,,percent of total billed charges,,
Iv Infusion Therapy Primary Up To 1 Hour,,96365,CPT,Facility,Outpatient,,,,364,309.4,104.3224,364,"UCare Health, Inc.",Individual & Family Plan,205.114,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Iv Infusion Therapy Primary Up To 1 Hour,,96365,CPT,Facility,Inpatient,,,,364,309.4,104.3224,364,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Iv Infusion Therapy Primary Up To 1 Hour,,96365,CPT,Facility,Outpatient,,,,364,309.4,104.3224,364,"UCare Health, Inc.",Medical Assistance,183.7108,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Iv Infusion Therapy Primary Up To 1 Hour,,96365,CPT,Facility,Inpatient,,,,364,309.4,104.3224,364,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Iv Infusion Therapy Primary Up To 1 Hour,,96365,CPT,Facility,Outpatient,,,,364,309.4,104.3224,364,"UCare Health, Inc.",Medicare Advantage,183.7108,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Iv Infusion Therapy Primary Up To 1 Hour,,96365,CPT,Facility,Inpatient,,,,364,309.4,104.3224,364,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Iv Infusion Therapy Primary Up To 1 Hour,,96365,CPT,Facility,Outpatient,,,,364,309.4,104.3224,364,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),183.7108,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Iv Infusion Therapy Primary Up To 1 Hour,,96365,CPT,Facility,Inpatient,,,,364,309.4,104.3224,364,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Iv Infusion Therapy Primary Up To 1 Hour,,96365,CPT,Facility,Both,,,,364,309.4,104.3224,364,UnitedHealthcare,Individual & Family,342.16,94,,percent of total billed charges,,
Iv Infusion Therapy Primary Up To 1 Hour,,96365,CPT,Facility,Outpatient,,,,364,309.4,104.3224,364,UnitedHealthcare,Medicare Advantage,178.36,49,,percent of total billed charges,,
Iv Infusion Therapy Primary Up To 1 Hour,,96365,CPT,Facility,Inpatient,,,,364,309.4,104.3224,364,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Iv Infusion Therapy Primary Up To 1 Hour,,96365,CPT,Facility,Outpatient,,,,364,309.4,104.3224,364,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,174.72,48,,percent of total billed charges,,100% of DHS outpatient percentage
Iv Infusion Therapy Primary Up To 1 Hour,,96365,CPT,Facility,Inpatient,,,,364,309.4,104.3224,364,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Iv Infusion Therapy Each Additional Hour,,96366,CPT,Facility,Both,,,,97,82.45,27.8002,97,Aetna,Commercial,89.24,92,,percent of total billed charges,,
Iv Infusion Therapy Each Additional Hour,,96366,CPT,Facility,Outpatient,,,,97,82.45,27.8002,97,Aetna,Medicare Advantage,47.53,49,,percent of total billed charges,,
Iv Infusion Therapy Each Additional Hour,,96366,CPT,Facility,Inpatient,,,,97,82.45,27.8002,97,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Iv Infusion Therapy Each Additional Hour,,96366,CPT,Facility,Both,,,,97,82.45,27.8002,97,Aetna,PPO,90.21,93,,percent of total billed charges,,
Iv Infusion Therapy Each Additional Hour,,96366,CPT,Facility,Both,,,,97,82.45,27.8002,97,America's PPO,America's PPO,93.1491,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Iv Infusion Therapy Each Additional Hour,,96366,CPT,Facility,Both,,,,97,82.45,27.8002,97,BlueCross BlueShield Minnesota, Federal Employee Program,95.448,98.4,,percent of total billed charges,,
Iv Infusion Therapy Each Additional Hour,,96366,CPT,Facility,Both,,,,97,82.45,27.8002,97,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,97,100,,percent of total billed charges,,
Iv Infusion Therapy Each Additional Hour,,96366,CPT,Facility,Both,,,,97,82.45,27.8002,97,BlueCross BlueShield Minnesota,High Value Network Plan,87.3,90,,percent of total billed charges,,
Iv Infusion Therapy Each Additional Hour,,96366,CPT,Facility,Outpatient,,,,97,82.45,27.8002,97,BlueCross BlueShield Minnesota,Medicare Advantage,47.53,49,,percent of total billed charges,,
Iv Infusion Therapy Each Additional Hour,,96366,CPT,Facility,Inpatient,,,,97,82.45,27.8002,97,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Iv Infusion Therapy Each Additional Hour,,96366,CPT,Facility,Both,,,,97,82.45,27.8002,97,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,85.9129,88.57,,percent of total billed charges,,
Iv Infusion Therapy Each Additional Hour,,96366,CPT,Facility,Both,,,,97,82.45,27.8002,97,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,27.8002,28.66,,percent of total billed charges,,
Iv Infusion Therapy Each Additional Hour,,96366,CPT,Facility,Outpatient,,,,97,82.45,27.8002,97,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),47.53,49,,percent of total billed charges,,
Iv Infusion Therapy Each Additional Hour,,96366,CPT,Facility,Inpatient,,,,97,82.45,27.8002,97,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Iv Infusion Therapy Each Additional Hour,,96366,CPT,Facility,Both,,,,97,82.45,27.8002,97,CorVel,Worker's Compensation,97,100,,percent of total billed charges,,
Iv Infusion Therapy Each Additional Hour,,96366,CPT,Facility,Both,,,,97,82.45,27.8002,97,First Health Group Corporation,First Health Network,94.09,97,,percent of total billed charges,,
Iv Infusion Therapy Each Additional Hour,,96366,CPT,Facility,Both,,,,97,82.45,27.8002,97,"Health Partners, Inc.",Commercial,91.762,94.6,,percent of total billed charges,,
Iv Infusion Therapy Each Additional Hour,,96366,CPT,Facility,Outpatient,,,,97,82.45,27.8002,97,"Health Partners, Inc.",Medicare Advantage,47.53,49,,percent of total billed charges,,
Iv Infusion Therapy Each Additional Hour,,96366,CPT,Facility,Inpatient,,,,97,82.45,27.8002,97,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Iv Infusion Therapy Each Additional Hour,,96366,CPT,Facility,Both,,,,97,82.45,27.8002,97,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),58.2,60,,percent of total billed charges,,
Iv Infusion Therapy Each Additional Hour,,96366,CPT,Facility,Both,,,,97,82.45,27.8002,97,"Health Partners, Inc.",State of Minnesota Advantage Program,79.055,81.5,,percent of total billed charges,,
Iv Infusion Therapy Each Additional Hour,,96366,CPT,Facility,Both,,,,97,82.45,27.8002,97,"Health Partners, Inc.",State Public Programs,48.5,50,,percent of total billed charges,,
Iv Infusion Therapy Each Additional Hour,,96366,CPT,Facility,Both,,,,97,82.45,27.8002,97,Humana Insurance Company,Commercial PPO,92.15,95,,percent of total billed charges,,
Iv Infusion Therapy Each Additional Hour,,96366,CPT,Facility,Outpatient,,,,97,82.45,27.8002,97,Humana Insurance Company,Medicare PPO,47.53,49,,percent of total billed charges,,
Iv Infusion Therapy Each Additional Hour,,96366,CPT,Facility,Inpatient,,,,97,82.45,27.8002,97,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Iv Infusion Therapy Each Additional Hour,,96366,CPT,Facility,Both,,,,97,82.45,27.8002,97,Medica,Individual & Family,96.127,99.1,,percent of total billed charges,,
Iv Infusion Therapy Each Additional Hour,,96366,CPT,Facility,Outpatient,,,,97,82.45,27.8002,97,Medica,Medica Advantage Solution,48.306,49.8,,percent of total billed charges,,
Iv Infusion Therapy Each Additional Hour,,96366,CPT,Facility,Inpatient,,,,97,82.45,27.8002,97,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Iv Infusion Therapy Each Additional Hour,,96366,CPT,Facility,Outpatient,,,,97,82.45,27.8002,97,Medica,Medical Assistance,43.262,44.6,,percent of total billed charges,,
Iv Infusion Therapy Each Additional Hour,,96366,CPT,Facility,Inpatient,,,,97,82.45,27.8002,97,Medica,Medical Assistance,,,,,Included in per diem rate,
Iv Infusion Therapy Each Additional Hour,,96366,CPT,Facility,Outpatient,,,,97,82.45,27.8002,97,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,48.306,49.8,,percent of total billed charges,,
Iv Infusion Therapy Each Additional Hour,,96366,CPT,Facility,Inpatient,,,,97,82.45,27.8002,97,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Iv Infusion Therapy Each Additional Hour,,96366,CPT,Facility,Both,,,,97,82.45,27.8002,97,"Multiplan, Inc.","Multiplan, Inc.",91.18,94,,percent of total billed charges,,
Iv Infusion Therapy Each Additional Hour,,96366,CPT,Facility,Outpatient,,,,97,82.45,27.8002,97,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,87.397,90.1,,percent of total billed charges,,
Iv Infusion Therapy Each Additional Hour,,96366,CPT,Facility,Inpatient,,,,97,82.45,27.8002,97,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Iv Infusion Therapy Each Additional Hour,,96366,CPT,Facility,Both,,,,97,82.45,27.8002,97,"Preferred One Administrative Services, INC.",PPO,95.642,98.6,,percent of total billed charges,,
Iv Infusion Therapy Each Additional Hour,,96366,CPT,Facility,Outpatient,,,,97,82.45,27.8002,97,PrimeWest Health,Minnesota Senior Health Options (MSHO),49.9065,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Iv Infusion Therapy Each Additional Hour,,96366,CPT,Facility,Inpatient,,,,97,82.45,27.8002,97,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Iv Infusion Therapy Each Additional Hour,,96366,CPT,Facility,Outpatient,,,,97,82.45,27.8002,97,PrimeWest Health,MinnesotaCare,49.8192,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Iv Infusion Therapy Each Additional Hour,,96366,CPT,Facility,Inpatient,,,,97,82.45,27.8002,97,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Iv Infusion Therapy Each Additional Hour,,96366,CPT,Facility,Both,,,,97,82.45,27.8002,97,Sanford Health Plan,Sanford Health Plan,89.24,92,,percent of total billed charges,,
Iv Infusion Therapy Each Additional Hour,,96366,CPT,Facility,Outpatient,,,,97,82.45,27.8002,97,"UCare Health, Inc.",Individual & Family Plan,54.6595,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Iv Infusion Therapy Each Additional Hour,,96366,CPT,Facility,Inpatient,,,,97,82.45,27.8002,97,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Iv Infusion Therapy Each Additional Hour,,96366,CPT,Facility,Outpatient,,,,97,82.45,27.8002,97,"UCare Health, Inc.",Medical Assistance,48.9559,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Iv Infusion Therapy Each Additional Hour,,96366,CPT,Facility,Inpatient,,,,97,82.45,27.8002,97,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Iv Infusion Therapy Each Additional Hour,,96366,CPT,Facility,Outpatient,,,,97,82.45,27.8002,97,"UCare Health, Inc.",Medicare Advantage,48.9559,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Iv Infusion Therapy Each Additional Hour,,96366,CPT,Facility,Inpatient,,,,97,82.45,27.8002,97,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Iv Infusion Therapy Each Additional Hour,,96366,CPT,Facility,Outpatient,,,,97,82.45,27.8002,97,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),48.9559,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Iv Infusion Therapy Each Additional Hour,,96366,CPT,Facility,Inpatient,,,,97,82.45,27.8002,97,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Iv Infusion Therapy Each Additional Hour,,96366,CPT,Facility,Both,,,,97,82.45,27.8002,97,UnitedHealthcare,Individual & Family,91.18,94,,percent of total billed charges,,
Iv Infusion Therapy Each Additional Hour,,96366,CPT,Facility,Outpatient,,,,97,82.45,27.8002,97,UnitedHealthcare,Medicare Advantage,47.53,49,,percent of total billed charges,,
Iv Infusion Therapy Each Additional Hour,,96366,CPT,Facility,Inpatient,,,,97,82.45,27.8002,97,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Iv Infusion Therapy Each Additional Hour,,96366,CPT,Facility,Outpatient,,,,97,82.45,27.8002,97,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,46.56,48,,percent of total billed charges,,100% of DHS outpatient percentage
Iv Infusion Therapy Each Additional Hour,,96366,CPT,Facility,Inpatient,,,,97,82.45,27.8002,97,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Iv Infusion Therapy Sequential Up To 1 Hour,,96367,CPT,Facility,Both,,,,102,86.7,29.2332,102,Aetna,Commercial,93.84,92,,percent of total billed charges,,
Iv Infusion Therapy Sequential Up To 1 Hour,,96367,CPT,Facility,Outpatient,,,,102,86.7,29.2332,102,Aetna,Medicare Advantage,49.98,49,,percent of total billed charges,,
Iv Infusion Therapy Sequential Up To 1 Hour,,96367,CPT,Facility,Inpatient,,,,102,86.7,29.2332,102,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Iv Infusion Therapy Sequential Up To 1 Hour,,96367,CPT,Facility,Both,,,,102,86.7,29.2332,102,Aetna,PPO,94.86,93,,percent of total billed charges,,
Iv Infusion Therapy Sequential Up To 1 Hour,,96367,CPT,Facility,Both,,,,102,86.7,29.2332,102,America's PPO,America's PPO,97.9506,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Iv Infusion Therapy Sequential Up To 1 Hour,,96367,CPT,Facility,Both,,,,102,86.7,29.2332,102,BlueCross BlueShield Minnesota, Federal Employee Program,100.368,98.4,,percent of total billed charges,,
Iv Infusion Therapy Sequential Up To 1 Hour,,96367,CPT,Facility,Both,,,,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,102,100,,percent of total billed charges,,
Iv Infusion Therapy Sequential Up To 1 Hour,,96367,CPT,Facility,Both,,,,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,High Value Network Plan,91.8,90,,percent of total billed charges,,
Iv Infusion Therapy Sequential Up To 1 Hour,,96367,CPT,Facility,Outpatient,,,,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,Medicare Advantage,49.98,49,,percent of total billed charges,,
Iv Infusion Therapy Sequential Up To 1 Hour,,96367,CPT,Facility,Inpatient,,,,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Iv Infusion Therapy Sequential Up To 1 Hour,,96367,CPT,Facility,Both,,,,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,90.3414,88.57,,percent of total billed charges,,
Iv Infusion Therapy Sequential Up To 1 Hour,,96367,CPT,Facility,Both,,,,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,29.2332,28.66,,percent of total billed charges,,
Iv Infusion Therapy Sequential Up To 1 Hour,,96367,CPT,Facility,Outpatient,,,,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),49.98,49,,percent of total billed charges,,
Iv Infusion Therapy Sequential Up To 1 Hour,,96367,CPT,Facility,Inpatient,,,,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Iv Infusion Therapy Sequential Up To 1 Hour,,96367,CPT,Facility,Both,,,,102,86.7,29.2332,102,CorVel,Worker's Compensation,102,100,,percent of total billed charges,,
Iv Infusion Therapy Sequential Up To 1 Hour,,96367,CPT,Facility,Both,,,,102,86.7,29.2332,102,First Health Group Corporation,First Health Network,98.94,97,,percent of total billed charges,,
Iv Infusion Therapy Sequential Up To 1 Hour,,96367,CPT,Facility,Both,,,,102,86.7,29.2332,102,"Health Partners, Inc.",Commercial,96.492,94.6,,percent of total billed charges,,
Iv Infusion Therapy Sequential Up To 1 Hour,,96367,CPT,Facility,Outpatient,,,,102,86.7,29.2332,102,"Health Partners, Inc.",Medicare Advantage,49.98,49,,percent of total billed charges,,
Iv Infusion Therapy Sequential Up To 1 Hour,,96367,CPT,Facility,Inpatient,,,,102,86.7,29.2332,102,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Iv Infusion Therapy Sequential Up To 1 Hour,,96367,CPT,Facility,Both,,,,102,86.7,29.2332,102,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),61.2,60,,percent of total billed charges,,
Iv Infusion Therapy Sequential Up To 1 Hour,,96367,CPT,Facility,Both,,,,102,86.7,29.2332,102,"Health Partners, Inc.",State of Minnesota Advantage Program,83.13,81.5,,percent of total billed charges,,
Iv Infusion Therapy Sequential Up To 1 Hour,,96367,CPT,Facility,Both,,,,102,86.7,29.2332,102,"Health Partners, Inc.",State Public Programs,51,50,,percent of total billed charges,,
Iv Infusion Therapy Sequential Up To 1 Hour,,96367,CPT,Facility,Both,,,,102,86.7,29.2332,102,Humana Insurance Company,Commercial PPO,96.9,95,,percent of total billed charges,,
Iv Infusion Therapy Sequential Up To 1 Hour,,96367,CPT,Facility,Outpatient,,,,102,86.7,29.2332,102,Humana Insurance Company,Medicare PPO,49.98,49,,percent of total billed charges,,
Iv Infusion Therapy Sequential Up To 1 Hour,,96367,CPT,Facility,Inpatient,,,,102,86.7,29.2332,102,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Iv Infusion Therapy Sequential Up To 1 Hour,,96367,CPT,Facility,Both,,,,102,86.7,29.2332,102,Medica,Individual & Family,101.082,99.1,,percent of total billed charges,,
Iv Infusion Therapy Sequential Up To 1 Hour,,96367,CPT,Facility,Outpatient,,,,102,86.7,29.2332,102,Medica,Medica Advantage Solution,50.796,49.8,,percent of total billed charges,,
Iv Infusion Therapy Sequential Up To 1 Hour,,96367,CPT,Facility,Inpatient,,,,102,86.7,29.2332,102,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Iv Infusion Therapy Sequential Up To 1 Hour,,96367,CPT,Facility,Outpatient,,,,102,86.7,29.2332,102,Medica,Medical Assistance,45.492,44.6,,percent of total billed charges,,
Iv Infusion Therapy Sequential Up To 1 Hour,,96367,CPT,Facility,Inpatient,,,,102,86.7,29.2332,102,Medica,Medical Assistance,,,,,Included in per diem rate,
Iv Infusion Therapy Sequential Up To 1 Hour,,96367,CPT,Facility,Outpatient,,,,102,86.7,29.2332,102,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,50.796,49.8,,percent of total billed charges,,
Iv Infusion Therapy Sequential Up To 1 Hour,,96367,CPT,Facility,Inpatient,,,,102,86.7,29.2332,102,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Iv Infusion Therapy Sequential Up To 1 Hour,,96367,CPT,Facility,Both,,,,102,86.7,29.2332,102,"Multiplan, Inc.","Multiplan, Inc.",95.88,94,,percent of total billed charges,,
Iv Infusion Therapy Sequential Up To 1 Hour,,96367,CPT,Facility,Outpatient,,,,102,86.7,29.2332,102,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,91.902,90.1,,percent of total billed charges,,
Iv Infusion Therapy Sequential Up To 1 Hour,,96367,CPT,Facility,Inpatient,,,,102,86.7,29.2332,102,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Iv Infusion Therapy Sequential Up To 1 Hour,,96367,CPT,Facility,Both,,,,102,86.7,29.2332,102,"Preferred One Administrative Services, INC.",PPO,100.572,98.6,,percent of total billed charges,,
Iv Infusion Therapy Sequential Up To 1 Hour,,96367,CPT,Facility,Outpatient,,,,102,86.7,29.2332,102,PrimeWest Health,Minnesota Senior Health Options (MSHO),52.479,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Iv Infusion Therapy Sequential Up To 1 Hour,,96367,CPT,Facility,Inpatient,,,,102,86.7,29.2332,102,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Iv Infusion Therapy Sequential Up To 1 Hour,,96367,CPT,Facility,Outpatient,,,,102,86.7,29.2332,102,PrimeWest Health,MinnesotaCare,52.3872,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Iv Infusion Therapy Sequential Up To 1 Hour,,96367,CPT,Facility,Inpatient,,,,102,86.7,29.2332,102,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Iv Infusion Therapy Sequential Up To 1 Hour,,96367,CPT,Facility,Both,,,,102,86.7,29.2332,102,Sanford Health Plan,Sanford Health Plan,93.84,92,,percent of total billed charges,,
Iv Infusion Therapy Sequential Up To 1 Hour,,96367,CPT,Facility,Outpatient,,,,102,86.7,29.2332,102,"UCare Health, Inc.",Individual & Family Plan,57.477,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Iv Infusion Therapy Sequential Up To 1 Hour,,96367,CPT,Facility,Inpatient,,,,102,86.7,29.2332,102,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Iv Infusion Therapy Sequential Up To 1 Hour,,96367,CPT,Facility,Outpatient,,,,102,86.7,29.2332,102,"UCare Health, Inc.",Medical Assistance,51.4794,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Iv Infusion Therapy Sequential Up To 1 Hour,,96367,CPT,Facility,Inpatient,,,,102,86.7,29.2332,102,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Iv Infusion Therapy Sequential Up To 1 Hour,,96367,CPT,Facility,Outpatient,,,,102,86.7,29.2332,102,"UCare Health, Inc.",Medicare Advantage,51.4794,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Iv Infusion Therapy Sequential Up To 1 Hour,,96367,CPT,Facility,Inpatient,,,,102,86.7,29.2332,102,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Iv Infusion Therapy Sequential Up To 1 Hour,,96367,CPT,Facility,Outpatient,,,,102,86.7,29.2332,102,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),51.4794,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Iv Infusion Therapy Sequential Up To 1 Hour,,96367,CPT,Facility,Inpatient,,,,102,86.7,29.2332,102,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Iv Infusion Therapy Sequential Up To 1 Hour,,96367,CPT,Facility,Both,,,,102,86.7,29.2332,102,UnitedHealthcare,Individual & Family,95.88,94,,percent of total billed charges,,
Iv Infusion Therapy Sequential Up To 1 Hour,,96367,CPT,Facility,Outpatient,,,,102,86.7,29.2332,102,UnitedHealthcare,Medicare Advantage,49.98,49,,percent of total billed charges,,
Iv Infusion Therapy Sequential Up To 1 Hour,,96367,CPT,Facility,Inpatient,,,,102,86.7,29.2332,102,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Iv Infusion Therapy Sequential Up To 1 Hour,,96367,CPT,Facility,Outpatient,,,,102,86.7,29.2332,102,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,48.96,48,,percent of total billed charges,,100% of DHS outpatient percentage
Iv Infusion Therapy Sequential Up To 1 Hour,,96367,CPT,Facility,Inpatient,,,,102,86.7,29.2332,102,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Iv Infusion Therapy Concurrent,,96368,CPT,Facility,Both,,,,101,85.85,28.9466,101,Aetna,Commercial,92.92,92,,percent of total billed charges,,
Iv Infusion Therapy Concurrent,,96368,CPT,Facility,Outpatient,,,,101,85.85,28.9466,101,Aetna,Medicare Advantage,49.49,49,,percent of total billed charges,,
Iv Infusion Therapy Concurrent,,96368,CPT,Facility,Inpatient,,,,101,85.85,28.9466,101,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Iv Infusion Therapy Concurrent,,96368,CPT,Facility,Both,,,,101,85.85,28.9466,101,Aetna,PPO,93.93,93,,percent of total billed charges,,
Iv Infusion Therapy Concurrent,,96368,CPT,Facility,Both,,,,101,85.85,28.9466,101,America's PPO,America's PPO,96.9903,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Iv Infusion Therapy Concurrent,,96368,CPT,Facility,Both,,,,101,85.85,28.9466,101,BlueCross BlueShield Minnesota, Federal Employee Program,99.384,98.4,,percent of total billed charges,,
Iv Infusion Therapy Concurrent,,96368,CPT,Facility,Both,,,,101,85.85,28.9466,101,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,101,100,,percent of total billed charges,,
Iv Infusion Therapy Concurrent,,96368,CPT,Facility,Both,,,,101,85.85,28.9466,101,BlueCross BlueShield Minnesota,High Value Network Plan,90.9,90,,percent of total billed charges,,
Iv Infusion Therapy Concurrent,,96368,CPT,Facility,Outpatient,,,,101,85.85,28.9466,101,BlueCross BlueShield Minnesota,Medicare Advantage,49.49,49,,percent of total billed charges,,
Iv Infusion Therapy Concurrent,,96368,CPT,Facility,Inpatient,,,,101,85.85,28.9466,101,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Iv Infusion Therapy Concurrent,,96368,CPT,Facility,Both,,,,101,85.85,28.9466,101,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,89.4557,88.57,,percent of total billed charges,,
Iv Infusion Therapy Concurrent,,96368,CPT,Facility,Both,,,,101,85.85,28.9466,101,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,28.9466,28.66,,percent of total billed charges,,
Iv Infusion Therapy Concurrent,,96368,CPT,Facility,Outpatient,,,,101,85.85,28.9466,101,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),49.49,49,,percent of total billed charges,,
Iv Infusion Therapy Concurrent,,96368,CPT,Facility,Inpatient,,,,101,85.85,28.9466,101,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Iv Infusion Therapy Concurrent,,96368,CPT,Facility,Both,,,,101,85.85,28.9466,101,CorVel,Worker's Compensation,101,100,,percent of total billed charges,,
Iv Infusion Therapy Concurrent,,96368,CPT,Facility,Both,,,,101,85.85,28.9466,101,First Health Group Corporation,First Health Network,97.97,97,,percent of total billed charges,,
Iv Infusion Therapy Concurrent,,96368,CPT,Facility,Both,,,,101,85.85,28.9466,101,"Health Partners, Inc.",Commercial,95.546,94.6,,percent of total billed charges,,
Iv Infusion Therapy Concurrent,,96368,CPT,Facility,Outpatient,,,,101,85.85,28.9466,101,"Health Partners, Inc.",Medicare Advantage,49.49,49,,percent of total billed charges,,
Iv Infusion Therapy Concurrent,,96368,CPT,Facility,Inpatient,,,,101,85.85,28.9466,101,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Iv Infusion Therapy Concurrent,,96368,CPT,Facility,Both,,,,101,85.85,28.9466,101,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),60.6,60,,percent of total billed charges,,
Iv Infusion Therapy Concurrent,,96368,CPT,Facility,Both,,,,101,85.85,28.9466,101,"Health Partners, Inc.",State of Minnesota Advantage Program,82.315,81.5,,percent of total billed charges,,
Iv Infusion Therapy Concurrent,,96368,CPT,Facility,Both,,,,101,85.85,28.9466,101,"Health Partners, Inc.",State Public Programs,50.5,50,,percent of total billed charges,,
Iv Infusion Therapy Concurrent,,96368,CPT,Facility,Both,,,,101,85.85,28.9466,101,Humana Insurance Company,Commercial PPO,95.95,95,,percent of total billed charges,,
Iv Infusion Therapy Concurrent,,96368,CPT,Facility,Outpatient,,,,101,85.85,28.9466,101,Humana Insurance Company,Medicare PPO,49.49,49,,percent of total billed charges,,
Iv Infusion Therapy Concurrent,,96368,CPT,Facility,Inpatient,,,,101,85.85,28.9466,101,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Iv Infusion Therapy Concurrent,,96368,CPT,Facility,Both,,,,101,85.85,28.9466,101,Medica,Individual & Family,100.091,99.1,,percent of total billed charges,,
Iv Infusion Therapy Concurrent,,96368,CPT,Facility,Outpatient,,,,101,85.85,28.9466,101,Medica,Medica Advantage Solution,50.298,49.8,,percent of total billed charges,,
Iv Infusion Therapy Concurrent,,96368,CPT,Facility,Inpatient,,,,101,85.85,28.9466,101,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Iv Infusion Therapy Concurrent,,96368,CPT,Facility,Outpatient,,,,101,85.85,28.9466,101,Medica,Medical Assistance,45.046,44.6,,percent of total billed charges,,
Iv Infusion Therapy Concurrent,,96368,CPT,Facility,Inpatient,,,,101,85.85,28.9466,101,Medica,Medical Assistance,,,,,Included in per diem rate,
Iv Infusion Therapy Concurrent,,96368,CPT,Facility,Outpatient,,,,101,85.85,28.9466,101,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,50.298,49.8,,percent of total billed charges,,
Iv Infusion Therapy Concurrent,,96368,CPT,Facility,Inpatient,,,,101,85.85,28.9466,101,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Iv Infusion Therapy Concurrent,,96368,CPT,Facility,Both,,,,101,85.85,28.9466,101,"Multiplan, Inc.","Multiplan, Inc.",94.94,94,,percent of total billed charges,,
Iv Infusion Therapy Concurrent,,96368,CPT,Facility,Outpatient,,,,101,85.85,28.9466,101,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,91.001,90.1,,percent of total billed charges,,
Iv Infusion Therapy Concurrent,,96368,CPT,Facility,Inpatient,,,,101,85.85,28.9466,101,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Iv Infusion Therapy Concurrent,,96368,CPT,Facility,Both,,,,101,85.85,28.9466,101,"Preferred One Administrative Services, INC.",PPO,99.586,98.6,,percent of total billed charges,,
Iv Infusion Therapy Concurrent,,96368,CPT,Facility,Outpatient,,,,101,85.85,28.9466,101,PrimeWest Health,Minnesota Senior Health Options (MSHO),51.9645,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Iv Infusion Therapy Concurrent,,96368,CPT,Facility,Inpatient,,,,101,85.85,28.9466,101,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Iv Infusion Therapy Concurrent,,96368,CPT,Facility,Outpatient,,,,101,85.85,28.9466,101,PrimeWest Health,MinnesotaCare,51.8736,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Iv Infusion Therapy Concurrent,,96368,CPT,Facility,Inpatient,,,,101,85.85,28.9466,101,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Iv Infusion Therapy Concurrent,,96368,CPT,Facility,Both,,,,101,85.85,28.9466,101,Sanford Health Plan,Sanford Health Plan,92.92,92,,percent of total billed charges,,
Iv Infusion Therapy Concurrent,,96368,CPT,Facility,Outpatient,,,,101,85.85,28.9466,101,"UCare Health, Inc.",Individual & Family Plan,56.9135,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Iv Infusion Therapy Concurrent,,96368,CPT,Facility,Inpatient,,,,101,85.85,28.9466,101,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Iv Infusion Therapy Concurrent,,96368,CPT,Facility,Outpatient,,,,101,85.85,28.9466,101,"UCare Health, Inc.",Medical Assistance,50.9747,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Iv Infusion Therapy Concurrent,,96368,CPT,Facility,Inpatient,,,,101,85.85,28.9466,101,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Iv Infusion Therapy Concurrent,,96368,CPT,Facility,Outpatient,,,,101,85.85,28.9466,101,"UCare Health, Inc.",Medicare Advantage,50.9747,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Iv Infusion Therapy Concurrent,,96368,CPT,Facility,Inpatient,,,,101,85.85,28.9466,101,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Iv Infusion Therapy Concurrent,,96368,CPT,Facility,Outpatient,,,,101,85.85,28.9466,101,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),50.9747,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Iv Infusion Therapy Concurrent,,96368,CPT,Facility,Inpatient,,,,101,85.85,28.9466,101,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Iv Infusion Therapy Concurrent,,96368,CPT,Facility,Both,,,,101,85.85,28.9466,101,UnitedHealthcare,Individual & Family,94.94,94,,percent of total billed charges,,
Iv Infusion Therapy Concurrent,,96368,CPT,Facility,Outpatient,,,,101,85.85,28.9466,101,UnitedHealthcare,Medicare Advantage,49.49,49,,percent of total billed charges,,
Iv Infusion Therapy Concurrent,,96368,CPT,Facility,Inpatient,,,,101,85.85,28.9466,101,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Iv Infusion Therapy Concurrent,,96368,CPT,Facility,Outpatient,,,,101,85.85,28.9466,101,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,48.48,48,,percent of total billed charges,,100% of DHS outpatient percentage
Iv Infusion Therapy Concurrent,,96368,CPT,Facility,Inpatient,,,,101,85.85,28.9466,101,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Im/Sq Med Injection,,96372,CPT,Facility,Both,,,,71,60.35,20.3486,71,Aetna,Commercial,65.32,92,,percent of total billed charges,,
Im/Sq Med Injection,,96372,CPT,Facility,Outpatient,,,,71,60.35,20.3486,71,Aetna,Medicare Advantage,34.79,49,,percent of total billed charges,,
Im/Sq Med Injection,,96372,CPT,Facility,Inpatient,,,,71,60.35,20.3486,71,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Im/Sq Med Injection,,96372,CPT,Facility,Both,,,,71,60.35,20.3486,71,Aetna,PPO,66.03,93,,percent of total billed charges,,
Im/Sq Med Injection,,96372,CPT,Facility,Both,,,,71,60.35,20.3486,71,America's PPO,America's PPO,68.1813,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Im/Sq Med Injection,,96372,CPT,Facility,Both,,,,71,60.35,20.3486,71,BlueCross BlueShield Minnesota, Federal Employee Program,69.864,98.4,,percent of total billed charges,,
Im/Sq Med Injection,,96372,CPT,Facility,Both,,,,71,60.35,20.3486,71,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,71,100,,percent of total billed charges,,
Im/Sq Med Injection,,96372,CPT,Facility,Both,,,,71,60.35,20.3486,71,BlueCross BlueShield Minnesota,High Value Network Plan,63.9,90,,percent of total billed charges,,
Im/Sq Med Injection,,96372,CPT,Facility,Outpatient,,,,71,60.35,20.3486,71,BlueCross BlueShield Minnesota,Medicare Advantage,34.79,49,,percent of total billed charges,,
Im/Sq Med Injection,,96372,CPT,Facility,Inpatient,,,,71,60.35,20.3486,71,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Im/Sq Med Injection,,96372,CPT,Facility,Both,,,,71,60.35,20.3486,71,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,62.8847,88.57,,percent of total billed charges,,
Im/Sq Med Injection,,96372,CPT,Facility,Both,,,,71,60.35,20.3486,71,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,20.3486,28.66,,percent of total billed charges,,
Im/Sq Med Injection,,96372,CPT,Facility,Outpatient,,,,71,60.35,20.3486,71,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),34.79,49,,percent of total billed charges,,
Im/Sq Med Injection,,96372,CPT,Facility,Inpatient,,,,71,60.35,20.3486,71,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Im/Sq Med Injection,,96372,CPT,Facility,Both,,,,71,60.35,20.3486,71,CorVel,Worker's Compensation,71,100,,percent of total billed charges,,
Im/Sq Med Injection,,96372,CPT,Facility,Both,,,,71,60.35,20.3486,71,First Health Group Corporation,First Health Network,68.87,97,,percent of total billed charges,,
Im/Sq Med Injection,,96372,CPT,Facility,Both,,,,71,60.35,20.3486,71,"Health Partners, Inc.",Commercial,67.166,94.6,,percent of total billed charges,,
Im/Sq Med Injection,,96372,CPT,Facility,Outpatient,,,,71,60.35,20.3486,71,"Health Partners, Inc.",Medicare Advantage,34.79,49,,percent of total billed charges,,
Im/Sq Med Injection,,96372,CPT,Facility,Inpatient,,,,71,60.35,20.3486,71,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Im/Sq Med Injection,,96372,CPT,Facility,Both,,,,71,60.35,20.3486,71,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),42.6,60,,percent of total billed charges,,
Im/Sq Med Injection,,96372,CPT,Facility,Both,,,,71,60.35,20.3486,71,"Health Partners, Inc.",State of Minnesota Advantage Program,57.865,81.5,,percent of total billed charges,,
Im/Sq Med Injection,,96372,CPT,Facility,Both,,,,71,60.35,20.3486,71,"Health Partners, Inc.",State Public Programs,35.5,50,,percent of total billed charges,,
Im/Sq Med Injection,,96372,CPT,Facility,Both,,,,71,60.35,20.3486,71,Humana Insurance Company,Commercial PPO,67.45,95,,percent of total billed charges,,
Im/Sq Med Injection,,96372,CPT,Facility,Outpatient,,,,71,60.35,20.3486,71,Humana Insurance Company,Medicare PPO,34.79,49,,percent of total billed charges,,
Im/Sq Med Injection,,96372,CPT,Facility,Inpatient,,,,71,60.35,20.3486,71,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Im/Sq Med Injection,,96372,CPT,Facility,Both,,,,71,60.35,20.3486,71,Medica,Individual & Family,70.361,99.1,,percent of total billed charges,,
Im/Sq Med Injection,,96372,CPT,Facility,Outpatient,,,,71,60.35,20.3486,71,Medica,Medica Advantage Solution,35.358,49.8,,percent of total billed charges,,
Im/Sq Med Injection,,96372,CPT,Facility,Inpatient,,,,71,60.35,20.3486,71,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Im/Sq Med Injection,,96372,CPT,Facility,Outpatient,,,,71,60.35,20.3486,71,Medica,Medical Assistance,31.666,44.6,,percent of total billed charges,,
Im/Sq Med Injection,,96372,CPT,Facility,Inpatient,,,,71,60.35,20.3486,71,Medica,Medical Assistance,,,,,Included in per diem rate,
Im/Sq Med Injection,,96372,CPT,Facility,Outpatient,,,,71,60.35,20.3486,71,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,35.358,49.8,,percent of total billed charges,,
Im/Sq Med Injection,,96372,CPT,Facility,Inpatient,,,,71,60.35,20.3486,71,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Im/Sq Med Injection,,96372,CPT,Facility,Both,,,,71,60.35,20.3486,71,"Multiplan, Inc.","Multiplan, Inc.",66.74,94,,percent of total billed charges,,
Im/Sq Med Injection,,96372,CPT,Facility,Outpatient,,,,71,60.35,20.3486,71,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,63.971,90.1,,percent of total billed charges,,
Im/Sq Med Injection,,96372,CPT,Facility,Inpatient,,,,71,60.35,20.3486,71,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Im/Sq Med Injection,,96372,CPT,Facility,Both,,,,71,60.35,20.3486,71,"Preferred One Administrative Services, INC.",PPO,70.006,98.6,,percent of total billed charges,,
Im/Sq Med Injection,,96372,CPT,Facility,Outpatient,,,,71,60.35,20.3486,71,PrimeWest Health,Minnesota Senior Health Options (MSHO),36.5295,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Im/Sq Med Injection,,96372,CPT,Facility,Inpatient,,,,71,60.35,20.3486,71,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Im/Sq Med Injection,,96372,CPT,Facility,Outpatient,,,,71,60.35,20.3486,71,PrimeWest Health,MinnesotaCare,36.4656,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Im/Sq Med Injection,,96372,CPT,Facility,Inpatient,,,,71,60.35,20.3486,71,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Im/Sq Med Injection,,96372,CPT,Facility,Both,,,,71,60.35,20.3486,71,Sanford Health Plan,Sanford Health Plan,65.32,92,,percent of total billed charges,,
Im/Sq Med Injection,,96372,CPT,Facility,Outpatient,,,,71,60.35,20.3486,71,"UCare Health, Inc.",Individual & Family Plan,40.0085,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Im/Sq Med Injection,,96372,CPT,Facility,Inpatient,,,,71,60.35,20.3486,71,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Im/Sq Med Injection,,96372,CPT,Facility,Outpatient,,,,71,60.35,20.3486,71,"UCare Health, Inc.",Medical Assistance,35.8337,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Im/Sq Med Injection,,96372,CPT,Facility,Inpatient,,,,71,60.35,20.3486,71,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Im/Sq Med Injection,,96372,CPT,Facility,Outpatient,,,,71,60.35,20.3486,71,"UCare Health, Inc.",Medicare Advantage,35.8337,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Im/Sq Med Injection,,96372,CPT,Facility,Inpatient,,,,71,60.35,20.3486,71,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Im/Sq Med Injection,,96372,CPT,Facility,Outpatient,,,,71,60.35,20.3486,71,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),35.8337,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Im/Sq Med Injection,,96372,CPT,Facility,Inpatient,,,,71,60.35,20.3486,71,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Im/Sq Med Injection,,96372,CPT,Facility,Both,,,,71,60.35,20.3486,71,UnitedHealthcare,Individual & Family,66.74,94,,percent of total billed charges,,
Im/Sq Med Injection,,96372,CPT,Facility,Outpatient,,,,71,60.35,20.3486,71,UnitedHealthcare,Medicare Advantage,34.79,49,,percent of total billed charges,,
Im/Sq Med Injection,,96372,CPT,Facility,Inpatient,,,,71,60.35,20.3486,71,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Im/Sq Med Injection,,96372,CPT,Facility,Outpatient,,,,71,60.35,20.3486,71,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,34.08,48,,percent of total billed charges,,100% of DHS outpatient percentage
Im/Sq Med Injection,,96372,CPT,Facility,Inpatient,,,,71,60.35,20.3486,71,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Iv Push Single Or Primary Drug,,96374,CPT,Facility,Both,,,,133,113.05,38.1178,133,Aetna,Commercial,122.36,92,,percent of total billed charges,,
Iv Push Single Or Primary Drug,,96374,CPT,Facility,Outpatient,,,,133,113.05,38.1178,133,Aetna,Medicare Advantage,65.17,49,,percent of total billed charges,,
Iv Push Single Or Primary Drug,,96374,CPT,Facility,Inpatient,,,,133,113.05,38.1178,133,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Iv Push Single Or Primary Drug,,96374,CPT,Facility,Both,,,,133,113.05,38.1178,133,Aetna,PPO,123.69,93,,percent of total billed charges,,
Iv Push Single Or Primary Drug,,96374,CPT,Facility,Both,,,,133,113.05,38.1178,133,America's PPO,America's PPO,127.7199,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Iv Push Single Or Primary Drug,,96374,CPT,Facility,Both,,,,133,113.05,38.1178,133,BlueCross BlueShield Minnesota, Federal Employee Program,130.872,98.4,,percent of total billed charges,,
Iv Push Single Or Primary Drug,,96374,CPT,Facility,Both,,,,133,113.05,38.1178,133,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,133,100,,percent of total billed charges,,
Iv Push Single Or Primary Drug,,96374,CPT,Facility,Both,,,,133,113.05,38.1178,133,BlueCross BlueShield Minnesota,High Value Network Plan,119.7,90,,percent of total billed charges,,
Iv Push Single Or Primary Drug,,96374,CPT,Facility,Outpatient,,,,133,113.05,38.1178,133,BlueCross BlueShield Minnesota,Medicare Advantage,65.17,49,,percent of total billed charges,,
Iv Push Single Or Primary Drug,,96374,CPT,Facility,Inpatient,,,,133,113.05,38.1178,133,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Iv Push Single Or Primary Drug,,96374,CPT,Facility,Both,,,,133,113.05,38.1178,133,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,117.7981,88.57,,percent of total billed charges,,
Iv Push Single Or Primary Drug,,96374,CPT,Facility,Both,,,,133,113.05,38.1178,133,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,38.1178,28.66,,percent of total billed charges,,
Iv Push Single Or Primary Drug,,96374,CPT,Facility,Outpatient,,,,133,113.05,38.1178,133,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),65.17,49,,percent of total billed charges,,
Iv Push Single Or Primary Drug,,96374,CPT,Facility,Inpatient,,,,133,113.05,38.1178,133,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Iv Push Single Or Primary Drug,,96374,CPT,Facility,Both,,,,133,113.05,38.1178,133,CorVel,Worker's Compensation,133,100,,percent of total billed charges,,
Iv Push Single Or Primary Drug,,96374,CPT,Facility,Both,,,,133,113.05,38.1178,133,First Health Group Corporation,First Health Network,129.01,97,,percent of total billed charges,,
Iv Push Single Or Primary Drug,,96374,CPT,Facility,Both,,,,133,113.05,38.1178,133,"Health Partners, Inc.",Commercial,125.818,94.6,,percent of total billed charges,,
Iv Push Single Or Primary Drug,,96374,CPT,Facility,Outpatient,,,,133,113.05,38.1178,133,"Health Partners, Inc.",Medicare Advantage,65.17,49,,percent of total billed charges,,
Iv Push Single Or Primary Drug,,96374,CPT,Facility,Inpatient,,,,133,113.05,38.1178,133,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Iv Push Single Or Primary Drug,,96374,CPT,Facility,Both,,,,133,113.05,38.1178,133,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),79.8,60,,percent of total billed charges,,
Iv Push Single Or Primary Drug,,96374,CPT,Facility,Both,,,,133,113.05,38.1178,133,"Health Partners, Inc.",State of Minnesota Advantage Program,108.395,81.5,,percent of total billed charges,,
Iv Push Single Or Primary Drug,,96374,CPT,Facility,Both,,,,133,113.05,38.1178,133,"Health Partners, Inc.",State Public Programs,66.5,50,,percent of total billed charges,,
Iv Push Single Or Primary Drug,,96374,CPT,Facility,Both,,,,133,113.05,38.1178,133,Humana Insurance Company,Commercial PPO,126.35,95,,percent of total billed charges,,
Iv Push Single Or Primary Drug,,96374,CPT,Facility,Outpatient,,,,133,113.05,38.1178,133,Humana Insurance Company,Medicare PPO,65.17,49,,percent of total billed charges,,
Iv Push Single Or Primary Drug,,96374,CPT,Facility,Inpatient,,,,133,113.05,38.1178,133,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Iv Push Single Or Primary Drug,,96374,CPT,Facility,Both,,,,133,113.05,38.1178,133,Medica,Individual & Family,131.803,99.1,,percent of total billed charges,,
Iv Push Single Or Primary Drug,,96374,CPT,Facility,Outpatient,,,,133,113.05,38.1178,133,Medica,Medica Advantage Solution,66.234,49.8,,percent of total billed charges,,
Iv Push Single Or Primary Drug,,96374,CPT,Facility,Inpatient,,,,133,113.05,38.1178,133,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Iv Push Single Or Primary Drug,,96374,CPT,Facility,Outpatient,,,,133,113.05,38.1178,133,Medica,Medical Assistance,59.318,44.6,,percent of total billed charges,,
Iv Push Single Or Primary Drug,,96374,CPT,Facility,Inpatient,,,,133,113.05,38.1178,133,Medica,Medical Assistance,,,,,Included in per diem rate,
Iv Push Single Or Primary Drug,,96374,CPT,Facility,Outpatient,,,,133,113.05,38.1178,133,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,66.234,49.8,,percent of total billed charges,,
Iv Push Single Or Primary Drug,,96374,CPT,Facility,Inpatient,,,,133,113.05,38.1178,133,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Iv Push Single Or Primary Drug,,96374,CPT,Facility,Both,,,,133,113.05,38.1178,133,"Multiplan, Inc.","Multiplan, Inc.",125.02,94,,percent of total billed charges,,
Iv Push Single Or Primary Drug,,96374,CPT,Facility,Outpatient,,,,133,113.05,38.1178,133,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,119.833,90.1,,percent of total billed charges,,
Iv Push Single Or Primary Drug,,96374,CPT,Facility,Inpatient,,,,133,113.05,38.1178,133,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Iv Push Single Or Primary Drug,,96374,CPT,Facility,Both,,,,133,113.05,38.1178,133,"Preferred One Administrative Services, INC.",PPO,131.138,98.6,,percent of total billed charges,,
Iv Push Single Or Primary Drug,,96374,CPT,Facility,Outpatient,,,,133,113.05,38.1178,133,PrimeWest Health,Minnesota Senior Health Options (MSHO),68.4285,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Iv Push Single Or Primary Drug,,96374,CPT,Facility,Inpatient,,,,133,113.05,38.1178,133,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Iv Push Single Or Primary Drug,,96374,CPT,Facility,Outpatient,,,,133,113.05,38.1178,133,PrimeWest Health,MinnesotaCare,68.3088,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Iv Push Single Or Primary Drug,,96374,CPT,Facility,Inpatient,,,,133,113.05,38.1178,133,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Iv Push Single Or Primary Drug,,96374,CPT,Facility,Both,,,,133,113.05,38.1178,133,Sanford Health Plan,Sanford Health Plan,122.36,92,,percent of total billed charges,,
Iv Push Single Or Primary Drug,,96374,CPT,Facility,Outpatient,,,,133,113.05,38.1178,133,"UCare Health, Inc.",Individual & Family Plan,74.9455,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Iv Push Single Or Primary Drug,,96374,CPT,Facility,Inpatient,,,,133,113.05,38.1178,133,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Iv Push Single Or Primary Drug,,96374,CPT,Facility,Outpatient,,,,133,113.05,38.1178,133,"UCare Health, Inc.",Medical Assistance,67.1251,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Iv Push Single Or Primary Drug,,96374,CPT,Facility,Inpatient,,,,133,113.05,38.1178,133,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Iv Push Single Or Primary Drug,,96374,CPT,Facility,Outpatient,,,,133,113.05,38.1178,133,"UCare Health, Inc.",Medicare Advantage,67.1251,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Iv Push Single Or Primary Drug,,96374,CPT,Facility,Inpatient,,,,133,113.05,38.1178,133,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Iv Push Single Or Primary Drug,,96374,CPT,Facility,Outpatient,,,,133,113.05,38.1178,133,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),67.1251,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Iv Push Single Or Primary Drug,,96374,CPT,Facility,Inpatient,,,,133,113.05,38.1178,133,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Iv Push Single Or Primary Drug,,96374,CPT,Facility,Both,,,,133,113.05,38.1178,133,UnitedHealthcare,Individual & Family,125.02,94,,percent of total billed charges,,
Iv Push Single Or Primary Drug,,96374,CPT,Facility,Outpatient,,,,133,113.05,38.1178,133,UnitedHealthcare,Medicare Advantage,65.17,49,,percent of total billed charges,,
Iv Push Single Or Primary Drug,,96374,CPT,Facility,Inpatient,,,,133,113.05,38.1178,133,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Iv Push Single Or Primary Drug,,96374,CPT,Facility,Outpatient,,,,133,113.05,38.1178,133,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,63.84,48,,percent of total billed charges,,100% of DHS outpatient percentage
Iv Push Single Or Primary Drug,,96374,CPT,Facility,Inpatient,,,,133,113.05,38.1178,133,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Iv Push Each Add Seq Different Drug,,96375,CPT,Facility,Both,,,,102,86.7,29.2332,102,Aetna,Commercial,93.84,92,,percent of total billed charges,,
Iv Push Each Add Seq Different Drug,,96375,CPT,Facility,Outpatient,,,,102,86.7,29.2332,102,Aetna,Medicare Advantage,49.98,49,,percent of total billed charges,,
Iv Push Each Add Seq Different Drug,,96375,CPT,Facility,Inpatient,,,,102,86.7,29.2332,102,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Iv Push Each Add Seq Different Drug,,96375,CPT,Facility,Both,,,,102,86.7,29.2332,102,Aetna,PPO,94.86,93,,percent of total billed charges,,
Iv Push Each Add Seq Different Drug,,96375,CPT,Facility,Both,,,,102,86.7,29.2332,102,America's PPO,America's PPO,97.9506,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Iv Push Each Add Seq Different Drug,,96375,CPT,Facility,Both,,,,102,86.7,29.2332,102,BlueCross BlueShield Minnesota, Federal Employee Program,100.368,98.4,,percent of total billed charges,,
Iv Push Each Add Seq Different Drug,,96375,CPT,Facility,Both,,,,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,102,100,,percent of total billed charges,,
Iv Push Each Add Seq Different Drug,,96375,CPT,Facility,Both,,,,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,High Value Network Plan,91.8,90,,percent of total billed charges,,
Iv Push Each Add Seq Different Drug,,96375,CPT,Facility,Outpatient,,,,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,Medicare Advantage,49.98,49,,percent of total billed charges,,
Iv Push Each Add Seq Different Drug,,96375,CPT,Facility,Inpatient,,,,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Iv Push Each Add Seq Different Drug,,96375,CPT,Facility,Both,,,,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,90.3414,88.57,,percent of total billed charges,,
Iv Push Each Add Seq Different Drug,,96375,CPT,Facility,Both,,,,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,29.2332,28.66,,percent of total billed charges,,
Iv Push Each Add Seq Different Drug,,96375,CPT,Facility,Outpatient,,,,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),49.98,49,,percent of total billed charges,,
Iv Push Each Add Seq Different Drug,,96375,CPT,Facility,Inpatient,,,,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Iv Push Each Add Seq Different Drug,,96375,CPT,Facility,Both,,,,102,86.7,29.2332,102,CorVel,Worker's Compensation,102,100,,percent of total billed charges,,
Iv Push Each Add Seq Different Drug,,96375,CPT,Facility,Both,,,,102,86.7,29.2332,102,First Health Group Corporation,First Health Network,98.94,97,,percent of total billed charges,,
Iv Push Each Add Seq Different Drug,,96375,CPT,Facility,Both,,,,102,86.7,29.2332,102,"Health Partners, Inc.",Commercial,96.492,94.6,,percent of total billed charges,,
Iv Push Each Add Seq Different Drug,,96375,CPT,Facility,Outpatient,,,,102,86.7,29.2332,102,"Health Partners, Inc.",Medicare Advantage,49.98,49,,percent of total billed charges,,
Iv Push Each Add Seq Different Drug,,96375,CPT,Facility,Inpatient,,,,102,86.7,29.2332,102,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Iv Push Each Add Seq Different Drug,,96375,CPT,Facility,Both,,,,102,86.7,29.2332,102,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),61.2,60,,percent of total billed charges,,
Iv Push Each Add Seq Different Drug,,96375,CPT,Facility,Both,,,,102,86.7,29.2332,102,"Health Partners, Inc.",State of Minnesota Advantage Program,83.13,81.5,,percent of total billed charges,,
Iv Push Each Add Seq Different Drug,,96375,CPT,Facility,Both,,,,102,86.7,29.2332,102,"Health Partners, Inc.",State Public Programs,51,50,,percent of total billed charges,,
Iv Push Each Add Seq Different Drug,,96375,CPT,Facility,Both,,,,102,86.7,29.2332,102,Humana Insurance Company,Commercial PPO,96.9,95,,percent of total billed charges,,
Iv Push Each Add Seq Different Drug,,96375,CPT,Facility,Outpatient,,,,102,86.7,29.2332,102,Humana Insurance Company,Medicare PPO,49.98,49,,percent of total billed charges,,
Iv Push Each Add Seq Different Drug,,96375,CPT,Facility,Inpatient,,,,102,86.7,29.2332,102,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Iv Push Each Add Seq Different Drug,,96375,CPT,Facility,Both,,,,102,86.7,29.2332,102,Medica,Individual & Family,101.082,99.1,,percent of total billed charges,,
Iv Push Each Add Seq Different Drug,,96375,CPT,Facility,Outpatient,,,,102,86.7,29.2332,102,Medica,Medica Advantage Solution,50.796,49.8,,percent of total billed charges,,
Iv Push Each Add Seq Different Drug,,96375,CPT,Facility,Inpatient,,,,102,86.7,29.2332,102,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Iv Push Each Add Seq Different Drug,,96375,CPT,Facility,Outpatient,,,,102,86.7,29.2332,102,Medica,Medical Assistance,45.492,44.6,,percent of total billed charges,,
Iv Push Each Add Seq Different Drug,,96375,CPT,Facility,Inpatient,,,,102,86.7,29.2332,102,Medica,Medical Assistance,,,,,Included in per diem rate,
Iv Push Each Add Seq Different Drug,,96375,CPT,Facility,Outpatient,,,,102,86.7,29.2332,102,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,50.796,49.8,,percent of total billed charges,,
Iv Push Each Add Seq Different Drug,,96375,CPT,Facility,Inpatient,,,,102,86.7,29.2332,102,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Iv Push Each Add Seq Different Drug,,96375,CPT,Facility,Both,,,,102,86.7,29.2332,102,"Multiplan, Inc.","Multiplan, Inc.",95.88,94,,percent of total billed charges,,
Iv Push Each Add Seq Different Drug,,96375,CPT,Facility,Outpatient,,,,102,86.7,29.2332,102,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,91.902,90.1,,percent of total billed charges,,
Iv Push Each Add Seq Different Drug,,96375,CPT,Facility,Inpatient,,,,102,86.7,29.2332,102,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Iv Push Each Add Seq Different Drug,,96375,CPT,Facility,Both,,,,102,86.7,29.2332,102,"Preferred One Administrative Services, INC.",PPO,100.572,98.6,,percent of total billed charges,,
Iv Push Each Add Seq Different Drug,,96375,CPT,Facility,Outpatient,,,,102,86.7,29.2332,102,PrimeWest Health,Minnesota Senior Health Options (MSHO),52.479,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Iv Push Each Add Seq Different Drug,,96375,CPT,Facility,Inpatient,,,,102,86.7,29.2332,102,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Iv Push Each Add Seq Different Drug,,96375,CPT,Facility,Outpatient,,,,102,86.7,29.2332,102,PrimeWest Health,MinnesotaCare,52.3872,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Iv Push Each Add Seq Different Drug,,96375,CPT,Facility,Inpatient,,,,102,86.7,29.2332,102,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Iv Push Each Add Seq Different Drug,,96375,CPT,Facility,Both,,,,102,86.7,29.2332,102,Sanford Health Plan,Sanford Health Plan,93.84,92,,percent of total billed charges,,
Iv Push Each Add Seq Different Drug,,96375,CPT,Facility,Outpatient,,,,102,86.7,29.2332,102,"UCare Health, Inc.",Individual & Family Plan,57.477,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Iv Push Each Add Seq Different Drug,,96375,CPT,Facility,Inpatient,,,,102,86.7,29.2332,102,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Iv Push Each Add Seq Different Drug,,96375,CPT,Facility,Outpatient,,,,102,86.7,29.2332,102,"UCare Health, Inc.",Medical Assistance,51.4794,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Iv Push Each Add Seq Different Drug,,96375,CPT,Facility,Inpatient,,,,102,86.7,29.2332,102,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Iv Push Each Add Seq Different Drug,,96375,CPT,Facility,Outpatient,,,,102,86.7,29.2332,102,"UCare Health, Inc.",Medicare Advantage,51.4794,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Iv Push Each Add Seq Different Drug,,96375,CPT,Facility,Inpatient,,,,102,86.7,29.2332,102,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Iv Push Each Add Seq Different Drug,,96375,CPT,Facility,Outpatient,,,,102,86.7,29.2332,102,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),51.4794,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Iv Push Each Add Seq Different Drug,,96375,CPT,Facility,Inpatient,,,,102,86.7,29.2332,102,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Iv Push Each Add Seq Different Drug,,96375,CPT,Facility,Both,,,,102,86.7,29.2332,102,UnitedHealthcare,Individual & Family,95.88,94,,percent of total billed charges,,
Iv Push Each Add Seq Different Drug,,96375,CPT,Facility,Outpatient,,,,102,86.7,29.2332,102,UnitedHealthcare,Medicare Advantage,49.98,49,,percent of total billed charges,,
Iv Push Each Add Seq Different Drug,,96375,CPT,Facility,Inpatient,,,,102,86.7,29.2332,102,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Iv Push Each Add Seq Different Drug,,96375,CPT,Facility,Outpatient,,,,102,86.7,29.2332,102,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,48.96,48,,percent of total billed charges,,100% of DHS outpatient percentage
Iv Push Each Add Seq Different Drug,,96375,CPT,Facility,Inpatient,,,,102,86.7,29.2332,102,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Iv Push Each Add Seq Same Drug,,96376,CPT,Facility,Both,,,,77,65.45,22.0682,77,Aetna,Commercial,70.84,92,,percent of total billed charges,,
Iv Push Each Add Seq Same Drug,,96376,CPT,Facility,Outpatient,,,,77,65.45,22.0682,77,Aetna,Medicare Advantage,37.73,49,,percent of total billed charges,,
Iv Push Each Add Seq Same Drug,,96376,CPT,Facility,Inpatient,,,,77,65.45,22.0682,77,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Iv Push Each Add Seq Same Drug,,96376,CPT,Facility,Both,,,,77,65.45,22.0682,77,Aetna,PPO,71.61,93,,percent of total billed charges,,
Iv Push Each Add Seq Same Drug,,96376,CPT,Facility,Both,,,,77,65.45,22.0682,77,America's PPO,America's PPO,73.9431,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Iv Push Each Add Seq Same Drug,,96376,CPT,Facility,Both,,,,77,65.45,22.0682,77,BlueCross BlueShield Minnesota, Federal Employee Program,75.768,98.4,,percent of total billed charges,,
Iv Push Each Add Seq Same Drug,,96376,CPT,Facility,Both,,,,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,77,100,,percent of total billed charges,,
Iv Push Each Add Seq Same Drug,,96376,CPT,Facility,Both,,,,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,High Value Network Plan,69.3,90,,percent of total billed charges,,
Iv Push Each Add Seq Same Drug,,96376,CPT,Facility,Outpatient,,,,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,Medicare Advantage,37.73,49,,percent of total billed charges,,
Iv Push Each Add Seq Same Drug,,96376,CPT,Facility,Inpatient,,,,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Iv Push Each Add Seq Same Drug,,96376,CPT,Facility,Both,,,,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,68.1989,88.57,,percent of total billed charges,,
Iv Push Each Add Seq Same Drug,,96376,CPT,Facility,Both,,,,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,22.0682,28.66,,percent of total billed charges,,
Iv Push Each Add Seq Same Drug,,96376,CPT,Facility,Outpatient,,,,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),37.73,49,,percent of total billed charges,,
Iv Push Each Add Seq Same Drug,,96376,CPT,Facility,Inpatient,,,,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Iv Push Each Add Seq Same Drug,,96376,CPT,Facility,Both,,,,77,65.45,22.0682,77,CorVel,Worker's Compensation,77,100,,percent of total billed charges,,
Iv Push Each Add Seq Same Drug,,96376,CPT,Facility,Both,,,,77,65.45,22.0682,77,First Health Group Corporation,First Health Network,74.69,97,,percent of total billed charges,,
Iv Push Each Add Seq Same Drug,,96376,CPT,Facility,Both,,,,77,65.45,22.0682,77,"Health Partners, Inc.",Commercial,72.842,94.6,,percent of total billed charges,,
Iv Push Each Add Seq Same Drug,,96376,CPT,Facility,Outpatient,,,,77,65.45,22.0682,77,"Health Partners, Inc.",Medicare Advantage,37.73,49,,percent of total billed charges,,
Iv Push Each Add Seq Same Drug,,96376,CPT,Facility,Inpatient,,,,77,65.45,22.0682,77,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Iv Push Each Add Seq Same Drug,,96376,CPT,Facility,Both,,,,77,65.45,22.0682,77,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),46.2,60,,percent of total billed charges,,
Iv Push Each Add Seq Same Drug,,96376,CPT,Facility,Both,,,,77,65.45,22.0682,77,"Health Partners, Inc.",State of Minnesota Advantage Program,62.755,81.5,,percent of total billed charges,,
Iv Push Each Add Seq Same Drug,,96376,CPT,Facility,Both,,,,77,65.45,22.0682,77,"Health Partners, Inc.",State Public Programs,38.5,50,,percent of total billed charges,,
Iv Push Each Add Seq Same Drug,,96376,CPT,Facility,Both,,,,77,65.45,22.0682,77,Humana Insurance Company,Commercial PPO,73.15,95,,percent of total billed charges,,
Iv Push Each Add Seq Same Drug,,96376,CPT,Facility,Outpatient,,,,77,65.45,22.0682,77,Humana Insurance Company,Medicare PPO,37.73,49,,percent of total billed charges,,
Iv Push Each Add Seq Same Drug,,96376,CPT,Facility,Inpatient,,,,77,65.45,22.0682,77,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Iv Push Each Add Seq Same Drug,,96376,CPT,Facility,Both,,,,77,65.45,22.0682,77,Medica,Individual & Family,76.307,99.1,,percent of total billed charges,,
Iv Push Each Add Seq Same Drug,,96376,CPT,Facility,Outpatient,,,,77,65.45,22.0682,77,Medica,Medica Advantage Solution,38.346,49.8,,percent of total billed charges,,
Iv Push Each Add Seq Same Drug,,96376,CPT,Facility,Inpatient,,,,77,65.45,22.0682,77,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Iv Push Each Add Seq Same Drug,,96376,CPT,Facility,Outpatient,,,,77,65.45,22.0682,77,Medica,Medical Assistance,34.342,44.6,,percent of total billed charges,,
Iv Push Each Add Seq Same Drug,,96376,CPT,Facility,Inpatient,,,,77,65.45,22.0682,77,Medica,Medical Assistance,,,,,Included in per diem rate,
Iv Push Each Add Seq Same Drug,,96376,CPT,Facility,Outpatient,,,,77,65.45,22.0682,77,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,38.346,49.8,,percent of total billed charges,,
Iv Push Each Add Seq Same Drug,,96376,CPT,Facility,Inpatient,,,,77,65.45,22.0682,77,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Iv Push Each Add Seq Same Drug,,96376,CPT,Facility,Both,,,,77,65.45,22.0682,77,"Multiplan, Inc.","Multiplan, Inc.",72.38,94,,percent of total billed charges,,
Iv Push Each Add Seq Same Drug,,96376,CPT,Facility,Outpatient,,,,77,65.45,22.0682,77,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,69.377,90.1,,percent of total billed charges,,
Iv Push Each Add Seq Same Drug,,96376,CPT,Facility,Inpatient,,,,77,65.45,22.0682,77,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Iv Push Each Add Seq Same Drug,,96376,CPT,Facility,Both,,,,77,65.45,22.0682,77,"Preferred One Administrative Services, INC.",PPO,75.922,98.6,,percent of total billed charges,,
Iv Push Each Add Seq Same Drug,,96376,CPT,Facility,Outpatient,,,,77,65.45,22.0682,77,PrimeWest Health,Minnesota Senior Health Options (MSHO),39.6165,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Iv Push Each Add Seq Same Drug,,96376,CPT,Facility,Inpatient,,,,77,65.45,22.0682,77,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Iv Push Each Add Seq Same Drug,,96376,CPT,Facility,Outpatient,,,,77,65.45,22.0682,77,PrimeWest Health,MinnesotaCare,39.5472,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Iv Push Each Add Seq Same Drug,,96376,CPT,Facility,Inpatient,,,,77,65.45,22.0682,77,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Iv Push Each Add Seq Same Drug,,96376,CPT,Facility,Both,,,,77,65.45,22.0682,77,Sanford Health Plan,Sanford Health Plan,70.84,92,,percent of total billed charges,,
Iv Push Each Add Seq Same Drug,,96376,CPT,Facility,Outpatient,,,,77,65.45,22.0682,77,"UCare Health, Inc.",Individual & Family Plan,43.3895,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Iv Push Each Add Seq Same Drug,,96376,CPT,Facility,Inpatient,,,,77,65.45,22.0682,77,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Iv Push Each Add Seq Same Drug,,96376,CPT,Facility,Outpatient,,,,77,65.45,22.0682,77,"UCare Health, Inc.",Medical Assistance,38.8619,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Iv Push Each Add Seq Same Drug,,96376,CPT,Facility,Inpatient,,,,77,65.45,22.0682,77,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Iv Push Each Add Seq Same Drug,,96376,CPT,Facility,Outpatient,,,,77,65.45,22.0682,77,"UCare Health, Inc.",Medicare Advantage,38.8619,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Iv Push Each Add Seq Same Drug,,96376,CPT,Facility,Inpatient,,,,77,65.45,22.0682,77,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Iv Push Each Add Seq Same Drug,,96376,CPT,Facility,Outpatient,,,,77,65.45,22.0682,77,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),38.8619,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Iv Push Each Add Seq Same Drug,,96376,CPT,Facility,Inpatient,,,,77,65.45,22.0682,77,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Iv Push Each Add Seq Same Drug,,96376,CPT,Facility,Both,,,,77,65.45,22.0682,77,UnitedHealthcare,Individual & Family,72.38,94,,percent of total billed charges,,
Iv Push Each Add Seq Same Drug,,96376,CPT,Facility,Outpatient,,,,77,65.45,22.0682,77,UnitedHealthcare,Medicare Advantage,37.73,49,,percent of total billed charges,,
Iv Push Each Add Seq Same Drug,,96376,CPT,Facility,Inpatient,,,,77,65.45,22.0682,77,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Iv Push Each Add Seq Same Drug,,96376,CPT,Facility,Outpatient,,,,77,65.45,22.0682,77,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,36.96,48,,percent of total billed charges,,100% of DHS outpatient percentage
Iv Push Each Add Seq Same Drug,,96376,CPT,Facility,Inpatient,,,,77,65.45,22.0682,77,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Chemotherapy Admin Sq/Im Non-Hormonal,,96401,CPT,Facility,Both,,,,230,195.5,65.918,230,Aetna,Commercial,211.6,92,,percent of total billed charges,,
Chemotherapy Admin Sq/Im Non-Hormonal,,96401,CPT,Facility,Outpatient,,,,230,195.5,65.918,230,Aetna,Medicare Advantage,112.7,49,,percent of total billed charges,,
Chemotherapy Admin Sq/Im Non-Hormonal,,96401,CPT,Facility,Inpatient,,,,230,195.5,65.918,230,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Chemotherapy Admin Sq/Im Non-Hormonal,,96401,CPT,Facility,Both,,,,230,195.5,65.918,230,Aetna,PPO,213.9,93,,percent of total billed charges,,
Chemotherapy Admin Sq/Im Non-Hormonal,,96401,CPT,Facility,Both,,,,230,195.5,65.918,230,America's PPO,America's PPO,220.869,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Chemotherapy Admin Sq/Im Non-Hormonal,,96401,CPT,Facility,Both,,,,230,195.5,65.918,230,BlueCross BlueShield Minnesota, Federal Employee Program,226.32,98.4,,percent of total billed charges,,
Chemotherapy Admin Sq/Im Non-Hormonal,,96401,CPT,Facility,Both,,,,230,195.5,65.918,230,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,230,100,,percent of total billed charges,,
Chemotherapy Admin Sq/Im Non-Hormonal,,96401,CPT,Facility,Both,,,,230,195.5,65.918,230,BlueCross BlueShield Minnesota,High Value Network Plan,207,90,,percent of total billed charges,,
Chemotherapy Admin Sq/Im Non-Hormonal,,96401,CPT,Facility,Outpatient,,,,230,195.5,65.918,230,BlueCross BlueShield Minnesota,Medicare Advantage,112.7,49,,percent of total billed charges,,
Chemotherapy Admin Sq/Im Non-Hormonal,,96401,CPT,Facility,Inpatient,,,,230,195.5,65.918,230,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Chemotherapy Admin Sq/Im Non-Hormonal,,96401,CPT,Facility,Both,,,,230,195.5,65.918,230,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,203.711,88.57,,percent of total billed charges,,
Chemotherapy Admin Sq/Im Non-Hormonal,,96401,CPT,Facility,Both,,,,230,195.5,65.918,230,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,65.918,28.66,,percent of total billed charges,,
Chemotherapy Admin Sq/Im Non-Hormonal,,96401,CPT,Facility,Outpatient,,,,230,195.5,65.918,230,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),112.7,49,,percent of total billed charges,,
Chemotherapy Admin Sq/Im Non-Hormonal,,96401,CPT,Facility,Inpatient,,,,230,195.5,65.918,230,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Chemotherapy Admin Sq/Im Non-Hormonal,,96401,CPT,Facility,Both,,,,230,195.5,65.918,230,CorVel,Worker's Compensation,230,100,,percent of total billed charges,,
Chemotherapy Admin Sq/Im Non-Hormonal,,96401,CPT,Facility,Both,,,,230,195.5,65.918,230,First Health Group Corporation,First Health Network,223.1,97,,percent of total billed charges,,
Chemotherapy Admin Sq/Im Non-Hormonal,,96401,CPT,Facility,Both,,,,230,195.5,65.918,230,"Health Partners, Inc.",Commercial,217.58,94.6,,percent of total billed charges,,
Chemotherapy Admin Sq/Im Non-Hormonal,,96401,CPT,Facility,Outpatient,,,,230,195.5,65.918,230,"Health Partners, Inc.",Medicare Advantage,112.7,49,,percent of total billed charges,,
Chemotherapy Admin Sq/Im Non-Hormonal,,96401,CPT,Facility,Inpatient,,,,230,195.5,65.918,230,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Chemotherapy Admin Sq/Im Non-Hormonal,,96401,CPT,Facility,Both,,,,230,195.5,65.918,230,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),138,60,,percent of total billed charges,,
Chemotherapy Admin Sq/Im Non-Hormonal,,96401,CPT,Facility,Both,,,,230,195.5,65.918,230,"Health Partners, Inc.",State of Minnesota Advantage Program,187.45,81.5,,percent of total billed charges,,
Chemotherapy Admin Sq/Im Non-Hormonal,,96401,CPT,Facility,Both,,,,230,195.5,65.918,230,"Health Partners, Inc.",State Public Programs,115,50,,percent of total billed charges,,
Chemotherapy Admin Sq/Im Non-Hormonal,,96401,CPT,Facility,Both,,,,230,195.5,65.918,230,Humana Insurance Company,Commercial PPO,218.5,95,,percent of total billed charges,,
Chemotherapy Admin Sq/Im Non-Hormonal,,96401,CPT,Facility,Outpatient,,,,230,195.5,65.918,230,Humana Insurance Company,Medicare PPO,112.7,49,,percent of total billed charges,,
Chemotherapy Admin Sq/Im Non-Hormonal,,96401,CPT,Facility,Inpatient,,,,230,195.5,65.918,230,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Chemotherapy Admin Sq/Im Non-Hormonal,,96401,CPT,Facility,Both,,,,230,195.5,65.918,230,Medica,Individual & Family,227.93,99.1,,percent of total billed charges,,
Chemotherapy Admin Sq/Im Non-Hormonal,,96401,CPT,Facility,Outpatient,,,,230,195.5,65.918,230,Medica,Medica Advantage Solution,114.54,49.8,,percent of total billed charges,,
Chemotherapy Admin Sq/Im Non-Hormonal,,96401,CPT,Facility,Inpatient,,,,230,195.5,65.918,230,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Chemotherapy Admin Sq/Im Non-Hormonal,,96401,CPT,Facility,Outpatient,,,,230,195.5,65.918,230,Medica,Medical Assistance,102.58,44.6,,percent of total billed charges,,
Chemotherapy Admin Sq/Im Non-Hormonal,,96401,CPT,Facility,Inpatient,,,,230,195.5,65.918,230,Medica,Medical Assistance,,,,,Included in per diem rate,
Chemotherapy Admin Sq/Im Non-Hormonal,,96401,CPT,Facility,Outpatient,,,,230,195.5,65.918,230,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,114.54,49.8,,percent of total billed charges,,
Chemotherapy Admin Sq/Im Non-Hormonal,,96401,CPT,Facility,Inpatient,,,,230,195.5,65.918,230,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Chemotherapy Admin Sq/Im Non-Hormonal,,96401,CPT,Facility,Both,,,,230,195.5,65.918,230,"Multiplan, Inc.","Multiplan, Inc.",216.2,94,,percent of total billed charges,,
Chemotherapy Admin Sq/Im Non-Hormonal,,96401,CPT,Facility,Outpatient,,,,230,195.5,65.918,230,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,207.23,90.1,,percent of total billed charges,,
Chemotherapy Admin Sq/Im Non-Hormonal,,96401,CPT,Facility,Inpatient,,,,230,195.5,65.918,230,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Chemotherapy Admin Sq/Im Non-Hormonal,,96401,CPT,Facility,Both,,,,230,195.5,65.918,230,"Preferred One Administrative Services, INC.",PPO,226.78,98.6,,percent of total billed charges,,
Chemotherapy Admin Sq/Im Non-Hormonal,,96401,CPT,Facility,Outpatient,,,,230,195.5,65.918,230,PrimeWest Health,Minnesota Senior Health Options (MSHO),118.335,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Chemotherapy Admin Sq/Im Non-Hormonal,,96401,CPT,Facility,Inpatient,,,,230,195.5,65.918,230,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Chemotherapy Admin Sq/Im Non-Hormonal,,96401,CPT,Facility,Outpatient,,,,230,195.5,65.918,230,PrimeWest Health,MinnesotaCare,118.128,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Chemotherapy Admin Sq/Im Non-Hormonal,,96401,CPT,Facility,Inpatient,,,,230,195.5,65.918,230,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Chemotherapy Admin Sq/Im Non-Hormonal,,96401,CPT,Facility,Both,,,,230,195.5,65.918,230,Sanford Health Plan,Sanford Health Plan,211.6,92,,percent of total billed charges,,
Chemotherapy Admin Sq/Im Non-Hormonal,,96401,CPT,Facility,Outpatient,,,,230,195.5,65.918,230,"UCare Health, Inc.",Individual & Family Plan,129.605,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Chemotherapy Admin Sq/Im Non-Hormonal,,96401,CPT,Facility,Inpatient,,,,230,195.5,65.918,230,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Chemotherapy Admin Sq/Im Non-Hormonal,,96401,CPT,Facility,Outpatient,,,,230,195.5,65.918,230,"UCare Health, Inc.",Medical Assistance,116.081,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Chemotherapy Admin Sq/Im Non-Hormonal,,96401,CPT,Facility,Inpatient,,,,230,195.5,65.918,230,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Chemotherapy Admin Sq/Im Non-Hormonal,,96401,CPT,Facility,Outpatient,,,,230,195.5,65.918,230,"UCare Health, Inc.",Medicare Advantage,116.081,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Chemotherapy Admin Sq/Im Non-Hormonal,,96401,CPT,Facility,Inpatient,,,,230,195.5,65.918,230,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Chemotherapy Admin Sq/Im Non-Hormonal,,96401,CPT,Facility,Outpatient,,,,230,195.5,65.918,230,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),116.081,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Chemotherapy Admin Sq/Im Non-Hormonal,,96401,CPT,Facility,Inpatient,,,,230,195.5,65.918,230,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Chemotherapy Admin Sq/Im Non-Hormonal,,96401,CPT,Facility,Both,,,,230,195.5,65.918,230,UnitedHealthcare,Individual & Family,216.2,94,,percent of total billed charges,,
Chemotherapy Admin Sq/Im Non-Hormonal,,96401,CPT,Facility,Outpatient,,,,230,195.5,65.918,230,UnitedHealthcare,Medicare Advantage,112.7,49,,percent of total billed charges,,
Chemotherapy Admin Sq/Im Non-Hormonal,,96401,CPT,Facility,Inpatient,,,,230,195.5,65.918,230,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Chemotherapy Admin Sq/Im Non-Hormonal,,96401,CPT,Facility,Outpatient,,,,230,195.5,65.918,230,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,110.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
Chemotherapy Admin Sq/Im Non-Hormonal,,96401,CPT,Facility,Inpatient,,,,230,195.5,65.918,230,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Chemotherapy Admin Sq/Im Hormonal,,96402,CPT,Facility,Both,,,,148,125.8,42.4168,148,Aetna,Commercial,136.16,92,,percent of total billed charges,,
Chemotherapy Admin Sq/Im Hormonal,,96402,CPT,Facility,Outpatient,,,,148,125.8,42.4168,148,Aetna,Medicare Advantage,72.52,49,,percent of total billed charges,,
Chemotherapy Admin Sq/Im Hormonal,,96402,CPT,Facility,Inpatient,,,,148,125.8,42.4168,148,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Chemotherapy Admin Sq/Im Hormonal,,96402,CPT,Facility,Both,,,,148,125.8,42.4168,148,Aetna,PPO,137.64,93,,percent of total billed charges,,
Chemotherapy Admin Sq/Im Hormonal,,96402,CPT,Facility,Both,,,,148,125.8,42.4168,148,America's PPO,America's PPO,142.1244,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Chemotherapy Admin Sq/Im Hormonal,,96402,CPT,Facility,Both,,,,148,125.8,42.4168,148,BlueCross BlueShield Minnesota, Federal Employee Program,145.632,98.4,,percent of total billed charges,,
Chemotherapy Admin Sq/Im Hormonal,,96402,CPT,Facility,Both,,,,148,125.8,42.4168,148,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,148,100,,percent of total billed charges,,
Chemotherapy Admin Sq/Im Hormonal,,96402,CPT,Facility,Both,,,,148,125.8,42.4168,148,BlueCross BlueShield Minnesota,High Value Network Plan,133.2,90,,percent of total billed charges,,
Chemotherapy Admin Sq/Im Hormonal,,96402,CPT,Facility,Outpatient,,,,148,125.8,42.4168,148,BlueCross BlueShield Minnesota,Medicare Advantage,72.52,49,,percent of total billed charges,,
Chemotherapy Admin Sq/Im Hormonal,,96402,CPT,Facility,Inpatient,,,,148,125.8,42.4168,148,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Chemotherapy Admin Sq/Im Hormonal,,96402,CPT,Facility,Both,,,,148,125.8,42.4168,148,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,131.0836,88.57,,percent of total billed charges,,
Chemotherapy Admin Sq/Im Hormonal,,96402,CPT,Facility,Both,,,,148,125.8,42.4168,148,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,42.4168,28.66,,percent of total billed charges,,
Chemotherapy Admin Sq/Im Hormonal,,96402,CPT,Facility,Outpatient,,,,148,125.8,42.4168,148,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),72.52,49,,percent of total billed charges,,
Chemotherapy Admin Sq/Im Hormonal,,96402,CPT,Facility,Inpatient,,,,148,125.8,42.4168,148,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Chemotherapy Admin Sq/Im Hormonal,,96402,CPT,Facility,Both,,,,148,125.8,42.4168,148,CorVel,Worker's Compensation,148,100,,percent of total billed charges,,
Chemotherapy Admin Sq/Im Hormonal,,96402,CPT,Facility,Both,,,,148,125.8,42.4168,148,First Health Group Corporation,First Health Network,143.56,97,,percent of total billed charges,,
Chemotherapy Admin Sq/Im Hormonal,,96402,CPT,Facility,Both,,,,148,125.8,42.4168,148,"Health Partners, Inc.",Commercial,140.008,94.6,,percent of total billed charges,,
Chemotherapy Admin Sq/Im Hormonal,,96402,CPT,Facility,Outpatient,,,,148,125.8,42.4168,148,"Health Partners, Inc.",Medicare Advantage,72.52,49,,percent of total billed charges,,
Chemotherapy Admin Sq/Im Hormonal,,96402,CPT,Facility,Inpatient,,,,148,125.8,42.4168,148,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Chemotherapy Admin Sq/Im Hormonal,,96402,CPT,Facility,Both,,,,148,125.8,42.4168,148,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),88.8,60,,percent of total billed charges,,
Chemotherapy Admin Sq/Im Hormonal,,96402,CPT,Facility,Both,,,,148,125.8,42.4168,148,"Health Partners, Inc.",State of Minnesota Advantage Program,120.62,81.5,,percent of total billed charges,,
Chemotherapy Admin Sq/Im Hormonal,,96402,CPT,Facility,Both,,,,148,125.8,42.4168,148,"Health Partners, Inc.",State Public Programs,74,50,,percent of total billed charges,,
Chemotherapy Admin Sq/Im Hormonal,,96402,CPT,Facility,Both,,,,148,125.8,42.4168,148,Humana Insurance Company,Commercial PPO,140.6,95,,percent of total billed charges,,
Chemotherapy Admin Sq/Im Hormonal,,96402,CPT,Facility,Outpatient,,,,148,125.8,42.4168,148,Humana Insurance Company,Medicare PPO,72.52,49,,percent of total billed charges,,
Chemotherapy Admin Sq/Im Hormonal,,96402,CPT,Facility,Inpatient,,,,148,125.8,42.4168,148,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Chemotherapy Admin Sq/Im Hormonal,,96402,CPT,Facility,Both,,,,148,125.8,42.4168,148,Medica,Individual & Family,146.668,99.1,,percent of total billed charges,,
Chemotherapy Admin Sq/Im Hormonal,,96402,CPT,Facility,Outpatient,,,,148,125.8,42.4168,148,Medica,Medica Advantage Solution,73.704,49.8,,percent of total billed charges,,
Chemotherapy Admin Sq/Im Hormonal,,96402,CPT,Facility,Inpatient,,,,148,125.8,42.4168,148,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Chemotherapy Admin Sq/Im Hormonal,,96402,CPT,Facility,Outpatient,,,,148,125.8,42.4168,148,Medica,Medical Assistance,66.008,44.6,,percent of total billed charges,,
Chemotherapy Admin Sq/Im Hormonal,,96402,CPT,Facility,Inpatient,,,,148,125.8,42.4168,148,Medica,Medical Assistance,,,,,Included in per diem rate,
Chemotherapy Admin Sq/Im Hormonal,,96402,CPT,Facility,Outpatient,,,,148,125.8,42.4168,148,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,73.704,49.8,,percent of total billed charges,,
Chemotherapy Admin Sq/Im Hormonal,,96402,CPT,Facility,Inpatient,,,,148,125.8,42.4168,148,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Chemotherapy Admin Sq/Im Hormonal,,96402,CPT,Facility,Both,,,,148,125.8,42.4168,148,"Multiplan, Inc.","Multiplan, Inc.",139.12,94,,percent of total billed charges,,
Chemotherapy Admin Sq/Im Hormonal,,96402,CPT,Facility,Outpatient,,,,148,125.8,42.4168,148,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,133.348,90.1,,percent of total billed charges,,
Chemotherapy Admin Sq/Im Hormonal,,96402,CPT,Facility,Inpatient,,,,148,125.8,42.4168,148,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Chemotherapy Admin Sq/Im Hormonal,,96402,CPT,Facility,Both,,,,148,125.8,42.4168,148,"Preferred One Administrative Services, INC.",PPO,145.928,98.6,,percent of total billed charges,,
Chemotherapy Admin Sq/Im Hormonal,,96402,CPT,Facility,Outpatient,,,,148,125.8,42.4168,148,PrimeWest Health,Minnesota Senior Health Options (MSHO),76.146,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Chemotherapy Admin Sq/Im Hormonal,,96402,CPT,Facility,Inpatient,,,,148,125.8,42.4168,148,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Chemotherapy Admin Sq/Im Hormonal,,96402,CPT,Facility,Outpatient,,,,148,125.8,42.4168,148,PrimeWest Health,MinnesotaCare,76.0128,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Chemotherapy Admin Sq/Im Hormonal,,96402,CPT,Facility,Inpatient,,,,148,125.8,42.4168,148,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Chemotherapy Admin Sq/Im Hormonal,,96402,CPT,Facility,Both,,,,148,125.8,42.4168,148,Sanford Health Plan,Sanford Health Plan,136.16,92,,percent of total billed charges,,
Chemotherapy Admin Sq/Im Hormonal,,96402,CPT,Facility,Outpatient,,,,148,125.8,42.4168,148,"UCare Health, Inc.",Individual & Family Plan,83.398,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Chemotherapy Admin Sq/Im Hormonal,,96402,CPT,Facility,Inpatient,,,,148,125.8,42.4168,148,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Chemotherapy Admin Sq/Im Hormonal,,96402,CPT,Facility,Outpatient,,,,148,125.8,42.4168,148,"UCare Health, Inc.",Medical Assistance,74.6956,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Chemotherapy Admin Sq/Im Hormonal,,96402,CPT,Facility,Inpatient,,,,148,125.8,42.4168,148,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Chemotherapy Admin Sq/Im Hormonal,,96402,CPT,Facility,Outpatient,,,,148,125.8,42.4168,148,"UCare Health, Inc.",Medicare Advantage,74.6956,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Chemotherapy Admin Sq/Im Hormonal,,96402,CPT,Facility,Inpatient,,,,148,125.8,42.4168,148,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Chemotherapy Admin Sq/Im Hormonal,,96402,CPT,Facility,Outpatient,,,,148,125.8,42.4168,148,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),74.6956,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Chemotherapy Admin Sq/Im Hormonal,,96402,CPT,Facility,Inpatient,,,,148,125.8,42.4168,148,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Chemotherapy Admin Sq/Im Hormonal,,96402,CPT,Facility,Both,,,,148,125.8,42.4168,148,UnitedHealthcare,Individual & Family,139.12,94,,percent of total billed charges,,
Chemotherapy Admin Sq/Im Hormonal,,96402,CPT,Facility,Outpatient,,,,148,125.8,42.4168,148,UnitedHealthcare,Medicare Advantage,72.52,49,,percent of total billed charges,,
Chemotherapy Admin Sq/Im Hormonal,,96402,CPT,Facility,Inpatient,,,,148,125.8,42.4168,148,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Chemotherapy Admin Sq/Im Hormonal,,96402,CPT,Facility,Outpatient,,,,148,125.8,42.4168,148,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,71.04,48,,percent of total billed charges,,100% of DHS outpatient percentage
Chemotherapy Admin Sq/Im Hormonal,,96402,CPT,Facility,Inpatient,,,,148,125.8,42.4168,148,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Irrigation Implanted Venous Access Device,,96523,CPT,Facility,Both,,,,393,334.05,112.6338,393,Aetna,Commercial,361.56,92,,percent of total billed charges,,
Irrigation Implanted Venous Access Device,,96523,CPT,Facility,Outpatient,,,,393,334.05,112.6338,393,Aetna,Medicare Advantage,192.57,49,,percent of total billed charges,,
Irrigation Implanted Venous Access Device,,96523,CPT,Facility,Inpatient,,,,393,334.05,112.6338,393,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Irrigation Implanted Venous Access Device,,96523,CPT,Facility,Both,,,,393,334.05,112.6338,393,Aetna,PPO,365.49,93,,percent of total billed charges,,
Irrigation Implanted Venous Access Device,,96523,CPT,Facility,Both,,,,393,334.05,112.6338,393,America's PPO,America's PPO,377.3979,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Irrigation Implanted Venous Access Device,,96523,CPT,Facility,Both,,,,393,334.05,112.6338,393,BlueCross BlueShield Minnesota, Federal Employee Program,386.712,98.4,,percent of total billed charges,,
Irrigation Implanted Venous Access Device,,96523,CPT,Facility,Both,,,,393,334.05,112.6338,393,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,393,100,,percent of total billed charges,,
Irrigation Implanted Venous Access Device,,96523,CPT,Facility,Both,,,,393,334.05,112.6338,393,BlueCross BlueShield Minnesota,High Value Network Plan,353.7,90,,percent of total billed charges,,
Irrigation Implanted Venous Access Device,,96523,CPT,Facility,Outpatient,,,,393,334.05,112.6338,393,BlueCross BlueShield Minnesota,Medicare Advantage,192.57,49,,percent of total billed charges,,
Irrigation Implanted Venous Access Device,,96523,CPT,Facility,Inpatient,,,,393,334.05,112.6338,393,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Irrigation Implanted Venous Access Device,,96523,CPT,Facility,Both,,,,393,334.05,112.6338,393,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,348.0801,88.57,,percent of total billed charges,,
Irrigation Implanted Venous Access Device,,96523,CPT,Facility,Both,,,,393,334.05,112.6338,393,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,112.6338,28.66,,percent of total billed charges,,
Irrigation Implanted Venous Access Device,,96523,CPT,Facility,Outpatient,,,,393,334.05,112.6338,393,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),192.57,49,,percent of total billed charges,,
Irrigation Implanted Venous Access Device,,96523,CPT,Facility,Inpatient,,,,393,334.05,112.6338,393,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Irrigation Implanted Venous Access Device,,96523,CPT,Facility,Both,,,,393,334.05,112.6338,393,CorVel,Worker's Compensation,393,100,,percent of total billed charges,,
Irrigation Implanted Venous Access Device,,96523,CPT,Facility,Both,,,,393,334.05,112.6338,393,First Health Group Corporation,First Health Network,381.21,97,,percent of total billed charges,,
Irrigation Implanted Venous Access Device,,96523,CPT,Facility,Both,,,,393,334.05,112.6338,393,"Health Partners, Inc.",Commercial,371.778,94.6,,percent of total billed charges,,
Irrigation Implanted Venous Access Device,,96523,CPT,Facility,Outpatient,,,,393,334.05,112.6338,393,"Health Partners, Inc.",Medicare Advantage,192.57,49,,percent of total billed charges,,
Irrigation Implanted Venous Access Device,,96523,CPT,Facility,Inpatient,,,,393,334.05,112.6338,393,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Irrigation Implanted Venous Access Device,,96523,CPT,Facility,Both,,,,393,334.05,112.6338,393,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),235.8,60,,percent of total billed charges,,
Irrigation Implanted Venous Access Device,,96523,CPT,Facility,Both,,,,393,334.05,112.6338,393,"Health Partners, Inc.",State of Minnesota Advantage Program,320.295,81.5,,percent of total billed charges,,
Irrigation Implanted Venous Access Device,,96523,CPT,Facility,Both,,,,393,334.05,112.6338,393,"Health Partners, Inc.",State Public Programs,196.5,50,,percent of total billed charges,,
Irrigation Implanted Venous Access Device,,96523,CPT,Facility,Both,,,,393,334.05,112.6338,393,Humana Insurance Company,Commercial PPO,373.35,95,,percent of total billed charges,,
Irrigation Implanted Venous Access Device,,96523,CPT,Facility,Outpatient,,,,393,334.05,112.6338,393,Humana Insurance Company,Medicare PPO,192.57,49,,percent of total billed charges,,
Irrigation Implanted Venous Access Device,,96523,CPT,Facility,Inpatient,,,,393,334.05,112.6338,393,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Irrigation Implanted Venous Access Device,,96523,CPT,Facility,Both,,,,393,334.05,112.6338,393,Medica,Individual & Family,389.463,99.1,,percent of total billed charges,,
Irrigation Implanted Venous Access Device,,96523,CPT,Facility,Outpatient,,,,393,334.05,112.6338,393,Medica,Medica Advantage Solution,195.714,49.8,,percent of total billed charges,,
Irrigation Implanted Venous Access Device,,96523,CPT,Facility,Inpatient,,,,393,334.05,112.6338,393,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Irrigation Implanted Venous Access Device,,96523,CPT,Facility,Outpatient,,,,393,334.05,112.6338,393,Medica,Medical Assistance,175.278,44.6,,percent of total billed charges,,
Irrigation Implanted Venous Access Device,,96523,CPT,Facility,Inpatient,,,,393,334.05,112.6338,393,Medica,Medical Assistance,,,,,Included in per diem rate,
Irrigation Implanted Venous Access Device,,96523,CPT,Facility,Outpatient,,,,393,334.05,112.6338,393,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,195.714,49.8,,percent of total billed charges,,
Irrigation Implanted Venous Access Device,,96523,CPT,Facility,Inpatient,,,,393,334.05,112.6338,393,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Irrigation Implanted Venous Access Device,,96523,CPT,Facility,Both,,,,393,334.05,112.6338,393,"Multiplan, Inc.","Multiplan, Inc.",369.42,94,,percent of total billed charges,,
Irrigation Implanted Venous Access Device,,96523,CPT,Facility,Outpatient,,,,393,334.05,112.6338,393,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,354.093,90.1,,percent of total billed charges,,
Irrigation Implanted Venous Access Device,,96523,CPT,Facility,Inpatient,,,,393,334.05,112.6338,393,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Irrigation Implanted Venous Access Device,,96523,CPT,Facility,Both,,,,393,334.05,112.6338,393,"Preferred One Administrative Services, INC.",PPO,387.498,98.6,,percent of total billed charges,,
Irrigation Implanted Venous Access Device,,96523,CPT,Facility,Outpatient,,,,393,334.05,112.6338,393,PrimeWest Health,Minnesota Senior Health Options (MSHO),202.1985,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Irrigation Implanted Venous Access Device,,96523,CPT,Facility,Inpatient,,,,393,334.05,112.6338,393,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Irrigation Implanted Venous Access Device,,96523,CPT,Facility,Outpatient,,,,393,334.05,112.6338,393,PrimeWest Health,MinnesotaCare,201.8448,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Irrigation Implanted Venous Access Device,,96523,CPT,Facility,Inpatient,,,,393,334.05,112.6338,393,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Irrigation Implanted Venous Access Device,,96523,CPT,Facility,Both,,,,393,334.05,112.6338,393,Sanford Health Plan,Sanford Health Plan,361.56,92,,percent of total billed charges,,
Irrigation Implanted Venous Access Device,,96523,CPT,Facility,Outpatient,,,,393,334.05,112.6338,393,"UCare Health, Inc.",Individual & Family Plan,221.4555,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Irrigation Implanted Venous Access Device,,96523,CPT,Facility,Inpatient,,,,393,334.05,112.6338,393,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Irrigation Implanted Venous Access Device,,96523,CPT,Facility,Outpatient,,,,393,334.05,112.6338,393,"UCare Health, Inc.",Medical Assistance,198.3471,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Irrigation Implanted Venous Access Device,,96523,CPT,Facility,Inpatient,,,,393,334.05,112.6338,393,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Irrigation Implanted Venous Access Device,,96523,CPT,Facility,Outpatient,,,,393,334.05,112.6338,393,"UCare Health, Inc.",Medicare Advantage,198.3471,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Irrigation Implanted Venous Access Device,,96523,CPT,Facility,Inpatient,,,,393,334.05,112.6338,393,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Irrigation Implanted Venous Access Device,,96523,CPT,Facility,Outpatient,,,,393,334.05,112.6338,393,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),198.3471,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Irrigation Implanted Venous Access Device,,96523,CPT,Facility,Inpatient,,,,393,334.05,112.6338,393,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Irrigation Implanted Venous Access Device,,96523,CPT,Facility,Both,,,,393,334.05,112.6338,393,UnitedHealthcare,Individual & Family,369.42,94,,percent of total billed charges,,
Irrigation Implanted Venous Access Device,,96523,CPT,Facility,Outpatient,,,,393,334.05,112.6338,393,UnitedHealthcare,Medicare Advantage,192.57,49,,percent of total billed charges,,
Irrigation Implanted Venous Access Device,,96523,CPT,Facility,Inpatient,,,,393,334.05,112.6338,393,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Irrigation Implanted Venous Access Device,,96523,CPT,Facility,Outpatient,,,,393,334.05,112.6338,393,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,188.64,48,,percent of total billed charges,,100% of DHS outpatient percentage
Irrigation Implanted Venous Access Device,,96523,CPT,Facility,Inpatient,,,,393,334.05,112.6338,393,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Actinotherapy (Ultra Violet Light),,96900,CPT,Facility,Both,,,,39,33.15,11.1774,39,Aetna,Commercial,35.88,92,,percent of total billed charges,,
Actinotherapy (Ultra Violet Light),,96900,CPT,Facility,Outpatient,,,,39,33.15,11.1774,39,Aetna,Medicare Advantage,19.11,49,,percent of total billed charges,,
Actinotherapy (Ultra Violet Light),,96900,CPT,Facility,Inpatient,,,,39,33.15,11.1774,39,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Actinotherapy (Ultra Violet Light),,96900,CPT,Facility,Both,,,,39,33.15,11.1774,39,Aetna,PPO,36.27,93,,percent of total billed charges,,
Actinotherapy (Ultra Violet Light),,96900,CPT,Facility,Both,,,,39,33.15,11.1774,39,America's PPO,America's PPO,37.4517,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Actinotherapy (Ultra Violet Light),,96900,CPT,Facility,Both,,,,39,33.15,11.1774,39,BlueCross BlueShield Minnesota, Federal Employee Program,38.376,98.4,,percent of total billed charges,,
Actinotherapy (Ultra Violet Light),,96900,CPT,Facility,Both,,,,39,33.15,11.1774,39,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,39,100,,percent of total billed charges,,
Actinotherapy (Ultra Violet Light),,96900,CPT,Facility,Both,,,,39,33.15,11.1774,39,BlueCross BlueShield Minnesota,High Value Network Plan,35.1,90,,percent of total billed charges,,
Actinotherapy (Ultra Violet Light),,96900,CPT,Facility,Outpatient,,,,39,33.15,11.1774,39,BlueCross BlueShield Minnesota,Medicare Advantage,19.11,49,,percent of total billed charges,,
Actinotherapy (Ultra Violet Light),,96900,CPT,Facility,Inpatient,,,,39,33.15,11.1774,39,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Actinotherapy (Ultra Violet Light),,96900,CPT,Facility,Both,,,,39,33.15,11.1774,39,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,34.5423,88.57,,percent of total billed charges,,
Actinotherapy (Ultra Violet Light),,96900,CPT,Facility,Both,,,,39,33.15,11.1774,39,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,11.1774,28.66,,percent of total billed charges,,
Actinotherapy (Ultra Violet Light),,96900,CPT,Facility,Outpatient,,,,39,33.15,11.1774,39,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),19.11,49,,percent of total billed charges,,
Actinotherapy (Ultra Violet Light),,96900,CPT,Facility,Inpatient,,,,39,33.15,11.1774,39,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Actinotherapy (Ultra Violet Light),,96900,CPT,Facility,Both,,,,39,33.15,11.1774,39,CorVel,Worker's Compensation,39,100,,percent of total billed charges,,
Actinotherapy (Ultra Violet Light),,96900,CPT,Facility,Both,,,,39,33.15,11.1774,39,First Health Group Corporation,First Health Network,37.83,97,,percent of total billed charges,,
Actinotherapy (Ultra Violet Light),,96900,CPT,Facility,Both,,,,39,33.15,11.1774,39,"Health Partners, Inc.",Commercial,36.894,94.6,,percent of total billed charges,,
Actinotherapy (Ultra Violet Light),,96900,CPT,Facility,Outpatient,,,,39,33.15,11.1774,39,"Health Partners, Inc.",Medicare Advantage,19.11,49,,percent of total billed charges,,
Actinotherapy (Ultra Violet Light),,96900,CPT,Facility,Inpatient,,,,39,33.15,11.1774,39,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Actinotherapy (Ultra Violet Light),,96900,CPT,Facility,Both,,,,39,33.15,11.1774,39,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),23.4,60,,percent of total billed charges,,
Actinotherapy (Ultra Violet Light),,96900,CPT,Facility,Both,,,,39,33.15,11.1774,39,"Health Partners, Inc.",State of Minnesota Advantage Program,31.785,81.5,,percent of total billed charges,,
Actinotherapy (Ultra Violet Light),,96900,CPT,Facility,Both,,,,39,33.15,11.1774,39,"Health Partners, Inc.",State Public Programs,19.5,50,,percent of total billed charges,,
Actinotherapy (Ultra Violet Light),,96900,CPT,Facility,Both,,,,39,33.15,11.1774,39,Humana Insurance Company,Commercial PPO,37.05,95,,percent of total billed charges,,
Actinotherapy (Ultra Violet Light),,96900,CPT,Facility,Outpatient,,,,39,33.15,11.1774,39,Humana Insurance Company,Medicare PPO,19.11,49,,percent of total billed charges,,
Actinotherapy (Ultra Violet Light),,96900,CPT,Facility,Inpatient,,,,39,33.15,11.1774,39,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Actinotherapy (Ultra Violet Light),,96900,CPT,Facility,Both,,,,39,33.15,11.1774,39,Medica,Individual & Family,38.649,99.1,,percent of total billed charges,,
Actinotherapy (Ultra Violet Light),,96900,CPT,Facility,Outpatient,,,,39,33.15,11.1774,39,Medica,Medica Advantage Solution,19.422,49.8,,percent of total billed charges,,
Actinotherapy (Ultra Violet Light),,96900,CPT,Facility,Inpatient,,,,39,33.15,11.1774,39,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Actinotherapy (Ultra Violet Light),,96900,CPT,Facility,Outpatient,,,,39,33.15,11.1774,39,Medica,Medical Assistance,17.394,44.6,,percent of total billed charges,,
Actinotherapy (Ultra Violet Light),,96900,CPT,Facility,Inpatient,,,,39,33.15,11.1774,39,Medica,Medical Assistance,,,,,Included in per diem rate,
Actinotherapy (Ultra Violet Light),,96900,CPT,Facility,Outpatient,,,,39,33.15,11.1774,39,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,19.422,49.8,,percent of total billed charges,,
Actinotherapy (Ultra Violet Light),,96900,CPT,Facility,Inpatient,,,,39,33.15,11.1774,39,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Actinotherapy (Ultra Violet Light),,96900,CPT,Facility,Both,,,,39,33.15,11.1774,39,"Multiplan, Inc.","Multiplan, Inc.",36.66,94,,percent of total billed charges,,
Actinotherapy (Ultra Violet Light),,96900,CPT,Facility,Outpatient,,,,39,33.15,11.1774,39,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,35.139,90.1,,percent of total billed charges,,
Actinotherapy (Ultra Violet Light),,96900,CPT,Facility,Inpatient,,,,39,33.15,11.1774,39,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Actinotherapy (Ultra Violet Light),,96900,CPT,Facility,Both,,,,39,33.15,11.1774,39,"Preferred One Administrative Services, INC.",PPO,38.454,98.6,,percent of total billed charges,,
Actinotherapy (Ultra Violet Light),,96900,CPT,Facility,Outpatient,,,,39,33.15,11.1774,39,PrimeWest Health,Minnesota Senior Health Options (MSHO),20.0655,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Actinotherapy (Ultra Violet Light),,96900,CPT,Facility,Inpatient,,,,39,33.15,11.1774,39,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Actinotherapy (Ultra Violet Light),,96900,CPT,Facility,Outpatient,,,,39,33.15,11.1774,39,PrimeWest Health,MinnesotaCare,20.0304,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Actinotherapy (Ultra Violet Light),,96900,CPT,Facility,Inpatient,,,,39,33.15,11.1774,39,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Actinotherapy (Ultra Violet Light),,96900,CPT,Facility,Both,,,,39,33.15,11.1774,39,Sanford Health Plan,Sanford Health Plan,35.88,92,,percent of total billed charges,,
Actinotherapy (Ultra Violet Light),,96900,CPT,Facility,Outpatient,,,,39,33.15,11.1774,39,"UCare Health, Inc.",Individual & Family Plan,21.9765,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Actinotherapy (Ultra Violet Light),,96900,CPT,Facility,Inpatient,,,,39,33.15,11.1774,39,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Actinotherapy (Ultra Violet Light),,96900,CPT,Facility,Outpatient,,,,39,33.15,11.1774,39,"UCare Health, Inc.",Medical Assistance,19.6833,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Actinotherapy (Ultra Violet Light),,96900,CPT,Facility,Inpatient,,,,39,33.15,11.1774,39,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Actinotherapy (Ultra Violet Light),,96900,CPT,Facility,Outpatient,,,,39,33.15,11.1774,39,"UCare Health, Inc.",Medicare Advantage,19.6833,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Actinotherapy (Ultra Violet Light),,96900,CPT,Facility,Inpatient,,,,39,33.15,11.1774,39,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Actinotherapy (Ultra Violet Light),,96900,CPT,Facility,Outpatient,,,,39,33.15,11.1774,39,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),19.6833,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Actinotherapy (Ultra Violet Light),,96900,CPT,Facility,Inpatient,,,,39,33.15,11.1774,39,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Actinotherapy (Ultra Violet Light),,96900,CPT,Facility,Both,,,,39,33.15,11.1774,39,UnitedHealthcare,Individual & Family,36.66,94,,percent of total billed charges,,
Actinotherapy (Ultra Violet Light),,96900,CPT,Facility,Outpatient,,,,39,33.15,11.1774,39,UnitedHealthcare,Medicare Advantage,19.11,49,,percent of total billed charges,,
Actinotherapy (Ultra Violet Light),,96900,CPT,Facility,Inpatient,,,,39,33.15,11.1774,39,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Actinotherapy (Ultra Violet Light),,96900,CPT,Facility,Outpatient,,,,39,33.15,11.1774,39,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,18.72,48,,percent of total billed charges,,100% of DHS outpatient percentage
Actinotherapy (Ultra Violet Light),,96900,CPT,Facility,Inpatient,,,,39,33.15,11.1774,39,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Actinotherapy (Ultra Violet Light) (Procah),,96900,CPT,Professional,Both,,,,56,47.6,15.92,56,Aetna,Commercial,47.6,85,,percent of total billed charges,,
Actinotherapy (Ultra Violet Light) (Procah),,96900,CPT,Professional,Both,,,,56,47.6,15.92,56,Aetna,Medicare Advantage,23.81,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Actinotherapy (Ultra Violet Light) (Procah),,96900,CPT,Professional,Both,,,,56,47.6,15.92,56,Aetna,PPO,52.08,93,,percent of total billed charges,,
Actinotherapy (Ultra Violet Light) (Procah),,96900,CPT,Professional,Both,,,,56,47.6,15.92,56,America's PPO,America's PPO,47.8464,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Actinotherapy (Ultra Violet Light) (Procah),,96900,CPT,Professional,Both,,,,56,47.6,15.92,56,BlueCross BlueShield Minnesota, Federal Employee Program,42.6,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Actinotherapy (Ultra Violet Light) (Procah),,96900,CPT,Professional,Both,,,,56,47.6,15.92,56,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,43.2816,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Actinotherapy (Ultra Violet Light) (Procah),,96900,CPT,Professional,Both,,,,56,47.6,15.92,56,BlueCross BlueShield Minnesota,High Value Network Plan,43.2816,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Actinotherapy (Ultra Violet Light) (Procah),,96900,CPT,Professional,Both,,,,56,47.6,15.92,56,BlueCross BlueShield Minnesota,Medicare Advantage,28.7155,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Actinotherapy (Ultra Violet Light) (Procah),,96900,CPT,Professional,Both,,,,56,47.6,15.92,56,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,43.2816,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Actinotherapy (Ultra Violet Light) (Procah),,96900,CPT,Professional,Both,,,,56,47.6,15.92,56,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,18.37944,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Actinotherapy (Ultra Violet Light) (Procah),,96900,CPT,Professional,Both,,,,56,47.6,15.92,56,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),28.7155,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Actinotherapy (Ultra Violet Light) (Procah),,96900,CPT,Professional,Both,,,,56,47.6,15.92,56,CorVel,Worker's Compensation,47.8673571,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Actinotherapy (Ultra Violet Light) (Procah),,96900,CPT,Professional,Both,,,,56,47.6,15.92,56,First Health Group Corporation,First Health Network,54.32,97,,percent of total billed charges,,
Actinotherapy (Ultra Violet Light) (Procah),,96900,CPT,Professional,Both,,,,56,47.6,15.92,56,"Health Partners, Inc.",Commercial,51.51,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Actinotherapy (Ultra Violet Light) (Procah),,96900,CPT,Professional,Both,,,,56,47.6,15.92,56,"Health Partners, Inc.",Medicare Advantage,28.7155,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Actinotherapy (Ultra Violet Light) (Procah),,96900,CPT,Professional,Both,,,,56,47.6,15.92,56,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),24.74,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Actinotherapy (Ultra Violet Light) (Procah),,96900,CPT,Professional,Both,,,,56,47.6,15.92,56,"Health Partners, Inc.",State of Minnesota Advantage Program,44.375865,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Actinotherapy (Ultra Violet Light) (Procah),,96900,CPT,Professional,Both,,,,56,47.6,15.92,56,"Health Partners, Inc.",State Public Programs,15.92,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Actinotherapy (Ultra Violet Light) (Procah),,96900,CPT,Professional,Both,,,,56,47.6,15.92,56,Humana Insurance Company,Commercial PPO,24.97,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Actinotherapy (Ultra Violet Light) (Procah),,96900,CPT,Professional,Both,,,,56,47.6,15.92,56,Humana Insurance Company,Medicare PPO,56,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Actinotherapy (Ultra Violet Light) (Procah),,96900,CPT,Professional,Both,,,,56,47.6,15.92,56,Medica,Individual & Family,47.488,84.8,,percent of total billed charges,,
Actinotherapy (Ultra Violet Light) (Procah),,96900,CPT,Professional,Both,,,,56,47.6,15.92,56,Medica,Medica Advantage Solution,27.888,49.8,,percent of total billed charges,,
Actinotherapy (Ultra Violet Light) (Procah),,96900,CPT,Professional,Both,,,,56,47.6,15.92,56,Medica,Medical Assistance,18.38,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Actinotherapy (Ultra Violet Light) (Procah),,96900,CPT,Professional,Both,,,,56,47.6,15.92,56,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,24.97,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Actinotherapy (Ultra Violet Light) (Procah),,96900,CPT,Professional,Both,,,,56,47.6,15.92,56,"Multiplan, Inc.","Multiplan, Inc.",52.64,94,,percent of total billed charges,,
Actinotherapy (Ultra Violet Light) (Procah),,96900,CPT,Professional,Both,,,,56,47.6,15.92,56,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,50.456,90.1,,percent of total billed charges,,
Actinotherapy (Ultra Violet Light) (Procah),,96900,CPT,Professional,Both,,,,56,47.6,15.92,56,"Preferred One Administrative Services, INC.",PPO,55.216,98.6,,percent of total billed charges,,
Actinotherapy (Ultra Violet Light) (Procah),,96900,CPT,Professional,Both,,,,56,47.6,15.92,56,PrimeWest Health,Minnesota Senior Health Options (MSHO),28.7155,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Actinotherapy (Ultra Violet Light) (Procah),,96900,CPT,Professional,Both,,,,56,47.6,15.92,56,PrimeWest Health,MinnesotaCare,19.6660008,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Actinotherapy (Ultra Violet Light) (Procah),,96900,CPT,Professional,Both,,,,56,47.6,15.92,56,Sanford Health Plan,Sanford Health Plan,49.28,88,,percent of total billed charges,,
Actinotherapy (Ultra Violet Light) (Procah),,96900,CPT,Professional,Both,,,,56,47.6,15.92,56,"UCare Health, Inc.",Individual & Family Plan,40.591232,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Actinotherapy (Ultra Violet Light) (Procah),,96900,CPT,Professional,Both,,,,56,47.6,15.92,56,"UCare Health, Inc.",Medical Assistance,20.217384,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Actinotherapy (Ultra Violet Light) (Procah),,96900,CPT,Professional,Both,,,,56,47.6,15.92,56,"UCare Health, Inc.",Medicare Advantage,28.7155,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Actinotherapy (Ultra Violet Light) (Procah),,96900,CPT,Professional,Both,,,,56,47.6,15.92,56,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),22.9724,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Actinotherapy (Ultra Violet Light) (Procah),,96900,CPT,Professional,Both,,,,56,47.6,15.92,56,UnitedHealthcare,Individual & Family,56,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Actinotherapy (Ultra Violet Light) (Procah),,96900,CPT,Professional,Both,,,,56,47.6,15.92,56,UnitedHealthcare,Medicare Advantage,28.7155,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Actinotherapy (Ultra Violet Light) (Procah),,96900,CPT,Professional,Both,,,,56,47.6,15.92,56,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,18.37944,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
BUDESONIDE-FORMOTEROL 160-4.5 MCG/ACTUATION INHL HFAA,,76245,LOCAL,Facility,Both,10.2,g,,1687,1433.95,483.4942,1687,Aetna,Commercial,1552.04,92,,percent of total billed charges,,
BUDESONIDE-FORMOTEROL 160-4.5 MCG/ACTUATION INHL HFAA,,76245,LOCAL,Facility,Outpatient,10.2,g,,1687,1433.95,483.4942,1687,Aetna,Medicare Advantage,826.63,49,,percent of total billed charges,,
BUDESONIDE-FORMOTEROL 160-4.5 MCG/ACTUATION INHL HFAA,,76245,LOCAL,Facility,Inpatient,10.2,g,,1687,1433.95,483.4942,1687,Aetna,Medicare Advantage,,,,,Included in per diem rate,
BUDESONIDE-FORMOTEROL 160-4.5 MCG/ACTUATION INHL HFAA,,76245,LOCAL,Facility,Both,10.2,g,,1687,1433.95,483.4942,1687,Aetna,PPO,1568.91,93,,percent of total billed charges,,
BUDESONIDE-FORMOTEROL 160-4.5 MCG/ACTUATION INHL HFAA,,76245,LOCAL,Facility,Both,10.2,g,,1687,1433.95,483.4942,1687,America's PPO,America's PPO,1620.0261,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
BUDESONIDE-FORMOTEROL 160-4.5 MCG/ACTUATION INHL HFAA,,76245,LOCAL,Facility,Both,10.2,g,,1687,1433.95,483.4942,1687,BlueCross BlueShield Minnesota, Federal Employee Program,1660.008,98.4,,percent of total billed charges,,
BUDESONIDE-FORMOTEROL 160-4.5 MCG/ACTUATION INHL HFAA,,76245,LOCAL,Facility,Both,10.2,g,,1687,1433.95,483.4942,1687,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1687,100,,percent of total billed charges,,
BUDESONIDE-FORMOTEROL 160-4.5 MCG/ACTUATION INHL HFAA,,76245,LOCAL,Facility,Both,10.2,g,,1687,1433.95,483.4942,1687,BlueCross BlueShield Minnesota,High Value Network Plan,1518.3,90,,percent of total billed charges,,
BUDESONIDE-FORMOTEROL 160-4.5 MCG/ACTUATION INHL HFAA,,76245,LOCAL,Facility,Outpatient,10.2,g,,1687,1433.95,483.4942,1687,BlueCross BlueShield Minnesota,Medicare Advantage,826.63,49,,percent of total billed charges,,
BUDESONIDE-FORMOTEROL 160-4.5 MCG/ACTUATION INHL HFAA,,76245,LOCAL,Facility,Inpatient,10.2,g,,1687,1433.95,483.4942,1687,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
BUDESONIDE-FORMOTEROL 160-4.5 MCG/ACTUATION INHL HFAA,,76245,LOCAL,Facility,Both,10.2,g,,1687,1433.95,483.4942,1687,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1494.1759,88.57,,percent of total billed charges,,
BUDESONIDE-FORMOTEROL 160-4.5 MCG/ACTUATION INHL HFAA,,76245,LOCAL,Facility,Both,10.2,g,,1687,1433.95,483.4942,1687,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,483.4942,28.66,,percent of total billed charges,,
BUDESONIDE-FORMOTEROL 160-4.5 MCG/ACTUATION INHL HFAA,,76245,LOCAL,Facility,Outpatient,10.2,g,,1687,1433.95,483.4942,1687,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),826.63,49,,percent of total billed charges,,
BUDESONIDE-FORMOTEROL 160-4.5 MCG/ACTUATION INHL HFAA,,76245,LOCAL,Facility,Inpatient,10.2,g,,1687,1433.95,483.4942,1687,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
BUDESONIDE-FORMOTEROL 160-4.5 MCG/ACTUATION INHL HFAA,,76245,LOCAL,Facility,Both,10.2,g,,1687,1433.95,483.4942,1687,CorVel,Worker's Compensation,1687,100,,percent of total billed charges,,
BUDESONIDE-FORMOTEROL 160-4.5 MCG/ACTUATION INHL HFAA,,76245,LOCAL,Facility,Both,10.2,g,,1687,1433.95,483.4942,1687,First Health Group Corporation,First Health Network,1636.39,97,,percent of total billed charges,,
BUDESONIDE-FORMOTEROL 160-4.5 MCG/ACTUATION INHL HFAA,,76245,LOCAL,Facility,Both,10.2,g,,1687,1433.95,483.4942,1687,"Health Partners, Inc.",Commercial,1595.902,94.6,,percent of total billed charges,,
BUDESONIDE-FORMOTEROL 160-4.5 MCG/ACTUATION INHL HFAA,,76245,LOCAL,Facility,Outpatient,10.2,g,,1687,1433.95,483.4942,1687,"Health Partners, Inc.",Medicare Advantage,826.63,49,,percent of total billed charges,,
BUDESONIDE-FORMOTEROL 160-4.5 MCG/ACTUATION INHL HFAA,,76245,LOCAL,Facility,Inpatient,10.2,g,,1687,1433.95,483.4942,1687,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
BUDESONIDE-FORMOTEROL 160-4.5 MCG/ACTUATION INHL HFAA,,76245,LOCAL,Facility,Both,10.2,g,,1687,1433.95,483.4942,1687,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1012.2,60,,percent of total billed charges,,
BUDESONIDE-FORMOTEROL 160-4.5 MCG/ACTUATION INHL HFAA,,76245,LOCAL,Facility,Both,10.2,g,,1687,1433.95,483.4942,1687,"Health Partners, Inc.",State of Minnesota Advantage Program,1374.905,81.5,,percent of total billed charges,,
BUDESONIDE-FORMOTEROL 160-4.5 MCG/ACTUATION INHL HFAA,,76245,LOCAL,Facility,Both,10.2,g,,1687,1433.95,483.4942,1687,"Health Partners, Inc.",State Public Programs,843.5,50,,percent of total billed charges,,
BUDESONIDE-FORMOTEROL 160-4.5 MCG/ACTUATION INHL HFAA,,76245,LOCAL,Facility,Both,10.2,g,,1687,1433.95,483.4942,1687,Humana Insurance Company,Commercial PPO,1602.65,95,,percent of total billed charges,,
BUDESONIDE-FORMOTEROL 160-4.5 MCG/ACTUATION INHL HFAA,,76245,LOCAL,Facility,Outpatient,10.2,g,,1687,1433.95,483.4942,1687,Humana Insurance Company,Medicare PPO,826.63,49,,percent of total billed charges,,
BUDESONIDE-FORMOTEROL 160-4.5 MCG/ACTUATION INHL HFAA,,76245,LOCAL,Facility,Inpatient,10.2,g,,1687,1433.95,483.4942,1687,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
BUDESONIDE-FORMOTEROL 160-4.5 MCG/ACTUATION INHL HFAA,,76245,LOCAL,Facility,Both,10.2,g,,1687,1433.95,483.4942,1687,Medica,Individual & Family,1671.817,99.1,,percent of total billed charges,,
BUDESONIDE-FORMOTEROL 160-4.5 MCG/ACTUATION INHL HFAA,,76245,LOCAL,Facility,Outpatient,10.2,g,,1687,1433.95,483.4942,1687,Medica,Medica Advantage Solution,840.126,49.8,,percent of total billed charges,,
BUDESONIDE-FORMOTEROL 160-4.5 MCG/ACTUATION INHL HFAA,,76245,LOCAL,Facility,Inpatient,10.2,g,,1687,1433.95,483.4942,1687,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
BUDESONIDE-FORMOTEROL 160-4.5 MCG/ACTUATION INHL HFAA,,76245,LOCAL,Facility,Outpatient,10.2,g,,1687,1433.95,483.4942,1687,Medica,Medical Assistance,752.402,44.6,,percent of total billed charges,,
BUDESONIDE-FORMOTEROL 160-4.5 MCG/ACTUATION INHL HFAA,,76245,LOCAL,Facility,Inpatient,10.2,g,,1687,1433.95,483.4942,1687,Medica,Medical Assistance,,,,,Included in per diem rate,
BUDESONIDE-FORMOTEROL 160-4.5 MCG/ACTUATION INHL HFAA,,76245,LOCAL,Facility,Outpatient,10.2,g,,1687,1433.95,483.4942,1687,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,840.126,49.8,,percent of total billed charges,,
BUDESONIDE-FORMOTEROL 160-4.5 MCG/ACTUATION INHL HFAA,,76245,LOCAL,Facility,Inpatient,10.2,g,,1687,1433.95,483.4942,1687,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
BUDESONIDE-FORMOTEROL 160-4.5 MCG/ACTUATION INHL HFAA,,76245,LOCAL,Facility,Both,10.2,g,,1687,1433.95,483.4942,1687,"Multiplan, Inc.","Multiplan, Inc.",1585.78,94,,percent of total billed charges,,
BUDESONIDE-FORMOTEROL 160-4.5 MCG/ACTUATION INHL HFAA,,76245,LOCAL,Facility,Outpatient,10.2,g,,1687,1433.95,483.4942,1687,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1519.987,90.1,,percent of total billed charges,,
BUDESONIDE-FORMOTEROL 160-4.5 MCG/ACTUATION INHL HFAA,,76245,LOCAL,Facility,Inpatient,10.2,g,,1687,1433.95,483.4942,1687,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
BUDESONIDE-FORMOTEROL 160-4.5 MCG/ACTUATION INHL HFAA,,76245,LOCAL,Facility,Both,10.2,g,,1687,1433.95,483.4942,1687,"Preferred One Administrative Services, INC.",PPO,1663.382,98.6,,percent of total billed charges,,
BUDESONIDE-FORMOTEROL 160-4.5 MCG/ACTUATION INHL HFAA,,76245,LOCAL,Facility,Outpatient,10.2,g,,1687,1433.95,483.4942,1687,PrimeWest Health,Minnesota Senior Health Options (MSHO),867.9615,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
BUDESONIDE-FORMOTEROL 160-4.5 MCG/ACTUATION INHL HFAA,,76245,LOCAL,Facility,Inpatient,10.2,g,,1687,1433.95,483.4942,1687,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
BUDESONIDE-FORMOTEROL 160-4.5 MCG/ACTUATION INHL HFAA,,76245,LOCAL,Facility,Outpatient,10.2,g,,1687,1433.95,483.4942,1687,PrimeWest Health,MinnesotaCare,866.4432,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
BUDESONIDE-FORMOTEROL 160-4.5 MCG/ACTUATION INHL HFAA,,76245,LOCAL,Facility,Inpatient,10.2,g,,1687,1433.95,483.4942,1687,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
BUDESONIDE-FORMOTEROL 160-4.5 MCG/ACTUATION INHL HFAA,,76245,LOCAL,Facility,Both,10.2,g,,1687,1433.95,483.4942,1687,Sanford Health Plan,Sanford Health Plan,1552.04,92,,percent of total billed charges,,
BUDESONIDE-FORMOTEROL 160-4.5 MCG/ACTUATION INHL HFAA,,76245,LOCAL,Facility,Outpatient,10.2,g,,1687,1433.95,483.4942,1687,"UCare Health, Inc.",Individual & Family Plan,950.6245,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
BUDESONIDE-FORMOTEROL 160-4.5 MCG/ACTUATION INHL HFAA,,76245,LOCAL,Facility,Inpatient,10.2,g,,1687,1433.95,483.4942,1687,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
BUDESONIDE-FORMOTEROL 160-4.5 MCG/ACTUATION INHL HFAA,,76245,LOCAL,Facility,Outpatient,10.2,g,,1687,1433.95,483.4942,1687,"UCare Health, Inc.",Medical Assistance,851.4289,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BUDESONIDE-FORMOTEROL 160-4.5 MCG/ACTUATION INHL HFAA,,76245,LOCAL,Facility,Inpatient,10.2,g,,1687,1433.95,483.4942,1687,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
BUDESONIDE-FORMOTEROL 160-4.5 MCG/ACTUATION INHL HFAA,,76245,LOCAL,Facility,Outpatient,10.2,g,,1687,1433.95,483.4942,1687,"UCare Health, Inc.",Medicare Advantage,851.4289,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BUDESONIDE-FORMOTEROL 160-4.5 MCG/ACTUATION INHL HFAA,,76245,LOCAL,Facility,Inpatient,10.2,g,,1687,1433.95,483.4942,1687,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
BUDESONIDE-FORMOTEROL 160-4.5 MCG/ACTUATION INHL HFAA,,76245,LOCAL,Facility,Outpatient,10.2,g,,1687,1433.95,483.4942,1687,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),851.4289,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BUDESONIDE-FORMOTEROL 160-4.5 MCG/ACTUATION INHL HFAA,,76245,LOCAL,Facility,Inpatient,10.2,g,,1687,1433.95,483.4942,1687,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
BUDESONIDE-FORMOTEROL 160-4.5 MCG/ACTUATION INHL HFAA,,76245,LOCAL,Facility,Both,10.2,g,,1687,1433.95,483.4942,1687,UnitedHealthcare,Individual & Family,1585.78,94,,percent of total billed charges,,
BUDESONIDE-FORMOTEROL 160-4.5 MCG/ACTUATION INHL HFAA,,76245,LOCAL,Facility,Outpatient,10.2,g,,1687,1433.95,483.4942,1687,UnitedHealthcare,Medicare Advantage,826.63,49,,percent of total billed charges,,
BUDESONIDE-FORMOTEROL 160-4.5 MCG/ACTUATION INHL HFAA,,76245,LOCAL,Facility,Inpatient,10.2,g,,1687,1433.95,483.4942,1687,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
BUDESONIDE-FORMOTEROL 160-4.5 MCG/ACTUATION INHL HFAA,,76245,LOCAL,Facility,Outpatient,10.2,g,,1687,1433.95,483.4942,1687,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,809.76,48,,percent of total billed charges,,100% of DHS outpatient percentage
BUDESONIDE-FORMOTEROL 160-4.5 MCG/ACTUATION INHL HFAA,,76245,LOCAL,Facility,Inpatient,10.2,g,,1687,1433.95,483.4942,1687,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Application Of Modality To 1 Or More Areas; Electrical Stimulation (Manual), Each 15 Minutes (Procah)",,97032,CPT,Professional,Both,,,,66,56.1,9.898635,66,Aetna,Commercial,56.1,85,,percent of total billed charges,,
"Application Of Modality To 1 Or More Areas; Electrical Stimulation (Manual), Each 15 Minutes (Procah)",,97032,CPT,Professional,Both,,,,66,56.1,9.898635,66,Aetna,Medicare Advantage,14.86,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Application Of Modality To 1 Or More Areas; Electrical Stimulation (Manual), Each 15 Minutes (Procah)",,97032,CPT,Professional,Both,,,,66,56.1,9.898635,66,Aetna,PPO,61.38,93,,percent of total billed charges,,
"Application Of Modality To 1 Or More Areas; Electrical Stimulation (Manual), Each 15 Minutes (Procah)",,97032,CPT,Professional,Both,,,,66,56.1,9.898635,66,America's PPO,America's PPO,56.3904,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Application Of Modality To 1 Or More Areas; Electrical Stimulation (Manual), Each 15 Minutes (Procah)",,97032,CPT,Professional,Both,,,,66,56.1,9.898635,66,BlueCross BlueShield Minnesota, Federal Employee Program,18.49,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Application Of Modality To 1 Or More Areas; Electrical Stimulation (Manual), Each 15 Minutes (Procah)",,97032,CPT,Professional,Both,,,,66,56.1,9.898635,66,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,18.78584,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Application Of Modality To 1 Or More Areas; Electrical Stimulation (Manual), Each 15 Minutes (Procah)",,97032,CPT,Professional,Both,,,,66,56.1,9.898635,66,BlueCross BlueShield Minnesota,High Value Network Plan,18.78584,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Application Of Modality To 1 Or More Areas; Electrical Stimulation (Manual), Each 15 Minutes (Procah)",,97032,CPT,Professional,Both,,,,66,56.1,9.898635,66,BlueCross BlueShield Minnesota,Medicare Advantage,16.6175,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Application Of Modality To 1 Or More Areas; Electrical Stimulation (Manual), Each 15 Minutes (Procah)",,97032,CPT,Professional,Both,,,,66,56.1,9.898635,66,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,18.78584,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Application Of Modality To 1 Or More Areas; Electrical Stimulation (Manual), Each 15 Minutes (Procah)",,97032,CPT,Professional,Both,,,,66,56.1,9.898635,66,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,10.57656,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Application Of Modality To 1 Or More Areas; Electrical Stimulation (Manual), Each 15 Minutes (Procah)",,97032,CPT,Professional,Both,,,,66,56.1,9.898635,66,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),16.6175,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Application Of Modality To 1 Or More Areas; Electrical Stimulation (Manual), Each 15 Minutes (Procah)",,97032,CPT,Professional,Both,,,,66,56.1,9.898635,66,CorVel,Worker's Compensation,25.68,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Application Of Modality To 1 Or More Areas; Electrical Stimulation (Manual), Each 15 Minutes (Procah)",,97032,CPT,Professional,Both,,,,66,56.1,9.898635,66,First Health Group Corporation,First Health Network,64.02,97,,percent of total billed charges,,
"Application Of Modality To 1 Or More Areas; Electrical Stimulation (Manual), Each 15 Minutes (Procah)",,97032,CPT,Professional,Both,,,,66,56.1,9.898635,66,"Health Partners, Inc.",Commercial,11.49,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Application Of Modality To 1 Or More Areas; Electrical Stimulation (Manual), Each 15 Minutes (Procah)",,97032,CPT,Professional,Both,,,,66,56.1,9.898635,66,"Health Partners, Inc.",Medicare Advantage,16.6175,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Application Of Modality To 1 Or More Areas; Electrical Stimulation (Manual), Each 15 Minutes (Procah)",,97032,CPT,Professional,Both,,,,66,56.1,9.898635,66,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),14.23,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Application Of Modality To 1 Or More Areas; Electrical Stimulation (Manual), Each 15 Minutes (Procah)",,97032,CPT,Professional,Both,,,,66,56.1,9.898635,66,"Health Partners, Inc.",State of Minnesota Advantage Program,9.898635,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Application Of Modality To 1 Or More Areas; Electrical Stimulation (Manual), Each 15 Minutes (Procah)",,97032,CPT,Professional,Both,,,,66,56.1,9.898635,66,"Health Partners, Inc.",State Public Programs,10.41,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Application Of Modality To 1 Or More Areas; Electrical Stimulation (Manual), Each 15 Minutes (Procah)",,97032,CPT,Professional,Both,,,,66,56.1,9.898635,66,Humana Insurance Company,Commercial PPO,14.45,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Application Of Modality To 1 Or More Areas; Electrical Stimulation (Manual), Each 15 Minutes (Procah)",,97032,CPT,Professional,Both,,,,66,56.1,9.898635,66,Humana Insurance Company,Medicare PPO,66,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Application Of Modality To 1 Or More Areas; Electrical Stimulation (Manual), Each 15 Minutes (Procah)",,97032,CPT,Professional,Both,,,,66,56.1,9.898635,66,Medica,Individual & Family,55.968,84.8,,percent of total billed charges,,
"Application Of Modality To 1 Or More Areas; Electrical Stimulation (Manual), Each 15 Minutes (Procah)",,97032,CPT,Professional,Both,,,,66,56.1,9.898635,66,Medica,Medica Advantage Solution,32.868,49.8,,percent of total billed charges,,
"Application Of Modality To 1 Or More Areas; Electrical Stimulation (Manual), Each 15 Minutes (Procah)",,97032,CPT,Professional,Both,,,,66,56.1,9.898635,66,Medica,Medical Assistance,10.58,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Application Of Modality To 1 Or More Areas; Electrical Stimulation (Manual), Each 15 Minutes (Procah)",,97032,CPT,Professional,Both,,,,66,56.1,9.898635,66,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,14.45,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Application Of Modality To 1 Or More Areas; Electrical Stimulation (Manual), Each 15 Minutes (Procah)",,97032,CPT,Professional,Both,,,,66,56.1,9.898635,66,"Multiplan, Inc.","Multiplan, Inc.",62.04,94,,percent of total billed charges,,
"Application Of Modality To 1 Or More Areas; Electrical Stimulation (Manual), Each 15 Minutes (Procah)",,97032,CPT,Professional,Both,,,,66,56.1,9.898635,66,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,59.466,90.1,,percent of total billed charges,,
"Application Of Modality To 1 Or More Areas; Electrical Stimulation (Manual), Each 15 Minutes (Procah)",,97032,CPT,Professional,Both,,,,66,56.1,9.898635,66,"Preferred One Administrative Services, INC.",PPO,65.076,98.6,,percent of total billed charges,,
"Application Of Modality To 1 Or More Areas; Electrical Stimulation (Manual), Each 15 Minutes (Procah)",,97032,CPT,Professional,Both,,,,66,56.1,9.898635,66,PrimeWest Health,Minnesota Senior Health Options (MSHO),16.6175,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Application Of Modality To 1 Or More Areas; Electrical Stimulation (Manual), Each 15 Minutes (Procah)",,97032,CPT,Professional,Both,,,,66,56.1,9.898635,66,PrimeWest Health,MinnesotaCare,11.3169192,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Application Of Modality To 1 Or More Areas; Electrical Stimulation (Manual), Each 15 Minutes (Procah)",,97032,CPT,Professional,Both,,,,66,56.1,9.898635,66,Sanford Health Plan,Sanford Health Plan,58.08,88,,percent of total billed charges,,
"Application Of Modality To 1 Or More Areas; Electrical Stimulation (Manual), Each 15 Minutes (Procah)",,97032,CPT,Professional,Both,,,,66,56.1,9.898635,66,"UCare Health, Inc.",Individual & Family Plan,23.48992,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Application Of Modality To 1 Or More Areas; Electrical Stimulation (Manual), Each 15 Minutes (Procah)",,97032,CPT,Professional,Both,,,,66,56.1,9.898635,66,"UCare Health, Inc.",Medical Assistance,11.634216,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Application Of Modality To 1 Or More Areas; Electrical Stimulation (Manual), Each 15 Minutes (Procah)",,97032,CPT,Professional,Both,,,,66,56.1,9.898635,66,"UCare Health, Inc.",Medicare Advantage,16.6175,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Application Of Modality To 1 Or More Areas; Electrical Stimulation (Manual), Each 15 Minutes (Procah)",,97032,CPT,Professional,Both,,,,66,56.1,9.898635,66,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),13.294,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Application Of Modality To 1 Or More Areas; Electrical Stimulation (Manual), Each 15 Minutes (Procah)",,97032,CPT,Professional,Both,,,,66,56.1,9.898635,66,UnitedHealthcare,Individual & Family,66,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Application Of Modality To 1 Or More Areas; Electrical Stimulation (Manual), Each 15 Minutes (Procah)",,97032,CPT,Professional,Both,,,,66,56.1,9.898635,66,UnitedHealthcare,Medicare Advantage,16.6175,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Application Of Modality To 1 Or More Areas; Electrical Stimulation (Manual), Each 15 Minutes (Procah)",,97032,CPT,Professional,Both,,,,66,56.1,9.898635,66,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,10.57656,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
FLUTICASONE PROPIONATE 44 MCG/ACTUATION INHL HFAA,,13515,LOCAL,Facility,Both,10.6,g,,958,814.3,274.5628,958,Aetna,Commercial,881.36,92,,percent of total billed charges,,
FLUTICASONE PROPIONATE 44 MCG/ACTUATION INHL HFAA,,13515,LOCAL,Facility,Outpatient,10.6,g,,958,814.3,274.5628,958,Aetna,Medicare Advantage,469.42,49,,percent of total billed charges,,
FLUTICASONE PROPIONATE 44 MCG/ACTUATION INHL HFAA,,13515,LOCAL,Facility,Inpatient,10.6,g,,958,814.3,274.5628,958,Aetna,Medicare Advantage,,,,,Included in per diem rate,
FLUTICASONE PROPIONATE 44 MCG/ACTUATION INHL HFAA,,13515,LOCAL,Facility,Both,10.6,g,,958,814.3,274.5628,958,Aetna,PPO,890.94,93,,percent of total billed charges,,
FLUTICASONE PROPIONATE 44 MCG/ACTUATION INHL HFAA,,13515,LOCAL,Facility,Both,10.6,g,,958,814.3,274.5628,958,America's PPO,America's PPO,919.9674,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
FLUTICASONE PROPIONATE 44 MCG/ACTUATION INHL HFAA,,13515,LOCAL,Facility,Both,10.6,g,,958,814.3,274.5628,958,BlueCross BlueShield Minnesota, Federal Employee Program,942.672,98.4,,percent of total billed charges,,
FLUTICASONE PROPIONATE 44 MCG/ACTUATION INHL HFAA,,13515,LOCAL,Facility,Both,10.6,g,,958,814.3,274.5628,958,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,958,100,,percent of total billed charges,,
FLUTICASONE PROPIONATE 44 MCG/ACTUATION INHL HFAA,,13515,LOCAL,Facility,Both,10.6,g,,958,814.3,274.5628,958,BlueCross BlueShield Minnesota,High Value Network Plan,862.2,90,,percent of total billed charges,,
FLUTICASONE PROPIONATE 44 MCG/ACTUATION INHL HFAA,,13515,LOCAL,Facility,Outpatient,10.6,g,,958,814.3,274.5628,958,BlueCross BlueShield Minnesota,Medicare Advantage,469.42,49,,percent of total billed charges,,
FLUTICASONE PROPIONATE 44 MCG/ACTUATION INHL HFAA,,13515,LOCAL,Facility,Inpatient,10.6,g,,958,814.3,274.5628,958,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
FLUTICASONE PROPIONATE 44 MCG/ACTUATION INHL HFAA,,13515,LOCAL,Facility,Both,10.6,g,,958,814.3,274.5628,958,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,848.5006,88.57,,percent of total billed charges,,
FLUTICASONE PROPIONATE 44 MCG/ACTUATION INHL HFAA,,13515,LOCAL,Facility,Both,10.6,g,,958,814.3,274.5628,958,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,274.5628,28.66,,percent of total billed charges,,
FLUTICASONE PROPIONATE 44 MCG/ACTUATION INHL HFAA,,13515,LOCAL,Facility,Outpatient,10.6,g,,958,814.3,274.5628,958,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),469.42,49,,percent of total billed charges,,
FLUTICASONE PROPIONATE 44 MCG/ACTUATION INHL HFAA,,13515,LOCAL,Facility,Inpatient,10.6,g,,958,814.3,274.5628,958,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
FLUTICASONE PROPIONATE 44 MCG/ACTUATION INHL HFAA,,13515,LOCAL,Facility,Both,10.6,g,,958,814.3,274.5628,958,CorVel,Worker's Compensation,958,100,,percent of total billed charges,,
FLUTICASONE PROPIONATE 44 MCG/ACTUATION INHL HFAA,,13515,LOCAL,Facility,Both,10.6,g,,958,814.3,274.5628,958,First Health Group Corporation,First Health Network,929.26,97,,percent of total billed charges,,
FLUTICASONE PROPIONATE 44 MCG/ACTUATION INHL HFAA,,13515,LOCAL,Facility,Both,10.6,g,,958,814.3,274.5628,958,"Health Partners, Inc.",Commercial,906.268,94.6,,percent of total billed charges,,
FLUTICASONE PROPIONATE 44 MCG/ACTUATION INHL HFAA,,13515,LOCAL,Facility,Outpatient,10.6,g,,958,814.3,274.5628,958,"Health Partners, Inc.",Medicare Advantage,469.42,49,,percent of total billed charges,,
FLUTICASONE PROPIONATE 44 MCG/ACTUATION INHL HFAA,,13515,LOCAL,Facility,Inpatient,10.6,g,,958,814.3,274.5628,958,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
FLUTICASONE PROPIONATE 44 MCG/ACTUATION INHL HFAA,,13515,LOCAL,Facility,Both,10.6,g,,958,814.3,274.5628,958,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),574.8,60,,percent of total billed charges,,
FLUTICASONE PROPIONATE 44 MCG/ACTUATION INHL HFAA,,13515,LOCAL,Facility,Both,10.6,g,,958,814.3,274.5628,958,"Health Partners, Inc.",State of Minnesota Advantage Program,780.77,81.5,,percent of total billed charges,,
FLUTICASONE PROPIONATE 44 MCG/ACTUATION INHL HFAA,,13515,LOCAL,Facility,Both,10.6,g,,958,814.3,274.5628,958,"Health Partners, Inc.",State Public Programs,479,50,,percent of total billed charges,,
FLUTICASONE PROPIONATE 44 MCG/ACTUATION INHL HFAA,,13515,LOCAL,Facility,Both,10.6,g,,958,814.3,274.5628,958,Humana Insurance Company,Commercial PPO,910.1,95,,percent of total billed charges,,
FLUTICASONE PROPIONATE 44 MCG/ACTUATION INHL HFAA,,13515,LOCAL,Facility,Outpatient,10.6,g,,958,814.3,274.5628,958,Humana Insurance Company,Medicare PPO,469.42,49,,percent of total billed charges,,
FLUTICASONE PROPIONATE 44 MCG/ACTUATION INHL HFAA,,13515,LOCAL,Facility,Inpatient,10.6,g,,958,814.3,274.5628,958,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
FLUTICASONE PROPIONATE 44 MCG/ACTUATION INHL HFAA,,13515,LOCAL,Facility,Both,10.6,g,,958,814.3,274.5628,958,Medica,Individual & Family,949.378,99.1,,percent of total billed charges,,
FLUTICASONE PROPIONATE 44 MCG/ACTUATION INHL HFAA,,13515,LOCAL,Facility,Outpatient,10.6,g,,958,814.3,274.5628,958,Medica,Medica Advantage Solution,477.084,49.8,,percent of total billed charges,,
FLUTICASONE PROPIONATE 44 MCG/ACTUATION INHL HFAA,,13515,LOCAL,Facility,Inpatient,10.6,g,,958,814.3,274.5628,958,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
FLUTICASONE PROPIONATE 44 MCG/ACTUATION INHL HFAA,,13515,LOCAL,Facility,Outpatient,10.6,g,,958,814.3,274.5628,958,Medica,Medical Assistance,427.268,44.6,,percent of total billed charges,,
FLUTICASONE PROPIONATE 44 MCG/ACTUATION INHL HFAA,,13515,LOCAL,Facility,Inpatient,10.6,g,,958,814.3,274.5628,958,Medica,Medical Assistance,,,,,Included in per diem rate,
FLUTICASONE PROPIONATE 44 MCG/ACTUATION INHL HFAA,,13515,LOCAL,Facility,Outpatient,10.6,g,,958,814.3,274.5628,958,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,477.084,49.8,,percent of total billed charges,,
FLUTICASONE PROPIONATE 44 MCG/ACTUATION INHL HFAA,,13515,LOCAL,Facility,Inpatient,10.6,g,,958,814.3,274.5628,958,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
FLUTICASONE PROPIONATE 44 MCG/ACTUATION INHL HFAA,,13515,LOCAL,Facility,Both,10.6,g,,958,814.3,274.5628,958,"Multiplan, Inc.","Multiplan, Inc.",900.52,94,,percent of total billed charges,,
FLUTICASONE PROPIONATE 44 MCG/ACTUATION INHL HFAA,,13515,LOCAL,Facility,Outpatient,10.6,g,,958,814.3,274.5628,958,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,863.158,90.1,,percent of total billed charges,,
FLUTICASONE PROPIONATE 44 MCG/ACTUATION INHL HFAA,,13515,LOCAL,Facility,Inpatient,10.6,g,,958,814.3,274.5628,958,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
FLUTICASONE PROPIONATE 44 MCG/ACTUATION INHL HFAA,,13515,LOCAL,Facility,Both,10.6,g,,958,814.3,274.5628,958,"Preferred One Administrative Services, INC.",PPO,944.588,98.6,,percent of total billed charges,,
FLUTICASONE PROPIONATE 44 MCG/ACTUATION INHL HFAA,,13515,LOCAL,Facility,Outpatient,10.6,g,,958,814.3,274.5628,958,PrimeWest Health,Minnesota Senior Health Options (MSHO),492.891,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
FLUTICASONE PROPIONATE 44 MCG/ACTUATION INHL HFAA,,13515,LOCAL,Facility,Inpatient,10.6,g,,958,814.3,274.5628,958,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
FLUTICASONE PROPIONATE 44 MCG/ACTUATION INHL HFAA,,13515,LOCAL,Facility,Outpatient,10.6,g,,958,814.3,274.5628,958,PrimeWest Health,MinnesotaCare,492.0288,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
FLUTICASONE PROPIONATE 44 MCG/ACTUATION INHL HFAA,,13515,LOCAL,Facility,Inpatient,10.6,g,,958,814.3,274.5628,958,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
FLUTICASONE PROPIONATE 44 MCG/ACTUATION INHL HFAA,,13515,LOCAL,Facility,Both,10.6,g,,958,814.3,274.5628,958,Sanford Health Plan,Sanford Health Plan,881.36,92,,percent of total billed charges,,
FLUTICASONE PROPIONATE 44 MCG/ACTUATION INHL HFAA,,13515,LOCAL,Facility,Outpatient,10.6,g,,958,814.3,274.5628,958,"UCare Health, Inc.",Individual & Family Plan,539.833,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
FLUTICASONE PROPIONATE 44 MCG/ACTUATION INHL HFAA,,13515,LOCAL,Facility,Inpatient,10.6,g,,958,814.3,274.5628,958,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
FLUTICASONE PROPIONATE 44 MCG/ACTUATION INHL HFAA,,13515,LOCAL,Facility,Outpatient,10.6,g,,958,814.3,274.5628,958,"UCare Health, Inc.",Medical Assistance,483.5026,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FLUTICASONE PROPIONATE 44 MCG/ACTUATION INHL HFAA,,13515,LOCAL,Facility,Inpatient,10.6,g,,958,814.3,274.5628,958,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
FLUTICASONE PROPIONATE 44 MCG/ACTUATION INHL HFAA,,13515,LOCAL,Facility,Outpatient,10.6,g,,958,814.3,274.5628,958,"UCare Health, Inc.",Medicare Advantage,483.5026,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FLUTICASONE PROPIONATE 44 MCG/ACTUATION INHL HFAA,,13515,LOCAL,Facility,Inpatient,10.6,g,,958,814.3,274.5628,958,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
FLUTICASONE PROPIONATE 44 MCG/ACTUATION INHL HFAA,,13515,LOCAL,Facility,Outpatient,10.6,g,,958,814.3,274.5628,958,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),483.5026,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FLUTICASONE PROPIONATE 44 MCG/ACTUATION INHL HFAA,,13515,LOCAL,Facility,Inpatient,10.6,g,,958,814.3,274.5628,958,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
FLUTICASONE PROPIONATE 44 MCG/ACTUATION INHL HFAA,,13515,LOCAL,Facility,Both,10.6,g,,958,814.3,274.5628,958,UnitedHealthcare,Individual & Family,900.52,94,,percent of total billed charges,,
FLUTICASONE PROPIONATE 44 MCG/ACTUATION INHL HFAA,,13515,LOCAL,Facility,Outpatient,10.6,g,,958,814.3,274.5628,958,UnitedHealthcare,Medicare Advantage,469.42,49,,percent of total billed charges,,
FLUTICASONE PROPIONATE 44 MCG/ACTUATION INHL HFAA,,13515,LOCAL,Facility,Inpatient,10.6,g,,958,814.3,274.5628,958,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
FLUTICASONE PROPIONATE 44 MCG/ACTUATION INHL HFAA,,13515,LOCAL,Facility,Outpatient,10.6,g,,958,814.3,274.5628,958,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,459.84,48,,percent of total billed charges,,100% of DHS outpatient percentage
FLUTICASONE PROPIONATE 44 MCG/ACTUATION INHL HFAA,,13515,LOCAL,Facility,Inpatient,10.6,g,,958,814.3,274.5628,958,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
TRIAMCINOLONE ACETONIDE 55 MCG NASL SPRA,,13126,LOCAL,Facility,Both,10.8,mL,,96,81.6,27.5136,96,Aetna,Commercial,88.32,92,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 55 MCG NASL SPRA,,13126,LOCAL,Facility,Outpatient,10.8,mL,,96,81.6,27.5136,96,Aetna,Medicare Advantage,47.04,49,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 55 MCG NASL SPRA,,13126,LOCAL,Facility,Inpatient,10.8,mL,,96,81.6,27.5136,96,Aetna,Medicare Advantage,,,,,Included in per diem rate,
TRIAMCINOLONE ACETONIDE 55 MCG NASL SPRA,,13126,LOCAL,Facility,Both,10.8,mL,,96,81.6,27.5136,96,Aetna,PPO,89.28,93,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 55 MCG NASL SPRA,,13126,LOCAL,Facility,Both,10.8,mL,,96,81.6,27.5136,96,America's PPO,America's PPO,92.1888,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
TRIAMCINOLONE ACETONIDE 55 MCG NASL SPRA,,13126,LOCAL,Facility,Both,10.8,mL,,96,81.6,27.5136,96,BlueCross BlueShield Minnesota, Federal Employee Program,94.464,98.4,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 55 MCG NASL SPRA,,13126,LOCAL,Facility,Both,10.8,mL,,96,81.6,27.5136,96,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,96,100,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 55 MCG NASL SPRA,,13126,LOCAL,Facility,Both,10.8,mL,,96,81.6,27.5136,96,BlueCross BlueShield Minnesota,High Value Network Plan,86.4,90,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 55 MCG NASL SPRA,,13126,LOCAL,Facility,Outpatient,10.8,mL,,96,81.6,27.5136,96,BlueCross BlueShield Minnesota,Medicare Advantage,47.04,49,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 55 MCG NASL SPRA,,13126,LOCAL,Facility,Inpatient,10.8,mL,,96,81.6,27.5136,96,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
TRIAMCINOLONE ACETONIDE 55 MCG NASL SPRA,,13126,LOCAL,Facility,Both,10.8,mL,,96,81.6,27.5136,96,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,85.0272,88.57,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 55 MCG NASL SPRA,,13126,LOCAL,Facility,Both,10.8,mL,,96,81.6,27.5136,96,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,27.5136,28.66,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 55 MCG NASL SPRA,,13126,LOCAL,Facility,Outpatient,10.8,mL,,96,81.6,27.5136,96,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),47.04,49,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 55 MCG NASL SPRA,,13126,LOCAL,Facility,Inpatient,10.8,mL,,96,81.6,27.5136,96,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
TRIAMCINOLONE ACETONIDE 55 MCG NASL SPRA,,13126,LOCAL,Facility,Both,10.8,mL,,96,81.6,27.5136,96,CorVel,Worker's Compensation,96,100,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 55 MCG NASL SPRA,,13126,LOCAL,Facility,Both,10.8,mL,,96,81.6,27.5136,96,First Health Group Corporation,First Health Network,93.12,97,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 55 MCG NASL SPRA,,13126,LOCAL,Facility,Both,10.8,mL,,96,81.6,27.5136,96,"Health Partners, Inc.",Commercial,90.816,94.6,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 55 MCG NASL SPRA,,13126,LOCAL,Facility,Outpatient,10.8,mL,,96,81.6,27.5136,96,"Health Partners, Inc.",Medicare Advantage,47.04,49,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 55 MCG NASL SPRA,,13126,LOCAL,Facility,Inpatient,10.8,mL,,96,81.6,27.5136,96,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
TRIAMCINOLONE ACETONIDE 55 MCG NASL SPRA,,13126,LOCAL,Facility,Both,10.8,mL,,96,81.6,27.5136,96,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),57.6,60,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 55 MCG NASL SPRA,,13126,LOCAL,Facility,Both,10.8,mL,,96,81.6,27.5136,96,"Health Partners, Inc.",State of Minnesota Advantage Program,78.24,81.5,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 55 MCG NASL SPRA,,13126,LOCAL,Facility,Both,10.8,mL,,96,81.6,27.5136,96,"Health Partners, Inc.",State Public Programs,48,50,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 55 MCG NASL SPRA,,13126,LOCAL,Facility,Both,10.8,mL,,96,81.6,27.5136,96,Humana Insurance Company,Commercial PPO,91.2,95,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 55 MCG NASL SPRA,,13126,LOCAL,Facility,Outpatient,10.8,mL,,96,81.6,27.5136,96,Humana Insurance Company,Medicare PPO,47.04,49,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 55 MCG NASL SPRA,,13126,LOCAL,Facility,Inpatient,10.8,mL,,96,81.6,27.5136,96,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
TRIAMCINOLONE ACETONIDE 55 MCG NASL SPRA,,13126,LOCAL,Facility,Both,10.8,mL,,96,81.6,27.5136,96,Medica,Individual & Family,95.136,99.1,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 55 MCG NASL SPRA,,13126,LOCAL,Facility,Outpatient,10.8,mL,,96,81.6,27.5136,96,Medica,Medica Advantage Solution,47.808,49.8,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 55 MCG NASL SPRA,,13126,LOCAL,Facility,Inpatient,10.8,mL,,96,81.6,27.5136,96,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
TRIAMCINOLONE ACETONIDE 55 MCG NASL SPRA,,13126,LOCAL,Facility,Outpatient,10.8,mL,,96,81.6,27.5136,96,Medica,Medical Assistance,42.816,44.6,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 55 MCG NASL SPRA,,13126,LOCAL,Facility,Inpatient,10.8,mL,,96,81.6,27.5136,96,Medica,Medical Assistance,,,,,Included in per diem rate,
TRIAMCINOLONE ACETONIDE 55 MCG NASL SPRA,,13126,LOCAL,Facility,Outpatient,10.8,mL,,96,81.6,27.5136,96,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,47.808,49.8,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 55 MCG NASL SPRA,,13126,LOCAL,Facility,Inpatient,10.8,mL,,96,81.6,27.5136,96,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
TRIAMCINOLONE ACETONIDE 55 MCG NASL SPRA,,13126,LOCAL,Facility,Both,10.8,mL,,96,81.6,27.5136,96,"Multiplan, Inc.","Multiplan, Inc.",90.24,94,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 55 MCG NASL SPRA,,13126,LOCAL,Facility,Outpatient,10.8,mL,,96,81.6,27.5136,96,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,86.496,90.1,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 55 MCG NASL SPRA,,13126,LOCAL,Facility,Inpatient,10.8,mL,,96,81.6,27.5136,96,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
TRIAMCINOLONE ACETONIDE 55 MCG NASL SPRA,,13126,LOCAL,Facility,Both,10.8,mL,,96,81.6,27.5136,96,"Preferred One Administrative Services, INC.",PPO,94.656,98.6,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 55 MCG NASL SPRA,,13126,LOCAL,Facility,Outpatient,10.8,mL,,96,81.6,27.5136,96,PrimeWest Health,Minnesota Senior Health Options (MSHO),49.392,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
TRIAMCINOLONE ACETONIDE 55 MCG NASL SPRA,,13126,LOCAL,Facility,Inpatient,10.8,mL,,96,81.6,27.5136,96,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
TRIAMCINOLONE ACETONIDE 55 MCG NASL SPRA,,13126,LOCAL,Facility,Outpatient,10.8,mL,,96,81.6,27.5136,96,PrimeWest Health,MinnesotaCare,49.3056,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
TRIAMCINOLONE ACETONIDE 55 MCG NASL SPRA,,13126,LOCAL,Facility,Inpatient,10.8,mL,,96,81.6,27.5136,96,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
TRIAMCINOLONE ACETONIDE 55 MCG NASL SPRA,,13126,LOCAL,Facility,Both,10.8,mL,,96,81.6,27.5136,96,Sanford Health Plan,Sanford Health Plan,88.32,92,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 55 MCG NASL SPRA,,13126,LOCAL,Facility,Outpatient,10.8,mL,,96,81.6,27.5136,96,"UCare Health, Inc.",Individual & Family Plan,54.096,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
TRIAMCINOLONE ACETONIDE 55 MCG NASL SPRA,,13126,LOCAL,Facility,Inpatient,10.8,mL,,96,81.6,27.5136,96,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
TRIAMCINOLONE ACETONIDE 55 MCG NASL SPRA,,13126,LOCAL,Facility,Outpatient,10.8,mL,,96,81.6,27.5136,96,"UCare Health, Inc.",Medical Assistance,48.4512,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TRIAMCINOLONE ACETONIDE 55 MCG NASL SPRA,,13126,LOCAL,Facility,Inpatient,10.8,mL,,96,81.6,27.5136,96,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
TRIAMCINOLONE ACETONIDE 55 MCG NASL SPRA,,13126,LOCAL,Facility,Outpatient,10.8,mL,,96,81.6,27.5136,96,"UCare Health, Inc.",Medicare Advantage,48.4512,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TRIAMCINOLONE ACETONIDE 55 MCG NASL SPRA,,13126,LOCAL,Facility,Inpatient,10.8,mL,,96,81.6,27.5136,96,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
TRIAMCINOLONE ACETONIDE 55 MCG NASL SPRA,,13126,LOCAL,Facility,Outpatient,10.8,mL,,96,81.6,27.5136,96,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),48.4512,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TRIAMCINOLONE ACETONIDE 55 MCG NASL SPRA,,13126,LOCAL,Facility,Inpatient,10.8,mL,,96,81.6,27.5136,96,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
TRIAMCINOLONE ACETONIDE 55 MCG NASL SPRA,,13126,LOCAL,Facility,Both,10.8,mL,,96,81.6,27.5136,96,UnitedHealthcare,Individual & Family,90.24,94,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 55 MCG NASL SPRA,,13126,LOCAL,Facility,Outpatient,10.8,mL,,96,81.6,27.5136,96,UnitedHealthcare,Medicare Advantage,47.04,49,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 55 MCG NASL SPRA,,13126,LOCAL,Facility,Inpatient,10.8,mL,,96,81.6,27.5136,96,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
TRIAMCINOLONE ACETONIDE 55 MCG NASL SPRA,,13126,LOCAL,Facility,Outpatient,10.8,mL,,96,81.6,27.5136,96,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,46.08,48,,percent of total billed charges,,100% of DHS outpatient percentage
TRIAMCINOLONE ACETONIDE 55 MCG NASL SPRA,,13126,LOCAL,Facility,Inpatient,10.8,mL,,96,81.6,27.5136,96,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
FLUTICASONE PROPIONATE 220 MCG/ACTUATION INHL HFAA,,16178,LOCAL,Facility,Both,12,g,,1685,1432.25,482.921,1685,Aetna,Commercial,1550.2,92,,percent of total billed charges,,
FLUTICASONE PROPIONATE 220 MCG/ACTUATION INHL HFAA,,16178,LOCAL,Facility,Outpatient,12,g,,1685,1432.25,482.921,1685,Aetna,Medicare Advantage,825.65,49,,percent of total billed charges,,
FLUTICASONE PROPIONATE 220 MCG/ACTUATION INHL HFAA,,16178,LOCAL,Facility,Inpatient,12,g,,1685,1432.25,482.921,1685,Aetna,Medicare Advantage,,,,,Included in per diem rate,
FLUTICASONE PROPIONATE 220 MCG/ACTUATION INHL HFAA,,16178,LOCAL,Facility,Both,12,g,,1685,1432.25,482.921,1685,Aetna,PPO,1567.05,93,,percent of total billed charges,,
FLUTICASONE PROPIONATE 220 MCG/ACTUATION INHL HFAA,,16178,LOCAL,Facility,Both,12,g,,1685,1432.25,482.921,1685,America's PPO,America's PPO,1618.1055,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
FLUTICASONE PROPIONATE 220 MCG/ACTUATION INHL HFAA,,16178,LOCAL,Facility,Both,12,g,,1685,1432.25,482.921,1685,BlueCross BlueShield Minnesota, Federal Employee Program,1658.04,98.4,,percent of total billed charges,,
FLUTICASONE PROPIONATE 220 MCG/ACTUATION INHL HFAA,,16178,LOCAL,Facility,Both,12,g,,1685,1432.25,482.921,1685,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1685,100,,percent of total billed charges,,
FLUTICASONE PROPIONATE 220 MCG/ACTUATION INHL HFAA,,16178,LOCAL,Facility,Both,12,g,,1685,1432.25,482.921,1685,BlueCross BlueShield Minnesota,High Value Network Plan,1516.5,90,,percent of total billed charges,,
FLUTICASONE PROPIONATE 220 MCG/ACTUATION INHL HFAA,,16178,LOCAL,Facility,Outpatient,12,g,,1685,1432.25,482.921,1685,BlueCross BlueShield Minnesota,Medicare Advantage,825.65,49,,percent of total billed charges,,
FLUTICASONE PROPIONATE 220 MCG/ACTUATION INHL HFAA,,16178,LOCAL,Facility,Inpatient,12,g,,1685,1432.25,482.921,1685,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
FLUTICASONE PROPIONATE 220 MCG/ACTUATION INHL HFAA,,16178,LOCAL,Facility,Both,12,g,,1685,1432.25,482.921,1685,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1492.4045,88.57,,percent of total billed charges,,
FLUTICASONE PROPIONATE 220 MCG/ACTUATION INHL HFAA,,16178,LOCAL,Facility,Both,12,g,,1685,1432.25,482.921,1685,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,482.921,28.66,,percent of total billed charges,,
FLUTICASONE PROPIONATE 220 MCG/ACTUATION INHL HFAA,,16178,LOCAL,Facility,Outpatient,12,g,,1685,1432.25,482.921,1685,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),825.65,49,,percent of total billed charges,,
FLUTICASONE PROPIONATE 220 MCG/ACTUATION INHL HFAA,,16178,LOCAL,Facility,Inpatient,12,g,,1685,1432.25,482.921,1685,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
FLUTICASONE PROPIONATE 220 MCG/ACTUATION INHL HFAA,,16178,LOCAL,Facility,Both,12,g,,1685,1432.25,482.921,1685,CorVel,Worker's Compensation,1685,100,,percent of total billed charges,,
FLUTICASONE PROPIONATE 220 MCG/ACTUATION INHL HFAA,,16178,LOCAL,Facility,Both,12,g,,1685,1432.25,482.921,1685,First Health Group Corporation,First Health Network,1634.45,97,,percent of total billed charges,,
FLUTICASONE PROPIONATE 220 MCG/ACTUATION INHL HFAA,,16178,LOCAL,Facility,Both,12,g,,1685,1432.25,482.921,1685,"Health Partners, Inc.",Commercial,1594.01,94.6,,percent of total billed charges,,
FLUTICASONE PROPIONATE 220 MCG/ACTUATION INHL HFAA,,16178,LOCAL,Facility,Outpatient,12,g,,1685,1432.25,482.921,1685,"Health Partners, Inc.",Medicare Advantage,825.65,49,,percent of total billed charges,,
FLUTICASONE PROPIONATE 220 MCG/ACTUATION INHL HFAA,,16178,LOCAL,Facility,Inpatient,12,g,,1685,1432.25,482.921,1685,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
FLUTICASONE PROPIONATE 220 MCG/ACTUATION INHL HFAA,,16178,LOCAL,Facility,Both,12,g,,1685,1432.25,482.921,1685,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1011,60,,percent of total billed charges,,
FLUTICASONE PROPIONATE 220 MCG/ACTUATION INHL HFAA,,16178,LOCAL,Facility,Both,12,g,,1685,1432.25,482.921,1685,"Health Partners, Inc.",State of Minnesota Advantage Program,1373.275,81.5,,percent of total billed charges,,
FLUTICASONE PROPIONATE 220 MCG/ACTUATION INHL HFAA,,16178,LOCAL,Facility,Both,12,g,,1685,1432.25,482.921,1685,"Health Partners, Inc.",State Public Programs,842.5,50,,percent of total billed charges,,
FLUTICASONE PROPIONATE 220 MCG/ACTUATION INHL HFAA,,16178,LOCAL,Facility,Both,12,g,,1685,1432.25,482.921,1685,Humana Insurance Company,Commercial PPO,1600.75,95,,percent of total billed charges,,
FLUTICASONE PROPIONATE 220 MCG/ACTUATION INHL HFAA,,16178,LOCAL,Facility,Outpatient,12,g,,1685,1432.25,482.921,1685,Humana Insurance Company,Medicare PPO,825.65,49,,percent of total billed charges,,
FLUTICASONE PROPIONATE 220 MCG/ACTUATION INHL HFAA,,16178,LOCAL,Facility,Inpatient,12,g,,1685,1432.25,482.921,1685,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
FLUTICASONE PROPIONATE 220 MCG/ACTUATION INHL HFAA,,16178,LOCAL,Facility,Both,12,g,,1685,1432.25,482.921,1685,Medica,Individual & Family,1669.835,99.1,,percent of total billed charges,,
FLUTICASONE PROPIONATE 220 MCG/ACTUATION INHL HFAA,,16178,LOCAL,Facility,Outpatient,12,g,,1685,1432.25,482.921,1685,Medica,Medica Advantage Solution,839.13,49.8,,percent of total billed charges,,
FLUTICASONE PROPIONATE 220 MCG/ACTUATION INHL HFAA,,16178,LOCAL,Facility,Inpatient,12,g,,1685,1432.25,482.921,1685,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
FLUTICASONE PROPIONATE 220 MCG/ACTUATION INHL HFAA,,16178,LOCAL,Facility,Outpatient,12,g,,1685,1432.25,482.921,1685,Medica,Medical Assistance,751.51,44.6,,percent of total billed charges,,
FLUTICASONE PROPIONATE 220 MCG/ACTUATION INHL HFAA,,16178,LOCAL,Facility,Inpatient,12,g,,1685,1432.25,482.921,1685,Medica,Medical Assistance,,,,,Included in per diem rate,
FLUTICASONE PROPIONATE 220 MCG/ACTUATION INHL HFAA,,16178,LOCAL,Facility,Outpatient,12,g,,1685,1432.25,482.921,1685,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,839.13,49.8,,percent of total billed charges,,
FLUTICASONE PROPIONATE 220 MCG/ACTUATION INHL HFAA,,16178,LOCAL,Facility,Inpatient,12,g,,1685,1432.25,482.921,1685,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
FLUTICASONE PROPIONATE 220 MCG/ACTUATION INHL HFAA,,16178,LOCAL,Facility,Both,12,g,,1685,1432.25,482.921,1685,"Multiplan, Inc.","Multiplan, Inc.",1583.9,94,,percent of total billed charges,,
FLUTICASONE PROPIONATE 220 MCG/ACTUATION INHL HFAA,,16178,LOCAL,Facility,Outpatient,12,g,,1685,1432.25,482.921,1685,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1518.185,90.1,,percent of total billed charges,,
FLUTICASONE PROPIONATE 220 MCG/ACTUATION INHL HFAA,,16178,LOCAL,Facility,Inpatient,12,g,,1685,1432.25,482.921,1685,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
FLUTICASONE PROPIONATE 220 MCG/ACTUATION INHL HFAA,,16178,LOCAL,Facility,Both,12,g,,1685,1432.25,482.921,1685,"Preferred One Administrative Services, INC.",PPO,1661.41,98.6,,percent of total billed charges,,
FLUTICASONE PROPIONATE 220 MCG/ACTUATION INHL HFAA,,16178,LOCAL,Facility,Outpatient,12,g,,1685,1432.25,482.921,1685,PrimeWest Health,Minnesota Senior Health Options (MSHO),866.9325,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
FLUTICASONE PROPIONATE 220 MCG/ACTUATION INHL HFAA,,16178,LOCAL,Facility,Inpatient,12,g,,1685,1432.25,482.921,1685,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
FLUTICASONE PROPIONATE 220 MCG/ACTUATION INHL HFAA,,16178,LOCAL,Facility,Outpatient,12,g,,1685,1432.25,482.921,1685,PrimeWest Health,MinnesotaCare,865.416,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
FLUTICASONE PROPIONATE 220 MCG/ACTUATION INHL HFAA,,16178,LOCAL,Facility,Inpatient,12,g,,1685,1432.25,482.921,1685,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
FLUTICASONE PROPIONATE 220 MCG/ACTUATION INHL HFAA,,16178,LOCAL,Facility,Both,12,g,,1685,1432.25,482.921,1685,Sanford Health Plan,Sanford Health Plan,1550.2,92,,percent of total billed charges,,
FLUTICASONE PROPIONATE 220 MCG/ACTUATION INHL HFAA,,16178,LOCAL,Facility,Outpatient,12,g,,1685,1432.25,482.921,1685,"UCare Health, Inc.",Individual & Family Plan,949.4975,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
FLUTICASONE PROPIONATE 220 MCG/ACTUATION INHL HFAA,,16178,LOCAL,Facility,Inpatient,12,g,,1685,1432.25,482.921,1685,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
FLUTICASONE PROPIONATE 220 MCG/ACTUATION INHL HFAA,,16178,LOCAL,Facility,Outpatient,12,g,,1685,1432.25,482.921,1685,"UCare Health, Inc.",Medical Assistance,850.4195,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FLUTICASONE PROPIONATE 220 MCG/ACTUATION INHL HFAA,,16178,LOCAL,Facility,Inpatient,12,g,,1685,1432.25,482.921,1685,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
FLUTICASONE PROPIONATE 220 MCG/ACTUATION INHL HFAA,,16178,LOCAL,Facility,Outpatient,12,g,,1685,1432.25,482.921,1685,"UCare Health, Inc.",Medicare Advantage,850.4195,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FLUTICASONE PROPIONATE 220 MCG/ACTUATION INHL HFAA,,16178,LOCAL,Facility,Inpatient,12,g,,1685,1432.25,482.921,1685,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
FLUTICASONE PROPIONATE 220 MCG/ACTUATION INHL HFAA,,16178,LOCAL,Facility,Outpatient,12,g,,1685,1432.25,482.921,1685,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),850.4195,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FLUTICASONE PROPIONATE 220 MCG/ACTUATION INHL HFAA,,16178,LOCAL,Facility,Inpatient,12,g,,1685,1432.25,482.921,1685,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
FLUTICASONE PROPIONATE 220 MCG/ACTUATION INHL HFAA,,16178,LOCAL,Facility,Both,12,g,,1685,1432.25,482.921,1685,UnitedHealthcare,Individual & Family,1583.9,94,,percent of total billed charges,,
FLUTICASONE PROPIONATE 220 MCG/ACTUATION INHL HFAA,,16178,LOCAL,Facility,Outpatient,12,g,,1685,1432.25,482.921,1685,UnitedHealthcare,Medicare Advantage,825.65,49,,percent of total billed charges,,
FLUTICASONE PROPIONATE 220 MCG/ACTUATION INHL HFAA,,16178,LOCAL,Facility,Inpatient,12,g,,1685,1432.25,482.921,1685,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
FLUTICASONE PROPIONATE 220 MCG/ACTUATION INHL HFAA,,16178,LOCAL,Facility,Outpatient,12,g,,1685,1432.25,482.921,1685,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,808.8,48,,percent of total billed charges,,100% of DHS outpatient percentage
FLUTICASONE PROPIONATE 220 MCG/ACTUATION INHL HFAA,,16178,LOCAL,Facility,Inpatient,12,g,,1685,1432.25,482.921,1685,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Open Wound Debridement 1St 20 Sq Cm,,97597,CPT,Facility,Both,,,,79,67.15,22.6414,79,Aetna,Commercial,72.68,92,,percent of total billed charges,,
Open Wound Debridement 1St 20 Sq Cm,,97597,CPT,Facility,Outpatient,,,,79,67.15,22.6414,79,Aetna,Medicare Advantage,38.71,49,,percent of total billed charges,,
Open Wound Debridement 1St 20 Sq Cm,,97597,CPT,Facility,Inpatient,,,,79,67.15,22.6414,79,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Open Wound Debridement 1St 20 Sq Cm,,97597,CPT,Facility,Both,,,,79,67.15,22.6414,79,Aetna,PPO,73.47,93,,percent of total billed charges,,
Open Wound Debridement 1St 20 Sq Cm,,97597,CPT,Facility,Both,,,,79,67.15,22.6414,79,America's PPO,America's PPO,75.8637,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Open Wound Debridement 1St 20 Sq Cm,,97597,CPT,Facility,Both,,,,79,67.15,22.6414,79,BlueCross BlueShield Minnesota, Federal Employee Program,77.736,98.4,,percent of total billed charges,,
Open Wound Debridement 1St 20 Sq Cm,,97597,CPT,Facility,Both,,,,79,67.15,22.6414,79,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,79,100,,percent of total billed charges,,
Open Wound Debridement 1St 20 Sq Cm,,97597,CPT,Facility,Both,,,,79,67.15,22.6414,79,BlueCross BlueShield Minnesota,High Value Network Plan,71.1,90,,percent of total billed charges,,
Open Wound Debridement 1St 20 Sq Cm,,97597,CPT,Facility,Outpatient,,,,79,67.15,22.6414,79,BlueCross BlueShield Minnesota,Medicare Advantage,38.71,49,,percent of total billed charges,,
Open Wound Debridement 1St 20 Sq Cm,,97597,CPT,Facility,Inpatient,,,,79,67.15,22.6414,79,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Open Wound Debridement 1St 20 Sq Cm,,97597,CPT,Facility,Both,,,,79,67.15,22.6414,79,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,69.9703,88.57,,percent of total billed charges,,
Open Wound Debridement 1St 20 Sq Cm,,97597,CPT,Facility,Both,,,,79,67.15,22.6414,79,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,22.6414,28.66,,percent of total billed charges,,
Open Wound Debridement 1St 20 Sq Cm,,97597,CPT,Facility,Outpatient,,,,79,67.15,22.6414,79,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),38.71,49,,percent of total billed charges,,
Open Wound Debridement 1St 20 Sq Cm,,97597,CPT,Facility,Inpatient,,,,79,67.15,22.6414,79,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Open Wound Debridement 1St 20 Sq Cm,,97597,CPT,Facility,Both,,,,79,67.15,22.6414,79,CorVel,Worker's Compensation,79,100,,percent of total billed charges,,
Open Wound Debridement 1St 20 Sq Cm,,97597,CPT,Facility,Both,,,,79,67.15,22.6414,79,First Health Group Corporation,First Health Network,76.63,97,,percent of total billed charges,,
Open Wound Debridement 1St 20 Sq Cm,,97597,CPT,Facility,Both,,,,79,67.15,22.6414,79,"Health Partners, Inc.",Commercial,74.734,94.6,,percent of total billed charges,,
Open Wound Debridement 1St 20 Sq Cm,,97597,CPT,Facility,Outpatient,,,,79,67.15,22.6414,79,"Health Partners, Inc.",Medicare Advantage,38.71,49,,percent of total billed charges,,
Open Wound Debridement 1St 20 Sq Cm,,97597,CPT,Facility,Inpatient,,,,79,67.15,22.6414,79,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Open Wound Debridement 1St 20 Sq Cm,,97597,CPT,Facility,Both,,,,79,67.15,22.6414,79,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),47.4,60,,percent of total billed charges,,
Open Wound Debridement 1St 20 Sq Cm,,97597,CPT,Facility,Both,,,,79,67.15,22.6414,79,"Health Partners, Inc.",State of Minnesota Advantage Program,64.385,81.5,,percent of total billed charges,,
Open Wound Debridement 1St 20 Sq Cm,,97597,CPT,Facility,Both,,,,79,67.15,22.6414,79,"Health Partners, Inc.",State Public Programs,39.5,50,,percent of total billed charges,,
Open Wound Debridement 1St 20 Sq Cm,,97597,CPT,Facility,Both,,,,79,67.15,22.6414,79,Humana Insurance Company,Commercial PPO,75.05,95,,percent of total billed charges,,
Open Wound Debridement 1St 20 Sq Cm,,97597,CPT,Facility,Outpatient,,,,79,67.15,22.6414,79,Humana Insurance Company,Medicare PPO,38.71,49,,percent of total billed charges,,
Open Wound Debridement 1St 20 Sq Cm,,97597,CPT,Facility,Inpatient,,,,79,67.15,22.6414,79,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Open Wound Debridement 1St 20 Sq Cm,,97597,CPT,Facility,Both,,,,79,67.15,22.6414,79,Medica,Individual & Family,78.289,99.1,,percent of total billed charges,,
Open Wound Debridement 1St 20 Sq Cm,,97597,CPT,Facility,Outpatient,,,,79,67.15,22.6414,79,Medica,Medica Advantage Solution,39.342,49.8,,percent of total billed charges,,
Open Wound Debridement 1St 20 Sq Cm,,97597,CPT,Facility,Inpatient,,,,79,67.15,22.6414,79,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Open Wound Debridement 1St 20 Sq Cm,,97597,CPT,Facility,Outpatient,,,,79,67.15,22.6414,79,Medica,Medical Assistance,35.234,44.6,,percent of total billed charges,,
Open Wound Debridement 1St 20 Sq Cm,,97597,CPT,Facility,Inpatient,,,,79,67.15,22.6414,79,Medica,Medical Assistance,,,,,Included in per diem rate,
Open Wound Debridement 1St 20 Sq Cm,,97597,CPT,Facility,Outpatient,,,,79,67.15,22.6414,79,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,39.342,49.8,,percent of total billed charges,,
Open Wound Debridement 1St 20 Sq Cm,,97597,CPT,Facility,Inpatient,,,,79,67.15,22.6414,79,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Open Wound Debridement 1St 20 Sq Cm,,97597,CPT,Facility,Both,,,,79,67.15,22.6414,79,"Multiplan, Inc.","Multiplan, Inc.",74.26,94,,percent of total billed charges,,
Open Wound Debridement 1St 20 Sq Cm,,97597,CPT,Facility,Outpatient,,,,79,67.15,22.6414,79,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,71.179,90.1,,percent of total billed charges,,
Open Wound Debridement 1St 20 Sq Cm,,97597,CPT,Facility,Inpatient,,,,79,67.15,22.6414,79,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Open Wound Debridement 1St 20 Sq Cm,,97597,CPT,Facility,Both,,,,79,67.15,22.6414,79,"Preferred One Administrative Services, INC.",PPO,77.894,98.6,,percent of total billed charges,,
Open Wound Debridement 1St 20 Sq Cm,,97597,CPT,Facility,Outpatient,,,,79,67.15,22.6414,79,PrimeWest Health,Minnesota Senior Health Options (MSHO),40.6455,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Open Wound Debridement 1St 20 Sq Cm,,97597,CPT,Facility,Inpatient,,,,79,67.15,22.6414,79,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Open Wound Debridement 1St 20 Sq Cm,,97597,CPT,Facility,Outpatient,,,,79,67.15,22.6414,79,PrimeWest Health,MinnesotaCare,40.5744,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Open Wound Debridement 1St 20 Sq Cm,,97597,CPT,Facility,Inpatient,,,,79,67.15,22.6414,79,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Open Wound Debridement 1St 20 Sq Cm,,97597,CPT,Facility,Both,,,,79,67.15,22.6414,79,Sanford Health Plan,Sanford Health Plan,72.68,92,,percent of total billed charges,,
Open Wound Debridement 1St 20 Sq Cm,,97597,CPT,Facility,Outpatient,,,,79,67.15,22.6414,79,"UCare Health, Inc.",Individual & Family Plan,44.5165,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Open Wound Debridement 1St 20 Sq Cm,,97597,CPT,Facility,Inpatient,,,,79,67.15,22.6414,79,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Open Wound Debridement 1St 20 Sq Cm,,97597,CPT,Facility,Outpatient,,,,79,67.15,22.6414,79,"UCare Health, Inc.",Medical Assistance,39.8713,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Open Wound Debridement 1St 20 Sq Cm,,97597,CPT,Facility,Inpatient,,,,79,67.15,22.6414,79,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Open Wound Debridement 1St 20 Sq Cm,,97597,CPT,Facility,Outpatient,,,,79,67.15,22.6414,79,"UCare Health, Inc.",Medicare Advantage,39.8713,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Open Wound Debridement 1St 20 Sq Cm,,97597,CPT,Facility,Inpatient,,,,79,67.15,22.6414,79,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Open Wound Debridement 1St 20 Sq Cm,,97597,CPT,Facility,Outpatient,,,,79,67.15,22.6414,79,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),39.8713,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Open Wound Debridement 1St 20 Sq Cm,,97597,CPT,Facility,Inpatient,,,,79,67.15,22.6414,79,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Open Wound Debridement 1St 20 Sq Cm,,97597,CPT,Facility,Both,,,,79,67.15,22.6414,79,UnitedHealthcare,Individual & Family,74.26,94,,percent of total billed charges,,
Open Wound Debridement 1St 20 Sq Cm,,97597,CPT,Facility,Outpatient,,,,79,67.15,22.6414,79,UnitedHealthcare,Medicare Advantage,38.71,49,,percent of total billed charges,,
Open Wound Debridement 1St 20 Sq Cm,,97597,CPT,Facility,Inpatient,,,,79,67.15,22.6414,79,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Open Wound Debridement 1St 20 Sq Cm,,97597,CPT,Facility,Outpatient,,,,79,67.15,22.6414,79,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,37.92,48,,percent of total billed charges,,100% of DHS outpatient percentage
Open Wound Debridement 1St 20 Sq Cm,,97597,CPT,Facility,Inpatient,,,,79,67.15,22.6414,79,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Open Wound Debridement Ea Addl 20 Sq Cm,,97598,CPT,Facility,Both,,,,43,36.55,12.3238,43,Aetna,Commercial,39.56,92,,percent of total billed charges,,
Open Wound Debridement Ea Addl 20 Sq Cm,,97598,CPT,Facility,Outpatient,,,,43,36.55,12.3238,43,Aetna,Medicare Advantage,21.07,49,,percent of total billed charges,,
Open Wound Debridement Ea Addl 20 Sq Cm,,97598,CPT,Facility,Inpatient,,,,43,36.55,12.3238,43,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Open Wound Debridement Ea Addl 20 Sq Cm,,97598,CPT,Facility,Both,,,,43,36.55,12.3238,43,Aetna,PPO,39.99,93,,percent of total billed charges,,
Open Wound Debridement Ea Addl 20 Sq Cm,,97598,CPT,Facility,Both,,,,43,36.55,12.3238,43,America's PPO,America's PPO,41.2929,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Open Wound Debridement Ea Addl 20 Sq Cm,,97598,CPT,Facility,Both,,,,43,36.55,12.3238,43,BlueCross BlueShield Minnesota, Federal Employee Program,42.312,98.4,,percent of total billed charges,,
Open Wound Debridement Ea Addl 20 Sq Cm,,97598,CPT,Facility,Both,,,,43,36.55,12.3238,43,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,43,100,,percent of total billed charges,,
Open Wound Debridement Ea Addl 20 Sq Cm,,97598,CPT,Facility,Both,,,,43,36.55,12.3238,43,BlueCross BlueShield Minnesota,High Value Network Plan,38.7,90,,percent of total billed charges,,
Open Wound Debridement Ea Addl 20 Sq Cm,,97598,CPT,Facility,Outpatient,,,,43,36.55,12.3238,43,BlueCross BlueShield Minnesota,Medicare Advantage,21.07,49,,percent of total billed charges,,
Open Wound Debridement Ea Addl 20 Sq Cm,,97598,CPT,Facility,Inpatient,,,,43,36.55,12.3238,43,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Open Wound Debridement Ea Addl 20 Sq Cm,,97598,CPT,Facility,Both,,,,43,36.55,12.3238,43,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,38.0851,88.57,,percent of total billed charges,,
Open Wound Debridement Ea Addl 20 Sq Cm,,97598,CPT,Facility,Both,,,,43,36.55,12.3238,43,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,12.3238,28.66,,percent of total billed charges,,
Open Wound Debridement Ea Addl 20 Sq Cm,,97598,CPT,Facility,Outpatient,,,,43,36.55,12.3238,43,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),21.07,49,,percent of total billed charges,,
Open Wound Debridement Ea Addl 20 Sq Cm,,97598,CPT,Facility,Inpatient,,,,43,36.55,12.3238,43,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Open Wound Debridement Ea Addl 20 Sq Cm,,97598,CPT,Facility,Both,,,,43,36.55,12.3238,43,CorVel,Worker's Compensation,43,100,,percent of total billed charges,,
Open Wound Debridement Ea Addl 20 Sq Cm,,97598,CPT,Facility,Both,,,,43,36.55,12.3238,43,First Health Group Corporation,First Health Network,41.71,97,,percent of total billed charges,,
Open Wound Debridement Ea Addl 20 Sq Cm,,97598,CPT,Facility,Both,,,,43,36.55,12.3238,43,"Health Partners, Inc.",Commercial,40.678,94.6,,percent of total billed charges,,
Open Wound Debridement Ea Addl 20 Sq Cm,,97598,CPT,Facility,Outpatient,,,,43,36.55,12.3238,43,"Health Partners, Inc.",Medicare Advantage,21.07,49,,percent of total billed charges,,
Open Wound Debridement Ea Addl 20 Sq Cm,,97598,CPT,Facility,Inpatient,,,,43,36.55,12.3238,43,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Open Wound Debridement Ea Addl 20 Sq Cm,,97598,CPT,Facility,Both,,,,43,36.55,12.3238,43,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),25.8,60,,percent of total billed charges,,
Open Wound Debridement Ea Addl 20 Sq Cm,,97598,CPT,Facility,Both,,,,43,36.55,12.3238,43,"Health Partners, Inc.",State of Minnesota Advantage Program,35.045,81.5,,percent of total billed charges,,
Open Wound Debridement Ea Addl 20 Sq Cm,,97598,CPT,Facility,Both,,,,43,36.55,12.3238,43,"Health Partners, Inc.",State Public Programs,21.5,50,,percent of total billed charges,,
Open Wound Debridement Ea Addl 20 Sq Cm,,97598,CPT,Facility,Both,,,,43,36.55,12.3238,43,Humana Insurance Company,Commercial PPO,40.85,95,,percent of total billed charges,,
Open Wound Debridement Ea Addl 20 Sq Cm,,97598,CPT,Facility,Outpatient,,,,43,36.55,12.3238,43,Humana Insurance Company,Medicare PPO,21.07,49,,percent of total billed charges,,
Open Wound Debridement Ea Addl 20 Sq Cm,,97598,CPT,Facility,Inpatient,,,,43,36.55,12.3238,43,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Open Wound Debridement Ea Addl 20 Sq Cm,,97598,CPT,Facility,Both,,,,43,36.55,12.3238,43,Medica,Individual & Family,42.613,99.1,,percent of total billed charges,,
Open Wound Debridement Ea Addl 20 Sq Cm,,97598,CPT,Facility,Outpatient,,,,43,36.55,12.3238,43,Medica,Medica Advantage Solution,21.414,49.8,,percent of total billed charges,,
Open Wound Debridement Ea Addl 20 Sq Cm,,97598,CPT,Facility,Inpatient,,,,43,36.55,12.3238,43,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Open Wound Debridement Ea Addl 20 Sq Cm,,97598,CPT,Facility,Outpatient,,,,43,36.55,12.3238,43,Medica,Medical Assistance,19.178,44.6,,percent of total billed charges,,
Open Wound Debridement Ea Addl 20 Sq Cm,,97598,CPT,Facility,Inpatient,,,,43,36.55,12.3238,43,Medica,Medical Assistance,,,,,Included in per diem rate,
Open Wound Debridement Ea Addl 20 Sq Cm,,97598,CPT,Facility,Outpatient,,,,43,36.55,12.3238,43,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,21.414,49.8,,percent of total billed charges,,
Open Wound Debridement Ea Addl 20 Sq Cm,,97598,CPT,Facility,Inpatient,,,,43,36.55,12.3238,43,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Open Wound Debridement Ea Addl 20 Sq Cm,,97598,CPT,Facility,Both,,,,43,36.55,12.3238,43,"Multiplan, Inc.","Multiplan, Inc.",40.42,94,,percent of total billed charges,,
Open Wound Debridement Ea Addl 20 Sq Cm,,97598,CPT,Facility,Outpatient,,,,43,36.55,12.3238,43,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,38.743,90.1,,percent of total billed charges,,
Open Wound Debridement Ea Addl 20 Sq Cm,,97598,CPT,Facility,Inpatient,,,,43,36.55,12.3238,43,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Open Wound Debridement Ea Addl 20 Sq Cm,,97598,CPT,Facility,Both,,,,43,36.55,12.3238,43,"Preferred One Administrative Services, INC.",PPO,42.398,98.6,,percent of total billed charges,,
Open Wound Debridement Ea Addl 20 Sq Cm,,97598,CPT,Facility,Outpatient,,,,43,36.55,12.3238,43,PrimeWest Health,Minnesota Senior Health Options (MSHO),22.1235,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Open Wound Debridement Ea Addl 20 Sq Cm,,97598,CPT,Facility,Inpatient,,,,43,36.55,12.3238,43,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Open Wound Debridement Ea Addl 20 Sq Cm,,97598,CPT,Facility,Outpatient,,,,43,36.55,12.3238,43,PrimeWest Health,MinnesotaCare,22.0848,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Open Wound Debridement Ea Addl 20 Sq Cm,,97598,CPT,Facility,Inpatient,,,,43,36.55,12.3238,43,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Open Wound Debridement Ea Addl 20 Sq Cm,,97598,CPT,Facility,Both,,,,43,36.55,12.3238,43,Sanford Health Plan,Sanford Health Plan,39.56,92,,percent of total billed charges,,
Open Wound Debridement Ea Addl 20 Sq Cm,,97598,CPT,Facility,Outpatient,,,,43,36.55,12.3238,43,"UCare Health, Inc.",Individual & Family Plan,24.2305,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Open Wound Debridement Ea Addl 20 Sq Cm,,97598,CPT,Facility,Inpatient,,,,43,36.55,12.3238,43,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Open Wound Debridement Ea Addl 20 Sq Cm,,97598,CPT,Facility,Outpatient,,,,43,36.55,12.3238,43,"UCare Health, Inc.",Medical Assistance,21.7021,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Open Wound Debridement Ea Addl 20 Sq Cm,,97598,CPT,Facility,Inpatient,,,,43,36.55,12.3238,43,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Open Wound Debridement Ea Addl 20 Sq Cm,,97598,CPT,Facility,Outpatient,,,,43,36.55,12.3238,43,"UCare Health, Inc.",Medicare Advantage,21.7021,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Open Wound Debridement Ea Addl 20 Sq Cm,,97598,CPT,Facility,Inpatient,,,,43,36.55,12.3238,43,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Open Wound Debridement Ea Addl 20 Sq Cm,,97598,CPT,Facility,Outpatient,,,,43,36.55,12.3238,43,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),21.7021,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Open Wound Debridement Ea Addl 20 Sq Cm,,97598,CPT,Facility,Inpatient,,,,43,36.55,12.3238,43,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Open Wound Debridement Ea Addl 20 Sq Cm,,97598,CPT,Facility,Both,,,,43,36.55,12.3238,43,UnitedHealthcare,Individual & Family,40.42,94,,percent of total billed charges,,
Open Wound Debridement Ea Addl 20 Sq Cm,,97598,CPT,Facility,Outpatient,,,,43,36.55,12.3238,43,UnitedHealthcare,Medicare Advantage,21.07,49,,percent of total billed charges,,
Open Wound Debridement Ea Addl 20 Sq Cm,,97598,CPT,Facility,Inpatient,,,,43,36.55,12.3238,43,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Open Wound Debridement Ea Addl 20 Sq Cm,,97598,CPT,Facility,Outpatient,,,,43,36.55,12.3238,43,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,20.64,48,,percent of total billed charges,,100% of DHS outpatient percentage
Open Wound Debridement Ea Addl 20 Sq Cm,,97598,CPT,Facility,Inpatient,,,,43,36.55,12.3238,43,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Non-Selective Debridement  Assessment,,97602,CPT,Facility,Both,,,,45,38.25,12.897,45,Aetna,Commercial,41.4,92,,percent of total billed charges,,
Non-Selective Debridement  Assessment,,97602,CPT,Facility,Outpatient,,,,45,38.25,12.897,45,Aetna,Medicare Advantage,22.05,49,,percent of total billed charges,,
Non-Selective Debridement  Assessment,,97602,CPT,Facility,Inpatient,,,,45,38.25,12.897,45,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Non-Selective Debridement  Assessment,,97602,CPT,Facility,Both,,,,45,38.25,12.897,45,Aetna,PPO,41.85,93,,percent of total billed charges,,
Non-Selective Debridement  Assessment,,97602,CPT,Facility,Both,,,,45,38.25,12.897,45,America's PPO,America's PPO,43.2135,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Non-Selective Debridement  Assessment,,97602,CPT,Facility,Both,,,,45,38.25,12.897,45,BlueCross BlueShield Minnesota, Federal Employee Program,44.28,98.4,,percent of total billed charges,,
Non-Selective Debridement  Assessment,,97602,CPT,Facility,Both,,,,45,38.25,12.897,45,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,45,100,,percent of total billed charges,,
Non-Selective Debridement  Assessment,,97602,CPT,Facility,Both,,,,45,38.25,12.897,45,BlueCross BlueShield Minnesota,High Value Network Plan,40.5,90,,percent of total billed charges,,
Non-Selective Debridement  Assessment,,97602,CPT,Facility,Outpatient,,,,45,38.25,12.897,45,BlueCross BlueShield Minnesota,Medicare Advantage,22.05,49,,percent of total billed charges,,
Non-Selective Debridement  Assessment,,97602,CPT,Facility,Inpatient,,,,45,38.25,12.897,45,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Non-Selective Debridement  Assessment,,97602,CPT,Facility,Both,,,,45,38.25,12.897,45,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,39.8565,88.57,,percent of total billed charges,,
Non-Selective Debridement  Assessment,,97602,CPT,Facility,Both,,,,45,38.25,12.897,45,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,12.897,28.66,,percent of total billed charges,,
Non-Selective Debridement  Assessment,,97602,CPT,Facility,Outpatient,,,,45,38.25,12.897,45,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),22.05,49,,percent of total billed charges,,
Non-Selective Debridement  Assessment,,97602,CPT,Facility,Inpatient,,,,45,38.25,12.897,45,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Non-Selective Debridement  Assessment,,97602,CPT,Facility,Both,,,,45,38.25,12.897,45,CorVel,Worker's Compensation,45,100,,percent of total billed charges,,
Non-Selective Debridement  Assessment,,97602,CPT,Facility,Both,,,,45,38.25,12.897,45,First Health Group Corporation,First Health Network,43.65,97,,percent of total billed charges,,
Non-Selective Debridement  Assessment,,97602,CPT,Facility,Both,,,,45,38.25,12.897,45,"Health Partners, Inc.",Commercial,42.57,94.6,,percent of total billed charges,,
Non-Selective Debridement  Assessment,,97602,CPT,Facility,Outpatient,,,,45,38.25,12.897,45,"Health Partners, Inc.",Medicare Advantage,22.05,49,,percent of total billed charges,,
Non-Selective Debridement  Assessment,,97602,CPT,Facility,Inpatient,,,,45,38.25,12.897,45,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Non-Selective Debridement  Assessment,,97602,CPT,Facility,Both,,,,45,38.25,12.897,45,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),27,60,,percent of total billed charges,,
Non-Selective Debridement  Assessment,,97602,CPT,Facility,Both,,,,45,38.25,12.897,45,"Health Partners, Inc.",State of Minnesota Advantage Program,36.675,81.5,,percent of total billed charges,,
Non-Selective Debridement  Assessment,,97602,CPT,Facility,Both,,,,45,38.25,12.897,45,"Health Partners, Inc.",State Public Programs,22.5,50,,percent of total billed charges,,
Non-Selective Debridement  Assessment,,97602,CPT,Facility,Both,,,,45,38.25,12.897,45,Humana Insurance Company,Commercial PPO,42.75,95,,percent of total billed charges,,
Non-Selective Debridement  Assessment,,97602,CPT,Facility,Outpatient,,,,45,38.25,12.897,45,Humana Insurance Company,Medicare PPO,22.05,49,,percent of total billed charges,,
Non-Selective Debridement  Assessment,,97602,CPT,Facility,Inpatient,,,,45,38.25,12.897,45,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Non-Selective Debridement  Assessment,,97602,CPT,Facility,Both,,,,45,38.25,12.897,45,Medica,Individual & Family,44.595,99.1,,percent of total billed charges,,
Non-Selective Debridement  Assessment,,97602,CPT,Facility,Outpatient,,,,45,38.25,12.897,45,Medica,Medica Advantage Solution,22.41,49.8,,percent of total billed charges,,
Non-Selective Debridement  Assessment,,97602,CPT,Facility,Inpatient,,,,45,38.25,12.897,45,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Non-Selective Debridement  Assessment,,97602,CPT,Facility,Outpatient,,,,45,38.25,12.897,45,Medica,Medical Assistance,20.07,44.6,,percent of total billed charges,,
Non-Selective Debridement  Assessment,,97602,CPT,Facility,Inpatient,,,,45,38.25,12.897,45,Medica,Medical Assistance,,,,,Included in per diem rate,
Non-Selective Debridement  Assessment,,97602,CPT,Facility,Outpatient,,,,45,38.25,12.897,45,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,22.41,49.8,,percent of total billed charges,,
Non-Selective Debridement  Assessment,,97602,CPT,Facility,Inpatient,,,,45,38.25,12.897,45,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Non-Selective Debridement  Assessment,,97602,CPT,Facility,Both,,,,45,38.25,12.897,45,"Multiplan, Inc.","Multiplan, Inc.",42.3,94,,percent of total billed charges,,
Non-Selective Debridement  Assessment,,97602,CPT,Facility,Outpatient,,,,45,38.25,12.897,45,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,40.545,90.1,,percent of total billed charges,,
Non-Selective Debridement  Assessment,,97602,CPT,Facility,Inpatient,,,,45,38.25,12.897,45,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Non-Selective Debridement  Assessment,,97602,CPT,Facility,Both,,,,45,38.25,12.897,45,"Preferred One Administrative Services, INC.",PPO,44.37,98.6,,percent of total billed charges,,
Non-Selective Debridement  Assessment,,97602,CPT,Facility,Outpatient,,,,45,38.25,12.897,45,PrimeWest Health,Minnesota Senior Health Options (MSHO),23.1525,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Non-Selective Debridement  Assessment,,97602,CPT,Facility,Inpatient,,,,45,38.25,12.897,45,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Non-Selective Debridement  Assessment,,97602,CPT,Facility,Outpatient,,,,45,38.25,12.897,45,PrimeWest Health,MinnesotaCare,23.112,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Non-Selective Debridement  Assessment,,97602,CPT,Facility,Inpatient,,,,45,38.25,12.897,45,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Non-Selective Debridement  Assessment,,97602,CPT,Facility,Both,,,,45,38.25,12.897,45,Sanford Health Plan,Sanford Health Plan,41.4,92,,percent of total billed charges,,
Non-Selective Debridement  Assessment,,97602,CPT,Facility,Outpatient,,,,45,38.25,12.897,45,"UCare Health, Inc.",Individual & Family Plan,25.3575,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Non-Selective Debridement  Assessment,,97602,CPT,Facility,Inpatient,,,,45,38.25,12.897,45,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Non-Selective Debridement  Assessment,,97602,CPT,Facility,Outpatient,,,,45,38.25,12.897,45,"UCare Health, Inc.",Medical Assistance,22.7115,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Non-Selective Debridement  Assessment,,97602,CPT,Facility,Inpatient,,,,45,38.25,12.897,45,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Non-Selective Debridement  Assessment,,97602,CPT,Facility,Outpatient,,,,45,38.25,12.897,45,"UCare Health, Inc.",Medicare Advantage,22.7115,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Non-Selective Debridement  Assessment,,97602,CPT,Facility,Inpatient,,,,45,38.25,12.897,45,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Non-Selective Debridement  Assessment,,97602,CPT,Facility,Outpatient,,,,45,38.25,12.897,45,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),22.7115,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Non-Selective Debridement  Assessment,,97602,CPT,Facility,Inpatient,,,,45,38.25,12.897,45,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Non-Selective Debridement  Assessment,,97602,CPT,Facility,Both,,,,45,38.25,12.897,45,UnitedHealthcare,Individual & Family,42.3,94,,percent of total billed charges,,
Non-Selective Debridement  Assessment,,97602,CPT,Facility,Outpatient,,,,45,38.25,12.897,45,UnitedHealthcare,Medicare Advantage,22.05,49,,percent of total billed charges,,
Non-Selective Debridement  Assessment,,97602,CPT,Facility,Inpatient,,,,45,38.25,12.897,45,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Non-Selective Debridement  Assessment,,97602,CPT,Facility,Outpatient,,,,45,38.25,12.897,45,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,21.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
Non-Selective Debridement  Assessment,,97602,CPT,Facility,Inpatient,,,,45,38.25,12.897,45,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Negative Pressure Wound Therapy < Or = To 50 Sq Cm,,97605,CPT,Facility,Both,,,,158,134.3,45.2828,158,Aetna,Commercial,145.36,92,,percent of total billed charges,,
Negative Pressure Wound Therapy < Or = To 50 Sq Cm,,97605,CPT,Facility,Outpatient,,,,158,134.3,45.2828,158,Aetna,Medicare Advantage,77.42,49,,percent of total billed charges,,
Negative Pressure Wound Therapy < Or = To 50 Sq Cm,,97605,CPT,Facility,Inpatient,,,,158,134.3,45.2828,158,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Negative Pressure Wound Therapy < Or = To 50 Sq Cm,,97605,CPT,Facility,Both,,,,158,134.3,45.2828,158,Aetna,PPO,146.94,93,,percent of total billed charges,,
Negative Pressure Wound Therapy < Or = To 50 Sq Cm,,97605,CPT,Facility,Both,,,,158,134.3,45.2828,158,America's PPO,America's PPO,151.7274,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Negative Pressure Wound Therapy < Or = To 50 Sq Cm,,97605,CPT,Facility,Both,,,,158,134.3,45.2828,158,BlueCross BlueShield Minnesota, Federal Employee Program,155.472,98.4,,percent of total billed charges,,
Negative Pressure Wound Therapy < Or = To 50 Sq Cm,,97605,CPT,Facility,Both,,,,158,134.3,45.2828,158,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,158,100,,percent of total billed charges,,
Negative Pressure Wound Therapy < Or = To 50 Sq Cm,,97605,CPT,Facility,Both,,,,158,134.3,45.2828,158,BlueCross BlueShield Minnesota,High Value Network Plan,142.2,90,,percent of total billed charges,,
Negative Pressure Wound Therapy < Or = To 50 Sq Cm,,97605,CPT,Facility,Outpatient,,,,158,134.3,45.2828,158,BlueCross BlueShield Minnesota,Medicare Advantage,77.42,49,,percent of total billed charges,,
Negative Pressure Wound Therapy < Or = To 50 Sq Cm,,97605,CPT,Facility,Inpatient,,,,158,134.3,45.2828,158,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Negative Pressure Wound Therapy < Or = To 50 Sq Cm,,97605,CPT,Facility,Both,,,,158,134.3,45.2828,158,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,139.9406,88.57,,percent of total billed charges,,
Negative Pressure Wound Therapy < Or = To 50 Sq Cm,,97605,CPT,Facility,Both,,,,158,134.3,45.2828,158,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,45.2828,28.66,,percent of total billed charges,,
Negative Pressure Wound Therapy < Or = To 50 Sq Cm,,97605,CPT,Facility,Outpatient,,,,158,134.3,45.2828,158,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),77.42,49,,percent of total billed charges,,
Negative Pressure Wound Therapy < Or = To 50 Sq Cm,,97605,CPT,Facility,Inpatient,,,,158,134.3,45.2828,158,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Negative Pressure Wound Therapy < Or = To 50 Sq Cm,,97605,CPT,Facility,Both,,,,158,134.3,45.2828,158,CorVel,Worker's Compensation,158,100,,percent of total billed charges,,
Negative Pressure Wound Therapy < Or = To 50 Sq Cm,,97605,CPT,Facility,Both,,,,158,134.3,45.2828,158,First Health Group Corporation,First Health Network,153.26,97,,percent of total billed charges,,
Negative Pressure Wound Therapy < Or = To 50 Sq Cm,,97605,CPT,Facility,Both,,,,158,134.3,45.2828,158,"Health Partners, Inc.",Commercial,149.468,94.6,,percent of total billed charges,,
Negative Pressure Wound Therapy < Or = To 50 Sq Cm,,97605,CPT,Facility,Outpatient,,,,158,134.3,45.2828,158,"Health Partners, Inc.",Medicare Advantage,77.42,49,,percent of total billed charges,,
Negative Pressure Wound Therapy < Or = To 50 Sq Cm,,97605,CPT,Facility,Inpatient,,,,158,134.3,45.2828,158,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Negative Pressure Wound Therapy < Or = To 50 Sq Cm,,97605,CPT,Facility,Both,,,,158,134.3,45.2828,158,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),94.8,60,,percent of total billed charges,,
Negative Pressure Wound Therapy < Or = To 50 Sq Cm,,97605,CPT,Facility,Both,,,,158,134.3,45.2828,158,"Health Partners, Inc.",State of Minnesota Advantage Program,128.77,81.5,,percent of total billed charges,,
Negative Pressure Wound Therapy < Or = To 50 Sq Cm,,97605,CPT,Facility,Both,,,,158,134.3,45.2828,158,"Health Partners, Inc.",State Public Programs,79,50,,percent of total billed charges,,
Negative Pressure Wound Therapy < Or = To 50 Sq Cm,,97605,CPT,Facility,Both,,,,158,134.3,45.2828,158,Humana Insurance Company,Commercial PPO,150.1,95,,percent of total billed charges,,
Negative Pressure Wound Therapy < Or = To 50 Sq Cm,,97605,CPT,Facility,Outpatient,,,,158,134.3,45.2828,158,Humana Insurance Company,Medicare PPO,77.42,49,,percent of total billed charges,,
Negative Pressure Wound Therapy < Or = To 50 Sq Cm,,97605,CPT,Facility,Inpatient,,,,158,134.3,45.2828,158,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Negative Pressure Wound Therapy < Or = To 50 Sq Cm,,97605,CPT,Facility,Both,,,,158,134.3,45.2828,158,Medica,Individual & Family,156.578,99.1,,percent of total billed charges,,
Negative Pressure Wound Therapy < Or = To 50 Sq Cm,,97605,CPT,Facility,Outpatient,,,,158,134.3,45.2828,158,Medica,Medica Advantage Solution,78.684,49.8,,percent of total billed charges,,
Negative Pressure Wound Therapy < Or = To 50 Sq Cm,,97605,CPT,Facility,Inpatient,,,,158,134.3,45.2828,158,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Negative Pressure Wound Therapy < Or = To 50 Sq Cm,,97605,CPT,Facility,Outpatient,,,,158,134.3,45.2828,158,Medica,Medical Assistance,70.468,44.6,,percent of total billed charges,,
Negative Pressure Wound Therapy < Or = To 50 Sq Cm,,97605,CPT,Facility,Inpatient,,,,158,134.3,45.2828,158,Medica,Medical Assistance,,,,,Included in per diem rate,
Negative Pressure Wound Therapy < Or = To 50 Sq Cm,,97605,CPT,Facility,Outpatient,,,,158,134.3,45.2828,158,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,78.684,49.8,,percent of total billed charges,,
Negative Pressure Wound Therapy < Or = To 50 Sq Cm,,97605,CPT,Facility,Inpatient,,,,158,134.3,45.2828,158,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Negative Pressure Wound Therapy < Or = To 50 Sq Cm,,97605,CPT,Facility,Both,,,,158,134.3,45.2828,158,"Multiplan, Inc.","Multiplan, Inc.",148.52,94,,percent of total billed charges,,
Negative Pressure Wound Therapy < Or = To 50 Sq Cm,,97605,CPT,Facility,Outpatient,,,,158,134.3,45.2828,158,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,142.358,90.1,,percent of total billed charges,,
Negative Pressure Wound Therapy < Or = To 50 Sq Cm,,97605,CPT,Facility,Inpatient,,,,158,134.3,45.2828,158,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Negative Pressure Wound Therapy < Or = To 50 Sq Cm,,97605,CPT,Facility,Both,,,,158,134.3,45.2828,158,"Preferred One Administrative Services, INC.",PPO,155.788,98.6,,percent of total billed charges,,
Negative Pressure Wound Therapy < Or = To 50 Sq Cm,,97605,CPT,Facility,Outpatient,,,,158,134.3,45.2828,158,PrimeWest Health,Minnesota Senior Health Options (MSHO),81.291,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Negative Pressure Wound Therapy < Or = To 50 Sq Cm,,97605,CPT,Facility,Inpatient,,,,158,134.3,45.2828,158,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Negative Pressure Wound Therapy < Or = To 50 Sq Cm,,97605,CPT,Facility,Outpatient,,,,158,134.3,45.2828,158,PrimeWest Health,MinnesotaCare,81.1488,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Negative Pressure Wound Therapy < Or = To 50 Sq Cm,,97605,CPT,Facility,Inpatient,,,,158,134.3,45.2828,158,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Negative Pressure Wound Therapy < Or = To 50 Sq Cm,,97605,CPT,Facility,Both,,,,158,134.3,45.2828,158,Sanford Health Plan,Sanford Health Plan,145.36,92,,percent of total billed charges,,
Negative Pressure Wound Therapy < Or = To 50 Sq Cm,,97605,CPT,Facility,Outpatient,,,,158,134.3,45.2828,158,"UCare Health, Inc.",Individual & Family Plan,89.033,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Negative Pressure Wound Therapy < Or = To 50 Sq Cm,,97605,CPT,Facility,Inpatient,,,,158,134.3,45.2828,158,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Negative Pressure Wound Therapy < Or = To 50 Sq Cm,,97605,CPT,Facility,Outpatient,,,,158,134.3,45.2828,158,"UCare Health, Inc.",Medical Assistance,79.7426,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Negative Pressure Wound Therapy < Or = To 50 Sq Cm,,97605,CPT,Facility,Inpatient,,,,158,134.3,45.2828,158,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Negative Pressure Wound Therapy < Or = To 50 Sq Cm,,97605,CPT,Facility,Outpatient,,,,158,134.3,45.2828,158,"UCare Health, Inc.",Medicare Advantage,79.7426,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Negative Pressure Wound Therapy < Or = To 50 Sq Cm,,97605,CPT,Facility,Inpatient,,,,158,134.3,45.2828,158,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Negative Pressure Wound Therapy < Or = To 50 Sq Cm,,97605,CPT,Facility,Outpatient,,,,158,134.3,45.2828,158,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),79.7426,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Negative Pressure Wound Therapy < Or = To 50 Sq Cm,,97605,CPT,Facility,Inpatient,,,,158,134.3,45.2828,158,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Negative Pressure Wound Therapy < Or = To 50 Sq Cm,,97605,CPT,Facility,Both,,,,158,134.3,45.2828,158,UnitedHealthcare,Individual & Family,148.52,94,,percent of total billed charges,,
Negative Pressure Wound Therapy < Or = To 50 Sq Cm,,97605,CPT,Facility,Outpatient,,,,158,134.3,45.2828,158,UnitedHealthcare,Medicare Advantage,77.42,49,,percent of total billed charges,,
Negative Pressure Wound Therapy < Or = To 50 Sq Cm,,97605,CPT,Facility,Inpatient,,,,158,134.3,45.2828,158,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Negative Pressure Wound Therapy < Or = To 50 Sq Cm,,97605,CPT,Facility,Outpatient,,,,158,134.3,45.2828,158,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,75.84,48,,percent of total billed charges,,100% of DHS outpatient percentage
Negative Pressure Wound Therapy < Or = To 50 Sq Cm,,97605,CPT,Facility,Inpatient,,,,158,134.3,45.2828,158,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Negative Pressure Wound Therapy > 50 Sq Cm,,97606,CPT,Facility,Both,,,,55,46.75,15.763,55,Aetna,Commercial,50.6,92,,percent of total billed charges,,
Negative Pressure Wound Therapy > 50 Sq Cm,,97606,CPT,Facility,Outpatient,,,,55,46.75,15.763,55,Aetna,Medicare Advantage,26.95,49,,percent of total billed charges,,
Negative Pressure Wound Therapy > 50 Sq Cm,,97606,CPT,Facility,Inpatient,,,,55,46.75,15.763,55,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Negative Pressure Wound Therapy > 50 Sq Cm,,97606,CPT,Facility,Both,,,,55,46.75,15.763,55,Aetna,PPO,51.15,93,,percent of total billed charges,,
Negative Pressure Wound Therapy > 50 Sq Cm,,97606,CPT,Facility,Both,,,,55,46.75,15.763,55,America's PPO,America's PPO,52.8165,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Negative Pressure Wound Therapy > 50 Sq Cm,,97606,CPT,Facility,Both,,,,55,46.75,15.763,55,BlueCross BlueShield Minnesota, Federal Employee Program,54.12,98.4,,percent of total billed charges,,
Negative Pressure Wound Therapy > 50 Sq Cm,,97606,CPT,Facility,Both,,,,55,46.75,15.763,55,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,55,100,,percent of total billed charges,,
Negative Pressure Wound Therapy > 50 Sq Cm,,97606,CPT,Facility,Both,,,,55,46.75,15.763,55,BlueCross BlueShield Minnesota,High Value Network Plan,49.5,90,,percent of total billed charges,,
Negative Pressure Wound Therapy > 50 Sq Cm,,97606,CPT,Facility,Outpatient,,,,55,46.75,15.763,55,BlueCross BlueShield Minnesota,Medicare Advantage,26.95,49,,percent of total billed charges,,
Negative Pressure Wound Therapy > 50 Sq Cm,,97606,CPT,Facility,Inpatient,,,,55,46.75,15.763,55,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Negative Pressure Wound Therapy > 50 Sq Cm,,97606,CPT,Facility,Both,,,,55,46.75,15.763,55,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,48.7135,88.57,,percent of total billed charges,,
Negative Pressure Wound Therapy > 50 Sq Cm,,97606,CPT,Facility,Both,,,,55,46.75,15.763,55,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,15.763,28.66,,percent of total billed charges,,
Negative Pressure Wound Therapy > 50 Sq Cm,,97606,CPT,Facility,Outpatient,,,,55,46.75,15.763,55,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),26.95,49,,percent of total billed charges,,
Negative Pressure Wound Therapy > 50 Sq Cm,,97606,CPT,Facility,Inpatient,,,,55,46.75,15.763,55,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Negative Pressure Wound Therapy > 50 Sq Cm,,97606,CPT,Facility,Both,,,,55,46.75,15.763,55,CorVel,Worker's Compensation,55,100,,percent of total billed charges,,
Negative Pressure Wound Therapy > 50 Sq Cm,,97606,CPT,Facility,Both,,,,55,46.75,15.763,55,First Health Group Corporation,First Health Network,53.35,97,,percent of total billed charges,,
Negative Pressure Wound Therapy > 50 Sq Cm,,97606,CPT,Facility,Both,,,,55,46.75,15.763,55,"Health Partners, Inc.",Commercial,52.03,94.6,,percent of total billed charges,,
Negative Pressure Wound Therapy > 50 Sq Cm,,97606,CPT,Facility,Outpatient,,,,55,46.75,15.763,55,"Health Partners, Inc.",Medicare Advantage,26.95,49,,percent of total billed charges,,
Negative Pressure Wound Therapy > 50 Sq Cm,,97606,CPT,Facility,Inpatient,,,,55,46.75,15.763,55,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Negative Pressure Wound Therapy > 50 Sq Cm,,97606,CPT,Facility,Both,,,,55,46.75,15.763,55,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),33,60,,percent of total billed charges,,
Negative Pressure Wound Therapy > 50 Sq Cm,,97606,CPT,Facility,Both,,,,55,46.75,15.763,55,"Health Partners, Inc.",State of Minnesota Advantage Program,44.825,81.5,,percent of total billed charges,,
Negative Pressure Wound Therapy > 50 Sq Cm,,97606,CPT,Facility,Both,,,,55,46.75,15.763,55,"Health Partners, Inc.",State Public Programs,27.5,50,,percent of total billed charges,,
Negative Pressure Wound Therapy > 50 Sq Cm,,97606,CPT,Facility,Both,,,,55,46.75,15.763,55,Humana Insurance Company,Commercial PPO,52.25,95,,percent of total billed charges,,
Negative Pressure Wound Therapy > 50 Sq Cm,,97606,CPT,Facility,Outpatient,,,,55,46.75,15.763,55,Humana Insurance Company,Medicare PPO,26.95,49,,percent of total billed charges,,
Negative Pressure Wound Therapy > 50 Sq Cm,,97606,CPT,Facility,Inpatient,,,,55,46.75,15.763,55,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Negative Pressure Wound Therapy > 50 Sq Cm,,97606,CPT,Facility,Both,,,,55,46.75,15.763,55,Medica,Individual & Family,54.505,99.1,,percent of total billed charges,,
Negative Pressure Wound Therapy > 50 Sq Cm,,97606,CPT,Facility,Outpatient,,,,55,46.75,15.763,55,Medica,Medica Advantage Solution,27.39,49.8,,percent of total billed charges,,
Negative Pressure Wound Therapy > 50 Sq Cm,,97606,CPT,Facility,Inpatient,,,,55,46.75,15.763,55,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Negative Pressure Wound Therapy > 50 Sq Cm,,97606,CPT,Facility,Outpatient,,,,55,46.75,15.763,55,Medica,Medical Assistance,24.53,44.6,,percent of total billed charges,,
Negative Pressure Wound Therapy > 50 Sq Cm,,97606,CPT,Facility,Inpatient,,,,55,46.75,15.763,55,Medica,Medical Assistance,,,,,Included in per diem rate,
Negative Pressure Wound Therapy > 50 Sq Cm,,97606,CPT,Facility,Outpatient,,,,55,46.75,15.763,55,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,27.39,49.8,,percent of total billed charges,,
Negative Pressure Wound Therapy > 50 Sq Cm,,97606,CPT,Facility,Inpatient,,,,55,46.75,15.763,55,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Negative Pressure Wound Therapy > 50 Sq Cm,,97606,CPT,Facility,Both,,,,55,46.75,15.763,55,"Multiplan, Inc.","Multiplan, Inc.",51.7,94,,percent of total billed charges,,
Negative Pressure Wound Therapy > 50 Sq Cm,,97606,CPT,Facility,Outpatient,,,,55,46.75,15.763,55,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,49.555,90.1,,percent of total billed charges,,
Negative Pressure Wound Therapy > 50 Sq Cm,,97606,CPT,Facility,Inpatient,,,,55,46.75,15.763,55,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Negative Pressure Wound Therapy > 50 Sq Cm,,97606,CPT,Facility,Both,,,,55,46.75,15.763,55,"Preferred One Administrative Services, INC.",PPO,54.23,98.6,,percent of total billed charges,,
Negative Pressure Wound Therapy > 50 Sq Cm,,97606,CPT,Facility,Outpatient,,,,55,46.75,15.763,55,PrimeWest Health,Minnesota Senior Health Options (MSHO),28.2975,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Negative Pressure Wound Therapy > 50 Sq Cm,,97606,CPT,Facility,Inpatient,,,,55,46.75,15.763,55,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Negative Pressure Wound Therapy > 50 Sq Cm,,97606,CPT,Facility,Outpatient,,,,55,46.75,15.763,55,PrimeWest Health,MinnesotaCare,28.248,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Negative Pressure Wound Therapy > 50 Sq Cm,,97606,CPT,Facility,Inpatient,,,,55,46.75,15.763,55,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Negative Pressure Wound Therapy > 50 Sq Cm,,97606,CPT,Facility,Both,,,,55,46.75,15.763,55,Sanford Health Plan,Sanford Health Plan,50.6,92,,percent of total billed charges,,
Negative Pressure Wound Therapy > 50 Sq Cm,,97606,CPT,Facility,Outpatient,,,,55,46.75,15.763,55,"UCare Health, Inc.",Individual & Family Plan,30.9925,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Negative Pressure Wound Therapy > 50 Sq Cm,,97606,CPT,Facility,Inpatient,,,,55,46.75,15.763,55,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Negative Pressure Wound Therapy > 50 Sq Cm,,97606,CPT,Facility,Outpatient,,,,55,46.75,15.763,55,"UCare Health, Inc.",Medical Assistance,27.7585,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Negative Pressure Wound Therapy > 50 Sq Cm,,97606,CPT,Facility,Inpatient,,,,55,46.75,15.763,55,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Negative Pressure Wound Therapy > 50 Sq Cm,,97606,CPT,Facility,Outpatient,,,,55,46.75,15.763,55,"UCare Health, Inc.",Medicare Advantage,27.7585,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Negative Pressure Wound Therapy > 50 Sq Cm,,97606,CPT,Facility,Inpatient,,,,55,46.75,15.763,55,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Negative Pressure Wound Therapy > 50 Sq Cm,,97606,CPT,Facility,Outpatient,,,,55,46.75,15.763,55,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),27.7585,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Negative Pressure Wound Therapy > 50 Sq Cm,,97606,CPT,Facility,Inpatient,,,,55,46.75,15.763,55,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Negative Pressure Wound Therapy > 50 Sq Cm,,97606,CPT,Facility,Both,,,,55,46.75,15.763,55,UnitedHealthcare,Individual & Family,51.7,94,,percent of total billed charges,,
Negative Pressure Wound Therapy > 50 Sq Cm,,97606,CPT,Facility,Outpatient,,,,55,46.75,15.763,55,UnitedHealthcare,Medicare Advantage,26.95,49,,percent of total billed charges,,
Negative Pressure Wound Therapy > 50 Sq Cm,,97606,CPT,Facility,Inpatient,,,,55,46.75,15.763,55,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Negative Pressure Wound Therapy > 50 Sq Cm,,97606,CPT,Facility,Outpatient,,,,55,46.75,15.763,55,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,26.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
Negative Pressure Wound Therapy > 50 Sq Cm,,97606,CPT,Facility,Inpatient,,,,55,46.75,15.763,55,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Negative Pressure Wound Therapy, W/Disposable,Non-Dme; < Or = 50 Sq Cm",,97607,CPT,Facility,Both,,,,37,31.45,10.6042,37,Aetna,Commercial,34.04,92,,percent of total billed charges,,
"Negative Pressure Wound Therapy, W/Disposable,Non-Dme; < Or = 50 Sq Cm",,97607,CPT,Facility,Outpatient,,,,37,31.45,10.6042,37,Aetna,Medicare Advantage,18.13,49,,percent of total billed charges,,
"Negative Pressure Wound Therapy, W/Disposable,Non-Dme; < Or = 50 Sq Cm",,97607,CPT,Facility,Inpatient,,,,37,31.45,10.6042,37,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Negative Pressure Wound Therapy, W/Disposable,Non-Dme; < Or = 50 Sq Cm",,97607,CPT,Facility,Both,,,,37,31.45,10.6042,37,Aetna,PPO,34.41,93,,percent of total billed charges,,
"Negative Pressure Wound Therapy, W/Disposable,Non-Dme; < Or = 50 Sq Cm",,97607,CPT,Facility,Both,,,,37,31.45,10.6042,37,America's PPO,America's PPO,35.5311,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Negative Pressure Wound Therapy, W/Disposable,Non-Dme; < Or = 50 Sq Cm",,97607,CPT,Facility,Both,,,,37,31.45,10.6042,37,BlueCross BlueShield Minnesota, Federal Employee Program,36.408,98.4,,percent of total billed charges,,
"Negative Pressure Wound Therapy, W/Disposable,Non-Dme; < Or = 50 Sq Cm",,97607,CPT,Facility,Both,,,,37,31.45,10.6042,37,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,37,100,,percent of total billed charges,,
"Negative Pressure Wound Therapy, W/Disposable,Non-Dme; < Or = 50 Sq Cm",,97607,CPT,Facility,Both,,,,37,31.45,10.6042,37,BlueCross BlueShield Minnesota,High Value Network Plan,33.3,90,,percent of total billed charges,,
"Negative Pressure Wound Therapy, W/Disposable,Non-Dme; < Or = 50 Sq Cm",,97607,CPT,Facility,Outpatient,,,,37,31.45,10.6042,37,BlueCross BlueShield Minnesota,Medicare Advantage,18.13,49,,percent of total billed charges,,
"Negative Pressure Wound Therapy, W/Disposable,Non-Dme; < Or = 50 Sq Cm",,97607,CPT,Facility,Inpatient,,,,37,31.45,10.6042,37,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Negative Pressure Wound Therapy, W/Disposable,Non-Dme; < Or = 50 Sq Cm",,97607,CPT,Facility,Both,,,,37,31.45,10.6042,37,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,32.7709,88.57,,percent of total billed charges,,
"Negative Pressure Wound Therapy, W/Disposable,Non-Dme; < Or = 50 Sq Cm",,97607,CPT,Facility,Both,,,,37,31.45,10.6042,37,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,10.6042,28.66,,percent of total billed charges,,
"Negative Pressure Wound Therapy, W/Disposable,Non-Dme; < Or = 50 Sq Cm",,97607,CPT,Facility,Outpatient,,,,37,31.45,10.6042,37,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),18.13,49,,percent of total billed charges,,
"Negative Pressure Wound Therapy, W/Disposable,Non-Dme; < Or = 50 Sq Cm",,97607,CPT,Facility,Inpatient,,,,37,31.45,10.6042,37,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Negative Pressure Wound Therapy, W/Disposable,Non-Dme; < Or = 50 Sq Cm",,97607,CPT,Facility,Both,,,,37,31.45,10.6042,37,CorVel,Worker's Compensation,37,100,,percent of total billed charges,,
"Negative Pressure Wound Therapy, W/Disposable,Non-Dme; < Or = 50 Sq Cm",,97607,CPT,Facility,Both,,,,37,31.45,10.6042,37,First Health Group Corporation,First Health Network,35.89,97,,percent of total billed charges,,
"Negative Pressure Wound Therapy, W/Disposable,Non-Dme; < Or = 50 Sq Cm",,97607,CPT,Facility,Both,,,,37,31.45,10.6042,37,"Health Partners, Inc.",Commercial,35.002,94.6,,percent of total billed charges,,
"Negative Pressure Wound Therapy, W/Disposable,Non-Dme; < Or = 50 Sq Cm",,97607,CPT,Facility,Outpatient,,,,37,31.45,10.6042,37,"Health Partners, Inc.",Medicare Advantage,18.13,49,,percent of total billed charges,,
"Negative Pressure Wound Therapy, W/Disposable,Non-Dme; < Or = 50 Sq Cm",,97607,CPT,Facility,Inpatient,,,,37,31.45,10.6042,37,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Negative Pressure Wound Therapy, W/Disposable,Non-Dme; < Or = 50 Sq Cm",,97607,CPT,Facility,Both,,,,37,31.45,10.6042,37,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),22.2,60,,percent of total billed charges,,
"Negative Pressure Wound Therapy, W/Disposable,Non-Dme; < Or = 50 Sq Cm",,97607,CPT,Facility,Both,,,,37,31.45,10.6042,37,"Health Partners, Inc.",State of Minnesota Advantage Program,30.155,81.5,,percent of total billed charges,,
"Negative Pressure Wound Therapy, W/Disposable,Non-Dme; < Or = 50 Sq Cm",,97607,CPT,Facility,Both,,,,37,31.45,10.6042,37,"Health Partners, Inc.",State Public Programs,18.5,50,,percent of total billed charges,,
"Negative Pressure Wound Therapy, W/Disposable,Non-Dme; < Or = 50 Sq Cm",,97607,CPT,Facility,Both,,,,37,31.45,10.6042,37,Humana Insurance Company,Commercial PPO,35.15,95,,percent of total billed charges,,
"Negative Pressure Wound Therapy, W/Disposable,Non-Dme; < Or = 50 Sq Cm",,97607,CPT,Facility,Outpatient,,,,37,31.45,10.6042,37,Humana Insurance Company,Medicare PPO,18.13,49,,percent of total billed charges,,
"Negative Pressure Wound Therapy, W/Disposable,Non-Dme; < Or = 50 Sq Cm",,97607,CPT,Facility,Inpatient,,,,37,31.45,10.6042,37,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Negative Pressure Wound Therapy, W/Disposable,Non-Dme; < Or = 50 Sq Cm",,97607,CPT,Facility,Both,,,,37,31.45,10.6042,37,Medica,Individual & Family,36.667,99.1,,percent of total billed charges,,
"Negative Pressure Wound Therapy, W/Disposable,Non-Dme; < Or = 50 Sq Cm",,97607,CPT,Facility,Outpatient,,,,37,31.45,10.6042,37,Medica,Medica Advantage Solution,18.426,49.8,,percent of total billed charges,,
"Negative Pressure Wound Therapy, W/Disposable,Non-Dme; < Or = 50 Sq Cm",,97607,CPT,Facility,Inpatient,,,,37,31.45,10.6042,37,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Negative Pressure Wound Therapy, W/Disposable,Non-Dme; < Or = 50 Sq Cm",,97607,CPT,Facility,Outpatient,,,,37,31.45,10.6042,37,Medica,Medical Assistance,16.502,44.6,,percent of total billed charges,,
"Negative Pressure Wound Therapy, W/Disposable,Non-Dme; < Or = 50 Sq Cm",,97607,CPT,Facility,Inpatient,,,,37,31.45,10.6042,37,Medica,Medical Assistance,,,,,Included in per diem rate,
"Negative Pressure Wound Therapy, W/Disposable,Non-Dme; < Or = 50 Sq Cm",,97607,CPT,Facility,Outpatient,,,,37,31.45,10.6042,37,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,18.426,49.8,,percent of total billed charges,,
"Negative Pressure Wound Therapy, W/Disposable,Non-Dme; < Or = 50 Sq Cm",,97607,CPT,Facility,Inpatient,,,,37,31.45,10.6042,37,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Negative Pressure Wound Therapy, W/Disposable,Non-Dme; < Or = 50 Sq Cm",,97607,CPT,Facility,Both,,,,37,31.45,10.6042,37,"Multiplan, Inc.","Multiplan, Inc.",34.78,94,,percent of total billed charges,,
"Negative Pressure Wound Therapy, W/Disposable,Non-Dme; < Or = 50 Sq Cm",,97607,CPT,Facility,Outpatient,,,,37,31.45,10.6042,37,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,33.337,90.1,,percent of total billed charges,,
"Negative Pressure Wound Therapy, W/Disposable,Non-Dme; < Or = 50 Sq Cm",,97607,CPT,Facility,Inpatient,,,,37,31.45,10.6042,37,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Negative Pressure Wound Therapy, W/Disposable,Non-Dme; < Or = 50 Sq Cm",,97607,CPT,Facility,Both,,,,37,31.45,10.6042,37,"Preferred One Administrative Services, INC.",PPO,36.482,98.6,,percent of total billed charges,,
"Negative Pressure Wound Therapy, W/Disposable,Non-Dme; < Or = 50 Sq Cm",,97607,CPT,Facility,Outpatient,,,,37,31.45,10.6042,37,PrimeWest Health,Minnesota Senior Health Options (MSHO),19.0365,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Negative Pressure Wound Therapy, W/Disposable,Non-Dme; < Or = 50 Sq Cm",,97607,CPT,Facility,Inpatient,,,,37,31.45,10.6042,37,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Negative Pressure Wound Therapy, W/Disposable,Non-Dme; < Or = 50 Sq Cm",,97607,CPT,Facility,Outpatient,,,,37,31.45,10.6042,37,PrimeWest Health,MinnesotaCare,19.0032,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Negative Pressure Wound Therapy, W/Disposable,Non-Dme; < Or = 50 Sq Cm",,97607,CPT,Facility,Inpatient,,,,37,31.45,10.6042,37,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Negative Pressure Wound Therapy, W/Disposable,Non-Dme; < Or = 50 Sq Cm",,97607,CPT,Facility,Both,,,,37,31.45,10.6042,37,Sanford Health Plan,Sanford Health Plan,34.04,92,,percent of total billed charges,,
"Negative Pressure Wound Therapy, W/Disposable,Non-Dme; < Or = 50 Sq Cm",,97607,CPT,Facility,Outpatient,,,,37,31.45,10.6042,37,"UCare Health, Inc.",Individual & Family Plan,20.8495,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Negative Pressure Wound Therapy, W/Disposable,Non-Dme; < Or = 50 Sq Cm",,97607,CPT,Facility,Inpatient,,,,37,31.45,10.6042,37,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Negative Pressure Wound Therapy, W/Disposable,Non-Dme; < Or = 50 Sq Cm",,97607,CPT,Facility,Outpatient,,,,37,31.45,10.6042,37,"UCare Health, Inc.",Medical Assistance,18.6739,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Negative Pressure Wound Therapy, W/Disposable,Non-Dme; < Or = 50 Sq Cm",,97607,CPT,Facility,Inpatient,,,,37,31.45,10.6042,37,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Negative Pressure Wound Therapy, W/Disposable,Non-Dme; < Or = 50 Sq Cm",,97607,CPT,Facility,Outpatient,,,,37,31.45,10.6042,37,"UCare Health, Inc.",Medicare Advantage,18.6739,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Negative Pressure Wound Therapy, W/Disposable,Non-Dme; < Or = 50 Sq Cm",,97607,CPT,Facility,Inpatient,,,,37,31.45,10.6042,37,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Negative Pressure Wound Therapy, W/Disposable,Non-Dme; < Or = 50 Sq Cm",,97607,CPT,Facility,Outpatient,,,,37,31.45,10.6042,37,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),18.6739,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Negative Pressure Wound Therapy, W/Disposable,Non-Dme; < Or = 50 Sq Cm",,97607,CPT,Facility,Inpatient,,,,37,31.45,10.6042,37,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Negative Pressure Wound Therapy, W/Disposable,Non-Dme; < Or = 50 Sq Cm",,97607,CPT,Facility,Both,,,,37,31.45,10.6042,37,UnitedHealthcare,Individual & Family,34.78,94,,percent of total billed charges,,
"Negative Pressure Wound Therapy, W/Disposable,Non-Dme; < Or = 50 Sq Cm",,97607,CPT,Facility,Outpatient,,,,37,31.45,10.6042,37,UnitedHealthcare,Medicare Advantage,18.13,49,,percent of total billed charges,,
"Negative Pressure Wound Therapy, W/Disposable,Non-Dme; < Or = 50 Sq Cm",,97607,CPT,Facility,Inpatient,,,,37,31.45,10.6042,37,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Negative Pressure Wound Therapy, W/Disposable,Non-Dme; < Or = 50 Sq Cm",,97607,CPT,Facility,Outpatient,,,,37,31.45,10.6042,37,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,17.76,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Negative Pressure Wound Therapy, W/Disposable,Non-Dme; < Or = 50 Sq Cm",,97607,CPT,Facility,Inpatient,,,,37,31.45,10.6042,37,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Negative Pressure Wound Therapy, W/Disposable,Non-Dme; > 50 Sq Cm",,97608,CPT,Facility,Both,,,,42,35.7,12.0372,42,Aetna,Commercial,38.64,92,,percent of total billed charges,,
"Negative Pressure Wound Therapy, W/Disposable,Non-Dme; > 50 Sq Cm",,97608,CPT,Facility,Outpatient,,,,42,35.7,12.0372,42,Aetna,Medicare Advantage,20.58,49,,percent of total billed charges,,
"Negative Pressure Wound Therapy, W/Disposable,Non-Dme; > 50 Sq Cm",,97608,CPT,Facility,Inpatient,,,,42,35.7,12.0372,42,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Negative Pressure Wound Therapy, W/Disposable,Non-Dme; > 50 Sq Cm",,97608,CPT,Facility,Both,,,,42,35.7,12.0372,42,Aetna,PPO,39.06,93,,percent of total billed charges,,
"Negative Pressure Wound Therapy, W/Disposable,Non-Dme; > 50 Sq Cm",,97608,CPT,Facility,Both,,,,42,35.7,12.0372,42,America's PPO,America's PPO,40.3326,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Negative Pressure Wound Therapy, W/Disposable,Non-Dme; > 50 Sq Cm",,97608,CPT,Facility,Both,,,,42,35.7,12.0372,42,BlueCross BlueShield Minnesota, Federal Employee Program,41.328,98.4,,percent of total billed charges,,
"Negative Pressure Wound Therapy, W/Disposable,Non-Dme; > 50 Sq Cm",,97608,CPT,Facility,Both,,,,42,35.7,12.0372,42,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,42,100,,percent of total billed charges,,
"Negative Pressure Wound Therapy, W/Disposable,Non-Dme; > 50 Sq Cm",,97608,CPT,Facility,Both,,,,42,35.7,12.0372,42,BlueCross BlueShield Minnesota,High Value Network Plan,37.8,90,,percent of total billed charges,,
"Negative Pressure Wound Therapy, W/Disposable,Non-Dme; > 50 Sq Cm",,97608,CPT,Facility,Outpatient,,,,42,35.7,12.0372,42,BlueCross BlueShield Minnesota,Medicare Advantage,20.58,49,,percent of total billed charges,,
"Negative Pressure Wound Therapy, W/Disposable,Non-Dme; > 50 Sq Cm",,97608,CPT,Facility,Inpatient,,,,42,35.7,12.0372,42,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Negative Pressure Wound Therapy, W/Disposable,Non-Dme; > 50 Sq Cm",,97608,CPT,Facility,Both,,,,42,35.7,12.0372,42,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,37.1994,88.57,,percent of total billed charges,,
"Negative Pressure Wound Therapy, W/Disposable,Non-Dme; > 50 Sq Cm",,97608,CPT,Facility,Both,,,,42,35.7,12.0372,42,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,12.0372,28.66,,percent of total billed charges,,
"Negative Pressure Wound Therapy, W/Disposable,Non-Dme; > 50 Sq Cm",,97608,CPT,Facility,Outpatient,,,,42,35.7,12.0372,42,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),20.58,49,,percent of total billed charges,,
"Negative Pressure Wound Therapy, W/Disposable,Non-Dme; > 50 Sq Cm",,97608,CPT,Facility,Inpatient,,,,42,35.7,12.0372,42,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Negative Pressure Wound Therapy, W/Disposable,Non-Dme; > 50 Sq Cm",,97608,CPT,Facility,Both,,,,42,35.7,12.0372,42,CorVel,Worker's Compensation,42,100,,percent of total billed charges,,
"Negative Pressure Wound Therapy, W/Disposable,Non-Dme; > 50 Sq Cm",,97608,CPT,Facility,Both,,,,42,35.7,12.0372,42,First Health Group Corporation,First Health Network,40.74,97,,percent of total billed charges,,
"Negative Pressure Wound Therapy, W/Disposable,Non-Dme; > 50 Sq Cm",,97608,CPT,Facility,Both,,,,42,35.7,12.0372,42,"Health Partners, Inc.",Commercial,39.732,94.6,,percent of total billed charges,,
"Negative Pressure Wound Therapy, W/Disposable,Non-Dme; > 50 Sq Cm",,97608,CPT,Facility,Outpatient,,,,42,35.7,12.0372,42,"Health Partners, Inc.",Medicare Advantage,20.58,49,,percent of total billed charges,,
"Negative Pressure Wound Therapy, W/Disposable,Non-Dme; > 50 Sq Cm",,97608,CPT,Facility,Inpatient,,,,42,35.7,12.0372,42,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Negative Pressure Wound Therapy, W/Disposable,Non-Dme; > 50 Sq Cm",,97608,CPT,Facility,Both,,,,42,35.7,12.0372,42,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),25.2,60,,percent of total billed charges,,
"Negative Pressure Wound Therapy, W/Disposable,Non-Dme; > 50 Sq Cm",,97608,CPT,Facility,Both,,,,42,35.7,12.0372,42,"Health Partners, Inc.",State of Minnesota Advantage Program,34.23,81.5,,percent of total billed charges,,
"Negative Pressure Wound Therapy, W/Disposable,Non-Dme; > 50 Sq Cm",,97608,CPT,Facility,Both,,,,42,35.7,12.0372,42,"Health Partners, Inc.",State Public Programs,21,50,,percent of total billed charges,,
"Negative Pressure Wound Therapy, W/Disposable,Non-Dme; > 50 Sq Cm",,97608,CPT,Facility,Both,,,,42,35.7,12.0372,42,Humana Insurance Company,Commercial PPO,39.9,95,,percent of total billed charges,,
"Negative Pressure Wound Therapy, W/Disposable,Non-Dme; > 50 Sq Cm",,97608,CPT,Facility,Outpatient,,,,42,35.7,12.0372,42,Humana Insurance Company,Medicare PPO,20.58,49,,percent of total billed charges,,
"Negative Pressure Wound Therapy, W/Disposable,Non-Dme; > 50 Sq Cm",,97608,CPT,Facility,Inpatient,,,,42,35.7,12.0372,42,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Negative Pressure Wound Therapy, W/Disposable,Non-Dme; > 50 Sq Cm",,97608,CPT,Facility,Both,,,,42,35.7,12.0372,42,Medica,Individual & Family,41.622,99.1,,percent of total billed charges,,
"Negative Pressure Wound Therapy, W/Disposable,Non-Dme; > 50 Sq Cm",,97608,CPT,Facility,Outpatient,,,,42,35.7,12.0372,42,Medica,Medica Advantage Solution,20.916,49.8,,percent of total billed charges,,
"Negative Pressure Wound Therapy, W/Disposable,Non-Dme; > 50 Sq Cm",,97608,CPT,Facility,Inpatient,,,,42,35.7,12.0372,42,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Negative Pressure Wound Therapy, W/Disposable,Non-Dme; > 50 Sq Cm",,97608,CPT,Facility,Outpatient,,,,42,35.7,12.0372,42,Medica,Medical Assistance,18.732,44.6,,percent of total billed charges,,
"Negative Pressure Wound Therapy, W/Disposable,Non-Dme; > 50 Sq Cm",,97608,CPT,Facility,Inpatient,,,,42,35.7,12.0372,42,Medica,Medical Assistance,,,,,Included in per diem rate,
"Negative Pressure Wound Therapy, W/Disposable,Non-Dme; > 50 Sq Cm",,97608,CPT,Facility,Outpatient,,,,42,35.7,12.0372,42,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,20.916,49.8,,percent of total billed charges,,
"Negative Pressure Wound Therapy, W/Disposable,Non-Dme; > 50 Sq Cm",,97608,CPT,Facility,Inpatient,,,,42,35.7,12.0372,42,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Negative Pressure Wound Therapy, W/Disposable,Non-Dme; > 50 Sq Cm",,97608,CPT,Facility,Both,,,,42,35.7,12.0372,42,"Multiplan, Inc.","Multiplan, Inc.",39.48,94,,percent of total billed charges,,
"Negative Pressure Wound Therapy, W/Disposable,Non-Dme; > 50 Sq Cm",,97608,CPT,Facility,Outpatient,,,,42,35.7,12.0372,42,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,37.842,90.1,,percent of total billed charges,,
"Negative Pressure Wound Therapy, W/Disposable,Non-Dme; > 50 Sq Cm",,97608,CPT,Facility,Inpatient,,,,42,35.7,12.0372,42,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Negative Pressure Wound Therapy, W/Disposable,Non-Dme; > 50 Sq Cm",,97608,CPT,Facility,Both,,,,42,35.7,12.0372,42,"Preferred One Administrative Services, INC.",PPO,41.412,98.6,,percent of total billed charges,,
"Negative Pressure Wound Therapy, W/Disposable,Non-Dme; > 50 Sq Cm",,97608,CPT,Facility,Outpatient,,,,42,35.7,12.0372,42,PrimeWest Health,Minnesota Senior Health Options (MSHO),21.609,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Negative Pressure Wound Therapy, W/Disposable,Non-Dme; > 50 Sq Cm",,97608,CPT,Facility,Inpatient,,,,42,35.7,12.0372,42,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Negative Pressure Wound Therapy, W/Disposable,Non-Dme; > 50 Sq Cm",,97608,CPT,Facility,Outpatient,,,,42,35.7,12.0372,42,PrimeWest Health,MinnesotaCare,21.5712,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Negative Pressure Wound Therapy, W/Disposable,Non-Dme; > 50 Sq Cm",,97608,CPT,Facility,Inpatient,,,,42,35.7,12.0372,42,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Negative Pressure Wound Therapy, W/Disposable,Non-Dme; > 50 Sq Cm",,97608,CPT,Facility,Both,,,,42,35.7,12.0372,42,Sanford Health Plan,Sanford Health Plan,38.64,92,,percent of total billed charges,,
"Negative Pressure Wound Therapy, W/Disposable,Non-Dme; > 50 Sq Cm",,97608,CPT,Facility,Outpatient,,,,42,35.7,12.0372,42,"UCare Health, Inc.",Individual & Family Plan,23.667,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Negative Pressure Wound Therapy, W/Disposable,Non-Dme; > 50 Sq Cm",,97608,CPT,Facility,Inpatient,,,,42,35.7,12.0372,42,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Negative Pressure Wound Therapy, W/Disposable,Non-Dme; > 50 Sq Cm",,97608,CPT,Facility,Outpatient,,,,42,35.7,12.0372,42,"UCare Health, Inc.",Medical Assistance,21.1974,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Negative Pressure Wound Therapy, W/Disposable,Non-Dme; > 50 Sq Cm",,97608,CPT,Facility,Inpatient,,,,42,35.7,12.0372,42,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Negative Pressure Wound Therapy, W/Disposable,Non-Dme; > 50 Sq Cm",,97608,CPT,Facility,Outpatient,,,,42,35.7,12.0372,42,"UCare Health, Inc.",Medicare Advantage,21.1974,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Negative Pressure Wound Therapy, W/Disposable,Non-Dme; > 50 Sq Cm",,97608,CPT,Facility,Inpatient,,,,42,35.7,12.0372,42,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Negative Pressure Wound Therapy, W/Disposable,Non-Dme; > 50 Sq Cm",,97608,CPT,Facility,Outpatient,,,,42,35.7,12.0372,42,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),21.1974,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Negative Pressure Wound Therapy, W/Disposable,Non-Dme; > 50 Sq Cm",,97608,CPT,Facility,Inpatient,,,,42,35.7,12.0372,42,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Negative Pressure Wound Therapy, W/Disposable,Non-Dme; > 50 Sq Cm",,97608,CPT,Facility,Both,,,,42,35.7,12.0372,42,UnitedHealthcare,Individual & Family,39.48,94,,percent of total billed charges,,
"Negative Pressure Wound Therapy, W/Disposable,Non-Dme; > 50 Sq Cm",,97608,CPT,Facility,Outpatient,,,,42,35.7,12.0372,42,UnitedHealthcare,Medicare Advantage,20.58,49,,percent of total billed charges,,
"Negative Pressure Wound Therapy, W/Disposable,Non-Dme; > 50 Sq Cm",,97608,CPT,Facility,Inpatient,,,,42,35.7,12.0372,42,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Negative Pressure Wound Therapy, W/Disposable,Non-Dme; > 50 Sq Cm",,97608,CPT,Facility,Outpatient,,,,42,35.7,12.0372,42,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,20.16,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Negative Pressure Wound Therapy, W/Disposable,Non-Dme; > 50 Sq Cm",,97608,CPT,Facility,Inpatient,,,,42,35.7,12.0372,42,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Mnt-New-Fup Yr,,97802,CPT,Facility,Both,,,,35,29.75,10.031,35,Aetna,Commercial,32.2,92,,percent of total billed charges,,
Mnt-New-Fup Yr,,97802,CPT,Facility,Outpatient,,,,35,29.75,10.031,35,Aetna,Medicare Advantage,17.15,49,,percent of total billed charges,,
Mnt-New-Fup Yr,,97802,CPT,Facility,Inpatient,,,,35,29.75,10.031,35,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Mnt-New-Fup Yr,,97802,CPT,Facility,Both,,,,35,29.75,10.031,35,Aetna,PPO,32.55,93,,percent of total billed charges,,
Mnt-New-Fup Yr,,97802,CPT,Facility,Both,,,,35,29.75,10.031,35,America's PPO,America's PPO,33.6105,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Mnt-New-Fup Yr,,97802,CPT,Facility,Both,,,,35,29.75,10.031,35,BlueCross BlueShield Minnesota, Federal Employee Program,34.44,98.4,,percent of total billed charges,,
Mnt-New-Fup Yr,,97802,CPT,Facility,Both,,,,35,29.75,10.031,35,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,35,100,,percent of total billed charges,,
Mnt-New-Fup Yr,,97802,CPT,Facility,Both,,,,35,29.75,10.031,35,BlueCross BlueShield Minnesota,High Value Network Plan,31.5,90,,percent of total billed charges,,
Mnt-New-Fup Yr,,97802,CPT,Facility,Outpatient,,,,35,29.75,10.031,35,BlueCross BlueShield Minnesota,Medicare Advantage,17.15,49,,percent of total billed charges,,
Mnt-New-Fup Yr,,97802,CPT,Facility,Inpatient,,,,35,29.75,10.031,35,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Mnt-New-Fup Yr,,97802,CPT,Facility,Both,,,,35,29.75,10.031,35,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,30.9995,88.57,,percent of total billed charges,,
Mnt-New-Fup Yr,,97802,CPT,Facility,Both,,,,35,29.75,10.031,35,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,10.031,28.66,,percent of total billed charges,,
Mnt-New-Fup Yr,,97802,CPT,Facility,Outpatient,,,,35,29.75,10.031,35,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),17.15,49,,percent of total billed charges,,
Mnt-New-Fup Yr,,97802,CPT,Facility,Inpatient,,,,35,29.75,10.031,35,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Mnt-New-Fup Yr,,97802,CPT,Facility,Both,,,,35,29.75,10.031,35,CorVel,Worker's Compensation,35,100,,percent of total billed charges,,
Mnt-New-Fup Yr,,97802,CPT,Facility,Both,,,,35,29.75,10.031,35,First Health Group Corporation,First Health Network,33.95,97,,percent of total billed charges,,
Mnt-New-Fup Yr,,97802,CPT,Facility,Both,,,,35,29.75,10.031,35,"Health Partners, Inc.",Commercial,33.11,94.6,,percent of total billed charges,,
Mnt-New-Fup Yr,,97802,CPT,Facility,Outpatient,,,,35,29.75,10.031,35,"Health Partners, Inc.",Medicare Advantage,17.15,49,,percent of total billed charges,,
Mnt-New-Fup Yr,,97802,CPT,Facility,Inpatient,,,,35,29.75,10.031,35,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mnt-New-Fup Yr,,97802,CPT,Facility,Both,,,,35,29.75,10.031,35,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),21,60,,percent of total billed charges,,
Mnt-New-Fup Yr,,97802,CPT,Facility,Both,,,,35,29.75,10.031,35,"Health Partners, Inc.",State of Minnesota Advantage Program,28.525,81.5,,percent of total billed charges,,
Mnt-New-Fup Yr,,97802,CPT,Facility,Both,,,,35,29.75,10.031,35,"Health Partners, Inc.",State Public Programs,17.5,50,,percent of total billed charges,,
Mnt-New-Fup Yr,,97802,CPT,Facility,Both,,,,35,29.75,10.031,35,Humana Insurance Company,Commercial PPO,33.25,95,,percent of total billed charges,,
Mnt-New-Fup Yr,,97802,CPT,Facility,Outpatient,,,,35,29.75,10.031,35,Humana Insurance Company,Medicare PPO,17.15,49,,percent of total billed charges,,
Mnt-New-Fup Yr,,97802,CPT,Facility,Inpatient,,,,35,29.75,10.031,35,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Mnt-New-Fup Yr,,97802,CPT,Facility,Both,,,,35,29.75,10.031,35,Medica,Individual & Family,34.685,99.1,,percent of total billed charges,,
Mnt-New-Fup Yr,,97802,CPT,Facility,Outpatient,,,,35,29.75,10.031,35,Medica,Medica Advantage Solution,17.43,49.8,,percent of total billed charges,,
Mnt-New-Fup Yr,,97802,CPT,Facility,Inpatient,,,,35,29.75,10.031,35,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Mnt-New-Fup Yr,,97802,CPT,Facility,Outpatient,,,,35,29.75,10.031,35,Medica,Medical Assistance,15.61,44.6,,percent of total billed charges,,
Mnt-New-Fup Yr,,97802,CPT,Facility,Inpatient,,,,35,29.75,10.031,35,Medica,Medical Assistance,,,,,Included in per diem rate,
Mnt-New-Fup Yr,,97802,CPT,Facility,Outpatient,,,,35,29.75,10.031,35,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,17.43,49.8,,percent of total billed charges,,
Mnt-New-Fup Yr,,97802,CPT,Facility,Inpatient,,,,35,29.75,10.031,35,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Mnt-New-Fup Yr,,97802,CPT,Facility,Both,,,,35,29.75,10.031,35,"Multiplan, Inc.","Multiplan, Inc.",32.9,94,,percent of total billed charges,,
Mnt-New-Fup Yr,,97802,CPT,Facility,Outpatient,,,,35,29.75,10.031,35,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,31.535,90.1,,percent of total billed charges,,
Mnt-New-Fup Yr,,97802,CPT,Facility,Inpatient,,,,35,29.75,10.031,35,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Mnt-New-Fup Yr,,97802,CPT,Facility,Both,,,,35,29.75,10.031,35,"Preferred One Administrative Services, INC.",PPO,34.51,98.6,,percent of total billed charges,,
Mnt-New-Fup Yr,,97802,CPT,Facility,Outpatient,,,,35,29.75,10.031,35,PrimeWest Health,Minnesota Senior Health Options (MSHO),18.0075,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Mnt-New-Fup Yr,,97802,CPT,Facility,Inpatient,,,,35,29.75,10.031,35,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mnt-New-Fup Yr,,97802,CPT,Facility,Outpatient,,,,35,29.75,10.031,35,PrimeWest Health,MinnesotaCare,17.976,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Mnt-New-Fup Yr,,97802,CPT,Facility,Inpatient,,,,35,29.75,10.031,35,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Mnt-New-Fup Yr,,97802,CPT,Facility,Both,,,,35,29.75,10.031,35,Sanford Health Plan,Sanford Health Plan,32.2,92,,percent of total billed charges,,
Mnt-New-Fup Yr,,97802,CPT,Facility,Outpatient,,,,35,29.75,10.031,35,"UCare Health, Inc.",Individual & Family Plan,19.7225,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Mnt-New-Fup Yr,,97802,CPT,Facility,Inpatient,,,,35,29.75,10.031,35,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Mnt-New-Fup Yr,,97802,CPT,Facility,Outpatient,,,,35,29.75,10.031,35,"UCare Health, Inc.",Medical Assistance,17.6645,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mnt-New-Fup Yr,,97802,CPT,Facility,Inpatient,,,,35,29.75,10.031,35,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Mnt-New-Fup Yr,,97802,CPT,Facility,Outpatient,,,,35,29.75,10.031,35,"UCare Health, Inc.",Medicare Advantage,17.6645,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mnt-New-Fup Yr,,97802,CPT,Facility,Inpatient,,,,35,29.75,10.031,35,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mnt-New-Fup Yr,,97802,CPT,Facility,Outpatient,,,,35,29.75,10.031,35,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),17.6645,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mnt-New-Fup Yr,,97802,CPT,Facility,Inpatient,,,,35,29.75,10.031,35,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mnt-New-Fup Yr,,97802,CPT,Facility,Both,,,,35,29.75,10.031,35,UnitedHealthcare,Individual & Family,32.9,94,,percent of total billed charges,,
Mnt-New-Fup Yr,,97802,CPT,Facility,Outpatient,,,,35,29.75,10.031,35,UnitedHealthcare,Medicare Advantage,17.15,49,,percent of total billed charges,,
Mnt-New-Fup Yr,,97802,CPT,Facility,Inpatient,,,,35,29.75,10.031,35,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Mnt-New-Fup Yr,,97802,CPT,Facility,Outpatient,,,,35,29.75,10.031,35,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,16.8,48,,percent of total billed charges,,100% of DHS outpatient percentage
Mnt-New-Fup Yr,,97802,CPT,Facility,Inpatient,,,,35,29.75,10.031,35,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Mnt Annual,,97803,CPT,Facility,Both,,,,30,25.5,8.598,30,Aetna,Commercial,27.6,92,,percent of total billed charges,,
Mnt Annual,,97803,CPT,Facility,Outpatient,,,,30,25.5,8.598,30,Aetna,Medicare Advantage,14.7,49,,percent of total billed charges,,
Mnt Annual,,97803,CPT,Facility,Inpatient,,,,30,25.5,8.598,30,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Mnt Annual,,97803,CPT,Facility,Both,,,,30,25.5,8.598,30,Aetna,PPO,27.9,93,,percent of total billed charges,,
Mnt Annual,,97803,CPT,Facility,Both,,,,30,25.5,8.598,30,America's PPO,America's PPO,28.809,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Mnt Annual,,97803,CPT,Facility,Both,,,,30,25.5,8.598,30,BlueCross BlueShield Minnesota, Federal Employee Program,29.52,98.4,,percent of total billed charges,,
Mnt Annual,,97803,CPT,Facility,Both,,,,30,25.5,8.598,30,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,30,100,,percent of total billed charges,,
Mnt Annual,,97803,CPT,Facility,Both,,,,30,25.5,8.598,30,BlueCross BlueShield Minnesota,High Value Network Plan,27,90,,percent of total billed charges,,
Mnt Annual,,97803,CPT,Facility,Outpatient,,,,30,25.5,8.598,30,BlueCross BlueShield Minnesota,Medicare Advantage,14.7,49,,percent of total billed charges,,
Mnt Annual,,97803,CPT,Facility,Inpatient,,,,30,25.5,8.598,30,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Mnt Annual,,97803,CPT,Facility,Both,,,,30,25.5,8.598,30,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,26.571,88.57,,percent of total billed charges,,
Mnt Annual,,97803,CPT,Facility,Both,,,,30,25.5,8.598,30,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,8.598,28.66,,percent of total billed charges,,
Mnt Annual,,97803,CPT,Facility,Outpatient,,,,30,25.5,8.598,30,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),14.7,49,,percent of total billed charges,,
Mnt Annual,,97803,CPT,Facility,Inpatient,,,,30,25.5,8.598,30,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Mnt Annual,,97803,CPT,Facility,Both,,,,30,25.5,8.598,30,CorVel,Worker's Compensation,30,100,,percent of total billed charges,,
Mnt Annual,,97803,CPT,Facility,Both,,,,30,25.5,8.598,30,First Health Group Corporation,First Health Network,29.1,97,,percent of total billed charges,,
Mnt Annual,,97803,CPT,Facility,Both,,,,30,25.5,8.598,30,"Health Partners, Inc.",Commercial,28.38,94.6,,percent of total billed charges,,
Mnt Annual,,97803,CPT,Facility,Outpatient,,,,30,25.5,8.598,30,"Health Partners, Inc.",Medicare Advantage,14.7,49,,percent of total billed charges,,
Mnt Annual,,97803,CPT,Facility,Inpatient,,,,30,25.5,8.598,30,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mnt Annual,,97803,CPT,Facility,Both,,,,30,25.5,8.598,30,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),18,60,,percent of total billed charges,,
Mnt Annual,,97803,CPT,Facility,Both,,,,30,25.5,8.598,30,"Health Partners, Inc.",State of Minnesota Advantage Program,24.45,81.5,,percent of total billed charges,,
Mnt Annual,,97803,CPT,Facility,Both,,,,30,25.5,8.598,30,"Health Partners, Inc.",State Public Programs,15,50,,percent of total billed charges,,
Mnt Annual,,97803,CPT,Facility,Both,,,,30,25.5,8.598,30,Humana Insurance Company,Commercial PPO,28.5,95,,percent of total billed charges,,
Mnt Annual,,97803,CPT,Facility,Outpatient,,,,30,25.5,8.598,30,Humana Insurance Company,Medicare PPO,14.7,49,,percent of total billed charges,,
Mnt Annual,,97803,CPT,Facility,Inpatient,,,,30,25.5,8.598,30,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Mnt Annual,,97803,CPT,Facility,Both,,,,30,25.5,8.598,30,Medica,Individual & Family,29.73,99.1,,percent of total billed charges,,
Mnt Annual,,97803,CPT,Facility,Outpatient,,,,30,25.5,8.598,30,Medica,Medica Advantage Solution,14.94,49.8,,percent of total billed charges,,
Mnt Annual,,97803,CPT,Facility,Inpatient,,,,30,25.5,8.598,30,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Mnt Annual,,97803,CPT,Facility,Outpatient,,,,30,25.5,8.598,30,Medica,Medical Assistance,13.38,44.6,,percent of total billed charges,,
Mnt Annual,,97803,CPT,Facility,Inpatient,,,,30,25.5,8.598,30,Medica,Medical Assistance,,,,,Included in per diem rate,
Mnt Annual,,97803,CPT,Facility,Outpatient,,,,30,25.5,8.598,30,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,14.94,49.8,,percent of total billed charges,,
Mnt Annual,,97803,CPT,Facility,Inpatient,,,,30,25.5,8.598,30,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Mnt Annual,,97803,CPT,Facility,Both,,,,30,25.5,8.598,30,"Multiplan, Inc.","Multiplan, Inc.",28.2,94,,percent of total billed charges,,
Mnt Annual,,97803,CPT,Facility,Outpatient,,,,30,25.5,8.598,30,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,27.03,90.1,,percent of total billed charges,,
Mnt Annual,,97803,CPT,Facility,Inpatient,,,,30,25.5,8.598,30,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Mnt Annual,,97803,CPT,Facility,Both,,,,30,25.5,8.598,30,"Preferred One Administrative Services, INC.",PPO,29.58,98.6,,percent of total billed charges,,
Mnt Annual,,97803,CPT,Facility,Outpatient,,,,30,25.5,8.598,30,PrimeWest Health,Minnesota Senior Health Options (MSHO),15.435,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Mnt Annual,,97803,CPT,Facility,Inpatient,,,,30,25.5,8.598,30,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mnt Annual,,97803,CPT,Facility,Outpatient,,,,30,25.5,8.598,30,PrimeWest Health,MinnesotaCare,15.408,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Mnt Annual,,97803,CPT,Facility,Inpatient,,,,30,25.5,8.598,30,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Mnt Annual,,97803,CPT,Facility,Both,,,,30,25.5,8.598,30,Sanford Health Plan,Sanford Health Plan,27.6,92,,percent of total billed charges,,
Mnt Annual,,97803,CPT,Facility,Outpatient,,,,30,25.5,8.598,30,"UCare Health, Inc.",Individual & Family Plan,16.905,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Mnt Annual,,97803,CPT,Facility,Inpatient,,,,30,25.5,8.598,30,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Mnt Annual,,97803,CPT,Facility,Outpatient,,,,30,25.5,8.598,30,"UCare Health, Inc.",Medical Assistance,15.141,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mnt Annual,,97803,CPT,Facility,Inpatient,,,,30,25.5,8.598,30,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Mnt Annual,,97803,CPT,Facility,Outpatient,,,,30,25.5,8.598,30,"UCare Health, Inc.",Medicare Advantage,15.141,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mnt Annual,,97803,CPT,Facility,Inpatient,,,,30,25.5,8.598,30,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mnt Annual,,97803,CPT,Facility,Outpatient,,,,30,25.5,8.598,30,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),15.141,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mnt Annual,,97803,CPT,Facility,Inpatient,,,,30,25.5,8.598,30,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mnt Annual,,97803,CPT,Facility,Both,,,,30,25.5,8.598,30,UnitedHealthcare,Individual & Family,28.2,94,,percent of total billed charges,,
Mnt Annual,,97803,CPT,Facility,Outpatient,,,,30,25.5,8.598,30,UnitedHealthcare,Medicare Advantage,14.7,49,,percent of total billed charges,,
Mnt Annual,,97803,CPT,Facility,Inpatient,,,,30,25.5,8.598,30,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Mnt Annual,,97803,CPT,Facility,Outpatient,,,,30,25.5,8.598,30,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,14.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
Mnt Annual,,97803,CPT,Facility,Inpatient,,,,30,25.5,8.598,30,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Medical Nutrition Therapy Group,,97804,CPT,Facility,Both,,,,45,38.25,12.897,45,Aetna,Commercial,41.4,92,,percent of total billed charges,,
Medical Nutrition Therapy Group,,97804,CPT,Facility,Outpatient,,,,45,38.25,12.897,45,Aetna,Medicare Advantage,22.05,49,,percent of total billed charges,,
Medical Nutrition Therapy Group,,97804,CPT,Facility,Inpatient,,,,45,38.25,12.897,45,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Medical Nutrition Therapy Group,,97804,CPT,Facility,Both,,,,45,38.25,12.897,45,Aetna,PPO,41.85,93,,percent of total billed charges,,
Medical Nutrition Therapy Group,,97804,CPT,Facility,Both,,,,45,38.25,12.897,45,America's PPO,America's PPO,43.2135,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Medical Nutrition Therapy Group,,97804,CPT,Facility,Both,,,,45,38.25,12.897,45,BlueCross BlueShield Minnesota, Federal Employee Program,44.28,98.4,,percent of total billed charges,,
Medical Nutrition Therapy Group,,97804,CPT,Facility,Both,,,,45,38.25,12.897,45,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,45,100,,percent of total billed charges,,
Medical Nutrition Therapy Group,,97804,CPT,Facility,Both,,,,45,38.25,12.897,45,BlueCross BlueShield Minnesota,High Value Network Plan,40.5,90,,percent of total billed charges,,
Medical Nutrition Therapy Group,,97804,CPT,Facility,Outpatient,,,,45,38.25,12.897,45,BlueCross BlueShield Minnesota,Medicare Advantage,22.05,49,,percent of total billed charges,,
Medical Nutrition Therapy Group,,97804,CPT,Facility,Inpatient,,,,45,38.25,12.897,45,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Medical Nutrition Therapy Group,,97804,CPT,Facility,Both,,,,45,38.25,12.897,45,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,39.8565,88.57,,percent of total billed charges,,
Medical Nutrition Therapy Group,,97804,CPT,Facility,Both,,,,45,38.25,12.897,45,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,12.897,28.66,,percent of total billed charges,,
Medical Nutrition Therapy Group,,97804,CPT,Facility,Outpatient,,,,45,38.25,12.897,45,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),22.05,49,,percent of total billed charges,,
Medical Nutrition Therapy Group,,97804,CPT,Facility,Inpatient,,,,45,38.25,12.897,45,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Medical Nutrition Therapy Group,,97804,CPT,Facility,Both,,,,45,38.25,12.897,45,CorVel,Worker's Compensation,45,100,,percent of total billed charges,,
Medical Nutrition Therapy Group,,97804,CPT,Facility,Both,,,,45,38.25,12.897,45,First Health Group Corporation,First Health Network,43.65,97,,percent of total billed charges,,
Medical Nutrition Therapy Group,,97804,CPT,Facility,Both,,,,45,38.25,12.897,45,"Health Partners, Inc.",Commercial,42.57,94.6,,percent of total billed charges,,
Medical Nutrition Therapy Group,,97804,CPT,Facility,Outpatient,,,,45,38.25,12.897,45,"Health Partners, Inc.",Medicare Advantage,22.05,49,,percent of total billed charges,,
Medical Nutrition Therapy Group,,97804,CPT,Facility,Inpatient,,,,45,38.25,12.897,45,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Medical Nutrition Therapy Group,,97804,CPT,Facility,Both,,,,45,38.25,12.897,45,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),27,60,,percent of total billed charges,,
Medical Nutrition Therapy Group,,97804,CPT,Facility,Both,,,,45,38.25,12.897,45,"Health Partners, Inc.",State of Minnesota Advantage Program,36.675,81.5,,percent of total billed charges,,
Medical Nutrition Therapy Group,,97804,CPT,Facility,Both,,,,45,38.25,12.897,45,"Health Partners, Inc.",State Public Programs,22.5,50,,percent of total billed charges,,
Medical Nutrition Therapy Group,,97804,CPT,Facility,Both,,,,45,38.25,12.897,45,Humana Insurance Company,Commercial PPO,42.75,95,,percent of total billed charges,,
Medical Nutrition Therapy Group,,97804,CPT,Facility,Outpatient,,,,45,38.25,12.897,45,Humana Insurance Company,Medicare PPO,22.05,49,,percent of total billed charges,,
Medical Nutrition Therapy Group,,97804,CPT,Facility,Inpatient,,,,45,38.25,12.897,45,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Medical Nutrition Therapy Group,,97804,CPT,Facility,Both,,,,45,38.25,12.897,45,Medica,Individual & Family,44.595,99.1,,percent of total billed charges,,
Medical Nutrition Therapy Group,,97804,CPT,Facility,Outpatient,,,,45,38.25,12.897,45,Medica,Medica Advantage Solution,22.41,49.8,,percent of total billed charges,,
Medical Nutrition Therapy Group,,97804,CPT,Facility,Inpatient,,,,45,38.25,12.897,45,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Medical Nutrition Therapy Group,,97804,CPT,Facility,Outpatient,,,,45,38.25,12.897,45,Medica,Medical Assistance,20.07,44.6,,percent of total billed charges,,
Medical Nutrition Therapy Group,,97804,CPT,Facility,Inpatient,,,,45,38.25,12.897,45,Medica,Medical Assistance,,,,,Included in per diem rate,
Medical Nutrition Therapy Group,,97804,CPT,Facility,Outpatient,,,,45,38.25,12.897,45,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,22.41,49.8,,percent of total billed charges,,
Medical Nutrition Therapy Group,,97804,CPT,Facility,Inpatient,,,,45,38.25,12.897,45,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Medical Nutrition Therapy Group,,97804,CPT,Facility,Both,,,,45,38.25,12.897,45,"Multiplan, Inc.","Multiplan, Inc.",42.3,94,,percent of total billed charges,,
Medical Nutrition Therapy Group,,97804,CPT,Facility,Outpatient,,,,45,38.25,12.897,45,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,40.545,90.1,,percent of total billed charges,,
Medical Nutrition Therapy Group,,97804,CPT,Facility,Inpatient,,,,45,38.25,12.897,45,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Medical Nutrition Therapy Group,,97804,CPT,Facility,Both,,,,45,38.25,12.897,45,"Preferred One Administrative Services, INC.",PPO,44.37,98.6,,percent of total billed charges,,
Medical Nutrition Therapy Group,,97804,CPT,Facility,Outpatient,,,,45,38.25,12.897,45,PrimeWest Health,Minnesota Senior Health Options (MSHO),23.1525,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Medical Nutrition Therapy Group,,97804,CPT,Facility,Inpatient,,,,45,38.25,12.897,45,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Medical Nutrition Therapy Group,,97804,CPT,Facility,Outpatient,,,,45,38.25,12.897,45,PrimeWest Health,MinnesotaCare,23.112,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Medical Nutrition Therapy Group,,97804,CPT,Facility,Inpatient,,,,45,38.25,12.897,45,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Medical Nutrition Therapy Group,,97804,CPT,Facility,Both,,,,45,38.25,12.897,45,Sanford Health Plan,Sanford Health Plan,41.4,92,,percent of total billed charges,,
Medical Nutrition Therapy Group,,97804,CPT,Facility,Outpatient,,,,45,38.25,12.897,45,"UCare Health, Inc.",Individual & Family Plan,25.3575,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Medical Nutrition Therapy Group,,97804,CPT,Facility,Inpatient,,,,45,38.25,12.897,45,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Medical Nutrition Therapy Group,,97804,CPT,Facility,Outpatient,,,,45,38.25,12.897,45,"UCare Health, Inc.",Medical Assistance,22.7115,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Medical Nutrition Therapy Group,,97804,CPT,Facility,Inpatient,,,,45,38.25,12.897,45,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Medical Nutrition Therapy Group,,97804,CPT,Facility,Outpatient,,,,45,38.25,12.897,45,"UCare Health, Inc.",Medicare Advantage,22.7115,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Medical Nutrition Therapy Group,,97804,CPT,Facility,Inpatient,,,,45,38.25,12.897,45,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Medical Nutrition Therapy Group,,97804,CPT,Facility,Outpatient,,,,45,38.25,12.897,45,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),22.7115,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Medical Nutrition Therapy Group,,97804,CPT,Facility,Inpatient,,,,45,38.25,12.897,45,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Medical Nutrition Therapy Group,,97804,CPT,Facility,Both,,,,45,38.25,12.897,45,UnitedHealthcare,Individual & Family,42.3,94,,percent of total billed charges,,
Medical Nutrition Therapy Group,,97804,CPT,Facility,Outpatient,,,,45,38.25,12.897,45,UnitedHealthcare,Medicare Advantage,22.05,49,,percent of total billed charges,,
Medical Nutrition Therapy Group,,97804,CPT,Facility,Inpatient,,,,45,38.25,12.897,45,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Medical Nutrition Therapy Group,,97804,CPT,Facility,Outpatient,,,,45,38.25,12.897,45,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,21.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
Medical Nutrition Therapy Group,,97804,CPT,Facility,Inpatient,,,,45,38.25,12.897,45,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
FLUTICASONE PROPIONATE 110 MCG/ACTUATION INHL HFAA,,19701,LOCAL,Facility,Both,12,g,,1183,1005.55,339.0478,1183,Aetna,Commercial,1088.36,92,,percent of total billed charges,,
FLUTICASONE PROPIONATE 110 MCG/ACTUATION INHL HFAA,,19701,LOCAL,Facility,Outpatient,12,g,,1183,1005.55,339.0478,1183,Aetna,Medicare Advantage,579.67,49,,percent of total billed charges,,
FLUTICASONE PROPIONATE 110 MCG/ACTUATION INHL HFAA,,19701,LOCAL,Facility,Inpatient,12,g,,1183,1005.55,339.0478,1183,Aetna,Medicare Advantage,,,,,Included in per diem rate,
FLUTICASONE PROPIONATE 110 MCG/ACTUATION INHL HFAA,,19701,LOCAL,Facility,Both,12,g,,1183,1005.55,339.0478,1183,Aetna,PPO,1100.19,93,,percent of total billed charges,,
FLUTICASONE PROPIONATE 110 MCG/ACTUATION INHL HFAA,,19701,LOCAL,Facility,Both,12,g,,1183,1005.55,339.0478,1183,America's PPO,America's PPO,1136.0349,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
FLUTICASONE PROPIONATE 110 MCG/ACTUATION INHL HFAA,,19701,LOCAL,Facility,Both,12,g,,1183,1005.55,339.0478,1183,BlueCross BlueShield Minnesota, Federal Employee Program,1164.072,98.4,,percent of total billed charges,,
FLUTICASONE PROPIONATE 110 MCG/ACTUATION INHL HFAA,,19701,LOCAL,Facility,Both,12,g,,1183,1005.55,339.0478,1183,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1183,100,,percent of total billed charges,,
FLUTICASONE PROPIONATE 110 MCG/ACTUATION INHL HFAA,,19701,LOCAL,Facility,Both,12,g,,1183,1005.55,339.0478,1183,BlueCross BlueShield Minnesota,High Value Network Plan,1064.7,90,,percent of total billed charges,,
FLUTICASONE PROPIONATE 110 MCG/ACTUATION INHL HFAA,,19701,LOCAL,Facility,Outpatient,12,g,,1183,1005.55,339.0478,1183,BlueCross BlueShield Minnesota,Medicare Advantage,579.67,49,,percent of total billed charges,,
FLUTICASONE PROPIONATE 110 MCG/ACTUATION INHL HFAA,,19701,LOCAL,Facility,Inpatient,12,g,,1183,1005.55,339.0478,1183,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
FLUTICASONE PROPIONATE 110 MCG/ACTUATION INHL HFAA,,19701,LOCAL,Facility,Both,12,g,,1183,1005.55,339.0478,1183,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1047.7831,88.57,,percent of total billed charges,,
FLUTICASONE PROPIONATE 110 MCG/ACTUATION INHL HFAA,,19701,LOCAL,Facility,Both,12,g,,1183,1005.55,339.0478,1183,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,339.0478,28.66,,percent of total billed charges,,
FLUTICASONE PROPIONATE 110 MCG/ACTUATION INHL HFAA,,19701,LOCAL,Facility,Outpatient,12,g,,1183,1005.55,339.0478,1183,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),579.67,49,,percent of total billed charges,,
FLUTICASONE PROPIONATE 110 MCG/ACTUATION INHL HFAA,,19701,LOCAL,Facility,Inpatient,12,g,,1183,1005.55,339.0478,1183,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
FLUTICASONE PROPIONATE 110 MCG/ACTUATION INHL HFAA,,19701,LOCAL,Facility,Both,12,g,,1183,1005.55,339.0478,1183,CorVel,Worker's Compensation,1183,100,,percent of total billed charges,,
FLUTICASONE PROPIONATE 110 MCG/ACTUATION INHL HFAA,,19701,LOCAL,Facility,Both,12,g,,1183,1005.55,339.0478,1183,First Health Group Corporation,First Health Network,1147.51,97,,percent of total billed charges,,
FLUTICASONE PROPIONATE 110 MCG/ACTUATION INHL HFAA,,19701,LOCAL,Facility,Both,12,g,,1183,1005.55,339.0478,1183,"Health Partners, Inc.",Commercial,1119.118,94.6,,percent of total billed charges,,
FLUTICASONE PROPIONATE 110 MCG/ACTUATION INHL HFAA,,19701,LOCAL,Facility,Outpatient,12,g,,1183,1005.55,339.0478,1183,"Health Partners, Inc.",Medicare Advantage,579.67,49,,percent of total billed charges,,
FLUTICASONE PROPIONATE 110 MCG/ACTUATION INHL HFAA,,19701,LOCAL,Facility,Inpatient,12,g,,1183,1005.55,339.0478,1183,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
FLUTICASONE PROPIONATE 110 MCG/ACTUATION INHL HFAA,,19701,LOCAL,Facility,Both,12,g,,1183,1005.55,339.0478,1183,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),709.8,60,,percent of total billed charges,,
FLUTICASONE PROPIONATE 110 MCG/ACTUATION INHL HFAA,,19701,LOCAL,Facility,Both,12,g,,1183,1005.55,339.0478,1183,"Health Partners, Inc.",State of Minnesota Advantage Program,964.145,81.5,,percent of total billed charges,,
FLUTICASONE PROPIONATE 110 MCG/ACTUATION INHL HFAA,,19701,LOCAL,Facility,Both,12,g,,1183,1005.55,339.0478,1183,"Health Partners, Inc.",State Public Programs,591.5,50,,percent of total billed charges,,
FLUTICASONE PROPIONATE 110 MCG/ACTUATION INHL HFAA,,19701,LOCAL,Facility,Both,12,g,,1183,1005.55,339.0478,1183,Humana Insurance Company,Commercial PPO,1123.85,95,,percent of total billed charges,,
FLUTICASONE PROPIONATE 110 MCG/ACTUATION INHL HFAA,,19701,LOCAL,Facility,Outpatient,12,g,,1183,1005.55,339.0478,1183,Humana Insurance Company,Medicare PPO,579.67,49,,percent of total billed charges,,
FLUTICASONE PROPIONATE 110 MCG/ACTUATION INHL HFAA,,19701,LOCAL,Facility,Inpatient,12,g,,1183,1005.55,339.0478,1183,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
FLUTICASONE PROPIONATE 110 MCG/ACTUATION INHL HFAA,,19701,LOCAL,Facility,Both,12,g,,1183,1005.55,339.0478,1183,Medica,Individual & Family,1172.353,99.1,,percent of total billed charges,,
FLUTICASONE PROPIONATE 110 MCG/ACTUATION INHL HFAA,,19701,LOCAL,Facility,Outpatient,12,g,,1183,1005.55,339.0478,1183,Medica,Medica Advantage Solution,589.134,49.8,,percent of total billed charges,,
FLUTICASONE PROPIONATE 110 MCG/ACTUATION INHL HFAA,,19701,LOCAL,Facility,Inpatient,12,g,,1183,1005.55,339.0478,1183,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
FLUTICASONE PROPIONATE 110 MCG/ACTUATION INHL HFAA,,19701,LOCAL,Facility,Outpatient,12,g,,1183,1005.55,339.0478,1183,Medica,Medical Assistance,527.618,44.6,,percent of total billed charges,,
FLUTICASONE PROPIONATE 110 MCG/ACTUATION INHL HFAA,,19701,LOCAL,Facility,Inpatient,12,g,,1183,1005.55,339.0478,1183,Medica,Medical Assistance,,,,,Included in per diem rate,
FLUTICASONE PROPIONATE 110 MCG/ACTUATION INHL HFAA,,19701,LOCAL,Facility,Outpatient,12,g,,1183,1005.55,339.0478,1183,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,589.134,49.8,,percent of total billed charges,,
FLUTICASONE PROPIONATE 110 MCG/ACTUATION INHL HFAA,,19701,LOCAL,Facility,Inpatient,12,g,,1183,1005.55,339.0478,1183,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
FLUTICASONE PROPIONATE 110 MCG/ACTUATION INHL HFAA,,19701,LOCAL,Facility,Both,12,g,,1183,1005.55,339.0478,1183,"Multiplan, Inc.","Multiplan, Inc.",1112.02,94,,percent of total billed charges,,
FLUTICASONE PROPIONATE 110 MCG/ACTUATION INHL HFAA,,19701,LOCAL,Facility,Outpatient,12,g,,1183,1005.55,339.0478,1183,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1065.883,90.1,,percent of total billed charges,,
FLUTICASONE PROPIONATE 110 MCG/ACTUATION INHL HFAA,,19701,LOCAL,Facility,Inpatient,12,g,,1183,1005.55,339.0478,1183,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
FLUTICASONE PROPIONATE 110 MCG/ACTUATION INHL HFAA,,19701,LOCAL,Facility,Both,12,g,,1183,1005.55,339.0478,1183,"Preferred One Administrative Services, INC.",PPO,1166.438,98.6,,percent of total billed charges,,
FLUTICASONE PROPIONATE 110 MCG/ACTUATION INHL HFAA,,19701,LOCAL,Facility,Outpatient,12,g,,1183,1005.55,339.0478,1183,PrimeWest Health,Minnesota Senior Health Options (MSHO),608.6535,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
FLUTICASONE PROPIONATE 110 MCG/ACTUATION INHL HFAA,,19701,LOCAL,Facility,Inpatient,12,g,,1183,1005.55,339.0478,1183,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
FLUTICASONE PROPIONATE 110 MCG/ACTUATION INHL HFAA,,19701,LOCAL,Facility,Outpatient,12,g,,1183,1005.55,339.0478,1183,PrimeWest Health,MinnesotaCare,607.5888,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
FLUTICASONE PROPIONATE 110 MCG/ACTUATION INHL HFAA,,19701,LOCAL,Facility,Inpatient,12,g,,1183,1005.55,339.0478,1183,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
FLUTICASONE PROPIONATE 110 MCG/ACTUATION INHL HFAA,,19701,LOCAL,Facility,Both,12,g,,1183,1005.55,339.0478,1183,Sanford Health Plan,Sanford Health Plan,1088.36,92,,percent of total billed charges,,
FLUTICASONE PROPIONATE 110 MCG/ACTUATION INHL HFAA,,19701,LOCAL,Facility,Outpatient,12,g,,1183,1005.55,339.0478,1183,"UCare Health, Inc.",Individual & Family Plan,666.6205,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
FLUTICASONE PROPIONATE 110 MCG/ACTUATION INHL HFAA,,19701,LOCAL,Facility,Inpatient,12,g,,1183,1005.55,339.0478,1183,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
FLUTICASONE PROPIONATE 110 MCG/ACTUATION INHL HFAA,,19701,LOCAL,Facility,Outpatient,12,g,,1183,1005.55,339.0478,1183,"UCare Health, Inc.",Medical Assistance,597.0601,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FLUTICASONE PROPIONATE 110 MCG/ACTUATION INHL HFAA,,19701,LOCAL,Facility,Inpatient,12,g,,1183,1005.55,339.0478,1183,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
FLUTICASONE PROPIONATE 110 MCG/ACTUATION INHL HFAA,,19701,LOCAL,Facility,Outpatient,12,g,,1183,1005.55,339.0478,1183,"UCare Health, Inc.",Medicare Advantage,597.0601,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FLUTICASONE PROPIONATE 110 MCG/ACTUATION INHL HFAA,,19701,LOCAL,Facility,Inpatient,12,g,,1183,1005.55,339.0478,1183,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
FLUTICASONE PROPIONATE 110 MCG/ACTUATION INHL HFAA,,19701,LOCAL,Facility,Outpatient,12,g,,1183,1005.55,339.0478,1183,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),597.0601,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FLUTICASONE PROPIONATE 110 MCG/ACTUATION INHL HFAA,,19701,LOCAL,Facility,Inpatient,12,g,,1183,1005.55,339.0478,1183,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
FLUTICASONE PROPIONATE 110 MCG/ACTUATION INHL HFAA,,19701,LOCAL,Facility,Both,12,g,,1183,1005.55,339.0478,1183,UnitedHealthcare,Individual & Family,1112.02,94,,percent of total billed charges,,
FLUTICASONE PROPIONATE 110 MCG/ACTUATION INHL HFAA,,19701,LOCAL,Facility,Outpatient,12,g,,1183,1005.55,339.0478,1183,UnitedHealthcare,Medicare Advantage,579.67,49,,percent of total billed charges,,
FLUTICASONE PROPIONATE 110 MCG/ACTUATION INHL HFAA,,19701,LOCAL,Facility,Inpatient,12,g,,1183,1005.55,339.0478,1183,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
FLUTICASONE PROPIONATE 110 MCG/ACTUATION INHL HFAA,,19701,LOCAL,Facility,Outpatient,12,g,,1183,1005.55,339.0478,1183,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,567.84,48,,percent of total billed charges,,100% of DHS outpatient percentage
FLUTICASONE PROPIONATE 110 MCG/ACTUATION INHL HFAA,,19701,LOCAL,Facility,Inpatient,12,g,,1183,1005.55,339.0478,1183,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Telephone Assessment And Management Service Provided By Nonphysician, 5-10 Mins Medical Discussion",,98966,CPT,Facility,Both,,,,25,21.25,7.165,25,Aetna,Commercial,23,92,,percent of total billed charges,,
"Telephone Assessment And Management Service Provided By Nonphysician, 5-10 Mins Medical Discussion",,98966,CPT,Facility,Outpatient,,,,25,21.25,7.165,25,Aetna,Medicare Advantage,12.25,49,,percent of total billed charges,,
"Telephone Assessment And Management Service Provided By Nonphysician, 5-10 Mins Medical Discussion",,98966,CPT,Facility,Inpatient,,,,25,21.25,7.165,25,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Telephone Assessment And Management Service Provided By Nonphysician, 5-10 Mins Medical Discussion",,98966,CPT,Facility,Both,,,,25,21.25,7.165,25,Aetna,PPO,23.25,93,,percent of total billed charges,,
"Telephone Assessment And Management Service Provided By Nonphysician, 5-10 Mins Medical Discussion",,98966,CPT,Facility,Both,,,,25,21.25,7.165,25,America's PPO,America's PPO,24.0075,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Telephone Assessment And Management Service Provided By Nonphysician, 5-10 Mins Medical Discussion",,98966,CPT,Facility,Both,,,,25,21.25,7.165,25,BlueCross BlueShield Minnesota, Federal Employee Program,24.6,98.4,,percent of total billed charges,,
"Telephone Assessment And Management Service Provided By Nonphysician, 5-10 Mins Medical Discussion",,98966,CPT,Facility,Both,,,,25,21.25,7.165,25,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,25,100,,percent of total billed charges,,
"Telephone Assessment And Management Service Provided By Nonphysician, 5-10 Mins Medical Discussion",,98966,CPT,Facility,Both,,,,25,21.25,7.165,25,BlueCross BlueShield Minnesota,High Value Network Plan,22.5,90,,percent of total billed charges,,
"Telephone Assessment And Management Service Provided By Nonphysician, 5-10 Mins Medical Discussion",,98966,CPT,Facility,Outpatient,,,,25,21.25,7.165,25,BlueCross BlueShield Minnesota,Medicare Advantage,12.25,49,,percent of total billed charges,,
"Telephone Assessment And Management Service Provided By Nonphysician, 5-10 Mins Medical Discussion",,98966,CPT,Facility,Inpatient,,,,25,21.25,7.165,25,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Telephone Assessment And Management Service Provided By Nonphysician, 5-10 Mins Medical Discussion",,98966,CPT,Facility,Both,,,,25,21.25,7.165,25,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,22.1425,88.57,,percent of total billed charges,,
"Telephone Assessment And Management Service Provided By Nonphysician, 5-10 Mins Medical Discussion",,98966,CPT,Facility,Both,,,,25,21.25,7.165,25,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,7.165,28.66,,percent of total billed charges,,
"Telephone Assessment And Management Service Provided By Nonphysician, 5-10 Mins Medical Discussion",,98966,CPT,Facility,Outpatient,,,,25,21.25,7.165,25,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),12.25,49,,percent of total billed charges,,
"Telephone Assessment And Management Service Provided By Nonphysician, 5-10 Mins Medical Discussion",,98966,CPT,Facility,Inpatient,,,,25,21.25,7.165,25,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Telephone Assessment And Management Service Provided By Nonphysician, 5-10 Mins Medical Discussion",,98966,CPT,Facility,Both,,,,25,21.25,7.165,25,CorVel,Worker's Compensation,25,100,,percent of total billed charges,,
"Telephone Assessment And Management Service Provided By Nonphysician, 5-10 Mins Medical Discussion",,98966,CPT,Facility,Both,,,,25,21.25,7.165,25,First Health Group Corporation,First Health Network,24.25,97,,percent of total billed charges,,
"Telephone Assessment And Management Service Provided By Nonphysician, 5-10 Mins Medical Discussion",,98966,CPT,Facility,Both,,,,25,21.25,7.165,25,"Health Partners, Inc.",Commercial,23.65,94.6,,percent of total billed charges,,
"Telephone Assessment And Management Service Provided By Nonphysician, 5-10 Mins Medical Discussion",,98966,CPT,Facility,Outpatient,,,,25,21.25,7.165,25,"Health Partners, Inc.",Medicare Advantage,12.25,49,,percent of total billed charges,,
"Telephone Assessment And Management Service Provided By Nonphysician, 5-10 Mins Medical Discussion",,98966,CPT,Facility,Inpatient,,,,25,21.25,7.165,25,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Telephone Assessment And Management Service Provided By Nonphysician, 5-10 Mins Medical Discussion",,98966,CPT,Facility,Both,,,,25,21.25,7.165,25,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),15,60,,percent of total billed charges,,
"Telephone Assessment And Management Service Provided By Nonphysician, 5-10 Mins Medical Discussion",,98966,CPT,Facility,Both,,,,25,21.25,7.165,25,"Health Partners, Inc.",State of Minnesota Advantage Program,20.375,81.5,,percent of total billed charges,,
"Telephone Assessment And Management Service Provided By Nonphysician, 5-10 Mins Medical Discussion",,98966,CPT,Facility,Both,,,,25,21.25,7.165,25,"Health Partners, Inc.",State Public Programs,12.5,50,,percent of total billed charges,,
"Telephone Assessment And Management Service Provided By Nonphysician, 5-10 Mins Medical Discussion",,98966,CPT,Facility,Both,,,,25,21.25,7.165,25,Humana Insurance Company,Commercial PPO,23.75,95,,percent of total billed charges,,
"Telephone Assessment And Management Service Provided By Nonphysician, 5-10 Mins Medical Discussion",,98966,CPT,Facility,Outpatient,,,,25,21.25,7.165,25,Humana Insurance Company,Medicare PPO,12.25,49,,percent of total billed charges,,
"Telephone Assessment And Management Service Provided By Nonphysician, 5-10 Mins Medical Discussion",,98966,CPT,Facility,Inpatient,,,,25,21.25,7.165,25,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Telephone Assessment And Management Service Provided By Nonphysician, 5-10 Mins Medical Discussion",,98966,CPT,Facility,Both,,,,25,21.25,7.165,25,Medica,Individual & Family,24.775,99.1,,percent of total billed charges,,
"Telephone Assessment And Management Service Provided By Nonphysician, 5-10 Mins Medical Discussion",,98966,CPT,Facility,Outpatient,,,,25,21.25,7.165,25,Medica,Medica Advantage Solution,12.45,49.8,,percent of total billed charges,,
"Telephone Assessment And Management Service Provided By Nonphysician, 5-10 Mins Medical Discussion",,98966,CPT,Facility,Inpatient,,,,25,21.25,7.165,25,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Telephone Assessment And Management Service Provided By Nonphysician, 5-10 Mins Medical Discussion",,98966,CPT,Facility,Outpatient,,,,25,21.25,7.165,25,Medica,Medical Assistance,11.15,44.6,,percent of total billed charges,,
"Telephone Assessment And Management Service Provided By Nonphysician, 5-10 Mins Medical Discussion",,98966,CPT,Facility,Inpatient,,,,25,21.25,7.165,25,Medica,Medical Assistance,,,,,Included in per diem rate,
"Telephone Assessment And Management Service Provided By Nonphysician, 5-10 Mins Medical Discussion",,98966,CPT,Facility,Outpatient,,,,25,21.25,7.165,25,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,12.45,49.8,,percent of total billed charges,,
"Telephone Assessment And Management Service Provided By Nonphysician, 5-10 Mins Medical Discussion",,98966,CPT,Facility,Inpatient,,,,25,21.25,7.165,25,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Telephone Assessment And Management Service Provided By Nonphysician, 5-10 Mins Medical Discussion",,98966,CPT,Facility,Both,,,,25,21.25,7.165,25,"Multiplan, Inc.","Multiplan, Inc.",23.5,94,,percent of total billed charges,,
"Telephone Assessment And Management Service Provided By Nonphysician, 5-10 Mins Medical Discussion",,98966,CPT,Facility,Outpatient,,,,25,21.25,7.165,25,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,22.525,90.1,,percent of total billed charges,,
"Telephone Assessment And Management Service Provided By Nonphysician, 5-10 Mins Medical Discussion",,98966,CPT,Facility,Inpatient,,,,25,21.25,7.165,25,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Telephone Assessment And Management Service Provided By Nonphysician, 5-10 Mins Medical Discussion",,98966,CPT,Facility,Both,,,,25,21.25,7.165,25,"Preferred One Administrative Services, INC.",PPO,24.65,98.6,,percent of total billed charges,,
"Telephone Assessment And Management Service Provided By Nonphysician, 5-10 Mins Medical Discussion",,98966,CPT,Facility,Outpatient,,,,25,21.25,7.165,25,PrimeWest Health,Minnesota Senior Health Options (MSHO),12.8625,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Telephone Assessment And Management Service Provided By Nonphysician, 5-10 Mins Medical Discussion",,98966,CPT,Facility,Inpatient,,,,25,21.25,7.165,25,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Telephone Assessment And Management Service Provided By Nonphysician, 5-10 Mins Medical Discussion",,98966,CPT,Facility,Outpatient,,,,25,21.25,7.165,25,PrimeWest Health,MinnesotaCare,12.84,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Telephone Assessment And Management Service Provided By Nonphysician, 5-10 Mins Medical Discussion",,98966,CPT,Facility,Inpatient,,,,25,21.25,7.165,25,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Telephone Assessment And Management Service Provided By Nonphysician, 5-10 Mins Medical Discussion",,98966,CPT,Facility,Both,,,,25,21.25,7.165,25,Sanford Health Plan,Sanford Health Plan,23,92,,percent of total billed charges,,
"Telephone Assessment And Management Service Provided By Nonphysician, 5-10 Mins Medical Discussion",,98966,CPT,Facility,Outpatient,,,,25,21.25,7.165,25,"UCare Health, Inc.",Individual & Family Plan,14.0875,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Telephone Assessment And Management Service Provided By Nonphysician, 5-10 Mins Medical Discussion",,98966,CPT,Facility,Inpatient,,,,25,21.25,7.165,25,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Telephone Assessment And Management Service Provided By Nonphysician, 5-10 Mins Medical Discussion",,98966,CPT,Facility,Outpatient,,,,25,21.25,7.165,25,"UCare Health, Inc.",Medical Assistance,12.6175,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Telephone Assessment And Management Service Provided By Nonphysician, 5-10 Mins Medical Discussion",,98966,CPT,Facility,Inpatient,,,,25,21.25,7.165,25,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Telephone Assessment And Management Service Provided By Nonphysician, 5-10 Mins Medical Discussion",,98966,CPT,Facility,Outpatient,,,,25,21.25,7.165,25,"UCare Health, Inc.",Medicare Advantage,12.6175,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Telephone Assessment And Management Service Provided By Nonphysician, 5-10 Mins Medical Discussion",,98966,CPT,Facility,Inpatient,,,,25,21.25,7.165,25,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Telephone Assessment And Management Service Provided By Nonphysician, 5-10 Mins Medical Discussion",,98966,CPT,Facility,Outpatient,,,,25,21.25,7.165,25,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),12.6175,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Telephone Assessment And Management Service Provided By Nonphysician, 5-10 Mins Medical Discussion",,98966,CPT,Facility,Inpatient,,,,25,21.25,7.165,25,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Telephone Assessment And Management Service Provided By Nonphysician, 5-10 Mins Medical Discussion",,98966,CPT,Facility,Both,,,,25,21.25,7.165,25,UnitedHealthcare,Individual & Family,23.5,94,,percent of total billed charges,,
"Telephone Assessment And Management Service Provided By Nonphysician, 5-10 Mins Medical Discussion",,98966,CPT,Facility,Outpatient,,,,25,21.25,7.165,25,UnitedHealthcare,Medicare Advantage,12.25,49,,percent of total billed charges,,
"Telephone Assessment And Management Service Provided By Nonphysician, 5-10 Mins Medical Discussion",,98966,CPT,Facility,Inpatient,,,,25,21.25,7.165,25,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Telephone Assessment And Management Service Provided By Nonphysician, 5-10 Mins Medical Discussion",,98966,CPT,Facility,Outpatient,,,,25,21.25,7.165,25,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,12,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Telephone Assessment And Management Service Provided By Nonphysician, 5-10 Mins Medical Discussion",,98966,CPT,Facility,Inpatient,,,,25,21.25,7.165,25,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Telephone Assessment And Management Service Provided By Nonphysician, 11-20 Mins Medical Discussion",,98967,CPT,Facility,Both,,,,48,40.8,13.7568,48,Aetna,Commercial,44.16,92,,percent of total billed charges,,
"Telephone Assessment And Management Service Provided By Nonphysician, 11-20 Mins Medical Discussion",,98967,CPT,Facility,Outpatient,,,,48,40.8,13.7568,48,Aetna,Medicare Advantage,23.52,49,,percent of total billed charges,,
"Telephone Assessment And Management Service Provided By Nonphysician, 11-20 Mins Medical Discussion",,98967,CPT,Facility,Inpatient,,,,48,40.8,13.7568,48,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Telephone Assessment And Management Service Provided By Nonphysician, 11-20 Mins Medical Discussion",,98967,CPT,Facility,Both,,,,48,40.8,13.7568,48,Aetna,PPO,44.64,93,,percent of total billed charges,,
"Telephone Assessment And Management Service Provided By Nonphysician, 11-20 Mins Medical Discussion",,98967,CPT,Facility,Both,,,,48,40.8,13.7568,48,America's PPO,America's PPO,46.0944,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Telephone Assessment And Management Service Provided By Nonphysician, 11-20 Mins Medical Discussion",,98967,CPT,Facility,Both,,,,48,40.8,13.7568,48,BlueCross BlueShield Minnesota, Federal Employee Program,47.232,98.4,,percent of total billed charges,,
"Telephone Assessment And Management Service Provided By Nonphysician, 11-20 Mins Medical Discussion",,98967,CPT,Facility,Both,,,,48,40.8,13.7568,48,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,48,100,,percent of total billed charges,,
"Telephone Assessment And Management Service Provided By Nonphysician, 11-20 Mins Medical Discussion",,98967,CPT,Facility,Both,,,,48,40.8,13.7568,48,BlueCross BlueShield Minnesota,High Value Network Plan,43.2,90,,percent of total billed charges,,
"Telephone Assessment And Management Service Provided By Nonphysician, 11-20 Mins Medical Discussion",,98967,CPT,Facility,Outpatient,,,,48,40.8,13.7568,48,BlueCross BlueShield Minnesota,Medicare Advantage,23.52,49,,percent of total billed charges,,
"Telephone Assessment And Management Service Provided By Nonphysician, 11-20 Mins Medical Discussion",,98967,CPT,Facility,Inpatient,,,,48,40.8,13.7568,48,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Telephone Assessment And Management Service Provided By Nonphysician, 11-20 Mins Medical Discussion",,98967,CPT,Facility,Both,,,,48,40.8,13.7568,48,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,42.5136,88.57,,percent of total billed charges,,
"Telephone Assessment And Management Service Provided By Nonphysician, 11-20 Mins Medical Discussion",,98967,CPT,Facility,Both,,,,48,40.8,13.7568,48,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,13.7568,28.66,,percent of total billed charges,,
"Telephone Assessment And Management Service Provided By Nonphysician, 11-20 Mins Medical Discussion",,98967,CPT,Facility,Outpatient,,,,48,40.8,13.7568,48,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),23.52,49,,percent of total billed charges,,
"Telephone Assessment And Management Service Provided By Nonphysician, 11-20 Mins Medical Discussion",,98967,CPT,Facility,Inpatient,,,,48,40.8,13.7568,48,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Telephone Assessment And Management Service Provided By Nonphysician, 11-20 Mins Medical Discussion",,98967,CPT,Facility,Both,,,,48,40.8,13.7568,48,CorVel,Worker's Compensation,48,100,,percent of total billed charges,,
"Telephone Assessment And Management Service Provided By Nonphysician, 11-20 Mins Medical Discussion",,98967,CPT,Facility,Both,,,,48,40.8,13.7568,48,First Health Group Corporation,First Health Network,46.56,97,,percent of total billed charges,,
"Telephone Assessment And Management Service Provided By Nonphysician, 11-20 Mins Medical Discussion",,98967,CPT,Facility,Both,,,,48,40.8,13.7568,48,"Health Partners, Inc.",Commercial,45.408,94.6,,percent of total billed charges,,
"Telephone Assessment And Management Service Provided By Nonphysician, 11-20 Mins Medical Discussion",,98967,CPT,Facility,Outpatient,,,,48,40.8,13.7568,48,"Health Partners, Inc.",Medicare Advantage,23.52,49,,percent of total billed charges,,
"Telephone Assessment And Management Service Provided By Nonphysician, 11-20 Mins Medical Discussion",,98967,CPT,Facility,Inpatient,,,,48,40.8,13.7568,48,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Telephone Assessment And Management Service Provided By Nonphysician, 11-20 Mins Medical Discussion",,98967,CPT,Facility,Both,,,,48,40.8,13.7568,48,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),28.8,60,,percent of total billed charges,,
"Telephone Assessment And Management Service Provided By Nonphysician, 11-20 Mins Medical Discussion",,98967,CPT,Facility,Both,,,,48,40.8,13.7568,48,"Health Partners, Inc.",State of Minnesota Advantage Program,39.12,81.5,,percent of total billed charges,,
"Telephone Assessment And Management Service Provided By Nonphysician, 11-20 Mins Medical Discussion",,98967,CPT,Facility,Both,,,,48,40.8,13.7568,48,"Health Partners, Inc.",State Public Programs,24,50,,percent of total billed charges,,
"Telephone Assessment And Management Service Provided By Nonphysician, 11-20 Mins Medical Discussion",,98967,CPT,Facility,Both,,,,48,40.8,13.7568,48,Humana Insurance Company,Commercial PPO,45.6,95,,percent of total billed charges,,
"Telephone Assessment And Management Service Provided By Nonphysician, 11-20 Mins Medical Discussion",,98967,CPT,Facility,Outpatient,,,,48,40.8,13.7568,48,Humana Insurance Company,Medicare PPO,23.52,49,,percent of total billed charges,,
"Telephone Assessment And Management Service Provided By Nonphysician, 11-20 Mins Medical Discussion",,98967,CPT,Facility,Inpatient,,,,48,40.8,13.7568,48,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Telephone Assessment And Management Service Provided By Nonphysician, 11-20 Mins Medical Discussion",,98967,CPT,Facility,Both,,,,48,40.8,13.7568,48,Medica,Individual & Family,47.568,99.1,,percent of total billed charges,,
"Telephone Assessment And Management Service Provided By Nonphysician, 11-20 Mins Medical Discussion",,98967,CPT,Facility,Outpatient,,,,48,40.8,13.7568,48,Medica,Medica Advantage Solution,23.904,49.8,,percent of total billed charges,,
"Telephone Assessment And Management Service Provided By Nonphysician, 11-20 Mins Medical Discussion",,98967,CPT,Facility,Inpatient,,,,48,40.8,13.7568,48,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Telephone Assessment And Management Service Provided By Nonphysician, 11-20 Mins Medical Discussion",,98967,CPT,Facility,Outpatient,,,,48,40.8,13.7568,48,Medica,Medical Assistance,21.408,44.6,,percent of total billed charges,,
"Telephone Assessment And Management Service Provided By Nonphysician, 11-20 Mins Medical Discussion",,98967,CPT,Facility,Inpatient,,,,48,40.8,13.7568,48,Medica,Medical Assistance,,,,,Included in per diem rate,
"Telephone Assessment And Management Service Provided By Nonphysician, 11-20 Mins Medical Discussion",,98967,CPT,Facility,Outpatient,,,,48,40.8,13.7568,48,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,23.904,49.8,,percent of total billed charges,,
"Telephone Assessment And Management Service Provided By Nonphysician, 11-20 Mins Medical Discussion",,98967,CPT,Facility,Inpatient,,,,48,40.8,13.7568,48,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Telephone Assessment And Management Service Provided By Nonphysician, 11-20 Mins Medical Discussion",,98967,CPT,Facility,Both,,,,48,40.8,13.7568,48,"Multiplan, Inc.","Multiplan, Inc.",45.12,94,,percent of total billed charges,,
"Telephone Assessment And Management Service Provided By Nonphysician, 11-20 Mins Medical Discussion",,98967,CPT,Facility,Outpatient,,,,48,40.8,13.7568,48,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,43.248,90.1,,percent of total billed charges,,
"Telephone Assessment And Management Service Provided By Nonphysician, 11-20 Mins Medical Discussion",,98967,CPT,Facility,Inpatient,,,,48,40.8,13.7568,48,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Telephone Assessment And Management Service Provided By Nonphysician, 11-20 Mins Medical Discussion",,98967,CPT,Facility,Both,,,,48,40.8,13.7568,48,"Preferred One Administrative Services, INC.",PPO,47.328,98.6,,percent of total billed charges,,
"Telephone Assessment And Management Service Provided By Nonphysician, 11-20 Mins Medical Discussion",,98967,CPT,Facility,Outpatient,,,,48,40.8,13.7568,48,PrimeWest Health,Minnesota Senior Health Options (MSHO),24.696,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Telephone Assessment And Management Service Provided By Nonphysician, 11-20 Mins Medical Discussion",,98967,CPT,Facility,Inpatient,,,,48,40.8,13.7568,48,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Telephone Assessment And Management Service Provided By Nonphysician, 11-20 Mins Medical Discussion",,98967,CPT,Facility,Outpatient,,,,48,40.8,13.7568,48,PrimeWest Health,MinnesotaCare,24.6528,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Telephone Assessment And Management Service Provided By Nonphysician, 11-20 Mins Medical Discussion",,98967,CPT,Facility,Inpatient,,,,48,40.8,13.7568,48,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Telephone Assessment And Management Service Provided By Nonphysician, 11-20 Mins Medical Discussion",,98967,CPT,Facility,Both,,,,48,40.8,13.7568,48,Sanford Health Plan,Sanford Health Plan,44.16,92,,percent of total billed charges,,
"Telephone Assessment And Management Service Provided By Nonphysician, 11-20 Mins Medical Discussion",,98967,CPT,Facility,Outpatient,,,,48,40.8,13.7568,48,"UCare Health, Inc.",Individual & Family Plan,27.048,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Telephone Assessment And Management Service Provided By Nonphysician, 11-20 Mins Medical Discussion",,98967,CPT,Facility,Inpatient,,,,48,40.8,13.7568,48,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Telephone Assessment And Management Service Provided By Nonphysician, 11-20 Mins Medical Discussion",,98967,CPT,Facility,Outpatient,,,,48,40.8,13.7568,48,"UCare Health, Inc.",Medical Assistance,24.2256,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Telephone Assessment And Management Service Provided By Nonphysician, 11-20 Mins Medical Discussion",,98967,CPT,Facility,Inpatient,,,,48,40.8,13.7568,48,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Telephone Assessment And Management Service Provided By Nonphysician, 11-20 Mins Medical Discussion",,98967,CPT,Facility,Outpatient,,,,48,40.8,13.7568,48,"UCare Health, Inc.",Medicare Advantage,24.2256,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Telephone Assessment And Management Service Provided By Nonphysician, 11-20 Mins Medical Discussion",,98967,CPT,Facility,Inpatient,,,,48,40.8,13.7568,48,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Telephone Assessment And Management Service Provided By Nonphysician, 11-20 Mins Medical Discussion",,98967,CPT,Facility,Outpatient,,,,48,40.8,13.7568,48,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),24.2256,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Telephone Assessment And Management Service Provided By Nonphysician, 11-20 Mins Medical Discussion",,98967,CPT,Facility,Inpatient,,,,48,40.8,13.7568,48,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Telephone Assessment And Management Service Provided By Nonphysician, 11-20 Mins Medical Discussion",,98967,CPT,Facility,Both,,,,48,40.8,13.7568,48,UnitedHealthcare,Individual & Family,45.12,94,,percent of total billed charges,,
"Telephone Assessment And Management Service Provided By Nonphysician, 11-20 Mins Medical Discussion",,98967,CPT,Facility,Outpatient,,,,48,40.8,13.7568,48,UnitedHealthcare,Medicare Advantage,23.52,49,,percent of total billed charges,,
"Telephone Assessment And Management Service Provided By Nonphysician, 11-20 Mins Medical Discussion",,98967,CPT,Facility,Inpatient,,,,48,40.8,13.7568,48,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Telephone Assessment And Management Service Provided By Nonphysician, 11-20 Mins Medical Discussion",,98967,CPT,Facility,Outpatient,,,,48,40.8,13.7568,48,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,23.04,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Telephone Assessment And Management Service Provided By Nonphysician, 11-20 Mins Medical Discussion",,98967,CPT,Facility,Inpatient,,,,48,40.8,13.7568,48,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Telephone Assessment And Management Service Provided By Nonphysician, 21-30 Mins Medical Discussion",,98968,CPT,Facility,Both,,,,81,68.85,23.2146,81,Aetna,Commercial,74.52,92,,percent of total billed charges,,
"Telephone Assessment And Management Service Provided By Nonphysician, 21-30 Mins Medical Discussion",,98968,CPT,Facility,Outpatient,,,,81,68.85,23.2146,81,Aetna,Medicare Advantage,39.69,49,,percent of total billed charges,,
"Telephone Assessment And Management Service Provided By Nonphysician, 21-30 Mins Medical Discussion",,98968,CPT,Facility,Inpatient,,,,81,68.85,23.2146,81,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Telephone Assessment And Management Service Provided By Nonphysician, 21-30 Mins Medical Discussion",,98968,CPT,Facility,Both,,,,81,68.85,23.2146,81,Aetna,PPO,75.33,93,,percent of total billed charges,,
"Telephone Assessment And Management Service Provided By Nonphysician, 21-30 Mins Medical Discussion",,98968,CPT,Facility,Both,,,,81,68.85,23.2146,81,America's PPO,America's PPO,77.7843,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Telephone Assessment And Management Service Provided By Nonphysician, 21-30 Mins Medical Discussion",,98968,CPT,Facility,Both,,,,81,68.85,23.2146,81,BlueCross BlueShield Minnesota, Federal Employee Program,79.704,98.4,,percent of total billed charges,,
"Telephone Assessment And Management Service Provided By Nonphysician, 21-30 Mins Medical Discussion",,98968,CPT,Facility,Both,,,,81,68.85,23.2146,81,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,81,100,,percent of total billed charges,,
"Telephone Assessment And Management Service Provided By Nonphysician, 21-30 Mins Medical Discussion",,98968,CPT,Facility,Both,,,,81,68.85,23.2146,81,BlueCross BlueShield Minnesota,High Value Network Plan,72.9,90,,percent of total billed charges,,
"Telephone Assessment And Management Service Provided By Nonphysician, 21-30 Mins Medical Discussion",,98968,CPT,Facility,Outpatient,,,,81,68.85,23.2146,81,BlueCross BlueShield Minnesota,Medicare Advantage,39.69,49,,percent of total billed charges,,
"Telephone Assessment And Management Service Provided By Nonphysician, 21-30 Mins Medical Discussion",,98968,CPT,Facility,Inpatient,,,,81,68.85,23.2146,81,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Telephone Assessment And Management Service Provided By Nonphysician, 21-30 Mins Medical Discussion",,98968,CPT,Facility,Both,,,,81,68.85,23.2146,81,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,71.7417,88.57,,percent of total billed charges,,
"Telephone Assessment And Management Service Provided By Nonphysician, 21-30 Mins Medical Discussion",,98968,CPT,Facility,Both,,,,81,68.85,23.2146,81,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,23.2146,28.66,,percent of total billed charges,,
"Telephone Assessment And Management Service Provided By Nonphysician, 21-30 Mins Medical Discussion",,98968,CPT,Facility,Outpatient,,,,81,68.85,23.2146,81,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),39.69,49,,percent of total billed charges,,
"Telephone Assessment And Management Service Provided By Nonphysician, 21-30 Mins Medical Discussion",,98968,CPT,Facility,Inpatient,,,,81,68.85,23.2146,81,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Telephone Assessment And Management Service Provided By Nonphysician, 21-30 Mins Medical Discussion",,98968,CPT,Facility,Both,,,,81,68.85,23.2146,81,CorVel,Worker's Compensation,81,100,,percent of total billed charges,,
"Telephone Assessment And Management Service Provided By Nonphysician, 21-30 Mins Medical Discussion",,98968,CPT,Facility,Both,,,,81,68.85,23.2146,81,First Health Group Corporation,First Health Network,78.57,97,,percent of total billed charges,,
"Telephone Assessment And Management Service Provided By Nonphysician, 21-30 Mins Medical Discussion",,98968,CPT,Facility,Both,,,,81,68.85,23.2146,81,"Health Partners, Inc.",Commercial,76.626,94.6,,percent of total billed charges,,
"Telephone Assessment And Management Service Provided By Nonphysician, 21-30 Mins Medical Discussion",,98968,CPT,Facility,Outpatient,,,,81,68.85,23.2146,81,"Health Partners, Inc.",Medicare Advantage,39.69,49,,percent of total billed charges,,
"Telephone Assessment And Management Service Provided By Nonphysician, 21-30 Mins Medical Discussion",,98968,CPT,Facility,Inpatient,,,,81,68.85,23.2146,81,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Telephone Assessment And Management Service Provided By Nonphysician, 21-30 Mins Medical Discussion",,98968,CPT,Facility,Both,,,,81,68.85,23.2146,81,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),48.6,60,,percent of total billed charges,,
"Telephone Assessment And Management Service Provided By Nonphysician, 21-30 Mins Medical Discussion",,98968,CPT,Facility,Both,,,,81,68.85,23.2146,81,"Health Partners, Inc.",State of Minnesota Advantage Program,66.015,81.5,,percent of total billed charges,,
"Telephone Assessment And Management Service Provided By Nonphysician, 21-30 Mins Medical Discussion",,98968,CPT,Facility,Both,,,,81,68.85,23.2146,81,"Health Partners, Inc.",State Public Programs,40.5,50,,percent of total billed charges,,
"Telephone Assessment And Management Service Provided By Nonphysician, 21-30 Mins Medical Discussion",,98968,CPT,Facility,Both,,,,81,68.85,23.2146,81,Humana Insurance Company,Commercial PPO,76.95,95,,percent of total billed charges,,
"Telephone Assessment And Management Service Provided By Nonphysician, 21-30 Mins Medical Discussion",,98968,CPT,Facility,Outpatient,,,,81,68.85,23.2146,81,Humana Insurance Company,Medicare PPO,39.69,49,,percent of total billed charges,,
"Telephone Assessment And Management Service Provided By Nonphysician, 21-30 Mins Medical Discussion",,98968,CPT,Facility,Inpatient,,,,81,68.85,23.2146,81,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Telephone Assessment And Management Service Provided By Nonphysician, 21-30 Mins Medical Discussion",,98968,CPT,Facility,Both,,,,81,68.85,23.2146,81,Medica,Individual & Family,80.271,99.1,,percent of total billed charges,,
"Telephone Assessment And Management Service Provided By Nonphysician, 21-30 Mins Medical Discussion",,98968,CPT,Facility,Outpatient,,,,81,68.85,23.2146,81,Medica,Medica Advantage Solution,40.338,49.8,,percent of total billed charges,,
"Telephone Assessment And Management Service Provided By Nonphysician, 21-30 Mins Medical Discussion",,98968,CPT,Facility,Inpatient,,,,81,68.85,23.2146,81,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Telephone Assessment And Management Service Provided By Nonphysician, 21-30 Mins Medical Discussion",,98968,CPT,Facility,Outpatient,,,,81,68.85,23.2146,81,Medica,Medical Assistance,36.126,44.6,,percent of total billed charges,,
"Telephone Assessment And Management Service Provided By Nonphysician, 21-30 Mins Medical Discussion",,98968,CPT,Facility,Inpatient,,,,81,68.85,23.2146,81,Medica,Medical Assistance,,,,,Included in per diem rate,
"Telephone Assessment And Management Service Provided By Nonphysician, 21-30 Mins Medical Discussion",,98968,CPT,Facility,Outpatient,,,,81,68.85,23.2146,81,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,40.338,49.8,,percent of total billed charges,,
"Telephone Assessment And Management Service Provided By Nonphysician, 21-30 Mins Medical Discussion",,98968,CPT,Facility,Inpatient,,,,81,68.85,23.2146,81,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Telephone Assessment And Management Service Provided By Nonphysician, 21-30 Mins Medical Discussion",,98968,CPT,Facility,Both,,,,81,68.85,23.2146,81,"Multiplan, Inc.","Multiplan, Inc.",76.14,94,,percent of total billed charges,,
"Telephone Assessment And Management Service Provided By Nonphysician, 21-30 Mins Medical Discussion",,98968,CPT,Facility,Outpatient,,,,81,68.85,23.2146,81,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,72.981,90.1,,percent of total billed charges,,
"Telephone Assessment And Management Service Provided By Nonphysician, 21-30 Mins Medical Discussion",,98968,CPT,Facility,Inpatient,,,,81,68.85,23.2146,81,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Telephone Assessment And Management Service Provided By Nonphysician, 21-30 Mins Medical Discussion",,98968,CPT,Facility,Both,,,,81,68.85,23.2146,81,"Preferred One Administrative Services, INC.",PPO,79.866,98.6,,percent of total billed charges,,
"Telephone Assessment And Management Service Provided By Nonphysician, 21-30 Mins Medical Discussion",,98968,CPT,Facility,Outpatient,,,,81,68.85,23.2146,81,PrimeWest Health,Minnesota Senior Health Options (MSHO),41.6745,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Telephone Assessment And Management Service Provided By Nonphysician, 21-30 Mins Medical Discussion",,98968,CPT,Facility,Inpatient,,,,81,68.85,23.2146,81,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Telephone Assessment And Management Service Provided By Nonphysician, 21-30 Mins Medical Discussion",,98968,CPT,Facility,Outpatient,,,,81,68.85,23.2146,81,PrimeWest Health,MinnesotaCare,41.6016,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Telephone Assessment And Management Service Provided By Nonphysician, 21-30 Mins Medical Discussion",,98968,CPT,Facility,Inpatient,,,,81,68.85,23.2146,81,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Telephone Assessment And Management Service Provided By Nonphysician, 21-30 Mins Medical Discussion",,98968,CPT,Facility,Both,,,,81,68.85,23.2146,81,Sanford Health Plan,Sanford Health Plan,74.52,92,,percent of total billed charges,,
"Telephone Assessment And Management Service Provided By Nonphysician, 21-30 Mins Medical Discussion",,98968,CPT,Facility,Outpatient,,,,81,68.85,23.2146,81,"UCare Health, Inc.",Individual & Family Plan,45.6435,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Telephone Assessment And Management Service Provided By Nonphysician, 21-30 Mins Medical Discussion",,98968,CPT,Facility,Inpatient,,,,81,68.85,23.2146,81,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Telephone Assessment And Management Service Provided By Nonphysician, 21-30 Mins Medical Discussion",,98968,CPT,Facility,Outpatient,,,,81,68.85,23.2146,81,"UCare Health, Inc.",Medical Assistance,40.8807,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Telephone Assessment And Management Service Provided By Nonphysician, 21-30 Mins Medical Discussion",,98968,CPT,Facility,Inpatient,,,,81,68.85,23.2146,81,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Telephone Assessment And Management Service Provided By Nonphysician, 21-30 Mins Medical Discussion",,98968,CPT,Facility,Outpatient,,,,81,68.85,23.2146,81,"UCare Health, Inc.",Medicare Advantage,40.8807,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Telephone Assessment And Management Service Provided By Nonphysician, 21-30 Mins Medical Discussion",,98968,CPT,Facility,Inpatient,,,,81,68.85,23.2146,81,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Telephone Assessment And Management Service Provided By Nonphysician, 21-30 Mins Medical Discussion",,98968,CPT,Facility,Outpatient,,,,81,68.85,23.2146,81,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),40.8807,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Telephone Assessment And Management Service Provided By Nonphysician, 21-30 Mins Medical Discussion",,98968,CPT,Facility,Inpatient,,,,81,68.85,23.2146,81,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Telephone Assessment And Management Service Provided By Nonphysician, 21-30 Mins Medical Discussion",,98968,CPT,Facility,Both,,,,81,68.85,23.2146,81,UnitedHealthcare,Individual & Family,76.14,94,,percent of total billed charges,,
"Telephone Assessment And Management Service Provided By Nonphysician, 21-30 Mins Medical Discussion",,98968,CPT,Facility,Outpatient,,,,81,68.85,23.2146,81,UnitedHealthcare,Medicare Advantage,39.69,49,,percent of total billed charges,,
"Telephone Assessment And Management Service Provided By Nonphysician, 21-30 Mins Medical Discussion",,98968,CPT,Facility,Inpatient,,,,81,68.85,23.2146,81,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Telephone Assessment And Management Service Provided By Nonphysician, 21-30 Mins Medical Discussion",,98968,CPT,Facility,Outpatient,,,,81,68.85,23.2146,81,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,38.88,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Telephone Assessment And Management Service Provided By Nonphysician, 21-30 Mins Medical Discussion",,98968,CPT,Facility,Inpatient,,,,81,68.85,23.2146,81,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Qnhp Online Digital Assmt&Mgmt, Est Pt Up To 7 Days, Cumulative Time During The 7 Days; 5-10 Min",,98970,CPT,Facility,Both,,,,25,21.25,7.165,25,Aetna,Commercial,23,92,,percent of total billed charges,,
"Qnhp Online Digital Assmt&Mgmt, Est Pt Up To 7 Days, Cumulative Time During The 7 Days; 5-10 Min",,98970,CPT,Facility,Outpatient,,,,25,21.25,7.165,25,Aetna,Medicare Advantage,12.25,49,,percent of total billed charges,,
"Qnhp Online Digital Assmt&Mgmt, Est Pt Up To 7 Days, Cumulative Time During The 7 Days; 5-10 Min",,98970,CPT,Facility,Inpatient,,,,25,21.25,7.165,25,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Qnhp Online Digital Assmt&Mgmt, Est Pt Up To 7 Days, Cumulative Time During The 7 Days; 5-10 Min",,98970,CPT,Facility,Both,,,,25,21.25,7.165,25,Aetna,PPO,23.25,93,,percent of total billed charges,,
"Qnhp Online Digital Assmt&Mgmt, Est Pt Up To 7 Days, Cumulative Time During The 7 Days; 5-10 Min",,98970,CPT,Facility,Both,,,,25,21.25,7.165,25,America's PPO,America's PPO,24.0075,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Qnhp Online Digital Assmt&Mgmt, Est Pt Up To 7 Days, Cumulative Time During The 7 Days; 5-10 Min",,98970,CPT,Facility,Both,,,,25,21.25,7.165,25,BlueCross BlueShield Minnesota, Federal Employee Program,24.6,98.4,,percent of total billed charges,,
"Qnhp Online Digital Assmt&Mgmt, Est Pt Up To 7 Days, Cumulative Time During The 7 Days; 5-10 Min",,98970,CPT,Facility,Both,,,,25,21.25,7.165,25,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,25,100,,percent of total billed charges,,
"Qnhp Online Digital Assmt&Mgmt, Est Pt Up To 7 Days, Cumulative Time During The 7 Days; 5-10 Min",,98970,CPT,Facility,Both,,,,25,21.25,7.165,25,BlueCross BlueShield Minnesota,High Value Network Plan,22.5,90,,percent of total billed charges,,
"Qnhp Online Digital Assmt&Mgmt, Est Pt Up To 7 Days, Cumulative Time During The 7 Days; 5-10 Min",,98970,CPT,Facility,Outpatient,,,,25,21.25,7.165,25,BlueCross BlueShield Minnesota,Medicare Advantage,12.25,49,,percent of total billed charges,,
"Qnhp Online Digital Assmt&Mgmt, Est Pt Up To 7 Days, Cumulative Time During The 7 Days; 5-10 Min",,98970,CPT,Facility,Inpatient,,,,25,21.25,7.165,25,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Qnhp Online Digital Assmt&Mgmt, Est Pt Up To 7 Days, Cumulative Time During The 7 Days; 5-10 Min",,98970,CPT,Facility,Both,,,,25,21.25,7.165,25,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,22.1425,88.57,,percent of total billed charges,,
"Qnhp Online Digital Assmt&Mgmt, Est Pt Up To 7 Days, Cumulative Time During The 7 Days; 5-10 Min",,98970,CPT,Facility,Both,,,,25,21.25,7.165,25,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,7.165,28.66,,percent of total billed charges,,
"Qnhp Online Digital Assmt&Mgmt, Est Pt Up To 7 Days, Cumulative Time During The 7 Days; 5-10 Min",,98970,CPT,Facility,Outpatient,,,,25,21.25,7.165,25,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),12.25,49,,percent of total billed charges,,
"Qnhp Online Digital Assmt&Mgmt, Est Pt Up To 7 Days, Cumulative Time During The 7 Days; 5-10 Min",,98970,CPT,Facility,Inpatient,,,,25,21.25,7.165,25,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Qnhp Online Digital Assmt&Mgmt, Est Pt Up To 7 Days, Cumulative Time During The 7 Days; 5-10 Min",,98970,CPT,Facility,Both,,,,25,21.25,7.165,25,CorVel,Worker's Compensation,25,100,,percent of total billed charges,,
"Qnhp Online Digital Assmt&Mgmt, Est Pt Up To 7 Days, Cumulative Time During The 7 Days; 5-10 Min",,98970,CPT,Facility,Both,,,,25,21.25,7.165,25,First Health Group Corporation,First Health Network,24.25,97,,percent of total billed charges,,
"Qnhp Online Digital Assmt&Mgmt, Est Pt Up To 7 Days, Cumulative Time During The 7 Days; 5-10 Min",,98970,CPT,Facility,Both,,,,25,21.25,7.165,25,"Health Partners, Inc.",Commercial,23.65,94.6,,percent of total billed charges,,
"Qnhp Online Digital Assmt&Mgmt, Est Pt Up To 7 Days, Cumulative Time During The 7 Days; 5-10 Min",,98970,CPT,Facility,Outpatient,,,,25,21.25,7.165,25,"Health Partners, Inc.",Medicare Advantage,12.25,49,,percent of total billed charges,,
"Qnhp Online Digital Assmt&Mgmt, Est Pt Up To 7 Days, Cumulative Time During The 7 Days; 5-10 Min",,98970,CPT,Facility,Inpatient,,,,25,21.25,7.165,25,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Qnhp Online Digital Assmt&Mgmt, Est Pt Up To 7 Days, Cumulative Time During The 7 Days; 5-10 Min",,98970,CPT,Facility,Both,,,,25,21.25,7.165,25,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),15,60,,percent of total billed charges,,
"Qnhp Online Digital Assmt&Mgmt, Est Pt Up To 7 Days, Cumulative Time During The 7 Days; 5-10 Min",,98970,CPT,Facility,Both,,,,25,21.25,7.165,25,"Health Partners, Inc.",State of Minnesota Advantage Program,20.375,81.5,,percent of total billed charges,,
"Qnhp Online Digital Assmt&Mgmt, Est Pt Up To 7 Days, Cumulative Time During The 7 Days; 5-10 Min",,98970,CPT,Facility,Both,,,,25,21.25,7.165,25,"Health Partners, Inc.",State Public Programs,12.5,50,,percent of total billed charges,,
"Qnhp Online Digital Assmt&Mgmt, Est Pt Up To 7 Days, Cumulative Time During The 7 Days; 5-10 Min",,98970,CPT,Facility,Both,,,,25,21.25,7.165,25,Humana Insurance Company,Commercial PPO,23.75,95,,percent of total billed charges,,
"Qnhp Online Digital Assmt&Mgmt, Est Pt Up To 7 Days, Cumulative Time During The 7 Days; 5-10 Min",,98970,CPT,Facility,Outpatient,,,,25,21.25,7.165,25,Humana Insurance Company,Medicare PPO,12.25,49,,percent of total billed charges,,
"Qnhp Online Digital Assmt&Mgmt, Est Pt Up To 7 Days, Cumulative Time During The 7 Days; 5-10 Min",,98970,CPT,Facility,Inpatient,,,,25,21.25,7.165,25,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Qnhp Online Digital Assmt&Mgmt, Est Pt Up To 7 Days, Cumulative Time During The 7 Days; 5-10 Min",,98970,CPT,Facility,Both,,,,25,21.25,7.165,25,Medica,Individual & Family,24.775,99.1,,percent of total billed charges,,
"Qnhp Online Digital Assmt&Mgmt, Est Pt Up To 7 Days, Cumulative Time During The 7 Days; 5-10 Min",,98970,CPT,Facility,Outpatient,,,,25,21.25,7.165,25,Medica,Medica Advantage Solution,12.45,49.8,,percent of total billed charges,,
"Qnhp Online Digital Assmt&Mgmt, Est Pt Up To 7 Days, Cumulative Time During The 7 Days; 5-10 Min",,98970,CPT,Facility,Inpatient,,,,25,21.25,7.165,25,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Qnhp Online Digital Assmt&Mgmt, Est Pt Up To 7 Days, Cumulative Time During The 7 Days; 5-10 Min",,98970,CPT,Facility,Outpatient,,,,25,21.25,7.165,25,Medica,Medical Assistance,11.15,44.6,,percent of total billed charges,,
"Qnhp Online Digital Assmt&Mgmt, Est Pt Up To 7 Days, Cumulative Time During The 7 Days; 5-10 Min",,98970,CPT,Facility,Inpatient,,,,25,21.25,7.165,25,Medica,Medical Assistance,,,,,Included in per diem rate,
"Qnhp Online Digital Assmt&Mgmt, Est Pt Up To 7 Days, Cumulative Time During The 7 Days; 5-10 Min",,98970,CPT,Facility,Outpatient,,,,25,21.25,7.165,25,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,12.45,49.8,,percent of total billed charges,,
"Qnhp Online Digital Assmt&Mgmt, Est Pt Up To 7 Days, Cumulative Time During The 7 Days; 5-10 Min",,98970,CPT,Facility,Inpatient,,,,25,21.25,7.165,25,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Qnhp Online Digital Assmt&Mgmt, Est Pt Up To 7 Days, Cumulative Time During The 7 Days; 5-10 Min",,98970,CPT,Facility,Both,,,,25,21.25,7.165,25,"Multiplan, Inc.","Multiplan, Inc.",23.5,94,,percent of total billed charges,,
"Qnhp Online Digital Assmt&Mgmt, Est Pt Up To 7 Days, Cumulative Time During The 7 Days; 5-10 Min",,98970,CPT,Facility,Outpatient,,,,25,21.25,7.165,25,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,22.525,90.1,,percent of total billed charges,,
"Qnhp Online Digital Assmt&Mgmt, Est Pt Up To 7 Days, Cumulative Time During The 7 Days; 5-10 Min",,98970,CPT,Facility,Inpatient,,,,25,21.25,7.165,25,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Qnhp Online Digital Assmt&Mgmt, Est Pt Up To 7 Days, Cumulative Time During The 7 Days; 5-10 Min",,98970,CPT,Facility,Both,,,,25,21.25,7.165,25,"Preferred One Administrative Services, INC.",PPO,24.65,98.6,,percent of total billed charges,,
"Qnhp Online Digital Assmt&Mgmt, Est Pt Up To 7 Days, Cumulative Time During The 7 Days; 5-10 Min",,98970,CPT,Facility,Outpatient,,,,25,21.25,7.165,25,PrimeWest Health,Minnesota Senior Health Options (MSHO),12.8625,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Qnhp Online Digital Assmt&Mgmt, Est Pt Up To 7 Days, Cumulative Time During The 7 Days; 5-10 Min",,98970,CPT,Facility,Inpatient,,,,25,21.25,7.165,25,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Qnhp Online Digital Assmt&Mgmt, Est Pt Up To 7 Days, Cumulative Time During The 7 Days; 5-10 Min",,98970,CPT,Facility,Outpatient,,,,25,21.25,7.165,25,PrimeWest Health,MinnesotaCare,12.84,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Qnhp Online Digital Assmt&Mgmt, Est Pt Up To 7 Days, Cumulative Time During The 7 Days; 5-10 Min",,98970,CPT,Facility,Inpatient,,,,25,21.25,7.165,25,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Qnhp Online Digital Assmt&Mgmt, Est Pt Up To 7 Days, Cumulative Time During The 7 Days; 5-10 Min",,98970,CPT,Facility,Both,,,,25,21.25,7.165,25,Sanford Health Plan,Sanford Health Plan,23,92,,percent of total billed charges,,
"Qnhp Online Digital Assmt&Mgmt, Est Pt Up To 7 Days, Cumulative Time During The 7 Days; 5-10 Min",,98970,CPT,Facility,Outpatient,,,,25,21.25,7.165,25,"UCare Health, Inc.",Individual & Family Plan,14.0875,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Qnhp Online Digital Assmt&Mgmt, Est Pt Up To 7 Days, Cumulative Time During The 7 Days; 5-10 Min",,98970,CPT,Facility,Inpatient,,,,25,21.25,7.165,25,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Qnhp Online Digital Assmt&Mgmt, Est Pt Up To 7 Days, Cumulative Time During The 7 Days; 5-10 Min",,98970,CPT,Facility,Outpatient,,,,25,21.25,7.165,25,"UCare Health, Inc.",Medical Assistance,12.6175,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Qnhp Online Digital Assmt&Mgmt, Est Pt Up To 7 Days, Cumulative Time During The 7 Days; 5-10 Min",,98970,CPT,Facility,Inpatient,,,,25,21.25,7.165,25,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Qnhp Online Digital Assmt&Mgmt, Est Pt Up To 7 Days, Cumulative Time During The 7 Days; 5-10 Min",,98970,CPT,Facility,Outpatient,,,,25,21.25,7.165,25,"UCare Health, Inc.",Medicare Advantage,12.6175,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Qnhp Online Digital Assmt&Mgmt, Est Pt Up To 7 Days, Cumulative Time During The 7 Days; 5-10 Min",,98970,CPT,Facility,Inpatient,,,,25,21.25,7.165,25,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Qnhp Online Digital Assmt&Mgmt, Est Pt Up To 7 Days, Cumulative Time During The 7 Days; 5-10 Min",,98970,CPT,Facility,Outpatient,,,,25,21.25,7.165,25,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),12.6175,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Qnhp Online Digital Assmt&Mgmt, Est Pt Up To 7 Days, Cumulative Time During The 7 Days; 5-10 Min",,98970,CPT,Facility,Inpatient,,,,25,21.25,7.165,25,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Qnhp Online Digital Assmt&Mgmt, Est Pt Up To 7 Days, Cumulative Time During The 7 Days; 5-10 Min",,98970,CPT,Facility,Both,,,,25,21.25,7.165,25,UnitedHealthcare,Individual & Family,23.5,94,,percent of total billed charges,,
"Qnhp Online Digital Assmt&Mgmt, Est Pt Up To 7 Days, Cumulative Time During The 7 Days; 5-10 Min",,98970,CPT,Facility,Outpatient,,,,25,21.25,7.165,25,UnitedHealthcare,Medicare Advantage,12.25,49,,percent of total billed charges,,
"Qnhp Online Digital Assmt&Mgmt, Est Pt Up To 7 Days, Cumulative Time During The 7 Days; 5-10 Min",,98970,CPT,Facility,Inpatient,,,,25,21.25,7.165,25,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Qnhp Online Digital Assmt&Mgmt, Est Pt Up To 7 Days, Cumulative Time During The 7 Days; 5-10 Min",,98970,CPT,Facility,Outpatient,,,,25,21.25,7.165,25,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,12,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Qnhp Online Digital Assmt&Mgmt, Est Pt Up To 7 Days, Cumulative Time During The 7 Days; 5-10 Min",,98970,CPT,Facility,Inpatient,,,,25,21.25,7.165,25,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Qnhp Online Digital Assmt&Mgmt, Est Pt Up To 7 Days, Cumulative Time During The 7 Days; 11-20 Min",,98971,CPT,Facility,Both,,,,48,40.8,13.7568,48,Aetna,Commercial,44.16,92,,percent of total billed charges,,
"Qnhp Online Digital Assmt&Mgmt, Est Pt Up To 7 Days, Cumulative Time During The 7 Days; 11-20 Min",,98971,CPT,Facility,Outpatient,,,,48,40.8,13.7568,48,Aetna,Medicare Advantage,23.52,49,,percent of total billed charges,,
"Qnhp Online Digital Assmt&Mgmt, Est Pt Up To 7 Days, Cumulative Time During The 7 Days; 11-20 Min",,98971,CPT,Facility,Inpatient,,,,48,40.8,13.7568,48,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Qnhp Online Digital Assmt&Mgmt, Est Pt Up To 7 Days, Cumulative Time During The 7 Days; 11-20 Min",,98971,CPT,Facility,Both,,,,48,40.8,13.7568,48,Aetna,PPO,44.64,93,,percent of total billed charges,,
"Qnhp Online Digital Assmt&Mgmt, Est Pt Up To 7 Days, Cumulative Time During The 7 Days; 11-20 Min",,98971,CPT,Facility,Both,,,,48,40.8,13.7568,48,America's PPO,America's PPO,46.0944,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Qnhp Online Digital Assmt&Mgmt, Est Pt Up To 7 Days, Cumulative Time During The 7 Days; 11-20 Min",,98971,CPT,Facility,Both,,,,48,40.8,13.7568,48,BlueCross BlueShield Minnesota, Federal Employee Program,47.232,98.4,,percent of total billed charges,,
"Qnhp Online Digital Assmt&Mgmt, Est Pt Up To 7 Days, Cumulative Time During The 7 Days; 11-20 Min",,98971,CPT,Facility,Both,,,,48,40.8,13.7568,48,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,48,100,,percent of total billed charges,,
"Qnhp Online Digital Assmt&Mgmt, Est Pt Up To 7 Days, Cumulative Time During The 7 Days; 11-20 Min",,98971,CPT,Facility,Both,,,,48,40.8,13.7568,48,BlueCross BlueShield Minnesota,High Value Network Plan,43.2,90,,percent of total billed charges,,
"Qnhp Online Digital Assmt&Mgmt, Est Pt Up To 7 Days, Cumulative Time During The 7 Days; 11-20 Min",,98971,CPT,Facility,Outpatient,,,,48,40.8,13.7568,48,BlueCross BlueShield Minnesota,Medicare Advantage,23.52,49,,percent of total billed charges,,
"Qnhp Online Digital Assmt&Mgmt, Est Pt Up To 7 Days, Cumulative Time During The 7 Days; 11-20 Min",,98971,CPT,Facility,Inpatient,,,,48,40.8,13.7568,48,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Qnhp Online Digital Assmt&Mgmt, Est Pt Up To 7 Days, Cumulative Time During The 7 Days; 11-20 Min",,98971,CPT,Facility,Both,,,,48,40.8,13.7568,48,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,42.5136,88.57,,percent of total billed charges,,
"Qnhp Online Digital Assmt&Mgmt, Est Pt Up To 7 Days, Cumulative Time During The 7 Days; 11-20 Min",,98971,CPT,Facility,Both,,,,48,40.8,13.7568,48,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,13.7568,28.66,,percent of total billed charges,,
"Qnhp Online Digital Assmt&Mgmt, Est Pt Up To 7 Days, Cumulative Time During The 7 Days; 11-20 Min",,98971,CPT,Facility,Outpatient,,,,48,40.8,13.7568,48,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),23.52,49,,percent of total billed charges,,
"Qnhp Online Digital Assmt&Mgmt, Est Pt Up To 7 Days, Cumulative Time During The 7 Days; 11-20 Min",,98971,CPT,Facility,Inpatient,,,,48,40.8,13.7568,48,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Qnhp Online Digital Assmt&Mgmt, Est Pt Up To 7 Days, Cumulative Time During The 7 Days; 11-20 Min",,98971,CPT,Facility,Both,,,,48,40.8,13.7568,48,CorVel,Worker's Compensation,48,100,,percent of total billed charges,,
"Qnhp Online Digital Assmt&Mgmt, Est Pt Up To 7 Days, Cumulative Time During The 7 Days; 11-20 Min",,98971,CPT,Facility,Both,,,,48,40.8,13.7568,48,First Health Group Corporation,First Health Network,46.56,97,,percent of total billed charges,,
"Qnhp Online Digital Assmt&Mgmt, Est Pt Up To 7 Days, Cumulative Time During The 7 Days; 11-20 Min",,98971,CPT,Facility,Both,,,,48,40.8,13.7568,48,"Health Partners, Inc.",Commercial,45.408,94.6,,percent of total billed charges,,
"Qnhp Online Digital Assmt&Mgmt, Est Pt Up To 7 Days, Cumulative Time During The 7 Days; 11-20 Min",,98971,CPT,Facility,Outpatient,,,,48,40.8,13.7568,48,"Health Partners, Inc.",Medicare Advantage,23.52,49,,percent of total billed charges,,
"Qnhp Online Digital Assmt&Mgmt, Est Pt Up To 7 Days, Cumulative Time During The 7 Days; 11-20 Min",,98971,CPT,Facility,Inpatient,,,,48,40.8,13.7568,48,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Qnhp Online Digital Assmt&Mgmt, Est Pt Up To 7 Days, Cumulative Time During The 7 Days; 11-20 Min",,98971,CPT,Facility,Both,,,,48,40.8,13.7568,48,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),28.8,60,,percent of total billed charges,,
"Qnhp Online Digital Assmt&Mgmt, Est Pt Up To 7 Days, Cumulative Time During The 7 Days; 11-20 Min",,98971,CPT,Facility,Both,,,,48,40.8,13.7568,48,"Health Partners, Inc.",State of Minnesota Advantage Program,39.12,81.5,,percent of total billed charges,,
"Qnhp Online Digital Assmt&Mgmt, Est Pt Up To 7 Days, Cumulative Time During The 7 Days; 11-20 Min",,98971,CPT,Facility,Both,,,,48,40.8,13.7568,48,"Health Partners, Inc.",State Public Programs,24,50,,percent of total billed charges,,
"Qnhp Online Digital Assmt&Mgmt, Est Pt Up To 7 Days, Cumulative Time During The 7 Days; 11-20 Min",,98971,CPT,Facility,Both,,,,48,40.8,13.7568,48,Humana Insurance Company,Commercial PPO,45.6,95,,percent of total billed charges,,
"Qnhp Online Digital Assmt&Mgmt, Est Pt Up To 7 Days, Cumulative Time During The 7 Days; 11-20 Min",,98971,CPT,Facility,Outpatient,,,,48,40.8,13.7568,48,Humana Insurance Company,Medicare PPO,23.52,49,,percent of total billed charges,,
"Qnhp Online Digital Assmt&Mgmt, Est Pt Up To 7 Days, Cumulative Time During The 7 Days; 11-20 Min",,98971,CPT,Facility,Inpatient,,,,48,40.8,13.7568,48,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Qnhp Online Digital Assmt&Mgmt, Est Pt Up To 7 Days, Cumulative Time During The 7 Days; 11-20 Min",,98971,CPT,Facility,Both,,,,48,40.8,13.7568,48,Medica,Individual & Family,47.568,99.1,,percent of total billed charges,,
"Qnhp Online Digital Assmt&Mgmt, Est Pt Up To 7 Days, Cumulative Time During The 7 Days; 11-20 Min",,98971,CPT,Facility,Outpatient,,,,48,40.8,13.7568,48,Medica,Medica Advantage Solution,23.904,49.8,,percent of total billed charges,,
"Qnhp Online Digital Assmt&Mgmt, Est Pt Up To 7 Days, Cumulative Time During The 7 Days; 11-20 Min",,98971,CPT,Facility,Inpatient,,,,48,40.8,13.7568,48,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Qnhp Online Digital Assmt&Mgmt, Est Pt Up To 7 Days, Cumulative Time During The 7 Days; 11-20 Min",,98971,CPT,Facility,Outpatient,,,,48,40.8,13.7568,48,Medica,Medical Assistance,21.408,44.6,,percent of total billed charges,,
"Qnhp Online Digital Assmt&Mgmt, Est Pt Up To 7 Days, Cumulative Time During The 7 Days; 11-20 Min",,98971,CPT,Facility,Inpatient,,,,48,40.8,13.7568,48,Medica,Medical Assistance,,,,,Included in per diem rate,
"Qnhp Online Digital Assmt&Mgmt, Est Pt Up To 7 Days, Cumulative Time During The 7 Days; 11-20 Min",,98971,CPT,Facility,Outpatient,,,,48,40.8,13.7568,48,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,23.904,49.8,,percent of total billed charges,,
"Qnhp Online Digital Assmt&Mgmt, Est Pt Up To 7 Days, Cumulative Time During The 7 Days; 11-20 Min",,98971,CPT,Facility,Inpatient,,,,48,40.8,13.7568,48,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Qnhp Online Digital Assmt&Mgmt, Est Pt Up To 7 Days, Cumulative Time During The 7 Days; 11-20 Min",,98971,CPT,Facility,Both,,,,48,40.8,13.7568,48,"Multiplan, Inc.","Multiplan, Inc.",45.12,94,,percent of total billed charges,,
"Qnhp Online Digital Assmt&Mgmt, Est Pt Up To 7 Days, Cumulative Time During The 7 Days; 11-20 Min",,98971,CPT,Facility,Outpatient,,,,48,40.8,13.7568,48,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,43.248,90.1,,percent of total billed charges,,
"Qnhp Online Digital Assmt&Mgmt, Est Pt Up To 7 Days, Cumulative Time During The 7 Days; 11-20 Min",,98971,CPT,Facility,Inpatient,,,,48,40.8,13.7568,48,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Qnhp Online Digital Assmt&Mgmt, Est Pt Up To 7 Days, Cumulative Time During The 7 Days; 11-20 Min",,98971,CPT,Facility,Both,,,,48,40.8,13.7568,48,"Preferred One Administrative Services, INC.",PPO,47.328,98.6,,percent of total billed charges,,
"Qnhp Online Digital Assmt&Mgmt, Est Pt Up To 7 Days, Cumulative Time During The 7 Days; 11-20 Min",,98971,CPT,Facility,Outpatient,,,,48,40.8,13.7568,48,PrimeWest Health,Minnesota Senior Health Options (MSHO),24.696,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Qnhp Online Digital Assmt&Mgmt, Est Pt Up To 7 Days, Cumulative Time During The 7 Days; 11-20 Min",,98971,CPT,Facility,Inpatient,,,,48,40.8,13.7568,48,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Qnhp Online Digital Assmt&Mgmt, Est Pt Up To 7 Days, Cumulative Time During The 7 Days; 11-20 Min",,98971,CPT,Facility,Outpatient,,,,48,40.8,13.7568,48,PrimeWest Health,MinnesotaCare,24.6528,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Qnhp Online Digital Assmt&Mgmt, Est Pt Up To 7 Days, Cumulative Time During The 7 Days; 11-20 Min",,98971,CPT,Facility,Inpatient,,,,48,40.8,13.7568,48,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Qnhp Online Digital Assmt&Mgmt, Est Pt Up To 7 Days, Cumulative Time During The 7 Days; 11-20 Min",,98971,CPT,Facility,Both,,,,48,40.8,13.7568,48,Sanford Health Plan,Sanford Health Plan,44.16,92,,percent of total billed charges,,
"Qnhp Online Digital Assmt&Mgmt, Est Pt Up To 7 Days, Cumulative Time During The 7 Days; 11-20 Min",,98971,CPT,Facility,Outpatient,,,,48,40.8,13.7568,48,"UCare Health, Inc.",Individual & Family Plan,27.048,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Qnhp Online Digital Assmt&Mgmt, Est Pt Up To 7 Days, Cumulative Time During The 7 Days; 11-20 Min",,98971,CPT,Facility,Inpatient,,,,48,40.8,13.7568,48,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Qnhp Online Digital Assmt&Mgmt, Est Pt Up To 7 Days, Cumulative Time During The 7 Days; 11-20 Min",,98971,CPT,Facility,Outpatient,,,,48,40.8,13.7568,48,"UCare Health, Inc.",Medical Assistance,24.2256,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Qnhp Online Digital Assmt&Mgmt, Est Pt Up To 7 Days, Cumulative Time During The 7 Days; 11-20 Min",,98971,CPT,Facility,Inpatient,,,,48,40.8,13.7568,48,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Qnhp Online Digital Assmt&Mgmt, Est Pt Up To 7 Days, Cumulative Time During The 7 Days; 11-20 Min",,98971,CPT,Facility,Outpatient,,,,48,40.8,13.7568,48,"UCare Health, Inc.",Medicare Advantage,24.2256,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Qnhp Online Digital Assmt&Mgmt, Est Pt Up To 7 Days, Cumulative Time During The 7 Days; 11-20 Min",,98971,CPT,Facility,Inpatient,,,,48,40.8,13.7568,48,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Qnhp Online Digital Assmt&Mgmt, Est Pt Up To 7 Days, Cumulative Time During The 7 Days; 11-20 Min",,98971,CPT,Facility,Outpatient,,,,48,40.8,13.7568,48,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),24.2256,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Qnhp Online Digital Assmt&Mgmt, Est Pt Up To 7 Days, Cumulative Time During The 7 Days; 11-20 Min",,98971,CPT,Facility,Inpatient,,,,48,40.8,13.7568,48,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Qnhp Online Digital Assmt&Mgmt, Est Pt Up To 7 Days, Cumulative Time During The 7 Days; 11-20 Min",,98971,CPT,Facility,Both,,,,48,40.8,13.7568,48,UnitedHealthcare,Individual & Family,45.12,94,,percent of total billed charges,,
"Qnhp Online Digital Assmt&Mgmt, Est Pt Up To 7 Days, Cumulative Time During The 7 Days; 11-20 Min",,98971,CPT,Facility,Outpatient,,,,48,40.8,13.7568,48,UnitedHealthcare,Medicare Advantage,23.52,49,,percent of total billed charges,,
"Qnhp Online Digital Assmt&Mgmt, Est Pt Up To 7 Days, Cumulative Time During The 7 Days; 11-20 Min",,98971,CPT,Facility,Inpatient,,,,48,40.8,13.7568,48,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Qnhp Online Digital Assmt&Mgmt, Est Pt Up To 7 Days, Cumulative Time During The 7 Days; 11-20 Min",,98971,CPT,Facility,Outpatient,,,,48,40.8,13.7568,48,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,23.04,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Qnhp Online Digital Assmt&Mgmt, Est Pt Up To 7 Days, Cumulative Time During The 7 Days; 11-20 Min",,98971,CPT,Facility,Inpatient,,,,48,40.8,13.7568,48,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Qnhp Online Digital Assmt&Mgmt, Est Pt Up To 7 Days, Cumulative Time During 7 Days; 21 Or More Min",,98972,CPT,Facility,Both,,,,85,72.25,24.361,85,Aetna,Commercial,78.2,92,,percent of total billed charges,,
"Qnhp Online Digital Assmt&Mgmt, Est Pt Up To 7 Days, Cumulative Time During 7 Days; 21 Or More Min",,98972,CPT,Facility,Outpatient,,,,85,72.25,24.361,85,Aetna,Medicare Advantage,41.65,49,,percent of total billed charges,,
"Qnhp Online Digital Assmt&Mgmt, Est Pt Up To 7 Days, Cumulative Time During 7 Days; 21 Or More Min",,98972,CPT,Facility,Inpatient,,,,85,72.25,24.361,85,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Qnhp Online Digital Assmt&Mgmt, Est Pt Up To 7 Days, Cumulative Time During 7 Days; 21 Or More Min",,98972,CPT,Facility,Both,,,,85,72.25,24.361,85,Aetna,PPO,79.05,93,,percent of total billed charges,,
"Qnhp Online Digital Assmt&Mgmt, Est Pt Up To 7 Days, Cumulative Time During 7 Days; 21 Or More Min",,98972,CPT,Facility,Both,,,,85,72.25,24.361,85,America's PPO,America's PPO,81.6255,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Qnhp Online Digital Assmt&Mgmt, Est Pt Up To 7 Days, Cumulative Time During 7 Days; 21 Or More Min",,98972,CPT,Facility,Both,,,,85,72.25,24.361,85,BlueCross BlueShield Minnesota, Federal Employee Program,83.64,98.4,,percent of total billed charges,,
"Qnhp Online Digital Assmt&Mgmt, Est Pt Up To 7 Days, Cumulative Time During 7 Days; 21 Or More Min",,98972,CPT,Facility,Both,,,,85,72.25,24.361,85,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,85,100,,percent of total billed charges,,
"Qnhp Online Digital Assmt&Mgmt, Est Pt Up To 7 Days, Cumulative Time During 7 Days; 21 Or More Min",,98972,CPT,Facility,Both,,,,85,72.25,24.361,85,BlueCross BlueShield Minnesota,High Value Network Plan,76.5,90,,percent of total billed charges,,
"Qnhp Online Digital Assmt&Mgmt, Est Pt Up To 7 Days, Cumulative Time During 7 Days; 21 Or More Min",,98972,CPT,Facility,Outpatient,,,,85,72.25,24.361,85,BlueCross BlueShield Minnesota,Medicare Advantage,41.65,49,,percent of total billed charges,,
"Qnhp Online Digital Assmt&Mgmt, Est Pt Up To 7 Days, Cumulative Time During 7 Days; 21 Or More Min",,98972,CPT,Facility,Inpatient,,,,85,72.25,24.361,85,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Qnhp Online Digital Assmt&Mgmt, Est Pt Up To 7 Days, Cumulative Time During 7 Days; 21 Or More Min",,98972,CPT,Facility,Both,,,,85,72.25,24.361,85,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,75.2845,88.57,,percent of total billed charges,,
"Qnhp Online Digital Assmt&Mgmt, Est Pt Up To 7 Days, Cumulative Time During 7 Days; 21 Or More Min",,98972,CPT,Facility,Both,,,,85,72.25,24.361,85,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,24.361,28.66,,percent of total billed charges,,
"Qnhp Online Digital Assmt&Mgmt, Est Pt Up To 7 Days, Cumulative Time During 7 Days; 21 Or More Min",,98972,CPT,Facility,Outpatient,,,,85,72.25,24.361,85,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),41.65,49,,percent of total billed charges,,
"Qnhp Online Digital Assmt&Mgmt, Est Pt Up To 7 Days, Cumulative Time During 7 Days; 21 Or More Min",,98972,CPT,Facility,Inpatient,,,,85,72.25,24.361,85,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Qnhp Online Digital Assmt&Mgmt, Est Pt Up To 7 Days, Cumulative Time During 7 Days; 21 Or More Min",,98972,CPT,Facility,Both,,,,85,72.25,24.361,85,CorVel,Worker's Compensation,85,100,,percent of total billed charges,,
"Qnhp Online Digital Assmt&Mgmt, Est Pt Up To 7 Days, Cumulative Time During 7 Days; 21 Or More Min",,98972,CPT,Facility,Both,,,,85,72.25,24.361,85,First Health Group Corporation,First Health Network,82.45,97,,percent of total billed charges,,
"Qnhp Online Digital Assmt&Mgmt, Est Pt Up To 7 Days, Cumulative Time During 7 Days; 21 Or More Min",,98972,CPT,Facility,Both,,,,85,72.25,24.361,85,"Health Partners, Inc.",Commercial,80.41,94.6,,percent of total billed charges,,
"Qnhp Online Digital Assmt&Mgmt, Est Pt Up To 7 Days, Cumulative Time During 7 Days; 21 Or More Min",,98972,CPT,Facility,Outpatient,,,,85,72.25,24.361,85,"Health Partners, Inc.",Medicare Advantage,41.65,49,,percent of total billed charges,,
"Qnhp Online Digital Assmt&Mgmt, Est Pt Up To 7 Days, Cumulative Time During 7 Days; 21 Or More Min",,98972,CPT,Facility,Inpatient,,,,85,72.25,24.361,85,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Qnhp Online Digital Assmt&Mgmt, Est Pt Up To 7 Days, Cumulative Time During 7 Days; 21 Or More Min",,98972,CPT,Facility,Both,,,,85,72.25,24.361,85,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),51,60,,percent of total billed charges,,
"Qnhp Online Digital Assmt&Mgmt, Est Pt Up To 7 Days, Cumulative Time During 7 Days; 21 Or More Min",,98972,CPT,Facility,Both,,,,85,72.25,24.361,85,"Health Partners, Inc.",State of Minnesota Advantage Program,69.275,81.5,,percent of total billed charges,,
"Qnhp Online Digital Assmt&Mgmt, Est Pt Up To 7 Days, Cumulative Time During 7 Days; 21 Or More Min",,98972,CPT,Facility,Both,,,,85,72.25,24.361,85,"Health Partners, Inc.",State Public Programs,42.5,50,,percent of total billed charges,,
"Qnhp Online Digital Assmt&Mgmt, Est Pt Up To 7 Days, Cumulative Time During 7 Days; 21 Or More Min",,98972,CPT,Facility,Both,,,,85,72.25,24.361,85,Humana Insurance Company,Commercial PPO,80.75,95,,percent of total billed charges,,
"Qnhp Online Digital Assmt&Mgmt, Est Pt Up To 7 Days, Cumulative Time During 7 Days; 21 Or More Min",,98972,CPT,Facility,Outpatient,,,,85,72.25,24.361,85,Humana Insurance Company,Medicare PPO,41.65,49,,percent of total billed charges,,
"Qnhp Online Digital Assmt&Mgmt, Est Pt Up To 7 Days, Cumulative Time During 7 Days; 21 Or More Min",,98972,CPT,Facility,Inpatient,,,,85,72.25,24.361,85,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Qnhp Online Digital Assmt&Mgmt, Est Pt Up To 7 Days, Cumulative Time During 7 Days; 21 Or More Min",,98972,CPT,Facility,Both,,,,85,72.25,24.361,85,Medica,Individual & Family,84.235,99.1,,percent of total billed charges,,
"Qnhp Online Digital Assmt&Mgmt, Est Pt Up To 7 Days, Cumulative Time During 7 Days; 21 Or More Min",,98972,CPT,Facility,Outpatient,,,,85,72.25,24.361,85,Medica,Medica Advantage Solution,42.33,49.8,,percent of total billed charges,,
"Qnhp Online Digital Assmt&Mgmt, Est Pt Up To 7 Days, Cumulative Time During 7 Days; 21 Or More Min",,98972,CPT,Facility,Inpatient,,,,85,72.25,24.361,85,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Qnhp Online Digital Assmt&Mgmt, Est Pt Up To 7 Days, Cumulative Time During 7 Days; 21 Or More Min",,98972,CPT,Facility,Outpatient,,,,85,72.25,24.361,85,Medica,Medical Assistance,37.91,44.6,,percent of total billed charges,,
"Qnhp Online Digital Assmt&Mgmt, Est Pt Up To 7 Days, Cumulative Time During 7 Days; 21 Or More Min",,98972,CPT,Facility,Inpatient,,,,85,72.25,24.361,85,Medica,Medical Assistance,,,,,Included in per diem rate,
"Qnhp Online Digital Assmt&Mgmt, Est Pt Up To 7 Days, Cumulative Time During 7 Days; 21 Or More Min",,98972,CPT,Facility,Outpatient,,,,85,72.25,24.361,85,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,42.33,49.8,,percent of total billed charges,,
"Qnhp Online Digital Assmt&Mgmt, Est Pt Up To 7 Days, Cumulative Time During 7 Days; 21 Or More Min",,98972,CPT,Facility,Inpatient,,,,85,72.25,24.361,85,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Qnhp Online Digital Assmt&Mgmt, Est Pt Up To 7 Days, Cumulative Time During 7 Days; 21 Or More Min",,98972,CPT,Facility,Both,,,,85,72.25,24.361,85,"Multiplan, Inc.","Multiplan, Inc.",79.9,94,,percent of total billed charges,,
"Qnhp Online Digital Assmt&Mgmt, Est Pt Up To 7 Days, Cumulative Time During 7 Days; 21 Or More Min",,98972,CPT,Facility,Outpatient,,,,85,72.25,24.361,85,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,76.585,90.1,,percent of total billed charges,,
"Qnhp Online Digital Assmt&Mgmt, Est Pt Up To 7 Days, Cumulative Time During 7 Days; 21 Or More Min",,98972,CPT,Facility,Inpatient,,,,85,72.25,24.361,85,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Qnhp Online Digital Assmt&Mgmt, Est Pt Up To 7 Days, Cumulative Time During 7 Days; 21 Or More Min",,98972,CPT,Facility,Both,,,,85,72.25,24.361,85,"Preferred One Administrative Services, INC.",PPO,83.81,98.6,,percent of total billed charges,,
"Qnhp Online Digital Assmt&Mgmt, Est Pt Up To 7 Days, Cumulative Time During 7 Days; 21 Or More Min",,98972,CPT,Facility,Outpatient,,,,85,72.25,24.361,85,PrimeWest Health,Minnesota Senior Health Options (MSHO),43.7325,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Qnhp Online Digital Assmt&Mgmt, Est Pt Up To 7 Days, Cumulative Time During 7 Days; 21 Or More Min",,98972,CPT,Facility,Inpatient,,,,85,72.25,24.361,85,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Qnhp Online Digital Assmt&Mgmt, Est Pt Up To 7 Days, Cumulative Time During 7 Days; 21 Or More Min",,98972,CPT,Facility,Outpatient,,,,85,72.25,24.361,85,PrimeWest Health,MinnesotaCare,43.656,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Qnhp Online Digital Assmt&Mgmt, Est Pt Up To 7 Days, Cumulative Time During 7 Days; 21 Or More Min",,98972,CPT,Facility,Inpatient,,,,85,72.25,24.361,85,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Qnhp Online Digital Assmt&Mgmt, Est Pt Up To 7 Days, Cumulative Time During 7 Days; 21 Or More Min",,98972,CPT,Facility,Both,,,,85,72.25,24.361,85,Sanford Health Plan,Sanford Health Plan,78.2,92,,percent of total billed charges,,
"Qnhp Online Digital Assmt&Mgmt, Est Pt Up To 7 Days, Cumulative Time During 7 Days; 21 Or More Min",,98972,CPT,Facility,Outpatient,,,,85,72.25,24.361,85,"UCare Health, Inc.",Individual & Family Plan,47.8975,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Qnhp Online Digital Assmt&Mgmt, Est Pt Up To 7 Days, Cumulative Time During 7 Days; 21 Or More Min",,98972,CPT,Facility,Inpatient,,,,85,72.25,24.361,85,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Qnhp Online Digital Assmt&Mgmt, Est Pt Up To 7 Days, Cumulative Time During 7 Days; 21 Or More Min",,98972,CPT,Facility,Outpatient,,,,85,72.25,24.361,85,"UCare Health, Inc.",Medical Assistance,42.8995,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Qnhp Online Digital Assmt&Mgmt, Est Pt Up To 7 Days, Cumulative Time During 7 Days; 21 Or More Min",,98972,CPT,Facility,Inpatient,,,,85,72.25,24.361,85,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Qnhp Online Digital Assmt&Mgmt, Est Pt Up To 7 Days, Cumulative Time During 7 Days; 21 Or More Min",,98972,CPT,Facility,Outpatient,,,,85,72.25,24.361,85,"UCare Health, Inc.",Medicare Advantage,42.8995,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Qnhp Online Digital Assmt&Mgmt, Est Pt Up To 7 Days, Cumulative Time During 7 Days; 21 Or More Min",,98972,CPT,Facility,Inpatient,,,,85,72.25,24.361,85,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Qnhp Online Digital Assmt&Mgmt, Est Pt Up To 7 Days, Cumulative Time During 7 Days; 21 Or More Min",,98972,CPT,Facility,Outpatient,,,,85,72.25,24.361,85,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),42.8995,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Qnhp Online Digital Assmt&Mgmt, Est Pt Up To 7 Days, Cumulative Time During 7 Days; 21 Or More Min",,98972,CPT,Facility,Inpatient,,,,85,72.25,24.361,85,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Qnhp Online Digital Assmt&Mgmt, Est Pt Up To 7 Days, Cumulative Time During 7 Days; 21 Or More Min",,98972,CPT,Facility,Both,,,,85,72.25,24.361,85,UnitedHealthcare,Individual & Family,79.9,94,,percent of total billed charges,,
"Qnhp Online Digital Assmt&Mgmt, Est Pt Up To 7 Days, Cumulative Time During 7 Days; 21 Or More Min",,98972,CPT,Facility,Outpatient,,,,85,72.25,24.361,85,UnitedHealthcare,Medicare Advantage,41.65,49,,percent of total billed charges,,
"Qnhp Online Digital Assmt&Mgmt, Est Pt Up To 7 Days, Cumulative Time During 7 Days; 21 Or More Min",,98972,CPT,Facility,Inpatient,,,,85,72.25,24.361,85,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Qnhp Online Digital Assmt&Mgmt, Est Pt Up To 7 Days, Cumulative Time During 7 Days; 21 Or More Min",,98972,CPT,Facility,Outpatient,,,,85,72.25,24.361,85,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,40.8,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Qnhp Online Digital Assmt&Mgmt, Est Pt Up To 7 Days, Cumulative Time During 7 Days; 21 Or More Min",,98972,CPT,Facility,Inpatient,,,,85,72.25,24.361,85,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Specimen Handling And Transport From Office To Laboratory,,99000,CPT,Facility,Both,,,,51,43.35,14.6166,51,Aetna,Commercial,46.92,92,,percent of total billed charges,,
Specimen Handling And Transport From Office To Laboratory,,99000,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,Aetna,Medicare Advantage,24.99,49,,percent of total billed charges,,
Specimen Handling And Transport From Office To Laboratory,,99000,CPT,Facility,Inpatient,,,,51,43.35,14.6166,51,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Specimen Handling And Transport From Office To Laboratory,,99000,CPT,Facility,Both,,,,51,43.35,14.6166,51,Aetna,PPO,47.43,93,,percent of total billed charges,,
Specimen Handling And Transport From Office To Laboratory,,99000,CPT,Facility,Both,,,,51,43.35,14.6166,51,America's PPO,America's PPO,48.9753,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Specimen Handling And Transport From Office To Laboratory,,99000,CPT,Facility,Both,,,,51,43.35,14.6166,51,BlueCross BlueShield Minnesota, Federal Employee Program,50.184,98.4,,percent of total billed charges,,
Specimen Handling And Transport From Office To Laboratory,,99000,CPT,Facility,Both,,,,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,51,100,,percent of total billed charges,,
Specimen Handling And Transport From Office To Laboratory,,99000,CPT,Facility,Both,,,,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,High Value Network Plan,45.9,90,,percent of total billed charges,,
Specimen Handling And Transport From Office To Laboratory,,99000,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,Medicare Advantage,24.99,49,,percent of total billed charges,,
Specimen Handling And Transport From Office To Laboratory,,99000,CPT,Facility,Inpatient,,,,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Specimen Handling And Transport From Office To Laboratory,,99000,CPT,Facility,Both,,,,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,45.1707,88.57,,percent of total billed charges,,
Specimen Handling And Transport From Office To Laboratory,,99000,CPT,Facility,Both,,,,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,14.6166,28.66,,percent of total billed charges,,
Specimen Handling And Transport From Office To Laboratory,,99000,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),24.99,49,,percent of total billed charges,,
Specimen Handling And Transport From Office To Laboratory,,99000,CPT,Facility,Inpatient,,,,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Specimen Handling And Transport From Office To Laboratory,,99000,CPT,Facility,Both,,,,51,43.35,14.6166,51,CorVel,Worker's Compensation,51,100,,percent of total billed charges,,
Specimen Handling And Transport From Office To Laboratory,,99000,CPT,Facility,Both,,,,51,43.35,14.6166,51,First Health Group Corporation,First Health Network,49.47,97,,percent of total billed charges,,
Specimen Handling And Transport From Office To Laboratory,,99000,CPT,Facility,Both,,,,51,43.35,14.6166,51,"Health Partners, Inc.",Commercial,48.246,94.6,,percent of total billed charges,,
Specimen Handling And Transport From Office To Laboratory,,99000,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,"Health Partners, Inc.",Medicare Advantage,24.99,49,,percent of total billed charges,,
Specimen Handling And Transport From Office To Laboratory,,99000,CPT,Facility,Inpatient,,,,51,43.35,14.6166,51,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Specimen Handling And Transport From Office To Laboratory,,99000,CPT,Facility,Both,,,,51,43.35,14.6166,51,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),30.6,60,,percent of total billed charges,,
Specimen Handling And Transport From Office To Laboratory,,99000,CPT,Facility,Both,,,,51,43.35,14.6166,51,"Health Partners, Inc.",State of Minnesota Advantage Program,41.565,81.5,,percent of total billed charges,,
Specimen Handling And Transport From Office To Laboratory,,99000,CPT,Facility,Both,,,,51,43.35,14.6166,51,"Health Partners, Inc.",State Public Programs,25.5,50,,percent of total billed charges,,
Specimen Handling And Transport From Office To Laboratory,,99000,CPT,Facility,Both,,,,51,43.35,14.6166,51,Humana Insurance Company,Commercial PPO,48.45,95,,percent of total billed charges,,
Specimen Handling And Transport From Office To Laboratory,,99000,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,Humana Insurance Company,Medicare PPO,24.99,49,,percent of total billed charges,,
Specimen Handling And Transport From Office To Laboratory,,99000,CPT,Facility,Inpatient,,,,51,43.35,14.6166,51,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Specimen Handling And Transport From Office To Laboratory,,99000,CPT,Facility,Both,,,,51,43.35,14.6166,51,Medica,Individual & Family,50.541,99.1,,percent of total billed charges,,
Specimen Handling And Transport From Office To Laboratory,,99000,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,Medica,Medica Advantage Solution,25.398,49.8,,percent of total billed charges,,
Specimen Handling And Transport From Office To Laboratory,,99000,CPT,Facility,Inpatient,,,,51,43.35,14.6166,51,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Specimen Handling And Transport From Office To Laboratory,,99000,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,Medica,Medical Assistance,22.746,44.6,,percent of total billed charges,,
Specimen Handling And Transport From Office To Laboratory,,99000,CPT,Facility,Inpatient,,,,51,43.35,14.6166,51,Medica,Medical Assistance,,,,,Included in per diem rate,
Specimen Handling And Transport From Office To Laboratory,,99000,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,25.398,49.8,,percent of total billed charges,,
Specimen Handling And Transport From Office To Laboratory,,99000,CPT,Facility,Inpatient,,,,51,43.35,14.6166,51,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Specimen Handling And Transport From Office To Laboratory,,99000,CPT,Facility,Both,,,,51,43.35,14.6166,51,"Multiplan, Inc.","Multiplan, Inc.",47.94,94,,percent of total billed charges,,
Specimen Handling And Transport From Office To Laboratory,,99000,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,44.064,86.4,,percent of total billed charges,,
Specimen Handling And Transport From Office To Laboratory,,99000,CPT,Facility,Inpatient,,,,51,43.35,14.6166,51,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Specimen Handling And Transport From Office To Laboratory,,99000,CPT,Facility,Both,,,,51,43.35,14.6166,51,"Preferred One Administrative Services, INC.",PPO,50.286,98.6,,percent of total billed charges,,
Specimen Handling And Transport From Office To Laboratory,,99000,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,PrimeWest Health,Minnesota Senior Health Options (MSHO),26.2395,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Specimen Handling And Transport From Office To Laboratory,,99000,CPT,Facility,Inpatient,,,,51,43.35,14.6166,51,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Specimen Handling And Transport From Office To Laboratory,,99000,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,PrimeWest Health,MinnesotaCare,26.1936,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Specimen Handling And Transport From Office To Laboratory,,99000,CPT,Facility,Inpatient,,,,51,43.35,14.6166,51,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Specimen Handling And Transport From Office To Laboratory,,99000,CPT,Facility,Both,,,,51,43.35,14.6166,51,Sanford Health Plan,Sanford Health Plan,46.92,92,,percent of total billed charges,,
Specimen Handling And Transport From Office To Laboratory,,99000,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,"UCare Health, Inc.",Individual & Family Plan,28.7385,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Specimen Handling And Transport From Office To Laboratory,,99000,CPT,Facility,Inpatient,,,,51,43.35,14.6166,51,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Specimen Handling And Transport From Office To Laboratory,,99000,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,"UCare Health, Inc.",Medical Assistance,25.7397,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Specimen Handling And Transport From Office To Laboratory,,99000,CPT,Facility,Inpatient,,,,51,43.35,14.6166,51,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Specimen Handling And Transport From Office To Laboratory,,99000,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,"UCare Health, Inc.",Medicare Advantage,25.7397,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Specimen Handling And Transport From Office To Laboratory,,99000,CPT,Facility,Inpatient,,,,51,43.35,14.6166,51,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Specimen Handling And Transport From Office To Laboratory,,99000,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),25.7397,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Specimen Handling And Transport From Office To Laboratory,,99000,CPT,Facility,Inpatient,,,,51,43.35,14.6166,51,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Specimen Handling And Transport From Office To Laboratory,,99000,CPT,Facility,Both,,,,51,43.35,14.6166,51,UnitedHealthcare,Individual & Family,47.94,94,,percent of total billed charges,,
Specimen Handling And Transport From Office To Laboratory,,99000,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,UnitedHealthcare,Medicare Advantage,24.99,49,,percent of total billed charges,,
Specimen Handling And Transport From Office To Laboratory,,99000,CPT,Facility,Inpatient,,,,51,43.35,14.6166,51,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Specimen Handling And Transport From Office To Laboratory,,99000,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,24.48,48,,percent of total billed charges,,100% of DHS outpatient percentage
Specimen Handling And Transport From Office To Laboratory,,99000,CPT,Facility,Inpatient,,,,51,43.35,14.6166,51,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Kit Testing,,99001,CPT,Facility,Both,,,,46,39.1,13.1836,46,Aetna,Commercial,42.32,92,,percent of total billed charges,,
Kit Testing,,99001,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,Aetna,Medicare Advantage,22.54,49,,percent of total billed charges,,
Kit Testing,,99001,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Kit Testing,,99001,CPT,Facility,Both,,,,46,39.1,13.1836,46,Aetna,PPO,42.78,93,,percent of total billed charges,,
Kit Testing,,99001,CPT,Facility,Both,,,,46,39.1,13.1836,46,America's PPO,America's PPO,44.1738,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Kit Testing,,99001,CPT,Facility,Both,,,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota, Federal Employee Program,45.264,98.4,,percent of total billed charges,,
Kit Testing,,99001,CPT,Facility,Both,,,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,46,100,,percent of total billed charges,,
Kit Testing,,99001,CPT,Facility,Both,,,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,High Value Network Plan,41.4,90,,percent of total billed charges,,
Kit Testing,,99001,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Medicare Advantage,22.54,49,,percent of total billed charges,,
Kit Testing,,99001,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Kit Testing,,99001,CPT,Facility,Both,,,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,40.7422,88.57,,percent of total billed charges,,
Kit Testing,,99001,CPT,Facility,Both,,,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,13.1836,28.66,,percent of total billed charges,,
Kit Testing,,99001,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),22.54,49,,percent of total billed charges,,
Kit Testing,,99001,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Kit Testing,,99001,CPT,Facility,Both,,,,46,39.1,13.1836,46,CorVel,Worker's Compensation,46,100,,percent of total billed charges,,
Kit Testing,,99001,CPT,Facility,Both,,,,46,39.1,13.1836,46,First Health Group Corporation,First Health Network,44.62,97,,percent of total billed charges,,
Kit Testing,,99001,CPT,Facility,Both,,,,46,39.1,13.1836,46,"Health Partners, Inc.",Commercial,43.516,94.6,,percent of total billed charges,,
Kit Testing,,99001,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,"Health Partners, Inc.",Medicare Advantage,22.54,49,,percent of total billed charges,,
Kit Testing,,99001,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Kit Testing,,99001,CPT,Facility,Both,,,,46,39.1,13.1836,46,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),27.6,60,,percent of total billed charges,,
Kit Testing,,99001,CPT,Facility,Both,,,,46,39.1,13.1836,46,"Health Partners, Inc.",State of Minnesota Advantage Program,37.49,81.5,,percent of total billed charges,,
Kit Testing,,99001,CPT,Facility,Both,,,,46,39.1,13.1836,46,"Health Partners, Inc.",State Public Programs,23,50,,percent of total billed charges,,
Kit Testing,,99001,CPT,Facility,Both,,,,46,39.1,13.1836,46,Humana Insurance Company,Commercial PPO,43.7,95,,percent of total billed charges,,
Kit Testing,,99001,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,Humana Insurance Company,Medicare PPO,22.54,49,,percent of total billed charges,,
Kit Testing,,99001,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Kit Testing,,99001,CPT,Facility,Both,,,,46,39.1,13.1836,46,Medica,Individual & Family,45.586,99.1,,percent of total billed charges,,
Kit Testing,,99001,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,Medica,Medica Advantage Solution,22.908,49.8,,percent of total billed charges,,
Kit Testing,,99001,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Kit Testing,,99001,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,Medica,Medical Assistance,20.516,44.6,,percent of total billed charges,,
Kit Testing,,99001,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,Medica,Medical Assistance,,,,,Included in per diem rate,
Kit Testing,,99001,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,22.908,49.8,,percent of total billed charges,,
Kit Testing,,99001,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Kit Testing,,99001,CPT,Facility,Both,,,,46,39.1,13.1836,46,"Multiplan, Inc.","Multiplan, Inc.",43.24,94,,percent of total billed charges,,
Kit Testing,,99001,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,39.744,86.4,,percent of total billed charges,,
Kit Testing,,99001,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Kit Testing,,99001,CPT,Facility,Both,,,,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PPO,45.356,98.6,,percent of total billed charges,,
Kit Testing,,99001,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,PrimeWest Health,Minnesota Senior Health Options (MSHO),23.667,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Kit Testing,,99001,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Kit Testing,,99001,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,PrimeWest Health,MinnesotaCare,23.6256,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Kit Testing,,99001,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Kit Testing,,99001,CPT,Facility,Both,,,,46,39.1,13.1836,46,Sanford Health Plan,Sanford Health Plan,42.32,92,,percent of total billed charges,,
Kit Testing,,99001,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,"UCare Health, Inc.",Individual & Family Plan,25.921,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Kit Testing,,99001,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Kit Testing,,99001,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,"UCare Health, Inc.",Medical Assistance,23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Kit Testing,,99001,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Kit Testing,,99001,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,"UCare Health, Inc.",Medicare Advantage,23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Kit Testing,,99001,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Kit Testing,,99001,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Kit Testing,,99001,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Kit Testing,,99001,CPT,Facility,Both,,,,46,39.1,13.1836,46,UnitedHealthcare,Individual & Family,43.24,94,,percent of total billed charges,,
Kit Testing,,99001,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,UnitedHealthcare,Medicare Advantage,22.54,49,,percent of total billed charges,,
Kit Testing,,99001,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Kit Testing,,99001,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,22.08,48,,percent of total billed charges,,100% of DHS outpatient percentage
Kit Testing,,99001,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Kit Testing With Complex Handling,,99001,CPT,Facility,Both,,,,77,65.45,22.0682,77,Aetna,Commercial,70.84,92,,percent of total billed charges,,
Kit Testing With Complex Handling,,99001,CPT,Facility,Outpatient,,,,77,65.45,22.0682,77,Aetna,Medicare Advantage,37.73,49,,percent of total billed charges,,
Kit Testing With Complex Handling,,99001,CPT,Facility,Inpatient,,,,77,65.45,22.0682,77,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Kit Testing With Complex Handling,,99001,CPT,Facility,Both,,,,77,65.45,22.0682,77,Aetna,PPO,71.61,93,,percent of total billed charges,,
Kit Testing With Complex Handling,,99001,CPT,Facility,Both,,,,77,65.45,22.0682,77,America's PPO,America's PPO,73.9431,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Kit Testing With Complex Handling,,99001,CPT,Facility,Both,,,,77,65.45,22.0682,77,BlueCross BlueShield Minnesota, Federal Employee Program,75.768,98.4,,percent of total billed charges,,
Kit Testing With Complex Handling,,99001,CPT,Facility,Both,,,,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,77,100,,percent of total billed charges,,
Kit Testing With Complex Handling,,99001,CPT,Facility,Both,,,,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,High Value Network Plan,69.3,90,,percent of total billed charges,,
Kit Testing With Complex Handling,,99001,CPT,Facility,Outpatient,,,,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,Medicare Advantage,37.73,49,,percent of total billed charges,,
Kit Testing With Complex Handling,,99001,CPT,Facility,Inpatient,,,,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Kit Testing With Complex Handling,,99001,CPT,Facility,Both,,,,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,68.1989,88.57,,percent of total billed charges,,
Kit Testing With Complex Handling,,99001,CPT,Facility,Both,,,,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,22.0682,28.66,,percent of total billed charges,,
Kit Testing With Complex Handling,,99001,CPT,Facility,Outpatient,,,,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),37.73,49,,percent of total billed charges,,
Kit Testing With Complex Handling,,99001,CPT,Facility,Inpatient,,,,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Kit Testing With Complex Handling,,99001,CPT,Facility,Both,,,,77,65.45,22.0682,77,CorVel,Worker's Compensation,77,100,,percent of total billed charges,,
Kit Testing With Complex Handling,,99001,CPT,Facility,Both,,,,77,65.45,22.0682,77,First Health Group Corporation,First Health Network,74.69,97,,percent of total billed charges,,
Kit Testing With Complex Handling,,99001,CPT,Facility,Both,,,,77,65.45,22.0682,77,"Health Partners, Inc.",Commercial,72.842,94.6,,percent of total billed charges,,
Kit Testing With Complex Handling,,99001,CPT,Facility,Outpatient,,,,77,65.45,22.0682,77,"Health Partners, Inc.",Medicare Advantage,37.73,49,,percent of total billed charges,,
Kit Testing With Complex Handling,,99001,CPT,Facility,Inpatient,,,,77,65.45,22.0682,77,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Kit Testing With Complex Handling,,99001,CPT,Facility,Both,,,,77,65.45,22.0682,77,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),46.2,60,,percent of total billed charges,,
Kit Testing With Complex Handling,,99001,CPT,Facility,Both,,,,77,65.45,22.0682,77,"Health Partners, Inc.",State of Minnesota Advantage Program,62.755,81.5,,percent of total billed charges,,
Kit Testing With Complex Handling,,99001,CPT,Facility,Both,,,,77,65.45,22.0682,77,"Health Partners, Inc.",State Public Programs,38.5,50,,percent of total billed charges,,
Kit Testing With Complex Handling,,99001,CPT,Facility,Both,,,,77,65.45,22.0682,77,Humana Insurance Company,Commercial PPO,73.15,95,,percent of total billed charges,,
Kit Testing With Complex Handling,,99001,CPT,Facility,Outpatient,,,,77,65.45,22.0682,77,Humana Insurance Company,Medicare PPO,37.73,49,,percent of total billed charges,,
Kit Testing With Complex Handling,,99001,CPT,Facility,Inpatient,,,,77,65.45,22.0682,77,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Kit Testing With Complex Handling,,99001,CPT,Facility,Both,,,,77,65.45,22.0682,77,Medica,Individual & Family,76.307,99.1,,percent of total billed charges,,
Kit Testing With Complex Handling,,99001,CPT,Facility,Outpatient,,,,77,65.45,22.0682,77,Medica,Medica Advantage Solution,38.346,49.8,,percent of total billed charges,,
Kit Testing With Complex Handling,,99001,CPT,Facility,Inpatient,,,,77,65.45,22.0682,77,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Kit Testing With Complex Handling,,99001,CPT,Facility,Outpatient,,,,77,65.45,22.0682,77,Medica,Medical Assistance,34.342,44.6,,percent of total billed charges,,
Kit Testing With Complex Handling,,99001,CPT,Facility,Inpatient,,,,77,65.45,22.0682,77,Medica,Medical Assistance,,,,,Included in per diem rate,
Kit Testing With Complex Handling,,99001,CPT,Facility,Outpatient,,,,77,65.45,22.0682,77,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,38.346,49.8,,percent of total billed charges,,
Kit Testing With Complex Handling,,99001,CPT,Facility,Inpatient,,,,77,65.45,22.0682,77,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Kit Testing With Complex Handling,,99001,CPT,Facility,Both,,,,77,65.45,22.0682,77,"Multiplan, Inc.","Multiplan, Inc.",72.38,94,,percent of total billed charges,,
Kit Testing With Complex Handling,,99001,CPT,Facility,Outpatient,,,,77,65.45,22.0682,77,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,66.528,86.4,,percent of total billed charges,,
Kit Testing With Complex Handling,,99001,CPT,Facility,Inpatient,,,,77,65.45,22.0682,77,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Kit Testing With Complex Handling,,99001,CPT,Facility,Both,,,,77,65.45,22.0682,77,"Preferred One Administrative Services, INC.",PPO,75.922,98.6,,percent of total billed charges,,
Kit Testing With Complex Handling,,99001,CPT,Facility,Outpatient,,,,77,65.45,22.0682,77,PrimeWest Health,Minnesota Senior Health Options (MSHO),39.6165,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Kit Testing With Complex Handling,,99001,CPT,Facility,Inpatient,,,,77,65.45,22.0682,77,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Kit Testing With Complex Handling,,99001,CPT,Facility,Outpatient,,,,77,65.45,22.0682,77,PrimeWest Health,MinnesotaCare,39.5472,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Kit Testing With Complex Handling,,99001,CPT,Facility,Inpatient,,,,77,65.45,22.0682,77,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Kit Testing With Complex Handling,,99001,CPT,Facility,Both,,,,77,65.45,22.0682,77,Sanford Health Plan,Sanford Health Plan,70.84,92,,percent of total billed charges,,
Kit Testing With Complex Handling,,99001,CPT,Facility,Outpatient,,,,77,65.45,22.0682,77,"UCare Health, Inc.",Individual & Family Plan,43.3895,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Kit Testing With Complex Handling,,99001,CPT,Facility,Inpatient,,,,77,65.45,22.0682,77,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Kit Testing With Complex Handling,,99001,CPT,Facility,Outpatient,,,,77,65.45,22.0682,77,"UCare Health, Inc.",Medical Assistance,38.8619,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Kit Testing With Complex Handling,,99001,CPT,Facility,Inpatient,,,,77,65.45,22.0682,77,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Kit Testing With Complex Handling,,99001,CPT,Facility,Outpatient,,,,77,65.45,22.0682,77,"UCare Health, Inc.",Medicare Advantage,38.8619,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Kit Testing With Complex Handling,,99001,CPT,Facility,Inpatient,,,,77,65.45,22.0682,77,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Kit Testing With Complex Handling,,99001,CPT,Facility,Outpatient,,,,77,65.45,22.0682,77,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),38.8619,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Kit Testing With Complex Handling,,99001,CPT,Facility,Inpatient,,,,77,65.45,22.0682,77,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Kit Testing With Complex Handling,,99001,CPT,Facility,Both,,,,77,65.45,22.0682,77,UnitedHealthcare,Individual & Family,72.38,94,,percent of total billed charges,,
Kit Testing With Complex Handling,,99001,CPT,Facility,Outpatient,,,,77,65.45,22.0682,77,UnitedHealthcare,Medicare Advantage,37.73,49,,percent of total billed charges,,
Kit Testing With Complex Handling,,99001,CPT,Facility,Inpatient,,,,77,65.45,22.0682,77,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Kit Testing With Complex Handling,,99001,CPT,Facility,Outpatient,,,,77,65.45,22.0682,77,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,36.96,48,,percent of total billed charges,,100% of DHS outpatient percentage
Kit Testing With Complex Handling,,99001,CPT,Facility,Inpatient,,,,77,65.45,22.0682,77,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Urine Drug Screen Collection,,99001,CPT,Facility,Both,,,,49,41.65,14.0434,49,Aetna,Commercial,45.08,92,,percent of total billed charges,,
Urine Drug Screen Collection,,99001,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,Aetna,Medicare Advantage,24.01,49,,percent of total billed charges,,
Urine Drug Screen Collection,,99001,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Urine Drug Screen Collection,,99001,CPT,Facility,Both,,,,49,41.65,14.0434,49,Aetna,PPO,45.57,93,,percent of total billed charges,,
Urine Drug Screen Collection,,99001,CPT,Facility,Both,,,,49,41.65,14.0434,49,America's PPO,America's PPO,47.0547,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Urine Drug Screen Collection,,99001,CPT,Facility,Both,,,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota, Federal Employee Program,48.216,98.4,,percent of total billed charges,,
Urine Drug Screen Collection,,99001,CPT,Facility,Both,,,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,49,100,,percent of total billed charges,,
Urine Drug Screen Collection,,99001,CPT,Facility,Both,,,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,High Value Network Plan,44.1,90,,percent of total billed charges,,
Urine Drug Screen Collection,,99001,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Medicare Advantage,24.01,49,,percent of total billed charges,,
Urine Drug Screen Collection,,99001,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Urine Drug Screen Collection,,99001,CPT,Facility,Both,,,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,43.3993,88.57,,percent of total billed charges,,
Urine Drug Screen Collection,,99001,CPT,Facility,Both,,,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,14.0434,28.66,,percent of total billed charges,,
Urine Drug Screen Collection,,99001,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),24.01,49,,percent of total billed charges,,
Urine Drug Screen Collection,,99001,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Urine Drug Screen Collection,,99001,CPT,Facility,Both,,,,49,41.65,14.0434,49,CorVel,Worker's Compensation,49,100,,percent of total billed charges,,
Urine Drug Screen Collection,,99001,CPT,Facility,Both,,,,49,41.65,14.0434,49,First Health Group Corporation,First Health Network,47.53,97,,percent of total billed charges,,
Urine Drug Screen Collection,,99001,CPT,Facility,Both,,,,49,41.65,14.0434,49,"Health Partners, Inc.",Commercial,46.354,94.6,,percent of total billed charges,,
Urine Drug Screen Collection,,99001,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,"Health Partners, Inc.",Medicare Advantage,24.01,49,,percent of total billed charges,,
Urine Drug Screen Collection,,99001,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Urine Drug Screen Collection,,99001,CPT,Facility,Both,,,,49,41.65,14.0434,49,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),29.4,60,,percent of total billed charges,,
Urine Drug Screen Collection,,99001,CPT,Facility,Both,,,,49,41.65,14.0434,49,"Health Partners, Inc.",State of Minnesota Advantage Program,39.935,81.5,,percent of total billed charges,,
Urine Drug Screen Collection,,99001,CPT,Facility,Both,,,,49,41.65,14.0434,49,"Health Partners, Inc.",State Public Programs,24.5,50,,percent of total billed charges,,
Urine Drug Screen Collection,,99001,CPT,Facility,Both,,,,49,41.65,14.0434,49,Humana Insurance Company,Commercial PPO,46.55,95,,percent of total billed charges,,
Urine Drug Screen Collection,,99001,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,Humana Insurance Company,Medicare PPO,24.01,49,,percent of total billed charges,,
Urine Drug Screen Collection,,99001,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Urine Drug Screen Collection,,99001,CPT,Facility,Both,,,,49,41.65,14.0434,49,Medica,Individual & Family,48.559,99.1,,percent of total billed charges,,
Urine Drug Screen Collection,,99001,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,Medica,Medica Advantage Solution,24.402,49.8,,percent of total billed charges,,
Urine Drug Screen Collection,,99001,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Urine Drug Screen Collection,,99001,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,Medica,Medical Assistance,21.854,44.6,,percent of total billed charges,,
Urine Drug Screen Collection,,99001,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,Medica,Medical Assistance,,,,,Included in per diem rate,
Urine Drug Screen Collection,,99001,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,24.402,49.8,,percent of total billed charges,,
Urine Drug Screen Collection,,99001,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Urine Drug Screen Collection,,99001,CPT,Facility,Both,,,,49,41.65,14.0434,49,"Multiplan, Inc.","Multiplan, Inc.",46.06,94,,percent of total billed charges,,
Urine Drug Screen Collection,,99001,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,42.336,86.4,,percent of total billed charges,,
Urine Drug Screen Collection,,99001,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Urine Drug Screen Collection,,99001,CPT,Facility,Both,,,,49,41.65,14.0434,49,"Preferred One Administrative Services, INC.",PPO,48.314,98.6,,percent of total billed charges,,
Urine Drug Screen Collection,,99001,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,PrimeWest Health,Minnesota Senior Health Options (MSHO),25.2105,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Urine Drug Screen Collection,,99001,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Urine Drug Screen Collection,,99001,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,PrimeWest Health,MinnesotaCare,25.1664,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Urine Drug Screen Collection,,99001,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Urine Drug Screen Collection,,99001,CPT,Facility,Both,,,,49,41.65,14.0434,49,Sanford Health Plan,Sanford Health Plan,45.08,92,,percent of total billed charges,,
Urine Drug Screen Collection,,99001,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,"UCare Health, Inc.",Individual & Family Plan,27.6115,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Urine Drug Screen Collection,,99001,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Urine Drug Screen Collection,,99001,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,"UCare Health, Inc.",Medical Assistance,24.7303,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Urine Drug Screen Collection,,99001,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Urine Drug Screen Collection,,99001,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,"UCare Health, Inc.",Medicare Advantage,24.7303,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Urine Drug Screen Collection,,99001,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Urine Drug Screen Collection,,99001,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),24.7303,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Urine Drug Screen Collection,,99001,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Urine Drug Screen Collection,,99001,CPT,Facility,Both,,,,49,41.65,14.0434,49,UnitedHealthcare,Individual & Family,46.06,94,,percent of total billed charges,,
Urine Drug Screen Collection,,99001,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,UnitedHealthcare,Medicare Advantage,24.01,49,,percent of total billed charges,,
Urine Drug Screen Collection,,99001,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Urine Drug Screen Collection,,99001,CPT,Facility,Outpatient,,,,49,41.65,14.0434,49,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,23.52,48,,percent of total billed charges,,100% of DHS outpatient percentage
Urine Drug Screen Collection,,99001,CPT,Facility,Inpatient,,,,49,41.65,14.0434,49,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Urine Drug Screen Collection, Complex",,99001,CPT,Facility,Both,,,,148,125.8,42.4168,148,Aetna,Commercial,136.16,92,,percent of total billed charges,,
"Urine Drug Screen Collection, Complex",,99001,CPT,Facility,Outpatient,,,,148,125.8,42.4168,148,Aetna,Medicare Advantage,72.52,49,,percent of total billed charges,,
"Urine Drug Screen Collection, Complex",,99001,CPT,Facility,Inpatient,,,,148,125.8,42.4168,148,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Urine Drug Screen Collection, Complex",,99001,CPT,Facility,Both,,,,148,125.8,42.4168,148,Aetna,PPO,137.64,93,,percent of total billed charges,,
"Urine Drug Screen Collection, Complex",,99001,CPT,Facility,Both,,,,148,125.8,42.4168,148,America's PPO,America's PPO,142.1244,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Urine Drug Screen Collection, Complex",,99001,CPT,Facility,Both,,,,148,125.8,42.4168,148,BlueCross BlueShield Minnesota, Federal Employee Program,145.632,98.4,,percent of total billed charges,,
"Urine Drug Screen Collection, Complex",,99001,CPT,Facility,Both,,,,148,125.8,42.4168,148,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,148,100,,percent of total billed charges,,
"Urine Drug Screen Collection, Complex",,99001,CPT,Facility,Both,,,,148,125.8,42.4168,148,BlueCross BlueShield Minnesota,High Value Network Plan,133.2,90,,percent of total billed charges,,
"Urine Drug Screen Collection, Complex",,99001,CPT,Facility,Outpatient,,,,148,125.8,42.4168,148,BlueCross BlueShield Minnesota,Medicare Advantage,72.52,49,,percent of total billed charges,,
"Urine Drug Screen Collection, Complex",,99001,CPT,Facility,Inpatient,,,,148,125.8,42.4168,148,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Urine Drug Screen Collection, Complex",,99001,CPT,Facility,Both,,,,148,125.8,42.4168,148,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,131.0836,88.57,,percent of total billed charges,,
"Urine Drug Screen Collection, Complex",,99001,CPT,Facility,Both,,,,148,125.8,42.4168,148,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,42.4168,28.66,,percent of total billed charges,,
"Urine Drug Screen Collection, Complex",,99001,CPT,Facility,Outpatient,,,,148,125.8,42.4168,148,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),72.52,49,,percent of total billed charges,,
"Urine Drug Screen Collection, Complex",,99001,CPT,Facility,Inpatient,,,,148,125.8,42.4168,148,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Urine Drug Screen Collection, Complex",,99001,CPT,Facility,Both,,,,148,125.8,42.4168,148,CorVel,Worker's Compensation,148,100,,percent of total billed charges,,
"Urine Drug Screen Collection, Complex",,99001,CPT,Facility,Both,,,,148,125.8,42.4168,148,First Health Group Corporation,First Health Network,143.56,97,,percent of total billed charges,,
"Urine Drug Screen Collection, Complex",,99001,CPT,Facility,Both,,,,148,125.8,42.4168,148,"Health Partners, Inc.",Commercial,140.008,94.6,,percent of total billed charges,,
"Urine Drug Screen Collection, Complex",,99001,CPT,Facility,Outpatient,,,,148,125.8,42.4168,148,"Health Partners, Inc.",Medicare Advantage,72.52,49,,percent of total billed charges,,
"Urine Drug Screen Collection, Complex",,99001,CPT,Facility,Inpatient,,,,148,125.8,42.4168,148,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Urine Drug Screen Collection, Complex",,99001,CPT,Facility,Both,,,,148,125.8,42.4168,148,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),88.8,60,,percent of total billed charges,,
"Urine Drug Screen Collection, Complex",,99001,CPT,Facility,Both,,,,148,125.8,42.4168,148,"Health Partners, Inc.",State of Minnesota Advantage Program,120.62,81.5,,percent of total billed charges,,
"Urine Drug Screen Collection, Complex",,99001,CPT,Facility,Both,,,,148,125.8,42.4168,148,"Health Partners, Inc.",State Public Programs,74,50,,percent of total billed charges,,
"Urine Drug Screen Collection, Complex",,99001,CPT,Facility,Both,,,,148,125.8,42.4168,148,Humana Insurance Company,Commercial PPO,140.6,95,,percent of total billed charges,,
"Urine Drug Screen Collection, Complex",,99001,CPT,Facility,Outpatient,,,,148,125.8,42.4168,148,Humana Insurance Company,Medicare PPO,72.52,49,,percent of total billed charges,,
"Urine Drug Screen Collection, Complex",,99001,CPT,Facility,Inpatient,,,,148,125.8,42.4168,148,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Urine Drug Screen Collection, Complex",,99001,CPT,Facility,Both,,,,148,125.8,42.4168,148,Medica,Individual & Family,146.668,99.1,,percent of total billed charges,,
"Urine Drug Screen Collection, Complex",,99001,CPT,Facility,Outpatient,,,,148,125.8,42.4168,148,Medica,Medica Advantage Solution,73.704,49.8,,percent of total billed charges,,
"Urine Drug Screen Collection, Complex",,99001,CPT,Facility,Inpatient,,,,148,125.8,42.4168,148,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Urine Drug Screen Collection, Complex",,99001,CPT,Facility,Outpatient,,,,148,125.8,42.4168,148,Medica,Medical Assistance,66.008,44.6,,percent of total billed charges,,
"Urine Drug Screen Collection, Complex",,99001,CPT,Facility,Inpatient,,,,148,125.8,42.4168,148,Medica,Medical Assistance,,,,,Included in per diem rate,
"Urine Drug Screen Collection, Complex",,99001,CPT,Facility,Outpatient,,,,148,125.8,42.4168,148,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,73.704,49.8,,percent of total billed charges,,
"Urine Drug Screen Collection, Complex",,99001,CPT,Facility,Inpatient,,,,148,125.8,42.4168,148,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Urine Drug Screen Collection, Complex",,99001,CPT,Facility,Both,,,,148,125.8,42.4168,148,"Multiplan, Inc.","Multiplan, Inc.",139.12,94,,percent of total billed charges,,
"Urine Drug Screen Collection, Complex",,99001,CPT,Facility,Outpatient,,,,148,125.8,42.4168,148,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,127.872,86.4,,percent of total billed charges,,
"Urine Drug Screen Collection, Complex",,99001,CPT,Facility,Inpatient,,,,148,125.8,42.4168,148,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Urine Drug Screen Collection, Complex",,99001,CPT,Facility,Both,,,,148,125.8,42.4168,148,"Preferred One Administrative Services, INC.",PPO,145.928,98.6,,percent of total billed charges,,
"Urine Drug Screen Collection, Complex",,99001,CPT,Facility,Outpatient,,,,148,125.8,42.4168,148,PrimeWest Health,Minnesota Senior Health Options (MSHO),76.146,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Urine Drug Screen Collection, Complex",,99001,CPT,Facility,Inpatient,,,,148,125.8,42.4168,148,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Urine Drug Screen Collection, Complex",,99001,CPT,Facility,Outpatient,,,,148,125.8,42.4168,148,PrimeWest Health,MinnesotaCare,76.0128,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Urine Drug Screen Collection, Complex",,99001,CPT,Facility,Inpatient,,,,148,125.8,42.4168,148,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Urine Drug Screen Collection, Complex",,99001,CPT,Facility,Both,,,,148,125.8,42.4168,148,Sanford Health Plan,Sanford Health Plan,136.16,92,,percent of total billed charges,,
"Urine Drug Screen Collection, Complex",,99001,CPT,Facility,Outpatient,,,,148,125.8,42.4168,148,"UCare Health, Inc.",Individual & Family Plan,83.398,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Urine Drug Screen Collection, Complex",,99001,CPT,Facility,Inpatient,,,,148,125.8,42.4168,148,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Urine Drug Screen Collection, Complex",,99001,CPT,Facility,Outpatient,,,,148,125.8,42.4168,148,"UCare Health, Inc.",Medical Assistance,74.6956,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Urine Drug Screen Collection, Complex",,99001,CPT,Facility,Inpatient,,,,148,125.8,42.4168,148,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Urine Drug Screen Collection, Complex",,99001,CPT,Facility,Outpatient,,,,148,125.8,42.4168,148,"UCare Health, Inc.",Medicare Advantage,74.6956,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Urine Drug Screen Collection, Complex",,99001,CPT,Facility,Inpatient,,,,148,125.8,42.4168,148,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Urine Drug Screen Collection, Complex",,99001,CPT,Facility,Outpatient,,,,148,125.8,42.4168,148,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),74.6956,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Urine Drug Screen Collection, Complex",,99001,CPT,Facility,Inpatient,,,,148,125.8,42.4168,148,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Urine Drug Screen Collection, Complex",,99001,CPT,Facility,Both,,,,148,125.8,42.4168,148,UnitedHealthcare,Individual & Family,139.12,94,,percent of total billed charges,,
"Urine Drug Screen Collection, Complex",,99001,CPT,Facility,Outpatient,,,,148,125.8,42.4168,148,UnitedHealthcare,Medicare Advantage,72.52,49,,percent of total billed charges,,
"Urine Drug Screen Collection, Complex",,99001,CPT,Facility,Inpatient,,,,148,125.8,42.4168,148,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Urine Drug Screen Collection, Complex",,99001,CPT,Facility,Outpatient,,,,148,125.8,42.4168,148,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,71.04,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Urine Drug Screen Collection, Complex",,99001,CPT,Facility,Inpatient,,,,148,125.8,42.4168,148,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Global Package Services Part Of A Global Period (Pbb),,99024,CPT,Facility,Outpatient,,,,50,42.5,14.33,50,Aetna,Commercial,46,92,,percent of total billed charges,,
Global Package Services Part Of A Global Period (Pbb),,99024,CPT,Facility,Outpatient,,,,50,42.5,14.33,50,Aetna,Medicare Advantage,24.5,49,,percent of total billed charges,,
Global Package Services Part Of A Global Period (Pbb),,99024,CPT,Facility,Outpatient,,,,50,42.5,14.33,50,Aetna,PPO,46.5,93,,percent of total billed charges,,
Global Package Services Part Of A Global Period (Pbb),,99024,CPT,Facility,Outpatient,,,,50,42.5,14.33,50,America's PPO,America's PPO,48.015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Global Package Services Part Of A Global Period (Pbb),,99024,CPT,Facility,Outpatient,,,,50,42.5,14.33,50,BlueCross BlueShield Minnesota, Federal Employee Program,49.2,98.4,,percent of total billed charges,,
Global Package Services Part Of A Global Period (Pbb),,99024,CPT,Facility,Outpatient,,,,50,42.5,14.33,50,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,50,100,,percent of total billed charges,,
Global Package Services Part Of A Global Period (Pbb),,99024,CPT,Facility,Outpatient,,,,50,42.5,14.33,50,BlueCross BlueShield Minnesota,High Value Network Plan,45,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
Global Package Services Part Of A Global Period (Pbb),,99024,CPT,Facility,Outpatient,,,,50,42.5,14.33,50,BlueCross BlueShield Minnesota,Medicare Advantage,24.5,49,,percent of total billed charges,,
Global Package Services Part Of A Global Period (Pbb),,99024,CPT,Facility,Outpatient,,,,50,42.5,14.33,50,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,14.33,28.66,,percent of total billed charges,,
Global Package Services Part Of A Global Period (Pbb),,99024,CPT,Facility,Outpatient,,,,50,42.5,14.33,50,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),24.5,49,,percent of total billed charges,,
Global Package Services Part Of A Global Period (Pbb),,99024,CPT,Facility,Outpatient,,,,50,42.5,14.33,50,CorVel,Worker's Compensation,50,100,,percent of total billed charges,,
Global Package Services Part Of A Global Period (Pbb),,99024,CPT,Facility,Outpatient,,,,50,42.5,14.33,50,First Health Group Corporation,First Health Network,48.5,97,,percent of total billed charges,,
Global Package Services Part Of A Global Period (Pbb),,99024,CPT,Facility,Outpatient,,,,50,42.5,14.33,50,"Health Partners, Inc.",Commercial,47.3,94.6,,percent of total billed charges,,
Global Package Services Part Of A Global Period (Pbb),,99024,CPT,Facility,Outpatient,,,,50,42.5,14.33,50,"Health Partners, Inc.",Medicare Advantage,24.5,49,,percent of total billed charges,,
Global Package Services Part Of A Global Period (Pbb),,99024,CPT,Facility,Outpatient,,,,50,42.5,14.33,50,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),30,60,,percent of total billed charges,,
Global Package Services Part Of A Global Period (Pbb),,99024,CPT,Facility,Outpatient,,,,50,42.5,14.33,50,"Health Partners, Inc.",State of Minnesota Advantage Program,40.75,81.5,,percent of total billed charges,,
Global Package Services Part Of A Global Period (Pbb),,99024,CPT,Facility,Outpatient,,,,50,42.5,14.33,50,"Health Partners, Inc.",State Public Programs,25,50,,percent of total billed charges,,
Global Package Services Part Of A Global Period (Pbb),,99024,CPT,Facility,Outpatient,,,,50,42.5,14.33,50,Humana Insurance Company,Commercial PPO,47.5,95,,percent of total billed charges,,
Global Package Services Part Of A Global Period (Pbb),,99024,CPT,Facility,Outpatient,,,,50,42.5,14.33,50,Humana Insurance Company,Medicare PPO,24.5,49,,percent of total billed charges,,
Global Package Services Part Of A Global Period (Pbb),,99024,CPT,Facility,Outpatient,,,,50,42.5,14.33,50,Medica,Individual & Family,49.55,99.1,,percent of total billed charges,,
Global Package Services Part Of A Global Period (Pbb),,99024,CPT,Facility,Outpatient,,,,50,42.5,14.33,50,Medica,Medica Advantage Solution,24.9,49.8,,percent of total billed charges,,
Global Package Services Part Of A Global Period (Pbb),,99024,CPT,Facility,Outpatient,,,,50,42.5,14.33,50,Medica,Medical Assistance,22.3,44.6,,percent of total billed charges,,
Global Package Services Part Of A Global Period (Pbb),,99024,CPT,Facility,Outpatient,,,,50,42.5,14.33,50,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,24.9,49.8,,percent of total billed charges,,
Global Package Services Part Of A Global Period (Pbb),,99024,CPT,Facility,Outpatient,,,,50,42.5,14.33,50,"Multiplan, Inc.","Multiplan, Inc.",47,94,,percent of total billed charges,,
Global Package Services Part Of A Global Period (Pbb),,99024,CPT,Facility,Outpatient,,,,50,42.5,14.33,50,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,45.05,90.1,,percent of total billed charges,,
Global Package Services Part Of A Global Period (Pbb),,99024,CPT,Facility,Outpatient,,,,50,42.5,14.33,50,"Preferred One Administrative Services, INC.",PPO,49.3,98.6,,percent of total billed charges,,
Global Package Services Part Of A Global Period (Pbb),,99024,CPT,Facility,Outpatient,,,,50,42.5,14.33,50,PrimeWest Health,Minnesota Senior Health Options (MSHO),25.725,51.45,,percent of total billed charges,,
Global Package Services Part Of A Global Period (Pbb),,99024,CPT,Facility,Outpatient,,,,50,42.5,14.33,50,PrimeWest Health,MinnesotaCare,25.68,51.36,,percent of total billed charges,,
Global Package Services Part Of A Global Period (Pbb),,99024,CPT,Facility,Outpatient,,,,50,42.5,14.33,50,Sanford Health Plan,Sanford Health Plan,46,92,,percent of total billed charges,,
Global Package Services Part Of A Global Period (Pbb),,99024,CPT,Facility,Outpatient,,,,50,42.5,14.33,50,"UCare Health, Inc.",Individual & Family Plan,28.175,56.35,,percent of total billed charges,,
Global Package Services Part Of A Global Period (Pbb),,99024,CPT,Facility,Outpatient,,,,50,42.5,14.33,50,"UCare Health, Inc.",Medical Assistance,25.235,50.47,,percent of total billed charges,,
Global Package Services Part Of A Global Period (Pbb),,99024,CPT,Facility,Outpatient,,,,50,42.5,14.33,50,"UCare Health, Inc.",Medicare Advantage,25.235,50.47,,percent of total billed charges,,
Global Package Services Part Of A Global Period (Pbb),,99024,CPT,Facility,Outpatient,,,,50,42.5,14.33,50,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),25.235,50.47,,percent of total billed charges,,
Global Package Services Part Of A Global Period (Pbb),,99024,CPT,Facility,Outpatient,,,,50,42.5,14.33,50,UnitedHealthcare,Individual & Family,47,94,,percent of total billed charges,,
Global Package Services Part Of A Global Period (Pbb),,99024,CPT,Facility,Outpatient,,,,50,42.5,14.33,50,UnitedHealthcare,Medicare Advantage,24.5,49,,percent of total billed charges,,
Global Package Services Part Of A Global Period (Pbb),,99024,CPT,Facility,Outpatient,,,,50,42.5,14.33,50,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,24,48,,percent of total billed charges,,100% of DHS outpatient percentage
MOMETASONE-FORMOTEROL 100-5 MCG/ACTUATION INHL HFAA,,92113,LOCAL,Facility,Both,13,g,,1346,1144.1,385.7636,1346,Aetna,Commercial,1238.32,92,,percent of total billed charges,,
MOMETASONE-FORMOTEROL 100-5 MCG/ACTUATION INHL HFAA,,92113,LOCAL,Facility,Outpatient,13,g,,1346,1144.1,385.7636,1346,Aetna,Medicare Advantage,659.54,49,,percent of total billed charges,,
MOMETASONE-FORMOTEROL 100-5 MCG/ACTUATION INHL HFAA,,92113,LOCAL,Facility,Inpatient,13,g,,1346,1144.1,385.7636,1346,Aetna,Medicare Advantage,,,,,Included in per diem rate,
MOMETASONE-FORMOTEROL 100-5 MCG/ACTUATION INHL HFAA,,92113,LOCAL,Facility,Both,13,g,,1346,1144.1,385.7636,1346,Aetna,PPO,1251.78,93,,percent of total billed charges,,
MOMETASONE-FORMOTEROL 100-5 MCG/ACTUATION INHL HFAA,,92113,LOCAL,Facility,Both,13,g,,1346,1144.1,385.7636,1346,America's PPO,America's PPO,1292.5638,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
MOMETASONE-FORMOTEROL 100-5 MCG/ACTUATION INHL HFAA,,92113,LOCAL,Facility,Both,13,g,,1346,1144.1,385.7636,1346,BlueCross BlueShield Minnesota, Federal Employee Program,1324.464,98.4,,percent of total billed charges,,
MOMETASONE-FORMOTEROL 100-5 MCG/ACTUATION INHL HFAA,,92113,LOCAL,Facility,Both,13,g,,1346,1144.1,385.7636,1346,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1346,100,,percent of total billed charges,,
MOMETASONE-FORMOTEROL 100-5 MCG/ACTUATION INHL HFAA,,92113,LOCAL,Facility,Both,13,g,,1346,1144.1,385.7636,1346,BlueCross BlueShield Minnesota,High Value Network Plan,1211.4,90,,percent of total billed charges,,
MOMETASONE-FORMOTEROL 100-5 MCG/ACTUATION INHL HFAA,,92113,LOCAL,Facility,Outpatient,13,g,,1346,1144.1,385.7636,1346,BlueCross BlueShield Minnesota,Medicare Advantage,659.54,49,,percent of total billed charges,,
MOMETASONE-FORMOTEROL 100-5 MCG/ACTUATION INHL HFAA,,92113,LOCAL,Facility,Inpatient,13,g,,1346,1144.1,385.7636,1346,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
MOMETASONE-FORMOTEROL 100-5 MCG/ACTUATION INHL HFAA,,92113,LOCAL,Facility,Both,13,g,,1346,1144.1,385.7636,1346,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1192.1522,88.57,,percent of total billed charges,,
MOMETASONE-FORMOTEROL 100-5 MCG/ACTUATION INHL HFAA,,92113,LOCAL,Facility,Both,13,g,,1346,1144.1,385.7636,1346,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,385.7636,28.66,,percent of total billed charges,,
MOMETASONE-FORMOTEROL 100-5 MCG/ACTUATION INHL HFAA,,92113,LOCAL,Facility,Outpatient,13,g,,1346,1144.1,385.7636,1346,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),659.54,49,,percent of total billed charges,,
MOMETASONE-FORMOTEROL 100-5 MCG/ACTUATION INHL HFAA,,92113,LOCAL,Facility,Inpatient,13,g,,1346,1144.1,385.7636,1346,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
MOMETASONE-FORMOTEROL 100-5 MCG/ACTUATION INHL HFAA,,92113,LOCAL,Facility,Both,13,g,,1346,1144.1,385.7636,1346,CorVel,Worker's Compensation,1346,100,,percent of total billed charges,,
MOMETASONE-FORMOTEROL 100-5 MCG/ACTUATION INHL HFAA,,92113,LOCAL,Facility,Both,13,g,,1346,1144.1,385.7636,1346,First Health Group Corporation,First Health Network,1305.62,97,,percent of total billed charges,,
MOMETASONE-FORMOTEROL 100-5 MCG/ACTUATION INHL HFAA,,92113,LOCAL,Facility,Both,13,g,,1346,1144.1,385.7636,1346,"Health Partners, Inc.",Commercial,1273.316,94.6,,percent of total billed charges,,
MOMETASONE-FORMOTEROL 100-5 MCG/ACTUATION INHL HFAA,,92113,LOCAL,Facility,Outpatient,13,g,,1346,1144.1,385.7636,1346,"Health Partners, Inc.",Medicare Advantage,659.54,49,,percent of total billed charges,,
MOMETASONE-FORMOTEROL 100-5 MCG/ACTUATION INHL HFAA,,92113,LOCAL,Facility,Inpatient,13,g,,1346,1144.1,385.7636,1346,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
MOMETASONE-FORMOTEROL 100-5 MCG/ACTUATION INHL HFAA,,92113,LOCAL,Facility,Both,13,g,,1346,1144.1,385.7636,1346,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),807.6,60,,percent of total billed charges,,
MOMETASONE-FORMOTEROL 100-5 MCG/ACTUATION INHL HFAA,,92113,LOCAL,Facility,Both,13,g,,1346,1144.1,385.7636,1346,"Health Partners, Inc.",State of Minnesota Advantage Program,1096.99,81.5,,percent of total billed charges,,
MOMETASONE-FORMOTEROL 100-5 MCG/ACTUATION INHL HFAA,,92113,LOCAL,Facility,Both,13,g,,1346,1144.1,385.7636,1346,"Health Partners, Inc.",State Public Programs,673,50,,percent of total billed charges,,
MOMETASONE-FORMOTEROL 100-5 MCG/ACTUATION INHL HFAA,,92113,LOCAL,Facility,Both,13,g,,1346,1144.1,385.7636,1346,Humana Insurance Company,Commercial PPO,1278.7,95,,percent of total billed charges,,
MOMETASONE-FORMOTEROL 100-5 MCG/ACTUATION INHL HFAA,,92113,LOCAL,Facility,Outpatient,13,g,,1346,1144.1,385.7636,1346,Humana Insurance Company,Medicare PPO,659.54,49,,percent of total billed charges,,
MOMETASONE-FORMOTEROL 100-5 MCG/ACTUATION INHL HFAA,,92113,LOCAL,Facility,Inpatient,13,g,,1346,1144.1,385.7636,1346,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
MOMETASONE-FORMOTEROL 100-5 MCG/ACTUATION INHL HFAA,,92113,LOCAL,Facility,Both,13,g,,1346,1144.1,385.7636,1346,Medica,Individual & Family,1333.886,99.1,,percent of total billed charges,,
MOMETASONE-FORMOTEROL 100-5 MCG/ACTUATION INHL HFAA,,92113,LOCAL,Facility,Outpatient,13,g,,1346,1144.1,385.7636,1346,Medica,Medica Advantage Solution,670.308,49.8,,percent of total billed charges,,
MOMETASONE-FORMOTEROL 100-5 MCG/ACTUATION INHL HFAA,,92113,LOCAL,Facility,Inpatient,13,g,,1346,1144.1,385.7636,1346,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
MOMETASONE-FORMOTEROL 100-5 MCG/ACTUATION INHL HFAA,,92113,LOCAL,Facility,Outpatient,13,g,,1346,1144.1,385.7636,1346,Medica,Medical Assistance,600.316,44.6,,percent of total billed charges,,
MOMETASONE-FORMOTEROL 100-5 MCG/ACTUATION INHL HFAA,,92113,LOCAL,Facility,Inpatient,13,g,,1346,1144.1,385.7636,1346,Medica,Medical Assistance,,,,,Included in per diem rate,
MOMETASONE-FORMOTEROL 100-5 MCG/ACTUATION INHL HFAA,,92113,LOCAL,Facility,Outpatient,13,g,,1346,1144.1,385.7636,1346,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,670.308,49.8,,percent of total billed charges,,
MOMETASONE-FORMOTEROL 100-5 MCG/ACTUATION INHL HFAA,,92113,LOCAL,Facility,Inpatient,13,g,,1346,1144.1,385.7636,1346,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
MOMETASONE-FORMOTEROL 100-5 MCG/ACTUATION INHL HFAA,,92113,LOCAL,Facility,Both,13,g,,1346,1144.1,385.7636,1346,"Multiplan, Inc.","Multiplan, Inc.",1265.24,94,,percent of total billed charges,,
MOMETASONE-FORMOTEROL 100-5 MCG/ACTUATION INHL HFAA,,92113,LOCAL,Facility,Outpatient,13,g,,1346,1144.1,385.7636,1346,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1212.746,90.1,,percent of total billed charges,,
MOMETASONE-FORMOTEROL 100-5 MCG/ACTUATION INHL HFAA,,92113,LOCAL,Facility,Inpatient,13,g,,1346,1144.1,385.7636,1346,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
MOMETASONE-FORMOTEROL 100-5 MCG/ACTUATION INHL HFAA,,92113,LOCAL,Facility,Both,13,g,,1346,1144.1,385.7636,1346,"Preferred One Administrative Services, INC.",PPO,1327.156,98.6,,percent of total billed charges,,
MOMETASONE-FORMOTEROL 100-5 MCG/ACTUATION INHL HFAA,,92113,LOCAL,Facility,Outpatient,13,g,,1346,1144.1,385.7636,1346,PrimeWest Health,Minnesota Senior Health Options (MSHO),692.517,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
MOMETASONE-FORMOTEROL 100-5 MCG/ACTUATION INHL HFAA,,92113,LOCAL,Facility,Inpatient,13,g,,1346,1144.1,385.7636,1346,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
MOMETASONE-FORMOTEROL 100-5 MCG/ACTUATION INHL HFAA,,92113,LOCAL,Facility,Outpatient,13,g,,1346,1144.1,385.7636,1346,PrimeWest Health,MinnesotaCare,691.3056,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
MOMETASONE-FORMOTEROL 100-5 MCG/ACTUATION INHL HFAA,,92113,LOCAL,Facility,Inpatient,13,g,,1346,1144.1,385.7636,1346,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
MOMETASONE-FORMOTEROL 100-5 MCG/ACTUATION INHL HFAA,,92113,LOCAL,Facility,Both,13,g,,1346,1144.1,385.7636,1346,Sanford Health Plan,Sanford Health Plan,1238.32,92,,percent of total billed charges,,
MOMETASONE-FORMOTEROL 100-5 MCG/ACTUATION INHL HFAA,,92113,LOCAL,Facility,Outpatient,13,g,,1346,1144.1,385.7636,1346,"UCare Health, Inc.",Individual & Family Plan,758.471,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
MOMETASONE-FORMOTEROL 100-5 MCG/ACTUATION INHL HFAA,,92113,LOCAL,Facility,Inpatient,13,g,,1346,1144.1,385.7636,1346,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
MOMETASONE-FORMOTEROL 100-5 MCG/ACTUATION INHL HFAA,,92113,LOCAL,Facility,Outpatient,13,g,,1346,1144.1,385.7636,1346,"UCare Health, Inc.",Medical Assistance,679.3262,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MOMETASONE-FORMOTEROL 100-5 MCG/ACTUATION INHL HFAA,,92113,LOCAL,Facility,Inpatient,13,g,,1346,1144.1,385.7636,1346,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
MOMETASONE-FORMOTEROL 100-5 MCG/ACTUATION INHL HFAA,,92113,LOCAL,Facility,Outpatient,13,g,,1346,1144.1,385.7636,1346,"UCare Health, Inc.",Medicare Advantage,679.3262,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MOMETASONE-FORMOTEROL 100-5 MCG/ACTUATION INHL HFAA,,92113,LOCAL,Facility,Inpatient,13,g,,1346,1144.1,385.7636,1346,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
MOMETASONE-FORMOTEROL 100-5 MCG/ACTUATION INHL HFAA,,92113,LOCAL,Facility,Outpatient,13,g,,1346,1144.1,385.7636,1346,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),679.3262,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MOMETASONE-FORMOTEROL 100-5 MCG/ACTUATION INHL HFAA,,92113,LOCAL,Facility,Inpatient,13,g,,1346,1144.1,385.7636,1346,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
MOMETASONE-FORMOTEROL 100-5 MCG/ACTUATION INHL HFAA,,92113,LOCAL,Facility,Both,13,g,,1346,1144.1,385.7636,1346,UnitedHealthcare,Individual & Family,1265.24,94,,percent of total billed charges,,
MOMETASONE-FORMOTEROL 100-5 MCG/ACTUATION INHL HFAA,,92113,LOCAL,Facility,Outpatient,13,g,,1346,1144.1,385.7636,1346,UnitedHealthcare,Medicare Advantage,659.54,49,,percent of total billed charges,,
MOMETASONE-FORMOTEROL 100-5 MCG/ACTUATION INHL HFAA,,92113,LOCAL,Facility,Inpatient,13,g,,1346,1144.1,385.7636,1346,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
MOMETASONE-FORMOTEROL 100-5 MCG/ACTUATION INHL HFAA,,92113,LOCAL,Facility,Outpatient,13,g,,1346,1144.1,385.7636,1346,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,646.08,48,,percent of total billed charges,,100% of DHS outpatient percentage
MOMETASONE-FORMOTEROL 100-5 MCG/ACTUATION INHL HFAA,,92113,LOCAL,Facility,Inpatient,13,g,,1346,1144.1,385.7636,1346,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Moderate Sedation Same Phy/Qhcp, Initial 15 Mins, 5 Yrs Or Greater",,99152,CPT,Facility,Both,,,,120,102,34.392,120,Aetna,Commercial,110.4,92,,percent of total billed charges,,
"Moderate Sedation Same Phy/Qhcp, Initial 15 Mins, 5 Yrs Or Greater",,99152,CPT,Facility,Outpatient,,,,120,102,34.392,120,Aetna,Medicare Advantage,58.8,49,,percent of total billed charges,,
"Moderate Sedation Same Phy/Qhcp, Initial 15 Mins, 5 Yrs Or Greater",,99152,CPT,Facility,Inpatient,,,,120,102,34.392,120,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Moderate Sedation Same Phy/Qhcp, Initial 15 Mins, 5 Yrs Or Greater",,99152,CPT,Facility,Both,,,,120,102,34.392,120,Aetna,PPO,111.6,93,,percent of total billed charges,,
"Moderate Sedation Same Phy/Qhcp, Initial 15 Mins, 5 Yrs Or Greater",,99152,CPT,Facility,Both,,,,120,102,34.392,120,America's PPO,America's PPO,115.236,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Moderate Sedation Same Phy/Qhcp, Initial 15 Mins, 5 Yrs Or Greater",,99152,CPT,Facility,Both,,,,120,102,34.392,120,BlueCross BlueShield Minnesota, Federal Employee Program,118.08,98.4,,percent of total billed charges,,
"Moderate Sedation Same Phy/Qhcp, Initial 15 Mins, 5 Yrs Or Greater",,99152,CPT,Facility,Both,,,,120,102,34.392,120,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,120,100,,percent of total billed charges,,
"Moderate Sedation Same Phy/Qhcp, Initial 15 Mins, 5 Yrs Or Greater",,99152,CPT,Facility,Both,,,,120,102,34.392,120,BlueCross BlueShield Minnesota,High Value Network Plan,108,90,,percent of total billed charges,,
"Moderate Sedation Same Phy/Qhcp, Initial 15 Mins, 5 Yrs Or Greater",,99152,CPT,Facility,Outpatient,,,,120,102,34.392,120,BlueCross BlueShield Minnesota,Medicare Advantage,58.8,49,,percent of total billed charges,,
"Moderate Sedation Same Phy/Qhcp, Initial 15 Mins, 5 Yrs Or Greater",,99152,CPT,Facility,Inpatient,,,,120,102,34.392,120,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Moderate Sedation Same Phy/Qhcp, Initial 15 Mins, 5 Yrs Or Greater",,99152,CPT,Facility,Both,,,,120,102,34.392,120,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,106.284,88.57,,percent of total billed charges,,
"Moderate Sedation Same Phy/Qhcp, Initial 15 Mins, 5 Yrs Or Greater",,99152,CPT,Facility,Both,,,,120,102,34.392,120,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,34.392,28.66,,percent of total billed charges,,
"Moderate Sedation Same Phy/Qhcp, Initial 15 Mins, 5 Yrs Or Greater",,99152,CPT,Facility,Outpatient,,,,120,102,34.392,120,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),58.8,49,,percent of total billed charges,,
"Moderate Sedation Same Phy/Qhcp, Initial 15 Mins, 5 Yrs Or Greater",,99152,CPT,Facility,Inpatient,,,,120,102,34.392,120,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Moderate Sedation Same Phy/Qhcp, Initial 15 Mins, 5 Yrs Or Greater",,99152,CPT,Facility,Both,,,,120,102,34.392,120,CorVel,Worker's Compensation,120,100,,percent of total billed charges,,
"Moderate Sedation Same Phy/Qhcp, Initial 15 Mins, 5 Yrs Or Greater",,99152,CPT,Facility,Both,,,,120,102,34.392,120,First Health Group Corporation,First Health Network,116.4,97,,percent of total billed charges,,
"Moderate Sedation Same Phy/Qhcp, Initial 15 Mins, 5 Yrs Or Greater",,99152,CPT,Facility,Both,,,,120,102,34.392,120,"Health Partners, Inc.",Commercial,113.52,94.6,,percent of total billed charges,,
"Moderate Sedation Same Phy/Qhcp, Initial 15 Mins, 5 Yrs Or Greater",,99152,CPT,Facility,Outpatient,,,,120,102,34.392,120,"Health Partners, Inc.",Medicare Advantage,58.8,49,,percent of total billed charges,,
"Moderate Sedation Same Phy/Qhcp, Initial 15 Mins, 5 Yrs Or Greater",,99152,CPT,Facility,Inpatient,,,,120,102,34.392,120,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Moderate Sedation Same Phy/Qhcp, Initial 15 Mins, 5 Yrs Or Greater",,99152,CPT,Facility,Both,,,,120,102,34.392,120,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),72,60,,percent of total billed charges,,
"Moderate Sedation Same Phy/Qhcp, Initial 15 Mins, 5 Yrs Or Greater",,99152,CPT,Facility,Both,,,,120,102,34.392,120,"Health Partners, Inc.",State of Minnesota Advantage Program,97.8,81.5,,percent of total billed charges,,
"Moderate Sedation Same Phy/Qhcp, Initial 15 Mins, 5 Yrs Or Greater",,99152,CPT,Facility,Both,,,,120,102,34.392,120,"Health Partners, Inc.",State Public Programs,60,50,,percent of total billed charges,,
"Moderate Sedation Same Phy/Qhcp, Initial 15 Mins, 5 Yrs Or Greater",,99152,CPT,Facility,Both,,,,120,102,34.392,120,Humana Insurance Company,Commercial PPO,114,95,,percent of total billed charges,,
"Moderate Sedation Same Phy/Qhcp, Initial 15 Mins, 5 Yrs Or Greater",,99152,CPT,Facility,Outpatient,,,,120,102,34.392,120,Humana Insurance Company,Medicare PPO,58.8,49,,percent of total billed charges,,
"Moderate Sedation Same Phy/Qhcp, Initial 15 Mins, 5 Yrs Or Greater",,99152,CPT,Facility,Inpatient,,,,120,102,34.392,120,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Moderate Sedation Same Phy/Qhcp, Initial 15 Mins, 5 Yrs Or Greater",,99152,CPT,Facility,Both,,,,120,102,34.392,120,Medica,Individual & Family,118.92,99.1,,percent of total billed charges,,
"Moderate Sedation Same Phy/Qhcp, Initial 15 Mins, 5 Yrs Or Greater",,99152,CPT,Facility,Outpatient,,,,120,102,34.392,120,Medica,Medica Advantage Solution,59.76,49.8,,percent of total billed charges,,
"Moderate Sedation Same Phy/Qhcp, Initial 15 Mins, 5 Yrs Or Greater",,99152,CPT,Facility,Inpatient,,,,120,102,34.392,120,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Moderate Sedation Same Phy/Qhcp, Initial 15 Mins, 5 Yrs Or Greater",,99152,CPT,Facility,Outpatient,,,,120,102,34.392,120,Medica,Medical Assistance,53.52,44.6,,percent of total billed charges,,
"Moderate Sedation Same Phy/Qhcp, Initial 15 Mins, 5 Yrs Or Greater",,99152,CPT,Facility,Inpatient,,,,120,102,34.392,120,Medica,Medical Assistance,,,,,Included in per diem rate,
"Moderate Sedation Same Phy/Qhcp, Initial 15 Mins, 5 Yrs Or Greater",,99152,CPT,Facility,Outpatient,,,,120,102,34.392,120,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,59.76,49.8,,percent of total billed charges,,
"Moderate Sedation Same Phy/Qhcp, Initial 15 Mins, 5 Yrs Or Greater",,99152,CPT,Facility,Inpatient,,,,120,102,34.392,120,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Moderate Sedation Same Phy/Qhcp, Initial 15 Mins, 5 Yrs Or Greater",,99152,CPT,Facility,Both,,,,120,102,34.392,120,"Multiplan, Inc.","Multiplan, Inc.",112.8,94,,percent of total billed charges,,
"Moderate Sedation Same Phy/Qhcp, Initial 15 Mins, 5 Yrs Or Greater",,99152,CPT,Facility,Outpatient,,,,120,102,34.392,120,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,108.12,90.1,,percent of total billed charges,,
"Moderate Sedation Same Phy/Qhcp, Initial 15 Mins, 5 Yrs Or Greater",,99152,CPT,Facility,Inpatient,,,,120,102,34.392,120,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Moderate Sedation Same Phy/Qhcp, Initial 15 Mins, 5 Yrs Or Greater",,99152,CPT,Facility,Both,,,,120,102,34.392,120,"Preferred One Administrative Services, INC.",PPO,118.32,98.6,,percent of total billed charges,,
"Moderate Sedation Same Phy/Qhcp, Initial 15 Mins, 5 Yrs Or Greater",,99152,CPT,Facility,Outpatient,,,,120,102,34.392,120,PrimeWest Health,Minnesota Senior Health Options (MSHO),61.74,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Moderate Sedation Same Phy/Qhcp, Initial 15 Mins, 5 Yrs Or Greater",,99152,CPT,Facility,Inpatient,,,,120,102,34.392,120,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Moderate Sedation Same Phy/Qhcp, Initial 15 Mins, 5 Yrs Or Greater",,99152,CPT,Facility,Outpatient,,,,120,102,34.392,120,PrimeWest Health,MinnesotaCare,61.632,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Moderate Sedation Same Phy/Qhcp, Initial 15 Mins, 5 Yrs Or Greater",,99152,CPT,Facility,Inpatient,,,,120,102,34.392,120,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Moderate Sedation Same Phy/Qhcp, Initial 15 Mins, 5 Yrs Or Greater",,99152,CPT,Facility,Both,,,,120,102,34.392,120,Sanford Health Plan,Sanford Health Plan,110.4,92,,percent of total billed charges,,
"Moderate Sedation Same Phy/Qhcp, Initial 15 Mins, 5 Yrs Or Greater",,99152,CPT,Facility,Outpatient,,,,120,102,34.392,120,"UCare Health, Inc.",Individual & Family Plan,67.62,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Moderate Sedation Same Phy/Qhcp, Initial 15 Mins, 5 Yrs Or Greater",,99152,CPT,Facility,Inpatient,,,,120,102,34.392,120,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Moderate Sedation Same Phy/Qhcp, Initial 15 Mins, 5 Yrs Or Greater",,99152,CPT,Facility,Outpatient,,,,120,102,34.392,120,"UCare Health, Inc.",Medical Assistance,60.564,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Moderate Sedation Same Phy/Qhcp, Initial 15 Mins, 5 Yrs Or Greater",,99152,CPT,Facility,Inpatient,,,,120,102,34.392,120,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Moderate Sedation Same Phy/Qhcp, Initial 15 Mins, 5 Yrs Or Greater",,99152,CPT,Facility,Outpatient,,,,120,102,34.392,120,"UCare Health, Inc.",Medicare Advantage,60.564,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Moderate Sedation Same Phy/Qhcp, Initial 15 Mins, 5 Yrs Or Greater",,99152,CPT,Facility,Inpatient,,,,120,102,34.392,120,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Moderate Sedation Same Phy/Qhcp, Initial 15 Mins, 5 Yrs Or Greater",,99152,CPT,Facility,Outpatient,,,,120,102,34.392,120,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),60.564,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Moderate Sedation Same Phy/Qhcp, Initial 15 Mins, 5 Yrs Or Greater",,99152,CPT,Facility,Inpatient,,,,120,102,34.392,120,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Moderate Sedation Same Phy/Qhcp, Initial 15 Mins, 5 Yrs Or Greater",,99152,CPT,Facility,Both,,,,120,102,34.392,120,UnitedHealthcare,Individual & Family,112.8,94,,percent of total billed charges,,
"Moderate Sedation Same Phy/Qhcp, Initial 15 Mins, 5 Yrs Or Greater",,99152,CPT,Facility,Outpatient,,,,120,102,34.392,120,UnitedHealthcare,Medicare Advantage,58.8,49,,percent of total billed charges,,
"Moderate Sedation Same Phy/Qhcp, Initial 15 Mins, 5 Yrs Or Greater",,99152,CPT,Facility,Inpatient,,,,120,102,34.392,120,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Moderate Sedation Same Phy/Qhcp, Initial 15 Mins, 5 Yrs Or Greater",,99152,CPT,Facility,Outpatient,,,,120,102,34.392,120,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,57.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Moderate Sedation Same Phy/Qhcp, Initial 15 Mins, 5 Yrs Or Greater",,99152,CPT,Facility,Inpatient,,,,120,102,34.392,120,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Moderate Sedation, By Same Dr Performing Service; Pt 5Yrs+, Initial 15 Min Intra-Ser Time (Pro Cah)",,99152,CPT,Professional,Both,,,,250,212.5,7.41,250,Aetna,Commercial,212.5,85,,percent of total billed charges,,
"Moderate Sedation, By Same Dr Performing Service; Pt 5Yrs+, Initial 15 Min Intra-Ser Time (Pro Cah)",,99152,CPT,Professional,Both,,,,250,212.5,7.41,250,Aetna,Medicare Advantage,12.15,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Moderate Sedation, By Same Dr Performing Service; Pt 5Yrs+, Initial 15 Min Intra-Ser Time (Pro Cah)",,99152,CPT,Professional,Both,,,,250,212.5,7.41,250,Aetna,PPO,232.5,93,,percent of total billed charges,,
"Moderate Sedation, By Same Dr Performing Service; Pt 5Yrs+, Initial 15 Min Intra-Ser Time (Pro Cah)",,99152,CPT,Professional,Both,,,,250,212.5,7.41,250,America's PPO,America's PPO,213.6,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Moderate Sedation, By Same Dr Performing Service; Pt 5Yrs+, Initial 15 Min Intra-Ser Time (Pro Cah)",,99152,CPT,Professional,Both,,,,250,212.5,7.41,250,BlueCross BlueShield Minnesota, Federal Employee Program,21.59,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Moderate Sedation, By Same Dr Performing Service; Pt 5Yrs+, Initial 15 Min Intra-Ser Time (Pro Cah)",,99152,CPT,Professional,Both,,,,250,212.5,7.41,250,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,21.93544,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Moderate Sedation, By Same Dr Performing Service; Pt 5Yrs+, Initial 15 Min Intra-Ser Time (Pro Cah)",,99152,CPT,Professional,Both,,,,250,212.5,7.41,250,BlueCross BlueShield Minnesota,High Value Network Plan,21.93544,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Moderate Sedation, By Same Dr Performing Service; Pt 5Yrs+, Initial 15 Min Intra-Ser Time (Pro Cah)",,99152,CPT,Professional,Both,,,,250,212.5,7.41,250,BlueCross BlueShield Minnesota,Medicare Advantage,13.432,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Moderate Sedation, By Same Dr Performing Service; Pt 5Yrs+, Initial 15 Min Intra-Ser Time (Pro Cah)",,99152,CPT,Professional,Both,,,,250,212.5,7.41,250,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,21.93544,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Moderate Sedation, By Same Dr Performing Service; Pt 5Yrs+, Initial 15 Min Intra-Ser Time (Pro Cah)",,99152,CPT,Professional,Both,,,,250,212.5,7.41,250,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,8.55472,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Moderate Sedation, By Same Dr Performing Service; Pt 5Yrs+, Initial 15 Min Intra-Ser Time (Pro Cah)",,99152,CPT,Professional,Both,,,,250,212.5,7.41,250,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),13.432,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Moderate Sedation, By Same Dr Performing Service; Pt 5Yrs+, Initial 15 Min Intra-Ser Time (Pro Cah)",,99152,CPT,Professional,Both,,,,250,212.5,7.41,250,CorVel,Worker's Compensation,23.1843972,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Moderate Sedation, By Same Dr Performing Service; Pt 5Yrs+, Initial 15 Min Intra-Ser Time (Pro Cah)",,99152,CPT,Professional,Both,,,,250,212.5,7.41,250,First Health Group Corporation,First Health Network,242.5,97,,percent of total billed charges,,
"Moderate Sedation, By Same Dr Performing Service; Pt 5Yrs+, Initial 15 Min Intra-Ser Time (Pro Cah)",,99152,CPT,Professional,Both,,,,250,212.5,7.41,250,"Health Partners, Inc.",Commercial,24.67,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Moderate Sedation, By Same Dr Performing Service; Pt 5Yrs+, Initial 15 Min Intra-Ser Time (Pro Cah)",,99152,CPT,Professional,Both,,,,250,212.5,7.41,250,"Health Partners, Inc.",Medicare Advantage,13.432,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Moderate Sedation, By Same Dr Performing Service; Pt 5Yrs+, Initial 15 Min Intra-Ser Time (Pro Cah)",,99152,CPT,Professional,Both,,,,250,212.5,7.41,250,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),11.52,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Moderate Sedation, By Same Dr Performing Service; Pt 5Yrs+, Initial 15 Min Intra-Ser Time (Pro Cah)",,99152,CPT,Professional,Both,,,,250,212.5,7.41,250,"Health Partners, Inc.",State of Minnesota Advantage Program,21.253205,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Moderate Sedation, By Same Dr Performing Service; Pt 5Yrs+, Initial 15 Min Intra-Ser Time (Pro Cah)",,99152,CPT,Professional,Both,,,,250,212.5,7.41,250,"Health Partners, Inc.",State Public Programs,7.41,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Moderate Sedation, By Same Dr Performing Service; Pt 5Yrs+, Initial 15 Min Intra-Ser Time (Pro Cah)",,99152,CPT,Professional,Both,,,,250,212.5,7.41,250,Humana Insurance Company,Commercial PPO,11.68,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Moderate Sedation, By Same Dr Performing Service; Pt 5Yrs+, Initial 15 Min Intra-Ser Time (Pro Cah)",,99152,CPT,Professional,Both,,,,250,212.5,7.41,250,Humana Insurance Company,Medicare PPO,250,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Moderate Sedation, By Same Dr Performing Service; Pt 5Yrs+, Initial 15 Min Intra-Ser Time (Pro Cah)",,99152,CPT,Professional,Both,,,,250,212.5,7.41,250,Medica,Individual & Family,212,84.8,,percent of total billed charges,,
"Moderate Sedation, By Same Dr Performing Service; Pt 5Yrs+, Initial 15 Min Intra-Ser Time (Pro Cah)",,99152,CPT,Professional,Both,,,,250,212.5,7.41,250,Medica,Medica Advantage Solution,124.5,49.8,,percent of total billed charges,,
"Moderate Sedation, By Same Dr Performing Service; Pt 5Yrs+, Initial 15 Min Intra-Ser Time (Pro Cah)",,99152,CPT,Professional,Both,,,,250,212.5,7.41,250,Medica,Medical Assistance,8.55,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Moderate Sedation, By Same Dr Performing Service; Pt 5Yrs+, Initial 15 Min Intra-Ser Time (Pro Cah)",,99152,CPT,Professional,Both,,,,250,212.5,7.41,250,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,11.68,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Moderate Sedation, By Same Dr Performing Service; Pt 5Yrs+, Initial 15 Min Intra-Ser Time (Pro Cah)",,99152,CPT,Professional,Both,,,,250,212.5,7.41,250,"Multiplan, Inc.","Multiplan, Inc.",235,94,,percent of total billed charges,,
"Moderate Sedation, By Same Dr Performing Service; Pt 5Yrs+, Initial 15 Min Intra-Ser Time (Pro Cah)",,99152,CPT,Professional,Both,,,,250,212.5,7.41,250,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,225.25,90.1,,percent of total billed charges,,
"Moderate Sedation, By Same Dr Performing Service; Pt 5Yrs+, Initial 15 Min Intra-Ser Time (Pro Cah)",,99152,CPT,Professional,Both,,,,250,212.5,7.41,250,"Preferred One Administrative Services, INC.",PPO,246.5,98.6,,percent of total billed charges,,
"Moderate Sedation, By Same Dr Performing Service; Pt 5Yrs+, Initial 15 Min Intra-Ser Time (Pro Cah)",,99152,CPT,Professional,Both,,,,250,212.5,7.41,250,PrimeWest Health,Minnesota Senior Health Options (MSHO),13.432,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Moderate Sedation, By Same Dr Performing Service; Pt 5Yrs+, Initial 15 Min Intra-Ser Time (Pro Cah)",,99152,CPT,Professional,Both,,,,250,212.5,7.41,250,PrimeWest Health,MinnesotaCare,9.1535504,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Moderate Sedation, By Same Dr Performing Service; Pt 5Yrs+, Initial 15 Min Intra-Ser Time (Pro Cah)",,99152,CPT,Professional,Both,,,,250,212.5,7.41,250,Sanford Health Plan,Sanford Health Plan,220,88,,percent of total billed charges,,
"Moderate Sedation, By Same Dr Performing Service; Pt 5Yrs+, Initial 15 Min Intra-Ser Time (Pro Cah)",,99152,CPT,Professional,Both,,,,250,212.5,7.41,250,"UCare Health, Inc.",Individual & Family Plan,18.987008,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Moderate Sedation, By Same Dr Performing Service; Pt 5Yrs+, Initial 15 Min Intra-Ser Time (Pro Cah)",,99152,CPT,Professional,Both,,,,250,212.5,7.41,250,"UCare Health, Inc.",Medical Assistance,9.410192,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Moderate Sedation, By Same Dr Performing Service; Pt 5Yrs+, Initial 15 Min Intra-Ser Time (Pro Cah)",,99152,CPT,Professional,Both,,,,250,212.5,7.41,250,"UCare Health, Inc.",Medicare Advantage,13.432,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Moderate Sedation, By Same Dr Performing Service; Pt 5Yrs+, Initial 15 Min Intra-Ser Time (Pro Cah)",,99152,CPT,Professional,Both,,,,250,212.5,7.41,250,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),10.7456,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Moderate Sedation, By Same Dr Performing Service; Pt 5Yrs+, Initial 15 Min Intra-Ser Time (Pro Cah)",,99152,CPT,Professional,Both,,,,250,212.5,7.41,250,UnitedHealthcare,Individual & Family,250,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Moderate Sedation, By Same Dr Performing Service; Pt 5Yrs+, Initial 15 Min Intra-Ser Time (Pro Cah)",,99152,CPT,Professional,Both,,,,250,212.5,7.41,250,UnitedHealthcare,Medicare Advantage,13.432,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Moderate Sedation, By Same Dr Performing Service; Pt 5Yrs+, Initial 15 Min Intra-Ser Time (Pro Cah)",,99152,CPT,Professional,Both,,,,250,212.5,7.41,250,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,8.55472,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Moderate Sedation, By Same Dr Performing Service; Pt 5Yrs+, Initial 15 Min Intra-Service Time (Pbb)",,99152,CPT,Facility,Outpatient,,,,122,103.7,34.9652,122,Aetna,Commercial,112.24,92,,percent of total billed charges,,
"Moderate Sedation, By Same Dr Performing Service; Pt 5Yrs+, Initial 15 Min Intra-Service Time (Pbb)",,99152,CPT,Professional,Outpatient,,,,128,108.8,7.41,128,Aetna,Commercial,108.8,85,,percent of total billed charges,,
"Moderate Sedation, By Same Dr Performing Service; Pt 5Yrs+, Initial 15 Min Intra-Service Time (Pbb)",,99152,CPT,Facility,Outpatient,,,,122,103.7,34.9652,122,Aetna,Medicare Advantage,59.78,49,,percent of total billed charges,,
"Moderate Sedation, By Same Dr Performing Service; Pt 5Yrs+, Initial 15 Min Intra-Service Time (Pbb)",,99152,CPT,Professional,Outpatient,,,,128,108.8,7.41,128,Aetna,Medicare Advantage,12.15,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Moderate Sedation, By Same Dr Performing Service; Pt 5Yrs+, Initial 15 Min Intra-Service Time (Pbb)",,99152,CPT,Facility,Outpatient,,,,122,103.7,34.9652,122,Aetna,PPO,113.46,93,,percent of total billed charges,,
"Moderate Sedation, By Same Dr Performing Service; Pt 5Yrs+, Initial 15 Min Intra-Service Time (Pbb)",,99152,CPT,Professional,Outpatient,,,,128,108.8,7.41,128,Aetna,PPO,119.04,93,,percent of total billed charges,,
"Moderate Sedation, By Same Dr Performing Service; Pt 5Yrs+, Initial 15 Min Intra-Service Time (Pbb)",,99152,CPT,Facility,Outpatient,,,,122,103.7,34.9652,122,America's PPO,America's PPO,117.1566,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Moderate Sedation, By Same Dr Performing Service; Pt 5Yrs+, Initial 15 Min Intra-Service Time (Pbb)",,99152,CPT,Professional,Outpatient,,,,128,108.8,7.41,128,America's PPO,America's PPO,109.3632,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Moderate Sedation, By Same Dr Performing Service; Pt 5Yrs+, Initial 15 Min Intra-Service Time (Pbb)",,99152,CPT,Facility,Outpatient,,,,122,103.7,34.9652,122,BlueCross BlueShield Minnesota, Federal Employee Program,120.048,98.4,,percent of total billed charges,,
"Moderate Sedation, By Same Dr Performing Service; Pt 5Yrs+, Initial 15 Min Intra-Service Time (Pbb)",,99152,CPT,Professional,Outpatient,,,,128,108.8,7.41,128,BlueCross BlueShield Minnesota, Federal Employee Program,21.59,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Moderate Sedation, By Same Dr Performing Service; Pt 5Yrs+, Initial 15 Min Intra-Service Time (Pbb)",,99152,CPT,Facility,Outpatient,,,,122,103.7,34.9652,122,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,122,100,,percent of total billed charges,,
"Moderate Sedation, By Same Dr Performing Service; Pt 5Yrs+, Initial 15 Min Intra-Service Time (Pbb)",,99152,CPT,Professional,Outpatient,,,,128,108.8,7.41,128,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,21.93544,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Moderate Sedation, By Same Dr Performing Service; Pt 5Yrs+, Initial 15 Min Intra-Service Time (Pbb)",,99152,CPT,Facility,Outpatient,,,,122,103.7,34.9652,122,BlueCross BlueShield Minnesota,High Value Network Plan,109.8,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
"Moderate Sedation, By Same Dr Performing Service; Pt 5Yrs+, Initial 15 Min Intra-Service Time (Pbb)",,99152,CPT,Professional,Outpatient,,,,128,108.8,7.41,128,BlueCross BlueShield Minnesota,High Value Network Plan,21.93544,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Moderate Sedation, By Same Dr Performing Service; Pt 5Yrs+, Initial 15 Min Intra-Service Time (Pbb)",,99152,CPT,Facility,Outpatient,,,,122,103.7,34.9652,122,BlueCross BlueShield Minnesota,Medicare Advantage,59.78,49,,percent of total billed charges,,
"Moderate Sedation, By Same Dr Performing Service; Pt 5Yrs+, Initial 15 Min Intra-Service Time (Pbb)",,99152,CPT,Professional,Outpatient,,,,128,108.8,7.41,128,BlueCross BlueShield Minnesota,Medicare Advantage,13.432,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Moderate Sedation, By Same Dr Performing Service; Pt 5Yrs+, Initial 15 Min Intra-Service Time (Pbb)",,99152,CPT,Professional,Outpatient,,,,128,108.8,7.41,128,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,21.93544,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Moderate Sedation, By Same Dr Performing Service; Pt 5Yrs+, Initial 15 Min Intra-Service Time (Pbb)",,99152,CPT,Facility,Outpatient,,,,122,103.7,34.9652,122,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,34.9652,28.66,,percent of total billed charges,,
"Moderate Sedation, By Same Dr Performing Service; Pt 5Yrs+, Initial 15 Min Intra-Service Time (Pbb)",,99152,CPT,Professional,Outpatient,,,,128,108.8,7.41,128,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,8.55472,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Moderate Sedation, By Same Dr Performing Service; Pt 5Yrs+, Initial 15 Min Intra-Service Time (Pbb)",,99152,CPT,Facility,Outpatient,,,,122,103.7,34.9652,122,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),59.78,49,,percent of total billed charges,,
"Moderate Sedation, By Same Dr Performing Service; Pt 5Yrs+, Initial 15 Min Intra-Service Time (Pbb)",,99152,CPT,Professional,Outpatient,,,,128,108.8,7.41,128,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),13.432,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Moderate Sedation, By Same Dr Performing Service; Pt 5Yrs+, Initial 15 Min Intra-Service Time (Pbb)",,99152,CPT,Facility,Outpatient,,,,122,103.7,34.9652,122,CorVel,Worker's Compensation,122,100,,percent of total billed charges,,
"Moderate Sedation, By Same Dr Performing Service; Pt 5Yrs+, Initial 15 Min Intra-Service Time (Pbb)",,99152,CPT,Professional,Outpatient,,,,128,108.8,7.41,128,CorVel,Worker's Compensation,23.1843972,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Moderate Sedation, By Same Dr Performing Service; Pt 5Yrs+, Initial 15 Min Intra-Service Time (Pbb)",,99152,CPT,Facility,Outpatient,,,,122,103.7,34.9652,122,First Health Group Corporation,First Health Network,118.34,97,,percent of total billed charges,,
"Moderate Sedation, By Same Dr Performing Service; Pt 5Yrs+, Initial 15 Min Intra-Service Time (Pbb)",,99152,CPT,Professional,Outpatient,,,,128,108.8,7.41,128,First Health Group Corporation,First Health Network,124.16,97,,percent of total billed charges,,
"Moderate Sedation, By Same Dr Performing Service; Pt 5Yrs+, Initial 15 Min Intra-Service Time (Pbb)",,99152,CPT,Facility,Outpatient,,,,122,103.7,34.9652,122,"Health Partners, Inc.",Commercial,115.412,94.6,,percent of total billed charges,,
"Moderate Sedation, By Same Dr Performing Service; Pt 5Yrs+, Initial 15 Min Intra-Service Time (Pbb)",,99152,CPT,Professional,Outpatient,,,,128,108.8,7.41,128,"Health Partners, Inc.",Commercial,24.67,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Moderate Sedation, By Same Dr Performing Service; Pt 5Yrs+, Initial 15 Min Intra-Service Time (Pbb)",,99152,CPT,Facility,Outpatient,,,,122,103.7,34.9652,122,"Health Partners, Inc.",Medicare Advantage,59.78,49,,percent of total billed charges,,
"Moderate Sedation, By Same Dr Performing Service; Pt 5Yrs+, Initial 15 Min Intra-Service Time (Pbb)",,99152,CPT,Professional,Outpatient,,,,128,108.8,7.41,128,"Health Partners, Inc.",Medicare Advantage,13.432,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Moderate Sedation, By Same Dr Performing Service; Pt 5Yrs+, Initial 15 Min Intra-Service Time (Pbb)",,99152,CPT,Facility,Outpatient,,,,122,103.7,34.9652,122,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),73.2,60,,percent of total billed charges,,
"Moderate Sedation, By Same Dr Performing Service; Pt 5Yrs+, Initial 15 Min Intra-Service Time (Pbb)",,99152,CPT,Professional,Outpatient,,,,128,108.8,7.41,128,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),11.52,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Moderate Sedation, By Same Dr Performing Service; Pt 5Yrs+, Initial 15 Min Intra-Service Time (Pbb)",,99152,CPT,Facility,Outpatient,,,,122,103.7,34.9652,122,"Health Partners, Inc.",State of Minnesota Advantage Program,99.43,81.5,,percent of total billed charges,,
"Moderate Sedation, By Same Dr Performing Service; Pt 5Yrs+, Initial 15 Min Intra-Service Time (Pbb)",,99152,CPT,Professional,Outpatient,,,,128,108.8,7.41,128,"Health Partners, Inc.",State of Minnesota Advantage Program,21.253205,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Moderate Sedation, By Same Dr Performing Service; Pt 5Yrs+, Initial 15 Min Intra-Service Time (Pbb)",,99152,CPT,Facility,Outpatient,,,,122,103.7,34.9652,122,"Health Partners, Inc.",State Public Programs,61,50,,percent of total billed charges,,
"Moderate Sedation, By Same Dr Performing Service; Pt 5Yrs+, Initial 15 Min Intra-Service Time (Pbb)",,99152,CPT,Professional,Outpatient,,,,128,108.8,7.41,128,"Health Partners, Inc.",State Public Programs,7.41,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Moderate Sedation, By Same Dr Performing Service; Pt 5Yrs+, Initial 15 Min Intra-Service Time (Pbb)",,99152,CPT,Facility,Outpatient,,,,122,103.7,34.9652,122,Humana Insurance Company,Commercial PPO,115.9,95,,percent of total billed charges,,
"Moderate Sedation, By Same Dr Performing Service; Pt 5Yrs+, Initial 15 Min Intra-Service Time (Pbb)",,99152,CPT,Professional,Outpatient,,,,128,108.8,7.41,128,Humana Insurance Company,Commercial PPO,11.68,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Moderate Sedation, By Same Dr Performing Service; Pt 5Yrs+, Initial 15 Min Intra-Service Time (Pbb)",,99152,CPT,Facility,Outpatient,,,,122,103.7,34.9652,122,Humana Insurance Company,Medicare PPO,59.78,49,,percent of total billed charges,,
"Moderate Sedation, By Same Dr Performing Service; Pt 5Yrs+, Initial 15 Min Intra-Service Time (Pbb)",,99152,CPT,Professional,Outpatient,,,,128,108.8,7.41,128,Humana Insurance Company,Medicare PPO,128,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Moderate Sedation, By Same Dr Performing Service; Pt 5Yrs+, Initial 15 Min Intra-Service Time (Pbb)",,99152,CPT,Facility,Outpatient,,,,122,103.7,34.9652,122,Medica,Individual & Family,120.902,99.1,,percent of total billed charges,,
"Moderate Sedation, By Same Dr Performing Service; Pt 5Yrs+, Initial 15 Min Intra-Service Time (Pbb)",,99152,CPT,Professional,Outpatient,,,,128,108.8,7.41,128,Medica,Individual & Family,108.544,84.8,,percent of total billed charges,,
"Moderate Sedation, By Same Dr Performing Service; Pt 5Yrs+, Initial 15 Min Intra-Service Time (Pbb)",,99152,CPT,Facility,Outpatient,,,,122,103.7,34.9652,122,Medica,Medica Advantage Solution,60.756,49.8,,percent of total billed charges,,
"Moderate Sedation, By Same Dr Performing Service; Pt 5Yrs+, Initial 15 Min Intra-Service Time (Pbb)",,99152,CPT,Professional,Outpatient,,,,128,108.8,7.41,128,Medica,Medica Advantage Solution,63.744,49.8,,percent of total billed charges,,
"Moderate Sedation, By Same Dr Performing Service; Pt 5Yrs+, Initial 15 Min Intra-Service Time (Pbb)",,99152,CPT,Facility,Outpatient,,,,122,103.7,34.9652,122,Medica,Medical Assistance,54.412,44.6,,percent of total billed charges,,
"Moderate Sedation, By Same Dr Performing Service; Pt 5Yrs+, Initial 15 Min Intra-Service Time (Pbb)",,99152,CPT,Professional,Outpatient,,,,128,108.8,7.41,128,Medica,Medical Assistance,8.55,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Moderate Sedation, By Same Dr Performing Service; Pt 5Yrs+, Initial 15 Min Intra-Service Time (Pbb)",,99152,CPT,Facility,Outpatient,,,,122,103.7,34.9652,122,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,60.756,49.8,,percent of total billed charges,,
"Moderate Sedation, By Same Dr Performing Service; Pt 5Yrs+, Initial 15 Min Intra-Service Time (Pbb)",,99152,CPT,Professional,Outpatient,,,,128,108.8,7.41,128,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,11.68,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Moderate Sedation, By Same Dr Performing Service; Pt 5Yrs+, Initial 15 Min Intra-Service Time (Pbb)",,99152,CPT,Facility,Outpatient,,,,122,103.7,34.9652,122,"Multiplan, Inc.","Multiplan, Inc.",114.68,94,,percent of total billed charges,,
"Moderate Sedation, By Same Dr Performing Service; Pt 5Yrs+, Initial 15 Min Intra-Service Time (Pbb)",,99152,CPT,Professional,Outpatient,,,,128,108.8,7.41,128,"Multiplan, Inc.","Multiplan, Inc.",120.32,94,,percent of total billed charges,,
"Moderate Sedation, By Same Dr Performing Service; Pt 5Yrs+, Initial 15 Min Intra-Service Time (Pbb)",,99152,CPT,Facility,Outpatient,,,,122,103.7,34.9652,122,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,109.922,90.1,,percent of total billed charges,,
"Moderate Sedation, By Same Dr Performing Service; Pt 5Yrs+, Initial 15 Min Intra-Service Time (Pbb)",,99152,CPT,Professional,Outpatient,,,,128,108.8,7.41,128,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,115.328,90.1,,percent of total billed charges,,
"Moderate Sedation, By Same Dr Performing Service; Pt 5Yrs+, Initial 15 Min Intra-Service Time (Pbb)",,99152,CPT,Facility,Outpatient,,,,122,103.7,34.9652,122,"Preferred One Administrative Services, INC.",PPO,120.292,98.6,,percent of total billed charges,,
"Moderate Sedation, By Same Dr Performing Service; Pt 5Yrs+, Initial 15 Min Intra-Service Time (Pbb)",,99152,CPT,Professional,Outpatient,,,,128,108.8,7.41,128,"Preferred One Administrative Services, INC.",PPO,126.208,98.6,,percent of total billed charges,,
"Moderate Sedation, By Same Dr Performing Service; Pt 5Yrs+, Initial 15 Min Intra-Service Time (Pbb)",,99152,CPT,Facility,Outpatient,,,,122,103.7,34.9652,122,PrimeWest Health,Minnesota Senior Health Options (MSHO),62.769,51.45,,percent of total billed charges,,
"Moderate Sedation, By Same Dr Performing Service; Pt 5Yrs+, Initial 15 Min Intra-Service Time (Pbb)",,99152,CPT,Professional,Outpatient,,,,128,108.8,7.41,128,PrimeWest Health,Minnesota Senior Health Options (MSHO),13.432,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Moderate Sedation, By Same Dr Performing Service; Pt 5Yrs+, Initial 15 Min Intra-Service Time (Pbb)",,99152,CPT,Facility,Outpatient,,,,122,103.7,34.9652,122,PrimeWest Health,MinnesotaCare,62.6592,51.36,,percent of total billed charges,,
"Moderate Sedation, By Same Dr Performing Service; Pt 5Yrs+, Initial 15 Min Intra-Service Time (Pbb)",,99152,CPT,Professional,Outpatient,,,,128,108.8,7.41,128,PrimeWest Health,MinnesotaCare,9.1535504,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Moderate Sedation, By Same Dr Performing Service; Pt 5Yrs+, Initial 15 Min Intra-Service Time (Pbb)",,99152,CPT,Facility,Outpatient,,,,122,103.7,34.9652,122,Sanford Health Plan,Sanford Health Plan,112.24,92,,percent of total billed charges,,
"Moderate Sedation, By Same Dr Performing Service; Pt 5Yrs+, Initial 15 Min Intra-Service Time (Pbb)",,99152,CPT,Professional,Outpatient,,,,128,108.8,7.41,128,Sanford Health Plan,Sanford Health Plan,112.64,88,,percent of total billed charges,,
"Moderate Sedation, By Same Dr Performing Service; Pt 5Yrs+, Initial 15 Min Intra-Service Time (Pbb)",,99152,CPT,Facility,Outpatient,,,,122,103.7,34.9652,122,"UCare Health, Inc.",Individual & Family Plan,68.747,56.35,,percent of total billed charges,,
"Moderate Sedation, By Same Dr Performing Service; Pt 5Yrs+, Initial 15 Min Intra-Service Time (Pbb)",,99152,CPT,Professional,Outpatient,,,,128,108.8,7.41,128,"UCare Health, Inc.",Individual & Family Plan,18.987008,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Moderate Sedation, By Same Dr Performing Service; Pt 5Yrs+, Initial 15 Min Intra-Service Time (Pbb)",,99152,CPT,Facility,Outpatient,,,,122,103.7,34.9652,122,"UCare Health, Inc.",Medical Assistance,61.5734,50.47,,percent of total billed charges,,
"Moderate Sedation, By Same Dr Performing Service; Pt 5Yrs+, Initial 15 Min Intra-Service Time (Pbb)",,99152,CPT,Professional,Outpatient,,,,128,108.8,7.41,128,"UCare Health, Inc.",Medical Assistance,9.410192,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Moderate Sedation, By Same Dr Performing Service; Pt 5Yrs+, Initial 15 Min Intra-Service Time (Pbb)",,99152,CPT,Facility,Outpatient,,,,122,103.7,34.9652,122,"UCare Health, Inc.",Medicare Advantage,61.5734,50.47,,percent of total billed charges,,
"Moderate Sedation, By Same Dr Performing Service; Pt 5Yrs+, Initial 15 Min Intra-Service Time (Pbb)",,99152,CPT,Professional,Outpatient,,,,128,108.8,7.41,128,"UCare Health, Inc.",Medicare Advantage,13.432,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Moderate Sedation, By Same Dr Performing Service; Pt 5Yrs+, Initial 15 Min Intra-Service Time (Pbb)",,99152,CPT,Facility,Outpatient,,,,122,103.7,34.9652,122,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),61.5734,50.47,,percent of total billed charges,,
"Moderate Sedation, By Same Dr Performing Service; Pt 5Yrs+, Initial 15 Min Intra-Service Time (Pbb)",,99152,CPT,Professional,Outpatient,,,,128,108.8,7.41,128,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),10.7456,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Moderate Sedation, By Same Dr Performing Service; Pt 5Yrs+, Initial 15 Min Intra-Service Time (Pbb)",,99152,CPT,Facility,Outpatient,,,,122,103.7,34.9652,122,UnitedHealthcare,Individual & Family,114.68,94,,percent of total billed charges,,
"Moderate Sedation, By Same Dr Performing Service; Pt 5Yrs+, Initial 15 Min Intra-Service Time (Pbb)",,99152,CPT,Professional,Outpatient,,,,128,108.8,7.41,128,UnitedHealthcare,Individual & Family,128,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Moderate Sedation, By Same Dr Performing Service; Pt 5Yrs+, Initial 15 Min Intra-Service Time (Pbb)",,99152,CPT,Facility,Outpatient,,,,122,103.7,34.9652,122,UnitedHealthcare,Medicare Advantage,59.78,49,,percent of total billed charges,,
"Moderate Sedation, By Same Dr Performing Service; Pt 5Yrs+, Initial 15 Min Intra-Service Time (Pbb)",,99152,CPT,Professional,Outpatient,,,,128,108.8,7.41,128,UnitedHealthcare,Medicare Advantage,13.432,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Moderate Sedation, By Same Dr Performing Service; Pt 5Yrs+, Initial 15 Min Intra-Service Time (Pbb)",,99152,CPT,Facility,Outpatient,,,,122,103.7,34.9652,122,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,58.56,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Moderate Sedation, By Same Dr Performing Service; Pt 5Yrs+, Initial 15 Min Intra-Service Time (Pbb)",,99152,CPT,Professional,Outpatient,,,,128,108.8,7.41,128,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,8.55472,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Moderate Sedation Same Phy/Qhcp, Each Additional 15 Mins",,99153,CPT,Facility,Both,,,,50,42.5,14.33,50,Aetna,Commercial,46,92,,percent of total billed charges,,
"Moderate Sedation Same Phy/Qhcp, Each Additional 15 Mins",,99153,CPT,Facility,Outpatient,,,,50,42.5,14.33,50,Aetna,Medicare Advantage,24.5,49,,percent of total billed charges,,
"Moderate Sedation Same Phy/Qhcp, Each Additional 15 Mins",,99153,CPT,Facility,Inpatient,,,,50,42.5,14.33,50,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Moderate Sedation Same Phy/Qhcp, Each Additional 15 Mins",,99153,CPT,Facility,Both,,,,50,42.5,14.33,50,Aetna,PPO,46.5,93,,percent of total billed charges,,
"Moderate Sedation Same Phy/Qhcp, Each Additional 15 Mins",,99153,CPT,Facility,Both,,,,50,42.5,14.33,50,America's PPO,America's PPO,48.015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Moderate Sedation Same Phy/Qhcp, Each Additional 15 Mins",,99153,CPT,Facility,Both,,,,50,42.5,14.33,50,BlueCross BlueShield Minnesota, Federal Employee Program,49.2,98.4,,percent of total billed charges,,
"Moderate Sedation Same Phy/Qhcp, Each Additional 15 Mins",,99153,CPT,Facility,Both,,,,50,42.5,14.33,50,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,50,100,,percent of total billed charges,,
"Moderate Sedation Same Phy/Qhcp, Each Additional 15 Mins",,99153,CPT,Facility,Both,,,,50,42.5,14.33,50,BlueCross BlueShield Minnesota,High Value Network Plan,45,90,,percent of total billed charges,,
"Moderate Sedation Same Phy/Qhcp, Each Additional 15 Mins",,99153,CPT,Facility,Outpatient,,,,50,42.5,14.33,50,BlueCross BlueShield Minnesota,Medicare Advantage,24.5,49,,percent of total billed charges,,
"Moderate Sedation Same Phy/Qhcp, Each Additional 15 Mins",,99153,CPT,Facility,Inpatient,,,,50,42.5,14.33,50,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Moderate Sedation Same Phy/Qhcp, Each Additional 15 Mins",,99153,CPT,Facility,Both,,,,50,42.5,14.33,50,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,44.285,88.57,,percent of total billed charges,,
"Moderate Sedation Same Phy/Qhcp, Each Additional 15 Mins",,99153,CPT,Facility,Both,,,,50,42.5,14.33,50,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,14.33,28.66,,percent of total billed charges,,
"Moderate Sedation Same Phy/Qhcp, Each Additional 15 Mins",,99153,CPT,Facility,Outpatient,,,,50,42.5,14.33,50,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),24.5,49,,percent of total billed charges,,
"Moderate Sedation Same Phy/Qhcp, Each Additional 15 Mins",,99153,CPT,Facility,Inpatient,,,,50,42.5,14.33,50,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Moderate Sedation Same Phy/Qhcp, Each Additional 15 Mins",,99153,CPT,Facility,Both,,,,50,42.5,14.33,50,CorVel,Worker's Compensation,50,100,,percent of total billed charges,,
"Moderate Sedation Same Phy/Qhcp, Each Additional 15 Mins",,99153,CPT,Facility,Both,,,,50,42.5,14.33,50,First Health Group Corporation,First Health Network,48.5,97,,percent of total billed charges,,
"Moderate Sedation Same Phy/Qhcp, Each Additional 15 Mins",,99153,CPT,Facility,Both,,,,50,42.5,14.33,50,"Health Partners, Inc.",Commercial,47.3,94.6,,percent of total billed charges,,
"Moderate Sedation Same Phy/Qhcp, Each Additional 15 Mins",,99153,CPT,Facility,Outpatient,,,,50,42.5,14.33,50,"Health Partners, Inc.",Medicare Advantage,24.5,49,,percent of total billed charges,,
"Moderate Sedation Same Phy/Qhcp, Each Additional 15 Mins",,99153,CPT,Facility,Inpatient,,,,50,42.5,14.33,50,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Moderate Sedation Same Phy/Qhcp, Each Additional 15 Mins",,99153,CPT,Facility,Both,,,,50,42.5,14.33,50,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),30,60,,percent of total billed charges,,
"Moderate Sedation Same Phy/Qhcp, Each Additional 15 Mins",,99153,CPT,Facility,Both,,,,50,42.5,14.33,50,"Health Partners, Inc.",State of Minnesota Advantage Program,40.75,81.5,,percent of total billed charges,,
"Moderate Sedation Same Phy/Qhcp, Each Additional 15 Mins",,99153,CPT,Facility,Both,,,,50,42.5,14.33,50,"Health Partners, Inc.",State Public Programs,25,50,,percent of total billed charges,,
"Moderate Sedation Same Phy/Qhcp, Each Additional 15 Mins",,99153,CPT,Facility,Both,,,,50,42.5,14.33,50,Humana Insurance Company,Commercial PPO,47.5,95,,percent of total billed charges,,
"Moderate Sedation Same Phy/Qhcp, Each Additional 15 Mins",,99153,CPT,Facility,Outpatient,,,,50,42.5,14.33,50,Humana Insurance Company,Medicare PPO,24.5,49,,percent of total billed charges,,
"Moderate Sedation Same Phy/Qhcp, Each Additional 15 Mins",,99153,CPT,Facility,Inpatient,,,,50,42.5,14.33,50,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Moderate Sedation Same Phy/Qhcp, Each Additional 15 Mins",,99153,CPT,Facility,Both,,,,50,42.5,14.33,50,Medica,Individual & Family,49.55,99.1,,percent of total billed charges,,
"Moderate Sedation Same Phy/Qhcp, Each Additional 15 Mins",,99153,CPT,Facility,Outpatient,,,,50,42.5,14.33,50,Medica,Medica Advantage Solution,24.9,49.8,,percent of total billed charges,,
"Moderate Sedation Same Phy/Qhcp, Each Additional 15 Mins",,99153,CPT,Facility,Inpatient,,,,50,42.5,14.33,50,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Moderate Sedation Same Phy/Qhcp, Each Additional 15 Mins",,99153,CPT,Facility,Outpatient,,,,50,42.5,14.33,50,Medica,Medical Assistance,22.3,44.6,,percent of total billed charges,,
"Moderate Sedation Same Phy/Qhcp, Each Additional 15 Mins",,99153,CPT,Facility,Inpatient,,,,50,42.5,14.33,50,Medica,Medical Assistance,,,,,Included in per diem rate,
"Moderate Sedation Same Phy/Qhcp, Each Additional 15 Mins",,99153,CPT,Facility,Outpatient,,,,50,42.5,14.33,50,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,24.9,49.8,,percent of total billed charges,,
"Moderate Sedation Same Phy/Qhcp, Each Additional 15 Mins",,99153,CPT,Facility,Inpatient,,,,50,42.5,14.33,50,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Moderate Sedation Same Phy/Qhcp, Each Additional 15 Mins",,99153,CPT,Facility,Both,,,,50,42.5,14.33,50,"Multiplan, Inc.","Multiplan, Inc.",47,94,,percent of total billed charges,,
"Moderate Sedation Same Phy/Qhcp, Each Additional 15 Mins",,99153,CPT,Facility,Outpatient,,,,50,42.5,14.33,50,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,45.05,90.1,,percent of total billed charges,,
"Moderate Sedation Same Phy/Qhcp, Each Additional 15 Mins",,99153,CPT,Facility,Inpatient,,,,50,42.5,14.33,50,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Moderate Sedation Same Phy/Qhcp, Each Additional 15 Mins",,99153,CPT,Facility,Both,,,,50,42.5,14.33,50,"Preferred One Administrative Services, INC.",PPO,49.3,98.6,,percent of total billed charges,,
"Moderate Sedation Same Phy/Qhcp, Each Additional 15 Mins",,99153,CPT,Facility,Outpatient,,,,50,42.5,14.33,50,PrimeWest Health,Minnesota Senior Health Options (MSHO),25.725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Moderate Sedation Same Phy/Qhcp, Each Additional 15 Mins",,99153,CPT,Facility,Inpatient,,,,50,42.5,14.33,50,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Moderate Sedation Same Phy/Qhcp, Each Additional 15 Mins",,99153,CPT,Facility,Outpatient,,,,50,42.5,14.33,50,PrimeWest Health,MinnesotaCare,25.68,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Moderate Sedation Same Phy/Qhcp, Each Additional 15 Mins",,99153,CPT,Facility,Inpatient,,,,50,42.5,14.33,50,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Moderate Sedation Same Phy/Qhcp, Each Additional 15 Mins",,99153,CPT,Facility,Both,,,,50,42.5,14.33,50,Sanford Health Plan,Sanford Health Plan,46,92,,percent of total billed charges,,
"Moderate Sedation Same Phy/Qhcp, Each Additional 15 Mins",,99153,CPT,Facility,Outpatient,,,,50,42.5,14.33,50,"UCare Health, Inc.",Individual & Family Plan,28.175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Moderate Sedation Same Phy/Qhcp, Each Additional 15 Mins",,99153,CPT,Facility,Inpatient,,,,50,42.5,14.33,50,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Moderate Sedation Same Phy/Qhcp, Each Additional 15 Mins",,99153,CPT,Facility,Outpatient,,,,50,42.5,14.33,50,"UCare Health, Inc.",Medical Assistance,25.235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Moderate Sedation Same Phy/Qhcp, Each Additional 15 Mins",,99153,CPT,Facility,Inpatient,,,,50,42.5,14.33,50,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Moderate Sedation Same Phy/Qhcp, Each Additional 15 Mins",,99153,CPT,Facility,Outpatient,,,,50,42.5,14.33,50,"UCare Health, Inc.",Medicare Advantage,25.235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Moderate Sedation Same Phy/Qhcp, Each Additional 15 Mins",,99153,CPT,Facility,Inpatient,,,,50,42.5,14.33,50,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Moderate Sedation Same Phy/Qhcp, Each Additional 15 Mins",,99153,CPT,Facility,Outpatient,,,,50,42.5,14.33,50,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),25.235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Moderate Sedation Same Phy/Qhcp, Each Additional 15 Mins",,99153,CPT,Facility,Inpatient,,,,50,42.5,14.33,50,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Moderate Sedation Same Phy/Qhcp, Each Additional 15 Mins",,99153,CPT,Facility,Both,,,,50,42.5,14.33,50,UnitedHealthcare,Individual & Family,47,94,,percent of total billed charges,,
"Moderate Sedation Same Phy/Qhcp, Each Additional 15 Mins",,99153,CPT,Facility,Outpatient,,,,50,42.5,14.33,50,UnitedHealthcare,Medicare Advantage,24.5,49,,percent of total billed charges,,
"Moderate Sedation Same Phy/Qhcp, Each Additional 15 Mins",,99153,CPT,Facility,Inpatient,,,,50,42.5,14.33,50,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Moderate Sedation Same Phy/Qhcp, Each Additional 15 Mins",,99153,CPT,Facility,Outpatient,,,,50,42.5,14.33,50,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,24,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Moderate Sedation Same Phy/Qhcp, Each Additional 15 Mins",,99153,CPT,Facility,Inpatient,,,,50,42.5,14.33,50,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Moderate Sedation, By Same Dr Performing Service; Each Additional 15 Min Intra-Service Time (Pro Cah)",,99153,CPT,Professional,Both,,,,125,106.25,6.98,125,Aetna,Commercial,106.25,85,,percent of total billed charges,,
"Moderate Sedation, By Same Dr Performing Service; Each Additional 15 Min Intra-Service Time (Pro Cah)",,99153,CPT,Professional,Both,,,,125,106.25,6.98,125,Aetna,Medicare Advantage,10.73,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Moderate Sedation, By Same Dr Performing Service; Each Additional 15 Min Intra-Service Time (Pro Cah)",,99153,CPT,Professional,Both,,,,125,106.25,6.98,125,Aetna,PPO,116.25,93,,percent of total billed charges,,
"Moderate Sedation, By Same Dr Performing Service; Each Additional 15 Min Intra-Service Time (Pro Cah)",,99153,CPT,Professional,Both,,,,125,106.25,6.98,125,America's PPO,America's PPO,106.8,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Moderate Sedation, By Same Dr Performing Service; Each Additional 15 Min Intra-Service Time (Pro Cah)",,99153,CPT,Professional,Both,,,,125,106.25,6.98,125,BlueCross BlueShield Minnesota, Federal Employee Program,19.26,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Moderate Sedation, By Same Dr Performing Service; Each Additional 15 Min Intra-Service Time (Pro Cah)",,99153,CPT,Professional,Both,,,,125,106.25,6.98,125,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,19.56816,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Moderate Sedation, By Same Dr Performing Service; Each Additional 15 Min Intra-Service Time (Pro Cah)",,99153,CPT,Professional,Both,,,,125,106.25,6.98,125,BlueCross BlueShield Minnesota,High Value Network Plan,19.56816,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Moderate Sedation, By Same Dr Performing Service; Each Additional 15 Min Intra-Service Time (Pro Cah)",,99153,CPT,Professional,Both,,,,125,106.25,6.98,125,BlueCross BlueShield Minnesota,Medicare Advantage,12.5695,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Moderate Sedation, By Same Dr Performing Service; Each Additional 15 Min Intra-Service Time (Pro Cah)",,99153,CPT,Professional,Both,,,,125,106.25,6.98,125,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,19.56816,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Moderate Sedation, By Same Dr Performing Service; Each Additional 15 Min Intra-Service Time (Pro Cah)",,99153,CPT,Professional,Both,,,,125,106.25,6.98,125,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,8.05688,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Moderate Sedation, By Same Dr Performing Service; Each Additional 15 Min Intra-Service Time (Pro Cah)",,99153,CPT,Professional,Both,,,,125,106.25,6.98,125,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),12.5695,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Moderate Sedation, By Same Dr Performing Service; Each Additional 15 Min Intra-Service Time (Pro Cah)",,99153,CPT,Professional,Both,,,,125,106.25,6.98,125,CorVel,Worker's Compensation,20.8871832,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Moderate Sedation, By Same Dr Performing Service; Each Additional 15 Min Intra-Service Time (Pro Cah)",,99153,CPT,Professional,Both,,,,125,106.25,6.98,125,First Health Group Corporation,First Health Network,121.25,97,,percent of total billed charges,,
"Moderate Sedation, By Same Dr Performing Service; Each Additional 15 Min Intra-Service Time (Pro Cah)",,99153,CPT,Professional,Both,,,,125,106.25,6.98,125,"Health Partners, Inc.",Commercial,22.49,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Moderate Sedation, By Same Dr Performing Service; Each Additional 15 Min Intra-Service Time (Pro Cah)",,99153,CPT,Professional,Both,,,,125,106.25,6.98,125,"Health Partners, Inc.",Medicare Advantage,12.5695,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Moderate Sedation, By Same Dr Performing Service; Each Additional 15 Min Intra-Service Time (Pro Cah)",,99153,CPT,Professional,Both,,,,125,106.25,6.98,125,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),11.18,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Moderate Sedation, By Same Dr Performing Service; Each Additional 15 Min Intra-Service Time (Pro Cah)",,99153,CPT,Professional,Both,,,,125,106.25,6.98,125,"Health Partners, Inc.",State of Minnesota Advantage Program,19.375135,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Moderate Sedation, By Same Dr Performing Service; Each Additional 15 Min Intra-Service Time (Pro Cah)",,99153,CPT,Professional,Both,,,,125,106.25,6.98,125,"Health Partners, Inc.",State Public Programs,6.98,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Moderate Sedation, By Same Dr Performing Service; Each Additional 15 Min Intra-Service Time (Pro Cah)",,99153,CPT,Professional,Both,,,,125,106.25,6.98,125,Humana Insurance Company,Commercial PPO,10.93,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Moderate Sedation, By Same Dr Performing Service; Each Additional 15 Min Intra-Service Time (Pro Cah)",,99153,CPT,Professional,Both,,,,125,106.25,6.98,125,Humana Insurance Company,Medicare PPO,125,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Moderate Sedation, By Same Dr Performing Service; Each Additional 15 Min Intra-Service Time (Pro Cah)",,99153,CPT,Professional,Both,,,,125,106.25,6.98,125,Medica,Individual & Family,106,84.8,,percent of total billed charges,,
"Moderate Sedation, By Same Dr Performing Service; Each Additional 15 Min Intra-Service Time (Pro Cah)",,99153,CPT,Professional,Both,,,,125,106.25,6.98,125,Medica,Medica Advantage Solution,62.25,49.8,,percent of total billed charges,,
"Moderate Sedation, By Same Dr Performing Service; Each Additional 15 Min Intra-Service Time (Pro Cah)",,99153,CPT,Professional,Both,,,,125,106.25,6.98,125,Medica,Medical Assistance,8.06,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Moderate Sedation, By Same Dr Performing Service; Each Additional 15 Min Intra-Service Time (Pro Cah)",,99153,CPT,Professional,Both,,,,125,106.25,6.98,125,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,10.93,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Moderate Sedation, By Same Dr Performing Service; Each Additional 15 Min Intra-Service Time (Pro Cah)",,99153,CPT,Professional,Both,,,,125,106.25,6.98,125,"Multiplan, Inc.","Multiplan, Inc.",117.5,94,,percent of total billed charges,,
"Moderate Sedation, By Same Dr Performing Service; Each Additional 15 Min Intra-Service Time (Pro Cah)",,99153,CPT,Professional,Both,,,,125,106.25,6.98,125,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,112.625,90.1,,percent of total billed charges,,
"Moderate Sedation, By Same Dr Performing Service; Each Additional 15 Min Intra-Service Time (Pro Cah)",,99153,CPT,Professional,Both,,,,125,106.25,6.98,125,"Preferred One Administrative Services, INC.",PPO,123.25,98.6,,percent of total billed charges,,
"Moderate Sedation, By Same Dr Performing Service; Each Additional 15 Min Intra-Service Time (Pro Cah)",,99153,CPT,Professional,Both,,,,125,106.25,6.98,125,PrimeWest Health,Minnesota Senior Health Options (MSHO),12.5695,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Moderate Sedation, By Same Dr Performing Service; Each Additional 15 Min Intra-Service Time (Pro Cah)",,99153,CPT,Professional,Both,,,,125,106.25,6.98,125,PrimeWest Health,MinnesotaCare,8.6208616,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Moderate Sedation, By Same Dr Performing Service; Each Additional 15 Min Intra-Service Time (Pro Cah)",,99153,CPT,Professional,Both,,,,125,106.25,6.98,125,Sanford Health Plan,Sanford Health Plan,110,88,,percent of total billed charges,,
"Moderate Sedation, By Same Dr Performing Service; Each Additional 15 Min Intra-Service Time (Pro Cah)",,99153,CPT,Professional,Both,,,,125,106.25,6.98,125,"UCare Health, Inc.",Individual & Family Plan,17.767808,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Moderate Sedation, By Same Dr Performing Service; Each Additional 15 Min Intra-Service Time (Pro Cah)",,99153,CPT,Professional,Both,,,,125,106.25,6.98,125,"UCare Health, Inc.",Medical Assistance,8.862568,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Moderate Sedation, By Same Dr Performing Service; Each Additional 15 Min Intra-Service Time (Pro Cah)",,99153,CPT,Professional,Both,,,,125,106.25,6.98,125,"UCare Health, Inc.",Medicare Advantage,12.5695,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Moderate Sedation, By Same Dr Performing Service; Each Additional 15 Min Intra-Service Time (Pro Cah)",,99153,CPT,Professional,Both,,,,125,106.25,6.98,125,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),10.0556,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Moderate Sedation, By Same Dr Performing Service; Each Additional 15 Min Intra-Service Time (Pro Cah)",,99153,CPT,Professional,Both,,,,125,106.25,6.98,125,UnitedHealthcare,Individual & Family,125,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Moderate Sedation, By Same Dr Performing Service; Each Additional 15 Min Intra-Service Time (Pro Cah)",,99153,CPT,Professional,Both,,,,125,106.25,6.98,125,UnitedHealthcare,Medicare Advantage,12.5695,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Moderate Sedation, By Same Dr Performing Service; Each Additional 15 Min Intra-Service Time (Pro Cah)",,99153,CPT,Professional,Both,,,,125,106.25,6.98,125,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,8.05688,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Moderate Sedation Other Phy/Qhcp, Initial 15 Min, Less Than 5 Yrs",,99155,CPT,Facility,Both,,,,431,366.35,123.5246,431,Aetna,Commercial,396.52,92,,percent of total billed charges,,
"Moderate Sedation Other Phy/Qhcp, Initial 15 Min, Less Than 5 Yrs",,99155,CPT,Facility,Outpatient,,,,431,366.35,123.5246,431,Aetna,Medicare Advantage,211.19,49,,percent of total billed charges,,
"Moderate Sedation Other Phy/Qhcp, Initial 15 Min, Less Than 5 Yrs",,99155,CPT,Facility,Inpatient,,,,431,366.35,123.5246,431,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Moderate Sedation Other Phy/Qhcp, Initial 15 Min, Less Than 5 Yrs",,99155,CPT,Facility,Both,,,,431,366.35,123.5246,431,Aetna,PPO,400.83,93,,percent of total billed charges,,
"Moderate Sedation Other Phy/Qhcp, Initial 15 Min, Less Than 5 Yrs",,99155,CPT,Facility,Both,,,,431,366.35,123.5246,431,America's PPO,America's PPO,413.8893,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Moderate Sedation Other Phy/Qhcp, Initial 15 Min, Less Than 5 Yrs",,99155,CPT,Facility,Both,,,,431,366.35,123.5246,431,BlueCross BlueShield Minnesota, Federal Employee Program,424.104,98.4,,percent of total billed charges,,
"Moderate Sedation Other Phy/Qhcp, Initial 15 Min, Less Than 5 Yrs",,99155,CPT,Facility,Both,,,,431,366.35,123.5246,431,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,431,100,,percent of total billed charges,,
"Moderate Sedation Other Phy/Qhcp, Initial 15 Min, Less Than 5 Yrs",,99155,CPT,Facility,Both,,,,431,366.35,123.5246,431,BlueCross BlueShield Minnesota,High Value Network Plan,387.9,90,,percent of total billed charges,,
"Moderate Sedation Other Phy/Qhcp, Initial 15 Min, Less Than 5 Yrs",,99155,CPT,Facility,Outpatient,,,,431,366.35,123.5246,431,BlueCross BlueShield Minnesota,Medicare Advantage,211.19,49,,percent of total billed charges,,
"Moderate Sedation Other Phy/Qhcp, Initial 15 Min, Less Than 5 Yrs",,99155,CPT,Facility,Inpatient,,,,431,366.35,123.5246,431,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Moderate Sedation Other Phy/Qhcp, Initial 15 Min, Less Than 5 Yrs",,99155,CPT,Facility,Both,,,,431,366.35,123.5246,431,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,381.7367,88.57,,percent of total billed charges,,
"Moderate Sedation Other Phy/Qhcp, Initial 15 Min, Less Than 5 Yrs",,99155,CPT,Facility,Both,,,,431,366.35,123.5246,431,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,123.5246,28.66,,percent of total billed charges,,
"Moderate Sedation Other Phy/Qhcp, Initial 15 Min, Less Than 5 Yrs",,99155,CPT,Facility,Outpatient,,,,431,366.35,123.5246,431,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),211.19,49,,percent of total billed charges,,
"Moderate Sedation Other Phy/Qhcp, Initial 15 Min, Less Than 5 Yrs",,99155,CPT,Facility,Inpatient,,,,431,366.35,123.5246,431,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Moderate Sedation Other Phy/Qhcp, Initial 15 Min, Less Than 5 Yrs",,99155,CPT,Facility,Both,,,,431,366.35,123.5246,431,CorVel,Worker's Compensation,431,100,,percent of total billed charges,,
"Moderate Sedation Other Phy/Qhcp, Initial 15 Min, Less Than 5 Yrs",,99155,CPT,Facility,Both,,,,431,366.35,123.5246,431,First Health Group Corporation,First Health Network,418.07,97,,percent of total billed charges,,
"Moderate Sedation Other Phy/Qhcp, Initial 15 Min, Less Than 5 Yrs",,99155,CPT,Facility,Both,,,,431,366.35,123.5246,431,"Health Partners, Inc.",Commercial,407.726,94.6,,percent of total billed charges,,
"Moderate Sedation Other Phy/Qhcp, Initial 15 Min, Less Than 5 Yrs",,99155,CPT,Facility,Outpatient,,,,431,366.35,123.5246,431,"Health Partners, Inc.",Medicare Advantage,211.19,49,,percent of total billed charges,,
"Moderate Sedation Other Phy/Qhcp, Initial 15 Min, Less Than 5 Yrs",,99155,CPT,Facility,Inpatient,,,,431,366.35,123.5246,431,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Moderate Sedation Other Phy/Qhcp, Initial 15 Min, Less Than 5 Yrs",,99155,CPT,Facility,Both,,,,431,366.35,123.5246,431,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),258.6,60,,percent of total billed charges,,
"Moderate Sedation Other Phy/Qhcp, Initial 15 Min, Less Than 5 Yrs",,99155,CPT,Facility,Both,,,,431,366.35,123.5246,431,"Health Partners, Inc.",State of Minnesota Advantage Program,351.265,81.5,,percent of total billed charges,,
"Moderate Sedation Other Phy/Qhcp, Initial 15 Min, Less Than 5 Yrs",,99155,CPT,Facility,Both,,,,431,366.35,123.5246,431,"Health Partners, Inc.",State Public Programs,215.5,50,,percent of total billed charges,,
"Moderate Sedation Other Phy/Qhcp, Initial 15 Min, Less Than 5 Yrs",,99155,CPT,Facility,Both,,,,431,366.35,123.5246,431,Humana Insurance Company,Commercial PPO,409.45,95,,percent of total billed charges,,
"Moderate Sedation Other Phy/Qhcp, Initial 15 Min, Less Than 5 Yrs",,99155,CPT,Facility,Outpatient,,,,431,366.35,123.5246,431,Humana Insurance Company,Medicare PPO,211.19,49,,percent of total billed charges,,
"Moderate Sedation Other Phy/Qhcp, Initial 15 Min, Less Than 5 Yrs",,99155,CPT,Facility,Inpatient,,,,431,366.35,123.5246,431,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Moderate Sedation Other Phy/Qhcp, Initial 15 Min, Less Than 5 Yrs",,99155,CPT,Facility,Both,,,,431,366.35,123.5246,431,Medica,Individual & Family,427.121,99.1,,percent of total billed charges,,
"Moderate Sedation Other Phy/Qhcp, Initial 15 Min, Less Than 5 Yrs",,99155,CPT,Facility,Outpatient,,,,431,366.35,123.5246,431,Medica,Medica Advantage Solution,214.638,49.8,,percent of total billed charges,,
"Moderate Sedation Other Phy/Qhcp, Initial 15 Min, Less Than 5 Yrs",,99155,CPT,Facility,Inpatient,,,,431,366.35,123.5246,431,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Moderate Sedation Other Phy/Qhcp, Initial 15 Min, Less Than 5 Yrs",,99155,CPT,Facility,Outpatient,,,,431,366.35,123.5246,431,Medica,Medical Assistance,192.226,44.6,,percent of total billed charges,,
"Moderate Sedation Other Phy/Qhcp, Initial 15 Min, Less Than 5 Yrs",,99155,CPT,Facility,Inpatient,,,,431,366.35,123.5246,431,Medica,Medical Assistance,,,,,Included in per diem rate,
"Moderate Sedation Other Phy/Qhcp, Initial 15 Min, Less Than 5 Yrs",,99155,CPT,Facility,Outpatient,,,,431,366.35,123.5246,431,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,214.638,49.8,,percent of total billed charges,,
"Moderate Sedation Other Phy/Qhcp, Initial 15 Min, Less Than 5 Yrs",,99155,CPT,Facility,Inpatient,,,,431,366.35,123.5246,431,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Moderate Sedation Other Phy/Qhcp, Initial 15 Min, Less Than 5 Yrs",,99155,CPT,Facility,Both,,,,431,366.35,123.5246,431,"Multiplan, Inc.","Multiplan, Inc.",405.14,94,,percent of total billed charges,,
"Moderate Sedation Other Phy/Qhcp, Initial 15 Min, Less Than 5 Yrs",,99155,CPT,Facility,Outpatient,,,,431,366.35,123.5246,431,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,388.331,90.1,,percent of total billed charges,,
"Moderate Sedation Other Phy/Qhcp, Initial 15 Min, Less Than 5 Yrs",,99155,CPT,Facility,Inpatient,,,,431,366.35,123.5246,431,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Moderate Sedation Other Phy/Qhcp, Initial 15 Min, Less Than 5 Yrs",,99155,CPT,Facility,Both,,,,431,366.35,123.5246,431,"Preferred One Administrative Services, INC.",PPO,424.966,98.6,,percent of total billed charges,,
"Moderate Sedation Other Phy/Qhcp, Initial 15 Min, Less Than 5 Yrs",,99155,CPT,Facility,Outpatient,,,,431,366.35,123.5246,431,PrimeWest Health,Minnesota Senior Health Options (MSHO),221.7495,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Moderate Sedation Other Phy/Qhcp, Initial 15 Min, Less Than 5 Yrs",,99155,CPT,Facility,Inpatient,,,,431,366.35,123.5246,431,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Moderate Sedation Other Phy/Qhcp, Initial 15 Min, Less Than 5 Yrs",,99155,CPT,Facility,Outpatient,,,,431,366.35,123.5246,431,PrimeWest Health,MinnesotaCare,221.3616,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Moderate Sedation Other Phy/Qhcp, Initial 15 Min, Less Than 5 Yrs",,99155,CPT,Facility,Inpatient,,,,431,366.35,123.5246,431,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Moderate Sedation Other Phy/Qhcp, Initial 15 Min, Less Than 5 Yrs",,99155,CPT,Facility,Both,,,,431,366.35,123.5246,431,Sanford Health Plan,Sanford Health Plan,396.52,92,,percent of total billed charges,,
"Moderate Sedation Other Phy/Qhcp, Initial 15 Min, Less Than 5 Yrs",,99155,CPT,Facility,Outpatient,,,,431,366.35,123.5246,431,"UCare Health, Inc.",Individual & Family Plan,242.8685,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Moderate Sedation Other Phy/Qhcp, Initial 15 Min, Less Than 5 Yrs",,99155,CPT,Facility,Inpatient,,,,431,366.35,123.5246,431,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Moderate Sedation Other Phy/Qhcp, Initial 15 Min, Less Than 5 Yrs",,99155,CPT,Facility,Outpatient,,,,431,366.35,123.5246,431,"UCare Health, Inc.",Medical Assistance,217.5257,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Moderate Sedation Other Phy/Qhcp, Initial 15 Min, Less Than 5 Yrs",,99155,CPT,Facility,Inpatient,,,,431,366.35,123.5246,431,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Moderate Sedation Other Phy/Qhcp, Initial 15 Min, Less Than 5 Yrs",,99155,CPT,Facility,Outpatient,,,,431,366.35,123.5246,431,"UCare Health, Inc.",Medicare Advantage,217.5257,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Moderate Sedation Other Phy/Qhcp, Initial 15 Min, Less Than 5 Yrs",,99155,CPT,Facility,Inpatient,,,,431,366.35,123.5246,431,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Moderate Sedation Other Phy/Qhcp, Initial 15 Min, Less Than 5 Yrs",,99155,CPT,Facility,Outpatient,,,,431,366.35,123.5246,431,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),217.5257,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Moderate Sedation Other Phy/Qhcp, Initial 15 Min, Less Than 5 Yrs",,99155,CPT,Facility,Inpatient,,,,431,366.35,123.5246,431,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Moderate Sedation Other Phy/Qhcp, Initial 15 Min, Less Than 5 Yrs",,99155,CPT,Facility,Both,,,,431,366.35,123.5246,431,UnitedHealthcare,Individual & Family,405.14,94,,percent of total billed charges,,
"Moderate Sedation Other Phy/Qhcp, Initial 15 Min, Less Than 5 Yrs",,99155,CPT,Facility,Outpatient,,,,431,366.35,123.5246,431,UnitedHealthcare,Medicare Advantage,211.19,49,,percent of total billed charges,,
"Moderate Sedation Other Phy/Qhcp, Initial 15 Min, Less Than 5 Yrs",,99155,CPT,Facility,Inpatient,,,,431,366.35,123.5246,431,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Moderate Sedation Other Phy/Qhcp, Initial 15 Min, Less Than 5 Yrs",,99155,CPT,Facility,Outpatient,,,,431,366.35,123.5246,431,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,206.88,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Moderate Sedation Other Phy/Qhcp, Initial 15 Min, Less Than 5 Yrs",,99155,CPT,Facility,Inpatient,,,,431,366.35,123.5246,431,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Mod Sedation, By Dr Other Than Perform Dr; Pt 5Yrs+, Initial 15 Min Intra-Service Time (Pro Cah)",,99156,CPT,Professional,Both,,,,204,173.4,46.24,204,Aetna,Commercial,173.4,85,,percent of total billed charges,,
"Mod Sedation, By Dr Other Than Perform Dr; Pt 5Yrs+, Initial 15 Min Intra-Service Time (Pro Cah)",,99156,CPT,Professional,Both,,,,204,173.4,46.24,204,Aetna,Medicare Advantage,74.04,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Mod Sedation, By Dr Other Than Perform Dr; Pt 5Yrs+, Initial 15 Min Intra-Service Time (Pro Cah)",,99156,CPT,Professional,Both,,,,204,173.4,46.24,204,Aetna,PPO,189.72,93,,percent of total billed charges,,
"Mod Sedation, By Dr Other Than Perform Dr; Pt 5Yrs+, Initial 15 Min Intra-Service Time (Pro Cah)",,99156,CPT,Professional,Both,,,,204,173.4,46.24,204,America's PPO,America's PPO,174.2976,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Mod Sedation, By Dr Other Than Perform Dr; Pt 5Yrs+, Initial 15 Min Intra-Service Time (Pro Cah)",,99156,CPT,Professional,Both,,,,204,173.4,46.24,204,BlueCross BlueShield Minnesota, Federal Employee Program,130.7,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Mod Sedation, By Dr Other Than Perform Dr; Pt 5Yrs+, Initial 15 Min Intra-Service Time (Pro Cah)",,99156,CPT,Professional,Both,,,,204,173.4,46.24,204,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,132.7912,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Mod Sedation, By Dr Other Than Perform Dr; Pt 5Yrs+, Initial 15 Min Intra-Service Time (Pro Cah)",,99156,CPT,Professional,Both,,,,204,173.4,46.24,204,BlueCross BlueShield Minnesota,High Value Network Plan,132.7912,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Mod Sedation, By Dr Other Than Perform Dr; Pt 5Yrs+, Initial 15 Min Intra-Service Time (Pro Cah)",,99156,CPT,Professional,Both,,,,204,173.4,46.24,204,BlueCross BlueShield Minnesota,Medicare Advantage,82.869,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Mod Sedation, By Dr Other Than Perform Dr; Pt 5Yrs+, Initial 15 Min Intra-Service Time (Pro Cah)",,99156,CPT,Professional,Both,,,,204,173.4,46.24,204,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,132.7912,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Mod Sedation, By Dr Other Than Perform Dr; Pt 5Yrs+, Initial 15 Min Intra-Service Time (Pro Cah)",,99156,CPT,Professional,Both,,,,204,173.4,46.24,204,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,53.3908,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Mod Sedation, By Dr Other Than Perform Dr; Pt 5Yrs+, Initial 15 Min Intra-Service Time (Pro Cah)",,99156,CPT,Professional,Both,,,,204,173.4,46.24,204,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),82.869,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Mod Sedation, By Dr Other Than Perform Dr; Pt 5Yrs+, Initial 15 Min Intra-Service Time (Pro Cah)",,99156,CPT,Professional,Both,,,,204,173.4,46.24,204,CorVel,Worker's Compensation,142.3157658,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Mod Sedation, By Dr Other Than Perform Dr; Pt 5Yrs+, Initial 15 Min Intra-Service Time (Pro Cah)",,99156,CPT,Professional,Both,,,,204,173.4,46.24,204,First Health Group Corporation,First Health Network,197.88,97,,percent of total billed charges,,
"Mod Sedation, By Dr Other Than Perform Dr; Pt 5Yrs+, Initial 15 Min Intra-Service Time (Pro Cah)",,99156,CPT,Professional,Both,,,,204,173.4,46.24,204,"Health Partners, Inc.",Commercial,153.81,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Mod Sedation, By Dr Other Than Perform Dr; Pt 5Yrs+, Initial 15 Min Intra-Service Time (Pro Cah)",,99156,CPT,Professional,Both,,,,204,173.4,46.24,204,"Health Partners, Inc.",Medicare Advantage,82.869,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Mod Sedation, By Dr Other Than Perform Dr; Pt 5Yrs+, Initial 15 Min Intra-Service Time (Pro Cah)",,99156,CPT,Professional,Both,,,,204,173.4,46.24,204,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),72.18,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Mod Sedation, By Dr Other Than Perform Dr; Pt 5Yrs+, Initial 15 Min Intra-Service Time (Pro Cah)",,99156,CPT,Professional,Both,,,,204,173.4,46.24,204,"Health Partners, Inc.",State of Minnesota Advantage Program,132.507315,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Mod Sedation, By Dr Other Than Perform Dr; Pt 5Yrs+, Initial 15 Min Intra-Service Time (Pro Cah)",,99156,CPT,Professional,Both,,,,204,173.4,46.24,204,"Health Partners, Inc.",State Public Programs,46.24,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Mod Sedation, By Dr Other Than Perform Dr; Pt 5Yrs+, Initial 15 Min Intra-Service Time (Pro Cah)",,99156,CPT,Professional,Both,,,,204,173.4,46.24,204,Humana Insurance Company,Commercial PPO,72.06,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Mod Sedation, By Dr Other Than Perform Dr; Pt 5Yrs+, Initial 15 Min Intra-Service Time (Pro Cah)",,99156,CPT,Professional,Both,,,,204,173.4,46.24,204,Humana Insurance Company,Medicare PPO,204,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Mod Sedation, By Dr Other Than Perform Dr; Pt 5Yrs+, Initial 15 Min Intra-Service Time (Pro Cah)",,99156,CPT,Professional,Both,,,,204,173.4,46.24,204,Medica,Individual & Family,172.992,84.8,,percent of total billed charges,,
"Mod Sedation, By Dr Other Than Perform Dr; Pt 5Yrs+, Initial 15 Min Intra-Service Time (Pro Cah)",,99156,CPT,Professional,Both,,,,204,173.4,46.24,204,Medica,Medica Advantage Solution,101.592,49.8,,percent of total billed charges,,
"Mod Sedation, By Dr Other Than Perform Dr; Pt 5Yrs+, Initial 15 Min Intra-Service Time (Pro Cah)",,99156,CPT,Professional,Both,,,,204,173.4,46.24,204,Medica,Medical Assistance,53.39,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Mod Sedation, By Dr Other Than Perform Dr; Pt 5Yrs+, Initial 15 Min Intra-Service Time (Pro Cah)",,99156,CPT,Professional,Both,,,,204,173.4,46.24,204,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,72.06,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Mod Sedation, By Dr Other Than Perform Dr; Pt 5Yrs+, Initial 15 Min Intra-Service Time (Pro Cah)",,99156,CPT,Professional,Both,,,,204,173.4,46.24,204,"Multiplan, Inc.","Multiplan, Inc.",191.76,94,,percent of total billed charges,,
"Mod Sedation, By Dr Other Than Perform Dr; Pt 5Yrs+, Initial 15 Min Intra-Service Time (Pro Cah)",,99156,CPT,Professional,Both,,,,204,173.4,46.24,204,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,183.804,90.1,,percent of total billed charges,,
"Mod Sedation, By Dr Other Than Perform Dr; Pt 5Yrs+, Initial 15 Min Intra-Service Time (Pro Cah)",,99156,CPT,Professional,Both,,,,204,173.4,46.24,204,"Preferred One Administrative Services, INC.",PPO,201.144,98.6,,percent of total billed charges,,
"Mod Sedation, By Dr Other Than Perform Dr; Pt 5Yrs+, Initial 15 Min Intra-Service Time (Pro Cah)",,99156,CPT,Professional,Both,,,,204,173.4,46.24,204,PrimeWest Health,Minnesota Senior Health Options (MSHO),82.869,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Mod Sedation, By Dr Other Than Perform Dr; Pt 5Yrs+, Initial 15 Min Intra-Service Time (Pro Cah)",,99156,CPT,Professional,Both,,,,204,173.4,46.24,204,PrimeWest Health,MinnesotaCare,57.128156,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Mod Sedation, By Dr Other Than Perform Dr; Pt 5Yrs+, Initial 15 Min Intra-Service Time (Pro Cah)",,99156,CPT,Professional,Both,,,,204,173.4,46.24,204,Sanford Health Plan,Sanford Health Plan,179.52,88,,percent of total billed charges,,
"Mod Sedation, By Dr Other Than Perform Dr; Pt 5Yrs+, Initial 15 Min Intra-Service Time (Pro Cah)",,99156,CPT,Professional,Both,,,,204,173.4,46.24,204,"UCare Health, Inc.",Individual & Family Plan,117.140736,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Mod Sedation, By Dr Other Than Perform Dr; Pt 5Yrs+, Initial 15 Min Intra-Service Time (Pro Cah)",,99156,CPT,Professional,Both,,,,204,173.4,46.24,204,"UCare Health, Inc.",Medical Assistance,58.72988,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Mod Sedation, By Dr Other Than Perform Dr; Pt 5Yrs+, Initial 15 Min Intra-Service Time (Pro Cah)",,99156,CPT,Professional,Both,,,,204,173.4,46.24,204,"UCare Health, Inc.",Medicare Advantage,82.869,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Mod Sedation, By Dr Other Than Perform Dr; Pt 5Yrs+, Initial 15 Min Intra-Service Time (Pro Cah)",,99156,CPT,Professional,Both,,,,204,173.4,46.24,204,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),66.2952,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Mod Sedation, By Dr Other Than Perform Dr; Pt 5Yrs+, Initial 15 Min Intra-Service Time (Pro Cah)",,99156,CPT,Professional,Both,,,,204,173.4,46.24,204,UnitedHealthcare,Individual & Family,204,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Mod Sedation, By Dr Other Than Perform Dr; Pt 5Yrs+, Initial 15 Min Intra-Service Time (Pro Cah)",,99156,CPT,Professional,Both,,,,204,173.4,46.24,204,UnitedHealthcare,Medicare Advantage,82.869,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Mod Sedation, By Dr Other Than Perform Dr; Pt 5Yrs+, Initial 15 Min Intra-Service Time (Pro Cah)",,99156,CPT,Professional,Both,,,,204,173.4,46.24,204,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,53.3908,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Moderate Sedation Other Phy/Qhcp, Initial 15 Min, 5 Yrs Or Greater",,99156,CPT,Facility,Both,,,,153,130.05,43.8498,153,Aetna,Commercial,140.76,92,,percent of total billed charges,,
"Moderate Sedation Other Phy/Qhcp, Initial 15 Min, 5 Yrs Or Greater",,99156,CPT,Facility,Outpatient,,,,153,130.05,43.8498,153,Aetna,Medicare Advantage,74.97,49,,percent of total billed charges,,
"Moderate Sedation Other Phy/Qhcp, Initial 15 Min, 5 Yrs Or Greater",,99156,CPT,Facility,Inpatient,,,,153,130.05,43.8498,153,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Moderate Sedation Other Phy/Qhcp, Initial 15 Min, 5 Yrs Or Greater",,99156,CPT,Facility,Both,,,,153,130.05,43.8498,153,Aetna,PPO,142.29,93,,percent of total billed charges,,
"Moderate Sedation Other Phy/Qhcp, Initial 15 Min, 5 Yrs Or Greater",,99156,CPT,Facility,Both,,,,153,130.05,43.8498,153,America's PPO,America's PPO,146.9259,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Moderate Sedation Other Phy/Qhcp, Initial 15 Min, 5 Yrs Or Greater",,99156,CPT,Facility,Both,,,,153,130.05,43.8498,153,BlueCross BlueShield Minnesota, Federal Employee Program,150.552,98.4,,percent of total billed charges,,
"Moderate Sedation Other Phy/Qhcp, Initial 15 Min, 5 Yrs Or Greater",,99156,CPT,Facility,Both,,,,153,130.05,43.8498,153,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,153,100,,percent of total billed charges,,
"Moderate Sedation Other Phy/Qhcp, Initial 15 Min, 5 Yrs Or Greater",,99156,CPT,Facility,Both,,,,153,130.05,43.8498,153,BlueCross BlueShield Minnesota,High Value Network Plan,137.7,90,,percent of total billed charges,,
"Moderate Sedation Other Phy/Qhcp, Initial 15 Min, 5 Yrs Or Greater",,99156,CPT,Facility,Outpatient,,,,153,130.05,43.8498,153,BlueCross BlueShield Minnesota,Medicare Advantage,74.97,49,,percent of total billed charges,,
"Moderate Sedation Other Phy/Qhcp, Initial 15 Min, 5 Yrs Or Greater",,99156,CPT,Facility,Inpatient,,,,153,130.05,43.8498,153,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Moderate Sedation Other Phy/Qhcp, Initial 15 Min, 5 Yrs Or Greater",,99156,CPT,Facility,Both,,,,153,130.05,43.8498,153,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,135.5121,88.57,,percent of total billed charges,,
"Moderate Sedation Other Phy/Qhcp, Initial 15 Min, 5 Yrs Or Greater",,99156,CPT,Facility,Both,,,,153,130.05,43.8498,153,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,43.8498,28.66,,percent of total billed charges,,
"Moderate Sedation Other Phy/Qhcp, Initial 15 Min, 5 Yrs Or Greater",,99156,CPT,Facility,Outpatient,,,,153,130.05,43.8498,153,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),74.97,49,,percent of total billed charges,,
"Moderate Sedation Other Phy/Qhcp, Initial 15 Min, 5 Yrs Or Greater",,99156,CPT,Facility,Inpatient,,,,153,130.05,43.8498,153,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Moderate Sedation Other Phy/Qhcp, Initial 15 Min, 5 Yrs Or Greater",,99156,CPT,Facility,Both,,,,153,130.05,43.8498,153,CorVel,Worker's Compensation,153,100,,percent of total billed charges,,
"Moderate Sedation Other Phy/Qhcp, Initial 15 Min, 5 Yrs Or Greater",,99156,CPT,Facility,Both,,,,153,130.05,43.8498,153,First Health Group Corporation,First Health Network,148.41,97,,percent of total billed charges,,
"Moderate Sedation Other Phy/Qhcp, Initial 15 Min, 5 Yrs Or Greater",,99156,CPT,Facility,Both,,,,153,130.05,43.8498,153,"Health Partners, Inc.",Commercial,144.738,94.6,,percent of total billed charges,,
"Moderate Sedation Other Phy/Qhcp, Initial 15 Min, 5 Yrs Or Greater",,99156,CPT,Facility,Outpatient,,,,153,130.05,43.8498,153,"Health Partners, Inc.",Medicare Advantage,74.97,49,,percent of total billed charges,,
"Moderate Sedation Other Phy/Qhcp, Initial 15 Min, 5 Yrs Or Greater",,99156,CPT,Facility,Inpatient,,,,153,130.05,43.8498,153,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Moderate Sedation Other Phy/Qhcp, Initial 15 Min, 5 Yrs Or Greater",,99156,CPT,Facility,Both,,,,153,130.05,43.8498,153,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),91.8,60,,percent of total billed charges,,
"Moderate Sedation Other Phy/Qhcp, Initial 15 Min, 5 Yrs Or Greater",,99156,CPT,Facility,Both,,,,153,130.05,43.8498,153,"Health Partners, Inc.",State of Minnesota Advantage Program,124.695,81.5,,percent of total billed charges,,
"Moderate Sedation Other Phy/Qhcp, Initial 15 Min, 5 Yrs Or Greater",,99156,CPT,Facility,Both,,,,153,130.05,43.8498,153,"Health Partners, Inc.",State Public Programs,76.5,50,,percent of total billed charges,,
"Moderate Sedation Other Phy/Qhcp, Initial 15 Min, 5 Yrs Or Greater",,99156,CPT,Facility,Both,,,,153,130.05,43.8498,153,Humana Insurance Company,Commercial PPO,145.35,95,,percent of total billed charges,,
"Moderate Sedation Other Phy/Qhcp, Initial 15 Min, 5 Yrs Or Greater",,99156,CPT,Facility,Outpatient,,,,153,130.05,43.8498,153,Humana Insurance Company,Medicare PPO,74.97,49,,percent of total billed charges,,
"Moderate Sedation Other Phy/Qhcp, Initial 15 Min, 5 Yrs Or Greater",,99156,CPT,Facility,Inpatient,,,,153,130.05,43.8498,153,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Moderate Sedation Other Phy/Qhcp, Initial 15 Min, 5 Yrs Or Greater",,99156,CPT,Facility,Both,,,,153,130.05,43.8498,153,Medica,Individual & Family,151.623,99.1,,percent of total billed charges,,
"Moderate Sedation Other Phy/Qhcp, Initial 15 Min, 5 Yrs Or Greater",,99156,CPT,Facility,Outpatient,,,,153,130.05,43.8498,153,Medica,Medica Advantage Solution,76.194,49.8,,percent of total billed charges,,
"Moderate Sedation Other Phy/Qhcp, Initial 15 Min, 5 Yrs Or Greater",,99156,CPT,Facility,Inpatient,,,,153,130.05,43.8498,153,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Moderate Sedation Other Phy/Qhcp, Initial 15 Min, 5 Yrs Or Greater",,99156,CPT,Facility,Outpatient,,,,153,130.05,43.8498,153,Medica,Medical Assistance,68.238,44.6,,percent of total billed charges,,
"Moderate Sedation Other Phy/Qhcp, Initial 15 Min, 5 Yrs Or Greater",,99156,CPT,Facility,Inpatient,,,,153,130.05,43.8498,153,Medica,Medical Assistance,,,,,Included in per diem rate,
"Moderate Sedation Other Phy/Qhcp, Initial 15 Min, 5 Yrs Or Greater",,99156,CPT,Facility,Outpatient,,,,153,130.05,43.8498,153,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,76.194,49.8,,percent of total billed charges,,
"Moderate Sedation Other Phy/Qhcp, Initial 15 Min, 5 Yrs Or Greater",,99156,CPT,Facility,Inpatient,,,,153,130.05,43.8498,153,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Moderate Sedation Other Phy/Qhcp, Initial 15 Min, 5 Yrs Or Greater",,99156,CPT,Facility,Both,,,,153,130.05,43.8498,153,"Multiplan, Inc.","Multiplan, Inc.",143.82,94,,percent of total billed charges,,
"Moderate Sedation Other Phy/Qhcp, Initial 15 Min, 5 Yrs Or Greater",,99156,CPT,Facility,Outpatient,,,,153,130.05,43.8498,153,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,137.853,90.1,,percent of total billed charges,,
"Moderate Sedation Other Phy/Qhcp, Initial 15 Min, 5 Yrs Or Greater",,99156,CPT,Facility,Inpatient,,,,153,130.05,43.8498,153,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Moderate Sedation Other Phy/Qhcp, Initial 15 Min, 5 Yrs Or Greater",,99156,CPT,Facility,Both,,,,153,130.05,43.8498,153,"Preferred One Administrative Services, INC.",PPO,150.858,98.6,,percent of total billed charges,,
"Moderate Sedation Other Phy/Qhcp, Initial 15 Min, 5 Yrs Or Greater",,99156,CPT,Facility,Outpatient,,,,153,130.05,43.8498,153,PrimeWest Health,Minnesota Senior Health Options (MSHO),78.7185,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Moderate Sedation Other Phy/Qhcp, Initial 15 Min, 5 Yrs Or Greater",,99156,CPT,Facility,Inpatient,,,,153,130.05,43.8498,153,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Moderate Sedation Other Phy/Qhcp, Initial 15 Min, 5 Yrs Or Greater",,99156,CPT,Facility,Outpatient,,,,153,130.05,43.8498,153,PrimeWest Health,MinnesotaCare,78.5808,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Moderate Sedation Other Phy/Qhcp, Initial 15 Min, 5 Yrs Or Greater",,99156,CPT,Facility,Inpatient,,,,153,130.05,43.8498,153,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Moderate Sedation Other Phy/Qhcp, Initial 15 Min, 5 Yrs Or Greater",,99156,CPT,Facility,Both,,,,153,130.05,43.8498,153,Sanford Health Plan,Sanford Health Plan,140.76,92,,percent of total billed charges,,
"Moderate Sedation Other Phy/Qhcp, Initial 15 Min, 5 Yrs Or Greater",,99156,CPT,Facility,Outpatient,,,,153,130.05,43.8498,153,"UCare Health, Inc.",Individual & Family Plan,86.2155,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Moderate Sedation Other Phy/Qhcp, Initial 15 Min, 5 Yrs Or Greater",,99156,CPT,Facility,Inpatient,,,,153,130.05,43.8498,153,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Moderate Sedation Other Phy/Qhcp, Initial 15 Min, 5 Yrs Or Greater",,99156,CPT,Facility,Outpatient,,,,153,130.05,43.8498,153,"UCare Health, Inc.",Medical Assistance,77.2191,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Moderate Sedation Other Phy/Qhcp, Initial 15 Min, 5 Yrs Or Greater",,99156,CPT,Facility,Inpatient,,,,153,130.05,43.8498,153,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Moderate Sedation Other Phy/Qhcp, Initial 15 Min, 5 Yrs Or Greater",,99156,CPT,Facility,Outpatient,,,,153,130.05,43.8498,153,"UCare Health, Inc.",Medicare Advantage,77.2191,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Moderate Sedation Other Phy/Qhcp, Initial 15 Min, 5 Yrs Or Greater",,99156,CPT,Facility,Inpatient,,,,153,130.05,43.8498,153,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Moderate Sedation Other Phy/Qhcp, Initial 15 Min, 5 Yrs Or Greater",,99156,CPT,Facility,Outpatient,,,,153,130.05,43.8498,153,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),77.2191,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Moderate Sedation Other Phy/Qhcp, Initial 15 Min, 5 Yrs Or Greater",,99156,CPT,Facility,Inpatient,,,,153,130.05,43.8498,153,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Moderate Sedation Other Phy/Qhcp, Initial 15 Min, 5 Yrs Or Greater",,99156,CPT,Facility,Both,,,,153,130.05,43.8498,153,UnitedHealthcare,Individual & Family,143.82,94,,percent of total billed charges,,
"Moderate Sedation Other Phy/Qhcp, Initial 15 Min, 5 Yrs Or Greater",,99156,CPT,Facility,Outpatient,,,,153,130.05,43.8498,153,UnitedHealthcare,Medicare Advantage,74.97,49,,percent of total billed charges,,
"Moderate Sedation Other Phy/Qhcp, Initial 15 Min, 5 Yrs Or Greater",,99156,CPT,Facility,Inpatient,,,,153,130.05,43.8498,153,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Moderate Sedation Other Phy/Qhcp, Initial 15 Min, 5 Yrs Or Greater",,99156,CPT,Facility,Outpatient,,,,153,130.05,43.8498,153,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,73.44,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Moderate Sedation Other Phy/Qhcp, Initial 15 Min, 5 Yrs Or Greater",,99156,CPT,Facility,Inpatient,,,,153,130.05,43.8498,153,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Moderate Sedation Other Phy/Qhcp, Each Additional 15 Mins",,99157,CPT,Facility,Both,,,,61,51.85,17.4826,61,Aetna,Commercial,56.12,92,,percent of total billed charges,,
"Moderate Sedation Other Phy/Qhcp, Each Additional 15 Mins",,99157,CPT,Facility,Outpatient,,,,61,51.85,17.4826,61,Aetna,Medicare Advantage,29.89,49,,percent of total billed charges,,
"Moderate Sedation Other Phy/Qhcp, Each Additional 15 Mins",,99157,CPT,Facility,Inpatient,,,,61,51.85,17.4826,61,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Moderate Sedation Other Phy/Qhcp, Each Additional 15 Mins",,99157,CPT,Facility,Both,,,,61,51.85,17.4826,61,Aetna,PPO,56.73,93,,percent of total billed charges,,
"Moderate Sedation Other Phy/Qhcp, Each Additional 15 Mins",,99157,CPT,Facility,Both,,,,61,51.85,17.4826,61,America's PPO,America's PPO,58.5783,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Moderate Sedation Other Phy/Qhcp, Each Additional 15 Mins",,99157,CPT,Facility,Both,,,,61,51.85,17.4826,61,BlueCross BlueShield Minnesota, Federal Employee Program,60.024,98.4,,percent of total billed charges,,
"Moderate Sedation Other Phy/Qhcp, Each Additional 15 Mins",,99157,CPT,Facility,Both,,,,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,61,100,,percent of total billed charges,,
"Moderate Sedation Other Phy/Qhcp, Each Additional 15 Mins",,99157,CPT,Facility,Both,,,,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,High Value Network Plan,54.9,90,,percent of total billed charges,,
"Moderate Sedation Other Phy/Qhcp, Each Additional 15 Mins",,99157,CPT,Facility,Outpatient,,,,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,Medicare Advantage,29.89,49,,percent of total billed charges,,
"Moderate Sedation Other Phy/Qhcp, Each Additional 15 Mins",,99157,CPT,Facility,Inpatient,,,,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Moderate Sedation Other Phy/Qhcp, Each Additional 15 Mins",,99157,CPT,Facility,Both,,,,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,54.0277,88.57,,percent of total billed charges,,
"Moderate Sedation Other Phy/Qhcp, Each Additional 15 Mins",,99157,CPT,Facility,Both,,,,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,17.4826,28.66,,percent of total billed charges,,
"Moderate Sedation Other Phy/Qhcp, Each Additional 15 Mins",,99157,CPT,Facility,Outpatient,,,,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),29.89,49,,percent of total billed charges,,
"Moderate Sedation Other Phy/Qhcp, Each Additional 15 Mins",,99157,CPT,Facility,Inpatient,,,,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Moderate Sedation Other Phy/Qhcp, Each Additional 15 Mins",,99157,CPT,Facility,Both,,,,61,51.85,17.4826,61,CorVel,Worker's Compensation,61,100,,percent of total billed charges,,
"Moderate Sedation Other Phy/Qhcp, Each Additional 15 Mins",,99157,CPT,Facility,Both,,,,61,51.85,17.4826,61,First Health Group Corporation,First Health Network,59.17,97,,percent of total billed charges,,
"Moderate Sedation Other Phy/Qhcp, Each Additional 15 Mins",,99157,CPT,Facility,Both,,,,61,51.85,17.4826,61,"Health Partners, Inc.",Commercial,57.706,94.6,,percent of total billed charges,,
"Moderate Sedation Other Phy/Qhcp, Each Additional 15 Mins",,99157,CPT,Facility,Outpatient,,,,61,51.85,17.4826,61,"Health Partners, Inc.",Medicare Advantage,29.89,49,,percent of total billed charges,,
"Moderate Sedation Other Phy/Qhcp, Each Additional 15 Mins",,99157,CPT,Facility,Inpatient,,,,61,51.85,17.4826,61,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Moderate Sedation Other Phy/Qhcp, Each Additional 15 Mins",,99157,CPT,Facility,Both,,,,61,51.85,17.4826,61,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),36.6,60,,percent of total billed charges,,
"Moderate Sedation Other Phy/Qhcp, Each Additional 15 Mins",,99157,CPT,Facility,Both,,,,61,51.85,17.4826,61,"Health Partners, Inc.",State of Minnesota Advantage Program,49.715,81.5,,percent of total billed charges,,
"Moderate Sedation Other Phy/Qhcp, Each Additional 15 Mins",,99157,CPT,Facility,Both,,,,61,51.85,17.4826,61,"Health Partners, Inc.",State Public Programs,30.5,50,,percent of total billed charges,,
"Moderate Sedation Other Phy/Qhcp, Each Additional 15 Mins",,99157,CPT,Facility,Both,,,,61,51.85,17.4826,61,Humana Insurance Company,Commercial PPO,57.95,95,,percent of total billed charges,,
"Moderate Sedation Other Phy/Qhcp, Each Additional 15 Mins",,99157,CPT,Facility,Outpatient,,,,61,51.85,17.4826,61,Humana Insurance Company,Medicare PPO,29.89,49,,percent of total billed charges,,
"Moderate Sedation Other Phy/Qhcp, Each Additional 15 Mins",,99157,CPT,Facility,Inpatient,,,,61,51.85,17.4826,61,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Moderate Sedation Other Phy/Qhcp, Each Additional 15 Mins",,99157,CPT,Facility,Both,,,,61,51.85,17.4826,61,Medica,Individual & Family,60.451,99.1,,percent of total billed charges,,
"Moderate Sedation Other Phy/Qhcp, Each Additional 15 Mins",,99157,CPT,Facility,Outpatient,,,,61,51.85,17.4826,61,Medica,Medica Advantage Solution,30.378,49.8,,percent of total billed charges,,
"Moderate Sedation Other Phy/Qhcp, Each Additional 15 Mins",,99157,CPT,Facility,Inpatient,,,,61,51.85,17.4826,61,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Moderate Sedation Other Phy/Qhcp, Each Additional 15 Mins",,99157,CPT,Facility,Outpatient,,,,61,51.85,17.4826,61,Medica,Medical Assistance,27.206,44.6,,percent of total billed charges,,
"Moderate Sedation Other Phy/Qhcp, Each Additional 15 Mins",,99157,CPT,Facility,Inpatient,,,,61,51.85,17.4826,61,Medica,Medical Assistance,,,,,Included in per diem rate,
"Moderate Sedation Other Phy/Qhcp, Each Additional 15 Mins",,99157,CPT,Facility,Outpatient,,,,61,51.85,17.4826,61,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,30.378,49.8,,percent of total billed charges,,
"Moderate Sedation Other Phy/Qhcp, Each Additional 15 Mins",,99157,CPT,Facility,Inpatient,,,,61,51.85,17.4826,61,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Moderate Sedation Other Phy/Qhcp, Each Additional 15 Mins",,99157,CPT,Facility,Both,,,,61,51.85,17.4826,61,"Multiplan, Inc.","Multiplan, Inc.",57.34,94,,percent of total billed charges,,
"Moderate Sedation Other Phy/Qhcp, Each Additional 15 Mins",,99157,CPT,Facility,Outpatient,,,,61,51.85,17.4826,61,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,54.961,90.1,,percent of total billed charges,,
"Moderate Sedation Other Phy/Qhcp, Each Additional 15 Mins",,99157,CPT,Facility,Inpatient,,,,61,51.85,17.4826,61,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Moderate Sedation Other Phy/Qhcp, Each Additional 15 Mins",,99157,CPT,Facility,Both,,,,61,51.85,17.4826,61,"Preferred One Administrative Services, INC.",PPO,60.146,98.6,,percent of total billed charges,,
"Moderate Sedation Other Phy/Qhcp, Each Additional 15 Mins",,99157,CPT,Facility,Outpatient,,,,61,51.85,17.4826,61,PrimeWest Health,Minnesota Senior Health Options (MSHO),31.3845,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Moderate Sedation Other Phy/Qhcp, Each Additional 15 Mins",,99157,CPT,Facility,Inpatient,,,,61,51.85,17.4826,61,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Moderate Sedation Other Phy/Qhcp, Each Additional 15 Mins",,99157,CPT,Facility,Outpatient,,,,61,51.85,17.4826,61,PrimeWest Health,MinnesotaCare,31.3296,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Moderate Sedation Other Phy/Qhcp, Each Additional 15 Mins",,99157,CPT,Facility,Inpatient,,,,61,51.85,17.4826,61,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Moderate Sedation Other Phy/Qhcp, Each Additional 15 Mins",,99157,CPT,Facility,Both,,,,61,51.85,17.4826,61,Sanford Health Plan,Sanford Health Plan,56.12,92,,percent of total billed charges,,
"Moderate Sedation Other Phy/Qhcp, Each Additional 15 Mins",,99157,CPT,Facility,Outpatient,,,,61,51.85,17.4826,61,"UCare Health, Inc.",Individual & Family Plan,34.3735,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Moderate Sedation Other Phy/Qhcp, Each Additional 15 Mins",,99157,CPT,Facility,Inpatient,,,,61,51.85,17.4826,61,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Moderate Sedation Other Phy/Qhcp, Each Additional 15 Mins",,99157,CPT,Facility,Outpatient,,,,61,51.85,17.4826,61,"UCare Health, Inc.",Medical Assistance,30.7867,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Moderate Sedation Other Phy/Qhcp, Each Additional 15 Mins",,99157,CPT,Facility,Inpatient,,,,61,51.85,17.4826,61,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Moderate Sedation Other Phy/Qhcp, Each Additional 15 Mins",,99157,CPT,Facility,Outpatient,,,,61,51.85,17.4826,61,"UCare Health, Inc.",Medicare Advantage,30.7867,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Moderate Sedation Other Phy/Qhcp, Each Additional 15 Mins",,99157,CPT,Facility,Inpatient,,,,61,51.85,17.4826,61,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Moderate Sedation Other Phy/Qhcp, Each Additional 15 Mins",,99157,CPT,Facility,Outpatient,,,,61,51.85,17.4826,61,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),30.7867,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Moderate Sedation Other Phy/Qhcp, Each Additional 15 Mins",,99157,CPT,Facility,Inpatient,,,,61,51.85,17.4826,61,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Moderate Sedation Other Phy/Qhcp, Each Additional 15 Mins",,99157,CPT,Facility,Both,,,,61,51.85,17.4826,61,UnitedHealthcare,Individual & Family,57.34,94,,percent of total billed charges,,
"Moderate Sedation Other Phy/Qhcp, Each Additional 15 Mins",,99157,CPT,Facility,Outpatient,,,,61,51.85,17.4826,61,UnitedHealthcare,Medicare Advantage,29.89,49,,percent of total billed charges,,
"Moderate Sedation Other Phy/Qhcp, Each Additional 15 Mins",,99157,CPT,Facility,Inpatient,,,,61,51.85,17.4826,61,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Moderate Sedation Other Phy/Qhcp, Each Additional 15 Mins",,99157,CPT,Facility,Outpatient,,,,61,51.85,17.4826,61,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,29.28,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Moderate Sedation Other Phy/Qhcp, Each Additional 15 Mins",,99157,CPT,Facility,Inpatient,,,,61,51.85,17.4826,61,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Moderate Sedation, By Dr Other Than Performing Dr; Ea Add  15 Min Intra-Ser (Pro Cah)",,99157,CPT,Professional,Both,,,,51,43.35,25.398,55.016,Aetna,Commercial,43.35,85,,percent of total billed charges,,
"Moderate Sedation, By Dr Other Than Performing Dr; Ea Add  15 Min Intra-Ser (Pro Cah)",,99157,CPT,Professional,Both,,,,51,43.35,25.398,55.016,Aetna,Medicare Advantage,51,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Moderate Sedation, By Dr Other Than Performing Dr; Ea Add  15 Min Intra-Ser (Pro Cah)",,99157,CPT,Professional,Both,,,,51,43.35,25.398,55.016,Aetna,PPO,47.43,93,,percent of total billed charges,,
"Moderate Sedation, By Dr Other Than Performing Dr; Ea Add  15 Min Intra-Ser (Pro Cah)",,99157,CPT,Professional,Both,,,,51,43.35,25.398,55.016,America's PPO,America's PPO,43.5744,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Moderate Sedation, By Dr Other Than Performing Dr; Ea Add  15 Min Intra-Ser (Pro Cah)",,99157,CPT,Professional,Both,,,,51,43.35,25.398,55.016,BlueCross BlueShield Minnesota, Federal Employee Program,51,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Moderate Sedation, By Dr Other Than Performing Dr; Ea Add  15 Min Intra-Ser (Pro Cah)",,99157,CPT,Professional,Both,,,,51,43.35,25.398,55.016,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,51,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Moderate Sedation, By Dr Other Than Performing Dr; Ea Add  15 Min Intra-Ser (Pro Cah)",,99157,CPT,Professional,Both,,,,51,43.35,25.398,55.016,BlueCross BlueShield Minnesota,High Value Network Plan,51,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Moderate Sedation, By Dr Other Than Performing Dr; Ea Add  15 Min Intra-Ser (Pro Cah)",,99157,CPT,Professional,Both,,,,51,43.35,25.398,55.016,BlueCross BlueShield Minnesota,Medicare Advantage,51,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Moderate Sedation, By Dr Other Than Performing Dr; Ea Add  15 Min Intra-Ser (Pro Cah)",,99157,CPT,Professional,Both,,,,51,43.35,25.398,55.016,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,51,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Moderate Sedation, By Dr Other Than Performing Dr; Ea Add  15 Min Intra-Ser (Pro Cah)",,99157,CPT,Professional,Both,,,,51,43.35,25.398,55.016,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,44.32808,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Moderate Sedation, By Dr Other Than Performing Dr; Ea Add  15 Min Intra-Ser (Pro Cah)",,99157,CPT,Professional,Both,,,,51,43.35,25.398,55.016,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),51,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Moderate Sedation, By Dr Other Than Performing Dr; Ea Add  15 Min Intra-Ser (Pro Cah)",,99157,CPT,Professional,Both,,,,51,43.35,25.398,55.016,CorVel,Worker's Compensation,51,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Moderate Sedation, By Dr Other Than Performing Dr; Ea Add  15 Min Intra-Ser (Pro Cah)",,99157,CPT,Professional,Both,,,,51,43.35,25.398,55.016,First Health Group Corporation,First Health Network,49.47,97,,percent of total billed charges,,
"Moderate Sedation, By Dr Other Than Performing Dr; Ea Add  15 Min Intra-Ser (Pro Cah)",,99157,CPT,Professional,Both,,,,51,43.35,25.398,55.016,"Health Partners, Inc.",Commercial,51,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Moderate Sedation, By Dr Other Than Performing Dr; Ea Add  15 Min Intra-Ser (Pro Cah)",,99157,CPT,Professional,Both,,,,51,43.35,25.398,55.016,"Health Partners, Inc.",Medicare Advantage,51,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Moderate Sedation, By Dr Other Than Performing Dr; Ea Add  15 Min Intra-Ser (Pro Cah)",,99157,CPT,Professional,Both,,,,51,43.35,25.398,55.016,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),51,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Moderate Sedation, By Dr Other Than Performing Dr; Ea Add  15 Min Intra-Ser (Pro Cah)",,99157,CPT,Professional,Both,,,,51,43.35,25.398,55.016,"Health Partners, Inc.",State of Minnesota Advantage Program,51,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Moderate Sedation, By Dr Other Than Performing Dr; Ea Add  15 Min Intra-Ser (Pro Cah)",,99157,CPT,Professional,Both,,,,51,43.35,25.398,55.016,"Health Partners, Inc.",State Public Programs,38.39,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Moderate Sedation, By Dr Other Than Performing Dr; Ea Add  15 Min Intra-Ser (Pro Cah)",,99157,CPT,Professional,Both,,,,51,43.35,25.398,55.016,Humana Insurance Company,Commercial PPO,51,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Moderate Sedation, By Dr Other Than Performing Dr; Ea Add  15 Min Intra-Ser (Pro Cah)",,99157,CPT,Professional,Both,,,,51,43.35,25.398,55.016,Humana Insurance Company,Medicare PPO,51,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Moderate Sedation, By Dr Other Than Performing Dr; Ea Add  15 Min Intra-Ser (Pro Cah)",,99157,CPT,Professional,Both,,,,51,43.35,25.398,55.016,Medica,Individual & Family,43.248,84.8,,percent of total billed charges,,
"Moderate Sedation, By Dr Other Than Performing Dr; Ea Add  15 Min Intra-Ser (Pro Cah)",,99157,CPT,Professional,Both,,,,51,43.35,25.398,55.016,Medica,Medica Advantage Solution,25.398,49.8,,percent of total billed charges,,
"Moderate Sedation, By Dr Other Than Performing Dr; Ea Add  15 Min Intra-Ser (Pro Cah)",,99157,CPT,Professional,Both,,,,51,43.35,25.398,55.016,Medica,Medical Assistance,44.33,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Moderate Sedation, By Dr Other Than Performing Dr; Ea Add  15 Min Intra-Ser (Pro Cah)",,99157,CPT,Professional,Both,,,,51,43.35,25.398,55.016,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,51,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Moderate Sedation, By Dr Other Than Performing Dr; Ea Add  15 Min Intra-Ser (Pro Cah)",,99157,CPT,Professional,Both,,,,51,43.35,25.398,55.016,"Multiplan, Inc.","Multiplan, Inc.",47.94,94,,percent of total billed charges,,
"Moderate Sedation, By Dr Other Than Performing Dr; Ea Add  15 Min Intra-Ser (Pro Cah)",,99157,CPT,Professional,Both,,,,51,43.35,25.398,55.016,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,45.951,90.1,,percent of total billed charges,,
"Moderate Sedation, By Dr Other Than Performing Dr; Ea Add  15 Min Intra-Ser (Pro Cah)",,99157,CPT,Professional,Both,,,,51,43.35,25.398,55.016,"Preferred One Administrative Services, INC.",PPO,50.286,98.6,,percent of total billed charges,,
"Moderate Sedation, By Dr Other Than Performing Dr; Ea Add  15 Min Intra-Ser (Pro Cah)",,99157,CPT,Professional,Both,,,,51,43.35,25.398,55.016,PrimeWest Health,Minnesota Senior Health Options (MSHO),51,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Moderate Sedation, By Dr Other Than Performing Dr; Ea Add  15 Min Intra-Ser (Pro Cah)",,99157,CPT,Professional,Both,,,,51,43.35,25.398,55.016,PrimeWest Health,MinnesotaCare,47.4310456,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Moderate Sedation, By Dr Other Than Performing Dr; Ea Add  15 Min Intra-Ser (Pro Cah)",,99157,CPT,Professional,Both,,,,51,43.35,25.398,55.016,Sanford Health Plan,Sanford Health Plan,44.88,88,,percent of total billed charges,,
"Moderate Sedation, By Dr Other Than Performing Dr; Ea Add  15 Min Intra-Ser (Pro Cah)",,99157,CPT,Professional,Both,,,,51,43.35,25.398,55.016,"UCare Health, Inc.",Individual & Family Plan,51,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Moderate Sedation, By Dr Other Than Performing Dr; Ea Add  15 Min Intra-Ser (Pro Cah)",,99157,CPT,Professional,Both,,,,51,43.35,25.398,55.016,"UCare Health, Inc.",Medical Assistance,48.760888,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Moderate Sedation, By Dr Other Than Performing Dr; Ea Add  15 Min Intra-Ser (Pro Cah)",,99157,CPT,Professional,Both,,,,51,43.35,25.398,55.016,"UCare Health, Inc.",Medicare Advantage,51,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Moderate Sedation, By Dr Other Than Performing Dr; Ea Add  15 Min Intra-Ser (Pro Cah)",,99157,CPT,Professional,Both,,,,51,43.35,25.398,55.016,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),55.016,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Moderate Sedation, By Dr Other Than Performing Dr; Ea Add  15 Min Intra-Ser (Pro Cah)",,99157,CPT,Professional,Both,,,,51,43.35,25.398,55.016,UnitedHealthcare,Individual & Family,51,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Moderate Sedation, By Dr Other Than Performing Dr; Ea Add  15 Min Intra-Ser (Pro Cah)",,99157,CPT,Professional,Both,,,,51,43.35,25.398,55.016,UnitedHealthcare,Medicare Advantage,51,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Moderate Sedation, By Dr Other Than Performing Dr; Ea Add  15 Min Intra-Ser (Pro Cah)",,99157,CPT,Professional,Both,,,,51,43.35,25.398,55.016,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,44.32808,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Phlebotomy, Therapuetic",,99195,CPT,Facility,Both,,,,362,307.7,103.7492,362,Aetna,Commercial,333.04,92,,percent of total billed charges,,
"Phlebotomy, Therapuetic",,99195,CPT,Facility,Outpatient,,,,362,307.7,103.7492,362,Aetna,Medicare Advantage,177.38,49,,percent of total billed charges,,
"Phlebotomy, Therapuetic",,99195,CPT,Facility,Inpatient,,,,362,307.7,103.7492,362,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Phlebotomy, Therapuetic",,99195,CPT,Facility,Both,,,,362,307.7,103.7492,362,Aetna,PPO,336.66,93,,percent of total billed charges,,
"Phlebotomy, Therapuetic",,99195,CPT,Facility,Both,,,,362,307.7,103.7492,362,America's PPO,America's PPO,347.6286,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Phlebotomy, Therapuetic",,99195,CPT,Facility,Both,,,,362,307.7,103.7492,362,BlueCross BlueShield Minnesota, Federal Employee Program,356.208,98.4,,percent of total billed charges,,
"Phlebotomy, Therapuetic",,99195,CPT,Facility,Both,,,,362,307.7,103.7492,362,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,362,100,,percent of total billed charges,,
"Phlebotomy, Therapuetic",,99195,CPT,Facility,Both,,,,362,307.7,103.7492,362,BlueCross BlueShield Minnesota,High Value Network Plan,325.8,90,,percent of total billed charges,,
"Phlebotomy, Therapuetic",,99195,CPT,Facility,Outpatient,,,,362,307.7,103.7492,362,BlueCross BlueShield Minnesota,Medicare Advantage,177.38,49,,percent of total billed charges,,
"Phlebotomy, Therapuetic",,99195,CPT,Facility,Inpatient,,,,362,307.7,103.7492,362,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Phlebotomy, Therapuetic",,99195,CPT,Facility,Both,,,,362,307.7,103.7492,362,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,320.6234,88.57,,percent of total billed charges,,
"Phlebotomy, Therapuetic",,99195,CPT,Facility,Both,,,,362,307.7,103.7492,362,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,103.7492,28.66,,percent of total billed charges,,
"Phlebotomy, Therapuetic",,99195,CPT,Facility,Outpatient,,,,362,307.7,103.7492,362,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),177.38,49,,percent of total billed charges,,
"Phlebotomy, Therapuetic",,99195,CPT,Facility,Inpatient,,,,362,307.7,103.7492,362,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Phlebotomy, Therapuetic",,99195,CPT,Facility,Both,,,,362,307.7,103.7492,362,CorVel,Worker's Compensation,362,100,,percent of total billed charges,,
"Phlebotomy, Therapuetic",,99195,CPT,Facility,Both,,,,362,307.7,103.7492,362,First Health Group Corporation,First Health Network,351.14,97,,percent of total billed charges,,
"Phlebotomy, Therapuetic",,99195,CPT,Facility,Both,,,,362,307.7,103.7492,362,"Health Partners, Inc.",Commercial,342.452,94.6,,percent of total billed charges,,
"Phlebotomy, Therapuetic",,99195,CPT,Facility,Outpatient,,,,362,307.7,103.7492,362,"Health Partners, Inc.",Medicare Advantage,177.38,49,,percent of total billed charges,,
"Phlebotomy, Therapuetic",,99195,CPT,Facility,Inpatient,,,,362,307.7,103.7492,362,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Phlebotomy, Therapuetic",,99195,CPT,Facility,Both,,,,362,307.7,103.7492,362,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),217.2,60,,percent of total billed charges,,
"Phlebotomy, Therapuetic",,99195,CPT,Facility,Both,,,,362,307.7,103.7492,362,"Health Partners, Inc.",State of Minnesota Advantage Program,295.03,81.5,,percent of total billed charges,,
"Phlebotomy, Therapuetic",,99195,CPT,Facility,Both,,,,362,307.7,103.7492,362,"Health Partners, Inc.",State Public Programs,181,50,,percent of total billed charges,,
"Phlebotomy, Therapuetic",,99195,CPT,Facility,Both,,,,362,307.7,103.7492,362,Humana Insurance Company,Commercial PPO,343.9,95,,percent of total billed charges,,
"Phlebotomy, Therapuetic",,99195,CPT,Facility,Outpatient,,,,362,307.7,103.7492,362,Humana Insurance Company,Medicare PPO,177.38,49,,percent of total billed charges,,
"Phlebotomy, Therapuetic",,99195,CPT,Facility,Inpatient,,,,362,307.7,103.7492,362,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Phlebotomy, Therapuetic",,99195,CPT,Facility,Both,,,,362,307.7,103.7492,362,Medica,Individual & Family,358.742,99.1,,percent of total billed charges,,
"Phlebotomy, Therapuetic",,99195,CPT,Facility,Outpatient,,,,362,307.7,103.7492,362,Medica,Medica Advantage Solution,180.276,49.8,,percent of total billed charges,,
"Phlebotomy, Therapuetic",,99195,CPT,Facility,Inpatient,,,,362,307.7,103.7492,362,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Phlebotomy, Therapuetic",,99195,CPT,Facility,Outpatient,,,,362,307.7,103.7492,362,Medica,Medical Assistance,161.452,44.6,,percent of total billed charges,,
"Phlebotomy, Therapuetic",,99195,CPT,Facility,Inpatient,,,,362,307.7,103.7492,362,Medica,Medical Assistance,,,,,Included in per diem rate,
"Phlebotomy, Therapuetic",,99195,CPT,Facility,Outpatient,,,,362,307.7,103.7492,362,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,180.276,49.8,,percent of total billed charges,,
"Phlebotomy, Therapuetic",,99195,CPT,Facility,Inpatient,,,,362,307.7,103.7492,362,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Phlebotomy, Therapuetic",,99195,CPT,Facility,Both,,,,362,307.7,103.7492,362,"Multiplan, Inc.","Multiplan, Inc.",340.28,94,,percent of total billed charges,,
"Phlebotomy, Therapuetic",,99195,CPT,Facility,Outpatient,,,,362,307.7,103.7492,362,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,326.162,90.1,,percent of total billed charges,,
"Phlebotomy, Therapuetic",,99195,CPT,Facility,Inpatient,,,,362,307.7,103.7492,362,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Phlebotomy, Therapuetic",,99195,CPT,Facility,Both,,,,362,307.7,103.7492,362,"Preferred One Administrative Services, INC.",PPO,356.932,98.6,,percent of total billed charges,,
"Phlebotomy, Therapuetic",,99195,CPT,Facility,Outpatient,,,,362,307.7,103.7492,362,PrimeWest Health,Minnesota Senior Health Options (MSHO),186.249,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Phlebotomy, Therapuetic",,99195,CPT,Facility,Inpatient,,,,362,307.7,103.7492,362,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Phlebotomy, Therapuetic",,99195,CPT,Facility,Outpatient,,,,362,307.7,103.7492,362,PrimeWest Health,MinnesotaCare,185.9232,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Phlebotomy, Therapuetic",,99195,CPT,Facility,Inpatient,,,,362,307.7,103.7492,362,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Phlebotomy, Therapuetic",,99195,CPT,Facility,Both,,,,362,307.7,103.7492,362,Sanford Health Plan,Sanford Health Plan,333.04,92,,percent of total billed charges,,
"Phlebotomy, Therapuetic",,99195,CPT,Facility,Outpatient,,,,362,307.7,103.7492,362,"UCare Health, Inc.",Individual & Family Plan,203.987,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Phlebotomy, Therapuetic",,99195,CPT,Facility,Inpatient,,,,362,307.7,103.7492,362,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Phlebotomy, Therapuetic",,99195,CPT,Facility,Outpatient,,,,362,307.7,103.7492,362,"UCare Health, Inc.",Medical Assistance,182.7014,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Phlebotomy, Therapuetic",,99195,CPT,Facility,Inpatient,,,,362,307.7,103.7492,362,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Phlebotomy, Therapuetic",,99195,CPT,Facility,Outpatient,,,,362,307.7,103.7492,362,"UCare Health, Inc.",Medicare Advantage,182.7014,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Phlebotomy, Therapuetic",,99195,CPT,Facility,Inpatient,,,,362,307.7,103.7492,362,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Phlebotomy, Therapuetic",,99195,CPT,Facility,Outpatient,,,,362,307.7,103.7492,362,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),182.7014,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Phlebotomy, Therapuetic",,99195,CPT,Facility,Inpatient,,,,362,307.7,103.7492,362,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Phlebotomy, Therapuetic",,99195,CPT,Facility,Both,,,,362,307.7,103.7492,362,UnitedHealthcare,Individual & Family,340.28,94,,percent of total billed charges,,
"Phlebotomy, Therapuetic",,99195,CPT,Facility,Outpatient,,,,362,307.7,103.7492,362,UnitedHealthcare,Medicare Advantage,177.38,49,,percent of total billed charges,,
"Phlebotomy, Therapuetic",,99195,CPT,Facility,Inpatient,,,,362,307.7,103.7492,362,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Phlebotomy, Therapuetic",,99195,CPT,Facility,Outpatient,,,,362,307.7,103.7492,362,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,173.76,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Phlebotomy, Therapuetic",,99195,CPT,Facility,Inpatient,,,,362,307.7,103.7492,362,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time",,99202,CPT,Facility,Outpatient,,,,75,63.75,21.495,75,Aetna,Commercial,69,92,,percent of total billed charges,,
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time",,99202,CPT,Facility,Outpatient,,,,75,63.75,21.495,75,Aetna,Medicare Advantage,36.75,49,,percent of total billed charges,,
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time",,99202,CPT,Facility,Outpatient,,,,75,63.75,21.495,75,Aetna,PPO,69.75,93,,percent of total billed charges,,
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time",,99202,CPT,Facility,Outpatient,,,,75,63.75,21.495,75,America's PPO,America's PPO,72.0225,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time",,99202,CPT,Facility,Outpatient,,,,75,63.75,21.495,75,BlueCross BlueShield Minnesota, Federal Employee Program,73.8,98.4,,percent of total billed charges,,
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time",,99202,CPT,Facility,Outpatient,,,,75,63.75,21.495,75,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,75,100,,percent of total billed charges,,
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time",,99202,CPT,Facility,Outpatient,,,,75,63.75,21.495,75,BlueCross BlueShield Minnesota,High Value Network Plan,67.5,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time",,99202,CPT,Facility,Outpatient,,,,75,63.75,21.495,75,BlueCross BlueShield Minnesota,Medicare Advantage,36.75,49,,percent of total billed charges,,
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time",,99202,CPT,Facility,Outpatient,,,,75,63.75,21.495,75,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,21.495,28.66,,percent of total billed charges,,
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time",,99202,CPT,Facility,Outpatient,,,,75,63.75,21.495,75,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),36.75,49,,percent of total billed charges,,
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time",,99202,CPT,Facility,Outpatient,,,,75,63.75,21.495,75,CorVel,Worker's Compensation,75,100,,percent of total billed charges,,
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time",,99202,CPT,Facility,Outpatient,,,,75,63.75,21.495,75,First Health Group Corporation,First Health Network,72.75,97,,percent of total billed charges,,
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time",,99202,CPT,Facility,Outpatient,,,,75,63.75,21.495,75,"Health Partners, Inc.",Commercial,70.95,94.6,,percent of total billed charges,,
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time",,99202,CPT,Facility,Outpatient,,,,75,63.75,21.495,75,"Health Partners, Inc.",Medicare Advantage,36.75,49,,percent of total billed charges,,
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time",,99202,CPT,Facility,Outpatient,,,,75,63.75,21.495,75,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),45,60,,percent of total billed charges,,
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time",,99202,CPT,Facility,Outpatient,,,,75,63.75,21.495,75,"Health Partners, Inc.",State of Minnesota Advantage Program,61.125,81.5,,percent of total billed charges,,
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time",,99202,CPT,Facility,Outpatient,,,,75,63.75,21.495,75,"Health Partners, Inc.",State Public Programs,37.5,50,,percent of total billed charges,,
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time",,99202,CPT,Facility,Outpatient,,,,75,63.75,21.495,75,Humana Insurance Company,Commercial PPO,71.25,95,,percent of total billed charges,,
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time",,99202,CPT,Facility,Outpatient,,,,75,63.75,21.495,75,Humana Insurance Company,Medicare PPO,36.75,49,,percent of total billed charges,,
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time",,99202,CPT,Facility,Outpatient,,,,75,63.75,21.495,75,Medica,Individual & Family,74.325,99.1,,percent of total billed charges,,
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time",,99202,CPT,Facility,Outpatient,,,,75,63.75,21.495,75,Medica,Medica Advantage Solution,37.35,49.8,,percent of total billed charges,,
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time",,99202,CPT,Facility,Outpatient,,,,75,63.75,21.495,75,Medica,Medical Assistance,33.45,44.6,,percent of total billed charges,,
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time",,99202,CPT,Facility,Outpatient,,,,75,63.75,21.495,75,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,37.35,49.8,,percent of total billed charges,,
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time",,99202,CPT,Facility,Outpatient,,,,75,63.75,21.495,75,"Multiplan, Inc.","Multiplan, Inc.",70.5,94,,percent of total billed charges,,
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time",,99202,CPT,Facility,Outpatient,,,,75,63.75,21.495,75,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,67.575,90.1,,percent of total billed charges,,
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time",,99202,CPT,Facility,Outpatient,,,,75,63.75,21.495,75,"Preferred One Administrative Services, INC.",PPO,73.95,98.6,,percent of total billed charges,,
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time",,99202,CPT,Facility,Outpatient,,,,75,63.75,21.495,75,PrimeWest Health,Minnesota Senior Health Options (MSHO),38.5875,51.45,,percent of total billed charges,,
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time",,99202,CPT,Facility,Outpatient,,,,75,63.75,21.495,75,PrimeWest Health,MinnesotaCare,38.52,51.36,,percent of total billed charges,,
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time",,99202,CPT,Facility,Outpatient,,,,75,63.75,21.495,75,Sanford Health Plan,Sanford Health Plan,69,92,,percent of total billed charges,,
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time",,99202,CPT,Facility,Outpatient,,,,75,63.75,21.495,75,"UCare Health, Inc.",Individual & Family Plan,42.2625,56.35,,percent of total billed charges,,
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time",,99202,CPT,Facility,Outpatient,,,,75,63.75,21.495,75,"UCare Health, Inc.",Medical Assistance,37.8525,50.47,,percent of total billed charges,,
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time",,99202,CPT,Facility,Outpatient,,,,75,63.75,21.495,75,"UCare Health, Inc.",Medicare Advantage,37.8525,50.47,,percent of total billed charges,,
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time",,99202,CPT,Facility,Outpatient,,,,75,63.75,21.495,75,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),37.8525,50.47,,percent of total billed charges,,
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time",,99202,CPT,Facility,Outpatient,,,,75,63.75,21.495,75,UnitedHealthcare,Individual & Family,70.5,94,,percent of total billed charges,,
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time",,99202,CPT,Facility,Outpatient,,,,75,63.75,21.495,75,UnitedHealthcare,Medicare Advantage,36.75,49,,percent of total billed charges,,
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time",,99202,CPT,Facility,Outpatient,,,,75,63.75,21.495,75,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,36,48,,percent of total billed charges,,100% of DHS outpatient percentage
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pbb)",,99202,CPT,Facility,Outpatient,,,,75,63.75,21.495,75,Aetna,Commercial,69,92,,percent of total billed charges,,
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pbb)",,99202,CPT,Professional,Outpatient,,,,125,106.25,32.44,125,Aetna,Commercial,106.25,85,,percent of total billed charges,,
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pbb)",,99202,CPT,Facility,Outpatient,,,,75,63.75,21.495,75,Aetna,Medicare Advantage,36.75,49,,percent of total billed charges,,
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pbb)",,99202,CPT,Professional,Outpatient,,,,125,106.25,32.44,125,Aetna,Medicare Advantage,48.05,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pbb)",,99202,CPT,Facility,Outpatient,,,,75,63.75,21.495,75,Aetna,PPO,69.75,93,,percent of total billed charges,,
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pbb)",,99202,CPT,Professional,Outpatient,,,,125,106.25,32.44,125,Aetna,PPO,116.25,93,,percent of total billed charges,,
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pbb)",,99202,CPT,Facility,Outpatient,,,,75,63.75,21.495,75,America's PPO,America's PPO,72.0225,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pbb)",,99202,CPT,Professional,Outpatient,,,,125,106.25,32.44,125,America's PPO,America's PPO,106.8,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pbb)",,99202,CPT,Facility,Outpatient,,,,75,63.75,21.495,75,BlueCross BlueShield Minnesota, Federal Employee Program,73.8,98.4,,percent of total billed charges,,
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pbb)",,99202,CPT,Professional,Outpatient,,,,125,106.25,32.44,125,BlueCross BlueShield Minnesota, Federal Employee Program,84.97,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pbb)",,99202,CPT,Facility,Outpatient,,,,75,63.75,21.495,75,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,75,100,,percent of total billed charges,,
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pbb)",,99202,CPT,Professional,Outpatient,,,,125,106.25,32.44,125,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,86.32952,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pbb)",,99202,CPT,Facility,Outpatient,,,,75,63.75,21.495,75,BlueCross BlueShield Minnesota,High Value Network Plan,67.5,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pbb)",,99202,CPT,Professional,Outpatient,,,,125,106.25,32.44,125,BlueCross BlueShield Minnesota,High Value Network Plan,86.32952,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pbb)",,99202,CPT,Facility,Outpatient,,,,75,63.75,21.495,75,BlueCross BlueShield Minnesota,Medicare Advantage,36.75,49,,percent of total billed charges,,
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pbb)",,99202,CPT,Professional,Outpatient,,,,125,106.25,32.44,125,BlueCross BlueShield Minnesota,Medicare Advantage,53.544,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pbb)",,99202,CPT,Professional,Outpatient,,,,125,106.25,32.44,125,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,86.32952,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pbb)",,99202,CPT,Facility,Outpatient,,,,75,63.75,21.495,75,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,21.495,28.66,,percent of total billed charges,,
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pbb)",,99202,CPT,Professional,Outpatient,,,,125,106.25,32.44,125,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,34.51352,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pbb)",,99202,CPT,Facility,Outpatient,,,,75,63.75,21.495,75,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),36.75,49,,percent of total billed charges,,
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pbb)",,99202,CPT,Professional,Outpatient,,,,125,106.25,32.44,125,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),53.544,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pbb)",,99202,CPT,Facility,Outpatient,,,,75,63.75,21.495,75,CorVel,Worker's Compensation,75,100,,percent of total billed charges,,
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pbb)",,99202,CPT,Professional,Outpatient,,,,125,106.25,32.44,125,CorVel,Worker's Compensation,92.499807,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pbb)",,99202,CPT,Facility,Outpatient,,,,75,63.75,21.495,75,First Health Group Corporation,First Health Network,72.75,97,,percent of total billed charges,,
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pbb)",,99202,CPT,Professional,Outpatient,,,,125,106.25,32.44,125,First Health Group Corporation,First Health Network,121.25,97,,percent of total billed charges,,
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pbb)",,99202,CPT,Facility,Outpatient,,,,75,63.75,21.495,75,"Health Partners, Inc.",Commercial,70.95,94.6,,percent of total billed charges,,
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pbb)",,99202,CPT,Professional,Outpatient,,,,125,106.25,32.44,125,"Health Partners, Inc.",Commercial,100.13,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pbb)",,99202,CPT,Facility,Outpatient,,,,75,63.75,21.495,75,"Health Partners, Inc.",Medicare Advantage,36.75,49,,percent of total billed charges,,
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pbb)",,99202,CPT,Professional,Outpatient,,,,125,106.25,32.44,125,"Health Partners, Inc.",Medicare Advantage,53.544,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pbb)",,99202,CPT,Facility,Outpatient,,,,75,63.75,21.495,75,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),45,60,,percent of total billed charges,,
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pbb)",,99202,CPT,Professional,Outpatient,,,,125,106.25,32.44,125,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),46.76,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pbb)",,99202,CPT,Facility,Outpatient,,,,75,63.75,21.495,75,"Health Partners, Inc.",State of Minnesota Advantage Program,61.125,81.5,,percent of total billed charges,,
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pbb)",,99202,CPT,Professional,Outpatient,,,,125,106.25,32.44,125,"Health Partners, Inc.",State of Minnesota Advantage Program,86.261995,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pbb)",,99202,CPT,Facility,Outpatient,,,,75,63.75,21.495,75,"Health Partners, Inc.",State Public Programs,37.5,50,,percent of total billed charges,,
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pbb)",,99202,CPT,Professional,Outpatient,,,,125,106.25,32.44,125,"Health Partners, Inc.",State Public Programs,32.44,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pbb)",,99202,CPT,Facility,Outpatient,,,,75,63.75,21.495,75,Humana Insurance Company,Commercial PPO,71.25,95,,percent of total billed charges,,
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pbb)",,99202,CPT,Professional,Outpatient,,,,125,106.25,32.44,125,Humana Insurance Company,Commercial PPO,46.56,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pbb)",,99202,CPT,Facility,Outpatient,,,,75,63.75,21.495,75,Humana Insurance Company,Medicare PPO,36.75,49,,percent of total billed charges,,
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pbb)",,99202,CPT,Professional,Outpatient,,,,125,106.25,32.44,125,Humana Insurance Company,Medicare PPO,125,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pbb)",,99202,CPT,Facility,Outpatient,,,,75,63.75,21.495,75,Medica,Individual & Family,74.325,99.1,,percent of total billed charges,,
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pbb)",,99202,CPT,Professional,Outpatient,,,,125,106.25,32.44,125,Medica,Individual & Family,106,84.8,,percent of total billed charges,,
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pbb)",,99202,CPT,Facility,Outpatient,,,,75,63.75,21.495,75,Medica,Medica Advantage Solution,37.35,49.8,,percent of total billed charges,,
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pbb)",,99202,CPT,Professional,Outpatient,,,,125,106.25,32.44,125,Medica,Medica Advantage Solution,62.25,49.8,,percent of total billed charges,,
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pbb)",,99202,CPT,Facility,Outpatient,,,,75,63.75,21.495,75,Medica,Medical Assistance,33.45,44.6,,percent of total billed charges,,
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pbb)",,99202,CPT,Professional,Outpatient,,,,125,106.25,32.44,125,Medica,Medical Assistance,34.51,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pbb)",,99202,CPT,Facility,Outpatient,,,,75,63.75,21.495,75,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,37.35,49.8,,percent of total billed charges,,
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pbb)",,99202,CPT,Professional,Outpatient,,,,125,106.25,32.44,125,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,46.56,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pbb)",,99202,CPT,Facility,Outpatient,,,,75,63.75,21.495,75,"Multiplan, Inc.","Multiplan, Inc.",70.5,94,,percent of total billed charges,,
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pbb)",,99202,CPT,Professional,Outpatient,,,,125,106.25,32.44,125,"Multiplan, Inc.","Multiplan, Inc.",117.5,94,,percent of total billed charges,,
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pbb)",,99202,CPT,Facility,Outpatient,,,,75,63.75,21.495,75,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,67.575,90.1,,percent of total billed charges,,
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pbb)",,99202,CPT,Professional,Outpatient,,,,125,106.25,32.44,125,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,112.625,90.1,,percent of total billed charges,,
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pbb)",,99202,CPT,Facility,Outpatient,,,,75,63.75,21.495,75,"Preferred One Administrative Services, INC.",PPO,73.95,98.6,,percent of total billed charges,,
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pbb)",,99202,CPT,Professional,Outpatient,,,,125,106.25,32.44,125,"Preferred One Administrative Services, INC.",PPO,123.25,98.6,,percent of total billed charges,,
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pbb)",,99202,CPT,Facility,Outpatient,,,,75,63.75,21.495,75,PrimeWest Health,Minnesota Senior Health Options (MSHO),38.5875,51.45,,percent of total billed charges,,
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pbb)",,99202,CPT,Professional,Outpatient,,,,125,106.25,32.44,125,PrimeWest Health,Minnesota Senior Health Options (MSHO),53.544,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pbb)",,99202,CPT,Facility,Outpatient,,,,75,63.75,21.495,75,PrimeWest Health,MinnesotaCare,38.52,51.36,,percent of total billed charges,,
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pbb)",,99202,CPT,Professional,Outpatient,,,,125,106.25,32.44,125,PrimeWest Health,MinnesotaCare,36.9294664,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pbb)",,99202,CPT,Facility,Outpatient,,,,75,63.75,21.495,75,Sanford Health Plan,Sanford Health Plan,69,92,,percent of total billed charges,,
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pbb)",,99202,CPT,Professional,Outpatient,,,,125,106.25,32.44,125,Sanford Health Plan,Sanford Health Plan,110,88,,percent of total billed charges,,
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pbb)",,99202,CPT,Facility,Outpatient,,,,75,63.75,21.495,75,"UCare Health, Inc.",Individual & Family Plan,42.2625,56.35,,percent of total billed charges,,
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pbb)",,99202,CPT,Professional,Outpatient,,,,125,106.25,32.44,125,"UCare Health, Inc.",Individual & Family Plan,75.687936,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pbb)",,99202,CPT,Facility,Outpatient,,,,75,63.75,21.495,75,"UCare Health, Inc.",Medical Assistance,37.8525,50.47,,percent of total billed charges,,
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pbb)",,99202,CPT,Professional,Outpatient,,,,125,106.25,32.44,125,"UCare Health, Inc.",Medical Assistance,37.964872,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pbb)",,99202,CPT,Facility,Outpatient,,,,75,63.75,21.495,75,"UCare Health, Inc.",Medicare Advantage,37.8525,50.47,,percent of total billed charges,,
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pbb)",,99202,CPT,Professional,Outpatient,,,,125,106.25,32.44,125,"UCare Health, Inc.",Medicare Advantage,53.544,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pbb)",,99202,CPT,Facility,Outpatient,,,,75,63.75,21.495,75,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),37.8525,50.47,,percent of total billed charges,,
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pbb)",,99202,CPT,Professional,Outpatient,,,,125,106.25,32.44,125,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),42.8352,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pbb)",,99202,CPT,Facility,Outpatient,,,,75,63.75,21.495,75,UnitedHealthcare,Individual & Family,70.5,94,,percent of total billed charges,,
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pbb)",,99202,CPT,Professional,Outpatient,,,,125,106.25,32.44,125,UnitedHealthcare,Individual & Family,125,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pbb)",,99202,CPT,Facility,Outpatient,,,,75,63.75,21.495,75,UnitedHealthcare,Medicare Advantage,36.75,49,,percent of total billed charges,,
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pbb)",,99202,CPT,Professional,Outpatient,,,,125,106.25,32.44,125,UnitedHealthcare,Medicare Advantage,53.544,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pbb)",,99202,CPT,Facility,Outpatient,,,,75,63.75,21.495,75,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,36,48,,percent of total billed charges,,100% of DHS outpatient percentage
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pbb)",,99202,CPT,Professional,Outpatient,,,,125,106.25,32.44,125,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,34.51352,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pro Cah)",,99202,CPT,Professional,Outpatient,,,,180,153,32.44,180,Aetna,Commercial,153,85,,percent of total billed charges,,
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pro Cah)",,99202,CPT,Professional,Outpatient,,,,200,170,32.44,200,Aetna,Commercial,170,85,,percent of total billed charges,,
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pro Cah)",,99202,CPT,Professional,Outpatient,,,,250,212.5,32.44,250,Aetna,Commercial,212.5,85,,percent of total billed charges,,
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pro Cah)",,99202,CPT,Professional,Outpatient,,,,180,153,32.44,180,Aetna,Medicare Advantage,48.05,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pro Cah)",,99202,CPT,Professional,Outpatient,,,,200,170,32.44,200,Aetna,Medicare Advantage,48.05,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pro Cah)",,99202,CPT,Professional,Outpatient,,,,250,212.5,32.44,250,Aetna,Medicare Advantage,48.05,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pro Cah)",,99202,CPT,Professional,Outpatient,,,,180,153,32.44,180,Aetna,PPO,167.4,93,,percent of total billed charges,,
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pro Cah)",,99202,CPT,Professional,Outpatient,,,,200,170,32.44,200,Aetna,PPO,186,93,,percent of total billed charges,,
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pro Cah)",,99202,CPT,Professional,Outpatient,,,,250,212.5,32.44,250,Aetna,PPO,232.5,93,,percent of total billed charges,,
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pro Cah)",,99202,CPT,Professional,Outpatient,,,,180,153,32.44,180,America's PPO,America's PPO,153.792,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pro Cah)",,99202,CPT,Professional,Outpatient,,,,200,170,32.44,200,America's PPO,America's PPO,170.88,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pro Cah)",,99202,CPT,Professional,Outpatient,,,,250,212.5,32.44,250,America's PPO,America's PPO,213.6,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pro Cah)",,99202,CPT,Professional,Outpatient,,,,180,153,32.44,180,BlueCross BlueShield Minnesota, Federal Employee Program,84.97,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pro Cah)",,99202,CPT,Professional,Outpatient,,,,200,170,32.44,200,BlueCross BlueShield Minnesota, Federal Employee Program,84.97,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pro Cah)",,99202,CPT,Professional,Outpatient,,,,250,212.5,32.44,250,BlueCross BlueShield Minnesota, Federal Employee Program,84.97,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pro Cah)",,99202,CPT,Professional,Outpatient,,,,180,153,32.44,180,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,86.32952,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pro Cah)",,99202,CPT,Professional,Outpatient,,,,200,170,32.44,200,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,86.32952,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pro Cah)",,99202,CPT,Professional,Outpatient,,,,250,212.5,32.44,250,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,86.32952,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pro Cah)",,99202,CPT,Professional,Outpatient,,,,180,153,32.44,180,BlueCross BlueShield Minnesota,High Value Network Plan,86.32952,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pro Cah)",,99202,CPT,Professional,Outpatient,,,,200,170,32.44,200,BlueCross BlueShield Minnesota,High Value Network Plan,86.32952,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pro Cah)",,99202,CPT,Professional,Outpatient,,,,250,212.5,32.44,250,BlueCross BlueShield Minnesota,High Value Network Plan,86.32952,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pro Cah)",,99202,CPT,Professional,Outpatient,,,,180,153,32.44,180,BlueCross BlueShield Minnesota,Medicare Advantage,53.544,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pro Cah)",,99202,CPT,Professional,Outpatient,,,,200,170,32.44,200,BlueCross BlueShield Minnesota,Medicare Advantage,53.544,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pro Cah)",,99202,CPT,Professional,Outpatient,,,,250,212.5,32.44,250,BlueCross BlueShield Minnesota,Medicare Advantage,53.544,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pro Cah)",,99202,CPT,Professional,Outpatient,,,,180,153,32.44,180,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,86.32952,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pro Cah)",,99202,CPT,Professional,Outpatient,,,,200,170,32.44,200,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,86.32952,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pro Cah)",,99202,CPT,Professional,Outpatient,,,,250,212.5,32.44,250,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,86.32952,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pro Cah)",,99202,CPT,Professional,Outpatient,,,,180,153,32.44,180,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,34.51352,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pro Cah)",,99202,CPT,Professional,Outpatient,,,,200,170,32.44,200,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,34.51352,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pro Cah)",,99202,CPT,Professional,Outpatient,,,,250,212.5,32.44,250,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,34.51352,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pro Cah)",,99202,CPT,Professional,Outpatient,,,,180,153,32.44,180,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),53.544,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pro Cah)",,99202,CPT,Professional,Outpatient,,,,200,170,32.44,200,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),53.544,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pro Cah)",,99202,CPT,Professional,Outpatient,,,,250,212.5,32.44,250,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),53.544,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pro Cah)",,99202,CPT,Professional,Outpatient,,,,180,153,32.44,180,CorVel,Worker's Compensation,92.499807,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pro Cah)",,99202,CPT,Professional,Outpatient,,,,200,170,32.44,200,CorVel,Worker's Compensation,92.499807,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pro Cah)",,99202,CPT,Professional,Outpatient,,,,250,212.5,32.44,250,CorVel,Worker's Compensation,92.499807,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pro Cah)",,99202,CPT,Professional,Outpatient,,,,180,153,32.44,180,First Health Group Corporation,First Health Network,174.6,97,,percent of total billed charges,,
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pro Cah)",,99202,CPT,Professional,Outpatient,,,,200,170,32.44,200,First Health Group Corporation,First Health Network,194,97,,percent of total billed charges,,
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pro Cah)",,99202,CPT,Professional,Outpatient,,,,250,212.5,32.44,250,First Health Group Corporation,First Health Network,242.5,97,,percent of total billed charges,,
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pro Cah)",,99202,CPT,Professional,Outpatient,,,,180,153,32.44,180,"Health Partners, Inc.",Commercial,100.13,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pro Cah)",,99202,CPT,Professional,Outpatient,,,,200,170,32.44,200,"Health Partners, Inc.",Commercial,100.13,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pro Cah)",,99202,CPT,Professional,Outpatient,,,,250,212.5,32.44,250,"Health Partners, Inc.",Commercial,100.13,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pro Cah)",,99202,CPT,Professional,Outpatient,,,,180,153,32.44,180,"Health Partners, Inc.",Medicare Advantage,53.544,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pro Cah)",,99202,CPT,Professional,Outpatient,,,,200,170,32.44,200,"Health Partners, Inc.",Medicare Advantage,53.544,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pro Cah)",,99202,CPT,Professional,Outpatient,,,,250,212.5,32.44,250,"Health Partners, Inc.",Medicare Advantage,53.544,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pro Cah)",,99202,CPT,Professional,Outpatient,,,,180,153,32.44,180,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),46.76,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pro Cah)",,99202,CPT,Professional,Outpatient,,,,200,170,32.44,200,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),46.76,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pro Cah)",,99202,CPT,Professional,Outpatient,,,,250,212.5,32.44,250,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),46.76,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pro Cah)",,99202,CPT,Professional,Outpatient,,,,180,153,32.44,180,"Health Partners, Inc.",State of Minnesota Advantage Program,86.261995,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pro Cah)",,99202,CPT,Professional,Outpatient,,,,200,170,32.44,200,"Health Partners, Inc.",State of Minnesota Advantage Program,86.261995,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pro Cah)",,99202,CPT,Professional,Outpatient,,,,250,212.5,32.44,250,"Health Partners, Inc.",State of Minnesota Advantage Program,86.261995,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pro Cah)",,99202,CPT,Professional,Outpatient,,,,180,153,32.44,180,"Health Partners, Inc.",State Public Programs,32.44,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pro Cah)",,99202,CPT,Professional,Outpatient,,,,200,170,32.44,200,"Health Partners, Inc.",State Public Programs,32.44,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pro Cah)",,99202,CPT,Professional,Outpatient,,,,250,212.5,32.44,250,"Health Partners, Inc.",State Public Programs,32.44,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pro Cah)",,99202,CPT,Professional,Outpatient,,,,180,153,32.44,180,Humana Insurance Company,Commercial PPO,46.56,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pro Cah)",,99202,CPT,Professional,Outpatient,,,,200,170,32.44,200,Humana Insurance Company,Commercial PPO,46.56,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pro Cah)",,99202,CPT,Professional,Outpatient,,,,250,212.5,32.44,250,Humana Insurance Company,Commercial PPO,46.56,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pro Cah)",,99202,CPT,Professional,Outpatient,,,,180,153,32.44,180,Humana Insurance Company,Medicare PPO,180,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pro Cah)",,99202,CPT,Professional,Outpatient,,,,200,170,32.44,200,Humana Insurance Company,Medicare PPO,200,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pro Cah)",,99202,CPT,Professional,Outpatient,,,,250,212.5,32.44,250,Humana Insurance Company,Medicare PPO,250,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pro Cah)",,99202,CPT,Professional,Outpatient,,,,180,153,32.44,180,Medica,Individual & Family,152.64,84.8,,percent of total billed charges,,
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pro Cah)",,99202,CPT,Professional,Outpatient,,,,200,170,32.44,200,Medica,Individual & Family,169.6,84.8,,percent of total billed charges,,
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pro Cah)",,99202,CPT,Professional,Outpatient,,,,250,212.5,32.44,250,Medica,Individual & Family,212,84.8,,percent of total billed charges,,
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pro Cah)",,99202,CPT,Professional,Outpatient,,,,180,153,32.44,180,Medica,Medica Advantage Solution,89.64,49.8,,percent of total billed charges,,
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pro Cah)",,99202,CPT,Professional,Outpatient,,,,200,170,32.44,200,Medica,Medica Advantage Solution,99.6,49.8,,percent of total billed charges,,
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pro Cah)",,99202,CPT,Professional,Outpatient,,,,250,212.5,32.44,250,Medica,Medica Advantage Solution,124.5,49.8,,percent of total billed charges,,
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pro Cah)",,99202,CPT,Professional,Outpatient,,,,180,153,32.44,180,Medica,Medical Assistance,34.51,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pro Cah)",,99202,CPT,Professional,Outpatient,,,,200,170,32.44,200,Medica,Medical Assistance,34.51,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pro Cah)",,99202,CPT,Professional,Outpatient,,,,250,212.5,32.44,250,Medica,Medical Assistance,34.51,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pro Cah)",,99202,CPT,Professional,Outpatient,,,,180,153,32.44,180,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,46.56,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pro Cah)",,99202,CPT,Professional,Outpatient,,,,200,170,32.44,200,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,46.56,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pro Cah)",,99202,CPT,Professional,Outpatient,,,,250,212.5,32.44,250,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,46.56,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pro Cah)",,99202,CPT,Professional,Outpatient,,,,180,153,32.44,180,"Multiplan, Inc.","Multiplan, Inc.",169.2,94,,percent of total billed charges,,
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pro Cah)",,99202,CPT,Professional,Outpatient,,,,200,170,32.44,200,"Multiplan, Inc.","Multiplan, Inc.",188,94,,percent of total billed charges,,
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pro Cah)",,99202,CPT,Professional,Outpatient,,,,250,212.5,32.44,250,"Multiplan, Inc.","Multiplan, Inc.",235,94,,percent of total billed charges,,
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pro Cah)",,99202,CPT,Professional,Outpatient,,,,180,153,32.44,180,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,162.18,90.1,,percent of total billed charges,,
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pro Cah)",,99202,CPT,Professional,Outpatient,,,,200,170,32.44,200,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,180.2,90.1,,percent of total billed charges,,
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pro Cah)",,99202,CPT,Professional,Outpatient,,,,250,212.5,32.44,250,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,225.25,90.1,,percent of total billed charges,,
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pro Cah)",,99202,CPT,Professional,Outpatient,,,,180,153,32.44,180,"Preferred One Administrative Services, INC.",PPO,177.48,98.6,,percent of total billed charges,,
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pro Cah)",,99202,CPT,Professional,Outpatient,,,,200,170,32.44,200,"Preferred One Administrative Services, INC.",PPO,197.2,98.6,,percent of total billed charges,,
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pro Cah)",,99202,CPT,Professional,Outpatient,,,,250,212.5,32.44,250,"Preferred One Administrative Services, INC.",PPO,246.5,98.6,,percent of total billed charges,,
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pro Cah)",,99202,CPT,Professional,Outpatient,,,,180,153,32.44,180,PrimeWest Health,Minnesota Senior Health Options (MSHO),53.544,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pro Cah)",,99202,CPT,Professional,Outpatient,,,,200,170,32.44,200,PrimeWest Health,Minnesota Senior Health Options (MSHO),53.544,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pro Cah)",,99202,CPT,Professional,Outpatient,,,,250,212.5,32.44,250,PrimeWest Health,Minnesota Senior Health Options (MSHO),53.544,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pro Cah)",,99202,CPT,Professional,Outpatient,,,,180,153,32.44,180,PrimeWest Health,MinnesotaCare,36.9294664,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pro Cah)",,99202,CPT,Professional,Outpatient,,,,200,170,32.44,200,PrimeWest Health,MinnesotaCare,36.9294664,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pro Cah)",,99202,CPT,Professional,Outpatient,,,,250,212.5,32.44,250,PrimeWest Health,MinnesotaCare,36.9294664,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pro Cah)",,99202,CPT,Professional,Outpatient,,,,180,153,32.44,180,Sanford Health Plan,Sanford Health Plan,158.4,88,,percent of total billed charges,,
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pro Cah)",,99202,CPT,Professional,Outpatient,,,,200,170,32.44,200,Sanford Health Plan,Sanford Health Plan,176,88,,percent of total billed charges,,
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pro Cah)",,99202,CPT,Professional,Outpatient,,,,250,212.5,32.44,250,Sanford Health Plan,Sanford Health Plan,220,88,,percent of total billed charges,,
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pro Cah)",,99202,CPT,Professional,Outpatient,,,,180,153,32.44,180,"UCare Health, Inc.",Individual & Family Plan,75.687936,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pro Cah)",,99202,CPT,Professional,Outpatient,,,,200,170,32.44,200,"UCare Health, Inc.",Individual & Family Plan,75.687936,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pro Cah)",,99202,CPT,Professional,Outpatient,,,,250,212.5,32.44,250,"UCare Health, Inc.",Individual & Family Plan,75.687936,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pro Cah)",,99202,CPT,Professional,Outpatient,,,,180,153,32.44,180,"UCare Health, Inc.",Medical Assistance,37.964872,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pro Cah)",,99202,CPT,Professional,Outpatient,,,,200,170,32.44,200,"UCare Health, Inc.",Medical Assistance,37.964872,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pro Cah)",,99202,CPT,Professional,Outpatient,,,,250,212.5,32.44,250,"UCare Health, Inc.",Medical Assistance,37.964872,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pro Cah)",,99202,CPT,Professional,Outpatient,,,,180,153,32.44,180,"UCare Health, Inc.",Medicare Advantage,53.544,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pro Cah)",,99202,CPT,Professional,Outpatient,,,,200,170,32.44,200,"UCare Health, Inc.",Medicare Advantage,53.544,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pro Cah)",,99202,CPT,Professional,Outpatient,,,,250,212.5,32.44,250,"UCare Health, Inc.",Medicare Advantage,53.544,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pro Cah)",,99202,CPT,Professional,Outpatient,,,,180,153,32.44,180,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),42.8352,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pro Cah)",,99202,CPT,Professional,Outpatient,,,,200,170,32.44,200,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),42.8352,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pro Cah)",,99202,CPT,Professional,Outpatient,,,,250,212.5,32.44,250,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),42.8352,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pro Cah)",,99202,CPT,Professional,Outpatient,,,,180,153,32.44,180,UnitedHealthcare,Individual & Family,180,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pro Cah)",,99202,CPT,Professional,Outpatient,,,,200,170,32.44,200,UnitedHealthcare,Individual & Family,200,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pro Cah)",,99202,CPT,Professional,Outpatient,,,,250,212.5,32.44,250,UnitedHealthcare,Individual & Family,250,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pro Cah)",,99202,CPT,Professional,Outpatient,,,,180,153,32.44,180,UnitedHealthcare,Medicare Advantage,53.544,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pro Cah)",,99202,CPT,Professional,Outpatient,,,,200,170,32.44,200,UnitedHealthcare,Medicare Advantage,53.544,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pro Cah)",,99202,CPT,Professional,Outpatient,,,,250,212.5,32.44,250,UnitedHealthcare,Medicare Advantage,53.544,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pro Cah)",,99202,CPT,Professional,Outpatient,,,,180,153,32.44,180,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,34.51352,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pro Cah)",,99202,CPT,Professional,Outpatient,,,,200,170,32.44,200,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,34.51352,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pro Cah)",,99202,CPT,Professional,Outpatient,,,,250,212.5,32.44,250,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,34.51352,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time",,99203,CPT,Facility,Outpatient,,,,100,85,28.66,100,Aetna,Commercial,92,92,,percent of total billed charges,,
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time",,99203,CPT,Facility,Outpatient,,,,100,85,28.66,100,Aetna,Medicare Advantage,49,49,,percent of total billed charges,,
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time",,99203,CPT,Facility,Outpatient,,,,100,85,28.66,100,Aetna,PPO,93,93,,percent of total billed charges,,
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time",,99203,CPT,Facility,Outpatient,,,,100,85,28.66,100,America's PPO,America's PPO,96.03,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time",,99203,CPT,Facility,Outpatient,,,,100,85,28.66,100,BlueCross BlueShield Minnesota, Federal Employee Program,98.4,98.4,,percent of total billed charges,,
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time",,99203,CPT,Facility,Outpatient,,,,100,85,28.66,100,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,100,100,,percent of total billed charges,,
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time",,99203,CPT,Facility,Outpatient,,,,100,85,28.66,100,BlueCross BlueShield Minnesota,High Value Network Plan,90,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time",,99203,CPT,Facility,Outpatient,,,,100,85,28.66,100,BlueCross BlueShield Minnesota,Medicare Advantage,49,49,,percent of total billed charges,,
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time",,99203,CPT,Facility,Outpatient,,,,100,85,28.66,100,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,28.66,28.66,,percent of total billed charges,,
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time",,99203,CPT,Facility,Outpatient,,,,100,85,28.66,100,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),49,49,,percent of total billed charges,,
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time",,99203,CPT,Facility,Outpatient,,,,100,85,28.66,100,CorVel,Worker's Compensation,100,100,,percent of total billed charges,,
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time",,99203,CPT,Facility,Outpatient,,,,100,85,28.66,100,First Health Group Corporation,First Health Network,97,97,,percent of total billed charges,,
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time",,99203,CPT,Facility,Outpatient,,,,100,85,28.66,100,"Health Partners, Inc.",Commercial,94.6,94.6,,percent of total billed charges,,
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time",,99203,CPT,Facility,Outpatient,,,,100,85,28.66,100,"Health Partners, Inc.",Medicare Advantage,49,49,,percent of total billed charges,,
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time",,99203,CPT,Facility,Outpatient,,,,100,85,28.66,100,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),60,60,,percent of total billed charges,,
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time",,99203,CPT,Facility,Outpatient,,,,100,85,28.66,100,"Health Partners, Inc.",State of Minnesota Advantage Program,81.5,81.5,,percent of total billed charges,,
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time",,99203,CPT,Facility,Outpatient,,,,100,85,28.66,100,"Health Partners, Inc.",State Public Programs,50,50,,percent of total billed charges,,
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time",,99203,CPT,Facility,Outpatient,,,,100,85,28.66,100,Humana Insurance Company,Commercial PPO,95,95,,percent of total billed charges,,
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time",,99203,CPT,Facility,Outpatient,,,,100,85,28.66,100,Humana Insurance Company,Medicare PPO,49,49,,percent of total billed charges,,
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time",,99203,CPT,Facility,Outpatient,,,,100,85,28.66,100,Medica,Individual & Family,99.1,99.1,,percent of total billed charges,,
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time",,99203,CPT,Facility,Outpatient,,,,100,85,28.66,100,Medica,Medica Advantage Solution,49.8,49.8,,percent of total billed charges,,
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time",,99203,CPT,Facility,Outpatient,,,,100,85,28.66,100,Medica,Medical Assistance,44.6,44.6,,percent of total billed charges,,
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time",,99203,CPT,Facility,Outpatient,,,,100,85,28.66,100,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,49.8,49.8,,percent of total billed charges,,
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time",,99203,CPT,Facility,Outpatient,,,,100,85,28.66,100,"Multiplan, Inc.","Multiplan, Inc.",94,94,,percent of total billed charges,,
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time",,99203,CPT,Facility,Outpatient,,,,100,85,28.66,100,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,90.1,90.1,,percent of total billed charges,,
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time",,99203,CPT,Facility,Outpatient,,,,100,85,28.66,100,"Preferred One Administrative Services, INC.",PPO,98.6,98.6,,percent of total billed charges,,
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time",,99203,CPT,Facility,Outpatient,,,,100,85,28.66,100,PrimeWest Health,Minnesota Senior Health Options (MSHO),51.45,51.45,,percent of total billed charges,,
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time",,99203,CPT,Facility,Outpatient,,,,100,85,28.66,100,PrimeWest Health,MinnesotaCare,51.36,51.36,,percent of total billed charges,,
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time",,99203,CPT,Facility,Outpatient,,,,100,85,28.66,100,Sanford Health Plan,Sanford Health Plan,92,92,,percent of total billed charges,,
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time",,99203,CPT,Facility,Outpatient,,,,100,85,28.66,100,"UCare Health, Inc.",Individual & Family Plan,56.35,56.35,,percent of total billed charges,,
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time",,99203,CPT,Facility,Outpatient,,,,100,85,28.66,100,"UCare Health, Inc.",Medical Assistance,50.47,50.47,,percent of total billed charges,,
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time",,99203,CPT,Facility,Outpatient,,,,100,85,28.66,100,"UCare Health, Inc.",Medicare Advantage,50.47,50.47,,percent of total billed charges,,
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time",,99203,CPT,Facility,Outpatient,,,,100,85,28.66,100,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),50.47,50.47,,percent of total billed charges,,
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time",,99203,CPT,Facility,Outpatient,,,,100,85,28.66,100,UnitedHealthcare,Individual & Family,94,94,,percent of total billed charges,,
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time",,99203,CPT,Facility,Outpatient,,,,100,85,28.66,100,UnitedHealthcare,Medicare Advantage,49,49,,percent of total billed charges,,
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time",,99203,CPT,Facility,Outpatient,,,,100,85,28.66,100,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,48,48,,percent of total billed charges,,100% of DHS outpatient percentage
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pbb)",,99203,CPT,Facility,Outpatient,,,,100,85,28.66,100,Aetna,Commercial,92,92,,percent of total billed charges,,
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pbb)",,99203,CPT,Professional,Outpatient,,,,215,182.75,55.42,215,Aetna,Commercial,182.75,85,,percent of total billed charges,,
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pbb)",,99203,CPT,Facility,Outpatient,,,,100,85,28.66,100,Aetna,Medicare Advantage,49,49,,percent of total billed charges,,
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pbb)",,99203,CPT,Professional,Outpatient,,,,215,182.75,55.42,215,Aetna,Medicare Advantage,81.36,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pbb)",,99203,CPT,Facility,Outpatient,,,,100,85,28.66,100,Aetna,PPO,93,93,,percent of total billed charges,,
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pbb)",,99203,CPT,Professional,Outpatient,,,,215,182.75,55.42,215,Aetna,PPO,199.95,93,,percent of total billed charges,,
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pbb)",,99203,CPT,Facility,Outpatient,,,,100,85,28.66,100,America's PPO,America's PPO,96.03,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pbb)",,99203,CPT,Professional,Outpatient,,,,215,182.75,55.42,215,America's PPO,America's PPO,183.696,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pbb)",,99203,CPT,Facility,Outpatient,,,,100,85,28.66,100,BlueCross BlueShield Minnesota, Federal Employee Program,98.4,98.4,,percent of total billed charges,,
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pbb)",,99203,CPT,Professional,Outpatient,,,,215,182.75,55.42,215,BlueCross BlueShield Minnesota, Federal Employee Program,146.61,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pbb)",,99203,CPT,Facility,Outpatient,,,,100,85,28.66,100,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,100,100,,percent of total billed charges,,
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pbb)",,99203,CPT,Professional,Outpatient,,,,215,182.75,55.42,215,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,148.95576,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pbb)",,99203,CPT,Facility,Outpatient,,,,100,85,28.66,100,BlueCross BlueShield Minnesota,High Value Network Plan,90,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pbb)",,99203,CPT,Professional,Outpatient,,,,215,182.75,55.42,215,BlueCross BlueShield Minnesota,High Value Network Plan,148.95576,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pbb)",,99203,CPT,Facility,Outpatient,,,,100,85,28.66,100,BlueCross BlueShield Minnesota,Medicare Advantage,49,49,,percent of total billed charges,,
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pbb)",,99203,CPT,Professional,Outpatient,,,,215,182.75,55.42,215,BlueCross BlueShield Minnesota,Medicare Advantage,91.517,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pbb)",,99203,CPT,Professional,Outpatient,,,,215,182.75,55.42,215,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,148.95576,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pbb)",,99203,CPT,Facility,Outpatient,,,,100,85,28.66,100,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,28.66,28.66,,percent of total billed charges,,
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pbb)",,99203,CPT,Professional,Outpatient,,,,215,182.75,55.42,215,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,58.95848,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pbb)",,99203,CPT,Facility,Outpatient,,,,100,85,28.66,100,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),49,49,,percent of total billed charges,,
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pbb)",,99203,CPT,Professional,Outpatient,,,,215,182.75,55.42,215,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),91.517,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pbb)",,99203,CPT,Facility,Outpatient,,,,100,85,28.66,100,CorVel,Worker's Compensation,100,100,,percent of total billed charges,,
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pbb)",,99203,CPT,Professional,Outpatient,,,,215,182.75,55.42,215,CorVel,Worker's Compensation,157.0918224,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pbb)",,99203,CPT,Facility,Outpatient,,,,100,85,28.66,100,First Health Group Corporation,First Health Network,97,97,,percent of total billed charges,,
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pbb)",,99203,CPT,Professional,Outpatient,,,,215,182.75,55.42,215,First Health Group Corporation,First Health Network,208.55,97,,percent of total billed charges,,
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pbb)",,99203,CPT,Facility,Outpatient,,,,100,85,28.66,100,"Health Partners, Inc.",Commercial,94.6,94.6,,percent of total billed charges,,
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pbb)",,99203,CPT,Professional,Outpatient,,,,215,182.75,55.42,215,"Health Partners, Inc.",Commercial,169.77,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pbb)",,99203,CPT,Facility,Outpatient,,,,100,85,28.66,100,"Health Partners, Inc.",Medicare Advantage,49,49,,percent of total billed charges,,
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pbb)",,99203,CPT,Professional,Outpatient,,,,215,182.75,55.42,215,"Health Partners, Inc.",Medicare Advantage,91.517,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pbb)",,99203,CPT,Facility,Outpatient,,,,100,85,28.66,100,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),60,60,,percent of total billed charges,,
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pbb)",,99203,CPT,Professional,Outpatient,,,,215,182.75,55.42,215,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),79.63,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pbb)",,99203,CPT,Facility,Outpatient,,,,100,85,28.66,100,"Health Partners, Inc.",State of Minnesota Advantage Program,81.5,81.5,,percent of total billed charges,,
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pbb)",,99203,CPT,Professional,Outpatient,,,,215,182.75,55.42,215,"Health Partners, Inc.",State of Minnesota Advantage Program,146.256855,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pbb)",,99203,CPT,Facility,Outpatient,,,,100,85,28.66,100,"Health Partners, Inc.",State Public Programs,50,50,,percent of total billed charges,,
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pbb)",,99203,CPT,Professional,Outpatient,,,,215,182.75,55.42,215,"Health Partners, Inc.",State Public Programs,55.42,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pbb)",,99203,CPT,Facility,Outpatient,,,,100,85,28.66,100,Humana Insurance Company,Commercial PPO,95,95,,percent of total billed charges,,
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pbb)",,99203,CPT,Professional,Outpatient,,,,215,182.75,55.42,215,Humana Insurance Company,Commercial PPO,79.58,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pbb)",,99203,CPT,Facility,Outpatient,,,,100,85,28.66,100,Humana Insurance Company,Medicare PPO,49,49,,percent of total billed charges,,
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pbb)",,99203,CPT,Professional,Outpatient,,,,215,182.75,55.42,215,Humana Insurance Company,Medicare PPO,215,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pbb)",,99203,CPT,Facility,Outpatient,,,,100,85,28.66,100,Medica,Individual & Family,99.1,99.1,,percent of total billed charges,,
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pbb)",,99203,CPT,Professional,Outpatient,,,,215,182.75,55.42,215,Medica,Individual & Family,182.32,84.8,,percent of total billed charges,,
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pbb)",,99203,CPT,Facility,Outpatient,,,,100,85,28.66,100,Medica,Medica Advantage Solution,49.8,49.8,,percent of total billed charges,,
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pbb)",,99203,CPT,Professional,Outpatient,,,,215,182.75,55.42,215,Medica,Medica Advantage Solution,107.07,49.8,,percent of total billed charges,,
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pbb)",,99203,CPT,Facility,Outpatient,,,,100,85,28.66,100,Medica,Medical Assistance,44.6,44.6,,percent of total billed charges,,
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pbb)",,99203,CPT,Professional,Outpatient,,,,215,182.75,55.42,215,Medica,Medical Assistance,58.96,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pbb)",,99203,CPT,Facility,Outpatient,,,,100,85,28.66,100,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,49.8,49.8,,percent of total billed charges,,
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pbb)",,99203,CPT,Professional,Outpatient,,,,215,182.75,55.42,215,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,79.58,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pbb)",,99203,CPT,Facility,Outpatient,,,,100,85,28.66,100,"Multiplan, Inc.","Multiplan, Inc.",94,94,,percent of total billed charges,,
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pbb)",,99203,CPT,Professional,Outpatient,,,,215,182.75,55.42,215,"Multiplan, Inc.","Multiplan, Inc.",202.1,94,,percent of total billed charges,,
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pbb)",,99203,CPT,Facility,Outpatient,,,,100,85,28.66,100,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,90.1,90.1,,percent of total billed charges,,
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pbb)",,99203,CPT,Professional,Outpatient,,,,215,182.75,55.42,215,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,193.715,90.1,,percent of total billed charges,,
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pbb)",,99203,CPT,Facility,Outpatient,,,,100,85,28.66,100,"Preferred One Administrative Services, INC.",PPO,98.6,98.6,,percent of total billed charges,,
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pbb)",,99203,CPT,Professional,Outpatient,,,,215,182.75,55.42,215,"Preferred One Administrative Services, INC.",PPO,211.99,98.6,,percent of total billed charges,,
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pbb)",,99203,CPT,Facility,Outpatient,,,,100,85,28.66,100,PrimeWest Health,Minnesota Senior Health Options (MSHO),51.45,51.45,,percent of total billed charges,,
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pbb)",,99203,CPT,Professional,Outpatient,,,,215,182.75,55.42,215,PrimeWest Health,Minnesota Senior Health Options (MSHO),91.517,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pbb)",,99203,CPT,Facility,Outpatient,,,,100,85,28.66,100,PrimeWest Health,MinnesotaCare,51.36,51.36,,percent of total billed charges,,
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pbb)",,99203,CPT,Professional,Outpatient,,,,215,182.75,55.42,215,PrimeWest Health,MinnesotaCare,63.0855736,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pbb)",,99203,CPT,Facility,Outpatient,,,,100,85,28.66,100,Sanford Health Plan,Sanford Health Plan,92,92,,percent of total billed charges,,
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pbb)",,99203,CPT,Professional,Outpatient,,,,215,182.75,55.42,215,Sanford Health Plan,Sanford Health Plan,189.2,88,,percent of total billed charges,,
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pbb)",,99203,CPT,Facility,Outpatient,,,,100,85,28.66,100,"UCare Health, Inc.",Individual & Family Plan,56.35,56.35,,percent of total billed charges,,
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pbb)",,99203,CPT,Professional,Outpatient,,,,215,182.75,55.42,215,"UCare Health, Inc.",Individual & Family Plan,129.365248,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pbb)",,99203,CPT,Facility,Outpatient,,,,100,85,28.66,100,"UCare Health, Inc.",Medical Assistance,50.47,50.47,,percent of total billed charges,,
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pbb)",,99203,CPT,Professional,Outpatient,,,,215,182.75,55.42,215,"UCare Health, Inc.",Medical Assistance,64.854328,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pbb)",,99203,CPT,Facility,Outpatient,,,,100,85,28.66,100,"UCare Health, Inc.",Medicare Advantage,50.47,50.47,,percent of total billed charges,,
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pbb)",,99203,CPT,Professional,Outpatient,,,,215,182.75,55.42,215,"UCare Health, Inc.",Medicare Advantage,91.517,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pbb)",,99203,CPT,Facility,Outpatient,,,,100,85,28.66,100,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),50.47,50.47,,percent of total billed charges,,
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pbb)",,99203,CPT,Professional,Outpatient,,,,215,182.75,55.42,215,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),73.2136,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pbb)",,99203,CPT,Facility,Outpatient,,,,100,85,28.66,100,UnitedHealthcare,Individual & Family,94,94,,percent of total billed charges,,
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pbb)",,99203,CPT,Professional,Outpatient,,,,215,182.75,55.42,215,UnitedHealthcare,Individual & Family,215,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pbb)",,99203,CPT,Facility,Outpatient,,,,100,85,28.66,100,UnitedHealthcare,Medicare Advantage,49,49,,percent of total billed charges,,
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pbb)",,99203,CPT,Professional,Outpatient,,,,215,182.75,55.42,215,UnitedHealthcare,Medicare Advantage,91.517,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pbb)",,99203,CPT,Facility,Outpatient,,,,100,85,28.66,100,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,48,48,,percent of total billed charges,,100% of DHS outpatient percentage
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pbb)",,99203,CPT,Professional,Outpatient,,,,215,182.75,55.42,215,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,58.95848,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pro Cah)",,99203,CPT,Professional,Outpatient,,,,295,250.75,55.42,295,Aetna,Commercial,250.75,85,,percent of total billed charges,,
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pro Cah)",,99203,CPT,Professional,Outpatient,,,,315,267.75,55.42,315,Aetna,Commercial,267.75,85,,percent of total billed charges,,
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pro Cah)",,99203,CPT,Professional,Outpatient,,,,365,310.25,55.42,365,Aetna,Commercial,310.25,85,,percent of total billed charges,,
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pro Cah)",,99203,CPT,Professional,Outpatient,,,,295,250.75,55.42,295,Aetna,Medicare Advantage,81.36,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pro Cah)",,99203,CPT,Professional,Outpatient,,,,315,267.75,55.42,315,Aetna,Medicare Advantage,81.36,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pro Cah)",,99203,CPT,Professional,Outpatient,,,,365,310.25,55.42,365,Aetna,Medicare Advantage,81.36,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pro Cah)",,99203,CPT,Professional,Outpatient,,,,295,250.75,55.42,295,Aetna,PPO,274.35,93,,percent of total billed charges,,
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pro Cah)",,99203,CPT,Professional,Outpatient,,,,315,267.75,55.42,315,Aetna,PPO,292.95,93,,percent of total billed charges,,
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pro Cah)",,99203,CPT,Professional,Outpatient,,,,365,310.25,55.42,365,Aetna,PPO,339.45,93,,percent of total billed charges,,
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pro Cah)",,99203,CPT,Professional,Outpatient,,,,295,250.75,55.42,295,America's PPO,America's PPO,252.048,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pro Cah)",,99203,CPT,Professional,Outpatient,,,,315,267.75,55.42,315,America's PPO,America's PPO,269.136,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pro Cah)",,99203,CPT,Professional,Outpatient,,,,365,310.25,55.42,365,America's PPO,America's PPO,311.856,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pro Cah)",,99203,CPT,Professional,Outpatient,,,,295,250.75,55.42,295,BlueCross BlueShield Minnesota, Federal Employee Program,146.61,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pro Cah)",,99203,CPT,Professional,Outpatient,,,,315,267.75,55.42,315,BlueCross BlueShield Minnesota, Federal Employee Program,146.61,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pro Cah)",,99203,CPT,Professional,Outpatient,,,,365,310.25,55.42,365,BlueCross BlueShield Minnesota, Federal Employee Program,146.61,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pro Cah)",,99203,CPT,Professional,Outpatient,,,,295,250.75,55.42,295,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,148.95576,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pro Cah)",,99203,CPT,Professional,Outpatient,,,,315,267.75,55.42,315,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,148.95576,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pro Cah)",,99203,CPT,Professional,Outpatient,,,,365,310.25,55.42,365,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,148.95576,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pro Cah)",,99203,CPT,Professional,Outpatient,,,,295,250.75,55.42,295,BlueCross BlueShield Minnesota,High Value Network Plan,148.95576,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pro Cah)",,99203,CPT,Professional,Outpatient,,,,315,267.75,55.42,315,BlueCross BlueShield Minnesota,High Value Network Plan,148.95576,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pro Cah)",,99203,CPT,Professional,Outpatient,,,,365,310.25,55.42,365,BlueCross BlueShield Minnesota,High Value Network Plan,148.95576,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pro Cah)",,99203,CPT,Professional,Outpatient,,,,295,250.75,55.42,295,BlueCross BlueShield Minnesota,Medicare Advantage,91.517,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pro Cah)",,99203,CPT,Professional,Outpatient,,,,315,267.75,55.42,315,BlueCross BlueShield Minnesota,Medicare Advantage,91.517,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pro Cah)",,99203,CPT,Professional,Outpatient,,,,365,310.25,55.42,365,BlueCross BlueShield Minnesota,Medicare Advantage,91.517,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pro Cah)",,99203,CPT,Professional,Outpatient,,,,295,250.75,55.42,295,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,148.95576,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pro Cah)",,99203,CPT,Professional,Outpatient,,,,315,267.75,55.42,315,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,148.95576,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pro Cah)",,99203,CPT,Professional,Outpatient,,,,365,310.25,55.42,365,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,148.95576,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pro Cah)",,99203,CPT,Professional,Outpatient,,,,295,250.75,55.42,295,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,58.95848,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pro Cah)",,99203,CPT,Professional,Outpatient,,,,315,267.75,55.42,315,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,58.95848,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pro Cah)",,99203,CPT,Professional,Outpatient,,,,365,310.25,55.42,365,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,58.95848,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pro Cah)",,99203,CPT,Professional,Outpatient,,,,295,250.75,55.42,295,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),91.517,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pro Cah)",,99203,CPT,Professional,Outpatient,,,,315,267.75,55.42,315,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),91.517,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pro Cah)",,99203,CPT,Professional,Outpatient,,,,365,310.25,55.42,365,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),91.517,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pro Cah)",,99203,CPT,Professional,Outpatient,,,,295,250.75,55.42,295,CorVel,Worker's Compensation,157.0918224,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pro Cah)",,99203,CPT,Professional,Outpatient,,,,315,267.75,55.42,315,CorVel,Worker's Compensation,157.0918224,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pro Cah)",,99203,CPT,Professional,Outpatient,,,,365,310.25,55.42,365,CorVel,Worker's Compensation,157.0918224,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pro Cah)",,99203,CPT,Professional,Outpatient,,,,295,250.75,55.42,295,First Health Group Corporation,First Health Network,286.15,97,,percent of total billed charges,,
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pro Cah)",,99203,CPT,Professional,Outpatient,,,,315,267.75,55.42,315,First Health Group Corporation,First Health Network,305.55,97,,percent of total billed charges,,
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pro Cah)",,99203,CPT,Professional,Outpatient,,,,365,310.25,55.42,365,First Health Group Corporation,First Health Network,354.05,97,,percent of total billed charges,,
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pro Cah)",,99203,CPT,Professional,Outpatient,,,,295,250.75,55.42,295,"Health Partners, Inc.",Commercial,169.77,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pro Cah)",,99203,CPT,Professional,Outpatient,,,,315,267.75,55.42,315,"Health Partners, Inc.",Commercial,169.77,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pro Cah)",,99203,CPT,Professional,Outpatient,,,,365,310.25,55.42,365,"Health Partners, Inc.",Commercial,169.77,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pro Cah)",,99203,CPT,Professional,Outpatient,,,,295,250.75,55.42,295,"Health Partners, Inc.",Medicare Advantage,91.517,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pro Cah)",,99203,CPT,Professional,Outpatient,,,,315,267.75,55.42,315,"Health Partners, Inc.",Medicare Advantage,91.517,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pro Cah)",,99203,CPT,Professional,Outpatient,,,,365,310.25,55.42,365,"Health Partners, Inc.",Medicare Advantage,91.517,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pro Cah)",,99203,CPT,Professional,Outpatient,,,,295,250.75,55.42,295,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),79.63,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pro Cah)",,99203,CPT,Professional,Outpatient,,,,315,267.75,55.42,315,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),79.63,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pro Cah)",,99203,CPT,Professional,Outpatient,,,,365,310.25,55.42,365,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),79.63,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pro Cah)",,99203,CPT,Professional,Outpatient,,,,295,250.75,55.42,295,"Health Partners, Inc.",State of Minnesota Advantage Program,146.256855,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pro Cah)",,99203,CPT,Professional,Outpatient,,,,315,267.75,55.42,315,"Health Partners, Inc.",State of Minnesota Advantage Program,146.256855,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pro Cah)",,99203,CPT,Professional,Outpatient,,,,365,310.25,55.42,365,"Health Partners, Inc.",State of Minnesota Advantage Program,146.256855,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pro Cah)",,99203,CPT,Professional,Outpatient,,,,295,250.75,55.42,295,"Health Partners, Inc.",State Public Programs,55.42,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pro Cah)",,99203,CPT,Professional,Outpatient,,,,315,267.75,55.42,315,"Health Partners, Inc.",State Public Programs,55.42,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pro Cah)",,99203,CPT,Professional,Outpatient,,,,365,310.25,55.42,365,"Health Partners, Inc.",State Public Programs,55.42,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pro Cah)",,99203,CPT,Professional,Outpatient,,,,295,250.75,55.42,295,Humana Insurance Company,Commercial PPO,79.58,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pro Cah)",,99203,CPT,Professional,Outpatient,,,,315,267.75,55.42,315,Humana Insurance Company,Commercial PPO,79.58,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pro Cah)",,99203,CPT,Professional,Outpatient,,,,365,310.25,55.42,365,Humana Insurance Company,Commercial PPO,79.58,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pro Cah)",,99203,CPT,Professional,Outpatient,,,,295,250.75,55.42,295,Humana Insurance Company,Medicare PPO,295,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pro Cah)",,99203,CPT,Professional,Outpatient,,,,315,267.75,55.42,315,Humana Insurance Company,Medicare PPO,315,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pro Cah)",,99203,CPT,Professional,Outpatient,,,,365,310.25,55.42,365,Humana Insurance Company,Medicare PPO,365,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pro Cah)",,99203,CPT,Professional,Outpatient,,,,295,250.75,55.42,295,Medica,Individual & Family,250.16,84.8,,percent of total billed charges,,
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pro Cah)",,99203,CPT,Professional,Outpatient,,,,315,267.75,55.42,315,Medica,Individual & Family,267.12,84.8,,percent of total billed charges,,
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pro Cah)",,99203,CPT,Professional,Outpatient,,,,365,310.25,55.42,365,Medica,Individual & Family,309.52,84.8,,percent of total billed charges,,
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pro Cah)",,99203,CPT,Professional,Outpatient,,,,295,250.75,55.42,295,Medica,Medica Advantage Solution,146.91,49.8,,percent of total billed charges,,
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pro Cah)",,99203,CPT,Professional,Outpatient,,,,315,267.75,55.42,315,Medica,Medica Advantage Solution,156.87,49.8,,percent of total billed charges,,
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pro Cah)",,99203,CPT,Professional,Outpatient,,,,365,310.25,55.42,365,Medica,Medica Advantage Solution,181.77,49.8,,percent of total billed charges,,
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pro Cah)",,99203,CPT,Professional,Outpatient,,,,295,250.75,55.42,295,Medica,Medical Assistance,58.96,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pro Cah)",,99203,CPT,Professional,Outpatient,,,,315,267.75,55.42,315,Medica,Medical Assistance,58.96,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pro Cah)",,99203,CPT,Professional,Outpatient,,,,365,310.25,55.42,365,Medica,Medical Assistance,58.96,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pro Cah)",,99203,CPT,Professional,Outpatient,,,,295,250.75,55.42,295,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,79.58,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pro Cah)",,99203,CPT,Professional,Outpatient,,,,315,267.75,55.42,315,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,79.58,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pro Cah)",,99203,CPT,Professional,Outpatient,,,,365,310.25,55.42,365,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,79.58,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pro Cah)",,99203,CPT,Professional,Outpatient,,,,295,250.75,55.42,295,"Multiplan, Inc.","Multiplan, Inc.",277.3,94,,percent of total billed charges,,
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pro Cah)",,99203,CPT,Professional,Outpatient,,,,315,267.75,55.42,315,"Multiplan, Inc.","Multiplan, Inc.",296.1,94,,percent of total billed charges,,
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pro Cah)",,99203,CPT,Professional,Outpatient,,,,365,310.25,55.42,365,"Multiplan, Inc.","Multiplan, Inc.",343.1,94,,percent of total billed charges,,
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pro Cah)",,99203,CPT,Professional,Outpatient,,,,295,250.75,55.42,295,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,265.795,90.1,,percent of total billed charges,,
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pro Cah)",,99203,CPT,Professional,Outpatient,,,,315,267.75,55.42,315,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,283.815,90.1,,percent of total billed charges,,
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pro Cah)",,99203,CPT,Professional,Outpatient,,,,365,310.25,55.42,365,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,328.865,90.1,,percent of total billed charges,,
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pro Cah)",,99203,CPT,Professional,Outpatient,,,,295,250.75,55.42,295,"Preferred One Administrative Services, INC.",PPO,290.87,98.6,,percent of total billed charges,,
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pro Cah)",,99203,CPT,Professional,Outpatient,,,,315,267.75,55.42,315,"Preferred One Administrative Services, INC.",PPO,310.59,98.6,,percent of total billed charges,,
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pro Cah)",,99203,CPT,Professional,Outpatient,,,,365,310.25,55.42,365,"Preferred One Administrative Services, INC.",PPO,359.89,98.6,,percent of total billed charges,,
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pro Cah)",,99203,CPT,Professional,Outpatient,,,,295,250.75,55.42,295,PrimeWest Health,Minnesota Senior Health Options (MSHO),91.517,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pro Cah)",,99203,CPT,Professional,Outpatient,,,,315,267.75,55.42,315,PrimeWest Health,Minnesota Senior Health Options (MSHO),91.517,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pro Cah)",,99203,CPT,Professional,Outpatient,,,,365,310.25,55.42,365,PrimeWest Health,Minnesota Senior Health Options (MSHO),91.517,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pro Cah)",,99203,CPT,Professional,Outpatient,,,,295,250.75,55.42,295,PrimeWest Health,MinnesotaCare,63.0855736,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pro Cah)",,99203,CPT,Professional,Outpatient,,,,315,267.75,55.42,315,PrimeWest Health,MinnesotaCare,63.0855736,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pro Cah)",,99203,CPT,Professional,Outpatient,,,,365,310.25,55.42,365,PrimeWest Health,MinnesotaCare,63.0855736,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pro Cah)",,99203,CPT,Professional,Outpatient,,,,295,250.75,55.42,295,Sanford Health Plan,Sanford Health Plan,259.6,88,,percent of total billed charges,,
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pro Cah)",,99203,CPT,Professional,Outpatient,,,,315,267.75,55.42,315,Sanford Health Plan,Sanford Health Plan,277.2,88,,percent of total billed charges,,
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pro Cah)",,99203,CPT,Professional,Outpatient,,,,365,310.25,55.42,365,Sanford Health Plan,Sanford Health Plan,321.2,88,,percent of total billed charges,,
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pro Cah)",,99203,CPT,Professional,Outpatient,,,,295,250.75,55.42,295,"UCare Health, Inc.",Individual & Family Plan,129.365248,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pro Cah)",,99203,CPT,Professional,Outpatient,,,,315,267.75,55.42,315,"UCare Health, Inc.",Individual & Family Plan,129.365248,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pro Cah)",,99203,CPT,Professional,Outpatient,,,,365,310.25,55.42,365,"UCare Health, Inc.",Individual & Family Plan,129.365248,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pro Cah)",,99203,CPT,Professional,Outpatient,,,,295,250.75,55.42,295,"UCare Health, Inc.",Medical Assistance,64.854328,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pro Cah)",,99203,CPT,Professional,Outpatient,,,,315,267.75,55.42,315,"UCare Health, Inc.",Medical Assistance,64.854328,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pro Cah)",,99203,CPT,Professional,Outpatient,,,,365,310.25,55.42,365,"UCare Health, Inc.",Medical Assistance,64.854328,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pro Cah)",,99203,CPT,Professional,Outpatient,,,,295,250.75,55.42,295,"UCare Health, Inc.",Medicare Advantage,91.517,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pro Cah)",,99203,CPT,Professional,Outpatient,,,,315,267.75,55.42,315,"UCare Health, Inc.",Medicare Advantage,91.517,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pro Cah)",,99203,CPT,Professional,Outpatient,,,,365,310.25,55.42,365,"UCare Health, Inc.",Medicare Advantage,91.517,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pro Cah)",,99203,CPT,Professional,Outpatient,,,,295,250.75,55.42,295,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),73.2136,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pro Cah)",,99203,CPT,Professional,Outpatient,,,,315,267.75,55.42,315,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),73.2136,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pro Cah)",,99203,CPT,Professional,Outpatient,,,,365,310.25,55.42,365,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),73.2136,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pro Cah)",,99203,CPT,Professional,Outpatient,,,,295,250.75,55.42,295,UnitedHealthcare,Individual & Family,295,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pro Cah)",,99203,CPT,Professional,Outpatient,,,,315,267.75,55.42,315,UnitedHealthcare,Individual & Family,315,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pro Cah)",,99203,CPT,Professional,Outpatient,,,,365,310.25,55.42,365,UnitedHealthcare,Individual & Family,365,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pro Cah)",,99203,CPT,Professional,Outpatient,,,,295,250.75,55.42,295,UnitedHealthcare,Medicare Advantage,91.517,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pro Cah)",,99203,CPT,Professional,Outpatient,,,,315,267.75,55.42,315,UnitedHealthcare,Medicare Advantage,91.517,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pro Cah)",,99203,CPT,Professional,Outpatient,,,,365,310.25,55.42,365,UnitedHealthcare,Medicare Advantage,91.517,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pro Cah)",,99203,CPT,Professional,Outpatient,,,,295,250.75,55.42,295,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,58.95848,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pro Cah)",,99203,CPT,Professional,Outpatient,,,,315,267.75,55.42,315,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,58.95848,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pro Cah)",,99203,CPT,Professional,Outpatient,,,,365,310.25,55.42,365,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,58.95848,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time",,99204,CPT,Facility,Outpatient,,,,125,106.25,35.825,125,Aetna,Commercial,115,92,,percent of total billed charges,,
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time",,99204,CPT,Facility,Outpatient,,,,125,106.25,35.825,125,Aetna,Medicare Advantage,61.25,49,,percent of total billed charges,,
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time",,99204,CPT,Facility,Outpatient,,,,125,106.25,35.825,125,Aetna,PPO,116.25,93,,percent of total billed charges,,
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time",,99204,CPT,Facility,Outpatient,,,,125,106.25,35.825,125,America's PPO,America's PPO,120.0375,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time",,99204,CPT,Facility,Outpatient,,,,125,106.25,35.825,125,BlueCross BlueShield Minnesota, Federal Employee Program,123,98.4,,percent of total billed charges,,
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time",,99204,CPT,Facility,Outpatient,,,,125,106.25,35.825,125,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,125,100,,percent of total billed charges,,
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time",,99204,CPT,Facility,Outpatient,,,,125,106.25,35.825,125,BlueCross BlueShield Minnesota,High Value Network Plan,112.5,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time",,99204,CPT,Facility,Outpatient,,,,125,106.25,35.825,125,BlueCross BlueShield Minnesota,Medicare Advantage,61.25,49,,percent of total billed charges,,
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time",,99204,CPT,Facility,Outpatient,,,,125,106.25,35.825,125,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,35.825,28.66,,percent of total billed charges,,
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time",,99204,CPT,Facility,Outpatient,,,,125,106.25,35.825,125,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),61.25,49,,percent of total billed charges,,
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time",,99204,CPT,Facility,Outpatient,,,,125,106.25,35.825,125,CorVel,Worker's Compensation,125,100,,percent of total billed charges,,
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time",,99204,CPT,Facility,Outpatient,,,,125,106.25,35.825,125,First Health Group Corporation,First Health Network,121.25,97,,percent of total billed charges,,
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time",,99204,CPT,Facility,Outpatient,,,,125,106.25,35.825,125,"Health Partners, Inc.",Commercial,118.25,94.6,,percent of total billed charges,,
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time",,99204,CPT,Facility,Outpatient,,,,125,106.25,35.825,125,"Health Partners, Inc.",Medicare Advantage,61.25,49,,percent of total billed charges,,
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time",,99204,CPT,Facility,Outpatient,,,,125,106.25,35.825,125,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),75,60,,percent of total billed charges,,
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time",,99204,CPT,Facility,Outpatient,,,,125,106.25,35.825,125,"Health Partners, Inc.",State of Minnesota Advantage Program,101.875,81.5,,percent of total billed charges,,
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time",,99204,CPT,Facility,Outpatient,,,,125,106.25,35.825,125,"Health Partners, Inc.",State Public Programs,62.5,50,,percent of total billed charges,,
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time",,99204,CPT,Facility,Outpatient,,,,125,106.25,35.825,125,Humana Insurance Company,Commercial PPO,118.75,95,,percent of total billed charges,,
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time",,99204,CPT,Facility,Outpatient,,,,125,106.25,35.825,125,Humana Insurance Company,Medicare PPO,61.25,49,,percent of total billed charges,,
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time",,99204,CPT,Facility,Outpatient,,,,125,106.25,35.825,125,Medica,Individual & Family,123.875,99.1,,percent of total billed charges,,
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time",,99204,CPT,Facility,Outpatient,,,,125,106.25,35.825,125,Medica,Medica Advantage Solution,62.25,49.8,,percent of total billed charges,,
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time",,99204,CPT,Facility,Outpatient,,,,125,106.25,35.825,125,Medica,Medical Assistance,55.75,44.6,,percent of total billed charges,,
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time",,99204,CPT,Facility,Outpatient,,,,125,106.25,35.825,125,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,62.25,49.8,,percent of total billed charges,,
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time",,99204,CPT,Facility,Outpatient,,,,125,106.25,35.825,125,"Multiplan, Inc.","Multiplan, Inc.",117.5,94,,percent of total billed charges,,
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time",,99204,CPT,Facility,Outpatient,,,,125,106.25,35.825,125,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,112.625,90.1,,percent of total billed charges,,
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time",,99204,CPT,Facility,Outpatient,,,,125,106.25,35.825,125,"Preferred One Administrative Services, INC.",PPO,123.25,98.6,,percent of total billed charges,,
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time",,99204,CPT,Facility,Outpatient,,,,125,106.25,35.825,125,PrimeWest Health,Minnesota Senior Health Options (MSHO),64.3125,51.45,,percent of total billed charges,,
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time",,99204,CPT,Facility,Outpatient,,,,125,106.25,35.825,125,PrimeWest Health,MinnesotaCare,64.2,51.36,,percent of total billed charges,,
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time",,99204,CPT,Facility,Outpatient,,,,125,106.25,35.825,125,Sanford Health Plan,Sanford Health Plan,115,92,,percent of total billed charges,,
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time",,99204,CPT,Facility,Outpatient,,,,125,106.25,35.825,125,"UCare Health, Inc.",Individual & Family Plan,70.4375,56.35,,percent of total billed charges,,
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time",,99204,CPT,Facility,Outpatient,,,,125,106.25,35.825,125,"UCare Health, Inc.",Medical Assistance,63.0875,50.47,,percent of total billed charges,,
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time",,99204,CPT,Facility,Outpatient,,,,125,106.25,35.825,125,"UCare Health, Inc.",Medicare Advantage,63.0875,50.47,,percent of total billed charges,,
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time",,99204,CPT,Facility,Outpatient,,,,125,106.25,35.825,125,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),63.0875,50.47,,percent of total billed charges,,
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time",,99204,CPT,Facility,Outpatient,,,,125,106.25,35.825,125,UnitedHealthcare,Individual & Family,117.5,94,,percent of total billed charges,,
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time",,99204,CPT,Facility,Outpatient,,,,125,106.25,35.825,125,UnitedHealthcare,Medicare Advantage,61.25,49,,percent of total billed charges,,
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time",,99204,CPT,Facility,Outpatient,,,,125,106.25,35.825,125,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,60,48,,percent of total billed charges,,100% of DHS outpatient percentage
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pbb)",,99204,CPT,Facility,Outpatient,,,,125,106.25,35.825,125,Aetna,Commercial,115,92,,percent of total billed charges,,
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pbb)",,99204,CPT,Professional,Outpatient,,,,295,250.75,90,295,Aetna,Commercial,250.75,85,,percent of total billed charges,,
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pbb)",,99204,CPT,Facility,Outpatient,,,,125,106.25,35.825,125,Aetna,Medicare Advantage,61.25,49,,percent of total billed charges,,
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pbb)",,99204,CPT,Professional,Outpatient,,,,295,250.75,90,295,Aetna,Medicare Advantage,132.79,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pbb)",,99204,CPT,Facility,Outpatient,,,,125,106.25,35.825,125,Aetna,PPO,116.25,93,,percent of total billed charges,,
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pbb)",,99204,CPT,Professional,Outpatient,,,,295,250.75,90,295,Aetna,PPO,274.35,93,,percent of total billed charges,,
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pbb)",,99204,CPT,Facility,Outpatient,,,,125,106.25,35.825,125,America's PPO,America's PPO,120.0375,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pbb)",,99204,CPT,Professional,Outpatient,,,,295,250.75,90,295,America's PPO,America's PPO,252.048,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pbb)",,99204,CPT,Facility,Outpatient,,,,125,106.25,35.825,125,BlueCross BlueShield Minnesota, Federal Employee Program,123,98.4,,percent of total billed charges,,
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pbb)",,99204,CPT,Professional,Outpatient,,,,295,250.75,90,295,BlueCross BlueShield Minnesota, Federal Employee Program,235.77,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pbb)",,99204,CPT,Facility,Outpatient,,,,125,106.25,35.825,125,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,125,100,,percent of total billed charges,,
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pbb)",,99204,CPT,Professional,Outpatient,,,,295,250.75,90,295,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,239.54232,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pbb)",,99204,CPT,Facility,Outpatient,,,,125,106.25,35.825,125,BlueCross BlueShield Minnesota,High Value Network Plan,112.5,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pbb)",,99204,CPT,Professional,Outpatient,,,,295,250.75,90,295,BlueCross BlueShield Minnesota,High Value Network Plan,239.54232,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pbb)",,99204,CPT,Facility,Outpatient,,,,125,106.25,35.825,125,BlueCross BlueShield Minnesota,Medicare Advantage,61.25,49,,percent of total billed charges,,
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pbb)",,99204,CPT,Professional,Outpatient,,,,295,250.75,90,295,BlueCross BlueShield Minnesota,Medicare Advantage,148.327,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pbb)",,99204,CPT,Professional,Outpatient,,,,295,250.75,90,295,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,239.54232,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pbb)",,99204,CPT,Facility,Outpatient,,,,125,106.25,35.825,125,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,35.825,28.66,,percent of total billed charges,,
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pbb)",,99204,CPT,Professional,Outpatient,,,,295,250.75,90,295,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,95.74784,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pbb)",,99204,CPT,Facility,Outpatient,,,,125,106.25,35.825,125,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),61.25,49,,percent of total billed charges,,
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pbb)",,99204,CPT,Professional,Outpatient,,,,295,250.75,90,295,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),148.327,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pbb)",,99204,CPT,Facility,Outpatient,,,,125,106.25,35.825,125,CorVel,Worker's Compensation,125,100,,percent of total billed charges,,
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pbb)",,99204,CPT,Professional,Outpatient,,,,295,250.75,90,295,CorVel,Worker's Compensation,255.8606055,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pbb)",,99204,CPT,Facility,Outpatient,,,,125,106.25,35.825,125,First Health Group Corporation,First Health Network,121.25,97,,percent of total billed charges,,
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pbb)",,99204,CPT,Professional,Outpatient,,,,295,250.75,90,295,First Health Group Corporation,First Health Network,286.15,97,,percent of total billed charges,,
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pbb)",,99204,CPT,Facility,Outpatient,,,,125,106.25,35.825,125,"Health Partners, Inc.",Commercial,118.25,94.6,,percent of total billed charges,,
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pbb)",,99204,CPT,Professional,Outpatient,,,,295,250.75,90,295,"Health Partners, Inc.",Commercial,275.7,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pbb)",,99204,CPT,Facility,Outpatient,,,,125,106.25,35.825,125,"Health Partners, Inc.",Medicare Advantage,61.25,49,,percent of total billed charges,,
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pbb)",,99204,CPT,Professional,Outpatient,,,,295,250.75,90,295,"Health Partners, Inc.",Medicare Advantage,148.327,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pbb)",,99204,CPT,Facility,Outpatient,,,,125,106.25,35.825,125,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),75,60,,percent of total billed charges,,
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pbb)",,99204,CPT,Professional,Outpatient,,,,295,250.75,90,295,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),128.77,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pbb)",,99204,CPT,Facility,Outpatient,,,,125,106.25,35.825,125,"Health Partners, Inc.",State of Minnesota Advantage Program,101.875,81.5,,percent of total billed charges,,
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pbb)",,99204,CPT,Professional,Outpatient,,,,295,250.75,90,295,"Health Partners, Inc.",State of Minnesota Advantage Program,237.51555,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pbb)",,99204,CPT,Facility,Outpatient,,,,125,106.25,35.825,125,"Health Partners, Inc.",State Public Programs,62.5,50,,percent of total billed charges,,
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pbb)",,99204,CPT,Professional,Outpatient,,,,295,250.75,90,295,"Health Partners, Inc.",State Public Programs,90,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pbb)",,99204,CPT,Facility,Outpatient,,,,125,106.25,35.825,125,Humana Insurance Company,Commercial PPO,118.75,95,,percent of total billed charges,,
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pbb)",,99204,CPT,Professional,Outpatient,,,,295,250.75,90,295,Humana Insurance Company,Commercial PPO,128.98,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pbb)",,99204,CPT,Facility,Outpatient,,,,125,106.25,35.825,125,Humana Insurance Company,Medicare PPO,61.25,49,,percent of total billed charges,,
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pbb)",,99204,CPT,Professional,Outpatient,,,,295,250.75,90,295,Humana Insurance Company,Medicare PPO,295,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pbb)",,99204,CPT,Facility,Outpatient,,,,125,106.25,35.825,125,Medica,Individual & Family,123.875,99.1,,percent of total billed charges,,
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pbb)",,99204,CPT,Professional,Outpatient,,,,295,250.75,90,295,Medica,Individual & Family,250.16,84.8,,percent of total billed charges,,
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pbb)",,99204,CPT,Facility,Outpatient,,,,125,106.25,35.825,125,Medica,Medica Advantage Solution,62.25,49.8,,percent of total billed charges,,
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pbb)",,99204,CPT,Professional,Outpatient,,,,295,250.75,90,295,Medica,Medica Advantage Solution,146.91,49.8,,percent of total billed charges,,
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pbb)",,99204,CPT,Facility,Outpatient,,,,125,106.25,35.825,125,Medica,Medical Assistance,55.75,44.6,,percent of total billed charges,,
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pbb)",,99204,CPT,Professional,Outpatient,,,,295,250.75,90,295,Medica,Medical Assistance,95.75,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pbb)",,99204,CPT,Facility,Outpatient,,,,125,106.25,35.825,125,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,62.25,49.8,,percent of total billed charges,,
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pbb)",,99204,CPT,Professional,Outpatient,,,,295,250.75,90,295,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,128.98,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pbb)",,99204,CPT,Facility,Outpatient,,,,125,106.25,35.825,125,"Multiplan, Inc.","Multiplan, Inc.",117.5,94,,percent of total billed charges,,
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pbb)",,99204,CPT,Professional,Outpatient,,,,295,250.75,90,295,"Multiplan, Inc.","Multiplan, Inc.",277.3,94,,percent of total billed charges,,
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pbb)",,99204,CPT,Facility,Outpatient,,,,125,106.25,35.825,125,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,112.625,90.1,,percent of total billed charges,,
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pbb)",,99204,CPT,Professional,Outpatient,,,,295,250.75,90,295,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,265.795,90.1,,percent of total billed charges,,
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pbb)",,99204,CPT,Facility,Outpatient,,,,125,106.25,35.825,125,"Preferred One Administrative Services, INC.",PPO,123.25,98.6,,percent of total billed charges,,
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pbb)",,99204,CPT,Professional,Outpatient,,,,295,250.75,90,295,"Preferred One Administrative Services, INC.",PPO,290.87,98.6,,percent of total billed charges,,
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pbb)",,99204,CPT,Facility,Outpatient,,,,125,106.25,35.825,125,PrimeWest Health,Minnesota Senior Health Options (MSHO),64.3125,51.45,,percent of total billed charges,,
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pbb)",,99204,CPT,Professional,Outpatient,,,,295,250.75,90,295,PrimeWest Health,Minnesota Senior Health Options (MSHO),148.327,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pbb)",,99204,CPT,Facility,Outpatient,,,,125,106.25,35.825,125,PrimeWest Health,MinnesotaCare,64.2,51.36,,percent of total billed charges,,
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pbb)",,99204,CPT,Professional,Outpatient,,,,295,250.75,90,295,PrimeWest Health,MinnesotaCare,102.4501888,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pbb)",,99204,CPT,Facility,Outpatient,,,,125,106.25,35.825,125,Sanford Health Plan,Sanford Health Plan,115,92,,percent of total billed charges,,
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pbb)",,99204,CPT,Professional,Outpatient,,,,295,250.75,90,295,Sanford Health Plan,Sanford Health Plan,259.6,88,,percent of total billed charges,,
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pbb)",,99204,CPT,Facility,Outpatient,,,,125,106.25,35.825,125,"UCare Health, Inc.",Individual & Family Plan,70.4375,56.35,,percent of total billed charges,,
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pbb)",,99204,CPT,Professional,Outpatient,,,,295,250.75,90,295,"UCare Health, Inc.",Individual & Family Plan,209.669888,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pbb)",,99204,CPT,Facility,Outpatient,,,,125,106.25,35.825,125,"UCare Health, Inc.",Medical Assistance,63.0875,50.47,,percent of total billed charges,,
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pbb)",,99204,CPT,Professional,Outpatient,,,,295,250.75,90,295,"UCare Health, Inc.",Medical Assistance,105.322624,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pbb)",,99204,CPT,Facility,Outpatient,,,,125,106.25,35.825,125,"UCare Health, Inc.",Medicare Advantage,63.0875,50.47,,percent of total billed charges,,
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pbb)",,99204,CPT,Professional,Outpatient,,,,295,250.75,90,295,"UCare Health, Inc.",Medicare Advantage,148.327,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pbb)",,99204,CPT,Facility,Outpatient,,,,125,106.25,35.825,125,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),63.0875,50.47,,percent of total billed charges,,
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pbb)",,99204,CPT,Professional,Outpatient,,,,295,250.75,90,295,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),118.6616,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pbb)",,99204,CPT,Facility,Outpatient,,,,125,106.25,35.825,125,UnitedHealthcare,Individual & Family,117.5,94,,percent of total billed charges,,
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pbb)",,99204,CPT,Professional,Outpatient,,,,295,250.75,90,295,UnitedHealthcare,Individual & Family,295,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pbb)",,99204,CPT,Facility,Outpatient,,,,125,106.25,35.825,125,UnitedHealthcare,Medicare Advantage,61.25,49,,percent of total billed charges,,
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pbb)",,99204,CPT,Professional,Outpatient,,,,295,250.75,90,295,UnitedHealthcare,Medicare Advantage,148.327,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pbb)",,99204,CPT,Facility,Outpatient,,,,125,106.25,35.825,125,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,60,48,,percent of total billed charges,,100% of DHS outpatient percentage
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pbb)",,99204,CPT,Professional,Outpatient,,,,295,250.75,90,295,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,95.74784,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pro Cah)",,99204,CPT,Professional,Outpatient,,,,410,348.5,90,410,Aetna,Commercial,348.5,85,,percent of total billed charges,,
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pro Cah)",,99204,CPT,Professional,Outpatient,,,,420,357,90,420,Aetna,Commercial,357,85,,percent of total billed charges,,
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pro Cah)",,99204,CPT,Professional,Outpatient,,,,470,399.5,90,470,Aetna,Commercial,399.5,85,,percent of total billed charges,,
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pro Cah)",,99204,CPT,Professional,Outpatient,,,,410,348.5,90,410,Aetna,Medicare Advantage,132.79,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pro Cah)",,99204,CPT,Professional,Outpatient,,,,420,357,90,420,Aetna,Medicare Advantage,132.79,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pro Cah)",,99204,CPT,Professional,Outpatient,,,,470,399.5,90,470,Aetna,Medicare Advantage,132.79,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pro Cah)",,99204,CPT,Professional,Outpatient,,,,410,348.5,90,410,Aetna,PPO,381.3,93,,percent of total billed charges,,
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pro Cah)",,99204,CPT,Professional,Outpatient,,,,420,357,90,420,Aetna,PPO,390.6,93,,percent of total billed charges,,
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pro Cah)",,99204,CPT,Professional,Outpatient,,,,470,399.5,90,470,Aetna,PPO,437.1,93,,percent of total billed charges,,
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pro Cah)",,99204,CPT,Professional,Outpatient,,,,410,348.5,90,410,America's PPO,America's PPO,350.304,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pro Cah)",,99204,CPT,Professional,Outpatient,,,,420,357,90,420,America's PPO,America's PPO,358.848,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pro Cah)",,99204,CPT,Professional,Outpatient,,,,470,399.5,90,470,America's PPO,America's PPO,401.568,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pro Cah)",,99204,CPT,Professional,Outpatient,,,,410,348.5,90,410,BlueCross BlueShield Minnesota, Federal Employee Program,235.77,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pro Cah)",,99204,CPT,Professional,Outpatient,,,,420,357,90,420,BlueCross BlueShield Minnesota, Federal Employee Program,235.77,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pro Cah)",,99204,CPT,Professional,Outpatient,,,,470,399.5,90,470,BlueCross BlueShield Minnesota, Federal Employee Program,235.77,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pro Cah)",,99204,CPT,Professional,Outpatient,,,,410,348.5,90,410,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,239.54232,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pro Cah)",,99204,CPT,Professional,Outpatient,,,,420,357,90,420,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,239.54232,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pro Cah)",,99204,CPT,Professional,Outpatient,,,,470,399.5,90,470,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,239.54232,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pro Cah)",,99204,CPT,Professional,Outpatient,,,,410,348.5,90,410,BlueCross BlueShield Minnesota,High Value Network Plan,239.54232,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pro Cah)",,99204,CPT,Professional,Outpatient,,,,420,357,90,420,BlueCross BlueShield Minnesota,High Value Network Plan,239.54232,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pro Cah)",,99204,CPT,Professional,Outpatient,,,,470,399.5,90,470,BlueCross BlueShield Minnesota,High Value Network Plan,239.54232,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pro Cah)",,99204,CPT,Professional,Outpatient,,,,410,348.5,90,410,BlueCross BlueShield Minnesota,Medicare Advantage,148.327,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pro Cah)",,99204,CPT,Professional,Outpatient,,,,420,357,90,420,BlueCross BlueShield Minnesota,Medicare Advantage,148.327,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pro Cah)",,99204,CPT,Professional,Outpatient,,,,470,399.5,90,470,BlueCross BlueShield Minnesota,Medicare Advantage,148.327,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pro Cah)",,99204,CPT,Professional,Outpatient,,,,410,348.5,90,410,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,239.54232,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pro Cah)",,99204,CPT,Professional,Outpatient,,,,420,357,90,420,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,239.54232,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pro Cah)",,99204,CPT,Professional,Outpatient,,,,470,399.5,90,470,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,239.54232,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pro Cah)",,99204,CPT,Professional,Outpatient,,,,410,348.5,90,410,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,95.74784,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pro Cah)",,99204,CPT,Professional,Outpatient,,,,420,357,90,420,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,95.74784,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pro Cah)",,99204,CPT,Professional,Outpatient,,,,470,399.5,90,470,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,95.74784,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pro Cah)",,99204,CPT,Professional,Outpatient,,,,410,348.5,90,410,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),148.327,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pro Cah)",,99204,CPT,Professional,Outpatient,,,,420,357,90,420,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),148.327,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pro Cah)",,99204,CPT,Professional,Outpatient,,,,470,399.5,90,470,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),148.327,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pro Cah)",,99204,CPT,Professional,Outpatient,,,,410,348.5,90,410,CorVel,Worker's Compensation,255.8606055,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pro Cah)",,99204,CPT,Professional,Outpatient,,,,420,357,90,420,CorVel,Worker's Compensation,255.8606055,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pro Cah)",,99204,CPT,Professional,Outpatient,,,,470,399.5,90,470,CorVel,Worker's Compensation,255.8606055,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pro Cah)",,99204,CPT,Professional,Outpatient,,,,410,348.5,90,410,First Health Group Corporation,First Health Network,397.7,97,,percent of total billed charges,,
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pro Cah)",,99204,CPT,Professional,Outpatient,,,,420,357,90,420,First Health Group Corporation,First Health Network,407.4,97,,percent of total billed charges,,
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pro Cah)",,99204,CPT,Professional,Outpatient,,,,470,399.5,90,470,First Health Group Corporation,First Health Network,455.9,97,,percent of total billed charges,,
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pro Cah)",,99204,CPT,Professional,Outpatient,,,,410,348.5,90,410,"Health Partners, Inc.",Commercial,275.7,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pro Cah)",,99204,CPT,Professional,Outpatient,,,,420,357,90,420,"Health Partners, Inc.",Commercial,275.7,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pro Cah)",,99204,CPT,Professional,Outpatient,,,,470,399.5,90,470,"Health Partners, Inc.",Commercial,275.7,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pro Cah)",,99204,CPT,Professional,Outpatient,,,,410,348.5,90,410,"Health Partners, Inc.",Medicare Advantage,148.327,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pro Cah)",,99204,CPT,Professional,Outpatient,,,,420,357,90,420,"Health Partners, Inc.",Medicare Advantage,148.327,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pro Cah)",,99204,CPT,Professional,Outpatient,,,,470,399.5,90,470,"Health Partners, Inc.",Medicare Advantage,148.327,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pro Cah)",,99204,CPT,Professional,Outpatient,,,,410,348.5,90,410,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),128.77,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pro Cah)",,99204,CPT,Professional,Outpatient,,,,420,357,90,420,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),128.77,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pro Cah)",,99204,CPT,Professional,Outpatient,,,,470,399.5,90,470,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),128.77,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pro Cah)",,99204,CPT,Professional,Outpatient,,,,410,348.5,90,410,"Health Partners, Inc.",State of Minnesota Advantage Program,237.51555,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pro Cah)",,99204,CPT,Professional,Outpatient,,,,420,357,90,420,"Health Partners, Inc.",State of Minnesota Advantage Program,237.51555,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pro Cah)",,99204,CPT,Professional,Outpatient,,,,470,399.5,90,470,"Health Partners, Inc.",State of Minnesota Advantage Program,237.51555,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pro Cah)",,99204,CPT,Professional,Outpatient,,,,410,348.5,90,410,"Health Partners, Inc.",State Public Programs,90,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pro Cah)",,99204,CPT,Professional,Outpatient,,,,420,357,90,420,"Health Partners, Inc.",State Public Programs,90,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pro Cah)",,99204,CPT,Professional,Outpatient,,,,470,399.5,90,470,"Health Partners, Inc.",State Public Programs,90,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pro Cah)",,99204,CPT,Professional,Outpatient,,,,410,348.5,90,410,Humana Insurance Company,Commercial PPO,128.98,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pro Cah)",,99204,CPT,Professional,Outpatient,,,,420,357,90,420,Humana Insurance Company,Commercial PPO,128.98,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pro Cah)",,99204,CPT,Professional,Outpatient,,,,470,399.5,90,470,Humana Insurance Company,Commercial PPO,128.98,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pro Cah)",,99204,CPT,Professional,Outpatient,,,,410,348.5,90,410,Humana Insurance Company,Medicare PPO,410,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pro Cah)",,99204,CPT,Professional,Outpatient,,,,420,357,90,420,Humana Insurance Company,Medicare PPO,420,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pro Cah)",,99204,CPT,Professional,Outpatient,,,,470,399.5,90,470,Humana Insurance Company,Medicare PPO,470,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pro Cah)",,99204,CPT,Professional,Outpatient,,,,410,348.5,90,410,Medica,Individual & Family,347.68,84.8,,percent of total billed charges,,
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pro Cah)",,99204,CPT,Professional,Outpatient,,,,420,357,90,420,Medica,Individual & Family,356.16,84.8,,percent of total billed charges,,
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pro Cah)",,99204,CPT,Professional,Outpatient,,,,470,399.5,90,470,Medica,Individual & Family,398.56,84.8,,percent of total billed charges,,
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pro Cah)",,99204,CPT,Professional,Outpatient,,,,410,348.5,90,410,Medica,Medica Advantage Solution,204.18,49.8,,percent of total billed charges,,
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pro Cah)",,99204,CPT,Professional,Outpatient,,,,420,357,90,420,Medica,Medica Advantage Solution,209.16,49.8,,percent of total billed charges,,
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pro Cah)",,99204,CPT,Professional,Outpatient,,,,470,399.5,90,470,Medica,Medica Advantage Solution,234.06,49.8,,percent of total billed charges,,
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pro Cah)",,99204,CPT,Professional,Outpatient,,,,410,348.5,90,410,Medica,Medical Assistance,95.75,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pro Cah)",,99204,CPT,Professional,Outpatient,,,,420,357,90,420,Medica,Medical Assistance,95.75,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pro Cah)",,99204,CPT,Professional,Outpatient,,,,470,399.5,90,470,Medica,Medical Assistance,95.75,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pro Cah)",,99204,CPT,Professional,Outpatient,,,,410,348.5,90,410,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,128.98,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pro Cah)",,99204,CPT,Professional,Outpatient,,,,420,357,90,420,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,128.98,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pro Cah)",,99204,CPT,Professional,Outpatient,,,,470,399.5,90,470,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,128.98,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pro Cah)",,99204,CPT,Professional,Outpatient,,,,410,348.5,90,410,"Multiplan, Inc.","Multiplan, Inc.",385.4,94,,percent of total billed charges,,
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pro Cah)",,99204,CPT,Professional,Outpatient,,,,420,357,90,420,"Multiplan, Inc.","Multiplan, Inc.",394.8,94,,percent of total billed charges,,
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pro Cah)",,99204,CPT,Professional,Outpatient,,,,470,399.5,90,470,"Multiplan, Inc.","Multiplan, Inc.",441.8,94,,percent of total billed charges,,
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pro Cah)",,99204,CPT,Professional,Outpatient,,,,410,348.5,90,410,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,369.41,90.1,,percent of total billed charges,,
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pro Cah)",,99204,CPT,Professional,Outpatient,,,,420,357,90,420,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,378.42,90.1,,percent of total billed charges,,
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pro Cah)",,99204,CPT,Professional,Outpatient,,,,470,399.5,90,470,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,423.47,90.1,,percent of total billed charges,,
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pro Cah)",,99204,CPT,Professional,Outpatient,,,,410,348.5,90,410,"Preferred One Administrative Services, INC.",PPO,404.26,98.6,,percent of total billed charges,,
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pro Cah)",,99204,CPT,Professional,Outpatient,,,,420,357,90,420,"Preferred One Administrative Services, INC.",PPO,414.12,98.6,,percent of total billed charges,,
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pro Cah)",,99204,CPT,Professional,Outpatient,,,,470,399.5,90,470,"Preferred One Administrative Services, INC.",PPO,463.42,98.6,,percent of total billed charges,,
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pro Cah)",,99204,CPT,Professional,Outpatient,,,,410,348.5,90,410,PrimeWest Health,Minnesota Senior Health Options (MSHO),148.327,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pro Cah)",,99204,CPT,Professional,Outpatient,,,,420,357,90,420,PrimeWest Health,Minnesota Senior Health Options (MSHO),148.327,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pro Cah)",,99204,CPT,Professional,Outpatient,,,,470,399.5,90,470,PrimeWest Health,Minnesota Senior Health Options (MSHO),148.327,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pro Cah)",,99204,CPT,Professional,Outpatient,,,,410,348.5,90,410,PrimeWest Health,MinnesotaCare,102.4501888,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pro Cah)",,99204,CPT,Professional,Outpatient,,,,420,357,90,420,PrimeWest Health,MinnesotaCare,102.4501888,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pro Cah)",,99204,CPT,Professional,Outpatient,,,,470,399.5,90,470,PrimeWest Health,MinnesotaCare,102.4501888,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pro Cah)",,99204,CPT,Professional,Outpatient,,,,410,348.5,90,410,Sanford Health Plan,Sanford Health Plan,360.8,88,,percent of total billed charges,,
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pro Cah)",,99204,CPT,Professional,Outpatient,,,,420,357,90,420,Sanford Health Plan,Sanford Health Plan,369.6,88,,percent of total billed charges,,
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pro Cah)",,99204,CPT,Professional,Outpatient,,,,470,399.5,90,470,Sanford Health Plan,Sanford Health Plan,413.6,88,,percent of total billed charges,,
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pro Cah)",,99204,CPT,Professional,Outpatient,,,,410,348.5,90,410,"UCare Health, Inc.",Individual & Family Plan,209.669888,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pro Cah)",,99204,CPT,Professional,Outpatient,,,,420,357,90,420,"UCare Health, Inc.",Individual & Family Plan,209.669888,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pro Cah)",,99204,CPT,Professional,Outpatient,,,,470,399.5,90,470,"UCare Health, Inc.",Individual & Family Plan,209.669888,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pro Cah)",,99204,CPT,Professional,Outpatient,,,,410,348.5,90,410,"UCare Health, Inc.",Medical Assistance,105.322624,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pro Cah)",,99204,CPT,Professional,Outpatient,,,,420,357,90,420,"UCare Health, Inc.",Medical Assistance,105.322624,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pro Cah)",,99204,CPT,Professional,Outpatient,,,,470,399.5,90,470,"UCare Health, Inc.",Medical Assistance,105.322624,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pro Cah)",,99204,CPT,Professional,Outpatient,,,,410,348.5,90,410,"UCare Health, Inc.",Medicare Advantage,148.327,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pro Cah)",,99204,CPT,Professional,Outpatient,,,,420,357,90,420,"UCare Health, Inc.",Medicare Advantage,148.327,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pro Cah)",,99204,CPT,Professional,Outpatient,,,,470,399.5,90,470,"UCare Health, Inc.",Medicare Advantage,148.327,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pro Cah)",,99204,CPT,Professional,Outpatient,,,,410,348.5,90,410,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),118.6616,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pro Cah)",,99204,CPT,Professional,Outpatient,,,,420,357,90,420,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),118.6616,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pro Cah)",,99204,CPT,Professional,Outpatient,,,,470,399.5,90,470,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),118.6616,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pro Cah)",,99204,CPT,Professional,Outpatient,,,,410,348.5,90,410,UnitedHealthcare,Individual & Family,410,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pro Cah)",,99204,CPT,Professional,Outpatient,,,,420,357,90,420,UnitedHealthcare,Individual & Family,420,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pro Cah)",,99204,CPT,Professional,Outpatient,,,,470,399.5,90,470,UnitedHealthcare,Individual & Family,470,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pro Cah)",,99204,CPT,Professional,Outpatient,,,,410,348.5,90,410,UnitedHealthcare,Medicare Advantage,148.327,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pro Cah)",,99204,CPT,Professional,Outpatient,,,,420,357,90,420,UnitedHealthcare,Medicare Advantage,148.327,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pro Cah)",,99204,CPT,Professional,Outpatient,,,,470,399.5,90,470,UnitedHealthcare,Medicare Advantage,148.327,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pro Cah)",,99204,CPT,Professional,Outpatient,,,,410,348.5,90,410,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,95.74784,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pro Cah)",,99204,CPT,Professional,Outpatient,,,,420,357,90,420,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,95.74784,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pro Cah)",,99204,CPT,Professional,Outpatient,,,,470,399.5,90,470,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,95.74784,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"New Pt Level 5 Office/Other Outpt Visit Eval And Mgmt, High Level Mdm Or 60-74 Min Total Time (Pro Cah)",,99205,CPT,Professional,Outpatient,,,,525,446.25,122.44,525,Aetna,Commercial,446.25,85,,percent of total billed charges,,
"New Pt Level 5 Office/Other Outpt Visit Eval And Mgmt, High Level Mdm Or 60-74 Min Total Time (Pro Cah)",,99205,CPT,Professional,Outpatient,,,,575,488.75,122.44,575,Aetna,Commercial,488.75,85,,percent of total billed charges,,
"New Pt Level 5 Office/Other Outpt Visit Eval And Mgmt, High Level Mdm Or 60-74 Min Total Time (Pro Cah)",,99205,CPT,Professional,Outpatient,,,,525,446.25,122.44,525,Aetna,Medicare Advantage,180.38,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"New Pt Level 5 Office/Other Outpt Visit Eval And Mgmt, High Level Mdm Or 60-74 Min Total Time (Pro Cah)",,99205,CPT,Professional,Outpatient,,,,575,488.75,122.44,575,Aetna,Medicare Advantage,180.38,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"New Pt Level 5 Office/Other Outpt Visit Eval And Mgmt, High Level Mdm Or 60-74 Min Total Time (Pro Cah)",,99205,CPT,Professional,Outpatient,,,,525,446.25,122.44,525,Aetna,PPO,488.25,93,,percent of total billed charges,,
"New Pt Level 5 Office/Other Outpt Visit Eval And Mgmt, High Level Mdm Or 60-74 Min Total Time (Pro Cah)",,99205,CPT,Professional,Outpatient,,,,575,488.75,122.44,575,Aetna,PPO,534.75,93,,percent of total billed charges,,
"New Pt Level 5 Office/Other Outpt Visit Eval And Mgmt, High Level Mdm Or 60-74 Min Total Time (Pro Cah)",,99205,CPT,Professional,Outpatient,,,,525,446.25,122.44,525,America's PPO,America's PPO,448.56,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"New Pt Level 5 Office/Other Outpt Visit Eval And Mgmt, High Level Mdm Or 60-74 Min Total Time (Pro Cah)",,99205,CPT,Professional,Outpatient,,,,575,488.75,122.44,575,America's PPO,America's PPO,491.28,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"New Pt Level 5 Office/Other Outpt Visit Eval And Mgmt, High Level Mdm Or 60-74 Min Total Time (Pro Cah)",,99205,CPT,Professional,Outpatient,,,,525,446.25,122.44,525,BlueCross BlueShield Minnesota, Federal Employee Program,320.14,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"New Pt Level 5 Office/Other Outpt Visit Eval And Mgmt, High Level Mdm Or 60-74 Min Total Time (Pro Cah)",,99205,CPT,Professional,Outpatient,,,,575,488.75,122.44,575,BlueCross BlueShield Minnesota, Federal Employee Program,320.14,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"New Pt Level 5 Office/Other Outpt Visit Eval And Mgmt, High Level Mdm Or 60-74 Min Total Time (Pro Cah)",,99205,CPT,Professional,Outpatient,,,,525,446.25,122.44,525,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,325.26224,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"New Pt Level 5 Office/Other Outpt Visit Eval And Mgmt, High Level Mdm Or 60-74 Min Total Time (Pro Cah)",,99205,CPT,Professional,Outpatient,,,,575,488.75,122.44,575,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,325.26224,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"New Pt Level 5 Office/Other Outpt Visit Eval And Mgmt, High Level Mdm Or 60-74 Min Total Time (Pro Cah)",,99205,CPT,Professional,Outpatient,,,,525,446.25,122.44,525,BlueCross BlueShield Minnesota,High Value Network Plan,325.26224,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"New Pt Level 5 Office/Other Outpt Visit Eval And Mgmt, High Level Mdm Or 60-74 Min Total Time (Pro Cah)",,99205,CPT,Professional,Outpatient,,,,575,488.75,122.44,575,BlueCross BlueShield Minnesota,High Value Network Plan,325.26224,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"New Pt Level 5 Office/Other Outpt Visit Eval And Mgmt, High Level Mdm Or 60-74 Min Total Time (Pro Cah)",,99205,CPT,Professional,Outpatient,,,,525,446.25,122.44,525,BlueCross BlueShield Minnesota,Medicare Advantage,201.4915,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"New Pt Level 5 Office/Other Outpt Visit Eval And Mgmt, High Level Mdm Or 60-74 Min Total Time (Pro Cah)",,99205,CPT,Professional,Outpatient,,,,575,488.75,122.44,575,BlueCross BlueShield Minnesota,Medicare Advantage,201.4915,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"New Pt Level 5 Office/Other Outpt Visit Eval And Mgmt, High Level Mdm Or 60-74 Min Total Time (Pro Cah)",,99205,CPT,Professional,Outpatient,,,,525,446.25,122.44,525,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,325.26224,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"New Pt Level 5 Office/Other Outpt Visit Eval And Mgmt, High Level Mdm Or 60-74 Min Total Time (Pro Cah)",,99205,CPT,Professional,Outpatient,,,,575,488.75,122.44,575,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,325.26224,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"New Pt Level 5 Office/Other Outpt Visit Eval And Mgmt, High Level Mdm Or 60-74 Min Total Time (Pro Cah)",,99205,CPT,Professional,Outpatient,,,,525,446.25,122.44,525,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,130.26136,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"New Pt Level 5 Office/Other Outpt Visit Eval And Mgmt, High Level Mdm Or 60-74 Min Total Time (Pro Cah)",,99205,CPT,Professional,Outpatient,,,,575,488.75,122.44,575,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,130.26136,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"New Pt Level 5 Office/Other Outpt Visit Eval And Mgmt, High Level Mdm Or 60-74 Min Total Time (Pro Cah)",,99205,CPT,Professional,Outpatient,,,,525,446.25,122.44,525,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),201.4915,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"New Pt Level 5 Office/Other Outpt Visit Eval And Mgmt, High Level Mdm Or 60-74 Min Total Time (Pro Cah)",,99205,CPT,Professional,Outpatient,,,,575,488.75,122.44,575,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),201.4915,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"New Pt Level 5 Office/Other Outpt Visit Eval And Mgmt, High Level Mdm Or 60-74 Min Total Time (Pro Cah)",,99205,CPT,Professional,Outpatient,,,,525,446.25,122.44,525,CorVel,Worker's Compensation,347.4690666,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"New Pt Level 5 Office/Other Outpt Visit Eval And Mgmt, High Level Mdm Or 60-74 Min Total Time (Pro Cah)",,99205,CPT,Professional,Outpatient,,,,575,488.75,122.44,575,CorVel,Worker's Compensation,347.4690666,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"New Pt Level 5 Office/Other Outpt Visit Eval And Mgmt, High Level Mdm Or 60-74 Min Total Time (Pro Cah)",,99205,CPT,Professional,Outpatient,,,,525,446.25,122.44,525,First Health Group Corporation,First Health Network,509.25,97,,percent of total billed charges,,
"New Pt Level 5 Office/Other Outpt Visit Eval And Mgmt, High Level Mdm Or 60-74 Min Total Time (Pro Cah)",,99205,CPT,Professional,Outpatient,,,,575,488.75,122.44,575,First Health Group Corporation,First Health Network,557.75,97,,percent of total billed charges,,
"New Pt Level 5 Office/Other Outpt Visit Eval And Mgmt, High Level Mdm Or 60-74 Min Total Time (Pro Cah)",,99205,CPT,Professional,Outpatient,,,,525,446.25,122.44,525,"Health Partners, Inc.",Commercial,375.1,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"New Pt Level 5 Office/Other Outpt Visit Eval And Mgmt, High Level Mdm Or 60-74 Min Total Time (Pro Cah)",,99205,CPT,Professional,Outpatient,,,,575,488.75,122.44,575,"Health Partners, Inc.",Commercial,375.1,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"New Pt Level 5 Office/Other Outpt Visit Eval And Mgmt, High Level Mdm Or 60-74 Min Total Time (Pro Cah)",,99205,CPT,Professional,Outpatient,,,,525,446.25,122.44,525,"Health Partners, Inc.",Medicare Advantage,201.4915,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"New Pt Level 5 Office/Other Outpt Visit Eval And Mgmt, High Level Mdm Or 60-74 Min Total Time (Pro Cah)",,99205,CPT,Professional,Outpatient,,,,575,488.75,122.44,575,"Health Partners, Inc.",Medicare Advantage,201.4915,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"New Pt Level 5 Office/Other Outpt Visit Eval And Mgmt, High Level Mdm Or 60-74 Min Total Time (Pro Cah)",,99205,CPT,Professional,Outpatient,,,,525,446.25,122.44,525,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),175.2,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"New Pt Level 5 Office/Other Outpt Visit Eval And Mgmt, High Level Mdm Or 60-74 Min Total Time (Pro Cah)",,99205,CPT,Professional,Outpatient,,,,575,488.75,122.44,575,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),175.2,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"New Pt Level 5 Office/Other Outpt Visit Eval And Mgmt, High Level Mdm Or 60-74 Min Total Time (Pro Cah)",,99205,CPT,Professional,Outpatient,,,,525,446.25,122.44,525,"Health Partners, Inc.",State of Minnesota Advantage Program,323.14865,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"New Pt Level 5 Office/Other Outpt Visit Eval And Mgmt, High Level Mdm Or 60-74 Min Total Time (Pro Cah)",,99205,CPT,Professional,Outpatient,,,,575,488.75,122.44,575,"Health Partners, Inc.",State of Minnesota Advantage Program,323.14865,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"New Pt Level 5 Office/Other Outpt Visit Eval And Mgmt, High Level Mdm Or 60-74 Min Total Time (Pro Cah)",,99205,CPT,Professional,Outpatient,,,,525,446.25,122.44,525,"Health Partners, Inc.",State Public Programs,122.44,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"New Pt Level 5 Office/Other Outpt Visit Eval And Mgmt, High Level Mdm Or 60-74 Min Total Time (Pro Cah)",,99205,CPT,Professional,Outpatient,,,,575,488.75,122.44,575,"Health Partners, Inc.",State Public Programs,122.44,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"New Pt Level 5 Office/Other Outpt Visit Eval And Mgmt, High Level Mdm Or 60-74 Min Total Time (Pro Cah)",,99205,CPT,Professional,Outpatient,,,,525,446.25,122.44,525,Humana Insurance Company,Commercial PPO,175.21,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"New Pt Level 5 Office/Other Outpt Visit Eval And Mgmt, High Level Mdm Or 60-74 Min Total Time (Pro Cah)",,99205,CPT,Professional,Outpatient,,,,575,488.75,122.44,575,Humana Insurance Company,Commercial PPO,175.21,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"New Pt Level 5 Office/Other Outpt Visit Eval And Mgmt, High Level Mdm Or 60-74 Min Total Time (Pro Cah)",,99205,CPT,Professional,Outpatient,,,,525,446.25,122.44,525,Humana Insurance Company,Medicare PPO,525,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"New Pt Level 5 Office/Other Outpt Visit Eval And Mgmt, High Level Mdm Or 60-74 Min Total Time (Pro Cah)",,99205,CPT,Professional,Outpatient,,,,575,488.75,122.44,575,Humana Insurance Company,Medicare PPO,575,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"New Pt Level 5 Office/Other Outpt Visit Eval And Mgmt, High Level Mdm Or 60-74 Min Total Time (Pro Cah)",,99205,CPT,Professional,Outpatient,,,,525,446.25,122.44,525,Medica,Individual & Family,445.2,84.8,,percent of total billed charges,,
"New Pt Level 5 Office/Other Outpt Visit Eval And Mgmt, High Level Mdm Or 60-74 Min Total Time (Pro Cah)",,99205,CPT,Professional,Outpatient,,,,575,488.75,122.44,575,Medica,Individual & Family,487.6,84.8,,percent of total billed charges,,
"New Pt Level 5 Office/Other Outpt Visit Eval And Mgmt, High Level Mdm Or 60-74 Min Total Time (Pro Cah)",,99205,CPT,Professional,Outpatient,,,,525,446.25,122.44,525,Medica,Medica Advantage Solution,261.45,49.8,,percent of total billed charges,,
"New Pt Level 5 Office/Other Outpt Visit Eval And Mgmt, High Level Mdm Or 60-74 Min Total Time (Pro Cah)",,99205,CPT,Professional,Outpatient,,,,575,488.75,122.44,575,Medica,Medica Advantage Solution,286.35,49.8,,percent of total billed charges,,
"New Pt Level 5 Office/Other Outpt Visit Eval And Mgmt, High Level Mdm Or 60-74 Min Total Time (Pro Cah)",,99205,CPT,Professional,Outpatient,,,,525,446.25,122.44,525,Medica,Medical Assistance,130.26,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"New Pt Level 5 Office/Other Outpt Visit Eval And Mgmt, High Level Mdm Or 60-74 Min Total Time (Pro Cah)",,99205,CPT,Professional,Outpatient,,,,575,488.75,122.44,575,Medica,Medical Assistance,130.26,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"New Pt Level 5 Office/Other Outpt Visit Eval And Mgmt, High Level Mdm Or 60-74 Min Total Time (Pro Cah)",,99205,CPT,Professional,Outpatient,,,,525,446.25,122.44,525,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,175.21,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"New Pt Level 5 Office/Other Outpt Visit Eval And Mgmt, High Level Mdm Or 60-74 Min Total Time (Pro Cah)",,99205,CPT,Professional,Outpatient,,,,575,488.75,122.44,575,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,175.21,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"New Pt Level 5 Office/Other Outpt Visit Eval And Mgmt, High Level Mdm Or 60-74 Min Total Time (Pro Cah)",,99205,CPT,Professional,Outpatient,,,,525,446.25,122.44,525,"Multiplan, Inc.","Multiplan, Inc.",493.5,94,,percent of total billed charges,,
"New Pt Level 5 Office/Other Outpt Visit Eval And Mgmt, High Level Mdm Or 60-74 Min Total Time (Pro Cah)",,99205,CPT,Professional,Outpatient,,,,575,488.75,122.44,575,"Multiplan, Inc.","Multiplan, Inc.",540.5,94,,percent of total billed charges,,
"New Pt Level 5 Office/Other Outpt Visit Eval And Mgmt, High Level Mdm Or 60-74 Min Total Time (Pro Cah)",,99205,CPT,Professional,Outpatient,,,,525,446.25,122.44,525,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,473.025,90.1,,percent of total billed charges,,
"New Pt Level 5 Office/Other Outpt Visit Eval And Mgmt, High Level Mdm Or 60-74 Min Total Time (Pro Cah)",,99205,CPT,Professional,Outpatient,,,,575,488.75,122.44,575,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,518.075,90.1,,percent of total billed charges,,
"New Pt Level 5 Office/Other Outpt Visit Eval And Mgmt, High Level Mdm Or 60-74 Min Total Time (Pro Cah)",,99205,CPT,Professional,Outpatient,,,,525,446.25,122.44,525,"Preferred One Administrative Services, INC.",PPO,517.65,98.6,,percent of total billed charges,,
"New Pt Level 5 Office/Other Outpt Visit Eval And Mgmt, High Level Mdm Or 60-74 Min Total Time (Pro Cah)",,99205,CPT,Professional,Outpatient,,,,575,488.75,122.44,575,"Preferred One Administrative Services, INC.",PPO,566.95,98.6,,percent of total billed charges,,
"New Pt Level 5 Office/Other Outpt Visit Eval And Mgmt, High Level Mdm Or 60-74 Min Total Time (Pro Cah)",,99205,CPT,Professional,Outpatient,,,,525,446.25,122.44,525,PrimeWest Health,Minnesota Senior Health Options (MSHO),201.4915,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"New Pt Level 5 Office/Other Outpt Visit Eval And Mgmt, High Level Mdm Or 60-74 Min Total Time (Pro Cah)",,99205,CPT,Professional,Outpatient,,,,575,488.75,122.44,575,PrimeWest Health,Minnesota Senior Health Options (MSHO),201.4915,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"New Pt Level 5 Office/Other Outpt Visit Eval And Mgmt, High Level Mdm Or 60-74 Min Total Time (Pro Cah)",,99205,CPT,Professional,Outpatient,,,,525,446.25,122.44,525,PrimeWest Health,MinnesotaCare,139.3796552,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"New Pt Level 5 Office/Other Outpt Visit Eval And Mgmt, High Level Mdm Or 60-74 Min Total Time (Pro Cah)",,99205,CPT,Professional,Outpatient,,,,575,488.75,122.44,575,PrimeWest Health,MinnesotaCare,139.3796552,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"New Pt Level 5 Office/Other Outpt Visit Eval And Mgmt, High Level Mdm Or 60-74 Min Total Time (Pro Cah)",,99205,CPT,Professional,Outpatient,,,,525,446.25,122.44,525,Sanford Health Plan,Sanford Health Plan,462,88,,percent of total billed charges,,
"New Pt Level 5 Office/Other Outpt Visit Eval And Mgmt, High Level Mdm Or 60-74 Min Total Time (Pro Cah)",,99205,CPT,Professional,Outpatient,,,,575,488.75,122.44,575,Sanford Health Plan,Sanford Health Plan,506,88,,percent of total billed charges,,
"New Pt Level 5 Office/Other Outpt Visit Eval And Mgmt, High Level Mdm Or 60-74 Min Total Time (Pro Cah)",,99205,CPT,Professional,Outpatient,,,,525,446.25,122.44,525,"UCare Health, Inc.",Individual & Family Plan,284.821376,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"New Pt Level 5 Office/Other Outpt Visit Eval And Mgmt, High Level Mdm Or 60-74 Min Total Time (Pro Cah)",,99205,CPT,Professional,Outpatient,,,,575,488.75,122.44,575,"UCare Health, Inc.",Individual & Family Plan,284.821376,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"New Pt Level 5 Office/Other Outpt Visit Eval And Mgmt, High Level Mdm Or 60-74 Min Total Time (Pro Cah)",,99205,CPT,Professional,Outpatient,,,,525,446.25,122.44,525,"UCare Health, Inc.",Medical Assistance,143.287496,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"New Pt Level 5 Office/Other Outpt Visit Eval And Mgmt, High Level Mdm Or 60-74 Min Total Time (Pro Cah)",,99205,CPT,Professional,Outpatient,,,,575,488.75,122.44,575,"UCare Health, Inc.",Medical Assistance,143.287496,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"New Pt Level 5 Office/Other Outpt Visit Eval And Mgmt, High Level Mdm Or 60-74 Min Total Time (Pro Cah)",,99205,CPT,Professional,Outpatient,,,,525,446.25,122.44,525,"UCare Health, Inc.",Medicare Advantage,201.4915,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"New Pt Level 5 Office/Other Outpt Visit Eval And Mgmt, High Level Mdm Or 60-74 Min Total Time (Pro Cah)",,99205,CPT,Professional,Outpatient,,,,575,488.75,122.44,575,"UCare Health, Inc.",Medicare Advantage,201.4915,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"New Pt Level 5 Office/Other Outpt Visit Eval And Mgmt, High Level Mdm Or 60-74 Min Total Time (Pro Cah)",,99205,CPT,Professional,Outpatient,,,,525,446.25,122.44,525,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),161.1932,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"New Pt Level 5 Office/Other Outpt Visit Eval And Mgmt, High Level Mdm Or 60-74 Min Total Time (Pro Cah)",,99205,CPT,Professional,Outpatient,,,,575,488.75,122.44,575,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),161.1932,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"New Pt Level 5 Office/Other Outpt Visit Eval And Mgmt, High Level Mdm Or 60-74 Min Total Time (Pro Cah)",,99205,CPT,Professional,Outpatient,,,,525,446.25,122.44,525,UnitedHealthcare,Individual & Family,525,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"New Pt Level 5 Office/Other Outpt Visit Eval And Mgmt, High Level Mdm Or 60-74 Min Total Time (Pro Cah)",,99205,CPT,Professional,Outpatient,,,,575,488.75,122.44,575,UnitedHealthcare,Individual & Family,575,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"New Pt Level 5 Office/Other Outpt Visit Eval And Mgmt, High Level Mdm Or 60-74 Min Total Time (Pro Cah)",,99205,CPT,Professional,Outpatient,,,,525,446.25,122.44,525,UnitedHealthcare,Medicare Advantage,201.4915,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"New Pt Level 5 Office/Other Outpt Visit Eval And Mgmt, High Level Mdm Or 60-74 Min Total Time (Pro Cah)",,99205,CPT,Professional,Outpatient,,,,575,488.75,122.44,575,UnitedHealthcare,Medicare Advantage,201.4915,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"New Pt Level 5 Office/Other Outpt Visit Eval And Mgmt, High Level Mdm Or 60-74 Min Total Time (Pro Cah)",,99205,CPT,Professional,Outpatient,,,,525,446.25,122.44,525,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,130.26136,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"New Pt Level 5 Office/Other Outpt Visit Eval And Mgmt, High Level Mdm Or 60-74 Min Total Time (Pro Cah)",,99205,CPT,Professional,Outpatient,,,,575,488.75,122.44,575,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,130.26136,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Clinical Nursing Level 1 (Ep),,99211,CPT,Facility,Both,,,,75,63.75,21.495,75,Aetna,Commercial,69,92,,percent of total billed charges,,
Clinical Nursing Level 1 (Ep),,99211,CPT,Facility,Outpatient,,,,75,63.75,21.495,75,Aetna,Medicare Advantage,36.75,49,,percent of total billed charges,,
Clinical Nursing Level 1 (Ep),,99211,CPT,Facility,Inpatient,,,,75,63.75,21.495,75,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Clinical Nursing Level 1 (Ep),,99211,CPT,Facility,Both,,,,75,63.75,21.495,75,Aetna,PPO,69.75,93,,percent of total billed charges,,
Clinical Nursing Level 1 (Ep),,99211,CPT,Facility,Both,,,,75,63.75,21.495,75,America's PPO,America's PPO,72.0225,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Clinical Nursing Level 1 (Ep),,99211,CPT,Facility,Both,,,,75,63.75,21.495,75,BlueCross BlueShield Minnesota, Federal Employee Program,73.8,98.4,,percent of total billed charges,,
Clinical Nursing Level 1 (Ep),,99211,CPT,Facility,Both,,,,75,63.75,21.495,75,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,75,100,,percent of total billed charges,,
Clinical Nursing Level 1 (Ep),,99211,CPT,Facility,Both,,,,75,63.75,21.495,75,BlueCross BlueShield Minnesota,High Value Network Plan,67.5,90,,percent of total billed charges,,
Clinical Nursing Level 1 (Ep),,99211,CPT,Facility,Outpatient,,,,75,63.75,21.495,75,BlueCross BlueShield Minnesota,Medicare Advantage,36.75,49,,percent of total billed charges,,
Clinical Nursing Level 1 (Ep),,99211,CPT,Facility,Inpatient,,,,75,63.75,21.495,75,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Clinical Nursing Level 1 (Ep),,99211,CPT,Facility,Both,,,,75,63.75,21.495,75,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,66.4275,88.57,,percent of total billed charges,,
Clinical Nursing Level 1 (Ep),,99211,CPT,Facility,Both,,,,75,63.75,21.495,75,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,21.495,28.66,,percent of total billed charges,,
Clinical Nursing Level 1 (Ep),,99211,CPT,Facility,Outpatient,,,,75,63.75,21.495,75,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),36.75,49,,percent of total billed charges,,
Clinical Nursing Level 1 (Ep),,99211,CPT,Facility,Inpatient,,,,75,63.75,21.495,75,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Clinical Nursing Level 1 (Ep),,99211,CPT,Facility,Both,,,,75,63.75,21.495,75,CorVel,Worker's Compensation,75,100,,percent of total billed charges,,
Clinical Nursing Level 1 (Ep),,99211,CPT,Facility,Both,,,,75,63.75,21.495,75,First Health Group Corporation,First Health Network,72.75,97,,percent of total billed charges,,
Clinical Nursing Level 1 (Ep),,99211,CPT,Facility,Both,,,,75,63.75,21.495,75,"Health Partners, Inc.",Commercial,70.95,94.6,,percent of total billed charges,,
Clinical Nursing Level 1 (Ep),,99211,CPT,Facility,Outpatient,,,,75,63.75,21.495,75,"Health Partners, Inc.",Medicare Advantage,36.75,49,,percent of total billed charges,,
Clinical Nursing Level 1 (Ep),,99211,CPT,Facility,Inpatient,,,,75,63.75,21.495,75,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Clinical Nursing Level 1 (Ep),,99211,CPT,Facility,Both,,,,75,63.75,21.495,75,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),45,60,,percent of total billed charges,,
Clinical Nursing Level 1 (Ep),,99211,CPT,Facility,Both,,,,75,63.75,21.495,75,"Health Partners, Inc.",State of Minnesota Advantage Program,61.125,81.5,,percent of total billed charges,,
Clinical Nursing Level 1 (Ep),,99211,CPT,Facility,Both,,,,75,63.75,21.495,75,"Health Partners, Inc.",State Public Programs,37.5,50,,percent of total billed charges,,
Clinical Nursing Level 1 (Ep),,99211,CPT,Facility,Both,,,,75,63.75,21.495,75,Humana Insurance Company,Commercial PPO,71.25,95,,percent of total billed charges,,
Clinical Nursing Level 1 (Ep),,99211,CPT,Facility,Outpatient,,,,75,63.75,21.495,75,Humana Insurance Company,Medicare PPO,36.75,49,,percent of total billed charges,,
Clinical Nursing Level 1 (Ep),,99211,CPT,Facility,Inpatient,,,,75,63.75,21.495,75,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Clinical Nursing Level 1 (Ep),,99211,CPT,Facility,Both,,,,75,63.75,21.495,75,Medica,Individual & Family,74.325,99.1,,percent of total billed charges,,
Clinical Nursing Level 1 (Ep),,99211,CPT,Facility,Outpatient,,,,75,63.75,21.495,75,Medica,Medica Advantage Solution,37.35,49.8,,percent of total billed charges,,
Clinical Nursing Level 1 (Ep),,99211,CPT,Facility,Inpatient,,,,75,63.75,21.495,75,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Clinical Nursing Level 1 (Ep),,99211,CPT,Facility,Outpatient,,,,75,63.75,21.495,75,Medica,Medical Assistance,33.45,44.6,,percent of total billed charges,,
Clinical Nursing Level 1 (Ep),,99211,CPT,Facility,Inpatient,,,,75,63.75,21.495,75,Medica,Medical Assistance,,,,,Included in per diem rate,
Clinical Nursing Level 1 (Ep),,99211,CPT,Facility,Outpatient,,,,75,63.75,21.495,75,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,37.35,49.8,,percent of total billed charges,,
Clinical Nursing Level 1 (Ep),,99211,CPT,Facility,Inpatient,,,,75,63.75,21.495,75,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Clinical Nursing Level 1 (Ep),,99211,CPT,Facility,Both,,,,75,63.75,21.495,75,"Multiplan, Inc.","Multiplan, Inc.",70.5,94,,percent of total billed charges,,
Clinical Nursing Level 1 (Ep),,99211,CPT,Facility,Outpatient,,,,75,63.75,21.495,75,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,67.575,90.1,,percent of total billed charges,,
Clinical Nursing Level 1 (Ep),,99211,CPT,Facility,Inpatient,,,,75,63.75,21.495,75,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Clinical Nursing Level 1 (Ep),,99211,CPT,Facility,Both,,,,75,63.75,21.495,75,"Preferred One Administrative Services, INC.",PPO,73.95,98.6,,percent of total billed charges,,
Clinical Nursing Level 1 (Ep),,99211,CPT,Facility,Outpatient,,,,75,63.75,21.495,75,PrimeWest Health,Minnesota Senior Health Options (MSHO),38.5875,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Clinical Nursing Level 1 (Ep),,99211,CPT,Facility,Inpatient,,,,75,63.75,21.495,75,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Clinical Nursing Level 1 (Ep),,99211,CPT,Facility,Outpatient,,,,75,63.75,21.495,75,PrimeWest Health,MinnesotaCare,38.52,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Clinical Nursing Level 1 (Ep),,99211,CPT,Facility,Inpatient,,,,75,63.75,21.495,75,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Clinical Nursing Level 1 (Ep),,99211,CPT,Facility,Both,,,,75,63.75,21.495,75,Sanford Health Plan,Sanford Health Plan,69,92,,percent of total billed charges,,
Clinical Nursing Level 1 (Ep),,99211,CPT,Facility,Outpatient,,,,75,63.75,21.495,75,"UCare Health, Inc.",Individual & Family Plan,42.2625,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Clinical Nursing Level 1 (Ep),,99211,CPT,Facility,Inpatient,,,,75,63.75,21.495,75,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Clinical Nursing Level 1 (Ep),,99211,CPT,Facility,Outpatient,,,,75,63.75,21.495,75,"UCare Health, Inc.",Medical Assistance,37.8525,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Clinical Nursing Level 1 (Ep),,99211,CPT,Facility,Inpatient,,,,75,63.75,21.495,75,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Clinical Nursing Level 1 (Ep),,99211,CPT,Facility,Outpatient,,,,75,63.75,21.495,75,"UCare Health, Inc.",Medicare Advantage,37.8525,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Clinical Nursing Level 1 (Ep),,99211,CPT,Facility,Inpatient,,,,75,63.75,21.495,75,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Clinical Nursing Level 1 (Ep),,99211,CPT,Facility,Outpatient,,,,75,63.75,21.495,75,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),37.8525,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Clinical Nursing Level 1 (Ep),,99211,CPT,Facility,Inpatient,,,,75,63.75,21.495,75,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Clinical Nursing Level 1 (Ep),,99211,CPT,Facility,Both,,,,75,63.75,21.495,75,UnitedHealthcare,Individual & Family,70.5,94,,percent of total billed charges,,
Clinical Nursing Level 1 (Ep),,99211,CPT,Facility,Outpatient,,,,75,63.75,21.495,75,UnitedHealthcare,Medicare Advantage,36.75,49,,percent of total billed charges,,
Clinical Nursing Level 1 (Ep),,99211,CPT,Facility,Inpatient,,,,75,63.75,21.495,75,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Clinical Nursing Level 1 (Ep),,99211,CPT,Facility,Outpatient,,,,75,63.75,21.495,75,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,36,48,,percent of total billed charges,,100% of DHS outpatient percentage
Clinical Nursing Level 1 (Ep),,99211,CPT,Facility,Inpatient,,,,75,63.75,21.495,75,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Clinical Nursing Level 2 (Ep),,99212,CPT,Facility,Both,,,,130,110.5,37.258,130,Aetna,Commercial,119.6,92,,percent of total billed charges,,
Clinical Nursing Level 2 (Ep),,99212,CPT,Facility,Outpatient,,,,130,110.5,37.258,130,Aetna,Medicare Advantage,63.7,49,,percent of total billed charges,,
Clinical Nursing Level 2 (Ep),,99212,CPT,Facility,Inpatient,,,,130,110.5,37.258,130,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Clinical Nursing Level 2 (Ep),,99212,CPT,Facility,Both,,,,130,110.5,37.258,130,Aetna,PPO,120.9,93,,percent of total billed charges,,
Clinical Nursing Level 2 (Ep),,99212,CPT,Facility,Both,,,,130,110.5,37.258,130,America's PPO,America's PPO,124.839,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Clinical Nursing Level 2 (Ep),,99212,CPT,Facility,Both,,,,130,110.5,37.258,130,BlueCross BlueShield Minnesota, Federal Employee Program,127.92,98.4,,percent of total billed charges,,
Clinical Nursing Level 2 (Ep),,99212,CPT,Facility,Both,,,,130,110.5,37.258,130,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,130,100,,percent of total billed charges,,
Clinical Nursing Level 2 (Ep),,99212,CPT,Facility,Both,,,,130,110.5,37.258,130,BlueCross BlueShield Minnesota,High Value Network Plan,117,90,,percent of total billed charges,,
Clinical Nursing Level 2 (Ep),,99212,CPT,Facility,Outpatient,,,,130,110.5,37.258,130,BlueCross BlueShield Minnesota,Medicare Advantage,63.7,49,,percent of total billed charges,,
Clinical Nursing Level 2 (Ep),,99212,CPT,Facility,Inpatient,,,,130,110.5,37.258,130,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Clinical Nursing Level 2 (Ep),,99212,CPT,Facility,Both,,,,130,110.5,37.258,130,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,115.141,88.57,,percent of total billed charges,,
Clinical Nursing Level 2 (Ep),,99212,CPT,Facility,Both,,,,130,110.5,37.258,130,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,37.258,28.66,,percent of total billed charges,,
Clinical Nursing Level 2 (Ep),,99212,CPT,Facility,Outpatient,,,,130,110.5,37.258,130,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),63.7,49,,percent of total billed charges,,
Clinical Nursing Level 2 (Ep),,99212,CPT,Facility,Inpatient,,,,130,110.5,37.258,130,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Clinical Nursing Level 2 (Ep),,99212,CPT,Facility,Both,,,,130,110.5,37.258,130,CorVel,Worker's Compensation,130,100,,percent of total billed charges,,
Clinical Nursing Level 2 (Ep),,99212,CPT,Facility,Both,,,,130,110.5,37.258,130,First Health Group Corporation,First Health Network,126.1,97,,percent of total billed charges,,
Clinical Nursing Level 2 (Ep),,99212,CPT,Facility,Both,,,,130,110.5,37.258,130,"Health Partners, Inc.",Commercial,122.98,94.6,,percent of total billed charges,,
Clinical Nursing Level 2 (Ep),,99212,CPT,Facility,Outpatient,,,,130,110.5,37.258,130,"Health Partners, Inc.",Medicare Advantage,63.7,49,,percent of total billed charges,,
Clinical Nursing Level 2 (Ep),,99212,CPT,Facility,Inpatient,,,,130,110.5,37.258,130,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Clinical Nursing Level 2 (Ep),,99212,CPT,Facility,Both,,,,130,110.5,37.258,130,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),78,60,,percent of total billed charges,,
Clinical Nursing Level 2 (Ep),,99212,CPT,Facility,Both,,,,130,110.5,37.258,130,"Health Partners, Inc.",State of Minnesota Advantage Program,105.95,81.5,,percent of total billed charges,,
Clinical Nursing Level 2 (Ep),,99212,CPT,Facility,Both,,,,130,110.5,37.258,130,"Health Partners, Inc.",State Public Programs,65,50,,percent of total billed charges,,
Clinical Nursing Level 2 (Ep),,99212,CPT,Facility,Both,,,,130,110.5,37.258,130,Humana Insurance Company,Commercial PPO,123.5,95,,percent of total billed charges,,
Clinical Nursing Level 2 (Ep),,99212,CPT,Facility,Outpatient,,,,130,110.5,37.258,130,Humana Insurance Company,Medicare PPO,63.7,49,,percent of total billed charges,,
Clinical Nursing Level 2 (Ep),,99212,CPT,Facility,Inpatient,,,,130,110.5,37.258,130,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Clinical Nursing Level 2 (Ep),,99212,CPT,Facility,Both,,,,130,110.5,37.258,130,Medica,Individual & Family,128.83,99.1,,percent of total billed charges,,
Clinical Nursing Level 2 (Ep),,99212,CPT,Facility,Outpatient,,,,130,110.5,37.258,130,Medica,Medica Advantage Solution,64.74,49.8,,percent of total billed charges,,
Clinical Nursing Level 2 (Ep),,99212,CPT,Facility,Inpatient,,,,130,110.5,37.258,130,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Clinical Nursing Level 2 (Ep),,99212,CPT,Facility,Outpatient,,,,130,110.5,37.258,130,Medica,Medical Assistance,57.98,44.6,,percent of total billed charges,,
Clinical Nursing Level 2 (Ep),,99212,CPT,Facility,Inpatient,,,,130,110.5,37.258,130,Medica,Medical Assistance,,,,,Included in per diem rate,
Clinical Nursing Level 2 (Ep),,99212,CPT,Facility,Outpatient,,,,130,110.5,37.258,130,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,64.74,49.8,,percent of total billed charges,,
Clinical Nursing Level 2 (Ep),,99212,CPT,Facility,Inpatient,,,,130,110.5,37.258,130,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Clinical Nursing Level 2 (Ep),,99212,CPT,Facility,Both,,,,130,110.5,37.258,130,"Multiplan, Inc.","Multiplan, Inc.",122.2,94,,percent of total billed charges,,
Clinical Nursing Level 2 (Ep),,99212,CPT,Facility,Outpatient,,,,130,110.5,37.258,130,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,117.13,90.1,,percent of total billed charges,,
Clinical Nursing Level 2 (Ep),,99212,CPT,Facility,Inpatient,,,,130,110.5,37.258,130,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Clinical Nursing Level 2 (Ep),,99212,CPT,Facility,Both,,,,130,110.5,37.258,130,"Preferred One Administrative Services, INC.",PPO,128.18,98.6,,percent of total billed charges,,
Clinical Nursing Level 2 (Ep),,99212,CPT,Facility,Outpatient,,,,130,110.5,37.258,130,PrimeWest Health,Minnesota Senior Health Options (MSHO),66.885,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Clinical Nursing Level 2 (Ep),,99212,CPT,Facility,Inpatient,,,,130,110.5,37.258,130,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Clinical Nursing Level 2 (Ep),,99212,CPT,Facility,Outpatient,,,,130,110.5,37.258,130,PrimeWest Health,MinnesotaCare,66.768,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Clinical Nursing Level 2 (Ep),,99212,CPT,Facility,Inpatient,,,,130,110.5,37.258,130,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Clinical Nursing Level 2 (Ep),,99212,CPT,Facility,Both,,,,130,110.5,37.258,130,Sanford Health Plan,Sanford Health Plan,119.6,92,,percent of total billed charges,,
Clinical Nursing Level 2 (Ep),,99212,CPT,Facility,Outpatient,,,,130,110.5,37.258,130,"UCare Health, Inc.",Individual & Family Plan,73.255,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Clinical Nursing Level 2 (Ep),,99212,CPT,Facility,Inpatient,,,,130,110.5,37.258,130,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Clinical Nursing Level 2 (Ep),,99212,CPT,Facility,Outpatient,,,,130,110.5,37.258,130,"UCare Health, Inc.",Medical Assistance,65.611,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Clinical Nursing Level 2 (Ep),,99212,CPT,Facility,Inpatient,,,,130,110.5,37.258,130,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Clinical Nursing Level 2 (Ep),,99212,CPT,Facility,Outpatient,,,,130,110.5,37.258,130,"UCare Health, Inc.",Medicare Advantage,65.611,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Clinical Nursing Level 2 (Ep),,99212,CPT,Facility,Inpatient,,,,130,110.5,37.258,130,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Clinical Nursing Level 2 (Ep),,99212,CPT,Facility,Outpatient,,,,130,110.5,37.258,130,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),65.611,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Clinical Nursing Level 2 (Ep),,99212,CPT,Facility,Inpatient,,,,130,110.5,37.258,130,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Clinical Nursing Level 2 (Ep),,99212,CPT,Facility,Both,,,,130,110.5,37.258,130,UnitedHealthcare,Individual & Family,122.2,94,,percent of total billed charges,,
Clinical Nursing Level 2 (Ep),,99212,CPT,Facility,Outpatient,,,,130,110.5,37.258,130,UnitedHealthcare,Medicare Advantage,63.7,49,,percent of total billed charges,,
Clinical Nursing Level 2 (Ep),,99212,CPT,Facility,Inpatient,,,,130,110.5,37.258,130,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Clinical Nursing Level 2 (Ep),,99212,CPT,Facility,Outpatient,,,,130,110.5,37.258,130,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,62.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
Clinical Nursing Level 2 (Ep),,99212,CPT,Facility,Inpatient,,,,130,110.5,37.258,130,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time",,99212,CPT,Facility,Outpatient,,,,50,42.5,14.33,50,Aetna,Commercial,46,92,,percent of total billed charges,,
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time",,99212,CPT,Facility,Outpatient,,,,50,42.5,14.33,50,Aetna,Medicare Advantage,24.5,49,,percent of total billed charges,,
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time",,99212,CPT,Facility,Outpatient,,,,50,42.5,14.33,50,Aetna,PPO,46.5,93,,percent of total billed charges,,
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time",,99212,CPT,Facility,Outpatient,,,,50,42.5,14.33,50,America's PPO,America's PPO,48.015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time",,99212,CPT,Facility,Outpatient,,,,50,42.5,14.33,50,BlueCross BlueShield Minnesota, Federal Employee Program,49.2,98.4,,percent of total billed charges,,
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time",,99212,CPT,Facility,Outpatient,,,,50,42.5,14.33,50,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,50,100,,percent of total billed charges,,
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time",,99212,CPT,Facility,Outpatient,,,,50,42.5,14.33,50,BlueCross BlueShield Minnesota,High Value Network Plan,45,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time",,99212,CPT,Facility,Outpatient,,,,50,42.5,14.33,50,BlueCross BlueShield Minnesota,Medicare Advantage,24.5,49,,percent of total billed charges,,
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time",,99212,CPT,Facility,Outpatient,,,,50,42.5,14.33,50,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,14.33,28.66,,percent of total billed charges,,
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time",,99212,CPT,Facility,Outpatient,,,,50,42.5,14.33,50,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),24.5,49,,percent of total billed charges,,
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time",,99212,CPT,Facility,Outpatient,,,,50,42.5,14.33,50,CorVel,Worker's Compensation,50,100,,percent of total billed charges,,
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time",,99212,CPT,Facility,Outpatient,,,,50,42.5,14.33,50,First Health Group Corporation,First Health Network,48.5,97,,percent of total billed charges,,
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time",,99212,CPT,Facility,Outpatient,,,,50,42.5,14.33,50,"Health Partners, Inc.",Commercial,47.3,94.6,,percent of total billed charges,,
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time",,99212,CPT,Facility,Outpatient,,,,50,42.5,14.33,50,"Health Partners, Inc.",Medicare Advantage,24.5,49,,percent of total billed charges,,
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time",,99212,CPT,Facility,Outpatient,,,,50,42.5,14.33,50,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),30,60,,percent of total billed charges,,
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time",,99212,CPT,Facility,Outpatient,,,,50,42.5,14.33,50,"Health Partners, Inc.",State of Minnesota Advantage Program,40.75,81.5,,percent of total billed charges,,
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time",,99212,CPT,Facility,Outpatient,,,,50,42.5,14.33,50,"Health Partners, Inc.",State Public Programs,25,50,,percent of total billed charges,,
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time",,99212,CPT,Facility,Outpatient,,,,50,42.5,14.33,50,Humana Insurance Company,Commercial PPO,47.5,95,,percent of total billed charges,,
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time",,99212,CPT,Facility,Outpatient,,,,50,42.5,14.33,50,Humana Insurance Company,Medicare PPO,24.5,49,,percent of total billed charges,,
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time",,99212,CPT,Facility,Outpatient,,,,50,42.5,14.33,50,Medica,Individual & Family,49.55,99.1,,percent of total billed charges,,
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time",,99212,CPT,Facility,Outpatient,,,,50,42.5,14.33,50,Medica,Medica Advantage Solution,24.9,49.8,,percent of total billed charges,,
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time",,99212,CPT,Facility,Outpatient,,,,50,42.5,14.33,50,Medica,Medical Assistance,22.3,44.6,,percent of total billed charges,,
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time",,99212,CPT,Facility,Outpatient,,,,50,42.5,14.33,50,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,24.9,49.8,,percent of total billed charges,,
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time",,99212,CPT,Facility,Outpatient,,,,50,42.5,14.33,50,"Multiplan, Inc.","Multiplan, Inc.",47,94,,percent of total billed charges,,
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time",,99212,CPT,Facility,Outpatient,,,,50,42.5,14.33,50,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,45.05,90.1,,percent of total billed charges,,
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time",,99212,CPT,Facility,Outpatient,,,,50,42.5,14.33,50,"Preferred One Administrative Services, INC.",PPO,49.3,98.6,,percent of total billed charges,,
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time",,99212,CPT,Facility,Outpatient,,,,50,42.5,14.33,50,PrimeWest Health,Minnesota Senior Health Options (MSHO),25.725,51.45,,percent of total billed charges,,
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time",,99212,CPT,Facility,Outpatient,,,,50,42.5,14.33,50,PrimeWest Health,MinnesotaCare,25.68,51.36,,percent of total billed charges,,
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time",,99212,CPT,Facility,Outpatient,,,,50,42.5,14.33,50,Sanford Health Plan,Sanford Health Plan,46,92,,percent of total billed charges,,
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time",,99212,CPT,Facility,Outpatient,,,,50,42.5,14.33,50,"UCare Health, Inc.",Individual & Family Plan,28.175,56.35,,percent of total billed charges,,
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time",,99212,CPT,Facility,Outpatient,,,,50,42.5,14.33,50,"UCare Health, Inc.",Medical Assistance,25.235,50.47,,percent of total billed charges,,
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time",,99212,CPT,Facility,Outpatient,,,,50,42.5,14.33,50,"UCare Health, Inc.",Medicare Advantage,25.235,50.47,,percent of total billed charges,,
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time",,99212,CPT,Facility,Outpatient,,,,50,42.5,14.33,50,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),25.235,50.47,,percent of total billed charges,,
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time",,99212,CPT,Facility,Outpatient,,,,50,42.5,14.33,50,UnitedHealthcare,Individual & Family,47,94,,percent of total billed charges,,
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time",,99212,CPT,Facility,Outpatient,,,,50,42.5,14.33,50,UnitedHealthcare,Medicare Advantage,24.5,49,,percent of total billed charges,,
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time",,99212,CPT,Facility,Outpatient,,,,50,42.5,14.33,50,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,24,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pbb)",,99212,CPT,Facility,Outpatient,,,,60,51,17.196,60,Aetna,Commercial,55.2,92,,percent of total billed charges,,
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pbb)",,99212,CPT,Professional,Outpatient,,,,75,63.75,23.91,75,Aetna,Commercial,63.75,85,,percent of total billed charges,,
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pbb)",,99212,CPT,Facility,Outpatient,,,,60,51,17.196,60,Aetna,Medicare Advantage,29.4,49,,percent of total billed charges,,
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pbb)",,99212,CPT,Professional,Outpatient,,,,75,63.75,23.91,75,Aetna,Medicare Advantage,35.29,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pbb)",,99212,CPT,Facility,Outpatient,,,,60,51,17.196,60,Aetna,PPO,55.8,93,,percent of total billed charges,,
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pbb)",,99212,CPT,Professional,Outpatient,,,,75,63.75,23.91,75,Aetna,PPO,69.75,93,,percent of total billed charges,,
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pbb)",,99212,CPT,Facility,Outpatient,,,,60,51,17.196,60,America's PPO,America's PPO,57.618,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pbb)",,99212,CPT,Professional,Outpatient,,,,75,63.75,23.91,75,America's PPO,America's PPO,64.08,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pbb)",,99212,CPT,Facility,Outpatient,,,,60,51,17.196,60,BlueCross BlueShield Minnesota, Federal Employee Program,59.04,98.4,,percent of total billed charges,,
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pbb)",,99212,CPT,Professional,Outpatient,,,,75,63.75,23.91,75,BlueCross BlueShield Minnesota, Federal Employee Program,62.83,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pbb)",,99212,CPT,Facility,Outpatient,,,,60,51,17.196,60,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,60,100,,percent of total billed charges,,
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pbb)",,99212,CPT,Professional,Outpatient,,,,75,63.75,23.91,75,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,63.83528,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pbb)",,99212,CPT,Facility,Outpatient,,,,60,51,17.196,60,BlueCross BlueShield Minnesota,High Value Network Plan,54,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pbb)",,99212,CPT,Professional,Outpatient,,,,75,63.75,23.91,75,BlueCross BlueShield Minnesota,High Value Network Plan,63.83528,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pbb)",,99212,CPT,Facility,Outpatient,,,,60,51,17.196,60,BlueCross BlueShield Minnesota,Medicare Advantage,29.4,49,,percent of total billed charges,,
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pbb)",,99212,CPT,Professional,Outpatient,,,,75,63.75,23.91,75,BlueCross BlueShield Minnesota,Medicare Advantage,39.56,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pbb)",,99212,CPT,Professional,Outpatient,,,,75,63.75,23.91,75,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,63.83528,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pbb)",,99212,CPT,Facility,Outpatient,,,,60,51,17.196,60,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,17.196,28.66,,percent of total billed charges,,
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pbb)",,99212,CPT,Professional,Outpatient,,,,75,63.75,23.91,75,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,25.44064,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pbb)",,99212,CPT,Facility,Outpatient,,,,60,51,17.196,60,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),29.4,49,,percent of total billed charges,,
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pbb)",,99212,CPT,Professional,Outpatient,,,,75,63.75,23.91,75,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),39.56,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pbb)",,99212,CPT,Facility,Outpatient,,,,60,51,17.196,60,CorVel,Worker's Compensation,60,100,,percent of total billed charges,,
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pbb)",,99212,CPT,Professional,Outpatient,,,,75,63.75,23.91,75,CorVel,Worker's Compensation,68.4113016,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pbb)",,99212,CPT,Facility,Outpatient,,,,60,51,17.196,60,First Health Group Corporation,First Health Network,58.2,97,,percent of total billed charges,,
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pbb)",,99212,CPT,Professional,Outpatient,,,,75,63.75,23.91,75,First Health Group Corporation,First Health Network,72.75,97,,percent of total billed charges,,
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pbb)",,99212,CPT,Facility,Outpatient,,,,60,51,17.196,60,"Health Partners, Inc.",Commercial,56.76,94.6,,percent of total billed charges,,
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pbb)",,99212,CPT,Professional,Outpatient,,,,75,63.75,23.91,75,"Health Partners, Inc.",Commercial,73.27,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pbb)",,99212,CPT,Facility,Outpatient,,,,60,51,17.196,60,"Health Partners, Inc.",Medicare Advantage,29.4,49,,percent of total billed charges,,
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pbb)",,99212,CPT,Professional,Outpatient,,,,75,63.75,23.91,75,"Health Partners, Inc.",Medicare Advantage,39.56,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pbb)",,99212,CPT,Facility,Outpatient,,,,60,51,17.196,60,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),36,60,,percent of total billed charges,,
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pbb)",,99212,CPT,Professional,Outpatient,,,,75,63.75,23.91,75,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),34.56,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pbb)",,99212,CPT,Facility,Outpatient,,,,60,51,17.196,60,"Health Partners, Inc.",State of Minnesota Advantage Program,48.9,81.5,,percent of total billed charges,,
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pbb)",,99212,CPT,Professional,Outpatient,,,,75,63.75,23.91,75,"Health Partners, Inc.",State of Minnesota Advantage Program,63.122105,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pbb)",,99212,CPT,Facility,Outpatient,,,,60,51,17.196,60,"Health Partners, Inc.",State Public Programs,30,50,,percent of total billed charges,,
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pbb)",,99212,CPT,Professional,Outpatient,,,,75,63.75,23.91,75,"Health Partners, Inc.",State Public Programs,23.91,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pbb)",,99212,CPT,Facility,Outpatient,,,,60,51,17.196,60,Humana Insurance Company,Commercial PPO,57,95,,percent of total billed charges,,
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pbb)",,99212,CPT,Professional,Outpatient,,,,75,63.75,23.91,75,Humana Insurance Company,Commercial PPO,34.4,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pbb)",,99212,CPT,Facility,Outpatient,,,,60,51,17.196,60,Humana Insurance Company,Medicare PPO,29.4,49,,percent of total billed charges,,
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pbb)",,99212,CPT,Professional,Outpatient,,,,75,63.75,23.91,75,Humana Insurance Company,Medicare PPO,75,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pbb)",,99212,CPT,Facility,Outpatient,,,,60,51,17.196,60,Medica,Individual & Family,59.46,99.1,,percent of total billed charges,,
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pbb)",,99212,CPT,Professional,Outpatient,,,,75,63.75,23.91,75,Medica,Individual & Family,63.6,84.8,,percent of total billed charges,,
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pbb)",,99212,CPT,Facility,Outpatient,,,,60,51,17.196,60,Medica,Medica Advantage Solution,29.88,49.8,,percent of total billed charges,,
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pbb)",,99212,CPT,Professional,Outpatient,,,,75,63.75,23.91,75,Medica,Medica Advantage Solution,37.35,49.8,,percent of total billed charges,,
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pbb)",,99212,CPT,Facility,Outpatient,,,,60,51,17.196,60,Medica,Medical Assistance,26.76,44.6,,percent of total billed charges,,
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pbb)",,99212,CPT,Professional,Outpatient,,,,75,63.75,23.91,75,Medica,Medical Assistance,25.44,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pbb)",,99212,CPT,Facility,Outpatient,,,,60,51,17.196,60,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,29.88,49.8,,percent of total billed charges,,
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pbb)",,99212,CPT,Professional,Outpatient,,,,75,63.75,23.91,75,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,34.4,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pbb)",,99212,CPT,Facility,Outpatient,,,,60,51,17.196,60,"Multiplan, Inc.","Multiplan, Inc.",56.4,94,,percent of total billed charges,,
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pbb)",,99212,CPT,Professional,Outpatient,,,,75,63.75,23.91,75,"Multiplan, Inc.","Multiplan, Inc.",70.5,94,,percent of total billed charges,,
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pbb)",,99212,CPT,Facility,Outpatient,,,,60,51,17.196,60,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,54.06,90.1,,percent of total billed charges,,
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pbb)",,99212,CPT,Professional,Outpatient,,,,75,63.75,23.91,75,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,67.575,90.1,,percent of total billed charges,,
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pbb)",,99212,CPT,Facility,Outpatient,,,,60,51,17.196,60,"Preferred One Administrative Services, INC.",PPO,59.16,98.6,,percent of total billed charges,,
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pbb)",,99212,CPT,Professional,Outpatient,,,,75,63.75,23.91,75,"Preferred One Administrative Services, INC.",PPO,73.95,98.6,,percent of total billed charges,,
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pbb)",,99212,CPT,Facility,Outpatient,,,,60,51,17.196,60,PrimeWest Health,Minnesota Senior Health Options (MSHO),30.87,51.45,,percent of total billed charges,,
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pbb)",,99212,CPT,Professional,Outpatient,,,,75,63.75,23.91,75,PrimeWest Health,Minnesota Senior Health Options (MSHO),39.56,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pbb)",,99212,CPT,Facility,Outpatient,,,,60,51,17.196,60,PrimeWest Health,MinnesotaCare,30.816,51.36,,percent of total billed charges,,
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pbb)",,99212,CPT,Professional,Outpatient,,,,75,63.75,23.91,75,PrimeWest Health,MinnesotaCare,27.2214848,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pbb)",,99212,CPT,Facility,Outpatient,,,,60,51,17.196,60,Sanford Health Plan,Sanford Health Plan,55.2,92,,percent of total billed charges,,
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pbb)",,99212,CPT,Professional,Outpatient,,,,75,63.75,23.91,75,Sanford Health Plan,Sanford Health Plan,66,88,,percent of total billed charges,,
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pbb)",,99212,CPT,Facility,Outpatient,,,,60,51,17.196,60,"UCare Health, Inc.",Individual & Family Plan,33.81,56.35,,percent of total billed charges,,
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pbb)",,99212,CPT,Professional,Outpatient,,,,75,63.75,23.91,75,"UCare Health, Inc.",Individual & Family Plan,55.92064,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pbb)",,99212,CPT,Facility,Outpatient,,,,60,51,17.196,60,"UCare Health, Inc.",Medical Assistance,30.282,50.47,,percent of total billed charges,,
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pbb)",,99212,CPT,Professional,Outpatient,,,,75,63.75,23.91,75,"UCare Health, Inc.",Medical Assistance,27.984704,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pbb)",,99212,CPT,Facility,Outpatient,,,,60,51,17.196,60,"UCare Health, Inc.",Medicare Advantage,30.282,50.47,,percent of total billed charges,,
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pbb)",,99212,CPT,Professional,Outpatient,,,,75,63.75,23.91,75,"UCare Health, Inc.",Medicare Advantage,39.56,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pbb)",,99212,CPT,Facility,Outpatient,,,,60,51,17.196,60,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),30.282,50.47,,percent of total billed charges,,
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pbb)",,99212,CPT,Professional,Outpatient,,,,75,63.75,23.91,75,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),31.648,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pbb)",,99212,CPT,Facility,Outpatient,,,,60,51,17.196,60,UnitedHealthcare,Individual & Family,56.4,94,,percent of total billed charges,,
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pbb)",,99212,CPT,Professional,Outpatient,,,,75,63.75,23.91,75,UnitedHealthcare,Individual & Family,75,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pbb)",,99212,CPT,Facility,Outpatient,,,,60,51,17.196,60,UnitedHealthcare,Medicare Advantage,29.4,49,,percent of total billed charges,,
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pbb)",,99212,CPT,Professional,Outpatient,,,,75,63.75,23.91,75,UnitedHealthcare,Medicare Advantage,39.56,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pbb)",,99212,CPT,Facility,Outpatient,,,,60,51,17.196,60,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,28.8,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pbb)",,99212,CPT,Professional,Outpatient,,,,75,63.75,23.91,75,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,25.44064,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pro Cah)",,99212,CPT,Professional,Outpatient,,,,155,131.75,23.91,155,Aetna,Commercial,131.75,85,,percent of total billed charges,,
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pro Cah)",,99212,CPT,Professional,Outpatient,,,,135,114.75,23.91,135,Aetna,Commercial,114.75,85,,percent of total billed charges,,
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pro Cah)",,99212,CPT,Professional,Outpatient,,,,185,157.25,23.91,185,Aetna,Commercial,157.25,85,,percent of total billed charges,,
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pro Cah)",,99212,CPT,Professional,Outpatient,,,,155,131.75,23.91,155,Aetna,Medicare Advantage,35.29,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pro Cah)",,99212,CPT,Professional,Outpatient,,,,135,114.75,23.91,135,Aetna,Medicare Advantage,35.29,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pro Cah)",,99212,CPT,Professional,Outpatient,,,,185,157.25,23.91,185,Aetna,Medicare Advantage,35.29,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pro Cah)",,99212,CPT,Professional,Outpatient,,,,155,131.75,23.91,155,Aetna,PPO,144.15,93,,percent of total billed charges,,
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pro Cah)",,99212,CPT,Professional,Outpatient,,,,135,114.75,23.91,135,Aetna,PPO,125.55,93,,percent of total billed charges,,
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pro Cah)",,99212,CPT,Professional,Outpatient,,,,185,157.25,23.91,185,Aetna,PPO,172.05,93,,percent of total billed charges,,
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pro Cah)",,99212,CPT,Professional,Outpatient,,,,155,131.75,23.91,155,America's PPO,America's PPO,132.432,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pro Cah)",,99212,CPT,Professional,Outpatient,,,,135,114.75,23.91,135,America's PPO,America's PPO,115.344,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pro Cah)",,99212,CPT,Professional,Outpatient,,,,185,157.25,23.91,185,America's PPO,America's PPO,158.064,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pro Cah)",,99212,CPT,Professional,Outpatient,,,,155,131.75,23.91,155,BlueCross BlueShield Minnesota, Federal Employee Program,62.83,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pro Cah)",,99212,CPT,Professional,Outpatient,,,,135,114.75,23.91,135,BlueCross BlueShield Minnesota, Federal Employee Program,62.83,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pro Cah)",,99212,CPT,Professional,Outpatient,,,,185,157.25,23.91,185,BlueCross BlueShield Minnesota, Federal Employee Program,62.83,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pro Cah)",,99212,CPT,Professional,Outpatient,,,,155,131.75,23.91,155,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,63.83528,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pro Cah)",,99212,CPT,Professional,Outpatient,,,,135,114.75,23.91,135,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,63.83528,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pro Cah)",,99212,CPT,Professional,Outpatient,,,,185,157.25,23.91,185,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,63.83528,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pro Cah)",,99212,CPT,Professional,Outpatient,,,,155,131.75,23.91,155,BlueCross BlueShield Minnesota,High Value Network Plan,63.83528,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pro Cah)",,99212,CPT,Professional,Outpatient,,,,135,114.75,23.91,135,BlueCross BlueShield Minnesota,High Value Network Plan,63.83528,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pro Cah)",,99212,CPT,Professional,Outpatient,,,,185,157.25,23.91,185,BlueCross BlueShield Minnesota,High Value Network Plan,63.83528,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pro Cah)",,99212,CPT,Professional,Outpatient,,,,155,131.75,23.91,155,BlueCross BlueShield Minnesota,Medicare Advantage,39.56,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pro Cah)",,99212,CPT,Professional,Outpatient,,,,135,114.75,23.91,135,BlueCross BlueShield Minnesota,Medicare Advantage,39.56,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pro Cah)",,99212,CPT,Professional,Outpatient,,,,185,157.25,23.91,185,BlueCross BlueShield Minnesota,Medicare Advantage,39.56,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pro Cah)",,99212,CPT,Professional,Outpatient,,,,155,131.75,23.91,155,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,63.83528,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pro Cah)",,99212,CPT,Professional,Outpatient,,,,135,114.75,23.91,135,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,63.83528,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pro Cah)",,99212,CPT,Professional,Outpatient,,,,185,157.25,23.91,185,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,63.83528,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pro Cah)",,99212,CPT,Professional,Outpatient,,,,155,131.75,23.91,155,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,25.44064,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pro Cah)",,99212,CPT,Professional,Outpatient,,,,135,114.75,23.91,135,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,25.44064,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pro Cah)",,99212,CPT,Professional,Outpatient,,,,185,157.25,23.91,185,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,25.44064,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pro Cah)",,99212,CPT,Professional,Outpatient,,,,155,131.75,23.91,155,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),39.56,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pro Cah)",,99212,CPT,Professional,Outpatient,,,,135,114.75,23.91,135,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),39.56,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pro Cah)",,99212,CPT,Professional,Outpatient,,,,185,157.25,23.91,185,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),39.56,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pro Cah)",,99212,CPT,Professional,Outpatient,,,,155,131.75,23.91,155,CorVel,Worker's Compensation,68.4113016,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pro Cah)",,99212,CPT,Professional,Outpatient,,,,135,114.75,23.91,135,CorVel,Worker's Compensation,68.4113016,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pro Cah)",,99212,CPT,Professional,Outpatient,,,,185,157.25,23.91,185,CorVel,Worker's Compensation,68.4113016,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pro Cah)",,99212,CPT,Professional,Outpatient,,,,155,131.75,23.91,155,First Health Group Corporation,First Health Network,150.35,97,,percent of total billed charges,,
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pro Cah)",,99212,CPT,Professional,Outpatient,,,,135,114.75,23.91,135,First Health Group Corporation,First Health Network,130.95,97,,percent of total billed charges,,
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pro Cah)",,99212,CPT,Professional,Outpatient,,,,185,157.25,23.91,185,First Health Group Corporation,First Health Network,179.45,97,,percent of total billed charges,,
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pro Cah)",,99212,CPT,Professional,Outpatient,,,,155,131.75,23.91,155,"Health Partners, Inc.",Commercial,73.27,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pro Cah)",,99212,CPT,Professional,Outpatient,,,,135,114.75,23.91,135,"Health Partners, Inc.",Commercial,73.27,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pro Cah)",,99212,CPT,Professional,Outpatient,,,,185,157.25,23.91,185,"Health Partners, Inc.",Commercial,73.27,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pro Cah)",,99212,CPT,Professional,Outpatient,,,,155,131.75,23.91,155,"Health Partners, Inc.",Medicare Advantage,39.56,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pro Cah)",,99212,CPT,Professional,Outpatient,,,,135,114.75,23.91,135,"Health Partners, Inc.",Medicare Advantage,39.56,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pro Cah)",,99212,CPT,Professional,Outpatient,,,,185,157.25,23.91,185,"Health Partners, Inc.",Medicare Advantage,39.56,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pro Cah)",,99212,CPT,Professional,Outpatient,,,,155,131.75,23.91,155,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),34.56,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pro Cah)",,99212,CPT,Professional,Outpatient,,,,135,114.75,23.91,135,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),34.56,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pro Cah)",,99212,CPT,Professional,Outpatient,,,,185,157.25,23.91,185,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),34.56,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pro Cah)",,99212,CPT,Professional,Outpatient,,,,155,131.75,23.91,155,"Health Partners, Inc.",State of Minnesota Advantage Program,63.122105,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pro Cah)",,99212,CPT,Professional,Outpatient,,,,135,114.75,23.91,135,"Health Partners, Inc.",State of Minnesota Advantage Program,63.122105,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pro Cah)",,99212,CPT,Professional,Outpatient,,,,185,157.25,23.91,185,"Health Partners, Inc.",State of Minnesota Advantage Program,63.122105,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pro Cah)",,99212,CPT,Professional,Outpatient,,,,155,131.75,23.91,155,"Health Partners, Inc.",State Public Programs,23.91,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pro Cah)",,99212,CPT,Professional,Outpatient,,,,135,114.75,23.91,135,"Health Partners, Inc.",State Public Programs,23.91,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pro Cah)",,99212,CPT,Professional,Outpatient,,,,185,157.25,23.91,185,"Health Partners, Inc.",State Public Programs,23.91,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pro Cah)",,99212,CPT,Professional,Outpatient,,,,155,131.75,23.91,155,Humana Insurance Company,Commercial PPO,34.4,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pro Cah)",,99212,CPT,Professional,Outpatient,,,,135,114.75,23.91,135,Humana Insurance Company,Commercial PPO,34.4,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pro Cah)",,99212,CPT,Professional,Outpatient,,,,185,157.25,23.91,185,Humana Insurance Company,Commercial PPO,34.4,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pro Cah)",,99212,CPT,Professional,Outpatient,,,,155,131.75,23.91,155,Humana Insurance Company,Medicare PPO,155,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pro Cah)",,99212,CPT,Professional,Outpatient,,,,135,114.75,23.91,135,Humana Insurance Company,Medicare PPO,135,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pro Cah)",,99212,CPT,Professional,Outpatient,,,,185,157.25,23.91,185,Humana Insurance Company,Medicare PPO,185,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pro Cah)",,99212,CPT,Professional,Outpatient,,,,155,131.75,23.91,155,Medica,Individual & Family,131.44,84.8,,percent of total billed charges,,
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pro Cah)",,99212,CPT,Professional,Outpatient,,,,135,114.75,23.91,135,Medica,Individual & Family,114.48,84.8,,percent of total billed charges,,
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pro Cah)",,99212,CPT,Professional,Outpatient,,,,185,157.25,23.91,185,Medica,Individual & Family,156.88,84.8,,percent of total billed charges,,
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pro Cah)",,99212,CPT,Professional,Outpatient,,,,155,131.75,23.91,155,Medica,Medica Advantage Solution,77.19,49.8,,percent of total billed charges,,
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pro Cah)",,99212,CPT,Professional,Outpatient,,,,135,114.75,23.91,135,Medica,Medica Advantage Solution,67.23,49.8,,percent of total billed charges,,
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pro Cah)",,99212,CPT,Professional,Outpatient,,,,185,157.25,23.91,185,Medica,Medica Advantage Solution,92.13,49.8,,percent of total billed charges,,
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pro Cah)",,99212,CPT,Professional,Outpatient,,,,155,131.75,23.91,155,Medica,Medical Assistance,25.44,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pro Cah)",,99212,CPT,Professional,Outpatient,,,,135,114.75,23.91,135,Medica,Medical Assistance,25.44,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pro Cah)",,99212,CPT,Professional,Outpatient,,,,185,157.25,23.91,185,Medica,Medical Assistance,25.44,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pro Cah)",,99212,CPT,Professional,Outpatient,,,,155,131.75,23.91,155,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,34.4,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pro Cah)",,99212,CPT,Professional,Outpatient,,,,135,114.75,23.91,135,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,34.4,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pro Cah)",,99212,CPT,Professional,Outpatient,,,,185,157.25,23.91,185,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,34.4,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pro Cah)",,99212,CPT,Professional,Outpatient,,,,155,131.75,23.91,155,"Multiplan, Inc.","Multiplan, Inc.",145.7,94,,percent of total billed charges,,
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pro Cah)",,99212,CPT,Professional,Outpatient,,,,135,114.75,23.91,135,"Multiplan, Inc.","Multiplan, Inc.",126.9,94,,percent of total billed charges,,
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pro Cah)",,99212,CPT,Professional,Outpatient,,,,185,157.25,23.91,185,"Multiplan, Inc.","Multiplan, Inc.",173.9,94,,percent of total billed charges,,
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pro Cah)",,99212,CPT,Professional,Outpatient,,,,155,131.75,23.91,155,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,139.655,90.1,,percent of total billed charges,,
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pro Cah)",,99212,CPT,Professional,Outpatient,,,,135,114.75,23.91,135,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,121.635,90.1,,percent of total billed charges,,
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pro Cah)",,99212,CPT,Professional,Outpatient,,,,185,157.25,23.91,185,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,166.685,90.1,,percent of total billed charges,,
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pro Cah)",,99212,CPT,Professional,Outpatient,,,,155,131.75,23.91,155,"Preferred One Administrative Services, INC.",PPO,152.83,98.6,,percent of total billed charges,,
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pro Cah)",,99212,CPT,Professional,Outpatient,,,,135,114.75,23.91,135,"Preferred One Administrative Services, INC.",PPO,133.11,98.6,,percent of total billed charges,,
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pro Cah)",,99212,CPT,Professional,Outpatient,,,,185,157.25,23.91,185,"Preferred One Administrative Services, INC.",PPO,182.41,98.6,,percent of total billed charges,,
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pro Cah)",,99212,CPT,Professional,Outpatient,,,,155,131.75,23.91,155,PrimeWest Health,Minnesota Senior Health Options (MSHO),39.56,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pro Cah)",,99212,CPT,Professional,Outpatient,,,,135,114.75,23.91,135,PrimeWest Health,Minnesota Senior Health Options (MSHO),39.56,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pro Cah)",,99212,CPT,Professional,Outpatient,,,,185,157.25,23.91,185,PrimeWest Health,Minnesota Senior Health Options (MSHO),39.56,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pro Cah)",,99212,CPT,Professional,Outpatient,,,,155,131.75,23.91,155,PrimeWest Health,MinnesotaCare,27.2214848,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pro Cah)",,99212,CPT,Professional,Outpatient,,,,135,114.75,23.91,135,PrimeWest Health,MinnesotaCare,27.2214848,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pro Cah)",,99212,CPT,Professional,Outpatient,,,,185,157.25,23.91,185,PrimeWest Health,MinnesotaCare,27.2214848,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pro Cah)",,99212,CPT,Professional,Outpatient,,,,155,131.75,23.91,155,Sanford Health Plan,Sanford Health Plan,136.4,88,,percent of total billed charges,,
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pro Cah)",,99212,CPT,Professional,Outpatient,,,,135,114.75,23.91,135,Sanford Health Plan,Sanford Health Plan,118.8,88,,percent of total billed charges,,
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pro Cah)",,99212,CPT,Professional,Outpatient,,,,185,157.25,23.91,185,Sanford Health Plan,Sanford Health Plan,162.8,88,,percent of total billed charges,,
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pro Cah)",,99212,CPT,Professional,Outpatient,,,,155,131.75,23.91,155,"UCare Health, Inc.",Individual & Family Plan,55.92064,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pro Cah)",,99212,CPT,Professional,Outpatient,,,,135,114.75,23.91,135,"UCare Health, Inc.",Individual & Family Plan,55.92064,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pro Cah)",,99212,CPT,Professional,Outpatient,,,,185,157.25,23.91,185,"UCare Health, Inc.",Individual & Family Plan,55.92064,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pro Cah)",,99212,CPT,Professional,Outpatient,,,,155,131.75,23.91,155,"UCare Health, Inc.",Medical Assistance,27.984704,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pro Cah)",,99212,CPT,Professional,Outpatient,,,,135,114.75,23.91,135,"UCare Health, Inc.",Medical Assistance,27.984704,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pro Cah)",,99212,CPT,Professional,Outpatient,,,,185,157.25,23.91,185,"UCare Health, Inc.",Medical Assistance,27.984704,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pro Cah)",,99212,CPT,Professional,Outpatient,,,,155,131.75,23.91,155,"UCare Health, Inc.",Medicare Advantage,39.56,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pro Cah)",,99212,CPT,Professional,Outpatient,,,,135,114.75,23.91,135,"UCare Health, Inc.",Medicare Advantage,39.56,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pro Cah)",,99212,CPT,Professional,Outpatient,,,,185,157.25,23.91,185,"UCare Health, Inc.",Medicare Advantage,39.56,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pro Cah)",,99212,CPT,Professional,Outpatient,,,,155,131.75,23.91,155,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),31.648,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pro Cah)",,99212,CPT,Professional,Outpatient,,,,135,114.75,23.91,135,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),31.648,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pro Cah)",,99212,CPT,Professional,Outpatient,,,,185,157.25,23.91,185,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),31.648,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pro Cah)",,99212,CPT,Professional,Outpatient,,,,155,131.75,23.91,155,UnitedHealthcare,Individual & Family,155,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pro Cah)",,99212,CPT,Professional,Outpatient,,,,135,114.75,23.91,135,UnitedHealthcare,Individual & Family,135,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pro Cah)",,99212,CPT,Professional,Outpatient,,,,185,157.25,23.91,185,UnitedHealthcare,Individual & Family,185,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pro Cah)",,99212,CPT,Professional,Outpatient,,,,155,131.75,23.91,155,UnitedHealthcare,Medicare Advantage,39.56,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pro Cah)",,99212,CPT,Professional,Outpatient,,,,135,114.75,23.91,135,UnitedHealthcare,Medicare Advantage,39.56,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pro Cah)",,99212,CPT,Professional,Outpatient,,,,185,157.25,23.91,185,UnitedHealthcare,Medicare Advantage,39.56,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pro Cah)",,99212,CPT,Professional,Outpatient,,,,155,131.75,23.91,155,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,25.44064,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pro Cah)",,99212,CPT,Professional,Outpatient,,,,135,114.75,23.91,135,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,25.44064,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pro Cah)",,99212,CPT,Professional,Outpatient,,,,185,157.25,23.91,185,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,25.44064,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Clinical Nursing Level 3 (Ep),,99213,CPT,Facility,Both,,,,210,178.5,60.186,210,Aetna,Commercial,193.2,92,,percent of total billed charges,,
Clinical Nursing Level 3 (Ep),,99213,CPT,Facility,Outpatient,,,,210,178.5,60.186,210,Aetna,Medicare Advantage,102.9,49,,percent of total billed charges,,
Clinical Nursing Level 3 (Ep),,99213,CPT,Facility,Inpatient,,,,210,178.5,60.186,210,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Clinical Nursing Level 3 (Ep),,99213,CPT,Facility,Both,,,,210,178.5,60.186,210,Aetna,PPO,195.3,93,,percent of total billed charges,,
Clinical Nursing Level 3 (Ep),,99213,CPT,Facility,Both,,,,210,178.5,60.186,210,America's PPO,America's PPO,201.663,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Clinical Nursing Level 3 (Ep),,99213,CPT,Facility,Both,,,,210,178.5,60.186,210,BlueCross BlueShield Minnesota, Federal Employee Program,206.64,98.4,,percent of total billed charges,,
Clinical Nursing Level 3 (Ep),,99213,CPT,Facility,Both,,,,210,178.5,60.186,210,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,210,100,,percent of total billed charges,,
Clinical Nursing Level 3 (Ep),,99213,CPT,Facility,Both,,,,210,178.5,60.186,210,BlueCross BlueShield Minnesota,High Value Network Plan,189,90,,percent of total billed charges,,
Clinical Nursing Level 3 (Ep),,99213,CPT,Facility,Outpatient,,,,210,178.5,60.186,210,BlueCross BlueShield Minnesota,Medicare Advantage,102.9,49,,percent of total billed charges,,
Clinical Nursing Level 3 (Ep),,99213,CPT,Facility,Inpatient,,,,210,178.5,60.186,210,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Clinical Nursing Level 3 (Ep),,99213,CPT,Facility,Both,,,,210,178.5,60.186,210,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,185.997,88.57,,percent of total billed charges,,
Clinical Nursing Level 3 (Ep),,99213,CPT,Facility,Both,,,,210,178.5,60.186,210,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,60.186,28.66,,percent of total billed charges,,
Clinical Nursing Level 3 (Ep),,99213,CPT,Facility,Outpatient,,,,210,178.5,60.186,210,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),102.9,49,,percent of total billed charges,,
Clinical Nursing Level 3 (Ep),,99213,CPT,Facility,Inpatient,,,,210,178.5,60.186,210,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Clinical Nursing Level 3 (Ep),,99213,CPT,Facility,Both,,,,210,178.5,60.186,210,CorVel,Worker's Compensation,210,100,,percent of total billed charges,,
Clinical Nursing Level 3 (Ep),,99213,CPT,Facility,Both,,,,210,178.5,60.186,210,First Health Group Corporation,First Health Network,203.7,97,,percent of total billed charges,,
Clinical Nursing Level 3 (Ep),,99213,CPT,Facility,Both,,,,210,178.5,60.186,210,"Health Partners, Inc.",Commercial,198.66,94.6,,percent of total billed charges,,
Clinical Nursing Level 3 (Ep),,99213,CPT,Facility,Outpatient,,,,210,178.5,60.186,210,"Health Partners, Inc.",Medicare Advantage,102.9,49,,percent of total billed charges,,
Clinical Nursing Level 3 (Ep),,99213,CPT,Facility,Inpatient,,,,210,178.5,60.186,210,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Clinical Nursing Level 3 (Ep),,99213,CPT,Facility,Both,,,,210,178.5,60.186,210,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),126,60,,percent of total billed charges,,
Clinical Nursing Level 3 (Ep),,99213,CPT,Facility,Both,,,,210,178.5,60.186,210,"Health Partners, Inc.",State of Minnesota Advantage Program,171.15,81.5,,percent of total billed charges,,
Clinical Nursing Level 3 (Ep),,99213,CPT,Facility,Both,,,,210,178.5,60.186,210,"Health Partners, Inc.",State Public Programs,105,50,,percent of total billed charges,,
Clinical Nursing Level 3 (Ep),,99213,CPT,Facility,Both,,,,210,178.5,60.186,210,Humana Insurance Company,Commercial PPO,199.5,95,,percent of total billed charges,,
Clinical Nursing Level 3 (Ep),,99213,CPT,Facility,Outpatient,,,,210,178.5,60.186,210,Humana Insurance Company,Medicare PPO,102.9,49,,percent of total billed charges,,
Clinical Nursing Level 3 (Ep),,99213,CPT,Facility,Inpatient,,,,210,178.5,60.186,210,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Clinical Nursing Level 3 (Ep),,99213,CPT,Facility,Both,,,,210,178.5,60.186,210,Medica,Individual & Family,208.11,99.1,,percent of total billed charges,,
Clinical Nursing Level 3 (Ep),,99213,CPT,Facility,Outpatient,,,,210,178.5,60.186,210,Medica,Medica Advantage Solution,104.58,49.8,,percent of total billed charges,,
Clinical Nursing Level 3 (Ep),,99213,CPT,Facility,Inpatient,,,,210,178.5,60.186,210,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Clinical Nursing Level 3 (Ep),,99213,CPT,Facility,Outpatient,,,,210,178.5,60.186,210,Medica,Medical Assistance,93.66,44.6,,percent of total billed charges,,
Clinical Nursing Level 3 (Ep),,99213,CPT,Facility,Inpatient,,,,210,178.5,60.186,210,Medica,Medical Assistance,,,,,Included in per diem rate,
Clinical Nursing Level 3 (Ep),,99213,CPT,Facility,Outpatient,,,,210,178.5,60.186,210,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,104.58,49.8,,percent of total billed charges,,
Clinical Nursing Level 3 (Ep),,99213,CPT,Facility,Inpatient,,,,210,178.5,60.186,210,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Clinical Nursing Level 3 (Ep),,99213,CPT,Facility,Both,,,,210,178.5,60.186,210,"Multiplan, Inc.","Multiplan, Inc.",197.4,94,,percent of total billed charges,,
Clinical Nursing Level 3 (Ep),,99213,CPT,Facility,Outpatient,,,,210,178.5,60.186,210,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,189.21,90.1,,percent of total billed charges,,
Clinical Nursing Level 3 (Ep),,99213,CPT,Facility,Inpatient,,,,210,178.5,60.186,210,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Clinical Nursing Level 3 (Ep),,99213,CPT,Facility,Both,,,,210,178.5,60.186,210,"Preferred One Administrative Services, INC.",PPO,207.06,98.6,,percent of total billed charges,,
Clinical Nursing Level 3 (Ep),,99213,CPT,Facility,Outpatient,,,,210,178.5,60.186,210,PrimeWest Health,Minnesota Senior Health Options (MSHO),108.045,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Clinical Nursing Level 3 (Ep),,99213,CPT,Facility,Inpatient,,,,210,178.5,60.186,210,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Clinical Nursing Level 3 (Ep),,99213,CPT,Facility,Outpatient,,,,210,178.5,60.186,210,PrimeWest Health,MinnesotaCare,107.856,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Clinical Nursing Level 3 (Ep),,99213,CPT,Facility,Inpatient,,,,210,178.5,60.186,210,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Clinical Nursing Level 3 (Ep),,99213,CPT,Facility,Both,,,,210,178.5,60.186,210,Sanford Health Plan,Sanford Health Plan,193.2,92,,percent of total billed charges,,
Clinical Nursing Level 3 (Ep),,99213,CPT,Facility,Outpatient,,,,210,178.5,60.186,210,"UCare Health, Inc.",Individual & Family Plan,118.335,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Clinical Nursing Level 3 (Ep),,99213,CPT,Facility,Inpatient,,,,210,178.5,60.186,210,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Clinical Nursing Level 3 (Ep),,99213,CPT,Facility,Outpatient,,,,210,178.5,60.186,210,"UCare Health, Inc.",Medical Assistance,105.987,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Clinical Nursing Level 3 (Ep),,99213,CPT,Facility,Inpatient,,,,210,178.5,60.186,210,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Clinical Nursing Level 3 (Ep),,99213,CPT,Facility,Outpatient,,,,210,178.5,60.186,210,"UCare Health, Inc.",Medicare Advantage,105.987,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Clinical Nursing Level 3 (Ep),,99213,CPT,Facility,Inpatient,,,,210,178.5,60.186,210,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Clinical Nursing Level 3 (Ep),,99213,CPT,Facility,Outpatient,,,,210,178.5,60.186,210,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),105.987,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Clinical Nursing Level 3 (Ep),,99213,CPT,Facility,Inpatient,,,,210,178.5,60.186,210,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Clinical Nursing Level 3 (Ep),,99213,CPT,Facility,Both,,,,210,178.5,60.186,210,UnitedHealthcare,Individual & Family,197.4,94,,percent of total billed charges,,
Clinical Nursing Level 3 (Ep),,99213,CPT,Facility,Outpatient,,,,210,178.5,60.186,210,UnitedHealthcare,Medicare Advantage,102.9,49,,percent of total billed charges,,
Clinical Nursing Level 3 (Ep),,99213,CPT,Facility,Inpatient,,,,210,178.5,60.186,210,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Clinical Nursing Level 3 (Ep),,99213,CPT,Facility,Outpatient,,,,210,178.5,60.186,210,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,100.8,48,,percent of total billed charges,,100% of DHS outpatient percentage
Clinical Nursing Level 3 (Ep),,99213,CPT,Facility,Inpatient,,,,210,178.5,60.186,210,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time",,99213,CPT,Facility,Outpatient,,,,85,72.25,24.361,85,Aetna,Commercial,78.2,92,,percent of total billed charges,,
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time",,99213,CPT,Facility,Outpatient,,,,85,72.25,24.361,85,Aetna,Medicare Advantage,41.65,49,,percent of total billed charges,,
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time",,99213,CPT,Facility,Outpatient,,,,85,72.25,24.361,85,Aetna,PPO,79.05,93,,percent of total billed charges,,
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time",,99213,CPT,Facility,Outpatient,,,,85,72.25,24.361,85,America's PPO,America's PPO,81.6255,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time",,99213,CPT,Facility,Outpatient,,,,85,72.25,24.361,85,BlueCross BlueShield Minnesota, Federal Employee Program,83.64,98.4,,percent of total billed charges,,
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time",,99213,CPT,Facility,Outpatient,,,,85,72.25,24.361,85,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,85,100,,percent of total billed charges,,
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time",,99213,CPT,Facility,Outpatient,,,,85,72.25,24.361,85,BlueCross BlueShield Minnesota,High Value Network Plan,76.5,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time",,99213,CPT,Facility,Outpatient,,,,85,72.25,24.361,85,BlueCross BlueShield Minnesota,Medicare Advantage,41.65,49,,percent of total billed charges,,
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time",,99213,CPT,Facility,Outpatient,,,,85,72.25,24.361,85,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,24.361,28.66,,percent of total billed charges,,
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time",,99213,CPT,Facility,Outpatient,,,,85,72.25,24.361,85,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),41.65,49,,percent of total billed charges,,
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time",,99213,CPT,Facility,Outpatient,,,,85,72.25,24.361,85,CorVel,Worker's Compensation,85,100,,percent of total billed charges,,
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time",,99213,CPT,Facility,Outpatient,,,,85,72.25,24.361,85,First Health Group Corporation,First Health Network,82.45,97,,percent of total billed charges,,
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time",,99213,CPT,Facility,Outpatient,,,,85,72.25,24.361,85,"Health Partners, Inc.",Commercial,80.41,94.6,,percent of total billed charges,,
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time",,99213,CPT,Facility,Outpatient,,,,85,72.25,24.361,85,"Health Partners, Inc.",Medicare Advantage,41.65,49,,percent of total billed charges,,
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time",,99213,CPT,Facility,Outpatient,,,,85,72.25,24.361,85,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),51,60,,percent of total billed charges,,
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time",,99213,CPT,Facility,Outpatient,,,,85,72.25,24.361,85,"Health Partners, Inc.",State of Minnesota Advantage Program,69.275,81.5,,percent of total billed charges,,
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time",,99213,CPT,Facility,Outpatient,,,,85,72.25,24.361,85,"Health Partners, Inc.",State Public Programs,42.5,50,,percent of total billed charges,,
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time",,99213,CPT,Facility,Outpatient,,,,85,72.25,24.361,85,Humana Insurance Company,Commercial PPO,80.75,95,,percent of total billed charges,,
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time",,99213,CPT,Facility,Outpatient,,,,85,72.25,24.361,85,Humana Insurance Company,Medicare PPO,41.65,49,,percent of total billed charges,,
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time",,99213,CPT,Facility,Outpatient,,,,85,72.25,24.361,85,Medica,Individual & Family,84.235,99.1,,percent of total billed charges,,
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time",,99213,CPT,Facility,Outpatient,,,,85,72.25,24.361,85,Medica,Medica Advantage Solution,42.33,49.8,,percent of total billed charges,,
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time",,99213,CPT,Facility,Outpatient,,,,85,72.25,24.361,85,Medica,Medical Assistance,37.91,44.6,,percent of total billed charges,,
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time",,99213,CPT,Facility,Outpatient,,,,85,72.25,24.361,85,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,42.33,49.8,,percent of total billed charges,,
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time",,99213,CPT,Facility,Outpatient,,,,85,72.25,24.361,85,"Multiplan, Inc.","Multiplan, Inc.",79.9,94,,percent of total billed charges,,
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time",,99213,CPT,Facility,Outpatient,,,,85,72.25,24.361,85,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,76.585,90.1,,percent of total billed charges,,
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time",,99213,CPT,Facility,Outpatient,,,,85,72.25,24.361,85,"Preferred One Administrative Services, INC.",PPO,83.81,98.6,,percent of total billed charges,,
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time",,99213,CPT,Facility,Outpatient,,,,85,72.25,24.361,85,PrimeWest Health,Minnesota Senior Health Options (MSHO),43.7325,51.45,,percent of total billed charges,,
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time",,99213,CPT,Facility,Outpatient,,,,85,72.25,24.361,85,PrimeWest Health,MinnesotaCare,43.656,51.36,,percent of total billed charges,,
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time",,99213,CPT,Facility,Outpatient,,,,85,72.25,24.361,85,Sanford Health Plan,Sanford Health Plan,78.2,92,,percent of total billed charges,,
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time",,99213,CPT,Facility,Outpatient,,,,85,72.25,24.361,85,"UCare Health, Inc.",Individual & Family Plan,47.8975,56.35,,percent of total billed charges,,
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time",,99213,CPT,Facility,Outpatient,,,,85,72.25,24.361,85,"UCare Health, Inc.",Medical Assistance,42.8995,50.47,,percent of total billed charges,,
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time",,99213,CPT,Facility,Outpatient,,,,85,72.25,24.361,85,"UCare Health, Inc.",Medicare Advantage,42.8995,50.47,,percent of total billed charges,,
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time",,99213,CPT,Facility,Outpatient,,,,85,72.25,24.361,85,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),42.8995,50.47,,percent of total billed charges,,
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time",,99213,CPT,Facility,Outpatient,,,,85,72.25,24.361,85,UnitedHealthcare,Individual & Family,79.9,94,,percent of total billed charges,,
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time",,99213,CPT,Facility,Outpatient,,,,85,72.25,24.361,85,UnitedHealthcare,Medicare Advantage,41.65,49,,percent of total billed charges,,
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time",,99213,CPT,Facility,Outpatient,,,,85,72.25,24.361,85,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,40.8,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pbb)",,99213,CPT,Facility,Outpatient,,,,80,68,22.928,80,Aetna,Commercial,73.6,92,,percent of total billed charges,,
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pbb)",,99213,CPT,Professional,Outpatient,,,,130,110.5,44.76,130,Aetna,Commercial,110.5,85,,percent of total billed charges,,
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pbb)",,99213,CPT,Facility,Outpatient,,,,80,68,22.928,80,Aetna,Medicare Advantage,39.2,49,,percent of total billed charges,,
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pbb)",,99213,CPT,Professional,Outpatient,,,,130,110.5,44.76,130,Aetna,Medicare Advantage,66.03,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pbb)",,99213,CPT,Facility,Outpatient,,,,80,68,22.928,80,Aetna,PPO,74.4,93,,percent of total billed charges,,
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pbb)",,99213,CPT,Professional,Outpatient,,,,130,110.5,44.76,130,Aetna,PPO,120.9,93,,percent of total billed charges,,
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pbb)",,99213,CPT,Facility,Outpatient,,,,80,68,22.928,80,America's PPO,America's PPO,76.824,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pbb)",,99213,CPT,Professional,Outpatient,,,,130,110.5,44.76,130,America's PPO,America's PPO,111.072,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pbb)",,99213,CPT,Facility,Outpatient,,,,80,68,22.928,80,BlueCross BlueShield Minnesota, Federal Employee Program,78.72,98.4,,percent of total billed charges,,
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pbb)",,99213,CPT,Professional,Outpatient,,,,130,110.5,44.76,130,BlueCross BlueShield Minnesota, Federal Employee Program,116.69,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pbb)",,99213,CPT,Facility,Outpatient,,,,80,68,22.928,80,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,80,100,,percent of total billed charges,,
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pbb)",,99213,CPT,Professional,Outpatient,,,,130,110.5,44.76,130,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,118.55704,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pbb)",,99213,CPT,Facility,Outpatient,,,,80,68,22.928,80,BlueCross BlueShield Minnesota,High Value Network Plan,72,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pbb)",,99213,CPT,Professional,Outpatient,,,,130,110.5,44.76,130,BlueCross BlueShield Minnesota,High Value Network Plan,118.55704,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pbb)",,99213,CPT,Facility,Outpatient,,,,80,68,22.928,80,BlueCross BlueShield Minnesota,Medicare Advantage,39.2,49,,percent of total billed charges,,
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pbb)",,99213,CPT,Professional,Outpatient,,,,130,110.5,44.76,130,BlueCross BlueShield Minnesota,Medicare Advantage,73.7725,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pbb)",,99213,CPT,Professional,Outpatient,,,,130,110.5,44.76,130,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,118.55704,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pbb)",,99213,CPT,Facility,Outpatient,,,,80,68,22.928,80,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,22.928,28.66,,percent of total billed charges,,
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pbb)",,99213,CPT,Professional,Outpatient,,,,130,110.5,44.76,130,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,47.61992,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pbb)",,99213,CPT,Facility,Outpatient,,,,80,68,22.928,80,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),39.2,49,,percent of total billed charges,,
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pbb)",,99213,CPT,Professional,Outpatient,,,,130,110.5,44.76,130,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),73.7725,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pbb)",,99213,CPT,Facility,Outpatient,,,,80,68,22.928,80,CorVel,Worker's Compensation,80,100,,percent of total billed charges,,
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pbb)",,99213,CPT,Professional,Outpatient,,,,130,110.5,44.76,130,CorVel,Worker's Compensation,127.1158665,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pbb)",,99213,CPT,Facility,Outpatient,,,,80,68,22.928,80,First Health Group Corporation,First Health Network,77.6,97,,percent of total billed charges,,
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pbb)",,99213,CPT,Professional,Outpatient,,,,130,110.5,44.76,130,First Health Group Corporation,First Health Network,126.1,97,,percent of total billed charges,,
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pbb)",,99213,CPT,Facility,Outpatient,,,,80,68,22.928,80,"Health Partners, Inc.",Commercial,75.68,94.6,,percent of total billed charges,,
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pbb)",,99213,CPT,Professional,Outpatient,,,,130,110.5,44.76,130,"Health Partners, Inc.",Commercial,130,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pbb)",,99213,CPT,Facility,Outpatient,,,,80,68,22.928,80,"Health Partners, Inc.",Medicare Advantage,39.2,49,,percent of total billed charges,,
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pbb)",,99213,CPT,Professional,Outpatient,,,,130,110.5,44.76,130,"Health Partners, Inc.",Medicare Advantage,73.7725,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pbb)",,99213,CPT,Facility,Outpatient,,,,80,68,22.928,80,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),48,60,,percent of total billed charges,,
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pbb)",,99213,CPT,Professional,Outpatient,,,,130,110.5,44.76,130,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),64.05,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pbb)",,99213,CPT,Facility,Outpatient,,,,80,68,22.928,80,"Health Partners, Inc.",State of Minnesota Advantage Program,65.2,81.5,,percent of total billed charges,,
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pbb)",,99213,CPT,Professional,Outpatient,,,,130,110.5,44.76,130,"Health Partners, Inc.",State of Minnesota Advantage Program,118.757775,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pbb)",,99213,CPT,Facility,Outpatient,,,,80,68,22.928,80,"Health Partners, Inc.",State Public Programs,40,50,,percent of total billed charges,,
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pbb)",,99213,CPT,Professional,Outpatient,,,,130,110.5,44.76,130,"Health Partners, Inc.",State Public Programs,44.76,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pbb)",,99213,CPT,Facility,Outpatient,,,,80,68,22.928,80,Humana Insurance Company,Commercial PPO,76,95,,percent of total billed charges,,
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pbb)",,99213,CPT,Professional,Outpatient,,,,130,110.5,44.76,130,Humana Insurance Company,Commercial PPO,64.15,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pbb)",,99213,CPT,Facility,Outpatient,,,,80,68,22.928,80,Humana Insurance Company,Medicare PPO,39.2,49,,percent of total billed charges,,
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pbb)",,99213,CPT,Professional,Outpatient,,,,130,110.5,44.76,130,Humana Insurance Company,Medicare PPO,130,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pbb)",,99213,CPT,Facility,Outpatient,,,,80,68,22.928,80,Medica,Individual & Family,79.28,99.1,,percent of total billed charges,,
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pbb)",,99213,CPT,Professional,Outpatient,,,,130,110.5,44.76,130,Medica,Individual & Family,110.24,84.8,,percent of total billed charges,,
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pbb)",,99213,CPT,Facility,Outpatient,,,,80,68,22.928,80,Medica,Medica Advantage Solution,39.84,49.8,,percent of total billed charges,,
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pbb)",,99213,CPT,Professional,Outpatient,,,,130,110.5,44.76,130,Medica,Medica Advantage Solution,64.74,49.8,,percent of total billed charges,,
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pbb)",,99213,CPT,Facility,Outpatient,,,,80,68,22.928,80,Medica,Medical Assistance,35.68,44.6,,percent of total billed charges,,
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pbb)",,99213,CPT,Professional,Outpatient,,,,130,110.5,44.76,130,Medica,Medical Assistance,47.62,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pbb)",,99213,CPT,Facility,Outpatient,,,,80,68,22.928,80,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,39.84,49.8,,percent of total billed charges,,
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pbb)",,99213,CPT,Professional,Outpatient,,,,130,110.5,44.76,130,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,64.15,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pbb)",,99213,CPT,Facility,Outpatient,,,,80,68,22.928,80,"Multiplan, Inc.","Multiplan, Inc.",75.2,94,,percent of total billed charges,,
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pbb)",,99213,CPT,Professional,Outpatient,,,,130,110.5,44.76,130,"Multiplan, Inc.","Multiplan, Inc.",122.2,94,,percent of total billed charges,,
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pbb)",,99213,CPT,Facility,Outpatient,,,,80,68,22.928,80,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,72.08,90.1,,percent of total billed charges,,
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pbb)",,99213,CPT,Professional,Outpatient,,,,130,110.5,44.76,130,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,117.13,90.1,,percent of total billed charges,,
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pbb)",,99213,CPT,Facility,Outpatient,,,,80,68,22.928,80,"Preferred One Administrative Services, INC.",PPO,78.88,98.6,,percent of total billed charges,,
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pbb)",,99213,CPT,Professional,Outpatient,,,,130,110.5,44.76,130,"Preferred One Administrative Services, INC.",PPO,128.18,98.6,,percent of total billed charges,,
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pbb)",,99213,CPT,Facility,Outpatient,,,,80,68,22.928,80,PrimeWest Health,Minnesota Senior Health Options (MSHO),41.16,51.45,,percent of total billed charges,,
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pbb)",,99213,CPT,Professional,Outpatient,,,,130,110.5,44.76,130,PrimeWest Health,Minnesota Senior Health Options (MSHO),73.7725,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pbb)",,99213,CPT,Facility,Outpatient,,,,80,68,22.928,80,PrimeWest Health,MinnesotaCare,41.088,51.36,,percent of total billed charges,,
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pbb)",,99213,CPT,Professional,Outpatient,,,,130,110.5,44.76,130,PrimeWest Health,MinnesotaCare,50.9533144,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pbb)",,99213,CPT,Facility,Outpatient,,,,80,68,22.928,80,Sanford Health Plan,Sanford Health Plan,73.6,92,,percent of total billed charges,,
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pbb)",,99213,CPT,Professional,Outpatient,,,,130,110.5,44.76,130,Sanford Health Plan,Sanford Health Plan,114.4,88,,percent of total billed charges,,
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pbb)",,99213,CPT,Facility,Outpatient,,,,80,68,22.928,80,"UCare Health, Inc.",Individual & Family Plan,45.08,56.35,,percent of total billed charges,,
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pbb)",,99213,CPT,Professional,Outpatient,,,,130,110.5,44.76,130,"UCare Health, Inc.",Individual & Family Plan,104.28224,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pbb)",,99213,CPT,Facility,Outpatient,,,,80,68,22.928,80,"UCare Health, Inc.",Medical Assistance,40.376,50.47,,percent of total billed charges,,
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pbb)",,99213,CPT,Professional,Outpatient,,,,130,110.5,44.76,130,"UCare Health, Inc.",Medical Assistance,52.381912,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pbb)",,99213,CPT,Facility,Outpatient,,,,80,68,22.928,80,"UCare Health, Inc.",Medicare Advantage,40.376,50.47,,percent of total billed charges,,
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pbb)",,99213,CPT,Professional,Outpatient,,,,130,110.5,44.76,130,"UCare Health, Inc.",Medicare Advantage,73.7725,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pbb)",,99213,CPT,Facility,Outpatient,,,,80,68,22.928,80,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),40.376,50.47,,percent of total billed charges,,
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pbb)",,99213,CPT,Professional,Outpatient,,,,130,110.5,44.76,130,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),59.018,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pbb)",,99213,CPT,Facility,Outpatient,,,,80,68,22.928,80,UnitedHealthcare,Individual & Family,75.2,94,,percent of total billed charges,,
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pbb)",,99213,CPT,Professional,Outpatient,,,,130,110.5,44.76,130,UnitedHealthcare,Individual & Family,130,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pbb)",,99213,CPT,Facility,Outpatient,,,,80,68,22.928,80,UnitedHealthcare,Medicare Advantage,39.2,49,,percent of total billed charges,,
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pbb)",,99213,CPT,Professional,Outpatient,,,,130,110.5,44.76,130,UnitedHealthcare,Medicare Advantage,73.7725,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pbb)",,99213,CPT,Facility,Outpatient,,,,80,68,22.928,80,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,38.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pbb)",,99213,CPT,Professional,Outpatient,,,,130,110.5,44.76,130,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,47.61992,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pro Cah)",,99213,CPT,Professional,Outpatient,,,,205,174.25,44.76,205,Aetna,Commercial,174.25,85,,percent of total billed charges,,
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pro Cah)",,99213,CPT,Professional,Outpatient,,,,210,178.5,44.76,210,Aetna,Commercial,178.5,85,,percent of total billed charges,,
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pro Cah)",,99213,CPT,Professional,Outpatient,,,,260,221,44.76,260,Aetna,Commercial,221,85,,percent of total billed charges,,
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pro Cah)",,99213,CPT,Professional,Outpatient,,,,205,174.25,44.76,205,Aetna,Medicare Advantage,66.03,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pro Cah)",,99213,CPT,Professional,Outpatient,,,,210,178.5,44.76,210,Aetna,Medicare Advantage,66.03,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pro Cah)",,99213,CPT,Professional,Outpatient,,,,260,221,44.76,260,Aetna,Medicare Advantage,66.03,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pro Cah)",,99213,CPT,Professional,Outpatient,,,,205,174.25,44.76,205,Aetna,PPO,190.65,93,,percent of total billed charges,,
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pro Cah)",,99213,CPT,Professional,Outpatient,,,,210,178.5,44.76,210,Aetna,PPO,195.3,93,,percent of total billed charges,,
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pro Cah)",,99213,CPT,Professional,Outpatient,,,,260,221,44.76,260,Aetna,PPO,241.8,93,,percent of total billed charges,,
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pro Cah)",,99213,CPT,Professional,Outpatient,,,,205,174.25,44.76,205,America's PPO,America's PPO,175.152,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pro Cah)",,99213,CPT,Professional,Outpatient,,,,210,178.5,44.76,210,America's PPO,America's PPO,179.424,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pro Cah)",,99213,CPT,Professional,Outpatient,,,,260,221,44.76,260,America's PPO,America's PPO,222.144,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pro Cah)",,99213,CPT,Professional,Outpatient,,,,205,174.25,44.76,205,BlueCross BlueShield Minnesota, Federal Employee Program,116.69,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pro Cah)",,99213,CPT,Professional,Outpatient,,,,210,178.5,44.76,210,BlueCross BlueShield Minnesota, Federal Employee Program,116.69,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pro Cah)",,99213,CPT,Professional,Outpatient,,,,260,221,44.76,260,BlueCross BlueShield Minnesota, Federal Employee Program,116.69,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pro Cah)",,99213,CPT,Professional,Outpatient,,,,205,174.25,44.76,205,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,118.55704,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pro Cah)",,99213,CPT,Professional,Outpatient,,,,210,178.5,44.76,210,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,118.55704,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pro Cah)",,99213,CPT,Professional,Outpatient,,,,260,221,44.76,260,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,118.55704,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pro Cah)",,99213,CPT,Professional,Outpatient,,,,205,174.25,44.76,205,BlueCross BlueShield Minnesota,High Value Network Plan,118.55704,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pro Cah)",,99213,CPT,Professional,Outpatient,,,,210,178.5,44.76,210,BlueCross BlueShield Minnesota,High Value Network Plan,118.55704,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pro Cah)",,99213,CPT,Professional,Outpatient,,,,260,221,44.76,260,BlueCross BlueShield Minnesota,High Value Network Plan,118.55704,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pro Cah)",,99213,CPT,Professional,Outpatient,,,,205,174.25,44.76,205,BlueCross BlueShield Minnesota,Medicare Advantage,73.7725,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pro Cah)",,99213,CPT,Professional,Outpatient,,,,210,178.5,44.76,210,BlueCross BlueShield Minnesota,Medicare Advantage,73.7725,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pro Cah)",,99213,CPT,Professional,Outpatient,,,,260,221,44.76,260,BlueCross BlueShield Minnesota,Medicare Advantage,73.7725,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pro Cah)",,99213,CPT,Professional,Outpatient,,,,205,174.25,44.76,205,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,118.55704,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pro Cah)",,99213,CPT,Professional,Outpatient,,,,210,178.5,44.76,210,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,118.55704,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pro Cah)",,99213,CPT,Professional,Outpatient,,,,260,221,44.76,260,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,118.55704,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pro Cah)",,99213,CPT,Professional,Outpatient,,,,205,174.25,44.76,205,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,47.61992,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pro Cah)",,99213,CPT,Professional,Outpatient,,,,210,178.5,44.76,210,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,47.61992,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pro Cah)",,99213,CPT,Professional,Outpatient,,,,260,221,44.76,260,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,47.61992,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pro Cah)",,99213,CPT,Professional,Outpatient,,,,205,174.25,44.76,205,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),73.7725,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pro Cah)",,99213,CPT,Professional,Outpatient,,,,210,178.5,44.76,210,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),73.7725,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pro Cah)",,99213,CPT,Professional,Outpatient,,,,260,221,44.76,260,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),73.7725,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pro Cah)",,99213,CPT,Professional,Outpatient,,,,205,174.25,44.76,205,CorVel,Worker's Compensation,127.1158665,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pro Cah)",,99213,CPT,Professional,Outpatient,,,,210,178.5,44.76,210,CorVel,Worker's Compensation,127.1158665,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pro Cah)",,99213,CPT,Professional,Outpatient,,,,260,221,44.76,260,CorVel,Worker's Compensation,127.1158665,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pro Cah)",,99213,CPT,Professional,Outpatient,,,,205,174.25,44.76,205,First Health Group Corporation,First Health Network,198.85,97,,percent of total billed charges,,
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pro Cah)",,99213,CPT,Professional,Outpatient,,,,210,178.5,44.76,210,First Health Group Corporation,First Health Network,203.7,97,,percent of total billed charges,,
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pro Cah)",,99213,CPT,Professional,Outpatient,,,,260,221,44.76,260,First Health Group Corporation,First Health Network,252.2,97,,percent of total billed charges,,
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pro Cah)",,99213,CPT,Professional,Outpatient,,,,205,174.25,44.76,205,"Health Partners, Inc.",Commercial,137.85,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pro Cah)",,99213,CPT,Professional,Outpatient,,,,210,178.5,44.76,210,"Health Partners, Inc.",Commercial,137.85,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pro Cah)",,99213,CPT,Professional,Outpatient,,,,260,221,44.76,260,"Health Partners, Inc.",Commercial,137.85,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pro Cah)",,99213,CPT,Professional,Outpatient,,,,205,174.25,44.76,205,"Health Partners, Inc.",Medicare Advantage,73.7725,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pro Cah)",,99213,CPT,Professional,Outpatient,,,,210,178.5,44.76,210,"Health Partners, Inc.",Medicare Advantage,73.7725,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pro Cah)",,99213,CPT,Professional,Outpatient,,,,260,221,44.76,260,"Health Partners, Inc.",Medicare Advantage,73.7725,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pro Cah)",,99213,CPT,Professional,Outpatient,,,,205,174.25,44.76,205,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),64.05,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pro Cah)",,99213,CPT,Professional,Outpatient,,,,210,178.5,44.76,210,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),64.05,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pro Cah)",,99213,CPT,Professional,Outpatient,,,,260,221,44.76,260,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),64.05,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pro Cah)",,99213,CPT,Professional,Outpatient,,,,205,174.25,44.76,205,"Health Partners, Inc.",State of Minnesota Advantage Program,118.757775,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pro Cah)",,99213,CPT,Professional,Outpatient,,,,210,178.5,44.76,210,"Health Partners, Inc.",State of Minnesota Advantage Program,118.757775,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pro Cah)",,99213,CPT,Professional,Outpatient,,,,260,221,44.76,260,"Health Partners, Inc.",State of Minnesota Advantage Program,118.757775,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pro Cah)",,99213,CPT,Professional,Outpatient,,,,205,174.25,44.76,205,"Health Partners, Inc.",State Public Programs,44.76,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pro Cah)",,99213,CPT,Professional,Outpatient,,,,210,178.5,44.76,210,"Health Partners, Inc.",State Public Programs,44.76,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pro Cah)",,99213,CPT,Professional,Outpatient,,,,260,221,44.76,260,"Health Partners, Inc.",State Public Programs,44.76,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pro Cah)",,99213,CPT,Professional,Outpatient,,,,205,174.25,44.76,205,Humana Insurance Company,Commercial PPO,64.15,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pro Cah)",,99213,CPT,Professional,Outpatient,,,,210,178.5,44.76,210,Humana Insurance Company,Commercial PPO,64.15,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pro Cah)",,99213,CPT,Professional,Outpatient,,,,260,221,44.76,260,Humana Insurance Company,Commercial PPO,64.15,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pro Cah)",,99213,CPT,Professional,Outpatient,,,,205,174.25,44.76,205,Humana Insurance Company,Medicare PPO,205,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pro Cah)",,99213,CPT,Professional,Outpatient,,,,210,178.5,44.76,210,Humana Insurance Company,Medicare PPO,210,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pro Cah)",,99213,CPT,Professional,Outpatient,,,,260,221,44.76,260,Humana Insurance Company,Medicare PPO,260,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pro Cah)",,99213,CPT,Professional,Outpatient,,,,205,174.25,44.76,205,Medica,Individual & Family,173.84,84.8,,percent of total billed charges,,
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pro Cah)",,99213,CPT,Professional,Outpatient,,,,210,178.5,44.76,210,Medica,Individual & Family,178.08,84.8,,percent of total billed charges,,
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pro Cah)",,99213,CPT,Professional,Outpatient,,,,260,221,44.76,260,Medica,Individual & Family,220.48,84.8,,percent of total billed charges,,
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pro Cah)",,99213,CPT,Professional,Outpatient,,,,205,174.25,44.76,205,Medica,Medica Advantage Solution,102.09,49.8,,percent of total billed charges,,
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pro Cah)",,99213,CPT,Professional,Outpatient,,,,210,178.5,44.76,210,Medica,Medica Advantage Solution,104.58,49.8,,percent of total billed charges,,
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pro Cah)",,99213,CPT,Professional,Outpatient,,,,260,221,44.76,260,Medica,Medica Advantage Solution,129.48,49.8,,percent of total billed charges,,
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pro Cah)",,99213,CPT,Professional,Outpatient,,,,205,174.25,44.76,205,Medica,Medical Assistance,47.62,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pro Cah)",,99213,CPT,Professional,Outpatient,,,,210,178.5,44.76,210,Medica,Medical Assistance,47.62,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pro Cah)",,99213,CPT,Professional,Outpatient,,,,260,221,44.76,260,Medica,Medical Assistance,47.62,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pro Cah)",,99213,CPT,Professional,Outpatient,,,,205,174.25,44.76,205,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,64.15,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pro Cah)",,99213,CPT,Professional,Outpatient,,,,210,178.5,44.76,210,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,64.15,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pro Cah)",,99213,CPT,Professional,Outpatient,,,,260,221,44.76,260,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,64.15,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pro Cah)",,99213,CPT,Professional,Outpatient,,,,205,174.25,44.76,205,"Multiplan, Inc.","Multiplan, Inc.",192.7,94,,percent of total billed charges,,
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pro Cah)",,99213,CPT,Professional,Outpatient,,,,210,178.5,44.76,210,"Multiplan, Inc.","Multiplan, Inc.",197.4,94,,percent of total billed charges,,
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pro Cah)",,99213,CPT,Professional,Outpatient,,,,260,221,44.76,260,"Multiplan, Inc.","Multiplan, Inc.",244.4,94,,percent of total billed charges,,
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pro Cah)",,99213,CPT,Professional,Outpatient,,,,205,174.25,44.76,205,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,184.705,90.1,,percent of total billed charges,,
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pro Cah)",,99213,CPT,Professional,Outpatient,,,,210,178.5,44.76,210,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,189.21,90.1,,percent of total billed charges,,
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pro Cah)",,99213,CPT,Professional,Outpatient,,,,260,221,44.76,260,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,234.26,90.1,,percent of total billed charges,,
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pro Cah)",,99213,CPT,Professional,Outpatient,,,,205,174.25,44.76,205,"Preferred One Administrative Services, INC.",PPO,202.13,98.6,,percent of total billed charges,,
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pro Cah)",,99213,CPT,Professional,Outpatient,,,,210,178.5,44.76,210,"Preferred One Administrative Services, INC.",PPO,207.06,98.6,,percent of total billed charges,,
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pro Cah)",,99213,CPT,Professional,Outpatient,,,,260,221,44.76,260,"Preferred One Administrative Services, INC.",PPO,256.36,98.6,,percent of total billed charges,,
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pro Cah)",,99213,CPT,Professional,Outpatient,,,,205,174.25,44.76,205,PrimeWest Health,Minnesota Senior Health Options (MSHO),73.7725,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pro Cah)",,99213,CPT,Professional,Outpatient,,,,210,178.5,44.76,210,PrimeWest Health,Minnesota Senior Health Options (MSHO),73.7725,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pro Cah)",,99213,CPT,Professional,Outpatient,,,,260,221,44.76,260,PrimeWest Health,Minnesota Senior Health Options (MSHO),73.7725,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pro Cah)",,99213,CPT,Professional,Outpatient,,,,205,174.25,44.76,205,PrimeWest Health,MinnesotaCare,50.9533144,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pro Cah)",,99213,CPT,Professional,Outpatient,,,,210,178.5,44.76,210,PrimeWest Health,MinnesotaCare,50.9533144,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pro Cah)",,99213,CPT,Professional,Outpatient,,,,260,221,44.76,260,PrimeWest Health,MinnesotaCare,50.9533144,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pro Cah)",,99213,CPT,Professional,Outpatient,,,,205,174.25,44.76,205,Sanford Health Plan,Sanford Health Plan,180.4,88,,percent of total billed charges,,
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pro Cah)",,99213,CPT,Professional,Outpatient,,,,210,178.5,44.76,210,Sanford Health Plan,Sanford Health Plan,184.8,88,,percent of total billed charges,,
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pro Cah)",,99213,CPT,Professional,Outpatient,,,,260,221,44.76,260,Sanford Health Plan,Sanford Health Plan,228.8,88,,percent of total billed charges,,
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pro Cah)",,99213,CPT,Professional,Outpatient,,,,205,174.25,44.76,205,"UCare Health, Inc.",Individual & Family Plan,104.28224,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pro Cah)",,99213,CPT,Professional,Outpatient,,,,210,178.5,44.76,210,"UCare Health, Inc.",Individual & Family Plan,104.28224,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pro Cah)",,99213,CPT,Professional,Outpatient,,,,260,221,44.76,260,"UCare Health, Inc.",Individual & Family Plan,104.28224,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pro Cah)",,99213,CPT,Professional,Outpatient,,,,205,174.25,44.76,205,"UCare Health, Inc.",Medical Assistance,52.381912,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pro Cah)",,99213,CPT,Professional,Outpatient,,,,210,178.5,44.76,210,"UCare Health, Inc.",Medical Assistance,52.381912,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pro Cah)",,99213,CPT,Professional,Outpatient,,,,260,221,44.76,260,"UCare Health, Inc.",Medical Assistance,52.381912,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pro Cah)",,99213,CPT,Professional,Outpatient,,,,205,174.25,44.76,205,"UCare Health, Inc.",Medicare Advantage,73.7725,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pro Cah)",,99213,CPT,Professional,Outpatient,,,,210,178.5,44.76,210,"UCare Health, Inc.",Medicare Advantage,73.7725,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pro Cah)",,99213,CPT,Professional,Outpatient,,,,260,221,44.76,260,"UCare Health, Inc.",Medicare Advantage,73.7725,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pro Cah)",,99213,CPT,Professional,Outpatient,,,,205,174.25,44.76,205,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),59.018,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pro Cah)",,99213,CPT,Professional,Outpatient,,,,210,178.5,44.76,210,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),59.018,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pro Cah)",,99213,CPT,Professional,Outpatient,,,,260,221,44.76,260,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),59.018,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pro Cah)",,99213,CPT,Professional,Outpatient,,,,205,174.25,44.76,205,UnitedHealthcare,Individual & Family,205,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pro Cah)",,99213,CPT,Professional,Outpatient,,,,210,178.5,44.76,210,UnitedHealthcare,Individual & Family,210,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pro Cah)",,99213,CPT,Professional,Outpatient,,,,260,221,44.76,260,UnitedHealthcare,Individual & Family,260,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pro Cah)",,99213,CPT,Professional,Outpatient,,,,205,174.25,44.76,205,UnitedHealthcare,Medicare Advantage,73.7725,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pro Cah)",,99213,CPT,Professional,Outpatient,,,,210,178.5,44.76,210,UnitedHealthcare,Medicare Advantage,73.7725,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pro Cah)",,99213,CPT,Professional,Outpatient,,,,260,221,44.76,260,UnitedHealthcare,Medicare Advantage,73.7725,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pro Cah)",,99213,CPT,Professional,Outpatient,,,,205,174.25,44.76,205,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,47.61992,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pro Cah)",,99213,CPT,Professional,Outpatient,,,,210,178.5,44.76,210,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,47.61992,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pro Cah)",,99213,CPT,Professional,Outpatient,,,,260,221,44.76,260,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,47.61992,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Clinical Nursing Level 4 (Ep),,99214,CPT,Facility,Both,,,,300,255,85.98,300,Aetna,Commercial,276,92,,percent of total billed charges,,
Clinical Nursing Level 4 (Ep),,99214,CPT,Facility,Outpatient,,,,300,255,85.98,300,Aetna,Medicare Advantage,147,49,,percent of total billed charges,,
Clinical Nursing Level 4 (Ep),,99214,CPT,Facility,Inpatient,,,,300,255,85.98,300,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Clinical Nursing Level 4 (Ep),,99214,CPT,Facility,Both,,,,300,255,85.98,300,Aetna,PPO,279,93,,percent of total billed charges,,
Clinical Nursing Level 4 (Ep),,99214,CPT,Facility,Both,,,,300,255,85.98,300,America's PPO,America's PPO,288.09,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Clinical Nursing Level 4 (Ep),,99214,CPT,Facility,Both,,,,300,255,85.98,300,BlueCross BlueShield Minnesota, Federal Employee Program,295.2,98.4,,percent of total billed charges,,
Clinical Nursing Level 4 (Ep),,99214,CPT,Facility,Both,,,,300,255,85.98,300,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,300,100,,percent of total billed charges,,
Clinical Nursing Level 4 (Ep),,99214,CPT,Facility,Both,,,,300,255,85.98,300,BlueCross BlueShield Minnesota,High Value Network Plan,270,90,,percent of total billed charges,,
Clinical Nursing Level 4 (Ep),,99214,CPT,Facility,Outpatient,,,,300,255,85.98,300,BlueCross BlueShield Minnesota,Medicare Advantage,147,49,,percent of total billed charges,,
Clinical Nursing Level 4 (Ep),,99214,CPT,Facility,Inpatient,,,,300,255,85.98,300,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Clinical Nursing Level 4 (Ep),,99214,CPT,Facility,Both,,,,300,255,85.98,300,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,265.71,88.57,,percent of total billed charges,,
Clinical Nursing Level 4 (Ep),,99214,CPT,Facility,Both,,,,300,255,85.98,300,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,85.98,28.66,,percent of total billed charges,,
Clinical Nursing Level 4 (Ep),,99214,CPT,Facility,Outpatient,,,,300,255,85.98,300,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),147,49,,percent of total billed charges,,
Clinical Nursing Level 4 (Ep),,99214,CPT,Facility,Inpatient,,,,300,255,85.98,300,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Clinical Nursing Level 4 (Ep),,99214,CPT,Facility,Both,,,,300,255,85.98,300,CorVel,Worker's Compensation,300,100,,percent of total billed charges,,
Clinical Nursing Level 4 (Ep),,99214,CPT,Facility,Both,,,,300,255,85.98,300,First Health Group Corporation,First Health Network,291,97,,percent of total billed charges,,
Clinical Nursing Level 4 (Ep),,99214,CPT,Facility,Both,,,,300,255,85.98,300,"Health Partners, Inc.",Commercial,283.8,94.6,,percent of total billed charges,,
Clinical Nursing Level 4 (Ep),,99214,CPT,Facility,Outpatient,,,,300,255,85.98,300,"Health Partners, Inc.",Medicare Advantage,147,49,,percent of total billed charges,,
Clinical Nursing Level 4 (Ep),,99214,CPT,Facility,Inpatient,,,,300,255,85.98,300,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Clinical Nursing Level 4 (Ep),,99214,CPT,Facility,Both,,,,300,255,85.98,300,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),180,60,,percent of total billed charges,,
Clinical Nursing Level 4 (Ep),,99214,CPT,Facility,Both,,,,300,255,85.98,300,"Health Partners, Inc.",State of Minnesota Advantage Program,244.5,81.5,,percent of total billed charges,,
Clinical Nursing Level 4 (Ep),,99214,CPT,Facility,Both,,,,300,255,85.98,300,"Health Partners, Inc.",State Public Programs,150,50,,percent of total billed charges,,
Clinical Nursing Level 4 (Ep),,99214,CPT,Facility,Both,,,,300,255,85.98,300,Humana Insurance Company,Commercial PPO,285,95,,percent of total billed charges,,
Clinical Nursing Level 4 (Ep),,99214,CPT,Facility,Outpatient,,,,300,255,85.98,300,Humana Insurance Company,Medicare PPO,147,49,,percent of total billed charges,,
Clinical Nursing Level 4 (Ep),,99214,CPT,Facility,Inpatient,,,,300,255,85.98,300,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Clinical Nursing Level 4 (Ep),,99214,CPT,Facility,Both,,,,300,255,85.98,300,Medica,Individual & Family,297.3,99.1,,percent of total billed charges,,
Clinical Nursing Level 4 (Ep),,99214,CPT,Facility,Outpatient,,,,300,255,85.98,300,Medica,Medica Advantage Solution,149.4,49.8,,percent of total billed charges,,
Clinical Nursing Level 4 (Ep),,99214,CPT,Facility,Inpatient,,,,300,255,85.98,300,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Clinical Nursing Level 4 (Ep),,99214,CPT,Facility,Outpatient,,,,300,255,85.98,300,Medica,Medical Assistance,133.8,44.6,,percent of total billed charges,,
Clinical Nursing Level 4 (Ep),,99214,CPT,Facility,Inpatient,,,,300,255,85.98,300,Medica,Medical Assistance,,,,,Included in per diem rate,
Clinical Nursing Level 4 (Ep),,99214,CPT,Facility,Outpatient,,,,300,255,85.98,300,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,149.4,49.8,,percent of total billed charges,,
Clinical Nursing Level 4 (Ep),,99214,CPT,Facility,Inpatient,,,,300,255,85.98,300,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Clinical Nursing Level 4 (Ep),,99214,CPT,Facility,Both,,,,300,255,85.98,300,"Multiplan, Inc.","Multiplan, Inc.",282,94,,percent of total billed charges,,
Clinical Nursing Level 4 (Ep),,99214,CPT,Facility,Outpatient,,,,300,255,85.98,300,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,270.3,90.1,,percent of total billed charges,,
Clinical Nursing Level 4 (Ep),,99214,CPT,Facility,Inpatient,,,,300,255,85.98,300,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Clinical Nursing Level 4 (Ep),,99214,CPT,Facility,Both,,,,300,255,85.98,300,"Preferred One Administrative Services, INC.",PPO,295.8,98.6,,percent of total billed charges,,
Clinical Nursing Level 4 (Ep),,99214,CPT,Facility,Outpatient,,,,300,255,85.98,300,PrimeWest Health,Minnesota Senior Health Options (MSHO),154.35,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Clinical Nursing Level 4 (Ep),,99214,CPT,Facility,Inpatient,,,,300,255,85.98,300,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Clinical Nursing Level 4 (Ep),,99214,CPT,Facility,Outpatient,,,,300,255,85.98,300,PrimeWest Health,MinnesotaCare,154.08,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Clinical Nursing Level 4 (Ep),,99214,CPT,Facility,Inpatient,,,,300,255,85.98,300,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Clinical Nursing Level 4 (Ep),,99214,CPT,Facility,Both,,,,300,255,85.98,300,Sanford Health Plan,Sanford Health Plan,276,92,,percent of total billed charges,,
Clinical Nursing Level 4 (Ep),,99214,CPT,Facility,Outpatient,,,,300,255,85.98,300,"UCare Health, Inc.",Individual & Family Plan,169.05,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Clinical Nursing Level 4 (Ep),,99214,CPT,Facility,Inpatient,,,,300,255,85.98,300,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Clinical Nursing Level 4 (Ep),,99214,CPT,Facility,Outpatient,,,,300,255,85.98,300,"UCare Health, Inc.",Medical Assistance,151.41,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Clinical Nursing Level 4 (Ep),,99214,CPT,Facility,Inpatient,,,,300,255,85.98,300,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Clinical Nursing Level 4 (Ep),,99214,CPT,Facility,Outpatient,,,,300,255,85.98,300,"UCare Health, Inc.",Medicare Advantage,151.41,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Clinical Nursing Level 4 (Ep),,99214,CPT,Facility,Inpatient,,,,300,255,85.98,300,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Clinical Nursing Level 4 (Ep),,99214,CPT,Facility,Outpatient,,,,300,255,85.98,300,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),151.41,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Clinical Nursing Level 4 (Ep),,99214,CPT,Facility,Inpatient,,,,300,255,85.98,300,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Clinical Nursing Level 4 (Ep),,99214,CPT,Facility,Both,,,,300,255,85.98,300,UnitedHealthcare,Individual & Family,282,94,,percent of total billed charges,,
Clinical Nursing Level 4 (Ep),,99214,CPT,Facility,Outpatient,,,,300,255,85.98,300,UnitedHealthcare,Medicare Advantage,147,49,,percent of total billed charges,,
Clinical Nursing Level 4 (Ep),,99214,CPT,Facility,Inpatient,,,,300,255,85.98,300,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Clinical Nursing Level 4 (Ep),,99214,CPT,Facility,Outpatient,,,,300,255,85.98,300,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,144,48,,percent of total billed charges,,100% of DHS outpatient percentage
Clinical Nursing Level 4 (Ep),,99214,CPT,Facility,Inpatient,,,,300,255,85.98,300,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time",,99214,CPT,Facility,Outpatient,,,,120,102,34.392,120,Aetna,Commercial,110.4,92,,percent of total billed charges,,
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time",,99214,CPT,Facility,Outpatient,,,,120,102,34.392,120,Aetna,Medicare Advantage,58.8,49,,percent of total billed charges,,
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time",,99214,CPT,Facility,Outpatient,,,,120,102,34.392,120,Aetna,PPO,111.6,93,,percent of total billed charges,,
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time",,99214,CPT,Facility,Outpatient,,,,120,102,34.392,120,America's PPO,America's PPO,115.236,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time",,99214,CPT,Facility,Outpatient,,,,120,102,34.392,120,BlueCross BlueShield Minnesota, Federal Employee Program,118.08,98.4,,percent of total billed charges,,
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time",,99214,CPT,Facility,Outpatient,,,,120,102,34.392,120,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,120,100,,percent of total billed charges,,
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time",,99214,CPT,Facility,Outpatient,,,,120,102,34.392,120,BlueCross BlueShield Minnesota,High Value Network Plan,108,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time",,99214,CPT,Facility,Outpatient,,,,120,102,34.392,120,BlueCross BlueShield Minnesota,Medicare Advantage,58.8,49,,percent of total billed charges,,
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time",,99214,CPT,Facility,Outpatient,,,,120,102,34.392,120,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,34.392,28.66,,percent of total billed charges,,
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time",,99214,CPT,Facility,Outpatient,,,,120,102,34.392,120,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),58.8,49,,percent of total billed charges,,
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time",,99214,CPT,Facility,Outpatient,,,,120,102,34.392,120,CorVel,Worker's Compensation,120,100,,percent of total billed charges,,
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time",,99214,CPT,Facility,Outpatient,,,,120,102,34.392,120,First Health Group Corporation,First Health Network,116.4,97,,percent of total billed charges,,
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time",,99214,CPT,Facility,Outpatient,,,,120,102,34.392,120,"Health Partners, Inc.",Commercial,113.52,94.6,,percent of total billed charges,,
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time",,99214,CPT,Facility,Outpatient,,,,120,102,34.392,120,"Health Partners, Inc.",Medicare Advantage,58.8,49,,percent of total billed charges,,
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time",,99214,CPT,Facility,Outpatient,,,,120,102,34.392,120,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),72,60,,percent of total billed charges,,
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time",,99214,CPT,Facility,Outpatient,,,,120,102,34.392,120,"Health Partners, Inc.",State of Minnesota Advantage Program,97.8,81.5,,percent of total billed charges,,
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time",,99214,CPT,Facility,Outpatient,,,,120,102,34.392,120,"Health Partners, Inc.",State Public Programs,60,50,,percent of total billed charges,,
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time",,99214,CPT,Facility,Outpatient,,,,120,102,34.392,120,Humana Insurance Company,Commercial PPO,114,95,,percent of total billed charges,,
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time",,99214,CPT,Facility,Outpatient,,,,120,102,34.392,120,Humana Insurance Company,Medicare PPO,58.8,49,,percent of total billed charges,,
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time",,99214,CPT,Facility,Outpatient,,,,120,102,34.392,120,Medica,Individual & Family,118.92,99.1,,percent of total billed charges,,
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time",,99214,CPT,Facility,Outpatient,,,,120,102,34.392,120,Medica,Medica Advantage Solution,59.76,49.8,,percent of total billed charges,,
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time",,99214,CPT,Facility,Outpatient,,,,120,102,34.392,120,Medica,Medical Assistance,53.52,44.6,,percent of total billed charges,,
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time",,99214,CPT,Facility,Outpatient,,,,120,102,34.392,120,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,59.76,49.8,,percent of total billed charges,,
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time",,99214,CPT,Facility,Outpatient,,,,120,102,34.392,120,"Multiplan, Inc.","Multiplan, Inc.",112.8,94,,percent of total billed charges,,
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time",,99214,CPT,Facility,Outpatient,,,,120,102,34.392,120,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,108.12,90.1,,percent of total billed charges,,
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time",,99214,CPT,Facility,Outpatient,,,,120,102,34.392,120,"Preferred One Administrative Services, INC.",PPO,118.32,98.6,,percent of total billed charges,,
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time",,99214,CPT,Facility,Outpatient,,,,120,102,34.392,120,PrimeWest Health,Minnesota Senior Health Options (MSHO),61.74,51.45,,percent of total billed charges,,
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time",,99214,CPT,Facility,Outpatient,,,,120,102,34.392,120,PrimeWest Health,MinnesotaCare,61.632,51.36,,percent of total billed charges,,
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time",,99214,CPT,Facility,Outpatient,,,,120,102,34.392,120,Sanford Health Plan,Sanford Health Plan,110.4,92,,percent of total billed charges,,
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time",,99214,CPT,Facility,Outpatient,,,,120,102,34.392,120,"UCare Health, Inc.",Individual & Family Plan,67.62,56.35,,percent of total billed charges,,
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time",,99214,CPT,Facility,Outpatient,,,,120,102,34.392,120,"UCare Health, Inc.",Medical Assistance,60.564,50.47,,percent of total billed charges,,
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time",,99214,CPT,Facility,Outpatient,,,,120,102,34.392,120,"UCare Health, Inc.",Medicare Advantage,60.564,50.47,,percent of total billed charges,,
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time",,99214,CPT,Facility,Outpatient,,,,120,102,34.392,120,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),60.564,50.47,,percent of total billed charges,,
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time",,99214,CPT,Facility,Outpatient,,,,120,102,34.392,120,UnitedHealthcare,Individual & Family,112.8,94,,percent of total billed charges,,
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time",,99214,CPT,Facility,Outpatient,,,,120,102,34.392,120,UnitedHealthcare,Medicare Advantage,58.8,49,,percent of total billed charges,,
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time",,99214,CPT,Facility,Outpatient,,,,120,102,34.392,120,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,57.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pbb)",,99214,CPT,Facility,Outpatient,,,,120,102,34.392,120,Aetna,Commercial,110.4,92,,percent of total billed charges,,
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pbb)",,99214,CPT,Professional,Outpatient,,,,185,157.25,66.32,185,Aetna,Commercial,157.25,85,,percent of total billed charges,,
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pbb)",,99214,CPT,Facility,Outpatient,,,,120,102,34.392,120,Aetna,Medicare Advantage,58.8,49,,percent of total billed charges,,
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pbb)",,99214,CPT,Professional,Outpatient,,,,185,157.25,66.32,185,Aetna,Medicare Advantage,97.7,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pbb)",,99214,CPT,Facility,Outpatient,,,,120,102,34.392,120,Aetna,PPO,111.6,93,,percent of total billed charges,,
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pbb)",,99214,CPT,Professional,Outpatient,,,,185,157.25,66.32,185,Aetna,PPO,172.05,93,,percent of total billed charges,,
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pbb)",,99214,CPT,Facility,Outpatient,,,,120,102,34.392,120,America's PPO,America's PPO,115.236,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pbb)",,99214,CPT,Professional,Outpatient,,,,185,157.25,66.32,185,America's PPO,America's PPO,158.064,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pbb)",,99214,CPT,Facility,Outpatient,,,,120,102,34.392,120,BlueCross BlueShield Minnesota, Federal Employee Program,118.08,98.4,,percent of total billed charges,,
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pbb)",,99214,CPT,Professional,Outpatient,,,,185,157.25,66.32,185,BlueCross BlueShield Minnesota, Federal Employee Program,172.34,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pbb)",,99214,CPT,Facility,Outpatient,,,,120,102,34.392,120,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,120,100,,percent of total billed charges,,
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pbb)",,99214,CPT,Professional,Outpatient,,,,185,157.25,66.32,185,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,175.09744,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pbb)",,99214,CPT,Facility,Outpatient,,,,120,102,34.392,120,BlueCross BlueShield Minnesota,High Value Network Plan,108,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pbb)",,99214,CPT,Professional,Outpatient,,,,185,157.25,66.32,185,BlueCross BlueShield Minnesota,High Value Network Plan,175.09744,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pbb)",,99214,CPT,Facility,Outpatient,,,,120,102,34.392,120,BlueCross BlueShield Minnesota,Medicare Advantage,58.8,49,,percent of total billed charges,,
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pbb)",,99214,CPT,Professional,Outpatient,,,,185,157.25,66.32,185,BlueCross BlueShield Minnesota,Medicare Advantage,109.1695,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pbb)",,99214,CPT,Professional,Outpatient,,,,185,157.25,66.32,185,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,175.09744,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pbb)",,99214,CPT,Facility,Outpatient,,,,120,102,34.392,120,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,34.392,28.66,,percent of total billed charges,,
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pbb)",,99214,CPT,Professional,Outpatient,,,,185,157.25,66.32,185,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,70.55104,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pbb)",,99214,CPT,Facility,Outpatient,,,,120,102,34.392,120,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),58.8,49,,percent of total billed charges,,
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pbb)",,99214,CPT,Professional,Outpatient,,,,185,157.25,66.32,185,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),109.1695,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pbb)",,99214,CPT,Facility,Outpatient,,,,120,102,34.392,120,CorVel,Worker's Compensation,120,100,,percent of total billed charges,,
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pbb)",,99214,CPT,Professional,Outpatient,,,,185,157.25,66.32,185,CorVel,Worker's Compensation,185,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pbb)",,99214,CPT,Facility,Outpatient,,,,120,102,34.392,120,First Health Group Corporation,First Health Network,116.4,97,,percent of total billed charges,,
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pbb)",,99214,CPT,Professional,Outpatient,,,,185,157.25,66.32,185,First Health Group Corporation,First Health Network,179.45,97,,percent of total billed charges,,
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pbb)",,99214,CPT,Facility,Outpatient,,,,120,102,34.392,120,"Health Partners, Inc.",Commercial,113.52,94.6,,percent of total billed charges,,
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pbb)",,99214,CPT,Professional,Outpatient,,,,185,157.25,66.32,185,"Health Partners, Inc.",Commercial,185,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pbb)",,99214,CPT,Facility,Outpatient,,,,120,102,34.392,120,"Health Partners, Inc.",Medicare Advantage,58.8,49,,percent of total billed charges,,
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pbb)",,99214,CPT,Professional,Outpatient,,,,185,157.25,66.32,185,"Health Partners, Inc.",Medicare Advantage,109.1695,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pbb)",,99214,CPT,Facility,Outpatient,,,,120,102,34.392,120,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),72,60,,percent of total billed charges,,
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pbb)",,99214,CPT,Professional,Outpatient,,,,185,157.25,66.32,185,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),95.22,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pbb)",,99214,CPT,Facility,Outpatient,,,,120,102,34.392,120,"Health Partners, Inc.",State of Minnesota Advantage Program,97.8,81.5,,percent of total billed charges,,
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pbb)",,99214,CPT,Professional,Outpatient,,,,185,157.25,66.32,185,"Health Partners, Inc.",State of Minnesota Advantage Program,174.38483,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pbb)",,99214,CPT,Facility,Outpatient,,,,120,102,34.392,120,"Health Partners, Inc.",State Public Programs,60,50,,percent of total billed charges,,
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pbb)",,99214,CPT,Professional,Outpatient,,,,185,157.25,66.32,185,"Health Partners, Inc.",State Public Programs,66.32,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pbb)",,99214,CPT,Facility,Outpatient,,,,120,102,34.392,120,Humana Insurance Company,Commercial PPO,114,95,,percent of total billed charges,,
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pbb)",,99214,CPT,Professional,Outpatient,,,,185,157.25,66.32,185,Humana Insurance Company,Commercial PPO,94.93,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pbb)",,99214,CPT,Facility,Outpatient,,,,120,102,34.392,120,Humana Insurance Company,Medicare PPO,58.8,49,,percent of total billed charges,,
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pbb)",,99214,CPT,Professional,Outpatient,,,,185,157.25,66.32,185,Humana Insurance Company,Medicare PPO,185,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pbb)",,99214,CPT,Facility,Outpatient,,,,120,102,34.392,120,Medica,Individual & Family,118.92,99.1,,percent of total billed charges,,
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pbb)",,99214,CPT,Professional,Outpatient,,,,185,157.25,66.32,185,Medica,Individual & Family,156.88,84.8,,percent of total billed charges,,
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pbb)",,99214,CPT,Facility,Outpatient,,,,120,102,34.392,120,Medica,Medica Advantage Solution,59.76,49.8,,percent of total billed charges,,
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pbb)",,99214,CPT,Professional,Outpatient,,,,185,157.25,66.32,185,Medica,Medica Advantage Solution,92.13,49.8,,percent of total billed charges,,
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pbb)",,99214,CPT,Facility,Outpatient,,,,120,102,34.392,120,Medica,Medical Assistance,53.52,44.6,,percent of total billed charges,,
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pbb)",,99214,CPT,Professional,Outpatient,,,,185,157.25,66.32,185,Medica,Medical Assistance,70.55,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pbb)",,99214,CPT,Facility,Outpatient,,,,120,102,34.392,120,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,59.76,49.8,,percent of total billed charges,,
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pbb)",,99214,CPT,Professional,Outpatient,,,,185,157.25,66.32,185,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,94.93,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pbb)",,99214,CPT,Facility,Outpatient,,,,120,102,34.392,120,"Multiplan, Inc.","Multiplan, Inc.",112.8,94,,percent of total billed charges,,
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pbb)",,99214,CPT,Professional,Outpatient,,,,185,157.25,66.32,185,"Multiplan, Inc.","Multiplan, Inc.",173.9,94,,percent of total billed charges,,
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pbb)",,99214,CPT,Facility,Outpatient,,,,120,102,34.392,120,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,108.12,90.1,,percent of total billed charges,,
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pbb)",,99214,CPT,Professional,Outpatient,,,,185,157.25,66.32,185,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,166.685,90.1,,percent of total billed charges,,
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pbb)",,99214,CPT,Facility,Outpatient,,,,120,102,34.392,120,"Preferred One Administrative Services, INC.",PPO,118.32,98.6,,percent of total billed charges,,
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pbb)",,99214,CPT,Professional,Outpatient,,,,185,157.25,66.32,185,"Preferred One Administrative Services, INC.",PPO,182.41,98.6,,percent of total billed charges,,
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pbb)",,99214,CPT,Facility,Outpatient,,,,120,102,34.392,120,PrimeWest Health,Minnesota Senior Health Options (MSHO),61.74,51.45,,percent of total billed charges,,
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pbb)",,99214,CPT,Professional,Outpatient,,,,185,157.25,66.32,185,PrimeWest Health,Minnesota Senior Health Options (MSHO),109.1695,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pbb)",,99214,CPT,Facility,Outpatient,,,,120,102,34.392,120,PrimeWest Health,MinnesotaCare,61.632,51.36,,percent of total billed charges,,
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pbb)",,99214,CPT,Professional,Outpatient,,,,185,157.25,66.32,185,PrimeWest Health,MinnesotaCare,75.4896128,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pbb)",,99214,CPT,Facility,Outpatient,,,,120,102,34.392,120,Sanford Health Plan,Sanford Health Plan,110.4,92,,percent of total billed charges,,
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pbb)",,99214,CPT,Professional,Outpatient,,,,185,157.25,66.32,185,Sanford Health Plan,Sanford Health Plan,162.8,88,,percent of total billed charges,,
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pbb)",,99214,CPT,Facility,Outpatient,,,,120,102,34.392,120,"UCare Health, Inc.",Individual & Family Plan,67.62,56.35,,percent of total billed charges,,
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pbb)",,99214,CPT,Professional,Outpatient,,,,185,157.25,66.32,185,"UCare Health, Inc.",Individual & Family Plan,154.318208,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pbb)",,99214,CPT,Facility,Outpatient,,,,120,102,34.392,120,"UCare Health, Inc.",Medical Assistance,60.564,50.47,,percent of total billed charges,,
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pbb)",,99214,CPT,Professional,Outpatient,,,,185,157.25,66.32,185,"UCare Health, Inc.",Medical Assistance,77.606144,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pbb)",,99214,CPT,Facility,Outpatient,,,,120,102,34.392,120,"UCare Health, Inc.",Medicare Advantage,60.564,50.47,,percent of total billed charges,,
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pbb)",,99214,CPT,Professional,Outpatient,,,,185,157.25,66.32,185,"UCare Health, Inc.",Medicare Advantage,109.1695,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pbb)",,99214,CPT,Facility,Outpatient,,,,120,102,34.392,120,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),60.564,50.47,,percent of total billed charges,,
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pbb)",,99214,CPT,Professional,Outpatient,,,,185,157.25,66.32,185,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),87.3356,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pbb)",,99214,CPT,Facility,Outpatient,,,,120,102,34.392,120,UnitedHealthcare,Individual & Family,112.8,94,,percent of total billed charges,,
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pbb)",,99214,CPT,Professional,Outpatient,,,,185,157.25,66.32,185,UnitedHealthcare,Individual & Family,185,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pbb)",,99214,CPT,Facility,Outpatient,,,,120,102,34.392,120,UnitedHealthcare,Medicare Advantage,58.8,49,,percent of total billed charges,,
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pbb)",,99214,CPT,Professional,Outpatient,,,,185,157.25,66.32,185,UnitedHealthcare,Medicare Advantage,109.1695,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pbb)",,99214,CPT,Facility,Outpatient,,,,120,102,34.392,120,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,57.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pbb)",,99214,CPT,Professional,Outpatient,,,,185,157.25,66.32,185,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,70.55104,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pro Cah)",,99214,CPT,Professional,Outpatient,,,,280,238,66.32,280,Aetna,Commercial,238,85,,percent of total billed charges,,
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pro Cah)",,99214,CPT,Professional,Outpatient,,,,305,259.25,66.32,305,Aetna,Commercial,259.25,85,,percent of total billed charges,,
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pro Cah)",,99214,CPT,Professional,Outpatient,,,,355,301.75,66.32,355,Aetna,Commercial,301.75,85,,percent of total billed charges,,
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pro Cah)",,99214,CPT,Professional,Outpatient,,,,280,238,66.32,280,Aetna,Medicare Advantage,97.7,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pro Cah)",,99214,CPT,Professional,Outpatient,,,,305,259.25,66.32,305,Aetna,Medicare Advantage,97.7,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pro Cah)",,99214,CPT,Professional,Outpatient,,,,355,301.75,66.32,355,Aetna,Medicare Advantage,97.7,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pro Cah)",,99214,CPT,Professional,Outpatient,,,,280,238,66.32,280,Aetna,PPO,260.4,93,,percent of total billed charges,,
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pro Cah)",,99214,CPT,Professional,Outpatient,,,,305,259.25,66.32,305,Aetna,PPO,283.65,93,,percent of total billed charges,,
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pro Cah)",,99214,CPT,Professional,Outpatient,,,,355,301.75,66.32,355,Aetna,PPO,330.15,93,,percent of total billed charges,,
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pro Cah)",,99214,CPT,Professional,Outpatient,,,,280,238,66.32,280,America's PPO,America's PPO,239.232,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pro Cah)",,99214,CPT,Professional,Outpatient,,,,305,259.25,66.32,305,America's PPO,America's PPO,260.592,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pro Cah)",,99214,CPT,Professional,Outpatient,,,,355,301.75,66.32,355,America's PPO,America's PPO,303.312,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pro Cah)",,99214,CPT,Professional,Outpatient,,,,280,238,66.32,280,BlueCross BlueShield Minnesota, Federal Employee Program,172.34,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pro Cah)",,99214,CPT,Professional,Outpatient,,,,305,259.25,66.32,305,BlueCross BlueShield Minnesota, Federal Employee Program,172.34,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pro Cah)",,99214,CPT,Professional,Outpatient,,,,355,301.75,66.32,355,BlueCross BlueShield Minnesota, Federal Employee Program,172.34,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pro Cah)",,99214,CPT,Professional,Outpatient,,,,280,238,66.32,280,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,175.09744,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pro Cah)",,99214,CPT,Professional,Outpatient,,,,305,259.25,66.32,305,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,175.09744,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pro Cah)",,99214,CPT,Professional,Outpatient,,,,355,301.75,66.32,355,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,175.09744,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pro Cah)",,99214,CPT,Professional,Outpatient,,,,280,238,66.32,280,BlueCross BlueShield Minnesota,High Value Network Plan,175.09744,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pro Cah)",,99214,CPT,Professional,Outpatient,,,,305,259.25,66.32,305,BlueCross BlueShield Minnesota,High Value Network Plan,175.09744,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pro Cah)",,99214,CPT,Professional,Outpatient,,,,355,301.75,66.32,355,BlueCross BlueShield Minnesota,High Value Network Plan,175.09744,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pro Cah)",,99214,CPT,Professional,Outpatient,,,,280,238,66.32,280,BlueCross BlueShield Minnesota,Medicare Advantage,109.1695,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pro Cah)",,99214,CPT,Professional,Outpatient,,,,305,259.25,66.32,305,BlueCross BlueShield Minnesota,Medicare Advantage,109.1695,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pro Cah)",,99214,CPT,Professional,Outpatient,,,,355,301.75,66.32,355,BlueCross BlueShield Minnesota,Medicare Advantage,109.1695,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pro Cah)",,99214,CPT,Professional,Outpatient,,,,280,238,66.32,280,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,175.09744,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pro Cah)",,99214,CPT,Professional,Outpatient,,,,305,259.25,66.32,305,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,175.09744,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pro Cah)",,99214,CPT,Professional,Outpatient,,,,355,301.75,66.32,355,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,175.09744,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pro Cah)",,99214,CPT,Professional,Outpatient,,,,280,238,66.32,280,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,70.55104,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pro Cah)",,99214,CPT,Professional,Outpatient,,,,305,259.25,66.32,305,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,70.55104,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pro Cah)",,99214,CPT,Professional,Outpatient,,,,355,301.75,66.32,355,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,70.55104,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pro Cah)",,99214,CPT,Professional,Outpatient,,,,280,238,66.32,280,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),109.1695,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pro Cah)",,99214,CPT,Professional,Outpatient,,,,305,259.25,66.32,305,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),109.1695,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pro Cah)",,99214,CPT,Professional,Outpatient,,,,355,301.75,66.32,355,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),109.1695,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pro Cah)",,99214,CPT,Professional,Outpatient,,,,280,238,66.32,280,CorVel,Worker's Compensation,187.6071534,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pro Cah)",,99214,CPT,Professional,Outpatient,,,,305,259.25,66.32,305,CorVel,Worker's Compensation,187.6071534,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pro Cah)",,99214,CPT,Professional,Outpatient,,,,355,301.75,66.32,355,CorVel,Worker's Compensation,187.6071534,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pro Cah)",,99214,CPT,Professional,Outpatient,,,,280,238,66.32,280,First Health Group Corporation,First Health Network,271.6,97,,percent of total billed charges,,
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pro Cah)",,99214,CPT,Professional,Outpatient,,,,305,259.25,66.32,305,First Health Group Corporation,First Health Network,295.85,97,,percent of total billed charges,,
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pro Cah)",,99214,CPT,Professional,Outpatient,,,,355,301.75,66.32,355,First Health Group Corporation,First Health Network,344.35,97,,percent of total billed charges,,
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pro Cah)",,99214,CPT,Professional,Outpatient,,,,280,238,66.32,280,"Health Partners, Inc.",Commercial,202.42,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pro Cah)",,99214,CPT,Professional,Outpatient,,,,305,259.25,66.32,305,"Health Partners, Inc.",Commercial,202.42,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pro Cah)",,99214,CPT,Professional,Outpatient,,,,355,301.75,66.32,355,"Health Partners, Inc.",Commercial,202.42,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pro Cah)",,99214,CPT,Professional,Outpatient,,,,280,238,66.32,280,"Health Partners, Inc.",Medicare Advantage,109.1695,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pro Cah)",,99214,CPT,Professional,Outpatient,,,,305,259.25,66.32,305,"Health Partners, Inc.",Medicare Advantage,109.1695,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pro Cah)",,99214,CPT,Professional,Outpatient,,,,355,301.75,66.32,355,"Health Partners, Inc.",Medicare Advantage,109.1695,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pro Cah)",,99214,CPT,Professional,Outpatient,,,,280,238,66.32,280,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),95.22,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pro Cah)",,99214,CPT,Professional,Outpatient,,,,305,259.25,66.32,305,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),95.22,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pro Cah)",,99214,CPT,Professional,Outpatient,,,,355,301.75,66.32,355,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),95.22,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pro Cah)",,99214,CPT,Professional,Outpatient,,,,280,238,66.32,280,"Health Partners, Inc.",State of Minnesota Advantage Program,174.38483,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pro Cah)",,99214,CPT,Professional,Outpatient,,,,305,259.25,66.32,305,"Health Partners, Inc.",State of Minnesota Advantage Program,174.38483,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pro Cah)",,99214,CPT,Professional,Outpatient,,,,355,301.75,66.32,355,"Health Partners, Inc.",State of Minnesota Advantage Program,174.38483,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pro Cah)",,99214,CPT,Professional,Outpatient,,,,280,238,66.32,280,"Health Partners, Inc.",State Public Programs,66.32,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pro Cah)",,99214,CPT,Professional,Outpatient,,,,305,259.25,66.32,305,"Health Partners, Inc.",State Public Programs,66.32,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pro Cah)",,99214,CPT,Professional,Outpatient,,,,355,301.75,66.32,355,"Health Partners, Inc.",State Public Programs,66.32,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pro Cah)",,99214,CPT,Professional,Outpatient,,,,280,238,66.32,280,Humana Insurance Company,Commercial PPO,94.93,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pro Cah)",,99214,CPT,Professional,Outpatient,,,,305,259.25,66.32,305,Humana Insurance Company,Commercial PPO,94.93,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pro Cah)",,99214,CPT,Professional,Outpatient,,,,355,301.75,66.32,355,Humana Insurance Company,Commercial PPO,94.93,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pro Cah)",,99214,CPT,Professional,Outpatient,,,,280,238,66.32,280,Humana Insurance Company,Medicare PPO,280,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pro Cah)",,99214,CPT,Professional,Outpatient,,,,305,259.25,66.32,305,Humana Insurance Company,Medicare PPO,305,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pro Cah)",,99214,CPT,Professional,Outpatient,,,,355,301.75,66.32,355,Humana Insurance Company,Medicare PPO,355,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pro Cah)",,99214,CPT,Professional,Outpatient,,,,280,238,66.32,280,Medica,Individual & Family,237.44,84.8,,percent of total billed charges,,
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pro Cah)",,99214,CPT,Professional,Outpatient,,,,305,259.25,66.32,305,Medica,Individual & Family,258.64,84.8,,percent of total billed charges,,
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pro Cah)",,99214,CPT,Professional,Outpatient,,,,355,301.75,66.32,355,Medica,Individual & Family,301.04,84.8,,percent of total billed charges,,
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pro Cah)",,99214,CPT,Professional,Outpatient,,,,280,238,66.32,280,Medica,Medica Advantage Solution,139.44,49.8,,percent of total billed charges,,
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pro Cah)",,99214,CPT,Professional,Outpatient,,,,305,259.25,66.32,305,Medica,Medica Advantage Solution,151.89,49.8,,percent of total billed charges,,
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pro Cah)",,99214,CPT,Professional,Outpatient,,,,355,301.75,66.32,355,Medica,Medica Advantage Solution,176.79,49.8,,percent of total billed charges,,
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pro Cah)",,99214,CPT,Professional,Outpatient,,,,280,238,66.32,280,Medica,Medical Assistance,70.55,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pro Cah)",,99214,CPT,Professional,Outpatient,,,,305,259.25,66.32,305,Medica,Medical Assistance,70.55,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pro Cah)",,99214,CPT,Professional,Outpatient,,,,355,301.75,66.32,355,Medica,Medical Assistance,70.55,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pro Cah)",,99214,CPT,Professional,Outpatient,,,,280,238,66.32,280,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,94.93,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pro Cah)",,99214,CPT,Professional,Outpatient,,,,305,259.25,66.32,305,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,94.93,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pro Cah)",,99214,CPT,Professional,Outpatient,,,,355,301.75,66.32,355,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,94.93,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pro Cah)",,99214,CPT,Professional,Outpatient,,,,280,238,66.32,280,"Multiplan, Inc.","Multiplan, Inc.",263.2,94,,percent of total billed charges,,
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pro Cah)",,99214,CPT,Professional,Outpatient,,,,305,259.25,66.32,305,"Multiplan, Inc.","Multiplan, Inc.",286.7,94,,percent of total billed charges,,
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pro Cah)",,99214,CPT,Professional,Outpatient,,,,355,301.75,66.32,355,"Multiplan, Inc.","Multiplan, Inc.",333.7,94,,percent of total billed charges,,
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pro Cah)",,99214,CPT,Professional,Outpatient,,,,280,238,66.32,280,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,252.28,90.1,,percent of total billed charges,,
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pro Cah)",,99214,CPT,Professional,Outpatient,,,,305,259.25,66.32,305,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,274.805,90.1,,percent of total billed charges,,
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pro Cah)",,99214,CPT,Professional,Outpatient,,,,355,301.75,66.32,355,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,319.855,90.1,,percent of total billed charges,,
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pro Cah)",,99214,CPT,Professional,Outpatient,,,,280,238,66.32,280,"Preferred One Administrative Services, INC.",PPO,276.08,98.6,,percent of total billed charges,,
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pro Cah)",,99214,CPT,Professional,Outpatient,,,,305,259.25,66.32,305,"Preferred One Administrative Services, INC.",PPO,300.73,98.6,,percent of total billed charges,,
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pro Cah)",,99214,CPT,Professional,Outpatient,,,,355,301.75,66.32,355,"Preferred One Administrative Services, INC.",PPO,350.03,98.6,,percent of total billed charges,,
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pro Cah)",,99214,CPT,Professional,Outpatient,,,,280,238,66.32,280,PrimeWest Health,Minnesota Senior Health Options (MSHO),109.1695,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pro Cah)",,99214,CPT,Professional,Outpatient,,,,305,259.25,66.32,305,PrimeWest Health,Minnesota Senior Health Options (MSHO),109.1695,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pro Cah)",,99214,CPT,Professional,Outpatient,,,,355,301.75,66.32,355,PrimeWest Health,Minnesota Senior Health Options (MSHO),109.1695,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pro Cah)",,99214,CPT,Professional,Outpatient,,,,280,238,66.32,280,PrimeWest Health,MinnesotaCare,75.4896128,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pro Cah)",,99214,CPT,Professional,Outpatient,,,,305,259.25,66.32,305,PrimeWest Health,MinnesotaCare,75.4896128,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pro Cah)",,99214,CPT,Professional,Outpatient,,,,355,301.75,66.32,355,PrimeWest Health,MinnesotaCare,75.4896128,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pro Cah)",,99214,CPT,Professional,Outpatient,,,,280,238,66.32,280,Sanford Health Plan,Sanford Health Plan,246.4,88,,percent of total billed charges,,
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pro Cah)",,99214,CPT,Professional,Outpatient,,,,305,259.25,66.32,305,Sanford Health Plan,Sanford Health Plan,268.4,88,,percent of total billed charges,,
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pro Cah)",,99214,CPT,Professional,Outpatient,,,,355,301.75,66.32,355,Sanford Health Plan,Sanford Health Plan,312.4,88,,percent of total billed charges,,
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pro Cah)",,99214,CPT,Professional,Outpatient,,,,280,238,66.32,280,"UCare Health, Inc.",Individual & Family Plan,154.318208,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pro Cah)",,99214,CPT,Professional,Outpatient,,,,305,259.25,66.32,305,"UCare Health, Inc.",Individual & Family Plan,154.318208,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pro Cah)",,99214,CPT,Professional,Outpatient,,,,355,301.75,66.32,355,"UCare Health, Inc.",Individual & Family Plan,154.318208,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pro Cah)",,99214,CPT,Professional,Outpatient,,,,280,238,66.32,280,"UCare Health, Inc.",Medical Assistance,77.606144,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pro Cah)",,99214,CPT,Professional,Outpatient,,,,305,259.25,66.32,305,"UCare Health, Inc.",Medical Assistance,77.606144,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pro Cah)",,99214,CPT,Professional,Outpatient,,,,355,301.75,66.32,355,"UCare Health, Inc.",Medical Assistance,77.606144,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pro Cah)",,99214,CPT,Professional,Outpatient,,,,280,238,66.32,280,"UCare Health, Inc.",Medicare Advantage,109.1695,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pro Cah)",,99214,CPT,Professional,Outpatient,,,,305,259.25,66.32,305,"UCare Health, Inc.",Medicare Advantage,109.1695,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pro Cah)",,99214,CPT,Professional,Outpatient,,,,355,301.75,66.32,355,"UCare Health, Inc.",Medicare Advantage,109.1695,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pro Cah)",,99214,CPT,Professional,Outpatient,,,,280,238,66.32,280,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),87.3356,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pro Cah)",,99214,CPT,Professional,Outpatient,,,,305,259.25,66.32,305,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),87.3356,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pro Cah)",,99214,CPT,Professional,Outpatient,,,,355,301.75,66.32,355,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),87.3356,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pro Cah)",,99214,CPT,Professional,Outpatient,,,,280,238,66.32,280,UnitedHealthcare,Individual & Family,280,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pro Cah)",,99214,CPT,Professional,Outpatient,,,,305,259.25,66.32,305,UnitedHealthcare,Individual & Family,305,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pro Cah)",,99214,CPT,Professional,Outpatient,,,,355,301.75,66.32,355,UnitedHealthcare,Individual & Family,355,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pro Cah)",,99214,CPT,Professional,Outpatient,,,,280,238,66.32,280,UnitedHealthcare,Medicare Advantage,109.1695,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pro Cah)",,99214,CPT,Professional,Outpatient,,,,305,259.25,66.32,305,UnitedHealthcare,Medicare Advantage,109.1695,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pro Cah)",,99214,CPT,Professional,Outpatient,,,,355,301.75,66.32,355,UnitedHealthcare,Medicare Advantage,109.1695,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pro Cah)",,99214,CPT,Professional,Outpatient,,,,280,238,66.32,280,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,70.55104,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pro Cah)",,99214,CPT,Professional,Outpatient,,,,305,259.25,66.32,305,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,70.55104,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pro Cah)",,99214,CPT,Professional,Outpatient,,,,355,301.75,66.32,355,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,70.55104,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Clinical Nursing Level 5 (Ep),,99215,CPT,Facility,Both,,,,400,340,114.64,400,Aetna,Commercial,368,92,,percent of total billed charges,,
Clinical Nursing Level 5 (Ep),,99215,CPT,Facility,Outpatient,,,,400,340,114.64,400,Aetna,Medicare Advantage,196,49,,percent of total billed charges,,
Clinical Nursing Level 5 (Ep),,99215,CPT,Facility,Inpatient,,,,400,340,114.64,400,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Clinical Nursing Level 5 (Ep),,99215,CPT,Facility,Both,,,,400,340,114.64,400,Aetna,PPO,372,93,,percent of total billed charges,,
Clinical Nursing Level 5 (Ep),,99215,CPT,Facility,Both,,,,400,340,114.64,400,America's PPO,America's PPO,384.12,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Clinical Nursing Level 5 (Ep),,99215,CPT,Facility,Both,,,,400,340,114.64,400,BlueCross BlueShield Minnesota, Federal Employee Program,393.6,98.4,,percent of total billed charges,,
Clinical Nursing Level 5 (Ep),,99215,CPT,Facility,Both,,,,400,340,114.64,400,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,400,100,,percent of total billed charges,,
Clinical Nursing Level 5 (Ep),,99215,CPT,Facility,Both,,,,400,340,114.64,400,BlueCross BlueShield Minnesota,High Value Network Plan,360,90,,percent of total billed charges,,
Clinical Nursing Level 5 (Ep),,99215,CPT,Facility,Outpatient,,,,400,340,114.64,400,BlueCross BlueShield Minnesota,Medicare Advantage,196,49,,percent of total billed charges,,
Clinical Nursing Level 5 (Ep),,99215,CPT,Facility,Inpatient,,,,400,340,114.64,400,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Clinical Nursing Level 5 (Ep),,99215,CPT,Facility,Both,,,,400,340,114.64,400,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,354.28,88.57,,percent of total billed charges,,
Clinical Nursing Level 5 (Ep),,99215,CPT,Facility,Both,,,,400,340,114.64,400,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,114.64,28.66,,percent of total billed charges,,
Clinical Nursing Level 5 (Ep),,99215,CPT,Facility,Outpatient,,,,400,340,114.64,400,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),196,49,,percent of total billed charges,,
Clinical Nursing Level 5 (Ep),,99215,CPT,Facility,Inpatient,,,,400,340,114.64,400,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Clinical Nursing Level 5 (Ep),,99215,CPT,Facility,Both,,,,400,340,114.64,400,CorVel,Worker's Compensation,400,100,,percent of total billed charges,,
Clinical Nursing Level 5 (Ep),,99215,CPT,Facility,Both,,,,400,340,114.64,400,First Health Group Corporation,First Health Network,388,97,,percent of total billed charges,,
Clinical Nursing Level 5 (Ep),,99215,CPT,Facility,Both,,,,400,340,114.64,400,"Health Partners, Inc.",Commercial,378.4,94.6,,percent of total billed charges,,
Clinical Nursing Level 5 (Ep),,99215,CPT,Facility,Outpatient,,,,400,340,114.64,400,"Health Partners, Inc.",Medicare Advantage,196,49,,percent of total billed charges,,
Clinical Nursing Level 5 (Ep),,99215,CPT,Facility,Inpatient,,,,400,340,114.64,400,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Clinical Nursing Level 5 (Ep),,99215,CPT,Facility,Both,,,,400,340,114.64,400,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),240,60,,percent of total billed charges,,
Clinical Nursing Level 5 (Ep),,99215,CPT,Facility,Both,,,,400,340,114.64,400,"Health Partners, Inc.",State of Minnesota Advantage Program,326,81.5,,percent of total billed charges,,
Clinical Nursing Level 5 (Ep),,99215,CPT,Facility,Both,,,,400,340,114.64,400,"Health Partners, Inc.",State Public Programs,200,50,,percent of total billed charges,,
Clinical Nursing Level 5 (Ep),,99215,CPT,Facility,Both,,,,400,340,114.64,400,Humana Insurance Company,Commercial PPO,380,95,,percent of total billed charges,,
Clinical Nursing Level 5 (Ep),,99215,CPT,Facility,Outpatient,,,,400,340,114.64,400,Humana Insurance Company,Medicare PPO,196,49,,percent of total billed charges,,
Clinical Nursing Level 5 (Ep),,99215,CPT,Facility,Inpatient,,,,400,340,114.64,400,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Clinical Nursing Level 5 (Ep),,99215,CPT,Facility,Both,,,,400,340,114.64,400,Medica,Individual & Family,396.4,99.1,,percent of total billed charges,,
Clinical Nursing Level 5 (Ep),,99215,CPT,Facility,Outpatient,,,,400,340,114.64,400,Medica,Medica Advantage Solution,199.2,49.8,,percent of total billed charges,,
Clinical Nursing Level 5 (Ep),,99215,CPT,Facility,Inpatient,,,,400,340,114.64,400,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Clinical Nursing Level 5 (Ep),,99215,CPT,Facility,Outpatient,,,,400,340,114.64,400,Medica,Medical Assistance,178.4,44.6,,percent of total billed charges,,
Clinical Nursing Level 5 (Ep),,99215,CPT,Facility,Inpatient,,,,400,340,114.64,400,Medica,Medical Assistance,,,,,Included in per diem rate,
Clinical Nursing Level 5 (Ep),,99215,CPT,Facility,Outpatient,,,,400,340,114.64,400,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,199.2,49.8,,percent of total billed charges,,
Clinical Nursing Level 5 (Ep),,99215,CPT,Facility,Inpatient,,,,400,340,114.64,400,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Clinical Nursing Level 5 (Ep),,99215,CPT,Facility,Both,,,,400,340,114.64,400,"Multiplan, Inc.","Multiplan, Inc.",376,94,,percent of total billed charges,,
Clinical Nursing Level 5 (Ep),,99215,CPT,Facility,Outpatient,,,,400,340,114.64,400,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,360.4,90.1,,percent of total billed charges,,
Clinical Nursing Level 5 (Ep),,99215,CPT,Facility,Inpatient,,,,400,340,114.64,400,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Clinical Nursing Level 5 (Ep),,99215,CPT,Facility,Both,,,,400,340,114.64,400,"Preferred One Administrative Services, INC.",PPO,394.4,98.6,,percent of total billed charges,,
Clinical Nursing Level 5 (Ep),,99215,CPT,Facility,Outpatient,,,,400,340,114.64,400,PrimeWest Health,Minnesota Senior Health Options (MSHO),205.8,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Clinical Nursing Level 5 (Ep),,99215,CPT,Facility,Inpatient,,,,400,340,114.64,400,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Clinical Nursing Level 5 (Ep),,99215,CPT,Facility,Outpatient,,,,400,340,114.64,400,PrimeWest Health,MinnesotaCare,205.44,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Clinical Nursing Level 5 (Ep),,99215,CPT,Facility,Inpatient,,,,400,340,114.64,400,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Clinical Nursing Level 5 (Ep),,99215,CPT,Facility,Both,,,,400,340,114.64,400,Sanford Health Plan,Sanford Health Plan,368,92,,percent of total billed charges,,
Clinical Nursing Level 5 (Ep),,99215,CPT,Facility,Outpatient,,,,400,340,114.64,400,"UCare Health, Inc.",Individual & Family Plan,225.4,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Clinical Nursing Level 5 (Ep),,99215,CPT,Facility,Inpatient,,,,400,340,114.64,400,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Clinical Nursing Level 5 (Ep),,99215,CPT,Facility,Outpatient,,,,400,340,114.64,400,"UCare Health, Inc.",Medical Assistance,201.88,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Clinical Nursing Level 5 (Ep),,99215,CPT,Facility,Inpatient,,,,400,340,114.64,400,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Clinical Nursing Level 5 (Ep),,99215,CPT,Facility,Outpatient,,,,400,340,114.64,400,"UCare Health, Inc.",Medicare Advantage,201.88,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Clinical Nursing Level 5 (Ep),,99215,CPT,Facility,Inpatient,,,,400,340,114.64,400,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Clinical Nursing Level 5 (Ep),,99215,CPT,Facility,Outpatient,,,,400,340,114.64,400,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),201.88,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Clinical Nursing Level 5 (Ep),,99215,CPT,Facility,Inpatient,,,,400,340,114.64,400,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Clinical Nursing Level 5 (Ep),,99215,CPT,Facility,Both,,,,400,340,114.64,400,UnitedHealthcare,Individual & Family,376,94,,percent of total billed charges,,
Clinical Nursing Level 5 (Ep),,99215,CPT,Facility,Outpatient,,,,400,340,114.64,400,UnitedHealthcare,Medicare Advantage,196,49,,percent of total billed charges,,
Clinical Nursing Level 5 (Ep),,99215,CPT,Facility,Inpatient,,,,400,340,114.64,400,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Clinical Nursing Level 5 (Ep),,99215,CPT,Facility,Outpatient,,,,400,340,114.64,400,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,192,48,,percent of total billed charges,,100% of DHS outpatient percentage
Clinical Nursing Level 5 (Ep),,99215,CPT,Facility,Inpatient,,,,400,340,114.64,400,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Est Pt Level 5 Office/Other Outpt Visit Eval And Mgmt, High Level Mdm Or 40-54 Min Total Time (Pro Cah)",,99215,CPT,Professional,Outpatient,,,,380,323,97.33,380,Aetna,Commercial,323,85,,percent of total billed charges,,
"Est Pt Level 5 Office/Other Outpt Visit Eval And Mgmt, High Level Mdm Or 40-54 Min Total Time (Pro Cah)",,99215,CPT,Professional,Outpatient,,,,450,382.5,97.33,450,Aetna,Commercial,382.5,85,,percent of total billed charges,,
"Est Pt Level 5 Office/Other Outpt Visit Eval And Mgmt, High Level Mdm Or 40-54 Min Total Time (Pro Cah)",,99215,CPT,Professional,Outpatient,,,,380,323,97.33,380,Aetna,Medicare Advantage,143.76,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Est Pt Level 5 Office/Other Outpt Visit Eval And Mgmt, High Level Mdm Or 40-54 Min Total Time (Pro Cah)",,99215,CPT,Professional,Outpatient,,,,450,382.5,97.33,450,Aetna,Medicare Advantage,143.76,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Est Pt Level 5 Office/Other Outpt Visit Eval And Mgmt, High Level Mdm Or 40-54 Min Total Time (Pro Cah)",,99215,CPT,Professional,Outpatient,,,,380,323,97.33,380,Aetna,PPO,353.4,93,,percent of total billed charges,,
"Est Pt Level 5 Office/Other Outpt Visit Eval And Mgmt, High Level Mdm Or 40-54 Min Total Time (Pro Cah)",,99215,CPT,Professional,Outpatient,,,,450,382.5,97.33,450,Aetna,PPO,418.5,93,,percent of total billed charges,,
"Est Pt Level 5 Office/Other Outpt Visit Eval And Mgmt, High Level Mdm Or 40-54 Min Total Time (Pro Cah)",,99215,CPT,Professional,Outpatient,,,,380,323,97.33,380,America's PPO,America's PPO,324.672,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Est Pt Level 5 Office/Other Outpt Visit Eval And Mgmt, High Level Mdm Or 40-54 Min Total Time (Pro Cah)",,99215,CPT,Professional,Outpatient,,,,450,382.5,97.33,450,America's PPO,America's PPO,384.48,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Est Pt Level 5 Office/Other Outpt Visit Eval And Mgmt, High Level Mdm Or 40-54 Min Total Time (Pro Cah)",,99215,CPT,Professional,Outpatient,,,,380,323,97.33,380,BlueCross BlueShield Minnesota, Federal Employee Program,253.12,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Est Pt Level 5 Office/Other Outpt Visit Eval And Mgmt, High Level Mdm Or 40-54 Min Total Time (Pro Cah)",,99215,CPT,Professional,Outpatient,,,,450,382.5,97.33,450,BlueCross BlueShield Minnesota, Federal Employee Program,253.12,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Est Pt Level 5 Office/Other Outpt Visit Eval And Mgmt, High Level Mdm Or 40-54 Min Total Time (Pro Cah)",,99215,CPT,Professional,Outpatient,,,,380,323,97.33,380,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,257.16992,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Est Pt Level 5 Office/Other Outpt Visit Eval And Mgmt, High Level Mdm Or 40-54 Min Total Time (Pro Cah)",,99215,CPT,Professional,Outpatient,,,,450,382.5,97.33,450,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,257.16992,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Est Pt Level 5 Office/Other Outpt Visit Eval And Mgmt, High Level Mdm Or 40-54 Min Total Time (Pro Cah)",,99215,CPT,Professional,Outpatient,,,,380,323,97.33,380,BlueCross BlueShield Minnesota,High Value Network Plan,257.16992,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Est Pt Level 5 Office/Other Outpt Visit Eval And Mgmt, High Level Mdm Or 40-54 Min Total Time (Pro Cah)",,99215,CPT,Professional,Outpatient,,,,450,382.5,97.33,450,BlueCross BlueShield Minnesota,High Value Network Plan,257.16992,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Est Pt Level 5 Office/Other Outpt Visit Eval And Mgmt, High Level Mdm Or 40-54 Min Total Time (Pro Cah)",,99215,CPT,Professional,Outpatient,,,,380,323,97.33,380,BlueCross BlueShield Minnesota,Medicare Advantage,160.5055,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Est Pt Level 5 Office/Other Outpt Visit Eval And Mgmt, High Level Mdm Or 40-54 Min Total Time (Pro Cah)",,99215,CPT,Professional,Outpatient,,,,450,382.5,97.33,450,BlueCross BlueShield Minnesota,Medicare Advantage,160.5055,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Est Pt Level 5 Office/Other Outpt Visit Eval And Mgmt, High Level Mdm Or 40-54 Min Total Time (Pro Cah)",,99215,CPT,Professional,Outpatient,,,,380,323,97.33,380,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,257.16992,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Est Pt Level 5 Office/Other Outpt Visit Eval And Mgmt, High Level Mdm Or 40-54 Min Total Time (Pro Cah)",,99215,CPT,Professional,Outpatient,,,,450,382.5,97.33,450,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,257.16992,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Est Pt Level 5 Office/Other Outpt Visit Eval And Mgmt, High Level Mdm Or 40-54 Min Total Time (Pro Cah)",,99215,CPT,Professional,Outpatient,,,,380,323,97.33,380,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,103.55072,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Est Pt Level 5 Office/Other Outpt Visit Eval And Mgmt, High Level Mdm Or 40-54 Min Total Time (Pro Cah)",,99215,CPT,Professional,Outpatient,,,,450,382.5,97.33,450,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,103.55072,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Est Pt Level 5 Office/Other Outpt Visit Eval And Mgmt, High Level Mdm Or 40-54 Min Total Time (Pro Cah)",,99215,CPT,Professional,Outpatient,,,,380,323,97.33,380,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),160.5055,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Est Pt Level 5 Office/Other Outpt Visit Eval And Mgmt, High Level Mdm Or 40-54 Min Total Time (Pro Cah)",,99215,CPT,Professional,Outpatient,,,,450,382.5,97.33,450,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),160.5055,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Est Pt Level 5 Office/Other Outpt Visit Eval And Mgmt, High Level Mdm Or 40-54 Min Total Time (Pro Cah)",,99215,CPT,Professional,Outpatient,,,,380,323,97.33,380,CorVel,Worker's Compensation,277.4288925,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Est Pt Level 5 Office/Other Outpt Visit Eval And Mgmt, High Level Mdm Or 40-54 Min Total Time (Pro Cah)",,99215,CPT,Professional,Outpatient,,,,450,382.5,97.33,450,CorVel,Worker's Compensation,277.4288925,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Est Pt Level 5 Office/Other Outpt Visit Eval And Mgmt, High Level Mdm Or 40-54 Min Total Time (Pro Cah)",,99215,CPT,Professional,Outpatient,,,,380,323,97.33,380,First Health Group Corporation,First Health Network,368.6,97,,percent of total billed charges,,
"Est Pt Level 5 Office/Other Outpt Visit Eval And Mgmt, High Level Mdm Or 40-54 Min Total Time (Pro Cah)",,99215,CPT,Professional,Outpatient,,,,450,382.5,97.33,450,First Health Group Corporation,First Health Network,436.5,97,,percent of total billed charges,,
"Est Pt Level 5 Office/Other Outpt Visit Eval And Mgmt, High Level Mdm Or 40-54 Min Total Time (Pro Cah)",,99215,CPT,Professional,Outpatient,,,,380,323,97.33,380,"Health Partners, Inc.",Commercial,299.64,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Est Pt Level 5 Office/Other Outpt Visit Eval And Mgmt, High Level Mdm Or 40-54 Min Total Time (Pro Cah)",,99215,CPT,Professional,Outpatient,,,,450,382.5,97.33,450,"Health Partners, Inc.",Commercial,299.64,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Est Pt Level 5 Office/Other Outpt Visit Eval And Mgmt, High Level Mdm Or 40-54 Min Total Time (Pro Cah)",,99215,CPT,Professional,Outpatient,,,,380,323,97.33,380,"Health Partners, Inc.",Medicare Advantage,160.5055,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Est Pt Level 5 Office/Other Outpt Visit Eval And Mgmt, High Level Mdm Or 40-54 Min Total Time (Pro Cah)",,99215,CPT,Professional,Outpatient,,,,450,382.5,97.33,450,"Health Partners, Inc.",Medicare Advantage,160.5055,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Est Pt Level 5 Office/Other Outpt Visit Eval And Mgmt, High Level Mdm Or 40-54 Min Total Time (Pro Cah)",,99215,CPT,Professional,Outpatient,,,,380,323,97.33,380,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),139.62,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Est Pt Level 5 Office/Other Outpt Visit Eval And Mgmt, High Level Mdm Or 40-54 Min Total Time (Pro Cah)",,99215,CPT,Professional,Outpatient,,,,450,382.5,97.33,450,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),139.62,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Est Pt Level 5 Office/Other Outpt Visit Eval And Mgmt, High Level Mdm Or 40-54 Min Total Time (Pro Cah)",,99215,CPT,Professional,Outpatient,,,,380,323,97.33,380,"Health Partners, Inc.",State of Minnesota Advantage Program,258.13986,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Est Pt Level 5 Office/Other Outpt Visit Eval And Mgmt, High Level Mdm Or 40-54 Min Total Time (Pro Cah)",,99215,CPT,Professional,Outpatient,,,,450,382.5,97.33,450,"Health Partners, Inc.",State of Minnesota Advantage Program,258.13986,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Est Pt Level 5 Office/Other Outpt Visit Eval And Mgmt, High Level Mdm Or 40-54 Min Total Time (Pro Cah)",,99215,CPT,Professional,Outpatient,,,,380,323,97.33,380,"Health Partners, Inc.",State Public Programs,97.33,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Est Pt Level 5 Office/Other Outpt Visit Eval And Mgmt, High Level Mdm Or 40-54 Min Total Time (Pro Cah)",,99215,CPT,Professional,Outpatient,,,,450,382.5,97.33,450,"Health Partners, Inc.",State Public Programs,97.33,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Est Pt Level 5 Office/Other Outpt Visit Eval And Mgmt, High Level Mdm Or 40-54 Min Total Time (Pro Cah)",,99215,CPT,Professional,Outpatient,,,,380,323,97.33,380,Humana Insurance Company,Commercial PPO,139.57,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Est Pt Level 5 Office/Other Outpt Visit Eval And Mgmt, High Level Mdm Or 40-54 Min Total Time (Pro Cah)",,99215,CPT,Professional,Outpatient,,,,450,382.5,97.33,450,Humana Insurance Company,Commercial PPO,139.57,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Est Pt Level 5 Office/Other Outpt Visit Eval And Mgmt, High Level Mdm Or 40-54 Min Total Time (Pro Cah)",,99215,CPT,Professional,Outpatient,,,,380,323,97.33,380,Humana Insurance Company,Medicare PPO,380,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Est Pt Level 5 Office/Other Outpt Visit Eval And Mgmt, High Level Mdm Or 40-54 Min Total Time (Pro Cah)",,99215,CPT,Professional,Outpatient,,,,450,382.5,97.33,450,Humana Insurance Company,Medicare PPO,450,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Est Pt Level 5 Office/Other Outpt Visit Eval And Mgmt, High Level Mdm Or 40-54 Min Total Time (Pro Cah)",,99215,CPT,Professional,Outpatient,,,,380,323,97.33,380,Medica,Individual & Family,322.24,84.8,,percent of total billed charges,,
"Est Pt Level 5 Office/Other Outpt Visit Eval And Mgmt, High Level Mdm Or 40-54 Min Total Time (Pro Cah)",,99215,CPT,Professional,Outpatient,,,,450,382.5,97.33,450,Medica,Individual & Family,381.6,84.8,,percent of total billed charges,,
"Est Pt Level 5 Office/Other Outpt Visit Eval And Mgmt, High Level Mdm Or 40-54 Min Total Time (Pro Cah)",,99215,CPT,Professional,Outpatient,,,,380,323,97.33,380,Medica,Medica Advantage Solution,189.24,49.8,,percent of total billed charges,,
"Est Pt Level 5 Office/Other Outpt Visit Eval And Mgmt, High Level Mdm Or 40-54 Min Total Time (Pro Cah)",,99215,CPT,Professional,Outpatient,,,,450,382.5,97.33,450,Medica,Medica Advantage Solution,224.1,49.8,,percent of total billed charges,,
"Est Pt Level 5 Office/Other Outpt Visit Eval And Mgmt, High Level Mdm Or 40-54 Min Total Time (Pro Cah)",,99215,CPT,Professional,Outpatient,,,,380,323,97.33,380,Medica,Medical Assistance,103.55,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Est Pt Level 5 Office/Other Outpt Visit Eval And Mgmt, High Level Mdm Or 40-54 Min Total Time (Pro Cah)",,99215,CPT,Professional,Outpatient,,,,450,382.5,97.33,450,Medica,Medical Assistance,103.55,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Est Pt Level 5 Office/Other Outpt Visit Eval And Mgmt, High Level Mdm Or 40-54 Min Total Time (Pro Cah)",,99215,CPT,Professional,Outpatient,,,,380,323,97.33,380,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,139.57,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Est Pt Level 5 Office/Other Outpt Visit Eval And Mgmt, High Level Mdm Or 40-54 Min Total Time (Pro Cah)",,99215,CPT,Professional,Outpatient,,,,450,382.5,97.33,450,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,139.57,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Est Pt Level 5 Office/Other Outpt Visit Eval And Mgmt, High Level Mdm Or 40-54 Min Total Time (Pro Cah)",,99215,CPT,Professional,Outpatient,,,,380,323,97.33,380,"Multiplan, Inc.","Multiplan, Inc.",357.2,94,,percent of total billed charges,,
"Est Pt Level 5 Office/Other Outpt Visit Eval And Mgmt, High Level Mdm Or 40-54 Min Total Time (Pro Cah)",,99215,CPT,Professional,Outpatient,,,,450,382.5,97.33,450,"Multiplan, Inc.","Multiplan, Inc.",423,94,,percent of total billed charges,,
"Est Pt Level 5 Office/Other Outpt Visit Eval And Mgmt, High Level Mdm Or 40-54 Min Total Time (Pro Cah)",,99215,CPT,Professional,Outpatient,,,,380,323,97.33,380,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,342.38,90.1,,percent of total billed charges,,
"Est Pt Level 5 Office/Other Outpt Visit Eval And Mgmt, High Level Mdm Or 40-54 Min Total Time (Pro Cah)",,99215,CPT,Professional,Outpatient,,,,450,382.5,97.33,450,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,405.45,90.1,,percent of total billed charges,,
"Est Pt Level 5 Office/Other Outpt Visit Eval And Mgmt, High Level Mdm Or 40-54 Min Total Time (Pro Cah)",,99215,CPT,Professional,Outpatient,,,,380,323,97.33,380,"Preferred One Administrative Services, INC.",PPO,374.68,98.6,,percent of total billed charges,,
"Est Pt Level 5 Office/Other Outpt Visit Eval And Mgmt, High Level Mdm Or 40-54 Min Total Time (Pro Cah)",,99215,CPT,Professional,Outpatient,,,,450,382.5,97.33,450,"Preferred One Administrative Services, INC.",PPO,443.7,98.6,,percent of total billed charges,,
"Est Pt Level 5 Office/Other Outpt Visit Eval And Mgmt, High Level Mdm Or 40-54 Min Total Time (Pro Cah)",,99215,CPT,Professional,Outpatient,,,,380,323,97.33,380,PrimeWest Health,Minnesota Senior Health Options (MSHO),160.5055,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Est Pt Level 5 Office/Other Outpt Visit Eval And Mgmt, High Level Mdm Or 40-54 Min Total Time (Pro Cah)",,99215,CPT,Professional,Outpatient,,,,450,382.5,97.33,450,PrimeWest Health,Minnesota Senior Health Options (MSHO),160.5055,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Est Pt Level 5 Office/Other Outpt Visit Eval And Mgmt, High Level Mdm Or 40-54 Min Total Time (Pro Cah)",,99215,CPT,Professional,Outpatient,,,,380,323,97.33,380,PrimeWest Health,MinnesotaCare,110.7992704,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Est Pt Level 5 Office/Other Outpt Visit Eval And Mgmt, High Level Mdm Or 40-54 Min Total Time (Pro Cah)",,99215,CPT,Professional,Outpatient,,,,450,382.5,97.33,450,PrimeWest Health,MinnesotaCare,110.7992704,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Est Pt Level 5 Office/Other Outpt Visit Eval And Mgmt, High Level Mdm Or 40-54 Min Total Time (Pro Cah)",,99215,CPT,Professional,Outpatient,,,,380,323,97.33,380,Sanford Health Plan,Sanford Health Plan,334.4,88,,percent of total billed charges,,
"Est Pt Level 5 Office/Other Outpt Visit Eval And Mgmt, High Level Mdm Or 40-54 Min Total Time (Pro Cah)",,99215,CPT,Professional,Outpatient,,,,450,382.5,97.33,450,Sanford Health Plan,Sanford Health Plan,396,88,,percent of total billed charges,,
"Est Pt Level 5 Office/Other Outpt Visit Eval And Mgmt, High Level Mdm Or 40-54 Min Total Time (Pro Cah)",,99215,CPT,Professional,Outpatient,,,,380,323,97.33,380,"UCare Health, Inc.",Individual & Family Plan,226.884992,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Est Pt Level 5 Office/Other Outpt Visit Eval And Mgmt, High Level Mdm Or 40-54 Min Total Time (Pro Cah)",,99215,CPT,Professional,Outpatient,,,,450,382.5,97.33,450,"UCare Health, Inc.",Individual & Family Plan,226.884992,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Est Pt Level 5 Office/Other Outpt Visit Eval And Mgmt, High Level Mdm Or 40-54 Min Total Time (Pro Cah)",,99215,CPT,Professional,Outpatient,,,,380,323,97.33,380,"UCare Health, Inc.",Medical Assistance,113.905792,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Est Pt Level 5 Office/Other Outpt Visit Eval And Mgmt, High Level Mdm Or 40-54 Min Total Time (Pro Cah)",,99215,CPT,Professional,Outpatient,,,,450,382.5,97.33,450,"UCare Health, Inc.",Medical Assistance,113.905792,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Est Pt Level 5 Office/Other Outpt Visit Eval And Mgmt, High Level Mdm Or 40-54 Min Total Time (Pro Cah)",,99215,CPT,Professional,Outpatient,,,,380,323,97.33,380,"UCare Health, Inc.",Medicare Advantage,160.5055,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Est Pt Level 5 Office/Other Outpt Visit Eval And Mgmt, High Level Mdm Or 40-54 Min Total Time (Pro Cah)",,99215,CPT,Professional,Outpatient,,,,450,382.5,97.33,450,"UCare Health, Inc.",Medicare Advantage,160.5055,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Est Pt Level 5 Office/Other Outpt Visit Eval And Mgmt, High Level Mdm Or 40-54 Min Total Time (Pro Cah)",,99215,CPT,Professional,Outpatient,,,,380,323,97.33,380,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),128.4044,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Est Pt Level 5 Office/Other Outpt Visit Eval And Mgmt, High Level Mdm Or 40-54 Min Total Time (Pro Cah)",,99215,CPT,Professional,Outpatient,,,,450,382.5,97.33,450,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),128.4044,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Est Pt Level 5 Office/Other Outpt Visit Eval And Mgmt, High Level Mdm Or 40-54 Min Total Time (Pro Cah)",,99215,CPT,Professional,Outpatient,,,,380,323,97.33,380,UnitedHealthcare,Individual & Family,380,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Est Pt Level 5 Office/Other Outpt Visit Eval And Mgmt, High Level Mdm Or 40-54 Min Total Time (Pro Cah)",,99215,CPT,Professional,Outpatient,,,,450,382.5,97.33,450,UnitedHealthcare,Individual & Family,450,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Est Pt Level 5 Office/Other Outpt Visit Eval And Mgmt, High Level Mdm Or 40-54 Min Total Time (Pro Cah)",,99215,CPT,Professional,Outpatient,,,,380,323,97.33,380,UnitedHealthcare,Medicare Advantage,160.5055,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Est Pt Level 5 Office/Other Outpt Visit Eval And Mgmt, High Level Mdm Or 40-54 Min Total Time (Pro Cah)",,99215,CPT,Professional,Outpatient,,,,450,382.5,97.33,450,UnitedHealthcare,Medicare Advantage,160.5055,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Est Pt Level 5 Office/Other Outpt Visit Eval And Mgmt, High Level Mdm Or 40-54 Min Total Time (Pro Cah)",,99215,CPT,Professional,Outpatient,,,,380,323,97.33,380,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,103.55072,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Est Pt Level 5 Office/Other Outpt Visit Eval And Mgmt, High Level Mdm Or 40-54 Min Total Time (Pro Cah)",,99215,CPT,Professional,Outpatient,,,,450,382.5,97.33,450,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,103.55072,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Initial Hosp Inpt Or Obs Care, Per Day, Straightforward Or Low Mdm Or 40-54 Mins (Pro Cah)",,99221,CPT,Professional,Both,,,,231,196.35,51.29,231,Aetna,Commercial,196.35,85,,percent of total billed charges,,
"Initial Hosp Inpt Or Obs Care, Per Day, Straightforward Or Low Mdm Or 40-54 Mins (Pro Cah)",,99221,CPT,Professional,Both,,,,231,196.35,51.29,231,Aetna,Medicare Advantage,97.03,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Initial Hosp Inpt Or Obs Care, Per Day, Straightforward Or Low Mdm Or 40-54 Mins (Pro Cah)",,99221,CPT,Professional,Both,,,,231,196.35,51.29,231,Aetna,PPO,214.83,93,,percent of total billed charges,,
"Initial Hosp Inpt Or Obs Care, Per Day, Straightforward Or Low Mdm Or 40-54 Mins (Pro Cah)",,99221,CPT,Professional,Both,,,,231,196.35,51.29,231,America's PPO,America's PPO,197.3664,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Initial Hosp Inpt Or Obs Care, Per Day, Straightforward Or Low Mdm Or 40-54 Mins (Pro Cah)",,99221,CPT,Professional,Both,,,,231,196.35,51.29,231,BlueCross BlueShield Minnesota, Federal Employee Program,147.21,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Initial Hosp Inpt Or Obs Care, Per Day, Straightforward Or Low Mdm Or 40-54 Mins (Pro Cah)",,99221,CPT,Professional,Both,,,,231,196.35,51.29,231,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,149.56536,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Initial Hosp Inpt Or Obs Care, Per Day, Straightforward Or Low Mdm Or 40-54 Mins (Pro Cah)",,99221,CPT,Professional,Both,,,,231,196.35,51.29,231,BlueCross BlueShield Minnesota,High Value Network Plan,149.56536,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Initial Hosp Inpt Or Obs Care, Per Day, Straightforward Or Low Mdm Or 40-54 Mins (Pro Cah)",,99221,CPT,Professional,Both,,,,231,196.35,51.29,231,BlueCross BlueShield Minnesota,Medicare Advantage,91.6205,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Initial Hosp Inpt Or Obs Care, Per Day, Straightforward Or Low Mdm Or 40-54 Mins (Pro Cah)",,99221,CPT,Professional,Both,,,,231,196.35,51.29,231,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,149.56536,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Initial Hosp Inpt Or Obs Care, Per Day, Straightforward Or Low Mdm Or 40-54 Mins (Pro Cah)",,99221,CPT,Professional,Both,,,,231,196.35,51.29,231,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,59.21248,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Initial Hosp Inpt Or Obs Care, Per Day, Straightforward Or Low Mdm Or 40-54 Mins (Pro Cah)",,99221,CPT,Professional,Both,,,,231,196.35,51.29,231,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),91.6205,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Initial Hosp Inpt Or Obs Care, Per Day, Straightforward Or Low Mdm Or 40-54 Mins (Pro Cah)",,99221,CPT,Professional,Both,,,,231,196.35,51.29,231,CorVel,Worker's Compensation,187.0194159,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Initial Hosp Inpt Or Obs Care, Per Day, Straightforward Or Low Mdm Or 40-54 Mins (Pro Cah)",,99221,CPT,Professional,Both,,,,231,196.35,51.29,231,First Health Group Corporation,First Health Network,224.07,97,,percent of total billed charges,,
"Initial Hosp Inpt Or Obs Care, Per Day, Straightforward Or Low Mdm Or 40-54 Mins (Pro Cah)",,99221,CPT,Professional,Both,,,,231,196.35,51.29,231,"Health Partners, Inc.",Commercial,201.7,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Initial Hosp Inpt Or Obs Care, Per Day, Straightforward Or Low Mdm Or 40-54 Mins (Pro Cah)",,99221,CPT,Professional,Both,,,,231,196.35,51.29,231,"Health Partners, Inc.",Medicare Advantage,91.6205,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Initial Hosp Inpt Or Obs Care, Per Day, Straightforward Or Low Mdm Or 40-54 Mins (Pro Cah)",,99221,CPT,Professional,Both,,,,231,196.35,51.29,231,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),79.63,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Initial Hosp Inpt Or Obs Care, Per Day, Straightforward Or Low Mdm Or 40-54 Mins (Pro Cah)",,99221,CPT,Professional,Both,,,,231,196.35,51.29,231,"Health Partners, Inc.",State of Minnesota Advantage Program,173.76455,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Initial Hosp Inpt Or Obs Care, Per Day, Straightforward Or Low Mdm Or 40-54 Mins (Pro Cah)",,99221,CPT,Professional,Both,,,,231,196.35,51.29,231,"Health Partners, Inc.",State Public Programs,51.29,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Initial Hosp Inpt Or Obs Care, Per Day, Straightforward Or Low Mdm Or 40-54 Mins (Pro Cah)",,99221,CPT,Professional,Both,,,,231,196.35,51.29,231,Humana Insurance Company,Commercial PPO,79.67,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Initial Hosp Inpt Or Obs Care, Per Day, Straightforward Or Low Mdm Or 40-54 Mins (Pro Cah)",,99221,CPT,Professional,Both,,,,231,196.35,51.29,231,Humana Insurance Company,Medicare PPO,231,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Initial Hosp Inpt Or Obs Care, Per Day, Straightforward Or Low Mdm Or 40-54 Mins (Pro Cah)",,99221,CPT,Professional,Both,,,,231,196.35,51.29,231,Medica,Individual & Family,195.888,84.8,,percent of total billed charges,,
"Initial Hosp Inpt Or Obs Care, Per Day, Straightforward Or Low Mdm Or 40-54 Mins (Pro Cah)",,99221,CPT,Professional,Both,,,,231,196.35,51.29,231,Medica,Medica Advantage Solution,115.038,49.8,,percent of total billed charges,,
"Initial Hosp Inpt Or Obs Care, Per Day, Straightforward Or Low Mdm Or 40-54 Mins (Pro Cah)",,99221,CPT,Professional,Both,,,,231,196.35,51.29,231,Medica,Medical Assistance,59.21,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Initial Hosp Inpt Or Obs Care, Per Day, Straightforward Or Low Mdm Or 40-54 Mins (Pro Cah)",,99221,CPT,Professional,Both,,,,231,196.35,51.29,231,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,79.67,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Initial Hosp Inpt Or Obs Care, Per Day, Straightforward Or Low Mdm Or 40-54 Mins (Pro Cah)",,99221,CPT,Professional,Both,,,,231,196.35,51.29,231,"Multiplan, Inc.","Multiplan, Inc.",217.14,94,,percent of total billed charges,,
"Initial Hosp Inpt Or Obs Care, Per Day, Straightforward Or Low Mdm Or 40-54 Mins (Pro Cah)",,99221,CPT,Professional,Both,,,,231,196.35,51.29,231,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,208.131,90.1,,percent of total billed charges,,
"Initial Hosp Inpt Or Obs Care, Per Day, Straightforward Or Low Mdm Or 40-54 Mins (Pro Cah)",,99221,CPT,Professional,Both,,,,231,196.35,51.29,231,"Preferred One Administrative Services, INC.",PPO,227.766,98.6,,percent of total billed charges,,
"Initial Hosp Inpt Or Obs Care, Per Day, Straightforward Or Low Mdm Or 40-54 Mins (Pro Cah)",,99221,CPT,Professional,Both,,,,231,196.35,51.29,231,PrimeWest Health,Minnesota Senior Health Options (MSHO),91.6205,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Initial Hosp Inpt Or Obs Care, Per Day, Straightforward Or Low Mdm Or 40-54 Mins (Pro Cah)",,99221,CPT,Professional,Both,,,,231,196.35,51.29,231,PrimeWest Health,MinnesotaCare,63.3573536,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Initial Hosp Inpt Or Obs Care, Per Day, Straightforward Or Low Mdm Or 40-54 Mins (Pro Cah)",,99221,CPT,Professional,Both,,,,231,196.35,51.29,231,Sanford Health Plan,Sanford Health Plan,203.28,88,,percent of total billed charges,,
"Initial Hosp Inpt Or Obs Care, Per Day, Straightforward Or Low Mdm Or 40-54 Mins (Pro Cah)",,99221,CPT,Professional,Both,,,,231,196.35,51.29,231,"UCare Health, Inc.",Individual & Family Plan,129.511552,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Initial Hosp Inpt Or Obs Care, Per Day, Straightforward Or Low Mdm Or 40-54 Mins (Pro Cah)",,99221,CPT,Professional,Both,,,,231,196.35,51.29,231,"UCare Health, Inc.",Medical Assistance,65.133728,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Initial Hosp Inpt Or Obs Care, Per Day, Straightforward Or Low Mdm Or 40-54 Mins (Pro Cah)",,99221,CPT,Professional,Both,,,,231,196.35,51.29,231,"UCare Health, Inc.",Medicare Advantage,91.6205,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Initial Hosp Inpt Or Obs Care, Per Day, Straightforward Or Low Mdm Or 40-54 Mins (Pro Cah)",,99221,CPT,Professional,Both,,,,231,196.35,51.29,231,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),73.2964,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Initial Hosp Inpt Or Obs Care, Per Day, Straightforward Or Low Mdm Or 40-54 Mins (Pro Cah)",,99221,CPT,Professional,Both,,,,231,196.35,51.29,231,UnitedHealthcare,Individual & Family,231,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Initial Hosp Inpt Or Obs Care, Per Day, Straightforward Or Low Mdm Or 40-54 Mins (Pro Cah)",,99221,CPT,Professional,Both,,,,231,196.35,51.29,231,UnitedHealthcare,Medicare Advantage,91.6205,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Initial Hosp Inpt Or Obs Care, Per Day, Straightforward Or Low Mdm Or 40-54 Mins (Pro Cah)",,99221,CPT,Professional,Both,,,,231,196.35,51.29,231,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,59.21248,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Initial Hosp Inpt Or Obs Care, Per Day, Moderate Mdm Or 55-74 Mins (Pro Cah)",,99222,CPT,Professional,Both,,,,277,235.45,81.18,277,Aetna,Commercial,235.45,85,,percent of total billed charges,,
"Initial Hosp Inpt Or Obs Care, Per Day, Moderate Mdm Or 55-74 Mins (Pro Cah)",,99222,CPT,Professional,Both,,,,277,235.45,81.18,277,Aetna,Medicare Advantage,131.83,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Initial Hosp Inpt Or Obs Care, Per Day, Moderate Mdm Or 55-74 Mins (Pro Cah)",,99222,CPT,Professional,Both,,,,277,235.45,81.18,277,Aetna,PPO,257.61,93,,percent of total billed charges,,
"Initial Hosp Inpt Or Obs Care, Per Day, Moderate Mdm Or 55-74 Mins (Pro Cah)",,99222,CPT,Professional,Both,,,,277,235.45,81.18,277,America's PPO,America's PPO,236.6688,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Initial Hosp Inpt Or Obs Care, Per Day, Moderate Mdm Or 55-74 Mins (Pro Cah)",,99222,CPT,Professional,Both,,,,277,235.45,81.18,277,BlueCross BlueShield Minnesota, Federal Employee Program,230.38,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Initial Hosp Inpt Or Obs Care, Per Day, Moderate Mdm Or 55-74 Mins (Pro Cah)",,99222,CPT,Professional,Both,,,,277,235.45,81.18,277,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,234.06608,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Initial Hosp Inpt Or Obs Care, Per Day, Moderate Mdm Or 55-74 Mins (Pro Cah)",,99222,CPT,Professional,Both,,,,277,235.45,81.18,277,BlueCross BlueShield Minnesota,High Value Network Plan,234.06608,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Initial Hosp Inpt Or Obs Care, Per Day, Moderate Mdm Or 55-74 Mins (Pro Cah)",,99222,CPT,Professional,Both,,,,277,235.45,81.18,277,BlueCross BlueShield Minnesota,Medicare Advantage,145.015,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Initial Hosp Inpt Or Obs Care, Per Day, Moderate Mdm Or 55-74 Mins (Pro Cah)",,99222,CPT,Professional,Both,,,,277,235.45,81.18,277,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,234.06608,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Initial Hosp Inpt Or Obs Care, Per Day, Moderate Mdm Or 55-74 Mins (Pro Cah)",,99222,CPT,Professional,Both,,,,277,235.45,81.18,277,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,93.726,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Initial Hosp Inpt Or Obs Care, Per Day, Moderate Mdm Or 55-74 Mins (Pro Cah)",,99222,CPT,Professional,Both,,,,277,235.45,81.18,277,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),145.015,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Initial Hosp Inpt Or Obs Care, Per Day, Moderate Mdm Or 55-74 Mins (Pro Cah)",,99222,CPT,Professional,Both,,,,277,235.45,81.18,277,CorVel,Worker's Compensation,254.016789,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Initial Hosp Inpt Or Obs Care, Per Day, Moderate Mdm Or 55-74 Mins (Pro Cah)",,99222,CPT,Professional,Both,,,,277,235.45,81.18,277,First Health Group Corporation,First Health Network,268.69,97,,percent of total billed charges,,
"Initial Hosp Inpt Or Obs Care, Per Day, Moderate Mdm Or 55-74 Mins (Pro Cah)",,99222,CPT,Professional,Both,,,,277,235.45,81.18,277,"Health Partners, Inc.",Commercial,274.25,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Initial Hosp Inpt Or Obs Care, Per Day, Moderate Mdm Or 55-74 Mins (Pro Cah)",,99222,CPT,Professional,Both,,,,277,235.45,81.18,277,"Health Partners, Inc.",Medicare Advantage,145.015,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Initial Hosp Inpt Or Obs Care, Per Day, Moderate Mdm Or 55-74 Mins (Pro Cah)",,99222,CPT,Professional,Both,,,,277,235.45,81.18,277,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),126.06,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Initial Hosp Inpt Or Obs Care, Per Day, Moderate Mdm Or 55-74 Mins (Pro Cah)",,99222,CPT,Professional,Both,,,,277,235.45,81.18,277,"Health Partners, Inc.",State of Minnesota Advantage Program,236.266375,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Initial Hosp Inpt Or Obs Care, Per Day, Moderate Mdm Or 55-74 Mins (Pro Cah)",,99222,CPT,Professional,Both,,,,277,235.45,81.18,277,"Health Partners, Inc.",State Public Programs,81.18,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Initial Hosp Inpt Or Obs Care, Per Day, Moderate Mdm Or 55-74 Mins (Pro Cah)",,99222,CPT,Professional,Both,,,,277,235.45,81.18,277,Humana Insurance Company,Commercial PPO,126.1,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Initial Hosp Inpt Or Obs Care, Per Day, Moderate Mdm Or 55-74 Mins (Pro Cah)",,99222,CPT,Professional,Both,,,,277,235.45,81.18,277,Humana Insurance Company,Medicare PPO,277,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Initial Hosp Inpt Or Obs Care, Per Day, Moderate Mdm Or 55-74 Mins (Pro Cah)",,99222,CPT,Professional,Both,,,,277,235.45,81.18,277,Medica,Individual & Family,234.896,84.8,,percent of total billed charges,,
"Initial Hosp Inpt Or Obs Care, Per Day, Moderate Mdm Or 55-74 Mins (Pro Cah)",,99222,CPT,Professional,Both,,,,277,235.45,81.18,277,Medica,Medica Advantage Solution,137.946,49.8,,percent of total billed charges,,
"Initial Hosp Inpt Or Obs Care, Per Day, Moderate Mdm Or 55-74 Mins (Pro Cah)",,99222,CPT,Professional,Both,,,,277,235.45,81.18,277,Medica,Medical Assistance,93.73,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Initial Hosp Inpt Or Obs Care, Per Day, Moderate Mdm Or 55-74 Mins (Pro Cah)",,99222,CPT,Professional,Both,,,,277,235.45,81.18,277,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,126.1,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Initial Hosp Inpt Or Obs Care, Per Day, Moderate Mdm Or 55-74 Mins (Pro Cah)",,99222,CPT,Professional,Both,,,,277,235.45,81.18,277,"Multiplan, Inc.","Multiplan, Inc.",260.38,94,,percent of total billed charges,,
"Initial Hosp Inpt Or Obs Care, Per Day, Moderate Mdm Or 55-74 Mins (Pro Cah)",,99222,CPT,Professional,Both,,,,277,235.45,81.18,277,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,249.577,90.1,,percent of total billed charges,,
"Initial Hosp Inpt Or Obs Care, Per Day, Moderate Mdm Or 55-74 Mins (Pro Cah)",,99222,CPT,Professional,Both,,,,277,235.45,81.18,277,"Preferred One Administrative Services, INC.",PPO,273.122,98.6,,percent of total billed charges,,
"Initial Hosp Inpt Or Obs Care, Per Day, Moderate Mdm Or 55-74 Mins (Pro Cah)",,99222,CPT,Professional,Both,,,,277,235.45,81.18,277,PrimeWest Health,Minnesota Senior Health Options (MSHO),145.015,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Initial Hosp Inpt Or Obs Care, Per Day, Moderate Mdm Or 55-74 Mins (Pro Cah)",,99222,CPT,Professional,Both,,,,277,235.45,81.18,277,PrimeWest Health,MinnesotaCare,100.28682,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Initial Hosp Inpt Or Obs Care, Per Day, Moderate Mdm Or 55-74 Mins (Pro Cah)",,99222,CPT,Professional,Both,,,,277,235.45,81.18,277,Sanford Health Plan,Sanford Health Plan,243.76,88,,percent of total billed charges,,
"Initial Hosp Inpt Or Obs Care, Per Day, Moderate Mdm Or 55-74 Mins (Pro Cah)",,99222,CPT,Professional,Both,,,,277,235.45,81.18,277,"UCare Health, Inc.",Individual & Family Plan,204.98816,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Initial Hosp Inpt Or Obs Care, Per Day, Moderate Mdm Or 55-74 Mins (Pro Cah)",,99222,CPT,Professional,Both,,,,277,235.45,81.18,277,"UCare Health, Inc.",Medical Assistance,103.0986,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Initial Hosp Inpt Or Obs Care, Per Day, Moderate Mdm Or 55-74 Mins (Pro Cah)",,99222,CPT,Professional,Both,,,,277,235.45,81.18,277,"UCare Health, Inc.",Medicare Advantage,145.015,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Initial Hosp Inpt Or Obs Care, Per Day, Moderate Mdm Or 55-74 Mins (Pro Cah)",,99222,CPT,Professional,Both,,,,277,235.45,81.18,277,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),116.012,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Initial Hosp Inpt Or Obs Care, Per Day, Moderate Mdm Or 55-74 Mins (Pro Cah)",,99222,CPT,Professional,Both,,,,277,235.45,81.18,277,UnitedHealthcare,Individual & Family,277,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Initial Hosp Inpt Or Obs Care, Per Day, Moderate Mdm Or 55-74 Mins (Pro Cah)",,99222,CPT,Professional,Both,,,,277,235.45,81.18,277,UnitedHealthcare,Medicare Advantage,145.015,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Initial Hosp Inpt Or Obs Care, Per Day, Moderate Mdm Or 55-74 Mins (Pro Cah)",,99222,CPT,Professional,Both,,,,277,235.45,81.18,277,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,93.726,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Initial Hosp Inpt Or Obs Care, Per Day, High Mdm Or 75+ Mins (Pro Cah)",,99223,CPT,Professional,Both,,,,372,316.2,108.68,372,Aetna,Commercial,316.2,85,,percent of total billed charges,,
"Initial Hosp Inpt Or Obs Care, Per Day, High Mdm Or 75+ Mins (Pro Cah)",,99223,CPT,Professional,Both,,,,372,316.2,108.68,372,Aetna,Medicare Advantage,194.69,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Initial Hosp Inpt Or Obs Care, Per Day, High Mdm Or 75+ Mins (Pro Cah)",,99223,CPT,Professional,Both,,,,372,316.2,108.68,372,Aetna,PPO,345.96,93,,percent of total billed charges,,
"Initial Hosp Inpt Or Obs Care, Per Day, High Mdm Or 75+ Mins (Pro Cah)",,99223,CPT,Professional,Both,,,,372,316.2,108.68,372,America's PPO,America's PPO,317.8368,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Initial Hosp Inpt Or Obs Care, Per Day, High Mdm Or 75+ Mins (Pro Cah)",,99223,CPT,Professional,Both,,,,372,316.2,108.68,372,BlueCross BlueShield Minnesota, Federal Employee Program,306.98,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Initial Hosp Inpt Or Obs Care, Per Day, High Mdm Or 75+ Mins (Pro Cah)",,99223,CPT,Professional,Both,,,,372,316.2,108.68,372,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,311.89168,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Initial Hosp Inpt Or Obs Care, Per Day, High Mdm Or 75+ Mins (Pro Cah)",,99223,CPT,Professional,Both,,,,372,316.2,108.68,372,BlueCross BlueShield Minnesota,High Value Network Plan,311.89168,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Initial Hosp Inpt Or Obs Care, Per Day, High Mdm Or 75+ Mins (Pro Cah)",,99223,CPT,Professional,Both,,,,372,316.2,108.68,372,BlueCross BlueShield Minnesota,Medicare Advantage,194.1085,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Initial Hosp Inpt Or Obs Care, Per Day, High Mdm Or 75+ Mins (Pro Cah)",,99223,CPT,Professional,Both,,,,372,316.2,108.68,372,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,311.89168,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Initial Hosp Inpt Or Obs Care, Per Day, High Mdm Or 75+ Mins (Pro Cah)",,99223,CPT,Professional,Both,,,,372,316.2,108.68,372,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,125.476,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Initial Hosp Inpt Or Obs Care, Per Day, High Mdm Or 75+ Mins (Pro Cah)",,99223,CPT,Professional,Both,,,,372,316.2,108.68,372,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),194.1085,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Initial Hosp Inpt Or Obs Care, Per Day, High Mdm Or 75+ Mins (Pro Cah)",,99223,CPT,Professional,Both,,,,372,316.2,108.68,372,CorVel,Worker's Compensation,372,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Initial Hosp Inpt Or Obs Care, Per Day, High Mdm Or 75+ Mins (Pro Cah)",,99223,CPT,Professional,Both,,,,372,316.2,108.68,372,First Health Group Corporation,First Health Network,360.84,97,,percent of total billed charges,,
"Initial Hosp Inpt Or Obs Care, Per Day, High Mdm Or 75+ Mins (Pro Cah)",,99223,CPT,Professional,Both,,,,372,316.2,108.68,372,"Health Partners, Inc.",Commercial,372,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Initial Hosp Inpt Or Obs Care, Per Day, High Mdm Or 75+ Mins (Pro Cah)",,99223,CPT,Professional,Both,,,,372,316.2,108.68,372,"Health Partners, Inc.",Medicare Advantage,194.1085,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Initial Hosp Inpt Or Obs Care, Per Day, High Mdm Or 75+ Mins (Pro Cah)",,99223,CPT,Professional,Both,,,,372,316.2,108.68,372,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),168.76,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Initial Hosp Inpt Or Obs Care, Per Day, High Mdm Or 75+ Mins (Pro Cah)",,99223,CPT,Professional,Both,,,,372,316.2,108.68,372,"Health Partners, Inc.",State of Minnesota Advantage Program,347.520485,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Initial Hosp Inpt Or Obs Care, Per Day, High Mdm Or 75+ Mins (Pro Cah)",,99223,CPT,Professional,Both,,,,372,316.2,108.68,372,"Health Partners, Inc.",State Public Programs,108.68,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Initial Hosp Inpt Or Obs Care, Per Day, High Mdm Or 75+ Mins (Pro Cah)",,99223,CPT,Professional,Both,,,,372,316.2,108.68,372,Humana Insurance Company,Commercial PPO,168.79,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Initial Hosp Inpt Or Obs Care, Per Day, High Mdm Or 75+ Mins (Pro Cah)",,99223,CPT,Professional,Both,,,,372,316.2,108.68,372,Humana Insurance Company,Medicare PPO,372,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Initial Hosp Inpt Or Obs Care, Per Day, High Mdm Or 75+ Mins (Pro Cah)",,99223,CPT,Professional,Both,,,,372,316.2,108.68,372,Medica,Individual & Family,315.456,84.8,,percent of total billed charges,,
"Initial Hosp Inpt Or Obs Care, Per Day, High Mdm Or 75+ Mins (Pro Cah)",,99223,CPT,Professional,Both,,,,372,316.2,108.68,372,Medica,Medica Advantage Solution,185.256,49.8,,percent of total billed charges,,
"Initial Hosp Inpt Or Obs Care, Per Day, High Mdm Or 75+ Mins (Pro Cah)",,99223,CPT,Professional,Both,,,,372,316.2,108.68,372,Medica,Medical Assistance,125.48,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Initial Hosp Inpt Or Obs Care, Per Day, High Mdm Or 75+ Mins (Pro Cah)",,99223,CPT,Professional,Both,,,,372,316.2,108.68,372,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,168.79,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Initial Hosp Inpt Or Obs Care, Per Day, High Mdm Or 75+ Mins (Pro Cah)",,99223,CPT,Professional,Both,,,,372,316.2,108.68,372,"Multiplan, Inc.","Multiplan, Inc.",349.68,94,,percent of total billed charges,,
"Initial Hosp Inpt Or Obs Care, Per Day, High Mdm Or 75+ Mins (Pro Cah)",,99223,CPT,Professional,Both,,,,372,316.2,108.68,372,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,335.172,90.1,,percent of total billed charges,,
"Initial Hosp Inpt Or Obs Care, Per Day, High Mdm Or 75+ Mins (Pro Cah)",,99223,CPT,Professional,Both,,,,372,316.2,108.68,372,"Preferred One Administrative Services, INC.",PPO,366.792,98.6,,percent of total billed charges,,
"Initial Hosp Inpt Or Obs Care, Per Day, High Mdm Or 75+ Mins (Pro Cah)",,99223,CPT,Professional,Both,,,,372,316.2,108.68,372,PrimeWest Health,Minnesota Senior Health Options (MSHO),194.1085,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Initial Hosp Inpt Or Obs Care, Per Day, High Mdm Or 75+ Mins (Pro Cah)",,99223,CPT,Professional,Both,,,,372,316.2,108.68,372,PrimeWest Health,MinnesotaCare,134.25932,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Initial Hosp Inpt Or Obs Care, Per Day, High Mdm Or 75+ Mins (Pro Cah)",,99223,CPT,Professional,Both,,,,372,316.2,108.68,372,Sanford Health Plan,Sanford Health Plan,327.36,88,,percent of total billed charges,,
"Initial Hosp Inpt Or Obs Care, Per Day, High Mdm Or 75+ Mins (Pro Cah)",,99223,CPT,Professional,Both,,,,372,316.2,108.68,372,"UCare Health, Inc.",Individual & Family Plan,274.385024,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Initial Hosp Inpt Or Obs Care, Per Day, High Mdm Or 75+ Mins (Pro Cah)",,99223,CPT,Professional,Both,,,,372,316.2,108.68,372,"UCare Health, Inc.",Medical Assistance,138.0236,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Initial Hosp Inpt Or Obs Care, Per Day, High Mdm Or 75+ Mins (Pro Cah)",,99223,CPT,Professional,Both,,,,372,316.2,108.68,372,"UCare Health, Inc.",Medicare Advantage,194.1085,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Initial Hosp Inpt Or Obs Care, Per Day, High Mdm Or 75+ Mins (Pro Cah)",,99223,CPT,Professional,Both,,,,372,316.2,108.68,372,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),155.2868,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Initial Hosp Inpt Or Obs Care, Per Day, High Mdm Or 75+ Mins (Pro Cah)",,99223,CPT,Professional,Both,,,,372,316.2,108.68,372,UnitedHealthcare,Individual & Family,372,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Initial Hosp Inpt Or Obs Care, Per Day, High Mdm Or 75+ Mins (Pro Cah)",,99223,CPT,Professional,Both,,,,372,316.2,108.68,372,UnitedHealthcare,Medicare Advantage,194.1085,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Initial Hosp Inpt Or Obs Care, Per Day, High Mdm Or 75+ Mins (Pro Cah)",,99223,CPT,Professional,Both,,,,372,316.2,108.68,372,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,125.476,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Subsq Hosp Inpt Or Obs Care, Per Day, Straightforward Or Low Mdm Or 25-34 Mins (Pro Cah)",,99231,CPT,Professional,Both,,,,96,81.6,30.55,96,Aetna,Commercial,81.6,85,,percent of total billed charges,,
"Subsq Hosp Inpt Or Obs Care, Per Day, Straightforward Or Low Mdm Or 25-34 Mins (Pro Cah)",,99231,CPT,Professional,Both,,,,96,81.6,30.55,96,Aetna,Medicare Advantage,37.39,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Subsq Hosp Inpt Or Obs Care, Per Day, Straightforward Or Low Mdm Or 25-34 Mins (Pro Cah)",,99231,CPT,Professional,Both,,,,96,81.6,30.55,96,Aetna,PPO,89.28,93,,percent of total billed charges,,
"Subsq Hosp Inpt Or Obs Care, Per Day, Straightforward Or Low Mdm Or 25-34 Mins (Pro Cah)",,99231,CPT,Professional,Both,,,,96,81.6,30.55,96,America's PPO,America's PPO,82.0224,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Subsq Hosp Inpt Or Obs Care, Per Day, Straightforward Or Low Mdm Or 25-34 Mins (Pro Cah)",,99231,CPT,Professional,Both,,,,96,81.6,30.55,96,BlueCross BlueShield Minnesota, Federal Employee Program,87.96,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Subsq Hosp Inpt Or Obs Care, Per Day, Straightforward Or Low Mdm Or 25-34 Mins (Pro Cah)",,99231,CPT,Professional,Both,,,,96,81.6,30.55,96,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,89.36736,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Subsq Hosp Inpt Or Obs Care, Per Day, Straightforward Or Low Mdm Or 25-34 Mins (Pro Cah)",,99231,CPT,Professional,Both,,,,96,81.6,30.55,96,BlueCross BlueShield Minnesota,High Value Network Plan,89.36736,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Subsq Hosp Inpt Or Obs Care, Per Day, Straightforward Or Low Mdm Or 25-34 Mins (Pro Cah)",,99231,CPT,Professional,Both,,,,96,81.6,30.55,96,BlueCross BlueShield Minnesota,Medicare Advantage,54.9355,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Subsq Hosp Inpt Or Obs Care, Per Day, Straightforward Or Low Mdm Or 25-34 Mins (Pro Cah)",,99231,CPT,Professional,Both,,,,96,81.6,30.55,96,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,89.36736,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Subsq Hosp Inpt Or Obs Care, Per Day, Straightforward Or Low Mdm Or 25-34 Mins (Pro Cah)",,99231,CPT,Professional,Both,,,,96,81.6,30.55,96,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,35.27552,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Subsq Hosp Inpt Or Obs Care, Per Day, Straightforward Or Low Mdm Or 25-34 Mins (Pro Cah)",,99231,CPT,Professional,Both,,,,96,81.6,30.55,96,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),54.9355,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Subsq Hosp Inpt Or Obs Care, Per Day, Straightforward Or Low Mdm Or 25-34 Mins (Pro Cah)",,99231,CPT,Professional,Both,,,,96,81.6,30.55,96,CorVel,Worker's Compensation,72.4415016,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Subsq Hosp Inpt Or Obs Care, Per Day, Straightforward Or Low Mdm Or 25-34 Mins (Pro Cah)",,99231,CPT,Professional,Both,,,,96,81.6,30.55,96,First Health Group Corporation,First Health Network,93.12,97,,percent of total billed charges,,
"Subsq Hosp Inpt Or Obs Care, Per Day, Straightforward Or Low Mdm Or 25-34 Mins (Pro Cah)",,99231,CPT,Professional,Both,,,,96,81.6,30.55,96,"Health Partners, Inc.",Commercial,77.63,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Subsq Hosp Inpt Or Obs Care, Per Day, Straightforward Or Low Mdm Or 25-34 Mins (Pro Cah)",,99231,CPT,Professional,Both,,,,96,81.6,30.55,96,"Health Partners, Inc.",Medicare Advantage,54.9355,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Subsq Hosp Inpt Or Obs Care, Per Day, Straightforward Or Low Mdm Or 25-34 Mins (Pro Cah)",,99231,CPT,Professional,Both,,,,96,81.6,30.55,96,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),47.78,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Subsq Hosp Inpt Or Obs Care, Per Day, Straightforward Or Low Mdm Or 25-34 Mins (Pro Cah)",,99231,CPT,Professional,Both,,,,96,81.6,30.55,96,"Health Partners, Inc.",State of Minnesota Advantage Program,66.878245,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Subsq Hosp Inpt Or Obs Care, Per Day, Straightforward Or Low Mdm Or 25-34 Mins (Pro Cah)",,99231,CPT,Professional,Both,,,,96,81.6,30.55,96,"Health Partners, Inc.",State Public Programs,30.55,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Subsq Hosp Inpt Or Obs Care, Per Day, Straightforward Or Low Mdm Or 25-34 Mins (Pro Cah)",,99231,CPT,Professional,Both,,,,96,81.6,30.55,96,Humana Insurance Company,Commercial PPO,47.77,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Subsq Hosp Inpt Or Obs Care, Per Day, Straightforward Or Low Mdm Or 25-34 Mins (Pro Cah)",,99231,CPT,Professional,Both,,,,96,81.6,30.55,96,Humana Insurance Company,Medicare PPO,96,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Subsq Hosp Inpt Or Obs Care, Per Day, Straightforward Or Low Mdm Or 25-34 Mins (Pro Cah)",,99231,CPT,Professional,Both,,,,96,81.6,30.55,96,Medica,Individual & Family,81.408,84.8,,percent of total billed charges,,
"Subsq Hosp Inpt Or Obs Care, Per Day, Straightforward Or Low Mdm Or 25-34 Mins (Pro Cah)",,99231,CPT,Professional,Both,,,,96,81.6,30.55,96,Medica,Medica Advantage Solution,47.808,49.8,,percent of total billed charges,,
"Subsq Hosp Inpt Or Obs Care, Per Day, Straightforward Or Low Mdm Or 25-34 Mins (Pro Cah)",,99231,CPT,Professional,Both,,,,96,81.6,30.55,96,Medica,Medical Assistance,35.28,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Subsq Hosp Inpt Or Obs Care, Per Day, Straightforward Or Low Mdm Or 25-34 Mins (Pro Cah)",,99231,CPT,Professional,Both,,,,96,81.6,30.55,96,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,47.77,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Subsq Hosp Inpt Or Obs Care, Per Day, Straightforward Or Low Mdm Or 25-34 Mins (Pro Cah)",,99231,CPT,Professional,Both,,,,96,81.6,30.55,96,"Multiplan, Inc.","Multiplan, Inc.",90.24,94,,percent of total billed charges,,
"Subsq Hosp Inpt Or Obs Care, Per Day, Straightforward Or Low Mdm Or 25-34 Mins (Pro Cah)",,99231,CPT,Professional,Both,,,,96,81.6,30.55,96,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,86.496,90.1,,percent of total billed charges,,
"Subsq Hosp Inpt Or Obs Care, Per Day, Straightforward Or Low Mdm Or 25-34 Mins (Pro Cah)",,99231,CPT,Professional,Both,,,,96,81.6,30.55,96,"Preferred One Administrative Services, INC.",PPO,94.656,98.6,,percent of total billed charges,,
"Subsq Hosp Inpt Or Obs Care, Per Day, Straightforward Or Low Mdm Or 25-34 Mins (Pro Cah)",,99231,CPT,Professional,Both,,,,96,81.6,30.55,96,PrimeWest Health,Minnesota Senior Health Options (MSHO),54.9355,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Subsq Hosp Inpt Or Obs Care, Per Day, Straightforward Or Low Mdm Or 25-34 Mins (Pro Cah)",,99231,CPT,Professional,Both,,,,96,81.6,30.55,96,PrimeWest Health,MinnesotaCare,37.7448064,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Subsq Hosp Inpt Or Obs Care, Per Day, Straightforward Or Low Mdm Or 25-34 Mins (Pro Cah)",,99231,CPT,Professional,Both,,,,96,81.6,30.55,96,Sanford Health Plan,Sanford Health Plan,84.48,88,,percent of total billed charges,,
"Subsq Hosp Inpt Or Obs Care, Per Day, Straightforward Or Low Mdm Or 25-34 Mins (Pro Cah)",,99231,CPT,Professional,Both,,,,96,81.6,30.55,96,"UCare Health, Inc.",Individual & Family Plan,77.654912,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Subsq Hosp Inpt Or Obs Care, Per Day, Straightforward Or Low Mdm Or 25-34 Mins (Pro Cah)",,99231,CPT,Professional,Both,,,,96,81.6,30.55,96,"UCare Health, Inc.",Medical Assistance,38.803072,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Subsq Hosp Inpt Or Obs Care, Per Day, Straightforward Or Low Mdm Or 25-34 Mins (Pro Cah)",,99231,CPT,Professional,Both,,,,96,81.6,30.55,96,"UCare Health, Inc.",Medicare Advantage,54.9355,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Subsq Hosp Inpt Or Obs Care, Per Day, Straightforward Or Low Mdm Or 25-34 Mins (Pro Cah)",,99231,CPT,Professional,Both,,,,96,81.6,30.55,96,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),43.9484,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Subsq Hosp Inpt Or Obs Care, Per Day, Straightforward Or Low Mdm Or 25-34 Mins (Pro Cah)",,99231,CPT,Professional,Both,,,,96,81.6,30.55,96,UnitedHealthcare,Individual & Family,96,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Subsq Hosp Inpt Or Obs Care, Per Day, Straightforward Or Low Mdm Or 25-34 Mins (Pro Cah)",,99231,CPT,Professional,Both,,,,96,81.6,30.55,96,UnitedHealthcare,Medicare Advantage,54.9355,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Subsq Hosp Inpt Or Obs Care, Per Day, Straightforward Or Low Mdm Or 25-34 Mins (Pro Cah)",,99231,CPT,Professional,Both,,,,96,81.6,30.55,96,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,35.27552,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Subsq Hosp Inpt Or Obs Care, Per Day, Moderate Mdm Or 35-49 Mins (Pro Cah)",,99232,CPT,Professional,Both,,,,145,123.25,49.54,145,Aetna,Commercial,123.25,85,,percent of total billed charges,,
"Subsq Hosp Inpt Or Obs Care, Per Day, Moderate Mdm Or 35-49 Mins (Pro Cah)",,99232,CPT,Professional,Both,,,,145,123.25,49.54,145,Aetna,Medicare Advantage,69.88,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Subsq Hosp Inpt Or Obs Care, Per Day, Moderate Mdm Or 35-49 Mins (Pro Cah)",,99232,CPT,Professional,Both,,,,145,123.25,49.54,145,Aetna,PPO,134.85,93,,percent of total billed charges,,
"Subsq Hosp Inpt Or Obs Care, Per Day, Moderate Mdm Or 35-49 Mins (Pro Cah)",,99232,CPT,Professional,Both,,,,145,123.25,49.54,145,America's PPO,America's PPO,123.888,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Subsq Hosp Inpt Or Obs Care, Per Day, Moderate Mdm Or 35-49 Mins (Pro Cah)",,99232,CPT,Professional,Both,,,,145,123.25,49.54,145,BlueCross BlueShield Minnesota, Federal Employee Program,140.03,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Subsq Hosp Inpt Or Obs Care, Per Day, Moderate Mdm Or 35-49 Mins (Pro Cah)",,99232,CPT,Professional,Both,,,,145,123.25,49.54,145,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,142.27048,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Subsq Hosp Inpt Or Obs Care, Per Day, Moderate Mdm Or 35-49 Mins (Pro Cah)",,99232,CPT,Professional,Both,,,,145,123.25,49.54,145,BlueCross BlueShield Minnesota,High Value Network Plan,142.27048,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Subsq Hosp Inpt Or Obs Care, Per Day, Moderate Mdm Or 35-49 Mins (Pro Cah)",,99232,CPT,Professional,Both,,,,145,123.25,49.54,145,BlueCross BlueShield Minnesota,Medicare Advantage,88.504,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Subsq Hosp Inpt Or Obs Care, Per Day, Moderate Mdm Or 35-49 Mins (Pro Cah)",,99232,CPT,Professional,Both,,,,145,123.25,49.54,145,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,142.27048,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Subsq Hosp Inpt Or Obs Care, Per Day, Moderate Mdm Or 35-49 Mins (Pro Cah)",,99232,CPT,Professional,Both,,,,145,123.25,49.54,145,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,57.19064,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Subsq Hosp Inpt Or Obs Care, Per Day, Moderate Mdm Or 35-49 Mins (Pro Cah)",,99232,CPT,Professional,Both,,,,145,123.25,49.54,145,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),88.504,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Subsq Hosp Inpt Or Obs Care, Per Day, Moderate Mdm Or 35-49 Mins (Pro Cah)",,99232,CPT,Professional,Both,,,,145,123.25,49.54,145,CorVel,Worker's Compensation,134.5220307,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Subsq Hosp Inpt Or Obs Care, Per Day, Moderate Mdm Or 35-49 Mins (Pro Cah)",,99232,CPT,Professional,Both,,,,145,123.25,49.54,145,First Health Group Corporation,First Health Network,140.65,97,,percent of total billed charges,,
"Subsq Hosp Inpt Or Obs Care, Per Day, Moderate Mdm Or 35-49 Mins (Pro Cah)",,99232,CPT,Professional,Both,,,,145,123.25,49.54,145,"Health Partners, Inc.",Commercial,145,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Subsq Hosp Inpt Or Obs Care, Per Day, Moderate Mdm Or 35-49 Mins (Pro Cah)",,99232,CPT,Professional,Both,,,,145,123.25,49.54,145,"Health Partners, Inc.",Medicare Advantage,88.504,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Subsq Hosp Inpt Or Obs Care, Per Day, Moderate Mdm Or 35-49 Mins (Pro Cah)",,99232,CPT,Professional,Both,,,,145,123.25,49.54,145,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),76.92,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Subsq Hosp Inpt Or Obs Care, Per Day, Moderate Mdm Or 35-49 Mins (Pro Cah)",,99232,CPT,Professional,Both,,,,145,123.25,49.54,145,"Health Partners, Inc.",State of Minnesota Advantage Program,125.632545,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Subsq Hosp Inpt Or Obs Care, Per Day, Moderate Mdm Or 35-49 Mins (Pro Cah)",,99232,CPT,Professional,Both,,,,145,123.25,49.54,145,"Health Partners, Inc.",State Public Programs,49.54,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Subsq Hosp Inpt Or Obs Care, Per Day, Moderate Mdm Or 35-49 Mins (Pro Cah)",,99232,CPT,Professional,Both,,,,145,123.25,49.54,145,Humana Insurance Company,Commercial PPO,76.96,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Subsq Hosp Inpt Or Obs Care, Per Day, Moderate Mdm Or 35-49 Mins (Pro Cah)",,99232,CPT,Professional,Both,,,,145,123.25,49.54,145,Humana Insurance Company,Medicare PPO,145,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Subsq Hosp Inpt Or Obs Care, Per Day, Moderate Mdm Or 35-49 Mins (Pro Cah)",,99232,CPT,Professional,Both,,,,145,123.25,49.54,145,Medica,Individual & Family,122.96,84.8,,percent of total billed charges,,
"Subsq Hosp Inpt Or Obs Care, Per Day, Moderate Mdm Or 35-49 Mins (Pro Cah)",,99232,CPT,Professional,Both,,,,145,123.25,49.54,145,Medica,Medica Advantage Solution,72.21,49.8,,percent of total billed charges,,
"Subsq Hosp Inpt Or Obs Care, Per Day, Moderate Mdm Or 35-49 Mins (Pro Cah)",,99232,CPT,Professional,Both,,,,145,123.25,49.54,145,Medica,Medical Assistance,57.19,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Subsq Hosp Inpt Or Obs Care, Per Day, Moderate Mdm Or 35-49 Mins (Pro Cah)",,99232,CPT,Professional,Both,,,,145,123.25,49.54,145,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,76.96,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Subsq Hosp Inpt Or Obs Care, Per Day, Moderate Mdm Or 35-49 Mins (Pro Cah)",,99232,CPT,Professional,Both,,,,145,123.25,49.54,145,"Multiplan, Inc.","Multiplan, Inc.",136.3,94,,percent of total billed charges,,
"Subsq Hosp Inpt Or Obs Care, Per Day, Moderate Mdm Or 35-49 Mins (Pro Cah)",,99232,CPT,Professional,Both,,,,145,123.25,49.54,145,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,130.645,90.1,,percent of total billed charges,,
"Subsq Hosp Inpt Or Obs Care, Per Day, Moderate Mdm Or 35-49 Mins (Pro Cah)",,99232,CPT,Professional,Both,,,,145,123.25,49.54,145,"Preferred One Administrative Services, INC.",PPO,142.97,98.6,,percent of total billed charges,,
"Subsq Hosp Inpt Or Obs Care, Per Day, Moderate Mdm Or 35-49 Mins (Pro Cah)",,99232,CPT,Professional,Both,,,,145,123.25,49.54,145,PrimeWest Health,Minnesota Senior Health Options (MSHO),88.504,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Subsq Hosp Inpt Or Obs Care, Per Day, Moderate Mdm Or 35-49 Mins (Pro Cah)",,99232,CPT,Professional,Both,,,,145,123.25,49.54,145,PrimeWest Health,MinnesotaCare,61.1939848,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Subsq Hosp Inpt Or Obs Care, Per Day, Moderate Mdm Or 35-49 Mins (Pro Cah)",,99232,CPT,Professional,Both,,,,145,123.25,49.54,145,Sanford Health Plan,Sanford Health Plan,127.6,88,,percent of total billed charges,,
"Subsq Hosp Inpt Or Obs Care, Per Day, Moderate Mdm Or 35-49 Mins (Pro Cah)",,99232,CPT,Professional,Both,,,,145,123.25,49.54,145,"UCare Health, Inc.",Individual & Family Plan,125.106176,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Subsq Hosp Inpt Or Obs Care, Per Day, Moderate Mdm Or 35-49 Mins (Pro Cah)",,99232,CPT,Professional,Both,,,,145,123.25,49.54,145,"UCare Health, Inc.",Medical Assistance,62.909704,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Subsq Hosp Inpt Or Obs Care, Per Day, Moderate Mdm Or 35-49 Mins (Pro Cah)",,99232,CPT,Professional,Both,,,,145,123.25,49.54,145,"UCare Health, Inc.",Medicare Advantage,88.504,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Subsq Hosp Inpt Or Obs Care, Per Day, Moderate Mdm Or 35-49 Mins (Pro Cah)",,99232,CPT,Professional,Both,,,,145,123.25,49.54,145,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),70.8032,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Subsq Hosp Inpt Or Obs Care, Per Day, Moderate Mdm Or 35-49 Mins (Pro Cah)",,99232,CPT,Professional,Both,,,,145,123.25,49.54,145,UnitedHealthcare,Individual & Family,145,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Subsq Hosp Inpt Or Obs Care, Per Day, Moderate Mdm Or 35-49 Mins (Pro Cah)",,99232,CPT,Professional,Both,,,,145,123.25,49.54,145,UnitedHealthcare,Medicare Advantage,88.504,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Subsq Hosp Inpt Or Obs Care, Per Day, Moderate Mdm Or 35-49 Mins (Pro Cah)",,99232,CPT,Professional,Both,,,,145,123.25,49.54,145,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,57.19064,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Subsq Hosp Inpt Or Obs Hosp Care, Per Day, High Mdm Or 50+ Mins (Pro Cah)",,99233,CPT,Professional,Both,,,,194,164.9,74.41,194,Aetna,Commercial,164.9,85,,percent of total billed charges,,
"Subsq Hosp Inpt Or Obs Hosp Care, Per Day, High Mdm Or 50+ Mins (Pro Cah)",,99233,CPT,Professional,Both,,,,194,164.9,74.41,194,Aetna,Medicare Advantage,100.49,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Subsq Hosp Inpt Or Obs Hosp Care, Per Day, High Mdm Or 50+ Mins (Pro Cah)",,99233,CPT,Professional,Both,,,,194,164.9,74.41,194,Aetna,PPO,180.42,93,,percent of total billed charges,,
"Subsq Hosp Inpt Or Obs Hosp Care, Per Day, High Mdm Or 50+ Mins (Pro Cah)",,99233,CPT,Professional,Both,,,,194,164.9,74.41,194,America's PPO,America's PPO,165.7536,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Subsq Hosp Inpt Or Obs Hosp Care, Per Day, High Mdm Or 50+ Mins (Pro Cah)",,99233,CPT,Professional,Both,,,,194,164.9,74.41,194,BlueCross BlueShield Minnesota, Federal Employee Program,194,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Subsq Hosp Inpt Or Obs Hosp Care, Per Day, High Mdm Or 50+ Mins (Pro Cah)",,99233,CPT,Professional,Both,,,,194,164.9,74.41,194,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,194,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Subsq Hosp Inpt Or Obs Hosp Care, Per Day, High Mdm Or 50+ Mins (Pro Cah)",,99233,CPT,Professional,Both,,,,194,164.9,74.41,194,BlueCross BlueShield Minnesota,High Value Network Plan,194,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Subsq Hosp Inpt Or Obs Hosp Care, Per Day, High Mdm Or 50+ Mins (Pro Cah)",,99233,CPT,Professional,Both,,,,194,164.9,74.41,194,BlueCross BlueShield Minnesota,Medicare Advantage,133.147,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Subsq Hosp Inpt Or Obs Hosp Care, Per Day, High Mdm Or 50+ Mins (Pro Cah)",,99233,CPT,Professional,Both,,,,194,164.9,74.41,194,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,194,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Subsq Hosp Inpt Or Obs Hosp Care, Per Day, High Mdm Or 50+ Mins (Pro Cah)",,99233,CPT,Professional,Both,,,,194,164.9,74.41,194,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,85.91296,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Subsq Hosp Inpt Or Obs Hosp Care, Per Day, High Mdm Or 50+ Mins (Pro Cah)",,99233,CPT,Professional,Both,,,,194,164.9,74.41,194,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),133.147,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Subsq Hosp Inpt Or Obs Hosp Care, Per Day, High Mdm Or 50+ Mins (Pro Cah)",,99233,CPT,Professional,Both,,,,194,164.9,74.41,194,CorVel,Worker's Compensation,193.4549736,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Subsq Hosp Inpt Or Obs Hosp Care, Per Day, High Mdm Or 50+ Mins (Pro Cah)",,99233,CPT,Professional,Both,,,,194,164.9,74.41,194,First Health Group Corporation,First Health Network,188.18,97,,percent of total billed charges,,
"Subsq Hosp Inpt Or Obs Hosp Care, Per Day, High Mdm Or 50+ Mins (Pro Cah)",,99233,CPT,Professional,Both,,,,194,164.9,74.41,194,"Health Partners, Inc.",Commercial,194,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Subsq Hosp Inpt Or Obs Hosp Care, Per Day, High Mdm Or 50+ Mins (Pro Cah)",,99233,CPT,Professional,Both,,,,194,164.9,74.41,194,"Health Partners, Inc.",Medicare Advantage,133.147,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Subsq Hosp Inpt Or Obs Hosp Care, Per Day, High Mdm Or 50+ Mins (Pro Cah)",,99233,CPT,Professional,Both,,,,194,164.9,74.41,194,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),115.89,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Subsq Hosp Inpt Or Obs Hosp Care, Per Day, High Mdm Or 50+ Mins (Pro Cah)",,99233,CPT,Professional,Both,,,,194,164.9,74.41,194,"Health Partners, Inc.",State of Minnesota Advantage Program,180.010425,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Subsq Hosp Inpt Or Obs Hosp Care, Per Day, High Mdm Or 50+ Mins (Pro Cah)",,99233,CPT,Professional,Both,,,,194,164.9,74.41,194,"Health Partners, Inc.",State Public Programs,74.41,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Subsq Hosp Inpt Or Obs Hosp Care, Per Day, High Mdm Or 50+ Mins (Pro Cah)",,99233,CPT,Professional,Both,,,,194,164.9,74.41,194,Humana Insurance Company,Commercial PPO,115.78,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Subsq Hosp Inpt Or Obs Hosp Care, Per Day, High Mdm Or 50+ Mins (Pro Cah)",,99233,CPT,Professional,Both,,,,194,164.9,74.41,194,Humana Insurance Company,Medicare PPO,194,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Subsq Hosp Inpt Or Obs Hosp Care, Per Day, High Mdm Or 50+ Mins (Pro Cah)",,99233,CPT,Professional,Both,,,,194,164.9,74.41,194,Medica,Individual & Family,164.512,84.8,,percent of total billed charges,,
"Subsq Hosp Inpt Or Obs Hosp Care, Per Day, High Mdm Or 50+ Mins (Pro Cah)",,99233,CPT,Professional,Both,,,,194,164.9,74.41,194,Medica,Medica Advantage Solution,96.612,49.8,,percent of total billed charges,,
"Subsq Hosp Inpt Or Obs Hosp Care, Per Day, High Mdm Or 50+ Mins (Pro Cah)",,99233,CPT,Professional,Both,,,,194,164.9,74.41,194,Medica,Medical Assistance,85.91,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Subsq Hosp Inpt Or Obs Hosp Care, Per Day, High Mdm Or 50+ Mins (Pro Cah)",,99233,CPT,Professional,Both,,,,194,164.9,74.41,194,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,115.78,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Subsq Hosp Inpt Or Obs Hosp Care, Per Day, High Mdm Or 50+ Mins (Pro Cah)",,99233,CPT,Professional,Both,,,,194,164.9,74.41,194,"Multiplan, Inc.","Multiplan, Inc.",182.36,94,,percent of total billed charges,,
"Subsq Hosp Inpt Or Obs Hosp Care, Per Day, High Mdm Or 50+ Mins (Pro Cah)",,99233,CPT,Professional,Both,,,,194,164.9,74.41,194,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,174.794,90.1,,percent of total billed charges,,
"Subsq Hosp Inpt Or Obs Hosp Care, Per Day, High Mdm Or 50+ Mins (Pro Cah)",,99233,CPT,Professional,Both,,,,194,164.9,74.41,194,"Preferred One Administrative Services, INC.",PPO,191.284,98.6,,percent of total billed charges,,
"Subsq Hosp Inpt Or Obs Hosp Care, Per Day, High Mdm Or 50+ Mins (Pro Cah)",,99233,CPT,Professional,Both,,,,194,164.9,74.41,194,PrimeWest Health,Minnesota Senior Health Options (MSHO),133.147,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Subsq Hosp Inpt Or Obs Hosp Care, Per Day, High Mdm Or 50+ Mins (Pro Cah)",,99233,CPT,Professional,Both,,,,194,164.9,74.41,194,PrimeWest Health,MinnesotaCare,91.9268672,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Subsq Hosp Inpt Or Obs Hosp Care, Per Day, High Mdm Or 50+ Mins (Pro Cah)",,99233,CPT,Professional,Both,,,,194,164.9,74.41,194,Sanford Health Plan,Sanford Health Plan,170.72,88,,percent of total billed charges,,
"Subsq Hosp Inpt Or Obs Hosp Care, Per Day, High Mdm Or 50+ Mins (Pro Cah)",,99233,CPT,Professional,Both,,,,194,164.9,74.41,194,"UCare Health, Inc.",Individual & Family Plan,188.211968,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Subsq Hosp Inpt Or Obs Hosp Care, Per Day, High Mdm Or 50+ Mins (Pro Cah)",,99233,CPT,Professional,Both,,,,194,164.9,74.41,194,"UCare Health, Inc.",Medical Assistance,94.504256,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Subsq Hosp Inpt Or Obs Hosp Care, Per Day, High Mdm Or 50+ Mins (Pro Cah)",,99233,CPT,Professional,Both,,,,194,164.9,74.41,194,"UCare Health, Inc.",Medicare Advantage,133.147,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Subsq Hosp Inpt Or Obs Hosp Care, Per Day, High Mdm Or 50+ Mins (Pro Cah)",,99233,CPT,Professional,Both,,,,194,164.9,74.41,194,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),106.5176,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Subsq Hosp Inpt Or Obs Hosp Care, Per Day, High Mdm Or 50+ Mins (Pro Cah)",,99233,CPT,Professional,Both,,,,194,164.9,74.41,194,UnitedHealthcare,Individual & Family,194,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Subsq Hosp Inpt Or Obs Hosp Care, Per Day, High Mdm Or 50+ Mins (Pro Cah)",,99233,CPT,Professional,Both,,,,194,164.9,74.41,194,UnitedHealthcare,Medicare Advantage,133.147,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Subsq Hosp Inpt Or Obs Hosp Care, Per Day, High Mdm Or 50+ Mins (Pro Cah)",,99233,CPT,Professional,Both,,,,194,164.9,74.41,194,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,85.91296,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Hosp Inpt Or Obs Care Incl Admit And Discharge Same Date, Straightforward Or Low Mdm Or 45-69 Mins (Pro Cah)",,99234,CPT,Professional,Both,,,,357,303.45,61.32,357,Aetna,Commercial,303.45,85,,percent of total billed charges,,
"Hosp Inpt Or Obs Care Incl Admit And Discharge Same Date, Straightforward Or Low Mdm Or 45-69 Mins (Pro Cah)",,99234,CPT,Professional,Both,,,,357,303.45,61.32,357,Aetna,Medicare Advantage,127.26,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Hosp Inpt Or Obs Care Incl Admit And Discharge Same Date, Straightforward Or Low Mdm Or 45-69 Mins (Pro Cah)",,99234,CPT,Professional,Both,,,,357,303.45,61.32,357,Aetna,PPO,332.01,93,,percent of total billed charges,,
"Hosp Inpt Or Obs Care Incl Admit And Discharge Same Date, Straightforward Or Low Mdm Or 45-69 Mins (Pro Cah)",,99234,CPT,Professional,Both,,,,357,303.45,61.32,357,America's PPO,America's PPO,305.0208,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Hosp Inpt Or Obs Care Incl Admit And Discharge Same Date, Straightforward Or Low Mdm Or 45-69 Mins (Pro Cah)",,99234,CPT,Professional,Both,,,,357,303.45,61.32,357,BlueCross BlueShield Minnesota, Federal Employee Program,174.73,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Hosp Inpt Or Obs Care Incl Admit And Discharge Same Date, Straightforward Or Low Mdm Or 45-69 Mins (Pro Cah)",,99234,CPT,Professional,Both,,,,357,303.45,61.32,357,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,177.52568,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Hosp Inpt Or Obs Care Incl Admit And Discharge Same Date, Straightforward Or Low Mdm Or 45-69 Mins (Pro Cah)",,99234,CPT,Professional,Both,,,,357,303.45,61.32,357,BlueCross BlueShield Minnesota,High Value Network Plan,177.52568,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Hosp Inpt Or Obs Care Incl Admit And Discharge Same Date, Straightforward Or Low Mdm Or 45-69 Mins (Pro Cah)",,99234,CPT,Professional,Both,,,,357,303.45,61.32,357,BlueCross BlueShield Minnesota,Medicare Advantage,109.618,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Hosp Inpt Or Obs Care Incl Admit And Discharge Same Date, Straightforward Or Low Mdm Or 45-69 Mins (Pro Cah)",,99234,CPT,Professional,Both,,,,357,303.45,61.32,357,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,177.52568,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Hosp Inpt Or Obs Care Incl Admit And Discharge Same Date, Straightforward Or Low Mdm Or 45-69 Mins (Pro Cah)",,99234,CPT,Professional,Both,,,,357,303.45,61.32,357,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,70.79488,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Hosp Inpt Or Obs Care Incl Admit And Discharge Same Date, Straightforward Or Low Mdm Or 45-69 Mins (Pro Cah)",,99234,CPT,Professional,Both,,,,357,303.45,61.32,357,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),109.618,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Hosp Inpt Or Obs Care Incl Admit And Discharge Same Date, Straightforward Or Low Mdm Or 45-69 Mins (Pro Cah)",,99234,CPT,Professional,Both,,,,357,303.45,61.32,357,CorVel,Worker's Compensation,244.5344001,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Hosp Inpt Or Obs Care Incl Admit And Discharge Same Date, Straightforward Or Low Mdm Or 45-69 Mins (Pro Cah)",,99234,CPT,Professional,Both,,,,357,303.45,61.32,357,First Health Group Corporation,First Health Network,346.29,97,,percent of total billed charges,,
"Hosp Inpt Or Obs Care Incl Admit And Discharge Same Date, Straightforward Or Low Mdm Or 45-69 Mins (Pro Cah)",,99234,CPT,Professional,Both,,,,357,303.45,61.32,357,"Health Partners, Inc.",Commercial,264.09,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Hosp Inpt Or Obs Care Incl Admit And Discharge Same Date, Straightforward Or Low Mdm Or 45-69 Mins (Pro Cah)",,99234,CPT,Professional,Both,,,,357,303.45,61.32,357,"Health Partners, Inc.",Medicare Advantage,109.618,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Hosp Inpt Or Obs Care Incl Admit And Discharge Same Date, Straightforward Or Low Mdm Or 45-69 Mins (Pro Cah)",,99234,CPT,Professional,Both,,,,357,303.45,61.32,357,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),95.22,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Hosp Inpt Or Obs Care Incl Admit And Discharge Same Date, Straightforward Or Low Mdm Or 45-69 Mins (Pro Cah)",,99234,CPT,Professional,Both,,,,357,303.45,61.32,357,"Health Partners, Inc.",State of Minnesota Advantage Program,227.513535,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Hosp Inpt Or Obs Care Incl Admit And Discharge Same Date, Straightforward Or Low Mdm Or 45-69 Mins (Pro Cah)",,99234,CPT,Professional,Both,,,,357,303.45,61.32,357,"Health Partners, Inc.",State Public Programs,61.32,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Hosp Inpt Or Obs Care Incl Admit And Discharge Same Date, Straightforward Or Low Mdm Or 45-69 Mins (Pro Cah)",,99234,CPT,Professional,Both,,,,357,303.45,61.32,357,Humana Insurance Company,Commercial PPO,95.32,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Hosp Inpt Or Obs Care Incl Admit And Discharge Same Date, Straightforward Or Low Mdm Or 45-69 Mins (Pro Cah)",,99234,CPT,Professional,Both,,,,357,303.45,61.32,357,Humana Insurance Company,Medicare PPO,357,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Hosp Inpt Or Obs Care Incl Admit And Discharge Same Date, Straightforward Or Low Mdm Or 45-69 Mins (Pro Cah)",,99234,CPT,Professional,Both,,,,357,303.45,61.32,357,Medica,Individual & Family,302.736,84.8,,percent of total billed charges,,
"Hosp Inpt Or Obs Care Incl Admit And Discharge Same Date, Straightforward Or Low Mdm Or 45-69 Mins (Pro Cah)",,99234,CPT,Professional,Both,,,,357,303.45,61.32,357,Medica,Medica Advantage Solution,177.786,49.8,,percent of total billed charges,,
"Hosp Inpt Or Obs Care Incl Admit And Discharge Same Date, Straightforward Or Low Mdm Or 45-69 Mins (Pro Cah)",,99234,CPT,Professional,Both,,,,357,303.45,61.32,357,Medica,Medical Assistance,70.79,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Hosp Inpt Or Obs Care Incl Admit And Discharge Same Date, Straightforward Or Low Mdm Or 45-69 Mins (Pro Cah)",,99234,CPT,Professional,Both,,,,357,303.45,61.32,357,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,95.32,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Hosp Inpt Or Obs Care Incl Admit And Discharge Same Date, Straightforward Or Low Mdm Or 45-69 Mins (Pro Cah)",,99234,CPT,Professional,Both,,,,357,303.45,61.32,357,"Multiplan, Inc.","Multiplan, Inc.",335.58,94,,percent of total billed charges,,
"Hosp Inpt Or Obs Care Incl Admit And Discharge Same Date, Straightforward Or Low Mdm Or 45-69 Mins (Pro Cah)",,99234,CPT,Professional,Both,,,,357,303.45,61.32,357,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,321.657,90.1,,percent of total billed charges,,
"Hosp Inpt Or Obs Care Incl Admit And Discharge Same Date, Straightforward Or Low Mdm Or 45-69 Mins (Pro Cah)",,99234,CPT,Professional,Both,,,,357,303.45,61.32,357,"Preferred One Administrative Services, INC.",PPO,352.002,98.6,,percent of total billed charges,,
"Hosp Inpt Or Obs Care Incl Admit And Discharge Same Date, Straightforward Or Low Mdm Or 45-69 Mins (Pro Cah)",,99234,CPT,Professional,Both,,,,357,303.45,61.32,357,PrimeWest Health,Minnesota Senior Health Options (MSHO),109.618,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Hosp Inpt Or Obs Care Incl Admit And Discharge Same Date, Straightforward Or Low Mdm Or 45-69 Mins (Pro Cah)",,99234,CPT,Professional,Both,,,,357,303.45,61.32,357,PrimeWest Health,MinnesotaCare,75.7505216,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Hosp Inpt Or Obs Care Incl Admit And Discharge Same Date, Straightforward Or Low Mdm Or 45-69 Mins (Pro Cah)",,99234,CPT,Professional,Both,,,,357,303.45,61.32,357,Sanford Health Plan,Sanford Health Plan,314.16,88,,percent of total billed charges,,
"Hosp Inpt Or Obs Care Incl Admit And Discharge Same Date, Straightforward Or Low Mdm Or 45-69 Mins (Pro Cah)",,99234,CPT,Professional,Both,,,,357,303.45,61.32,357,"UCare Health, Inc.",Individual & Family Plan,154.952192,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Hosp Inpt Or Obs Care Incl Admit And Discharge Same Date, Straightforward Or Low Mdm Or 45-69 Mins (Pro Cah)",,99234,CPT,Professional,Both,,,,357,303.45,61.32,357,"UCare Health, Inc.",Medical Assistance,77.874368,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Hosp Inpt Or Obs Care Incl Admit And Discharge Same Date, Straightforward Or Low Mdm Or 45-69 Mins (Pro Cah)",,99234,CPT,Professional,Both,,,,357,303.45,61.32,357,"UCare Health, Inc.",Medicare Advantage,109.618,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Hosp Inpt Or Obs Care Incl Admit And Discharge Same Date, Straightforward Or Low Mdm Or 45-69 Mins (Pro Cah)",,99234,CPT,Professional,Both,,,,357,303.45,61.32,357,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),87.6944,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Hosp Inpt Or Obs Care Incl Admit And Discharge Same Date, Straightforward Or Low Mdm Or 45-69 Mins (Pro Cah)",,99234,CPT,Professional,Both,,,,357,303.45,61.32,357,UnitedHealthcare,Individual & Family,357,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Hosp Inpt Or Obs Care Incl Admit And Discharge Same Date, Straightforward Or Low Mdm Or 45-69 Mins (Pro Cah)",,99234,CPT,Professional,Both,,,,357,303.45,61.32,357,UnitedHealthcare,Medicare Advantage,109.618,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Hosp Inpt Or Obs Care Incl Admit And Discharge Same Date, Straightforward Or Low Mdm Or 45-69 Mins (Pro Cah)",,99234,CPT,Professional,Both,,,,357,303.45,61.32,357,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,70.79488,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Hosp Inpt Or Obs Care Incl Admit And Discharge Same Date, Moderate Mdm Or 70-84 Mins (Pro Cah)",,99235,CPT,Professional,Both,,,,476,404.6,99.73,476,Aetna,Commercial,404.6,85,,percent of total billed charges,,
"Hosp Inpt Or Obs Care Incl Admit And Discharge Same Date, Moderate Mdm Or 70-84 Mins (Pro Cah)",,99235,CPT,Professional,Both,,,,476,404.6,99.73,476,Aetna,Medicare Advantage,162.54,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Hosp Inpt Or Obs Care Incl Admit And Discharge Same Date, Moderate Mdm Or 70-84 Mins (Pro Cah)",,99235,CPT,Professional,Both,,,,476,404.6,99.73,476,Aetna,PPO,442.68,93,,percent of total billed charges,,
"Hosp Inpt Or Obs Care Incl Admit And Discharge Same Date, Moderate Mdm Or 70-84 Mins (Pro Cah)",,99235,CPT,Professional,Both,,,,476,404.6,99.73,476,America's PPO,America's PPO,406.6944,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Hosp Inpt Or Obs Care Incl Admit And Discharge Same Date, Moderate Mdm Or 70-84 Mins (Pro Cah)",,99235,CPT,Professional,Both,,,,476,404.6,99.73,476,BlueCross BlueShield Minnesota, Federal Employee Program,281.85,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Hosp Inpt Or Obs Care Incl Admit And Discharge Same Date, Moderate Mdm Or 70-84 Mins (Pro Cah)",,99235,CPT,Professional,Both,,,,476,404.6,99.73,476,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,286.3596,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Hosp Inpt Or Obs Care Incl Admit And Discharge Same Date, Moderate Mdm Or 70-84 Mins (Pro Cah)",,99235,CPT,Professional,Both,,,,476,404.6,99.73,476,BlueCross BlueShield Minnesota,High Value Network Plan,286.3596,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Hosp Inpt Or Obs Care Incl Admit And Discharge Same Date, Moderate Mdm Or 70-84 Mins (Pro Cah)",,99235,CPT,Professional,Both,,,,476,404.6,99.73,476,BlueCross BlueShield Minnesota,Medicare Advantage,178.4225,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Hosp Inpt Or Obs Care Incl Admit And Discharge Same Date, Moderate Mdm Or 70-84 Mins (Pro Cah)",,99235,CPT,Professional,Both,,,,476,404.6,99.73,476,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,286.3596,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Hosp Inpt Or Obs Care Incl Admit And Discharge Same Date, Moderate Mdm Or 70-84 Mins (Pro Cah)",,99235,CPT,Professional,Both,,,,476,404.6,99.73,476,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,115.14328,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Hosp Inpt Or Obs Care Incl Admit And Discharge Same Date, Moderate Mdm Or 70-84 Mins (Pro Cah)",,99235,CPT,Professional,Both,,,,476,404.6,99.73,476,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),178.4225,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Hosp Inpt Or Obs Care Incl Admit And Discharge Same Date, Moderate Mdm Or 70-84 Mins (Pro Cah)",,99235,CPT,Professional,Both,,,,476,404.6,99.73,476,CorVel,Worker's Compensation,311.7776154,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Hosp Inpt Or Obs Care Incl Admit And Discharge Same Date, Moderate Mdm Or 70-84 Mins (Pro Cah)",,99235,CPT,Professional,Both,,,,476,404.6,99.73,476,First Health Group Corporation,First Health Network,461.72,97,,percent of total billed charges,,
"Hosp Inpt Or Obs Care Incl Admit And Discharge Same Date, Moderate Mdm Or 70-84 Mins (Pro Cah)",,99235,CPT,Professional,Both,,,,476,404.6,99.73,476,"Health Partners, Inc.",Commercial,336.64,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Hosp Inpt Or Obs Care Incl Admit And Discharge Same Date, Moderate Mdm Or 70-84 Mins (Pro Cah)",,99235,CPT,Professional,Both,,,,476,404.6,99.73,476,"Health Partners, Inc.",Medicare Advantage,178.4225,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Hosp Inpt Or Obs Care Incl Admit And Discharge Same Date, Moderate Mdm Or 70-84 Mins (Pro Cah)",,99235,CPT,Professional,Both,,,,476,404.6,99.73,476,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),154.86,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Hosp Inpt Or Obs Care Incl Admit And Discharge Same Date, Moderate Mdm Or 70-84 Mins (Pro Cah)",,99235,CPT,Professional,Both,,,,476,404.6,99.73,476,"Health Partners, Inc.",State of Minnesota Advantage Program,290.01536,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Hosp Inpt Or Obs Care Incl Admit And Discharge Same Date, Moderate Mdm Or 70-84 Mins (Pro Cah)",,99235,CPT,Professional,Both,,,,476,404.6,99.73,476,"Health Partners, Inc.",State Public Programs,99.73,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Hosp Inpt Or Obs Care Incl Admit And Discharge Same Date, Moderate Mdm Or 70-84 Mins (Pro Cah)",,99235,CPT,Professional,Both,,,,476,404.6,99.73,476,Humana Insurance Company,Commercial PPO,155.15,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Hosp Inpt Or Obs Care Incl Admit And Discharge Same Date, Moderate Mdm Or 70-84 Mins (Pro Cah)",,99235,CPT,Professional,Both,,,,476,404.6,99.73,476,Humana Insurance Company,Medicare PPO,476,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Hosp Inpt Or Obs Care Incl Admit And Discharge Same Date, Moderate Mdm Or 70-84 Mins (Pro Cah)",,99235,CPT,Professional,Both,,,,476,404.6,99.73,476,Medica,Individual & Family,403.648,84.8,,percent of total billed charges,,
"Hosp Inpt Or Obs Care Incl Admit And Discharge Same Date, Moderate Mdm Or 70-84 Mins (Pro Cah)",,99235,CPT,Professional,Both,,,,476,404.6,99.73,476,Medica,Medica Advantage Solution,237.048,49.8,,percent of total billed charges,,
"Hosp Inpt Or Obs Care Incl Admit And Discharge Same Date, Moderate Mdm Or 70-84 Mins (Pro Cah)",,99235,CPT,Professional,Both,,,,476,404.6,99.73,476,Medica,Medical Assistance,115.14,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Hosp Inpt Or Obs Care Incl Admit And Discharge Same Date, Moderate Mdm Or 70-84 Mins (Pro Cah)",,99235,CPT,Professional,Both,,,,476,404.6,99.73,476,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,155.15,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Hosp Inpt Or Obs Care Incl Admit And Discharge Same Date, Moderate Mdm Or 70-84 Mins (Pro Cah)",,99235,CPT,Professional,Both,,,,476,404.6,99.73,476,"Multiplan, Inc.","Multiplan, Inc.",447.44,94,,percent of total billed charges,,
"Hosp Inpt Or Obs Care Incl Admit And Discharge Same Date, Moderate Mdm Or 70-84 Mins (Pro Cah)",,99235,CPT,Professional,Both,,,,476,404.6,99.73,476,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,428.876,90.1,,percent of total billed charges,,
"Hosp Inpt Or Obs Care Incl Admit And Discharge Same Date, Moderate Mdm Or 70-84 Mins (Pro Cah)",,99235,CPT,Professional,Both,,,,476,404.6,99.73,476,"Preferred One Administrative Services, INC.",PPO,469.336,98.6,,percent of total billed charges,,
"Hosp Inpt Or Obs Care Incl Admit And Discharge Same Date, Moderate Mdm Or 70-84 Mins (Pro Cah)",,99235,CPT,Professional,Both,,,,476,404.6,99.73,476,PrimeWest Health,Minnesota Senior Health Options (MSHO),178.4225,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Hosp Inpt Or Obs Care Incl Admit And Discharge Same Date, Moderate Mdm Or 70-84 Mins (Pro Cah)",,99235,CPT,Professional,Both,,,,476,404.6,99.73,476,PrimeWest Health,MinnesotaCare,123.2033096,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Hosp Inpt Or Obs Care Incl Admit And Discharge Same Date, Moderate Mdm Or 70-84 Mins (Pro Cah)",,99235,CPT,Professional,Both,,,,476,404.6,99.73,476,Sanford Health Plan,Sanford Health Plan,418.88,88,,percent of total billed charges,,
"Hosp Inpt Or Obs Care Incl Admit And Discharge Same Date, Moderate Mdm Or 70-84 Mins (Pro Cah)",,99235,CPT,Professional,Both,,,,476,404.6,99.73,476,"UCare Health, Inc.",Individual & Family Plan,252.21184,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Hosp Inpt Or Obs Care Incl Admit And Discharge Same Date, Moderate Mdm Or 70-84 Mins (Pro Cah)",,99235,CPT,Professional,Both,,,,476,404.6,99.73,476,"UCare Health, Inc.",Medical Assistance,126.657608,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Hosp Inpt Or Obs Care Incl Admit And Discharge Same Date, Moderate Mdm Or 70-84 Mins (Pro Cah)",,99235,CPT,Professional,Both,,,,476,404.6,99.73,476,"UCare Health, Inc.",Medicare Advantage,178.4225,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Hosp Inpt Or Obs Care Incl Admit And Discharge Same Date, Moderate Mdm Or 70-84 Mins (Pro Cah)",,99235,CPT,Professional,Both,,,,476,404.6,99.73,476,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),142.738,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Hosp Inpt Or Obs Care Incl Admit And Discharge Same Date, Moderate Mdm Or 70-84 Mins (Pro Cah)",,99235,CPT,Professional,Both,,,,476,404.6,99.73,476,UnitedHealthcare,Individual & Family,476,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Hosp Inpt Or Obs Care Incl Admit And Discharge Same Date, Moderate Mdm Or 70-84 Mins (Pro Cah)",,99235,CPT,Professional,Both,,,,476,404.6,99.73,476,UnitedHealthcare,Medicare Advantage,178.4225,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Hosp Inpt Or Obs Care Incl Admit And Discharge Same Date, Moderate Mdm Or 70-84 Mins (Pro Cah)",,99235,CPT,Professional,Both,,,,476,404.6,99.73,476,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,115.14328,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Hosp Inpt Or Obs Care Incl Admit And Discharge Same Date, High Mdm Or 85+ Mins (Pro Cah)",,99236,CPT,Professional,Both,,,,613,521.05,130.94,613,Aetna,Commercial,521.05,85,,percent of total billed charges,,
"Hosp Inpt Or Obs Care Incl Admit And Discharge Same Date, High Mdm Or 85+ Mins (Pro Cah)",,99236,CPT,Professional,Both,,,,613,521.05,130.94,613,Aetna,Medicare Advantage,208.57,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Hosp Inpt Or Obs Care Incl Admit And Discharge Same Date, High Mdm Or 85+ Mins (Pro Cah)",,99236,CPT,Professional,Both,,,,613,521.05,130.94,613,Aetna,PPO,570.09,93,,percent of total billed charges,,
"Hosp Inpt Or Obs Care Incl Admit And Discharge Same Date, High Mdm Or 85+ Mins (Pro Cah)",,99236,CPT,Professional,Both,,,,613,521.05,130.94,613,America's PPO,America's PPO,523.7472,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Hosp Inpt Or Obs Care Incl Admit And Discharge Same Date, High Mdm Or 85+ Mins (Pro Cah)",,99236,CPT,Professional,Both,,,,613,521.05,130.94,613,BlueCross BlueShield Minnesota, Federal Employee Program,369.81,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Hosp Inpt Or Obs Care Incl Admit And Discharge Same Date, High Mdm Or 85+ Mins (Pro Cah)",,99236,CPT,Professional,Both,,,,613,521.05,130.94,613,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,375.72696,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Hosp Inpt Or Obs Care Incl Admit And Discharge Same Date, High Mdm Or 85+ Mins (Pro Cah)",,99236,CPT,Professional,Both,,,,613,521.05,130.94,613,BlueCross BlueShield Minnesota,High Value Network Plan,375.72696,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Hosp Inpt Or Obs Care Incl Admit And Discharge Same Date, High Mdm Or 85+ Mins (Pro Cah)",,99236,CPT,Professional,Both,,,,613,521.05,130.94,613,BlueCross BlueShield Minnesota,Medicare Advantage,233.726,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Hosp Inpt Or Obs Care Incl Admit And Discharge Same Date, High Mdm Or 85+ Mins (Pro Cah)",,99236,CPT,Professional,Both,,,,613,521.05,130.94,613,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,375.72696,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Hosp Inpt Or Obs Care Incl Admit And Discharge Same Date, High Mdm Or 85+ Mins (Pro Cah)",,99236,CPT,Professional,Both,,,,613,521.05,130.94,613,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,151.1808,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Hosp Inpt Or Obs Care Incl Admit And Discharge Same Date, High Mdm Or 85+ Mins (Pro Cah)",,99236,CPT,Professional,Both,,,,613,521.05,130.94,613,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),233.726,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Hosp Inpt Or Obs Care Incl Admit And Discharge Same Date, High Mdm Or 85+ Mins (Pro Cah)",,99236,CPT,Professional,Both,,,,613,521.05,130.94,613,CorVel,Worker's Compensation,399.0139812,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Hosp Inpt Or Obs Care Incl Admit And Discharge Same Date, High Mdm Or 85+ Mins (Pro Cah)",,99236,CPT,Professional,Both,,,,613,521.05,130.94,613,First Health Group Corporation,First Health Network,594.61,97,,percent of total billed charges,,
"Hosp Inpt Or Obs Care Incl Admit And Discharge Same Date, High Mdm Or 85+ Mins (Pro Cah)",,99236,CPT,Professional,Both,,,,613,521.05,130.94,613,"Health Partners, Inc.",Commercial,430.97,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Hosp Inpt Or Obs Care Incl Admit And Discharge Same Date, High Mdm Or 85+ Mins (Pro Cah)",,99236,CPT,Professional,Both,,,,613,521.05,130.94,613,"Health Partners, Inc.",Medicare Advantage,233.726,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Hosp Inpt Or Obs Care Incl Admit And Discharge Same Date, High Mdm Or 85+ Mins (Pro Cah)",,99236,CPT,Professional,Both,,,,613,521.05,130.94,613,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),203.32,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Hosp Inpt Or Obs Care Incl Admit And Discharge Same Date, High Mdm Or 85+ Mins (Pro Cah)",,99236,CPT,Professional,Both,,,,613,521.05,130.94,613,"Health Partners, Inc.",State of Minnesota Advantage Program,371.280655,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Hosp Inpt Or Obs Care Incl Admit And Discharge Same Date, High Mdm Or 85+ Mins (Pro Cah)",,99236,CPT,Professional,Both,,,,613,521.05,130.94,613,"Health Partners, Inc.",State Public Programs,130.94,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Hosp Inpt Or Obs Care Incl Admit And Discharge Same Date, High Mdm Or 85+ Mins (Pro Cah)",,99236,CPT,Professional,Both,,,,613,521.05,130.94,613,Humana Insurance Company,Commercial PPO,203.24,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Hosp Inpt Or Obs Care Incl Admit And Discharge Same Date, High Mdm Or 85+ Mins (Pro Cah)",,99236,CPT,Professional,Both,,,,613,521.05,130.94,613,Humana Insurance Company,Medicare PPO,613,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Hosp Inpt Or Obs Care Incl Admit And Discharge Same Date, High Mdm Or 85+ Mins (Pro Cah)",,99236,CPT,Professional,Both,,,,613,521.05,130.94,613,Medica,Individual & Family,519.824,84.8,,percent of total billed charges,,
"Hosp Inpt Or Obs Care Incl Admit And Discharge Same Date, High Mdm Or 85+ Mins (Pro Cah)",,99236,CPT,Professional,Both,,,,613,521.05,130.94,613,Medica,Medica Advantage Solution,305.274,49.8,,percent of total billed charges,,
"Hosp Inpt Or Obs Care Incl Admit And Discharge Same Date, High Mdm Or 85+ Mins (Pro Cah)",,99236,CPT,Professional,Both,,,,613,521.05,130.94,613,Medica,Medical Assistance,151.18,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Hosp Inpt Or Obs Care Incl Admit And Discharge Same Date, High Mdm Or 85+ Mins (Pro Cah)",,99236,CPT,Professional,Both,,,,613,521.05,130.94,613,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,203.24,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Hosp Inpt Or Obs Care Incl Admit And Discharge Same Date, High Mdm Or 85+ Mins (Pro Cah)",,99236,CPT,Professional,Both,,,,613,521.05,130.94,613,"Multiplan, Inc.","Multiplan, Inc.",576.22,94,,percent of total billed charges,,
"Hosp Inpt Or Obs Care Incl Admit And Discharge Same Date, High Mdm Or 85+ Mins (Pro Cah)",,99236,CPT,Professional,Both,,,,613,521.05,130.94,613,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,552.313,90.1,,percent of total billed charges,,
"Hosp Inpt Or Obs Care Incl Admit And Discharge Same Date, High Mdm Or 85+ Mins (Pro Cah)",,99236,CPT,Professional,Both,,,,613,521.05,130.94,613,"Preferred One Administrative Services, INC.",PPO,604.418,98.6,,percent of total billed charges,,
"Hosp Inpt Or Obs Care Incl Admit And Discharge Same Date, High Mdm Or 85+ Mins (Pro Cah)",,99236,CPT,Professional,Both,,,,613,521.05,130.94,613,PrimeWest Health,Minnesota Senior Health Options (MSHO),233.726,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Hosp Inpt Or Obs Care Incl Admit And Discharge Same Date, High Mdm Or 85+ Mins (Pro Cah)",,99236,CPT,Professional,Both,,,,613,521.05,130.94,613,PrimeWest Health,MinnesotaCare,161.763456,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Hosp Inpt Or Obs Care Incl Admit And Discharge Same Date, High Mdm Or 85+ Mins (Pro Cah)",,99236,CPT,Professional,Both,,,,613,521.05,130.94,613,Sanford Health Plan,Sanford Health Plan,539.44,88,,percent of total billed charges,,
"Hosp Inpt Or Obs Care Incl Admit And Discharge Same Date, High Mdm Or 85+ Mins (Pro Cah)",,99236,CPT,Professional,Both,,,,613,521.05,130.94,613,"UCare Health, Inc.",Individual & Family Plan,330.386944,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Hosp Inpt Or Obs Care Incl Admit And Discharge Same Date, High Mdm Or 85+ Mins (Pro Cah)",,99236,CPT,Professional,Both,,,,613,521.05,130.94,613,"UCare Health, Inc.",Medical Assistance,166.29888,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Hosp Inpt Or Obs Care Incl Admit And Discharge Same Date, High Mdm Or 85+ Mins (Pro Cah)",,99236,CPT,Professional,Both,,,,613,521.05,130.94,613,"UCare Health, Inc.",Medicare Advantage,233.726,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Hosp Inpt Or Obs Care Incl Admit And Discharge Same Date, High Mdm Or 85+ Mins (Pro Cah)",,99236,CPT,Professional,Both,,,,613,521.05,130.94,613,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),186.9808,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Hosp Inpt Or Obs Care Incl Admit And Discharge Same Date, High Mdm Or 85+ Mins (Pro Cah)",,99236,CPT,Professional,Both,,,,613,521.05,130.94,613,UnitedHealthcare,Individual & Family,613,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Hosp Inpt Or Obs Care Incl Admit And Discharge Same Date, High Mdm Or 85+ Mins (Pro Cah)",,99236,CPT,Professional,Both,,,,613,521.05,130.94,613,UnitedHealthcare,Medicare Advantage,233.726,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Hosp Inpt Or Obs Care Incl Admit And Discharge Same Date, High Mdm Or 85+ Mins (Pro Cah)",,99236,CPT,Professional,Both,,,,613,521.05,130.94,613,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,151.1808,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Hospital Inpatient Or Observation Discharge Day Management; 30 Minutes Or Less (Pro Cah),,99238,CPT,Professional,Outpatient,,,,196,166.6,50.85,196,Aetna,Commercial,166.6,85,,percent of total billed charges,,
Hospital Inpatient Or Observation Discharge Day Management; 30 Minutes Or Less (Pro Cah),,99238,CPT,Professional,Outpatient,,,,196,166.6,50.85,196,Aetna,Medicare Advantage,70.51,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Hospital Inpatient Or Observation Discharge Day Management; 30 Minutes Or Less (Pro Cah),,99238,CPT,Professional,Outpatient,,,,196,166.6,50.85,196,Aetna,PPO,182.28,93,,percent of total billed charges,,
Hospital Inpatient Or Observation Discharge Day Management; 30 Minutes Or Less (Pro Cah),,99238,CPT,Professional,Outpatient,,,,196,166.6,50.85,196,America's PPO,America's PPO,167.4624,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Hospital Inpatient Or Observation Discharge Day Management; 30 Minutes Or Less (Pro Cah),,99238,CPT,Professional,Outpatient,,,,196,166.6,50.85,196,BlueCross BlueShield Minnesota, Federal Employee Program,143.02,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Hospital Inpatient Or Observation Discharge Day Management; 30 Minutes Or Less (Pro Cah),,99238,CPT,Professional,Outpatient,,,,196,166.6,50.85,196,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,145.30832,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Hospital Inpatient Or Observation Discharge Day Management; 30 Minutes Or Less (Pro Cah),,99238,CPT,Professional,Outpatient,,,,196,166.6,50.85,196,BlueCross BlueShield Minnesota,High Value Network Plan,145.30832,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Hospital Inpatient Or Observation Discharge Day Management; 30 Minutes Or Less (Pro Cah),,99238,CPT,Professional,Outpatient,,,,196,166.6,50.85,196,BlueCross BlueShield Minnesota,Medicare Advantage,90.827,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Hospital Inpatient Or Observation Discharge Day Management; 30 Minutes Or Less (Pro Cah),,99238,CPT,Professional,Outpatient,,,,196,166.6,50.85,196,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,145.30832,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Hospital Inpatient Or Observation Discharge Day Management; 30 Minutes Or Less (Pro Cah),,99238,CPT,Professional,Outpatient,,,,196,166.6,50.85,196,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,58.70448,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Hospital Inpatient Or Observation Discharge Day Management; 30 Minutes Or Less (Pro Cah),,99238,CPT,Professional,Outpatient,,,,196,166.6,50.85,196,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),90.827,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Hospital Inpatient Or Observation Discharge Day Management; 30 Minutes Or Less (Pro Cah),,99238,CPT,Professional,Outpatient,,,,196,166.6,50.85,196,CorVel,Worker's Compensation,136.42227,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Hospital Inpatient Or Observation Discharge Day Management; 30 Minutes Or Less (Pro Cah),,99238,CPT,Professional,Outpatient,,,,196,166.6,50.85,196,First Health Group Corporation,First Health Network,190.12,97,,percent of total billed charges,,
Hospital Inpatient Or Observation Discharge Day Management; 30 Minutes Or Less (Pro Cah),,99238,CPT,Professional,Outpatient,,,,196,166.6,50.85,196,"Health Partners, Inc.",Commercial,147.28,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Hospital Inpatient Or Observation Discharge Day Management; 30 Minutes Or Less (Pro Cah),,99238,CPT,Professional,Outpatient,,,,196,166.6,50.85,196,"Health Partners, Inc.",Medicare Advantage,90.827,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Hospital Inpatient Or Observation Discharge Day Management; 30 Minutes Or Less (Pro Cah),,99238,CPT,Professional,Outpatient,,,,196,166.6,50.85,196,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),78.96,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Hospital Inpatient Or Observation Discharge Day Management; 30 Minutes Or Less (Pro Cah),,99238,CPT,Professional,Outpatient,,,,196,166.6,50.85,196,"Health Partners, Inc.",State of Minnesota Advantage Program,126.88172,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Hospital Inpatient Or Observation Discharge Day Management; 30 Minutes Or Less (Pro Cah),,99238,CPT,Professional,Outpatient,,,,196,166.6,50.85,196,"Health Partners, Inc.",State Public Programs,50.85,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Hospital Inpatient Or Observation Discharge Day Management; 30 Minutes Or Less (Pro Cah),,99238,CPT,Professional,Outpatient,,,,196,166.6,50.85,196,Humana Insurance Company,Commercial PPO,78.98,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Hospital Inpatient Or Observation Discharge Day Management; 30 Minutes Or Less (Pro Cah),,99238,CPT,Professional,Outpatient,,,,196,166.6,50.85,196,Humana Insurance Company,Medicare PPO,196,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Hospital Inpatient Or Observation Discharge Day Management; 30 Minutes Or Less (Pro Cah),,99238,CPT,Professional,Outpatient,,,,196,166.6,50.85,196,Medica,Individual & Family,166.208,84.8,,percent of total billed charges,,
Hospital Inpatient Or Observation Discharge Day Management; 30 Minutes Or Less (Pro Cah),,99238,CPT,Professional,Outpatient,,,,196,166.6,50.85,196,Medica,Medica Advantage Solution,97.608,49.8,,percent of total billed charges,,
Hospital Inpatient Or Observation Discharge Day Management; 30 Minutes Or Less (Pro Cah),,99238,CPT,Professional,Outpatient,,,,196,166.6,50.85,196,Medica,Medical Assistance,58.7,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Hospital Inpatient Or Observation Discharge Day Management; 30 Minutes Or Less (Pro Cah),,99238,CPT,Professional,Outpatient,,,,196,166.6,50.85,196,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,78.98,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Hospital Inpatient Or Observation Discharge Day Management; 30 Minutes Or Less (Pro Cah),,99238,CPT,Professional,Outpatient,,,,196,166.6,50.85,196,"Multiplan, Inc.","Multiplan, Inc.",184.24,94,,percent of total billed charges,,
Hospital Inpatient Or Observation Discharge Day Management; 30 Minutes Or Less (Pro Cah),,99238,CPT,Professional,Outpatient,,,,196,166.6,50.85,196,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,176.596,90.1,,percent of total billed charges,,
Hospital Inpatient Or Observation Discharge Day Management; 30 Minutes Or Less (Pro Cah),,99238,CPT,Professional,Outpatient,,,,196,166.6,50.85,196,"Preferred One Administrative Services, INC.",PPO,193.256,98.6,,percent of total billed charges,,
Hospital Inpatient Or Observation Discharge Day Management; 30 Minutes Or Less (Pro Cah),,99238,CPT,Professional,Outpatient,,,,196,166.6,50.85,196,PrimeWest Health,Minnesota Senior Health Options (MSHO),90.827,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Hospital Inpatient Or Observation Discharge Day Management; 30 Minutes Or Less (Pro Cah),,99238,CPT,Professional,Outpatient,,,,196,166.6,50.85,196,PrimeWest Health,MinnesotaCare,62.8137936,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Hospital Inpatient Or Observation Discharge Day Management; 30 Minutes Or Less (Pro Cah),,99238,CPT,Professional,Outpatient,,,,196,166.6,50.85,196,Sanford Health Plan,Sanford Health Plan,172.48,88,,percent of total billed charges,,
Hospital Inpatient Or Observation Discharge Day Management; 30 Minutes Or Less (Pro Cah),,99238,CPT,Professional,Outpatient,,,,196,166.6,50.85,196,"UCare Health, Inc.",Individual & Family Plan,128.389888,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Hospital Inpatient Or Observation Discharge Day Management; 30 Minutes Or Less (Pro Cah),,99238,CPT,Professional,Outpatient,,,,196,166.6,50.85,196,"UCare Health, Inc.",Medical Assistance,64.574928,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Hospital Inpatient Or Observation Discharge Day Management; 30 Minutes Or Less (Pro Cah),,99238,CPT,Professional,Outpatient,,,,196,166.6,50.85,196,"UCare Health, Inc.",Medicare Advantage,90.827,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Hospital Inpatient Or Observation Discharge Day Management; 30 Minutes Or Less (Pro Cah),,99238,CPT,Professional,Outpatient,,,,196,166.6,50.85,196,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),72.6616,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Hospital Inpatient Or Observation Discharge Day Management; 30 Minutes Or Less (Pro Cah),,99238,CPT,Professional,Outpatient,,,,196,166.6,50.85,196,UnitedHealthcare,Individual & Family,196,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Hospital Inpatient Or Observation Discharge Day Management; 30 Minutes Or Less (Pro Cah),,99238,CPT,Professional,Outpatient,,,,196,166.6,50.85,196,UnitedHealthcare,Medicare Advantage,90.827,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Hospital Inpatient Or Observation Discharge Day Management; 30 Minutes Or Less (Pro Cah),,99238,CPT,Professional,Outpatient,,,,196,166.6,50.85,196,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,58.70448,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Hospital Inpatient Or Observation Discharge Day Management; More Than 30 Minutes (Pro Cah),,99239,CPT,Professional,Outpatient,,,,230,195.5,71.8,230,Aetna,Commercial,195.5,85,,percent of total billed charges,,
Hospital Inpatient Or Observation Discharge Day Management; More Than 30 Minutes (Pro Cah),,99239,CPT,Professional,Outpatient,,,,230,195.5,71.8,230,Aetna,Medicare Advantage,103.95,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Hospital Inpatient Or Observation Discharge Day Management; More Than 30 Minutes (Pro Cah),,99239,CPT,Professional,Outpatient,,,,230,195.5,71.8,230,Aetna,PPO,213.9,93,,percent of total billed charges,,
Hospital Inpatient Or Observation Discharge Day Management; More Than 30 Minutes (Pro Cah),,99239,CPT,Professional,Outpatient,,,,230,195.5,71.8,230,America's PPO,America's PPO,196.512,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Hospital Inpatient Or Observation Discharge Day Management; More Than 30 Minutes (Pro Cah),,99239,CPT,Professional,Outpatient,,,,230,195.5,71.8,230,BlueCross BlueShield Minnesota, Federal Employee Program,202.86,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Hospital Inpatient Or Observation Discharge Day Management; More Than 30 Minutes (Pro Cah),,99239,CPT,Professional,Outpatient,,,,230,195.5,71.8,230,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,206.10576,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Hospital Inpatient Or Observation Discharge Day Management; More Than 30 Minutes (Pro Cah),,99239,CPT,Professional,Outpatient,,,,230,195.5,71.8,230,BlueCross BlueShield Minnesota,High Value Network Plan,206.10576,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Hospital Inpatient Or Observation Discharge Day Management; More Than 30 Minutes (Pro Cah),,99239,CPT,Professional,Outpatient,,,,230,195.5,71.8,230,BlueCross BlueShield Minnesota,Medicare Advantage,128.432,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Hospital Inpatient Or Observation Discharge Day Management; More Than 30 Minutes (Pro Cah),,99239,CPT,Professional,Outpatient,,,,230,195.5,71.8,230,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,206.10576,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Hospital Inpatient Or Observation Discharge Day Management; More Than 30 Minutes (Pro Cah),,99239,CPT,Professional,Outpatient,,,,230,195.5,71.8,230,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,82.89544,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Hospital Inpatient Or Observation Discharge Day Management; More Than 30 Minutes (Pro Cah),,99239,CPT,Professional,Outpatient,,,,230,195.5,71.8,230,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),128.432,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Hospital Inpatient Or Observation Discharge Day Management; More Than 30 Minutes (Pro Cah),,99239,CPT,Professional,Outpatient,,,,230,195.5,71.8,230,CorVel,Worker's Compensation,199.8723954,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Hospital Inpatient Or Observation Discharge Day Management; More Than 30 Minutes (Pro Cah),,99239,CPT,Professional,Outpatient,,,,230,195.5,71.8,230,First Health Group Corporation,First Health Network,223.1,97,,percent of total billed charges,,
Hospital Inpatient Or Observation Discharge Day Management; More Than 30 Minutes (Pro Cah),,99239,CPT,Professional,Outpatient,,,,230,195.5,71.8,230,"Health Partners, Inc.",Commercial,215.48,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Hospital Inpatient Or Observation Discharge Day Management; More Than 30 Minutes (Pro Cah),,99239,CPT,Professional,Outpatient,,,,230,195.5,71.8,230,"Health Partners, Inc.",Medicare Advantage,128.432,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Hospital Inpatient Or Observation Discharge Day Management; More Than 30 Minutes (Pro Cah),,99239,CPT,Professional,Outpatient,,,,230,195.5,71.8,230,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),111.83,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Hospital Inpatient Or Observation Discharge Day Management; More Than 30 Minutes (Pro Cah),,99239,CPT,Professional,Outpatient,,,,230,195.5,71.8,230,"Health Partners, Inc.",State of Minnesota Advantage Program,185.63602,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Hospital Inpatient Or Observation Discharge Day Management; More Than 30 Minutes (Pro Cah),,99239,CPT,Professional,Outpatient,,,,230,195.5,71.8,230,"Health Partners, Inc.",State Public Programs,71.8,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Hospital Inpatient Or Observation Discharge Day Management; More Than 30 Minutes (Pro Cah),,99239,CPT,Professional,Outpatient,,,,230,195.5,71.8,230,Humana Insurance Company,Commercial PPO,111.68,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Hospital Inpatient Or Observation Discharge Day Management; More Than 30 Minutes (Pro Cah),,99239,CPT,Professional,Outpatient,,,,230,195.5,71.8,230,Humana Insurance Company,Medicare PPO,230,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Hospital Inpatient Or Observation Discharge Day Management; More Than 30 Minutes (Pro Cah),,99239,CPT,Professional,Outpatient,,,,230,195.5,71.8,230,Medica,Individual & Family,195.04,84.8,,percent of total billed charges,,
Hospital Inpatient Or Observation Discharge Day Management; More Than 30 Minutes (Pro Cah),,99239,CPT,Professional,Outpatient,,,,230,195.5,71.8,230,Medica,Medica Advantage Solution,114.54,49.8,,percent of total billed charges,,
Hospital Inpatient Or Observation Discharge Day Management; More Than 30 Minutes (Pro Cah),,99239,CPT,Professional,Outpatient,,,,230,195.5,71.8,230,Medica,Medical Assistance,82.9,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Hospital Inpatient Or Observation Discharge Day Management; More Than 30 Minutes (Pro Cah),,99239,CPT,Professional,Outpatient,,,,230,195.5,71.8,230,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,111.68,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Hospital Inpatient Or Observation Discharge Day Management; More Than 30 Minutes (Pro Cah),,99239,CPT,Professional,Outpatient,,,,230,195.5,71.8,230,"Multiplan, Inc.","Multiplan, Inc.",216.2,94,,percent of total billed charges,,
Hospital Inpatient Or Observation Discharge Day Management; More Than 30 Minutes (Pro Cah),,99239,CPT,Professional,Outpatient,,,,230,195.5,71.8,230,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,207.23,90.1,,percent of total billed charges,,
Hospital Inpatient Or Observation Discharge Day Management; More Than 30 Minutes (Pro Cah),,99239,CPT,Professional,Outpatient,,,,230,195.5,71.8,230,"Preferred One Administrative Services, INC.",PPO,226.78,98.6,,percent of total billed charges,,
Hospital Inpatient Or Observation Discharge Day Management; More Than 30 Minutes (Pro Cah),,99239,CPT,Professional,Outpatient,,,,230,195.5,71.8,230,PrimeWest Health,Minnesota Senior Health Options (MSHO),128.432,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Hospital Inpatient Or Observation Discharge Day Management; More Than 30 Minutes (Pro Cah),,99239,CPT,Professional,Outpatient,,,,230,195.5,71.8,230,PrimeWest Health,MinnesotaCare,88.6981208,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Hospital Inpatient Or Observation Discharge Day Management; More Than 30 Minutes (Pro Cah),,99239,CPT,Professional,Outpatient,,,,230,195.5,71.8,230,Sanford Health Plan,Sanford Health Plan,202.4,88,,percent of total billed charges,,
Hospital Inpatient Or Observation Discharge Day Management; More Than 30 Minutes (Pro Cah),,99239,CPT,Professional,Outpatient,,,,230,195.5,71.8,230,"UCare Health, Inc.",Individual & Family Plan,181.547008,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Hospital Inpatient Or Observation Discharge Day Management; More Than 30 Minutes (Pro Cah),,99239,CPT,Professional,Outpatient,,,,230,195.5,71.8,230,"UCare Health, Inc.",Medical Assistance,91.184984,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Hospital Inpatient Or Observation Discharge Day Management; More Than 30 Minutes (Pro Cah),,99239,CPT,Professional,Outpatient,,,,230,195.5,71.8,230,"UCare Health, Inc.",Medicare Advantage,128.432,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Hospital Inpatient Or Observation Discharge Day Management; More Than 30 Minutes (Pro Cah),,99239,CPT,Professional,Outpatient,,,,230,195.5,71.8,230,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),102.7456,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Hospital Inpatient Or Observation Discharge Day Management; More Than 30 Minutes (Pro Cah),,99239,CPT,Professional,Outpatient,,,,230,195.5,71.8,230,UnitedHealthcare,Individual & Family,230,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Hospital Inpatient Or Observation Discharge Day Management; More Than 30 Minutes (Pro Cah),,99239,CPT,Professional,Outpatient,,,,230,195.5,71.8,230,UnitedHealthcare,Medicare Advantage,128.432,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Hospital Inpatient Or Observation Discharge Day Management; More Than 30 Minutes (Pro Cah),,99239,CPT,Professional,Outpatient,,,,230,195.5,71.8,230,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,82.89544,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Office Or Outpt Consult, New Or Est Pt, Moderate Mdm Or 40-54 Mins (Pbb)",,99244,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,Aetna,Commercial,46.92,92,,percent of total billed charges,,
"Office Or Outpt Consult, New Or Est Pt, Moderate Mdm Or 40-54 Mins (Pbb)",,99244,CPT,Professional,Outpatient,,,,428,363.8,92.37,428,Aetna,Commercial,363.8,85,,percent of total billed charges,,
"Office Or Outpt Consult, New Or Est Pt, Moderate Mdm Or 40-54 Mins (Pbb)",,99244,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,Aetna,Medicare Advantage,24.99,49,,percent of total billed charges,,
"Office Or Outpt Consult, New Or Est Pt, Moderate Mdm Or 40-54 Mins (Pbb)",,99244,CPT,Professional,Outpatient,,,,428,363.8,92.37,428,Aetna,Medicare Advantage,148.75,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Office Or Outpt Consult, New Or Est Pt, Moderate Mdm Or 40-54 Mins (Pbb)",,99244,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,Aetna,PPO,47.43,93,,percent of total billed charges,,
"Office Or Outpt Consult, New Or Est Pt, Moderate Mdm Or 40-54 Mins (Pbb)",,99244,CPT,Professional,Outpatient,,,,428,363.8,92.37,428,Aetna,PPO,398.04,93,,percent of total billed charges,,
"Office Or Outpt Consult, New Or Est Pt, Moderate Mdm Or 40-54 Mins (Pbb)",,99244,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,America's PPO,America's PPO,48.9753,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Office Or Outpt Consult, New Or Est Pt, Moderate Mdm Or 40-54 Mins (Pbb)",,99244,CPT,Professional,Outpatient,,,,428,363.8,92.37,428,America's PPO,America's PPO,365.6832,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Office Or Outpt Consult, New Or Est Pt, Moderate Mdm Or 40-54 Mins (Pbb)",,99244,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,BlueCross BlueShield Minnesota, Federal Employee Program,50.184,98.4,,percent of total billed charges,,
"Office Or Outpt Consult, New Or Est Pt, Moderate Mdm Or 40-54 Mins (Pbb)",,99244,CPT,Professional,Outpatient,,,,428,363.8,92.37,428,BlueCross BlueShield Minnesota, Federal Employee Program,239.36,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Office Or Outpt Consult, New Or Est Pt, Moderate Mdm Or 40-54 Mins (Pbb)",,99244,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,51,100,,percent of total billed charges,,
"Office Or Outpt Consult, New Or Est Pt, Moderate Mdm Or 40-54 Mins (Pbb)",,99244,CPT,Professional,Outpatient,,,,428,363.8,92.37,428,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,243.18976,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Office Or Outpt Consult, New Or Est Pt, Moderate Mdm Or 40-54 Mins (Pbb)",,99244,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,High Value Network Plan,45.9,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
"Office Or Outpt Consult, New Or Est Pt, Moderate Mdm Or 40-54 Mins (Pbb)",,99244,CPT,Professional,Outpatient,,,,428,363.8,92.37,428,BlueCross BlueShield Minnesota,High Value Network Plan,243.18976,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Office Or Outpt Consult, New Or Est Pt, Moderate Mdm Or 40-54 Mins (Pbb)",,99244,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,Medicare Advantage,24.99,49,,percent of total billed charges,,
"Office Or Outpt Consult, New Or Est Pt, Moderate Mdm Or 40-54 Mins (Pbb)",,99244,CPT,Professional,Outpatient,,,,428,363.8,92.37,428,BlueCross BlueShield Minnesota,Medicare Advantage,,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Office Or Outpt Consult, New Or Est Pt, Moderate Mdm Or 40-54 Mins (Pbb)",,99244,CPT,Professional,Outpatient,,,,428,363.8,92.37,428,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,243.18976,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Office Or Outpt Consult, New Or Est Pt, Moderate Mdm Or 40-54 Mins (Pbb)",,99244,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,14.6166,28.66,,percent of total billed charges,,
"Office Or Outpt Consult, New Or Est Pt, Moderate Mdm Or 40-54 Mins (Pbb)",,99244,CPT,Professional,Outpatient,,,,428,363.8,92.37,428,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,98.26752,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Office Or Outpt Consult, New Or Est Pt, Moderate Mdm Or 40-54 Mins (Pbb)",,99244,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),24.99,49,,percent of total billed charges,,
"Office Or Outpt Consult, New Or Est Pt, Moderate Mdm Or 40-54 Mins (Pbb)",,99244,CPT,Professional,Outpatient,,,,428,363.8,92.37,428,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Office Or Outpt Consult, New Or Est Pt, Moderate Mdm Or 40-54 Mins (Pbb)",,99244,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,CorVel,Worker's Compensation,51,100,,percent of total billed charges,,
"Office Or Outpt Consult, New Or Est Pt, Moderate Mdm Or 40-54 Mins (Pbb)",,99244,CPT,Professional,Outpatient,,,,428,363.8,92.37,428,CorVel,Worker's Compensation,286.3504119,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Office Or Outpt Consult, New Or Est Pt, Moderate Mdm Or 40-54 Mins (Pbb)",,99244,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,First Health Group Corporation,First Health Network,49.47,97,,percent of total billed charges,,
"Office Or Outpt Consult, New Or Est Pt, Moderate Mdm Or 40-54 Mins (Pbb)",,99244,CPT,Professional,Outpatient,,,,428,363.8,92.37,428,First Health Group Corporation,First Health Network,415.16,97,,percent of total billed charges,,
"Office Or Outpt Consult, New Or Est Pt, Moderate Mdm Or 40-54 Mins (Pbb)",,99244,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,"Health Partners, Inc.",Commercial,48.246,94.6,,percent of total billed charges,,
"Office Or Outpt Consult, New Or Est Pt, Moderate Mdm Or 40-54 Mins (Pbb)",,99244,CPT,Professional,Outpatient,,,,428,363.8,92.37,428,"Health Partners, Inc.",Commercial,,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Office Or Outpt Consult, New Or Est Pt, Moderate Mdm Or 40-54 Mins (Pbb)",,99244,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,"Health Partners, Inc.",Medicare Advantage,24.99,49,,percent of total billed charges,,
"Office Or Outpt Consult, New Or Est Pt, Moderate Mdm Or 40-54 Mins (Pbb)",,99244,CPT,Professional,Outpatient,,,,428,363.8,92.37,428,"Health Partners, Inc.",Medicare Advantage,,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Office Or Outpt Consult, New Or Est Pt, Moderate Mdm Or 40-54 Mins (Pbb)",,99244,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),30.6,60,,percent of total billed charges,,
"Office Or Outpt Consult, New Or Est Pt, Moderate Mdm Or 40-54 Mins (Pbb)",,99244,CPT,Professional,Outpatient,,,,428,363.8,92.37,428,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),132.5,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Office Or Outpt Consult, New Or Est Pt, Moderate Mdm Or 40-54 Mins (Pbb)",,99244,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,"Health Partners, Inc.",State of Minnesota Advantage Program,41.565,81.5,,percent of total billed charges,,
"Office Or Outpt Consult, New Or Est Pt, Moderate Mdm Or 40-54 Mins (Pbb)",,99244,CPT,Professional,Outpatient,,,,428,363.8,92.37,428,"Health Partners, Inc.",State of Minnesota Advantage Program,,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Office Or Outpt Consult, New Or Est Pt, Moderate Mdm Or 40-54 Mins (Pbb)",,99244,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,"Health Partners, Inc.",State Public Programs,25.5,50,,percent of total billed charges,,
"Office Or Outpt Consult, New Or Est Pt, Moderate Mdm Or 40-54 Mins (Pbb)",,99244,CPT,Professional,Outpatient,,,,428,363.8,92.37,428,"Health Partners, Inc.",State Public Programs,92.37,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Office Or Outpt Consult, New Or Est Pt, Moderate Mdm Or 40-54 Mins (Pbb)",,99244,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,Humana Insurance Company,Commercial PPO,48.45,95,,percent of total billed charges,,
"Office Or Outpt Consult, New Or Est Pt, Moderate Mdm Or 40-54 Mins (Pbb)",,99244,CPT,Professional,Outpatient,,,,428,363.8,92.37,428,Humana Insurance Company,Commercial PPO,132.4,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Office Or Outpt Consult, New Or Est Pt, Moderate Mdm Or 40-54 Mins (Pbb)",,99244,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,Humana Insurance Company,Medicare PPO,24.99,49,,percent of total billed charges,,
"Office Or Outpt Consult, New Or Est Pt, Moderate Mdm Or 40-54 Mins (Pbb)",,99244,CPT,Professional,Outpatient,,,,428,363.8,92.37,428,Humana Insurance Company,Medicare PPO,,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Office Or Outpt Consult, New Or Est Pt, Moderate Mdm Or 40-54 Mins (Pbb)",,99244,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,Medica,Individual & Family,50.541,99.1,,percent of total billed charges,,
"Office Or Outpt Consult, New Or Est Pt, Moderate Mdm Or 40-54 Mins (Pbb)",,99244,CPT,Professional,Outpatient,,,,428,363.8,92.37,428,Medica,Individual & Family,362.944,84.8,,percent of total billed charges,,
"Office Or Outpt Consult, New Or Est Pt, Moderate Mdm Or 40-54 Mins (Pbb)",,99244,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,Medica,Medica Advantage Solution,25.398,49.8,,percent of total billed charges,,
"Office Or Outpt Consult, New Or Est Pt, Moderate Mdm Or 40-54 Mins (Pbb)",,99244,CPT,Professional,Outpatient,,,,428,363.8,92.37,428,Medica,Medica Advantage Solution,213.144,49.8,,percent of total billed charges,,
"Office Or Outpt Consult, New Or Est Pt, Moderate Mdm Or 40-54 Mins (Pbb)",,99244,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,Medica,Medical Assistance,22.746,44.6,,percent of total billed charges,,
"Office Or Outpt Consult, New Or Est Pt, Moderate Mdm Or 40-54 Mins (Pbb)",,99244,CPT,Professional,Outpatient,,,,428,363.8,92.37,428,Medica,Medical Assistance,98.27,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Office Or Outpt Consult, New Or Est Pt, Moderate Mdm Or 40-54 Mins (Pbb)",,99244,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,25.398,49.8,,percent of total billed charges,,
"Office Or Outpt Consult, New Or Est Pt, Moderate Mdm Or 40-54 Mins (Pbb)",,99244,CPT,Professional,Outpatient,,,,428,363.8,92.37,428,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,132.4,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Office Or Outpt Consult, New Or Est Pt, Moderate Mdm Or 40-54 Mins (Pbb)",,99244,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,"Multiplan, Inc.","Multiplan, Inc.",47.94,94,,percent of total billed charges,,
"Office Or Outpt Consult, New Or Est Pt, Moderate Mdm Or 40-54 Mins (Pbb)",,99244,CPT,Professional,Outpatient,,,,428,363.8,92.37,428,"Multiplan, Inc.","Multiplan, Inc.",402.32,94,,percent of total billed charges,,
"Office Or Outpt Consult, New Or Est Pt, Moderate Mdm Or 40-54 Mins (Pbb)",,99244,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,45.951,90.1,,percent of total billed charges,,
"Office Or Outpt Consult, New Or Est Pt, Moderate Mdm Or 40-54 Mins (Pbb)",,99244,CPT,Professional,Outpatient,,,,428,363.8,92.37,428,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,385.628,90.1,,percent of total billed charges,,
"Office Or Outpt Consult, New Or Est Pt, Moderate Mdm Or 40-54 Mins (Pbb)",,99244,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,"Preferred One Administrative Services, INC.",PPO,50.286,98.6,,percent of total billed charges,,
"Office Or Outpt Consult, New Or Est Pt, Moderate Mdm Or 40-54 Mins (Pbb)",,99244,CPT,Professional,Outpatient,,,,428,363.8,92.37,428,"Preferred One Administrative Services, INC.",PPO,422.008,98.6,,percent of total billed charges,,
"Office Or Outpt Consult, New Or Est Pt, Moderate Mdm Or 40-54 Mins (Pbb)",,99244,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,PrimeWest Health,Minnesota Senior Health Options (MSHO),26.2395,51.45,,percent of total billed charges,,
"Office Or Outpt Consult, New Or Est Pt, Moderate Mdm Or 40-54 Mins (Pbb)",,99244,CPT,Professional,Outpatient,,,,428,363.8,92.37,428,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Office Or Outpt Consult, New Or Est Pt, Moderate Mdm Or 40-54 Mins (Pbb)",,99244,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,PrimeWest Health,MinnesotaCare,26.1936,51.36,,percent of total billed charges,,
"Office Or Outpt Consult, New Or Est Pt, Moderate Mdm Or 40-54 Mins (Pbb)",,99244,CPT,Professional,Outpatient,,,,428,363.8,92.37,428,PrimeWest Health,MinnesotaCare,105.1462464,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Office Or Outpt Consult, New Or Est Pt, Moderate Mdm Or 40-54 Mins (Pbb)",,99244,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,Sanford Health Plan,Sanford Health Plan,46.92,92,,percent of total billed charges,,
"Office Or Outpt Consult, New Or Est Pt, Moderate Mdm Or 40-54 Mins (Pbb)",,99244,CPT,Professional,Outpatient,,,,428,363.8,92.37,428,Sanford Health Plan,Sanford Health Plan,376.64,88,,percent of total billed charges,,
"Office Or Outpt Consult, New Or Est Pt, Moderate Mdm Or 40-54 Mins (Pbb)",,99244,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,"UCare Health, Inc.",Individual & Family Plan,28.7385,56.35,,percent of total billed charges,,
"Office Or Outpt Consult, New Or Est Pt, Moderate Mdm Or 40-54 Mins (Pbb)",,99244,CPT,Professional,Outpatient,,,,428,363.8,92.37,428,"UCare Health, Inc.",Individual & Family Plan,,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Office Or Outpt Consult, New Or Est Pt, Moderate Mdm Or 40-54 Mins (Pbb)",,99244,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,"UCare Health, Inc.",Medical Assistance,25.7397,50.47,,percent of total billed charges,,
"Office Or Outpt Consult, New Or Est Pt, Moderate Mdm Or 40-54 Mins (Pbb)",,99244,CPT,Professional,Outpatient,,,,428,363.8,92.37,428,"UCare Health, Inc.",Medical Assistance,108.094272,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Office Or Outpt Consult, New Or Est Pt, Moderate Mdm Or 40-54 Mins (Pbb)",,99244,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,"UCare Health, Inc.",Medicare Advantage,25.7397,50.47,,percent of total billed charges,,
"Office Or Outpt Consult, New Or Est Pt, Moderate Mdm Or 40-54 Mins (Pbb)",,99244,CPT,Professional,Outpatient,,,,428,363.8,92.37,428,"UCare Health, Inc.",Medicare Advantage,,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Office Or Outpt Consult, New Or Est Pt, Moderate Mdm Or 40-54 Mins (Pbb)",,99244,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),25.7397,50.47,,percent of total billed charges,,
"Office Or Outpt Consult, New Or Est Pt, Moderate Mdm Or 40-54 Mins (Pbb)",,99244,CPT,Professional,Outpatient,,,,428,363.8,92.37,428,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Office Or Outpt Consult, New Or Est Pt, Moderate Mdm Or 40-54 Mins (Pbb)",,99244,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,UnitedHealthcare,Individual & Family,47.94,94,,percent of total billed charges,,
"Office Or Outpt Consult, New Or Est Pt, Moderate Mdm Or 40-54 Mins (Pbb)",,99244,CPT,Professional,Outpatient,,,,428,363.8,92.37,428,UnitedHealthcare,Individual & Family,428,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Office Or Outpt Consult, New Or Est Pt, Moderate Mdm Or 40-54 Mins (Pbb)",,99244,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,UnitedHealthcare,Medicare Advantage,24.99,49,,percent of total billed charges,,
"Office Or Outpt Consult, New Or Est Pt, Moderate Mdm Or 40-54 Mins (Pbb)",,99244,CPT,Professional,Outpatient,,,,428,363.8,92.37,428,UnitedHealthcare,Medicare Advantage,,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Office Or Outpt Consult, New Or Est Pt, Moderate Mdm Or 40-54 Mins (Pbb)",,99244,CPT,Facility,Outpatient,,,,51,43.35,14.6166,51,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,24.48,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Office Or Outpt Consult, New Or Est Pt, Moderate Mdm Or 40-54 Mins (Pbb)",,99244,CPT,Professional,Outpatient,,,,428,363.8,92.37,428,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,98.26752,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Emergent Level 1,,99281,CPT,Facility,Outpatient,,,,332,282.2,95.1512,332,Aetna,Commercial,305.44,92,,percent of total billed charges,,
Emergent Level 1,,99281,CPT,Facility,Outpatient,,,,332,282.2,95.1512,332,Aetna,Medicare Advantage,162.68,49,,percent of total billed charges,,
Emergent Level 1,,99281,CPT,Facility,Outpatient,,,,332,282.2,95.1512,332,Aetna,PPO,308.76,93,,percent of total billed charges,,
Emergent Level 1,,99281,CPT,Facility,Outpatient,,,,332,282.2,95.1512,332,America's PPO,America's PPO,318.8196,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Emergent Level 1,,99281,CPT,Facility,Outpatient,,,,332,282.2,95.1512,332,BlueCross BlueShield Minnesota, Federal Employee Program,326.688,98.4,,percent of total billed charges,,
Emergent Level 1,,99281,CPT,Facility,Outpatient,,,,332,282.2,95.1512,332,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,332,100,,percent of total billed charges,,
Emergent Level 1,,99281,CPT,Facility,Outpatient,,,,332,282.2,95.1512,332,BlueCross BlueShield Minnesota,High Value Network Plan,298.8,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
Emergent Level 1,,99281,CPT,Facility,Outpatient,,,,332,282.2,95.1512,332,BlueCross BlueShield Minnesota,Medicare Advantage,162.68,49,,percent of total billed charges,,
Emergent Level 1,,99281,CPT,Facility,Outpatient,,,,332,282.2,95.1512,332,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,95.1512,28.66,,percent of total billed charges,,
Emergent Level 1,,99281,CPT,Facility,Outpatient,,,,332,282.2,95.1512,332,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),162.68,49,,percent of total billed charges,,
Emergent Level 1,,99281,CPT,Facility,Outpatient,,,,332,282.2,95.1512,332,CorVel,Worker's Compensation,332,100,,percent of total billed charges,,
Emergent Level 1,,99281,CPT,Facility,Outpatient,,,,332,282.2,95.1512,332,First Health Group Corporation,First Health Network,322.04,97,,percent of total billed charges,,
Emergent Level 1,,99281,CPT,Facility,Outpatient,,,,332,282.2,95.1512,332,"Health Partners, Inc.",Commercial,314.072,94.6,,percent of total billed charges,,
Emergent Level 1,,99281,CPT,Facility,Outpatient,,,,332,282.2,95.1512,332,"Health Partners, Inc.",Medicare Advantage,162.68,49,,percent of total billed charges,,
Emergent Level 1,,99281,CPT,Facility,Outpatient,,,,332,282.2,95.1512,332,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),199.2,60,,percent of total billed charges,,
Emergent Level 1,,99281,CPT,Facility,Outpatient,,,,332,282.2,95.1512,332,"Health Partners, Inc.",State of Minnesota Advantage Program,270.58,81.5,,percent of total billed charges,,
Emergent Level 1,,99281,CPT,Facility,Outpatient,,,,332,282.2,95.1512,332,"Health Partners, Inc.",State Public Programs,166,50,,percent of total billed charges,,
Emergent Level 1,,99281,CPT,Facility,Outpatient,,,,332,282.2,95.1512,332,Humana Insurance Company,Commercial PPO,315.4,95,,percent of total billed charges,,
Emergent Level 1,,99281,CPT,Facility,Outpatient,,,,332,282.2,95.1512,332,Humana Insurance Company,Medicare PPO,162.68,49,,percent of total billed charges,,
Emergent Level 1,,99281,CPT,Facility,Outpatient,,,,332,282.2,95.1512,332,Medica,Individual & Family,309.424,93.2,,percent of total billed charges,,
Emergent Level 1,,99281,CPT,Facility,Outpatient,,,,332,282.2,95.1512,332,Medica,Medica Advantage Solution,165.336,49.8,,percent of total billed charges,,
Emergent Level 1,,99281,CPT,Facility,Outpatient,,,,332,282.2,95.1512,332,Medica,Medical Assistance,148.072,44.6,,percent of total billed charges,,
Emergent Level 1,,99281,CPT,Facility,Outpatient,,,,332,282.2,95.1512,332,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,165.336,49.8,,percent of total billed charges,,
Emergent Level 1,,99281,CPT,Facility,Outpatient,,,,332,282.2,95.1512,332,"Multiplan, Inc.","Multiplan, Inc.",312.08,94,,percent of total billed charges,,
Emergent Level 1,,99281,CPT,Facility,Outpatient,,,,332,282.2,95.1512,332,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,299.132,90.1,,percent of total billed charges,,
Emergent Level 1,,99281,CPT,Facility,Outpatient,,,,332,282.2,95.1512,332,"Preferred One Administrative Services, INC.",PPO,327.352,98.6,,percent of total billed charges,,
Emergent Level 1,,99281,CPT,Facility,Outpatient,,,,332,282.2,95.1512,332,PrimeWest Health,Minnesota Senior Health Options (MSHO),170.814,51.45,,percent of total billed charges,,
Emergent Level 1,,99281,CPT,Facility,Outpatient,,,,332,282.2,95.1512,332,PrimeWest Health,MinnesotaCare,170.5152,51.36,,percent of total billed charges,,
Emergent Level 1,,99281,CPT,Facility,Outpatient,,,,332,282.2,95.1512,332,Sanford Health Plan,Sanford Health Plan,305.44,92,,percent of total billed charges,,
Emergent Level 1,,99281,CPT,Facility,Outpatient,,,,332,282.2,95.1512,332,"UCare Health, Inc.",Individual & Family Plan,187.082,56.35,,percent of total billed charges,,
Emergent Level 1,,99281,CPT,Facility,Outpatient,,,,332,282.2,95.1512,332,"UCare Health, Inc.",Medical Assistance,167.5604,50.47,,percent of total billed charges,,
Emergent Level 1,,99281,CPT,Facility,Outpatient,,,,332,282.2,95.1512,332,"UCare Health, Inc.",Medicare Advantage,167.5604,50.47,,percent of total billed charges,,
Emergent Level 1,,99281,CPT,Facility,Outpatient,,,,332,282.2,95.1512,332,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),167.5604,50.47,,percent of total billed charges,,
Emergent Level 1,,99281,CPT,Facility,Outpatient,,,,332,282.2,95.1512,332,UnitedHealthcare,Individual & Family,312.08,94,,percent of total billed charges,,
Emergent Level 1,,99281,CPT,Facility,Outpatient,,,,332,282.2,95.1512,332,UnitedHealthcare,Medicare Advantage,162.68,49,,percent of total billed charges,,
Emergent Level 1,,99281,CPT,Facility,Outpatient,,,,332,282.2,95.1512,332,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,159.36,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Emergency Department Visit, Straightforward Mdm (Pro Cah)",,99282,CPT,Professional,Outpatient,,,,255,216.75,25.53,255,Aetna,Commercial,216.75,85,,percent of total billed charges,,
"Emergency Department Visit, Straightforward Mdm (Pro Cah)",,99282,CPT,Professional,Outpatient,,,,255,216.75,25.53,255,Aetna,Medicare Advantage,41.11,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Emergency Department Visit, Straightforward Mdm (Pro Cah)",,99282,CPT,Professional,Outpatient,,,,255,216.75,25.53,255,Aetna,PPO,237.15,93,,percent of total billed charges,,
"Emergency Department Visit, Straightforward Mdm (Pro Cah)",,99282,CPT,Professional,Outpatient,,,,255,216.75,25.53,255,America's PPO,America's PPO,217.872,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Emergency Department Visit, Straightforward Mdm (Pro Cah)",,99282,CPT,Professional,Outpatient,,,,255,216.75,25.53,255,BlueCross BlueShield Minnesota, Federal Employee Program,74.2,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Emergency Department Visit, Straightforward Mdm (Pro Cah)",,99282,CPT,Professional,Outpatient,,,,255,216.75,25.53,255,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,75.3872,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Emergency Department Visit, Straightforward Mdm (Pro Cah)",,99282,CPT,Professional,Outpatient,,,,255,216.75,25.53,255,BlueCross BlueShield Minnesota,High Value Network Plan,75.3872,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Emergency Department Visit, Straightforward Mdm (Pro Cah)",,99282,CPT,Professional,Outpatient,,,,255,216.75,25.53,255,BlueCross BlueShield Minnesota,Medicare Advantage,45.8505,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Emergency Department Visit, Straightforward Mdm (Pro Cah)",,99282,CPT,Professional,Outpatient,,,,255,216.75,25.53,255,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,75.3872,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Emergency Department Visit, Straightforward Mdm (Pro Cah)",,99282,CPT,Professional,Outpatient,,,,255,216.75,25.53,255,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,29.47416,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Emergency Department Visit, Straightforward Mdm (Pro Cah)",,99282,CPT,Professional,Outpatient,,,,255,216.75,25.53,255,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),45.8505,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Emergency Department Visit, Straightforward Mdm (Pro Cah)",,99282,CPT,Professional,Outpatient,,,,255,216.75,25.53,255,CorVel,Worker's Compensation,79.1282751,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Emergency Department Visit, Straightforward Mdm (Pro Cah)",,99282,CPT,Professional,Outpatient,,,,255,216.75,25.53,255,First Health Group Corporation,First Health Network,247.35,97,,percent of total billed charges,,
"Emergency Department Visit, Straightforward Mdm (Pro Cah)",,99282,CPT,Professional,Outpatient,,,,255,216.75,25.53,255,"Health Partners, Inc.",Commercial,85.61,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Emergency Department Visit, Straightforward Mdm (Pro Cah)",,99282,CPT,Professional,Outpatient,,,,255,216.75,25.53,255,"Health Partners, Inc.",Medicare Advantage,45.8505,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Emergency Department Visit, Straightforward Mdm (Pro Cah)",,99282,CPT,Professional,Outpatient,,,,255,216.75,25.53,255,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),39.65,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Emergency Department Visit, Straightforward Mdm (Pro Cah)",,99282,CPT,Professional,Outpatient,,,,255,216.75,25.53,255,"Health Partners, Inc.",State of Minnesota Advantage Program,73.753015,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Emergency Department Visit, Straightforward Mdm (Pro Cah)",,99282,CPT,Professional,Outpatient,,,,255,216.75,25.53,255,"Health Partners, Inc.",State Public Programs,25.53,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Emergency Department Visit, Straightforward Mdm (Pro Cah)",,99282,CPT,Professional,Outpatient,,,,255,216.75,25.53,255,Humana Insurance Company,Commercial PPO,39.87,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Emergency Department Visit, Straightforward Mdm (Pro Cah)",,99282,CPT,Professional,Outpatient,,,,255,216.75,25.53,255,Humana Insurance Company,Medicare PPO,255,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Emergency Department Visit, Straightforward Mdm (Pro Cah)",,99282,CPT,Professional,Outpatient,,,,255,216.75,25.53,255,Medica,Individual & Family,216.24,84.8,,percent of total billed charges,,
"Emergency Department Visit, Straightforward Mdm (Pro Cah)",,99282,CPT,Professional,Outpatient,,,,255,216.75,25.53,255,Medica,Medica Advantage Solution,126.99,49.8,,percent of total billed charges,,
"Emergency Department Visit, Straightforward Mdm (Pro Cah)",,99282,CPT,Professional,Outpatient,,,,255,216.75,25.53,255,Medica,Medical Assistance,29.47,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Emergency Department Visit, Straightforward Mdm (Pro Cah)",,99282,CPT,Professional,Outpatient,,,,255,216.75,25.53,255,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,39.87,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Emergency Department Visit, Straightforward Mdm (Pro Cah)",,99282,CPT,Professional,Outpatient,,,,255,216.75,25.53,255,"Multiplan, Inc.","Multiplan, Inc.",239.7,94,,percent of total billed charges,,
"Emergency Department Visit, Straightforward Mdm (Pro Cah)",,99282,CPT,Professional,Outpatient,,,,255,216.75,25.53,255,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,229.755,90.1,,percent of total billed charges,,
"Emergency Department Visit, Straightforward Mdm (Pro Cah)",,99282,CPT,Professional,Outpatient,,,,255,216.75,25.53,255,"Preferred One Administrative Services, INC.",PPO,251.43,98.6,,percent of total billed charges,,
"Emergency Department Visit, Straightforward Mdm (Pro Cah)",,99282,CPT,Professional,Outpatient,,,,255,216.75,25.53,255,PrimeWest Health,Minnesota Senior Health Options (MSHO),45.8505,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Emergency Department Visit, Straightforward Mdm (Pro Cah)",,99282,CPT,Professional,Outpatient,,,,255,216.75,25.53,255,PrimeWest Health,MinnesotaCare,31.5373512,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Emergency Department Visit, Straightforward Mdm (Pro Cah)",,99282,CPT,Professional,Outpatient,,,,255,216.75,25.53,255,Sanford Health Plan,Sanford Health Plan,224.4,88,,percent of total billed charges,,
"Emergency Department Visit, Straightforward Mdm (Pro Cah)",,99282,CPT,Professional,Outpatient,,,,255,216.75,25.53,255,"UCare Health, Inc.",Individual & Family Plan,64.812672,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Emergency Department Visit, Straightforward Mdm (Pro Cah)",,99282,CPT,Professional,Outpatient,,,,255,216.75,25.53,255,"UCare Health, Inc.",Medical Assistance,32.421576,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Emergency Department Visit, Straightforward Mdm (Pro Cah)",,99282,CPT,Professional,Outpatient,,,,255,216.75,25.53,255,"UCare Health, Inc.",Medicare Advantage,45.8505,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Emergency Department Visit, Straightforward Mdm (Pro Cah)",,99282,CPT,Professional,Outpatient,,,,255,216.75,25.53,255,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),36.6804,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Emergency Department Visit, Straightforward Mdm (Pro Cah)",,99282,CPT,Professional,Outpatient,,,,255,216.75,25.53,255,UnitedHealthcare,Individual & Family,255,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Emergency Department Visit, Straightforward Mdm (Pro Cah)",,99282,CPT,Professional,Outpatient,,,,255,216.75,25.53,255,UnitedHealthcare,Medicare Advantage,45.8505,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Emergency Department Visit, Straightforward Mdm (Pro Cah)",,99282,CPT,Professional,Outpatient,,,,255,216.75,25.53,255,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,29.47416,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Emergent Level 2,,99282,CPT,Facility,Outpatient,,,,439,373.15,125.8174,439,Aetna,Commercial,403.88,92,,percent of total billed charges,,
Emergent Level 2,,99282,CPT,Facility,Outpatient,,,,439,373.15,125.8174,439,Aetna,Medicare Advantage,215.11,49,,percent of total billed charges,,
Emergent Level 2,,99282,CPT,Facility,Outpatient,,,,439,373.15,125.8174,439,Aetna,PPO,408.27,93,,percent of total billed charges,,
Emergent Level 2,,99282,CPT,Facility,Outpatient,,,,439,373.15,125.8174,439,America's PPO,America's PPO,421.5717,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Emergent Level 2,,99282,CPT,Facility,Outpatient,,,,439,373.15,125.8174,439,BlueCross BlueShield Minnesota, Federal Employee Program,431.976,98.4,,percent of total billed charges,,
Emergent Level 2,,99282,CPT,Facility,Outpatient,,,,439,373.15,125.8174,439,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,439,100,,percent of total billed charges,,
Emergent Level 2,,99282,CPT,Facility,Outpatient,,,,439,373.15,125.8174,439,BlueCross BlueShield Minnesota,High Value Network Plan,395.1,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
Emergent Level 2,,99282,CPT,Facility,Outpatient,,,,439,373.15,125.8174,439,BlueCross BlueShield Minnesota,Medicare Advantage,215.11,49,,percent of total billed charges,,
Emergent Level 2,,99282,CPT,Facility,Outpatient,,,,439,373.15,125.8174,439,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,125.8174,28.66,,percent of total billed charges,,
Emergent Level 2,,99282,CPT,Facility,Outpatient,,,,439,373.15,125.8174,439,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),215.11,49,,percent of total billed charges,,
Emergent Level 2,,99282,CPT,Facility,Outpatient,,,,439,373.15,125.8174,439,CorVel,Worker's Compensation,439,100,,percent of total billed charges,,
Emergent Level 2,,99282,CPT,Facility,Outpatient,,,,439,373.15,125.8174,439,First Health Group Corporation,First Health Network,425.83,97,,percent of total billed charges,,
Emergent Level 2,,99282,CPT,Facility,Outpatient,,,,439,373.15,125.8174,439,"Health Partners, Inc.",Commercial,415.294,94.6,,percent of total billed charges,,
Emergent Level 2,,99282,CPT,Facility,Outpatient,,,,439,373.15,125.8174,439,"Health Partners, Inc.",Medicare Advantage,215.11,49,,percent of total billed charges,,
Emergent Level 2,,99282,CPT,Facility,Outpatient,,,,439,373.15,125.8174,439,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),263.4,60,,percent of total billed charges,,
Emergent Level 2,,99282,CPT,Facility,Outpatient,,,,439,373.15,125.8174,439,"Health Partners, Inc.",State of Minnesota Advantage Program,357.785,81.5,,percent of total billed charges,,
Emergent Level 2,,99282,CPT,Facility,Outpatient,,,,439,373.15,125.8174,439,"Health Partners, Inc.",State Public Programs,219.5,50,,percent of total billed charges,,
Emergent Level 2,,99282,CPT,Facility,Outpatient,,,,439,373.15,125.8174,439,Humana Insurance Company,Commercial PPO,417.05,95,,percent of total billed charges,,
Emergent Level 2,,99282,CPT,Facility,Outpatient,,,,439,373.15,125.8174,439,Humana Insurance Company,Medicare PPO,215.11,49,,percent of total billed charges,,
Emergent Level 2,,99282,CPT,Facility,Outpatient,,,,439,373.15,125.8174,439,Medica,Individual & Family,409.148,93.2,,percent of total billed charges,,
Emergent Level 2,,99282,CPT,Facility,Outpatient,,,,439,373.15,125.8174,439,Medica,Medica Advantage Solution,218.622,49.8,,percent of total billed charges,,
Emergent Level 2,,99282,CPT,Facility,Outpatient,,,,439,373.15,125.8174,439,Medica,Medical Assistance,195.794,44.6,,percent of total billed charges,,
Emergent Level 2,,99282,CPT,Facility,Outpatient,,,,439,373.15,125.8174,439,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,218.622,49.8,,percent of total billed charges,,
Emergent Level 2,,99282,CPT,Facility,Outpatient,,,,439,373.15,125.8174,439,"Multiplan, Inc.","Multiplan, Inc.",412.66,94,,percent of total billed charges,,
Emergent Level 2,,99282,CPT,Facility,Outpatient,,,,439,373.15,125.8174,439,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,395.539,90.1,,percent of total billed charges,,
Emergent Level 2,,99282,CPT,Facility,Outpatient,,,,439,373.15,125.8174,439,"Preferred One Administrative Services, INC.",PPO,432.854,98.6,,percent of total billed charges,,
Emergent Level 2,,99282,CPT,Facility,Outpatient,,,,439,373.15,125.8174,439,PrimeWest Health,Minnesota Senior Health Options (MSHO),225.8655,51.45,,percent of total billed charges,,
Emergent Level 2,,99282,CPT,Facility,Outpatient,,,,439,373.15,125.8174,439,PrimeWest Health,MinnesotaCare,225.4704,51.36,,percent of total billed charges,,
Emergent Level 2,,99282,CPT,Facility,Outpatient,,,,439,373.15,125.8174,439,Sanford Health Plan,Sanford Health Plan,403.88,92,,percent of total billed charges,,
Emergent Level 2,,99282,CPT,Facility,Outpatient,,,,439,373.15,125.8174,439,"UCare Health, Inc.",Individual & Family Plan,247.3765,56.35,,percent of total billed charges,,
Emergent Level 2,,99282,CPT,Facility,Outpatient,,,,439,373.15,125.8174,439,"UCare Health, Inc.",Medical Assistance,221.5633,50.47,,percent of total billed charges,,
Emergent Level 2,,99282,CPT,Facility,Outpatient,,,,439,373.15,125.8174,439,"UCare Health, Inc.",Medicare Advantage,221.5633,50.47,,percent of total billed charges,,
Emergent Level 2,,99282,CPT,Facility,Outpatient,,,,439,373.15,125.8174,439,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),221.5633,50.47,,percent of total billed charges,,
Emergent Level 2,,99282,CPT,Facility,Outpatient,,,,439,373.15,125.8174,439,UnitedHealthcare,Individual & Family,412.66,94,,percent of total billed charges,,
Emergent Level 2,,99282,CPT,Facility,Outpatient,,,,439,373.15,125.8174,439,UnitedHealthcare,Medicare Advantage,215.11,49,,percent of total billed charges,,
Emergent Level 2,,99282,CPT,Facility,Outpatient,,,,439,373.15,125.8174,439,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,210.72,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Emergency Department Visit, Limited Mdm (Pro Cah)",,99283,CPT,Professional,Outpatient,,,,357,303.45,43.86,357,Aetna,Commercial,303.45,85,,percent of total billed charges,,
"Emergency Department Visit, Limited Mdm (Pro Cah)",,99283,CPT,Professional,Outpatient,,,,357,303.45,43.86,357,Aetna,Medicare Advantage,69.46,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Emergency Department Visit, Limited Mdm (Pro Cah)",,99283,CPT,Professional,Outpatient,,,,357,303.45,43.86,357,Aetna,PPO,332.01,93,,percent of total billed charges,,
"Emergency Department Visit, Limited Mdm (Pro Cah)",,99283,CPT,Professional,Outpatient,,,,357,303.45,43.86,357,America's PPO,America's PPO,305.0208,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Emergency Department Visit, Limited Mdm (Pro Cah)",,99283,CPT,Professional,Outpatient,,,,357,303.45,43.86,357,BlueCross BlueShield Minnesota, Federal Employee Program,127.46,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Emergency Department Visit, Limited Mdm (Pro Cah)",,99283,CPT,Professional,Outpatient,,,,357,303.45,43.86,357,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,129.49936,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Emergency Department Visit, Limited Mdm (Pro Cah)",,99283,CPT,Professional,Outpatient,,,,357,303.45,43.86,357,BlueCross BlueShield Minnesota,High Value Network Plan,129.49936,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Emergency Department Visit, Limited Mdm (Pro Cah)",,99283,CPT,Professional,Outpatient,,,,357,303.45,43.86,357,BlueCross BlueShield Minnesota,Medicare Advantage,78.5335,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Emergency Department Visit, Limited Mdm (Pro Cah)",,99283,CPT,Professional,Outpatient,,,,357,303.45,43.86,357,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,129.49936,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Emergency Department Visit, Limited Mdm (Pro Cah)",,99283,CPT,Professional,Outpatient,,,,357,303.45,43.86,357,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,50.63744,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Emergency Department Visit, Limited Mdm (Pro Cah)",,99283,CPT,Professional,Outpatient,,,,357,303.45,43.86,357,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),78.5335,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Emergency Department Visit, Limited Mdm (Pro Cah)",,99283,CPT,Professional,Outpatient,,,,357,303.45,43.86,357,CorVel,Worker's Compensation,134.1942411,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Emergency Department Visit, Limited Mdm (Pro Cah)",,99283,CPT,Professional,Outpatient,,,,357,303.45,43.86,357,First Health Group Corporation,First Health Network,346.29,97,,percent of total billed charges,,
"Emergency Department Visit, Limited Mdm (Pro Cah)",,99283,CPT,Professional,Outpatient,,,,357,303.45,43.86,357,"Health Partners, Inc.",Commercial,144.38,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Emergency Department Visit, Limited Mdm (Pro Cah)",,99283,CPT,Professional,Outpatient,,,,357,303.45,43.86,357,"Health Partners, Inc.",Medicare Advantage,78.5335,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Emergency Department Visit, Limited Mdm (Pro Cah)",,99283,CPT,Professional,Outpatient,,,,357,303.45,43.86,357,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),68.45,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Emergency Department Visit, Limited Mdm (Pro Cah)",,99283,CPT,Professional,Outpatient,,,,357,303.45,43.86,357,"Health Partners, Inc.",State of Minnesota Advantage Program,124.38337,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Emergency Department Visit, Limited Mdm (Pro Cah)",,99283,CPT,Professional,Outpatient,,,,357,303.45,43.86,357,"Health Partners, Inc.",State Public Programs,43.86,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Emergency Department Visit, Limited Mdm (Pro Cah)",,99283,CPT,Professional,Outpatient,,,,357,303.45,43.86,357,Humana Insurance Company,Commercial PPO,68.29,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Emergency Department Visit, Limited Mdm (Pro Cah)",,99283,CPT,Professional,Outpatient,,,,357,303.45,43.86,357,Humana Insurance Company,Medicare PPO,357,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Emergency Department Visit, Limited Mdm (Pro Cah)",,99283,CPT,Professional,Outpatient,,,,357,303.45,43.86,357,Medica,Individual & Family,302.736,84.8,,percent of total billed charges,,
"Emergency Department Visit, Limited Mdm (Pro Cah)",,99283,CPT,Professional,Outpatient,,,,357,303.45,43.86,357,Medica,Medica Advantage Solution,177.786,49.8,,percent of total billed charges,,
"Emergency Department Visit, Limited Mdm (Pro Cah)",,99283,CPT,Professional,Outpatient,,,,357,303.45,43.86,357,Medica,Medical Assistance,50.64,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Emergency Department Visit, Limited Mdm (Pro Cah)",,99283,CPT,Professional,Outpatient,,,,357,303.45,43.86,357,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,68.29,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Emergency Department Visit, Limited Mdm (Pro Cah)",,99283,CPT,Professional,Outpatient,,,,357,303.45,43.86,357,"Multiplan, Inc.","Multiplan, Inc.",335.58,94,,percent of total billed charges,,
"Emergency Department Visit, Limited Mdm (Pro Cah)",,99283,CPT,Professional,Outpatient,,,,357,303.45,43.86,357,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,321.657,90.1,,percent of total billed charges,,
"Emergency Department Visit, Limited Mdm (Pro Cah)",,99283,CPT,Professional,Outpatient,,,,357,303.45,43.86,357,"Preferred One Administrative Services, INC.",PPO,352.002,98.6,,percent of total billed charges,,
"Emergency Department Visit, Limited Mdm (Pro Cah)",,99283,CPT,Professional,Outpatient,,,,357,303.45,43.86,357,PrimeWest Health,Minnesota Senior Health Options (MSHO),78.5335,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Emergency Department Visit, Limited Mdm (Pro Cah)",,99283,CPT,Professional,Outpatient,,,,357,303.45,43.86,357,PrimeWest Health,MinnesotaCare,54.1820608,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Emergency Department Visit, Limited Mdm (Pro Cah)",,99283,CPT,Professional,Outpatient,,,,357,303.45,43.86,357,Sanford Health Plan,Sanford Health Plan,314.16,88,,percent of total billed charges,,
"Emergency Department Visit, Limited Mdm (Pro Cah)",,99283,CPT,Professional,Outpatient,,,,357,303.45,43.86,357,"UCare Health, Inc.",Individual & Family Plan,111.012224,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Emergency Department Visit, Limited Mdm (Pro Cah)",,99283,CPT,Professional,Outpatient,,,,357,303.45,43.86,357,"UCare Health, Inc.",Medical Assistance,55.701184,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Emergency Department Visit, Limited Mdm (Pro Cah)",,99283,CPT,Professional,Outpatient,,,,357,303.45,43.86,357,"UCare Health, Inc.",Medicare Advantage,78.5335,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Emergency Department Visit, Limited Mdm (Pro Cah)",,99283,CPT,Professional,Outpatient,,,,357,303.45,43.86,357,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),62.8268,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Emergency Department Visit, Limited Mdm (Pro Cah)",,99283,CPT,Professional,Outpatient,,,,357,303.45,43.86,357,UnitedHealthcare,Individual & Family,357,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Emergency Department Visit, Limited Mdm (Pro Cah)",,99283,CPT,Professional,Outpatient,,,,357,303.45,43.86,357,UnitedHealthcare,Medicare Advantage,78.5335,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Emergency Department Visit, Limited Mdm (Pro Cah)",,99283,CPT,Professional,Outpatient,,,,357,303.45,43.86,357,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,50.63744,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Emergent Level 3,,99283,CPT,Facility,Outpatient,,,,525,446.25,150.465,525,Aetna,Commercial,483,92,,percent of total billed charges,,
Emergent Level 3,,99283,CPT,Facility,Outpatient,,,,525,446.25,150.465,525,Aetna,Medicare Advantage,257.25,49,,percent of total billed charges,,
Emergent Level 3,,99283,CPT,Facility,Outpatient,,,,525,446.25,150.465,525,Aetna,PPO,488.25,93,,percent of total billed charges,,
Emergent Level 3,,99283,CPT,Facility,Outpatient,,,,525,446.25,150.465,525,America's PPO,America's PPO,504.1575,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Emergent Level 3,,99283,CPT,Facility,Outpatient,,,,525,446.25,150.465,525,BlueCross BlueShield Minnesota, Federal Employee Program,516.6,98.4,,percent of total billed charges,,
Emergent Level 3,,99283,CPT,Facility,Outpatient,,,,525,446.25,150.465,525,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,525,100,,percent of total billed charges,,
Emergent Level 3,,99283,CPT,Facility,Outpatient,,,,525,446.25,150.465,525,BlueCross BlueShield Minnesota,High Value Network Plan,472.5,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
Emergent Level 3,,99283,CPT,Facility,Outpatient,,,,525,446.25,150.465,525,BlueCross BlueShield Minnesota,Medicare Advantage,257.25,49,,percent of total billed charges,,
Emergent Level 3,,99283,CPT,Facility,Outpatient,,,,525,446.25,150.465,525,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,150.465,28.66,,percent of total billed charges,,
Emergent Level 3,,99283,CPT,Facility,Outpatient,,,,525,446.25,150.465,525,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),257.25,49,,percent of total billed charges,,
Emergent Level 3,,99283,CPT,Facility,Outpatient,,,,525,446.25,150.465,525,CorVel,Worker's Compensation,525,100,,percent of total billed charges,,
Emergent Level 3,,99283,CPT,Facility,Outpatient,,,,525,446.25,150.465,525,First Health Group Corporation,First Health Network,509.25,97,,percent of total billed charges,,
Emergent Level 3,,99283,CPT,Facility,Outpatient,,,,525,446.25,150.465,525,"Health Partners, Inc.",Commercial,496.65,94.6,,percent of total billed charges,,
Emergent Level 3,,99283,CPT,Facility,Outpatient,,,,525,446.25,150.465,525,"Health Partners, Inc.",Medicare Advantage,257.25,49,,percent of total billed charges,,
Emergent Level 3,,99283,CPT,Facility,Outpatient,,,,525,446.25,150.465,525,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),315,60,,percent of total billed charges,,
Emergent Level 3,,99283,CPT,Facility,Outpatient,,,,525,446.25,150.465,525,"Health Partners, Inc.",State of Minnesota Advantage Program,427.875,81.5,,percent of total billed charges,,
Emergent Level 3,,99283,CPT,Facility,Outpatient,,,,525,446.25,150.465,525,"Health Partners, Inc.",State Public Programs,262.5,50,,percent of total billed charges,,
Emergent Level 3,,99283,CPT,Facility,Outpatient,,,,525,446.25,150.465,525,Humana Insurance Company,Commercial PPO,498.75,95,,percent of total billed charges,,
Emergent Level 3,,99283,CPT,Facility,Outpatient,,,,525,446.25,150.465,525,Humana Insurance Company,Medicare PPO,257.25,49,,percent of total billed charges,,
Emergent Level 3,,99283,CPT,Facility,Outpatient,,,,525,446.25,150.465,525,Medica,Individual & Family,489.3,93.2,,percent of total billed charges,,
Emergent Level 3,,99283,CPT,Facility,Outpatient,,,,525,446.25,150.465,525,Medica,Medica Advantage Solution,261.45,49.8,,percent of total billed charges,,
Emergent Level 3,,99283,CPT,Facility,Outpatient,,,,525,446.25,150.465,525,Medica,Medical Assistance,234.15,44.6,,percent of total billed charges,,
Emergent Level 3,,99283,CPT,Facility,Outpatient,,,,525,446.25,150.465,525,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,261.45,49.8,,percent of total billed charges,,
Emergent Level 3,,99283,CPT,Facility,Outpatient,,,,525,446.25,150.465,525,"Multiplan, Inc.","Multiplan, Inc.",493.5,94,,percent of total billed charges,,
Emergent Level 3,,99283,CPT,Facility,Outpatient,,,,525,446.25,150.465,525,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,473.025,90.1,,percent of total billed charges,,
Emergent Level 3,,99283,CPT,Facility,Outpatient,,,,525,446.25,150.465,525,"Preferred One Administrative Services, INC.",PPO,517.65,98.6,,percent of total billed charges,,
Emergent Level 3,,99283,CPT,Facility,Outpatient,,,,525,446.25,150.465,525,PrimeWest Health,Minnesota Senior Health Options (MSHO),270.1125,51.45,,percent of total billed charges,,
Emergent Level 3,,99283,CPT,Facility,Outpatient,,,,525,446.25,150.465,525,PrimeWest Health,MinnesotaCare,269.64,51.36,,percent of total billed charges,,
Emergent Level 3,,99283,CPT,Facility,Outpatient,,,,525,446.25,150.465,525,Sanford Health Plan,Sanford Health Plan,483,92,,percent of total billed charges,,
Emergent Level 3,,99283,CPT,Facility,Outpatient,,,,525,446.25,150.465,525,"UCare Health, Inc.",Individual & Family Plan,295.8375,56.35,,percent of total billed charges,,
Emergent Level 3,,99283,CPT,Facility,Outpatient,,,,525,446.25,150.465,525,"UCare Health, Inc.",Medical Assistance,264.9675,50.47,,percent of total billed charges,,
Emergent Level 3,,99283,CPT,Facility,Outpatient,,,,525,446.25,150.465,525,"UCare Health, Inc.",Medicare Advantage,264.9675,50.47,,percent of total billed charges,,
Emergent Level 3,,99283,CPT,Facility,Outpatient,,,,525,446.25,150.465,525,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),264.9675,50.47,,percent of total billed charges,,
Emergent Level 3,,99283,CPT,Facility,Outpatient,,,,525,446.25,150.465,525,UnitedHealthcare,Individual & Family,493.5,94,,percent of total billed charges,,
Emergent Level 3,,99283,CPT,Facility,Outpatient,,,,525,446.25,150.465,525,UnitedHealthcare,Medicare Advantage,257.25,49,,percent of total billed charges,,
Emergent Level 3,,99283,CPT,Facility,Outpatient,,,,525,446.25,150.465,525,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,252,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Emergency Department Visit, Moderate Mdm (Pro Cah)",,99284,CPT,Professional,Outpatient,,,,673,572.05,74.2,673,Aetna,Commercial,572.05,85,,percent of total billed charges,,
"Emergency Department Visit, Moderate Mdm (Pro Cah)",,99284,CPT,Professional,Outpatient,,,,673,572.05,74.2,673,Aetna,Medicare Advantage,118.02,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Emergency Department Visit, Moderate Mdm (Pro Cah)",,99284,CPT,Professional,Outpatient,,,,673,572.05,74.2,673,Aetna,PPO,625.89,93,,percent of total billed charges,,
"Emergency Department Visit, Moderate Mdm (Pro Cah)",,99284,CPT,Professional,Outpatient,,,,673,572.05,74.2,673,America's PPO,America's PPO,575.0112,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Emergency Department Visit, Moderate Mdm (Pro Cah)",,99284,CPT,Professional,Outpatient,,,,673,572.05,74.2,673,BlueCross BlueShield Minnesota, Federal Employee Program,214.23,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Emergency Department Visit, Moderate Mdm (Pro Cah)",,99284,CPT,Professional,Outpatient,,,,673,572.05,74.2,673,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,217.65768,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Emergency Department Visit, Moderate Mdm (Pro Cah)",,99284,CPT,Professional,Outpatient,,,,673,572.05,74.2,673,BlueCross BlueShield Minnesota,High Value Network Plan,217.65768,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Emergency Department Visit, Moderate Mdm (Pro Cah)",,99284,CPT,Professional,Outpatient,,,,673,572.05,74.2,673,BlueCross BlueShield Minnesota,Medicare Advantage,132.848,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Emergency Department Visit, Moderate Mdm (Pro Cah)",,99284,CPT,Professional,Outpatient,,,,673,572.05,74.2,673,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,217.65768,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Emergency Department Visit, Moderate Mdm (Pro Cah)",,99284,CPT,Professional,Outpatient,,,,673,572.05,74.2,673,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,85.66912,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Emergency Department Visit, Moderate Mdm (Pro Cah)",,99284,CPT,Professional,Outpatient,,,,673,572.05,74.2,673,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),132.848,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Emergency Department Visit, Moderate Mdm (Pro Cah)",,99284,CPT,Professional,Outpatient,,,,673,572.05,74.2,673,CorVel,Worker's Compensation,227.4282162,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Emergency Department Visit, Moderate Mdm (Pro Cah)",,99284,CPT,Professional,Outpatient,,,,673,572.05,74.2,673,First Health Group Corporation,First Health Network,652.81,97,,percent of total billed charges,,
"Emergency Department Visit, Moderate Mdm (Pro Cah)",,99284,CPT,Professional,Outpatient,,,,673,572.05,74.2,673,"Health Partners, Inc.",Commercial,245.95,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Emergency Department Visit, Moderate Mdm (Pro Cah)",,99284,CPT,Professional,Outpatient,,,,673,572.05,74.2,673,"Health Partners, Inc.",Medicare Advantage,132.848,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Emergency Department Visit, Moderate Mdm (Pro Cah)",,99284,CPT,Professional,Outpatient,,,,673,572.05,74.2,673,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),115.56,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Emergency Department Visit, Moderate Mdm (Pro Cah)",,99284,CPT,Professional,Outpatient,,,,673,572.05,74.2,673,"Health Partners, Inc.",State of Minnesota Advantage Program,211.885925,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Emergency Department Visit, Moderate Mdm (Pro Cah)",,99284,CPT,Professional,Outpatient,,,,673,572.05,74.2,673,"Health Partners, Inc.",State Public Programs,74.2,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Emergency Department Visit, Moderate Mdm (Pro Cah)",,99284,CPT,Professional,Outpatient,,,,673,572.05,74.2,673,Humana Insurance Company,Commercial PPO,115.52,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Emergency Department Visit, Moderate Mdm (Pro Cah)",,99284,CPT,Professional,Outpatient,,,,673,572.05,74.2,673,Humana Insurance Company,Medicare PPO,673,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Emergency Department Visit, Moderate Mdm (Pro Cah)",,99284,CPT,Professional,Outpatient,,,,673,572.05,74.2,673,Medica,Individual & Family,570.704,84.8,,percent of total billed charges,,
"Emergency Department Visit, Moderate Mdm (Pro Cah)",,99284,CPT,Professional,Outpatient,,,,673,572.05,74.2,673,Medica,Medica Advantage Solution,335.154,49.8,,percent of total billed charges,,
"Emergency Department Visit, Moderate Mdm (Pro Cah)",,99284,CPT,Professional,Outpatient,,,,673,572.05,74.2,673,Medica,Medical Assistance,85.67,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Emergency Department Visit, Moderate Mdm (Pro Cah)",,99284,CPT,Professional,Outpatient,,,,673,572.05,74.2,673,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,115.52,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Emergency Department Visit, Moderate Mdm (Pro Cah)",,99284,CPT,Professional,Outpatient,,,,673,572.05,74.2,673,"Multiplan, Inc.","Multiplan, Inc.",632.62,94,,percent of total billed charges,,
"Emergency Department Visit, Moderate Mdm (Pro Cah)",,99284,CPT,Professional,Outpatient,,,,673,572.05,74.2,673,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,606.373,90.1,,percent of total billed charges,,
"Emergency Department Visit, Moderate Mdm (Pro Cah)",,99284,CPT,Professional,Outpatient,,,,673,572.05,74.2,673,"Preferred One Administrative Services, INC.",PPO,663.578,98.6,,percent of total billed charges,,
"Emergency Department Visit, Moderate Mdm (Pro Cah)",,99284,CPT,Professional,Outpatient,,,,673,572.05,74.2,673,PrimeWest Health,Minnesota Senior Health Options (MSHO),132.848,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Emergency Department Visit, Moderate Mdm (Pro Cah)",,99284,CPT,Professional,Outpatient,,,,673,572.05,74.2,673,PrimeWest Health,MinnesotaCare,91.6659584,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Emergency Department Visit, Moderate Mdm (Pro Cah)",,99284,CPT,Professional,Outpatient,,,,673,572.05,74.2,673,Sanford Health Plan,Sanford Health Plan,592.24,88,,percent of total billed charges,,
"Emergency Department Visit, Moderate Mdm (Pro Cah)",,99284,CPT,Professional,Outpatient,,,,673,572.05,74.2,673,"UCare Health, Inc.",Individual & Family Plan,187.789312,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Emergency Department Visit, Moderate Mdm (Pro Cah)",,99284,CPT,Professional,Outpatient,,,,673,572.05,74.2,673,"UCare Health, Inc.",Medical Assistance,94.236032,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Emergency Department Visit, Moderate Mdm (Pro Cah)",,99284,CPT,Professional,Outpatient,,,,673,572.05,74.2,673,"UCare Health, Inc.",Medicare Advantage,132.848,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Emergency Department Visit, Moderate Mdm (Pro Cah)",,99284,CPT,Professional,Outpatient,,,,673,572.05,74.2,673,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),106.2784,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Emergency Department Visit, Moderate Mdm (Pro Cah)",,99284,CPT,Professional,Outpatient,,,,673,572.05,74.2,673,UnitedHealthcare,Individual & Family,673,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Emergency Department Visit, Moderate Mdm (Pro Cah)",,99284,CPT,Professional,Outpatient,,,,673,572.05,74.2,673,UnitedHealthcare,Medicare Advantage,132.848,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Emergency Department Visit, Moderate Mdm (Pro Cah)",,99284,CPT,Professional,Outpatient,,,,673,572.05,74.2,673,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,85.66912,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Emergent Level 4,,99284,CPT,Facility,Outpatient,,,,944,802.4,270.5504,944,Aetna,Commercial,868.48,92,,percent of total billed charges,,
Emergent Level 4,,99284,CPT,Facility,Outpatient,,,,944,802.4,270.5504,944,Aetna,Medicare Advantage,462.56,49,,percent of total billed charges,,
Emergent Level 4,,99284,CPT,Facility,Outpatient,,,,944,802.4,270.5504,944,Aetna,PPO,877.92,93,,percent of total billed charges,,
Emergent Level 4,,99284,CPT,Facility,Outpatient,,,,944,802.4,270.5504,944,America's PPO,America's PPO,906.5232,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Emergent Level 4,,99284,CPT,Facility,Outpatient,,,,944,802.4,270.5504,944,BlueCross BlueShield Minnesota, Federal Employee Program,928.896,98.4,,percent of total billed charges,,
Emergent Level 4,,99284,CPT,Facility,Outpatient,,,,944,802.4,270.5504,944,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,944,100,,percent of total billed charges,,
Emergent Level 4,,99284,CPT,Facility,Outpatient,,,,944,802.4,270.5504,944,BlueCross BlueShield Minnesota,High Value Network Plan,849.6,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
Emergent Level 4,,99284,CPT,Facility,Outpatient,,,,944,802.4,270.5504,944,BlueCross BlueShield Minnesota,Medicare Advantage,462.56,49,,percent of total billed charges,,
Emergent Level 4,,99284,CPT,Facility,Outpatient,,,,944,802.4,270.5504,944,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,270.5504,28.66,,percent of total billed charges,,
Emergent Level 4,,99284,CPT,Facility,Outpatient,,,,944,802.4,270.5504,944,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),462.56,49,,percent of total billed charges,,
Emergent Level 4,,99284,CPT,Facility,Outpatient,,,,944,802.4,270.5504,944,CorVel,Worker's Compensation,944,100,,percent of total billed charges,,
Emergent Level 4,,99284,CPT,Facility,Outpatient,,,,944,802.4,270.5504,944,First Health Group Corporation,First Health Network,915.68,97,,percent of total billed charges,,
Emergent Level 4,,99284,CPT,Facility,Outpatient,,,,944,802.4,270.5504,944,"Health Partners, Inc.",Commercial,893.024,94.6,,percent of total billed charges,,
Emergent Level 4,,99284,CPT,Facility,Outpatient,,,,944,802.4,270.5504,944,"Health Partners, Inc.",Medicare Advantage,462.56,49,,percent of total billed charges,,
Emergent Level 4,,99284,CPT,Facility,Outpatient,,,,944,802.4,270.5504,944,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),566.4,60,,percent of total billed charges,,
Emergent Level 4,,99284,CPT,Facility,Outpatient,,,,944,802.4,270.5504,944,"Health Partners, Inc.",State of Minnesota Advantage Program,769.36,81.5,,percent of total billed charges,,
Emergent Level 4,,99284,CPT,Facility,Outpatient,,,,944,802.4,270.5504,944,"Health Partners, Inc.",State Public Programs,472,50,,percent of total billed charges,,
Emergent Level 4,,99284,CPT,Facility,Outpatient,,,,944,802.4,270.5504,944,Humana Insurance Company,Commercial PPO,896.8,95,,percent of total billed charges,,
Emergent Level 4,,99284,CPT,Facility,Outpatient,,,,944,802.4,270.5504,944,Humana Insurance Company,Medicare PPO,462.56,49,,percent of total billed charges,,
Emergent Level 4,,99284,CPT,Facility,Outpatient,,,,944,802.4,270.5504,944,Medica,Individual & Family,879.808,93.2,,percent of total billed charges,,
Emergent Level 4,,99284,CPT,Facility,Outpatient,,,,944,802.4,270.5504,944,Medica,Medica Advantage Solution,470.112,49.8,,percent of total billed charges,,
Emergent Level 4,,99284,CPT,Facility,Outpatient,,,,944,802.4,270.5504,944,Medica,Medical Assistance,421.024,44.6,,percent of total billed charges,,
Emergent Level 4,,99284,CPT,Facility,Outpatient,,,,944,802.4,270.5504,944,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,470.112,49.8,,percent of total billed charges,,
Emergent Level 4,,99284,CPT,Facility,Outpatient,,,,944,802.4,270.5504,944,"Multiplan, Inc.","Multiplan, Inc.",887.36,94,,percent of total billed charges,,
Emergent Level 4,,99284,CPT,Facility,Outpatient,,,,944,802.4,270.5504,944,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,850.544,90.1,,percent of total billed charges,,
Emergent Level 4,,99284,CPT,Facility,Outpatient,,,,944,802.4,270.5504,944,"Preferred One Administrative Services, INC.",PPO,930.784,98.6,,percent of total billed charges,,
Emergent Level 4,,99284,CPT,Facility,Outpatient,,,,944,802.4,270.5504,944,PrimeWest Health,Minnesota Senior Health Options (MSHO),485.688,51.45,,percent of total billed charges,,
Emergent Level 4,,99284,CPT,Facility,Outpatient,,,,944,802.4,270.5504,944,PrimeWest Health,MinnesotaCare,484.8384,51.36,,percent of total billed charges,,
Emergent Level 4,,99284,CPT,Facility,Outpatient,,,,944,802.4,270.5504,944,Sanford Health Plan,Sanford Health Plan,868.48,92,,percent of total billed charges,,
Emergent Level 4,,99284,CPT,Facility,Outpatient,,,,944,802.4,270.5504,944,"UCare Health, Inc.",Individual & Family Plan,531.944,56.35,,percent of total billed charges,,
Emergent Level 4,,99284,CPT,Facility,Outpatient,,,,944,802.4,270.5504,944,"UCare Health, Inc.",Medical Assistance,476.4368,50.47,,percent of total billed charges,,
Emergent Level 4,,99284,CPT,Facility,Outpatient,,,,944,802.4,270.5504,944,"UCare Health, Inc.",Medicare Advantage,476.4368,50.47,,percent of total billed charges,,
Emergent Level 4,,99284,CPT,Facility,Outpatient,,,,944,802.4,270.5504,944,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),476.4368,50.47,,percent of total billed charges,,
Emergent Level 4,,99284,CPT,Facility,Outpatient,,,,944,802.4,270.5504,944,UnitedHealthcare,Individual & Family,887.36,94,,percent of total billed charges,,
Emergent Level 4,,99284,CPT,Facility,Outpatient,,,,944,802.4,270.5504,944,UnitedHealthcare,Medicare Advantage,462.56,49,,percent of total billed charges,,
Emergent Level 4,,99284,CPT,Facility,Outpatient,,,,944,802.4,270.5504,944,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,453.12,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Emergency Department Visit, High Mdm (Pro Cah)",,99285,CPT,Professional,Outpatient,,,,1066,906.1,107.81,1066,Aetna,Commercial,906.1,85,,percent of total billed charges,,
"Emergency Department Visit, High Mdm (Pro Cah)",,99285,CPT,Professional,Outpatient,,,,1066,906.1,107.81,1066,Aetna,Medicare Advantage,171.38,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Emergency Department Visit, High Mdm (Pro Cah)",,99285,CPT,Professional,Outpatient,,,,1066,906.1,107.81,1066,Aetna,PPO,991.38,93,,percent of total billed charges,,
"Emergency Department Visit, High Mdm (Pro Cah)",,99285,CPT,Professional,Outpatient,,,,1066,906.1,107.81,1066,America's PPO,America's PPO,910.7904,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Emergency Department Visit, High Mdm (Pro Cah)",,99285,CPT,Professional,Outpatient,,,,1066,906.1,107.81,1066,BlueCross BlueShield Minnesota, Federal Employee Program,311.77,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Emergency Department Visit, High Mdm (Pro Cah)",,99285,CPT,Professional,Outpatient,,,,1066,906.1,107.81,1066,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,316.75832,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Emergency Department Visit, High Mdm (Pro Cah)",,99285,CPT,Professional,Outpatient,,,,1066,906.1,107.81,1066,BlueCross BlueShield Minnesota,High Value Network Plan,316.75832,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Emergency Department Visit, High Mdm (Pro Cah)",,99285,CPT,Professional,Outpatient,,,,1066,906.1,107.81,1066,BlueCross BlueShield Minnesota,Medicare Advantage,192.5905,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Emergency Department Visit, High Mdm (Pro Cah)",,99285,CPT,Professional,Outpatient,,,,1066,906.1,107.81,1066,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,316.75832,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Emergency Department Visit, High Mdm (Pro Cah)",,99285,CPT,Professional,Outpatient,,,,1066,906.1,107.81,1066,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,124.47016,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Emergency Department Visit, High Mdm (Pro Cah)",,99285,CPT,Professional,Outpatient,,,,1066,906.1,107.81,1066,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),192.5905,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Emergency Department Visit, High Mdm (Pro Cah)",,99285,CPT,Professional,Outpatient,,,,1066,906.1,107.81,1066,CorVel,Worker's Compensation,329.6710317,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Emergency Department Visit, High Mdm (Pro Cah)",,99285,CPT,Professional,Outpatient,,,,1066,906.1,107.81,1066,First Health Group Corporation,First Health Network,1034.02,97,,percent of total billed charges,,
"Emergency Department Visit, High Mdm (Pro Cah)",,99285,CPT,Professional,Outpatient,,,,1066,906.1,107.81,1066,"Health Partners, Inc.",Commercial,356.23,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Emergency Department Visit, High Mdm (Pro Cah)",,99285,CPT,Professional,Outpatient,,,,1066,906.1,107.81,1066,"Health Partners, Inc.",Medicare Advantage,192.5905,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Emergency Department Visit, High Mdm (Pro Cah)",,99285,CPT,Professional,Outpatient,,,,1066,906.1,107.81,1066,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),167.74,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Emergency Department Visit, High Mdm (Pro Cah)",,99285,CPT,Professional,Outpatient,,,,1066,906.1,107.81,1066,"Health Partners, Inc.",State of Minnesota Advantage Program,306.892145,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Emergency Department Visit, High Mdm (Pro Cah)",,99285,CPT,Professional,Outpatient,,,,1066,906.1,107.81,1066,"Health Partners, Inc.",State Public Programs,107.81,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Emergency Department Visit, High Mdm (Pro Cah)",,99285,CPT,Professional,Outpatient,,,,1066,906.1,107.81,1066,Humana Insurance Company,Commercial PPO,167.47,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Emergency Department Visit, High Mdm (Pro Cah)",,99285,CPT,Professional,Outpatient,,,,1066,906.1,107.81,1066,Humana Insurance Company,Medicare PPO,1066,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Emergency Department Visit, High Mdm (Pro Cah)",,99285,CPT,Professional,Outpatient,,,,1066,906.1,107.81,1066,Medica,Individual & Family,903.968,84.8,,percent of total billed charges,,
"Emergency Department Visit, High Mdm (Pro Cah)",,99285,CPT,Professional,Outpatient,,,,1066,906.1,107.81,1066,Medica,Medica Advantage Solution,530.868,49.8,,percent of total billed charges,,
"Emergency Department Visit, High Mdm (Pro Cah)",,99285,CPT,Professional,Outpatient,,,,1066,906.1,107.81,1066,Medica,Medical Assistance,124.47,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Emergency Department Visit, High Mdm (Pro Cah)",,99285,CPT,Professional,Outpatient,,,,1066,906.1,107.81,1066,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,167.47,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Emergency Department Visit, High Mdm (Pro Cah)",,99285,CPT,Professional,Outpatient,,,,1066,906.1,107.81,1066,"Multiplan, Inc.","Multiplan, Inc.",1002.04,94,,percent of total billed charges,,
"Emergency Department Visit, High Mdm (Pro Cah)",,99285,CPT,Professional,Outpatient,,,,1066,906.1,107.81,1066,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,960.466,90.1,,percent of total billed charges,,
"Emergency Department Visit, High Mdm (Pro Cah)",,99285,CPT,Professional,Outpatient,,,,1066,906.1,107.81,1066,"Preferred One Administrative Services, INC.",PPO,1051.076,98.6,,percent of total billed charges,,
"Emergency Department Visit, High Mdm (Pro Cah)",,99285,CPT,Professional,Outpatient,,,,1066,906.1,107.81,1066,PrimeWest Health,Minnesota Senior Health Options (MSHO),192.5905,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Emergency Department Visit, High Mdm (Pro Cah)",,99285,CPT,Professional,Outpatient,,,,1066,906.1,107.81,1066,PrimeWest Health,MinnesotaCare,133.1830712,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Emergency Department Visit, High Mdm (Pro Cah)",,99285,CPT,Professional,Outpatient,,,,1066,906.1,107.81,1066,Sanford Health Plan,Sanford Health Plan,938.08,88,,percent of total billed charges,,
"Emergency Department Visit, High Mdm (Pro Cah)",,99285,CPT,Professional,Outpatient,,,,1066,906.1,107.81,1066,"UCare Health, Inc.",Individual & Family Plan,272.239232,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Emergency Department Visit, High Mdm (Pro Cah)",,99285,CPT,Professional,Outpatient,,,,1066,906.1,107.81,1066,"UCare Health, Inc.",Medical Assistance,136.917176,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Emergency Department Visit, High Mdm (Pro Cah)",,99285,CPT,Professional,Outpatient,,,,1066,906.1,107.81,1066,"UCare Health, Inc.",Medicare Advantage,192.5905,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Emergency Department Visit, High Mdm (Pro Cah)",,99285,CPT,Professional,Outpatient,,,,1066,906.1,107.81,1066,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),154.0724,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Emergency Department Visit, High Mdm (Pro Cah)",,99285,CPT,Professional,Outpatient,,,,1066,906.1,107.81,1066,UnitedHealthcare,Individual & Family,1066,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Emergency Department Visit, High Mdm (Pro Cah)",,99285,CPT,Professional,Outpatient,,,,1066,906.1,107.81,1066,UnitedHealthcare,Medicare Advantage,192.5905,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Emergency Department Visit, High Mdm (Pro Cah)",,99285,CPT,Professional,Outpatient,,,,1066,906.1,107.81,1066,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,124.47016,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Emergent Level 5,,99285,CPT,Facility,Outpatient,,,,1632,1387.2,467.7312,1632,Aetna,Commercial,1501.44,92,,percent of total billed charges,,
Emergent Level 5,,99285,CPT,Facility,Outpatient,,,,1632,1387.2,467.7312,1632,Aetna,Medicare Advantage,799.68,49,,percent of total billed charges,,
Emergent Level 5,,99285,CPT,Facility,Outpatient,,,,1632,1387.2,467.7312,1632,Aetna,PPO,1517.76,93,,percent of total billed charges,,
Emergent Level 5,,99285,CPT,Facility,Outpatient,,,,1632,1387.2,467.7312,1632,America's PPO,America's PPO,1567.2096,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Emergent Level 5,,99285,CPT,Facility,Outpatient,,,,1632,1387.2,467.7312,1632,BlueCross BlueShield Minnesota, Federal Employee Program,1605.888,98.4,,percent of total billed charges,,
Emergent Level 5,,99285,CPT,Facility,Outpatient,,,,1632,1387.2,467.7312,1632,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1632,100,,percent of total billed charges,,
Emergent Level 5,,99285,CPT,Facility,Outpatient,,,,1632,1387.2,467.7312,1632,BlueCross BlueShield Minnesota,High Value Network Plan,1468.8,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
Emergent Level 5,,99285,CPT,Facility,Outpatient,,,,1632,1387.2,467.7312,1632,BlueCross BlueShield Minnesota,Medicare Advantage,799.68,49,,percent of total billed charges,,
Emergent Level 5,,99285,CPT,Facility,Outpatient,,,,1632,1387.2,467.7312,1632,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,467.7312,28.66,,percent of total billed charges,,
Emergent Level 5,,99285,CPT,Facility,Outpatient,,,,1632,1387.2,467.7312,1632,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),799.68,49,,percent of total billed charges,,
Emergent Level 5,,99285,CPT,Facility,Outpatient,,,,1632,1387.2,467.7312,1632,CorVel,Worker's Compensation,1632,100,,percent of total billed charges,,
Emergent Level 5,,99285,CPT,Facility,Outpatient,,,,1632,1387.2,467.7312,1632,First Health Group Corporation,First Health Network,1583.04,97,,percent of total billed charges,,
Emergent Level 5,,99285,CPT,Facility,Outpatient,,,,1632,1387.2,467.7312,1632,"Health Partners, Inc.",Commercial,1543.872,94.6,,percent of total billed charges,,
Emergent Level 5,,99285,CPT,Facility,Outpatient,,,,1632,1387.2,467.7312,1632,"Health Partners, Inc.",Medicare Advantage,799.68,49,,percent of total billed charges,,
Emergent Level 5,,99285,CPT,Facility,Outpatient,,,,1632,1387.2,467.7312,1632,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),979.2,60,,percent of total billed charges,,
Emergent Level 5,,99285,CPT,Facility,Outpatient,,,,1632,1387.2,467.7312,1632,"Health Partners, Inc.",State of Minnesota Advantage Program,1330.08,81.5,,percent of total billed charges,,
Emergent Level 5,,99285,CPT,Facility,Outpatient,,,,1632,1387.2,467.7312,1632,"Health Partners, Inc.",State Public Programs,816,50,,percent of total billed charges,,
Emergent Level 5,,99285,CPT,Facility,Outpatient,,,,1632,1387.2,467.7312,1632,Humana Insurance Company,Commercial PPO,1550.4,95,,percent of total billed charges,,
Emergent Level 5,,99285,CPT,Facility,Outpatient,,,,1632,1387.2,467.7312,1632,Humana Insurance Company,Medicare PPO,799.68,49,,percent of total billed charges,,
Emergent Level 5,,99285,CPT,Facility,Outpatient,,,,1632,1387.2,467.7312,1632,Medica,Individual & Family,1521.024,93.2,,percent of total billed charges,,
Emergent Level 5,,99285,CPT,Facility,Outpatient,,,,1632,1387.2,467.7312,1632,Medica,Medica Advantage Solution,812.736,49.8,,percent of total billed charges,,
Emergent Level 5,,99285,CPT,Facility,Outpatient,,,,1632,1387.2,467.7312,1632,Medica,Medical Assistance,727.872,44.6,,percent of total billed charges,,
Emergent Level 5,,99285,CPT,Facility,Outpatient,,,,1632,1387.2,467.7312,1632,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,812.736,49.8,,percent of total billed charges,,
Emergent Level 5,,99285,CPT,Facility,Outpatient,,,,1632,1387.2,467.7312,1632,"Multiplan, Inc.","Multiplan, Inc.",1534.08,94,,percent of total billed charges,,
Emergent Level 5,,99285,CPT,Facility,Outpatient,,,,1632,1387.2,467.7312,1632,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1470.432,90.1,,percent of total billed charges,,
Emergent Level 5,,99285,CPT,Facility,Outpatient,,,,1632,1387.2,467.7312,1632,"Preferred One Administrative Services, INC.",PPO,1609.152,98.6,,percent of total billed charges,,
Emergent Level 5,,99285,CPT,Facility,Outpatient,,,,1632,1387.2,467.7312,1632,PrimeWest Health,Minnesota Senior Health Options (MSHO),839.664,51.45,,percent of total billed charges,,
Emergent Level 5,,99285,CPT,Facility,Outpatient,,,,1632,1387.2,467.7312,1632,PrimeWest Health,MinnesotaCare,838.1952,51.36,,percent of total billed charges,,
Emergent Level 5,,99285,CPT,Facility,Outpatient,,,,1632,1387.2,467.7312,1632,Sanford Health Plan,Sanford Health Plan,1501.44,92,,percent of total billed charges,,
Emergent Level 5,,99285,CPT,Facility,Outpatient,,,,1632,1387.2,467.7312,1632,"UCare Health, Inc.",Individual & Family Plan,919.632,56.35,,percent of total billed charges,,
Emergent Level 5,,99285,CPT,Facility,Outpatient,,,,1632,1387.2,467.7312,1632,"UCare Health, Inc.",Medical Assistance,823.6704,50.47,,percent of total billed charges,,
Emergent Level 5,,99285,CPT,Facility,Outpatient,,,,1632,1387.2,467.7312,1632,"UCare Health, Inc.",Medicare Advantage,823.6704,50.47,,percent of total billed charges,,
Emergent Level 5,,99285,CPT,Facility,Outpatient,,,,1632,1387.2,467.7312,1632,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),823.6704,50.47,,percent of total billed charges,,
Emergent Level 5,,99285,CPT,Facility,Outpatient,,,,1632,1387.2,467.7312,1632,UnitedHealthcare,Individual & Family,1534.08,94,,percent of total billed charges,,
Emergent Level 5,,99285,CPT,Facility,Outpatient,,,,1632,1387.2,467.7312,1632,UnitedHealthcare,Medicare Advantage,799.68,49,,percent of total billed charges,,
Emergent Level 5,,99285,CPT,Facility,Outpatient,,,,1632,1387.2,467.7312,1632,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,783.36,48,,percent of total billed charges,,100% of DHS outpatient percentage
Critical Care 30 - 74 Minutes,,99291,CPT,Facility,Outpatient,,,,2020,1717,578.932,2020,Aetna,Commercial,1858.4,92,,percent of total billed charges,,
Critical Care 30 - 74 Minutes,,99291,CPT,Facility,Outpatient,,,,2020,1717,578.932,2020,Aetna,Medicare Advantage,989.8,49,,percent of total billed charges,,
Critical Care 30 - 74 Minutes,,99291,CPT,Facility,Outpatient,,,,2020,1717,578.932,2020,Aetna,PPO,1878.6,93,,percent of total billed charges,,
Critical Care 30 - 74 Minutes,,99291,CPT,Facility,Outpatient,,,,2020,1717,578.932,2020,America's PPO,America's PPO,1939.806,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Critical Care 30 - 74 Minutes,,99291,CPT,Facility,Outpatient,,,,2020,1717,578.932,2020,BlueCross BlueShield Minnesota, Federal Employee Program,1987.68,98.4,,percent of total billed charges,,
Critical Care 30 - 74 Minutes,,99291,CPT,Facility,Outpatient,,,,2020,1717,578.932,2020,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,2020,100,,percent of total billed charges,,
Critical Care 30 - 74 Minutes,,99291,CPT,Facility,Outpatient,,,,2020,1717,578.932,2020,BlueCross BlueShield Minnesota,High Value Network Plan,1818,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
Critical Care 30 - 74 Minutes,,99291,CPT,Facility,Outpatient,,,,2020,1717,578.932,2020,BlueCross BlueShield Minnesota,Medicare Advantage,989.8,49,,percent of total billed charges,,
Critical Care 30 - 74 Minutes,,99291,CPT,Facility,Outpatient,,,,2020,1717,578.932,2020,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,578.932,28.66,,percent of total billed charges,,
Critical Care 30 - 74 Minutes,,99291,CPT,Facility,Outpatient,,,,2020,1717,578.932,2020,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),989.8,49,,percent of total billed charges,,
Critical Care 30 - 74 Minutes,,99291,CPT,Facility,Outpatient,,,,2020,1717,578.932,2020,CorVel,Worker's Compensation,2020,100,,percent of total billed charges,,
Critical Care 30 - 74 Minutes,,99291,CPT,Facility,Outpatient,,,,2020,1717,578.932,2020,First Health Group Corporation,First Health Network,1959.4,97,,percent of total billed charges,,
Critical Care 30 - 74 Minutes,,99291,CPT,Facility,Outpatient,,,,2020,1717,578.932,2020,"Health Partners, Inc.",Commercial,1910.92,94.6,,percent of total billed charges,,
Critical Care 30 - 74 Minutes,,99291,CPT,Facility,Outpatient,,,,2020,1717,578.932,2020,"Health Partners, Inc.",Medicare Advantage,989.8,49,,percent of total billed charges,,
Critical Care 30 - 74 Minutes,,99291,CPT,Facility,Outpatient,,,,2020,1717,578.932,2020,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1212,60,,percent of total billed charges,,
Critical Care 30 - 74 Minutes,,99291,CPT,Facility,Outpatient,,,,2020,1717,578.932,2020,"Health Partners, Inc.",State of Minnesota Advantage Program,1646.3,81.5,,percent of total billed charges,,
Critical Care 30 - 74 Minutes,,99291,CPT,Facility,Outpatient,,,,2020,1717,578.932,2020,"Health Partners, Inc.",State Public Programs,1010,50,,percent of total billed charges,,
Critical Care 30 - 74 Minutes,,99291,CPT,Facility,Outpatient,,,,2020,1717,578.932,2020,Humana Insurance Company,Commercial PPO,1919,95,,percent of total billed charges,,
Critical Care 30 - 74 Minutes,,99291,CPT,Facility,Outpatient,,,,2020,1717,578.932,2020,Humana Insurance Company,Medicare PPO,989.8,49,,percent of total billed charges,,
Critical Care 30 - 74 Minutes,,99291,CPT,Facility,Outpatient,,,,2020,1717,578.932,2020,Medica,Individual & Family,1882.64,93.2,,percent of total billed charges,,
Critical Care 30 - 74 Minutes,,99291,CPT,Facility,Outpatient,,,,2020,1717,578.932,2020,Medica,Medica Advantage Solution,1005.96,49.8,,percent of total billed charges,,
Critical Care 30 - 74 Minutes,,99291,CPT,Facility,Outpatient,,,,2020,1717,578.932,2020,Medica,Medical Assistance,900.92,44.6,,percent of total billed charges,,
Critical Care 30 - 74 Minutes,,99291,CPT,Facility,Outpatient,,,,2020,1717,578.932,2020,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1005.96,49.8,,percent of total billed charges,,
Critical Care 30 - 74 Minutes,,99291,CPT,Facility,Outpatient,,,,2020,1717,578.932,2020,"Multiplan, Inc.","Multiplan, Inc.",1898.8,94,,percent of total billed charges,,
Critical Care 30 - 74 Minutes,,99291,CPT,Facility,Outpatient,,,,2020,1717,578.932,2020,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1820.02,90.1,,percent of total billed charges,,
Critical Care 30 - 74 Minutes,,99291,CPT,Facility,Outpatient,,,,2020,1717,578.932,2020,"Preferred One Administrative Services, INC.",PPO,1991.72,98.6,,percent of total billed charges,,
Critical Care 30 - 74 Minutes,,99291,CPT,Facility,Outpatient,,,,2020,1717,578.932,2020,PrimeWest Health,Minnesota Senior Health Options (MSHO),1039.29,51.45,,percent of total billed charges,,
Critical Care 30 - 74 Minutes,,99291,CPT,Facility,Outpatient,,,,2020,1717,578.932,2020,PrimeWest Health,MinnesotaCare,1037.472,51.36,,percent of total billed charges,,
Critical Care 30 - 74 Minutes,,99291,CPT,Facility,Outpatient,,,,2020,1717,578.932,2020,Sanford Health Plan,Sanford Health Plan,1858.4,92,,percent of total billed charges,,
Critical Care 30 - 74 Minutes,,99291,CPT,Facility,Outpatient,,,,2020,1717,578.932,2020,"UCare Health, Inc.",Individual & Family Plan,1138.27,56.35,,percent of total billed charges,,
Critical Care 30 - 74 Minutes,,99291,CPT,Facility,Outpatient,,,,2020,1717,578.932,2020,"UCare Health, Inc.",Medical Assistance,1019.494,50.47,,percent of total billed charges,,
Critical Care 30 - 74 Minutes,,99291,CPT,Facility,Outpatient,,,,2020,1717,578.932,2020,"UCare Health, Inc.",Medicare Advantage,1019.494,50.47,,percent of total billed charges,,
Critical Care 30 - 74 Minutes,,99291,CPT,Facility,Outpatient,,,,2020,1717,578.932,2020,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1019.494,50.47,,percent of total billed charges,,
Critical Care 30 - 74 Minutes,,99291,CPT,Facility,Outpatient,,,,2020,1717,578.932,2020,UnitedHealthcare,Individual & Family,1898.8,94,,percent of total billed charges,,
Critical Care 30 - 74 Minutes,,99291,CPT,Facility,Outpatient,,,,2020,1717,578.932,2020,UnitedHealthcare,Medicare Advantage,989.8,49,,percent of total billed charges,,
Critical Care 30 - 74 Minutes,,99291,CPT,Facility,Outpatient,,,,2020,1717,578.932,2020,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,969.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Critical Care, E&M Of Critically Injured Patient; First 30-74 Minutes (Pro Cah)",,99291,CPT,Professional,Both,,,,1066,906.1,132.04,1066,Aetna,Commercial,906.1,85,,percent of total billed charges,,
"Critical Care, E&M Of Critically Injured Patient; First 30-74 Minutes (Pro Cah)",,99291,CPT,Professional,Both,,,,1066,906.1,132.04,1066,Aetna,Medicare Advantage,212.26,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Critical Care, E&M Of Critically Injured Patient; First 30-74 Minutes (Pro Cah)",,99291,CPT,Professional,Both,,,,1066,906.1,132.04,1066,Aetna,PPO,991.38,93,,percent of total billed charges,,
"Critical Care, E&M Of Critically Injured Patient; First 30-74 Minutes (Pro Cah)",,99291,CPT,Professional,Both,,,,1066,906.1,132.04,1066,America's PPO,America's PPO,910.7904,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Critical Care, E&M Of Critically Injured Patient; First 30-74 Minutes (Pro Cah)",,99291,CPT,Professional,Both,,,,1066,906.1,132.04,1066,BlueCross BlueShield Minnesota, Federal Employee Program,377.59,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Critical Care, E&M Of Critically Injured Patient; First 30-74 Minutes (Pro Cah)",,99291,CPT,Professional,Both,,,,1066,906.1,132.04,1066,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,383.63144,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Critical Care, E&M Of Critically Injured Patient; First 30-74 Minutes (Pro Cah)",,99291,CPT,Professional,Both,,,,1066,906.1,132.04,1066,BlueCross BlueShield Minnesota,High Value Network Plan,383.63144,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Critical Care, E&M Of Critically Injured Patient; First 30-74 Minutes (Pro Cah)",,99291,CPT,Professional,Both,,,,1066,906.1,132.04,1066,BlueCross BlueShield Minnesota,Medicare Advantage,235.8995,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Critical Care, E&M Of Critically Injured Patient; First 30-74 Minutes (Pro Cah)",,99291,CPT,Professional,Both,,,,1066,906.1,132.04,1066,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,383.63144,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Critical Care, E&M Of Critically Injured Patient; First 30-74 Minutes (Pro Cah)",,99291,CPT,Professional,Both,,,,1066,906.1,132.04,1066,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,152.44064,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Critical Care, E&M Of Critically Injured Patient; First 30-74 Minutes (Pro Cah)",,99291,CPT,Professional,Both,,,,1066,906.1,132.04,1066,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),235.8995,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Critical Care, E&M Of Critically Injured Patient; First 30-74 Minutes (Pro Cah)",,99291,CPT,Professional,Both,,,,1066,906.1,132.04,1066,CorVel,Worker's Compensation,408.6078723,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Critical Care, E&M Of Critically Injured Patient; First 30-74 Minutes (Pro Cah)",,99291,CPT,Professional,Both,,,,1066,906.1,132.04,1066,First Health Group Corporation,First Health Network,1034.02,97,,percent of total billed charges,,
"Critical Care, E&M Of Critically Injured Patient; First 30-74 Minutes (Pro Cah)",,99291,CPT,Professional,Both,,,,1066,906.1,132.04,1066,"Health Partners, Inc.",Commercial,441.12,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Critical Care, E&M Of Critically Injured Patient; First 30-74 Minutes (Pro Cah)",,99291,CPT,Professional,Both,,,,1066,906.1,132.04,1066,"Health Partners, Inc.",Medicare Advantage,235.8995,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Critical Care, E&M Of Critically Injured Patient; First 30-74 Minutes (Pro Cah)",,99291,CPT,Professional,Both,,,,1066,906.1,132.04,1066,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),205.36,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Critical Care, E&M Of Critically Injured Patient; First 30-74 Minutes (Pro Cah)",,99291,CPT,Professional,Both,,,,1066,906.1,132.04,1066,"Health Partners, Inc.",State of Minnesota Advantage Program,380.02488,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Critical Care, E&M Of Critically Injured Patient; First 30-74 Minutes (Pro Cah)",,99291,CPT,Professional,Both,,,,1066,906.1,132.04,1066,"Health Partners, Inc.",State Public Programs,132.04,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Critical Care, E&M Of Critically Injured Patient; First 30-74 Minutes (Pro Cah)",,99291,CPT,Professional,Both,,,,1066,906.1,132.04,1066,Humana Insurance Company,Commercial PPO,205.13,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Critical Care, E&M Of Critically Injured Patient; First 30-74 Minutes (Pro Cah)",,99291,CPT,Professional,Both,,,,1066,906.1,132.04,1066,Humana Insurance Company,Medicare PPO,1066,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Critical Care, E&M Of Critically Injured Patient; First 30-74 Minutes (Pro Cah)",,99291,CPT,Professional,Both,,,,1066,906.1,132.04,1066,Medica,Individual & Family,903.968,84.8,,percent of total billed charges,,
"Critical Care, E&M Of Critically Injured Patient; First 30-74 Minutes (Pro Cah)",,99291,CPT,Professional,Both,,,,1066,906.1,132.04,1066,Medica,Medica Advantage Solution,530.868,49.8,,percent of total billed charges,,
"Critical Care, E&M Of Critically Injured Patient; First 30-74 Minutes (Pro Cah)",,99291,CPT,Professional,Both,,,,1066,906.1,132.04,1066,Medica,Medical Assistance,152.44,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Critical Care, E&M Of Critically Injured Patient; First 30-74 Minutes (Pro Cah)",,99291,CPT,Professional,Both,,,,1066,906.1,132.04,1066,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,205.13,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Critical Care, E&M Of Critically Injured Patient; First 30-74 Minutes (Pro Cah)",,99291,CPT,Professional,Both,,,,1066,906.1,132.04,1066,"Multiplan, Inc.","Multiplan, Inc.",1002.04,94,,percent of total billed charges,,
"Critical Care, E&M Of Critically Injured Patient; First 30-74 Minutes (Pro Cah)",,99291,CPT,Professional,Both,,,,1066,906.1,132.04,1066,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,960.466,90.1,,percent of total billed charges,,
"Critical Care, E&M Of Critically Injured Patient; First 30-74 Minutes (Pro Cah)",,99291,CPT,Professional,Both,,,,1066,906.1,132.04,1066,"Preferred One Administrative Services, INC.",PPO,1051.076,98.6,,percent of total billed charges,,
"Critical Care, E&M Of Critically Injured Patient; First 30-74 Minutes (Pro Cah)",,99291,CPT,Professional,Both,,,,1066,906.1,132.04,1066,PrimeWest Health,Minnesota Senior Health Options (MSHO),235.8995,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Critical Care, E&M Of Critically Injured Patient; First 30-74 Minutes (Pro Cah)",,99291,CPT,Professional,Both,,,,1066,906.1,132.04,1066,PrimeWest Health,MinnesotaCare,163.1114848,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Critical Care, E&M Of Critically Injured Patient; First 30-74 Minutes (Pro Cah)",,99291,CPT,Professional,Both,,,,1066,906.1,132.04,1066,Sanford Health Plan,Sanford Health Plan,938.08,88,,percent of total billed charges,,
"Critical Care, E&M Of Critically Injured Patient; First 30-74 Minutes (Pro Cah)",,99291,CPT,Professional,Both,,,,1066,906.1,132.04,1066,"UCare Health, Inc.",Individual & Family Plan,333.459328,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Critical Care, E&M Of Critically Injured Patient; First 30-74 Minutes (Pro Cah)",,99291,CPT,Professional,Both,,,,1066,906.1,132.04,1066,"UCare Health, Inc.",Medical Assistance,167.684704,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Critical Care, E&M Of Critically Injured Patient; First 30-74 Minutes (Pro Cah)",,99291,CPT,Professional,Both,,,,1066,906.1,132.04,1066,"UCare Health, Inc.",Medicare Advantage,235.8995,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Critical Care, E&M Of Critically Injured Patient; First 30-74 Minutes (Pro Cah)",,99291,CPT,Professional,Both,,,,1066,906.1,132.04,1066,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),188.7196,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Critical Care, E&M Of Critically Injured Patient; First 30-74 Minutes (Pro Cah)",,99291,CPT,Professional,Both,,,,1066,906.1,132.04,1066,UnitedHealthcare,Individual & Family,1066,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Critical Care, E&M Of Critically Injured Patient; First 30-74 Minutes (Pro Cah)",,99291,CPT,Professional,Both,,,,1066,906.1,132.04,1066,UnitedHealthcare,Medicare Advantage,235.8995,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Critical Care, E&M Of Critically Injured Patient; First 30-74 Minutes (Pro Cah)",,99291,CPT,Professional,Both,,,,1066,906.1,132.04,1066,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,152.44064,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Critical Care > 74 Min Ea Addl 30 Min,,99292,CPT,Facility,Outpatient,,,,816,693.6,233.8656,816,Aetna,Commercial,750.72,92,,percent of total billed charges,,
Critical Care > 74 Min Ea Addl 30 Min,,99292,CPT,Facility,Outpatient,,,,816,693.6,233.8656,816,Aetna,Medicare Advantage,399.84,49,,percent of total billed charges,,
Critical Care > 74 Min Ea Addl 30 Min,,99292,CPT,Facility,Outpatient,,,,816,693.6,233.8656,816,Aetna,PPO,758.88,93,,percent of total billed charges,,
Critical Care > 74 Min Ea Addl 30 Min,,99292,CPT,Facility,Outpatient,,,,816,693.6,233.8656,816,America's PPO,America's PPO,783.6048,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Critical Care > 74 Min Ea Addl 30 Min,,99292,CPT,Facility,Outpatient,,,,816,693.6,233.8656,816,BlueCross BlueShield Minnesota, Federal Employee Program,802.944,98.4,,percent of total billed charges,,
Critical Care > 74 Min Ea Addl 30 Min,,99292,CPT,Facility,Outpatient,,,,816,693.6,233.8656,816,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,816,100,,percent of total billed charges,,
Critical Care > 74 Min Ea Addl 30 Min,,99292,CPT,Facility,Outpatient,,,,816,693.6,233.8656,816,BlueCross BlueShield Minnesota,High Value Network Plan,734.4,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
Critical Care > 74 Min Ea Addl 30 Min,,99292,CPT,Facility,Outpatient,,,,816,693.6,233.8656,816,BlueCross BlueShield Minnesota,Medicare Advantage,399.84,49,,percent of total billed charges,,
Critical Care > 74 Min Ea Addl 30 Min,,99292,CPT,Facility,Outpatient,,,,816,693.6,233.8656,816,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,233.8656,28.66,,percent of total billed charges,,
Critical Care > 74 Min Ea Addl 30 Min,,99292,CPT,Facility,Outpatient,,,,816,693.6,233.8656,816,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),399.84,49,,percent of total billed charges,,
Critical Care > 74 Min Ea Addl 30 Min,,99292,CPT,Facility,Outpatient,,,,816,693.6,233.8656,816,CorVel,Worker's Compensation,816,100,,percent of total billed charges,,
Critical Care > 74 Min Ea Addl 30 Min,,99292,CPT,Facility,Outpatient,,,,816,693.6,233.8656,816,First Health Group Corporation,First Health Network,791.52,97,,percent of total billed charges,,
Critical Care > 74 Min Ea Addl 30 Min,,99292,CPT,Facility,Outpatient,,,,816,693.6,233.8656,816,"Health Partners, Inc.",Commercial,771.936,94.6,,percent of total billed charges,,
Critical Care > 74 Min Ea Addl 30 Min,,99292,CPT,Facility,Outpatient,,,,816,693.6,233.8656,816,"Health Partners, Inc.",Medicare Advantage,399.84,49,,percent of total billed charges,,
Critical Care > 74 Min Ea Addl 30 Min,,99292,CPT,Facility,Outpatient,,,,816,693.6,233.8656,816,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),489.6,60,,percent of total billed charges,,
Critical Care > 74 Min Ea Addl 30 Min,,99292,CPT,Facility,Outpatient,,,,816,693.6,233.8656,816,"Health Partners, Inc.",State of Minnesota Advantage Program,665.04,81.5,,percent of total billed charges,,
Critical Care > 74 Min Ea Addl 30 Min,,99292,CPT,Facility,Outpatient,,,,816,693.6,233.8656,816,"Health Partners, Inc.",State Public Programs,408,50,,percent of total billed charges,,
Critical Care > 74 Min Ea Addl 30 Min,,99292,CPT,Facility,Outpatient,,,,816,693.6,233.8656,816,Humana Insurance Company,Commercial PPO,775.2,95,,percent of total billed charges,,
Critical Care > 74 Min Ea Addl 30 Min,,99292,CPT,Facility,Outpatient,,,,816,693.6,233.8656,816,Humana Insurance Company,Medicare PPO,399.84,49,,percent of total billed charges,,
Critical Care > 74 Min Ea Addl 30 Min,,99292,CPT,Facility,Outpatient,,,,816,693.6,233.8656,816,Medica,Individual & Family,760.512,93.2,,percent of total billed charges,,
Critical Care > 74 Min Ea Addl 30 Min,,99292,CPT,Facility,Outpatient,,,,816,693.6,233.8656,816,Medica,Medica Advantage Solution,406.368,49.8,,percent of total billed charges,,
Critical Care > 74 Min Ea Addl 30 Min,,99292,CPT,Facility,Outpatient,,,,816,693.6,233.8656,816,Medica,Medical Assistance,363.936,44.6,,percent of total billed charges,,
Critical Care > 74 Min Ea Addl 30 Min,,99292,CPT,Facility,Outpatient,,,,816,693.6,233.8656,816,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,406.368,49.8,,percent of total billed charges,,
Critical Care > 74 Min Ea Addl 30 Min,,99292,CPT,Facility,Outpatient,,,,816,693.6,233.8656,816,"Multiplan, Inc.","Multiplan, Inc.",767.04,94,,percent of total billed charges,,
Critical Care > 74 Min Ea Addl 30 Min,,99292,CPT,Facility,Outpatient,,,,816,693.6,233.8656,816,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,735.216,90.1,,percent of total billed charges,,
Critical Care > 74 Min Ea Addl 30 Min,,99292,CPT,Facility,Outpatient,,,,816,693.6,233.8656,816,"Preferred One Administrative Services, INC.",PPO,804.576,98.6,,percent of total billed charges,,
Critical Care > 74 Min Ea Addl 30 Min,,99292,CPT,Facility,Outpatient,,,,816,693.6,233.8656,816,PrimeWest Health,Minnesota Senior Health Options (MSHO),419.832,51.45,,percent of total billed charges,,
Critical Care > 74 Min Ea Addl 30 Min,,99292,CPT,Facility,Outpatient,,,,816,693.6,233.8656,816,PrimeWest Health,MinnesotaCare,419.0976,51.36,,percent of total billed charges,,
Critical Care > 74 Min Ea Addl 30 Min,,99292,CPT,Facility,Outpatient,,,,816,693.6,233.8656,816,Sanford Health Plan,Sanford Health Plan,750.72,92,,percent of total billed charges,,
Critical Care > 74 Min Ea Addl 30 Min,,99292,CPT,Facility,Outpatient,,,,816,693.6,233.8656,816,"UCare Health, Inc.",Individual & Family Plan,459.816,56.35,,percent of total billed charges,,
Critical Care > 74 Min Ea Addl 30 Min,,99292,CPT,Facility,Outpatient,,,,816,693.6,233.8656,816,"UCare Health, Inc.",Medical Assistance,411.8352,50.47,,percent of total billed charges,,
Critical Care > 74 Min Ea Addl 30 Min,,99292,CPT,Facility,Outpatient,,,,816,693.6,233.8656,816,"UCare Health, Inc.",Medicare Advantage,411.8352,50.47,,percent of total billed charges,,
Critical Care > 74 Min Ea Addl 30 Min,,99292,CPT,Facility,Outpatient,,,,816,693.6,233.8656,816,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),411.8352,50.47,,percent of total billed charges,,
Critical Care > 74 Min Ea Addl 30 Min,,99292,CPT,Facility,Outpatient,,,,816,693.6,233.8656,816,UnitedHealthcare,Individual & Family,767.04,94,,percent of total billed charges,,
Critical Care > 74 Min Ea Addl 30 Min,,99292,CPT,Facility,Outpatient,,,,816,693.6,233.8656,816,UnitedHealthcare,Medicare Advantage,399.84,49,,percent of total billed charges,,
Critical Care > 74 Min Ea Addl 30 Min,,99292,CPT,Facility,Outpatient,,,,816,693.6,233.8656,816,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,391.68,48,,percent of total billed charges,,100% of DHS outpatient percentage
Critical Care Addl 30 Min (Pro Cah),,99292,CPT,Professional,Both,,,,398,338.3,66.12,398,Aetna,Commercial,338.3,85,,percent of total billed charges,,
Critical Care Addl 30 Min (Pro Cah),,99292,CPT,Professional,Both,,,,398,338.3,66.12,398,Aetna,Medicare Advantage,106.55,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Critical Care Addl 30 Min (Pro Cah),,99292,CPT,Professional,Both,,,,398,338.3,66.12,398,Aetna,PPO,370.14,93,,percent of total billed charges,,
Critical Care Addl 30 Min (Pro Cah),,99292,CPT,Professional,Both,,,,398,338.3,66.12,398,America's PPO,America's PPO,340.0512,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Critical Care Addl 30 Min (Pro Cah),,99292,CPT,Professional,Both,,,,398,338.3,66.12,398,BlueCross BlueShield Minnesota, Federal Employee Program,189.69,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Critical Care Addl 30 Min (Pro Cah),,99292,CPT,Professional,Both,,,,398,338.3,66.12,398,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,192.72504,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Critical Care Addl 30 Min (Pro Cah),,99292,CPT,Professional,Both,,,,398,338.3,66.12,398,BlueCross BlueShield Minnesota,High Value Network Plan,192.72504,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Critical Care Addl 30 Min (Pro Cah),,99292,CPT,Professional,Both,,,,398,338.3,66.12,398,BlueCross BlueShield Minnesota,Medicare Advantage,118.2775,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Critical Care Addl 30 Min (Pro Cah),,99292,CPT,Professional,Both,,,,398,338.3,66.12,398,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,192.72504,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Critical Care Addl 30 Min (Pro Cah),,99292,CPT,Professional,Both,,,,398,338.3,66.12,398,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,76.34224,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Critical Care Addl 30 Min (Pro Cah),,99292,CPT,Professional,Both,,,,398,338.3,66.12,398,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),118.2775,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Critical Care Addl 30 Min (Pro Cah),,99292,CPT,Professional,Both,,,,398,338.3,66.12,398,CorVel,Worker's Compensation,205.1029233,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Critical Care Addl 30 Min (Pro Cah),,99292,CPT,Professional,Both,,,,398,338.3,66.12,398,First Health Group Corporation,First Health Network,386.06,97,,percent of total billed charges,,
Critical Care Addl 30 Min (Pro Cah),,99292,CPT,Professional,Both,,,,398,338.3,66.12,398,"Health Partners, Inc.",Commercial,221.28,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Critical Care Addl 30 Min (Pro Cah),,99292,CPT,Professional,Both,,,,398,338.3,66.12,398,"Health Partners, Inc.",Medicare Advantage,118.2775,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Critical Care Addl 30 Min (Pro Cah),,99292,CPT,Professional,Both,,,,398,338.3,66.12,398,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),102.68,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Critical Care Addl 30 Min (Pro Cah),,99292,CPT,Professional,Both,,,,398,338.3,66.12,398,"Health Partners, Inc.",State of Minnesota Advantage Program,190.63272,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Critical Care Addl 30 Min (Pro Cah),,99292,CPT,Professional,Both,,,,398,338.3,66.12,398,"Health Partners, Inc.",State Public Programs,66.12,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Critical Care Addl 30 Min (Pro Cah),,99292,CPT,Professional,Both,,,,398,338.3,66.12,398,Humana Insurance Company,Commercial PPO,102.85,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Critical Care Addl 30 Min (Pro Cah),,99292,CPT,Professional,Both,,,,398,338.3,66.12,398,Humana Insurance Company,Medicare PPO,398,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Critical Care Addl 30 Min (Pro Cah),,99292,CPT,Professional,Both,,,,398,338.3,66.12,398,Medica,Individual & Family,337.504,84.8,,percent of total billed charges,,
Critical Care Addl 30 Min (Pro Cah),,99292,CPT,Professional,Both,,,,398,338.3,66.12,398,Medica,Medica Advantage Solution,198.204,49.8,,percent of total billed charges,,
Critical Care Addl 30 Min (Pro Cah),,99292,CPT,Professional,Both,,,,398,338.3,66.12,398,Medica,Medical Assistance,76.34,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Critical Care Addl 30 Min (Pro Cah),,99292,CPT,Professional,Both,,,,398,338.3,66.12,398,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,102.85,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Critical Care Addl 30 Min (Pro Cah),,99292,CPT,Professional,Both,,,,398,338.3,66.12,398,"Multiplan, Inc.","Multiplan, Inc.",374.12,94,,percent of total billed charges,,
Critical Care Addl 30 Min (Pro Cah),,99292,CPT,Professional,Both,,,,398,338.3,66.12,398,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,358.598,90.1,,percent of total billed charges,,
Critical Care Addl 30 Min (Pro Cah),,99292,CPT,Professional,Both,,,,398,338.3,66.12,398,"Preferred One Administrative Services, INC.",PPO,392.428,98.6,,percent of total billed charges,,
Critical Care Addl 30 Min (Pro Cah),,99292,CPT,Professional,Both,,,,398,338.3,66.12,398,PrimeWest Health,Minnesota Senior Health Options (MSHO),118.2775,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Critical Care Addl 30 Min (Pro Cah),,99292,CPT,Professional,Both,,,,398,338.3,66.12,398,PrimeWest Health,MinnesotaCare,81.6861968,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Critical Care Addl 30 Min (Pro Cah),,99292,CPT,Professional,Both,,,,398,338.3,66.12,398,Sanford Health Plan,Sanford Health Plan,350.24,88,,percent of total billed charges,,
Critical Care Addl 30 Min (Pro Cah),,99292,CPT,Professional,Both,,,,398,338.3,66.12,398,"UCare Health, Inc.",Individual & Family Plan,167.19296,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Critical Care Addl 30 Min (Pro Cah),,99292,CPT,Professional,Both,,,,398,338.3,66.12,398,"UCare Health, Inc.",Medical Assistance,83.976464,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Critical Care Addl 30 Min (Pro Cah),,99292,CPT,Professional,Both,,,,398,338.3,66.12,398,"UCare Health, Inc.",Medicare Advantage,118.2775,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Critical Care Addl 30 Min (Pro Cah),,99292,CPT,Professional,Both,,,,398,338.3,66.12,398,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),94.622,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Critical Care Addl 30 Min (Pro Cah),,99292,CPT,Professional,Both,,,,398,338.3,66.12,398,UnitedHealthcare,Individual & Family,398,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Critical Care Addl 30 Min (Pro Cah),,99292,CPT,Professional,Both,,,,398,338.3,66.12,398,UnitedHealthcare,Medicare Advantage,118.2775,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Critical Care Addl 30 Min (Pro Cah),,99292,CPT,Professional,Both,,,,398,338.3,66.12,398,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,76.34224,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
SODIUM CHLORIDE 5 % OPHT DROP,,399,LOCAL,Facility,Both,15,mL,,25,21.25,7.165,25,Aetna,Commercial,23,92,,percent of total billed charges,,
SODIUM CHLORIDE 5 % OPHT DROP,,399,LOCAL,Facility,Outpatient,15,mL,,25,21.25,7.165,25,Aetna,Medicare Advantage,12.25,49,,percent of total billed charges,,
SODIUM CHLORIDE 5 % OPHT DROP,,399,LOCAL,Facility,Inpatient,15,mL,,25,21.25,7.165,25,Aetna,Medicare Advantage,,,,,Included in per diem rate,
SODIUM CHLORIDE 5 % OPHT DROP,,399,LOCAL,Facility,Both,15,mL,,25,21.25,7.165,25,Aetna,PPO,23.25,93,,percent of total billed charges,,
SODIUM CHLORIDE 5 % OPHT DROP,,399,LOCAL,Facility,Both,15,mL,,25,21.25,7.165,25,America's PPO,America's PPO,24.0075,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SODIUM CHLORIDE 5 % OPHT DROP,,399,LOCAL,Facility,Both,15,mL,,25,21.25,7.165,25,BlueCross BlueShield Minnesota, Federal Employee Program,24.6,98.4,,percent of total billed charges,,
SODIUM CHLORIDE 5 % OPHT DROP,,399,LOCAL,Facility,Both,15,mL,,25,21.25,7.165,25,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,25,100,,percent of total billed charges,,
SODIUM CHLORIDE 5 % OPHT DROP,,399,LOCAL,Facility,Both,15,mL,,25,21.25,7.165,25,BlueCross BlueShield Minnesota,High Value Network Plan,22.5,90,,percent of total billed charges,,
SODIUM CHLORIDE 5 % OPHT DROP,,399,LOCAL,Facility,Outpatient,15,mL,,25,21.25,7.165,25,BlueCross BlueShield Minnesota,Medicare Advantage,12.25,49,,percent of total billed charges,,
SODIUM CHLORIDE 5 % OPHT DROP,,399,LOCAL,Facility,Inpatient,15,mL,,25,21.25,7.165,25,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
SODIUM CHLORIDE 5 % OPHT DROP,,399,LOCAL,Facility,Both,15,mL,,25,21.25,7.165,25,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,22.1425,88.57,,percent of total billed charges,,
SODIUM CHLORIDE 5 % OPHT DROP,,399,LOCAL,Facility,Both,15,mL,,25,21.25,7.165,25,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,7.165,28.66,,percent of total billed charges,,
SODIUM CHLORIDE 5 % OPHT DROP,,399,LOCAL,Facility,Outpatient,15,mL,,25,21.25,7.165,25,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),12.25,49,,percent of total billed charges,,
SODIUM CHLORIDE 5 % OPHT DROP,,399,LOCAL,Facility,Inpatient,15,mL,,25,21.25,7.165,25,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
SODIUM CHLORIDE 5 % OPHT DROP,,399,LOCAL,Facility,Both,15,mL,,25,21.25,7.165,25,CorVel,Worker's Compensation,25,100,,percent of total billed charges,,
SODIUM CHLORIDE 5 % OPHT DROP,,399,LOCAL,Facility,Both,15,mL,,25,21.25,7.165,25,First Health Group Corporation,First Health Network,24.25,97,,percent of total billed charges,,
SODIUM CHLORIDE 5 % OPHT DROP,,399,LOCAL,Facility,Both,15,mL,,25,21.25,7.165,25,"Health Partners, Inc.",Commercial,23.65,94.6,,percent of total billed charges,,
SODIUM CHLORIDE 5 % OPHT DROP,,399,LOCAL,Facility,Outpatient,15,mL,,25,21.25,7.165,25,"Health Partners, Inc.",Medicare Advantage,12.25,49,,percent of total billed charges,,
SODIUM CHLORIDE 5 % OPHT DROP,,399,LOCAL,Facility,Inpatient,15,mL,,25,21.25,7.165,25,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SODIUM CHLORIDE 5 % OPHT DROP,,399,LOCAL,Facility,Both,15,mL,,25,21.25,7.165,25,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),15,60,,percent of total billed charges,,
SODIUM CHLORIDE 5 % OPHT DROP,,399,LOCAL,Facility,Both,15,mL,,25,21.25,7.165,25,"Health Partners, Inc.",State of Minnesota Advantage Program,20.375,81.5,,percent of total billed charges,,
SODIUM CHLORIDE 5 % OPHT DROP,,399,LOCAL,Facility,Both,15,mL,,25,21.25,7.165,25,"Health Partners, Inc.",State Public Programs,12.5,50,,percent of total billed charges,,
SODIUM CHLORIDE 5 % OPHT DROP,,399,LOCAL,Facility,Both,15,mL,,25,21.25,7.165,25,Humana Insurance Company,Commercial PPO,23.75,95,,percent of total billed charges,,
SODIUM CHLORIDE 5 % OPHT DROP,,399,LOCAL,Facility,Outpatient,15,mL,,25,21.25,7.165,25,Humana Insurance Company,Medicare PPO,12.25,49,,percent of total billed charges,,
SODIUM CHLORIDE 5 % OPHT DROP,,399,LOCAL,Facility,Inpatient,15,mL,,25,21.25,7.165,25,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
SODIUM CHLORIDE 5 % OPHT DROP,,399,LOCAL,Facility,Both,15,mL,,25,21.25,7.165,25,Medica,Individual & Family,24.775,99.1,,percent of total billed charges,,
SODIUM CHLORIDE 5 % OPHT DROP,,399,LOCAL,Facility,Outpatient,15,mL,,25,21.25,7.165,25,Medica,Medica Advantage Solution,12.45,49.8,,percent of total billed charges,,
SODIUM CHLORIDE 5 % OPHT DROP,,399,LOCAL,Facility,Inpatient,15,mL,,25,21.25,7.165,25,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
SODIUM CHLORIDE 5 % OPHT DROP,,399,LOCAL,Facility,Outpatient,15,mL,,25,21.25,7.165,25,Medica,Medical Assistance,11.15,44.6,,percent of total billed charges,,
SODIUM CHLORIDE 5 % OPHT DROP,,399,LOCAL,Facility,Inpatient,15,mL,,25,21.25,7.165,25,Medica,Medical Assistance,,,,,Included in per diem rate,
SODIUM CHLORIDE 5 % OPHT DROP,,399,LOCAL,Facility,Outpatient,15,mL,,25,21.25,7.165,25,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,12.45,49.8,,percent of total billed charges,,
SODIUM CHLORIDE 5 % OPHT DROP,,399,LOCAL,Facility,Inpatient,15,mL,,25,21.25,7.165,25,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
SODIUM CHLORIDE 5 % OPHT DROP,,399,LOCAL,Facility,Both,15,mL,,25,21.25,7.165,25,"Multiplan, Inc.","Multiplan, Inc.",23.5,94,,percent of total billed charges,,
SODIUM CHLORIDE 5 % OPHT DROP,,399,LOCAL,Facility,Outpatient,15,mL,,25,21.25,7.165,25,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,22.525,90.1,,percent of total billed charges,,
SODIUM CHLORIDE 5 % OPHT DROP,,399,LOCAL,Facility,Inpatient,15,mL,,25,21.25,7.165,25,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
SODIUM CHLORIDE 5 % OPHT DROP,,399,LOCAL,Facility,Both,15,mL,,25,21.25,7.165,25,"Preferred One Administrative Services, INC.",PPO,24.65,98.6,,percent of total billed charges,,
SODIUM CHLORIDE 5 % OPHT DROP,,399,LOCAL,Facility,Outpatient,15,mL,,25,21.25,7.165,25,PrimeWest Health,Minnesota Senior Health Options (MSHO),12.8625,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
SODIUM CHLORIDE 5 % OPHT DROP,,399,LOCAL,Facility,Inpatient,15,mL,,25,21.25,7.165,25,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SODIUM CHLORIDE 5 % OPHT DROP,,399,LOCAL,Facility,Outpatient,15,mL,,25,21.25,7.165,25,PrimeWest Health,MinnesotaCare,12.84,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
SODIUM CHLORIDE 5 % OPHT DROP,,399,LOCAL,Facility,Inpatient,15,mL,,25,21.25,7.165,25,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
SODIUM CHLORIDE 5 % OPHT DROP,,399,LOCAL,Facility,Both,15,mL,,25,21.25,7.165,25,Sanford Health Plan,Sanford Health Plan,23,92,,percent of total billed charges,,
SODIUM CHLORIDE 5 % OPHT DROP,,399,LOCAL,Facility,Outpatient,15,mL,,25,21.25,7.165,25,"UCare Health, Inc.",Individual & Family Plan,14.0875,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
SODIUM CHLORIDE 5 % OPHT DROP,,399,LOCAL,Facility,Inpatient,15,mL,,25,21.25,7.165,25,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
SODIUM CHLORIDE 5 % OPHT DROP,,399,LOCAL,Facility,Outpatient,15,mL,,25,21.25,7.165,25,"UCare Health, Inc.",Medical Assistance,12.6175,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SODIUM CHLORIDE 5 % OPHT DROP,,399,LOCAL,Facility,Inpatient,15,mL,,25,21.25,7.165,25,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
SODIUM CHLORIDE 5 % OPHT DROP,,399,LOCAL,Facility,Outpatient,15,mL,,25,21.25,7.165,25,"UCare Health, Inc.",Medicare Advantage,12.6175,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SODIUM CHLORIDE 5 % OPHT DROP,,399,LOCAL,Facility,Inpatient,15,mL,,25,21.25,7.165,25,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SODIUM CHLORIDE 5 % OPHT DROP,,399,LOCAL,Facility,Outpatient,15,mL,,25,21.25,7.165,25,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),12.6175,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SODIUM CHLORIDE 5 % OPHT DROP,,399,LOCAL,Facility,Inpatient,15,mL,,25,21.25,7.165,25,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SODIUM CHLORIDE 5 % OPHT DROP,,399,LOCAL,Facility,Both,15,mL,,25,21.25,7.165,25,UnitedHealthcare,Individual & Family,23.5,94,,percent of total billed charges,,
SODIUM CHLORIDE 5 % OPHT DROP,,399,LOCAL,Facility,Outpatient,15,mL,,25,21.25,7.165,25,UnitedHealthcare,Medicare Advantage,12.25,49,,percent of total billed charges,,
SODIUM CHLORIDE 5 % OPHT DROP,,399,LOCAL,Facility,Inpatient,15,mL,,25,21.25,7.165,25,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
SODIUM CHLORIDE 5 % OPHT DROP,,399,LOCAL,Facility,Outpatient,15,mL,,25,21.25,7.165,25,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,12,48,,percent of total billed charges,,100% of DHS outpatient percentage
SODIUM CHLORIDE 5 % OPHT DROP,,399,LOCAL,Facility,Inpatient,15,mL,,25,21.25,7.165,25,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual; 15 Min,,99401,CPT,Facility,Both,,,,46,39.1,13.1836,46,Aetna,Commercial,42.32,92,,percent of total billed charges,,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual; 15 Min,,99401,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,Aetna,Medicare Advantage,22.54,49,,percent of total billed charges,,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual; 15 Min,,99401,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual; 15 Min,,99401,CPT,Facility,Both,,,,46,39.1,13.1836,46,Aetna,PPO,42.78,93,,percent of total billed charges,,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual; 15 Min,,99401,CPT,Facility,Both,,,,46,39.1,13.1836,46,America's PPO,America's PPO,44.1738,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual; 15 Min,,99401,CPT,Facility,Both,,,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota, Federal Employee Program,45.264,98.4,,percent of total billed charges,,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual; 15 Min,,99401,CPT,Facility,Both,,,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,46,100,,percent of total billed charges,,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual; 15 Min,,99401,CPT,Facility,Both,,,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,High Value Network Plan,41.4,90,,percent of total billed charges,,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual; 15 Min,,99401,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Medicare Advantage,22.54,49,,percent of total billed charges,,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual; 15 Min,,99401,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual; 15 Min,,99401,CPT,Facility,Both,,,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,40.7422,88.57,,percent of total billed charges,,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual; 15 Min,,99401,CPT,Facility,Both,,,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,13.1836,28.66,,percent of total billed charges,,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual; 15 Min,,99401,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),22.54,49,,percent of total billed charges,,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual; 15 Min,,99401,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual; 15 Min,,99401,CPT,Facility,Both,,,,46,39.1,13.1836,46,CorVel,Worker's Compensation,46,100,,percent of total billed charges,,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual; 15 Min,,99401,CPT,Facility,Both,,,,46,39.1,13.1836,46,First Health Group Corporation,First Health Network,44.62,97,,percent of total billed charges,,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual; 15 Min,,99401,CPT,Facility,Both,,,,46,39.1,13.1836,46,"Health Partners, Inc.",Commercial,43.516,94.6,,percent of total billed charges,,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual; 15 Min,,99401,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,"Health Partners, Inc.",Medicare Advantage,22.54,49,,percent of total billed charges,,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual; 15 Min,,99401,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual; 15 Min,,99401,CPT,Facility,Both,,,,46,39.1,13.1836,46,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),27.6,60,,percent of total billed charges,,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual; 15 Min,,99401,CPT,Facility,Both,,,,46,39.1,13.1836,46,"Health Partners, Inc.",State of Minnesota Advantage Program,37.49,81.5,,percent of total billed charges,,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual; 15 Min,,99401,CPT,Facility,Both,,,,46,39.1,13.1836,46,"Health Partners, Inc.",State Public Programs,23,50,,percent of total billed charges,,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual; 15 Min,,99401,CPT,Facility,Both,,,,46,39.1,13.1836,46,Humana Insurance Company,Commercial PPO,43.7,95,,percent of total billed charges,,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual; 15 Min,,99401,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,Humana Insurance Company,Medicare PPO,22.54,49,,percent of total billed charges,,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual; 15 Min,,99401,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual; 15 Min,,99401,CPT,Facility,Both,,,,46,39.1,13.1836,46,Medica,Individual & Family,45.586,99.1,,percent of total billed charges,,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual; 15 Min,,99401,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,Medica,Medica Advantage Solution,22.908,49.8,,percent of total billed charges,,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual; 15 Min,,99401,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual; 15 Min,,99401,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,Medica,Medical Assistance,20.516,44.6,,percent of total billed charges,,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual; 15 Min,,99401,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,Medica,Medical Assistance,,,,,Included in per diem rate,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual; 15 Min,,99401,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,22.908,49.8,,percent of total billed charges,,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual; 15 Min,,99401,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual; 15 Min,,99401,CPT,Facility,Both,,,,46,39.1,13.1836,46,"Multiplan, Inc.","Multiplan, Inc.",43.24,94,,percent of total billed charges,,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual; 15 Min,,99401,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,41.446,90.1,,percent of total billed charges,,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual; 15 Min,,99401,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual; 15 Min,,99401,CPT,Facility,Both,,,,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PPO,45.356,98.6,,percent of total billed charges,,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual; 15 Min,,99401,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,PrimeWest Health,Minnesota Senior Health Options (MSHO),23.667,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual; 15 Min,,99401,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual; 15 Min,,99401,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,PrimeWest Health,MinnesotaCare,23.6256,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual; 15 Min,,99401,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual; 15 Min,,99401,CPT,Facility,Both,,,,46,39.1,13.1836,46,Sanford Health Plan,Sanford Health Plan,42.32,92,,percent of total billed charges,,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual; 15 Min,,99401,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,"UCare Health, Inc.",Individual & Family Plan,25.921,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual; 15 Min,,99401,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual; 15 Min,,99401,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,"UCare Health, Inc.",Medical Assistance,23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual; 15 Min,,99401,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual; 15 Min,,99401,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,"UCare Health, Inc.",Medicare Advantage,23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual; 15 Min,,99401,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual; 15 Min,,99401,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual; 15 Min,,99401,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual; 15 Min,,99401,CPT,Facility,Both,,,,46,39.1,13.1836,46,UnitedHealthcare,Individual & Family,43.24,94,,percent of total billed charges,,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual; 15 Min,,99401,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,UnitedHealthcare,Medicare Advantage,22.54,49,,percent of total billed charges,,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual; 15 Min,,99401,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual; 15 Min,,99401,CPT,Facility,Outpatient,,,,46,39.1,13.1836,46,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,22.08,48,,percent of total billed charges,,100% of DHS outpatient percentage
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual; 15 Min,,99401,CPT,Facility,Inpatient,,,,46,39.1,13.1836,46,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual; 30 Min,,99402,CPT,Facility,Both,,,,67,56.95,19.2022,67,Aetna,Commercial,61.64,92,,percent of total billed charges,,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual; 30 Min,,99402,CPT,Facility,Outpatient,,,,67,56.95,19.2022,67,Aetna,Medicare Advantage,32.83,49,,percent of total billed charges,,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual; 30 Min,,99402,CPT,Facility,Inpatient,,,,67,56.95,19.2022,67,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual; 30 Min,,99402,CPT,Facility,Both,,,,67,56.95,19.2022,67,Aetna,PPO,62.31,93,,percent of total billed charges,,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual; 30 Min,,99402,CPT,Facility,Both,,,,67,56.95,19.2022,67,America's PPO,America's PPO,64.3401,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual; 30 Min,,99402,CPT,Facility,Both,,,,67,56.95,19.2022,67,BlueCross BlueShield Minnesota, Federal Employee Program,65.928,98.4,,percent of total billed charges,,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual; 30 Min,,99402,CPT,Facility,Both,,,,67,56.95,19.2022,67,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,67,100,,percent of total billed charges,,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual; 30 Min,,99402,CPT,Facility,Both,,,,67,56.95,19.2022,67,BlueCross BlueShield Minnesota,High Value Network Plan,60.3,90,,percent of total billed charges,,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual; 30 Min,,99402,CPT,Facility,Outpatient,,,,67,56.95,19.2022,67,BlueCross BlueShield Minnesota,Medicare Advantage,32.83,49,,percent of total billed charges,,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual; 30 Min,,99402,CPT,Facility,Inpatient,,,,67,56.95,19.2022,67,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual; 30 Min,,99402,CPT,Facility,Both,,,,67,56.95,19.2022,67,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,59.3419,88.57,,percent of total billed charges,,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual; 30 Min,,99402,CPT,Facility,Both,,,,67,56.95,19.2022,67,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,19.2022,28.66,,percent of total billed charges,,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual; 30 Min,,99402,CPT,Facility,Outpatient,,,,67,56.95,19.2022,67,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),32.83,49,,percent of total billed charges,,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual; 30 Min,,99402,CPT,Facility,Inpatient,,,,67,56.95,19.2022,67,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual; 30 Min,,99402,CPT,Facility,Both,,,,67,56.95,19.2022,67,CorVel,Worker's Compensation,67,100,,percent of total billed charges,,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual; 30 Min,,99402,CPT,Facility,Both,,,,67,56.95,19.2022,67,First Health Group Corporation,First Health Network,64.99,97,,percent of total billed charges,,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual; 30 Min,,99402,CPT,Facility,Both,,,,67,56.95,19.2022,67,"Health Partners, Inc.",Commercial,63.382,94.6,,percent of total billed charges,,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual; 30 Min,,99402,CPT,Facility,Outpatient,,,,67,56.95,19.2022,67,"Health Partners, Inc.",Medicare Advantage,32.83,49,,percent of total billed charges,,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual; 30 Min,,99402,CPT,Facility,Inpatient,,,,67,56.95,19.2022,67,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual; 30 Min,,99402,CPT,Facility,Both,,,,67,56.95,19.2022,67,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),40.2,60,,percent of total billed charges,,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual; 30 Min,,99402,CPT,Facility,Both,,,,67,56.95,19.2022,67,"Health Partners, Inc.",State of Minnesota Advantage Program,54.605,81.5,,percent of total billed charges,,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual; 30 Min,,99402,CPT,Facility,Both,,,,67,56.95,19.2022,67,"Health Partners, Inc.",State Public Programs,33.5,50,,percent of total billed charges,,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual; 30 Min,,99402,CPT,Facility,Both,,,,67,56.95,19.2022,67,Humana Insurance Company,Commercial PPO,63.65,95,,percent of total billed charges,,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual; 30 Min,,99402,CPT,Facility,Outpatient,,,,67,56.95,19.2022,67,Humana Insurance Company,Medicare PPO,32.83,49,,percent of total billed charges,,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual; 30 Min,,99402,CPT,Facility,Inpatient,,,,67,56.95,19.2022,67,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual; 30 Min,,99402,CPT,Facility,Both,,,,67,56.95,19.2022,67,Medica,Individual & Family,66.397,99.1,,percent of total billed charges,,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual; 30 Min,,99402,CPT,Facility,Outpatient,,,,67,56.95,19.2022,67,Medica,Medica Advantage Solution,33.366,49.8,,percent of total billed charges,,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual; 30 Min,,99402,CPT,Facility,Inpatient,,,,67,56.95,19.2022,67,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual; 30 Min,,99402,CPT,Facility,Outpatient,,,,67,56.95,19.2022,67,Medica,Medical Assistance,29.882,44.6,,percent of total billed charges,,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual; 30 Min,,99402,CPT,Facility,Inpatient,,,,67,56.95,19.2022,67,Medica,Medical Assistance,,,,,Included in per diem rate,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual; 30 Min,,99402,CPT,Facility,Outpatient,,,,67,56.95,19.2022,67,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,33.366,49.8,,percent of total billed charges,,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual; 30 Min,,99402,CPT,Facility,Inpatient,,,,67,56.95,19.2022,67,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual; 30 Min,,99402,CPT,Facility,Both,,,,67,56.95,19.2022,67,"Multiplan, Inc.","Multiplan, Inc.",62.98,94,,percent of total billed charges,,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual; 30 Min,,99402,CPT,Facility,Outpatient,,,,67,56.95,19.2022,67,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,60.367,90.1,,percent of total billed charges,,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual; 30 Min,,99402,CPT,Facility,Inpatient,,,,67,56.95,19.2022,67,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual; 30 Min,,99402,CPT,Facility,Both,,,,67,56.95,19.2022,67,"Preferred One Administrative Services, INC.",PPO,66.062,98.6,,percent of total billed charges,,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual; 30 Min,,99402,CPT,Facility,Outpatient,,,,67,56.95,19.2022,67,PrimeWest Health,Minnesota Senior Health Options (MSHO),34.4715,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual; 30 Min,,99402,CPT,Facility,Inpatient,,,,67,56.95,19.2022,67,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual; 30 Min,,99402,CPT,Facility,Outpatient,,,,67,56.95,19.2022,67,PrimeWest Health,MinnesotaCare,34.4112,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual; 30 Min,,99402,CPT,Facility,Inpatient,,,,67,56.95,19.2022,67,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual; 30 Min,,99402,CPT,Facility,Both,,,,67,56.95,19.2022,67,Sanford Health Plan,Sanford Health Plan,61.64,92,,percent of total billed charges,,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual; 30 Min,,99402,CPT,Facility,Outpatient,,,,67,56.95,19.2022,67,"UCare Health, Inc.",Individual & Family Plan,37.7545,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual; 30 Min,,99402,CPT,Facility,Inpatient,,,,67,56.95,19.2022,67,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual; 30 Min,,99402,CPT,Facility,Outpatient,,,,67,56.95,19.2022,67,"UCare Health, Inc.",Medical Assistance,33.8149,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual; 30 Min,,99402,CPT,Facility,Inpatient,,,,67,56.95,19.2022,67,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual; 30 Min,,99402,CPT,Facility,Outpatient,,,,67,56.95,19.2022,67,"UCare Health, Inc.",Medicare Advantage,33.8149,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual; 30 Min,,99402,CPT,Facility,Inpatient,,,,67,56.95,19.2022,67,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual; 30 Min,,99402,CPT,Facility,Outpatient,,,,67,56.95,19.2022,67,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),33.8149,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual; 30 Min,,99402,CPT,Facility,Inpatient,,,,67,56.95,19.2022,67,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual; 30 Min,,99402,CPT,Facility,Both,,,,67,56.95,19.2022,67,UnitedHealthcare,Individual & Family,62.98,94,,percent of total billed charges,,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual; 30 Min,,99402,CPT,Facility,Outpatient,,,,67,56.95,19.2022,67,UnitedHealthcare,Medicare Advantage,32.83,49,,percent of total billed charges,,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual; 30 Min,,99402,CPT,Facility,Inpatient,,,,67,56.95,19.2022,67,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual; 30 Min,,99402,CPT,Facility,Outpatient,,,,67,56.95,19.2022,67,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,32.16,48,,percent of total billed charges,,100% of DHS outpatient percentage
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual; 30 Min,,99402,CPT,Facility,Inpatient,,,,67,56.95,19.2022,67,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual; 45 Min,,99403,CPT,Facility,Both,,,,94,79.9,26.9404,94,Aetna,Commercial,86.48,92,,percent of total billed charges,,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual; 45 Min,,99403,CPT,Facility,Outpatient,,,,94,79.9,26.9404,94,Aetna,Medicare Advantage,46.06,49,,percent of total billed charges,,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual; 45 Min,,99403,CPT,Facility,Inpatient,,,,94,79.9,26.9404,94,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual; 45 Min,,99403,CPT,Facility,Both,,,,94,79.9,26.9404,94,Aetna,PPO,87.42,93,,percent of total billed charges,,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual; 45 Min,,99403,CPT,Facility,Both,,,,94,79.9,26.9404,94,America's PPO,America's PPO,90.2682,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual; 45 Min,,99403,CPT,Facility,Both,,,,94,79.9,26.9404,94,BlueCross BlueShield Minnesota, Federal Employee Program,92.496,98.4,,percent of total billed charges,,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual; 45 Min,,99403,CPT,Facility,Both,,,,94,79.9,26.9404,94,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,94,100,,percent of total billed charges,,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual; 45 Min,,99403,CPT,Facility,Both,,,,94,79.9,26.9404,94,BlueCross BlueShield Minnesota,High Value Network Plan,84.6,90,,percent of total billed charges,,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual; 45 Min,,99403,CPT,Facility,Outpatient,,,,94,79.9,26.9404,94,BlueCross BlueShield Minnesota,Medicare Advantage,46.06,49,,percent of total billed charges,,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual; 45 Min,,99403,CPT,Facility,Inpatient,,,,94,79.9,26.9404,94,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual; 45 Min,,99403,CPT,Facility,Both,,,,94,79.9,26.9404,94,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,83.2558,88.57,,percent of total billed charges,,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual; 45 Min,,99403,CPT,Facility,Both,,,,94,79.9,26.9404,94,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,26.9404,28.66,,percent of total billed charges,,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual; 45 Min,,99403,CPT,Facility,Outpatient,,,,94,79.9,26.9404,94,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),46.06,49,,percent of total billed charges,,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual; 45 Min,,99403,CPT,Facility,Inpatient,,,,94,79.9,26.9404,94,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual; 45 Min,,99403,CPT,Facility,Both,,,,94,79.9,26.9404,94,CorVel,Worker's Compensation,94,100,,percent of total billed charges,,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual; 45 Min,,99403,CPT,Facility,Both,,,,94,79.9,26.9404,94,First Health Group Corporation,First Health Network,91.18,97,,percent of total billed charges,,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual; 45 Min,,99403,CPT,Facility,Both,,,,94,79.9,26.9404,94,"Health Partners, Inc.",Commercial,88.924,94.6,,percent of total billed charges,,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual; 45 Min,,99403,CPT,Facility,Outpatient,,,,94,79.9,26.9404,94,"Health Partners, Inc.",Medicare Advantage,46.06,49,,percent of total billed charges,,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual; 45 Min,,99403,CPT,Facility,Inpatient,,,,94,79.9,26.9404,94,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual; 45 Min,,99403,CPT,Facility,Both,,,,94,79.9,26.9404,94,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),56.4,60,,percent of total billed charges,,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual; 45 Min,,99403,CPT,Facility,Both,,,,94,79.9,26.9404,94,"Health Partners, Inc.",State of Minnesota Advantage Program,76.61,81.5,,percent of total billed charges,,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual; 45 Min,,99403,CPT,Facility,Both,,,,94,79.9,26.9404,94,"Health Partners, Inc.",State Public Programs,47,50,,percent of total billed charges,,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual; 45 Min,,99403,CPT,Facility,Both,,,,94,79.9,26.9404,94,Humana Insurance Company,Commercial PPO,89.3,95,,percent of total billed charges,,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual; 45 Min,,99403,CPT,Facility,Outpatient,,,,94,79.9,26.9404,94,Humana Insurance Company,Medicare PPO,46.06,49,,percent of total billed charges,,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual; 45 Min,,99403,CPT,Facility,Inpatient,,,,94,79.9,26.9404,94,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual; 45 Min,,99403,CPT,Facility,Both,,,,94,79.9,26.9404,94,Medica,Individual & Family,93.154,99.1,,percent of total billed charges,,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual; 45 Min,,99403,CPT,Facility,Outpatient,,,,94,79.9,26.9404,94,Medica,Medica Advantage Solution,46.812,49.8,,percent of total billed charges,,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual; 45 Min,,99403,CPT,Facility,Inpatient,,,,94,79.9,26.9404,94,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual; 45 Min,,99403,CPT,Facility,Outpatient,,,,94,79.9,26.9404,94,Medica,Medical Assistance,41.924,44.6,,percent of total billed charges,,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual; 45 Min,,99403,CPT,Facility,Inpatient,,,,94,79.9,26.9404,94,Medica,Medical Assistance,,,,,Included in per diem rate,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual; 45 Min,,99403,CPT,Facility,Outpatient,,,,94,79.9,26.9404,94,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,46.812,49.8,,percent of total billed charges,,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual; 45 Min,,99403,CPT,Facility,Inpatient,,,,94,79.9,26.9404,94,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual; 45 Min,,99403,CPT,Facility,Both,,,,94,79.9,26.9404,94,"Multiplan, Inc.","Multiplan, Inc.",88.36,94,,percent of total billed charges,,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual; 45 Min,,99403,CPT,Facility,Outpatient,,,,94,79.9,26.9404,94,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,84.694,90.1,,percent of total billed charges,,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual; 45 Min,,99403,CPT,Facility,Inpatient,,,,94,79.9,26.9404,94,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual; 45 Min,,99403,CPT,Facility,Both,,,,94,79.9,26.9404,94,"Preferred One Administrative Services, INC.",PPO,92.684,98.6,,percent of total billed charges,,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual; 45 Min,,99403,CPT,Facility,Outpatient,,,,94,79.9,26.9404,94,PrimeWest Health,Minnesota Senior Health Options (MSHO),48.363,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual; 45 Min,,99403,CPT,Facility,Inpatient,,,,94,79.9,26.9404,94,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual; 45 Min,,99403,CPT,Facility,Outpatient,,,,94,79.9,26.9404,94,PrimeWest Health,MinnesotaCare,48.2784,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual; 45 Min,,99403,CPT,Facility,Inpatient,,,,94,79.9,26.9404,94,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual; 45 Min,,99403,CPT,Facility,Both,,,,94,79.9,26.9404,94,Sanford Health Plan,Sanford Health Plan,86.48,92,,percent of total billed charges,,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual; 45 Min,,99403,CPT,Facility,Outpatient,,,,94,79.9,26.9404,94,"UCare Health, Inc.",Individual & Family Plan,52.969,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual; 45 Min,,99403,CPT,Facility,Inpatient,,,,94,79.9,26.9404,94,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual; 45 Min,,99403,CPT,Facility,Outpatient,,,,94,79.9,26.9404,94,"UCare Health, Inc.",Medical Assistance,47.4418,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual; 45 Min,,99403,CPT,Facility,Inpatient,,,,94,79.9,26.9404,94,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual; 45 Min,,99403,CPT,Facility,Outpatient,,,,94,79.9,26.9404,94,"UCare Health, Inc.",Medicare Advantage,47.4418,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual; 45 Min,,99403,CPT,Facility,Inpatient,,,,94,79.9,26.9404,94,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual; 45 Min,,99403,CPT,Facility,Outpatient,,,,94,79.9,26.9404,94,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),47.4418,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual; 45 Min,,99403,CPT,Facility,Inpatient,,,,94,79.9,26.9404,94,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual; 45 Min,,99403,CPT,Facility,Both,,,,94,79.9,26.9404,94,UnitedHealthcare,Individual & Family,88.36,94,,percent of total billed charges,,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual; 45 Min,,99403,CPT,Facility,Outpatient,,,,94,79.9,26.9404,94,UnitedHealthcare,Medicare Advantage,46.06,49,,percent of total billed charges,,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual; 45 Min,,99403,CPT,Facility,Inpatient,,,,94,79.9,26.9404,94,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual; 45 Min,,99403,CPT,Facility,Outpatient,,,,94,79.9,26.9404,94,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,45.12,48,,percent of total billed charges,,100% of DHS outpatient percentage
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual; 45 Min,,99403,CPT,Facility,Inpatient,,,,94,79.9,26.9404,94,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual, 60 Min",,99404,CPT,Facility,Both,,,,111,94.35,31.8126,111,Aetna,Commercial,102.12,92,,percent of total billed charges,,
"Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual, 60 Min",,99404,CPT,Facility,Outpatient,,,,111,94.35,31.8126,111,Aetna,Medicare Advantage,54.39,49,,percent of total billed charges,,
"Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual, 60 Min",,99404,CPT,Facility,Inpatient,,,,111,94.35,31.8126,111,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual, 60 Min",,99404,CPT,Facility,Both,,,,111,94.35,31.8126,111,Aetna,PPO,103.23,93,,percent of total billed charges,,
"Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual, 60 Min",,99404,CPT,Facility,Both,,,,111,94.35,31.8126,111,America's PPO,America's PPO,106.5933,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual, 60 Min",,99404,CPT,Facility,Both,,,,111,94.35,31.8126,111,BlueCross BlueShield Minnesota, Federal Employee Program,109.224,98.4,,percent of total billed charges,,
"Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual, 60 Min",,99404,CPT,Facility,Both,,,,111,94.35,31.8126,111,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,111,100,,percent of total billed charges,,
"Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual, 60 Min",,99404,CPT,Facility,Both,,,,111,94.35,31.8126,111,BlueCross BlueShield Minnesota,High Value Network Plan,99.9,90,,percent of total billed charges,,
"Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual, 60 Min",,99404,CPT,Facility,Outpatient,,,,111,94.35,31.8126,111,BlueCross BlueShield Minnesota,Medicare Advantage,54.39,49,,percent of total billed charges,,
"Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual, 60 Min",,99404,CPT,Facility,Inpatient,,,,111,94.35,31.8126,111,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual, 60 Min",,99404,CPT,Facility,Both,,,,111,94.35,31.8126,111,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,98.3127,88.57,,percent of total billed charges,,
"Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual, 60 Min",,99404,CPT,Facility,Both,,,,111,94.35,31.8126,111,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,31.8126,28.66,,percent of total billed charges,,
"Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual, 60 Min",,99404,CPT,Facility,Outpatient,,,,111,94.35,31.8126,111,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),54.39,49,,percent of total billed charges,,
"Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual, 60 Min",,99404,CPT,Facility,Inpatient,,,,111,94.35,31.8126,111,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual, 60 Min",,99404,CPT,Facility,Both,,,,111,94.35,31.8126,111,CorVel,Worker's Compensation,111,100,,percent of total billed charges,,
"Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual, 60 Min",,99404,CPT,Facility,Both,,,,111,94.35,31.8126,111,First Health Group Corporation,First Health Network,107.67,97,,percent of total billed charges,,
"Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual, 60 Min",,99404,CPT,Facility,Both,,,,111,94.35,31.8126,111,"Health Partners, Inc.",Commercial,105.006,94.6,,percent of total billed charges,,
"Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual, 60 Min",,99404,CPT,Facility,Outpatient,,,,111,94.35,31.8126,111,"Health Partners, Inc.",Medicare Advantage,54.39,49,,percent of total billed charges,,
"Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual, 60 Min",,99404,CPT,Facility,Inpatient,,,,111,94.35,31.8126,111,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual, 60 Min",,99404,CPT,Facility,Both,,,,111,94.35,31.8126,111,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),66.6,60,,percent of total billed charges,,
"Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual, 60 Min",,99404,CPT,Facility,Both,,,,111,94.35,31.8126,111,"Health Partners, Inc.",State of Minnesota Advantage Program,90.465,81.5,,percent of total billed charges,,
"Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual, 60 Min",,99404,CPT,Facility,Both,,,,111,94.35,31.8126,111,"Health Partners, Inc.",State Public Programs,55.5,50,,percent of total billed charges,,
"Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual, 60 Min",,99404,CPT,Facility,Both,,,,111,94.35,31.8126,111,Humana Insurance Company,Commercial PPO,105.45,95,,percent of total billed charges,,
"Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual, 60 Min",,99404,CPT,Facility,Outpatient,,,,111,94.35,31.8126,111,Humana Insurance Company,Medicare PPO,54.39,49,,percent of total billed charges,,
"Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual, 60 Min",,99404,CPT,Facility,Inpatient,,,,111,94.35,31.8126,111,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual, 60 Min",,99404,CPT,Facility,Both,,,,111,94.35,31.8126,111,Medica,Individual & Family,110.001,99.1,,percent of total billed charges,,
"Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual, 60 Min",,99404,CPT,Facility,Outpatient,,,,111,94.35,31.8126,111,Medica,Medica Advantage Solution,55.278,49.8,,percent of total billed charges,,
"Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual, 60 Min",,99404,CPT,Facility,Inpatient,,,,111,94.35,31.8126,111,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual, 60 Min",,99404,CPT,Facility,Outpatient,,,,111,94.35,31.8126,111,Medica,Medical Assistance,49.506,44.6,,percent of total billed charges,,
"Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual, 60 Min",,99404,CPT,Facility,Inpatient,,,,111,94.35,31.8126,111,Medica,Medical Assistance,,,,,Included in per diem rate,
"Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual, 60 Min",,99404,CPT,Facility,Outpatient,,,,111,94.35,31.8126,111,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,55.278,49.8,,percent of total billed charges,,
"Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual, 60 Min",,99404,CPT,Facility,Inpatient,,,,111,94.35,31.8126,111,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual, 60 Min",,99404,CPT,Facility,Both,,,,111,94.35,31.8126,111,"Multiplan, Inc.","Multiplan, Inc.",104.34,94,,percent of total billed charges,,
"Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual, 60 Min",,99404,CPT,Facility,Outpatient,,,,111,94.35,31.8126,111,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,100.011,90.1,,percent of total billed charges,,
"Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual, 60 Min",,99404,CPT,Facility,Inpatient,,,,111,94.35,31.8126,111,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual, 60 Min",,99404,CPT,Facility,Both,,,,111,94.35,31.8126,111,"Preferred One Administrative Services, INC.",PPO,109.446,98.6,,percent of total billed charges,,
"Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual, 60 Min",,99404,CPT,Facility,Outpatient,,,,111,94.35,31.8126,111,PrimeWest Health,Minnesota Senior Health Options (MSHO),57.1095,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual, 60 Min",,99404,CPT,Facility,Inpatient,,,,111,94.35,31.8126,111,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual, 60 Min",,99404,CPT,Facility,Outpatient,,,,111,94.35,31.8126,111,PrimeWest Health,MinnesotaCare,57.0096,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual, 60 Min",,99404,CPT,Facility,Inpatient,,,,111,94.35,31.8126,111,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual, 60 Min",,99404,CPT,Facility,Both,,,,111,94.35,31.8126,111,Sanford Health Plan,Sanford Health Plan,102.12,92,,percent of total billed charges,,
"Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual, 60 Min",,99404,CPT,Facility,Outpatient,,,,111,94.35,31.8126,111,"UCare Health, Inc.",Individual & Family Plan,62.5485,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual, 60 Min",,99404,CPT,Facility,Inpatient,,,,111,94.35,31.8126,111,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual, 60 Min",,99404,CPT,Facility,Outpatient,,,,111,94.35,31.8126,111,"UCare Health, Inc.",Medical Assistance,56.0217,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual, 60 Min",,99404,CPT,Facility,Inpatient,,,,111,94.35,31.8126,111,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual, 60 Min",,99404,CPT,Facility,Outpatient,,,,111,94.35,31.8126,111,"UCare Health, Inc.",Medicare Advantage,56.0217,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual, 60 Min",,99404,CPT,Facility,Inpatient,,,,111,94.35,31.8126,111,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual, 60 Min",,99404,CPT,Facility,Outpatient,,,,111,94.35,31.8126,111,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),56.0217,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual, 60 Min",,99404,CPT,Facility,Inpatient,,,,111,94.35,31.8126,111,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual, 60 Min",,99404,CPT,Facility,Both,,,,111,94.35,31.8126,111,UnitedHealthcare,Individual & Family,104.34,94,,percent of total billed charges,,
"Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual, 60 Min",,99404,CPT,Facility,Outpatient,,,,111,94.35,31.8126,111,UnitedHealthcare,Medicare Advantage,54.39,49,,percent of total billed charges,,
"Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual, 60 Min",,99404,CPT,Facility,Inpatient,,,,111,94.35,31.8126,111,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual, 60 Min",,99404,CPT,Facility,Outpatient,,,,111,94.35,31.8126,111,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,53.28,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S); Individual, 60 Min",,99404,CPT,Facility,Inpatient,,,,111,94.35,31.8126,111,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S);ÿGroup; 30 Minutes,,99411,CPT,Facility,Both,,,,76,64.6,21.7816,76,Aetna,Commercial,69.92,92,,percent of total billed charges,,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S);ÿGroup; 30 Minutes,,99411,CPT,Facility,Outpatient,,,,76,64.6,21.7816,76,Aetna,Medicare Advantage,37.24,49,,percent of total billed charges,,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S);ÿGroup; 30 Minutes,,99411,CPT,Facility,Inpatient,,,,76,64.6,21.7816,76,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S);ÿGroup; 30 Minutes,,99411,CPT,Facility,Both,,,,76,64.6,21.7816,76,Aetna,PPO,70.68,93,,percent of total billed charges,,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S);ÿGroup; 30 Minutes,,99411,CPT,Facility,Both,,,,76,64.6,21.7816,76,America's PPO,America's PPO,72.9828,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S);ÿGroup; 30 Minutes,,99411,CPT,Facility,Both,,,,76,64.6,21.7816,76,BlueCross BlueShield Minnesota, Federal Employee Program,74.784,98.4,,percent of total billed charges,,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S);ÿGroup; 30 Minutes,,99411,CPT,Facility,Both,,,,76,64.6,21.7816,76,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,76,100,,percent of total billed charges,,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S);ÿGroup; 30 Minutes,,99411,CPT,Facility,Both,,,,76,64.6,21.7816,76,BlueCross BlueShield Minnesota,High Value Network Plan,68.4,90,,percent of total billed charges,,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S);ÿGroup; 30 Minutes,,99411,CPT,Facility,Outpatient,,,,76,64.6,21.7816,76,BlueCross BlueShield Minnesota,Medicare Advantage,37.24,49,,percent of total billed charges,,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S);ÿGroup; 30 Minutes,,99411,CPT,Facility,Inpatient,,,,76,64.6,21.7816,76,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S);ÿGroup; 30 Minutes,,99411,CPT,Facility,Both,,,,76,64.6,21.7816,76,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,67.3132,88.57,,percent of total billed charges,,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S);ÿGroup; 30 Minutes,,99411,CPT,Facility,Both,,,,76,64.6,21.7816,76,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,21.7816,28.66,,percent of total billed charges,,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S);ÿGroup; 30 Minutes,,99411,CPT,Facility,Outpatient,,,,76,64.6,21.7816,76,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),37.24,49,,percent of total billed charges,,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S);ÿGroup; 30 Minutes,,99411,CPT,Facility,Inpatient,,,,76,64.6,21.7816,76,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S);ÿGroup; 30 Minutes,,99411,CPT,Facility,Both,,,,76,64.6,21.7816,76,CorVel,Worker's Compensation,76,100,,percent of total billed charges,,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S);ÿGroup; 30 Minutes,,99411,CPT,Facility,Both,,,,76,64.6,21.7816,76,First Health Group Corporation,First Health Network,73.72,97,,percent of total billed charges,,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S);ÿGroup; 30 Minutes,,99411,CPT,Facility,Both,,,,76,64.6,21.7816,76,"Health Partners, Inc.",Commercial,71.896,94.6,,percent of total billed charges,,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S);ÿGroup; 30 Minutes,,99411,CPT,Facility,Outpatient,,,,76,64.6,21.7816,76,"Health Partners, Inc.",Medicare Advantage,37.24,49,,percent of total billed charges,,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S);ÿGroup; 30 Minutes,,99411,CPT,Facility,Inpatient,,,,76,64.6,21.7816,76,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S);ÿGroup; 30 Minutes,,99411,CPT,Facility,Both,,,,76,64.6,21.7816,76,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),45.6,60,,percent of total billed charges,,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S);ÿGroup; 30 Minutes,,99411,CPT,Facility,Both,,,,76,64.6,21.7816,76,"Health Partners, Inc.",State of Minnesota Advantage Program,61.94,81.5,,percent of total billed charges,,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S);ÿGroup; 30 Minutes,,99411,CPT,Facility,Both,,,,76,64.6,21.7816,76,"Health Partners, Inc.",State Public Programs,38,50,,percent of total billed charges,,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S);ÿGroup; 30 Minutes,,99411,CPT,Facility,Both,,,,76,64.6,21.7816,76,Humana Insurance Company,Commercial PPO,72.2,95,,percent of total billed charges,,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S);ÿGroup; 30 Minutes,,99411,CPT,Facility,Outpatient,,,,76,64.6,21.7816,76,Humana Insurance Company,Medicare PPO,37.24,49,,percent of total billed charges,,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S);ÿGroup; 30 Minutes,,99411,CPT,Facility,Inpatient,,,,76,64.6,21.7816,76,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S);ÿGroup; 30 Minutes,,99411,CPT,Facility,Both,,,,76,64.6,21.7816,76,Medica,Individual & Family,75.316,99.1,,percent of total billed charges,,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S);ÿGroup; 30 Minutes,,99411,CPT,Facility,Outpatient,,,,76,64.6,21.7816,76,Medica,Medica Advantage Solution,37.848,49.8,,percent of total billed charges,,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S);ÿGroup; 30 Minutes,,99411,CPT,Facility,Inpatient,,,,76,64.6,21.7816,76,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S);ÿGroup; 30 Minutes,,99411,CPT,Facility,Outpatient,,,,76,64.6,21.7816,76,Medica,Medical Assistance,33.896,44.6,,percent of total billed charges,,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S);ÿGroup; 30 Minutes,,99411,CPT,Facility,Inpatient,,,,76,64.6,21.7816,76,Medica,Medical Assistance,,,,,Included in per diem rate,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S);ÿGroup; 30 Minutes,,99411,CPT,Facility,Outpatient,,,,76,64.6,21.7816,76,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,37.848,49.8,,percent of total billed charges,,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S);ÿGroup; 30 Minutes,,99411,CPT,Facility,Inpatient,,,,76,64.6,21.7816,76,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S);ÿGroup; 30 Minutes,,99411,CPT,Facility,Both,,,,76,64.6,21.7816,76,"Multiplan, Inc.","Multiplan, Inc.",71.44,94,,percent of total billed charges,,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S);ÿGroup; 30 Minutes,,99411,CPT,Facility,Outpatient,,,,76,64.6,21.7816,76,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,68.476,90.1,,percent of total billed charges,,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S);ÿGroup; 30 Minutes,,99411,CPT,Facility,Inpatient,,,,76,64.6,21.7816,76,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S);ÿGroup; 30 Minutes,,99411,CPT,Facility,Both,,,,76,64.6,21.7816,76,"Preferred One Administrative Services, INC.",PPO,74.936,98.6,,percent of total billed charges,,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S);ÿGroup; 30 Minutes,,99411,CPT,Facility,Outpatient,,,,76,64.6,21.7816,76,PrimeWest Health,Minnesota Senior Health Options (MSHO),39.102,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S);ÿGroup; 30 Minutes,,99411,CPT,Facility,Inpatient,,,,76,64.6,21.7816,76,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S);ÿGroup; 30 Minutes,,99411,CPT,Facility,Outpatient,,,,76,64.6,21.7816,76,PrimeWest Health,MinnesotaCare,39.0336,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S);ÿGroup; 30 Minutes,,99411,CPT,Facility,Inpatient,,,,76,64.6,21.7816,76,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S);ÿGroup; 30 Minutes,,99411,CPT,Facility,Both,,,,76,64.6,21.7816,76,Sanford Health Plan,Sanford Health Plan,69.92,92,,percent of total billed charges,,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S);ÿGroup; 30 Minutes,,99411,CPT,Facility,Outpatient,,,,76,64.6,21.7816,76,"UCare Health, Inc.",Individual & Family Plan,42.826,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S);ÿGroup; 30 Minutes,,99411,CPT,Facility,Inpatient,,,,76,64.6,21.7816,76,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S);ÿGroup; 30 Minutes,,99411,CPT,Facility,Outpatient,,,,76,64.6,21.7816,76,"UCare Health, Inc.",Medical Assistance,38.3572,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S);ÿGroup; 30 Minutes,,99411,CPT,Facility,Inpatient,,,,76,64.6,21.7816,76,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S);ÿGroup; 30 Minutes,,99411,CPT,Facility,Outpatient,,,,76,64.6,21.7816,76,"UCare Health, Inc.",Medicare Advantage,38.3572,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S);ÿGroup; 30 Minutes,,99411,CPT,Facility,Inpatient,,,,76,64.6,21.7816,76,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S);ÿGroup; 30 Minutes,,99411,CPT,Facility,Outpatient,,,,76,64.6,21.7816,76,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),38.3572,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S);ÿGroup; 30 Minutes,,99411,CPT,Facility,Inpatient,,,,76,64.6,21.7816,76,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S);ÿGroup; 30 Minutes,,99411,CPT,Facility,Both,,,,76,64.6,21.7816,76,UnitedHealthcare,Individual & Family,71.44,94,,percent of total billed charges,,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S);ÿGroup; 30 Minutes,,99411,CPT,Facility,Outpatient,,,,76,64.6,21.7816,76,UnitedHealthcare,Medicare Advantage,37.24,49,,percent of total billed charges,,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S);ÿGroup; 30 Minutes,,99411,CPT,Facility,Inpatient,,,,76,64.6,21.7816,76,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S);ÿGroup; 30 Minutes,,99411,CPT,Facility,Outpatient,,,,76,64.6,21.7816,76,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,36.48,48,,percent of total billed charges,,100% of DHS outpatient percentage
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S);ÿGroup; 30 Minutes,,99411,CPT,Facility,Inpatient,,,,76,64.6,21.7816,76,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S);ÿGroup; 60 Minutes,,99412,CPT,Facility,Both,,,,100,85,28.66,100,Aetna,Commercial,92,92,,percent of total billed charges,,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S);ÿGroup; 60 Minutes,,99412,CPT,Facility,Outpatient,,,,100,85,28.66,100,Aetna,Medicare Advantage,49,49,,percent of total billed charges,,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S);ÿGroup; 60 Minutes,,99412,CPT,Facility,Inpatient,,,,100,85,28.66,100,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S);ÿGroup; 60 Minutes,,99412,CPT,Facility,Both,,,,100,85,28.66,100,Aetna,PPO,93,93,,percent of total billed charges,,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S);ÿGroup; 60 Minutes,,99412,CPT,Facility,Both,,,,100,85,28.66,100,America's PPO,America's PPO,96.03,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S);ÿGroup; 60 Minutes,,99412,CPT,Facility,Both,,,,100,85,28.66,100,BlueCross BlueShield Minnesota, Federal Employee Program,98.4,98.4,,percent of total billed charges,,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S);ÿGroup; 60 Minutes,,99412,CPT,Facility,Both,,,,100,85,28.66,100,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,100,100,,percent of total billed charges,,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S);ÿGroup; 60 Minutes,,99412,CPT,Facility,Both,,,,100,85,28.66,100,BlueCross BlueShield Minnesota,High Value Network Plan,90,90,,percent of total billed charges,,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S);ÿGroup; 60 Minutes,,99412,CPT,Facility,Outpatient,,,,100,85,28.66,100,BlueCross BlueShield Minnesota,Medicare Advantage,49,49,,percent of total billed charges,,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S);ÿGroup; 60 Minutes,,99412,CPT,Facility,Inpatient,,,,100,85,28.66,100,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S);ÿGroup; 60 Minutes,,99412,CPT,Facility,Both,,,,100,85,28.66,100,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,88.57,88.57,,percent of total billed charges,,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S);ÿGroup; 60 Minutes,,99412,CPT,Facility,Both,,,,100,85,28.66,100,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,28.66,28.66,,percent of total billed charges,,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S);ÿGroup; 60 Minutes,,99412,CPT,Facility,Outpatient,,,,100,85,28.66,100,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),49,49,,percent of total billed charges,,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S);ÿGroup; 60 Minutes,,99412,CPT,Facility,Inpatient,,,,100,85,28.66,100,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S);ÿGroup; 60 Minutes,,99412,CPT,Facility,Both,,,,100,85,28.66,100,CorVel,Worker's Compensation,100,100,,percent of total billed charges,,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S);ÿGroup; 60 Minutes,,99412,CPT,Facility,Both,,,,100,85,28.66,100,First Health Group Corporation,First Health Network,97,97,,percent of total billed charges,,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S);ÿGroup; 60 Minutes,,99412,CPT,Facility,Both,,,,100,85,28.66,100,"Health Partners, Inc.",Commercial,94.6,94.6,,percent of total billed charges,,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S);ÿGroup; 60 Minutes,,99412,CPT,Facility,Outpatient,,,,100,85,28.66,100,"Health Partners, Inc.",Medicare Advantage,49,49,,percent of total billed charges,,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S);ÿGroup; 60 Minutes,,99412,CPT,Facility,Inpatient,,,,100,85,28.66,100,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S);ÿGroup; 60 Minutes,,99412,CPT,Facility,Both,,,,100,85,28.66,100,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),60,60,,percent of total billed charges,,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S);ÿGroup; 60 Minutes,,99412,CPT,Facility,Both,,,,100,85,28.66,100,"Health Partners, Inc.",State of Minnesota Advantage Program,81.5,81.5,,percent of total billed charges,,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S);ÿGroup; 60 Minutes,,99412,CPT,Facility,Both,,,,100,85,28.66,100,"Health Partners, Inc.",State Public Programs,50,50,,percent of total billed charges,,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S);ÿGroup; 60 Minutes,,99412,CPT,Facility,Both,,,,100,85,28.66,100,Humana Insurance Company,Commercial PPO,95,95,,percent of total billed charges,,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S);ÿGroup; 60 Minutes,,99412,CPT,Facility,Outpatient,,,,100,85,28.66,100,Humana Insurance Company,Medicare PPO,49,49,,percent of total billed charges,,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S);ÿGroup; 60 Minutes,,99412,CPT,Facility,Inpatient,,,,100,85,28.66,100,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S);ÿGroup; 60 Minutes,,99412,CPT,Facility,Both,,,,100,85,28.66,100,Medica,Individual & Family,99.1,99.1,,percent of total billed charges,,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S);ÿGroup; 60 Minutes,,99412,CPT,Facility,Outpatient,,,,100,85,28.66,100,Medica,Medica Advantage Solution,49.8,49.8,,percent of total billed charges,,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S);ÿGroup; 60 Minutes,,99412,CPT,Facility,Inpatient,,,,100,85,28.66,100,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S);ÿGroup; 60 Minutes,,99412,CPT,Facility,Outpatient,,,,100,85,28.66,100,Medica,Medical Assistance,44.6,44.6,,percent of total billed charges,,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S);ÿGroup; 60 Minutes,,99412,CPT,Facility,Inpatient,,,,100,85,28.66,100,Medica,Medical Assistance,,,,,Included in per diem rate,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S);ÿGroup; 60 Minutes,,99412,CPT,Facility,Outpatient,,,,100,85,28.66,100,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,49.8,49.8,,percent of total billed charges,,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S);ÿGroup; 60 Minutes,,99412,CPT,Facility,Inpatient,,,,100,85,28.66,100,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S);ÿGroup; 60 Minutes,,99412,CPT,Facility,Both,,,,100,85,28.66,100,"Multiplan, Inc.","Multiplan, Inc.",94,94,,percent of total billed charges,,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S);ÿGroup; 60 Minutes,,99412,CPT,Facility,Outpatient,,,,100,85,28.66,100,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,90.1,90.1,,percent of total billed charges,,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S);ÿGroup; 60 Minutes,,99412,CPT,Facility,Inpatient,,,,100,85,28.66,100,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S);ÿGroup; 60 Minutes,,99412,CPT,Facility,Both,,,,100,85,28.66,100,"Preferred One Administrative Services, INC.",PPO,98.6,98.6,,percent of total billed charges,,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S);ÿGroup; 60 Minutes,,99412,CPT,Facility,Outpatient,,,,100,85,28.66,100,PrimeWest Health,Minnesota Senior Health Options (MSHO),51.45,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S);ÿGroup; 60 Minutes,,99412,CPT,Facility,Inpatient,,,,100,85,28.66,100,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S);ÿGroup; 60 Minutes,,99412,CPT,Facility,Outpatient,,,,100,85,28.66,100,PrimeWest Health,MinnesotaCare,51.36,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S);ÿGroup; 60 Minutes,,99412,CPT,Facility,Inpatient,,,,100,85,28.66,100,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S);ÿGroup; 60 Minutes,,99412,CPT,Facility,Both,,,,100,85,28.66,100,Sanford Health Plan,Sanford Health Plan,92,92,,percent of total billed charges,,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S);ÿGroup; 60 Minutes,,99412,CPT,Facility,Outpatient,,,,100,85,28.66,100,"UCare Health, Inc.",Individual & Family Plan,56.35,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S);ÿGroup; 60 Minutes,,99412,CPT,Facility,Inpatient,,,,100,85,28.66,100,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S);ÿGroup; 60 Minutes,,99412,CPT,Facility,Outpatient,,,,100,85,28.66,100,"UCare Health, Inc.",Medical Assistance,50.47,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S);ÿGroup; 60 Minutes,,99412,CPT,Facility,Inpatient,,,,100,85,28.66,100,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S);ÿGroup; 60 Minutes,,99412,CPT,Facility,Outpatient,,,,100,85,28.66,100,"UCare Health, Inc.",Medicare Advantage,50.47,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S);ÿGroup; 60 Minutes,,99412,CPT,Facility,Inpatient,,,,100,85,28.66,100,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S);ÿGroup; 60 Minutes,,99412,CPT,Facility,Outpatient,,,,100,85,28.66,100,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),50.47,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S);ÿGroup; 60 Minutes,,99412,CPT,Facility,Inpatient,,,,100,85,28.66,100,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S);ÿGroup; 60 Minutes,,99412,CPT,Facility,Both,,,,100,85,28.66,100,UnitedHealthcare,Individual & Family,94,94,,percent of total billed charges,,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S);ÿGroup; 60 Minutes,,99412,CPT,Facility,Outpatient,,,,100,85,28.66,100,UnitedHealthcare,Medicare Advantage,49,49,,percent of total billed charges,,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S);ÿGroup; 60 Minutes,,99412,CPT,Facility,Inpatient,,,,100,85,28.66,100,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S);ÿGroup; 60 Minutes,,99412,CPT,Facility,Outpatient,,,,100,85,28.66,100,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,48,48,,percent of total billed charges,,100% of DHS outpatient percentage
Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S);ÿGroup; 60 Minutes,,99412,CPT,Facility,Inpatient,,,,100,85,28.66,100,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Prolonged Ip/Obs E/M Time W/Wo Direct Pt Contact Beyond Required Time Of Primary Service,Each 15 Min (Pro Cah)",,99418,CPT,Professional,Both,,,,376,319.6,26.76,376,Aetna,Commercial,319.6,85,,percent of total billed charges,,
"Prolonged Ip/Obs E/M Time W/Wo Direct Pt Contact Beyond Required Time Of Primary Service,Each 15 Min (Pro Cah)",,99418,CPT,Professional,Both,,,,376,319.6,26.76,376,Aetna,Medicare Advantage,,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Prolonged Ip/Obs E/M Time W/Wo Direct Pt Contact Beyond Required Time Of Primary Service,Each 15 Min (Pro Cah)",,99418,CPT,Professional,Both,,,,376,319.6,26.76,376,Aetna,PPO,349.68,93,,percent of total billed charges,,
"Prolonged Ip/Obs E/M Time W/Wo Direct Pt Contact Beyond Required Time Of Primary Service,Each 15 Min (Pro Cah)",,99418,CPT,Professional,Both,,,,376,319.6,26.76,376,America's PPO,America's PPO,321.2544,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Prolonged Ip/Obs E/M Time W/Wo Direct Pt Contact Beyond Required Time Of Primary Service,Each 15 Min (Pro Cah)",,99418,CPT,Professional,Both,,,,376,319.6,26.76,376,BlueCross BlueShield Minnesota, Federal Employee Program,69.41,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Prolonged Ip/Obs E/M Time W/Wo Direct Pt Contact Beyond Required Time Of Primary Service,Each 15 Min (Pro Cah)",,99418,CPT,Professional,Both,,,,376,319.6,26.76,376,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,70.52056,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Prolonged Ip/Obs E/M Time W/Wo Direct Pt Contact Beyond Required Time Of Primary Service,Each 15 Min (Pro Cah)",,99418,CPT,Professional,Both,,,,376,319.6,26.76,376,BlueCross BlueShield Minnesota,High Value Network Plan,70.52056,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Prolonged Ip/Obs E/M Time W/Wo Direct Pt Contact Beyond Required Time Of Primary Service,Each 15 Min (Pro Cah)",,99418,CPT,Professional,Both,,,,376,319.6,26.76,376,BlueCross BlueShield Minnesota,Medicare Advantage,,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Prolonged Ip/Obs E/M Time W/Wo Direct Pt Contact Beyond Required Time Of Primary Service,Each 15 Min (Pro Cah)",,99418,CPT,Professional,Both,,,,376,319.6,26.76,376,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,70.52056,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Prolonged Ip/Obs E/M Time W/Wo Direct Pt Contact Beyond Required Time Of Primary Service,Each 15 Min (Pro Cah)",,99418,CPT,Professional,Both,,,,376,319.6,26.76,376,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,28.46832,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Prolonged Ip/Obs E/M Time W/Wo Direct Pt Contact Beyond Required Time Of Primary Service,Each 15 Min (Pro Cah)",,99418,CPT,Professional,Both,,,,376,319.6,26.76,376,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Prolonged Ip/Obs E/M Time W/Wo Direct Pt Contact Beyond Required Time Of Primary Service,Each 15 Min (Pro Cah)",,99418,CPT,Professional,Both,,,,376,319.6,26.76,376,CorVel,Worker's Compensation,,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Prolonged Ip/Obs E/M Time W/Wo Direct Pt Contact Beyond Required Time Of Primary Service,Each 15 Min (Pro Cah)",,99418,CPT,Professional,Both,,,,376,319.6,26.76,376,First Health Group Corporation,First Health Network,364.72,97,,percent of total billed charges,,
"Prolonged Ip/Obs E/M Time W/Wo Direct Pt Contact Beyond Required Time Of Primary Service,Each 15 Min (Pro Cah)",,99418,CPT,Professional,Both,,,,376,319.6,26.76,376,"Health Partners, Inc.",Commercial,82.71,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Prolonged Ip/Obs E/M Time W/Wo Direct Pt Contact Beyond Required Time Of Primary Service,Each 15 Min (Pro Cah)",,99418,CPT,Professional,Both,,,,376,319.6,26.76,376,"Health Partners, Inc.",Medicare Advantage,,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Prolonged Ip/Obs E/M Time W/Wo Direct Pt Contact Beyond Required Time Of Primary Service,Each 15 Min (Pro Cah)",,99418,CPT,Professional,Both,,,,376,319.6,26.76,376,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),38.63,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Prolonged Ip/Obs E/M Time W/Wo Direct Pt Contact Beyond Required Time Of Primary Service,Each 15 Min (Pro Cah)",,99418,CPT,Professional,Both,,,,376,319.6,26.76,376,"Health Partners, Inc.",State of Minnesota Advantage Program,71.254665,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Prolonged Ip/Obs E/M Time W/Wo Direct Pt Contact Beyond Required Time Of Primary Service,Each 15 Min (Pro Cah)",,99418,CPT,Professional,Both,,,,376,319.6,26.76,376,"Health Partners, Inc.",State Public Programs,26.76,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Prolonged Ip/Obs E/M Time W/Wo Direct Pt Contact Beyond Required Time Of Primary Service,Each 15 Min (Pro Cah)",,99418,CPT,Professional,Both,,,,376,319.6,26.76,376,Humana Insurance Company,Commercial PPO,38.6,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Prolonged Ip/Obs E/M Time W/Wo Direct Pt Contact Beyond Required Time Of Primary Service,Each 15 Min (Pro Cah)",,99418,CPT,Professional,Both,,,,376,319.6,26.76,376,Humana Insurance Company,Medicare PPO,,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Prolonged Ip/Obs E/M Time W/Wo Direct Pt Contact Beyond Required Time Of Primary Service,Each 15 Min (Pro Cah)",,99418,CPT,Professional,Both,,,,376,319.6,26.76,376,Medica,Individual & Family,318.848,84.8,,percent of total billed charges,,
"Prolonged Ip/Obs E/M Time W/Wo Direct Pt Contact Beyond Required Time Of Primary Service,Each 15 Min (Pro Cah)",,99418,CPT,Professional,Both,,,,376,319.6,26.76,376,Medica,Medica Advantage Solution,187.248,49.8,,percent of total billed charges,,
"Prolonged Ip/Obs E/M Time W/Wo Direct Pt Contact Beyond Required Time Of Primary Service,Each 15 Min (Pro Cah)",,99418,CPT,Professional,Both,,,,376,319.6,26.76,376,Medica,Medical Assistance,28.47,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Prolonged Ip/Obs E/M Time W/Wo Direct Pt Contact Beyond Required Time Of Primary Service,Each 15 Min (Pro Cah)",,99418,CPT,Professional,Both,,,,376,319.6,26.76,376,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,38.6,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Prolonged Ip/Obs E/M Time W/Wo Direct Pt Contact Beyond Required Time Of Primary Service,Each 15 Min (Pro Cah)",,99418,CPT,Professional,Both,,,,376,319.6,26.76,376,"Multiplan, Inc.","Multiplan, Inc.",353.44,94,,percent of total billed charges,,
"Prolonged Ip/Obs E/M Time W/Wo Direct Pt Contact Beyond Required Time Of Primary Service,Each 15 Min (Pro Cah)",,99418,CPT,Professional,Both,,,,376,319.6,26.76,376,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,338.776,90.1,,percent of total billed charges,,
"Prolonged Ip/Obs E/M Time W/Wo Direct Pt Contact Beyond Required Time Of Primary Service,Each 15 Min (Pro Cah)",,99418,CPT,Professional,Both,,,,376,319.6,26.76,376,"Preferred One Administrative Services, INC.",PPO,370.736,98.6,,percent of total billed charges,,
"Prolonged Ip/Obs E/M Time W/Wo Direct Pt Contact Beyond Required Time Of Primary Service,Each 15 Min (Pro Cah)",,99418,CPT,Professional,Both,,,,376,319.6,26.76,376,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Prolonged Ip/Obs E/M Time W/Wo Direct Pt Contact Beyond Required Time Of Primary Service,Each 15 Min (Pro Cah)",,99418,CPT,Professional,Both,,,,376,319.6,26.76,376,PrimeWest Health,MinnesotaCare,30.4611024,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Prolonged Ip/Obs E/M Time W/Wo Direct Pt Contact Beyond Required Time Of Primary Service,Each 15 Min (Pro Cah)",,99418,CPT,Professional,Both,,,,376,319.6,26.76,376,Sanford Health Plan,Sanford Health Plan,330.88,88,,percent of total billed charges,,
"Prolonged Ip/Obs E/M Time W/Wo Direct Pt Contact Beyond Required Time Of Primary Service,Each 15 Min (Pro Cah)",,99418,CPT,Professional,Both,,,,376,319.6,26.76,376,"UCare Health, Inc.",Individual & Family Plan,,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Prolonged Ip/Obs E/M Time W/Wo Direct Pt Contact Beyond Required Time Of Primary Service,Each 15 Min (Pro Cah)",,99418,CPT,Professional,Both,,,,376,319.6,26.76,376,"UCare Health, Inc.",Medical Assistance,31.315152,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Prolonged Ip/Obs E/M Time W/Wo Direct Pt Contact Beyond Required Time Of Primary Service,Each 15 Min (Pro Cah)",,99418,CPT,Professional,Both,,,,376,319.6,26.76,376,"UCare Health, Inc.",Medicare Advantage,,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Prolonged Ip/Obs E/M Time W/Wo Direct Pt Contact Beyond Required Time Of Primary Service,Each 15 Min (Pro Cah)",,99418,CPT,Professional,Both,,,,376,319.6,26.76,376,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Prolonged Ip/Obs E/M Time W/Wo Direct Pt Contact Beyond Required Time Of Primary Service,Each 15 Min (Pro Cah)",,99418,CPT,Professional,Both,,,,376,319.6,26.76,376,UnitedHealthcare,Individual & Family,376,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Prolonged Ip/Obs E/M Time W/Wo Direct Pt Contact Beyond Required Time Of Primary Service,Each 15 Min (Pro Cah)",,99418,CPT,Professional,Both,,,,376,319.6,26.76,376,UnitedHealthcare,Medicare Advantage,,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Prolonged Ip/Obs E/M Time W/Wo Direct Pt Contact Beyond Required Time Of Primary Service,Each 15 Min (Pro Cah)",,99418,CPT,Professional,Both,,,,376,319.6,26.76,376,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,28.46832,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
TROPICAMIDE 0.5 % OPHT DROP,,675,LOCAL,Facility,Both,15,mL,,49,41.65,14.0434,49,Aetna,Commercial,45.08,92,,percent of total billed charges,,
TROPICAMIDE 0.5 % OPHT DROP,,675,LOCAL,Facility,Outpatient,15,mL,,49,41.65,14.0434,49,Aetna,Medicare Advantage,24.01,49,,percent of total billed charges,,
TROPICAMIDE 0.5 % OPHT DROP,,675,LOCAL,Facility,Inpatient,15,mL,,49,41.65,14.0434,49,Aetna,Medicare Advantage,,,,,Included in per diem rate,
TROPICAMIDE 0.5 % OPHT DROP,,675,LOCAL,Facility,Both,15,mL,,49,41.65,14.0434,49,Aetna,PPO,45.57,93,,percent of total billed charges,,
TROPICAMIDE 0.5 % OPHT DROP,,675,LOCAL,Facility,Both,15,mL,,49,41.65,14.0434,49,America's PPO,America's PPO,47.0547,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
TROPICAMIDE 0.5 % OPHT DROP,,675,LOCAL,Facility,Both,15,mL,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota, Federal Employee Program,48.216,98.4,,percent of total billed charges,,
TROPICAMIDE 0.5 % OPHT DROP,,675,LOCAL,Facility,Both,15,mL,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,49,100,,percent of total billed charges,,
TROPICAMIDE 0.5 % OPHT DROP,,675,LOCAL,Facility,Both,15,mL,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,High Value Network Plan,44.1,90,,percent of total billed charges,,
TROPICAMIDE 0.5 % OPHT DROP,,675,LOCAL,Facility,Outpatient,15,mL,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Medicare Advantage,24.01,49,,percent of total billed charges,,
TROPICAMIDE 0.5 % OPHT DROP,,675,LOCAL,Facility,Inpatient,15,mL,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
TROPICAMIDE 0.5 % OPHT DROP,,675,LOCAL,Facility,Both,15,mL,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,43.3993,88.57,,percent of total billed charges,,
TROPICAMIDE 0.5 % OPHT DROP,,675,LOCAL,Facility,Both,15,mL,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,14.0434,28.66,,percent of total billed charges,,
TROPICAMIDE 0.5 % OPHT DROP,,675,LOCAL,Facility,Outpatient,15,mL,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),24.01,49,,percent of total billed charges,,
TROPICAMIDE 0.5 % OPHT DROP,,675,LOCAL,Facility,Inpatient,15,mL,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
TROPICAMIDE 0.5 % OPHT DROP,,675,LOCAL,Facility,Both,15,mL,,49,41.65,14.0434,49,CorVel,Worker's Compensation,49,100,,percent of total billed charges,,
TROPICAMIDE 0.5 % OPHT DROP,,675,LOCAL,Facility,Both,15,mL,,49,41.65,14.0434,49,First Health Group Corporation,First Health Network,47.53,97,,percent of total billed charges,,
TROPICAMIDE 0.5 % OPHT DROP,,675,LOCAL,Facility,Both,15,mL,,49,41.65,14.0434,49,"Health Partners, Inc.",Commercial,46.354,94.6,,percent of total billed charges,,
TROPICAMIDE 0.5 % OPHT DROP,,675,LOCAL,Facility,Outpatient,15,mL,,49,41.65,14.0434,49,"Health Partners, Inc.",Medicare Advantage,24.01,49,,percent of total billed charges,,
TROPICAMIDE 0.5 % OPHT DROP,,675,LOCAL,Facility,Inpatient,15,mL,,49,41.65,14.0434,49,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
TROPICAMIDE 0.5 % OPHT DROP,,675,LOCAL,Facility,Both,15,mL,,49,41.65,14.0434,49,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),29.4,60,,percent of total billed charges,,
TROPICAMIDE 0.5 % OPHT DROP,,675,LOCAL,Facility,Both,15,mL,,49,41.65,14.0434,49,"Health Partners, Inc.",State of Minnesota Advantage Program,39.935,81.5,,percent of total billed charges,,
TROPICAMIDE 0.5 % OPHT DROP,,675,LOCAL,Facility,Both,15,mL,,49,41.65,14.0434,49,"Health Partners, Inc.",State Public Programs,24.5,50,,percent of total billed charges,,
TROPICAMIDE 0.5 % OPHT DROP,,675,LOCAL,Facility,Both,15,mL,,49,41.65,14.0434,49,Humana Insurance Company,Commercial PPO,46.55,95,,percent of total billed charges,,
TROPICAMIDE 0.5 % OPHT DROP,,675,LOCAL,Facility,Outpatient,15,mL,,49,41.65,14.0434,49,Humana Insurance Company,Medicare PPO,24.01,49,,percent of total billed charges,,
TROPICAMIDE 0.5 % OPHT DROP,,675,LOCAL,Facility,Inpatient,15,mL,,49,41.65,14.0434,49,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
TROPICAMIDE 0.5 % OPHT DROP,,675,LOCAL,Facility,Both,15,mL,,49,41.65,14.0434,49,Medica,Individual & Family,48.559,99.1,,percent of total billed charges,,
TROPICAMIDE 0.5 % OPHT DROP,,675,LOCAL,Facility,Outpatient,15,mL,,49,41.65,14.0434,49,Medica,Medica Advantage Solution,24.402,49.8,,percent of total billed charges,,
TROPICAMIDE 0.5 % OPHT DROP,,675,LOCAL,Facility,Inpatient,15,mL,,49,41.65,14.0434,49,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
TROPICAMIDE 0.5 % OPHT DROP,,675,LOCAL,Facility,Outpatient,15,mL,,49,41.65,14.0434,49,Medica,Medical Assistance,21.854,44.6,,percent of total billed charges,,
TROPICAMIDE 0.5 % OPHT DROP,,675,LOCAL,Facility,Inpatient,15,mL,,49,41.65,14.0434,49,Medica,Medical Assistance,,,,,Included in per diem rate,
TROPICAMIDE 0.5 % OPHT DROP,,675,LOCAL,Facility,Outpatient,15,mL,,49,41.65,14.0434,49,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,24.402,49.8,,percent of total billed charges,,
TROPICAMIDE 0.5 % OPHT DROP,,675,LOCAL,Facility,Inpatient,15,mL,,49,41.65,14.0434,49,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
TROPICAMIDE 0.5 % OPHT DROP,,675,LOCAL,Facility,Both,15,mL,,49,41.65,14.0434,49,"Multiplan, Inc.","Multiplan, Inc.",46.06,94,,percent of total billed charges,,
TROPICAMIDE 0.5 % OPHT DROP,,675,LOCAL,Facility,Outpatient,15,mL,,49,41.65,14.0434,49,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,44.149,90.1,,percent of total billed charges,,
TROPICAMIDE 0.5 % OPHT DROP,,675,LOCAL,Facility,Inpatient,15,mL,,49,41.65,14.0434,49,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
TROPICAMIDE 0.5 % OPHT DROP,,675,LOCAL,Facility,Both,15,mL,,49,41.65,14.0434,49,"Preferred One Administrative Services, INC.",PPO,48.314,98.6,,percent of total billed charges,,
TROPICAMIDE 0.5 % OPHT DROP,,675,LOCAL,Facility,Outpatient,15,mL,,49,41.65,14.0434,49,PrimeWest Health,Minnesota Senior Health Options (MSHO),25.2105,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
TROPICAMIDE 0.5 % OPHT DROP,,675,LOCAL,Facility,Inpatient,15,mL,,49,41.65,14.0434,49,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
TROPICAMIDE 0.5 % OPHT DROP,,675,LOCAL,Facility,Outpatient,15,mL,,49,41.65,14.0434,49,PrimeWest Health,MinnesotaCare,25.1664,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
TROPICAMIDE 0.5 % OPHT DROP,,675,LOCAL,Facility,Inpatient,15,mL,,49,41.65,14.0434,49,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
TROPICAMIDE 0.5 % OPHT DROP,,675,LOCAL,Facility,Both,15,mL,,49,41.65,14.0434,49,Sanford Health Plan,Sanford Health Plan,45.08,92,,percent of total billed charges,,
TROPICAMIDE 0.5 % OPHT DROP,,675,LOCAL,Facility,Outpatient,15,mL,,49,41.65,14.0434,49,"UCare Health, Inc.",Individual & Family Plan,27.6115,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
TROPICAMIDE 0.5 % OPHT DROP,,675,LOCAL,Facility,Inpatient,15,mL,,49,41.65,14.0434,49,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
TROPICAMIDE 0.5 % OPHT DROP,,675,LOCAL,Facility,Outpatient,15,mL,,49,41.65,14.0434,49,"UCare Health, Inc.",Medical Assistance,24.7303,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TROPICAMIDE 0.5 % OPHT DROP,,675,LOCAL,Facility,Inpatient,15,mL,,49,41.65,14.0434,49,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
TROPICAMIDE 0.5 % OPHT DROP,,675,LOCAL,Facility,Outpatient,15,mL,,49,41.65,14.0434,49,"UCare Health, Inc.",Medicare Advantage,24.7303,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TROPICAMIDE 0.5 % OPHT DROP,,675,LOCAL,Facility,Inpatient,15,mL,,49,41.65,14.0434,49,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
TROPICAMIDE 0.5 % OPHT DROP,,675,LOCAL,Facility,Outpatient,15,mL,,49,41.65,14.0434,49,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),24.7303,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TROPICAMIDE 0.5 % OPHT DROP,,675,LOCAL,Facility,Inpatient,15,mL,,49,41.65,14.0434,49,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
TROPICAMIDE 0.5 % OPHT DROP,,675,LOCAL,Facility,Both,15,mL,,49,41.65,14.0434,49,UnitedHealthcare,Individual & Family,46.06,94,,percent of total billed charges,,
TROPICAMIDE 0.5 % OPHT DROP,,675,LOCAL,Facility,Outpatient,15,mL,,49,41.65,14.0434,49,UnitedHealthcare,Medicare Advantage,24.01,49,,percent of total billed charges,,
TROPICAMIDE 0.5 % OPHT DROP,,675,LOCAL,Facility,Inpatient,15,mL,,49,41.65,14.0434,49,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
TROPICAMIDE 0.5 % OPHT DROP,,675,LOCAL,Facility,Outpatient,15,mL,,49,41.65,14.0434,49,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,23.52,48,,percent of total billed charges,,100% of DHS outpatient percentage
TROPICAMIDE 0.5 % OPHT DROP,,675,LOCAL,Facility,Inpatient,15,mL,,49,41.65,14.0434,49,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
TERBINAFINE HCL 1 % TOP CREAM,,792,LOCAL,Facility,Both,15,g,,41,34.85,11.7506,41,Aetna,Commercial,37.72,92,,percent of total billed charges,,
TERBINAFINE HCL 1 % TOP CREAM,,792,LOCAL,Facility,Outpatient,15,g,,41,34.85,11.7506,41,Aetna,Medicare Advantage,20.09,49,,percent of total billed charges,,
TERBINAFINE HCL 1 % TOP CREAM,,792,LOCAL,Facility,Inpatient,15,g,,41,34.85,11.7506,41,Aetna,Medicare Advantage,,,,,Included in per diem rate,
TERBINAFINE HCL 1 % TOP CREAM,,792,LOCAL,Facility,Both,15,g,,41,34.85,11.7506,41,Aetna,PPO,38.13,93,,percent of total billed charges,,
TERBINAFINE HCL 1 % TOP CREAM,,792,LOCAL,Facility,Both,15,g,,41,34.85,11.7506,41,America's PPO,America's PPO,39.3723,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
TERBINAFINE HCL 1 % TOP CREAM,,792,LOCAL,Facility,Both,15,g,,41,34.85,11.7506,41,BlueCross BlueShield Minnesota, Federal Employee Program,40.344,98.4,,percent of total billed charges,,
TERBINAFINE HCL 1 % TOP CREAM,,792,LOCAL,Facility,Both,15,g,,41,34.85,11.7506,41,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,41,100,,percent of total billed charges,,
TERBINAFINE HCL 1 % TOP CREAM,,792,LOCAL,Facility,Both,15,g,,41,34.85,11.7506,41,BlueCross BlueShield Minnesota,High Value Network Plan,36.9,90,,percent of total billed charges,,
TERBINAFINE HCL 1 % TOP CREAM,,792,LOCAL,Facility,Outpatient,15,g,,41,34.85,11.7506,41,BlueCross BlueShield Minnesota,Medicare Advantage,20.09,49,,percent of total billed charges,,
TERBINAFINE HCL 1 % TOP CREAM,,792,LOCAL,Facility,Inpatient,15,g,,41,34.85,11.7506,41,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
TERBINAFINE HCL 1 % TOP CREAM,,792,LOCAL,Facility,Both,15,g,,41,34.85,11.7506,41,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,36.3137,88.57,,percent of total billed charges,,
TERBINAFINE HCL 1 % TOP CREAM,,792,LOCAL,Facility,Both,15,g,,41,34.85,11.7506,41,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,11.7506,28.66,,percent of total billed charges,,
TERBINAFINE HCL 1 % TOP CREAM,,792,LOCAL,Facility,Outpatient,15,g,,41,34.85,11.7506,41,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),20.09,49,,percent of total billed charges,,
TERBINAFINE HCL 1 % TOP CREAM,,792,LOCAL,Facility,Inpatient,15,g,,41,34.85,11.7506,41,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
TERBINAFINE HCL 1 % TOP CREAM,,792,LOCAL,Facility,Both,15,g,,41,34.85,11.7506,41,CorVel,Worker's Compensation,41,100,,percent of total billed charges,,
TERBINAFINE HCL 1 % TOP CREAM,,792,LOCAL,Facility,Both,15,g,,41,34.85,11.7506,41,First Health Group Corporation,First Health Network,39.77,97,,percent of total billed charges,,
TERBINAFINE HCL 1 % TOP CREAM,,792,LOCAL,Facility,Both,15,g,,41,34.85,11.7506,41,"Health Partners, Inc.",Commercial,38.786,94.6,,percent of total billed charges,,
TERBINAFINE HCL 1 % TOP CREAM,,792,LOCAL,Facility,Outpatient,15,g,,41,34.85,11.7506,41,"Health Partners, Inc.",Medicare Advantage,20.09,49,,percent of total billed charges,,
TERBINAFINE HCL 1 % TOP CREAM,,792,LOCAL,Facility,Inpatient,15,g,,41,34.85,11.7506,41,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
TERBINAFINE HCL 1 % TOP CREAM,,792,LOCAL,Facility,Both,15,g,,41,34.85,11.7506,41,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),24.6,60,,percent of total billed charges,,
TERBINAFINE HCL 1 % TOP CREAM,,792,LOCAL,Facility,Both,15,g,,41,34.85,11.7506,41,"Health Partners, Inc.",State of Minnesota Advantage Program,33.415,81.5,,percent of total billed charges,,
TERBINAFINE HCL 1 % TOP CREAM,,792,LOCAL,Facility,Both,15,g,,41,34.85,11.7506,41,"Health Partners, Inc.",State Public Programs,20.5,50,,percent of total billed charges,,
TERBINAFINE HCL 1 % TOP CREAM,,792,LOCAL,Facility,Both,15,g,,41,34.85,11.7506,41,Humana Insurance Company,Commercial PPO,38.95,95,,percent of total billed charges,,
TERBINAFINE HCL 1 % TOP CREAM,,792,LOCAL,Facility,Outpatient,15,g,,41,34.85,11.7506,41,Humana Insurance Company,Medicare PPO,20.09,49,,percent of total billed charges,,
TERBINAFINE HCL 1 % TOP CREAM,,792,LOCAL,Facility,Inpatient,15,g,,41,34.85,11.7506,41,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
TERBINAFINE HCL 1 % TOP CREAM,,792,LOCAL,Facility,Both,15,g,,41,34.85,11.7506,41,Medica,Individual & Family,40.631,99.1,,percent of total billed charges,,
TERBINAFINE HCL 1 % TOP CREAM,,792,LOCAL,Facility,Outpatient,15,g,,41,34.85,11.7506,41,Medica,Medica Advantage Solution,20.418,49.8,,percent of total billed charges,,
TERBINAFINE HCL 1 % TOP CREAM,,792,LOCAL,Facility,Inpatient,15,g,,41,34.85,11.7506,41,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
TERBINAFINE HCL 1 % TOP CREAM,,792,LOCAL,Facility,Outpatient,15,g,,41,34.85,11.7506,41,Medica,Medical Assistance,18.286,44.6,,percent of total billed charges,,
TERBINAFINE HCL 1 % TOP CREAM,,792,LOCAL,Facility,Inpatient,15,g,,41,34.85,11.7506,41,Medica,Medical Assistance,,,,,Included in per diem rate,
TERBINAFINE HCL 1 % TOP CREAM,,792,LOCAL,Facility,Outpatient,15,g,,41,34.85,11.7506,41,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,20.418,49.8,,percent of total billed charges,,
TERBINAFINE HCL 1 % TOP CREAM,,792,LOCAL,Facility,Inpatient,15,g,,41,34.85,11.7506,41,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
TERBINAFINE HCL 1 % TOP CREAM,,792,LOCAL,Facility,Both,15,g,,41,34.85,11.7506,41,"Multiplan, Inc.","Multiplan, Inc.",38.54,94,,percent of total billed charges,,
TERBINAFINE HCL 1 % TOP CREAM,,792,LOCAL,Facility,Outpatient,15,g,,41,34.85,11.7506,41,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,36.941,90.1,,percent of total billed charges,,
TERBINAFINE HCL 1 % TOP CREAM,,792,LOCAL,Facility,Inpatient,15,g,,41,34.85,11.7506,41,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
TERBINAFINE HCL 1 % TOP CREAM,,792,LOCAL,Facility,Both,15,g,,41,34.85,11.7506,41,"Preferred One Administrative Services, INC.",PPO,40.426,98.6,,percent of total billed charges,,
TERBINAFINE HCL 1 % TOP CREAM,,792,LOCAL,Facility,Outpatient,15,g,,41,34.85,11.7506,41,PrimeWest Health,Minnesota Senior Health Options (MSHO),21.0945,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
TERBINAFINE HCL 1 % TOP CREAM,,792,LOCAL,Facility,Inpatient,15,g,,41,34.85,11.7506,41,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
TERBINAFINE HCL 1 % TOP CREAM,,792,LOCAL,Facility,Outpatient,15,g,,41,34.85,11.7506,41,PrimeWest Health,MinnesotaCare,21.0576,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
TERBINAFINE HCL 1 % TOP CREAM,,792,LOCAL,Facility,Inpatient,15,g,,41,34.85,11.7506,41,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
TERBINAFINE HCL 1 % TOP CREAM,,792,LOCAL,Facility,Both,15,g,,41,34.85,11.7506,41,Sanford Health Plan,Sanford Health Plan,37.72,92,,percent of total billed charges,,
TERBINAFINE HCL 1 % TOP CREAM,,792,LOCAL,Facility,Outpatient,15,g,,41,34.85,11.7506,41,"UCare Health, Inc.",Individual & Family Plan,23.1035,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
TERBINAFINE HCL 1 % TOP CREAM,,792,LOCAL,Facility,Inpatient,15,g,,41,34.85,11.7506,41,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
TERBINAFINE HCL 1 % TOP CREAM,,792,LOCAL,Facility,Outpatient,15,g,,41,34.85,11.7506,41,"UCare Health, Inc.",Medical Assistance,20.6927,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TERBINAFINE HCL 1 % TOP CREAM,,792,LOCAL,Facility,Inpatient,15,g,,41,34.85,11.7506,41,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
TERBINAFINE HCL 1 % TOP CREAM,,792,LOCAL,Facility,Outpatient,15,g,,41,34.85,11.7506,41,"UCare Health, Inc.",Medicare Advantage,20.6927,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TERBINAFINE HCL 1 % TOP CREAM,,792,LOCAL,Facility,Inpatient,15,g,,41,34.85,11.7506,41,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
TERBINAFINE HCL 1 % TOP CREAM,,792,LOCAL,Facility,Outpatient,15,g,,41,34.85,11.7506,41,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),20.6927,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TERBINAFINE HCL 1 % TOP CREAM,,792,LOCAL,Facility,Inpatient,15,g,,41,34.85,11.7506,41,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
TERBINAFINE HCL 1 % TOP CREAM,,792,LOCAL,Facility,Both,15,g,,41,34.85,11.7506,41,UnitedHealthcare,Individual & Family,38.54,94,,percent of total billed charges,,
TERBINAFINE HCL 1 % TOP CREAM,,792,LOCAL,Facility,Outpatient,15,g,,41,34.85,11.7506,41,UnitedHealthcare,Medicare Advantage,20.09,49,,percent of total billed charges,,
TERBINAFINE HCL 1 % TOP CREAM,,792,LOCAL,Facility,Inpatient,15,g,,41,34.85,11.7506,41,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
TERBINAFINE HCL 1 % TOP CREAM,,792,LOCAL,Facility,Outpatient,15,g,,41,34.85,11.7506,41,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,19.68,48,,percent of total billed charges,,100% of DHS outpatient percentage
TERBINAFINE HCL 1 % TOP CREAM,,792,LOCAL,Facility,Inpatient,15,g,,41,34.85,11.7506,41,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"NYSTATIN 100,000 UNIT/GRAM TOP OINT",,3449,LOCAL,Facility,Both,15,g,,85,72.25,24.361,85,Aetna,Commercial,78.2,92,,percent of total billed charges,,
"NYSTATIN 100,000 UNIT/GRAM TOP OINT",,3449,LOCAL,Facility,Outpatient,15,g,,85,72.25,24.361,85,Aetna,Medicare Advantage,41.65,49,,percent of total billed charges,,
"NYSTATIN 100,000 UNIT/GRAM TOP OINT",,3449,LOCAL,Facility,Inpatient,15,g,,85,72.25,24.361,85,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"NYSTATIN 100,000 UNIT/GRAM TOP OINT",,3449,LOCAL,Facility,Both,15,g,,85,72.25,24.361,85,Aetna,PPO,79.05,93,,percent of total billed charges,,
"NYSTATIN 100,000 UNIT/GRAM TOP OINT",,3449,LOCAL,Facility,Both,15,g,,85,72.25,24.361,85,America's PPO,America's PPO,81.6255,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"NYSTATIN 100,000 UNIT/GRAM TOP OINT",,3449,LOCAL,Facility,Both,15,g,,85,72.25,24.361,85,BlueCross BlueShield Minnesota, Federal Employee Program,83.64,98.4,,percent of total billed charges,,
"NYSTATIN 100,000 UNIT/GRAM TOP OINT",,3449,LOCAL,Facility,Both,15,g,,85,72.25,24.361,85,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,85,100,,percent of total billed charges,,
"NYSTATIN 100,000 UNIT/GRAM TOP OINT",,3449,LOCAL,Facility,Both,15,g,,85,72.25,24.361,85,BlueCross BlueShield Minnesota,High Value Network Plan,76.5,90,,percent of total billed charges,,
"NYSTATIN 100,000 UNIT/GRAM TOP OINT",,3449,LOCAL,Facility,Outpatient,15,g,,85,72.25,24.361,85,BlueCross BlueShield Minnesota,Medicare Advantage,41.65,49,,percent of total billed charges,,
"NYSTATIN 100,000 UNIT/GRAM TOP OINT",,3449,LOCAL,Facility,Inpatient,15,g,,85,72.25,24.361,85,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"NYSTATIN 100,000 UNIT/GRAM TOP OINT",,3449,LOCAL,Facility,Both,15,g,,85,72.25,24.361,85,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,75.2845,88.57,,percent of total billed charges,,
"NYSTATIN 100,000 UNIT/GRAM TOP OINT",,3449,LOCAL,Facility,Both,15,g,,85,72.25,24.361,85,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,24.361,28.66,,percent of total billed charges,,
"NYSTATIN 100,000 UNIT/GRAM TOP OINT",,3449,LOCAL,Facility,Outpatient,15,g,,85,72.25,24.361,85,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),41.65,49,,percent of total billed charges,,
"NYSTATIN 100,000 UNIT/GRAM TOP OINT",,3449,LOCAL,Facility,Inpatient,15,g,,85,72.25,24.361,85,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"NYSTATIN 100,000 UNIT/GRAM TOP OINT",,3449,LOCAL,Facility,Both,15,g,,85,72.25,24.361,85,CorVel,Worker's Compensation,85,100,,percent of total billed charges,,
"NYSTATIN 100,000 UNIT/GRAM TOP OINT",,3449,LOCAL,Facility,Both,15,g,,85,72.25,24.361,85,First Health Group Corporation,First Health Network,82.45,97,,percent of total billed charges,,
"NYSTATIN 100,000 UNIT/GRAM TOP OINT",,3449,LOCAL,Facility,Both,15,g,,85,72.25,24.361,85,"Health Partners, Inc.",Commercial,80.41,94.6,,percent of total billed charges,,
"NYSTATIN 100,000 UNIT/GRAM TOP OINT",,3449,LOCAL,Facility,Outpatient,15,g,,85,72.25,24.361,85,"Health Partners, Inc.",Medicare Advantage,41.65,49,,percent of total billed charges,,
"NYSTATIN 100,000 UNIT/GRAM TOP OINT",,3449,LOCAL,Facility,Inpatient,15,g,,85,72.25,24.361,85,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"NYSTATIN 100,000 UNIT/GRAM TOP OINT",,3449,LOCAL,Facility,Both,15,g,,85,72.25,24.361,85,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),51,60,,percent of total billed charges,,
"NYSTATIN 100,000 UNIT/GRAM TOP OINT",,3449,LOCAL,Facility,Both,15,g,,85,72.25,24.361,85,"Health Partners, Inc.",State of Minnesota Advantage Program,69.275,81.5,,percent of total billed charges,,
"NYSTATIN 100,000 UNIT/GRAM TOP OINT",,3449,LOCAL,Facility,Both,15,g,,85,72.25,24.361,85,"Health Partners, Inc.",State Public Programs,42.5,50,,percent of total billed charges,,
"NYSTATIN 100,000 UNIT/GRAM TOP OINT",,3449,LOCAL,Facility,Both,15,g,,85,72.25,24.361,85,Humana Insurance Company,Commercial PPO,80.75,95,,percent of total billed charges,,
"NYSTATIN 100,000 UNIT/GRAM TOP OINT",,3449,LOCAL,Facility,Outpatient,15,g,,85,72.25,24.361,85,Humana Insurance Company,Medicare PPO,41.65,49,,percent of total billed charges,,
"NYSTATIN 100,000 UNIT/GRAM TOP OINT",,3449,LOCAL,Facility,Inpatient,15,g,,85,72.25,24.361,85,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"NYSTATIN 100,000 UNIT/GRAM TOP OINT",,3449,LOCAL,Facility,Both,15,g,,85,72.25,24.361,85,Medica,Individual & Family,84.235,99.1,,percent of total billed charges,,
"NYSTATIN 100,000 UNIT/GRAM TOP OINT",,3449,LOCAL,Facility,Outpatient,15,g,,85,72.25,24.361,85,Medica,Medica Advantage Solution,42.33,49.8,,percent of total billed charges,,
"NYSTATIN 100,000 UNIT/GRAM TOP OINT",,3449,LOCAL,Facility,Inpatient,15,g,,85,72.25,24.361,85,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"NYSTATIN 100,000 UNIT/GRAM TOP OINT",,3449,LOCAL,Facility,Outpatient,15,g,,85,72.25,24.361,85,Medica,Medical Assistance,37.91,44.6,,percent of total billed charges,,
"NYSTATIN 100,000 UNIT/GRAM TOP OINT",,3449,LOCAL,Facility,Inpatient,15,g,,85,72.25,24.361,85,Medica,Medical Assistance,,,,,Included in per diem rate,
"NYSTATIN 100,000 UNIT/GRAM TOP OINT",,3449,LOCAL,Facility,Outpatient,15,g,,85,72.25,24.361,85,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,42.33,49.8,,percent of total billed charges,,
"NYSTATIN 100,000 UNIT/GRAM TOP OINT",,3449,LOCAL,Facility,Inpatient,15,g,,85,72.25,24.361,85,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"NYSTATIN 100,000 UNIT/GRAM TOP OINT",,3449,LOCAL,Facility,Both,15,g,,85,72.25,24.361,85,"Multiplan, Inc.","Multiplan, Inc.",79.9,94,,percent of total billed charges,,
"NYSTATIN 100,000 UNIT/GRAM TOP OINT",,3449,LOCAL,Facility,Outpatient,15,g,,85,72.25,24.361,85,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,76.585,90.1,,percent of total billed charges,,
"NYSTATIN 100,000 UNIT/GRAM TOP OINT",,3449,LOCAL,Facility,Inpatient,15,g,,85,72.25,24.361,85,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"NYSTATIN 100,000 UNIT/GRAM TOP OINT",,3449,LOCAL,Facility,Both,15,g,,85,72.25,24.361,85,"Preferred One Administrative Services, INC.",PPO,83.81,98.6,,percent of total billed charges,,
"NYSTATIN 100,000 UNIT/GRAM TOP OINT",,3449,LOCAL,Facility,Outpatient,15,g,,85,72.25,24.361,85,PrimeWest Health,Minnesota Senior Health Options (MSHO),43.7325,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"NYSTATIN 100,000 UNIT/GRAM TOP OINT",,3449,LOCAL,Facility,Inpatient,15,g,,85,72.25,24.361,85,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"NYSTATIN 100,000 UNIT/GRAM TOP OINT",,3449,LOCAL,Facility,Outpatient,15,g,,85,72.25,24.361,85,PrimeWest Health,MinnesotaCare,43.656,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"NYSTATIN 100,000 UNIT/GRAM TOP OINT",,3449,LOCAL,Facility,Inpatient,15,g,,85,72.25,24.361,85,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"NYSTATIN 100,000 UNIT/GRAM TOP OINT",,3449,LOCAL,Facility,Both,15,g,,85,72.25,24.361,85,Sanford Health Plan,Sanford Health Plan,78.2,92,,percent of total billed charges,,
"NYSTATIN 100,000 UNIT/GRAM TOP OINT",,3449,LOCAL,Facility,Outpatient,15,g,,85,72.25,24.361,85,"UCare Health, Inc.",Individual & Family Plan,47.8975,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"NYSTATIN 100,000 UNIT/GRAM TOP OINT",,3449,LOCAL,Facility,Inpatient,15,g,,85,72.25,24.361,85,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"NYSTATIN 100,000 UNIT/GRAM TOP OINT",,3449,LOCAL,Facility,Outpatient,15,g,,85,72.25,24.361,85,"UCare Health, Inc.",Medical Assistance,42.8995,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"NYSTATIN 100,000 UNIT/GRAM TOP OINT",,3449,LOCAL,Facility,Inpatient,15,g,,85,72.25,24.361,85,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"NYSTATIN 100,000 UNIT/GRAM TOP OINT",,3449,LOCAL,Facility,Outpatient,15,g,,85,72.25,24.361,85,"UCare Health, Inc.",Medicare Advantage,42.8995,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"NYSTATIN 100,000 UNIT/GRAM TOP OINT",,3449,LOCAL,Facility,Inpatient,15,g,,85,72.25,24.361,85,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"NYSTATIN 100,000 UNIT/GRAM TOP OINT",,3449,LOCAL,Facility,Outpatient,15,g,,85,72.25,24.361,85,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),42.8995,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"NYSTATIN 100,000 UNIT/GRAM TOP OINT",,3449,LOCAL,Facility,Inpatient,15,g,,85,72.25,24.361,85,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"NYSTATIN 100,000 UNIT/GRAM TOP OINT",,3449,LOCAL,Facility,Both,15,g,,85,72.25,24.361,85,UnitedHealthcare,Individual & Family,79.9,94,,percent of total billed charges,,
"NYSTATIN 100,000 UNIT/GRAM TOP OINT",,3449,LOCAL,Facility,Outpatient,15,g,,85,72.25,24.361,85,UnitedHealthcare,Medicare Advantage,41.65,49,,percent of total billed charges,,
"NYSTATIN 100,000 UNIT/GRAM TOP OINT",,3449,LOCAL,Facility,Inpatient,15,g,,85,72.25,24.361,85,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"NYSTATIN 100,000 UNIT/GRAM TOP OINT",,3449,LOCAL,Facility,Outpatient,15,g,,85,72.25,24.361,85,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,40.8,48,,percent of total billed charges,,100% of DHS outpatient percentage
"NYSTATIN 100,000 UNIT/GRAM TOP OINT",,3449,LOCAL,Facility,Inpatient,15,g,,85,72.25,24.361,85,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
FLUOCINONIDE 0.05 % TOP GEL,,4186,LOCAL,Facility,Both,15,g,,251,213.35,71.9366,251,Aetna,Commercial,230.92,92,,percent of total billed charges,,
FLUOCINONIDE 0.05 % TOP GEL,,4186,LOCAL,Facility,Outpatient,15,g,,251,213.35,71.9366,251,Aetna,Medicare Advantage,122.99,49,,percent of total billed charges,,
FLUOCINONIDE 0.05 % TOP GEL,,4186,LOCAL,Facility,Inpatient,15,g,,251,213.35,71.9366,251,Aetna,Medicare Advantage,,,,,Included in per diem rate,
FLUOCINONIDE 0.05 % TOP GEL,,4186,LOCAL,Facility,Both,15,g,,251,213.35,71.9366,251,Aetna,PPO,233.43,93,,percent of total billed charges,,
FLUOCINONIDE 0.05 % TOP GEL,,4186,LOCAL,Facility,Both,15,g,,251,213.35,71.9366,251,America's PPO,America's PPO,241.0353,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
FLUOCINONIDE 0.05 % TOP GEL,,4186,LOCAL,Facility,Both,15,g,,251,213.35,71.9366,251,BlueCross BlueShield Minnesota, Federal Employee Program,246.984,98.4,,percent of total billed charges,,
FLUOCINONIDE 0.05 % TOP GEL,,4186,LOCAL,Facility,Both,15,g,,251,213.35,71.9366,251,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,251,100,,percent of total billed charges,,
FLUOCINONIDE 0.05 % TOP GEL,,4186,LOCAL,Facility,Both,15,g,,251,213.35,71.9366,251,BlueCross BlueShield Minnesota,High Value Network Plan,225.9,90,,percent of total billed charges,,
FLUOCINONIDE 0.05 % TOP GEL,,4186,LOCAL,Facility,Outpatient,15,g,,251,213.35,71.9366,251,BlueCross BlueShield Minnesota,Medicare Advantage,122.99,49,,percent of total billed charges,,
FLUOCINONIDE 0.05 % TOP GEL,,4186,LOCAL,Facility,Inpatient,15,g,,251,213.35,71.9366,251,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
FLUOCINONIDE 0.05 % TOP GEL,,4186,LOCAL,Facility,Both,15,g,,251,213.35,71.9366,251,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,222.3107,88.57,,percent of total billed charges,,
FLUOCINONIDE 0.05 % TOP GEL,,4186,LOCAL,Facility,Both,15,g,,251,213.35,71.9366,251,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,71.9366,28.66,,percent of total billed charges,,
FLUOCINONIDE 0.05 % TOP GEL,,4186,LOCAL,Facility,Outpatient,15,g,,251,213.35,71.9366,251,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),122.99,49,,percent of total billed charges,,
FLUOCINONIDE 0.05 % TOP GEL,,4186,LOCAL,Facility,Inpatient,15,g,,251,213.35,71.9366,251,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
FLUOCINONIDE 0.05 % TOP GEL,,4186,LOCAL,Facility,Both,15,g,,251,213.35,71.9366,251,CorVel,Worker's Compensation,251,100,,percent of total billed charges,,
FLUOCINONIDE 0.05 % TOP GEL,,4186,LOCAL,Facility,Both,15,g,,251,213.35,71.9366,251,First Health Group Corporation,First Health Network,243.47,97,,percent of total billed charges,,
FLUOCINONIDE 0.05 % TOP GEL,,4186,LOCAL,Facility,Both,15,g,,251,213.35,71.9366,251,"Health Partners, Inc.",Commercial,237.446,94.6,,percent of total billed charges,,
FLUOCINONIDE 0.05 % TOP GEL,,4186,LOCAL,Facility,Outpatient,15,g,,251,213.35,71.9366,251,"Health Partners, Inc.",Medicare Advantage,122.99,49,,percent of total billed charges,,
FLUOCINONIDE 0.05 % TOP GEL,,4186,LOCAL,Facility,Inpatient,15,g,,251,213.35,71.9366,251,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
FLUOCINONIDE 0.05 % TOP GEL,,4186,LOCAL,Facility,Both,15,g,,251,213.35,71.9366,251,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),150.6,60,,percent of total billed charges,,
FLUOCINONIDE 0.05 % TOP GEL,,4186,LOCAL,Facility,Both,15,g,,251,213.35,71.9366,251,"Health Partners, Inc.",State of Minnesota Advantage Program,204.565,81.5,,percent of total billed charges,,
FLUOCINONIDE 0.05 % TOP GEL,,4186,LOCAL,Facility,Both,15,g,,251,213.35,71.9366,251,"Health Partners, Inc.",State Public Programs,125.5,50,,percent of total billed charges,,
FLUOCINONIDE 0.05 % TOP GEL,,4186,LOCAL,Facility,Both,15,g,,251,213.35,71.9366,251,Humana Insurance Company,Commercial PPO,238.45,95,,percent of total billed charges,,
FLUOCINONIDE 0.05 % TOP GEL,,4186,LOCAL,Facility,Outpatient,15,g,,251,213.35,71.9366,251,Humana Insurance Company,Medicare PPO,122.99,49,,percent of total billed charges,,
FLUOCINONIDE 0.05 % TOP GEL,,4186,LOCAL,Facility,Inpatient,15,g,,251,213.35,71.9366,251,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
FLUOCINONIDE 0.05 % TOP GEL,,4186,LOCAL,Facility,Both,15,g,,251,213.35,71.9366,251,Medica,Individual & Family,248.741,99.1,,percent of total billed charges,,
FLUOCINONIDE 0.05 % TOP GEL,,4186,LOCAL,Facility,Outpatient,15,g,,251,213.35,71.9366,251,Medica,Medica Advantage Solution,124.998,49.8,,percent of total billed charges,,
FLUOCINONIDE 0.05 % TOP GEL,,4186,LOCAL,Facility,Inpatient,15,g,,251,213.35,71.9366,251,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
FLUOCINONIDE 0.05 % TOP GEL,,4186,LOCAL,Facility,Outpatient,15,g,,251,213.35,71.9366,251,Medica,Medical Assistance,111.946,44.6,,percent of total billed charges,,
FLUOCINONIDE 0.05 % TOP GEL,,4186,LOCAL,Facility,Inpatient,15,g,,251,213.35,71.9366,251,Medica,Medical Assistance,,,,,Included in per diem rate,
FLUOCINONIDE 0.05 % TOP GEL,,4186,LOCAL,Facility,Outpatient,15,g,,251,213.35,71.9366,251,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,124.998,49.8,,percent of total billed charges,,
FLUOCINONIDE 0.05 % TOP GEL,,4186,LOCAL,Facility,Inpatient,15,g,,251,213.35,71.9366,251,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
FLUOCINONIDE 0.05 % TOP GEL,,4186,LOCAL,Facility,Both,15,g,,251,213.35,71.9366,251,"Multiplan, Inc.","Multiplan, Inc.",235.94,94,,percent of total billed charges,,
FLUOCINONIDE 0.05 % TOP GEL,,4186,LOCAL,Facility,Outpatient,15,g,,251,213.35,71.9366,251,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,226.151,90.1,,percent of total billed charges,,
FLUOCINONIDE 0.05 % TOP GEL,,4186,LOCAL,Facility,Inpatient,15,g,,251,213.35,71.9366,251,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
FLUOCINONIDE 0.05 % TOP GEL,,4186,LOCAL,Facility,Both,15,g,,251,213.35,71.9366,251,"Preferred One Administrative Services, INC.",PPO,247.486,98.6,,percent of total billed charges,,
FLUOCINONIDE 0.05 % TOP GEL,,4186,LOCAL,Facility,Outpatient,15,g,,251,213.35,71.9366,251,PrimeWest Health,Minnesota Senior Health Options (MSHO),129.1395,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
FLUOCINONIDE 0.05 % TOP GEL,,4186,LOCAL,Facility,Inpatient,15,g,,251,213.35,71.9366,251,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
FLUOCINONIDE 0.05 % TOP GEL,,4186,LOCAL,Facility,Outpatient,15,g,,251,213.35,71.9366,251,PrimeWest Health,MinnesotaCare,128.9136,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
FLUOCINONIDE 0.05 % TOP GEL,,4186,LOCAL,Facility,Inpatient,15,g,,251,213.35,71.9366,251,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
FLUOCINONIDE 0.05 % TOP GEL,,4186,LOCAL,Facility,Both,15,g,,251,213.35,71.9366,251,Sanford Health Plan,Sanford Health Plan,230.92,92,,percent of total billed charges,,
FLUOCINONIDE 0.05 % TOP GEL,,4186,LOCAL,Facility,Outpatient,15,g,,251,213.35,71.9366,251,"UCare Health, Inc.",Individual & Family Plan,141.4385,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
FLUOCINONIDE 0.05 % TOP GEL,,4186,LOCAL,Facility,Inpatient,15,g,,251,213.35,71.9366,251,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
FLUOCINONIDE 0.05 % TOP GEL,,4186,LOCAL,Facility,Outpatient,15,g,,251,213.35,71.9366,251,"UCare Health, Inc.",Medical Assistance,126.6797,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FLUOCINONIDE 0.05 % TOP GEL,,4186,LOCAL,Facility,Inpatient,15,g,,251,213.35,71.9366,251,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
FLUOCINONIDE 0.05 % TOP GEL,,4186,LOCAL,Facility,Outpatient,15,g,,251,213.35,71.9366,251,"UCare Health, Inc.",Medicare Advantage,126.6797,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FLUOCINONIDE 0.05 % TOP GEL,,4186,LOCAL,Facility,Inpatient,15,g,,251,213.35,71.9366,251,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
FLUOCINONIDE 0.05 % TOP GEL,,4186,LOCAL,Facility,Outpatient,15,g,,251,213.35,71.9366,251,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),126.6797,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FLUOCINONIDE 0.05 % TOP GEL,,4186,LOCAL,Facility,Inpatient,15,g,,251,213.35,71.9366,251,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
FLUOCINONIDE 0.05 % TOP GEL,,4186,LOCAL,Facility,Both,15,g,,251,213.35,71.9366,251,UnitedHealthcare,Individual & Family,235.94,94,,percent of total billed charges,,
FLUOCINONIDE 0.05 % TOP GEL,,4186,LOCAL,Facility,Outpatient,15,g,,251,213.35,71.9366,251,UnitedHealthcare,Medicare Advantage,122.99,49,,percent of total billed charges,,
FLUOCINONIDE 0.05 % TOP GEL,,4186,LOCAL,Facility,Inpatient,15,g,,251,213.35,71.9366,251,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
FLUOCINONIDE 0.05 % TOP GEL,,4186,LOCAL,Facility,Outpatient,15,g,,251,213.35,71.9366,251,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,120.48,48,,percent of total billed charges,,100% of DHS outpatient percentage
FLUOCINONIDE 0.05 % TOP GEL,,4186,LOCAL,Facility,Inpatient,15,g,,251,213.35,71.9366,251,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
CLOBETASOL 0.05 % TOP CREAM,,5840,LOCAL,Facility,Both,15,g,,501,425.85,143.5866,501,Aetna,Commercial,460.92,92,,percent of total billed charges,,
CLOBETASOL 0.05 % TOP CREAM,,5840,LOCAL,Facility,Outpatient,15,g,,501,425.85,143.5866,501,Aetna,Medicare Advantage,245.49,49,,percent of total billed charges,,
CLOBETASOL 0.05 % TOP CREAM,,5840,LOCAL,Facility,Inpatient,15,g,,501,425.85,143.5866,501,Aetna,Medicare Advantage,,,,,Included in per diem rate,
CLOBETASOL 0.05 % TOP CREAM,,5840,LOCAL,Facility,Both,15,g,,501,425.85,143.5866,501,Aetna,PPO,465.93,93,,percent of total billed charges,,
CLOBETASOL 0.05 % TOP CREAM,,5840,LOCAL,Facility,Both,15,g,,501,425.85,143.5866,501,America's PPO,America's PPO,481.1103,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
CLOBETASOL 0.05 % TOP CREAM,,5840,LOCAL,Facility,Both,15,g,,501,425.85,143.5866,501,BlueCross BlueShield Minnesota, Federal Employee Program,492.984,98.4,,percent of total billed charges,,
CLOBETASOL 0.05 % TOP CREAM,,5840,LOCAL,Facility,Both,15,g,,501,425.85,143.5866,501,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,501,100,,percent of total billed charges,,
CLOBETASOL 0.05 % TOP CREAM,,5840,LOCAL,Facility,Both,15,g,,501,425.85,143.5866,501,BlueCross BlueShield Minnesota,High Value Network Plan,450.9,90,,percent of total billed charges,,
CLOBETASOL 0.05 % TOP CREAM,,5840,LOCAL,Facility,Outpatient,15,g,,501,425.85,143.5866,501,BlueCross BlueShield Minnesota,Medicare Advantage,245.49,49,,percent of total billed charges,,
CLOBETASOL 0.05 % TOP CREAM,,5840,LOCAL,Facility,Inpatient,15,g,,501,425.85,143.5866,501,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
CLOBETASOL 0.05 % TOP CREAM,,5840,LOCAL,Facility,Both,15,g,,501,425.85,143.5866,501,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,443.7357,88.57,,percent of total billed charges,,
CLOBETASOL 0.05 % TOP CREAM,,5840,LOCAL,Facility,Both,15,g,,501,425.85,143.5866,501,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,143.5866,28.66,,percent of total billed charges,,
CLOBETASOL 0.05 % TOP CREAM,,5840,LOCAL,Facility,Outpatient,15,g,,501,425.85,143.5866,501,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),245.49,49,,percent of total billed charges,,
CLOBETASOL 0.05 % TOP CREAM,,5840,LOCAL,Facility,Inpatient,15,g,,501,425.85,143.5866,501,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
CLOBETASOL 0.05 % TOP CREAM,,5840,LOCAL,Facility,Both,15,g,,501,425.85,143.5866,501,CorVel,Worker's Compensation,501,100,,percent of total billed charges,,
CLOBETASOL 0.05 % TOP CREAM,,5840,LOCAL,Facility,Both,15,g,,501,425.85,143.5866,501,First Health Group Corporation,First Health Network,485.97,97,,percent of total billed charges,,
CLOBETASOL 0.05 % TOP CREAM,,5840,LOCAL,Facility,Both,15,g,,501,425.85,143.5866,501,"Health Partners, Inc.",Commercial,473.946,94.6,,percent of total billed charges,,
CLOBETASOL 0.05 % TOP CREAM,,5840,LOCAL,Facility,Outpatient,15,g,,501,425.85,143.5866,501,"Health Partners, Inc.",Medicare Advantage,245.49,49,,percent of total billed charges,,
CLOBETASOL 0.05 % TOP CREAM,,5840,LOCAL,Facility,Inpatient,15,g,,501,425.85,143.5866,501,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CLOBETASOL 0.05 % TOP CREAM,,5840,LOCAL,Facility,Both,15,g,,501,425.85,143.5866,501,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),300.6,60,,percent of total billed charges,,
CLOBETASOL 0.05 % TOP CREAM,,5840,LOCAL,Facility,Both,15,g,,501,425.85,143.5866,501,"Health Partners, Inc.",State of Minnesota Advantage Program,408.315,81.5,,percent of total billed charges,,
CLOBETASOL 0.05 % TOP CREAM,,5840,LOCAL,Facility,Both,15,g,,501,425.85,143.5866,501,"Health Partners, Inc.",State Public Programs,250.5,50,,percent of total billed charges,,
CLOBETASOL 0.05 % TOP CREAM,,5840,LOCAL,Facility,Both,15,g,,501,425.85,143.5866,501,Humana Insurance Company,Commercial PPO,475.95,95,,percent of total billed charges,,
CLOBETASOL 0.05 % TOP CREAM,,5840,LOCAL,Facility,Outpatient,15,g,,501,425.85,143.5866,501,Humana Insurance Company,Medicare PPO,245.49,49,,percent of total billed charges,,
CLOBETASOL 0.05 % TOP CREAM,,5840,LOCAL,Facility,Inpatient,15,g,,501,425.85,143.5866,501,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
CLOBETASOL 0.05 % TOP CREAM,,5840,LOCAL,Facility,Both,15,g,,501,425.85,143.5866,501,Medica,Individual & Family,496.491,99.1,,percent of total billed charges,,
CLOBETASOL 0.05 % TOP CREAM,,5840,LOCAL,Facility,Outpatient,15,g,,501,425.85,143.5866,501,Medica,Medica Advantage Solution,249.498,49.8,,percent of total billed charges,,
CLOBETASOL 0.05 % TOP CREAM,,5840,LOCAL,Facility,Inpatient,15,g,,501,425.85,143.5866,501,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
CLOBETASOL 0.05 % TOP CREAM,,5840,LOCAL,Facility,Outpatient,15,g,,501,425.85,143.5866,501,Medica,Medical Assistance,223.446,44.6,,percent of total billed charges,,
CLOBETASOL 0.05 % TOP CREAM,,5840,LOCAL,Facility,Inpatient,15,g,,501,425.85,143.5866,501,Medica,Medical Assistance,,,,,Included in per diem rate,
CLOBETASOL 0.05 % TOP CREAM,,5840,LOCAL,Facility,Outpatient,15,g,,501,425.85,143.5866,501,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,249.498,49.8,,percent of total billed charges,,
CLOBETASOL 0.05 % TOP CREAM,,5840,LOCAL,Facility,Inpatient,15,g,,501,425.85,143.5866,501,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
CLOBETASOL 0.05 % TOP CREAM,,5840,LOCAL,Facility,Both,15,g,,501,425.85,143.5866,501,"Multiplan, Inc.","Multiplan, Inc.",470.94,94,,percent of total billed charges,,
CLOBETASOL 0.05 % TOP CREAM,,5840,LOCAL,Facility,Outpatient,15,g,,501,425.85,143.5866,501,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,451.401,90.1,,percent of total billed charges,,
CLOBETASOL 0.05 % TOP CREAM,,5840,LOCAL,Facility,Inpatient,15,g,,501,425.85,143.5866,501,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
CLOBETASOL 0.05 % TOP CREAM,,5840,LOCAL,Facility,Both,15,g,,501,425.85,143.5866,501,"Preferred One Administrative Services, INC.",PPO,493.986,98.6,,percent of total billed charges,,
CLOBETASOL 0.05 % TOP CREAM,,5840,LOCAL,Facility,Outpatient,15,g,,501,425.85,143.5866,501,PrimeWest Health,Minnesota Senior Health Options (MSHO),257.7645,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
CLOBETASOL 0.05 % TOP CREAM,,5840,LOCAL,Facility,Inpatient,15,g,,501,425.85,143.5866,501,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CLOBETASOL 0.05 % TOP CREAM,,5840,LOCAL,Facility,Outpatient,15,g,,501,425.85,143.5866,501,PrimeWest Health,MinnesotaCare,257.3136,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
CLOBETASOL 0.05 % TOP CREAM,,5840,LOCAL,Facility,Inpatient,15,g,,501,425.85,143.5866,501,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
CLOBETASOL 0.05 % TOP CREAM,,5840,LOCAL,Facility,Both,15,g,,501,425.85,143.5866,501,Sanford Health Plan,Sanford Health Plan,460.92,92,,percent of total billed charges,,
CLOBETASOL 0.05 % TOP CREAM,,5840,LOCAL,Facility,Outpatient,15,g,,501,425.85,143.5866,501,"UCare Health, Inc.",Individual & Family Plan,282.3135,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
CLOBETASOL 0.05 % TOP CREAM,,5840,LOCAL,Facility,Inpatient,15,g,,501,425.85,143.5866,501,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
CLOBETASOL 0.05 % TOP CREAM,,5840,LOCAL,Facility,Outpatient,15,g,,501,425.85,143.5866,501,"UCare Health, Inc.",Medical Assistance,252.8547,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CLOBETASOL 0.05 % TOP CREAM,,5840,LOCAL,Facility,Inpatient,15,g,,501,425.85,143.5866,501,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
CLOBETASOL 0.05 % TOP CREAM,,5840,LOCAL,Facility,Outpatient,15,g,,501,425.85,143.5866,501,"UCare Health, Inc.",Medicare Advantage,252.8547,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CLOBETASOL 0.05 % TOP CREAM,,5840,LOCAL,Facility,Inpatient,15,g,,501,425.85,143.5866,501,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CLOBETASOL 0.05 % TOP CREAM,,5840,LOCAL,Facility,Outpatient,15,g,,501,425.85,143.5866,501,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),252.8547,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CLOBETASOL 0.05 % TOP CREAM,,5840,LOCAL,Facility,Inpatient,15,g,,501,425.85,143.5866,501,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CLOBETASOL 0.05 % TOP CREAM,,5840,LOCAL,Facility,Both,15,g,,501,425.85,143.5866,501,UnitedHealthcare,Individual & Family,470.94,94,,percent of total billed charges,,
CLOBETASOL 0.05 % TOP CREAM,,5840,LOCAL,Facility,Outpatient,15,g,,501,425.85,143.5866,501,UnitedHealthcare,Medicare Advantage,245.49,49,,percent of total billed charges,,
CLOBETASOL 0.05 % TOP CREAM,,5840,LOCAL,Facility,Inpatient,15,g,,501,425.85,143.5866,501,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
CLOBETASOL 0.05 % TOP CREAM,,5840,LOCAL,Facility,Outpatient,15,g,,501,425.85,143.5866,501,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,240.48,48,,percent of total billed charges,,100% of DHS outpatient percentage
CLOBETASOL 0.05 % TOP CREAM,,5840,LOCAL,Facility,Inpatient,15,g,,501,425.85,143.5866,501,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
TRIAMCINOLONE ACETONIDE 0.5 % TOP OINT,,6626,LOCAL,Facility,Both,15,g,,50,42.5,14.33,50,Aetna,Commercial,46,92,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.5 % TOP OINT,,6626,LOCAL,Facility,Outpatient,15,g,,50,42.5,14.33,50,Aetna,Medicare Advantage,24.5,49,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.5 % TOP OINT,,6626,LOCAL,Facility,Inpatient,15,g,,50,42.5,14.33,50,Aetna,Medicare Advantage,,,,,Included in per diem rate,
TRIAMCINOLONE ACETONIDE 0.5 % TOP OINT,,6626,LOCAL,Facility,Both,15,g,,50,42.5,14.33,50,Aetna,PPO,46.5,93,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.5 % TOP OINT,,6626,LOCAL,Facility,Both,15,g,,50,42.5,14.33,50,America's PPO,America's PPO,48.015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
TRIAMCINOLONE ACETONIDE 0.5 % TOP OINT,,6626,LOCAL,Facility,Both,15,g,,50,42.5,14.33,50,BlueCross BlueShield Minnesota, Federal Employee Program,49.2,98.4,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.5 % TOP OINT,,6626,LOCAL,Facility,Both,15,g,,50,42.5,14.33,50,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,50,100,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.5 % TOP OINT,,6626,LOCAL,Facility,Both,15,g,,50,42.5,14.33,50,BlueCross BlueShield Minnesota,High Value Network Plan,45,90,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.5 % TOP OINT,,6626,LOCAL,Facility,Outpatient,15,g,,50,42.5,14.33,50,BlueCross BlueShield Minnesota,Medicare Advantage,24.5,49,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.5 % TOP OINT,,6626,LOCAL,Facility,Inpatient,15,g,,50,42.5,14.33,50,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
TRIAMCINOLONE ACETONIDE 0.5 % TOP OINT,,6626,LOCAL,Facility,Both,15,g,,50,42.5,14.33,50,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,44.285,88.57,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.5 % TOP OINT,,6626,LOCAL,Facility,Both,15,g,,50,42.5,14.33,50,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,14.33,28.66,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.5 % TOP OINT,,6626,LOCAL,Facility,Outpatient,15,g,,50,42.5,14.33,50,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),24.5,49,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.5 % TOP OINT,,6626,LOCAL,Facility,Inpatient,15,g,,50,42.5,14.33,50,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
TRIAMCINOLONE ACETONIDE 0.5 % TOP OINT,,6626,LOCAL,Facility,Both,15,g,,50,42.5,14.33,50,CorVel,Worker's Compensation,50,100,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.5 % TOP OINT,,6626,LOCAL,Facility,Both,15,g,,50,42.5,14.33,50,First Health Group Corporation,First Health Network,48.5,97,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.5 % TOP OINT,,6626,LOCAL,Facility,Both,15,g,,50,42.5,14.33,50,"Health Partners, Inc.",Commercial,47.3,94.6,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.5 % TOP OINT,,6626,LOCAL,Facility,Outpatient,15,g,,50,42.5,14.33,50,"Health Partners, Inc.",Medicare Advantage,24.5,49,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.5 % TOP OINT,,6626,LOCAL,Facility,Inpatient,15,g,,50,42.5,14.33,50,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
TRIAMCINOLONE ACETONIDE 0.5 % TOP OINT,,6626,LOCAL,Facility,Both,15,g,,50,42.5,14.33,50,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),30,60,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.5 % TOP OINT,,6626,LOCAL,Facility,Both,15,g,,50,42.5,14.33,50,"Health Partners, Inc.",State of Minnesota Advantage Program,40.75,81.5,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.5 % TOP OINT,,6626,LOCAL,Facility,Both,15,g,,50,42.5,14.33,50,"Health Partners, Inc.",State Public Programs,25,50,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.5 % TOP OINT,,6626,LOCAL,Facility,Both,15,g,,50,42.5,14.33,50,Humana Insurance Company,Commercial PPO,47.5,95,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.5 % TOP OINT,,6626,LOCAL,Facility,Outpatient,15,g,,50,42.5,14.33,50,Humana Insurance Company,Medicare PPO,24.5,49,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.5 % TOP OINT,,6626,LOCAL,Facility,Inpatient,15,g,,50,42.5,14.33,50,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
TRIAMCINOLONE ACETONIDE 0.5 % TOP OINT,,6626,LOCAL,Facility,Both,15,g,,50,42.5,14.33,50,Medica,Individual & Family,49.55,99.1,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.5 % TOP OINT,,6626,LOCAL,Facility,Outpatient,15,g,,50,42.5,14.33,50,Medica,Medica Advantage Solution,24.9,49.8,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.5 % TOP OINT,,6626,LOCAL,Facility,Inpatient,15,g,,50,42.5,14.33,50,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
TRIAMCINOLONE ACETONIDE 0.5 % TOP OINT,,6626,LOCAL,Facility,Outpatient,15,g,,50,42.5,14.33,50,Medica,Medical Assistance,22.3,44.6,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.5 % TOP OINT,,6626,LOCAL,Facility,Inpatient,15,g,,50,42.5,14.33,50,Medica,Medical Assistance,,,,,Included in per diem rate,
TRIAMCINOLONE ACETONIDE 0.5 % TOP OINT,,6626,LOCAL,Facility,Outpatient,15,g,,50,42.5,14.33,50,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,24.9,49.8,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.5 % TOP OINT,,6626,LOCAL,Facility,Inpatient,15,g,,50,42.5,14.33,50,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
TRIAMCINOLONE ACETONIDE 0.5 % TOP OINT,,6626,LOCAL,Facility,Both,15,g,,50,42.5,14.33,50,"Multiplan, Inc.","Multiplan, Inc.",47,94,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.5 % TOP OINT,,6626,LOCAL,Facility,Outpatient,15,g,,50,42.5,14.33,50,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,45.05,90.1,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.5 % TOP OINT,,6626,LOCAL,Facility,Inpatient,15,g,,50,42.5,14.33,50,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
TRIAMCINOLONE ACETONIDE 0.5 % TOP OINT,,6626,LOCAL,Facility,Both,15,g,,50,42.5,14.33,50,"Preferred One Administrative Services, INC.",PPO,49.3,98.6,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.5 % TOP OINT,,6626,LOCAL,Facility,Outpatient,15,g,,50,42.5,14.33,50,PrimeWest Health,Minnesota Senior Health Options (MSHO),25.725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
TRIAMCINOLONE ACETONIDE 0.5 % TOP OINT,,6626,LOCAL,Facility,Inpatient,15,g,,50,42.5,14.33,50,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
TRIAMCINOLONE ACETONIDE 0.5 % TOP OINT,,6626,LOCAL,Facility,Outpatient,15,g,,50,42.5,14.33,50,PrimeWest Health,MinnesotaCare,25.68,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
TRIAMCINOLONE ACETONIDE 0.5 % TOP OINT,,6626,LOCAL,Facility,Inpatient,15,g,,50,42.5,14.33,50,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
TRIAMCINOLONE ACETONIDE 0.5 % TOP OINT,,6626,LOCAL,Facility,Both,15,g,,50,42.5,14.33,50,Sanford Health Plan,Sanford Health Plan,46,92,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.5 % TOP OINT,,6626,LOCAL,Facility,Outpatient,15,g,,50,42.5,14.33,50,"UCare Health, Inc.",Individual & Family Plan,28.175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
TRIAMCINOLONE ACETONIDE 0.5 % TOP OINT,,6626,LOCAL,Facility,Inpatient,15,g,,50,42.5,14.33,50,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
TRIAMCINOLONE ACETONIDE 0.5 % TOP OINT,,6626,LOCAL,Facility,Outpatient,15,g,,50,42.5,14.33,50,"UCare Health, Inc.",Medical Assistance,25.235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TRIAMCINOLONE ACETONIDE 0.5 % TOP OINT,,6626,LOCAL,Facility,Inpatient,15,g,,50,42.5,14.33,50,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
TRIAMCINOLONE ACETONIDE 0.5 % TOP OINT,,6626,LOCAL,Facility,Outpatient,15,g,,50,42.5,14.33,50,"UCare Health, Inc.",Medicare Advantage,25.235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TRIAMCINOLONE ACETONIDE 0.5 % TOP OINT,,6626,LOCAL,Facility,Inpatient,15,g,,50,42.5,14.33,50,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
TRIAMCINOLONE ACETONIDE 0.5 % TOP OINT,,6626,LOCAL,Facility,Outpatient,15,g,,50,42.5,14.33,50,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),25.235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TRIAMCINOLONE ACETONIDE 0.5 % TOP OINT,,6626,LOCAL,Facility,Inpatient,15,g,,50,42.5,14.33,50,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
TRIAMCINOLONE ACETONIDE 0.5 % TOP OINT,,6626,LOCAL,Facility,Both,15,g,,50,42.5,14.33,50,UnitedHealthcare,Individual & Family,47,94,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.5 % TOP OINT,,6626,LOCAL,Facility,Outpatient,15,g,,50,42.5,14.33,50,UnitedHealthcare,Medicare Advantage,24.5,49,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.5 % TOP OINT,,6626,LOCAL,Facility,Inpatient,15,g,,50,42.5,14.33,50,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
TRIAMCINOLONE ACETONIDE 0.5 % TOP OINT,,6626,LOCAL,Facility,Outpatient,15,g,,50,42.5,14.33,50,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,24,48,,percent of total billed charges,,100% of DHS outpatient percentage
TRIAMCINOLONE ACETONIDE 0.5 % TOP OINT,,6626,LOCAL,Facility,Inpatient,15,g,,50,42.5,14.33,50,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
TRIAMCINOLONE ACETONIDE 0.025 % TOP CREAM,,10469,LOCAL,Facility,Both,15,g,,23,19.55,6.5918,23,Aetna,Commercial,21.16,92,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.025 % TOP CREAM,,10469,LOCAL,Facility,Outpatient,15,g,,23,19.55,6.5918,23,Aetna,Medicare Advantage,11.27,49,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.025 % TOP CREAM,,10469,LOCAL,Facility,Inpatient,15,g,,23,19.55,6.5918,23,Aetna,Medicare Advantage,,,,,Included in per diem rate,
TRIAMCINOLONE ACETONIDE 0.025 % TOP CREAM,,10469,LOCAL,Facility,Both,15,g,,23,19.55,6.5918,23,Aetna,PPO,21.39,93,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.025 % TOP CREAM,,10469,LOCAL,Facility,Both,15,g,,23,19.55,6.5918,23,America's PPO,America's PPO,22.0869,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
TRIAMCINOLONE ACETONIDE 0.025 % TOP CREAM,,10469,LOCAL,Facility,Both,15,g,,23,19.55,6.5918,23,BlueCross BlueShield Minnesota, Federal Employee Program,22.632,98.4,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.025 % TOP CREAM,,10469,LOCAL,Facility,Both,15,g,,23,19.55,6.5918,23,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,23,100,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.025 % TOP CREAM,,10469,LOCAL,Facility,Both,15,g,,23,19.55,6.5918,23,BlueCross BlueShield Minnesota,High Value Network Plan,20.7,90,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.025 % TOP CREAM,,10469,LOCAL,Facility,Outpatient,15,g,,23,19.55,6.5918,23,BlueCross BlueShield Minnesota,Medicare Advantage,11.27,49,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.025 % TOP CREAM,,10469,LOCAL,Facility,Inpatient,15,g,,23,19.55,6.5918,23,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
TRIAMCINOLONE ACETONIDE 0.025 % TOP CREAM,,10469,LOCAL,Facility,Both,15,g,,23,19.55,6.5918,23,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,20.3711,88.57,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.025 % TOP CREAM,,10469,LOCAL,Facility,Both,15,g,,23,19.55,6.5918,23,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,6.5918,28.66,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.025 % TOP CREAM,,10469,LOCAL,Facility,Outpatient,15,g,,23,19.55,6.5918,23,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),11.27,49,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.025 % TOP CREAM,,10469,LOCAL,Facility,Inpatient,15,g,,23,19.55,6.5918,23,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
TRIAMCINOLONE ACETONIDE 0.025 % TOP CREAM,,10469,LOCAL,Facility,Both,15,g,,23,19.55,6.5918,23,CorVel,Worker's Compensation,23,100,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.025 % TOP CREAM,,10469,LOCAL,Facility,Both,15,g,,23,19.55,6.5918,23,First Health Group Corporation,First Health Network,22.31,97,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.025 % TOP CREAM,,10469,LOCAL,Facility,Both,15,g,,23,19.55,6.5918,23,"Health Partners, Inc.",Commercial,21.758,94.6,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.025 % TOP CREAM,,10469,LOCAL,Facility,Outpatient,15,g,,23,19.55,6.5918,23,"Health Partners, Inc.",Medicare Advantage,11.27,49,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.025 % TOP CREAM,,10469,LOCAL,Facility,Inpatient,15,g,,23,19.55,6.5918,23,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
TRIAMCINOLONE ACETONIDE 0.025 % TOP CREAM,,10469,LOCAL,Facility,Both,15,g,,23,19.55,6.5918,23,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),13.8,60,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.025 % TOP CREAM,,10469,LOCAL,Facility,Both,15,g,,23,19.55,6.5918,23,"Health Partners, Inc.",State of Minnesota Advantage Program,18.745,81.5,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.025 % TOP CREAM,,10469,LOCAL,Facility,Both,15,g,,23,19.55,6.5918,23,"Health Partners, Inc.",State Public Programs,11.5,50,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.025 % TOP CREAM,,10469,LOCAL,Facility,Both,15,g,,23,19.55,6.5918,23,Humana Insurance Company,Commercial PPO,21.85,95,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.025 % TOP CREAM,,10469,LOCAL,Facility,Outpatient,15,g,,23,19.55,6.5918,23,Humana Insurance Company,Medicare PPO,11.27,49,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.025 % TOP CREAM,,10469,LOCAL,Facility,Inpatient,15,g,,23,19.55,6.5918,23,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
TRIAMCINOLONE ACETONIDE 0.025 % TOP CREAM,,10469,LOCAL,Facility,Both,15,g,,23,19.55,6.5918,23,Medica,Individual & Family,22.793,99.1,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.025 % TOP CREAM,,10469,LOCAL,Facility,Outpatient,15,g,,23,19.55,6.5918,23,Medica,Medica Advantage Solution,11.454,49.8,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.025 % TOP CREAM,,10469,LOCAL,Facility,Inpatient,15,g,,23,19.55,6.5918,23,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
TRIAMCINOLONE ACETONIDE 0.025 % TOP CREAM,,10469,LOCAL,Facility,Outpatient,15,g,,23,19.55,6.5918,23,Medica,Medical Assistance,10.258,44.6,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.025 % TOP CREAM,,10469,LOCAL,Facility,Inpatient,15,g,,23,19.55,6.5918,23,Medica,Medical Assistance,,,,,Included in per diem rate,
TRIAMCINOLONE ACETONIDE 0.025 % TOP CREAM,,10469,LOCAL,Facility,Outpatient,15,g,,23,19.55,6.5918,23,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,11.454,49.8,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.025 % TOP CREAM,,10469,LOCAL,Facility,Inpatient,15,g,,23,19.55,6.5918,23,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
TRIAMCINOLONE ACETONIDE 0.025 % TOP CREAM,,10469,LOCAL,Facility,Both,15,g,,23,19.55,6.5918,23,"Multiplan, Inc.","Multiplan, Inc.",21.62,94,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.025 % TOP CREAM,,10469,LOCAL,Facility,Outpatient,15,g,,23,19.55,6.5918,23,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,20.723,90.1,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.025 % TOP CREAM,,10469,LOCAL,Facility,Inpatient,15,g,,23,19.55,6.5918,23,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
TRIAMCINOLONE ACETONIDE 0.025 % TOP CREAM,,10469,LOCAL,Facility,Both,15,g,,23,19.55,6.5918,23,"Preferred One Administrative Services, INC.",PPO,22.678,98.6,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.025 % TOP CREAM,,10469,LOCAL,Facility,Outpatient,15,g,,23,19.55,6.5918,23,PrimeWest Health,Minnesota Senior Health Options (MSHO),11.8335,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
TRIAMCINOLONE ACETONIDE 0.025 % TOP CREAM,,10469,LOCAL,Facility,Inpatient,15,g,,23,19.55,6.5918,23,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
TRIAMCINOLONE ACETONIDE 0.025 % TOP CREAM,,10469,LOCAL,Facility,Outpatient,15,g,,23,19.55,6.5918,23,PrimeWest Health,MinnesotaCare,11.8128,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
TRIAMCINOLONE ACETONIDE 0.025 % TOP CREAM,,10469,LOCAL,Facility,Inpatient,15,g,,23,19.55,6.5918,23,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
TRIAMCINOLONE ACETONIDE 0.025 % TOP CREAM,,10469,LOCAL,Facility,Both,15,g,,23,19.55,6.5918,23,Sanford Health Plan,Sanford Health Plan,21.16,92,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.025 % TOP CREAM,,10469,LOCAL,Facility,Outpatient,15,g,,23,19.55,6.5918,23,"UCare Health, Inc.",Individual & Family Plan,12.9605,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
TRIAMCINOLONE ACETONIDE 0.025 % TOP CREAM,,10469,LOCAL,Facility,Inpatient,15,g,,23,19.55,6.5918,23,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
TRIAMCINOLONE ACETONIDE 0.025 % TOP CREAM,,10469,LOCAL,Facility,Outpatient,15,g,,23,19.55,6.5918,23,"UCare Health, Inc.",Medical Assistance,11.6081,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TRIAMCINOLONE ACETONIDE 0.025 % TOP CREAM,,10469,LOCAL,Facility,Inpatient,15,g,,23,19.55,6.5918,23,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
TRIAMCINOLONE ACETONIDE 0.025 % TOP CREAM,,10469,LOCAL,Facility,Outpatient,15,g,,23,19.55,6.5918,23,"UCare Health, Inc.",Medicare Advantage,11.6081,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TRIAMCINOLONE ACETONIDE 0.025 % TOP CREAM,,10469,LOCAL,Facility,Inpatient,15,g,,23,19.55,6.5918,23,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
TRIAMCINOLONE ACETONIDE 0.025 % TOP CREAM,,10469,LOCAL,Facility,Outpatient,15,g,,23,19.55,6.5918,23,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),11.6081,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TRIAMCINOLONE ACETONIDE 0.025 % TOP CREAM,,10469,LOCAL,Facility,Inpatient,15,g,,23,19.55,6.5918,23,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
TRIAMCINOLONE ACETONIDE 0.025 % TOP CREAM,,10469,LOCAL,Facility,Both,15,g,,23,19.55,6.5918,23,UnitedHealthcare,Individual & Family,21.62,94,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.025 % TOP CREAM,,10469,LOCAL,Facility,Outpatient,15,g,,23,19.55,6.5918,23,UnitedHealthcare,Medicare Advantage,11.27,49,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.025 % TOP CREAM,,10469,LOCAL,Facility,Inpatient,15,g,,23,19.55,6.5918,23,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
TRIAMCINOLONE ACETONIDE 0.025 % TOP CREAM,,10469,LOCAL,Facility,Outpatient,15,g,,23,19.55,6.5918,23,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,11.04,48,,percent of total billed charges,,100% of DHS outpatient percentage
TRIAMCINOLONE ACETONIDE 0.025 % TOP CREAM,,10469,LOCAL,Facility,Inpatient,15,g,,23,19.55,6.5918,23,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
CLOTRIMAZOLE-BETAMETHASONE 1-0.05 % TOP CREAM,,12777,LOCAL,Facility,Both,15,g,,237,201.45,67.9242,237,Aetna,Commercial,218.04,92,,percent of total billed charges,,
CLOTRIMAZOLE-BETAMETHASONE 1-0.05 % TOP CREAM,,12777,LOCAL,Facility,Outpatient,15,g,,237,201.45,67.9242,237,Aetna,Medicare Advantage,116.13,49,,percent of total billed charges,,
CLOTRIMAZOLE-BETAMETHASONE 1-0.05 % TOP CREAM,,12777,LOCAL,Facility,Inpatient,15,g,,237,201.45,67.9242,237,Aetna,Medicare Advantage,,,,,Included in per diem rate,
CLOTRIMAZOLE-BETAMETHASONE 1-0.05 % TOP CREAM,,12777,LOCAL,Facility,Both,15,g,,237,201.45,67.9242,237,Aetna,PPO,220.41,93,,percent of total billed charges,,
CLOTRIMAZOLE-BETAMETHASONE 1-0.05 % TOP CREAM,,12777,LOCAL,Facility,Both,15,g,,237,201.45,67.9242,237,America's PPO,America's PPO,227.5911,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
CLOTRIMAZOLE-BETAMETHASONE 1-0.05 % TOP CREAM,,12777,LOCAL,Facility,Both,15,g,,237,201.45,67.9242,237,BlueCross BlueShield Minnesota, Federal Employee Program,233.208,98.4,,percent of total billed charges,,
CLOTRIMAZOLE-BETAMETHASONE 1-0.05 % TOP CREAM,,12777,LOCAL,Facility,Both,15,g,,237,201.45,67.9242,237,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,237,100,,percent of total billed charges,,
CLOTRIMAZOLE-BETAMETHASONE 1-0.05 % TOP CREAM,,12777,LOCAL,Facility,Both,15,g,,237,201.45,67.9242,237,BlueCross BlueShield Minnesota,High Value Network Plan,213.3,90,,percent of total billed charges,,
CLOTRIMAZOLE-BETAMETHASONE 1-0.05 % TOP CREAM,,12777,LOCAL,Facility,Outpatient,15,g,,237,201.45,67.9242,237,BlueCross BlueShield Minnesota,Medicare Advantage,116.13,49,,percent of total billed charges,,
CLOTRIMAZOLE-BETAMETHASONE 1-0.05 % TOP CREAM,,12777,LOCAL,Facility,Inpatient,15,g,,237,201.45,67.9242,237,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
CLOTRIMAZOLE-BETAMETHASONE 1-0.05 % TOP CREAM,,12777,LOCAL,Facility,Both,15,g,,237,201.45,67.9242,237,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,209.9109,88.57,,percent of total billed charges,,
CLOTRIMAZOLE-BETAMETHASONE 1-0.05 % TOP CREAM,,12777,LOCAL,Facility,Both,15,g,,237,201.45,67.9242,237,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,67.9242,28.66,,percent of total billed charges,,
CLOTRIMAZOLE-BETAMETHASONE 1-0.05 % TOP CREAM,,12777,LOCAL,Facility,Outpatient,15,g,,237,201.45,67.9242,237,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),116.13,49,,percent of total billed charges,,
CLOTRIMAZOLE-BETAMETHASONE 1-0.05 % TOP CREAM,,12777,LOCAL,Facility,Inpatient,15,g,,237,201.45,67.9242,237,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
CLOTRIMAZOLE-BETAMETHASONE 1-0.05 % TOP CREAM,,12777,LOCAL,Facility,Both,15,g,,237,201.45,67.9242,237,CorVel,Worker's Compensation,237,100,,percent of total billed charges,,
CLOTRIMAZOLE-BETAMETHASONE 1-0.05 % TOP CREAM,,12777,LOCAL,Facility,Both,15,g,,237,201.45,67.9242,237,First Health Group Corporation,First Health Network,229.89,97,,percent of total billed charges,,
CLOTRIMAZOLE-BETAMETHASONE 1-0.05 % TOP CREAM,,12777,LOCAL,Facility,Both,15,g,,237,201.45,67.9242,237,"Health Partners, Inc.",Commercial,224.202,94.6,,percent of total billed charges,,
CLOTRIMAZOLE-BETAMETHASONE 1-0.05 % TOP CREAM,,12777,LOCAL,Facility,Outpatient,15,g,,237,201.45,67.9242,237,"Health Partners, Inc.",Medicare Advantage,116.13,49,,percent of total billed charges,,
CLOTRIMAZOLE-BETAMETHASONE 1-0.05 % TOP CREAM,,12777,LOCAL,Facility,Inpatient,15,g,,237,201.45,67.9242,237,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CLOTRIMAZOLE-BETAMETHASONE 1-0.05 % TOP CREAM,,12777,LOCAL,Facility,Both,15,g,,237,201.45,67.9242,237,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),142.2,60,,percent of total billed charges,,
CLOTRIMAZOLE-BETAMETHASONE 1-0.05 % TOP CREAM,,12777,LOCAL,Facility,Both,15,g,,237,201.45,67.9242,237,"Health Partners, Inc.",State of Minnesota Advantage Program,193.155,81.5,,percent of total billed charges,,
CLOTRIMAZOLE-BETAMETHASONE 1-0.05 % TOP CREAM,,12777,LOCAL,Facility,Both,15,g,,237,201.45,67.9242,237,"Health Partners, Inc.",State Public Programs,118.5,50,,percent of total billed charges,,
CLOTRIMAZOLE-BETAMETHASONE 1-0.05 % TOP CREAM,,12777,LOCAL,Facility,Both,15,g,,237,201.45,67.9242,237,Humana Insurance Company,Commercial PPO,225.15,95,,percent of total billed charges,,
CLOTRIMAZOLE-BETAMETHASONE 1-0.05 % TOP CREAM,,12777,LOCAL,Facility,Outpatient,15,g,,237,201.45,67.9242,237,Humana Insurance Company,Medicare PPO,116.13,49,,percent of total billed charges,,
CLOTRIMAZOLE-BETAMETHASONE 1-0.05 % TOP CREAM,,12777,LOCAL,Facility,Inpatient,15,g,,237,201.45,67.9242,237,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
CLOTRIMAZOLE-BETAMETHASONE 1-0.05 % TOP CREAM,,12777,LOCAL,Facility,Both,15,g,,237,201.45,67.9242,237,Medica,Individual & Family,234.867,99.1,,percent of total billed charges,,
CLOTRIMAZOLE-BETAMETHASONE 1-0.05 % TOP CREAM,,12777,LOCAL,Facility,Outpatient,15,g,,237,201.45,67.9242,237,Medica,Medica Advantage Solution,118.026,49.8,,percent of total billed charges,,
CLOTRIMAZOLE-BETAMETHASONE 1-0.05 % TOP CREAM,,12777,LOCAL,Facility,Inpatient,15,g,,237,201.45,67.9242,237,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
CLOTRIMAZOLE-BETAMETHASONE 1-0.05 % TOP CREAM,,12777,LOCAL,Facility,Outpatient,15,g,,237,201.45,67.9242,237,Medica,Medical Assistance,105.702,44.6,,percent of total billed charges,,
CLOTRIMAZOLE-BETAMETHASONE 1-0.05 % TOP CREAM,,12777,LOCAL,Facility,Inpatient,15,g,,237,201.45,67.9242,237,Medica,Medical Assistance,,,,,Included in per diem rate,
CLOTRIMAZOLE-BETAMETHASONE 1-0.05 % TOP CREAM,,12777,LOCAL,Facility,Outpatient,15,g,,237,201.45,67.9242,237,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,118.026,49.8,,percent of total billed charges,,
CLOTRIMAZOLE-BETAMETHASONE 1-0.05 % TOP CREAM,,12777,LOCAL,Facility,Inpatient,15,g,,237,201.45,67.9242,237,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
CLOTRIMAZOLE-BETAMETHASONE 1-0.05 % TOP CREAM,,12777,LOCAL,Facility,Both,15,g,,237,201.45,67.9242,237,"Multiplan, Inc.","Multiplan, Inc.",222.78,94,,percent of total billed charges,,
CLOTRIMAZOLE-BETAMETHASONE 1-0.05 % TOP CREAM,,12777,LOCAL,Facility,Outpatient,15,g,,237,201.45,67.9242,237,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,213.537,90.1,,percent of total billed charges,,
CLOTRIMAZOLE-BETAMETHASONE 1-0.05 % TOP CREAM,,12777,LOCAL,Facility,Inpatient,15,g,,237,201.45,67.9242,237,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
CLOTRIMAZOLE-BETAMETHASONE 1-0.05 % TOP CREAM,,12777,LOCAL,Facility,Both,15,g,,237,201.45,67.9242,237,"Preferred One Administrative Services, INC.",PPO,233.682,98.6,,percent of total billed charges,,
CLOTRIMAZOLE-BETAMETHASONE 1-0.05 % TOP CREAM,,12777,LOCAL,Facility,Outpatient,15,g,,237,201.45,67.9242,237,PrimeWest Health,Minnesota Senior Health Options (MSHO),121.9365,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
CLOTRIMAZOLE-BETAMETHASONE 1-0.05 % TOP CREAM,,12777,LOCAL,Facility,Inpatient,15,g,,237,201.45,67.9242,237,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CLOTRIMAZOLE-BETAMETHASONE 1-0.05 % TOP CREAM,,12777,LOCAL,Facility,Outpatient,15,g,,237,201.45,67.9242,237,PrimeWest Health,MinnesotaCare,121.7232,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
CLOTRIMAZOLE-BETAMETHASONE 1-0.05 % TOP CREAM,,12777,LOCAL,Facility,Inpatient,15,g,,237,201.45,67.9242,237,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
CLOTRIMAZOLE-BETAMETHASONE 1-0.05 % TOP CREAM,,12777,LOCAL,Facility,Both,15,g,,237,201.45,67.9242,237,Sanford Health Plan,Sanford Health Plan,218.04,92,,percent of total billed charges,,
CLOTRIMAZOLE-BETAMETHASONE 1-0.05 % TOP CREAM,,12777,LOCAL,Facility,Outpatient,15,g,,237,201.45,67.9242,237,"UCare Health, Inc.",Individual & Family Plan,133.5495,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
CLOTRIMAZOLE-BETAMETHASONE 1-0.05 % TOP CREAM,,12777,LOCAL,Facility,Inpatient,15,g,,237,201.45,67.9242,237,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
CLOTRIMAZOLE-BETAMETHASONE 1-0.05 % TOP CREAM,,12777,LOCAL,Facility,Outpatient,15,g,,237,201.45,67.9242,237,"UCare Health, Inc.",Medical Assistance,119.6139,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CLOTRIMAZOLE-BETAMETHASONE 1-0.05 % TOP CREAM,,12777,LOCAL,Facility,Inpatient,15,g,,237,201.45,67.9242,237,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
CLOTRIMAZOLE-BETAMETHASONE 1-0.05 % TOP CREAM,,12777,LOCAL,Facility,Outpatient,15,g,,237,201.45,67.9242,237,"UCare Health, Inc.",Medicare Advantage,119.6139,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CLOTRIMAZOLE-BETAMETHASONE 1-0.05 % TOP CREAM,,12777,LOCAL,Facility,Inpatient,15,g,,237,201.45,67.9242,237,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CLOTRIMAZOLE-BETAMETHASONE 1-0.05 % TOP CREAM,,12777,LOCAL,Facility,Outpatient,15,g,,237,201.45,67.9242,237,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),119.6139,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CLOTRIMAZOLE-BETAMETHASONE 1-0.05 % TOP CREAM,,12777,LOCAL,Facility,Inpatient,15,g,,237,201.45,67.9242,237,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CLOTRIMAZOLE-BETAMETHASONE 1-0.05 % TOP CREAM,,12777,LOCAL,Facility,Both,15,g,,237,201.45,67.9242,237,UnitedHealthcare,Individual & Family,222.78,94,,percent of total billed charges,,
CLOTRIMAZOLE-BETAMETHASONE 1-0.05 % TOP CREAM,,12777,LOCAL,Facility,Outpatient,15,g,,237,201.45,67.9242,237,UnitedHealthcare,Medicare Advantage,116.13,49,,percent of total billed charges,,
CLOTRIMAZOLE-BETAMETHASONE 1-0.05 % TOP CREAM,,12777,LOCAL,Facility,Inpatient,15,g,,237,201.45,67.9242,237,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
CLOTRIMAZOLE-BETAMETHASONE 1-0.05 % TOP CREAM,,12777,LOCAL,Facility,Outpatient,15,g,,237,201.45,67.9242,237,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,113.76,48,,percent of total billed charges,,100% of DHS outpatient percentage
CLOTRIMAZOLE-BETAMETHASONE 1-0.05 % TOP CREAM,,12777,LOCAL,Facility,Inpatient,15,g,,237,201.45,67.9242,237,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
MUPIROCIN 2 % TOP OINT,,16394,LOCAL,Facility,Both,15,g,,82,69.7,23.5012,82,Aetna,Commercial,75.44,92,,percent of total billed charges,,
MUPIROCIN 2 % TOP OINT,,16394,LOCAL,Facility,Outpatient,15,g,,82,69.7,23.5012,82,Aetna,Medicare Advantage,40.18,49,,percent of total billed charges,,
MUPIROCIN 2 % TOP OINT,,16394,LOCAL,Facility,Inpatient,15,g,,82,69.7,23.5012,82,Aetna,Medicare Advantage,,,,,Included in per diem rate,
MUPIROCIN 2 % TOP OINT,,16394,LOCAL,Facility,Both,15,g,,82,69.7,23.5012,82,Aetna,PPO,76.26,93,,percent of total billed charges,,
MUPIROCIN 2 % TOP OINT,,16394,LOCAL,Facility,Both,15,g,,82,69.7,23.5012,82,America's PPO,America's PPO,78.7446,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
MUPIROCIN 2 % TOP OINT,,16394,LOCAL,Facility,Both,15,g,,82,69.7,23.5012,82,BlueCross BlueShield Minnesota, Federal Employee Program,80.688,98.4,,percent of total billed charges,,
MUPIROCIN 2 % TOP OINT,,16394,LOCAL,Facility,Both,15,g,,82,69.7,23.5012,82,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,82,100,,percent of total billed charges,,
MUPIROCIN 2 % TOP OINT,,16394,LOCAL,Facility,Both,15,g,,82,69.7,23.5012,82,BlueCross BlueShield Minnesota,High Value Network Plan,73.8,90,,percent of total billed charges,,
MUPIROCIN 2 % TOP OINT,,16394,LOCAL,Facility,Outpatient,15,g,,82,69.7,23.5012,82,BlueCross BlueShield Minnesota,Medicare Advantage,40.18,49,,percent of total billed charges,,
MUPIROCIN 2 % TOP OINT,,16394,LOCAL,Facility,Inpatient,15,g,,82,69.7,23.5012,82,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
MUPIROCIN 2 % TOP OINT,,16394,LOCAL,Facility,Both,15,g,,82,69.7,23.5012,82,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,72.6274,88.57,,percent of total billed charges,,
MUPIROCIN 2 % TOP OINT,,16394,LOCAL,Facility,Both,15,g,,82,69.7,23.5012,82,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,23.5012,28.66,,percent of total billed charges,,
MUPIROCIN 2 % TOP OINT,,16394,LOCAL,Facility,Outpatient,15,g,,82,69.7,23.5012,82,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),40.18,49,,percent of total billed charges,,
MUPIROCIN 2 % TOP OINT,,16394,LOCAL,Facility,Inpatient,15,g,,82,69.7,23.5012,82,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
MUPIROCIN 2 % TOP OINT,,16394,LOCAL,Facility,Both,15,g,,82,69.7,23.5012,82,CorVel,Worker's Compensation,82,100,,percent of total billed charges,,
MUPIROCIN 2 % TOP OINT,,16394,LOCAL,Facility,Both,15,g,,82,69.7,23.5012,82,First Health Group Corporation,First Health Network,79.54,97,,percent of total billed charges,,
MUPIROCIN 2 % TOP OINT,,16394,LOCAL,Facility,Both,15,g,,82,69.7,23.5012,82,"Health Partners, Inc.",Commercial,77.572,94.6,,percent of total billed charges,,
MUPIROCIN 2 % TOP OINT,,16394,LOCAL,Facility,Outpatient,15,g,,82,69.7,23.5012,82,"Health Partners, Inc.",Medicare Advantage,40.18,49,,percent of total billed charges,,
MUPIROCIN 2 % TOP OINT,,16394,LOCAL,Facility,Inpatient,15,g,,82,69.7,23.5012,82,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
MUPIROCIN 2 % TOP OINT,,16394,LOCAL,Facility,Both,15,g,,82,69.7,23.5012,82,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),49.2,60,,percent of total billed charges,,
MUPIROCIN 2 % TOP OINT,,16394,LOCAL,Facility,Both,15,g,,82,69.7,23.5012,82,"Health Partners, Inc.",State of Minnesota Advantage Program,66.83,81.5,,percent of total billed charges,,
MUPIROCIN 2 % TOP OINT,,16394,LOCAL,Facility,Both,15,g,,82,69.7,23.5012,82,"Health Partners, Inc.",State Public Programs,41,50,,percent of total billed charges,,
MUPIROCIN 2 % TOP OINT,,16394,LOCAL,Facility,Both,15,g,,82,69.7,23.5012,82,Humana Insurance Company,Commercial PPO,77.9,95,,percent of total billed charges,,
MUPIROCIN 2 % TOP OINT,,16394,LOCAL,Facility,Outpatient,15,g,,82,69.7,23.5012,82,Humana Insurance Company,Medicare PPO,40.18,49,,percent of total billed charges,,
MUPIROCIN 2 % TOP OINT,,16394,LOCAL,Facility,Inpatient,15,g,,82,69.7,23.5012,82,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
MUPIROCIN 2 % TOP OINT,,16394,LOCAL,Facility,Both,15,g,,82,69.7,23.5012,82,Medica,Individual & Family,81.262,99.1,,percent of total billed charges,,
MUPIROCIN 2 % TOP OINT,,16394,LOCAL,Facility,Outpatient,15,g,,82,69.7,23.5012,82,Medica,Medica Advantage Solution,40.836,49.8,,percent of total billed charges,,
MUPIROCIN 2 % TOP OINT,,16394,LOCAL,Facility,Inpatient,15,g,,82,69.7,23.5012,82,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
MUPIROCIN 2 % TOP OINT,,16394,LOCAL,Facility,Outpatient,15,g,,82,69.7,23.5012,82,Medica,Medical Assistance,36.572,44.6,,percent of total billed charges,,
MUPIROCIN 2 % TOP OINT,,16394,LOCAL,Facility,Inpatient,15,g,,82,69.7,23.5012,82,Medica,Medical Assistance,,,,,Included in per diem rate,
MUPIROCIN 2 % TOP OINT,,16394,LOCAL,Facility,Outpatient,15,g,,82,69.7,23.5012,82,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,40.836,49.8,,percent of total billed charges,,
MUPIROCIN 2 % TOP OINT,,16394,LOCAL,Facility,Inpatient,15,g,,82,69.7,23.5012,82,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
MUPIROCIN 2 % TOP OINT,,16394,LOCAL,Facility,Both,15,g,,82,69.7,23.5012,82,"Multiplan, Inc.","Multiplan, Inc.",77.08,94,,percent of total billed charges,,
MUPIROCIN 2 % TOP OINT,,16394,LOCAL,Facility,Outpatient,15,g,,82,69.7,23.5012,82,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,73.882,90.1,,percent of total billed charges,,
MUPIROCIN 2 % TOP OINT,,16394,LOCAL,Facility,Inpatient,15,g,,82,69.7,23.5012,82,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
MUPIROCIN 2 % TOP OINT,,16394,LOCAL,Facility,Both,15,g,,82,69.7,23.5012,82,"Preferred One Administrative Services, INC.",PPO,80.852,98.6,,percent of total billed charges,,
MUPIROCIN 2 % TOP OINT,,16394,LOCAL,Facility,Outpatient,15,g,,82,69.7,23.5012,82,PrimeWest Health,Minnesota Senior Health Options (MSHO),42.189,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
MUPIROCIN 2 % TOP OINT,,16394,LOCAL,Facility,Inpatient,15,g,,82,69.7,23.5012,82,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
MUPIROCIN 2 % TOP OINT,,16394,LOCAL,Facility,Outpatient,15,g,,82,69.7,23.5012,82,PrimeWest Health,MinnesotaCare,42.1152,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
MUPIROCIN 2 % TOP OINT,,16394,LOCAL,Facility,Inpatient,15,g,,82,69.7,23.5012,82,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
MUPIROCIN 2 % TOP OINT,,16394,LOCAL,Facility,Both,15,g,,82,69.7,23.5012,82,Sanford Health Plan,Sanford Health Plan,75.44,92,,percent of total billed charges,,
MUPIROCIN 2 % TOP OINT,,16394,LOCAL,Facility,Outpatient,15,g,,82,69.7,23.5012,82,"UCare Health, Inc.",Individual & Family Plan,46.207,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
MUPIROCIN 2 % TOP OINT,,16394,LOCAL,Facility,Inpatient,15,g,,82,69.7,23.5012,82,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
MUPIROCIN 2 % TOP OINT,,16394,LOCAL,Facility,Outpatient,15,g,,82,69.7,23.5012,82,"UCare Health, Inc.",Medical Assistance,41.3854,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MUPIROCIN 2 % TOP OINT,,16394,LOCAL,Facility,Inpatient,15,g,,82,69.7,23.5012,82,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
MUPIROCIN 2 % TOP OINT,,16394,LOCAL,Facility,Outpatient,15,g,,82,69.7,23.5012,82,"UCare Health, Inc.",Medicare Advantage,41.3854,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MUPIROCIN 2 % TOP OINT,,16394,LOCAL,Facility,Inpatient,15,g,,82,69.7,23.5012,82,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
MUPIROCIN 2 % TOP OINT,,16394,LOCAL,Facility,Outpatient,15,g,,82,69.7,23.5012,82,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),41.3854,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MUPIROCIN 2 % TOP OINT,,16394,LOCAL,Facility,Inpatient,15,g,,82,69.7,23.5012,82,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
MUPIROCIN 2 % TOP OINT,,16394,LOCAL,Facility,Both,15,g,,82,69.7,23.5012,82,UnitedHealthcare,Individual & Family,77.08,94,,percent of total billed charges,,
MUPIROCIN 2 % TOP OINT,,16394,LOCAL,Facility,Outpatient,15,g,,82,69.7,23.5012,82,UnitedHealthcare,Medicare Advantage,40.18,49,,percent of total billed charges,,
MUPIROCIN 2 % TOP OINT,,16394,LOCAL,Facility,Inpatient,15,g,,82,69.7,23.5012,82,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
MUPIROCIN 2 % TOP OINT,,16394,LOCAL,Facility,Outpatient,15,g,,82,69.7,23.5012,82,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,39.36,48,,percent of total billed charges,,100% of DHS outpatient percentage
MUPIROCIN 2 % TOP OINT,,16394,LOCAL,Facility,Inpatient,15,g,,82,69.7,23.5012,82,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"NYSTATIN 100,000 UNIT/GRAM TOP POWD",,16891,LOCAL,Facility,Both,15,SQUEEZ BTL,,23,19.55,6.5918,23,Aetna,Commercial,21.16,92,,percent of total billed charges,,
"NYSTATIN 100,000 UNIT/GRAM TOP POWD",,16891,LOCAL,Facility,Outpatient,15,SQUEEZ BTL,,23,19.55,6.5918,23,Aetna,Medicare Advantage,11.27,49,,percent of total billed charges,,
"NYSTATIN 100,000 UNIT/GRAM TOP POWD",,16891,LOCAL,Facility,Inpatient,15,SQUEEZ BTL,,23,19.55,6.5918,23,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"NYSTATIN 100,000 UNIT/GRAM TOP POWD",,16891,LOCAL,Facility,Both,15,SQUEEZ BTL,,23,19.55,6.5918,23,Aetna,PPO,21.39,93,,percent of total billed charges,,
"NYSTATIN 100,000 UNIT/GRAM TOP POWD",,16891,LOCAL,Facility,Both,15,SQUEEZ BTL,,23,19.55,6.5918,23,America's PPO,America's PPO,22.0869,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"NYSTATIN 100,000 UNIT/GRAM TOP POWD",,16891,LOCAL,Facility,Both,15,SQUEEZ BTL,,23,19.55,6.5918,23,BlueCross BlueShield Minnesota, Federal Employee Program,22.632,98.4,,percent of total billed charges,,
"NYSTATIN 100,000 UNIT/GRAM TOP POWD",,16891,LOCAL,Facility,Both,15,SQUEEZ BTL,,23,19.55,6.5918,23,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,23,100,,percent of total billed charges,,
"NYSTATIN 100,000 UNIT/GRAM TOP POWD",,16891,LOCAL,Facility,Both,15,SQUEEZ BTL,,23,19.55,6.5918,23,BlueCross BlueShield Minnesota,High Value Network Plan,20.7,90,,percent of total billed charges,,
"NYSTATIN 100,000 UNIT/GRAM TOP POWD",,16891,LOCAL,Facility,Outpatient,15,SQUEEZ BTL,,23,19.55,6.5918,23,BlueCross BlueShield Minnesota,Medicare Advantage,11.27,49,,percent of total billed charges,,
"NYSTATIN 100,000 UNIT/GRAM TOP POWD",,16891,LOCAL,Facility,Inpatient,15,SQUEEZ BTL,,23,19.55,6.5918,23,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"NYSTATIN 100,000 UNIT/GRAM TOP POWD",,16891,LOCAL,Facility,Both,15,SQUEEZ BTL,,23,19.55,6.5918,23,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,20.3711,88.57,,percent of total billed charges,,
"NYSTATIN 100,000 UNIT/GRAM TOP POWD",,16891,LOCAL,Facility,Both,15,SQUEEZ BTL,,23,19.55,6.5918,23,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,6.5918,28.66,,percent of total billed charges,,
"NYSTATIN 100,000 UNIT/GRAM TOP POWD",,16891,LOCAL,Facility,Outpatient,15,SQUEEZ BTL,,23,19.55,6.5918,23,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),11.27,49,,percent of total billed charges,,
"NYSTATIN 100,000 UNIT/GRAM TOP POWD",,16891,LOCAL,Facility,Inpatient,15,SQUEEZ BTL,,23,19.55,6.5918,23,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"NYSTATIN 100,000 UNIT/GRAM TOP POWD",,16891,LOCAL,Facility,Both,15,SQUEEZ BTL,,23,19.55,6.5918,23,CorVel,Worker's Compensation,23,100,,percent of total billed charges,,
"NYSTATIN 100,000 UNIT/GRAM TOP POWD",,16891,LOCAL,Facility,Both,15,SQUEEZ BTL,,23,19.55,6.5918,23,First Health Group Corporation,First Health Network,22.31,97,,percent of total billed charges,,
"NYSTATIN 100,000 UNIT/GRAM TOP POWD",,16891,LOCAL,Facility,Both,15,SQUEEZ BTL,,23,19.55,6.5918,23,"Health Partners, Inc.",Commercial,21.758,94.6,,percent of total billed charges,,
"NYSTATIN 100,000 UNIT/GRAM TOP POWD",,16891,LOCAL,Facility,Outpatient,15,SQUEEZ BTL,,23,19.55,6.5918,23,"Health Partners, Inc.",Medicare Advantage,11.27,49,,percent of total billed charges,,
"NYSTATIN 100,000 UNIT/GRAM TOP POWD",,16891,LOCAL,Facility,Inpatient,15,SQUEEZ BTL,,23,19.55,6.5918,23,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"NYSTATIN 100,000 UNIT/GRAM TOP POWD",,16891,LOCAL,Facility,Both,15,SQUEEZ BTL,,23,19.55,6.5918,23,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),13.8,60,,percent of total billed charges,,
"NYSTATIN 100,000 UNIT/GRAM TOP POWD",,16891,LOCAL,Facility,Both,15,SQUEEZ BTL,,23,19.55,6.5918,23,"Health Partners, Inc.",State of Minnesota Advantage Program,18.745,81.5,,percent of total billed charges,,
"NYSTATIN 100,000 UNIT/GRAM TOP POWD",,16891,LOCAL,Facility,Both,15,SQUEEZ BTL,,23,19.55,6.5918,23,"Health Partners, Inc.",State Public Programs,11.5,50,,percent of total billed charges,,
"NYSTATIN 100,000 UNIT/GRAM TOP POWD",,16891,LOCAL,Facility,Both,15,SQUEEZ BTL,,23,19.55,6.5918,23,Humana Insurance Company,Commercial PPO,21.85,95,,percent of total billed charges,,
"NYSTATIN 100,000 UNIT/GRAM TOP POWD",,16891,LOCAL,Facility,Outpatient,15,SQUEEZ BTL,,23,19.55,6.5918,23,Humana Insurance Company,Medicare PPO,11.27,49,,percent of total billed charges,,
"NYSTATIN 100,000 UNIT/GRAM TOP POWD",,16891,LOCAL,Facility,Inpatient,15,SQUEEZ BTL,,23,19.55,6.5918,23,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"NYSTATIN 100,000 UNIT/GRAM TOP POWD",,16891,LOCAL,Facility,Both,15,SQUEEZ BTL,,23,19.55,6.5918,23,Medica,Individual & Family,22.793,99.1,,percent of total billed charges,,
"NYSTATIN 100,000 UNIT/GRAM TOP POWD",,16891,LOCAL,Facility,Outpatient,15,SQUEEZ BTL,,23,19.55,6.5918,23,Medica,Medica Advantage Solution,11.454,49.8,,percent of total billed charges,,
"NYSTATIN 100,000 UNIT/GRAM TOP POWD",,16891,LOCAL,Facility,Inpatient,15,SQUEEZ BTL,,23,19.55,6.5918,23,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"NYSTATIN 100,000 UNIT/GRAM TOP POWD",,16891,LOCAL,Facility,Outpatient,15,SQUEEZ BTL,,23,19.55,6.5918,23,Medica,Medical Assistance,10.258,44.6,,percent of total billed charges,,
"NYSTATIN 100,000 UNIT/GRAM TOP POWD",,16891,LOCAL,Facility,Inpatient,15,SQUEEZ BTL,,23,19.55,6.5918,23,Medica,Medical Assistance,,,,,Included in per diem rate,
"NYSTATIN 100,000 UNIT/GRAM TOP POWD",,16891,LOCAL,Facility,Outpatient,15,SQUEEZ BTL,,23,19.55,6.5918,23,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,11.454,49.8,,percent of total billed charges,,
"NYSTATIN 100,000 UNIT/GRAM TOP POWD",,16891,LOCAL,Facility,Inpatient,15,SQUEEZ BTL,,23,19.55,6.5918,23,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"NYSTATIN 100,000 UNIT/GRAM TOP POWD",,16891,LOCAL,Facility,Both,15,SQUEEZ BTL,,23,19.55,6.5918,23,"Multiplan, Inc.","Multiplan, Inc.",21.62,94,,percent of total billed charges,,
"NYSTATIN 100,000 UNIT/GRAM TOP POWD",,16891,LOCAL,Facility,Outpatient,15,SQUEEZ BTL,,23,19.55,6.5918,23,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,20.723,90.1,,percent of total billed charges,,
"NYSTATIN 100,000 UNIT/GRAM TOP POWD",,16891,LOCAL,Facility,Inpatient,15,SQUEEZ BTL,,23,19.55,6.5918,23,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"NYSTATIN 100,000 UNIT/GRAM TOP POWD",,16891,LOCAL,Facility,Both,15,SQUEEZ BTL,,23,19.55,6.5918,23,"Preferred One Administrative Services, INC.",PPO,22.678,98.6,,percent of total billed charges,,
"NYSTATIN 100,000 UNIT/GRAM TOP POWD",,16891,LOCAL,Facility,Outpatient,15,SQUEEZ BTL,,23,19.55,6.5918,23,PrimeWest Health,Minnesota Senior Health Options (MSHO),11.8335,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"NYSTATIN 100,000 UNIT/GRAM TOP POWD",,16891,LOCAL,Facility,Inpatient,15,SQUEEZ BTL,,23,19.55,6.5918,23,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"NYSTATIN 100,000 UNIT/GRAM TOP POWD",,16891,LOCAL,Facility,Outpatient,15,SQUEEZ BTL,,23,19.55,6.5918,23,PrimeWest Health,MinnesotaCare,11.8128,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"NYSTATIN 100,000 UNIT/GRAM TOP POWD",,16891,LOCAL,Facility,Inpatient,15,SQUEEZ BTL,,23,19.55,6.5918,23,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"NYSTATIN 100,000 UNIT/GRAM TOP POWD",,16891,LOCAL,Facility,Both,15,SQUEEZ BTL,,23,19.55,6.5918,23,Sanford Health Plan,Sanford Health Plan,21.16,92,,percent of total billed charges,,
"NYSTATIN 100,000 UNIT/GRAM TOP POWD",,16891,LOCAL,Facility,Outpatient,15,SQUEEZ BTL,,23,19.55,6.5918,23,"UCare Health, Inc.",Individual & Family Plan,12.9605,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"NYSTATIN 100,000 UNIT/GRAM TOP POWD",,16891,LOCAL,Facility,Inpatient,15,SQUEEZ BTL,,23,19.55,6.5918,23,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"NYSTATIN 100,000 UNIT/GRAM TOP POWD",,16891,LOCAL,Facility,Outpatient,15,SQUEEZ BTL,,23,19.55,6.5918,23,"UCare Health, Inc.",Medical Assistance,11.6081,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"NYSTATIN 100,000 UNIT/GRAM TOP POWD",,16891,LOCAL,Facility,Inpatient,15,SQUEEZ BTL,,23,19.55,6.5918,23,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"NYSTATIN 100,000 UNIT/GRAM TOP POWD",,16891,LOCAL,Facility,Outpatient,15,SQUEEZ BTL,,23,19.55,6.5918,23,"UCare Health, Inc.",Medicare Advantage,11.6081,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"NYSTATIN 100,000 UNIT/GRAM TOP POWD",,16891,LOCAL,Facility,Inpatient,15,SQUEEZ BTL,,23,19.55,6.5918,23,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"NYSTATIN 100,000 UNIT/GRAM TOP POWD",,16891,LOCAL,Facility,Outpatient,15,SQUEEZ BTL,,23,19.55,6.5918,23,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),11.6081,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"NYSTATIN 100,000 UNIT/GRAM TOP POWD",,16891,LOCAL,Facility,Inpatient,15,SQUEEZ BTL,,23,19.55,6.5918,23,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"NYSTATIN 100,000 UNIT/GRAM TOP POWD",,16891,LOCAL,Facility,Both,15,SQUEEZ BTL,,23,19.55,6.5918,23,UnitedHealthcare,Individual & Family,21.62,94,,percent of total billed charges,,
"NYSTATIN 100,000 UNIT/GRAM TOP POWD",,16891,LOCAL,Facility,Outpatient,15,SQUEEZ BTL,,23,19.55,6.5918,23,UnitedHealthcare,Medicare Advantage,11.27,49,,percent of total billed charges,,
"NYSTATIN 100,000 UNIT/GRAM TOP POWD",,16891,LOCAL,Facility,Inpatient,15,SQUEEZ BTL,,23,19.55,6.5918,23,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"NYSTATIN 100,000 UNIT/GRAM TOP POWD",,16891,LOCAL,Facility,Outpatient,15,SQUEEZ BTL,,23,19.55,6.5918,23,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,11.04,48,,percent of total billed charges,,100% of DHS outpatient percentage
"NYSTATIN 100,000 UNIT/GRAM TOP POWD",,16891,LOCAL,Facility,Inpatient,15,SQUEEZ BTL,,23,19.55,6.5918,23,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
KETOCONAZOLE 2 % TOP CREAM,,18136,LOCAL,Facility,Both,15,g,,140,119,40.124,140,Aetna,Commercial,128.8,92,,percent of total billed charges,,
KETOCONAZOLE 2 % TOP CREAM,,18136,LOCAL,Facility,Outpatient,15,g,,140,119,40.124,140,Aetna,Medicare Advantage,68.6,49,,percent of total billed charges,,
KETOCONAZOLE 2 % TOP CREAM,,18136,LOCAL,Facility,Inpatient,15,g,,140,119,40.124,140,Aetna,Medicare Advantage,,,,,Included in per diem rate,
KETOCONAZOLE 2 % TOP CREAM,,18136,LOCAL,Facility,Both,15,g,,140,119,40.124,140,Aetna,PPO,130.2,93,,percent of total billed charges,,
KETOCONAZOLE 2 % TOP CREAM,,18136,LOCAL,Facility,Both,15,g,,140,119,40.124,140,America's PPO,America's PPO,134.442,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
KETOCONAZOLE 2 % TOP CREAM,,18136,LOCAL,Facility,Both,15,g,,140,119,40.124,140,BlueCross BlueShield Minnesota, Federal Employee Program,137.76,98.4,,percent of total billed charges,,
KETOCONAZOLE 2 % TOP CREAM,,18136,LOCAL,Facility,Both,15,g,,140,119,40.124,140,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,140,100,,percent of total billed charges,,
KETOCONAZOLE 2 % TOP CREAM,,18136,LOCAL,Facility,Both,15,g,,140,119,40.124,140,BlueCross BlueShield Minnesota,High Value Network Plan,126,90,,percent of total billed charges,,
KETOCONAZOLE 2 % TOP CREAM,,18136,LOCAL,Facility,Outpatient,15,g,,140,119,40.124,140,BlueCross BlueShield Minnesota,Medicare Advantage,68.6,49,,percent of total billed charges,,
KETOCONAZOLE 2 % TOP CREAM,,18136,LOCAL,Facility,Inpatient,15,g,,140,119,40.124,140,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
KETOCONAZOLE 2 % TOP CREAM,,18136,LOCAL,Facility,Both,15,g,,140,119,40.124,140,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,123.998,88.57,,percent of total billed charges,,
KETOCONAZOLE 2 % TOP CREAM,,18136,LOCAL,Facility,Both,15,g,,140,119,40.124,140,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,40.124,28.66,,percent of total billed charges,,
KETOCONAZOLE 2 % TOP CREAM,,18136,LOCAL,Facility,Outpatient,15,g,,140,119,40.124,140,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),68.6,49,,percent of total billed charges,,
KETOCONAZOLE 2 % TOP CREAM,,18136,LOCAL,Facility,Inpatient,15,g,,140,119,40.124,140,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
KETOCONAZOLE 2 % TOP CREAM,,18136,LOCAL,Facility,Both,15,g,,140,119,40.124,140,CorVel,Worker's Compensation,140,100,,percent of total billed charges,,
KETOCONAZOLE 2 % TOP CREAM,,18136,LOCAL,Facility,Both,15,g,,140,119,40.124,140,First Health Group Corporation,First Health Network,135.8,97,,percent of total billed charges,,
KETOCONAZOLE 2 % TOP CREAM,,18136,LOCAL,Facility,Both,15,g,,140,119,40.124,140,"Health Partners, Inc.",Commercial,132.44,94.6,,percent of total billed charges,,
KETOCONAZOLE 2 % TOP CREAM,,18136,LOCAL,Facility,Outpatient,15,g,,140,119,40.124,140,"Health Partners, Inc.",Medicare Advantage,68.6,49,,percent of total billed charges,,
KETOCONAZOLE 2 % TOP CREAM,,18136,LOCAL,Facility,Inpatient,15,g,,140,119,40.124,140,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
KETOCONAZOLE 2 % TOP CREAM,,18136,LOCAL,Facility,Both,15,g,,140,119,40.124,140,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),84,60,,percent of total billed charges,,
KETOCONAZOLE 2 % TOP CREAM,,18136,LOCAL,Facility,Both,15,g,,140,119,40.124,140,"Health Partners, Inc.",State of Minnesota Advantage Program,114.1,81.5,,percent of total billed charges,,
KETOCONAZOLE 2 % TOP CREAM,,18136,LOCAL,Facility,Both,15,g,,140,119,40.124,140,"Health Partners, Inc.",State Public Programs,70,50,,percent of total billed charges,,
KETOCONAZOLE 2 % TOP CREAM,,18136,LOCAL,Facility,Both,15,g,,140,119,40.124,140,Humana Insurance Company,Commercial PPO,133,95,,percent of total billed charges,,
KETOCONAZOLE 2 % TOP CREAM,,18136,LOCAL,Facility,Outpatient,15,g,,140,119,40.124,140,Humana Insurance Company,Medicare PPO,68.6,49,,percent of total billed charges,,
KETOCONAZOLE 2 % TOP CREAM,,18136,LOCAL,Facility,Inpatient,15,g,,140,119,40.124,140,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
KETOCONAZOLE 2 % TOP CREAM,,18136,LOCAL,Facility,Both,15,g,,140,119,40.124,140,Medica,Individual & Family,138.74,99.1,,percent of total billed charges,,
KETOCONAZOLE 2 % TOP CREAM,,18136,LOCAL,Facility,Outpatient,15,g,,140,119,40.124,140,Medica,Medica Advantage Solution,69.72,49.8,,percent of total billed charges,,
KETOCONAZOLE 2 % TOP CREAM,,18136,LOCAL,Facility,Inpatient,15,g,,140,119,40.124,140,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
KETOCONAZOLE 2 % TOP CREAM,,18136,LOCAL,Facility,Outpatient,15,g,,140,119,40.124,140,Medica,Medical Assistance,62.44,44.6,,percent of total billed charges,,
KETOCONAZOLE 2 % TOP CREAM,,18136,LOCAL,Facility,Inpatient,15,g,,140,119,40.124,140,Medica,Medical Assistance,,,,,Included in per diem rate,
KETOCONAZOLE 2 % TOP CREAM,,18136,LOCAL,Facility,Outpatient,15,g,,140,119,40.124,140,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,69.72,49.8,,percent of total billed charges,,
KETOCONAZOLE 2 % TOP CREAM,,18136,LOCAL,Facility,Inpatient,15,g,,140,119,40.124,140,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
KETOCONAZOLE 2 % TOP CREAM,,18136,LOCAL,Facility,Both,15,g,,140,119,40.124,140,"Multiplan, Inc.","Multiplan, Inc.",131.6,94,,percent of total billed charges,,
KETOCONAZOLE 2 % TOP CREAM,,18136,LOCAL,Facility,Outpatient,15,g,,140,119,40.124,140,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,126.14,90.1,,percent of total billed charges,,
KETOCONAZOLE 2 % TOP CREAM,,18136,LOCAL,Facility,Inpatient,15,g,,140,119,40.124,140,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
KETOCONAZOLE 2 % TOP CREAM,,18136,LOCAL,Facility,Both,15,g,,140,119,40.124,140,"Preferred One Administrative Services, INC.",PPO,138.04,98.6,,percent of total billed charges,,
KETOCONAZOLE 2 % TOP CREAM,,18136,LOCAL,Facility,Outpatient,15,g,,140,119,40.124,140,PrimeWest Health,Minnesota Senior Health Options (MSHO),72.03,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
KETOCONAZOLE 2 % TOP CREAM,,18136,LOCAL,Facility,Inpatient,15,g,,140,119,40.124,140,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
KETOCONAZOLE 2 % TOP CREAM,,18136,LOCAL,Facility,Outpatient,15,g,,140,119,40.124,140,PrimeWest Health,MinnesotaCare,71.904,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
KETOCONAZOLE 2 % TOP CREAM,,18136,LOCAL,Facility,Inpatient,15,g,,140,119,40.124,140,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
KETOCONAZOLE 2 % TOP CREAM,,18136,LOCAL,Facility,Both,15,g,,140,119,40.124,140,Sanford Health Plan,Sanford Health Plan,128.8,92,,percent of total billed charges,,
KETOCONAZOLE 2 % TOP CREAM,,18136,LOCAL,Facility,Outpatient,15,g,,140,119,40.124,140,"UCare Health, Inc.",Individual & Family Plan,78.89,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
KETOCONAZOLE 2 % TOP CREAM,,18136,LOCAL,Facility,Inpatient,15,g,,140,119,40.124,140,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
KETOCONAZOLE 2 % TOP CREAM,,18136,LOCAL,Facility,Outpatient,15,g,,140,119,40.124,140,"UCare Health, Inc.",Medical Assistance,70.658,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
KETOCONAZOLE 2 % TOP CREAM,,18136,LOCAL,Facility,Inpatient,15,g,,140,119,40.124,140,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
KETOCONAZOLE 2 % TOP CREAM,,18136,LOCAL,Facility,Outpatient,15,g,,140,119,40.124,140,"UCare Health, Inc.",Medicare Advantage,70.658,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
KETOCONAZOLE 2 % TOP CREAM,,18136,LOCAL,Facility,Inpatient,15,g,,140,119,40.124,140,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
KETOCONAZOLE 2 % TOP CREAM,,18136,LOCAL,Facility,Outpatient,15,g,,140,119,40.124,140,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),70.658,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
KETOCONAZOLE 2 % TOP CREAM,,18136,LOCAL,Facility,Inpatient,15,g,,140,119,40.124,140,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
KETOCONAZOLE 2 % TOP CREAM,,18136,LOCAL,Facility,Both,15,g,,140,119,40.124,140,UnitedHealthcare,Individual & Family,131.6,94,,percent of total billed charges,,
KETOCONAZOLE 2 % TOP CREAM,,18136,LOCAL,Facility,Outpatient,15,g,,140,119,40.124,140,UnitedHealthcare,Medicare Advantage,68.6,49,,percent of total billed charges,,
KETOCONAZOLE 2 % TOP CREAM,,18136,LOCAL,Facility,Inpatient,15,g,,140,119,40.124,140,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
KETOCONAZOLE 2 % TOP CREAM,,18136,LOCAL,Facility,Outpatient,15,g,,140,119,40.124,140,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,67.2,48,,percent of total billed charges,,100% of DHS outpatient percentage
KETOCONAZOLE 2 % TOP CREAM,,18136,LOCAL,Facility,Inpatient,15,g,,140,119,40.124,140,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
GENTAMICIN 0.1 % TOP OINT,,19681,LOCAL,Facility,Both,15,g,,223,189.55,63.9118,223,Aetna,Commercial,205.16,92,,percent of total billed charges,,
GENTAMICIN 0.1 % TOP OINT,,19681,LOCAL,Facility,Outpatient,15,g,,223,189.55,63.9118,223,Aetna,Medicare Advantage,109.27,49,,percent of total billed charges,,
GENTAMICIN 0.1 % TOP OINT,,19681,LOCAL,Facility,Inpatient,15,g,,223,189.55,63.9118,223,Aetna,Medicare Advantage,,,,,Included in per diem rate,
GENTAMICIN 0.1 % TOP OINT,,19681,LOCAL,Facility,Both,15,g,,223,189.55,63.9118,223,Aetna,PPO,207.39,93,,percent of total billed charges,,
GENTAMICIN 0.1 % TOP OINT,,19681,LOCAL,Facility,Both,15,g,,223,189.55,63.9118,223,America's PPO,America's PPO,214.1469,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
GENTAMICIN 0.1 % TOP OINT,,19681,LOCAL,Facility,Both,15,g,,223,189.55,63.9118,223,BlueCross BlueShield Minnesota, Federal Employee Program,219.432,98.4,,percent of total billed charges,,
GENTAMICIN 0.1 % TOP OINT,,19681,LOCAL,Facility,Both,15,g,,223,189.55,63.9118,223,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,223,100,,percent of total billed charges,,
GENTAMICIN 0.1 % TOP OINT,,19681,LOCAL,Facility,Both,15,g,,223,189.55,63.9118,223,BlueCross BlueShield Minnesota,High Value Network Plan,200.7,90,,percent of total billed charges,,
GENTAMICIN 0.1 % TOP OINT,,19681,LOCAL,Facility,Outpatient,15,g,,223,189.55,63.9118,223,BlueCross BlueShield Minnesota,Medicare Advantage,109.27,49,,percent of total billed charges,,
GENTAMICIN 0.1 % TOP OINT,,19681,LOCAL,Facility,Inpatient,15,g,,223,189.55,63.9118,223,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
GENTAMICIN 0.1 % TOP OINT,,19681,LOCAL,Facility,Both,15,g,,223,189.55,63.9118,223,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,197.5111,88.57,,percent of total billed charges,,
GENTAMICIN 0.1 % TOP OINT,,19681,LOCAL,Facility,Both,15,g,,223,189.55,63.9118,223,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,63.9118,28.66,,percent of total billed charges,,
GENTAMICIN 0.1 % TOP OINT,,19681,LOCAL,Facility,Outpatient,15,g,,223,189.55,63.9118,223,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),109.27,49,,percent of total billed charges,,
GENTAMICIN 0.1 % TOP OINT,,19681,LOCAL,Facility,Inpatient,15,g,,223,189.55,63.9118,223,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
GENTAMICIN 0.1 % TOP OINT,,19681,LOCAL,Facility,Both,15,g,,223,189.55,63.9118,223,CorVel,Worker's Compensation,223,100,,percent of total billed charges,,
GENTAMICIN 0.1 % TOP OINT,,19681,LOCAL,Facility,Both,15,g,,223,189.55,63.9118,223,First Health Group Corporation,First Health Network,216.31,97,,percent of total billed charges,,
GENTAMICIN 0.1 % TOP OINT,,19681,LOCAL,Facility,Both,15,g,,223,189.55,63.9118,223,"Health Partners, Inc.",Commercial,210.958,94.6,,percent of total billed charges,,
GENTAMICIN 0.1 % TOP OINT,,19681,LOCAL,Facility,Outpatient,15,g,,223,189.55,63.9118,223,"Health Partners, Inc.",Medicare Advantage,109.27,49,,percent of total billed charges,,
GENTAMICIN 0.1 % TOP OINT,,19681,LOCAL,Facility,Inpatient,15,g,,223,189.55,63.9118,223,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
GENTAMICIN 0.1 % TOP OINT,,19681,LOCAL,Facility,Both,15,g,,223,189.55,63.9118,223,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),133.8,60,,percent of total billed charges,,
GENTAMICIN 0.1 % TOP OINT,,19681,LOCAL,Facility,Both,15,g,,223,189.55,63.9118,223,"Health Partners, Inc.",State of Minnesota Advantage Program,181.745,81.5,,percent of total billed charges,,
GENTAMICIN 0.1 % TOP OINT,,19681,LOCAL,Facility,Both,15,g,,223,189.55,63.9118,223,"Health Partners, Inc.",State Public Programs,111.5,50,,percent of total billed charges,,
GENTAMICIN 0.1 % TOP OINT,,19681,LOCAL,Facility,Both,15,g,,223,189.55,63.9118,223,Humana Insurance Company,Commercial PPO,211.85,95,,percent of total billed charges,,
GENTAMICIN 0.1 % TOP OINT,,19681,LOCAL,Facility,Outpatient,15,g,,223,189.55,63.9118,223,Humana Insurance Company,Medicare PPO,109.27,49,,percent of total billed charges,,
GENTAMICIN 0.1 % TOP OINT,,19681,LOCAL,Facility,Inpatient,15,g,,223,189.55,63.9118,223,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
GENTAMICIN 0.1 % TOP OINT,,19681,LOCAL,Facility,Both,15,g,,223,189.55,63.9118,223,Medica,Individual & Family,220.993,99.1,,percent of total billed charges,,
GENTAMICIN 0.1 % TOP OINT,,19681,LOCAL,Facility,Outpatient,15,g,,223,189.55,63.9118,223,Medica,Medica Advantage Solution,111.054,49.8,,percent of total billed charges,,
GENTAMICIN 0.1 % TOP OINT,,19681,LOCAL,Facility,Inpatient,15,g,,223,189.55,63.9118,223,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
GENTAMICIN 0.1 % TOP OINT,,19681,LOCAL,Facility,Outpatient,15,g,,223,189.55,63.9118,223,Medica,Medical Assistance,99.458,44.6,,percent of total billed charges,,
GENTAMICIN 0.1 % TOP OINT,,19681,LOCAL,Facility,Inpatient,15,g,,223,189.55,63.9118,223,Medica,Medical Assistance,,,,,Included in per diem rate,
GENTAMICIN 0.1 % TOP OINT,,19681,LOCAL,Facility,Outpatient,15,g,,223,189.55,63.9118,223,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,111.054,49.8,,percent of total billed charges,,
GENTAMICIN 0.1 % TOP OINT,,19681,LOCAL,Facility,Inpatient,15,g,,223,189.55,63.9118,223,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
GENTAMICIN 0.1 % TOP OINT,,19681,LOCAL,Facility,Both,15,g,,223,189.55,63.9118,223,"Multiplan, Inc.","Multiplan, Inc.",209.62,94,,percent of total billed charges,,
GENTAMICIN 0.1 % TOP OINT,,19681,LOCAL,Facility,Outpatient,15,g,,223,189.55,63.9118,223,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,200.923,90.1,,percent of total billed charges,,
GENTAMICIN 0.1 % TOP OINT,,19681,LOCAL,Facility,Inpatient,15,g,,223,189.55,63.9118,223,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
GENTAMICIN 0.1 % TOP OINT,,19681,LOCAL,Facility,Both,15,g,,223,189.55,63.9118,223,"Preferred One Administrative Services, INC.",PPO,219.878,98.6,,percent of total billed charges,,
GENTAMICIN 0.1 % TOP OINT,,19681,LOCAL,Facility,Outpatient,15,g,,223,189.55,63.9118,223,PrimeWest Health,Minnesota Senior Health Options (MSHO),114.7335,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
GENTAMICIN 0.1 % TOP OINT,,19681,LOCAL,Facility,Inpatient,15,g,,223,189.55,63.9118,223,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
GENTAMICIN 0.1 % TOP OINT,,19681,LOCAL,Facility,Outpatient,15,g,,223,189.55,63.9118,223,PrimeWest Health,MinnesotaCare,114.5328,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
GENTAMICIN 0.1 % TOP OINT,,19681,LOCAL,Facility,Inpatient,15,g,,223,189.55,63.9118,223,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
GENTAMICIN 0.1 % TOP OINT,,19681,LOCAL,Facility,Both,15,g,,223,189.55,63.9118,223,Sanford Health Plan,Sanford Health Plan,205.16,92,,percent of total billed charges,,
GENTAMICIN 0.1 % TOP OINT,,19681,LOCAL,Facility,Outpatient,15,g,,223,189.55,63.9118,223,"UCare Health, Inc.",Individual & Family Plan,125.6605,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
GENTAMICIN 0.1 % TOP OINT,,19681,LOCAL,Facility,Inpatient,15,g,,223,189.55,63.9118,223,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
GENTAMICIN 0.1 % TOP OINT,,19681,LOCAL,Facility,Outpatient,15,g,,223,189.55,63.9118,223,"UCare Health, Inc.",Medical Assistance,112.5481,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
GENTAMICIN 0.1 % TOP OINT,,19681,LOCAL,Facility,Inpatient,15,g,,223,189.55,63.9118,223,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
GENTAMICIN 0.1 % TOP OINT,,19681,LOCAL,Facility,Outpatient,15,g,,223,189.55,63.9118,223,"UCare Health, Inc.",Medicare Advantage,112.5481,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
GENTAMICIN 0.1 % TOP OINT,,19681,LOCAL,Facility,Inpatient,15,g,,223,189.55,63.9118,223,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
GENTAMICIN 0.1 % TOP OINT,,19681,LOCAL,Facility,Outpatient,15,g,,223,189.55,63.9118,223,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),112.5481,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
GENTAMICIN 0.1 % TOP OINT,,19681,LOCAL,Facility,Inpatient,15,g,,223,189.55,63.9118,223,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
GENTAMICIN 0.1 % TOP OINT,,19681,LOCAL,Facility,Both,15,g,,223,189.55,63.9118,223,UnitedHealthcare,Individual & Family,209.62,94,,percent of total billed charges,,
GENTAMICIN 0.1 % TOP OINT,,19681,LOCAL,Facility,Outpatient,15,g,,223,189.55,63.9118,223,UnitedHealthcare,Medicare Advantage,109.27,49,,percent of total billed charges,,
GENTAMICIN 0.1 % TOP OINT,,19681,LOCAL,Facility,Inpatient,15,g,,223,189.55,63.9118,223,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
GENTAMICIN 0.1 % TOP OINT,,19681,LOCAL,Facility,Outpatient,15,g,,223,189.55,63.9118,223,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,107.04,48,,percent of total billed charges,,100% of DHS outpatient percentage
GENTAMICIN 0.1 % TOP OINT,,19681,LOCAL,Facility,Inpatient,15,g,,223,189.55,63.9118,223,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
LEVALBUTEROL TARTRATE 45 MCG/ACTUATION INHL HFAA,,37969,LOCAL,Facility,Both,15,g,,310,263.5,88.846,310,Aetna,Commercial,285.2,92,,percent of total billed charges,,
LEVALBUTEROL TARTRATE 45 MCG/ACTUATION INHL HFAA,,37969,LOCAL,Facility,Outpatient,15,g,,310,263.5,88.846,310,Aetna,Medicare Advantage,151.9,49,,percent of total billed charges,,
LEVALBUTEROL TARTRATE 45 MCG/ACTUATION INHL HFAA,,37969,LOCAL,Facility,Inpatient,15,g,,310,263.5,88.846,310,Aetna,Medicare Advantage,,,,,Included in per diem rate,
LEVALBUTEROL TARTRATE 45 MCG/ACTUATION INHL HFAA,,37969,LOCAL,Facility,Both,15,g,,310,263.5,88.846,310,Aetna,PPO,288.3,93,,percent of total billed charges,,
LEVALBUTEROL TARTRATE 45 MCG/ACTUATION INHL HFAA,,37969,LOCAL,Facility,Both,15,g,,310,263.5,88.846,310,America's PPO,America's PPO,297.693,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
LEVALBUTEROL TARTRATE 45 MCG/ACTUATION INHL HFAA,,37969,LOCAL,Facility,Both,15,g,,310,263.5,88.846,310,BlueCross BlueShield Minnesota, Federal Employee Program,305.04,98.4,,percent of total billed charges,,
LEVALBUTEROL TARTRATE 45 MCG/ACTUATION INHL HFAA,,37969,LOCAL,Facility,Both,15,g,,310,263.5,88.846,310,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,310,100,,percent of total billed charges,,
LEVALBUTEROL TARTRATE 45 MCG/ACTUATION INHL HFAA,,37969,LOCAL,Facility,Both,15,g,,310,263.5,88.846,310,BlueCross BlueShield Minnesota,High Value Network Plan,279,90,,percent of total billed charges,,
LEVALBUTEROL TARTRATE 45 MCG/ACTUATION INHL HFAA,,37969,LOCAL,Facility,Outpatient,15,g,,310,263.5,88.846,310,BlueCross BlueShield Minnesota,Medicare Advantage,151.9,49,,percent of total billed charges,,
LEVALBUTEROL TARTRATE 45 MCG/ACTUATION INHL HFAA,,37969,LOCAL,Facility,Inpatient,15,g,,310,263.5,88.846,310,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
LEVALBUTEROL TARTRATE 45 MCG/ACTUATION INHL HFAA,,37969,LOCAL,Facility,Both,15,g,,310,263.5,88.846,310,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,274.567,88.57,,percent of total billed charges,,
LEVALBUTEROL TARTRATE 45 MCG/ACTUATION INHL HFAA,,37969,LOCAL,Facility,Both,15,g,,310,263.5,88.846,310,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,88.846,28.66,,percent of total billed charges,,
LEVALBUTEROL TARTRATE 45 MCG/ACTUATION INHL HFAA,,37969,LOCAL,Facility,Outpatient,15,g,,310,263.5,88.846,310,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),151.9,49,,percent of total billed charges,,
LEVALBUTEROL TARTRATE 45 MCG/ACTUATION INHL HFAA,,37969,LOCAL,Facility,Inpatient,15,g,,310,263.5,88.846,310,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
LEVALBUTEROL TARTRATE 45 MCG/ACTUATION INHL HFAA,,37969,LOCAL,Facility,Both,15,g,,310,263.5,88.846,310,CorVel,Worker's Compensation,310,100,,percent of total billed charges,,
LEVALBUTEROL TARTRATE 45 MCG/ACTUATION INHL HFAA,,37969,LOCAL,Facility,Both,15,g,,310,263.5,88.846,310,First Health Group Corporation,First Health Network,300.7,97,,percent of total billed charges,,
LEVALBUTEROL TARTRATE 45 MCG/ACTUATION INHL HFAA,,37969,LOCAL,Facility,Both,15,g,,310,263.5,88.846,310,"Health Partners, Inc.",Commercial,293.26,94.6,,percent of total billed charges,,
LEVALBUTEROL TARTRATE 45 MCG/ACTUATION INHL HFAA,,37969,LOCAL,Facility,Outpatient,15,g,,310,263.5,88.846,310,"Health Partners, Inc.",Medicare Advantage,151.9,49,,percent of total billed charges,,
LEVALBUTEROL TARTRATE 45 MCG/ACTUATION INHL HFAA,,37969,LOCAL,Facility,Inpatient,15,g,,310,263.5,88.846,310,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LEVALBUTEROL TARTRATE 45 MCG/ACTUATION INHL HFAA,,37969,LOCAL,Facility,Both,15,g,,310,263.5,88.846,310,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),186,60,,percent of total billed charges,,
LEVALBUTEROL TARTRATE 45 MCG/ACTUATION INHL HFAA,,37969,LOCAL,Facility,Both,15,g,,310,263.5,88.846,310,"Health Partners, Inc.",State of Minnesota Advantage Program,252.65,81.5,,percent of total billed charges,,
LEVALBUTEROL TARTRATE 45 MCG/ACTUATION INHL HFAA,,37969,LOCAL,Facility,Both,15,g,,310,263.5,88.846,310,"Health Partners, Inc.",State Public Programs,155,50,,percent of total billed charges,,
LEVALBUTEROL TARTRATE 45 MCG/ACTUATION INHL HFAA,,37969,LOCAL,Facility,Both,15,g,,310,263.5,88.846,310,Humana Insurance Company,Commercial PPO,294.5,95,,percent of total billed charges,,
LEVALBUTEROL TARTRATE 45 MCG/ACTUATION INHL HFAA,,37969,LOCAL,Facility,Outpatient,15,g,,310,263.5,88.846,310,Humana Insurance Company,Medicare PPO,151.9,49,,percent of total billed charges,,
LEVALBUTEROL TARTRATE 45 MCG/ACTUATION INHL HFAA,,37969,LOCAL,Facility,Inpatient,15,g,,310,263.5,88.846,310,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
LEVALBUTEROL TARTRATE 45 MCG/ACTUATION INHL HFAA,,37969,LOCAL,Facility,Both,15,g,,310,263.5,88.846,310,Medica,Individual & Family,307.21,99.1,,percent of total billed charges,,
LEVALBUTEROL TARTRATE 45 MCG/ACTUATION INHL HFAA,,37969,LOCAL,Facility,Outpatient,15,g,,310,263.5,88.846,310,Medica,Medica Advantage Solution,154.38,49.8,,percent of total billed charges,,
LEVALBUTEROL TARTRATE 45 MCG/ACTUATION INHL HFAA,,37969,LOCAL,Facility,Inpatient,15,g,,310,263.5,88.846,310,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
LEVALBUTEROL TARTRATE 45 MCG/ACTUATION INHL HFAA,,37969,LOCAL,Facility,Outpatient,15,g,,310,263.5,88.846,310,Medica,Medical Assistance,138.26,44.6,,percent of total billed charges,,
LEVALBUTEROL TARTRATE 45 MCG/ACTUATION INHL HFAA,,37969,LOCAL,Facility,Inpatient,15,g,,310,263.5,88.846,310,Medica,Medical Assistance,,,,,Included in per diem rate,
LEVALBUTEROL TARTRATE 45 MCG/ACTUATION INHL HFAA,,37969,LOCAL,Facility,Outpatient,15,g,,310,263.5,88.846,310,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,154.38,49.8,,percent of total billed charges,,
LEVALBUTEROL TARTRATE 45 MCG/ACTUATION INHL HFAA,,37969,LOCAL,Facility,Inpatient,15,g,,310,263.5,88.846,310,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
LEVALBUTEROL TARTRATE 45 MCG/ACTUATION INHL HFAA,,37969,LOCAL,Facility,Both,15,g,,310,263.5,88.846,310,"Multiplan, Inc.","Multiplan, Inc.",291.4,94,,percent of total billed charges,,
LEVALBUTEROL TARTRATE 45 MCG/ACTUATION INHL HFAA,,37969,LOCAL,Facility,Outpatient,15,g,,310,263.5,88.846,310,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,279.31,90.1,,percent of total billed charges,,
LEVALBUTEROL TARTRATE 45 MCG/ACTUATION INHL HFAA,,37969,LOCAL,Facility,Inpatient,15,g,,310,263.5,88.846,310,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
LEVALBUTEROL TARTRATE 45 MCG/ACTUATION INHL HFAA,,37969,LOCAL,Facility,Both,15,g,,310,263.5,88.846,310,"Preferred One Administrative Services, INC.",PPO,305.66,98.6,,percent of total billed charges,,
LEVALBUTEROL TARTRATE 45 MCG/ACTUATION INHL HFAA,,37969,LOCAL,Facility,Outpatient,15,g,,310,263.5,88.846,310,PrimeWest Health,Minnesota Senior Health Options (MSHO),159.495,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
LEVALBUTEROL TARTRATE 45 MCG/ACTUATION INHL HFAA,,37969,LOCAL,Facility,Inpatient,15,g,,310,263.5,88.846,310,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LEVALBUTEROL TARTRATE 45 MCG/ACTUATION INHL HFAA,,37969,LOCAL,Facility,Outpatient,15,g,,310,263.5,88.846,310,PrimeWest Health,MinnesotaCare,159.216,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
LEVALBUTEROL TARTRATE 45 MCG/ACTUATION INHL HFAA,,37969,LOCAL,Facility,Inpatient,15,g,,310,263.5,88.846,310,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
LEVALBUTEROL TARTRATE 45 MCG/ACTUATION INHL HFAA,,37969,LOCAL,Facility,Both,15,g,,310,263.5,88.846,310,Sanford Health Plan,Sanford Health Plan,285.2,92,,percent of total billed charges,,
LEVALBUTEROL TARTRATE 45 MCG/ACTUATION INHL HFAA,,37969,LOCAL,Facility,Outpatient,15,g,,310,263.5,88.846,310,"UCare Health, Inc.",Individual & Family Plan,174.685,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
LEVALBUTEROL TARTRATE 45 MCG/ACTUATION INHL HFAA,,37969,LOCAL,Facility,Inpatient,15,g,,310,263.5,88.846,310,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
LEVALBUTEROL TARTRATE 45 MCG/ACTUATION INHL HFAA,,37969,LOCAL,Facility,Outpatient,15,g,,310,263.5,88.846,310,"UCare Health, Inc.",Medical Assistance,156.457,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LEVALBUTEROL TARTRATE 45 MCG/ACTUATION INHL HFAA,,37969,LOCAL,Facility,Inpatient,15,g,,310,263.5,88.846,310,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
LEVALBUTEROL TARTRATE 45 MCG/ACTUATION INHL HFAA,,37969,LOCAL,Facility,Outpatient,15,g,,310,263.5,88.846,310,"UCare Health, Inc.",Medicare Advantage,156.457,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LEVALBUTEROL TARTRATE 45 MCG/ACTUATION INHL HFAA,,37969,LOCAL,Facility,Inpatient,15,g,,310,263.5,88.846,310,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LEVALBUTEROL TARTRATE 45 MCG/ACTUATION INHL HFAA,,37969,LOCAL,Facility,Outpatient,15,g,,310,263.5,88.846,310,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),156.457,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LEVALBUTEROL TARTRATE 45 MCG/ACTUATION INHL HFAA,,37969,LOCAL,Facility,Inpatient,15,g,,310,263.5,88.846,310,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LEVALBUTEROL TARTRATE 45 MCG/ACTUATION INHL HFAA,,37969,LOCAL,Facility,Both,15,g,,310,263.5,88.846,310,UnitedHealthcare,Individual & Family,291.4,94,,percent of total billed charges,,
LEVALBUTEROL TARTRATE 45 MCG/ACTUATION INHL HFAA,,37969,LOCAL,Facility,Outpatient,15,g,,310,263.5,88.846,310,UnitedHealthcare,Medicare Advantage,151.9,49,,percent of total billed charges,,
LEVALBUTEROL TARTRATE 45 MCG/ACTUATION INHL HFAA,,37969,LOCAL,Facility,Inpatient,15,g,,310,263.5,88.846,310,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
LEVALBUTEROL TARTRATE 45 MCG/ACTUATION INHL HFAA,,37969,LOCAL,Facility,Outpatient,15,g,,310,263.5,88.846,310,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,148.8,48,,percent of total billed charges,,100% of DHS outpatient percentage
LEVALBUTEROL TARTRATE 45 MCG/ACTUATION INHL HFAA,,37969,LOCAL,Facility,Inpatient,15,g,,310,263.5,88.846,310,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
PREDNISOLONE 15 MG/5 ML ORAL SOLN,,J7510,HCPCS,Facility,Both,15,mL,,13,11.05,3.7258,13,Aetna,Commercial,11.96,92,,percent of total billed charges,,
PREDNISOLONE 15 MG/5 ML ORAL SOLN,,J7510,HCPCS,Facility,Outpatient,15,mL,,13,11.05,3.7258,13,Aetna,Medicare Advantage,6.37,49,,percent of total billed charges,,
PREDNISOLONE 15 MG/5 ML ORAL SOLN,,J7510,HCPCS,Facility,Inpatient,15,mL,,13,11.05,3.7258,13,Aetna,Medicare Advantage,,,,,Included in per diem rate,
PREDNISOLONE 15 MG/5 ML ORAL SOLN,,J7510,HCPCS,Facility,Both,15,mL,,13,11.05,3.7258,13,Aetna,PPO,12.09,93,,percent of total billed charges,,
PREDNISOLONE 15 MG/5 ML ORAL SOLN,,J7510,HCPCS,Facility,Both,15,mL,,13,11.05,3.7258,13,America's PPO,America's PPO,12.4839,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
PREDNISOLONE 15 MG/5 ML ORAL SOLN,,J7510,HCPCS,Facility,Both,15,mL,,13,11.05,3.7258,13,BlueCross BlueShield Minnesota, Federal Employee Program,12.792,98.4,,percent of total billed charges,,
PREDNISOLONE 15 MG/5 ML ORAL SOLN,,J7510,HCPCS,Facility,Both,15,mL,,13,11.05,3.7258,13,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,13,100,,percent of total billed charges,,
PREDNISOLONE 15 MG/5 ML ORAL SOLN,,J7510,HCPCS,Facility,Both,15,mL,,13,11.05,3.7258,13,BlueCross BlueShield Minnesota,High Value Network Plan,11.7,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
PREDNISOLONE 15 MG/5 ML ORAL SOLN,,J7510,HCPCS,Facility,Outpatient,15,mL,,13,11.05,3.7258,13,BlueCross BlueShield Minnesota,Medicare Advantage,6.37,49,,percent of total billed charges,,
PREDNISOLONE 15 MG/5 ML ORAL SOLN,,J7510,HCPCS,Facility,Inpatient,15,mL,,13,11.05,3.7258,13,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
PREDNISOLONE 15 MG/5 ML ORAL SOLN,,J7510,HCPCS,Facility,Both,15,mL,,13,11.05,3.7258,13,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,11.5141,88.57,,percent of total billed charges,,
PREDNISOLONE 15 MG/5 ML ORAL SOLN,,J7510,HCPCS,Facility,Both,15,mL,,13,11.05,3.7258,13,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,3.7258,28.66,,percent of total billed charges,,
PREDNISOLONE 15 MG/5 ML ORAL SOLN,,J7510,HCPCS,Facility,Outpatient,15,mL,,13,11.05,3.7258,13,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),6.37,49,,percent of total billed charges,,
PREDNISOLONE 15 MG/5 ML ORAL SOLN,,J7510,HCPCS,Facility,Inpatient,15,mL,,13,11.05,3.7258,13,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
PREDNISOLONE 15 MG/5 ML ORAL SOLN,,J7510,HCPCS,Facility,Both,15,mL,,13,11.05,3.7258,13,CorVel,Worker's Compensation,13,100,,percent of total billed charges,,
PREDNISOLONE 15 MG/5 ML ORAL SOLN,,J7510,HCPCS,Facility,Both,15,mL,,13,11.05,3.7258,13,First Health Group Corporation,First Health Network,12.61,97,,percent of total billed charges,,
PREDNISOLONE 15 MG/5 ML ORAL SOLN,,J7510,HCPCS,Facility,Both,15,mL,,13,11.05,3.7258,13,"Health Partners, Inc.",Commercial,12.298,94.6,,percent of total billed charges,,
PREDNISOLONE 15 MG/5 ML ORAL SOLN,,J7510,HCPCS,Facility,Outpatient,15,mL,,13,11.05,3.7258,13,"Health Partners, Inc.",Medicare Advantage,6.37,49,,percent of total billed charges,,
PREDNISOLONE 15 MG/5 ML ORAL SOLN,,J7510,HCPCS,Facility,Inpatient,15,mL,,13,11.05,3.7258,13,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PREDNISOLONE 15 MG/5 ML ORAL SOLN,,J7510,HCPCS,Facility,Both,15,mL,,13,11.05,3.7258,13,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),7.8,60,,percent of total billed charges,,
PREDNISOLONE 15 MG/5 ML ORAL SOLN,,J7510,HCPCS,Facility,Both,15,mL,,13,11.05,3.7258,13,"Health Partners, Inc.",State of Minnesota Advantage Program,10.595,81.5,,percent of total billed charges,,
PREDNISOLONE 15 MG/5 ML ORAL SOLN,,J7510,HCPCS,Facility,Both,15,mL,,13,11.05,3.7258,13,"Health Partners, Inc.",State Public Programs,6.5,50,,percent of total billed charges,,
PREDNISOLONE 15 MG/5 ML ORAL SOLN,,J7510,HCPCS,Facility,Both,15,mL,,13,11.05,3.7258,13,Humana Insurance Company,Commercial PPO,12.35,95,,percent of total billed charges,,
PREDNISOLONE 15 MG/5 ML ORAL SOLN,,J7510,HCPCS,Facility,Outpatient,15,mL,,13,11.05,3.7258,13,Humana Insurance Company,Medicare PPO,6.37,49,,percent of total billed charges,,
PREDNISOLONE 15 MG/5 ML ORAL SOLN,,J7510,HCPCS,Facility,Inpatient,15,mL,,13,11.05,3.7258,13,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
PREDNISOLONE 15 MG/5 ML ORAL SOLN,,J7510,HCPCS,Facility,Both,15,mL,,13,11.05,3.7258,13,Medica,Individual & Family,12.883,99.1,,percent of total billed charges,,
PREDNISOLONE 15 MG/5 ML ORAL SOLN,,J7510,HCPCS,Facility,Outpatient,15,mL,,13,11.05,3.7258,13,Medica,Medica Advantage Solution,6.474,49.8,,percent of total billed charges,,
PREDNISOLONE 15 MG/5 ML ORAL SOLN,,J7510,HCPCS,Facility,Inpatient,15,mL,,13,11.05,3.7258,13,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
PREDNISOLONE 15 MG/5 ML ORAL SOLN,,J7510,HCPCS,Facility,Outpatient,15,mL,,13,11.05,3.7258,13,Medica,Medical Assistance,5.798,44.6,,percent of total billed charges,,
PREDNISOLONE 15 MG/5 ML ORAL SOLN,,J7510,HCPCS,Facility,Inpatient,15,mL,,13,11.05,3.7258,13,Medica,Medical Assistance,,,,,Included in per diem rate,
PREDNISOLONE 15 MG/5 ML ORAL SOLN,,J7510,HCPCS,Facility,Outpatient,15,mL,,13,11.05,3.7258,13,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,6.474,49.8,,percent of total billed charges,,
PREDNISOLONE 15 MG/5 ML ORAL SOLN,,J7510,HCPCS,Facility,Inpatient,15,mL,,13,11.05,3.7258,13,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
PREDNISOLONE 15 MG/5 ML ORAL SOLN,,J7510,HCPCS,Facility,Both,15,mL,,13,11.05,3.7258,13,"Multiplan, Inc.","Multiplan, Inc.",12.22,94,,percent of total billed charges,,
PREDNISOLONE 15 MG/5 ML ORAL SOLN,,J7510,HCPCS,Facility,Outpatient,15,mL,,13,11.05,3.7258,13,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,11.713,90.1,,percent of total billed charges,,
PREDNISOLONE 15 MG/5 ML ORAL SOLN,,J7510,HCPCS,Facility,Inpatient,15,mL,,13,11.05,3.7258,13,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
PREDNISOLONE 15 MG/5 ML ORAL SOLN,,J7510,HCPCS,Facility,Both,15,mL,,13,11.05,3.7258,13,"Preferred One Administrative Services, INC.",PPO,12.818,98.6,,percent of total billed charges,,
PREDNISOLONE 15 MG/5 ML ORAL SOLN,,J7510,HCPCS,Facility,Outpatient,15,mL,,13,11.05,3.7258,13,PrimeWest Health,Minnesota Senior Health Options (MSHO),6.6885,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
PREDNISOLONE 15 MG/5 ML ORAL SOLN,,J7510,HCPCS,Facility,Inpatient,15,mL,,13,11.05,3.7258,13,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PREDNISOLONE 15 MG/5 ML ORAL SOLN,,J7510,HCPCS,Facility,Outpatient,15,mL,,13,11.05,3.7258,13,PrimeWest Health,MinnesotaCare,6.6768,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
PREDNISOLONE 15 MG/5 ML ORAL SOLN,,J7510,HCPCS,Facility,Inpatient,15,mL,,13,11.05,3.7258,13,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
PREDNISOLONE 15 MG/5 ML ORAL SOLN,,J7510,HCPCS,Facility,Both,15,mL,,13,11.05,3.7258,13,Sanford Health Plan,Sanford Health Plan,11.96,92,,percent of total billed charges,,
PREDNISOLONE 15 MG/5 ML ORAL SOLN,,J7510,HCPCS,Facility,Outpatient,15,mL,,13,11.05,3.7258,13,"UCare Health, Inc.",Individual & Family Plan,7.3255,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
PREDNISOLONE 15 MG/5 ML ORAL SOLN,,J7510,HCPCS,Facility,Inpatient,15,mL,,13,11.05,3.7258,13,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
PREDNISOLONE 15 MG/5 ML ORAL SOLN,,J7510,HCPCS,Facility,Outpatient,15,mL,,13,11.05,3.7258,13,"UCare Health, Inc.",Medical Assistance,6.5611,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PREDNISOLONE 15 MG/5 ML ORAL SOLN,,J7510,HCPCS,Facility,Inpatient,15,mL,,13,11.05,3.7258,13,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
PREDNISOLONE 15 MG/5 ML ORAL SOLN,,J7510,HCPCS,Facility,Outpatient,15,mL,,13,11.05,3.7258,13,"UCare Health, Inc.",Medicare Advantage,6.5611,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PREDNISOLONE 15 MG/5 ML ORAL SOLN,,J7510,HCPCS,Facility,Inpatient,15,mL,,13,11.05,3.7258,13,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PREDNISOLONE 15 MG/5 ML ORAL SOLN,,J7510,HCPCS,Facility,Outpatient,15,mL,,13,11.05,3.7258,13,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),6.5611,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PREDNISOLONE 15 MG/5 ML ORAL SOLN,,J7510,HCPCS,Facility,Inpatient,15,mL,,13,11.05,3.7258,13,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PREDNISOLONE 15 MG/5 ML ORAL SOLN,,J7510,HCPCS,Facility,Both,15,mL,,13,11.05,3.7258,13,UnitedHealthcare,Individual & Family,12.22,94,,percent of total billed charges,,
PREDNISOLONE 15 MG/5 ML ORAL SOLN,,J7510,HCPCS,Facility,Outpatient,15,mL,,13,11.05,3.7258,13,UnitedHealthcare,Medicare Advantage,6.37,49,,percent of total billed charges,,
PREDNISOLONE 15 MG/5 ML ORAL SOLN,,J7510,HCPCS,Facility,Inpatient,15,mL,,13,11.05,3.7258,13,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
PREDNISOLONE 15 MG/5 ML ORAL SOLN,,J7510,HCPCS,Facility,Outpatient,15,mL,,13,11.05,3.7258,13,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,6.24,48,,percent of total billed charges,,100% of DHS outpatient percentage
PREDNISOLONE 15 MG/5 ML ORAL SOLN,,J7510,HCPCS,Facility,Inpatient,15,mL,,13,11.05,3.7258,13,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
POTASSIUM PHOSPHATE M-/D-BASIC 3 MMOL/ML IV SOLN,,1930,LOCAL,Facility,Both,15,mL,,86,73.1,24.6476,86,Aetna,Commercial,79.12,92,,percent of total billed charges,,
POTASSIUM PHOSPHATE M-/D-BASIC 3 MMOL/ML IV SOLN,,1930,LOCAL,Facility,Outpatient,15,mL,,86,73.1,24.6476,86,Aetna,Medicare Advantage,42.14,49,,percent of total billed charges,,
POTASSIUM PHOSPHATE M-/D-BASIC 3 MMOL/ML IV SOLN,,1930,LOCAL,Facility,Inpatient,15,mL,,86,73.1,24.6476,86,Aetna,Medicare Advantage,,,,,Included in per diem rate,
POTASSIUM PHOSPHATE M-/D-BASIC 3 MMOL/ML IV SOLN,,1930,LOCAL,Facility,Both,15,mL,,86,73.1,24.6476,86,Aetna,PPO,79.98,93,,percent of total billed charges,,
POTASSIUM PHOSPHATE M-/D-BASIC 3 MMOL/ML IV SOLN,,1930,LOCAL,Facility,Both,15,mL,,86,73.1,24.6476,86,America's PPO,America's PPO,82.5858,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
POTASSIUM PHOSPHATE M-/D-BASIC 3 MMOL/ML IV SOLN,,1930,LOCAL,Facility,Both,15,mL,,86,73.1,24.6476,86,BlueCross BlueShield Minnesota, Federal Employee Program,84.624,98.4,,percent of total billed charges,,
POTASSIUM PHOSPHATE M-/D-BASIC 3 MMOL/ML IV SOLN,,1930,LOCAL,Facility,Both,15,mL,,86,73.1,24.6476,86,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,86,100,,percent of total billed charges,,
POTASSIUM PHOSPHATE M-/D-BASIC 3 MMOL/ML IV SOLN,,1930,LOCAL,Facility,Both,15,mL,,86,73.1,24.6476,86,BlueCross BlueShield Minnesota,High Value Network Plan,77.4,90,,percent of total billed charges,,
POTASSIUM PHOSPHATE M-/D-BASIC 3 MMOL/ML IV SOLN,,1930,LOCAL,Facility,Outpatient,15,mL,,86,73.1,24.6476,86,BlueCross BlueShield Minnesota,Medicare Advantage,42.14,49,,percent of total billed charges,,
POTASSIUM PHOSPHATE M-/D-BASIC 3 MMOL/ML IV SOLN,,1930,LOCAL,Facility,Inpatient,15,mL,,86,73.1,24.6476,86,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
POTASSIUM PHOSPHATE M-/D-BASIC 3 MMOL/ML IV SOLN,,1930,LOCAL,Facility,Both,15,mL,,86,73.1,24.6476,86,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,76.1702,88.57,,percent of total billed charges,,
POTASSIUM PHOSPHATE M-/D-BASIC 3 MMOL/ML IV SOLN,,1930,LOCAL,Facility,Both,15,mL,,86,73.1,24.6476,86,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,24.6476,28.66,,percent of total billed charges,,
POTASSIUM PHOSPHATE M-/D-BASIC 3 MMOL/ML IV SOLN,,1930,LOCAL,Facility,Outpatient,15,mL,,86,73.1,24.6476,86,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),42.14,49,,percent of total billed charges,,
POTASSIUM PHOSPHATE M-/D-BASIC 3 MMOL/ML IV SOLN,,1930,LOCAL,Facility,Inpatient,15,mL,,86,73.1,24.6476,86,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
POTASSIUM PHOSPHATE M-/D-BASIC 3 MMOL/ML IV SOLN,,1930,LOCAL,Facility,Both,15,mL,,86,73.1,24.6476,86,CorVel,Worker's Compensation,86,100,,percent of total billed charges,,
POTASSIUM PHOSPHATE M-/D-BASIC 3 MMOL/ML IV SOLN,,1930,LOCAL,Facility,Both,15,mL,,86,73.1,24.6476,86,First Health Group Corporation,First Health Network,83.42,97,,percent of total billed charges,,
POTASSIUM PHOSPHATE M-/D-BASIC 3 MMOL/ML IV SOLN,,1930,LOCAL,Facility,Both,15,mL,,86,73.1,24.6476,86,"Health Partners, Inc.",Commercial,81.356,94.6,,percent of total billed charges,,
POTASSIUM PHOSPHATE M-/D-BASIC 3 MMOL/ML IV SOLN,,1930,LOCAL,Facility,Outpatient,15,mL,,86,73.1,24.6476,86,"Health Partners, Inc.",Medicare Advantage,42.14,49,,percent of total billed charges,,
POTASSIUM PHOSPHATE M-/D-BASIC 3 MMOL/ML IV SOLN,,1930,LOCAL,Facility,Inpatient,15,mL,,86,73.1,24.6476,86,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
POTASSIUM PHOSPHATE M-/D-BASIC 3 MMOL/ML IV SOLN,,1930,LOCAL,Facility,Both,15,mL,,86,73.1,24.6476,86,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),51.6,60,,percent of total billed charges,,
POTASSIUM PHOSPHATE M-/D-BASIC 3 MMOL/ML IV SOLN,,1930,LOCAL,Facility,Both,15,mL,,86,73.1,24.6476,86,"Health Partners, Inc.",State of Minnesota Advantage Program,70.09,81.5,,percent of total billed charges,,
POTASSIUM PHOSPHATE M-/D-BASIC 3 MMOL/ML IV SOLN,,1930,LOCAL,Facility,Both,15,mL,,86,73.1,24.6476,86,"Health Partners, Inc.",State Public Programs,43,50,,percent of total billed charges,,
POTASSIUM PHOSPHATE M-/D-BASIC 3 MMOL/ML IV SOLN,,1930,LOCAL,Facility,Both,15,mL,,86,73.1,24.6476,86,Humana Insurance Company,Commercial PPO,81.7,95,,percent of total billed charges,,
POTASSIUM PHOSPHATE M-/D-BASIC 3 MMOL/ML IV SOLN,,1930,LOCAL,Facility,Outpatient,15,mL,,86,73.1,24.6476,86,Humana Insurance Company,Medicare PPO,42.14,49,,percent of total billed charges,,
POTASSIUM PHOSPHATE M-/D-BASIC 3 MMOL/ML IV SOLN,,1930,LOCAL,Facility,Inpatient,15,mL,,86,73.1,24.6476,86,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
POTASSIUM PHOSPHATE M-/D-BASIC 3 MMOL/ML IV SOLN,,1930,LOCAL,Facility,Both,15,mL,,86,73.1,24.6476,86,Medica,Individual & Family,85.226,99.1,,percent of total billed charges,,
POTASSIUM PHOSPHATE M-/D-BASIC 3 MMOL/ML IV SOLN,,1930,LOCAL,Facility,Outpatient,15,mL,,86,73.1,24.6476,86,Medica,Medica Advantage Solution,42.828,49.8,,percent of total billed charges,,
POTASSIUM PHOSPHATE M-/D-BASIC 3 MMOL/ML IV SOLN,,1930,LOCAL,Facility,Inpatient,15,mL,,86,73.1,24.6476,86,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
POTASSIUM PHOSPHATE M-/D-BASIC 3 MMOL/ML IV SOLN,,1930,LOCAL,Facility,Outpatient,15,mL,,86,73.1,24.6476,86,Medica,Medical Assistance,38.356,44.6,,percent of total billed charges,,
POTASSIUM PHOSPHATE M-/D-BASIC 3 MMOL/ML IV SOLN,,1930,LOCAL,Facility,Inpatient,15,mL,,86,73.1,24.6476,86,Medica,Medical Assistance,,,,,Included in per diem rate,
POTASSIUM PHOSPHATE M-/D-BASIC 3 MMOL/ML IV SOLN,,1930,LOCAL,Facility,Outpatient,15,mL,,86,73.1,24.6476,86,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,42.828,49.8,,percent of total billed charges,,
POTASSIUM PHOSPHATE M-/D-BASIC 3 MMOL/ML IV SOLN,,1930,LOCAL,Facility,Inpatient,15,mL,,86,73.1,24.6476,86,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
POTASSIUM PHOSPHATE M-/D-BASIC 3 MMOL/ML IV SOLN,,1930,LOCAL,Facility,Both,15,mL,,86,73.1,24.6476,86,"Multiplan, Inc.","Multiplan, Inc.",80.84,94,,percent of total billed charges,,
POTASSIUM PHOSPHATE M-/D-BASIC 3 MMOL/ML IV SOLN,,1930,LOCAL,Facility,Outpatient,15,mL,,86,73.1,24.6476,86,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,77.486,90.1,,percent of total billed charges,,
POTASSIUM PHOSPHATE M-/D-BASIC 3 MMOL/ML IV SOLN,,1930,LOCAL,Facility,Inpatient,15,mL,,86,73.1,24.6476,86,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
POTASSIUM PHOSPHATE M-/D-BASIC 3 MMOL/ML IV SOLN,,1930,LOCAL,Facility,Both,15,mL,,86,73.1,24.6476,86,"Preferred One Administrative Services, INC.",PPO,84.796,98.6,,percent of total billed charges,,
POTASSIUM PHOSPHATE M-/D-BASIC 3 MMOL/ML IV SOLN,,1930,LOCAL,Facility,Outpatient,15,mL,,86,73.1,24.6476,86,PrimeWest Health,Minnesota Senior Health Options (MSHO),44.247,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
POTASSIUM PHOSPHATE M-/D-BASIC 3 MMOL/ML IV SOLN,,1930,LOCAL,Facility,Inpatient,15,mL,,86,73.1,24.6476,86,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
POTASSIUM PHOSPHATE M-/D-BASIC 3 MMOL/ML IV SOLN,,1930,LOCAL,Facility,Outpatient,15,mL,,86,73.1,24.6476,86,PrimeWest Health,MinnesotaCare,44.1696,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
POTASSIUM PHOSPHATE M-/D-BASIC 3 MMOL/ML IV SOLN,,1930,LOCAL,Facility,Inpatient,15,mL,,86,73.1,24.6476,86,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
POTASSIUM PHOSPHATE M-/D-BASIC 3 MMOL/ML IV SOLN,,1930,LOCAL,Facility,Both,15,mL,,86,73.1,24.6476,86,Sanford Health Plan,Sanford Health Plan,79.12,92,,percent of total billed charges,,
POTASSIUM PHOSPHATE M-/D-BASIC 3 MMOL/ML IV SOLN,,1930,LOCAL,Facility,Outpatient,15,mL,,86,73.1,24.6476,86,"UCare Health, Inc.",Individual & Family Plan,48.461,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
POTASSIUM PHOSPHATE M-/D-BASIC 3 MMOL/ML IV SOLN,,1930,LOCAL,Facility,Inpatient,15,mL,,86,73.1,24.6476,86,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
POTASSIUM PHOSPHATE M-/D-BASIC 3 MMOL/ML IV SOLN,,1930,LOCAL,Facility,Outpatient,15,mL,,86,73.1,24.6476,86,"UCare Health, Inc.",Medical Assistance,43.4042,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
POTASSIUM PHOSPHATE M-/D-BASIC 3 MMOL/ML IV SOLN,,1930,LOCAL,Facility,Inpatient,15,mL,,86,73.1,24.6476,86,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
POTASSIUM PHOSPHATE M-/D-BASIC 3 MMOL/ML IV SOLN,,1930,LOCAL,Facility,Outpatient,15,mL,,86,73.1,24.6476,86,"UCare Health, Inc.",Medicare Advantage,43.4042,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
POTASSIUM PHOSPHATE M-/D-BASIC 3 MMOL/ML IV SOLN,,1930,LOCAL,Facility,Inpatient,15,mL,,86,73.1,24.6476,86,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
POTASSIUM PHOSPHATE M-/D-BASIC 3 MMOL/ML IV SOLN,,1930,LOCAL,Facility,Outpatient,15,mL,,86,73.1,24.6476,86,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),43.4042,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
POTASSIUM PHOSPHATE M-/D-BASIC 3 MMOL/ML IV SOLN,,1930,LOCAL,Facility,Inpatient,15,mL,,86,73.1,24.6476,86,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
POTASSIUM PHOSPHATE M-/D-BASIC 3 MMOL/ML IV SOLN,,1930,LOCAL,Facility,Both,15,mL,,86,73.1,24.6476,86,UnitedHealthcare,Individual & Family,80.84,94,,percent of total billed charges,,
POTASSIUM PHOSPHATE M-/D-BASIC 3 MMOL/ML IV SOLN,,1930,LOCAL,Facility,Outpatient,15,mL,,86,73.1,24.6476,86,UnitedHealthcare,Medicare Advantage,42.14,49,,percent of total billed charges,,
POTASSIUM PHOSPHATE M-/D-BASIC 3 MMOL/ML IV SOLN,,1930,LOCAL,Facility,Inpatient,15,mL,,86,73.1,24.6476,86,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
POTASSIUM PHOSPHATE M-/D-BASIC 3 MMOL/ML IV SOLN,,1930,LOCAL,Facility,Outpatient,15,mL,,86,73.1,24.6476,86,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,41.28,48,,percent of total billed charges,,100% of DHS outpatient percentage
POTASSIUM PHOSPHATE M-/D-BASIC 3 MMOL/ML IV SOLN,,1930,LOCAL,Facility,Inpatient,15,mL,,86,73.1,24.6476,86,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
PILOCARPINE HCL 1 % OPHT DROP,,2072,LOCAL,Facility,Both,15,mL,,414,351.9,118.6524,414,Aetna,Commercial,380.88,92,,percent of total billed charges,,
PILOCARPINE HCL 1 % OPHT DROP,,2072,LOCAL,Facility,Outpatient,15,mL,,414,351.9,118.6524,414,Aetna,Medicare Advantage,202.86,49,,percent of total billed charges,,
PILOCARPINE HCL 1 % OPHT DROP,,2072,LOCAL,Facility,Inpatient,15,mL,,414,351.9,118.6524,414,Aetna,Medicare Advantage,,,,,Included in per diem rate,
PILOCARPINE HCL 1 % OPHT DROP,,2072,LOCAL,Facility,Both,15,mL,,414,351.9,118.6524,414,Aetna,PPO,385.02,93,,percent of total billed charges,,
PILOCARPINE HCL 1 % OPHT DROP,,2072,LOCAL,Facility,Both,15,mL,,414,351.9,118.6524,414,America's PPO,America's PPO,397.5642,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
PILOCARPINE HCL 1 % OPHT DROP,,2072,LOCAL,Facility,Both,15,mL,,414,351.9,118.6524,414,BlueCross BlueShield Minnesota, Federal Employee Program,407.376,98.4,,percent of total billed charges,,
PILOCARPINE HCL 1 % OPHT DROP,,2072,LOCAL,Facility,Both,15,mL,,414,351.9,118.6524,414,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,414,100,,percent of total billed charges,,
PILOCARPINE HCL 1 % OPHT DROP,,2072,LOCAL,Facility,Both,15,mL,,414,351.9,118.6524,414,BlueCross BlueShield Minnesota,High Value Network Plan,372.6,90,,percent of total billed charges,,
PILOCARPINE HCL 1 % OPHT DROP,,2072,LOCAL,Facility,Outpatient,15,mL,,414,351.9,118.6524,414,BlueCross BlueShield Minnesota,Medicare Advantage,202.86,49,,percent of total billed charges,,
PILOCARPINE HCL 1 % OPHT DROP,,2072,LOCAL,Facility,Inpatient,15,mL,,414,351.9,118.6524,414,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
PILOCARPINE HCL 1 % OPHT DROP,,2072,LOCAL,Facility,Both,15,mL,,414,351.9,118.6524,414,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,366.6798,88.57,,percent of total billed charges,,
PILOCARPINE HCL 1 % OPHT DROP,,2072,LOCAL,Facility,Both,15,mL,,414,351.9,118.6524,414,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,118.6524,28.66,,percent of total billed charges,,
PILOCARPINE HCL 1 % OPHT DROP,,2072,LOCAL,Facility,Outpatient,15,mL,,414,351.9,118.6524,414,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),202.86,49,,percent of total billed charges,,
PILOCARPINE HCL 1 % OPHT DROP,,2072,LOCAL,Facility,Inpatient,15,mL,,414,351.9,118.6524,414,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
PILOCARPINE HCL 1 % OPHT DROP,,2072,LOCAL,Facility,Both,15,mL,,414,351.9,118.6524,414,CorVel,Worker's Compensation,414,100,,percent of total billed charges,,
PILOCARPINE HCL 1 % OPHT DROP,,2072,LOCAL,Facility,Both,15,mL,,414,351.9,118.6524,414,First Health Group Corporation,First Health Network,401.58,97,,percent of total billed charges,,
PILOCARPINE HCL 1 % OPHT DROP,,2072,LOCAL,Facility,Both,15,mL,,414,351.9,118.6524,414,"Health Partners, Inc.",Commercial,391.644,94.6,,percent of total billed charges,,
PILOCARPINE HCL 1 % OPHT DROP,,2072,LOCAL,Facility,Outpatient,15,mL,,414,351.9,118.6524,414,"Health Partners, Inc.",Medicare Advantage,202.86,49,,percent of total billed charges,,
PILOCARPINE HCL 1 % OPHT DROP,,2072,LOCAL,Facility,Inpatient,15,mL,,414,351.9,118.6524,414,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PILOCARPINE HCL 1 % OPHT DROP,,2072,LOCAL,Facility,Both,15,mL,,414,351.9,118.6524,414,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),248.4,60,,percent of total billed charges,,
PILOCARPINE HCL 1 % OPHT DROP,,2072,LOCAL,Facility,Both,15,mL,,414,351.9,118.6524,414,"Health Partners, Inc.",State of Minnesota Advantage Program,337.41,81.5,,percent of total billed charges,,
PILOCARPINE HCL 1 % OPHT DROP,,2072,LOCAL,Facility,Both,15,mL,,414,351.9,118.6524,414,"Health Partners, Inc.",State Public Programs,207,50,,percent of total billed charges,,
PILOCARPINE HCL 1 % OPHT DROP,,2072,LOCAL,Facility,Both,15,mL,,414,351.9,118.6524,414,Humana Insurance Company,Commercial PPO,393.3,95,,percent of total billed charges,,
PILOCARPINE HCL 1 % OPHT DROP,,2072,LOCAL,Facility,Outpatient,15,mL,,414,351.9,118.6524,414,Humana Insurance Company,Medicare PPO,202.86,49,,percent of total billed charges,,
PILOCARPINE HCL 1 % OPHT DROP,,2072,LOCAL,Facility,Inpatient,15,mL,,414,351.9,118.6524,414,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
PILOCARPINE HCL 1 % OPHT DROP,,2072,LOCAL,Facility,Both,15,mL,,414,351.9,118.6524,414,Medica,Individual & Family,410.274,99.1,,percent of total billed charges,,
PILOCARPINE HCL 1 % OPHT DROP,,2072,LOCAL,Facility,Outpatient,15,mL,,414,351.9,118.6524,414,Medica,Medica Advantage Solution,206.172,49.8,,percent of total billed charges,,
PILOCARPINE HCL 1 % OPHT DROP,,2072,LOCAL,Facility,Inpatient,15,mL,,414,351.9,118.6524,414,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
PILOCARPINE HCL 1 % OPHT DROP,,2072,LOCAL,Facility,Outpatient,15,mL,,414,351.9,118.6524,414,Medica,Medical Assistance,184.644,44.6,,percent of total billed charges,,
PILOCARPINE HCL 1 % OPHT DROP,,2072,LOCAL,Facility,Inpatient,15,mL,,414,351.9,118.6524,414,Medica,Medical Assistance,,,,,Included in per diem rate,
PILOCARPINE HCL 1 % OPHT DROP,,2072,LOCAL,Facility,Outpatient,15,mL,,414,351.9,118.6524,414,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,206.172,49.8,,percent of total billed charges,,
PILOCARPINE HCL 1 % OPHT DROP,,2072,LOCAL,Facility,Inpatient,15,mL,,414,351.9,118.6524,414,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
PILOCARPINE HCL 1 % OPHT DROP,,2072,LOCAL,Facility,Both,15,mL,,414,351.9,118.6524,414,"Multiplan, Inc.","Multiplan, Inc.",389.16,94,,percent of total billed charges,,
PILOCARPINE HCL 1 % OPHT DROP,,2072,LOCAL,Facility,Outpatient,15,mL,,414,351.9,118.6524,414,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,373.014,90.1,,percent of total billed charges,,
PILOCARPINE HCL 1 % OPHT DROP,,2072,LOCAL,Facility,Inpatient,15,mL,,414,351.9,118.6524,414,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
PILOCARPINE HCL 1 % OPHT DROP,,2072,LOCAL,Facility,Both,15,mL,,414,351.9,118.6524,414,"Preferred One Administrative Services, INC.",PPO,408.204,98.6,,percent of total billed charges,,
PILOCARPINE HCL 1 % OPHT DROP,,2072,LOCAL,Facility,Outpatient,15,mL,,414,351.9,118.6524,414,PrimeWest Health,Minnesota Senior Health Options (MSHO),213.003,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
PILOCARPINE HCL 1 % OPHT DROP,,2072,LOCAL,Facility,Inpatient,15,mL,,414,351.9,118.6524,414,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PILOCARPINE HCL 1 % OPHT DROP,,2072,LOCAL,Facility,Outpatient,15,mL,,414,351.9,118.6524,414,PrimeWest Health,MinnesotaCare,212.6304,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
PILOCARPINE HCL 1 % OPHT DROP,,2072,LOCAL,Facility,Inpatient,15,mL,,414,351.9,118.6524,414,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
PILOCARPINE HCL 1 % OPHT DROP,,2072,LOCAL,Facility,Both,15,mL,,414,351.9,118.6524,414,Sanford Health Plan,Sanford Health Plan,380.88,92,,percent of total billed charges,,
PILOCARPINE HCL 1 % OPHT DROP,,2072,LOCAL,Facility,Outpatient,15,mL,,414,351.9,118.6524,414,"UCare Health, Inc.",Individual & Family Plan,233.289,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
PILOCARPINE HCL 1 % OPHT DROP,,2072,LOCAL,Facility,Inpatient,15,mL,,414,351.9,118.6524,414,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
PILOCARPINE HCL 1 % OPHT DROP,,2072,LOCAL,Facility,Outpatient,15,mL,,414,351.9,118.6524,414,"UCare Health, Inc.",Medical Assistance,208.9458,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PILOCARPINE HCL 1 % OPHT DROP,,2072,LOCAL,Facility,Inpatient,15,mL,,414,351.9,118.6524,414,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
PILOCARPINE HCL 1 % OPHT DROP,,2072,LOCAL,Facility,Outpatient,15,mL,,414,351.9,118.6524,414,"UCare Health, Inc.",Medicare Advantage,208.9458,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PILOCARPINE HCL 1 % OPHT DROP,,2072,LOCAL,Facility,Inpatient,15,mL,,414,351.9,118.6524,414,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PILOCARPINE HCL 1 % OPHT DROP,,2072,LOCAL,Facility,Outpatient,15,mL,,414,351.9,118.6524,414,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),208.9458,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PILOCARPINE HCL 1 % OPHT DROP,,2072,LOCAL,Facility,Inpatient,15,mL,,414,351.9,118.6524,414,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PILOCARPINE HCL 1 % OPHT DROP,,2072,LOCAL,Facility,Both,15,mL,,414,351.9,118.6524,414,UnitedHealthcare,Individual & Family,389.16,94,,percent of total billed charges,,
PILOCARPINE HCL 1 % OPHT DROP,,2072,LOCAL,Facility,Outpatient,15,mL,,414,351.9,118.6524,414,UnitedHealthcare,Medicare Advantage,202.86,49,,percent of total billed charges,,
PILOCARPINE HCL 1 % OPHT DROP,,2072,LOCAL,Facility,Inpatient,15,mL,,414,351.9,118.6524,414,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
PILOCARPINE HCL 1 % OPHT DROP,,2072,LOCAL,Facility,Outpatient,15,mL,,414,351.9,118.6524,414,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,198.72,48,,percent of total billed charges,,100% of DHS outpatient percentage
PILOCARPINE HCL 1 % OPHT DROP,,2072,LOCAL,Facility,Inpatient,15,mL,,414,351.9,118.6524,414,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
POLYVINYL ALCOHOL 1.4 % OPHT DROP,,4597,LOCAL,Facility,Both,15,mL,,32,27.2,9.1712,32,Aetna,Commercial,29.44,92,,percent of total billed charges,,
POLYVINYL ALCOHOL 1.4 % OPHT DROP,,4597,LOCAL,Facility,Outpatient,15,mL,,32,27.2,9.1712,32,Aetna,Medicare Advantage,15.68,49,,percent of total billed charges,,
POLYVINYL ALCOHOL 1.4 % OPHT DROP,,4597,LOCAL,Facility,Inpatient,15,mL,,32,27.2,9.1712,32,Aetna,Medicare Advantage,,,,,Included in per diem rate,
POLYVINYL ALCOHOL 1.4 % OPHT DROP,,4597,LOCAL,Facility,Both,15,mL,,32,27.2,9.1712,32,Aetna,PPO,29.76,93,,percent of total billed charges,,
POLYVINYL ALCOHOL 1.4 % OPHT DROP,,4597,LOCAL,Facility,Both,15,mL,,32,27.2,9.1712,32,America's PPO,America's PPO,30.7296,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
POLYVINYL ALCOHOL 1.4 % OPHT DROP,,4597,LOCAL,Facility,Both,15,mL,,32,27.2,9.1712,32,BlueCross BlueShield Minnesota, Federal Employee Program,31.488,98.4,,percent of total billed charges,,
POLYVINYL ALCOHOL 1.4 % OPHT DROP,,4597,LOCAL,Facility,Both,15,mL,,32,27.2,9.1712,32,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,32,100,,percent of total billed charges,,
POLYVINYL ALCOHOL 1.4 % OPHT DROP,,4597,LOCAL,Facility,Both,15,mL,,32,27.2,9.1712,32,BlueCross BlueShield Minnesota,High Value Network Plan,28.8,90,,percent of total billed charges,,
POLYVINYL ALCOHOL 1.4 % OPHT DROP,,4597,LOCAL,Facility,Outpatient,15,mL,,32,27.2,9.1712,32,BlueCross BlueShield Minnesota,Medicare Advantage,15.68,49,,percent of total billed charges,,
POLYVINYL ALCOHOL 1.4 % OPHT DROP,,4597,LOCAL,Facility,Inpatient,15,mL,,32,27.2,9.1712,32,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
POLYVINYL ALCOHOL 1.4 % OPHT DROP,,4597,LOCAL,Facility,Both,15,mL,,32,27.2,9.1712,32,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,28.3424,88.57,,percent of total billed charges,,
POLYVINYL ALCOHOL 1.4 % OPHT DROP,,4597,LOCAL,Facility,Both,15,mL,,32,27.2,9.1712,32,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,9.1712,28.66,,percent of total billed charges,,
POLYVINYL ALCOHOL 1.4 % OPHT DROP,,4597,LOCAL,Facility,Outpatient,15,mL,,32,27.2,9.1712,32,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),15.68,49,,percent of total billed charges,,
POLYVINYL ALCOHOL 1.4 % OPHT DROP,,4597,LOCAL,Facility,Inpatient,15,mL,,32,27.2,9.1712,32,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
POLYVINYL ALCOHOL 1.4 % OPHT DROP,,4597,LOCAL,Facility,Both,15,mL,,32,27.2,9.1712,32,CorVel,Worker's Compensation,32,100,,percent of total billed charges,,
POLYVINYL ALCOHOL 1.4 % OPHT DROP,,4597,LOCAL,Facility,Both,15,mL,,32,27.2,9.1712,32,First Health Group Corporation,First Health Network,31.04,97,,percent of total billed charges,,
POLYVINYL ALCOHOL 1.4 % OPHT DROP,,4597,LOCAL,Facility,Both,15,mL,,32,27.2,9.1712,32,"Health Partners, Inc.",Commercial,30.272,94.6,,percent of total billed charges,,
POLYVINYL ALCOHOL 1.4 % OPHT DROP,,4597,LOCAL,Facility,Outpatient,15,mL,,32,27.2,9.1712,32,"Health Partners, Inc.",Medicare Advantage,15.68,49,,percent of total billed charges,,
POLYVINYL ALCOHOL 1.4 % OPHT DROP,,4597,LOCAL,Facility,Inpatient,15,mL,,32,27.2,9.1712,32,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
POLYVINYL ALCOHOL 1.4 % OPHT DROP,,4597,LOCAL,Facility,Both,15,mL,,32,27.2,9.1712,32,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),19.2,60,,percent of total billed charges,,
POLYVINYL ALCOHOL 1.4 % OPHT DROP,,4597,LOCAL,Facility,Both,15,mL,,32,27.2,9.1712,32,"Health Partners, Inc.",State of Minnesota Advantage Program,26.08,81.5,,percent of total billed charges,,
POLYVINYL ALCOHOL 1.4 % OPHT DROP,,4597,LOCAL,Facility,Both,15,mL,,32,27.2,9.1712,32,"Health Partners, Inc.",State Public Programs,16,50,,percent of total billed charges,,
POLYVINYL ALCOHOL 1.4 % OPHT DROP,,4597,LOCAL,Facility,Both,15,mL,,32,27.2,9.1712,32,Humana Insurance Company,Commercial PPO,30.4,95,,percent of total billed charges,,
POLYVINYL ALCOHOL 1.4 % OPHT DROP,,4597,LOCAL,Facility,Outpatient,15,mL,,32,27.2,9.1712,32,Humana Insurance Company,Medicare PPO,15.68,49,,percent of total billed charges,,
POLYVINYL ALCOHOL 1.4 % OPHT DROP,,4597,LOCAL,Facility,Inpatient,15,mL,,32,27.2,9.1712,32,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
POLYVINYL ALCOHOL 1.4 % OPHT DROP,,4597,LOCAL,Facility,Both,15,mL,,32,27.2,9.1712,32,Medica,Individual & Family,31.712,99.1,,percent of total billed charges,,
POLYVINYL ALCOHOL 1.4 % OPHT DROP,,4597,LOCAL,Facility,Outpatient,15,mL,,32,27.2,9.1712,32,Medica,Medica Advantage Solution,15.936,49.8,,percent of total billed charges,,
POLYVINYL ALCOHOL 1.4 % OPHT DROP,,4597,LOCAL,Facility,Inpatient,15,mL,,32,27.2,9.1712,32,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
POLYVINYL ALCOHOL 1.4 % OPHT DROP,,4597,LOCAL,Facility,Outpatient,15,mL,,32,27.2,9.1712,32,Medica,Medical Assistance,14.272,44.6,,percent of total billed charges,,
POLYVINYL ALCOHOL 1.4 % OPHT DROP,,4597,LOCAL,Facility,Inpatient,15,mL,,32,27.2,9.1712,32,Medica,Medical Assistance,,,,,Included in per diem rate,
POLYVINYL ALCOHOL 1.4 % OPHT DROP,,4597,LOCAL,Facility,Outpatient,15,mL,,32,27.2,9.1712,32,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,15.936,49.8,,percent of total billed charges,,
POLYVINYL ALCOHOL 1.4 % OPHT DROP,,4597,LOCAL,Facility,Inpatient,15,mL,,32,27.2,9.1712,32,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
POLYVINYL ALCOHOL 1.4 % OPHT DROP,,4597,LOCAL,Facility,Both,15,mL,,32,27.2,9.1712,32,"Multiplan, Inc.","Multiplan, Inc.",30.08,94,,percent of total billed charges,,
POLYVINYL ALCOHOL 1.4 % OPHT DROP,,4597,LOCAL,Facility,Outpatient,15,mL,,32,27.2,9.1712,32,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,28.832,90.1,,percent of total billed charges,,
POLYVINYL ALCOHOL 1.4 % OPHT DROP,,4597,LOCAL,Facility,Inpatient,15,mL,,32,27.2,9.1712,32,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
POLYVINYL ALCOHOL 1.4 % OPHT DROP,,4597,LOCAL,Facility,Both,15,mL,,32,27.2,9.1712,32,"Preferred One Administrative Services, INC.",PPO,31.552,98.6,,percent of total billed charges,,
POLYVINYL ALCOHOL 1.4 % OPHT DROP,,4597,LOCAL,Facility,Outpatient,15,mL,,32,27.2,9.1712,32,PrimeWest Health,Minnesota Senior Health Options (MSHO),16.464,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
POLYVINYL ALCOHOL 1.4 % OPHT DROP,,4597,LOCAL,Facility,Inpatient,15,mL,,32,27.2,9.1712,32,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
POLYVINYL ALCOHOL 1.4 % OPHT DROP,,4597,LOCAL,Facility,Outpatient,15,mL,,32,27.2,9.1712,32,PrimeWest Health,MinnesotaCare,16.4352,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
POLYVINYL ALCOHOL 1.4 % OPHT DROP,,4597,LOCAL,Facility,Inpatient,15,mL,,32,27.2,9.1712,32,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
POLYVINYL ALCOHOL 1.4 % OPHT DROP,,4597,LOCAL,Facility,Both,15,mL,,32,27.2,9.1712,32,Sanford Health Plan,Sanford Health Plan,29.44,92,,percent of total billed charges,,
POLYVINYL ALCOHOL 1.4 % OPHT DROP,,4597,LOCAL,Facility,Outpatient,15,mL,,32,27.2,9.1712,32,"UCare Health, Inc.",Individual & Family Plan,18.032,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
POLYVINYL ALCOHOL 1.4 % OPHT DROP,,4597,LOCAL,Facility,Inpatient,15,mL,,32,27.2,9.1712,32,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
POLYVINYL ALCOHOL 1.4 % OPHT DROP,,4597,LOCAL,Facility,Outpatient,15,mL,,32,27.2,9.1712,32,"UCare Health, Inc.",Medical Assistance,16.1504,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
POLYVINYL ALCOHOL 1.4 % OPHT DROP,,4597,LOCAL,Facility,Inpatient,15,mL,,32,27.2,9.1712,32,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
POLYVINYL ALCOHOL 1.4 % OPHT DROP,,4597,LOCAL,Facility,Outpatient,15,mL,,32,27.2,9.1712,32,"UCare Health, Inc.",Medicare Advantage,16.1504,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
POLYVINYL ALCOHOL 1.4 % OPHT DROP,,4597,LOCAL,Facility,Inpatient,15,mL,,32,27.2,9.1712,32,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
POLYVINYL ALCOHOL 1.4 % OPHT DROP,,4597,LOCAL,Facility,Outpatient,15,mL,,32,27.2,9.1712,32,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),16.1504,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
POLYVINYL ALCOHOL 1.4 % OPHT DROP,,4597,LOCAL,Facility,Inpatient,15,mL,,32,27.2,9.1712,32,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
POLYVINYL ALCOHOL 1.4 % OPHT DROP,,4597,LOCAL,Facility,Both,15,mL,,32,27.2,9.1712,32,UnitedHealthcare,Individual & Family,30.08,94,,percent of total billed charges,,
POLYVINYL ALCOHOL 1.4 % OPHT DROP,,4597,LOCAL,Facility,Outpatient,15,mL,,32,27.2,9.1712,32,UnitedHealthcare,Medicare Advantage,15.68,49,,percent of total billed charges,,
POLYVINYL ALCOHOL 1.4 % OPHT DROP,,4597,LOCAL,Facility,Inpatient,15,mL,,32,27.2,9.1712,32,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
POLYVINYL ALCOHOL 1.4 % OPHT DROP,,4597,LOCAL,Facility,Outpatient,15,mL,,32,27.2,9.1712,32,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,15.36,48,,percent of total billed charges,,100% of DHS outpatient percentage
POLYVINYL ALCOHOL 1.4 % OPHT DROP,,4597,LOCAL,Facility,Inpatient,15,mL,,32,27.2,9.1712,32,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
TROPICAMIDE 1 % OPHT DROP,,6840,LOCAL,Facility,Both,15,mL,,52,44.2,14.9032,52,Aetna,Commercial,47.84,92,,percent of total billed charges,,
TROPICAMIDE 1 % OPHT DROP,,6840,LOCAL,Facility,Outpatient,15,mL,,52,44.2,14.9032,52,Aetna,Medicare Advantage,25.48,49,,percent of total billed charges,,
TROPICAMIDE 1 % OPHT DROP,,6840,LOCAL,Facility,Inpatient,15,mL,,52,44.2,14.9032,52,Aetna,Medicare Advantage,,,,,Included in per diem rate,
TROPICAMIDE 1 % OPHT DROP,,6840,LOCAL,Facility,Both,15,mL,,52,44.2,14.9032,52,Aetna,PPO,48.36,93,,percent of total billed charges,,
TROPICAMIDE 1 % OPHT DROP,,6840,LOCAL,Facility,Both,15,mL,,52,44.2,14.9032,52,America's PPO,America's PPO,49.9356,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
TROPICAMIDE 1 % OPHT DROP,,6840,LOCAL,Facility,Both,15,mL,,52,44.2,14.9032,52,BlueCross BlueShield Minnesota, Federal Employee Program,51.168,98.4,,percent of total billed charges,,
TROPICAMIDE 1 % OPHT DROP,,6840,LOCAL,Facility,Both,15,mL,,52,44.2,14.9032,52,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,52,100,,percent of total billed charges,,
TROPICAMIDE 1 % OPHT DROP,,6840,LOCAL,Facility,Both,15,mL,,52,44.2,14.9032,52,BlueCross BlueShield Minnesota,High Value Network Plan,46.8,90,,percent of total billed charges,,
TROPICAMIDE 1 % OPHT DROP,,6840,LOCAL,Facility,Outpatient,15,mL,,52,44.2,14.9032,52,BlueCross BlueShield Minnesota,Medicare Advantage,25.48,49,,percent of total billed charges,,
TROPICAMIDE 1 % OPHT DROP,,6840,LOCAL,Facility,Inpatient,15,mL,,52,44.2,14.9032,52,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
TROPICAMIDE 1 % OPHT DROP,,6840,LOCAL,Facility,Both,15,mL,,52,44.2,14.9032,52,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,46.0564,88.57,,percent of total billed charges,,
TROPICAMIDE 1 % OPHT DROP,,6840,LOCAL,Facility,Both,15,mL,,52,44.2,14.9032,52,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,14.9032,28.66,,percent of total billed charges,,
TROPICAMIDE 1 % OPHT DROP,,6840,LOCAL,Facility,Outpatient,15,mL,,52,44.2,14.9032,52,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),25.48,49,,percent of total billed charges,,
TROPICAMIDE 1 % OPHT DROP,,6840,LOCAL,Facility,Inpatient,15,mL,,52,44.2,14.9032,52,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
TROPICAMIDE 1 % OPHT DROP,,6840,LOCAL,Facility,Both,15,mL,,52,44.2,14.9032,52,CorVel,Worker's Compensation,52,100,,percent of total billed charges,,
TROPICAMIDE 1 % OPHT DROP,,6840,LOCAL,Facility,Both,15,mL,,52,44.2,14.9032,52,First Health Group Corporation,First Health Network,50.44,97,,percent of total billed charges,,
TROPICAMIDE 1 % OPHT DROP,,6840,LOCAL,Facility,Both,15,mL,,52,44.2,14.9032,52,"Health Partners, Inc.",Commercial,49.192,94.6,,percent of total billed charges,,
TROPICAMIDE 1 % OPHT DROP,,6840,LOCAL,Facility,Outpatient,15,mL,,52,44.2,14.9032,52,"Health Partners, Inc.",Medicare Advantage,25.48,49,,percent of total billed charges,,
TROPICAMIDE 1 % OPHT DROP,,6840,LOCAL,Facility,Inpatient,15,mL,,52,44.2,14.9032,52,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
TROPICAMIDE 1 % OPHT DROP,,6840,LOCAL,Facility,Both,15,mL,,52,44.2,14.9032,52,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),31.2,60,,percent of total billed charges,,
TROPICAMIDE 1 % OPHT DROP,,6840,LOCAL,Facility,Both,15,mL,,52,44.2,14.9032,52,"Health Partners, Inc.",State of Minnesota Advantage Program,42.38,81.5,,percent of total billed charges,,
TROPICAMIDE 1 % OPHT DROP,,6840,LOCAL,Facility,Both,15,mL,,52,44.2,14.9032,52,"Health Partners, Inc.",State Public Programs,26,50,,percent of total billed charges,,
TROPICAMIDE 1 % OPHT DROP,,6840,LOCAL,Facility,Both,15,mL,,52,44.2,14.9032,52,Humana Insurance Company,Commercial PPO,49.4,95,,percent of total billed charges,,
TROPICAMIDE 1 % OPHT DROP,,6840,LOCAL,Facility,Outpatient,15,mL,,52,44.2,14.9032,52,Humana Insurance Company,Medicare PPO,25.48,49,,percent of total billed charges,,
TROPICAMIDE 1 % OPHT DROP,,6840,LOCAL,Facility,Inpatient,15,mL,,52,44.2,14.9032,52,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
TROPICAMIDE 1 % OPHT DROP,,6840,LOCAL,Facility,Both,15,mL,,52,44.2,14.9032,52,Medica,Individual & Family,51.532,99.1,,percent of total billed charges,,
TROPICAMIDE 1 % OPHT DROP,,6840,LOCAL,Facility,Outpatient,15,mL,,52,44.2,14.9032,52,Medica,Medica Advantage Solution,25.896,49.8,,percent of total billed charges,,
TROPICAMIDE 1 % OPHT DROP,,6840,LOCAL,Facility,Inpatient,15,mL,,52,44.2,14.9032,52,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
TROPICAMIDE 1 % OPHT DROP,,6840,LOCAL,Facility,Outpatient,15,mL,,52,44.2,14.9032,52,Medica,Medical Assistance,23.192,44.6,,percent of total billed charges,,
TROPICAMIDE 1 % OPHT DROP,,6840,LOCAL,Facility,Inpatient,15,mL,,52,44.2,14.9032,52,Medica,Medical Assistance,,,,,Included in per diem rate,
TROPICAMIDE 1 % OPHT DROP,,6840,LOCAL,Facility,Outpatient,15,mL,,52,44.2,14.9032,52,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,25.896,49.8,,percent of total billed charges,,
TROPICAMIDE 1 % OPHT DROP,,6840,LOCAL,Facility,Inpatient,15,mL,,52,44.2,14.9032,52,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
TROPICAMIDE 1 % OPHT DROP,,6840,LOCAL,Facility,Both,15,mL,,52,44.2,14.9032,52,"Multiplan, Inc.","Multiplan, Inc.",48.88,94,,percent of total billed charges,,
TROPICAMIDE 1 % OPHT DROP,,6840,LOCAL,Facility,Outpatient,15,mL,,52,44.2,14.9032,52,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,46.852,90.1,,percent of total billed charges,,
TROPICAMIDE 1 % OPHT DROP,,6840,LOCAL,Facility,Inpatient,15,mL,,52,44.2,14.9032,52,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
TROPICAMIDE 1 % OPHT DROP,,6840,LOCAL,Facility,Both,15,mL,,52,44.2,14.9032,52,"Preferred One Administrative Services, INC.",PPO,51.272,98.6,,percent of total billed charges,,
TROPICAMIDE 1 % OPHT DROP,,6840,LOCAL,Facility,Outpatient,15,mL,,52,44.2,14.9032,52,PrimeWest Health,Minnesota Senior Health Options (MSHO),26.754,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
TROPICAMIDE 1 % OPHT DROP,,6840,LOCAL,Facility,Inpatient,15,mL,,52,44.2,14.9032,52,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
TROPICAMIDE 1 % OPHT DROP,,6840,LOCAL,Facility,Outpatient,15,mL,,52,44.2,14.9032,52,PrimeWest Health,MinnesotaCare,26.7072,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
TROPICAMIDE 1 % OPHT DROP,,6840,LOCAL,Facility,Inpatient,15,mL,,52,44.2,14.9032,52,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
TROPICAMIDE 1 % OPHT DROP,,6840,LOCAL,Facility,Both,15,mL,,52,44.2,14.9032,52,Sanford Health Plan,Sanford Health Plan,47.84,92,,percent of total billed charges,,
TROPICAMIDE 1 % OPHT DROP,,6840,LOCAL,Facility,Outpatient,15,mL,,52,44.2,14.9032,52,"UCare Health, Inc.",Individual & Family Plan,29.302,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
TROPICAMIDE 1 % OPHT DROP,,6840,LOCAL,Facility,Inpatient,15,mL,,52,44.2,14.9032,52,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
TROPICAMIDE 1 % OPHT DROP,,6840,LOCAL,Facility,Outpatient,15,mL,,52,44.2,14.9032,52,"UCare Health, Inc.",Medical Assistance,26.2444,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TROPICAMIDE 1 % OPHT DROP,,6840,LOCAL,Facility,Inpatient,15,mL,,52,44.2,14.9032,52,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
TROPICAMIDE 1 % OPHT DROP,,6840,LOCAL,Facility,Outpatient,15,mL,,52,44.2,14.9032,52,"UCare Health, Inc.",Medicare Advantage,26.2444,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TROPICAMIDE 1 % OPHT DROP,,6840,LOCAL,Facility,Inpatient,15,mL,,52,44.2,14.9032,52,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
TROPICAMIDE 1 % OPHT DROP,,6840,LOCAL,Facility,Outpatient,15,mL,,52,44.2,14.9032,52,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),26.2444,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TROPICAMIDE 1 % OPHT DROP,,6840,LOCAL,Facility,Inpatient,15,mL,,52,44.2,14.9032,52,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
TROPICAMIDE 1 % OPHT DROP,,6840,LOCAL,Facility,Both,15,mL,,52,44.2,14.9032,52,UnitedHealthcare,Individual & Family,48.88,94,,percent of total billed charges,,
TROPICAMIDE 1 % OPHT DROP,,6840,LOCAL,Facility,Outpatient,15,mL,,52,44.2,14.9032,52,UnitedHealthcare,Medicare Advantage,25.48,49,,percent of total billed charges,,
TROPICAMIDE 1 % OPHT DROP,,6840,LOCAL,Facility,Inpatient,15,mL,,52,44.2,14.9032,52,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
TROPICAMIDE 1 % OPHT DROP,,6840,LOCAL,Facility,Outpatient,15,mL,,52,44.2,14.9032,52,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,24.96,48,,percent of total billed charges,,100% of DHS outpatient percentage
TROPICAMIDE 1 % OPHT DROP,,6840,LOCAL,Facility,Inpatient,15,mL,,52,44.2,14.9032,52,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
CARBOXYMETHYLCELLULOSE SODIUM 0.5 % OPHT DROP,,11441,LOCAL,Facility,Both,15,mL,,49,41.65,14.0434,49,Aetna,Commercial,45.08,92,,percent of total billed charges,,
CARBOXYMETHYLCELLULOSE SODIUM 0.5 % OPHT DROP,,11441,LOCAL,Facility,Outpatient,15,mL,,49,41.65,14.0434,49,Aetna,Medicare Advantage,24.01,49,,percent of total billed charges,,
CARBOXYMETHYLCELLULOSE SODIUM 0.5 % OPHT DROP,,11441,LOCAL,Facility,Inpatient,15,mL,,49,41.65,14.0434,49,Aetna,Medicare Advantage,,,,,Included in per diem rate,
CARBOXYMETHYLCELLULOSE SODIUM 0.5 % OPHT DROP,,11441,LOCAL,Facility,Both,15,mL,,49,41.65,14.0434,49,Aetna,PPO,45.57,93,,percent of total billed charges,,
CARBOXYMETHYLCELLULOSE SODIUM 0.5 % OPHT DROP,,11441,LOCAL,Facility,Both,15,mL,,49,41.65,14.0434,49,America's PPO,America's PPO,47.0547,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
CARBOXYMETHYLCELLULOSE SODIUM 0.5 % OPHT DROP,,11441,LOCAL,Facility,Both,15,mL,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota, Federal Employee Program,48.216,98.4,,percent of total billed charges,,
CARBOXYMETHYLCELLULOSE SODIUM 0.5 % OPHT DROP,,11441,LOCAL,Facility,Both,15,mL,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,49,100,,percent of total billed charges,,
CARBOXYMETHYLCELLULOSE SODIUM 0.5 % OPHT DROP,,11441,LOCAL,Facility,Both,15,mL,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,High Value Network Plan,44.1,90,,percent of total billed charges,,
CARBOXYMETHYLCELLULOSE SODIUM 0.5 % OPHT DROP,,11441,LOCAL,Facility,Outpatient,15,mL,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Medicare Advantage,24.01,49,,percent of total billed charges,,
CARBOXYMETHYLCELLULOSE SODIUM 0.5 % OPHT DROP,,11441,LOCAL,Facility,Inpatient,15,mL,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
CARBOXYMETHYLCELLULOSE SODIUM 0.5 % OPHT DROP,,11441,LOCAL,Facility,Both,15,mL,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,43.3993,88.57,,percent of total billed charges,,
CARBOXYMETHYLCELLULOSE SODIUM 0.5 % OPHT DROP,,11441,LOCAL,Facility,Both,15,mL,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,14.0434,28.66,,percent of total billed charges,,
CARBOXYMETHYLCELLULOSE SODIUM 0.5 % OPHT DROP,,11441,LOCAL,Facility,Outpatient,15,mL,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),24.01,49,,percent of total billed charges,,
CARBOXYMETHYLCELLULOSE SODIUM 0.5 % OPHT DROP,,11441,LOCAL,Facility,Inpatient,15,mL,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
CARBOXYMETHYLCELLULOSE SODIUM 0.5 % OPHT DROP,,11441,LOCAL,Facility,Both,15,mL,,49,41.65,14.0434,49,CorVel,Worker's Compensation,49,100,,percent of total billed charges,,
CARBOXYMETHYLCELLULOSE SODIUM 0.5 % OPHT DROP,,11441,LOCAL,Facility,Both,15,mL,,49,41.65,14.0434,49,First Health Group Corporation,First Health Network,47.53,97,,percent of total billed charges,,
CARBOXYMETHYLCELLULOSE SODIUM 0.5 % OPHT DROP,,11441,LOCAL,Facility,Both,15,mL,,49,41.65,14.0434,49,"Health Partners, Inc.",Commercial,46.354,94.6,,percent of total billed charges,,
CARBOXYMETHYLCELLULOSE SODIUM 0.5 % OPHT DROP,,11441,LOCAL,Facility,Outpatient,15,mL,,49,41.65,14.0434,49,"Health Partners, Inc.",Medicare Advantage,24.01,49,,percent of total billed charges,,
CARBOXYMETHYLCELLULOSE SODIUM 0.5 % OPHT DROP,,11441,LOCAL,Facility,Inpatient,15,mL,,49,41.65,14.0434,49,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CARBOXYMETHYLCELLULOSE SODIUM 0.5 % OPHT DROP,,11441,LOCAL,Facility,Both,15,mL,,49,41.65,14.0434,49,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),29.4,60,,percent of total billed charges,,
CARBOXYMETHYLCELLULOSE SODIUM 0.5 % OPHT DROP,,11441,LOCAL,Facility,Both,15,mL,,49,41.65,14.0434,49,"Health Partners, Inc.",State of Minnesota Advantage Program,39.935,81.5,,percent of total billed charges,,
CARBOXYMETHYLCELLULOSE SODIUM 0.5 % OPHT DROP,,11441,LOCAL,Facility,Both,15,mL,,49,41.65,14.0434,49,"Health Partners, Inc.",State Public Programs,24.5,50,,percent of total billed charges,,
CARBOXYMETHYLCELLULOSE SODIUM 0.5 % OPHT DROP,,11441,LOCAL,Facility,Both,15,mL,,49,41.65,14.0434,49,Humana Insurance Company,Commercial PPO,46.55,95,,percent of total billed charges,,
CARBOXYMETHYLCELLULOSE SODIUM 0.5 % OPHT DROP,,11441,LOCAL,Facility,Outpatient,15,mL,,49,41.65,14.0434,49,Humana Insurance Company,Medicare PPO,24.01,49,,percent of total billed charges,,
CARBOXYMETHYLCELLULOSE SODIUM 0.5 % OPHT DROP,,11441,LOCAL,Facility,Inpatient,15,mL,,49,41.65,14.0434,49,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
CARBOXYMETHYLCELLULOSE SODIUM 0.5 % OPHT DROP,,11441,LOCAL,Facility,Both,15,mL,,49,41.65,14.0434,49,Medica,Individual & Family,48.559,99.1,,percent of total billed charges,,
CARBOXYMETHYLCELLULOSE SODIUM 0.5 % OPHT DROP,,11441,LOCAL,Facility,Outpatient,15,mL,,49,41.65,14.0434,49,Medica,Medica Advantage Solution,24.402,49.8,,percent of total billed charges,,
CARBOXYMETHYLCELLULOSE SODIUM 0.5 % OPHT DROP,,11441,LOCAL,Facility,Inpatient,15,mL,,49,41.65,14.0434,49,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
CARBOXYMETHYLCELLULOSE SODIUM 0.5 % OPHT DROP,,11441,LOCAL,Facility,Outpatient,15,mL,,49,41.65,14.0434,49,Medica,Medical Assistance,21.854,44.6,,percent of total billed charges,,
CARBOXYMETHYLCELLULOSE SODIUM 0.5 % OPHT DROP,,11441,LOCAL,Facility,Inpatient,15,mL,,49,41.65,14.0434,49,Medica,Medical Assistance,,,,,Included in per diem rate,
CARBOXYMETHYLCELLULOSE SODIUM 0.5 % OPHT DROP,,11441,LOCAL,Facility,Outpatient,15,mL,,49,41.65,14.0434,49,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,24.402,49.8,,percent of total billed charges,,
CARBOXYMETHYLCELLULOSE SODIUM 0.5 % OPHT DROP,,11441,LOCAL,Facility,Inpatient,15,mL,,49,41.65,14.0434,49,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
CARBOXYMETHYLCELLULOSE SODIUM 0.5 % OPHT DROP,,11441,LOCAL,Facility,Both,15,mL,,49,41.65,14.0434,49,"Multiplan, Inc.","Multiplan, Inc.",46.06,94,,percent of total billed charges,,
CARBOXYMETHYLCELLULOSE SODIUM 0.5 % OPHT DROP,,11441,LOCAL,Facility,Outpatient,15,mL,,49,41.65,14.0434,49,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,44.149,90.1,,percent of total billed charges,,
CARBOXYMETHYLCELLULOSE SODIUM 0.5 % OPHT DROP,,11441,LOCAL,Facility,Inpatient,15,mL,,49,41.65,14.0434,49,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
CARBOXYMETHYLCELLULOSE SODIUM 0.5 % OPHT DROP,,11441,LOCAL,Facility,Both,15,mL,,49,41.65,14.0434,49,"Preferred One Administrative Services, INC.",PPO,48.314,98.6,,percent of total billed charges,,
CARBOXYMETHYLCELLULOSE SODIUM 0.5 % OPHT DROP,,11441,LOCAL,Facility,Outpatient,15,mL,,49,41.65,14.0434,49,PrimeWest Health,Minnesota Senior Health Options (MSHO),25.2105,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
CARBOXYMETHYLCELLULOSE SODIUM 0.5 % OPHT DROP,,11441,LOCAL,Facility,Inpatient,15,mL,,49,41.65,14.0434,49,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CARBOXYMETHYLCELLULOSE SODIUM 0.5 % OPHT DROP,,11441,LOCAL,Facility,Outpatient,15,mL,,49,41.65,14.0434,49,PrimeWest Health,MinnesotaCare,25.1664,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
CARBOXYMETHYLCELLULOSE SODIUM 0.5 % OPHT DROP,,11441,LOCAL,Facility,Inpatient,15,mL,,49,41.65,14.0434,49,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
CARBOXYMETHYLCELLULOSE SODIUM 0.5 % OPHT DROP,,11441,LOCAL,Facility,Both,15,mL,,49,41.65,14.0434,49,Sanford Health Plan,Sanford Health Plan,45.08,92,,percent of total billed charges,,
CARBOXYMETHYLCELLULOSE SODIUM 0.5 % OPHT DROP,,11441,LOCAL,Facility,Outpatient,15,mL,,49,41.65,14.0434,49,"UCare Health, Inc.",Individual & Family Plan,27.6115,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
CARBOXYMETHYLCELLULOSE SODIUM 0.5 % OPHT DROP,,11441,LOCAL,Facility,Inpatient,15,mL,,49,41.65,14.0434,49,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
CARBOXYMETHYLCELLULOSE SODIUM 0.5 % OPHT DROP,,11441,LOCAL,Facility,Outpatient,15,mL,,49,41.65,14.0434,49,"UCare Health, Inc.",Medical Assistance,24.7303,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CARBOXYMETHYLCELLULOSE SODIUM 0.5 % OPHT DROP,,11441,LOCAL,Facility,Inpatient,15,mL,,49,41.65,14.0434,49,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
CARBOXYMETHYLCELLULOSE SODIUM 0.5 % OPHT DROP,,11441,LOCAL,Facility,Outpatient,15,mL,,49,41.65,14.0434,49,"UCare Health, Inc.",Medicare Advantage,24.7303,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CARBOXYMETHYLCELLULOSE SODIUM 0.5 % OPHT DROP,,11441,LOCAL,Facility,Inpatient,15,mL,,49,41.65,14.0434,49,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CARBOXYMETHYLCELLULOSE SODIUM 0.5 % OPHT DROP,,11441,LOCAL,Facility,Outpatient,15,mL,,49,41.65,14.0434,49,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),24.7303,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CARBOXYMETHYLCELLULOSE SODIUM 0.5 % OPHT DROP,,11441,LOCAL,Facility,Inpatient,15,mL,,49,41.65,14.0434,49,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CARBOXYMETHYLCELLULOSE SODIUM 0.5 % OPHT DROP,,11441,LOCAL,Facility,Both,15,mL,,49,41.65,14.0434,49,UnitedHealthcare,Individual & Family,46.06,94,,percent of total billed charges,,
CARBOXYMETHYLCELLULOSE SODIUM 0.5 % OPHT DROP,,11441,LOCAL,Facility,Outpatient,15,mL,,49,41.65,14.0434,49,UnitedHealthcare,Medicare Advantage,24.01,49,,percent of total billed charges,,
CARBOXYMETHYLCELLULOSE SODIUM 0.5 % OPHT DROP,,11441,LOCAL,Facility,Inpatient,15,mL,,49,41.65,14.0434,49,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
CARBOXYMETHYLCELLULOSE SODIUM 0.5 % OPHT DROP,,11441,LOCAL,Facility,Outpatient,15,mL,,49,41.65,14.0434,49,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,23.52,48,,percent of total billed charges,,100% of DHS outpatient percentage
CARBOXYMETHYLCELLULOSE SODIUM 0.5 % OPHT DROP,,11441,LOCAL,Facility,Inpatient,15,mL,,49,41.65,14.0434,49,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
SULFACETAMIDE SODIUM 10 % OPHT DROP,,11541,LOCAL,Facility,Both,15,mL,,234,198.9,67.0644,234,Aetna,Commercial,215.28,92,,percent of total billed charges,,
SULFACETAMIDE SODIUM 10 % OPHT DROP,,11541,LOCAL,Facility,Both,15,mL,,257,218.45,73.6562,257,Aetna,Commercial,236.44,92,,percent of total billed charges,,
SULFACETAMIDE SODIUM 10 % OPHT DROP,,11541,LOCAL,Facility,Outpatient,15,mL,,234,198.9,67.0644,234,Aetna,Medicare Advantage,114.66,49,,percent of total billed charges,,
SULFACETAMIDE SODIUM 10 % OPHT DROP,,11541,LOCAL,Facility,Outpatient,15,mL,,257,218.45,73.6562,257,Aetna,Medicare Advantage,125.93,49,,percent of total billed charges,,
SULFACETAMIDE SODIUM 10 % OPHT DROP,,11541,LOCAL,Facility,Inpatient,15,mL,,234,198.9,67.0644,234,Aetna,Medicare Advantage,,,,,Included in per diem rate,
SULFACETAMIDE SODIUM 10 % OPHT DROP,,11541,LOCAL,Facility,Inpatient,15,mL,,257,218.45,73.6562,257,Aetna,Medicare Advantage,,,,,Included in per diem rate,
SULFACETAMIDE SODIUM 10 % OPHT DROP,,11541,LOCAL,Facility,Both,15,mL,,234,198.9,67.0644,234,Aetna,PPO,217.62,93,,percent of total billed charges,,
SULFACETAMIDE SODIUM 10 % OPHT DROP,,11541,LOCAL,Facility,Both,15,mL,,257,218.45,73.6562,257,Aetna,PPO,239.01,93,,percent of total billed charges,,
SULFACETAMIDE SODIUM 10 % OPHT DROP,,11541,LOCAL,Facility,Both,15,mL,,234,198.9,67.0644,234,America's PPO,America's PPO,224.7102,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SULFACETAMIDE SODIUM 10 % OPHT DROP,,11541,LOCAL,Facility,Both,15,mL,,257,218.45,73.6562,257,America's PPO,America's PPO,246.7971,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SULFACETAMIDE SODIUM 10 % OPHT DROP,,11541,LOCAL,Facility,Both,15,mL,,234,198.9,67.0644,234,BlueCross BlueShield Minnesota, Federal Employee Program,230.256,98.4,,percent of total billed charges,,
SULFACETAMIDE SODIUM 10 % OPHT DROP,,11541,LOCAL,Facility,Both,15,mL,,257,218.45,73.6562,257,BlueCross BlueShield Minnesota, Federal Employee Program,252.888,98.4,,percent of total billed charges,,
SULFACETAMIDE SODIUM 10 % OPHT DROP,,11541,LOCAL,Facility,Both,15,mL,,234,198.9,67.0644,234,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,234,100,,percent of total billed charges,,
SULFACETAMIDE SODIUM 10 % OPHT DROP,,11541,LOCAL,Facility,Both,15,mL,,257,218.45,73.6562,257,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,257,100,,percent of total billed charges,,
SULFACETAMIDE SODIUM 10 % OPHT DROP,,11541,LOCAL,Facility,Both,15,mL,,234,198.9,67.0644,234,BlueCross BlueShield Minnesota,High Value Network Plan,210.6,90,,percent of total billed charges,,
SULFACETAMIDE SODIUM 10 % OPHT DROP,,11541,LOCAL,Facility,Both,15,mL,,257,218.45,73.6562,257,BlueCross BlueShield Minnesota,High Value Network Plan,231.3,90,,percent of total billed charges,,
SULFACETAMIDE SODIUM 10 % OPHT DROP,,11541,LOCAL,Facility,Outpatient,15,mL,,234,198.9,67.0644,234,BlueCross BlueShield Minnesota,Medicare Advantage,114.66,49,,percent of total billed charges,,
SULFACETAMIDE SODIUM 10 % OPHT DROP,,11541,LOCAL,Facility,Outpatient,15,mL,,257,218.45,73.6562,257,BlueCross BlueShield Minnesota,Medicare Advantage,125.93,49,,percent of total billed charges,,
SULFACETAMIDE SODIUM 10 % OPHT DROP,,11541,LOCAL,Facility,Inpatient,15,mL,,234,198.9,67.0644,234,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
SULFACETAMIDE SODIUM 10 % OPHT DROP,,11541,LOCAL,Facility,Inpatient,15,mL,,257,218.45,73.6562,257,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
SULFACETAMIDE SODIUM 10 % OPHT DROP,,11541,LOCAL,Facility,Both,15,mL,,234,198.9,67.0644,234,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,207.2538,88.57,,percent of total billed charges,,
SULFACETAMIDE SODIUM 10 % OPHT DROP,,11541,LOCAL,Facility,Both,15,mL,,257,218.45,73.6562,257,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,227.6249,88.57,,percent of total billed charges,,
SULFACETAMIDE SODIUM 10 % OPHT DROP,,11541,LOCAL,Facility,Both,15,mL,,234,198.9,67.0644,234,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,67.0644,28.66,,percent of total billed charges,,
SULFACETAMIDE SODIUM 10 % OPHT DROP,,11541,LOCAL,Facility,Both,15,mL,,257,218.45,73.6562,257,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,73.6562,28.66,,percent of total billed charges,,
SULFACETAMIDE SODIUM 10 % OPHT DROP,,11541,LOCAL,Facility,Outpatient,15,mL,,234,198.9,67.0644,234,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),114.66,49,,percent of total billed charges,,
SULFACETAMIDE SODIUM 10 % OPHT DROP,,11541,LOCAL,Facility,Outpatient,15,mL,,257,218.45,73.6562,257,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),125.93,49,,percent of total billed charges,,
SULFACETAMIDE SODIUM 10 % OPHT DROP,,11541,LOCAL,Facility,Inpatient,15,mL,,234,198.9,67.0644,234,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
SULFACETAMIDE SODIUM 10 % OPHT DROP,,11541,LOCAL,Facility,Inpatient,15,mL,,257,218.45,73.6562,257,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
SULFACETAMIDE SODIUM 10 % OPHT DROP,,11541,LOCAL,Facility,Both,15,mL,,234,198.9,67.0644,234,CorVel,Worker's Compensation,234,100,,percent of total billed charges,,
SULFACETAMIDE SODIUM 10 % OPHT DROP,,11541,LOCAL,Facility,Both,15,mL,,257,218.45,73.6562,257,CorVel,Worker's Compensation,257,100,,percent of total billed charges,,
SULFACETAMIDE SODIUM 10 % OPHT DROP,,11541,LOCAL,Facility,Both,15,mL,,234,198.9,67.0644,234,First Health Group Corporation,First Health Network,226.98,97,,percent of total billed charges,,
SULFACETAMIDE SODIUM 10 % OPHT DROP,,11541,LOCAL,Facility,Both,15,mL,,257,218.45,73.6562,257,First Health Group Corporation,First Health Network,249.29,97,,percent of total billed charges,,
SULFACETAMIDE SODIUM 10 % OPHT DROP,,11541,LOCAL,Facility,Both,15,mL,,234,198.9,67.0644,234,"Health Partners, Inc.",Commercial,221.364,94.6,,percent of total billed charges,,
SULFACETAMIDE SODIUM 10 % OPHT DROP,,11541,LOCAL,Facility,Both,15,mL,,257,218.45,73.6562,257,"Health Partners, Inc.",Commercial,243.122,94.6,,percent of total billed charges,,
SULFACETAMIDE SODIUM 10 % OPHT DROP,,11541,LOCAL,Facility,Outpatient,15,mL,,234,198.9,67.0644,234,"Health Partners, Inc.",Medicare Advantage,114.66,49,,percent of total billed charges,,
SULFACETAMIDE SODIUM 10 % OPHT DROP,,11541,LOCAL,Facility,Outpatient,15,mL,,257,218.45,73.6562,257,"Health Partners, Inc.",Medicare Advantage,125.93,49,,percent of total billed charges,,
SULFACETAMIDE SODIUM 10 % OPHT DROP,,11541,LOCAL,Facility,Inpatient,15,mL,,234,198.9,67.0644,234,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SULFACETAMIDE SODIUM 10 % OPHT DROP,,11541,LOCAL,Facility,Inpatient,15,mL,,257,218.45,73.6562,257,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SULFACETAMIDE SODIUM 10 % OPHT DROP,,11541,LOCAL,Facility,Both,15,mL,,234,198.9,67.0644,234,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),140.4,60,,percent of total billed charges,,
SULFACETAMIDE SODIUM 10 % OPHT DROP,,11541,LOCAL,Facility,Both,15,mL,,257,218.45,73.6562,257,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),154.2,60,,percent of total billed charges,,
SULFACETAMIDE SODIUM 10 % OPHT DROP,,11541,LOCAL,Facility,Both,15,mL,,234,198.9,67.0644,234,"Health Partners, Inc.",State of Minnesota Advantage Program,190.71,81.5,,percent of total billed charges,,
SULFACETAMIDE SODIUM 10 % OPHT DROP,,11541,LOCAL,Facility,Both,15,mL,,257,218.45,73.6562,257,"Health Partners, Inc.",State of Minnesota Advantage Program,209.455,81.5,,percent of total billed charges,,
SULFACETAMIDE SODIUM 10 % OPHT DROP,,11541,LOCAL,Facility,Both,15,mL,,234,198.9,67.0644,234,"Health Partners, Inc.",State Public Programs,117,50,,percent of total billed charges,,
SULFACETAMIDE SODIUM 10 % OPHT DROP,,11541,LOCAL,Facility,Both,15,mL,,257,218.45,73.6562,257,"Health Partners, Inc.",State Public Programs,128.5,50,,percent of total billed charges,,
SULFACETAMIDE SODIUM 10 % OPHT DROP,,11541,LOCAL,Facility,Both,15,mL,,234,198.9,67.0644,234,Humana Insurance Company,Commercial PPO,222.3,95,,percent of total billed charges,,
SULFACETAMIDE SODIUM 10 % OPHT DROP,,11541,LOCAL,Facility,Both,15,mL,,257,218.45,73.6562,257,Humana Insurance Company,Commercial PPO,244.15,95,,percent of total billed charges,,
SULFACETAMIDE SODIUM 10 % OPHT DROP,,11541,LOCAL,Facility,Outpatient,15,mL,,234,198.9,67.0644,234,Humana Insurance Company,Medicare PPO,114.66,49,,percent of total billed charges,,
SULFACETAMIDE SODIUM 10 % OPHT DROP,,11541,LOCAL,Facility,Outpatient,15,mL,,257,218.45,73.6562,257,Humana Insurance Company,Medicare PPO,125.93,49,,percent of total billed charges,,
SULFACETAMIDE SODIUM 10 % OPHT DROP,,11541,LOCAL,Facility,Inpatient,15,mL,,234,198.9,67.0644,234,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
SULFACETAMIDE SODIUM 10 % OPHT DROP,,11541,LOCAL,Facility,Inpatient,15,mL,,257,218.45,73.6562,257,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
SULFACETAMIDE SODIUM 10 % OPHT DROP,,11541,LOCAL,Facility,Both,15,mL,,234,198.9,67.0644,234,Medica,Individual & Family,231.894,99.1,,percent of total billed charges,,
SULFACETAMIDE SODIUM 10 % OPHT DROP,,11541,LOCAL,Facility,Both,15,mL,,257,218.45,73.6562,257,Medica,Individual & Family,254.687,99.1,,percent of total billed charges,,
SULFACETAMIDE SODIUM 10 % OPHT DROP,,11541,LOCAL,Facility,Outpatient,15,mL,,234,198.9,67.0644,234,Medica,Medica Advantage Solution,116.532,49.8,,percent of total billed charges,,
SULFACETAMIDE SODIUM 10 % OPHT DROP,,11541,LOCAL,Facility,Outpatient,15,mL,,257,218.45,73.6562,257,Medica,Medica Advantage Solution,127.986,49.8,,percent of total billed charges,,
SULFACETAMIDE SODIUM 10 % OPHT DROP,,11541,LOCAL,Facility,Inpatient,15,mL,,234,198.9,67.0644,234,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
SULFACETAMIDE SODIUM 10 % OPHT DROP,,11541,LOCAL,Facility,Inpatient,15,mL,,257,218.45,73.6562,257,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
SULFACETAMIDE SODIUM 10 % OPHT DROP,,11541,LOCAL,Facility,Outpatient,15,mL,,234,198.9,67.0644,234,Medica,Medical Assistance,104.364,44.6,,percent of total billed charges,,
SULFACETAMIDE SODIUM 10 % OPHT DROP,,11541,LOCAL,Facility,Outpatient,15,mL,,257,218.45,73.6562,257,Medica,Medical Assistance,114.622,44.6,,percent of total billed charges,,
SULFACETAMIDE SODIUM 10 % OPHT DROP,,11541,LOCAL,Facility,Inpatient,15,mL,,234,198.9,67.0644,234,Medica,Medical Assistance,,,,,Included in per diem rate,
SULFACETAMIDE SODIUM 10 % OPHT DROP,,11541,LOCAL,Facility,Inpatient,15,mL,,257,218.45,73.6562,257,Medica,Medical Assistance,,,,,Included in per diem rate,
SULFACETAMIDE SODIUM 10 % OPHT DROP,,11541,LOCAL,Facility,Outpatient,15,mL,,234,198.9,67.0644,234,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,116.532,49.8,,percent of total billed charges,,
SULFACETAMIDE SODIUM 10 % OPHT DROP,,11541,LOCAL,Facility,Outpatient,15,mL,,257,218.45,73.6562,257,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,127.986,49.8,,percent of total billed charges,,
SULFACETAMIDE SODIUM 10 % OPHT DROP,,11541,LOCAL,Facility,Inpatient,15,mL,,234,198.9,67.0644,234,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
SULFACETAMIDE SODIUM 10 % OPHT DROP,,11541,LOCAL,Facility,Inpatient,15,mL,,257,218.45,73.6562,257,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
SULFACETAMIDE SODIUM 10 % OPHT DROP,,11541,LOCAL,Facility,Both,15,mL,,234,198.9,67.0644,234,"Multiplan, Inc.","Multiplan, Inc.",219.96,94,,percent of total billed charges,,
SULFACETAMIDE SODIUM 10 % OPHT DROP,,11541,LOCAL,Facility,Both,15,mL,,257,218.45,73.6562,257,"Multiplan, Inc.","Multiplan, Inc.",241.58,94,,percent of total billed charges,,
SULFACETAMIDE SODIUM 10 % OPHT DROP,,11541,LOCAL,Facility,Outpatient,15,mL,,234,198.9,67.0644,234,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,210.834,90.1,,percent of total billed charges,,
SULFACETAMIDE SODIUM 10 % OPHT DROP,,11541,LOCAL,Facility,Outpatient,15,mL,,257,218.45,73.6562,257,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,231.557,90.1,,percent of total billed charges,,
SULFACETAMIDE SODIUM 10 % OPHT DROP,,11541,LOCAL,Facility,Inpatient,15,mL,,234,198.9,67.0644,234,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
SULFACETAMIDE SODIUM 10 % OPHT DROP,,11541,LOCAL,Facility,Inpatient,15,mL,,257,218.45,73.6562,257,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
SULFACETAMIDE SODIUM 10 % OPHT DROP,,11541,LOCAL,Facility,Both,15,mL,,234,198.9,67.0644,234,"Preferred One Administrative Services, INC.",PPO,230.724,98.6,,percent of total billed charges,,
SULFACETAMIDE SODIUM 10 % OPHT DROP,,11541,LOCAL,Facility,Both,15,mL,,257,218.45,73.6562,257,"Preferred One Administrative Services, INC.",PPO,253.402,98.6,,percent of total billed charges,,
SULFACETAMIDE SODIUM 10 % OPHT DROP,,11541,LOCAL,Facility,Outpatient,15,mL,,234,198.9,67.0644,234,PrimeWest Health,Minnesota Senior Health Options (MSHO),120.393,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
SULFACETAMIDE SODIUM 10 % OPHT DROP,,11541,LOCAL,Facility,Outpatient,15,mL,,257,218.45,73.6562,257,PrimeWest Health,Minnesota Senior Health Options (MSHO),132.2265,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
SULFACETAMIDE SODIUM 10 % OPHT DROP,,11541,LOCAL,Facility,Inpatient,15,mL,,234,198.9,67.0644,234,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SULFACETAMIDE SODIUM 10 % OPHT DROP,,11541,LOCAL,Facility,Inpatient,15,mL,,257,218.45,73.6562,257,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SULFACETAMIDE SODIUM 10 % OPHT DROP,,11541,LOCAL,Facility,Outpatient,15,mL,,234,198.9,67.0644,234,PrimeWest Health,MinnesotaCare,120.1824,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
SULFACETAMIDE SODIUM 10 % OPHT DROP,,11541,LOCAL,Facility,Outpatient,15,mL,,257,218.45,73.6562,257,PrimeWest Health,MinnesotaCare,131.9952,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
SULFACETAMIDE SODIUM 10 % OPHT DROP,,11541,LOCAL,Facility,Inpatient,15,mL,,234,198.9,67.0644,234,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
SULFACETAMIDE SODIUM 10 % OPHT DROP,,11541,LOCAL,Facility,Inpatient,15,mL,,257,218.45,73.6562,257,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
SULFACETAMIDE SODIUM 10 % OPHT DROP,,11541,LOCAL,Facility,Both,15,mL,,234,198.9,67.0644,234,Sanford Health Plan,Sanford Health Plan,215.28,92,,percent of total billed charges,,
SULFACETAMIDE SODIUM 10 % OPHT DROP,,11541,LOCAL,Facility,Both,15,mL,,257,218.45,73.6562,257,Sanford Health Plan,Sanford Health Plan,236.44,92,,percent of total billed charges,,
SULFACETAMIDE SODIUM 10 % OPHT DROP,,11541,LOCAL,Facility,Outpatient,15,mL,,234,198.9,67.0644,234,"UCare Health, Inc.",Individual & Family Plan,131.859,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
SULFACETAMIDE SODIUM 10 % OPHT DROP,,11541,LOCAL,Facility,Outpatient,15,mL,,257,218.45,73.6562,257,"UCare Health, Inc.",Individual & Family Plan,144.8195,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
SULFACETAMIDE SODIUM 10 % OPHT DROP,,11541,LOCAL,Facility,Inpatient,15,mL,,234,198.9,67.0644,234,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
SULFACETAMIDE SODIUM 10 % OPHT DROP,,11541,LOCAL,Facility,Inpatient,15,mL,,257,218.45,73.6562,257,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
SULFACETAMIDE SODIUM 10 % OPHT DROP,,11541,LOCAL,Facility,Outpatient,15,mL,,234,198.9,67.0644,234,"UCare Health, Inc.",Medical Assistance,118.0998,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SULFACETAMIDE SODIUM 10 % OPHT DROP,,11541,LOCAL,Facility,Outpatient,15,mL,,257,218.45,73.6562,257,"UCare Health, Inc.",Medical Assistance,129.7079,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SULFACETAMIDE SODIUM 10 % OPHT DROP,,11541,LOCAL,Facility,Inpatient,15,mL,,234,198.9,67.0644,234,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
SULFACETAMIDE SODIUM 10 % OPHT DROP,,11541,LOCAL,Facility,Inpatient,15,mL,,257,218.45,73.6562,257,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
SULFACETAMIDE SODIUM 10 % OPHT DROP,,11541,LOCAL,Facility,Outpatient,15,mL,,234,198.9,67.0644,234,"UCare Health, Inc.",Medicare Advantage,118.0998,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SULFACETAMIDE SODIUM 10 % OPHT DROP,,11541,LOCAL,Facility,Outpatient,15,mL,,257,218.45,73.6562,257,"UCare Health, Inc.",Medicare Advantage,129.7079,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SULFACETAMIDE SODIUM 10 % OPHT DROP,,11541,LOCAL,Facility,Inpatient,15,mL,,234,198.9,67.0644,234,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SULFACETAMIDE SODIUM 10 % OPHT DROP,,11541,LOCAL,Facility,Inpatient,15,mL,,257,218.45,73.6562,257,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SULFACETAMIDE SODIUM 10 % OPHT DROP,,11541,LOCAL,Facility,Outpatient,15,mL,,234,198.9,67.0644,234,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),118.0998,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SULFACETAMIDE SODIUM 10 % OPHT DROP,,11541,LOCAL,Facility,Outpatient,15,mL,,257,218.45,73.6562,257,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),129.7079,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SULFACETAMIDE SODIUM 10 % OPHT DROP,,11541,LOCAL,Facility,Inpatient,15,mL,,234,198.9,67.0644,234,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SULFACETAMIDE SODIUM 10 % OPHT DROP,,11541,LOCAL,Facility,Inpatient,15,mL,,257,218.45,73.6562,257,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SULFACETAMIDE SODIUM 10 % OPHT DROP,,11541,LOCAL,Facility,Both,15,mL,,234,198.9,67.0644,234,UnitedHealthcare,Individual & Family,219.96,94,,percent of total billed charges,,
SULFACETAMIDE SODIUM 10 % OPHT DROP,,11541,LOCAL,Facility,Both,15,mL,,257,218.45,73.6562,257,UnitedHealthcare,Individual & Family,241.58,94,,percent of total billed charges,,
SULFACETAMIDE SODIUM 10 % OPHT DROP,,11541,LOCAL,Facility,Outpatient,15,mL,,234,198.9,67.0644,234,UnitedHealthcare,Medicare Advantage,114.66,49,,percent of total billed charges,,
SULFACETAMIDE SODIUM 10 % OPHT DROP,,11541,LOCAL,Facility,Outpatient,15,mL,,257,218.45,73.6562,257,UnitedHealthcare,Medicare Advantage,125.93,49,,percent of total billed charges,,
SULFACETAMIDE SODIUM 10 % OPHT DROP,,11541,LOCAL,Facility,Inpatient,15,mL,,234,198.9,67.0644,234,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
SULFACETAMIDE SODIUM 10 % OPHT DROP,,11541,LOCAL,Facility,Inpatient,15,mL,,257,218.45,73.6562,257,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
SULFACETAMIDE SODIUM 10 % OPHT DROP,,11541,LOCAL,Facility,Outpatient,15,mL,,234,198.9,67.0644,234,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,112.32,48,,percent of total billed charges,,100% of DHS outpatient percentage
SULFACETAMIDE SODIUM 10 % OPHT DROP,,11541,LOCAL,Facility,Outpatient,15,mL,,257,218.45,73.6562,257,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,123.36,48,,percent of total billed charges,,100% of DHS outpatient percentage
SULFACETAMIDE SODIUM 10 % OPHT DROP,,11541,LOCAL,Facility,Inpatient,15,mL,,234,198.9,67.0644,234,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
SULFACETAMIDE SODIUM 10 % OPHT DROP,,11541,LOCAL,Facility,Inpatient,15,mL,,257,218.45,73.6562,257,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
PHENYLEPHRINE HCL 1 % NASL SPRY,,11921,LOCAL,Facility,Both,15,mL,,23,19.55,6.5918,23,Aetna,Commercial,21.16,92,,percent of total billed charges,,
PHENYLEPHRINE HCL 1 % NASL SPRY,,11921,LOCAL,Facility,Outpatient,15,mL,,23,19.55,6.5918,23,Aetna,Medicare Advantage,11.27,49,,percent of total billed charges,,
PHENYLEPHRINE HCL 1 % NASL SPRY,,11921,LOCAL,Facility,Inpatient,15,mL,,23,19.55,6.5918,23,Aetna,Medicare Advantage,,,,,Included in per diem rate,
PHENYLEPHRINE HCL 1 % NASL SPRY,,11921,LOCAL,Facility,Both,15,mL,,23,19.55,6.5918,23,Aetna,PPO,21.39,93,,percent of total billed charges,,
PHENYLEPHRINE HCL 1 % NASL SPRY,,11921,LOCAL,Facility,Both,15,mL,,23,19.55,6.5918,23,America's PPO,America's PPO,22.0869,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
PHENYLEPHRINE HCL 1 % NASL SPRY,,11921,LOCAL,Facility,Both,15,mL,,23,19.55,6.5918,23,BlueCross BlueShield Minnesota, Federal Employee Program,22.632,98.4,,percent of total billed charges,,
PHENYLEPHRINE HCL 1 % NASL SPRY,,11921,LOCAL,Facility,Both,15,mL,,23,19.55,6.5918,23,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,23,100,,percent of total billed charges,,
PHENYLEPHRINE HCL 1 % NASL SPRY,,11921,LOCAL,Facility,Both,15,mL,,23,19.55,6.5918,23,BlueCross BlueShield Minnesota,High Value Network Plan,20.7,90,,percent of total billed charges,,
PHENYLEPHRINE HCL 1 % NASL SPRY,,11921,LOCAL,Facility,Outpatient,15,mL,,23,19.55,6.5918,23,BlueCross BlueShield Minnesota,Medicare Advantage,11.27,49,,percent of total billed charges,,
PHENYLEPHRINE HCL 1 % NASL SPRY,,11921,LOCAL,Facility,Inpatient,15,mL,,23,19.55,6.5918,23,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
PHENYLEPHRINE HCL 1 % NASL SPRY,,11921,LOCAL,Facility,Both,15,mL,,23,19.55,6.5918,23,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,20.3711,88.57,,percent of total billed charges,,
PHENYLEPHRINE HCL 1 % NASL SPRY,,11921,LOCAL,Facility,Both,15,mL,,23,19.55,6.5918,23,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,6.5918,28.66,,percent of total billed charges,,
PHENYLEPHRINE HCL 1 % NASL SPRY,,11921,LOCAL,Facility,Outpatient,15,mL,,23,19.55,6.5918,23,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),11.27,49,,percent of total billed charges,,
PHENYLEPHRINE HCL 1 % NASL SPRY,,11921,LOCAL,Facility,Inpatient,15,mL,,23,19.55,6.5918,23,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
PHENYLEPHRINE HCL 1 % NASL SPRY,,11921,LOCAL,Facility,Both,15,mL,,23,19.55,6.5918,23,CorVel,Worker's Compensation,23,100,,percent of total billed charges,,
PHENYLEPHRINE HCL 1 % NASL SPRY,,11921,LOCAL,Facility,Both,15,mL,,23,19.55,6.5918,23,First Health Group Corporation,First Health Network,22.31,97,,percent of total billed charges,,
PHENYLEPHRINE HCL 1 % NASL SPRY,,11921,LOCAL,Facility,Both,15,mL,,23,19.55,6.5918,23,"Health Partners, Inc.",Commercial,21.758,94.6,,percent of total billed charges,,
PHENYLEPHRINE HCL 1 % NASL SPRY,,11921,LOCAL,Facility,Outpatient,15,mL,,23,19.55,6.5918,23,"Health Partners, Inc.",Medicare Advantage,11.27,49,,percent of total billed charges,,
PHENYLEPHRINE HCL 1 % NASL SPRY,,11921,LOCAL,Facility,Inpatient,15,mL,,23,19.55,6.5918,23,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PHENYLEPHRINE HCL 1 % NASL SPRY,,11921,LOCAL,Facility,Both,15,mL,,23,19.55,6.5918,23,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),13.8,60,,percent of total billed charges,,
PHENYLEPHRINE HCL 1 % NASL SPRY,,11921,LOCAL,Facility,Both,15,mL,,23,19.55,6.5918,23,"Health Partners, Inc.",State of Minnesota Advantage Program,18.745,81.5,,percent of total billed charges,,
PHENYLEPHRINE HCL 1 % NASL SPRY,,11921,LOCAL,Facility,Both,15,mL,,23,19.55,6.5918,23,"Health Partners, Inc.",State Public Programs,11.5,50,,percent of total billed charges,,
PHENYLEPHRINE HCL 1 % NASL SPRY,,11921,LOCAL,Facility,Both,15,mL,,23,19.55,6.5918,23,Humana Insurance Company,Commercial PPO,21.85,95,,percent of total billed charges,,
PHENYLEPHRINE HCL 1 % NASL SPRY,,11921,LOCAL,Facility,Outpatient,15,mL,,23,19.55,6.5918,23,Humana Insurance Company,Medicare PPO,11.27,49,,percent of total billed charges,,
PHENYLEPHRINE HCL 1 % NASL SPRY,,11921,LOCAL,Facility,Inpatient,15,mL,,23,19.55,6.5918,23,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
PHENYLEPHRINE HCL 1 % NASL SPRY,,11921,LOCAL,Facility,Both,15,mL,,23,19.55,6.5918,23,Medica,Individual & Family,22.793,99.1,,percent of total billed charges,,
PHENYLEPHRINE HCL 1 % NASL SPRY,,11921,LOCAL,Facility,Outpatient,15,mL,,23,19.55,6.5918,23,Medica,Medica Advantage Solution,11.454,49.8,,percent of total billed charges,,
PHENYLEPHRINE HCL 1 % NASL SPRY,,11921,LOCAL,Facility,Inpatient,15,mL,,23,19.55,6.5918,23,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
PHENYLEPHRINE HCL 1 % NASL SPRY,,11921,LOCAL,Facility,Outpatient,15,mL,,23,19.55,6.5918,23,Medica,Medical Assistance,10.258,44.6,,percent of total billed charges,,
PHENYLEPHRINE HCL 1 % NASL SPRY,,11921,LOCAL,Facility,Inpatient,15,mL,,23,19.55,6.5918,23,Medica,Medical Assistance,,,,,Included in per diem rate,
PHENYLEPHRINE HCL 1 % NASL SPRY,,11921,LOCAL,Facility,Outpatient,15,mL,,23,19.55,6.5918,23,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,11.454,49.8,,percent of total billed charges,,
PHENYLEPHRINE HCL 1 % NASL SPRY,,11921,LOCAL,Facility,Inpatient,15,mL,,23,19.55,6.5918,23,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
PHENYLEPHRINE HCL 1 % NASL SPRY,,11921,LOCAL,Facility,Both,15,mL,,23,19.55,6.5918,23,"Multiplan, Inc.","Multiplan, Inc.",21.62,94,,percent of total billed charges,,
PHENYLEPHRINE HCL 1 % NASL SPRY,,11921,LOCAL,Facility,Outpatient,15,mL,,23,19.55,6.5918,23,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,20.723,90.1,,percent of total billed charges,,
PHENYLEPHRINE HCL 1 % NASL SPRY,,11921,LOCAL,Facility,Inpatient,15,mL,,23,19.55,6.5918,23,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
PHENYLEPHRINE HCL 1 % NASL SPRY,,11921,LOCAL,Facility,Both,15,mL,,23,19.55,6.5918,23,"Preferred One Administrative Services, INC.",PPO,22.678,98.6,,percent of total billed charges,,
PHENYLEPHRINE HCL 1 % NASL SPRY,,11921,LOCAL,Facility,Outpatient,15,mL,,23,19.55,6.5918,23,PrimeWest Health,Minnesota Senior Health Options (MSHO),11.8335,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
PHENYLEPHRINE HCL 1 % NASL SPRY,,11921,LOCAL,Facility,Inpatient,15,mL,,23,19.55,6.5918,23,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PHENYLEPHRINE HCL 1 % NASL SPRY,,11921,LOCAL,Facility,Outpatient,15,mL,,23,19.55,6.5918,23,PrimeWest Health,MinnesotaCare,11.8128,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
PHENYLEPHRINE HCL 1 % NASL SPRY,,11921,LOCAL,Facility,Inpatient,15,mL,,23,19.55,6.5918,23,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
PHENYLEPHRINE HCL 1 % NASL SPRY,,11921,LOCAL,Facility,Both,15,mL,,23,19.55,6.5918,23,Sanford Health Plan,Sanford Health Plan,21.16,92,,percent of total billed charges,,
PHENYLEPHRINE HCL 1 % NASL SPRY,,11921,LOCAL,Facility,Outpatient,15,mL,,23,19.55,6.5918,23,"UCare Health, Inc.",Individual & Family Plan,12.9605,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
PHENYLEPHRINE HCL 1 % NASL SPRY,,11921,LOCAL,Facility,Inpatient,15,mL,,23,19.55,6.5918,23,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
PHENYLEPHRINE HCL 1 % NASL SPRY,,11921,LOCAL,Facility,Outpatient,15,mL,,23,19.55,6.5918,23,"UCare Health, Inc.",Medical Assistance,11.6081,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PHENYLEPHRINE HCL 1 % NASL SPRY,,11921,LOCAL,Facility,Inpatient,15,mL,,23,19.55,6.5918,23,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
PHENYLEPHRINE HCL 1 % NASL SPRY,,11921,LOCAL,Facility,Outpatient,15,mL,,23,19.55,6.5918,23,"UCare Health, Inc.",Medicare Advantage,11.6081,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PHENYLEPHRINE HCL 1 % NASL SPRY,,11921,LOCAL,Facility,Inpatient,15,mL,,23,19.55,6.5918,23,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PHENYLEPHRINE HCL 1 % NASL SPRY,,11921,LOCAL,Facility,Outpatient,15,mL,,23,19.55,6.5918,23,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),11.6081,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PHENYLEPHRINE HCL 1 % NASL SPRY,,11921,LOCAL,Facility,Inpatient,15,mL,,23,19.55,6.5918,23,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PHENYLEPHRINE HCL 1 % NASL SPRY,,11921,LOCAL,Facility,Both,15,mL,,23,19.55,6.5918,23,UnitedHealthcare,Individual & Family,21.62,94,,percent of total billed charges,,
PHENYLEPHRINE HCL 1 % NASL SPRY,,11921,LOCAL,Facility,Outpatient,15,mL,,23,19.55,6.5918,23,UnitedHealthcare,Medicare Advantage,11.27,49,,percent of total billed charges,,
PHENYLEPHRINE HCL 1 % NASL SPRY,,11921,LOCAL,Facility,Inpatient,15,mL,,23,19.55,6.5918,23,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
PHENYLEPHRINE HCL 1 % NASL SPRY,,11921,LOCAL,Facility,Outpatient,15,mL,,23,19.55,6.5918,23,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,11.04,48,,percent of total billed charges,,100% of DHS outpatient percentage
PHENYLEPHRINE HCL 1 % NASL SPRY,,11921,LOCAL,Facility,Inpatient,15,mL,,23,19.55,6.5918,23,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
IBUPROFEN 50 MG/1.25 ML ORAL DRPS,,11992,LOCAL,Facility,Both,15,mL,,22,18.7,6.3052,22,Aetna,Commercial,20.24,92,,percent of total billed charges,,
IBUPROFEN 50 MG/1.25 ML ORAL DRPS,,11992,LOCAL,Facility,Outpatient,15,mL,,22,18.7,6.3052,22,Aetna,Medicare Advantage,10.78,49,,percent of total billed charges,,
IBUPROFEN 50 MG/1.25 ML ORAL DRPS,,11992,LOCAL,Facility,Inpatient,15,mL,,22,18.7,6.3052,22,Aetna,Medicare Advantage,,,,,Included in per diem rate,
IBUPROFEN 50 MG/1.25 ML ORAL DRPS,,11992,LOCAL,Facility,Both,15,mL,,22,18.7,6.3052,22,Aetna,PPO,20.46,93,,percent of total billed charges,,
IBUPROFEN 50 MG/1.25 ML ORAL DRPS,,11992,LOCAL,Facility,Both,15,mL,,22,18.7,6.3052,22,America's PPO,America's PPO,21.1266,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
IBUPROFEN 50 MG/1.25 ML ORAL DRPS,,11992,LOCAL,Facility,Both,15,mL,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota, Federal Employee Program,21.648,98.4,,percent of total billed charges,,
IBUPROFEN 50 MG/1.25 ML ORAL DRPS,,11992,LOCAL,Facility,Both,15,mL,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,22,100,,percent of total billed charges,,
IBUPROFEN 50 MG/1.25 ML ORAL DRPS,,11992,LOCAL,Facility,Both,15,mL,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota,High Value Network Plan,19.8,90,,percent of total billed charges,,
IBUPROFEN 50 MG/1.25 ML ORAL DRPS,,11992,LOCAL,Facility,Outpatient,15,mL,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota,Medicare Advantage,10.78,49,,percent of total billed charges,,
IBUPROFEN 50 MG/1.25 ML ORAL DRPS,,11992,LOCAL,Facility,Inpatient,15,mL,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
IBUPROFEN 50 MG/1.25 ML ORAL DRPS,,11992,LOCAL,Facility,Both,15,mL,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,19.4854,88.57,,percent of total billed charges,,
IBUPROFEN 50 MG/1.25 ML ORAL DRPS,,11992,LOCAL,Facility,Both,15,mL,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,6.3052,28.66,,percent of total billed charges,,
IBUPROFEN 50 MG/1.25 ML ORAL DRPS,,11992,LOCAL,Facility,Outpatient,15,mL,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),10.78,49,,percent of total billed charges,,
IBUPROFEN 50 MG/1.25 ML ORAL DRPS,,11992,LOCAL,Facility,Inpatient,15,mL,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
IBUPROFEN 50 MG/1.25 ML ORAL DRPS,,11992,LOCAL,Facility,Both,15,mL,,22,18.7,6.3052,22,CorVel,Worker's Compensation,22,100,,percent of total billed charges,,
IBUPROFEN 50 MG/1.25 ML ORAL DRPS,,11992,LOCAL,Facility,Both,15,mL,,22,18.7,6.3052,22,First Health Group Corporation,First Health Network,21.34,97,,percent of total billed charges,,
IBUPROFEN 50 MG/1.25 ML ORAL DRPS,,11992,LOCAL,Facility,Both,15,mL,,22,18.7,6.3052,22,"Health Partners, Inc.",Commercial,20.812,94.6,,percent of total billed charges,,
IBUPROFEN 50 MG/1.25 ML ORAL DRPS,,11992,LOCAL,Facility,Outpatient,15,mL,,22,18.7,6.3052,22,"Health Partners, Inc.",Medicare Advantage,10.78,49,,percent of total billed charges,,
IBUPROFEN 50 MG/1.25 ML ORAL DRPS,,11992,LOCAL,Facility,Inpatient,15,mL,,22,18.7,6.3052,22,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
IBUPROFEN 50 MG/1.25 ML ORAL DRPS,,11992,LOCAL,Facility,Both,15,mL,,22,18.7,6.3052,22,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),13.2,60,,percent of total billed charges,,
IBUPROFEN 50 MG/1.25 ML ORAL DRPS,,11992,LOCAL,Facility,Both,15,mL,,22,18.7,6.3052,22,"Health Partners, Inc.",State of Minnesota Advantage Program,17.93,81.5,,percent of total billed charges,,
IBUPROFEN 50 MG/1.25 ML ORAL DRPS,,11992,LOCAL,Facility,Both,15,mL,,22,18.7,6.3052,22,"Health Partners, Inc.",State Public Programs,11,50,,percent of total billed charges,,
IBUPROFEN 50 MG/1.25 ML ORAL DRPS,,11992,LOCAL,Facility,Both,15,mL,,22,18.7,6.3052,22,Humana Insurance Company,Commercial PPO,20.9,95,,percent of total billed charges,,
IBUPROFEN 50 MG/1.25 ML ORAL DRPS,,11992,LOCAL,Facility,Outpatient,15,mL,,22,18.7,6.3052,22,Humana Insurance Company,Medicare PPO,10.78,49,,percent of total billed charges,,
IBUPROFEN 50 MG/1.25 ML ORAL DRPS,,11992,LOCAL,Facility,Inpatient,15,mL,,22,18.7,6.3052,22,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
IBUPROFEN 50 MG/1.25 ML ORAL DRPS,,11992,LOCAL,Facility,Both,15,mL,,22,18.7,6.3052,22,Medica,Individual & Family,21.802,99.1,,percent of total billed charges,,
IBUPROFEN 50 MG/1.25 ML ORAL DRPS,,11992,LOCAL,Facility,Outpatient,15,mL,,22,18.7,6.3052,22,Medica,Medica Advantage Solution,10.956,49.8,,percent of total billed charges,,
IBUPROFEN 50 MG/1.25 ML ORAL DRPS,,11992,LOCAL,Facility,Inpatient,15,mL,,22,18.7,6.3052,22,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
IBUPROFEN 50 MG/1.25 ML ORAL DRPS,,11992,LOCAL,Facility,Outpatient,15,mL,,22,18.7,6.3052,22,Medica,Medical Assistance,9.812,44.6,,percent of total billed charges,,
IBUPROFEN 50 MG/1.25 ML ORAL DRPS,,11992,LOCAL,Facility,Inpatient,15,mL,,22,18.7,6.3052,22,Medica,Medical Assistance,,,,,Included in per diem rate,
IBUPROFEN 50 MG/1.25 ML ORAL DRPS,,11992,LOCAL,Facility,Outpatient,15,mL,,22,18.7,6.3052,22,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,10.956,49.8,,percent of total billed charges,,
IBUPROFEN 50 MG/1.25 ML ORAL DRPS,,11992,LOCAL,Facility,Inpatient,15,mL,,22,18.7,6.3052,22,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
IBUPROFEN 50 MG/1.25 ML ORAL DRPS,,11992,LOCAL,Facility,Both,15,mL,,22,18.7,6.3052,22,"Multiplan, Inc.","Multiplan, Inc.",20.68,94,,percent of total billed charges,,
IBUPROFEN 50 MG/1.25 ML ORAL DRPS,,11992,LOCAL,Facility,Outpatient,15,mL,,22,18.7,6.3052,22,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,19.822,90.1,,percent of total billed charges,,
IBUPROFEN 50 MG/1.25 ML ORAL DRPS,,11992,LOCAL,Facility,Inpatient,15,mL,,22,18.7,6.3052,22,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
IBUPROFEN 50 MG/1.25 ML ORAL DRPS,,11992,LOCAL,Facility,Both,15,mL,,22,18.7,6.3052,22,"Preferred One Administrative Services, INC.",PPO,21.692,98.6,,percent of total billed charges,,
IBUPROFEN 50 MG/1.25 ML ORAL DRPS,,11992,LOCAL,Facility,Outpatient,15,mL,,22,18.7,6.3052,22,PrimeWest Health,Minnesota Senior Health Options (MSHO),11.319,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
IBUPROFEN 50 MG/1.25 ML ORAL DRPS,,11992,LOCAL,Facility,Inpatient,15,mL,,22,18.7,6.3052,22,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
IBUPROFEN 50 MG/1.25 ML ORAL DRPS,,11992,LOCAL,Facility,Outpatient,15,mL,,22,18.7,6.3052,22,PrimeWest Health,MinnesotaCare,11.2992,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
IBUPROFEN 50 MG/1.25 ML ORAL DRPS,,11992,LOCAL,Facility,Inpatient,15,mL,,22,18.7,6.3052,22,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
IBUPROFEN 50 MG/1.25 ML ORAL DRPS,,11992,LOCAL,Facility,Both,15,mL,,22,18.7,6.3052,22,Sanford Health Plan,Sanford Health Plan,20.24,92,,percent of total billed charges,,
IBUPROFEN 50 MG/1.25 ML ORAL DRPS,,11992,LOCAL,Facility,Outpatient,15,mL,,22,18.7,6.3052,22,"UCare Health, Inc.",Individual & Family Plan,12.397,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
IBUPROFEN 50 MG/1.25 ML ORAL DRPS,,11992,LOCAL,Facility,Inpatient,15,mL,,22,18.7,6.3052,22,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
IBUPROFEN 50 MG/1.25 ML ORAL DRPS,,11992,LOCAL,Facility,Outpatient,15,mL,,22,18.7,6.3052,22,"UCare Health, Inc.",Medical Assistance,11.1034,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
IBUPROFEN 50 MG/1.25 ML ORAL DRPS,,11992,LOCAL,Facility,Inpatient,15,mL,,22,18.7,6.3052,22,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
IBUPROFEN 50 MG/1.25 ML ORAL DRPS,,11992,LOCAL,Facility,Outpatient,15,mL,,22,18.7,6.3052,22,"UCare Health, Inc.",Medicare Advantage,11.1034,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
IBUPROFEN 50 MG/1.25 ML ORAL DRPS,,11992,LOCAL,Facility,Inpatient,15,mL,,22,18.7,6.3052,22,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
IBUPROFEN 50 MG/1.25 ML ORAL DRPS,,11992,LOCAL,Facility,Outpatient,15,mL,,22,18.7,6.3052,22,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),11.1034,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
IBUPROFEN 50 MG/1.25 ML ORAL DRPS,,11992,LOCAL,Facility,Inpatient,15,mL,,22,18.7,6.3052,22,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
IBUPROFEN 50 MG/1.25 ML ORAL DRPS,,11992,LOCAL,Facility,Both,15,mL,,22,18.7,6.3052,22,UnitedHealthcare,Individual & Family,20.68,94,,percent of total billed charges,,
IBUPROFEN 50 MG/1.25 ML ORAL DRPS,,11992,LOCAL,Facility,Outpatient,15,mL,,22,18.7,6.3052,22,UnitedHealthcare,Medicare Advantage,10.78,49,,percent of total billed charges,,
IBUPROFEN 50 MG/1.25 ML ORAL DRPS,,11992,LOCAL,Facility,Inpatient,15,mL,,22,18.7,6.3052,22,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
IBUPROFEN 50 MG/1.25 ML ORAL DRPS,,11992,LOCAL,Facility,Outpatient,15,mL,,22,18.7,6.3052,22,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,10.56,48,,percent of total billed charges,,100% of DHS outpatient percentage
IBUPROFEN 50 MG/1.25 ML ORAL DRPS,,11992,LOCAL,Facility,Inpatient,15,mL,,22,18.7,6.3052,22,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
CARBAMIDE PEROXIDE 6.5 % OTIC DROP,,14638,LOCAL,Facility,Both,15,mL,,9,7.65,2.5794,9,Aetna,Commercial,8.28,92,,percent of total billed charges,,
CARBAMIDE PEROXIDE 6.5 % OTIC DROP,,14638,LOCAL,Facility,Outpatient,15,mL,,9,7.65,2.5794,9,Aetna,Medicare Advantage,4.41,49,,percent of total billed charges,,
CARBAMIDE PEROXIDE 6.5 % OTIC DROP,,14638,LOCAL,Facility,Inpatient,15,mL,,9,7.65,2.5794,9,Aetna,Medicare Advantage,,,,,Included in per diem rate,
CARBAMIDE PEROXIDE 6.5 % OTIC DROP,,14638,LOCAL,Facility,Both,15,mL,,9,7.65,2.5794,9,Aetna,PPO,8.37,93,,percent of total billed charges,,
CARBAMIDE PEROXIDE 6.5 % OTIC DROP,,14638,LOCAL,Facility,Both,15,mL,,9,7.65,2.5794,9,America's PPO,America's PPO,8.6427,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
CARBAMIDE PEROXIDE 6.5 % OTIC DROP,,14638,LOCAL,Facility,Both,15,mL,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota, Federal Employee Program,8.856,98.4,,percent of total billed charges,,
CARBAMIDE PEROXIDE 6.5 % OTIC DROP,,14638,LOCAL,Facility,Both,15,mL,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,9,100,,percent of total billed charges,,
CARBAMIDE PEROXIDE 6.5 % OTIC DROP,,14638,LOCAL,Facility,Both,15,mL,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota,High Value Network Plan,8.1,90,,percent of total billed charges,,
CARBAMIDE PEROXIDE 6.5 % OTIC DROP,,14638,LOCAL,Facility,Outpatient,15,mL,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota,Medicare Advantage,4.41,49,,percent of total billed charges,,
CARBAMIDE PEROXIDE 6.5 % OTIC DROP,,14638,LOCAL,Facility,Inpatient,15,mL,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
CARBAMIDE PEROXIDE 6.5 % OTIC DROP,,14638,LOCAL,Facility,Both,15,mL,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,7.9713,88.57,,percent of total billed charges,,
CARBAMIDE PEROXIDE 6.5 % OTIC DROP,,14638,LOCAL,Facility,Both,15,mL,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,2.5794,28.66,,percent of total billed charges,,
CARBAMIDE PEROXIDE 6.5 % OTIC DROP,,14638,LOCAL,Facility,Outpatient,15,mL,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),4.41,49,,percent of total billed charges,,
CARBAMIDE PEROXIDE 6.5 % OTIC DROP,,14638,LOCAL,Facility,Inpatient,15,mL,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
CARBAMIDE PEROXIDE 6.5 % OTIC DROP,,14638,LOCAL,Facility,Both,15,mL,,9,7.65,2.5794,9,CorVel,Worker's Compensation,9,100,,percent of total billed charges,,
CARBAMIDE PEROXIDE 6.5 % OTIC DROP,,14638,LOCAL,Facility,Both,15,mL,,9,7.65,2.5794,9,First Health Group Corporation,First Health Network,8.73,97,,percent of total billed charges,,
CARBAMIDE PEROXIDE 6.5 % OTIC DROP,,14638,LOCAL,Facility,Both,15,mL,,9,7.65,2.5794,9,"Health Partners, Inc.",Commercial,8.514,94.6,,percent of total billed charges,,
CARBAMIDE PEROXIDE 6.5 % OTIC DROP,,14638,LOCAL,Facility,Outpatient,15,mL,,9,7.65,2.5794,9,"Health Partners, Inc.",Medicare Advantage,4.41,49,,percent of total billed charges,,
CARBAMIDE PEROXIDE 6.5 % OTIC DROP,,14638,LOCAL,Facility,Inpatient,15,mL,,9,7.65,2.5794,9,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CARBAMIDE PEROXIDE 6.5 % OTIC DROP,,14638,LOCAL,Facility,Both,15,mL,,9,7.65,2.5794,9,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),5.4,60,,percent of total billed charges,,
CARBAMIDE PEROXIDE 6.5 % OTIC DROP,,14638,LOCAL,Facility,Both,15,mL,,9,7.65,2.5794,9,"Health Partners, Inc.",State of Minnesota Advantage Program,7.335,81.5,,percent of total billed charges,,
CARBAMIDE PEROXIDE 6.5 % OTIC DROP,,14638,LOCAL,Facility,Both,15,mL,,9,7.65,2.5794,9,"Health Partners, Inc.",State Public Programs,4.5,50,,percent of total billed charges,,
CARBAMIDE PEROXIDE 6.5 % OTIC DROP,,14638,LOCAL,Facility,Both,15,mL,,9,7.65,2.5794,9,Humana Insurance Company,Commercial PPO,8.55,95,,percent of total billed charges,,
CARBAMIDE PEROXIDE 6.5 % OTIC DROP,,14638,LOCAL,Facility,Outpatient,15,mL,,9,7.65,2.5794,9,Humana Insurance Company,Medicare PPO,4.41,49,,percent of total billed charges,,
CARBAMIDE PEROXIDE 6.5 % OTIC DROP,,14638,LOCAL,Facility,Inpatient,15,mL,,9,7.65,2.5794,9,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
CARBAMIDE PEROXIDE 6.5 % OTIC DROP,,14638,LOCAL,Facility,Both,15,mL,,9,7.65,2.5794,9,Medica,Individual & Family,8.919,99.1,,percent of total billed charges,,
CARBAMIDE PEROXIDE 6.5 % OTIC DROP,,14638,LOCAL,Facility,Outpatient,15,mL,,9,7.65,2.5794,9,Medica,Medica Advantage Solution,4.482,49.8,,percent of total billed charges,,
CARBAMIDE PEROXIDE 6.5 % OTIC DROP,,14638,LOCAL,Facility,Inpatient,15,mL,,9,7.65,2.5794,9,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
CARBAMIDE PEROXIDE 6.5 % OTIC DROP,,14638,LOCAL,Facility,Outpatient,15,mL,,9,7.65,2.5794,9,Medica,Medical Assistance,4.014,44.6,,percent of total billed charges,,
CARBAMIDE PEROXIDE 6.5 % OTIC DROP,,14638,LOCAL,Facility,Inpatient,15,mL,,9,7.65,2.5794,9,Medica,Medical Assistance,,,,,Included in per diem rate,
CARBAMIDE PEROXIDE 6.5 % OTIC DROP,,14638,LOCAL,Facility,Outpatient,15,mL,,9,7.65,2.5794,9,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,4.482,49.8,,percent of total billed charges,,
CARBAMIDE PEROXIDE 6.5 % OTIC DROP,,14638,LOCAL,Facility,Inpatient,15,mL,,9,7.65,2.5794,9,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
CARBAMIDE PEROXIDE 6.5 % OTIC DROP,,14638,LOCAL,Facility,Both,15,mL,,9,7.65,2.5794,9,"Multiplan, Inc.","Multiplan, Inc.",8.46,94,,percent of total billed charges,,
CARBAMIDE PEROXIDE 6.5 % OTIC DROP,,14638,LOCAL,Facility,Outpatient,15,mL,,9,7.65,2.5794,9,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,8.109,90.1,,percent of total billed charges,,
CARBAMIDE PEROXIDE 6.5 % OTIC DROP,,14638,LOCAL,Facility,Inpatient,15,mL,,9,7.65,2.5794,9,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
CARBAMIDE PEROXIDE 6.5 % OTIC DROP,,14638,LOCAL,Facility,Both,15,mL,,9,7.65,2.5794,9,"Preferred One Administrative Services, INC.",PPO,8.874,98.6,,percent of total billed charges,,
CARBAMIDE PEROXIDE 6.5 % OTIC DROP,,14638,LOCAL,Facility,Outpatient,15,mL,,9,7.65,2.5794,9,PrimeWest Health,Minnesota Senior Health Options (MSHO),4.6305,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
CARBAMIDE PEROXIDE 6.5 % OTIC DROP,,14638,LOCAL,Facility,Inpatient,15,mL,,9,7.65,2.5794,9,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CARBAMIDE PEROXIDE 6.5 % OTIC DROP,,14638,LOCAL,Facility,Outpatient,15,mL,,9,7.65,2.5794,9,PrimeWest Health,MinnesotaCare,4.6224,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
CARBAMIDE PEROXIDE 6.5 % OTIC DROP,,14638,LOCAL,Facility,Inpatient,15,mL,,9,7.65,2.5794,9,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
CARBAMIDE PEROXIDE 6.5 % OTIC DROP,,14638,LOCAL,Facility,Both,15,mL,,9,7.65,2.5794,9,Sanford Health Plan,Sanford Health Plan,8.28,92,,percent of total billed charges,,
CARBAMIDE PEROXIDE 6.5 % OTIC DROP,,14638,LOCAL,Facility,Outpatient,15,mL,,9,7.65,2.5794,9,"UCare Health, Inc.",Individual & Family Plan,5.0715,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
CARBAMIDE PEROXIDE 6.5 % OTIC DROP,,14638,LOCAL,Facility,Inpatient,15,mL,,9,7.65,2.5794,9,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
CARBAMIDE PEROXIDE 6.5 % OTIC DROP,,14638,LOCAL,Facility,Outpatient,15,mL,,9,7.65,2.5794,9,"UCare Health, Inc.",Medical Assistance,4.5423,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CARBAMIDE PEROXIDE 6.5 % OTIC DROP,,14638,LOCAL,Facility,Inpatient,15,mL,,9,7.65,2.5794,9,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
CARBAMIDE PEROXIDE 6.5 % OTIC DROP,,14638,LOCAL,Facility,Outpatient,15,mL,,9,7.65,2.5794,9,"UCare Health, Inc.",Medicare Advantage,4.5423,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CARBAMIDE PEROXIDE 6.5 % OTIC DROP,,14638,LOCAL,Facility,Inpatient,15,mL,,9,7.65,2.5794,9,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CARBAMIDE PEROXIDE 6.5 % OTIC DROP,,14638,LOCAL,Facility,Outpatient,15,mL,,9,7.65,2.5794,9,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),4.5423,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CARBAMIDE PEROXIDE 6.5 % OTIC DROP,,14638,LOCAL,Facility,Inpatient,15,mL,,9,7.65,2.5794,9,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CARBAMIDE PEROXIDE 6.5 % OTIC DROP,,14638,LOCAL,Facility,Both,15,mL,,9,7.65,2.5794,9,UnitedHealthcare,Individual & Family,8.46,94,,percent of total billed charges,,
CARBAMIDE PEROXIDE 6.5 % OTIC DROP,,14638,LOCAL,Facility,Outpatient,15,mL,,9,7.65,2.5794,9,UnitedHealthcare,Medicare Advantage,4.41,49,,percent of total billed charges,,
CARBAMIDE PEROXIDE 6.5 % OTIC DROP,,14638,LOCAL,Facility,Inpatient,15,mL,,9,7.65,2.5794,9,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
CARBAMIDE PEROXIDE 6.5 % OTIC DROP,,14638,LOCAL,Facility,Outpatient,15,mL,,9,7.65,2.5794,9,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,4.32,48,,percent of total billed charges,,100% of DHS outpatient percentage
CARBAMIDE PEROXIDE 6.5 % OTIC DROP,,14638,LOCAL,Facility,Inpatient,15,mL,,9,7.65,2.5794,9,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
LIDOCAINE HCL 2 % MM SOLN,,14994,LOCAL,Facility,Both,15,mL,,6,5.1,1.7196,6,Aetna,Commercial,5.52,92,,percent of total billed charges,,
LIDOCAINE HCL 2 % MM SOLN,,14994,LOCAL,Facility,Outpatient,15,mL,,6,5.1,1.7196,6,Aetna,Medicare Advantage,2.94,49,,percent of total billed charges,,
LIDOCAINE HCL 2 % MM SOLN,,14994,LOCAL,Facility,Inpatient,15,mL,,6,5.1,1.7196,6,Aetna,Medicare Advantage,,,,,Included in per diem rate,
LIDOCAINE HCL 2 % MM SOLN,,14994,LOCAL,Facility,Both,15,mL,,6,5.1,1.7196,6,Aetna,PPO,5.58,93,,percent of total billed charges,,
LIDOCAINE HCL 2 % MM SOLN,,14994,LOCAL,Facility,Both,15,mL,,6,5.1,1.7196,6,America's PPO,America's PPO,5.7618,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
LIDOCAINE HCL 2 % MM SOLN,,14994,LOCAL,Facility,Both,15,mL,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota, Federal Employee Program,5.904,98.4,,percent of total billed charges,,
LIDOCAINE HCL 2 % MM SOLN,,14994,LOCAL,Facility,Both,15,mL,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,6,100,,percent of total billed charges,,
LIDOCAINE HCL 2 % MM SOLN,,14994,LOCAL,Facility,Both,15,mL,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota,High Value Network Plan,5.4,90,,percent of total billed charges,,
LIDOCAINE HCL 2 % MM SOLN,,14994,LOCAL,Facility,Outpatient,15,mL,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota,Medicare Advantage,2.94,49,,percent of total billed charges,,
LIDOCAINE HCL 2 % MM SOLN,,14994,LOCAL,Facility,Inpatient,15,mL,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
LIDOCAINE HCL 2 % MM SOLN,,14994,LOCAL,Facility,Both,15,mL,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,5.3142,88.57,,percent of total billed charges,,
LIDOCAINE HCL 2 % MM SOLN,,14994,LOCAL,Facility,Both,15,mL,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.7196,28.66,,percent of total billed charges,,
LIDOCAINE HCL 2 % MM SOLN,,14994,LOCAL,Facility,Outpatient,15,mL,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.94,49,,percent of total billed charges,,
LIDOCAINE HCL 2 % MM SOLN,,14994,LOCAL,Facility,Inpatient,15,mL,,6,5.1,1.7196,6,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
LIDOCAINE HCL 2 % MM SOLN,,14994,LOCAL,Facility,Both,15,mL,,6,5.1,1.7196,6,CorVel,Worker's Compensation,6,100,,percent of total billed charges,,
LIDOCAINE HCL 2 % MM SOLN,,14994,LOCAL,Facility,Both,15,mL,,6,5.1,1.7196,6,First Health Group Corporation,First Health Network,5.82,97,,percent of total billed charges,,
LIDOCAINE HCL 2 % MM SOLN,,14994,LOCAL,Facility,Both,15,mL,,6,5.1,1.7196,6,"Health Partners, Inc.",Commercial,5.676,94.6,,percent of total billed charges,,
LIDOCAINE HCL 2 % MM SOLN,,14994,LOCAL,Facility,Outpatient,15,mL,,6,5.1,1.7196,6,"Health Partners, Inc.",Medicare Advantage,2.94,49,,percent of total billed charges,,
LIDOCAINE HCL 2 % MM SOLN,,14994,LOCAL,Facility,Inpatient,15,mL,,6,5.1,1.7196,6,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LIDOCAINE HCL 2 % MM SOLN,,14994,LOCAL,Facility,Both,15,mL,,6,5.1,1.7196,6,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3.6,60,,percent of total billed charges,,
LIDOCAINE HCL 2 % MM SOLN,,14994,LOCAL,Facility,Both,15,mL,,6,5.1,1.7196,6,"Health Partners, Inc.",State of Minnesota Advantage Program,4.89,81.5,,percent of total billed charges,,
LIDOCAINE HCL 2 % MM SOLN,,14994,LOCAL,Facility,Both,15,mL,,6,5.1,1.7196,6,"Health Partners, Inc.",State Public Programs,3,50,,percent of total billed charges,,
LIDOCAINE HCL 2 % MM SOLN,,14994,LOCAL,Facility,Both,15,mL,,6,5.1,1.7196,6,Humana Insurance Company,Commercial PPO,5.7,95,,percent of total billed charges,,
LIDOCAINE HCL 2 % MM SOLN,,14994,LOCAL,Facility,Outpatient,15,mL,,6,5.1,1.7196,6,Humana Insurance Company,Medicare PPO,2.94,49,,percent of total billed charges,,
LIDOCAINE HCL 2 % MM SOLN,,14994,LOCAL,Facility,Inpatient,15,mL,,6,5.1,1.7196,6,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
LIDOCAINE HCL 2 % MM SOLN,,14994,LOCAL,Facility,Both,15,mL,,6,5.1,1.7196,6,Medica,Individual & Family,5.946,99.1,,percent of total billed charges,,
LIDOCAINE HCL 2 % MM SOLN,,14994,LOCAL,Facility,Outpatient,15,mL,,6,5.1,1.7196,6,Medica,Medica Advantage Solution,2.988,49.8,,percent of total billed charges,,
LIDOCAINE HCL 2 % MM SOLN,,14994,LOCAL,Facility,Inpatient,15,mL,,6,5.1,1.7196,6,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
LIDOCAINE HCL 2 % MM SOLN,,14994,LOCAL,Facility,Outpatient,15,mL,,6,5.1,1.7196,6,Medica,Medical Assistance,2.676,44.6,,percent of total billed charges,,
LIDOCAINE HCL 2 % MM SOLN,,14994,LOCAL,Facility,Inpatient,15,mL,,6,5.1,1.7196,6,Medica,Medical Assistance,,,,,Included in per diem rate,
LIDOCAINE HCL 2 % MM SOLN,,14994,LOCAL,Facility,Outpatient,15,mL,,6,5.1,1.7196,6,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.988,49.8,,percent of total billed charges,,
LIDOCAINE HCL 2 % MM SOLN,,14994,LOCAL,Facility,Inpatient,15,mL,,6,5.1,1.7196,6,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
LIDOCAINE HCL 2 % MM SOLN,,14994,LOCAL,Facility,Both,15,mL,,6,5.1,1.7196,6,"Multiplan, Inc.","Multiplan, Inc.",5.64,94,,percent of total billed charges,,
LIDOCAINE HCL 2 % MM SOLN,,14994,LOCAL,Facility,Outpatient,15,mL,,6,5.1,1.7196,6,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,5.406,90.1,,percent of total billed charges,,
LIDOCAINE HCL 2 % MM SOLN,,14994,LOCAL,Facility,Inpatient,15,mL,,6,5.1,1.7196,6,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
LIDOCAINE HCL 2 % MM SOLN,,14994,LOCAL,Facility,Both,15,mL,,6,5.1,1.7196,6,"Preferred One Administrative Services, INC.",PPO,5.916,98.6,,percent of total billed charges,,
LIDOCAINE HCL 2 % MM SOLN,,14994,LOCAL,Facility,Outpatient,15,mL,,6,5.1,1.7196,6,PrimeWest Health,Minnesota Senior Health Options (MSHO),3.087,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
LIDOCAINE HCL 2 % MM SOLN,,14994,LOCAL,Facility,Inpatient,15,mL,,6,5.1,1.7196,6,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LIDOCAINE HCL 2 % MM SOLN,,14994,LOCAL,Facility,Outpatient,15,mL,,6,5.1,1.7196,6,PrimeWest Health,MinnesotaCare,3.0816,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
LIDOCAINE HCL 2 % MM SOLN,,14994,LOCAL,Facility,Inpatient,15,mL,,6,5.1,1.7196,6,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
LIDOCAINE HCL 2 % MM SOLN,,14994,LOCAL,Facility,Both,15,mL,,6,5.1,1.7196,6,Sanford Health Plan,Sanford Health Plan,5.52,92,,percent of total billed charges,,
LIDOCAINE HCL 2 % MM SOLN,,14994,LOCAL,Facility,Outpatient,15,mL,,6,5.1,1.7196,6,"UCare Health, Inc.",Individual & Family Plan,3.381,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
LIDOCAINE HCL 2 % MM SOLN,,14994,LOCAL,Facility,Inpatient,15,mL,,6,5.1,1.7196,6,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
LIDOCAINE HCL 2 % MM SOLN,,14994,LOCAL,Facility,Outpatient,15,mL,,6,5.1,1.7196,6,"UCare Health, Inc.",Medical Assistance,3.0282,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LIDOCAINE HCL 2 % MM SOLN,,14994,LOCAL,Facility,Inpatient,15,mL,,6,5.1,1.7196,6,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
LIDOCAINE HCL 2 % MM SOLN,,14994,LOCAL,Facility,Outpatient,15,mL,,6,5.1,1.7196,6,"UCare Health, Inc.",Medicare Advantage,3.0282,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LIDOCAINE HCL 2 % MM SOLN,,14994,LOCAL,Facility,Inpatient,15,mL,,6,5.1,1.7196,6,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LIDOCAINE HCL 2 % MM SOLN,,14994,LOCAL,Facility,Outpatient,15,mL,,6,5.1,1.7196,6,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),3.0282,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LIDOCAINE HCL 2 % MM SOLN,,14994,LOCAL,Facility,Inpatient,15,mL,,6,5.1,1.7196,6,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LIDOCAINE HCL 2 % MM SOLN,,14994,LOCAL,Facility,Both,15,mL,,6,5.1,1.7196,6,UnitedHealthcare,Individual & Family,5.64,94,,percent of total billed charges,,
LIDOCAINE HCL 2 % MM SOLN,,14994,LOCAL,Facility,Outpatient,15,mL,,6,5.1,1.7196,6,UnitedHealthcare,Medicare Advantage,2.94,49,,percent of total billed charges,,
LIDOCAINE HCL 2 % MM SOLN,,14994,LOCAL,Facility,Inpatient,15,mL,,6,5.1,1.7196,6,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
LIDOCAINE HCL 2 % MM SOLN,,14994,LOCAL,Facility,Outpatient,15,mL,,6,5.1,1.7196,6,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.88,48,,percent of total billed charges,,100% of DHS outpatient percentage
LIDOCAINE HCL 2 % MM SOLN,,14994,LOCAL,Facility,Inpatient,15,mL,,6,5.1,1.7196,6,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
SIMETHICONE 40 MG/0.6 ML ORAL DRPS,,15146,LOCAL,Facility,Both,15,mL,,27,22.95,7.7382,27,Aetna,Commercial,24.84,92,,percent of total billed charges,,
SIMETHICONE 40 MG/0.6 ML ORAL DRPS,,15146,LOCAL,Facility,Outpatient,15,mL,,27,22.95,7.7382,27,Aetna,Medicare Advantage,13.23,49,,percent of total billed charges,,
SIMETHICONE 40 MG/0.6 ML ORAL DRPS,,15146,LOCAL,Facility,Inpatient,15,mL,,27,22.95,7.7382,27,Aetna,Medicare Advantage,,,,,Included in per diem rate,
SIMETHICONE 40 MG/0.6 ML ORAL DRPS,,15146,LOCAL,Facility,Both,15,mL,,27,22.95,7.7382,27,Aetna,PPO,25.11,93,,percent of total billed charges,,
SIMETHICONE 40 MG/0.6 ML ORAL DRPS,,15146,LOCAL,Facility,Both,15,mL,,27,22.95,7.7382,27,America's PPO,America's PPO,25.9281,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SIMETHICONE 40 MG/0.6 ML ORAL DRPS,,15146,LOCAL,Facility,Both,15,mL,,27,22.95,7.7382,27,BlueCross BlueShield Minnesota, Federal Employee Program,26.568,98.4,,percent of total billed charges,,
SIMETHICONE 40 MG/0.6 ML ORAL DRPS,,15146,LOCAL,Facility,Both,15,mL,,27,22.95,7.7382,27,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,27,100,,percent of total billed charges,,
SIMETHICONE 40 MG/0.6 ML ORAL DRPS,,15146,LOCAL,Facility,Both,15,mL,,27,22.95,7.7382,27,BlueCross BlueShield Minnesota,High Value Network Plan,24.3,90,,percent of total billed charges,,
SIMETHICONE 40 MG/0.6 ML ORAL DRPS,,15146,LOCAL,Facility,Outpatient,15,mL,,27,22.95,7.7382,27,BlueCross BlueShield Minnesota,Medicare Advantage,13.23,49,,percent of total billed charges,,
SIMETHICONE 40 MG/0.6 ML ORAL DRPS,,15146,LOCAL,Facility,Inpatient,15,mL,,27,22.95,7.7382,27,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
SIMETHICONE 40 MG/0.6 ML ORAL DRPS,,15146,LOCAL,Facility,Both,15,mL,,27,22.95,7.7382,27,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,23.9139,88.57,,percent of total billed charges,,
SIMETHICONE 40 MG/0.6 ML ORAL DRPS,,15146,LOCAL,Facility,Both,15,mL,,27,22.95,7.7382,27,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,7.7382,28.66,,percent of total billed charges,,
SIMETHICONE 40 MG/0.6 ML ORAL DRPS,,15146,LOCAL,Facility,Outpatient,15,mL,,27,22.95,7.7382,27,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),13.23,49,,percent of total billed charges,,
SIMETHICONE 40 MG/0.6 ML ORAL DRPS,,15146,LOCAL,Facility,Inpatient,15,mL,,27,22.95,7.7382,27,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
SIMETHICONE 40 MG/0.6 ML ORAL DRPS,,15146,LOCAL,Facility,Both,15,mL,,27,22.95,7.7382,27,CorVel,Worker's Compensation,27,100,,percent of total billed charges,,
SIMETHICONE 40 MG/0.6 ML ORAL DRPS,,15146,LOCAL,Facility,Both,15,mL,,27,22.95,7.7382,27,First Health Group Corporation,First Health Network,26.19,97,,percent of total billed charges,,
SIMETHICONE 40 MG/0.6 ML ORAL DRPS,,15146,LOCAL,Facility,Both,15,mL,,27,22.95,7.7382,27,"Health Partners, Inc.",Commercial,25.542,94.6,,percent of total billed charges,,
SIMETHICONE 40 MG/0.6 ML ORAL DRPS,,15146,LOCAL,Facility,Outpatient,15,mL,,27,22.95,7.7382,27,"Health Partners, Inc.",Medicare Advantage,13.23,49,,percent of total billed charges,,
SIMETHICONE 40 MG/0.6 ML ORAL DRPS,,15146,LOCAL,Facility,Inpatient,15,mL,,27,22.95,7.7382,27,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SIMETHICONE 40 MG/0.6 ML ORAL DRPS,,15146,LOCAL,Facility,Both,15,mL,,27,22.95,7.7382,27,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),16.2,60,,percent of total billed charges,,
SIMETHICONE 40 MG/0.6 ML ORAL DRPS,,15146,LOCAL,Facility,Both,15,mL,,27,22.95,7.7382,27,"Health Partners, Inc.",State of Minnesota Advantage Program,22.005,81.5,,percent of total billed charges,,
SIMETHICONE 40 MG/0.6 ML ORAL DRPS,,15146,LOCAL,Facility,Both,15,mL,,27,22.95,7.7382,27,"Health Partners, Inc.",State Public Programs,13.5,50,,percent of total billed charges,,
SIMETHICONE 40 MG/0.6 ML ORAL DRPS,,15146,LOCAL,Facility,Both,15,mL,,27,22.95,7.7382,27,Humana Insurance Company,Commercial PPO,25.65,95,,percent of total billed charges,,
SIMETHICONE 40 MG/0.6 ML ORAL DRPS,,15146,LOCAL,Facility,Outpatient,15,mL,,27,22.95,7.7382,27,Humana Insurance Company,Medicare PPO,13.23,49,,percent of total billed charges,,
SIMETHICONE 40 MG/0.6 ML ORAL DRPS,,15146,LOCAL,Facility,Inpatient,15,mL,,27,22.95,7.7382,27,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
SIMETHICONE 40 MG/0.6 ML ORAL DRPS,,15146,LOCAL,Facility,Both,15,mL,,27,22.95,7.7382,27,Medica,Individual & Family,26.757,99.1,,percent of total billed charges,,
SIMETHICONE 40 MG/0.6 ML ORAL DRPS,,15146,LOCAL,Facility,Outpatient,15,mL,,27,22.95,7.7382,27,Medica,Medica Advantage Solution,13.446,49.8,,percent of total billed charges,,
SIMETHICONE 40 MG/0.6 ML ORAL DRPS,,15146,LOCAL,Facility,Inpatient,15,mL,,27,22.95,7.7382,27,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
SIMETHICONE 40 MG/0.6 ML ORAL DRPS,,15146,LOCAL,Facility,Outpatient,15,mL,,27,22.95,7.7382,27,Medica,Medical Assistance,12.042,44.6,,percent of total billed charges,,
SIMETHICONE 40 MG/0.6 ML ORAL DRPS,,15146,LOCAL,Facility,Inpatient,15,mL,,27,22.95,7.7382,27,Medica,Medical Assistance,,,,,Included in per diem rate,
SIMETHICONE 40 MG/0.6 ML ORAL DRPS,,15146,LOCAL,Facility,Outpatient,15,mL,,27,22.95,7.7382,27,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,13.446,49.8,,percent of total billed charges,,
SIMETHICONE 40 MG/0.6 ML ORAL DRPS,,15146,LOCAL,Facility,Inpatient,15,mL,,27,22.95,7.7382,27,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
SIMETHICONE 40 MG/0.6 ML ORAL DRPS,,15146,LOCAL,Facility,Both,15,mL,,27,22.95,7.7382,27,"Multiplan, Inc.","Multiplan, Inc.",25.38,94,,percent of total billed charges,,
SIMETHICONE 40 MG/0.6 ML ORAL DRPS,,15146,LOCAL,Facility,Outpatient,15,mL,,27,22.95,7.7382,27,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,24.327,90.1,,percent of total billed charges,,
SIMETHICONE 40 MG/0.6 ML ORAL DRPS,,15146,LOCAL,Facility,Inpatient,15,mL,,27,22.95,7.7382,27,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
SIMETHICONE 40 MG/0.6 ML ORAL DRPS,,15146,LOCAL,Facility,Both,15,mL,,27,22.95,7.7382,27,"Preferred One Administrative Services, INC.",PPO,26.622,98.6,,percent of total billed charges,,
SIMETHICONE 40 MG/0.6 ML ORAL DRPS,,15146,LOCAL,Facility,Outpatient,15,mL,,27,22.95,7.7382,27,PrimeWest Health,Minnesota Senior Health Options (MSHO),13.8915,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
SIMETHICONE 40 MG/0.6 ML ORAL DRPS,,15146,LOCAL,Facility,Inpatient,15,mL,,27,22.95,7.7382,27,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SIMETHICONE 40 MG/0.6 ML ORAL DRPS,,15146,LOCAL,Facility,Outpatient,15,mL,,27,22.95,7.7382,27,PrimeWest Health,MinnesotaCare,13.8672,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
SIMETHICONE 40 MG/0.6 ML ORAL DRPS,,15146,LOCAL,Facility,Inpatient,15,mL,,27,22.95,7.7382,27,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
SIMETHICONE 40 MG/0.6 ML ORAL DRPS,,15146,LOCAL,Facility,Both,15,mL,,27,22.95,7.7382,27,Sanford Health Plan,Sanford Health Plan,24.84,92,,percent of total billed charges,,
SIMETHICONE 40 MG/0.6 ML ORAL DRPS,,15146,LOCAL,Facility,Outpatient,15,mL,,27,22.95,7.7382,27,"UCare Health, Inc.",Individual & Family Plan,15.2145,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
SIMETHICONE 40 MG/0.6 ML ORAL DRPS,,15146,LOCAL,Facility,Inpatient,15,mL,,27,22.95,7.7382,27,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
SIMETHICONE 40 MG/0.6 ML ORAL DRPS,,15146,LOCAL,Facility,Outpatient,15,mL,,27,22.95,7.7382,27,"UCare Health, Inc.",Medical Assistance,13.6269,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SIMETHICONE 40 MG/0.6 ML ORAL DRPS,,15146,LOCAL,Facility,Inpatient,15,mL,,27,22.95,7.7382,27,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
SIMETHICONE 40 MG/0.6 ML ORAL DRPS,,15146,LOCAL,Facility,Outpatient,15,mL,,27,22.95,7.7382,27,"UCare Health, Inc.",Medicare Advantage,13.6269,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SIMETHICONE 40 MG/0.6 ML ORAL DRPS,,15146,LOCAL,Facility,Inpatient,15,mL,,27,22.95,7.7382,27,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SIMETHICONE 40 MG/0.6 ML ORAL DRPS,,15146,LOCAL,Facility,Outpatient,15,mL,,27,22.95,7.7382,27,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),13.6269,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SIMETHICONE 40 MG/0.6 ML ORAL DRPS,,15146,LOCAL,Facility,Inpatient,15,mL,,27,22.95,7.7382,27,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SIMETHICONE 40 MG/0.6 ML ORAL DRPS,,15146,LOCAL,Facility,Both,15,mL,,27,22.95,7.7382,27,UnitedHealthcare,Individual & Family,25.38,94,,percent of total billed charges,,
SIMETHICONE 40 MG/0.6 ML ORAL DRPS,,15146,LOCAL,Facility,Outpatient,15,mL,,27,22.95,7.7382,27,UnitedHealthcare,Medicare Advantage,13.23,49,,percent of total billed charges,,
SIMETHICONE 40 MG/0.6 ML ORAL DRPS,,15146,LOCAL,Facility,Inpatient,15,mL,,27,22.95,7.7382,27,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
SIMETHICONE 40 MG/0.6 ML ORAL DRPS,,15146,LOCAL,Facility,Outpatient,15,mL,,27,22.95,7.7382,27,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,12.96,48,,percent of total billed charges,,100% of DHS outpatient percentage
SIMETHICONE 40 MG/0.6 ML ORAL DRPS,,15146,LOCAL,Facility,Inpatient,15,mL,,27,22.95,7.7382,27,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
AZITHROMYCIN 100 MG/5 ML ORAL SUSR,,15615,LOCAL,Facility,Both,15,mL,,157,133.45,44.9962,157,Aetna,Commercial,144.44,92,,percent of total billed charges,,
AZITHROMYCIN 100 MG/5 ML ORAL SUSR,,15615,LOCAL,Facility,Outpatient,15,mL,,157,133.45,44.9962,157,Aetna,Medicare Advantage,76.93,49,,percent of total billed charges,,
AZITHROMYCIN 100 MG/5 ML ORAL SUSR,,15615,LOCAL,Facility,Inpatient,15,mL,,157,133.45,44.9962,157,Aetna,Medicare Advantage,,,,,Included in per diem rate,
AZITHROMYCIN 100 MG/5 ML ORAL SUSR,,15615,LOCAL,Facility,Both,15,mL,,157,133.45,44.9962,157,Aetna,PPO,146.01,93,,percent of total billed charges,,
AZITHROMYCIN 100 MG/5 ML ORAL SUSR,,15615,LOCAL,Facility,Both,15,mL,,157,133.45,44.9962,157,America's PPO,America's PPO,150.7671,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
AZITHROMYCIN 100 MG/5 ML ORAL SUSR,,15615,LOCAL,Facility,Both,15,mL,,157,133.45,44.9962,157,BlueCross BlueShield Minnesota, Federal Employee Program,154.488,98.4,,percent of total billed charges,,
AZITHROMYCIN 100 MG/5 ML ORAL SUSR,,15615,LOCAL,Facility,Both,15,mL,,157,133.45,44.9962,157,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,157,100,,percent of total billed charges,,
AZITHROMYCIN 100 MG/5 ML ORAL SUSR,,15615,LOCAL,Facility,Both,15,mL,,157,133.45,44.9962,157,BlueCross BlueShield Minnesota,High Value Network Plan,141.3,90,,percent of total billed charges,,
AZITHROMYCIN 100 MG/5 ML ORAL SUSR,,15615,LOCAL,Facility,Outpatient,15,mL,,157,133.45,44.9962,157,BlueCross BlueShield Minnesota,Medicare Advantage,76.93,49,,percent of total billed charges,,
AZITHROMYCIN 100 MG/5 ML ORAL SUSR,,15615,LOCAL,Facility,Inpatient,15,mL,,157,133.45,44.9962,157,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
AZITHROMYCIN 100 MG/5 ML ORAL SUSR,,15615,LOCAL,Facility,Both,15,mL,,157,133.45,44.9962,157,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,139.0549,88.57,,percent of total billed charges,,
AZITHROMYCIN 100 MG/5 ML ORAL SUSR,,15615,LOCAL,Facility,Both,15,mL,,157,133.45,44.9962,157,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,44.9962,28.66,,percent of total billed charges,,
AZITHROMYCIN 100 MG/5 ML ORAL SUSR,,15615,LOCAL,Facility,Outpatient,15,mL,,157,133.45,44.9962,157,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),76.93,49,,percent of total billed charges,,
AZITHROMYCIN 100 MG/5 ML ORAL SUSR,,15615,LOCAL,Facility,Inpatient,15,mL,,157,133.45,44.9962,157,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
AZITHROMYCIN 100 MG/5 ML ORAL SUSR,,15615,LOCAL,Facility,Both,15,mL,,157,133.45,44.9962,157,CorVel,Worker's Compensation,157,100,,percent of total billed charges,,
AZITHROMYCIN 100 MG/5 ML ORAL SUSR,,15615,LOCAL,Facility,Both,15,mL,,157,133.45,44.9962,157,First Health Group Corporation,First Health Network,152.29,97,,percent of total billed charges,,
AZITHROMYCIN 100 MG/5 ML ORAL SUSR,,15615,LOCAL,Facility,Both,15,mL,,157,133.45,44.9962,157,"Health Partners, Inc.",Commercial,148.522,94.6,,percent of total billed charges,,
AZITHROMYCIN 100 MG/5 ML ORAL SUSR,,15615,LOCAL,Facility,Outpatient,15,mL,,157,133.45,44.9962,157,"Health Partners, Inc.",Medicare Advantage,76.93,49,,percent of total billed charges,,
AZITHROMYCIN 100 MG/5 ML ORAL SUSR,,15615,LOCAL,Facility,Inpatient,15,mL,,157,133.45,44.9962,157,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
AZITHROMYCIN 100 MG/5 ML ORAL SUSR,,15615,LOCAL,Facility,Both,15,mL,,157,133.45,44.9962,157,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),94.2,60,,percent of total billed charges,,
AZITHROMYCIN 100 MG/5 ML ORAL SUSR,,15615,LOCAL,Facility,Both,15,mL,,157,133.45,44.9962,157,"Health Partners, Inc.",State of Minnesota Advantage Program,127.955,81.5,,percent of total billed charges,,
AZITHROMYCIN 100 MG/5 ML ORAL SUSR,,15615,LOCAL,Facility,Both,15,mL,,157,133.45,44.9962,157,"Health Partners, Inc.",State Public Programs,78.5,50,,percent of total billed charges,,
AZITHROMYCIN 100 MG/5 ML ORAL SUSR,,15615,LOCAL,Facility,Both,15,mL,,157,133.45,44.9962,157,Humana Insurance Company,Commercial PPO,149.15,95,,percent of total billed charges,,
AZITHROMYCIN 100 MG/5 ML ORAL SUSR,,15615,LOCAL,Facility,Outpatient,15,mL,,157,133.45,44.9962,157,Humana Insurance Company,Medicare PPO,76.93,49,,percent of total billed charges,,
AZITHROMYCIN 100 MG/5 ML ORAL SUSR,,15615,LOCAL,Facility,Inpatient,15,mL,,157,133.45,44.9962,157,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
AZITHROMYCIN 100 MG/5 ML ORAL SUSR,,15615,LOCAL,Facility,Both,15,mL,,157,133.45,44.9962,157,Medica,Individual & Family,155.587,99.1,,percent of total billed charges,,
AZITHROMYCIN 100 MG/5 ML ORAL SUSR,,15615,LOCAL,Facility,Outpatient,15,mL,,157,133.45,44.9962,157,Medica,Medica Advantage Solution,78.186,49.8,,percent of total billed charges,,
AZITHROMYCIN 100 MG/5 ML ORAL SUSR,,15615,LOCAL,Facility,Inpatient,15,mL,,157,133.45,44.9962,157,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
AZITHROMYCIN 100 MG/5 ML ORAL SUSR,,15615,LOCAL,Facility,Outpatient,15,mL,,157,133.45,44.9962,157,Medica,Medical Assistance,70.022,44.6,,percent of total billed charges,,
AZITHROMYCIN 100 MG/5 ML ORAL SUSR,,15615,LOCAL,Facility,Inpatient,15,mL,,157,133.45,44.9962,157,Medica,Medical Assistance,,,,,Included in per diem rate,
AZITHROMYCIN 100 MG/5 ML ORAL SUSR,,15615,LOCAL,Facility,Outpatient,15,mL,,157,133.45,44.9962,157,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,78.186,49.8,,percent of total billed charges,,
AZITHROMYCIN 100 MG/5 ML ORAL SUSR,,15615,LOCAL,Facility,Inpatient,15,mL,,157,133.45,44.9962,157,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
AZITHROMYCIN 100 MG/5 ML ORAL SUSR,,15615,LOCAL,Facility,Both,15,mL,,157,133.45,44.9962,157,"Multiplan, Inc.","Multiplan, Inc.",147.58,94,,percent of total billed charges,,
AZITHROMYCIN 100 MG/5 ML ORAL SUSR,,15615,LOCAL,Facility,Outpatient,15,mL,,157,133.45,44.9962,157,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,141.457,90.1,,percent of total billed charges,,
AZITHROMYCIN 100 MG/5 ML ORAL SUSR,,15615,LOCAL,Facility,Inpatient,15,mL,,157,133.45,44.9962,157,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
AZITHROMYCIN 100 MG/5 ML ORAL SUSR,,15615,LOCAL,Facility,Both,15,mL,,157,133.45,44.9962,157,"Preferred One Administrative Services, INC.",PPO,154.802,98.6,,percent of total billed charges,,
AZITHROMYCIN 100 MG/5 ML ORAL SUSR,,15615,LOCAL,Facility,Outpatient,15,mL,,157,133.45,44.9962,157,PrimeWest Health,Minnesota Senior Health Options (MSHO),80.7765,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
AZITHROMYCIN 100 MG/5 ML ORAL SUSR,,15615,LOCAL,Facility,Inpatient,15,mL,,157,133.45,44.9962,157,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
AZITHROMYCIN 100 MG/5 ML ORAL SUSR,,15615,LOCAL,Facility,Outpatient,15,mL,,157,133.45,44.9962,157,PrimeWest Health,MinnesotaCare,80.6352,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
AZITHROMYCIN 100 MG/5 ML ORAL SUSR,,15615,LOCAL,Facility,Inpatient,15,mL,,157,133.45,44.9962,157,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
AZITHROMYCIN 100 MG/5 ML ORAL SUSR,,15615,LOCAL,Facility,Both,15,mL,,157,133.45,44.9962,157,Sanford Health Plan,Sanford Health Plan,144.44,92,,percent of total billed charges,,
AZITHROMYCIN 100 MG/5 ML ORAL SUSR,,15615,LOCAL,Facility,Outpatient,15,mL,,157,133.45,44.9962,157,"UCare Health, Inc.",Individual & Family Plan,88.4695,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
AZITHROMYCIN 100 MG/5 ML ORAL SUSR,,15615,LOCAL,Facility,Inpatient,15,mL,,157,133.45,44.9962,157,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
AZITHROMYCIN 100 MG/5 ML ORAL SUSR,,15615,LOCAL,Facility,Outpatient,15,mL,,157,133.45,44.9962,157,"UCare Health, Inc.",Medical Assistance,79.2379,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
AZITHROMYCIN 100 MG/5 ML ORAL SUSR,,15615,LOCAL,Facility,Inpatient,15,mL,,157,133.45,44.9962,157,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
AZITHROMYCIN 100 MG/5 ML ORAL SUSR,,15615,LOCAL,Facility,Outpatient,15,mL,,157,133.45,44.9962,157,"UCare Health, Inc.",Medicare Advantage,79.2379,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
AZITHROMYCIN 100 MG/5 ML ORAL SUSR,,15615,LOCAL,Facility,Inpatient,15,mL,,157,133.45,44.9962,157,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
AZITHROMYCIN 100 MG/5 ML ORAL SUSR,,15615,LOCAL,Facility,Outpatient,15,mL,,157,133.45,44.9962,157,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),79.2379,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
AZITHROMYCIN 100 MG/5 ML ORAL SUSR,,15615,LOCAL,Facility,Inpatient,15,mL,,157,133.45,44.9962,157,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
AZITHROMYCIN 100 MG/5 ML ORAL SUSR,,15615,LOCAL,Facility,Both,15,mL,,157,133.45,44.9962,157,UnitedHealthcare,Individual & Family,147.58,94,,percent of total billed charges,,
AZITHROMYCIN 100 MG/5 ML ORAL SUSR,,15615,LOCAL,Facility,Outpatient,15,mL,,157,133.45,44.9962,157,UnitedHealthcare,Medicare Advantage,76.93,49,,percent of total billed charges,,
AZITHROMYCIN 100 MG/5 ML ORAL SUSR,,15615,LOCAL,Facility,Inpatient,15,mL,,157,133.45,44.9962,157,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
AZITHROMYCIN 100 MG/5 ML ORAL SUSR,,15615,LOCAL,Facility,Outpatient,15,mL,,157,133.45,44.9962,157,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,75.36,48,,percent of total billed charges,,100% of DHS outpatient percentage
AZITHROMYCIN 100 MG/5 ML ORAL SUSR,,15615,LOCAL,Facility,Inpatient,15,mL,,157,133.45,44.9962,157,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
SODIUM PHOSPHATE 3 MMOL/ML IV SOLN,,17667,LOCAL,Facility,Both,15,mL,,99,84.15,28.3734,99,Aetna,Commercial,91.08,92,,percent of total billed charges,,
SODIUM PHOSPHATE 3 MMOL/ML IV SOLN,,17667,LOCAL,Facility,Outpatient,15,mL,,99,84.15,28.3734,99,Aetna,Medicare Advantage,48.51,49,,percent of total billed charges,,
SODIUM PHOSPHATE 3 MMOL/ML IV SOLN,,17667,LOCAL,Facility,Inpatient,15,mL,,99,84.15,28.3734,99,Aetna,Medicare Advantage,,,,,Included in per diem rate,
SODIUM PHOSPHATE 3 MMOL/ML IV SOLN,,17667,LOCAL,Facility,Both,15,mL,,99,84.15,28.3734,99,Aetna,PPO,92.07,93,,percent of total billed charges,,
SODIUM PHOSPHATE 3 MMOL/ML IV SOLN,,17667,LOCAL,Facility,Both,15,mL,,99,84.15,28.3734,99,America's PPO,America's PPO,95.0697,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SODIUM PHOSPHATE 3 MMOL/ML IV SOLN,,17667,LOCAL,Facility,Both,15,mL,,99,84.15,28.3734,99,BlueCross BlueShield Minnesota, Federal Employee Program,97.416,98.4,,percent of total billed charges,,
SODIUM PHOSPHATE 3 MMOL/ML IV SOLN,,17667,LOCAL,Facility,Both,15,mL,,99,84.15,28.3734,99,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,99,100,,percent of total billed charges,,
SODIUM PHOSPHATE 3 MMOL/ML IV SOLN,,17667,LOCAL,Facility,Both,15,mL,,99,84.15,28.3734,99,BlueCross BlueShield Minnesota,High Value Network Plan,89.1,90,,percent of total billed charges,,
SODIUM PHOSPHATE 3 MMOL/ML IV SOLN,,17667,LOCAL,Facility,Outpatient,15,mL,,99,84.15,28.3734,99,BlueCross BlueShield Minnesota,Medicare Advantage,48.51,49,,percent of total billed charges,,
SODIUM PHOSPHATE 3 MMOL/ML IV SOLN,,17667,LOCAL,Facility,Inpatient,15,mL,,99,84.15,28.3734,99,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
SODIUM PHOSPHATE 3 MMOL/ML IV SOLN,,17667,LOCAL,Facility,Both,15,mL,,99,84.15,28.3734,99,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,87.6843,88.57,,percent of total billed charges,,
SODIUM PHOSPHATE 3 MMOL/ML IV SOLN,,17667,LOCAL,Facility,Both,15,mL,,99,84.15,28.3734,99,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,28.3734,28.66,,percent of total billed charges,,
SODIUM PHOSPHATE 3 MMOL/ML IV SOLN,,17667,LOCAL,Facility,Outpatient,15,mL,,99,84.15,28.3734,99,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),48.51,49,,percent of total billed charges,,
SODIUM PHOSPHATE 3 MMOL/ML IV SOLN,,17667,LOCAL,Facility,Inpatient,15,mL,,99,84.15,28.3734,99,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
SODIUM PHOSPHATE 3 MMOL/ML IV SOLN,,17667,LOCAL,Facility,Both,15,mL,,99,84.15,28.3734,99,CorVel,Worker's Compensation,99,100,,percent of total billed charges,,
SODIUM PHOSPHATE 3 MMOL/ML IV SOLN,,17667,LOCAL,Facility,Both,15,mL,,99,84.15,28.3734,99,First Health Group Corporation,First Health Network,96.03,97,,percent of total billed charges,,
SODIUM PHOSPHATE 3 MMOL/ML IV SOLN,,17667,LOCAL,Facility,Both,15,mL,,99,84.15,28.3734,99,"Health Partners, Inc.",Commercial,93.654,94.6,,percent of total billed charges,,
SODIUM PHOSPHATE 3 MMOL/ML IV SOLN,,17667,LOCAL,Facility,Outpatient,15,mL,,99,84.15,28.3734,99,"Health Partners, Inc.",Medicare Advantage,48.51,49,,percent of total billed charges,,
SODIUM PHOSPHATE 3 MMOL/ML IV SOLN,,17667,LOCAL,Facility,Inpatient,15,mL,,99,84.15,28.3734,99,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SODIUM PHOSPHATE 3 MMOL/ML IV SOLN,,17667,LOCAL,Facility,Both,15,mL,,99,84.15,28.3734,99,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),59.4,60,,percent of total billed charges,,
SODIUM PHOSPHATE 3 MMOL/ML IV SOLN,,17667,LOCAL,Facility,Both,15,mL,,99,84.15,28.3734,99,"Health Partners, Inc.",State of Minnesota Advantage Program,80.685,81.5,,percent of total billed charges,,
SODIUM PHOSPHATE 3 MMOL/ML IV SOLN,,17667,LOCAL,Facility,Both,15,mL,,99,84.15,28.3734,99,"Health Partners, Inc.",State Public Programs,49.5,50,,percent of total billed charges,,
SODIUM PHOSPHATE 3 MMOL/ML IV SOLN,,17667,LOCAL,Facility,Both,15,mL,,99,84.15,28.3734,99,Humana Insurance Company,Commercial PPO,94.05,95,,percent of total billed charges,,
SODIUM PHOSPHATE 3 MMOL/ML IV SOLN,,17667,LOCAL,Facility,Outpatient,15,mL,,99,84.15,28.3734,99,Humana Insurance Company,Medicare PPO,48.51,49,,percent of total billed charges,,
SODIUM PHOSPHATE 3 MMOL/ML IV SOLN,,17667,LOCAL,Facility,Inpatient,15,mL,,99,84.15,28.3734,99,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
SODIUM PHOSPHATE 3 MMOL/ML IV SOLN,,17667,LOCAL,Facility,Both,15,mL,,99,84.15,28.3734,99,Medica,Individual & Family,98.109,99.1,,percent of total billed charges,,
SODIUM PHOSPHATE 3 MMOL/ML IV SOLN,,17667,LOCAL,Facility,Outpatient,15,mL,,99,84.15,28.3734,99,Medica,Medica Advantage Solution,49.302,49.8,,percent of total billed charges,,
SODIUM PHOSPHATE 3 MMOL/ML IV SOLN,,17667,LOCAL,Facility,Inpatient,15,mL,,99,84.15,28.3734,99,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
SODIUM PHOSPHATE 3 MMOL/ML IV SOLN,,17667,LOCAL,Facility,Outpatient,15,mL,,99,84.15,28.3734,99,Medica,Medical Assistance,44.154,44.6,,percent of total billed charges,,
SODIUM PHOSPHATE 3 MMOL/ML IV SOLN,,17667,LOCAL,Facility,Inpatient,15,mL,,99,84.15,28.3734,99,Medica,Medical Assistance,,,,,Included in per diem rate,
SODIUM PHOSPHATE 3 MMOL/ML IV SOLN,,17667,LOCAL,Facility,Outpatient,15,mL,,99,84.15,28.3734,99,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,49.302,49.8,,percent of total billed charges,,
SODIUM PHOSPHATE 3 MMOL/ML IV SOLN,,17667,LOCAL,Facility,Inpatient,15,mL,,99,84.15,28.3734,99,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
SODIUM PHOSPHATE 3 MMOL/ML IV SOLN,,17667,LOCAL,Facility,Both,15,mL,,99,84.15,28.3734,99,"Multiplan, Inc.","Multiplan, Inc.",93.06,94,,percent of total billed charges,,
SODIUM PHOSPHATE 3 MMOL/ML IV SOLN,,17667,LOCAL,Facility,Outpatient,15,mL,,99,84.15,28.3734,99,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,89.199,90.1,,percent of total billed charges,,
SODIUM PHOSPHATE 3 MMOL/ML IV SOLN,,17667,LOCAL,Facility,Inpatient,15,mL,,99,84.15,28.3734,99,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
SODIUM PHOSPHATE 3 MMOL/ML IV SOLN,,17667,LOCAL,Facility,Both,15,mL,,99,84.15,28.3734,99,"Preferred One Administrative Services, INC.",PPO,97.614,98.6,,percent of total billed charges,,
SODIUM PHOSPHATE 3 MMOL/ML IV SOLN,,17667,LOCAL,Facility,Outpatient,15,mL,,99,84.15,28.3734,99,PrimeWest Health,Minnesota Senior Health Options (MSHO),50.9355,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
SODIUM PHOSPHATE 3 MMOL/ML IV SOLN,,17667,LOCAL,Facility,Inpatient,15,mL,,99,84.15,28.3734,99,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SODIUM PHOSPHATE 3 MMOL/ML IV SOLN,,17667,LOCAL,Facility,Outpatient,15,mL,,99,84.15,28.3734,99,PrimeWest Health,MinnesotaCare,50.8464,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
SODIUM PHOSPHATE 3 MMOL/ML IV SOLN,,17667,LOCAL,Facility,Inpatient,15,mL,,99,84.15,28.3734,99,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
SODIUM PHOSPHATE 3 MMOL/ML IV SOLN,,17667,LOCAL,Facility,Both,15,mL,,99,84.15,28.3734,99,Sanford Health Plan,Sanford Health Plan,91.08,92,,percent of total billed charges,,
SODIUM PHOSPHATE 3 MMOL/ML IV SOLN,,17667,LOCAL,Facility,Outpatient,15,mL,,99,84.15,28.3734,99,"UCare Health, Inc.",Individual & Family Plan,55.7865,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
SODIUM PHOSPHATE 3 MMOL/ML IV SOLN,,17667,LOCAL,Facility,Inpatient,15,mL,,99,84.15,28.3734,99,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
SODIUM PHOSPHATE 3 MMOL/ML IV SOLN,,17667,LOCAL,Facility,Outpatient,15,mL,,99,84.15,28.3734,99,"UCare Health, Inc.",Medical Assistance,49.9653,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SODIUM PHOSPHATE 3 MMOL/ML IV SOLN,,17667,LOCAL,Facility,Inpatient,15,mL,,99,84.15,28.3734,99,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
SODIUM PHOSPHATE 3 MMOL/ML IV SOLN,,17667,LOCAL,Facility,Outpatient,15,mL,,99,84.15,28.3734,99,"UCare Health, Inc.",Medicare Advantage,49.9653,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SODIUM PHOSPHATE 3 MMOL/ML IV SOLN,,17667,LOCAL,Facility,Inpatient,15,mL,,99,84.15,28.3734,99,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SODIUM PHOSPHATE 3 MMOL/ML IV SOLN,,17667,LOCAL,Facility,Outpatient,15,mL,,99,84.15,28.3734,99,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),49.9653,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SODIUM PHOSPHATE 3 MMOL/ML IV SOLN,,17667,LOCAL,Facility,Inpatient,15,mL,,99,84.15,28.3734,99,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SODIUM PHOSPHATE 3 MMOL/ML IV SOLN,,17667,LOCAL,Facility,Both,15,mL,,99,84.15,28.3734,99,UnitedHealthcare,Individual & Family,93.06,94,,percent of total billed charges,,
SODIUM PHOSPHATE 3 MMOL/ML IV SOLN,,17667,LOCAL,Facility,Outpatient,15,mL,,99,84.15,28.3734,99,UnitedHealthcare,Medicare Advantage,48.51,49,,percent of total billed charges,,
SODIUM PHOSPHATE 3 MMOL/ML IV SOLN,,17667,LOCAL,Facility,Inpatient,15,mL,,99,84.15,28.3734,99,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
SODIUM PHOSPHATE 3 MMOL/ML IV SOLN,,17667,LOCAL,Facility,Outpatient,15,mL,,99,84.15,28.3734,99,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,47.52,48,,percent of total billed charges,,100% of DHS outpatient percentage
SODIUM PHOSPHATE 3 MMOL/ML IV SOLN,,17667,LOCAL,Facility,Inpatient,15,mL,,99,84.15,28.3734,99,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
TIMOLOL MALEATE 0.5 % OPHT DROP,,17826,LOCAL,Facility,Both,15,mL,,220,187,63.052,220,Aetna,Commercial,202.4,92,,percent of total billed charges,,
TIMOLOL MALEATE 0.5 % OPHT DROP,,17826,LOCAL,Facility,Outpatient,15,mL,,220,187,63.052,220,Aetna,Medicare Advantage,107.8,49,,percent of total billed charges,,
TIMOLOL MALEATE 0.5 % OPHT DROP,,17826,LOCAL,Facility,Inpatient,15,mL,,220,187,63.052,220,Aetna,Medicare Advantage,,,,,Included in per diem rate,
TIMOLOL MALEATE 0.5 % OPHT DROP,,17826,LOCAL,Facility,Both,15,mL,,220,187,63.052,220,Aetna,PPO,204.6,93,,percent of total billed charges,,
TIMOLOL MALEATE 0.5 % OPHT DROP,,17826,LOCAL,Facility,Both,15,mL,,220,187,63.052,220,America's PPO,America's PPO,211.266,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
TIMOLOL MALEATE 0.5 % OPHT DROP,,17826,LOCAL,Facility,Both,15,mL,,220,187,63.052,220,BlueCross BlueShield Minnesota, Federal Employee Program,216.48,98.4,,percent of total billed charges,,
TIMOLOL MALEATE 0.5 % OPHT DROP,,17826,LOCAL,Facility,Both,15,mL,,220,187,63.052,220,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,220,100,,percent of total billed charges,,
TIMOLOL MALEATE 0.5 % OPHT DROP,,17826,LOCAL,Facility,Both,15,mL,,220,187,63.052,220,BlueCross BlueShield Minnesota,High Value Network Plan,198,90,,percent of total billed charges,,
TIMOLOL MALEATE 0.5 % OPHT DROP,,17826,LOCAL,Facility,Outpatient,15,mL,,220,187,63.052,220,BlueCross BlueShield Minnesota,Medicare Advantage,107.8,49,,percent of total billed charges,,
TIMOLOL MALEATE 0.5 % OPHT DROP,,17826,LOCAL,Facility,Inpatient,15,mL,,220,187,63.052,220,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
TIMOLOL MALEATE 0.5 % OPHT DROP,,17826,LOCAL,Facility,Both,15,mL,,220,187,63.052,220,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,194.854,88.57,,percent of total billed charges,,
TIMOLOL MALEATE 0.5 % OPHT DROP,,17826,LOCAL,Facility,Both,15,mL,,220,187,63.052,220,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,63.052,28.66,,percent of total billed charges,,
TIMOLOL MALEATE 0.5 % OPHT DROP,,17826,LOCAL,Facility,Outpatient,15,mL,,220,187,63.052,220,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),107.8,49,,percent of total billed charges,,
TIMOLOL MALEATE 0.5 % OPHT DROP,,17826,LOCAL,Facility,Inpatient,15,mL,,220,187,63.052,220,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
TIMOLOL MALEATE 0.5 % OPHT DROP,,17826,LOCAL,Facility,Both,15,mL,,220,187,63.052,220,CorVel,Worker's Compensation,220,100,,percent of total billed charges,,
TIMOLOL MALEATE 0.5 % OPHT DROP,,17826,LOCAL,Facility,Both,15,mL,,220,187,63.052,220,First Health Group Corporation,First Health Network,213.4,97,,percent of total billed charges,,
TIMOLOL MALEATE 0.5 % OPHT DROP,,17826,LOCAL,Facility,Both,15,mL,,220,187,63.052,220,"Health Partners, Inc.",Commercial,208.12,94.6,,percent of total billed charges,,
TIMOLOL MALEATE 0.5 % OPHT DROP,,17826,LOCAL,Facility,Outpatient,15,mL,,220,187,63.052,220,"Health Partners, Inc.",Medicare Advantage,107.8,49,,percent of total billed charges,,
TIMOLOL MALEATE 0.5 % OPHT DROP,,17826,LOCAL,Facility,Inpatient,15,mL,,220,187,63.052,220,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
TIMOLOL MALEATE 0.5 % OPHT DROP,,17826,LOCAL,Facility,Both,15,mL,,220,187,63.052,220,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),132,60,,percent of total billed charges,,
TIMOLOL MALEATE 0.5 % OPHT DROP,,17826,LOCAL,Facility,Both,15,mL,,220,187,63.052,220,"Health Partners, Inc.",State of Minnesota Advantage Program,179.3,81.5,,percent of total billed charges,,
TIMOLOL MALEATE 0.5 % OPHT DROP,,17826,LOCAL,Facility,Both,15,mL,,220,187,63.052,220,"Health Partners, Inc.",State Public Programs,110,50,,percent of total billed charges,,
TIMOLOL MALEATE 0.5 % OPHT DROP,,17826,LOCAL,Facility,Both,15,mL,,220,187,63.052,220,Humana Insurance Company,Commercial PPO,209,95,,percent of total billed charges,,
TIMOLOL MALEATE 0.5 % OPHT DROP,,17826,LOCAL,Facility,Outpatient,15,mL,,220,187,63.052,220,Humana Insurance Company,Medicare PPO,107.8,49,,percent of total billed charges,,
TIMOLOL MALEATE 0.5 % OPHT DROP,,17826,LOCAL,Facility,Inpatient,15,mL,,220,187,63.052,220,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
TIMOLOL MALEATE 0.5 % OPHT DROP,,17826,LOCAL,Facility,Both,15,mL,,220,187,63.052,220,Medica,Individual & Family,218.02,99.1,,percent of total billed charges,,
TIMOLOL MALEATE 0.5 % OPHT DROP,,17826,LOCAL,Facility,Outpatient,15,mL,,220,187,63.052,220,Medica,Medica Advantage Solution,109.56,49.8,,percent of total billed charges,,
TIMOLOL MALEATE 0.5 % OPHT DROP,,17826,LOCAL,Facility,Inpatient,15,mL,,220,187,63.052,220,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
TIMOLOL MALEATE 0.5 % OPHT DROP,,17826,LOCAL,Facility,Outpatient,15,mL,,220,187,63.052,220,Medica,Medical Assistance,98.12,44.6,,percent of total billed charges,,
TIMOLOL MALEATE 0.5 % OPHT DROP,,17826,LOCAL,Facility,Inpatient,15,mL,,220,187,63.052,220,Medica,Medical Assistance,,,,,Included in per diem rate,
TIMOLOL MALEATE 0.5 % OPHT DROP,,17826,LOCAL,Facility,Outpatient,15,mL,,220,187,63.052,220,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,109.56,49.8,,percent of total billed charges,,
TIMOLOL MALEATE 0.5 % OPHT DROP,,17826,LOCAL,Facility,Inpatient,15,mL,,220,187,63.052,220,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
TIMOLOL MALEATE 0.5 % OPHT DROP,,17826,LOCAL,Facility,Both,15,mL,,220,187,63.052,220,"Multiplan, Inc.","Multiplan, Inc.",206.8,94,,percent of total billed charges,,
TIMOLOL MALEATE 0.5 % OPHT DROP,,17826,LOCAL,Facility,Outpatient,15,mL,,220,187,63.052,220,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,198.22,90.1,,percent of total billed charges,,
TIMOLOL MALEATE 0.5 % OPHT DROP,,17826,LOCAL,Facility,Inpatient,15,mL,,220,187,63.052,220,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
TIMOLOL MALEATE 0.5 % OPHT DROP,,17826,LOCAL,Facility,Both,15,mL,,220,187,63.052,220,"Preferred One Administrative Services, INC.",PPO,216.92,98.6,,percent of total billed charges,,
TIMOLOL MALEATE 0.5 % OPHT DROP,,17826,LOCAL,Facility,Outpatient,15,mL,,220,187,63.052,220,PrimeWest Health,Minnesota Senior Health Options (MSHO),113.19,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
TIMOLOL MALEATE 0.5 % OPHT DROP,,17826,LOCAL,Facility,Inpatient,15,mL,,220,187,63.052,220,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
TIMOLOL MALEATE 0.5 % OPHT DROP,,17826,LOCAL,Facility,Outpatient,15,mL,,220,187,63.052,220,PrimeWest Health,MinnesotaCare,112.992,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
TIMOLOL MALEATE 0.5 % OPHT DROP,,17826,LOCAL,Facility,Inpatient,15,mL,,220,187,63.052,220,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
TIMOLOL MALEATE 0.5 % OPHT DROP,,17826,LOCAL,Facility,Both,15,mL,,220,187,63.052,220,Sanford Health Plan,Sanford Health Plan,202.4,92,,percent of total billed charges,,
TIMOLOL MALEATE 0.5 % OPHT DROP,,17826,LOCAL,Facility,Outpatient,15,mL,,220,187,63.052,220,"UCare Health, Inc.",Individual & Family Plan,123.97,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
TIMOLOL MALEATE 0.5 % OPHT DROP,,17826,LOCAL,Facility,Inpatient,15,mL,,220,187,63.052,220,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
TIMOLOL MALEATE 0.5 % OPHT DROP,,17826,LOCAL,Facility,Outpatient,15,mL,,220,187,63.052,220,"UCare Health, Inc.",Medical Assistance,111.034,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TIMOLOL MALEATE 0.5 % OPHT DROP,,17826,LOCAL,Facility,Inpatient,15,mL,,220,187,63.052,220,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
TIMOLOL MALEATE 0.5 % OPHT DROP,,17826,LOCAL,Facility,Outpatient,15,mL,,220,187,63.052,220,"UCare Health, Inc.",Medicare Advantage,111.034,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TIMOLOL MALEATE 0.5 % OPHT DROP,,17826,LOCAL,Facility,Inpatient,15,mL,,220,187,63.052,220,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
TIMOLOL MALEATE 0.5 % OPHT DROP,,17826,LOCAL,Facility,Outpatient,15,mL,,220,187,63.052,220,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),111.034,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TIMOLOL MALEATE 0.5 % OPHT DROP,,17826,LOCAL,Facility,Inpatient,15,mL,,220,187,63.052,220,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
TIMOLOL MALEATE 0.5 % OPHT DROP,,17826,LOCAL,Facility,Both,15,mL,,220,187,63.052,220,UnitedHealthcare,Individual & Family,206.8,94,,percent of total billed charges,,
TIMOLOL MALEATE 0.5 % OPHT DROP,,17826,LOCAL,Facility,Outpatient,15,mL,,220,187,63.052,220,UnitedHealthcare,Medicare Advantage,107.8,49,,percent of total billed charges,,
TIMOLOL MALEATE 0.5 % OPHT DROP,,17826,LOCAL,Facility,Inpatient,15,mL,,220,187,63.052,220,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
TIMOLOL MALEATE 0.5 % OPHT DROP,,17826,LOCAL,Facility,Outpatient,15,mL,,220,187,63.052,220,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,105.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
TIMOLOL MALEATE 0.5 % OPHT DROP,,17826,LOCAL,Facility,Inpatient,15,mL,,220,187,63.052,220,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
PROPARACAINE 0.5 % OPHT DROP,,18386,LOCAL,Facility,Both,15,mL,,198,168.3,56.7468,198,Aetna,Commercial,182.16,92,,percent of total billed charges,,
PROPARACAINE 0.5 % OPHT DROP,,18386,LOCAL,Facility,Outpatient,15,mL,,198,168.3,56.7468,198,Aetna,Medicare Advantage,97.02,49,,percent of total billed charges,,
PROPARACAINE 0.5 % OPHT DROP,,18386,LOCAL,Facility,Inpatient,15,mL,,198,168.3,56.7468,198,Aetna,Medicare Advantage,,,,,Included in per diem rate,
PROPARACAINE 0.5 % OPHT DROP,,18386,LOCAL,Facility,Both,15,mL,,198,168.3,56.7468,198,Aetna,PPO,184.14,93,,percent of total billed charges,,
PROPARACAINE 0.5 % OPHT DROP,,18386,LOCAL,Facility,Both,15,mL,,198,168.3,56.7468,198,America's PPO,America's PPO,190.1394,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
PROPARACAINE 0.5 % OPHT DROP,,18386,LOCAL,Facility,Both,15,mL,,198,168.3,56.7468,198,BlueCross BlueShield Minnesota, Federal Employee Program,194.832,98.4,,percent of total billed charges,,
PROPARACAINE 0.5 % OPHT DROP,,18386,LOCAL,Facility,Both,15,mL,,198,168.3,56.7468,198,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,198,100,,percent of total billed charges,,
PROPARACAINE 0.5 % OPHT DROP,,18386,LOCAL,Facility,Both,15,mL,,198,168.3,56.7468,198,BlueCross BlueShield Minnesota,High Value Network Plan,178.2,90,,percent of total billed charges,,
PROPARACAINE 0.5 % OPHT DROP,,18386,LOCAL,Facility,Outpatient,15,mL,,198,168.3,56.7468,198,BlueCross BlueShield Minnesota,Medicare Advantage,97.02,49,,percent of total billed charges,,
PROPARACAINE 0.5 % OPHT DROP,,18386,LOCAL,Facility,Inpatient,15,mL,,198,168.3,56.7468,198,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
PROPARACAINE 0.5 % OPHT DROP,,18386,LOCAL,Facility,Both,15,mL,,198,168.3,56.7468,198,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,175.3686,88.57,,percent of total billed charges,,
PROPARACAINE 0.5 % OPHT DROP,,18386,LOCAL,Facility,Both,15,mL,,198,168.3,56.7468,198,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,56.7468,28.66,,percent of total billed charges,,
PROPARACAINE 0.5 % OPHT DROP,,18386,LOCAL,Facility,Outpatient,15,mL,,198,168.3,56.7468,198,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),97.02,49,,percent of total billed charges,,
PROPARACAINE 0.5 % OPHT DROP,,18386,LOCAL,Facility,Inpatient,15,mL,,198,168.3,56.7468,198,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
PROPARACAINE 0.5 % OPHT DROP,,18386,LOCAL,Facility,Both,15,mL,,198,168.3,56.7468,198,CorVel,Worker's Compensation,198,100,,percent of total billed charges,,
PROPARACAINE 0.5 % OPHT DROP,,18386,LOCAL,Facility,Both,15,mL,,198,168.3,56.7468,198,First Health Group Corporation,First Health Network,192.06,97,,percent of total billed charges,,
PROPARACAINE 0.5 % OPHT DROP,,18386,LOCAL,Facility,Both,15,mL,,198,168.3,56.7468,198,"Health Partners, Inc.",Commercial,187.308,94.6,,percent of total billed charges,,
PROPARACAINE 0.5 % OPHT DROP,,18386,LOCAL,Facility,Outpatient,15,mL,,198,168.3,56.7468,198,"Health Partners, Inc.",Medicare Advantage,97.02,49,,percent of total billed charges,,
PROPARACAINE 0.5 % OPHT DROP,,18386,LOCAL,Facility,Inpatient,15,mL,,198,168.3,56.7468,198,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PROPARACAINE 0.5 % OPHT DROP,,18386,LOCAL,Facility,Both,15,mL,,198,168.3,56.7468,198,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),118.8,60,,percent of total billed charges,,
PROPARACAINE 0.5 % OPHT DROP,,18386,LOCAL,Facility,Both,15,mL,,198,168.3,56.7468,198,"Health Partners, Inc.",State of Minnesota Advantage Program,161.37,81.5,,percent of total billed charges,,
PROPARACAINE 0.5 % OPHT DROP,,18386,LOCAL,Facility,Both,15,mL,,198,168.3,56.7468,198,"Health Partners, Inc.",State Public Programs,99,50,,percent of total billed charges,,
PROPARACAINE 0.5 % OPHT DROP,,18386,LOCAL,Facility,Both,15,mL,,198,168.3,56.7468,198,Humana Insurance Company,Commercial PPO,188.1,95,,percent of total billed charges,,
PROPARACAINE 0.5 % OPHT DROP,,18386,LOCAL,Facility,Outpatient,15,mL,,198,168.3,56.7468,198,Humana Insurance Company,Medicare PPO,97.02,49,,percent of total billed charges,,
PROPARACAINE 0.5 % OPHT DROP,,18386,LOCAL,Facility,Inpatient,15,mL,,198,168.3,56.7468,198,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
PROPARACAINE 0.5 % OPHT DROP,,18386,LOCAL,Facility,Both,15,mL,,198,168.3,56.7468,198,Medica,Individual & Family,196.218,99.1,,percent of total billed charges,,
PROPARACAINE 0.5 % OPHT DROP,,18386,LOCAL,Facility,Outpatient,15,mL,,198,168.3,56.7468,198,Medica,Medica Advantage Solution,98.604,49.8,,percent of total billed charges,,
PROPARACAINE 0.5 % OPHT DROP,,18386,LOCAL,Facility,Inpatient,15,mL,,198,168.3,56.7468,198,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
PROPARACAINE 0.5 % OPHT DROP,,18386,LOCAL,Facility,Outpatient,15,mL,,198,168.3,56.7468,198,Medica,Medical Assistance,88.308,44.6,,percent of total billed charges,,
PROPARACAINE 0.5 % OPHT DROP,,18386,LOCAL,Facility,Inpatient,15,mL,,198,168.3,56.7468,198,Medica,Medical Assistance,,,,,Included in per diem rate,
PROPARACAINE 0.5 % OPHT DROP,,18386,LOCAL,Facility,Outpatient,15,mL,,198,168.3,56.7468,198,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,98.604,49.8,,percent of total billed charges,,
PROPARACAINE 0.5 % OPHT DROP,,18386,LOCAL,Facility,Inpatient,15,mL,,198,168.3,56.7468,198,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
PROPARACAINE 0.5 % OPHT DROP,,18386,LOCAL,Facility,Both,15,mL,,198,168.3,56.7468,198,"Multiplan, Inc.","Multiplan, Inc.",186.12,94,,percent of total billed charges,,
PROPARACAINE 0.5 % OPHT DROP,,18386,LOCAL,Facility,Outpatient,15,mL,,198,168.3,56.7468,198,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,178.398,90.1,,percent of total billed charges,,
PROPARACAINE 0.5 % OPHT DROP,,18386,LOCAL,Facility,Inpatient,15,mL,,198,168.3,56.7468,198,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
PROPARACAINE 0.5 % OPHT DROP,,18386,LOCAL,Facility,Both,15,mL,,198,168.3,56.7468,198,"Preferred One Administrative Services, INC.",PPO,195.228,98.6,,percent of total billed charges,,
PROPARACAINE 0.5 % OPHT DROP,,18386,LOCAL,Facility,Outpatient,15,mL,,198,168.3,56.7468,198,PrimeWest Health,Minnesota Senior Health Options (MSHO),101.871,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
PROPARACAINE 0.5 % OPHT DROP,,18386,LOCAL,Facility,Inpatient,15,mL,,198,168.3,56.7468,198,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PROPARACAINE 0.5 % OPHT DROP,,18386,LOCAL,Facility,Outpatient,15,mL,,198,168.3,56.7468,198,PrimeWest Health,MinnesotaCare,101.6928,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
PROPARACAINE 0.5 % OPHT DROP,,18386,LOCAL,Facility,Inpatient,15,mL,,198,168.3,56.7468,198,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
PROPARACAINE 0.5 % OPHT DROP,,18386,LOCAL,Facility,Both,15,mL,,198,168.3,56.7468,198,Sanford Health Plan,Sanford Health Plan,182.16,92,,percent of total billed charges,,
PROPARACAINE 0.5 % OPHT DROP,,18386,LOCAL,Facility,Outpatient,15,mL,,198,168.3,56.7468,198,"UCare Health, Inc.",Individual & Family Plan,111.573,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
PROPARACAINE 0.5 % OPHT DROP,,18386,LOCAL,Facility,Inpatient,15,mL,,198,168.3,56.7468,198,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
PROPARACAINE 0.5 % OPHT DROP,,18386,LOCAL,Facility,Outpatient,15,mL,,198,168.3,56.7468,198,"UCare Health, Inc.",Medical Assistance,99.9306,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PROPARACAINE 0.5 % OPHT DROP,,18386,LOCAL,Facility,Inpatient,15,mL,,198,168.3,56.7468,198,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
PROPARACAINE 0.5 % OPHT DROP,,18386,LOCAL,Facility,Outpatient,15,mL,,198,168.3,56.7468,198,"UCare Health, Inc.",Medicare Advantage,99.9306,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PROPARACAINE 0.5 % OPHT DROP,,18386,LOCAL,Facility,Inpatient,15,mL,,198,168.3,56.7468,198,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PROPARACAINE 0.5 % OPHT DROP,,18386,LOCAL,Facility,Outpatient,15,mL,,198,168.3,56.7468,198,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),99.9306,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PROPARACAINE 0.5 % OPHT DROP,,18386,LOCAL,Facility,Inpatient,15,mL,,198,168.3,56.7468,198,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PROPARACAINE 0.5 % OPHT DROP,,18386,LOCAL,Facility,Both,15,mL,,198,168.3,56.7468,198,UnitedHealthcare,Individual & Family,186.12,94,,percent of total billed charges,,
PROPARACAINE 0.5 % OPHT DROP,,18386,LOCAL,Facility,Outpatient,15,mL,,198,168.3,56.7468,198,UnitedHealthcare,Medicare Advantage,97.02,49,,percent of total billed charges,,
PROPARACAINE 0.5 % OPHT DROP,,18386,LOCAL,Facility,Inpatient,15,mL,,198,168.3,56.7468,198,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
PROPARACAINE 0.5 % OPHT DROP,,18386,LOCAL,Facility,Outpatient,15,mL,,198,168.3,56.7468,198,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,95.04,48,,percent of total billed charges,,100% of DHS outpatient percentage
PROPARACAINE 0.5 % OPHT DROP,,18386,LOCAL,Facility,Inpatient,15,mL,,198,168.3,56.7468,198,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
OXYMETAZOLINE 0.05 % NASL SPRY,,28372,LOCAL,Facility,Both,15,mL,,12,10.2,3.4392,12,Aetna,Commercial,11.04,92,,percent of total billed charges,,
OXYMETAZOLINE 0.05 % NASL SPRY,,28372,LOCAL,Facility,Outpatient,15,mL,,12,10.2,3.4392,12,Aetna,Medicare Advantage,5.88,49,,percent of total billed charges,,
OXYMETAZOLINE 0.05 % NASL SPRY,,28372,LOCAL,Facility,Inpatient,15,mL,,12,10.2,3.4392,12,Aetna,Medicare Advantage,,,,,Included in per diem rate,
OXYMETAZOLINE 0.05 % NASL SPRY,,28372,LOCAL,Facility,Both,15,mL,,12,10.2,3.4392,12,Aetna,PPO,11.16,93,,percent of total billed charges,,
OXYMETAZOLINE 0.05 % NASL SPRY,,28372,LOCAL,Facility,Both,15,mL,,12,10.2,3.4392,12,America's PPO,America's PPO,11.5236,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
OXYMETAZOLINE 0.05 % NASL SPRY,,28372,LOCAL,Facility,Both,15,mL,,12,10.2,3.4392,12,BlueCross BlueShield Minnesota, Federal Employee Program,11.808,98.4,,percent of total billed charges,,
OXYMETAZOLINE 0.05 % NASL SPRY,,28372,LOCAL,Facility,Both,15,mL,,12,10.2,3.4392,12,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,12,100,,percent of total billed charges,,
OXYMETAZOLINE 0.05 % NASL SPRY,,28372,LOCAL,Facility,Both,15,mL,,12,10.2,3.4392,12,BlueCross BlueShield Minnesota,High Value Network Plan,10.8,90,,percent of total billed charges,,
OXYMETAZOLINE 0.05 % NASL SPRY,,28372,LOCAL,Facility,Outpatient,15,mL,,12,10.2,3.4392,12,BlueCross BlueShield Minnesota,Medicare Advantage,5.88,49,,percent of total billed charges,,
OXYMETAZOLINE 0.05 % NASL SPRY,,28372,LOCAL,Facility,Inpatient,15,mL,,12,10.2,3.4392,12,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
OXYMETAZOLINE 0.05 % NASL SPRY,,28372,LOCAL,Facility,Both,15,mL,,12,10.2,3.4392,12,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,10.6284,88.57,,percent of total billed charges,,
OXYMETAZOLINE 0.05 % NASL SPRY,,28372,LOCAL,Facility,Both,15,mL,,12,10.2,3.4392,12,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,3.4392,28.66,,percent of total billed charges,,
OXYMETAZOLINE 0.05 % NASL SPRY,,28372,LOCAL,Facility,Outpatient,15,mL,,12,10.2,3.4392,12,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),5.88,49,,percent of total billed charges,,
OXYMETAZOLINE 0.05 % NASL SPRY,,28372,LOCAL,Facility,Inpatient,15,mL,,12,10.2,3.4392,12,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
OXYMETAZOLINE 0.05 % NASL SPRY,,28372,LOCAL,Facility,Both,15,mL,,12,10.2,3.4392,12,CorVel,Worker's Compensation,12,100,,percent of total billed charges,,
OXYMETAZOLINE 0.05 % NASL SPRY,,28372,LOCAL,Facility,Both,15,mL,,12,10.2,3.4392,12,First Health Group Corporation,First Health Network,11.64,97,,percent of total billed charges,,
OXYMETAZOLINE 0.05 % NASL SPRY,,28372,LOCAL,Facility,Both,15,mL,,12,10.2,3.4392,12,"Health Partners, Inc.",Commercial,11.352,94.6,,percent of total billed charges,,
OXYMETAZOLINE 0.05 % NASL SPRY,,28372,LOCAL,Facility,Outpatient,15,mL,,12,10.2,3.4392,12,"Health Partners, Inc.",Medicare Advantage,5.88,49,,percent of total billed charges,,
OXYMETAZOLINE 0.05 % NASL SPRY,,28372,LOCAL,Facility,Inpatient,15,mL,,12,10.2,3.4392,12,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
OXYMETAZOLINE 0.05 % NASL SPRY,,28372,LOCAL,Facility,Both,15,mL,,12,10.2,3.4392,12,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),7.2,60,,percent of total billed charges,,
OXYMETAZOLINE 0.05 % NASL SPRY,,28372,LOCAL,Facility,Both,15,mL,,12,10.2,3.4392,12,"Health Partners, Inc.",State of Minnesota Advantage Program,9.78,81.5,,percent of total billed charges,,
OXYMETAZOLINE 0.05 % NASL SPRY,,28372,LOCAL,Facility,Both,15,mL,,12,10.2,3.4392,12,"Health Partners, Inc.",State Public Programs,6,50,,percent of total billed charges,,
OXYMETAZOLINE 0.05 % NASL SPRY,,28372,LOCAL,Facility,Both,15,mL,,12,10.2,3.4392,12,Humana Insurance Company,Commercial PPO,11.4,95,,percent of total billed charges,,
OXYMETAZOLINE 0.05 % NASL SPRY,,28372,LOCAL,Facility,Outpatient,15,mL,,12,10.2,3.4392,12,Humana Insurance Company,Medicare PPO,5.88,49,,percent of total billed charges,,
OXYMETAZOLINE 0.05 % NASL SPRY,,28372,LOCAL,Facility,Inpatient,15,mL,,12,10.2,3.4392,12,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
OXYMETAZOLINE 0.05 % NASL SPRY,,28372,LOCAL,Facility,Both,15,mL,,12,10.2,3.4392,12,Medica,Individual & Family,11.892,99.1,,percent of total billed charges,,
OXYMETAZOLINE 0.05 % NASL SPRY,,28372,LOCAL,Facility,Outpatient,15,mL,,12,10.2,3.4392,12,Medica,Medica Advantage Solution,5.976,49.8,,percent of total billed charges,,
OXYMETAZOLINE 0.05 % NASL SPRY,,28372,LOCAL,Facility,Inpatient,15,mL,,12,10.2,3.4392,12,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
OXYMETAZOLINE 0.05 % NASL SPRY,,28372,LOCAL,Facility,Outpatient,15,mL,,12,10.2,3.4392,12,Medica,Medical Assistance,5.352,44.6,,percent of total billed charges,,
OXYMETAZOLINE 0.05 % NASL SPRY,,28372,LOCAL,Facility,Inpatient,15,mL,,12,10.2,3.4392,12,Medica,Medical Assistance,,,,,Included in per diem rate,
OXYMETAZOLINE 0.05 % NASL SPRY,,28372,LOCAL,Facility,Outpatient,15,mL,,12,10.2,3.4392,12,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,5.976,49.8,,percent of total billed charges,,
OXYMETAZOLINE 0.05 % NASL SPRY,,28372,LOCAL,Facility,Inpatient,15,mL,,12,10.2,3.4392,12,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
OXYMETAZOLINE 0.05 % NASL SPRY,,28372,LOCAL,Facility,Both,15,mL,,12,10.2,3.4392,12,"Multiplan, Inc.","Multiplan, Inc.",11.28,94,,percent of total billed charges,,
OXYMETAZOLINE 0.05 % NASL SPRY,,28372,LOCAL,Facility,Outpatient,15,mL,,12,10.2,3.4392,12,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,10.812,90.1,,percent of total billed charges,,
OXYMETAZOLINE 0.05 % NASL SPRY,,28372,LOCAL,Facility,Inpatient,15,mL,,12,10.2,3.4392,12,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
OXYMETAZOLINE 0.05 % NASL SPRY,,28372,LOCAL,Facility,Both,15,mL,,12,10.2,3.4392,12,"Preferred One Administrative Services, INC.",PPO,11.832,98.6,,percent of total billed charges,,
OXYMETAZOLINE 0.05 % NASL SPRY,,28372,LOCAL,Facility,Outpatient,15,mL,,12,10.2,3.4392,12,PrimeWest Health,Minnesota Senior Health Options (MSHO),6.174,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
OXYMETAZOLINE 0.05 % NASL SPRY,,28372,LOCAL,Facility,Inpatient,15,mL,,12,10.2,3.4392,12,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
OXYMETAZOLINE 0.05 % NASL SPRY,,28372,LOCAL,Facility,Outpatient,15,mL,,12,10.2,3.4392,12,PrimeWest Health,MinnesotaCare,6.1632,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
OXYMETAZOLINE 0.05 % NASL SPRY,,28372,LOCAL,Facility,Inpatient,15,mL,,12,10.2,3.4392,12,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
OXYMETAZOLINE 0.05 % NASL SPRY,,28372,LOCAL,Facility,Both,15,mL,,12,10.2,3.4392,12,Sanford Health Plan,Sanford Health Plan,11.04,92,,percent of total billed charges,,
OXYMETAZOLINE 0.05 % NASL SPRY,,28372,LOCAL,Facility,Outpatient,15,mL,,12,10.2,3.4392,12,"UCare Health, Inc.",Individual & Family Plan,6.762,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
OXYMETAZOLINE 0.05 % NASL SPRY,,28372,LOCAL,Facility,Inpatient,15,mL,,12,10.2,3.4392,12,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
OXYMETAZOLINE 0.05 % NASL SPRY,,28372,LOCAL,Facility,Outpatient,15,mL,,12,10.2,3.4392,12,"UCare Health, Inc.",Medical Assistance,6.0564,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
OXYMETAZOLINE 0.05 % NASL SPRY,,28372,LOCAL,Facility,Inpatient,15,mL,,12,10.2,3.4392,12,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
OXYMETAZOLINE 0.05 % NASL SPRY,,28372,LOCAL,Facility,Outpatient,15,mL,,12,10.2,3.4392,12,"UCare Health, Inc.",Medicare Advantage,6.0564,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
OXYMETAZOLINE 0.05 % NASL SPRY,,28372,LOCAL,Facility,Inpatient,15,mL,,12,10.2,3.4392,12,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
OXYMETAZOLINE 0.05 % NASL SPRY,,28372,LOCAL,Facility,Outpatient,15,mL,,12,10.2,3.4392,12,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),6.0564,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
OXYMETAZOLINE 0.05 % NASL SPRY,,28372,LOCAL,Facility,Inpatient,15,mL,,12,10.2,3.4392,12,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
OXYMETAZOLINE 0.05 % NASL SPRY,,28372,LOCAL,Facility,Both,15,mL,,12,10.2,3.4392,12,UnitedHealthcare,Individual & Family,11.28,94,,percent of total billed charges,,
OXYMETAZOLINE 0.05 % NASL SPRY,,28372,LOCAL,Facility,Outpatient,15,mL,,12,10.2,3.4392,12,UnitedHealthcare,Medicare Advantage,5.88,49,,percent of total billed charges,,
OXYMETAZOLINE 0.05 % NASL SPRY,,28372,LOCAL,Facility,Inpatient,15,mL,,12,10.2,3.4392,12,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
OXYMETAZOLINE 0.05 % NASL SPRY,,28372,LOCAL,Facility,Outpatient,15,mL,,12,10.2,3.4392,12,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,5.76,48,,percent of total billed charges,,100% of DHS outpatient percentage
OXYMETAZOLINE 0.05 % NASL SPRY,,28372,LOCAL,Facility,Inpatient,15,mL,,12,10.2,3.4392,12,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
PHENYLEPHRINE HCL 0.5 % NASL SPRY,,28382,LOCAL,Facility,Both,15,mL,,19,16.15,5.4454,19,Aetna,Commercial,17.48,92,,percent of total billed charges,,
PHENYLEPHRINE HCL 0.5 % NASL SPRY,,28382,LOCAL,Facility,Outpatient,15,mL,,19,16.15,5.4454,19,Aetna,Medicare Advantage,9.31,49,,percent of total billed charges,,
PHENYLEPHRINE HCL 0.5 % NASL SPRY,,28382,LOCAL,Facility,Inpatient,15,mL,,19,16.15,5.4454,19,Aetna,Medicare Advantage,,,,,Included in per diem rate,
PHENYLEPHRINE HCL 0.5 % NASL SPRY,,28382,LOCAL,Facility,Both,15,mL,,19,16.15,5.4454,19,Aetna,PPO,17.67,93,,percent of total billed charges,,
PHENYLEPHRINE HCL 0.5 % NASL SPRY,,28382,LOCAL,Facility,Both,15,mL,,19,16.15,5.4454,19,America's PPO,America's PPO,18.2457,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
PHENYLEPHRINE HCL 0.5 % NASL SPRY,,28382,LOCAL,Facility,Both,15,mL,,19,16.15,5.4454,19,BlueCross BlueShield Minnesota, Federal Employee Program,18.696,98.4,,percent of total billed charges,,
PHENYLEPHRINE HCL 0.5 % NASL SPRY,,28382,LOCAL,Facility,Both,15,mL,,19,16.15,5.4454,19,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,19,100,,percent of total billed charges,,
PHENYLEPHRINE HCL 0.5 % NASL SPRY,,28382,LOCAL,Facility,Both,15,mL,,19,16.15,5.4454,19,BlueCross BlueShield Minnesota,High Value Network Plan,17.1,90,,percent of total billed charges,,
PHENYLEPHRINE HCL 0.5 % NASL SPRY,,28382,LOCAL,Facility,Outpatient,15,mL,,19,16.15,5.4454,19,BlueCross BlueShield Minnesota,Medicare Advantage,9.31,49,,percent of total billed charges,,
PHENYLEPHRINE HCL 0.5 % NASL SPRY,,28382,LOCAL,Facility,Inpatient,15,mL,,19,16.15,5.4454,19,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
PHENYLEPHRINE HCL 0.5 % NASL SPRY,,28382,LOCAL,Facility,Both,15,mL,,19,16.15,5.4454,19,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,16.8283,88.57,,percent of total billed charges,,
PHENYLEPHRINE HCL 0.5 % NASL SPRY,,28382,LOCAL,Facility,Both,15,mL,,19,16.15,5.4454,19,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,5.4454,28.66,,percent of total billed charges,,
PHENYLEPHRINE HCL 0.5 % NASL SPRY,,28382,LOCAL,Facility,Outpatient,15,mL,,19,16.15,5.4454,19,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),9.31,49,,percent of total billed charges,,
PHENYLEPHRINE HCL 0.5 % NASL SPRY,,28382,LOCAL,Facility,Inpatient,15,mL,,19,16.15,5.4454,19,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
PHENYLEPHRINE HCL 0.5 % NASL SPRY,,28382,LOCAL,Facility,Both,15,mL,,19,16.15,5.4454,19,CorVel,Worker's Compensation,19,100,,percent of total billed charges,,
PHENYLEPHRINE HCL 0.5 % NASL SPRY,,28382,LOCAL,Facility,Both,15,mL,,19,16.15,5.4454,19,First Health Group Corporation,First Health Network,18.43,97,,percent of total billed charges,,
PHENYLEPHRINE HCL 0.5 % NASL SPRY,,28382,LOCAL,Facility,Both,15,mL,,19,16.15,5.4454,19,"Health Partners, Inc.",Commercial,17.974,94.6,,percent of total billed charges,,
PHENYLEPHRINE HCL 0.5 % NASL SPRY,,28382,LOCAL,Facility,Outpatient,15,mL,,19,16.15,5.4454,19,"Health Partners, Inc.",Medicare Advantage,9.31,49,,percent of total billed charges,,
PHENYLEPHRINE HCL 0.5 % NASL SPRY,,28382,LOCAL,Facility,Inpatient,15,mL,,19,16.15,5.4454,19,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PHENYLEPHRINE HCL 0.5 % NASL SPRY,,28382,LOCAL,Facility,Both,15,mL,,19,16.15,5.4454,19,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),11.4,60,,percent of total billed charges,,
PHENYLEPHRINE HCL 0.5 % NASL SPRY,,28382,LOCAL,Facility,Both,15,mL,,19,16.15,5.4454,19,"Health Partners, Inc.",State of Minnesota Advantage Program,15.485,81.5,,percent of total billed charges,,
PHENYLEPHRINE HCL 0.5 % NASL SPRY,,28382,LOCAL,Facility,Both,15,mL,,19,16.15,5.4454,19,"Health Partners, Inc.",State Public Programs,9.5,50,,percent of total billed charges,,
PHENYLEPHRINE HCL 0.5 % NASL SPRY,,28382,LOCAL,Facility,Both,15,mL,,19,16.15,5.4454,19,Humana Insurance Company,Commercial PPO,18.05,95,,percent of total billed charges,,
PHENYLEPHRINE HCL 0.5 % NASL SPRY,,28382,LOCAL,Facility,Outpatient,15,mL,,19,16.15,5.4454,19,Humana Insurance Company,Medicare PPO,9.31,49,,percent of total billed charges,,
PHENYLEPHRINE HCL 0.5 % NASL SPRY,,28382,LOCAL,Facility,Inpatient,15,mL,,19,16.15,5.4454,19,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
PHENYLEPHRINE HCL 0.5 % NASL SPRY,,28382,LOCAL,Facility,Both,15,mL,,19,16.15,5.4454,19,Medica,Individual & Family,18.829,99.1,,percent of total billed charges,,
PHENYLEPHRINE HCL 0.5 % NASL SPRY,,28382,LOCAL,Facility,Outpatient,15,mL,,19,16.15,5.4454,19,Medica,Medica Advantage Solution,9.462,49.8,,percent of total billed charges,,
PHENYLEPHRINE HCL 0.5 % NASL SPRY,,28382,LOCAL,Facility,Inpatient,15,mL,,19,16.15,5.4454,19,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
PHENYLEPHRINE HCL 0.5 % NASL SPRY,,28382,LOCAL,Facility,Outpatient,15,mL,,19,16.15,5.4454,19,Medica,Medical Assistance,8.474,44.6,,percent of total billed charges,,
PHENYLEPHRINE HCL 0.5 % NASL SPRY,,28382,LOCAL,Facility,Inpatient,15,mL,,19,16.15,5.4454,19,Medica,Medical Assistance,,,,,Included in per diem rate,
PHENYLEPHRINE HCL 0.5 % NASL SPRY,,28382,LOCAL,Facility,Outpatient,15,mL,,19,16.15,5.4454,19,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,9.462,49.8,,percent of total billed charges,,
PHENYLEPHRINE HCL 0.5 % NASL SPRY,,28382,LOCAL,Facility,Inpatient,15,mL,,19,16.15,5.4454,19,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
PHENYLEPHRINE HCL 0.5 % NASL SPRY,,28382,LOCAL,Facility,Both,15,mL,,19,16.15,5.4454,19,"Multiplan, Inc.","Multiplan, Inc.",17.86,94,,percent of total billed charges,,
PHENYLEPHRINE HCL 0.5 % NASL SPRY,,28382,LOCAL,Facility,Outpatient,15,mL,,19,16.15,5.4454,19,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,17.119,90.1,,percent of total billed charges,,
PHENYLEPHRINE HCL 0.5 % NASL SPRY,,28382,LOCAL,Facility,Inpatient,15,mL,,19,16.15,5.4454,19,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
PHENYLEPHRINE HCL 0.5 % NASL SPRY,,28382,LOCAL,Facility,Both,15,mL,,19,16.15,5.4454,19,"Preferred One Administrative Services, INC.",PPO,18.734,98.6,,percent of total billed charges,,
PHENYLEPHRINE HCL 0.5 % NASL SPRY,,28382,LOCAL,Facility,Outpatient,15,mL,,19,16.15,5.4454,19,PrimeWest Health,Minnesota Senior Health Options (MSHO),9.7755,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
PHENYLEPHRINE HCL 0.5 % NASL SPRY,,28382,LOCAL,Facility,Inpatient,15,mL,,19,16.15,5.4454,19,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PHENYLEPHRINE HCL 0.5 % NASL SPRY,,28382,LOCAL,Facility,Outpatient,15,mL,,19,16.15,5.4454,19,PrimeWest Health,MinnesotaCare,9.7584,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
PHENYLEPHRINE HCL 0.5 % NASL SPRY,,28382,LOCAL,Facility,Inpatient,15,mL,,19,16.15,5.4454,19,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
PHENYLEPHRINE HCL 0.5 % NASL SPRY,,28382,LOCAL,Facility,Both,15,mL,,19,16.15,5.4454,19,Sanford Health Plan,Sanford Health Plan,17.48,92,,percent of total billed charges,,
PHENYLEPHRINE HCL 0.5 % NASL SPRY,,28382,LOCAL,Facility,Outpatient,15,mL,,19,16.15,5.4454,19,"UCare Health, Inc.",Individual & Family Plan,10.7065,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
PHENYLEPHRINE HCL 0.5 % NASL SPRY,,28382,LOCAL,Facility,Inpatient,15,mL,,19,16.15,5.4454,19,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
PHENYLEPHRINE HCL 0.5 % NASL SPRY,,28382,LOCAL,Facility,Outpatient,15,mL,,19,16.15,5.4454,19,"UCare Health, Inc.",Medical Assistance,9.5893,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PHENYLEPHRINE HCL 0.5 % NASL SPRY,,28382,LOCAL,Facility,Inpatient,15,mL,,19,16.15,5.4454,19,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
PHENYLEPHRINE HCL 0.5 % NASL SPRY,,28382,LOCAL,Facility,Outpatient,15,mL,,19,16.15,5.4454,19,"UCare Health, Inc.",Medicare Advantage,9.5893,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PHENYLEPHRINE HCL 0.5 % NASL SPRY,,28382,LOCAL,Facility,Inpatient,15,mL,,19,16.15,5.4454,19,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PHENYLEPHRINE HCL 0.5 % NASL SPRY,,28382,LOCAL,Facility,Outpatient,15,mL,,19,16.15,5.4454,19,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),9.5893,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PHENYLEPHRINE HCL 0.5 % NASL SPRY,,28382,LOCAL,Facility,Inpatient,15,mL,,19,16.15,5.4454,19,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PHENYLEPHRINE HCL 0.5 % NASL SPRY,,28382,LOCAL,Facility,Both,15,mL,,19,16.15,5.4454,19,UnitedHealthcare,Individual & Family,17.86,94,,percent of total billed charges,,
PHENYLEPHRINE HCL 0.5 % NASL SPRY,,28382,LOCAL,Facility,Outpatient,15,mL,,19,16.15,5.4454,19,UnitedHealthcare,Medicare Advantage,9.31,49,,percent of total billed charges,,
PHENYLEPHRINE HCL 0.5 % NASL SPRY,,28382,LOCAL,Facility,Inpatient,15,mL,,19,16.15,5.4454,19,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
PHENYLEPHRINE HCL 0.5 % NASL SPRY,,28382,LOCAL,Facility,Outpatient,15,mL,,19,16.15,5.4454,19,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,9.12,48,,percent of total billed charges,,100% of DHS outpatient percentage
PHENYLEPHRINE HCL 0.5 % NASL SPRY,,28382,LOCAL,Facility,Inpatient,15,mL,,19,16.15,5.4454,19,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
FERRIC CARBOXYMALTOSE 50 MG IRON/ML IV SOLN,,J1439,HCPCS,Facility,Both,15,mL,,4852,4124.2,1390.5832,4852,Aetna,Commercial,4463.84,92,,percent of total billed charges,,
FERRIC CARBOXYMALTOSE 50 MG IRON/ML IV SOLN,,J1439,HCPCS,Facility,Outpatient,15,mL,,4852,4124.2,1390.5832,4852,Aetna,Medicare Advantage,2377.48,49,,percent of total billed charges,,
FERRIC CARBOXYMALTOSE 50 MG IRON/ML IV SOLN,,J1439,HCPCS,Facility,Inpatient,15,mL,,4852,4124.2,1390.5832,4852,Aetna,Medicare Advantage,,,,,Included in per diem rate,
FERRIC CARBOXYMALTOSE 50 MG IRON/ML IV SOLN,,J1439,HCPCS,Facility,Both,15,mL,,4852,4124.2,1390.5832,4852,Aetna,PPO,4512.36,93,,percent of total billed charges,,
FERRIC CARBOXYMALTOSE 50 MG IRON/ML IV SOLN,,J1439,HCPCS,Facility,Both,15,mL,,4852,4124.2,1390.5832,4852,America's PPO,America's PPO,4659.3756,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
FERRIC CARBOXYMALTOSE 50 MG IRON/ML IV SOLN,,J1439,HCPCS,Facility,Both,15,mL,,4852,4124.2,1390.5832,4852,BlueCross BlueShield Minnesota, Federal Employee Program,4774.368,98.4,,percent of total billed charges,,
FERRIC CARBOXYMALTOSE 50 MG IRON/ML IV SOLN,,J1439,HCPCS,Facility,Both,15,mL,,4852,4124.2,1390.5832,4852,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,4852,100,,percent of total billed charges,,
FERRIC CARBOXYMALTOSE 50 MG IRON/ML IV SOLN,,J1439,HCPCS,Facility,Both,15,mL,,4852,4124.2,1390.5832,4852,BlueCross BlueShield Minnesota,High Value Network Plan,4366.8,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
FERRIC CARBOXYMALTOSE 50 MG IRON/ML IV SOLN,,J1439,HCPCS,Facility,Outpatient,15,mL,,4852,4124.2,1390.5832,4852,BlueCross BlueShield Minnesota,Medicare Advantage,2377.48,49,,percent of total billed charges,,
FERRIC CARBOXYMALTOSE 50 MG IRON/ML IV SOLN,,J1439,HCPCS,Facility,Inpatient,15,mL,,4852,4124.2,1390.5832,4852,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
FERRIC CARBOXYMALTOSE 50 MG IRON/ML IV SOLN,,J1439,HCPCS,Facility,Both,15,mL,,4852,4124.2,1390.5832,4852,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4297.4164,88.57,,percent of total billed charges,,
FERRIC CARBOXYMALTOSE 50 MG IRON/ML IV SOLN,,J1439,HCPCS,Facility,Both,15,mL,,4852,4124.2,1390.5832,4852,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1390.5832,28.66,,percent of total billed charges,,
FERRIC CARBOXYMALTOSE 50 MG IRON/ML IV SOLN,,J1439,HCPCS,Facility,Outpatient,15,mL,,4852,4124.2,1390.5832,4852,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2377.48,49,,percent of total billed charges,,
FERRIC CARBOXYMALTOSE 50 MG IRON/ML IV SOLN,,J1439,HCPCS,Facility,Inpatient,15,mL,,4852,4124.2,1390.5832,4852,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
FERRIC CARBOXYMALTOSE 50 MG IRON/ML IV SOLN,,J1439,HCPCS,Facility,Both,15,mL,,4852,4124.2,1390.5832,4852,CorVel,Worker's Compensation,4852,100,,percent of total billed charges,,
FERRIC CARBOXYMALTOSE 50 MG IRON/ML IV SOLN,,J1439,HCPCS,Facility,Both,15,mL,,4852,4124.2,1390.5832,4852,First Health Group Corporation,First Health Network,4706.44,97,,percent of total billed charges,,
FERRIC CARBOXYMALTOSE 50 MG IRON/ML IV SOLN,,J1439,HCPCS,Facility,Both,15,mL,,4852,4124.2,1390.5832,4852,"Health Partners, Inc.",Commercial,4589.992,94.6,,percent of total billed charges,,
FERRIC CARBOXYMALTOSE 50 MG IRON/ML IV SOLN,,J1439,HCPCS,Facility,Outpatient,15,mL,,4852,4124.2,1390.5832,4852,"Health Partners, Inc.",Medicare Advantage,2377.48,49,,percent of total billed charges,,
FERRIC CARBOXYMALTOSE 50 MG IRON/ML IV SOLN,,J1439,HCPCS,Facility,Inpatient,15,mL,,4852,4124.2,1390.5832,4852,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
FERRIC CARBOXYMALTOSE 50 MG IRON/ML IV SOLN,,J1439,HCPCS,Facility,Both,15,mL,,4852,4124.2,1390.5832,4852,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),2911.2,60,,percent of total billed charges,,
FERRIC CARBOXYMALTOSE 50 MG IRON/ML IV SOLN,,J1439,HCPCS,Facility,Both,15,mL,,4852,4124.2,1390.5832,4852,"Health Partners, Inc.",State of Minnesota Advantage Program,3954.38,81.5,,percent of total billed charges,,
FERRIC CARBOXYMALTOSE 50 MG IRON/ML IV SOLN,,J1439,HCPCS,Facility,Both,15,mL,,4852,4124.2,1390.5832,4852,"Health Partners, Inc.",State Public Programs,2426,50,,percent of total billed charges,,
FERRIC CARBOXYMALTOSE 50 MG IRON/ML IV SOLN,,J1439,HCPCS,Facility,Both,15,mL,,4852,4124.2,1390.5832,4852,Humana Insurance Company,Commercial PPO,4609.4,95,,percent of total billed charges,,
FERRIC CARBOXYMALTOSE 50 MG IRON/ML IV SOLN,,J1439,HCPCS,Facility,Outpatient,15,mL,,4852,4124.2,1390.5832,4852,Humana Insurance Company,Medicare PPO,2377.48,49,,percent of total billed charges,,
FERRIC CARBOXYMALTOSE 50 MG IRON/ML IV SOLN,,J1439,HCPCS,Facility,Inpatient,15,mL,,4852,4124.2,1390.5832,4852,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
FERRIC CARBOXYMALTOSE 50 MG IRON/ML IV SOLN,,J1439,HCPCS,Facility,Both,15,mL,,4852,4124.2,1390.5832,4852,Medica,Individual & Family,4808.332,99.1,,percent of total billed charges,,
FERRIC CARBOXYMALTOSE 50 MG IRON/ML IV SOLN,,J1439,HCPCS,Facility,Outpatient,15,mL,,4852,4124.2,1390.5832,4852,Medica,Medica Advantage Solution,2416.296,49.8,,percent of total billed charges,,
FERRIC CARBOXYMALTOSE 50 MG IRON/ML IV SOLN,,J1439,HCPCS,Facility,Inpatient,15,mL,,4852,4124.2,1390.5832,4852,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
FERRIC CARBOXYMALTOSE 50 MG IRON/ML IV SOLN,,J1439,HCPCS,Facility,Outpatient,15,mL,,4852,4124.2,1390.5832,4852,Medica,Medical Assistance,2163.992,44.6,,percent of total billed charges,,
FERRIC CARBOXYMALTOSE 50 MG IRON/ML IV SOLN,,J1439,HCPCS,Facility,Inpatient,15,mL,,4852,4124.2,1390.5832,4852,Medica,Medical Assistance,,,,,Included in per diem rate,
FERRIC CARBOXYMALTOSE 50 MG IRON/ML IV SOLN,,J1439,HCPCS,Facility,Outpatient,15,mL,,4852,4124.2,1390.5832,4852,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2416.296,49.8,,percent of total billed charges,,
FERRIC CARBOXYMALTOSE 50 MG IRON/ML IV SOLN,,J1439,HCPCS,Facility,Inpatient,15,mL,,4852,4124.2,1390.5832,4852,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
FERRIC CARBOXYMALTOSE 50 MG IRON/ML IV SOLN,,J1439,HCPCS,Facility,Both,15,mL,,4852,4124.2,1390.5832,4852,"Multiplan, Inc.","Multiplan, Inc.",4560.88,94,,percent of total billed charges,,
FERRIC CARBOXYMALTOSE 50 MG IRON/ML IV SOLN,,J1439,HCPCS,Facility,Outpatient,15,mL,,4852,4124.2,1390.5832,4852,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4371.652,90.1,,percent of total billed charges,,
FERRIC CARBOXYMALTOSE 50 MG IRON/ML IV SOLN,,J1439,HCPCS,Facility,Inpatient,15,mL,,4852,4124.2,1390.5832,4852,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
FERRIC CARBOXYMALTOSE 50 MG IRON/ML IV SOLN,,J1439,HCPCS,Facility,Both,15,mL,,4852,4124.2,1390.5832,4852,"Preferred One Administrative Services, INC.",PPO,4784.072,98.6,,percent of total billed charges,,
FERRIC CARBOXYMALTOSE 50 MG IRON/ML IV SOLN,,J1439,HCPCS,Facility,Outpatient,15,mL,,4852,4124.2,1390.5832,4852,PrimeWest Health,Minnesota Senior Health Options (MSHO),2496.354,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
FERRIC CARBOXYMALTOSE 50 MG IRON/ML IV SOLN,,J1439,HCPCS,Facility,Inpatient,15,mL,,4852,4124.2,1390.5832,4852,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
FERRIC CARBOXYMALTOSE 50 MG IRON/ML IV SOLN,,J1439,HCPCS,Facility,Outpatient,15,mL,,4852,4124.2,1390.5832,4852,PrimeWest Health,MinnesotaCare,2491.9872,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
FERRIC CARBOXYMALTOSE 50 MG IRON/ML IV SOLN,,J1439,HCPCS,Facility,Inpatient,15,mL,,4852,4124.2,1390.5832,4852,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
FERRIC CARBOXYMALTOSE 50 MG IRON/ML IV SOLN,,J1439,HCPCS,Facility,Both,15,mL,,4852,4124.2,1390.5832,4852,Sanford Health Plan,Sanford Health Plan,4463.84,92,,percent of total billed charges,,
FERRIC CARBOXYMALTOSE 50 MG IRON/ML IV SOLN,,J1439,HCPCS,Facility,Outpatient,15,mL,,4852,4124.2,1390.5832,4852,"UCare Health, Inc.",Individual & Family Plan,2734.102,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
FERRIC CARBOXYMALTOSE 50 MG IRON/ML IV SOLN,,J1439,HCPCS,Facility,Inpatient,15,mL,,4852,4124.2,1390.5832,4852,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
FERRIC CARBOXYMALTOSE 50 MG IRON/ML IV SOLN,,J1439,HCPCS,Facility,Outpatient,15,mL,,4852,4124.2,1390.5832,4852,"UCare Health, Inc.",Medical Assistance,2448.8044,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FERRIC CARBOXYMALTOSE 50 MG IRON/ML IV SOLN,,J1439,HCPCS,Facility,Inpatient,15,mL,,4852,4124.2,1390.5832,4852,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
FERRIC CARBOXYMALTOSE 50 MG IRON/ML IV SOLN,,J1439,HCPCS,Facility,Outpatient,15,mL,,4852,4124.2,1390.5832,4852,"UCare Health, Inc.",Medicare Advantage,2448.8044,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FERRIC CARBOXYMALTOSE 50 MG IRON/ML IV SOLN,,J1439,HCPCS,Facility,Inpatient,15,mL,,4852,4124.2,1390.5832,4852,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
FERRIC CARBOXYMALTOSE 50 MG IRON/ML IV SOLN,,J1439,HCPCS,Facility,Outpatient,15,mL,,4852,4124.2,1390.5832,4852,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2448.8044,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FERRIC CARBOXYMALTOSE 50 MG IRON/ML IV SOLN,,J1439,HCPCS,Facility,Inpatient,15,mL,,4852,4124.2,1390.5832,4852,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
FERRIC CARBOXYMALTOSE 50 MG IRON/ML IV SOLN,,J1439,HCPCS,Facility,Both,15,mL,,4852,4124.2,1390.5832,4852,UnitedHealthcare,Individual & Family,4560.88,94,,percent of total billed charges,,
FERRIC CARBOXYMALTOSE 50 MG IRON/ML IV SOLN,,J1439,HCPCS,Facility,Outpatient,15,mL,,4852,4124.2,1390.5832,4852,UnitedHealthcare,Medicare Advantage,2377.48,49,,percent of total billed charges,,
FERRIC CARBOXYMALTOSE 50 MG IRON/ML IV SOLN,,J1439,HCPCS,Facility,Inpatient,15,mL,,4852,4124.2,1390.5832,4852,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
FERRIC CARBOXYMALTOSE 50 MG IRON/ML IV SOLN,,J1439,HCPCS,Facility,Outpatient,15,mL,,4852,4124.2,1390.5832,4852,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2328.96,48,,percent of total billed charges,,100% of DHS outpatient percentage
FERRIC CARBOXYMALTOSE 50 MG IRON/ML IV SOLN,,J1439,HCPCS,Facility,Inpatient,15,mL,,4852,4124.2,1390.5832,4852,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
DIGOXIN 50 MCG/ML (0.05 MG/ML) ORAL SOLN,,203,LOCAL,Facility,Both,60,mL,,656,557.6,188.0096,656,Aetna,Commercial,603.52,92,,percent of total billed charges,,
DIGOXIN 50 MCG/ML (0.05 MG/ML) ORAL SOLN,,203,LOCAL,Facility,Outpatient,60,mL,,656,557.6,188.0096,656,Aetna,Medicare Advantage,321.44,49,,percent of total billed charges,,
DIGOXIN 50 MCG/ML (0.05 MG/ML) ORAL SOLN,,203,LOCAL,Facility,Inpatient,60,mL,,656,557.6,188.0096,656,Aetna,Medicare Advantage,,,,,Included in per diem rate,
DIGOXIN 50 MCG/ML (0.05 MG/ML) ORAL SOLN,,203,LOCAL,Facility,Both,60,mL,,656,557.6,188.0096,656,Aetna,PPO,610.08,93,,percent of total billed charges,,
DIGOXIN 50 MCG/ML (0.05 MG/ML) ORAL SOLN,,203,LOCAL,Facility,Both,60,mL,,656,557.6,188.0096,656,America's PPO,America's PPO,629.9568,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
DIGOXIN 50 MCG/ML (0.05 MG/ML) ORAL SOLN,,203,LOCAL,Facility,Both,60,mL,,656,557.6,188.0096,656,BlueCross BlueShield Minnesota, Federal Employee Program,645.504,98.4,,percent of total billed charges,,
DIGOXIN 50 MCG/ML (0.05 MG/ML) ORAL SOLN,,203,LOCAL,Facility,Both,60,mL,,656,557.6,188.0096,656,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,656,100,,percent of total billed charges,,
DIGOXIN 50 MCG/ML (0.05 MG/ML) ORAL SOLN,,203,LOCAL,Facility,Both,60,mL,,656,557.6,188.0096,656,BlueCross BlueShield Minnesota,High Value Network Plan,590.4,90,,percent of total billed charges,,
DIGOXIN 50 MCG/ML (0.05 MG/ML) ORAL SOLN,,203,LOCAL,Facility,Outpatient,60,mL,,656,557.6,188.0096,656,BlueCross BlueShield Minnesota,Medicare Advantage,321.44,49,,percent of total billed charges,,
DIGOXIN 50 MCG/ML (0.05 MG/ML) ORAL SOLN,,203,LOCAL,Facility,Inpatient,60,mL,,656,557.6,188.0096,656,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
DIGOXIN 50 MCG/ML (0.05 MG/ML) ORAL SOLN,,203,LOCAL,Facility,Both,60,mL,,656,557.6,188.0096,656,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,581.0192,88.57,,percent of total billed charges,,
DIGOXIN 50 MCG/ML (0.05 MG/ML) ORAL SOLN,,203,LOCAL,Facility,Both,60,mL,,656,557.6,188.0096,656,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,188.0096,28.66,,percent of total billed charges,,
DIGOXIN 50 MCG/ML (0.05 MG/ML) ORAL SOLN,,203,LOCAL,Facility,Outpatient,60,mL,,656,557.6,188.0096,656,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),321.44,49,,percent of total billed charges,,
DIGOXIN 50 MCG/ML (0.05 MG/ML) ORAL SOLN,,203,LOCAL,Facility,Inpatient,60,mL,,656,557.6,188.0096,656,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
DIGOXIN 50 MCG/ML (0.05 MG/ML) ORAL SOLN,,203,LOCAL,Facility,Both,60,mL,,656,557.6,188.0096,656,CorVel,Worker's Compensation,656,100,,percent of total billed charges,,
DIGOXIN 50 MCG/ML (0.05 MG/ML) ORAL SOLN,,203,LOCAL,Facility,Both,60,mL,,656,557.6,188.0096,656,First Health Group Corporation,First Health Network,636.32,97,,percent of total billed charges,,
DIGOXIN 50 MCG/ML (0.05 MG/ML) ORAL SOLN,,203,LOCAL,Facility,Both,60,mL,,656,557.6,188.0096,656,"Health Partners, Inc.",Commercial,620.576,94.6,,percent of total billed charges,,
DIGOXIN 50 MCG/ML (0.05 MG/ML) ORAL SOLN,,203,LOCAL,Facility,Outpatient,60,mL,,656,557.6,188.0096,656,"Health Partners, Inc.",Medicare Advantage,321.44,49,,percent of total billed charges,,
DIGOXIN 50 MCG/ML (0.05 MG/ML) ORAL SOLN,,203,LOCAL,Facility,Inpatient,60,mL,,656,557.6,188.0096,656,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DIGOXIN 50 MCG/ML (0.05 MG/ML) ORAL SOLN,,203,LOCAL,Facility,Both,60,mL,,656,557.6,188.0096,656,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),393.6,60,,percent of total billed charges,,
DIGOXIN 50 MCG/ML (0.05 MG/ML) ORAL SOLN,,203,LOCAL,Facility,Both,60,mL,,656,557.6,188.0096,656,"Health Partners, Inc.",State of Minnesota Advantage Program,534.64,81.5,,percent of total billed charges,,
DIGOXIN 50 MCG/ML (0.05 MG/ML) ORAL SOLN,,203,LOCAL,Facility,Both,60,mL,,656,557.6,188.0096,656,"Health Partners, Inc.",State Public Programs,328,50,,percent of total billed charges,,
DIGOXIN 50 MCG/ML (0.05 MG/ML) ORAL SOLN,,203,LOCAL,Facility,Both,60,mL,,656,557.6,188.0096,656,Humana Insurance Company,Commercial PPO,623.2,95,,percent of total billed charges,,
DIGOXIN 50 MCG/ML (0.05 MG/ML) ORAL SOLN,,203,LOCAL,Facility,Outpatient,60,mL,,656,557.6,188.0096,656,Humana Insurance Company,Medicare PPO,321.44,49,,percent of total billed charges,,
DIGOXIN 50 MCG/ML (0.05 MG/ML) ORAL SOLN,,203,LOCAL,Facility,Inpatient,60,mL,,656,557.6,188.0096,656,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
DIGOXIN 50 MCG/ML (0.05 MG/ML) ORAL SOLN,,203,LOCAL,Facility,Both,60,mL,,656,557.6,188.0096,656,Medica,Individual & Family,650.096,99.1,,percent of total billed charges,,
DIGOXIN 50 MCG/ML (0.05 MG/ML) ORAL SOLN,,203,LOCAL,Facility,Outpatient,60,mL,,656,557.6,188.0096,656,Medica,Medica Advantage Solution,326.688,49.8,,percent of total billed charges,,
DIGOXIN 50 MCG/ML (0.05 MG/ML) ORAL SOLN,,203,LOCAL,Facility,Inpatient,60,mL,,656,557.6,188.0096,656,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
DIGOXIN 50 MCG/ML (0.05 MG/ML) ORAL SOLN,,203,LOCAL,Facility,Outpatient,60,mL,,656,557.6,188.0096,656,Medica,Medical Assistance,292.576,44.6,,percent of total billed charges,,
DIGOXIN 50 MCG/ML (0.05 MG/ML) ORAL SOLN,,203,LOCAL,Facility,Inpatient,60,mL,,656,557.6,188.0096,656,Medica,Medical Assistance,,,,,Included in per diem rate,
DIGOXIN 50 MCG/ML (0.05 MG/ML) ORAL SOLN,,203,LOCAL,Facility,Outpatient,60,mL,,656,557.6,188.0096,656,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,326.688,49.8,,percent of total billed charges,,
DIGOXIN 50 MCG/ML (0.05 MG/ML) ORAL SOLN,,203,LOCAL,Facility,Inpatient,60,mL,,656,557.6,188.0096,656,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
DIGOXIN 50 MCG/ML (0.05 MG/ML) ORAL SOLN,,203,LOCAL,Facility,Both,60,mL,,656,557.6,188.0096,656,"Multiplan, Inc.","Multiplan, Inc.",616.64,94,,percent of total billed charges,,
DIGOXIN 50 MCG/ML (0.05 MG/ML) ORAL SOLN,,203,LOCAL,Facility,Outpatient,60,mL,,656,557.6,188.0096,656,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,591.056,90.1,,percent of total billed charges,,
DIGOXIN 50 MCG/ML (0.05 MG/ML) ORAL SOLN,,203,LOCAL,Facility,Inpatient,60,mL,,656,557.6,188.0096,656,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
DIGOXIN 50 MCG/ML (0.05 MG/ML) ORAL SOLN,,203,LOCAL,Facility,Both,60,mL,,656,557.6,188.0096,656,"Preferred One Administrative Services, INC.",PPO,646.816,98.6,,percent of total billed charges,,
DIGOXIN 50 MCG/ML (0.05 MG/ML) ORAL SOLN,,203,LOCAL,Facility,Outpatient,60,mL,,656,557.6,188.0096,656,PrimeWest Health,Minnesota Senior Health Options (MSHO),337.512,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
DIGOXIN 50 MCG/ML (0.05 MG/ML) ORAL SOLN,,203,LOCAL,Facility,Inpatient,60,mL,,656,557.6,188.0096,656,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DIGOXIN 50 MCG/ML (0.05 MG/ML) ORAL SOLN,,203,LOCAL,Facility,Outpatient,60,mL,,656,557.6,188.0096,656,PrimeWest Health,MinnesotaCare,336.9216,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
DIGOXIN 50 MCG/ML (0.05 MG/ML) ORAL SOLN,,203,LOCAL,Facility,Inpatient,60,mL,,656,557.6,188.0096,656,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
DIGOXIN 50 MCG/ML (0.05 MG/ML) ORAL SOLN,,203,LOCAL,Facility,Both,60,mL,,656,557.6,188.0096,656,Sanford Health Plan,Sanford Health Plan,603.52,92,,percent of total billed charges,,
DIGOXIN 50 MCG/ML (0.05 MG/ML) ORAL SOLN,,203,LOCAL,Facility,Outpatient,60,mL,,656,557.6,188.0096,656,"UCare Health, Inc.",Individual & Family Plan,369.656,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
DIGOXIN 50 MCG/ML (0.05 MG/ML) ORAL SOLN,,203,LOCAL,Facility,Inpatient,60,mL,,656,557.6,188.0096,656,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
DIGOXIN 50 MCG/ML (0.05 MG/ML) ORAL SOLN,,203,LOCAL,Facility,Outpatient,60,mL,,656,557.6,188.0096,656,"UCare Health, Inc.",Medical Assistance,331.0832,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DIGOXIN 50 MCG/ML (0.05 MG/ML) ORAL SOLN,,203,LOCAL,Facility,Inpatient,60,mL,,656,557.6,188.0096,656,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
DIGOXIN 50 MCG/ML (0.05 MG/ML) ORAL SOLN,,203,LOCAL,Facility,Outpatient,60,mL,,656,557.6,188.0096,656,"UCare Health, Inc.",Medicare Advantage,331.0832,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DIGOXIN 50 MCG/ML (0.05 MG/ML) ORAL SOLN,,203,LOCAL,Facility,Inpatient,60,mL,,656,557.6,188.0096,656,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DIGOXIN 50 MCG/ML (0.05 MG/ML) ORAL SOLN,,203,LOCAL,Facility,Outpatient,60,mL,,656,557.6,188.0096,656,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),331.0832,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DIGOXIN 50 MCG/ML (0.05 MG/ML) ORAL SOLN,,203,LOCAL,Facility,Inpatient,60,mL,,656,557.6,188.0096,656,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DIGOXIN 50 MCG/ML (0.05 MG/ML) ORAL SOLN,,203,LOCAL,Facility,Both,60,mL,,656,557.6,188.0096,656,UnitedHealthcare,Individual & Family,616.64,94,,percent of total billed charges,,
DIGOXIN 50 MCG/ML (0.05 MG/ML) ORAL SOLN,,203,LOCAL,Facility,Outpatient,60,mL,,656,557.6,188.0096,656,UnitedHealthcare,Medicare Advantage,321.44,49,,percent of total billed charges,,
DIGOXIN 50 MCG/ML (0.05 MG/ML) ORAL SOLN,,203,LOCAL,Facility,Inpatient,60,mL,,656,557.6,188.0096,656,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
DIGOXIN 50 MCG/ML (0.05 MG/ML) ORAL SOLN,,203,LOCAL,Facility,Outpatient,60,mL,,656,557.6,188.0096,656,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,314.88,48,,percent of total billed charges,,100% of DHS outpatient percentage
DIGOXIN 50 MCG/ML (0.05 MG/ML) ORAL SOLN,,203,LOCAL,Facility,Inpatient,60,mL,,656,557.6,188.0096,656,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
DICLOFENAC SODIUM 1 % TOP GEL,,81799,LOCAL,Facility,Both,100,g,,221,187.85,63.3386,221,Aetna,Commercial,203.32,92,,percent of total billed charges,,
DICLOFENAC SODIUM 1 % TOP GEL,,81799,LOCAL,Facility,Outpatient,100,g,,221,187.85,63.3386,221,Aetna,Medicare Advantage,108.29,49,,percent of total billed charges,,
DICLOFENAC SODIUM 1 % TOP GEL,,81799,LOCAL,Facility,Inpatient,100,g,,221,187.85,63.3386,221,Aetna,Medicare Advantage,,,,,Included in per diem rate,
DICLOFENAC SODIUM 1 % TOP GEL,,81799,LOCAL,Facility,Both,100,g,,221,187.85,63.3386,221,Aetna,PPO,205.53,93,,percent of total billed charges,,
DICLOFENAC SODIUM 1 % TOP GEL,,81799,LOCAL,Facility,Both,100,g,,221,187.85,63.3386,221,America's PPO,America's PPO,212.2263,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
DICLOFENAC SODIUM 1 % TOP GEL,,81799,LOCAL,Facility,Both,100,g,,221,187.85,63.3386,221,BlueCross BlueShield Minnesota, Federal Employee Program,217.464,98.4,,percent of total billed charges,,
DICLOFENAC SODIUM 1 % TOP GEL,,81799,LOCAL,Facility,Both,100,g,,221,187.85,63.3386,221,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,221,100,,percent of total billed charges,,
DICLOFENAC SODIUM 1 % TOP GEL,,81799,LOCAL,Facility,Both,100,g,,221,187.85,63.3386,221,BlueCross BlueShield Minnesota,High Value Network Plan,198.9,90,,percent of total billed charges,,
DICLOFENAC SODIUM 1 % TOP GEL,,81799,LOCAL,Facility,Outpatient,100,g,,221,187.85,63.3386,221,BlueCross BlueShield Minnesota,Medicare Advantage,108.29,49,,percent of total billed charges,,
DICLOFENAC SODIUM 1 % TOP GEL,,81799,LOCAL,Facility,Inpatient,100,g,,221,187.85,63.3386,221,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
DICLOFENAC SODIUM 1 % TOP GEL,,81799,LOCAL,Facility,Both,100,g,,221,187.85,63.3386,221,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,195.7397,88.57,,percent of total billed charges,,
DICLOFENAC SODIUM 1 % TOP GEL,,81799,LOCAL,Facility,Both,100,g,,221,187.85,63.3386,221,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,63.3386,28.66,,percent of total billed charges,,
DICLOFENAC SODIUM 1 % TOP GEL,,81799,LOCAL,Facility,Outpatient,100,g,,221,187.85,63.3386,221,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),108.29,49,,percent of total billed charges,,
DICLOFENAC SODIUM 1 % TOP GEL,,81799,LOCAL,Facility,Inpatient,100,g,,221,187.85,63.3386,221,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
DICLOFENAC SODIUM 1 % TOP GEL,,81799,LOCAL,Facility,Both,100,g,,221,187.85,63.3386,221,CorVel,Worker's Compensation,221,100,,percent of total billed charges,,
DICLOFENAC SODIUM 1 % TOP GEL,,81799,LOCAL,Facility,Both,100,g,,221,187.85,63.3386,221,First Health Group Corporation,First Health Network,214.37,97,,percent of total billed charges,,
DICLOFENAC SODIUM 1 % TOP GEL,,81799,LOCAL,Facility,Both,100,g,,221,187.85,63.3386,221,"Health Partners, Inc.",Commercial,209.066,94.6,,percent of total billed charges,,
DICLOFENAC SODIUM 1 % TOP GEL,,81799,LOCAL,Facility,Outpatient,100,g,,221,187.85,63.3386,221,"Health Partners, Inc.",Medicare Advantage,108.29,49,,percent of total billed charges,,
DICLOFENAC SODIUM 1 % TOP GEL,,81799,LOCAL,Facility,Inpatient,100,g,,221,187.85,63.3386,221,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DICLOFENAC SODIUM 1 % TOP GEL,,81799,LOCAL,Facility,Both,100,g,,221,187.85,63.3386,221,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),132.6,60,,percent of total billed charges,,
DICLOFENAC SODIUM 1 % TOP GEL,,81799,LOCAL,Facility,Both,100,g,,221,187.85,63.3386,221,"Health Partners, Inc.",State of Minnesota Advantage Program,180.115,81.5,,percent of total billed charges,,
DICLOFENAC SODIUM 1 % TOP GEL,,81799,LOCAL,Facility,Both,100,g,,221,187.85,63.3386,221,"Health Partners, Inc.",State Public Programs,110.5,50,,percent of total billed charges,,
DICLOFENAC SODIUM 1 % TOP GEL,,81799,LOCAL,Facility,Both,100,g,,221,187.85,63.3386,221,Humana Insurance Company,Commercial PPO,209.95,95,,percent of total billed charges,,
DICLOFENAC SODIUM 1 % TOP GEL,,81799,LOCAL,Facility,Outpatient,100,g,,221,187.85,63.3386,221,Humana Insurance Company,Medicare PPO,108.29,49,,percent of total billed charges,,
DICLOFENAC SODIUM 1 % TOP GEL,,81799,LOCAL,Facility,Inpatient,100,g,,221,187.85,63.3386,221,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
DICLOFENAC SODIUM 1 % TOP GEL,,81799,LOCAL,Facility,Both,100,g,,221,187.85,63.3386,221,Medica,Individual & Family,219.011,99.1,,percent of total billed charges,,
DICLOFENAC SODIUM 1 % TOP GEL,,81799,LOCAL,Facility,Outpatient,100,g,,221,187.85,63.3386,221,Medica,Medica Advantage Solution,110.058,49.8,,percent of total billed charges,,
DICLOFENAC SODIUM 1 % TOP GEL,,81799,LOCAL,Facility,Inpatient,100,g,,221,187.85,63.3386,221,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
DICLOFENAC SODIUM 1 % TOP GEL,,81799,LOCAL,Facility,Outpatient,100,g,,221,187.85,63.3386,221,Medica,Medical Assistance,98.566,44.6,,percent of total billed charges,,
DICLOFENAC SODIUM 1 % TOP GEL,,81799,LOCAL,Facility,Inpatient,100,g,,221,187.85,63.3386,221,Medica,Medical Assistance,,,,,Included in per diem rate,
DICLOFENAC SODIUM 1 % TOP GEL,,81799,LOCAL,Facility,Outpatient,100,g,,221,187.85,63.3386,221,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,110.058,49.8,,percent of total billed charges,,
DICLOFENAC SODIUM 1 % TOP GEL,,81799,LOCAL,Facility,Inpatient,100,g,,221,187.85,63.3386,221,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
DICLOFENAC SODIUM 1 % TOP GEL,,81799,LOCAL,Facility,Both,100,g,,221,187.85,63.3386,221,"Multiplan, Inc.","Multiplan, Inc.",207.74,94,,percent of total billed charges,,
DICLOFENAC SODIUM 1 % TOP GEL,,81799,LOCAL,Facility,Outpatient,100,g,,221,187.85,63.3386,221,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,199.121,90.1,,percent of total billed charges,,
DICLOFENAC SODIUM 1 % TOP GEL,,81799,LOCAL,Facility,Inpatient,100,g,,221,187.85,63.3386,221,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
DICLOFENAC SODIUM 1 % TOP GEL,,81799,LOCAL,Facility,Both,100,g,,221,187.85,63.3386,221,"Preferred One Administrative Services, INC.",PPO,217.906,98.6,,percent of total billed charges,,
DICLOFENAC SODIUM 1 % TOP GEL,,81799,LOCAL,Facility,Outpatient,100,g,,221,187.85,63.3386,221,PrimeWest Health,Minnesota Senior Health Options (MSHO),113.7045,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
DICLOFENAC SODIUM 1 % TOP GEL,,81799,LOCAL,Facility,Inpatient,100,g,,221,187.85,63.3386,221,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DICLOFENAC SODIUM 1 % TOP GEL,,81799,LOCAL,Facility,Outpatient,100,g,,221,187.85,63.3386,221,PrimeWest Health,MinnesotaCare,113.5056,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
DICLOFENAC SODIUM 1 % TOP GEL,,81799,LOCAL,Facility,Inpatient,100,g,,221,187.85,63.3386,221,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
DICLOFENAC SODIUM 1 % TOP GEL,,81799,LOCAL,Facility,Both,100,g,,221,187.85,63.3386,221,Sanford Health Plan,Sanford Health Plan,203.32,92,,percent of total billed charges,,
DICLOFENAC SODIUM 1 % TOP GEL,,81799,LOCAL,Facility,Outpatient,100,g,,221,187.85,63.3386,221,"UCare Health, Inc.",Individual & Family Plan,124.5335,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
DICLOFENAC SODIUM 1 % TOP GEL,,81799,LOCAL,Facility,Inpatient,100,g,,221,187.85,63.3386,221,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
DICLOFENAC SODIUM 1 % TOP GEL,,81799,LOCAL,Facility,Outpatient,100,g,,221,187.85,63.3386,221,"UCare Health, Inc.",Medical Assistance,111.5387,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DICLOFENAC SODIUM 1 % TOP GEL,,81799,LOCAL,Facility,Inpatient,100,g,,221,187.85,63.3386,221,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
DICLOFENAC SODIUM 1 % TOP GEL,,81799,LOCAL,Facility,Outpatient,100,g,,221,187.85,63.3386,221,"UCare Health, Inc.",Medicare Advantage,111.5387,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DICLOFENAC SODIUM 1 % TOP GEL,,81799,LOCAL,Facility,Inpatient,100,g,,221,187.85,63.3386,221,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DICLOFENAC SODIUM 1 % TOP GEL,,81799,LOCAL,Facility,Outpatient,100,g,,221,187.85,63.3386,221,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),111.5387,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DICLOFENAC SODIUM 1 % TOP GEL,,81799,LOCAL,Facility,Inpatient,100,g,,221,187.85,63.3386,221,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DICLOFENAC SODIUM 1 % TOP GEL,,81799,LOCAL,Facility,Both,100,g,,221,187.85,63.3386,221,UnitedHealthcare,Individual & Family,207.74,94,,percent of total billed charges,,
DICLOFENAC SODIUM 1 % TOP GEL,,81799,LOCAL,Facility,Outpatient,100,g,,221,187.85,63.3386,221,UnitedHealthcare,Medicare Advantage,108.29,49,,percent of total billed charges,,
DICLOFENAC SODIUM 1 % TOP GEL,,81799,LOCAL,Facility,Inpatient,100,g,,221,187.85,63.3386,221,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
DICLOFENAC SODIUM 1 % TOP GEL,,81799,LOCAL,Facility,Outpatient,100,g,,221,187.85,63.3386,221,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,106.08,48,,percent of total billed charges,,100% of DHS outpatient percentage
DICLOFENAC SODIUM 1 % TOP GEL,,81799,LOCAL,Facility,Inpatient,100,g,,221,187.85,63.3386,221,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
FAT EMULSION 20 % IV EMUL,,2303,LOCAL,Facility,Both,100,mL,,170,144.5,48.722,170,Aetna,Commercial,156.4,92,,percent of total billed charges,,
FAT EMULSION 20 % IV EMUL,,2303,LOCAL,Facility,Outpatient,100,mL,,170,144.5,48.722,170,Aetna,Medicare Advantage,83.3,49,,percent of total billed charges,,
FAT EMULSION 20 % IV EMUL,,2303,LOCAL,Facility,Inpatient,100,mL,,170,144.5,48.722,170,Aetna,Medicare Advantage,,,,,Included in per diem rate,
FAT EMULSION 20 % IV EMUL,,2303,LOCAL,Facility,Both,100,mL,,170,144.5,48.722,170,Aetna,PPO,158.1,93,,percent of total billed charges,,
FAT EMULSION 20 % IV EMUL,,2303,LOCAL,Facility,Both,100,mL,,170,144.5,48.722,170,America's PPO,America's PPO,163.251,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
FAT EMULSION 20 % IV EMUL,,2303,LOCAL,Facility,Both,100,mL,,170,144.5,48.722,170,BlueCross BlueShield Minnesota, Federal Employee Program,167.28,98.4,,percent of total billed charges,,
FAT EMULSION 20 % IV EMUL,,2303,LOCAL,Facility,Both,100,mL,,170,144.5,48.722,170,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,170,100,,percent of total billed charges,,
FAT EMULSION 20 % IV EMUL,,2303,LOCAL,Facility,Both,100,mL,,170,144.5,48.722,170,BlueCross BlueShield Minnesota,High Value Network Plan,153,90,,percent of total billed charges,,
FAT EMULSION 20 % IV EMUL,,2303,LOCAL,Facility,Outpatient,100,mL,,170,144.5,48.722,170,BlueCross BlueShield Minnesota,Medicare Advantage,83.3,49,,percent of total billed charges,,
FAT EMULSION 20 % IV EMUL,,2303,LOCAL,Facility,Inpatient,100,mL,,170,144.5,48.722,170,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
FAT EMULSION 20 % IV EMUL,,2303,LOCAL,Facility,Both,100,mL,,170,144.5,48.722,170,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,150.569,88.57,,percent of total billed charges,,
FAT EMULSION 20 % IV EMUL,,2303,LOCAL,Facility,Both,100,mL,,170,144.5,48.722,170,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,48.722,28.66,,percent of total billed charges,,
FAT EMULSION 20 % IV EMUL,,2303,LOCAL,Facility,Outpatient,100,mL,,170,144.5,48.722,170,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),83.3,49,,percent of total billed charges,,
FAT EMULSION 20 % IV EMUL,,2303,LOCAL,Facility,Inpatient,100,mL,,170,144.5,48.722,170,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
FAT EMULSION 20 % IV EMUL,,2303,LOCAL,Facility,Both,100,mL,,170,144.5,48.722,170,CorVel,Worker's Compensation,170,100,,percent of total billed charges,,
FAT EMULSION 20 % IV EMUL,,2303,LOCAL,Facility,Both,100,mL,,170,144.5,48.722,170,First Health Group Corporation,First Health Network,164.9,97,,percent of total billed charges,,
FAT EMULSION 20 % IV EMUL,,2303,LOCAL,Facility,Both,100,mL,,170,144.5,48.722,170,"Health Partners, Inc.",Commercial,160.82,94.6,,percent of total billed charges,,
FAT EMULSION 20 % IV EMUL,,2303,LOCAL,Facility,Outpatient,100,mL,,170,144.5,48.722,170,"Health Partners, Inc.",Medicare Advantage,83.3,49,,percent of total billed charges,,
FAT EMULSION 20 % IV EMUL,,2303,LOCAL,Facility,Inpatient,100,mL,,170,144.5,48.722,170,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
FAT EMULSION 20 % IV EMUL,,2303,LOCAL,Facility,Both,100,mL,,170,144.5,48.722,170,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),102,60,,percent of total billed charges,,
FAT EMULSION 20 % IV EMUL,,2303,LOCAL,Facility,Both,100,mL,,170,144.5,48.722,170,"Health Partners, Inc.",State of Minnesota Advantage Program,138.55,81.5,,percent of total billed charges,,
FAT EMULSION 20 % IV EMUL,,2303,LOCAL,Facility,Both,100,mL,,170,144.5,48.722,170,"Health Partners, Inc.",State Public Programs,85,50,,percent of total billed charges,,
FAT EMULSION 20 % IV EMUL,,2303,LOCAL,Facility,Both,100,mL,,170,144.5,48.722,170,Humana Insurance Company,Commercial PPO,161.5,95,,percent of total billed charges,,
FAT EMULSION 20 % IV EMUL,,2303,LOCAL,Facility,Outpatient,100,mL,,170,144.5,48.722,170,Humana Insurance Company,Medicare PPO,83.3,49,,percent of total billed charges,,
FAT EMULSION 20 % IV EMUL,,2303,LOCAL,Facility,Inpatient,100,mL,,170,144.5,48.722,170,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
FAT EMULSION 20 % IV EMUL,,2303,LOCAL,Facility,Both,100,mL,,170,144.5,48.722,170,Medica,Individual & Family,168.47,99.1,,percent of total billed charges,,
FAT EMULSION 20 % IV EMUL,,2303,LOCAL,Facility,Outpatient,100,mL,,170,144.5,48.722,170,Medica,Medica Advantage Solution,84.66,49.8,,percent of total billed charges,,
FAT EMULSION 20 % IV EMUL,,2303,LOCAL,Facility,Inpatient,100,mL,,170,144.5,48.722,170,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
FAT EMULSION 20 % IV EMUL,,2303,LOCAL,Facility,Outpatient,100,mL,,170,144.5,48.722,170,Medica,Medical Assistance,75.82,44.6,,percent of total billed charges,,
FAT EMULSION 20 % IV EMUL,,2303,LOCAL,Facility,Inpatient,100,mL,,170,144.5,48.722,170,Medica,Medical Assistance,,,,,Included in per diem rate,
FAT EMULSION 20 % IV EMUL,,2303,LOCAL,Facility,Outpatient,100,mL,,170,144.5,48.722,170,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,84.66,49.8,,percent of total billed charges,,
FAT EMULSION 20 % IV EMUL,,2303,LOCAL,Facility,Inpatient,100,mL,,170,144.5,48.722,170,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
FAT EMULSION 20 % IV EMUL,,2303,LOCAL,Facility,Both,100,mL,,170,144.5,48.722,170,"Multiplan, Inc.","Multiplan, Inc.",159.8,94,,percent of total billed charges,,
FAT EMULSION 20 % IV EMUL,,2303,LOCAL,Facility,Outpatient,100,mL,,170,144.5,48.722,170,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,153.17,90.1,,percent of total billed charges,,
FAT EMULSION 20 % IV EMUL,,2303,LOCAL,Facility,Inpatient,100,mL,,170,144.5,48.722,170,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
FAT EMULSION 20 % IV EMUL,,2303,LOCAL,Facility,Both,100,mL,,170,144.5,48.722,170,"Preferred One Administrative Services, INC.",PPO,167.62,98.6,,percent of total billed charges,,
FAT EMULSION 20 % IV EMUL,,2303,LOCAL,Facility,Outpatient,100,mL,,170,144.5,48.722,170,PrimeWest Health,Minnesota Senior Health Options (MSHO),87.465,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
FAT EMULSION 20 % IV EMUL,,2303,LOCAL,Facility,Inpatient,100,mL,,170,144.5,48.722,170,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
FAT EMULSION 20 % IV EMUL,,2303,LOCAL,Facility,Outpatient,100,mL,,170,144.5,48.722,170,PrimeWest Health,MinnesotaCare,87.312,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
FAT EMULSION 20 % IV EMUL,,2303,LOCAL,Facility,Inpatient,100,mL,,170,144.5,48.722,170,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
FAT EMULSION 20 % IV EMUL,,2303,LOCAL,Facility,Both,100,mL,,170,144.5,48.722,170,Sanford Health Plan,Sanford Health Plan,156.4,92,,percent of total billed charges,,
FAT EMULSION 20 % IV EMUL,,2303,LOCAL,Facility,Outpatient,100,mL,,170,144.5,48.722,170,"UCare Health, Inc.",Individual & Family Plan,95.795,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
FAT EMULSION 20 % IV EMUL,,2303,LOCAL,Facility,Inpatient,100,mL,,170,144.5,48.722,170,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
FAT EMULSION 20 % IV EMUL,,2303,LOCAL,Facility,Outpatient,100,mL,,170,144.5,48.722,170,"UCare Health, Inc.",Medical Assistance,85.799,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FAT EMULSION 20 % IV EMUL,,2303,LOCAL,Facility,Inpatient,100,mL,,170,144.5,48.722,170,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
FAT EMULSION 20 % IV EMUL,,2303,LOCAL,Facility,Outpatient,100,mL,,170,144.5,48.722,170,"UCare Health, Inc.",Medicare Advantage,85.799,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FAT EMULSION 20 % IV EMUL,,2303,LOCAL,Facility,Inpatient,100,mL,,170,144.5,48.722,170,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
FAT EMULSION 20 % IV EMUL,,2303,LOCAL,Facility,Outpatient,100,mL,,170,144.5,48.722,170,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),85.799,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FAT EMULSION 20 % IV EMUL,,2303,LOCAL,Facility,Inpatient,100,mL,,170,144.5,48.722,170,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
FAT EMULSION 20 % IV EMUL,,2303,LOCAL,Facility,Both,100,mL,,170,144.5,48.722,170,UnitedHealthcare,Individual & Family,159.8,94,,percent of total billed charges,,
FAT EMULSION 20 % IV EMUL,,2303,LOCAL,Facility,Outpatient,100,mL,,170,144.5,48.722,170,UnitedHealthcare,Medicare Advantage,83.3,49,,percent of total billed charges,,
FAT EMULSION 20 % IV EMUL,,2303,LOCAL,Facility,Inpatient,100,mL,,170,144.5,48.722,170,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
FAT EMULSION 20 % IV EMUL,,2303,LOCAL,Facility,Outpatient,100,mL,,170,144.5,48.722,170,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,81.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
FAT EMULSION 20 % IV EMUL,,2303,LOCAL,Facility,Inpatient,100,mL,,170,144.5,48.722,170,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
CEPHALEXIN 125 MG/5 ML ORAL SUSR,,5666,LOCAL,Facility,Both,100,mL,,106,90.1,30.3796,106,Aetna,Commercial,97.52,92,,percent of total billed charges,,
CEPHALEXIN 125 MG/5 ML ORAL SUSR,,5666,LOCAL,Facility,Outpatient,100,mL,,106,90.1,30.3796,106,Aetna,Medicare Advantage,51.94,49,,percent of total billed charges,,
CEPHALEXIN 125 MG/5 ML ORAL SUSR,,5666,LOCAL,Facility,Inpatient,100,mL,,106,90.1,30.3796,106,Aetna,Medicare Advantage,,,,,Included in per diem rate,
CEPHALEXIN 125 MG/5 ML ORAL SUSR,,5666,LOCAL,Facility,Both,100,mL,,106,90.1,30.3796,106,Aetna,PPO,98.58,93,,percent of total billed charges,,
CEPHALEXIN 125 MG/5 ML ORAL SUSR,,5666,LOCAL,Facility,Both,100,mL,,106,90.1,30.3796,106,America's PPO,America's PPO,101.7918,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
CEPHALEXIN 125 MG/5 ML ORAL SUSR,,5666,LOCAL,Facility,Both,100,mL,,106,90.1,30.3796,106,BlueCross BlueShield Minnesota, Federal Employee Program,104.304,98.4,,percent of total billed charges,,
CEPHALEXIN 125 MG/5 ML ORAL SUSR,,5666,LOCAL,Facility,Both,100,mL,,106,90.1,30.3796,106,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,106,100,,percent of total billed charges,,
CEPHALEXIN 125 MG/5 ML ORAL SUSR,,5666,LOCAL,Facility,Both,100,mL,,106,90.1,30.3796,106,BlueCross BlueShield Minnesota,High Value Network Plan,95.4,90,,percent of total billed charges,,
CEPHALEXIN 125 MG/5 ML ORAL SUSR,,5666,LOCAL,Facility,Outpatient,100,mL,,106,90.1,30.3796,106,BlueCross BlueShield Minnesota,Medicare Advantage,51.94,49,,percent of total billed charges,,
CEPHALEXIN 125 MG/5 ML ORAL SUSR,,5666,LOCAL,Facility,Inpatient,100,mL,,106,90.1,30.3796,106,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
CEPHALEXIN 125 MG/5 ML ORAL SUSR,,5666,LOCAL,Facility,Both,100,mL,,106,90.1,30.3796,106,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,93.8842,88.57,,percent of total billed charges,,
CEPHALEXIN 125 MG/5 ML ORAL SUSR,,5666,LOCAL,Facility,Both,100,mL,,106,90.1,30.3796,106,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,30.3796,28.66,,percent of total billed charges,,
CEPHALEXIN 125 MG/5 ML ORAL SUSR,,5666,LOCAL,Facility,Outpatient,100,mL,,106,90.1,30.3796,106,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),51.94,49,,percent of total billed charges,,
CEPHALEXIN 125 MG/5 ML ORAL SUSR,,5666,LOCAL,Facility,Inpatient,100,mL,,106,90.1,30.3796,106,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
CEPHALEXIN 125 MG/5 ML ORAL SUSR,,5666,LOCAL,Facility,Both,100,mL,,106,90.1,30.3796,106,CorVel,Worker's Compensation,106,100,,percent of total billed charges,,
CEPHALEXIN 125 MG/5 ML ORAL SUSR,,5666,LOCAL,Facility,Both,100,mL,,106,90.1,30.3796,106,First Health Group Corporation,First Health Network,102.82,97,,percent of total billed charges,,
CEPHALEXIN 125 MG/5 ML ORAL SUSR,,5666,LOCAL,Facility,Both,100,mL,,106,90.1,30.3796,106,"Health Partners, Inc.",Commercial,100.276,94.6,,percent of total billed charges,,
CEPHALEXIN 125 MG/5 ML ORAL SUSR,,5666,LOCAL,Facility,Outpatient,100,mL,,106,90.1,30.3796,106,"Health Partners, Inc.",Medicare Advantage,51.94,49,,percent of total billed charges,,
CEPHALEXIN 125 MG/5 ML ORAL SUSR,,5666,LOCAL,Facility,Inpatient,100,mL,,106,90.1,30.3796,106,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CEPHALEXIN 125 MG/5 ML ORAL SUSR,,5666,LOCAL,Facility,Both,100,mL,,106,90.1,30.3796,106,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),63.6,60,,percent of total billed charges,,
CEPHALEXIN 125 MG/5 ML ORAL SUSR,,5666,LOCAL,Facility,Both,100,mL,,106,90.1,30.3796,106,"Health Partners, Inc.",State of Minnesota Advantage Program,86.39,81.5,,percent of total billed charges,,
CEPHALEXIN 125 MG/5 ML ORAL SUSR,,5666,LOCAL,Facility,Both,100,mL,,106,90.1,30.3796,106,"Health Partners, Inc.",State Public Programs,53,50,,percent of total billed charges,,
CEPHALEXIN 125 MG/5 ML ORAL SUSR,,5666,LOCAL,Facility,Both,100,mL,,106,90.1,30.3796,106,Humana Insurance Company,Commercial PPO,100.7,95,,percent of total billed charges,,
CEPHALEXIN 125 MG/5 ML ORAL SUSR,,5666,LOCAL,Facility,Outpatient,100,mL,,106,90.1,30.3796,106,Humana Insurance Company,Medicare PPO,51.94,49,,percent of total billed charges,,
CEPHALEXIN 125 MG/5 ML ORAL SUSR,,5666,LOCAL,Facility,Inpatient,100,mL,,106,90.1,30.3796,106,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
CEPHALEXIN 125 MG/5 ML ORAL SUSR,,5666,LOCAL,Facility,Both,100,mL,,106,90.1,30.3796,106,Medica,Individual & Family,105.046,99.1,,percent of total billed charges,,
CEPHALEXIN 125 MG/5 ML ORAL SUSR,,5666,LOCAL,Facility,Outpatient,100,mL,,106,90.1,30.3796,106,Medica,Medica Advantage Solution,52.788,49.8,,percent of total billed charges,,
CEPHALEXIN 125 MG/5 ML ORAL SUSR,,5666,LOCAL,Facility,Inpatient,100,mL,,106,90.1,30.3796,106,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
CEPHALEXIN 125 MG/5 ML ORAL SUSR,,5666,LOCAL,Facility,Outpatient,100,mL,,106,90.1,30.3796,106,Medica,Medical Assistance,47.276,44.6,,percent of total billed charges,,
CEPHALEXIN 125 MG/5 ML ORAL SUSR,,5666,LOCAL,Facility,Inpatient,100,mL,,106,90.1,30.3796,106,Medica,Medical Assistance,,,,,Included in per diem rate,
CEPHALEXIN 125 MG/5 ML ORAL SUSR,,5666,LOCAL,Facility,Outpatient,100,mL,,106,90.1,30.3796,106,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,52.788,49.8,,percent of total billed charges,,
CEPHALEXIN 125 MG/5 ML ORAL SUSR,,5666,LOCAL,Facility,Inpatient,100,mL,,106,90.1,30.3796,106,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
CEPHALEXIN 125 MG/5 ML ORAL SUSR,,5666,LOCAL,Facility,Both,100,mL,,106,90.1,30.3796,106,"Multiplan, Inc.","Multiplan, Inc.",99.64,94,,percent of total billed charges,,
CEPHALEXIN 125 MG/5 ML ORAL SUSR,,5666,LOCAL,Facility,Outpatient,100,mL,,106,90.1,30.3796,106,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,95.506,90.1,,percent of total billed charges,,
CEPHALEXIN 125 MG/5 ML ORAL SUSR,,5666,LOCAL,Facility,Inpatient,100,mL,,106,90.1,30.3796,106,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
CEPHALEXIN 125 MG/5 ML ORAL SUSR,,5666,LOCAL,Facility,Both,100,mL,,106,90.1,30.3796,106,"Preferred One Administrative Services, INC.",PPO,104.516,98.6,,percent of total billed charges,,
CEPHALEXIN 125 MG/5 ML ORAL SUSR,,5666,LOCAL,Facility,Outpatient,100,mL,,106,90.1,30.3796,106,PrimeWest Health,Minnesota Senior Health Options (MSHO),54.537,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
CEPHALEXIN 125 MG/5 ML ORAL SUSR,,5666,LOCAL,Facility,Inpatient,100,mL,,106,90.1,30.3796,106,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CEPHALEXIN 125 MG/5 ML ORAL SUSR,,5666,LOCAL,Facility,Outpatient,100,mL,,106,90.1,30.3796,106,PrimeWest Health,MinnesotaCare,54.4416,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
CEPHALEXIN 125 MG/5 ML ORAL SUSR,,5666,LOCAL,Facility,Inpatient,100,mL,,106,90.1,30.3796,106,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
CEPHALEXIN 125 MG/5 ML ORAL SUSR,,5666,LOCAL,Facility,Both,100,mL,,106,90.1,30.3796,106,Sanford Health Plan,Sanford Health Plan,97.52,92,,percent of total billed charges,,
CEPHALEXIN 125 MG/5 ML ORAL SUSR,,5666,LOCAL,Facility,Outpatient,100,mL,,106,90.1,30.3796,106,"UCare Health, Inc.",Individual & Family Plan,59.731,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
CEPHALEXIN 125 MG/5 ML ORAL SUSR,,5666,LOCAL,Facility,Inpatient,100,mL,,106,90.1,30.3796,106,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
CEPHALEXIN 125 MG/5 ML ORAL SUSR,,5666,LOCAL,Facility,Outpatient,100,mL,,106,90.1,30.3796,106,"UCare Health, Inc.",Medical Assistance,53.4982,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CEPHALEXIN 125 MG/5 ML ORAL SUSR,,5666,LOCAL,Facility,Inpatient,100,mL,,106,90.1,30.3796,106,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
CEPHALEXIN 125 MG/5 ML ORAL SUSR,,5666,LOCAL,Facility,Outpatient,100,mL,,106,90.1,30.3796,106,"UCare Health, Inc.",Medicare Advantage,53.4982,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CEPHALEXIN 125 MG/5 ML ORAL SUSR,,5666,LOCAL,Facility,Inpatient,100,mL,,106,90.1,30.3796,106,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CEPHALEXIN 125 MG/5 ML ORAL SUSR,,5666,LOCAL,Facility,Outpatient,100,mL,,106,90.1,30.3796,106,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),53.4982,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CEPHALEXIN 125 MG/5 ML ORAL SUSR,,5666,LOCAL,Facility,Inpatient,100,mL,,106,90.1,30.3796,106,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CEPHALEXIN 125 MG/5 ML ORAL SUSR,,5666,LOCAL,Facility,Both,100,mL,,106,90.1,30.3796,106,UnitedHealthcare,Individual & Family,99.64,94,,percent of total billed charges,,
CEPHALEXIN 125 MG/5 ML ORAL SUSR,,5666,LOCAL,Facility,Outpatient,100,mL,,106,90.1,30.3796,106,UnitedHealthcare,Medicare Advantage,51.94,49,,percent of total billed charges,,
CEPHALEXIN 125 MG/5 ML ORAL SUSR,,5666,LOCAL,Facility,Inpatient,100,mL,,106,90.1,30.3796,106,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
CEPHALEXIN 125 MG/5 ML ORAL SUSR,,5666,LOCAL,Facility,Outpatient,100,mL,,106,90.1,30.3796,106,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,50.88,48,,percent of total billed charges,,100% of DHS outpatient percentage
CEPHALEXIN 125 MG/5 ML ORAL SUSR,,5666,LOCAL,Facility,Inpatient,100,mL,,106,90.1,30.3796,106,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
PENICILLIN V POTASSIUM 250 MG/5 ML ORAL SOLR,,5948,LOCAL,Facility,Both,100,mL,,54,45.9,15.4764,54,Aetna,Commercial,49.68,92,,percent of total billed charges,,
PENICILLIN V POTASSIUM 250 MG/5 ML ORAL SOLR,,5948,LOCAL,Facility,Outpatient,100,mL,,54,45.9,15.4764,54,Aetna,Medicare Advantage,26.46,49,,percent of total billed charges,,
PENICILLIN V POTASSIUM 250 MG/5 ML ORAL SOLR,,5948,LOCAL,Facility,Inpatient,100,mL,,54,45.9,15.4764,54,Aetna,Medicare Advantage,,,,,Included in per diem rate,
PENICILLIN V POTASSIUM 250 MG/5 ML ORAL SOLR,,5948,LOCAL,Facility,Both,100,mL,,54,45.9,15.4764,54,Aetna,PPO,50.22,93,,percent of total billed charges,,
PENICILLIN V POTASSIUM 250 MG/5 ML ORAL SOLR,,5948,LOCAL,Facility,Both,100,mL,,54,45.9,15.4764,54,America's PPO,America's PPO,51.8562,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
PENICILLIN V POTASSIUM 250 MG/5 ML ORAL SOLR,,5948,LOCAL,Facility,Both,100,mL,,54,45.9,15.4764,54,BlueCross BlueShield Minnesota, Federal Employee Program,53.136,98.4,,percent of total billed charges,,
PENICILLIN V POTASSIUM 250 MG/5 ML ORAL SOLR,,5948,LOCAL,Facility,Both,100,mL,,54,45.9,15.4764,54,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,54,100,,percent of total billed charges,,
PENICILLIN V POTASSIUM 250 MG/5 ML ORAL SOLR,,5948,LOCAL,Facility,Both,100,mL,,54,45.9,15.4764,54,BlueCross BlueShield Minnesota,High Value Network Plan,48.6,90,,percent of total billed charges,,
PENICILLIN V POTASSIUM 250 MG/5 ML ORAL SOLR,,5948,LOCAL,Facility,Outpatient,100,mL,,54,45.9,15.4764,54,BlueCross BlueShield Minnesota,Medicare Advantage,26.46,49,,percent of total billed charges,,
PENICILLIN V POTASSIUM 250 MG/5 ML ORAL SOLR,,5948,LOCAL,Facility,Inpatient,100,mL,,54,45.9,15.4764,54,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
PENICILLIN V POTASSIUM 250 MG/5 ML ORAL SOLR,,5948,LOCAL,Facility,Both,100,mL,,54,45.9,15.4764,54,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,47.8278,88.57,,percent of total billed charges,,
PENICILLIN V POTASSIUM 250 MG/5 ML ORAL SOLR,,5948,LOCAL,Facility,Both,100,mL,,54,45.9,15.4764,54,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,15.4764,28.66,,percent of total billed charges,,
PENICILLIN V POTASSIUM 250 MG/5 ML ORAL SOLR,,5948,LOCAL,Facility,Outpatient,100,mL,,54,45.9,15.4764,54,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),26.46,49,,percent of total billed charges,,
PENICILLIN V POTASSIUM 250 MG/5 ML ORAL SOLR,,5948,LOCAL,Facility,Inpatient,100,mL,,54,45.9,15.4764,54,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
PENICILLIN V POTASSIUM 250 MG/5 ML ORAL SOLR,,5948,LOCAL,Facility,Both,100,mL,,54,45.9,15.4764,54,CorVel,Worker's Compensation,54,100,,percent of total billed charges,,
PENICILLIN V POTASSIUM 250 MG/5 ML ORAL SOLR,,5948,LOCAL,Facility,Both,100,mL,,54,45.9,15.4764,54,First Health Group Corporation,First Health Network,52.38,97,,percent of total billed charges,,
PENICILLIN V POTASSIUM 250 MG/5 ML ORAL SOLR,,5948,LOCAL,Facility,Both,100,mL,,54,45.9,15.4764,54,"Health Partners, Inc.",Commercial,51.084,94.6,,percent of total billed charges,,
PENICILLIN V POTASSIUM 250 MG/5 ML ORAL SOLR,,5948,LOCAL,Facility,Outpatient,100,mL,,54,45.9,15.4764,54,"Health Partners, Inc.",Medicare Advantage,26.46,49,,percent of total billed charges,,
PENICILLIN V POTASSIUM 250 MG/5 ML ORAL SOLR,,5948,LOCAL,Facility,Inpatient,100,mL,,54,45.9,15.4764,54,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PENICILLIN V POTASSIUM 250 MG/5 ML ORAL SOLR,,5948,LOCAL,Facility,Both,100,mL,,54,45.9,15.4764,54,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),32.4,60,,percent of total billed charges,,
PENICILLIN V POTASSIUM 250 MG/5 ML ORAL SOLR,,5948,LOCAL,Facility,Both,100,mL,,54,45.9,15.4764,54,"Health Partners, Inc.",State of Minnesota Advantage Program,44.01,81.5,,percent of total billed charges,,
PENICILLIN V POTASSIUM 250 MG/5 ML ORAL SOLR,,5948,LOCAL,Facility,Both,100,mL,,54,45.9,15.4764,54,"Health Partners, Inc.",State Public Programs,27,50,,percent of total billed charges,,
PENICILLIN V POTASSIUM 250 MG/5 ML ORAL SOLR,,5948,LOCAL,Facility,Both,100,mL,,54,45.9,15.4764,54,Humana Insurance Company,Commercial PPO,51.3,95,,percent of total billed charges,,
PENICILLIN V POTASSIUM 250 MG/5 ML ORAL SOLR,,5948,LOCAL,Facility,Outpatient,100,mL,,54,45.9,15.4764,54,Humana Insurance Company,Medicare PPO,26.46,49,,percent of total billed charges,,
PENICILLIN V POTASSIUM 250 MG/5 ML ORAL SOLR,,5948,LOCAL,Facility,Inpatient,100,mL,,54,45.9,15.4764,54,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
PENICILLIN V POTASSIUM 250 MG/5 ML ORAL SOLR,,5948,LOCAL,Facility,Both,100,mL,,54,45.9,15.4764,54,Medica,Individual & Family,53.514,99.1,,percent of total billed charges,,
PENICILLIN V POTASSIUM 250 MG/5 ML ORAL SOLR,,5948,LOCAL,Facility,Outpatient,100,mL,,54,45.9,15.4764,54,Medica,Medica Advantage Solution,26.892,49.8,,percent of total billed charges,,
PENICILLIN V POTASSIUM 250 MG/5 ML ORAL SOLR,,5948,LOCAL,Facility,Inpatient,100,mL,,54,45.9,15.4764,54,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
PENICILLIN V POTASSIUM 250 MG/5 ML ORAL SOLR,,5948,LOCAL,Facility,Outpatient,100,mL,,54,45.9,15.4764,54,Medica,Medical Assistance,24.084,44.6,,percent of total billed charges,,
PENICILLIN V POTASSIUM 250 MG/5 ML ORAL SOLR,,5948,LOCAL,Facility,Inpatient,100,mL,,54,45.9,15.4764,54,Medica,Medical Assistance,,,,,Included in per diem rate,
PENICILLIN V POTASSIUM 250 MG/5 ML ORAL SOLR,,5948,LOCAL,Facility,Outpatient,100,mL,,54,45.9,15.4764,54,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,26.892,49.8,,percent of total billed charges,,
PENICILLIN V POTASSIUM 250 MG/5 ML ORAL SOLR,,5948,LOCAL,Facility,Inpatient,100,mL,,54,45.9,15.4764,54,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
PENICILLIN V POTASSIUM 250 MG/5 ML ORAL SOLR,,5948,LOCAL,Facility,Both,100,mL,,54,45.9,15.4764,54,"Multiplan, Inc.","Multiplan, Inc.",50.76,94,,percent of total billed charges,,
PENICILLIN V POTASSIUM 250 MG/5 ML ORAL SOLR,,5948,LOCAL,Facility,Outpatient,100,mL,,54,45.9,15.4764,54,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,48.654,90.1,,percent of total billed charges,,
PENICILLIN V POTASSIUM 250 MG/5 ML ORAL SOLR,,5948,LOCAL,Facility,Inpatient,100,mL,,54,45.9,15.4764,54,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
PENICILLIN V POTASSIUM 250 MG/5 ML ORAL SOLR,,5948,LOCAL,Facility,Both,100,mL,,54,45.9,15.4764,54,"Preferred One Administrative Services, INC.",PPO,53.244,98.6,,percent of total billed charges,,
PENICILLIN V POTASSIUM 250 MG/5 ML ORAL SOLR,,5948,LOCAL,Facility,Outpatient,100,mL,,54,45.9,15.4764,54,PrimeWest Health,Minnesota Senior Health Options (MSHO),27.783,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
PENICILLIN V POTASSIUM 250 MG/5 ML ORAL SOLR,,5948,LOCAL,Facility,Inpatient,100,mL,,54,45.9,15.4764,54,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PENICILLIN V POTASSIUM 250 MG/5 ML ORAL SOLR,,5948,LOCAL,Facility,Outpatient,100,mL,,54,45.9,15.4764,54,PrimeWest Health,MinnesotaCare,27.7344,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
PENICILLIN V POTASSIUM 250 MG/5 ML ORAL SOLR,,5948,LOCAL,Facility,Inpatient,100,mL,,54,45.9,15.4764,54,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
PENICILLIN V POTASSIUM 250 MG/5 ML ORAL SOLR,,5948,LOCAL,Facility,Both,100,mL,,54,45.9,15.4764,54,Sanford Health Plan,Sanford Health Plan,49.68,92,,percent of total billed charges,,
PENICILLIN V POTASSIUM 250 MG/5 ML ORAL SOLR,,5948,LOCAL,Facility,Outpatient,100,mL,,54,45.9,15.4764,54,"UCare Health, Inc.",Individual & Family Plan,30.429,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
PENICILLIN V POTASSIUM 250 MG/5 ML ORAL SOLR,,5948,LOCAL,Facility,Inpatient,100,mL,,54,45.9,15.4764,54,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
PENICILLIN V POTASSIUM 250 MG/5 ML ORAL SOLR,,5948,LOCAL,Facility,Outpatient,100,mL,,54,45.9,15.4764,54,"UCare Health, Inc.",Medical Assistance,27.2538,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PENICILLIN V POTASSIUM 250 MG/5 ML ORAL SOLR,,5948,LOCAL,Facility,Inpatient,100,mL,,54,45.9,15.4764,54,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
PENICILLIN V POTASSIUM 250 MG/5 ML ORAL SOLR,,5948,LOCAL,Facility,Outpatient,100,mL,,54,45.9,15.4764,54,"UCare Health, Inc.",Medicare Advantage,27.2538,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PENICILLIN V POTASSIUM 250 MG/5 ML ORAL SOLR,,5948,LOCAL,Facility,Inpatient,100,mL,,54,45.9,15.4764,54,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PENICILLIN V POTASSIUM 250 MG/5 ML ORAL SOLR,,5948,LOCAL,Facility,Outpatient,100,mL,,54,45.9,15.4764,54,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),27.2538,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PENICILLIN V POTASSIUM 250 MG/5 ML ORAL SOLR,,5948,LOCAL,Facility,Inpatient,100,mL,,54,45.9,15.4764,54,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PENICILLIN V POTASSIUM 250 MG/5 ML ORAL SOLR,,5948,LOCAL,Facility,Both,100,mL,,54,45.9,15.4764,54,UnitedHealthcare,Individual & Family,50.76,94,,percent of total billed charges,,
PENICILLIN V POTASSIUM 250 MG/5 ML ORAL SOLR,,5948,LOCAL,Facility,Outpatient,100,mL,,54,45.9,15.4764,54,UnitedHealthcare,Medicare Advantage,26.46,49,,percent of total billed charges,,
PENICILLIN V POTASSIUM 250 MG/5 ML ORAL SOLR,,5948,LOCAL,Facility,Inpatient,100,mL,,54,45.9,15.4764,54,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
PENICILLIN V POTASSIUM 250 MG/5 ML ORAL SOLR,,5948,LOCAL,Facility,Outpatient,100,mL,,54,45.9,15.4764,54,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,25.92,48,,percent of total billed charges,,100% of DHS outpatient percentage
PENICILLIN V POTASSIUM 250 MG/5 ML ORAL SOLR,,5948,LOCAL,Facility,Inpatient,100,mL,,54,45.9,15.4764,54,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
AMOXICILLIN 250 MG/5 ML ORAL SUSR,,11173,LOCAL,Facility,Both,100,mL,,31,26.35,8.8846,31,Aetna,Commercial,28.52,92,,percent of total billed charges,,
AMOXICILLIN 250 MG/5 ML ORAL SUSR,,11173,LOCAL,Facility,Outpatient,100,mL,,31,26.35,8.8846,31,Aetna,Medicare Advantage,15.19,49,,percent of total billed charges,,
AMOXICILLIN 250 MG/5 ML ORAL SUSR,,11173,LOCAL,Facility,Inpatient,100,mL,,31,26.35,8.8846,31,Aetna,Medicare Advantage,,,,,Included in per diem rate,
AMOXICILLIN 250 MG/5 ML ORAL SUSR,,11173,LOCAL,Facility,Both,100,mL,,31,26.35,8.8846,31,Aetna,PPO,28.83,93,,percent of total billed charges,,
AMOXICILLIN 250 MG/5 ML ORAL SUSR,,11173,LOCAL,Facility,Both,100,mL,,31,26.35,8.8846,31,America's PPO,America's PPO,29.7693,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
AMOXICILLIN 250 MG/5 ML ORAL SUSR,,11173,LOCAL,Facility,Both,100,mL,,31,26.35,8.8846,31,BlueCross BlueShield Minnesota, Federal Employee Program,30.504,98.4,,percent of total billed charges,,
AMOXICILLIN 250 MG/5 ML ORAL SUSR,,11173,LOCAL,Facility,Both,100,mL,,31,26.35,8.8846,31,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,31,100,,percent of total billed charges,,
AMOXICILLIN 250 MG/5 ML ORAL SUSR,,11173,LOCAL,Facility,Both,100,mL,,31,26.35,8.8846,31,BlueCross BlueShield Minnesota,High Value Network Plan,27.9,90,,percent of total billed charges,,
AMOXICILLIN 250 MG/5 ML ORAL SUSR,,11173,LOCAL,Facility,Outpatient,100,mL,,31,26.35,8.8846,31,BlueCross BlueShield Minnesota,Medicare Advantage,15.19,49,,percent of total billed charges,,
AMOXICILLIN 250 MG/5 ML ORAL SUSR,,11173,LOCAL,Facility,Inpatient,100,mL,,31,26.35,8.8846,31,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
AMOXICILLIN 250 MG/5 ML ORAL SUSR,,11173,LOCAL,Facility,Both,100,mL,,31,26.35,8.8846,31,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,27.4567,88.57,,percent of total billed charges,,
AMOXICILLIN 250 MG/5 ML ORAL SUSR,,11173,LOCAL,Facility,Both,100,mL,,31,26.35,8.8846,31,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,8.8846,28.66,,percent of total billed charges,,
AMOXICILLIN 250 MG/5 ML ORAL SUSR,,11173,LOCAL,Facility,Outpatient,100,mL,,31,26.35,8.8846,31,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),15.19,49,,percent of total billed charges,,
AMOXICILLIN 250 MG/5 ML ORAL SUSR,,11173,LOCAL,Facility,Inpatient,100,mL,,31,26.35,8.8846,31,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
AMOXICILLIN 250 MG/5 ML ORAL SUSR,,11173,LOCAL,Facility,Both,100,mL,,31,26.35,8.8846,31,CorVel,Worker's Compensation,31,100,,percent of total billed charges,,
AMOXICILLIN 250 MG/5 ML ORAL SUSR,,11173,LOCAL,Facility,Both,100,mL,,31,26.35,8.8846,31,First Health Group Corporation,First Health Network,30.07,97,,percent of total billed charges,,
AMOXICILLIN 250 MG/5 ML ORAL SUSR,,11173,LOCAL,Facility,Both,100,mL,,31,26.35,8.8846,31,"Health Partners, Inc.",Commercial,29.326,94.6,,percent of total billed charges,,
AMOXICILLIN 250 MG/5 ML ORAL SUSR,,11173,LOCAL,Facility,Outpatient,100,mL,,31,26.35,8.8846,31,"Health Partners, Inc.",Medicare Advantage,15.19,49,,percent of total billed charges,,
AMOXICILLIN 250 MG/5 ML ORAL SUSR,,11173,LOCAL,Facility,Inpatient,100,mL,,31,26.35,8.8846,31,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
AMOXICILLIN 250 MG/5 ML ORAL SUSR,,11173,LOCAL,Facility,Both,100,mL,,31,26.35,8.8846,31,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),18.6,60,,percent of total billed charges,,
AMOXICILLIN 250 MG/5 ML ORAL SUSR,,11173,LOCAL,Facility,Both,100,mL,,31,26.35,8.8846,31,"Health Partners, Inc.",State of Minnesota Advantage Program,25.265,81.5,,percent of total billed charges,,
AMOXICILLIN 250 MG/5 ML ORAL SUSR,,11173,LOCAL,Facility,Both,100,mL,,31,26.35,8.8846,31,"Health Partners, Inc.",State Public Programs,15.5,50,,percent of total billed charges,,
AMOXICILLIN 250 MG/5 ML ORAL SUSR,,11173,LOCAL,Facility,Both,100,mL,,31,26.35,8.8846,31,Humana Insurance Company,Commercial PPO,29.45,95,,percent of total billed charges,,
AMOXICILLIN 250 MG/5 ML ORAL SUSR,,11173,LOCAL,Facility,Outpatient,100,mL,,31,26.35,8.8846,31,Humana Insurance Company,Medicare PPO,15.19,49,,percent of total billed charges,,
AMOXICILLIN 250 MG/5 ML ORAL SUSR,,11173,LOCAL,Facility,Inpatient,100,mL,,31,26.35,8.8846,31,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
AMOXICILLIN 250 MG/5 ML ORAL SUSR,,11173,LOCAL,Facility,Both,100,mL,,31,26.35,8.8846,31,Medica,Individual & Family,30.721,99.1,,percent of total billed charges,,
AMOXICILLIN 250 MG/5 ML ORAL SUSR,,11173,LOCAL,Facility,Outpatient,100,mL,,31,26.35,8.8846,31,Medica,Medica Advantage Solution,15.438,49.8,,percent of total billed charges,,
AMOXICILLIN 250 MG/5 ML ORAL SUSR,,11173,LOCAL,Facility,Inpatient,100,mL,,31,26.35,8.8846,31,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
AMOXICILLIN 250 MG/5 ML ORAL SUSR,,11173,LOCAL,Facility,Outpatient,100,mL,,31,26.35,8.8846,31,Medica,Medical Assistance,13.826,44.6,,percent of total billed charges,,
AMOXICILLIN 250 MG/5 ML ORAL SUSR,,11173,LOCAL,Facility,Inpatient,100,mL,,31,26.35,8.8846,31,Medica,Medical Assistance,,,,,Included in per diem rate,
AMOXICILLIN 250 MG/5 ML ORAL SUSR,,11173,LOCAL,Facility,Outpatient,100,mL,,31,26.35,8.8846,31,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,15.438,49.8,,percent of total billed charges,,
AMOXICILLIN 250 MG/5 ML ORAL SUSR,,11173,LOCAL,Facility,Inpatient,100,mL,,31,26.35,8.8846,31,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
AMOXICILLIN 250 MG/5 ML ORAL SUSR,,11173,LOCAL,Facility,Both,100,mL,,31,26.35,8.8846,31,"Multiplan, Inc.","Multiplan, Inc.",29.14,94,,percent of total billed charges,,
AMOXICILLIN 250 MG/5 ML ORAL SUSR,,11173,LOCAL,Facility,Outpatient,100,mL,,31,26.35,8.8846,31,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,27.931,90.1,,percent of total billed charges,,
AMOXICILLIN 250 MG/5 ML ORAL SUSR,,11173,LOCAL,Facility,Inpatient,100,mL,,31,26.35,8.8846,31,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
AMOXICILLIN 250 MG/5 ML ORAL SUSR,,11173,LOCAL,Facility,Both,100,mL,,31,26.35,8.8846,31,"Preferred One Administrative Services, INC.",PPO,30.566,98.6,,percent of total billed charges,,
AMOXICILLIN 250 MG/5 ML ORAL SUSR,,11173,LOCAL,Facility,Outpatient,100,mL,,31,26.35,8.8846,31,PrimeWest Health,Minnesota Senior Health Options (MSHO),15.9495,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
AMOXICILLIN 250 MG/5 ML ORAL SUSR,,11173,LOCAL,Facility,Inpatient,100,mL,,31,26.35,8.8846,31,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
AMOXICILLIN 250 MG/5 ML ORAL SUSR,,11173,LOCAL,Facility,Outpatient,100,mL,,31,26.35,8.8846,31,PrimeWest Health,MinnesotaCare,15.9216,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
AMOXICILLIN 250 MG/5 ML ORAL SUSR,,11173,LOCAL,Facility,Inpatient,100,mL,,31,26.35,8.8846,31,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
AMOXICILLIN 250 MG/5 ML ORAL SUSR,,11173,LOCAL,Facility,Both,100,mL,,31,26.35,8.8846,31,Sanford Health Plan,Sanford Health Plan,28.52,92,,percent of total billed charges,,
AMOXICILLIN 250 MG/5 ML ORAL SUSR,,11173,LOCAL,Facility,Outpatient,100,mL,,31,26.35,8.8846,31,"UCare Health, Inc.",Individual & Family Plan,17.4685,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
AMOXICILLIN 250 MG/5 ML ORAL SUSR,,11173,LOCAL,Facility,Inpatient,100,mL,,31,26.35,8.8846,31,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
AMOXICILLIN 250 MG/5 ML ORAL SUSR,,11173,LOCAL,Facility,Outpatient,100,mL,,31,26.35,8.8846,31,"UCare Health, Inc.",Medical Assistance,15.6457,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
AMOXICILLIN 250 MG/5 ML ORAL SUSR,,11173,LOCAL,Facility,Inpatient,100,mL,,31,26.35,8.8846,31,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
AMOXICILLIN 250 MG/5 ML ORAL SUSR,,11173,LOCAL,Facility,Outpatient,100,mL,,31,26.35,8.8846,31,"UCare Health, Inc.",Medicare Advantage,15.6457,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
AMOXICILLIN 250 MG/5 ML ORAL SUSR,,11173,LOCAL,Facility,Inpatient,100,mL,,31,26.35,8.8846,31,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
AMOXICILLIN 250 MG/5 ML ORAL SUSR,,11173,LOCAL,Facility,Outpatient,100,mL,,31,26.35,8.8846,31,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),15.6457,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
AMOXICILLIN 250 MG/5 ML ORAL SUSR,,11173,LOCAL,Facility,Inpatient,100,mL,,31,26.35,8.8846,31,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
AMOXICILLIN 250 MG/5 ML ORAL SUSR,,11173,LOCAL,Facility,Both,100,mL,,31,26.35,8.8846,31,UnitedHealthcare,Individual & Family,29.14,94,,percent of total billed charges,,
AMOXICILLIN 250 MG/5 ML ORAL SUSR,,11173,LOCAL,Facility,Outpatient,100,mL,,31,26.35,8.8846,31,UnitedHealthcare,Medicare Advantage,15.19,49,,percent of total billed charges,,
AMOXICILLIN 250 MG/5 ML ORAL SUSR,,11173,LOCAL,Facility,Inpatient,100,mL,,31,26.35,8.8846,31,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
AMOXICILLIN 250 MG/5 ML ORAL SUSR,,11173,LOCAL,Facility,Outpatient,100,mL,,31,26.35,8.8846,31,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,14.88,48,,percent of total billed charges,,100% of DHS outpatient percentage
AMOXICILLIN 250 MG/5 ML ORAL SUSR,,11173,LOCAL,Facility,Inpatient,100,mL,,31,26.35,8.8846,31,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
CEPHALEXIN 250 MG/5 ML ORAL SUSR,,12366,LOCAL,Facility,Both,100,mL,,104,88.4,29.8064,104,Aetna,Commercial,95.68,92,,percent of total billed charges,,
CEPHALEXIN 250 MG/5 ML ORAL SUSR,,12366,LOCAL,Facility,Outpatient,100,mL,,104,88.4,29.8064,104,Aetna,Medicare Advantage,50.96,49,,percent of total billed charges,,
CEPHALEXIN 250 MG/5 ML ORAL SUSR,,12366,LOCAL,Facility,Inpatient,100,mL,,104,88.4,29.8064,104,Aetna,Medicare Advantage,,,,,Included in per diem rate,
CEPHALEXIN 250 MG/5 ML ORAL SUSR,,12366,LOCAL,Facility,Both,100,mL,,104,88.4,29.8064,104,Aetna,PPO,96.72,93,,percent of total billed charges,,
CEPHALEXIN 250 MG/5 ML ORAL SUSR,,12366,LOCAL,Facility,Both,100,mL,,104,88.4,29.8064,104,America's PPO,America's PPO,99.8712,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
CEPHALEXIN 250 MG/5 ML ORAL SUSR,,12366,LOCAL,Facility,Both,100,mL,,104,88.4,29.8064,104,BlueCross BlueShield Minnesota, Federal Employee Program,102.336,98.4,,percent of total billed charges,,
CEPHALEXIN 250 MG/5 ML ORAL SUSR,,12366,LOCAL,Facility,Both,100,mL,,104,88.4,29.8064,104,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,104,100,,percent of total billed charges,,
CEPHALEXIN 250 MG/5 ML ORAL SUSR,,12366,LOCAL,Facility,Both,100,mL,,104,88.4,29.8064,104,BlueCross BlueShield Minnesota,High Value Network Plan,93.6,90,,percent of total billed charges,,
CEPHALEXIN 250 MG/5 ML ORAL SUSR,,12366,LOCAL,Facility,Outpatient,100,mL,,104,88.4,29.8064,104,BlueCross BlueShield Minnesota,Medicare Advantage,50.96,49,,percent of total billed charges,,
CEPHALEXIN 250 MG/5 ML ORAL SUSR,,12366,LOCAL,Facility,Inpatient,100,mL,,104,88.4,29.8064,104,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
CEPHALEXIN 250 MG/5 ML ORAL SUSR,,12366,LOCAL,Facility,Both,100,mL,,104,88.4,29.8064,104,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,92.1128,88.57,,percent of total billed charges,,
CEPHALEXIN 250 MG/5 ML ORAL SUSR,,12366,LOCAL,Facility,Both,100,mL,,104,88.4,29.8064,104,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,29.8064,28.66,,percent of total billed charges,,
CEPHALEXIN 250 MG/5 ML ORAL SUSR,,12366,LOCAL,Facility,Outpatient,100,mL,,104,88.4,29.8064,104,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),50.96,49,,percent of total billed charges,,
CEPHALEXIN 250 MG/5 ML ORAL SUSR,,12366,LOCAL,Facility,Inpatient,100,mL,,104,88.4,29.8064,104,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
CEPHALEXIN 250 MG/5 ML ORAL SUSR,,12366,LOCAL,Facility,Both,100,mL,,104,88.4,29.8064,104,CorVel,Worker's Compensation,104,100,,percent of total billed charges,,
CEPHALEXIN 250 MG/5 ML ORAL SUSR,,12366,LOCAL,Facility,Both,100,mL,,104,88.4,29.8064,104,First Health Group Corporation,First Health Network,100.88,97,,percent of total billed charges,,
CEPHALEXIN 250 MG/5 ML ORAL SUSR,,12366,LOCAL,Facility,Both,100,mL,,104,88.4,29.8064,104,"Health Partners, Inc.",Commercial,98.384,94.6,,percent of total billed charges,,
CEPHALEXIN 250 MG/5 ML ORAL SUSR,,12366,LOCAL,Facility,Outpatient,100,mL,,104,88.4,29.8064,104,"Health Partners, Inc.",Medicare Advantage,50.96,49,,percent of total billed charges,,
CEPHALEXIN 250 MG/5 ML ORAL SUSR,,12366,LOCAL,Facility,Inpatient,100,mL,,104,88.4,29.8064,104,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CEPHALEXIN 250 MG/5 ML ORAL SUSR,,12366,LOCAL,Facility,Both,100,mL,,104,88.4,29.8064,104,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),62.4,60,,percent of total billed charges,,
CEPHALEXIN 250 MG/5 ML ORAL SUSR,,12366,LOCAL,Facility,Both,100,mL,,104,88.4,29.8064,104,"Health Partners, Inc.",State of Minnesota Advantage Program,84.76,81.5,,percent of total billed charges,,
CEPHALEXIN 250 MG/5 ML ORAL SUSR,,12366,LOCAL,Facility,Both,100,mL,,104,88.4,29.8064,104,"Health Partners, Inc.",State Public Programs,52,50,,percent of total billed charges,,
CEPHALEXIN 250 MG/5 ML ORAL SUSR,,12366,LOCAL,Facility,Both,100,mL,,104,88.4,29.8064,104,Humana Insurance Company,Commercial PPO,98.8,95,,percent of total billed charges,,
CEPHALEXIN 250 MG/5 ML ORAL SUSR,,12366,LOCAL,Facility,Outpatient,100,mL,,104,88.4,29.8064,104,Humana Insurance Company,Medicare PPO,50.96,49,,percent of total billed charges,,
CEPHALEXIN 250 MG/5 ML ORAL SUSR,,12366,LOCAL,Facility,Inpatient,100,mL,,104,88.4,29.8064,104,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
CEPHALEXIN 250 MG/5 ML ORAL SUSR,,12366,LOCAL,Facility,Both,100,mL,,104,88.4,29.8064,104,Medica,Individual & Family,103.064,99.1,,percent of total billed charges,,
CEPHALEXIN 250 MG/5 ML ORAL SUSR,,12366,LOCAL,Facility,Outpatient,100,mL,,104,88.4,29.8064,104,Medica,Medica Advantage Solution,51.792,49.8,,percent of total billed charges,,
CEPHALEXIN 250 MG/5 ML ORAL SUSR,,12366,LOCAL,Facility,Inpatient,100,mL,,104,88.4,29.8064,104,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
CEPHALEXIN 250 MG/5 ML ORAL SUSR,,12366,LOCAL,Facility,Outpatient,100,mL,,104,88.4,29.8064,104,Medica,Medical Assistance,46.384,44.6,,percent of total billed charges,,
CEPHALEXIN 250 MG/5 ML ORAL SUSR,,12366,LOCAL,Facility,Inpatient,100,mL,,104,88.4,29.8064,104,Medica,Medical Assistance,,,,,Included in per diem rate,
CEPHALEXIN 250 MG/5 ML ORAL SUSR,,12366,LOCAL,Facility,Outpatient,100,mL,,104,88.4,29.8064,104,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,51.792,49.8,,percent of total billed charges,,
CEPHALEXIN 250 MG/5 ML ORAL SUSR,,12366,LOCAL,Facility,Inpatient,100,mL,,104,88.4,29.8064,104,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
CEPHALEXIN 250 MG/5 ML ORAL SUSR,,12366,LOCAL,Facility,Both,100,mL,,104,88.4,29.8064,104,"Multiplan, Inc.","Multiplan, Inc.",97.76,94,,percent of total billed charges,,
CEPHALEXIN 250 MG/5 ML ORAL SUSR,,12366,LOCAL,Facility,Outpatient,100,mL,,104,88.4,29.8064,104,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,93.704,90.1,,percent of total billed charges,,
CEPHALEXIN 250 MG/5 ML ORAL SUSR,,12366,LOCAL,Facility,Inpatient,100,mL,,104,88.4,29.8064,104,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
CEPHALEXIN 250 MG/5 ML ORAL SUSR,,12366,LOCAL,Facility,Both,100,mL,,104,88.4,29.8064,104,"Preferred One Administrative Services, INC.",PPO,102.544,98.6,,percent of total billed charges,,
CEPHALEXIN 250 MG/5 ML ORAL SUSR,,12366,LOCAL,Facility,Outpatient,100,mL,,104,88.4,29.8064,104,PrimeWest Health,Minnesota Senior Health Options (MSHO),53.508,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
CEPHALEXIN 250 MG/5 ML ORAL SUSR,,12366,LOCAL,Facility,Inpatient,100,mL,,104,88.4,29.8064,104,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CEPHALEXIN 250 MG/5 ML ORAL SUSR,,12366,LOCAL,Facility,Outpatient,100,mL,,104,88.4,29.8064,104,PrimeWest Health,MinnesotaCare,53.4144,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
CEPHALEXIN 250 MG/5 ML ORAL SUSR,,12366,LOCAL,Facility,Inpatient,100,mL,,104,88.4,29.8064,104,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
CEPHALEXIN 250 MG/5 ML ORAL SUSR,,12366,LOCAL,Facility,Both,100,mL,,104,88.4,29.8064,104,Sanford Health Plan,Sanford Health Plan,95.68,92,,percent of total billed charges,,
CEPHALEXIN 250 MG/5 ML ORAL SUSR,,12366,LOCAL,Facility,Outpatient,100,mL,,104,88.4,29.8064,104,"UCare Health, Inc.",Individual & Family Plan,58.604,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
CEPHALEXIN 250 MG/5 ML ORAL SUSR,,12366,LOCAL,Facility,Inpatient,100,mL,,104,88.4,29.8064,104,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
CEPHALEXIN 250 MG/5 ML ORAL SUSR,,12366,LOCAL,Facility,Outpatient,100,mL,,104,88.4,29.8064,104,"UCare Health, Inc.",Medical Assistance,52.4888,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CEPHALEXIN 250 MG/5 ML ORAL SUSR,,12366,LOCAL,Facility,Inpatient,100,mL,,104,88.4,29.8064,104,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
CEPHALEXIN 250 MG/5 ML ORAL SUSR,,12366,LOCAL,Facility,Outpatient,100,mL,,104,88.4,29.8064,104,"UCare Health, Inc.",Medicare Advantage,52.4888,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CEPHALEXIN 250 MG/5 ML ORAL SUSR,,12366,LOCAL,Facility,Inpatient,100,mL,,104,88.4,29.8064,104,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CEPHALEXIN 250 MG/5 ML ORAL SUSR,,12366,LOCAL,Facility,Outpatient,100,mL,,104,88.4,29.8064,104,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),52.4888,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CEPHALEXIN 250 MG/5 ML ORAL SUSR,,12366,LOCAL,Facility,Inpatient,100,mL,,104,88.4,29.8064,104,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CEPHALEXIN 250 MG/5 ML ORAL SUSR,,12366,LOCAL,Facility,Both,100,mL,,104,88.4,29.8064,104,UnitedHealthcare,Individual & Family,97.76,94,,percent of total billed charges,,
CEPHALEXIN 250 MG/5 ML ORAL SUSR,,12366,LOCAL,Facility,Outpatient,100,mL,,104,88.4,29.8064,104,UnitedHealthcare,Medicare Advantage,50.96,49,,percent of total billed charges,,
CEPHALEXIN 250 MG/5 ML ORAL SUSR,,12366,LOCAL,Facility,Inpatient,100,mL,,104,88.4,29.8064,104,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
CEPHALEXIN 250 MG/5 ML ORAL SUSR,,12366,LOCAL,Facility,Outpatient,100,mL,,104,88.4,29.8064,104,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,49.92,48,,percent of total billed charges,,100% of DHS outpatient percentage
CEPHALEXIN 250 MG/5 ML ORAL SUSR,,12366,LOCAL,Facility,Inpatient,100,mL,,104,88.4,29.8064,104,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
TIROFIBAN-0.9% SODIUM CHLORIDE 5 MG/100 ML (50 MCG/ML) IV SOLN,,87039,LOCAL,Facility,Both,100,mL,,431,366.35,123.5246,431,Aetna,Commercial,396.52,92,,percent of total billed charges,,
TIROFIBAN-0.9% SODIUM CHLORIDE 5 MG/100 ML (50 MCG/ML) IV SOLN,,87039,LOCAL,Facility,Outpatient,100,mL,,431,366.35,123.5246,431,Aetna,Medicare Advantage,211.19,49,,percent of total billed charges,,
TIROFIBAN-0.9% SODIUM CHLORIDE 5 MG/100 ML (50 MCG/ML) IV SOLN,,87039,LOCAL,Facility,Inpatient,100,mL,,431,366.35,123.5246,431,Aetna,Medicare Advantage,,,,,Included in per diem rate,
TIROFIBAN-0.9% SODIUM CHLORIDE 5 MG/100 ML (50 MCG/ML) IV SOLN,,87039,LOCAL,Facility,Both,100,mL,,431,366.35,123.5246,431,Aetna,PPO,400.83,93,,percent of total billed charges,,
TIROFIBAN-0.9% SODIUM CHLORIDE 5 MG/100 ML (50 MCG/ML) IV SOLN,,87039,LOCAL,Facility,Both,100,mL,,431,366.35,123.5246,431,America's PPO,America's PPO,413.8893,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
TIROFIBAN-0.9% SODIUM CHLORIDE 5 MG/100 ML (50 MCG/ML) IV SOLN,,87039,LOCAL,Facility,Both,100,mL,,431,366.35,123.5246,431,BlueCross BlueShield Minnesota, Federal Employee Program,424.104,98.4,,percent of total billed charges,,
TIROFIBAN-0.9% SODIUM CHLORIDE 5 MG/100 ML (50 MCG/ML) IV SOLN,,87039,LOCAL,Facility,Both,100,mL,,431,366.35,123.5246,431,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,431,100,,percent of total billed charges,,
TIROFIBAN-0.9% SODIUM CHLORIDE 5 MG/100 ML (50 MCG/ML) IV SOLN,,87039,LOCAL,Facility,Both,100,mL,,431,366.35,123.5246,431,BlueCross BlueShield Minnesota,High Value Network Plan,387.9,90,,percent of total billed charges,,
TIROFIBAN-0.9% SODIUM CHLORIDE 5 MG/100 ML (50 MCG/ML) IV SOLN,,87039,LOCAL,Facility,Outpatient,100,mL,,431,366.35,123.5246,431,BlueCross BlueShield Minnesota,Medicare Advantage,211.19,49,,percent of total billed charges,,
TIROFIBAN-0.9% SODIUM CHLORIDE 5 MG/100 ML (50 MCG/ML) IV SOLN,,87039,LOCAL,Facility,Inpatient,100,mL,,431,366.35,123.5246,431,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
TIROFIBAN-0.9% SODIUM CHLORIDE 5 MG/100 ML (50 MCG/ML) IV SOLN,,87039,LOCAL,Facility,Both,100,mL,,431,366.35,123.5246,431,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,381.7367,88.57,,percent of total billed charges,,
TIROFIBAN-0.9% SODIUM CHLORIDE 5 MG/100 ML (50 MCG/ML) IV SOLN,,87039,LOCAL,Facility,Both,100,mL,,431,366.35,123.5246,431,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,123.5246,28.66,,percent of total billed charges,,
TIROFIBAN-0.9% SODIUM CHLORIDE 5 MG/100 ML (50 MCG/ML) IV SOLN,,87039,LOCAL,Facility,Outpatient,100,mL,,431,366.35,123.5246,431,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),211.19,49,,percent of total billed charges,,
TIROFIBAN-0.9% SODIUM CHLORIDE 5 MG/100 ML (50 MCG/ML) IV SOLN,,87039,LOCAL,Facility,Inpatient,100,mL,,431,366.35,123.5246,431,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
TIROFIBAN-0.9% SODIUM CHLORIDE 5 MG/100 ML (50 MCG/ML) IV SOLN,,87039,LOCAL,Facility,Both,100,mL,,431,366.35,123.5246,431,CorVel,Worker's Compensation,431,100,,percent of total billed charges,,
TIROFIBAN-0.9% SODIUM CHLORIDE 5 MG/100 ML (50 MCG/ML) IV SOLN,,87039,LOCAL,Facility,Both,100,mL,,431,366.35,123.5246,431,First Health Group Corporation,First Health Network,418.07,97,,percent of total billed charges,,
TIROFIBAN-0.9% SODIUM CHLORIDE 5 MG/100 ML (50 MCG/ML) IV SOLN,,87039,LOCAL,Facility,Both,100,mL,,431,366.35,123.5246,431,"Health Partners, Inc.",Commercial,407.726,94.6,,percent of total billed charges,,
TIROFIBAN-0.9% SODIUM CHLORIDE 5 MG/100 ML (50 MCG/ML) IV SOLN,,87039,LOCAL,Facility,Outpatient,100,mL,,431,366.35,123.5246,431,"Health Partners, Inc.",Medicare Advantage,211.19,49,,percent of total billed charges,,
TIROFIBAN-0.9% SODIUM CHLORIDE 5 MG/100 ML (50 MCG/ML) IV SOLN,,87039,LOCAL,Facility,Inpatient,100,mL,,431,366.35,123.5246,431,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
TIROFIBAN-0.9% SODIUM CHLORIDE 5 MG/100 ML (50 MCG/ML) IV SOLN,,87039,LOCAL,Facility,Both,100,mL,,431,366.35,123.5246,431,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),258.6,60,,percent of total billed charges,,
TIROFIBAN-0.9% SODIUM CHLORIDE 5 MG/100 ML (50 MCG/ML) IV SOLN,,87039,LOCAL,Facility,Both,100,mL,,431,366.35,123.5246,431,"Health Partners, Inc.",State of Minnesota Advantage Program,351.265,81.5,,percent of total billed charges,,
TIROFIBAN-0.9% SODIUM CHLORIDE 5 MG/100 ML (50 MCG/ML) IV SOLN,,87039,LOCAL,Facility,Both,100,mL,,431,366.35,123.5246,431,"Health Partners, Inc.",State Public Programs,215.5,50,,percent of total billed charges,,
TIROFIBAN-0.9% SODIUM CHLORIDE 5 MG/100 ML (50 MCG/ML) IV SOLN,,87039,LOCAL,Facility,Both,100,mL,,431,366.35,123.5246,431,Humana Insurance Company,Commercial PPO,409.45,95,,percent of total billed charges,,
TIROFIBAN-0.9% SODIUM CHLORIDE 5 MG/100 ML (50 MCG/ML) IV SOLN,,87039,LOCAL,Facility,Outpatient,100,mL,,431,366.35,123.5246,431,Humana Insurance Company,Medicare PPO,211.19,49,,percent of total billed charges,,
TIROFIBAN-0.9% SODIUM CHLORIDE 5 MG/100 ML (50 MCG/ML) IV SOLN,,87039,LOCAL,Facility,Inpatient,100,mL,,431,366.35,123.5246,431,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
TIROFIBAN-0.9% SODIUM CHLORIDE 5 MG/100 ML (50 MCG/ML) IV SOLN,,87039,LOCAL,Facility,Both,100,mL,,431,366.35,123.5246,431,Medica,Individual & Family,427.121,99.1,,percent of total billed charges,,
TIROFIBAN-0.9% SODIUM CHLORIDE 5 MG/100 ML (50 MCG/ML) IV SOLN,,87039,LOCAL,Facility,Outpatient,100,mL,,431,366.35,123.5246,431,Medica,Medica Advantage Solution,214.638,49.8,,percent of total billed charges,,
TIROFIBAN-0.9% SODIUM CHLORIDE 5 MG/100 ML (50 MCG/ML) IV SOLN,,87039,LOCAL,Facility,Inpatient,100,mL,,431,366.35,123.5246,431,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
TIROFIBAN-0.9% SODIUM CHLORIDE 5 MG/100 ML (50 MCG/ML) IV SOLN,,87039,LOCAL,Facility,Outpatient,100,mL,,431,366.35,123.5246,431,Medica,Medical Assistance,192.226,44.6,,percent of total billed charges,,
TIROFIBAN-0.9% SODIUM CHLORIDE 5 MG/100 ML (50 MCG/ML) IV SOLN,,87039,LOCAL,Facility,Inpatient,100,mL,,431,366.35,123.5246,431,Medica,Medical Assistance,,,,,Included in per diem rate,
TIROFIBAN-0.9% SODIUM CHLORIDE 5 MG/100 ML (50 MCG/ML) IV SOLN,,87039,LOCAL,Facility,Outpatient,100,mL,,431,366.35,123.5246,431,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,214.638,49.8,,percent of total billed charges,,
TIROFIBAN-0.9% SODIUM CHLORIDE 5 MG/100 ML (50 MCG/ML) IV SOLN,,87039,LOCAL,Facility,Inpatient,100,mL,,431,366.35,123.5246,431,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
TIROFIBAN-0.9% SODIUM CHLORIDE 5 MG/100 ML (50 MCG/ML) IV SOLN,,87039,LOCAL,Facility,Both,100,mL,,431,366.35,123.5246,431,"Multiplan, Inc.","Multiplan, Inc.",405.14,94,,percent of total billed charges,,
TIROFIBAN-0.9% SODIUM CHLORIDE 5 MG/100 ML (50 MCG/ML) IV SOLN,,87039,LOCAL,Facility,Outpatient,100,mL,,431,366.35,123.5246,431,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,388.331,90.1,,percent of total billed charges,,
TIROFIBAN-0.9% SODIUM CHLORIDE 5 MG/100 ML (50 MCG/ML) IV SOLN,,87039,LOCAL,Facility,Inpatient,100,mL,,431,366.35,123.5246,431,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
TIROFIBAN-0.9% SODIUM CHLORIDE 5 MG/100 ML (50 MCG/ML) IV SOLN,,87039,LOCAL,Facility,Both,100,mL,,431,366.35,123.5246,431,"Preferred One Administrative Services, INC.",PPO,424.966,98.6,,percent of total billed charges,,
TIROFIBAN-0.9% SODIUM CHLORIDE 5 MG/100 ML (50 MCG/ML) IV SOLN,,87039,LOCAL,Facility,Outpatient,100,mL,,431,366.35,123.5246,431,PrimeWest Health,Minnesota Senior Health Options (MSHO),221.7495,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
TIROFIBAN-0.9% SODIUM CHLORIDE 5 MG/100 ML (50 MCG/ML) IV SOLN,,87039,LOCAL,Facility,Inpatient,100,mL,,431,366.35,123.5246,431,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
TIROFIBAN-0.9% SODIUM CHLORIDE 5 MG/100 ML (50 MCG/ML) IV SOLN,,87039,LOCAL,Facility,Outpatient,100,mL,,431,366.35,123.5246,431,PrimeWest Health,MinnesotaCare,221.3616,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
TIROFIBAN-0.9% SODIUM CHLORIDE 5 MG/100 ML (50 MCG/ML) IV SOLN,,87039,LOCAL,Facility,Inpatient,100,mL,,431,366.35,123.5246,431,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
TIROFIBAN-0.9% SODIUM CHLORIDE 5 MG/100 ML (50 MCG/ML) IV SOLN,,87039,LOCAL,Facility,Both,100,mL,,431,366.35,123.5246,431,Sanford Health Plan,Sanford Health Plan,396.52,92,,percent of total billed charges,,
TIROFIBAN-0.9% SODIUM CHLORIDE 5 MG/100 ML (50 MCG/ML) IV SOLN,,87039,LOCAL,Facility,Outpatient,100,mL,,431,366.35,123.5246,431,"UCare Health, Inc.",Individual & Family Plan,242.8685,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
TIROFIBAN-0.9% SODIUM CHLORIDE 5 MG/100 ML (50 MCG/ML) IV SOLN,,87039,LOCAL,Facility,Inpatient,100,mL,,431,366.35,123.5246,431,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
TIROFIBAN-0.9% SODIUM CHLORIDE 5 MG/100 ML (50 MCG/ML) IV SOLN,,87039,LOCAL,Facility,Outpatient,100,mL,,431,366.35,123.5246,431,"UCare Health, Inc.",Medical Assistance,217.5257,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TIROFIBAN-0.9% SODIUM CHLORIDE 5 MG/100 ML (50 MCG/ML) IV SOLN,,87039,LOCAL,Facility,Inpatient,100,mL,,431,366.35,123.5246,431,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
TIROFIBAN-0.9% SODIUM CHLORIDE 5 MG/100 ML (50 MCG/ML) IV SOLN,,87039,LOCAL,Facility,Outpatient,100,mL,,431,366.35,123.5246,431,"UCare Health, Inc.",Medicare Advantage,217.5257,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TIROFIBAN-0.9% SODIUM CHLORIDE 5 MG/100 ML (50 MCG/ML) IV SOLN,,87039,LOCAL,Facility,Inpatient,100,mL,,431,366.35,123.5246,431,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
TIROFIBAN-0.9% SODIUM CHLORIDE 5 MG/100 ML (50 MCG/ML) IV SOLN,,87039,LOCAL,Facility,Outpatient,100,mL,,431,366.35,123.5246,431,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),217.5257,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TIROFIBAN-0.9% SODIUM CHLORIDE 5 MG/100 ML (50 MCG/ML) IV SOLN,,87039,LOCAL,Facility,Inpatient,100,mL,,431,366.35,123.5246,431,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
TIROFIBAN-0.9% SODIUM CHLORIDE 5 MG/100 ML (50 MCG/ML) IV SOLN,,87039,LOCAL,Facility,Both,100,mL,,431,366.35,123.5246,431,UnitedHealthcare,Individual & Family,405.14,94,,percent of total billed charges,,
TIROFIBAN-0.9% SODIUM CHLORIDE 5 MG/100 ML (50 MCG/ML) IV SOLN,,87039,LOCAL,Facility,Outpatient,100,mL,,431,366.35,123.5246,431,UnitedHealthcare,Medicare Advantage,211.19,49,,percent of total billed charges,,
TIROFIBAN-0.9% SODIUM CHLORIDE 5 MG/100 ML (50 MCG/ML) IV SOLN,,87039,LOCAL,Facility,Inpatient,100,mL,,431,366.35,123.5246,431,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
TIROFIBAN-0.9% SODIUM CHLORIDE 5 MG/100 ML (50 MCG/ML) IV SOLN,,87039,LOCAL,Facility,Outpatient,100,mL,,431,366.35,123.5246,431,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,206.88,48,,percent of total billed charges,,100% of DHS outpatient percentage
TIROFIBAN-0.9% SODIUM CHLORIDE 5 MG/100 ML (50 MCG/ML) IV SOLN,,87039,LOCAL,Facility,Inpatient,100,mL,,431,366.35,123.5246,431,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
INSULIN REGULAR IN 0.9 % NACL 100 UNIT/100 ML (1 UNIT/ML) IV SOLN,,135416,LOCAL,Facility,Both,100,mL,,189,160.65,54.1674,189,Aetna,Commercial,173.88,92,,percent of total billed charges,,
INSULIN REGULAR IN 0.9 % NACL 100 UNIT/100 ML (1 UNIT/ML) IV SOLN,,135416,LOCAL,Facility,Outpatient,100,mL,,189,160.65,54.1674,189,Aetna,Medicare Advantage,92.61,49,,percent of total billed charges,,
INSULIN REGULAR IN 0.9 % NACL 100 UNIT/100 ML (1 UNIT/ML) IV SOLN,,135416,LOCAL,Facility,Inpatient,100,mL,,189,160.65,54.1674,189,Aetna,Medicare Advantage,,,,,Included in per diem rate,
INSULIN REGULAR IN 0.9 % NACL 100 UNIT/100 ML (1 UNIT/ML) IV SOLN,,135416,LOCAL,Facility,Both,100,mL,,189,160.65,54.1674,189,Aetna,PPO,175.77,93,,percent of total billed charges,,
INSULIN REGULAR IN 0.9 % NACL 100 UNIT/100 ML (1 UNIT/ML) IV SOLN,,135416,LOCAL,Facility,Both,100,mL,,189,160.65,54.1674,189,America's PPO,America's PPO,181.4967,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
INSULIN REGULAR IN 0.9 % NACL 100 UNIT/100 ML (1 UNIT/ML) IV SOLN,,135416,LOCAL,Facility,Both,100,mL,,189,160.65,54.1674,189,BlueCross BlueShield Minnesota, Federal Employee Program,185.976,98.4,,percent of total billed charges,,
INSULIN REGULAR IN 0.9 % NACL 100 UNIT/100 ML (1 UNIT/ML) IV SOLN,,135416,LOCAL,Facility,Both,100,mL,,189,160.65,54.1674,189,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,189,100,,percent of total billed charges,,
INSULIN REGULAR IN 0.9 % NACL 100 UNIT/100 ML (1 UNIT/ML) IV SOLN,,135416,LOCAL,Facility,Both,100,mL,,189,160.65,54.1674,189,BlueCross BlueShield Minnesota,High Value Network Plan,170.1,90,,percent of total billed charges,,
INSULIN REGULAR IN 0.9 % NACL 100 UNIT/100 ML (1 UNIT/ML) IV SOLN,,135416,LOCAL,Facility,Outpatient,100,mL,,189,160.65,54.1674,189,BlueCross BlueShield Minnesota,Medicare Advantage,92.61,49,,percent of total billed charges,,
INSULIN REGULAR IN 0.9 % NACL 100 UNIT/100 ML (1 UNIT/ML) IV SOLN,,135416,LOCAL,Facility,Inpatient,100,mL,,189,160.65,54.1674,189,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
INSULIN REGULAR IN 0.9 % NACL 100 UNIT/100 ML (1 UNIT/ML) IV SOLN,,135416,LOCAL,Facility,Both,100,mL,,189,160.65,54.1674,189,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,167.3973,88.57,,percent of total billed charges,,
INSULIN REGULAR IN 0.9 % NACL 100 UNIT/100 ML (1 UNIT/ML) IV SOLN,,135416,LOCAL,Facility,Both,100,mL,,189,160.65,54.1674,189,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,54.1674,28.66,,percent of total billed charges,,
INSULIN REGULAR IN 0.9 % NACL 100 UNIT/100 ML (1 UNIT/ML) IV SOLN,,135416,LOCAL,Facility,Outpatient,100,mL,,189,160.65,54.1674,189,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),92.61,49,,percent of total billed charges,,
INSULIN REGULAR IN 0.9 % NACL 100 UNIT/100 ML (1 UNIT/ML) IV SOLN,,135416,LOCAL,Facility,Inpatient,100,mL,,189,160.65,54.1674,189,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
INSULIN REGULAR IN 0.9 % NACL 100 UNIT/100 ML (1 UNIT/ML) IV SOLN,,135416,LOCAL,Facility,Both,100,mL,,189,160.65,54.1674,189,CorVel,Worker's Compensation,189,100,,percent of total billed charges,,
INSULIN REGULAR IN 0.9 % NACL 100 UNIT/100 ML (1 UNIT/ML) IV SOLN,,135416,LOCAL,Facility,Both,100,mL,,189,160.65,54.1674,189,First Health Group Corporation,First Health Network,183.33,97,,percent of total billed charges,,
INSULIN REGULAR IN 0.9 % NACL 100 UNIT/100 ML (1 UNIT/ML) IV SOLN,,135416,LOCAL,Facility,Both,100,mL,,189,160.65,54.1674,189,"Health Partners, Inc.",Commercial,178.794,94.6,,percent of total billed charges,,
INSULIN REGULAR IN 0.9 % NACL 100 UNIT/100 ML (1 UNIT/ML) IV SOLN,,135416,LOCAL,Facility,Outpatient,100,mL,,189,160.65,54.1674,189,"Health Partners, Inc.",Medicare Advantage,92.61,49,,percent of total billed charges,,
INSULIN REGULAR IN 0.9 % NACL 100 UNIT/100 ML (1 UNIT/ML) IV SOLN,,135416,LOCAL,Facility,Inpatient,100,mL,,189,160.65,54.1674,189,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
INSULIN REGULAR IN 0.9 % NACL 100 UNIT/100 ML (1 UNIT/ML) IV SOLN,,135416,LOCAL,Facility,Both,100,mL,,189,160.65,54.1674,189,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),113.4,60,,percent of total billed charges,,
INSULIN REGULAR IN 0.9 % NACL 100 UNIT/100 ML (1 UNIT/ML) IV SOLN,,135416,LOCAL,Facility,Both,100,mL,,189,160.65,54.1674,189,"Health Partners, Inc.",State of Minnesota Advantage Program,154.035,81.5,,percent of total billed charges,,
INSULIN REGULAR IN 0.9 % NACL 100 UNIT/100 ML (1 UNIT/ML) IV SOLN,,135416,LOCAL,Facility,Both,100,mL,,189,160.65,54.1674,189,"Health Partners, Inc.",State Public Programs,94.5,50,,percent of total billed charges,,
INSULIN REGULAR IN 0.9 % NACL 100 UNIT/100 ML (1 UNIT/ML) IV SOLN,,135416,LOCAL,Facility,Both,100,mL,,189,160.65,54.1674,189,Humana Insurance Company,Commercial PPO,179.55,95,,percent of total billed charges,,
INSULIN REGULAR IN 0.9 % NACL 100 UNIT/100 ML (1 UNIT/ML) IV SOLN,,135416,LOCAL,Facility,Outpatient,100,mL,,189,160.65,54.1674,189,Humana Insurance Company,Medicare PPO,92.61,49,,percent of total billed charges,,
INSULIN REGULAR IN 0.9 % NACL 100 UNIT/100 ML (1 UNIT/ML) IV SOLN,,135416,LOCAL,Facility,Inpatient,100,mL,,189,160.65,54.1674,189,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
INSULIN REGULAR IN 0.9 % NACL 100 UNIT/100 ML (1 UNIT/ML) IV SOLN,,135416,LOCAL,Facility,Both,100,mL,,189,160.65,54.1674,189,Medica,Individual & Family,187.299,99.1,,percent of total billed charges,,
INSULIN REGULAR IN 0.9 % NACL 100 UNIT/100 ML (1 UNIT/ML) IV SOLN,,135416,LOCAL,Facility,Outpatient,100,mL,,189,160.65,54.1674,189,Medica,Medica Advantage Solution,94.122,49.8,,percent of total billed charges,,
INSULIN REGULAR IN 0.9 % NACL 100 UNIT/100 ML (1 UNIT/ML) IV SOLN,,135416,LOCAL,Facility,Inpatient,100,mL,,189,160.65,54.1674,189,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
INSULIN REGULAR IN 0.9 % NACL 100 UNIT/100 ML (1 UNIT/ML) IV SOLN,,135416,LOCAL,Facility,Outpatient,100,mL,,189,160.65,54.1674,189,Medica,Medical Assistance,84.294,44.6,,percent of total billed charges,,
INSULIN REGULAR IN 0.9 % NACL 100 UNIT/100 ML (1 UNIT/ML) IV SOLN,,135416,LOCAL,Facility,Inpatient,100,mL,,189,160.65,54.1674,189,Medica,Medical Assistance,,,,,Included in per diem rate,
INSULIN REGULAR IN 0.9 % NACL 100 UNIT/100 ML (1 UNIT/ML) IV SOLN,,135416,LOCAL,Facility,Outpatient,100,mL,,189,160.65,54.1674,189,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,94.122,49.8,,percent of total billed charges,,
INSULIN REGULAR IN 0.9 % NACL 100 UNIT/100 ML (1 UNIT/ML) IV SOLN,,135416,LOCAL,Facility,Inpatient,100,mL,,189,160.65,54.1674,189,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
INSULIN REGULAR IN 0.9 % NACL 100 UNIT/100 ML (1 UNIT/ML) IV SOLN,,135416,LOCAL,Facility,Both,100,mL,,189,160.65,54.1674,189,"Multiplan, Inc.","Multiplan, Inc.",177.66,94,,percent of total billed charges,,
INSULIN REGULAR IN 0.9 % NACL 100 UNIT/100 ML (1 UNIT/ML) IV SOLN,,135416,LOCAL,Facility,Outpatient,100,mL,,189,160.65,54.1674,189,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,170.289,90.1,,percent of total billed charges,,
INSULIN REGULAR IN 0.9 % NACL 100 UNIT/100 ML (1 UNIT/ML) IV SOLN,,135416,LOCAL,Facility,Inpatient,100,mL,,189,160.65,54.1674,189,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
INSULIN REGULAR IN 0.9 % NACL 100 UNIT/100 ML (1 UNIT/ML) IV SOLN,,135416,LOCAL,Facility,Both,100,mL,,189,160.65,54.1674,189,"Preferred One Administrative Services, INC.",PPO,186.354,98.6,,percent of total billed charges,,
INSULIN REGULAR IN 0.9 % NACL 100 UNIT/100 ML (1 UNIT/ML) IV SOLN,,135416,LOCAL,Facility,Outpatient,100,mL,,189,160.65,54.1674,189,PrimeWest Health,Minnesota Senior Health Options (MSHO),97.2405,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
INSULIN REGULAR IN 0.9 % NACL 100 UNIT/100 ML (1 UNIT/ML) IV SOLN,,135416,LOCAL,Facility,Inpatient,100,mL,,189,160.65,54.1674,189,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
INSULIN REGULAR IN 0.9 % NACL 100 UNIT/100 ML (1 UNIT/ML) IV SOLN,,135416,LOCAL,Facility,Outpatient,100,mL,,189,160.65,54.1674,189,PrimeWest Health,MinnesotaCare,97.0704,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
INSULIN REGULAR IN 0.9 % NACL 100 UNIT/100 ML (1 UNIT/ML) IV SOLN,,135416,LOCAL,Facility,Inpatient,100,mL,,189,160.65,54.1674,189,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
INSULIN REGULAR IN 0.9 % NACL 100 UNIT/100 ML (1 UNIT/ML) IV SOLN,,135416,LOCAL,Facility,Both,100,mL,,189,160.65,54.1674,189,Sanford Health Plan,Sanford Health Plan,173.88,92,,percent of total billed charges,,
INSULIN REGULAR IN 0.9 % NACL 100 UNIT/100 ML (1 UNIT/ML) IV SOLN,,135416,LOCAL,Facility,Outpatient,100,mL,,189,160.65,54.1674,189,"UCare Health, Inc.",Individual & Family Plan,106.5015,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
INSULIN REGULAR IN 0.9 % NACL 100 UNIT/100 ML (1 UNIT/ML) IV SOLN,,135416,LOCAL,Facility,Inpatient,100,mL,,189,160.65,54.1674,189,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
INSULIN REGULAR IN 0.9 % NACL 100 UNIT/100 ML (1 UNIT/ML) IV SOLN,,135416,LOCAL,Facility,Outpatient,100,mL,,189,160.65,54.1674,189,"UCare Health, Inc.",Medical Assistance,95.3883,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
INSULIN REGULAR IN 0.9 % NACL 100 UNIT/100 ML (1 UNIT/ML) IV SOLN,,135416,LOCAL,Facility,Inpatient,100,mL,,189,160.65,54.1674,189,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
INSULIN REGULAR IN 0.9 % NACL 100 UNIT/100 ML (1 UNIT/ML) IV SOLN,,135416,LOCAL,Facility,Outpatient,100,mL,,189,160.65,54.1674,189,"UCare Health, Inc.",Medicare Advantage,95.3883,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
INSULIN REGULAR IN 0.9 % NACL 100 UNIT/100 ML (1 UNIT/ML) IV SOLN,,135416,LOCAL,Facility,Inpatient,100,mL,,189,160.65,54.1674,189,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
INSULIN REGULAR IN 0.9 % NACL 100 UNIT/100 ML (1 UNIT/ML) IV SOLN,,135416,LOCAL,Facility,Outpatient,100,mL,,189,160.65,54.1674,189,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),95.3883,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
INSULIN REGULAR IN 0.9 % NACL 100 UNIT/100 ML (1 UNIT/ML) IV SOLN,,135416,LOCAL,Facility,Inpatient,100,mL,,189,160.65,54.1674,189,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
INSULIN REGULAR IN 0.9 % NACL 100 UNIT/100 ML (1 UNIT/ML) IV SOLN,,135416,LOCAL,Facility,Both,100,mL,,189,160.65,54.1674,189,UnitedHealthcare,Individual & Family,177.66,94,,percent of total billed charges,,
INSULIN REGULAR IN 0.9 % NACL 100 UNIT/100 ML (1 UNIT/ML) IV SOLN,,135416,LOCAL,Facility,Outpatient,100,mL,,189,160.65,54.1674,189,UnitedHealthcare,Medicare Advantage,92.61,49,,percent of total billed charges,,
INSULIN REGULAR IN 0.9 % NACL 100 UNIT/100 ML (1 UNIT/ML) IV SOLN,,135416,LOCAL,Facility,Inpatient,100,mL,,189,160.65,54.1674,189,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
INSULIN REGULAR IN 0.9 % NACL 100 UNIT/100 ML (1 UNIT/ML) IV SOLN,,135416,LOCAL,Facility,Outpatient,100,mL,,189,160.65,54.1674,189,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,90.72,48,,percent of total billed charges,,100% of DHS outpatient percentage
INSULIN REGULAR IN 0.9 % NACL 100 UNIT/100 ML (1 UNIT/ML) IV SOLN,,135416,LOCAL,Facility,Inpatient,100,mL,,189,160.65,54.1674,189,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) IV SOLN",,J0131,HCPCS,Facility,Both,100,mL,,108,91.8,30.9528,108,Aetna,Commercial,99.36,92,,percent of total billed charges,,
"ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) IV SOLN",,J0131,HCPCS,Facility,Both,100,mL,,108,91.8,30.9528,108,Aetna,Commercial,99.36,92,,percent of total billed charges,,
"ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) IV SOLN",,J0131,HCPCS,Facility,Outpatient,100,mL,,108,91.8,30.9528,108,Aetna,Medicare Advantage,52.92,49,,percent of total billed charges,,
"ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) IV SOLN",,J0131,HCPCS,Facility,Outpatient,100,mL,,108,91.8,30.9528,108,Aetna,Medicare Advantage,52.92,49,,percent of total billed charges,,
"ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) IV SOLN",,J0131,HCPCS,Facility,Inpatient,100,mL,,108,91.8,30.9528,108,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) IV SOLN",,J0131,HCPCS,Facility,Inpatient,100,mL,,108,91.8,30.9528,108,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) IV SOLN",,J0131,HCPCS,Facility,Both,100,mL,,108,91.8,30.9528,108,Aetna,PPO,100.44,93,,percent of total billed charges,,
"ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) IV SOLN",,J0131,HCPCS,Facility,Both,100,mL,,108,91.8,30.9528,108,Aetna,PPO,100.44,93,,percent of total billed charges,,
"ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) IV SOLN",,J0131,HCPCS,Facility,Both,100,mL,,108,91.8,30.9528,108,America's PPO,America's PPO,103.7124,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) IV SOLN",,J0131,HCPCS,Facility,Both,100,mL,,108,91.8,30.9528,108,America's PPO,America's PPO,103.7124,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) IV SOLN",,J0131,HCPCS,Facility,Both,100,mL,,108,91.8,30.9528,108,BlueCross BlueShield Minnesota, Federal Employee Program,106.272,98.4,,percent of total billed charges,,
"ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) IV SOLN",,J0131,HCPCS,Facility,Both,100,mL,,108,91.8,30.9528,108,BlueCross BlueShield Minnesota, Federal Employee Program,106.272,98.4,,percent of total billed charges,,
"ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) IV SOLN",,J0131,HCPCS,Facility,Both,100,mL,,108,91.8,30.9528,108,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,108,100,,percent of total billed charges,,
"ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) IV SOLN",,J0131,HCPCS,Facility,Both,100,mL,,108,91.8,30.9528,108,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,108,100,,percent of total billed charges,,
"ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) IV SOLN",,J0131,HCPCS,Facility,Both,100,mL,,108,91.8,30.9528,108,BlueCross BlueShield Minnesota,High Value Network Plan,97.2,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
"ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) IV SOLN",,J0131,HCPCS,Facility,Both,100,mL,,108,91.8,30.9528,108,BlueCross BlueShield Minnesota,High Value Network Plan,97.2,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
"ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) IV SOLN",,J0131,HCPCS,Facility,Outpatient,100,mL,,108,91.8,30.9528,108,BlueCross BlueShield Minnesota,Medicare Advantage,52.92,49,,percent of total billed charges,,
"ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) IV SOLN",,J0131,HCPCS,Facility,Outpatient,100,mL,,108,91.8,30.9528,108,BlueCross BlueShield Minnesota,Medicare Advantage,52.92,49,,percent of total billed charges,,
"ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) IV SOLN",,J0131,HCPCS,Facility,Inpatient,100,mL,,108,91.8,30.9528,108,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) IV SOLN",,J0131,HCPCS,Facility,Inpatient,100,mL,,108,91.8,30.9528,108,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) IV SOLN",,J0131,HCPCS,Facility,Both,100,mL,,108,91.8,30.9528,108,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,95.6556,88.57,,percent of total billed charges,,
"ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) IV SOLN",,J0131,HCPCS,Facility,Both,100,mL,,108,91.8,30.9528,108,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,95.6556,88.57,,percent of total billed charges,,
"ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) IV SOLN",,J0131,HCPCS,Facility,Both,100,mL,,108,91.8,30.9528,108,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,30.9528,28.66,,percent of total billed charges,,
"ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) IV SOLN",,J0131,HCPCS,Facility,Both,100,mL,,108,91.8,30.9528,108,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,30.9528,28.66,,percent of total billed charges,,
"ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) IV SOLN",,J0131,HCPCS,Facility,Outpatient,100,mL,,108,91.8,30.9528,108,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),52.92,49,,percent of total billed charges,,
"ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) IV SOLN",,J0131,HCPCS,Facility,Outpatient,100,mL,,108,91.8,30.9528,108,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),52.92,49,,percent of total billed charges,,
"ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) IV SOLN",,J0131,HCPCS,Facility,Inpatient,100,mL,,108,91.8,30.9528,108,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) IV SOLN",,J0131,HCPCS,Facility,Inpatient,100,mL,,108,91.8,30.9528,108,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) IV SOLN",,J0131,HCPCS,Facility,Both,100,mL,,108,91.8,30.9528,108,CorVel,Worker's Compensation,108,100,,percent of total billed charges,,
"ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) IV SOLN",,J0131,HCPCS,Facility,Both,100,mL,,108,91.8,30.9528,108,CorVel,Worker's Compensation,108,100,,percent of total billed charges,,
"ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) IV SOLN",,J0131,HCPCS,Facility,Both,100,mL,,108,91.8,30.9528,108,First Health Group Corporation,First Health Network,104.76,97,,percent of total billed charges,,
"ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) IV SOLN",,J0131,HCPCS,Facility,Both,100,mL,,108,91.8,30.9528,108,First Health Group Corporation,First Health Network,104.76,97,,percent of total billed charges,,
"ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) IV SOLN",,J0131,HCPCS,Facility,Both,100,mL,,108,91.8,30.9528,108,"Health Partners, Inc.",Commercial,102.168,94.6,,percent of total billed charges,,
"ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) IV SOLN",,J0131,HCPCS,Facility,Both,100,mL,,108,91.8,30.9528,108,"Health Partners, Inc.",Commercial,102.168,94.6,,percent of total billed charges,,
"ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) IV SOLN",,J0131,HCPCS,Facility,Outpatient,100,mL,,108,91.8,30.9528,108,"Health Partners, Inc.",Medicare Advantage,52.92,49,,percent of total billed charges,,
"ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) IV SOLN",,J0131,HCPCS,Facility,Outpatient,100,mL,,108,91.8,30.9528,108,"Health Partners, Inc.",Medicare Advantage,52.92,49,,percent of total billed charges,,
"ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) IV SOLN",,J0131,HCPCS,Facility,Inpatient,100,mL,,108,91.8,30.9528,108,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) IV SOLN",,J0131,HCPCS,Facility,Inpatient,100,mL,,108,91.8,30.9528,108,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) IV SOLN",,J0131,HCPCS,Facility,Both,100,mL,,108,91.8,30.9528,108,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),64.8,60,,percent of total billed charges,,
"ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) IV SOLN",,J0131,HCPCS,Facility,Both,100,mL,,108,91.8,30.9528,108,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),64.8,60,,percent of total billed charges,,
"ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) IV SOLN",,J0131,HCPCS,Facility,Both,100,mL,,108,91.8,30.9528,108,"Health Partners, Inc.",State of Minnesota Advantage Program,88.02,81.5,,percent of total billed charges,,
"ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) IV SOLN",,J0131,HCPCS,Facility,Both,100,mL,,108,91.8,30.9528,108,"Health Partners, Inc.",State of Minnesota Advantage Program,88.02,81.5,,percent of total billed charges,,
"ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) IV SOLN",,J0131,HCPCS,Facility,Both,100,mL,,108,91.8,30.9528,108,"Health Partners, Inc.",State Public Programs,54,50,,percent of total billed charges,,
"ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) IV SOLN",,J0131,HCPCS,Facility,Both,100,mL,,108,91.8,30.9528,108,"Health Partners, Inc.",State Public Programs,54,50,,percent of total billed charges,,
"ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) IV SOLN",,J0131,HCPCS,Facility,Both,100,mL,,108,91.8,30.9528,108,Humana Insurance Company,Commercial PPO,102.6,95,,percent of total billed charges,,
"ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) IV SOLN",,J0131,HCPCS,Facility,Both,100,mL,,108,91.8,30.9528,108,Humana Insurance Company,Commercial PPO,102.6,95,,percent of total billed charges,,
"ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) IV SOLN",,J0131,HCPCS,Facility,Outpatient,100,mL,,108,91.8,30.9528,108,Humana Insurance Company,Medicare PPO,52.92,49,,percent of total billed charges,,
"ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) IV SOLN",,J0131,HCPCS,Facility,Outpatient,100,mL,,108,91.8,30.9528,108,Humana Insurance Company,Medicare PPO,52.92,49,,percent of total billed charges,,
"ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) IV SOLN",,J0131,HCPCS,Facility,Inpatient,100,mL,,108,91.8,30.9528,108,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) IV SOLN",,J0131,HCPCS,Facility,Inpatient,100,mL,,108,91.8,30.9528,108,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) IV SOLN",,J0131,HCPCS,Facility,Both,100,mL,,108,91.8,30.9528,108,Medica,Individual & Family,107.028,99.1,,percent of total billed charges,,
"ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) IV SOLN",,J0131,HCPCS,Facility,Both,100,mL,,108,91.8,30.9528,108,Medica,Individual & Family,107.028,99.1,,percent of total billed charges,,
"ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) IV SOLN",,J0131,HCPCS,Facility,Outpatient,100,mL,,108,91.8,30.9528,108,Medica,Medica Advantage Solution,53.784,49.8,,percent of total billed charges,,
"ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) IV SOLN",,J0131,HCPCS,Facility,Outpatient,100,mL,,108,91.8,30.9528,108,Medica,Medica Advantage Solution,53.784,49.8,,percent of total billed charges,,
"ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) IV SOLN",,J0131,HCPCS,Facility,Inpatient,100,mL,,108,91.8,30.9528,108,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) IV SOLN",,J0131,HCPCS,Facility,Inpatient,100,mL,,108,91.8,30.9528,108,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) IV SOLN",,J0131,HCPCS,Facility,Outpatient,100,mL,,108,91.8,30.9528,108,Medica,Medical Assistance,48.168,44.6,,percent of total billed charges,,
"ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) IV SOLN",,J0131,HCPCS,Facility,Outpatient,100,mL,,108,91.8,30.9528,108,Medica,Medical Assistance,48.168,44.6,,percent of total billed charges,,
"ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) IV SOLN",,J0131,HCPCS,Facility,Inpatient,100,mL,,108,91.8,30.9528,108,Medica,Medical Assistance,,,,,Included in per diem rate,
"ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) IV SOLN",,J0131,HCPCS,Facility,Inpatient,100,mL,,108,91.8,30.9528,108,Medica,Medical Assistance,,,,,Included in per diem rate,
"ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) IV SOLN",,J0131,HCPCS,Facility,Outpatient,100,mL,,108,91.8,30.9528,108,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,53.784,49.8,,percent of total billed charges,,
"ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) IV SOLN",,J0131,HCPCS,Facility,Outpatient,100,mL,,108,91.8,30.9528,108,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,53.784,49.8,,percent of total billed charges,,
"ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) IV SOLN",,J0131,HCPCS,Facility,Inpatient,100,mL,,108,91.8,30.9528,108,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) IV SOLN",,J0131,HCPCS,Facility,Inpatient,100,mL,,108,91.8,30.9528,108,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) IV SOLN",,J0131,HCPCS,Facility,Both,100,mL,,108,91.8,30.9528,108,"Multiplan, Inc.","Multiplan, Inc.",101.52,94,,percent of total billed charges,,
"ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) IV SOLN",,J0131,HCPCS,Facility,Both,100,mL,,108,91.8,30.9528,108,"Multiplan, Inc.","Multiplan, Inc.",101.52,94,,percent of total billed charges,,
"ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) IV SOLN",,J0131,HCPCS,Facility,Outpatient,100,mL,,108,91.8,30.9528,108,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,97.308,90.1,,percent of total billed charges,,
"ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) IV SOLN",,J0131,HCPCS,Facility,Outpatient,100,mL,,108,91.8,30.9528,108,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,97.308,90.1,,percent of total billed charges,,
"ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) IV SOLN",,J0131,HCPCS,Facility,Inpatient,100,mL,,108,91.8,30.9528,108,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) IV SOLN",,J0131,HCPCS,Facility,Inpatient,100,mL,,108,91.8,30.9528,108,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) IV SOLN",,J0131,HCPCS,Facility,Both,100,mL,,108,91.8,30.9528,108,"Preferred One Administrative Services, INC.",PPO,106.488,98.6,,percent of total billed charges,,
"ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) IV SOLN",,J0131,HCPCS,Facility,Both,100,mL,,108,91.8,30.9528,108,"Preferred One Administrative Services, INC.",PPO,106.488,98.6,,percent of total billed charges,,
"ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) IV SOLN",,J0131,HCPCS,Facility,Outpatient,100,mL,,108,91.8,30.9528,108,PrimeWest Health,Minnesota Senior Health Options (MSHO),55.566,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) IV SOLN",,J0131,HCPCS,Facility,Outpatient,100,mL,,108,91.8,30.9528,108,PrimeWest Health,Minnesota Senior Health Options (MSHO),55.566,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) IV SOLN",,J0131,HCPCS,Facility,Inpatient,100,mL,,108,91.8,30.9528,108,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) IV SOLN",,J0131,HCPCS,Facility,Inpatient,100,mL,,108,91.8,30.9528,108,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) IV SOLN",,J0131,HCPCS,Facility,Outpatient,100,mL,,108,91.8,30.9528,108,PrimeWest Health,MinnesotaCare,55.4688,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) IV SOLN",,J0131,HCPCS,Facility,Outpatient,100,mL,,108,91.8,30.9528,108,PrimeWest Health,MinnesotaCare,55.4688,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) IV SOLN",,J0131,HCPCS,Facility,Inpatient,100,mL,,108,91.8,30.9528,108,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) IV SOLN",,J0131,HCPCS,Facility,Inpatient,100,mL,,108,91.8,30.9528,108,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) IV SOLN",,J0131,HCPCS,Facility,Both,100,mL,,108,91.8,30.9528,108,Sanford Health Plan,Sanford Health Plan,99.36,92,,percent of total billed charges,,
"ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) IV SOLN",,J0131,HCPCS,Facility,Both,100,mL,,108,91.8,30.9528,108,Sanford Health Plan,Sanford Health Plan,99.36,92,,percent of total billed charges,,
"ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) IV SOLN",,J0131,HCPCS,Facility,Outpatient,100,mL,,108,91.8,30.9528,108,"UCare Health, Inc.",Individual & Family Plan,60.858,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) IV SOLN",,J0131,HCPCS,Facility,Outpatient,100,mL,,108,91.8,30.9528,108,"UCare Health, Inc.",Individual & Family Plan,60.858,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) IV SOLN",,J0131,HCPCS,Facility,Inpatient,100,mL,,108,91.8,30.9528,108,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) IV SOLN",,J0131,HCPCS,Facility,Inpatient,100,mL,,108,91.8,30.9528,108,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) IV SOLN",,J0131,HCPCS,Facility,Outpatient,100,mL,,108,91.8,30.9528,108,"UCare Health, Inc.",Medical Assistance,54.5076,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) IV SOLN",,J0131,HCPCS,Facility,Outpatient,100,mL,,108,91.8,30.9528,108,"UCare Health, Inc.",Medical Assistance,54.5076,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) IV SOLN",,J0131,HCPCS,Facility,Inpatient,100,mL,,108,91.8,30.9528,108,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) IV SOLN",,J0131,HCPCS,Facility,Inpatient,100,mL,,108,91.8,30.9528,108,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) IV SOLN",,J0131,HCPCS,Facility,Outpatient,100,mL,,108,91.8,30.9528,108,"UCare Health, Inc.",Medicare Advantage,54.5076,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) IV SOLN",,J0131,HCPCS,Facility,Outpatient,100,mL,,108,91.8,30.9528,108,"UCare Health, Inc.",Medicare Advantage,54.5076,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) IV SOLN",,J0131,HCPCS,Facility,Inpatient,100,mL,,108,91.8,30.9528,108,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) IV SOLN",,J0131,HCPCS,Facility,Inpatient,100,mL,,108,91.8,30.9528,108,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) IV SOLN",,J0131,HCPCS,Facility,Outpatient,100,mL,,108,91.8,30.9528,108,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),54.5076,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) IV SOLN",,J0131,HCPCS,Facility,Outpatient,100,mL,,108,91.8,30.9528,108,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),54.5076,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) IV SOLN",,J0131,HCPCS,Facility,Inpatient,100,mL,,108,91.8,30.9528,108,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) IV SOLN",,J0131,HCPCS,Facility,Inpatient,100,mL,,108,91.8,30.9528,108,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) IV SOLN",,J0131,HCPCS,Facility,Both,100,mL,,108,91.8,30.9528,108,UnitedHealthcare,Individual & Family,101.52,94,,percent of total billed charges,,
"ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) IV SOLN",,J0131,HCPCS,Facility,Both,100,mL,,108,91.8,30.9528,108,UnitedHealthcare,Individual & Family,101.52,94,,percent of total billed charges,,
"ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) IV SOLN",,J0131,HCPCS,Facility,Outpatient,100,mL,,108,91.8,30.9528,108,UnitedHealthcare,Medicare Advantage,52.92,49,,percent of total billed charges,,
"ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) IV SOLN",,J0131,HCPCS,Facility,Outpatient,100,mL,,108,91.8,30.9528,108,UnitedHealthcare,Medicare Advantage,52.92,49,,percent of total billed charges,,
"ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) IV SOLN",,J0131,HCPCS,Facility,Inpatient,100,mL,,108,91.8,30.9528,108,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) IV SOLN",,J0131,HCPCS,Facility,Inpatient,100,mL,,108,91.8,30.9528,108,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) IV SOLN",,J0131,HCPCS,Facility,Outpatient,100,mL,,108,91.8,30.9528,108,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,51.84,48,,percent of total billed charges,,100% of DHS outpatient percentage
"ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) IV SOLN",,J0131,HCPCS,Facility,Outpatient,100,mL,,108,91.8,30.9528,108,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,51.84,48,,percent of total billed charges,,100% of DHS outpatient percentage
"ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) IV SOLN",,J0131,HCPCS,Facility,Inpatient,100,mL,,108,91.8,30.9528,108,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) IV SOLN",,J0131,HCPCS,Facility,Inpatient,100,mL,,108,91.8,30.9528,108,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
CIPROFLOXACIN IN 5 % DEXTROSE 200 MG/100 ML IV PGBK,,J0744,HCPCS,Facility,Both,100,mL,,17,14.45,4.8722,17,Aetna,Commercial,15.64,92,,percent of total billed charges,,
CIPROFLOXACIN IN 5 % DEXTROSE 200 MG/100 ML IV PGBK,,J0744,HCPCS,Facility,Outpatient,100,mL,,17,14.45,4.8722,17,Aetna,Medicare Advantage,8.33,49,,percent of total billed charges,,
CIPROFLOXACIN IN 5 % DEXTROSE 200 MG/100 ML IV PGBK,,J0744,HCPCS,Facility,Inpatient,100,mL,,17,14.45,4.8722,17,Aetna,Medicare Advantage,,,,,Included in per diem rate,
CIPROFLOXACIN IN 5 % DEXTROSE 200 MG/100 ML IV PGBK,,J0744,HCPCS,Facility,Both,100,mL,,17,14.45,4.8722,17,Aetna,PPO,15.81,93,,percent of total billed charges,,
CIPROFLOXACIN IN 5 % DEXTROSE 200 MG/100 ML IV PGBK,,J0744,HCPCS,Facility,Both,100,mL,,17,14.45,4.8722,17,America's PPO,America's PPO,16.3251,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
CIPROFLOXACIN IN 5 % DEXTROSE 200 MG/100 ML IV PGBK,,J0744,HCPCS,Facility,Both,100,mL,,17,14.45,4.8722,17,BlueCross BlueShield Minnesota, Federal Employee Program,16.728,98.4,,percent of total billed charges,,
CIPROFLOXACIN IN 5 % DEXTROSE 200 MG/100 ML IV PGBK,,J0744,HCPCS,Facility,Both,100,mL,,17,14.45,4.8722,17,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,17,100,,percent of total billed charges,,
CIPROFLOXACIN IN 5 % DEXTROSE 200 MG/100 ML IV PGBK,,J0744,HCPCS,Facility,Both,100,mL,,17,14.45,4.8722,17,BlueCross BlueShield Minnesota,High Value Network Plan,15.3,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
CIPROFLOXACIN IN 5 % DEXTROSE 200 MG/100 ML IV PGBK,,J0744,HCPCS,Facility,Outpatient,100,mL,,17,14.45,4.8722,17,BlueCross BlueShield Minnesota,Medicare Advantage,8.33,49,,percent of total billed charges,,
CIPROFLOXACIN IN 5 % DEXTROSE 200 MG/100 ML IV PGBK,,J0744,HCPCS,Facility,Inpatient,100,mL,,17,14.45,4.8722,17,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
CIPROFLOXACIN IN 5 % DEXTROSE 200 MG/100 ML IV PGBK,,J0744,HCPCS,Facility,Both,100,mL,,17,14.45,4.8722,17,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,15.0569,88.57,,percent of total billed charges,,
CIPROFLOXACIN IN 5 % DEXTROSE 200 MG/100 ML IV PGBK,,J0744,HCPCS,Facility,Both,100,mL,,17,14.45,4.8722,17,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,4.8722,28.66,,percent of total billed charges,,
CIPROFLOXACIN IN 5 % DEXTROSE 200 MG/100 ML IV PGBK,,J0744,HCPCS,Facility,Outpatient,100,mL,,17,14.45,4.8722,17,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),8.33,49,,percent of total billed charges,,
CIPROFLOXACIN IN 5 % DEXTROSE 200 MG/100 ML IV PGBK,,J0744,HCPCS,Facility,Inpatient,100,mL,,17,14.45,4.8722,17,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
CIPROFLOXACIN IN 5 % DEXTROSE 200 MG/100 ML IV PGBK,,J0744,HCPCS,Facility,Both,100,mL,,17,14.45,4.8722,17,CorVel,Worker's Compensation,17,100,,percent of total billed charges,,
CIPROFLOXACIN IN 5 % DEXTROSE 200 MG/100 ML IV PGBK,,J0744,HCPCS,Facility,Both,100,mL,,17,14.45,4.8722,17,First Health Group Corporation,First Health Network,16.49,97,,percent of total billed charges,,
CIPROFLOXACIN IN 5 % DEXTROSE 200 MG/100 ML IV PGBK,,J0744,HCPCS,Facility,Both,100,mL,,17,14.45,4.8722,17,"Health Partners, Inc.",Commercial,16.082,94.6,,percent of total billed charges,,
CIPROFLOXACIN IN 5 % DEXTROSE 200 MG/100 ML IV PGBK,,J0744,HCPCS,Facility,Outpatient,100,mL,,17,14.45,4.8722,17,"Health Partners, Inc.",Medicare Advantage,8.33,49,,percent of total billed charges,,
CIPROFLOXACIN IN 5 % DEXTROSE 200 MG/100 ML IV PGBK,,J0744,HCPCS,Facility,Inpatient,100,mL,,17,14.45,4.8722,17,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CIPROFLOXACIN IN 5 % DEXTROSE 200 MG/100 ML IV PGBK,,J0744,HCPCS,Facility,Both,100,mL,,17,14.45,4.8722,17,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),10.2,60,,percent of total billed charges,,
CIPROFLOXACIN IN 5 % DEXTROSE 200 MG/100 ML IV PGBK,,J0744,HCPCS,Facility,Both,100,mL,,17,14.45,4.8722,17,"Health Partners, Inc.",State of Minnesota Advantage Program,13.855,81.5,,percent of total billed charges,,
CIPROFLOXACIN IN 5 % DEXTROSE 200 MG/100 ML IV PGBK,,J0744,HCPCS,Facility,Both,100,mL,,17,14.45,4.8722,17,"Health Partners, Inc.",State Public Programs,8.5,50,,percent of total billed charges,,
CIPROFLOXACIN IN 5 % DEXTROSE 200 MG/100 ML IV PGBK,,J0744,HCPCS,Facility,Both,100,mL,,17,14.45,4.8722,17,Humana Insurance Company,Commercial PPO,16.15,95,,percent of total billed charges,,
CIPROFLOXACIN IN 5 % DEXTROSE 200 MG/100 ML IV PGBK,,J0744,HCPCS,Facility,Outpatient,100,mL,,17,14.45,4.8722,17,Humana Insurance Company,Medicare PPO,8.33,49,,percent of total billed charges,,
CIPROFLOXACIN IN 5 % DEXTROSE 200 MG/100 ML IV PGBK,,J0744,HCPCS,Facility,Inpatient,100,mL,,17,14.45,4.8722,17,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
CIPROFLOXACIN IN 5 % DEXTROSE 200 MG/100 ML IV PGBK,,J0744,HCPCS,Facility,Both,100,mL,,17,14.45,4.8722,17,Medica,Individual & Family,16.847,99.1,,percent of total billed charges,,
CIPROFLOXACIN IN 5 % DEXTROSE 200 MG/100 ML IV PGBK,,J0744,HCPCS,Facility,Outpatient,100,mL,,17,14.45,4.8722,17,Medica,Medica Advantage Solution,8.466,49.8,,percent of total billed charges,,
CIPROFLOXACIN IN 5 % DEXTROSE 200 MG/100 ML IV PGBK,,J0744,HCPCS,Facility,Inpatient,100,mL,,17,14.45,4.8722,17,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
CIPROFLOXACIN IN 5 % DEXTROSE 200 MG/100 ML IV PGBK,,J0744,HCPCS,Facility,Outpatient,100,mL,,17,14.45,4.8722,17,Medica,Medical Assistance,7.582,44.6,,percent of total billed charges,,
CIPROFLOXACIN IN 5 % DEXTROSE 200 MG/100 ML IV PGBK,,J0744,HCPCS,Facility,Inpatient,100,mL,,17,14.45,4.8722,17,Medica,Medical Assistance,,,,,Included in per diem rate,
CIPROFLOXACIN IN 5 % DEXTROSE 200 MG/100 ML IV PGBK,,J0744,HCPCS,Facility,Outpatient,100,mL,,17,14.45,4.8722,17,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,8.466,49.8,,percent of total billed charges,,
CIPROFLOXACIN IN 5 % DEXTROSE 200 MG/100 ML IV PGBK,,J0744,HCPCS,Facility,Inpatient,100,mL,,17,14.45,4.8722,17,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
CIPROFLOXACIN IN 5 % DEXTROSE 200 MG/100 ML IV PGBK,,J0744,HCPCS,Facility,Both,100,mL,,17,14.45,4.8722,17,"Multiplan, Inc.","Multiplan, Inc.",15.98,94,,percent of total billed charges,,
CIPROFLOXACIN IN 5 % DEXTROSE 200 MG/100 ML IV PGBK,,J0744,HCPCS,Facility,Outpatient,100,mL,,17,14.45,4.8722,17,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,15.317,90.1,,percent of total billed charges,,
CIPROFLOXACIN IN 5 % DEXTROSE 200 MG/100 ML IV PGBK,,J0744,HCPCS,Facility,Inpatient,100,mL,,17,14.45,4.8722,17,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
CIPROFLOXACIN IN 5 % DEXTROSE 200 MG/100 ML IV PGBK,,J0744,HCPCS,Facility,Both,100,mL,,17,14.45,4.8722,17,"Preferred One Administrative Services, INC.",PPO,16.762,98.6,,percent of total billed charges,,
CIPROFLOXACIN IN 5 % DEXTROSE 200 MG/100 ML IV PGBK,,J0744,HCPCS,Facility,Outpatient,100,mL,,17,14.45,4.8722,17,PrimeWest Health,Minnesota Senior Health Options (MSHO),8.7465,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
CIPROFLOXACIN IN 5 % DEXTROSE 200 MG/100 ML IV PGBK,,J0744,HCPCS,Facility,Inpatient,100,mL,,17,14.45,4.8722,17,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CIPROFLOXACIN IN 5 % DEXTROSE 200 MG/100 ML IV PGBK,,J0744,HCPCS,Facility,Outpatient,100,mL,,17,14.45,4.8722,17,PrimeWest Health,MinnesotaCare,8.7312,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
CIPROFLOXACIN IN 5 % DEXTROSE 200 MG/100 ML IV PGBK,,J0744,HCPCS,Facility,Inpatient,100,mL,,17,14.45,4.8722,17,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
CIPROFLOXACIN IN 5 % DEXTROSE 200 MG/100 ML IV PGBK,,J0744,HCPCS,Facility,Both,100,mL,,17,14.45,4.8722,17,Sanford Health Plan,Sanford Health Plan,15.64,92,,percent of total billed charges,,
CIPROFLOXACIN IN 5 % DEXTROSE 200 MG/100 ML IV PGBK,,J0744,HCPCS,Facility,Outpatient,100,mL,,17,14.45,4.8722,17,"UCare Health, Inc.",Individual & Family Plan,9.5795,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
CIPROFLOXACIN IN 5 % DEXTROSE 200 MG/100 ML IV PGBK,,J0744,HCPCS,Facility,Inpatient,100,mL,,17,14.45,4.8722,17,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
CIPROFLOXACIN IN 5 % DEXTROSE 200 MG/100 ML IV PGBK,,J0744,HCPCS,Facility,Outpatient,100,mL,,17,14.45,4.8722,17,"UCare Health, Inc.",Medical Assistance,8.5799,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CIPROFLOXACIN IN 5 % DEXTROSE 200 MG/100 ML IV PGBK,,J0744,HCPCS,Facility,Inpatient,100,mL,,17,14.45,4.8722,17,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
CIPROFLOXACIN IN 5 % DEXTROSE 200 MG/100 ML IV PGBK,,J0744,HCPCS,Facility,Outpatient,100,mL,,17,14.45,4.8722,17,"UCare Health, Inc.",Medicare Advantage,8.5799,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CIPROFLOXACIN IN 5 % DEXTROSE 200 MG/100 ML IV PGBK,,J0744,HCPCS,Facility,Inpatient,100,mL,,17,14.45,4.8722,17,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CIPROFLOXACIN IN 5 % DEXTROSE 200 MG/100 ML IV PGBK,,J0744,HCPCS,Facility,Outpatient,100,mL,,17,14.45,4.8722,17,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),8.5799,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CIPROFLOXACIN IN 5 % DEXTROSE 200 MG/100 ML IV PGBK,,J0744,HCPCS,Facility,Inpatient,100,mL,,17,14.45,4.8722,17,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CIPROFLOXACIN IN 5 % DEXTROSE 200 MG/100 ML IV PGBK,,J0744,HCPCS,Facility,Both,100,mL,,17,14.45,4.8722,17,UnitedHealthcare,Individual & Family,15.98,94,,percent of total billed charges,,
CIPROFLOXACIN IN 5 % DEXTROSE 200 MG/100 ML IV PGBK,,J0744,HCPCS,Facility,Outpatient,100,mL,,17,14.45,4.8722,17,UnitedHealthcare,Medicare Advantage,8.33,49,,percent of total billed charges,,
CIPROFLOXACIN IN 5 % DEXTROSE 200 MG/100 ML IV PGBK,,J0744,HCPCS,Facility,Inpatient,100,mL,,17,14.45,4.8722,17,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
CIPROFLOXACIN IN 5 % DEXTROSE 200 MG/100 ML IV PGBK,,J0744,HCPCS,Facility,Outpatient,100,mL,,17,14.45,4.8722,17,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,8.16,48,,percent of total billed charges,,100% of DHS outpatient percentage
CIPROFLOXACIN IN 5 % DEXTROSE 200 MG/100 ML IV PGBK,,J0744,HCPCS,Facility,Inpatient,100,mL,,17,14.45,4.8722,17,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
FLUCONAZOLE IN NACL (ISO-OSM) 200 MG/100 ML IV PGBK,,J1450,HCPCS,Facility,Both,100,mL,,36,30.6,10.3176,36,Aetna,Commercial,33.12,92,,percent of total billed charges,,
FLUCONAZOLE IN NACL (ISO-OSM) 200 MG/100 ML IV PGBK,,J1450,HCPCS,Facility,Outpatient,100,mL,,36,30.6,10.3176,36,Aetna,Medicare Advantage,17.64,49,,percent of total billed charges,,
FLUCONAZOLE IN NACL (ISO-OSM) 200 MG/100 ML IV PGBK,,J1450,HCPCS,Facility,Inpatient,100,mL,,36,30.6,10.3176,36,Aetna,Medicare Advantage,,,,,Included in per diem rate,
FLUCONAZOLE IN NACL (ISO-OSM) 200 MG/100 ML IV PGBK,,J1450,HCPCS,Facility,Both,100,mL,,36,30.6,10.3176,36,Aetna,PPO,33.48,93,,percent of total billed charges,,
FLUCONAZOLE IN NACL (ISO-OSM) 200 MG/100 ML IV PGBK,,J1450,HCPCS,Facility,Both,100,mL,,36,30.6,10.3176,36,America's PPO,America's PPO,34.5708,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
FLUCONAZOLE IN NACL (ISO-OSM) 200 MG/100 ML IV PGBK,,J1450,HCPCS,Facility,Both,100,mL,,36,30.6,10.3176,36,BlueCross BlueShield Minnesota, Federal Employee Program,35.424,98.4,,percent of total billed charges,,
FLUCONAZOLE IN NACL (ISO-OSM) 200 MG/100 ML IV PGBK,,J1450,HCPCS,Facility,Both,100,mL,,36,30.6,10.3176,36,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,36,100,,percent of total billed charges,,
FLUCONAZOLE IN NACL (ISO-OSM) 200 MG/100 ML IV PGBK,,J1450,HCPCS,Facility,Both,100,mL,,36,30.6,10.3176,36,BlueCross BlueShield Minnesota,High Value Network Plan,32.4,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
FLUCONAZOLE IN NACL (ISO-OSM) 200 MG/100 ML IV PGBK,,J1450,HCPCS,Facility,Outpatient,100,mL,,36,30.6,10.3176,36,BlueCross BlueShield Minnesota,Medicare Advantage,17.64,49,,percent of total billed charges,,
FLUCONAZOLE IN NACL (ISO-OSM) 200 MG/100 ML IV PGBK,,J1450,HCPCS,Facility,Inpatient,100,mL,,36,30.6,10.3176,36,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
FLUCONAZOLE IN NACL (ISO-OSM) 200 MG/100 ML IV PGBK,,J1450,HCPCS,Facility,Both,100,mL,,36,30.6,10.3176,36,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,31.8852,88.57,,percent of total billed charges,,
FLUCONAZOLE IN NACL (ISO-OSM) 200 MG/100 ML IV PGBK,,J1450,HCPCS,Facility,Both,100,mL,,36,30.6,10.3176,36,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,10.3176,28.66,,percent of total billed charges,,
FLUCONAZOLE IN NACL (ISO-OSM) 200 MG/100 ML IV PGBK,,J1450,HCPCS,Facility,Outpatient,100,mL,,36,30.6,10.3176,36,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),17.64,49,,percent of total billed charges,,
FLUCONAZOLE IN NACL (ISO-OSM) 200 MG/100 ML IV PGBK,,J1450,HCPCS,Facility,Inpatient,100,mL,,36,30.6,10.3176,36,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
FLUCONAZOLE IN NACL (ISO-OSM) 200 MG/100 ML IV PGBK,,J1450,HCPCS,Facility,Both,100,mL,,36,30.6,10.3176,36,CorVel,Worker's Compensation,36,100,,percent of total billed charges,,
FLUCONAZOLE IN NACL (ISO-OSM) 200 MG/100 ML IV PGBK,,J1450,HCPCS,Facility,Both,100,mL,,36,30.6,10.3176,36,First Health Group Corporation,First Health Network,34.92,97,,percent of total billed charges,,
FLUCONAZOLE IN NACL (ISO-OSM) 200 MG/100 ML IV PGBK,,J1450,HCPCS,Facility,Both,100,mL,,36,30.6,10.3176,36,"Health Partners, Inc.",Commercial,34.056,94.6,,percent of total billed charges,,
FLUCONAZOLE IN NACL (ISO-OSM) 200 MG/100 ML IV PGBK,,J1450,HCPCS,Facility,Outpatient,100,mL,,36,30.6,10.3176,36,"Health Partners, Inc.",Medicare Advantage,17.64,49,,percent of total billed charges,,
FLUCONAZOLE IN NACL (ISO-OSM) 200 MG/100 ML IV PGBK,,J1450,HCPCS,Facility,Inpatient,100,mL,,36,30.6,10.3176,36,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
FLUCONAZOLE IN NACL (ISO-OSM) 200 MG/100 ML IV PGBK,,J1450,HCPCS,Facility,Both,100,mL,,36,30.6,10.3176,36,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),21.6,60,,percent of total billed charges,,
FLUCONAZOLE IN NACL (ISO-OSM) 200 MG/100 ML IV PGBK,,J1450,HCPCS,Facility,Both,100,mL,,36,30.6,10.3176,36,"Health Partners, Inc.",State of Minnesota Advantage Program,29.34,81.5,,percent of total billed charges,,
FLUCONAZOLE IN NACL (ISO-OSM) 200 MG/100 ML IV PGBK,,J1450,HCPCS,Facility,Both,100,mL,,36,30.6,10.3176,36,"Health Partners, Inc.",State Public Programs,18,50,,percent of total billed charges,,
FLUCONAZOLE IN NACL (ISO-OSM) 200 MG/100 ML IV PGBK,,J1450,HCPCS,Facility,Both,100,mL,,36,30.6,10.3176,36,Humana Insurance Company,Commercial PPO,34.2,95,,percent of total billed charges,,
FLUCONAZOLE IN NACL (ISO-OSM) 200 MG/100 ML IV PGBK,,J1450,HCPCS,Facility,Outpatient,100,mL,,36,30.6,10.3176,36,Humana Insurance Company,Medicare PPO,17.64,49,,percent of total billed charges,,
FLUCONAZOLE IN NACL (ISO-OSM) 200 MG/100 ML IV PGBK,,J1450,HCPCS,Facility,Inpatient,100,mL,,36,30.6,10.3176,36,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
FLUCONAZOLE IN NACL (ISO-OSM) 200 MG/100 ML IV PGBK,,J1450,HCPCS,Facility,Both,100,mL,,36,30.6,10.3176,36,Medica,Individual & Family,35.676,99.1,,percent of total billed charges,,
FLUCONAZOLE IN NACL (ISO-OSM) 200 MG/100 ML IV PGBK,,J1450,HCPCS,Facility,Outpatient,100,mL,,36,30.6,10.3176,36,Medica,Medica Advantage Solution,17.928,49.8,,percent of total billed charges,,
FLUCONAZOLE IN NACL (ISO-OSM) 200 MG/100 ML IV PGBK,,J1450,HCPCS,Facility,Inpatient,100,mL,,36,30.6,10.3176,36,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
FLUCONAZOLE IN NACL (ISO-OSM) 200 MG/100 ML IV PGBK,,J1450,HCPCS,Facility,Outpatient,100,mL,,36,30.6,10.3176,36,Medica,Medical Assistance,16.056,44.6,,percent of total billed charges,,
FLUCONAZOLE IN NACL (ISO-OSM) 200 MG/100 ML IV PGBK,,J1450,HCPCS,Facility,Inpatient,100,mL,,36,30.6,10.3176,36,Medica,Medical Assistance,,,,,Included in per diem rate,
FLUCONAZOLE IN NACL (ISO-OSM) 200 MG/100 ML IV PGBK,,J1450,HCPCS,Facility,Outpatient,100,mL,,36,30.6,10.3176,36,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,17.928,49.8,,percent of total billed charges,,
FLUCONAZOLE IN NACL (ISO-OSM) 200 MG/100 ML IV PGBK,,J1450,HCPCS,Facility,Inpatient,100,mL,,36,30.6,10.3176,36,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
FLUCONAZOLE IN NACL (ISO-OSM) 200 MG/100 ML IV PGBK,,J1450,HCPCS,Facility,Both,100,mL,,36,30.6,10.3176,36,"Multiplan, Inc.","Multiplan, Inc.",33.84,94,,percent of total billed charges,,
FLUCONAZOLE IN NACL (ISO-OSM) 200 MG/100 ML IV PGBK,,J1450,HCPCS,Facility,Outpatient,100,mL,,36,30.6,10.3176,36,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,32.436,90.1,,percent of total billed charges,,
FLUCONAZOLE IN NACL (ISO-OSM) 200 MG/100 ML IV PGBK,,J1450,HCPCS,Facility,Inpatient,100,mL,,36,30.6,10.3176,36,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
FLUCONAZOLE IN NACL (ISO-OSM) 200 MG/100 ML IV PGBK,,J1450,HCPCS,Facility,Both,100,mL,,36,30.6,10.3176,36,"Preferred One Administrative Services, INC.",PPO,35.496,98.6,,percent of total billed charges,,
FLUCONAZOLE IN NACL (ISO-OSM) 200 MG/100 ML IV PGBK,,J1450,HCPCS,Facility,Outpatient,100,mL,,36,30.6,10.3176,36,PrimeWest Health,Minnesota Senior Health Options (MSHO),18.522,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
FLUCONAZOLE IN NACL (ISO-OSM) 200 MG/100 ML IV PGBK,,J1450,HCPCS,Facility,Inpatient,100,mL,,36,30.6,10.3176,36,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
FLUCONAZOLE IN NACL (ISO-OSM) 200 MG/100 ML IV PGBK,,J1450,HCPCS,Facility,Outpatient,100,mL,,36,30.6,10.3176,36,PrimeWest Health,MinnesotaCare,18.4896,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
FLUCONAZOLE IN NACL (ISO-OSM) 200 MG/100 ML IV PGBK,,J1450,HCPCS,Facility,Inpatient,100,mL,,36,30.6,10.3176,36,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
FLUCONAZOLE IN NACL (ISO-OSM) 200 MG/100 ML IV PGBK,,J1450,HCPCS,Facility,Both,100,mL,,36,30.6,10.3176,36,Sanford Health Plan,Sanford Health Plan,33.12,92,,percent of total billed charges,,
FLUCONAZOLE IN NACL (ISO-OSM) 200 MG/100 ML IV PGBK,,J1450,HCPCS,Facility,Outpatient,100,mL,,36,30.6,10.3176,36,"UCare Health, Inc.",Individual & Family Plan,20.286,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
FLUCONAZOLE IN NACL (ISO-OSM) 200 MG/100 ML IV PGBK,,J1450,HCPCS,Facility,Inpatient,100,mL,,36,30.6,10.3176,36,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
FLUCONAZOLE IN NACL (ISO-OSM) 200 MG/100 ML IV PGBK,,J1450,HCPCS,Facility,Outpatient,100,mL,,36,30.6,10.3176,36,"UCare Health, Inc.",Medical Assistance,18.1692,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FLUCONAZOLE IN NACL (ISO-OSM) 200 MG/100 ML IV PGBK,,J1450,HCPCS,Facility,Inpatient,100,mL,,36,30.6,10.3176,36,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
FLUCONAZOLE IN NACL (ISO-OSM) 200 MG/100 ML IV PGBK,,J1450,HCPCS,Facility,Outpatient,100,mL,,36,30.6,10.3176,36,"UCare Health, Inc.",Medicare Advantage,18.1692,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FLUCONAZOLE IN NACL (ISO-OSM) 200 MG/100 ML IV PGBK,,J1450,HCPCS,Facility,Inpatient,100,mL,,36,30.6,10.3176,36,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
FLUCONAZOLE IN NACL (ISO-OSM) 200 MG/100 ML IV PGBK,,J1450,HCPCS,Facility,Outpatient,100,mL,,36,30.6,10.3176,36,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),18.1692,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FLUCONAZOLE IN NACL (ISO-OSM) 200 MG/100 ML IV PGBK,,J1450,HCPCS,Facility,Inpatient,100,mL,,36,30.6,10.3176,36,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
FLUCONAZOLE IN NACL (ISO-OSM) 200 MG/100 ML IV PGBK,,J1450,HCPCS,Facility,Both,100,mL,,36,30.6,10.3176,36,UnitedHealthcare,Individual & Family,33.84,94,,percent of total billed charges,,
FLUCONAZOLE IN NACL (ISO-OSM) 200 MG/100 ML IV PGBK,,J1450,HCPCS,Facility,Outpatient,100,mL,,36,30.6,10.3176,36,UnitedHealthcare,Medicare Advantage,17.64,49,,percent of total billed charges,,
FLUCONAZOLE IN NACL (ISO-OSM) 200 MG/100 ML IV PGBK,,J1450,HCPCS,Facility,Inpatient,100,mL,,36,30.6,10.3176,36,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
FLUCONAZOLE IN NACL (ISO-OSM) 200 MG/100 ML IV PGBK,,J1450,HCPCS,Facility,Outpatient,100,mL,,36,30.6,10.3176,36,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,17.28,48,,percent of total billed charges,,100% of DHS outpatient percentage
FLUCONAZOLE IN NACL (ISO-OSM) 200 MG/100 ML IV PGBK,,J1450,HCPCS,Facility,Inpatient,100,mL,,36,30.6,10.3176,36,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
METRONIDAZOLE IN NACL (ISO-OS) 500 MG/100 ML IV PGBK,,J1836,HCPCS,Facility,Both,100,mL,,14,11.9,4.0124,14,Aetna,Commercial,12.88,92,,percent of total billed charges,,
METRONIDAZOLE IN NACL (ISO-OS) 500 MG/100 ML IV PGBK,,J1836,HCPCS,Facility,Outpatient,100,mL,,14,11.9,4.0124,14,Aetna,Medicare Advantage,6.86,49,,percent of total billed charges,,
METRONIDAZOLE IN NACL (ISO-OS) 500 MG/100 ML IV PGBK,,J1836,HCPCS,Facility,Inpatient,100,mL,,14,11.9,4.0124,14,Aetna,Medicare Advantage,,,,,Included in per diem rate,
METRONIDAZOLE IN NACL (ISO-OS) 500 MG/100 ML IV PGBK,,J1836,HCPCS,Facility,Both,100,mL,,14,11.9,4.0124,14,Aetna,PPO,13.02,93,,percent of total billed charges,,
METRONIDAZOLE IN NACL (ISO-OS) 500 MG/100 ML IV PGBK,,J1836,HCPCS,Facility,Both,100,mL,,14,11.9,4.0124,14,America's PPO,America's PPO,13.4442,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
METRONIDAZOLE IN NACL (ISO-OS) 500 MG/100 ML IV PGBK,,J1836,HCPCS,Facility,Both,100,mL,,14,11.9,4.0124,14,BlueCross BlueShield Minnesota, Federal Employee Program,13.776,98.4,,percent of total billed charges,,
METRONIDAZOLE IN NACL (ISO-OS) 500 MG/100 ML IV PGBK,,J1836,HCPCS,Facility,Both,100,mL,,14,11.9,4.0124,14,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,14,100,,percent of total billed charges,,
METRONIDAZOLE IN NACL (ISO-OS) 500 MG/100 ML IV PGBK,,J1836,HCPCS,Facility,Both,100,mL,,14,11.9,4.0124,14,BlueCross BlueShield Minnesota,High Value Network Plan,12.6,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
METRONIDAZOLE IN NACL (ISO-OS) 500 MG/100 ML IV PGBK,,J1836,HCPCS,Facility,Outpatient,100,mL,,14,11.9,4.0124,14,BlueCross BlueShield Minnesota,Medicare Advantage,6.86,49,,percent of total billed charges,,
METRONIDAZOLE IN NACL (ISO-OS) 500 MG/100 ML IV PGBK,,J1836,HCPCS,Facility,Inpatient,100,mL,,14,11.9,4.0124,14,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
METRONIDAZOLE IN NACL (ISO-OS) 500 MG/100 ML IV PGBK,,J1836,HCPCS,Facility,Both,100,mL,,14,11.9,4.0124,14,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,12.3998,88.57,,percent of total billed charges,,
METRONIDAZOLE IN NACL (ISO-OS) 500 MG/100 ML IV PGBK,,J1836,HCPCS,Facility,Both,100,mL,,14,11.9,4.0124,14,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,4.0124,28.66,,percent of total billed charges,,
METRONIDAZOLE IN NACL (ISO-OS) 500 MG/100 ML IV PGBK,,J1836,HCPCS,Facility,Outpatient,100,mL,,14,11.9,4.0124,14,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),6.86,49,,percent of total billed charges,,
METRONIDAZOLE IN NACL (ISO-OS) 500 MG/100 ML IV PGBK,,J1836,HCPCS,Facility,Inpatient,100,mL,,14,11.9,4.0124,14,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
METRONIDAZOLE IN NACL (ISO-OS) 500 MG/100 ML IV PGBK,,J1836,HCPCS,Facility,Both,100,mL,,14,11.9,4.0124,14,CorVel,Worker's Compensation,14,100,,percent of total billed charges,,
METRONIDAZOLE IN NACL (ISO-OS) 500 MG/100 ML IV PGBK,,J1836,HCPCS,Facility,Both,100,mL,,14,11.9,4.0124,14,First Health Group Corporation,First Health Network,13.58,97,,percent of total billed charges,,
METRONIDAZOLE IN NACL (ISO-OS) 500 MG/100 ML IV PGBK,,J1836,HCPCS,Facility,Both,100,mL,,14,11.9,4.0124,14,"Health Partners, Inc.",Commercial,13.244,94.6,,percent of total billed charges,,
METRONIDAZOLE IN NACL (ISO-OS) 500 MG/100 ML IV PGBK,,J1836,HCPCS,Facility,Outpatient,100,mL,,14,11.9,4.0124,14,"Health Partners, Inc.",Medicare Advantage,6.86,49,,percent of total billed charges,,
METRONIDAZOLE IN NACL (ISO-OS) 500 MG/100 ML IV PGBK,,J1836,HCPCS,Facility,Inpatient,100,mL,,14,11.9,4.0124,14,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
METRONIDAZOLE IN NACL (ISO-OS) 500 MG/100 ML IV PGBK,,J1836,HCPCS,Facility,Both,100,mL,,14,11.9,4.0124,14,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),8.4,60,,percent of total billed charges,,
METRONIDAZOLE IN NACL (ISO-OS) 500 MG/100 ML IV PGBK,,J1836,HCPCS,Facility,Both,100,mL,,14,11.9,4.0124,14,"Health Partners, Inc.",State of Minnesota Advantage Program,11.41,81.5,,percent of total billed charges,,
METRONIDAZOLE IN NACL (ISO-OS) 500 MG/100 ML IV PGBK,,J1836,HCPCS,Facility,Both,100,mL,,14,11.9,4.0124,14,"Health Partners, Inc.",State Public Programs,7,50,,percent of total billed charges,,
METRONIDAZOLE IN NACL (ISO-OS) 500 MG/100 ML IV PGBK,,J1836,HCPCS,Facility,Both,100,mL,,14,11.9,4.0124,14,Humana Insurance Company,Commercial PPO,13.3,95,,percent of total billed charges,,
METRONIDAZOLE IN NACL (ISO-OS) 500 MG/100 ML IV PGBK,,J1836,HCPCS,Facility,Outpatient,100,mL,,14,11.9,4.0124,14,Humana Insurance Company,Medicare PPO,6.86,49,,percent of total billed charges,,
METRONIDAZOLE IN NACL (ISO-OS) 500 MG/100 ML IV PGBK,,J1836,HCPCS,Facility,Inpatient,100,mL,,14,11.9,4.0124,14,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
METRONIDAZOLE IN NACL (ISO-OS) 500 MG/100 ML IV PGBK,,J1836,HCPCS,Facility,Both,100,mL,,14,11.9,4.0124,14,Medica,Individual & Family,13.874,99.1,,percent of total billed charges,,
METRONIDAZOLE IN NACL (ISO-OS) 500 MG/100 ML IV PGBK,,J1836,HCPCS,Facility,Outpatient,100,mL,,14,11.9,4.0124,14,Medica,Medica Advantage Solution,6.972,49.8,,percent of total billed charges,,
METRONIDAZOLE IN NACL (ISO-OS) 500 MG/100 ML IV PGBK,,J1836,HCPCS,Facility,Inpatient,100,mL,,14,11.9,4.0124,14,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
METRONIDAZOLE IN NACL (ISO-OS) 500 MG/100 ML IV PGBK,,J1836,HCPCS,Facility,Outpatient,100,mL,,14,11.9,4.0124,14,Medica,Medical Assistance,6.244,44.6,,percent of total billed charges,,
METRONIDAZOLE IN NACL (ISO-OS) 500 MG/100 ML IV PGBK,,J1836,HCPCS,Facility,Inpatient,100,mL,,14,11.9,4.0124,14,Medica,Medical Assistance,,,,,Included in per diem rate,
METRONIDAZOLE IN NACL (ISO-OS) 500 MG/100 ML IV PGBK,,J1836,HCPCS,Facility,Outpatient,100,mL,,14,11.9,4.0124,14,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,6.972,49.8,,percent of total billed charges,,
METRONIDAZOLE IN NACL (ISO-OS) 500 MG/100 ML IV PGBK,,J1836,HCPCS,Facility,Inpatient,100,mL,,14,11.9,4.0124,14,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
METRONIDAZOLE IN NACL (ISO-OS) 500 MG/100 ML IV PGBK,,J1836,HCPCS,Facility,Both,100,mL,,14,11.9,4.0124,14,"Multiplan, Inc.","Multiplan, Inc.",13.16,94,,percent of total billed charges,,
METRONIDAZOLE IN NACL (ISO-OS) 500 MG/100 ML IV PGBK,,J1836,HCPCS,Facility,Outpatient,100,mL,,14,11.9,4.0124,14,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,12.614,90.1,,percent of total billed charges,,
METRONIDAZOLE IN NACL (ISO-OS) 500 MG/100 ML IV PGBK,,J1836,HCPCS,Facility,Inpatient,100,mL,,14,11.9,4.0124,14,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
METRONIDAZOLE IN NACL (ISO-OS) 500 MG/100 ML IV PGBK,,J1836,HCPCS,Facility,Both,100,mL,,14,11.9,4.0124,14,"Preferred One Administrative Services, INC.",PPO,13.804,98.6,,percent of total billed charges,,
METRONIDAZOLE IN NACL (ISO-OS) 500 MG/100 ML IV PGBK,,J1836,HCPCS,Facility,Outpatient,100,mL,,14,11.9,4.0124,14,PrimeWest Health,Minnesota Senior Health Options (MSHO),7.203,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
METRONIDAZOLE IN NACL (ISO-OS) 500 MG/100 ML IV PGBK,,J1836,HCPCS,Facility,Inpatient,100,mL,,14,11.9,4.0124,14,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
METRONIDAZOLE IN NACL (ISO-OS) 500 MG/100 ML IV PGBK,,J1836,HCPCS,Facility,Outpatient,100,mL,,14,11.9,4.0124,14,PrimeWest Health,MinnesotaCare,7.1904,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
METRONIDAZOLE IN NACL (ISO-OS) 500 MG/100 ML IV PGBK,,J1836,HCPCS,Facility,Inpatient,100,mL,,14,11.9,4.0124,14,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
METRONIDAZOLE IN NACL (ISO-OS) 500 MG/100 ML IV PGBK,,J1836,HCPCS,Facility,Both,100,mL,,14,11.9,4.0124,14,Sanford Health Plan,Sanford Health Plan,12.88,92,,percent of total billed charges,,
METRONIDAZOLE IN NACL (ISO-OS) 500 MG/100 ML IV PGBK,,J1836,HCPCS,Facility,Outpatient,100,mL,,14,11.9,4.0124,14,"UCare Health, Inc.",Individual & Family Plan,7.889,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
METRONIDAZOLE IN NACL (ISO-OS) 500 MG/100 ML IV PGBK,,J1836,HCPCS,Facility,Inpatient,100,mL,,14,11.9,4.0124,14,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
METRONIDAZOLE IN NACL (ISO-OS) 500 MG/100 ML IV PGBK,,J1836,HCPCS,Facility,Outpatient,100,mL,,14,11.9,4.0124,14,"UCare Health, Inc.",Medical Assistance,7.0658,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
METRONIDAZOLE IN NACL (ISO-OS) 500 MG/100 ML IV PGBK,,J1836,HCPCS,Facility,Inpatient,100,mL,,14,11.9,4.0124,14,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
METRONIDAZOLE IN NACL (ISO-OS) 500 MG/100 ML IV PGBK,,J1836,HCPCS,Facility,Outpatient,100,mL,,14,11.9,4.0124,14,"UCare Health, Inc.",Medicare Advantage,7.0658,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
METRONIDAZOLE IN NACL (ISO-OS) 500 MG/100 ML IV PGBK,,J1836,HCPCS,Facility,Inpatient,100,mL,,14,11.9,4.0124,14,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
METRONIDAZOLE IN NACL (ISO-OS) 500 MG/100 ML IV PGBK,,J1836,HCPCS,Facility,Outpatient,100,mL,,14,11.9,4.0124,14,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),7.0658,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
METRONIDAZOLE IN NACL (ISO-OS) 500 MG/100 ML IV PGBK,,J1836,HCPCS,Facility,Inpatient,100,mL,,14,11.9,4.0124,14,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
METRONIDAZOLE IN NACL (ISO-OS) 500 MG/100 ML IV PGBK,,J1836,HCPCS,Facility,Both,100,mL,,14,11.9,4.0124,14,UnitedHealthcare,Individual & Family,13.16,94,,percent of total billed charges,,
METRONIDAZOLE IN NACL (ISO-OS) 500 MG/100 ML IV PGBK,,J1836,HCPCS,Facility,Outpatient,100,mL,,14,11.9,4.0124,14,UnitedHealthcare,Medicare Advantage,6.86,49,,percent of total billed charges,,
METRONIDAZOLE IN NACL (ISO-OS) 500 MG/100 ML IV PGBK,,J1836,HCPCS,Facility,Inpatient,100,mL,,14,11.9,4.0124,14,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
METRONIDAZOLE IN NACL (ISO-OS) 500 MG/100 ML IV PGBK,,J1836,HCPCS,Facility,Outpatient,100,mL,,14,11.9,4.0124,14,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,6.72,48,,percent of total billed charges,,100% of DHS outpatient percentage
METRONIDAZOLE IN NACL (ISO-OS) 500 MG/100 ML IV PGBK,,J1836,HCPCS,Facility,Inpatient,100,mL,,14,11.9,4.0124,14,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
LEVOFLOXACIN IN D5W 500 MG/100 ML IV PGBK,,J1956,HCPCS,Facility,Both,100,mL,,37,31.45,10.6042,37,Aetna,Commercial,34.04,92,,percent of total billed charges,,
LEVOFLOXACIN IN D5W 500 MG/100 ML IV PGBK,,J1956,HCPCS,Facility,Outpatient,100,mL,,37,31.45,10.6042,37,Aetna,Medicare Advantage,18.13,49,,percent of total billed charges,,
LEVOFLOXACIN IN D5W 500 MG/100 ML IV PGBK,,J1956,HCPCS,Facility,Inpatient,100,mL,,37,31.45,10.6042,37,Aetna,Medicare Advantage,,,,,Included in per diem rate,
LEVOFLOXACIN IN D5W 500 MG/100 ML IV PGBK,,J1956,HCPCS,Facility,Both,100,mL,,37,31.45,10.6042,37,Aetna,PPO,34.41,93,,percent of total billed charges,,
LEVOFLOXACIN IN D5W 500 MG/100 ML IV PGBK,,J1956,HCPCS,Facility,Both,100,mL,,37,31.45,10.6042,37,America's PPO,America's PPO,35.5311,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
LEVOFLOXACIN IN D5W 500 MG/100 ML IV PGBK,,J1956,HCPCS,Facility,Both,100,mL,,37,31.45,10.6042,37,BlueCross BlueShield Minnesota, Federal Employee Program,36.408,98.4,,percent of total billed charges,,
LEVOFLOXACIN IN D5W 500 MG/100 ML IV PGBK,,J1956,HCPCS,Facility,Both,100,mL,,37,31.45,10.6042,37,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,37,100,,percent of total billed charges,,
LEVOFLOXACIN IN D5W 500 MG/100 ML IV PGBK,,J1956,HCPCS,Facility,Both,100,mL,,37,31.45,10.6042,37,BlueCross BlueShield Minnesota,High Value Network Plan,33.3,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
LEVOFLOXACIN IN D5W 500 MG/100 ML IV PGBK,,J1956,HCPCS,Facility,Outpatient,100,mL,,37,31.45,10.6042,37,BlueCross BlueShield Minnesota,Medicare Advantage,18.13,49,,percent of total billed charges,,
LEVOFLOXACIN IN D5W 500 MG/100 ML IV PGBK,,J1956,HCPCS,Facility,Inpatient,100,mL,,37,31.45,10.6042,37,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
LEVOFLOXACIN IN D5W 500 MG/100 ML IV PGBK,,J1956,HCPCS,Facility,Both,100,mL,,37,31.45,10.6042,37,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,32.7709,88.57,,percent of total billed charges,,
LEVOFLOXACIN IN D5W 500 MG/100 ML IV PGBK,,J1956,HCPCS,Facility,Both,100,mL,,37,31.45,10.6042,37,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,10.6042,28.66,,percent of total billed charges,,
LEVOFLOXACIN IN D5W 500 MG/100 ML IV PGBK,,J1956,HCPCS,Facility,Outpatient,100,mL,,37,31.45,10.6042,37,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),18.13,49,,percent of total billed charges,,
LEVOFLOXACIN IN D5W 500 MG/100 ML IV PGBK,,J1956,HCPCS,Facility,Inpatient,100,mL,,37,31.45,10.6042,37,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
LEVOFLOXACIN IN D5W 500 MG/100 ML IV PGBK,,J1956,HCPCS,Facility,Both,100,mL,,37,31.45,10.6042,37,CorVel,Worker's Compensation,37,100,,percent of total billed charges,,
LEVOFLOXACIN IN D5W 500 MG/100 ML IV PGBK,,J1956,HCPCS,Facility,Both,100,mL,,37,31.45,10.6042,37,First Health Group Corporation,First Health Network,35.89,97,,percent of total billed charges,,
LEVOFLOXACIN IN D5W 500 MG/100 ML IV PGBK,,J1956,HCPCS,Facility,Both,100,mL,,37,31.45,10.6042,37,"Health Partners, Inc.",Commercial,35.002,94.6,,percent of total billed charges,,
LEVOFLOXACIN IN D5W 500 MG/100 ML IV PGBK,,J1956,HCPCS,Facility,Outpatient,100,mL,,37,31.45,10.6042,37,"Health Partners, Inc.",Medicare Advantage,18.13,49,,percent of total billed charges,,
LEVOFLOXACIN IN D5W 500 MG/100 ML IV PGBK,,J1956,HCPCS,Facility,Inpatient,100,mL,,37,31.45,10.6042,37,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LEVOFLOXACIN IN D5W 500 MG/100 ML IV PGBK,,J1956,HCPCS,Facility,Both,100,mL,,37,31.45,10.6042,37,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),22.2,60,,percent of total billed charges,,
LEVOFLOXACIN IN D5W 500 MG/100 ML IV PGBK,,J1956,HCPCS,Facility,Both,100,mL,,37,31.45,10.6042,37,"Health Partners, Inc.",State of Minnesota Advantage Program,30.155,81.5,,percent of total billed charges,,
LEVOFLOXACIN IN D5W 500 MG/100 ML IV PGBK,,J1956,HCPCS,Facility,Both,100,mL,,37,31.45,10.6042,37,"Health Partners, Inc.",State Public Programs,18.5,50,,percent of total billed charges,,
LEVOFLOXACIN IN D5W 500 MG/100 ML IV PGBK,,J1956,HCPCS,Facility,Both,100,mL,,37,31.45,10.6042,37,Humana Insurance Company,Commercial PPO,35.15,95,,percent of total billed charges,,
LEVOFLOXACIN IN D5W 500 MG/100 ML IV PGBK,,J1956,HCPCS,Facility,Outpatient,100,mL,,37,31.45,10.6042,37,Humana Insurance Company,Medicare PPO,18.13,49,,percent of total billed charges,,
LEVOFLOXACIN IN D5W 500 MG/100 ML IV PGBK,,J1956,HCPCS,Facility,Inpatient,100,mL,,37,31.45,10.6042,37,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
LEVOFLOXACIN IN D5W 500 MG/100 ML IV PGBK,,J1956,HCPCS,Facility,Both,100,mL,,37,31.45,10.6042,37,Medica,Individual & Family,36.667,99.1,,percent of total billed charges,,
LEVOFLOXACIN IN D5W 500 MG/100 ML IV PGBK,,J1956,HCPCS,Facility,Outpatient,100,mL,,37,31.45,10.6042,37,Medica,Medica Advantage Solution,18.426,49.8,,percent of total billed charges,,
LEVOFLOXACIN IN D5W 500 MG/100 ML IV PGBK,,J1956,HCPCS,Facility,Inpatient,100,mL,,37,31.45,10.6042,37,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
LEVOFLOXACIN IN D5W 500 MG/100 ML IV PGBK,,J1956,HCPCS,Facility,Outpatient,100,mL,,37,31.45,10.6042,37,Medica,Medical Assistance,16.502,44.6,,percent of total billed charges,,
LEVOFLOXACIN IN D5W 500 MG/100 ML IV PGBK,,J1956,HCPCS,Facility,Inpatient,100,mL,,37,31.45,10.6042,37,Medica,Medical Assistance,,,,,Included in per diem rate,
LEVOFLOXACIN IN D5W 500 MG/100 ML IV PGBK,,J1956,HCPCS,Facility,Outpatient,100,mL,,37,31.45,10.6042,37,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,18.426,49.8,,percent of total billed charges,,
LEVOFLOXACIN IN D5W 500 MG/100 ML IV PGBK,,J1956,HCPCS,Facility,Inpatient,100,mL,,37,31.45,10.6042,37,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
LEVOFLOXACIN IN D5W 500 MG/100 ML IV PGBK,,J1956,HCPCS,Facility,Both,100,mL,,37,31.45,10.6042,37,"Multiplan, Inc.","Multiplan, Inc.",34.78,94,,percent of total billed charges,,
LEVOFLOXACIN IN D5W 500 MG/100 ML IV PGBK,,J1956,HCPCS,Facility,Outpatient,100,mL,,37,31.45,10.6042,37,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,33.337,90.1,,percent of total billed charges,,
LEVOFLOXACIN IN D5W 500 MG/100 ML IV PGBK,,J1956,HCPCS,Facility,Inpatient,100,mL,,37,31.45,10.6042,37,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
LEVOFLOXACIN IN D5W 500 MG/100 ML IV PGBK,,J1956,HCPCS,Facility,Both,100,mL,,37,31.45,10.6042,37,"Preferred One Administrative Services, INC.",PPO,36.482,98.6,,percent of total billed charges,,
LEVOFLOXACIN IN D5W 500 MG/100 ML IV PGBK,,J1956,HCPCS,Facility,Outpatient,100,mL,,37,31.45,10.6042,37,PrimeWest Health,Minnesota Senior Health Options (MSHO),19.0365,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
LEVOFLOXACIN IN D5W 500 MG/100 ML IV PGBK,,J1956,HCPCS,Facility,Inpatient,100,mL,,37,31.45,10.6042,37,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LEVOFLOXACIN IN D5W 500 MG/100 ML IV PGBK,,J1956,HCPCS,Facility,Outpatient,100,mL,,37,31.45,10.6042,37,PrimeWest Health,MinnesotaCare,19.0032,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
LEVOFLOXACIN IN D5W 500 MG/100 ML IV PGBK,,J1956,HCPCS,Facility,Inpatient,100,mL,,37,31.45,10.6042,37,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
LEVOFLOXACIN IN D5W 500 MG/100 ML IV PGBK,,J1956,HCPCS,Facility,Both,100,mL,,37,31.45,10.6042,37,Sanford Health Plan,Sanford Health Plan,34.04,92,,percent of total billed charges,,
LEVOFLOXACIN IN D5W 500 MG/100 ML IV PGBK,,J1956,HCPCS,Facility,Outpatient,100,mL,,37,31.45,10.6042,37,"UCare Health, Inc.",Individual & Family Plan,20.8495,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
LEVOFLOXACIN IN D5W 500 MG/100 ML IV PGBK,,J1956,HCPCS,Facility,Inpatient,100,mL,,37,31.45,10.6042,37,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
LEVOFLOXACIN IN D5W 500 MG/100 ML IV PGBK,,J1956,HCPCS,Facility,Outpatient,100,mL,,37,31.45,10.6042,37,"UCare Health, Inc.",Medical Assistance,18.6739,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LEVOFLOXACIN IN D5W 500 MG/100 ML IV PGBK,,J1956,HCPCS,Facility,Inpatient,100,mL,,37,31.45,10.6042,37,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
LEVOFLOXACIN IN D5W 500 MG/100 ML IV PGBK,,J1956,HCPCS,Facility,Outpatient,100,mL,,37,31.45,10.6042,37,"UCare Health, Inc.",Medicare Advantage,18.6739,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LEVOFLOXACIN IN D5W 500 MG/100 ML IV PGBK,,J1956,HCPCS,Facility,Inpatient,100,mL,,37,31.45,10.6042,37,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LEVOFLOXACIN IN D5W 500 MG/100 ML IV PGBK,,J1956,HCPCS,Facility,Outpatient,100,mL,,37,31.45,10.6042,37,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),18.6739,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LEVOFLOXACIN IN D5W 500 MG/100 ML IV PGBK,,J1956,HCPCS,Facility,Inpatient,100,mL,,37,31.45,10.6042,37,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LEVOFLOXACIN IN D5W 500 MG/100 ML IV PGBK,,J1956,HCPCS,Facility,Both,100,mL,,37,31.45,10.6042,37,UnitedHealthcare,Individual & Family,34.78,94,,percent of total billed charges,,
LEVOFLOXACIN IN D5W 500 MG/100 ML IV PGBK,,J1956,HCPCS,Facility,Outpatient,100,mL,,37,31.45,10.6042,37,UnitedHealthcare,Medicare Advantage,18.13,49,,percent of total billed charges,,
LEVOFLOXACIN IN D5W 500 MG/100 ML IV PGBK,,J1956,HCPCS,Facility,Inpatient,100,mL,,37,31.45,10.6042,37,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
LEVOFLOXACIN IN D5W 500 MG/100 ML IV PGBK,,J1956,HCPCS,Facility,Outpatient,100,mL,,37,31.45,10.6042,37,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,17.76,48,,percent of total billed charges,,100% of DHS outpatient percentage
LEVOFLOXACIN IN D5W 500 MG/100 ML IV PGBK,,J1956,HCPCS,Facility,Inpatient,100,mL,,37,31.45,10.6042,37,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
POTASSIUM CHLORIDE IN WATER 10 MEQ/100 ML IV PGBK,,J3480,HCPCS,Facility,Both,100,mL,,24,20.4,6.8784,24,Aetna,Commercial,22.08,92,,percent of total billed charges,,
POTASSIUM CHLORIDE IN WATER 10 MEQ/100 ML IV PGBK,,J3480,HCPCS,Facility,Outpatient,100,mL,,24,20.4,6.8784,24,Aetna,Medicare Advantage,11.76,49,,percent of total billed charges,,
POTASSIUM CHLORIDE IN WATER 10 MEQ/100 ML IV PGBK,,J3480,HCPCS,Facility,Inpatient,100,mL,,24,20.4,6.8784,24,Aetna,Medicare Advantage,,,,,Included in per diem rate,
POTASSIUM CHLORIDE IN WATER 10 MEQ/100 ML IV PGBK,,J3480,HCPCS,Facility,Both,100,mL,,24,20.4,6.8784,24,Aetna,PPO,22.32,93,,percent of total billed charges,,
POTASSIUM CHLORIDE IN WATER 10 MEQ/100 ML IV PGBK,,J3480,HCPCS,Facility,Both,100,mL,,24,20.4,6.8784,24,America's PPO,America's PPO,23.0472,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
POTASSIUM CHLORIDE IN WATER 10 MEQ/100 ML IV PGBK,,J3480,HCPCS,Facility,Both,100,mL,,24,20.4,6.8784,24,BlueCross BlueShield Minnesota, Federal Employee Program,23.616,98.4,,percent of total billed charges,,
POTASSIUM CHLORIDE IN WATER 10 MEQ/100 ML IV PGBK,,J3480,HCPCS,Facility,Both,100,mL,,24,20.4,6.8784,24,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,24,100,,percent of total billed charges,,
POTASSIUM CHLORIDE IN WATER 10 MEQ/100 ML IV PGBK,,J3480,HCPCS,Facility,Both,100,mL,,24,20.4,6.8784,24,BlueCross BlueShield Minnesota,High Value Network Plan,21.6,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
POTASSIUM CHLORIDE IN WATER 10 MEQ/100 ML IV PGBK,,J3480,HCPCS,Facility,Outpatient,100,mL,,24,20.4,6.8784,24,BlueCross BlueShield Minnesota,Medicare Advantage,11.76,49,,percent of total billed charges,,
POTASSIUM CHLORIDE IN WATER 10 MEQ/100 ML IV PGBK,,J3480,HCPCS,Facility,Inpatient,100,mL,,24,20.4,6.8784,24,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
POTASSIUM CHLORIDE IN WATER 10 MEQ/100 ML IV PGBK,,J3480,HCPCS,Facility,Both,100,mL,,24,20.4,6.8784,24,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,21.2568,88.57,,percent of total billed charges,,
POTASSIUM CHLORIDE IN WATER 10 MEQ/100 ML IV PGBK,,J3480,HCPCS,Facility,Both,100,mL,,24,20.4,6.8784,24,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,6.8784,28.66,,percent of total billed charges,,
POTASSIUM CHLORIDE IN WATER 10 MEQ/100 ML IV PGBK,,J3480,HCPCS,Facility,Outpatient,100,mL,,24,20.4,6.8784,24,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),11.76,49,,percent of total billed charges,,
POTASSIUM CHLORIDE IN WATER 10 MEQ/100 ML IV PGBK,,J3480,HCPCS,Facility,Inpatient,100,mL,,24,20.4,6.8784,24,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
POTASSIUM CHLORIDE IN WATER 10 MEQ/100 ML IV PGBK,,J3480,HCPCS,Facility,Both,100,mL,,24,20.4,6.8784,24,CorVel,Worker's Compensation,24,100,,percent of total billed charges,,
POTASSIUM CHLORIDE IN WATER 10 MEQ/100 ML IV PGBK,,J3480,HCPCS,Facility,Both,100,mL,,24,20.4,6.8784,24,First Health Group Corporation,First Health Network,23.28,97,,percent of total billed charges,,
POTASSIUM CHLORIDE IN WATER 10 MEQ/100 ML IV PGBK,,J3480,HCPCS,Facility,Both,100,mL,,24,20.4,6.8784,24,"Health Partners, Inc.",Commercial,22.704,94.6,,percent of total billed charges,,
POTASSIUM CHLORIDE IN WATER 10 MEQ/100 ML IV PGBK,,J3480,HCPCS,Facility,Outpatient,100,mL,,24,20.4,6.8784,24,"Health Partners, Inc.",Medicare Advantage,11.76,49,,percent of total billed charges,,
POTASSIUM CHLORIDE IN WATER 10 MEQ/100 ML IV PGBK,,J3480,HCPCS,Facility,Inpatient,100,mL,,24,20.4,6.8784,24,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
POTASSIUM CHLORIDE IN WATER 10 MEQ/100 ML IV PGBK,,J3480,HCPCS,Facility,Both,100,mL,,24,20.4,6.8784,24,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),14.4,60,,percent of total billed charges,,
POTASSIUM CHLORIDE IN WATER 10 MEQ/100 ML IV PGBK,,J3480,HCPCS,Facility,Both,100,mL,,24,20.4,6.8784,24,"Health Partners, Inc.",State of Minnesota Advantage Program,19.56,81.5,,percent of total billed charges,,
POTASSIUM CHLORIDE IN WATER 10 MEQ/100 ML IV PGBK,,J3480,HCPCS,Facility,Both,100,mL,,24,20.4,6.8784,24,"Health Partners, Inc.",State Public Programs,12,50,,percent of total billed charges,,
POTASSIUM CHLORIDE IN WATER 10 MEQ/100 ML IV PGBK,,J3480,HCPCS,Facility,Both,100,mL,,24,20.4,6.8784,24,Humana Insurance Company,Commercial PPO,22.8,95,,percent of total billed charges,,
POTASSIUM CHLORIDE IN WATER 10 MEQ/100 ML IV PGBK,,J3480,HCPCS,Facility,Outpatient,100,mL,,24,20.4,6.8784,24,Humana Insurance Company,Medicare PPO,11.76,49,,percent of total billed charges,,
POTASSIUM CHLORIDE IN WATER 10 MEQ/100 ML IV PGBK,,J3480,HCPCS,Facility,Inpatient,100,mL,,24,20.4,6.8784,24,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
POTASSIUM CHLORIDE IN WATER 10 MEQ/100 ML IV PGBK,,J3480,HCPCS,Facility,Both,100,mL,,24,20.4,6.8784,24,Medica,Individual & Family,23.784,99.1,,percent of total billed charges,,
POTASSIUM CHLORIDE IN WATER 10 MEQ/100 ML IV PGBK,,J3480,HCPCS,Facility,Outpatient,100,mL,,24,20.4,6.8784,24,Medica,Medica Advantage Solution,11.952,49.8,,percent of total billed charges,,
POTASSIUM CHLORIDE IN WATER 10 MEQ/100 ML IV PGBK,,J3480,HCPCS,Facility,Inpatient,100,mL,,24,20.4,6.8784,24,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
POTASSIUM CHLORIDE IN WATER 10 MEQ/100 ML IV PGBK,,J3480,HCPCS,Facility,Outpatient,100,mL,,24,20.4,6.8784,24,Medica,Medical Assistance,10.704,44.6,,percent of total billed charges,,
POTASSIUM CHLORIDE IN WATER 10 MEQ/100 ML IV PGBK,,J3480,HCPCS,Facility,Inpatient,100,mL,,24,20.4,6.8784,24,Medica,Medical Assistance,,,,,Included in per diem rate,
POTASSIUM CHLORIDE IN WATER 10 MEQ/100 ML IV PGBK,,J3480,HCPCS,Facility,Outpatient,100,mL,,24,20.4,6.8784,24,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,11.952,49.8,,percent of total billed charges,,
POTASSIUM CHLORIDE IN WATER 10 MEQ/100 ML IV PGBK,,J3480,HCPCS,Facility,Inpatient,100,mL,,24,20.4,6.8784,24,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
POTASSIUM CHLORIDE IN WATER 10 MEQ/100 ML IV PGBK,,J3480,HCPCS,Facility,Both,100,mL,,24,20.4,6.8784,24,"Multiplan, Inc.","Multiplan, Inc.",22.56,94,,percent of total billed charges,,
POTASSIUM CHLORIDE IN WATER 10 MEQ/100 ML IV PGBK,,J3480,HCPCS,Facility,Outpatient,100,mL,,24,20.4,6.8784,24,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,21.624,90.1,,percent of total billed charges,,
POTASSIUM CHLORIDE IN WATER 10 MEQ/100 ML IV PGBK,,J3480,HCPCS,Facility,Inpatient,100,mL,,24,20.4,6.8784,24,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
POTASSIUM CHLORIDE IN WATER 10 MEQ/100 ML IV PGBK,,J3480,HCPCS,Facility,Both,100,mL,,24,20.4,6.8784,24,"Preferred One Administrative Services, INC.",PPO,23.664,98.6,,percent of total billed charges,,
POTASSIUM CHLORIDE IN WATER 10 MEQ/100 ML IV PGBK,,J3480,HCPCS,Facility,Outpatient,100,mL,,24,20.4,6.8784,24,PrimeWest Health,Minnesota Senior Health Options (MSHO),12.348,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
POTASSIUM CHLORIDE IN WATER 10 MEQ/100 ML IV PGBK,,J3480,HCPCS,Facility,Inpatient,100,mL,,24,20.4,6.8784,24,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
POTASSIUM CHLORIDE IN WATER 10 MEQ/100 ML IV PGBK,,J3480,HCPCS,Facility,Outpatient,100,mL,,24,20.4,6.8784,24,PrimeWest Health,MinnesotaCare,12.3264,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
POTASSIUM CHLORIDE IN WATER 10 MEQ/100 ML IV PGBK,,J3480,HCPCS,Facility,Inpatient,100,mL,,24,20.4,6.8784,24,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
POTASSIUM CHLORIDE IN WATER 10 MEQ/100 ML IV PGBK,,J3480,HCPCS,Facility,Both,100,mL,,24,20.4,6.8784,24,Sanford Health Plan,Sanford Health Plan,22.08,92,,percent of total billed charges,,
POTASSIUM CHLORIDE IN WATER 10 MEQ/100 ML IV PGBK,,J3480,HCPCS,Facility,Outpatient,100,mL,,24,20.4,6.8784,24,"UCare Health, Inc.",Individual & Family Plan,13.524,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
POTASSIUM CHLORIDE IN WATER 10 MEQ/100 ML IV PGBK,,J3480,HCPCS,Facility,Inpatient,100,mL,,24,20.4,6.8784,24,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
POTASSIUM CHLORIDE IN WATER 10 MEQ/100 ML IV PGBK,,J3480,HCPCS,Facility,Outpatient,100,mL,,24,20.4,6.8784,24,"UCare Health, Inc.",Medical Assistance,12.1128,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
POTASSIUM CHLORIDE IN WATER 10 MEQ/100 ML IV PGBK,,J3480,HCPCS,Facility,Inpatient,100,mL,,24,20.4,6.8784,24,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
POTASSIUM CHLORIDE IN WATER 10 MEQ/100 ML IV PGBK,,J3480,HCPCS,Facility,Outpatient,100,mL,,24,20.4,6.8784,24,"UCare Health, Inc.",Medicare Advantage,12.1128,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
POTASSIUM CHLORIDE IN WATER 10 MEQ/100 ML IV PGBK,,J3480,HCPCS,Facility,Inpatient,100,mL,,24,20.4,6.8784,24,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
POTASSIUM CHLORIDE IN WATER 10 MEQ/100 ML IV PGBK,,J3480,HCPCS,Facility,Outpatient,100,mL,,24,20.4,6.8784,24,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),12.1128,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
POTASSIUM CHLORIDE IN WATER 10 MEQ/100 ML IV PGBK,,J3480,HCPCS,Facility,Inpatient,100,mL,,24,20.4,6.8784,24,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
POTASSIUM CHLORIDE IN WATER 10 MEQ/100 ML IV PGBK,,J3480,HCPCS,Facility,Both,100,mL,,24,20.4,6.8784,24,UnitedHealthcare,Individual & Family,22.56,94,,percent of total billed charges,,
POTASSIUM CHLORIDE IN WATER 10 MEQ/100 ML IV PGBK,,J3480,HCPCS,Facility,Outpatient,100,mL,,24,20.4,6.8784,24,UnitedHealthcare,Medicare Advantage,11.76,49,,percent of total billed charges,,
POTASSIUM CHLORIDE IN WATER 10 MEQ/100 ML IV PGBK,,J3480,HCPCS,Facility,Inpatient,100,mL,,24,20.4,6.8784,24,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
POTASSIUM CHLORIDE IN WATER 10 MEQ/100 ML IV PGBK,,J3480,HCPCS,Facility,Outpatient,100,mL,,24,20.4,6.8784,24,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,11.52,48,,percent of total billed charges,,100% of DHS outpatient percentage
POTASSIUM CHLORIDE IN WATER 10 MEQ/100 ML IV PGBK,,J3480,HCPCS,Facility,Inpatient,100,mL,,24,20.4,6.8784,24,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
ZOLEDRONIC ACID-MANNITOL-WATER 5 MG/100 ML IV PGBK,,J3489,HCPCS,Facility,Both,100,mL,,1512,1285.2,433.3392,1512,Aetna,Commercial,1391.04,92,,percent of total billed charges,,
ZOLEDRONIC ACID-MANNITOL-WATER 5 MG/100 ML IV PGBK,,J3489,HCPCS,Facility,Outpatient,100,mL,,1512,1285.2,433.3392,1512,Aetna,Medicare Advantage,740.88,49,,percent of total billed charges,,
ZOLEDRONIC ACID-MANNITOL-WATER 5 MG/100 ML IV PGBK,,J3489,HCPCS,Facility,Inpatient,100,mL,,1512,1285.2,433.3392,1512,Aetna,Medicare Advantage,,,,,Included in per diem rate,
ZOLEDRONIC ACID-MANNITOL-WATER 5 MG/100 ML IV PGBK,,J3489,HCPCS,Facility,Both,100,mL,,1512,1285.2,433.3392,1512,Aetna,PPO,1406.16,93,,percent of total billed charges,,
ZOLEDRONIC ACID-MANNITOL-WATER 5 MG/100 ML IV PGBK,,J3489,HCPCS,Facility,Both,100,mL,,1512,1285.2,433.3392,1512,America's PPO,America's PPO,1451.9736,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
ZOLEDRONIC ACID-MANNITOL-WATER 5 MG/100 ML IV PGBK,,J3489,HCPCS,Facility,Both,100,mL,,1512,1285.2,433.3392,1512,BlueCross BlueShield Minnesota, Federal Employee Program,1487.808,98.4,,percent of total billed charges,,
ZOLEDRONIC ACID-MANNITOL-WATER 5 MG/100 ML IV PGBK,,J3489,HCPCS,Facility,Both,100,mL,,1512,1285.2,433.3392,1512,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1512,100,,percent of total billed charges,,
ZOLEDRONIC ACID-MANNITOL-WATER 5 MG/100 ML IV PGBK,,J3489,HCPCS,Facility,Both,100,mL,,1512,1285.2,433.3392,1512,BlueCross BlueShield Minnesota,High Value Network Plan,1360.8,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
ZOLEDRONIC ACID-MANNITOL-WATER 5 MG/100 ML IV PGBK,,J3489,HCPCS,Facility,Outpatient,100,mL,,1512,1285.2,433.3392,1512,BlueCross BlueShield Minnesota,Medicare Advantage,740.88,49,,percent of total billed charges,,
ZOLEDRONIC ACID-MANNITOL-WATER 5 MG/100 ML IV PGBK,,J3489,HCPCS,Facility,Inpatient,100,mL,,1512,1285.2,433.3392,1512,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
ZOLEDRONIC ACID-MANNITOL-WATER 5 MG/100 ML IV PGBK,,J3489,HCPCS,Facility,Both,100,mL,,1512,1285.2,433.3392,1512,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1339.1784,88.57,,percent of total billed charges,,
ZOLEDRONIC ACID-MANNITOL-WATER 5 MG/100 ML IV PGBK,,J3489,HCPCS,Facility,Both,100,mL,,1512,1285.2,433.3392,1512,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,433.3392,28.66,,percent of total billed charges,,
ZOLEDRONIC ACID-MANNITOL-WATER 5 MG/100 ML IV PGBK,,J3489,HCPCS,Facility,Outpatient,100,mL,,1512,1285.2,433.3392,1512,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),740.88,49,,percent of total billed charges,,
ZOLEDRONIC ACID-MANNITOL-WATER 5 MG/100 ML IV PGBK,,J3489,HCPCS,Facility,Inpatient,100,mL,,1512,1285.2,433.3392,1512,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
ZOLEDRONIC ACID-MANNITOL-WATER 5 MG/100 ML IV PGBK,,J3489,HCPCS,Facility,Both,100,mL,,1512,1285.2,433.3392,1512,CorVel,Worker's Compensation,1512,100,,percent of total billed charges,,
ZOLEDRONIC ACID-MANNITOL-WATER 5 MG/100 ML IV PGBK,,J3489,HCPCS,Facility,Both,100,mL,,1512,1285.2,433.3392,1512,First Health Group Corporation,First Health Network,1466.64,97,,percent of total billed charges,,
ZOLEDRONIC ACID-MANNITOL-WATER 5 MG/100 ML IV PGBK,,J3489,HCPCS,Facility,Both,100,mL,,1512,1285.2,433.3392,1512,"Health Partners, Inc.",Commercial,1430.352,94.6,,percent of total billed charges,,
ZOLEDRONIC ACID-MANNITOL-WATER 5 MG/100 ML IV PGBK,,J3489,HCPCS,Facility,Outpatient,100,mL,,1512,1285.2,433.3392,1512,"Health Partners, Inc.",Medicare Advantage,740.88,49,,percent of total billed charges,,
ZOLEDRONIC ACID-MANNITOL-WATER 5 MG/100 ML IV PGBK,,J3489,HCPCS,Facility,Inpatient,100,mL,,1512,1285.2,433.3392,1512,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ZOLEDRONIC ACID-MANNITOL-WATER 5 MG/100 ML IV PGBK,,J3489,HCPCS,Facility,Both,100,mL,,1512,1285.2,433.3392,1512,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),907.2,60,,percent of total billed charges,,
ZOLEDRONIC ACID-MANNITOL-WATER 5 MG/100 ML IV PGBK,,J3489,HCPCS,Facility,Both,100,mL,,1512,1285.2,433.3392,1512,"Health Partners, Inc.",State of Minnesota Advantage Program,1232.28,81.5,,percent of total billed charges,,
ZOLEDRONIC ACID-MANNITOL-WATER 5 MG/100 ML IV PGBK,,J3489,HCPCS,Facility,Both,100,mL,,1512,1285.2,433.3392,1512,"Health Partners, Inc.",State Public Programs,756,50,,percent of total billed charges,,
ZOLEDRONIC ACID-MANNITOL-WATER 5 MG/100 ML IV PGBK,,J3489,HCPCS,Facility,Both,100,mL,,1512,1285.2,433.3392,1512,Humana Insurance Company,Commercial PPO,1436.4,95,,percent of total billed charges,,
ZOLEDRONIC ACID-MANNITOL-WATER 5 MG/100 ML IV PGBK,,J3489,HCPCS,Facility,Outpatient,100,mL,,1512,1285.2,433.3392,1512,Humana Insurance Company,Medicare PPO,740.88,49,,percent of total billed charges,,
ZOLEDRONIC ACID-MANNITOL-WATER 5 MG/100 ML IV PGBK,,J3489,HCPCS,Facility,Inpatient,100,mL,,1512,1285.2,433.3392,1512,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
ZOLEDRONIC ACID-MANNITOL-WATER 5 MG/100 ML IV PGBK,,J3489,HCPCS,Facility,Both,100,mL,,1512,1285.2,433.3392,1512,Medica,Individual & Family,1498.392,99.1,,percent of total billed charges,,
ZOLEDRONIC ACID-MANNITOL-WATER 5 MG/100 ML IV PGBK,,J3489,HCPCS,Facility,Outpatient,100,mL,,1512,1285.2,433.3392,1512,Medica,Medica Advantage Solution,752.976,49.8,,percent of total billed charges,,
ZOLEDRONIC ACID-MANNITOL-WATER 5 MG/100 ML IV PGBK,,J3489,HCPCS,Facility,Inpatient,100,mL,,1512,1285.2,433.3392,1512,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
ZOLEDRONIC ACID-MANNITOL-WATER 5 MG/100 ML IV PGBK,,J3489,HCPCS,Facility,Outpatient,100,mL,,1512,1285.2,433.3392,1512,Medica,Medical Assistance,674.352,44.6,,percent of total billed charges,,
ZOLEDRONIC ACID-MANNITOL-WATER 5 MG/100 ML IV PGBK,,J3489,HCPCS,Facility,Inpatient,100,mL,,1512,1285.2,433.3392,1512,Medica,Medical Assistance,,,,,Included in per diem rate,
ZOLEDRONIC ACID-MANNITOL-WATER 5 MG/100 ML IV PGBK,,J3489,HCPCS,Facility,Outpatient,100,mL,,1512,1285.2,433.3392,1512,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,752.976,49.8,,percent of total billed charges,,
ZOLEDRONIC ACID-MANNITOL-WATER 5 MG/100 ML IV PGBK,,J3489,HCPCS,Facility,Inpatient,100,mL,,1512,1285.2,433.3392,1512,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
ZOLEDRONIC ACID-MANNITOL-WATER 5 MG/100 ML IV PGBK,,J3489,HCPCS,Facility,Both,100,mL,,1512,1285.2,433.3392,1512,"Multiplan, Inc.","Multiplan, Inc.",1421.28,94,,percent of total billed charges,,
ZOLEDRONIC ACID-MANNITOL-WATER 5 MG/100 ML IV PGBK,,J3489,HCPCS,Facility,Outpatient,100,mL,,1512,1285.2,433.3392,1512,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1362.312,90.1,,percent of total billed charges,,
ZOLEDRONIC ACID-MANNITOL-WATER 5 MG/100 ML IV PGBK,,J3489,HCPCS,Facility,Inpatient,100,mL,,1512,1285.2,433.3392,1512,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
ZOLEDRONIC ACID-MANNITOL-WATER 5 MG/100 ML IV PGBK,,J3489,HCPCS,Facility,Both,100,mL,,1512,1285.2,433.3392,1512,"Preferred One Administrative Services, INC.",PPO,1490.832,98.6,,percent of total billed charges,,
ZOLEDRONIC ACID-MANNITOL-WATER 5 MG/100 ML IV PGBK,,J3489,HCPCS,Facility,Outpatient,100,mL,,1512,1285.2,433.3392,1512,PrimeWest Health,Minnesota Senior Health Options (MSHO),777.924,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
ZOLEDRONIC ACID-MANNITOL-WATER 5 MG/100 ML IV PGBK,,J3489,HCPCS,Facility,Inpatient,100,mL,,1512,1285.2,433.3392,1512,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ZOLEDRONIC ACID-MANNITOL-WATER 5 MG/100 ML IV PGBK,,J3489,HCPCS,Facility,Outpatient,100,mL,,1512,1285.2,433.3392,1512,PrimeWest Health,MinnesotaCare,776.5632,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
ZOLEDRONIC ACID-MANNITOL-WATER 5 MG/100 ML IV PGBK,,J3489,HCPCS,Facility,Inpatient,100,mL,,1512,1285.2,433.3392,1512,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
ZOLEDRONIC ACID-MANNITOL-WATER 5 MG/100 ML IV PGBK,,J3489,HCPCS,Facility,Both,100,mL,,1512,1285.2,433.3392,1512,Sanford Health Plan,Sanford Health Plan,1391.04,92,,percent of total billed charges,,
ZOLEDRONIC ACID-MANNITOL-WATER 5 MG/100 ML IV PGBK,,J3489,HCPCS,Facility,Outpatient,100,mL,,1512,1285.2,433.3392,1512,"UCare Health, Inc.",Individual & Family Plan,852.012,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
ZOLEDRONIC ACID-MANNITOL-WATER 5 MG/100 ML IV PGBK,,J3489,HCPCS,Facility,Inpatient,100,mL,,1512,1285.2,433.3392,1512,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
ZOLEDRONIC ACID-MANNITOL-WATER 5 MG/100 ML IV PGBK,,J3489,HCPCS,Facility,Outpatient,100,mL,,1512,1285.2,433.3392,1512,"UCare Health, Inc.",Medical Assistance,763.1064,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ZOLEDRONIC ACID-MANNITOL-WATER 5 MG/100 ML IV PGBK,,J3489,HCPCS,Facility,Inpatient,100,mL,,1512,1285.2,433.3392,1512,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
ZOLEDRONIC ACID-MANNITOL-WATER 5 MG/100 ML IV PGBK,,J3489,HCPCS,Facility,Outpatient,100,mL,,1512,1285.2,433.3392,1512,"UCare Health, Inc.",Medicare Advantage,763.1064,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ZOLEDRONIC ACID-MANNITOL-WATER 5 MG/100 ML IV PGBK,,J3489,HCPCS,Facility,Inpatient,100,mL,,1512,1285.2,433.3392,1512,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ZOLEDRONIC ACID-MANNITOL-WATER 5 MG/100 ML IV PGBK,,J3489,HCPCS,Facility,Outpatient,100,mL,,1512,1285.2,433.3392,1512,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),763.1064,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ZOLEDRONIC ACID-MANNITOL-WATER 5 MG/100 ML IV PGBK,,J3489,HCPCS,Facility,Inpatient,100,mL,,1512,1285.2,433.3392,1512,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ZOLEDRONIC ACID-MANNITOL-WATER 5 MG/100 ML IV PGBK,,J3489,HCPCS,Facility,Both,100,mL,,1512,1285.2,433.3392,1512,UnitedHealthcare,Individual & Family,1421.28,94,,percent of total billed charges,,
ZOLEDRONIC ACID-MANNITOL-WATER 5 MG/100 ML IV PGBK,,J3489,HCPCS,Facility,Outpatient,100,mL,,1512,1285.2,433.3392,1512,UnitedHealthcare,Medicare Advantage,740.88,49,,percent of total billed charges,,
ZOLEDRONIC ACID-MANNITOL-WATER 5 MG/100 ML IV PGBK,,J3489,HCPCS,Facility,Inpatient,100,mL,,1512,1285.2,433.3392,1512,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
ZOLEDRONIC ACID-MANNITOL-WATER 5 MG/100 ML IV PGBK,,J3489,HCPCS,Facility,Outpatient,100,mL,,1512,1285.2,433.3392,1512,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,725.76,48,,percent of total billed charges,,100% of DHS outpatient percentage
ZOLEDRONIC ACID-MANNITOL-WATER 5 MG/100 ML IV PGBK,,J3489,HCPCS,Facility,Inpatient,100,mL,,1512,1285.2,433.3392,1512,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
IODIXANOL 320 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Both,100,mL,,375,318.75,107.475,375,Aetna,Commercial,345,92,,percent of total billed charges,,
IODIXANOL 320 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Outpatient,100,mL,,375,318.75,107.475,375,Aetna,Medicare Advantage,183.75,49,,percent of total billed charges,,
IODIXANOL 320 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Inpatient,100,mL,,375,318.75,107.475,375,Aetna,Medicare Advantage,,,,,Included in per diem rate,
IODIXANOL 320 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Both,100,mL,,375,318.75,107.475,375,Aetna,PPO,348.75,93,,percent of total billed charges,,
IODIXANOL 320 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Both,100,mL,,375,318.75,107.475,375,America's PPO,America's PPO,360.1125,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
IODIXANOL 320 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Both,100,mL,,375,318.75,107.475,375,BlueCross BlueShield Minnesota, Federal Employee Program,369,98.4,,percent of total billed charges,,
IODIXANOL 320 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Both,100,mL,,375,318.75,107.475,375,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,375,100,,percent of total billed charges,,
IODIXANOL 320 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Both,100,mL,,375,318.75,107.475,375,BlueCross BlueShield Minnesota,High Value Network Plan,337.5,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
IODIXANOL 320 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Outpatient,100,mL,,375,318.75,107.475,375,BlueCross BlueShield Minnesota,Medicare Advantage,183.75,49,,percent of total billed charges,,
IODIXANOL 320 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Inpatient,100,mL,,375,318.75,107.475,375,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
IODIXANOL 320 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Both,100,mL,,375,318.75,107.475,375,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,332.1375,88.57,,percent of total billed charges,,
IODIXANOL 320 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Both,100,mL,,375,318.75,107.475,375,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,107.475,28.66,,percent of total billed charges,,
IODIXANOL 320 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Outpatient,100,mL,,375,318.75,107.475,375,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),183.75,49,,percent of total billed charges,,
IODIXANOL 320 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Inpatient,100,mL,,375,318.75,107.475,375,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
IODIXANOL 320 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Both,100,mL,,375,318.75,107.475,375,CorVel,Worker's Compensation,375,100,,percent of total billed charges,,
IODIXANOL 320 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Both,100,mL,,375,318.75,107.475,375,First Health Group Corporation,First Health Network,363.75,97,,percent of total billed charges,,
IODIXANOL 320 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Both,100,mL,,375,318.75,107.475,375,"Health Partners, Inc.",Commercial,354.75,94.6,,percent of total billed charges,,
IODIXANOL 320 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Outpatient,100,mL,,375,318.75,107.475,375,"Health Partners, Inc.",Medicare Advantage,183.75,49,,percent of total billed charges,,
IODIXANOL 320 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Inpatient,100,mL,,375,318.75,107.475,375,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
IODIXANOL 320 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Both,100,mL,,375,318.75,107.475,375,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),225,60,,percent of total billed charges,,
IODIXANOL 320 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Both,100,mL,,375,318.75,107.475,375,"Health Partners, Inc.",State of Minnesota Advantage Program,305.625,81.5,,percent of total billed charges,,
IODIXANOL 320 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Both,100,mL,,375,318.75,107.475,375,"Health Partners, Inc.",State Public Programs,187.5,50,,percent of total billed charges,,
IODIXANOL 320 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Both,100,mL,,375,318.75,107.475,375,Humana Insurance Company,Commercial PPO,356.25,95,,percent of total billed charges,,
IODIXANOL 320 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Outpatient,100,mL,,375,318.75,107.475,375,Humana Insurance Company,Medicare PPO,183.75,49,,percent of total billed charges,,
IODIXANOL 320 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Inpatient,100,mL,,375,318.75,107.475,375,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
IODIXANOL 320 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Both,100,mL,,375,318.75,107.475,375,Medica,Individual & Family,371.625,99.1,,percent of total billed charges,,
IODIXANOL 320 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Outpatient,100,mL,,375,318.75,107.475,375,Medica,Medica Advantage Solution,186.75,49.8,,percent of total billed charges,,
IODIXANOL 320 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Inpatient,100,mL,,375,318.75,107.475,375,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
IODIXANOL 320 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Outpatient,100,mL,,375,318.75,107.475,375,Medica,Medical Assistance,167.25,44.6,,percent of total billed charges,,
IODIXANOL 320 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Inpatient,100,mL,,375,318.75,107.475,375,Medica,Medical Assistance,,,,,Included in per diem rate,
IODIXANOL 320 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Outpatient,100,mL,,375,318.75,107.475,375,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,186.75,49.8,,percent of total billed charges,,
IODIXANOL 320 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Inpatient,100,mL,,375,318.75,107.475,375,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
IODIXANOL 320 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Both,100,mL,,375,318.75,107.475,375,"Multiplan, Inc.","Multiplan, Inc.",352.5,94,,percent of total billed charges,,
IODIXANOL 320 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Outpatient,100,mL,,375,318.75,107.475,375,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,337.875,90.1,,percent of total billed charges,,
IODIXANOL 320 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Inpatient,100,mL,,375,318.75,107.475,375,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
IODIXANOL 320 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Both,100,mL,,375,318.75,107.475,375,"Preferred One Administrative Services, INC.",PPO,369.75,98.6,,percent of total billed charges,,
IODIXANOL 320 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Outpatient,100,mL,,375,318.75,107.475,375,PrimeWest Health,Minnesota Senior Health Options (MSHO),192.9375,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
IODIXANOL 320 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Inpatient,100,mL,,375,318.75,107.475,375,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
IODIXANOL 320 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Outpatient,100,mL,,375,318.75,107.475,375,PrimeWest Health,MinnesotaCare,192.6,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
IODIXANOL 320 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Inpatient,100,mL,,375,318.75,107.475,375,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
IODIXANOL 320 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Both,100,mL,,375,318.75,107.475,375,Sanford Health Plan,Sanford Health Plan,345,92,,percent of total billed charges,,
IODIXANOL 320 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Outpatient,100,mL,,375,318.75,107.475,375,"UCare Health, Inc.",Individual & Family Plan,211.3125,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
IODIXANOL 320 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Inpatient,100,mL,,375,318.75,107.475,375,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
IODIXANOL 320 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Outpatient,100,mL,,375,318.75,107.475,375,"UCare Health, Inc.",Medical Assistance,189.2625,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
IODIXANOL 320 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Inpatient,100,mL,,375,318.75,107.475,375,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
IODIXANOL 320 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Outpatient,100,mL,,375,318.75,107.475,375,"UCare Health, Inc.",Medicare Advantage,189.2625,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
IODIXANOL 320 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Inpatient,100,mL,,375,318.75,107.475,375,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
IODIXANOL 320 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Outpatient,100,mL,,375,318.75,107.475,375,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),189.2625,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
IODIXANOL 320 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Inpatient,100,mL,,375,318.75,107.475,375,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
IODIXANOL 320 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Both,100,mL,,375,318.75,107.475,375,UnitedHealthcare,Individual & Family,352.5,94,,percent of total billed charges,,
IODIXANOL 320 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Outpatient,100,mL,,375,318.75,107.475,375,UnitedHealthcare,Medicare Advantage,183.75,49,,percent of total billed charges,,
IODIXANOL 320 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Inpatient,100,mL,,375,318.75,107.475,375,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
IODIXANOL 320 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Outpatient,100,mL,,375,318.75,107.475,375,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,180,48,,percent of total billed charges,,100% of DHS outpatient percentage
IODIXANOL 320 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Inpatient,100,mL,,375,318.75,107.475,375,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Both,100,mL,,275,233.75,78.815,275,Aetna,Commercial,253,92,,percent of total billed charges,,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Outpatient,100,mL,,275,233.75,78.815,275,Aetna,Medicare Advantage,134.75,49,,percent of total billed charges,,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Inpatient,100,mL,,275,233.75,78.815,275,Aetna,Medicare Advantage,,,,,Included in per diem rate,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Both,100,mL,,275,233.75,78.815,275,Aetna,PPO,255.75,93,,percent of total billed charges,,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Both,100,mL,,275,233.75,78.815,275,America's PPO,America's PPO,264.0825,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Both,100,mL,,275,233.75,78.815,275,BlueCross BlueShield Minnesota, Federal Employee Program,270.6,98.4,,percent of total billed charges,,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Both,100,mL,,275,233.75,78.815,275,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,275,100,,percent of total billed charges,,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Both,100,mL,,275,233.75,78.815,275,BlueCross BlueShield Minnesota,High Value Network Plan,247.5,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Outpatient,100,mL,,275,233.75,78.815,275,BlueCross BlueShield Minnesota,Medicare Advantage,134.75,49,,percent of total billed charges,,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Inpatient,100,mL,,275,233.75,78.815,275,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Both,100,mL,,275,233.75,78.815,275,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,243.5675,88.57,,percent of total billed charges,,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Both,100,mL,,275,233.75,78.815,275,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,78.815,28.66,,percent of total billed charges,,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Outpatient,100,mL,,275,233.75,78.815,275,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),134.75,49,,percent of total billed charges,,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Inpatient,100,mL,,275,233.75,78.815,275,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Both,100,mL,,275,233.75,78.815,275,CorVel,Worker's Compensation,275,100,,percent of total billed charges,,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Both,100,mL,,275,233.75,78.815,275,First Health Group Corporation,First Health Network,266.75,97,,percent of total billed charges,,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Both,100,mL,,275,233.75,78.815,275,"Health Partners, Inc.",Commercial,260.15,94.6,,percent of total billed charges,,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Outpatient,100,mL,,275,233.75,78.815,275,"Health Partners, Inc.",Medicare Advantage,134.75,49,,percent of total billed charges,,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Inpatient,100,mL,,275,233.75,78.815,275,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Both,100,mL,,275,233.75,78.815,275,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),165,60,,percent of total billed charges,,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Both,100,mL,,275,233.75,78.815,275,"Health Partners, Inc.",State of Minnesota Advantage Program,224.125,81.5,,percent of total billed charges,,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Both,100,mL,,275,233.75,78.815,275,"Health Partners, Inc.",State Public Programs,137.5,50,,percent of total billed charges,,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Both,100,mL,,275,233.75,78.815,275,Humana Insurance Company,Commercial PPO,261.25,95,,percent of total billed charges,,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Outpatient,100,mL,,275,233.75,78.815,275,Humana Insurance Company,Medicare PPO,134.75,49,,percent of total billed charges,,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Inpatient,100,mL,,275,233.75,78.815,275,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Both,100,mL,,275,233.75,78.815,275,Medica,Individual & Family,272.525,99.1,,percent of total billed charges,,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Outpatient,100,mL,,275,233.75,78.815,275,Medica,Medica Advantage Solution,136.95,49.8,,percent of total billed charges,,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Inpatient,100,mL,,275,233.75,78.815,275,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Outpatient,100,mL,,275,233.75,78.815,275,Medica,Medical Assistance,122.65,44.6,,percent of total billed charges,,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Inpatient,100,mL,,275,233.75,78.815,275,Medica,Medical Assistance,,,,,Included in per diem rate,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Outpatient,100,mL,,275,233.75,78.815,275,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,136.95,49.8,,percent of total billed charges,,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Inpatient,100,mL,,275,233.75,78.815,275,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Both,100,mL,,275,233.75,78.815,275,"Multiplan, Inc.","Multiplan, Inc.",258.5,94,,percent of total billed charges,,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Outpatient,100,mL,,275,233.75,78.815,275,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,247.775,90.1,,percent of total billed charges,,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Inpatient,100,mL,,275,233.75,78.815,275,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Both,100,mL,,275,233.75,78.815,275,"Preferred One Administrative Services, INC.",PPO,271.15,98.6,,percent of total billed charges,,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Outpatient,100,mL,,275,233.75,78.815,275,PrimeWest Health,Minnesota Senior Health Options (MSHO),141.4875,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Inpatient,100,mL,,275,233.75,78.815,275,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Outpatient,100,mL,,275,233.75,78.815,275,PrimeWest Health,MinnesotaCare,141.24,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Inpatient,100,mL,,275,233.75,78.815,275,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Both,100,mL,,275,233.75,78.815,275,Sanford Health Plan,Sanford Health Plan,253,92,,percent of total billed charges,,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Outpatient,100,mL,,275,233.75,78.815,275,"UCare Health, Inc.",Individual & Family Plan,154.9625,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Inpatient,100,mL,,275,233.75,78.815,275,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Outpatient,100,mL,,275,233.75,78.815,275,"UCare Health, Inc.",Medical Assistance,138.7925,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Inpatient,100,mL,,275,233.75,78.815,275,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Outpatient,100,mL,,275,233.75,78.815,275,"UCare Health, Inc.",Medicare Advantage,138.7925,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Inpatient,100,mL,,275,233.75,78.815,275,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Outpatient,100,mL,,275,233.75,78.815,275,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),138.7925,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Inpatient,100,mL,,275,233.75,78.815,275,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Both,100,mL,,275,233.75,78.815,275,UnitedHealthcare,Individual & Family,258.5,94,,percent of total billed charges,,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Outpatient,100,mL,,275,233.75,78.815,275,UnitedHealthcare,Medicare Advantage,134.75,49,,percent of total billed charges,,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Inpatient,100,mL,,275,233.75,78.815,275,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Outpatient,100,mL,,275,233.75,78.815,275,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,132,48,,percent of total billed charges,,100% of DHS outpatient percentage
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Inpatient,100,mL,,275,233.75,78.815,275,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
IOHEXOL 350 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Both,100,mL,,275,233.75,78.815,275,Aetna,Commercial,253,92,,percent of total billed charges,,
IOHEXOL 350 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Outpatient,100,mL,,275,233.75,78.815,275,Aetna,Medicare Advantage,134.75,49,,percent of total billed charges,,
IOHEXOL 350 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Inpatient,100,mL,,275,233.75,78.815,275,Aetna,Medicare Advantage,,,,,Included in per diem rate,
IOHEXOL 350 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Both,100,mL,,275,233.75,78.815,275,Aetna,PPO,255.75,93,,percent of total billed charges,,
IOHEXOL 350 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Both,100,mL,,275,233.75,78.815,275,America's PPO,America's PPO,264.0825,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
IOHEXOL 350 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Both,100,mL,,275,233.75,78.815,275,BlueCross BlueShield Minnesota, Federal Employee Program,270.6,98.4,,percent of total billed charges,,
IOHEXOL 350 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Both,100,mL,,275,233.75,78.815,275,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,275,100,,percent of total billed charges,,
IOHEXOL 350 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Both,100,mL,,275,233.75,78.815,275,BlueCross BlueShield Minnesota,High Value Network Plan,247.5,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
IOHEXOL 350 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Outpatient,100,mL,,275,233.75,78.815,275,BlueCross BlueShield Minnesota,Medicare Advantage,134.75,49,,percent of total billed charges,,
IOHEXOL 350 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Inpatient,100,mL,,275,233.75,78.815,275,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
IOHEXOL 350 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Both,100,mL,,275,233.75,78.815,275,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,243.5675,88.57,,percent of total billed charges,,
IOHEXOL 350 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Both,100,mL,,275,233.75,78.815,275,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,78.815,28.66,,percent of total billed charges,,
IOHEXOL 350 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Outpatient,100,mL,,275,233.75,78.815,275,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),134.75,49,,percent of total billed charges,,
IOHEXOL 350 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Inpatient,100,mL,,275,233.75,78.815,275,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
IOHEXOL 350 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Both,100,mL,,275,233.75,78.815,275,CorVel,Worker's Compensation,275,100,,percent of total billed charges,,
IOHEXOL 350 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Both,100,mL,,275,233.75,78.815,275,First Health Group Corporation,First Health Network,266.75,97,,percent of total billed charges,,
IOHEXOL 350 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Both,100,mL,,275,233.75,78.815,275,"Health Partners, Inc.",Commercial,260.15,94.6,,percent of total billed charges,,
IOHEXOL 350 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Outpatient,100,mL,,275,233.75,78.815,275,"Health Partners, Inc.",Medicare Advantage,134.75,49,,percent of total billed charges,,
IOHEXOL 350 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Inpatient,100,mL,,275,233.75,78.815,275,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
IOHEXOL 350 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Both,100,mL,,275,233.75,78.815,275,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),165,60,,percent of total billed charges,,
IOHEXOL 350 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Both,100,mL,,275,233.75,78.815,275,"Health Partners, Inc.",State of Minnesota Advantage Program,224.125,81.5,,percent of total billed charges,,
IOHEXOL 350 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Both,100,mL,,275,233.75,78.815,275,"Health Partners, Inc.",State Public Programs,137.5,50,,percent of total billed charges,,
IOHEXOL 350 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Both,100,mL,,275,233.75,78.815,275,Humana Insurance Company,Commercial PPO,261.25,95,,percent of total billed charges,,
IOHEXOL 350 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Outpatient,100,mL,,275,233.75,78.815,275,Humana Insurance Company,Medicare PPO,134.75,49,,percent of total billed charges,,
IOHEXOL 350 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Inpatient,100,mL,,275,233.75,78.815,275,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
IOHEXOL 350 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Both,100,mL,,275,233.75,78.815,275,Medica,Individual & Family,272.525,99.1,,percent of total billed charges,,
IOHEXOL 350 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Outpatient,100,mL,,275,233.75,78.815,275,Medica,Medica Advantage Solution,136.95,49.8,,percent of total billed charges,,
IOHEXOL 350 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Inpatient,100,mL,,275,233.75,78.815,275,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
IOHEXOL 350 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Outpatient,100,mL,,275,233.75,78.815,275,Medica,Medical Assistance,122.65,44.6,,percent of total billed charges,,
IOHEXOL 350 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Inpatient,100,mL,,275,233.75,78.815,275,Medica,Medical Assistance,,,,,Included in per diem rate,
IOHEXOL 350 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Outpatient,100,mL,,275,233.75,78.815,275,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,136.95,49.8,,percent of total billed charges,,
IOHEXOL 350 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Inpatient,100,mL,,275,233.75,78.815,275,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
IOHEXOL 350 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Both,100,mL,,275,233.75,78.815,275,"Multiplan, Inc.","Multiplan, Inc.",258.5,94,,percent of total billed charges,,
IOHEXOL 350 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Outpatient,100,mL,,275,233.75,78.815,275,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,247.775,90.1,,percent of total billed charges,,
IOHEXOL 350 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Inpatient,100,mL,,275,233.75,78.815,275,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
IOHEXOL 350 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Both,100,mL,,275,233.75,78.815,275,"Preferred One Administrative Services, INC.",PPO,271.15,98.6,,percent of total billed charges,,
IOHEXOL 350 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Outpatient,100,mL,,275,233.75,78.815,275,PrimeWest Health,Minnesota Senior Health Options (MSHO),141.4875,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
IOHEXOL 350 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Inpatient,100,mL,,275,233.75,78.815,275,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
IOHEXOL 350 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Outpatient,100,mL,,275,233.75,78.815,275,PrimeWest Health,MinnesotaCare,141.24,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
IOHEXOL 350 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Inpatient,100,mL,,275,233.75,78.815,275,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
IOHEXOL 350 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Both,100,mL,,275,233.75,78.815,275,Sanford Health Plan,Sanford Health Plan,253,92,,percent of total billed charges,,
IOHEXOL 350 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Outpatient,100,mL,,275,233.75,78.815,275,"UCare Health, Inc.",Individual & Family Plan,154.9625,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
IOHEXOL 350 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Inpatient,100,mL,,275,233.75,78.815,275,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
IOHEXOL 350 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Outpatient,100,mL,,275,233.75,78.815,275,"UCare Health, Inc.",Medical Assistance,138.7925,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
IOHEXOL 350 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Inpatient,100,mL,,275,233.75,78.815,275,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
IOHEXOL 350 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Outpatient,100,mL,,275,233.75,78.815,275,"UCare Health, Inc.",Medicare Advantage,138.7925,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
IOHEXOL 350 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Inpatient,100,mL,,275,233.75,78.815,275,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
IOHEXOL 350 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Outpatient,100,mL,,275,233.75,78.815,275,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),138.7925,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
IOHEXOL 350 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Inpatient,100,mL,,275,233.75,78.815,275,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
IOHEXOL 350 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Both,100,mL,,275,233.75,78.815,275,UnitedHealthcare,Individual & Family,258.5,94,,percent of total billed charges,,
IOHEXOL 350 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Outpatient,100,mL,,275,233.75,78.815,275,UnitedHealthcare,Medicare Advantage,134.75,49,,percent of total billed charges,,
IOHEXOL 350 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Inpatient,100,mL,,275,233.75,78.815,275,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
IOHEXOL 350 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Outpatient,100,mL,,275,233.75,78.815,275,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,132,48,,percent of total billed charges,,100% of DHS outpatient percentage
IOHEXOL 350 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Inpatient,100,mL,,275,233.75,78.815,275,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
EMOLLIENT TOP CREAM,,26254,LOCAL,Facility,Both,113,g,,25,21.25,7.165,25,Aetna,Commercial,23,92,,percent of total billed charges,,
EMOLLIENT TOP CREAM,,26254,LOCAL,Facility,Outpatient,113,g,,25,21.25,7.165,25,Aetna,Medicare Advantage,12.25,49,,percent of total billed charges,,
EMOLLIENT TOP CREAM,,26254,LOCAL,Facility,Inpatient,113,g,,25,21.25,7.165,25,Aetna,Medicare Advantage,,,,,Included in per diem rate,
EMOLLIENT TOP CREAM,,26254,LOCAL,Facility,Both,113,g,,25,21.25,7.165,25,Aetna,PPO,23.25,93,,percent of total billed charges,,
EMOLLIENT TOP CREAM,,26254,LOCAL,Facility,Both,113,g,,25,21.25,7.165,25,America's PPO,America's PPO,24.0075,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
EMOLLIENT TOP CREAM,,26254,LOCAL,Facility,Both,113,g,,25,21.25,7.165,25,BlueCross BlueShield Minnesota, Federal Employee Program,24.6,98.4,,percent of total billed charges,,
EMOLLIENT TOP CREAM,,26254,LOCAL,Facility,Both,113,g,,25,21.25,7.165,25,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,25,100,,percent of total billed charges,,
EMOLLIENT TOP CREAM,,26254,LOCAL,Facility,Both,113,g,,25,21.25,7.165,25,BlueCross BlueShield Minnesota,High Value Network Plan,22.5,90,,percent of total billed charges,,
EMOLLIENT TOP CREAM,,26254,LOCAL,Facility,Outpatient,113,g,,25,21.25,7.165,25,BlueCross BlueShield Minnesota,Medicare Advantage,12.25,49,,percent of total billed charges,,
EMOLLIENT TOP CREAM,,26254,LOCAL,Facility,Inpatient,113,g,,25,21.25,7.165,25,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
EMOLLIENT TOP CREAM,,26254,LOCAL,Facility,Both,113,g,,25,21.25,7.165,25,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,22.1425,88.57,,percent of total billed charges,,
EMOLLIENT TOP CREAM,,26254,LOCAL,Facility,Both,113,g,,25,21.25,7.165,25,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,7.165,28.66,,percent of total billed charges,,
EMOLLIENT TOP CREAM,,26254,LOCAL,Facility,Outpatient,113,g,,25,21.25,7.165,25,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),12.25,49,,percent of total billed charges,,
EMOLLIENT TOP CREAM,,26254,LOCAL,Facility,Inpatient,113,g,,25,21.25,7.165,25,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
EMOLLIENT TOP CREAM,,26254,LOCAL,Facility,Both,113,g,,25,21.25,7.165,25,CorVel,Worker's Compensation,25,100,,percent of total billed charges,,
EMOLLIENT TOP CREAM,,26254,LOCAL,Facility,Both,113,g,,25,21.25,7.165,25,First Health Group Corporation,First Health Network,24.25,97,,percent of total billed charges,,
EMOLLIENT TOP CREAM,,26254,LOCAL,Facility,Both,113,g,,25,21.25,7.165,25,"Health Partners, Inc.",Commercial,23.65,94.6,,percent of total billed charges,,
EMOLLIENT TOP CREAM,,26254,LOCAL,Facility,Outpatient,113,g,,25,21.25,7.165,25,"Health Partners, Inc.",Medicare Advantage,12.25,49,,percent of total billed charges,,
EMOLLIENT TOP CREAM,,26254,LOCAL,Facility,Inpatient,113,g,,25,21.25,7.165,25,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
EMOLLIENT TOP CREAM,,26254,LOCAL,Facility,Both,113,g,,25,21.25,7.165,25,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),15,60,,percent of total billed charges,,
EMOLLIENT TOP CREAM,,26254,LOCAL,Facility,Both,113,g,,25,21.25,7.165,25,"Health Partners, Inc.",State of Minnesota Advantage Program,20.375,81.5,,percent of total billed charges,,
EMOLLIENT TOP CREAM,,26254,LOCAL,Facility,Both,113,g,,25,21.25,7.165,25,"Health Partners, Inc.",State Public Programs,12.5,50,,percent of total billed charges,,
EMOLLIENT TOP CREAM,,26254,LOCAL,Facility,Both,113,g,,25,21.25,7.165,25,Humana Insurance Company,Commercial PPO,23.75,95,,percent of total billed charges,,
EMOLLIENT TOP CREAM,,26254,LOCAL,Facility,Outpatient,113,g,,25,21.25,7.165,25,Humana Insurance Company,Medicare PPO,12.25,49,,percent of total billed charges,,
EMOLLIENT TOP CREAM,,26254,LOCAL,Facility,Inpatient,113,g,,25,21.25,7.165,25,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
EMOLLIENT TOP CREAM,,26254,LOCAL,Facility,Both,113,g,,25,21.25,7.165,25,Medica,Individual & Family,24.775,99.1,,percent of total billed charges,,
EMOLLIENT TOP CREAM,,26254,LOCAL,Facility,Outpatient,113,g,,25,21.25,7.165,25,Medica,Medica Advantage Solution,12.45,49.8,,percent of total billed charges,,
EMOLLIENT TOP CREAM,,26254,LOCAL,Facility,Inpatient,113,g,,25,21.25,7.165,25,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
EMOLLIENT TOP CREAM,,26254,LOCAL,Facility,Outpatient,113,g,,25,21.25,7.165,25,Medica,Medical Assistance,11.15,44.6,,percent of total billed charges,,
EMOLLIENT TOP CREAM,,26254,LOCAL,Facility,Inpatient,113,g,,25,21.25,7.165,25,Medica,Medical Assistance,,,,,Included in per diem rate,
EMOLLIENT TOP CREAM,,26254,LOCAL,Facility,Outpatient,113,g,,25,21.25,7.165,25,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,12.45,49.8,,percent of total billed charges,,
EMOLLIENT TOP CREAM,,26254,LOCAL,Facility,Inpatient,113,g,,25,21.25,7.165,25,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
EMOLLIENT TOP CREAM,,26254,LOCAL,Facility,Both,113,g,,25,21.25,7.165,25,"Multiplan, Inc.","Multiplan, Inc.",23.5,94,,percent of total billed charges,,
EMOLLIENT TOP CREAM,,26254,LOCAL,Facility,Outpatient,113,g,,25,21.25,7.165,25,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,22.525,90.1,,percent of total billed charges,,
EMOLLIENT TOP CREAM,,26254,LOCAL,Facility,Inpatient,113,g,,25,21.25,7.165,25,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
EMOLLIENT TOP CREAM,,26254,LOCAL,Facility,Both,113,g,,25,21.25,7.165,25,"Preferred One Administrative Services, INC.",PPO,24.65,98.6,,percent of total billed charges,,
EMOLLIENT TOP CREAM,,26254,LOCAL,Facility,Outpatient,113,g,,25,21.25,7.165,25,PrimeWest Health,Minnesota Senior Health Options (MSHO),12.8625,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
EMOLLIENT TOP CREAM,,26254,LOCAL,Facility,Inpatient,113,g,,25,21.25,7.165,25,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
EMOLLIENT TOP CREAM,,26254,LOCAL,Facility,Outpatient,113,g,,25,21.25,7.165,25,PrimeWest Health,MinnesotaCare,12.84,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
EMOLLIENT TOP CREAM,,26254,LOCAL,Facility,Inpatient,113,g,,25,21.25,7.165,25,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
EMOLLIENT TOP CREAM,,26254,LOCAL,Facility,Both,113,g,,25,21.25,7.165,25,Sanford Health Plan,Sanford Health Plan,23,92,,percent of total billed charges,,
EMOLLIENT TOP CREAM,,26254,LOCAL,Facility,Outpatient,113,g,,25,21.25,7.165,25,"UCare Health, Inc.",Individual & Family Plan,14.0875,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
EMOLLIENT TOP CREAM,,26254,LOCAL,Facility,Inpatient,113,g,,25,21.25,7.165,25,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
EMOLLIENT TOP CREAM,,26254,LOCAL,Facility,Outpatient,113,g,,25,21.25,7.165,25,"UCare Health, Inc.",Medical Assistance,12.6175,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
EMOLLIENT TOP CREAM,,26254,LOCAL,Facility,Inpatient,113,g,,25,21.25,7.165,25,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
EMOLLIENT TOP CREAM,,26254,LOCAL,Facility,Outpatient,113,g,,25,21.25,7.165,25,"UCare Health, Inc.",Medicare Advantage,12.6175,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
EMOLLIENT TOP CREAM,,26254,LOCAL,Facility,Inpatient,113,g,,25,21.25,7.165,25,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
EMOLLIENT TOP CREAM,,26254,LOCAL,Facility,Outpatient,113,g,,25,21.25,7.165,25,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),12.6175,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
EMOLLIENT TOP CREAM,,26254,LOCAL,Facility,Inpatient,113,g,,25,21.25,7.165,25,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
EMOLLIENT TOP CREAM,,26254,LOCAL,Facility,Both,113,g,,25,21.25,7.165,25,UnitedHealthcare,Individual & Family,23.5,94,,percent of total billed charges,,
EMOLLIENT TOP CREAM,,26254,LOCAL,Facility,Outpatient,113,g,,25,21.25,7.165,25,UnitedHealthcare,Medicare Advantage,12.25,49,,percent of total billed charges,,
EMOLLIENT TOP CREAM,,26254,LOCAL,Facility,Inpatient,113,g,,25,21.25,7.165,25,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
EMOLLIENT TOP CREAM,,26254,LOCAL,Facility,Outpatient,113,g,,25,21.25,7.165,25,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,12,48,,percent of total billed charges,,100% of DHS outpatient percentage
EMOLLIENT TOP CREAM,,26254,LOCAL,Facility,Inpatient,113,g,,25,21.25,7.165,25,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
ETHYL CHLORIDE 100 % TOP SPRA,,76033,LOCAL,Facility,Both,116,mL,,181,153.85,51.8746,181,Aetna,Commercial,166.52,92,,percent of total billed charges,,
ETHYL CHLORIDE 100 % TOP SPRA,,76033,LOCAL,Facility,Outpatient,116,mL,,181,153.85,51.8746,181,Aetna,Medicare Advantage,88.69,49,,percent of total billed charges,,
ETHYL CHLORIDE 100 % TOP SPRA,,76033,LOCAL,Facility,Inpatient,116,mL,,181,153.85,51.8746,181,Aetna,Medicare Advantage,,,,,Included in per diem rate,
ETHYL CHLORIDE 100 % TOP SPRA,,76033,LOCAL,Facility,Both,116,mL,,181,153.85,51.8746,181,Aetna,PPO,168.33,93,,percent of total billed charges,,
ETHYL CHLORIDE 100 % TOP SPRA,,76033,LOCAL,Facility,Both,116,mL,,181,153.85,51.8746,181,America's PPO,America's PPO,173.8143,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
ETHYL CHLORIDE 100 % TOP SPRA,,76033,LOCAL,Facility,Both,116,mL,,181,153.85,51.8746,181,BlueCross BlueShield Minnesota, Federal Employee Program,178.104,98.4,,percent of total billed charges,,
ETHYL CHLORIDE 100 % TOP SPRA,,76033,LOCAL,Facility,Both,116,mL,,181,153.85,51.8746,181,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,181,100,,percent of total billed charges,,
ETHYL CHLORIDE 100 % TOP SPRA,,76033,LOCAL,Facility,Both,116,mL,,181,153.85,51.8746,181,BlueCross BlueShield Minnesota,High Value Network Plan,162.9,90,,percent of total billed charges,,
ETHYL CHLORIDE 100 % TOP SPRA,,76033,LOCAL,Facility,Outpatient,116,mL,,181,153.85,51.8746,181,BlueCross BlueShield Minnesota,Medicare Advantage,88.69,49,,percent of total billed charges,,
ETHYL CHLORIDE 100 % TOP SPRA,,76033,LOCAL,Facility,Inpatient,116,mL,,181,153.85,51.8746,181,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
ETHYL CHLORIDE 100 % TOP SPRA,,76033,LOCAL,Facility,Both,116,mL,,181,153.85,51.8746,181,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,160.3117,88.57,,percent of total billed charges,,
ETHYL CHLORIDE 100 % TOP SPRA,,76033,LOCAL,Facility,Both,116,mL,,181,153.85,51.8746,181,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,51.8746,28.66,,percent of total billed charges,,
ETHYL CHLORIDE 100 % TOP SPRA,,76033,LOCAL,Facility,Outpatient,116,mL,,181,153.85,51.8746,181,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),88.69,49,,percent of total billed charges,,
ETHYL CHLORIDE 100 % TOP SPRA,,76033,LOCAL,Facility,Inpatient,116,mL,,181,153.85,51.8746,181,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
ETHYL CHLORIDE 100 % TOP SPRA,,76033,LOCAL,Facility,Both,116,mL,,181,153.85,51.8746,181,CorVel,Worker's Compensation,181,100,,percent of total billed charges,,
ETHYL CHLORIDE 100 % TOP SPRA,,76033,LOCAL,Facility,Both,116,mL,,181,153.85,51.8746,181,First Health Group Corporation,First Health Network,175.57,97,,percent of total billed charges,,
ETHYL CHLORIDE 100 % TOP SPRA,,76033,LOCAL,Facility,Both,116,mL,,181,153.85,51.8746,181,"Health Partners, Inc.",Commercial,171.226,94.6,,percent of total billed charges,,
ETHYL CHLORIDE 100 % TOP SPRA,,76033,LOCAL,Facility,Outpatient,116,mL,,181,153.85,51.8746,181,"Health Partners, Inc.",Medicare Advantage,88.69,49,,percent of total billed charges,,
ETHYL CHLORIDE 100 % TOP SPRA,,76033,LOCAL,Facility,Inpatient,116,mL,,181,153.85,51.8746,181,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ETHYL CHLORIDE 100 % TOP SPRA,,76033,LOCAL,Facility,Both,116,mL,,181,153.85,51.8746,181,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),108.6,60,,percent of total billed charges,,
ETHYL CHLORIDE 100 % TOP SPRA,,76033,LOCAL,Facility,Both,116,mL,,181,153.85,51.8746,181,"Health Partners, Inc.",State of Minnesota Advantage Program,147.515,81.5,,percent of total billed charges,,
ETHYL CHLORIDE 100 % TOP SPRA,,76033,LOCAL,Facility,Both,116,mL,,181,153.85,51.8746,181,"Health Partners, Inc.",State Public Programs,90.5,50,,percent of total billed charges,,
ETHYL CHLORIDE 100 % TOP SPRA,,76033,LOCAL,Facility,Both,116,mL,,181,153.85,51.8746,181,Humana Insurance Company,Commercial PPO,171.95,95,,percent of total billed charges,,
ETHYL CHLORIDE 100 % TOP SPRA,,76033,LOCAL,Facility,Outpatient,116,mL,,181,153.85,51.8746,181,Humana Insurance Company,Medicare PPO,88.69,49,,percent of total billed charges,,
ETHYL CHLORIDE 100 % TOP SPRA,,76033,LOCAL,Facility,Inpatient,116,mL,,181,153.85,51.8746,181,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
ETHYL CHLORIDE 100 % TOP SPRA,,76033,LOCAL,Facility,Both,116,mL,,181,153.85,51.8746,181,Medica,Individual & Family,179.371,99.1,,percent of total billed charges,,
ETHYL CHLORIDE 100 % TOP SPRA,,76033,LOCAL,Facility,Outpatient,116,mL,,181,153.85,51.8746,181,Medica,Medica Advantage Solution,90.138,49.8,,percent of total billed charges,,
ETHYL CHLORIDE 100 % TOP SPRA,,76033,LOCAL,Facility,Inpatient,116,mL,,181,153.85,51.8746,181,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
ETHYL CHLORIDE 100 % TOP SPRA,,76033,LOCAL,Facility,Outpatient,116,mL,,181,153.85,51.8746,181,Medica,Medical Assistance,80.726,44.6,,percent of total billed charges,,
ETHYL CHLORIDE 100 % TOP SPRA,,76033,LOCAL,Facility,Inpatient,116,mL,,181,153.85,51.8746,181,Medica,Medical Assistance,,,,,Included in per diem rate,
ETHYL CHLORIDE 100 % TOP SPRA,,76033,LOCAL,Facility,Outpatient,116,mL,,181,153.85,51.8746,181,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,90.138,49.8,,percent of total billed charges,,
ETHYL CHLORIDE 100 % TOP SPRA,,76033,LOCAL,Facility,Inpatient,116,mL,,181,153.85,51.8746,181,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
ETHYL CHLORIDE 100 % TOP SPRA,,76033,LOCAL,Facility,Both,116,mL,,181,153.85,51.8746,181,"Multiplan, Inc.","Multiplan, Inc.",170.14,94,,percent of total billed charges,,
ETHYL CHLORIDE 100 % TOP SPRA,,76033,LOCAL,Facility,Outpatient,116,mL,,181,153.85,51.8746,181,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,163.081,90.1,,percent of total billed charges,,
ETHYL CHLORIDE 100 % TOP SPRA,,76033,LOCAL,Facility,Inpatient,116,mL,,181,153.85,51.8746,181,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
ETHYL CHLORIDE 100 % TOP SPRA,,76033,LOCAL,Facility,Both,116,mL,,181,153.85,51.8746,181,"Preferred One Administrative Services, INC.",PPO,178.466,98.6,,percent of total billed charges,,
ETHYL CHLORIDE 100 % TOP SPRA,,76033,LOCAL,Facility,Outpatient,116,mL,,181,153.85,51.8746,181,PrimeWest Health,Minnesota Senior Health Options (MSHO),93.1245,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
ETHYL CHLORIDE 100 % TOP SPRA,,76033,LOCAL,Facility,Inpatient,116,mL,,181,153.85,51.8746,181,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ETHYL CHLORIDE 100 % TOP SPRA,,76033,LOCAL,Facility,Outpatient,116,mL,,181,153.85,51.8746,181,PrimeWest Health,MinnesotaCare,92.9616,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
ETHYL CHLORIDE 100 % TOP SPRA,,76033,LOCAL,Facility,Inpatient,116,mL,,181,153.85,51.8746,181,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
ETHYL CHLORIDE 100 % TOP SPRA,,76033,LOCAL,Facility,Both,116,mL,,181,153.85,51.8746,181,Sanford Health Plan,Sanford Health Plan,166.52,92,,percent of total billed charges,,
ETHYL CHLORIDE 100 % TOP SPRA,,76033,LOCAL,Facility,Outpatient,116,mL,,181,153.85,51.8746,181,"UCare Health, Inc.",Individual & Family Plan,101.9935,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
ETHYL CHLORIDE 100 % TOP SPRA,,76033,LOCAL,Facility,Inpatient,116,mL,,181,153.85,51.8746,181,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
ETHYL CHLORIDE 100 % TOP SPRA,,76033,LOCAL,Facility,Outpatient,116,mL,,181,153.85,51.8746,181,"UCare Health, Inc.",Medical Assistance,91.3507,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ETHYL CHLORIDE 100 % TOP SPRA,,76033,LOCAL,Facility,Inpatient,116,mL,,181,153.85,51.8746,181,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
ETHYL CHLORIDE 100 % TOP SPRA,,76033,LOCAL,Facility,Outpatient,116,mL,,181,153.85,51.8746,181,"UCare Health, Inc.",Medicare Advantage,91.3507,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ETHYL CHLORIDE 100 % TOP SPRA,,76033,LOCAL,Facility,Inpatient,116,mL,,181,153.85,51.8746,181,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ETHYL CHLORIDE 100 % TOP SPRA,,76033,LOCAL,Facility,Outpatient,116,mL,,181,153.85,51.8746,181,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),91.3507,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ETHYL CHLORIDE 100 % TOP SPRA,,76033,LOCAL,Facility,Inpatient,116,mL,,181,153.85,51.8746,181,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ETHYL CHLORIDE 100 % TOP SPRA,,76033,LOCAL,Facility,Both,116,mL,,181,153.85,51.8746,181,UnitedHealthcare,Individual & Family,170.14,94,,percent of total billed charges,,
ETHYL CHLORIDE 100 % TOP SPRA,,76033,LOCAL,Facility,Outpatient,116,mL,,181,153.85,51.8746,181,UnitedHealthcare,Medicare Advantage,88.69,49,,percent of total billed charges,,
ETHYL CHLORIDE 100 % TOP SPRA,,76033,LOCAL,Facility,Inpatient,116,mL,,181,153.85,51.8746,181,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
ETHYL CHLORIDE 100 % TOP SPRA,,76033,LOCAL,Facility,Outpatient,116,mL,,181,153.85,51.8746,181,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,86.88,48,,percent of total billed charges,,100% of DHS outpatient percentage
ETHYL CHLORIDE 100 % TOP SPRA,,76033,LOCAL,Facility,Inpatient,116,mL,,181,153.85,51.8746,181,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
DIPHENHYDRAMINE HCL 12.5 MG/5 ML ORAL LIQD,,796,LOCAL,Facility,Both,118,mL,,15,12.75,4.299,15,Aetna,Commercial,13.8,92,,percent of total billed charges,,
DIPHENHYDRAMINE HCL 12.5 MG/5 ML ORAL LIQD,,796,LOCAL,Facility,Outpatient,118,mL,,15,12.75,4.299,15,Aetna,Medicare Advantage,7.35,49,,percent of total billed charges,,
DIPHENHYDRAMINE HCL 12.5 MG/5 ML ORAL LIQD,,796,LOCAL,Facility,Inpatient,118,mL,,15,12.75,4.299,15,Aetna,Medicare Advantage,,,,,Included in per diem rate,
DIPHENHYDRAMINE HCL 12.5 MG/5 ML ORAL LIQD,,796,LOCAL,Facility,Both,118,mL,,15,12.75,4.299,15,Aetna,PPO,13.95,93,,percent of total billed charges,,
DIPHENHYDRAMINE HCL 12.5 MG/5 ML ORAL LIQD,,796,LOCAL,Facility,Both,118,mL,,15,12.75,4.299,15,America's PPO,America's PPO,14.4045,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
DIPHENHYDRAMINE HCL 12.5 MG/5 ML ORAL LIQD,,796,LOCAL,Facility,Both,118,mL,,15,12.75,4.299,15,BlueCross BlueShield Minnesota, Federal Employee Program,14.76,98.4,,percent of total billed charges,,
DIPHENHYDRAMINE HCL 12.5 MG/5 ML ORAL LIQD,,796,LOCAL,Facility,Both,118,mL,,15,12.75,4.299,15,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,15,100,,percent of total billed charges,,
DIPHENHYDRAMINE HCL 12.5 MG/5 ML ORAL LIQD,,796,LOCAL,Facility,Both,118,mL,,15,12.75,4.299,15,BlueCross BlueShield Minnesota,High Value Network Plan,13.5,90,,percent of total billed charges,,
DIPHENHYDRAMINE HCL 12.5 MG/5 ML ORAL LIQD,,796,LOCAL,Facility,Outpatient,118,mL,,15,12.75,4.299,15,BlueCross BlueShield Minnesota,Medicare Advantage,7.35,49,,percent of total billed charges,,
DIPHENHYDRAMINE HCL 12.5 MG/5 ML ORAL LIQD,,796,LOCAL,Facility,Inpatient,118,mL,,15,12.75,4.299,15,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
DIPHENHYDRAMINE HCL 12.5 MG/5 ML ORAL LIQD,,796,LOCAL,Facility,Both,118,mL,,15,12.75,4.299,15,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,13.2855,88.57,,percent of total billed charges,,
DIPHENHYDRAMINE HCL 12.5 MG/5 ML ORAL LIQD,,796,LOCAL,Facility,Both,118,mL,,15,12.75,4.299,15,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,4.299,28.66,,percent of total billed charges,,
DIPHENHYDRAMINE HCL 12.5 MG/5 ML ORAL LIQD,,796,LOCAL,Facility,Outpatient,118,mL,,15,12.75,4.299,15,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),7.35,49,,percent of total billed charges,,
DIPHENHYDRAMINE HCL 12.5 MG/5 ML ORAL LIQD,,796,LOCAL,Facility,Inpatient,118,mL,,15,12.75,4.299,15,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
DIPHENHYDRAMINE HCL 12.5 MG/5 ML ORAL LIQD,,796,LOCAL,Facility,Both,118,mL,,15,12.75,4.299,15,CorVel,Worker's Compensation,15,100,,percent of total billed charges,,
DIPHENHYDRAMINE HCL 12.5 MG/5 ML ORAL LIQD,,796,LOCAL,Facility,Both,118,mL,,15,12.75,4.299,15,First Health Group Corporation,First Health Network,14.55,97,,percent of total billed charges,,
DIPHENHYDRAMINE HCL 12.5 MG/5 ML ORAL LIQD,,796,LOCAL,Facility,Both,118,mL,,15,12.75,4.299,15,"Health Partners, Inc.",Commercial,14.19,94.6,,percent of total billed charges,,
DIPHENHYDRAMINE HCL 12.5 MG/5 ML ORAL LIQD,,796,LOCAL,Facility,Outpatient,118,mL,,15,12.75,4.299,15,"Health Partners, Inc.",Medicare Advantage,7.35,49,,percent of total billed charges,,
DIPHENHYDRAMINE HCL 12.5 MG/5 ML ORAL LIQD,,796,LOCAL,Facility,Inpatient,118,mL,,15,12.75,4.299,15,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DIPHENHYDRAMINE HCL 12.5 MG/5 ML ORAL LIQD,,796,LOCAL,Facility,Both,118,mL,,15,12.75,4.299,15,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),9,60,,percent of total billed charges,,
DIPHENHYDRAMINE HCL 12.5 MG/5 ML ORAL LIQD,,796,LOCAL,Facility,Both,118,mL,,15,12.75,4.299,15,"Health Partners, Inc.",State of Minnesota Advantage Program,12.225,81.5,,percent of total billed charges,,
DIPHENHYDRAMINE HCL 12.5 MG/5 ML ORAL LIQD,,796,LOCAL,Facility,Both,118,mL,,15,12.75,4.299,15,"Health Partners, Inc.",State Public Programs,7.5,50,,percent of total billed charges,,
DIPHENHYDRAMINE HCL 12.5 MG/5 ML ORAL LIQD,,796,LOCAL,Facility,Both,118,mL,,15,12.75,4.299,15,Humana Insurance Company,Commercial PPO,14.25,95,,percent of total billed charges,,
DIPHENHYDRAMINE HCL 12.5 MG/5 ML ORAL LIQD,,796,LOCAL,Facility,Outpatient,118,mL,,15,12.75,4.299,15,Humana Insurance Company,Medicare PPO,7.35,49,,percent of total billed charges,,
DIPHENHYDRAMINE HCL 12.5 MG/5 ML ORAL LIQD,,796,LOCAL,Facility,Inpatient,118,mL,,15,12.75,4.299,15,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
DIPHENHYDRAMINE HCL 12.5 MG/5 ML ORAL LIQD,,796,LOCAL,Facility,Both,118,mL,,15,12.75,4.299,15,Medica,Individual & Family,14.865,99.1,,percent of total billed charges,,
DIPHENHYDRAMINE HCL 12.5 MG/5 ML ORAL LIQD,,796,LOCAL,Facility,Outpatient,118,mL,,15,12.75,4.299,15,Medica,Medica Advantage Solution,7.47,49.8,,percent of total billed charges,,
DIPHENHYDRAMINE HCL 12.5 MG/5 ML ORAL LIQD,,796,LOCAL,Facility,Inpatient,118,mL,,15,12.75,4.299,15,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
DIPHENHYDRAMINE HCL 12.5 MG/5 ML ORAL LIQD,,796,LOCAL,Facility,Outpatient,118,mL,,15,12.75,4.299,15,Medica,Medical Assistance,6.69,44.6,,percent of total billed charges,,
DIPHENHYDRAMINE HCL 12.5 MG/5 ML ORAL LIQD,,796,LOCAL,Facility,Inpatient,118,mL,,15,12.75,4.299,15,Medica,Medical Assistance,,,,,Included in per diem rate,
DIPHENHYDRAMINE HCL 12.5 MG/5 ML ORAL LIQD,,796,LOCAL,Facility,Outpatient,118,mL,,15,12.75,4.299,15,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,7.47,49.8,,percent of total billed charges,,
DIPHENHYDRAMINE HCL 12.5 MG/5 ML ORAL LIQD,,796,LOCAL,Facility,Inpatient,118,mL,,15,12.75,4.299,15,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
DIPHENHYDRAMINE HCL 12.5 MG/5 ML ORAL LIQD,,796,LOCAL,Facility,Both,118,mL,,15,12.75,4.299,15,"Multiplan, Inc.","Multiplan, Inc.",14.1,94,,percent of total billed charges,,
DIPHENHYDRAMINE HCL 12.5 MG/5 ML ORAL LIQD,,796,LOCAL,Facility,Outpatient,118,mL,,15,12.75,4.299,15,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,13.515,90.1,,percent of total billed charges,,
DIPHENHYDRAMINE HCL 12.5 MG/5 ML ORAL LIQD,,796,LOCAL,Facility,Inpatient,118,mL,,15,12.75,4.299,15,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
DIPHENHYDRAMINE HCL 12.5 MG/5 ML ORAL LIQD,,796,LOCAL,Facility,Both,118,mL,,15,12.75,4.299,15,"Preferred One Administrative Services, INC.",PPO,14.79,98.6,,percent of total billed charges,,
DIPHENHYDRAMINE HCL 12.5 MG/5 ML ORAL LIQD,,796,LOCAL,Facility,Outpatient,118,mL,,15,12.75,4.299,15,PrimeWest Health,Minnesota Senior Health Options (MSHO),7.7175,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
DIPHENHYDRAMINE HCL 12.5 MG/5 ML ORAL LIQD,,796,LOCAL,Facility,Inpatient,118,mL,,15,12.75,4.299,15,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DIPHENHYDRAMINE HCL 12.5 MG/5 ML ORAL LIQD,,796,LOCAL,Facility,Outpatient,118,mL,,15,12.75,4.299,15,PrimeWest Health,MinnesotaCare,7.704,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
DIPHENHYDRAMINE HCL 12.5 MG/5 ML ORAL LIQD,,796,LOCAL,Facility,Inpatient,118,mL,,15,12.75,4.299,15,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
DIPHENHYDRAMINE HCL 12.5 MG/5 ML ORAL LIQD,,796,LOCAL,Facility,Both,118,mL,,15,12.75,4.299,15,Sanford Health Plan,Sanford Health Plan,13.8,92,,percent of total billed charges,,
DIPHENHYDRAMINE HCL 12.5 MG/5 ML ORAL LIQD,,796,LOCAL,Facility,Outpatient,118,mL,,15,12.75,4.299,15,"UCare Health, Inc.",Individual & Family Plan,8.4525,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
DIPHENHYDRAMINE HCL 12.5 MG/5 ML ORAL LIQD,,796,LOCAL,Facility,Inpatient,118,mL,,15,12.75,4.299,15,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
DIPHENHYDRAMINE HCL 12.5 MG/5 ML ORAL LIQD,,796,LOCAL,Facility,Outpatient,118,mL,,15,12.75,4.299,15,"UCare Health, Inc.",Medical Assistance,7.5705,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DIPHENHYDRAMINE HCL 12.5 MG/5 ML ORAL LIQD,,796,LOCAL,Facility,Inpatient,118,mL,,15,12.75,4.299,15,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
DIPHENHYDRAMINE HCL 12.5 MG/5 ML ORAL LIQD,,796,LOCAL,Facility,Outpatient,118,mL,,15,12.75,4.299,15,"UCare Health, Inc.",Medicare Advantage,7.5705,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DIPHENHYDRAMINE HCL 12.5 MG/5 ML ORAL LIQD,,796,LOCAL,Facility,Inpatient,118,mL,,15,12.75,4.299,15,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DIPHENHYDRAMINE HCL 12.5 MG/5 ML ORAL LIQD,,796,LOCAL,Facility,Outpatient,118,mL,,15,12.75,4.299,15,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),7.5705,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DIPHENHYDRAMINE HCL 12.5 MG/5 ML ORAL LIQD,,796,LOCAL,Facility,Inpatient,118,mL,,15,12.75,4.299,15,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DIPHENHYDRAMINE HCL 12.5 MG/5 ML ORAL LIQD,,796,LOCAL,Facility,Both,118,mL,,15,12.75,4.299,15,UnitedHealthcare,Individual & Family,14.1,94,,percent of total billed charges,,
DIPHENHYDRAMINE HCL 12.5 MG/5 ML ORAL LIQD,,796,LOCAL,Facility,Outpatient,118,mL,,15,12.75,4.299,15,UnitedHealthcare,Medicare Advantage,7.35,49,,percent of total billed charges,,
DIPHENHYDRAMINE HCL 12.5 MG/5 ML ORAL LIQD,,796,LOCAL,Facility,Inpatient,118,mL,,15,12.75,4.299,15,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
DIPHENHYDRAMINE HCL 12.5 MG/5 ML ORAL LIQD,,796,LOCAL,Facility,Outpatient,118,mL,,15,12.75,4.299,15,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,7.2,48,,percent of total billed charges,,100% of DHS outpatient percentage
DIPHENHYDRAMINE HCL 12.5 MG/5 ML ORAL LIQD,,796,LOCAL,Facility,Inpatient,118,mL,,15,12.75,4.299,15,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
ACETAMINOPHEN 160 MG/5 ML ORAL SUSP,,1173,LOCAL,Facility,Both,118,mL,,15,12.75,4.299,15,Aetna,Commercial,13.8,92,,percent of total billed charges,,
ACETAMINOPHEN 160 MG/5 ML ORAL SUSP,,1173,LOCAL,Facility,Outpatient,118,mL,,15,12.75,4.299,15,Aetna,Medicare Advantage,7.35,49,,percent of total billed charges,,
ACETAMINOPHEN 160 MG/5 ML ORAL SUSP,,1173,LOCAL,Facility,Inpatient,118,mL,,15,12.75,4.299,15,Aetna,Medicare Advantage,,,,,Included in per diem rate,
ACETAMINOPHEN 160 MG/5 ML ORAL SUSP,,1173,LOCAL,Facility,Both,118,mL,,15,12.75,4.299,15,Aetna,PPO,13.95,93,,percent of total billed charges,,
ACETAMINOPHEN 160 MG/5 ML ORAL SUSP,,1173,LOCAL,Facility,Both,118,mL,,15,12.75,4.299,15,America's PPO,America's PPO,14.4045,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
ACETAMINOPHEN 160 MG/5 ML ORAL SUSP,,1173,LOCAL,Facility,Both,118,mL,,15,12.75,4.299,15,BlueCross BlueShield Minnesota, Federal Employee Program,14.76,98.4,,percent of total billed charges,,
ACETAMINOPHEN 160 MG/5 ML ORAL SUSP,,1173,LOCAL,Facility,Both,118,mL,,15,12.75,4.299,15,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,15,100,,percent of total billed charges,,
ACETAMINOPHEN 160 MG/5 ML ORAL SUSP,,1173,LOCAL,Facility,Both,118,mL,,15,12.75,4.299,15,BlueCross BlueShield Minnesota,High Value Network Plan,13.5,90,,percent of total billed charges,,
ACETAMINOPHEN 160 MG/5 ML ORAL SUSP,,1173,LOCAL,Facility,Outpatient,118,mL,,15,12.75,4.299,15,BlueCross BlueShield Minnesota,Medicare Advantage,7.35,49,,percent of total billed charges,,
ACETAMINOPHEN 160 MG/5 ML ORAL SUSP,,1173,LOCAL,Facility,Inpatient,118,mL,,15,12.75,4.299,15,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
ACETAMINOPHEN 160 MG/5 ML ORAL SUSP,,1173,LOCAL,Facility,Both,118,mL,,15,12.75,4.299,15,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,13.2855,88.57,,percent of total billed charges,,
ACETAMINOPHEN 160 MG/5 ML ORAL SUSP,,1173,LOCAL,Facility,Both,118,mL,,15,12.75,4.299,15,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,4.299,28.66,,percent of total billed charges,,
ACETAMINOPHEN 160 MG/5 ML ORAL SUSP,,1173,LOCAL,Facility,Outpatient,118,mL,,15,12.75,4.299,15,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),7.35,49,,percent of total billed charges,,
ACETAMINOPHEN 160 MG/5 ML ORAL SUSP,,1173,LOCAL,Facility,Inpatient,118,mL,,15,12.75,4.299,15,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
ACETAMINOPHEN 160 MG/5 ML ORAL SUSP,,1173,LOCAL,Facility,Both,118,mL,,15,12.75,4.299,15,CorVel,Worker's Compensation,15,100,,percent of total billed charges,,
ACETAMINOPHEN 160 MG/5 ML ORAL SUSP,,1173,LOCAL,Facility,Both,118,mL,,15,12.75,4.299,15,First Health Group Corporation,First Health Network,14.55,97,,percent of total billed charges,,
ACETAMINOPHEN 160 MG/5 ML ORAL SUSP,,1173,LOCAL,Facility,Both,118,mL,,15,12.75,4.299,15,"Health Partners, Inc.",Commercial,14.19,94.6,,percent of total billed charges,,
ACETAMINOPHEN 160 MG/5 ML ORAL SUSP,,1173,LOCAL,Facility,Outpatient,118,mL,,15,12.75,4.299,15,"Health Partners, Inc.",Medicare Advantage,7.35,49,,percent of total billed charges,,
ACETAMINOPHEN 160 MG/5 ML ORAL SUSP,,1173,LOCAL,Facility,Inpatient,118,mL,,15,12.75,4.299,15,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ACETAMINOPHEN 160 MG/5 ML ORAL SUSP,,1173,LOCAL,Facility,Both,118,mL,,15,12.75,4.299,15,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),9,60,,percent of total billed charges,,
ACETAMINOPHEN 160 MG/5 ML ORAL SUSP,,1173,LOCAL,Facility,Both,118,mL,,15,12.75,4.299,15,"Health Partners, Inc.",State of Minnesota Advantage Program,12.225,81.5,,percent of total billed charges,,
ACETAMINOPHEN 160 MG/5 ML ORAL SUSP,,1173,LOCAL,Facility,Both,118,mL,,15,12.75,4.299,15,"Health Partners, Inc.",State Public Programs,7.5,50,,percent of total billed charges,,
ACETAMINOPHEN 160 MG/5 ML ORAL SUSP,,1173,LOCAL,Facility,Both,118,mL,,15,12.75,4.299,15,Humana Insurance Company,Commercial PPO,14.25,95,,percent of total billed charges,,
ACETAMINOPHEN 160 MG/5 ML ORAL SUSP,,1173,LOCAL,Facility,Outpatient,118,mL,,15,12.75,4.299,15,Humana Insurance Company,Medicare PPO,7.35,49,,percent of total billed charges,,
ACETAMINOPHEN 160 MG/5 ML ORAL SUSP,,1173,LOCAL,Facility,Inpatient,118,mL,,15,12.75,4.299,15,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
ACETAMINOPHEN 160 MG/5 ML ORAL SUSP,,1173,LOCAL,Facility,Both,118,mL,,15,12.75,4.299,15,Medica,Individual & Family,14.865,99.1,,percent of total billed charges,,
ACETAMINOPHEN 160 MG/5 ML ORAL SUSP,,1173,LOCAL,Facility,Outpatient,118,mL,,15,12.75,4.299,15,Medica,Medica Advantage Solution,7.47,49.8,,percent of total billed charges,,
ACETAMINOPHEN 160 MG/5 ML ORAL SUSP,,1173,LOCAL,Facility,Inpatient,118,mL,,15,12.75,4.299,15,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
ACETAMINOPHEN 160 MG/5 ML ORAL SUSP,,1173,LOCAL,Facility,Outpatient,118,mL,,15,12.75,4.299,15,Medica,Medical Assistance,6.69,44.6,,percent of total billed charges,,
ACETAMINOPHEN 160 MG/5 ML ORAL SUSP,,1173,LOCAL,Facility,Inpatient,118,mL,,15,12.75,4.299,15,Medica,Medical Assistance,,,,,Included in per diem rate,
ACETAMINOPHEN 160 MG/5 ML ORAL SUSP,,1173,LOCAL,Facility,Outpatient,118,mL,,15,12.75,4.299,15,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,7.47,49.8,,percent of total billed charges,,
ACETAMINOPHEN 160 MG/5 ML ORAL SUSP,,1173,LOCAL,Facility,Inpatient,118,mL,,15,12.75,4.299,15,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
ACETAMINOPHEN 160 MG/5 ML ORAL SUSP,,1173,LOCAL,Facility,Both,118,mL,,15,12.75,4.299,15,"Multiplan, Inc.","Multiplan, Inc.",14.1,94,,percent of total billed charges,,
ACETAMINOPHEN 160 MG/5 ML ORAL SUSP,,1173,LOCAL,Facility,Outpatient,118,mL,,15,12.75,4.299,15,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,13.515,90.1,,percent of total billed charges,,
ACETAMINOPHEN 160 MG/5 ML ORAL SUSP,,1173,LOCAL,Facility,Inpatient,118,mL,,15,12.75,4.299,15,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
ACETAMINOPHEN 160 MG/5 ML ORAL SUSP,,1173,LOCAL,Facility,Both,118,mL,,15,12.75,4.299,15,"Preferred One Administrative Services, INC.",PPO,14.79,98.6,,percent of total billed charges,,
ACETAMINOPHEN 160 MG/5 ML ORAL SUSP,,1173,LOCAL,Facility,Outpatient,118,mL,,15,12.75,4.299,15,PrimeWest Health,Minnesota Senior Health Options (MSHO),7.7175,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
ACETAMINOPHEN 160 MG/5 ML ORAL SUSP,,1173,LOCAL,Facility,Inpatient,118,mL,,15,12.75,4.299,15,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ACETAMINOPHEN 160 MG/5 ML ORAL SUSP,,1173,LOCAL,Facility,Outpatient,118,mL,,15,12.75,4.299,15,PrimeWest Health,MinnesotaCare,7.704,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
ACETAMINOPHEN 160 MG/5 ML ORAL SUSP,,1173,LOCAL,Facility,Inpatient,118,mL,,15,12.75,4.299,15,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
ACETAMINOPHEN 160 MG/5 ML ORAL SUSP,,1173,LOCAL,Facility,Both,118,mL,,15,12.75,4.299,15,Sanford Health Plan,Sanford Health Plan,13.8,92,,percent of total billed charges,,
ACETAMINOPHEN 160 MG/5 ML ORAL SUSP,,1173,LOCAL,Facility,Outpatient,118,mL,,15,12.75,4.299,15,"UCare Health, Inc.",Individual & Family Plan,8.4525,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
ACETAMINOPHEN 160 MG/5 ML ORAL SUSP,,1173,LOCAL,Facility,Inpatient,118,mL,,15,12.75,4.299,15,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
ACETAMINOPHEN 160 MG/5 ML ORAL SUSP,,1173,LOCAL,Facility,Outpatient,118,mL,,15,12.75,4.299,15,"UCare Health, Inc.",Medical Assistance,7.5705,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ACETAMINOPHEN 160 MG/5 ML ORAL SUSP,,1173,LOCAL,Facility,Inpatient,118,mL,,15,12.75,4.299,15,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
ACETAMINOPHEN 160 MG/5 ML ORAL SUSP,,1173,LOCAL,Facility,Outpatient,118,mL,,15,12.75,4.299,15,"UCare Health, Inc.",Medicare Advantage,7.5705,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ACETAMINOPHEN 160 MG/5 ML ORAL SUSP,,1173,LOCAL,Facility,Inpatient,118,mL,,15,12.75,4.299,15,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ACETAMINOPHEN 160 MG/5 ML ORAL SUSP,,1173,LOCAL,Facility,Outpatient,118,mL,,15,12.75,4.299,15,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),7.5705,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ACETAMINOPHEN 160 MG/5 ML ORAL SUSP,,1173,LOCAL,Facility,Inpatient,118,mL,,15,12.75,4.299,15,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ACETAMINOPHEN 160 MG/5 ML ORAL SUSP,,1173,LOCAL,Facility,Both,118,mL,,15,12.75,4.299,15,UnitedHealthcare,Individual & Family,14.1,94,,percent of total billed charges,,
ACETAMINOPHEN 160 MG/5 ML ORAL SUSP,,1173,LOCAL,Facility,Outpatient,118,mL,,15,12.75,4.299,15,UnitedHealthcare,Medicare Advantage,7.35,49,,percent of total billed charges,,
ACETAMINOPHEN 160 MG/5 ML ORAL SUSP,,1173,LOCAL,Facility,Inpatient,118,mL,,15,12.75,4.299,15,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
ACETAMINOPHEN 160 MG/5 ML ORAL SUSP,,1173,LOCAL,Facility,Outpatient,118,mL,,15,12.75,4.299,15,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,7.2,48,,percent of total billed charges,,100% of DHS outpatient percentage
ACETAMINOPHEN 160 MG/5 ML ORAL SUSP,,1173,LOCAL,Facility,Inpatient,118,mL,,15,12.75,4.299,15,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
MIDAZOLAM 2 MG/ML ORAL SYRP,,5061,LOCAL,Facility,Both,118,mL,,992,843.2,284.3072,992,Aetna,Commercial,912.64,92,,percent of total billed charges,,
MIDAZOLAM 2 MG/ML ORAL SYRP,,5061,LOCAL,Facility,Outpatient,118,mL,,992,843.2,284.3072,992,Aetna,Medicare Advantage,486.08,49,,percent of total billed charges,,
MIDAZOLAM 2 MG/ML ORAL SYRP,,5061,LOCAL,Facility,Inpatient,118,mL,,992,843.2,284.3072,992,Aetna,Medicare Advantage,,,,,Included in per diem rate,
MIDAZOLAM 2 MG/ML ORAL SYRP,,5061,LOCAL,Facility,Both,118,mL,,992,843.2,284.3072,992,Aetna,PPO,922.56,93,,percent of total billed charges,,
MIDAZOLAM 2 MG/ML ORAL SYRP,,5061,LOCAL,Facility,Both,118,mL,,992,843.2,284.3072,992,America's PPO,America's PPO,952.6176,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
MIDAZOLAM 2 MG/ML ORAL SYRP,,5061,LOCAL,Facility,Both,118,mL,,992,843.2,284.3072,992,BlueCross BlueShield Minnesota, Federal Employee Program,976.128,98.4,,percent of total billed charges,,
MIDAZOLAM 2 MG/ML ORAL SYRP,,5061,LOCAL,Facility,Both,118,mL,,992,843.2,284.3072,992,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,992,100,,percent of total billed charges,,
MIDAZOLAM 2 MG/ML ORAL SYRP,,5061,LOCAL,Facility,Both,118,mL,,992,843.2,284.3072,992,BlueCross BlueShield Minnesota,High Value Network Plan,892.8,90,,percent of total billed charges,,
MIDAZOLAM 2 MG/ML ORAL SYRP,,5061,LOCAL,Facility,Outpatient,118,mL,,992,843.2,284.3072,992,BlueCross BlueShield Minnesota,Medicare Advantage,486.08,49,,percent of total billed charges,,
MIDAZOLAM 2 MG/ML ORAL SYRP,,5061,LOCAL,Facility,Inpatient,118,mL,,992,843.2,284.3072,992,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
MIDAZOLAM 2 MG/ML ORAL SYRP,,5061,LOCAL,Facility,Both,118,mL,,992,843.2,284.3072,992,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,878.6144,88.57,,percent of total billed charges,,
MIDAZOLAM 2 MG/ML ORAL SYRP,,5061,LOCAL,Facility,Both,118,mL,,992,843.2,284.3072,992,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,284.3072,28.66,,percent of total billed charges,,
MIDAZOLAM 2 MG/ML ORAL SYRP,,5061,LOCAL,Facility,Outpatient,118,mL,,992,843.2,284.3072,992,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),486.08,49,,percent of total billed charges,,
MIDAZOLAM 2 MG/ML ORAL SYRP,,5061,LOCAL,Facility,Inpatient,118,mL,,992,843.2,284.3072,992,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
MIDAZOLAM 2 MG/ML ORAL SYRP,,5061,LOCAL,Facility,Both,118,mL,,992,843.2,284.3072,992,CorVel,Worker's Compensation,992,100,,percent of total billed charges,,
MIDAZOLAM 2 MG/ML ORAL SYRP,,5061,LOCAL,Facility,Both,118,mL,,992,843.2,284.3072,992,First Health Group Corporation,First Health Network,962.24,97,,percent of total billed charges,,
MIDAZOLAM 2 MG/ML ORAL SYRP,,5061,LOCAL,Facility,Both,118,mL,,992,843.2,284.3072,992,"Health Partners, Inc.",Commercial,938.432,94.6,,percent of total billed charges,,
MIDAZOLAM 2 MG/ML ORAL SYRP,,5061,LOCAL,Facility,Outpatient,118,mL,,992,843.2,284.3072,992,"Health Partners, Inc.",Medicare Advantage,486.08,49,,percent of total billed charges,,
MIDAZOLAM 2 MG/ML ORAL SYRP,,5061,LOCAL,Facility,Inpatient,118,mL,,992,843.2,284.3072,992,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
MIDAZOLAM 2 MG/ML ORAL SYRP,,5061,LOCAL,Facility,Both,118,mL,,992,843.2,284.3072,992,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),595.2,60,,percent of total billed charges,,
MIDAZOLAM 2 MG/ML ORAL SYRP,,5061,LOCAL,Facility,Both,118,mL,,992,843.2,284.3072,992,"Health Partners, Inc.",State of Minnesota Advantage Program,808.48,81.5,,percent of total billed charges,,
MIDAZOLAM 2 MG/ML ORAL SYRP,,5061,LOCAL,Facility,Both,118,mL,,992,843.2,284.3072,992,"Health Partners, Inc.",State Public Programs,496,50,,percent of total billed charges,,
MIDAZOLAM 2 MG/ML ORAL SYRP,,5061,LOCAL,Facility,Both,118,mL,,992,843.2,284.3072,992,Humana Insurance Company,Commercial PPO,942.4,95,,percent of total billed charges,,
MIDAZOLAM 2 MG/ML ORAL SYRP,,5061,LOCAL,Facility,Outpatient,118,mL,,992,843.2,284.3072,992,Humana Insurance Company,Medicare PPO,486.08,49,,percent of total billed charges,,
MIDAZOLAM 2 MG/ML ORAL SYRP,,5061,LOCAL,Facility,Inpatient,118,mL,,992,843.2,284.3072,992,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
MIDAZOLAM 2 MG/ML ORAL SYRP,,5061,LOCAL,Facility,Both,118,mL,,992,843.2,284.3072,992,Medica,Individual & Family,983.072,99.1,,percent of total billed charges,,
MIDAZOLAM 2 MG/ML ORAL SYRP,,5061,LOCAL,Facility,Outpatient,118,mL,,992,843.2,284.3072,992,Medica,Medica Advantage Solution,494.016,49.8,,percent of total billed charges,,
MIDAZOLAM 2 MG/ML ORAL SYRP,,5061,LOCAL,Facility,Inpatient,118,mL,,992,843.2,284.3072,992,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
MIDAZOLAM 2 MG/ML ORAL SYRP,,5061,LOCAL,Facility,Outpatient,118,mL,,992,843.2,284.3072,992,Medica,Medical Assistance,442.432,44.6,,percent of total billed charges,,
MIDAZOLAM 2 MG/ML ORAL SYRP,,5061,LOCAL,Facility,Inpatient,118,mL,,992,843.2,284.3072,992,Medica,Medical Assistance,,,,,Included in per diem rate,
MIDAZOLAM 2 MG/ML ORAL SYRP,,5061,LOCAL,Facility,Outpatient,118,mL,,992,843.2,284.3072,992,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,494.016,49.8,,percent of total billed charges,,
MIDAZOLAM 2 MG/ML ORAL SYRP,,5061,LOCAL,Facility,Inpatient,118,mL,,992,843.2,284.3072,992,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
MIDAZOLAM 2 MG/ML ORAL SYRP,,5061,LOCAL,Facility,Both,118,mL,,992,843.2,284.3072,992,"Multiplan, Inc.","Multiplan, Inc.",932.48,94,,percent of total billed charges,,
MIDAZOLAM 2 MG/ML ORAL SYRP,,5061,LOCAL,Facility,Outpatient,118,mL,,992,843.2,284.3072,992,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,893.792,90.1,,percent of total billed charges,,
MIDAZOLAM 2 MG/ML ORAL SYRP,,5061,LOCAL,Facility,Inpatient,118,mL,,992,843.2,284.3072,992,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
MIDAZOLAM 2 MG/ML ORAL SYRP,,5061,LOCAL,Facility,Both,118,mL,,992,843.2,284.3072,992,"Preferred One Administrative Services, INC.",PPO,978.112,98.6,,percent of total billed charges,,
MIDAZOLAM 2 MG/ML ORAL SYRP,,5061,LOCAL,Facility,Outpatient,118,mL,,992,843.2,284.3072,992,PrimeWest Health,Minnesota Senior Health Options (MSHO),510.384,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
MIDAZOLAM 2 MG/ML ORAL SYRP,,5061,LOCAL,Facility,Inpatient,118,mL,,992,843.2,284.3072,992,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
MIDAZOLAM 2 MG/ML ORAL SYRP,,5061,LOCAL,Facility,Outpatient,118,mL,,992,843.2,284.3072,992,PrimeWest Health,MinnesotaCare,509.4912,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
MIDAZOLAM 2 MG/ML ORAL SYRP,,5061,LOCAL,Facility,Inpatient,118,mL,,992,843.2,284.3072,992,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
MIDAZOLAM 2 MG/ML ORAL SYRP,,5061,LOCAL,Facility,Both,118,mL,,992,843.2,284.3072,992,Sanford Health Plan,Sanford Health Plan,912.64,92,,percent of total billed charges,,
MIDAZOLAM 2 MG/ML ORAL SYRP,,5061,LOCAL,Facility,Outpatient,118,mL,,992,843.2,284.3072,992,"UCare Health, Inc.",Individual & Family Plan,558.992,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
MIDAZOLAM 2 MG/ML ORAL SYRP,,5061,LOCAL,Facility,Inpatient,118,mL,,992,843.2,284.3072,992,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
MIDAZOLAM 2 MG/ML ORAL SYRP,,5061,LOCAL,Facility,Outpatient,118,mL,,992,843.2,284.3072,992,"UCare Health, Inc.",Medical Assistance,500.6624,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MIDAZOLAM 2 MG/ML ORAL SYRP,,5061,LOCAL,Facility,Inpatient,118,mL,,992,843.2,284.3072,992,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
MIDAZOLAM 2 MG/ML ORAL SYRP,,5061,LOCAL,Facility,Outpatient,118,mL,,992,843.2,284.3072,992,"UCare Health, Inc.",Medicare Advantage,500.6624,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MIDAZOLAM 2 MG/ML ORAL SYRP,,5061,LOCAL,Facility,Inpatient,118,mL,,992,843.2,284.3072,992,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
MIDAZOLAM 2 MG/ML ORAL SYRP,,5061,LOCAL,Facility,Outpatient,118,mL,,992,843.2,284.3072,992,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),500.6624,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MIDAZOLAM 2 MG/ML ORAL SYRP,,5061,LOCAL,Facility,Inpatient,118,mL,,992,843.2,284.3072,992,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
MIDAZOLAM 2 MG/ML ORAL SYRP,,5061,LOCAL,Facility,Both,118,mL,,992,843.2,284.3072,992,UnitedHealthcare,Individual & Family,932.48,94,,percent of total billed charges,,
MIDAZOLAM 2 MG/ML ORAL SYRP,,5061,LOCAL,Facility,Outpatient,118,mL,,992,843.2,284.3072,992,UnitedHealthcare,Medicare Advantage,486.08,49,,percent of total billed charges,,
MIDAZOLAM 2 MG/ML ORAL SYRP,,5061,LOCAL,Facility,Inpatient,118,mL,,992,843.2,284.3072,992,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
MIDAZOLAM 2 MG/ML ORAL SYRP,,5061,LOCAL,Facility,Outpatient,118,mL,,992,843.2,284.3072,992,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,476.16,48,,percent of total billed charges,,100% of DHS outpatient percentage
MIDAZOLAM 2 MG/ML ORAL SYRP,,5061,LOCAL,Facility,Inpatient,118,mL,,992,843.2,284.3072,992,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
DEXTROMETHORPHAN-GUAIFENESIN 10-100 MG/5 ML ORAL SYRP,,7112,LOCAL,Facility,Both,118,mL,,9,7.65,2.5794,9,Aetna,Commercial,8.28,92,,percent of total billed charges,,
DEXTROMETHORPHAN-GUAIFENESIN 10-100 MG/5 ML ORAL SYRP,,7112,LOCAL,Facility,Outpatient,118,mL,,9,7.65,2.5794,9,Aetna,Medicare Advantage,4.41,49,,percent of total billed charges,,
DEXTROMETHORPHAN-GUAIFENESIN 10-100 MG/5 ML ORAL SYRP,,7112,LOCAL,Facility,Inpatient,118,mL,,9,7.65,2.5794,9,Aetna,Medicare Advantage,,,,,Included in per diem rate,
DEXTROMETHORPHAN-GUAIFENESIN 10-100 MG/5 ML ORAL SYRP,,7112,LOCAL,Facility,Both,118,mL,,9,7.65,2.5794,9,Aetna,PPO,8.37,93,,percent of total billed charges,,
DEXTROMETHORPHAN-GUAIFENESIN 10-100 MG/5 ML ORAL SYRP,,7112,LOCAL,Facility,Both,118,mL,,9,7.65,2.5794,9,America's PPO,America's PPO,8.6427,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
DEXTROMETHORPHAN-GUAIFENESIN 10-100 MG/5 ML ORAL SYRP,,7112,LOCAL,Facility,Both,118,mL,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota, Federal Employee Program,8.856,98.4,,percent of total billed charges,,
DEXTROMETHORPHAN-GUAIFENESIN 10-100 MG/5 ML ORAL SYRP,,7112,LOCAL,Facility,Both,118,mL,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,9,100,,percent of total billed charges,,
DEXTROMETHORPHAN-GUAIFENESIN 10-100 MG/5 ML ORAL SYRP,,7112,LOCAL,Facility,Both,118,mL,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota,High Value Network Plan,8.1,90,,percent of total billed charges,,
DEXTROMETHORPHAN-GUAIFENESIN 10-100 MG/5 ML ORAL SYRP,,7112,LOCAL,Facility,Outpatient,118,mL,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota,Medicare Advantage,4.41,49,,percent of total billed charges,,
DEXTROMETHORPHAN-GUAIFENESIN 10-100 MG/5 ML ORAL SYRP,,7112,LOCAL,Facility,Inpatient,118,mL,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
DEXTROMETHORPHAN-GUAIFENESIN 10-100 MG/5 ML ORAL SYRP,,7112,LOCAL,Facility,Both,118,mL,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,7.9713,88.57,,percent of total billed charges,,
DEXTROMETHORPHAN-GUAIFENESIN 10-100 MG/5 ML ORAL SYRP,,7112,LOCAL,Facility,Both,118,mL,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,2.5794,28.66,,percent of total billed charges,,
DEXTROMETHORPHAN-GUAIFENESIN 10-100 MG/5 ML ORAL SYRP,,7112,LOCAL,Facility,Outpatient,118,mL,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),4.41,49,,percent of total billed charges,,
DEXTROMETHORPHAN-GUAIFENESIN 10-100 MG/5 ML ORAL SYRP,,7112,LOCAL,Facility,Inpatient,118,mL,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
DEXTROMETHORPHAN-GUAIFENESIN 10-100 MG/5 ML ORAL SYRP,,7112,LOCAL,Facility,Both,118,mL,,9,7.65,2.5794,9,CorVel,Worker's Compensation,9,100,,percent of total billed charges,,
DEXTROMETHORPHAN-GUAIFENESIN 10-100 MG/5 ML ORAL SYRP,,7112,LOCAL,Facility,Both,118,mL,,9,7.65,2.5794,9,First Health Group Corporation,First Health Network,8.73,97,,percent of total billed charges,,
DEXTROMETHORPHAN-GUAIFENESIN 10-100 MG/5 ML ORAL SYRP,,7112,LOCAL,Facility,Both,118,mL,,9,7.65,2.5794,9,"Health Partners, Inc.",Commercial,8.514,94.6,,percent of total billed charges,,
DEXTROMETHORPHAN-GUAIFENESIN 10-100 MG/5 ML ORAL SYRP,,7112,LOCAL,Facility,Outpatient,118,mL,,9,7.65,2.5794,9,"Health Partners, Inc.",Medicare Advantage,4.41,49,,percent of total billed charges,,
DEXTROMETHORPHAN-GUAIFENESIN 10-100 MG/5 ML ORAL SYRP,,7112,LOCAL,Facility,Inpatient,118,mL,,9,7.65,2.5794,9,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DEXTROMETHORPHAN-GUAIFENESIN 10-100 MG/5 ML ORAL SYRP,,7112,LOCAL,Facility,Both,118,mL,,9,7.65,2.5794,9,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),5.4,60,,percent of total billed charges,,
DEXTROMETHORPHAN-GUAIFENESIN 10-100 MG/5 ML ORAL SYRP,,7112,LOCAL,Facility,Both,118,mL,,9,7.65,2.5794,9,"Health Partners, Inc.",State of Minnesota Advantage Program,7.335,81.5,,percent of total billed charges,,
DEXTROMETHORPHAN-GUAIFENESIN 10-100 MG/5 ML ORAL SYRP,,7112,LOCAL,Facility,Both,118,mL,,9,7.65,2.5794,9,"Health Partners, Inc.",State Public Programs,4.5,50,,percent of total billed charges,,
DEXTROMETHORPHAN-GUAIFENESIN 10-100 MG/5 ML ORAL SYRP,,7112,LOCAL,Facility,Both,118,mL,,9,7.65,2.5794,9,Humana Insurance Company,Commercial PPO,8.55,95,,percent of total billed charges,,
DEXTROMETHORPHAN-GUAIFENESIN 10-100 MG/5 ML ORAL SYRP,,7112,LOCAL,Facility,Outpatient,118,mL,,9,7.65,2.5794,9,Humana Insurance Company,Medicare PPO,4.41,49,,percent of total billed charges,,
DEXTROMETHORPHAN-GUAIFENESIN 10-100 MG/5 ML ORAL SYRP,,7112,LOCAL,Facility,Inpatient,118,mL,,9,7.65,2.5794,9,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
DEXTROMETHORPHAN-GUAIFENESIN 10-100 MG/5 ML ORAL SYRP,,7112,LOCAL,Facility,Both,118,mL,,9,7.65,2.5794,9,Medica,Individual & Family,8.919,99.1,,percent of total billed charges,,
DEXTROMETHORPHAN-GUAIFENESIN 10-100 MG/5 ML ORAL SYRP,,7112,LOCAL,Facility,Outpatient,118,mL,,9,7.65,2.5794,9,Medica,Medica Advantage Solution,4.482,49.8,,percent of total billed charges,,
DEXTROMETHORPHAN-GUAIFENESIN 10-100 MG/5 ML ORAL SYRP,,7112,LOCAL,Facility,Inpatient,118,mL,,9,7.65,2.5794,9,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
DEXTROMETHORPHAN-GUAIFENESIN 10-100 MG/5 ML ORAL SYRP,,7112,LOCAL,Facility,Outpatient,118,mL,,9,7.65,2.5794,9,Medica,Medical Assistance,4.014,44.6,,percent of total billed charges,,
DEXTROMETHORPHAN-GUAIFENESIN 10-100 MG/5 ML ORAL SYRP,,7112,LOCAL,Facility,Inpatient,118,mL,,9,7.65,2.5794,9,Medica,Medical Assistance,,,,,Included in per diem rate,
DEXTROMETHORPHAN-GUAIFENESIN 10-100 MG/5 ML ORAL SYRP,,7112,LOCAL,Facility,Outpatient,118,mL,,9,7.65,2.5794,9,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,4.482,49.8,,percent of total billed charges,,
DEXTROMETHORPHAN-GUAIFENESIN 10-100 MG/5 ML ORAL SYRP,,7112,LOCAL,Facility,Inpatient,118,mL,,9,7.65,2.5794,9,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
DEXTROMETHORPHAN-GUAIFENESIN 10-100 MG/5 ML ORAL SYRP,,7112,LOCAL,Facility,Both,118,mL,,9,7.65,2.5794,9,"Multiplan, Inc.","Multiplan, Inc.",8.46,94,,percent of total billed charges,,
DEXTROMETHORPHAN-GUAIFENESIN 10-100 MG/5 ML ORAL SYRP,,7112,LOCAL,Facility,Outpatient,118,mL,,9,7.65,2.5794,9,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,8.109,90.1,,percent of total billed charges,,
DEXTROMETHORPHAN-GUAIFENESIN 10-100 MG/5 ML ORAL SYRP,,7112,LOCAL,Facility,Inpatient,118,mL,,9,7.65,2.5794,9,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
DEXTROMETHORPHAN-GUAIFENESIN 10-100 MG/5 ML ORAL SYRP,,7112,LOCAL,Facility,Both,118,mL,,9,7.65,2.5794,9,"Preferred One Administrative Services, INC.",PPO,8.874,98.6,,percent of total billed charges,,
DEXTROMETHORPHAN-GUAIFENESIN 10-100 MG/5 ML ORAL SYRP,,7112,LOCAL,Facility,Outpatient,118,mL,,9,7.65,2.5794,9,PrimeWest Health,Minnesota Senior Health Options (MSHO),4.6305,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
DEXTROMETHORPHAN-GUAIFENESIN 10-100 MG/5 ML ORAL SYRP,,7112,LOCAL,Facility,Inpatient,118,mL,,9,7.65,2.5794,9,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DEXTROMETHORPHAN-GUAIFENESIN 10-100 MG/5 ML ORAL SYRP,,7112,LOCAL,Facility,Outpatient,118,mL,,9,7.65,2.5794,9,PrimeWest Health,MinnesotaCare,4.6224,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
DEXTROMETHORPHAN-GUAIFENESIN 10-100 MG/5 ML ORAL SYRP,,7112,LOCAL,Facility,Inpatient,118,mL,,9,7.65,2.5794,9,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
DEXTROMETHORPHAN-GUAIFENESIN 10-100 MG/5 ML ORAL SYRP,,7112,LOCAL,Facility,Both,118,mL,,9,7.65,2.5794,9,Sanford Health Plan,Sanford Health Plan,8.28,92,,percent of total billed charges,,
DEXTROMETHORPHAN-GUAIFENESIN 10-100 MG/5 ML ORAL SYRP,,7112,LOCAL,Facility,Outpatient,118,mL,,9,7.65,2.5794,9,"UCare Health, Inc.",Individual & Family Plan,5.0715,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
DEXTROMETHORPHAN-GUAIFENESIN 10-100 MG/5 ML ORAL SYRP,,7112,LOCAL,Facility,Inpatient,118,mL,,9,7.65,2.5794,9,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
DEXTROMETHORPHAN-GUAIFENESIN 10-100 MG/5 ML ORAL SYRP,,7112,LOCAL,Facility,Outpatient,118,mL,,9,7.65,2.5794,9,"UCare Health, Inc.",Medical Assistance,4.5423,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DEXTROMETHORPHAN-GUAIFENESIN 10-100 MG/5 ML ORAL SYRP,,7112,LOCAL,Facility,Inpatient,118,mL,,9,7.65,2.5794,9,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
DEXTROMETHORPHAN-GUAIFENESIN 10-100 MG/5 ML ORAL SYRP,,7112,LOCAL,Facility,Outpatient,118,mL,,9,7.65,2.5794,9,"UCare Health, Inc.",Medicare Advantage,4.5423,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DEXTROMETHORPHAN-GUAIFENESIN 10-100 MG/5 ML ORAL SYRP,,7112,LOCAL,Facility,Inpatient,118,mL,,9,7.65,2.5794,9,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DEXTROMETHORPHAN-GUAIFENESIN 10-100 MG/5 ML ORAL SYRP,,7112,LOCAL,Facility,Outpatient,118,mL,,9,7.65,2.5794,9,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),4.5423,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DEXTROMETHORPHAN-GUAIFENESIN 10-100 MG/5 ML ORAL SYRP,,7112,LOCAL,Facility,Inpatient,118,mL,,9,7.65,2.5794,9,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DEXTROMETHORPHAN-GUAIFENESIN 10-100 MG/5 ML ORAL SYRP,,7112,LOCAL,Facility,Both,118,mL,,9,7.65,2.5794,9,UnitedHealthcare,Individual & Family,8.46,94,,percent of total billed charges,,
DEXTROMETHORPHAN-GUAIFENESIN 10-100 MG/5 ML ORAL SYRP,,7112,LOCAL,Facility,Outpatient,118,mL,,9,7.65,2.5794,9,UnitedHealthcare,Medicare Advantage,4.41,49,,percent of total billed charges,,
DEXTROMETHORPHAN-GUAIFENESIN 10-100 MG/5 ML ORAL SYRP,,7112,LOCAL,Facility,Inpatient,118,mL,,9,7.65,2.5794,9,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
DEXTROMETHORPHAN-GUAIFENESIN 10-100 MG/5 ML ORAL SYRP,,7112,LOCAL,Facility,Outpatient,118,mL,,9,7.65,2.5794,9,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,4.32,48,,percent of total billed charges,,100% of DHS outpatient percentage
DEXTROMETHORPHAN-GUAIFENESIN 10-100 MG/5 ML ORAL SYRP,,7112,LOCAL,Facility,Inpatient,118,mL,,9,7.65,2.5794,9,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Sup Ambu Bag Infant,,12000029,LOCAL,Facility,Both,,,,59,50.15,16.9094,59,Aetna,Commercial,54.28,92,,percent of total billed charges,,
Sup Ambu Bag Infant,,12000029,LOCAL,Facility,Outpatient,,,,59,50.15,16.9094,59,Aetna,Medicare Advantage,28.91,49,,percent of total billed charges,,
Sup Ambu Bag Infant,,12000029,LOCAL,Facility,Inpatient,,,,59,50.15,16.9094,59,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Sup Ambu Bag Infant,,12000029,LOCAL,Facility,Both,,,,59,50.15,16.9094,59,Aetna,PPO,54.87,93,,percent of total billed charges,,
Sup Ambu Bag Infant,,12000029,LOCAL,Facility,Both,,,,59,50.15,16.9094,59,America's PPO,America's PPO,56.6577,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Sup Ambu Bag Infant,,12000029,LOCAL,Facility,Both,,,,59,50.15,16.9094,59,BlueCross BlueShield Minnesota, Federal Employee Program,58.056,98.4,,percent of total billed charges,,
Sup Ambu Bag Infant,,12000029,LOCAL,Facility,Both,,,,59,50.15,16.9094,59,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,59,100,,percent of total billed charges,,
Sup Ambu Bag Infant,,12000029,LOCAL,Facility,Both,,,,59,50.15,16.9094,59,BlueCross BlueShield Minnesota,High Value Network Plan,53.1,90,,percent of total billed charges,,
Sup Ambu Bag Infant,,12000029,LOCAL,Facility,Outpatient,,,,59,50.15,16.9094,59,BlueCross BlueShield Minnesota,Medicare Advantage,28.91,49,,percent of total billed charges,,
Sup Ambu Bag Infant,,12000029,LOCAL,Facility,Inpatient,,,,59,50.15,16.9094,59,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Sup Ambu Bag Infant,,12000029,LOCAL,Facility,Both,,,,59,50.15,16.9094,59,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,52.2563,88.57,,percent of total billed charges,,
Sup Ambu Bag Infant,,12000029,LOCAL,Facility,Both,,,,59,50.15,16.9094,59,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,16.9094,28.66,,percent of total billed charges,,
Sup Ambu Bag Infant,,12000029,LOCAL,Facility,Outpatient,,,,59,50.15,16.9094,59,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),28.91,49,,percent of total billed charges,,
Sup Ambu Bag Infant,,12000029,LOCAL,Facility,Inpatient,,,,59,50.15,16.9094,59,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Sup Ambu Bag Infant,,12000029,LOCAL,Facility,Both,,,,59,50.15,16.9094,59,CorVel,Worker's Compensation,59,100,,percent of total billed charges,,
Sup Ambu Bag Infant,,12000029,LOCAL,Facility,Both,,,,59,50.15,16.9094,59,First Health Group Corporation,First Health Network,57.23,97,,percent of total billed charges,,
Sup Ambu Bag Infant,,12000029,LOCAL,Facility,Both,,,,59,50.15,16.9094,59,"Health Partners, Inc.",Commercial,55.814,94.6,,percent of total billed charges,,
Sup Ambu Bag Infant,,12000029,LOCAL,Facility,Outpatient,,,,59,50.15,16.9094,59,"Health Partners, Inc.",Medicare Advantage,28.91,49,,percent of total billed charges,,
Sup Ambu Bag Infant,,12000029,LOCAL,Facility,Inpatient,,,,59,50.15,16.9094,59,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Ambu Bag Infant,,12000029,LOCAL,Facility,Both,,,,59,50.15,16.9094,59,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),35.4,60,,percent of total billed charges,,
Sup Ambu Bag Infant,,12000029,LOCAL,Facility,Both,,,,59,50.15,16.9094,59,"Health Partners, Inc.",State of Minnesota Advantage Program,48.085,81.5,,percent of total billed charges,,
Sup Ambu Bag Infant,,12000029,LOCAL,Facility,Both,,,,59,50.15,16.9094,59,"Health Partners, Inc.",State Public Programs,29.5,50,,percent of total billed charges,,
Sup Ambu Bag Infant,,12000029,LOCAL,Facility,Both,,,,59,50.15,16.9094,59,Humana Insurance Company,Commercial PPO,56.05,95,,percent of total billed charges,,
Sup Ambu Bag Infant,,12000029,LOCAL,Facility,Outpatient,,,,59,50.15,16.9094,59,Humana Insurance Company,Medicare PPO,28.91,49,,percent of total billed charges,,
Sup Ambu Bag Infant,,12000029,LOCAL,Facility,Inpatient,,,,59,50.15,16.9094,59,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Sup Ambu Bag Infant,,12000029,LOCAL,Facility,Both,,,,59,50.15,16.9094,59,Medica,Individual & Family,58.469,99.1,,percent of total billed charges,,
Sup Ambu Bag Infant,,12000029,LOCAL,Facility,Outpatient,,,,59,50.15,16.9094,59,Medica,Medica Advantage Solution,29.382,49.8,,percent of total billed charges,,
Sup Ambu Bag Infant,,12000029,LOCAL,Facility,Inpatient,,,,59,50.15,16.9094,59,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Sup Ambu Bag Infant,,12000029,LOCAL,Facility,Outpatient,,,,59,50.15,16.9094,59,Medica,Medical Assistance,26.314,44.6,,percent of total billed charges,,
Sup Ambu Bag Infant,,12000029,LOCAL,Facility,Inpatient,,,,59,50.15,16.9094,59,Medica,Medical Assistance,,,,,Included in per diem rate,
Sup Ambu Bag Infant,,12000029,LOCAL,Facility,Outpatient,,,,59,50.15,16.9094,59,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,29.382,49.8,,percent of total billed charges,,
Sup Ambu Bag Infant,,12000029,LOCAL,Facility,Inpatient,,,,59,50.15,16.9094,59,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Sup Ambu Bag Infant,,12000029,LOCAL,Facility,Both,,,,59,50.15,16.9094,59,"Multiplan, Inc.","Multiplan, Inc.",55.46,94,,percent of total billed charges,,
Sup Ambu Bag Infant,,12000029,LOCAL,Facility,Outpatient,,,,59,50.15,16.9094,59,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,53.159,90.1,,percent of total billed charges,,
Sup Ambu Bag Infant,,12000029,LOCAL,Facility,Inpatient,,,,59,50.15,16.9094,59,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Sup Ambu Bag Infant,,12000029,LOCAL,Facility,Both,,,,59,50.15,16.9094,59,"Preferred One Administrative Services, INC.",PPO,58.174,98.6,,percent of total billed charges,,
Sup Ambu Bag Infant,,12000029,LOCAL,Facility,Outpatient,,,,59,50.15,16.9094,59,PrimeWest Health,Minnesota Senior Health Options (MSHO),30.3555,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Sup Ambu Bag Infant,,12000029,LOCAL,Facility,Inpatient,,,,59,50.15,16.9094,59,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Ambu Bag Infant,,12000029,LOCAL,Facility,Outpatient,,,,59,50.15,16.9094,59,PrimeWest Health,MinnesotaCare,30.3024,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Sup Ambu Bag Infant,,12000029,LOCAL,Facility,Inpatient,,,,59,50.15,16.9094,59,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Sup Ambu Bag Infant,,12000029,LOCAL,Facility,Both,,,,59,50.15,16.9094,59,Sanford Health Plan,Sanford Health Plan,54.28,92,,percent of total billed charges,,
Sup Ambu Bag Infant,,12000029,LOCAL,Facility,Outpatient,,,,59,50.15,16.9094,59,"UCare Health, Inc.",Individual & Family Plan,33.2465,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Sup Ambu Bag Infant,,12000029,LOCAL,Facility,Inpatient,,,,59,50.15,16.9094,59,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Sup Ambu Bag Infant,,12000029,LOCAL,Facility,Outpatient,,,,59,50.15,16.9094,59,"UCare Health, Inc.",Medical Assistance,29.7773,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Ambu Bag Infant,,12000029,LOCAL,Facility,Inpatient,,,,59,50.15,16.9094,59,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Sup Ambu Bag Infant,,12000029,LOCAL,Facility,Outpatient,,,,59,50.15,16.9094,59,"UCare Health, Inc.",Medicare Advantage,29.7773,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Ambu Bag Infant,,12000029,LOCAL,Facility,Inpatient,,,,59,50.15,16.9094,59,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Ambu Bag Infant,,12000029,LOCAL,Facility,Outpatient,,,,59,50.15,16.9094,59,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),29.7773,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Ambu Bag Infant,,12000029,LOCAL,Facility,Inpatient,,,,59,50.15,16.9094,59,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Ambu Bag Infant,,12000029,LOCAL,Facility,Both,,,,59,50.15,16.9094,59,UnitedHealthcare,Individual & Family,55.46,94,,percent of total billed charges,,
Sup Ambu Bag Infant,,12000029,LOCAL,Facility,Outpatient,,,,59,50.15,16.9094,59,UnitedHealthcare,Medicare Advantage,28.91,49,,percent of total billed charges,,
Sup Ambu Bag Infant,,12000029,LOCAL,Facility,Inpatient,,,,59,50.15,16.9094,59,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Sup Ambu Bag Infant,,12000029,LOCAL,Facility,Outpatient,,,,59,50.15,16.9094,59,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,28.32,48,,percent of total billed charges,,100% of DHS outpatient percentage
Sup Ambu Bag Infant,,12000029,LOCAL,Facility,Inpatient,,,,59,50.15,16.9094,59,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Sup Thoracentesis Tray,,12000309,LOCAL,Facility,Both,,,,131,111.35,37.5446,131,Aetna,Commercial,120.52,92,,percent of total billed charges,,
Sup Thoracentesis Tray,,12000309,LOCAL,Facility,Outpatient,,,,131,111.35,37.5446,131,Aetna,Medicare Advantage,64.19,49,,percent of total billed charges,,
Sup Thoracentesis Tray,,12000309,LOCAL,Facility,Inpatient,,,,131,111.35,37.5446,131,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Sup Thoracentesis Tray,,12000309,LOCAL,Facility,Both,,,,131,111.35,37.5446,131,Aetna,PPO,121.83,93,,percent of total billed charges,,
Sup Thoracentesis Tray,,12000309,LOCAL,Facility,Both,,,,131,111.35,37.5446,131,America's PPO,America's PPO,125.7993,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Sup Thoracentesis Tray,,12000309,LOCAL,Facility,Both,,,,131,111.35,37.5446,131,BlueCross BlueShield Minnesota, Federal Employee Program,128.904,98.4,,percent of total billed charges,,
Sup Thoracentesis Tray,,12000309,LOCAL,Facility,Both,,,,131,111.35,37.5446,131,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,131,100,,percent of total billed charges,,
Sup Thoracentesis Tray,,12000309,LOCAL,Facility,Both,,,,131,111.35,37.5446,131,BlueCross BlueShield Minnesota,High Value Network Plan,117.9,90,,percent of total billed charges,,
Sup Thoracentesis Tray,,12000309,LOCAL,Facility,Outpatient,,,,131,111.35,37.5446,131,BlueCross BlueShield Minnesota,Medicare Advantage,64.19,49,,percent of total billed charges,,
Sup Thoracentesis Tray,,12000309,LOCAL,Facility,Inpatient,,,,131,111.35,37.5446,131,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Sup Thoracentesis Tray,,12000309,LOCAL,Facility,Both,,,,131,111.35,37.5446,131,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,116.0267,88.57,,percent of total billed charges,,
Sup Thoracentesis Tray,,12000309,LOCAL,Facility,Both,,,,131,111.35,37.5446,131,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,37.5446,28.66,,percent of total billed charges,,
Sup Thoracentesis Tray,,12000309,LOCAL,Facility,Outpatient,,,,131,111.35,37.5446,131,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),64.19,49,,percent of total billed charges,,
Sup Thoracentesis Tray,,12000309,LOCAL,Facility,Inpatient,,,,131,111.35,37.5446,131,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Sup Thoracentesis Tray,,12000309,LOCAL,Facility,Both,,,,131,111.35,37.5446,131,CorVel,Worker's Compensation,131,100,,percent of total billed charges,,
Sup Thoracentesis Tray,,12000309,LOCAL,Facility,Both,,,,131,111.35,37.5446,131,First Health Group Corporation,First Health Network,127.07,97,,percent of total billed charges,,
Sup Thoracentesis Tray,,12000309,LOCAL,Facility,Both,,,,131,111.35,37.5446,131,"Health Partners, Inc.",Commercial,123.926,94.6,,percent of total billed charges,,
Sup Thoracentesis Tray,,12000309,LOCAL,Facility,Outpatient,,,,131,111.35,37.5446,131,"Health Partners, Inc.",Medicare Advantage,64.19,49,,percent of total billed charges,,
Sup Thoracentesis Tray,,12000309,LOCAL,Facility,Inpatient,,,,131,111.35,37.5446,131,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Thoracentesis Tray,,12000309,LOCAL,Facility,Both,,,,131,111.35,37.5446,131,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),78.6,60,,percent of total billed charges,,
Sup Thoracentesis Tray,,12000309,LOCAL,Facility,Both,,,,131,111.35,37.5446,131,"Health Partners, Inc.",State of Minnesota Advantage Program,106.765,81.5,,percent of total billed charges,,
Sup Thoracentesis Tray,,12000309,LOCAL,Facility,Both,,,,131,111.35,37.5446,131,"Health Partners, Inc.",State Public Programs,65.5,50,,percent of total billed charges,,
Sup Thoracentesis Tray,,12000309,LOCAL,Facility,Both,,,,131,111.35,37.5446,131,Humana Insurance Company,Commercial PPO,124.45,95,,percent of total billed charges,,
Sup Thoracentesis Tray,,12000309,LOCAL,Facility,Outpatient,,,,131,111.35,37.5446,131,Humana Insurance Company,Medicare PPO,64.19,49,,percent of total billed charges,,
Sup Thoracentesis Tray,,12000309,LOCAL,Facility,Inpatient,,,,131,111.35,37.5446,131,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Sup Thoracentesis Tray,,12000309,LOCAL,Facility,Both,,,,131,111.35,37.5446,131,Medica,Individual & Family,129.821,99.1,,percent of total billed charges,,
Sup Thoracentesis Tray,,12000309,LOCAL,Facility,Outpatient,,,,131,111.35,37.5446,131,Medica,Medica Advantage Solution,65.238,49.8,,percent of total billed charges,,
Sup Thoracentesis Tray,,12000309,LOCAL,Facility,Inpatient,,,,131,111.35,37.5446,131,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Sup Thoracentesis Tray,,12000309,LOCAL,Facility,Outpatient,,,,131,111.35,37.5446,131,Medica,Medical Assistance,58.426,44.6,,percent of total billed charges,,
Sup Thoracentesis Tray,,12000309,LOCAL,Facility,Inpatient,,,,131,111.35,37.5446,131,Medica,Medical Assistance,,,,,Included in per diem rate,
Sup Thoracentesis Tray,,12000309,LOCAL,Facility,Outpatient,,,,131,111.35,37.5446,131,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,65.238,49.8,,percent of total billed charges,,
Sup Thoracentesis Tray,,12000309,LOCAL,Facility,Inpatient,,,,131,111.35,37.5446,131,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Sup Thoracentesis Tray,,12000309,LOCAL,Facility,Both,,,,131,111.35,37.5446,131,"Multiplan, Inc.","Multiplan, Inc.",123.14,94,,percent of total billed charges,,
Sup Thoracentesis Tray,,12000309,LOCAL,Facility,Outpatient,,,,131,111.35,37.5446,131,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,118.031,90.1,,percent of total billed charges,,
Sup Thoracentesis Tray,,12000309,LOCAL,Facility,Inpatient,,,,131,111.35,37.5446,131,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Sup Thoracentesis Tray,,12000309,LOCAL,Facility,Both,,,,131,111.35,37.5446,131,"Preferred One Administrative Services, INC.",PPO,129.166,98.6,,percent of total billed charges,,
Sup Thoracentesis Tray,,12000309,LOCAL,Facility,Outpatient,,,,131,111.35,37.5446,131,PrimeWest Health,Minnesota Senior Health Options (MSHO),67.3995,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Sup Thoracentesis Tray,,12000309,LOCAL,Facility,Inpatient,,,,131,111.35,37.5446,131,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Thoracentesis Tray,,12000309,LOCAL,Facility,Outpatient,,,,131,111.35,37.5446,131,PrimeWest Health,MinnesotaCare,67.2816,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Sup Thoracentesis Tray,,12000309,LOCAL,Facility,Inpatient,,,,131,111.35,37.5446,131,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Sup Thoracentesis Tray,,12000309,LOCAL,Facility,Both,,,,131,111.35,37.5446,131,Sanford Health Plan,Sanford Health Plan,120.52,92,,percent of total billed charges,,
Sup Thoracentesis Tray,,12000309,LOCAL,Facility,Outpatient,,,,131,111.35,37.5446,131,"UCare Health, Inc.",Individual & Family Plan,73.8185,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Sup Thoracentesis Tray,,12000309,LOCAL,Facility,Inpatient,,,,131,111.35,37.5446,131,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Sup Thoracentesis Tray,,12000309,LOCAL,Facility,Outpatient,,,,131,111.35,37.5446,131,"UCare Health, Inc.",Medical Assistance,66.1157,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Thoracentesis Tray,,12000309,LOCAL,Facility,Inpatient,,,,131,111.35,37.5446,131,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Sup Thoracentesis Tray,,12000309,LOCAL,Facility,Outpatient,,,,131,111.35,37.5446,131,"UCare Health, Inc.",Medicare Advantage,66.1157,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Thoracentesis Tray,,12000309,LOCAL,Facility,Inpatient,,,,131,111.35,37.5446,131,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Thoracentesis Tray,,12000309,LOCAL,Facility,Outpatient,,,,131,111.35,37.5446,131,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),66.1157,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Thoracentesis Tray,,12000309,LOCAL,Facility,Inpatient,,,,131,111.35,37.5446,131,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Thoracentesis Tray,,12000309,LOCAL,Facility,Both,,,,131,111.35,37.5446,131,UnitedHealthcare,Individual & Family,123.14,94,,percent of total billed charges,,
Sup Thoracentesis Tray,,12000309,LOCAL,Facility,Outpatient,,,,131,111.35,37.5446,131,UnitedHealthcare,Medicare Advantage,64.19,49,,percent of total billed charges,,
Sup Thoracentesis Tray,,12000309,LOCAL,Facility,Inpatient,,,,131,111.35,37.5446,131,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Sup Thoracentesis Tray,,12000309,LOCAL,Facility,Outpatient,,,,131,111.35,37.5446,131,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,62.88,48,,percent of total billed charges,,100% of DHS outpatient percentage
Sup Thoracentesis Tray,,12000309,LOCAL,Facility,Inpatient,,,,131,111.35,37.5446,131,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Sup Needle Gripper,,12000664,LOCAL,Facility,Both,,,,47,39.95,13.4702,47,Aetna,Commercial,43.24,92,,percent of total billed charges,,
Sup Needle Gripper,,12000664,LOCAL,Facility,Outpatient,,,,47,39.95,13.4702,47,Aetna,Medicare Advantage,23.03,49,,percent of total billed charges,,
Sup Needle Gripper,,12000664,LOCAL,Facility,Inpatient,,,,47,39.95,13.4702,47,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Sup Needle Gripper,,12000664,LOCAL,Facility,Both,,,,47,39.95,13.4702,47,Aetna,PPO,43.71,93,,percent of total billed charges,,
Sup Needle Gripper,,12000664,LOCAL,Facility,Both,,,,47,39.95,13.4702,47,America's PPO,America's PPO,45.1341,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Sup Needle Gripper,,12000664,LOCAL,Facility,Both,,,,47,39.95,13.4702,47,BlueCross BlueShield Minnesota, Federal Employee Program,46.248,98.4,,percent of total billed charges,,
Sup Needle Gripper,,12000664,LOCAL,Facility,Both,,,,47,39.95,13.4702,47,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,47,100,,percent of total billed charges,,
Sup Needle Gripper,,12000664,LOCAL,Facility,Both,,,,47,39.95,13.4702,47,BlueCross BlueShield Minnesota,High Value Network Plan,42.3,90,,percent of total billed charges,,
Sup Needle Gripper,,12000664,LOCAL,Facility,Outpatient,,,,47,39.95,13.4702,47,BlueCross BlueShield Minnesota,Medicare Advantage,23.03,49,,percent of total billed charges,,
Sup Needle Gripper,,12000664,LOCAL,Facility,Inpatient,,,,47,39.95,13.4702,47,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Sup Needle Gripper,,12000664,LOCAL,Facility,Both,,,,47,39.95,13.4702,47,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,41.6279,88.57,,percent of total billed charges,,
Sup Needle Gripper,,12000664,LOCAL,Facility,Both,,,,47,39.95,13.4702,47,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,13.4702,28.66,,percent of total billed charges,,
Sup Needle Gripper,,12000664,LOCAL,Facility,Outpatient,,,,47,39.95,13.4702,47,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),23.03,49,,percent of total billed charges,,
Sup Needle Gripper,,12000664,LOCAL,Facility,Inpatient,,,,47,39.95,13.4702,47,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Sup Needle Gripper,,12000664,LOCAL,Facility,Both,,,,47,39.95,13.4702,47,CorVel,Worker's Compensation,47,100,,percent of total billed charges,,
Sup Needle Gripper,,12000664,LOCAL,Facility,Both,,,,47,39.95,13.4702,47,First Health Group Corporation,First Health Network,45.59,97,,percent of total billed charges,,
Sup Needle Gripper,,12000664,LOCAL,Facility,Both,,,,47,39.95,13.4702,47,"Health Partners, Inc.",Commercial,44.462,94.6,,percent of total billed charges,,
Sup Needle Gripper,,12000664,LOCAL,Facility,Outpatient,,,,47,39.95,13.4702,47,"Health Partners, Inc.",Medicare Advantage,23.03,49,,percent of total billed charges,,
Sup Needle Gripper,,12000664,LOCAL,Facility,Inpatient,,,,47,39.95,13.4702,47,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Needle Gripper,,12000664,LOCAL,Facility,Both,,,,47,39.95,13.4702,47,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),28.2,60,,percent of total billed charges,,
Sup Needle Gripper,,12000664,LOCAL,Facility,Both,,,,47,39.95,13.4702,47,"Health Partners, Inc.",State of Minnesota Advantage Program,38.305,81.5,,percent of total billed charges,,
Sup Needle Gripper,,12000664,LOCAL,Facility,Both,,,,47,39.95,13.4702,47,"Health Partners, Inc.",State Public Programs,23.5,50,,percent of total billed charges,,
Sup Needle Gripper,,12000664,LOCAL,Facility,Both,,,,47,39.95,13.4702,47,Humana Insurance Company,Commercial PPO,44.65,95,,percent of total billed charges,,
Sup Needle Gripper,,12000664,LOCAL,Facility,Outpatient,,,,47,39.95,13.4702,47,Humana Insurance Company,Medicare PPO,23.03,49,,percent of total billed charges,,
Sup Needle Gripper,,12000664,LOCAL,Facility,Inpatient,,,,47,39.95,13.4702,47,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Sup Needle Gripper,,12000664,LOCAL,Facility,Both,,,,47,39.95,13.4702,47,Medica,Individual & Family,46.577,99.1,,percent of total billed charges,,
Sup Needle Gripper,,12000664,LOCAL,Facility,Outpatient,,,,47,39.95,13.4702,47,Medica,Medica Advantage Solution,23.406,49.8,,percent of total billed charges,,
Sup Needle Gripper,,12000664,LOCAL,Facility,Inpatient,,,,47,39.95,13.4702,47,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Sup Needle Gripper,,12000664,LOCAL,Facility,Outpatient,,,,47,39.95,13.4702,47,Medica,Medical Assistance,20.962,44.6,,percent of total billed charges,,
Sup Needle Gripper,,12000664,LOCAL,Facility,Inpatient,,,,47,39.95,13.4702,47,Medica,Medical Assistance,,,,,Included in per diem rate,
Sup Needle Gripper,,12000664,LOCAL,Facility,Outpatient,,,,47,39.95,13.4702,47,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,23.406,49.8,,percent of total billed charges,,
Sup Needle Gripper,,12000664,LOCAL,Facility,Inpatient,,,,47,39.95,13.4702,47,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Sup Needle Gripper,,12000664,LOCAL,Facility,Both,,,,47,39.95,13.4702,47,"Multiplan, Inc.","Multiplan, Inc.",44.18,94,,percent of total billed charges,,
Sup Needle Gripper,,12000664,LOCAL,Facility,Outpatient,,,,47,39.95,13.4702,47,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,42.347,90.1,,percent of total billed charges,,
Sup Needle Gripper,,12000664,LOCAL,Facility,Inpatient,,,,47,39.95,13.4702,47,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Sup Needle Gripper,,12000664,LOCAL,Facility,Both,,,,47,39.95,13.4702,47,"Preferred One Administrative Services, INC.",PPO,46.342,98.6,,percent of total billed charges,,
Sup Needle Gripper,,12000664,LOCAL,Facility,Outpatient,,,,47,39.95,13.4702,47,PrimeWest Health,Minnesota Senior Health Options (MSHO),24.1815,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Sup Needle Gripper,,12000664,LOCAL,Facility,Inpatient,,,,47,39.95,13.4702,47,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Needle Gripper,,12000664,LOCAL,Facility,Outpatient,,,,47,39.95,13.4702,47,PrimeWest Health,MinnesotaCare,24.1392,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Sup Needle Gripper,,12000664,LOCAL,Facility,Inpatient,,,,47,39.95,13.4702,47,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Sup Needle Gripper,,12000664,LOCAL,Facility,Both,,,,47,39.95,13.4702,47,Sanford Health Plan,Sanford Health Plan,43.24,92,,percent of total billed charges,,
Sup Needle Gripper,,12000664,LOCAL,Facility,Outpatient,,,,47,39.95,13.4702,47,"UCare Health, Inc.",Individual & Family Plan,26.4845,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Sup Needle Gripper,,12000664,LOCAL,Facility,Inpatient,,,,47,39.95,13.4702,47,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Sup Needle Gripper,,12000664,LOCAL,Facility,Outpatient,,,,47,39.95,13.4702,47,"UCare Health, Inc.",Medical Assistance,23.7209,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Needle Gripper,,12000664,LOCAL,Facility,Inpatient,,,,47,39.95,13.4702,47,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Sup Needle Gripper,,12000664,LOCAL,Facility,Outpatient,,,,47,39.95,13.4702,47,"UCare Health, Inc.",Medicare Advantage,23.7209,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Needle Gripper,,12000664,LOCAL,Facility,Inpatient,,,,47,39.95,13.4702,47,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Needle Gripper,,12000664,LOCAL,Facility,Outpatient,,,,47,39.95,13.4702,47,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),23.7209,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Needle Gripper,,12000664,LOCAL,Facility,Inpatient,,,,47,39.95,13.4702,47,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Needle Gripper,,12000664,LOCAL,Facility,Both,,,,47,39.95,13.4702,47,UnitedHealthcare,Individual & Family,44.18,94,,percent of total billed charges,,
Sup Needle Gripper,,12000664,LOCAL,Facility,Outpatient,,,,47,39.95,13.4702,47,UnitedHealthcare,Medicare Advantage,23.03,49,,percent of total billed charges,,
Sup Needle Gripper,,12000664,LOCAL,Facility,Inpatient,,,,47,39.95,13.4702,47,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Sup Needle Gripper,,12000664,LOCAL,Facility,Outpatient,,,,47,39.95,13.4702,47,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,22.56,48,,percent of total billed charges,,100% of DHS outpatient percentage
Sup Needle Gripper,,12000664,LOCAL,Facility,Inpatient,,,,47,39.95,13.4702,47,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Sup Warming Blanket,,12000993,LOCAL,Facility,Both,,,,46,39.1,13.1836,46,Aetna,Commercial,42.32,92,,percent of total billed charges,,
Sup Warming Blanket,,12000993,LOCAL,Facility,Outpatient,,,,46,39.1,13.1836,46,Aetna,Medicare Advantage,22.54,49,,percent of total billed charges,,
Sup Warming Blanket,,12000993,LOCAL,Facility,Inpatient,,,,46,39.1,13.1836,46,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Sup Warming Blanket,,12000993,LOCAL,Facility,Both,,,,46,39.1,13.1836,46,Aetna,PPO,42.78,93,,percent of total billed charges,,
Sup Warming Blanket,,12000993,LOCAL,Facility,Both,,,,46,39.1,13.1836,46,America's PPO,America's PPO,44.1738,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Sup Warming Blanket,,12000993,LOCAL,Facility,Both,,,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota, Federal Employee Program,45.264,98.4,,percent of total billed charges,,
Sup Warming Blanket,,12000993,LOCAL,Facility,Both,,,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,46,100,,percent of total billed charges,,
Sup Warming Blanket,,12000993,LOCAL,Facility,Both,,,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,High Value Network Plan,41.4,90,,percent of total billed charges,,
Sup Warming Blanket,,12000993,LOCAL,Facility,Outpatient,,,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Medicare Advantage,22.54,49,,percent of total billed charges,,
Sup Warming Blanket,,12000993,LOCAL,Facility,Inpatient,,,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Sup Warming Blanket,,12000993,LOCAL,Facility,Both,,,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,40.7422,88.57,,percent of total billed charges,,
Sup Warming Blanket,,12000993,LOCAL,Facility,Both,,,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,13.1836,28.66,,percent of total billed charges,,
Sup Warming Blanket,,12000993,LOCAL,Facility,Outpatient,,,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),22.54,49,,percent of total billed charges,,
Sup Warming Blanket,,12000993,LOCAL,Facility,Inpatient,,,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Sup Warming Blanket,,12000993,LOCAL,Facility,Both,,,,46,39.1,13.1836,46,CorVel,Worker's Compensation,46,100,,percent of total billed charges,,
Sup Warming Blanket,,12000993,LOCAL,Facility,Both,,,,46,39.1,13.1836,46,First Health Group Corporation,First Health Network,44.62,97,,percent of total billed charges,,
Sup Warming Blanket,,12000993,LOCAL,Facility,Both,,,,46,39.1,13.1836,46,"Health Partners, Inc.",Commercial,43.516,94.6,,percent of total billed charges,,
Sup Warming Blanket,,12000993,LOCAL,Facility,Outpatient,,,,46,39.1,13.1836,46,"Health Partners, Inc.",Medicare Advantage,22.54,49,,percent of total billed charges,,
Sup Warming Blanket,,12000993,LOCAL,Facility,Inpatient,,,,46,39.1,13.1836,46,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Warming Blanket,,12000993,LOCAL,Facility,Both,,,,46,39.1,13.1836,46,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),27.6,60,,percent of total billed charges,,
Sup Warming Blanket,,12000993,LOCAL,Facility,Both,,,,46,39.1,13.1836,46,"Health Partners, Inc.",State of Minnesota Advantage Program,37.49,81.5,,percent of total billed charges,,
Sup Warming Blanket,,12000993,LOCAL,Facility,Both,,,,46,39.1,13.1836,46,"Health Partners, Inc.",State Public Programs,23,50,,percent of total billed charges,,
Sup Warming Blanket,,12000993,LOCAL,Facility,Both,,,,46,39.1,13.1836,46,Humana Insurance Company,Commercial PPO,43.7,95,,percent of total billed charges,,
Sup Warming Blanket,,12000993,LOCAL,Facility,Outpatient,,,,46,39.1,13.1836,46,Humana Insurance Company,Medicare PPO,22.54,49,,percent of total billed charges,,
Sup Warming Blanket,,12000993,LOCAL,Facility,Inpatient,,,,46,39.1,13.1836,46,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Sup Warming Blanket,,12000993,LOCAL,Facility,Both,,,,46,39.1,13.1836,46,Medica,Individual & Family,45.586,99.1,,percent of total billed charges,,
Sup Warming Blanket,,12000993,LOCAL,Facility,Outpatient,,,,46,39.1,13.1836,46,Medica,Medica Advantage Solution,22.908,49.8,,percent of total billed charges,,
Sup Warming Blanket,,12000993,LOCAL,Facility,Inpatient,,,,46,39.1,13.1836,46,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Sup Warming Blanket,,12000993,LOCAL,Facility,Outpatient,,,,46,39.1,13.1836,46,Medica,Medical Assistance,20.516,44.6,,percent of total billed charges,,
Sup Warming Blanket,,12000993,LOCAL,Facility,Inpatient,,,,46,39.1,13.1836,46,Medica,Medical Assistance,,,,,Included in per diem rate,
Sup Warming Blanket,,12000993,LOCAL,Facility,Outpatient,,,,46,39.1,13.1836,46,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,22.908,49.8,,percent of total billed charges,,
Sup Warming Blanket,,12000993,LOCAL,Facility,Inpatient,,,,46,39.1,13.1836,46,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Sup Warming Blanket,,12000993,LOCAL,Facility,Both,,,,46,39.1,13.1836,46,"Multiplan, Inc.","Multiplan, Inc.",43.24,94,,percent of total billed charges,,
Sup Warming Blanket,,12000993,LOCAL,Facility,Outpatient,,,,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,41.446,90.1,,percent of total billed charges,,
Sup Warming Blanket,,12000993,LOCAL,Facility,Inpatient,,,,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Sup Warming Blanket,,12000993,LOCAL,Facility,Both,,,,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PPO,45.356,98.6,,percent of total billed charges,,
Sup Warming Blanket,,12000993,LOCAL,Facility,Outpatient,,,,46,39.1,13.1836,46,PrimeWest Health,Minnesota Senior Health Options (MSHO),23.667,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Sup Warming Blanket,,12000993,LOCAL,Facility,Inpatient,,,,46,39.1,13.1836,46,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Warming Blanket,,12000993,LOCAL,Facility,Outpatient,,,,46,39.1,13.1836,46,PrimeWest Health,MinnesotaCare,23.6256,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Sup Warming Blanket,,12000993,LOCAL,Facility,Inpatient,,,,46,39.1,13.1836,46,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Sup Warming Blanket,,12000993,LOCAL,Facility,Both,,,,46,39.1,13.1836,46,Sanford Health Plan,Sanford Health Plan,42.32,92,,percent of total billed charges,,
Sup Warming Blanket,,12000993,LOCAL,Facility,Outpatient,,,,46,39.1,13.1836,46,"UCare Health, Inc.",Individual & Family Plan,25.921,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Sup Warming Blanket,,12000993,LOCAL,Facility,Inpatient,,,,46,39.1,13.1836,46,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Sup Warming Blanket,,12000993,LOCAL,Facility,Outpatient,,,,46,39.1,13.1836,46,"UCare Health, Inc.",Medical Assistance,23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Warming Blanket,,12000993,LOCAL,Facility,Inpatient,,,,46,39.1,13.1836,46,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Sup Warming Blanket,,12000993,LOCAL,Facility,Outpatient,,,,46,39.1,13.1836,46,"UCare Health, Inc.",Medicare Advantage,23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Warming Blanket,,12000993,LOCAL,Facility,Inpatient,,,,46,39.1,13.1836,46,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Warming Blanket,,12000993,LOCAL,Facility,Outpatient,,,,46,39.1,13.1836,46,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Warming Blanket,,12000993,LOCAL,Facility,Inpatient,,,,46,39.1,13.1836,46,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Warming Blanket,,12000993,LOCAL,Facility,Both,,,,46,39.1,13.1836,46,UnitedHealthcare,Individual & Family,43.24,94,,percent of total billed charges,,
Sup Warming Blanket,,12000993,LOCAL,Facility,Outpatient,,,,46,39.1,13.1836,46,UnitedHealthcare,Medicare Advantage,22.54,49,,percent of total billed charges,,
Sup Warming Blanket,,12000993,LOCAL,Facility,Inpatient,,,,46,39.1,13.1836,46,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Sup Warming Blanket,,12000993,LOCAL,Facility,Outpatient,,,,46,39.1,13.1836,46,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,22.08,48,,percent of total billed charges,,100% of DHS outpatient percentage
Sup Warming Blanket,,12000993,LOCAL,Facility,Inpatient,,,,46,39.1,13.1836,46,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Sup Bipap Circuit,,12001571,LOCAL,Facility,Both,,,,77,65.45,22.0682,77,Aetna,Commercial,70.84,92,,percent of total billed charges,,
Sup Bipap Circuit,,12001571,LOCAL,Facility,Outpatient,,,,77,65.45,22.0682,77,Aetna,Medicare Advantage,37.73,49,,percent of total billed charges,,
Sup Bipap Circuit,,12001571,LOCAL,Facility,Inpatient,,,,77,65.45,22.0682,77,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Sup Bipap Circuit,,12001571,LOCAL,Facility,Both,,,,77,65.45,22.0682,77,Aetna,PPO,71.61,93,,percent of total billed charges,,
Sup Bipap Circuit,,12001571,LOCAL,Facility,Both,,,,77,65.45,22.0682,77,America's PPO,America's PPO,73.9431,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Sup Bipap Circuit,,12001571,LOCAL,Facility,Both,,,,77,65.45,22.0682,77,BlueCross BlueShield Minnesota, Federal Employee Program,75.768,98.4,,percent of total billed charges,,
Sup Bipap Circuit,,12001571,LOCAL,Facility,Both,,,,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,77,100,,percent of total billed charges,,
Sup Bipap Circuit,,12001571,LOCAL,Facility,Both,,,,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,High Value Network Plan,69.3,90,,percent of total billed charges,,
Sup Bipap Circuit,,12001571,LOCAL,Facility,Outpatient,,,,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,Medicare Advantage,37.73,49,,percent of total billed charges,,
Sup Bipap Circuit,,12001571,LOCAL,Facility,Inpatient,,,,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Sup Bipap Circuit,,12001571,LOCAL,Facility,Both,,,,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,68.1989,88.57,,percent of total billed charges,,
Sup Bipap Circuit,,12001571,LOCAL,Facility,Both,,,,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,22.0682,28.66,,percent of total billed charges,,
Sup Bipap Circuit,,12001571,LOCAL,Facility,Outpatient,,,,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),37.73,49,,percent of total billed charges,,
Sup Bipap Circuit,,12001571,LOCAL,Facility,Inpatient,,,,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Sup Bipap Circuit,,12001571,LOCAL,Facility,Both,,,,77,65.45,22.0682,77,CorVel,Worker's Compensation,77,100,,percent of total billed charges,,
Sup Bipap Circuit,,12001571,LOCAL,Facility,Both,,,,77,65.45,22.0682,77,First Health Group Corporation,First Health Network,74.69,97,,percent of total billed charges,,
Sup Bipap Circuit,,12001571,LOCAL,Facility,Both,,,,77,65.45,22.0682,77,"Health Partners, Inc.",Commercial,72.842,94.6,,percent of total billed charges,,
Sup Bipap Circuit,,12001571,LOCAL,Facility,Outpatient,,,,77,65.45,22.0682,77,"Health Partners, Inc.",Medicare Advantage,37.73,49,,percent of total billed charges,,
Sup Bipap Circuit,,12001571,LOCAL,Facility,Inpatient,,,,77,65.45,22.0682,77,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Bipap Circuit,,12001571,LOCAL,Facility,Both,,,,77,65.45,22.0682,77,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),46.2,60,,percent of total billed charges,,
Sup Bipap Circuit,,12001571,LOCAL,Facility,Both,,,,77,65.45,22.0682,77,"Health Partners, Inc.",State of Minnesota Advantage Program,62.755,81.5,,percent of total billed charges,,
Sup Bipap Circuit,,12001571,LOCAL,Facility,Both,,,,77,65.45,22.0682,77,"Health Partners, Inc.",State Public Programs,38.5,50,,percent of total billed charges,,
Sup Bipap Circuit,,12001571,LOCAL,Facility,Both,,,,77,65.45,22.0682,77,Humana Insurance Company,Commercial PPO,73.15,95,,percent of total billed charges,,
Sup Bipap Circuit,,12001571,LOCAL,Facility,Outpatient,,,,77,65.45,22.0682,77,Humana Insurance Company,Medicare PPO,37.73,49,,percent of total billed charges,,
Sup Bipap Circuit,,12001571,LOCAL,Facility,Inpatient,,,,77,65.45,22.0682,77,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Sup Bipap Circuit,,12001571,LOCAL,Facility,Both,,,,77,65.45,22.0682,77,Medica,Individual & Family,76.307,99.1,,percent of total billed charges,,
Sup Bipap Circuit,,12001571,LOCAL,Facility,Outpatient,,,,77,65.45,22.0682,77,Medica,Medica Advantage Solution,38.346,49.8,,percent of total billed charges,,
Sup Bipap Circuit,,12001571,LOCAL,Facility,Inpatient,,,,77,65.45,22.0682,77,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Sup Bipap Circuit,,12001571,LOCAL,Facility,Outpatient,,,,77,65.45,22.0682,77,Medica,Medical Assistance,34.342,44.6,,percent of total billed charges,,
Sup Bipap Circuit,,12001571,LOCAL,Facility,Inpatient,,,,77,65.45,22.0682,77,Medica,Medical Assistance,,,,,Included in per diem rate,
Sup Bipap Circuit,,12001571,LOCAL,Facility,Outpatient,,,,77,65.45,22.0682,77,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,38.346,49.8,,percent of total billed charges,,
Sup Bipap Circuit,,12001571,LOCAL,Facility,Inpatient,,,,77,65.45,22.0682,77,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Sup Bipap Circuit,,12001571,LOCAL,Facility,Both,,,,77,65.45,22.0682,77,"Multiplan, Inc.","Multiplan, Inc.",72.38,94,,percent of total billed charges,,
Sup Bipap Circuit,,12001571,LOCAL,Facility,Outpatient,,,,77,65.45,22.0682,77,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,69.377,90.1,,percent of total billed charges,,
Sup Bipap Circuit,,12001571,LOCAL,Facility,Inpatient,,,,77,65.45,22.0682,77,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Sup Bipap Circuit,,12001571,LOCAL,Facility,Both,,,,77,65.45,22.0682,77,"Preferred One Administrative Services, INC.",PPO,75.922,98.6,,percent of total billed charges,,
Sup Bipap Circuit,,12001571,LOCAL,Facility,Outpatient,,,,77,65.45,22.0682,77,PrimeWest Health,Minnesota Senior Health Options (MSHO),39.6165,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Sup Bipap Circuit,,12001571,LOCAL,Facility,Inpatient,,,,77,65.45,22.0682,77,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Bipap Circuit,,12001571,LOCAL,Facility,Outpatient,,,,77,65.45,22.0682,77,PrimeWest Health,MinnesotaCare,39.5472,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Sup Bipap Circuit,,12001571,LOCAL,Facility,Inpatient,,,,77,65.45,22.0682,77,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Sup Bipap Circuit,,12001571,LOCAL,Facility,Both,,,,77,65.45,22.0682,77,Sanford Health Plan,Sanford Health Plan,70.84,92,,percent of total billed charges,,
Sup Bipap Circuit,,12001571,LOCAL,Facility,Outpatient,,,,77,65.45,22.0682,77,"UCare Health, Inc.",Individual & Family Plan,43.3895,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Sup Bipap Circuit,,12001571,LOCAL,Facility,Inpatient,,,,77,65.45,22.0682,77,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Sup Bipap Circuit,,12001571,LOCAL,Facility,Outpatient,,,,77,65.45,22.0682,77,"UCare Health, Inc.",Medical Assistance,38.8619,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Bipap Circuit,,12001571,LOCAL,Facility,Inpatient,,,,77,65.45,22.0682,77,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Sup Bipap Circuit,,12001571,LOCAL,Facility,Outpatient,,,,77,65.45,22.0682,77,"UCare Health, Inc.",Medicare Advantage,38.8619,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Bipap Circuit,,12001571,LOCAL,Facility,Inpatient,,,,77,65.45,22.0682,77,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Bipap Circuit,,12001571,LOCAL,Facility,Outpatient,,,,77,65.45,22.0682,77,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),38.8619,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Bipap Circuit,,12001571,LOCAL,Facility,Inpatient,,,,77,65.45,22.0682,77,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Bipap Circuit,,12001571,LOCAL,Facility,Both,,,,77,65.45,22.0682,77,UnitedHealthcare,Individual & Family,72.38,94,,percent of total billed charges,,
Sup Bipap Circuit,,12001571,LOCAL,Facility,Outpatient,,,,77,65.45,22.0682,77,UnitedHealthcare,Medicare Advantage,37.73,49,,percent of total billed charges,,
Sup Bipap Circuit,,12001571,LOCAL,Facility,Inpatient,,,,77,65.45,22.0682,77,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Sup Bipap Circuit,,12001571,LOCAL,Facility,Outpatient,,,,77,65.45,22.0682,77,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,36.96,48,,percent of total billed charges,,100% of DHS outpatient percentage
Sup Bipap Circuit,,12001571,LOCAL,Facility,Inpatient,,,,77,65.45,22.0682,77,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Sup Bone Marrow Bx Needle,,12001605,LOCAL,Facility,Both,,,,226,192.1,64.7716,226,Aetna,Commercial,207.92,92,,percent of total billed charges,,
Sup Bone Marrow Bx Needle,,12001605,LOCAL,Facility,Outpatient,,,,226,192.1,64.7716,226,Aetna,Medicare Advantage,110.74,49,,percent of total billed charges,,
Sup Bone Marrow Bx Needle,,12001605,LOCAL,Facility,Inpatient,,,,226,192.1,64.7716,226,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Sup Bone Marrow Bx Needle,,12001605,LOCAL,Facility,Both,,,,226,192.1,64.7716,226,Aetna,PPO,210.18,93,,percent of total billed charges,,
Sup Bone Marrow Bx Needle,,12001605,LOCAL,Facility,Both,,,,226,192.1,64.7716,226,America's PPO,America's PPO,217.0278,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Sup Bone Marrow Bx Needle,,12001605,LOCAL,Facility,Both,,,,226,192.1,64.7716,226,BlueCross BlueShield Minnesota, Federal Employee Program,222.384,98.4,,percent of total billed charges,,
Sup Bone Marrow Bx Needle,,12001605,LOCAL,Facility,Both,,,,226,192.1,64.7716,226,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,226,100,,percent of total billed charges,,
Sup Bone Marrow Bx Needle,,12001605,LOCAL,Facility,Both,,,,226,192.1,64.7716,226,BlueCross BlueShield Minnesota,High Value Network Plan,203.4,90,,percent of total billed charges,,
Sup Bone Marrow Bx Needle,,12001605,LOCAL,Facility,Outpatient,,,,226,192.1,64.7716,226,BlueCross BlueShield Minnesota,Medicare Advantage,110.74,49,,percent of total billed charges,,
Sup Bone Marrow Bx Needle,,12001605,LOCAL,Facility,Inpatient,,,,226,192.1,64.7716,226,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Sup Bone Marrow Bx Needle,,12001605,LOCAL,Facility,Both,,,,226,192.1,64.7716,226,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,200.1682,88.57,,percent of total billed charges,,
Sup Bone Marrow Bx Needle,,12001605,LOCAL,Facility,Both,,,,226,192.1,64.7716,226,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,64.7716,28.66,,percent of total billed charges,,
Sup Bone Marrow Bx Needle,,12001605,LOCAL,Facility,Outpatient,,,,226,192.1,64.7716,226,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),110.74,49,,percent of total billed charges,,
Sup Bone Marrow Bx Needle,,12001605,LOCAL,Facility,Inpatient,,,,226,192.1,64.7716,226,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Sup Bone Marrow Bx Needle,,12001605,LOCAL,Facility,Both,,,,226,192.1,64.7716,226,CorVel,Worker's Compensation,226,100,,percent of total billed charges,,
Sup Bone Marrow Bx Needle,,12001605,LOCAL,Facility,Both,,,,226,192.1,64.7716,226,First Health Group Corporation,First Health Network,219.22,97,,percent of total billed charges,,
Sup Bone Marrow Bx Needle,,12001605,LOCAL,Facility,Both,,,,226,192.1,64.7716,226,"Health Partners, Inc.",Commercial,213.796,94.6,,percent of total billed charges,,
Sup Bone Marrow Bx Needle,,12001605,LOCAL,Facility,Outpatient,,,,226,192.1,64.7716,226,"Health Partners, Inc.",Medicare Advantage,110.74,49,,percent of total billed charges,,
Sup Bone Marrow Bx Needle,,12001605,LOCAL,Facility,Inpatient,,,,226,192.1,64.7716,226,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Bone Marrow Bx Needle,,12001605,LOCAL,Facility,Both,,,,226,192.1,64.7716,226,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),135.6,60,,percent of total billed charges,,
Sup Bone Marrow Bx Needle,,12001605,LOCAL,Facility,Both,,,,226,192.1,64.7716,226,"Health Partners, Inc.",State of Minnesota Advantage Program,184.19,81.5,,percent of total billed charges,,
Sup Bone Marrow Bx Needle,,12001605,LOCAL,Facility,Both,,,,226,192.1,64.7716,226,"Health Partners, Inc.",State Public Programs,113,50,,percent of total billed charges,,
Sup Bone Marrow Bx Needle,,12001605,LOCAL,Facility,Both,,,,226,192.1,64.7716,226,Humana Insurance Company,Commercial PPO,214.7,95,,percent of total billed charges,,
Sup Bone Marrow Bx Needle,,12001605,LOCAL,Facility,Outpatient,,,,226,192.1,64.7716,226,Humana Insurance Company,Medicare PPO,110.74,49,,percent of total billed charges,,
Sup Bone Marrow Bx Needle,,12001605,LOCAL,Facility,Inpatient,,,,226,192.1,64.7716,226,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Sup Bone Marrow Bx Needle,,12001605,LOCAL,Facility,Both,,,,226,192.1,64.7716,226,Medica,Individual & Family,223.966,99.1,,percent of total billed charges,,
Sup Bone Marrow Bx Needle,,12001605,LOCAL,Facility,Outpatient,,,,226,192.1,64.7716,226,Medica,Medica Advantage Solution,112.548,49.8,,percent of total billed charges,,
Sup Bone Marrow Bx Needle,,12001605,LOCAL,Facility,Inpatient,,,,226,192.1,64.7716,226,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Sup Bone Marrow Bx Needle,,12001605,LOCAL,Facility,Outpatient,,,,226,192.1,64.7716,226,Medica,Medical Assistance,100.796,44.6,,percent of total billed charges,,
Sup Bone Marrow Bx Needle,,12001605,LOCAL,Facility,Inpatient,,,,226,192.1,64.7716,226,Medica,Medical Assistance,,,,,Included in per diem rate,
Sup Bone Marrow Bx Needle,,12001605,LOCAL,Facility,Outpatient,,,,226,192.1,64.7716,226,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,112.548,49.8,,percent of total billed charges,,
Sup Bone Marrow Bx Needle,,12001605,LOCAL,Facility,Inpatient,,,,226,192.1,64.7716,226,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Sup Bone Marrow Bx Needle,,12001605,LOCAL,Facility,Both,,,,226,192.1,64.7716,226,"Multiplan, Inc.","Multiplan, Inc.",212.44,94,,percent of total billed charges,,
Sup Bone Marrow Bx Needle,,12001605,LOCAL,Facility,Outpatient,,,,226,192.1,64.7716,226,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,203.626,90.1,,percent of total billed charges,,
Sup Bone Marrow Bx Needle,,12001605,LOCAL,Facility,Inpatient,,,,226,192.1,64.7716,226,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Sup Bone Marrow Bx Needle,,12001605,LOCAL,Facility,Both,,,,226,192.1,64.7716,226,"Preferred One Administrative Services, INC.",PPO,222.836,98.6,,percent of total billed charges,,
Sup Bone Marrow Bx Needle,,12001605,LOCAL,Facility,Outpatient,,,,226,192.1,64.7716,226,PrimeWest Health,Minnesota Senior Health Options (MSHO),116.277,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Sup Bone Marrow Bx Needle,,12001605,LOCAL,Facility,Inpatient,,,,226,192.1,64.7716,226,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Bone Marrow Bx Needle,,12001605,LOCAL,Facility,Outpatient,,,,226,192.1,64.7716,226,PrimeWest Health,MinnesotaCare,116.0736,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Sup Bone Marrow Bx Needle,,12001605,LOCAL,Facility,Inpatient,,,,226,192.1,64.7716,226,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Sup Bone Marrow Bx Needle,,12001605,LOCAL,Facility,Both,,,,226,192.1,64.7716,226,Sanford Health Plan,Sanford Health Plan,207.92,92,,percent of total billed charges,,
Sup Bone Marrow Bx Needle,,12001605,LOCAL,Facility,Outpatient,,,,226,192.1,64.7716,226,"UCare Health, Inc.",Individual & Family Plan,127.351,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Sup Bone Marrow Bx Needle,,12001605,LOCAL,Facility,Inpatient,,,,226,192.1,64.7716,226,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Sup Bone Marrow Bx Needle,,12001605,LOCAL,Facility,Outpatient,,,,226,192.1,64.7716,226,"UCare Health, Inc.",Medical Assistance,114.0622,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Bone Marrow Bx Needle,,12001605,LOCAL,Facility,Inpatient,,,,226,192.1,64.7716,226,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Sup Bone Marrow Bx Needle,,12001605,LOCAL,Facility,Outpatient,,,,226,192.1,64.7716,226,"UCare Health, Inc.",Medicare Advantage,114.0622,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Bone Marrow Bx Needle,,12001605,LOCAL,Facility,Inpatient,,,,226,192.1,64.7716,226,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Bone Marrow Bx Needle,,12001605,LOCAL,Facility,Outpatient,,,,226,192.1,64.7716,226,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),114.0622,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Bone Marrow Bx Needle,,12001605,LOCAL,Facility,Inpatient,,,,226,192.1,64.7716,226,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Bone Marrow Bx Needle,,12001605,LOCAL,Facility,Both,,,,226,192.1,64.7716,226,UnitedHealthcare,Individual & Family,212.44,94,,percent of total billed charges,,
Sup Bone Marrow Bx Needle,,12001605,LOCAL,Facility,Outpatient,,,,226,192.1,64.7716,226,UnitedHealthcare,Medicare Advantage,110.74,49,,percent of total billed charges,,
Sup Bone Marrow Bx Needle,,12001605,LOCAL,Facility,Inpatient,,,,226,192.1,64.7716,226,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Sup Bone Marrow Bx Needle,,12001605,LOCAL,Facility,Outpatient,,,,226,192.1,64.7716,226,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,108.48,48,,percent of total billed charges,,100% of DHS outpatient percentage
Sup Bone Marrow Bx Needle,,12001605,LOCAL,Facility,Inpatient,,,,226,192.1,64.7716,226,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Sup Combitube/King Airway,,12001907,LOCAL,Facility,Both,,,,227,192.95,65.0582,227,Aetna,Commercial,208.84,92,,percent of total billed charges,,
Sup Combitube/King Airway,,12001907,LOCAL,Facility,Outpatient,,,,227,192.95,65.0582,227,Aetna,Medicare Advantage,111.23,49,,percent of total billed charges,,
Sup Combitube/King Airway,,12001907,LOCAL,Facility,Inpatient,,,,227,192.95,65.0582,227,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Sup Combitube/King Airway,,12001907,LOCAL,Facility,Both,,,,227,192.95,65.0582,227,Aetna,PPO,211.11,93,,percent of total billed charges,,
Sup Combitube/King Airway,,12001907,LOCAL,Facility,Both,,,,227,192.95,65.0582,227,America's PPO,America's PPO,217.9881,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Sup Combitube/King Airway,,12001907,LOCAL,Facility,Both,,,,227,192.95,65.0582,227,BlueCross BlueShield Minnesota, Federal Employee Program,223.368,98.4,,percent of total billed charges,,
Sup Combitube/King Airway,,12001907,LOCAL,Facility,Both,,,,227,192.95,65.0582,227,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,227,100,,percent of total billed charges,,
Sup Combitube/King Airway,,12001907,LOCAL,Facility,Both,,,,227,192.95,65.0582,227,BlueCross BlueShield Minnesota,High Value Network Plan,204.3,90,,percent of total billed charges,,
Sup Combitube/King Airway,,12001907,LOCAL,Facility,Outpatient,,,,227,192.95,65.0582,227,BlueCross BlueShield Minnesota,Medicare Advantage,111.23,49,,percent of total billed charges,,
Sup Combitube/King Airway,,12001907,LOCAL,Facility,Inpatient,,,,227,192.95,65.0582,227,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Sup Combitube/King Airway,,12001907,LOCAL,Facility,Both,,,,227,192.95,65.0582,227,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,201.0539,88.57,,percent of total billed charges,,
Sup Combitube/King Airway,,12001907,LOCAL,Facility,Both,,,,227,192.95,65.0582,227,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,65.0582,28.66,,percent of total billed charges,,
Sup Combitube/King Airway,,12001907,LOCAL,Facility,Outpatient,,,,227,192.95,65.0582,227,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),111.23,49,,percent of total billed charges,,
Sup Combitube/King Airway,,12001907,LOCAL,Facility,Inpatient,,,,227,192.95,65.0582,227,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Sup Combitube/King Airway,,12001907,LOCAL,Facility,Both,,,,227,192.95,65.0582,227,CorVel,Worker's Compensation,227,100,,percent of total billed charges,,
Sup Combitube/King Airway,,12001907,LOCAL,Facility,Both,,,,227,192.95,65.0582,227,First Health Group Corporation,First Health Network,220.19,97,,percent of total billed charges,,
Sup Combitube/King Airway,,12001907,LOCAL,Facility,Both,,,,227,192.95,65.0582,227,"Health Partners, Inc.",Commercial,214.742,94.6,,percent of total billed charges,,
Sup Combitube/King Airway,,12001907,LOCAL,Facility,Outpatient,,,,227,192.95,65.0582,227,"Health Partners, Inc.",Medicare Advantage,111.23,49,,percent of total billed charges,,
Sup Combitube/King Airway,,12001907,LOCAL,Facility,Inpatient,,,,227,192.95,65.0582,227,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Combitube/King Airway,,12001907,LOCAL,Facility,Both,,,,227,192.95,65.0582,227,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),136.2,60,,percent of total billed charges,,
Sup Combitube/King Airway,,12001907,LOCAL,Facility,Both,,,,227,192.95,65.0582,227,"Health Partners, Inc.",State of Minnesota Advantage Program,185.005,81.5,,percent of total billed charges,,
Sup Combitube/King Airway,,12001907,LOCAL,Facility,Both,,,,227,192.95,65.0582,227,"Health Partners, Inc.",State Public Programs,113.5,50,,percent of total billed charges,,
Sup Combitube/King Airway,,12001907,LOCAL,Facility,Both,,,,227,192.95,65.0582,227,Humana Insurance Company,Commercial PPO,215.65,95,,percent of total billed charges,,
Sup Combitube/King Airway,,12001907,LOCAL,Facility,Outpatient,,,,227,192.95,65.0582,227,Humana Insurance Company,Medicare PPO,111.23,49,,percent of total billed charges,,
Sup Combitube/King Airway,,12001907,LOCAL,Facility,Inpatient,,,,227,192.95,65.0582,227,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Sup Combitube/King Airway,,12001907,LOCAL,Facility,Both,,,,227,192.95,65.0582,227,Medica,Individual & Family,224.957,99.1,,percent of total billed charges,,
Sup Combitube/King Airway,,12001907,LOCAL,Facility,Outpatient,,,,227,192.95,65.0582,227,Medica,Medica Advantage Solution,113.046,49.8,,percent of total billed charges,,
Sup Combitube/King Airway,,12001907,LOCAL,Facility,Inpatient,,,,227,192.95,65.0582,227,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Sup Combitube/King Airway,,12001907,LOCAL,Facility,Outpatient,,,,227,192.95,65.0582,227,Medica,Medical Assistance,101.242,44.6,,percent of total billed charges,,
Sup Combitube/King Airway,,12001907,LOCAL,Facility,Inpatient,,,,227,192.95,65.0582,227,Medica,Medical Assistance,,,,,Included in per diem rate,
Sup Combitube/King Airway,,12001907,LOCAL,Facility,Outpatient,,,,227,192.95,65.0582,227,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,113.046,49.8,,percent of total billed charges,,
Sup Combitube/King Airway,,12001907,LOCAL,Facility,Inpatient,,,,227,192.95,65.0582,227,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Sup Combitube/King Airway,,12001907,LOCAL,Facility,Both,,,,227,192.95,65.0582,227,"Multiplan, Inc.","Multiplan, Inc.",213.38,94,,percent of total billed charges,,
Sup Combitube/King Airway,,12001907,LOCAL,Facility,Outpatient,,,,227,192.95,65.0582,227,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,204.527,90.1,,percent of total billed charges,,
Sup Combitube/King Airway,,12001907,LOCAL,Facility,Inpatient,,,,227,192.95,65.0582,227,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Sup Combitube/King Airway,,12001907,LOCAL,Facility,Both,,,,227,192.95,65.0582,227,"Preferred One Administrative Services, INC.",PPO,223.822,98.6,,percent of total billed charges,,
Sup Combitube/King Airway,,12001907,LOCAL,Facility,Outpatient,,,,227,192.95,65.0582,227,PrimeWest Health,Minnesota Senior Health Options (MSHO),116.7915,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Sup Combitube/King Airway,,12001907,LOCAL,Facility,Inpatient,,,,227,192.95,65.0582,227,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Combitube/King Airway,,12001907,LOCAL,Facility,Outpatient,,,,227,192.95,65.0582,227,PrimeWest Health,MinnesotaCare,116.5872,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Sup Combitube/King Airway,,12001907,LOCAL,Facility,Inpatient,,,,227,192.95,65.0582,227,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Sup Combitube/King Airway,,12001907,LOCAL,Facility,Both,,,,227,192.95,65.0582,227,Sanford Health Plan,Sanford Health Plan,208.84,92,,percent of total billed charges,,
Sup Combitube/King Airway,,12001907,LOCAL,Facility,Outpatient,,,,227,192.95,65.0582,227,"UCare Health, Inc.",Individual & Family Plan,127.9145,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Sup Combitube/King Airway,,12001907,LOCAL,Facility,Inpatient,,,,227,192.95,65.0582,227,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Sup Combitube/King Airway,,12001907,LOCAL,Facility,Outpatient,,,,227,192.95,65.0582,227,"UCare Health, Inc.",Medical Assistance,114.5669,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Combitube/King Airway,,12001907,LOCAL,Facility,Inpatient,,,,227,192.95,65.0582,227,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Sup Combitube/King Airway,,12001907,LOCAL,Facility,Outpatient,,,,227,192.95,65.0582,227,"UCare Health, Inc.",Medicare Advantage,114.5669,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Combitube/King Airway,,12001907,LOCAL,Facility,Inpatient,,,,227,192.95,65.0582,227,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Combitube/King Airway,,12001907,LOCAL,Facility,Outpatient,,,,227,192.95,65.0582,227,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),114.5669,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Combitube/King Airway,,12001907,LOCAL,Facility,Inpatient,,,,227,192.95,65.0582,227,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Combitube/King Airway,,12001907,LOCAL,Facility,Both,,,,227,192.95,65.0582,227,UnitedHealthcare,Individual & Family,213.38,94,,percent of total billed charges,,
Sup Combitube/King Airway,,12001907,LOCAL,Facility,Outpatient,,,,227,192.95,65.0582,227,UnitedHealthcare,Medicare Advantage,111.23,49,,percent of total billed charges,,
Sup Combitube/King Airway,,12001907,LOCAL,Facility,Inpatient,,,,227,192.95,65.0582,227,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Sup Combitube/King Airway,,12001907,LOCAL,Facility,Outpatient,,,,227,192.95,65.0582,227,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,108.96,48,,percent of total billed charges,,100% of DHS outpatient percentage
Sup Combitube/King Airway,,12001907,LOCAL,Facility,Inpatient,,,,227,192.95,65.0582,227,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Sup Fluid Warming Set,,12002268,LOCAL,Facility,Both,,,,47,39.95,13.4702,47,Aetna,Commercial,43.24,92,,percent of total billed charges,,
Sup Fluid Warming Set,,12002268,LOCAL,Facility,Outpatient,,,,47,39.95,13.4702,47,Aetna,Medicare Advantage,23.03,49,,percent of total billed charges,,
Sup Fluid Warming Set,,12002268,LOCAL,Facility,Inpatient,,,,47,39.95,13.4702,47,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Sup Fluid Warming Set,,12002268,LOCAL,Facility,Both,,,,47,39.95,13.4702,47,Aetna,PPO,43.71,93,,percent of total billed charges,,
Sup Fluid Warming Set,,12002268,LOCAL,Facility,Both,,,,47,39.95,13.4702,47,America's PPO,America's PPO,45.1341,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Sup Fluid Warming Set,,12002268,LOCAL,Facility,Both,,,,47,39.95,13.4702,47,BlueCross BlueShield Minnesota, Federal Employee Program,46.248,98.4,,percent of total billed charges,,
Sup Fluid Warming Set,,12002268,LOCAL,Facility,Both,,,,47,39.95,13.4702,47,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,47,100,,percent of total billed charges,,
Sup Fluid Warming Set,,12002268,LOCAL,Facility,Both,,,,47,39.95,13.4702,47,BlueCross BlueShield Minnesota,High Value Network Plan,42.3,90,,percent of total billed charges,,
Sup Fluid Warming Set,,12002268,LOCAL,Facility,Outpatient,,,,47,39.95,13.4702,47,BlueCross BlueShield Minnesota,Medicare Advantage,23.03,49,,percent of total billed charges,,
Sup Fluid Warming Set,,12002268,LOCAL,Facility,Inpatient,,,,47,39.95,13.4702,47,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Sup Fluid Warming Set,,12002268,LOCAL,Facility,Both,,,,47,39.95,13.4702,47,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,41.6279,88.57,,percent of total billed charges,,
Sup Fluid Warming Set,,12002268,LOCAL,Facility,Both,,,,47,39.95,13.4702,47,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,13.4702,28.66,,percent of total billed charges,,
Sup Fluid Warming Set,,12002268,LOCAL,Facility,Outpatient,,,,47,39.95,13.4702,47,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),23.03,49,,percent of total billed charges,,
Sup Fluid Warming Set,,12002268,LOCAL,Facility,Inpatient,,,,47,39.95,13.4702,47,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Sup Fluid Warming Set,,12002268,LOCAL,Facility,Both,,,,47,39.95,13.4702,47,CorVel,Worker's Compensation,47,100,,percent of total billed charges,,
Sup Fluid Warming Set,,12002268,LOCAL,Facility,Both,,,,47,39.95,13.4702,47,First Health Group Corporation,First Health Network,45.59,97,,percent of total billed charges,,
Sup Fluid Warming Set,,12002268,LOCAL,Facility,Both,,,,47,39.95,13.4702,47,"Health Partners, Inc.",Commercial,44.462,94.6,,percent of total billed charges,,
Sup Fluid Warming Set,,12002268,LOCAL,Facility,Outpatient,,,,47,39.95,13.4702,47,"Health Partners, Inc.",Medicare Advantage,23.03,49,,percent of total billed charges,,
Sup Fluid Warming Set,,12002268,LOCAL,Facility,Inpatient,,,,47,39.95,13.4702,47,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Fluid Warming Set,,12002268,LOCAL,Facility,Both,,,,47,39.95,13.4702,47,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),28.2,60,,percent of total billed charges,,
Sup Fluid Warming Set,,12002268,LOCAL,Facility,Both,,,,47,39.95,13.4702,47,"Health Partners, Inc.",State of Minnesota Advantage Program,38.305,81.5,,percent of total billed charges,,
Sup Fluid Warming Set,,12002268,LOCAL,Facility,Both,,,,47,39.95,13.4702,47,"Health Partners, Inc.",State Public Programs,23.5,50,,percent of total billed charges,,
Sup Fluid Warming Set,,12002268,LOCAL,Facility,Both,,,,47,39.95,13.4702,47,Humana Insurance Company,Commercial PPO,44.65,95,,percent of total billed charges,,
Sup Fluid Warming Set,,12002268,LOCAL,Facility,Outpatient,,,,47,39.95,13.4702,47,Humana Insurance Company,Medicare PPO,23.03,49,,percent of total billed charges,,
Sup Fluid Warming Set,,12002268,LOCAL,Facility,Inpatient,,,,47,39.95,13.4702,47,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Sup Fluid Warming Set,,12002268,LOCAL,Facility,Both,,,,47,39.95,13.4702,47,Medica,Individual & Family,46.577,99.1,,percent of total billed charges,,
Sup Fluid Warming Set,,12002268,LOCAL,Facility,Outpatient,,,,47,39.95,13.4702,47,Medica,Medica Advantage Solution,23.406,49.8,,percent of total billed charges,,
Sup Fluid Warming Set,,12002268,LOCAL,Facility,Inpatient,,,,47,39.95,13.4702,47,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Sup Fluid Warming Set,,12002268,LOCAL,Facility,Outpatient,,,,47,39.95,13.4702,47,Medica,Medical Assistance,20.962,44.6,,percent of total billed charges,,
Sup Fluid Warming Set,,12002268,LOCAL,Facility,Inpatient,,,,47,39.95,13.4702,47,Medica,Medical Assistance,,,,,Included in per diem rate,
Sup Fluid Warming Set,,12002268,LOCAL,Facility,Outpatient,,,,47,39.95,13.4702,47,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,23.406,49.8,,percent of total billed charges,,
Sup Fluid Warming Set,,12002268,LOCAL,Facility,Inpatient,,,,47,39.95,13.4702,47,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Sup Fluid Warming Set,,12002268,LOCAL,Facility,Both,,,,47,39.95,13.4702,47,"Multiplan, Inc.","Multiplan, Inc.",44.18,94,,percent of total billed charges,,
Sup Fluid Warming Set,,12002268,LOCAL,Facility,Outpatient,,,,47,39.95,13.4702,47,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,42.347,90.1,,percent of total billed charges,,
Sup Fluid Warming Set,,12002268,LOCAL,Facility,Inpatient,,,,47,39.95,13.4702,47,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Sup Fluid Warming Set,,12002268,LOCAL,Facility,Both,,,,47,39.95,13.4702,47,"Preferred One Administrative Services, INC.",PPO,46.342,98.6,,percent of total billed charges,,
Sup Fluid Warming Set,,12002268,LOCAL,Facility,Outpatient,,,,47,39.95,13.4702,47,PrimeWest Health,Minnesota Senior Health Options (MSHO),24.1815,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Sup Fluid Warming Set,,12002268,LOCAL,Facility,Inpatient,,,,47,39.95,13.4702,47,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Fluid Warming Set,,12002268,LOCAL,Facility,Outpatient,,,,47,39.95,13.4702,47,PrimeWest Health,MinnesotaCare,24.1392,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Sup Fluid Warming Set,,12002268,LOCAL,Facility,Inpatient,,,,47,39.95,13.4702,47,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Sup Fluid Warming Set,,12002268,LOCAL,Facility,Both,,,,47,39.95,13.4702,47,Sanford Health Plan,Sanford Health Plan,43.24,92,,percent of total billed charges,,
Sup Fluid Warming Set,,12002268,LOCAL,Facility,Outpatient,,,,47,39.95,13.4702,47,"UCare Health, Inc.",Individual & Family Plan,26.4845,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Sup Fluid Warming Set,,12002268,LOCAL,Facility,Inpatient,,,,47,39.95,13.4702,47,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Sup Fluid Warming Set,,12002268,LOCAL,Facility,Outpatient,,,,47,39.95,13.4702,47,"UCare Health, Inc.",Medical Assistance,23.7209,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Fluid Warming Set,,12002268,LOCAL,Facility,Inpatient,,,,47,39.95,13.4702,47,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Sup Fluid Warming Set,,12002268,LOCAL,Facility,Outpatient,,,,47,39.95,13.4702,47,"UCare Health, Inc.",Medicare Advantage,23.7209,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Fluid Warming Set,,12002268,LOCAL,Facility,Inpatient,,,,47,39.95,13.4702,47,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Fluid Warming Set,,12002268,LOCAL,Facility,Outpatient,,,,47,39.95,13.4702,47,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),23.7209,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Fluid Warming Set,,12002268,LOCAL,Facility,Inpatient,,,,47,39.95,13.4702,47,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Fluid Warming Set,,12002268,LOCAL,Facility,Both,,,,47,39.95,13.4702,47,UnitedHealthcare,Individual & Family,44.18,94,,percent of total billed charges,,
Sup Fluid Warming Set,,12002268,LOCAL,Facility,Outpatient,,,,47,39.95,13.4702,47,UnitedHealthcare,Medicare Advantage,23.03,49,,percent of total billed charges,,
Sup Fluid Warming Set,,12002268,LOCAL,Facility,Inpatient,,,,47,39.95,13.4702,47,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Sup Fluid Warming Set,,12002268,LOCAL,Facility,Outpatient,,,,47,39.95,13.4702,47,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,22.56,48,,percent of total billed charges,,100% of DHS outpatient percentage
Sup Fluid Warming Set,,12002268,LOCAL,Facility,Inpatient,,,,47,39.95,13.4702,47,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Sup Full Bipap Mask All Sizes,,12002324,LOCAL,Facility,Both,,,,87,73.95,24.9342,87,Aetna,Commercial,80.04,92,,percent of total billed charges,,
Sup Full Bipap Mask All Sizes,,12002324,LOCAL,Facility,Outpatient,,,,87,73.95,24.9342,87,Aetna,Medicare Advantage,42.63,49,,percent of total billed charges,,
Sup Full Bipap Mask All Sizes,,12002324,LOCAL,Facility,Inpatient,,,,87,73.95,24.9342,87,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Sup Full Bipap Mask All Sizes,,12002324,LOCAL,Facility,Both,,,,87,73.95,24.9342,87,Aetna,PPO,80.91,93,,percent of total billed charges,,
Sup Full Bipap Mask All Sizes,,12002324,LOCAL,Facility,Both,,,,87,73.95,24.9342,87,America's PPO,America's PPO,83.5461,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Sup Full Bipap Mask All Sizes,,12002324,LOCAL,Facility,Both,,,,87,73.95,24.9342,87,BlueCross BlueShield Minnesota, Federal Employee Program,85.608,98.4,,percent of total billed charges,,
Sup Full Bipap Mask All Sizes,,12002324,LOCAL,Facility,Both,,,,87,73.95,24.9342,87,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,87,100,,percent of total billed charges,,
Sup Full Bipap Mask All Sizes,,12002324,LOCAL,Facility,Both,,,,87,73.95,24.9342,87,BlueCross BlueShield Minnesota,High Value Network Plan,78.3,90,,percent of total billed charges,,
Sup Full Bipap Mask All Sizes,,12002324,LOCAL,Facility,Outpatient,,,,87,73.95,24.9342,87,BlueCross BlueShield Minnesota,Medicare Advantage,42.63,49,,percent of total billed charges,,
Sup Full Bipap Mask All Sizes,,12002324,LOCAL,Facility,Inpatient,,,,87,73.95,24.9342,87,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Sup Full Bipap Mask All Sizes,,12002324,LOCAL,Facility,Both,,,,87,73.95,24.9342,87,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,77.0559,88.57,,percent of total billed charges,,
Sup Full Bipap Mask All Sizes,,12002324,LOCAL,Facility,Both,,,,87,73.95,24.9342,87,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,24.9342,28.66,,percent of total billed charges,,
Sup Full Bipap Mask All Sizes,,12002324,LOCAL,Facility,Outpatient,,,,87,73.95,24.9342,87,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),42.63,49,,percent of total billed charges,,
Sup Full Bipap Mask All Sizes,,12002324,LOCAL,Facility,Inpatient,,,,87,73.95,24.9342,87,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Sup Full Bipap Mask All Sizes,,12002324,LOCAL,Facility,Both,,,,87,73.95,24.9342,87,CorVel,Worker's Compensation,87,100,,percent of total billed charges,,
Sup Full Bipap Mask All Sizes,,12002324,LOCAL,Facility,Both,,,,87,73.95,24.9342,87,First Health Group Corporation,First Health Network,84.39,97,,percent of total billed charges,,
Sup Full Bipap Mask All Sizes,,12002324,LOCAL,Facility,Both,,,,87,73.95,24.9342,87,"Health Partners, Inc.",Commercial,82.302,94.6,,percent of total billed charges,,
Sup Full Bipap Mask All Sizes,,12002324,LOCAL,Facility,Outpatient,,,,87,73.95,24.9342,87,"Health Partners, Inc.",Medicare Advantage,42.63,49,,percent of total billed charges,,
Sup Full Bipap Mask All Sizes,,12002324,LOCAL,Facility,Inpatient,,,,87,73.95,24.9342,87,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Full Bipap Mask All Sizes,,12002324,LOCAL,Facility,Both,,,,87,73.95,24.9342,87,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),52.2,60,,percent of total billed charges,,
Sup Full Bipap Mask All Sizes,,12002324,LOCAL,Facility,Both,,,,87,73.95,24.9342,87,"Health Partners, Inc.",State of Minnesota Advantage Program,70.905,81.5,,percent of total billed charges,,
Sup Full Bipap Mask All Sizes,,12002324,LOCAL,Facility,Both,,,,87,73.95,24.9342,87,"Health Partners, Inc.",State Public Programs,43.5,50,,percent of total billed charges,,
Sup Full Bipap Mask All Sizes,,12002324,LOCAL,Facility,Both,,,,87,73.95,24.9342,87,Humana Insurance Company,Commercial PPO,82.65,95,,percent of total billed charges,,
Sup Full Bipap Mask All Sizes,,12002324,LOCAL,Facility,Outpatient,,,,87,73.95,24.9342,87,Humana Insurance Company,Medicare PPO,42.63,49,,percent of total billed charges,,
Sup Full Bipap Mask All Sizes,,12002324,LOCAL,Facility,Inpatient,,,,87,73.95,24.9342,87,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Sup Full Bipap Mask All Sizes,,12002324,LOCAL,Facility,Both,,,,87,73.95,24.9342,87,Medica,Individual & Family,86.217,99.1,,percent of total billed charges,,
Sup Full Bipap Mask All Sizes,,12002324,LOCAL,Facility,Outpatient,,,,87,73.95,24.9342,87,Medica,Medica Advantage Solution,43.326,49.8,,percent of total billed charges,,
Sup Full Bipap Mask All Sizes,,12002324,LOCAL,Facility,Inpatient,,,,87,73.95,24.9342,87,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Sup Full Bipap Mask All Sizes,,12002324,LOCAL,Facility,Outpatient,,,,87,73.95,24.9342,87,Medica,Medical Assistance,38.802,44.6,,percent of total billed charges,,
Sup Full Bipap Mask All Sizes,,12002324,LOCAL,Facility,Inpatient,,,,87,73.95,24.9342,87,Medica,Medical Assistance,,,,,Included in per diem rate,
Sup Full Bipap Mask All Sizes,,12002324,LOCAL,Facility,Outpatient,,,,87,73.95,24.9342,87,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,43.326,49.8,,percent of total billed charges,,
Sup Full Bipap Mask All Sizes,,12002324,LOCAL,Facility,Inpatient,,,,87,73.95,24.9342,87,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Sup Full Bipap Mask All Sizes,,12002324,LOCAL,Facility,Both,,,,87,73.95,24.9342,87,"Multiplan, Inc.","Multiplan, Inc.",81.78,94,,percent of total billed charges,,
Sup Full Bipap Mask All Sizes,,12002324,LOCAL,Facility,Outpatient,,,,87,73.95,24.9342,87,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,78.387,90.1,,percent of total billed charges,,
Sup Full Bipap Mask All Sizes,,12002324,LOCAL,Facility,Inpatient,,,,87,73.95,24.9342,87,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Sup Full Bipap Mask All Sizes,,12002324,LOCAL,Facility,Both,,,,87,73.95,24.9342,87,"Preferred One Administrative Services, INC.",PPO,85.782,98.6,,percent of total billed charges,,
Sup Full Bipap Mask All Sizes,,12002324,LOCAL,Facility,Outpatient,,,,87,73.95,24.9342,87,PrimeWest Health,Minnesota Senior Health Options (MSHO),44.7615,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Sup Full Bipap Mask All Sizes,,12002324,LOCAL,Facility,Inpatient,,,,87,73.95,24.9342,87,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Full Bipap Mask All Sizes,,12002324,LOCAL,Facility,Outpatient,,,,87,73.95,24.9342,87,PrimeWest Health,MinnesotaCare,44.6832,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Sup Full Bipap Mask All Sizes,,12002324,LOCAL,Facility,Inpatient,,,,87,73.95,24.9342,87,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Sup Full Bipap Mask All Sizes,,12002324,LOCAL,Facility,Both,,,,87,73.95,24.9342,87,Sanford Health Plan,Sanford Health Plan,80.04,92,,percent of total billed charges,,
Sup Full Bipap Mask All Sizes,,12002324,LOCAL,Facility,Outpatient,,,,87,73.95,24.9342,87,"UCare Health, Inc.",Individual & Family Plan,49.0245,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Sup Full Bipap Mask All Sizes,,12002324,LOCAL,Facility,Inpatient,,,,87,73.95,24.9342,87,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Sup Full Bipap Mask All Sizes,,12002324,LOCAL,Facility,Outpatient,,,,87,73.95,24.9342,87,"UCare Health, Inc.",Medical Assistance,43.9089,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Full Bipap Mask All Sizes,,12002324,LOCAL,Facility,Inpatient,,,,87,73.95,24.9342,87,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Sup Full Bipap Mask All Sizes,,12002324,LOCAL,Facility,Outpatient,,,,87,73.95,24.9342,87,"UCare Health, Inc.",Medicare Advantage,43.9089,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Full Bipap Mask All Sizes,,12002324,LOCAL,Facility,Inpatient,,,,87,73.95,24.9342,87,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Full Bipap Mask All Sizes,,12002324,LOCAL,Facility,Outpatient,,,,87,73.95,24.9342,87,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),43.9089,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Full Bipap Mask All Sizes,,12002324,LOCAL,Facility,Inpatient,,,,87,73.95,24.9342,87,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Full Bipap Mask All Sizes,,12002324,LOCAL,Facility,Both,,,,87,73.95,24.9342,87,UnitedHealthcare,Individual & Family,81.78,94,,percent of total billed charges,,
Sup Full Bipap Mask All Sizes,,12002324,LOCAL,Facility,Outpatient,,,,87,73.95,24.9342,87,UnitedHealthcare,Medicare Advantage,42.63,49,,percent of total billed charges,,
Sup Full Bipap Mask All Sizes,,12002324,LOCAL,Facility,Inpatient,,,,87,73.95,24.9342,87,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Sup Full Bipap Mask All Sizes,,12002324,LOCAL,Facility,Outpatient,,,,87,73.95,24.9342,87,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,41.76,48,,percent of total billed charges,,100% of DHS outpatient percentage
Sup Full Bipap Mask All Sizes,,12002324,LOCAL,Facility,Inpatient,,,,87,73.95,24.9342,87,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Sup Incentive Spirometer,,12002420,LOCAL,Facility,Both,,,,51,43.35,14.6166,51,Aetna,Commercial,46.92,92,,percent of total billed charges,,
Sup Incentive Spirometer,,12002420,LOCAL,Facility,Outpatient,,,,51,43.35,14.6166,51,Aetna,Medicare Advantage,24.99,49,,percent of total billed charges,,
Sup Incentive Spirometer,,12002420,LOCAL,Facility,Inpatient,,,,51,43.35,14.6166,51,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Sup Incentive Spirometer,,12002420,LOCAL,Facility,Both,,,,51,43.35,14.6166,51,Aetna,PPO,47.43,93,,percent of total billed charges,,
Sup Incentive Spirometer,,12002420,LOCAL,Facility,Both,,,,51,43.35,14.6166,51,America's PPO,America's PPO,48.9753,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Sup Incentive Spirometer,,12002420,LOCAL,Facility,Both,,,,51,43.35,14.6166,51,BlueCross BlueShield Minnesota, Federal Employee Program,50.184,98.4,,percent of total billed charges,,
Sup Incentive Spirometer,,12002420,LOCAL,Facility,Both,,,,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,51,100,,percent of total billed charges,,
Sup Incentive Spirometer,,12002420,LOCAL,Facility,Both,,,,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,High Value Network Plan,45.9,90,,percent of total billed charges,,
Sup Incentive Spirometer,,12002420,LOCAL,Facility,Outpatient,,,,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,Medicare Advantage,24.99,49,,percent of total billed charges,,
Sup Incentive Spirometer,,12002420,LOCAL,Facility,Inpatient,,,,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Sup Incentive Spirometer,,12002420,LOCAL,Facility,Both,,,,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,45.1707,88.57,,percent of total billed charges,,
Sup Incentive Spirometer,,12002420,LOCAL,Facility,Both,,,,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,14.6166,28.66,,percent of total billed charges,,
Sup Incentive Spirometer,,12002420,LOCAL,Facility,Outpatient,,,,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),24.99,49,,percent of total billed charges,,
Sup Incentive Spirometer,,12002420,LOCAL,Facility,Inpatient,,,,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Sup Incentive Spirometer,,12002420,LOCAL,Facility,Both,,,,51,43.35,14.6166,51,CorVel,Worker's Compensation,51,100,,percent of total billed charges,,
Sup Incentive Spirometer,,12002420,LOCAL,Facility,Both,,,,51,43.35,14.6166,51,First Health Group Corporation,First Health Network,49.47,97,,percent of total billed charges,,
Sup Incentive Spirometer,,12002420,LOCAL,Facility,Both,,,,51,43.35,14.6166,51,"Health Partners, Inc.",Commercial,48.246,94.6,,percent of total billed charges,,
Sup Incentive Spirometer,,12002420,LOCAL,Facility,Outpatient,,,,51,43.35,14.6166,51,"Health Partners, Inc.",Medicare Advantage,24.99,49,,percent of total billed charges,,
Sup Incentive Spirometer,,12002420,LOCAL,Facility,Inpatient,,,,51,43.35,14.6166,51,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Incentive Spirometer,,12002420,LOCAL,Facility,Both,,,,51,43.35,14.6166,51,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),30.6,60,,percent of total billed charges,,
Sup Incentive Spirometer,,12002420,LOCAL,Facility,Both,,,,51,43.35,14.6166,51,"Health Partners, Inc.",State of Minnesota Advantage Program,41.565,81.5,,percent of total billed charges,,
Sup Incentive Spirometer,,12002420,LOCAL,Facility,Both,,,,51,43.35,14.6166,51,"Health Partners, Inc.",State Public Programs,25.5,50,,percent of total billed charges,,
Sup Incentive Spirometer,,12002420,LOCAL,Facility,Both,,,,51,43.35,14.6166,51,Humana Insurance Company,Commercial PPO,48.45,95,,percent of total billed charges,,
Sup Incentive Spirometer,,12002420,LOCAL,Facility,Outpatient,,,,51,43.35,14.6166,51,Humana Insurance Company,Medicare PPO,24.99,49,,percent of total billed charges,,
Sup Incentive Spirometer,,12002420,LOCAL,Facility,Inpatient,,,,51,43.35,14.6166,51,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Sup Incentive Spirometer,,12002420,LOCAL,Facility,Both,,,,51,43.35,14.6166,51,Medica,Individual & Family,50.541,99.1,,percent of total billed charges,,
Sup Incentive Spirometer,,12002420,LOCAL,Facility,Outpatient,,,,51,43.35,14.6166,51,Medica,Medica Advantage Solution,25.398,49.8,,percent of total billed charges,,
Sup Incentive Spirometer,,12002420,LOCAL,Facility,Inpatient,,,,51,43.35,14.6166,51,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Sup Incentive Spirometer,,12002420,LOCAL,Facility,Outpatient,,,,51,43.35,14.6166,51,Medica,Medical Assistance,22.746,44.6,,percent of total billed charges,,
Sup Incentive Spirometer,,12002420,LOCAL,Facility,Inpatient,,,,51,43.35,14.6166,51,Medica,Medical Assistance,,,,,Included in per diem rate,
Sup Incentive Spirometer,,12002420,LOCAL,Facility,Outpatient,,,,51,43.35,14.6166,51,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,25.398,49.8,,percent of total billed charges,,
Sup Incentive Spirometer,,12002420,LOCAL,Facility,Inpatient,,,,51,43.35,14.6166,51,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Sup Incentive Spirometer,,12002420,LOCAL,Facility,Both,,,,51,43.35,14.6166,51,"Multiplan, Inc.","Multiplan, Inc.",47.94,94,,percent of total billed charges,,
Sup Incentive Spirometer,,12002420,LOCAL,Facility,Outpatient,,,,51,43.35,14.6166,51,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,45.951,90.1,,percent of total billed charges,,
Sup Incentive Spirometer,,12002420,LOCAL,Facility,Inpatient,,,,51,43.35,14.6166,51,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Sup Incentive Spirometer,,12002420,LOCAL,Facility,Both,,,,51,43.35,14.6166,51,"Preferred One Administrative Services, INC.",PPO,50.286,98.6,,percent of total billed charges,,
Sup Incentive Spirometer,,12002420,LOCAL,Facility,Outpatient,,,,51,43.35,14.6166,51,PrimeWest Health,Minnesota Senior Health Options (MSHO),26.2395,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Sup Incentive Spirometer,,12002420,LOCAL,Facility,Inpatient,,,,51,43.35,14.6166,51,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Incentive Spirometer,,12002420,LOCAL,Facility,Outpatient,,,,51,43.35,14.6166,51,PrimeWest Health,MinnesotaCare,26.1936,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Sup Incentive Spirometer,,12002420,LOCAL,Facility,Inpatient,,,,51,43.35,14.6166,51,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Sup Incentive Spirometer,,12002420,LOCAL,Facility,Both,,,,51,43.35,14.6166,51,Sanford Health Plan,Sanford Health Plan,46.92,92,,percent of total billed charges,,
Sup Incentive Spirometer,,12002420,LOCAL,Facility,Outpatient,,,,51,43.35,14.6166,51,"UCare Health, Inc.",Individual & Family Plan,28.7385,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Sup Incentive Spirometer,,12002420,LOCAL,Facility,Inpatient,,,,51,43.35,14.6166,51,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Sup Incentive Spirometer,,12002420,LOCAL,Facility,Outpatient,,,,51,43.35,14.6166,51,"UCare Health, Inc.",Medical Assistance,25.7397,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Incentive Spirometer,,12002420,LOCAL,Facility,Inpatient,,,,51,43.35,14.6166,51,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Sup Incentive Spirometer,,12002420,LOCAL,Facility,Outpatient,,,,51,43.35,14.6166,51,"UCare Health, Inc.",Medicare Advantage,25.7397,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Incentive Spirometer,,12002420,LOCAL,Facility,Inpatient,,,,51,43.35,14.6166,51,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Incentive Spirometer,,12002420,LOCAL,Facility,Outpatient,,,,51,43.35,14.6166,51,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),25.7397,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Incentive Spirometer,,12002420,LOCAL,Facility,Inpatient,,,,51,43.35,14.6166,51,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Incentive Spirometer,,12002420,LOCAL,Facility,Both,,,,51,43.35,14.6166,51,UnitedHealthcare,Individual & Family,47.94,94,,percent of total billed charges,,
Sup Incentive Spirometer,,12002420,LOCAL,Facility,Outpatient,,,,51,43.35,14.6166,51,UnitedHealthcare,Medicare Advantage,24.99,49,,percent of total billed charges,,
Sup Incentive Spirometer,,12002420,LOCAL,Facility,Inpatient,,,,51,43.35,14.6166,51,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Sup Incentive Spirometer,,12002420,LOCAL,Facility,Outpatient,,,,51,43.35,14.6166,51,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,24.48,48,,percent of total billed charges,,100% of DHS outpatient percentage
Sup Incentive Spirometer,,12002420,LOCAL,Facility,Inpatient,,,,51,43.35,14.6166,51,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Sup J-Vac Drain,,12002493,LOCAL,Facility,Both,,,,24,20.4,6.8784,24,Aetna,Commercial,22.08,92,,percent of total billed charges,,
Sup J-Vac Drain,,12002493,LOCAL,Facility,Outpatient,,,,24,20.4,6.8784,24,Aetna,Medicare Advantage,11.76,49,,percent of total billed charges,,
Sup J-Vac Drain,,12002493,LOCAL,Facility,Inpatient,,,,24,20.4,6.8784,24,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Sup J-Vac Drain,,12002493,LOCAL,Facility,Both,,,,24,20.4,6.8784,24,Aetna,PPO,22.32,93,,percent of total billed charges,,
Sup J-Vac Drain,,12002493,LOCAL,Facility,Both,,,,24,20.4,6.8784,24,America's PPO,America's PPO,23.0472,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Sup J-Vac Drain,,12002493,LOCAL,Facility,Both,,,,24,20.4,6.8784,24,BlueCross BlueShield Minnesota, Federal Employee Program,23.616,98.4,,percent of total billed charges,,
Sup J-Vac Drain,,12002493,LOCAL,Facility,Both,,,,24,20.4,6.8784,24,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,24,100,,percent of total billed charges,,
Sup J-Vac Drain,,12002493,LOCAL,Facility,Both,,,,24,20.4,6.8784,24,BlueCross BlueShield Minnesota,High Value Network Plan,21.6,90,,percent of total billed charges,,
Sup J-Vac Drain,,12002493,LOCAL,Facility,Outpatient,,,,24,20.4,6.8784,24,BlueCross BlueShield Minnesota,Medicare Advantage,11.76,49,,percent of total billed charges,,
Sup J-Vac Drain,,12002493,LOCAL,Facility,Inpatient,,,,24,20.4,6.8784,24,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Sup J-Vac Drain,,12002493,LOCAL,Facility,Both,,,,24,20.4,6.8784,24,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,21.2568,88.57,,percent of total billed charges,,
Sup J-Vac Drain,,12002493,LOCAL,Facility,Both,,,,24,20.4,6.8784,24,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,6.8784,28.66,,percent of total billed charges,,
Sup J-Vac Drain,,12002493,LOCAL,Facility,Outpatient,,,,24,20.4,6.8784,24,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),11.76,49,,percent of total billed charges,,
Sup J-Vac Drain,,12002493,LOCAL,Facility,Inpatient,,,,24,20.4,6.8784,24,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Sup J-Vac Drain,,12002493,LOCAL,Facility,Both,,,,24,20.4,6.8784,24,CorVel,Worker's Compensation,24,100,,percent of total billed charges,,
Sup J-Vac Drain,,12002493,LOCAL,Facility,Both,,,,24,20.4,6.8784,24,First Health Group Corporation,First Health Network,23.28,97,,percent of total billed charges,,
Sup J-Vac Drain,,12002493,LOCAL,Facility,Both,,,,24,20.4,6.8784,24,"Health Partners, Inc.",Commercial,22.704,94.6,,percent of total billed charges,,
Sup J-Vac Drain,,12002493,LOCAL,Facility,Outpatient,,,,24,20.4,6.8784,24,"Health Partners, Inc.",Medicare Advantage,11.76,49,,percent of total billed charges,,
Sup J-Vac Drain,,12002493,LOCAL,Facility,Inpatient,,,,24,20.4,6.8784,24,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup J-Vac Drain,,12002493,LOCAL,Facility,Both,,,,24,20.4,6.8784,24,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),14.4,60,,percent of total billed charges,,
Sup J-Vac Drain,,12002493,LOCAL,Facility,Both,,,,24,20.4,6.8784,24,"Health Partners, Inc.",State of Minnesota Advantage Program,19.56,81.5,,percent of total billed charges,,
Sup J-Vac Drain,,12002493,LOCAL,Facility,Both,,,,24,20.4,6.8784,24,"Health Partners, Inc.",State Public Programs,12,50,,percent of total billed charges,,
Sup J-Vac Drain,,12002493,LOCAL,Facility,Both,,,,24,20.4,6.8784,24,Humana Insurance Company,Commercial PPO,22.8,95,,percent of total billed charges,,
Sup J-Vac Drain,,12002493,LOCAL,Facility,Outpatient,,,,24,20.4,6.8784,24,Humana Insurance Company,Medicare PPO,11.76,49,,percent of total billed charges,,
Sup J-Vac Drain,,12002493,LOCAL,Facility,Inpatient,,,,24,20.4,6.8784,24,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Sup J-Vac Drain,,12002493,LOCAL,Facility,Both,,,,24,20.4,6.8784,24,Medica,Individual & Family,23.784,99.1,,percent of total billed charges,,
Sup J-Vac Drain,,12002493,LOCAL,Facility,Outpatient,,,,24,20.4,6.8784,24,Medica,Medica Advantage Solution,11.952,49.8,,percent of total billed charges,,
Sup J-Vac Drain,,12002493,LOCAL,Facility,Inpatient,,,,24,20.4,6.8784,24,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Sup J-Vac Drain,,12002493,LOCAL,Facility,Outpatient,,,,24,20.4,6.8784,24,Medica,Medical Assistance,10.704,44.6,,percent of total billed charges,,
Sup J-Vac Drain,,12002493,LOCAL,Facility,Inpatient,,,,24,20.4,6.8784,24,Medica,Medical Assistance,,,,,Included in per diem rate,
Sup J-Vac Drain,,12002493,LOCAL,Facility,Outpatient,,,,24,20.4,6.8784,24,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,11.952,49.8,,percent of total billed charges,,
Sup J-Vac Drain,,12002493,LOCAL,Facility,Inpatient,,,,24,20.4,6.8784,24,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Sup J-Vac Drain,,12002493,LOCAL,Facility,Both,,,,24,20.4,6.8784,24,"Multiplan, Inc.","Multiplan, Inc.",22.56,94,,percent of total billed charges,,
Sup J-Vac Drain,,12002493,LOCAL,Facility,Outpatient,,,,24,20.4,6.8784,24,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,21.624,90.1,,percent of total billed charges,,
Sup J-Vac Drain,,12002493,LOCAL,Facility,Inpatient,,,,24,20.4,6.8784,24,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Sup J-Vac Drain,,12002493,LOCAL,Facility,Both,,,,24,20.4,6.8784,24,"Preferred One Administrative Services, INC.",PPO,23.664,98.6,,percent of total billed charges,,
Sup J-Vac Drain,,12002493,LOCAL,Facility,Outpatient,,,,24,20.4,6.8784,24,PrimeWest Health,Minnesota Senior Health Options (MSHO),12.348,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Sup J-Vac Drain,,12002493,LOCAL,Facility,Inpatient,,,,24,20.4,6.8784,24,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup J-Vac Drain,,12002493,LOCAL,Facility,Outpatient,,,,24,20.4,6.8784,24,PrimeWest Health,MinnesotaCare,12.3264,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Sup J-Vac Drain,,12002493,LOCAL,Facility,Inpatient,,,,24,20.4,6.8784,24,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Sup J-Vac Drain,,12002493,LOCAL,Facility,Both,,,,24,20.4,6.8784,24,Sanford Health Plan,Sanford Health Plan,22.08,92,,percent of total billed charges,,
Sup J-Vac Drain,,12002493,LOCAL,Facility,Outpatient,,,,24,20.4,6.8784,24,"UCare Health, Inc.",Individual & Family Plan,13.524,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Sup J-Vac Drain,,12002493,LOCAL,Facility,Inpatient,,,,24,20.4,6.8784,24,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Sup J-Vac Drain,,12002493,LOCAL,Facility,Outpatient,,,,24,20.4,6.8784,24,"UCare Health, Inc.",Medical Assistance,12.1128,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup J-Vac Drain,,12002493,LOCAL,Facility,Inpatient,,,,24,20.4,6.8784,24,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Sup J-Vac Drain,,12002493,LOCAL,Facility,Outpatient,,,,24,20.4,6.8784,24,"UCare Health, Inc.",Medicare Advantage,12.1128,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup J-Vac Drain,,12002493,LOCAL,Facility,Inpatient,,,,24,20.4,6.8784,24,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup J-Vac Drain,,12002493,LOCAL,Facility,Outpatient,,,,24,20.4,6.8784,24,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),12.1128,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup J-Vac Drain,,12002493,LOCAL,Facility,Inpatient,,,,24,20.4,6.8784,24,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup J-Vac Drain,,12002493,LOCAL,Facility,Both,,,,24,20.4,6.8784,24,UnitedHealthcare,Individual & Family,22.56,94,,percent of total billed charges,,
Sup J-Vac Drain,,12002493,LOCAL,Facility,Outpatient,,,,24,20.4,6.8784,24,UnitedHealthcare,Medicare Advantage,11.76,49,,percent of total billed charges,,
Sup J-Vac Drain,,12002493,LOCAL,Facility,Inpatient,,,,24,20.4,6.8784,24,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Sup J-Vac Drain,,12002493,LOCAL,Facility,Outpatient,,,,24,20.4,6.8784,24,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,11.52,48,,percent of total billed charges,,100% of DHS outpatient percentage
Sup J-Vac Drain,,12002493,LOCAL,Facility,Inpatient,,,,24,20.4,6.8784,24,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Sup J-Vac Reservoir,,12002508,LOCAL,Facility,Both,,,,33,28.05,9.4578,33,Aetna,Commercial,30.36,92,,percent of total billed charges,,
Sup J-Vac Reservoir,,12002508,LOCAL,Facility,Outpatient,,,,33,28.05,9.4578,33,Aetna,Medicare Advantage,16.17,49,,percent of total billed charges,,
Sup J-Vac Reservoir,,12002508,LOCAL,Facility,Inpatient,,,,33,28.05,9.4578,33,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Sup J-Vac Reservoir,,12002508,LOCAL,Facility,Both,,,,33,28.05,9.4578,33,Aetna,PPO,30.69,93,,percent of total billed charges,,
Sup J-Vac Reservoir,,12002508,LOCAL,Facility,Both,,,,33,28.05,9.4578,33,America's PPO,America's PPO,31.6899,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Sup J-Vac Reservoir,,12002508,LOCAL,Facility,Both,,,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota, Federal Employee Program,32.472,98.4,,percent of total billed charges,,
Sup J-Vac Reservoir,,12002508,LOCAL,Facility,Both,,,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,33,100,,percent of total billed charges,,
Sup J-Vac Reservoir,,12002508,LOCAL,Facility,Both,,,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota,High Value Network Plan,29.7,90,,percent of total billed charges,,
Sup J-Vac Reservoir,,12002508,LOCAL,Facility,Outpatient,,,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota,Medicare Advantage,16.17,49,,percent of total billed charges,,
Sup J-Vac Reservoir,,12002508,LOCAL,Facility,Inpatient,,,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Sup J-Vac Reservoir,,12002508,LOCAL,Facility,Both,,,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,29.2281,88.57,,percent of total billed charges,,
Sup J-Vac Reservoir,,12002508,LOCAL,Facility,Both,,,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,9.4578,28.66,,percent of total billed charges,,
Sup J-Vac Reservoir,,12002508,LOCAL,Facility,Outpatient,,,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),16.17,49,,percent of total billed charges,,
Sup J-Vac Reservoir,,12002508,LOCAL,Facility,Inpatient,,,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Sup J-Vac Reservoir,,12002508,LOCAL,Facility,Both,,,,33,28.05,9.4578,33,CorVel,Worker's Compensation,33,100,,percent of total billed charges,,
Sup J-Vac Reservoir,,12002508,LOCAL,Facility,Both,,,,33,28.05,9.4578,33,First Health Group Corporation,First Health Network,32.01,97,,percent of total billed charges,,
Sup J-Vac Reservoir,,12002508,LOCAL,Facility,Both,,,,33,28.05,9.4578,33,"Health Partners, Inc.",Commercial,31.218,94.6,,percent of total billed charges,,
Sup J-Vac Reservoir,,12002508,LOCAL,Facility,Outpatient,,,,33,28.05,9.4578,33,"Health Partners, Inc.",Medicare Advantage,16.17,49,,percent of total billed charges,,
Sup J-Vac Reservoir,,12002508,LOCAL,Facility,Inpatient,,,,33,28.05,9.4578,33,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup J-Vac Reservoir,,12002508,LOCAL,Facility,Both,,,,33,28.05,9.4578,33,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),19.8,60,,percent of total billed charges,,
Sup J-Vac Reservoir,,12002508,LOCAL,Facility,Both,,,,33,28.05,9.4578,33,"Health Partners, Inc.",State of Minnesota Advantage Program,26.895,81.5,,percent of total billed charges,,
Sup J-Vac Reservoir,,12002508,LOCAL,Facility,Both,,,,33,28.05,9.4578,33,"Health Partners, Inc.",State Public Programs,16.5,50,,percent of total billed charges,,
Sup J-Vac Reservoir,,12002508,LOCAL,Facility,Both,,,,33,28.05,9.4578,33,Humana Insurance Company,Commercial PPO,31.35,95,,percent of total billed charges,,
Sup J-Vac Reservoir,,12002508,LOCAL,Facility,Outpatient,,,,33,28.05,9.4578,33,Humana Insurance Company,Medicare PPO,16.17,49,,percent of total billed charges,,
Sup J-Vac Reservoir,,12002508,LOCAL,Facility,Inpatient,,,,33,28.05,9.4578,33,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Sup J-Vac Reservoir,,12002508,LOCAL,Facility,Both,,,,33,28.05,9.4578,33,Medica,Individual & Family,32.703,99.1,,percent of total billed charges,,
Sup J-Vac Reservoir,,12002508,LOCAL,Facility,Outpatient,,,,33,28.05,9.4578,33,Medica,Medica Advantage Solution,16.434,49.8,,percent of total billed charges,,
Sup J-Vac Reservoir,,12002508,LOCAL,Facility,Inpatient,,,,33,28.05,9.4578,33,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Sup J-Vac Reservoir,,12002508,LOCAL,Facility,Outpatient,,,,33,28.05,9.4578,33,Medica,Medical Assistance,14.718,44.6,,percent of total billed charges,,
Sup J-Vac Reservoir,,12002508,LOCAL,Facility,Inpatient,,,,33,28.05,9.4578,33,Medica,Medical Assistance,,,,,Included in per diem rate,
Sup J-Vac Reservoir,,12002508,LOCAL,Facility,Outpatient,,,,33,28.05,9.4578,33,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,16.434,49.8,,percent of total billed charges,,
Sup J-Vac Reservoir,,12002508,LOCAL,Facility,Inpatient,,,,33,28.05,9.4578,33,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Sup J-Vac Reservoir,,12002508,LOCAL,Facility,Both,,,,33,28.05,9.4578,33,"Multiplan, Inc.","Multiplan, Inc.",31.02,94,,percent of total billed charges,,
Sup J-Vac Reservoir,,12002508,LOCAL,Facility,Outpatient,,,,33,28.05,9.4578,33,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,29.733,90.1,,percent of total billed charges,,
Sup J-Vac Reservoir,,12002508,LOCAL,Facility,Inpatient,,,,33,28.05,9.4578,33,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Sup J-Vac Reservoir,,12002508,LOCAL,Facility,Both,,,,33,28.05,9.4578,33,"Preferred One Administrative Services, INC.",PPO,32.538,98.6,,percent of total billed charges,,
Sup J-Vac Reservoir,,12002508,LOCAL,Facility,Outpatient,,,,33,28.05,9.4578,33,PrimeWest Health,Minnesota Senior Health Options (MSHO),16.9785,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Sup J-Vac Reservoir,,12002508,LOCAL,Facility,Inpatient,,,,33,28.05,9.4578,33,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup J-Vac Reservoir,,12002508,LOCAL,Facility,Outpatient,,,,33,28.05,9.4578,33,PrimeWest Health,MinnesotaCare,16.9488,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Sup J-Vac Reservoir,,12002508,LOCAL,Facility,Inpatient,,,,33,28.05,9.4578,33,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Sup J-Vac Reservoir,,12002508,LOCAL,Facility,Both,,,,33,28.05,9.4578,33,Sanford Health Plan,Sanford Health Plan,30.36,92,,percent of total billed charges,,
Sup J-Vac Reservoir,,12002508,LOCAL,Facility,Outpatient,,,,33,28.05,9.4578,33,"UCare Health, Inc.",Individual & Family Plan,18.5955,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Sup J-Vac Reservoir,,12002508,LOCAL,Facility,Inpatient,,,,33,28.05,9.4578,33,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Sup J-Vac Reservoir,,12002508,LOCAL,Facility,Outpatient,,,,33,28.05,9.4578,33,"UCare Health, Inc.",Medical Assistance,16.6551,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup J-Vac Reservoir,,12002508,LOCAL,Facility,Inpatient,,,,33,28.05,9.4578,33,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Sup J-Vac Reservoir,,12002508,LOCAL,Facility,Outpatient,,,,33,28.05,9.4578,33,"UCare Health, Inc.",Medicare Advantage,16.6551,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup J-Vac Reservoir,,12002508,LOCAL,Facility,Inpatient,,,,33,28.05,9.4578,33,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup J-Vac Reservoir,,12002508,LOCAL,Facility,Outpatient,,,,33,28.05,9.4578,33,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),16.6551,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup J-Vac Reservoir,,12002508,LOCAL,Facility,Inpatient,,,,33,28.05,9.4578,33,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup J-Vac Reservoir,,12002508,LOCAL,Facility,Both,,,,33,28.05,9.4578,33,UnitedHealthcare,Individual & Family,31.02,94,,percent of total billed charges,,
Sup J-Vac Reservoir,,12002508,LOCAL,Facility,Outpatient,,,,33,28.05,9.4578,33,UnitedHealthcare,Medicare Advantage,16.17,49,,percent of total billed charges,,
Sup J-Vac Reservoir,,12002508,LOCAL,Facility,Inpatient,,,,33,28.05,9.4578,33,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Sup J-Vac Reservoir,,12002508,LOCAL,Facility,Outpatient,,,,33,28.05,9.4578,33,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,15.84,48,,percent of total billed charges,,100% of DHS outpatient percentage
Sup J-Vac Reservoir,,12002508,LOCAL,Facility,Inpatient,,,,33,28.05,9.4578,33,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Sup Nasogastric Suction,,12002716,LOCAL,Facility,Both,,,,153,130.05,43.8498,153,Aetna,Commercial,140.76,92,,percent of total billed charges,,
Sup Nasogastric Suction,,12002716,LOCAL,Facility,Outpatient,,,,153,130.05,43.8498,153,Aetna,Medicare Advantage,74.97,49,,percent of total billed charges,,
Sup Nasogastric Suction,,12002716,LOCAL,Facility,Inpatient,,,,153,130.05,43.8498,153,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Sup Nasogastric Suction,,12002716,LOCAL,Facility,Both,,,,153,130.05,43.8498,153,Aetna,PPO,142.29,93,,percent of total billed charges,,
Sup Nasogastric Suction,,12002716,LOCAL,Facility,Both,,,,153,130.05,43.8498,153,America's PPO,America's PPO,146.9259,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Sup Nasogastric Suction,,12002716,LOCAL,Facility,Both,,,,153,130.05,43.8498,153,BlueCross BlueShield Minnesota, Federal Employee Program,150.552,98.4,,percent of total billed charges,,
Sup Nasogastric Suction,,12002716,LOCAL,Facility,Both,,,,153,130.05,43.8498,153,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,153,100,,percent of total billed charges,,
Sup Nasogastric Suction,,12002716,LOCAL,Facility,Both,,,,153,130.05,43.8498,153,BlueCross BlueShield Minnesota,High Value Network Plan,137.7,90,,percent of total billed charges,,
Sup Nasogastric Suction,,12002716,LOCAL,Facility,Outpatient,,,,153,130.05,43.8498,153,BlueCross BlueShield Minnesota,Medicare Advantage,74.97,49,,percent of total billed charges,,
Sup Nasogastric Suction,,12002716,LOCAL,Facility,Inpatient,,,,153,130.05,43.8498,153,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Sup Nasogastric Suction,,12002716,LOCAL,Facility,Both,,,,153,130.05,43.8498,153,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,135.5121,88.57,,percent of total billed charges,,
Sup Nasogastric Suction,,12002716,LOCAL,Facility,Both,,,,153,130.05,43.8498,153,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,43.8498,28.66,,percent of total billed charges,,
Sup Nasogastric Suction,,12002716,LOCAL,Facility,Outpatient,,,,153,130.05,43.8498,153,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),74.97,49,,percent of total billed charges,,
Sup Nasogastric Suction,,12002716,LOCAL,Facility,Inpatient,,,,153,130.05,43.8498,153,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Sup Nasogastric Suction,,12002716,LOCAL,Facility,Both,,,,153,130.05,43.8498,153,CorVel,Worker's Compensation,153,100,,percent of total billed charges,,
Sup Nasogastric Suction,,12002716,LOCAL,Facility,Both,,,,153,130.05,43.8498,153,First Health Group Corporation,First Health Network,148.41,97,,percent of total billed charges,,
Sup Nasogastric Suction,,12002716,LOCAL,Facility,Both,,,,153,130.05,43.8498,153,"Health Partners, Inc.",Commercial,144.738,94.6,,percent of total billed charges,,
Sup Nasogastric Suction,,12002716,LOCAL,Facility,Outpatient,,,,153,130.05,43.8498,153,"Health Partners, Inc.",Medicare Advantage,74.97,49,,percent of total billed charges,,
Sup Nasogastric Suction,,12002716,LOCAL,Facility,Inpatient,,,,153,130.05,43.8498,153,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Nasogastric Suction,,12002716,LOCAL,Facility,Both,,,,153,130.05,43.8498,153,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),91.8,60,,percent of total billed charges,,
Sup Nasogastric Suction,,12002716,LOCAL,Facility,Both,,,,153,130.05,43.8498,153,"Health Partners, Inc.",State of Minnesota Advantage Program,124.695,81.5,,percent of total billed charges,,
Sup Nasogastric Suction,,12002716,LOCAL,Facility,Both,,,,153,130.05,43.8498,153,"Health Partners, Inc.",State Public Programs,76.5,50,,percent of total billed charges,,
Sup Nasogastric Suction,,12002716,LOCAL,Facility,Both,,,,153,130.05,43.8498,153,Humana Insurance Company,Commercial PPO,145.35,95,,percent of total billed charges,,
Sup Nasogastric Suction,,12002716,LOCAL,Facility,Outpatient,,,,153,130.05,43.8498,153,Humana Insurance Company,Medicare PPO,74.97,49,,percent of total billed charges,,
Sup Nasogastric Suction,,12002716,LOCAL,Facility,Inpatient,,,,153,130.05,43.8498,153,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Sup Nasogastric Suction,,12002716,LOCAL,Facility,Both,,,,153,130.05,43.8498,153,Medica,Individual & Family,151.623,99.1,,percent of total billed charges,,
Sup Nasogastric Suction,,12002716,LOCAL,Facility,Outpatient,,,,153,130.05,43.8498,153,Medica,Medica Advantage Solution,76.194,49.8,,percent of total billed charges,,
Sup Nasogastric Suction,,12002716,LOCAL,Facility,Inpatient,,,,153,130.05,43.8498,153,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Sup Nasogastric Suction,,12002716,LOCAL,Facility,Outpatient,,,,153,130.05,43.8498,153,Medica,Medical Assistance,68.238,44.6,,percent of total billed charges,,
Sup Nasogastric Suction,,12002716,LOCAL,Facility,Inpatient,,,,153,130.05,43.8498,153,Medica,Medical Assistance,,,,,Included in per diem rate,
Sup Nasogastric Suction,,12002716,LOCAL,Facility,Outpatient,,,,153,130.05,43.8498,153,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,76.194,49.8,,percent of total billed charges,,
Sup Nasogastric Suction,,12002716,LOCAL,Facility,Inpatient,,,,153,130.05,43.8498,153,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Sup Nasogastric Suction,,12002716,LOCAL,Facility,Both,,,,153,130.05,43.8498,153,"Multiplan, Inc.","Multiplan, Inc.",143.82,94,,percent of total billed charges,,
Sup Nasogastric Suction,,12002716,LOCAL,Facility,Outpatient,,,,153,130.05,43.8498,153,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,137.853,90.1,,percent of total billed charges,,
Sup Nasogastric Suction,,12002716,LOCAL,Facility,Inpatient,,,,153,130.05,43.8498,153,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Sup Nasogastric Suction,,12002716,LOCAL,Facility,Both,,,,153,130.05,43.8498,153,"Preferred One Administrative Services, INC.",PPO,150.858,98.6,,percent of total billed charges,,
Sup Nasogastric Suction,,12002716,LOCAL,Facility,Outpatient,,,,153,130.05,43.8498,153,PrimeWest Health,Minnesota Senior Health Options (MSHO),78.7185,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Sup Nasogastric Suction,,12002716,LOCAL,Facility,Inpatient,,,,153,130.05,43.8498,153,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Nasogastric Suction,,12002716,LOCAL,Facility,Outpatient,,,,153,130.05,43.8498,153,PrimeWest Health,MinnesotaCare,78.5808,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Sup Nasogastric Suction,,12002716,LOCAL,Facility,Inpatient,,,,153,130.05,43.8498,153,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Sup Nasogastric Suction,,12002716,LOCAL,Facility,Both,,,,153,130.05,43.8498,153,Sanford Health Plan,Sanford Health Plan,140.76,92,,percent of total billed charges,,
Sup Nasogastric Suction,,12002716,LOCAL,Facility,Outpatient,,,,153,130.05,43.8498,153,"UCare Health, Inc.",Individual & Family Plan,86.2155,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Sup Nasogastric Suction,,12002716,LOCAL,Facility,Inpatient,,,,153,130.05,43.8498,153,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Sup Nasogastric Suction,,12002716,LOCAL,Facility,Outpatient,,,,153,130.05,43.8498,153,"UCare Health, Inc.",Medical Assistance,77.2191,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Nasogastric Suction,,12002716,LOCAL,Facility,Inpatient,,,,153,130.05,43.8498,153,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Sup Nasogastric Suction,,12002716,LOCAL,Facility,Outpatient,,,,153,130.05,43.8498,153,"UCare Health, Inc.",Medicare Advantage,77.2191,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Nasogastric Suction,,12002716,LOCAL,Facility,Inpatient,,,,153,130.05,43.8498,153,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Nasogastric Suction,,12002716,LOCAL,Facility,Outpatient,,,,153,130.05,43.8498,153,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),77.2191,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Nasogastric Suction,,12002716,LOCAL,Facility,Inpatient,,,,153,130.05,43.8498,153,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Nasogastric Suction,,12002716,LOCAL,Facility,Both,,,,153,130.05,43.8498,153,UnitedHealthcare,Individual & Family,143.82,94,,percent of total billed charges,,
Sup Nasogastric Suction,,12002716,LOCAL,Facility,Outpatient,,,,153,130.05,43.8498,153,UnitedHealthcare,Medicare Advantage,74.97,49,,percent of total billed charges,,
Sup Nasogastric Suction,,12002716,LOCAL,Facility,Inpatient,,,,153,130.05,43.8498,153,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Sup Nasogastric Suction,,12002716,LOCAL,Facility,Outpatient,,,,153,130.05,43.8498,153,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,73.44,48,,percent of total billed charges,,100% of DHS outpatient percentage
Sup Nasogastric Suction,,12002716,LOCAL,Facility,Inpatient,,,,153,130.05,43.8498,153,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Sup Picc Catheter Tray,,12003029,LOCAL,Facility,Both,,,,1066,906.1,305.5156,1066,Aetna,Commercial,980.72,92,,percent of total billed charges,,
Sup Picc Catheter Tray,,12003029,LOCAL,Facility,Outpatient,,,,1066,906.1,305.5156,1066,Aetna,Medicare Advantage,522.34,49,,percent of total billed charges,,
Sup Picc Catheter Tray,,12003029,LOCAL,Facility,Inpatient,,,,1066,906.1,305.5156,1066,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Sup Picc Catheter Tray,,12003029,LOCAL,Facility,Both,,,,1066,906.1,305.5156,1066,Aetna,PPO,991.38,93,,percent of total billed charges,,
Sup Picc Catheter Tray,,12003029,LOCAL,Facility,Both,,,,1066,906.1,305.5156,1066,America's PPO,America's PPO,1023.6798,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Sup Picc Catheter Tray,,12003029,LOCAL,Facility,Both,,,,1066,906.1,305.5156,1066,BlueCross BlueShield Minnesota, Federal Employee Program,1048.944,98.4,,percent of total billed charges,,
Sup Picc Catheter Tray,,12003029,LOCAL,Facility,Both,,,,1066,906.1,305.5156,1066,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1066,100,,percent of total billed charges,,
Sup Picc Catheter Tray,,12003029,LOCAL,Facility,Both,,,,1066,906.1,305.5156,1066,BlueCross BlueShield Minnesota,High Value Network Plan,959.4,90,,percent of total billed charges,,
Sup Picc Catheter Tray,,12003029,LOCAL,Facility,Outpatient,,,,1066,906.1,305.5156,1066,BlueCross BlueShield Minnesota,Medicare Advantage,522.34,49,,percent of total billed charges,,
Sup Picc Catheter Tray,,12003029,LOCAL,Facility,Inpatient,,,,1066,906.1,305.5156,1066,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Sup Picc Catheter Tray,,12003029,LOCAL,Facility,Both,,,,1066,906.1,305.5156,1066,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,944.1562,88.57,,percent of total billed charges,,
Sup Picc Catheter Tray,,12003029,LOCAL,Facility,Both,,,,1066,906.1,305.5156,1066,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,305.5156,28.66,,percent of total billed charges,,
Sup Picc Catheter Tray,,12003029,LOCAL,Facility,Outpatient,,,,1066,906.1,305.5156,1066,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),522.34,49,,percent of total billed charges,,
Sup Picc Catheter Tray,,12003029,LOCAL,Facility,Inpatient,,,,1066,906.1,305.5156,1066,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Sup Picc Catheter Tray,,12003029,LOCAL,Facility,Both,,,,1066,906.1,305.5156,1066,CorVel,Worker's Compensation,1066,100,,percent of total billed charges,,
Sup Picc Catheter Tray,,12003029,LOCAL,Facility,Both,,,,1066,906.1,305.5156,1066,First Health Group Corporation,First Health Network,1034.02,97,,percent of total billed charges,,
Sup Picc Catheter Tray,,12003029,LOCAL,Facility,Both,,,,1066,906.1,305.5156,1066,"Health Partners, Inc.",Commercial,1008.436,94.6,,percent of total billed charges,,
Sup Picc Catheter Tray,,12003029,LOCAL,Facility,Outpatient,,,,1066,906.1,305.5156,1066,"Health Partners, Inc.",Medicare Advantage,522.34,49,,percent of total billed charges,,
Sup Picc Catheter Tray,,12003029,LOCAL,Facility,Inpatient,,,,1066,906.1,305.5156,1066,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Picc Catheter Tray,,12003029,LOCAL,Facility,Both,,,,1066,906.1,305.5156,1066,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),639.6,60,,percent of total billed charges,,
Sup Picc Catheter Tray,,12003029,LOCAL,Facility,Both,,,,1066,906.1,305.5156,1066,"Health Partners, Inc.",State of Minnesota Advantage Program,868.79,81.5,,percent of total billed charges,,
Sup Picc Catheter Tray,,12003029,LOCAL,Facility,Both,,,,1066,906.1,305.5156,1066,"Health Partners, Inc.",State Public Programs,533,50,,percent of total billed charges,,
Sup Picc Catheter Tray,,12003029,LOCAL,Facility,Both,,,,1066,906.1,305.5156,1066,Humana Insurance Company,Commercial PPO,1012.7,95,,percent of total billed charges,,
Sup Picc Catheter Tray,,12003029,LOCAL,Facility,Outpatient,,,,1066,906.1,305.5156,1066,Humana Insurance Company,Medicare PPO,522.34,49,,percent of total billed charges,,
Sup Picc Catheter Tray,,12003029,LOCAL,Facility,Inpatient,,,,1066,906.1,305.5156,1066,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Sup Picc Catheter Tray,,12003029,LOCAL,Facility,Both,,,,1066,906.1,305.5156,1066,Medica,Individual & Family,1056.406,99.1,,percent of total billed charges,,
Sup Picc Catheter Tray,,12003029,LOCAL,Facility,Outpatient,,,,1066,906.1,305.5156,1066,Medica,Medica Advantage Solution,530.868,49.8,,percent of total billed charges,,
Sup Picc Catheter Tray,,12003029,LOCAL,Facility,Inpatient,,,,1066,906.1,305.5156,1066,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Sup Picc Catheter Tray,,12003029,LOCAL,Facility,Outpatient,,,,1066,906.1,305.5156,1066,Medica,Medical Assistance,475.436,44.6,,percent of total billed charges,,
Sup Picc Catheter Tray,,12003029,LOCAL,Facility,Inpatient,,,,1066,906.1,305.5156,1066,Medica,Medical Assistance,,,,,Included in per diem rate,
Sup Picc Catheter Tray,,12003029,LOCAL,Facility,Outpatient,,,,1066,906.1,305.5156,1066,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,530.868,49.8,,percent of total billed charges,,
Sup Picc Catheter Tray,,12003029,LOCAL,Facility,Inpatient,,,,1066,906.1,305.5156,1066,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Sup Picc Catheter Tray,,12003029,LOCAL,Facility,Both,,,,1066,906.1,305.5156,1066,"Multiplan, Inc.","Multiplan, Inc.",1002.04,94,,percent of total billed charges,,
Sup Picc Catheter Tray,,12003029,LOCAL,Facility,Outpatient,,,,1066,906.1,305.5156,1066,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,960.466,90.1,,percent of total billed charges,,
Sup Picc Catheter Tray,,12003029,LOCAL,Facility,Inpatient,,,,1066,906.1,305.5156,1066,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Sup Picc Catheter Tray,,12003029,LOCAL,Facility,Both,,,,1066,906.1,305.5156,1066,"Preferred One Administrative Services, INC.",PPO,1051.076,98.6,,percent of total billed charges,,
Sup Picc Catheter Tray,,12003029,LOCAL,Facility,Outpatient,,,,1066,906.1,305.5156,1066,PrimeWest Health,Minnesota Senior Health Options (MSHO),548.457,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Sup Picc Catheter Tray,,12003029,LOCAL,Facility,Inpatient,,,,1066,906.1,305.5156,1066,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Picc Catheter Tray,,12003029,LOCAL,Facility,Outpatient,,,,1066,906.1,305.5156,1066,PrimeWest Health,MinnesotaCare,547.4976,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Sup Picc Catheter Tray,,12003029,LOCAL,Facility,Inpatient,,,,1066,906.1,305.5156,1066,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Sup Picc Catheter Tray,,12003029,LOCAL,Facility,Both,,,,1066,906.1,305.5156,1066,Sanford Health Plan,Sanford Health Plan,980.72,92,,percent of total billed charges,,
Sup Picc Catheter Tray,,12003029,LOCAL,Facility,Outpatient,,,,1066,906.1,305.5156,1066,"UCare Health, Inc.",Individual & Family Plan,600.691,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Sup Picc Catheter Tray,,12003029,LOCAL,Facility,Inpatient,,,,1066,906.1,305.5156,1066,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Sup Picc Catheter Tray,,12003029,LOCAL,Facility,Outpatient,,,,1066,906.1,305.5156,1066,"UCare Health, Inc.",Medical Assistance,538.0102,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Picc Catheter Tray,,12003029,LOCAL,Facility,Inpatient,,,,1066,906.1,305.5156,1066,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Sup Picc Catheter Tray,,12003029,LOCAL,Facility,Outpatient,,,,1066,906.1,305.5156,1066,"UCare Health, Inc.",Medicare Advantage,538.0102,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Picc Catheter Tray,,12003029,LOCAL,Facility,Inpatient,,,,1066,906.1,305.5156,1066,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Picc Catheter Tray,,12003029,LOCAL,Facility,Outpatient,,,,1066,906.1,305.5156,1066,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),538.0102,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Picc Catheter Tray,,12003029,LOCAL,Facility,Inpatient,,,,1066,906.1,305.5156,1066,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Picc Catheter Tray,,12003029,LOCAL,Facility,Both,,,,1066,906.1,305.5156,1066,UnitedHealthcare,Individual & Family,1002.04,94,,percent of total billed charges,,
Sup Picc Catheter Tray,,12003029,LOCAL,Facility,Outpatient,,,,1066,906.1,305.5156,1066,UnitedHealthcare,Medicare Advantage,522.34,49,,percent of total billed charges,,
Sup Picc Catheter Tray,,12003029,LOCAL,Facility,Inpatient,,,,1066,906.1,305.5156,1066,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Sup Picc Catheter Tray,,12003029,LOCAL,Facility,Outpatient,,,,1066,906.1,305.5156,1066,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,511.68,48,,percent of total billed charges,,100% of DHS outpatient percentage
Sup Picc Catheter Tray,,12003029,LOCAL,Facility,Inpatient,,,,1066,906.1,305.5156,1066,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Sup Pleurovac Unit,,12003035,LOCAL,Facility,Both,,,,421,357.85,120.6586,421,Aetna,Commercial,387.32,92,,percent of total billed charges,,
Sup Pleurovac Unit,,12003035,LOCAL,Facility,Outpatient,,,,421,357.85,120.6586,421,Aetna,Medicare Advantage,206.29,49,,percent of total billed charges,,
Sup Pleurovac Unit,,12003035,LOCAL,Facility,Inpatient,,,,421,357.85,120.6586,421,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Sup Pleurovac Unit,,12003035,LOCAL,Facility,Both,,,,421,357.85,120.6586,421,Aetna,PPO,391.53,93,,percent of total billed charges,,
Sup Pleurovac Unit,,12003035,LOCAL,Facility,Both,,,,421,357.85,120.6586,421,America's PPO,America's PPO,404.2863,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Sup Pleurovac Unit,,12003035,LOCAL,Facility,Both,,,,421,357.85,120.6586,421,BlueCross BlueShield Minnesota, Federal Employee Program,414.264,98.4,,percent of total billed charges,,
Sup Pleurovac Unit,,12003035,LOCAL,Facility,Both,,,,421,357.85,120.6586,421,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,421,100,,percent of total billed charges,,
Sup Pleurovac Unit,,12003035,LOCAL,Facility,Both,,,,421,357.85,120.6586,421,BlueCross BlueShield Minnesota,High Value Network Plan,378.9,90,,percent of total billed charges,,
Sup Pleurovac Unit,,12003035,LOCAL,Facility,Outpatient,,,,421,357.85,120.6586,421,BlueCross BlueShield Minnesota,Medicare Advantage,206.29,49,,percent of total billed charges,,
Sup Pleurovac Unit,,12003035,LOCAL,Facility,Inpatient,,,,421,357.85,120.6586,421,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Sup Pleurovac Unit,,12003035,LOCAL,Facility,Both,,,,421,357.85,120.6586,421,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,372.8797,88.57,,percent of total billed charges,,
Sup Pleurovac Unit,,12003035,LOCAL,Facility,Both,,,,421,357.85,120.6586,421,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,120.6586,28.66,,percent of total billed charges,,
Sup Pleurovac Unit,,12003035,LOCAL,Facility,Outpatient,,,,421,357.85,120.6586,421,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),206.29,49,,percent of total billed charges,,
Sup Pleurovac Unit,,12003035,LOCAL,Facility,Inpatient,,,,421,357.85,120.6586,421,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Sup Pleurovac Unit,,12003035,LOCAL,Facility,Both,,,,421,357.85,120.6586,421,CorVel,Worker's Compensation,421,100,,percent of total billed charges,,
Sup Pleurovac Unit,,12003035,LOCAL,Facility,Both,,,,421,357.85,120.6586,421,First Health Group Corporation,First Health Network,408.37,97,,percent of total billed charges,,
Sup Pleurovac Unit,,12003035,LOCAL,Facility,Both,,,,421,357.85,120.6586,421,"Health Partners, Inc.",Commercial,398.266,94.6,,percent of total billed charges,,
Sup Pleurovac Unit,,12003035,LOCAL,Facility,Outpatient,,,,421,357.85,120.6586,421,"Health Partners, Inc.",Medicare Advantage,206.29,49,,percent of total billed charges,,
Sup Pleurovac Unit,,12003035,LOCAL,Facility,Inpatient,,,,421,357.85,120.6586,421,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Pleurovac Unit,,12003035,LOCAL,Facility,Both,,,,421,357.85,120.6586,421,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),252.6,60,,percent of total billed charges,,
Sup Pleurovac Unit,,12003035,LOCAL,Facility,Both,,,,421,357.85,120.6586,421,"Health Partners, Inc.",State of Minnesota Advantage Program,343.115,81.5,,percent of total billed charges,,
Sup Pleurovac Unit,,12003035,LOCAL,Facility,Both,,,,421,357.85,120.6586,421,"Health Partners, Inc.",State Public Programs,210.5,50,,percent of total billed charges,,
Sup Pleurovac Unit,,12003035,LOCAL,Facility,Both,,,,421,357.85,120.6586,421,Humana Insurance Company,Commercial PPO,399.95,95,,percent of total billed charges,,
Sup Pleurovac Unit,,12003035,LOCAL,Facility,Outpatient,,,,421,357.85,120.6586,421,Humana Insurance Company,Medicare PPO,206.29,49,,percent of total billed charges,,
Sup Pleurovac Unit,,12003035,LOCAL,Facility,Inpatient,,,,421,357.85,120.6586,421,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Sup Pleurovac Unit,,12003035,LOCAL,Facility,Both,,,,421,357.85,120.6586,421,Medica,Individual & Family,417.211,99.1,,percent of total billed charges,,
Sup Pleurovac Unit,,12003035,LOCAL,Facility,Outpatient,,,,421,357.85,120.6586,421,Medica,Medica Advantage Solution,209.658,49.8,,percent of total billed charges,,
Sup Pleurovac Unit,,12003035,LOCAL,Facility,Inpatient,,,,421,357.85,120.6586,421,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Sup Pleurovac Unit,,12003035,LOCAL,Facility,Outpatient,,,,421,357.85,120.6586,421,Medica,Medical Assistance,187.766,44.6,,percent of total billed charges,,
Sup Pleurovac Unit,,12003035,LOCAL,Facility,Inpatient,,,,421,357.85,120.6586,421,Medica,Medical Assistance,,,,,Included in per diem rate,
Sup Pleurovac Unit,,12003035,LOCAL,Facility,Outpatient,,,,421,357.85,120.6586,421,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,209.658,49.8,,percent of total billed charges,,
Sup Pleurovac Unit,,12003035,LOCAL,Facility,Inpatient,,,,421,357.85,120.6586,421,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Sup Pleurovac Unit,,12003035,LOCAL,Facility,Both,,,,421,357.85,120.6586,421,"Multiplan, Inc.","Multiplan, Inc.",395.74,94,,percent of total billed charges,,
Sup Pleurovac Unit,,12003035,LOCAL,Facility,Outpatient,,,,421,357.85,120.6586,421,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,379.321,90.1,,percent of total billed charges,,
Sup Pleurovac Unit,,12003035,LOCAL,Facility,Inpatient,,,,421,357.85,120.6586,421,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Sup Pleurovac Unit,,12003035,LOCAL,Facility,Both,,,,421,357.85,120.6586,421,"Preferred One Administrative Services, INC.",PPO,415.106,98.6,,percent of total billed charges,,
Sup Pleurovac Unit,,12003035,LOCAL,Facility,Outpatient,,,,421,357.85,120.6586,421,PrimeWest Health,Minnesota Senior Health Options (MSHO),216.6045,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Sup Pleurovac Unit,,12003035,LOCAL,Facility,Inpatient,,,,421,357.85,120.6586,421,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Pleurovac Unit,,12003035,LOCAL,Facility,Outpatient,,,,421,357.85,120.6586,421,PrimeWest Health,MinnesotaCare,216.2256,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Sup Pleurovac Unit,,12003035,LOCAL,Facility,Inpatient,,,,421,357.85,120.6586,421,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Sup Pleurovac Unit,,12003035,LOCAL,Facility,Both,,,,421,357.85,120.6586,421,Sanford Health Plan,Sanford Health Plan,387.32,92,,percent of total billed charges,,
Sup Pleurovac Unit,,12003035,LOCAL,Facility,Outpatient,,,,421,357.85,120.6586,421,"UCare Health, Inc.",Individual & Family Plan,237.2335,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Sup Pleurovac Unit,,12003035,LOCAL,Facility,Inpatient,,,,421,357.85,120.6586,421,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Sup Pleurovac Unit,,12003035,LOCAL,Facility,Outpatient,,,,421,357.85,120.6586,421,"UCare Health, Inc.",Medical Assistance,212.4787,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Pleurovac Unit,,12003035,LOCAL,Facility,Inpatient,,,,421,357.85,120.6586,421,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Sup Pleurovac Unit,,12003035,LOCAL,Facility,Outpatient,,,,421,357.85,120.6586,421,"UCare Health, Inc.",Medicare Advantage,212.4787,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Pleurovac Unit,,12003035,LOCAL,Facility,Inpatient,,,,421,357.85,120.6586,421,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Pleurovac Unit,,12003035,LOCAL,Facility,Outpatient,,,,421,357.85,120.6586,421,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),212.4787,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Pleurovac Unit,,12003035,LOCAL,Facility,Inpatient,,,,421,357.85,120.6586,421,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Pleurovac Unit,,12003035,LOCAL,Facility,Both,,,,421,357.85,120.6586,421,UnitedHealthcare,Individual & Family,395.74,94,,percent of total billed charges,,
Sup Pleurovac Unit,,12003035,LOCAL,Facility,Outpatient,,,,421,357.85,120.6586,421,UnitedHealthcare,Medicare Advantage,206.29,49,,percent of total billed charges,,
Sup Pleurovac Unit,,12003035,LOCAL,Facility,Inpatient,,,,421,357.85,120.6586,421,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Sup Pleurovac Unit,,12003035,LOCAL,Facility,Outpatient,,,,421,357.85,120.6586,421,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,202.08,48,,percent of total billed charges,,100% of DHS outpatient percentage
Sup Pleurovac Unit,,12003035,LOCAL,Facility,Inpatient,,,,421,357.85,120.6586,421,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Sup Stiff Neck Cervical Collar,,12003428,LOCAL,Facility,Both,,,,95,80.75,27.227,95,Aetna,Commercial,87.4,92,,percent of total billed charges,,
Sup Stiff Neck Cervical Collar,,12003428,LOCAL,Facility,Outpatient,,,,95,80.75,27.227,95,Aetna,Medicare Advantage,46.55,49,,percent of total billed charges,,
Sup Stiff Neck Cervical Collar,,12003428,LOCAL,Facility,Inpatient,,,,95,80.75,27.227,95,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Sup Stiff Neck Cervical Collar,,12003428,LOCAL,Facility,Both,,,,95,80.75,27.227,95,Aetna,PPO,88.35,93,,percent of total billed charges,,
Sup Stiff Neck Cervical Collar,,12003428,LOCAL,Facility,Both,,,,95,80.75,27.227,95,America's PPO,America's PPO,91.2285,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Sup Stiff Neck Cervical Collar,,12003428,LOCAL,Facility,Both,,,,95,80.75,27.227,95,BlueCross BlueShield Minnesota, Federal Employee Program,93.48,98.4,,percent of total billed charges,,
Sup Stiff Neck Cervical Collar,,12003428,LOCAL,Facility,Both,,,,95,80.75,27.227,95,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,95,100,,percent of total billed charges,,
Sup Stiff Neck Cervical Collar,,12003428,LOCAL,Facility,Both,,,,95,80.75,27.227,95,BlueCross BlueShield Minnesota,High Value Network Plan,85.5,90,,percent of total billed charges,,
Sup Stiff Neck Cervical Collar,,12003428,LOCAL,Facility,Outpatient,,,,95,80.75,27.227,95,BlueCross BlueShield Minnesota,Medicare Advantage,46.55,49,,percent of total billed charges,,
Sup Stiff Neck Cervical Collar,,12003428,LOCAL,Facility,Inpatient,,,,95,80.75,27.227,95,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Sup Stiff Neck Cervical Collar,,12003428,LOCAL,Facility,Both,,,,95,80.75,27.227,95,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,84.1415,88.57,,percent of total billed charges,,
Sup Stiff Neck Cervical Collar,,12003428,LOCAL,Facility,Both,,,,95,80.75,27.227,95,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,27.227,28.66,,percent of total billed charges,,
Sup Stiff Neck Cervical Collar,,12003428,LOCAL,Facility,Outpatient,,,,95,80.75,27.227,95,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),46.55,49,,percent of total billed charges,,
Sup Stiff Neck Cervical Collar,,12003428,LOCAL,Facility,Inpatient,,,,95,80.75,27.227,95,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Sup Stiff Neck Cervical Collar,,12003428,LOCAL,Facility,Both,,,,95,80.75,27.227,95,CorVel,Worker's Compensation,95,100,,percent of total billed charges,,
Sup Stiff Neck Cervical Collar,,12003428,LOCAL,Facility,Both,,,,95,80.75,27.227,95,First Health Group Corporation,First Health Network,92.15,97,,percent of total billed charges,,
Sup Stiff Neck Cervical Collar,,12003428,LOCAL,Facility,Both,,,,95,80.75,27.227,95,"Health Partners, Inc.",Commercial,89.87,94.6,,percent of total billed charges,,
Sup Stiff Neck Cervical Collar,,12003428,LOCAL,Facility,Outpatient,,,,95,80.75,27.227,95,"Health Partners, Inc.",Medicare Advantage,46.55,49,,percent of total billed charges,,
Sup Stiff Neck Cervical Collar,,12003428,LOCAL,Facility,Inpatient,,,,95,80.75,27.227,95,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Stiff Neck Cervical Collar,,12003428,LOCAL,Facility,Both,,,,95,80.75,27.227,95,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),57,60,,percent of total billed charges,,
Sup Stiff Neck Cervical Collar,,12003428,LOCAL,Facility,Both,,,,95,80.75,27.227,95,"Health Partners, Inc.",State of Minnesota Advantage Program,77.425,81.5,,percent of total billed charges,,
Sup Stiff Neck Cervical Collar,,12003428,LOCAL,Facility,Both,,,,95,80.75,27.227,95,"Health Partners, Inc.",State Public Programs,47.5,50,,percent of total billed charges,,
Sup Stiff Neck Cervical Collar,,12003428,LOCAL,Facility,Both,,,,95,80.75,27.227,95,Humana Insurance Company,Commercial PPO,90.25,95,,percent of total billed charges,,
Sup Stiff Neck Cervical Collar,,12003428,LOCAL,Facility,Outpatient,,,,95,80.75,27.227,95,Humana Insurance Company,Medicare PPO,46.55,49,,percent of total billed charges,,
Sup Stiff Neck Cervical Collar,,12003428,LOCAL,Facility,Inpatient,,,,95,80.75,27.227,95,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Sup Stiff Neck Cervical Collar,,12003428,LOCAL,Facility,Both,,,,95,80.75,27.227,95,Medica,Individual & Family,94.145,99.1,,percent of total billed charges,,
Sup Stiff Neck Cervical Collar,,12003428,LOCAL,Facility,Outpatient,,,,95,80.75,27.227,95,Medica,Medica Advantage Solution,47.31,49.8,,percent of total billed charges,,
Sup Stiff Neck Cervical Collar,,12003428,LOCAL,Facility,Inpatient,,,,95,80.75,27.227,95,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Sup Stiff Neck Cervical Collar,,12003428,LOCAL,Facility,Outpatient,,,,95,80.75,27.227,95,Medica,Medical Assistance,42.37,44.6,,percent of total billed charges,,
Sup Stiff Neck Cervical Collar,,12003428,LOCAL,Facility,Inpatient,,,,95,80.75,27.227,95,Medica,Medical Assistance,,,,,Included in per diem rate,
Sup Stiff Neck Cervical Collar,,12003428,LOCAL,Facility,Outpatient,,,,95,80.75,27.227,95,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,47.31,49.8,,percent of total billed charges,,
Sup Stiff Neck Cervical Collar,,12003428,LOCAL,Facility,Inpatient,,,,95,80.75,27.227,95,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Sup Stiff Neck Cervical Collar,,12003428,LOCAL,Facility,Both,,,,95,80.75,27.227,95,"Multiplan, Inc.","Multiplan, Inc.",89.3,94,,percent of total billed charges,,
Sup Stiff Neck Cervical Collar,,12003428,LOCAL,Facility,Outpatient,,,,95,80.75,27.227,95,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,85.595,90.1,,percent of total billed charges,,
Sup Stiff Neck Cervical Collar,,12003428,LOCAL,Facility,Inpatient,,,,95,80.75,27.227,95,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Sup Stiff Neck Cervical Collar,,12003428,LOCAL,Facility,Both,,,,95,80.75,27.227,95,"Preferred One Administrative Services, INC.",PPO,93.67,98.6,,percent of total billed charges,,
Sup Stiff Neck Cervical Collar,,12003428,LOCAL,Facility,Outpatient,,,,95,80.75,27.227,95,PrimeWest Health,Minnesota Senior Health Options (MSHO),48.8775,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Sup Stiff Neck Cervical Collar,,12003428,LOCAL,Facility,Inpatient,,,,95,80.75,27.227,95,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Stiff Neck Cervical Collar,,12003428,LOCAL,Facility,Outpatient,,,,95,80.75,27.227,95,PrimeWest Health,MinnesotaCare,48.792,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Sup Stiff Neck Cervical Collar,,12003428,LOCAL,Facility,Inpatient,,,,95,80.75,27.227,95,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Sup Stiff Neck Cervical Collar,,12003428,LOCAL,Facility,Both,,,,95,80.75,27.227,95,Sanford Health Plan,Sanford Health Plan,87.4,92,,percent of total billed charges,,
Sup Stiff Neck Cervical Collar,,12003428,LOCAL,Facility,Outpatient,,,,95,80.75,27.227,95,"UCare Health, Inc.",Individual & Family Plan,53.5325,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Sup Stiff Neck Cervical Collar,,12003428,LOCAL,Facility,Inpatient,,,,95,80.75,27.227,95,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Sup Stiff Neck Cervical Collar,,12003428,LOCAL,Facility,Outpatient,,,,95,80.75,27.227,95,"UCare Health, Inc.",Medical Assistance,47.9465,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Stiff Neck Cervical Collar,,12003428,LOCAL,Facility,Inpatient,,,,95,80.75,27.227,95,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Sup Stiff Neck Cervical Collar,,12003428,LOCAL,Facility,Outpatient,,,,95,80.75,27.227,95,"UCare Health, Inc.",Medicare Advantage,47.9465,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Stiff Neck Cervical Collar,,12003428,LOCAL,Facility,Inpatient,,,,95,80.75,27.227,95,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Stiff Neck Cervical Collar,,12003428,LOCAL,Facility,Outpatient,,,,95,80.75,27.227,95,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),47.9465,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Stiff Neck Cervical Collar,,12003428,LOCAL,Facility,Inpatient,,,,95,80.75,27.227,95,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Stiff Neck Cervical Collar,,12003428,LOCAL,Facility,Both,,,,95,80.75,27.227,95,UnitedHealthcare,Individual & Family,89.3,94,,percent of total billed charges,,
Sup Stiff Neck Cervical Collar,,12003428,LOCAL,Facility,Outpatient,,,,95,80.75,27.227,95,UnitedHealthcare,Medicare Advantage,46.55,49,,percent of total billed charges,,
Sup Stiff Neck Cervical Collar,,12003428,LOCAL,Facility,Inpatient,,,,95,80.75,27.227,95,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Sup Stiff Neck Cervical Collar,,12003428,LOCAL,Facility,Outpatient,,,,95,80.75,27.227,95,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,45.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
Sup Stiff Neck Cervical Collar,,12003428,LOCAL,Facility,Inpatient,,,,95,80.75,27.227,95,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Sup Oxygen (Daily Charge),,12004296,LOCAL,Facility,Both,,,,200,170,57.32,200,Aetna,Commercial,184,92,,percent of total billed charges,,
Sup Oxygen (Daily Charge),,12004296,LOCAL,Facility,Outpatient,,,,200,170,57.32,200,Aetna,Medicare Advantage,98,49,,percent of total billed charges,,
Sup Oxygen (Daily Charge),,12004296,LOCAL,Facility,Inpatient,,,,200,170,57.32,200,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Sup Oxygen (Daily Charge),,12004296,LOCAL,Facility,Both,,,,200,170,57.32,200,Aetna,PPO,186,93,,percent of total billed charges,,
Sup Oxygen (Daily Charge),,12004296,LOCAL,Facility,Both,,,,200,170,57.32,200,America's PPO,America's PPO,192.06,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Sup Oxygen (Daily Charge),,12004296,LOCAL,Facility,Both,,,,200,170,57.32,200,BlueCross BlueShield Minnesota, Federal Employee Program,196.8,98.4,,percent of total billed charges,,
Sup Oxygen (Daily Charge),,12004296,LOCAL,Facility,Both,,,,200,170,57.32,200,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,200,100,,percent of total billed charges,,
Sup Oxygen (Daily Charge),,12004296,LOCAL,Facility,Both,,,,200,170,57.32,200,BlueCross BlueShield Minnesota,High Value Network Plan,180,90,,percent of total billed charges,,
Sup Oxygen (Daily Charge),,12004296,LOCAL,Facility,Outpatient,,,,200,170,57.32,200,BlueCross BlueShield Minnesota,Medicare Advantage,98,49,,percent of total billed charges,,
Sup Oxygen (Daily Charge),,12004296,LOCAL,Facility,Inpatient,,,,200,170,57.32,200,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Sup Oxygen (Daily Charge),,12004296,LOCAL,Facility,Both,,,,200,170,57.32,200,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,177.14,88.57,,percent of total billed charges,,
Sup Oxygen (Daily Charge),,12004296,LOCAL,Facility,Both,,,,200,170,57.32,200,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,57.32,28.66,,percent of total billed charges,,
Sup Oxygen (Daily Charge),,12004296,LOCAL,Facility,Outpatient,,,,200,170,57.32,200,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),98,49,,percent of total billed charges,,
Sup Oxygen (Daily Charge),,12004296,LOCAL,Facility,Inpatient,,,,200,170,57.32,200,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Sup Oxygen (Daily Charge),,12004296,LOCAL,Facility,Both,,,,200,170,57.32,200,CorVel,Worker's Compensation,200,100,,percent of total billed charges,,
Sup Oxygen (Daily Charge),,12004296,LOCAL,Facility,Both,,,,200,170,57.32,200,First Health Group Corporation,First Health Network,194,97,,percent of total billed charges,,
Sup Oxygen (Daily Charge),,12004296,LOCAL,Facility,Both,,,,200,170,57.32,200,"Health Partners, Inc.",Commercial,189.2,94.6,,percent of total billed charges,,
Sup Oxygen (Daily Charge),,12004296,LOCAL,Facility,Outpatient,,,,200,170,57.32,200,"Health Partners, Inc.",Medicare Advantage,98,49,,percent of total billed charges,,
Sup Oxygen (Daily Charge),,12004296,LOCAL,Facility,Inpatient,,,,200,170,57.32,200,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Oxygen (Daily Charge),,12004296,LOCAL,Facility,Both,,,,200,170,57.32,200,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),120,60,,percent of total billed charges,,
Sup Oxygen (Daily Charge),,12004296,LOCAL,Facility,Both,,,,200,170,57.32,200,"Health Partners, Inc.",State of Minnesota Advantage Program,163,81.5,,percent of total billed charges,,
Sup Oxygen (Daily Charge),,12004296,LOCAL,Facility,Both,,,,200,170,57.32,200,"Health Partners, Inc.",State Public Programs,100,50,,percent of total billed charges,,
Sup Oxygen (Daily Charge),,12004296,LOCAL,Facility,Both,,,,200,170,57.32,200,Humana Insurance Company,Commercial PPO,190,95,,percent of total billed charges,,
Sup Oxygen (Daily Charge),,12004296,LOCAL,Facility,Outpatient,,,,200,170,57.32,200,Humana Insurance Company,Medicare PPO,98,49,,percent of total billed charges,,
Sup Oxygen (Daily Charge),,12004296,LOCAL,Facility,Inpatient,,,,200,170,57.32,200,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Sup Oxygen (Daily Charge),,12004296,LOCAL,Facility,Both,,,,200,170,57.32,200,Medica,Individual & Family,198.2,99.1,,percent of total billed charges,,
Sup Oxygen (Daily Charge),,12004296,LOCAL,Facility,Outpatient,,,,200,170,57.32,200,Medica,Medica Advantage Solution,99.6,49.8,,percent of total billed charges,,
Sup Oxygen (Daily Charge),,12004296,LOCAL,Facility,Inpatient,,,,200,170,57.32,200,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Sup Oxygen (Daily Charge),,12004296,LOCAL,Facility,Outpatient,,,,200,170,57.32,200,Medica,Medical Assistance,89.2,44.6,,percent of total billed charges,,
Sup Oxygen (Daily Charge),,12004296,LOCAL,Facility,Inpatient,,,,200,170,57.32,200,Medica,Medical Assistance,,,,,Included in per diem rate,
Sup Oxygen (Daily Charge),,12004296,LOCAL,Facility,Outpatient,,,,200,170,57.32,200,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,99.6,49.8,,percent of total billed charges,,
Sup Oxygen (Daily Charge),,12004296,LOCAL,Facility,Inpatient,,,,200,170,57.32,200,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Sup Oxygen (Daily Charge),,12004296,LOCAL,Facility,Both,,,,200,170,57.32,200,"Multiplan, Inc.","Multiplan, Inc.",188,94,,percent of total billed charges,,
Sup Oxygen (Daily Charge),,12004296,LOCAL,Facility,Outpatient,,,,200,170,57.32,200,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,180.2,90.1,,percent of total billed charges,,
Sup Oxygen (Daily Charge),,12004296,LOCAL,Facility,Inpatient,,,,200,170,57.32,200,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Sup Oxygen (Daily Charge),,12004296,LOCAL,Facility,Both,,,,200,170,57.32,200,"Preferred One Administrative Services, INC.",PPO,197.2,98.6,,percent of total billed charges,,
Sup Oxygen (Daily Charge),,12004296,LOCAL,Facility,Outpatient,,,,200,170,57.32,200,PrimeWest Health,Minnesota Senior Health Options (MSHO),102.9,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Sup Oxygen (Daily Charge),,12004296,LOCAL,Facility,Inpatient,,,,200,170,57.32,200,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Oxygen (Daily Charge),,12004296,LOCAL,Facility,Outpatient,,,,200,170,57.32,200,PrimeWest Health,MinnesotaCare,102.72,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Sup Oxygen (Daily Charge),,12004296,LOCAL,Facility,Inpatient,,,,200,170,57.32,200,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Sup Oxygen (Daily Charge),,12004296,LOCAL,Facility,Both,,,,200,170,57.32,200,Sanford Health Plan,Sanford Health Plan,184,92,,percent of total billed charges,,
Sup Oxygen (Daily Charge),,12004296,LOCAL,Facility,Outpatient,,,,200,170,57.32,200,"UCare Health, Inc.",Individual & Family Plan,112.7,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Sup Oxygen (Daily Charge),,12004296,LOCAL,Facility,Inpatient,,,,200,170,57.32,200,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Sup Oxygen (Daily Charge),,12004296,LOCAL,Facility,Outpatient,,,,200,170,57.32,200,"UCare Health, Inc.",Medical Assistance,100.94,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Oxygen (Daily Charge),,12004296,LOCAL,Facility,Inpatient,,,,200,170,57.32,200,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Sup Oxygen (Daily Charge),,12004296,LOCAL,Facility,Outpatient,,,,200,170,57.32,200,"UCare Health, Inc.",Medicare Advantage,100.94,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Oxygen (Daily Charge),,12004296,LOCAL,Facility,Inpatient,,,,200,170,57.32,200,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Oxygen (Daily Charge),,12004296,LOCAL,Facility,Outpatient,,,,200,170,57.32,200,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),100.94,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Oxygen (Daily Charge),,12004296,LOCAL,Facility,Inpatient,,,,200,170,57.32,200,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Oxygen (Daily Charge),,12004296,LOCAL,Facility,Both,,,,200,170,57.32,200,UnitedHealthcare,Individual & Family,188,94,,percent of total billed charges,,
Sup Oxygen (Daily Charge),,12004296,LOCAL,Facility,Outpatient,,,,200,170,57.32,200,UnitedHealthcare,Medicare Advantage,98,49,,percent of total billed charges,,
Sup Oxygen (Daily Charge),,12004296,LOCAL,Facility,Inpatient,,,,200,170,57.32,200,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Sup Oxygen (Daily Charge),,12004296,LOCAL,Facility,Outpatient,,,,200,170,57.32,200,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,96,48,,percent of total billed charges,,100% of DHS outpatient percentage
Sup Oxygen (Daily Charge),,12004296,LOCAL,Facility,Inpatient,,,,200,170,57.32,200,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Sup Ted Thigh Med, Reg, Long",,12004358,LOCAL,Facility,Both,,,,36,30.6,10.3176,36,Aetna,Commercial,33.12,92,,percent of total billed charges,,
"Sup Ted Thigh Med, Reg, Long",,12004358,LOCAL,Facility,Outpatient,,,,36,30.6,10.3176,36,Aetna,Medicare Advantage,17.64,49,,percent of total billed charges,,
"Sup Ted Thigh Med, Reg, Long",,12004358,LOCAL,Facility,Inpatient,,,,36,30.6,10.3176,36,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Sup Ted Thigh Med, Reg, Long",,12004358,LOCAL,Facility,Both,,,,36,30.6,10.3176,36,Aetna,PPO,33.48,93,,percent of total billed charges,,
"Sup Ted Thigh Med, Reg, Long",,12004358,LOCAL,Facility,Both,,,,36,30.6,10.3176,36,America's PPO,America's PPO,34.5708,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Sup Ted Thigh Med, Reg, Long",,12004358,LOCAL,Facility,Both,,,,36,30.6,10.3176,36,BlueCross BlueShield Minnesota, Federal Employee Program,35.424,98.4,,percent of total billed charges,,
"Sup Ted Thigh Med, Reg, Long",,12004358,LOCAL,Facility,Both,,,,36,30.6,10.3176,36,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,36,100,,percent of total billed charges,,
"Sup Ted Thigh Med, Reg, Long",,12004358,LOCAL,Facility,Both,,,,36,30.6,10.3176,36,BlueCross BlueShield Minnesota,High Value Network Plan,32.4,90,,percent of total billed charges,,
"Sup Ted Thigh Med, Reg, Long",,12004358,LOCAL,Facility,Outpatient,,,,36,30.6,10.3176,36,BlueCross BlueShield Minnesota,Medicare Advantage,17.64,49,,percent of total billed charges,,
"Sup Ted Thigh Med, Reg, Long",,12004358,LOCAL,Facility,Inpatient,,,,36,30.6,10.3176,36,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Sup Ted Thigh Med, Reg, Long",,12004358,LOCAL,Facility,Both,,,,36,30.6,10.3176,36,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,31.8852,88.57,,percent of total billed charges,,
"Sup Ted Thigh Med, Reg, Long",,12004358,LOCAL,Facility,Both,,,,36,30.6,10.3176,36,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,10.3176,28.66,,percent of total billed charges,,
"Sup Ted Thigh Med, Reg, Long",,12004358,LOCAL,Facility,Outpatient,,,,36,30.6,10.3176,36,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),17.64,49,,percent of total billed charges,,
"Sup Ted Thigh Med, Reg, Long",,12004358,LOCAL,Facility,Inpatient,,,,36,30.6,10.3176,36,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Sup Ted Thigh Med, Reg, Long",,12004358,LOCAL,Facility,Both,,,,36,30.6,10.3176,36,CorVel,Worker's Compensation,36,100,,percent of total billed charges,,
"Sup Ted Thigh Med, Reg, Long",,12004358,LOCAL,Facility,Both,,,,36,30.6,10.3176,36,First Health Group Corporation,First Health Network,34.92,97,,percent of total billed charges,,
"Sup Ted Thigh Med, Reg, Long",,12004358,LOCAL,Facility,Both,,,,36,30.6,10.3176,36,"Health Partners, Inc.",Commercial,34.056,94.6,,percent of total billed charges,,
"Sup Ted Thigh Med, Reg, Long",,12004358,LOCAL,Facility,Outpatient,,,,36,30.6,10.3176,36,"Health Partners, Inc.",Medicare Advantage,17.64,49,,percent of total billed charges,,
"Sup Ted Thigh Med, Reg, Long",,12004358,LOCAL,Facility,Inpatient,,,,36,30.6,10.3176,36,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Sup Ted Thigh Med, Reg, Long",,12004358,LOCAL,Facility,Both,,,,36,30.6,10.3176,36,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),21.6,60,,percent of total billed charges,,
"Sup Ted Thigh Med, Reg, Long",,12004358,LOCAL,Facility,Both,,,,36,30.6,10.3176,36,"Health Partners, Inc.",State of Minnesota Advantage Program,29.34,81.5,,percent of total billed charges,,
"Sup Ted Thigh Med, Reg, Long",,12004358,LOCAL,Facility,Both,,,,36,30.6,10.3176,36,"Health Partners, Inc.",State Public Programs,18,50,,percent of total billed charges,,
"Sup Ted Thigh Med, Reg, Long",,12004358,LOCAL,Facility,Both,,,,36,30.6,10.3176,36,Humana Insurance Company,Commercial PPO,34.2,95,,percent of total billed charges,,
"Sup Ted Thigh Med, Reg, Long",,12004358,LOCAL,Facility,Outpatient,,,,36,30.6,10.3176,36,Humana Insurance Company,Medicare PPO,17.64,49,,percent of total billed charges,,
"Sup Ted Thigh Med, Reg, Long",,12004358,LOCAL,Facility,Inpatient,,,,36,30.6,10.3176,36,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Sup Ted Thigh Med, Reg, Long",,12004358,LOCAL,Facility,Both,,,,36,30.6,10.3176,36,Medica,Individual & Family,35.676,99.1,,percent of total billed charges,,
"Sup Ted Thigh Med, Reg, Long",,12004358,LOCAL,Facility,Outpatient,,,,36,30.6,10.3176,36,Medica,Medica Advantage Solution,17.928,49.8,,percent of total billed charges,,
"Sup Ted Thigh Med, Reg, Long",,12004358,LOCAL,Facility,Inpatient,,,,36,30.6,10.3176,36,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Sup Ted Thigh Med, Reg, Long",,12004358,LOCAL,Facility,Outpatient,,,,36,30.6,10.3176,36,Medica,Medical Assistance,16.056,44.6,,percent of total billed charges,,
"Sup Ted Thigh Med, Reg, Long",,12004358,LOCAL,Facility,Inpatient,,,,36,30.6,10.3176,36,Medica,Medical Assistance,,,,,Included in per diem rate,
"Sup Ted Thigh Med, Reg, Long",,12004358,LOCAL,Facility,Outpatient,,,,36,30.6,10.3176,36,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,17.928,49.8,,percent of total billed charges,,
"Sup Ted Thigh Med, Reg, Long",,12004358,LOCAL,Facility,Inpatient,,,,36,30.6,10.3176,36,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Sup Ted Thigh Med, Reg, Long",,12004358,LOCAL,Facility,Both,,,,36,30.6,10.3176,36,"Multiplan, Inc.","Multiplan, Inc.",33.84,94,,percent of total billed charges,,
"Sup Ted Thigh Med, Reg, Long",,12004358,LOCAL,Facility,Outpatient,,,,36,30.6,10.3176,36,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,32.436,90.1,,percent of total billed charges,,
"Sup Ted Thigh Med, Reg, Long",,12004358,LOCAL,Facility,Inpatient,,,,36,30.6,10.3176,36,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Sup Ted Thigh Med, Reg, Long",,12004358,LOCAL,Facility,Both,,,,36,30.6,10.3176,36,"Preferred One Administrative Services, INC.",PPO,35.496,98.6,,percent of total billed charges,,
"Sup Ted Thigh Med, Reg, Long",,12004358,LOCAL,Facility,Outpatient,,,,36,30.6,10.3176,36,PrimeWest Health,Minnesota Senior Health Options (MSHO),18.522,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Sup Ted Thigh Med, Reg, Long",,12004358,LOCAL,Facility,Inpatient,,,,36,30.6,10.3176,36,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Sup Ted Thigh Med, Reg, Long",,12004358,LOCAL,Facility,Outpatient,,,,36,30.6,10.3176,36,PrimeWest Health,MinnesotaCare,18.4896,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Sup Ted Thigh Med, Reg, Long",,12004358,LOCAL,Facility,Inpatient,,,,36,30.6,10.3176,36,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Sup Ted Thigh Med, Reg, Long",,12004358,LOCAL,Facility,Both,,,,36,30.6,10.3176,36,Sanford Health Plan,Sanford Health Plan,33.12,92,,percent of total billed charges,,
"Sup Ted Thigh Med, Reg, Long",,12004358,LOCAL,Facility,Outpatient,,,,36,30.6,10.3176,36,"UCare Health, Inc.",Individual & Family Plan,20.286,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Sup Ted Thigh Med, Reg, Long",,12004358,LOCAL,Facility,Inpatient,,,,36,30.6,10.3176,36,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Sup Ted Thigh Med, Reg, Long",,12004358,LOCAL,Facility,Outpatient,,,,36,30.6,10.3176,36,"UCare Health, Inc.",Medical Assistance,18.1692,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Sup Ted Thigh Med, Reg, Long",,12004358,LOCAL,Facility,Inpatient,,,,36,30.6,10.3176,36,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Sup Ted Thigh Med, Reg, Long",,12004358,LOCAL,Facility,Outpatient,,,,36,30.6,10.3176,36,"UCare Health, Inc.",Medicare Advantage,18.1692,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Sup Ted Thigh Med, Reg, Long",,12004358,LOCAL,Facility,Inpatient,,,,36,30.6,10.3176,36,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Sup Ted Thigh Med, Reg, Long",,12004358,LOCAL,Facility,Outpatient,,,,36,30.6,10.3176,36,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),18.1692,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Sup Ted Thigh Med, Reg, Long",,12004358,LOCAL,Facility,Inpatient,,,,36,30.6,10.3176,36,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Sup Ted Thigh Med, Reg, Long",,12004358,LOCAL,Facility,Both,,,,36,30.6,10.3176,36,UnitedHealthcare,Individual & Family,33.84,94,,percent of total billed charges,,
"Sup Ted Thigh Med, Reg, Long",,12004358,LOCAL,Facility,Outpatient,,,,36,30.6,10.3176,36,UnitedHealthcare,Medicare Advantage,17.64,49,,percent of total billed charges,,
"Sup Ted Thigh Med, Reg, Long",,12004358,LOCAL,Facility,Inpatient,,,,36,30.6,10.3176,36,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Sup Ted Thigh Med, Reg, Long",,12004358,LOCAL,Facility,Outpatient,,,,36,30.6,10.3176,36,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,17.28,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Sup Ted Thigh Med, Reg, Long",,12004358,LOCAL,Facility,Inpatient,,,,36,30.6,10.3176,36,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Sup Cath Thoracic,,12008218,LOCAL,Facility,Both,,,,51,43.35,14.6166,51,Aetna,Commercial,46.92,92,,percent of total billed charges,,
Sup Cath Thoracic,,12008218,LOCAL,Facility,Outpatient,,,,51,43.35,14.6166,51,Aetna,Medicare Advantage,24.99,49,,percent of total billed charges,,
Sup Cath Thoracic,,12008218,LOCAL,Facility,Inpatient,,,,51,43.35,14.6166,51,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Sup Cath Thoracic,,12008218,LOCAL,Facility,Both,,,,51,43.35,14.6166,51,Aetna,PPO,47.43,93,,percent of total billed charges,,
Sup Cath Thoracic,,12008218,LOCAL,Facility,Both,,,,51,43.35,14.6166,51,America's PPO,America's PPO,48.9753,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Sup Cath Thoracic,,12008218,LOCAL,Facility,Both,,,,51,43.35,14.6166,51,BlueCross BlueShield Minnesota, Federal Employee Program,50.184,98.4,,percent of total billed charges,,
Sup Cath Thoracic,,12008218,LOCAL,Facility,Both,,,,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,51,100,,percent of total billed charges,,
Sup Cath Thoracic,,12008218,LOCAL,Facility,Both,,,,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,High Value Network Plan,45.9,90,,percent of total billed charges,,
Sup Cath Thoracic,,12008218,LOCAL,Facility,Outpatient,,,,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,Medicare Advantage,24.99,49,,percent of total billed charges,,
Sup Cath Thoracic,,12008218,LOCAL,Facility,Inpatient,,,,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Sup Cath Thoracic,,12008218,LOCAL,Facility,Both,,,,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,45.1707,88.57,,percent of total billed charges,,
Sup Cath Thoracic,,12008218,LOCAL,Facility,Both,,,,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,14.6166,28.66,,percent of total billed charges,,
Sup Cath Thoracic,,12008218,LOCAL,Facility,Outpatient,,,,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),24.99,49,,percent of total billed charges,,
Sup Cath Thoracic,,12008218,LOCAL,Facility,Inpatient,,,,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Sup Cath Thoracic,,12008218,LOCAL,Facility,Both,,,,51,43.35,14.6166,51,CorVel,Worker's Compensation,51,100,,percent of total billed charges,,
Sup Cath Thoracic,,12008218,LOCAL,Facility,Both,,,,51,43.35,14.6166,51,First Health Group Corporation,First Health Network,49.47,97,,percent of total billed charges,,
Sup Cath Thoracic,,12008218,LOCAL,Facility,Both,,,,51,43.35,14.6166,51,"Health Partners, Inc.",Commercial,48.246,94.6,,percent of total billed charges,,
Sup Cath Thoracic,,12008218,LOCAL,Facility,Outpatient,,,,51,43.35,14.6166,51,"Health Partners, Inc.",Medicare Advantage,24.99,49,,percent of total billed charges,,
Sup Cath Thoracic,,12008218,LOCAL,Facility,Inpatient,,,,51,43.35,14.6166,51,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Cath Thoracic,,12008218,LOCAL,Facility,Both,,,,51,43.35,14.6166,51,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),30.6,60,,percent of total billed charges,,
Sup Cath Thoracic,,12008218,LOCAL,Facility,Both,,,,51,43.35,14.6166,51,"Health Partners, Inc.",State of Minnesota Advantage Program,41.565,81.5,,percent of total billed charges,,
Sup Cath Thoracic,,12008218,LOCAL,Facility,Both,,,,51,43.35,14.6166,51,"Health Partners, Inc.",State Public Programs,25.5,50,,percent of total billed charges,,
Sup Cath Thoracic,,12008218,LOCAL,Facility,Both,,,,51,43.35,14.6166,51,Humana Insurance Company,Commercial PPO,48.45,95,,percent of total billed charges,,
Sup Cath Thoracic,,12008218,LOCAL,Facility,Outpatient,,,,51,43.35,14.6166,51,Humana Insurance Company,Medicare PPO,24.99,49,,percent of total billed charges,,
Sup Cath Thoracic,,12008218,LOCAL,Facility,Inpatient,,,,51,43.35,14.6166,51,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Sup Cath Thoracic,,12008218,LOCAL,Facility,Both,,,,51,43.35,14.6166,51,Medica,Individual & Family,50.541,99.1,,percent of total billed charges,,
Sup Cath Thoracic,,12008218,LOCAL,Facility,Outpatient,,,,51,43.35,14.6166,51,Medica,Medica Advantage Solution,25.398,49.8,,percent of total billed charges,,
Sup Cath Thoracic,,12008218,LOCAL,Facility,Inpatient,,,,51,43.35,14.6166,51,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Sup Cath Thoracic,,12008218,LOCAL,Facility,Outpatient,,,,51,43.35,14.6166,51,Medica,Medical Assistance,22.746,44.6,,percent of total billed charges,,
Sup Cath Thoracic,,12008218,LOCAL,Facility,Inpatient,,,,51,43.35,14.6166,51,Medica,Medical Assistance,,,,,Included in per diem rate,
Sup Cath Thoracic,,12008218,LOCAL,Facility,Outpatient,,,,51,43.35,14.6166,51,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,25.398,49.8,,percent of total billed charges,,
Sup Cath Thoracic,,12008218,LOCAL,Facility,Inpatient,,,,51,43.35,14.6166,51,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Sup Cath Thoracic,,12008218,LOCAL,Facility,Both,,,,51,43.35,14.6166,51,"Multiplan, Inc.","Multiplan, Inc.",47.94,94,,percent of total billed charges,,
Sup Cath Thoracic,,12008218,LOCAL,Facility,Outpatient,,,,51,43.35,14.6166,51,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,45.951,90.1,,percent of total billed charges,,
Sup Cath Thoracic,,12008218,LOCAL,Facility,Inpatient,,,,51,43.35,14.6166,51,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Sup Cath Thoracic,,12008218,LOCAL,Facility,Both,,,,51,43.35,14.6166,51,"Preferred One Administrative Services, INC.",PPO,50.286,98.6,,percent of total billed charges,,
Sup Cath Thoracic,,12008218,LOCAL,Facility,Outpatient,,,,51,43.35,14.6166,51,PrimeWest Health,Minnesota Senior Health Options (MSHO),26.2395,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Sup Cath Thoracic,,12008218,LOCAL,Facility,Inpatient,,,,51,43.35,14.6166,51,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Cath Thoracic,,12008218,LOCAL,Facility,Outpatient,,,,51,43.35,14.6166,51,PrimeWest Health,MinnesotaCare,26.1936,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Sup Cath Thoracic,,12008218,LOCAL,Facility,Inpatient,,,,51,43.35,14.6166,51,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Sup Cath Thoracic,,12008218,LOCAL,Facility,Both,,,,51,43.35,14.6166,51,Sanford Health Plan,Sanford Health Plan,46.92,92,,percent of total billed charges,,
Sup Cath Thoracic,,12008218,LOCAL,Facility,Outpatient,,,,51,43.35,14.6166,51,"UCare Health, Inc.",Individual & Family Plan,28.7385,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Sup Cath Thoracic,,12008218,LOCAL,Facility,Inpatient,,,,51,43.35,14.6166,51,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Sup Cath Thoracic,,12008218,LOCAL,Facility,Outpatient,,,,51,43.35,14.6166,51,"UCare Health, Inc.",Medical Assistance,25.7397,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Cath Thoracic,,12008218,LOCAL,Facility,Inpatient,,,,51,43.35,14.6166,51,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Sup Cath Thoracic,,12008218,LOCAL,Facility,Outpatient,,,,51,43.35,14.6166,51,"UCare Health, Inc.",Medicare Advantage,25.7397,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Cath Thoracic,,12008218,LOCAL,Facility,Inpatient,,,,51,43.35,14.6166,51,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Cath Thoracic,,12008218,LOCAL,Facility,Outpatient,,,,51,43.35,14.6166,51,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),25.7397,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Cath Thoracic,,12008218,LOCAL,Facility,Inpatient,,,,51,43.35,14.6166,51,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Cath Thoracic,,12008218,LOCAL,Facility,Both,,,,51,43.35,14.6166,51,UnitedHealthcare,Individual & Family,47.94,94,,percent of total billed charges,,
Sup Cath Thoracic,,12008218,LOCAL,Facility,Outpatient,,,,51,43.35,14.6166,51,UnitedHealthcare,Medicare Advantage,24.99,49,,percent of total billed charges,,
Sup Cath Thoracic,,12008218,LOCAL,Facility,Inpatient,,,,51,43.35,14.6166,51,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Sup Cath Thoracic,,12008218,LOCAL,Facility,Outpatient,,,,51,43.35,14.6166,51,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,24.48,48,,percent of total billed charges,,100% of DHS outpatient percentage
Sup Cath Thoracic,,12008218,LOCAL,Facility,Inpatient,,,,51,43.35,14.6166,51,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Sup Catheter Balloon Ureteral,,12008324,LOCAL,Facility,Both,,,,102,86.7,29.2332,102,Aetna,Commercial,93.84,92,,percent of total billed charges,,
Sup Catheter Balloon Ureteral,,12008324,LOCAL,Facility,Outpatient,,,,102,86.7,29.2332,102,Aetna,Medicare Advantage,49.98,49,,percent of total billed charges,,
Sup Catheter Balloon Ureteral,,12008324,LOCAL,Facility,Inpatient,,,,102,86.7,29.2332,102,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Sup Catheter Balloon Ureteral,,12008324,LOCAL,Facility,Both,,,,102,86.7,29.2332,102,Aetna,PPO,94.86,93,,percent of total billed charges,,
Sup Catheter Balloon Ureteral,,12008324,LOCAL,Facility,Both,,,,102,86.7,29.2332,102,America's PPO,America's PPO,97.9506,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Sup Catheter Balloon Ureteral,,12008324,LOCAL,Facility,Both,,,,102,86.7,29.2332,102,BlueCross BlueShield Minnesota, Federal Employee Program,100.368,98.4,,percent of total billed charges,,
Sup Catheter Balloon Ureteral,,12008324,LOCAL,Facility,Both,,,,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,102,100,,percent of total billed charges,,
Sup Catheter Balloon Ureteral,,12008324,LOCAL,Facility,Both,,,,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,High Value Network Plan,91.8,90,,percent of total billed charges,,
Sup Catheter Balloon Ureteral,,12008324,LOCAL,Facility,Outpatient,,,,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,Medicare Advantage,49.98,49,,percent of total billed charges,,
Sup Catheter Balloon Ureteral,,12008324,LOCAL,Facility,Inpatient,,,,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Sup Catheter Balloon Ureteral,,12008324,LOCAL,Facility,Both,,,,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,90.3414,88.57,,percent of total billed charges,,
Sup Catheter Balloon Ureteral,,12008324,LOCAL,Facility,Both,,,,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,29.2332,28.66,,percent of total billed charges,,
Sup Catheter Balloon Ureteral,,12008324,LOCAL,Facility,Outpatient,,,,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),49.98,49,,percent of total billed charges,,
Sup Catheter Balloon Ureteral,,12008324,LOCAL,Facility,Inpatient,,,,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Sup Catheter Balloon Ureteral,,12008324,LOCAL,Facility,Both,,,,102,86.7,29.2332,102,CorVel,Worker's Compensation,102,100,,percent of total billed charges,,
Sup Catheter Balloon Ureteral,,12008324,LOCAL,Facility,Both,,,,102,86.7,29.2332,102,First Health Group Corporation,First Health Network,98.94,97,,percent of total billed charges,,
Sup Catheter Balloon Ureteral,,12008324,LOCAL,Facility,Both,,,,102,86.7,29.2332,102,"Health Partners, Inc.",Commercial,96.492,94.6,,percent of total billed charges,,
Sup Catheter Balloon Ureteral,,12008324,LOCAL,Facility,Outpatient,,,,102,86.7,29.2332,102,"Health Partners, Inc.",Medicare Advantage,49.98,49,,percent of total billed charges,,
Sup Catheter Balloon Ureteral,,12008324,LOCAL,Facility,Inpatient,,,,102,86.7,29.2332,102,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Catheter Balloon Ureteral,,12008324,LOCAL,Facility,Both,,,,102,86.7,29.2332,102,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),61.2,60,,percent of total billed charges,,
Sup Catheter Balloon Ureteral,,12008324,LOCAL,Facility,Both,,,,102,86.7,29.2332,102,"Health Partners, Inc.",State of Minnesota Advantage Program,83.13,81.5,,percent of total billed charges,,
Sup Catheter Balloon Ureteral,,12008324,LOCAL,Facility,Both,,,,102,86.7,29.2332,102,"Health Partners, Inc.",State Public Programs,51,50,,percent of total billed charges,,
Sup Catheter Balloon Ureteral,,12008324,LOCAL,Facility,Both,,,,102,86.7,29.2332,102,Humana Insurance Company,Commercial PPO,96.9,95,,percent of total billed charges,,
Sup Catheter Balloon Ureteral,,12008324,LOCAL,Facility,Outpatient,,,,102,86.7,29.2332,102,Humana Insurance Company,Medicare PPO,49.98,49,,percent of total billed charges,,
Sup Catheter Balloon Ureteral,,12008324,LOCAL,Facility,Inpatient,,,,102,86.7,29.2332,102,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Sup Catheter Balloon Ureteral,,12008324,LOCAL,Facility,Both,,,,102,86.7,29.2332,102,Medica,Individual & Family,101.082,99.1,,percent of total billed charges,,
Sup Catheter Balloon Ureteral,,12008324,LOCAL,Facility,Outpatient,,,,102,86.7,29.2332,102,Medica,Medica Advantage Solution,50.796,49.8,,percent of total billed charges,,
Sup Catheter Balloon Ureteral,,12008324,LOCAL,Facility,Inpatient,,,,102,86.7,29.2332,102,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Sup Catheter Balloon Ureteral,,12008324,LOCAL,Facility,Outpatient,,,,102,86.7,29.2332,102,Medica,Medical Assistance,45.492,44.6,,percent of total billed charges,,
Sup Catheter Balloon Ureteral,,12008324,LOCAL,Facility,Inpatient,,,,102,86.7,29.2332,102,Medica,Medical Assistance,,,,,Included in per diem rate,
Sup Catheter Balloon Ureteral,,12008324,LOCAL,Facility,Outpatient,,,,102,86.7,29.2332,102,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,50.796,49.8,,percent of total billed charges,,
Sup Catheter Balloon Ureteral,,12008324,LOCAL,Facility,Inpatient,,,,102,86.7,29.2332,102,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Sup Catheter Balloon Ureteral,,12008324,LOCAL,Facility,Both,,,,102,86.7,29.2332,102,"Multiplan, Inc.","Multiplan, Inc.",95.88,94,,percent of total billed charges,,
Sup Catheter Balloon Ureteral,,12008324,LOCAL,Facility,Outpatient,,,,102,86.7,29.2332,102,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,91.902,90.1,,percent of total billed charges,,
Sup Catheter Balloon Ureteral,,12008324,LOCAL,Facility,Inpatient,,,,102,86.7,29.2332,102,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Sup Catheter Balloon Ureteral,,12008324,LOCAL,Facility,Both,,,,102,86.7,29.2332,102,"Preferred One Administrative Services, INC.",PPO,100.572,98.6,,percent of total billed charges,,
Sup Catheter Balloon Ureteral,,12008324,LOCAL,Facility,Outpatient,,,,102,86.7,29.2332,102,PrimeWest Health,Minnesota Senior Health Options (MSHO),52.479,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Sup Catheter Balloon Ureteral,,12008324,LOCAL,Facility,Inpatient,,,,102,86.7,29.2332,102,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Catheter Balloon Ureteral,,12008324,LOCAL,Facility,Outpatient,,,,102,86.7,29.2332,102,PrimeWest Health,MinnesotaCare,52.3872,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Sup Catheter Balloon Ureteral,,12008324,LOCAL,Facility,Inpatient,,,,102,86.7,29.2332,102,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Sup Catheter Balloon Ureteral,,12008324,LOCAL,Facility,Both,,,,102,86.7,29.2332,102,Sanford Health Plan,Sanford Health Plan,93.84,92,,percent of total billed charges,,
Sup Catheter Balloon Ureteral,,12008324,LOCAL,Facility,Outpatient,,,,102,86.7,29.2332,102,"UCare Health, Inc.",Individual & Family Plan,57.477,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Sup Catheter Balloon Ureteral,,12008324,LOCAL,Facility,Inpatient,,,,102,86.7,29.2332,102,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Sup Catheter Balloon Ureteral,,12008324,LOCAL,Facility,Outpatient,,,,102,86.7,29.2332,102,"UCare Health, Inc.",Medical Assistance,51.4794,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Catheter Balloon Ureteral,,12008324,LOCAL,Facility,Inpatient,,,,102,86.7,29.2332,102,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Sup Catheter Balloon Ureteral,,12008324,LOCAL,Facility,Outpatient,,,,102,86.7,29.2332,102,"UCare Health, Inc.",Medicare Advantage,51.4794,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Catheter Balloon Ureteral,,12008324,LOCAL,Facility,Inpatient,,,,102,86.7,29.2332,102,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Catheter Balloon Ureteral,,12008324,LOCAL,Facility,Outpatient,,,,102,86.7,29.2332,102,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),51.4794,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Catheter Balloon Ureteral,,12008324,LOCAL,Facility,Inpatient,,,,102,86.7,29.2332,102,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Catheter Balloon Ureteral,,12008324,LOCAL,Facility,Both,,,,102,86.7,29.2332,102,UnitedHealthcare,Individual & Family,95.88,94,,percent of total billed charges,,
Sup Catheter Balloon Ureteral,,12008324,LOCAL,Facility,Outpatient,,,,102,86.7,29.2332,102,UnitedHealthcare,Medicare Advantage,49.98,49,,percent of total billed charges,,
Sup Catheter Balloon Ureteral,,12008324,LOCAL,Facility,Inpatient,,,,102,86.7,29.2332,102,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Sup Catheter Balloon Ureteral,,12008324,LOCAL,Facility,Outpatient,,,,102,86.7,29.2332,102,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,48.96,48,,percent of total billed charges,,100% of DHS outpatient percentage
Sup Catheter Balloon Ureteral,,12008324,LOCAL,Facility,Inpatient,,,,102,86.7,29.2332,102,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Sup Extension Set Tur,,12009196,LOCAL,Facility,Both,,,,32,27.2,9.1712,32,Aetna,Commercial,29.44,92,,percent of total billed charges,,
Sup Extension Set Tur,,12009196,LOCAL,Facility,Outpatient,,,,32,27.2,9.1712,32,Aetna,Medicare Advantage,15.68,49,,percent of total billed charges,,
Sup Extension Set Tur,,12009196,LOCAL,Facility,Inpatient,,,,32,27.2,9.1712,32,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Sup Extension Set Tur,,12009196,LOCAL,Facility,Both,,,,32,27.2,9.1712,32,Aetna,PPO,29.76,93,,percent of total billed charges,,
Sup Extension Set Tur,,12009196,LOCAL,Facility,Both,,,,32,27.2,9.1712,32,America's PPO,America's PPO,30.7296,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Sup Extension Set Tur,,12009196,LOCAL,Facility,Both,,,,32,27.2,9.1712,32,BlueCross BlueShield Minnesota, Federal Employee Program,31.488,98.4,,percent of total billed charges,,
Sup Extension Set Tur,,12009196,LOCAL,Facility,Both,,,,32,27.2,9.1712,32,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,32,100,,percent of total billed charges,,
Sup Extension Set Tur,,12009196,LOCAL,Facility,Both,,,,32,27.2,9.1712,32,BlueCross BlueShield Minnesota,High Value Network Plan,28.8,90,,percent of total billed charges,,
Sup Extension Set Tur,,12009196,LOCAL,Facility,Outpatient,,,,32,27.2,9.1712,32,BlueCross BlueShield Minnesota,Medicare Advantage,15.68,49,,percent of total billed charges,,
Sup Extension Set Tur,,12009196,LOCAL,Facility,Inpatient,,,,32,27.2,9.1712,32,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Sup Extension Set Tur,,12009196,LOCAL,Facility,Both,,,,32,27.2,9.1712,32,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,28.3424,88.57,,percent of total billed charges,,
Sup Extension Set Tur,,12009196,LOCAL,Facility,Both,,,,32,27.2,9.1712,32,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,9.1712,28.66,,percent of total billed charges,,
Sup Extension Set Tur,,12009196,LOCAL,Facility,Outpatient,,,,32,27.2,9.1712,32,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),15.68,49,,percent of total billed charges,,
Sup Extension Set Tur,,12009196,LOCAL,Facility,Inpatient,,,,32,27.2,9.1712,32,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Sup Extension Set Tur,,12009196,LOCAL,Facility,Both,,,,32,27.2,9.1712,32,CorVel,Worker's Compensation,32,100,,percent of total billed charges,,
Sup Extension Set Tur,,12009196,LOCAL,Facility,Both,,,,32,27.2,9.1712,32,First Health Group Corporation,First Health Network,31.04,97,,percent of total billed charges,,
Sup Extension Set Tur,,12009196,LOCAL,Facility,Both,,,,32,27.2,9.1712,32,"Health Partners, Inc.",Commercial,30.272,94.6,,percent of total billed charges,,
Sup Extension Set Tur,,12009196,LOCAL,Facility,Outpatient,,,,32,27.2,9.1712,32,"Health Partners, Inc.",Medicare Advantage,15.68,49,,percent of total billed charges,,
Sup Extension Set Tur,,12009196,LOCAL,Facility,Inpatient,,,,32,27.2,9.1712,32,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Extension Set Tur,,12009196,LOCAL,Facility,Both,,,,32,27.2,9.1712,32,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),19.2,60,,percent of total billed charges,,
Sup Extension Set Tur,,12009196,LOCAL,Facility,Both,,,,32,27.2,9.1712,32,"Health Partners, Inc.",State of Minnesota Advantage Program,26.08,81.5,,percent of total billed charges,,
Sup Extension Set Tur,,12009196,LOCAL,Facility,Both,,,,32,27.2,9.1712,32,"Health Partners, Inc.",State Public Programs,16,50,,percent of total billed charges,,
Sup Extension Set Tur,,12009196,LOCAL,Facility,Both,,,,32,27.2,9.1712,32,Humana Insurance Company,Commercial PPO,30.4,95,,percent of total billed charges,,
Sup Extension Set Tur,,12009196,LOCAL,Facility,Outpatient,,,,32,27.2,9.1712,32,Humana Insurance Company,Medicare PPO,15.68,49,,percent of total billed charges,,
Sup Extension Set Tur,,12009196,LOCAL,Facility,Inpatient,,,,32,27.2,9.1712,32,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Sup Extension Set Tur,,12009196,LOCAL,Facility,Both,,,,32,27.2,9.1712,32,Medica,Individual & Family,31.712,99.1,,percent of total billed charges,,
Sup Extension Set Tur,,12009196,LOCAL,Facility,Outpatient,,,,32,27.2,9.1712,32,Medica,Medica Advantage Solution,15.936,49.8,,percent of total billed charges,,
Sup Extension Set Tur,,12009196,LOCAL,Facility,Inpatient,,,,32,27.2,9.1712,32,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Sup Extension Set Tur,,12009196,LOCAL,Facility,Outpatient,,,,32,27.2,9.1712,32,Medica,Medical Assistance,14.272,44.6,,percent of total billed charges,,
Sup Extension Set Tur,,12009196,LOCAL,Facility,Inpatient,,,,32,27.2,9.1712,32,Medica,Medical Assistance,,,,,Included in per diem rate,
Sup Extension Set Tur,,12009196,LOCAL,Facility,Outpatient,,,,32,27.2,9.1712,32,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,15.936,49.8,,percent of total billed charges,,
Sup Extension Set Tur,,12009196,LOCAL,Facility,Inpatient,,,,32,27.2,9.1712,32,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Sup Extension Set Tur,,12009196,LOCAL,Facility,Both,,,,32,27.2,9.1712,32,"Multiplan, Inc.","Multiplan, Inc.",30.08,94,,percent of total billed charges,,
Sup Extension Set Tur,,12009196,LOCAL,Facility,Outpatient,,,,32,27.2,9.1712,32,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,28.832,90.1,,percent of total billed charges,,
Sup Extension Set Tur,,12009196,LOCAL,Facility,Inpatient,,,,32,27.2,9.1712,32,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Sup Extension Set Tur,,12009196,LOCAL,Facility,Both,,,,32,27.2,9.1712,32,"Preferred One Administrative Services, INC.",PPO,31.552,98.6,,percent of total billed charges,,
Sup Extension Set Tur,,12009196,LOCAL,Facility,Outpatient,,,,32,27.2,9.1712,32,PrimeWest Health,Minnesota Senior Health Options (MSHO),16.464,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Sup Extension Set Tur,,12009196,LOCAL,Facility,Inpatient,,,,32,27.2,9.1712,32,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Extension Set Tur,,12009196,LOCAL,Facility,Outpatient,,,,32,27.2,9.1712,32,PrimeWest Health,MinnesotaCare,16.4352,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Sup Extension Set Tur,,12009196,LOCAL,Facility,Inpatient,,,,32,27.2,9.1712,32,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Sup Extension Set Tur,,12009196,LOCAL,Facility,Both,,,,32,27.2,9.1712,32,Sanford Health Plan,Sanford Health Plan,29.44,92,,percent of total billed charges,,
Sup Extension Set Tur,,12009196,LOCAL,Facility,Outpatient,,,,32,27.2,9.1712,32,"UCare Health, Inc.",Individual & Family Plan,18.032,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Sup Extension Set Tur,,12009196,LOCAL,Facility,Inpatient,,,,32,27.2,9.1712,32,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Sup Extension Set Tur,,12009196,LOCAL,Facility,Outpatient,,,,32,27.2,9.1712,32,"UCare Health, Inc.",Medical Assistance,16.1504,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Extension Set Tur,,12009196,LOCAL,Facility,Inpatient,,,,32,27.2,9.1712,32,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Sup Extension Set Tur,,12009196,LOCAL,Facility,Outpatient,,,,32,27.2,9.1712,32,"UCare Health, Inc.",Medicare Advantage,16.1504,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Extension Set Tur,,12009196,LOCAL,Facility,Inpatient,,,,32,27.2,9.1712,32,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Extension Set Tur,,12009196,LOCAL,Facility,Outpatient,,,,32,27.2,9.1712,32,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),16.1504,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Extension Set Tur,,12009196,LOCAL,Facility,Inpatient,,,,32,27.2,9.1712,32,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Extension Set Tur,,12009196,LOCAL,Facility,Both,,,,32,27.2,9.1712,32,UnitedHealthcare,Individual & Family,30.08,94,,percent of total billed charges,,
Sup Extension Set Tur,,12009196,LOCAL,Facility,Outpatient,,,,32,27.2,9.1712,32,UnitedHealthcare,Medicare Advantage,15.68,49,,percent of total billed charges,,
Sup Extension Set Tur,,12009196,LOCAL,Facility,Inpatient,,,,32,27.2,9.1712,32,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Sup Extension Set Tur,,12009196,LOCAL,Facility,Outpatient,,,,32,27.2,9.1712,32,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,15.36,48,,percent of total billed charges,,100% of DHS outpatient percentage
Sup Extension Set Tur,,12009196,LOCAL,Facility,Inpatient,,,,32,27.2,9.1712,32,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Sup Ifob Kit,,12009238,LOCAL,Facility,Both,,,,31,26.35,8.8846,31,Aetna,Commercial,28.52,92,,percent of total billed charges,,
Sup Ifob Kit,,12009238,LOCAL,Facility,Outpatient,,,,31,26.35,8.8846,31,Aetna,Medicare Advantage,15.19,49,,percent of total billed charges,,
Sup Ifob Kit,,12009238,LOCAL,Facility,Inpatient,,,,31,26.35,8.8846,31,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Sup Ifob Kit,,12009238,LOCAL,Facility,Both,,,,31,26.35,8.8846,31,Aetna,PPO,28.83,93,,percent of total billed charges,,
Sup Ifob Kit,,12009238,LOCAL,Facility,Both,,,,31,26.35,8.8846,31,America's PPO,America's PPO,29.7693,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Sup Ifob Kit,,12009238,LOCAL,Facility,Both,,,,31,26.35,8.8846,31,BlueCross BlueShield Minnesota, Federal Employee Program,30.504,98.4,,percent of total billed charges,,
Sup Ifob Kit,,12009238,LOCAL,Facility,Both,,,,31,26.35,8.8846,31,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,31,100,,percent of total billed charges,,
Sup Ifob Kit,,12009238,LOCAL,Facility,Both,,,,31,26.35,8.8846,31,BlueCross BlueShield Minnesota,High Value Network Plan,27.9,90,,percent of total billed charges,,
Sup Ifob Kit,,12009238,LOCAL,Facility,Outpatient,,,,31,26.35,8.8846,31,BlueCross BlueShield Minnesota,Medicare Advantage,15.19,49,,percent of total billed charges,,
Sup Ifob Kit,,12009238,LOCAL,Facility,Inpatient,,,,31,26.35,8.8846,31,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Sup Ifob Kit,,12009238,LOCAL,Facility,Both,,,,31,26.35,8.8846,31,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,27.4567,88.57,,percent of total billed charges,,
Sup Ifob Kit,,12009238,LOCAL,Facility,Both,,,,31,26.35,8.8846,31,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,8.8846,28.66,,percent of total billed charges,,
Sup Ifob Kit,,12009238,LOCAL,Facility,Outpatient,,,,31,26.35,8.8846,31,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),15.19,49,,percent of total billed charges,,
Sup Ifob Kit,,12009238,LOCAL,Facility,Inpatient,,,,31,26.35,8.8846,31,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Sup Ifob Kit,,12009238,LOCAL,Facility,Both,,,,31,26.35,8.8846,31,CorVel,Worker's Compensation,31,100,,percent of total billed charges,,
Sup Ifob Kit,,12009238,LOCAL,Facility,Both,,,,31,26.35,8.8846,31,First Health Group Corporation,First Health Network,30.07,97,,percent of total billed charges,,
Sup Ifob Kit,,12009238,LOCAL,Facility,Both,,,,31,26.35,8.8846,31,"Health Partners, Inc.",Commercial,29.326,94.6,,percent of total billed charges,,
Sup Ifob Kit,,12009238,LOCAL,Facility,Outpatient,,,,31,26.35,8.8846,31,"Health Partners, Inc.",Medicare Advantage,15.19,49,,percent of total billed charges,,
Sup Ifob Kit,,12009238,LOCAL,Facility,Inpatient,,,,31,26.35,8.8846,31,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Ifob Kit,,12009238,LOCAL,Facility,Both,,,,31,26.35,8.8846,31,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),18.6,60,,percent of total billed charges,,
Sup Ifob Kit,,12009238,LOCAL,Facility,Both,,,,31,26.35,8.8846,31,"Health Partners, Inc.",State of Minnesota Advantage Program,25.265,81.5,,percent of total billed charges,,
Sup Ifob Kit,,12009238,LOCAL,Facility,Both,,,,31,26.35,8.8846,31,"Health Partners, Inc.",State Public Programs,15.5,50,,percent of total billed charges,,
Sup Ifob Kit,,12009238,LOCAL,Facility,Both,,,,31,26.35,8.8846,31,Humana Insurance Company,Commercial PPO,29.45,95,,percent of total billed charges,,
Sup Ifob Kit,,12009238,LOCAL,Facility,Outpatient,,,,31,26.35,8.8846,31,Humana Insurance Company,Medicare PPO,15.19,49,,percent of total billed charges,,
Sup Ifob Kit,,12009238,LOCAL,Facility,Inpatient,,,,31,26.35,8.8846,31,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Sup Ifob Kit,,12009238,LOCAL,Facility,Both,,,,31,26.35,8.8846,31,Medica,Individual & Family,30.721,99.1,,percent of total billed charges,,
Sup Ifob Kit,,12009238,LOCAL,Facility,Outpatient,,,,31,26.35,8.8846,31,Medica,Medica Advantage Solution,15.438,49.8,,percent of total billed charges,,
Sup Ifob Kit,,12009238,LOCAL,Facility,Inpatient,,,,31,26.35,8.8846,31,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Sup Ifob Kit,,12009238,LOCAL,Facility,Outpatient,,,,31,26.35,8.8846,31,Medica,Medical Assistance,13.826,44.6,,percent of total billed charges,,
Sup Ifob Kit,,12009238,LOCAL,Facility,Inpatient,,,,31,26.35,8.8846,31,Medica,Medical Assistance,,,,,Included in per diem rate,
Sup Ifob Kit,,12009238,LOCAL,Facility,Outpatient,,,,31,26.35,8.8846,31,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,15.438,49.8,,percent of total billed charges,,
Sup Ifob Kit,,12009238,LOCAL,Facility,Inpatient,,,,31,26.35,8.8846,31,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Sup Ifob Kit,,12009238,LOCAL,Facility,Both,,,,31,26.35,8.8846,31,"Multiplan, Inc.","Multiplan, Inc.",29.14,94,,percent of total billed charges,,
Sup Ifob Kit,,12009238,LOCAL,Facility,Outpatient,,,,31,26.35,8.8846,31,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,27.931,90.1,,percent of total billed charges,,
Sup Ifob Kit,,12009238,LOCAL,Facility,Inpatient,,,,31,26.35,8.8846,31,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Sup Ifob Kit,,12009238,LOCAL,Facility,Both,,,,31,26.35,8.8846,31,"Preferred One Administrative Services, INC.",PPO,30.566,98.6,,percent of total billed charges,,
Sup Ifob Kit,,12009238,LOCAL,Facility,Outpatient,,,,31,26.35,8.8846,31,PrimeWest Health,Minnesota Senior Health Options (MSHO),15.9495,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Sup Ifob Kit,,12009238,LOCAL,Facility,Inpatient,,,,31,26.35,8.8846,31,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Ifob Kit,,12009238,LOCAL,Facility,Outpatient,,,,31,26.35,8.8846,31,PrimeWest Health,MinnesotaCare,15.9216,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Sup Ifob Kit,,12009238,LOCAL,Facility,Inpatient,,,,31,26.35,8.8846,31,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Sup Ifob Kit,,12009238,LOCAL,Facility,Both,,,,31,26.35,8.8846,31,Sanford Health Plan,Sanford Health Plan,28.52,92,,percent of total billed charges,,
Sup Ifob Kit,,12009238,LOCAL,Facility,Outpatient,,,,31,26.35,8.8846,31,"UCare Health, Inc.",Individual & Family Plan,17.4685,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Sup Ifob Kit,,12009238,LOCAL,Facility,Inpatient,,,,31,26.35,8.8846,31,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Sup Ifob Kit,,12009238,LOCAL,Facility,Outpatient,,,,31,26.35,8.8846,31,"UCare Health, Inc.",Medical Assistance,15.6457,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Ifob Kit,,12009238,LOCAL,Facility,Inpatient,,,,31,26.35,8.8846,31,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Sup Ifob Kit,,12009238,LOCAL,Facility,Outpatient,,,,31,26.35,8.8846,31,"UCare Health, Inc.",Medicare Advantage,15.6457,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Ifob Kit,,12009238,LOCAL,Facility,Inpatient,,,,31,26.35,8.8846,31,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Ifob Kit,,12009238,LOCAL,Facility,Outpatient,,,,31,26.35,8.8846,31,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),15.6457,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Ifob Kit,,12009238,LOCAL,Facility,Inpatient,,,,31,26.35,8.8846,31,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Ifob Kit,,12009238,LOCAL,Facility,Both,,,,31,26.35,8.8846,31,UnitedHealthcare,Individual & Family,29.14,94,,percent of total billed charges,,
Sup Ifob Kit,,12009238,LOCAL,Facility,Outpatient,,,,31,26.35,8.8846,31,UnitedHealthcare,Medicare Advantage,15.19,49,,percent of total billed charges,,
Sup Ifob Kit,,12009238,LOCAL,Facility,Inpatient,,,,31,26.35,8.8846,31,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Sup Ifob Kit,,12009238,LOCAL,Facility,Outpatient,,,,31,26.35,8.8846,31,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,14.88,48,,percent of total billed charges,,100% of DHS outpatient percentage
Sup Ifob Kit,,12009238,LOCAL,Facility,Inpatient,,,,31,26.35,8.8846,31,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Sup Iodosorb Gel Cadexomer,,12009697,LOCAL,Facility,Both,,,,73.9,62.815,21.17974,73.9,Aetna,Commercial,67.988,92,,percent of total billed charges,,
Sup Iodosorb Gel Cadexomer,,12009697,LOCAL,Facility,Outpatient,,,,73.9,62.815,21.17974,73.9,Aetna,Medicare Advantage,36.211,49,,percent of total billed charges,,
Sup Iodosorb Gel Cadexomer,,12009697,LOCAL,Facility,Inpatient,,,,73.9,62.815,21.17974,73.9,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Sup Iodosorb Gel Cadexomer,,12009697,LOCAL,Facility,Both,,,,73.9,62.815,21.17974,73.9,Aetna,PPO,68.727,93,,percent of total billed charges,,
Sup Iodosorb Gel Cadexomer,,12009697,LOCAL,Facility,Both,,,,73.9,62.815,21.17974,73.9,America's PPO,America's PPO,70.96617,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Sup Iodosorb Gel Cadexomer,,12009697,LOCAL,Facility,Both,,,,73.9,62.815,21.17974,73.9,BlueCross BlueShield Minnesota, Federal Employee Program,72.7176,98.4,,percent of total billed charges,,
Sup Iodosorb Gel Cadexomer,,12009697,LOCAL,Facility,Both,,,,73.9,62.815,21.17974,73.9,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,73.9,100,,percent of total billed charges,,
Sup Iodosorb Gel Cadexomer,,12009697,LOCAL,Facility,Both,,,,73.9,62.815,21.17974,73.9,BlueCross BlueShield Minnesota,High Value Network Plan,66.51,90,,percent of total billed charges,,
Sup Iodosorb Gel Cadexomer,,12009697,LOCAL,Facility,Outpatient,,,,73.9,62.815,21.17974,73.9,BlueCross BlueShield Minnesota,Medicare Advantage,36.211,49,,percent of total billed charges,,
Sup Iodosorb Gel Cadexomer,,12009697,LOCAL,Facility,Inpatient,,,,73.9,62.815,21.17974,73.9,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Sup Iodosorb Gel Cadexomer,,12009697,LOCAL,Facility,Both,,,,73.9,62.815,21.17974,73.9,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,65.45323,88.57,,percent of total billed charges,,
Sup Iodosorb Gel Cadexomer,,12009697,LOCAL,Facility,Both,,,,73.9,62.815,21.17974,73.9,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,21.17974,28.66,,percent of total billed charges,,
Sup Iodosorb Gel Cadexomer,,12009697,LOCAL,Facility,Outpatient,,,,73.9,62.815,21.17974,73.9,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),36.211,49,,percent of total billed charges,,
Sup Iodosorb Gel Cadexomer,,12009697,LOCAL,Facility,Inpatient,,,,73.9,62.815,21.17974,73.9,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Sup Iodosorb Gel Cadexomer,,12009697,LOCAL,Facility,Both,,,,73.9,62.815,21.17974,73.9,CorVel,Worker's Compensation,73.9,100,,percent of total billed charges,,
Sup Iodosorb Gel Cadexomer,,12009697,LOCAL,Facility,Both,,,,73.9,62.815,21.17974,73.9,First Health Group Corporation,First Health Network,71.683,97,,percent of total billed charges,,
Sup Iodosorb Gel Cadexomer,,12009697,LOCAL,Facility,Both,,,,73.9,62.815,21.17974,73.9,"Health Partners, Inc.",Commercial,69.9094,94.6,,percent of total billed charges,,
Sup Iodosorb Gel Cadexomer,,12009697,LOCAL,Facility,Outpatient,,,,73.9,62.815,21.17974,73.9,"Health Partners, Inc.",Medicare Advantage,36.211,49,,percent of total billed charges,,
Sup Iodosorb Gel Cadexomer,,12009697,LOCAL,Facility,Inpatient,,,,73.9,62.815,21.17974,73.9,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Iodosorb Gel Cadexomer,,12009697,LOCAL,Facility,Both,,,,73.9,62.815,21.17974,73.9,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),44.34,60,,percent of total billed charges,,
Sup Iodosorb Gel Cadexomer,,12009697,LOCAL,Facility,Both,,,,73.9,62.815,21.17974,73.9,"Health Partners, Inc.",State of Minnesota Advantage Program,60.2285,81.5,,percent of total billed charges,,
Sup Iodosorb Gel Cadexomer,,12009697,LOCAL,Facility,Both,,,,73.9,62.815,21.17974,73.9,"Health Partners, Inc.",State Public Programs,36.95,50,,percent of total billed charges,,
Sup Iodosorb Gel Cadexomer,,12009697,LOCAL,Facility,Both,,,,73.9,62.815,21.17974,73.9,Humana Insurance Company,Commercial PPO,70.205,95,,percent of total billed charges,,
Sup Iodosorb Gel Cadexomer,,12009697,LOCAL,Facility,Outpatient,,,,73.9,62.815,21.17974,73.9,Humana Insurance Company,Medicare PPO,36.211,49,,percent of total billed charges,,
Sup Iodosorb Gel Cadexomer,,12009697,LOCAL,Facility,Inpatient,,,,73.9,62.815,21.17974,73.9,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Sup Iodosorb Gel Cadexomer,,12009697,LOCAL,Facility,Both,,,,73.9,62.815,21.17974,73.9,Medica,Individual & Family,73.2349,99.1,,percent of total billed charges,,
Sup Iodosorb Gel Cadexomer,,12009697,LOCAL,Facility,Outpatient,,,,73.9,62.815,21.17974,73.9,Medica,Medica Advantage Solution,36.8022,49.8,,percent of total billed charges,,
Sup Iodosorb Gel Cadexomer,,12009697,LOCAL,Facility,Inpatient,,,,73.9,62.815,21.17974,73.9,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Sup Iodosorb Gel Cadexomer,,12009697,LOCAL,Facility,Outpatient,,,,73.9,62.815,21.17974,73.9,Medica,Medical Assistance,32.9594,44.6,,percent of total billed charges,,
Sup Iodosorb Gel Cadexomer,,12009697,LOCAL,Facility,Inpatient,,,,73.9,62.815,21.17974,73.9,Medica,Medical Assistance,,,,,Included in per diem rate,
Sup Iodosorb Gel Cadexomer,,12009697,LOCAL,Facility,Outpatient,,,,73.9,62.815,21.17974,73.9,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,36.8022,49.8,,percent of total billed charges,,
Sup Iodosorb Gel Cadexomer,,12009697,LOCAL,Facility,Inpatient,,,,73.9,62.815,21.17974,73.9,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Sup Iodosorb Gel Cadexomer,,12009697,LOCAL,Facility,Both,,,,73.9,62.815,21.17974,73.9,"Multiplan, Inc.","Multiplan, Inc.",69.466,94,,percent of total billed charges,,
Sup Iodosorb Gel Cadexomer,,12009697,LOCAL,Facility,Outpatient,,,,73.9,62.815,21.17974,73.9,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,66.5839,90.1,,percent of total billed charges,,
Sup Iodosorb Gel Cadexomer,,12009697,LOCAL,Facility,Inpatient,,,,73.9,62.815,21.17974,73.9,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Sup Iodosorb Gel Cadexomer,,12009697,LOCAL,Facility,Both,,,,73.9,62.815,21.17974,73.9,"Preferred One Administrative Services, INC.",PPO,72.8654,98.6,,percent of total billed charges,,
Sup Iodosorb Gel Cadexomer,,12009697,LOCAL,Facility,Outpatient,,,,73.9,62.815,21.17974,73.9,PrimeWest Health,Minnesota Senior Health Options (MSHO),38.02155,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Sup Iodosorb Gel Cadexomer,,12009697,LOCAL,Facility,Inpatient,,,,73.9,62.815,21.17974,73.9,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Iodosorb Gel Cadexomer,,12009697,LOCAL,Facility,Outpatient,,,,73.9,62.815,21.17974,73.9,PrimeWest Health,MinnesotaCare,37.95504,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Sup Iodosorb Gel Cadexomer,,12009697,LOCAL,Facility,Inpatient,,,,73.9,62.815,21.17974,73.9,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Sup Iodosorb Gel Cadexomer,,12009697,LOCAL,Facility,Both,,,,73.9,62.815,21.17974,73.9,Sanford Health Plan,Sanford Health Plan,67.988,92,,percent of total billed charges,,
Sup Iodosorb Gel Cadexomer,,12009697,LOCAL,Facility,Outpatient,,,,73.9,62.815,21.17974,73.9,"UCare Health, Inc.",Individual & Family Plan,41.64265,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Sup Iodosorb Gel Cadexomer,,12009697,LOCAL,Facility,Inpatient,,,,73.9,62.815,21.17974,73.9,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Sup Iodosorb Gel Cadexomer,,12009697,LOCAL,Facility,Outpatient,,,,73.9,62.815,21.17974,73.9,"UCare Health, Inc.",Medical Assistance,37.29733,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Iodosorb Gel Cadexomer,,12009697,LOCAL,Facility,Inpatient,,,,73.9,62.815,21.17974,73.9,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Sup Iodosorb Gel Cadexomer,,12009697,LOCAL,Facility,Outpatient,,,,73.9,62.815,21.17974,73.9,"UCare Health, Inc.",Medicare Advantage,37.29733,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Iodosorb Gel Cadexomer,,12009697,LOCAL,Facility,Inpatient,,,,73.9,62.815,21.17974,73.9,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Iodosorb Gel Cadexomer,,12009697,LOCAL,Facility,Outpatient,,,,73.9,62.815,21.17974,73.9,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),37.29733,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Iodosorb Gel Cadexomer,,12009697,LOCAL,Facility,Inpatient,,,,73.9,62.815,21.17974,73.9,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Iodosorb Gel Cadexomer,,12009697,LOCAL,Facility,Both,,,,73.9,62.815,21.17974,73.9,UnitedHealthcare,Individual & Family,69.466,94,,percent of total billed charges,,
Sup Iodosorb Gel Cadexomer,,12009697,LOCAL,Facility,Outpatient,,,,73.9,62.815,21.17974,73.9,UnitedHealthcare,Medicare Advantage,36.211,49,,percent of total billed charges,,
Sup Iodosorb Gel Cadexomer,,12009697,LOCAL,Facility,Inpatient,,,,73.9,62.815,21.17974,73.9,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Sup Iodosorb Gel Cadexomer,,12009697,LOCAL,Facility,Outpatient,,,,73.9,62.815,21.17974,73.9,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,35.472,48,,percent of total billed charges,,100% of DHS outpatient percentage
Sup Iodosorb Gel Cadexomer,,12009697,LOCAL,Facility,Inpatient,,,,73.9,62.815,21.17974,73.9,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Sup Mask Laryngeal,,12009957,LOCAL,Facility,Both,,,,30,25.5,8.598,30,Aetna,Commercial,27.6,92,,percent of total billed charges,,
Sup Mask Laryngeal,,12009957,LOCAL,Facility,Outpatient,,,,30,25.5,8.598,30,Aetna,Medicare Advantage,14.7,49,,percent of total billed charges,,
Sup Mask Laryngeal,,12009957,LOCAL,Facility,Inpatient,,,,30,25.5,8.598,30,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Sup Mask Laryngeal,,12009957,LOCAL,Facility,Both,,,,30,25.5,8.598,30,Aetna,PPO,27.9,93,,percent of total billed charges,,
Sup Mask Laryngeal,,12009957,LOCAL,Facility,Both,,,,30,25.5,8.598,30,America's PPO,America's PPO,28.809,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Sup Mask Laryngeal,,12009957,LOCAL,Facility,Both,,,,30,25.5,8.598,30,BlueCross BlueShield Minnesota, Federal Employee Program,29.52,98.4,,percent of total billed charges,,
Sup Mask Laryngeal,,12009957,LOCAL,Facility,Both,,,,30,25.5,8.598,30,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,30,100,,percent of total billed charges,,
Sup Mask Laryngeal,,12009957,LOCAL,Facility,Both,,,,30,25.5,8.598,30,BlueCross BlueShield Minnesota,High Value Network Plan,27,90,,percent of total billed charges,,
Sup Mask Laryngeal,,12009957,LOCAL,Facility,Outpatient,,,,30,25.5,8.598,30,BlueCross BlueShield Minnesota,Medicare Advantage,14.7,49,,percent of total billed charges,,
Sup Mask Laryngeal,,12009957,LOCAL,Facility,Inpatient,,,,30,25.5,8.598,30,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Sup Mask Laryngeal,,12009957,LOCAL,Facility,Both,,,,30,25.5,8.598,30,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,26.571,88.57,,percent of total billed charges,,
Sup Mask Laryngeal,,12009957,LOCAL,Facility,Both,,,,30,25.5,8.598,30,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,8.598,28.66,,percent of total billed charges,,
Sup Mask Laryngeal,,12009957,LOCAL,Facility,Outpatient,,,,30,25.5,8.598,30,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),14.7,49,,percent of total billed charges,,
Sup Mask Laryngeal,,12009957,LOCAL,Facility,Inpatient,,,,30,25.5,8.598,30,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Sup Mask Laryngeal,,12009957,LOCAL,Facility,Both,,,,30,25.5,8.598,30,CorVel,Worker's Compensation,30,100,,percent of total billed charges,,
Sup Mask Laryngeal,,12009957,LOCAL,Facility,Both,,,,30,25.5,8.598,30,First Health Group Corporation,First Health Network,29.1,97,,percent of total billed charges,,
Sup Mask Laryngeal,,12009957,LOCAL,Facility,Both,,,,30,25.5,8.598,30,"Health Partners, Inc.",Commercial,28.38,94.6,,percent of total billed charges,,
Sup Mask Laryngeal,,12009957,LOCAL,Facility,Outpatient,,,,30,25.5,8.598,30,"Health Partners, Inc.",Medicare Advantage,14.7,49,,percent of total billed charges,,
Sup Mask Laryngeal,,12009957,LOCAL,Facility,Inpatient,,,,30,25.5,8.598,30,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Mask Laryngeal,,12009957,LOCAL,Facility,Both,,,,30,25.5,8.598,30,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),18,60,,percent of total billed charges,,
Sup Mask Laryngeal,,12009957,LOCAL,Facility,Both,,,,30,25.5,8.598,30,"Health Partners, Inc.",State of Minnesota Advantage Program,24.45,81.5,,percent of total billed charges,,
Sup Mask Laryngeal,,12009957,LOCAL,Facility,Both,,,,30,25.5,8.598,30,"Health Partners, Inc.",State Public Programs,15,50,,percent of total billed charges,,
Sup Mask Laryngeal,,12009957,LOCAL,Facility,Both,,,,30,25.5,8.598,30,Humana Insurance Company,Commercial PPO,28.5,95,,percent of total billed charges,,
Sup Mask Laryngeal,,12009957,LOCAL,Facility,Outpatient,,,,30,25.5,8.598,30,Humana Insurance Company,Medicare PPO,14.7,49,,percent of total billed charges,,
Sup Mask Laryngeal,,12009957,LOCAL,Facility,Inpatient,,,,30,25.5,8.598,30,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Sup Mask Laryngeal,,12009957,LOCAL,Facility,Both,,,,30,25.5,8.598,30,Medica,Individual & Family,29.73,99.1,,percent of total billed charges,,
Sup Mask Laryngeal,,12009957,LOCAL,Facility,Outpatient,,,,30,25.5,8.598,30,Medica,Medica Advantage Solution,14.94,49.8,,percent of total billed charges,,
Sup Mask Laryngeal,,12009957,LOCAL,Facility,Inpatient,,,,30,25.5,8.598,30,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Sup Mask Laryngeal,,12009957,LOCAL,Facility,Outpatient,,,,30,25.5,8.598,30,Medica,Medical Assistance,13.38,44.6,,percent of total billed charges,,
Sup Mask Laryngeal,,12009957,LOCAL,Facility,Inpatient,,,,30,25.5,8.598,30,Medica,Medical Assistance,,,,,Included in per diem rate,
Sup Mask Laryngeal,,12009957,LOCAL,Facility,Outpatient,,,,30,25.5,8.598,30,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,14.94,49.8,,percent of total billed charges,,
Sup Mask Laryngeal,,12009957,LOCAL,Facility,Inpatient,,,,30,25.5,8.598,30,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Sup Mask Laryngeal,,12009957,LOCAL,Facility,Both,,,,30,25.5,8.598,30,"Multiplan, Inc.","Multiplan, Inc.",28.2,94,,percent of total billed charges,,
Sup Mask Laryngeal,,12009957,LOCAL,Facility,Outpatient,,,,30,25.5,8.598,30,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,27.03,90.1,,percent of total billed charges,,
Sup Mask Laryngeal,,12009957,LOCAL,Facility,Inpatient,,,,30,25.5,8.598,30,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Sup Mask Laryngeal,,12009957,LOCAL,Facility,Both,,,,30,25.5,8.598,30,"Preferred One Administrative Services, INC.",PPO,29.58,98.6,,percent of total billed charges,,
Sup Mask Laryngeal,,12009957,LOCAL,Facility,Outpatient,,,,30,25.5,8.598,30,PrimeWest Health,Minnesota Senior Health Options (MSHO),15.435,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Sup Mask Laryngeal,,12009957,LOCAL,Facility,Inpatient,,,,30,25.5,8.598,30,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Mask Laryngeal,,12009957,LOCAL,Facility,Outpatient,,,,30,25.5,8.598,30,PrimeWest Health,MinnesotaCare,15.408,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Sup Mask Laryngeal,,12009957,LOCAL,Facility,Inpatient,,,,30,25.5,8.598,30,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Sup Mask Laryngeal,,12009957,LOCAL,Facility,Both,,,,30,25.5,8.598,30,Sanford Health Plan,Sanford Health Plan,27.6,92,,percent of total billed charges,,
Sup Mask Laryngeal,,12009957,LOCAL,Facility,Outpatient,,,,30,25.5,8.598,30,"UCare Health, Inc.",Individual & Family Plan,16.905,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Sup Mask Laryngeal,,12009957,LOCAL,Facility,Inpatient,,,,30,25.5,8.598,30,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Sup Mask Laryngeal,,12009957,LOCAL,Facility,Outpatient,,,,30,25.5,8.598,30,"UCare Health, Inc.",Medical Assistance,15.141,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Mask Laryngeal,,12009957,LOCAL,Facility,Inpatient,,,,30,25.5,8.598,30,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Sup Mask Laryngeal,,12009957,LOCAL,Facility,Outpatient,,,,30,25.5,8.598,30,"UCare Health, Inc.",Medicare Advantage,15.141,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Mask Laryngeal,,12009957,LOCAL,Facility,Inpatient,,,,30,25.5,8.598,30,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Mask Laryngeal,,12009957,LOCAL,Facility,Outpatient,,,,30,25.5,8.598,30,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),15.141,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Mask Laryngeal,,12009957,LOCAL,Facility,Inpatient,,,,30,25.5,8.598,30,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Mask Laryngeal,,12009957,LOCAL,Facility,Both,,,,30,25.5,8.598,30,UnitedHealthcare,Individual & Family,28.2,94,,percent of total billed charges,,
Sup Mask Laryngeal,,12009957,LOCAL,Facility,Outpatient,,,,30,25.5,8.598,30,UnitedHealthcare,Medicare Advantage,14.7,49,,percent of total billed charges,,
Sup Mask Laryngeal,,12009957,LOCAL,Facility,Inpatient,,,,30,25.5,8.598,30,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Sup Mask Laryngeal,,12009957,LOCAL,Facility,Outpatient,,,,30,25.5,8.598,30,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,14.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
Sup Mask Laryngeal,,12009957,LOCAL,Facility,Inpatient,,,,30,25.5,8.598,30,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Sup Mepilex Sacrum 7.2 X 7.2,,12010075,LOCAL,Facility,Both,,,,70.89,60.2565,20.317074,70.89,Aetna,Commercial,65.2188,92,,percent of total billed charges,,
Sup Mepilex Sacrum 7.2 X 7.2,,12010075,LOCAL,Facility,Outpatient,,,,70.89,60.2565,20.317074,70.89,Aetna,Medicare Advantage,34.7361,49,,percent of total billed charges,,
Sup Mepilex Sacrum 7.2 X 7.2,,12010075,LOCAL,Facility,Inpatient,,,,70.89,60.2565,20.317074,70.89,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Sup Mepilex Sacrum 7.2 X 7.2,,12010075,LOCAL,Facility,Both,,,,70.89,60.2565,20.317074,70.89,Aetna,PPO,65.9277,93,,percent of total billed charges,,
Sup Mepilex Sacrum 7.2 X 7.2,,12010075,LOCAL,Facility,Both,,,,70.89,60.2565,20.317074,70.89,America's PPO,America's PPO,68.075667,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Sup Mepilex Sacrum 7.2 X 7.2,,12010075,LOCAL,Facility,Both,,,,70.89,60.2565,20.317074,70.89,BlueCross BlueShield Minnesota, Federal Employee Program,69.75576,98.4,,percent of total billed charges,,
Sup Mepilex Sacrum 7.2 X 7.2,,12010075,LOCAL,Facility,Both,,,,70.89,60.2565,20.317074,70.89,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,70.89,100,,percent of total billed charges,,
Sup Mepilex Sacrum 7.2 X 7.2,,12010075,LOCAL,Facility,Both,,,,70.89,60.2565,20.317074,70.89,BlueCross BlueShield Minnesota,High Value Network Plan,63.801,90,,percent of total billed charges,,
Sup Mepilex Sacrum 7.2 X 7.2,,12010075,LOCAL,Facility,Outpatient,,,,70.89,60.2565,20.317074,70.89,BlueCross BlueShield Minnesota,Medicare Advantage,34.7361,49,,percent of total billed charges,,
Sup Mepilex Sacrum 7.2 X 7.2,,12010075,LOCAL,Facility,Inpatient,,,,70.89,60.2565,20.317074,70.89,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Sup Mepilex Sacrum 7.2 X 7.2,,12010075,LOCAL,Facility,Both,,,,70.89,60.2565,20.317074,70.89,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,62.787273,88.57,,percent of total billed charges,,
Sup Mepilex Sacrum 7.2 X 7.2,,12010075,LOCAL,Facility,Both,,,,70.89,60.2565,20.317074,70.89,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,20.317074,28.66,,percent of total billed charges,,
Sup Mepilex Sacrum 7.2 X 7.2,,12010075,LOCAL,Facility,Outpatient,,,,70.89,60.2565,20.317074,70.89,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),34.7361,49,,percent of total billed charges,,
Sup Mepilex Sacrum 7.2 X 7.2,,12010075,LOCAL,Facility,Inpatient,,,,70.89,60.2565,20.317074,70.89,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Sup Mepilex Sacrum 7.2 X 7.2,,12010075,LOCAL,Facility,Both,,,,70.89,60.2565,20.317074,70.89,CorVel,Worker's Compensation,70.89,100,,percent of total billed charges,,
Sup Mepilex Sacrum 7.2 X 7.2,,12010075,LOCAL,Facility,Both,,,,70.89,60.2565,20.317074,70.89,First Health Group Corporation,First Health Network,68.7633,97,,percent of total billed charges,,
Sup Mepilex Sacrum 7.2 X 7.2,,12010075,LOCAL,Facility,Both,,,,70.89,60.2565,20.317074,70.89,"Health Partners, Inc.",Commercial,67.06194,94.6,,percent of total billed charges,,
Sup Mepilex Sacrum 7.2 X 7.2,,12010075,LOCAL,Facility,Outpatient,,,,70.89,60.2565,20.317074,70.89,"Health Partners, Inc.",Medicare Advantage,34.7361,49,,percent of total billed charges,,
Sup Mepilex Sacrum 7.2 X 7.2,,12010075,LOCAL,Facility,Inpatient,,,,70.89,60.2565,20.317074,70.89,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Mepilex Sacrum 7.2 X 7.2,,12010075,LOCAL,Facility,Both,,,,70.89,60.2565,20.317074,70.89,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),42.534,60,,percent of total billed charges,,
Sup Mepilex Sacrum 7.2 X 7.2,,12010075,LOCAL,Facility,Both,,,,70.89,60.2565,20.317074,70.89,"Health Partners, Inc.",State of Minnesota Advantage Program,57.77535,81.5,,percent of total billed charges,,
Sup Mepilex Sacrum 7.2 X 7.2,,12010075,LOCAL,Facility,Both,,,,70.89,60.2565,20.317074,70.89,"Health Partners, Inc.",State Public Programs,35.445,50,,percent of total billed charges,,
Sup Mepilex Sacrum 7.2 X 7.2,,12010075,LOCAL,Facility,Both,,,,70.89,60.2565,20.317074,70.89,Humana Insurance Company,Commercial PPO,67.3455,95,,percent of total billed charges,,
Sup Mepilex Sacrum 7.2 X 7.2,,12010075,LOCAL,Facility,Outpatient,,,,70.89,60.2565,20.317074,70.89,Humana Insurance Company,Medicare PPO,34.7361,49,,percent of total billed charges,,
Sup Mepilex Sacrum 7.2 X 7.2,,12010075,LOCAL,Facility,Inpatient,,,,70.89,60.2565,20.317074,70.89,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Sup Mepilex Sacrum 7.2 X 7.2,,12010075,LOCAL,Facility,Both,,,,70.89,60.2565,20.317074,70.89,Medica,Individual & Family,70.25199,99.1,,percent of total billed charges,,
Sup Mepilex Sacrum 7.2 X 7.2,,12010075,LOCAL,Facility,Outpatient,,,,70.89,60.2565,20.317074,70.89,Medica,Medica Advantage Solution,35.30322,49.8,,percent of total billed charges,,
Sup Mepilex Sacrum 7.2 X 7.2,,12010075,LOCAL,Facility,Inpatient,,,,70.89,60.2565,20.317074,70.89,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Sup Mepilex Sacrum 7.2 X 7.2,,12010075,LOCAL,Facility,Outpatient,,,,70.89,60.2565,20.317074,70.89,Medica,Medical Assistance,31.61694,44.6,,percent of total billed charges,,
Sup Mepilex Sacrum 7.2 X 7.2,,12010075,LOCAL,Facility,Inpatient,,,,70.89,60.2565,20.317074,70.89,Medica,Medical Assistance,,,,,Included in per diem rate,
Sup Mepilex Sacrum 7.2 X 7.2,,12010075,LOCAL,Facility,Outpatient,,,,70.89,60.2565,20.317074,70.89,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,35.30322,49.8,,percent of total billed charges,,
Sup Mepilex Sacrum 7.2 X 7.2,,12010075,LOCAL,Facility,Inpatient,,,,70.89,60.2565,20.317074,70.89,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Sup Mepilex Sacrum 7.2 X 7.2,,12010075,LOCAL,Facility,Both,,,,70.89,60.2565,20.317074,70.89,"Multiplan, Inc.","Multiplan, Inc.",66.6366,94,,percent of total billed charges,,
Sup Mepilex Sacrum 7.2 X 7.2,,12010075,LOCAL,Facility,Outpatient,,,,70.89,60.2565,20.317074,70.89,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,63.87189,90.1,,percent of total billed charges,,
Sup Mepilex Sacrum 7.2 X 7.2,,12010075,LOCAL,Facility,Inpatient,,,,70.89,60.2565,20.317074,70.89,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Sup Mepilex Sacrum 7.2 X 7.2,,12010075,LOCAL,Facility,Both,,,,70.89,60.2565,20.317074,70.89,"Preferred One Administrative Services, INC.",PPO,69.89754,98.6,,percent of total billed charges,,
Sup Mepilex Sacrum 7.2 X 7.2,,12010075,LOCAL,Facility,Outpatient,,,,70.89,60.2565,20.317074,70.89,PrimeWest Health,Minnesota Senior Health Options (MSHO),36.472905,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Sup Mepilex Sacrum 7.2 X 7.2,,12010075,LOCAL,Facility,Inpatient,,,,70.89,60.2565,20.317074,70.89,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Mepilex Sacrum 7.2 X 7.2,,12010075,LOCAL,Facility,Outpatient,,,,70.89,60.2565,20.317074,70.89,PrimeWest Health,MinnesotaCare,36.409104,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Sup Mepilex Sacrum 7.2 X 7.2,,12010075,LOCAL,Facility,Inpatient,,,,70.89,60.2565,20.317074,70.89,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Sup Mepilex Sacrum 7.2 X 7.2,,12010075,LOCAL,Facility,Both,,,,70.89,60.2565,20.317074,70.89,Sanford Health Plan,Sanford Health Plan,65.2188,92,,percent of total billed charges,,
Sup Mepilex Sacrum 7.2 X 7.2,,12010075,LOCAL,Facility,Outpatient,,,,70.89,60.2565,20.317074,70.89,"UCare Health, Inc.",Individual & Family Plan,39.946515,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Sup Mepilex Sacrum 7.2 X 7.2,,12010075,LOCAL,Facility,Inpatient,,,,70.89,60.2565,20.317074,70.89,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Sup Mepilex Sacrum 7.2 X 7.2,,12010075,LOCAL,Facility,Outpatient,,,,70.89,60.2565,20.317074,70.89,"UCare Health, Inc.",Medical Assistance,35.778183,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Mepilex Sacrum 7.2 X 7.2,,12010075,LOCAL,Facility,Inpatient,,,,70.89,60.2565,20.317074,70.89,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Sup Mepilex Sacrum 7.2 X 7.2,,12010075,LOCAL,Facility,Outpatient,,,,70.89,60.2565,20.317074,70.89,"UCare Health, Inc.",Medicare Advantage,35.778183,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Mepilex Sacrum 7.2 X 7.2,,12010075,LOCAL,Facility,Inpatient,,,,70.89,60.2565,20.317074,70.89,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Mepilex Sacrum 7.2 X 7.2,,12010075,LOCAL,Facility,Outpatient,,,,70.89,60.2565,20.317074,70.89,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),35.778183,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Mepilex Sacrum 7.2 X 7.2,,12010075,LOCAL,Facility,Inpatient,,,,70.89,60.2565,20.317074,70.89,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Mepilex Sacrum 7.2 X 7.2,,12010075,LOCAL,Facility,Both,,,,70.89,60.2565,20.317074,70.89,UnitedHealthcare,Individual & Family,66.6366,94,,percent of total billed charges,,
Sup Mepilex Sacrum 7.2 X 7.2,,12010075,LOCAL,Facility,Outpatient,,,,70.89,60.2565,20.317074,70.89,UnitedHealthcare,Medicare Advantage,34.7361,49,,percent of total billed charges,,
Sup Mepilex Sacrum 7.2 X 7.2,,12010075,LOCAL,Facility,Inpatient,,,,70.89,60.2565,20.317074,70.89,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Sup Mepilex Sacrum 7.2 X 7.2,,12010075,LOCAL,Facility,Outpatient,,,,70.89,60.2565,20.317074,70.89,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,34.0272,48,,percent of total billed charges,,100% of DHS outpatient percentage
Sup Mepilex Sacrum 7.2 X 7.2,,12010075,LOCAL,Facility,Inpatient,,,,70.89,60.2565,20.317074,70.89,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Sup Suture Tray,,12011236,LOCAL,Facility,Both,,,,86,73.1,24.6476,86,Aetna,Commercial,79.12,92,,percent of total billed charges,,
Sup Suture Tray,,12011236,LOCAL,Facility,Outpatient,,,,86,73.1,24.6476,86,Aetna,Medicare Advantage,42.14,49,,percent of total billed charges,,
Sup Suture Tray,,12011236,LOCAL,Facility,Inpatient,,,,86,73.1,24.6476,86,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Sup Suture Tray,,12011236,LOCAL,Facility,Both,,,,86,73.1,24.6476,86,Aetna,PPO,79.98,93,,percent of total billed charges,,
Sup Suture Tray,,12011236,LOCAL,Facility,Both,,,,86,73.1,24.6476,86,America's PPO,America's PPO,82.5858,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Sup Suture Tray,,12011236,LOCAL,Facility,Both,,,,86,73.1,24.6476,86,BlueCross BlueShield Minnesota, Federal Employee Program,84.624,98.4,,percent of total billed charges,,
Sup Suture Tray,,12011236,LOCAL,Facility,Both,,,,86,73.1,24.6476,86,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,86,100,,percent of total billed charges,,
Sup Suture Tray,,12011236,LOCAL,Facility,Both,,,,86,73.1,24.6476,86,BlueCross BlueShield Minnesota,High Value Network Plan,77.4,90,,percent of total billed charges,,
Sup Suture Tray,,12011236,LOCAL,Facility,Outpatient,,,,86,73.1,24.6476,86,BlueCross BlueShield Minnesota,Medicare Advantage,42.14,49,,percent of total billed charges,,
Sup Suture Tray,,12011236,LOCAL,Facility,Inpatient,,,,86,73.1,24.6476,86,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Sup Suture Tray,,12011236,LOCAL,Facility,Both,,,,86,73.1,24.6476,86,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,76.1702,88.57,,percent of total billed charges,,
Sup Suture Tray,,12011236,LOCAL,Facility,Both,,,,86,73.1,24.6476,86,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,24.6476,28.66,,percent of total billed charges,,
Sup Suture Tray,,12011236,LOCAL,Facility,Outpatient,,,,86,73.1,24.6476,86,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),42.14,49,,percent of total billed charges,,
Sup Suture Tray,,12011236,LOCAL,Facility,Inpatient,,,,86,73.1,24.6476,86,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Sup Suture Tray,,12011236,LOCAL,Facility,Both,,,,86,73.1,24.6476,86,CorVel,Worker's Compensation,86,100,,percent of total billed charges,,
Sup Suture Tray,,12011236,LOCAL,Facility,Both,,,,86,73.1,24.6476,86,First Health Group Corporation,First Health Network,83.42,97,,percent of total billed charges,,
Sup Suture Tray,,12011236,LOCAL,Facility,Both,,,,86,73.1,24.6476,86,"Health Partners, Inc.",Commercial,81.356,94.6,,percent of total billed charges,,
Sup Suture Tray,,12011236,LOCAL,Facility,Outpatient,,,,86,73.1,24.6476,86,"Health Partners, Inc.",Medicare Advantage,42.14,49,,percent of total billed charges,,
Sup Suture Tray,,12011236,LOCAL,Facility,Inpatient,,,,86,73.1,24.6476,86,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Suture Tray,,12011236,LOCAL,Facility,Both,,,,86,73.1,24.6476,86,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),51.6,60,,percent of total billed charges,,
Sup Suture Tray,,12011236,LOCAL,Facility,Both,,,,86,73.1,24.6476,86,"Health Partners, Inc.",State of Minnesota Advantage Program,70.09,81.5,,percent of total billed charges,,
Sup Suture Tray,,12011236,LOCAL,Facility,Both,,,,86,73.1,24.6476,86,"Health Partners, Inc.",State Public Programs,43,50,,percent of total billed charges,,
Sup Suture Tray,,12011236,LOCAL,Facility,Both,,,,86,73.1,24.6476,86,Humana Insurance Company,Commercial PPO,81.7,95,,percent of total billed charges,,
Sup Suture Tray,,12011236,LOCAL,Facility,Outpatient,,,,86,73.1,24.6476,86,Humana Insurance Company,Medicare PPO,42.14,49,,percent of total billed charges,,
Sup Suture Tray,,12011236,LOCAL,Facility,Inpatient,,,,86,73.1,24.6476,86,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Sup Suture Tray,,12011236,LOCAL,Facility,Both,,,,86,73.1,24.6476,86,Medica,Individual & Family,85.226,99.1,,percent of total billed charges,,
Sup Suture Tray,,12011236,LOCAL,Facility,Outpatient,,,,86,73.1,24.6476,86,Medica,Medica Advantage Solution,42.828,49.8,,percent of total billed charges,,
Sup Suture Tray,,12011236,LOCAL,Facility,Inpatient,,,,86,73.1,24.6476,86,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Sup Suture Tray,,12011236,LOCAL,Facility,Outpatient,,,,86,73.1,24.6476,86,Medica,Medical Assistance,38.356,44.6,,percent of total billed charges,,
Sup Suture Tray,,12011236,LOCAL,Facility,Inpatient,,,,86,73.1,24.6476,86,Medica,Medical Assistance,,,,,Included in per diem rate,
Sup Suture Tray,,12011236,LOCAL,Facility,Outpatient,,,,86,73.1,24.6476,86,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,42.828,49.8,,percent of total billed charges,,
Sup Suture Tray,,12011236,LOCAL,Facility,Inpatient,,,,86,73.1,24.6476,86,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Sup Suture Tray,,12011236,LOCAL,Facility,Both,,,,86,73.1,24.6476,86,"Multiplan, Inc.","Multiplan, Inc.",80.84,94,,percent of total billed charges,,
Sup Suture Tray,,12011236,LOCAL,Facility,Outpatient,,,,86,73.1,24.6476,86,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,77.486,90.1,,percent of total billed charges,,
Sup Suture Tray,,12011236,LOCAL,Facility,Inpatient,,,,86,73.1,24.6476,86,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Sup Suture Tray,,12011236,LOCAL,Facility,Both,,,,86,73.1,24.6476,86,"Preferred One Administrative Services, INC.",PPO,84.796,98.6,,percent of total billed charges,,
Sup Suture Tray,,12011236,LOCAL,Facility,Outpatient,,,,86,73.1,24.6476,86,PrimeWest Health,Minnesota Senior Health Options (MSHO),44.247,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Sup Suture Tray,,12011236,LOCAL,Facility,Inpatient,,,,86,73.1,24.6476,86,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Suture Tray,,12011236,LOCAL,Facility,Outpatient,,,,86,73.1,24.6476,86,PrimeWest Health,MinnesotaCare,44.1696,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Sup Suture Tray,,12011236,LOCAL,Facility,Inpatient,,,,86,73.1,24.6476,86,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Sup Suture Tray,,12011236,LOCAL,Facility,Both,,,,86,73.1,24.6476,86,Sanford Health Plan,Sanford Health Plan,79.12,92,,percent of total billed charges,,
Sup Suture Tray,,12011236,LOCAL,Facility,Outpatient,,,,86,73.1,24.6476,86,"UCare Health, Inc.",Individual & Family Plan,48.461,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Sup Suture Tray,,12011236,LOCAL,Facility,Inpatient,,,,86,73.1,24.6476,86,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Sup Suture Tray,,12011236,LOCAL,Facility,Outpatient,,,,86,73.1,24.6476,86,"UCare Health, Inc.",Medical Assistance,43.4042,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Suture Tray,,12011236,LOCAL,Facility,Inpatient,,,,86,73.1,24.6476,86,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Sup Suture Tray,,12011236,LOCAL,Facility,Outpatient,,,,86,73.1,24.6476,86,"UCare Health, Inc.",Medicare Advantage,43.4042,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Suture Tray,,12011236,LOCAL,Facility,Inpatient,,,,86,73.1,24.6476,86,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Suture Tray,,12011236,LOCAL,Facility,Outpatient,,,,86,73.1,24.6476,86,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),43.4042,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Suture Tray,,12011236,LOCAL,Facility,Inpatient,,,,86,73.1,24.6476,86,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Suture Tray,,12011236,LOCAL,Facility,Both,,,,86,73.1,24.6476,86,UnitedHealthcare,Individual & Family,80.84,94,,percent of total billed charges,,
Sup Suture Tray,,12011236,LOCAL,Facility,Outpatient,,,,86,73.1,24.6476,86,UnitedHealthcare,Medicare Advantage,42.14,49,,percent of total billed charges,,
Sup Suture Tray,,12011236,LOCAL,Facility,Inpatient,,,,86,73.1,24.6476,86,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Sup Suture Tray,,12011236,LOCAL,Facility,Outpatient,,,,86,73.1,24.6476,86,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,41.28,48,,percent of total billed charges,,100% of DHS outpatient percentage
Sup Suture Tray,,12011236,LOCAL,Facility,Inpatient,,,,86,73.1,24.6476,86,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Sup Biopsy Needle,,12011986,LOCAL,Facility,Both,,,,209,177.65,59.8994,209,Aetna,Commercial,192.28,92,,percent of total billed charges,,
Sup Biopsy Needle,,12011986,LOCAL,Facility,Outpatient,,,,209,177.65,59.8994,209,Aetna,Medicare Advantage,102.41,49,,percent of total billed charges,,
Sup Biopsy Needle,,12011986,LOCAL,Facility,Inpatient,,,,209,177.65,59.8994,209,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Sup Biopsy Needle,,12011986,LOCAL,Facility,Both,,,,209,177.65,59.8994,209,Aetna,PPO,194.37,93,,percent of total billed charges,,
Sup Biopsy Needle,,12011986,LOCAL,Facility,Both,,,,209,177.65,59.8994,209,America's PPO,America's PPO,200.7027,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Sup Biopsy Needle,,12011986,LOCAL,Facility,Both,,,,209,177.65,59.8994,209,BlueCross BlueShield Minnesota, Federal Employee Program,205.656,98.4,,percent of total billed charges,,
Sup Biopsy Needle,,12011986,LOCAL,Facility,Both,,,,209,177.65,59.8994,209,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,209,100,,percent of total billed charges,,
Sup Biopsy Needle,,12011986,LOCAL,Facility,Both,,,,209,177.65,59.8994,209,BlueCross BlueShield Minnesota,High Value Network Plan,188.1,90,,percent of total billed charges,,
Sup Biopsy Needle,,12011986,LOCAL,Facility,Outpatient,,,,209,177.65,59.8994,209,BlueCross BlueShield Minnesota,Medicare Advantage,102.41,49,,percent of total billed charges,,
Sup Biopsy Needle,,12011986,LOCAL,Facility,Inpatient,,,,209,177.65,59.8994,209,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Sup Biopsy Needle,,12011986,LOCAL,Facility,Both,,,,209,177.65,59.8994,209,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,185.1113,88.57,,percent of total billed charges,,
Sup Biopsy Needle,,12011986,LOCAL,Facility,Both,,,,209,177.65,59.8994,209,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,59.8994,28.66,,percent of total billed charges,,
Sup Biopsy Needle,,12011986,LOCAL,Facility,Outpatient,,,,209,177.65,59.8994,209,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),102.41,49,,percent of total billed charges,,
Sup Biopsy Needle,,12011986,LOCAL,Facility,Inpatient,,,,209,177.65,59.8994,209,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Sup Biopsy Needle,,12011986,LOCAL,Facility,Both,,,,209,177.65,59.8994,209,CorVel,Worker's Compensation,209,100,,percent of total billed charges,,
Sup Biopsy Needle,,12011986,LOCAL,Facility,Both,,,,209,177.65,59.8994,209,First Health Group Corporation,First Health Network,202.73,97,,percent of total billed charges,,
Sup Biopsy Needle,,12011986,LOCAL,Facility,Both,,,,209,177.65,59.8994,209,"Health Partners, Inc.",Commercial,197.714,94.6,,percent of total billed charges,,
Sup Biopsy Needle,,12011986,LOCAL,Facility,Outpatient,,,,209,177.65,59.8994,209,"Health Partners, Inc.",Medicare Advantage,102.41,49,,percent of total billed charges,,
Sup Biopsy Needle,,12011986,LOCAL,Facility,Inpatient,,,,209,177.65,59.8994,209,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Biopsy Needle,,12011986,LOCAL,Facility,Both,,,,209,177.65,59.8994,209,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),125.4,60,,percent of total billed charges,,
Sup Biopsy Needle,,12011986,LOCAL,Facility,Both,,,,209,177.65,59.8994,209,"Health Partners, Inc.",State of Minnesota Advantage Program,170.335,81.5,,percent of total billed charges,,
Sup Biopsy Needle,,12011986,LOCAL,Facility,Both,,,,209,177.65,59.8994,209,"Health Partners, Inc.",State Public Programs,104.5,50,,percent of total billed charges,,
Sup Biopsy Needle,,12011986,LOCAL,Facility,Both,,,,209,177.65,59.8994,209,Humana Insurance Company,Commercial PPO,198.55,95,,percent of total billed charges,,
Sup Biopsy Needle,,12011986,LOCAL,Facility,Outpatient,,,,209,177.65,59.8994,209,Humana Insurance Company,Medicare PPO,102.41,49,,percent of total billed charges,,
Sup Biopsy Needle,,12011986,LOCAL,Facility,Inpatient,,,,209,177.65,59.8994,209,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Sup Biopsy Needle,,12011986,LOCAL,Facility,Both,,,,209,177.65,59.8994,209,Medica,Individual & Family,207.119,99.1,,percent of total billed charges,,
Sup Biopsy Needle,,12011986,LOCAL,Facility,Outpatient,,,,209,177.65,59.8994,209,Medica,Medica Advantage Solution,104.082,49.8,,percent of total billed charges,,
Sup Biopsy Needle,,12011986,LOCAL,Facility,Inpatient,,,,209,177.65,59.8994,209,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Sup Biopsy Needle,,12011986,LOCAL,Facility,Outpatient,,,,209,177.65,59.8994,209,Medica,Medical Assistance,93.214,44.6,,percent of total billed charges,,
Sup Biopsy Needle,,12011986,LOCAL,Facility,Inpatient,,,,209,177.65,59.8994,209,Medica,Medical Assistance,,,,,Included in per diem rate,
Sup Biopsy Needle,,12011986,LOCAL,Facility,Outpatient,,,,209,177.65,59.8994,209,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,104.082,49.8,,percent of total billed charges,,
Sup Biopsy Needle,,12011986,LOCAL,Facility,Inpatient,,,,209,177.65,59.8994,209,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Sup Biopsy Needle,,12011986,LOCAL,Facility,Both,,,,209,177.65,59.8994,209,"Multiplan, Inc.","Multiplan, Inc.",196.46,94,,percent of total billed charges,,
Sup Biopsy Needle,,12011986,LOCAL,Facility,Outpatient,,,,209,177.65,59.8994,209,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,188.309,90.1,,percent of total billed charges,,
Sup Biopsy Needle,,12011986,LOCAL,Facility,Inpatient,,,,209,177.65,59.8994,209,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Sup Biopsy Needle,,12011986,LOCAL,Facility,Both,,,,209,177.65,59.8994,209,"Preferred One Administrative Services, INC.",PPO,206.074,98.6,,percent of total billed charges,,
Sup Biopsy Needle,,12011986,LOCAL,Facility,Outpatient,,,,209,177.65,59.8994,209,PrimeWest Health,Minnesota Senior Health Options (MSHO),107.5305,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Sup Biopsy Needle,,12011986,LOCAL,Facility,Inpatient,,,,209,177.65,59.8994,209,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Biopsy Needle,,12011986,LOCAL,Facility,Outpatient,,,,209,177.65,59.8994,209,PrimeWest Health,MinnesotaCare,107.3424,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Sup Biopsy Needle,,12011986,LOCAL,Facility,Inpatient,,,,209,177.65,59.8994,209,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Sup Biopsy Needle,,12011986,LOCAL,Facility,Both,,,,209,177.65,59.8994,209,Sanford Health Plan,Sanford Health Plan,192.28,92,,percent of total billed charges,,
Sup Biopsy Needle,,12011986,LOCAL,Facility,Outpatient,,,,209,177.65,59.8994,209,"UCare Health, Inc.",Individual & Family Plan,117.7715,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Sup Biopsy Needle,,12011986,LOCAL,Facility,Inpatient,,,,209,177.65,59.8994,209,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Sup Biopsy Needle,,12011986,LOCAL,Facility,Outpatient,,,,209,177.65,59.8994,209,"UCare Health, Inc.",Medical Assistance,105.4823,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Biopsy Needle,,12011986,LOCAL,Facility,Inpatient,,,,209,177.65,59.8994,209,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Sup Biopsy Needle,,12011986,LOCAL,Facility,Outpatient,,,,209,177.65,59.8994,209,"UCare Health, Inc.",Medicare Advantage,105.4823,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Biopsy Needle,,12011986,LOCAL,Facility,Inpatient,,,,209,177.65,59.8994,209,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Biopsy Needle,,12011986,LOCAL,Facility,Outpatient,,,,209,177.65,59.8994,209,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),105.4823,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Biopsy Needle,,12011986,LOCAL,Facility,Inpatient,,,,209,177.65,59.8994,209,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Biopsy Needle,,12011986,LOCAL,Facility,Both,,,,209,177.65,59.8994,209,UnitedHealthcare,Individual & Family,196.46,94,,percent of total billed charges,,
Sup Biopsy Needle,,12011986,LOCAL,Facility,Outpatient,,,,209,177.65,59.8994,209,UnitedHealthcare,Medicare Advantage,102.41,49,,percent of total billed charges,,
Sup Biopsy Needle,,12011986,LOCAL,Facility,Inpatient,,,,209,177.65,59.8994,209,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Sup Biopsy Needle,,12011986,LOCAL,Facility,Outpatient,,,,209,177.65,59.8994,209,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,100.32,48,,percent of total billed charges,,100% of DHS outpatient percentage
Sup Biopsy Needle,,12011986,LOCAL,Facility,Inpatient,,,,209,177.65,59.8994,209,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Sup Suction Frazier,,12012188,LOCAL,Facility,Both,,,,34,28.9,9.7444,34,Aetna,Commercial,31.28,92,,percent of total billed charges,,
Sup Suction Frazier,,12012188,LOCAL,Facility,Outpatient,,,,34,28.9,9.7444,34,Aetna,Medicare Advantage,16.66,49,,percent of total billed charges,,
Sup Suction Frazier,,12012188,LOCAL,Facility,Inpatient,,,,34,28.9,9.7444,34,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Sup Suction Frazier,,12012188,LOCAL,Facility,Both,,,,34,28.9,9.7444,34,Aetna,PPO,31.62,93,,percent of total billed charges,,
Sup Suction Frazier,,12012188,LOCAL,Facility,Both,,,,34,28.9,9.7444,34,America's PPO,America's PPO,32.6502,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Sup Suction Frazier,,12012188,LOCAL,Facility,Both,,,,34,28.9,9.7444,34,BlueCross BlueShield Minnesota, Federal Employee Program,33.456,98.4,,percent of total billed charges,,
Sup Suction Frazier,,12012188,LOCAL,Facility,Both,,,,34,28.9,9.7444,34,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,34,100,,percent of total billed charges,,
Sup Suction Frazier,,12012188,LOCAL,Facility,Both,,,,34,28.9,9.7444,34,BlueCross BlueShield Minnesota,High Value Network Plan,30.6,90,,percent of total billed charges,,
Sup Suction Frazier,,12012188,LOCAL,Facility,Outpatient,,,,34,28.9,9.7444,34,BlueCross BlueShield Minnesota,Medicare Advantage,16.66,49,,percent of total billed charges,,
Sup Suction Frazier,,12012188,LOCAL,Facility,Inpatient,,,,34,28.9,9.7444,34,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Sup Suction Frazier,,12012188,LOCAL,Facility,Both,,,,34,28.9,9.7444,34,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,30.1138,88.57,,percent of total billed charges,,
Sup Suction Frazier,,12012188,LOCAL,Facility,Both,,,,34,28.9,9.7444,34,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,9.7444,28.66,,percent of total billed charges,,
Sup Suction Frazier,,12012188,LOCAL,Facility,Outpatient,,,,34,28.9,9.7444,34,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),16.66,49,,percent of total billed charges,,
Sup Suction Frazier,,12012188,LOCAL,Facility,Inpatient,,,,34,28.9,9.7444,34,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Sup Suction Frazier,,12012188,LOCAL,Facility,Both,,,,34,28.9,9.7444,34,CorVel,Worker's Compensation,34,100,,percent of total billed charges,,
Sup Suction Frazier,,12012188,LOCAL,Facility,Both,,,,34,28.9,9.7444,34,First Health Group Corporation,First Health Network,32.98,97,,percent of total billed charges,,
Sup Suction Frazier,,12012188,LOCAL,Facility,Both,,,,34,28.9,9.7444,34,"Health Partners, Inc.",Commercial,32.164,94.6,,percent of total billed charges,,
Sup Suction Frazier,,12012188,LOCAL,Facility,Outpatient,,,,34,28.9,9.7444,34,"Health Partners, Inc.",Medicare Advantage,16.66,49,,percent of total billed charges,,
Sup Suction Frazier,,12012188,LOCAL,Facility,Inpatient,,,,34,28.9,9.7444,34,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Suction Frazier,,12012188,LOCAL,Facility,Both,,,,34,28.9,9.7444,34,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),20.4,60,,percent of total billed charges,,
Sup Suction Frazier,,12012188,LOCAL,Facility,Both,,,,34,28.9,9.7444,34,"Health Partners, Inc.",State of Minnesota Advantage Program,27.71,81.5,,percent of total billed charges,,
Sup Suction Frazier,,12012188,LOCAL,Facility,Both,,,,34,28.9,9.7444,34,"Health Partners, Inc.",State Public Programs,17,50,,percent of total billed charges,,
Sup Suction Frazier,,12012188,LOCAL,Facility,Both,,,,34,28.9,9.7444,34,Humana Insurance Company,Commercial PPO,32.3,95,,percent of total billed charges,,
Sup Suction Frazier,,12012188,LOCAL,Facility,Outpatient,,,,34,28.9,9.7444,34,Humana Insurance Company,Medicare PPO,16.66,49,,percent of total billed charges,,
Sup Suction Frazier,,12012188,LOCAL,Facility,Inpatient,,,,34,28.9,9.7444,34,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Sup Suction Frazier,,12012188,LOCAL,Facility,Both,,,,34,28.9,9.7444,34,Medica,Individual & Family,33.694,99.1,,percent of total billed charges,,
Sup Suction Frazier,,12012188,LOCAL,Facility,Outpatient,,,,34,28.9,9.7444,34,Medica,Medica Advantage Solution,16.932,49.8,,percent of total billed charges,,
Sup Suction Frazier,,12012188,LOCAL,Facility,Inpatient,,,,34,28.9,9.7444,34,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Sup Suction Frazier,,12012188,LOCAL,Facility,Outpatient,,,,34,28.9,9.7444,34,Medica,Medical Assistance,15.164,44.6,,percent of total billed charges,,
Sup Suction Frazier,,12012188,LOCAL,Facility,Inpatient,,,,34,28.9,9.7444,34,Medica,Medical Assistance,,,,,Included in per diem rate,
Sup Suction Frazier,,12012188,LOCAL,Facility,Outpatient,,,,34,28.9,9.7444,34,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,16.932,49.8,,percent of total billed charges,,
Sup Suction Frazier,,12012188,LOCAL,Facility,Inpatient,,,,34,28.9,9.7444,34,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Sup Suction Frazier,,12012188,LOCAL,Facility,Both,,,,34,28.9,9.7444,34,"Multiplan, Inc.","Multiplan, Inc.",31.96,94,,percent of total billed charges,,
Sup Suction Frazier,,12012188,LOCAL,Facility,Outpatient,,,,34,28.9,9.7444,34,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,30.634,90.1,,percent of total billed charges,,
Sup Suction Frazier,,12012188,LOCAL,Facility,Inpatient,,,,34,28.9,9.7444,34,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Sup Suction Frazier,,12012188,LOCAL,Facility,Both,,,,34,28.9,9.7444,34,"Preferred One Administrative Services, INC.",PPO,33.524,98.6,,percent of total billed charges,,
Sup Suction Frazier,,12012188,LOCAL,Facility,Outpatient,,,,34,28.9,9.7444,34,PrimeWest Health,Minnesota Senior Health Options (MSHO),17.493,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Sup Suction Frazier,,12012188,LOCAL,Facility,Inpatient,,,,34,28.9,9.7444,34,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Suction Frazier,,12012188,LOCAL,Facility,Outpatient,,,,34,28.9,9.7444,34,PrimeWest Health,MinnesotaCare,17.4624,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Sup Suction Frazier,,12012188,LOCAL,Facility,Inpatient,,,,34,28.9,9.7444,34,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Sup Suction Frazier,,12012188,LOCAL,Facility,Both,,,,34,28.9,9.7444,34,Sanford Health Plan,Sanford Health Plan,31.28,92,,percent of total billed charges,,
Sup Suction Frazier,,12012188,LOCAL,Facility,Outpatient,,,,34,28.9,9.7444,34,"UCare Health, Inc.",Individual & Family Plan,19.159,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Sup Suction Frazier,,12012188,LOCAL,Facility,Inpatient,,,,34,28.9,9.7444,34,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Sup Suction Frazier,,12012188,LOCAL,Facility,Outpatient,,,,34,28.9,9.7444,34,"UCare Health, Inc.",Medical Assistance,17.1598,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Suction Frazier,,12012188,LOCAL,Facility,Inpatient,,,,34,28.9,9.7444,34,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Sup Suction Frazier,,12012188,LOCAL,Facility,Outpatient,,,,34,28.9,9.7444,34,"UCare Health, Inc.",Medicare Advantage,17.1598,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Suction Frazier,,12012188,LOCAL,Facility,Inpatient,,,,34,28.9,9.7444,34,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Suction Frazier,,12012188,LOCAL,Facility,Outpatient,,,,34,28.9,9.7444,34,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),17.1598,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Suction Frazier,,12012188,LOCAL,Facility,Inpatient,,,,34,28.9,9.7444,34,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Suction Frazier,,12012188,LOCAL,Facility,Both,,,,34,28.9,9.7444,34,UnitedHealthcare,Individual & Family,31.96,94,,percent of total billed charges,,
Sup Suction Frazier,,12012188,LOCAL,Facility,Outpatient,,,,34,28.9,9.7444,34,UnitedHealthcare,Medicare Advantage,16.66,49,,percent of total billed charges,,
Sup Suction Frazier,,12012188,LOCAL,Facility,Inpatient,,,,34,28.9,9.7444,34,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Sup Suction Frazier,,12012188,LOCAL,Facility,Outpatient,,,,34,28.9,9.7444,34,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,16.32,48,,percent of total billed charges,,100% of DHS outpatient percentage
Sup Suction Frazier,,12012188,LOCAL,Facility,Inpatient,,,,34,28.9,9.7444,34,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Sup Chest Drainage Kit,,12012315,LOCAL,Facility,Both,,,,51,43.35,14.6166,51,Aetna,Commercial,46.92,92,,percent of total billed charges,,
Sup Chest Drainage Kit,,12012315,LOCAL,Facility,Outpatient,,,,51,43.35,14.6166,51,Aetna,Medicare Advantage,24.99,49,,percent of total billed charges,,
Sup Chest Drainage Kit,,12012315,LOCAL,Facility,Inpatient,,,,51,43.35,14.6166,51,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Sup Chest Drainage Kit,,12012315,LOCAL,Facility,Both,,,,51,43.35,14.6166,51,Aetna,PPO,47.43,93,,percent of total billed charges,,
Sup Chest Drainage Kit,,12012315,LOCAL,Facility,Both,,,,51,43.35,14.6166,51,America's PPO,America's PPO,48.9753,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Sup Chest Drainage Kit,,12012315,LOCAL,Facility,Both,,,,51,43.35,14.6166,51,BlueCross BlueShield Minnesota, Federal Employee Program,50.184,98.4,,percent of total billed charges,,
Sup Chest Drainage Kit,,12012315,LOCAL,Facility,Both,,,,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,51,100,,percent of total billed charges,,
Sup Chest Drainage Kit,,12012315,LOCAL,Facility,Both,,,,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,High Value Network Plan,45.9,90,,percent of total billed charges,,
Sup Chest Drainage Kit,,12012315,LOCAL,Facility,Outpatient,,,,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,Medicare Advantage,24.99,49,,percent of total billed charges,,
Sup Chest Drainage Kit,,12012315,LOCAL,Facility,Inpatient,,,,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Sup Chest Drainage Kit,,12012315,LOCAL,Facility,Both,,,,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,45.1707,88.57,,percent of total billed charges,,
Sup Chest Drainage Kit,,12012315,LOCAL,Facility,Both,,,,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,14.6166,28.66,,percent of total billed charges,,
Sup Chest Drainage Kit,,12012315,LOCAL,Facility,Outpatient,,,,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),24.99,49,,percent of total billed charges,,
Sup Chest Drainage Kit,,12012315,LOCAL,Facility,Inpatient,,,,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Sup Chest Drainage Kit,,12012315,LOCAL,Facility,Both,,,,51,43.35,14.6166,51,CorVel,Worker's Compensation,51,100,,percent of total billed charges,,
Sup Chest Drainage Kit,,12012315,LOCAL,Facility,Both,,,,51,43.35,14.6166,51,First Health Group Corporation,First Health Network,49.47,97,,percent of total billed charges,,
Sup Chest Drainage Kit,,12012315,LOCAL,Facility,Both,,,,51,43.35,14.6166,51,"Health Partners, Inc.",Commercial,48.246,94.6,,percent of total billed charges,,
Sup Chest Drainage Kit,,12012315,LOCAL,Facility,Outpatient,,,,51,43.35,14.6166,51,"Health Partners, Inc.",Medicare Advantage,24.99,49,,percent of total billed charges,,
Sup Chest Drainage Kit,,12012315,LOCAL,Facility,Inpatient,,,,51,43.35,14.6166,51,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Chest Drainage Kit,,12012315,LOCAL,Facility,Both,,,,51,43.35,14.6166,51,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),30.6,60,,percent of total billed charges,,
Sup Chest Drainage Kit,,12012315,LOCAL,Facility,Both,,,,51,43.35,14.6166,51,"Health Partners, Inc.",State of Minnesota Advantage Program,41.565,81.5,,percent of total billed charges,,
Sup Chest Drainage Kit,,12012315,LOCAL,Facility,Both,,,,51,43.35,14.6166,51,"Health Partners, Inc.",State Public Programs,25.5,50,,percent of total billed charges,,
Sup Chest Drainage Kit,,12012315,LOCAL,Facility,Both,,,,51,43.35,14.6166,51,Humana Insurance Company,Commercial PPO,48.45,95,,percent of total billed charges,,
Sup Chest Drainage Kit,,12012315,LOCAL,Facility,Outpatient,,,,51,43.35,14.6166,51,Humana Insurance Company,Medicare PPO,24.99,49,,percent of total billed charges,,
Sup Chest Drainage Kit,,12012315,LOCAL,Facility,Inpatient,,,,51,43.35,14.6166,51,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Sup Chest Drainage Kit,,12012315,LOCAL,Facility,Both,,,,51,43.35,14.6166,51,Medica,Individual & Family,50.541,99.1,,percent of total billed charges,,
Sup Chest Drainage Kit,,12012315,LOCAL,Facility,Outpatient,,,,51,43.35,14.6166,51,Medica,Medica Advantage Solution,25.398,49.8,,percent of total billed charges,,
Sup Chest Drainage Kit,,12012315,LOCAL,Facility,Inpatient,,,,51,43.35,14.6166,51,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Sup Chest Drainage Kit,,12012315,LOCAL,Facility,Outpatient,,,,51,43.35,14.6166,51,Medica,Medical Assistance,22.746,44.6,,percent of total billed charges,,
Sup Chest Drainage Kit,,12012315,LOCAL,Facility,Inpatient,,,,51,43.35,14.6166,51,Medica,Medical Assistance,,,,,Included in per diem rate,
Sup Chest Drainage Kit,,12012315,LOCAL,Facility,Outpatient,,,,51,43.35,14.6166,51,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,25.398,49.8,,percent of total billed charges,,
Sup Chest Drainage Kit,,12012315,LOCAL,Facility,Inpatient,,,,51,43.35,14.6166,51,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Sup Chest Drainage Kit,,12012315,LOCAL,Facility,Both,,,,51,43.35,14.6166,51,"Multiplan, Inc.","Multiplan, Inc.",47.94,94,,percent of total billed charges,,
Sup Chest Drainage Kit,,12012315,LOCAL,Facility,Outpatient,,,,51,43.35,14.6166,51,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,45.951,90.1,,percent of total billed charges,,
Sup Chest Drainage Kit,,12012315,LOCAL,Facility,Inpatient,,,,51,43.35,14.6166,51,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Sup Chest Drainage Kit,,12012315,LOCAL,Facility,Both,,,,51,43.35,14.6166,51,"Preferred One Administrative Services, INC.",PPO,50.286,98.6,,percent of total billed charges,,
Sup Chest Drainage Kit,,12012315,LOCAL,Facility,Outpatient,,,,51,43.35,14.6166,51,PrimeWest Health,Minnesota Senior Health Options (MSHO),26.2395,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Sup Chest Drainage Kit,,12012315,LOCAL,Facility,Inpatient,,,,51,43.35,14.6166,51,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Chest Drainage Kit,,12012315,LOCAL,Facility,Outpatient,,,,51,43.35,14.6166,51,PrimeWest Health,MinnesotaCare,26.1936,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Sup Chest Drainage Kit,,12012315,LOCAL,Facility,Inpatient,,,,51,43.35,14.6166,51,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Sup Chest Drainage Kit,,12012315,LOCAL,Facility,Both,,,,51,43.35,14.6166,51,Sanford Health Plan,Sanford Health Plan,46.92,92,,percent of total billed charges,,
Sup Chest Drainage Kit,,12012315,LOCAL,Facility,Outpatient,,,,51,43.35,14.6166,51,"UCare Health, Inc.",Individual & Family Plan,28.7385,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Sup Chest Drainage Kit,,12012315,LOCAL,Facility,Inpatient,,,,51,43.35,14.6166,51,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Sup Chest Drainage Kit,,12012315,LOCAL,Facility,Outpatient,,,,51,43.35,14.6166,51,"UCare Health, Inc.",Medical Assistance,25.7397,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Chest Drainage Kit,,12012315,LOCAL,Facility,Inpatient,,,,51,43.35,14.6166,51,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Sup Chest Drainage Kit,,12012315,LOCAL,Facility,Outpatient,,,,51,43.35,14.6166,51,"UCare Health, Inc.",Medicare Advantage,25.7397,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Chest Drainage Kit,,12012315,LOCAL,Facility,Inpatient,,,,51,43.35,14.6166,51,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Chest Drainage Kit,,12012315,LOCAL,Facility,Outpatient,,,,51,43.35,14.6166,51,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),25.7397,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Chest Drainage Kit,,12012315,LOCAL,Facility,Inpatient,,,,51,43.35,14.6166,51,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Chest Drainage Kit,,12012315,LOCAL,Facility,Both,,,,51,43.35,14.6166,51,UnitedHealthcare,Individual & Family,47.94,94,,percent of total billed charges,,
Sup Chest Drainage Kit,,12012315,LOCAL,Facility,Outpatient,,,,51,43.35,14.6166,51,UnitedHealthcare,Medicare Advantage,24.99,49,,percent of total billed charges,,
Sup Chest Drainage Kit,,12012315,LOCAL,Facility,Inpatient,,,,51,43.35,14.6166,51,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Sup Chest Drainage Kit,,12012315,LOCAL,Facility,Outpatient,,,,51,43.35,14.6166,51,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,24.48,48,,percent of total billed charges,,100% of DHS outpatient percentage
Sup Chest Drainage Kit,,12012315,LOCAL,Facility,Inpatient,,,,51,43.35,14.6166,51,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Sup Warming Bair Paw Gown,,12012794,LOCAL,Facility,Both,,,,54,45.9,15.4764,54,Aetna,Commercial,49.68,92,,percent of total billed charges,,
Sup Warming Bair Paw Gown,,12012794,LOCAL,Facility,Outpatient,,,,54,45.9,15.4764,54,Aetna,Medicare Advantage,26.46,49,,percent of total billed charges,,
Sup Warming Bair Paw Gown,,12012794,LOCAL,Facility,Inpatient,,,,54,45.9,15.4764,54,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Sup Warming Bair Paw Gown,,12012794,LOCAL,Facility,Both,,,,54,45.9,15.4764,54,Aetna,PPO,50.22,93,,percent of total billed charges,,
Sup Warming Bair Paw Gown,,12012794,LOCAL,Facility,Both,,,,54,45.9,15.4764,54,America's PPO,America's PPO,51.8562,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Sup Warming Bair Paw Gown,,12012794,LOCAL,Facility,Both,,,,54,45.9,15.4764,54,BlueCross BlueShield Minnesota, Federal Employee Program,53.136,98.4,,percent of total billed charges,,
Sup Warming Bair Paw Gown,,12012794,LOCAL,Facility,Both,,,,54,45.9,15.4764,54,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,54,100,,percent of total billed charges,,
Sup Warming Bair Paw Gown,,12012794,LOCAL,Facility,Both,,,,54,45.9,15.4764,54,BlueCross BlueShield Minnesota,High Value Network Plan,48.6,90,,percent of total billed charges,,
Sup Warming Bair Paw Gown,,12012794,LOCAL,Facility,Outpatient,,,,54,45.9,15.4764,54,BlueCross BlueShield Minnesota,Medicare Advantage,26.46,49,,percent of total billed charges,,
Sup Warming Bair Paw Gown,,12012794,LOCAL,Facility,Inpatient,,,,54,45.9,15.4764,54,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Sup Warming Bair Paw Gown,,12012794,LOCAL,Facility,Both,,,,54,45.9,15.4764,54,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,47.8278,88.57,,percent of total billed charges,,
Sup Warming Bair Paw Gown,,12012794,LOCAL,Facility,Both,,,,54,45.9,15.4764,54,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,15.4764,28.66,,percent of total billed charges,,
Sup Warming Bair Paw Gown,,12012794,LOCAL,Facility,Outpatient,,,,54,45.9,15.4764,54,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),26.46,49,,percent of total billed charges,,
Sup Warming Bair Paw Gown,,12012794,LOCAL,Facility,Inpatient,,,,54,45.9,15.4764,54,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Sup Warming Bair Paw Gown,,12012794,LOCAL,Facility,Both,,,,54,45.9,15.4764,54,CorVel,Worker's Compensation,54,100,,percent of total billed charges,,
Sup Warming Bair Paw Gown,,12012794,LOCAL,Facility,Both,,,,54,45.9,15.4764,54,First Health Group Corporation,First Health Network,52.38,97,,percent of total billed charges,,
Sup Warming Bair Paw Gown,,12012794,LOCAL,Facility,Both,,,,54,45.9,15.4764,54,"Health Partners, Inc.",Commercial,51.084,94.6,,percent of total billed charges,,
Sup Warming Bair Paw Gown,,12012794,LOCAL,Facility,Outpatient,,,,54,45.9,15.4764,54,"Health Partners, Inc.",Medicare Advantage,26.46,49,,percent of total billed charges,,
Sup Warming Bair Paw Gown,,12012794,LOCAL,Facility,Inpatient,,,,54,45.9,15.4764,54,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Warming Bair Paw Gown,,12012794,LOCAL,Facility,Both,,,,54,45.9,15.4764,54,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),32.4,60,,percent of total billed charges,,
Sup Warming Bair Paw Gown,,12012794,LOCAL,Facility,Both,,,,54,45.9,15.4764,54,"Health Partners, Inc.",State of Minnesota Advantage Program,44.01,81.5,,percent of total billed charges,,
Sup Warming Bair Paw Gown,,12012794,LOCAL,Facility,Both,,,,54,45.9,15.4764,54,"Health Partners, Inc.",State Public Programs,27,50,,percent of total billed charges,,
Sup Warming Bair Paw Gown,,12012794,LOCAL,Facility,Both,,,,54,45.9,15.4764,54,Humana Insurance Company,Commercial PPO,51.3,95,,percent of total billed charges,,
Sup Warming Bair Paw Gown,,12012794,LOCAL,Facility,Outpatient,,,,54,45.9,15.4764,54,Humana Insurance Company,Medicare PPO,26.46,49,,percent of total billed charges,,
Sup Warming Bair Paw Gown,,12012794,LOCAL,Facility,Inpatient,,,,54,45.9,15.4764,54,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Sup Warming Bair Paw Gown,,12012794,LOCAL,Facility,Both,,,,54,45.9,15.4764,54,Medica,Individual & Family,53.514,99.1,,percent of total billed charges,,
Sup Warming Bair Paw Gown,,12012794,LOCAL,Facility,Outpatient,,,,54,45.9,15.4764,54,Medica,Medica Advantage Solution,26.892,49.8,,percent of total billed charges,,
Sup Warming Bair Paw Gown,,12012794,LOCAL,Facility,Inpatient,,,,54,45.9,15.4764,54,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Sup Warming Bair Paw Gown,,12012794,LOCAL,Facility,Outpatient,,,,54,45.9,15.4764,54,Medica,Medical Assistance,24.084,44.6,,percent of total billed charges,,
Sup Warming Bair Paw Gown,,12012794,LOCAL,Facility,Inpatient,,,,54,45.9,15.4764,54,Medica,Medical Assistance,,,,,Included in per diem rate,
Sup Warming Bair Paw Gown,,12012794,LOCAL,Facility,Outpatient,,,,54,45.9,15.4764,54,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,26.892,49.8,,percent of total billed charges,,
Sup Warming Bair Paw Gown,,12012794,LOCAL,Facility,Inpatient,,,,54,45.9,15.4764,54,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Sup Warming Bair Paw Gown,,12012794,LOCAL,Facility,Both,,,,54,45.9,15.4764,54,"Multiplan, Inc.","Multiplan, Inc.",50.76,94,,percent of total billed charges,,
Sup Warming Bair Paw Gown,,12012794,LOCAL,Facility,Outpatient,,,,54,45.9,15.4764,54,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,48.654,90.1,,percent of total billed charges,,
Sup Warming Bair Paw Gown,,12012794,LOCAL,Facility,Inpatient,,,,54,45.9,15.4764,54,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Sup Warming Bair Paw Gown,,12012794,LOCAL,Facility,Both,,,,54,45.9,15.4764,54,"Preferred One Administrative Services, INC.",PPO,53.244,98.6,,percent of total billed charges,,
Sup Warming Bair Paw Gown,,12012794,LOCAL,Facility,Outpatient,,,,54,45.9,15.4764,54,PrimeWest Health,Minnesota Senior Health Options (MSHO),27.783,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Sup Warming Bair Paw Gown,,12012794,LOCAL,Facility,Inpatient,,,,54,45.9,15.4764,54,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Warming Bair Paw Gown,,12012794,LOCAL,Facility,Outpatient,,,,54,45.9,15.4764,54,PrimeWest Health,MinnesotaCare,27.7344,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Sup Warming Bair Paw Gown,,12012794,LOCAL,Facility,Inpatient,,,,54,45.9,15.4764,54,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Sup Warming Bair Paw Gown,,12012794,LOCAL,Facility,Both,,,,54,45.9,15.4764,54,Sanford Health Plan,Sanford Health Plan,49.68,92,,percent of total billed charges,,
Sup Warming Bair Paw Gown,,12012794,LOCAL,Facility,Outpatient,,,,54,45.9,15.4764,54,"UCare Health, Inc.",Individual & Family Plan,30.429,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Sup Warming Bair Paw Gown,,12012794,LOCAL,Facility,Inpatient,,,,54,45.9,15.4764,54,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Sup Warming Bair Paw Gown,,12012794,LOCAL,Facility,Outpatient,,,,54,45.9,15.4764,54,"UCare Health, Inc.",Medical Assistance,27.2538,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Warming Bair Paw Gown,,12012794,LOCAL,Facility,Inpatient,,,,54,45.9,15.4764,54,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Sup Warming Bair Paw Gown,,12012794,LOCAL,Facility,Outpatient,,,,54,45.9,15.4764,54,"UCare Health, Inc.",Medicare Advantage,27.2538,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Warming Bair Paw Gown,,12012794,LOCAL,Facility,Inpatient,,,,54,45.9,15.4764,54,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Warming Bair Paw Gown,,12012794,LOCAL,Facility,Outpatient,,,,54,45.9,15.4764,54,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),27.2538,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Warming Bair Paw Gown,,12012794,LOCAL,Facility,Inpatient,,,,54,45.9,15.4764,54,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Warming Bair Paw Gown,,12012794,LOCAL,Facility,Both,,,,54,45.9,15.4764,54,UnitedHealthcare,Individual & Family,50.76,94,,percent of total billed charges,,
Sup Warming Bair Paw Gown,,12012794,LOCAL,Facility,Outpatient,,,,54,45.9,15.4764,54,UnitedHealthcare,Medicare Advantage,26.46,49,,percent of total billed charges,,
Sup Warming Bair Paw Gown,,12012794,LOCAL,Facility,Inpatient,,,,54,45.9,15.4764,54,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Sup Warming Bair Paw Gown,,12012794,LOCAL,Facility,Outpatient,,,,54,45.9,15.4764,54,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,25.92,48,,percent of total billed charges,,100% of DHS outpatient percentage
Sup Warming Bair Paw Gown,,12012794,LOCAL,Facility,Inpatient,,,,54,45.9,15.4764,54,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Sup Stapler Skin 35W,,12012928,LOCAL,Facility,Both,,,,49,41.65,14.0434,49,Aetna,Commercial,45.08,92,,percent of total billed charges,,
Sup Stapler Skin 35W,,12012928,LOCAL,Facility,Outpatient,,,,49,41.65,14.0434,49,Aetna,Medicare Advantage,24.01,49,,percent of total billed charges,,
Sup Stapler Skin 35W,,12012928,LOCAL,Facility,Inpatient,,,,49,41.65,14.0434,49,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Sup Stapler Skin 35W,,12012928,LOCAL,Facility,Both,,,,49,41.65,14.0434,49,Aetna,PPO,45.57,93,,percent of total billed charges,,
Sup Stapler Skin 35W,,12012928,LOCAL,Facility,Both,,,,49,41.65,14.0434,49,America's PPO,America's PPO,47.0547,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Sup Stapler Skin 35W,,12012928,LOCAL,Facility,Both,,,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota, Federal Employee Program,48.216,98.4,,percent of total billed charges,,
Sup Stapler Skin 35W,,12012928,LOCAL,Facility,Both,,,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,49,100,,percent of total billed charges,,
Sup Stapler Skin 35W,,12012928,LOCAL,Facility,Both,,,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,High Value Network Plan,44.1,90,,percent of total billed charges,,
Sup Stapler Skin 35W,,12012928,LOCAL,Facility,Outpatient,,,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Medicare Advantage,24.01,49,,percent of total billed charges,,
Sup Stapler Skin 35W,,12012928,LOCAL,Facility,Inpatient,,,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Sup Stapler Skin 35W,,12012928,LOCAL,Facility,Both,,,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,43.3993,88.57,,percent of total billed charges,,
Sup Stapler Skin 35W,,12012928,LOCAL,Facility,Both,,,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,14.0434,28.66,,percent of total billed charges,,
Sup Stapler Skin 35W,,12012928,LOCAL,Facility,Outpatient,,,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),24.01,49,,percent of total billed charges,,
Sup Stapler Skin 35W,,12012928,LOCAL,Facility,Inpatient,,,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Sup Stapler Skin 35W,,12012928,LOCAL,Facility,Both,,,,49,41.65,14.0434,49,CorVel,Worker's Compensation,49,100,,percent of total billed charges,,
Sup Stapler Skin 35W,,12012928,LOCAL,Facility,Both,,,,49,41.65,14.0434,49,First Health Group Corporation,First Health Network,47.53,97,,percent of total billed charges,,
Sup Stapler Skin 35W,,12012928,LOCAL,Facility,Both,,,,49,41.65,14.0434,49,"Health Partners, Inc.",Commercial,46.354,94.6,,percent of total billed charges,,
Sup Stapler Skin 35W,,12012928,LOCAL,Facility,Outpatient,,,,49,41.65,14.0434,49,"Health Partners, Inc.",Medicare Advantage,24.01,49,,percent of total billed charges,,
Sup Stapler Skin 35W,,12012928,LOCAL,Facility,Inpatient,,,,49,41.65,14.0434,49,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Stapler Skin 35W,,12012928,LOCAL,Facility,Both,,,,49,41.65,14.0434,49,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),29.4,60,,percent of total billed charges,,
Sup Stapler Skin 35W,,12012928,LOCAL,Facility,Both,,,,49,41.65,14.0434,49,"Health Partners, Inc.",State of Minnesota Advantage Program,39.935,81.5,,percent of total billed charges,,
Sup Stapler Skin 35W,,12012928,LOCAL,Facility,Both,,,,49,41.65,14.0434,49,"Health Partners, Inc.",State Public Programs,24.5,50,,percent of total billed charges,,
Sup Stapler Skin 35W,,12012928,LOCAL,Facility,Both,,,,49,41.65,14.0434,49,Humana Insurance Company,Commercial PPO,46.55,95,,percent of total billed charges,,
Sup Stapler Skin 35W,,12012928,LOCAL,Facility,Outpatient,,,,49,41.65,14.0434,49,Humana Insurance Company,Medicare PPO,24.01,49,,percent of total billed charges,,
Sup Stapler Skin 35W,,12012928,LOCAL,Facility,Inpatient,,,,49,41.65,14.0434,49,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Sup Stapler Skin 35W,,12012928,LOCAL,Facility,Both,,,,49,41.65,14.0434,49,Medica,Individual & Family,48.559,99.1,,percent of total billed charges,,
Sup Stapler Skin 35W,,12012928,LOCAL,Facility,Outpatient,,,,49,41.65,14.0434,49,Medica,Medica Advantage Solution,24.402,49.8,,percent of total billed charges,,
Sup Stapler Skin 35W,,12012928,LOCAL,Facility,Inpatient,,,,49,41.65,14.0434,49,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Sup Stapler Skin 35W,,12012928,LOCAL,Facility,Outpatient,,,,49,41.65,14.0434,49,Medica,Medical Assistance,21.854,44.6,,percent of total billed charges,,
Sup Stapler Skin 35W,,12012928,LOCAL,Facility,Inpatient,,,,49,41.65,14.0434,49,Medica,Medical Assistance,,,,,Included in per diem rate,
Sup Stapler Skin 35W,,12012928,LOCAL,Facility,Outpatient,,,,49,41.65,14.0434,49,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,24.402,49.8,,percent of total billed charges,,
Sup Stapler Skin 35W,,12012928,LOCAL,Facility,Inpatient,,,,49,41.65,14.0434,49,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Sup Stapler Skin 35W,,12012928,LOCAL,Facility,Both,,,,49,41.65,14.0434,49,"Multiplan, Inc.","Multiplan, Inc.",46.06,94,,percent of total billed charges,,
Sup Stapler Skin 35W,,12012928,LOCAL,Facility,Outpatient,,,,49,41.65,14.0434,49,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,44.149,90.1,,percent of total billed charges,,
Sup Stapler Skin 35W,,12012928,LOCAL,Facility,Inpatient,,,,49,41.65,14.0434,49,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Sup Stapler Skin 35W,,12012928,LOCAL,Facility,Both,,,,49,41.65,14.0434,49,"Preferred One Administrative Services, INC.",PPO,48.314,98.6,,percent of total billed charges,,
Sup Stapler Skin 35W,,12012928,LOCAL,Facility,Outpatient,,,,49,41.65,14.0434,49,PrimeWest Health,Minnesota Senior Health Options (MSHO),25.2105,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Sup Stapler Skin 35W,,12012928,LOCAL,Facility,Inpatient,,,,49,41.65,14.0434,49,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Stapler Skin 35W,,12012928,LOCAL,Facility,Outpatient,,,,49,41.65,14.0434,49,PrimeWest Health,MinnesotaCare,25.1664,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Sup Stapler Skin 35W,,12012928,LOCAL,Facility,Inpatient,,,,49,41.65,14.0434,49,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Sup Stapler Skin 35W,,12012928,LOCAL,Facility,Both,,,,49,41.65,14.0434,49,Sanford Health Plan,Sanford Health Plan,45.08,92,,percent of total billed charges,,
Sup Stapler Skin 35W,,12012928,LOCAL,Facility,Outpatient,,,,49,41.65,14.0434,49,"UCare Health, Inc.",Individual & Family Plan,27.6115,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Sup Stapler Skin 35W,,12012928,LOCAL,Facility,Inpatient,,,,49,41.65,14.0434,49,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Sup Stapler Skin 35W,,12012928,LOCAL,Facility,Outpatient,,,,49,41.65,14.0434,49,"UCare Health, Inc.",Medical Assistance,24.7303,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Stapler Skin 35W,,12012928,LOCAL,Facility,Inpatient,,,,49,41.65,14.0434,49,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Sup Stapler Skin 35W,,12012928,LOCAL,Facility,Outpatient,,,,49,41.65,14.0434,49,"UCare Health, Inc.",Medicare Advantage,24.7303,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Stapler Skin 35W,,12012928,LOCAL,Facility,Inpatient,,,,49,41.65,14.0434,49,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Stapler Skin 35W,,12012928,LOCAL,Facility,Outpatient,,,,49,41.65,14.0434,49,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),24.7303,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Stapler Skin 35W,,12012928,LOCAL,Facility,Inpatient,,,,49,41.65,14.0434,49,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Stapler Skin 35W,,12012928,LOCAL,Facility,Both,,,,49,41.65,14.0434,49,UnitedHealthcare,Individual & Family,46.06,94,,percent of total billed charges,,
Sup Stapler Skin 35W,,12012928,LOCAL,Facility,Outpatient,,,,49,41.65,14.0434,49,UnitedHealthcare,Medicare Advantage,24.01,49,,percent of total billed charges,,
Sup Stapler Skin 35W,,12012928,LOCAL,Facility,Inpatient,,,,49,41.65,14.0434,49,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Sup Stapler Skin 35W,,12012928,LOCAL,Facility,Outpatient,,,,49,41.65,14.0434,49,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,23.52,48,,percent of total billed charges,,100% of DHS outpatient percentage
Sup Stapler Skin 35W,,12012928,LOCAL,Facility,Inpatient,,,,49,41.65,14.0434,49,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Sup Cannula Hiflow,,12014537,LOCAL,Facility,Both,,,,36,30.6,10.3176,36,Aetna,Commercial,33.12,92,,percent of total billed charges,,
Sup Cannula Hiflow,,12014537,LOCAL,Facility,Outpatient,,,,36,30.6,10.3176,36,Aetna,Medicare Advantage,17.64,49,,percent of total billed charges,,
Sup Cannula Hiflow,,12014537,LOCAL,Facility,Inpatient,,,,36,30.6,10.3176,36,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Sup Cannula Hiflow,,12014537,LOCAL,Facility,Both,,,,36,30.6,10.3176,36,Aetna,PPO,33.48,93,,percent of total billed charges,,
Sup Cannula Hiflow,,12014537,LOCAL,Facility,Both,,,,36,30.6,10.3176,36,America's PPO,America's PPO,34.5708,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Sup Cannula Hiflow,,12014537,LOCAL,Facility,Both,,,,36,30.6,10.3176,36,BlueCross BlueShield Minnesota, Federal Employee Program,35.424,98.4,,percent of total billed charges,,
Sup Cannula Hiflow,,12014537,LOCAL,Facility,Both,,,,36,30.6,10.3176,36,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,36,100,,percent of total billed charges,,
Sup Cannula Hiflow,,12014537,LOCAL,Facility,Both,,,,36,30.6,10.3176,36,BlueCross BlueShield Minnesota,High Value Network Plan,32.4,90,,percent of total billed charges,,
Sup Cannula Hiflow,,12014537,LOCAL,Facility,Outpatient,,,,36,30.6,10.3176,36,BlueCross BlueShield Minnesota,Medicare Advantage,17.64,49,,percent of total billed charges,,
Sup Cannula Hiflow,,12014537,LOCAL,Facility,Inpatient,,,,36,30.6,10.3176,36,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Sup Cannula Hiflow,,12014537,LOCAL,Facility,Both,,,,36,30.6,10.3176,36,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,31.8852,88.57,,percent of total billed charges,,
Sup Cannula Hiflow,,12014537,LOCAL,Facility,Both,,,,36,30.6,10.3176,36,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,10.3176,28.66,,percent of total billed charges,,
Sup Cannula Hiflow,,12014537,LOCAL,Facility,Outpatient,,,,36,30.6,10.3176,36,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),17.64,49,,percent of total billed charges,,
Sup Cannula Hiflow,,12014537,LOCAL,Facility,Inpatient,,,,36,30.6,10.3176,36,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Sup Cannula Hiflow,,12014537,LOCAL,Facility,Both,,,,36,30.6,10.3176,36,CorVel,Worker's Compensation,36,100,,percent of total billed charges,,
Sup Cannula Hiflow,,12014537,LOCAL,Facility,Both,,,,36,30.6,10.3176,36,First Health Group Corporation,First Health Network,34.92,97,,percent of total billed charges,,
Sup Cannula Hiflow,,12014537,LOCAL,Facility,Both,,,,36,30.6,10.3176,36,"Health Partners, Inc.",Commercial,34.056,94.6,,percent of total billed charges,,
Sup Cannula Hiflow,,12014537,LOCAL,Facility,Outpatient,,,,36,30.6,10.3176,36,"Health Partners, Inc.",Medicare Advantage,17.64,49,,percent of total billed charges,,
Sup Cannula Hiflow,,12014537,LOCAL,Facility,Inpatient,,,,36,30.6,10.3176,36,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Cannula Hiflow,,12014537,LOCAL,Facility,Both,,,,36,30.6,10.3176,36,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),21.6,60,,percent of total billed charges,,
Sup Cannula Hiflow,,12014537,LOCAL,Facility,Both,,,,36,30.6,10.3176,36,"Health Partners, Inc.",State of Minnesota Advantage Program,29.34,81.5,,percent of total billed charges,,
Sup Cannula Hiflow,,12014537,LOCAL,Facility,Both,,,,36,30.6,10.3176,36,"Health Partners, Inc.",State Public Programs,18,50,,percent of total billed charges,,
Sup Cannula Hiflow,,12014537,LOCAL,Facility,Both,,,,36,30.6,10.3176,36,Humana Insurance Company,Commercial PPO,34.2,95,,percent of total billed charges,,
Sup Cannula Hiflow,,12014537,LOCAL,Facility,Outpatient,,,,36,30.6,10.3176,36,Humana Insurance Company,Medicare PPO,17.64,49,,percent of total billed charges,,
Sup Cannula Hiflow,,12014537,LOCAL,Facility,Inpatient,,,,36,30.6,10.3176,36,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Sup Cannula Hiflow,,12014537,LOCAL,Facility,Both,,,,36,30.6,10.3176,36,Medica,Individual & Family,35.676,99.1,,percent of total billed charges,,
Sup Cannula Hiflow,,12014537,LOCAL,Facility,Outpatient,,,,36,30.6,10.3176,36,Medica,Medica Advantage Solution,17.928,49.8,,percent of total billed charges,,
Sup Cannula Hiflow,,12014537,LOCAL,Facility,Inpatient,,,,36,30.6,10.3176,36,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Sup Cannula Hiflow,,12014537,LOCAL,Facility,Outpatient,,,,36,30.6,10.3176,36,Medica,Medical Assistance,16.056,44.6,,percent of total billed charges,,
Sup Cannula Hiflow,,12014537,LOCAL,Facility,Inpatient,,,,36,30.6,10.3176,36,Medica,Medical Assistance,,,,,Included in per diem rate,
Sup Cannula Hiflow,,12014537,LOCAL,Facility,Outpatient,,,,36,30.6,10.3176,36,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,17.928,49.8,,percent of total billed charges,,
Sup Cannula Hiflow,,12014537,LOCAL,Facility,Inpatient,,,,36,30.6,10.3176,36,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Sup Cannula Hiflow,,12014537,LOCAL,Facility,Both,,,,36,30.6,10.3176,36,"Multiplan, Inc.","Multiplan, Inc.",33.84,94,,percent of total billed charges,,
Sup Cannula Hiflow,,12014537,LOCAL,Facility,Outpatient,,,,36,30.6,10.3176,36,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,32.436,90.1,,percent of total billed charges,,
Sup Cannula Hiflow,,12014537,LOCAL,Facility,Inpatient,,,,36,30.6,10.3176,36,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Sup Cannula Hiflow,,12014537,LOCAL,Facility,Both,,,,36,30.6,10.3176,36,"Preferred One Administrative Services, INC.",PPO,35.496,98.6,,percent of total billed charges,,
Sup Cannula Hiflow,,12014537,LOCAL,Facility,Outpatient,,,,36,30.6,10.3176,36,PrimeWest Health,Minnesota Senior Health Options (MSHO),18.522,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Sup Cannula Hiflow,,12014537,LOCAL,Facility,Inpatient,,,,36,30.6,10.3176,36,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Cannula Hiflow,,12014537,LOCAL,Facility,Outpatient,,,,36,30.6,10.3176,36,PrimeWest Health,MinnesotaCare,18.4896,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Sup Cannula Hiflow,,12014537,LOCAL,Facility,Inpatient,,,,36,30.6,10.3176,36,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Sup Cannula Hiflow,,12014537,LOCAL,Facility,Both,,,,36,30.6,10.3176,36,Sanford Health Plan,Sanford Health Plan,33.12,92,,percent of total billed charges,,
Sup Cannula Hiflow,,12014537,LOCAL,Facility,Outpatient,,,,36,30.6,10.3176,36,"UCare Health, Inc.",Individual & Family Plan,20.286,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Sup Cannula Hiflow,,12014537,LOCAL,Facility,Inpatient,,,,36,30.6,10.3176,36,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Sup Cannula Hiflow,,12014537,LOCAL,Facility,Outpatient,,,,36,30.6,10.3176,36,"UCare Health, Inc.",Medical Assistance,18.1692,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Cannula Hiflow,,12014537,LOCAL,Facility,Inpatient,,,,36,30.6,10.3176,36,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Sup Cannula Hiflow,,12014537,LOCAL,Facility,Outpatient,,,,36,30.6,10.3176,36,"UCare Health, Inc.",Medicare Advantage,18.1692,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Cannula Hiflow,,12014537,LOCAL,Facility,Inpatient,,,,36,30.6,10.3176,36,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Cannula Hiflow,,12014537,LOCAL,Facility,Outpatient,,,,36,30.6,10.3176,36,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),18.1692,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Cannula Hiflow,,12014537,LOCAL,Facility,Inpatient,,,,36,30.6,10.3176,36,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Cannula Hiflow,,12014537,LOCAL,Facility,Both,,,,36,30.6,10.3176,36,UnitedHealthcare,Individual & Family,33.84,94,,percent of total billed charges,,
Sup Cannula Hiflow,,12014537,LOCAL,Facility,Outpatient,,,,36,30.6,10.3176,36,UnitedHealthcare,Medicare Advantage,17.64,49,,percent of total billed charges,,
Sup Cannula Hiflow,,12014537,LOCAL,Facility,Inpatient,,,,36,30.6,10.3176,36,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Sup Cannula Hiflow,,12014537,LOCAL,Facility,Outpatient,,,,36,30.6,10.3176,36,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,17.28,48,,percent of total billed charges,,100% of DHS outpatient percentage
Sup Cannula Hiflow,,12014537,LOCAL,Facility,Inpatient,,,,36,30.6,10.3176,36,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Sup Cpap Supplies,,12015453,LOCAL,Facility,Both,,,,214,181.9,61.3324,214,Aetna,Commercial,196.88,92,,percent of total billed charges,,
Sup Cpap Supplies,,12015453,LOCAL,Facility,Outpatient,,,,214,181.9,61.3324,214,Aetna,Medicare Advantage,104.86,49,,percent of total billed charges,,
Sup Cpap Supplies,,12015453,LOCAL,Facility,Inpatient,,,,214,181.9,61.3324,214,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Sup Cpap Supplies,,12015453,LOCAL,Facility,Both,,,,214,181.9,61.3324,214,Aetna,PPO,199.02,93,,percent of total billed charges,,
Sup Cpap Supplies,,12015453,LOCAL,Facility,Both,,,,214,181.9,61.3324,214,America's PPO,America's PPO,205.5042,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Sup Cpap Supplies,,12015453,LOCAL,Facility,Both,,,,214,181.9,61.3324,214,BlueCross BlueShield Minnesota, Federal Employee Program,210.576,98.4,,percent of total billed charges,,
Sup Cpap Supplies,,12015453,LOCAL,Facility,Both,,,,214,181.9,61.3324,214,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,214,100,,percent of total billed charges,,
Sup Cpap Supplies,,12015453,LOCAL,Facility,Both,,,,214,181.9,61.3324,214,BlueCross BlueShield Minnesota,High Value Network Plan,192.6,90,,percent of total billed charges,,
Sup Cpap Supplies,,12015453,LOCAL,Facility,Outpatient,,,,214,181.9,61.3324,214,BlueCross BlueShield Minnesota,Medicare Advantage,104.86,49,,percent of total billed charges,,
Sup Cpap Supplies,,12015453,LOCAL,Facility,Inpatient,,,,214,181.9,61.3324,214,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Sup Cpap Supplies,,12015453,LOCAL,Facility,Both,,,,214,181.9,61.3324,214,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,189.5398,88.57,,percent of total billed charges,,
Sup Cpap Supplies,,12015453,LOCAL,Facility,Both,,,,214,181.9,61.3324,214,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,61.3324,28.66,,percent of total billed charges,,
Sup Cpap Supplies,,12015453,LOCAL,Facility,Outpatient,,,,214,181.9,61.3324,214,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),104.86,49,,percent of total billed charges,,
Sup Cpap Supplies,,12015453,LOCAL,Facility,Inpatient,,,,214,181.9,61.3324,214,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Sup Cpap Supplies,,12015453,LOCAL,Facility,Both,,,,214,181.9,61.3324,214,CorVel,Worker's Compensation,214,100,,percent of total billed charges,,
Sup Cpap Supplies,,12015453,LOCAL,Facility,Both,,,,214,181.9,61.3324,214,First Health Group Corporation,First Health Network,207.58,97,,percent of total billed charges,,
Sup Cpap Supplies,,12015453,LOCAL,Facility,Both,,,,214,181.9,61.3324,214,"Health Partners, Inc.",Commercial,202.444,94.6,,percent of total billed charges,,
Sup Cpap Supplies,,12015453,LOCAL,Facility,Outpatient,,,,214,181.9,61.3324,214,"Health Partners, Inc.",Medicare Advantage,104.86,49,,percent of total billed charges,,
Sup Cpap Supplies,,12015453,LOCAL,Facility,Inpatient,,,,214,181.9,61.3324,214,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Cpap Supplies,,12015453,LOCAL,Facility,Both,,,,214,181.9,61.3324,214,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),128.4,60,,percent of total billed charges,,
Sup Cpap Supplies,,12015453,LOCAL,Facility,Both,,,,214,181.9,61.3324,214,"Health Partners, Inc.",State of Minnesota Advantage Program,174.41,81.5,,percent of total billed charges,,
Sup Cpap Supplies,,12015453,LOCAL,Facility,Both,,,,214,181.9,61.3324,214,"Health Partners, Inc.",State Public Programs,107,50,,percent of total billed charges,,
Sup Cpap Supplies,,12015453,LOCAL,Facility,Both,,,,214,181.9,61.3324,214,Humana Insurance Company,Commercial PPO,203.3,95,,percent of total billed charges,,
Sup Cpap Supplies,,12015453,LOCAL,Facility,Outpatient,,,,214,181.9,61.3324,214,Humana Insurance Company,Medicare PPO,104.86,49,,percent of total billed charges,,
Sup Cpap Supplies,,12015453,LOCAL,Facility,Inpatient,,,,214,181.9,61.3324,214,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Sup Cpap Supplies,,12015453,LOCAL,Facility,Both,,,,214,181.9,61.3324,214,Medica,Individual & Family,212.074,99.1,,percent of total billed charges,,
Sup Cpap Supplies,,12015453,LOCAL,Facility,Outpatient,,,,214,181.9,61.3324,214,Medica,Medica Advantage Solution,106.572,49.8,,percent of total billed charges,,
Sup Cpap Supplies,,12015453,LOCAL,Facility,Inpatient,,,,214,181.9,61.3324,214,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Sup Cpap Supplies,,12015453,LOCAL,Facility,Outpatient,,,,214,181.9,61.3324,214,Medica,Medical Assistance,95.444,44.6,,percent of total billed charges,,
Sup Cpap Supplies,,12015453,LOCAL,Facility,Inpatient,,,,214,181.9,61.3324,214,Medica,Medical Assistance,,,,,Included in per diem rate,
Sup Cpap Supplies,,12015453,LOCAL,Facility,Outpatient,,,,214,181.9,61.3324,214,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,106.572,49.8,,percent of total billed charges,,
Sup Cpap Supplies,,12015453,LOCAL,Facility,Inpatient,,,,214,181.9,61.3324,214,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Sup Cpap Supplies,,12015453,LOCAL,Facility,Both,,,,214,181.9,61.3324,214,"Multiplan, Inc.","Multiplan, Inc.",201.16,94,,percent of total billed charges,,
Sup Cpap Supplies,,12015453,LOCAL,Facility,Outpatient,,,,214,181.9,61.3324,214,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,192.814,90.1,,percent of total billed charges,,
Sup Cpap Supplies,,12015453,LOCAL,Facility,Inpatient,,,,214,181.9,61.3324,214,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Sup Cpap Supplies,,12015453,LOCAL,Facility,Both,,,,214,181.9,61.3324,214,"Preferred One Administrative Services, INC.",PPO,211.004,98.6,,percent of total billed charges,,
Sup Cpap Supplies,,12015453,LOCAL,Facility,Outpatient,,,,214,181.9,61.3324,214,PrimeWest Health,Minnesota Senior Health Options (MSHO),110.103,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Sup Cpap Supplies,,12015453,LOCAL,Facility,Inpatient,,,,214,181.9,61.3324,214,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Cpap Supplies,,12015453,LOCAL,Facility,Outpatient,,,,214,181.9,61.3324,214,PrimeWest Health,MinnesotaCare,109.9104,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Sup Cpap Supplies,,12015453,LOCAL,Facility,Inpatient,,,,214,181.9,61.3324,214,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Sup Cpap Supplies,,12015453,LOCAL,Facility,Both,,,,214,181.9,61.3324,214,Sanford Health Plan,Sanford Health Plan,196.88,92,,percent of total billed charges,,
Sup Cpap Supplies,,12015453,LOCAL,Facility,Outpatient,,,,214,181.9,61.3324,214,"UCare Health, Inc.",Individual & Family Plan,120.589,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Sup Cpap Supplies,,12015453,LOCAL,Facility,Inpatient,,,,214,181.9,61.3324,214,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Sup Cpap Supplies,,12015453,LOCAL,Facility,Outpatient,,,,214,181.9,61.3324,214,"UCare Health, Inc.",Medical Assistance,108.0058,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Cpap Supplies,,12015453,LOCAL,Facility,Inpatient,,,,214,181.9,61.3324,214,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Sup Cpap Supplies,,12015453,LOCAL,Facility,Outpatient,,,,214,181.9,61.3324,214,"UCare Health, Inc.",Medicare Advantage,108.0058,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Cpap Supplies,,12015453,LOCAL,Facility,Inpatient,,,,214,181.9,61.3324,214,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Cpap Supplies,,12015453,LOCAL,Facility,Outpatient,,,,214,181.9,61.3324,214,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),108.0058,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Cpap Supplies,,12015453,LOCAL,Facility,Inpatient,,,,214,181.9,61.3324,214,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Cpap Supplies,,12015453,LOCAL,Facility,Both,,,,214,181.9,61.3324,214,UnitedHealthcare,Individual & Family,201.16,94,,percent of total billed charges,,
Sup Cpap Supplies,,12015453,LOCAL,Facility,Outpatient,,,,214,181.9,61.3324,214,UnitedHealthcare,Medicare Advantage,104.86,49,,percent of total billed charges,,
Sup Cpap Supplies,,12015453,LOCAL,Facility,Inpatient,,,,214,181.9,61.3324,214,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Sup Cpap Supplies,,12015453,LOCAL,Facility,Outpatient,,,,214,181.9,61.3324,214,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,102.72,48,,percent of total billed charges,,100% of DHS outpatient percentage
Sup Cpap Supplies,,12015453,LOCAL,Facility,Inpatient,,,,214,181.9,61.3324,214,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Sup Mepilex Foam And Borders All Sizes,,12015551,LOCAL,Facility,Both,,,,16.73,14.2205,4.794818,16.73,Aetna,Commercial,15.3916,92,,percent of total billed charges,,
Sup Mepilex Foam And Borders All Sizes,,12015551,LOCAL,Facility,Outpatient,,,,16.73,14.2205,4.794818,16.73,Aetna,Medicare Advantage,8.1977,49,,percent of total billed charges,,
Sup Mepilex Foam And Borders All Sizes,,12015551,LOCAL,Facility,Inpatient,,,,16.73,14.2205,4.794818,16.73,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Sup Mepilex Foam And Borders All Sizes,,12015551,LOCAL,Facility,Both,,,,16.73,14.2205,4.794818,16.73,Aetna,PPO,15.5589,93,,percent of total billed charges,,
Sup Mepilex Foam And Borders All Sizes,,12015551,LOCAL,Facility,Both,,,,16.73,14.2205,4.794818,16.73,America's PPO,America's PPO,16.065819,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Sup Mepilex Foam And Borders All Sizes,,12015551,LOCAL,Facility,Both,,,,16.73,14.2205,4.794818,16.73,BlueCross BlueShield Minnesota, Federal Employee Program,16.46232,98.4,,percent of total billed charges,,
Sup Mepilex Foam And Borders All Sizes,,12015551,LOCAL,Facility,Both,,,,16.73,14.2205,4.794818,16.73,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,16.73,100,,percent of total billed charges,,
Sup Mepilex Foam And Borders All Sizes,,12015551,LOCAL,Facility,Both,,,,16.73,14.2205,4.794818,16.73,BlueCross BlueShield Minnesota,High Value Network Plan,15.057,90,,percent of total billed charges,,
Sup Mepilex Foam And Borders All Sizes,,12015551,LOCAL,Facility,Outpatient,,,,16.73,14.2205,4.794818,16.73,BlueCross BlueShield Minnesota,Medicare Advantage,8.1977,49,,percent of total billed charges,,
Sup Mepilex Foam And Borders All Sizes,,12015551,LOCAL,Facility,Inpatient,,,,16.73,14.2205,4.794818,16.73,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Sup Mepilex Foam And Borders All Sizes,,12015551,LOCAL,Facility,Both,,,,16.73,14.2205,4.794818,16.73,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,14.817761,88.57,,percent of total billed charges,,
Sup Mepilex Foam And Borders All Sizes,,12015551,LOCAL,Facility,Both,,,,16.73,14.2205,4.794818,16.73,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,4.794818,28.66,,percent of total billed charges,,
Sup Mepilex Foam And Borders All Sizes,,12015551,LOCAL,Facility,Outpatient,,,,16.73,14.2205,4.794818,16.73,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),8.1977,49,,percent of total billed charges,,
Sup Mepilex Foam And Borders All Sizes,,12015551,LOCAL,Facility,Inpatient,,,,16.73,14.2205,4.794818,16.73,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Sup Mepilex Foam And Borders All Sizes,,12015551,LOCAL,Facility,Both,,,,16.73,14.2205,4.794818,16.73,CorVel,Worker's Compensation,16.73,100,,percent of total billed charges,,
Sup Mepilex Foam And Borders All Sizes,,12015551,LOCAL,Facility,Both,,,,16.73,14.2205,4.794818,16.73,First Health Group Corporation,First Health Network,16.2281,97,,percent of total billed charges,,
Sup Mepilex Foam And Borders All Sizes,,12015551,LOCAL,Facility,Both,,,,16.73,14.2205,4.794818,16.73,"Health Partners, Inc.",Commercial,15.82658,94.6,,percent of total billed charges,,
Sup Mepilex Foam And Borders All Sizes,,12015551,LOCAL,Facility,Outpatient,,,,16.73,14.2205,4.794818,16.73,"Health Partners, Inc.",Medicare Advantage,8.1977,49,,percent of total billed charges,,
Sup Mepilex Foam And Borders All Sizes,,12015551,LOCAL,Facility,Inpatient,,,,16.73,14.2205,4.794818,16.73,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Mepilex Foam And Borders All Sizes,,12015551,LOCAL,Facility,Both,,,,16.73,14.2205,4.794818,16.73,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),10.038,60,,percent of total billed charges,,
Sup Mepilex Foam And Borders All Sizes,,12015551,LOCAL,Facility,Both,,,,16.73,14.2205,4.794818,16.73,"Health Partners, Inc.",State of Minnesota Advantage Program,13.63495,81.5,,percent of total billed charges,,
Sup Mepilex Foam And Borders All Sizes,,12015551,LOCAL,Facility,Both,,,,16.73,14.2205,4.794818,16.73,"Health Partners, Inc.",State Public Programs,8.365,50,,percent of total billed charges,,
Sup Mepilex Foam And Borders All Sizes,,12015551,LOCAL,Facility,Both,,,,16.73,14.2205,4.794818,16.73,Humana Insurance Company,Commercial PPO,15.8935,95,,percent of total billed charges,,
Sup Mepilex Foam And Borders All Sizes,,12015551,LOCAL,Facility,Outpatient,,,,16.73,14.2205,4.794818,16.73,Humana Insurance Company,Medicare PPO,8.1977,49,,percent of total billed charges,,
Sup Mepilex Foam And Borders All Sizes,,12015551,LOCAL,Facility,Inpatient,,,,16.73,14.2205,4.794818,16.73,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Sup Mepilex Foam And Borders All Sizes,,12015551,LOCAL,Facility,Both,,,,16.73,14.2205,4.794818,16.73,Medica,Individual & Family,16.57943,99.1,,percent of total billed charges,,
Sup Mepilex Foam And Borders All Sizes,,12015551,LOCAL,Facility,Outpatient,,,,16.73,14.2205,4.794818,16.73,Medica,Medica Advantage Solution,8.33154,49.8,,percent of total billed charges,,
Sup Mepilex Foam And Borders All Sizes,,12015551,LOCAL,Facility,Inpatient,,,,16.73,14.2205,4.794818,16.73,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Sup Mepilex Foam And Borders All Sizes,,12015551,LOCAL,Facility,Outpatient,,,,16.73,14.2205,4.794818,16.73,Medica,Medical Assistance,7.46158,44.6,,percent of total billed charges,,
Sup Mepilex Foam And Borders All Sizes,,12015551,LOCAL,Facility,Inpatient,,,,16.73,14.2205,4.794818,16.73,Medica,Medical Assistance,,,,,Included in per diem rate,
Sup Mepilex Foam And Borders All Sizes,,12015551,LOCAL,Facility,Outpatient,,,,16.73,14.2205,4.794818,16.73,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,8.33154,49.8,,percent of total billed charges,,
Sup Mepilex Foam And Borders All Sizes,,12015551,LOCAL,Facility,Inpatient,,,,16.73,14.2205,4.794818,16.73,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Sup Mepilex Foam And Borders All Sizes,,12015551,LOCAL,Facility,Both,,,,16.73,14.2205,4.794818,16.73,"Multiplan, Inc.","Multiplan, Inc.",15.7262,94,,percent of total billed charges,,
Sup Mepilex Foam And Borders All Sizes,,12015551,LOCAL,Facility,Outpatient,,,,16.73,14.2205,4.794818,16.73,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,15.07373,90.1,,percent of total billed charges,,
Sup Mepilex Foam And Borders All Sizes,,12015551,LOCAL,Facility,Inpatient,,,,16.73,14.2205,4.794818,16.73,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Sup Mepilex Foam And Borders All Sizes,,12015551,LOCAL,Facility,Both,,,,16.73,14.2205,4.794818,16.73,"Preferred One Administrative Services, INC.",PPO,16.49578,98.6,,percent of total billed charges,,
Sup Mepilex Foam And Borders All Sizes,,12015551,LOCAL,Facility,Outpatient,,,,16.73,14.2205,4.794818,16.73,PrimeWest Health,Minnesota Senior Health Options (MSHO),8.607585,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Sup Mepilex Foam And Borders All Sizes,,12015551,LOCAL,Facility,Inpatient,,,,16.73,14.2205,4.794818,16.73,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Mepilex Foam And Borders All Sizes,,12015551,LOCAL,Facility,Outpatient,,,,16.73,14.2205,4.794818,16.73,PrimeWest Health,MinnesotaCare,8.592528,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Sup Mepilex Foam And Borders All Sizes,,12015551,LOCAL,Facility,Inpatient,,,,16.73,14.2205,4.794818,16.73,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Sup Mepilex Foam And Borders All Sizes,,12015551,LOCAL,Facility,Both,,,,16.73,14.2205,4.794818,16.73,Sanford Health Plan,Sanford Health Plan,15.3916,92,,percent of total billed charges,,
Sup Mepilex Foam And Borders All Sizes,,12015551,LOCAL,Facility,Outpatient,,,,16.73,14.2205,4.794818,16.73,"UCare Health, Inc.",Individual & Family Plan,9.427355,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Sup Mepilex Foam And Borders All Sizes,,12015551,LOCAL,Facility,Inpatient,,,,16.73,14.2205,4.794818,16.73,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Sup Mepilex Foam And Borders All Sizes,,12015551,LOCAL,Facility,Outpatient,,,,16.73,14.2205,4.794818,16.73,"UCare Health, Inc.",Medical Assistance,8.443631,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Mepilex Foam And Borders All Sizes,,12015551,LOCAL,Facility,Inpatient,,,,16.73,14.2205,4.794818,16.73,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Sup Mepilex Foam And Borders All Sizes,,12015551,LOCAL,Facility,Outpatient,,,,16.73,14.2205,4.794818,16.73,"UCare Health, Inc.",Medicare Advantage,8.443631,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Mepilex Foam And Borders All Sizes,,12015551,LOCAL,Facility,Inpatient,,,,16.73,14.2205,4.794818,16.73,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Mepilex Foam And Borders All Sizes,,12015551,LOCAL,Facility,Outpatient,,,,16.73,14.2205,4.794818,16.73,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),8.443631,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Mepilex Foam And Borders All Sizes,,12015551,LOCAL,Facility,Inpatient,,,,16.73,14.2205,4.794818,16.73,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Mepilex Foam And Borders All Sizes,,12015551,LOCAL,Facility,Both,,,,16.73,14.2205,4.794818,16.73,UnitedHealthcare,Individual & Family,15.7262,94,,percent of total billed charges,,
Sup Mepilex Foam And Borders All Sizes,,12015551,LOCAL,Facility,Outpatient,,,,16.73,14.2205,4.794818,16.73,UnitedHealthcare,Medicare Advantage,8.1977,49,,percent of total billed charges,,
Sup Mepilex Foam And Borders All Sizes,,12015551,LOCAL,Facility,Inpatient,,,,16.73,14.2205,4.794818,16.73,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Sup Mepilex Foam And Borders All Sizes,,12015551,LOCAL,Facility,Outpatient,,,,16.73,14.2205,4.794818,16.73,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,8.0304,48,,percent of total billed charges,,100% of DHS outpatient percentage
Sup Mepilex Foam And Borders All Sizes,,12015551,LOCAL,Facility,Inpatient,,,,16.73,14.2205,4.794818,16.73,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Sup Rapid Rhino All Sizes,,12015679,LOCAL,Facility,Both,,,,135,114.75,38.691,135,Aetna,Commercial,124.2,92,,percent of total billed charges,,
Sup Rapid Rhino All Sizes,,12015679,LOCAL,Facility,Outpatient,,,,135,114.75,38.691,135,Aetna,Medicare Advantage,66.15,49,,percent of total billed charges,,
Sup Rapid Rhino All Sizes,,12015679,LOCAL,Facility,Inpatient,,,,135,114.75,38.691,135,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Sup Rapid Rhino All Sizes,,12015679,LOCAL,Facility,Both,,,,135,114.75,38.691,135,Aetna,PPO,125.55,93,,percent of total billed charges,,
Sup Rapid Rhino All Sizes,,12015679,LOCAL,Facility,Both,,,,135,114.75,38.691,135,America's PPO,America's PPO,129.6405,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Sup Rapid Rhino All Sizes,,12015679,LOCAL,Facility,Both,,,,135,114.75,38.691,135,BlueCross BlueShield Minnesota, Federal Employee Program,132.84,98.4,,percent of total billed charges,,
Sup Rapid Rhino All Sizes,,12015679,LOCAL,Facility,Both,,,,135,114.75,38.691,135,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,135,100,,percent of total billed charges,,
Sup Rapid Rhino All Sizes,,12015679,LOCAL,Facility,Both,,,,135,114.75,38.691,135,BlueCross BlueShield Minnesota,High Value Network Plan,121.5,90,,percent of total billed charges,,
Sup Rapid Rhino All Sizes,,12015679,LOCAL,Facility,Outpatient,,,,135,114.75,38.691,135,BlueCross BlueShield Minnesota,Medicare Advantage,66.15,49,,percent of total billed charges,,
Sup Rapid Rhino All Sizes,,12015679,LOCAL,Facility,Inpatient,,,,135,114.75,38.691,135,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Sup Rapid Rhino All Sizes,,12015679,LOCAL,Facility,Both,,,,135,114.75,38.691,135,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,119.5695,88.57,,percent of total billed charges,,
Sup Rapid Rhino All Sizes,,12015679,LOCAL,Facility,Both,,,,135,114.75,38.691,135,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,38.691,28.66,,percent of total billed charges,,
Sup Rapid Rhino All Sizes,,12015679,LOCAL,Facility,Outpatient,,,,135,114.75,38.691,135,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),66.15,49,,percent of total billed charges,,
Sup Rapid Rhino All Sizes,,12015679,LOCAL,Facility,Inpatient,,,,135,114.75,38.691,135,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Sup Rapid Rhino All Sizes,,12015679,LOCAL,Facility,Both,,,,135,114.75,38.691,135,CorVel,Worker's Compensation,135,100,,percent of total billed charges,,
Sup Rapid Rhino All Sizes,,12015679,LOCAL,Facility,Both,,,,135,114.75,38.691,135,First Health Group Corporation,First Health Network,130.95,97,,percent of total billed charges,,
Sup Rapid Rhino All Sizes,,12015679,LOCAL,Facility,Both,,,,135,114.75,38.691,135,"Health Partners, Inc.",Commercial,127.71,94.6,,percent of total billed charges,,
Sup Rapid Rhino All Sizes,,12015679,LOCAL,Facility,Outpatient,,,,135,114.75,38.691,135,"Health Partners, Inc.",Medicare Advantage,66.15,49,,percent of total billed charges,,
Sup Rapid Rhino All Sizes,,12015679,LOCAL,Facility,Inpatient,,,,135,114.75,38.691,135,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Rapid Rhino All Sizes,,12015679,LOCAL,Facility,Both,,,,135,114.75,38.691,135,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),81,60,,percent of total billed charges,,
Sup Rapid Rhino All Sizes,,12015679,LOCAL,Facility,Both,,,,135,114.75,38.691,135,"Health Partners, Inc.",State of Minnesota Advantage Program,110.025,81.5,,percent of total billed charges,,
Sup Rapid Rhino All Sizes,,12015679,LOCAL,Facility,Both,,,,135,114.75,38.691,135,"Health Partners, Inc.",State Public Programs,67.5,50,,percent of total billed charges,,
Sup Rapid Rhino All Sizes,,12015679,LOCAL,Facility,Both,,,,135,114.75,38.691,135,Humana Insurance Company,Commercial PPO,128.25,95,,percent of total billed charges,,
Sup Rapid Rhino All Sizes,,12015679,LOCAL,Facility,Outpatient,,,,135,114.75,38.691,135,Humana Insurance Company,Medicare PPO,66.15,49,,percent of total billed charges,,
Sup Rapid Rhino All Sizes,,12015679,LOCAL,Facility,Inpatient,,,,135,114.75,38.691,135,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Sup Rapid Rhino All Sizes,,12015679,LOCAL,Facility,Both,,,,135,114.75,38.691,135,Medica,Individual & Family,133.785,99.1,,percent of total billed charges,,
Sup Rapid Rhino All Sizes,,12015679,LOCAL,Facility,Outpatient,,,,135,114.75,38.691,135,Medica,Medica Advantage Solution,67.23,49.8,,percent of total billed charges,,
Sup Rapid Rhino All Sizes,,12015679,LOCAL,Facility,Inpatient,,,,135,114.75,38.691,135,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Sup Rapid Rhino All Sizes,,12015679,LOCAL,Facility,Outpatient,,,,135,114.75,38.691,135,Medica,Medical Assistance,60.21,44.6,,percent of total billed charges,,
Sup Rapid Rhino All Sizes,,12015679,LOCAL,Facility,Inpatient,,,,135,114.75,38.691,135,Medica,Medical Assistance,,,,,Included in per diem rate,
Sup Rapid Rhino All Sizes,,12015679,LOCAL,Facility,Outpatient,,,,135,114.75,38.691,135,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,67.23,49.8,,percent of total billed charges,,
Sup Rapid Rhino All Sizes,,12015679,LOCAL,Facility,Inpatient,,,,135,114.75,38.691,135,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Sup Rapid Rhino All Sizes,,12015679,LOCAL,Facility,Both,,,,135,114.75,38.691,135,"Multiplan, Inc.","Multiplan, Inc.",126.9,94,,percent of total billed charges,,
Sup Rapid Rhino All Sizes,,12015679,LOCAL,Facility,Outpatient,,,,135,114.75,38.691,135,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,121.635,90.1,,percent of total billed charges,,
Sup Rapid Rhino All Sizes,,12015679,LOCAL,Facility,Inpatient,,,,135,114.75,38.691,135,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Sup Rapid Rhino All Sizes,,12015679,LOCAL,Facility,Both,,,,135,114.75,38.691,135,"Preferred One Administrative Services, INC.",PPO,133.11,98.6,,percent of total billed charges,,
Sup Rapid Rhino All Sizes,,12015679,LOCAL,Facility,Outpatient,,,,135,114.75,38.691,135,PrimeWest Health,Minnesota Senior Health Options (MSHO),69.4575,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Sup Rapid Rhino All Sizes,,12015679,LOCAL,Facility,Inpatient,,,,135,114.75,38.691,135,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Rapid Rhino All Sizes,,12015679,LOCAL,Facility,Outpatient,,,,135,114.75,38.691,135,PrimeWest Health,MinnesotaCare,69.336,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Sup Rapid Rhino All Sizes,,12015679,LOCAL,Facility,Inpatient,,,,135,114.75,38.691,135,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Sup Rapid Rhino All Sizes,,12015679,LOCAL,Facility,Both,,,,135,114.75,38.691,135,Sanford Health Plan,Sanford Health Plan,124.2,92,,percent of total billed charges,,
Sup Rapid Rhino All Sizes,,12015679,LOCAL,Facility,Outpatient,,,,135,114.75,38.691,135,"UCare Health, Inc.",Individual & Family Plan,76.0725,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Sup Rapid Rhino All Sizes,,12015679,LOCAL,Facility,Inpatient,,,,135,114.75,38.691,135,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Sup Rapid Rhino All Sizes,,12015679,LOCAL,Facility,Outpatient,,,,135,114.75,38.691,135,"UCare Health, Inc.",Medical Assistance,68.1345,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Rapid Rhino All Sizes,,12015679,LOCAL,Facility,Inpatient,,,,135,114.75,38.691,135,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Sup Rapid Rhino All Sizes,,12015679,LOCAL,Facility,Outpatient,,,,135,114.75,38.691,135,"UCare Health, Inc.",Medicare Advantage,68.1345,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Rapid Rhino All Sizes,,12015679,LOCAL,Facility,Inpatient,,,,135,114.75,38.691,135,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Rapid Rhino All Sizes,,12015679,LOCAL,Facility,Outpatient,,,,135,114.75,38.691,135,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),68.1345,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Rapid Rhino All Sizes,,12015679,LOCAL,Facility,Inpatient,,,,135,114.75,38.691,135,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Rapid Rhino All Sizes,,12015679,LOCAL,Facility,Both,,,,135,114.75,38.691,135,UnitedHealthcare,Individual & Family,126.9,94,,percent of total billed charges,,
Sup Rapid Rhino All Sizes,,12015679,LOCAL,Facility,Outpatient,,,,135,114.75,38.691,135,UnitedHealthcare,Medicare Advantage,66.15,49,,percent of total billed charges,,
Sup Rapid Rhino All Sizes,,12015679,LOCAL,Facility,Inpatient,,,,135,114.75,38.691,135,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Sup Rapid Rhino All Sizes,,12015679,LOCAL,Facility,Outpatient,,,,135,114.75,38.691,135,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,64.8,48,,percent of total billed charges,,100% of DHS outpatient percentage
Sup Rapid Rhino All Sizes,,12015679,LOCAL,Facility,Inpatient,,,,135,114.75,38.691,135,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Sup Ambu Bag,,12016915,LOCAL,Facility,Both,,,,46,39.1,13.1836,46,Aetna,Commercial,42.32,92,,percent of total billed charges,,
Sup Ambu Bag,,12016915,LOCAL,Facility,Outpatient,,,,46,39.1,13.1836,46,Aetna,Medicare Advantage,22.54,49,,percent of total billed charges,,
Sup Ambu Bag,,12016915,LOCAL,Facility,Inpatient,,,,46,39.1,13.1836,46,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Sup Ambu Bag,,12016915,LOCAL,Facility,Both,,,,46,39.1,13.1836,46,Aetna,PPO,42.78,93,,percent of total billed charges,,
Sup Ambu Bag,,12016915,LOCAL,Facility,Both,,,,46,39.1,13.1836,46,America's PPO,America's PPO,44.1738,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Sup Ambu Bag,,12016915,LOCAL,Facility,Both,,,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota, Federal Employee Program,45.264,98.4,,percent of total billed charges,,
Sup Ambu Bag,,12016915,LOCAL,Facility,Both,,,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,46,100,,percent of total billed charges,,
Sup Ambu Bag,,12016915,LOCAL,Facility,Both,,,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,High Value Network Plan,41.4,90,,percent of total billed charges,,
Sup Ambu Bag,,12016915,LOCAL,Facility,Outpatient,,,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Medicare Advantage,22.54,49,,percent of total billed charges,,
Sup Ambu Bag,,12016915,LOCAL,Facility,Inpatient,,,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Sup Ambu Bag,,12016915,LOCAL,Facility,Both,,,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,40.7422,88.57,,percent of total billed charges,,
Sup Ambu Bag,,12016915,LOCAL,Facility,Both,,,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,13.1836,28.66,,percent of total billed charges,,
Sup Ambu Bag,,12016915,LOCAL,Facility,Outpatient,,,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),22.54,49,,percent of total billed charges,,
Sup Ambu Bag,,12016915,LOCAL,Facility,Inpatient,,,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Sup Ambu Bag,,12016915,LOCAL,Facility,Both,,,,46,39.1,13.1836,46,CorVel,Worker's Compensation,46,100,,percent of total billed charges,,
Sup Ambu Bag,,12016915,LOCAL,Facility,Both,,,,46,39.1,13.1836,46,First Health Group Corporation,First Health Network,44.62,97,,percent of total billed charges,,
Sup Ambu Bag,,12016915,LOCAL,Facility,Both,,,,46,39.1,13.1836,46,"Health Partners, Inc.",Commercial,43.516,94.6,,percent of total billed charges,,
Sup Ambu Bag,,12016915,LOCAL,Facility,Outpatient,,,,46,39.1,13.1836,46,"Health Partners, Inc.",Medicare Advantage,22.54,49,,percent of total billed charges,,
Sup Ambu Bag,,12016915,LOCAL,Facility,Inpatient,,,,46,39.1,13.1836,46,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Ambu Bag,,12016915,LOCAL,Facility,Both,,,,46,39.1,13.1836,46,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),27.6,60,,percent of total billed charges,,
Sup Ambu Bag,,12016915,LOCAL,Facility,Both,,,,46,39.1,13.1836,46,"Health Partners, Inc.",State of Minnesota Advantage Program,37.49,81.5,,percent of total billed charges,,
Sup Ambu Bag,,12016915,LOCAL,Facility,Both,,,,46,39.1,13.1836,46,"Health Partners, Inc.",State Public Programs,23,50,,percent of total billed charges,,
Sup Ambu Bag,,12016915,LOCAL,Facility,Both,,,,46,39.1,13.1836,46,Humana Insurance Company,Commercial PPO,43.7,95,,percent of total billed charges,,
Sup Ambu Bag,,12016915,LOCAL,Facility,Outpatient,,,,46,39.1,13.1836,46,Humana Insurance Company,Medicare PPO,22.54,49,,percent of total billed charges,,
Sup Ambu Bag,,12016915,LOCAL,Facility,Inpatient,,,,46,39.1,13.1836,46,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Sup Ambu Bag,,12016915,LOCAL,Facility,Both,,,,46,39.1,13.1836,46,Medica,Individual & Family,45.586,99.1,,percent of total billed charges,,
Sup Ambu Bag,,12016915,LOCAL,Facility,Outpatient,,,,46,39.1,13.1836,46,Medica,Medica Advantage Solution,22.908,49.8,,percent of total billed charges,,
Sup Ambu Bag,,12016915,LOCAL,Facility,Inpatient,,,,46,39.1,13.1836,46,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Sup Ambu Bag,,12016915,LOCAL,Facility,Outpatient,,,,46,39.1,13.1836,46,Medica,Medical Assistance,20.516,44.6,,percent of total billed charges,,
Sup Ambu Bag,,12016915,LOCAL,Facility,Inpatient,,,,46,39.1,13.1836,46,Medica,Medical Assistance,,,,,Included in per diem rate,
Sup Ambu Bag,,12016915,LOCAL,Facility,Outpatient,,,,46,39.1,13.1836,46,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,22.908,49.8,,percent of total billed charges,,
Sup Ambu Bag,,12016915,LOCAL,Facility,Inpatient,,,,46,39.1,13.1836,46,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Sup Ambu Bag,,12016915,LOCAL,Facility,Both,,,,46,39.1,13.1836,46,"Multiplan, Inc.","Multiplan, Inc.",43.24,94,,percent of total billed charges,,
Sup Ambu Bag,,12016915,LOCAL,Facility,Outpatient,,,,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,41.446,90.1,,percent of total billed charges,,
Sup Ambu Bag,,12016915,LOCAL,Facility,Inpatient,,,,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Sup Ambu Bag,,12016915,LOCAL,Facility,Both,,,,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PPO,45.356,98.6,,percent of total billed charges,,
Sup Ambu Bag,,12016915,LOCAL,Facility,Outpatient,,,,46,39.1,13.1836,46,PrimeWest Health,Minnesota Senior Health Options (MSHO),23.667,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Sup Ambu Bag,,12016915,LOCAL,Facility,Inpatient,,,,46,39.1,13.1836,46,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Ambu Bag,,12016915,LOCAL,Facility,Outpatient,,,,46,39.1,13.1836,46,PrimeWest Health,MinnesotaCare,23.6256,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Sup Ambu Bag,,12016915,LOCAL,Facility,Inpatient,,,,46,39.1,13.1836,46,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Sup Ambu Bag,,12016915,LOCAL,Facility,Both,,,,46,39.1,13.1836,46,Sanford Health Plan,Sanford Health Plan,42.32,92,,percent of total billed charges,,
Sup Ambu Bag,,12016915,LOCAL,Facility,Outpatient,,,,46,39.1,13.1836,46,"UCare Health, Inc.",Individual & Family Plan,25.921,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Sup Ambu Bag,,12016915,LOCAL,Facility,Inpatient,,,,46,39.1,13.1836,46,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Sup Ambu Bag,,12016915,LOCAL,Facility,Outpatient,,,,46,39.1,13.1836,46,"UCare Health, Inc.",Medical Assistance,23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Ambu Bag,,12016915,LOCAL,Facility,Inpatient,,,,46,39.1,13.1836,46,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Sup Ambu Bag,,12016915,LOCAL,Facility,Outpatient,,,,46,39.1,13.1836,46,"UCare Health, Inc.",Medicare Advantage,23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Ambu Bag,,12016915,LOCAL,Facility,Inpatient,,,,46,39.1,13.1836,46,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Ambu Bag,,12016915,LOCAL,Facility,Outpatient,,,,46,39.1,13.1836,46,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Ambu Bag,,12016915,LOCAL,Facility,Inpatient,,,,46,39.1,13.1836,46,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Ambu Bag,,12016915,LOCAL,Facility,Both,,,,46,39.1,13.1836,46,UnitedHealthcare,Individual & Family,43.24,94,,percent of total billed charges,,
Sup Ambu Bag,,12016915,LOCAL,Facility,Outpatient,,,,46,39.1,13.1836,46,UnitedHealthcare,Medicare Advantage,22.54,49,,percent of total billed charges,,
Sup Ambu Bag,,12016915,LOCAL,Facility,Inpatient,,,,46,39.1,13.1836,46,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Sup Ambu Bag,,12016915,LOCAL,Facility,Outpatient,,,,46,39.1,13.1836,46,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,22.08,48,,percent of total billed charges,,100% of DHS outpatient percentage
Sup Ambu Bag,,12016915,LOCAL,Facility,Inpatient,,,,46,39.1,13.1836,46,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Sup Ez Needle,,12017144,LOCAL,Facility,Both,,,,561,476.85,160.7826,561,Aetna,Commercial,516.12,92,,percent of total billed charges,,
Sup Ez Needle,,12017144,LOCAL,Facility,Outpatient,,,,561,476.85,160.7826,561,Aetna,Medicare Advantage,274.89,49,,percent of total billed charges,,
Sup Ez Needle,,12017144,LOCAL,Facility,Inpatient,,,,561,476.85,160.7826,561,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Sup Ez Needle,,12017144,LOCAL,Facility,Both,,,,561,476.85,160.7826,561,Aetna,PPO,521.73,93,,percent of total billed charges,,
Sup Ez Needle,,12017144,LOCAL,Facility,Both,,,,561,476.85,160.7826,561,America's PPO,America's PPO,538.7283,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Sup Ez Needle,,12017144,LOCAL,Facility,Both,,,,561,476.85,160.7826,561,BlueCross BlueShield Minnesota, Federal Employee Program,552.024,98.4,,percent of total billed charges,,
Sup Ez Needle,,12017144,LOCAL,Facility,Both,,,,561,476.85,160.7826,561,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,561,100,,percent of total billed charges,,
Sup Ez Needle,,12017144,LOCAL,Facility,Both,,,,561,476.85,160.7826,561,BlueCross BlueShield Minnesota,High Value Network Plan,504.9,90,,percent of total billed charges,,
Sup Ez Needle,,12017144,LOCAL,Facility,Outpatient,,,,561,476.85,160.7826,561,BlueCross BlueShield Minnesota,Medicare Advantage,274.89,49,,percent of total billed charges,,
Sup Ez Needle,,12017144,LOCAL,Facility,Inpatient,,,,561,476.85,160.7826,561,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Sup Ez Needle,,12017144,LOCAL,Facility,Both,,,,561,476.85,160.7826,561,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,496.8777,88.57,,percent of total billed charges,,
Sup Ez Needle,,12017144,LOCAL,Facility,Both,,,,561,476.85,160.7826,561,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,160.7826,28.66,,percent of total billed charges,,
Sup Ez Needle,,12017144,LOCAL,Facility,Outpatient,,,,561,476.85,160.7826,561,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),274.89,49,,percent of total billed charges,,
Sup Ez Needle,,12017144,LOCAL,Facility,Inpatient,,,,561,476.85,160.7826,561,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Sup Ez Needle,,12017144,LOCAL,Facility,Both,,,,561,476.85,160.7826,561,CorVel,Worker's Compensation,561,100,,percent of total billed charges,,
Sup Ez Needle,,12017144,LOCAL,Facility,Both,,,,561,476.85,160.7826,561,First Health Group Corporation,First Health Network,544.17,97,,percent of total billed charges,,
Sup Ez Needle,,12017144,LOCAL,Facility,Both,,,,561,476.85,160.7826,561,"Health Partners, Inc.",Commercial,530.706,94.6,,percent of total billed charges,,
Sup Ez Needle,,12017144,LOCAL,Facility,Outpatient,,,,561,476.85,160.7826,561,"Health Partners, Inc.",Medicare Advantage,274.89,49,,percent of total billed charges,,
Sup Ez Needle,,12017144,LOCAL,Facility,Inpatient,,,,561,476.85,160.7826,561,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Ez Needle,,12017144,LOCAL,Facility,Both,,,,561,476.85,160.7826,561,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),336.6,60,,percent of total billed charges,,
Sup Ez Needle,,12017144,LOCAL,Facility,Both,,,,561,476.85,160.7826,561,"Health Partners, Inc.",State of Minnesota Advantage Program,457.215,81.5,,percent of total billed charges,,
Sup Ez Needle,,12017144,LOCAL,Facility,Both,,,,561,476.85,160.7826,561,"Health Partners, Inc.",State Public Programs,280.5,50,,percent of total billed charges,,
Sup Ez Needle,,12017144,LOCAL,Facility,Both,,,,561,476.85,160.7826,561,Humana Insurance Company,Commercial PPO,532.95,95,,percent of total billed charges,,
Sup Ez Needle,,12017144,LOCAL,Facility,Outpatient,,,,561,476.85,160.7826,561,Humana Insurance Company,Medicare PPO,274.89,49,,percent of total billed charges,,
Sup Ez Needle,,12017144,LOCAL,Facility,Inpatient,,,,561,476.85,160.7826,561,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Sup Ez Needle,,12017144,LOCAL,Facility,Both,,,,561,476.85,160.7826,561,Medica,Individual & Family,555.951,99.1,,percent of total billed charges,,
Sup Ez Needle,,12017144,LOCAL,Facility,Outpatient,,,,561,476.85,160.7826,561,Medica,Medica Advantage Solution,279.378,49.8,,percent of total billed charges,,
Sup Ez Needle,,12017144,LOCAL,Facility,Inpatient,,,,561,476.85,160.7826,561,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Sup Ez Needle,,12017144,LOCAL,Facility,Outpatient,,,,561,476.85,160.7826,561,Medica,Medical Assistance,250.206,44.6,,percent of total billed charges,,
Sup Ez Needle,,12017144,LOCAL,Facility,Inpatient,,,,561,476.85,160.7826,561,Medica,Medical Assistance,,,,,Included in per diem rate,
Sup Ez Needle,,12017144,LOCAL,Facility,Outpatient,,,,561,476.85,160.7826,561,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,279.378,49.8,,percent of total billed charges,,
Sup Ez Needle,,12017144,LOCAL,Facility,Inpatient,,,,561,476.85,160.7826,561,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Sup Ez Needle,,12017144,LOCAL,Facility,Both,,,,561,476.85,160.7826,561,"Multiplan, Inc.","Multiplan, Inc.",527.34,94,,percent of total billed charges,,
Sup Ez Needle,,12017144,LOCAL,Facility,Outpatient,,,,561,476.85,160.7826,561,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,505.461,90.1,,percent of total billed charges,,
Sup Ez Needle,,12017144,LOCAL,Facility,Inpatient,,,,561,476.85,160.7826,561,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Sup Ez Needle,,12017144,LOCAL,Facility,Both,,,,561,476.85,160.7826,561,"Preferred One Administrative Services, INC.",PPO,553.146,98.6,,percent of total billed charges,,
Sup Ez Needle,,12017144,LOCAL,Facility,Outpatient,,,,561,476.85,160.7826,561,PrimeWest Health,Minnesota Senior Health Options (MSHO),288.6345,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Sup Ez Needle,,12017144,LOCAL,Facility,Inpatient,,,,561,476.85,160.7826,561,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Ez Needle,,12017144,LOCAL,Facility,Outpatient,,,,561,476.85,160.7826,561,PrimeWest Health,MinnesotaCare,288.1296,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Sup Ez Needle,,12017144,LOCAL,Facility,Inpatient,,,,561,476.85,160.7826,561,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Sup Ez Needle,,12017144,LOCAL,Facility,Both,,,,561,476.85,160.7826,561,Sanford Health Plan,Sanford Health Plan,516.12,92,,percent of total billed charges,,
Sup Ez Needle,,12017144,LOCAL,Facility,Outpatient,,,,561,476.85,160.7826,561,"UCare Health, Inc.",Individual & Family Plan,316.1235,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Sup Ez Needle,,12017144,LOCAL,Facility,Inpatient,,,,561,476.85,160.7826,561,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Sup Ez Needle,,12017144,LOCAL,Facility,Outpatient,,,,561,476.85,160.7826,561,"UCare Health, Inc.",Medical Assistance,283.1367,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Ez Needle,,12017144,LOCAL,Facility,Inpatient,,,,561,476.85,160.7826,561,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Sup Ez Needle,,12017144,LOCAL,Facility,Outpatient,,,,561,476.85,160.7826,561,"UCare Health, Inc.",Medicare Advantage,283.1367,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Ez Needle,,12017144,LOCAL,Facility,Inpatient,,,,561,476.85,160.7826,561,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Ez Needle,,12017144,LOCAL,Facility,Outpatient,,,,561,476.85,160.7826,561,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),283.1367,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Ez Needle,,12017144,LOCAL,Facility,Inpatient,,,,561,476.85,160.7826,561,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Ez Needle,,12017144,LOCAL,Facility,Both,,,,561,476.85,160.7826,561,UnitedHealthcare,Individual & Family,527.34,94,,percent of total billed charges,,
Sup Ez Needle,,12017144,LOCAL,Facility,Outpatient,,,,561,476.85,160.7826,561,UnitedHealthcare,Medicare Advantage,274.89,49,,percent of total billed charges,,
Sup Ez Needle,,12017144,LOCAL,Facility,Inpatient,,,,561,476.85,160.7826,561,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Sup Ez Needle,,12017144,LOCAL,Facility,Outpatient,,,,561,476.85,160.7826,561,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,269.28,48,,percent of total billed charges,,100% of DHS outpatient percentage
Sup Ez Needle,,12017144,LOCAL,Facility,Inpatient,,,,561,476.85,160.7826,561,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Sup Duo Therm Pad,,12017453,LOCAL,Facility,Both,,,,27,22.95,7.7382,27,Aetna,Commercial,24.84,92,,percent of total billed charges,,
Sup Duo Therm Pad,,12017453,LOCAL,Facility,Outpatient,,,,27,22.95,7.7382,27,Aetna,Medicare Advantage,13.23,49,,percent of total billed charges,,
Sup Duo Therm Pad,,12017453,LOCAL,Facility,Inpatient,,,,27,22.95,7.7382,27,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Sup Duo Therm Pad,,12017453,LOCAL,Facility,Both,,,,27,22.95,7.7382,27,Aetna,PPO,25.11,93,,percent of total billed charges,,
Sup Duo Therm Pad,,12017453,LOCAL,Facility,Both,,,,27,22.95,7.7382,27,America's PPO,America's PPO,25.9281,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Sup Duo Therm Pad,,12017453,LOCAL,Facility,Both,,,,27,22.95,7.7382,27,BlueCross BlueShield Minnesota, Federal Employee Program,26.568,98.4,,percent of total billed charges,,
Sup Duo Therm Pad,,12017453,LOCAL,Facility,Both,,,,27,22.95,7.7382,27,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,27,100,,percent of total billed charges,,
Sup Duo Therm Pad,,12017453,LOCAL,Facility,Both,,,,27,22.95,7.7382,27,BlueCross BlueShield Minnesota,High Value Network Plan,24.3,90,,percent of total billed charges,,
Sup Duo Therm Pad,,12017453,LOCAL,Facility,Outpatient,,,,27,22.95,7.7382,27,BlueCross BlueShield Minnesota,Medicare Advantage,13.23,49,,percent of total billed charges,,
Sup Duo Therm Pad,,12017453,LOCAL,Facility,Inpatient,,,,27,22.95,7.7382,27,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Sup Duo Therm Pad,,12017453,LOCAL,Facility,Both,,,,27,22.95,7.7382,27,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,23.9139,88.57,,percent of total billed charges,,
Sup Duo Therm Pad,,12017453,LOCAL,Facility,Both,,,,27,22.95,7.7382,27,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,7.7382,28.66,,percent of total billed charges,,
Sup Duo Therm Pad,,12017453,LOCAL,Facility,Outpatient,,,,27,22.95,7.7382,27,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),13.23,49,,percent of total billed charges,,
Sup Duo Therm Pad,,12017453,LOCAL,Facility,Inpatient,,,,27,22.95,7.7382,27,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Sup Duo Therm Pad,,12017453,LOCAL,Facility,Both,,,,27,22.95,7.7382,27,CorVel,Worker's Compensation,27,100,,percent of total billed charges,,
Sup Duo Therm Pad,,12017453,LOCAL,Facility,Both,,,,27,22.95,7.7382,27,First Health Group Corporation,First Health Network,26.19,97,,percent of total billed charges,,
Sup Duo Therm Pad,,12017453,LOCAL,Facility,Both,,,,27,22.95,7.7382,27,"Health Partners, Inc.",Commercial,25.542,94.6,,percent of total billed charges,,
Sup Duo Therm Pad,,12017453,LOCAL,Facility,Outpatient,,,,27,22.95,7.7382,27,"Health Partners, Inc.",Medicare Advantage,13.23,49,,percent of total billed charges,,
Sup Duo Therm Pad,,12017453,LOCAL,Facility,Inpatient,,,,27,22.95,7.7382,27,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Duo Therm Pad,,12017453,LOCAL,Facility,Both,,,,27,22.95,7.7382,27,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),16.2,60,,percent of total billed charges,,
Sup Duo Therm Pad,,12017453,LOCAL,Facility,Both,,,,27,22.95,7.7382,27,"Health Partners, Inc.",State of Minnesota Advantage Program,22.005,81.5,,percent of total billed charges,,
Sup Duo Therm Pad,,12017453,LOCAL,Facility,Both,,,,27,22.95,7.7382,27,"Health Partners, Inc.",State Public Programs,13.5,50,,percent of total billed charges,,
Sup Duo Therm Pad,,12017453,LOCAL,Facility,Both,,,,27,22.95,7.7382,27,Humana Insurance Company,Commercial PPO,25.65,95,,percent of total billed charges,,
Sup Duo Therm Pad,,12017453,LOCAL,Facility,Outpatient,,,,27,22.95,7.7382,27,Humana Insurance Company,Medicare PPO,13.23,49,,percent of total billed charges,,
Sup Duo Therm Pad,,12017453,LOCAL,Facility,Inpatient,,,,27,22.95,7.7382,27,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Sup Duo Therm Pad,,12017453,LOCAL,Facility,Both,,,,27,22.95,7.7382,27,Medica,Individual & Family,26.757,99.1,,percent of total billed charges,,
Sup Duo Therm Pad,,12017453,LOCAL,Facility,Outpatient,,,,27,22.95,7.7382,27,Medica,Medica Advantage Solution,13.446,49.8,,percent of total billed charges,,
Sup Duo Therm Pad,,12017453,LOCAL,Facility,Inpatient,,,,27,22.95,7.7382,27,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Sup Duo Therm Pad,,12017453,LOCAL,Facility,Outpatient,,,,27,22.95,7.7382,27,Medica,Medical Assistance,12.042,44.6,,percent of total billed charges,,
Sup Duo Therm Pad,,12017453,LOCAL,Facility,Inpatient,,,,27,22.95,7.7382,27,Medica,Medical Assistance,,,,,Included in per diem rate,
Sup Duo Therm Pad,,12017453,LOCAL,Facility,Outpatient,,,,27,22.95,7.7382,27,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,13.446,49.8,,percent of total billed charges,,
Sup Duo Therm Pad,,12017453,LOCAL,Facility,Inpatient,,,,27,22.95,7.7382,27,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Sup Duo Therm Pad,,12017453,LOCAL,Facility,Both,,,,27,22.95,7.7382,27,"Multiplan, Inc.","Multiplan, Inc.",25.38,94,,percent of total billed charges,,
Sup Duo Therm Pad,,12017453,LOCAL,Facility,Outpatient,,,,27,22.95,7.7382,27,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,24.327,90.1,,percent of total billed charges,,
Sup Duo Therm Pad,,12017453,LOCAL,Facility,Inpatient,,,,27,22.95,7.7382,27,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Sup Duo Therm Pad,,12017453,LOCAL,Facility,Both,,,,27,22.95,7.7382,27,"Preferred One Administrative Services, INC.",PPO,26.622,98.6,,percent of total billed charges,,
Sup Duo Therm Pad,,12017453,LOCAL,Facility,Outpatient,,,,27,22.95,7.7382,27,PrimeWest Health,Minnesota Senior Health Options (MSHO),13.8915,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Sup Duo Therm Pad,,12017453,LOCAL,Facility,Inpatient,,,,27,22.95,7.7382,27,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Duo Therm Pad,,12017453,LOCAL,Facility,Outpatient,,,,27,22.95,7.7382,27,PrimeWest Health,MinnesotaCare,13.8672,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Sup Duo Therm Pad,,12017453,LOCAL,Facility,Inpatient,,,,27,22.95,7.7382,27,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Sup Duo Therm Pad,,12017453,LOCAL,Facility,Both,,,,27,22.95,7.7382,27,Sanford Health Plan,Sanford Health Plan,24.84,92,,percent of total billed charges,,
Sup Duo Therm Pad,,12017453,LOCAL,Facility,Outpatient,,,,27,22.95,7.7382,27,"UCare Health, Inc.",Individual & Family Plan,15.2145,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Sup Duo Therm Pad,,12017453,LOCAL,Facility,Inpatient,,,,27,22.95,7.7382,27,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Sup Duo Therm Pad,,12017453,LOCAL,Facility,Outpatient,,,,27,22.95,7.7382,27,"UCare Health, Inc.",Medical Assistance,13.6269,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Duo Therm Pad,,12017453,LOCAL,Facility,Inpatient,,,,27,22.95,7.7382,27,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Sup Duo Therm Pad,,12017453,LOCAL,Facility,Outpatient,,,,27,22.95,7.7382,27,"UCare Health, Inc.",Medicare Advantage,13.6269,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Duo Therm Pad,,12017453,LOCAL,Facility,Inpatient,,,,27,22.95,7.7382,27,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Duo Therm Pad,,12017453,LOCAL,Facility,Outpatient,,,,27,22.95,7.7382,27,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),13.6269,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Duo Therm Pad,,12017453,LOCAL,Facility,Inpatient,,,,27,22.95,7.7382,27,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Duo Therm Pad,,12017453,LOCAL,Facility,Both,,,,27,22.95,7.7382,27,UnitedHealthcare,Individual & Family,25.38,94,,percent of total billed charges,,
Sup Duo Therm Pad,,12017453,LOCAL,Facility,Outpatient,,,,27,22.95,7.7382,27,UnitedHealthcare,Medicare Advantage,13.23,49,,percent of total billed charges,,
Sup Duo Therm Pad,,12017453,LOCAL,Facility,Inpatient,,,,27,22.95,7.7382,27,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Sup Duo Therm Pad,,12017453,LOCAL,Facility,Outpatient,,,,27,22.95,7.7382,27,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,12.96,48,,percent of total billed charges,,100% of DHS outpatient percentage
Sup Duo Therm Pad,,12017453,LOCAL,Facility,Inpatient,,,,27,22.95,7.7382,27,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Sup Suture Any Type,,12017785,LOCAL,Facility,Both,,,,36,30.6,10.3176,36,Aetna,Commercial,33.12,92,,percent of total billed charges,,
Sup Suture Any Type,,12017785,LOCAL,Facility,Outpatient,,,,36,30.6,10.3176,36,Aetna,Medicare Advantage,17.64,49,,percent of total billed charges,,
Sup Suture Any Type,,12017785,LOCAL,Facility,Inpatient,,,,36,30.6,10.3176,36,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Sup Suture Any Type,,12017785,LOCAL,Facility,Both,,,,36,30.6,10.3176,36,Aetna,PPO,33.48,93,,percent of total billed charges,,
Sup Suture Any Type,,12017785,LOCAL,Facility,Both,,,,36,30.6,10.3176,36,America's PPO,America's PPO,34.5708,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Sup Suture Any Type,,12017785,LOCAL,Facility,Both,,,,36,30.6,10.3176,36,BlueCross BlueShield Minnesota, Federal Employee Program,35.424,98.4,,percent of total billed charges,,
Sup Suture Any Type,,12017785,LOCAL,Facility,Both,,,,36,30.6,10.3176,36,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,36,100,,percent of total billed charges,,
Sup Suture Any Type,,12017785,LOCAL,Facility,Both,,,,36,30.6,10.3176,36,BlueCross BlueShield Minnesota,High Value Network Plan,32.4,90,,percent of total billed charges,,
Sup Suture Any Type,,12017785,LOCAL,Facility,Outpatient,,,,36,30.6,10.3176,36,BlueCross BlueShield Minnesota,Medicare Advantage,17.64,49,,percent of total billed charges,,
Sup Suture Any Type,,12017785,LOCAL,Facility,Inpatient,,,,36,30.6,10.3176,36,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Sup Suture Any Type,,12017785,LOCAL,Facility,Both,,,,36,30.6,10.3176,36,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,31.8852,88.57,,percent of total billed charges,,
Sup Suture Any Type,,12017785,LOCAL,Facility,Both,,,,36,30.6,10.3176,36,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,10.3176,28.66,,percent of total billed charges,,
Sup Suture Any Type,,12017785,LOCAL,Facility,Outpatient,,,,36,30.6,10.3176,36,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),17.64,49,,percent of total billed charges,,
Sup Suture Any Type,,12017785,LOCAL,Facility,Inpatient,,,,36,30.6,10.3176,36,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Sup Suture Any Type,,12017785,LOCAL,Facility,Both,,,,36,30.6,10.3176,36,CorVel,Worker's Compensation,36,100,,percent of total billed charges,,
Sup Suture Any Type,,12017785,LOCAL,Facility,Both,,,,36,30.6,10.3176,36,First Health Group Corporation,First Health Network,34.92,97,,percent of total billed charges,,
Sup Suture Any Type,,12017785,LOCAL,Facility,Both,,,,36,30.6,10.3176,36,"Health Partners, Inc.",Commercial,34.056,94.6,,percent of total billed charges,,
Sup Suture Any Type,,12017785,LOCAL,Facility,Outpatient,,,,36,30.6,10.3176,36,"Health Partners, Inc.",Medicare Advantage,17.64,49,,percent of total billed charges,,
Sup Suture Any Type,,12017785,LOCAL,Facility,Inpatient,,,,36,30.6,10.3176,36,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Suture Any Type,,12017785,LOCAL,Facility,Both,,,,36,30.6,10.3176,36,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),21.6,60,,percent of total billed charges,,
Sup Suture Any Type,,12017785,LOCAL,Facility,Both,,,,36,30.6,10.3176,36,"Health Partners, Inc.",State of Minnesota Advantage Program,29.34,81.5,,percent of total billed charges,,
Sup Suture Any Type,,12017785,LOCAL,Facility,Both,,,,36,30.6,10.3176,36,"Health Partners, Inc.",State Public Programs,18,50,,percent of total billed charges,,
Sup Suture Any Type,,12017785,LOCAL,Facility,Both,,,,36,30.6,10.3176,36,Humana Insurance Company,Commercial PPO,34.2,95,,percent of total billed charges,,
Sup Suture Any Type,,12017785,LOCAL,Facility,Outpatient,,,,36,30.6,10.3176,36,Humana Insurance Company,Medicare PPO,17.64,49,,percent of total billed charges,,
Sup Suture Any Type,,12017785,LOCAL,Facility,Inpatient,,,,36,30.6,10.3176,36,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Sup Suture Any Type,,12017785,LOCAL,Facility,Both,,,,36,30.6,10.3176,36,Medica,Individual & Family,35.676,99.1,,percent of total billed charges,,
Sup Suture Any Type,,12017785,LOCAL,Facility,Outpatient,,,,36,30.6,10.3176,36,Medica,Medica Advantage Solution,17.928,49.8,,percent of total billed charges,,
Sup Suture Any Type,,12017785,LOCAL,Facility,Inpatient,,,,36,30.6,10.3176,36,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Sup Suture Any Type,,12017785,LOCAL,Facility,Outpatient,,,,36,30.6,10.3176,36,Medica,Medical Assistance,16.056,44.6,,percent of total billed charges,,
Sup Suture Any Type,,12017785,LOCAL,Facility,Inpatient,,,,36,30.6,10.3176,36,Medica,Medical Assistance,,,,,Included in per diem rate,
Sup Suture Any Type,,12017785,LOCAL,Facility,Outpatient,,,,36,30.6,10.3176,36,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,17.928,49.8,,percent of total billed charges,,
Sup Suture Any Type,,12017785,LOCAL,Facility,Inpatient,,,,36,30.6,10.3176,36,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Sup Suture Any Type,,12017785,LOCAL,Facility,Both,,,,36,30.6,10.3176,36,"Multiplan, Inc.","Multiplan, Inc.",33.84,94,,percent of total billed charges,,
Sup Suture Any Type,,12017785,LOCAL,Facility,Outpatient,,,,36,30.6,10.3176,36,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,32.436,90.1,,percent of total billed charges,,
Sup Suture Any Type,,12017785,LOCAL,Facility,Inpatient,,,,36,30.6,10.3176,36,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Sup Suture Any Type,,12017785,LOCAL,Facility,Both,,,,36,30.6,10.3176,36,"Preferred One Administrative Services, INC.",PPO,35.496,98.6,,percent of total billed charges,,
Sup Suture Any Type,,12017785,LOCAL,Facility,Outpatient,,,,36,30.6,10.3176,36,PrimeWest Health,Minnesota Senior Health Options (MSHO),18.522,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Sup Suture Any Type,,12017785,LOCAL,Facility,Inpatient,,,,36,30.6,10.3176,36,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Suture Any Type,,12017785,LOCAL,Facility,Outpatient,,,,36,30.6,10.3176,36,PrimeWest Health,MinnesotaCare,18.4896,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Sup Suture Any Type,,12017785,LOCAL,Facility,Inpatient,,,,36,30.6,10.3176,36,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Sup Suture Any Type,,12017785,LOCAL,Facility,Both,,,,36,30.6,10.3176,36,Sanford Health Plan,Sanford Health Plan,33.12,92,,percent of total billed charges,,
Sup Suture Any Type,,12017785,LOCAL,Facility,Outpatient,,,,36,30.6,10.3176,36,"UCare Health, Inc.",Individual & Family Plan,20.286,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Sup Suture Any Type,,12017785,LOCAL,Facility,Inpatient,,,,36,30.6,10.3176,36,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Sup Suture Any Type,,12017785,LOCAL,Facility,Outpatient,,,,36,30.6,10.3176,36,"UCare Health, Inc.",Medical Assistance,18.1692,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Suture Any Type,,12017785,LOCAL,Facility,Inpatient,,,,36,30.6,10.3176,36,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Sup Suture Any Type,,12017785,LOCAL,Facility,Outpatient,,,,36,30.6,10.3176,36,"UCare Health, Inc.",Medicare Advantage,18.1692,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Suture Any Type,,12017785,LOCAL,Facility,Inpatient,,,,36,30.6,10.3176,36,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Suture Any Type,,12017785,LOCAL,Facility,Outpatient,,,,36,30.6,10.3176,36,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),18.1692,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Suture Any Type,,12017785,LOCAL,Facility,Inpatient,,,,36,30.6,10.3176,36,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Suture Any Type,,12017785,LOCAL,Facility,Both,,,,36,30.6,10.3176,36,UnitedHealthcare,Individual & Family,33.84,94,,percent of total billed charges,,
Sup Suture Any Type,,12017785,LOCAL,Facility,Outpatient,,,,36,30.6,10.3176,36,UnitedHealthcare,Medicare Advantage,17.64,49,,percent of total billed charges,,
Sup Suture Any Type,,12017785,LOCAL,Facility,Inpatient,,,,36,30.6,10.3176,36,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Sup Suture Any Type,,12017785,LOCAL,Facility,Outpatient,,,,36,30.6,10.3176,36,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,17.28,48,,percent of total billed charges,,100% of DHS outpatient percentage
Sup Suture Any Type,,12017785,LOCAL,Facility,Inpatient,,,,36,30.6,10.3176,36,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Sup Dressing Hydrofera Blue,,12018707,LOCAL,Facility,Both,,,,33.88,28.798,9.710008,33.88,Aetna,Commercial,31.1696,92,,percent of total billed charges,,
Sup Dressing Hydrofera Blue,,12018707,LOCAL,Facility,Outpatient,,,,33.88,28.798,9.710008,33.88,Aetna,Medicare Advantage,16.6012,49,,percent of total billed charges,,
Sup Dressing Hydrofera Blue,,12018707,LOCAL,Facility,Inpatient,,,,33.88,28.798,9.710008,33.88,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Sup Dressing Hydrofera Blue,,12018707,LOCAL,Facility,Both,,,,33.88,28.798,9.710008,33.88,Aetna,PPO,31.5084,93,,percent of total billed charges,,
Sup Dressing Hydrofera Blue,,12018707,LOCAL,Facility,Both,,,,33.88,28.798,9.710008,33.88,America's PPO,America's PPO,32.534964,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Sup Dressing Hydrofera Blue,,12018707,LOCAL,Facility,Both,,,,33.88,28.798,9.710008,33.88,BlueCross BlueShield Minnesota, Federal Employee Program,33.33792,98.4,,percent of total billed charges,,
Sup Dressing Hydrofera Blue,,12018707,LOCAL,Facility,Both,,,,33.88,28.798,9.710008,33.88,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,33.88,100,,percent of total billed charges,,
Sup Dressing Hydrofera Blue,,12018707,LOCAL,Facility,Both,,,,33.88,28.798,9.710008,33.88,BlueCross BlueShield Minnesota,High Value Network Plan,30.492,90,,percent of total billed charges,,
Sup Dressing Hydrofera Blue,,12018707,LOCAL,Facility,Outpatient,,,,33.88,28.798,9.710008,33.88,BlueCross BlueShield Minnesota,Medicare Advantage,16.6012,49,,percent of total billed charges,,
Sup Dressing Hydrofera Blue,,12018707,LOCAL,Facility,Inpatient,,,,33.88,28.798,9.710008,33.88,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Sup Dressing Hydrofera Blue,,12018707,LOCAL,Facility,Both,,,,33.88,28.798,9.710008,33.88,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,30.007516,88.57,,percent of total billed charges,,
Sup Dressing Hydrofera Blue,,12018707,LOCAL,Facility,Both,,,,33.88,28.798,9.710008,33.88,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,9.710008,28.66,,percent of total billed charges,,
Sup Dressing Hydrofera Blue,,12018707,LOCAL,Facility,Outpatient,,,,33.88,28.798,9.710008,33.88,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),16.6012,49,,percent of total billed charges,,
Sup Dressing Hydrofera Blue,,12018707,LOCAL,Facility,Inpatient,,,,33.88,28.798,9.710008,33.88,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Sup Dressing Hydrofera Blue,,12018707,LOCAL,Facility,Both,,,,33.88,28.798,9.710008,33.88,CorVel,Worker's Compensation,33.88,100,,percent of total billed charges,,
Sup Dressing Hydrofera Blue,,12018707,LOCAL,Facility,Both,,,,33.88,28.798,9.710008,33.88,First Health Group Corporation,First Health Network,32.8636,97,,percent of total billed charges,,
Sup Dressing Hydrofera Blue,,12018707,LOCAL,Facility,Both,,,,33.88,28.798,9.710008,33.88,"Health Partners, Inc.",Commercial,32.05048,94.6,,percent of total billed charges,,
Sup Dressing Hydrofera Blue,,12018707,LOCAL,Facility,Outpatient,,,,33.88,28.798,9.710008,33.88,"Health Partners, Inc.",Medicare Advantage,16.6012,49,,percent of total billed charges,,
Sup Dressing Hydrofera Blue,,12018707,LOCAL,Facility,Inpatient,,,,33.88,28.798,9.710008,33.88,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Dressing Hydrofera Blue,,12018707,LOCAL,Facility,Both,,,,33.88,28.798,9.710008,33.88,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),20.328,60,,percent of total billed charges,,
Sup Dressing Hydrofera Blue,,12018707,LOCAL,Facility,Both,,,,33.88,28.798,9.710008,33.88,"Health Partners, Inc.",State of Minnesota Advantage Program,27.6122,81.5,,percent of total billed charges,,
Sup Dressing Hydrofera Blue,,12018707,LOCAL,Facility,Both,,,,33.88,28.798,9.710008,33.88,"Health Partners, Inc.",State Public Programs,16.94,50,,percent of total billed charges,,
Sup Dressing Hydrofera Blue,,12018707,LOCAL,Facility,Both,,,,33.88,28.798,9.710008,33.88,Humana Insurance Company,Commercial PPO,32.186,95,,percent of total billed charges,,
Sup Dressing Hydrofera Blue,,12018707,LOCAL,Facility,Outpatient,,,,33.88,28.798,9.710008,33.88,Humana Insurance Company,Medicare PPO,16.6012,49,,percent of total billed charges,,
Sup Dressing Hydrofera Blue,,12018707,LOCAL,Facility,Inpatient,,,,33.88,28.798,9.710008,33.88,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Sup Dressing Hydrofera Blue,,12018707,LOCAL,Facility,Both,,,,33.88,28.798,9.710008,33.88,Medica,Individual & Family,33.57508,99.1,,percent of total billed charges,,
Sup Dressing Hydrofera Blue,,12018707,LOCAL,Facility,Outpatient,,,,33.88,28.798,9.710008,33.88,Medica,Medica Advantage Solution,16.87224,49.8,,percent of total billed charges,,
Sup Dressing Hydrofera Blue,,12018707,LOCAL,Facility,Inpatient,,,,33.88,28.798,9.710008,33.88,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Sup Dressing Hydrofera Blue,,12018707,LOCAL,Facility,Outpatient,,,,33.88,28.798,9.710008,33.88,Medica,Medical Assistance,15.11048,44.6,,percent of total billed charges,,
Sup Dressing Hydrofera Blue,,12018707,LOCAL,Facility,Inpatient,,,,33.88,28.798,9.710008,33.88,Medica,Medical Assistance,,,,,Included in per diem rate,
Sup Dressing Hydrofera Blue,,12018707,LOCAL,Facility,Outpatient,,,,33.88,28.798,9.710008,33.88,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,16.87224,49.8,,percent of total billed charges,,
Sup Dressing Hydrofera Blue,,12018707,LOCAL,Facility,Inpatient,,,,33.88,28.798,9.710008,33.88,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Sup Dressing Hydrofera Blue,,12018707,LOCAL,Facility,Both,,,,33.88,28.798,9.710008,33.88,"Multiplan, Inc.","Multiplan, Inc.",31.8472,94,,percent of total billed charges,,
Sup Dressing Hydrofera Blue,,12018707,LOCAL,Facility,Outpatient,,,,33.88,28.798,9.710008,33.88,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,30.52588,90.1,,percent of total billed charges,,
Sup Dressing Hydrofera Blue,,12018707,LOCAL,Facility,Inpatient,,,,33.88,28.798,9.710008,33.88,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Sup Dressing Hydrofera Blue,,12018707,LOCAL,Facility,Both,,,,33.88,28.798,9.710008,33.88,"Preferred One Administrative Services, INC.",PPO,33.40568,98.6,,percent of total billed charges,,
Sup Dressing Hydrofera Blue,,12018707,LOCAL,Facility,Outpatient,,,,33.88,28.798,9.710008,33.88,PrimeWest Health,Minnesota Senior Health Options (MSHO),17.43126,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Sup Dressing Hydrofera Blue,,12018707,LOCAL,Facility,Inpatient,,,,33.88,28.798,9.710008,33.88,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Dressing Hydrofera Blue,,12018707,LOCAL,Facility,Outpatient,,,,33.88,28.798,9.710008,33.88,PrimeWest Health,MinnesotaCare,17.400768,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Sup Dressing Hydrofera Blue,,12018707,LOCAL,Facility,Inpatient,,,,33.88,28.798,9.710008,33.88,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Sup Dressing Hydrofera Blue,,12018707,LOCAL,Facility,Both,,,,33.88,28.798,9.710008,33.88,Sanford Health Plan,Sanford Health Plan,31.1696,92,,percent of total billed charges,,
Sup Dressing Hydrofera Blue,,12018707,LOCAL,Facility,Outpatient,,,,33.88,28.798,9.710008,33.88,"UCare Health, Inc.",Individual & Family Plan,19.09138,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Sup Dressing Hydrofera Blue,,12018707,LOCAL,Facility,Inpatient,,,,33.88,28.798,9.710008,33.88,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Sup Dressing Hydrofera Blue,,12018707,LOCAL,Facility,Outpatient,,,,33.88,28.798,9.710008,33.88,"UCare Health, Inc.",Medical Assistance,17.099236,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Dressing Hydrofera Blue,,12018707,LOCAL,Facility,Inpatient,,,,33.88,28.798,9.710008,33.88,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Sup Dressing Hydrofera Blue,,12018707,LOCAL,Facility,Outpatient,,,,33.88,28.798,9.710008,33.88,"UCare Health, Inc.",Medicare Advantage,17.099236,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Dressing Hydrofera Blue,,12018707,LOCAL,Facility,Inpatient,,,,33.88,28.798,9.710008,33.88,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Dressing Hydrofera Blue,,12018707,LOCAL,Facility,Outpatient,,,,33.88,28.798,9.710008,33.88,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),17.099236,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Dressing Hydrofera Blue,,12018707,LOCAL,Facility,Inpatient,,,,33.88,28.798,9.710008,33.88,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Dressing Hydrofera Blue,,12018707,LOCAL,Facility,Both,,,,33.88,28.798,9.710008,33.88,UnitedHealthcare,Individual & Family,31.8472,94,,percent of total billed charges,,
Sup Dressing Hydrofera Blue,,12018707,LOCAL,Facility,Outpatient,,,,33.88,28.798,9.710008,33.88,UnitedHealthcare,Medicare Advantage,16.6012,49,,percent of total billed charges,,
Sup Dressing Hydrofera Blue,,12018707,LOCAL,Facility,Inpatient,,,,33.88,28.798,9.710008,33.88,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Sup Dressing Hydrofera Blue,,12018707,LOCAL,Facility,Outpatient,,,,33.88,28.798,9.710008,33.88,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,16.2624,48,,percent of total billed charges,,100% of DHS outpatient percentage
Sup Dressing Hydrofera Blue,,12018707,LOCAL,Facility,Inpatient,,,,33.88,28.798,9.710008,33.88,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Sup Casting Supplies - Plaster,,12019427,LOCAL,Facility,Both,,,,22,18.7,6.3052,22,Aetna,Commercial,20.24,92,,percent of total billed charges,,
Sup Casting Supplies - Plaster,,12019427,LOCAL,Facility,Outpatient,,,,22,18.7,6.3052,22,Aetna,Medicare Advantage,10.78,49,,percent of total billed charges,,
Sup Casting Supplies - Plaster,,12019427,LOCAL,Facility,Inpatient,,,,22,18.7,6.3052,22,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Sup Casting Supplies - Plaster,,12019427,LOCAL,Facility,Both,,,,22,18.7,6.3052,22,Aetna,PPO,20.46,93,,percent of total billed charges,,
Sup Casting Supplies - Plaster,,12019427,LOCAL,Facility,Both,,,,22,18.7,6.3052,22,America's PPO,America's PPO,21.1266,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Sup Casting Supplies - Plaster,,12019427,LOCAL,Facility,Both,,,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota, Federal Employee Program,21.648,98.4,,percent of total billed charges,,
Sup Casting Supplies - Plaster,,12019427,LOCAL,Facility,Both,,,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,22,100,,percent of total billed charges,,
Sup Casting Supplies - Plaster,,12019427,LOCAL,Facility,Both,,,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota,High Value Network Plan,19.8,90,,percent of total billed charges,,
Sup Casting Supplies - Plaster,,12019427,LOCAL,Facility,Outpatient,,,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota,Medicare Advantage,10.78,49,,percent of total billed charges,,
Sup Casting Supplies - Plaster,,12019427,LOCAL,Facility,Inpatient,,,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Sup Casting Supplies - Plaster,,12019427,LOCAL,Facility,Both,,,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,19.4854,88.57,,percent of total billed charges,,
Sup Casting Supplies - Plaster,,12019427,LOCAL,Facility,Both,,,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,6.3052,28.66,,percent of total billed charges,,
Sup Casting Supplies - Plaster,,12019427,LOCAL,Facility,Outpatient,,,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),10.78,49,,percent of total billed charges,,
Sup Casting Supplies - Plaster,,12019427,LOCAL,Facility,Inpatient,,,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Sup Casting Supplies - Plaster,,12019427,LOCAL,Facility,Both,,,,22,18.7,6.3052,22,CorVel,Worker's Compensation,22,100,,percent of total billed charges,,
Sup Casting Supplies - Plaster,,12019427,LOCAL,Facility,Both,,,,22,18.7,6.3052,22,First Health Group Corporation,First Health Network,21.34,97,,percent of total billed charges,,
Sup Casting Supplies - Plaster,,12019427,LOCAL,Facility,Both,,,,22,18.7,6.3052,22,"Health Partners, Inc.",Commercial,20.812,94.6,,percent of total billed charges,,
Sup Casting Supplies - Plaster,,12019427,LOCAL,Facility,Outpatient,,,,22,18.7,6.3052,22,"Health Partners, Inc.",Medicare Advantage,10.78,49,,percent of total billed charges,,
Sup Casting Supplies - Plaster,,12019427,LOCAL,Facility,Inpatient,,,,22,18.7,6.3052,22,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Casting Supplies - Plaster,,12019427,LOCAL,Facility,Both,,,,22,18.7,6.3052,22,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),13.2,60,,percent of total billed charges,,
Sup Casting Supplies - Plaster,,12019427,LOCAL,Facility,Both,,,,22,18.7,6.3052,22,"Health Partners, Inc.",State of Minnesota Advantage Program,17.93,81.5,,percent of total billed charges,,
Sup Casting Supplies - Plaster,,12019427,LOCAL,Facility,Both,,,,22,18.7,6.3052,22,"Health Partners, Inc.",State Public Programs,11,50,,percent of total billed charges,,
Sup Casting Supplies - Plaster,,12019427,LOCAL,Facility,Both,,,,22,18.7,6.3052,22,Humana Insurance Company,Commercial PPO,20.9,95,,percent of total billed charges,,
Sup Casting Supplies - Plaster,,12019427,LOCAL,Facility,Outpatient,,,,22,18.7,6.3052,22,Humana Insurance Company,Medicare PPO,10.78,49,,percent of total billed charges,,
Sup Casting Supplies - Plaster,,12019427,LOCAL,Facility,Inpatient,,,,22,18.7,6.3052,22,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Sup Casting Supplies - Plaster,,12019427,LOCAL,Facility,Both,,,,22,18.7,6.3052,22,Medica,Individual & Family,21.802,99.1,,percent of total billed charges,,
Sup Casting Supplies - Plaster,,12019427,LOCAL,Facility,Outpatient,,,,22,18.7,6.3052,22,Medica,Medica Advantage Solution,10.956,49.8,,percent of total billed charges,,
Sup Casting Supplies - Plaster,,12019427,LOCAL,Facility,Inpatient,,,,22,18.7,6.3052,22,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Sup Casting Supplies - Plaster,,12019427,LOCAL,Facility,Outpatient,,,,22,18.7,6.3052,22,Medica,Medical Assistance,9.812,44.6,,percent of total billed charges,,
Sup Casting Supplies - Plaster,,12019427,LOCAL,Facility,Inpatient,,,,22,18.7,6.3052,22,Medica,Medical Assistance,,,,,Included in per diem rate,
Sup Casting Supplies - Plaster,,12019427,LOCAL,Facility,Outpatient,,,,22,18.7,6.3052,22,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,10.956,49.8,,percent of total billed charges,,
Sup Casting Supplies - Plaster,,12019427,LOCAL,Facility,Inpatient,,,,22,18.7,6.3052,22,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Sup Casting Supplies - Plaster,,12019427,LOCAL,Facility,Both,,,,22,18.7,6.3052,22,"Multiplan, Inc.","Multiplan, Inc.",20.68,94,,percent of total billed charges,,
Sup Casting Supplies - Plaster,,12019427,LOCAL,Facility,Outpatient,,,,22,18.7,6.3052,22,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,19.822,90.1,,percent of total billed charges,,
Sup Casting Supplies - Plaster,,12019427,LOCAL,Facility,Inpatient,,,,22,18.7,6.3052,22,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Sup Casting Supplies - Plaster,,12019427,LOCAL,Facility,Both,,,,22,18.7,6.3052,22,"Preferred One Administrative Services, INC.",PPO,21.692,98.6,,percent of total billed charges,,
Sup Casting Supplies - Plaster,,12019427,LOCAL,Facility,Outpatient,,,,22,18.7,6.3052,22,PrimeWest Health,Minnesota Senior Health Options (MSHO),11.319,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Sup Casting Supplies - Plaster,,12019427,LOCAL,Facility,Inpatient,,,,22,18.7,6.3052,22,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Casting Supplies - Plaster,,12019427,LOCAL,Facility,Outpatient,,,,22,18.7,6.3052,22,PrimeWest Health,MinnesotaCare,11.2992,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Sup Casting Supplies - Plaster,,12019427,LOCAL,Facility,Inpatient,,,,22,18.7,6.3052,22,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Sup Casting Supplies - Plaster,,12019427,LOCAL,Facility,Both,,,,22,18.7,6.3052,22,Sanford Health Plan,Sanford Health Plan,20.24,92,,percent of total billed charges,,
Sup Casting Supplies - Plaster,,12019427,LOCAL,Facility,Outpatient,,,,22,18.7,6.3052,22,"UCare Health, Inc.",Individual & Family Plan,12.397,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Sup Casting Supplies - Plaster,,12019427,LOCAL,Facility,Inpatient,,,,22,18.7,6.3052,22,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Sup Casting Supplies - Plaster,,12019427,LOCAL,Facility,Outpatient,,,,22,18.7,6.3052,22,"UCare Health, Inc.",Medical Assistance,11.1034,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Casting Supplies - Plaster,,12019427,LOCAL,Facility,Inpatient,,,,22,18.7,6.3052,22,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Sup Casting Supplies - Plaster,,12019427,LOCAL,Facility,Outpatient,,,,22,18.7,6.3052,22,"UCare Health, Inc.",Medicare Advantage,11.1034,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Casting Supplies - Plaster,,12019427,LOCAL,Facility,Inpatient,,,,22,18.7,6.3052,22,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Casting Supplies - Plaster,,12019427,LOCAL,Facility,Outpatient,,,,22,18.7,6.3052,22,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),11.1034,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Casting Supplies - Plaster,,12019427,LOCAL,Facility,Inpatient,,,,22,18.7,6.3052,22,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Casting Supplies - Plaster,,12019427,LOCAL,Facility,Both,,,,22,18.7,6.3052,22,UnitedHealthcare,Individual & Family,20.68,94,,percent of total billed charges,,
Sup Casting Supplies - Plaster,,12019427,LOCAL,Facility,Outpatient,,,,22,18.7,6.3052,22,UnitedHealthcare,Medicare Advantage,10.78,49,,percent of total billed charges,,
Sup Casting Supplies - Plaster,,12019427,LOCAL,Facility,Inpatient,,,,22,18.7,6.3052,22,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Sup Casting Supplies - Plaster,,12019427,LOCAL,Facility,Outpatient,,,,22,18.7,6.3052,22,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,10.56,48,,percent of total billed charges,,100% of DHS outpatient percentage
Sup Casting Supplies - Plaster,,12019427,LOCAL,Facility,Inpatient,,,,22,18.7,6.3052,22,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Sup Falls Management Kit,,12023693,LOCAL,Facility,Both,,,,81,68.85,23.2146,81,Aetna,Commercial,74.52,92,,percent of total billed charges,,
Sup Falls Management Kit,,12023693,LOCAL,Facility,Outpatient,,,,81,68.85,23.2146,81,Aetna,Medicare Advantage,39.69,49,,percent of total billed charges,,
Sup Falls Management Kit,,12023693,LOCAL,Facility,Inpatient,,,,81,68.85,23.2146,81,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Sup Falls Management Kit,,12023693,LOCAL,Facility,Both,,,,81,68.85,23.2146,81,Aetna,PPO,75.33,93,,percent of total billed charges,,
Sup Falls Management Kit,,12023693,LOCAL,Facility,Both,,,,81,68.85,23.2146,81,America's PPO,America's PPO,77.7843,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Sup Falls Management Kit,,12023693,LOCAL,Facility,Both,,,,81,68.85,23.2146,81,BlueCross BlueShield Minnesota, Federal Employee Program,79.704,98.4,,percent of total billed charges,,
Sup Falls Management Kit,,12023693,LOCAL,Facility,Both,,,,81,68.85,23.2146,81,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,81,100,,percent of total billed charges,,
Sup Falls Management Kit,,12023693,LOCAL,Facility,Both,,,,81,68.85,23.2146,81,BlueCross BlueShield Minnesota,High Value Network Plan,72.9,90,,percent of total billed charges,,
Sup Falls Management Kit,,12023693,LOCAL,Facility,Outpatient,,,,81,68.85,23.2146,81,BlueCross BlueShield Minnesota,Medicare Advantage,39.69,49,,percent of total billed charges,,
Sup Falls Management Kit,,12023693,LOCAL,Facility,Inpatient,,,,81,68.85,23.2146,81,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Sup Falls Management Kit,,12023693,LOCAL,Facility,Both,,,,81,68.85,23.2146,81,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,71.7417,88.57,,percent of total billed charges,,
Sup Falls Management Kit,,12023693,LOCAL,Facility,Both,,,,81,68.85,23.2146,81,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,23.2146,28.66,,percent of total billed charges,,
Sup Falls Management Kit,,12023693,LOCAL,Facility,Outpatient,,,,81,68.85,23.2146,81,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),39.69,49,,percent of total billed charges,,
Sup Falls Management Kit,,12023693,LOCAL,Facility,Inpatient,,,,81,68.85,23.2146,81,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Sup Falls Management Kit,,12023693,LOCAL,Facility,Both,,,,81,68.85,23.2146,81,CorVel,Worker's Compensation,81,100,,percent of total billed charges,,
Sup Falls Management Kit,,12023693,LOCAL,Facility,Both,,,,81,68.85,23.2146,81,First Health Group Corporation,First Health Network,78.57,97,,percent of total billed charges,,
Sup Falls Management Kit,,12023693,LOCAL,Facility,Both,,,,81,68.85,23.2146,81,"Health Partners, Inc.",Commercial,76.626,94.6,,percent of total billed charges,,
Sup Falls Management Kit,,12023693,LOCAL,Facility,Outpatient,,,,81,68.85,23.2146,81,"Health Partners, Inc.",Medicare Advantage,39.69,49,,percent of total billed charges,,
Sup Falls Management Kit,,12023693,LOCAL,Facility,Inpatient,,,,81,68.85,23.2146,81,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Falls Management Kit,,12023693,LOCAL,Facility,Both,,,,81,68.85,23.2146,81,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),48.6,60,,percent of total billed charges,,
Sup Falls Management Kit,,12023693,LOCAL,Facility,Both,,,,81,68.85,23.2146,81,"Health Partners, Inc.",State of Minnesota Advantage Program,66.015,81.5,,percent of total billed charges,,
Sup Falls Management Kit,,12023693,LOCAL,Facility,Both,,,,81,68.85,23.2146,81,"Health Partners, Inc.",State Public Programs,40.5,50,,percent of total billed charges,,
Sup Falls Management Kit,,12023693,LOCAL,Facility,Both,,,,81,68.85,23.2146,81,Humana Insurance Company,Commercial PPO,76.95,95,,percent of total billed charges,,
Sup Falls Management Kit,,12023693,LOCAL,Facility,Outpatient,,,,81,68.85,23.2146,81,Humana Insurance Company,Medicare PPO,39.69,49,,percent of total billed charges,,
Sup Falls Management Kit,,12023693,LOCAL,Facility,Inpatient,,,,81,68.85,23.2146,81,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Sup Falls Management Kit,,12023693,LOCAL,Facility,Both,,,,81,68.85,23.2146,81,Medica,Individual & Family,80.271,99.1,,percent of total billed charges,,
Sup Falls Management Kit,,12023693,LOCAL,Facility,Outpatient,,,,81,68.85,23.2146,81,Medica,Medica Advantage Solution,40.338,49.8,,percent of total billed charges,,
Sup Falls Management Kit,,12023693,LOCAL,Facility,Inpatient,,,,81,68.85,23.2146,81,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Sup Falls Management Kit,,12023693,LOCAL,Facility,Outpatient,,,,81,68.85,23.2146,81,Medica,Medical Assistance,36.126,44.6,,percent of total billed charges,,
Sup Falls Management Kit,,12023693,LOCAL,Facility,Inpatient,,,,81,68.85,23.2146,81,Medica,Medical Assistance,,,,,Included in per diem rate,
Sup Falls Management Kit,,12023693,LOCAL,Facility,Outpatient,,,,81,68.85,23.2146,81,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,40.338,49.8,,percent of total billed charges,,
Sup Falls Management Kit,,12023693,LOCAL,Facility,Inpatient,,,,81,68.85,23.2146,81,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Sup Falls Management Kit,,12023693,LOCAL,Facility,Both,,,,81,68.85,23.2146,81,"Multiplan, Inc.","Multiplan, Inc.",76.14,94,,percent of total billed charges,,
Sup Falls Management Kit,,12023693,LOCAL,Facility,Outpatient,,,,81,68.85,23.2146,81,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,72.981,90.1,,percent of total billed charges,,
Sup Falls Management Kit,,12023693,LOCAL,Facility,Inpatient,,,,81,68.85,23.2146,81,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Sup Falls Management Kit,,12023693,LOCAL,Facility,Both,,,,81,68.85,23.2146,81,"Preferred One Administrative Services, INC.",PPO,79.866,98.6,,percent of total billed charges,,
Sup Falls Management Kit,,12023693,LOCAL,Facility,Outpatient,,,,81,68.85,23.2146,81,PrimeWest Health,Minnesota Senior Health Options (MSHO),41.6745,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Sup Falls Management Kit,,12023693,LOCAL,Facility,Inpatient,,,,81,68.85,23.2146,81,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Falls Management Kit,,12023693,LOCAL,Facility,Outpatient,,,,81,68.85,23.2146,81,PrimeWest Health,MinnesotaCare,41.6016,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Sup Falls Management Kit,,12023693,LOCAL,Facility,Inpatient,,,,81,68.85,23.2146,81,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Sup Falls Management Kit,,12023693,LOCAL,Facility,Both,,,,81,68.85,23.2146,81,Sanford Health Plan,Sanford Health Plan,74.52,92,,percent of total billed charges,,
Sup Falls Management Kit,,12023693,LOCAL,Facility,Outpatient,,,,81,68.85,23.2146,81,"UCare Health, Inc.",Individual & Family Plan,45.6435,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Sup Falls Management Kit,,12023693,LOCAL,Facility,Inpatient,,,,81,68.85,23.2146,81,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Sup Falls Management Kit,,12023693,LOCAL,Facility,Outpatient,,,,81,68.85,23.2146,81,"UCare Health, Inc.",Medical Assistance,40.8807,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Falls Management Kit,,12023693,LOCAL,Facility,Inpatient,,,,81,68.85,23.2146,81,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Sup Falls Management Kit,,12023693,LOCAL,Facility,Outpatient,,,,81,68.85,23.2146,81,"UCare Health, Inc.",Medicare Advantage,40.8807,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Falls Management Kit,,12023693,LOCAL,Facility,Inpatient,,,,81,68.85,23.2146,81,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Falls Management Kit,,12023693,LOCAL,Facility,Outpatient,,,,81,68.85,23.2146,81,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),40.8807,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Falls Management Kit,,12023693,LOCAL,Facility,Inpatient,,,,81,68.85,23.2146,81,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Falls Management Kit,,12023693,LOCAL,Facility,Both,,,,81,68.85,23.2146,81,UnitedHealthcare,Individual & Family,76.14,94,,percent of total billed charges,,
Sup Falls Management Kit,,12023693,LOCAL,Facility,Outpatient,,,,81,68.85,23.2146,81,UnitedHealthcare,Medicare Advantage,39.69,49,,percent of total billed charges,,
Sup Falls Management Kit,,12023693,LOCAL,Facility,Inpatient,,,,81,68.85,23.2146,81,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Sup Falls Management Kit,,12023693,LOCAL,Facility,Outpatient,,,,81,68.85,23.2146,81,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,38.88,48,,percent of total billed charges,,100% of DHS outpatient percentage
Sup Falls Management Kit,,12023693,LOCAL,Facility,Inpatient,,,,81,68.85,23.2146,81,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Sup Pad, Multifunction",,12023714,LOCAL,Facility,Both,,,,116,98.6,33.2456,116,Aetna,Commercial,106.72,92,,percent of total billed charges,,
"Sup Pad, Multifunction",,12023714,LOCAL,Facility,Outpatient,,,,116,98.6,33.2456,116,Aetna,Medicare Advantage,56.84,49,,percent of total billed charges,,
"Sup Pad, Multifunction",,12023714,LOCAL,Facility,Inpatient,,,,116,98.6,33.2456,116,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Sup Pad, Multifunction",,12023714,LOCAL,Facility,Both,,,,116,98.6,33.2456,116,Aetna,PPO,107.88,93,,percent of total billed charges,,
"Sup Pad, Multifunction",,12023714,LOCAL,Facility,Both,,,,116,98.6,33.2456,116,America's PPO,America's PPO,111.3948,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Sup Pad, Multifunction",,12023714,LOCAL,Facility,Both,,,,116,98.6,33.2456,116,BlueCross BlueShield Minnesota, Federal Employee Program,114.144,98.4,,percent of total billed charges,,
"Sup Pad, Multifunction",,12023714,LOCAL,Facility,Both,,,,116,98.6,33.2456,116,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,116,100,,percent of total billed charges,,
"Sup Pad, Multifunction",,12023714,LOCAL,Facility,Both,,,,116,98.6,33.2456,116,BlueCross BlueShield Minnesota,High Value Network Plan,104.4,90,,percent of total billed charges,,
"Sup Pad, Multifunction",,12023714,LOCAL,Facility,Outpatient,,,,116,98.6,33.2456,116,BlueCross BlueShield Minnesota,Medicare Advantage,56.84,49,,percent of total billed charges,,
"Sup Pad, Multifunction",,12023714,LOCAL,Facility,Inpatient,,,,116,98.6,33.2456,116,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Sup Pad, Multifunction",,12023714,LOCAL,Facility,Both,,,,116,98.6,33.2456,116,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,102.7412,88.57,,percent of total billed charges,,
"Sup Pad, Multifunction",,12023714,LOCAL,Facility,Both,,,,116,98.6,33.2456,116,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,33.2456,28.66,,percent of total billed charges,,
"Sup Pad, Multifunction",,12023714,LOCAL,Facility,Outpatient,,,,116,98.6,33.2456,116,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),56.84,49,,percent of total billed charges,,
"Sup Pad, Multifunction",,12023714,LOCAL,Facility,Inpatient,,,,116,98.6,33.2456,116,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Sup Pad, Multifunction",,12023714,LOCAL,Facility,Both,,,,116,98.6,33.2456,116,CorVel,Worker's Compensation,116,100,,percent of total billed charges,,
"Sup Pad, Multifunction",,12023714,LOCAL,Facility,Both,,,,116,98.6,33.2456,116,First Health Group Corporation,First Health Network,112.52,97,,percent of total billed charges,,
"Sup Pad, Multifunction",,12023714,LOCAL,Facility,Both,,,,116,98.6,33.2456,116,"Health Partners, Inc.",Commercial,109.736,94.6,,percent of total billed charges,,
"Sup Pad, Multifunction",,12023714,LOCAL,Facility,Outpatient,,,,116,98.6,33.2456,116,"Health Partners, Inc.",Medicare Advantage,56.84,49,,percent of total billed charges,,
"Sup Pad, Multifunction",,12023714,LOCAL,Facility,Inpatient,,,,116,98.6,33.2456,116,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Sup Pad, Multifunction",,12023714,LOCAL,Facility,Both,,,,116,98.6,33.2456,116,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),69.6,60,,percent of total billed charges,,
"Sup Pad, Multifunction",,12023714,LOCAL,Facility,Both,,,,116,98.6,33.2456,116,"Health Partners, Inc.",State of Minnesota Advantage Program,94.54,81.5,,percent of total billed charges,,
"Sup Pad, Multifunction",,12023714,LOCAL,Facility,Both,,,,116,98.6,33.2456,116,"Health Partners, Inc.",State Public Programs,58,50,,percent of total billed charges,,
"Sup Pad, Multifunction",,12023714,LOCAL,Facility,Both,,,,116,98.6,33.2456,116,Humana Insurance Company,Commercial PPO,110.2,95,,percent of total billed charges,,
"Sup Pad, Multifunction",,12023714,LOCAL,Facility,Outpatient,,,,116,98.6,33.2456,116,Humana Insurance Company,Medicare PPO,56.84,49,,percent of total billed charges,,
"Sup Pad, Multifunction",,12023714,LOCAL,Facility,Inpatient,,,,116,98.6,33.2456,116,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Sup Pad, Multifunction",,12023714,LOCAL,Facility,Both,,,,116,98.6,33.2456,116,Medica,Individual & Family,114.956,99.1,,percent of total billed charges,,
"Sup Pad, Multifunction",,12023714,LOCAL,Facility,Outpatient,,,,116,98.6,33.2456,116,Medica,Medica Advantage Solution,57.768,49.8,,percent of total billed charges,,
"Sup Pad, Multifunction",,12023714,LOCAL,Facility,Inpatient,,,,116,98.6,33.2456,116,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Sup Pad, Multifunction",,12023714,LOCAL,Facility,Outpatient,,,,116,98.6,33.2456,116,Medica,Medical Assistance,51.736,44.6,,percent of total billed charges,,
"Sup Pad, Multifunction",,12023714,LOCAL,Facility,Inpatient,,,,116,98.6,33.2456,116,Medica,Medical Assistance,,,,,Included in per diem rate,
"Sup Pad, Multifunction",,12023714,LOCAL,Facility,Outpatient,,,,116,98.6,33.2456,116,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,57.768,49.8,,percent of total billed charges,,
"Sup Pad, Multifunction",,12023714,LOCAL,Facility,Inpatient,,,,116,98.6,33.2456,116,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Sup Pad, Multifunction",,12023714,LOCAL,Facility,Both,,,,116,98.6,33.2456,116,"Multiplan, Inc.","Multiplan, Inc.",109.04,94,,percent of total billed charges,,
"Sup Pad, Multifunction",,12023714,LOCAL,Facility,Outpatient,,,,116,98.6,33.2456,116,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,104.516,90.1,,percent of total billed charges,,
"Sup Pad, Multifunction",,12023714,LOCAL,Facility,Inpatient,,,,116,98.6,33.2456,116,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Sup Pad, Multifunction",,12023714,LOCAL,Facility,Both,,,,116,98.6,33.2456,116,"Preferred One Administrative Services, INC.",PPO,114.376,98.6,,percent of total billed charges,,
"Sup Pad, Multifunction",,12023714,LOCAL,Facility,Outpatient,,,,116,98.6,33.2456,116,PrimeWest Health,Minnesota Senior Health Options (MSHO),59.682,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Sup Pad, Multifunction",,12023714,LOCAL,Facility,Inpatient,,,,116,98.6,33.2456,116,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Sup Pad, Multifunction",,12023714,LOCAL,Facility,Outpatient,,,,116,98.6,33.2456,116,PrimeWest Health,MinnesotaCare,59.5776,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Sup Pad, Multifunction",,12023714,LOCAL,Facility,Inpatient,,,,116,98.6,33.2456,116,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Sup Pad, Multifunction",,12023714,LOCAL,Facility,Both,,,,116,98.6,33.2456,116,Sanford Health Plan,Sanford Health Plan,106.72,92,,percent of total billed charges,,
"Sup Pad, Multifunction",,12023714,LOCAL,Facility,Outpatient,,,,116,98.6,33.2456,116,"UCare Health, Inc.",Individual & Family Plan,65.366,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Sup Pad, Multifunction",,12023714,LOCAL,Facility,Inpatient,,,,116,98.6,33.2456,116,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Sup Pad, Multifunction",,12023714,LOCAL,Facility,Outpatient,,,,116,98.6,33.2456,116,"UCare Health, Inc.",Medical Assistance,58.5452,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Sup Pad, Multifunction",,12023714,LOCAL,Facility,Inpatient,,,,116,98.6,33.2456,116,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Sup Pad, Multifunction",,12023714,LOCAL,Facility,Outpatient,,,,116,98.6,33.2456,116,"UCare Health, Inc.",Medicare Advantage,58.5452,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Sup Pad, Multifunction",,12023714,LOCAL,Facility,Inpatient,,,,116,98.6,33.2456,116,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Sup Pad, Multifunction",,12023714,LOCAL,Facility,Outpatient,,,,116,98.6,33.2456,116,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),58.5452,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Sup Pad, Multifunction",,12023714,LOCAL,Facility,Inpatient,,,,116,98.6,33.2456,116,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Sup Pad, Multifunction",,12023714,LOCAL,Facility,Both,,,,116,98.6,33.2456,116,UnitedHealthcare,Individual & Family,109.04,94,,percent of total billed charges,,
"Sup Pad, Multifunction",,12023714,LOCAL,Facility,Outpatient,,,,116,98.6,33.2456,116,UnitedHealthcare,Medicare Advantage,56.84,49,,percent of total billed charges,,
"Sup Pad, Multifunction",,12023714,LOCAL,Facility,Inpatient,,,,116,98.6,33.2456,116,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Sup Pad, Multifunction",,12023714,LOCAL,Facility,Outpatient,,,,116,98.6,33.2456,116,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,55.68,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Sup Pad, Multifunction",,12023714,LOCAL,Facility,Inpatient,,,,116,98.6,33.2456,116,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Sup Electric Razor,,12024601,LOCAL,Facility,Both,,,,51,43.35,14.6166,51,Aetna,Commercial,46.92,92,,percent of total billed charges,,
Sup Electric Razor,,12024601,LOCAL,Facility,Outpatient,,,,51,43.35,14.6166,51,Aetna,Medicare Advantage,24.99,49,,percent of total billed charges,,
Sup Electric Razor,,12024601,LOCAL,Facility,Inpatient,,,,51,43.35,14.6166,51,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Sup Electric Razor,,12024601,LOCAL,Facility,Both,,,,51,43.35,14.6166,51,Aetna,PPO,47.43,93,,percent of total billed charges,,
Sup Electric Razor,,12024601,LOCAL,Facility,Both,,,,51,43.35,14.6166,51,America's PPO,America's PPO,48.9753,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Sup Electric Razor,,12024601,LOCAL,Facility,Both,,,,51,43.35,14.6166,51,BlueCross BlueShield Minnesota, Federal Employee Program,50.184,98.4,,percent of total billed charges,,
Sup Electric Razor,,12024601,LOCAL,Facility,Both,,,,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,51,100,,percent of total billed charges,,
Sup Electric Razor,,12024601,LOCAL,Facility,Both,,,,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,High Value Network Plan,45.9,90,,percent of total billed charges,,
Sup Electric Razor,,12024601,LOCAL,Facility,Outpatient,,,,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,Medicare Advantage,24.99,49,,percent of total billed charges,,
Sup Electric Razor,,12024601,LOCAL,Facility,Inpatient,,,,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Sup Electric Razor,,12024601,LOCAL,Facility,Both,,,,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,45.1707,88.57,,percent of total billed charges,,
Sup Electric Razor,,12024601,LOCAL,Facility,Both,,,,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,14.6166,28.66,,percent of total billed charges,,
Sup Electric Razor,,12024601,LOCAL,Facility,Outpatient,,,,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),24.99,49,,percent of total billed charges,,
Sup Electric Razor,,12024601,LOCAL,Facility,Inpatient,,,,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Sup Electric Razor,,12024601,LOCAL,Facility,Both,,,,51,43.35,14.6166,51,CorVel,Worker's Compensation,51,100,,percent of total billed charges,,
Sup Electric Razor,,12024601,LOCAL,Facility,Both,,,,51,43.35,14.6166,51,First Health Group Corporation,First Health Network,49.47,97,,percent of total billed charges,,
Sup Electric Razor,,12024601,LOCAL,Facility,Both,,,,51,43.35,14.6166,51,"Health Partners, Inc.",Commercial,48.246,94.6,,percent of total billed charges,,
Sup Electric Razor,,12024601,LOCAL,Facility,Outpatient,,,,51,43.35,14.6166,51,"Health Partners, Inc.",Medicare Advantage,24.99,49,,percent of total billed charges,,
Sup Electric Razor,,12024601,LOCAL,Facility,Inpatient,,,,51,43.35,14.6166,51,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Electric Razor,,12024601,LOCAL,Facility,Both,,,,51,43.35,14.6166,51,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),30.6,60,,percent of total billed charges,,
Sup Electric Razor,,12024601,LOCAL,Facility,Both,,,,51,43.35,14.6166,51,"Health Partners, Inc.",State of Minnesota Advantage Program,41.565,81.5,,percent of total billed charges,,
Sup Electric Razor,,12024601,LOCAL,Facility,Both,,,,51,43.35,14.6166,51,"Health Partners, Inc.",State Public Programs,25.5,50,,percent of total billed charges,,
Sup Electric Razor,,12024601,LOCAL,Facility,Both,,,,51,43.35,14.6166,51,Humana Insurance Company,Commercial PPO,48.45,95,,percent of total billed charges,,
Sup Electric Razor,,12024601,LOCAL,Facility,Outpatient,,,,51,43.35,14.6166,51,Humana Insurance Company,Medicare PPO,24.99,49,,percent of total billed charges,,
Sup Electric Razor,,12024601,LOCAL,Facility,Inpatient,,,,51,43.35,14.6166,51,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Sup Electric Razor,,12024601,LOCAL,Facility,Both,,,,51,43.35,14.6166,51,Medica,Individual & Family,50.541,99.1,,percent of total billed charges,,
Sup Electric Razor,,12024601,LOCAL,Facility,Outpatient,,,,51,43.35,14.6166,51,Medica,Medica Advantage Solution,25.398,49.8,,percent of total billed charges,,
Sup Electric Razor,,12024601,LOCAL,Facility,Inpatient,,,,51,43.35,14.6166,51,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Sup Electric Razor,,12024601,LOCAL,Facility,Outpatient,,,,51,43.35,14.6166,51,Medica,Medical Assistance,22.746,44.6,,percent of total billed charges,,
Sup Electric Razor,,12024601,LOCAL,Facility,Inpatient,,,,51,43.35,14.6166,51,Medica,Medical Assistance,,,,,Included in per diem rate,
Sup Electric Razor,,12024601,LOCAL,Facility,Outpatient,,,,51,43.35,14.6166,51,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,25.398,49.8,,percent of total billed charges,,
Sup Electric Razor,,12024601,LOCAL,Facility,Inpatient,,,,51,43.35,14.6166,51,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Sup Electric Razor,,12024601,LOCAL,Facility,Both,,,,51,43.35,14.6166,51,"Multiplan, Inc.","Multiplan, Inc.",47.94,94,,percent of total billed charges,,
Sup Electric Razor,,12024601,LOCAL,Facility,Outpatient,,,,51,43.35,14.6166,51,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,45.951,90.1,,percent of total billed charges,,
Sup Electric Razor,,12024601,LOCAL,Facility,Inpatient,,,,51,43.35,14.6166,51,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Sup Electric Razor,,12024601,LOCAL,Facility,Both,,,,51,43.35,14.6166,51,"Preferred One Administrative Services, INC.",PPO,50.286,98.6,,percent of total billed charges,,
Sup Electric Razor,,12024601,LOCAL,Facility,Outpatient,,,,51,43.35,14.6166,51,PrimeWest Health,Minnesota Senior Health Options (MSHO),26.2395,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Sup Electric Razor,,12024601,LOCAL,Facility,Inpatient,,,,51,43.35,14.6166,51,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Electric Razor,,12024601,LOCAL,Facility,Outpatient,,,,51,43.35,14.6166,51,PrimeWest Health,MinnesotaCare,26.1936,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Sup Electric Razor,,12024601,LOCAL,Facility,Inpatient,,,,51,43.35,14.6166,51,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Sup Electric Razor,,12024601,LOCAL,Facility,Both,,,,51,43.35,14.6166,51,Sanford Health Plan,Sanford Health Plan,46.92,92,,percent of total billed charges,,
Sup Electric Razor,,12024601,LOCAL,Facility,Outpatient,,,,51,43.35,14.6166,51,"UCare Health, Inc.",Individual & Family Plan,28.7385,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Sup Electric Razor,,12024601,LOCAL,Facility,Inpatient,,,,51,43.35,14.6166,51,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Sup Electric Razor,,12024601,LOCAL,Facility,Outpatient,,,,51,43.35,14.6166,51,"UCare Health, Inc.",Medical Assistance,25.7397,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Electric Razor,,12024601,LOCAL,Facility,Inpatient,,,,51,43.35,14.6166,51,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Sup Electric Razor,,12024601,LOCAL,Facility,Outpatient,,,,51,43.35,14.6166,51,"UCare Health, Inc.",Medicare Advantage,25.7397,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Electric Razor,,12024601,LOCAL,Facility,Inpatient,,,,51,43.35,14.6166,51,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Electric Razor,,12024601,LOCAL,Facility,Outpatient,,,,51,43.35,14.6166,51,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),25.7397,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Electric Razor,,12024601,LOCAL,Facility,Inpatient,,,,51,43.35,14.6166,51,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Electric Razor,,12024601,LOCAL,Facility,Both,,,,51,43.35,14.6166,51,UnitedHealthcare,Individual & Family,47.94,94,,percent of total billed charges,,
Sup Electric Razor,,12024601,LOCAL,Facility,Outpatient,,,,51,43.35,14.6166,51,UnitedHealthcare,Medicare Advantage,24.99,49,,percent of total billed charges,,
Sup Electric Razor,,12024601,LOCAL,Facility,Inpatient,,,,51,43.35,14.6166,51,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Sup Electric Razor,,12024601,LOCAL,Facility,Outpatient,,,,51,43.35,14.6166,51,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,24.48,48,,percent of total billed charges,,100% of DHS outpatient percentage
Sup Electric Razor,,12024601,LOCAL,Facility,Inpatient,,,,51,43.35,14.6166,51,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Sup Respiratory Vest Wrap,,12027068,LOCAL,Facility,Both,,,,270,229.5,77.382,270,Aetna,Commercial,248.4,92,,percent of total billed charges,,
Sup Respiratory Vest Wrap,,12027068,LOCAL,Facility,Outpatient,,,,270,229.5,77.382,270,Aetna,Medicare Advantage,132.3,49,,percent of total billed charges,,
Sup Respiratory Vest Wrap,,12027068,LOCAL,Facility,Inpatient,,,,270,229.5,77.382,270,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Sup Respiratory Vest Wrap,,12027068,LOCAL,Facility,Both,,,,270,229.5,77.382,270,Aetna,PPO,251.1,93,,percent of total billed charges,,
Sup Respiratory Vest Wrap,,12027068,LOCAL,Facility,Both,,,,270,229.5,77.382,270,America's PPO,America's PPO,259.281,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Sup Respiratory Vest Wrap,,12027068,LOCAL,Facility,Both,,,,270,229.5,77.382,270,BlueCross BlueShield Minnesota, Federal Employee Program,265.68,98.4,,percent of total billed charges,,
Sup Respiratory Vest Wrap,,12027068,LOCAL,Facility,Both,,,,270,229.5,77.382,270,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,270,100,,percent of total billed charges,,
Sup Respiratory Vest Wrap,,12027068,LOCAL,Facility,Both,,,,270,229.5,77.382,270,BlueCross BlueShield Minnesota,High Value Network Plan,243,90,,percent of total billed charges,,
Sup Respiratory Vest Wrap,,12027068,LOCAL,Facility,Outpatient,,,,270,229.5,77.382,270,BlueCross BlueShield Minnesota,Medicare Advantage,132.3,49,,percent of total billed charges,,
Sup Respiratory Vest Wrap,,12027068,LOCAL,Facility,Inpatient,,,,270,229.5,77.382,270,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Sup Respiratory Vest Wrap,,12027068,LOCAL,Facility,Both,,,,270,229.5,77.382,270,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,239.139,88.57,,percent of total billed charges,,
Sup Respiratory Vest Wrap,,12027068,LOCAL,Facility,Both,,,,270,229.5,77.382,270,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,77.382,28.66,,percent of total billed charges,,
Sup Respiratory Vest Wrap,,12027068,LOCAL,Facility,Outpatient,,,,270,229.5,77.382,270,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),132.3,49,,percent of total billed charges,,
Sup Respiratory Vest Wrap,,12027068,LOCAL,Facility,Inpatient,,,,270,229.5,77.382,270,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Sup Respiratory Vest Wrap,,12027068,LOCAL,Facility,Both,,,,270,229.5,77.382,270,CorVel,Worker's Compensation,270,100,,percent of total billed charges,,
Sup Respiratory Vest Wrap,,12027068,LOCAL,Facility,Both,,,,270,229.5,77.382,270,First Health Group Corporation,First Health Network,261.9,97,,percent of total billed charges,,
Sup Respiratory Vest Wrap,,12027068,LOCAL,Facility,Both,,,,270,229.5,77.382,270,"Health Partners, Inc.",Commercial,255.42,94.6,,percent of total billed charges,,
Sup Respiratory Vest Wrap,,12027068,LOCAL,Facility,Outpatient,,,,270,229.5,77.382,270,"Health Partners, Inc.",Medicare Advantage,132.3,49,,percent of total billed charges,,
Sup Respiratory Vest Wrap,,12027068,LOCAL,Facility,Inpatient,,,,270,229.5,77.382,270,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Respiratory Vest Wrap,,12027068,LOCAL,Facility,Both,,,,270,229.5,77.382,270,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),162,60,,percent of total billed charges,,
Sup Respiratory Vest Wrap,,12027068,LOCAL,Facility,Both,,,,270,229.5,77.382,270,"Health Partners, Inc.",State of Minnesota Advantage Program,220.05,81.5,,percent of total billed charges,,
Sup Respiratory Vest Wrap,,12027068,LOCAL,Facility,Both,,,,270,229.5,77.382,270,"Health Partners, Inc.",State Public Programs,135,50,,percent of total billed charges,,
Sup Respiratory Vest Wrap,,12027068,LOCAL,Facility,Both,,,,270,229.5,77.382,270,Humana Insurance Company,Commercial PPO,256.5,95,,percent of total billed charges,,
Sup Respiratory Vest Wrap,,12027068,LOCAL,Facility,Outpatient,,,,270,229.5,77.382,270,Humana Insurance Company,Medicare PPO,132.3,49,,percent of total billed charges,,
Sup Respiratory Vest Wrap,,12027068,LOCAL,Facility,Inpatient,,,,270,229.5,77.382,270,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Sup Respiratory Vest Wrap,,12027068,LOCAL,Facility,Both,,,,270,229.5,77.382,270,Medica,Individual & Family,267.57,99.1,,percent of total billed charges,,
Sup Respiratory Vest Wrap,,12027068,LOCAL,Facility,Outpatient,,,,270,229.5,77.382,270,Medica,Medica Advantage Solution,134.46,49.8,,percent of total billed charges,,
Sup Respiratory Vest Wrap,,12027068,LOCAL,Facility,Inpatient,,,,270,229.5,77.382,270,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Sup Respiratory Vest Wrap,,12027068,LOCAL,Facility,Outpatient,,,,270,229.5,77.382,270,Medica,Medical Assistance,120.42,44.6,,percent of total billed charges,,
Sup Respiratory Vest Wrap,,12027068,LOCAL,Facility,Inpatient,,,,270,229.5,77.382,270,Medica,Medical Assistance,,,,,Included in per diem rate,
Sup Respiratory Vest Wrap,,12027068,LOCAL,Facility,Outpatient,,,,270,229.5,77.382,270,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,134.46,49.8,,percent of total billed charges,,
Sup Respiratory Vest Wrap,,12027068,LOCAL,Facility,Inpatient,,,,270,229.5,77.382,270,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Sup Respiratory Vest Wrap,,12027068,LOCAL,Facility,Both,,,,270,229.5,77.382,270,"Multiplan, Inc.","Multiplan, Inc.",253.8,94,,percent of total billed charges,,
Sup Respiratory Vest Wrap,,12027068,LOCAL,Facility,Outpatient,,,,270,229.5,77.382,270,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,243.27,90.1,,percent of total billed charges,,
Sup Respiratory Vest Wrap,,12027068,LOCAL,Facility,Inpatient,,,,270,229.5,77.382,270,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Sup Respiratory Vest Wrap,,12027068,LOCAL,Facility,Both,,,,270,229.5,77.382,270,"Preferred One Administrative Services, INC.",PPO,266.22,98.6,,percent of total billed charges,,
Sup Respiratory Vest Wrap,,12027068,LOCAL,Facility,Outpatient,,,,270,229.5,77.382,270,PrimeWest Health,Minnesota Senior Health Options (MSHO),138.915,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Sup Respiratory Vest Wrap,,12027068,LOCAL,Facility,Inpatient,,,,270,229.5,77.382,270,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Respiratory Vest Wrap,,12027068,LOCAL,Facility,Outpatient,,,,270,229.5,77.382,270,PrimeWest Health,MinnesotaCare,138.672,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Sup Respiratory Vest Wrap,,12027068,LOCAL,Facility,Inpatient,,,,270,229.5,77.382,270,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Sup Respiratory Vest Wrap,,12027068,LOCAL,Facility,Both,,,,270,229.5,77.382,270,Sanford Health Plan,Sanford Health Plan,248.4,92,,percent of total billed charges,,
Sup Respiratory Vest Wrap,,12027068,LOCAL,Facility,Outpatient,,,,270,229.5,77.382,270,"UCare Health, Inc.",Individual & Family Plan,152.145,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Sup Respiratory Vest Wrap,,12027068,LOCAL,Facility,Inpatient,,,,270,229.5,77.382,270,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Sup Respiratory Vest Wrap,,12027068,LOCAL,Facility,Outpatient,,,,270,229.5,77.382,270,"UCare Health, Inc.",Medical Assistance,136.269,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Respiratory Vest Wrap,,12027068,LOCAL,Facility,Inpatient,,,,270,229.5,77.382,270,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Sup Respiratory Vest Wrap,,12027068,LOCAL,Facility,Outpatient,,,,270,229.5,77.382,270,"UCare Health, Inc.",Medicare Advantage,136.269,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Respiratory Vest Wrap,,12027068,LOCAL,Facility,Inpatient,,,,270,229.5,77.382,270,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Respiratory Vest Wrap,,12027068,LOCAL,Facility,Outpatient,,,,270,229.5,77.382,270,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),136.269,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Respiratory Vest Wrap,,12027068,LOCAL,Facility,Inpatient,,,,270,229.5,77.382,270,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Respiratory Vest Wrap,,12027068,LOCAL,Facility,Both,,,,270,229.5,77.382,270,UnitedHealthcare,Individual & Family,253.8,94,,percent of total billed charges,,
Sup Respiratory Vest Wrap,,12027068,LOCAL,Facility,Outpatient,,,,270,229.5,77.382,270,UnitedHealthcare,Medicare Advantage,132.3,49,,percent of total billed charges,,
Sup Respiratory Vest Wrap,,12027068,LOCAL,Facility,Inpatient,,,,270,229.5,77.382,270,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Sup Respiratory Vest Wrap,,12027068,LOCAL,Facility,Outpatient,,,,270,229.5,77.382,270,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,129.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
Sup Respiratory Vest Wrap,,12027068,LOCAL,Facility,Inpatient,,,,270,229.5,77.382,270,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Sup Transduc Set Iv Prss Sgl 72 In,,12028037,LOCAL,Facility,Both,,,,90,76.5,25.794,90,Aetna,Commercial,82.8,92,,percent of total billed charges,,
Sup Transduc Set Iv Prss Sgl 72 In,,12028037,LOCAL,Facility,Outpatient,,,,90,76.5,25.794,90,Aetna,Medicare Advantage,44.1,49,,percent of total billed charges,,
Sup Transduc Set Iv Prss Sgl 72 In,,12028037,LOCAL,Facility,Inpatient,,,,90,76.5,25.794,90,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Sup Transduc Set Iv Prss Sgl 72 In,,12028037,LOCAL,Facility,Both,,,,90,76.5,25.794,90,Aetna,PPO,83.7,93,,percent of total billed charges,,
Sup Transduc Set Iv Prss Sgl 72 In,,12028037,LOCAL,Facility,Both,,,,90,76.5,25.794,90,America's PPO,America's PPO,86.427,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Sup Transduc Set Iv Prss Sgl 72 In,,12028037,LOCAL,Facility,Both,,,,90,76.5,25.794,90,BlueCross BlueShield Minnesota, Federal Employee Program,88.56,98.4,,percent of total billed charges,,
Sup Transduc Set Iv Prss Sgl 72 In,,12028037,LOCAL,Facility,Both,,,,90,76.5,25.794,90,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,90,100,,percent of total billed charges,,
Sup Transduc Set Iv Prss Sgl 72 In,,12028037,LOCAL,Facility,Both,,,,90,76.5,25.794,90,BlueCross BlueShield Minnesota,High Value Network Plan,81,90,,percent of total billed charges,,
Sup Transduc Set Iv Prss Sgl 72 In,,12028037,LOCAL,Facility,Outpatient,,,,90,76.5,25.794,90,BlueCross BlueShield Minnesota,Medicare Advantage,44.1,49,,percent of total billed charges,,
Sup Transduc Set Iv Prss Sgl 72 In,,12028037,LOCAL,Facility,Inpatient,,,,90,76.5,25.794,90,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Sup Transduc Set Iv Prss Sgl 72 In,,12028037,LOCAL,Facility,Both,,,,90,76.5,25.794,90,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,79.713,88.57,,percent of total billed charges,,
Sup Transduc Set Iv Prss Sgl 72 In,,12028037,LOCAL,Facility,Both,,,,90,76.5,25.794,90,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,25.794,28.66,,percent of total billed charges,,
Sup Transduc Set Iv Prss Sgl 72 In,,12028037,LOCAL,Facility,Outpatient,,,,90,76.5,25.794,90,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),44.1,49,,percent of total billed charges,,
Sup Transduc Set Iv Prss Sgl 72 In,,12028037,LOCAL,Facility,Inpatient,,,,90,76.5,25.794,90,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Sup Transduc Set Iv Prss Sgl 72 In,,12028037,LOCAL,Facility,Both,,,,90,76.5,25.794,90,CorVel,Worker's Compensation,90,100,,percent of total billed charges,,
Sup Transduc Set Iv Prss Sgl 72 In,,12028037,LOCAL,Facility,Both,,,,90,76.5,25.794,90,First Health Group Corporation,First Health Network,87.3,97,,percent of total billed charges,,
Sup Transduc Set Iv Prss Sgl 72 In,,12028037,LOCAL,Facility,Both,,,,90,76.5,25.794,90,"Health Partners, Inc.",Commercial,85.14,94.6,,percent of total billed charges,,
Sup Transduc Set Iv Prss Sgl 72 In,,12028037,LOCAL,Facility,Outpatient,,,,90,76.5,25.794,90,"Health Partners, Inc.",Medicare Advantage,44.1,49,,percent of total billed charges,,
Sup Transduc Set Iv Prss Sgl 72 In,,12028037,LOCAL,Facility,Inpatient,,,,90,76.5,25.794,90,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Transduc Set Iv Prss Sgl 72 In,,12028037,LOCAL,Facility,Both,,,,90,76.5,25.794,90,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),54,60,,percent of total billed charges,,
Sup Transduc Set Iv Prss Sgl 72 In,,12028037,LOCAL,Facility,Both,,,,90,76.5,25.794,90,"Health Partners, Inc.",State of Minnesota Advantage Program,73.35,81.5,,percent of total billed charges,,
Sup Transduc Set Iv Prss Sgl 72 In,,12028037,LOCAL,Facility,Both,,,,90,76.5,25.794,90,"Health Partners, Inc.",State Public Programs,45,50,,percent of total billed charges,,
Sup Transduc Set Iv Prss Sgl 72 In,,12028037,LOCAL,Facility,Both,,,,90,76.5,25.794,90,Humana Insurance Company,Commercial PPO,85.5,95,,percent of total billed charges,,
Sup Transduc Set Iv Prss Sgl 72 In,,12028037,LOCAL,Facility,Outpatient,,,,90,76.5,25.794,90,Humana Insurance Company,Medicare PPO,44.1,49,,percent of total billed charges,,
Sup Transduc Set Iv Prss Sgl 72 In,,12028037,LOCAL,Facility,Inpatient,,,,90,76.5,25.794,90,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Sup Transduc Set Iv Prss Sgl 72 In,,12028037,LOCAL,Facility,Both,,,,90,76.5,25.794,90,Medica,Individual & Family,89.19,99.1,,percent of total billed charges,,
Sup Transduc Set Iv Prss Sgl 72 In,,12028037,LOCAL,Facility,Outpatient,,,,90,76.5,25.794,90,Medica,Medica Advantage Solution,44.82,49.8,,percent of total billed charges,,
Sup Transduc Set Iv Prss Sgl 72 In,,12028037,LOCAL,Facility,Inpatient,,,,90,76.5,25.794,90,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Sup Transduc Set Iv Prss Sgl 72 In,,12028037,LOCAL,Facility,Outpatient,,,,90,76.5,25.794,90,Medica,Medical Assistance,40.14,44.6,,percent of total billed charges,,
Sup Transduc Set Iv Prss Sgl 72 In,,12028037,LOCAL,Facility,Inpatient,,,,90,76.5,25.794,90,Medica,Medical Assistance,,,,,Included in per diem rate,
Sup Transduc Set Iv Prss Sgl 72 In,,12028037,LOCAL,Facility,Outpatient,,,,90,76.5,25.794,90,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,44.82,49.8,,percent of total billed charges,,
Sup Transduc Set Iv Prss Sgl 72 In,,12028037,LOCAL,Facility,Inpatient,,,,90,76.5,25.794,90,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Sup Transduc Set Iv Prss Sgl 72 In,,12028037,LOCAL,Facility,Both,,,,90,76.5,25.794,90,"Multiplan, Inc.","Multiplan, Inc.",84.6,94,,percent of total billed charges,,
Sup Transduc Set Iv Prss Sgl 72 In,,12028037,LOCAL,Facility,Outpatient,,,,90,76.5,25.794,90,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,81.09,90.1,,percent of total billed charges,,
Sup Transduc Set Iv Prss Sgl 72 In,,12028037,LOCAL,Facility,Inpatient,,,,90,76.5,25.794,90,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Sup Transduc Set Iv Prss Sgl 72 In,,12028037,LOCAL,Facility,Both,,,,90,76.5,25.794,90,"Preferred One Administrative Services, INC.",PPO,88.74,98.6,,percent of total billed charges,,
Sup Transduc Set Iv Prss Sgl 72 In,,12028037,LOCAL,Facility,Outpatient,,,,90,76.5,25.794,90,PrimeWest Health,Minnesota Senior Health Options (MSHO),46.305,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Sup Transduc Set Iv Prss Sgl 72 In,,12028037,LOCAL,Facility,Inpatient,,,,90,76.5,25.794,90,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Transduc Set Iv Prss Sgl 72 In,,12028037,LOCAL,Facility,Outpatient,,,,90,76.5,25.794,90,PrimeWest Health,MinnesotaCare,46.224,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Sup Transduc Set Iv Prss Sgl 72 In,,12028037,LOCAL,Facility,Inpatient,,,,90,76.5,25.794,90,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Sup Transduc Set Iv Prss Sgl 72 In,,12028037,LOCAL,Facility,Both,,,,90,76.5,25.794,90,Sanford Health Plan,Sanford Health Plan,82.8,92,,percent of total billed charges,,
Sup Transduc Set Iv Prss Sgl 72 In,,12028037,LOCAL,Facility,Outpatient,,,,90,76.5,25.794,90,"UCare Health, Inc.",Individual & Family Plan,50.715,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Sup Transduc Set Iv Prss Sgl 72 In,,12028037,LOCAL,Facility,Inpatient,,,,90,76.5,25.794,90,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Sup Transduc Set Iv Prss Sgl 72 In,,12028037,LOCAL,Facility,Outpatient,,,,90,76.5,25.794,90,"UCare Health, Inc.",Medical Assistance,45.423,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Transduc Set Iv Prss Sgl 72 In,,12028037,LOCAL,Facility,Inpatient,,,,90,76.5,25.794,90,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Sup Transduc Set Iv Prss Sgl 72 In,,12028037,LOCAL,Facility,Outpatient,,,,90,76.5,25.794,90,"UCare Health, Inc.",Medicare Advantage,45.423,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Transduc Set Iv Prss Sgl 72 In,,12028037,LOCAL,Facility,Inpatient,,,,90,76.5,25.794,90,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Transduc Set Iv Prss Sgl 72 In,,12028037,LOCAL,Facility,Outpatient,,,,90,76.5,25.794,90,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),45.423,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Transduc Set Iv Prss Sgl 72 In,,12028037,LOCAL,Facility,Inpatient,,,,90,76.5,25.794,90,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Transduc Set Iv Prss Sgl 72 In,,12028037,LOCAL,Facility,Both,,,,90,76.5,25.794,90,UnitedHealthcare,Individual & Family,84.6,94,,percent of total billed charges,,
Sup Transduc Set Iv Prss Sgl 72 In,,12028037,LOCAL,Facility,Outpatient,,,,90,76.5,25.794,90,UnitedHealthcare,Medicare Advantage,44.1,49,,percent of total billed charges,,
Sup Transduc Set Iv Prss Sgl 72 In,,12028037,LOCAL,Facility,Inpatient,,,,90,76.5,25.794,90,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Sup Transduc Set Iv Prss Sgl 72 In,,12028037,LOCAL,Facility,Outpatient,,,,90,76.5,25.794,90,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,43.2,48,,percent of total billed charges,,100% of DHS outpatient percentage
Sup Transduc Set Iv Prss Sgl 72 In,,12028037,LOCAL,Facility,Inpatient,,,,90,76.5,25.794,90,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Sup Therahoney Dressing,,12030897,LOCAL,Facility,Both,,,,42.68,36.278,12.232088,42.68,Aetna,Commercial,39.2656,92,,percent of total billed charges,,
Sup Therahoney Dressing,,12030897,LOCAL,Facility,Outpatient,,,,42.68,36.278,12.232088,42.68,Aetna,Medicare Advantage,20.9132,49,,percent of total billed charges,,
Sup Therahoney Dressing,,12030897,LOCAL,Facility,Inpatient,,,,42.68,36.278,12.232088,42.68,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Sup Therahoney Dressing,,12030897,LOCAL,Facility,Both,,,,42.68,36.278,12.232088,42.68,Aetna,PPO,39.6924,93,,percent of total billed charges,,
Sup Therahoney Dressing,,12030897,LOCAL,Facility,Both,,,,42.68,36.278,12.232088,42.68,America's PPO,America's PPO,40.985604,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Sup Therahoney Dressing,,12030897,LOCAL,Facility,Both,,,,42.68,36.278,12.232088,42.68,BlueCross BlueShield Minnesota, Federal Employee Program,41.99712,98.4,,percent of total billed charges,,
Sup Therahoney Dressing,,12030897,LOCAL,Facility,Both,,,,42.68,36.278,12.232088,42.68,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,42.68,100,,percent of total billed charges,,
Sup Therahoney Dressing,,12030897,LOCAL,Facility,Both,,,,42.68,36.278,12.232088,42.68,BlueCross BlueShield Minnesota,High Value Network Plan,38.412,90,,percent of total billed charges,,
Sup Therahoney Dressing,,12030897,LOCAL,Facility,Outpatient,,,,42.68,36.278,12.232088,42.68,BlueCross BlueShield Minnesota,Medicare Advantage,20.9132,49,,percent of total billed charges,,
Sup Therahoney Dressing,,12030897,LOCAL,Facility,Inpatient,,,,42.68,36.278,12.232088,42.68,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Sup Therahoney Dressing,,12030897,LOCAL,Facility,Both,,,,42.68,36.278,12.232088,42.68,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,37.801676,88.57,,percent of total billed charges,,
Sup Therahoney Dressing,,12030897,LOCAL,Facility,Both,,,,42.68,36.278,12.232088,42.68,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,12.232088,28.66,,percent of total billed charges,,
Sup Therahoney Dressing,,12030897,LOCAL,Facility,Outpatient,,,,42.68,36.278,12.232088,42.68,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),20.9132,49,,percent of total billed charges,,
Sup Therahoney Dressing,,12030897,LOCAL,Facility,Inpatient,,,,42.68,36.278,12.232088,42.68,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Sup Therahoney Dressing,,12030897,LOCAL,Facility,Both,,,,42.68,36.278,12.232088,42.68,CorVel,Worker's Compensation,42.68,100,,percent of total billed charges,,
Sup Therahoney Dressing,,12030897,LOCAL,Facility,Both,,,,42.68,36.278,12.232088,42.68,First Health Group Corporation,First Health Network,41.3996,97,,percent of total billed charges,,
Sup Therahoney Dressing,,12030897,LOCAL,Facility,Both,,,,42.68,36.278,12.232088,42.68,"Health Partners, Inc.",Commercial,40.37528,94.6,,percent of total billed charges,,
Sup Therahoney Dressing,,12030897,LOCAL,Facility,Outpatient,,,,42.68,36.278,12.232088,42.68,"Health Partners, Inc.",Medicare Advantage,20.9132,49,,percent of total billed charges,,
Sup Therahoney Dressing,,12030897,LOCAL,Facility,Inpatient,,,,42.68,36.278,12.232088,42.68,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Therahoney Dressing,,12030897,LOCAL,Facility,Both,,,,42.68,36.278,12.232088,42.68,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),25.608,60,,percent of total billed charges,,
Sup Therahoney Dressing,,12030897,LOCAL,Facility,Both,,,,42.68,36.278,12.232088,42.68,"Health Partners, Inc.",State of Minnesota Advantage Program,34.7842,81.5,,percent of total billed charges,,
Sup Therahoney Dressing,,12030897,LOCAL,Facility,Both,,,,42.68,36.278,12.232088,42.68,"Health Partners, Inc.",State Public Programs,21.34,50,,percent of total billed charges,,
Sup Therahoney Dressing,,12030897,LOCAL,Facility,Both,,,,42.68,36.278,12.232088,42.68,Humana Insurance Company,Commercial PPO,40.546,95,,percent of total billed charges,,
Sup Therahoney Dressing,,12030897,LOCAL,Facility,Outpatient,,,,42.68,36.278,12.232088,42.68,Humana Insurance Company,Medicare PPO,20.9132,49,,percent of total billed charges,,
Sup Therahoney Dressing,,12030897,LOCAL,Facility,Inpatient,,,,42.68,36.278,12.232088,42.68,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Sup Therahoney Dressing,,12030897,LOCAL,Facility,Both,,,,42.68,36.278,12.232088,42.68,Medica,Individual & Family,42.29588,99.1,,percent of total billed charges,,
Sup Therahoney Dressing,,12030897,LOCAL,Facility,Outpatient,,,,42.68,36.278,12.232088,42.68,Medica,Medica Advantage Solution,21.25464,49.8,,percent of total billed charges,,
Sup Therahoney Dressing,,12030897,LOCAL,Facility,Inpatient,,,,42.68,36.278,12.232088,42.68,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Sup Therahoney Dressing,,12030897,LOCAL,Facility,Outpatient,,,,42.68,36.278,12.232088,42.68,Medica,Medical Assistance,19.03528,44.6,,percent of total billed charges,,
Sup Therahoney Dressing,,12030897,LOCAL,Facility,Inpatient,,,,42.68,36.278,12.232088,42.68,Medica,Medical Assistance,,,,,Included in per diem rate,
Sup Therahoney Dressing,,12030897,LOCAL,Facility,Outpatient,,,,42.68,36.278,12.232088,42.68,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,21.25464,49.8,,percent of total billed charges,,
Sup Therahoney Dressing,,12030897,LOCAL,Facility,Inpatient,,,,42.68,36.278,12.232088,42.68,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Sup Therahoney Dressing,,12030897,LOCAL,Facility,Both,,,,42.68,36.278,12.232088,42.68,"Multiplan, Inc.","Multiplan, Inc.",40.1192,94,,percent of total billed charges,,
Sup Therahoney Dressing,,12030897,LOCAL,Facility,Outpatient,,,,42.68,36.278,12.232088,42.68,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,38.45468,90.1,,percent of total billed charges,,
Sup Therahoney Dressing,,12030897,LOCAL,Facility,Inpatient,,,,42.68,36.278,12.232088,42.68,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Sup Therahoney Dressing,,12030897,LOCAL,Facility,Both,,,,42.68,36.278,12.232088,42.68,"Preferred One Administrative Services, INC.",PPO,42.08248,98.6,,percent of total billed charges,,
Sup Therahoney Dressing,,12030897,LOCAL,Facility,Outpatient,,,,42.68,36.278,12.232088,42.68,PrimeWest Health,Minnesota Senior Health Options (MSHO),21.95886,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Sup Therahoney Dressing,,12030897,LOCAL,Facility,Inpatient,,,,42.68,36.278,12.232088,42.68,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Therahoney Dressing,,12030897,LOCAL,Facility,Outpatient,,,,42.68,36.278,12.232088,42.68,PrimeWest Health,MinnesotaCare,21.920448,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Sup Therahoney Dressing,,12030897,LOCAL,Facility,Inpatient,,,,42.68,36.278,12.232088,42.68,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Sup Therahoney Dressing,,12030897,LOCAL,Facility,Both,,,,42.68,36.278,12.232088,42.68,Sanford Health Plan,Sanford Health Plan,39.2656,92,,percent of total billed charges,,
Sup Therahoney Dressing,,12030897,LOCAL,Facility,Outpatient,,,,42.68,36.278,12.232088,42.68,"UCare Health, Inc.",Individual & Family Plan,24.05018,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Sup Therahoney Dressing,,12030897,LOCAL,Facility,Inpatient,,,,42.68,36.278,12.232088,42.68,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Sup Therahoney Dressing,,12030897,LOCAL,Facility,Outpatient,,,,42.68,36.278,12.232088,42.68,"UCare Health, Inc.",Medical Assistance,21.540596,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Therahoney Dressing,,12030897,LOCAL,Facility,Inpatient,,,,42.68,36.278,12.232088,42.68,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Sup Therahoney Dressing,,12030897,LOCAL,Facility,Outpatient,,,,42.68,36.278,12.232088,42.68,"UCare Health, Inc.",Medicare Advantage,21.540596,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Therahoney Dressing,,12030897,LOCAL,Facility,Inpatient,,,,42.68,36.278,12.232088,42.68,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Therahoney Dressing,,12030897,LOCAL,Facility,Outpatient,,,,42.68,36.278,12.232088,42.68,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),21.540596,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Therahoney Dressing,,12030897,LOCAL,Facility,Inpatient,,,,42.68,36.278,12.232088,42.68,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Therahoney Dressing,,12030897,LOCAL,Facility,Both,,,,42.68,36.278,12.232088,42.68,UnitedHealthcare,Individual & Family,40.1192,94,,percent of total billed charges,,
Sup Therahoney Dressing,,12030897,LOCAL,Facility,Outpatient,,,,42.68,36.278,12.232088,42.68,UnitedHealthcare,Medicare Advantage,20.9132,49,,percent of total billed charges,,
Sup Therahoney Dressing,,12030897,LOCAL,Facility,Inpatient,,,,42.68,36.278,12.232088,42.68,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Sup Therahoney Dressing,,12030897,LOCAL,Facility,Outpatient,,,,42.68,36.278,12.232088,42.68,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,20.4864,48,,percent of total billed charges,,100% of DHS outpatient percentage
Sup Therahoney Dressing,,12030897,LOCAL,Facility,Inpatient,,,,42.68,36.278,12.232088,42.68,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Sup Ear Tube,,12032915,LOCAL,Facility,Both,,,,65,55.25,18.629,65,Aetna,Commercial,59.8,92,,percent of total billed charges,,
Sup Ear Tube,,12032915,LOCAL,Facility,Outpatient,,,,65,55.25,18.629,65,Aetna,Medicare Advantage,31.85,49,,percent of total billed charges,,
Sup Ear Tube,,12032915,LOCAL,Facility,Inpatient,,,,65,55.25,18.629,65,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Sup Ear Tube,,12032915,LOCAL,Facility,Both,,,,65,55.25,18.629,65,Aetna,PPO,60.45,93,,percent of total billed charges,,
Sup Ear Tube,,12032915,LOCAL,Facility,Both,,,,65,55.25,18.629,65,America's PPO,America's PPO,62.4195,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Sup Ear Tube,,12032915,LOCAL,Facility,Both,,,,65,55.25,18.629,65,BlueCross BlueShield Minnesota, Federal Employee Program,63.96,98.4,,percent of total billed charges,,
Sup Ear Tube,,12032915,LOCAL,Facility,Both,,,,65,55.25,18.629,65,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,65,100,,percent of total billed charges,,
Sup Ear Tube,,12032915,LOCAL,Facility,Both,,,,65,55.25,18.629,65,BlueCross BlueShield Minnesota,High Value Network Plan,58.5,90,,percent of total billed charges,,
Sup Ear Tube,,12032915,LOCAL,Facility,Outpatient,,,,65,55.25,18.629,65,BlueCross BlueShield Minnesota,Medicare Advantage,31.85,49,,percent of total billed charges,,
Sup Ear Tube,,12032915,LOCAL,Facility,Inpatient,,,,65,55.25,18.629,65,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Sup Ear Tube,,12032915,LOCAL,Facility,Both,,,,65,55.25,18.629,65,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,57.5705,88.57,,percent of total billed charges,,
Sup Ear Tube,,12032915,LOCAL,Facility,Both,,,,65,55.25,18.629,65,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,18.629,28.66,,percent of total billed charges,,
Sup Ear Tube,,12032915,LOCAL,Facility,Outpatient,,,,65,55.25,18.629,65,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),31.85,49,,percent of total billed charges,,
Sup Ear Tube,,12032915,LOCAL,Facility,Inpatient,,,,65,55.25,18.629,65,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Sup Ear Tube,,12032915,LOCAL,Facility,Both,,,,65,55.25,18.629,65,CorVel,Worker's Compensation,65,100,,percent of total billed charges,,
Sup Ear Tube,,12032915,LOCAL,Facility,Both,,,,65,55.25,18.629,65,First Health Group Corporation,First Health Network,63.05,97,,percent of total billed charges,,
Sup Ear Tube,,12032915,LOCAL,Facility,Both,,,,65,55.25,18.629,65,"Health Partners, Inc.",Commercial,61.49,94.6,,percent of total billed charges,,
Sup Ear Tube,,12032915,LOCAL,Facility,Outpatient,,,,65,55.25,18.629,65,"Health Partners, Inc.",Medicare Advantage,31.85,49,,percent of total billed charges,,
Sup Ear Tube,,12032915,LOCAL,Facility,Inpatient,,,,65,55.25,18.629,65,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Ear Tube,,12032915,LOCAL,Facility,Both,,,,65,55.25,18.629,65,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),39,60,,percent of total billed charges,,
Sup Ear Tube,,12032915,LOCAL,Facility,Both,,,,65,55.25,18.629,65,"Health Partners, Inc.",State of Minnesota Advantage Program,52.975,81.5,,percent of total billed charges,,
Sup Ear Tube,,12032915,LOCAL,Facility,Both,,,,65,55.25,18.629,65,"Health Partners, Inc.",State Public Programs,32.5,50,,percent of total billed charges,,
Sup Ear Tube,,12032915,LOCAL,Facility,Both,,,,65,55.25,18.629,65,Humana Insurance Company,Commercial PPO,61.75,95,,percent of total billed charges,,
Sup Ear Tube,,12032915,LOCAL,Facility,Outpatient,,,,65,55.25,18.629,65,Humana Insurance Company,Medicare PPO,31.85,49,,percent of total billed charges,,
Sup Ear Tube,,12032915,LOCAL,Facility,Inpatient,,,,65,55.25,18.629,65,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Sup Ear Tube,,12032915,LOCAL,Facility,Both,,,,65,55.25,18.629,65,Medica,Individual & Family,64.415,99.1,,percent of total billed charges,,
Sup Ear Tube,,12032915,LOCAL,Facility,Outpatient,,,,65,55.25,18.629,65,Medica,Medica Advantage Solution,32.37,49.8,,percent of total billed charges,,
Sup Ear Tube,,12032915,LOCAL,Facility,Inpatient,,,,65,55.25,18.629,65,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Sup Ear Tube,,12032915,LOCAL,Facility,Outpatient,,,,65,55.25,18.629,65,Medica,Medical Assistance,28.99,44.6,,percent of total billed charges,,
Sup Ear Tube,,12032915,LOCAL,Facility,Inpatient,,,,65,55.25,18.629,65,Medica,Medical Assistance,,,,,Included in per diem rate,
Sup Ear Tube,,12032915,LOCAL,Facility,Outpatient,,,,65,55.25,18.629,65,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,32.37,49.8,,percent of total billed charges,,
Sup Ear Tube,,12032915,LOCAL,Facility,Inpatient,,,,65,55.25,18.629,65,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Sup Ear Tube,,12032915,LOCAL,Facility,Both,,,,65,55.25,18.629,65,"Multiplan, Inc.","Multiplan, Inc.",61.1,94,,percent of total billed charges,,
Sup Ear Tube,,12032915,LOCAL,Facility,Outpatient,,,,65,55.25,18.629,65,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,58.565,90.1,,percent of total billed charges,,
Sup Ear Tube,,12032915,LOCAL,Facility,Inpatient,,,,65,55.25,18.629,65,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Sup Ear Tube,,12032915,LOCAL,Facility,Both,,,,65,55.25,18.629,65,"Preferred One Administrative Services, INC.",PPO,64.09,98.6,,percent of total billed charges,,
Sup Ear Tube,,12032915,LOCAL,Facility,Outpatient,,,,65,55.25,18.629,65,PrimeWest Health,Minnesota Senior Health Options (MSHO),33.4425,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Sup Ear Tube,,12032915,LOCAL,Facility,Inpatient,,,,65,55.25,18.629,65,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Ear Tube,,12032915,LOCAL,Facility,Outpatient,,,,65,55.25,18.629,65,PrimeWest Health,MinnesotaCare,33.384,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Sup Ear Tube,,12032915,LOCAL,Facility,Inpatient,,,,65,55.25,18.629,65,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Sup Ear Tube,,12032915,LOCAL,Facility,Both,,,,65,55.25,18.629,65,Sanford Health Plan,Sanford Health Plan,59.8,92,,percent of total billed charges,,
Sup Ear Tube,,12032915,LOCAL,Facility,Outpatient,,,,65,55.25,18.629,65,"UCare Health, Inc.",Individual & Family Plan,36.6275,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Sup Ear Tube,,12032915,LOCAL,Facility,Inpatient,,,,65,55.25,18.629,65,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Sup Ear Tube,,12032915,LOCAL,Facility,Outpatient,,,,65,55.25,18.629,65,"UCare Health, Inc.",Medical Assistance,32.8055,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Ear Tube,,12032915,LOCAL,Facility,Inpatient,,,,65,55.25,18.629,65,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Sup Ear Tube,,12032915,LOCAL,Facility,Outpatient,,,,65,55.25,18.629,65,"UCare Health, Inc.",Medicare Advantage,32.8055,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Ear Tube,,12032915,LOCAL,Facility,Inpatient,,,,65,55.25,18.629,65,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Ear Tube,,12032915,LOCAL,Facility,Outpatient,,,,65,55.25,18.629,65,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),32.8055,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Ear Tube,,12032915,LOCAL,Facility,Inpatient,,,,65,55.25,18.629,65,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Ear Tube,,12032915,LOCAL,Facility,Both,,,,65,55.25,18.629,65,UnitedHealthcare,Individual & Family,61.1,94,,percent of total billed charges,,
Sup Ear Tube,,12032915,LOCAL,Facility,Outpatient,,,,65,55.25,18.629,65,UnitedHealthcare,Medicare Advantage,31.85,49,,percent of total billed charges,,
Sup Ear Tube,,12032915,LOCAL,Facility,Inpatient,,,,65,55.25,18.629,65,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Sup Ear Tube,,12032915,LOCAL,Facility,Outpatient,,,,65,55.25,18.629,65,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,31.2,48,,percent of total billed charges,,100% of DHS outpatient percentage
Sup Ear Tube,,12032915,LOCAL,Facility,Inpatient,,,,65,55.25,18.629,65,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Sup Debrisoft Pad,,12035047,LOCAL,Facility,Both,,,,126.03,107.1255,36.120198,126.03,Aetna,Commercial,115.9476,92,,percent of total billed charges,,
Sup Debrisoft Pad,,12035047,LOCAL,Facility,Outpatient,,,,126.03,107.1255,36.120198,126.03,Aetna,Medicare Advantage,61.7547,49,,percent of total billed charges,,
Sup Debrisoft Pad,,12035047,LOCAL,Facility,Inpatient,,,,126.03,107.1255,36.120198,126.03,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Sup Debrisoft Pad,,12035047,LOCAL,Facility,Both,,,,126.03,107.1255,36.120198,126.03,Aetna,PPO,117.2079,93,,percent of total billed charges,,
Sup Debrisoft Pad,,12035047,LOCAL,Facility,Both,,,,126.03,107.1255,36.120198,126.03,America's PPO,America's PPO,121.026609,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Sup Debrisoft Pad,,12035047,LOCAL,Facility,Both,,,,126.03,107.1255,36.120198,126.03,BlueCross BlueShield Minnesota, Federal Employee Program,124.01352,98.4,,percent of total billed charges,,
Sup Debrisoft Pad,,12035047,LOCAL,Facility,Both,,,,126.03,107.1255,36.120198,126.03,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,126.03,100,,percent of total billed charges,,
Sup Debrisoft Pad,,12035047,LOCAL,Facility,Both,,,,126.03,107.1255,36.120198,126.03,BlueCross BlueShield Minnesota,High Value Network Plan,113.427,90,,percent of total billed charges,,
Sup Debrisoft Pad,,12035047,LOCAL,Facility,Outpatient,,,,126.03,107.1255,36.120198,126.03,BlueCross BlueShield Minnesota,Medicare Advantage,61.7547,49,,percent of total billed charges,,
Sup Debrisoft Pad,,12035047,LOCAL,Facility,Inpatient,,,,126.03,107.1255,36.120198,126.03,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Sup Debrisoft Pad,,12035047,LOCAL,Facility,Both,,,,126.03,107.1255,36.120198,126.03,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,111.624771,88.57,,percent of total billed charges,,
Sup Debrisoft Pad,,12035047,LOCAL,Facility,Both,,,,126.03,107.1255,36.120198,126.03,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,36.120198,28.66,,percent of total billed charges,,
Sup Debrisoft Pad,,12035047,LOCAL,Facility,Outpatient,,,,126.03,107.1255,36.120198,126.03,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),61.7547,49,,percent of total billed charges,,
Sup Debrisoft Pad,,12035047,LOCAL,Facility,Inpatient,,,,126.03,107.1255,36.120198,126.03,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Sup Debrisoft Pad,,12035047,LOCAL,Facility,Both,,,,126.03,107.1255,36.120198,126.03,CorVel,Worker's Compensation,126.03,100,,percent of total billed charges,,
Sup Debrisoft Pad,,12035047,LOCAL,Facility,Both,,,,126.03,107.1255,36.120198,126.03,First Health Group Corporation,First Health Network,122.2491,97,,percent of total billed charges,,
Sup Debrisoft Pad,,12035047,LOCAL,Facility,Both,,,,126.03,107.1255,36.120198,126.03,"Health Partners, Inc.",Commercial,119.22438,94.6,,percent of total billed charges,,
Sup Debrisoft Pad,,12035047,LOCAL,Facility,Outpatient,,,,126.03,107.1255,36.120198,126.03,"Health Partners, Inc.",Medicare Advantage,61.7547,49,,percent of total billed charges,,
Sup Debrisoft Pad,,12035047,LOCAL,Facility,Inpatient,,,,126.03,107.1255,36.120198,126.03,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Debrisoft Pad,,12035047,LOCAL,Facility,Both,,,,126.03,107.1255,36.120198,126.03,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),75.618,60,,percent of total billed charges,,
Sup Debrisoft Pad,,12035047,LOCAL,Facility,Both,,,,126.03,107.1255,36.120198,126.03,"Health Partners, Inc.",State of Minnesota Advantage Program,102.71445,81.5,,percent of total billed charges,,
Sup Debrisoft Pad,,12035047,LOCAL,Facility,Both,,,,126.03,107.1255,36.120198,126.03,"Health Partners, Inc.",State Public Programs,63.015,50,,percent of total billed charges,,
Sup Debrisoft Pad,,12035047,LOCAL,Facility,Both,,,,126.03,107.1255,36.120198,126.03,Humana Insurance Company,Commercial PPO,119.7285,95,,percent of total billed charges,,
Sup Debrisoft Pad,,12035047,LOCAL,Facility,Outpatient,,,,126.03,107.1255,36.120198,126.03,Humana Insurance Company,Medicare PPO,61.7547,49,,percent of total billed charges,,
Sup Debrisoft Pad,,12035047,LOCAL,Facility,Inpatient,,,,126.03,107.1255,36.120198,126.03,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Sup Debrisoft Pad,,12035047,LOCAL,Facility,Both,,,,126.03,107.1255,36.120198,126.03,Medica,Individual & Family,124.89573,99.1,,percent of total billed charges,,
Sup Debrisoft Pad,,12035047,LOCAL,Facility,Outpatient,,,,126.03,107.1255,36.120198,126.03,Medica,Medica Advantage Solution,62.76294,49.8,,percent of total billed charges,,
Sup Debrisoft Pad,,12035047,LOCAL,Facility,Inpatient,,,,126.03,107.1255,36.120198,126.03,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Sup Debrisoft Pad,,12035047,LOCAL,Facility,Outpatient,,,,126.03,107.1255,36.120198,126.03,Medica,Medical Assistance,56.20938,44.6,,percent of total billed charges,,
Sup Debrisoft Pad,,12035047,LOCAL,Facility,Inpatient,,,,126.03,107.1255,36.120198,126.03,Medica,Medical Assistance,,,,,Included in per diem rate,
Sup Debrisoft Pad,,12035047,LOCAL,Facility,Outpatient,,,,126.03,107.1255,36.120198,126.03,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,62.76294,49.8,,percent of total billed charges,,
Sup Debrisoft Pad,,12035047,LOCAL,Facility,Inpatient,,,,126.03,107.1255,36.120198,126.03,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Sup Debrisoft Pad,,12035047,LOCAL,Facility,Both,,,,126.03,107.1255,36.120198,126.03,"Multiplan, Inc.","Multiplan, Inc.",118.4682,94,,percent of total billed charges,,
Sup Debrisoft Pad,,12035047,LOCAL,Facility,Outpatient,,,,126.03,107.1255,36.120198,126.03,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,113.55303,90.1,,percent of total billed charges,,
Sup Debrisoft Pad,,12035047,LOCAL,Facility,Inpatient,,,,126.03,107.1255,36.120198,126.03,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Sup Debrisoft Pad,,12035047,LOCAL,Facility,Both,,,,126.03,107.1255,36.120198,126.03,"Preferred One Administrative Services, INC.",PPO,124.26558,98.6,,percent of total billed charges,,
Sup Debrisoft Pad,,12035047,LOCAL,Facility,Outpatient,,,,126.03,107.1255,36.120198,126.03,PrimeWest Health,Minnesota Senior Health Options (MSHO),64.842435,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Sup Debrisoft Pad,,12035047,LOCAL,Facility,Inpatient,,,,126.03,107.1255,36.120198,126.03,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Debrisoft Pad,,12035047,LOCAL,Facility,Outpatient,,,,126.03,107.1255,36.120198,126.03,PrimeWest Health,MinnesotaCare,64.729008,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Sup Debrisoft Pad,,12035047,LOCAL,Facility,Inpatient,,,,126.03,107.1255,36.120198,126.03,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Sup Debrisoft Pad,,12035047,LOCAL,Facility,Both,,,,126.03,107.1255,36.120198,126.03,Sanford Health Plan,Sanford Health Plan,115.9476,92,,percent of total billed charges,,
Sup Debrisoft Pad,,12035047,LOCAL,Facility,Outpatient,,,,126.03,107.1255,36.120198,126.03,"UCare Health, Inc.",Individual & Family Plan,71.017905,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Sup Debrisoft Pad,,12035047,LOCAL,Facility,Inpatient,,,,126.03,107.1255,36.120198,126.03,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Sup Debrisoft Pad,,12035047,LOCAL,Facility,Outpatient,,,,126.03,107.1255,36.120198,126.03,"UCare Health, Inc.",Medical Assistance,63.607341,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Debrisoft Pad,,12035047,LOCAL,Facility,Inpatient,,,,126.03,107.1255,36.120198,126.03,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Sup Debrisoft Pad,,12035047,LOCAL,Facility,Outpatient,,,,126.03,107.1255,36.120198,126.03,"UCare Health, Inc.",Medicare Advantage,63.607341,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Debrisoft Pad,,12035047,LOCAL,Facility,Inpatient,,,,126.03,107.1255,36.120198,126.03,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Debrisoft Pad,,12035047,LOCAL,Facility,Outpatient,,,,126.03,107.1255,36.120198,126.03,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),63.607341,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Debrisoft Pad,,12035047,LOCAL,Facility,Inpatient,,,,126.03,107.1255,36.120198,126.03,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Debrisoft Pad,,12035047,LOCAL,Facility,Both,,,,126.03,107.1255,36.120198,126.03,UnitedHealthcare,Individual & Family,118.4682,94,,percent of total billed charges,,
Sup Debrisoft Pad,,12035047,LOCAL,Facility,Outpatient,,,,126.03,107.1255,36.120198,126.03,UnitedHealthcare,Medicare Advantage,61.7547,49,,percent of total billed charges,,
Sup Debrisoft Pad,,12035047,LOCAL,Facility,Inpatient,,,,126.03,107.1255,36.120198,126.03,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Sup Debrisoft Pad,,12035047,LOCAL,Facility,Outpatient,,,,126.03,107.1255,36.120198,126.03,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,60.4944,48,,percent of total billed charges,,100% of DHS outpatient percentage
Sup Debrisoft Pad,,12035047,LOCAL,Facility,Inpatient,,,,126.03,107.1255,36.120198,126.03,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Sup Debrisoft Lolly,,12035053,LOCAL,Facility,Both,,,,144.58,122.893,41.436628,144.58,Aetna,Commercial,133.0136,92,,percent of total billed charges,,
Sup Debrisoft Lolly,,12035053,LOCAL,Facility,Outpatient,,,,144.58,122.893,41.436628,144.58,Aetna,Medicare Advantage,70.8442,49,,percent of total billed charges,,
Sup Debrisoft Lolly,,12035053,LOCAL,Facility,Inpatient,,,,144.58,122.893,41.436628,144.58,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Sup Debrisoft Lolly,,12035053,LOCAL,Facility,Both,,,,144.58,122.893,41.436628,144.58,Aetna,PPO,134.4594,93,,percent of total billed charges,,
Sup Debrisoft Lolly,,12035053,LOCAL,Facility,Both,,,,144.58,122.893,41.436628,144.58,America's PPO,America's PPO,138.840174,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Sup Debrisoft Lolly,,12035053,LOCAL,Facility,Both,,,,144.58,122.893,41.436628,144.58,BlueCross BlueShield Minnesota, Federal Employee Program,142.26672,98.4,,percent of total billed charges,,
Sup Debrisoft Lolly,,12035053,LOCAL,Facility,Both,,,,144.58,122.893,41.436628,144.58,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,144.58,100,,percent of total billed charges,,
Sup Debrisoft Lolly,,12035053,LOCAL,Facility,Both,,,,144.58,122.893,41.436628,144.58,BlueCross BlueShield Minnesota,High Value Network Plan,130.122,90,,percent of total billed charges,,
Sup Debrisoft Lolly,,12035053,LOCAL,Facility,Outpatient,,,,144.58,122.893,41.436628,144.58,BlueCross BlueShield Minnesota,Medicare Advantage,70.8442,49,,percent of total billed charges,,
Sup Debrisoft Lolly,,12035053,LOCAL,Facility,Inpatient,,,,144.58,122.893,41.436628,144.58,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Sup Debrisoft Lolly,,12035053,LOCAL,Facility,Both,,,,144.58,122.893,41.436628,144.58,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,128.054506,88.57,,percent of total billed charges,,
Sup Debrisoft Lolly,,12035053,LOCAL,Facility,Both,,,,144.58,122.893,41.436628,144.58,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,41.436628,28.66,,percent of total billed charges,,
Sup Debrisoft Lolly,,12035053,LOCAL,Facility,Outpatient,,,,144.58,122.893,41.436628,144.58,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),70.8442,49,,percent of total billed charges,,
Sup Debrisoft Lolly,,12035053,LOCAL,Facility,Inpatient,,,,144.58,122.893,41.436628,144.58,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Sup Debrisoft Lolly,,12035053,LOCAL,Facility,Both,,,,144.58,122.893,41.436628,144.58,CorVel,Worker's Compensation,144.58,100,,percent of total billed charges,,
Sup Debrisoft Lolly,,12035053,LOCAL,Facility,Both,,,,144.58,122.893,41.436628,144.58,First Health Group Corporation,First Health Network,140.2426,97,,percent of total billed charges,,
Sup Debrisoft Lolly,,12035053,LOCAL,Facility,Both,,,,144.58,122.893,41.436628,144.58,"Health Partners, Inc.",Commercial,136.77268,94.6,,percent of total billed charges,,
Sup Debrisoft Lolly,,12035053,LOCAL,Facility,Outpatient,,,,144.58,122.893,41.436628,144.58,"Health Partners, Inc.",Medicare Advantage,70.8442,49,,percent of total billed charges,,
Sup Debrisoft Lolly,,12035053,LOCAL,Facility,Inpatient,,,,144.58,122.893,41.436628,144.58,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Debrisoft Lolly,,12035053,LOCAL,Facility,Both,,,,144.58,122.893,41.436628,144.58,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),86.748,60,,percent of total billed charges,,
Sup Debrisoft Lolly,,12035053,LOCAL,Facility,Both,,,,144.58,122.893,41.436628,144.58,"Health Partners, Inc.",State of Minnesota Advantage Program,117.8327,81.5,,percent of total billed charges,,
Sup Debrisoft Lolly,,12035053,LOCAL,Facility,Both,,,,144.58,122.893,41.436628,144.58,"Health Partners, Inc.",State Public Programs,72.29,50,,percent of total billed charges,,
Sup Debrisoft Lolly,,12035053,LOCAL,Facility,Both,,,,144.58,122.893,41.436628,144.58,Humana Insurance Company,Commercial PPO,137.351,95,,percent of total billed charges,,
Sup Debrisoft Lolly,,12035053,LOCAL,Facility,Outpatient,,,,144.58,122.893,41.436628,144.58,Humana Insurance Company,Medicare PPO,70.8442,49,,percent of total billed charges,,
Sup Debrisoft Lolly,,12035053,LOCAL,Facility,Inpatient,,,,144.58,122.893,41.436628,144.58,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Sup Debrisoft Lolly,,12035053,LOCAL,Facility,Both,,,,144.58,122.893,41.436628,144.58,Medica,Individual & Family,143.27878,99.1,,percent of total billed charges,,
Sup Debrisoft Lolly,,12035053,LOCAL,Facility,Outpatient,,,,144.58,122.893,41.436628,144.58,Medica,Medica Advantage Solution,72.00084,49.8,,percent of total billed charges,,
Sup Debrisoft Lolly,,12035053,LOCAL,Facility,Inpatient,,,,144.58,122.893,41.436628,144.58,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Sup Debrisoft Lolly,,12035053,LOCAL,Facility,Outpatient,,,,144.58,122.893,41.436628,144.58,Medica,Medical Assistance,64.48268,44.6,,percent of total billed charges,,
Sup Debrisoft Lolly,,12035053,LOCAL,Facility,Inpatient,,,,144.58,122.893,41.436628,144.58,Medica,Medical Assistance,,,,,Included in per diem rate,
Sup Debrisoft Lolly,,12035053,LOCAL,Facility,Outpatient,,,,144.58,122.893,41.436628,144.58,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,72.00084,49.8,,percent of total billed charges,,
Sup Debrisoft Lolly,,12035053,LOCAL,Facility,Inpatient,,,,144.58,122.893,41.436628,144.58,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Sup Debrisoft Lolly,,12035053,LOCAL,Facility,Both,,,,144.58,122.893,41.436628,144.58,"Multiplan, Inc.","Multiplan, Inc.",135.9052,94,,percent of total billed charges,,
Sup Debrisoft Lolly,,12035053,LOCAL,Facility,Outpatient,,,,144.58,122.893,41.436628,144.58,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,130.26658,90.1,,percent of total billed charges,,
Sup Debrisoft Lolly,,12035053,LOCAL,Facility,Inpatient,,,,144.58,122.893,41.436628,144.58,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Sup Debrisoft Lolly,,12035053,LOCAL,Facility,Both,,,,144.58,122.893,41.436628,144.58,"Preferred One Administrative Services, INC.",PPO,142.55588,98.6,,percent of total billed charges,,
Sup Debrisoft Lolly,,12035053,LOCAL,Facility,Outpatient,,,,144.58,122.893,41.436628,144.58,PrimeWest Health,Minnesota Senior Health Options (MSHO),74.38641,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Sup Debrisoft Lolly,,12035053,LOCAL,Facility,Inpatient,,,,144.58,122.893,41.436628,144.58,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Debrisoft Lolly,,12035053,LOCAL,Facility,Outpatient,,,,144.58,122.893,41.436628,144.58,PrimeWest Health,MinnesotaCare,74.256288,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Sup Debrisoft Lolly,,12035053,LOCAL,Facility,Inpatient,,,,144.58,122.893,41.436628,144.58,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Sup Debrisoft Lolly,,12035053,LOCAL,Facility,Both,,,,144.58,122.893,41.436628,144.58,Sanford Health Plan,Sanford Health Plan,133.0136,92,,percent of total billed charges,,
Sup Debrisoft Lolly,,12035053,LOCAL,Facility,Outpatient,,,,144.58,122.893,41.436628,144.58,"UCare Health, Inc.",Individual & Family Plan,81.47083,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Sup Debrisoft Lolly,,12035053,LOCAL,Facility,Inpatient,,,,144.58,122.893,41.436628,144.58,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Sup Debrisoft Lolly,,12035053,LOCAL,Facility,Outpatient,,,,144.58,122.893,41.436628,144.58,"UCare Health, Inc.",Medical Assistance,72.969526,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Debrisoft Lolly,,12035053,LOCAL,Facility,Inpatient,,,,144.58,122.893,41.436628,144.58,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Sup Debrisoft Lolly,,12035053,LOCAL,Facility,Outpatient,,,,144.58,122.893,41.436628,144.58,"UCare Health, Inc.",Medicare Advantage,72.969526,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Debrisoft Lolly,,12035053,LOCAL,Facility,Inpatient,,,,144.58,122.893,41.436628,144.58,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Debrisoft Lolly,,12035053,LOCAL,Facility,Outpatient,,,,144.58,122.893,41.436628,144.58,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),72.969526,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Debrisoft Lolly,,12035053,LOCAL,Facility,Inpatient,,,,144.58,122.893,41.436628,144.58,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Debrisoft Lolly,,12035053,LOCAL,Facility,Both,,,,144.58,122.893,41.436628,144.58,UnitedHealthcare,Individual & Family,135.9052,94,,percent of total billed charges,,
Sup Debrisoft Lolly,,12035053,LOCAL,Facility,Outpatient,,,,144.58,122.893,41.436628,144.58,UnitedHealthcare,Medicare Advantage,70.8442,49,,percent of total billed charges,,
Sup Debrisoft Lolly,,12035053,LOCAL,Facility,Inpatient,,,,144.58,122.893,41.436628,144.58,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Sup Debrisoft Lolly,,12035053,LOCAL,Facility,Outpatient,,,,144.58,122.893,41.436628,144.58,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,69.3984,48,,percent of total billed charges,,100% of DHS outpatient percentage
Sup Debrisoft Lolly,,12035053,LOCAL,Facility,Inpatient,,,,144.58,122.893,41.436628,144.58,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Sup Curette #2,,12035062,LOCAL,Facility,Both,,,,25.39,21.5815,7.276774,25.39,Aetna,Commercial,23.3588,92,,percent of total billed charges,,
Sup Curette #2,,12035062,LOCAL,Facility,Outpatient,,,,25.39,21.5815,7.276774,25.39,Aetna,Medicare Advantage,12.4411,49,,percent of total billed charges,,
Sup Curette #2,,12035062,LOCAL,Facility,Inpatient,,,,25.39,21.5815,7.276774,25.39,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Sup Curette #2,,12035062,LOCAL,Facility,Both,,,,25.39,21.5815,7.276774,25.39,Aetna,PPO,23.6127,93,,percent of total billed charges,,
Sup Curette #2,,12035062,LOCAL,Facility,Both,,,,25.39,21.5815,7.276774,25.39,America's PPO,America's PPO,24.382017,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Sup Curette #2,,12035062,LOCAL,Facility,Both,,,,25.39,21.5815,7.276774,25.39,BlueCross BlueShield Minnesota, Federal Employee Program,24.98376,98.4,,percent of total billed charges,,
Sup Curette #2,,12035062,LOCAL,Facility,Both,,,,25.39,21.5815,7.276774,25.39,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,25.39,100,,percent of total billed charges,,
Sup Curette #2,,12035062,LOCAL,Facility,Both,,,,25.39,21.5815,7.276774,25.39,BlueCross BlueShield Minnesota,High Value Network Plan,22.851,90,,percent of total billed charges,,
Sup Curette #2,,12035062,LOCAL,Facility,Outpatient,,,,25.39,21.5815,7.276774,25.39,BlueCross BlueShield Minnesota,Medicare Advantage,12.4411,49,,percent of total billed charges,,
Sup Curette #2,,12035062,LOCAL,Facility,Inpatient,,,,25.39,21.5815,7.276774,25.39,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Sup Curette #2,,12035062,LOCAL,Facility,Both,,,,25.39,21.5815,7.276774,25.39,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,22.487923,88.57,,percent of total billed charges,,
Sup Curette #2,,12035062,LOCAL,Facility,Both,,,,25.39,21.5815,7.276774,25.39,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,7.276774,28.66,,percent of total billed charges,,
Sup Curette #2,,12035062,LOCAL,Facility,Outpatient,,,,25.39,21.5815,7.276774,25.39,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),12.4411,49,,percent of total billed charges,,
Sup Curette #2,,12035062,LOCAL,Facility,Inpatient,,,,25.39,21.5815,7.276774,25.39,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Sup Curette #2,,12035062,LOCAL,Facility,Both,,,,25.39,21.5815,7.276774,25.39,CorVel,Worker's Compensation,25.39,100,,percent of total billed charges,,
Sup Curette #2,,12035062,LOCAL,Facility,Both,,,,25.39,21.5815,7.276774,25.39,First Health Group Corporation,First Health Network,24.6283,97,,percent of total billed charges,,
Sup Curette #2,,12035062,LOCAL,Facility,Both,,,,25.39,21.5815,7.276774,25.39,"Health Partners, Inc.",Commercial,24.01894,94.6,,percent of total billed charges,,
Sup Curette #2,,12035062,LOCAL,Facility,Outpatient,,,,25.39,21.5815,7.276774,25.39,"Health Partners, Inc.",Medicare Advantage,12.4411,49,,percent of total billed charges,,
Sup Curette #2,,12035062,LOCAL,Facility,Inpatient,,,,25.39,21.5815,7.276774,25.39,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Curette #2,,12035062,LOCAL,Facility,Both,,,,25.39,21.5815,7.276774,25.39,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),15.234,60,,percent of total billed charges,,
Sup Curette #2,,12035062,LOCAL,Facility,Both,,,,25.39,21.5815,7.276774,25.39,"Health Partners, Inc.",State of Minnesota Advantage Program,20.69285,81.5,,percent of total billed charges,,
Sup Curette #2,,12035062,LOCAL,Facility,Both,,,,25.39,21.5815,7.276774,25.39,"Health Partners, Inc.",State Public Programs,12.695,50,,percent of total billed charges,,
Sup Curette #2,,12035062,LOCAL,Facility,Both,,,,25.39,21.5815,7.276774,25.39,Humana Insurance Company,Commercial PPO,24.1205,95,,percent of total billed charges,,
Sup Curette #2,,12035062,LOCAL,Facility,Outpatient,,,,25.39,21.5815,7.276774,25.39,Humana Insurance Company,Medicare PPO,12.4411,49,,percent of total billed charges,,
Sup Curette #2,,12035062,LOCAL,Facility,Inpatient,,,,25.39,21.5815,7.276774,25.39,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Sup Curette #2,,12035062,LOCAL,Facility,Both,,,,25.39,21.5815,7.276774,25.39,Medica,Individual & Family,25.16149,99.1,,percent of total billed charges,,
Sup Curette #2,,12035062,LOCAL,Facility,Outpatient,,,,25.39,21.5815,7.276774,25.39,Medica,Medica Advantage Solution,12.64422,49.8,,percent of total billed charges,,
Sup Curette #2,,12035062,LOCAL,Facility,Inpatient,,,,25.39,21.5815,7.276774,25.39,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Sup Curette #2,,12035062,LOCAL,Facility,Outpatient,,,,25.39,21.5815,7.276774,25.39,Medica,Medical Assistance,11.32394,44.6,,percent of total billed charges,,
Sup Curette #2,,12035062,LOCAL,Facility,Inpatient,,,,25.39,21.5815,7.276774,25.39,Medica,Medical Assistance,,,,,Included in per diem rate,
Sup Curette #2,,12035062,LOCAL,Facility,Outpatient,,,,25.39,21.5815,7.276774,25.39,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,12.64422,49.8,,percent of total billed charges,,
Sup Curette #2,,12035062,LOCAL,Facility,Inpatient,,,,25.39,21.5815,7.276774,25.39,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Sup Curette #2,,12035062,LOCAL,Facility,Both,,,,25.39,21.5815,7.276774,25.39,"Multiplan, Inc.","Multiplan, Inc.",23.8666,94,,percent of total billed charges,,
Sup Curette #2,,12035062,LOCAL,Facility,Outpatient,,,,25.39,21.5815,7.276774,25.39,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,22.87639,90.1,,percent of total billed charges,,
Sup Curette #2,,12035062,LOCAL,Facility,Inpatient,,,,25.39,21.5815,7.276774,25.39,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Sup Curette #2,,12035062,LOCAL,Facility,Both,,,,25.39,21.5815,7.276774,25.39,"Preferred One Administrative Services, INC.",PPO,25.03454,98.6,,percent of total billed charges,,
Sup Curette #2,,12035062,LOCAL,Facility,Outpatient,,,,25.39,21.5815,7.276774,25.39,PrimeWest Health,Minnesota Senior Health Options (MSHO),13.063155,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Sup Curette #2,,12035062,LOCAL,Facility,Inpatient,,,,25.39,21.5815,7.276774,25.39,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Curette #2,,12035062,LOCAL,Facility,Outpatient,,,,25.39,21.5815,7.276774,25.39,PrimeWest Health,MinnesotaCare,13.040304,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Sup Curette #2,,12035062,LOCAL,Facility,Inpatient,,,,25.39,21.5815,7.276774,25.39,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Sup Curette #2,,12035062,LOCAL,Facility,Both,,,,25.39,21.5815,7.276774,25.39,Sanford Health Plan,Sanford Health Plan,23.3588,92,,percent of total billed charges,,
Sup Curette #2,,12035062,LOCAL,Facility,Outpatient,,,,25.39,21.5815,7.276774,25.39,"UCare Health, Inc.",Individual & Family Plan,14.307265,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Sup Curette #2,,12035062,LOCAL,Facility,Inpatient,,,,25.39,21.5815,7.276774,25.39,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Sup Curette #2,,12035062,LOCAL,Facility,Outpatient,,,,25.39,21.5815,7.276774,25.39,"UCare Health, Inc.",Medical Assistance,12.814333,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Curette #2,,12035062,LOCAL,Facility,Inpatient,,,,25.39,21.5815,7.276774,25.39,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Sup Curette #2,,12035062,LOCAL,Facility,Outpatient,,,,25.39,21.5815,7.276774,25.39,"UCare Health, Inc.",Medicare Advantage,12.814333,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Curette #2,,12035062,LOCAL,Facility,Inpatient,,,,25.39,21.5815,7.276774,25.39,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Curette #2,,12035062,LOCAL,Facility,Outpatient,,,,25.39,21.5815,7.276774,25.39,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),12.814333,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Curette #2,,12035062,LOCAL,Facility,Inpatient,,,,25.39,21.5815,7.276774,25.39,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Curette #2,,12035062,LOCAL,Facility,Both,,,,25.39,21.5815,7.276774,25.39,UnitedHealthcare,Individual & Family,23.8666,94,,percent of total billed charges,,
Sup Curette #2,,12035062,LOCAL,Facility,Outpatient,,,,25.39,21.5815,7.276774,25.39,UnitedHealthcare,Medicare Advantage,12.4411,49,,percent of total billed charges,,
Sup Curette #2,,12035062,LOCAL,Facility,Inpatient,,,,25.39,21.5815,7.276774,25.39,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Sup Curette #2,,12035062,LOCAL,Facility,Outpatient,,,,25.39,21.5815,7.276774,25.39,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,12.1872,48,,percent of total billed charges,,100% of DHS outpatient percentage
Sup Curette #2,,12035062,LOCAL,Facility,Inpatient,,,,25.39,21.5815,7.276774,25.39,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Sup Curette #4,,12035076,LOCAL,Facility,Both,,,,19.33,16.4305,5.539978,19.33,Aetna,Commercial,17.7836,92,,percent of total billed charges,,
Sup Curette #4,,12035076,LOCAL,Facility,Outpatient,,,,19.33,16.4305,5.539978,19.33,Aetna,Medicare Advantage,9.4717,49,,percent of total billed charges,,
Sup Curette #4,,12035076,LOCAL,Facility,Inpatient,,,,19.33,16.4305,5.539978,19.33,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Sup Curette #4,,12035076,LOCAL,Facility,Both,,,,19.33,16.4305,5.539978,19.33,Aetna,PPO,17.9769,93,,percent of total billed charges,,
Sup Curette #4,,12035076,LOCAL,Facility,Both,,,,19.33,16.4305,5.539978,19.33,America's PPO,America's PPO,18.562599,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Sup Curette #4,,12035076,LOCAL,Facility,Both,,,,19.33,16.4305,5.539978,19.33,BlueCross BlueShield Minnesota, Federal Employee Program,19.02072,98.4,,percent of total billed charges,,
Sup Curette #4,,12035076,LOCAL,Facility,Both,,,,19.33,16.4305,5.539978,19.33,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,19.33,100,,percent of total billed charges,,
Sup Curette #4,,12035076,LOCAL,Facility,Both,,,,19.33,16.4305,5.539978,19.33,BlueCross BlueShield Minnesota,High Value Network Plan,17.397,90,,percent of total billed charges,,
Sup Curette #4,,12035076,LOCAL,Facility,Outpatient,,,,19.33,16.4305,5.539978,19.33,BlueCross BlueShield Minnesota,Medicare Advantage,9.4717,49,,percent of total billed charges,,
Sup Curette #4,,12035076,LOCAL,Facility,Inpatient,,,,19.33,16.4305,5.539978,19.33,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Sup Curette #4,,12035076,LOCAL,Facility,Both,,,,19.33,16.4305,5.539978,19.33,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,17.120581,88.57,,percent of total billed charges,,
Sup Curette #4,,12035076,LOCAL,Facility,Both,,,,19.33,16.4305,5.539978,19.33,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,5.539978,28.66,,percent of total billed charges,,
Sup Curette #4,,12035076,LOCAL,Facility,Outpatient,,,,19.33,16.4305,5.539978,19.33,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),9.4717,49,,percent of total billed charges,,
Sup Curette #4,,12035076,LOCAL,Facility,Inpatient,,,,19.33,16.4305,5.539978,19.33,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Sup Curette #4,,12035076,LOCAL,Facility,Both,,,,19.33,16.4305,5.539978,19.33,CorVel,Worker's Compensation,19.33,100,,percent of total billed charges,,
Sup Curette #4,,12035076,LOCAL,Facility,Both,,,,19.33,16.4305,5.539978,19.33,First Health Group Corporation,First Health Network,18.7501,97,,percent of total billed charges,,
Sup Curette #4,,12035076,LOCAL,Facility,Both,,,,19.33,16.4305,5.539978,19.33,"Health Partners, Inc.",Commercial,18.28618,94.6,,percent of total billed charges,,
Sup Curette #4,,12035076,LOCAL,Facility,Outpatient,,,,19.33,16.4305,5.539978,19.33,"Health Partners, Inc.",Medicare Advantage,9.4717,49,,percent of total billed charges,,
Sup Curette #4,,12035076,LOCAL,Facility,Inpatient,,,,19.33,16.4305,5.539978,19.33,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Curette #4,,12035076,LOCAL,Facility,Both,,,,19.33,16.4305,5.539978,19.33,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),11.598,60,,percent of total billed charges,,
Sup Curette #4,,12035076,LOCAL,Facility,Both,,,,19.33,16.4305,5.539978,19.33,"Health Partners, Inc.",State of Minnesota Advantage Program,15.75395,81.5,,percent of total billed charges,,
Sup Curette #4,,12035076,LOCAL,Facility,Both,,,,19.33,16.4305,5.539978,19.33,"Health Partners, Inc.",State Public Programs,9.665,50,,percent of total billed charges,,
Sup Curette #4,,12035076,LOCAL,Facility,Both,,,,19.33,16.4305,5.539978,19.33,Humana Insurance Company,Commercial PPO,18.3635,95,,percent of total billed charges,,
Sup Curette #4,,12035076,LOCAL,Facility,Outpatient,,,,19.33,16.4305,5.539978,19.33,Humana Insurance Company,Medicare PPO,9.4717,49,,percent of total billed charges,,
Sup Curette #4,,12035076,LOCAL,Facility,Inpatient,,,,19.33,16.4305,5.539978,19.33,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Sup Curette #4,,12035076,LOCAL,Facility,Both,,,,19.33,16.4305,5.539978,19.33,Medica,Individual & Family,19.15603,99.1,,percent of total billed charges,,
Sup Curette #4,,12035076,LOCAL,Facility,Outpatient,,,,19.33,16.4305,5.539978,19.33,Medica,Medica Advantage Solution,9.62634,49.8,,percent of total billed charges,,
Sup Curette #4,,12035076,LOCAL,Facility,Inpatient,,,,19.33,16.4305,5.539978,19.33,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Sup Curette #4,,12035076,LOCAL,Facility,Outpatient,,,,19.33,16.4305,5.539978,19.33,Medica,Medical Assistance,8.62118,44.6,,percent of total billed charges,,
Sup Curette #4,,12035076,LOCAL,Facility,Inpatient,,,,19.33,16.4305,5.539978,19.33,Medica,Medical Assistance,,,,,Included in per diem rate,
Sup Curette #4,,12035076,LOCAL,Facility,Outpatient,,,,19.33,16.4305,5.539978,19.33,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,9.62634,49.8,,percent of total billed charges,,
Sup Curette #4,,12035076,LOCAL,Facility,Inpatient,,,,19.33,16.4305,5.539978,19.33,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Sup Curette #4,,12035076,LOCAL,Facility,Both,,,,19.33,16.4305,5.539978,19.33,"Multiplan, Inc.","Multiplan, Inc.",18.1702,94,,percent of total billed charges,,
Sup Curette #4,,12035076,LOCAL,Facility,Outpatient,,,,19.33,16.4305,5.539978,19.33,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,17.41633,90.1,,percent of total billed charges,,
Sup Curette #4,,12035076,LOCAL,Facility,Inpatient,,,,19.33,16.4305,5.539978,19.33,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Sup Curette #4,,12035076,LOCAL,Facility,Both,,,,19.33,16.4305,5.539978,19.33,"Preferred One Administrative Services, INC.",PPO,19.05938,98.6,,percent of total billed charges,,
Sup Curette #4,,12035076,LOCAL,Facility,Outpatient,,,,19.33,16.4305,5.539978,19.33,PrimeWest Health,Minnesota Senior Health Options (MSHO),9.945285,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Sup Curette #4,,12035076,LOCAL,Facility,Inpatient,,,,19.33,16.4305,5.539978,19.33,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Curette #4,,12035076,LOCAL,Facility,Outpatient,,,,19.33,16.4305,5.539978,19.33,PrimeWest Health,MinnesotaCare,9.927888,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Sup Curette #4,,12035076,LOCAL,Facility,Inpatient,,,,19.33,16.4305,5.539978,19.33,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Sup Curette #4,,12035076,LOCAL,Facility,Both,,,,19.33,16.4305,5.539978,19.33,Sanford Health Plan,Sanford Health Plan,17.7836,92,,percent of total billed charges,,
Sup Curette #4,,12035076,LOCAL,Facility,Outpatient,,,,19.33,16.4305,5.539978,19.33,"UCare Health, Inc.",Individual & Family Plan,10.892455,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Sup Curette #4,,12035076,LOCAL,Facility,Inpatient,,,,19.33,16.4305,5.539978,19.33,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Sup Curette #4,,12035076,LOCAL,Facility,Outpatient,,,,19.33,16.4305,5.539978,19.33,"UCare Health, Inc.",Medical Assistance,9.755851,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Curette #4,,12035076,LOCAL,Facility,Inpatient,,,,19.33,16.4305,5.539978,19.33,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Sup Curette #4,,12035076,LOCAL,Facility,Outpatient,,,,19.33,16.4305,5.539978,19.33,"UCare Health, Inc.",Medicare Advantage,9.755851,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Curette #4,,12035076,LOCAL,Facility,Inpatient,,,,19.33,16.4305,5.539978,19.33,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Curette #4,,12035076,LOCAL,Facility,Outpatient,,,,19.33,16.4305,5.539978,19.33,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),9.755851,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Curette #4,,12035076,LOCAL,Facility,Inpatient,,,,19.33,16.4305,5.539978,19.33,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Curette #4,,12035076,LOCAL,Facility,Both,,,,19.33,16.4305,5.539978,19.33,UnitedHealthcare,Individual & Family,18.1702,94,,percent of total billed charges,,
Sup Curette #4,,12035076,LOCAL,Facility,Outpatient,,,,19.33,16.4305,5.539978,19.33,UnitedHealthcare,Medicare Advantage,9.4717,49,,percent of total billed charges,,
Sup Curette #4,,12035076,LOCAL,Facility,Inpatient,,,,19.33,16.4305,5.539978,19.33,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Sup Curette #4,,12035076,LOCAL,Facility,Outpatient,,,,19.33,16.4305,5.539978,19.33,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,9.2784,48,,percent of total billed charges,,100% of DHS outpatient percentage
Sup Curette #4,,12035076,LOCAL,Facility,Inpatient,,,,19.33,16.4305,5.539978,19.33,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Sup Dressing Mepilex White Foam,,12035081,LOCAL,Facility,Both,,,,35.64,30.294,10.214424,35.64,Aetna,Commercial,32.7888,92,,percent of total billed charges,,
Sup Dressing Mepilex White Foam,,12035081,LOCAL,Facility,Outpatient,,,,35.64,30.294,10.214424,35.64,Aetna,Medicare Advantage,17.4636,49,,percent of total billed charges,,
Sup Dressing Mepilex White Foam,,12035081,LOCAL,Facility,Inpatient,,,,35.64,30.294,10.214424,35.64,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Sup Dressing Mepilex White Foam,,12035081,LOCAL,Facility,Both,,,,35.64,30.294,10.214424,35.64,Aetna,PPO,33.1452,93,,percent of total billed charges,,
Sup Dressing Mepilex White Foam,,12035081,LOCAL,Facility,Both,,,,35.64,30.294,10.214424,35.64,America's PPO,America's PPO,34.225092,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Sup Dressing Mepilex White Foam,,12035081,LOCAL,Facility,Both,,,,35.64,30.294,10.214424,35.64,BlueCross BlueShield Minnesota, Federal Employee Program,35.06976,98.4,,percent of total billed charges,,
Sup Dressing Mepilex White Foam,,12035081,LOCAL,Facility,Both,,,,35.64,30.294,10.214424,35.64,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,35.64,100,,percent of total billed charges,,
Sup Dressing Mepilex White Foam,,12035081,LOCAL,Facility,Both,,,,35.64,30.294,10.214424,35.64,BlueCross BlueShield Minnesota,High Value Network Plan,32.076,90,,percent of total billed charges,,
Sup Dressing Mepilex White Foam,,12035081,LOCAL,Facility,Outpatient,,,,35.64,30.294,10.214424,35.64,BlueCross BlueShield Minnesota,Medicare Advantage,17.4636,49,,percent of total billed charges,,
Sup Dressing Mepilex White Foam,,12035081,LOCAL,Facility,Inpatient,,,,35.64,30.294,10.214424,35.64,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Sup Dressing Mepilex White Foam,,12035081,LOCAL,Facility,Both,,,,35.64,30.294,10.214424,35.64,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,31.566348,88.57,,percent of total billed charges,,
Sup Dressing Mepilex White Foam,,12035081,LOCAL,Facility,Both,,,,35.64,30.294,10.214424,35.64,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,10.214424,28.66,,percent of total billed charges,,
Sup Dressing Mepilex White Foam,,12035081,LOCAL,Facility,Outpatient,,,,35.64,30.294,10.214424,35.64,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),17.4636,49,,percent of total billed charges,,
Sup Dressing Mepilex White Foam,,12035081,LOCAL,Facility,Inpatient,,,,35.64,30.294,10.214424,35.64,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Sup Dressing Mepilex White Foam,,12035081,LOCAL,Facility,Both,,,,35.64,30.294,10.214424,35.64,CorVel,Worker's Compensation,35.64,100,,percent of total billed charges,,
Sup Dressing Mepilex White Foam,,12035081,LOCAL,Facility,Both,,,,35.64,30.294,10.214424,35.64,First Health Group Corporation,First Health Network,34.5708,97,,percent of total billed charges,,
Sup Dressing Mepilex White Foam,,12035081,LOCAL,Facility,Both,,,,35.64,30.294,10.214424,35.64,"Health Partners, Inc.",Commercial,33.71544,94.6,,percent of total billed charges,,
Sup Dressing Mepilex White Foam,,12035081,LOCAL,Facility,Outpatient,,,,35.64,30.294,10.214424,35.64,"Health Partners, Inc.",Medicare Advantage,17.4636,49,,percent of total billed charges,,
Sup Dressing Mepilex White Foam,,12035081,LOCAL,Facility,Inpatient,,,,35.64,30.294,10.214424,35.64,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Dressing Mepilex White Foam,,12035081,LOCAL,Facility,Both,,,,35.64,30.294,10.214424,35.64,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),21.384,60,,percent of total billed charges,,
Sup Dressing Mepilex White Foam,,12035081,LOCAL,Facility,Both,,,,35.64,30.294,10.214424,35.64,"Health Partners, Inc.",State of Minnesota Advantage Program,29.0466,81.5,,percent of total billed charges,,
Sup Dressing Mepilex White Foam,,12035081,LOCAL,Facility,Both,,,,35.64,30.294,10.214424,35.64,"Health Partners, Inc.",State Public Programs,17.82,50,,percent of total billed charges,,
Sup Dressing Mepilex White Foam,,12035081,LOCAL,Facility,Both,,,,35.64,30.294,10.214424,35.64,Humana Insurance Company,Commercial PPO,33.858,95,,percent of total billed charges,,
Sup Dressing Mepilex White Foam,,12035081,LOCAL,Facility,Outpatient,,,,35.64,30.294,10.214424,35.64,Humana Insurance Company,Medicare PPO,17.4636,49,,percent of total billed charges,,
Sup Dressing Mepilex White Foam,,12035081,LOCAL,Facility,Inpatient,,,,35.64,30.294,10.214424,35.64,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Sup Dressing Mepilex White Foam,,12035081,LOCAL,Facility,Both,,,,35.64,30.294,10.214424,35.64,Medica,Individual & Family,35.31924,99.1,,percent of total billed charges,,
Sup Dressing Mepilex White Foam,,12035081,LOCAL,Facility,Outpatient,,,,35.64,30.294,10.214424,35.64,Medica,Medica Advantage Solution,17.74872,49.8,,percent of total billed charges,,
Sup Dressing Mepilex White Foam,,12035081,LOCAL,Facility,Inpatient,,,,35.64,30.294,10.214424,35.64,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Sup Dressing Mepilex White Foam,,12035081,LOCAL,Facility,Outpatient,,,,35.64,30.294,10.214424,35.64,Medica,Medical Assistance,15.89544,44.6,,percent of total billed charges,,
Sup Dressing Mepilex White Foam,,12035081,LOCAL,Facility,Inpatient,,,,35.64,30.294,10.214424,35.64,Medica,Medical Assistance,,,,,Included in per diem rate,
Sup Dressing Mepilex White Foam,,12035081,LOCAL,Facility,Outpatient,,,,35.64,30.294,10.214424,35.64,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,17.74872,49.8,,percent of total billed charges,,
Sup Dressing Mepilex White Foam,,12035081,LOCAL,Facility,Inpatient,,,,35.64,30.294,10.214424,35.64,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Sup Dressing Mepilex White Foam,,12035081,LOCAL,Facility,Both,,,,35.64,30.294,10.214424,35.64,"Multiplan, Inc.","Multiplan, Inc.",33.5016,94,,percent of total billed charges,,
Sup Dressing Mepilex White Foam,,12035081,LOCAL,Facility,Outpatient,,,,35.64,30.294,10.214424,35.64,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,32.11164,90.1,,percent of total billed charges,,
Sup Dressing Mepilex White Foam,,12035081,LOCAL,Facility,Inpatient,,,,35.64,30.294,10.214424,35.64,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Sup Dressing Mepilex White Foam,,12035081,LOCAL,Facility,Both,,,,35.64,30.294,10.214424,35.64,"Preferred One Administrative Services, INC.",PPO,35.14104,98.6,,percent of total billed charges,,
Sup Dressing Mepilex White Foam,,12035081,LOCAL,Facility,Outpatient,,,,35.64,30.294,10.214424,35.64,PrimeWest Health,Minnesota Senior Health Options (MSHO),18.33678,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Sup Dressing Mepilex White Foam,,12035081,LOCAL,Facility,Inpatient,,,,35.64,30.294,10.214424,35.64,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Dressing Mepilex White Foam,,12035081,LOCAL,Facility,Outpatient,,,,35.64,30.294,10.214424,35.64,PrimeWest Health,MinnesotaCare,18.304704,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Sup Dressing Mepilex White Foam,,12035081,LOCAL,Facility,Inpatient,,,,35.64,30.294,10.214424,35.64,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Sup Dressing Mepilex White Foam,,12035081,LOCAL,Facility,Both,,,,35.64,30.294,10.214424,35.64,Sanford Health Plan,Sanford Health Plan,32.7888,92,,percent of total billed charges,,
Sup Dressing Mepilex White Foam,,12035081,LOCAL,Facility,Outpatient,,,,35.64,30.294,10.214424,35.64,"UCare Health, Inc.",Individual & Family Plan,20.08314,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Sup Dressing Mepilex White Foam,,12035081,LOCAL,Facility,Inpatient,,,,35.64,30.294,10.214424,35.64,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Sup Dressing Mepilex White Foam,,12035081,LOCAL,Facility,Outpatient,,,,35.64,30.294,10.214424,35.64,"UCare Health, Inc.",Medical Assistance,17.987508,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Dressing Mepilex White Foam,,12035081,LOCAL,Facility,Inpatient,,,,35.64,30.294,10.214424,35.64,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Sup Dressing Mepilex White Foam,,12035081,LOCAL,Facility,Outpatient,,,,35.64,30.294,10.214424,35.64,"UCare Health, Inc.",Medicare Advantage,17.987508,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Dressing Mepilex White Foam,,12035081,LOCAL,Facility,Inpatient,,,,35.64,30.294,10.214424,35.64,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Dressing Mepilex White Foam,,12035081,LOCAL,Facility,Outpatient,,,,35.64,30.294,10.214424,35.64,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),17.987508,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Dressing Mepilex White Foam,,12035081,LOCAL,Facility,Inpatient,,,,35.64,30.294,10.214424,35.64,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Dressing Mepilex White Foam,,12035081,LOCAL,Facility,Both,,,,35.64,30.294,10.214424,35.64,UnitedHealthcare,Individual & Family,33.5016,94,,percent of total billed charges,,
Sup Dressing Mepilex White Foam,,12035081,LOCAL,Facility,Outpatient,,,,35.64,30.294,10.214424,35.64,UnitedHealthcare,Medicare Advantage,17.4636,49,,percent of total billed charges,,
Sup Dressing Mepilex White Foam,,12035081,LOCAL,Facility,Inpatient,,,,35.64,30.294,10.214424,35.64,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Sup Dressing Mepilex White Foam,,12035081,LOCAL,Facility,Outpatient,,,,35.64,30.294,10.214424,35.64,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,17.1072,48,,percent of total billed charges,,100% of DHS outpatient percentage
Sup Dressing Mepilex White Foam,,12035081,LOCAL,Facility,Inpatient,,,,35.64,30.294,10.214424,35.64,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Sup Dressing Mepilex Ag Foam,,12035095,LOCAL,Facility,Both,,,,83.23,70.7455,23.853718,83.23,Aetna,Commercial,76.5716,92,,percent of total billed charges,,
Sup Dressing Mepilex Ag Foam,,12035095,LOCAL,Facility,Outpatient,,,,83.23,70.7455,23.853718,83.23,Aetna,Medicare Advantage,40.7827,49,,percent of total billed charges,,
Sup Dressing Mepilex Ag Foam,,12035095,LOCAL,Facility,Inpatient,,,,83.23,70.7455,23.853718,83.23,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Sup Dressing Mepilex Ag Foam,,12035095,LOCAL,Facility,Both,,,,83.23,70.7455,23.853718,83.23,Aetna,PPO,77.4039,93,,percent of total billed charges,,
Sup Dressing Mepilex Ag Foam,,12035095,LOCAL,Facility,Both,,,,83.23,70.7455,23.853718,83.23,America's PPO,America's PPO,79.925769,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Sup Dressing Mepilex Ag Foam,,12035095,LOCAL,Facility,Both,,,,83.23,70.7455,23.853718,83.23,BlueCross BlueShield Minnesota, Federal Employee Program,81.89832,98.4,,percent of total billed charges,,
Sup Dressing Mepilex Ag Foam,,12035095,LOCAL,Facility,Both,,,,83.23,70.7455,23.853718,83.23,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,83.23,100,,percent of total billed charges,,
Sup Dressing Mepilex Ag Foam,,12035095,LOCAL,Facility,Both,,,,83.23,70.7455,23.853718,83.23,BlueCross BlueShield Minnesota,High Value Network Plan,74.907,90,,percent of total billed charges,,
Sup Dressing Mepilex Ag Foam,,12035095,LOCAL,Facility,Outpatient,,,,83.23,70.7455,23.853718,83.23,BlueCross BlueShield Minnesota,Medicare Advantage,40.7827,49,,percent of total billed charges,,
Sup Dressing Mepilex Ag Foam,,12035095,LOCAL,Facility,Inpatient,,,,83.23,70.7455,23.853718,83.23,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Sup Dressing Mepilex Ag Foam,,12035095,LOCAL,Facility,Both,,,,83.23,70.7455,23.853718,83.23,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,73.716811,88.57,,percent of total billed charges,,
Sup Dressing Mepilex Ag Foam,,12035095,LOCAL,Facility,Both,,,,83.23,70.7455,23.853718,83.23,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,23.853718,28.66,,percent of total billed charges,,
Sup Dressing Mepilex Ag Foam,,12035095,LOCAL,Facility,Outpatient,,,,83.23,70.7455,23.853718,83.23,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),40.7827,49,,percent of total billed charges,,
Sup Dressing Mepilex Ag Foam,,12035095,LOCAL,Facility,Inpatient,,,,83.23,70.7455,23.853718,83.23,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Sup Dressing Mepilex Ag Foam,,12035095,LOCAL,Facility,Both,,,,83.23,70.7455,23.853718,83.23,CorVel,Worker's Compensation,83.23,100,,percent of total billed charges,,
Sup Dressing Mepilex Ag Foam,,12035095,LOCAL,Facility,Both,,,,83.23,70.7455,23.853718,83.23,First Health Group Corporation,First Health Network,80.7331,97,,percent of total billed charges,,
Sup Dressing Mepilex Ag Foam,,12035095,LOCAL,Facility,Both,,,,83.23,70.7455,23.853718,83.23,"Health Partners, Inc.",Commercial,78.73558,94.6,,percent of total billed charges,,
Sup Dressing Mepilex Ag Foam,,12035095,LOCAL,Facility,Outpatient,,,,83.23,70.7455,23.853718,83.23,"Health Partners, Inc.",Medicare Advantage,40.7827,49,,percent of total billed charges,,
Sup Dressing Mepilex Ag Foam,,12035095,LOCAL,Facility,Inpatient,,,,83.23,70.7455,23.853718,83.23,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Dressing Mepilex Ag Foam,,12035095,LOCAL,Facility,Both,,,,83.23,70.7455,23.853718,83.23,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),49.938,60,,percent of total billed charges,,
Sup Dressing Mepilex Ag Foam,,12035095,LOCAL,Facility,Both,,,,83.23,70.7455,23.853718,83.23,"Health Partners, Inc.",State of Minnesota Advantage Program,67.83245,81.5,,percent of total billed charges,,
Sup Dressing Mepilex Ag Foam,,12035095,LOCAL,Facility,Both,,,,83.23,70.7455,23.853718,83.23,"Health Partners, Inc.",State Public Programs,41.615,50,,percent of total billed charges,,
Sup Dressing Mepilex Ag Foam,,12035095,LOCAL,Facility,Both,,,,83.23,70.7455,23.853718,83.23,Humana Insurance Company,Commercial PPO,79.0685,95,,percent of total billed charges,,
Sup Dressing Mepilex Ag Foam,,12035095,LOCAL,Facility,Outpatient,,,,83.23,70.7455,23.853718,83.23,Humana Insurance Company,Medicare PPO,40.7827,49,,percent of total billed charges,,
Sup Dressing Mepilex Ag Foam,,12035095,LOCAL,Facility,Inpatient,,,,83.23,70.7455,23.853718,83.23,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Sup Dressing Mepilex Ag Foam,,12035095,LOCAL,Facility,Both,,,,83.23,70.7455,23.853718,83.23,Medica,Individual & Family,82.48093,99.1,,percent of total billed charges,,
Sup Dressing Mepilex Ag Foam,,12035095,LOCAL,Facility,Outpatient,,,,83.23,70.7455,23.853718,83.23,Medica,Medica Advantage Solution,41.44854,49.8,,percent of total billed charges,,
Sup Dressing Mepilex Ag Foam,,12035095,LOCAL,Facility,Inpatient,,,,83.23,70.7455,23.853718,83.23,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Sup Dressing Mepilex Ag Foam,,12035095,LOCAL,Facility,Outpatient,,,,83.23,70.7455,23.853718,83.23,Medica,Medical Assistance,37.12058,44.6,,percent of total billed charges,,
Sup Dressing Mepilex Ag Foam,,12035095,LOCAL,Facility,Inpatient,,,,83.23,70.7455,23.853718,83.23,Medica,Medical Assistance,,,,,Included in per diem rate,
Sup Dressing Mepilex Ag Foam,,12035095,LOCAL,Facility,Outpatient,,,,83.23,70.7455,23.853718,83.23,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,41.44854,49.8,,percent of total billed charges,,
Sup Dressing Mepilex Ag Foam,,12035095,LOCAL,Facility,Inpatient,,,,83.23,70.7455,23.853718,83.23,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Sup Dressing Mepilex Ag Foam,,12035095,LOCAL,Facility,Both,,,,83.23,70.7455,23.853718,83.23,"Multiplan, Inc.","Multiplan, Inc.",78.2362,94,,percent of total billed charges,,
Sup Dressing Mepilex Ag Foam,,12035095,LOCAL,Facility,Outpatient,,,,83.23,70.7455,23.853718,83.23,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,74.99023,90.1,,percent of total billed charges,,
Sup Dressing Mepilex Ag Foam,,12035095,LOCAL,Facility,Inpatient,,,,83.23,70.7455,23.853718,83.23,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Sup Dressing Mepilex Ag Foam,,12035095,LOCAL,Facility,Both,,,,83.23,70.7455,23.853718,83.23,"Preferred One Administrative Services, INC.",PPO,82.06478,98.6,,percent of total billed charges,,
Sup Dressing Mepilex Ag Foam,,12035095,LOCAL,Facility,Outpatient,,,,83.23,70.7455,23.853718,83.23,PrimeWest Health,Minnesota Senior Health Options (MSHO),42.821835,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Sup Dressing Mepilex Ag Foam,,12035095,LOCAL,Facility,Inpatient,,,,83.23,70.7455,23.853718,83.23,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Dressing Mepilex Ag Foam,,12035095,LOCAL,Facility,Outpatient,,,,83.23,70.7455,23.853718,83.23,PrimeWest Health,MinnesotaCare,42.746928,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Sup Dressing Mepilex Ag Foam,,12035095,LOCAL,Facility,Inpatient,,,,83.23,70.7455,23.853718,83.23,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Sup Dressing Mepilex Ag Foam,,12035095,LOCAL,Facility,Both,,,,83.23,70.7455,23.853718,83.23,Sanford Health Plan,Sanford Health Plan,76.5716,92,,percent of total billed charges,,
Sup Dressing Mepilex Ag Foam,,12035095,LOCAL,Facility,Outpatient,,,,83.23,70.7455,23.853718,83.23,"UCare Health, Inc.",Individual & Family Plan,46.900105,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Sup Dressing Mepilex Ag Foam,,12035095,LOCAL,Facility,Inpatient,,,,83.23,70.7455,23.853718,83.23,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Sup Dressing Mepilex Ag Foam,,12035095,LOCAL,Facility,Outpatient,,,,83.23,70.7455,23.853718,83.23,"UCare Health, Inc.",Medical Assistance,42.006181,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Dressing Mepilex Ag Foam,,12035095,LOCAL,Facility,Inpatient,,,,83.23,70.7455,23.853718,83.23,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Sup Dressing Mepilex Ag Foam,,12035095,LOCAL,Facility,Outpatient,,,,83.23,70.7455,23.853718,83.23,"UCare Health, Inc.",Medicare Advantage,42.006181,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Dressing Mepilex Ag Foam,,12035095,LOCAL,Facility,Inpatient,,,,83.23,70.7455,23.853718,83.23,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Dressing Mepilex Ag Foam,,12035095,LOCAL,Facility,Outpatient,,,,83.23,70.7455,23.853718,83.23,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),42.006181,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Dressing Mepilex Ag Foam,,12035095,LOCAL,Facility,Inpatient,,,,83.23,70.7455,23.853718,83.23,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Dressing Mepilex Ag Foam,,12035095,LOCAL,Facility,Both,,,,83.23,70.7455,23.853718,83.23,UnitedHealthcare,Individual & Family,78.2362,94,,percent of total billed charges,,
Sup Dressing Mepilex Ag Foam,,12035095,LOCAL,Facility,Outpatient,,,,83.23,70.7455,23.853718,83.23,UnitedHealthcare,Medicare Advantage,40.7827,49,,percent of total billed charges,,
Sup Dressing Mepilex Ag Foam,,12035095,LOCAL,Facility,Inpatient,,,,83.23,70.7455,23.853718,83.23,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Sup Dressing Mepilex Ag Foam,,12035095,LOCAL,Facility,Outpatient,,,,83.23,70.7455,23.853718,83.23,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,39.9504,48,,percent of total billed charges,,100% of DHS outpatient percentage
Sup Dressing Mepilex Ag Foam,,12035095,LOCAL,Facility,Inpatient,,,,83.23,70.7455,23.853718,83.23,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Sup Dressing Convamax 10Cm X 10Cm,,12035429,LOCAL,Facility,Both,,,,109.32,92.922,31.331112,109.32,Aetna,Commercial,100.5744,92,,percent of total billed charges,,
Sup Dressing Convamax 10Cm X 10Cm,,12035429,LOCAL,Facility,Outpatient,,,,109.32,92.922,31.331112,109.32,Aetna,Medicare Advantage,53.5668,49,,percent of total billed charges,,
Sup Dressing Convamax 10Cm X 10Cm,,12035429,LOCAL,Facility,Inpatient,,,,109.32,92.922,31.331112,109.32,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Sup Dressing Convamax 10Cm X 10Cm,,12035429,LOCAL,Facility,Both,,,,109.32,92.922,31.331112,109.32,Aetna,PPO,101.6676,93,,percent of total billed charges,,
Sup Dressing Convamax 10Cm X 10Cm,,12035429,LOCAL,Facility,Both,,,,109.32,92.922,31.331112,109.32,America's PPO,America's PPO,104.979996,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Sup Dressing Convamax 10Cm X 10Cm,,12035429,LOCAL,Facility,Both,,,,109.32,92.922,31.331112,109.32,BlueCross BlueShield Minnesota, Federal Employee Program,107.57088,98.4,,percent of total billed charges,,
Sup Dressing Convamax 10Cm X 10Cm,,12035429,LOCAL,Facility,Both,,,,109.32,92.922,31.331112,109.32,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,109.32,100,,percent of total billed charges,,
Sup Dressing Convamax 10Cm X 10Cm,,12035429,LOCAL,Facility,Both,,,,109.32,92.922,31.331112,109.32,BlueCross BlueShield Minnesota,High Value Network Plan,98.388,90,,percent of total billed charges,,
Sup Dressing Convamax 10Cm X 10Cm,,12035429,LOCAL,Facility,Outpatient,,,,109.32,92.922,31.331112,109.32,BlueCross BlueShield Minnesota,Medicare Advantage,53.5668,49,,percent of total billed charges,,
Sup Dressing Convamax 10Cm X 10Cm,,12035429,LOCAL,Facility,Inpatient,,,,109.32,92.922,31.331112,109.32,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Sup Dressing Convamax 10Cm X 10Cm,,12035429,LOCAL,Facility,Both,,,,109.32,92.922,31.331112,109.32,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,96.824724,88.57,,percent of total billed charges,,
Sup Dressing Convamax 10Cm X 10Cm,,12035429,LOCAL,Facility,Both,,,,109.32,92.922,31.331112,109.32,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,31.331112,28.66,,percent of total billed charges,,
Sup Dressing Convamax 10Cm X 10Cm,,12035429,LOCAL,Facility,Outpatient,,,,109.32,92.922,31.331112,109.32,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),53.5668,49,,percent of total billed charges,,
Sup Dressing Convamax 10Cm X 10Cm,,12035429,LOCAL,Facility,Inpatient,,,,109.32,92.922,31.331112,109.32,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Sup Dressing Convamax 10Cm X 10Cm,,12035429,LOCAL,Facility,Both,,,,109.32,92.922,31.331112,109.32,CorVel,Worker's Compensation,109.32,100,,percent of total billed charges,,
Sup Dressing Convamax 10Cm X 10Cm,,12035429,LOCAL,Facility,Both,,,,109.32,92.922,31.331112,109.32,First Health Group Corporation,First Health Network,106.0404,97,,percent of total billed charges,,
Sup Dressing Convamax 10Cm X 10Cm,,12035429,LOCAL,Facility,Both,,,,109.32,92.922,31.331112,109.32,"Health Partners, Inc.",Commercial,103.41672,94.6,,percent of total billed charges,,
Sup Dressing Convamax 10Cm X 10Cm,,12035429,LOCAL,Facility,Outpatient,,,,109.32,92.922,31.331112,109.32,"Health Partners, Inc.",Medicare Advantage,53.5668,49,,percent of total billed charges,,
Sup Dressing Convamax 10Cm X 10Cm,,12035429,LOCAL,Facility,Inpatient,,,,109.32,92.922,31.331112,109.32,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Dressing Convamax 10Cm X 10Cm,,12035429,LOCAL,Facility,Both,,,,109.32,92.922,31.331112,109.32,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),65.592,60,,percent of total billed charges,,
Sup Dressing Convamax 10Cm X 10Cm,,12035429,LOCAL,Facility,Both,,,,109.32,92.922,31.331112,109.32,"Health Partners, Inc.",State of Minnesota Advantage Program,89.0958,81.5,,percent of total billed charges,,
Sup Dressing Convamax 10Cm X 10Cm,,12035429,LOCAL,Facility,Both,,,,109.32,92.922,31.331112,109.32,"Health Partners, Inc.",State Public Programs,54.66,50,,percent of total billed charges,,
Sup Dressing Convamax 10Cm X 10Cm,,12035429,LOCAL,Facility,Both,,,,109.32,92.922,31.331112,109.32,Humana Insurance Company,Commercial PPO,103.854,95,,percent of total billed charges,,
Sup Dressing Convamax 10Cm X 10Cm,,12035429,LOCAL,Facility,Outpatient,,,,109.32,92.922,31.331112,109.32,Humana Insurance Company,Medicare PPO,53.5668,49,,percent of total billed charges,,
Sup Dressing Convamax 10Cm X 10Cm,,12035429,LOCAL,Facility,Inpatient,,,,109.32,92.922,31.331112,109.32,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Sup Dressing Convamax 10Cm X 10Cm,,12035429,LOCAL,Facility,Both,,,,109.32,92.922,31.331112,109.32,Medica,Individual & Family,108.33612,99.1,,percent of total billed charges,,
Sup Dressing Convamax 10Cm X 10Cm,,12035429,LOCAL,Facility,Outpatient,,,,109.32,92.922,31.331112,109.32,Medica,Medica Advantage Solution,54.44136,49.8,,percent of total billed charges,,
Sup Dressing Convamax 10Cm X 10Cm,,12035429,LOCAL,Facility,Inpatient,,,,109.32,92.922,31.331112,109.32,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Sup Dressing Convamax 10Cm X 10Cm,,12035429,LOCAL,Facility,Outpatient,,,,109.32,92.922,31.331112,109.32,Medica,Medical Assistance,48.75672,44.6,,percent of total billed charges,,
Sup Dressing Convamax 10Cm X 10Cm,,12035429,LOCAL,Facility,Inpatient,,,,109.32,92.922,31.331112,109.32,Medica,Medical Assistance,,,,,Included in per diem rate,
Sup Dressing Convamax 10Cm X 10Cm,,12035429,LOCAL,Facility,Outpatient,,,,109.32,92.922,31.331112,109.32,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,54.44136,49.8,,percent of total billed charges,,
Sup Dressing Convamax 10Cm X 10Cm,,12035429,LOCAL,Facility,Inpatient,,,,109.32,92.922,31.331112,109.32,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Sup Dressing Convamax 10Cm X 10Cm,,12035429,LOCAL,Facility,Both,,,,109.32,92.922,31.331112,109.32,"Multiplan, Inc.","Multiplan, Inc.",102.7608,94,,percent of total billed charges,,
Sup Dressing Convamax 10Cm X 10Cm,,12035429,LOCAL,Facility,Outpatient,,,,109.32,92.922,31.331112,109.32,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,98.49732,90.1,,percent of total billed charges,,
Sup Dressing Convamax 10Cm X 10Cm,,12035429,LOCAL,Facility,Inpatient,,,,109.32,92.922,31.331112,109.32,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Sup Dressing Convamax 10Cm X 10Cm,,12035429,LOCAL,Facility,Both,,,,109.32,92.922,31.331112,109.32,"Preferred One Administrative Services, INC.",PPO,107.78952,98.6,,percent of total billed charges,,
Sup Dressing Convamax 10Cm X 10Cm,,12035429,LOCAL,Facility,Outpatient,,,,109.32,92.922,31.331112,109.32,PrimeWest Health,Minnesota Senior Health Options (MSHO),56.24514,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Sup Dressing Convamax 10Cm X 10Cm,,12035429,LOCAL,Facility,Inpatient,,,,109.32,92.922,31.331112,109.32,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Dressing Convamax 10Cm X 10Cm,,12035429,LOCAL,Facility,Outpatient,,,,109.32,92.922,31.331112,109.32,PrimeWest Health,MinnesotaCare,56.146752,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Sup Dressing Convamax 10Cm X 10Cm,,12035429,LOCAL,Facility,Inpatient,,,,109.32,92.922,31.331112,109.32,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Sup Dressing Convamax 10Cm X 10Cm,,12035429,LOCAL,Facility,Both,,,,109.32,92.922,31.331112,109.32,Sanford Health Plan,Sanford Health Plan,100.5744,92,,percent of total billed charges,,
Sup Dressing Convamax 10Cm X 10Cm,,12035429,LOCAL,Facility,Outpatient,,,,109.32,92.922,31.331112,109.32,"UCare Health, Inc.",Individual & Family Plan,61.60182,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Sup Dressing Convamax 10Cm X 10Cm,,12035429,LOCAL,Facility,Inpatient,,,,109.32,92.922,31.331112,109.32,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Sup Dressing Convamax 10Cm X 10Cm,,12035429,LOCAL,Facility,Outpatient,,,,109.32,92.922,31.331112,109.32,"UCare Health, Inc.",Medical Assistance,55.173804,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Dressing Convamax 10Cm X 10Cm,,12035429,LOCAL,Facility,Inpatient,,,,109.32,92.922,31.331112,109.32,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Sup Dressing Convamax 10Cm X 10Cm,,12035429,LOCAL,Facility,Outpatient,,,,109.32,92.922,31.331112,109.32,"UCare Health, Inc.",Medicare Advantage,55.173804,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Dressing Convamax 10Cm X 10Cm,,12035429,LOCAL,Facility,Inpatient,,,,109.32,92.922,31.331112,109.32,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Dressing Convamax 10Cm X 10Cm,,12035429,LOCAL,Facility,Outpatient,,,,109.32,92.922,31.331112,109.32,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),55.173804,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Dressing Convamax 10Cm X 10Cm,,12035429,LOCAL,Facility,Inpatient,,,,109.32,92.922,31.331112,109.32,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Dressing Convamax 10Cm X 10Cm,,12035429,LOCAL,Facility,Both,,,,109.32,92.922,31.331112,109.32,UnitedHealthcare,Individual & Family,102.7608,94,,percent of total billed charges,,
Sup Dressing Convamax 10Cm X 10Cm,,12035429,LOCAL,Facility,Outpatient,,,,109.32,92.922,31.331112,109.32,UnitedHealthcare,Medicare Advantage,53.5668,49,,percent of total billed charges,,
Sup Dressing Convamax 10Cm X 10Cm,,12035429,LOCAL,Facility,Inpatient,,,,109.32,92.922,31.331112,109.32,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Sup Dressing Convamax 10Cm X 10Cm,,12035429,LOCAL,Facility,Outpatient,,,,109.32,92.922,31.331112,109.32,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,52.4736,48,,percent of total billed charges,,100% of DHS outpatient percentage
Sup Dressing Convamax 10Cm X 10Cm,,12035429,LOCAL,Facility,Inpatient,,,,109.32,92.922,31.331112,109.32,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Pacu First Hour,,24000103,LOCAL,Facility,Both,,,,765,650.25,219.249,765,Aetna,Commercial,703.8,92,,percent of total billed charges,,
Pacu First Hour,,24000103,LOCAL,Facility,Outpatient,,,,765,650.25,219.249,765,Aetna,Medicare Advantage,374.85,49,,percent of total billed charges,,
Pacu First Hour,,24000103,LOCAL,Facility,Inpatient,,,,765,650.25,219.249,765,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Pacu First Hour,,24000103,LOCAL,Facility,Both,,,,765,650.25,219.249,765,Aetna,PPO,711.45,93,,percent of total billed charges,,
Pacu First Hour,,24000103,LOCAL,Facility,Both,,,,765,650.25,219.249,765,America's PPO,America's PPO,734.6295,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Pacu First Hour,,24000103,LOCAL,Facility,Both,,,,765,650.25,219.249,765,BlueCross BlueShield Minnesota, Federal Employee Program,752.76,98.4,,percent of total billed charges,,
Pacu First Hour,,24000103,LOCAL,Facility,Both,,,,765,650.25,219.249,765,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,765,100,,percent of total billed charges,,
Pacu First Hour,,24000103,LOCAL,Facility,Both,,,,765,650.25,219.249,765,BlueCross BlueShield Minnesota,High Value Network Plan,688.5,90,,percent of total billed charges,,
Pacu First Hour,,24000103,LOCAL,Facility,Outpatient,,,,765,650.25,219.249,765,BlueCross BlueShield Minnesota,Medicare Advantage,374.85,49,,percent of total billed charges,,
Pacu First Hour,,24000103,LOCAL,Facility,Inpatient,,,,765,650.25,219.249,765,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Pacu First Hour,,24000103,LOCAL,Facility,Both,,,,765,650.25,219.249,765,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,677.5605,88.57,,percent of total billed charges,,
Pacu First Hour,,24000103,LOCAL,Facility,Both,,,,765,650.25,219.249,765,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,219.249,28.66,,percent of total billed charges,,
Pacu First Hour,,24000103,LOCAL,Facility,Outpatient,,,,765,650.25,219.249,765,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),374.85,49,,percent of total billed charges,,
Pacu First Hour,,24000103,LOCAL,Facility,Inpatient,,,,765,650.25,219.249,765,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Pacu First Hour,,24000103,LOCAL,Facility,Both,,,,765,650.25,219.249,765,CorVel,Worker's Compensation,765,100,,percent of total billed charges,,
Pacu First Hour,,24000103,LOCAL,Facility,Both,,,,765,650.25,219.249,765,First Health Group Corporation,First Health Network,742.05,97,,percent of total billed charges,,
Pacu First Hour,,24000103,LOCAL,Facility,Both,,,,765,650.25,219.249,765,"Health Partners, Inc.",Commercial,723.69,94.6,,percent of total billed charges,,
Pacu First Hour,,24000103,LOCAL,Facility,Outpatient,,,,765,650.25,219.249,765,"Health Partners, Inc.",Medicare Advantage,374.85,49,,percent of total billed charges,,
Pacu First Hour,,24000103,LOCAL,Facility,Inpatient,,,,765,650.25,219.249,765,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Pacu First Hour,,24000103,LOCAL,Facility,Both,,,,765,650.25,219.249,765,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),459,60,,percent of total billed charges,,
Pacu First Hour,,24000103,LOCAL,Facility,Both,,,,765,650.25,219.249,765,"Health Partners, Inc.",State of Minnesota Advantage Program,623.475,81.5,,percent of total billed charges,,
Pacu First Hour,,24000103,LOCAL,Facility,Both,,,,765,650.25,219.249,765,"Health Partners, Inc.",State Public Programs,382.5,50,,percent of total billed charges,,
Pacu First Hour,,24000103,LOCAL,Facility,Both,,,,765,650.25,219.249,765,Humana Insurance Company,Commercial PPO,726.75,95,,percent of total billed charges,,
Pacu First Hour,,24000103,LOCAL,Facility,Outpatient,,,,765,650.25,219.249,765,Humana Insurance Company,Medicare PPO,374.85,49,,percent of total billed charges,,
Pacu First Hour,,24000103,LOCAL,Facility,Inpatient,,,,765,650.25,219.249,765,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Pacu First Hour,,24000103,LOCAL,Facility,Both,,,,765,650.25,219.249,765,Medica,Individual & Family,758.115,99.1,,percent of total billed charges,,
Pacu First Hour,,24000103,LOCAL,Facility,Outpatient,,,,765,650.25,219.249,765,Medica,Medica Advantage Solution,380.97,49.8,,percent of total billed charges,,
Pacu First Hour,,24000103,LOCAL,Facility,Inpatient,,,,765,650.25,219.249,765,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Pacu First Hour,,24000103,LOCAL,Facility,Outpatient,,,,765,650.25,219.249,765,Medica,Medical Assistance,341.19,44.6,,percent of total billed charges,,
Pacu First Hour,,24000103,LOCAL,Facility,Inpatient,,,,765,650.25,219.249,765,Medica,Medical Assistance,,,,,Included in per diem rate,
Pacu First Hour,,24000103,LOCAL,Facility,Outpatient,,,,765,650.25,219.249,765,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,380.97,49.8,,percent of total billed charges,,
Pacu First Hour,,24000103,LOCAL,Facility,Inpatient,,,,765,650.25,219.249,765,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Pacu First Hour,,24000103,LOCAL,Facility,Both,,,,765,650.25,219.249,765,"Multiplan, Inc.","Multiplan, Inc.",719.1,94,,percent of total billed charges,,
Pacu First Hour,,24000103,LOCAL,Facility,Outpatient,,,,765,650.25,219.249,765,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,689.265,90.1,,percent of total billed charges,,
Pacu First Hour,,24000103,LOCAL,Facility,Inpatient,,,,765,650.25,219.249,765,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Pacu First Hour,,24000103,LOCAL,Facility,Both,,,,765,650.25,219.249,765,"Preferred One Administrative Services, INC.",PPO,754.29,98.6,,percent of total billed charges,,
Pacu First Hour,,24000103,LOCAL,Facility,Outpatient,,,,765,650.25,219.249,765,PrimeWest Health,Minnesota Senior Health Options (MSHO),393.5925,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Pacu First Hour,,24000103,LOCAL,Facility,Inpatient,,,,765,650.25,219.249,765,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Pacu First Hour,,24000103,LOCAL,Facility,Outpatient,,,,765,650.25,219.249,765,PrimeWest Health,MinnesotaCare,392.904,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Pacu First Hour,,24000103,LOCAL,Facility,Inpatient,,,,765,650.25,219.249,765,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Pacu First Hour,,24000103,LOCAL,Facility,Both,,,,765,650.25,219.249,765,Sanford Health Plan,Sanford Health Plan,703.8,92,,percent of total billed charges,,
Pacu First Hour,,24000103,LOCAL,Facility,Outpatient,,,,765,650.25,219.249,765,"UCare Health, Inc.",Individual & Family Plan,431.0775,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Pacu First Hour,,24000103,LOCAL,Facility,Inpatient,,,,765,650.25,219.249,765,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Pacu First Hour,,24000103,LOCAL,Facility,Outpatient,,,,765,650.25,219.249,765,"UCare Health, Inc.",Medical Assistance,386.0955,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Pacu First Hour,,24000103,LOCAL,Facility,Inpatient,,,,765,650.25,219.249,765,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Pacu First Hour,,24000103,LOCAL,Facility,Outpatient,,,,765,650.25,219.249,765,"UCare Health, Inc.",Medicare Advantage,386.0955,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Pacu First Hour,,24000103,LOCAL,Facility,Inpatient,,,,765,650.25,219.249,765,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Pacu First Hour,,24000103,LOCAL,Facility,Outpatient,,,,765,650.25,219.249,765,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),386.0955,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Pacu First Hour,,24000103,LOCAL,Facility,Inpatient,,,,765,650.25,219.249,765,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Pacu First Hour,,24000103,LOCAL,Facility,Both,,,,765,650.25,219.249,765,UnitedHealthcare,Individual & Family,719.1,94,,percent of total billed charges,,
Pacu First Hour,,24000103,LOCAL,Facility,Outpatient,,,,765,650.25,219.249,765,UnitedHealthcare,Medicare Advantage,374.85,49,,percent of total billed charges,,
Pacu First Hour,,24000103,LOCAL,Facility,Inpatient,,,,765,650.25,219.249,765,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Pacu First Hour,,24000103,LOCAL,Facility,Outpatient,,,,765,650.25,219.249,765,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,367.2,48,,percent of total billed charges,,100% of DHS outpatient percentage
Pacu First Hour,,24000103,LOCAL,Facility,Inpatient,,,,765,650.25,219.249,765,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Pacu Add'L 1/2 Hour,,24000127,LOCAL,Facility,Both,,,,119,101.15,34.1054,119,Aetna,Commercial,109.48,92,,percent of total billed charges,,
Pacu Add'L 1/2 Hour,,24000127,LOCAL,Facility,Outpatient,,,,119,101.15,34.1054,119,Aetna,Medicare Advantage,58.31,49,,percent of total billed charges,,
Pacu Add'L 1/2 Hour,,24000127,LOCAL,Facility,Inpatient,,,,119,101.15,34.1054,119,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Pacu Add'L 1/2 Hour,,24000127,LOCAL,Facility,Both,,,,119,101.15,34.1054,119,Aetna,PPO,110.67,93,,percent of total billed charges,,
Pacu Add'L 1/2 Hour,,24000127,LOCAL,Facility,Both,,,,119,101.15,34.1054,119,America's PPO,America's PPO,114.2757,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Pacu Add'L 1/2 Hour,,24000127,LOCAL,Facility,Both,,,,119,101.15,34.1054,119,BlueCross BlueShield Minnesota, Federal Employee Program,117.096,98.4,,percent of total billed charges,,
Pacu Add'L 1/2 Hour,,24000127,LOCAL,Facility,Both,,,,119,101.15,34.1054,119,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,119,100,,percent of total billed charges,,
Pacu Add'L 1/2 Hour,,24000127,LOCAL,Facility,Both,,,,119,101.15,34.1054,119,BlueCross BlueShield Minnesota,High Value Network Plan,107.1,90,,percent of total billed charges,,
Pacu Add'L 1/2 Hour,,24000127,LOCAL,Facility,Outpatient,,,,119,101.15,34.1054,119,BlueCross BlueShield Minnesota,Medicare Advantage,58.31,49,,percent of total billed charges,,
Pacu Add'L 1/2 Hour,,24000127,LOCAL,Facility,Inpatient,,,,119,101.15,34.1054,119,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Pacu Add'L 1/2 Hour,,24000127,LOCAL,Facility,Both,,,,119,101.15,34.1054,119,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,105.3983,88.57,,percent of total billed charges,,
Pacu Add'L 1/2 Hour,,24000127,LOCAL,Facility,Both,,,,119,101.15,34.1054,119,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,34.1054,28.66,,percent of total billed charges,,
Pacu Add'L 1/2 Hour,,24000127,LOCAL,Facility,Outpatient,,,,119,101.15,34.1054,119,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),58.31,49,,percent of total billed charges,,
Pacu Add'L 1/2 Hour,,24000127,LOCAL,Facility,Inpatient,,,,119,101.15,34.1054,119,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Pacu Add'L 1/2 Hour,,24000127,LOCAL,Facility,Both,,,,119,101.15,34.1054,119,CorVel,Worker's Compensation,119,100,,percent of total billed charges,,
Pacu Add'L 1/2 Hour,,24000127,LOCAL,Facility,Both,,,,119,101.15,34.1054,119,First Health Group Corporation,First Health Network,115.43,97,,percent of total billed charges,,
Pacu Add'L 1/2 Hour,,24000127,LOCAL,Facility,Both,,,,119,101.15,34.1054,119,"Health Partners, Inc.",Commercial,112.574,94.6,,percent of total billed charges,,
Pacu Add'L 1/2 Hour,,24000127,LOCAL,Facility,Outpatient,,,,119,101.15,34.1054,119,"Health Partners, Inc.",Medicare Advantage,58.31,49,,percent of total billed charges,,
Pacu Add'L 1/2 Hour,,24000127,LOCAL,Facility,Inpatient,,,,119,101.15,34.1054,119,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Pacu Add'L 1/2 Hour,,24000127,LOCAL,Facility,Both,,,,119,101.15,34.1054,119,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),71.4,60,,percent of total billed charges,,
Pacu Add'L 1/2 Hour,,24000127,LOCAL,Facility,Both,,,,119,101.15,34.1054,119,"Health Partners, Inc.",State of Minnesota Advantage Program,96.985,81.5,,percent of total billed charges,,
Pacu Add'L 1/2 Hour,,24000127,LOCAL,Facility,Both,,,,119,101.15,34.1054,119,"Health Partners, Inc.",State Public Programs,59.5,50,,percent of total billed charges,,
Pacu Add'L 1/2 Hour,,24000127,LOCAL,Facility,Both,,,,119,101.15,34.1054,119,Humana Insurance Company,Commercial PPO,113.05,95,,percent of total billed charges,,
Pacu Add'L 1/2 Hour,,24000127,LOCAL,Facility,Outpatient,,,,119,101.15,34.1054,119,Humana Insurance Company,Medicare PPO,58.31,49,,percent of total billed charges,,
Pacu Add'L 1/2 Hour,,24000127,LOCAL,Facility,Inpatient,,,,119,101.15,34.1054,119,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Pacu Add'L 1/2 Hour,,24000127,LOCAL,Facility,Both,,,,119,101.15,34.1054,119,Medica,Individual & Family,117.929,99.1,,percent of total billed charges,,
Pacu Add'L 1/2 Hour,,24000127,LOCAL,Facility,Outpatient,,,,119,101.15,34.1054,119,Medica,Medica Advantage Solution,59.262,49.8,,percent of total billed charges,,
Pacu Add'L 1/2 Hour,,24000127,LOCAL,Facility,Inpatient,,,,119,101.15,34.1054,119,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Pacu Add'L 1/2 Hour,,24000127,LOCAL,Facility,Outpatient,,,,119,101.15,34.1054,119,Medica,Medical Assistance,53.074,44.6,,percent of total billed charges,,
Pacu Add'L 1/2 Hour,,24000127,LOCAL,Facility,Inpatient,,,,119,101.15,34.1054,119,Medica,Medical Assistance,,,,,Included in per diem rate,
Pacu Add'L 1/2 Hour,,24000127,LOCAL,Facility,Outpatient,,,,119,101.15,34.1054,119,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,59.262,49.8,,percent of total billed charges,,
Pacu Add'L 1/2 Hour,,24000127,LOCAL,Facility,Inpatient,,,,119,101.15,34.1054,119,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Pacu Add'L 1/2 Hour,,24000127,LOCAL,Facility,Both,,,,119,101.15,34.1054,119,"Multiplan, Inc.","Multiplan, Inc.",111.86,94,,percent of total billed charges,,
Pacu Add'L 1/2 Hour,,24000127,LOCAL,Facility,Outpatient,,,,119,101.15,34.1054,119,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,107.219,90.1,,percent of total billed charges,,
Pacu Add'L 1/2 Hour,,24000127,LOCAL,Facility,Inpatient,,,,119,101.15,34.1054,119,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Pacu Add'L 1/2 Hour,,24000127,LOCAL,Facility,Both,,,,119,101.15,34.1054,119,"Preferred One Administrative Services, INC.",PPO,117.334,98.6,,percent of total billed charges,,
Pacu Add'L 1/2 Hour,,24000127,LOCAL,Facility,Outpatient,,,,119,101.15,34.1054,119,PrimeWest Health,Minnesota Senior Health Options (MSHO),61.2255,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Pacu Add'L 1/2 Hour,,24000127,LOCAL,Facility,Inpatient,,,,119,101.15,34.1054,119,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Pacu Add'L 1/2 Hour,,24000127,LOCAL,Facility,Outpatient,,,,119,101.15,34.1054,119,PrimeWest Health,MinnesotaCare,61.1184,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Pacu Add'L 1/2 Hour,,24000127,LOCAL,Facility,Inpatient,,,,119,101.15,34.1054,119,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Pacu Add'L 1/2 Hour,,24000127,LOCAL,Facility,Both,,,,119,101.15,34.1054,119,Sanford Health Plan,Sanford Health Plan,109.48,92,,percent of total billed charges,,
Pacu Add'L 1/2 Hour,,24000127,LOCAL,Facility,Outpatient,,,,119,101.15,34.1054,119,"UCare Health, Inc.",Individual & Family Plan,67.0565,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Pacu Add'L 1/2 Hour,,24000127,LOCAL,Facility,Inpatient,,,,119,101.15,34.1054,119,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Pacu Add'L 1/2 Hour,,24000127,LOCAL,Facility,Outpatient,,,,119,101.15,34.1054,119,"UCare Health, Inc.",Medical Assistance,60.0593,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Pacu Add'L 1/2 Hour,,24000127,LOCAL,Facility,Inpatient,,,,119,101.15,34.1054,119,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Pacu Add'L 1/2 Hour,,24000127,LOCAL,Facility,Outpatient,,,,119,101.15,34.1054,119,"UCare Health, Inc.",Medicare Advantage,60.0593,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Pacu Add'L 1/2 Hour,,24000127,LOCAL,Facility,Inpatient,,,,119,101.15,34.1054,119,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Pacu Add'L 1/2 Hour,,24000127,LOCAL,Facility,Outpatient,,,,119,101.15,34.1054,119,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),60.0593,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Pacu Add'L 1/2 Hour,,24000127,LOCAL,Facility,Inpatient,,,,119,101.15,34.1054,119,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Pacu Add'L 1/2 Hour,,24000127,LOCAL,Facility,Both,,,,119,101.15,34.1054,119,UnitedHealthcare,Individual & Family,111.86,94,,percent of total billed charges,,
Pacu Add'L 1/2 Hour,,24000127,LOCAL,Facility,Outpatient,,,,119,101.15,34.1054,119,UnitedHealthcare,Medicare Advantage,58.31,49,,percent of total billed charges,,
Pacu Add'L 1/2 Hour,,24000127,LOCAL,Facility,Inpatient,,,,119,101.15,34.1054,119,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Pacu Add'L 1/2 Hour,,24000127,LOCAL,Facility,Outpatient,,,,119,101.15,34.1054,119,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,57.12,48,,percent of total billed charges,,100% of DHS outpatient percentage
Pacu Add'L 1/2 Hour,,24000127,LOCAL,Facility,Inpatient,,,,119,101.15,34.1054,119,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Recovery Room Each Addl Hour,,24000203,LOCAL,Facility,Both,,,,181,153.85,51.8746,181,Aetna,Commercial,166.52,92,,percent of total billed charges,,
Recovery Room Each Addl Hour,,24000203,LOCAL,Facility,Outpatient,,,,181,153.85,51.8746,181,Aetna,Medicare Advantage,88.69,49,,percent of total billed charges,,
Recovery Room Each Addl Hour,,24000203,LOCAL,Facility,Inpatient,,,,181,153.85,51.8746,181,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Recovery Room Each Addl Hour,,24000203,LOCAL,Facility,Both,,,,181,153.85,51.8746,181,Aetna,PPO,168.33,93,,percent of total billed charges,,
Recovery Room Each Addl Hour,,24000203,LOCAL,Facility,Both,,,,181,153.85,51.8746,181,America's PPO,America's PPO,173.8143,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Recovery Room Each Addl Hour,,24000203,LOCAL,Facility,Both,,,,181,153.85,51.8746,181,BlueCross BlueShield Minnesota, Federal Employee Program,178.104,98.4,,percent of total billed charges,,
Recovery Room Each Addl Hour,,24000203,LOCAL,Facility,Both,,,,181,153.85,51.8746,181,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,181,100,,percent of total billed charges,,
Recovery Room Each Addl Hour,,24000203,LOCAL,Facility,Both,,,,181,153.85,51.8746,181,BlueCross BlueShield Minnesota,High Value Network Plan,162.9,90,,percent of total billed charges,,
Recovery Room Each Addl Hour,,24000203,LOCAL,Facility,Outpatient,,,,181,153.85,51.8746,181,BlueCross BlueShield Minnesota,Medicare Advantage,88.69,49,,percent of total billed charges,,
Recovery Room Each Addl Hour,,24000203,LOCAL,Facility,Inpatient,,,,181,153.85,51.8746,181,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Recovery Room Each Addl Hour,,24000203,LOCAL,Facility,Both,,,,181,153.85,51.8746,181,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,160.3117,88.57,,percent of total billed charges,,
Recovery Room Each Addl Hour,,24000203,LOCAL,Facility,Both,,,,181,153.85,51.8746,181,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,51.8746,28.66,,percent of total billed charges,,
Recovery Room Each Addl Hour,,24000203,LOCAL,Facility,Outpatient,,,,181,153.85,51.8746,181,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),88.69,49,,percent of total billed charges,,
Recovery Room Each Addl Hour,,24000203,LOCAL,Facility,Inpatient,,,,181,153.85,51.8746,181,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Recovery Room Each Addl Hour,,24000203,LOCAL,Facility,Both,,,,181,153.85,51.8746,181,CorVel,Worker's Compensation,181,100,,percent of total billed charges,,
Recovery Room Each Addl Hour,,24000203,LOCAL,Facility,Both,,,,181,153.85,51.8746,181,First Health Group Corporation,First Health Network,175.57,97,,percent of total billed charges,,
Recovery Room Each Addl Hour,,24000203,LOCAL,Facility,Both,,,,181,153.85,51.8746,181,"Health Partners, Inc.",Commercial,171.226,94.6,,percent of total billed charges,,
Recovery Room Each Addl Hour,,24000203,LOCAL,Facility,Outpatient,,,,181,153.85,51.8746,181,"Health Partners, Inc.",Medicare Advantage,88.69,49,,percent of total billed charges,,
Recovery Room Each Addl Hour,,24000203,LOCAL,Facility,Inpatient,,,,181,153.85,51.8746,181,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Recovery Room Each Addl Hour,,24000203,LOCAL,Facility,Both,,,,181,153.85,51.8746,181,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),108.6,60,,percent of total billed charges,,
Recovery Room Each Addl Hour,,24000203,LOCAL,Facility,Both,,,,181,153.85,51.8746,181,"Health Partners, Inc.",State of Minnesota Advantage Program,147.515,81.5,,percent of total billed charges,,
Recovery Room Each Addl Hour,,24000203,LOCAL,Facility,Both,,,,181,153.85,51.8746,181,"Health Partners, Inc.",State Public Programs,90.5,50,,percent of total billed charges,,
Recovery Room Each Addl Hour,,24000203,LOCAL,Facility,Both,,,,181,153.85,51.8746,181,Humana Insurance Company,Commercial PPO,171.95,95,,percent of total billed charges,,
Recovery Room Each Addl Hour,,24000203,LOCAL,Facility,Outpatient,,,,181,153.85,51.8746,181,Humana Insurance Company,Medicare PPO,88.69,49,,percent of total billed charges,,
Recovery Room Each Addl Hour,,24000203,LOCAL,Facility,Inpatient,,,,181,153.85,51.8746,181,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Recovery Room Each Addl Hour,,24000203,LOCAL,Facility,Both,,,,181,153.85,51.8746,181,Medica,Individual & Family,179.371,99.1,,percent of total billed charges,,
Recovery Room Each Addl Hour,,24000203,LOCAL,Facility,Outpatient,,,,181,153.85,51.8746,181,Medica,Medica Advantage Solution,90.138,49.8,,percent of total billed charges,,
Recovery Room Each Addl Hour,,24000203,LOCAL,Facility,Inpatient,,,,181,153.85,51.8746,181,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Recovery Room Each Addl Hour,,24000203,LOCAL,Facility,Outpatient,,,,181,153.85,51.8746,181,Medica,Medical Assistance,80.726,44.6,,percent of total billed charges,,
Recovery Room Each Addl Hour,,24000203,LOCAL,Facility,Inpatient,,,,181,153.85,51.8746,181,Medica,Medical Assistance,,,,,Included in per diem rate,
Recovery Room Each Addl Hour,,24000203,LOCAL,Facility,Outpatient,,,,181,153.85,51.8746,181,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,90.138,49.8,,percent of total billed charges,,
Recovery Room Each Addl Hour,,24000203,LOCAL,Facility,Inpatient,,,,181,153.85,51.8746,181,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Recovery Room Each Addl Hour,,24000203,LOCAL,Facility,Both,,,,181,153.85,51.8746,181,"Multiplan, Inc.","Multiplan, Inc.",170.14,94,,percent of total billed charges,,
Recovery Room Each Addl Hour,,24000203,LOCAL,Facility,Outpatient,,,,181,153.85,51.8746,181,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,163.081,90.1,,percent of total billed charges,,
Recovery Room Each Addl Hour,,24000203,LOCAL,Facility,Inpatient,,,,181,153.85,51.8746,181,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Recovery Room Each Addl Hour,,24000203,LOCAL,Facility,Both,,,,181,153.85,51.8746,181,"Preferred One Administrative Services, INC.",PPO,178.466,98.6,,percent of total billed charges,,
Recovery Room Each Addl Hour,,24000203,LOCAL,Facility,Outpatient,,,,181,153.85,51.8746,181,PrimeWest Health,Minnesota Senior Health Options (MSHO),93.1245,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Recovery Room Each Addl Hour,,24000203,LOCAL,Facility,Inpatient,,,,181,153.85,51.8746,181,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Recovery Room Each Addl Hour,,24000203,LOCAL,Facility,Outpatient,,,,181,153.85,51.8746,181,PrimeWest Health,MinnesotaCare,92.9616,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Recovery Room Each Addl Hour,,24000203,LOCAL,Facility,Inpatient,,,,181,153.85,51.8746,181,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Recovery Room Each Addl Hour,,24000203,LOCAL,Facility,Both,,,,181,153.85,51.8746,181,Sanford Health Plan,Sanford Health Plan,166.52,92,,percent of total billed charges,,
Recovery Room Each Addl Hour,,24000203,LOCAL,Facility,Outpatient,,,,181,153.85,51.8746,181,"UCare Health, Inc.",Individual & Family Plan,101.9935,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Recovery Room Each Addl Hour,,24000203,LOCAL,Facility,Inpatient,,,,181,153.85,51.8746,181,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Recovery Room Each Addl Hour,,24000203,LOCAL,Facility,Outpatient,,,,181,153.85,51.8746,181,"UCare Health, Inc.",Medical Assistance,91.3507,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Recovery Room Each Addl Hour,,24000203,LOCAL,Facility,Inpatient,,,,181,153.85,51.8746,181,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Recovery Room Each Addl Hour,,24000203,LOCAL,Facility,Outpatient,,,,181,153.85,51.8746,181,"UCare Health, Inc.",Medicare Advantage,91.3507,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Recovery Room Each Addl Hour,,24000203,LOCAL,Facility,Inpatient,,,,181,153.85,51.8746,181,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Recovery Room Each Addl Hour,,24000203,LOCAL,Facility,Outpatient,,,,181,153.85,51.8746,181,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),91.3507,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Recovery Room Each Addl Hour,,24000203,LOCAL,Facility,Inpatient,,,,181,153.85,51.8746,181,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Recovery Room Each Addl Hour,,24000203,LOCAL,Facility,Both,,,,181,153.85,51.8746,181,UnitedHealthcare,Individual & Family,170.14,94,,percent of total billed charges,,
Recovery Room Each Addl Hour,,24000203,LOCAL,Facility,Outpatient,,,,181,153.85,51.8746,181,UnitedHealthcare,Medicare Advantage,88.69,49,,percent of total billed charges,,
Recovery Room Each Addl Hour,,24000203,LOCAL,Facility,Inpatient,,,,181,153.85,51.8746,181,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Recovery Room Each Addl Hour,,24000203,LOCAL,Facility,Outpatient,,,,181,153.85,51.8746,181,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,86.88,48,,percent of total billed charges,,100% of DHS outpatient percentage
Recovery Room Each Addl Hour,,24000203,LOCAL,Facility,Inpatient,,,,181,153.85,51.8746,181,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Amputation, Extremity",,25000021,LOCAL,Facility,Both,,,,3876,3294.6,1110.8616,3876,Aetna,Commercial,3565.92,92,,percent of total billed charges,,
"Amputation, Extremity",,25000021,LOCAL,Facility,Outpatient,,,,3876,3294.6,1110.8616,3876,Aetna,Medicare Advantage,1899.24,49,,percent of total billed charges,,
"Amputation, Extremity",,25000021,LOCAL,Facility,Inpatient,,,,3876,3294.6,1110.8616,3876,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Amputation, Extremity",,25000021,LOCAL,Facility,Both,,,,3876,3294.6,1110.8616,3876,Aetna,PPO,3604.68,93,,percent of total billed charges,,
"Amputation, Extremity",,25000021,LOCAL,Facility,Both,,,,3876,3294.6,1110.8616,3876,America's PPO,America's PPO,3722.1228,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Amputation, Extremity",,25000021,LOCAL,Facility,Both,,,,3876,3294.6,1110.8616,3876,BlueCross BlueShield Minnesota, Federal Employee Program,3813.984,98.4,,percent of total billed charges,,
"Amputation, Extremity",,25000021,LOCAL,Facility,Both,,,,3876,3294.6,1110.8616,3876,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,3876,100,,percent of total billed charges,,
"Amputation, Extremity",,25000021,LOCAL,Facility,Both,,,,3876,3294.6,1110.8616,3876,BlueCross BlueShield Minnesota,High Value Network Plan,3488.4,90,,percent of total billed charges,,
"Amputation, Extremity",,25000021,LOCAL,Facility,Outpatient,,,,3876,3294.6,1110.8616,3876,BlueCross BlueShield Minnesota,Medicare Advantage,1899.24,49,,percent of total billed charges,,
"Amputation, Extremity",,25000021,LOCAL,Facility,Inpatient,,,,3876,3294.6,1110.8616,3876,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Amputation, Extremity",,25000021,LOCAL,Facility,Both,,,,3876,3294.6,1110.8616,3876,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,3432.9732,88.57,,percent of total billed charges,,
"Amputation, Extremity",,25000021,LOCAL,Facility,Both,,,,3876,3294.6,1110.8616,3876,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1110.8616,28.66,,percent of total billed charges,,
"Amputation, Extremity",,25000021,LOCAL,Facility,Outpatient,,,,3876,3294.6,1110.8616,3876,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1899.24,49,,percent of total billed charges,,
"Amputation, Extremity",,25000021,LOCAL,Facility,Inpatient,,,,3876,3294.6,1110.8616,3876,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Amputation, Extremity",,25000021,LOCAL,Facility,Both,,,,3876,3294.6,1110.8616,3876,CorVel,Worker's Compensation,3876,100,,percent of total billed charges,,
"Amputation, Extremity",,25000021,LOCAL,Facility,Both,,,,3876,3294.6,1110.8616,3876,First Health Group Corporation,First Health Network,3759.72,97,,percent of total billed charges,,
"Amputation, Extremity",,25000021,LOCAL,Facility,Both,,,,3876,3294.6,1110.8616,3876,"Health Partners, Inc.",Commercial,3666.696,94.6,,percent of total billed charges,,
"Amputation, Extremity",,25000021,LOCAL,Facility,Outpatient,,,,3876,3294.6,1110.8616,3876,"Health Partners, Inc.",Medicare Advantage,1899.24,49,,percent of total billed charges,,
"Amputation, Extremity",,25000021,LOCAL,Facility,Inpatient,,,,3876,3294.6,1110.8616,3876,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Amputation, Extremity",,25000021,LOCAL,Facility,Both,,,,3876,3294.6,1110.8616,3876,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),2325.6,60,,percent of total billed charges,,
"Amputation, Extremity",,25000021,LOCAL,Facility,Both,,,,3876,3294.6,1110.8616,3876,"Health Partners, Inc.",State of Minnesota Advantage Program,3158.94,81.5,,percent of total billed charges,,
"Amputation, Extremity",,25000021,LOCAL,Facility,Both,,,,3876,3294.6,1110.8616,3876,"Health Partners, Inc.",State Public Programs,1938,50,,percent of total billed charges,,
"Amputation, Extremity",,25000021,LOCAL,Facility,Both,,,,3876,3294.6,1110.8616,3876,Humana Insurance Company,Commercial PPO,3682.2,95,,percent of total billed charges,,
"Amputation, Extremity",,25000021,LOCAL,Facility,Outpatient,,,,3876,3294.6,1110.8616,3876,Humana Insurance Company,Medicare PPO,1899.24,49,,percent of total billed charges,,
"Amputation, Extremity",,25000021,LOCAL,Facility,Inpatient,,,,3876,3294.6,1110.8616,3876,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Amputation, Extremity",,25000021,LOCAL,Facility,Both,,,,3876,3294.6,1110.8616,3876,Medica,Individual & Family,3841.116,99.1,,percent of total billed charges,,
"Amputation, Extremity",,25000021,LOCAL,Facility,Outpatient,,,,3876,3294.6,1110.8616,3876,Medica,Medica Advantage Solution,1930.248,49.8,,percent of total billed charges,,
"Amputation, Extremity",,25000021,LOCAL,Facility,Inpatient,,,,3876,3294.6,1110.8616,3876,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Amputation, Extremity",,25000021,LOCAL,Facility,Outpatient,,,,3876,3294.6,1110.8616,3876,Medica,Medical Assistance,1728.696,44.6,,percent of total billed charges,,
"Amputation, Extremity",,25000021,LOCAL,Facility,Inpatient,,,,3876,3294.6,1110.8616,3876,Medica,Medical Assistance,,,,,Included in per diem rate,
"Amputation, Extremity",,25000021,LOCAL,Facility,Outpatient,,,,3876,3294.6,1110.8616,3876,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1930.248,49.8,,percent of total billed charges,,
"Amputation, Extremity",,25000021,LOCAL,Facility,Inpatient,,,,3876,3294.6,1110.8616,3876,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Amputation, Extremity",,25000021,LOCAL,Facility,Both,,,,3876,3294.6,1110.8616,3876,"Multiplan, Inc.","Multiplan, Inc.",3643.44,94,,percent of total billed charges,,
"Amputation, Extremity",,25000021,LOCAL,Facility,Outpatient,,,,3876,3294.6,1110.8616,3876,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,3492.276,90.1,,percent of total billed charges,,
"Amputation, Extremity",,25000021,LOCAL,Facility,Inpatient,,,,3876,3294.6,1110.8616,3876,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Amputation, Extremity",,25000021,LOCAL,Facility,Both,,,,3876,3294.6,1110.8616,3876,"Preferred One Administrative Services, INC.",PPO,3821.736,98.6,,percent of total billed charges,,
"Amputation, Extremity",,25000021,LOCAL,Facility,Outpatient,,,,3876,3294.6,1110.8616,3876,PrimeWest Health,Minnesota Senior Health Options (MSHO),1994.202,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Amputation, Extremity",,25000021,LOCAL,Facility,Inpatient,,,,3876,3294.6,1110.8616,3876,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Amputation, Extremity",,25000021,LOCAL,Facility,Outpatient,,,,3876,3294.6,1110.8616,3876,PrimeWest Health,MinnesotaCare,1990.7136,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Amputation, Extremity",,25000021,LOCAL,Facility,Inpatient,,,,3876,3294.6,1110.8616,3876,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Amputation, Extremity",,25000021,LOCAL,Facility,Both,,,,3876,3294.6,1110.8616,3876,Sanford Health Plan,Sanford Health Plan,3565.92,92,,percent of total billed charges,,
"Amputation, Extremity",,25000021,LOCAL,Facility,Outpatient,,,,3876,3294.6,1110.8616,3876,"UCare Health, Inc.",Individual & Family Plan,2184.126,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Amputation, Extremity",,25000021,LOCAL,Facility,Inpatient,,,,3876,3294.6,1110.8616,3876,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Amputation, Extremity",,25000021,LOCAL,Facility,Outpatient,,,,3876,3294.6,1110.8616,3876,"UCare Health, Inc.",Medical Assistance,1956.2172,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Amputation, Extremity",,25000021,LOCAL,Facility,Inpatient,,,,3876,3294.6,1110.8616,3876,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Amputation, Extremity",,25000021,LOCAL,Facility,Outpatient,,,,3876,3294.6,1110.8616,3876,"UCare Health, Inc.",Medicare Advantage,1956.2172,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Amputation, Extremity",,25000021,LOCAL,Facility,Inpatient,,,,3876,3294.6,1110.8616,3876,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Amputation, Extremity",,25000021,LOCAL,Facility,Outpatient,,,,3876,3294.6,1110.8616,3876,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1956.2172,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Amputation, Extremity",,25000021,LOCAL,Facility,Inpatient,,,,3876,3294.6,1110.8616,3876,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Amputation, Extremity",,25000021,LOCAL,Facility,Both,,,,3876,3294.6,1110.8616,3876,UnitedHealthcare,Individual & Family,3643.44,94,,percent of total billed charges,,
"Amputation, Extremity",,25000021,LOCAL,Facility,Outpatient,,,,3876,3294.6,1110.8616,3876,UnitedHealthcare,Medicare Advantage,1899.24,49,,percent of total billed charges,,
"Amputation, Extremity",,25000021,LOCAL,Facility,Inpatient,,,,3876,3294.6,1110.8616,3876,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Amputation, Extremity",,25000021,LOCAL,Facility,Outpatient,,,,3876,3294.6,1110.8616,3876,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1860.48,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Amputation, Extremity",,25000021,LOCAL,Facility,Inpatient,,,,3876,3294.6,1110.8616,3876,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Amputation Of Toe,,25000039,LOCAL,Facility,Both,,,,2290,1946.5,656.314,2290,Aetna,Commercial,2106.8,92,,percent of total billed charges,,
Amputation Of Toe,,25000039,LOCAL,Facility,Outpatient,,,,2290,1946.5,656.314,2290,Aetna,Medicare Advantage,1122.1,49,,percent of total billed charges,,
Amputation Of Toe,,25000039,LOCAL,Facility,Inpatient,,,,2290,1946.5,656.314,2290,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Amputation Of Toe,,25000039,LOCAL,Facility,Both,,,,2290,1946.5,656.314,2290,Aetna,PPO,2129.7,93,,percent of total billed charges,,
Amputation Of Toe,,25000039,LOCAL,Facility,Both,,,,2290,1946.5,656.314,2290,America's PPO,America's PPO,2199.087,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Amputation Of Toe,,25000039,LOCAL,Facility,Both,,,,2290,1946.5,656.314,2290,BlueCross BlueShield Minnesota, Federal Employee Program,2253.36,98.4,,percent of total billed charges,,
Amputation Of Toe,,25000039,LOCAL,Facility,Both,,,,2290,1946.5,656.314,2290,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,2290,100,,percent of total billed charges,,
Amputation Of Toe,,25000039,LOCAL,Facility,Both,,,,2290,1946.5,656.314,2290,BlueCross BlueShield Minnesota,High Value Network Plan,2061,90,,percent of total billed charges,,
Amputation Of Toe,,25000039,LOCAL,Facility,Outpatient,,,,2290,1946.5,656.314,2290,BlueCross BlueShield Minnesota,Medicare Advantage,1122.1,49,,percent of total billed charges,,
Amputation Of Toe,,25000039,LOCAL,Facility,Inpatient,,,,2290,1946.5,656.314,2290,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Amputation Of Toe,,25000039,LOCAL,Facility,Both,,,,2290,1946.5,656.314,2290,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,2028.253,88.57,,percent of total billed charges,,
Amputation Of Toe,,25000039,LOCAL,Facility,Both,,,,2290,1946.5,656.314,2290,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,656.314,28.66,,percent of total billed charges,,
Amputation Of Toe,,25000039,LOCAL,Facility,Outpatient,,,,2290,1946.5,656.314,2290,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1122.1,49,,percent of total billed charges,,
Amputation Of Toe,,25000039,LOCAL,Facility,Inpatient,,,,2290,1946.5,656.314,2290,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Amputation Of Toe,,25000039,LOCAL,Facility,Both,,,,2290,1946.5,656.314,2290,CorVel,Worker's Compensation,2290,100,,percent of total billed charges,,
Amputation Of Toe,,25000039,LOCAL,Facility,Both,,,,2290,1946.5,656.314,2290,First Health Group Corporation,First Health Network,2221.3,97,,percent of total billed charges,,
Amputation Of Toe,,25000039,LOCAL,Facility,Both,,,,2290,1946.5,656.314,2290,"Health Partners, Inc.",Commercial,2166.34,94.6,,percent of total billed charges,,
Amputation Of Toe,,25000039,LOCAL,Facility,Outpatient,,,,2290,1946.5,656.314,2290,"Health Partners, Inc.",Medicare Advantage,1122.1,49,,percent of total billed charges,,
Amputation Of Toe,,25000039,LOCAL,Facility,Inpatient,,,,2290,1946.5,656.314,2290,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Amputation Of Toe,,25000039,LOCAL,Facility,Both,,,,2290,1946.5,656.314,2290,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1374,60,,percent of total billed charges,,
Amputation Of Toe,,25000039,LOCAL,Facility,Both,,,,2290,1946.5,656.314,2290,"Health Partners, Inc.",State of Minnesota Advantage Program,1866.35,81.5,,percent of total billed charges,,
Amputation Of Toe,,25000039,LOCAL,Facility,Both,,,,2290,1946.5,656.314,2290,"Health Partners, Inc.",State Public Programs,1145,50,,percent of total billed charges,,
Amputation Of Toe,,25000039,LOCAL,Facility,Both,,,,2290,1946.5,656.314,2290,Humana Insurance Company,Commercial PPO,2175.5,95,,percent of total billed charges,,
Amputation Of Toe,,25000039,LOCAL,Facility,Outpatient,,,,2290,1946.5,656.314,2290,Humana Insurance Company,Medicare PPO,1122.1,49,,percent of total billed charges,,
Amputation Of Toe,,25000039,LOCAL,Facility,Inpatient,,,,2290,1946.5,656.314,2290,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Amputation Of Toe,,25000039,LOCAL,Facility,Both,,,,2290,1946.5,656.314,2290,Medica,Individual & Family,2269.39,99.1,,percent of total billed charges,,
Amputation Of Toe,,25000039,LOCAL,Facility,Outpatient,,,,2290,1946.5,656.314,2290,Medica,Medica Advantage Solution,1140.42,49.8,,percent of total billed charges,,
Amputation Of Toe,,25000039,LOCAL,Facility,Inpatient,,,,2290,1946.5,656.314,2290,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Amputation Of Toe,,25000039,LOCAL,Facility,Outpatient,,,,2290,1946.5,656.314,2290,Medica,Medical Assistance,1021.34,44.6,,percent of total billed charges,,
Amputation Of Toe,,25000039,LOCAL,Facility,Inpatient,,,,2290,1946.5,656.314,2290,Medica,Medical Assistance,,,,,Included in per diem rate,
Amputation Of Toe,,25000039,LOCAL,Facility,Outpatient,,,,2290,1946.5,656.314,2290,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1140.42,49.8,,percent of total billed charges,,
Amputation Of Toe,,25000039,LOCAL,Facility,Inpatient,,,,2290,1946.5,656.314,2290,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Amputation Of Toe,,25000039,LOCAL,Facility,Both,,,,2290,1946.5,656.314,2290,"Multiplan, Inc.","Multiplan, Inc.",2152.6,94,,percent of total billed charges,,
Amputation Of Toe,,25000039,LOCAL,Facility,Outpatient,,,,2290,1946.5,656.314,2290,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,2063.29,90.1,,percent of total billed charges,,
Amputation Of Toe,,25000039,LOCAL,Facility,Inpatient,,,,2290,1946.5,656.314,2290,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Amputation Of Toe,,25000039,LOCAL,Facility,Both,,,,2290,1946.5,656.314,2290,"Preferred One Administrative Services, INC.",PPO,2257.94,98.6,,percent of total billed charges,,
Amputation Of Toe,,25000039,LOCAL,Facility,Outpatient,,,,2290,1946.5,656.314,2290,PrimeWest Health,Minnesota Senior Health Options (MSHO),1178.205,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Amputation Of Toe,,25000039,LOCAL,Facility,Inpatient,,,,2290,1946.5,656.314,2290,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Amputation Of Toe,,25000039,LOCAL,Facility,Outpatient,,,,2290,1946.5,656.314,2290,PrimeWest Health,MinnesotaCare,1176.144,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Amputation Of Toe,,25000039,LOCAL,Facility,Inpatient,,,,2290,1946.5,656.314,2290,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Amputation Of Toe,,25000039,LOCAL,Facility,Both,,,,2290,1946.5,656.314,2290,Sanford Health Plan,Sanford Health Plan,2106.8,92,,percent of total billed charges,,
Amputation Of Toe,,25000039,LOCAL,Facility,Outpatient,,,,2290,1946.5,656.314,2290,"UCare Health, Inc.",Individual & Family Plan,1290.415,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Amputation Of Toe,,25000039,LOCAL,Facility,Inpatient,,,,2290,1946.5,656.314,2290,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Amputation Of Toe,,25000039,LOCAL,Facility,Outpatient,,,,2290,1946.5,656.314,2290,"UCare Health, Inc.",Medical Assistance,1155.763,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Amputation Of Toe,,25000039,LOCAL,Facility,Inpatient,,,,2290,1946.5,656.314,2290,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Amputation Of Toe,,25000039,LOCAL,Facility,Outpatient,,,,2290,1946.5,656.314,2290,"UCare Health, Inc.",Medicare Advantage,1155.763,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Amputation Of Toe,,25000039,LOCAL,Facility,Inpatient,,,,2290,1946.5,656.314,2290,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Amputation Of Toe,,25000039,LOCAL,Facility,Outpatient,,,,2290,1946.5,656.314,2290,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1155.763,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Amputation Of Toe,,25000039,LOCAL,Facility,Inpatient,,,,2290,1946.5,656.314,2290,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Amputation Of Toe,,25000039,LOCAL,Facility,Both,,,,2290,1946.5,656.314,2290,UnitedHealthcare,Individual & Family,2152.6,94,,percent of total billed charges,,
Amputation Of Toe,,25000039,LOCAL,Facility,Outpatient,,,,2290,1946.5,656.314,2290,UnitedHealthcare,Medicare Advantage,1122.1,49,,percent of total billed charges,,
Amputation Of Toe,,25000039,LOCAL,Facility,Inpatient,,,,2290,1946.5,656.314,2290,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Amputation Of Toe,,25000039,LOCAL,Facility,Outpatient,,,,2290,1946.5,656.314,2290,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1099.2,48,,percent of total billed charges,,100% of DHS outpatient percentage
Amputation Of Toe,,25000039,LOCAL,Facility,Inpatient,,,,2290,1946.5,656.314,2290,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Appendectomy,,25000080,LOCAL,Facility,Both,,,,4488,3814.8,1286.2608,4488,Aetna,Commercial,4128.96,92,,percent of total billed charges,,
Appendectomy,,25000080,LOCAL,Facility,Outpatient,,,,4488,3814.8,1286.2608,4488,Aetna,Medicare Advantage,2199.12,49,,percent of total billed charges,,
Appendectomy,,25000080,LOCAL,Facility,Inpatient,,,,4488,3814.8,1286.2608,4488,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Appendectomy,,25000080,LOCAL,Facility,Both,,,,4488,3814.8,1286.2608,4488,Aetna,PPO,4173.84,93,,percent of total billed charges,,
Appendectomy,,25000080,LOCAL,Facility,Both,,,,4488,3814.8,1286.2608,4488,America's PPO,America's PPO,4309.8264,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Appendectomy,,25000080,LOCAL,Facility,Both,,,,4488,3814.8,1286.2608,4488,BlueCross BlueShield Minnesota, Federal Employee Program,4416.192,98.4,,percent of total billed charges,,
Appendectomy,,25000080,LOCAL,Facility,Both,,,,4488,3814.8,1286.2608,4488,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,4488,100,,percent of total billed charges,,
Appendectomy,,25000080,LOCAL,Facility,Both,,,,4488,3814.8,1286.2608,4488,BlueCross BlueShield Minnesota,High Value Network Plan,4039.2,90,,percent of total billed charges,,
Appendectomy,,25000080,LOCAL,Facility,Outpatient,,,,4488,3814.8,1286.2608,4488,BlueCross BlueShield Minnesota,Medicare Advantage,2199.12,49,,percent of total billed charges,,
Appendectomy,,25000080,LOCAL,Facility,Inpatient,,,,4488,3814.8,1286.2608,4488,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Appendectomy,,25000080,LOCAL,Facility,Both,,,,4488,3814.8,1286.2608,4488,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,3975.0216,88.57,,percent of total billed charges,,
Appendectomy,,25000080,LOCAL,Facility,Both,,,,4488,3814.8,1286.2608,4488,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1286.2608,28.66,,percent of total billed charges,,
Appendectomy,,25000080,LOCAL,Facility,Outpatient,,,,4488,3814.8,1286.2608,4488,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2199.12,49,,percent of total billed charges,,
Appendectomy,,25000080,LOCAL,Facility,Inpatient,,,,4488,3814.8,1286.2608,4488,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Appendectomy,,25000080,LOCAL,Facility,Both,,,,4488,3814.8,1286.2608,4488,CorVel,Worker's Compensation,4488,100,,percent of total billed charges,,
Appendectomy,,25000080,LOCAL,Facility,Both,,,,4488,3814.8,1286.2608,4488,First Health Group Corporation,First Health Network,4353.36,97,,percent of total billed charges,,
Appendectomy,,25000080,LOCAL,Facility,Both,,,,4488,3814.8,1286.2608,4488,"Health Partners, Inc.",Commercial,4245.648,94.6,,percent of total billed charges,,
Appendectomy,,25000080,LOCAL,Facility,Outpatient,,,,4488,3814.8,1286.2608,4488,"Health Partners, Inc.",Medicare Advantage,2199.12,49,,percent of total billed charges,,
Appendectomy,,25000080,LOCAL,Facility,Inpatient,,,,4488,3814.8,1286.2608,4488,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Appendectomy,,25000080,LOCAL,Facility,Both,,,,4488,3814.8,1286.2608,4488,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),2692.8,60,,percent of total billed charges,,
Appendectomy,,25000080,LOCAL,Facility,Both,,,,4488,3814.8,1286.2608,4488,"Health Partners, Inc.",State of Minnesota Advantage Program,3657.72,81.5,,percent of total billed charges,,
Appendectomy,,25000080,LOCAL,Facility,Both,,,,4488,3814.8,1286.2608,4488,"Health Partners, Inc.",State Public Programs,2244,50,,percent of total billed charges,,
Appendectomy,,25000080,LOCAL,Facility,Both,,,,4488,3814.8,1286.2608,4488,Humana Insurance Company,Commercial PPO,4263.6,95,,percent of total billed charges,,
Appendectomy,,25000080,LOCAL,Facility,Outpatient,,,,4488,3814.8,1286.2608,4488,Humana Insurance Company,Medicare PPO,2199.12,49,,percent of total billed charges,,
Appendectomy,,25000080,LOCAL,Facility,Inpatient,,,,4488,3814.8,1286.2608,4488,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Appendectomy,,25000080,LOCAL,Facility,Both,,,,4488,3814.8,1286.2608,4488,Medica,Individual & Family,4447.608,99.1,,percent of total billed charges,,
Appendectomy,,25000080,LOCAL,Facility,Outpatient,,,,4488,3814.8,1286.2608,4488,Medica,Medica Advantage Solution,2235.024,49.8,,percent of total billed charges,,
Appendectomy,,25000080,LOCAL,Facility,Inpatient,,,,4488,3814.8,1286.2608,4488,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Appendectomy,,25000080,LOCAL,Facility,Outpatient,,,,4488,3814.8,1286.2608,4488,Medica,Medical Assistance,2001.648,44.6,,percent of total billed charges,,
Appendectomy,,25000080,LOCAL,Facility,Inpatient,,,,4488,3814.8,1286.2608,4488,Medica,Medical Assistance,,,,,Included in per diem rate,
Appendectomy,,25000080,LOCAL,Facility,Outpatient,,,,4488,3814.8,1286.2608,4488,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2235.024,49.8,,percent of total billed charges,,
Appendectomy,,25000080,LOCAL,Facility,Inpatient,,,,4488,3814.8,1286.2608,4488,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Appendectomy,,25000080,LOCAL,Facility,Both,,,,4488,3814.8,1286.2608,4488,"Multiplan, Inc.","Multiplan, Inc.",4218.72,94,,percent of total billed charges,,
Appendectomy,,25000080,LOCAL,Facility,Outpatient,,,,4488,3814.8,1286.2608,4488,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4043.688,90.1,,percent of total billed charges,,
Appendectomy,,25000080,LOCAL,Facility,Inpatient,,,,4488,3814.8,1286.2608,4488,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Appendectomy,,25000080,LOCAL,Facility,Both,,,,4488,3814.8,1286.2608,4488,"Preferred One Administrative Services, INC.",PPO,4425.168,98.6,,percent of total billed charges,,
Appendectomy,,25000080,LOCAL,Facility,Outpatient,,,,4488,3814.8,1286.2608,4488,PrimeWest Health,Minnesota Senior Health Options (MSHO),2309.076,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Appendectomy,,25000080,LOCAL,Facility,Inpatient,,,,4488,3814.8,1286.2608,4488,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Appendectomy,,25000080,LOCAL,Facility,Outpatient,,,,4488,3814.8,1286.2608,4488,PrimeWest Health,MinnesotaCare,2305.0368,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Appendectomy,,25000080,LOCAL,Facility,Inpatient,,,,4488,3814.8,1286.2608,4488,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Appendectomy,,25000080,LOCAL,Facility,Both,,,,4488,3814.8,1286.2608,4488,Sanford Health Plan,Sanford Health Plan,4128.96,92,,percent of total billed charges,,
Appendectomy,,25000080,LOCAL,Facility,Outpatient,,,,4488,3814.8,1286.2608,4488,"UCare Health, Inc.",Individual & Family Plan,2528.988,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Appendectomy,,25000080,LOCAL,Facility,Inpatient,,,,4488,3814.8,1286.2608,4488,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Appendectomy,,25000080,LOCAL,Facility,Outpatient,,,,4488,3814.8,1286.2608,4488,"UCare Health, Inc.",Medical Assistance,2265.0936,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Appendectomy,,25000080,LOCAL,Facility,Inpatient,,,,4488,3814.8,1286.2608,4488,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Appendectomy,,25000080,LOCAL,Facility,Outpatient,,,,4488,3814.8,1286.2608,4488,"UCare Health, Inc.",Medicare Advantage,2265.0936,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Appendectomy,,25000080,LOCAL,Facility,Inpatient,,,,4488,3814.8,1286.2608,4488,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Appendectomy,,25000080,LOCAL,Facility,Outpatient,,,,4488,3814.8,1286.2608,4488,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2265.0936,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Appendectomy,,25000080,LOCAL,Facility,Inpatient,,,,4488,3814.8,1286.2608,4488,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Appendectomy,,25000080,LOCAL,Facility,Both,,,,4488,3814.8,1286.2608,4488,UnitedHealthcare,Individual & Family,4218.72,94,,percent of total billed charges,,
Appendectomy,,25000080,LOCAL,Facility,Outpatient,,,,4488,3814.8,1286.2608,4488,UnitedHealthcare,Medicare Advantage,2199.12,49,,percent of total billed charges,,
Appendectomy,,25000080,LOCAL,Facility,Inpatient,,,,4488,3814.8,1286.2608,4488,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Appendectomy,,25000080,LOCAL,Facility,Outpatient,,,,4488,3814.8,1286.2608,4488,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2154.24,48,,percent of total billed charges,,100% of DHS outpatient percentage
Appendectomy,,25000080,LOCAL,Facility,Inpatient,,,,4488,3814.8,1286.2608,4488,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Arthroplasty Of Toe,,25000129,LOCAL,Facility,Both,,,,2290,1946.5,656.314,2290,Aetna,Commercial,2106.8,92,,percent of total billed charges,,
Arthroplasty Of Toe,,25000129,LOCAL,Facility,Outpatient,,,,2290,1946.5,656.314,2290,Aetna,Medicare Advantage,1122.1,49,,percent of total billed charges,,
Arthroplasty Of Toe,,25000129,LOCAL,Facility,Inpatient,,,,2290,1946.5,656.314,2290,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Arthroplasty Of Toe,,25000129,LOCAL,Facility,Both,,,,2290,1946.5,656.314,2290,Aetna,PPO,2129.7,93,,percent of total billed charges,,
Arthroplasty Of Toe,,25000129,LOCAL,Facility,Both,,,,2290,1946.5,656.314,2290,America's PPO,America's PPO,2199.087,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Arthroplasty Of Toe,,25000129,LOCAL,Facility,Both,,,,2290,1946.5,656.314,2290,BlueCross BlueShield Minnesota, Federal Employee Program,2253.36,98.4,,percent of total billed charges,,
Arthroplasty Of Toe,,25000129,LOCAL,Facility,Both,,,,2290,1946.5,656.314,2290,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,2290,100,,percent of total billed charges,,
Arthroplasty Of Toe,,25000129,LOCAL,Facility,Both,,,,2290,1946.5,656.314,2290,BlueCross BlueShield Minnesota,High Value Network Plan,2061,90,,percent of total billed charges,,
Arthroplasty Of Toe,,25000129,LOCAL,Facility,Outpatient,,,,2290,1946.5,656.314,2290,BlueCross BlueShield Minnesota,Medicare Advantage,1122.1,49,,percent of total billed charges,,
Arthroplasty Of Toe,,25000129,LOCAL,Facility,Inpatient,,,,2290,1946.5,656.314,2290,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Arthroplasty Of Toe,,25000129,LOCAL,Facility,Both,,,,2290,1946.5,656.314,2290,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,2028.253,88.57,,percent of total billed charges,,
Arthroplasty Of Toe,,25000129,LOCAL,Facility,Both,,,,2290,1946.5,656.314,2290,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,656.314,28.66,,percent of total billed charges,,
Arthroplasty Of Toe,,25000129,LOCAL,Facility,Outpatient,,,,2290,1946.5,656.314,2290,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1122.1,49,,percent of total billed charges,,
Arthroplasty Of Toe,,25000129,LOCAL,Facility,Inpatient,,,,2290,1946.5,656.314,2290,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Arthroplasty Of Toe,,25000129,LOCAL,Facility,Both,,,,2290,1946.5,656.314,2290,CorVel,Worker's Compensation,2290,100,,percent of total billed charges,,
Arthroplasty Of Toe,,25000129,LOCAL,Facility,Both,,,,2290,1946.5,656.314,2290,First Health Group Corporation,First Health Network,2221.3,97,,percent of total billed charges,,
Arthroplasty Of Toe,,25000129,LOCAL,Facility,Both,,,,2290,1946.5,656.314,2290,"Health Partners, Inc.",Commercial,2166.34,94.6,,percent of total billed charges,,
Arthroplasty Of Toe,,25000129,LOCAL,Facility,Outpatient,,,,2290,1946.5,656.314,2290,"Health Partners, Inc.",Medicare Advantage,1122.1,49,,percent of total billed charges,,
Arthroplasty Of Toe,,25000129,LOCAL,Facility,Inpatient,,,,2290,1946.5,656.314,2290,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Arthroplasty Of Toe,,25000129,LOCAL,Facility,Both,,,,2290,1946.5,656.314,2290,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1374,60,,percent of total billed charges,,
Arthroplasty Of Toe,,25000129,LOCAL,Facility,Both,,,,2290,1946.5,656.314,2290,"Health Partners, Inc.",State of Minnesota Advantage Program,1866.35,81.5,,percent of total billed charges,,
Arthroplasty Of Toe,,25000129,LOCAL,Facility,Both,,,,2290,1946.5,656.314,2290,"Health Partners, Inc.",State Public Programs,1145,50,,percent of total billed charges,,
Arthroplasty Of Toe,,25000129,LOCAL,Facility,Both,,,,2290,1946.5,656.314,2290,Humana Insurance Company,Commercial PPO,2175.5,95,,percent of total billed charges,,
Arthroplasty Of Toe,,25000129,LOCAL,Facility,Outpatient,,,,2290,1946.5,656.314,2290,Humana Insurance Company,Medicare PPO,1122.1,49,,percent of total billed charges,,
Arthroplasty Of Toe,,25000129,LOCAL,Facility,Inpatient,,,,2290,1946.5,656.314,2290,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Arthroplasty Of Toe,,25000129,LOCAL,Facility,Both,,,,2290,1946.5,656.314,2290,Medica,Individual & Family,2269.39,99.1,,percent of total billed charges,,
Arthroplasty Of Toe,,25000129,LOCAL,Facility,Outpatient,,,,2290,1946.5,656.314,2290,Medica,Medica Advantage Solution,1140.42,49.8,,percent of total billed charges,,
Arthroplasty Of Toe,,25000129,LOCAL,Facility,Inpatient,,,,2290,1946.5,656.314,2290,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Arthroplasty Of Toe,,25000129,LOCAL,Facility,Outpatient,,,,2290,1946.5,656.314,2290,Medica,Medical Assistance,1021.34,44.6,,percent of total billed charges,,
Arthroplasty Of Toe,,25000129,LOCAL,Facility,Inpatient,,,,2290,1946.5,656.314,2290,Medica,Medical Assistance,,,,,Included in per diem rate,
Arthroplasty Of Toe,,25000129,LOCAL,Facility,Outpatient,,,,2290,1946.5,656.314,2290,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1140.42,49.8,,percent of total billed charges,,
Arthroplasty Of Toe,,25000129,LOCAL,Facility,Inpatient,,,,2290,1946.5,656.314,2290,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Arthroplasty Of Toe,,25000129,LOCAL,Facility,Both,,,,2290,1946.5,656.314,2290,"Multiplan, Inc.","Multiplan, Inc.",2152.6,94,,percent of total billed charges,,
Arthroplasty Of Toe,,25000129,LOCAL,Facility,Outpatient,,,,2290,1946.5,656.314,2290,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,2063.29,90.1,,percent of total billed charges,,
Arthroplasty Of Toe,,25000129,LOCAL,Facility,Inpatient,,,,2290,1946.5,656.314,2290,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Arthroplasty Of Toe,,25000129,LOCAL,Facility,Both,,,,2290,1946.5,656.314,2290,"Preferred One Administrative Services, INC.",PPO,2257.94,98.6,,percent of total billed charges,,
Arthroplasty Of Toe,,25000129,LOCAL,Facility,Outpatient,,,,2290,1946.5,656.314,2290,PrimeWest Health,Minnesota Senior Health Options (MSHO),1178.205,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Arthroplasty Of Toe,,25000129,LOCAL,Facility,Inpatient,,,,2290,1946.5,656.314,2290,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Arthroplasty Of Toe,,25000129,LOCAL,Facility,Outpatient,,,,2290,1946.5,656.314,2290,PrimeWest Health,MinnesotaCare,1176.144,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Arthroplasty Of Toe,,25000129,LOCAL,Facility,Inpatient,,,,2290,1946.5,656.314,2290,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Arthroplasty Of Toe,,25000129,LOCAL,Facility,Both,,,,2290,1946.5,656.314,2290,Sanford Health Plan,Sanford Health Plan,2106.8,92,,percent of total billed charges,,
Arthroplasty Of Toe,,25000129,LOCAL,Facility,Outpatient,,,,2290,1946.5,656.314,2290,"UCare Health, Inc.",Individual & Family Plan,1290.415,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Arthroplasty Of Toe,,25000129,LOCAL,Facility,Inpatient,,,,2290,1946.5,656.314,2290,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Arthroplasty Of Toe,,25000129,LOCAL,Facility,Outpatient,,,,2290,1946.5,656.314,2290,"UCare Health, Inc.",Medical Assistance,1155.763,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Arthroplasty Of Toe,,25000129,LOCAL,Facility,Inpatient,,,,2290,1946.5,656.314,2290,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Arthroplasty Of Toe,,25000129,LOCAL,Facility,Outpatient,,,,2290,1946.5,656.314,2290,"UCare Health, Inc.",Medicare Advantage,1155.763,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Arthroplasty Of Toe,,25000129,LOCAL,Facility,Inpatient,,,,2290,1946.5,656.314,2290,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Arthroplasty Of Toe,,25000129,LOCAL,Facility,Outpatient,,,,2290,1946.5,656.314,2290,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1155.763,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Arthroplasty Of Toe,,25000129,LOCAL,Facility,Inpatient,,,,2290,1946.5,656.314,2290,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Arthroplasty Of Toe,,25000129,LOCAL,Facility,Both,,,,2290,1946.5,656.314,2290,UnitedHealthcare,Individual & Family,2152.6,94,,percent of total billed charges,,
Arthroplasty Of Toe,,25000129,LOCAL,Facility,Outpatient,,,,2290,1946.5,656.314,2290,UnitedHealthcare,Medicare Advantage,1122.1,49,,percent of total billed charges,,
Arthroplasty Of Toe,,25000129,LOCAL,Facility,Inpatient,,,,2290,1946.5,656.314,2290,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Arthroplasty Of Toe,,25000129,LOCAL,Facility,Outpatient,,,,2290,1946.5,656.314,2290,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1099.2,48,,percent of total billed charges,,100% of DHS outpatient percentage
Arthroplasty Of Toe,,25000129,LOCAL,Facility,Inpatient,,,,2290,1946.5,656.314,2290,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Hernia Repair Inguinal Bilateral,,25000143,LOCAL,Facility,Both,,,,7140,6069,2046.324,7140,Aetna,Commercial,6568.8,92,,percent of total billed charges,,
Hernia Repair Inguinal Bilateral,,25000143,LOCAL,Facility,Outpatient,,,,7140,6069,2046.324,7140,Aetna,Medicare Advantage,3498.6,49,,percent of total billed charges,,
Hernia Repair Inguinal Bilateral,,25000143,LOCAL,Facility,Inpatient,,,,7140,6069,2046.324,7140,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Hernia Repair Inguinal Bilateral,,25000143,LOCAL,Facility,Both,,,,7140,6069,2046.324,7140,Aetna,PPO,6640.2,93,,percent of total billed charges,,
Hernia Repair Inguinal Bilateral,,25000143,LOCAL,Facility,Both,,,,7140,6069,2046.324,7140,America's PPO,America's PPO,6856.542,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Hernia Repair Inguinal Bilateral,,25000143,LOCAL,Facility,Both,,,,7140,6069,2046.324,7140,BlueCross BlueShield Minnesota, Federal Employee Program,7025.76,98.4,,percent of total billed charges,,
Hernia Repair Inguinal Bilateral,,25000143,LOCAL,Facility,Both,,,,7140,6069,2046.324,7140,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,7140,100,,percent of total billed charges,,
Hernia Repair Inguinal Bilateral,,25000143,LOCAL,Facility,Both,,,,7140,6069,2046.324,7140,BlueCross BlueShield Minnesota,High Value Network Plan,6426,90,,percent of total billed charges,,
Hernia Repair Inguinal Bilateral,,25000143,LOCAL,Facility,Outpatient,,,,7140,6069,2046.324,7140,BlueCross BlueShield Minnesota,Medicare Advantage,3498.6,49,,percent of total billed charges,,
Hernia Repair Inguinal Bilateral,,25000143,LOCAL,Facility,Inpatient,,,,7140,6069,2046.324,7140,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Hernia Repair Inguinal Bilateral,,25000143,LOCAL,Facility,Both,,,,7140,6069,2046.324,7140,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,6323.898,88.57,,percent of total billed charges,,
Hernia Repair Inguinal Bilateral,,25000143,LOCAL,Facility,Both,,,,7140,6069,2046.324,7140,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,2046.324,28.66,,percent of total billed charges,,
Hernia Repair Inguinal Bilateral,,25000143,LOCAL,Facility,Outpatient,,,,7140,6069,2046.324,7140,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),3498.6,49,,percent of total billed charges,,
Hernia Repair Inguinal Bilateral,,25000143,LOCAL,Facility,Inpatient,,,,7140,6069,2046.324,7140,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Hernia Repair Inguinal Bilateral,,25000143,LOCAL,Facility,Both,,,,7140,6069,2046.324,7140,CorVel,Worker's Compensation,7140,100,,percent of total billed charges,,
Hernia Repair Inguinal Bilateral,,25000143,LOCAL,Facility,Both,,,,7140,6069,2046.324,7140,First Health Group Corporation,First Health Network,6925.8,97,,percent of total billed charges,,
Hernia Repair Inguinal Bilateral,,25000143,LOCAL,Facility,Both,,,,7140,6069,2046.324,7140,"Health Partners, Inc.",Commercial,6754.44,94.6,,percent of total billed charges,,
Hernia Repair Inguinal Bilateral,,25000143,LOCAL,Facility,Outpatient,,,,7140,6069,2046.324,7140,"Health Partners, Inc.",Medicare Advantage,3498.6,49,,percent of total billed charges,,
Hernia Repair Inguinal Bilateral,,25000143,LOCAL,Facility,Inpatient,,,,7140,6069,2046.324,7140,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Hernia Repair Inguinal Bilateral,,25000143,LOCAL,Facility,Both,,,,7140,6069,2046.324,7140,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),4284,60,,percent of total billed charges,,
Hernia Repair Inguinal Bilateral,,25000143,LOCAL,Facility,Both,,,,7140,6069,2046.324,7140,"Health Partners, Inc.",State of Minnesota Advantage Program,5819.1,81.5,,percent of total billed charges,,
Hernia Repair Inguinal Bilateral,,25000143,LOCAL,Facility,Both,,,,7140,6069,2046.324,7140,"Health Partners, Inc.",State Public Programs,3570,50,,percent of total billed charges,,
Hernia Repair Inguinal Bilateral,,25000143,LOCAL,Facility,Both,,,,7140,6069,2046.324,7140,Humana Insurance Company,Commercial PPO,6783,95,,percent of total billed charges,,
Hernia Repair Inguinal Bilateral,,25000143,LOCAL,Facility,Outpatient,,,,7140,6069,2046.324,7140,Humana Insurance Company,Medicare PPO,3498.6,49,,percent of total billed charges,,
Hernia Repair Inguinal Bilateral,,25000143,LOCAL,Facility,Inpatient,,,,7140,6069,2046.324,7140,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Hernia Repair Inguinal Bilateral,,25000143,LOCAL,Facility,Both,,,,7140,6069,2046.324,7140,Medica,Individual & Family,7075.74,99.1,,percent of total billed charges,,
Hernia Repair Inguinal Bilateral,,25000143,LOCAL,Facility,Outpatient,,,,7140,6069,2046.324,7140,Medica,Medica Advantage Solution,3555.72,49.8,,percent of total billed charges,,
Hernia Repair Inguinal Bilateral,,25000143,LOCAL,Facility,Inpatient,,,,7140,6069,2046.324,7140,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Hernia Repair Inguinal Bilateral,,25000143,LOCAL,Facility,Outpatient,,,,7140,6069,2046.324,7140,Medica,Medical Assistance,3184.44,44.6,,percent of total billed charges,,
Hernia Repair Inguinal Bilateral,,25000143,LOCAL,Facility,Inpatient,,,,7140,6069,2046.324,7140,Medica,Medical Assistance,,,,,Included in per diem rate,
Hernia Repair Inguinal Bilateral,,25000143,LOCAL,Facility,Outpatient,,,,7140,6069,2046.324,7140,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,3555.72,49.8,,percent of total billed charges,,
Hernia Repair Inguinal Bilateral,,25000143,LOCAL,Facility,Inpatient,,,,7140,6069,2046.324,7140,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Hernia Repair Inguinal Bilateral,,25000143,LOCAL,Facility,Both,,,,7140,6069,2046.324,7140,"Multiplan, Inc.","Multiplan, Inc.",6711.6,94,,percent of total billed charges,,
Hernia Repair Inguinal Bilateral,,25000143,LOCAL,Facility,Outpatient,,,,7140,6069,2046.324,7140,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,6433.14,90.1,,percent of total billed charges,,
Hernia Repair Inguinal Bilateral,,25000143,LOCAL,Facility,Inpatient,,,,7140,6069,2046.324,7140,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Hernia Repair Inguinal Bilateral,,25000143,LOCAL,Facility,Both,,,,7140,6069,2046.324,7140,"Preferred One Administrative Services, INC.",PPO,7040.04,98.6,,percent of total billed charges,,
Hernia Repair Inguinal Bilateral,,25000143,LOCAL,Facility,Outpatient,,,,7140,6069,2046.324,7140,PrimeWest Health,Minnesota Senior Health Options (MSHO),3673.53,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Hernia Repair Inguinal Bilateral,,25000143,LOCAL,Facility,Inpatient,,,,7140,6069,2046.324,7140,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Hernia Repair Inguinal Bilateral,,25000143,LOCAL,Facility,Outpatient,,,,7140,6069,2046.324,7140,PrimeWest Health,MinnesotaCare,3667.104,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Hernia Repair Inguinal Bilateral,,25000143,LOCAL,Facility,Inpatient,,,,7140,6069,2046.324,7140,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Hernia Repair Inguinal Bilateral,,25000143,LOCAL,Facility,Both,,,,7140,6069,2046.324,7140,Sanford Health Plan,Sanford Health Plan,6568.8,92,,percent of total billed charges,,
Hernia Repair Inguinal Bilateral,,25000143,LOCAL,Facility,Outpatient,,,,7140,6069,2046.324,7140,"UCare Health, Inc.",Individual & Family Plan,4023.39,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Hernia Repair Inguinal Bilateral,,25000143,LOCAL,Facility,Inpatient,,,,7140,6069,2046.324,7140,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Hernia Repair Inguinal Bilateral,,25000143,LOCAL,Facility,Outpatient,,,,7140,6069,2046.324,7140,"UCare Health, Inc.",Medical Assistance,3603.558,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Hernia Repair Inguinal Bilateral,,25000143,LOCAL,Facility,Inpatient,,,,7140,6069,2046.324,7140,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Hernia Repair Inguinal Bilateral,,25000143,LOCAL,Facility,Outpatient,,,,7140,6069,2046.324,7140,"UCare Health, Inc.",Medicare Advantage,3603.558,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Hernia Repair Inguinal Bilateral,,25000143,LOCAL,Facility,Inpatient,,,,7140,6069,2046.324,7140,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Hernia Repair Inguinal Bilateral,,25000143,LOCAL,Facility,Outpatient,,,,7140,6069,2046.324,7140,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),3603.558,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Hernia Repair Inguinal Bilateral,,25000143,LOCAL,Facility,Inpatient,,,,7140,6069,2046.324,7140,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Hernia Repair Inguinal Bilateral,,25000143,LOCAL,Facility,Both,,,,7140,6069,2046.324,7140,UnitedHealthcare,Individual & Family,6711.6,94,,percent of total billed charges,,
Hernia Repair Inguinal Bilateral,,25000143,LOCAL,Facility,Outpatient,,,,7140,6069,2046.324,7140,UnitedHealthcare,Medicare Advantage,3498.6,49,,percent of total billed charges,,
Hernia Repair Inguinal Bilateral,,25000143,LOCAL,Facility,Inpatient,,,,7140,6069,2046.324,7140,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Hernia Repair Inguinal Bilateral,,25000143,LOCAL,Facility,Outpatient,,,,7140,6069,2046.324,7140,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,3427.2,48,,percent of total billed charges,,100% of DHS outpatient percentage
Hernia Repair Inguinal Bilateral,,25000143,LOCAL,Facility,Inpatient,,,,7140,6069,2046.324,7140,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Biopsy Of Breast (Needle),,25000155,LOCAL,Facility,Both,,,,2203,1872.55,631.3798,2203,Aetna,Commercial,2026.76,92,,percent of total billed charges,,
Biopsy Of Breast (Needle),,25000155,LOCAL,Facility,Outpatient,,,,2203,1872.55,631.3798,2203,Aetna,Medicare Advantage,1079.47,49,,percent of total billed charges,,
Biopsy Of Breast (Needle),,25000155,LOCAL,Facility,Inpatient,,,,2203,1872.55,631.3798,2203,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Biopsy Of Breast (Needle),,25000155,LOCAL,Facility,Both,,,,2203,1872.55,631.3798,2203,Aetna,PPO,2048.79,93,,percent of total billed charges,,
Biopsy Of Breast (Needle),,25000155,LOCAL,Facility,Both,,,,2203,1872.55,631.3798,2203,America's PPO,America's PPO,2115.5409,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Biopsy Of Breast (Needle),,25000155,LOCAL,Facility,Both,,,,2203,1872.55,631.3798,2203,BlueCross BlueShield Minnesota, Federal Employee Program,2167.752,98.4,,percent of total billed charges,,
Biopsy Of Breast (Needle),,25000155,LOCAL,Facility,Both,,,,2203,1872.55,631.3798,2203,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,2203,100,,percent of total billed charges,,
Biopsy Of Breast (Needle),,25000155,LOCAL,Facility,Both,,,,2203,1872.55,631.3798,2203,BlueCross BlueShield Minnesota,High Value Network Plan,1982.7,90,,percent of total billed charges,,
Biopsy Of Breast (Needle),,25000155,LOCAL,Facility,Outpatient,,,,2203,1872.55,631.3798,2203,BlueCross BlueShield Minnesota,Medicare Advantage,1079.47,49,,percent of total billed charges,,
Biopsy Of Breast (Needle),,25000155,LOCAL,Facility,Inpatient,,,,2203,1872.55,631.3798,2203,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Biopsy Of Breast (Needle),,25000155,LOCAL,Facility,Both,,,,2203,1872.55,631.3798,2203,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1951.1971,88.57,,percent of total billed charges,,
Biopsy Of Breast (Needle),,25000155,LOCAL,Facility,Both,,,,2203,1872.55,631.3798,2203,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,631.3798,28.66,,percent of total billed charges,,
Biopsy Of Breast (Needle),,25000155,LOCAL,Facility,Outpatient,,,,2203,1872.55,631.3798,2203,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1079.47,49,,percent of total billed charges,,
Biopsy Of Breast (Needle),,25000155,LOCAL,Facility,Inpatient,,,,2203,1872.55,631.3798,2203,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Biopsy Of Breast (Needle),,25000155,LOCAL,Facility,Both,,,,2203,1872.55,631.3798,2203,CorVel,Worker's Compensation,2203,100,,percent of total billed charges,,
Biopsy Of Breast (Needle),,25000155,LOCAL,Facility,Both,,,,2203,1872.55,631.3798,2203,First Health Group Corporation,First Health Network,2136.91,97,,percent of total billed charges,,
Biopsy Of Breast (Needle),,25000155,LOCAL,Facility,Both,,,,2203,1872.55,631.3798,2203,"Health Partners, Inc.",Commercial,2084.038,94.6,,percent of total billed charges,,
Biopsy Of Breast (Needle),,25000155,LOCAL,Facility,Outpatient,,,,2203,1872.55,631.3798,2203,"Health Partners, Inc.",Medicare Advantage,1079.47,49,,percent of total billed charges,,
Biopsy Of Breast (Needle),,25000155,LOCAL,Facility,Inpatient,,,,2203,1872.55,631.3798,2203,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Biopsy Of Breast (Needle),,25000155,LOCAL,Facility,Both,,,,2203,1872.55,631.3798,2203,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1321.8,60,,percent of total billed charges,,
Biopsy Of Breast (Needle),,25000155,LOCAL,Facility,Both,,,,2203,1872.55,631.3798,2203,"Health Partners, Inc.",State of Minnesota Advantage Program,1795.445,81.5,,percent of total billed charges,,
Biopsy Of Breast (Needle),,25000155,LOCAL,Facility,Both,,,,2203,1872.55,631.3798,2203,"Health Partners, Inc.",State Public Programs,1101.5,50,,percent of total billed charges,,
Biopsy Of Breast (Needle),,25000155,LOCAL,Facility,Both,,,,2203,1872.55,631.3798,2203,Humana Insurance Company,Commercial PPO,2092.85,95,,percent of total billed charges,,
Biopsy Of Breast (Needle),,25000155,LOCAL,Facility,Outpatient,,,,2203,1872.55,631.3798,2203,Humana Insurance Company,Medicare PPO,1079.47,49,,percent of total billed charges,,
Biopsy Of Breast (Needle),,25000155,LOCAL,Facility,Inpatient,,,,2203,1872.55,631.3798,2203,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Biopsy Of Breast (Needle),,25000155,LOCAL,Facility,Both,,,,2203,1872.55,631.3798,2203,Medica,Individual & Family,2183.173,99.1,,percent of total billed charges,,
Biopsy Of Breast (Needle),,25000155,LOCAL,Facility,Outpatient,,,,2203,1872.55,631.3798,2203,Medica,Medica Advantage Solution,1097.094,49.8,,percent of total billed charges,,
Biopsy Of Breast (Needle),,25000155,LOCAL,Facility,Inpatient,,,,2203,1872.55,631.3798,2203,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Biopsy Of Breast (Needle),,25000155,LOCAL,Facility,Outpatient,,,,2203,1872.55,631.3798,2203,Medica,Medical Assistance,982.538,44.6,,percent of total billed charges,,
Biopsy Of Breast (Needle),,25000155,LOCAL,Facility,Inpatient,,,,2203,1872.55,631.3798,2203,Medica,Medical Assistance,,,,,Included in per diem rate,
Biopsy Of Breast (Needle),,25000155,LOCAL,Facility,Outpatient,,,,2203,1872.55,631.3798,2203,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1097.094,49.8,,percent of total billed charges,,
Biopsy Of Breast (Needle),,25000155,LOCAL,Facility,Inpatient,,,,2203,1872.55,631.3798,2203,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Biopsy Of Breast (Needle),,25000155,LOCAL,Facility,Both,,,,2203,1872.55,631.3798,2203,"Multiplan, Inc.","Multiplan, Inc.",2070.82,94,,percent of total billed charges,,
Biopsy Of Breast (Needle),,25000155,LOCAL,Facility,Outpatient,,,,2203,1872.55,631.3798,2203,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1984.903,90.1,,percent of total billed charges,,
Biopsy Of Breast (Needle),,25000155,LOCAL,Facility,Inpatient,,,,2203,1872.55,631.3798,2203,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Biopsy Of Breast (Needle),,25000155,LOCAL,Facility,Both,,,,2203,1872.55,631.3798,2203,"Preferred One Administrative Services, INC.",PPO,2172.158,98.6,,percent of total billed charges,,
Biopsy Of Breast (Needle),,25000155,LOCAL,Facility,Outpatient,,,,2203,1872.55,631.3798,2203,PrimeWest Health,Minnesota Senior Health Options (MSHO),1133.4435,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Biopsy Of Breast (Needle),,25000155,LOCAL,Facility,Inpatient,,,,2203,1872.55,631.3798,2203,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Biopsy Of Breast (Needle),,25000155,LOCAL,Facility,Outpatient,,,,2203,1872.55,631.3798,2203,PrimeWest Health,MinnesotaCare,1131.4608,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Biopsy Of Breast (Needle),,25000155,LOCAL,Facility,Inpatient,,,,2203,1872.55,631.3798,2203,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Biopsy Of Breast (Needle),,25000155,LOCAL,Facility,Both,,,,2203,1872.55,631.3798,2203,Sanford Health Plan,Sanford Health Plan,2026.76,92,,percent of total billed charges,,
Biopsy Of Breast (Needle),,25000155,LOCAL,Facility,Outpatient,,,,2203,1872.55,631.3798,2203,"UCare Health, Inc.",Individual & Family Plan,1241.3905,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Biopsy Of Breast (Needle),,25000155,LOCAL,Facility,Inpatient,,,,2203,1872.55,631.3798,2203,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Biopsy Of Breast (Needle),,25000155,LOCAL,Facility,Outpatient,,,,2203,1872.55,631.3798,2203,"UCare Health, Inc.",Medical Assistance,1111.8541,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Biopsy Of Breast (Needle),,25000155,LOCAL,Facility,Inpatient,,,,2203,1872.55,631.3798,2203,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Biopsy Of Breast (Needle),,25000155,LOCAL,Facility,Outpatient,,,,2203,1872.55,631.3798,2203,"UCare Health, Inc.",Medicare Advantage,1111.8541,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Biopsy Of Breast (Needle),,25000155,LOCAL,Facility,Inpatient,,,,2203,1872.55,631.3798,2203,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Biopsy Of Breast (Needle),,25000155,LOCAL,Facility,Outpatient,,,,2203,1872.55,631.3798,2203,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1111.8541,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Biopsy Of Breast (Needle),,25000155,LOCAL,Facility,Inpatient,,,,2203,1872.55,631.3798,2203,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Biopsy Of Breast (Needle),,25000155,LOCAL,Facility,Both,,,,2203,1872.55,631.3798,2203,UnitedHealthcare,Individual & Family,2070.82,94,,percent of total billed charges,,
Biopsy Of Breast (Needle),,25000155,LOCAL,Facility,Outpatient,,,,2203,1872.55,631.3798,2203,UnitedHealthcare,Medicare Advantage,1079.47,49,,percent of total billed charges,,
Biopsy Of Breast (Needle),,25000155,LOCAL,Facility,Inpatient,,,,2203,1872.55,631.3798,2203,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Biopsy Of Breast (Needle),,25000155,LOCAL,Facility,Outpatient,,,,2203,1872.55,631.3798,2203,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1057.44,48,,percent of total billed charges,,100% of DHS outpatient percentage
Biopsy Of Breast (Needle),,25000155,LOCAL,Facility,Inpatient,,,,2203,1872.55,631.3798,2203,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Blepharoplasty,,25000171,LOCAL,Facility,Both,,,,1836,1560.6,526.1976,1836,Aetna,Commercial,1689.12,92,,percent of total billed charges,,
Blepharoplasty,,25000171,LOCAL,Facility,Outpatient,,,,1836,1560.6,526.1976,1836,Aetna,Medicare Advantage,899.64,49,,percent of total billed charges,,
Blepharoplasty,,25000171,LOCAL,Facility,Inpatient,,,,1836,1560.6,526.1976,1836,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Blepharoplasty,,25000171,LOCAL,Facility,Both,,,,1836,1560.6,526.1976,1836,Aetna,PPO,1707.48,93,,percent of total billed charges,,
Blepharoplasty,,25000171,LOCAL,Facility,Both,,,,1836,1560.6,526.1976,1836,America's PPO,America's PPO,1763.1108,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Blepharoplasty,,25000171,LOCAL,Facility,Both,,,,1836,1560.6,526.1976,1836,BlueCross BlueShield Minnesota, Federal Employee Program,1806.624,98.4,,percent of total billed charges,,
Blepharoplasty,,25000171,LOCAL,Facility,Both,,,,1836,1560.6,526.1976,1836,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1836,100,,percent of total billed charges,,
Blepharoplasty,,25000171,LOCAL,Facility,Both,,,,1836,1560.6,526.1976,1836,BlueCross BlueShield Minnesota,High Value Network Plan,1652.4,90,,percent of total billed charges,,
Blepharoplasty,,25000171,LOCAL,Facility,Outpatient,,,,1836,1560.6,526.1976,1836,BlueCross BlueShield Minnesota,Medicare Advantage,899.64,49,,percent of total billed charges,,
Blepharoplasty,,25000171,LOCAL,Facility,Inpatient,,,,1836,1560.6,526.1976,1836,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Blepharoplasty,,25000171,LOCAL,Facility,Both,,,,1836,1560.6,526.1976,1836,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1626.1452,88.57,,percent of total billed charges,,
Blepharoplasty,,25000171,LOCAL,Facility,Both,,,,1836,1560.6,526.1976,1836,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,526.1976,28.66,,percent of total billed charges,,
Blepharoplasty,,25000171,LOCAL,Facility,Outpatient,,,,1836,1560.6,526.1976,1836,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),899.64,49,,percent of total billed charges,,
Blepharoplasty,,25000171,LOCAL,Facility,Inpatient,,,,1836,1560.6,526.1976,1836,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Blepharoplasty,,25000171,LOCAL,Facility,Both,,,,1836,1560.6,526.1976,1836,CorVel,Worker's Compensation,1836,100,,percent of total billed charges,,
Blepharoplasty,,25000171,LOCAL,Facility,Both,,,,1836,1560.6,526.1976,1836,First Health Group Corporation,First Health Network,1780.92,97,,percent of total billed charges,,
Blepharoplasty,,25000171,LOCAL,Facility,Both,,,,1836,1560.6,526.1976,1836,"Health Partners, Inc.",Commercial,1736.856,94.6,,percent of total billed charges,,
Blepharoplasty,,25000171,LOCAL,Facility,Outpatient,,,,1836,1560.6,526.1976,1836,"Health Partners, Inc.",Medicare Advantage,899.64,49,,percent of total billed charges,,
Blepharoplasty,,25000171,LOCAL,Facility,Inpatient,,,,1836,1560.6,526.1976,1836,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Blepharoplasty,,25000171,LOCAL,Facility,Both,,,,1836,1560.6,526.1976,1836,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1101.6,60,,percent of total billed charges,,
Blepharoplasty,,25000171,LOCAL,Facility,Both,,,,1836,1560.6,526.1976,1836,"Health Partners, Inc.",State of Minnesota Advantage Program,1496.34,81.5,,percent of total billed charges,,
Blepharoplasty,,25000171,LOCAL,Facility,Both,,,,1836,1560.6,526.1976,1836,"Health Partners, Inc.",State Public Programs,918,50,,percent of total billed charges,,
Blepharoplasty,,25000171,LOCAL,Facility,Both,,,,1836,1560.6,526.1976,1836,Humana Insurance Company,Commercial PPO,1744.2,95,,percent of total billed charges,,
Blepharoplasty,,25000171,LOCAL,Facility,Outpatient,,,,1836,1560.6,526.1976,1836,Humana Insurance Company,Medicare PPO,899.64,49,,percent of total billed charges,,
Blepharoplasty,,25000171,LOCAL,Facility,Inpatient,,,,1836,1560.6,526.1976,1836,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Blepharoplasty,,25000171,LOCAL,Facility,Both,,,,1836,1560.6,526.1976,1836,Medica,Individual & Family,1819.476,99.1,,percent of total billed charges,,
Blepharoplasty,,25000171,LOCAL,Facility,Outpatient,,,,1836,1560.6,526.1976,1836,Medica,Medica Advantage Solution,914.328,49.8,,percent of total billed charges,,
Blepharoplasty,,25000171,LOCAL,Facility,Inpatient,,,,1836,1560.6,526.1976,1836,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Blepharoplasty,,25000171,LOCAL,Facility,Outpatient,,,,1836,1560.6,526.1976,1836,Medica,Medical Assistance,818.856,44.6,,percent of total billed charges,,
Blepharoplasty,,25000171,LOCAL,Facility,Inpatient,,,,1836,1560.6,526.1976,1836,Medica,Medical Assistance,,,,,Included in per diem rate,
Blepharoplasty,,25000171,LOCAL,Facility,Outpatient,,,,1836,1560.6,526.1976,1836,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,914.328,49.8,,percent of total billed charges,,
Blepharoplasty,,25000171,LOCAL,Facility,Inpatient,,,,1836,1560.6,526.1976,1836,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Blepharoplasty,,25000171,LOCAL,Facility,Both,,,,1836,1560.6,526.1976,1836,"Multiplan, Inc.","Multiplan, Inc.",1725.84,94,,percent of total billed charges,,
Blepharoplasty,,25000171,LOCAL,Facility,Outpatient,,,,1836,1560.6,526.1976,1836,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1654.236,90.1,,percent of total billed charges,,
Blepharoplasty,,25000171,LOCAL,Facility,Inpatient,,,,1836,1560.6,526.1976,1836,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Blepharoplasty,,25000171,LOCAL,Facility,Both,,,,1836,1560.6,526.1976,1836,"Preferred One Administrative Services, INC.",PPO,1810.296,98.6,,percent of total billed charges,,
Blepharoplasty,,25000171,LOCAL,Facility,Outpatient,,,,1836,1560.6,526.1976,1836,PrimeWest Health,Minnesota Senior Health Options (MSHO),944.622,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Blepharoplasty,,25000171,LOCAL,Facility,Inpatient,,,,1836,1560.6,526.1976,1836,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Blepharoplasty,,25000171,LOCAL,Facility,Outpatient,,,,1836,1560.6,526.1976,1836,PrimeWest Health,MinnesotaCare,942.9696,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Blepharoplasty,,25000171,LOCAL,Facility,Inpatient,,,,1836,1560.6,526.1976,1836,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Blepharoplasty,,25000171,LOCAL,Facility,Both,,,,1836,1560.6,526.1976,1836,Sanford Health Plan,Sanford Health Plan,1689.12,92,,percent of total billed charges,,
Blepharoplasty,,25000171,LOCAL,Facility,Outpatient,,,,1836,1560.6,526.1976,1836,"UCare Health, Inc.",Individual & Family Plan,1034.586,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Blepharoplasty,,25000171,LOCAL,Facility,Inpatient,,,,1836,1560.6,526.1976,1836,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Blepharoplasty,,25000171,LOCAL,Facility,Outpatient,,,,1836,1560.6,526.1976,1836,"UCare Health, Inc.",Medical Assistance,926.6292,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Blepharoplasty,,25000171,LOCAL,Facility,Inpatient,,,,1836,1560.6,526.1976,1836,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Blepharoplasty,,25000171,LOCAL,Facility,Outpatient,,,,1836,1560.6,526.1976,1836,"UCare Health, Inc.",Medicare Advantage,926.6292,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Blepharoplasty,,25000171,LOCAL,Facility,Inpatient,,,,1836,1560.6,526.1976,1836,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Blepharoplasty,,25000171,LOCAL,Facility,Outpatient,,,,1836,1560.6,526.1976,1836,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),926.6292,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Blepharoplasty,,25000171,LOCAL,Facility,Inpatient,,,,1836,1560.6,526.1976,1836,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Blepharoplasty,,25000171,LOCAL,Facility,Both,,,,1836,1560.6,526.1976,1836,UnitedHealthcare,Individual & Family,1725.84,94,,percent of total billed charges,,
Blepharoplasty,,25000171,LOCAL,Facility,Outpatient,,,,1836,1560.6,526.1976,1836,UnitedHealthcare,Medicare Advantage,899.64,49,,percent of total billed charges,,
Blepharoplasty,,25000171,LOCAL,Facility,Inpatient,,,,1836,1560.6,526.1976,1836,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Blepharoplasty,,25000171,LOCAL,Facility,Outpatient,,,,1836,1560.6,526.1976,1836,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,881.28,48,,percent of total billed charges,,100% of DHS outpatient percentage
Blepharoplasty,,25000171,LOCAL,Facility,Inpatient,,,,1836,1560.6,526.1976,1836,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Bone Marrow Aspiration,,25000192,LOCAL,Facility,Both,,,,742,630.7,212.6572,742,Aetna,Commercial,682.64,92,,percent of total billed charges,,
Bone Marrow Aspiration,,25000192,LOCAL,Facility,Outpatient,,,,742,630.7,212.6572,742,Aetna,Medicare Advantage,363.58,49,,percent of total billed charges,,
Bone Marrow Aspiration,,25000192,LOCAL,Facility,Inpatient,,,,742,630.7,212.6572,742,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Bone Marrow Aspiration,,25000192,LOCAL,Facility,Both,,,,742,630.7,212.6572,742,Aetna,PPO,690.06,93,,percent of total billed charges,,
Bone Marrow Aspiration,,25000192,LOCAL,Facility,Both,,,,742,630.7,212.6572,742,America's PPO,America's PPO,712.5426,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Bone Marrow Aspiration,,25000192,LOCAL,Facility,Both,,,,742,630.7,212.6572,742,BlueCross BlueShield Minnesota, Federal Employee Program,730.128,98.4,,percent of total billed charges,,
Bone Marrow Aspiration,,25000192,LOCAL,Facility,Both,,,,742,630.7,212.6572,742,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,742,100,,percent of total billed charges,,
Bone Marrow Aspiration,,25000192,LOCAL,Facility,Both,,,,742,630.7,212.6572,742,BlueCross BlueShield Minnesota,High Value Network Plan,667.8,90,,percent of total billed charges,,
Bone Marrow Aspiration,,25000192,LOCAL,Facility,Outpatient,,,,742,630.7,212.6572,742,BlueCross BlueShield Minnesota,Medicare Advantage,363.58,49,,percent of total billed charges,,
Bone Marrow Aspiration,,25000192,LOCAL,Facility,Inpatient,,,,742,630.7,212.6572,742,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Bone Marrow Aspiration,,25000192,LOCAL,Facility,Both,,,,742,630.7,212.6572,742,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,657.1894,88.57,,percent of total billed charges,,
Bone Marrow Aspiration,,25000192,LOCAL,Facility,Both,,,,742,630.7,212.6572,742,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,212.6572,28.66,,percent of total billed charges,,
Bone Marrow Aspiration,,25000192,LOCAL,Facility,Outpatient,,,,742,630.7,212.6572,742,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),363.58,49,,percent of total billed charges,,
Bone Marrow Aspiration,,25000192,LOCAL,Facility,Inpatient,,,,742,630.7,212.6572,742,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Bone Marrow Aspiration,,25000192,LOCAL,Facility,Both,,,,742,630.7,212.6572,742,CorVel,Worker's Compensation,742,100,,percent of total billed charges,,
Bone Marrow Aspiration,,25000192,LOCAL,Facility,Both,,,,742,630.7,212.6572,742,First Health Group Corporation,First Health Network,719.74,97,,percent of total billed charges,,
Bone Marrow Aspiration,,25000192,LOCAL,Facility,Both,,,,742,630.7,212.6572,742,"Health Partners, Inc.",Commercial,701.932,94.6,,percent of total billed charges,,
Bone Marrow Aspiration,,25000192,LOCAL,Facility,Outpatient,,,,742,630.7,212.6572,742,"Health Partners, Inc.",Medicare Advantage,363.58,49,,percent of total billed charges,,
Bone Marrow Aspiration,,25000192,LOCAL,Facility,Inpatient,,,,742,630.7,212.6572,742,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Bone Marrow Aspiration,,25000192,LOCAL,Facility,Both,,,,742,630.7,212.6572,742,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),445.2,60,,percent of total billed charges,,
Bone Marrow Aspiration,,25000192,LOCAL,Facility,Both,,,,742,630.7,212.6572,742,"Health Partners, Inc.",State of Minnesota Advantage Program,604.73,81.5,,percent of total billed charges,,
Bone Marrow Aspiration,,25000192,LOCAL,Facility,Both,,,,742,630.7,212.6572,742,"Health Partners, Inc.",State Public Programs,371,50,,percent of total billed charges,,
Bone Marrow Aspiration,,25000192,LOCAL,Facility,Both,,,,742,630.7,212.6572,742,Humana Insurance Company,Commercial PPO,704.9,95,,percent of total billed charges,,
Bone Marrow Aspiration,,25000192,LOCAL,Facility,Outpatient,,,,742,630.7,212.6572,742,Humana Insurance Company,Medicare PPO,363.58,49,,percent of total billed charges,,
Bone Marrow Aspiration,,25000192,LOCAL,Facility,Inpatient,,,,742,630.7,212.6572,742,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Bone Marrow Aspiration,,25000192,LOCAL,Facility,Both,,,,742,630.7,212.6572,742,Medica,Individual & Family,735.322,99.1,,percent of total billed charges,,
Bone Marrow Aspiration,,25000192,LOCAL,Facility,Outpatient,,,,742,630.7,212.6572,742,Medica,Medica Advantage Solution,369.516,49.8,,percent of total billed charges,,
Bone Marrow Aspiration,,25000192,LOCAL,Facility,Inpatient,,,,742,630.7,212.6572,742,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Bone Marrow Aspiration,,25000192,LOCAL,Facility,Outpatient,,,,742,630.7,212.6572,742,Medica,Medical Assistance,330.932,44.6,,percent of total billed charges,,
Bone Marrow Aspiration,,25000192,LOCAL,Facility,Inpatient,,,,742,630.7,212.6572,742,Medica,Medical Assistance,,,,,Included in per diem rate,
Bone Marrow Aspiration,,25000192,LOCAL,Facility,Outpatient,,,,742,630.7,212.6572,742,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,369.516,49.8,,percent of total billed charges,,
Bone Marrow Aspiration,,25000192,LOCAL,Facility,Inpatient,,,,742,630.7,212.6572,742,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Bone Marrow Aspiration,,25000192,LOCAL,Facility,Both,,,,742,630.7,212.6572,742,"Multiplan, Inc.","Multiplan, Inc.",697.48,94,,percent of total billed charges,,
Bone Marrow Aspiration,,25000192,LOCAL,Facility,Outpatient,,,,742,630.7,212.6572,742,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,668.542,90.1,,percent of total billed charges,,
Bone Marrow Aspiration,,25000192,LOCAL,Facility,Inpatient,,,,742,630.7,212.6572,742,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Bone Marrow Aspiration,,25000192,LOCAL,Facility,Both,,,,742,630.7,212.6572,742,"Preferred One Administrative Services, INC.",PPO,731.612,98.6,,percent of total billed charges,,
Bone Marrow Aspiration,,25000192,LOCAL,Facility,Outpatient,,,,742,630.7,212.6572,742,PrimeWest Health,Minnesota Senior Health Options (MSHO),381.759,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Bone Marrow Aspiration,,25000192,LOCAL,Facility,Inpatient,,,,742,630.7,212.6572,742,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Bone Marrow Aspiration,,25000192,LOCAL,Facility,Outpatient,,,,742,630.7,212.6572,742,PrimeWest Health,MinnesotaCare,381.0912,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Bone Marrow Aspiration,,25000192,LOCAL,Facility,Inpatient,,,,742,630.7,212.6572,742,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Bone Marrow Aspiration,,25000192,LOCAL,Facility,Both,,,,742,630.7,212.6572,742,Sanford Health Plan,Sanford Health Plan,682.64,92,,percent of total billed charges,,
Bone Marrow Aspiration,,25000192,LOCAL,Facility,Outpatient,,,,742,630.7,212.6572,742,"UCare Health, Inc.",Individual & Family Plan,418.117,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Bone Marrow Aspiration,,25000192,LOCAL,Facility,Inpatient,,,,742,630.7,212.6572,742,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Bone Marrow Aspiration,,25000192,LOCAL,Facility,Outpatient,,,,742,630.7,212.6572,742,"UCare Health, Inc.",Medical Assistance,374.4874,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Bone Marrow Aspiration,,25000192,LOCAL,Facility,Inpatient,,,,742,630.7,212.6572,742,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Bone Marrow Aspiration,,25000192,LOCAL,Facility,Outpatient,,,,742,630.7,212.6572,742,"UCare Health, Inc.",Medicare Advantage,374.4874,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Bone Marrow Aspiration,,25000192,LOCAL,Facility,Inpatient,,,,742,630.7,212.6572,742,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Bone Marrow Aspiration,,25000192,LOCAL,Facility,Outpatient,,,,742,630.7,212.6572,742,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),374.4874,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Bone Marrow Aspiration,,25000192,LOCAL,Facility,Inpatient,,,,742,630.7,212.6572,742,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Bone Marrow Aspiration,,25000192,LOCAL,Facility,Both,,,,742,630.7,212.6572,742,UnitedHealthcare,Individual & Family,697.48,94,,percent of total billed charges,,
Bone Marrow Aspiration,,25000192,LOCAL,Facility,Outpatient,,,,742,630.7,212.6572,742,UnitedHealthcare,Medicare Advantage,363.58,49,,percent of total billed charges,,
Bone Marrow Aspiration,,25000192,LOCAL,Facility,Inpatient,,,,742,630.7,212.6572,742,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Bone Marrow Aspiration,,25000192,LOCAL,Facility,Outpatient,,,,742,630.7,212.6572,742,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,356.16,48,,percent of total billed charges,,100% of DHS outpatient percentage
Bone Marrow Aspiration,,25000192,LOCAL,Facility,Inpatient,,,,742,630.7,212.6572,742,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Breast Biopsy (Excision),,25000219,LOCAL,Facility,Both,,,,765,650.25,219.249,765,Aetna,Commercial,703.8,92,,percent of total billed charges,,
Breast Biopsy (Excision),,25000219,LOCAL,Facility,Outpatient,,,,765,650.25,219.249,765,Aetna,Medicare Advantage,374.85,49,,percent of total billed charges,,
Breast Biopsy (Excision),,25000219,LOCAL,Facility,Inpatient,,,,765,650.25,219.249,765,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Breast Biopsy (Excision),,25000219,LOCAL,Facility,Both,,,,765,650.25,219.249,765,Aetna,PPO,711.45,93,,percent of total billed charges,,
Breast Biopsy (Excision),,25000219,LOCAL,Facility,Both,,,,765,650.25,219.249,765,America's PPO,America's PPO,734.6295,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Breast Biopsy (Excision),,25000219,LOCAL,Facility,Both,,,,765,650.25,219.249,765,BlueCross BlueShield Minnesota, Federal Employee Program,752.76,98.4,,percent of total billed charges,,
Breast Biopsy (Excision),,25000219,LOCAL,Facility,Both,,,,765,650.25,219.249,765,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,765,100,,percent of total billed charges,,
Breast Biopsy (Excision),,25000219,LOCAL,Facility,Both,,,,765,650.25,219.249,765,BlueCross BlueShield Minnesota,High Value Network Plan,688.5,90,,percent of total billed charges,,
Breast Biopsy (Excision),,25000219,LOCAL,Facility,Outpatient,,,,765,650.25,219.249,765,BlueCross BlueShield Minnesota,Medicare Advantage,374.85,49,,percent of total billed charges,,
Breast Biopsy (Excision),,25000219,LOCAL,Facility,Inpatient,,,,765,650.25,219.249,765,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Breast Biopsy (Excision),,25000219,LOCAL,Facility,Both,,,,765,650.25,219.249,765,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,677.5605,88.57,,percent of total billed charges,,
Breast Biopsy (Excision),,25000219,LOCAL,Facility,Both,,,,765,650.25,219.249,765,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,219.249,28.66,,percent of total billed charges,,
Breast Biopsy (Excision),,25000219,LOCAL,Facility,Outpatient,,,,765,650.25,219.249,765,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),374.85,49,,percent of total billed charges,,
Breast Biopsy (Excision),,25000219,LOCAL,Facility,Inpatient,,,,765,650.25,219.249,765,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Breast Biopsy (Excision),,25000219,LOCAL,Facility,Both,,,,765,650.25,219.249,765,CorVel,Worker's Compensation,765,100,,percent of total billed charges,,
Breast Biopsy (Excision),,25000219,LOCAL,Facility,Both,,,,765,650.25,219.249,765,First Health Group Corporation,First Health Network,742.05,97,,percent of total billed charges,,
Breast Biopsy (Excision),,25000219,LOCAL,Facility,Both,,,,765,650.25,219.249,765,"Health Partners, Inc.",Commercial,723.69,94.6,,percent of total billed charges,,
Breast Biopsy (Excision),,25000219,LOCAL,Facility,Outpatient,,,,765,650.25,219.249,765,"Health Partners, Inc.",Medicare Advantage,374.85,49,,percent of total billed charges,,
Breast Biopsy (Excision),,25000219,LOCAL,Facility,Inpatient,,,,765,650.25,219.249,765,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Breast Biopsy (Excision),,25000219,LOCAL,Facility,Both,,,,765,650.25,219.249,765,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),459,60,,percent of total billed charges,,
Breast Biopsy (Excision),,25000219,LOCAL,Facility,Both,,,,765,650.25,219.249,765,"Health Partners, Inc.",State of Minnesota Advantage Program,623.475,81.5,,percent of total billed charges,,
Breast Biopsy (Excision),,25000219,LOCAL,Facility,Both,,,,765,650.25,219.249,765,"Health Partners, Inc.",State Public Programs,382.5,50,,percent of total billed charges,,
Breast Biopsy (Excision),,25000219,LOCAL,Facility,Both,,,,765,650.25,219.249,765,Humana Insurance Company,Commercial PPO,726.75,95,,percent of total billed charges,,
Breast Biopsy (Excision),,25000219,LOCAL,Facility,Outpatient,,,,765,650.25,219.249,765,Humana Insurance Company,Medicare PPO,374.85,49,,percent of total billed charges,,
Breast Biopsy (Excision),,25000219,LOCAL,Facility,Inpatient,,,,765,650.25,219.249,765,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Breast Biopsy (Excision),,25000219,LOCAL,Facility,Both,,,,765,650.25,219.249,765,Medica,Individual & Family,758.115,99.1,,percent of total billed charges,,
Breast Biopsy (Excision),,25000219,LOCAL,Facility,Outpatient,,,,765,650.25,219.249,765,Medica,Medica Advantage Solution,380.97,49.8,,percent of total billed charges,,
Breast Biopsy (Excision),,25000219,LOCAL,Facility,Inpatient,,,,765,650.25,219.249,765,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Breast Biopsy (Excision),,25000219,LOCAL,Facility,Outpatient,,,,765,650.25,219.249,765,Medica,Medical Assistance,341.19,44.6,,percent of total billed charges,,
Breast Biopsy (Excision),,25000219,LOCAL,Facility,Inpatient,,,,765,650.25,219.249,765,Medica,Medical Assistance,,,,,Included in per diem rate,
Breast Biopsy (Excision),,25000219,LOCAL,Facility,Outpatient,,,,765,650.25,219.249,765,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,380.97,49.8,,percent of total billed charges,,
Breast Biopsy (Excision),,25000219,LOCAL,Facility,Inpatient,,,,765,650.25,219.249,765,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Breast Biopsy (Excision),,25000219,LOCAL,Facility,Both,,,,765,650.25,219.249,765,"Multiplan, Inc.","Multiplan, Inc.",719.1,94,,percent of total billed charges,,
Breast Biopsy (Excision),,25000219,LOCAL,Facility,Outpatient,,,,765,650.25,219.249,765,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,689.265,90.1,,percent of total billed charges,,
Breast Biopsy (Excision),,25000219,LOCAL,Facility,Inpatient,,,,765,650.25,219.249,765,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Breast Biopsy (Excision),,25000219,LOCAL,Facility,Both,,,,765,650.25,219.249,765,"Preferred One Administrative Services, INC.",PPO,754.29,98.6,,percent of total billed charges,,
Breast Biopsy (Excision),,25000219,LOCAL,Facility,Outpatient,,,,765,650.25,219.249,765,PrimeWest Health,Minnesota Senior Health Options (MSHO),393.5925,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Breast Biopsy (Excision),,25000219,LOCAL,Facility,Inpatient,,,,765,650.25,219.249,765,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Breast Biopsy (Excision),,25000219,LOCAL,Facility,Outpatient,,,,765,650.25,219.249,765,PrimeWest Health,MinnesotaCare,392.904,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Breast Biopsy (Excision),,25000219,LOCAL,Facility,Inpatient,,,,765,650.25,219.249,765,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Breast Biopsy (Excision),,25000219,LOCAL,Facility,Both,,,,765,650.25,219.249,765,Sanford Health Plan,Sanford Health Plan,703.8,92,,percent of total billed charges,,
Breast Biopsy (Excision),,25000219,LOCAL,Facility,Outpatient,,,,765,650.25,219.249,765,"UCare Health, Inc.",Individual & Family Plan,431.0775,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Breast Biopsy (Excision),,25000219,LOCAL,Facility,Inpatient,,,,765,650.25,219.249,765,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Breast Biopsy (Excision),,25000219,LOCAL,Facility,Outpatient,,,,765,650.25,219.249,765,"UCare Health, Inc.",Medical Assistance,386.0955,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Breast Biopsy (Excision),,25000219,LOCAL,Facility,Inpatient,,,,765,650.25,219.249,765,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Breast Biopsy (Excision),,25000219,LOCAL,Facility,Outpatient,,,,765,650.25,219.249,765,"UCare Health, Inc.",Medicare Advantage,386.0955,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Breast Biopsy (Excision),,25000219,LOCAL,Facility,Inpatient,,,,765,650.25,219.249,765,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Breast Biopsy (Excision),,25000219,LOCAL,Facility,Outpatient,,,,765,650.25,219.249,765,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),386.0955,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Breast Biopsy (Excision),,25000219,LOCAL,Facility,Inpatient,,,,765,650.25,219.249,765,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Breast Biopsy (Excision),,25000219,LOCAL,Facility,Both,,,,765,650.25,219.249,765,UnitedHealthcare,Individual & Family,719.1,94,,percent of total billed charges,,
Breast Biopsy (Excision),,25000219,LOCAL,Facility,Outpatient,,,,765,650.25,219.249,765,UnitedHealthcare,Medicare Advantage,374.85,49,,percent of total billed charges,,
Breast Biopsy (Excision),,25000219,LOCAL,Facility,Inpatient,,,,765,650.25,219.249,765,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Breast Biopsy (Excision),,25000219,LOCAL,Facility,Outpatient,,,,765,650.25,219.249,765,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,367.2,48,,percent of total billed charges,,100% of DHS outpatient percentage
Breast Biopsy (Excision),,25000219,LOCAL,Facility,Inpatient,,,,765,650.25,219.249,765,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Carpal Tunnel Release,,25000270,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,Aetna,Commercial,2064.48,92,,percent of total billed charges,,
Carpal Tunnel Release,,25000270,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,Aetna,Medicare Advantage,1099.56,49,,percent of total billed charges,,
Carpal Tunnel Release,,25000270,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Carpal Tunnel Release,,25000270,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,Aetna,PPO,2086.92,93,,percent of total billed charges,,
Carpal Tunnel Release,,25000270,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,America's PPO,America's PPO,2154.9132,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Carpal Tunnel Release,,25000270,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,BlueCross BlueShield Minnesota, Federal Employee Program,2208.096,98.4,,percent of total billed charges,,
Carpal Tunnel Release,,25000270,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,2244,100,,percent of total billed charges,,
Carpal Tunnel Release,,25000270,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,BlueCross BlueShield Minnesota,High Value Network Plan,2019.6,90,,percent of total billed charges,,
Carpal Tunnel Release,,25000270,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,BlueCross BlueShield Minnesota,Medicare Advantage,1099.56,49,,percent of total billed charges,,
Carpal Tunnel Release,,25000270,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Carpal Tunnel Release,,25000270,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1987.5108,88.57,,percent of total billed charges,,
Carpal Tunnel Release,,25000270,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,643.1304,28.66,,percent of total billed charges,,
Carpal Tunnel Release,,25000270,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1099.56,49,,percent of total billed charges,,
Carpal Tunnel Release,,25000270,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Carpal Tunnel Release,,25000270,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,CorVel,Worker's Compensation,2244,100,,percent of total billed charges,,
Carpal Tunnel Release,,25000270,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,First Health Group Corporation,First Health Network,2176.68,97,,percent of total billed charges,,
Carpal Tunnel Release,,25000270,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,"Health Partners, Inc.",Commercial,2122.824,94.6,,percent of total billed charges,,
Carpal Tunnel Release,,25000270,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,"Health Partners, Inc.",Medicare Advantage,1099.56,49,,percent of total billed charges,,
Carpal Tunnel Release,,25000270,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Carpal Tunnel Release,,25000270,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1346.4,60,,percent of total billed charges,,
Carpal Tunnel Release,,25000270,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,"Health Partners, Inc.",State of Minnesota Advantage Program,1828.86,81.5,,percent of total billed charges,,
Carpal Tunnel Release,,25000270,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,"Health Partners, Inc.",State Public Programs,1122,50,,percent of total billed charges,,
Carpal Tunnel Release,,25000270,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,Humana Insurance Company,Commercial PPO,2131.8,95,,percent of total billed charges,,
Carpal Tunnel Release,,25000270,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,Humana Insurance Company,Medicare PPO,1099.56,49,,percent of total billed charges,,
Carpal Tunnel Release,,25000270,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Carpal Tunnel Release,,25000270,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,Medica,Individual & Family,2223.804,99.1,,percent of total billed charges,,
Carpal Tunnel Release,,25000270,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,Medica,Medica Advantage Solution,1117.512,49.8,,percent of total billed charges,,
Carpal Tunnel Release,,25000270,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Carpal Tunnel Release,,25000270,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,Medica,Medical Assistance,1000.824,44.6,,percent of total billed charges,,
Carpal Tunnel Release,,25000270,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,Medica,Medical Assistance,,,,,Included in per diem rate,
Carpal Tunnel Release,,25000270,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1117.512,49.8,,percent of total billed charges,,
Carpal Tunnel Release,,25000270,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Carpal Tunnel Release,,25000270,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,"Multiplan, Inc.","Multiplan, Inc.",2109.36,94,,percent of total billed charges,,
Carpal Tunnel Release,,25000270,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,2021.844,90.1,,percent of total billed charges,,
Carpal Tunnel Release,,25000270,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Carpal Tunnel Release,,25000270,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,"Preferred One Administrative Services, INC.",PPO,2212.584,98.6,,percent of total billed charges,,
Carpal Tunnel Release,,25000270,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,PrimeWest Health,Minnesota Senior Health Options (MSHO),1154.538,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Carpal Tunnel Release,,25000270,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Carpal Tunnel Release,,25000270,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,PrimeWest Health,MinnesotaCare,1152.5184,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Carpal Tunnel Release,,25000270,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Carpal Tunnel Release,,25000270,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,Sanford Health Plan,Sanford Health Plan,2064.48,92,,percent of total billed charges,,
Carpal Tunnel Release,,25000270,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,"UCare Health, Inc.",Individual & Family Plan,1264.494,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Carpal Tunnel Release,,25000270,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Carpal Tunnel Release,,25000270,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,"UCare Health, Inc.",Medical Assistance,1132.5468,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Carpal Tunnel Release,,25000270,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Carpal Tunnel Release,,25000270,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,"UCare Health, Inc.",Medicare Advantage,1132.5468,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Carpal Tunnel Release,,25000270,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Carpal Tunnel Release,,25000270,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1132.5468,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Carpal Tunnel Release,,25000270,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Carpal Tunnel Release,,25000270,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,UnitedHealthcare,Individual & Family,2109.36,94,,percent of total billed charges,,
Carpal Tunnel Release,,25000270,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,UnitedHealthcare,Medicare Advantage,1099.56,49,,percent of total billed charges,,
Carpal Tunnel Release,,25000270,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Carpal Tunnel Release,,25000270,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1077.12,48,,percent of total billed charges,,100% of DHS outpatient percentage
Carpal Tunnel Release,,25000270,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Cataract Extraction W Iol,,25000291,LOCAL,Facility,Both,,,,1836,1560.6,526.1976,1836,Aetna,Commercial,1689.12,92,,percent of total billed charges,,
Cataract Extraction W Iol,,25000291,LOCAL,Facility,Outpatient,,,,1836,1560.6,526.1976,1836,Aetna,Medicare Advantage,899.64,49,,percent of total billed charges,,
Cataract Extraction W Iol,,25000291,LOCAL,Facility,Inpatient,,,,1836,1560.6,526.1976,1836,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Cataract Extraction W Iol,,25000291,LOCAL,Facility,Both,,,,1836,1560.6,526.1976,1836,Aetna,PPO,1707.48,93,,percent of total billed charges,,
Cataract Extraction W Iol,,25000291,LOCAL,Facility,Both,,,,1836,1560.6,526.1976,1836,America's PPO,America's PPO,1763.1108,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Cataract Extraction W Iol,,25000291,LOCAL,Facility,Both,,,,1836,1560.6,526.1976,1836,BlueCross BlueShield Minnesota, Federal Employee Program,1806.624,98.4,,percent of total billed charges,,
Cataract Extraction W Iol,,25000291,LOCAL,Facility,Both,,,,1836,1560.6,526.1976,1836,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1836,100,,percent of total billed charges,,
Cataract Extraction W Iol,,25000291,LOCAL,Facility,Both,,,,1836,1560.6,526.1976,1836,BlueCross BlueShield Minnesota,High Value Network Plan,1652.4,90,,percent of total billed charges,,
Cataract Extraction W Iol,,25000291,LOCAL,Facility,Outpatient,,,,1836,1560.6,526.1976,1836,BlueCross BlueShield Minnesota,Medicare Advantage,899.64,49,,percent of total billed charges,,
Cataract Extraction W Iol,,25000291,LOCAL,Facility,Inpatient,,,,1836,1560.6,526.1976,1836,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Cataract Extraction W Iol,,25000291,LOCAL,Facility,Both,,,,1836,1560.6,526.1976,1836,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1626.1452,88.57,,percent of total billed charges,,
Cataract Extraction W Iol,,25000291,LOCAL,Facility,Both,,,,1836,1560.6,526.1976,1836,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,526.1976,28.66,,percent of total billed charges,,
Cataract Extraction W Iol,,25000291,LOCAL,Facility,Outpatient,,,,1836,1560.6,526.1976,1836,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),899.64,49,,percent of total billed charges,,
Cataract Extraction W Iol,,25000291,LOCAL,Facility,Inpatient,,,,1836,1560.6,526.1976,1836,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Cataract Extraction W Iol,,25000291,LOCAL,Facility,Both,,,,1836,1560.6,526.1976,1836,CorVel,Worker's Compensation,1836,100,,percent of total billed charges,,
Cataract Extraction W Iol,,25000291,LOCAL,Facility,Both,,,,1836,1560.6,526.1976,1836,First Health Group Corporation,First Health Network,1780.92,97,,percent of total billed charges,,
Cataract Extraction W Iol,,25000291,LOCAL,Facility,Both,,,,1836,1560.6,526.1976,1836,"Health Partners, Inc.",Commercial,1736.856,94.6,,percent of total billed charges,,
Cataract Extraction W Iol,,25000291,LOCAL,Facility,Outpatient,,,,1836,1560.6,526.1976,1836,"Health Partners, Inc.",Medicare Advantage,899.64,49,,percent of total billed charges,,
Cataract Extraction W Iol,,25000291,LOCAL,Facility,Inpatient,,,,1836,1560.6,526.1976,1836,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Cataract Extraction W Iol,,25000291,LOCAL,Facility,Both,,,,1836,1560.6,526.1976,1836,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1101.6,60,,percent of total billed charges,,
Cataract Extraction W Iol,,25000291,LOCAL,Facility,Both,,,,1836,1560.6,526.1976,1836,"Health Partners, Inc.",State of Minnesota Advantage Program,1496.34,81.5,,percent of total billed charges,,
Cataract Extraction W Iol,,25000291,LOCAL,Facility,Both,,,,1836,1560.6,526.1976,1836,"Health Partners, Inc.",State Public Programs,918,50,,percent of total billed charges,,
Cataract Extraction W Iol,,25000291,LOCAL,Facility,Both,,,,1836,1560.6,526.1976,1836,Humana Insurance Company,Commercial PPO,1744.2,95,,percent of total billed charges,,
Cataract Extraction W Iol,,25000291,LOCAL,Facility,Outpatient,,,,1836,1560.6,526.1976,1836,Humana Insurance Company,Medicare PPO,899.64,49,,percent of total billed charges,,
Cataract Extraction W Iol,,25000291,LOCAL,Facility,Inpatient,,,,1836,1560.6,526.1976,1836,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Cataract Extraction W Iol,,25000291,LOCAL,Facility,Both,,,,1836,1560.6,526.1976,1836,Medica,Individual & Family,1819.476,99.1,,percent of total billed charges,,
Cataract Extraction W Iol,,25000291,LOCAL,Facility,Outpatient,,,,1836,1560.6,526.1976,1836,Medica,Medica Advantage Solution,914.328,49.8,,percent of total billed charges,,
Cataract Extraction W Iol,,25000291,LOCAL,Facility,Inpatient,,,,1836,1560.6,526.1976,1836,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Cataract Extraction W Iol,,25000291,LOCAL,Facility,Outpatient,,,,1836,1560.6,526.1976,1836,Medica,Medical Assistance,818.856,44.6,,percent of total billed charges,,
Cataract Extraction W Iol,,25000291,LOCAL,Facility,Inpatient,,,,1836,1560.6,526.1976,1836,Medica,Medical Assistance,,,,,Included in per diem rate,
Cataract Extraction W Iol,,25000291,LOCAL,Facility,Outpatient,,,,1836,1560.6,526.1976,1836,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,914.328,49.8,,percent of total billed charges,,
Cataract Extraction W Iol,,25000291,LOCAL,Facility,Inpatient,,,,1836,1560.6,526.1976,1836,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Cataract Extraction W Iol,,25000291,LOCAL,Facility,Both,,,,1836,1560.6,526.1976,1836,"Multiplan, Inc.","Multiplan, Inc.",1725.84,94,,percent of total billed charges,,
Cataract Extraction W Iol,,25000291,LOCAL,Facility,Outpatient,,,,1836,1560.6,526.1976,1836,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1654.236,90.1,,percent of total billed charges,,
Cataract Extraction W Iol,,25000291,LOCAL,Facility,Inpatient,,,,1836,1560.6,526.1976,1836,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Cataract Extraction W Iol,,25000291,LOCAL,Facility,Both,,,,1836,1560.6,526.1976,1836,"Preferred One Administrative Services, INC.",PPO,1810.296,98.6,,percent of total billed charges,,
Cataract Extraction W Iol,,25000291,LOCAL,Facility,Outpatient,,,,1836,1560.6,526.1976,1836,PrimeWest Health,Minnesota Senior Health Options (MSHO),944.622,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Cataract Extraction W Iol,,25000291,LOCAL,Facility,Inpatient,,,,1836,1560.6,526.1976,1836,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Cataract Extraction W Iol,,25000291,LOCAL,Facility,Outpatient,,,,1836,1560.6,526.1976,1836,PrimeWest Health,MinnesotaCare,942.9696,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Cataract Extraction W Iol,,25000291,LOCAL,Facility,Inpatient,,,,1836,1560.6,526.1976,1836,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Cataract Extraction W Iol,,25000291,LOCAL,Facility,Both,,,,1836,1560.6,526.1976,1836,Sanford Health Plan,Sanford Health Plan,1689.12,92,,percent of total billed charges,,
Cataract Extraction W Iol,,25000291,LOCAL,Facility,Outpatient,,,,1836,1560.6,526.1976,1836,"UCare Health, Inc.",Individual & Family Plan,1034.586,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Cataract Extraction W Iol,,25000291,LOCAL,Facility,Inpatient,,,,1836,1560.6,526.1976,1836,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Cataract Extraction W Iol,,25000291,LOCAL,Facility,Outpatient,,,,1836,1560.6,526.1976,1836,"UCare Health, Inc.",Medical Assistance,926.6292,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Cataract Extraction W Iol,,25000291,LOCAL,Facility,Inpatient,,,,1836,1560.6,526.1976,1836,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Cataract Extraction W Iol,,25000291,LOCAL,Facility,Outpatient,,,,1836,1560.6,526.1976,1836,"UCare Health, Inc.",Medicare Advantage,926.6292,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Cataract Extraction W Iol,,25000291,LOCAL,Facility,Inpatient,,,,1836,1560.6,526.1976,1836,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Cataract Extraction W Iol,,25000291,LOCAL,Facility,Outpatient,,,,1836,1560.6,526.1976,1836,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),926.6292,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Cataract Extraction W Iol,,25000291,LOCAL,Facility,Inpatient,,,,1836,1560.6,526.1976,1836,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Cataract Extraction W Iol,,25000291,LOCAL,Facility,Both,,,,1836,1560.6,526.1976,1836,UnitedHealthcare,Individual & Family,1725.84,94,,percent of total billed charges,,
Cataract Extraction W Iol,,25000291,LOCAL,Facility,Outpatient,,,,1836,1560.6,526.1976,1836,UnitedHealthcare,Medicare Advantage,899.64,49,,percent of total billed charges,,
Cataract Extraction W Iol,,25000291,LOCAL,Facility,Inpatient,,,,1836,1560.6,526.1976,1836,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Cataract Extraction W Iol,,25000291,LOCAL,Facility,Outpatient,,,,1836,1560.6,526.1976,1836,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,881.28,48,,percent of total billed charges,,100% of DHS outpatient percentage
Cataract Extraction W Iol,,25000291,LOCAL,Facility,Inpatient,,,,1836,1560.6,526.1976,1836,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Cesarean Section,,25000328,LOCAL,Facility,Both,,,,4794,4074.9,1373.9604,4794,Aetna,Commercial,4410.48,92,,percent of total billed charges,,
Cesarean Section,,25000328,LOCAL,Facility,Outpatient,,,,4794,4074.9,1373.9604,4794,Aetna,Medicare Advantage,2349.06,49,,percent of total billed charges,,
Cesarean Section,,25000328,LOCAL,Facility,Inpatient,,,,4794,4074.9,1373.9604,4794,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Cesarean Section,,25000328,LOCAL,Facility,Both,,,,4794,4074.9,1373.9604,4794,Aetna,PPO,4458.42,93,,percent of total billed charges,,
Cesarean Section,,25000328,LOCAL,Facility,Both,,,,4794,4074.9,1373.9604,4794,America's PPO,America's PPO,4603.6782,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Cesarean Section,,25000328,LOCAL,Facility,Both,,,,4794,4074.9,1373.9604,4794,BlueCross BlueShield Minnesota, Federal Employee Program,4717.296,98.4,,percent of total billed charges,,
Cesarean Section,,25000328,LOCAL,Facility,Both,,,,4794,4074.9,1373.9604,4794,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,4794,100,,percent of total billed charges,,
Cesarean Section,,25000328,LOCAL,Facility,Both,,,,4794,4074.9,1373.9604,4794,BlueCross BlueShield Minnesota,High Value Network Plan,4314.6,90,,percent of total billed charges,,
Cesarean Section,,25000328,LOCAL,Facility,Outpatient,,,,4794,4074.9,1373.9604,4794,BlueCross BlueShield Minnesota,Medicare Advantage,2349.06,49,,percent of total billed charges,,
Cesarean Section,,25000328,LOCAL,Facility,Inpatient,,,,4794,4074.9,1373.9604,4794,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Cesarean Section,,25000328,LOCAL,Facility,Both,,,,4794,4074.9,1373.9604,4794,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4246.0458,88.57,,percent of total billed charges,,
Cesarean Section,,25000328,LOCAL,Facility,Both,,,,4794,4074.9,1373.9604,4794,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1373.9604,28.66,,percent of total billed charges,,
Cesarean Section,,25000328,LOCAL,Facility,Outpatient,,,,4794,4074.9,1373.9604,4794,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2349.06,49,,percent of total billed charges,,
Cesarean Section,,25000328,LOCAL,Facility,Inpatient,,,,4794,4074.9,1373.9604,4794,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Cesarean Section,,25000328,LOCAL,Facility,Both,,,,4794,4074.9,1373.9604,4794,CorVel,Worker's Compensation,4794,100,,percent of total billed charges,,
Cesarean Section,,25000328,LOCAL,Facility,Both,,,,4794,4074.9,1373.9604,4794,First Health Group Corporation,First Health Network,4650.18,97,,percent of total billed charges,,
Cesarean Section,,25000328,LOCAL,Facility,Both,,,,4794,4074.9,1373.9604,4794,"Health Partners, Inc.",Commercial,4535.124,94.6,,percent of total billed charges,,
Cesarean Section,,25000328,LOCAL,Facility,Outpatient,,,,4794,4074.9,1373.9604,4794,"Health Partners, Inc.",Medicare Advantage,2349.06,49,,percent of total billed charges,,
Cesarean Section,,25000328,LOCAL,Facility,Inpatient,,,,4794,4074.9,1373.9604,4794,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Cesarean Section,,25000328,LOCAL,Facility,Both,,,,4794,4074.9,1373.9604,4794,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),2876.4,60,,percent of total billed charges,,
Cesarean Section,,25000328,LOCAL,Facility,Both,,,,4794,4074.9,1373.9604,4794,"Health Partners, Inc.",State of Minnesota Advantage Program,3907.11,81.5,,percent of total billed charges,,
Cesarean Section,,25000328,LOCAL,Facility,Both,,,,4794,4074.9,1373.9604,4794,"Health Partners, Inc.",State Public Programs,2397,50,,percent of total billed charges,,
Cesarean Section,,25000328,LOCAL,Facility,Both,,,,4794,4074.9,1373.9604,4794,Humana Insurance Company,Commercial PPO,4554.3,95,,percent of total billed charges,,
Cesarean Section,,25000328,LOCAL,Facility,Outpatient,,,,4794,4074.9,1373.9604,4794,Humana Insurance Company,Medicare PPO,2349.06,49,,percent of total billed charges,,
Cesarean Section,,25000328,LOCAL,Facility,Inpatient,,,,4794,4074.9,1373.9604,4794,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Cesarean Section,,25000328,LOCAL,Facility,Both,,,,4794,4074.9,1373.9604,4794,Medica,Individual & Family,4750.854,99.1,,percent of total billed charges,,
Cesarean Section,,25000328,LOCAL,Facility,Outpatient,,,,4794,4074.9,1373.9604,4794,Medica,Medica Advantage Solution,2387.412,49.8,,percent of total billed charges,,
Cesarean Section,,25000328,LOCAL,Facility,Inpatient,,,,4794,4074.9,1373.9604,4794,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Cesarean Section,,25000328,LOCAL,Facility,Outpatient,,,,4794,4074.9,1373.9604,4794,Medica,Medical Assistance,2138.124,44.6,,percent of total billed charges,,
Cesarean Section,,25000328,LOCAL,Facility,Inpatient,,,,4794,4074.9,1373.9604,4794,Medica,Medical Assistance,,,,,Included in per diem rate,
Cesarean Section,,25000328,LOCAL,Facility,Outpatient,,,,4794,4074.9,1373.9604,4794,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2387.412,49.8,,percent of total billed charges,,
Cesarean Section,,25000328,LOCAL,Facility,Inpatient,,,,4794,4074.9,1373.9604,4794,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Cesarean Section,,25000328,LOCAL,Facility,Both,,,,4794,4074.9,1373.9604,4794,"Multiplan, Inc.","Multiplan, Inc.",4506.36,94,,percent of total billed charges,,
Cesarean Section,,25000328,LOCAL,Facility,Outpatient,,,,4794,4074.9,1373.9604,4794,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4319.394,90.1,,percent of total billed charges,,
Cesarean Section,,25000328,LOCAL,Facility,Inpatient,,,,4794,4074.9,1373.9604,4794,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Cesarean Section,,25000328,LOCAL,Facility,Both,,,,4794,4074.9,1373.9604,4794,"Preferred One Administrative Services, INC.",PPO,4726.884,98.6,,percent of total billed charges,,
Cesarean Section,,25000328,LOCAL,Facility,Outpatient,,,,4794,4074.9,1373.9604,4794,PrimeWest Health,Minnesota Senior Health Options (MSHO),2466.513,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Cesarean Section,,25000328,LOCAL,Facility,Inpatient,,,,4794,4074.9,1373.9604,4794,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Cesarean Section,,25000328,LOCAL,Facility,Outpatient,,,,4794,4074.9,1373.9604,4794,PrimeWest Health,MinnesotaCare,2462.1984,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Cesarean Section,,25000328,LOCAL,Facility,Inpatient,,,,4794,4074.9,1373.9604,4794,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Cesarean Section,,25000328,LOCAL,Facility,Both,,,,4794,4074.9,1373.9604,4794,Sanford Health Plan,Sanford Health Plan,4410.48,92,,percent of total billed charges,,
Cesarean Section,,25000328,LOCAL,Facility,Outpatient,,,,4794,4074.9,1373.9604,4794,"UCare Health, Inc.",Individual & Family Plan,2701.419,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Cesarean Section,,25000328,LOCAL,Facility,Inpatient,,,,4794,4074.9,1373.9604,4794,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Cesarean Section,,25000328,LOCAL,Facility,Outpatient,,,,4794,4074.9,1373.9604,4794,"UCare Health, Inc.",Medical Assistance,2419.5318,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Cesarean Section,,25000328,LOCAL,Facility,Inpatient,,,,4794,4074.9,1373.9604,4794,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Cesarean Section,,25000328,LOCAL,Facility,Outpatient,,,,4794,4074.9,1373.9604,4794,"UCare Health, Inc.",Medicare Advantage,2419.5318,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Cesarean Section,,25000328,LOCAL,Facility,Inpatient,,,,4794,4074.9,1373.9604,4794,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Cesarean Section,,25000328,LOCAL,Facility,Outpatient,,,,4794,4074.9,1373.9604,4794,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2419.5318,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Cesarean Section,,25000328,LOCAL,Facility,Inpatient,,,,4794,4074.9,1373.9604,4794,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Cesarean Section,,25000328,LOCAL,Facility,Both,,,,4794,4074.9,1373.9604,4794,UnitedHealthcare,Individual & Family,4506.36,94,,percent of total billed charges,,
Cesarean Section,,25000328,LOCAL,Facility,Outpatient,,,,4794,4074.9,1373.9604,4794,UnitedHealthcare,Medicare Advantage,2349.06,49,,percent of total billed charges,,
Cesarean Section,,25000328,LOCAL,Facility,Inpatient,,,,4794,4074.9,1373.9604,4794,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Cesarean Section,,25000328,LOCAL,Facility,Outpatient,,,,4794,4074.9,1373.9604,4794,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2301.12,48,,percent of total billed charges,,100% of DHS outpatient percentage
Cesarean Section,,25000328,LOCAL,Facility,Inpatient,,,,4794,4074.9,1373.9604,4794,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Cholecystectomy (Open),,25000355,LOCAL,Facility,Both,,,,4437,3771.45,1271.6442,4437,Aetna,Commercial,4082.04,92,,percent of total billed charges,,
Cholecystectomy (Open),,25000355,LOCAL,Facility,Outpatient,,,,4437,3771.45,1271.6442,4437,Aetna,Medicare Advantage,2174.13,49,,percent of total billed charges,,
Cholecystectomy (Open),,25000355,LOCAL,Facility,Inpatient,,,,4437,3771.45,1271.6442,4437,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Cholecystectomy (Open),,25000355,LOCAL,Facility,Both,,,,4437,3771.45,1271.6442,4437,Aetna,PPO,4126.41,93,,percent of total billed charges,,
Cholecystectomy (Open),,25000355,LOCAL,Facility,Both,,,,4437,3771.45,1271.6442,4437,America's PPO,America's PPO,4260.8511,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Cholecystectomy (Open),,25000355,LOCAL,Facility,Both,,,,4437,3771.45,1271.6442,4437,BlueCross BlueShield Minnesota, Federal Employee Program,4366.008,98.4,,percent of total billed charges,,
Cholecystectomy (Open),,25000355,LOCAL,Facility,Both,,,,4437,3771.45,1271.6442,4437,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,4437,100,,percent of total billed charges,,
Cholecystectomy (Open),,25000355,LOCAL,Facility,Both,,,,4437,3771.45,1271.6442,4437,BlueCross BlueShield Minnesota,High Value Network Plan,3993.3,90,,percent of total billed charges,,
Cholecystectomy (Open),,25000355,LOCAL,Facility,Outpatient,,,,4437,3771.45,1271.6442,4437,BlueCross BlueShield Minnesota,Medicare Advantage,2174.13,49,,percent of total billed charges,,
Cholecystectomy (Open),,25000355,LOCAL,Facility,Inpatient,,,,4437,3771.45,1271.6442,4437,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Cholecystectomy (Open),,25000355,LOCAL,Facility,Both,,,,4437,3771.45,1271.6442,4437,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,3929.8509,88.57,,percent of total billed charges,,
Cholecystectomy (Open),,25000355,LOCAL,Facility,Both,,,,4437,3771.45,1271.6442,4437,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1271.6442,28.66,,percent of total billed charges,,
Cholecystectomy (Open),,25000355,LOCAL,Facility,Outpatient,,,,4437,3771.45,1271.6442,4437,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2174.13,49,,percent of total billed charges,,
Cholecystectomy (Open),,25000355,LOCAL,Facility,Inpatient,,,,4437,3771.45,1271.6442,4437,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Cholecystectomy (Open),,25000355,LOCAL,Facility,Both,,,,4437,3771.45,1271.6442,4437,CorVel,Worker's Compensation,4437,100,,percent of total billed charges,,
Cholecystectomy (Open),,25000355,LOCAL,Facility,Both,,,,4437,3771.45,1271.6442,4437,First Health Group Corporation,First Health Network,4303.89,97,,percent of total billed charges,,
Cholecystectomy (Open),,25000355,LOCAL,Facility,Both,,,,4437,3771.45,1271.6442,4437,"Health Partners, Inc.",Commercial,4197.402,94.6,,percent of total billed charges,,
Cholecystectomy (Open),,25000355,LOCAL,Facility,Outpatient,,,,4437,3771.45,1271.6442,4437,"Health Partners, Inc.",Medicare Advantage,2174.13,49,,percent of total billed charges,,
Cholecystectomy (Open),,25000355,LOCAL,Facility,Inpatient,,,,4437,3771.45,1271.6442,4437,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Cholecystectomy (Open),,25000355,LOCAL,Facility,Both,,,,4437,3771.45,1271.6442,4437,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),2662.2,60,,percent of total billed charges,,
Cholecystectomy (Open),,25000355,LOCAL,Facility,Both,,,,4437,3771.45,1271.6442,4437,"Health Partners, Inc.",State of Minnesota Advantage Program,3616.155,81.5,,percent of total billed charges,,
Cholecystectomy (Open),,25000355,LOCAL,Facility,Both,,,,4437,3771.45,1271.6442,4437,"Health Partners, Inc.",State Public Programs,2218.5,50,,percent of total billed charges,,
Cholecystectomy (Open),,25000355,LOCAL,Facility,Both,,,,4437,3771.45,1271.6442,4437,Humana Insurance Company,Commercial PPO,4215.15,95,,percent of total billed charges,,
Cholecystectomy (Open),,25000355,LOCAL,Facility,Outpatient,,,,4437,3771.45,1271.6442,4437,Humana Insurance Company,Medicare PPO,2174.13,49,,percent of total billed charges,,
Cholecystectomy (Open),,25000355,LOCAL,Facility,Inpatient,,,,4437,3771.45,1271.6442,4437,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Cholecystectomy (Open),,25000355,LOCAL,Facility,Both,,,,4437,3771.45,1271.6442,4437,Medica,Individual & Family,4397.067,99.1,,percent of total billed charges,,
Cholecystectomy (Open),,25000355,LOCAL,Facility,Outpatient,,,,4437,3771.45,1271.6442,4437,Medica,Medica Advantage Solution,2209.626,49.8,,percent of total billed charges,,
Cholecystectomy (Open),,25000355,LOCAL,Facility,Inpatient,,,,4437,3771.45,1271.6442,4437,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Cholecystectomy (Open),,25000355,LOCAL,Facility,Outpatient,,,,4437,3771.45,1271.6442,4437,Medica,Medical Assistance,1978.902,44.6,,percent of total billed charges,,
Cholecystectomy (Open),,25000355,LOCAL,Facility,Inpatient,,,,4437,3771.45,1271.6442,4437,Medica,Medical Assistance,,,,,Included in per diem rate,
Cholecystectomy (Open),,25000355,LOCAL,Facility,Outpatient,,,,4437,3771.45,1271.6442,4437,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2209.626,49.8,,percent of total billed charges,,
Cholecystectomy (Open),,25000355,LOCAL,Facility,Inpatient,,,,4437,3771.45,1271.6442,4437,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Cholecystectomy (Open),,25000355,LOCAL,Facility,Both,,,,4437,3771.45,1271.6442,4437,"Multiplan, Inc.","Multiplan, Inc.",4170.78,94,,percent of total billed charges,,
Cholecystectomy (Open),,25000355,LOCAL,Facility,Outpatient,,,,4437,3771.45,1271.6442,4437,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,3997.737,90.1,,percent of total billed charges,,
Cholecystectomy (Open),,25000355,LOCAL,Facility,Inpatient,,,,4437,3771.45,1271.6442,4437,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Cholecystectomy (Open),,25000355,LOCAL,Facility,Both,,,,4437,3771.45,1271.6442,4437,"Preferred One Administrative Services, INC.",PPO,4374.882,98.6,,percent of total billed charges,,
Cholecystectomy (Open),,25000355,LOCAL,Facility,Outpatient,,,,4437,3771.45,1271.6442,4437,PrimeWest Health,Minnesota Senior Health Options (MSHO),2282.8365,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Cholecystectomy (Open),,25000355,LOCAL,Facility,Inpatient,,,,4437,3771.45,1271.6442,4437,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Cholecystectomy (Open),,25000355,LOCAL,Facility,Outpatient,,,,4437,3771.45,1271.6442,4437,PrimeWest Health,MinnesotaCare,2278.8432,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Cholecystectomy (Open),,25000355,LOCAL,Facility,Inpatient,,,,4437,3771.45,1271.6442,4437,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Cholecystectomy (Open),,25000355,LOCAL,Facility,Both,,,,4437,3771.45,1271.6442,4437,Sanford Health Plan,Sanford Health Plan,4082.04,92,,percent of total billed charges,,
Cholecystectomy (Open),,25000355,LOCAL,Facility,Outpatient,,,,4437,3771.45,1271.6442,4437,"UCare Health, Inc.",Individual & Family Plan,2500.2495,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Cholecystectomy (Open),,25000355,LOCAL,Facility,Inpatient,,,,4437,3771.45,1271.6442,4437,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Cholecystectomy (Open),,25000355,LOCAL,Facility,Outpatient,,,,4437,3771.45,1271.6442,4437,"UCare Health, Inc.",Medical Assistance,2239.3539,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Cholecystectomy (Open),,25000355,LOCAL,Facility,Inpatient,,,,4437,3771.45,1271.6442,4437,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Cholecystectomy (Open),,25000355,LOCAL,Facility,Outpatient,,,,4437,3771.45,1271.6442,4437,"UCare Health, Inc.",Medicare Advantage,2239.3539,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Cholecystectomy (Open),,25000355,LOCAL,Facility,Inpatient,,,,4437,3771.45,1271.6442,4437,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Cholecystectomy (Open),,25000355,LOCAL,Facility,Outpatient,,,,4437,3771.45,1271.6442,4437,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2239.3539,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Cholecystectomy (Open),,25000355,LOCAL,Facility,Inpatient,,,,4437,3771.45,1271.6442,4437,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Cholecystectomy (Open),,25000355,LOCAL,Facility,Both,,,,4437,3771.45,1271.6442,4437,UnitedHealthcare,Individual & Family,4170.78,94,,percent of total billed charges,,
Cholecystectomy (Open),,25000355,LOCAL,Facility,Outpatient,,,,4437,3771.45,1271.6442,4437,UnitedHealthcare,Medicare Advantage,2174.13,49,,percent of total billed charges,,
Cholecystectomy (Open),,25000355,LOCAL,Facility,Inpatient,,,,4437,3771.45,1271.6442,4437,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Cholecystectomy (Open),,25000355,LOCAL,Facility,Outpatient,,,,4437,3771.45,1271.6442,4437,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2129.76,48,,percent of total billed charges,,100% of DHS outpatient percentage
Cholecystectomy (Open),,25000355,LOCAL,Facility,Inpatient,,,,4437,3771.45,1271.6442,4437,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Circumcision > 28 Old,,25000381,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,Aetna,Commercial,2064.48,92,,percent of total billed charges,,
Circumcision > 28 Old,,25000381,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,Aetna,Medicare Advantage,1099.56,49,,percent of total billed charges,,
Circumcision > 28 Old,,25000381,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Circumcision > 28 Old,,25000381,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,Aetna,PPO,2086.92,93,,percent of total billed charges,,
Circumcision > 28 Old,,25000381,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,America's PPO,America's PPO,2154.9132,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Circumcision > 28 Old,,25000381,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,BlueCross BlueShield Minnesota, Federal Employee Program,2208.096,98.4,,percent of total billed charges,,
Circumcision > 28 Old,,25000381,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,2244,100,,percent of total billed charges,,
Circumcision > 28 Old,,25000381,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,BlueCross BlueShield Minnesota,High Value Network Plan,2019.6,90,,percent of total billed charges,,
Circumcision > 28 Old,,25000381,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,BlueCross BlueShield Minnesota,Medicare Advantage,1099.56,49,,percent of total billed charges,,
Circumcision > 28 Old,,25000381,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Circumcision > 28 Old,,25000381,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1987.5108,88.57,,percent of total billed charges,,
Circumcision > 28 Old,,25000381,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,643.1304,28.66,,percent of total billed charges,,
Circumcision > 28 Old,,25000381,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1099.56,49,,percent of total billed charges,,
Circumcision > 28 Old,,25000381,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Circumcision > 28 Old,,25000381,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,CorVel,Worker's Compensation,2244,100,,percent of total billed charges,,
Circumcision > 28 Old,,25000381,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,First Health Group Corporation,First Health Network,2176.68,97,,percent of total billed charges,,
Circumcision > 28 Old,,25000381,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,"Health Partners, Inc.",Commercial,2122.824,94.6,,percent of total billed charges,,
Circumcision > 28 Old,,25000381,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,"Health Partners, Inc.",Medicare Advantage,1099.56,49,,percent of total billed charges,,
Circumcision > 28 Old,,25000381,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Circumcision > 28 Old,,25000381,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1346.4,60,,percent of total billed charges,,
Circumcision > 28 Old,,25000381,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,"Health Partners, Inc.",State of Minnesota Advantage Program,1828.86,81.5,,percent of total billed charges,,
Circumcision > 28 Old,,25000381,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,"Health Partners, Inc.",State Public Programs,1122,50,,percent of total billed charges,,
Circumcision > 28 Old,,25000381,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,Humana Insurance Company,Commercial PPO,2131.8,95,,percent of total billed charges,,
Circumcision > 28 Old,,25000381,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,Humana Insurance Company,Medicare PPO,1099.56,49,,percent of total billed charges,,
Circumcision > 28 Old,,25000381,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Circumcision > 28 Old,,25000381,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,Medica,Individual & Family,2223.804,99.1,,percent of total billed charges,,
Circumcision > 28 Old,,25000381,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,Medica,Medica Advantage Solution,1117.512,49.8,,percent of total billed charges,,
Circumcision > 28 Old,,25000381,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Circumcision > 28 Old,,25000381,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,Medica,Medical Assistance,1000.824,44.6,,percent of total billed charges,,
Circumcision > 28 Old,,25000381,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,Medica,Medical Assistance,,,,,Included in per diem rate,
Circumcision > 28 Old,,25000381,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1117.512,49.8,,percent of total billed charges,,
Circumcision > 28 Old,,25000381,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Circumcision > 28 Old,,25000381,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,"Multiplan, Inc.","Multiplan, Inc.",2109.36,94,,percent of total billed charges,,
Circumcision > 28 Old,,25000381,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,2021.844,90.1,,percent of total billed charges,,
Circumcision > 28 Old,,25000381,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Circumcision > 28 Old,,25000381,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,"Preferred One Administrative Services, INC.",PPO,2212.584,98.6,,percent of total billed charges,,
Circumcision > 28 Old,,25000381,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,PrimeWest Health,Minnesota Senior Health Options (MSHO),1154.538,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Circumcision > 28 Old,,25000381,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Circumcision > 28 Old,,25000381,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,PrimeWest Health,MinnesotaCare,1152.5184,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Circumcision > 28 Old,,25000381,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Circumcision > 28 Old,,25000381,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,Sanford Health Plan,Sanford Health Plan,2064.48,92,,percent of total billed charges,,
Circumcision > 28 Old,,25000381,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,"UCare Health, Inc.",Individual & Family Plan,1264.494,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Circumcision > 28 Old,,25000381,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Circumcision > 28 Old,,25000381,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,"UCare Health, Inc.",Medical Assistance,1132.5468,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Circumcision > 28 Old,,25000381,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Circumcision > 28 Old,,25000381,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,"UCare Health, Inc.",Medicare Advantage,1132.5468,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Circumcision > 28 Old,,25000381,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Circumcision > 28 Old,,25000381,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1132.5468,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Circumcision > 28 Old,,25000381,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Circumcision > 28 Old,,25000381,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,UnitedHealthcare,Individual & Family,2109.36,94,,percent of total billed charges,,
Circumcision > 28 Old,,25000381,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,UnitedHealthcare,Medicare Advantage,1099.56,49,,percent of total billed charges,,
Circumcision > 28 Old,,25000381,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Circumcision > 28 Old,,25000381,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1077.12,48,,percent of total billed charges,,100% of DHS outpatient percentage
Circumcision > 28 Old,,25000381,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Colon/Intestine Resection,,25000403,LOCAL,Facility,Both,,,,5993,5094.05,1717.5938,5993,Aetna,Commercial,5513.56,92,,percent of total billed charges,,
Colon/Intestine Resection,,25000403,LOCAL,Facility,Outpatient,,,,5993,5094.05,1717.5938,5993,Aetna,Medicare Advantage,2936.57,49,,percent of total billed charges,,
Colon/Intestine Resection,,25000403,LOCAL,Facility,Inpatient,,,,5993,5094.05,1717.5938,5993,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Colon/Intestine Resection,,25000403,LOCAL,Facility,Both,,,,5993,5094.05,1717.5938,5993,Aetna,PPO,5573.49,93,,percent of total billed charges,,
Colon/Intestine Resection,,25000403,LOCAL,Facility,Both,,,,5993,5094.05,1717.5938,5993,America's PPO,America's PPO,5755.0779,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Colon/Intestine Resection,,25000403,LOCAL,Facility,Both,,,,5993,5094.05,1717.5938,5993,BlueCross BlueShield Minnesota, Federal Employee Program,5897.112,98.4,,percent of total billed charges,,
Colon/Intestine Resection,,25000403,LOCAL,Facility,Both,,,,5993,5094.05,1717.5938,5993,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5993,100,,percent of total billed charges,,
Colon/Intestine Resection,,25000403,LOCAL,Facility,Both,,,,5993,5094.05,1717.5938,5993,BlueCross BlueShield Minnesota,High Value Network Plan,5393.7,90,,percent of total billed charges,,
Colon/Intestine Resection,,25000403,LOCAL,Facility,Outpatient,,,,5993,5094.05,1717.5938,5993,BlueCross BlueShield Minnesota,Medicare Advantage,2936.57,49,,percent of total billed charges,,
Colon/Intestine Resection,,25000403,LOCAL,Facility,Inpatient,,,,5993,5094.05,1717.5938,5993,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Colon/Intestine Resection,,25000403,LOCAL,Facility,Both,,,,5993,5094.05,1717.5938,5993,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,5308.0001,88.57,,percent of total billed charges,,
Colon/Intestine Resection,,25000403,LOCAL,Facility,Both,,,,5993,5094.05,1717.5938,5993,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1717.5938,28.66,,percent of total billed charges,,
Colon/Intestine Resection,,25000403,LOCAL,Facility,Outpatient,,,,5993,5094.05,1717.5938,5993,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2936.57,49,,percent of total billed charges,,
Colon/Intestine Resection,,25000403,LOCAL,Facility,Inpatient,,,,5993,5094.05,1717.5938,5993,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Colon/Intestine Resection,,25000403,LOCAL,Facility,Both,,,,5993,5094.05,1717.5938,5993,CorVel,Worker's Compensation,5993,100,,percent of total billed charges,,
Colon/Intestine Resection,,25000403,LOCAL,Facility,Both,,,,5993,5094.05,1717.5938,5993,First Health Group Corporation,First Health Network,5813.21,97,,percent of total billed charges,,
Colon/Intestine Resection,,25000403,LOCAL,Facility,Both,,,,5993,5094.05,1717.5938,5993,"Health Partners, Inc.",Commercial,5669.378,94.6,,percent of total billed charges,,
Colon/Intestine Resection,,25000403,LOCAL,Facility,Outpatient,,,,5993,5094.05,1717.5938,5993,"Health Partners, Inc.",Medicare Advantage,2936.57,49,,percent of total billed charges,,
Colon/Intestine Resection,,25000403,LOCAL,Facility,Inpatient,,,,5993,5094.05,1717.5938,5993,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Colon/Intestine Resection,,25000403,LOCAL,Facility,Both,,,,5993,5094.05,1717.5938,5993,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3595.8,60,,percent of total billed charges,,
Colon/Intestine Resection,,25000403,LOCAL,Facility,Both,,,,5993,5094.05,1717.5938,5993,"Health Partners, Inc.",State of Minnesota Advantage Program,4884.295,81.5,,percent of total billed charges,,
Colon/Intestine Resection,,25000403,LOCAL,Facility,Both,,,,5993,5094.05,1717.5938,5993,"Health Partners, Inc.",State Public Programs,2996.5,50,,percent of total billed charges,,
Colon/Intestine Resection,,25000403,LOCAL,Facility,Both,,,,5993,5094.05,1717.5938,5993,Humana Insurance Company,Commercial PPO,5693.35,95,,percent of total billed charges,,
Colon/Intestine Resection,,25000403,LOCAL,Facility,Outpatient,,,,5993,5094.05,1717.5938,5993,Humana Insurance Company,Medicare PPO,2936.57,49,,percent of total billed charges,,
Colon/Intestine Resection,,25000403,LOCAL,Facility,Inpatient,,,,5993,5094.05,1717.5938,5993,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Colon/Intestine Resection,,25000403,LOCAL,Facility,Both,,,,5993,5094.05,1717.5938,5993,Medica,Individual & Family,5939.063,99.1,,percent of total billed charges,,
Colon/Intestine Resection,,25000403,LOCAL,Facility,Outpatient,,,,5993,5094.05,1717.5938,5993,Medica,Medica Advantage Solution,2984.514,49.8,,percent of total billed charges,,
Colon/Intestine Resection,,25000403,LOCAL,Facility,Inpatient,,,,5993,5094.05,1717.5938,5993,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Colon/Intestine Resection,,25000403,LOCAL,Facility,Outpatient,,,,5993,5094.05,1717.5938,5993,Medica,Medical Assistance,2672.878,44.6,,percent of total billed charges,,
Colon/Intestine Resection,,25000403,LOCAL,Facility,Inpatient,,,,5993,5094.05,1717.5938,5993,Medica,Medical Assistance,,,,,Included in per diem rate,
Colon/Intestine Resection,,25000403,LOCAL,Facility,Outpatient,,,,5993,5094.05,1717.5938,5993,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2984.514,49.8,,percent of total billed charges,,
Colon/Intestine Resection,,25000403,LOCAL,Facility,Inpatient,,,,5993,5094.05,1717.5938,5993,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Colon/Intestine Resection,,25000403,LOCAL,Facility,Both,,,,5993,5094.05,1717.5938,5993,"Multiplan, Inc.","Multiplan, Inc.",5633.42,94,,percent of total billed charges,,
Colon/Intestine Resection,,25000403,LOCAL,Facility,Outpatient,,,,5993,5094.05,1717.5938,5993,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,5399.693,90.1,,percent of total billed charges,,
Colon/Intestine Resection,,25000403,LOCAL,Facility,Inpatient,,,,5993,5094.05,1717.5938,5993,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Colon/Intestine Resection,,25000403,LOCAL,Facility,Both,,,,5993,5094.05,1717.5938,5993,"Preferred One Administrative Services, INC.",PPO,5909.098,98.6,,percent of total billed charges,,
Colon/Intestine Resection,,25000403,LOCAL,Facility,Outpatient,,,,5993,5094.05,1717.5938,5993,PrimeWest Health,Minnesota Senior Health Options (MSHO),3083.3985,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Colon/Intestine Resection,,25000403,LOCAL,Facility,Inpatient,,,,5993,5094.05,1717.5938,5993,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Colon/Intestine Resection,,25000403,LOCAL,Facility,Outpatient,,,,5993,5094.05,1717.5938,5993,PrimeWest Health,MinnesotaCare,3078.0048,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Colon/Intestine Resection,,25000403,LOCAL,Facility,Inpatient,,,,5993,5094.05,1717.5938,5993,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Colon/Intestine Resection,,25000403,LOCAL,Facility,Both,,,,5993,5094.05,1717.5938,5993,Sanford Health Plan,Sanford Health Plan,5513.56,92,,percent of total billed charges,,
Colon/Intestine Resection,,25000403,LOCAL,Facility,Outpatient,,,,5993,5094.05,1717.5938,5993,"UCare Health, Inc.",Individual & Family Plan,3377.0555,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Colon/Intestine Resection,,25000403,LOCAL,Facility,Inpatient,,,,5993,5094.05,1717.5938,5993,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Colon/Intestine Resection,,25000403,LOCAL,Facility,Outpatient,,,,5993,5094.05,1717.5938,5993,"UCare Health, Inc.",Medical Assistance,3024.6671,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Colon/Intestine Resection,,25000403,LOCAL,Facility,Inpatient,,,,5993,5094.05,1717.5938,5993,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Colon/Intestine Resection,,25000403,LOCAL,Facility,Outpatient,,,,5993,5094.05,1717.5938,5993,"UCare Health, Inc.",Medicare Advantage,3024.6671,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Colon/Intestine Resection,,25000403,LOCAL,Facility,Inpatient,,,,5993,5094.05,1717.5938,5993,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Colon/Intestine Resection,,25000403,LOCAL,Facility,Outpatient,,,,5993,5094.05,1717.5938,5993,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),3024.6671,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Colon/Intestine Resection,,25000403,LOCAL,Facility,Inpatient,,,,5993,5094.05,1717.5938,5993,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Colon/Intestine Resection,,25000403,LOCAL,Facility,Both,,,,5993,5094.05,1717.5938,5993,UnitedHealthcare,Individual & Family,5633.42,94,,percent of total billed charges,,
Colon/Intestine Resection,,25000403,LOCAL,Facility,Outpatient,,,,5993,5094.05,1717.5938,5993,UnitedHealthcare,Medicare Advantage,2936.57,49,,percent of total billed charges,,
Colon/Intestine Resection,,25000403,LOCAL,Facility,Inpatient,,,,5993,5094.05,1717.5938,5993,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Colon/Intestine Resection,,25000403,LOCAL,Facility,Outpatient,,,,5993,5094.05,1717.5938,5993,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2876.64,48,,percent of total billed charges,,100% of DHS outpatient percentage
Colon/Intestine Resection,,25000403,LOCAL,Facility,Inpatient,,,,5993,5094.05,1717.5938,5993,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Colpocleisis,,25000418,LOCAL,Facility,Both,,,,4947,4204.95,1417.8102,4947,Aetna,Commercial,4551.24,92,,percent of total billed charges,,
Colpocleisis,,25000418,LOCAL,Facility,Outpatient,,,,4947,4204.95,1417.8102,4947,Aetna,Medicare Advantage,2424.03,49,,percent of total billed charges,,
Colpocleisis,,25000418,LOCAL,Facility,Inpatient,,,,4947,4204.95,1417.8102,4947,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Colpocleisis,,25000418,LOCAL,Facility,Both,,,,4947,4204.95,1417.8102,4947,Aetna,PPO,4600.71,93,,percent of total billed charges,,
Colpocleisis,,25000418,LOCAL,Facility,Both,,,,4947,4204.95,1417.8102,4947,America's PPO,America's PPO,4750.6041,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Colpocleisis,,25000418,LOCAL,Facility,Both,,,,4947,4204.95,1417.8102,4947,BlueCross BlueShield Minnesota, Federal Employee Program,4867.848,98.4,,percent of total billed charges,,
Colpocleisis,,25000418,LOCAL,Facility,Both,,,,4947,4204.95,1417.8102,4947,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,4947,100,,percent of total billed charges,,
Colpocleisis,,25000418,LOCAL,Facility,Both,,,,4947,4204.95,1417.8102,4947,BlueCross BlueShield Minnesota,High Value Network Plan,4452.3,90,,percent of total billed charges,,
Colpocleisis,,25000418,LOCAL,Facility,Outpatient,,,,4947,4204.95,1417.8102,4947,BlueCross BlueShield Minnesota,Medicare Advantage,2424.03,49,,percent of total billed charges,,
Colpocleisis,,25000418,LOCAL,Facility,Inpatient,,,,4947,4204.95,1417.8102,4947,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Colpocleisis,,25000418,LOCAL,Facility,Both,,,,4947,4204.95,1417.8102,4947,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4381.5579,88.57,,percent of total billed charges,,
Colpocleisis,,25000418,LOCAL,Facility,Both,,,,4947,4204.95,1417.8102,4947,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1417.8102,28.66,,percent of total billed charges,,
Colpocleisis,,25000418,LOCAL,Facility,Outpatient,,,,4947,4204.95,1417.8102,4947,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2424.03,49,,percent of total billed charges,,
Colpocleisis,,25000418,LOCAL,Facility,Inpatient,,,,4947,4204.95,1417.8102,4947,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Colpocleisis,,25000418,LOCAL,Facility,Both,,,,4947,4204.95,1417.8102,4947,CorVel,Worker's Compensation,4947,100,,percent of total billed charges,,
Colpocleisis,,25000418,LOCAL,Facility,Both,,,,4947,4204.95,1417.8102,4947,First Health Group Corporation,First Health Network,4798.59,97,,percent of total billed charges,,
Colpocleisis,,25000418,LOCAL,Facility,Both,,,,4947,4204.95,1417.8102,4947,"Health Partners, Inc.",Commercial,4679.862,94.6,,percent of total billed charges,,
Colpocleisis,,25000418,LOCAL,Facility,Outpatient,,,,4947,4204.95,1417.8102,4947,"Health Partners, Inc.",Medicare Advantage,2424.03,49,,percent of total billed charges,,
Colpocleisis,,25000418,LOCAL,Facility,Inpatient,,,,4947,4204.95,1417.8102,4947,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Colpocleisis,,25000418,LOCAL,Facility,Both,,,,4947,4204.95,1417.8102,4947,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),2968.2,60,,percent of total billed charges,,
Colpocleisis,,25000418,LOCAL,Facility,Both,,,,4947,4204.95,1417.8102,4947,"Health Partners, Inc.",State of Minnesota Advantage Program,4031.805,81.5,,percent of total billed charges,,
Colpocleisis,,25000418,LOCAL,Facility,Both,,,,4947,4204.95,1417.8102,4947,"Health Partners, Inc.",State Public Programs,2473.5,50,,percent of total billed charges,,
Colpocleisis,,25000418,LOCAL,Facility,Both,,,,4947,4204.95,1417.8102,4947,Humana Insurance Company,Commercial PPO,4699.65,95,,percent of total billed charges,,
Colpocleisis,,25000418,LOCAL,Facility,Outpatient,,,,4947,4204.95,1417.8102,4947,Humana Insurance Company,Medicare PPO,2424.03,49,,percent of total billed charges,,
Colpocleisis,,25000418,LOCAL,Facility,Inpatient,,,,4947,4204.95,1417.8102,4947,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Colpocleisis,,25000418,LOCAL,Facility,Both,,,,4947,4204.95,1417.8102,4947,Medica,Individual & Family,4902.477,99.1,,percent of total billed charges,,
Colpocleisis,,25000418,LOCAL,Facility,Outpatient,,,,4947,4204.95,1417.8102,4947,Medica,Medica Advantage Solution,2463.606,49.8,,percent of total billed charges,,
Colpocleisis,,25000418,LOCAL,Facility,Inpatient,,,,4947,4204.95,1417.8102,4947,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Colpocleisis,,25000418,LOCAL,Facility,Outpatient,,,,4947,4204.95,1417.8102,4947,Medica,Medical Assistance,2206.362,44.6,,percent of total billed charges,,
Colpocleisis,,25000418,LOCAL,Facility,Inpatient,,,,4947,4204.95,1417.8102,4947,Medica,Medical Assistance,,,,,Included in per diem rate,
Colpocleisis,,25000418,LOCAL,Facility,Outpatient,,,,4947,4204.95,1417.8102,4947,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2463.606,49.8,,percent of total billed charges,,
Colpocleisis,,25000418,LOCAL,Facility,Inpatient,,,,4947,4204.95,1417.8102,4947,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Colpocleisis,,25000418,LOCAL,Facility,Both,,,,4947,4204.95,1417.8102,4947,"Multiplan, Inc.","Multiplan, Inc.",4650.18,94,,percent of total billed charges,,
Colpocleisis,,25000418,LOCAL,Facility,Outpatient,,,,4947,4204.95,1417.8102,4947,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4457.247,90.1,,percent of total billed charges,,
Colpocleisis,,25000418,LOCAL,Facility,Inpatient,,,,4947,4204.95,1417.8102,4947,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Colpocleisis,,25000418,LOCAL,Facility,Both,,,,4947,4204.95,1417.8102,4947,"Preferred One Administrative Services, INC.",PPO,4877.742,98.6,,percent of total billed charges,,
Colpocleisis,,25000418,LOCAL,Facility,Outpatient,,,,4947,4204.95,1417.8102,4947,PrimeWest Health,Minnesota Senior Health Options (MSHO),2545.2315,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Colpocleisis,,25000418,LOCAL,Facility,Inpatient,,,,4947,4204.95,1417.8102,4947,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Colpocleisis,,25000418,LOCAL,Facility,Outpatient,,,,4947,4204.95,1417.8102,4947,PrimeWest Health,MinnesotaCare,2540.7792,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Colpocleisis,,25000418,LOCAL,Facility,Inpatient,,,,4947,4204.95,1417.8102,4947,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Colpocleisis,,25000418,LOCAL,Facility,Both,,,,4947,4204.95,1417.8102,4947,Sanford Health Plan,Sanford Health Plan,4551.24,92,,percent of total billed charges,,
Colpocleisis,,25000418,LOCAL,Facility,Outpatient,,,,4947,4204.95,1417.8102,4947,"UCare Health, Inc.",Individual & Family Plan,2787.6345,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Colpocleisis,,25000418,LOCAL,Facility,Inpatient,,,,4947,4204.95,1417.8102,4947,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Colpocleisis,,25000418,LOCAL,Facility,Outpatient,,,,4947,4204.95,1417.8102,4947,"UCare Health, Inc.",Medical Assistance,2496.7509,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Colpocleisis,,25000418,LOCAL,Facility,Inpatient,,,,4947,4204.95,1417.8102,4947,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Colpocleisis,,25000418,LOCAL,Facility,Outpatient,,,,4947,4204.95,1417.8102,4947,"UCare Health, Inc.",Medicare Advantage,2496.7509,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Colpocleisis,,25000418,LOCAL,Facility,Inpatient,,,,4947,4204.95,1417.8102,4947,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Colpocleisis,,25000418,LOCAL,Facility,Outpatient,,,,4947,4204.95,1417.8102,4947,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2496.7509,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Colpocleisis,,25000418,LOCAL,Facility,Inpatient,,,,4947,4204.95,1417.8102,4947,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Colpocleisis,,25000418,LOCAL,Facility,Both,,,,4947,4204.95,1417.8102,4947,UnitedHealthcare,Individual & Family,4650.18,94,,percent of total billed charges,,
Colpocleisis,,25000418,LOCAL,Facility,Outpatient,,,,4947,4204.95,1417.8102,4947,UnitedHealthcare,Medicare Advantage,2424.03,49,,percent of total billed charges,,
Colpocleisis,,25000418,LOCAL,Facility,Inpatient,,,,4947,4204.95,1417.8102,4947,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Colpocleisis,,25000418,LOCAL,Facility,Outpatient,,,,4947,4204.95,1417.8102,4947,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2374.56,48,,percent of total billed charges,,100% of DHS outpatient percentage
Colpocleisis,,25000418,LOCAL,Facility,Inpatient,,,,4947,4204.95,1417.8102,4947,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Cystoscopy,,25000465,LOCAL,Facility,Both,,,,1020,867,292.332,1020,Aetna,Commercial,938.4,92,,percent of total billed charges,,
Cystoscopy,,25000465,LOCAL,Facility,Outpatient,,,,1020,867,292.332,1020,Aetna,Medicare Advantage,499.8,49,,percent of total billed charges,,
Cystoscopy,,25000465,LOCAL,Facility,Inpatient,,,,1020,867,292.332,1020,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Cystoscopy,,25000465,LOCAL,Facility,Both,,,,1020,867,292.332,1020,Aetna,PPO,948.6,93,,percent of total billed charges,,
Cystoscopy,,25000465,LOCAL,Facility,Both,,,,1020,867,292.332,1020,America's PPO,America's PPO,979.506,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Cystoscopy,,25000465,LOCAL,Facility,Both,,,,1020,867,292.332,1020,BlueCross BlueShield Minnesota, Federal Employee Program,1003.68,98.4,,percent of total billed charges,,
Cystoscopy,,25000465,LOCAL,Facility,Both,,,,1020,867,292.332,1020,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1020,100,,percent of total billed charges,,
Cystoscopy,,25000465,LOCAL,Facility,Both,,,,1020,867,292.332,1020,BlueCross BlueShield Minnesota,High Value Network Plan,918,90,,percent of total billed charges,,
Cystoscopy,,25000465,LOCAL,Facility,Outpatient,,,,1020,867,292.332,1020,BlueCross BlueShield Minnesota,Medicare Advantage,499.8,49,,percent of total billed charges,,
Cystoscopy,,25000465,LOCAL,Facility,Inpatient,,,,1020,867,292.332,1020,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Cystoscopy,,25000465,LOCAL,Facility,Both,,,,1020,867,292.332,1020,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,903.414,88.57,,percent of total billed charges,,
Cystoscopy,,25000465,LOCAL,Facility,Both,,,,1020,867,292.332,1020,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,292.332,28.66,,percent of total billed charges,,
Cystoscopy,,25000465,LOCAL,Facility,Outpatient,,,,1020,867,292.332,1020,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),499.8,49,,percent of total billed charges,,
Cystoscopy,,25000465,LOCAL,Facility,Inpatient,,,,1020,867,292.332,1020,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Cystoscopy,,25000465,LOCAL,Facility,Both,,,,1020,867,292.332,1020,CorVel,Worker's Compensation,1020,100,,percent of total billed charges,,
Cystoscopy,,25000465,LOCAL,Facility,Both,,,,1020,867,292.332,1020,First Health Group Corporation,First Health Network,989.4,97,,percent of total billed charges,,
Cystoscopy,,25000465,LOCAL,Facility,Both,,,,1020,867,292.332,1020,"Health Partners, Inc.",Commercial,964.92,94.6,,percent of total billed charges,,
Cystoscopy,,25000465,LOCAL,Facility,Outpatient,,,,1020,867,292.332,1020,"Health Partners, Inc.",Medicare Advantage,499.8,49,,percent of total billed charges,,
Cystoscopy,,25000465,LOCAL,Facility,Inpatient,,,,1020,867,292.332,1020,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Cystoscopy,,25000465,LOCAL,Facility,Both,,,,1020,867,292.332,1020,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),612,60,,percent of total billed charges,,
Cystoscopy,,25000465,LOCAL,Facility,Both,,,,1020,867,292.332,1020,"Health Partners, Inc.",State of Minnesota Advantage Program,831.3,81.5,,percent of total billed charges,,
Cystoscopy,,25000465,LOCAL,Facility,Both,,,,1020,867,292.332,1020,"Health Partners, Inc.",State Public Programs,510,50,,percent of total billed charges,,
Cystoscopy,,25000465,LOCAL,Facility,Both,,,,1020,867,292.332,1020,Humana Insurance Company,Commercial PPO,969,95,,percent of total billed charges,,
Cystoscopy,,25000465,LOCAL,Facility,Outpatient,,,,1020,867,292.332,1020,Humana Insurance Company,Medicare PPO,499.8,49,,percent of total billed charges,,
Cystoscopy,,25000465,LOCAL,Facility,Inpatient,,,,1020,867,292.332,1020,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Cystoscopy,,25000465,LOCAL,Facility,Both,,,,1020,867,292.332,1020,Medica,Individual & Family,1010.82,99.1,,percent of total billed charges,,
Cystoscopy,,25000465,LOCAL,Facility,Outpatient,,,,1020,867,292.332,1020,Medica,Medica Advantage Solution,507.96,49.8,,percent of total billed charges,,
Cystoscopy,,25000465,LOCAL,Facility,Inpatient,,,,1020,867,292.332,1020,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Cystoscopy,,25000465,LOCAL,Facility,Outpatient,,,,1020,867,292.332,1020,Medica,Medical Assistance,454.92,44.6,,percent of total billed charges,,
Cystoscopy,,25000465,LOCAL,Facility,Inpatient,,,,1020,867,292.332,1020,Medica,Medical Assistance,,,,,Included in per diem rate,
Cystoscopy,,25000465,LOCAL,Facility,Outpatient,,,,1020,867,292.332,1020,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,507.96,49.8,,percent of total billed charges,,
Cystoscopy,,25000465,LOCAL,Facility,Inpatient,,,,1020,867,292.332,1020,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Cystoscopy,,25000465,LOCAL,Facility,Both,,,,1020,867,292.332,1020,"Multiplan, Inc.","Multiplan, Inc.",958.8,94,,percent of total billed charges,,
Cystoscopy,,25000465,LOCAL,Facility,Outpatient,,,,1020,867,292.332,1020,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,919.02,90.1,,percent of total billed charges,,
Cystoscopy,,25000465,LOCAL,Facility,Inpatient,,,,1020,867,292.332,1020,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Cystoscopy,,25000465,LOCAL,Facility,Both,,,,1020,867,292.332,1020,"Preferred One Administrative Services, INC.",PPO,1005.72,98.6,,percent of total billed charges,,
Cystoscopy,,25000465,LOCAL,Facility,Outpatient,,,,1020,867,292.332,1020,PrimeWest Health,Minnesota Senior Health Options (MSHO),524.79,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Cystoscopy,,25000465,LOCAL,Facility,Inpatient,,,,1020,867,292.332,1020,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Cystoscopy,,25000465,LOCAL,Facility,Outpatient,,,,1020,867,292.332,1020,PrimeWest Health,MinnesotaCare,523.872,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Cystoscopy,,25000465,LOCAL,Facility,Inpatient,,,,1020,867,292.332,1020,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Cystoscopy,,25000465,LOCAL,Facility,Both,,,,1020,867,292.332,1020,Sanford Health Plan,Sanford Health Plan,938.4,92,,percent of total billed charges,,
Cystoscopy,,25000465,LOCAL,Facility,Outpatient,,,,1020,867,292.332,1020,"UCare Health, Inc.",Individual & Family Plan,574.77,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Cystoscopy,,25000465,LOCAL,Facility,Inpatient,,,,1020,867,292.332,1020,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Cystoscopy,,25000465,LOCAL,Facility,Outpatient,,,,1020,867,292.332,1020,"UCare Health, Inc.",Medical Assistance,514.794,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Cystoscopy,,25000465,LOCAL,Facility,Inpatient,,,,1020,867,292.332,1020,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Cystoscopy,,25000465,LOCAL,Facility,Outpatient,,,,1020,867,292.332,1020,"UCare Health, Inc.",Medicare Advantage,514.794,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Cystoscopy,,25000465,LOCAL,Facility,Inpatient,,,,1020,867,292.332,1020,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Cystoscopy,,25000465,LOCAL,Facility,Outpatient,,,,1020,867,292.332,1020,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),514.794,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Cystoscopy,,25000465,LOCAL,Facility,Inpatient,,,,1020,867,292.332,1020,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Cystoscopy,,25000465,LOCAL,Facility,Both,,,,1020,867,292.332,1020,UnitedHealthcare,Individual & Family,958.8,94,,percent of total billed charges,,
Cystoscopy,,25000465,LOCAL,Facility,Outpatient,,,,1020,867,292.332,1020,UnitedHealthcare,Medicare Advantage,499.8,49,,percent of total billed charges,,
Cystoscopy,,25000465,LOCAL,Facility,Inpatient,,,,1020,867,292.332,1020,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Cystoscopy,,25000465,LOCAL,Facility,Outpatient,,,,1020,867,292.332,1020,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,489.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
Cystoscopy,,25000465,LOCAL,Facility,Inpatient,,,,1020,867,292.332,1020,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Cystourethroscopy W Fulg/Bx,,25000520,LOCAL,Facility,Both,,,,2290,1946.5,656.314,2290,Aetna,Commercial,2106.8,92,,percent of total billed charges,,
Cystourethroscopy W Fulg/Bx,,25000520,LOCAL,Facility,Outpatient,,,,2290,1946.5,656.314,2290,Aetna,Medicare Advantage,1122.1,49,,percent of total billed charges,,
Cystourethroscopy W Fulg/Bx,,25000520,LOCAL,Facility,Inpatient,,,,2290,1946.5,656.314,2290,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Cystourethroscopy W Fulg/Bx,,25000520,LOCAL,Facility,Both,,,,2290,1946.5,656.314,2290,Aetna,PPO,2129.7,93,,percent of total billed charges,,
Cystourethroscopy W Fulg/Bx,,25000520,LOCAL,Facility,Both,,,,2290,1946.5,656.314,2290,America's PPO,America's PPO,2199.087,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Cystourethroscopy W Fulg/Bx,,25000520,LOCAL,Facility,Both,,,,2290,1946.5,656.314,2290,BlueCross BlueShield Minnesota, Federal Employee Program,2253.36,98.4,,percent of total billed charges,,
Cystourethroscopy W Fulg/Bx,,25000520,LOCAL,Facility,Both,,,,2290,1946.5,656.314,2290,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,2290,100,,percent of total billed charges,,
Cystourethroscopy W Fulg/Bx,,25000520,LOCAL,Facility,Both,,,,2290,1946.5,656.314,2290,BlueCross BlueShield Minnesota,High Value Network Plan,2061,90,,percent of total billed charges,,
Cystourethroscopy W Fulg/Bx,,25000520,LOCAL,Facility,Outpatient,,,,2290,1946.5,656.314,2290,BlueCross BlueShield Minnesota,Medicare Advantage,1122.1,49,,percent of total billed charges,,
Cystourethroscopy W Fulg/Bx,,25000520,LOCAL,Facility,Inpatient,,,,2290,1946.5,656.314,2290,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Cystourethroscopy W Fulg/Bx,,25000520,LOCAL,Facility,Both,,,,2290,1946.5,656.314,2290,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,2028.253,88.57,,percent of total billed charges,,
Cystourethroscopy W Fulg/Bx,,25000520,LOCAL,Facility,Both,,,,2290,1946.5,656.314,2290,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,656.314,28.66,,percent of total billed charges,,
Cystourethroscopy W Fulg/Bx,,25000520,LOCAL,Facility,Outpatient,,,,2290,1946.5,656.314,2290,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1122.1,49,,percent of total billed charges,,
Cystourethroscopy W Fulg/Bx,,25000520,LOCAL,Facility,Inpatient,,,,2290,1946.5,656.314,2290,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Cystourethroscopy W Fulg/Bx,,25000520,LOCAL,Facility,Both,,,,2290,1946.5,656.314,2290,CorVel,Worker's Compensation,2290,100,,percent of total billed charges,,
Cystourethroscopy W Fulg/Bx,,25000520,LOCAL,Facility,Both,,,,2290,1946.5,656.314,2290,First Health Group Corporation,First Health Network,2221.3,97,,percent of total billed charges,,
Cystourethroscopy W Fulg/Bx,,25000520,LOCAL,Facility,Both,,,,2290,1946.5,656.314,2290,"Health Partners, Inc.",Commercial,2166.34,94.6,,percent of total billed charges,,
Cystourethroscopy W Fulg/Bx,,25000520,LOCAL,Facility,Outpatient,,,,2290,1946.5,656.314,2290,"Health Partners, Inc.",Medicare Advantage,1122.1,49,,percent of total billed charges,,
Cystourethroscopy W Fulg/Bx,,25000520,LOCAL,Facility,Inpatient,,,,2290,1946.5,656.314,2290,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Cystourethroscopy W Fulg/Bx,,25000520,LOCAL,Facility,Both,,,,2290,1946.5,656.314,2290,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1374,60,,percent of total billed charges,,
Cystourethroscopy W Fulg/Bx,,25000520,LOCAL,Facility,Both,,,,2290,1946.5,656.314,2290,"Health Partners, Inc.",State of Minnesota Advantage Program,1866.35,81.5,,percent of total billed charges,,
Cystourethroscopy W Fulg/Bx,,25000520,LOCAL,Facility,Both,,,,2290,1946.5,656.314,2290,"Health Partners, Inc.",State Public Programs,1145,50,,percent of total billed charges,,
Cystourethroscopy W Fulg/Bx,,25000520,LOCAL,Facility,Both,,,,2290,1946.5,656.314,2290,Humana Insurance Company,Commercial PPO,2175.5,95,,percent of total billed charges,,
Cystourethroscopy W Fulg/Bx,,25000520,LOCAL,Facility,Outpatient,,,,2290,1946.5,656.314,2290,Humana Insurance Company,Medicare PPO,1122.1,49,,percent of total billed charges,,
Cystourethroscopy W Fulg/Bx,,25000520,LOCAL,Facility,Inpatient,,,,2290,1946.5,656.314,2290,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Cystourethroscopy W Fulg/Bx,,25000520,LOCAL,Facility,Both,,,,2290,1946.5,656.314,2290,Medica,Individual & Family,2269.39,99.1,,percent of total billed charges,,
Cystourethroscopy W Fulg/Bx,,25000520,LOCAL,Facility,Outpatient,,,,2290,1946.5,656.314,2290,Medica,Medica Advantage Solution,1140.42,49.8,,percent of total billed charges,,
Cystourethroscopy W Fulg/Bx,,25000520,LOCAL,Facility,Inpatient,,,,2290,1946.5,656.314,2290,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Cystourethroscopy W Fulg/Bx,,25000520,LOCAL,Facility,Outpatient,,,,2290,1946.5,656.314,2290,Medica,Medical Assistance,1021.34,44.6,,percent of total billed charges,,
Cystourethroscopy W Fulg/Bx,,25000520,LOCAL,Facility,Inpatient,,,,2290,1946.5,656.314,2290,Medica,Medical Assistance,,,,,Included in per diem rate,
Cystourethroscopy W Fulg/Bx,,25000520,LOCAL,Facility,Outpatient,,,,2290,1946.5,656.314,2290,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1140.42,49.8,,percent of total billed charges,,
Cystourethroscopy W Fulg/Bx,,25000520,LOCAL,Facility,Inpatient,,,,2290,1946.5,656.314,2290,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Cystourethroscopy W Fulg/Bx,,25000520,LOCAL,Facility,Both,,,,2290,1946.5,656.314,2290,"Multiplan, Inc.","Multiplan, Inc.",2152.6,94,,percent of total billed charges,,
Cystourethroscopy W Fulg/Bx,,25000520,LOCAL,Facility,Outpatient,,,,2290,1946.5,656.314,2290,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,2063.29,90.1,,percent of total billed charges,,
Cystourethroscopy W Fulg/Bx,,25000520,LOCAL,Facility,Inpatient,,,,2290,1946.5,656.314,2290,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Cystourethroscopy W Fulg/Bx,,25000520,LOCAL,Facility,Both,,,,2290,1946.5,656.314,2290,"Preferred One Administrative Services, INC.",PPO,2257.94,98.6,,percent of total billed charges,,
Cystourethroscopy W Fulg/Bx,,25000520,LOCAL,Facility,Outpatient,,,,2290,1946.5,656.314,2290,PrimeWest Health,Minnesota Senior Health Options (MSHO),1178.205,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Cystourethroscopy W Fulg/Bx,,25000520,LOCAL,Facility,Inpatient,,,,2290,1946.5,656.314,2290,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Cystourethroscopy W Fulg/Bx,,25000520,LOCAL,Facility,Outpatient,,,,2290,1946.5,656.314,2290,PrimeWest Health,MinnesotaCare,1176.144,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Cystourethroscopy W Fulg/Bx,,25000520,LOCAL,Facility,Inpatient,,,,2290,1946.5,656.314,2290,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Cystourethroscopy W Fulg/Bx,,25000520,LOCAL,Facility,Both,,,,2290,1946.5,656.314,2290,Sanford Health Plan,Sanford Health Plan,2106.8,92,,percent of total billed charges,,
Cystourethroscopy W Fulg/Bx,,25000520,LOCAL,Facility,Outpatient,,,,2290,1946.5,656.314,2290,"UCare Health, Inc.",Individual & Family Plan,1290.415,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Cystourethroscopy W Fulg/Bx,,25000520,LOCAL,Facility,Inpatient,,,,2290,1946.5,656.314,2290,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Cystourethroscopy W Fulg/Bx,,25000520,LOCAL,Facility,Outpatient,,,,2290,1946.5,656.314,2290,"UCare Health, Inc.",Medical Assistance,1155.763,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Cystourethroscopy W Fulg/Bx,,25000520,LOCAL,Facility,Inpatient,,,,2290,1946.5,656.314,2290,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Cystourethroscopy W Fulg/Bx,,25000520,LOCAL,Facility,Outpatient,,,,2290,1946.5,656.314,2290,"UCare Health, Inc.",Medicare Advantage,1155.763,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Cystourethroscopy W Fulg/Bx,,25000520,LOCAL,Facility,Inpatient,,,,2290,1946.5,656.314,2290,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Cystourethroscopy W Fulg/Bx,,25000520,LOCAL,Facility,Outpatient,,,,2290,1946.5,656.314,2290,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1155.763,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Cystourethroscopy W Fulg/Bx,,25000520,LOCAL,Facility,Inpatient,,,,2290,1946.5,656.314,2290,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Cystourethroscopy W Fulg/Bx,,25000520,LOCAL,Facility,Both,,,,2290,1946.5,656.314,2290,UnitedHealthcare,Individual & Family,2152.6,94,,percent of total billed charges,,
Cystourethroscopy W Fulg/Bx,,25000520,LOCAL,Facility,Outpatient,,,,2290,1946.5,656.314,2290,UnitedHealthcare,Medicare Advantage,1122.1,49,,percent of total billed charges,,
Cystourethroscopy W Fulg/Bx,,25000520,LOCAL,Facility,Inpatient,,,,2290,1946.5,656.314,2290,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Cystourethroscopy W Fulg/Bx,,25000520,LOCAL,Facility,Outpatient,,,,2290,1946.5,656.314,2290,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1099.2,48,,percent of total billed charges,,100% of DHS outpatient percentage
Cystourethroscopy W Fulg/Bx,,25000520,LOCAL,Facility,Inpatient,,,,2290,1946.5,656.314,2290,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
D & C,,25000586,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,Aetna,Commercial,2064.48,92,,percent of total billed charges,,
D & C,,25000586,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,Aetna,Medicare Advantage,1099.56,49,,percent of total billed charges,,
D & C,,25000586,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,Aetna,Medicare Advantage,,,,,Included in per diem rate,
D & C,,25000586,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,Aetna,PPO,2086.92,93,,percent of total billed charges,,
D & C,,25000586,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,America's PPO,America's PPO,2154.9132,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
D & C,,25000586,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,BlueCross BlueShield Minnesota, Federal Employee Program,2208.096,98.4,,percent of total billed charges,,
D & C,,25000586,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,2244,100,,percent of total billed charges,,
D & C,,25000586,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,BlueCross BlueShield Minnesota,High Value Network Plan,2019.6,90,,percent of total billed charges,,
D & C,,25000586,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,BlueCross BlueShield Minnesota,Medicare Advantage,1099.56,49,,percent of total billed charges,,
D & C,,25000586,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
D & C,,25000586,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1987.5108,88.57,,percent of total billed charges,,
D & C,,25000586,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,643.1304,28.66,,percent of total billed charges,,
D & C,,25000586,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1099.56,49,,percent of total billed charges,,
D & C,,25000586,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
D & C,,25000586,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,CorVel,Worker's Compensation,2244,100,,percent of total billed charges,,
D & C,,25000586,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,First Health Group Corporation,First Health Network,2176.68,97,,percent of total billed charges,,
D & C,,25000586,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,"Health Partners, Inc.",Commercial,2122.824,94.6,,percent of total billed charges,,
D & C,,25000586,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,"Health Partners, Inc.",Medicare Advantage,1099.56,49,,percent of total billed charges,,
D & C,,25000586,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
D & C,,25000586,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1346.4,60,,percent of total billed charges,,
D & C,,25000586,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,"Health Partners, Inc.",State of Minnesota Advantage Program,1828.86,81.5,,percent of total billed charges,,
D & C,,25000586,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,"Health Partners, Inc.",State Public Programs,1122,50,,percent of total billed charges,,
D & C,,25000586,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,Humana Insurance Company,Commercial PPO,2131.8,95,,percent of total billed charges,,
D & C,,25000586,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,Humana Insurance Company,Medicare PPO,1099.56,49,,percent of total billed charges,,
D & C,,25000586,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
D & C,,25000586,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,Medica,Individual & Family,2223.804,99.1,,percent of total billed charges,,
D & C,,25000586,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,Medica,Medica Advantage Solution,1117.512,49.8,,percent of total billed charges,,
D & C,,25000586,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
D & C,,25000586,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,Medica,Medical Assistance,1000.824,44.6,,percent of total billed charges,,
D & C,,25000586,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,Medica,Medical Assistance,,,,,Included in per diem rate,
D & C,,25000586,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1117.512,49.8,,percent of total billed charges,,
D & C,,25000586,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
D & C,,25000586,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,"Multiplan, Inc.","Multiplan, Inc.",2109.36,94,,percent of total billed charges,,
D & C,,25000586,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,2021.844,90.1,,percent of total billed charges,,
D & C,,25000586,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
D & C,,25000586,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,"Preferred One Administrative Services, INC.",PPO,2212.584,98.6,,percent of total billed charges,,
D & C,,25000586,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,PrimeWest Health,Minnesota Senior Health Options (MSHO),1154.538,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
D & C,,25000586,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
D & C,,25000586,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,PrimeWest Health,MinnesotaCare,1152.5184,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
D & C,,25000586,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
D & C,,25000586,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,Sanford Health Plan,Sanford Health Plan,2064.48,92,,percent of total billed charges,,
D & C,,25000586,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,"UCare Health, Inc.",Individual & Family Plan,1264.494,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
D & C,,25000586,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
D & C,,25000586,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,"UCare Health, Inc.",Medical Assistance,1132.5468,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
D & C,,25000586,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
D & C,,25000586,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,"UCare Health, Inc.",Medicare Advantage,1132.5468,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
D & C,,25000586,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
D & C,,25000586,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1132.5468,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
D & C,,25000586,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
D & C,,25000586,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,UnitedHealthcare,Individual & Family,2109.36,94,,percent of total billed charges,,
D & C,,25000586,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,UnitedHealthcare,Medicare Advantage,1099.56,49,,percent of total billed charges,,
D & C,,25000586,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
D & C,,25000586,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1077.12,48,,percent of total billed charges,,100% of DHS outpatient percentage
D & C,,25000586,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Dupuytrens Release,,25000664,LOCAL,Facility,Both,,,,3341,2839.85,957.5306,3341,Aetna,Commercial,3073.72,92,,percent of total billed charges,,
Dupuytrens Release,,25000664,LOCAL,Facility,Outpatient,,,,3341,2839.85,957.5306,3341,Aetna,Medicare Advantage,1637.09,49,,percent of total billed charges,,
Dupuytrens Release,,25000664,LOCAL,Facility,Inpatient,,,,3341,2839.85,957.5306,3341,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Dupuytrens Release,,25000664,LOCAL,Facility,Both,,,,3341,2839.85,957.5306,3341,Aetna,PPO,3107.13,93,,percent of total billed charges,,
Dupuytrens Release,,25000664,LOCAL,Facility,Both,,,,3341,2839.85,957.5306,3341,America's PPO,America's PPO,3208.3623,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Dupuytrens Release,,25000664,LOCAL,Facility,Both,,,,3341,2839.85,957.5306,3341,BlueCross BlueShield Minnesota, Federal Employee Program,3287.544,98.4,,percent of total billed charges,,
Dupuytrens Release,,25000664,LOCAL,Facility,Both,,,,3341,2839.85,957.5306,3341,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,3341,100,,percent of total billed charges,,
Dupuytrens Release,,25000664,LOCAL,Facility,Both,,,,3341,2839.85,957.5306,3341,BlueCross BlueShield Minnesota,High Value Network Plan,3006.9,90,,percent of total billed charges,,
Dupuytrens Release,,25000664,LOCAL,Facility,Outpatient,,,,3341,2839.85,957.5306,3341,BlueCross BlueShield Minnesota,Medicare Advantage,1637.09,49,,percent of total billed charges,,
Dupuytrens Release,,25000664,LOCAL,Facility,Inpatient,,,,3341,2839.85,957.5306,3341,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Dupuytrens Release,,25000664,LOCAL,Facility,Both,,,,3341,2839.85,957.5306,3341,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,2959.1237,88.57,,percent of total billed charges,,
Dupuytrens Release,,25000664,LOCAL,Facility,Both,,,,3341,2839.85,957.5306,3341,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,957.5306,28.66,,percent of total billed charges,,
Dupuytrens Release,,25000664,LOCAL,Facility,Outpatient,,,,3341,2839.85,957.5306,3341,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1637.09,49,,percent of total billed charges,,
Dupuytrens Release,,25000664,LOCAL,Facility,Inpatient,,,,3341,2839.85,957.5306,3341,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Dupuytrens Release,,25000664,LOCAL,Facility,Both,,,,3341,2839.85,957.5306,3341,CorVel,Worker's Compensation,3341,100,,percent of total billed charges,,
Dupuytrens Release,,25000664,LOCAL,Facility,Both,,,,3341,2839.85,957.5306,3341,First Health Group Corporation,First Health Network,3240.77,97,,percent of total billed charges,,
Dupuytrens Release,,25000664,LOCAL,Facility,Both,,,,3341,2839.85,957.5306,3341,"Health Partners, Inc.",Commercial,3160.586,94.6,,percent of total billed charges,,
Dupuytrens Release,,25000664,LOCAL,Facility,Outpatient,,,,3341,2839.85,957.5306,3341,"Health Partners, Inc.",Medicare Advantage,1637.09,49,,percent of total billed charges,,
Dupuytrens Release,,25000664,LOCAL,Facility,Inpatient,,,,3341,2839.85,957.5306,3341,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Dupuytrens Release,,25000664,LOCAL,Facility,Both,,,,3341,2839.85,957.5306,3341,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),2004.6,60,,percent of total billed charges,,
Dupuytrens Release,,25000664,LOCAL,Facility,Both,,,,3341,2839.85,957.5306,3341,"Health Partners, Inc.",State of Minnesota Advantage Program,2722.915,81.5,,percent of total billed charges,,
Dupuytrens Release,,25000664,LOCAL,Facility,Both,,,,3341,2839.85,957.5306,3341,"Health Partners, Inc.",State Public Programs,1670.5,50,,percent of total billed charges,,
Dupuytrens Release,,25000664,LOCAL,Facility,Both,,,,3341,2839.85,957.5306,3341,Humana Insurance Company,Commercial PPO,3173.95,95,,percent of total billed charges,,
Dupuytrens Release,,25000664,LOCAL,Facility,Outpatient,,,,3341,2839.85,957.5306,3341,Humana Insurance Company,Medicare PPO,1637.09,49,,percent of total billed charges,,
Dupuytrens Release,,25000664,LOCAL,Facility,Inpatient,,,,3341,2839.85,957.5306,3341,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Dupuytrens Release,,25000664,LOCAL,Facility,Both,,,,3341,2839.85,957.5306,3341,Medica,Individual & Family,3310.931,99.1,,percent of total billed charges,,
Dupuytrens Release,,25000664,LOCAL,Facility,Outpatient,,,,3341,2839.85,957.5306,3341,Medica,Medica Advantage Solution,1663.818,49.8,,percent of total billed charges,,
Dupuytrens Release,,25000664,LOCAL,Facility,Inpatient,,,,3341,2839.85,957.5306,3341,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Dupuytrens Release,,25000664,LOCAL,Facility,Outpatient,,,,3341,2839.85,957.5306,3341,Medica,Medical Assistance,1490.086,44.6,,percent of total billed charges,,
Dupuytrens Release,,25000664,LOCAL,Facility,Inpatient,,,,3341,2839.85,957.5306,3341,Medica,Medical Assistance,,,,,Included in per diem rate,
Dupuytrens Release,,25000664,LOCAL,Facility,Outpatient,,,,3341,2839.85,957.5306,3341,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1663.818,49.8,,percent of total billed charges,,
Dupuytrens Release,,25000664,LOCAL,Facility,Inpatient,,,,3341,2839.85,957.5306,3341,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Dupuytrens Release,,25000664,LOCAL,Facility,Both,,,,3341,2839.85,957.5306,3341,"Multiplan, Inc.","Multiplan, Inc.",3140.54,94,,percent of total billed charges,,
Dupuytrens Release,,25000664,LOCAL,Facility,Outpatient,,,,3341,2839.85,957.5306,3341,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,3010.241,90.1,,percent of total billed charges,,
Dupuytrens Release,,25000664,LOCAL,Facility,Inpatient,,,,3341,2839.85,957.5306,3341,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Dupuytrens Release,,25000664,LOCAL,Facility,Both,,,,3341,2839.85,957.5306,3341,"Preferred One Administrative Services, INC.",PPO,3294.226,98.6,,percent of total billed charges,,
Dupuytrens Release,,25000664,LOCAL,Facility,Outpatient,,,,3341,2839.85,957.5306,3341,PrimeWest Health,Minnesota Senior Health Options (MSHO),1718.9445,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Dupuytrens Release,,25000664,LOCAL,Facility,Inpatient,,,,3341,2839.85,957.5306,3341,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Dupuytrens Release,,25000664,LOCAL,Facility,Outpatient,,,,3341,2839.85,957.5306,3341,PrimeWest Health,MinnesotaCare,1715.9376,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Dupuytrens Release,,25000664,LOCAL,Facility,Inpatient,,,,3341,2839.85,957.5306,3341,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Dupuytrens Release,,25000664,LOCAL,Facility,Both,,,,3341,2839.85,957.5306,3341,Sanford Health Plan,Sanford Health Plan,3073.72,92,,percent of total billed charges,,
Dupuytrens Release,,25000664,LOCAL,Facility,Outpatient,,,,3341,2839.85,957.5306,3341,"UCare Health, Inc.",Individual & Family Plan,1882.6535,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Dupuytrens Release,,25000664,LOCAL,Facility,Inpatient,,,,3341,2839.85,957.5306,3341,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Dupuytrens Release,,25000664,LOCAL,Facility,Outpatient,,,,3341,2839.85,957.5306,3341,"UCare Health, Inc.",Medical Assistance,1686.2027,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Dupuytrens Release,,25000664,LOCAL,Facility,Inpatient,,,,3341,2839.85,957.5306,3341,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Dupuytrens Release,,25000664,LOCAL,Facility,Outpatient,,,,3341,2839.85,957.5306,3341,"UCare Health, Inc.",Medicare Advantage,1686.2027,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Dupuytrens Release,,25000664,LOCAL,Facility,Inpatient,,,,3341,2839.85,957.5306,3341,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Dupuytrens Release,,25000664,LOCAL,Facility,Outpatient,,,,3341,2839.85,957.5306,3341,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1686.2027,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Dupuytrens Release,,25000664,LOCAL,Facility,Inpatient,,,,3341,2839.85,957.5306,3341,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Dupuytrens Release,,25000664,LOCAL,Facility,Both,,,,3341,2839.85,957.5306,3341,UnitedHealthcare,Individual & Family,3140.54,94,,percent of total billed charges,,
Dupuytrens Release,,25000664,LOCAL,Facility,Outpatient,,,,3341,2839.85,957.5306,3341,UnitedHealthcare,Medicare Advantage,1637.09,49,,percent of total billed charges,,
Dupuytrens Release,,25000664,LOCAL,Facility,Inpatient,,,,3341,2839.85,957.5306,3341,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Dupuytrens Release,,25000664,LOCAL,Facility,Outpatient,,,,3341,2839.85,957.5306,3341,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1603.68,48,,percent of total billed charges,,100% of DHS outpatient percentage
Dupuytrens Release,,25000664,LOCAL,Facility,Inpatient,,,,3341,2839.85,957.5306,3341,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Endo Pubo-Vag Bladder Sling W/Tvt,,25000692,LOCAL,Facility,Both,,,,4437,3771.45,1271.6442,4437,Aetna,Commercial,4082.04,92,,percent of total billed charges,,
Endo Pubo-Vag Bladder Sling W/Tvt,,25000692,LOCAL,Facility,Outpatient,,,,4437,3771.45,1271.6442,4437,Aetna,Medicare Advantage,2174.13,49,,percent of total billed charges,,
Endo Pubo-Vag Bladder Sling W/Tvt,,25000692,LOCAL,Facility,Inpatient,,,,4437,3771.45,1271.6442,4437,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Endo Pubo-Vag Bladder Sling W/Tvt,,25000692,LOCAL,Facility,Both,,,,4437,3771.45,1271.6442,4437,Aetna,PPO,4126.41,93,,percent of total billed charges,,
Endo Pubo-Vag Bladder Sling W/Tvt,,25000692,LOCAL,Facility,Both,,,,4437,3771.45,1271.6442,4437,America's PPO,America's PPO,4260.8511,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Endo Pubo-Vag Bladder Sling W/Tvt,,25000692,LOCAL,Facility,Both,,,,4437,3771.45,1271.6442,4437,BlueCross BlueShield Minnesota, Federal Employee Program,4366.008,98.4,,percent of total billed charges,,
Endo Pubo-Vag Bladder Sling W/Tvt,,25000692,LOCAL,Facility,Both,,,,4437,3771.45,1271.6442,4437,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,4437,100,,percent of total billed charges,,
Endo Pubo-Vag Bladder Sling W/Tvt,,25000692,LOCAL,Facility,Both,,,,4437,3771.45,1271.6442,4437,BlueCross BlueShield Minnesota,High Value Network Plan,3993.3,90,,percent of total billed charges,,
Endo Pubo-Vag Bladder Sling W/Tvt,,25000692,LOCAL,Facility,Outpatient,,,,4437,3771.45,1271.6442,4437,BlueCross BlueShield Minnesota,Medicare Advantage,2174.13,49,,percent of total billed charges,,
Endo Pubo-Vag Bladder Sling W/Tvt,,25000692,LOCAL,Facility,Inpatient,,,,4437,3771.45,1271.6442,4437,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Endo Pubo-Vag Bladder Sling W/Tvt,,25000692,LOCAL,Facility,Both,,,,4437,3771.45,1271.6442,4437,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,3929.8509,88.57,,percent of total billed charges,,
Endo Pubo-Vag Bladder Sling W/Tvt,,25000692,LOCAL,Facility,Both,,,,4437,3771.45,1271.6442,4437,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1271.6442,28.66,,percent of total billed charges,,
Endo Pubo-Vag Bladder Sling W/Tvt,,25000692,LOCAL,Facility,Outpatient,,,,4437,3771.45,1271.6442,4437,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2174.13,49,,percent of total billed charges,,
Endo Pubo-Vag Bladder Sling W/Tvt,,25000692,LOCAL,Facility,Inpatient,,,,4437,3771.45,1271.6442,4437,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Endo Pubo-Vag Bladder Sling W/Tvt,,25000692,LOCAL,Facility,Both,,,,4437,3771.45,1271.6442,4437,CorVel,Worker's Compensation,4437,100,,percent of total billed charges,,
Endo Pubo-Vag Bladder Sling W/Tvt,,25000692,LOCAL,Facility,Both,,,,4437,3771.45,1271.6442,4437,First Health Group Corporation,First Health Network,4303.89,97,,percent of total billed charges,,
Endo Pubo-Vag Bladder Sling W/Tvt,,25000692,LOCAL,Facility,Both,,,,4437,3771.45,1271.6442,4437,"Health Partners, Inc.",Commercial,4197.402,94.6,,percent of total billed charges,,
Endo Pubo-Vag Bladder Sling W/Tvt,,25000692,LOCAL,Facility,Outpatient,,,,4437,3771.45,1271.6442,4437,"Health Partners, Inc.",Medicare Advantage,2174.13,49,,percent of total billed charges,,
Endo Pubo-Vag Bladder Sling W/Tvt,,25000692,LOCAL,Facility,Inpatient,,,,4437,3771.45,1271.6442,4437,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Endo Pubo-Vag Bladder Sling W/Tvt,,25000692,LOCAL,Facility,Both,,,,4437,3771.45,1271.6442,4437,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),2662.2,60,,percent of total billed charges,,
Endo Pubo-Vag Bladder Sling W/Tvt,,25000692,LOCAL,Facility,Both,,,,4437,3771.45,1271.6442,4437,"Health Partners, Inc.",State of Minnesota Advantage Program,3616.155,81.5,,percent of total billed charges,,
Endo Pubo-Vag Bladder Sling W/Tvt,,25000692,LOCAL,Facility,Both,,,,4437,3771.45,1271.6442,4437,"Health Partners, Inc.",State Public Programs,2218.5,50,,percent of total billed charges,,
Endo Pubo-Vag Bladder Sling W/Tvt,,25000692,LOCAL,Facility,Both,,,,4437,3771.45,1271.6442,4437,Humana Insurance Company,Commercial PPO,4215.15,95,,percent of total billed charges,,
Endo Pubo-Vag Bladder Sling W/Tvt,,25000692,LOCAL,Facility,Outpatient,,,,4437,3771.45,1271.6442,4437,Humana Insurance Company,Medicare PPO,2174.13,49,,percent of total billed charges,,
Endo Pubo-Vag Bladder Sling W/Tvt,,25000692,LOCAL,Facility,Inpatient,,,,4437,3771.45,1271.6442,4437,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Endo Pubo-Vag Bladder Sling W/Tvt,,25000692,LOCAL,Facility,Both,,,,4437,3771.45,1271.6442,4437,Medica,Individual & Family,4397.067,99.1,,percent of total billed charges,,
Endo Pubo-Vag Bladder Sling W/Tvt,,25000692,LOCAL,Facility,Outpatient,,,,4437,3771.45,1271.6442,4437,Medica,Medica Advantage Solution,2209.626,49.8,,percent of total billed charges,,
Endo Pubo-Vag Bladder Sling W/Tvt,,25000692,LOCAL,Facility,Inpatient,,,,4437,3771.45,1271.6442,4437,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Endo Pubo-Vag Bladder Sling W/Tvt,,25000692,LOCAL,Facility,Outpatient,,,,4437,3771.45,1271.6442,4437,Medica,Medical Assistance,1978.902,44.6,,percent of total billed charges,,
Endo Pubo-Vag Bladder Sling W/Tvt,,25000692,LOCAL,Facility,Inpatient,,,,4437,3771.45,1271.6442,4437,Medica,Medical Assistance,,,,,Included in per diem rate,
Endo Pubo-Vag Bladder Sling W/Tvt,,25000692,LOCAL,Facility,Outpatient,,,,4437,3771.45,1271.6442,4437,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2209.626,49.8,,percent of total billed charges,,
Endo Pubo-Vag Bladder Sling W/Tvt,,25000692,LOCAL,Facility,Inpatient,,,,4437,3771.45,1271.6442,4437,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Endo Pubo-Vag Bladder Sling W/Tvt,,25000692,LOCAL,Facility,Both,,,,4437,3771.45,1271.6442,4437,"Multiplan, Inc.","Multiplan, Inc.",4170.78,94,,percent of total billed charges,,
Endo Pubo-Vag Bladder Sling W/Tvt,,25000692,LOCAL,Facility,Outpatient,,,,4437,3771.45,1271.6442,4437,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,3997.737,90.1,,percent of total billed charges,,
Endo Pubo-Vag Bladder Sling W/Tvt,,25000692,LOCAL,Facility,Inpatient,,,,4437,3771.45,1271.6442,4437,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Endo Pubo-Vag Bladder Sling W/Tvt,,25000692,LOCAL,Facility,Both,,,,4437,3771.45,1271.6442,4437,"Preferred One Administrative Services, INC.",PPO,4374.882,98.6,,percent of total billed charges,,
Endo Pubo-Vag Bladder Sling W/Tvt,,25000692,LOCAL,Facility,Outpatient,,,,4437,3771.45,1271.6442,4437,PrimeWest Health,Minnesota Senior Health Options (MSHO),2282.8365,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Endo Pubo-Vag Bladder Sling W/Tvt,,25000692,LOCAL,Facility,Inpatient,,,,4437,3771.45,1271.6442,4437,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Endo Pubo-Vag Bladder Sling W/Tvt,,25000692,LOCAL,Facility,Outpatient,,,,4437,3771.45,1271.6442,4437,PrimeWest Health,MinnesotaCare,2278.8432,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Endo Pubo-Vag Bladder Sling W/Tvt,,25000692,LOCAL,Facility,Inpatient,,,,4437,3771.45,1271.6442,4437,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Endo Pubo-Vag Bladder Sling W/Tvt,,25000692,LOCAL,Facility,Both,,,,4437,3771.45,1271.6442,4437,Sanford Health Plan,Sanford Health Plan,4082.04,92,,percent of total billed charges,,
Endo Pubo-Vag Bladder Sling W/Tvt,,25000692,LOCAL,Facility,Outpatient,,,,4437,3771.45,1271.6442,4437,"UCare Health, Inc.",Individual & Family Plan,2500.2495,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Endo Pubo-Vag Bladder Sling W/Tvt,,25000692,LOCAL,Facility,Inpatient,,,,4437,3771.45,1271.6442,4437,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Endo Pubo-Vag Bladder Sling W/Tvt,,25000692,LOCAL,Facility,Outpatient,,,,4437,3771.45,1271.6442,4437,"UCare Health, Inc.",Medical Assistance,2239.3539,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Endo Pubo-Vag Bladder Sling W/Tvt,,25000692,LOCAL,Facility,Inpatient,,,,4437,3771.45,1271.6442,4437,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Endo Pubo-Vag Bladder Sling W/Tvt,,25000692,LOCAL,Facility,Outpatient,,,,4437,3771.45,1271.6442,4437,"UCare Health, Inc.",Medicare Advantage,2239.3539,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Endo Pubo-Vag Bladder Sling W/Tvt,,25000692,LOCAL,Facility,Inpatient,,,,4437,3771.45,1271.6442,4437,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Endo Pubo-Vag Bladder Sling W/Tvt,,25000692,LOCAL,Facility,Outpatient,,,,4437,3771.45,1271.6442,4437,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2239.3539,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Endo Pubo-Vag Bladder Sling W/Tvt,,25000692,LOCAL,Facility,Inpatient,,,,4437,3771.45,1271.6442,4437,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Endo Pubo-Vag Bladder Sling W/Tvt,,25000692,LOCAL,Facility,Both,,,,4437,3771.45,1271.6442,4437,UnitedHealthcare,Individual & Family,4170.78,94,,percent of total billed charges,,
Endo Pubo-Vag Bladder Sling W/Tvt,,25000692,LOCAL,Facility,Outpatient,,,,4437,3771.45,1271.6442,4437,UnitedHealthcare,Medicare Advantage,2174.13,49,,percent of total billed charges,,
Endo Pubo-Vag Bladder Sling W/Tvt,,25000692,LOCAL,Facility,Inpatient,,,,4437,3771.45,1271.6442,4437,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Endo Pubo-Vag Bladder Sling W/Tvt,,25000692,LOCAL,Facility,Outpatient,,,,4437,3771.45,1271.6442,4437,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2129.76,48,,percent of total billed charges,,100% of DHS outpatient percentage
Endo Pubo-Vag Bladder Sling W/Tvt,,25000692,LOCAL,Facility,Inpatient,,,,4437,3771.45,1271.6442,4437,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Esophagogastroduodenoscopy,,25000753,LOCAL,Facility,Both,,,,2519,2141.15,721.9454,2519,Aetna,Commercial,2317.48,92,,percent of total billed charges,,
Esophagogastroduodenoscopy,,25000753,LOCAL,Facility,Outpatient,,,,2519,2141.15,721.9454,2519,Aetna,Medicare Advantage,1234.31,49,,percent of total billed charges,,
Esophagogastroduodenoscopy,,25000753,LOCAL,Facility,Inpatient,,,,2519,2141.15,721.9454,2519,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Esophagogastroduodenoscopy,,25000753,LOCAL,Facility,Both,,,,2519,2141.15,721.9454,2519,Aetna,PPO,2342.67,93,,percent of total billed charges,,
Esophagogastroduodenoscopy,,25000753,LOCAL,Facility,Both,,,,2519,2141.15,721.9454,2519,America's PPO,America's PPO,2418.9957,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Esophagogastroduodenoscopy,,25000753,LOCAL,Facility,Both,,,,2519,2141.15,721.9454,2519,BlueCross BlueShield Minnesota, Federal Employee Program,2478.696,98.4,,percent of total billed charges,,
Esophagogastroduodenoscopy,,25000753,LOCAL,Facility,Both,,,,2519,2141.15,721.9454,2519,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,2519,100,,percent of total billed charges,,
Esophagogastroduodenoscopy,,25000753,LOCAL,Facility,Both,,,,2519,2141.15,721.9454,2519,BlueCross BlueShield Minnesota,High Value Network Plan,2267.1,90,,percent of total billed charges,,
Esophagogastroduodenoscopy,,25000753,LOCAL,Facility,Outpatient,,,,2519,2141.15,721.9454,2519,BlueCross BlueShield Minnesota,Medicare Advantage,1234.31,49,,percent of total billed charges,,
Esophagogastroduodenoscopy,,25000753,LOCAL,Facility,Inpatient,,,,2519,2141.15,721.9454,2519,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Esophagogastroduodenoscopy,,25000753,LOCAL,Facility,Both,,,,2519,2141.15,721.9454,2519,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,2231.0783,88.57,,percent of total billed charges,,
Esophagogastroduodenoscopy,,25000753,LOCAL,Facility,Both,,,,2519,2141.15,721.9454,2519,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,721.9454,28.66,,percent of total billed charges,,
Esophagogastroduodenoscopy,,25000753,LOCAL,Facility,Outpatient,,,,2519,2141.15,721.9454,2519,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1234.31,49,,percent of total billed charges,,
Esophagogastroduodenoscopy,,25000753,LOCAL,Facility,Inpatient,,,,2519,2141.15,721.9454,2519,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Esophagogastroduodenoscopy,,25000753,LOCAL,Facility,Both,,,,2519,2141.15,721.9454,2519,CorVel,Worker's Compensation,2519,100,,percent of total billed charges,,
Esophagogastroduodenoscopy,,25000753,LOCAL,Facility,Both,,,,2519,2141.15,721.9454,2519,First Health Group Corporation,First Health Network,2443.43,97,,percent of total billed charges,,
Esophagogastroduodenoscopy,,25000753,LOCAL,Facility,Both,,,,2519,2141.15,721.9454,2519,"Health Partners, Inc.",Commercial,2382.974,94.6,,percent of total billed charges,,
Esophagogastroduodenoscopy,,25000753,LOCAL,Facility,Outpatient,,,,2519,2141.15,721.9454,2519,"Health Partners, Inc.",Medicare Advantage,1234.31,49,,percent of total billed charges,,
Esophagogastroduodenoscopy,,25000753,LOCAL,Facility,Inpatient,,,,2519,2141.15,721.9454,2519,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Esophagogastroduodenoscopy,,25000753,LOCAL,Facility,Both,,,,2519,2141.15,721.9454,2519,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1511.4,60,,percent of total billed charges,,
Esophagogastroduodenoscopy,,25000753,LOCAL,Facility,Both,,,,2519,2141.15,721.9454,2519,"Health Partners, Inc.",State of Minnesota Advantage Program,2052.985,81.5,,percent of total billed charges,,
Esophagogastroduodenoscopy,,25000753,LOCAL,Facility,Both,,,,2519,2141.15,721.9454,2519,"Health Partners, Inc.",State Public Programs,1259.5,50,,percent of total billed charges,,
Esophagogastroduodenoscopy,,25000753,LOCAL,Facility,Both,,,,2519,2141.15,721.9454,2519,Humana Insurance Company,Commercial PPO,2393.05,95,,percent of total billed charges,,
Esophagogastroduodenoscopy,,25000753,LOCAL,Facility,Outpatient,,,,2519,2141.15,721.9454,2519,Humana Insurance Company,Medicare PPO,1234.31,49,,percent of total billed charges,,
Esophagogastroduodenoscopy,,25000753,LOCAL,Facility,Inpatient,,,,2519,2141.15,721.9454,2519,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Esophagogastroduodenoscopy,,25000753,LOCAL,Facility,Both,,,,2519,2141.15,721.9454,2519,Medica,Individual & Family,2496.329,99.1,,percent of total billed charges,,
Esophagogastroduodenoscopy,,25000753,LOCAL,Facility,Outpatient,,,,2519,2141.15,721.9454,2519,Medica,Medica Advantage Solution,1254.462,49.8,,percent of total billed charges,,
Esophagogastroduodenoscopy,,25000753,LOCAL,Facility,Inpatient,,,,2519,2141.15,721.9454,2519,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Esophagogastroduodenoscopy,,25000753,LOCAL,Facility,Outpatient,,,,2519,2141.15,721.9454,2519,Medica,Medical Assistance,1123.474,44.6,,percent of total billed charges,,
Esophagogastroduodenoscopy,,25000753,LOCAL,Facility,Inpatient,,,,2519,2141.15,721.9454,2519,Medica,Medical Assistance,,,,,Included in per diem rate,
Esophagogastroduodenoscopy,,25000753,LOCAL,Facility,Outpatient,,,,2519,2141.15,721.9454,2519,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1254.462,49.8,,percent of total billed charges,,
Esophagogastroduodenoscopy,,25000753,LOCAL,Facility,Inpatient,,,,2519,2141.15,721.9454,2519,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Esophagogastroduodenoscopy,,25000753,LOCAL,Facility,Both,,,,2519,2141.15,721.9454,2519,"Multiplan, Inc.","Multiplan, Inc.",2367.86,94,,percent of total billed charges,,
Esophagogastroduodenoscopy,,25000753,LOCAL,Facility,Outpatient,,,,2519,2141.15,721.9454,2519,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,2269.619,90.1,,percent of total billed charges,,
Esophagogastroduodenoscopy,,25000753,LOCAL,Facility,Inpatient,,,,2519,2141.15,721.9454,2519,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Esophagogastroduodenoscopy,,25000753,LOCAL,Facility,Both,,,,2519,2141.15,721.9454,2519,"Preferred One Administrative Services, INC.",PPO,2483.734,98.6,,percent of total billed charges,,
Esophagogastroduodenoscopy,,25000753,LOCAL,Facility,Outpatient,,,,2519,2141.15,721.9454,2519,PrimeWest Health,Minnesota Senior Health Options (MSHO),1296.0255,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Esophagogastroduodenoscopy,,25000753,LOCAL,Facility,Inpatient,,,,2519,2141.15,721.9454,2519,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Esophagogastroduodenoscopy,,25000753,LOCAL,Facility,Outpatient,,,,2519,2141.15,721.9454,2519,PrimeWest Health,MinnesotaCare,1293.7584,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Esophagogastroduodenoscopy,,25000753,LOCAL,Facility,Inpatient,,,,2519,2141.15,721.9454,2519,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Esophagogastroduodenoscopy,,25000753,LOCAL,Facility,Both,,,,2519,2141.15,721.9454,2519,Sanford Health Plan,Sanford Health Plan,2317.48,92,,percent of total billed charges,,
Esophagogastroduodenoscopy,,25000753,LOCAL,Facility,Outpatient,,,,2519,2141.15,721.9454,2519,"UCare Health, Inc.",Individual & Family Plan,1419.4565,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Esophagogastroduodenoscopy,,25000753,LOCAL,Facility,Inpatient,,,,2519,2141.15,721.9454,2519,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Esophagogastroduodenoscopy,,25000753,LOCAL,Facility,Outpatient,,,,2519,2141.15,721.9454,2519,"UCare Health, Inc.",Medical Assistance,1271.3393,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Esophagogastroduodenoscopy,,25000753,LOCAL,Facility,Inpatient,,,,2519,2141.15,721.9454,2519,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Esophagogastroduodenoscopy,,25000753,LOCAL,Facility,Outpatient,,,,2519,2141.15,721.9454,2519,"UCare Health, Inc.",Medicare Advantage,1271.3393,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Esophagogastroduodenoscopy,,25000753,LOCAL,Facility,Inpatient,,,,2519,2141.15,721.9454,2519,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Esophagogastroduodenoscopy,,25000753,LOCAL,Facility,Outpatient,,,,2519,2141.15,721.9454,2519,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1271.3393,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Esophagogastroduodenoscopy,,25000753,LOCAL,Facility,Inpatient,,,,2519,2141.15,721.9454,2519,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Esophagogastroduodenoscopy,,25000753,LOCAL,Facility,Both,,,,2519,2141.15,721.9454,2519,UnitedHealthcare,Individual & Family,2367.86,94,,percent of total billed charges,,
Esophagogastroduodenoscopy,,25000753,LOCAL,Facility,Outpatient,,,,2519,2141.15,721.9454,2519,UnitedHealthcare,Medicare Advantage,1234.31,49,,percent of total billed charges,,
Esophagogastroduodenoscopy,,25000753,LOCAL,Facility,Inpatient,,,,2519,2141.15,721.9454,2519,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Esophagogastroduodenoscopy,,25000753,LOCAL,Facility,Outpatient,,,,2519,2141.15,721.9454,2519,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1209.12,48,,percent of total billed charges,,100% of DHS outpatient percentage
Esophagogastroduodenoscopy,,25000753,LOCAL,Facility,Inpatient,,,,2519,2141.15,721.9454,2519,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Esophagogastroduodenoscopy W Dilitation,,25000767,LOCAL,Facility,Both,,,,2519,2141.15,721.9454,2519,Aetna,Commercial,2317.48,92,,percent of total billed charges,,
Esophagogastroduodenoscopy W Dilitation,,25000767,LOCAL,Facility,Outpatient,,,,2519,2141.15,721.9454,2519,Aetna,Medicare Advantage,1234.31,49,,percent of total billed charges,,
Esophagogastroduodenoscopy W Dilitation,,25000767,LOCAL,Facility,Inpatient,,,,2519,2141.15,721.9454,2519,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Esophagogastroduodenoscopy W Dilitation,,25000767,LOCAL,Facility,Both,,,,2519,2141.15,721.9454,2519,Aetna,PPO,2342.67,93,,percent of total billed charges,,
Esophagogastroduodenoscopy W Dilitation,,25000767,LOCAL,Facility,Both,,,,2519,2141.15,721.9454,2519,America's PPO,America's PPO,2418.9957,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Esophagogastroduodenoscopy W Dilitation,,25000767,LOCAL,Facility,Both,,,,2519,2141.15,721.9454,2519,BlueCross BlueShield Minnesota, Federal Employee Program,2478.696,98.4,,percent of total billed charges,,
Esophagogastroduodenoscopy W Dilitation,,25000767,LOCAL,Facility,Both,,,,2519,2141.15,721.9454,2519,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,2519,100,,percent of total billed charges,,
Esophagogastroduodenoscopy W Dilitation,,25000767,LOCAL,Facility,Both,,,,2519,2141.15,721.9454,2519,BlueCross BlueShield Minnesota,High Value Network Plan,2267.1,90,,percent of total billed charges,,
Esophagogastroduodenoscopy W Dilitation,,25000767,LOCAL,Facility,Outpatient,,,,2519,2141.15,721.9454,2519,BlueCross BlueShield Minnesota,Medicare Advantage,1234.31,49,,percent of total billed charges,,
Esophagogastroduodenoscopy W Dilitation,,25000767,LOCAL,Facility,Inpatient,,,,2519,2141.15,721.9454,2519,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Esophagogastroduodenoscopy W Dilitation,,25000767,LOCAL,Facility,Both,,,,2519,2141.15,721.9454,2519,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,2231.0783,88.57,,percent of total billed charges,,
Esophagogastroduodenoscopy W Dilitation,,25000767,LOCAL,Facility,Both,,,,2519,2141.15,721.9454,2519,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,721.9454,28.66,,percent of total billed charges,,
Esophagogastroduodenoscopy W Dilitation,,25000767,LOCAL,Facility,Outpatient,,,,2519,2141.15,721.9454,2519,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1234.31,49,,percent of total billed charges,,
Esophagogastroduodenoscopy W Dilitation,,25000767,LOCAL,Facility,Inpatient,,,,2519,2141.15,721.9454,2519,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Esophagogastroduodenoscopy W Dilitation,,25000767,LOCAL,Facility,Both,,,,2519,2141.15,721.9454,2519,CorVel,Worker's Compensation,2519,100,,percent of total billed charges,,
Esophagogastroduodenoscopy W Dilitation,,25000767,LOCAL,Facility,Both,,,,2519,2141.15,721.9454,2519,First Health Group Corporation,First Health Network,2443.43,97,,percent of total billed charges,,
Esophagogastroduodenoscopy W Dilitation,,25000767,LOCAL,Facility,Both,,,,2519,2141.15,721.9454,2519,"Health Partners, Inc.",Commercial,2382.974,94.6,,percent of total billed charges,,
Esophagogastroduodenoscopy W Dilitation,,25000767,LOCAL,Facility,Outpatient,,,,2519,2141.15,721.9454,2519,"Health Partners, Inc.",Medicare Advantage,1234.31,49,,percent of total billed charges,,
Esophagogastroduodenoscopy W Dilitation,,25000767,LOCAL,Facility,Inpatient,,,,2519,2141.15,721.9454,2519,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Esophagogastroduodenoscopy W Dilitation,,25000767,LOCAL,Facility,Both,,,,2519,2141.15,721.9454,2519,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1511.4,60,,percent of total billed charges,,
Esophagogastroduodenoscopy W Dilitation,,25000767,LOCAL,Facility,Both,,,,2519,2141.15,721.9454,2519,"Health Partners, Inc.",State of Minnesota Advantage Program,2052.985,81.5,,percent of total billed charges,,
Esophagogastroduodenoscopy W Dilitation,,25000767,LOCAL,Facility,Both,,,,2519,2141.15,721.9454,2519,"Health Partners, Inc.",State Public Programs,1259.5,50,,percent of total billed charges,,
Esophagogastroduodenoscopy W Dilitation,,25000767,LOCAL,Facility,Both,,,,2519,2141.15,721.9454,2519,Humana Insurance Company,Commercial PPO,2393.05,95,,percent of total billed charges,,
Esophagogastroduodenoscopy W Dilitation,,25000767,LOCAL,Facility,Outpatient,,,,2519,2141.15,721.9454,2519,Humana Insurance Company,Medicare PPO,1234.31,49,,percent of total billed charges,,
Esophagogastroduodenoscopy W Dilitation,,25000767,LOCAL,Facility,Inpatient,,,,2519,2141.15,721.9454,2519,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Esophagogastroduodenoscopy W Dilitation,,25000767,LOCAL,Facility,Both,,,,2519,2141.15,721.9454,2519,Medica,Individual & Family,2496.329,99.1,,percent of total billed charges,,
Esophagogastroduodenoscopy W Dilitation,,25000767,LOCAL,Facility,Outpatient,,,,2519,2141.15,721.9454,2519,Medica,Medica Advantage Solution,1254.462,49.8,,percent of total billed charges,,
Esophagogastroduodenoscopy W Dilitation,,25000767,LOCAL,Facility,Inpatient,,,,2519,2141.15,721.9454,2519,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Esophagogastroduodenoscopy W Dilitation,,25000767,LOCAL,Facility,Outpatient,,,,2519,2141.15,721.9454,2519,Medica,Medical Assistance,1123.474,44.6,,percent of total billed charges,,
Esophagogastroduodenoscopy W Dilitation,,25000767,LOCAL,Facility,Inpatient,,,,2519,2141.15,721.9454,2519,Medica,Medical Assistance,,,,,Included in per diem rate,
Esophagogastroduodenoscopy W Dilitation,,25000767,LOCAL,Facility,Outpatient,,,,2519,2141.15,721.9454,2519,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1254.462,49.8,,percent of total billed charges,,
Esophagogastroduodenoscopy W Dilitation,,25000767,LOCAL,Facility,Inpatient,,,,2519,2141.15,721.9454,2519,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Esophagogastroduodenoscopy W Dilitation,,25000767,LOCAL,Facility,Both,,,,2519,2141.15,721.9454,2519,"Multiplan, Inc.","Multiplan, Inc.",2367.86,94,,percent of total billed charges,,
Esophagogastroduodenoscopy W Dilitation,,25000767,LOCAL,Facility,Outpatient,,,,2519,2141.15,721.9454,2519,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,2269.619,90.1,,percent of total billed charges,,
Esophagogastroduodenoscopy W Dilitation,,25000767,LOCAL,Facility,Inpatient,,,,2519,2141.15,721.9454,2519,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Esophagogastroduodenoscopy W Dilitation,,25000767,LOCAL,Facility,Both,,,,2519,2141.15,721.9454,2519,"Preferred One Administrative Services, INC.",PPO,2483.734,98.6,,percent of total billed charges,,
Esophagogastroduodenoscopy W Dilitation,,25000767,LOCAL,Facility,Outpatient,,,,2519,2141.15,721.9454,2519,PrimeWest Health,Minnesota Senior Health Options (MSHO),1296.0255,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Esophagogastroduodenoscopy W Dilitation,,25000767,LOCAL,Facility,Inpatient,,,,2519,2141.15,721.9454,2519,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Esophagogastroduodenoscopy W Dilitation,,25000767,LOCAL,Facility,Outpatient,,,,2519,2141.15,721.9454,2519,PrimeWest Health,MinnesotaCare,1293.7584,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Esophagogastroduodenoscopy W Dilitation,,25000767,LOCAL,Facility,Inpatient,,,,2519,2141.15,721.9454,2519,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Esophagogastroduodenoscopy W Dilitation,,25000767,LOCAL,Facility,Both,,,,2519,2141.15,721.9454,2519,Sanford Health Plan,Sanford Health Plan,2317.48,92,,percent of total billed charges,,
Esophagogastroduodenoscopy W Dilitation,,25000767,LOCAL,Facility,Outpatient,,,,2519,2141.15,721.9454,2519,"UCare Health, Inc.",Individual & Family Plan,1419.4565,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Esophagogastroduodenoscopy W Dilitation,,25000767,LOCAL,Facility,Inpatient,,,,2519,2141.15,721.9454,2519,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Esophagogastroduodenoscopy W Dilitation,,25000767,LOCAL,Facility,Outpatient,,,,2519,2141.15,721.9454,2519,"UCare Health, Inc.",Medical Assistance,1271.3393,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Esophagogastroduodenoscopy W Dilitation,,25000767,LOCAL,Facility,Inpatient,,,,2519,2141.15,721.9454,2519,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Esophagogastroduodenoscopy W Dilitation,,25000767,LOCAL,Facility,Outpatient,,,,2519,2141.15,721.9454,2519,"UCare Health, Inc.",Medicare Advantage,1271.3393,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Esophagogastroduodenoscopy W Dilitation,,25000767,LOCAL,Facility,Inpatient,,,,2519,2141.15,721.9454,2519,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Esophagogastroduodenoscopy W Dilitation,,25000767,LOCAL,Facility,Outpatient,,,,2519,2141.15,721.9454,2519,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1271.3393,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Esophagogastroduodenoscopy W Dilitation,,25000767,LOCAL,Facility,Inpatient,,,,2519,2141.15,721.9454,2519,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Esophagogastroduodenoscopy W Dilitation,,25000767,LOCAL,Facility,Both,,,,2519,2141.15,721.9454,2519,UnitedHealthcare,Individual & Family,2367.86,94,,percent of total billed charges,,
Esophagogastroduodenoscopy W Dilitation,,25000767,LOCAL,Facility,Outpatient,,,,2519,2141.15,721.9454,2519,UnitedHealthcare,Medicare Advantage,1234.31,49,,percent of total billed charges,,
Esophagogastroduodenoscopy W Dilitation,,25000767,LOCAL,Facility,Inpatient,,,,2519,2141.15,721.9454,2519,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Esophagogastroduodenoscopy W Dilitation,,25000767,LOCAL,Facility,Outpatient,,,,2519,2141.15,721.9454,2519,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1209.12,48,,percent of total billed charges,,100% of DHS outpatient percentage
Esophagogastroduodenoscopy W Dilitation,,25000767,LOCAL,Facility,Inpatient,,,,2519,2141.15,721.9454,2519,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Excision Of Axillary Lymph Node,,25000908,LOCAL,Facility,Both,,,,2346,1994.1,672.3636,2346,Aetna,Commercial,2158.32,92,,percent of total billed charges,,
Excision Of Axillary Lymph Node,,25000908,LOCAL,Facility,Outpatient,,,,2346,1994.1,672.3636,2346,Aetna,Medicare Advantage,1149.54,49,,percent of total billed charges,,
Excision Of Axillary Lymph Node,,25000908,LOCAL,Facility,Inpatient,,,,2346,1994.1,672.3636,2346,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Excision Of Axillary Lymph Node,,25000908,LOCAL,Facility,Both,,,,2346,1994.1,672.3636,2346,Aetna,PPO,2181.78,93,,percent of total billed charges,,
Excision Of Axillary Lymph Node,,25000908,LOCAL,Facility,Both,,,,2346,1994.1,672.3636,2346,America's PPO,America's PPO,2252.8638,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Excision Of Axillary Lymph Node,,25000908,LOCAL,Facility,Both,,,,2346,1994.1,672.3636,2346,BlueCross BlueShield Minnesota, Federal Employee Program,2308.464,98.4,,percent of total billed charges,,
Excision Of Axillary Lymph Node,,25000908,LOCAL,Facility,Both,,,,2346,1994.1,672.3636,2346,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,2346,100,,percent of total billed charges,,
Excision Of Axillary Lymph Node,,25000908,LOCAL,Facility,Both,,,,2346,1994.1,672.3636,2346,BlueCross BlueShield Minnesota,High Value Network Plan,2111.4,90,,percent of total billed charges,,
Excision Of Axillary Lymph Node,,25000908,LOCAL,Facility,Outpatient,,,,2346,1994.1,672.3636,2346,BlueCross BlueShield Minnesota,Medicare Advantage,1149.54,49,,percent of total billed charges,,
Excision Of Axillary Lymph Node,,25000908,LOCAL,Facility,Inpatient,,,,2346,1994.1,672.3636,2346,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Excision Of Axillary Lymph Node,,25000908,LOCAL,Facility,Both,,,,2346,1994.1,672.3636,2346,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,2077.8522,88.57,,percent of total billed charges,,
Excision Of Axillary Lymph Node,,25000908,LOCAL,Facility,Both,,,,2346,1994.1,672.3636,2346,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,672.3636,28.66,,percent of total billed charges,,
Excision Of Axillary Lymph Node,,25000908,LOCAL,Facility,Outpatient,,,,2346,1994.1,672.3636,2346,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1149.54,49,,percent of total billed charges,,
Excision Of Axillary Lymph Node,,25000908,LOCAL,Facility,Inpatient,,,,2346,1994.1,672.3636,2346,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Excision Of Axillary Lymph Node,,25000908,LOCAL,Facility,Both,,,,2346,1994.1,672.3636,2346,CorVel,Worker's Compensation,2346,100,,percent of total billed charges,,
Excision Of Axillary Lymph Node,,25000908,LOCAL,Facility,Both,,,,2346,1994.1,672.3636,2346,First Health Group Corporation,First Health Network,2275.62,97,,percent of total billed charges,,
Excision Of Axillary Lymph Node,,25000908,LOCAL,Facility,Both,,,,2346,1994.1,672.3636,2346,"Health Partners, Inc.",Commercial,2219.316,94.6,,percent of total billed charges,,
Excision Of Axillary Lymph Node,,25000908,LOCAL,Facility,Outpatient,,,,2346,1994.1,672.3636,2346,"Health Partners, Inc.",Medicare Advantage,1149.54,49,,percent of total billed charges,,
Excision Of Axillary Lymph Node,,25000908,LOCAL,Facility,Inpatient,,,,2346,1994.1,672.3636,2346,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Excision Of Axillary Lymph Node,,25000908,LOCAL,Facility,Both,,,,2346,1994.1,672.3636,2346,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1407.6,60,,percent of total billed charges,,
Excision Of Axillary Lymph Node,,25000908,LOCAL,Facility,Both,,,,2346,1994.1,672.3636,2346,"Health Partners, Inc.",State of Minnesota Advantage Program,1911.99,81.5,,percent of total billed charges,,
Excision Of Axillary Lymph Node,,25000908,LOCAL,Facility,Both,,,,2346,1994.1,672.3636,2346,"Health Partners, Inc.",State Public Programs,1173,50,,percent of total billed charges,,
Excision Of Axillary Lymph Node,,25000908,LOCAL,Facility,Both,,,,2346,1994.1,672.3636,2346,Humana Insurance Company,Commercial PPO,2228.7,95,,percent of total billed charges,,
Excision Of Axillary Lymph Node,,25000908,LOCAL,Facility,Outpatient,,,,2346,1994.1,672.3636,2346,Humana Insurance Company,Medicare PPO,1149.54,49,,percent of total billed charges,,
Excision Of Axillary Lymph Node,,25000908,LOCAL,Facility,Inpatient,,,,2346,1994.1,672.3636,2346,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Excision Of Axillary Lymph Node,,25000908,LOCAL,Facility,Both,,,,2346,1994.1,672.3636,2346,Medica,Individual & Family,2324.886,99.1,,percent of total billed charges,,
Excision Of Axillary Lymph Node,,25000908,LOCAL,Facility,Outpatient,,,,2346,1994.1,672.3636,2346,Medica,Medica Advantage Solution,1168.308,49.8,,percent of total billed charges,,
Excision Of Axillary Lymph Node,,25000908,LOCAL,Facility,Inpatient,,,,2346,1994.1,672.3636,2346,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Excision Of Axillary Lymph Node,,25000908,LOCAL,Facility,Outpatient,,,,2346,1994.1,672.3636,2346,Medica,Medical Assistance,1046.316,44.6,,percent of total billed charges,,
Excision Of Axillary Lymph Node,,25000908,LOCAL,Facility,Inpatient,,,,2346,1994.1,672.3636,2346,Medica,Medical Assistance,,,,,Included in per diem rate,
Excision Of Axillary Lymph Node,,25000908,LOCAL,Facility,Outpatient,,,,2346,1994.1,672.3636,2346,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1168.308,49.8,,percent of total billed charges,,
Excision Of Axillary Lymph Node,,25000908,LOCAL,Facility,Inpatient,,,,2346,1994.1,672.3636,2346,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Excision Of Axillary Lymph Node,,25000908,LOCAL,Facility,Both,,,,2346,1994.1,672.3636,2346,"Multiplan, Inc.","Multiplan, Inc.",2205.24,94,,percent of total billed charges,,
Excision Of Axillary Lymph Node,,25000908,LOCAL,Facility,Outpatient,,,,2346,1994.1,672.3636,2346,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,2113.746,90.1,,percent of total billed charges,,
Excision Of Axillary Lymph Node,,25000908,LOCAL,Facility,Inpatient,,,,2346,1994.1,672.3636,2346,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Excision Of Axillary Lymph Node,,25000908,LOCAL,Facility,Both,,,,2346,1994.1,672.3636,2346,"Preferred One Administrative Services, INC.",PPO,2313.156,98.6,,percent of total billed charges,,
Excision Of Axillary Lymph Node,,25000908,LOCAL,Facility,Outpatient,,,,2346,1994.1,672.3636,2346,PrimeWest Health,Minnesota Senior Health Options (MSHO),1207.017,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Excision Of Axillary Lymph Node,,25000908,LOCAL,Facility,Inpatient,,,,2346,1994.1,672.3636,2346,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Excision Of Axillary Lymph Node,,25000908,LOCAL,Facility,Outpatient,,,,2346,1994.1,672.3636,2346,PrimeWest Health,MinnesotaCare,1204.9056,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Excision Of Axillary Lymph Node,,25000908,LOCAL,Facility,Inpatient,,,,2346,1994.1,672.3636,2346,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Excision Of Axillary Lymph Node,,25000908,LOCAL,Facility,Both,,,,2346,1994.1,672.3636,2346,Sanford Health Plan,Sanford Health Plan,2158.32,92,,percent of total billed charges,,
Excision Of Axillary Lymph Node,,25000908,LOCAL,Facility,Outpatient,,,,2346,1994.1,672.3636,2346,"UCare Health, Inc.",Individual & Family Plan,1321.971,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Excision Of Axillary Lymph Node,,25000908,LOCAL,Facility,Inpatient,,,,2346,1994.1,672.3636,2346,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Excision Of Axillary Lymph Node,,25000908,LOCAL,Facility,Outpatient,,,,2346,1994.1,672.3636,2346,"UCare Health, Inc.",Medical Assistance,1184.0262,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Excision Of Axillary Lymph Node,,25000908,LOCAL,Facility,Inpatient,,,,2346,1994.1,672.3636,2346,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Excision Of Axillary Lymph Node,,25000908,LOCAL,Facility,Outpatient,,,,2346,1994.1,672.3636,2346,"UCare Health, Inc.",Medicare Advantage,1184.0262,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Excision Of Axillary Lymph Node,,25000908,LOCAL,Facility,Inpatient,,,,2346,1994.1,672.3636,2346,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Excision Of Axillary Lymph Node,,25000908,LOCAL,Facility,Outpatient,,,,2346,1994.1,672.3636,2346,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1184.0262,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Excision Of Axillary Lymph Node,,25000908,LOCAL,Facility,Inpatient,,,,2346,1994.1,672.3636,2346,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Excision Of Axillary Lymph Node,,25000908,LOCAL,Facility,Both,,,,2346,1994.1,672.3636,2346,UnitedHealthcare,Individual & Family,2205.24,94,,percent of total billed charges,,
Excision Of Axillary Lymph Node,,25000908,LOCAL,Facility,Outpatient,,,,2346,1994.1,672.3636,2346,UnitedHealthcare,Medicare Advantage,1149.54,49,,percent of total billed charges,,
Excision Of Axillary Lymph Node,,25000908,LOCAL,Facility,Inpatient,,,,2346,1994.1,672.3636,2346,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Excision Of Axillary Lymph Node,,25000908,LOCAL,Facility,Outpatient,,,,2346,1994.1,672.3636,2346,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1126.08,48,,percent of total billed charges,,100% of DHS outpatient percentage
Excision Of Axillary Lymph Node,,25000908,LOCAL,Facility,Inpatient,,,,2346,1994.1,672.3636,2346,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Exploratory Laparotomy,,25001029,LOCAL,Facility,Both,,,,5304,4508.4,1520.1264,5304,Aetna,Commercial,4879.68,92,,percent of total billed charges,,
Exploratory Laparotomy,,25001029,LOCAL,Facility,Outpatient,,,,5304,4508.4,1520.1264,5304,Aetna,Medicare Advantage,2598.96,49,,percent of total billed charges,,
Exploratory Laparotomy,,25001029,LOCAL,Facility,Inpatient,,,,5304,4508.4,1520.1264,5304,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Exploratory Laparotomy,,25001029,LOCAL,Facility,Both,,,,5304,4508.4,1520.1264,5304,Aetna,PPO,4932.72,93,,percent of total billed charges,,
Exploratory Laparotomy,,25001029,LOCAL,Facility,Both,,,,5304,4508.4,1520.1264,5304,America's PPO,America's PPO,5093.4312,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Exploratory Laparotomy,,25001029,LOCAL,Facility,Both,,,,5304,4508.4,1520.1264,5304,BlueCross BlueShield Minnesota, Federal Employee Program,5219.136,98.4,,percent of total billed charges,,
Exploratory Laparotomy,,25001029,LOCAL,Facility,Both,,,,5304,4508.4,1520.1264,5304,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5304,100,,percent of total billed charges,,
Exploratory Laparotomy,,25001029,LOCAL,Facility,Both,,,,5304,4508.4,1520.1264,5304,BlueCross BlueShield Minnesota,High Value Network Plan,4773.6,90,,percent of total billed charges,,
Exploratory Laparotomy,,25001029,LOCAL,Facility,Outpatient,,,,5304,4508.4,1520.1264,5304,BlueCross BlueShield Minnesota,Medicare Advantage,2598.96,49,,percent of total billed charges,,
Exploratory Laparotomy,,25001029,LOCAL,Facility,Inpatient,,,,5304,4508.4,1520.1264,5304,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Exploratory Laparotomy,,25001029,LOCAL,Facility,Both,,,,5304,4508.4,1520.1264,5304,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4697.7528,88.57,,percent of total billed charges,,
Exploratory Laparotomy,,25001029,LOCAL,Facility,Both,,,,5304,4508.4,1520.1264,5304,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1520.1264,28.66,,percent of total billed charges,,
Exploratory Laparotomy,,25001029,LOCAL,Facility,Outpatient,,,,5304,4508.4,1520.1264,5304,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2598.96,49,,percent of total billed charges,,
Exploratory Laparotomy,,25001029,LOCAL,Facility,Inpatient,,,,5304,4508.4,1520.1264,5304,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Exploratory Laparotomy,,25001029,LOCAL,Facility,Both,,,,5304,4508.4,1520.1264,5304,CorVel,Worker's Compensation,5304,100,,percent of total billed charges,,
Exploratory Laparotomy,,25001029,LOCAL,Facility,Both,,,,5304,4508.4,1520.1264,5304,First Health Group Corporation,First Health Network,5144.88,97,,percent of total billed charges,,
Exploratory Laparotomy,,25001029,LOCAL,Facility,Both,,,,5304,4508.4,1520.1264,5304,"Health Partners, Inc.",Commercial,5017.584,94.6,,percent of total billed charges,,
Exploratory Laparotomy,,25001029,LOCAL,Facility,Outpatient,,,,5304,4508.4,1520.1264,5304,"Health Partners, Inc.",Medicare Advantage,2598.96,49,,percent of total billed charges,,
Exploratory Laparotomy,,25001029,LOCAL,Facility,Inpatient,,,,5304,4508.4,1520.1264,5304,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Exploratory Laparotomy,,25001029,LOCAL,Facility,Both,,,,5304,4508.4,1520.1264,5304,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3182.4,60,,percent of total billed charges,,
Exploratory Laparotomy,,25001029,LOCAL,Facility,Both,,,,5304,4508.4,1520.1264,5304,"Health Partners, Inc.",State of Minnesota Advantage Program,4322.76,81.5,,percent of total billed charges,,
Exploratory Laparotomy,,25001029,LOCAL,Facility,Both,,,,5304,4508.4,1520.1264,5304,"Health Partners, Inc.",State Public Programs,2652,50,,percent of total billed charges,,
Exploratory Laparotomy,,25001029,LOCAL,Facility,Both,,,,5304,4508.4,1520.1264,5304,Humana Insurance Company,Commercial PPO,5038.8,95,,percent of total billed charges,,
Exploratory Laparotomy,,25001029,LOCAL,Facility,Outpatient,,,,5304,4508.4,1520.1264,5304,Humana Insurance Company,Medicare PPO,2598.96,49,,percent of total billed charges,,
Exploratory Laparotomy,,25001029,LOCAL,Facility,Inpatient,,,,5304,4508.4,1520.1264,5304,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Exploratory Laparotomy,,25001029,LOCAL,Facility,Both,,,,5304,4508.4,1520.1264,5304,Medica,Individual & Family,5256.264,99.1,,percent of total billed charges,,
Exploratory Laparotomy,,25001029,LOCAL,Facility,Outpatient,,,,5304,4508.4,1520.1264,5304,Medica,Medica Advantage Solution,2641.392,49.8,,percent of total billed charges,,
Exploratory Laparotomy,,25001029,LOCAL,Facility,Inpatient,,,,5304,4508.4,1520.1264,5304,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Exploratory Laparotomy,,25001029,LOCAL,Facility,Outpatient,,,,5304,4508.4,1520.1264,5304,Medica,Medical Assistance,2365.584,44.6,,percent of total billed charges,,
Exploratory Laparotomy,,25001029,LOCAL,Facility,Inpatient,,,,5304,4508.4,1520.1264,5304,Medica,Medical Assistance,,,,,Included in per diem rate,
Exploratory Laparotomy,,25001029,LOCAL,Facility,Outpatient,,,,5304,4508.4,1520.1264,5304,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2641.392,49.8,,percent of total billed charges,,
Exploratory Laparotomy,,25001029,LOCAL,Facility,Inpatient,,,,5304,4508.4,1520.1264,5304,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Exploratory Laparotomy,,25001029,LOCAL,Facility,Both,,,,5304,4508.4,1520.1264,5304,"Multiplan, Inc.","Multiplan, Inc.",4985.76,94,,percent of total billed charges,,
Exploratory Laparotomy,,25001029,LOCAL,Facility,Outpatient,,,,5304,4508.4,1520.1264,5304,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4778.904,90.1,,percent of total billed charges,,
Exploratory Laparotomy,,25001029,LOCAL,Facility,Inpatient,,,,5304,4508.4,1520.1264,5304,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Exploratory Laparotomy,,25001029,LOCAL,Facility,Both,,,,5304,4508.4,1520.1264,5304,"Preferred One Administrative Services, INC.",PPO,5229.744,98.6,,percent of total billed charges,,
Exploratory Laparotomy,,25001029,LOCAL,Facility,Outpatient,,,,5304,4508.4,1520.1264,5304,PrimeWest Health,Minnesota Senior Health Options (MSHO),2728.908,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Exploratory Laparotomy,,25001029,LOCAL,Facility,Inpatient,,,,5304,4508.4,1520.1264,5304,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Exploratory Laparotomy,,25001029,LOCAL,Facility,Outpatient,,,,5304,4508.4,1520.1264,5304,PrimeWest Health,MinnesotaCare,2724.1344,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Exploratory Laparotomy,,25001029,LOCAL,Facility,Inpatient,,,,5304,4508.4,1520.1264,5304,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Exploratory Laparotomy,,25001029,LOCAL,Facility,Both,,,,5304,4508.4,1520.1264,5304,Sanford Health Plan,Sanford Health Plan,4879.68,92,,percent of total billed charges,,
Exploratory Laparotomy,,25001029,LOCAL,Facility,Outpatient,,,,5304,4508.4,1520.1264,5304,"UCare Health, Inc.",Individual & Family Plan,2988.804,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Exploratory Laparotomy,,25001029,LOCAL,Facility,Inpatient,,,,5304,4508.4,1520.1264,5304,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Exploratory Laparotomy,,25001029,LOCAL,Facility,Outpatient,,,,5304,4508.4,1520.1264,5304,"UCare Health, Inc.",Medical Assistance,2676.9288,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Exploratory Laparotomy,,25001029,LOCAL,Facility,Inpatient,,,,5304,4508.4,1520.1264,5304,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Exploratory Laparotomy,,25001029,LOCAL,Facility,Outpatient,,,,5304,4508.4,1520.1264,5304,"UCare Health, Inc.",Medicare Advantage,2676.9288,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Exploratory Laparotomy,,25001029,LOCAL,Facility,Inpatient,,,,5304,4508.4,1520.1264,5304,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Exploratory Laparotomy,,25001029,LOCAL,Facility,Outpatient,,,,5304,4508.4,1520.1264,5304,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2676.9288,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Exploratory Laparotomy,,25001029,LOCAL,Facility,Inpatient,,,,5304,4508.4,1520.1264,5304,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Exploratory Laparotomy,,25001029,LOCAL,Facility,Both,,,,5304,4508.4,1520.1264,5304,UnitedHealthcare,Individual & Family,4985.76,94,,percent of total billed charges,,
Exploratory Laparotomy,,25001029,LOCAL,Facility,Outpatient,,,,5304,4508.4,1520.1264,5304,UnitedHealthcare,Medicare Advantage,2598.96,49,,percent of total billed charges,,
Exploratory Laparotomy,,25001029,LOCAL,Facility,Inpatient,,,,5304,4508.4,1520.1264,5304,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Exploratory Laparotomy,,25001029,LOCAL,Facility,Outpatient,,,,5304,4508.4,1520.1264,5304,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2545.92,48,,percent of total billed charges,,100% of DHS outpatient percentage
Exploratory Laparotomy,,25001029,LOCAL,Facility,Inpatient,,,,5304,4508.4,1520.1264,5304,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Ganglion Cyst,,25001088,LOCAL,Facility,Both,,,,2305,1959.25,660.613,2305,Aetna,Commercial,2120.6,92,,percent of total billed charges,,
Ganglion Cyst,,25001088,LOCAL,Facility,Outpatient,,,,2305,1959.25,660.613,2305,Aetna,Medicare Advantage,1129.45,49,,percent of total billed charges,,
Ganglion Cyst,,25001088,LOCAL,Facility,Inpatient,,,,2305,1959.25,660.613,2305,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Ganglion Cyst,,25001088,LOCAL,Facility,Both,,,,2305,1959.25,660.613,2305,Aetna,PPO,2143.65,93,,percent of total billed charges,,
Ganglion Cyst,,25001088,LOCAL,Facility,Both,,,,2305,1959.25,660.613,2305,America's PPO,America's PPO,2213.4915,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Ganglion Cyst,,25001088,LOCAL,Facility,Both,,,,2305,1959.25,660.613,2305,BlueCross BlueShield Minnesota, Federal Employee Program,2268.12,98.4,,percent of total billed charges,,
Ganglion Cyst,,25001088,LOCAL,Facility,Both,,,,2305,1959.25,660.613,2305,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,2305,100,,percent of total billed charges,,
Ganglion Cyst,,25001088,LOCAL,Facility,Both,,,,2305,1959.25,660.613,2305,BlueCross BlueShield Minnesota,High Value Network Plan,2074.5,90,,percent of total billed charges,,
Ganglion Cyst,,25001088,LOCAL,Facility,Outpatient,,,,2305,1959.25,660.613,2305,BlueCross BlueShield Minnesota,Medicare Advantage,1129.45,49,,percent of total billed charges,,
Ganglion Cyst,,25001088,LOCAL,Facility,Inpatient,,,,2305,1959.25,660.613,2305,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Ganglion Cyst,,25001088,LOCAL,Facility,Both,,,,2305,1959.25,660.613,2305,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,2041.5385,88.57,,percent of total billed charges,,
Ganglion Cyst,,25001088,LOCAL,Facility,Both,,,,2305,1959.25,660.613,2305,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,660.613,28.66,,percent of total billed charges,,
Ganglion Cyst,,25001088,LOCAL,Facility,Outpatient,,,,2305,1959.25,660.613,2305,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1129.45,49,,percent of total billed charges,,
Ganglion Cyst,,25001088,LOCAL,Facility,Inpatient,,,,2305,1959.25,660.613,2305,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Ganglion Cyst,,25001088,LOCAL,Facility,Both,,,,2305,1959.25,660.613,2305,CorVel,Worker's Compensation,2305,100,,percent of total billed charges,,
Ganglion Cyst,,25001088,LOCAL,Facility,Both,,,,2305,1959.25,660.613,2305,First Health Group Corporation,First Health Network,2235.85,97,,percent of total billed charges,,
Ganglion Cyst,,25001088,LOCAL,Facility,Both,,,,2305,1959.25,660.613,2305,"Health Partners, Inc.",Commercial,2180.53,94.6,,percent of total billed charges,,
Ganglion Cyst,,25001088,LOCAL,Facility,Outpatient,,,,2305,1959.25,660.613,2305,"Health Partners, Inc.",Medicare Advantage,1129.45,49,,percent of total billed charges,,
Ganglion Cyst,,25001088,LOCAL,Facility,Inpatient,,,,2305,1959.25,660.613,2305,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ganglion Cyst,,25001088,LOCAL,Facility,Both,,,,2305,1959.25,660.613,2305,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1383,60,,percent of total billed charges,,
Ganglion Cyst,,25001088,LOCAL,Facility,Both,,,,2305,1959.25,660.613,2305,"Health Partners, Inc.",State of Minnesota Advantage Program,1878.575,81.5,,percent of total billed charges,,
Ganglion Cyst,,25001088,LOCAL,Facility,Both,,,,2305,1959.25,660.613,2305,"Health Partners, Inc.",State Public Programs,1152.5,50,,percent of total billed charges,,
Ganglion Cyst,,25001088,LOCAL,Facility,Both,,,,2305,1959.25,660.613,2305,Humana Insurance Company,Commercial PPO,2189.75,95,,percent of total billed charges,,
Ganglion Cyst,,25001088,LOCAL,Facility,Outpatient,,,,2305,1959.25,660.613,2305,Humana Insurance Company,Medicare PPO,1129.45,49,,percent of total billed charges,,
Ganglion Cyst,,25001088,LOCAL,Facility,Inpatient,,,,2305,1959.25,660.613,2305,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Ganglion Cyst,,25001088,LOCAL,Facility,Both,,,,2305,1959.25,660.613,2305,Medica,Individual & Family,2284.255,99.1,,percent of total billed charges,,
Ganglion Cyst,,25001088,LOCAL,Facility,Outpatient,,,,2305,1959.25,660.613,2305,Medica,Medica Advantage Solution,1147.89,49.8,,percent of total billed charges,,
Ganglion Cyst,,25001088,LOCAL,Facility,Inpatient,,,,2305,1959.25,660.613,2305,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Ganglion Cyst,,25001088,LOCAL,Facility,Outpatient,,,,2305,1959.25,660.613,2305,Medica,Medical Assistance,1028.03,44.6,,percent of total billed charges,,
Ganglion Cyst,,25001088,LOCAL,Facility,Inpatient,,,,2305,1959.25,660.613,2305,Medica,Medical Assistance,,,,,Included in per diem rate,
Ganglion Cyst,,25001088,LOCAL,Facility,Outpatient,,,,2305,1959.25,660.613,2305,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1147.89,49.8,,percent of total billed charges,,
Ganglion Cyst,,25001088,LOCAL,Facility,Inpatient,,,,2305,1959.25,660.613,2305,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Ganglion Cyst,,25001088,LOCAL,Facility,Both,,,,2305,1959.25,660.613,2305,"Multiplan, Inc.","Multiplan, Inc.",2166.7,94,,percent of total billed charges,,
Ganglion Cyst,,25001088,LOCAL,Facility,Outpatient,,,,2305,1959.25,660.613,2305,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,2076.805,90.1,,percent of total billed charges,,
Ganglion Cyst,,25001088,LOCAL,Facility,Inpatient,,,,2305,1959.25,660.613,2305,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Ganglion Cyst,,25001088,LOCAL,Facility,Both,,,,2305,1959.25,660.613,2305,"Preferred One Administrative Services, INC.",PPO,2272.73,98.6,,percent of total billed charges,,
Ganglion Cyst,,25001088,LOCAL,Facility,Outpatient,,,,2305,1959.25,660.613,2305,PrimeWest Health,Minnesota Senior Health Options (MSHO),1185.9225,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Ganglion Cyst,,25001088,LOCAL,Facility,Inpatient,,,,2305,1959.25,660.613,2305,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ganglion Cyst,,25001088,LOCAL,Facility,Outpatient,,,,2305,1959.25,660.613,2305,PrimeWest Health,MinnesotaCare,1183.848,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Ganglion Cyst,,25001088,LOCAL,Facility,Inpatient,,,,2305,1959.25,660.613,2305,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Ganglion Cyst,,25001088,LOCAL,Facility,Both,,,,2305,1959.25,660.613,2305,Sanford Health Plan,Sanford Health Plan,2120.6,92,,percent of total billed charges,,
Ganglion Cyst,,25001088,LOCAL,Facility,Outpatient,,,,2305,1959.25,660.613,2305,"UCare Health, Inc.",Individual & Family Plan,1298.8675,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Ganglion Cyst,,25001088,LOCAL,Facility,Inpatient,,,,2305,1959.25,660.613,2305,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Ganglion Cyst,,25001088,LOCAL,Facility,Outpatient,,,,2305,1959.25,660.613,2305,"UCare Health, Inc.",Medical Assistance,1163.3335,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ganglion Cyst,,25001088,LOCAL,Facility,Inpatient,,,,2305,1959.25,660.613,2305,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Ganglion Cyst,,25001088,LOCAL,Facility,Outpatient,,,,2305,1959.25,660.613,2305,"UCare Health, Inc.",Medicare Advantage,1163.3335,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ganglion Cyst,,25001088,LOCAL,Facility,Inpatient,,,,2305,1959.25,660.613,2305,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ganglion Cyst,,25001088,LOCAL,Facility,Outpatient,,,,2305,1959.25,660.613,2305,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1163.3335,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ganglion Cyst,,25001088,LOCAL,Facility,Inpatient,,,,2305,1959.25,660.613,2305,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ganglion Cyst,,25001088,LOCAL,Facility,Both,,,,2305,1959.25,660.613,2305,UnitedHealthcare,Individual & Family,2166.7,94,,percent of total billed charges,,
Ganglion Cyst,,25001088,LOCAL,Facility,Outpatient,,,,2305,1959.25,660.613,2305,UnitedHealthcare,Medicare Advantage,1129.45,49,,percent of total billed charges,,
Ganglion Cyst,,25001088,LOCAL,Facility,Inpatient,,,,2305,1959.25,660.613,2305,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Ganglion Cyst,,25001088,LOCAL,Facility,Outpatient,,,,2305,1959.25,660.613,2305,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1106.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
Ganglion Cyst,,25001088,LOCAL,Facility,Inpatient,,,,2305,1959.25,660.613,2305,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Hemicolectomy,,25001129,LOCAL,Facility,Both,,,,5993,5094.05,1717.5938,5993,Aetna,Commercial,5513.56,92,,percent of total billed charges,,
Hemicolectomy,,25001129,LOCAL,Facility,Outpatient,,,,5993,5094.05,1717.5938,5993,Aetna,Medicare Advantage,2936.57,49,,percent of total billed charges,,
Hemicolectomy,,25001129,LOCAL,Facility,Inpatient,,,,5993,5094.05,1717.5938,5993,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Hemicolectomy,,25001129,LOCAL,Facility,Both,,,,5993,5094.05,1717.5938,5993,Aetna,PPO,5573.49,93,,percent of total billed charges,,
Hemicolectomy,,25001129,LOCAL,Facility,Both,,,,5993,5094.05,1717.5938,5993,America's PPO,America's PPO,5755.0779,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Hemicolectomy,,25001129,LOCAL,Facility,Both,,,,5993,5094.05,1717.5938,5993,BlueCross BlueShield Minnesota, Federal Employee Program,5897.112,98.4,,percent of total billed charges,,
Hemicolectomy,,25001129,LOCAL,Facility,Both,,,,5993,5094.05,1717.5938,5993,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5993,100,,percent of total billed charges,,
Hemicolectomy,,25001129,LOCAL,Facility,Both,,,,5993,5094.05,1717.5938,5993,BlueCross BlueShield Minnesota,High Value Network Plan,5393.7,90,,percent of total billed charges,,
Hemicolectomy,,25001129,LOCAL,Facility,Outpatient,,,,5993,5094.05,1717.5938,5993,BlueCross BlueShield Minnesota,Medicare Advantage,2936.57,49,,percent of total billed charges,,
Hemicolectomy,,25001129,LOCAL,Facility,Inpatient,,,,5993,5094.05,1717.5938,5993,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Hemicolectomy,,25001129,LOCAL,Facility,Both,,,,5993,5094.05,1717.5938,5993,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,5308.0001,88.57,,percent of total billed charges,,
Hemicolectomy,,25001129,LOCAL,Facility,Both,,,,5993,5094.05,1717.5938,5993,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1717.5938,28.66,,percent of total billed charges,,
Hemicolectomy,,25001129,LOCAL,Facility,Outpatient,,,,5993,5094.05,1717.5938,5993,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2936.57,49,,percent of total billed charges,,
Hemicolectomy,,25001129,LOCAL,Facility,Inpatient,,,,5993,5094.05,1717.5938,5993,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Hemicolectomy,,25001129,LOCAL,Facility,Both,,,,5993,5094.05,1717.5938,5993,CorVel,Worker's Compensation,5993,100,,percent of total billed charges,,
Hemicolectomy,,25001129,LOCAL,Facility,Both,,,,5993,5094.05,1717.5938,5993,First Health Group Corporation,First Health Network,5813.21,97,,percent of total billed charges,,
Hemicolectomy,,25001129,LOCAL,Facility,Both,,,,5993,5094.05,1717.5938,5993,"Health Partners, Inc.",Commercial,5669.378,94.6,,percent of total billed charges,,
Hemicolectomy,,25001129,LOCAL,Facility,Outpatient,,,,5993,5094.05,1717.5938,5993,"Health Partners, Inc.",Medicare Advantage,2936.57,49,,percent of total billed charges,,
Hemicolectomy,,25001129,LOCAL,Facility,Inpatient,,,,5993,5094.05,1717.5938,5993,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Hemicolectomy,,25001129,LOCAL,Facility,Both,,,,5993,5094.05,1717.5938,5993,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3595.8,60,,percent of total billed charges,,
Hemicolectomy,,25001129,LOCAL,Facility,Both,,,,5993,5094.05,1717.5938,5993,"Health Partners, Inc.",State of Minnesota Advantage Program,4884.295,81.5,,percent of total billed charges,,
Hemicolectomy,,25001129,LOCAL,Facility,Both,,,,5993,5094.05,1717.5938,5993,"Health Partners, Inc.",State Public Programs,2996.5,50,,percent of total billed charges,,
Hemicolectomy,,25001129,LOCAL,Facility,Both,,,,5993,5094.05,1717.5938,5993,Humana Insurance Company,Commercial PPO,5693.35,95,,percent of total billed charges,,
Hemicolectomy,,25001129,LOCAL,Facility,Outpatient,,,,5993,5094.05,1717.5938,5993,Humana Insurance Company,Medicare PPO,2936.57,49,,percent of total billed charges,,
Hemicolectomy,,25001129,LOCAL,Facility,Inpatient,,,,5993,5094.05,1717.5938,5993,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Hemicolectomy,,25001129,LOCAL,Facility,Both,,,,5993,5094.05,1717.5938,5993,Medica,Individual & Family,5939.063,99.1,,percent of total billed charges,,
Hemicolectomy,,25001129,LOCAL,Facility,Outpatient,,,,5993,5094.05,1717.5938,5993,Medica,Medica Advantage Solution,2984.514,49.8,,percent of total billed charges,,
Hemicolectomy,,25001129,LOCAL,Facility,Inpatient,,,,5993,5094.05,1717.5938,5993,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Hemicolectomy,,25001129,LOCAL,Facility,Outpatient,,,,5993,5094.05,1717.5938,5993,Medica,Medical Assistance,2672.878,44.6,,percent of total billed charges,,
Hemicolectomy,,25001129,LOCAL,Facility,Inpatient,,,,5993,5094.05,1717.5938,5993,Medica,Medical Assistance,,,,,Included in per diem rate,
Hemicolectomy,,25001129,LOCAL,Facility,Outpatient,,,,5993,5094.05,1717.5938,5993,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2984.514,49.8,,percent of total billed charges,,
Hemicolectomy,,25001129,LOCAL,Facility,Inpatient,,,,5993,5094.05,1717.5938,5993,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Hemicolectomy,,25001129,LOCAL,Facility,Both,,,,5993,5094.05,1717.5938,5993,"Multiplan, Inc.","Multiplan, Inc.",5633.42,94,,percent of total billed charges,,
Hemicolectomy,,25001129,LOCAL,Facility,Outpatient,,,,5993,5094.05,1717.5938,5993,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,5399.693,90.1,,percent of total billed charges,,
Hemicolectomy,,25001129,LOCAL,Facility,Inpatient,,,,5993,5094.05,1717.5938,5993,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Hemicolectomy,,25001129,LOCAL,Facility,Both,,,,5993,5094.05,1717.5938,5993,"Preferred One Administrative Services, INC.",PPO,5909.098,98.6,,percent of total billed charges,,
Hemicolectomy,,25001129,LOCAL,Facility,Outpatient,,,,5993,5094.05,1717.5938,5993,PrimeWest Health,Minnesota Senior Health Options (MSHO),3083.3985,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Hemicolectomy,,25001129,LOCAL,Facility,Inpatient,,,,5993,5094.05,1717.5938,5993,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Hemicolectomy,,25001129,LOCAL,Facility,Outpatient,,,,5993,5094.05,1717.5938,5993,PrimeWest Health,MinnesotaCare,3078.0048,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Hemicolectomy,,25001129,LOCAL,Facility,Inpatient,,,,5993,5094.05,1717.5938,5993,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Hemicolectomy,,25001129,LOCAL,Facility,Both,,,,5993,5094.05,1717.5938,5993,Sanford Health Plan,Sanford Health Plan,5513.56,92,,percent of total billed charges,,
Hemicolectomy,,25001129,LOCAL,Facility,Outpatient,,,,5993,5094.05,1717.5938,5993,"UCare Health, Inc.",Individual & Family Plan,3377.0555,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Hemicolectomy,,25001129,LOCAL,Facility,Inpatient,,,,5993,5094.05,1717.5938,5993,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Hemicolectomy,,25001129,LOCAL,Facility,Outpatient,,,,5993,5094.05,1717.5938,5993,"UCare Health, Inc.",Medical Assistance,3024.6671,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Hemicolectomy,,25001129,LOCAL,Facility,Inpatient,,,,5993,5094.05,1717.5938,5993,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Hemicolectomy,,25001129,LOCAL,Facility,Outpatient,,,,5993,5094.05,1717.5938,5993,"UCare Health, Inc.",Medicare Advantage,3024.6671,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Hemicolectomy,,25001129,LOCAL,Facility,Inpatient,,,,5993,5094.05,1717.5938,5993,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Hemicolectomy,,25001129,LOCAL,Facility,Outpatient,,,,5993,5094.05,1717.5938,5993,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),3024.6671,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Hemicolectomy,,25001129,LOCAL,Facility,Inpatient,,,,5993,5094.05,1717.5938,5993,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Hemicolectomy,,25001129,LOCAL,Facility,Both,,,,5993,5094.05,1717.5938,5993,UnitedHealthcare,Individual & Family,5633.42,94,,percent of total billed charges,,
Hemicolectomy,,25001129,LOCAL,Facility,Outpatient,,,,5993,5094.05,1717.5938,5993,UnitedHealthcare,Medicare Advantage,2936.57,49,,percent of total billed charges,,
Hemicolectomy,,25001129,LOCAL,Facility,Inpatient,,,,5993,5094.05,1717.5938,5993,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Hemicolectomy,,25001129,LOCAL,Facility,Outpatient,,,,5993,5094.05,1717.5938,5993,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2876.64,48,,percent of total billed charges,,100% of DHS outpatient percentage
Hemicolectomy,,25001129,LOCAL,Facility,Inpatient,,,,5993,5094.05,1717.5938,5993,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Hemorrhoidectomy,,25001134,LOCAL,Facility,Both,,,,4488,3814.8,1286.2608,4488,Aetna,Commercial,4128.96,92,,percent of total billed charges,,
Hemorrhoidectomy,,25001134,LOCAL,Facility,Outpatient,,,,4488,3814.8,1286.2608,4488,Aetna,Medicare Advantage,2199.12,49,,percent of total billed charges,,
Hemorrhoidectomy,,25001134,LOCAL,Facility,Inpatient,,,,4488,3814.8,1286.2608,4488,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Hemorrhoidectomy,,25001134,LOCAL,Facility,Both,,,,4488,3814.8,1286.2608,4488,Aetna,PPO,4173.84,93,,percent of total billed charges,,
Hemorrhoidectomy,,25001134,LOCAL,Facility,Both,,,,4488,3814.8,1286.2608,4488,America's PPO,America's PPO,4309.8264,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Hemorrhoidectomy,,25001134,LOCAL,Facility,Both,,,,4488,3814.8,1286.2608,4488,BlueCross BlueShield Minnesota, Federal Employee Program,4416.192,98.4,,percent of total billed charges,,
Hemorrhoidectomy,,25001134,LOCAL,Facility,Both,,,,4488,3814.8,1286.2608,4488,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,4488,100,,percent of total billed charges,,
Hemorrhoidectomy,,25001134,LOCAL,Facility,Both,,,,4488,3814.8,1286.2608,4488,BlueCross BlueShield Minnesota,High Value Network Plan,4039.2,90,,percent of total billed charges,,
Hemorrhoidectomy,,25001134,LOCAL,Facility,Outpatient,,,,4488,3814.8,1286.2608,4488,BlueCross BlueShield Minnesota,Medicare Advantage,2199.12,49,,percent of total billed charges,,
Hemorrhoidectomy,,25001134,LOCAL,Facility,Inpatient,,,,4488,3814.8,1286.2608,4488,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Hemorrhoidectomy,,25001134,LOCAL,Facility,Both,,,,4488,3814.8,1286.2608,4488,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,3975.0216,88.57,,percent of total billed charges,,
Hemorrhoidectomy,,25001134,LOCAL,Facility,Both,,,,4488,3814.8,1286.2608,4488,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1286.2608,28.66,,percent of total billed charges,,
Hemorrhoidectomy,,25001134,LOCAL,Facility,Outpatient,,,,4488,3814.8,1286.2608,4488,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2199.12,49,,percent of total billed charges,,
Hemorrhoidectomy,,25001134,LOCAL,Facility,Inpatient,,,,4488,3814.8,1286.2608,4488,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Hemorrhoidectomy,,25001134,LOCAL,Facility,Both,,,,4488,3814.8,1286.2608,4488,CorVel,Worker's Compensation,4488,100,,percent of total billed charges,,
Hemorrhoidectomy,,25001134,LOCAL,Facility,Both,,,,4488,3814.8,1286.2608,4488,First Health Group Corporation,First Health Network,4353.36,97,,percent of total billed charges,,
Hemorrhoidectomy,,25001134,LOCAL,Facility,Both,,,,4488,3814.8,1286.2608,4488,"Health Partners, Inc.",Commercial,4245.648,94.6,,percent of total billed charges,,
Hemorrhoidectomy,,25001134,LOCAL,Facility,Outpatient,,,,4488,3814.8,1286.2608,4488,"Health Partners, Inc.",Medicare Advantage,2199.12,49,,percent of total billed charges,,
Hemorrhoidectomy,,25001134,LOCAL,Facility,Inpatient,,,,4488,3814.8,1286.2608,4488,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Hemorrhoidectomy,,25001134,LOCAL,Facility,Both,,,,4488,3814.8,1286.2608,4488,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),2692.8,60,,percent of total billed charges,,
Hemorrhoidectomy,,25001134,LOCAL,Facility,Both,,,,4488,3814.8,1286.2608,4488,"Health Partners, Inc.",State of Minnesota Advantage Program,3657.72,81.5,,percent of total billed charges,,
Hemorrhoidectomy,,25001134,LOCAL,Facility,Both,,,,4488,3814.8,1286.2608,4488,"Health Partners, Inc.",State Public Programs,2244,50,,percent of total billed charges,,
Hemorrhoidectomy,,25001134,LOCAL,Facility,Both,,,,4488,3814.8,1286.2608,4488,Humana Insurance Company,Commercial PPO,4263.6,95,,percent of total billed charges,,
Hemorrhoidectomy,,25001134,LOCAL,Facility,Outpatient,,,,4488,3814.8,1286.2608,4488,Humana Insurance Company,Medicare PPO,2199.12,49,,percent of total billed charges,,
Hemorrhoidectomy,,25001134,LOCAL,Facility,Inpatient,,,,4488,3814.8,1286.2608,4488,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Hemorrhoidectomy,,25001134,LOCAL,Facility,Both,,,,4488,3814.8,1286.2608,4488,Medica,Individual & Family,4447.608,99.1,,percent of total billed charges,,
Hemorrhoidectomy,,25001134,LOCAL,Facility,Outpatient,,,,4488,3814.8,1286.2608,4488,Medica,Medica Advantage Solution,2235.024,49.8,,percent of total billed charges,,
Hemorrhoidectomy,,25001134,LOCAL,Facility,Inpatient,,,,4488,3814.8,1286.2608,4488,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Hemorrhoidectomy,,25001134,LOCAL,Facility,Outpatient,,,,4488,3814.8,1286.2608,4488,Medica,Medical Assistance,2001.648,44.6,,percent of total billed charges,,
Hemorrhoidectomy,,25001134,LOCAL,Facility,Inpatient,,,,4488,3814.8,1286.2608,4488,Medica,Medical Assistance,,,,,Included in per diem rate,
Hemorrhoidectomy,,25001134,LOCAL,Facility,Outpatient,,,,4488,3814.8,1286.2608,4488,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2235.024,49.8,,percent of total billed charges,,
Hemorrhoidectomy,,25001134,LOCAL,Facility,Inpatient,,,,4488,3814.8,1286.2608,4488,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Hemorrhoidectomy,,25001134,LOCAL,Facility,Both,,,,4488,3814.8,1286.2608,4488,"Multiplan, Inc.","Multiplan, Inc.",4218.72,94,,percent of total billed charges,,
Hemorrhoidectomy,,25001134,LOCAL,Facility,Outpatient,,,,4488,3814.8,1286.2608,4488,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4043.688,90.1,,percent of total billed charges,,
Hemorrhoidectomy,,25001134,LOCAL,Facility,Inpatient,,,,4488,3814.8,1286.2608,4488,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Hemorrhoidectomy,,25001134,LOCAL,Facility,Both,,,,4488,3814.8,1286.2608,4488,"Preferred One Administrative Services, INC.",PPO,4425.168,98.6,,percent of total billed charges,,
Hemorrhoidectomy,,25001134,LOCAL,Facility,Outpatient,,,,4488,3814.8,1286.2608,4488,PrimeWest Health,Minnesota Senior Health Options (MSHO),2309.076,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Hemorrhoidectomy,,25001134,LOCAL,Facility,Inpatient,,,,4488,3814.8,1286.2608,4488,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Hemorrhoidectomy,,25001134,LOCAL,Facility,Outpatient,,,,4488,3814.8,1286.2608,4488,PrimeWest Health,MinnesotaCare,2305.0368,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Hemorrhoidectomy,,25001134,LOCAL,Facility,Inpatient,,,,4488,3814.8,1286.2608,4488,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Hemorrhoidectomy,,25001134,LOCAL,Facility,Both,,,,4488,3814.8,1286.2608,4488,Sanford Health Plan,Sanford Health Plan,4128.96,92,,percent of total billed charges,,
Hemorrhoidectomy,,25001134,LOCAL,Facility,Outpatient,,,,4488,3814.8,1286.2608,4488,"UCare Health, Inc.",Individual & Family Plan,2528.988,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Hemorrhoidectomy,,25001134,LOCAL,Facility,Inpatient,,,,4488,3814.8,1286.2608,4488,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Hemorrhoidectomy,,25001134,LOCAL,Facility,Outpatient,,,,4488,3814.8,1286.2608,4488,"UCare Health, Inc.",Medical Assistance,2265.0936,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Hemorrhoidectomy,,25001134,LOCAL,Facility,Inpatient,,,,4488,3814.8,1286.2608,4488,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Hemorrhoidectomy,,25001134,LOCAL,Facility,Outpatient,,,,4488,3814.8,1286.2608,4488,"UCare Health, Inc.",Medicare Advantage,2265.0936,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Hemorrhoidectomy,,25001134,LOCAL,Facility,Inpatient,,,,4488,3814.8,1286.2608,4488,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Hemorrhoidectomy,,25001134,LOCAL,Facility,Outpatient,,,,4488,3814.8,1286.2608,4488,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2265.0936,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Hemorrhoidectomy,,25001134,LOCAL,Facility,Inpatient,,,,4488,3814.8,1286.2608,4488,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Hemorrhoidectomy,,25001134,LOCAL,Facility,Both,,,,4488,3814.8,1286.2608,4488,UnitedHealthcare,Individual & Family,4218.72,94,,percent of total billed charges,,
Hemorrhoidectomy,,25001134,LOCAL,Facility,Outpatient,,,,4488,3814.8,1286.2608,4488,UnitedHealthcare,Medicare Advantage,2199.12,49,,percent of total billed charges,,
Hemorrhoidectomy,,25001134,LOCAL,Facility,Inpatient,,,,4488,3814.8,1286.2608,4488,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Hemorrhoidectomy,,25001134,LOCAL,Facility,Outpatient,,,,4488,3814.8,1286.2608,4488,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2154.24,48,,percent of total billed charges,,100% of DHS outpatient percentage
Hemorrhoidectomy,,25001134,LOCAL,Facility,Inpatient,,,,4488,3814.8,1286.2608,4488,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Hernia Repair Implant Mesh Incis/Vent,,25001179,LOCAL,Facility,Both,,,,663,563.55,190.0158,663,Aetna,Commercial,609.96,92,,percent of total billed charges,,
Hernia Repair Implant Mesh Incis/Vent,,25001179,LOCAL,Facility,Outpatient,,,,663,563.55,190.0158,663,Aetna,Medicare Advantage,324.87,49,,percent of total billed charges,,
Hernia Repair Implant Mesh Incis/Vent,,25001179,LOCAL,Facility,Inpatient,,,,663,563.55,190.0158,663,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Hernia Repair Implant Mesh Incis/Vent,,25001179,LOCAL,Facility,Both,,,,663,563.55,190.0158,663,Aetna,PPO,616.59,93,,percent of total billed charges,,
Hernia Repair Implant Mesh Incis/Vent,,25001179,LOCAL,Facility,Both,,,,663,563.55,190.0158,663,America's PPO,America's PPO,636.6789,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Hernia Repair Implant Mesh Incis/Vent,,25001179,LOCAL,Facility,Both,,,,663,563.55,190.0158,663,BlueCross BlueShield Minnesota, Federal Employee Program,652.392,98.4,,percent of total billed charges,,
Hernia Repair Implant Mesh Incis/Vent,,25001179,LOCAL,Facility,Both,,,,663,563.55,190.0158,663,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,663,100,,percent of total billed charges,,
Hernia Repair Implant Mesh Incis/Vent,,25001179,LOCAL,Facility,Both,,,,663,563.55,190.0158,663,BlueCross BlueShield Minnesota,High Value Network Plan,596.7,90,,percent of total billed charges,,
Hernia Repair Implant Mesh Incis/Vent,,25001179,LOCAL,Facility,Outpatient,,,,663,563.55,190.0158,663,BlueCross BlueShield Minnesota,Medicare Advantage,324.87,49,,percent of total billed charges,,
Hernia Repair Implant Mesh Incis/Vent,,25001179,LOCAL,Facility,Inpatient,,,,663,563.55,190.0158,663,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Hernia Repair Implant Mesh Incis/Vent,,25001179,LOCAL,Facility,Both,,,,663,563.55,190.0158,663,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,587.2191,88.57,,percent of total billed charges,,
Hernia Repair Implant Mesh Incis/Vent,,25001179,LOCAL,Facility,Both,,,,663,563.55,190.0158,663,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,190.0158,28.66,,percent of total billed charges,,
Hernia Repair Implant Mesh Incis/Vent,,25001179,LOCAL,Facility,Outpatient,,,,663,563.55,190.0158,663,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),324.87,49,,percent of total billed charges,,
Hernia Repair Implant Mesh Incis/Vent,,25001179,LOCAL,Facility,Inpatient,,,,663,563.55,190.0158,663,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Hernia Repair Implant Mesh Incis/Vent,,25001179,LOCAL,Facility,Both,,,,663,563.55,190.0158,663,CorVel,Worker's Compensation,663,100,,percent of total billed charges,,
Hernia Repair Implant Mesh Incis/Vent,,25001179,LOCAL,Facility,Both,,,,663,563.55,190.0158,663,First Health Group Corporation,First Health Network,643.11,97,,percent of total billed charges,,
Hernia Repair Implant Mesh Incis/Vent,,25001179,LOCAL,Facility,Both,,,,663,563.55,190.0158,663,"Health Partners, Inc.",Commercial,627.198,94.6,,percent of total billed charges,,
Hernia Repair Implant Mesh Incis/Vent,,25001179,LOCAL,Facility,Outpatient,,,,663,563.55,190.0158,663,"Health Partners, Inc.",Medicare Advantage,324.87,49,,percent of total billed charges,,
Hernia Repair Implant Mesh Incis/Vent,,25001179,LOCAL,Facility,Inpatient,,,,663,563.55,190.0158,663,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Hernia Repair Implant Mesh Incis/Vent,,25001179,LOCAL,Facility,Both,,,,663,563.55,190.0158,663,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),397.8,60,,percent of total billed charges,,
Hernia Repair Implant Mesh Incis/Vent,,25001179,LOCAL,Facility,Both,,,,663,563.55,190.0158,663,"Health Partners, Inc.",State of Minnesota Advantage Program,540.345,81.5,,percent of total billed charges,,
Hernia Repair Implant Mesh Incis/Vent,,25001179,LOCAL,Facility,Both,,,,663,563.55,190.0158,663,"Health Partners, Inc.",State Public Programs,331.5,50,,percent of total billed charges,,
Hernia Repair Implant Mesh Incis/Vent,,25001179,LOCAL,Facility,Both,,,,663,563.55,190.0158,663,Humana Insurance Company,Commercial PPO,629.85,95,,percent of total billed charges,,
Hernia Repair Implant Mesh Incis/Vent,,25001179,LOCAL,Facility,Outpatient,,,,663,563.55,190.0158,663,Humana Insurance Company,Medicare PPO,324.87,49,,percent of total billed charges,,
Hernia Repair Implant Mesh Incis/Vent,,25001179,LOCAL,Facility,Inpatient,,,,663,563.55,190.0158,663,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Hernia Repair Implant Mesh Incis/Vent,,25001179,LOCAL,Facility,Both,,,,663,563.55,190.0158,663,Medica,Individual & Family,657.033,99.1,,percent of total billed charges,,
Hernia Repair Implant Mesh Incis/Vent,,25001179,LOCAL,Facility,Outpatient,,,,663,563.55,190.0158,663,Medica,Medica Advantage Solution,330.174,49.8,,percent of total billed charges,,
Hernia Repair Implant Mesh Incis/Vent,,25001179,LOCAL,Facility,Inpatient,,,,663,563.55,190.0158,663,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Hernia Repair Implant Mesh Incis/Vent,,25001179,LOCAL,Facility,Outpatient,,,,663,563.55,190.0158,663,Medica,Medical Assistance,295.698,44.6,,percent of total billed charges,,
Hernia Repair Implant Mesh Incis/Vent,,25001179,LOCAL,Facility,Inpatient,,,,663,563.55,190.0158,663,Medica,Medical Assistance,,,,,Included in per diem rate,
Hernia Repair Implant Mesh Incis/Vent,,25001179,LOCAL,Facility,Outpatient,,,,663,563.55,190.0158,663,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,330.174,49.8,,percent of total billed charges,,
Hernia Repair Implant Mesh Incis/Vent,,25001179,LOCAL,Facility,Inpatient,,,,663,563.55,190.0158,663,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Hernia Repair Implant Mesh Incis/Vent,,25001179,LOCAL,Facility,Both,,,,663,563.55,190.0158,663,"Multiplan, Inc.","Multiplan, Inc.",623.22,94,,percent of total billed charges,,
Hernia Repair Implant Mesh Incis/Vent,,25001179,LOCAL,Facility,Outpatient,,,,663,563.55,190.0158,663,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,597.363,90.1,,percent of total billed charges,,
Hernia Repair Implant Mesh Incis/Vent,,25001179,LOCAL,Facility,Inpatient,,,,663,563.55,190.0158,663,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Hernia Repair Implant Mesh Incis/Vent,,25001179,LOCAL,Facility,Both,,,,663,563.55,190.0158,663,"Preferred One Administrative Services, INC.",PPO,653.718,98.6,,percent of total billed charges,,
Hernia Repair Implant Mesh Incis/Vent,,25001179,LOCAL,Facility,Outpatient,,,,663,563.55,190.0158,663,PrimeWest Health,Minnesota Senior Health Options (MSHO),341.1135,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Hernia Repair Implant Mesh Incis/Vent,,25001179,LOCAL,Facility,Inpatient,,,,663,563.55,190.0158,663,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Hernia Repair Implant Mesh Incis/Vent,,25001179,LOCAL,Facility,Outpatient,,,,663,563.55,190.0158,663,PrimeWest Health,MinnesotaCare,340.5168,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Hernia Repair Implant Mesh Incis/Vent,,25001179,LOCAL,Facility,Inpatient,,,,663,563.55,190.0158,663,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Hernia Repair Implant Mesh Incis/Vent,,25001179,LOCAL,Facility,Both,,,,663,563.55,190.0158,663,Sanford Health Plan,Sanford Health Plan,609.96,92,,percent of total billed charges,,
Hernia Repair Implant Mesh Incis/Vent,,25001179,LOCAL,Facility,Outpatient,,,,663,563.55,190.0158,663,"UCare Health, Inc.",Individual & Family Plan,373.6005,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Hernia Repair Implant Mesh Incis/Vent,,25001179,LOCAL,Facility,Inpatient,,,,663,563.55,190.0158,663,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Hernia Repair Implant Mesh Incis/Vent,,25001179,LOCAL,Facility,Outpatient,,,,663,563.55,190.0158,663,"UCare Health, Inc.",Medical Assistance,334.6161,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Hernia Repair Implant Mesh Incis/Vent,,25001179,LOCAL,Facility,Inpatient,,,,663,563.55,190.0158,663,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Hernia Repair Implant Mesh Incis/Vent,,25001179,LOCAL,Facility,Outpatient,,,,663,563.55,190.0158,663,"UCare Health, Inc.",Medicare Advantage,334.6161,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Hernia Repair Implant Mesh Incis/Vent,,25001179,LOCAL,Facility,Inpatient,,,,663,563.55,190.0158,663,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Hernia Repair Implant Mesh Incis/Vent,,25001179,LOCAL,Facility,Outpatient,,,,663,563.55,190.0158,663,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),334.6161,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Hernia Repair Implant Mesh Incis/Vent,,25001179,LOCAL,Facility,Inpatient,,,,663,563.55,190.0158,663,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Hernia Repair Implant Mesh Incis/Vent,,25001179,LOCAL,Facility,Both,,,,663,563.55,190.0158,663,UnitedHealthcare,Individual & Family,623.22,94,,percent of total billed charges,,
Hernia Repair Implant Mesh Incis/Vent,,25001179,LOCAL,Facility,Outpatient,,,,663,563.55,190.0158,663,UnitedHealthcare,Medicare Advantage,324.87,49,,percent of total billed charges,,
Hernia Repair Implant Mesh Incis/Vent,,25001179,LOCAL,Facility,Inpatient,,,,663,563.55,190.0158,663,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Hernia Repair Implant Mesh Incis/Vent,,25001179,LOCAL,Facility,Outpatient,,,,663,563.55,190.0158,663,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,318.24,48,,percent of total billed charges,,100% of DHS outpatient percentage
Hernia Repair Implant Mesh Incis/Vent,,25001179,LOCAL,Facility,Inpatient,,,,663,563.55,190.0158,663,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Hernia Repair Inguinal Laparoscopic,,25001196,LOCAL,Facility,Both,,,,4692,3988.2,1344.7272,4692,Aetna,Commercial,4316.64,92,,percent of total billed charges,,
Hernia Repair Inguinal Laparoscopic,,25001196,LOCAL,Facility,Outpatient,,,,4692,3988.2,1344.7272,4692,Aetna,Medicare Advantage,2299.08,49,,percent of total billed charges,,
Hernia Repair Inguinal Laparoscopic,,25001196,LOCAL,Facility,Inpatient,,,,4692,3988.2,1344.7272,4692,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Hernia Repair Inguinal Laparoscopic,,25001196,LOCAL,Facility,Both,,,,4692,3988.2,1344.7272,4692,Aetna,PPO,4363.56,93,,percent of total billed charges,,
Hernia Repair Inguinal Laparoscopic,,25001196,LOCAL,Facility,Both,,,,4692,3988.2,1344.7272,4692,America's PPO,America's PPO,4505.7276,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Hernia Repair Inguinal Laparoscopic,,25001196,LOCAL,Facility,Both,,,,4692,3988.2,1344.7272,4692,BlueCross BlueShield Minnesota, Federal Employee Program,4616.928,98.4,,percent of total billed charges,,
Hernia Repair Inguinal Laparoscopic,,25001196,LOCAL,Facility,Both,,,,4692,3988.2,1344.7272,4692,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,4692,100,,percent of total billed charges,,
Hernia Repair Inguinal Laparoscopic,,25001196,LOCAL,Facility,Both,,,,4692,3988.2,1344.7272,4692,BlueCross BlueShield Minnesota,High Value Network Plan,4222.8,90,,percent of total billed charges,,
Hernia Repair Inguinal Laparoscopic,,25001196,LOCAL,Facility,Outpatient,,,,4692,3988.2,1344.7272,4692,BlueCross BlueShield Minnesota,Medicare Advantage,2299.08,49,,percent of total billed charges,,
Hernia Repair Inguinal Laparoscopic,,25001196,LOCAL,Facility,Inpatient,,,,4692,3988.2,1344.7272,4692,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Hernia Repair Inguinal Laparoscopic,,25001196,LOCAL,Facility,Both,,,,4692,3988.2,1344.7272,4692,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4155.7044,88.57,,percent of total billed charges,,
Hernia Repair Inguinal Laparoscopic,,25001196,LOCAL,Facility,Both,,,,4692,3988.2,1344.7272,4692,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1344.7272,28.66,,percent of total billed charges,,
Hernia Repair Inguinal Laparoscopic,,25001196,LOCAL,Facility,Outpatient,,,,4692,3988.2,1344.7272,4692,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2299.08,49,,percent of total billed charges,,
Hernia Repair Inguinal Laparoscopic,,25001196,LOCAL,Facility,Inpatient,,,,4692,3988.2,1344.7272,4692,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Hernia Repair Inguinal Laparoscopic,,25001196,LOCAL,Facility,Both,,,,4692,3988.2,1344.7272,4692,CorVel,Worker's Compensation,4692,100,,percent of total billed charges,,
Hernia Repair Inguinal Laparoscopic,,25001196,LOCAL,Facility,Both,,,,4692,3988.2,1344.7272,4692,First Health Group Corporation,First Health Network,4551.24,97,,percent of total billed charges,,
Hernia Repair Inguinal Laparoscopic,,25001196,LOCAL,Facility,Both,,,,4692,3988.2,1344.7272,4692,"Health Partners, Inc.",Commercial,4438.632,94.6,,percent of total billed charges,,
Hernia Repair Inguinal Laparoscopic,,25001196,LOCAL,Facility,Outpatient,,,,4692,3988.2,1344.7272,4692,"Health Partners, Inc.",Medicare Advantage,2299.08,49,,percent of total billed charges,,
Hernia Repair Inguinal Laparoscopic,,25001196,LOCAL,Facility,Inpatient,,,,4692,3988.2,1344.7272,4692,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Hernia Repair Inguinal Laparoscopic,,25001196,LOCAL,Facility,Both,,,,4692,3988.2,1344.7272,4692,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),2815.2,60,,percent of total billed charges,,
Hernia Repair Inguinal Laparoscopic,,25001196,LOCAL,Facility,Both,,,,4692,3988.2,1344.7272,4692,"Health Partners, Inc.",State of Minnesota Advantage Program,3823.98,81.5,,percent of total billed charges,,
Hernia Repair Inguinal Laparoscopic,,25001196,LOCAL,Facility,Both,,,,4692,3988.2,1344.7272,4692,"Health Partners, Inc.",State Public Programs,2346,50,,percent of total billed charges,,
Hernia Repair Inguinal Laparoscopic,,25001196,LOCAL,Facility,Both,,,,4692,3988.2,1344.7272,4692,Humana Insurance Company,Commercial PPO,4457.4,95,,percent of total billed charges,,
Hernia Repair Inguinal Laparoscopic,,25001196,LOCAL,Facility,Outpatient,,,,4692,3988.2,1344.7272,4692,Humana Insurance Company,Medicare PPO,2299.08,49,,percent of total billed charges,,
Hernia Repair Inguinal Laparoscopic,,25001196,LOCAL,Facility,Inpatient,,,,4692,3988.2,1344.7272,4692,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Hernia Repair Inguinal Laparoscopic,,25001196,LOCAL,Facility,Both,,,,4692,3988.2,1344.7272,4692,Medica,Individual & Family,4649.772,99.1,,percent of total billed charges,,
Hernia Repair Inguinal Laparoscopic,,25001196,LOCAL,Facility,Outpatient,,,,4692,3988.2,1344.7272,4692,Medica,Medica Advantage Solution,2336.616,49.8,,percent of total billed charges,,
Hernia Repair Inguinal Laparoscopic,,25001196,LOCAL,Facility,Inpatient,,,,4692,3988.2,1344.7272,4692,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Hernia Repair Inguinal Laparoscopic,,25001196,LOCAL,Facility,Outpatient,,,,4692,3988.2,1344.7272,4692,Medica,Medical Assistance,2092.632,44.6,,percent of total billed charges,,
Hernia Repair Inguinal Laparoscopic,,25001196,LOCAL,Facility,Inpatient,,,,4692,3988.2,1344.7272,4692,Medica,Medical Assistance,,,,,Included in per diem rate,
Hernia Repair Inguinal Laparoscopic,,25001196,LOCAL,Facility,Outpatient,,,,4692,3988.2,1344.7272,4692,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2336.616,49.8,,percent of total billed charges,,
Hernia Repair Inguinal Laparoscopic,,25001196,LOCAL,Facility,Inpatient,,,,4692,3988.2,1344.7272,4692,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Hernia Repair Inguinal Laparoscopic,,25001196,LOCAL,Facility,Both,,,,4692,3988.2,1344.7272,4692,"Multiplan, Inc.","Multiplan, Inc.",4410.48,94,,percent of total billed charges,,
Hernia Repair Inguinal Laparoscopic,,25001196,LOCAL,Facility,Outpatient,,,,4692,3988.2,1344.7272,4692,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4227.492,90.1,,percent of total billed charges,,
Hernia Repair Inguinal Laparoscopic,,25001196,LOCAL,Facility,Inpatient,,,,4692,3988.2,1344.7272,4692,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Hernia Repair Inguinal Laparoscopic,,25001196,LOCAL,Facility,Both,,,,4692,3988.2,1344.7272,4692,"Preferred One Administrative Services, INC.",PPO,4626.312,98.6,,percent of total billed charges,,
Hernia Repair Inguinal Laparoscopic,,25001196,LOCAL,Facility,Outpatient,,,,4692,3988.2,1344.7272,4692,PrimeWest Health,Minnesota Senior Health Options (MSHO),2414.034,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Hernia Repair Inguinal Laparoscopic,,25001196,LOCAL,Facility,Inpatient,,,,4692,3988.2,1344.7272,4692,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Hernia Repair Inguinal Laparoscopic,,25001196,LOCAL,Facility,Outpatient,,,,4692,3988.2,1344.7272,4692,PrimeWest Health,MinnesotaCare,2409.8112,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Hernia Repair Inguinal Laparoscopic,,25001196,LOCAL,Facility,Inpatient,,,,4692,3988.2,1344.7272,4692,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Hernia Repair Inguinal Laparoscopic,,25001196,LOCAL,Facility,Both,,,,4692,3988.2,1344.7272,4692,Sanford Health Plan,Sanford Health Plan,4316.64,92,,percent of total billed charges,,
Hernia Repair Inguinal Laparoscopic,,25001196,LOCAL,Facility,Outpatient,,,,4692,3988.2,1344.7272,4692,"UCare Health, Inc.",Individual & Family Plan,2643.942,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Hernia Repair Inguinal Laparoscopic,,25001196,LOCAL,Facility,Inpatient,,,,4692,3988.2,1344.7272,4692,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Hernia Repair Inguinal Laparoscopic,,25001196,LOCAL,Facility,Outpatient,,,,4692,3988.2,1344.7272,4692,"UCare Health, Inc.",Medical Assistance,2368.0524,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Hernia Repair Inguinal Laparoscopic,,25001196,LOCAL,Facility,Inpatient,,,,4692,3988.2,1344.7272,4692,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Hernia Repair Inguinal Laparoscopic,,25001196,LOCAL,Facility,Outpatient,,,,4692,3988.2,1344.7272,4692,"UCare Health, Inc.",Medicare Advantage,2368.0524,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Hernia Repair Inguinal Laparoscopic,,25001196,LOCAL,Facility,Inpatient,,,,4692,3988.2,1344.7272,4692,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Hernia Repair Inguinal Laparoscopic,,25001196,LOCAL,Facility,Outpatient,,,,4692,3988.2,1344.7272,4692,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2368.0524,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Hernia Repair Inguinal Laparoscopic,,25001196,LOCAL,Facility,Inpatient,,,,4692,3988.2,1344.7272,4692,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Hernia Repair Inguinal Laparoscopic,,25001196,LOCAL,Facility,Both,,,,4692,3988.2,1344.7272,4692,UnitedHealthcare,Individual & Family,4410.48,94,,percent of total billed charges,,
Hernia Repair Inguinal Laparoscopic,,25001196,LOCAL,Facility,Outpatient,,,,4692,3988.2,1344.7272,4692,UnitedHealthcare,Medicare Advantage,2299.08,49,,percent of total billed charges,,
Hernia Repair Inguinal Laparoscopic,,25001196,LOCAL,Facility,Inpatient,,,,4692,3988.2,1344.7272,4692,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Hernia Repair Inguinal Laparoscopic,,25001196,LOCAL,Facility,Outpatient,,,,4692,3988.2,1344.7272,4692,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2252.16,48,,percent of total billed charges,,100% of DHS outpatient percentage
Hernia Repair Inguinal Laparoscopic,,25001196,LOCAL,Facility,Inpatient,,,,4692,3988.2,1344.7272,4692,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Repair, Hernia, Inguinal, Open",,25001202,LOCAL,Facility,Both,,,,3978,3381.3,1140.0948,3978,Aetna,Commercial,3659.76,92,,percent of total billed charges,,
"Repair, Hernia, Inguinal, Open",,25001202,LOCAL,Facility,Outpatient,,,,3978,3381.3,1140.0948,3978,Aetna,Medicare Advantage,1949.22,49,,percent of total billed charges,,
"Repair, Hernia, Inguinal, Open",,25001202,LOCAL,Facility,Inpatient,,,,3978,3381.3,1140.0948,3978,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Repair, Hernia, Inguinal, Open",,25001202,LOCAL,Facility,Both,,,,3978,3381.3,1140.0948,3978,Aetna,PPO,3699.54,93,,percent of total billed charges,,
"Repair, Hernia, Inguinal, Open",,25001202,LOCAL,Facility,Both,,,,3978,3381.3,1140.0948,3978,America's PPO,America's PPO,3820.0734,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Repair, Hernia, Inguinal, Open",,25001202,LOCAL,Facility,Both,,,,3978,3381.3,1140.0948,3978,BlueCross BlueShield Minnesota, Federal Employee Program,3914.352,98.4,,percent of total billed charges,,
"Repair, Hernia, Inguinal, Open",,25001202,LOCAL,Facility,Both,,,,3978,3381.3,1140.0948,3978,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,3978,100,,percent of total billed charges,,
"Repair, Hernia, Inguinal, Open",,25001202,LOCAL,Facility,Both,,,,3978,3381.3,1140.0948,3978,BlueCross BlueShield Minnesota,High Value Network Plan,3580.2,90,,percent of total billed charges,,
"Repair, Hernia, Inguinal, Open",,25001202,LOCAL,Facility,Outpatient,,,,3978,3381.3,1140.0948,3978,BlueCross BlueShield Minnesota,Medicare Advantage,1949.22,49,,percent of total billed charges,,
"Repair, Hernia, Inguinal, Open",,25001202,LOCAL,Facility,Inpatient,,,,3978,3381.3,1140.0948,3978,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Repair, Hernia, Inguinal, Open",,25001202,LOCAL,Facility,Both,,,,3978,3381.3,1140.0948,3978,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,3523.3146,88.57,,percent of total billed charges,,
"Repair, Hernia, Inguinal, Open",,25001202,LOCAL,Facility,Both,,,,3978,3381.3,1140.0948,3978,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1140.0948,28.66,,percent of total billed charges,,
"Repair, Hernia, Inguinal, Open",,25001202,LOCAL,Facility,Outpatient,,,,3978,3381.3,1140.0948,3978,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1949.22,49,,percent of total billed charges,,
"Repair, Hernia, Inguinal, Open",,25001202,LOCAL,Facility,Inpatient,,,,3978,3381.3,1140.0948,3978,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Repair, Hernia, Inguinal, Open",,25001202,LOCAL,Facility,Both,,,,3978,3381.3,1140.0948,3978,CorVel,Worker's Compensation,3978,100,,percent of total billed charges,,
"Repair, Hernia, Inguinal, Open",,25001202,LOCAL,Facility,Both,,,,3978,3381.3,1140.0948,3978,First Health Group Corporation,First Health Network,3858.66,97,,percent of total billed charges,,
"Repair, Hernia, Inguinal, Open",,25001202,LOCAL,Facility,Both,,,,3978,3381.3,1140.0948,3978,"Health Partners, Inc.",Commercial,3763.188,94.6,,percent of total billed charges,,
"Repair, Hernia, Inguinal, Open",,25001202,LOCAL,Facility,Outpatient,,,,3978,3381.3,1140.0948,3978,"Health Partners, Inc.",Medicare Advantage,1949.22,49,,percent of total billed charges,,
"Repair, Hernia, Inguinal, Open",,25001202,LOCAL,Facility,Inpatient,,,,3978,3381.3,1140.0948,3978,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Repair, Hernia, Inguinal, Open",,25001202,LOCAL,Facility,Both,,,,3978,3381.3,1140.0948,3978,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),2386.8,60,,percent of total billed charges,,
"Repair, Hernia, Inguinal, Open",,25001202,LOCAL,Facility,Both,,,,3978,3381.3,1140.0948,3978,"Health Partners, Inc.",State of Minnesota Advantage Program,3242.07,81.5,,percent of total billed charges,,
"Repair, Hernia, Inguinal, Open",,25001202,LOCAL,Facility,Both,,,,3978,3381.3,1140.0948,3978,"Health Partners, Inc.",State Public Programs,1989,50,,percent of total billed charges,,
"Repair, Hernia, Inguinal, Open",,25001202,LOCAL,Facility,Both,,,,3978,3381.3,1140.0948,3978,Humana Insurance Company,Commercial PPO,3779.1,95,,percent of total billed charges,,
"Repair, Hernia, Inguinal, Open",,25001202,LOCAL,Facility,Outpatient,,,,3978,3381.3,1140.0948,3978,Humana Insurance Company,Medicare PPO,1949.22,49,,percent of total billed charges,,
"Repair, Hernia, Inguinal, Open",,25001202,LOCAL,Facility,Inpatient,,,,3978,3381.3,1140.0948,3978,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Repair, Hernia, Inguinal, Open",,25001202,LOCAL,Facility,Both,,,,3978,3381.3,1140.0948,3978,Medica,Individual & Family,3942.198,99.1,,percent of total billed charges,,
"Repair, Hernia, Inguinal, Open",,25001202,LOCAL,Facility,Outpatient,,,,3978,3381.3,1140.0948,3978,Medica,Medica Advantage Solution,1981.044,49.8,,percent of total billed charges,,
"Repair, Hernia, Inguinal, Open",,25001202,LOCAL,Facility,Inpatient,,,,3978,3381.3,1140.0948,3978,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Repair, Hernia, Inguinal, Open",,25001202,LOCAL,Facility,Outpatient,,,,3978,3381.3,1140.0948,3978,Medica,Medical Assistance,1774.188,44.6,,percent of total billed charges,,
"Repair, Hernia, Inguinal, Open",,25001202,LOCAL,Facility,Inpatient,,,,3978,3381.3,1140.0948,3978,Medica,Medical Assistance,,,,,Included in per diem rate,
"Repair, Hernia, Inguinal, Open",,25001202,LOCAL,Facility,Outpatient,,,,3978,3381.3,1140.0948,3978,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1981.044,49.8,,percent of total billed charges,,
"Repair, Hernia, Inguinal, Open",,25001202,LOCAL,Facility,Inpatient,,,,3978,3381.3,1140.0948,3978,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Repair, Hernia, Inguinal, Open",,25001202,LOCAL,Facility,Both,,,,3978,3381.3,1140.0948,3978,"Multiplan, Inc.","Multiplan, Inc.",3739.32,94,,percent of total billed charges,,
"Repair, Hernia, Inguinal, Open",,25001202,LOCAL,Facility,Outpatient,,,,3978,3381.3,1140.0948,3978,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,3584.178,90.1,,percent of total billed charges,,
"Repair, Hernia, Inguinal, Open",,25001202,LOCAL,Facility,Inpatient,,,,3978,3381.3,1140.0948,3978,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Repair, Hernia, Inguinal, Open",,25001202,LOCAL,Facility,Both,,,,3978,3381.3,1140.0948,3978,"Preferred One Administrative Services, INC.",PPO,3922.308,98.6,,percent of total billed charges,,
"Repair, Hernia, Inguinal, Open",,25001202,LOCAL,Facility,Outpatient,,,,3978,3381.3,1140.0948,3978,PrimeWest Health,Minnesota Senior Health Options (MSHO),2046.681,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Repair, Hernia, Inguinal, Open",,25001202,LOCAL,Facility,Inpatient,,,,3978,3381.3,1140.0948,3978,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Repair, Hernia, Inguinal, Open",,25001202,LOCAL,Facility,Outpatient,,,,3978,3381.3,1140.0948,3978,PrimeWest Health,MinnesotaCare,2043.1008,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Repair, Hernia, Inguinal, Open",,25001202,LOCAL,Facility,Inpatient,,,,3978,3381.3,1140.0948,3978,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Repair, Hernia, Inguinal, Open",,25001202,LOCAL,Facility,Both,,,,3978,3381.3,1140.0948,3978,Sanford Health Plan,Sanford Health Plan,3659.76,92,,percent of total billed charges,,
"Repair, Hernia, Inguinal, Open",,25001202,LOCAL,Facility,Outpatient,,,,3978,3381.3,1140.0948,3978,"UCare Health, Inc.",Individual & Family Plan,2241.603,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Repair, Hernia, Inguinal, Open",,25001202,LOCAL,Facility,Inpatient,,,,3978,3381.3,1140.0948,3978,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Repair, Hernia, Inguinal, Open",,25001202,LOCAL,Facility,Outpatient,,,,3978,3381.3,1140.0948,3978,"UCare Health, Inc.",Medical Assistance,2007.6966,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Repair, Hernia, Inguinal, Open",,25001202,LOCAL,Facility,Inpatient,,,,3978,3381.3,1140.0948,3978,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Repair, Hernia, Inguinal, Open",,25001202,LOCAL,Facility,Outpatient,,,,3978,3381.3,1140.0948,3978,"UCare Health, Inc.",Medicare Advantage,2007.6966,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Repair, Hernia, Inguinal, Open",,25001202,LOCAL,Facility,Inpatient,,,,3978,3381.3,1140.0948,3978,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Repair, Hernia, Inguinal, Open",,25001202,LOCAL,Facility,Outpatient,,,,3978,3381.3,1140.0948,3978,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2007.6966,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Repair, Hernia, Inguinal, Open",,25001202,LOCAL,Facility,Inpatient,,,,3978,3381.3,1140.0948,3978,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Repair, Hernia, Inguinal, Open",,25001202,LOCAL,Facility,Both,,,,3978,3381.3,1140.0948,3978,UnitedHealthcare,Individual & Family,3739.32,94,,percent of total billed charges,,
"Repair, Hernia, Inguinal, Open",,25001202,LOCAL,Facility,Outpatient,,,,3978,3381.3,1140.0948,3978,UnitedHealthcare,Medicare Advantage,1949.22,49,,percent of total billed charges,,
"Repair, Hernia, Inguinal, Open",,25001202,LOCAL,Facility,Inpatient,,,,3978,3381.3,1140.0948,3978,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Repair, Hernia, Inguinal, Open",,25001202,LOCAL,Facility,Outpatient,,,,3978,3381.3,1140.0948,3978,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1909.44,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Repair, Hernia, Inguinal, Open",,25001202,LOCAL,Facility,Inpatient,,,,3978,3381.3,1140.0948,3978,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Repair, Hernia, Umbilical, Open",,25001246,LOCAL,Facility,Both,,,,2708,2301.8,776.1128,2708,Aetna,Commercial,2491.36,92,,percent of total billed charges,,
"Repair, Hernia, Umbilical, Open",,25001246,LOCAL,Facility,Outpatient,,,,2708,2301.8,776.1128,2708,Aetna,Medicare Advantage,1326.92,49,,percent of total billed charges,,
"Repair, Hernia, Umbilical, Open",,25001246,LOCAL,Facility,Inpatient,,,,2708,2301.8,776.1128,2708,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Repair, Hernia, Umbilical, Open",,25001246,LOCAL,Facility,Both,,,,2708,2301.8,776.1128,2708,Aetna,PPO,2518.44,93,,percent of total billed charges,,
"Repair, Hernia, Umbilical, Open",,25001246,LOCAL,Facility,Both,,,,2708,2301.8,776.1128,2708,America's PPO,America's PPO,2600.4924,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Repair, Hernia, Umbilical, Open",,25001246,LOCAL,Facility,Both,,,,2708,2301.8,776.1128,2708,BlueCross BlueShield Minnesota, Federal Employee Program,2664.672,98.4,,percent of total billed charges,,
"Repair, Hernia, Umbilical, Open",,25001246,LOCAL,Facility,Both,,,,2708,2301.8,776.1128,2708,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,2708,100,,percent of total billed charges,,
"Repair, Hernia, Umbilical, Open",,25001246,LOCAL,Facility,Both,,,,2708,2301.8,776.1128,2708,BlueCross BlueShield Minnesota,High Value Network Plan,2437.2,90,,percent of total billed charges,,
"Repair, Hernia, Umbilical, Open",,25001246,LOCAL,Facility,Outpatient,,,,2708,2301.8,776.1128,2708,BlueCross BlueShield Minnesota,Medicare Advantage,1326.92,49,,percent of total billed charges,,
"Repair, Hernia, Umbilical, Open",,25001246,LOCAL,Facility,Inpatient,,,,2708,2301.8,776.1128,2708,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Repair, Hernia, Umbilical, Open",,25001246,LOCAL,Facility,Both,,,,2708,2301.8,776.1128,2708,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,2398.4756,88.57,,percent of total billed charges,,
"Repair, Hernia, Umbilical, Open",,25001246,LOCAL,Facility,Both,,,,2708,2301.8,776.1128,2708,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,776.1128,28.66,,percent of total billed charges,,
"Repair, Hernia, Umbilical, Open",,25001246,LOCAL,Facility,Outpatient,,,,2708,2301.8,776.1128,2708,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1326.92,49,,percent of total billed charges,,
"Repair, Hernia, Umbilical, Open",,25001246,LOCAL,Facility,Inpatient,,,,2708,2301.8,776.1128,2708,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Repair, Hernia, Umbilical, Open",,25001246,LOCAL,Facility,Both,,,,2708,2301.8,776.1128,2708,CorVel,Worker's Compensation,2708,100,,percent of total billed charges,,
"Repair, Hernia, Umbilical, Open",,25001246,LOCAL,Facility,Both,,,,2708,2301.8,776.1128,2708,First Health Group Corporation,First Health Network,2626.76,97,,percent of total billed charges,,
"Repair, Hernia, Umbilical, Open",,25001246,LOCAL,Facility,Both,,,,2708,2301.8,776.1128,2708,"Health Partners, Inc.",Commercial,2561.768,94.6,,percent of total billed charges,,
"Repair, Hernia, Umbilical, Open",,25001246,LOCAL,Facility,Outpatient,,,,2708,2301.8,776.1128,2708,"Health Partners, Inc.",Medicare Advantage,1326.92,49,,percent of total billed charges,,
"Repair, Hernia, Umbilical, Open",,25001246,LOCAL,Facility,Inpatient,,,,2708,2301.8,776.1128,2708,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Repair, Hernia, Umbilical, Open",,25001246,LOCAL,Facility,Both,,,,2708,2301.8,776.1128,2708,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1624.8,60,,percent of total billed charges,,
"Repair, Hernia, Umbilical, Open",,25001246,LOCAL,Facility,Both,,,,2708,2301.8,776.1128,2708,"Health Partners, Inc.",State of Minnesota Advantage Program,2207.02,81.5,,percent of total billed charges,,
"Repair, Hernia, Umbilical, Open",,25001246,LOCAL,Facility,Both,,,,2708,2301.8,776.1128,2708,"Health Partners, Inc.",State Public Programs,1354,50,,percent of total billed charges,,
"Repair, Hernia, Umbilical, Open",,25001246,LOCAL,Facility,Both,,,,2708,2301.8,776.1128,2708,Humana Insurance Company,Commercial PPO,2572.6,95,,percent of total billed charges,,
"Repair, Hernia, Umbilical, Open",,25001246,LOCAL,Facility,Outpatient,,,,2708,2301.8,776.1128,2708,Humana Insurance Company,Medicare PPO,1326.92,49,,percent of total billed charges,,
"Repair, Hernia, Umbilical, Open",,25001246,LOCAL,Facility,Inpatient,,,,2708,2301.8,776.1128,2708,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Repair, Hernia, Umbilical, Open",,25001246,LOCAL,Facility,Both,,,,2708,2301.8,776.1128,2708,Medica,Individual & Family,2683.628,99.1,,percent of total billed charges,,
"Repair, Hernia, Umbilical, Open",,25001246,LOCAL,Facility,Outpatient,,,,2708,2301.8,776.1128,2708,Medica,Medica Advantage Solution,1348.584,49.8,,percent of total billed charges,,
"Repair, Hernia, Umbilical, Open",,25001246,LOCAL,Facility,Inpatient,,,,2708,2301.8,776.1128,2708,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Repair, Hernia, Umbilical, Open",,25001246,LOCAL,Facility,Outpatient,,,,2708,2301.8,776.1128,2708,Medica,Medical Assistance,1207.768,44.6,,percent of total billed charges,,
"Repair, Hernia, Umbilical, Open",,25001246,LOCAL,Facility,Inpatient,,,,2708,2301.8,776.1128,2708,Medica,Medical Assistance,,,,,Included in per diem rate,
"Repair, Hernia, Umbilical, Open",,25001246,LOCAL,Facility,Outpatient,,,,2708,2301.8,776.1128,2708,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1348.584,49.8,,percent of total billed charges,,
"Repair, Hernia, Umbilical, Open",,25001246,LOCAL,Facility,Inpatient,,,,2708,2301.8,776.1128,2708,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Repair, Hernia, Umbilical, Open",,25001246,LOCAL,Facility,Both,,,,2708,2301.8,776.1128,2708,"Multiplan, Inc.","Multiplan, Inc.",2545.52,94,,percent of total billed charges,,
"Repair, Hernia, Umbilical, Open",,25001246,LOCAL,Facility,Outpatient,,,,2708,2301.8,776.1128,2708,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,2439.908,90.1,,percent of total billed charges,,
"Repair, Hernia, Umbilical, Open",,25001246,LOCAL,Facility,Inpatient,,,,2708,2301.8,776.1128,2708,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Repair, Hernia, Umbilical, Open",,25001246,LOCAL,Facility,Both,,,,2708,2301.8,776.1128,2708,"Preferred One Administrative Services, INC.",PPO,2670.088,98.6,,percent of total billed charges,,
"Repair, Hernia, Umbilical, Open",,25001246,LOCAL,Facility,Outpatient,,,,2708,2301.8,776.1128,2708,PrimeWest Health,Minnesota Senior Health Options (MSHO),1393.266,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Repair, Hernia, Umbilical, Open",,25001246,LOCAL,Facility,Inpatient,,,,2708,2301.8,776.1128,2708,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Repair, Hernia, Umbilical, Open",,25001246,LOCAL,Facility,Outpatient,,,,2708,2301.8,776.1128,2708,PrimeWest Health,MinnesotaCare,1390.8288,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Repair, Hernia, Umbilical, Open",,25001246,LOCAL,Facility,Inpatient,,,,2708,2301.8,776.1128,2708,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Repair, Hernia, Umbilical, Open",,25001246,LOCAL,Facility,Both,,,,2708,2301.8,776.1128,2708,Sanford Health Plan,Sanford Health Plan,2491.36,92,,percent of total billed charges,,
"Repair, Hernia, Umbilical, Open",,25001246,LOCAL,Facility,Outpatient,,,,2708,2301.8,776.1128,2708,"UCare Health, Inc.",Individual & Family Plan,1525.958,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Repair, Hernia, Umbilical, Open",,25001246,LOCAL,Facility,Inpatient,,,,2708,2301.8,776.1128,2708,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Repair, Hernia, Umbilical, Open",,25001246,LOCAL,Facility,Outpatient,,,,2708,2301.8,776.1128,2708,"UCare Health, Inc.",Medical Assistance,1366.7276,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Repair, Hernia, Umbilical, Open",,25001246,LOCAL,Facility,Inpatient,,,,2708,2301.8,776.1128,2708,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Repair, Hernia, Umbilical, Open",,25001246,LOCAL,Facility,Outpatient,,,,2708,2301.8,776.1128,2708,"UCare Health, Inc.",Medicare Advantage,1366.7276,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Repair, Hernia, Umbilical, Open",,25001246,LOCAL,Facility,Inpatient,,,,2708,2301.8,776.1128,2708,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Repair, Hernia, Umbilical, Open",,25001246,LOCAL,Facility,Outpatient,,,,2708,2301.8,776.1128,2708,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1366.7276,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Repair, Hernia, Umbilical, Open",,25001246,LOCAL,Facility,Inpatient,,,,2708,2301.8,776.1128,2708,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Repair, Hernia, Umbilical, Open",,25001246,LOCAL,Facility,Both,,,,2708,2301.8,776.1128,2708,UnitedHealthcare,Individual & Family,2545.52,94,,percent of total billed charges,,
"Repair, Hernia, Umbilical, Open",,25001246,LOCAL,Facility,Outpatient,,,,2708,2301.8,776.1128,2708,UnitedHealthcare,Medicare Advantage,1326.92,49,,percent of total billed charges,,
"Repair, Hernia, Umbilical, Open",,25001246,LOCAL,Facility,Inpatient,,,,2708,2301.8,776.1128,2708,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Repair, Hernia, Umbilical, Open",,25001246,LOCAL,Facility,Outpatient,,,,2708,2301.8,776.1128,2708,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1299.84,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Repair, Hernia, Umbilical, Open",,25001246,LOCAL,Facility,Inpatient,,,,2708,2301.8,776.1128,2708,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Hydrocelectomy,,25001261,LOCAL,Facility,Both,,,,3060,2601,876.996,3060,Aetna,Commercial,2815.2,92,,percent of total billed charges,,
Hydrocelectomy,,25001261,LOCAL,Facility,Outpatient,,,,3060,2601,876.996,3060,Aetna,Medicare Advantage,1499.4,49,,percent of total billed charges,,
Hydrocelectomy,,25001261,LOCAL,Facility,Inpatient,,,,3060,2601,876.996,3060,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Hydrocelectomy,,25001261,LOCAL,Facility,Both,,,,3060,2601,876.996,3060,Aetna,PPO,2845.8,93,,percent of total billed charges,,
Hydrocelectomy,,25001261,LOCAL,Facility,Both,,,,3060,2601,876.996,3060,America's PPO,America's PPO,2938.518,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Hydrocelectomy,,25001261,LOCAL,Facility,Both,,,,3060,2601,876.996,3060,BlueCross BlueShield Minnesota, Federal Employee Program,3011.04,98.4,,percent of total billed charges,,
Hydrocelectomy,,25001261,LOCAL,Facility,Both,,,,3060,2601,876.996,3060,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,3060,100,,percent of total billed charges,,
Hydrocelectomy,,25001261,LOCAL,Facility,Both,,,,3060,2601,876.996,3060,BlueCross BlueShield Minnesota,High Value Network Plan,2754,90,,percent of total billed charges,,
Hydrocelectomy,,25001261,LOCAL,Facility,Outpatient,,,,3060,2601,876.996,3060,BlueCross BlueShield Minnesota,Medicare Advantage,1499.4,49,,percent of total billed charges,,
Hydrocelectomy,,25001261,LOCAL,Facility,Inpatient,,,,3060,2601,876.996,3060,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Hydrocelectomy,,25001261,LOCAL,Facility,Both,,,,3060,2601,876.996,3060,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,2710.242,88.57,,percent of total billed charges,,
Hydrocelectomy,,25001261,LOCAL,Facility,Both,,,,3060,2601,876.996,3060,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,876.996,28.66,,percent of total billed charges,,
Hydrocelectomy,,25001261,LOCAL,Facility,Outpatient,,,,3060,2601,876.996,3060,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1499.4,49,,percent of total billed charges,,
Hydrocelectomy,,25001261,LOCAL,Facility,Inpatient,,,,3060,2601,876.996,3060,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Hydrocelectomy,,25001261,LOCAL,Facility,Both,,,,3060,2601,876.996,3060,CorVel,Worker's Compensation,3060,100,,percent of total billed charges,,
Hydrocelectomy,,25001261,LOCAL,Facility,Both,,,,3060,2601,876.996,3060,First Health Group Corporation,First Health Network,2968.2,97,,percent of total billed charges,,
Hydrocelectomy,,25001261,LOCAL,Facility,Both,,,,3060,2601,876.996,3060,"Health Partners, Inc.",Commercial,2894.76,94.6,,percent of total billed charges,,
Hydrocelectomy,,25001261,LOCAL,Facility,Outpatient,,,,3060,2601,876.996,3060,"Health Partners, Inc.",Medicare Advantage,1499.4,49,,percent of total billed charges,,
Hydrocelectomy,,25001261,LOCAL,Facility,Inpatient,,,,3060,2601,876.996,3060,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Hydrocelectomy,,25001261,LOCAL,Facility,Both,,,,3060,2601,876.996,3060,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1836,60,,percent of total billed charges,,
Hydrocelectomy,,25001261,LOCAL,Facility,Both,,,,3060,2601,876.996,3060,"Health Partners, Inc.",State of Minnesota Advantage Program,2493.9,81.5,,percent of total billed charges,,
Hydrocelectomy,,25001261,LOCAL,Facility,Both,,,,3060,2601,876.996,3060,"Health Partners, Inc.",State Public Programs,1530,50,,percent of total billed charges,,
Hydrocelectomy,,25001261,LOCAL,Facility,Both,,,,3060,2601,876.996,3060,Humana Insurance Company,Commercial PPO,2907,95,,percent of total billed charges,,
Hydrocelectomy,,25001261,LOCAL,Facility,Outpatient,,,,3060,2601,876.996,3060,Humana Insurance Company,Medicare PPO,1499.4,49,,percent of total billed charges,,
Hydrocelectomy,,25001261,LOCAL,Facility,Inpatient,,,,3060,2601,876.996,3060,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Hydrocelectomy,,25001261,LOCAL,Facility,Both,,,,3060,2601,876.996,3060,Medica,Individual & Family,3032.46,99.1,,percent of total billed charges,,
Hydrocelectomy,,25001261,LOCAL,Facility,Outpatient,,,,3060,2601,876.996,3060,Medica,Medica Advantage Solution,1523.88,49.8,,percent of total billed charges,,
Hydrocelectomy,,25001261,LOCAL,Facility,Inpatient,,,,3060,2601,876.996,3060,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Hydrocelectomy,,25001261,LOCAL,Facility,Outpatient,,,,3060,2601,876.996,3060,Medica,Medical Assistance,1364.76,44.6,,percent of total billed charges,,
Hydrocelectomy,,25001261,LOCAL,Facility,Inpatient,,,,3060,2601,876.996,3060,Medica,Medical Assistance,,,,,Included in per diem rate,
Hydrocelectomy,,25001261,LOCAL,Facility,Outpatient,,,,3060,2601,876.996,3060,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1523.88,49.8,,percent of total billed charges,,
Hydrocelectomy,,25001261,LOCAL,Facility,Inpatient,,,,3060,2601,876.996,3060,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Hydrocelectomy,,25001261,LOCAL,Facility,Both,,,,3060,2601,876.996,3060,"Multiplan, Inc.","Multiplan, Inc.",2876.4,94,,percent of total billed charges,,
Hydrocelectomy,,25001261,LOCAL,Facility,Outpatient,,,,3060,2601,876.996,3060,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,2757.06,90.1,,percent of total billed charges,,
Hydrocelectomy,,25001261,LOCAL,Facility,Inpatient,,,,3060,2601,876.996,3060,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Hydrocelectomy,,25001261,LOCAL,Facility,Both,,,,3060,2601,876.996,3060,"Preferred One Administrative Services, INC.",PPO,3017.16,98.6,,percent of total billed charges,,
Hydrocelectomy,,25001261,LOCAL,Facility,Outpatient,,,,3060,2601,876.996,3060,PrimeWest Health,Minnesota Senior Health Options (MSHO),1574.37,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Hydrocelectomy,,25001261,LOCAL,Facility,Inpatient,,,,3060,2601,876.996,3060,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Hydrocelectomy,,25001261,LOCAL,Facility,Outpatient,,,,3060,2601,876.996,3060,PrimeWest Health,MinnesotaCare,1571.616,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Hydrocelectomy,,25001261,LOCAL,Facility,Inpatient,,,,3060,2601,876.996,3060,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Hydrocelectomy,,25001261,LOCAL,Facility,Both,,,,3060,2601,876.996,3060,Sanford Health Plan,Sanford Health Plan,2815.2,92,,percent of total billed charges,,
Hydrocelectomy,,25001261,LOCAL,Facility,Outpatient,,,,3060,2601,876.996,3060,"UCare Health, Inc.",Individual & Family Plan,1724.31,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Hydrocelectomy,,25001261,LOCAL,Facility,Inpatient,,,,3060,2601,876.996,3060,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Hydrocelectomy,,25001261,LOCAL,Facility,Outpatient,,,,3060,2601,876.996,3060,"UCare Health, Inc.",Medical Assistance,1544.382,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Hydrocelectomy,,25001261,LOCAL,Facility,Inpatient,,,,3060,2601,876.996,3060,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Hydrocelectomy,,25001261,LOCAL,Facility,Outpatient,,,,3060,2601,876.996,3060,"UCare Health, Inc.",Medicare Advantage,1544.382,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Hydrocelectomy,,25001261,LOCAL,Facility,Inpatient,,,,3060,2601,876.996,3060,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Hydrocelectomy,,25001261,LOCAL,Facility,Outpatient,,,,3060,2601,876.996,3060,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1544.382,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Hydrocelectomy,,25001261,LOCAL,Facility,Inpatient,,,,3060,2601,876.996,3060,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Hydrocelectomy,,25001261,LOCAL,Facility,Both,,,,3060,2601,876.996,3060,UnitedHealthcare,Individual & Family,2876.4,94,,percent of total billed charges,,
Hydrocelectomy,,25001261,LOCAL,Facility,Outpatient,,,,3060,2601,876.996,3060,UnitedHealthcare,Medicare Advantage,1499.4,49,,percent of total billed charges,,
Hydrocelectomy,,25001261,LOCAL,Facility,Inpatient,,,,3060,2601,876.996,3060,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Hydrocelectomy,,25001261,LOCAL,Facility,Outpatient,,,,3060,2601,876.996,3060,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1468.8,48,,percent of total billed charges,,100% of DHS outpatient percentage
Hydrocelectomy,,25001261,LOCAL,Facility,Inpatient,,,,3060,2601,876.996,3060,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Hysterectomy Vaginal,,25001312,LOCAL,Facility,Both,,,,3876,3294.6,1110.8616,3876,Aetna,Commercial,3565.92,92,,percent of total billed charges,,
Hysterectomy Vaginal,,25001312,LOCAL,Facility,Outpatient,,,,3876,3294.6,1110.8616,3876,Aetna,Medicare Advantage,1899.24,49,,percent of total billed charges,,
Hysterectomy Vaginal,,25001312,LOCAL,Facility,Inpatient,,,,3876,3294.6,1110.8616,3876,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Hysterectomy Vaginal,,25001312,LOCAL,Facility,Both,,,,3876,3294.6,1110.8616,3876,Aetna,PPO,3604.68,93,,percent of total billed charges,,
Hysterectomy Vaginal,,25001312,LOCAL,Facility,Both,,,,3876,3294.6,1110.8616,3876,America's PPO,America's PPO,3722.1228,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Hysterectomy Vaginal,,25001312,LOCAL,Facility,Both,,,,3876,3294.6,1110.8616,3876,BlueCross BlueShield Minnesota, Federal Employee Program,3813.984,98.4,,percent of total billed charges,,
Hysterectomy Vaginal,,25001312,LOCAL,Facility,Both,,,,3876,3294.6,1110.8616,3876,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,3876,100,,percent of total billed charges,,
Hysterectomy Vaginal,,25001312,LOCAL,Facility,Both,,,,3876,3294.6,1110.8616,3876,BlueCross BlueShield Minnesota,High Value Network Plan,3488.4,90,,percent of total billed charges,,
Hysterectomy Vaginal,,25001312,LOCAL,Facility,Outpatient,,,,3876,3294.6,1110.8616,3876,BlueCross BlueShield Minnesota,Medicare Advantage,1899.24,49,,percent of total billed charges,,
Hysterectomy Vaginal,,25001312,LOCAL,Facility,Inpatient,,,,3876,3294.6,1110.8616,3876,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Hysterectomy Vaginal,,25001312,LOCAL,Facility,Both,,,,3876,3294.6,1110.8616,3876,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,3432.9732,88.57,,percent of total billed charges,,
Hysterectomy Vaginal,,25001312,LOCAL,Facility,Both,,,,3876,3294.6,1110.8616,3876,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1110.8616,28.66,,percent of total billed charges,,
Hysterectomy Vaginal,,25001312,LOCAL,Facility,Outpatient,,,,3876,3294.6,1110.8616,3876,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1899.24,49,,percent of total billed charges,,
Hysterectomy Vaginal,,25001312,LOCAL,Facility,Inpatient,,,,3876,3294.6,1110.8616,3876,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Hysterectomy Vaginal,,25001312,LOCAL,Facility,Both,,,,3876,3294.6,1110.8616,3876,CorVel,Worker's Compensation,3876,100,,percent of total billed charges,,
Hysterectomy Vaginal,,25001312,LOCAL,Facility,Both,,,,3876,3294.6,1110.8616,3876,First Health Group Corporation,First Health Network,3759.72,97,,percent of total billed charges,,
Hysterectomy Vaginal,,25001312,LOCAL,Facility,Both,,,,3876,3294.6,1110.8616,3876,"Health Partners, Inc.",Commercial,3666.696,94.6,,percent of total billed charges,,
Hysterectomy Vaginal,,25001312,LOCAL,Facility,Outpatient,,,,3876,3294.6,1110.8616,3876,"Health Partners, Inc.",Medicare Advantage,1899.24,49,,percent of total billed charges,,
Hysterectomy Vaginal,,25001312,LOCAL,Facility,Inpatient,,,,3876,3294.6,1110.8616,3876,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Hysterectomy Vaginal,,25001312,LOCAL,Facility,Both,,,,3876,3294.6,1110.8616,3876,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),2325.6,60,,percent of total billed charges,,
Hysterectomy Vaginal,,25001312,LOCAL,Facility,Both,,,,3876,3294.6,1110.8616,3876,"Health Partners, Inc.",State of Minnesota Advantage Program,3158.94,81.5,,percent of total billed charges,,
Hysterectomy Vaginal,,25001312,LOCAL,Facility,Both,,,,3876,3294.6,1110.8616,3876,"Health Partners, Inc.",State Public Programs,1938,50,,percent of total billed charges,,
Hysterectomy Vaginal,,25001312,LOCAL,Facility,Both,,,,3876,3294.6,1110.8616,3876,Humana Insurance Company,Commercial PPO,3682.2,95,,percent of total billed charges,,
Hysterectomy Vaginal,,25001312,LOCAL,Facility,Outpatient,,,,3876,3294.6,1110.8616,3876,Humana Insurance Company,Medicare PPO,1899.24,49,,percent of total billed charges,,
Hysterectomy Vaginal,,25001312,LOCAL,Facility,Inpatient,,,,3876,3294.6,1110.8616,3876,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Hysterectomy Vaginal,,25001312,LOCAL,Facility,Both,,,,3876,3294.6,1110.8616,3876,Medica,Individual & Family,3841.116,99.1,,percent of total billed charges,,
Hysterectomy Vaginal,,25001312,LOCAL,Facility,Outpatient,,,,3876,3294.6,1110.8616,3876,Medica,Medica Advantage Solution,1930.248,49.8,,percent of total billed charges,,
Hysterectomy Vaginal,,25001312,LOCAL,Facility,Inpatient,,,,3876,3294.6,1110.8616,3876,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Hysterectomy Vaginal,,25001312,LOCAL,Facility,Outpatient,,,,3876,3294.6,1110.8616,3876,Medica,Medical Assistance,1728.696,44.6,,percent of total billed charges,,
Hysterectomy Vaginal,,25001312,LOCAL,Facility,Inpatient,,,,3876,3294.6,1110.8616,3876,Medica,Medical Assistance,,,,,Included in per diem rate,
Hysterectomy Vaginal,,25001312,LOCAL,Facility,Outpatient,,,,3876,3294.6,1110.8616,3876,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1930.248,49.8,,percent of total billed charges,,
Hysterectomy Vaginal,,25001312,LOCAL,Facility,Inpatient,,,,3876,3294.6,1110.8616,3876,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Hysterectomy Vaginal,,25001312,LOCAL,Facility,Both,,,,3876,3294.6,1110.8616,3876,"Multiplan, Inc.","Multiplan, Inc.",3643.44,94,,percent of total billed charges,,
Hysterectomy Vaginal,,25001312,LOCAL,Facility,Outpatient,,,,3876,3294.6,1110.8616,3876,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,3492.276,90.1,,percent of total billed charges,,
Hysterectomy Vaginal,,25001312,LOCAL,Facility,Inpatient,,,,3876,3294.6,1110.8616,3876,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Hysterectomy Vaginal,,25001312,LOCAL,Facility,Both,,,,3876,3294.6,1110.8616,3876,"Preferred One Administrative Services, INC.",PPO,3821.736,98.6,,percent of total billed charges,,
Hysterectomy Vaginal,,25001312,LOCAL,Facility,Outpatient,,,,3876,3294.6,1110.8616,3876,PrimeWest Health,Minnesota Senior Health Options (MSHO),1994.202,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Hysterectomy Vaginal,,25001312,LOCAL,Facility,Inpatient,,,,3876,3294.6,1110.8616,3876,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Hysterectomy Vaginal,,25001312,LOCAL,Facility,Outpatient,,,,3876,3294.6,1110.8616,3876,PrimeWest Health,MinnesotaCare,1990.7136,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Hysterectomy Vaginal,,25001312,LOCAL,Facility,Inpatient,,,,3876,3294.6,1110.8616,3876,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Hysterectomy Vaginal,,25001312,LOCAL,Facility,Both,,,,3876,3294.6,1110.8616,3876,Sanford Health Plan,Sanford Health Plan,3565.92,92,,percent of total billed charges,,
Hysterectomy Vaginal,,25001312,LOCAL,Facility,Outpatient,,,,3876,3294.6,1110.8616,3876,"UCare Health, Inc.",Individual & Family Plan,2184.126,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Hysterectomy Vaginal,,25001312,LOCAL,Facility,Inpatient,,,,3876,3294.6,1110.8616,3876,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Hysterectomy Vaginal,,25001312,LOCAL,Facility,Outpatient,,,,3876,3294.6,1110.8616,3876,"UCare Health, Inc.",Medical Assistance,1956.2172,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Hysterectomy Vaginal,,25001312,LOCAL,Facility,Inpatient,,,,3876,3294.6,1110.8616,3876,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Hysterectomy Vaginal,,25001312,LOCAL,Facility,Outpatient,,,,3876,3294.6,1110.8616,3876,"UCare Health, Inc.",Medicare Advantage,1956.2172,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Hysterectomy Vaginal,,25001312,LOCAL,Facility,Inpatient,,,,3876,3294.6,1110.8616,3876,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Hysterectomy Vaginal,,25001312,LOCAL,Facility,Outpatient,,,,3876,3294.6,1110.8616,3876,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1956.2172,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Hysterectomy Vaginal,,25001312,LOCAL,Facility,Inpatient,,,,3876,3294.6,1110.8616,3876,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Hysterectomy Vaginal,,25001312,LOCAL,Facility,Both,,,,3876,3294.6,1110.8616,3876,UnitedHealthcare,Individual & Family,3643.44,94,,percent of total billed charges,,
Hysterectomy Vaginal,,25001312,LOCAL,Facility,Outpatient,,,,3876,3294.6,1110.8616,3876,UnitedHealthcare,Medicare Advantage,1899.24,49,,percent of total billed charges,,
Hysterectomy Vaginal,,25001312,LOCAL,Facility,Inpatient,,,,3876,3294.6,1110.8616,3876,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Hysterectomy Vaginal,,25001312,LOCAL,Facility,Outpatient,,,,3876,3294.6,1110.8616,3876,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1860.48,48,,percent of total billed charges,,100% of DHS outpatient percentage
Hysterectomy Vaginal,,25001312,LOCAL,Facility,Inpatient,,,,3876,3294.6,1110.8616,3876,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
I&D Abscess Subq Or Cutaneous,,25001387,LOCAL,Facility,Both,,,,2295,1950.75,657.747,2295,Aetna,Commercial,2111.4,92,,percent of total billed charges,,
I&D Abscess Subq Or Cutaneous,,25001387,LOCAL,Facility,Outpatient,,,,2295,1950.75,657.747,2295,Aetna,Medicare Advantage,1124.55,49,,percent of total billed charges,,
I&D Abscess Subq Or Cutaneous,,25001387,LOCAL,Facility,Inpatient,,,,2295,1950.75,657.747,2295,Aetna,Medicare Advantage,,,,,Included in per diem rate,
I&D Abscess Subq Or Cutaneous,,25001387,LOCAL,Facility,Both,,,,2295,1950.75,657.747,2295,Aetna,PPO,2134.35,93,,percent of total billed charges,,
I&D Abscess Subq Or Cutaneous,,25001387,LOCAL,Facility,Both,,,,2295,1950.75,657.747,2295,America's PPO,America's PPO,2203.8885,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
I&D Abscess Subq Or Cutaneous,,25001387,LOCAL,Facility,Both,,,,2295,1950.75,657.747,2295,BlueCross BlueShield Minnesota, Federal Employee Program,2258.28,98.4,,percent of total billed charges,,
I&D Abscess Subq Or Cutaneous,,25001387,LOCAL,Facility,Both,,,,2295,1950.75,657.747,2295,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,2295,100,,percent of total billed charges,,
I&D Abscess Subq Or Cutaneous,,25001387,LOCAL,Facility,Both,,,,2295,1950.75,657.747,2295,BlueCross BlueShield Minnesota,High Value Network Plan,2065.5,90,,percent of total billed charges,,
I&D Abscess Subq Or Cutaneous,,25001387,LOCAL,Facility,Outpatient,,,,2295,1950.75,657.747,2295,BlueCross BlueShield Minnesota,Medicare Advantage,1124.55,49,,percent of total billed charges,,
I&D Abscess Subq Or Cutaneous,,25001387,LOCAL,Facility,Inpatient,,,,2295,1950.75,657.747,2295,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
I&D Abscess Subq Or Cutaneous,,25001387,LOCAL,Facility,Both,,,,2295,1950.75,657.747,2295,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,2032.6815,88.57,,percent of total billed charges,,
I&D Abscess Subq Or Cutaneous,,25001387,LOCAL,Facility,Both,,,,2295,1950.75,657.747,2295,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,657.747,28.66,,percent of total billed charges,,
I&D Abscess Subq Or Cutaneous,,25001387,LOCAL,Facility,Outpatient,,,,2295,1950.75,657.747,2295,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1124.55,49,,percent of total billed charges,,
I&D Abscess Subq Or Cutaneous,,25001387,LOCAL,Facility,Inpatient,,,,2295,1950.75,657.747,2295,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
I&D Abscess Subq Or Cutaneous,,25001387,LOCAL,Facility,Both,,,,2295,1950.75,657.747,2295,CorVel,Worker's Compensation,2295,100,,percent of total billed charges,,
I&D Abscess Subq Or Cutaneous,,25001387,LOCAL,Facility,Both,,,,2295,1950.75,657.747,2295,First Health Group Corporation,First Health Network,2226.15,97,,percent of total billed charges,,
I&D Abscess Subq Or Cutaneous,,25001387,LOCAL,Facility,Both,,,,2295,1950.75,657.747,2295,"Health Partners, Inc.",Commercial,2171.07,94.6,,percent of total billed charges,,
I&D Abscess Subq Or Cutaneous,,25001387,LOCAL,Facility,Outpatient,,,,2295,1950.75,657.747,2295,"Health Partners, Inc.",Medicare Advantage,1124.55,49,,percent of total billed charges,,
I&D Abscess Subq Or Cutaneous,,25001387,LOCAL,Facility,Inpatient,,,,2295,1950.75,657.747,2295,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
I&D Abscess Subq Or Cutaneous,,25001387,LOCAL,Facility,Both,,,,2295,1950.75,657.747,2295,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1377,60,,percent of total billed charges,,
I&D Abscess Subq Or Cutaneous,,25001387,LOCAL,Facility,Both,,,,2295,1950.75,657.747,2295,"Health Partners, Inc.",State of Minnesota Advantage Program,1870.425,81.5,,percent of total billed charges,,
I&D Abscess Subq Or Cutaneous,,25001387,LOCAL,Facility,Both,,,,2295,1950.75,657.747,2295,"Health Partners, Inc.",State Public Programs,1147.5,50,,percent of total billed charges,,
I&D Abscess Subq Or Cutaneous,,25001387,LOCAL,Facility,Both,,,,2295,1950.75,657.747,2295,Humana Insurance Company,Commercial PPO,2180.25,95,,percent of total billed charges,,
I&D Abscess Subq Or Cutaneous,,25001387,LOCAL,Facility,Outpatient,,,,2295,1950.75,657.747,2295,Humana Insurance Company,Medicare PPO,1124.55,49,,percent of total billed charges,,
I&D Abscess Subq Or Cutaneous,,25001387,LOCAL,Facility,Inpatient,,,,2295,1950.75,657.747,2295,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
I&D Abscess Subq Or Cutaneous,,25001387,LOCAL,Facility,Both,,,,2295,1950.75,657.747,2295,Medica,Individual & Family,2274.345,99.1,,percent of total billed charges,,
I&D Abscess Subq Or Cutaneous,,25001387,LOCAL,Facility,Outpatient,,,,2295,1950.75,657.747,2295,Medica,Medica Advantage Solution,1142.91,49.8,,percent of total billed charges,,
I&D Abscess Subq Or Cutaneous,,25001387,LOCAL,Facility,Inpatient,,,,2295,1950.75,657.747,2295,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
I&D Abscess Subq Or Cutaneous,,25001387,LOCAL,Facility,Outpatient,,,,2295,1950.75,657.747,2295,Medica,Medical Assistance,1023.57,44.6,,percent of total billed charges,,
I&D Abscess Subq Or Cutaneous,,25001387,LOCAL,Facility,Inpatient,,,,2295,1950.75,657.747,2295,Medica,Medical Assistance,,,,,Included in per diem rate,
I&D Abscess Subq Or Cutaneous,,25001387,LOCAL,Facility,Outpatient,,,,2295,1950.75,657.747,2295,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1142.91,49.8,,percent of total billed charges,,
I&D Abscess Subq Or Cutaneous,,25001387,LOCAL,Facility,Inpatient,,,,2295,1950.75,657.747,2295,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
I&D Abscess Subq Or Cutaneous,,25001387,LOCAL,Facility,Both,,,,2295,1950.75,657.747,2295,"Multiplan, Inc.","Multiplan, Inc.",2157.3,94,,percent of total billed charges,,
I&D Abscess Subq Or Cutaneous,,25001387,LOCAL,Facility,Outpatient,,,,2295,1950.75,657.747,2295,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,2067.795,90.1,,percent of total billed charges,,
I&D Abscess Subq Or Cutaneous,,25001387,LOCAL,Facility,Inpatient,,,,2295,1950.75,657.747,2295,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
I&D Abscess Subq Or Cutaneous,,25001387,LOCAL,Facility,Both,,,,2295,1950.75,657.747,2295,"Preferred One Administrative Services, INC.",PPO,2262.87,98.6,,percent of total billed charges,,
I&D Abscess Subq Or Cutaneous,,25001387,LOCAL,Facility,Outpatient,,,,2295,1950.75,657.747,2295,PrimeWest Health,Minnesota Senior Health Options (MSHO),1180.7775,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
I&D Abscess Subq Or Cutaneous,,25001387,LOCAL,Facility,Inpatient,,,,2295,1950.75,657.747,2295,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
I&D Abscess Subq Or Cutaneous,,25001387,LOCAL,Facility,Outpatient,,,,2295,1950.75,657.747,2295,PrimeWest Health,MinnesotaCare,1178.712,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
I&D Abscess Subq Or Cutaneous,,25001387,LOCAL,Facility,Inpatient,,,,2295,1950.75,657.747,2295,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
I&D Abscess Subq Or Cutaneous,,25001387,LOCAL,Facility,Both,,,,2295,1950.75,657.747,2295,Sanford Health Plan,Sanford Health Plan,2111.4,92,,percent of total billed charges,,
I&D Abscess Subq Or Cutaneous,,25001387,LOCAL,Facility,Outpatient,,,,2295,1950.75,657.747,2295,"UCare Health, Inc.",Individual & Family Plan,1293.2325,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
I&D Abscess Subq Or Cutaneous,,25001387,LOCAL,Facility,Inpatient,,,,2295,1950.75,657.747,2295,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
I&D Abscess Subq Or Cutaneous,,25001387,LOCAL,Facility,Outpatient,,,,2295,1950.75,657.747,2295,"UCare Health, Inc.",Medical Assistance,1158.2865,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
I&D Abscess Subq Or Cutaneous,,25001387,LOCAL,Facility,Inpatient,,,,2295,1950.75,657.747,2295,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
I&D Abscess Subq Or Cutaneous,,25001387,LOCAL,Facility,Outpatient,,,,2295,1950.75,657.747,2295,"UCare Health, Inc.",Medicare Advantage,1158.2865,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
I&D Abscess Subq Or Cutaneous,,25001387,LOCAL,Facility,Inpatient,,,,2295,1950.75,657.747,2295,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
I&D Abscess Subq Or Cutaneous,,25001387,LOCAL,Facility,Outpatient,,,,2295,1950.75,657.747,2295,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1158.2865,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
I&D Abscess Subq Or Cutaneous,,25001387,LOCAL,Facility,Inpatient,,,,2295,1950.75,657.747,2295,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
I&D Abscess Subq Or Cutaneous,,25001387,LOCAL,Facility,Both,,,,2295,1950.75,657.747,2295,UnitedHealthcare,Individual & Family,2157.3,94,,percent of total billed charges,,
I&D Abscess Subq Or Cutaneous,,25001387,LOCAL,Facility,Outpatient,,,,2295,1950.75,657.747,2295,UnitedHealthcare,Medicare Advantage,1124.55,49,,percent of total billed charges,,
I&D Abscess Subq Or Cutaneous,,25001387,LOCAL,Facility,Inpatient,,,,2295,1950.75,657.747,2295,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
I&D Abscess Subq Or Cutaneous,,25001387,LOCAL,Facility,Outpatient,,,,2295,1950.75,657.747,2295,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1101.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
I&D Abscess Subq Or Cutaneous,,25001387,LOCAL,Facility,Inpatient,,,,2295,1950.75,657.747,2295,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Insertion Of Peripheral Central Catheter,,25001474,LOCAL,Facility,Both,,,,2856,2427.6,818.5296,2856,Aetna,Commercial,2627.52,92,,percent of total billed charges,,
Insertion Of Peripheral Central Catheter,,25001474,LOCAL,Facility,Outpatient,,,,2856,2427.6,818.5296,2856,Aetna,Medicare Advantage,1399.44,49,,percent of total billed charges,,
Insertion Of Peripheral Central Catheter,,25001474,LOCAL,Facility,Inpatient,,,,2856,2427.6,818.5296,2856,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Insertion Of Peripheral Central Catheter,,25001474,LOCAL,Facility,Both,,,,2856,2427.6,818.5296,2856,Aetna,PPO,2656.08,93,,percent of total billed charges,,
Insertion Of Peripheral Central Catheter,,25001474,LOCAL,Facility,Both,,,,2856,2427.6,818.5296,2856,America's PPO,America's PPO,2742.6168,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Insertion Of Peripheral Central Catheter,,25001474,LOCAL,Facility,Both,,,,2856,2427.6,818.5296,2856,BlueCross BlueShield Minnesota, Federal Employee Program,2810.304,98.4,,percent of total billed charges,,
Insertion Of Peripheral Central Catheter,,25001474,LOCAL,Facility,Both,,,,2856,2427.6,818.5296,2856,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,2856,100,,percent of total billed charges,,
Insertion Of Peripheral Central Catheter,,25001474,LOCAL,Facility,Both,,,,2856,2427.6,818.5296,2856,BlueCross BlueShield Minnesota,High Value Network Plan,2570.4,90,,percent of total billed charges,,
Insertion Of Peripheral Central Catheter,,25001474,LOCAL,Facility,Outpatient,,,,2856,2427.6,818.5296,2856,BlueCross BlueShield Minnesota,Medicare Advantage,1399.44,49,,percent of total billed charges,,
Insertion Of Peripheral Central Catheter,,25001474,LOCAL,Facility,Inpatient,,,,2856,2427.6,818.5296,2856,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Insertion Of Peripheral Central Catheter,,25001474,LOCAL,Facility,Both,,,,2856,2427.6,818.5296,2856,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,2529.5592,88.57,,percent of total billed charges,,
Insertion Of Peripheral Central Catheter,,25001474,LOCAL,Facility,Both,,,,2856,2427.6,818.5296,2856,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,818.5296,28.66,,percent of total billed charges,,
Insertion Of Peripheral Central Catheter,,25001474,LOCAL,Facility,Outpatient,,,,2856,2427.6,818.5296,2856,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1399.44,49,,percent of total billed charges,,
Insertion Of Peripheral Central Catheter,,25001474,LOCAL,Facility,Inpatient,,,,2856,2427.6,818.5296,2856,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Insertion Of Peripheral Central Catheter,,25001474,LOCAL,Facility,Both,,,,2856,2427.6,818.5296,2856,CorVel,Worker's Compensation,2856,100,,percent of total billed charges,,
Insertion Of Peripheral Central Catheter,,25001474,LOCAL,Facility,Both,,,,2856,2427.6,818.5296,2856,First Health Group Corporation,First Health Network,2770.32,97,,percent of total billed charges,,
Insertion Of Peripheral Central Catheter,,25001474,LOCAL,Facility,Both,,,,2856,2427.6,818.5296,2856,"Health Partners, Inc.",Commercial,2701.776,94.6,,percent of total billed charges,,
Insertion Of Peripheral Central Catheter,,25001474,LOCAL,Facility,Outpatient,,,,2856,2427.6,818.5296,2856,"Health Partners, Inc.",Medicare Advantage,1399.44,49,,percent of total billed charges,,
Insertion Of Peripheral Central Catheter,,25001474,LOCAL,Facility,Inpatient,,,,2856,2427.6,818.5296,2856,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Insertion Of Peripheral Central Catheter,,25001474,LOCAL,Facility,Both,,,,2856,2427.6,818.5296,2856,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1713.6,60,,percent of total billed charges,,
Insertion Of Peripheral Central Catheter,,25001474,LOCAL,Facility,Both,,,,2856,2427.6,818.5296,2856,"Health Partners, Inc.",State of Minnesota Advantage Program,2327.64,81.5,,percent of total billed charges,,
Insertion Of Peripheral Central Catheter,,25001474,LOCAL,Facility,Both,,,,2856,2427.6,818.5296,2856,"Health Partners, Inc.",State Public Programs,1428,50,,percent of total billed charges,,
Insertion Of Peripheral Central Catheter,,25001474,LOCAL,Facility,Both,,,,2856,2427.6,818.5296,2856,Humana Insurance Company,Commercial PPO,2713.2,95,,percent of total billed charges,,
Insertion Of Peripheral Central Catheter,,25001474,LOCAL,Facility,Outpatient,,,,2856,2427.6,818.5296,2856,Humana Insurance Company,Medicare PPO,1399.44,49,,percent of total billed charges,,
Insertion Of Peripheral Central Catheter,,25001474,LOCAL,Facility,Inpatient,,,,2856,2427.6,818.5296,2856,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Insertion Of Peripheral Central Catheter,,25001474,LOCAL,Facility,Both,,,,2856,2427.6,818.5296,2856,Medica,Individual & Family,2830.296,99.1,,percent of total billed charges,,
Insertion Of Peripheral Central Catheter,,25001474,LOCAL,Facility,Outpatient,,,,2856,2427.6,818.5296,2856,Medica,Medica Advantage Solution,1422.288,49.8,,percent of total billed charges,,
Insertion Of Peripheral Central Catheter,,25001474,LOCAL,Facility,Inpatient,,,,2856,2427.6,818.5296,2856,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Insertion Of Peripheral Central Catheter,,25001474,LOCAL,Facility,Outpatient,,,,2856,2427.6,818.5296,2856,Medica,Medical Assistance,1273.776,44.6,,percent of total billed charges,,
Insertion Of Peripheral Central Catheter,,25001474,LOCAL,Facility,Inpatient,,,,2856,2427.6,818.5296,2856,Medica,Medical Assistance,,,,,Included in per diem rate,
Insertion Of Peripheral Central Catheter,,25001474,LOCAL,Facility,Outpatient,,,,2856,2427.6,818.5296,2856,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1422.288,49.8,,percent of total billed charges,,
Insertion Of Peripheral Central Catheter,,25001474,LOCAL,Facility,Inpatient,,,,2856,2427.6,818.5296,2856,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Insertion Of Peripheral Central Catheter,,25001474,LOCAL,Facility,Both,,,,2856,2427.6,818.5296,2856,"Multiplan, Inc.","Multiplan, Inc.",2684.64,94,,percent of total billed charges,,
Insertion Of Peripheral Central Catheter,,25001474,LOCAL,Facility,Outpatient,,,,2856,2427.6,818.5296,2856,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,2573.256,90.1,,percent of total billed charges,,
Insertion Of Peripheral Central Catheter,,25001474,LOCAL,Facility,Inpatient,,,,2856,2427.6,818.5296,2856,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Insertion Of Peripheral Central Catheter,,25001474,LOCAL,Facility,Both,,,,2856,2427.6,818.5296,2856,"Preferred One Administrative Services, INC.",PPO,2816.016,98.6,,percent of total billed charges,,
Insertion Of Peripheral Central Catheter,,25001474,LOCAL,Facility,Outpatient,,,,2856,2427.6,818.5296,2856,PrimeWest Health,Minnesota Senior Health Options (MSHO),1469.412,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Insertion Of Peripheral Central Catheter,,25001474,LOCAL,Facility,Inpatient,,,,2856,2427.6,818.5296,2856,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Insertion Of Peripheral Central Catheter,,25001474,LOCAL,Facility,Outpatient,,,,2856,2427.6,818.5296,2856,PrimeWest Health,MinnesotaCare,1466.8416,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Insertion Of Peripheral Central Catheter,,25001474,LOCAL,Facility,Inpatient,,,,2856,2427.6,818.5296,2856,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Insertion Of Peripheral Central Catheter,,25001474,LOCAL,Facility,Both,,,,2856,2427.6,818.5296,2856,Sanford Health Plan,Sanford Health Plan,2627.52,92,,percent of total billed charges,,
Insertion Of Peripheral Central Catheter,,25001474,LOCAL,Facility,Outpatient,,,,2856,2427.6,818.5296,2856,"UCare Health, Inc.",Individual & Family Plan,1609.356,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Insertion Of Peripheral Central Catheter,,25001474,LOCAL,Facility,Inpatient,,,,2856,2427.6,818.5296,2856,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Insertion Of Peripheral Central Catheter,,25001474,LOCAL,Facility,Outpatient,,,,2856,2427.6,818.5296,2856,"UCare Health, Inc.",Medical Assistance,1441.4232,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Insertion Of Peripheral Central Catheter,,25001474,LOCAL,Facility,Inpatient,,,,2856,2427.6,818.5296,2856,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Insertion Of Peripheral Central Catheter,,25001474,LOCAL,Facility,Outpatient,,,,2856,2427.6,818.5296,2856,"UCare Health, Inc.",Medicare Advantage,1441.4232,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Insertion Of Peripheral Central Catheter,,25001474,LOCAL,Facility,Inpatient,,,,2856,2427.6,818.5296,2856,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Insertion Of Peripheral Central Catheter,,25001474,LOCAL,Facility,Outpatient,,,,2856,2427.6,818.5296,2856,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1441.4232,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Insertion Of Peripheral Central Catheter,,25001474,LOCAL,Facility,Inpatient,,,,2856,2427.6,818.5296,2856,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Insertion Of Peripheral Central Catheter,,25001474,LOCAL,Facility,Both,,,,2856,2427.6,818.5296,2856,UnitedHealthcare,Individual & Family,2684.64,94,,percent of total billed charges,,
Insertion Of Peripheral Central Catheter,,25001474,LOCAL,Facility,Outpatient,,,,2856,2427.6,818.5296,2856,UnitedHealthcare,Medicare Advantage,1399.44,49,,percent of total billed charges,,
Insertion Of Peripheral Central Catheter,,25001474,LOCAL,Facility,Inpatient,,,,2856,2427.6,818.5296,2856,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Insertion Of Peripheral Central Catheter,,25001474,LOCAL,Facility,Outpatient,,,,2856,2427.6,818.5296,2856,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1370.88,48,,percent of total billed charges,,100% of DHS outpatient percentage
Insertion Of Peripheral Central Catheter,,25001474,LOCAL,Facility,Inpatient,,,,2856,2427.6,818.5296,2856,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Intrauterine Device (Insert & Removal),,25001497,LOCAL,Facility,Both,,,,1530,1300.5,438.498,1530,Aetna,Commercial,1407.6,92,,percent of total billed charges,,
Intrauterine Device (Insert & Removal),,25001497,LOCAL,Facility,Outpatient,,,,1530,1300.5,438.498,1530,Aetna,Medicare Advantage,749.7,49,,percent of total billed charges,,
Intrauterine Device (Insert & Removal),,25001497,LOCAL,Facility,Inpatient,,,,1530,1300.5,438.498,1530,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Intrauterine Device (Insert & Removal),,25001497,LOCAL,Facility,Both,,,,1530,1300.5,438.498,1530,Aetna,PPO,1422.9,93,,percent of total billed charges,,
Intrauterine Device (Insert & Removal),,25001497,LOCAL,Facility,Both,,,,1530,1300.5,438.498,1530,America's PPO,America's PPO,1469.259,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Intrauterine Device (Insert & Removal),,25001497,LOCAL,Facility,Both,,,,1530,1300.5,438.498,1530,BlueCross BlueShield Minnesota, Federal Employee Program,1505.52,98.4,,percent of total billed charges,,
Intrauterine Device (Insert & Removal),,25001497,LOCAL,Facility,Both,,,,1530,1300.5,438.498,1530,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1530,100,,percent of total billed charges,,
Intrauterine Device (Insert & Removal),,25001497,LOCAL,Facility,Both,,,,1530,1300.5,438.498,1530,BlueCross BlueShield Minnesota,High Value Network Plan,1377,90,,percent of total billed charges,,
Intrauterine Device (Insert & Removal),,25001497,LOCAL,Facility,Outpatient,,,,1530,1300.5,438.498,1530,BlueCross BlueShield Minnesota,Medicare Advantage,749.7,49,,percent of total billed charges,,
Intrauterine Device (Insert & Removal),,25001497,LOCAL,Facility,Inpatient,,,,1530,1300.5,438.498,1530,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Intrauterine Device (Insert & Removal),,25001497,LOCAL,Facility,Both,,,,1530,1300.5,438.498,1530,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1355.121,88.57,,percent of total billed charges,,
Intrauterine Device (Insert & Removal),,25001497,LOCAL,Facility,Both,,,,1530,1300.5,438.498,1530,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,438.498,28.66,,percent of total billed charges,,
Intrauterine Device (Insert & Removal),,25001497,LOCAL,Facility,Outpatient,,,,1530,1300.5,438.498,1530,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),749.7,49,,percent of total billed charges,,
Intrauterine Device (Insert & Removal),,25001497,LOCAL,Facility,Inpatient,,,,1530,1300.5,438.498,1530,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Intrauterine Device (Insert & Removal),,25001497,LOCAL,Facility,Both,,,,1530,1300.5,438.498,1530,CorVel,Worker's Compensation,1530,100,,percent of total billed charges,,
Intrauterine Device (Insert & Removal),,25001497,LOCAL,Facility,Both,,,,1530,1300.5,438.498,1530,First Health Group Corporation,First Health Network,1484.1,97,,percent of total billed charges,,
Intrauterine Device (Insert & Removal),,25001497,LOCAL,Facility,Both,,,,1530,1300.5,438.498,1530,"Health Partners, Inc.",Commercial,1447.38,94.6,,percent of total billed charges,,
Intrauterine Device (Insert & Removal),,25001497,LOCAL,Facility,Outpatient,,,,1530,1300.5,438.498,1530,"Health Partners, Inc.",Medicare Advantage,749.7,49,,percent of total billed charges,,
Intrauterine Device (Insert & Removal),,25001497,LOCAL,Facility,Inpatient,,,,1530,1300.5,438.498,1530,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Intrauterine Device (Insert & Removal),,25001497,LOCAL,Facility,Both,,,,1530,1300.5,438.498,1530,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),918,60,,percent of total billed charges,,
Intrauterine Device (Insert & Removal),,25001497,LOCAL,Facility,Both,,,,1530,1300.5,438.498,1530,"Health Partners, Inc.",State of Minnesota Advantage Program,1246.95,81.5,,percent of total billed charges,,
Intrauterine Device (Insert & Removal),,25001497,LOCAL,Facility,Both,,,,1530,1300.5,438.498,1530,"Health Partners, Inc.",State Public Programs,765,50,,percent of total billed charges,,
Intrauterine Device (Insert & Removal),,25001497,LOCAL,Facility,Both,,,,1530,1300.5,438.498,1530,Humana Insurance Company,Commercial PPO,1453.5,95,,percent of total billed charges,,
Intrauterine Device (Insert & Removal),,25001497,LOCAL,Facility,Outpatient,,,,1530,1300.5,438.498,1530,Humana Insurance Company,Medicare PPO,749.7,49,,percent of total billed charges,,
Intrauterine Device (Insert & Removal),,25001497,LOCAL,Facility,Inpatient,,,,1530,1300.5,438.498,1530,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Intrauterine Device (Insert & Removal),,25001497,LOCAL,Facility,Both,,,,1530,1300.5,438.498,1530,Medica,Individual & Family,1516.23,99.1,,percent of total billed charges,,
Intrauterine Device (Insert & Removal),,25001497,LOCAL,Facility,Outpatient,,,,1530,1300.5,438.498,1530,Medica,Medica Advantage Solution,761.94,49.8,,percent of total billed charges,,
Intrauterine Device (Insert & Removal),,25001497,LOCAL,Facility,Inpatient,,,,1530,1300.5,438.498,1530,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Intrauterine Device (Insert & Removal),,25001497,LOCAL,Facility,Outpatient,,,,1530,1300.5,438.498,1530,Medica,Medical Assistance,682.38,44.6,,percent of total billed charges,,
Intrauterine Device (Insert & Removal),,25001497,LOCAL,Facility,Inpatient,,,,1530,1300.5,438.498,1530,Medica,Medical Assistance,,,,,Included in per diem rate,
Intrauterine Device (Insert & Removal),,25001497,LOCAL,Facility,Outpatient,,,,1530,1300.5,438.498,1530,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,761.94,49.8,,percent of total billed charges,,
Intrauterine Device (Insert & Removal),,25001497,LOCAL,Facility,Inpatient,,,,1530,1300.5,438.498,1530,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Intrauterine Device (Insert & Removal),,25001497,LOCAL,Facility,Both,,,,1530,1300.5,438.498,1530,"Multiplan, Inc.","Multiplan, Inc.",1438.2,94,,percent of total billed charges,,
Intrauterine Device (Insert & Removal),,25001497,LOCAL,Facility,Outpatient,,,,1530,1300.5,438.498,1530,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1378.53,90.1,,percent of total billed charges,,
Intrauterine Device (Insert & Removal),,25001497,LOCAL,Facility,Inpatient,,,,1530,1300.5,438.498,1530,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Intrauterine Device (Insert & Removal),,25001497,LOCAL,Facility,Both,,,,1530,1300.5,438.498,1530,"Preferred One Administrative Services, INC.",PPO,1508.58,98.6,,percent of total billed charges,,
Intrauterine Device (Insert & Removal),,25001497,LOCAL,Facility,Outpatient,,,,1530,1300.5,438.498,1530,PrimeWest Health,Minnesota Senior Health Options (MSHO),787.185,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Intrauterine Device (Insert & Removal),,25001497,LOCAL,Facility,Inpatient,,,,1530,1300.5,438.498,1530,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Intrauterine Device (Insert & Removal),,25001497,LOCAL,Facility,Outpatient,,,,1530,1300.5,438.498,1530,PrimeWest Health,MinnesotaCare,785.808,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Intrauterine Device (Insert & Removal),,25001497,LOCAL,Facility,Inpatient,,,,1530,1300.5,438.498,1530,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Intrauterine Device (Insert & Removal),,25001497,LOCAL,Facility,Both,,,,1530,1300.5,438.498,1530,Sanford Health Plan,Sanford Health Plan,1407.6,92,,percent of total billed charges,,
Intrauterine Device (Insert & Removal),,25001497,LOCAL,Facility,Outpatient,,,,1530,1300.5,438.498,1530,"UCare Health, Inc.",Individual & Family Plan,862.155,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Intrauterine Device (Insert & Removal),,25001497,LOCAL,Facility,Inpatient,,,,1530,1300.5,438.498,1530,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Intrauterine Device (Insert & Removal),,25001497,LOCAL,Facility,Outpatient,,,,1530,1300.5,438.498,1530,"UCare Health, Inc.",Medical Assistance,772.191,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Intrauterine Device (Insert & Removal),,25001497,LOCAL,Facility,Inpatient,,,,1530,1300.5,438.498,1530,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Intrauterine Device (Insert & Removal),,25001497,LOCAL,Facility,Outpatient,,,,1530,1300.5,438.498,1530,"UCare Health, Inc.",Medicare Advantage,772.191,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Intrauterine Device (Insert & Removal),,25001497,LOCAL,Facility,Inpatient,,,,1530,1300.5,438.498,1530,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Intrauterine Device (Insert & Removal),,25001497,LOCAL,Facility,Outpatient,,,,1530,1300.5,438.498,1530,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),772.191,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Intrauterine Device (Insert & Removal),,25001497,LOCAL,Facility,Inpatient,,,,1530,1300.5,438.498,1530,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Intrauterine Device (Insert & Removal),,25001497,LOCAL,Facility,Both,,,,1530,1300.5,438.498,1530,UnitedHealthcare,Individual & Family,1438.2,94,,percent of total billed charges,,
Intrauterine Device (Insert & Removal),,25001497,LOCAL,Facility,Outpatient,,,,1530,1300.5,438.498,1530,UnitedHealthcare,Medicare Advantage,749.7,49,,percent of total billed charges,,
Intrauterine Device (Insert & Removal),,25001497,LOCAL,Facility,Inpatient,,,,1530,1300.5,438.498,1530,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Intrauterine Device (Insert & Removal),,25001497,LOCAL,Facility,Outpatient,,,,1530,1300.5,438.498,1530,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,734.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
Intrauterine Device (Insert & Removal),,25001497,LOCAL,Facility,Inpatient,,,,1530,1300.5,438.498,1530,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Knee Arthroscopy,,25001518,LOCAL,Facility,Both,,,,3162,2687.7,906.2292,3162,Aetna,Commercial,2909.04,92,,percent of total billed charges,,
Knee Arthroscopy,,25001518,LOCAL,Facility,Outpatient,,,,3162,2687.7,906.2292,3162,Aetna,Medicare Advantage,1549.38,49,,percent of total billed charges,,
Knee Arthroscopy,,25001518,LOCAL,Facility,Inpatient,,,,3162,2687.7,906.2292,3162,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Knee Arthroscopy,,25001518,LOCAL,Facility,Both,,,,3162,2687.7,906.2292,3162,Aetna,PPO,2940.66,93,,percent of total billed charges,,
Knee Arthroscopy,,25001518,LOCAL,Facility,Both,,,,3162,2687.7,906.2292,3162,America's PPO,America's PPO,3036.4686,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Knee Arthroscopy,,25001518,LOCAL,Facility,Both,,,,3162,2687.7,906.2292,3162,BlueCross BlueShield Minnesota, Federal Employee Program,3111.408,98.4,,percent of total billed charges,,
Knee Arthroscopy,,25001518,LOCAL,Facility,Both,,,,3162,2687.7,906.2292,3162,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,3162,100,,percent of total billed charges,,
Knee Arthroscopy,,25001518,LOCAL,Facility,Both,,,,3162,2687.7,906.2292,3162,BlueCross BlueShield Minnesota,High Value Network Plan,2845.8,90,,percent of total billed charges,,
Knee Arthroscopy,,25001518,LOCAL,Facility,Outpatient,,,,3162,2687.7,906.2292,3162,BlueCross BlueShield Minnesota,Medicare Advantage,1549.38,49,,percent of total billed charges,,
Knee Arthroscopy,,25001518,LOCAL,Facility,Inpatient,,,,3162,2687.7,906.2292,3162,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Knee Arthroscopy,,25001518,LOCAL,Facility,Both,,,,3162,2687.7,906.2292,3162,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,2800.5834,88.57,,percent of total billed charges,,
Knee Arthroscopy,,25001518,LOCAL,Facility,Both,,,,3162,2687.7,906.2292,3162,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,906.2292,28.66,,percent of total billed charges,,
Knee Arthroscopy,,25001518,LOCAL,Facility,Outpatient,,,,3162,2687.7,906.2292,3162,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1549.38,49,,percent of total billed charges,,
Knee Arthroscopy,,25001518,LOCAL,Facility,Inpatient,,,,3162,2687.7,906.2292,3162,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Knee Arthroscopy,,25001518,LOCAL,Facility,Both,,,,3162,2687.7,906.2292,3162,CorVel,Worker's Compensation,3162,100,,percent of total billed charges,,
Knee Arthroscopy,,25001518,LOCAL,Facility,Both,,,,3162,2687.7,906.2292,3162,First Health Group Corporation,First Health Network,3067.14,97,,percent of total billed charges,,
Knee Arthroscopy,,25001518,LOCAL,Facility,Both,,,,3162,2687.7,906.2292,3162,"Health Partners, Inc.",Commercial,2991.252,94.6,,percent of total billed charges,,
Knee Arthroscopy,,25001518,LOCAL,Facility,Outpatient,,,,3162,2687.7,906.2292,3162,"Health Partners, Inc.",Medicare Advantage,1549.38,49,,percent of total billed charges,,
Knee Arthroscopy,,25001518,LOCAL,Facility,Inpatient,,,,3162,2687.7,906.2292,3162,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Knee Arthroscopy,,25001518,LOCAL,Facility,Both,,,,3162,2687.7,906.2292,3162,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1897.2,60,,percent of total billed charges,,
Knee Arthroscopy,,25001518,LOCAL,Facility,Both,,,,3162,2687.7,906.2292,3162,"Health Partners, Inc.",State of Minnesota Advantage Program,2577.03,81.5,,percent of total billed charges,,
Knee Arthroscopy,,25001518,LOCAL,Facility,Both,,,,3162,2687.7,906.2292,3162,"Health Partners, Inc.",State Public Programs,1581,50,,percent of total billed charges,,
Knee Arthroscopy,,25001518,LOCAL,Facility,Both,,,,3162,2687.7,906.2292,3162,Humana Insurance Company,Commercial PPO,3003.9,95,,percent of total billed charges,,
Knee Arthroscopy,,25001518,LOCAL,Facility,Outpatient,,,,3162,2687.7,906.2292,3162,Humana Insurance Company,Medicare PPO,1549.38,49,,percent of total billed charges,,
Knee Arthroscopy,,25001518,LOCAL,Facility,Inpatient,,,,3162,2687.7,906.2292,3162,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Knee Arthroscopy,,25001518,LOCAL,Facility,Both,,,,3162,2687.7,906.2292,3162,Medica,Individual & Family,3133.542,99.1,,percent of total billed charges,,
Knee Arthroscopy,,25001518,LOCAL,Facility,Outpatient,,,,3162,2687.7,906.2292,3162,Medica,Medica Advantage Solution,1574.676,49.8,,percent of total billed charges,,
Knee Arthroscopy,,25001518,LOCAL,Facility,Inpatient,,,,3162,2687.7,906.2292,3162,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Knee Arthroscopy,,25001518,LOCAL,Facility,Outpatient,,,,3162,2687.7,906.2292,3162,Medica,Medical Assistance,1410.252,44.6,,percent of total billed charges,,
Knee Arthroscopy,,25001518,LOCAL,Facility,Inpatient,,,,3162,2687.7,906.2292,3162,Medica,Medical Assistance,,,,,Included in per diem rate,
Knee Arthroscopy,,25001518,LOCAL,Facility,Outpatient,,,,3162,2687.7,906.2292,3162,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1574.676,49.8,,percent of total billed charges,,
Knee Arthroscopy,,25001518,LOCAL,Facility,Inpatient,,,,3162,2687.7,906.2292,3162,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Knee Arthroscopy,,25001518,LOCAL,Facility,Both,,,,3162,2687.7,906.2292,3162,"Multiplan, Inc.","Multiplan, Inc.",2972.28,94,,percent of total billed charges,,
Knee Arthroscopy,,25001518,LOCAL,Facility,Outpatient,,,,3162,2687.7,906.2292,3162,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,2848.962,90.1,,percent of total billed charges,,
Knee Arthroscopy,,25001518,LOCAL,Facility,Inpatient,,,,3162,2687.7,906.2292,3162,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Knee Arthroscopy,,25001518,LOCAL,Facility,Both,,,,3162,2687.7,906.2292,3162,"Preferred One Administrative Services, INC.",PPO,3117.732,98.6,,percent of total billed charges,,
Knee Arthroscopy,,25001518,LOCAL,Facility,Outpatient,,,,3162,2687.7,906.2292,3162,PrimeWest Health,Minnesota Senior Health Options (MSHO),1626.849,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Knee Arthroscopy,,25001518,LOCAL,Facility,Inpatient,,,,3162,2687.7,906.2292,3162,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Knee Arthroscopy,,25001518,LOCAL,Facility,Outpatient,,,,3162,2687.7,906.2292,3162,PrimeWest Health,MinnesotaCare,1624.0032,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Knee Arthroscopy,,25001518,LOCAL,Facility,Inpatient,,,,3162,2687.7,906.2292,3162,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Knee Arthroscopy,,25001518,LOCAL,Facility,Both,,,,3162,2687.7,906.2292,3162,Sanford Health Plan,Sanford Health Plan,2909.04,92,,percent of total billed charges,,
Knee Arthroscopy,,25001518,LOCAL,Facility,Outpatient,,,,3162,2687.7,906.2292,3162,"UCare Health, Inc.",Individual & Family Plan,1781.787,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Knee Arthroscopy,,25001518,LOCAL,Facility,Inpatient,,,,3162,2687.7,906.2292,3162,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Knee Arthroscopy,,25001518,LOCAL,Facility,Outpatient,,,,3162,2687.7,906.2292,3162,"UCare Health, Inc.",Medical Assistance,1595.8614,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Knee Arthroscopy,,25001518,LOCAL,Facility,Inpatient,,,,3162,2687.7,906.2292,3162,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Knee Arthroscopy,,25001518,LOCAL,Facility,Outpatient,,,,3162,2687.7,906.2292,3162,"UCare Health, Inc.",Medicare Advantage,1595.8614,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Knee Arthroscopy,,25001518,LOCAL,Facility,Inpatient,,,,3162,2687.7,906.2292,3162,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Knee Arthroscopy,,25001518,LOCAL,Facility,Outpatient,,,,3162,2687.7,906.2292,3162,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1595.8614,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Knee Arthroscopy,,25001518,LOCAL,Facility,Inpatient,,,,3162,2687.7,906.2292,3162,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Knee Arthroscopy,,25001518,LOCAL,Facility,Both,,,,3162,2687.7,906.2292,3162,UnitedHealthcare,Individual & Family,2972.28,94,,percent of total billed charges,,
Knee Arthroscopy,,25001518,LOCAL,Facility,Outpatient,,,,3162,2687.7,906.2292,3162,UnitedHealthcare,Medicare Advantage,1549.38,49,,percent of total billed charges,,
Knee Arthroscopy,,25001518,LOCAL,Facility,Inpatient,,,,3162,2687.7,906.2292,3162,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Knee Arthroscopy,,25001518,LOCAL,Facility,Outpatient,,,,3162,2687.7,906.2292,3162,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1517.76,48,,percent of total billed charges,,100% of DHS outpatient percentage
Knee Arthroscopy,,25001518,LOCAL,Facility,Inpatient,,,,3162,2687.7,906.2292,3162,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Knee Arthroscopy Synovectomy Major,,25001618,LOCAL,Facility,Both,,,,3672,3121.2,1052.3952,3672,Aetna,Commercial,3378.24,92,,percent of total billed charges,,
Knee Arthroscopy Synovectomy Major,,25001618,LOCAL,Facility,Outpatient,,,,3672,3121.2,1052.3952,3672,Aetna,Medicare Advantage,1799.28,49,,percent of total billed charges,,
Knee Arthroscopy Synovectomy Major,,25001618,LOCAL,Facility,Inpatient,,,,3672,3121.2,1052.3952,3672,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Knee Arthroscopy Synovectomy Major,,25001618,LOCAL,Facility,Both,,,,3672,3121.2,1052.3952,3672,Aetna,PPO,3414.96,93,,percent of total billed charges,,
Knee Arthroscopy Synovectomy Major,,25001618,LOCAL,Facility,Both,,,,3672,3121.2,1052.3952,3672,America's PPO,America's PPO,3526.2216,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Knee Arthroscopy Synovectomy Major,,25001618,LOCAL,Facility,Both,,,,3672,3121.2,1052.3952,3672,BlueCross BlueShield Minnesota, Federal Employee Program,3613.248,98.4,,percent of total billed charges,,
Knee Arthroscopy Synovectomy Major,,25001618,LOCAL,Facility,Both,,,,3672,3121.2,1052.3952,3672,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,3672,100,,percent of total billed charges,,
Knee Arthroscopy Synovectomy Major,,25001618,LOCAL,Facility,Both,,,,3672,3121.2,1052.3952,3672,BlueCross BlueShield Minnesota,High Value Network Plan,3304.8,90,,percent of total billed charges,,
Knee Arthroscopy Synovectomy Major,,25001618,LOCAL,Facility,Outpatient,,,,3672,3121.2,1052.3952,3672,BlueCross BlueShield Minnesota,Medicare Advantage,1799.28,49,,percent of total billed charges,,
Knee Arthroscopy Synovectomy Major,,25001618,LOCAL,Facility,Inpatient,,,,3672,3121.2,1052.3952,3672,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Knee Arthroscopy Synovectomy Major,,25001618,LOCAL,Facility,Both,,,,3672,3121.2,1052.3952,3672,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,3252.2904,88.57,,percent of total billed charges,,
Knee Arthroscopy Synovectomy Major,,25001618,LOCAL,Facility,Both,,,,3672,3121.2,1052.3952,3672,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1052.3952,28.66,,percent of total billed charges,,
Knee Arthroscopy Synovectomy Major,,25001618,LOCAL,Facility,Outpatient,,,,3672,3121.2,1052.3952,3672,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1799.28,49,,percent of total billed charges,,
Knee Arthroscopy Synovectomy Major,,25001618,LOCAL,Facility,Inpatient,,,,3672,3121.2,1052.3952,3672,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Knee Arthroscopy Synovectomy Major,,25001618,LOCAL,Facility,Both,,,,3672,3121.2,1052.3952,3672,CorVel,Worker's Compensation,3672,100,,percent of total billed charges,,
Knee Arthroscopy Synovectomy Major,,25001618,LOCAL,Facility,Both,,,,3672,3121.2,1052.3952,3672,First Health Group Corporation,First Health Network,3561.84,97,,percent of total billed charges,,
Knee Arthroscopy Synovectomy Major,,25001618,LOCAL,Facility,Both,,,,3672,3121.2,1052.3952,3672,"Health Partners, Inc.",Commercial,3473.712,94.6,,percent of total billed charges,,
Knee Arthroscopy Synovectomy Major,,25001618,LOCAL,Facility,Outpatient,,,,3672,3121.2,1052.3952,3672,"Health Partners, Inc.",Medicare Advantage,1799.28,49,,percent of total billed charges,,
Knee Arthroscopy Synovectomy Major,,25001618,LOCAL,Facility,Inpatient,,,,3672,3121.2,1052.3952,3672,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Knee Arthroscopy Synovectomy Major,,25001618,LOCAL,Facility,Both,,,,3672,3121.2,1052.3952,3672,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),2203.2,60,,percent of total billed charges,,
Knee Arthroscopy Synovectomy Major,,25001618,LOCAL,Facility,Both,,,,3672,3121.2,1052.3952,3672,"Health Partners, Inc.",State of Minnesota Advantage Program,2992.68,81.5,,percent of total billed charges,,
Knee Arthroscopy Synovectomy Major,,25001618,LOCAL,Facility,Both,,,,3672,3121.2,1052.3952,3672,"Health Partners, Inc.",State Public Programs,1836,50,,percent of total billed charges,,
Knee Arthroscopy Synovectomy Major,,25001618,LOCAL,Facility,Both,,,,3672,3121.2,1052.3952,3672,Humana Insurance Company,Commercial PPO,3488.4,95,,percent of total billed charges,,
Knee Arthroscopy Synovectomy Major,,25001618,LOCAL,Facility,Outpatient,,,,3672,3121.2,1052.3952,3672,Humana Insurance Company,Medicare PPO,1799.28,49,,percent of total billed charges,,
Knee Arthroscopy Synovectomy Major,,25001618,LOCAL,Facility,Inpatient,,,,3672,3121.2,1052.3952,3672,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Knee Arthroscopy Synovectomy Major,,25001618,LOCAL,Facility,Both,,,,3672,3121.2,1052.3952,3672,Medica,Individual & Family,3638.952,99.1,,percent of total billed charges,,
Knee Arthroscopy Synovectomy Major,,25001618,LOCAL,Facility,Outpatient,,,,3672,3121.2,1052.3952,3672,Medica,Medica Advantage Solution,1828.656,49.8,,percent of total billed charges,,
Knee Arthroscopy Synovectomy Major,,25001618,LOCAL,Facility,Inpatient,,,,3672,3121.2,1052.3952,3672,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Knee Arthroscopy Synovectomy Major,,25001618,LOCAL,Facility,Outpatient,,,,3672,3121.2,1052.3952,3672,Medica,Medical Assistance,1637.712,44.6,,percent of total billed charges,,
Knee Arthroscopy Synovectomy Major,,25001618,LOCAL,Facility,Inpatient,,,,3672,3121.2,1052.3952,3672,Medica,Medical Assistance,,,,,Included in per diem rate,
Knee Arthroscopy Synovectomy Major,,25001618,LOCAL,Facility,Outpatient,,,,3672,3121.2,1052.3952,3672,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1828.656,49.8,,percent of total billed charges,,
Knee Arthroscopy Synovectomy Major,,25001618,LOCAL,Facility,Inpatient,,,,3672,3121.2,1052.3952,3672,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Knee Arthroscopy Synovectomy Major,,25001618,LOCAL,Facility,Both,,,,3672,3121.2,1052.3952,3672,"Multiplan, Inc.","Multiplan, Inc.",3451.68,94,,percent of total billed charges,,
Knee Arthroscopy Synovectomy Major,,25001618,LOCAL,Facility,Outpatient,,,,3672,3121.2,1052.3952,3672,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,3308.472,90.1,,percent of total billed charges,,
Knee Arthroscopy Synovectomy Major,,25001618,LOCAL,Facility,Inpatient,,,,3672,3121.2,1052.3952,3672,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Knee Arthroscopy Synovectomy Major,,25001618,LOCAL,Facility,Both,,,,3672,3121.2,1052.3952,3672,"Preferred One Administrative Services, INC.",PPO,3620.592,98.6,,percent of total billed charges,,
Knee Arthroscopy Synovectomy Major,,25001618,LOCAL,Facility,Outpatient,,,,3672,3121.2,1052.3952,3672,PrimeWest Health,Minnesota Senior Health Options (MSHO),1889.244,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Knee Arthroscopy Synovectomy Major,,25001618,LOCAL,Facility,Inpatient,,,,3672,3121.2,1052.3952,3672,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Knee Arthroscopy Synovectomy Major,,25001618,LOCAL,Facility,Outpatient,,,,3672,3121.2,1052.3952,3672,PrimeWest Health,MinnesotaCare,1885.9392,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Knee Arthroscopy Synovectomy Major,,25001618,LOCAL,Facility,Inpatient,,,,3672,3121.2,1052.3952,3672,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Knee Arthroscopy Synovectomy Major,,25001618,LOCAL,Facility,Both,,,,3672,3121.2,1052.3952,3672,Sanford Health Plan,Sanford Health Plan,3378.24,92,,percent of total billed charges,,
Knee Arthroscopy Synovectomy Major,,25001618,LOCAL,Facility,Outpatient,,,,3672,3121.2,1052.3952,3672,"UCare Health, Inc.",Individual & Family Plan,2069.172,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Knee Arthroscopy Synovectomy Major,,25001618,LOCAL,Facility,Inpatient,,,,3672,3121.2,1052.3952,3672,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Knee Arthroscopy Synovectomy Major,,25001618,LOCAL,Facility,Outpatient,,,,3672,3121.2,1052.3952,3672,"UCare Health, Inc.",Medical Assistance,1853.2584,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Knee Arthroscopy Synovectomy Major,,25001618,LOCAL,Facility,Inpatient,,,,3672,3121.2,1052.3952,3672,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Knee Arthroscopy Synovectomy Major,,25001618,LOCAL,Facility,Outpatient,,,,3672,3121.2,1052.3952,3672,"UCare Health, Inc.",Medicare Advantage,1853.2584,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Knee Arthroscopy Synovectomy Major,,25001618,LOCAL,Facility,Inpatient,,,,3672,3121.2,1052.3952,3672,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Knee Arthroscopy Synovectomy Major,,25001618,LOCAL,Facility,Outpatient,,,,3672,3121.2,1052.3952,3672,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1853.2584,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Knee Arthroscopy Synovectomy Major,,25001618,LOCAL,Facility,Inpatient,,,,3672,3121.2,1052.3952,3672,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Knee Arthroscopy Synovectomy Major,,25001618,LOCAL,Facility,Both,,,,3672,3121.2,1052.3952,3672,UnitedHealthcare,Individual & Family,3451.68,94,,percent of total billed charges,,
Knee Arthroscopy Synovectomy Major,,25001618,LOCAL,Facility,Outpatient,,,,3672,3121.2,1052.3952,3672,UnitedHealthcare,Medicare Advantage,1799.28,49,,percent of total billed charges,,
Knee Arthroscopy Synovectomy Major,,25001618,LOCAL,Facility,Inpatient,,,,3672,3121.2,1052.3952,3672,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Knee Arthroscopy Synovectomy Major,,25001618,LOCAL,Facility,Outpatient,,,,3672,3121.2,1052.3952,3672,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1762.56,48,,percent of total billed charges,,100% of DHS outpatient percentage
Knee Arthroscopy Synovectomy Major,,25001618,LOCAL,Facility,Inpatient,,,,3672,3121.2,1052.3952,3672,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Knee Arthroscopy W Meniscectomy,,25001657,LOCAL,Facility,Both,,,,3672,3121.2,1052.3952,3672,Aetna,Commercial,3378.24,92,,percent of total billed charges,,
Knee Arthroscopy W Meniscectomy,,25001657,LOCAL,Facility,Outpatient,,,,3672,3121.2,1052.3952,3672,Aetna,Medicare Advantage,1799.28,49,,percent of total billed charges,,
Knee Arthroscopy W Meniscectomy,,25001657,LOCAL,Facility,Inpatient,,,,3672,3121.2,1052.3952,3672,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Knee Arthroscopy W Meniscectomy,,25001657,LOCAL,Facility,Both,,,,3672,3121.2,1052.3952,3672,Aetna,PPO,3414.96,93,,percent of total billed charges,,
Knee Arthroscopy W Meniscectomy,,25001657,LOCAL,Facility,Both,,,,3672,3121.2,1052.3952,3672,America's PPO,America's PPO,3526.2216,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Knee Arthroscopy W Meniscectomy,,25001657,LOCAL,Facility,Both,,,,3672,3121.2,1052.3952,3672,BlueCross BlueShield Minnesota, Federal Employee Program,3613.248,98.4,,percent of total billed charges,,
Knee Arthroscopy W Meniscectomy,,25001657,LOCAL,Facility,Both,,,,3672,3121.2,1052.3952,3672,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,3672,100,,percent of total billed charges,,
Knee Arthroscopy W Meniscectomy,,25001657,LOCAL,Facility,Both,,,,3672,3121.2,1052.3952,3672,BlueCross BlueShield Minnesota,High Value Network Plan,3304.8,90,,percent of total billed charges,,
Knee Arthroscopy W Meniscectomy,,25001657,LOCAL,Facility,Outpatient,,,,3672,3121.2,1052.3952,3672,BlueCross BlueShield Minnesota,Medicare Advantage,1799.28,49,,percent of total billed charges,,
Knee Arthroscopy W Meniscectomy,,25001657,LOCAL,Facility,Inpatient,,,,3672,3121.2,1052.3952,3672,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Knee Arthroscopy W Meniscectomy,,25001657,LOCAL,Facility,Both,,,,3672,3121.2,1052.3952,3672,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,3252.2904,88.57,,percent of total billed charges,,
Knee Arthroscopy W Meniscectomy,,25001657,LOCAL,Facility,Both,,,,3672,3121.2,1052.3952,3672,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1052.3952,28.66,,percent of total billed charges,,
Knee Arthroscopy W Meniscectomy,,25001657,LOCAL,Facility,Outpatient,,,,3672,3121.2,1052.3952,3672,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1799.28,49,,percent of total billed charges,,
Knee Arthroscopy W Meniscectomy,,25001657,LOCAL,Facility,Inpatient,,,,3672,3121.2,1052.3952,3672,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Knee Arthroscopy W Meniscectomy,,25001657,LOCAL,Facility,Both,,,,3672,3121.2,1052.3952,3672,CorVel,Worker's Compensation,3672,100,,percent of total billed charges,,
Knee Arthroscopy W Meniscectomy,,25001657,LOCAL,Facility,Both,,,,3672,3121.2,1052.3952,3672,First Health Group Corporation,First Health Network,3561.84,97,,percent of total billed charges,,
Knee Arthroscopy W Meniscectomy,,25001657,LOCAL,Facility,Both,,,,3672,3121.2,1052.3952,3672,"Health Partners, Inc.",Commercial,3473.712,94.6,,percent of total billed charges,,
Knee Arthroscopy W Meniscectomy,,25001657,LOCAL,Facility,Outpatient,,,,3672,3121.2,1052.3952,3672,"Health Partners, Inc.",Medicare Advantage,1799.28,49,,percent of total billed charges,,
Knee Arthroscopy W Meniscectomy,,25001657,LOCAL,Facility,Inpatient,,,,3672,3121.2,1052.3952,3672,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Knee Arthroscopy W Meniscectomy,,25001657,LOCAL,Facility,Both,,,,3672,3121.2,1052.3952,3672,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),2203.2,60,,percent of total billed charges,,
Knee Arthroscopy W Meniscectomy,,25001657,LOCAL,Facility,Both,,,,3672,3121.2,1052.3952,3672,"Health Partners, Inc.",State of Minnesota Advantage Program,2992.68,81.5,,percent of total billed charges,,
Knee Arthroscopy W Meniscectomy,,25001657,LOCAL,Facility,Both,,,,3672,3121.2,1052.3952,3672,"Health Partners, Inc.",State Public Programs,1836,50,,percent of total billed charges,,
Knee Arthroscopy W Meniscectomy,,25001657,LOCAL,Facility,Both,,,,3672,3121.2,1052.3952,3672,Humana Insurance Company,Commercial PPO,3488.4,95,,percent of total billed charges,,
Knee Arthroscopy W Meniscectomy,,25001657,LOCAL,Facility,Outpatient,,,,3672,3121.2,1052.3952,3672,Humana Insurance Company,Medicare PPO,1799.28,49,,percent of total billed charges,,
Knee Arthroscopy W Meniscectomy,,25001657,LOCAL,Facility,Inpatient,,,,3672,3121.2,1052.3952,3672,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Knee Arthroscopy W Meniscectomy,,25001657,LOCAL,Facility,Both,,,,3672,3121.2,1052.3952,3672,Medica,Individual & Family,3638.952,99.1,,percent of total billed charges,,
Knee Arthroscopy W Meniscectomy,,25001657,LOCAL,Facility,Outpatient,,,,3672,3121.2,1052.3952,3672,Medica,Medica Advantage Solution,1828.656,49.8,,percent of total billed charges,,
Knee Arthroscopy W Meniscectomy,,25001657,LOCAL,Facility,Inpatient,,,,3672,3121.2,1052.3952,3672,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Knee Arthroscopy W Meniscectomy,,25001657,LOCAL,Facility,Outpatient,,,,3672,3121.2,1052.3952,3672,Medica,Medical Assistance,1637.712,44.6,,percent of total billed charges,,
Knee Arthroscopy W Meniscectomy,,25001657,LOCAL,Facility,Inpatient,,,,3672,3121.2,1052.3952,3672,Medica,Medical Assistance,,,,,Included in per diem rate,
Knee Arthroscopy W Meniscectomy,,25001657,LOCAL,Facility,Outpatient,,,,3672,3121.2,1052.3952,3672,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1828.656,49.8,,percent of total billed charges,,
Knee Arthroscopy W Meniscectomy,,25001657,LOCAL,Facility,Inpatient,,,,3672,3121.2,1052.3952,3672,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Knee Arthroscopy W Meniscectomy,,25001657,LOCAL,Facility,Both,,,,3672,3121.2,1052.3952,3672,"Multiplan, Inc.","Multiplan, Inc.",3451.68,94,,percent of total billed charges,,
Knee Arthroscopy W Meniscectomy,,25001657,LOCAL,Facility,Outpatient,,,,3672,3121.2,1052.3952,3672,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,3308.472,90.1,,percent of total billed charges,,
Knee Arthroscopy W Meniscectomy,,25001657,LOCAL,Facility,Inpatient,,,,3672,3121.2,1052.3952,3672,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Knee Arthroscopy W Meniscectomy,,25001657,LOCAL,Facility,Both,,,,3672,3121.2,1052.3952,3672,"Preferred One Administrative Services, INC.",PPO,3620.592,98.6,,percent of total billed charges,,
Knee Arthroscopy W Meniscectomy,,25001657,LOCAL,Facility,Outpatient,,,,3672,3121.2,1052.3952,3672,PrimeWest Health,Minnesota Senior Health Options (MSHO),1889.244,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Knee Arthroscopy W Meniscectomy,,25001657,LOCAL,Facility,Inpatient,,,,3672,3121.2,1052.3952,3672,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Knee Arthroscopy W Meniscectomy,,25001657,LOCAL,Facility,Outpatient,,,,3672,3121.2,1052.3952,3672,PrimeWest Health,MinnesotaCare,1885.9392,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Knee Arthroscopy W Meniscectomy,,25001657,LOCAL,Facility,Inpatient,,,,3672,3121.2,1052.3952,3672,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Knee Arthroscopy W Meniscectomy,,25001657,LOCAL,Facility,Both,,,,3672,3121.2,1052.3952,3672,Sanford Health Plan,Sanford Health Plan,3378.24,92,,percent of total billed charges,,
Knee Arthroscopy W Meniscectomy,,25001657,LOCAL,Facility,Outpatient,,,,3672,3121.2,1052.3952,3672,"UCare Health, Inc.",Individual & Family Plan,2069.172,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Knee Arthroscopy W Meniscectomy,,25001657,LOCAL,Facility,Inpatient,,,,3672,3121.2,1052.3952,3672,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Knee Arthroscopy W Meniscectomy,,25001657,LOCAL,Facility,Outpatient,,,,3672,3121.2,1052.3952,3672,"UCare Health, Inc.",Medical Assistance,1853.2584,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Knee Arthroscopy W Meniscectomy,,25001657,LOCAL,Facility,Inpatient,,,,3672,3121.2,1052.3952,3672,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Knee Arthroscopy W Meniscectomy,,25001657,LOCAL,Facility,Outpatient,,,,3672,3121.2,1052.3952,3672,"UCare Health, Inc.",Medicare Advantage,1853.2584,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Knee Arthroscopy W Meniscectomy,,25001657,LOCAL,Facility,Inpatient,,,,3672,3121.2,1052.3952,3672,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Knee Arthroscopy W Meniscectomy,,25001657,LOCAL,Facility,Outpatient,,,,3672,3121.2,1052.3952,3672,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1853.2584,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Knee Arthroscopy W Meniscectomy,,25001657,LOCAL,Facility,Inpatient,,,,3672,3121.2,1052.3952,3672,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Knee Arthroscopy W Meniscectomy,,25001657,LOCAL,Facility,Both,,,,3672,3121.2,1052.3952,3672,UnitedHealthcare,Individual & Family,3451.68,94,,percent of total billed charges,,
Knee Arthroscopy W Meniscectomy,,25001657,LOCAL,Facility,Outpatient,,,,3672,3121.2,1052.3952,3672,UnitedHealthcare,Medicare Advantage,1799.28,49,,percent of total billed charges,,
Knee Arthroscopy W Meniscectomy,,25001657,LOCAL,Facility,Inpatient,,,,3672,3121.2,1052.3952,3672,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Knee Arthroscopy W Meniscectomy,,25001657,LOCAL,Facility,Outpatient,,,,3672,3121.2,1052.3952,3672,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1762.56,48,,percent of total billed charges,,100% of DHS outpatient percentage
Knee Arthroscopy W Meniscectomy,,25001657,LOCAL,Facility,Inpatient,,,,3672,3121.2,1052.3952,3672,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Laparoscopic Appendectomy,,25001714,LOCAL,Facility,Both,,,,6120,5202,1753.992,6120,Aetna,Commercial,5630.4,92,,percent of total billed charges,,
Laparoscopic Appendectomy,,25001714,LOCAL,Facility,Outpatient,,,,6120,5202,1753.992,6120,Aetna,Medicare Advantage,2998.8,49,,percent of total billed charges,,
Laparoscopic Appendectomy,,25001714,LOCAL,Facility,Inpatient,,,,6120,5202,1753.992,6120,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Laparoscopic Appendectomy,,25001714,LOCAL,Facility,Both,,,,6120,5202,1753.992,6120,Aetna,PPO,5691.6,93,,percent of total billed charges,,
Laparoscopic Appendectomy,,25001714,LOCAL,Facility,Both,,,,6120,5202,1753.992,6120,America's PPO,America's PPO,5877.036,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Laparoscopic Appendectomy,,25001714,LOCAL,Facility,Both,,,,6120,5202,1753.992,6120,BlueCross BlueShield Minnesota, Federal Employee Program,6022.08,98.4,,percent of total billed charges,,
Laparoscopic Appendectomy,,25001714,LOCAL,Facility,Both,,,,6120,5202,1753.992,6120,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,6120,100,,percent of total billed charges,,
Laparoscopic Appendectomy,,25001714,LOCAL,Facility,Both,,,,6120,5202,1753.992,6120,BlueCross BlueShield Minnesota,High Value Network Plan,5508,90,,percent of total billed charges,,
Laparoscopic Appendectomy,,25001714,LOCAL,Facility,Outpatient,,,,6120,5202,1753.992,6120,BlueCross BlueShield Minnesota,Medicare Advantage,2998.8,49,,percent of total billed charges,,
Laparoscopic Appendectomy,,25001714,LOCAL,Facility,Inpatient,,,,6120,5202,1753.992,6120,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Laparoscopic Appendectomy,,25001714,LOCAL,Facility,Both,,,,6120,5202,1753.992,6120,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,5420.484,88.57,,percent of total billed charges,,
Laparoscopic Appendectomy,,25001714,LOCAL,Facility,Both,,,,6120,5202,1753.992,6120,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1753.992,28.66,,percent of total billed charges,,
Laparoscopic Appendectomy,,25001714,LOCAL,Facility,Outpatient,,,,6120,5202,1753.992,6120,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2998.8,49,,percent of total billed charges,,
Laparoscopic Appendectomy,,25001714,LOCAL,Facility,Inpatient,,,,6120,5202,1753.992,6120,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Laparoscopic Appendectomy,,25001714,LOCAL,Facility,Both,,,,6120,5202,1753.992,6120,CorVel,Worker's Compensation,6120,100,,percent of total billed charges,,
Laparoscopic Appendectomy,,25001714,LOCAL,Facility,Both,,,,6120,5202,1753.992,6120,First Health Group Corporation,First Health Network,5936.4,97,,percent of total billed charges,,
Laparoscopic Appendectomy,,25001714,LOCAL,Facility,Both,,,,6120,5202,1753.992,6120,"Health Partners, Inc.",Commercial,5789.52,94.6,,percent of total billed charges,,
Laparoscopic Appendectomy,,25001714,LOCAL,Facility,Outpatient,,,,6120,5202,1753.992,6120,"Health Partners, Inc.",Medicare Advantage,2998.8,49,,percent of total billed charges,,
Laparoscopic Appendectomy,,25001714,LOCAL,Facility,Inpatient,,,,6120,5202,1753.992,6120,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Laparoscopic Appendectomy,,25001714,LOCAL,Facility,Both,,,,6120,5202,1753.992,6120,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3672,60,,percent of total billed charges,,
Laparoscopic Appendectomy,,25001714,LOCAL,Facility,Both,,,,6120,5202,1753.992,6120,"Health Partners, Inc.",State of Minnesota Advantage Program,4987.8,81.5,,percent of total billed charges,,
Laparoscopic Appendectomy,,25001714,LOCAL,Facility,Both,,,,6120,5202,1753.992,6120,"Health Partners, Inc.",State Public Programs,3060,50,,percent of total billed charges,,
Laparoscopic Appendectomy,,25001714,LOCAL,Facility,Both,,,,6120,5202,1753.992,6120,Humana Insurance Company,Commercial PPO,5814,95,,percent of total billed charges,,
Laparoscopic Appendectomy,,25001714,LOCAL,Facility,Outpatient,,,,6120,5202,1753.992,6120,Humana Insurance Company,Medicare PPO,2998.8,49,,percent of total billed charges,,
Laparoscopic Appendectomy,,25001714,LOCAL,Facility,Inpatient,,,,6120,5202,1753.992,6120,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Laparoscopic Appendectomy,,25001714,LOCAL,Facility,Both,,,,6120,5202,1753.992,6120,Medica,Individual & Family,6064.92,99.1,,percent of total billed charges,,
Laparoscopic Appendectomy,,25001714,LOCAL,Facility,Outpatient,,,,6120,5202,1753.992,6120,Medica,Medica Advantage Solution,3047.76,49.8,,percent of total billed charges,,
Laparoscopic Appendectomy,,25001714,LOCAL,Facility,Inpatient,,,,6120,5202,1753.992,6120,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Laparoscopic Appendectomy,,25001714,LOCAL,Facility,Outpatient,,,,6120,5202,1753.992,6120,Medica,Medical Assistance,2729.52,44.6,,percent of total billed charges,,
Laparoscopic Appendectomy,,25001714,LOCAL,Facility,Inpatient,,,,6120,5202,1753.992,6120,Medica,Medical Assistance,,,,,Included in per diem rate,
Laparoscopic Appendectomy,,25001714,LOCAL,Facility,Outpatient,,,,6120,5202,1753.992,6120,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,3047.76,49.8,,percent of total billed charges,,
Laparoscopic Appendectomy,,25001714,LOCAL,Facility,Inpatient,,,,6120,5202,1753.992,6120,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Laparoscopic Appendectomy,,25001714,LOCAL,Facility,Both,,,,6120,5202,1753.992,6120,"Multiplan, Inc.","Multiplan, Inc.",5752.8,94,,percent of total billed charges,,
Laparoscopic Appendectomy,,25001714,LOCAL,Facility,Outpatient,,,,6120,5202,1753.992,6120,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,5514.12,90.1,,percent of total billed charges,,
Laparoscopic Appendectomy,,25001714,LOCAL,Facility,Inpatient,,,,6120,5202,1753.992,6120,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Laparoscopic Appendectomy,,25001714,LOCAL,Facility,Both,,,,6120,5202,1753.992,6120,"Preferred One Administrative Services, INC.",PPO,6034.32,98.6,,percent of total billed charges,,
Laparoscopic Appendectomy,,25001714,LOCAL,Facility,Outpatient,,,,6120,5202,1753.992,6120,PrimeWest Health,Minnesota Senior Health Options (MSHO),3148.74,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Laparoscopic Appendectomy,,25001714,LOCAL,Facility,Inpatient,,,,6120,5202,1753.992,6120,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Laparoscopic Appendectomy,,25001714,LOCAL,Facility,Outpatient,,,,6120,5202,1753.992,6120,PrimeWest Health,MinnesotaCare,3143.232,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Laparoscopic Appendectomy,,25001714,LOCAL,Facility,Inpatient,,,,6120,5202,1753.992,6120,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Laparoscopic Appendectomy,,25001714,LOCAL,Facility,Both,,,,6120,5202,1753.992,6120,Sanford Health Plan,Sanford Health Plan,5630.4,92,,percent of total billed charges,,
Laparoscopic Appendectomy,,25001714,LOCAL,Facility,Outpatient,,,,6120,5202,1753.992,6120,"UCare Health, Inc.",Individual & Family Plan,3448.62,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Laparoscopic Appendectomy,,25001714,LOCAL,Facility,Inpatient,,,,6120,5202,1753.992,6120,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Laparoscopic Appendectomy,,25001714,LOCAL,Facility,Outpatient,,,,6120,5202,1753.992,6120,"UCare Health, Inc.",Medical Assistance,3088.764,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Laparoscopic Appendectomy,,25001714,LOCAL,Facility,Inpatient,,,,6120,5202,1753.992,6120,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Laparoscopic Appendectomy,,25001714,LOCAL,Facility,Outpatient,,,,6120,5202,1753.992,6120,"UCare Health, Inc.",Medicare Advantage,3088.764,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Laparoscopic Appendectomy,,25001714,LOCAL,Facility,Inpatient,,,,6120,5202,1753.992,6120,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Laparoscopic Appendectomy,,25001714,LOCAL,Facility,Outpatient,,,,6120,5202,1753.992,6120,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),3088.764,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Laparoscopic Appendectomy,,25001714,LOCAL,Facility,Inpatient,,,,6120,5202,1753.992,6120,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Laparoscopic Appendectomy,,25001714,LOCAL,Facility,Both,,,,6120,5202,1753.992,6120,UnitedHealthcare,Individual & Family,5752.8,94,,percent of total billed charges,,
Laparoscopic Appendectomy,,25001714,LOCAL,Facility,Outpatient,,,,6120,5202,1753.992,6120,UnitedHealthcare,Medicare Advantage,2998.8,49,,percent of total billed charges,,
Laparoscopic Appendectomy,,25001714,LOCAL,Facility,Inpatient,,,,6120,5202,1753.992,6120,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Laparoscopic Appendectomy,,25001714,LOCAL,Facility,Outpatient,,,,6120,5202,1753.992,6120,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2937.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
Laparoscopic Appendectomy,,25001714,LOCAL,Facility,Inpatient,,,,6120,5202,1753.992,6120,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Laparoscopic Cholecystectomy,,25001727,LOCAL,Facility,Both,,,,5100,4335,1461.66,5100,Aetna,Commercial,4692,92,,percent of total billed charges,,
Laparoscopic Cholecystectomy,,25001727,LOCAL,Facility,Outpatient,,,,5100,4335,1461.66,5100,Aetna,Medicare Advantage,2499,49,,percent of total billed charges,,
Laparoscopic Cholecystectomy,,25001727,LOCAL,Facility,Inpatient,,,,5100,4335,1461.66,5100,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Laparoscopic Cholecystectomy,,25001727,LOCAL,Facility,Both,,,,5100,4335,1461.66,5100,Aetna,PPO,4743,93,,percent of total billed charges,,
Laparoscopic Cholecystectomy,,25001727,LOCAL,Facility,Both,,,,5100,4335,1461.66,5100,America's PPO,America's PPO,4897.53,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Laparoscopic Cholecystectomy,,25001727,LOCAL,Facility,Both,,,,5100,4335,1461.66,5100,BlueCross BlueShield Minnesota, Federal Employee Program,5018.4,98.4,,percent of total billed charges,,
Laparoscopic Cholecystectomy,,25001727,LOCAL,Facility,Both,,,,5100,4335,1461.66,5100,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5100,100,,percent of total billed charges,,
Laparoscopic Cholecystectomy,,25001727,LOCAL,Facility,Both,,,,5100,4335,1461.66,5100,BlueCross BlueShield Minnesota,High Value Network Plan,4590,90,,percent of total billed charges,,
Laparoscopic Cholecystectomy,,25001727,LOCAL,Facility,Outpatient,,,,5100,4335,1461.66,5100,BlueCross BlueShield Minnesota,Medicare Advantage,2499,49,,percent of total billed charges,,
Laparoscopic Cholecystectomy,,25001727,LOCAL,Facility,Inpatient,,,,5100,4335,1461.66,5100,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Laparoscopic Cholecystectomy,,25001727,LOCAL,Facility,Both,,,,5100,4335,1461.66,5100,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4517.07,88.57,,percent of total billed charges,,
Laparoscopic Cholecystectomy,,25001727,LOCAL,Facility,Both,,,,5100,4335,1461.66,5100,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1461.66,28.66,,percent of total billed charges,,
Laparoscopic Cholecystectomy,,25001727,LOCAL,Facility,Outpatient,,,,5100,4335,1461.66,5100,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2499,49,,percent of total billed charges,,
Laparoscopic Cholecystectomy,,25001727,LOCAL,Facility,Inpatient,,,,5100,4335,1461.66,5100,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Laparoscopic Cholecystectomy,,25001727,LOCAL,Facility,Both,,,,5100,4335,1461.66,5100,CorVel,Worker's Compensation,5100,100,,percent of total billed charges,,
Laparoscopic Cholecystectomy,,25001727,LOCAL,Facility,Both,,,,5100,4335,1461.66,5100,First Health Group Corporation,First Health Network,4947,97,,percent of total billed charges,,
Laparoscopic Cholecystectomy,,25001727,LOCAL,Facility,Both,,,,5100,4335,1461.66,5100,"Health Partners, Inc.",Commercial,4824.6,94.6,,percent of total billed charges,,
Laparoscopic Cholecystectomy,,25001727,LOCAL,Facility,Outpatient,,,,5100,4335,1461.66,5100,"Health Partners, Inc.",Medicare Advantage,2499,49,,percent of total billed charges,,
Laparoscopic Cholecystectomy,,25001727,LOCAL,Facility,Inpatient,,,,5100,4335,1461.66,5100,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Laparoscopic Cholecystectomy,,25001727,LOCAL,Facility,Both,,,,5100,4335,1461.66,5100,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3060,60,,percent of total billed charges,,
Laparoscopic Cholecystectomy,,25001727,LOCAL,Facility,Both,,,,5100,4335,1461.66,5100,"Health Partners, Inc.",State of Minnesota Advantage Program,4156.5,81.5,,percent of total billed charges,,
Laparoscopic Cholecystectomy,,25001727,LOCAL,Facility,Both,,,,5100,4335,1461.66,5100,"Health Partners, Inc.",State Public Programs,2550,50,,percent of total billed charges,,
Laparoscopic Cholecystectomy,,25001727,LOCAL,Facility,Both,,,,5100,4335,1461.66,5100,Humana Insurance Company,Commercial PPO,4845,95,,percent of total billed charges,,
Laparoscopic Cholecystectomy,,25001727,LOCAL,Facility,Outpatient,,,,5100,4335,1461.66,5100,Humana Insurance Company,Medicare PPO,2499,49,,percent of total billed charges,,
Laparoscopic Cholecystectomy,,25001727,LOCAL,Facility,Inpatient,,,,5100,4335,1461.66,5100,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Laparoscopic Cholecystectomy,,25001727,LOCAL,Facility,Both,,,,5100,4335,1461.66,5100,Medica,Individual & Family,5054.1,99.1,,percent of total billed charges,,
Laparoscopic Cholecystectomy,,25001727,LOCAL,Facility,Outpatient,,,,5100,4335,1461.66,5100,Medica,Medica Advantage Solution,2539.8,49.8,,percent of total billed charges,,
Laparoscopic Cholecystectomy,,25001727,LOCAL,Facility,Inpatient,,,,5100,4335,1461.66,5100,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Laparoscopic Cholecystectomy,,25001727,LOCAL,Facility,Outpatient,,,,5100,4335,1461.66,5100,Medica,Medical Assistance,2274.6,44.6,,percent of total billed charges,,
Laparoscopic Cholecystectomy,,25001727,LOCAL,Facility,Inpatient,,,,5100,4335,1461.66,5100,Medica,Medical Assistance,,,,,Included in per diem rate,
Laparoscopic Cholecystectomy,,25001727,LOCAL,Facility,Outpatient,,,,5100,4335,1461.66,5100,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2539.8,49.8,,percent of total billed charges,,
Laparoscopic Cholecystectomy,,25001727,LOCAL,Facility,Inpatient,,,,5100,4335,1461.66,5100,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Laparoscopic Cholecystectomy,,25001727,LOCAL,Facility,Both,,,,5100,4335,1461.66,5100,"Multiplan, Inc.","Multiplan, Inc.",4794,94,,percent of total billed charges,,
Laparoscopic Cholecystectomy,,25001727,LOCAL,Facility,Outpatient,,,,5100,4335,1461.66,5100,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4595.1,90.1,,percent of total billed charges,,
Laparoscopic Cholecystectomy,,25001727,LOCAL,Facility,Inpatient,,,,5100,4335,1461.66,5100,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Laparoscopic Cholecystectomy,,25001727,LOCAL,Facility,Both,,,,5100,4335,1461.66,5100,"Preferred One Administrative Services, INC.",PPO,5028.6,98.6,,percent of total billed charges,,
Laparoscopic Cholecystectomy,,25001727,LOCAL,Facility,Outpatient,,,,5100,4335,1461.66,5100,PrimeWest Health,Minnesota Senior Health Options (MSHO),2623.95,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Laparoscopic Cholecystectomy,,25001727,LOCAL,Facility,Inpatient,,,,5100,4335,1461.66,5100,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Laparoscopic Cholecystectomy,,25001727,LOCAL,Facility,Outpatient,,,,5100,4335,1461.66,5100,PrimeWest Health,MinnesotaCare,2619.36,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Laparoscopic Cholecystectomy,,25001727,LOCAL,Facility,Inpatient,,,,5100,4335,1461.66,5100,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Laparoscopic Cholecystectomy,,25001727,LOCAL,Facility,Both,,,,5100,4335,1461.66,5100,Sanford Health Plan,Sanford Health Plan,4692,92,,percent of total billed charges,,
Laparoscopic Cholecystectomy,,25001727,LOCAL,Facility,Outpatient,,,,5100,4335,1461.66,5100,"UCare Health, Inc.",Individual & Family Plan,2873.85,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Laparoscopic Cholecystectomy,,25001727,LOCAL,Facility,Inpatient,,,,5100,4335,1461.66,5100,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Laparoscopic Cholecystectomy,,25001727,LOCAL,Facility,Outpatient,,,,5100,4335,1461.66,5100,"UCare Health, Inc.",Medical Assistance,2573.97,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Laparoscopic Cholecystectomy,,25001727,LOCAL,Facility,Inpatient,,,,5100,4335,1461.66,5100,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Laparoscopic Cholecystectomy,,25001727,LOCAL,Facility,Outpatient,,,,5100,4335,1461.66,5100,"UCare Health, Inc.",Medicare Advantage,2573.97,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Laparoscopic Cholecystectomy,,25001727,LOCAL,Facility,Inpatient,,,,5100,4335,1461.66,5100,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Laparoscopic Cholecystectomy,,25001727,LOCAL,Facility,Outpatient,,,,5100,4335,1461.66,5100,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2573.97,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Laparoscopic Cholecystectomy,,25001727,LOCAL,Facility,Inpatient,,,,5100,4335,1461.66,5100,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Laparoscopic Cholecystectomy,,25001727,LOCAL,Facility,Both,,,,5100,4335,1461.66,5100,UnitedHealthcare,Individual & Family,4794,94,,percent of total billed charges,,
Laparoscopic Cholecystectomy,,25001727,LOCAL,Facility,Outpatient,,,,5100,4335,1461.66,5100,UnitedHealthcare,Medicare Advantage,2499,49,,percent of total billed charges,,
Laparoscopic Cholecystectomy,,25001727,LOCAL,Facility,Inpatient,,,,5100,4335,1461.66,5100,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Laparoscopic Cholecystectomy,,25001727,LOCAL,Facility,Outpatient,,,,5100,4335,1461.66,5100,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2448,48,,percent of total billed charges,,100% of DHS outpatient percentage
Laparoscopic Cholecystectomy,,25001727,LOCAL,Facility,Inpatient,,,,5100,4335,1461.66,5100,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Laparoscopic Cholecystectomy W Chol,,25001731,LOCAL,Facility,Both,,,,6120,5202,1753.992,6120,Aetna,Commercial,5630.4,92,,percent of total billed charges,,
Laparoscopic Cholecystectomy W Chol,,25001731,LOCAL,Facility,Outpatient,,,,6120,5202,1753.992,6120,Aetna,Medicare Advantage,2998.8,49,,percent of total billed charges,,
Laparoscopic Cholecystectomy W Chol,,25001731,LOCAL,Facility,Inpatient,,,,6120,5202,1753.992,6120,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Laparoscopic Cholecystectomy W Chol,,25001731,LOCAL,Facility,Both,,,,6120,5202,1753.992,6120,Aetna,PPO,5691.6,93,,percent of total billed charges,,
Laparoscopic Cholecystectomy W Chol,,25001731,LOCAL,Facility,Both,,,,6120,5202,1753.992,6120,America's PPO,America's PPO,5877.036,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Laparoscopic Cholecystectomy W Chol,,25001731,LOCAL,Facility,Both,,,,6120,5202,1753.992,6120,BlueCross BlueShield Minnesota, Federal Employee Program,6022.08,98.4,,percent of total billed charges,,
Laparoscopic Cholecystectomy W Chol,,25001731,LOCAL,Facility,Both,,,,6120,5202,1753.992,6120,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,6120,100,,percent of total billed charges,,
Laparoscopic Cholecystectomy W Chol,,25001731,LOCAL,Facility,Both,,,,6120,5202,1753.992,6120,BlueCross BlueShield Minnesota,High Value Network Plan,5508,90,,percent of total billed charges,,
Laparoscopic Cholecystectomy W Chol,,25001731,LOCAL,Facility,Outpatient,,,,6120,5202,1753.992,6120,BlueCross BlueShield Minnesota,Medicare Advantage,2998.8,49,,percent of total billed charges,,
Laparoscopic Cholecystectomy W Chol,,25001731,LOCAL,Facility,Inpatient,,,,6120,5202,1753.992,6120,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Laparoscopic Cholecystectomy W Chol,,25001731,LOCAL,Facility,Both,,,,6120,5202,1753.992,6120,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,5420.484,88.57,,percent of total billed charges,,
Laparoscopic Cholecystectomy W Chol,,25001731,LOCAL,Facility,Both,,,,6120,5202,1753.992,6120,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1753.992,28.66,,percent of total billed charges,,
Laparoscopic Cholecystectomy W Chol,,25001731,LOCAL,Facility,Outpatient,,,,6120,5202,1753.992,6120,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2998.8,49,,percent of total billed charges,,
Laparoscopic Cholecystectomy W Chol,,25001731,LOCAL,Facility,Inpatient,,,,6120,5202,1753.992,6120,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Laparoscopic Cholecystectomy W Chol,,25001731,LOCAL,Facility,Both,,,,6120,5202,1753.992,6120,CorVel,Worker's Compensation,6120,100,,percent of total billed charges,,
Laparoscopic Cholecystectomy W Chol,,25001731,LOCAL,Facility,Both,,,,6120,5202,1753.992,6120,First Health Group Corporation,First Health Network,5936.4,97,,percent of total billed charges,,
Laparoscopic Cholecystectomy W Chol,,25001731,LOCAL,Facility,Both,,,,6120,5202,1753.992,6120,"Health Partners, Inc.",Commercial,5789.52,94.6,,percent of total billed charges,,
Laparoscopic Cholecystectomy W Chol,,25001731,LOCAL,Facility,Outpatient,,,,6120,5202,1753.992,6120,"Health Partners, Inc.",Medicare Advantage,2998.8,49,,percent of total billed charges,,
Laparoscopic Cholecystectomy W Chol,,25001731,LOCAL,Facility,Inpatient,,,,6120,5202,1753.992,6120,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Laparoscopic Cholecystectomy W Chol,,25001731,LOCAL,Facility,Both,,,,6120,5202,1753.992,6120,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3672,60,,percent of total billed charges,,
Laparoscopic Cholecystectomy W Chol,,25001731,LOCAL,Facility,Both,,,,6120,5202,1753.992,6120,"Health Partners, Inc.",State of Minnesota Advantage Program,4987.8,81.5,,percent of total billed charges,,
Laparoscopic Cholecystectomy W Chol,,25001731,LOCAL,Facility,Both,,,,6120,5202,1753.992,6120,"Health Partners, Inc.",State Public Programs,3060,50,,percent of total billed charges,,
Laparoscopic Cholecystectomy W Chol,,25001731,LOCAL,Facility,Both,,,,6120,5202,1753.992,6120,Humana Insurance Company,Commercial PPO,5814,95,,percent of total billed charges,,
Laparoscopic Cholecystectomy W Chol,,25001731,LOCAL,Facility,Outpatient,,,,6120,5202,1753.992,6120,Humana Insurance Company,Medicare PPO,2998.8,49,,percent of total billed charges,,
Laparoscopic Cholecystectomy W Chol,,25001731,LOCAL,Facility,Inpatient,,,,6120,5202,1753.992,6120,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Laparoscopic Cholecystectomy W Chol,,25001731,LOCAL,Facility,Both,,,,6120,5202,1753.992,6120,Medica,Individual & Family,6064.92,99.1,,percent of total billed charges,,
Laparoscopic Cholecystectomy W Chol,,25001731,LOCAL,Facility,Outpatient,,,,6120,5202,1753.992,6120,Medica,Medica Advantage Solution,3047.76,49.8,,percent of total billed charges,,
Laparoscopic Cholecystectomy W Chol,,25001731,LOCAL,Facility,Inpatient,,,,6120,5202,1753.992,6120,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Laparoscopic Cholecystectomy W Chol,,25001731,LOCAL,Facility,Outpatient,,,,6120,5202,1753.992,6120,Medica,Medical Assistance,2729.52,44.6,,percent of total billed charges,,
Laparoscopic Cholecystectomy W Chol,,25001731,LOCAL,Facility,Inpatient,,,,6120,5202,1753.992,6120,Medica,Medical Assistance,,,,,Included in per diem rate,
Laparoscopic Cholecystectomy W Chol,,25001731,LOCAL,Facility,Outpatient,,,,6120,5202,1753.992,6120,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,3047.76,49.8,,percent of total billed charges,,
Laparoscopic Cholecystectomy W Chol,,25001731,LOCAL,Facility,Inpatient,,,,6120,5202,1753.992,6120,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Laparoscopic Cholecystectomy W Chol,,25001731,LOCAL,Facility,Both,,,,6120,5202,1753.992,6120,"Multiplan, Inc.","Multiplan, Inc.",5752.8,94,,percent of total billed charges,,
Laparoscopic Cholecystectomy W Chol,,25001731,LOCAL,Facility,Outpatient,,,,6120,5202,1753.992,6120,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,5514.12,90.1,,percent of total billed charges,,
Laparoscopic Cholecystectomy W Chol,,25001731,LOCAL,Facility,Inpatient,,,,6120,5202,1753.992,6120,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Laparoscopic Cholecystectomy W Chol,,25001731,LOCAL,Facility,Both,,,,6120,5202,1753.992,6120,"Preferred One Administrative Services, INC.",PPO,6034.32,98.6,,percent of total billed charges,,
Laparoscopic Cholecystectomy W Chol,,25001731,LOCAL,Facility,Outpatient,,,,6120,5202,1753.992,6120,PrimeWest Health,Minnesota Senior Health Options (MSHO),3148.74,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Laparoscopic Cholecystectomy W Chol,,25001731,LOCAL,Facility,Inpatient,,,,6120,5202,1753.992,6120,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Laparoscopic Cholecystectomy W Chol,,25001731,LOCAL,Facility,Outpatient,,,,6120,5202,1753.992,6120,PrimeWest Health,MinnesotaCare,3143.232,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Laparoscopic Cholecystectomy W Chol,,25001731,LOCAL,Facility,Inpatient,,,,6120,5202,1753.992,6120,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Laparoscopic Cholecystectomy W Chol,,25001731,LOCAL,Facility,Both,,,,6120,5202,1753.992,6120,Sanford Health Plan,Sanford Health Plan,5630.4,92,,percent of total billed charges,,
Laparoscopic Cholecystectomy W Chol,,25001731,LOCAL,Facility,Outpatient,,,,6120,5202,1753.992,6120,"UCare Health, Inc.",Individual & Family Plan,3448.62,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Laparoscopic Cholecystectomy W Chol,,25001731,LOCAL,Facility,Inpatient,,,,6120,5202,1753.992,6120,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Laparoscopic Cholecystectomy W Chol,,25001731,LOCAL,Facility,Outpatient,,,,6120,5202,1753.992,6120,"UCare Health, Inc.",Medical Assistance,3088.764,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Laparoscopic Cholecystectomy W Chol,,25001731,LOCAL,Facility,Inpatient,,,,6120,5202,1753.992,6120,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Laparoscopic Cholecystectomy W Chol,,25001731,LOCAL,Facility,Outpatient,,,,6120,5202,1753.992,6120,"UCare Health, Inc.",Medicare Advantage,3088.764,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Laparoscopic Cholecystectomy W Chol,,25001731,LOCAL,Facility,Inpatient,,,,6120,5202,1753.992,6120,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Laparoscopic Cholecystectomy W Chol,,25001731,LOCAL,Facility,Outpatient,,,,6120,5202,1753.992,6120,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),3088.764,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Laparoscopic Cholecystectomy W Chol,,25001731,LOCAL,Facility,Inpatient,,,,6120,5202,1753.992,6120,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Laparoscopic Cholecystectomy W Chol,,25001731,LOCAL,Facility,Both,,,,6120,5202,1753.992,6120,UnitedHealthcare,Individual & Family,5752.8,94,,percent of total billed charges,,
Laparoscopic Cholecystectomy W Chol,,25001731,LOCAL,Facility,Outpatient,,,,6120,5202,1753.992,6120,UnitedHealthcare,Medicare Advantage,2998.8,49,,percent of total billed charges,,
Laparoscopic Cholecystectomy W Chol,,25001731,LOCAL,Facility,Inpatient,,,,6120,5202,1753.992,6120,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Laparoscopic Cholecystectomy W Chol,,25001731,LOCAL,Facility,Outpatient,,,,6120,5202,1753.992,6120,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2937.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
Laparoscopic Cholecystectomy W Chol,,25001731,LOCAL,Facility,Inpatient,,,,6120,5202,1753.992,6120,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Laparoscopic Supracervical Hysterectomy,,25001792,LOCAL,Facility,Both,,,,4131,3511.35,1183.9446,4131,Aetna,Commercial,3800.52,92,,percent of total billed charges,,
Laparoscopic Supracervical Hysterectomy,,25001792,LOCAL,Facility,Outpatient,,,,4131,3511.35,1183.9446,4131,Aetna,Medicare Advantage,2024.19,49,,percent of total billed charges,,
Laparoscopic Supracervical Hysterectomy,,25001792,LOCAL,Facility,Inpatient,,,,4131,3511.35,1183.9446,4131,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Laparoscopic Supracervical Hysterectomy,,25001792,LOCAL,Facility,Both,,,,4131,3511.35,1183.9446,4131,Aetna,PPO,3841.83,93,,percent of total billed charges,,
Laparoscopic Supracervical Hysterectomy,,25001792,LOCAL,Facility,Both,,,,4131,3511.35,1183.9446,4131,America's PPO,America's PPO,3966.9993,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Laparoscopic Supracervical Hysterectomy,,25001792,LOCAL,Facility,Both,,,,4131,3511.35,1183.9446,4131,BlueCross BlueShield Minnesota, Federal Employee Program,4064.904,98.4,,percent of total billed charges,,
Laparoscopic Supracervical Hysterectomy,,25001792,LOCAL,Facility,Both,,,,4131,3511.35,1183.9446,4131,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,4131,100,,percent of total billed charges,,
Laparoscopic Supracervical Hysterectomy,,25001792,LOCAL,Facility,Both,,,,4131,3511.35,1183.9446,4131,BlueCross BlueShield Minnesota,High Value Network Plan,3717.9,90,,percent of total billed charges,,
Laparoscopic Supracervical Hysterectomy,,25001792,LOCAL,Facility,Outpatient,,,,4131,3511.35,1183.9446,4131,BlueCross BlueShield Minnesota,Medicare Advantage,2024.19,49,,percent of total billed charges,,
Laparoscopic Supracervical Hysterectomy,,25001792,LOCAL,Facility,Inpatient,,,,4131,3511.35,1183.9446,4131,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Laparoscopic Supracervical Hysterectomy,,25001792,LOCAL,Facility,Both,,,,4131,3511.35,1183.9446,4131,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,3658.8267,88.57,,percent of total billed charges,,
Laparoscopic Supracervical Hysterectomy,,25001792,LOCAL,Facility,Both,,,,4131,3511.35,1183.9446,4131,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1183.9446,28.66,,percent of total billed charges,,
Laparoscopic Supracervical Hysterectomy,,25001792,LOCAL,Facility,Outpatient,,,,4131,3511.35,1183.9446,4131,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2024.19,49,,percent of total billed charges,,
Laparoscopic Supracervical Hysterectomy,,25001792,LOCAL,Facility,Inpatient,,,,4131,3511.35,1183.9446,4131,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Laparoscopic Supracervical Hysterectomy,,25001792,LOCAL,Facility,Both,,,,4131,3511.35,1183.9446,4131,CorVel,Worker's Compensation,4131,100,,percent of total billed charges,,
Laparoscopic Supracervical Hysterectomy,,25001792,LOCAL,Facility,Both,,,,4131,3511.35,1183.9446,4131,First Health Group Corporation,First Health Network,4007.07,97,,percent of total billed charges,,
Laparoscopic Supracervical Hysterectomy,,25001792,LOCAL,Facility,Both,,,,4131,3511.35,1183.9446,4131,"Health Partners, Inc.",Commercial,3907.926,94.6,,percent of total billed charges,,
Laparoscopic Supracervical Hysterectomy,,25001792,LOCAL,Facility,Outpatient,,,,4131,3511.35,1183.9446,4131,"Health Partners, Inc.",Medicare Advantage,2024.19,49,,percent of total billed charges,,
Laparoscopic Supracervical Hysterectomy,,25001792,LOCAL,Facility,Inpatient,,,,4131,3511.35,1183.9446,4131,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Laparoscopic Supracervical Hysterectomy,,25001792,LOCAL,Facility,Both,,,,4131,3511.35,1183.9446,4131,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),2478.6,60,,percent of total billed charges,,
Laparoscopic Supracervical Hysterectomy,,25001792,LOCAL,Facility,Both,,,,4131,3511.35,1183.9446,4131,"Health Partners, Inc.",State of Minnesota Advantage Program,3366.765,81.5,,percent of total billed charges,,
Laparoscopic Supracervical Hysterectomy,,25001792,LOCAL,Facility,Both,,,,4131,3511.35,1183.9446,4131,"Health Partners, Inc.",State Public Programs,2065.5,50,,percent of total billed charges,,
Laparoscopic Supracervical Hysterectomy,,25001792,LOCAL,Facility,Both,,,,4131,3511.35,1183.9446,4131,Humana Insurance Company,Commercial PPO,3924.45,95,,percent of total billed charges,,
Laparoscopic Supracervical Hysterectomy,,25001792,LOCAL,Facility,Outpatient,,,,4131,3511.35,1183.9446,4131,Humana Insurance Company,Medicare PPO,2024.19,49,,percent of total billed charges,,
Laparoscopic Supracervical Hysterectomy,,25001792,LOCAL,Facility,Inpatient,,,,4131,3511.35,1183.9446,4131,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Laparoscopic Supracervical Hysterectomy,,25001792,LOCAL,Facility,Both,,,,4131,3511.35,1183.9446,4131,Medica,Individual & Family,4093.821,99.1,,percent of total billed charges,,
Laparoscopic Supracervical Hysterectomy,,25001792,LOCAL,Facility,Outpatient,,,,4131,3511.35,1183.9446,4131,Medica,Medica Advantage Solution,2057.238,49.8,,percent of total billed charges,,
Laparoscopic Supracervical Hysterectomy,,25001792,LOCAL,Facility,Inpatient,,,,4131,3511.35,1183.9446,4131,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Laparoscopic Supracervical Hysterectomy,,25001792,LOCAL,Facility,Outpatient,,,,4131,3511.35,1183.9446,4131,Medica,Medical Assistance,1842.426,44.6,,percent of total billed charges,,
Laparoscopic Supracervical Hysterectomy,,25001792,LOCAL,Facility,Inpatient,,,,4131,3511.35,1183.9446,4131,Medica,Medical Assistance,,,,,Included in per diem rate,
Laparoscopic Supracervical Hysterectomy,,25001792,LOCAL,Facility,Outpatient,,,,4131,3511.35,1183.9446,4131,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2057.238,49.8,,percent of total billed charges,,
Laparoscopic Supracervical Hysterectomy,,25001792,LOCAL,Facility,Inpatient,,,,4131,3511.35,1183.9446,4131,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Laparoscopic Supracervical Hysterectomy,,25001792,LOCAL,Facility,Both,,,,4131,3511.35,1183.9446,4131,"Multiplan, Inc.","Multiplan, Inc.",3883.14,94,,percent of total billed charges,,
Laparoscopic Supracervical Hysterectomy,,25001792,LOCAL,Facility,Outpatient,,,,4131,3511.35,1183.9446,4131,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,3722.031,90.1,,percent of total billed charges,,
Laparoscopic Supracervical Hysterectomy,,25001792,LOCAL,Facility,Inpatient,,,,4131,3511.35,1183.9446,4131,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Laparoscopic Supracervical Hysterectomy,,25001792,LOCAL,Facility,Both,,,,4131,3511.35,1183.9446,4131,"Preferred One Administrative Services, INC.",PPO,4073.166,98.6,,percent of total billed charges,,
Laparoscopic Supracervical Hysterectomy,,25001792,LOCAL,Facility,Outpatient,,,,4131,3511.35,1183.9446,4131,PrimeWest Health,Minnesota Senior Health Options (MSHO),2125.3995,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Laparoscopic Supracervical Hysterectomy,,25001792,LOCAL,Facility,Inpatient,,,,4131,3511.35,1183.9446,4131,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Laparoscopic Supracervical Hysterectomy,,25001792,LOCAL,Facility,Outpatient,,,,4131,3511.35,1183.9446,4131,PrimeWest Health,MinnesotaCare,2121.6816,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Laparoscopic Supracervical Hysterectomy,,25001792,LOCAL,Facility,Inpatient,,,,4131,3511.35,1183.9446,4131,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Laparoscopic Supracervical Hysterectomy,,25001792,LOCAL,Facility,Both,,,,4131,3511.35,1183.9446,4131,Sanford Health Plan,Sanford Health Plan,3800.52,92,,percent of total billed charges,,
Laparoscopic Supracervical Hysterectomy,,25001792,LOCAL,Facility,Outpatient,,,,4131,3511.35,1183.9446,4131,"UCare Health, Inc.",Individual & Family Plan,2327.8185,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Laparoscopic Supracervical Hysterectomy,,25001792,LOCAL,Facility,Inpatient,,,,4131,3511.35,1183.9446,4131,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Laparoscopic Supracervical Hysterectomy,,25001792,LOCAL,Facility,Outpatient,,,,4131,3511.35,1183.9446,4131,"UCare Health, Inc.",Medical Assistance,2084.9157,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Laparoscopic Supracervical Hysterectomy,,25001792,LOCAL,Facility,Inpatient,,,,4131,3511.35,1183.9446,4131,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Laparoscopic Supracervical Hysterectomy,,25001792,LOCAL,Facility,Outpatient,,,,4131,3511.35,1183.9446,4131,"UCare Health, Inc.",Medicare Advantage,2084.9157,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Laparoscopic Supracervical Hysterectomy,,25001792,LOCAL,Facility,Inpatient,,,,4131,3511.35,1183.9446,4131,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Laparoscopic Supracervical Hysterectomy,,25001792,LOCAL,Facility,Outpatient,,,,4131,3511.35,1183.9446,4131,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2084.9157,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Laparoscopic Supracervical Hysterectomy,,25001792,LOCAL,Facility,Inpatient,,,,4131,3511.35,1183.9446,4131,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Laparoscopic Supracervical Hysterectomy,,25001792,LOCAL,Facility,Both,,,,4131,3511.35,1183.9446,4131,UnitedHealthcare,Individual & Family,3883.14,94,,percent of total billed charges,,
Laparoscopic Supracervical Hysterectomy,,25001792,LOCAL,Facility,Outpatient,,,,4131,3511.35,1183.9446,4131,UnitedHealthcare,Medicare Advantage,2024.19,49,,percent of total billed charges,,
Laparoscopic Supracervical Hysterectomy,,25001792,LOCAL,Facility,Inpatient,,,,4131,3511.35,1183.9446,4131,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Laparoscopic Supracervical Hysterectomy,,25001792,LOCAL,Facility,Outpatient,,,,4131,3511.35,1183.9446,4131,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1982.88,48,,percent of total billed charges,,100% of DHS outpatient percentage
Laparoscopic Supracervical Hysterectomy,,25001792,LOCAL,Facility,Inpatient,,,,4131,3511.35,1183.9446,4131,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Laparoscopic Tubal Ligation,,25001823,LOCAL,Facility,Both,,,,4080,3468,1169.328,4080,Aetna,Commercial,3753.6,92,,percent of total billed charges,,
Laparoscopic Tubal Ligation,,25001823,LOCAL,Facility,Outpatient,,,,4080,3468,1169.328,4080,Aetna,Medicare Advantage,1999.2,49,,percent of total billed charges,,
Laparoscopic Tubal Ligation,,25001823,LOCAL,Facility,Inpatient,,,,4080,3468,1169.328,4080,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Laparoscopic Tubal Ligation,,25001823,LOCAL,Facility,Both,,,,4080,3468,1169.328,4080,Aetna,PPO,3794.4,93,,percent of total billed charges,,
Laparoscopic Tubal Ligation,,25001823,LOCAL,Facility,Both,,,,4080,3468,1169.328,4080,America's PPO,America's PPO,3918.024,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Laparoscopic Tubal Ligation,,25001823,LOCAL,Facility,Both,,,,4080,3468,1169.328,4080,BlueCross BlueShield Minnesota, Federal Employee Program,4014.72,98.4,,percent of total billed charges,,
Laparoscopic Tubal Ligation,,25001823,LOCAL,Facility,Both,,,,4080,3468,1169.328,4080,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,4080,100,,percent of total billed charges,,
Laparoscopic Tubal Ligation,,25001823,LOCAL,Facility,Both,,,,4080,3468,1169.328,4080,BlueCross BlueShield Minnesota,High Value Network Plan,3672,90,,percent of total billed charges,,
Laparoscopic Tubal Ligation,,25001823,LOCAL,Facility,Outpatient,,,,4080,3468,1169.328,4080,BlueCross BlueShield Minnesota,Medicare Advantage,1999.2,49,,percent of total billed charges,,
Laparoscopic Tubal Ligation,,25001823,LOCAL,Facility,Inpatient,,,,4080,3468,1169.328,4080,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Laparoscopic Tubal Ligation,,25001823,LOCAL,Facility,Both,,,,4080,3468,1169.328,4080,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,3613.656,88.57,,percent of total billed charges,,
Laparoscopic Tubal Ligation,,25001823,LOCAL,Facility,Both,,,,4080,3468,1169.328,4080,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1169.328,28.66,,percent of total billed charges,,
Laparoscopic Tubal Ligation,,25001823,LOCAL,Facility,Outpatient,,,,4080,3468,1169.328,4080,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1999.2,49,,percent of total billed charges,,
Laparoscopic Tubal Ligation,,25001823,LOCAL,Facility,Inpatient,,,,4080,3468,1169.328,4080,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Laparoscopic Tubal Ligation,,25001823,LOCAL,Facility,Both,,,,4080,3468,1169.328,4080,CorVel,Worker's Compensation,4080,100,,percent of total billed charges,,
Laparoscopic Tubal Ligation,,25001823,LOCAL,Facility,Both,,,,4080,3468,1169.328,4080,First Health Group Corporation,First Health Network,3957.6,97,,percent of total billed charges,,
Laparoscopic Tubal Ligation,,25001823,LOCAL,Facility,Both,,,,4080,3468,1169.328,4080,"Health Partners, Inc.",Commercial,3859.68,94.6,,percent of total billed charges,,
Laparoscopic Tubal Ligation,,25001823,LOCAL,Facility,Outpatient,,,,4080,3468,1169.328,4080,"Health Partners, Inc.",Medicare Advantage,1999.2,49,,percent of total billed charges,,
Laparoscopic Tubal Ligation,,25001823,LOCAL,Facility,Inpatient,,,,4080,3468,1169.328,4080,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Laparoscopic Tubal Ligation,,25001823,LOCAL,Facility,Both,,,,4080,3468,1169.328,4080,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),2448,60,,percent of total billed charges,,
Laparoscopic Tubal Ligation,,25001823,LOCAL,Facility,Both,,,,4080,3468,1169.328,4080,"Health Partners, Inc.",State of Minnesota Advantage Program,3325.2,81.5,,percent of total billed charges,,
Laparoscopic Tubal Ligation,,25001823,LOCAL,Facility,Both,,,,4080,3468,1169.328,4080,"Health Partners, Inc.",State Public Programs,2040,50,,percent of total billed charges,,
Laparoscopic Tubal Ligation,,25001823,LOCAL,Facility,Both,,,,4080,3468,1169.328,4080,Humana Insurance Company,Commercial PPO,3876,95,,percent of total billed charges,,
Laparoscopic Tubal Ligation,,25001823,LOCAL,Facility,Outpatient,,,,4080,3468,1169.328,4080,Humana Insurance Company,Medicare PPO,1999.2,49,,percent of total billed charges,,
Laparoscopic Tubal Ligation,,25001823,LOCAL,Facility,Inpatient,,,,4080,3468,1169.328,4080,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Laparoscopic Tubal Ligation,,25001823,LOCAL,Facility,Both,,,,4080,3468,1169.328,4080,Medica,Individual & Family,4043.28,99.1,,percent of total billed charges,,
Laparoscopic Tubal Ligation,,25001823,LOCAL,Facility,Outpatient,,,,4080,3468,1169.328,4080,Medica,Medica Advantage Solution,2031.84,49.8,,percent of total billed charges,,
Laparoscopic Tubal Ligation,,25001823,LOCAL,Facility,Inpatient,,,,4080,3468,1169.328,4080,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Laparoscopic Tubal Ligation,,25001823,LOCAL,Facility,Outpatient,,,,4080,3468,1169.328,4080,Medica,Medical Assistance,1819.68,44.6,,percent of total billed charges,,
Laparoscopic Tubal Ligation,,25001823,LOCAL,Facility,Inpatient,,,,4080,3468,1169.328,4080,Medica,Medical Assistance,,,,,Included in per diem rate,
Laparoscopic Tubal Ligation,,25001823,LOCAL,Facility,Outpatient,,,,4080,3468,1169.328,4080,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2031.84,49.8,,percent of total billed charges,,
Laparoscopic Tubal Ligation,,25001823,LOCAL,Facility,Inpatient,,,,4080,3468,1169.328,4080,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Laparoscopic Tubal Ligation,,25001823,LOCAL,Facility,Both,,,,4080,3468,1169.328,4080,"Multiplan, Inc.","Multiplan, Inc.",3835.2,94,,percent of total billed charges,,
Laparoscopic Tubal Ligation,,25001823,LOCAL,Facility,Outpatient,,,,4080,3468,1169.328,4080,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,3676.08,90.1,,percent of total billed charges,,
Laparoscopic Tubal Ligation,,25001823,LOCAL,Facility,Inpatient,,,,4080,3468,1169.328,4080,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Laparoscopic Tubal Ligation,,25001823,LOCAL,Facility,Both,,,,4080,3468,1169.328,4080,"Preferred One Administrative Services, INC.",PPO,4022.88,98.6,,percent of total billed charges,,
Laparoscopic Tubal Ligation,,25001823,LOCAL,Facility,Outpatient,,,,4080,3468,1169.328,4080,PrimeWest Health,Minnesota Senior Health Options (MSHO),2099.16,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Laparoscopic Tubal Ligation,,25001823,LOCAL,Facility,Inpatient,,,,4080,3468,1169.328,4080,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Laparoscopic Tubal Ligation,,25001823,LOCAL,Facility,Outpatient,,,,4080,3468,1169.328,4080,PrimeWest Health,MinnesotaCare,2095.488,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Laparoscopic Tubal Ligation,,25001823,LOCAL,Facility,Inpatient,,,,4080,3468,1169.328,4080,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Laparoscopic Tubal Ligation,,25001823,LOCAL,Facility,Both,,,,4080,3468,1169.328,4080,Sanford Health Plan,Sanford Health Plan,3753.6,92,,percent of total billed charges,,
Laparoscopic Tubal Ligation,,25001823,LOCAL,Facility,Outpatient,,,,4080,3468,1169.328,4080,"UCare Health, Inc.",Individual & Family Plan,2299.08,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Laparoscopic Tubal Ligation,,25001823,LOCAL,Facility,Inpatient,,,,4080,3468,1169.328,4080,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Laparoscopic Tubal Ligation,,25001823,LOCAL,Facility,Outpatient,,,,4080,3468,1169.328,4080,"UCare Health, Inc.",Medical Assistance,2059.176,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Laparoscopic Tubal Ligation,,25001823,LOCAL,Facility,Inpatient,,,,4080,3468,1169.328,4080,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Laparoscopic Tubal Ligation,,25001823,LOCAL,Facility,Outpatient,,,,4080,3468,1169.328,4080,"UCare Health, Inc.",Medicare Advantage,2059.176,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Laparoscopic Tubal Ligation,,25001823,LOCAL,Facility,Inpatient,,,,4080,3468,1169.328,4080,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Laparoscopic Tubal Ligation,,25001823,LOCAL,Facility,Outpatient,,,,4080,3468,1169.328,4080,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2059.176,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Laparoscopic Tubal Ligation,,25001823,LOCAL,Facility,Inpatient,,,,4080,3468,1169.328,4080,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Laparoscopic Tubal Ligation,,25001823,LOCAL,Facility,Both,,,,4080,3468,1169.328,4080,UnitedHealthcare,Individual & Family,3835.2,94,,percent of total billed charges,,
Laparoscopic Tubal Ligation,,25001823,LOCAL,Facility,Outpatient,,,,4080,3468,1169.328,4080,UnitedHealthcare,Medicare Advantage,1999.2,49,,percent of total billed charges,,
Laparoscopic Tubal Ligation,,25001823,LOCAL,Facility,Inpatient,,,,4080,3468,1169.328,4080,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Laparoscopic Tubal Ligation,,25001823,LOCAL,Facility,Outpatient,,,,4080,3468,1169.328,4080,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1958.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
Laparoscopic Tubal Ligation,,25001823,LOCAL,Facility,Inpatient,,,,4080,3468,1169.328,4080,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Laparoscopic Ventral Hernia Repair,,25001838,LOCAL,Facility,Both,,,,4464,3794.4,1279.3824,4464,Aetna,Commercial,4106.88,92,,percent of total billed charges,,
Laparoscopic Ventral Hernia Repair,,25001838,LOCAL,Facility,Outpatient,,,,4464,3794.4,1279.3824,4464,Aetna,Medicare Advantage,2187.36,49,,percent of total billed charges,,
Laparoscopic Ventral Hernia Repair,,25001838,LOCAL,Facility,Inpatient,,,,4464,3794.4,1279.3824,4464,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Laparoscopic Ventral Hernia Repair,,25001838,LOCAL,Facility,Both,,,,4464,3794.4,1279.3824,4464,Aetna,PPO,4151.52,93,,percent of total billed charges,,
Laparoscopic Ventral Hernia Repair,,25001838,LOCAL,Facility,Both,,,,4464,3794.4,1279.3824,4464,America's PPO,America's PPO,4286.7792,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Laparoscopic Ventral Hernia Repair,,25001838,LOCAL,Facility,Both,,,,4464,3794.4,1279.3824,4464,BlueCross BlueShield Minnesota, Federal Employee Program,4392.576,98.4,,percent of total billed charges,,
Laparoscopic Ventral Hernia Repair,,25001838,LOCAL,Facility,Both,,,,4464,3794.4,1279.3824,4464,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,4464,100,,percent of total billed charges,,
Laparoscopic Ventral Hernia Repair,,25001838,LOCAL,Facility,Both,,,,4464,3794.4,1279.3824,4464,BlueCross BlueShield Minnesota,High Value Network Plan,4017.6,90,,percent of total billed charges,,
Laparoscopic Ventral Hernia Repair,,25001838,LOCAL,Facility,Outpatient,,,,4464,3794.4,1279.3824,4464,BlueCross BlueShield Minnesota,Medicare Advantage,2187.36,49,,percent of total billed charges,,
Laparoscopic Ventral Hernia Repair,,25001838,LOCAL,Facility,Inpatient,,,,4464,3794.4,1279.3824,4464,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Laparoscopic Ventral Hernia Repair,,25001838,LOCAL,Facility,Both,,,,4464,3794.4,1279.3824,4464,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,3953.7648,88.57,,percent of total billed charges,,
Laparoscopic Ventral Hernia Repair,,25001838,LOCAL,Facility,Both,,,,4464,3794.4,1279.3824,4464,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1279.3824,28.66,,percent of total billed charges,,
Laparoscopic Ventral Hernia Repair,,25001838,LOCAL,Facility,Outpatient,,,,4464,3794.4,1279.3824,4464,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2187.36,49,,percent of total billed charges,,
Laparoscopic Ventral Hernia Repair,,25001838,LOCAL,Facility,Inpatient,,,,4464,3794.4,1279.3824,4464,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Laparoscopic Ventral Hernia Repair,,25001838,LOCAL,Facility,Both,,,,4464,3794.4,1279.3824,4464,CorVel,Worker's Compensation,4464,100,,percent of total billed charges,,
Laparoscopic Ventral Hernia Repair,,25001838,LOCAL,Facility,Both,,,,4464,3794.4,1279.3824,4464,First Health Group Corporation,First Health Network,4330.08,97,,percent of total billed charges,,
Laparoscopic Ventral Hernia Repair,,25001838,LOCAL,Facility,Both,,,,4464,3794.4,1279.3824,4464,"Health Partners, Inc.",Commercial,4222.944,94.6,,percent of total billed charges,,
Laparoscopic Ventral Hernia Repair,,25001838,LOCAL,Facility,Outpatient,,,,4464,3794.4,1279.3824,4464,"Health Partners, Inc.",Medicare Advantage,2187.36,49,,percent of total billed charges,,
Laparoscopic Ventral Hernia Repair,,25001838,LOCAL,Facility,Inpatient,,,,4464,3794.4,1279.3824,4464,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Laparoscopic Ventral Hernia Repair,,25001838,LOCAL,Facility,Both,,,,4464,3794.4,1279.3824,4464,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),2678.4,60,,percent of total billed charges,,
Laparoscopic Ventral Hernia Repair,,25001838,LOCAL,Facility,Both,,,,4464,3794.4,1279.3824,4464,"Health Partners, Inc.",State of Minnesota Advantage Program,3638.16,81.5,,percent of total billed charges,,
Laparoscopic Ventral Hernia Repair,,25001838,LOCAL,Facility,Both,,,,4464,3794.4,1279.3824,4464,"Health Partners, Inc.",State Public Programs,2232,50,,percent of total billed charges,,
Laparoscopic Ventral Hernia Repair,,25001838,LOCAL,Facility,Both,,,,4464,3794.4,1279.3824,4464,Humana Insurance Company,Commercial PPO,4240.8,95,,percent of total billed charges,,
Laparoscopic Ventral Hernia Repair,,25001838,LOCAL,Facility,Outpatient,,,,4464,3794.4,1279.3824,4464,Humana Insurance Company,Medicare PPO,2187.36,49,,percent of total billed charges,,
Laparoscopic Ventral Hernia Repair,,25001838,LOCAL,Facility,Inpatient,,,,4464,3794.4,1279.3824,4464,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Laparoscopic Ventral Hernia Repair,,25001838,LOCAL,Facility,Both,,,,4464,3794.4,1279.3824,4464,Medica,Individual & Family,4423.824,99.1,,percent of total billed charges,,
Laparoscopic Ventral Hernia Repair,,25001838,LOCAL,Facility,Outpatient,,,,4464,3794.4,1279.3824,4464,Medica,Medica Advantage Solution,2223.072,49.8,,percent of total billed charges,,
Laparoscopic Ventral Hernia Repair,,25001838,LOCAL,Facility,Inpatient,,,,4464,3794.4,1279.3824,4464,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Laparoscopic Ventral Hernia Repair,,25001838,LOCAL,Facility,Outpatient,,,,4464,3794.4,1279.3824,4464,Medica,Medical Assistance,1990.944,44.6,,percent of total billed charges,,
Laparoscopic Ventral Hernia Repair,,25001838,LOCAL,Facility,Inpatient,,,,4464,3794.4,1279.3824,4464,Medica,Medical Assistance,,,,,Included in per diem rate,
Laparoscopic Ventral Hernia Repair,,25001838,LOCAL,Facility,Outpatient,,,,4464,3794.4,1279.3824,4464,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2223.072,49.8,,percent of total billed charges,,
Laparoscopic Ventral Hernia Repair,,25001838,LOCAL,Facility,Inpatient,,,,4464,3794.4,1279.3824,4464,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Laparoscopic Ventral Hernia Repair,,25001838,LOCAL,Facility,Both,,,,4464,3794.4,1279.3824,4464,"Multiplan, Inc.","Multiplan, Inc.",4196.16,94,,percent of total billed charges,,
Laparoscopic Ventral Hernia Repair,,25001838,LOCAL,Facility,Outpatient,,,,4464,3794.4,1279.3824,4464,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4022.064,90.1,,percent of total billed charges,,
Laparoscopic Ventral Hernia Repair,,25001838,LOCAL,Facility,Inpatient,,,,4464,3794.4,1279.3824,4464,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Laparoscopic Ventral Hernia Repair,,25001838,LOCAL,Facility,Both,,,,4464,3794.4,1279.3824,4464,"Preferred One Administrative Services, INC.",PPO,4401.504,98.6,,percent of total billed charges,,
Laparoscopic Ventral Hernia Repair,,25001838,LOCAL,Facility,Outpatient,,,,4464,3794.4,1279.3824,4464,PrimeWest Health,Minnesota Senior Health Options (MSHO),2296.728,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Laparoscopic Ventral Hernia Repair,,25001838,LOCAL,Facility,Inpatient,,,,4464,3794.4,1279.3824,4464,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Laparoscopic Ventral Hernia Repair,,25001838,LOCAL,Facility,Outpatient,,,,4464,3794.4,1279.3824,4464,PrimeWest Health,MinnesotaCare,2292.7104,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Laparoscopic Ventral Hernia Repair,,25001838,LOCAL,Facility,Inpatient,,,,4464,3794.4,1279.3824,4464,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Laparoscopic Ventral Hernia Repair,,25001838,LOCAL,Facility,Both,,,,4464,3794.4,1279.3824,4464,Sanford Health Plan,Sanford Health Plan,4106.88,92,,percent of total billed charges,,
Laparoscopic Ventral Hernia Repair,,25001838,LOCAL,Facility,Outpatient,,,,4464,3794.4,1279.3824,4464,"UCare Health, Inc.",Individual & Family Plan,2515.464,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Laparoscopic Ventral Hernia Repair,,25001838,LOCAL,Facility,Inpatient,,,,4464,3794.4,1279.3824,4464,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Laparoscopic Ventral Hernia Repair,,25001838,LOCAL,Facility,Outpatient,,,,4464,3794.4,1279.3824,4464,"UCare Health, Inc.",Medical Assistance,2252.9808,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Laparoscopic Ventral Hernia Repair,,25001838,LOCAL,Facility,Inpatient,,,,4464,3794.4,1279.3824,4464,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Laparoscopic Ventral Hernia Repair,,25001838,LOCAL,Facility,Outpatient,,,,4464,3794.4,1279.3824,4464,"UCare Health, Inc.",Medicare Advantage,2252.9808,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Laparoscopic Ventral Hernia Repair,,25001838,LOCAL,Facility,Inpatient,,,,4464,3794.4,1279.3824,4464,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Laparoscopic Ventral Hernia Repair,,25001838,LOCAL,Facility,Outpatient,,,,4464,3794.4,1279.3824,4464,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2252.9808,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Laparoscopic Ventral Hernia Repair,,25001838,LOCAL,Facility,Inpatient,,,,4464,3794.4,1279.3824,4464,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Laparoscopic Ventral Hernia Repair,,25001838,LOCAL,Facility,Both,,,,4464,3794.4,1279.3824,4464,UnitedHealthcare,Individual & Family,4196.16,94,,percent of total billed charges,,
Laparoscopic Ventral Hernia Repair,,25001838,LOCAL,Facility,Outpatient,,,,4464,3794.4,1279.3824,4464,UnitedHealthcare,Medicare Advantage,2187.36,49,,percent of total billed charges,,
Laparoscopic Ventral Hernia Repair,,25001838,LOCAL,Facility,Inpatient,,,,4464,3794.4,1279.3824,4464,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Laparoscopic Ventral Hernia Repair,,25001838,LOCAL,Facility,Outpatient,,,,4464,3794.4,1279.3824,4464,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2142.72,48,,percent of total billed charges,,100% of DHS outpatient percentage
Laparoscopic Ventral Hernia Repair,,25001838,LOCAL,Facility,Inpatient,,,,4464,3794.4,1279.3824,4464,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Laparoscopy Diagnostic,,25001844,LOCAL,Facility,Both,,,,4692,3988.2,1344.7272,4692,Aetna,Commercial,4316.64,92,,percent of total billed charges,,
Laparoscopy Diagnostic,,25001844,LOCAL,Facility,Outpatient,,,,4692,3988.2,1344.7272,4692,Aetna,Medicare Advantage,2299.08,49,,percent of total billed charges,,
Laparoscopy Diagnostic,,25001844,LOCAL,Facility,Inpatient,,,,4692,3988.2,1344.7272,4692,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Laparoscopy Diagnostic,,25001844,LOCAL,Facility,Both,,,,4692,3988.2,1344.7272,4692,Aetna,PPO,4363.56,93,,percent of total billed charges,,
Laparoscopy Diagnostic,,25001844,LOCAL,Facility,Both,,,,4692,3988.2,1344.7272,4692,America's PPO,America's PPO,4505.7276,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Laparoscopy Diagnostic,,25001844,LOCAL,Facility,Both,,,,4692,3988.2,1344.7272,4692,BlueCross BlueShield Minnesota, Federal Employee Program,4616.928,98.4,,percent of total billed charges,,
Laparoscopy Diagnostic,,25001844,LOCAL,Facility,Both,,,,4692,3988.2,1344.7272,4692,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,4692,100,,percent of total billed charges,,
Laparoscopy Diagnostic,,25001844,LOCAL,Facility,Both,,,,4692,3988.2,1344.7272,4692,BlueCross BlueShield Minnesota,High Value Network Plan,4222.8,90,,percent of total billed charges,,
Laparoscopy Diagnostic,,25001844,LOCAL,Facility,Outpatient,,,,4692,3988.2,1344.7272,4692,BlueCross BlueShield Minnesota,Medicare Advantage,2299.08,49,,percent of total billed charges,,
Laparoscopy Diagnostic,,25001844,LOCAL,Facility,Inpatient,,,,4692,3988.2,1344.7272,4692,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Laparoscopy Diagnostic,,25001844,LOCAL,Facility,Both,,,,4692,3988.2,1344.7272,4692,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4155.7044,88.57,,percent of total billed charges,,
Laparoscopy Diagnostic,,25001844,LOCAL,Facility,Both,,,,4692,3988.2,1344.7272,4692,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1344.7272,28.66,,percent of total billed charges,,
Laparoscopy Diagnostic,,25001844,LOCAL,Facility,Outpatient,,,,4692,3988.2,1344.7272,4692,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2299.08,49,,percent of total billed charges,,
Laparoscopy Diagnostic,,25001844,LOCAL,Facility,Inpatient,,,,4692,3988.2,1344.7272,4692,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Laparoscopy Diagnostic,,25001844,LOCAL,Facility,Both,,,,4692,3988.2,1344.7272,4692,CorVel,Worker's Compensation,4692,100,,percent of total billed charges,,
Laparoscopy Diagnostic,,25001844,LOCAL,Facility,Both,,,,4692,3988.2,1344.7272,4692,First Health Group Corporation,First Health Network,4551.24,97,,percent of total billed charges,,
Laparoscopy Diagnostic,,25001844,LOCAL,Facility,Both,,,,4692,3988.2,1344.7272,4692,"Health Partners, Inc.",Commercial,4438.632,94.6,,percent of total billed charges,,
Laparoscopy Diagnostic,,25001844,LOCAL,Facility,Outpatient,,,,4692,3988.2,1344.7272,4692,"Health Partners, Inc.",Medicare Advantage,2299.08,49,,percent of total billed charges,,
Laparoscopy Diagnostic,,25001844,LOCAL,Facility,Inpatient,,,,4692,3988.2,1344.7272,4692,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Laparoscopy Diagnostic,,25001844,LOCAL,Facility,Both,,,,4692,3988.2,1344.7272,4692,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),2815.2,60,,percent of total billed charges,,
Laparoscopy Diagnostic,,25001844,LOCAL,Facility,Both,,,,4692,3988.2,1344.7272,4692,"Health Partners, Inc.",State of Minnesota Advantage Program,3823.98,81.5,,percent of total billed charges,,
Laparoscopy Diagnostic,,25001844,LOCAL,Facility,Both,,,,4692,3988.2,1344.7272,4692,"Health Partners, Inc.",State Public Programs,2346,50,,percent of total billed charges,,
Laparoscopy Diagnostic,,25001844,LOCAL,Facility,Both,,,,4692,3988.2,1344.7272,4692,Humana Insurance Company,Commercial PPO,4457.4,95,,percent of total billed charges,,
Laparoscopy Diagnostic,,25001844,LOCAL,Facility,Outpatient,,,,4692,3988.2,1344.7272,4692,Humana Insurance Company,Medicare PPO,2299.08,49,,percent of total billed charges,,
Laparoscopy Diagnostic,,25001844,LOCAL,Facility,Inpatient,,,,4692,3988.2,1344.7272,4692,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Laparoscopy Diagnostic,,25001844,LOCAL,Facility,Both,,,,4692,3988.2,1344.7272,4692,Medica,Individual & Family,4649.772,99.1,,percent of total billed charges,,
Laparoscopy Diagnostic,,25001844,LOCAL,Facility,Outpatient,,,,4692,3988.2,1344.7272,4692,Medica,Medica Advantage Solution,2336.616,49.8,,percent of total billed charges,,
Laparoscopy Diagnostic,,25001844,LOCAL,Facility,Inpatient,,,,4692,3988.2,1344.7272,4692,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Laparoscopy Diagnostic,,25001844,LOCAL,Facility,Outpatient,,,,4692,3988.2,1344.7272,4692,Medica,Medical Assistance,2092.632,44.6,,percent of total billed charges,,
Laparoscopy Diagnostic,,25001844,LOCAL,Facility,Inpatient,,,,4692,3988.2,1344.7272,4692,Medica,Medical Assistance,,,,,Included in per diem rate,
Laparoscopy Diagnostic,,25001844,LOCAL,Facility,Outpatient,,,,4692,3988.2,1344.7272,4692,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2336.616,49.8,,percent of total billed charges,,
Laparoscopy Diagnostic,,25001844,LOCAL,Facility,Inpatient,,,,4692,3988.2,1344.7272,4692,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Laparoscopy Diagnostic,,25001844,LOCAL,Facility,Both,,,,4692,3988.2,1344.7272,4692,"Multiplan, Inc.","Multiplan, Inc.",4410.48,94,,percent of total billed charges,,
Laparoscopy Diagnostic,,25001844,LOCAL,Facility,Outpatient,,,,4692,3988.2,1344.7272,4692,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4227.492,90.1,,percent of total billed charges,,
Laparoscopy Diagnostic,,25001844,LOCAL,Facility,Inpatient,,,,4692,3988.2,1344.7272,4692,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Laparoscopy Diagnostic,,25001844,LOCAL,Facility,Both,,,,4692,3988.2,1344.7272,4692,"Preferred One Administrative Services, INC.",PPO,4626.312,98.6,,percent of total billed charges,,
Laparoscopy Diagnostic,,25001844,LOCAL,Facility,Outpatient,,,,4692,3988.2,1344.7272,4692,PrimeWest Health,Minnesota Senior Health Options (MSHO),2414.034,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Laparoscopy Diagnostic,,25001844,LOCAL,Facility,Inpatient,,,,4692,3988.2,1344.7272,4692,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Laparoscopy Diagnostic,,25001844,LOCAL,Facility,Outpatient,,,,4692,3988.2,1344.7272,4692,PrimeWest Health,MinnesotaCare,2409.8112,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Laparoscopy Diagnostic,,25001844,LOCAL,Facility,Inpatient,,,,4692,3988.2,1344.7272,4692,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Laparoscopy Diagnostic,,25001844,LOCAL,Facility,Both,,,,4692,3988.2,1344.7272,4692,Sanford Health Plan,Sanford Health Plan,4316.64,92,,percent of total billed charges,,
Laparoscopy Diagnostic,,25001844,LOCAL,Facility,Outpatient,,,,4692,3988.2,1344.7272,4692,"UCare Health, Inc.",Individual & Family Plan,2643.942,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Laparoscopy Diagnostic,,25001844,LOCAL,Facility,Inpatient,,,,4692,3988.2,1344.7272,4692,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Laparoscopy Diagnostic,,25001844,LOCAL,Facility,Outpatient,,,,4692,3988.2,1344.7272,4692,"UCare Health, Inc.",Medical Assistance,2368.0524,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Laparoscopy Diagnostic,,25001844,LOCAL,Facility,Inpatient,,,,4692,3988.2,1344.7272,4692,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Laparoscopy Diagnostic,,25001844,LOCAL,Facility,Outpatient,,,,4692,3988.2,1344.7272,4692,"UCare Health, Inc.",Medicare Advantage,2368.0524,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Laparoscopy Diagnostic,,25001844,LOCAL,Facility,Inpatient,,,,4692,3988.2,1344.7272,4692,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Laparoscopy Diagnostic,,25001844,LOCAL,Facility,Outpatient,,,,4692,3988.2,1344.7272,4692,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2368.0524,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Laparoscopy Diagnostic,,25001844,LOCAL,Facility,Inpatient,,,,4692,3988.2,1344.7272,4692,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Laparoscopy Diagnostic,,25001844,LOCAL,Facility,Both,,,,4692,3988.2,1344.7272,4692,UnitedHealthcare,Individual & Family,4410.48,94,,percent of total billed charges,,
Laparoscopy Diagnostic,,25001844,LOCAL,Facility,Outpatient,,,,4692,3988.2,1344.7272,4692,UnitedHealthcare,Medicare Advantage,2299.08,49,,percent of total billed charges,,
Laparoscopy Diagnostic,,25001844,LOCAL,Facility,Inpatient,,,,4692,3988.2,1344.7272,4692,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Laparoscopy Diagnostic,,25001844,LOCAL,Facility,Outpatient,,,,4692,3988.2,1344.7272,4692,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2252.16,48,,percent of total billed charges,,100% of DHS outpatient percentage
Laparoscopy Diagnostic,,25001844,LOCAL,Facility,Inpatient,,,,4692,3988.2,1344.7272,4692,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Laparoscopy Oviduct Ovary Unlisted,,25001851,LOCAL,Facility,Both,,,,4182,3554.7,1198.5612,4182,Aetna,Commercial,3847.44,92,,percent of total billed charges,,
Laparoscopy Oviduct Ovary Unlisted,,25001851,LOCAL,Facility,Outpatient,,,,4182,3554.7,1198.5612,4182,Aetna,Medicare Advantage,2049.18,49,,percent of total billed charges,,
Laparoscopy Oviduct Ovary Unlisted,,25001851,LOCAL,Facility,Inpatient,,,,4182,3554.7,1198.5612,4182,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Laparoscopy Oviduct Ovary Unlisted,,25001851,LOCAL,Facility,Both,,,,4182,3554.7,1198.5612,4182,Aetna,PPO,3889.26,93,,percent of total billed charges,,
Laparoscopy Oviduct Ovary Unlisted,,25001851,LOCAL,Facility,Both,,,,4182,3554.7,1198.5612,4182,America's PPO,America's PPO,4015.9746,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Laparoscopy Oviduct Ovary Unlisted,,25001851,LOCAL,Facility,Both,,,,4182,3554.7,1198.5612,4182,BlueCross BlueShield Minnesota, Federal Employee Program,4115.088,98.4,,percent of total billed charges,,
Laparoscopy Oviduct Ovary Unlisted,,25001851,LOCAL,Facility,Both,,,,4182,3554.7,1198.5612,4182,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,4182,100,,percent of total billed charges,,
Laparoscopy Oviduct Ovary Unlisted,,25001851,LOCAL,Facility,Both,,,,4182,3554.7,1198.5612,4182,BlueCross BlueShield Minnesota,High Value Network Plan,3763.8,90,,percent of total billed charges,,
Laparoscopy Oviduct Ovary Unlisted,,25001851,LOCAL,Facility,Outpatient,,,,4182,3554.7,1198.5612,4182,BlueCross BlueShield Minnesota,Medicare Advantage,2049.18,49,,percent of total billed charges,,
Laparoscopy Oviduct Ovary Unlisted,,25001851,LOCAL,Facility,Inpatient,,,,4182,3554.7,1198.5612,4182,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Laparoscopy Oviduct Ovary Unlisted,,25001851,LOCAL,Facility,Both,,,,4182,3554.7,1198.5612,4182,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,3703.9974,88.57,,percent of total billed charges,,
Laparoscopy Oviduct Ovary Unlisted,,25001851,LOCAL,Facility,Both,,,,4182,3554.7,1198.5612,4182,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1198.5612,28.66,,percent of total billed charges,,
Laparoscopy Oviduct Ovary Unlisted,,25001851,LOCAL,Facility,Outpatient,,,,4182,3554.7,1198.5612,4182,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2049.18,49,,percent of total billed charges,,
Laparoscopy Oviduct Ovary Unlisted,,25001851,LOCAL,Facility,Inpatient,,,,4182,3554.7,1198.5612,4182,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Laparoscopy Oviduct Ovary Unlisted,,25001851,LOCAL,Facility,Both,,,,4182,3554.7,1198.5612,4182,CorVel,Worker's Compensation,4182,100,,percent of total billed charges,,
Laparoscopy Oviduct Ovary Unlisted,,25001851,LOCAL,Facility,Both,,,,4182,3554.7,1198.5612,4182,First Health Group Corporation,First Health Network,4056.54,97,,percent of total billed charges,,
Laparoscopy Oviduct Ovary Unlisted,,25001851,LOCAL,Facility,Both,,,,4182,3554.7,1198.5612,4182,"Health Partners, Inc.",Commercial,3956.172,94.6,,percent of total billed charges,,
Laparoscopy Oviduct Ovary Unlisted,,25001851,LOCAL,Facility,Outpatient,,,,4182,3554.7,1198.5612,4182,"Health Partners, Inc.",Medicare Advantage,2049.18,49,,percent of total billed charges,,
Laparoscopy Oviduct Ovary Unlisted,,25001851,LOCAL,Facility,Inpatient,,,,4182,3554.7,1198.5612,4182,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Laparoscopy Oviduct Ovary Unlisted,,25001851,LOCAL,Facility,Both,,,,4182,3554.7,1198.5612,4182,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),2509.2,60,,percent of total billed charges,,
Laparoscopy Oviduct Ovary Unlisted,,25001851,LOCAL,Facility,Both,,,,4182,3554.7,1198.5612,4182,"Health Partners, Inc.",State of Minnesota Advantage Program,3408.33,81.5,,percent of total billed charges,,
Laparoscopy Oviduct Ovary Unlisted,,25001851,LOCAL,Facility,Both,,,,4182,3554.7,1198.5612,4182,"Health Partners, Inc.",State Public Programs,2091,50,,percent of total billed charges,,
Laparoscopy Oviduct Ovary Unlisted,,25001851,LOCAL,Facility,Both,,,,4182,3554.7,1198.5612,4182,Humana Insurance Company,Commercial PPO,3972.9,95,,percent of total billed charges,,
Laparoscopy Oviduct Ovary Unlisted,,25001851,LOCAL,Facility,Outpatient,,,,4182,3554.7,1198.5612,4182,Humana Insurance Company,Medicare PPO,2049.18,49,,percent of total billed charges,,
Laparoscopy Oviduct Ovary Unlisted,,25001851,LOCAL,Facility,Inpatient,,,,4182,3554.7,1198.5612,4182,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Laparoscopy Oviduct Ovary Unlisted,,25001851,LOCAL,Facility,Both,,,,4182,3554.7,1198.5612,4182,Medica,Individual & Family,4144.362,99.1,,percent of total billed charges,,
Laparoscopy Oviduct Ovary Unlisted,,25001851,LOCAL,Facility,Outpatient,,,,4182,3554.7,1198.5612,4182,Medica,Medica Advantage Solution,2082.636,49.8,,percent of total billed charges,,
Laparoscopy Oviduct Ovary Unlisted,,25001851,LOCAL,Facility,Inpatient,,,,4182,3554.7,1198.5612,4182,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Laparoscopy Oviduct Ovary Unlisted,,25001851,LOCAL,Facility,Outpatient,,,,4182,3554.7,1198.5612,4182,Medica,Medical Assistance,1865.172,44.6,,percent of total billed charges,,
Laparoscopy Oviduct Ovary Unlisted,,25001851,LOCAL,Facility,Inpatient,,,,4182,3554.7,1198.5612,4182,Medica,Medical Assistance,,,,,Included in per diem rate,
Laparoscopy Oviduct Ovary Unlisted,,25001851,LOCAL,Facility,Outpatient,,,,4182,3554.7,1198.5612,4182,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2082.636,49.8,,percent of total billed charges,,
Laparoscopy Oviduct Ovary Unlisted,,25001851,LOCAL,Facility,Inpatient,,,,4182,3554.7,1198.5612,4182,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Laparoscopy Oviduct Ovary Unlisted,,25001851,LOCAL,Facility,Both,,,,4182,3554.7,1198.5612,4182,"Multiplan, Inc.","Multiplan, Inc.",3931.08,94,,percent of total billed charges,,
Laparoscopy Oviduct Ovary Unlisted,,25001851,LOCAL,Facility,Outpatient,,,,4182,3554.7,1198.5612,4182,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,3767.982,90.1,,percent of total billed charges,,
Laparoscopy Oviduct Ovary Unlisted,,25001851,LOCAL,Facility,Inpatient,,,,4182,3554.7,1198.5612,4182,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Laparoscopy Oviduct Ovary Unlisted,,25001851,LOCAL,Facility,Both,,,,4182,3554.7,1198.5612,4182,"Preferred One Administrative Services, INC.",PPO,4123.452,98.6,,percent of total billed charges,,
Laparoscopy Oviduct Ovary Unlisted,,25001851,LOCAL,Facility,Outpatient,,,,4182,3554.7,1198.5612,4182,PrimeWest Health,Minnesota Senior Health Options (MSHO),2151.639,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Laparoscopy Oviduct Ovary Unlisted,,25001851,LOCAL,Facility,Inpatient,,,,4182,3554.7,1198.5612,4182,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Laparoscopy Oviduct Ovary Unlisted,,25001851,LOCAL,Facility,Outpatient,,,,4182,3554.7,1198.5612,4182,PrimeWest Health,MinnesotaCare,2147.8752,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Laparoscopy Oviduct Ovary Unlisted,,25001851,LOCAL,Facility,Inpatient,,,,4182,3554.7,1198.5612,4182,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Laparoscopy Oviduct Ovary Unlisted,,25001851,LOCAL,Facility,Both,,,,4182,3554.7,1198.5612,4182,Sanford Health Plan,Sanford Health Plan,3847.44,92,,percent of total billed charges,,
Laparoscopy Oviduct Ovary Unlisted,,25001851,LOCAL,Facility,Outpatient,,,,4182,3554.7,1198.5612,4182,"UCare Health, Inc.",Individual & Family Plan,2356.557,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Laparoscopy Oviduct Ovary Unlisted,,25001851,LOCAL,Facility,Inpatient,,,,4182,3554.7,1198.5612,4182,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Laparoscopy Oviduct Ovary Unlisted,,25001851,LOCAL,Facility,Outpatient,,,,4182,3554.7,1198.5612,4182,"UCare Health, Inc.",Medical Assistance,2110.6554,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Laparoscopy Oviduct Ovary Unlisted,,25001851,LOCAL,Facility,Inpatient,,,,4182,3554.7,1198.5612,4182,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Laparoscopy Oviduct Ovary Unlisted,,25001851,LOCAL,Facility,Outpatient,,,,4182,3554.7,1198.5612,4182,"UCare Health, Inc.",Medicare Advantage,2110.6554,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Laparoscopy Oviduct Ovary Unlisted,,25001851,LOCAL,Facility,Inpatient,,,,4182,3554.7,1198.5612,4182,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Laparoscopy Oviduct Ovary Unlisted,,25001851,LOCAL,Facility,Outpatient,,,,4182,3554.7,1198.5612,4182,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2110.6554,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Laparoscopy Oviduct Ovary Unlisted,,25001851,LOCAL,Facility,Inpatient,,,,4182,3554.7,1198.5612,4182,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Laparoscopy Oviduct Ovary Unlisted,,25001851,LOCAL,Facility,Both,,,,4182,3554.7,1198.5612,4182,UnitedHealthcare,Individual & Family,3931.08,94,,percent of total billed charges,,
Laparoscopy Oviduct Ovary Unlisted,,25001851,LOCAL,Facility,Outpatient,,,,4182,3554.7,1198.5612,4182,UnitedHealthcare,Medicare Advantage,2049.18,49,,percent of total billed charges,,
Laparoscopy Oviduct Ovary Unlisted,,25001851,LOCAL,Facility,Inpatient,,,,4182,3554.7,1198.5612,4182,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Laparoscopy Oviduct Ovary Unlisted,,25001851,LOCAL,Facility,Outpatient,,,,4182,3554.7,1198.5612,4182,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2007.36,48,,percent of total billed charges,,100% of DHS outpatient percentage
Laparoscopy Oviduct Ovary Unlisted,,25001851,LOCAL,Facility,Inpatient,,,,4182,3554.7,1198.5612,4182,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Laparoscopy W Lysis Of Adhesions,,25001882,LOCAL,Facility,Both,,,,4692,3988.2,1344.7272,4692,Aetna,Commercial,4316.64,92,,percent of total billed charges,,
Laparoscopy W Lysis Of Adhesions,,25001882,LOCAL,Facility,Outpatient,,,,4692,3988.2,1344.7272,4692,Aetna,Medicare Advantage,2299.08,49,,percent of total billed charges,,
Laparoscopy W Lysis Of Adhesions,,25001882,LOCAL,Facility,Inpatient,,,,4692,3988.2,1344.7272,4692,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Laparoscopy W Lysis Of Adhesions,,25001882,LOCAL,Facility,Both,,,,4692,3988.2,1344.7272,4692,Aetna,PPO,4363.56,93,,percent of total billed charges,,
Laparoscopy W Lysis Of Adhesions,,25001882,LOCAL,Facility,Both,,,,4692,3988.2,1344.7272,4692,America's PPO,America's PPO,4505.7276,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Laparoscopy W Lysis Of Adhesions,,25001882,LOCAL,Facility,Both,,,,4692,3988.2,1344.7272,4692,BlueCross BlueShield Minnesota, Federal Employee Program,4616.928,98.4,,percent of total billed charges,,
Laparoscopy W Lysis Of Adhesions,,25001882,LOCAL,Facility,Both,,,,4692,3988.2,1344.7272,4692,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,4692,100,,percent of total billed charges,,
Laparoscopy W Lysis Of Adhesions,,25001882,LOCAL,Facility,Both,,,,4692,3988.2,1344.7272,4692,BlueCross BlueShield Minnesota,High Value Network Plan,4222.8,90,,percent of total billed charges,,
Laparoscopy W Lysis Of Adhesions,,25001882,LOCAL,Facility,Outpatient,,,,4692,3988.2,1344.7272,4692,BlueCross BlueShield Minnesota,Medicare Advantage,2299.08,49,,percent of total billed charges,,
Laparoscopy W Lysis Of Adhesions,,25001882,LOCAL,Facility,Inpatient,,,,4692,3988.2,1344.7272,4692,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Laparoscopy W Lysis Of Adhesions,,25001882,LOCAL,Facility,Both,,,,4692,3988.2,1344.7272,4692,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4155.7044,88.57,,percent of total billed charges,,
Laparoscopy W Lysis Of Adhesions,,25001882,LOCAL,Facility,Both,,,,4692,3988.2,1344.7272,4692,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1344.7272,28.66,,percent of total billed charges,,
Laparoscopy W Lysis Of Adhesions,,25001882,LOCAL,Facility,Outpatient,,,,4692,3988.2,1344.7272,4692,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2299.08,49,,percent of total billed charges,,
Laparoscopy W Lysis Of Adhesions,,25001882,LOCAL,Facility,Inpatient,,,,4692,3988.2,1344.7272,4692,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Laparoscopy W Lysis Of Adhesions,,25001882,LOCAL,Facility,Both,,,,4692,3988.2,1344.7272,4692,CorVel,Worker's Compensation,4692,100,,percent of total billed charges,,
Laparoscopy W Lysis Of Adhesions,,25001882,LOCAL,Facility,Both,,,,4692,3988.2,1344.7272,4692,First Health Group Corporation,First Health Network,4551.24,97,,percent of total billed charges,,
Laparoscopy W Lysis Of Adhesions,,25001882,LOCAL,Facility,Both,,,,4692,3988.2,1344.7272,4692,"Health Partners, Inc.",Commercial,4438.632,94.6,,percent of total billed charges,,
Laparoscopy W Lysis Of Adhesions,,25001882,LOCAL,Facility,Outpatient,,,,4692,3988.2,1344.7272,4692,"Health Partners, Inc.",Medicare Advantage,2299.08,49,,percent of total billed charges,,
Laparoscopy W Lysis Of Adhesions,,25001882,LOCAL,Facility,Inpatient,,,,4692,3988.2,1344.7272,4692,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Laparoscopy W Lysis Of Adhesions,,25001882,LOCAL,Facility,Both,,,,4692,3988.2,1344.7272,4692,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),2815.2,60,,percent of total billed charges,,
Laparoscopy W Lysis Of Adhesions,,25001882,LOCAL,Facility,Both,,,,4692,3988.2,1344.7272,4692,"Health Partners, Inc.",State of Minnesota Advantage Program,3823.98,81.5,,percent of total billed charges,,
Laparoscopy W Lysis Of Adhesions,,25001882,LOCAL,Facility,Both,,,,4692,3988.2,1344.7272,4692,"Health Partners, Inc.",State Public Programs,2346,50,,percent of total billed charges,,
Laparoscopy W Lysis Of Adhesions,,25001882,LOCAL,Facility,Both,,,,4692,3988.2,1344.7272,4692,Humana Insurance Company,Commercial PPO,4457.4,95,,percent of total billed charges,,
Laparoscopy W Lysis Of Adhesions,,25001882,LOCAL,Facility,Outpatient,,,,4692,3988.2,1344.7272,4692,Humana Insurance Company,Medicare PPO,2299.08,49,,percent of total billed charges,,
Laparoscopy W Lysis Of Adhesions,,25001882,LOCAL,Facility,Inpatient,,,,4692,3988.2,1344.7272,4692,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Laparoscopy W Lysis Of Adhesions,,25001882,LOCAL,Facility,Both,,,,4692,3988.2,1344.7272,4692,Medica,Individual & Family,4649.772,99.1,,percent of total billed charges,,
Laparoscopy W Lysis Of Adhesions,,25001882,LOCAL,Facility,Outpatient,,,,4692,3988.2,1344.7272,4692,Medica,Medica Advantage Solution,2336.616,49.8,,percent of total billed charges,,
Laparoscopy W Lysis Of Adhesions,,25001882,LOCAL,Facility,Inpatient,,,,4692,3988.2,1344.7272,4692,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Laparoscopy W Lysis Of Adhesions,,25001882,LOCAL,Facility,Outpatient,,,,4692,3988.2,1344.7272,4692,Medica,Medical Assistance,2092.632,44.6,,percent of total billed charges,,
Laparoscopy W Lysis Of Adhesions,,25001882,LOCAL,Facility,Inpatient,,,,4692,3988.2,1344.7272,4692,Medica,Medical Assistance,,,,,Included in per diem rate,
Laparoscopy W Lysis Of Adhesions,,25001882,LOCAL,Facility,Outpatient,,,,4692,3988.2,1344.7272,4692,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2336.616,49.8,,percent of total billed charges,,
Laparoscopy W Lysis Of Adhesions,,25001882,LOCAL,Facility,Inpatient,,,,4692,3988.2,1344.7272,4692,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Laparoscopy W Lysis Of Adhesions,,25001882,LOCAL,Facility,Both,,,,4692,3988.2,1344.7272,4692,"Multiplan, Inc.","Multiplan, Inc.",4410.48,94,,percent of total billed charges,,
Laparoscopy W Lysis Of Adhesions,,25001882,LOCAL,Facility,Outpatient,,,,4692,3988.2,1344.7272,4692,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4227.492,90.1,,percent of total billed charges,,
Laparoscopy W Lysis Of Adhesions,,25001882,LOCAL,Facility,Inpatient,,,,4692,3988.2,1344.7272,4692,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Laparoscopy W Lysis Of Adhesions,,25001882,LOCAL,Facility,Both,,,,4692,3988.2,1344.7272,4692,"Preferred One Administrative Services, INC.",PPO,4626.312,98.6,,percent of total billed charges,,
Laparoscopy W Lysis Of Adhesions,,25001882,LOCAL,Facility,Outpatient,,,,4692,3988.2,1344.7272,4692,PrimeWest Health,Minnesota Senior Health Options (MSHO),2414.034,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Laparoscopy W Lysis Of Adhesions,,25001882,LOCAL,Facility,Inpatient,,,,4692,3988.2,1344.7272,4692,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Laparoscopy W Lysis Of Adhesions,,25001882,LOCAL,Facility,Outpatient,,,,4692,3988.2,1344.7272,4692,PrimeWest Health,MinnesotaCare,2409.8112,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Laparoscopy W Lysis Of Adhesions,,25001882,LOCAL,Facility,Inpatient,,,,4692,3988.2,1344.7272,4692,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Laparoscopy W Lysis Of Adhesions,,25001882,LOCAL,Facility,Both,,,,4692,3988.2,1344.7272,4692,Sanford Health Plan,Sanford Health Plan,4316.64,92,,percent of total billed charges,,
Laparoscopy W Lysis Of Adhesions,,25001882,LOCAL,Facility,Outpatient,,,,4692,3988.2,1344.7272,4692,"UCare Health, Inc.",Individual & Family Plan,2643.942,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Laparoscopy W Lysis Of Adhesions,,25001882,LOCAL,Facility,Inpatient,,,,4692,3988.2,1344.7272,4692,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Laparoscopy W Lysis Of Adhesions,,25001882,LOCAL,Facility,Outpatient,,,,4692,3988.2,1344.7272,4692,"UCare Health, Inc.",Medical Assistance,2368.0524,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Laparoscopy W Lysis Of Adhesions,,25001882,LOCAL,Facility,Inpatient,,,,4692,3988.2,1344.7272,4692,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Laparoscopy W Lysis Of Adhesions,,25001882,LOCAL,Facility,Outpatient,,,,4692,3988.2,1344.7272,4692,"UCare Health, Inc.",Medicare Advantage,2368.0524,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Laparoscopy W Lysis Of Adhesions,,25001882,LOCAL,Facility,Inpatient,,,,4692,3988.2,1344.7272,4692,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Laparoscopy W Lysis Of Adhesions,,25001882,LOCAL,Facility,Outpatient,,,,4692,3988.2,1344.7272,4692,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2368.0524,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Laparoscopy W Lysis Of Adhesions,,25001882,LOCAL,Facility,Inpatient,,,,4692,3988.2,1344.7272,4692,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Laparoscopy W Lysis Of Adhesions,,25001882,LOCAL,Facility,Both,,,,4692,3988.2,1344.7272,4692,UnitedHealthcare,Individual & Family,4410.48,94,,percent of total billed charges,,
Laparoscopy W Lysis Of Adhesions,,25001882,LOCAL,Facility,Outpatient,,,,4692,3988.2,1344.7272,4692,UnitedHealthcare,Medicare Advantage,2299.08,49,,percent of total billed charges,,
Laparoscopy W Lysis Of Adhesions,,25001882,LOCAL,Facility,Inpatient,,,,4692,3988.2,1344.7272,4692,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Laparoscopy W Lysis Of Adhesions,,25001882,LOCAL,Facility,Outpatient,,,,4692,3988.2,1344.7272,4692,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2252.16,48,,percent of total billed charges,,100% of DHS outpatient percentage
Laparoscopy W Lysis Of Adhesions,,25001882,LOCAL,Facility,Inpatient,,,,4692,3988.2,1344.7272,4692,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Lithotripsy,,25001958,LOCAL,Facility,Both,,,,6752,5739.2,1935.1232,6752,Aetna,Commercial,6211.84,92,,percent of total billed charges,,
Lithotripsy,,25001958,LOCAL,Facility,Outpatient,,,,6752,5739.2,1935.1232,6752,Aetna,Medicare Advantage,3308.48,49,,percent of total billed charges,,
Lithotripsy,,25001958,LOCAL,Facility,Inpatient,,,,6752,5739.2,1935.1232,6752,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Lithotripsy,,25001958,LOCAL,Facility,Both,,,,6752,5739.2,1935.1232,6752,Aetna,PPO,6279.36,93,,percent of total billed charges,,
Lithotripsy,,25001958,LOCAL,Facility,Both,,,,6752,5739.2,1935.1232,6752,America's PPO,America's PPO,6483.9456,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Lithotripsy,,25001958,LOCAL,Facility,Both,,,,6752,5739.2,1935.1232,6752,BlueCross BlueShield Minnesota, Federal Employee Program,6643.968,98.4,,percent of total billed charges,,
Lithotripsy,,25001958,LOCAL,Facility,Both,,,,6752,5739.2,1935.1232,6752,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,6752,100,,percent of total billed charges,,
Lithotripsy,,25001958,LOCAL,Facility,Both,,,,6752,5739.2,1935.1232,6752,BlueCross BlueShield Minnesota,High Value Network Plan,6076.8,90,,percent of total billed charges,,
Lithotripsy,,25001958,LOCAL,Facility,Outpatient,,,,6752,5739.2,1935.1232,6752,BlueCross BlueShield Minnesota,Medicare Advantage,3308.48,49,,percent of total billed charges,,
Lithotripsy,,25001958,LOCAL,Facility,Inpatient,,,,6752,5739.2,1935.1232,6752,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Lithotripsy,,25001958,LOCAL,Facility,Both,,,,6752,5739.2,1935.1232,6752,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,5980.2464,88.57,,percent of total billed charges,,
Lithotripsy,,25001958,LOCAL,Facility,Both,,,,6752,5739.2,1935.1232,6752,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1935.1232,28.66,,percent of total billed charges,,
Lithotripsy,,25001958,LOCAL,Facility,Outpatient,,,,6752,5739.2,1935.1232,6752,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),3308.48,49,,percent of total billed charges,,
Lithotripsy,,25001958,LOCAL,Facility,Inpatient,,,,6752,5739.2,1935.1232,6752,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Lithotripsy,,25001958,LOCAL,Facility,Both,,,,6752,5739.2,1935.1232,6752,CorVel,Worker's Compensation,6752,100,,percent of total billed charges,,
Lithotripsy,,25001958,LOCAL,Facility,Both,,,,6752,5739.2,1935.1232,6752,First Health Group Corporation,First Health Network,6549.44,97,,percent of total billed charges,,
Lithotripsy,,25001958,LOCAL,Facility,Both,,,,6752,5739.2,1935.1232,6752,"Health Partners, Inc.",Commercial,6387.392,94.6,,percent of total billed charges,,
Lithotripsy,,25001958,LOCAL,Facility,Outpatient,,,,6752,5739.2,1935.1232,6752,"Health Partners, Inc.",Medicare Advantage,3308.48,49,,percent of total billed charges,,
Lithotripsy,,25001958,LOCAL,Facility,Inpatient,,,,6752,5739.2,1935.1232,6752,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Lithotripsy,,25001958,LOCAL,Facility,Both,,,,6752,5739.2,1935.1232,6752,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),4051.2,60,,percent of total billed charges,,
Lithotripsy,,25001958,LOCAL,Facility,Both,,,,6752,5739.2,1935.1232,6752,"Health Partners, Inc.",State of Minnesota Advantage Program,5502.88,81.5,,percent of total billed charges,,
Lithotripsy,,25001958,LOCAL,Facility,Both,,,,6752,5739.2,1935.1232,6752,"Health Partners, Inc.",State Public Programs,3376,50,,percent of total billed charges,,
Lithotripsy,,25001958,LOCAL,Facility,Both,,,,6752,5739.2,1935.1232,6752,Humana Insurance Company,Commercial PPO,6414.4,95,,percent of total billed charges,,
Lithotripsy,,25001958,LOCAL,Facility,Outpatient,,,,6752,5739.2,1935.1232,6752,Humana Insurance Company,Medicare PPO,3308.48,49,,percent of total billed charges,,
Lithotripsy,,25001958,LOCAL,Facility,Inpatient,,,,6752,5739.2,1935.1232,6752,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Lithotripsy,,25001958,LOCAL,Facility,Both,,,,6752,5739.2,1935.1232,6752,Medica,Individual & Family,6691.232,99.1,,percent of total billed charges,,
Lithotripsy,,25001958,LOCAL,Facility,Outpatient,,,,6752,5739.2,1935.1232,6752,Medica,Medica Advantage Solution,3362.496,49.8,,percent of total billed charges,,
Lithotripsy,,25001958,LOCAL,Facility,Inpatient,,,,6752,5739.2,1935.1232,6752,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Lithotripsy,,25001958,LOCAL,Facility,Outpatient,,,,6752,5739.2,1935.1232,6752,Medica,Medical Assistance,3011.392,44.6,,percent of total billed charges,,
Lithotripsy,,25001958,LOCAL,Facility,Inpatient,,,,6752,5739.2,1935.1232,6752,Medica,Medical Assistance,,,,,Included in per diem rate,
Lithotripsy,,25001958,LOCAL,Facility,Outpatient,,,,6752,5739.2,1935.1232,6752,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,3362.496,49.8,,percent of total billed charges,,
Lithotripsy,,25001958,LOCAL,Facility,Inpatient,,,,6752,5739.2,1935.1232,6752,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Lithotripsy,,25001958,LOCAL,Facility,Both,,,,6752,5739.2,1935.1232,6752,"Multiplan, Inc.","Multiplan, Inc.",6346.88,94,,percent of total billed charges,,
Lithotripsy,,25001958,LOCAL,Facility,Outpatient,,,,6752,5739.2,1935.1232,6752,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,6083.552,90.1,,percent of total billed charges,,
Lithotripsy,,25001958,LOCAL,Facility,Inpatient,,,,6752,5739.2,1935.1232,6752,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Lithotripsy,,25001958,LOCAL,Facility,Both,,,,6752,5739.2,1935.1232,6752,"Preferred One Administrative Services, INC.",PPO,6657.472,98.6,,percent of total billed charges,,
Lithotripsy,,25001958,LOCAL,Facility,Outpatient,,,,6752,5739.2,1935.1232,6752,PrimeWest Health,Minnesota Senior Health Options (MSHO),3473.904,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Lithotripsy,,25001958,LOCAL,Facility,Inpatient,,,,6752,5739.2,1935.1232,6752,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Lithotripsy,,25001958,LOCAL,Facility,Outpatient,,,,6752,5739.2,1935.1232,6752,PrimeWest Health,MinnesotaCare,3467.8272,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Lithotripsy,,25001958,LOCAL,Facility,Inpatient,,,,6752,5739.2,1935.1232,6752,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Lithotripsy,,25001958,LOCAL,Facility,Both,,,,6752,5739.2,1935.1232,6752,Sanford Health Plan,Sanford Health Plan,6211.84,92,,percent of total billed charges,,
Lithotripsy,,25001958,LOCAL,Facility,Outpatient,,,,6752,5739.2,1935.1232,6752,"UCare Health, Inc.",Individual & Family Plan,3804.752,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Lithotripsy,,25001958,LOCAL,Facility,Inpatient,,,,6752,5739.2,1935.1232,6752,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Lithotripsy,,25001958,LOCAL,Facility,Outpatient,,,,6752,5739.2,1935.1232,6752,"UCare Health, Inc.",Medical Assistance,3407.7344,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Lithotripsy,,25001958,LOCAL,Facility,Inpatient,,,,6752,5739.2,1935.1232,6752,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Lithotripsy,,25001958,LOCAL,Facility,Outpatient,,,,6752,5739.2,1935.1232,6752,"UCare Health, Inc.",Medicare Advantage,3407.7344,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Lithotripsy,,25001958,LOCAL,Facility,Inpatient,,,,6752,5739.2,1935.1232,6752,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Lithotripsy,,25001958,LOCAL,Facility,Outpatient,,,,6752,5739.2,1935.1232,6752,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),3407.7344,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Lithotripsy,,25001958,LOCAL,Facility,Inpatient,,,,6752,5739.2,1935.1232,6752,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Lithotripsy,,25001958,LOCAL,Facility,Both,,,,6752,5739.2,1935.1232,6752,UnitedHealthcare,Individual & Family,6346.88,94,,percent of total billed charges,,
Lithotripsy,,25001958,LOCAL,Facility,Outpatient,,,,6752,5739.2,1935.1232,6752,UnitedHealthcare,Medicare Advantage,3308.48,49,,percent of total billed charges,,
Lithotripsy,,25001958,LOCAL,Facility,Inpatient,,,,6752,5739.2,1935.1232,6752,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Lithotripsy,,25001958,LOCAL,Facility,Outpatient,,,,6752,5739.2,1935.1232,6752,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,3240.96,48,,percent of total billed charges,,100% of DHS outpatient percentage
Lithotripsy,,25001958,LOCAL,Facility,Inpatient,,,,6752,5739.2,1935.1232,6752,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Lumpectomy,,25001995,LOCAL,Facility,Both,,,,3126,2657.1,895.9116,3126,Aetna,Commercial,2875.92,92,,percent of total billed charges,,
Lumpectomy,,25001995,LOCAL,Facility,Outpatient,,,,3126,2657.1,895.9116,3126,Aetna,Medicare Advantage,1531.74,49,,percent of total billed charges,,
Lumpectomy,,25001995,LOCAL,Facility,Inpatient,,,,3126,2657.1,895.9116,3126,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Lumpectomy,,25001995,LOCAL,Facility,Both,,,,3126,2657.1,895.9116,3126,Aetna,PPO,2907.18,93,,percent of total billed charges,,
Lumpectomy,,25001995,LOCAL,Facility,Both,,,,3126,2657.1,895.9116,3126,America's PPO,America's PPO,3001.8978,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Lumpectomy,,25001995,LOCAL,Facility,Both,,,,3126,2657.1,895.9116,3126,BlueCross BlueShield Minnesota, Federal Employee Program,3075.984,98.4,,percent of total billed charges,,
Lumpectomy,,25001995,LOCAL,Facility,Both,,,,3126,2657.1,895.9116,3126,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,3126,100,,percent of total billed charges,,
Lumpectomy,,25001995,LOCAL,Facility,Both,,,,3126,2657.1,895.9116,3126,BlueCross BlueShield Minnesota,High Value Network Plan,2813.4,90,,percent of total billed charges,,
Lumpectomy,,25001995,LOCAL,Facility,Outpatient,,,,3126,2657.1,895.9116,3126,BlueCross BlueShield Minnesota,Medicare Advantage,1531.74,49,,percent of total billed charges,,
Lumpectomy,,25001995,LOCAL,Facility,Inpatient,,,,3126,2657.1,895.9116,3126,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Lumpectomy,,25001995,LOCAL,Facility,Both,,,,3126,2657.1,895.9116,3126,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,2768.6982,88.57,,percent of total billed charges,,
Lumpectomy,,25001995,LOCAL,Facility,Both,,,,3126,2657.1,895.9116,3126,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,895.9116,28.66,,percent of total billed charges,,
Lumpectomy,,25001995,LOCAL,Facility,Outpatient,,,,3126,2657.1,895.9116,3126,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1531.74,49,,percent of total billed charges,,
Lumpectomy,,25001995,LOCAL,Facility,Inpatient,,,,3126,2657.1,895.9116,3126,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Lumpectomy,,25001995,LOCAL,Facility,Both,,,,3126,2657.1,895.9116,3126,CorVel,Worker's Compensation,3126,100,,percent of total billed charges,,
Lumpectomy,,25001995,LOCAL,Facility,Both,,,,3126,2657.1,895.9116,3126,First Health Group Corporation,First Health Network,3032.22,97,,percent of total billed charges,,
Lumpectomy,,25001995,LOCAL,Facility,Both,,,,3126,2657.1,895.9116,3126,"Health Partners, Inc.",Commercial,2957.196,94.6,,percent of total billed charges,,
Lumpectomy,,25001995,LOCAL,Facility,Outpatient,,,,3126,2657.1,895.9116,3126,"Health Partners, Inc.",Medicare Advantage,1531.74,49,,percent of total billed charges,,
Lumpectomy,,25001995,LOCAL,Facility,Inpatient,,,,3126,2657.1,895.9116,3126,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Lumpectomy,,25001995,LOCAL,Facility,Both,,,,3126,2657.1,895.9116,3126,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1875.6,60,,percent of total billed charges,,
Lumpectomy,,25001995,LOCAL,Facility,Both,,,,3126,2657.1,895.9116,3126,"Health Partners, Inc.",State of Minnesota Advantage Program,2547.69,81.5,,percent of total billed charges,,
Lumpectomy,,25001995,LOCAL,Facility,Both,,,,3126,2657.1,895.9116,3126,"Health Partners, Inc.",State Public Programs,1563,50,,percent of total billed charges,,
Lumpectomy,,25001995,LOCAL,Facility,Both,,,,3126,2657.1,895.9116,3126,Humana Insurance Company,Commercial PPO,2969.7,95,,percent of total billed charges,,
Lumpectomy,,25001995,LOCAL,Facility,Outpatient,,,,3126,2657.1,895.9116,3126,Humana Insurance Company,Medicare PPO,1531.74,49,,percent of total billed charges,,
Lumpectomy,,25001995,LOCAL,Facility,Inpatient,,,,3126,2657.1,895.9116,3126,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Lumpectomy,,25001995,LOCAL,Facility,Both,,,,3126,2657.1,895.9116,3126,Medica,Individual & Family,3097.866,99.1,,percent of total billed charges,,
Lumpectomy,,25001995,LOCAL,Facility,Outpatient,,,,3126,2657.1,895.9116,3126,Medica,Medica Advantage Solution,1556.748,49.8,,percent of total billed charges,,
Lumpectomy,,25001995,LOCAL,Facility,Inpatient,,,,3126,2657.1,895.9116,3126,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Lumpectomy,,25001995,LOCAL,Facility,Outpatient,,,,3126,2657.1,895.9116,3126,Medica,Medical Assistance,1394.196,44.6,,percent of total billed charges,,
Lumpectomy,,25001995,LOCAL,Facility,Inpatient,,,,3126,2657.1,895.9116,3126,Medica,Medical Assistance,,,,,Included in per diem rate,
Lumpectomy,,25001995,LOCAL,Facility,Outpatient,,,,3126,2657.1,895.9116,3126,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1556.748,49.8,,percent of total billed charges,,
Lumpectomy,,25001995,LOCAL,Facility,Inpatient,,,,3126,2657.1,895.9116,3126,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Lumpectomy,,25001995,LOCAL,Facility,Both,,,,3126,2657.1,895.9116,3126,"Multiplan, Inc.","Multiplan, Inc.",2938.44,94,,percent of total billed charges,,
Lumpectomy,,25001995,LOCAL,Facility,Outpatient,,,,3126,2657.1,895.9116,3126,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,2816.526,90.1,,percent of total billed charges,,
Lumpectomy,,25001995,LOCAL,Facility,Inpatient,,,,3126,2657.1,895.9116,3126,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Lumpectomy,,25001995,LOCAL,Facility,Both,,,,3126,2657.1,895.9116,3126,"Preferred One Administrative Services, INC.",PPO,3082.236,98.6,,percent of total billed charges,,
Lumpectomy,,25001995,LOCAL,Facility,Outpatient,,,,3126,2657.1,895.9116,3126,PrimeWest Health,Minnesota Senior Health Options (MSHO),1608.327,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Lumpectomy,,25001995,LOCAL,Facility,Inpatient,,,,3126,2657.1,895.9116,3126,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Lumpectomy,,25001995,LOCAL,Facility,Outpatient,,,,3126,2657.1,895.9116,3126,PrimeWest Health,MinnesotaCare,1605.5136,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Lumpectomy,,25001995,LOCAL,Facility,Inpatient,,,,3126,2657.1,895.9116,3126,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Lumpectomy,,25001995,LOCAL,Facility,Both,,,,3126,2657.1,895.9116,3126,Sanford Health Plan,Sanford Health Plan,2875.92,92,,percent of total billed charges,,
Lumpectomy,,25001995,LOCAL,Facility,Outpatient,,,,3126,2657.1,895.9116,3126,"UCare Health, Inc.",Individual & Family Plan,1761.501,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Lumpectomy,,25001995,LOCAL,Facility,Inpatient,,,,3126,2657.1,895.9116,3126,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Lumpectomy,,25001995,LOCAL,Facility,Outpatient,,,,3126,2657.1,895.9116,3126,"UCare Health, Inc.",Medical Assistance,1577.6922,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Lumpectomy,,25001995,LOCAL,Facility,Inpatient,,,,3126,2657.1,895.9116,3126,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Lumpectomy,,25001995,LOCAL,Facility,Outpatient,,,,3126,2657.1,895.9116,3126,"UCare Health, Inc.",Medicare Advantage,1577.6922,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Lumpectomy,,25001995,LOCAL,Facility,Inpatient,,,,3126,2657.1,895.9116,3126,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Lumpectomy,,25001995,LOCAL,Facility,Outpatient,,,,3126,2657.1,895.9116,3126,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1577.6922,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Lumpectomy,,25001995,LOCAL,Facility,Inpatient,,,,3126,2657.1,895.9116,3126,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Lumpectomy,,25001995,LOCAL,Facility,Both,,,,3126,2657.1,895.9116,3126,UnitedHealthcare,Individual & Family,2938.44,94,,percent of total billed charges,,
Lumpectomy,,25001995,LOCAL,Facility,Outpatient,,,,3126,2657.1,895.9116,3126,UnitedHealthcare,Medicare Advantage,1531.74,49,,percent of total billed charges,,
Lumpectomy,,25001995,LOCAL,Facility,Inpatient,,,,3126,2657.1,895.9116,3126,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Lumpectomy,,25001995,LOCAL,Facility,Outpatient,,,,3126,2657.1,895.9116,3126,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1500.48,48,,percent of total billed charges,,100% of DHS outpatient percentage
Lumpectomy,,25001995,LOCAL,Facility,Inpatient,,,,3126,2657.1,895.9116,3126,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Lumpectomy W Axillary Node Dissect,,25002009,LOCAL,Facility,Both,,,,2168,1842.8,621.3488,2168,Aetna,Commercial,1994.56,92,,percent of total billed charges,,
Lumpectomy W Axillary Node Dissect,,25002009,LOCAL,Facility,Outpatient,,,,2168,1842.8,621.3488,2168,Aetna,Medicare Advantage,1062.32,49,,percent of total billed charges,,
Lumpectomy W Axillary Node Dissect,,25002009,LOCAL,Facility,Inpatient,,,,2168,1842.8,621.3488,2168,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Lumpectomy W Axillary Node Dissect,,25002009,LOCAL,Facility,Both,,,,2168,1842.8,621.3488,2168,Aetna,PPO,2016.24,93,,percent of total billed charges,,
Lumpectomy W Axillary Node Dissect,,25002009,LOCAL,Facility,Both,,,,2168,1842.8,621.3488,2168,America's PPO,America's PPO,2081.9304,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Lumpectomy W Axillary Node Dissect,,25002009,LOCAL,Facility,Both,,,,2168,1842.8,621.3488,2168,BlueCross BlueShield Minnesota, Federal Employee Program,2133.312,98.4,,percent of total billed charges,,
Lumpectomy W Axillary Node Dissect,,25002009,LOCAL,Facility,Both,,,,2168,1842.8,621.3488,2168,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,2168,100,,percent of total billed charges,,
Lumpectomy W Axillary Node Dissect,,25002009,LOCAL,Facility,Both,,,,2168,1842.8,621.3488,2168,BlueCross BlueShield Minnesota,High Value Network Plan,1951.2,90,,percent of total billed charges,,
Lumpectomy W Axillary Node Dissect,,25002009,LOCAL,Facility,Outpatient,,,,2168,1842.8,621.3488,2168,BlueCross BlueShield Minnesota,Medicare Advantage,1062.32,49,,percent of total billed charges,,
Lumpectomy W Axillary Node Dissect,,25002009,LOCAL,Facility,Inpatient,,,,2168,1842.8,621.3488,2168,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Lumpectomy W Axillary Node Dissect,,25002009,LOCAL,Facility,Both,,,,2168,1842.8,621.3488,2168,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1920.1976,88.57,,percent of total billed charges,,
Lumpectomy W Axillary Node Dissect,,25002009,LOCAL,Facility,Both,,,,2168,1842.8,621.3488,2168,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,621.3488,28.66,,percent of total billed charges,,
Lumpectomy W Axillary Node Dissect,,25002009,LOCAL,Facility,Outpatient,,,,2168,1842.8,621.3488,2168,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1062.32,49,,percent of total billed charges,,
Lumpectomy W Axillary Node Dissect,,25002009,LOCAL,Facility,Inpatient,,,,2168,1842.8,621.3488,2168,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Lumpectomy W Axillary Node Dissect,,25002009,LOCAL,Facility,Both,,,,2168,1842.8,621.3488,2168,CorVel,Worker's Compensation,2168,100,,percent of total billed charges,,
Lumpectomy W Axillary Node Dissect,,25002009,LOCAL,Facility,Both,,,,2168,1842.8,621.3488,2168,First Health Group Corporation,First Health Network,2102.96,97,,percent of total billed charges,,
Lumpectomy W Axillary Node Dissect,,25002009,LOCAL,Facility,Both,,,,2168,1842.8,621.3488,2168,"Health Partners, Inc.",Commercial,2050.928,94.6,,percent of total billed charges,,
Lumpectomy W Axillary Node Dissect,,25002009,LOCAL,Facility,Outpatient,,,,2168,1842.8,621.3488,2168,"Health Partners, Inc.",Medicare Advantage,1062.32,49,,percent of total billed charges,,
Lumpectomy W Axillary Node Dissect,,25002009,LOCAL,Facility,Inpatient,,,,2168,1842.8,621.3488,2168,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Lumpectomy W Axillary Node Dissect,,25002009,LOCAL,Facility,Both,,,,2168,1842.8,621.3488,2168,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1300.8,60,,percent of total billed charges,,
Lumpectomy W Axillary Node Dissect,,25002009,LOCAL,Facility,Both,,,,2168,1842.8,621.3488,2168,"Health Partners, Inc.",State of Minnesota Advantage Program,1766.92,81.5,,percent of total billed charges,,
Lumpectomy W Axillary Node Dissect,,25002009,LOCAL,Facility,Both,,,,2168,1842.8,621.3488,2168,"Health Partners, Inc.",State Public Programs,1084,50,,percent of total billed charges,,
Lumpectomy W Axillary Node Dissect,,25002009,LOCAL,Facility,Both,,,,2168,1842.8,621.3488,2168,Humana Insurance Company,Commercial PPO,2059.6,95,,percent of total billed charges,,
Lumpectomy W Axillary Node Dissect,,25002009,LOCAL,Facility,Outpatient,,,,2168,1842.8,621.3488,2168,Humana Insurance Company,Medicare PPO,1062.32,49,,percent of total billed charges,,
Lumpectomy W Axillary Node Dissect,,25002009,LOCAL,Facility,Inpatient,,,,2168,1842.8,621.3488,2168,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Lumpectomy W Axillary Node Dissect,,25002009,LOCAL,Facility,Both,,,,2168,1842.8,621.3488,2168,Medica,Individual & Family,2148.488,99.1,,percent of total billed charges,,
Lumpectomy W Axillary Node Dissect,,25002009,LOCAL,Facility,Outpatient,,,,2168,1842.8,621.3488,2168,Medica,Medica Advantage Solution,1079.664,49.8,,percent of total billed charges,,
Lumpectomy W Axillary Node Dissect,,25002009,LOCAL,Facility,Inpatient,,,,2168,1842.8,621.3488,2168,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Lumpectomy W Axillary Node Dissect,,25002009,LOCAL,Facility,Outpatient,,,,2168,1842.8,621.3488,2168,Medica,Medical Assistance,966.928,44.6,,percent of total billed charges,,
Lumpectomy W Axillary Node Dissect,,25002009,LOCAL,Facility,Inpatient,,,,2168,1842.8,621.3488,2168,Medica,Medical Assistance,,,,,Included in per diem rate,
Lumpectomy W Axillary Node Dissect,,25002009,LOCAL,Facility,Outpatient,,,,2168,1842.8,621.3488,2168,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1079.664,49.8,,percent of total billed charges,,
Lumpectomy W Axillary Node Dissect,,25002009,LOCAL,Facility,Inpatient,,,,2168,1842.8,621.3488,2168,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Lumpectomy W Axillary Node Dissect,,25002009,LOCAL,Facility,Both,,,,2168,1842.8,621.3488,2168,"Multiplan, Inc.","Multiplan, Inc.",2037.92,94,,percent of total billed charges,,
Lumpectomy W Axillary Node Dissect,,25002009,LOCAL,Facility,Outpatient,,,,2168,1842.8,621.3488,2168,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1953.368,90.1,,percent of total billed charges,,
Lumpectomy W Axillary Node Dissect,,25002009,LOCAL,Facility,Inpatient,,,,2168,1842.8,621.3488,2168,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Lumpectomy W Axillary Node Dissect,,25002009,LOCAL,Facility,Both,,,,2168,1842.8,621.3488,2168,"Preferred One Administrative Services, INC.",PPO,2137.648,98.6,,percent of total billed charges,,
Lumpectomy W Axillary Node Dissect,,25002009,LOCAL,Facility,Outpatient,,,,2168,1842.8,621.3488,2168,PrimeWest Health,Minnesota Senior Health Options (MSHO),1115.436,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Lumpectomy W Axillary Node Dissect,,25002009,LOCAL,Facility,Inpatient,,,,2168,1842.8,621.3488,2168,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Lumpectomy W Axillary Node Dissect,,25002009,LOCAL,Facility,Outpatient,,,,2168,1842.8,621.3488,2168,PrimeWest Health,MinnesotaCare,1113.4848,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Lumpectomy W Axillary Node Dissect,,25002009,LOCAL,Facility,Inpatient,,,,2168,1842.8,621.3488,2168,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Lumpectomy W Axillary Node Dissect,,25002009,LOCAL,Facility,Both,,,,2168,1842.8,621.3488,2168,Sanford Health Plan,Sanford Health Plan,1994.56,92,,percent of total billed charges,,
Lumpectomy W Axillary Node Dissect,,25002009,LOCAL,Facility,Outpatient,,,,2168,1842.8,621.3488,2168,"UCare Health, Inc.",Individual & Family Plan,1221.668,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Lumpectomy W Axillary Node Dissect,,25002009,LOCAL,Facility,Inpatient,,,,2168,1842.8,621.3488,2168,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Lumpectomy W Axillary Node Dissect,,25002009,LOCAL,Facility,Outpatient,,,,2168,1842.8,621.3488,2168,"UCare Health, Inc.",Medical Assistance,1094.1896,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Lumpectomy W Axillary Node Dissect,,25002009,LOCAL,Facility,Inpatient,,,,2168,1842.8,621.3488,2168,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Lumpectomy W Axillary Node Dissect,,25002009,LOCAL,Facility,Outpatient,,,,2168,1842.8,621.3488,2168,"UCare Health, Inc.",Medicare Advantage,1094.1896,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Lumpectomy W Axillary Node Dissect,,25002009,LOCAL,Facility,Inpatient,,,,2168,1842.8,621.3488,2168,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Lumpectomy W Axillary Node Dissect,,25002009,LOCAL,Facility,Outpatient,,,,2168,1842.8,621.3488,2168,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1094.1896,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Lumpectomy W Axillary Node Dissect,,25002009,LOCAL,Facility,Inpatient,,,,2168,1842.8,621.3488,2168,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Lumpectomy W Axillary Node Dissect,,25002009,LOCAL,Facility,Both,,,,2168,1842.8,621.3488,2168,UnitedHealthcare,Individual & Family,2037.92,94,,percent of total billed charges,,
Lumpectomy W Axillary Node Dissect,,25002009,LOCAL,Facility,Outpatient,,,,2168,1842.8,621.3488,2168,UnitedHealthcare,Medicare Advantage,1062.32,49,,percent of total billed charges,,
Lumpectomy W Axillary Node Dissect,,25002009,LOCAL,Facility,Inpatient,,,,2168,1842.8,621.3488,2168,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Lumpectomy W Axillary Node Dissect,,25002009,LOCAL,Facility,Outpatient,,,,2168,1842.8,621.3488,2168,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1040.64,48,,percent of total billed charges,,100% of DHS outpatient percentage
Lumpectomy W Axillary Node Dissect,,25002009,LOCAL,Facility,Inpatient,,,,2168,1842.8,621.3488,2168,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Mastectomy,,25002116,LOCAL,Facility,Both,,,,4386,3728.1,1257.0276,4386,Aetna,Commercial,4035.12,92,,percent of total billed charges,,
Mastectomy,,25002116,LOCAL,Facility,Outpatient,,,,4386,3728.1,1257.0276,4386,Aetna,Medicare Advantage,2149.14,49,,percent of total billed charges,,
Mastectomy,,25002116,LOCAL,Facility,Inpatient,,,,4386,3728.1,1257.0276,4386,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Mastectomy,,25002116,LOCAL,Facility,Both,,,,4386,3728.1,1257.0276,4386,Aetna,PPO,4078.98,93,,percent of total billed charges,,
Mastectomy,,25002116,LOCAL,Facility,Both,,,,4386,3728.1,1257.0276,4386,America's PPO,America's PPO,4211.8758,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Mastectomy,,25002116,LOCAL,Facility,Both,,,,4386,3728.1,1257.0276,4386,BlueCross BlueShield Minnesota, Federal Employee Program,4315.824,98.4,,percent of total billed charges,,
Mastectomy,,25002116,LOCAL,Facility,Both,,,,4386,3728.1,1257.0276,4386,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,4386,100,,percent of total billed charges,,
Mastectomy,,25002116,LOCAL,Facility,Both,,,,4386,3728.1,1257.0276,4386,BlueCross BlueShield Minnesota,High Value Network Plan,3947.4,90,,percent of total billed charges,,
Mastectomy,,25002116,LOCAL,Facility,Outpatient,,,,4386,3728.1,1257.0276,4386,BlueCross BlueShield Minnesota,Medicare Advantage,2149.14,49,,percent of total billed charges,,
Mastectomy,,25002116,LOCAL,Facility,Inpatient,,,,4386,3728.1,1257.0276,4386,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Mastectomy,,25002116,LOCAL,Facility,Both,,,,4386,3728.1,1257.0276,4386,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,3884.6802,88.57,,percent of total billed charges,,
Mastectomy,,25002116,LOCAL,Facility,Both,,,,4386,3728.1,1257.0276,4386,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1257.0276,28.66,,percent of total billed charges,,
Mastectomy,,25002116,LOCAL,Facility,Outpatient,,,,4386,3728.1,1257.0276,4386,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2149.14,49,,percent of total billed charges,,
Mastectomy,,25002116,LOCAL,Facility,Inpatient,,,,4386,3728.1,1257.0276,4386,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Mastectomy,,25002116,LOCAL,Facility,Both,,,,4386,3728.1,1257.0276,4386,CorVel,Worker's Compensation,4386,100,,percent of total billed charges,,
Mastectomy,,25002116,LOCAL,Facility,Both,,,,4386,3728.1,1257.0276,4386,First Health Group Corporation,First Health Network,4254.42,97,,percent of total billed charges,,
Mastectomy,,25002116,LOCAL,Facility,Both,,,,4386,3728.1,1257.0276,4386,"Health Partners, Inc.",Commercial,4149.156,94.6,,percent of total billed charges,,
Mastectomy,,25002116,LOCAL,Facility,Outpatient,,,,4386,3728.1,1257.0276,4386,"Health Partners, Inc.",Medicare Advantage,2149.14,49,,percent of total billed charges,,
Mastectomy,,25002116,LOCAL,Facility,Inpatient,,,,4386,3728.1,1257.0276,4386,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mastectomy,,25002116,LOCAL,Facility,Both,,,,4386,3728.1,1257.0276,4386,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),2631.6,60,,percent of total billed charges,,
Mastectomy,,25002116,LOCAL,Facility,Both,,,,4386,3728.1,1257.0276,4386,"Health Partners, Inc.",State of Minnesota Advantage Program,3574.59,81.5,,percent of total billed charges,,
Mastectomy,,25002116,LOCAL,Facility,Both,,,,4386,3728.1,1257.0276,4386,"Health Partners, Inc.",State Public Programs,2193,50,,percent of total billed charges,,
Mastectomy,,25002116,LOCAL,Facility,Both,,,,4386,3728.1,1257.0276,4386,Humana Insurance Company,Commercial PPO,4166.7,95,,percent of total billed charges,,
Mastectomy,,25002116,LOCAL,Facility,Outpatient,,,,4386,3728.1,1257.0276,4386,Humana Insurance Company,Medicare PPO,2149.14,49,,percent of total billed charges,,
Mastectomy,,25002116,LOCAL,Facility,Inpatient,,,,4386,3728.1,1257.0276,4386,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Mastectomy,,25002116,LOCAL,Facility,Both,,,,4386,3728.1,1257.0276,4386,Medica,Individual & Family,4346.526,99.1,,percent of total billed charges,,
Mastectomy,,25002116,LOCAL,Facility,Outpatient,,,,4386,3728.1,1257.0276,4386,Medica,Medica Advantage Solution,2184.228,49.8,,percent of total billed charges,,
Mastectomy,,25002116,LOCAL,Facility,Inpatient,,,,4386,3728.1,1257.0276,4386,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Mastectomy,,25002116,LOCAL,Facility,Outpatient,,,,4386,3728.1,1257.0276,4386,Medica,Medical Assistance,1956.156,44.6,,percent of total billed charges,,
Mastectomy,,25002116,LOCAL,Facility,Inpatient,,,,4386,3728.1,1257.0276,4386,Medica,Medical Assistance,,,,,Included in per diem rate,
Mastectomy,,25002116,LOCAL,Facility,Outpatient,,,,4386,3728.1,1257.0276,4386,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2184.228,49.8,,percent of total billed charges,,
Mastectomy,,25002116,LOCAL,Facility,Inpatient,,,,4386,3728.1,1257.0276,4386,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Mastectomy,,25002116,LOCAL,Facility,Both,,,,4386,3728.1,1257.0276,4386,"Multiplan, Inc.","Multiplan, Inc.",4122.84,94,,percent of total billed charges,,
Mastectomy,,25002116,LOCAL,Facility,Outpatient,,,,4386,3728.1,1257.0276,4386,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,3951.786,90.1,,percent of total billed charges,,
Mastectomy,,25002116,LOCAL,Facility,Inpatient,,,,4386,3728.1,1257.0276,4386,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Mastectomy,,25002116,LOCAL,Facility,Both,,,,4386,3728.1,1257.0276,4386,"Preferred One Administrative Services, INC.",PPO,4324.596,98.6,,percent of total billed charges,,
Mastectomy,,25002116,LOCAL,Facility,Outpatient,,,,4386,3728.1,1257.0276,4386,PrimeWest Health,Minnesota Senior Health Options (MSHO),2256.597,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Mastectomy,,25002116,LOCAL,Facility,Inpatient,,,,4386,3728.1,1257.0276,4386,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mastectomy,,25002116,LOCAL,Facility,Outpatient,,,,4386,3728.1,1257.0276,4386,PrimeWest Health,MinnesotaCare,2252.6496,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Mastectomy,,25002116,LOCAL,Facility,Inpatient,,,,4386,3728.1,1257.0276,4386,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Mastectomy,,25002116,LOCAL,Facility,Both,,,,4386,3728.1,1257.0276,4386,Sanford Health Plan,Sanford Health Plan,4035.12,92,,percent of total billed charges,,
Mastectomy,,25002116,LOCAL,Facility,Outpatient,,,,4386,3728.1,1257.0276,4386,"UCare Health, Inc.",Individual & Family Plan,2471.511,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Mastectomy,,25002116,LOCAL,Facility,Inpatient,,,,4386,3728.1,1257.0276,4386,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Mastectomy,,25002116,LOCAL,Facility,Outpatient,,,,4386,3728.1,1257.0276,4386,"UCare Health, Inc.",Medical Assistance,2213.6142,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mastectomy,,25002116,LOCAL,Facility,Inpatient,,,,4386,3728.1,1257.0276,4386,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Mastectomy,,25002116,LOCAL,Facility,Outpatient,,,,4386,3728.1,1257.0276,4386,"UCare Health, Inc.",Medicare Advantage,2213.6142,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mastectomy,,25002116,LOCAL,Facility,Inpatient,,,,4386,3728.1,1257.0276,4386,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mastectomy,,25002116,LOCAL,Facility,Outpatient,,,,4386,3728.1,1257.0276,4386,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2213.6142,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mastectomy,,25002116,LOCAL,Facility,Inpatient,,,,4386,3728.1,1257.0276,4386,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mastectomy,,25002116,LOCAL,Facility,Both,,,,4386,3728.1,1257.0276,4386,UnitedHealthcare,Individual & Family,4122.84,94,,percent of total billed charges,,
Mastectomy,,25002116,LOCAL,Facility,Outpatient,,,,4386,3728.1,1257.0276,4386,UnitedHealthcare,Medicare Advantage,2149.14,49,,percent of total billed charges,,
Mastectomy,,25002116,LOCAL,Facility,Inpatient,,,,4386,3728.1,1257.0276,4386,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Mastectomy,,25002116,LOCAL,Facility,Outpatient,,,,4386,3728.1,1257.0276,4386,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2105.28,48,,percent of total billed charges,,100% of DHS outpatient percentage
Mastectomy,,25002116,LOCAL,Facility,Inpatient,,,,4386,3728.1,1257.0276,4386,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Orchiectomy,,25002246,LOCAL,Facility,Both,,,,4488,3814.8,1286.2608,4488,Aetna,Commercial,4128.96,92,,percent of total billed charges,,
Orchiectomy,,25002246,LOCAL,Facility,Outpatient,,,,4488,3814.8,1286.2608,4488,Aetna,Medicare Advantage,2199.12,49,,percent of total billed charges,,
Orchiectomy,,25002246,LOCAL,Facility,Inpatient,,,,4488,3814.8,1286.2608,4488,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Orchiectomy,,25002246,LOCAL,Facility,Both,,,,4488,3814.8,1286.2608,4488,Aetna,PPO,4173.84,93,,percent of total billed charges,,
Orchiectomy,,25002246,LOCAL,Facility,Both,,,,4488,3814.8,1286.2608,4488,America's PPO,America's PPO,4309.8264,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Orchiectomy,,25002246,LOCAL,Facility,Both,,,,4488,3814.8,1286.2608,4488,BlueCross BlueShield Minnesota, Federal Employee Program,4416.192,98.4,,percent of total billed charges,,
Orchiectomy,,25002246,LOCAL,Facility,Both,,,,4488,3814.8,1286.2608,4488,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,4488,100,,percent of total billed charges,,
Orchiectomy,,25002246,LOCAL,Facility,Both,,,,4488,3814.8,1286.2608,4488,BlueCross BlueShield Minnesota,High Value Network Plan,4039.2,90,,percent of total billed charges,,
Orchiectomy,,25002246,LOCAL,Facility,Outpatient,,,,4488,3814.8,1286.2608,4488,BlueCross BlueShield Minnesota,Medicare Advantage,2199.12,49,,percent of total billed charges,,
Orchiectomy,,25002246,LOCAL,Facility,Inpatient,,,,4488,3814.8,1286.2608,4488,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Orchiectomy,,25002246,LOCAL,Facility,Both,,,,4488,3814.8,1286.2608,4488,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,3975.0216,88.57,,percent of total billed charges,,
Orchiectomy,,25002246,LOCAL,Facility,Both,,,,4488,3814.8,1286.2608,4488,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1286.2608,28.66,,percent of total billed charges,,
Orchiectomy,,25002246,LOCAL,Facility,Outpatient,,,,4488,3814.8,1286.2608,4488,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2199.12,49,,percent of total billed charges,,
Orchiectomy,,25002246,LOCAL,Facility,Inpatient,,,,4488,3814.8,1286.2608,4488,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Orchiectomy,,25002246,LOCAL,Facility,Both,,,,4488,3814.8,1286.2608,4488,CorVel,Worker's Compensation,4488,100,,percent of total billed charges,,
Orchiectomy,,25002246,LOCAL,Facility,Both,,,,4488,3814.8,1286.2608,4488,First Health Group Corporation,First Health Network,4353.36,97,,percent of total billed charges,,
Orchiectomy,,25002246,LOCAL,Facility,Both,,,,4488,3814.8,1286.2608,4488,"Health Partners, Inc.",Commercial,4245.648,94.6,,percent of total billed charges,,
Orchiectomy,,25002246,LOCAL,Facility,Outpatient,,,,4488,3814.8,1286.2608,4488,"Health Partners, Inc.",Medicare Advantage,2199.12,49,,percent of total billed charges,,
Orchiectomy,,25002246,LOCAL,Facility,Inpatient,,,,4488,3814.8,1286.2608,4488,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Orchiectomy,,25002246,LOCAL,Facility,Both,,,,4488,3814.8,1286.2608,4488,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),2692.8,60,,percent of total billed charges,,
Orchiectomy,,25002246,LOCAL,Facility,Both,,,,4488,3814.8,1286.2608,4488,"Health Partners, Inc.",State of Minnesota Advantage Program,3657.72,81.5,,percent of total billed charges,,
Orchiectomy,,25002246,LOCAL,Facility,Both,,,,4488,3814.8,1286.2608,4488,"Health Partners, Inc.",State Public Programs,2244,50,,percent of total billed charges,,
Orchiectomy,,25002246,LOCAL,Facility,Both,,,,4488,3814.8,1286.2608,4488,Humana Insurance Company,Commercial PPO,4263.6,95,,percent of total billed charges,,
Orchiectomy,,25002246,LOCAL,Facility,Outpatient,,,,4488,3814.8,1286.2608,4488,Humana Insurance Company,Medicare PPO,2199.12,49,,percent of total billed charges,,
Orchiectomy,,25002246,LOCAL,Facility,Inpatient,,,,4488,3814.8,1286.2608,4488,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Orchiectomy,,25002246,LOCAL,Facility,Both,,,,4488,3814.8,1286.2608,4488,Medica,Individual & Family,4447.608,99.1,,percent of total billed charges,,
Orchiectomy,,25002246,LOCAL,Facility,Outpatient,,,,4488,3814.8,1286.2608,4488,Medica,Medica Advantage Solution,2235.024,49.8,,percent of total billed charges,,
Orchiectomy,,25002246,LOCAL,Facility,Inpatient,,,,4488,3814.8,1286.2608,4488,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Orchiectomy,,25002246,LOCAL,Facility,Outpatient,,,,4488,3814.8,1286.2608,4488,Medica,Medical Assistance,2001.648,44.6,,percent of total billed charges,,
Orchiectomy,,25002246,LOCAL,Facility,Inpatient,,,,4488,3814.8,1286.2608,4488,Medica,Medical Assistance,,,,,Included in per diem rate,
Orchiectomy,,25002246,LOCAL,Facility,Outpatient,,,,4488,3814.8,1286.2608,4488,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2235.024,49.8,,percent of total billed charges,,
Orchiectomy,,25002246,LOCAL,Facility,Inpatient,,,,4488,3814.8,1286.2608,4488,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Orchiectomy,,25002246,LOCAL,Facility,Both,,,,4488,3814.8,1286.2608,4488,"Multiplan, Inc.","Multiplan, Inc.",4218.72,94,,percent of total billed charges,,
Orchiectomy,,25002246,LOCAL,Facility,Outpatient,,,,4488,3814.8,1286.2608,4488,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4043.688,90.1,,percent of total billed charges,,
Orchiectomy,,25002246,LOCAL,Facility,Inpatient,,,,4488,3814.8,1286.2608,4488,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Orchiectomy,,25002246,LOCAL,Facility,Both,,,,4488,3814.8,1286.2608,4488,"Preferred One Administrative Services, INC.",PPO,4425.168,98.6,,percent of total billed charges,,
Orchiectomy,,25002246,LOCAL,Facility,Outpatient,,,,4488,3814.8,1286.2608,4488,PrimeWest Health,Minnesota Senior Health Options (MSHO),2309.076,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Orchiectomy,,25002246,LOCAL,Facility,Inpatient,,,,4488,3814.8,1286.2608,4488,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Orchiectomy,,25002246,LOCAL,Facility,Outpatient,,,,4488,3814.8,1286.2608,4488,PrimeWest Health,MinnesotaCare,2305.0368,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Orchiectomy,,25002246,LOCAL,Facility,Inpatient,,,,4488,3814.8,1286.2608,4488,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Orchiectomy,,25002246,LOCAL,Facility,Both,,,,4488,3814.8,1286.2608,4488,Sanford Health Plan,Sanford Health Plan,4128.96,92,,percent of total billed charges,,
Orchiectomy,,25002246,LOCAL,Facility,Outpatient,,,,4488,3814.8,1286.2608,4488,"UCare Health, Inc.",Individual & Family Plan,2528.988,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Orchiectomy,,25002246,LOCAL,Facility,Inpatient,,,,4488,3814.8,1286.2608,4488,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Orchiectomy,,25002246,LOCAL,Facility,Outpatient,,,,4488,3814.8,1286.2608,4488,"UCare Health, Inc.",Medical Assistance,2265.0936,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Orchiectomy,,25002246,LOCAL,Facility,Inpatient,,,,4488,3814.8,1286.2608,4488,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Orchiectomy,,25002246,LOCAL,Facility,Outpatient,,,,4488,3814.8,1286.2608,4488,"UCare Health, Inc.",Medicare Advantage,2265.0936,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Orchiectomy,,25002246,LOCAL,Facility,Inpatient,,,,4488,3814.8,1286.2608,4488,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Orchiectomy,,25002246,LOCAL,Facility,Outpatient,,,,4488,3814.8,1286.2608,4488,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2265.0936,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Orchiectomy,,25002246,LOCAL,Facility,Inpatient,,,,4488,3814.8,1286.2608,4488,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Orchiectomy,,25002246,LOCAL,Facility,Both,,,,4488,3814.8,1286.2608,4488,UnitedHealthcare,Individual & Family,4218.72,94,,percent of total billed charges,,
Orchiectomy,,25002246,LOCAL,Facility,Outpatient,,,,4488,3814.8,1286.2608,4488,UnitedHealthcare,Medicare Advantage,2199.12,49,,percent of total billed charges,,
Orchiectomy,,25002246,LOCAL,Facility,Inpatient,,,,4488,3814.8,1286.2608,4488,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Orchiectomy,,25002246,LOCAL,Facility,Outpatient,,,,4488,3814.8,1286.2608,4488,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2154.24,48,,percent of total billed charges,,100% of DHS outpatient percentage
Orchiectomy,,25002246,LOCAL,Facility,Inpatient,,,,4488,3814.8,1286.2608,4488,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Orif Of Metatarsal,,25002412,LOCAL,Facility,Both,,,,2774,2357.9,795.0284,2774,Aetna,Commercial,2552.08,92,,percent of total billed charges,,
Orif Of Metatarsal,,25002412,LOCAL,Facility,Outpatient,,,,2774,2357.9,795.0284,2774,Aetna,Medicare Advantage,1359.26,49,,percent of total billed charges,,
Orif Of Metatarsal,,25002412,LOCAL,Facility,Inpatient,,,,2774,2357.9,795.0284,2774,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Orif Of Metatarsal,,25002412,LOCAL,Facility,Both,,,,2774,2357.9,795.0284,2774,Aetna,PPO,2579.82,93,,percent of total billed charges,,
Orif Of Metatarsal,,25002412,LOCAL,Facility,Both,,,,2774,2357.9,795.0284,2774,America's PPO,America's PPO,2663.8722,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Orif Of Metatarsal,,25002412,LOCAL,Facility,Both,,,,2774,2357.9,795.0284,2774,BlueCross BlueShield Minnesota, Federal Employee Program,2729.616,98.4,,percent of total billed charges,,
Orif Of Metatarsal,,25002412,LOCAL,Facility,Both,,,,2774,2357.9,795.0284,2774,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,2774,100,,percent of total billed charges,,
Orif Of Metatarsal,,25002412,LOCAL,Facility,Both,,,,2774,2357.9,795.0284,2774,BlueCross BlueShield Minnesota,High Value Network Plan,2496.6,90,,percent of total billed charges,,
Orif Of Metatarsal,,25002412,LOCAL,Facility,Outpatient,,,,2774,2357.9,795.0284,2774,BlueCross BlueShield Minnesota,Medicare Advantage,1359.26,49,,percent of total billed charges,,
Orif Of Metatarsal,,25002412,LOCAL,Facility,Inpatient,,,,2774,2357.9,795.0284,2774,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Orif Of Metatarsal,,25002412,LOCAL,Facility,Both,,,,2774,2357.9,795.0284,2774,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,2456.9318,88.57,,percent of total billed charges,,
Orif Of Metatarsal,,25002412,LOCAL,Facility,Both,,,,2774,2357.9,795.0284,2774,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,795.0284,28.66,,percent of total billed charges,,
Orif Of Metatarsal,,25002412,LOCAL,Facility,Outpatient,,,,2774,2357.9,795.0284,2774,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1359.26,49,,percent of total billed charges,,
Orif Of Metatarsal,,25002412,LOCAL,Facility,Inpatient,,,,2774,2357.9,795.0284,2774,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Orif Of Metatarsal,,25002412,LOCAL,Facility,Both,,,,2774,2357.9,795.0284,2774,CorVel,Worker's Compensation,2774,100,,percent of total billed charges,,
Orif Of Metatarsal,,25002412,LOCAL,Facility,Both,,,,2774,2357.9,795.0284,2774,First Health Group Corporation,First Health Network,2690.78,97,,percent of total billed charges,,
Orif Of Metatarsal,,25002412,LOCAL,Facility,Both,,,,2774,2357.9,795.0284,2774,"Health Partners, Inc.",Commercial,2624.204,94.6,,percent of total billed charges,,
Orif Of Metatarsal,,25002412,LOCAL,Facility,Outpatient,,,,2774,2357.9,795.0284,2774,"Health Partners, Inc.",Medicare Advantage,1359.26,49,,percent of total billed charges,,
Orif Of Metatarsal,,25002412,LOCAL,Facility,Inpatient,,,,2774,2357.9,795.0284,2774,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Orif Of Metatarsal,,25002412,LOCAL,Facility,Both,,,,2774,2357.9,795.0284,2774,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1664.4,60,,percent of total billed charges,,
Orif Of Metatarsal,,25002412,LOCAL,Facility,Both,,,,2774,2357.9,795.0284,2774,"Health Partners, Inc.",State of Minnesota Advantage Program,2260.81,81.5,,percent of total billed charges,,
Orif Of Metatarsal,,25002412,LOCAL,Facility,Both,,,,2774,2357.9,795.0284,2774,"Health Partners, Inc.",State Public Programs,1387,50,,percent of total billed charges,,
Orif Of Metatarsal,,25002412,LOCAL,Facility,Both,,,,2774,2357.9,795.0284,2774,Humana Insurance Company,Commercial PPO,2635.3,95,,percent of total billed charges,,
Orif Of Metatarsal,,25002412,LOCAL,Facility,Outpatient,,,,2774,2357.9,795.0284,2774,Humana Insurance Company,Medicare PPO,1359.26,49,,percent of total billed charges,,
Orif Of Metatarsal,,25002412,LOCAL,Facility,Inpatient,,,,2774,2357.9,795.0284,2774,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Orif Of Metatarsal,,25002412,LOCAL,Facility,Both,,,,2774,2357.9,795.0284,2774,Medica,Individual & Family,2749.034,99.1,,percent of total billed charges,,
Orif Of Metatarsal,,25002412,LOCAL,Facility,Outpatient,,,,2774,2357.9,795.0284,2774,Medica,Medica Advantage Solution,1381.452,49.8,,percent of total billed charges,,
Orif Of Metatarsal,,25002412,LOCAL,Facility,Inpatient,,,,2774,2357.9,795.0284,2774,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Orif Of Metatarsal,,25002412,LOCAL,Facility,Outpatient,,,,2774,2357.9,795.0284,2774,Medica,Medical Assistance,1237.204,44.6,,percent of total billed charges,,
Orif Of Metatarsal,,25002412,LOCAL,Facility,Inpatient,,,,2774,2357.9,795.0284,2774,Medica,Medical Assistance,,,,,Included in per diem rate,
Orif Of Metatarsal,,25002412,LOCAL,Facility,Outpatient,,,,2774,2357.9,795.0284,2774,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1381.452,49.8,,percent of total billed charges,,
Orif Of Metatarsal,,25002412,LOCAL,Facility,Inpatient,,,,2774,2357.9,795.0284,2774,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Orif Of Metatarsal,,25002412,LOCAL,Facility,Both,,,,2774,2357.9,795.0284,2774,"Multiplan, Inc.","Multiplan, Inc.",2607.56,94,,percent of total billed charges,,
Orif Of Metatarsal,,25002412,LOCAL,Facility,Outpatient,,,,2774,2357.9,795.0284,2774,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,2499.374,90.1,,percent of total billed charges,,
Orif Of Metatarsal,,25002412,LOCAL,Facility,Inpatient,,,,2774,2357.9,795.0284,2774,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Orif Of Metatarsal,,25002412,LOCAL,Facility,Both,,,,2774,2357.9,795.0284,2774,"Preferred One Administrative Services, INC.",PPO,2735.164,98.6,,percent of total billed charges,,
Orif Of Metatarsal,,25002412,LOCAL,Facility,Outpatient,,,,2774,2357.9,795.0284,2774,PrimeWest Health,Minnesota Senior Health Options (MSHO),1427.223,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Orif Of Metatarsal,,25002412,LOCAL,Facility,Inpatient,,,,2774,2357.9,795.0284,2774,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Orif Of Metatarsal,,25002412,LOCAL,Facility,Outpatient,,,,2774,2357.9,795.0284,2774,PrimeWest Health,MinnesotaCare,1424.7264,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Orif Of Metatarsal,,25002412,LOCAL,Facility,Inpatient,,,,2774,2357.9,795.0284,2774,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Orif Of Metatarsal,,25002412,LOCAL,Facility,Both,,,,2774,2357.9,795.0284,2774,Sanford Health Plan,Sanford Health Plan,2552.08,92,,percent of total billed charges,,
Orif Of Metatarsal,,25002412,LOCAL,Facility,Outpatient,,,,2774,2357.9,795.0284,2774,"UCare Health, Inc.",Individual & Family Plan,1563.149,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Orif Of Metatarsal,,25002412,LOCAL,Facility,Inpatient,,,,2774,2357.9,795.0284,2774,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Orif Of Metatarsal,,25002412,LOCAL,Facility,Outpatient,,,,2774,2357.9,795.0284,2774,"UCare Health, Inc.",Medical Assistance,1400.0378,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Orif Of Metatarsal,,25002412,LOCAL,Facility,Inpatient,,,,2774,2357.9,795.0284,2774,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Orif Of Metatarsal,,25002412,LOCAL,Facility,Outpatient,,,,2774,2357.9,795.0284,2774,"UCare Health, Inc.",Medicare Advantage,1400.0378,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Orif Of Metatarsal,,25002412,LOCAL,Facility,Inpatient,,,,2774,2357.9,795.0284,2774,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Orif Of Metatarsal,,25002412,LOCAL,Facility,Outpatient,,,,2774,2357.9,795.0284,2774,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1400.0378,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Orif Of Metatarsal,,25002412,LOCAL,Facility,Inpatient,,,,2774,2357.9,795.0284,2774,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Orif Of Metatarsal,,25002412,LOCAL,Facility,Both,,,,2774,2357.9,795.0284,2774,UnitedHealthcare,Individual & Family,2607.56,94,,percent of total billed charges,,
Orif Of Metatarsal,,25002412,LOCAL,Facility,Outpatient,,,,2774,2357.9,795.0284,2774,UnitedHealthcare,Medicare Advantage,1359.26,49,,percent of total billed charges,,
Orif Of Metatarsal,,25002412,LOCAL,Facility,Inpatient,,,,2774,2357.9,795.0284,2774,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Orif Of Metatarsal,,25002412,LOCAL,Facility,Outpatient,,,,2774,2357.9,795.0284,2774,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1331.52,48,,percent of total billed charges,,100% of DHS outpatient percentage
Orif Of Metatarsal,,25002412,LOCAL,Facility,Inpatient,,,,2774,2357.9,795.0284,2774,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Paracentesis,,25002593,LOCAL,Facility,Both,,,,1015,862.75,290.899,1015,Aetna,Commercial,933.8,92,,percent of total billed charges,,
Paracentesis,,25002593,LOCAL,Facility,Outpatient,,,,1015,862.75,290.899,1015,Aetna,Medicare Advantage,497.35,49,,percent of total billed charges,,
Paracentesis,,25002593,LOCAL,Facility,Inpatient,,,,1015,862.75,290.899,1015,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Paracentesis,,25002593,LOCAL,Facility,Both,,,,1015,862.75,290.899,1015,Aetna,PPO,943.95,93,,percent of total billed charges,,
Paracentesis,,25002593,LOCAL,Facility,Both,,,,1015,862.75,290.899,1015,America's PPO,America's PPO,974.7045,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Paracentesis,,25002593,LOCAL,Facility,Both,,,,1015,862.75,290.899,1015,BlueCross BlueShield Minnesota, Federal Employee Program,998.76,98.4,,percent of total billed charges,,
Paracentesis,,25002593,LOCAL,Facility,Both,,,,1015,862.75,290.899,1015,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1015,100,,percent of total billed charges,,
Paracentesis,,25002593,LOCAL,Facility,Both,,,,1015,862.75,290.899,1015,BlueCross BlueShield Minnesota,High Value Network Plan,913.5,90,,percent of total billed charges,,
Paracentesis,,25002593,LOCAL,Facility,Outpatient,,,,1015,862.75,290.899,1015,BlueCross BlueShield Minnesota,Medicare Advantage,497.35,49,,percent of total billed charges,,
Paracentesis,,25002593,LOCAL,Facility,Inpatient,,,,1015,862.75,290.899,1015,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Paracentesis,,25002593,LOCAL,Facility,Both,,,,1015,862.75,290.899,1015,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,898.9855,88.57,,percent of total billed charges,,
Paracentesis,,25002593,LOCAL,Facility,Both,,,,1015,862.75,290.899,1015,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,290.899,28.66,,percent of total billed charges,,
Paracentesis,,25002593,LOCAL,Facility,Outpatient,,,,1015,862.75,290.899,1015,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),497.35,49,,percent of total billed charges,,
Paracentesis,,25002593,LOCAL,Facility,Inpatient,,,,1015,862.75,290.899,1015,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Paracentesis,,25002593,LOCAL,Facility,Both,,,,1015,862.75,290.899,1015,CorVel,Worker's Compensation,1015,100,,percent of total billed charges,,
Paracentesis,,25002593,LOCAL,Facility,Both,,,,1015,862.75,290.899,1015,First Health Group Corporation,First Health Network,984.55,97,,percent of total billed charges,,
Paracentesis,,25002593,LOCAL,Facility,Both,,,,1015,862.75,290.899,1015,"Health Partners, Inc.",Commercial,960.19,94.6,,percent of total billed charges,,
Paracentesis,,25002593,LOCAL,Facility,Outpatient,,,,1015,862.75,290.899,1015,"Health Partners, Inc.",Medicare Advantage,497.35,49,,percent of total billed charges,,
Paracentesis,,25002593,LOCAL,Facility,Inpatient,,,,1015,862.75,290.899,1015,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Paracentesis,,25002593,LOCAL,Facility,Both,,,,1015,862.75,290.899,1015,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),609,60,,percent of total billed charges,,
Paracentesis,,25002593,LOCAL,Facility,Both,,,,1015,862.75,290.899,1015,"Health Partners, Inc.",State of Minnesota Advantage Program,827.225,81.5,,percent of total billed charges,,
Paracentesis,,25002593,LOCAL,Facility,Both,,,,1015,862.75,290.899,1015,"Health Partners, Inc.",State Public Programs,507.5,50,,percent of total billed charges,,
Paracentesis,,25002593,LOCAL,Facility,Both,,,,1015,862.75,290.899,1015,Humana Insurance Company,Commercial PPO,964.25,95,,percent of total billed charges,,
Paracentesis,,25002593,LOCAL,Facility,Outpatient,,,,1015,862.75,290.899,1015,Humana Insurance Company,Medicare PPO,497.35,49,,percent of total billed charges,,
Paracentesis,,25002593,LOCAL,Facility,Inpatient,,,,1015,862.75,290.899,1015,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Paracentesis,,25002593,LOCAL,Facility,Both,,,,1015,862.75,290.899,1015,Medica,Individual & Family,1005.865,99.1,,percent of total billed charges,,
Paracentesis,,25002593,LOCAL,Facility,Outpatient,,,,1015,862.75,290.899,1015,Medica,Medica Advantage Solution,505.47,49.8,,percent of total billed charges,,
Paracentesis,,25002593,LOCAL,Facility,Inpatient,,,,1015,862.75,290.899,1015,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Paracentesis,,25002593,LOCAL,Facility,Outpatient,,,,1015,862.75,290.899,1015,Medica,Medical Assistance,452.69,44.6,,percent of total billed charges,,
Paracentesis,,25002593,LOCAL,Facility,Inpatient,,,,1015,862.75,290.899,1015,Medica,Medical Assistance,,,,,Included in per diem rate,
Paracentesis,,25002593,LOCAL,Facility,Outpatient,,,,1015,862.75,290.899,1015,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,505.47,49.8,,percent of total billed charges,,
Paracentesis,,25002593,LOCAL,Facility,Inpatient,,,,1015,862.75,290.899,1015,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Paracentesis,,25002593,LOCAL,Facility,Both,,,,1015,862.75,290.899,1015,"Multiplan, Inc.","Multiplan, Inc.",954.1,94,,percent of total billed charges,,
Paracentesis,,25002593,LOCAL,Facility,Outpatient,,,,1015,862.75,290.899,1015,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,914.515,90.1,,percent of total billed charges,,
Paracentesis,,25002593,LOCAL,Facility,Inpatient,,,,1015,862.75,290.899,1015,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Paracentesis,,25002593,LOCAL,Facility,Both,,,,1015,862.75,290.899,1015,"Preferred One Administrative Services, INC.",PPO,1000.79,98.6,,percent of total billed charges,,
Paracentesis,,25002593,LOCAL,Facility,Outpatient,,,,1015,862.75,290.899,1015,PrimeWest Health,Minnesota Senior Health Options (MSHO),522.2175,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Paracentesis,,25002593,LOCAL,Facility,Inpatient,,,,1015,862.75,290.899,1015,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Paracentesis,,25002593,LOCAL,Facility,Outpatient,,,,1015,862.75,290.899,1015,PrimeWest Health,MinnesotaCare,521.304,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Paracentesis,,25002593,LOCAL,Facility,Inpatient,,,,1015,862.75,290.899,1015,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Paracentesis,,25002593,LOCAL,Facility,Both,,,,1015,862.75,290.899,1015,Sanford Health Plan,Sanford Health Plan,933.8,92,,percent of total billed charges,,
Paracentesis,,25002593,LOCAL,Facility,Outpatient,,,,1015,862.75,290.899,1015,"UCare Health, Inc.",Individual & Family Plan,571.9525,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Paracentesis,,25002593,LOCAL,Facility,Inpatient,,,,1015,862.75,290.899,1015,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Paracentesis,,25002593,LOCAL,Facility,Outpatient,,,,1015,862.75,290.899,1015,"UCare Health, Inc.",Medical Assistance,512.2705,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Paracentesis,,25002593,LOCAL,Facility,Inpatient,,,,1015,862.75,290.899,1015,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Paracentesis,,25002593,LOCAL,Facility,Outpatient,,,,1015,862.75,290.899,1015,"UCare Health, Inc.",Medicare Advantage,512.2705,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Paracentesis,,25002593,LOCAL,Facility,Inpatient,,,,1015,862.75,290.899,1015,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Paracentesis,,25002593,LOCAL,Facility,Outpatient,,,,1015,862.75,290.899,1015,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),512.2705,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Paracentesis,,25002593,LOCAL,Facility,Inpatient,,,,1015,862.75,290.899,1015,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Paracentesis,,25002593,LOCAL,Facility,Both,,,,1015,862.75,290.899,1015,UnitedHealthcare,Individual & Family,954.1,94,,percent of total billed charges,,
Paracentesis,,25002593,LOCAL,Facility,Outpatient,,,,1015,862.75,290.899,1015,UnitedHealthcare,Medicare Advantage,497.35,49,,percent of total billed charges,,
Paracentesis,,25002593,LOCAL,Facility,Inpatient,,,,1015,862.75,290.899,1015,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Paracentesis,,25002593,LOCAL,Facility,Outpatient,,,,1015,862.75,290.899,1015,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,487.2,48,,percent of total billed charges,,100% of DHS outpatient percentage
Paracentesis,,25002593,LOCAL,Facility,Inpatient,,,,1015,862.75,290.899,1015,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Piloinidal Cystectomy,,25002654,LOCAL,Facility,Both,,,,1071,910.35,306.9486,1071,Aetna,Commercial,985.32,92,,percent of total billed charges,,
Piloinidal Cystectomy,,25002654,LOCAL,Facility,Outpatient,,,,1071,910.35,306.9486,1071,Aetna,Medicare Advantage,524.79,49,,percent of total billed charges,,
Piloinidal Cystectomy,,25002654,LOCAL,Facility,Inpatient,,,,1071,910.35,306.9486,1071,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Piloinidal Cystectomy,,25002654,LOCAL,Facility,Both,,,,1071,910.35,306.9486,1071,Aetna,PPO,996.03,93,,percent of total billed charges,,
Piloinidal Cystectomy,,25002654,LOCAL,Facility,Both,,,,1071,910.35,306.9486,1071,America's PPO,America's PPO,1028.4813,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Piloinidal Cystectomy,,25002654,LOCAL,Facility,Both,,,,1071,910.35,306.9486,1071,BlueCross BlueShield Minnesota, Federal Employee Program,1053.864,98.4,,percent of total billed charges,,
Piloinidal Cystectomy,,25002654,LOCAL,Facility,Both,,,,1071,910.35,306.9486,1071,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1071,100,,percent of total billed charges,,
Piloinidal Cystectomy,,25002654,LOCAL,Facility,Both,,,,1071,910.35,306.9486,1071,BlueCross BlueShield Minnesota,High Value Network Plan,963.9,90,,percent of total billed charges,,
Piloinidal Cystectomy,,25002654,LOCAL,Facility,Outpatient,,,,1071,910.35,306.9486,1071,BlueCross BlueShield Minnesota,Medicare Advantage,524.79,49,,percent of total billed charges,,
Piloinidal Cystectomy,,25002654,LOCAL,Facility,Inpatient,,,,1071,910.35,306.9486,1071,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Piloinidal Cystectomy,,25002654,LOCAL,Facility,Both,,,,1071,910.35,306.9486,1071,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,948.5847,88.57,,percent of total billed charges,,
Piloinidal Cystectomy,,25002654,LOCAL,Facility,Both,,,,1071,910.35,306.9486,1071,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,306.9486,28.66,,percent of total billed charges,,
Piloinidal Cystectomy,,25002654,LOCAL,Facility,Outpatient,,,,1071,910.35,306.9486,1071,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),524.79,49,,percent of total billed charges,,
Piloinidal Cystectomy,,25002654,LOCAL,Facility,Inpatient,,,,1071,910.35,306.9486,1071,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Piloinidal Cystectomy,,25002654,LOCAL,Facility,Both,,,,1071,910.35,306.9486,1071,CorVel,Worker's Compensation,1071,100,,percent of total billed charges,,
Piloinidal Cystectomy,,25002654,LOCAL,Facility,Both,,,,1071,910.35,306.9486,1071,First Health Group Corporation,First Health Network,1038.87,97,,percent of total billed charges,,
Piloinidal Cystectomy,,25002654,LOCAL,Facility,Both,,,,1071,910.35,306.9486,1071,"Health Partners, Inc.",Commercial,1013.166,94.6,,percent of total billed charges,,
Piloinidal Cystectomy,,25002654,LOCAL,Facility,Outpatient,,,,1071,910.35,306.9486,1071,"Health Partners, Inc.",Medicare Advantage,524.79,49,,percent of total billed charges,,
Piloinidal Cystectomy,,25002654,LOCAL,Facility,Inpatient,,,,1071,910.35,306.9486,1071,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Piloinidal Cystectomy,,25002654,LOCAL,Facility,Both,,,,1071,910.35,306.9486,1071,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),642.6,60,,percent of total billed charges,,
Piloinidal Cystectomy,,25002654,LOCAL,Facility,Both,,,,1071,910.35,306.9486,1071,"Health Partners, Inc.",State of Minnesota Advantage Program,872.865,81.5,,percent of total billed charges,,
Piloinidal Cystectomy,,25002654,LOCAL,Facility,Both,,,,1071,910.35,306.9486,1071,"Health Partners, Inc.",State Public Programs,535.5,50,,percent of total billed charges,,
Piloinidal Cystectomy,,25002654,LOCAL,Facility,Both,,,,1071,910.35,306.9486,1071,Humana Insurance Company,Commercial PPO,1017.45,95,,percent of total billed charges,,
Piloinidal Cystectomy,,25002654,LOCAL,Facility,Outpatient,,,,1071,910.35,306.9486,1071,Humana Insurance Company,Medicare PPO,524.79,49,,percent of total billed charges,,
Piloinidal Cystectomy,,25002654,LOCAL,Facility,Inpatient,,,,1071,910.35,306.9486,1071,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Piloinidal Cystectomy,,25002654,LOCAL,Facility,Both,,,,1071,910.35,306.9486,1071,Medica,Individual & Family,1061.361,99.1,,percent of total billed charges,,
Piloinidal Cystectomy,,25002654,LOCAL,Facility,Outpatient,,,,1071,910.35,306.9486,1071,Medica,Medica Advantage Solution,533.358,49.8,,percent of total billed charges,,
Piloinidal Cystectomy,,25002654,LOCAL,Facility,Inpatient,,,,1071,910.35,306.9486,1071,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Piloinidal Cystectomy,,25002654,LOCAL,Facility,Outpatient,,,,1071,910.35,306.9486,1071,Medica,Medical Assistance,477.666,44.6,,percent of total billed charges,,
Piloinidal Cystectomy,,25002654,LOCAL,Facility,Inpatient,,,,1071,910.35,306.9486,1071,Medica,Medical Assistance,,,,,Included in per diem rate,
Piloinidal Cystectomy,,25002654,LOCAL,Facility,Outpatient,,,,1071,910.35,306.9486,1071,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,533.358,49.8,,percent of total billed charges,,
Piloinidal Cystectomy,,25002654,LOCAL,Facility,Inpatient,,,,1071,910.35,306.9486,1071,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Piloinidal Cystectomy,,25002654,LOCAL,Facility,Both,,,,1071,910.35,306.9486,1071,"Multiplan, Inc.","Multiplan, Inc.",1006.74,94,,percent of total billed charges,,
Piloinidal Cystectomy,,25002654,LOCAL,Facility,Outpatient,,,,1071,910.35,306.9486,1071,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,964.971,90.1,,percent of total billed charges,,
Piloinidal Cystectomy,,25002654,LOCAL,Facility,Inpatient,,,,1071,910.35,306.9486,1071,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Piloinidal Cystectomy,,25002654,LOCAL,Facility,Both,,,,1071,910.35,306.9486,1071,"Preferred One Administrative Services, INC.",PPO,1056.006,98.6,,percent of total billed charges,,
Piloinidal Cystectomy,,25002654,LOCAL,Facility,Outpatient,,,,1071,910.35,306.9486,1071,PrimeWest Health,Minnesota Senior Health Options (MSHO),551.0295,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Piloinidal Cystectomy,,25002654,LOCAL,Facility,Inpatient,,,,1071,910.35,306.9486,1071,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Piloinidal Cystectomy,,25002654,LOCAL,Facility,Outpatient,,,,1071,910.35,306.9486,1071,PrimeWest Health,MinnesotaCare,550.0656,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Piloinidal Cystectomy,,25002654,LOCAL,Facility,Inpatient,,,,1071,910.35,306.9486,1071,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Piloinidal Cystectomy,,25002654,LOCAL,Facility,Both,,,,1071,910.35,306.9486,1071,Sanford Health Plan,Sanford Health Plan,985.32,92,,percent of total billed charges,,
Piloinidal Cystectomy,,25002654,LOCAL,Facility,Outpatient,,,,1071,910.35,306.9486,1071,"UCare Health, Inc.",Individual & Family Plan,603.5085,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Piloinidal Cystectomy,,25002654,LOCAL,Facility,Inpatient,,,,1071,910.35,306.9486,1071,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Piloinidal Cystectomy,,25002654,LOCAL,Facility,Outpatient,,,,1071,910.35,306.9486,1071,"UCare Health, Inc.",Medical Assistance,540.5337,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Piloinidal Cystectomy,,25002654,LOCAL,Facility,Inpatient,,,,1071,910.35,306.9486,1071,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Piloinidal Cystectomy,,25002654,LOCAL,Facility,Outpatient,,,,1071,910.35,306.9486,1071,"UCare Health, Inc.",Medicare Advantage,540.5337,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Piloinidal Cystectomy,,25002654,LOCAL,Facility,Inpatient,,,,1071,910.35,306.9486,1071,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Piloinidal Cystectomy,,25002654,LOCAL,Facility,Outpatient,,,,1071,910.35,306.9486,1071,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),540.5337,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Piloinidal Cystectomy,,25002654,LOCAL,Facility,Inpatient,,,,1071,910.35,306.9486,1071,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Piloinidal Cystectomy,,25002654,LOCAL,Facility,Both,,,,1071,910.35,306.9486,1071,UnitedHealthcare,Individual & Family,1006.74,94,,percent of total billed charges,,
Piloinidal Cystectomy,,25002654,LOCAL,Facility,Outpatient,,,,1071,910.35,306.9486,1071,UnitedHealthcare,Medicare Advantage,524.79,49,,percent of total billed charges,,
Piloinidal Cystectomy,,25002654,LOCAL,Facility,Inpatient,,,,1071,910.35,306.9486,1071,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Piloinidal Cystectomy,,25002654,LOCAL,Facility,Outpatient,,,,1071,910.35,306.9486,1071,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,514.08,48,,percent of total billed charges,,100% of DHS outpatient percentage
Piloinidal Cystectomy,,25002654,LOCAL,Facility,Inpatient,,,,1071,910.35,306.9486,1071,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Fasciotomy/Fasciectomy, Plantar",,25002668,LOCAL,Facility,Both,,,,3784,3216.4,1084.4944,3784,Aetna,Commercial,3481.28,92,,percent of total billed charges,,
"Fasciotomy/Fasciectomy, Plantar",,25002668,LOCAL,Facility,Outpatient,,,,3784,3216.4,1084.4944,3784,Aetna,Medicare Advantage,1854.16,49,,percent of total billed charges,,
"Fasciotomy/Fasciectomy, Plantar",,25002668,LOCAL,Facility,Inpatient,,,,3784,3216.4,1084.4944,3784,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Fasciotomy/Fasciectomy, Plantar",,25002668,LOCAL,Facility,Both,,,,3784,3216.4,1084.4944,3784,Aetna,PPO,3519.12,93,,percent of total billed charges,,
"Fasciotomy/Fasciectomy, Plantar",,25002668,LOCAL,Facility,Both,,,,3784,3216.4,1084.4944,3784,America's PPO,America's PPO,3633.7752,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Fasciotomy/Fasciectomy, Plantar",,25002668,LOCAL,Facility,Both,,,,3784,3216.4,1084.4944,3784,BlueCross BlueShield Minnesota, Federal Employee Program,3723.456,98.4,,percent of total billed charges,,
"Fasciotomy/Fasciectomy, Plantar",,25002668,LOCAL,Facility,Both,,,,3784,3216.4,1084.4944,3784,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,3784,100,,percent of total billed charges,,
"Fasciotomy/Fasciectomy, Plantar",,25002668,LOCAL,Facility,Both,,,,3784,3216.4,1084.4944,3784,BlueCross BlueShield Minnesota,High Value Network Plan,3405.6,90,,percent of total billed charges,,
"Fasciotomy/Fasciectomy, Plantar",,25002668,LOCAL,Facility,Outpatient,,,,3784,3216.4,1084.4944,3784,BlueCross BlueShield Minnesota,Medicare Advantage,1854.16,49,,percent of total billed charges,,
"Fasciotomy/Fasciectomy, Plantar",,25002668,LOCAL,Facility,Inpatient,,,,3784,3216.4,1084.4944,3784,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Fasciotomy/Fasciectomy, Plantar",,25002668,LOCAL,Facility,Both,,,,3784,3216.4,1084.4944,3784,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,3351.4888,88.57,,percent of total billed charges,,
"Fasciotomy/Fasciectomy, Plantar",,25002668,LOCAL,Facility,Both,,,,3784,3216.4,1084.4944,3784,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1084.4944,28.66,,percent of total billed charges,,
"Fasciotomy/Fasciectomy, Plantar",,25002668,LOCAL,Facility,Outpatient,,,,3784,3216.4,1084.4944,3784,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1854.16,49,,percent of total billed charges,,
"Fasciotomy/Fasciectomy, Plantar",,25002668,LOCAL,Facility,Inpatient,,,,3784,3216.4,1084.4944,3784,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Fasciotomy/Fasciectomy, Plantar",,25002668,LOCAL,Facility,Both,,,,3784,3216.4,1084.4944,3784,CorVel,Worker's Compensation,3784,100,,percent of total billed charges,,
"Fasciotomy/Fasciectomy, Plantar",,25002668,LOCAL,Facility,Both,,,,3784,3216.4,1084.4944,3784,First Health Group Corporation,First Health Network,3670.48,97,,percent of total billed charges,,
"Fasciotomy/Fasciectomy, Plantar",,25002668,LOCAL,Facility,Both,,,,3784,3216.4,1084.4944,3784,"Health Partners, Inc.",Commercial,3579.664,94.6,,percent of total billed charges,,
"Fasciotomy/Fasciectomy, Plantar",,25002668,LOCAL,Facility,Outpatient,,,,3784,3216.4,1084.4944,3784,"Health Partners, Inc.",Medicare Advantage,1854.16,49,,percent of total billed charges,,
"Fasciotomy/Fasciectomy, Plantar",,25002668,LOCAL,Facility,Inpatient,,,,3784,3216.4,1084.4944,3784,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Fasciotomy/Fasciectomy, Plantar",,25002668,LOCAL,Facility,Both,,,,3784,3216.4,1084.4944,3784,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),2270.4,60,,percent of total billed charges,,
"Fasciotomy/Fasciectomy, Plantar",,25002668,LOCAL,Facility,Both,,,,3784,3216.4,1084.4944,3784,"Health Partners, Inc.",State of Minnesota Advantage Program,3083.96,81.5,,percent of total billed charges,,
"Fasciotomy/Fasciectomy, Plantar",,25002668,LOCAL,Facility,Both,,,,3784,3216.4,1084.4944,3784,"Health Partners, Inc.",State Public Programs,1892,50,,percent of total billed charges,,
"Fasciotomy/Fasciectomy, Plantar",,25002668,LOCAL,Facility,Both,,,,3784,3216.4,1084.4944,3784,Humana Insurance Company,Commercial PPO,3594.8,95,,percent of total billed charges,,
"Fasciotomy/Fasciectomy, Plantar",,25002668,LOCAL,Facility,Outpatient,,,,3784,3216.4,1084.4944,3784,Humana Insurance Company,Medicare PPO,1854.16,49,,percent of total billed charges,,
"Fasciotomy/Fasciectomy, Plantar",,25002668,LOCAL,Facility,Inpatient,,,,3784,3216.4,1084.4944,3784,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Fasciotomy/Fasciectomy, Plantar",,25002668,LOCAL,Facility,Both,,,,3784,3216.4,1084.4944,3784,Medica,Individual & Family,3749.944,99.1,,percent of total billed charges,,
"Fasciotomy/Fasciectomy, Plantar",,25002668,LOCAL,Facility,Outpatient,,,,3784,3216.4,1084.4944,3784,Medica,Medica Advantage Solution,1884.432,49.8,,percent of total billed charges,,
"Fasciotomy/Fasciectomy, Plantar",,25002668,LOCAL,Facility,Inpatient,,,,3784,3216.4,1084.4944,3784,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Fasciotomy/Fasciectomy, Plantar",,25002668,LOCAL,Facility,Outpatient,,,,3784,3216.4,1084.4944,3784,Medica,Medical Assistance,1687.664,44.6,,percent of total billed charges,,
"Fasciotomy/Fasciectomy, Plantar",,25002668,LOCAL,Facility,Inpatient,,,,3784,3216.4,1084.4944,3784,Medica,Medical Assistance,,,,,Included in per diem rate,
"Fasciotomy/Fasciectomy, Plantar",,25002668,LOCAL,Facility,Outpatient,,,,3784,3216.4,1084.4944,3784,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1884.432,49.8,,percent of total billed charges,,
"Fasciotomy/Fasciectomy, Plantar",,25002668,LOCAL,Facility,Inpatient,,,,3784,3216.4,1084.4944,3784,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Fasciotomy/Fasciectomy, Plantar",,25002668,LOCAL,Facility,Both,,,,3784,3216.4,1084.4944,3784,"Multiplan, Inc.","Multiplan, Inc.",3556.96,94,,percent of total billed charges,,
"Fasciotomy/Fasciectomy, Plantar",,25002668,LOCAL,Facility,Outpatient,,,,3784,3216.4,1084.4944,3784,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,3409.384,90.1,,percent of total billed charges,,
"Fasciotomy/Fasciectomy, Plantar",,25002668,LOCAL,Facility,Inpatient,,,,3784,3216.4,1084.4944,3784,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Fasciotomy/Fasciectomy, Plantar",,25002668,LOCAL,Facility,Both,,,,3784,3216.4,1084.4944,3784,"Preferred One Administrative Services, INC.",PPO,3731.024,98.6,,percent of total billed charges,,
"Fasciotomy/Fasciectomy, Plantar",,25002668,LOCAL,Facility,Outpatient,,,,3784,3216.4,1084.4944,3784,PrimeWest Health,Minnesota Senior Health Options (MSHO),1946.868,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Fasciotomy/Fasciectomy, Plantar",,25002668,LOCAL,Facility,Inpatient,,,,3784,3216.4,1084.4944,3784,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Fasciotomy/Fasciectomy, Plantar",,25002668,LOCAL,Facility,Outpatient,,,,3784,3216.4,1084.4944,3784,PrimeWest Health,MinnesotaCare,1943.4624,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Fasciotomy/Fasciectomy, Plantar",,25002668,LOCAL,Facility,Inpatient,,,,3784,3216.4,1084.4944,3784,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Fasciotomy/Fasciectomy, Plantar",,25002668,LOCAL,Facility,Both,,,,3784,3216.4,1084.4944,3784,Sanford Health Plan,Sanford Health Plan,3481.28,92,,percent of total billed charges,,
"Fasciotomy/Fasciectomy, Plantar",,25002668,LOCAL,Facility,Outpatient,,,,3784,3216.4,1084.4944,3784,"UCare Health, Inc.",Individual & Family Plan,2132.284,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Fasciotomy/Fasciectomy, Plantar",,25002668,LOCAL,Facility,Inpatient,,,,3784,3216.4,1084.4944,3784,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Fasciotomy/Fasciectomy, Plantar",,25002668,LOCAL,Facility,Outpatient,,,,3784,3216.4,1084.4944,3784,"UCare Health, Inc.",Medical Assistance,1909.7848,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Fasciotomy/Fasciectomy, Plantar",,25002668,LOCAL,Facility,Inpatient,,,,3784,3216.4,1084.4944,3784,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Fasciotomy/Fasciectomy, Plantar",,25002668,LOCAL,Facility,Outpatient,,,,3784,3216.4,1084.4944,3784,"UCare Health, Inc.",Medicare Advantage,1909.7848,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Fasciotomy/Fasciectomy, Plantar",,25002668,LOCAL,Facility,Inpatient,,,,3784,3216.4,1084.4944,3784,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Fasciotomy/Fasciectomy, Plantar",,25002668,LOCAL,Facility,Outpatient,,,,3784,3216.4,1084.4944,3784,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1909.7848,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Fasciotomy/Fasciectomy, Plantar",,25002668,LOCAL,Facility,Inpatient,,,,3784,3216.4,1084.4944,3784,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Fasciotomy/Fasciectomy, Plantar",,25002668,LOCAL,Facility,Both,,,,3784,3216.4,1084.4944,3784,UnitedHealthcare,Individual & Family,3556.96,94,,percent of total billed charges,,
"Fasciotomy/Fasciectomy, Plantar",,25002668,LOCAL,Facility,Outpatient,,,,3784,3216.4,1084.4944,3784,UnitedHealthcare,Medicare Advantage,1854.16,49,,percent of total billed charges,,
"Fasciotomy/Fasciectomy, Plantar",,25002668,LOCAL,Facility,Inpatient,,,,3784,3216.4,1084.4944,3784,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Fasciotomy/Fasciectomy, Plantar",,25002668,LOCAL,Facility,Outpatient,,,,3784,3216.4,1084.4944,3784,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1816.32,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Fasciotomy/Fasciectomy, Plantar",,25002668,LOCAL,Facility,Inpatient,,,,3784,3216.4,1084.4944,3784,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Port Remove/Revision,,25002670,LOCAL,Facility,Both,,,,1326,1127.1,380.0316,1326,Aetna,Commercial,1219.92,92,,percent of total billed charges,,
Port Remove/Revision,,25002670,LOCAL,Facility,Outpatient,,,,1326,1127.1,380.0316,1326,Aetna,Medicare Advantage,649.74,49,,percent of total billed charges,,
Port Remove/Revision,,25002670,LOCAL,Facility,Inpatient,,,,1326,1127.1,380.0316,1326,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Port Remove/Revision,,25002670,LOCAL,Facility,Both,,,,1326,1127.1,380.0316,1326,Aetna,PPO,1233.18,93,,percent of total billed charges,,
Port Remove/Revision,,25002670,LOCAL,Facility,Both,,,,1326,1127.1,380.0316,1326,America's PPO,America's PPO,1273.3578,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Port Remove/Revision,,25002670,LOCAL,Facility,Both,,,,1326,1127.1,380.0316,1326,BlueCross BlueShield Minnesota, Federal Employee Program,1304.784,98.4,,percent of total billed charges,,
Port Remove/Revision,,25002670,LOCAL,Facility,Both,,,,1326,1127.1,380.0316,1326,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1326,100,,percent of total billed charges,,
Port Remove/Revision,,25002670,LOCAL,Facility,Both,,,,1326,1127.1,380.0316,1326,BlueCross BlueShield Minnesota,High Value Network Plan,1193.4,90,,percent of total billed charges,,
Port Remove/Revision,,25002670,LOCAL,Facility,Outpatient,,,,1326,1127.1,380.0316,1326,BlueCross BlueShield Minnesota,Medicare Advantage,649.74,49,,percent of total billed charges,,
Port Remove/Revision,,25002670,LOCAL,Facility,Inpatient,,,,1326,1127.1,380.0316,1326,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Port Remove/Revision,,25002670,LOCAL,Facility,Both,,,,1326,1127.1,380.0316,1326,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1174.4382,88.57,,percent of total billed charges,,
Port Remove/Revision,,25002670,LOCAL,Facility,Both,,,,1326,1127.1,380.0316,1326,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,380.0316,28.66,,percent of total billed charges,,
Port Remove/Revision,,25002670,LOCAL,Facility,Outpatient,,,,1326,1127.1,380.0316,1326,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),649.74,49,,percent of total billed charges,,
Port Remove/Revision,,25002670,LOCAL,Facility,Inpatient,,,,1326,1127.1,380.0316,1326,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Port Remove/Revision,,25002670,LOCAL,Facility,Both,,,,1326,1127.1,380.0316,1326,CorVel,Worker's Compensation,1326,100,,percent of total billed charges,,
Port Remove/Revision,,25002670,LOCAL,Facility,Both,,,,1326,1127.1,380.0316,1326,First Health Group Corporation,First Health Network,1286.22,97,,percent of total billed charges,,
Port Remove/Revision,,25002670,LOCAL,Facility,Both,,,,1326,1127.1,380.0316,1326,"Health Partners, Inc.",Commercial,1254.396,94.6,,percent of total billed charges,,
Port Remove/Revision,,25002670,LOCAL,Facility,Outpatient,,,,1326,1127.1,380.0316,1326,"Health Partners, Inc.",Medicare Advantage,649.74,49,,percent of total billed charges,,
Port Remove/Revision,,25002670,LOCAL,Facility,Inpatient,,,,1326,1127.1,380.0316,1326,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Port Remove/Revision,,25002670,LOCAL,Facility,Both,,,,1326,1127.1,380.0316,1326,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),795.6,60,,percent of total billed charges,,
Port Remove/Revision,,25002670,LOCAL,Facility,Both,,,,1326,1127.1,380.0316,1326,"Health Partners, Inc.",State of Minnesota Advantage Program,1080.69,81.5,,percent of total billed charges,,
Port Remove/Revision,,25002670,LOCAL,Facility,Both,,,,1326,1127.1,380.0316,1326,"Health Partners, Inc.",State Public Programs,663,50,,percent of total billed charges,,
Port Remove/Revision,,25002670,LOCAL,Facility,Both,,,,1326,1127.1,380.0316,1326,Humana Insurance Company,Commercial PPO,1259.7,95,,percent of total billed charges,,
Port Remove/Revision,,25002670,LOCAL,Facility,Outpatient,,,,1326,1127.1,380.0316,1326,Humana Insurance Company,Medicare PPO,649.74,49,,percent of total billed charges,,
Port Remove/Revision,,25002670,LOCAL,Facility,Inpatient,,,,1326,1127.1,380.0316,1326,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Port Remove/Revision,,25002670,LOCAL,Facility,Both,,,,1326,1127.1,380.0316,1326,Medica,Individual & Family,1314.066,99.1,,percent of total billed charges,,
Port Remove/Revision,,25002670,LOCAL,Facility,Outpatient,,,,1326,1127.1,380.0316,1326,Medica,Medica Advantage Solution,660.348,49.8,,percent of total billed charges,,
Port Remove/Revision,,25002670,LOCAL,Facility,Inpatient,,,,1326,1127.1,380.0316,1326,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Port Remove/Revision,,25002670,LOCAL,Facility,Outpatient,,,,1326,1127.1,380.0316,1326,Medica,Medical Assistance,591.396,44.6,,percent of total billed charges,,
Port Remove/Revision,,25002670,LOCAL,Facility,Inpatient,,,,1326,1127.1,380.0316,1326,Medica,Medical Assistance,,,,,Included in per diem rate,
Port Remove/Revision,,25002670,LOCAL,Facility,Outpatient,,,,1326,1127.1,380.0316,1326,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,660.348,49.8,,percent of total billed charges,,
Port Remove/Revision,,25002670,LOCAL,Facility,Inpatient,,,,1326,1127.1,380.0316,1326,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Port Remove/Revision,,25002670,LOCAL,Facility,Both,,,,1326,1127.1,380.0316,1326,"Multiplan, Inc.","Multiplan, Inc.",1246.44,94,,percent of total billed charges,,
Port Remove/Revision,,25002670,LOCAL,Facility,Outpatient,,,,1326,1127.1,380.0316,1326,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1194.726,90.1,,percent of total billed charges,,
Port Remove/Revision,,25002670,LOCAL,Facility,Inpatient,,,,1326,1127.1,380.0316,1326,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Port Remove/Revision,,25002670,LOCAL,Facility,Both,,,,1326,1127.1,380.0316,1326,"Preferred One Administrative Services, INC.",PPO,1307.436,98.6,,percent of total billed charges,,
Port Remove/Revision,,25002670,LOCAL,Facility,Outpatient,,,,1326,1127.1,380.0316,1326,PrimeWest Health,Minnesota Senior Health Options (MSHO),682.227,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Port Remove/Revision,,25002670,LOCAL,Facility,Inpatient,,,,1326,1127.1,380.0316,1326,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Port Remove/Revision,,25002670,LOCAL,Facility,Outpatient,,,,1326,1127.1,380.0316,1326,PrimeWest Health,MinnesotaCare,681.0336,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Port Remove/Revision,,25002670,LOCAL,Facility,Inpatient,,,,1326,1127.1,380.0316,1326,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Port Remove/Revision,,25002670,LOCAL,Facility,Both,,,,1326,1127.1,380.0316,1326,Sanford Health Plan,Sanford Health Plan,1219.92,92,,percent of total billed charges,,
Port Remove/Revision,,25002670,LOCAL,Facility,Outpatient,,,,1326,1127.1,380.0316,1326,"UCare Health, Inc.",Individual & Family Plan,747.201,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Port Remove/Revision,,25002670,LOCAL,Facility,Inpatient,,,,1326,1127.1,380.0316,1326,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Port Remove/Revision,,25002670,LOCAL,Facility,Outpatient,,,,1326,1127.1,380.0316,1326,"UCare Health, Inc.",Medical Assistance,669.2322,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Port Remove/Revision,,25002670,LOCAL,Facility,Inpatient,,,,1326,1127.1,380.0316,1326,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Port Remove/Revision,,25002670,LOCAL,Facility,Outpatient,,,,1326,1127.1,380.0316,1326,"UCare Health, Inc.",Medicare Advantage,669.2322,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Port Remove/Revision,,25002670,LOCAL,Facility,Inpatient,,,,1326,1127.1,380.0316,1326,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Port Remove/Revision,,25002670,LOCAL,Facility,Outpatient,,,,1326,1127.1,380.0316,1326,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),669.2322,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Port Remove/Revision,,25002670,LOCAL,Facility,Inpatient,,,,1326,1127.1,380.0316,1326,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Port Remove/Revision,,25002670,LOCAL,Facility,Both,,,,1326,1127.1,380.0316,1326,UnitedHealthcare,Individual & Family,1246.44,94,,percent of total billed charges,,
Port Remove/Revision,,25002670,LOCAL,Facility,Outpatient,,,,1326,1127.1,380.0316,1326,UnitedHealthcare,Medicare Advantage,649.74,49,,percent of total billed charges,,
Port Remove/Revision,,25002670,LOCAL,Facility,Inpatient,,,,1326,1127.1,380.0316,1326,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Port Remove/Revision,,25002670,LOCAL,Facility,Outpatient,,,,1326,1127.1,380.0316,1326,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,636.48,48,,percent of total billed charges,,100% of DHS outpatient percentage
Port Remove/Revision,,25002670,LOCAL,Facility,Inpatient,,,,1326,1127.1,380.0316,1326,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Porta Cath Insertion,,25002681,LOCAL,Facility,Both,,,,2040,1734,584.664,2040,Aetna,Commercial,1876.8,92,,percent of total billed charges,,
Porta Cath Insertion,,25002681,LOCAL,Facility,Outpatient,,,,2040,1734,584.664,2040,Aetna,Medicare Advantage,999.6,49,,percent of total billed charges,,
Porta Cath Insertion,,25002681,LOCAL,Facility,Inpatient,,,,2040,1734,584.664,2040,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Porta Cath Insertion,,25002681,LOCAL,Facility,Both,,,,2040,1734,584.664,2040,Aetna,PPO,1897.2,93,,percent of total billed charges,,
Porta Cath Insertion,,25002681,LOCAL,Facility,Both,,,,2040,1734,584.664,2040,America's PPO,America's PPO,1959.012,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Porta Cath Insertion,,25002681,LOCAL,Facility,Both,,,,2040,1734,584.664,2040,BlueCross BlueShield Minnesota, Federal Employee Program,2007.36,98.4,,percent of total billed charges,,
Porta Cath Insertion,,25002681,LOCAL,Facility,Both,,,,2040,1734,584.664,2040,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,2040,100,,percent of total billed charges,,
Porta Cath Insertion,,25002681,LOCAL,Facility,Both,,,,2040,1734,584.664,2040,BlueCross BlueShield Minnesota,High Value Network Plan,1836,90,,percent of total billed charges,,
Porta Cath Insertion,,25002681,LOCAL,Facility,Outpatient,,,,2040,1734,584.664,2040,BlueCross BlueShield Minnesota,Medicare Advantage,999.6,49,,percent of total billed charges,,
Porta Cath Insertion,,25002681,LOCAL,Facility,Inpatient,,,,2040,1734,584.664,2040,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Porta Cath Insertion,,25002681,LOCAL,Facility,Both,,,,2040,1734,584.664,2040,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1806.828,88.57,,percent of total billed charges,,
Porta Cath Insertion,,25002681,LOCAL,Facility,Both,,,,2040,1734,584.664,2040,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,584.664,28.66,,percent of total billed charges,,
Porta Cath Insertion,,25002681,LOCAL,Facility,Outpatient,,,,2040,1734,584.664,2040,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),999.6,49,,percent of total billed charges,,
Porta Cath Insertion,,25002681,LOCAL,Facility,Inpatient,,,,2040,1734,584.664,2040,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Porta Cath Insertion,,25002681,LOCAL,Facility,Both,,,,2040,1734,584.664,2040,CorVel,Worker's Compensation,2040,100,,percent of total billed charges,,
Porta Cath Insertion,,25002681,LOCAL,Facility,Both,,,,2040,1734,584.664,2040,First Health Group Corporation,First Health Network,1978.8,97,,percent of total billed charges,,
Porta Cath Insertion,,25002681,LOCAL,Facility,Both,,,,2040,1734,584.664,2040,"Health Partners, Inc.",Commercial,1929.84,94.6,,percent of total billed charges,,
Porta Cath Insertion,,25002681,LOCAL,Facility,Outpatient,,,,2040,1734,584.664,2040,"Health Partners, Inc.",Medicare Advantage,999.6,49,,percent of total billed charges,,
Porta Cath Insertion,,25002681,LOCAL,Facility,Inpatient,,,,2040,1734,584.664,2040,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Porta Cath Insertion,,25002681,LOCAL,Facility,Both,,,,2040,1734,584.664,2040,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1224,60,,percent of total billed charges,,
Porta Cath Insertion,,25002681,LOCAL,Facility,Both,,,,2040,1734,584.664,2040,"Health Partners, Inc.",State of Minnesota Advantage Program,1662.6,81.5,,percent of total billed charges,,
Porta Cath Insertion,,25002681,LOCAL,Facility,Both,,,,2040,1734,584.664,2040,"Health Partners, Inc.",State Public Programs,1020,50,,percent of total billed charges,,
Porta Cath Insertion,,25002681,LOCAL,Facility,Both,,,,2040,1734,584.664,2040,Humana Insurance Company,Commercial PPO,1938,95,,percent of total billed charges,,
Porta Cath Insertion,,25002681,LOCAL,Facility,Outpatient,,,,2040,1734,584.664,2040,Humana Insurance Company,Medicare PPO,999.6,49,,percent of total billed charges,,
Porta Cath Insertion,,25002681,LOCAL,Facility,Inpatient,,,,2040,1734,584.664,2040,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Porta Cath Insertion,,25002681,LOCAL,Facility,Both,,,,2040,1734,584.664,2040,Medica,Individual & Family,2021.64,99.1,,percent of total billed charges,,
Porta Cath Insertion,,25002681,LOCAL,Facility,Outpatient,,,,2040,1734,584.664,2040,Medica,Medica Advantage Solution,1015.92,49.8,,percent of total billed charges,,
Porta Cath Insertion,,25002681,LOCAL,Facility,Inpatient,,,,2040,1734,584.664,2040,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Porta Cath Insertion,,25002681,LOCAL,Facility,Outpatient,,,,2040,1734,584.664,2040,Medica,Medical Assistance,909.84,44.6,,percent of total billed charges,,
Porta Cath Insertion,,25002681,LOCAL,Facility,Inpatient,,,,2040,1734,584.664,2040,Medica,Medical Assistance,,,,,Included in per diem rate,
Porta Cath Insertion,,25002681,LOCAL,Facility,Outpatient,,,,2040,1734,584.664,2040,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1015.92,49.8,,percent of total billed charges,,
Porta Cath Insertion,,25002681,LOCAL,Facility,Inpatient,,,,2040,1734,584.664,2040,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Porta Cath Insertion,,25002681,LOCAL,Facility,Both,,,,2040,1734,584.664,2040,"Multiplan, Inc.","Multiplan, Inc.",1917.6,94,,percent of total billed charges,,
Porta Cath Insertion,,25002681,LOCAL,Facility,Outpatient,,,,2040,1734,584.664,2040,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1838.04,90.1,,percent of total billed charges,,
Porta Cath Insertion,,25002681,LOCAL,Facility,Inpatient,,,,2040,1734,584.664,2040,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Porta Cath Insertion,,25002681,LOCAL,Facility,Both,,,,2040,1734,584.664,2040,"Preferred One Administrative Services, INC.",PPO,2011.44,98.6,,percent of total billed charges,,
Porta Cath Insertion,,25002681,LOCAL,Facility,Outpatient,,,,2040,1734,584.664,2040,PrimeWest Health,Minnesota Senior Health Options (MSHO),1049.58,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Porta Cath Insertion,,25002681,LOCAL,Facility,Inpatient,,,,2040,1734,584.664,2040,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Porta Cath Insertion,,25002681,LOCAL,Facility,Outpatient,,,,2040,1734,584.664,2040,PrimeWest Health,MinnesotaCare,1047.744,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Porta Cath Insertion,,25002681,LOCAL,Facility,Inpatient,,,,2040,1734,584.664,2040,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Porta Cath Insertion,,25002681,LOCAL,Facility,Both,,,,2040,1734,584.664,2040,Sanford Health Plan,Sanford Health Plan,1876.8,92,,percent of total billed charges,,
Porta Cath Insertion,,25002681,LOCAL,Facility,Outpatient,,,,2040,1734,584.664,2040,"UCare Health, Inc.",Individual & Family Plan,1149.54,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Porta Cath Insertion,,25002681,LOCAL,Facility,Inpatient,,,,2040,1734,584.664,2040,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Porta Cath Insertion,,25002681,LOCAL,Facility,Outpatient,,,,2040,1734,584.664,2040,"UCare Health, Inc.",Medical Assistance,1029.588,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Porta Cath Insertion,,25002681,LOCAL,Facility,Inpatient,,,,2040,1734,584.664,2040,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Porta Cath Insertion,,25002681,LOCAL,Facility,Outpatient,,,,2040,1734,584.664,2040,"UCare Health, Inc.",Medicare Advantage,1029.588,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Porta Cath Insertion,,25002681,LOCAL,Facility,Inpatient,,,,2040,1734,584.664,2040,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Porta Cath Insertion,,25002681,LOCAL,Facility,Outpatient,,,,2040,1734,584.664,2040,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1029.588,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Porta Cath Insertion,,25002681,LOCAL,Facility,Inpatient,,,,2040,1734,584.664,2040,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Porta Cath Insertion,,25002681,LOCAL,Facility,Both,,,,2040,1734,584.664,2040,UnitedHealthcare,Individual & Family,1917.6,94,,percent of total billed charges,,
Porta Cath Insertion,,25002681,LOCAL,Facility,Outpatient,,,,2040,1734,584.664,2040,UnitedHealthcare,Medicare Advantage,999.6,49,,percent of total billed charges,,
Porta Cath Insertion,,25002681,LOCAL,Facility,Inpatient,,,,2040,1734,584.664,2040,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Porta Cath Insertion,,25002681,LOCAL,Facility,Outpatient,,,,2040,1734,584.664,2040,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,979.2,48,,percent of total billed charges,,100% of DHS outpatient percentage
Porta Cath Insertion,,25002681,LOCAL,Facility,Inpatient,,,,2040,1734,584.664,2040,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Removal Implant/Hardware,,25002768,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,Aetna,Commercial,2064.48,92,,percent of total billed charges,,
Removal Implant/Hardware,,25002768,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,Aetna,Medicare Advantage,1099.56,49,,percent of total billed charges,,
Removal Implant/Hardware,,25002768,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Removal Implant/Hardware,,25002768,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,Aetna,PPO,2086.92,93,,percent of total billed charges,,
Removal Implant/Hardware,,25002768,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,America's PPO,America's PPO,2154.9132,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Removal Implant/Hardware,,25002768,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,BlueCross BlueShield Minnesota, Federal Employee Program,2208.096,98.4,,percent of total billed charges,,
Removal Implant/Hardware,,25002768,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,2244,100,,percent of total billed charges,,
Removal Implant/Hardware,,25002768,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,BlueCross BlueShield Minnesota,High Value Network Plan,2019.6,90,,percent of total billed charges,,
Removal Implant/Hardware,,25002768,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,BlueCross BlueShield Minnesota,Medicare Advantage,1099.56,49,,percent of total billed charges,,
Removal Implant/Hardware,,25002768,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Removal Implant/Hardware,,25002768,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1987.5108,88.57,,percent of total billed charges,,
Removal Implant/Hardware,,25002768,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,643.1304,28.66,,percent of total billed charges,,
Removal Implant/Hardware,,25002768,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1099.56,49,,percent of total billed charges,,
Removal Implant/Hardware,,25002768,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Removal Implant/Hardware,,25002768,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,CorVel,Worker's Compensation,2244,100,,percent of total billed charges,,
Removal Implant/Hardware,,25002768,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,First Health Group Corporation,First Health Network,2176.68,97,,percent of total billed charges,,
Removal Implant/Hardware,,25002768,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,"Health Partners, Inc.",Commercial,2122.824,94.6,,percent of total billed charges,,
Removal Implant/Hardware,,25002768,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,"Health Partners, Inc.",Medicare Advantage,1099.56,49,,percent of total billed charges,,
Removal Implant/Hardware,,25002768,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Removal Implant/Hardware,,25002768,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1346.4,60,,percent of total billed charges,,
Removal Implant/Hardware,,25002768,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,"Health Partners, Inc.",State of Minnesota Advantage Program,1828.86,81.5,,percent of total billed charges,,
Removal Implant/Hardware,,25002768,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,"Health Partners, Inc.",State Public Programs,1122,50,,percent of total billed charges,,
Removal Implant/Hardware,,25002768,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,Humana Insurance Company,Commercial PPO,2131.8,95,,percent of total billed charges,,
Removal Implant/Hardware,,25002768,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,Humana Insurance Company,Medicare PPO,1099.56,49,,percent of total billed charges,,
Removal Implant/Hardware,,25002768,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Removal Implant/Hardware,,25002768,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,Medica,Individual & Family,2223.804,99.1,,percent of total billed charges,,
Removal Implant/Hardware,,25002768,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,Medica,Medica Advantage Solution,1117.512,49.8,,percent of total billed charges,,
Removal Implant/Hardware,,25002768,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Removal Implant/Hardware,,25002768,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,Medica,Medical Assistance,1000.824,44.6,,percent of total billed charges,,
Removal Implant/Hardware,,25002768,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,Medica,Medical Assistance,,,,,Included in per diem rate,
Removal Implant/Hardware,,25002768,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1117.512,49.8,,percent of total billed charges,,
Removal Implant/Hardware,,25002768,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Removal Implant/Hardware,,25002768,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,"Multiplan, Inc.","Multiplan, Inc.",2109.36,94,,percent of total billed charges,,
Removal Implant/Hardware,,25002768,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,2021.844,90.1,,percent of total billed charges,,
Removal Implant/Hardware,,25002768,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Removal Implant/Hardware,,25002768,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,"Preferred One Administrative Services, INC.",PPO,2212.584,98.6,,percent of total billed charges,,
Removal Implant/Hardware,,25002768,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,PrimeWest Health,Minnesota Senior Health Options (MSHO),1154.538,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Removal Implant/Hardware,,25002768,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Removal Implant/Hardware,,25002768,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,PrimeWest Health,MinnesotaCare,1152.5184,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Removal Implant/Hardware,,25002768,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Removal Implant/Hardware,,25002768,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,Sanford Health Plan,Sanford Health Plan,2064.48,92,,percent of total billed charges,,
Removal Implant/Hardware,,25002768,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,"UCare Health, Inc.",Individual & Family Plan,1264.494,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Removal Implant/Hardware,,25002768,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Removal Implant/Hardware,,25002768,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,"UCare Health, Inc.",Medical Assistance,1132.5468,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Removal Implant/Hardware,,25002768,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Removal Implant/Hardware,,25002768,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,"UCare Health, Inc.",Medicare Advantage,1132.5468,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Removal Implant/Hardware,,25002768,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Removal Implant/Hardware,,25002768,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1132.5468,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Removal Implant/Hardware,,25002768,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Removal Implant/Hardware,,25002768,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,UnitedHealthcare,Individual & Family,2109.36,94,,percent of total billed charges,,
Removal Implant/Hardware,,25002768,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,UnitedHealthcare,Medicare Advantage,1099.56,49,,percent of total billed charges,,
Removal Implant/Hardware,,25002768,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Removal Implant/Hardware,,25002768,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1077.12,48,,percent of total billed charges,,100% of DHS outpatient percentage
Removal Implant/Hardware,,25002768,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Removal/Excision Bartholin Cyst,,25002807,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,Aetna,Commercial,2064.48,92,,percent of total billed charges,,
Removal/Excision Bartholin Cyst,,25002807,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,Aetna,Medicare Advantage,1099.56,49,,percent of total billed charges,,
Removal/Excision Bartholin Cyst,,25002807,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Removal/Excision Bartholin Cyst,,25002807,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,Aetna,PPO,2086.92,93,,percent of total billed charges,,
Removal/Excision Bartholin Cyst,,25002807,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,America's PPO,America's PPO,2154.9132,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Removal/Excision Bartholin Cyst,,25002807,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,BlueCross BlueShield Minnesota, Federal Employee Program,2208.096,98.4,,percent of total billed charges,,
Removal/Excision Bartholin Cyst,,25002807,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,2244,100,,percent of total billed charges,,
Removal/Excision Bartholin Cyst,,25002807,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,BlueCross BlueShield Minnesota,High Value Network Plan,2019.6,90,,percent of total billed charges,,
Removal/Excision Bartholin Cyst,,25002807,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,BlueCross BlueShield Minnesota,Medicare Advantage,1099.56,49,,percent of total billed charges,,
Removal/Excision Bartholin Cyst,,25002807,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Removal/Excision Bartholin Cyst,,25002807,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1987.5108,88.57,,percent of total billed charges,,
Removal/Excision Bartholin Cyst,,25002807,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,643.1304,28.66,,percent of total billed charges,,
Removal/Excision Bartholin Cyst,,25002807,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1099.56,49,,percent of total billed charges,,
Removal/Excision Bartholin Cyst,,25002807,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Removal/Excision Bartholin Cyst,,25002807,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,CorVel,Worker's Compensation,2244,100,,percent of total billed charges,,
Removal/Excision Bartholin Cyst,,25002807,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,First Health Group Corporation,First Health Network,2176.68,97,,percent of total billed charges,,
Removal/Excision Bartholin Cyst,,25002807,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,"Health Partners, Inc.",Commercial,2122.824,94.6,,percent of total billed charges,,
Removal/Excision Bartholin Cyst,,25002807,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,"Health Partners, Inc.",Medicare Advantage,1099.56,49,,percent of total billed charges,,
Removal/Excision Bartholin Cyst,,25002807,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Removal/Excision Bartholin Cyst,,25002807,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1346.4,60,,percent of total billed charges,,
Removal/Excision Bartholin Cyst,,25002807,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,"Health Partners, Inc.",State of Minnesota Advantage Program,1828.86,81.5,,percent of total billed charges,,
Removal/Excision Bartholin Cyst,,25002807,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,"Health Partners, Inc.",State Public Programs,1122,50,,percent of total billed charges,,
Removal/Excision Bartholin Cyst,,25002807,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,Humana Insurance Company,Commercial PPO,2131.8,95,,percent of total billed charges,,
Removal/Excision Bartholin Cyst,,25002807,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,Humana Insurance Company,Medicare PPO,1099.56,49,,percent of total billed charges,,
Removal/Excision Bartholin Cyst,,25002807,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Removal/Excision Bartholin Cyst,,25002807,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,Medica,Individual & Family,2223.804,99.1,,percent of total billed charges,,
Removal/Excision Bartholin Cyst,,25002807,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,Medica,Medica Advantage Solution,1117.512,49.8,,percent of total billed charges,,
Removal/Excision Bartholin Cyst,,25002807,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Removal/Excision Bartholin Cyst,,25002807,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,Medica,Medical Assistance,1000.824,44.6,,percent of total billed charges,,
Removal/Excision Bartholin Cyst,,25002807,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,Medica,Medical Assistance,,,,,Included in per diem rate,
Removal/Excision Bartholin Cyst,,25002807,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1117.512,49.8,,percent of total billed charges,,
Removal/Excision Bartholin Cyst,,25002807,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Removal/Excision Bartholin Cyst,,25002807,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,"Multiplan, Inc.","Multiplan, Inc.",2109.36,94,,percent of total billed charges,,
Removal/Excision Bartholin Cyst,,25002807,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,2021.844,90.1,,percent of total billed charges,,
Removal/Excision Bartholin Cyst,,25002807,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Removal/Excision Bartholin Cyst,,25002807,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,"Preferred One Administrative Services, INC.",PPO,2212.584,98.6,,percent of total billed charges,,
Removal/Excision Bartholin Cyst,,25002807,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,PrimeWest Health,Minnesota Senior Health Options (MSHO),1154.538,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Removal/Excision Bartholin Cyst,,25002807,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Removal/Excision Bartholin Cyst,,25002807,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,PrimeWest Health,MinnesotaCare,1152.5184,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Removal/Excision Bartholin Cyst,,25002807,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Removal/Excision Bartholin Cyst,,25002807,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,Sanford Health Plan,Sanford Health Plan,2064.48,92,,percent of total billed charges,,
Removal/Excision Bartholin Cyst,,25002807,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,"UCare Health, Inc.",Individual & Family Plan,1264.494,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Removal/Excision Bartholin Cyst,,25002807,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Removal/Excision Bartholin Cyst,,25002807,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,"UCare Health, Inc.",Medical Assistance,1132.5468,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Removal/Excision Bartholin Cyst,,25002807,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Removal/Excision Bartholin Cyst,,25002807,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,"UCare Health, Inc.",Medicare Advantage,1132.5468,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Removal/Excision Bartholin Cyst,,25002807,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Removal/Excision Bartholin Cyst,,25002807,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1132.5468,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Removal/Excision Bartholin Cyst,,25002807,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Removal/Excision Bartholin Cyst,,25002807,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,UnitedHealthcare,Individual & Family,2109.36,94,,percent of total billed charges,,
Removal/Excision Bartholin Cyst,,25002807,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,UnitedHealthcare,Medicare Advantage,1099.56,49,,percent of total billed charges,,
Removal/Excision Bartholin Cyst,,25002807,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Removal/Excision Bartholin Cyst,,25002807,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1077.12,48,,percent of total billed charges,,100% of DHS outpatient percentage
Removal/Excision Bartholin Cyst,,25002807,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Salpingo-Oophorectomy,,25002937,LOCAL,Facility,Both,,,,4483,3810.55,1284.8278,4483,Aetna,Commercial,4124.36,92,,percent of total billed charges,,
Salpingo-Oophorectomy,,25002937,LOCAL,Facility,Outpatient,,,,4483,3810.55,1284.8278,4483,Aetna,Medicare Advantage,2196.67,49,,percent of total billed charges,,
Salpingo-Oophorectomy,,25002937,LOCAL,Facility,Inpatient,,,,4483,3810.55,1284.8278,4483,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Salpingo-Oophorectomy,,25002937,LOCAL,Facility,Both,,,,4483,3810.55,1284.8278,4483,Aetna,PPO,4169.19,93,,percent of total billed charges,,
Salpingo-Oophorectomy,,25002937,LOCAL,Facility,Both,,,,4483,3810.55,1284.8278,4483,America's PPO,America's PPO,4305.0249,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Salpingo-Oophorectomy,,25002937,LOCAL,Facility,Both,,,,4483,3810.55,1284.8278,4483,BlueCross BlueShield Minnesota, Federal Employee Program,4411.272,98.4,,percent of total billed charges,,
Salpingo-Oophorectomy,,25002937,LOCAL,Facility,Both,,,,4483,3810.55,1284.8278,4483,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,4483,100,,percent of total billed charges,,
Salpingo-Oophorectomy,,25002937,LOCAL,Facility,Both,,,,4483,3810.55,1284.8278,4483,BlueCross BlueShield Minnesota,High Value Network Plan,4034.7,90,,percent of total billed charges,,
Salpingo-Oophorectomy,,25002937,LOCAL,Facility,Outpatient,,,,4483,3810.55,1284.8278,4483,BlueCross BlueShield Minnesota,Medicare Advantage,2196.67,49,,percent of total billed charges,,
Salpingo-Oophorectomy,,25002937,LOCAL,Facility,Inpatient,,,,4483,3810.55,1284.8278,4483,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Salpingo-Oophorectomy,,25002937,LOCAL,Facility,Both,,,,4483,3810.55,1284.8278,4483,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,3970.5931,88.57,,percent of total billed charges,,
Salpingo-Oophorectomy,,25002937,LOCAL,Facility,Both,,,,4483,3810.55,1284.8278,4483,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1284.8278,28.66,,percent of total billed charges,,
Salpingo-Oophorectomy,,25002937,LOCAL,Facility,Outpatient,,,,4483,3810.55,1284.8278,4483,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2196.67,49,,percent of total billed charges,,
Salpingo-Oophorectomy,,25002937,LOCAL,Facility,Inpatient,,,,4483,3810.55,1284.8278,4483,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Salpingo-Oophorectomy,,25002937,LOCAL,Facility,Both,,,,4483,3810.55,1284.8278,4483,CorVel,Worker's Compensation,4483,100,,percent of total billed charges,,
Salpingo-Oophorectomy,,25002937,LOCAL,Facility,Both,,,,4483,3810.55,1284.8278,4483,First Health Group Corporation,First Health Network,4348.51,97,,percent of total billed charges,,
Salpingo-Oophorectomy,,25002937,LOCAL,Facility,Both,,,,4483,3810.55,1284.8278,4483,"Health Partners, Inc.",Commercial,4240.918,94.6,,percent of total billed charges,,
Salpingo-Oophorectomy,,25002937,LOCAL,Facility,Outpatient,,,,4483,3810.55,1284.8278,4483,"Health Partners, Inc.",Medicare Advantage,2196.67,49,,percent of total billed charges,,
Salpingo-Oophorectomy,,25002937,LOCAL,Facility,Inpatient,,,,4483,3810.55,1284.8278,4483,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Salpingo-Oophorectomy,,25002937,LOCAL,Facility,Both,,,,4483,3810.55,1284.8278,4483,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),2689.8,60,,percent of total billed charges,,
Salpingo-Oophorectomy,,25002937,LOCAL,Facility,Both,,,,4483,3810.55,1284.8278,4483,"Health Partners, Inc.",State of Minnesota Advantage Program,3653.645,81.5,,percent of total billed charges,,
Salpingo-Oophorectomy,,25002937,LOCAL,Facility,Both,,,,4483,3810.55,1284.8278,4483,"Health Partners, Inc.",State Public Programs,2241.5,50,,percent of total billed charges,,
Salpingo-Oophorectomy,,25002937,LOCAL,Facility,Both,,,,4483,3810.55,1284.8278,4483,Humana Insurance Company,Commercial PPO,4258.85,95,,percent of total billed charges,,
Salpingo-Oophorectomy,,25002937,LOCAL,Facility,Outpatient,,,,4483,3810.55,1284.8278,4483,Humana Insurance Company,Medicare PPO,2196.67,49,,percent of total billed charges,,
Salpingo-Oophorectomy,,25002937,LOCAL,Facility,Inpatient,,,,4483,3810.55,1284.8278,4483,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Salpingo-Oophorectomy,,25002937,LOCAL,Facility,Both,,,,4483,3810.55,1284.8278,4483,Medica,Individual & Family,4442.653,99.1,,percent of total billed charges,,
Salpingo-Oophorectomy,,25002937,LOCAL,Facility,Outpatient,,,,4483,3810.55,1284.8278,4483,Medica,Medica Advantage Solution,2232.534,49.8,,percent of total billed charges,,
Salpingo-Oophorectomy,,25002937,LOCAL,Facility,Inpatient,,,,4483,3810.55,1284.8278,4483,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Salpingo-Oophorectomy,,25002937,LOCAL,Facility,Outpatient,,,,4483,3810.55,1284.8278,4483,Medica,Medical Assistance,1999.418,44.6,,percent of total billed charges,,
Salpingo-Oophorectomy,,25002937,LOCAL,Facility,Inpatient,,,,4483,3810.55,1284.8278,4483,Medica,Medical Assistance,,,,,Included in per diem rate,
Salpingo-Oophorectomy,,25002937,LOCAL,Facility,Outpatient,,,,4483,3810.55,1284.8278,4483,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2232.534,49.8,,percent of total billed charges,,
Salpingo-Oophorectomy,,25002937,LOCAL,Facility,Inpatient,,,,4483,3810.55,1284.8278,4483,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Salpingo-Oophorectomy,,25002937,LOCAL,Facility,Both,,,,4483,3810.55,1284.8278,4483,"Multiplan, Inc.","Multiplan, Inc.",4214.02,94,,percent of total billed charges,,
Salpingo-Oophorectomy,,25002937,LOCAL,Facility,Outpatient,,,,4483,3810.55,1284.8278,4483,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4039.183,90.1,,percent of total billed charges,,
Salpingo-Oophorectomy,,25002937,LOCAL,Facility,Inpatient,,,,4483,3810.55,1284.8278,4483,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Salpingo-Oophorectomy,,25002937,LOCAL,Facility,Both,,,,4483,3810.55,1284.8278,4483,"Preferred One Administrative Services, INC.",PPO,4420.238,98.6,,percent of total billed charges,,
Salpingo-Oophorectomy,,25002937,LOCAL,Facility,Outpatient,,,,4483,3810.55,1284.8278,4483,PrimeWest Health,Minnesota Senior Health Options (MSHO),2306.5035,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Salpingo-Oophorectomy,,25002937,LOCAL,Facility,Inpatient,,,,4483,3810.55,1284.8278,4483,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Salpingo-Oophorectomy,,25002937,LOCAL,Facility,Outpatient,,,,4483,3810.55,1284.8278,4483,PrimeWest Health,MinnesotaCare,2302.4688,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Salpingo-Oophorectomy,,25002937,LOCAL,Facility,Inpatient,,,,4483,3810.55,1284.8278,4483,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Salpingo-Oophorectomy,,25002937,LOCAL,Facility,Both,,,,4483,3810.55,1284.8278,4483,Sanford Health Plan,Sanford Health Plan,4124.36,92,,percent of total billed charges,,
Salpingo-Oophorectomy,,25002937,LOCAL,Facility,Outpatient,,,,4483,3810.55,1284.8278,4483,"UCare Health, Inc.",Individual & Family Plan,2526.1705,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Salpingo-Oophorectomy,,25002937,LOCAL,Facility,Inpatient,,,,4483,3810.55,1284.8278,4483,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Salpingo-Oophorectomy,,25002937,LOCAL,Facility,Outpatient,,,,4483,3810.55,1284.8278,4483,"UCare Health, Inc.",Medical Assistance,2262.5701,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Salpingo-Oophorectomy,,25002937,LOCAL,Facility,Inpatient,,,,4483,3810.55,1284.8278,4483,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Salpingo-Oophorectomy,,25002937,LOCAL,Facility,Outpatient,,,,4483,3810.55,1284.8278,4483,"UCare Health, Inc.",Medicare Advantage,2262.5701,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Salpingo-Oophorectomy,,25002937,LOCAL,Facility,Inpatient,,,,4483,3810.55,1284.8278,4483,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Salpingo-Oophorectomy,,25002937,LOCAL,Facility,Outpatient,,,,4483,3810.55,1284.8278,4483,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2262.5701,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Salpingo-Oophorectomy,,25002937,LOCAL,Facility,Inpatient,,,,4483,3810.55,1284.8278,4483,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Salpingo-Oophorectomy,,25002937,LOCAL,Facility,Both,,,,4483,3810.55,1284.8278,4483,UnitedHealthcare,Individual & Family,4214.02,94,,percent of total billed charges,,
Salpingo-Oophorectomy,,25002937,LOCAL,Facility,Outpatient,,,,4483,3810.55,1284.8278,4483,UnitedHealthcare,Medicare Advantage,2196.67,49,,percent of total billed charges,,
Salpingo-Oophorectomy,,25002937,LOCAL,Facility,Inpatient,,,,4483,3810.55,1284.8278,4483,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Salpingo-Oophorectomy,,25002937,LOCAL,Facility,Outpatient,,,,4483,3810.55,1284.8278,4483,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2151.84,48,,percent of total billed charges,,100% of DHS outpatient percentage
Salpingo-Oophorectomy,,25002937,LOCAL,Facility,Inpatient,,,,4483,3810.55,1284.8278,4483,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Skin Graft,,25003093,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,Aetna,Commercial,2064.48,92,,percent of total billed charges,,
Skin Graft,,25003093,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,Aetna,Medicare Advantage,1099.56,49,,percent of total billed charges,,
Skin Graft,,25003093,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Skin Graft,,25003093,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,Aetna,PPO,2086.92,93,,percent of total billed charges,,
Skin Graft,,25003093,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,America's PPO,America's PPO,2154.9132,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Skin Graft,,25003093,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,BlueCross BlueShield Minnesota, Federal Employee Program,2208.096,98.4,,percent of total billed charges,,
Skin Graft,,25003093,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,2244,100,,percent of total billed charges,,
Skin Graft,,25003093,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,BlueCross BlueShield Minnesota,High Value Network Plan,2019.6,90,,percent of total billed charges,,
Skin Graft,,25003093,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,BlueCross BlueShield Minnesota,Medicare Advantage,1099.56,49,,percent of total billed charges,,
Skin Graft,,25003093,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Skin Graft,,25003093,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1987.5108,88.57,,percent of total billed charges,,
Skin Graft,,25003093,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,643.1304,28.66,,percent of total billed charges,,
Skin Graft,,25003093,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1099.56,49,,percent of total billed charges,,
Skin Graft,,25003093,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Skin Graft,,25003093,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,CorVel,Worker's Compensation,2244,100,,percent of total billed charges,,
Skin Graft,,25003093,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,First Health Group Corporation,First Health Network,2176.68,97,,percent of total billed charges,,
Skin Graft,,25003093,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,"Health Partners, Inc.",Commercial,2122.824,94.6,,percent of total billed charges,,
Skin Graft,,25003093,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,"Health Partners, Inc.",Medicare Advantage,1099.56,49,,percent of total billed charges,,
Skin Graft,,25003093,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Skin Graft,,25003093,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1346.4,60,,percent of total billed charges,,
Skin Graft,,25003093,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,"Health Partners, Inc.",State of Minnesota Advantage Program,1828.86,81.5,,percent of total billed charges,,
Skin Graft,,25003093,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,"Health Partners, Inc.",State Public Programs,1122,50,,percent of total billed charges,,
Skin Graft,,25003093,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,Humana Insurance Company,Commercial PPO,2131.8,95,,percent of total billed charges,,
Skin Graft,,25003093,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,Humana Insurance Company,Medicare PPO,1099.56,49,,percent of total billed charges,,
Skin Graft,,25003093,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Skin Graft,,25003093,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,Medica,Individual & Family,2223.804,99.1,,percent of total billed charges,,
Skin Graft,,25003093,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,Medica,Medica Advantage Solution,1117.512,49.8,,percent of total billed charges,,
Skin Graft,,25003093,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Skin Graft,,25003093,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,Medica,Medical Assistance,1000.824,44.6,,percent of total billed charges,,
Skin Graft,,25003093,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,Medica,Medical Assistance,,,,,Included in per diem rate,
Skin Graft,,25003093,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1117.512,49.8,,percent of total billed charges,,
Skin Graft,,25003093,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Skin Graft,,25003093,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,"Multiplan, Inc.","Multiplan, Inc.",2109.36,94,,percent of total billed charges,,
Skin Graft,,25003093,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,2021.844,90.1,,percent of total billed charges,,
Skin Graft,,25003093,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Skin Graft,,25003093,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,"Preferred One Administrative Services, INC.",PPO,2212.584,98.6,,percent of total billed charges,,
Skin Graft,,25003093,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,PrimeWest Health,Minnesota Senior Health Options (MSHO),1154.538,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Skin Graft,,25003093,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Skin Graft,,25003093,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,PrimeWest Health,MinnesotaCare,1152.5184,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Skin Graft,,25003093,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Skin Graft,,25003093,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,Sanford Health Plan,Sanford Health Plan,2064.48,92,,percent of total billed charges,,
Skin Graft,,25003093,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,"UCare Health, Inc.",Individual & Family Plan,1264.494,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Skin Graft,,25003093,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Skin Graft,,25003093,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,"UCare Health, Inc.",Medical Assistance,1132.5468,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Skin Graft,,25003093,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Skin Graft,,25003093,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,"UCare Health, Inc.",Medicare Advantage,1132.5468,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Skin Graft,,25003093,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Skin Graft,,25003093,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1132.5468,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Skin Graft,,25003093,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Skin Graft,,25003093,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,UnitedHealthcare,Individual & Family,2109.36,94,,percent of total billed charges,,
Skin Graft,,25003093,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,UnitedHealthcare,Medicare Advantage,1099.56,49,,percent of total billed charges,,
Skin Graft,,25003093,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Skin Graft,,25003093,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1077.12,48,,percent of total billed charges,,100% of DHS outpatient percentage
Skin Graft,,25003093,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Spermatocelectomy,,25003105,LOCAL,Facility,Both,,,,3060,2601,876.996,3060,Aetna,Commercial,2815.2,92,,percent of total billed charges,,
Spermatocelectomy,,25003105,LOCAL,Facility,Outpatient,,,,3060,2601,876.996,3060,Aetna,Medicare Advantage,1499.4,49,,percent of total billed charges,,
Spermatocelectomy,,25003105,LOCAL,Facility,Inpatient,,,,3060,2601,876.996,3060,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Spermatocelectomy,,25003105,LOCAL,Facility,Both,,,,3060,2601,876.996,3060,Aetna,PPO,2845.8,93,,percent of total billed charges,,
Spermatocelectomy,,25003105,LOCAL,Facility,Both,,,,3060,2601,876.996,3060,America's PPO,America's PPO,2938.518,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Spermatocelectomy,,25003105,LOCAL,Facility,Both,,,,3060,2601,876.996,3060,BlueCross BlueShield Minnesota, Federal Employee Program,3011.04,98.4,,percent of total billed charges,,
Spermatocelectomy,,25003105,LOCAL,Facility,Both,,,,3060,2601,876.996,3060,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,3060,100,,percent of total billed charges,,
Spermatocelectomy,,25003105,LOCAL,Facility,Both,,,,3060,2601,876.996,3060,BlueCross BlueShield Minnesota,High Value Network Plan,2754,90,,percent of total billed charges,,
Spermatocelectomy,,25003105,LOCAL,Facility,Outpatient,,,,3060,2601,876.996,3060,BlueCross BlueShield Minnesota,Medicare Advantage,1499.4,49,,percent of total billed charges,,
Spermatocelectomy,,25003105,LOCAL,Facility,Inpatient,,,,3060,2601,876.996,3060,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Spermatocelectomy,,25003105,LOCAL,Facility,Both,,,,3060,2601,876.996,3060,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,2710.242,88.57,,percent of total billed charges,,
Spermatocelectomy,,25003105,LOCAL,Facility,Both,,,,3060,2601,876.996,3060,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,876.996,28.66,,percent of total billed charges,,
Spermatocelectomy,,25003105,LOCAL,Facility,Outpatient,,,,3060,2601,876.996,3060,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1499.4,49,,percent of total billed charges,,
Spermatocelectomy,,25003105,LOCAL,Facility,Inpatient,,,,3060,2601,876.996,3060,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Spermatocelectomy,,25003105,LOCAL,Facility,Both,,,,3060,2601,876.996,3060,CorVel,Worker's Compensation,3060,100,,percent of total billed charges,,
Spermatocelectomy,,25003105,LOCAL,Facility,Both,,,,3060,2601,876.996,3060,First Health Group Corporation,First Health Network,2968.2,97,,percent of total billed charges,,
Spermatocelectomy,,25003105,LOCAL,Facility,Both,,,,3060,2601,876.996,3060,"Health Partners, Inc.",Commercial,2894.76,94.6,,percent of total billed charges,,
Spermatocelectomy,,25003105,LOCAL,Facility,Outpatient,,,,3060,2601,876.996,3060,"Health Partners, Inc.",Medicare Advantage,1499.4,49,,percent of total billed charges,,
Spermatocelectomy,,25003105,LOCAL,Facility,Inpatient,,,,3060,2601,876.996,3060,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Spermatocelectomy,,25003105,LOCAL,Facility,Both,,,,3060,2601,876.996,3060,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1836,60,,percent of total billed charges,,
Spermatocelectomy,,25003105,LOCAL,Facility,Both,,,,3060,2601,876.996,3060,"Health Partners, Inc.",State of Minnesota Advantage Program,2493.9,81.5,,percent of total billed charges,,
Spermatocelectomy,,25003105,LOCAL,Facility,Both,,,,3060,2601,876.996,3060,"Health Partners, Inc.",State Public Programs,1530,50,,percent of total billed charges,,
Spermatocelectomy,,25003105,LOCAL,Facility,Both,,,,3060,2601,876.996,3060,Humana Insurance Company,Commercial PPO,2907,95,,percent of total billed charges,,
Spermatocelectomy,,25003105,LOCAL,Facility,Outpatient,,,,3060,2601,876.996,3060,Humana Insurance Company,Medicare PPO,1499.4,49,,percent of total billed charges,,
Spermatocelectomy,,25003105,LOCAL,Facility,Inpatient,,,,3060,2601,876.996,3060,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Spermatocelectomy,,25003105,LOCAL,Facility,Both,,,,3060,2601,876.996,3060,Medica,Individual & Family,3032.46,99.1,,percent of total billed charges,,
Spermatocelectomy,,25003105,LOCAL,Facility,Outpatient,,,,3060,2601,876.996,3060,Medica,Medica Advantage Solution,1523.88,49.8,,percent of total billed charges,,
Spermatocelectomy,,25003105,LOCAL,Facility,Inpatient,,,,3060,2601,876.996,3060,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Spermatocelectomy,,25003105,LOCAL,Facility,Outpatient,,,,3060,2601,876.996,3060,Medica,Medical Assistance,1364.76,44.6,,percent of total billed charges,,
Spermatocelectomy,,25003105,LOCAL,Facility,Inpatient,,,,3060,2601,876.996,3060,Medica,Medical Assistance,,,,,Included in per diem rate,
Spermatocelectomy,,25003105,LOCAL,Facility,Outpatient,,,,3060,2601,876.996,3060,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1523.88,49.8,,percent of total billed charges,,
Spermatocelectomy,,25003105,LOCAL,Facility,Inpatient,,,,3060,2601,876.996,3060,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Spermatocelectomy,,25003105,LOCAL,Facility,Both,,,,3060,2601,876.996,3060,"Multiplan, Inc.","Multiplan, Inc.",2876.4,94,,percent of total billed charges,,
Spermatocelectomy,,25003105,LOCAL,Facility,Outpatient,,,,3060,2601,876.996,3060,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,2757.06,90.1,,percent of total billed charges,,
Spermatocelectomy,,25003105,LOCAL,Facility,Inpatient,,,,3060,2601,876.996,3060,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Spermatocelectomy,,25003105,LOCAL,Facility,Both,,,,3060,2601,876.996,3060,"Preferred One Administrative Services, INC.",PPO,3017.16,98.6,,percent of total billed charges,,
Spermatocelectomy,,25003105,LOCAL,Facility,Outpatient,,,,3060,2601,876.996,3060,PrimeWest Health,Minnesota Senior Health Options (MSHO),1574.37,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Spermatocelectomy,,25003105,LOCAL,Facility,Inpatient,,,,3060,2601,876.996,3060,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Spermatocelectomy,,25003105,LOCAL,Facility,Outpatient,,,,3060,2601,876.996,3060,PrimeWest Health,MinnesotaCare,1571.616,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Spermatocelectomy,,25003105,LOCAL,Facility,Inpatient,,,,3060,2601,876.996,3060,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Spermatocelectomy,,25003105,LOCAL,Facility,Both,,,,3060,2601,876.996,3060,Sanford Health Plan,Sanford Health Plan,2815.2,92,,percent of total billed charges,,
Spermatocelectomy,,25003105,LOCAL,Facility,Outpatient,,,,3060,2601,876.996,3060,"UCare Health, Inc.",Individual & Family Plan,1724.31,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Spermatocelectomy,,25003105,LOCAL,Facility,Inpatient,,,,3060,2601,876.996,3060,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Spermatocelectomy,,25003105,LOCAL,Facility,Outpatient,,,,3060,2601,876.996,3060,"UCare Health, Inc.",Medical Assistance,1544.382,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Spermatocelectomy,,25003105,LOCAL,Facility,Inpatient,,,,3060,2601,876.996,3060,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Spermatocelectomy,,25003105,LOCAL,Facility,Outpatient,,,,3060,2601,876.996,3060,"UCare Health, Inc.",Medicare Advantage,1544.382,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Spermatocelectomy,,25003105,LOCAL,Facility,Inpatient,,,,3060,2601,876.996,3060,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Spermatocelectomy,,25003105,LOCAL,Facility,Outpatient,,,,3060,2601,876.996,3060,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1544.382,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Spermatocelectomy,,25003105,LOCAL,Facility,Inpatient,,,,3060,2601,876.996,3060,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Spermatocelectomy,,25003105,LOCAL,Facility,Both,,,,3060,2601,876.996,3060,UnitedHealthcare,Individual & Family,2876.4,94,,percent of total billed charges,,
Spermatocelectomy,,25003105,LOCAL,Facility,Outpatient,,,,3060,2601,876.996,3060,UnitedHealthcare,Medicare Advantage,1499.4,49,,percent of total billed charges,,
Spermatocelectomy,,25003105,LOCAL,Facility,Inpatient,,,,3060,2601,876.996,3060,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Spermatocelectomy,,25003105,LOCAL,Facility,Outpatient,,,,3060,2601,876.996,3060,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1468.8,48,,percent of total billed charges,,100% of DHS outpatient percentage
Spermatocelectomy,,25003105,LOCAL,Facility,Inpatient,,,,3060,2601,876.996,3060,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Temporal Artery Biopsy,,25003169,LOCAL,Facility,Both,,,,2305,1959.25,660.613,2305,Aetna,Commercial,2120.6,92,,percent of total billed charges,,
Temporal Artery Biopsy,,25003169,LOCAL,Facility,Outpatient,,,,2305,1959.25,660.613,2305,Aetna,Medicare Advantage,1129.45,49,,percent of total billed charges,,
Temporal Artery Biopsy,,25003169,LOCAL,Facility,Inpatient,,,,2305,1959.25,660.613,2305,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Temporal Artery Biopsy,,25003169,LOCAL,Facility,Both,,,,2305,1959.25,660.613,2305,Aetna,PPO,2143.65,93,,percent of total billed charges,,
Temporal Artery Biopsy,,25003169,LOCAL,Facility,Both,,,,2305,1959.25,660.613,2305,America's PPO,America's PPO,2213.4915,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Temporal Artery Biopsy,,25003169,LOCAL,Facility,Both,,,,2305,1959.25,660.613,2305,BlueCross BlueShield Minnesota, Federal Employee Program,2268.12,98.4,,percent of total billed charges,,
Temporal Artery Biopsy,,25003169,LOCAL,Facility,Both,,,,2305,1959.25,660.613,2305,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,2305,100,,percent of total billed charges,,
Temporal Artery Biopsy,,25003169,LOCAL,Facility,Both,,,,2305,1959.25,660.613,2305,BlueCross BlueShield Minnesota,High Value Network Plan,2074.5,90,,percent of total billed charges,,
Temporal Artery Biopsy,,25003169,LOCAL,Facility,Outpatient,,,,2305,1959.25,660.613,2305,BlueCross BlueShield Minnesota,Medicare Advantage,1129.45,49,,percent of total billed charges,,
Temporal Artery Biopsy,,25003169,LOCAL,Facility,Inpatient,,,,2305,1959.25,660.613,2305,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Temporal Artery Biopsy,,25003169,LOCAL,Facility,Both,,,,2305,1959.25,660.613,2305,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,2041.5385,88.57,,percent of total billed charges,,
Temporal Artery Biopsy,,25003169,LOCAL,Facility,Both,,,,2305,1959.25,660.613,2305,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,660.613,28.66,,percent of total billed charges,,
Temporal Artery Biopsy,,25003169,LOCAL,Facility,Outpatient,,,,2305,1959.25,660.613,2305,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1129.45,49,,percent of total billed charges,,
Temporal Artery Biopsy,,25003169,LOCAL,Facility,Inpatient,,,,2305,1959.25,660.613,2305,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Temporal Artery Biopsy,,25003169,LOCAL,Facility,Both,,,,2305,1959.25,660.613,2305,CorVel,Worker's Compensation,2305,100,,percent of total billed charges,,
Temporal Artery Biopsy,,25003169,LOCAL,Facility,Both,,,,2305,1959.25,660.613,2305,First Health Group Corporation,First Health Network,2235.85,97,,percent of total billed charges,,
Temporal Artery Biopsy,,25003169,LOCAL,Facility,Both,,,,2305,1959.25,660.613,2305,"Health Partners, Inc.",Commercial,2180.53,94.6,,percent of total billed charges,,
Temporal Artery Biopsy,,25003169,LOCAL,Facility,Outpatient,,,,2305,1959.25,660.613,2305,"Health Partners, Inc.",Medicare Advantage,1129.45,49,,percent of total billed charges,,
Temporal Artery Biopsy,,25003169,LOCAL,Facility,Inpatient,,,,2305,1959.25,660.613,2305,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Temporal Artery Biopsy,,25003169,LOCAL,Facility,Both,,,,2305,1959.25,660.613,2305,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1383,60,,percent of total billed charges,,
Temporal Artery Biopsy,,25003169,LOCAL,Facility,Both,,,,2305,1959.25,660.613,2305,"Health Partners, Inc.",State of Minnesota Advantage Program,1878.575,81.5,,percent of total billed charges,,
Temporal Artery Biopsy,,25003169,LOCAL,Facility,Both,,,,2305,1959.25,660.613,2305,"Health Partners, Inc.",State Public Programs,1152.5,50,,percent of total billed charges,,
Temporal Artery Biopsy,,25003169,LOCAL,Facility,Both,,,,2305,1959.25,660.613,2305,Humana Insurance Company,Commercial PPO,2189.75,95,,percent of total billed charges,,
Temporal Artery Biopsy,,25003169,LOCAL,Facility,Outpatient,,,,2305,1959.25,660.613,2305,Humana Insurance Company,Medicare PPO,1129.45,49,,percent of total billed charges,,
Temporal Artery Biopsy,,25003169,LOCAL,Facility,Inpatient,,,,2305,1959.25,660.613,2305,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Temporal Artery Biopsy,,25003169,LOCAL,Facility,Both,,,,2305,1959.25,660.613,2305,Medica,Individual & Family,2284.255,99.1,,percent of total billed charges,,
Temporal Artery Biopsy,,25003169,LOCAL,Facility,Outpatient,,,,2305,1959.25,660.613,2305,Medica,Medica Advantage Solution,1147.89,49.8,,percent of total billed charges,,
Temporal Artery Biopsy,,25003169,LOCAL,Facility,Inpatient,,,,2305,1959.25,660.613,2305,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Temporal Artery Biopsy,,25003169,LOCAL,Facility,Outpatient,,,,2305,1959.25,660.613,2305,Medica,Medical Assistance,1028.03,44.6,,percent of total billed charges,,
Temporal Artery Biopsy,,25003169,LOCAL,Facility,Inpatient,,,,2305,1959.25,660.613,2305,Medica,Medical Assistance,,,,,Included in per diem rate,
Temporal Artery Biopsy,,25003169,LOCAL,Facility,Outpatient,,,,2305,1959.25,660.613,2305,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1147.89,49.8,,percent of total billed charges,,
Temporal Artery Biopsy,,25003169,LOCAL,Facility,Inpatient,,,,2305,1959.25,660.613,2305,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Temporal Artery Biopsy,,25003169,LOCAL,Facility,Both,,,,2305,1959.25,660.613,2305,"Multiplan, Inc.","Multiplan, Inc.",2166.7,94,,percent of total billed charges,,
Temporal Artery Biopsy,,25003169,LOCAL,Facility,Outpatient,,,,2305,1959.25,660.613,2305,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,2076.805,90.1,,percent of total billed charges,,
Temporal Artery Biopsy,,25003169,LOCAL,Facility,Inpatient,,,,2305,1959.25,660.613,2305,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Temporal Artery Biopsy,,25003169,LOCAL,Facility,Both,,,,2305,1959.25,660.613,2305,"Preferred One Administrative Services, INC.",PPO,2272.73,98.6,,percent of total billed charges,,
Temporal Artery Biopsy,,25003169,LOCAL,Facility,Outpatient,,,,2305,1959.25,660.613,2305,PrimeWest Health,Minnesota Senior Health Options (MSHO),1185.9225,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Temporal Artery Biopsy,,25003169,LOCAL,Facility,Inpatient,,,,2305,1959.25,660.613,2305,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Temporal Artery Biopsy,,25003169,LOCAL,Facility,Outpatient,,,,2305,1959.25,660.613,2305,PrimeWest Health,MinnesotaCare,1183.848,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Temporal Artery Biopsy,,25003169,LOCAL,Facility,Inpatient,,,,2305,1959.25,660.613,2305,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Temporal Artery Biopsy,,25003169,LOCAL,Facility,Both,,,,2305,1959.25,660.613,2305,Sanford Health Plan,Sanford Health Plan,2120.6,92,,percent of total billed charges,,
Temporal Artery Biopsy,,25003169,LOCAL,Facility,Outpatient,,,,2305,1959.25,660.613,2305,"UCare Health, Inc.",Individual & Family Plan,1298.8675,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Temporal Artery Biopsy,,25003169,LOCAL,Facility,Inpatient,,,,2305,1959.25,660.613,2305,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Temporal Artery Biopsy,,25003169,LOCAL,Facility,Outpatient,,,,2305,1959.25,660.613,2305,"UCare Health, Inc.",Medical Assistance,1163.3335,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Temporal Artery Biopsy,,25003169,LOCAL,Facility,Inpatient,,,,2305,1959.25,660.613,2305,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Temporal Artery Biopsy,,25003169,LOCAL,Facility,Outpatient,,,,2305,1959.25,660.613,2305,"UCare Health, Inc.",Medicare Advantage,1163.3335,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Temporal Artery Biopsy,,25003169,LOCAL,Facility,Inpatient,,,,2305,1959.25,660.613,2305,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Temporal Artery Biopsy,,25003169,LOCAL,Facility,Outpatient,,,,2305,1959.25,660.613,2305,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1163.3335,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Temporal Artery Biopsy,,25003169,LOCAL,Facility,Inpatient,,,,2305,1959.25,660.613,2305,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Temporal Artery Biopsy,,25003169,LOCAL,Facility,Both,,,,2305,1959.25,660.613,2305,UnitedHealthcare,Individual & Family,2166.7,94,,percent of total billed charges,,
Temporal Artery Biopsy,,25003169,LOCAL,Facility,Outpatient,,,,2305,1959.25,660.613,2305,UnitedHealthcare,Medicare Advantage,1129.45,49,,percent of total billed charges,,
Temporal Artery Biopsy,,25003169,LOCAL,Facility,Inpatient,,,,2305,1959.25,660.613,2305,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Temporal Artery Biopsy,,25003169,LOCAL,Facility,Outpatient,,,,2305,1959.25,660.613,2305,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1106.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
Temporal Artery Biopsy,,25003169,LOCAL,Facility,Inpatient,,,,2305,1959.25,660.613,2305,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Tendon Repair,,25003187,LOCAL,Facility,Both,,,,4070,3459.5,1166.462,4070,Aetna,Commercial,3744.4,92,,percent of total billed charges,,
Tendon Repair,,25003187,LOCAL,Facility,Outpatient,,,,4070,3459.5,1166.462,4070,Aetna,Medicare Advantage,1994.3,49,,percent of total billed charges,,
Tendon Repair,,25003187,LOCAL,Facility,Inpatient,,,,4070,3459.5,1166.462,4070,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Tendon Repair,,25003187,LOCAL,Facility,Both,,,,4070,3459.5,1166.462,4070,Aetna,PPO,3785.1,93,,percent of total billed charges,,
Tendon Repair,,25003187,LOCAL,Facility,Both,,,,4070,3459.5,1166.462,4070,America's PPO,America's PPO,3908.421,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Tendon Repair,,25003187,LOCAL,Facility,Both,,,,4070,3459.5,1166.462,4070,BlueCross BlueShield Minnesota, Federal Employee Program,4004.88,98.4,,percent of total billed charges,,
Tendon Repair,,25003187,LOCAL,Facility,Both,,,,4070,3459.5,1166.462,4070,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,4070,100,,percent of total billed charges,,
Tendon Repair,,25003187,LOCAL,Facility,Both,,,,4070,3459.5,1166.462,4070,BlueCross BlueShield Minnesota,High Value Network Plan,3663,90,,percent of total billed charges,,
Tendon Repair,,25003187,LOCAL,Facility,Outpatient,,,,4070,3459.5,1166.462,4070,BlueCross BlueShield Minnesota,Medicare Advantage,1994.3,49,,percent of total billed charges,,
Tendon Repair,,25003187,LOCAL,Facility,Inpatient,,,,4070,3459.5,1166.462,4070,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Tendon Repair,,25003187,LOCAL,Facility,Both,,,,4070,3459.5,1166.462,4070,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,3604.799,88.57,,percent of total billed charges,,
Tendon Repair,,25003187,LOCAL,Facility,Both,,,,4070,3459.5,1166.462,4070,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1166.462,28.66,,percent of total billed charges,,
Tendon Repair,,25003187,LOCAL,Facility,Outpatient,,,,4070,3459.5,1166.462,4070,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1994.3,49,,percent of total billed charges,,
Tendon Repair,,25003187,LOCAL,Facility,Inpatient,,,,4070,3459.5,1166.462,4070,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Tendon Repair,,25003187,LOCAL,Facility,Both,,,,4070,3459.5,1166.462,4070,CorVel,Worker's Compensation,4070,100,,percent of total billed charges,,
Tendon Repair,,25003187,LOCAL,Facility,Both,,,,4070,3459.5,1166.462,4070,First Health Group Corporation,First Health Network,3947.9,97,,percent of total billed charges,,
Tendon Repair,,25003187,LOCAL,Facility,Both,,,,4070,3459.5,1166.462,4070,"Health Partners, Inc.",Commercial,3850.22,94.6,,percent of total billed charges,,
Tendon Repair,,25003187,LOCAL,Facility,Outpatient,,,,4070,3459.5,1166.462,4070,"Health Partners, Inc.",Medicare Advantage,1994.3,49,,percent of total billed charges,,
Tendon Repair,,25003187,LOCAL,Facility,Inpatient,,,,4070,3459.5,1166.462,4070,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Tendon Repair,,25003187,LOCAL,Facility,Both,,,,4070,3459.5,1166.462,4070,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),2442,60,,percent of total billed charges,,
Tendon Repair,,25003187,LOCAL,Facility,Both,,,,4070,3459.5,1166.462,4070,"Health Partners, Inc.",State of Minnesota Advantage Program,3317.05,81.5,,percent of total billed charges,,
Tendon Repair,,25003187,LOCAL,Facility,Both,,,,4070,3459.5,1166.462,4070,"Health Partners, Inc.",State Public Programs,2035,50,,percent of total billed charges,,
Tendon Repair,,25003187,LOCAL,Facility,Both,,,,4070,3459.5,1166.462,4070,Humana Insurance Company,Commercial PPO,3866.5,95,,percent of total billed charges,,
Tendon Repair,,25003187,LOCAL,Facility,Outpatient,,,,4070,3459.5,1166.462,4070,Humana Insurance Company,Medicare PPO,1994.3,49,,percent of total billed charges,,
Tendon Repair,,25003187,LOCAL,Facility,Inpatient,,,,4070,3459.5,1166.462,4070,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Tendon Repair,,25003187,LOCAL,Facility,Both,,,,4070,3459.5,1166.462,4070,Medica,Individual & Family,4033.37,99.1,,percent of total billed charges,,
Tendon Repair,,25003187,LOCAL,Facility,Outpatient,,,,4070,3459.5,1166.462,4070,Medica,Medica Advantage Solution,2026.86,49.8,,percent of total billed charges,,
Tendon Repair,,25003187,LOCAL,Facility,Inpatient,,,,4070,3459.5,1166.462,4070,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Tendon Repair,,25003187,LOCAL,Facility,Outpatient,,,,4070,3459.5,1166.462,4070,Medica,Medical Assistance,1815.22,44.6,,percent of total billed charges,,
Tendon Repair,,25003187,LOCAL,Facility,Inpatient,,,,4070,3459.5,1166.462,4070,Medica,Medical Assistance,,,,,Included in per diem rate,
Tendon Repair,,25003187,LOCAL,Facility,Outpatient,,,,4070,3459.5,1166.462,4070,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2026.86,49.8,,percent of total billed charges,,
Tendon Repair,,25003187,LOCAL,Facility,Inpatient,,,,4070,3459.5,1166.462,4070,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Tendon Repair,,25003187,LOCAL,Facility,Both,,,,4070,3459.5,1166.462,4070,"Multiplan, Inc.","Multiplan, Inc.",3825.8,94,,percent of total billed charges,,
Tendon Repair,,25003187,LOCAL,Facility,Outpatient,,,,4070,3459.5,1166.462,4070,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,3667.07,90.1,,percent of total billed charges,,
Tendon Repair,,25003187,LOCAL,Facility,Inpatient,,,,4070,3459.5,1166.462,4070,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Tendon Repair,,25003187,LOCAL,Facility,Both,,,,4070,3459.5,1166.462,4070,"Preferred One Administrative Services, INC.",PPO,4013.02,98.6,,percent of total billed charges,,
Tendon Repair,,25003187,LOCAL,Facility,Outpatient,,,,4070,3459.5,1166.462,4070,PrimeWest Health,Minnesota Senior Health Options (MSHO),2094.015,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Tendon Repair,,25003187,LOCAL,Facility,Inpatient,,,,4070,3459.5,1166.462,4070,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Tendon Repair,,25003187,LOCAL,Facility,Outpatient,,,,4070,3459.5,1166.462,4070,PrimeWest Health,MinnesotaCare,2090.352,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Tendon Repair,,25003187,LOCAL,Facility,Inpatient,,,,4070,3459.5,1166.462,4070,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Tendon Repair,,25003187,LOCAL,Facility,Both,,,,4070,3459.5,1166.462,4070,Sanford Health Plan,Sanford Health Plan,3744.4,92,,percent of total billed charges,,
Tendon Repair,,25003187,LOCAL,Facility,Outpatient,,,,4070,3459.5,1166.462,4070,"UCare Health, Inc.",Individual & Family Plan,2293.445,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Tendon Repair,,25003187,LOCAL,Facility,Inpatient,,,,4070,3459.5,1166.462,4070,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Tendon Repair,,25003187,LOCAL,Facility,Outpatient,,,,4070,3459.5,1166.462,4070,"UCare Health, Inc.",Medical Assistance,2054.129,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Tendon Repair,,25003187,LOCAL,Facility,Inpatient,,,,4070,3459.5,1166.462,4070,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Tendon Repair,,25003187,LOCAL,Facility,Outpatient,,,,4070,3459.5,1166.462,4070,"UCare Health, Inc.",Medicare Advantage,2054.129,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Tendon Repair,,25003187,LOCAL,Facility,Inpatient,,,,4070,3459.5,1166.462,4070,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Tendon Repair,,25003187,LOCAL,Facility,Outpatient,,,,4070,3459.5,1166.462,4070,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2054.129,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Tendon Repair,,25003187,LOCAL,Facility,Inpatient,,,,4070,3459.5,1166.462,4070,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Tendon Repair,,25003187,LOCAL,Facility,Both,,,,4070,3459.5,1166.462,4070,UnitedHealthcare,Individual & Family,3825.8,94,,percent of total billed charges,,
Tendon Repair,,25003187,LOCAL,Facility,Outpatient,,,,4070,3459.5,1166.462,4070,UnitedHealthcare,Medicare Advantage,1994.3,49,,percent of total billed charges,,
Tendon Repair,,25003187,LOCAL,Facility,Inpatient,,,,4070,3459.5,1166.462,4070,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Tendon Repair,,25003187,LOCAL,Facility,Outpatient,,,,4070,3459.5,1166.462,4070,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1953.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
Tendon Repair,,25003187,LOCAL,Facility,Inpatient,,,,4070,3459.5,1166.462,4070,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Thyroid Lobectomy Isthmusectomy,,25003232,LOCAL,Facility,Both,,,,4488,3814.8,1286.2608,4488,Aetna,Commercial,4128.96,92,,percent of total billed charges,,
Thyroid Lobectomy Isthmusectomy,,25003232,LOCAL,Facility,Outpatient,,,,4488,3814.8,1286.2608,4488,Aetna,Medicare Advantage,2199.12,49,,percent of total billed charges,,
Thyroid Lobectomy Isthmusectomy,,25003232,LOCAL,Facility,Inpatient,,,,4488,3814.8,1286.2608,4488,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Thyroid Lobectomy Isthmusectomy,,25003232,LOCAL,Facility,Both,,,,4488,3814.8,1286.2608,4488,Aetna,PPO,4173.84,93,,percent of total billed charges,,
Thyroid Lobectomy Isthmusectomy,,25003232,LOCAL,Facility,Both,,,,4488,3814.8,1286.2608,4488,America's PPO,America's PPO,4309.8264,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Thyroid Lobectomy Isthmusectomy,,25003232,LOCAL,Facility,Both,,,,4488,3814.8,1286.2608,4488,BlueCross BlueShield Minnesota, Federal Employee Program,4416.192,98.4,,percent of total billed charges,,
Thyroid Lobectomy Isthmusectomy,,25003232,LOCAL,Facility,Both,,,,4488,3814.8,1286.2608,4488,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,4488,100,,percent of total billed charges,,
Thyroid Lobectomy Isthmusectomy,,25003232,LOCAL,Facility,Both,,,,4488,3814.8,1286.2608,4488,BlueCross BlueShield Minnesota,High Value Network Plan,4039.2,90,,percent of total billed charges,,
Thyroid Lobectomy Isthmusectomy,,25003232,LOCAL,Facility,Outpatient,,,,4488,3814.8,1286.2608,4488,BlueCross BlueShield Minnesota,Medicare Advantage,2199.12,49,,percent of total billed charges,,
Thyroid Lobectomy Isthmusectomy,,25003232,LOCAL,Facility,Inpatient,,,,4488,3814.8,1286.2608,4488,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Thyroid Lobectomy Isthmusectomy,,25003232,LOCAL,Facility,Both,,,,4488,3814.8,1286.2608,4488,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,3975.0216,88.57,,percent of total billed charges,,
Thyroid Lobectomy Isthmusectomy,,25003232,LOCAL,Facility,Both,,,,4488,3814.8,1286.2608,4488,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1286.2608,28.66,,percent of total billed charges,,
Thyroid Lobectomy Isthmusectomy,,25003232,LOCAL,Facility,Outpatient,,,,4488,3814.8,1286.2608,4488,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2199.12,49,,percent of total billed charges,,
Thyroid Lobectomy Isthmusectomy,,25003232,LOCAL,Facility,Inpatient,,,,4488,3814.8,1286.2608,4488,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Thyroid Lobectomy Isthmusectomy,,25003232,LOCAL,Facility,Both,,,,4488,3814.8,1286.2608,4488,CorVel,Worker's Compensation,4488,100,,percent of total billed charges,,
Thyroid Lobectomy Isthmusectomy,,25003232,LOCAL,Facility,Both,,,,4488,3814.8,1286.2608,4488,First Health Group Corporation,First Health Network,4353.36,97,,percent of total billed charges,,
Thyroid Lobectomy Isthmusectomy,,25003232,LOCAL,Facility,Both,,,,4488,3814.8,1286.2608,4488,"Health Partners, Inc.",Commercial,4245.648,94.6,,percent of total billed charges,,
Thyroid Lobectomy Isthmusectomy,,25003232,LOCAL,Facility,Outpatient,,,,4488,3814.8,1286.2608,4488,"Health Partners, Inc.",Medicare Advantage,2199.12,49,,percent of total billed charges,,
Thyroid Lobectomy Isthmusectomy,,25003232,LOCAL,Facility,Inpatient,,,,4488,3814.8,1286.2608,4488,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Thyroid Lobectomy Isthmusectomy,,25003232,LOCAL,Facility,Both,,,,4488,3814.8,1286.2608,4488,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),2692.8,60,,percent of total billed charges,,
Thyroid Lobectomy Isthmusectomy,,25003232,LOCAL,Facility,Both,,,,4488,3814.8,1286.2608,4488,"Health Partners, Inc.",State of Minnesota Advantage Program,3657.72,81.5,,percent of total billed charges,,
Thyroid Lobectomy Isthmusectomy,,25003232,LOCAL,Facility,Both,,,,4488,3814.8,1286.2608,4488,"Health Partners, Inc.",State Public Programs,2244,50,,percent of total billed charges,,
Thyroid Lobectomy Isthmusectomy,,25003232,LOCAL,Facility,Both,,,,4488,3814.8,1286.2608,4488,Humana Insurance Company,Commercial PPO,4263.6,95,,percent of total billed charges,,
Thyroid Lobectomy Isthmusectomy,,25003232,LOCAL,Facility,Outpatient,,,,4488,3814.8,1286.2608,4488,Humana Insurance Company,Medicare PPO,2199.12,49,,percent of total billed charges,,
Thyroid Lobectomy Isthmusectomy,,25003232,LOCAL,Facility,Inpatient,,,,4488,3814.8,1286.2608,4488,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Thyroid Lobectomy Isthmusectomy,,25003232,LOCAL,Facility,Both,,,,4488,3814.8,1286.2608,4488,Medica,Individual & Family,4447.608,99.1,,percent of total billed charges,,
Thyroid Lobectomy Isthmusectomy,,25003232,LOCAL,Facility,Outpatient,,,,4488,3814.8,1286.2608,4488,Medica,Medica Advantage Solution,2235.024,49.8,,percent of total billed charges,,
Thyroid Lobectomy Isthmusectomy,,25003232,LOCAL,Facility,Inpatient,,,,4488,3814.8,1286.2608,4488,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Thyroid Lobectomy Isthmusectomy,,25003232,LOCAL,Facility,Outpatient,,,,4488,3814.8,1286.2608,4488,Medica,Medical Assistance,2001.648,44.6,,percent of total billed charges,,
Thyroid Lobectomy Isthmusectomy,,25003232,LOCAL,Facility,Inpatient,,,,4488,3814.8,1286.2608,4488,Medica,Medical Assistance,,,,,Included in per diem rate,
Thyroid Lobectomy Isthmusectomy,,25003232,LOCAL,Facility,Outpatient,,,,4488,3814.8,1286.2608,4488,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2235.024,49.8,,percent of total billed charges,,
Thyroid Lobectomy Isthmusectomy,,25003232,LOCAL,Facility,Inpatient,,,,4488,3814.8,1286.2608,4488,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Thyroid Lobectomy Isthmusectomy,,25003232,LOCAL,Facility,Both,,,,4488,3814.8,1286.2608,4488,"Multiplan, Inc.","Multiplan, Inc.",4218.72,94,,percent of total billed charges,,
Thyroid Lobectomy Isthmusectomy,,25003232,LOCAL,Facility,Outpatient,,,,4488,3814.8,1286.2608,4488,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4043.688,90.1,,percent of total billed charges,,
Thyroid Lobectomy Isthmusectomy,,25003232,LOCAL,Facility,Inpatient,,,,4488,3814.8,1286.2608,4488,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Thyroid Lobectomy Isthmusectomy,,25003232,LOCAL,Facility,Both,,,,4488,3814.8,1286.2608,4488,"Preferred One Administrative Services, INC.",PPO,4425.168,98.6,,percent of total billed charges,,
Thyroid Lobectomy Isthmusectomy,,25003232,LOCAL,Facility,Outpatient,,,,4488,3814.8,1286.2608,4488,PrimeWest Health,Minnesota Senior Health Options (MSHO),2309.076,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Thyroid Lobectomy Isthmusectomy,,25003232,LOCAL,Facility,Inpatient,,,,4488,3814.8,1286.2608,4488,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Thyroid Lobectomy Isthmusectomy,,25003232,LOCAL,Facility,Outpatient,,,,4488,3814.8,1286.2608,4488,PrimeWest Health,MinnesotaCare,2305.0368,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Thyroid Lobectomy Isthmusectomy,,25003232,LOCAL,Facility,Inpatient,,,,4488,3814.8,1286.2608,4488,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Thyroid Lobectomy Isthmusectomy,,25003232,LOCAL,Facility,Both,,,,4488,3814.8,1286.2608,4488,Sanford Health Plan,Sanford Health Plan,4128.96,92,,percent of total billed charges,,
Thyroid Lobectomy Isthmusectomy,,25003232,LOCAL,Facility,Outpatient,,,,4488,3814.8,1286.2608,4488,"UCare Health, Inc.",Individual & Family Plan,2528.988,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Thyroid Lobectomy Isthmusectomy,,25003232,LOCAL,Facility,Inpatient,,,,4488,3814.8,1286.2608,4488,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Thyroid Lobectomy Isthmusectomy,,25003232,LOCAL,Facility,Outpatient,,,,4488,3814.8,1286.2608,4488,"UCare Health, Inc.",Medical Assistance,2265.0936,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Thyroid Lobectomy Isthmusectomy,,25003232,LOCAL,Facility,Inpatient,,,,4488,3814.8,1286.2608,4488,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Thyroid Lobectomy Isthmusectomy,,25003232,LOCAL,Facility,Outpatient,,,,4488,3814.8,1286.2608,4488,"UCare Health, Inc.",Medicare Advantage,2265.0936,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Thyroid Lobectomy Isthmusectomy,,25003232,LOCAL,Facility,Inpatient,,,,4488,3814.8,1286.2608,4488,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Thyroid Lobectomy Isthmusectomy,,25003232,LOCAL,Facility,Outpatient,,,,4488,3814.8,1286.2608,4488,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2265.0936,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Thyroid Lobectomy Isthmusectomy,,25003232,LOCAL,Facility,Inpatient,,,,4488,3814.8,1286.2608,4488,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Thyroid Lobectomy Isthmusectomy,,25003232,LOCAL,Facility,Both,,,,4488,3814.8,1286.2608,4488,UnitedHealthcare,Individual & Family,4218.72,94,,percent of total billed charges,,
Thyroid Lobectomy Isthmusectomy,,25003232,LOCAL,Facility,Outpatient,,,,4488,3814.8,1286.2608,4488,UnitedHealthcare,Medicare Advantage,2199.12,49,,percent of total billed charges,,
Thyroid Lobectomy Isthmusectomy,,25003232,LOCAL,Facility,Inpatient,,,,4488,3814.8,1286.2608,4488,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Thyroid Lobectomy Isthmusectomy,,25003232,LOCAL,Facility,Outpatient,,,,4488,3814.8,1286.2608,4488,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2154.24,48,,percent of total billed charges,,100% of DHS outpatient percentage
Thyroid Lobectomy Isthmusectomy,,25003232,LOCAL,Facility,Inpatient,,,,4488,3814.8,1286.2608,4488,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Thyroidectomy,,25003247,LOCAL,Facility,Both,,,,6222,5288.7,1783.2252,6222,Aetna,Commercial,5724.24,92,,percent of total billed charges,,
Thyroidectomy,,25003247,LOCAL,Facility,Outpatient,,,,6222,5288.7,1783.2252,6222,Aetna,Medicare Advantage,3048.78,49,,percent of total billed charges,,
Thyroidectomy,,25003247,LOCAL,Facility,Inpatient,,,,6222,5288.7,1783.2252,6222,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Thyroidectomy,,25003247,LOCAL,Facility,Both,,,,6222,5288.7,1783.2252,6222,Aetna,PPO,5786.46,93,,percent of total billed charges,,
Thyroidectomy,,25003247,LOCAL,Facility,Both,,,,6222,5288.7,1783.2252,6222,America's PPO,America's PPO,5974.9866,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Thyroidectomy,,25003247,LOCAL,Facility,Both,,,,6222,5288.7,1783.2252,6222,BlueCross BlueShield Minnesota, Federal Employee Program,6122.448,98.4,,percent of total billed charges,,
Thyroidectomy,,25003247,LOCAL,Facility,Both,,,,6222,5288.7,1783.2252,6222,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,6222,100,,percent of total billed charges,,
Thyroidectomy,,25003247,LOCAL,Facility,Both,,,,6222,5288.7,1783.2252,6222,BlueCross BlueShield Minnesota,High Value Network Plan,5599.8,90,,percent of total billed charges,,
Thyroidectomy,,25003247,LOCAL,Facility,Outpatient,,,,6222,5288.7,1783.2252,6222,BlueCross BlueShield Minnesota,Medicare Advantage,3048.78,49,,percent of total billed charges,,
Thyroidectomy,,25003247,LOCAL,Facility,Inpatient,,,,6222,5288.7,1783.2252,6222,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Thyroidectomy,,25003247,LOCAL,Facility,Both,,,,6222,5288.7,1783.2252,6222,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,5510.8254,88.57,,percent of total billed charges,,
Thyroidectomy,,25003247,LOCAL,Facility,Both,,,,6222,5288.7,1783.2252,6222,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1783.2252,28.66,,percent of total billed charges,,
Thyroidectomy,,25003247,LOCAL,Facility,Outpatient,,,,6222,5288.7,1783.2252,6222,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),3048.78,49,,percent of total billed charges,,
Thyroidectomy,,25003247,LOCAL,Facility,Inpatient,,,,6222,5288.7,1783.2252,6222,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Thyroidectomy,,25003247,LOCAL,Facility,Both,,,,6222,5288.7,1783.2252,6222,CorVel,Worker's Compensation,6222,100,,percent of total billed charges,,
Thyroidectomy,,25003247,LOCAL,Facility,Both,,,,6222,5288.7,1783.2252,6222,First Health Group Corporation,First Health Network,6035.34,97,,percent of total billed charges,,
Thyroidectomy,,25003247,LOCAL,Facility,Both,,,,6222,5288.7,1783.2252,6222,"Health Partners, Inc.",Commercial,5886.012,94.6,,percent of total billed charges,,
Thyroidectomy,,25003247,LOCAL,Facility,Outpatient,,,,6222,5288.7,1783.2252,6222,"Health Partners, Inc.",Medicare Advantage,3048.78,49,,percent of total billed charges,,
Thyroidectomy,,25003247,LOCAL,Facility,Inpatient,,,,6222,5288.7,1783.2252,6222,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Thyroidectomy,,25003247,LOCAL,Facility,Both,,,,6222,5288.7,1783.2252,6222,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3733.2,60,,percent of total billed charges,,
Thyroidectomy,,25003247,LOCAL,Facility,Both,,,,6222,5288.7,1783.2252,6222,"Health Partners, Inc.",State of Minnesota Advantage Program,5070.93,81.5,,percent of total billed charges,,
Thyroidectomy,,25003247,LOCAL,Facility,Both,,,,6222,5288.7,1783.2252,6222,"Health Partners, Inc.",State Public Programs,3111,50,,percent of total billed charges,,
Thyroidectomy,,25003247,LOCAL,Facility,Both,,,,6222,5288.7,1783.2252,6222,Humana Insurance Company,Commercial PPO,5910.9,95,,percent of total billed charges,,
Thyroidectomy,,25003247,LOCAL,Facility,Outpatient,,,,6222,5288.7,1783.2252,6222,Humana Insurance Company,Medicare PPO,3048.78,49,,percent of total billed charges,,
Thyroidectomy,,25003247,LOCAL,Facility,Inpatient,,,,6222,5288.7,1783.2252,6222,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Thyroidectomy,,25003247,LOCAL,Facility,Both,,,,6222,5288.7,1783.2252,6222,Medica,Individual & Family,6166.002,99.1,,percent of total billed charges,,
Thyroidectomy,,25003247,LOCAL,Facility,Outpatient,,,,6222,5288.7,1783.2252,6222,Medica,Medica Advantage Solution,3098.556,49.8,,percent of total billed charges,,
Thyroidectomy,,25003247,LOCAL,Facility,Inpatient,,,,6222,5288.7,1783.2252,6222,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Thyroidectomy,,25003247,LOCAL,Facility,Outpatient,,,,6222,5288.7,1783.2252,6222,Medica,Medical Assistance,2775.012,44.6,,percent of total billed charges,,
Thyroidectomy,,25003247,LOCAL,Facility,Inpatient,,,,6222,5288.7,1783.2252,6222,Medica,Medical Assistance,,,,,Included in per diem rate,
Thyroidectomy,,25003247,LOCAL,Facility,Outpatient,,,,6222,5288.7,1783.2252,6222,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,3098.556,49.8,,percent of total billed charges,,
Thyroidectomy,,25003247,LOCAL,Facility,Inpatient,,,,6222,5288.7,1783.2252,6222,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Thyroidectomy,,25003247,LOCAL,Facility,Both,,,,6222,5288.7,1783.2252,6222,"Multiplan, Inc.","Multiplan, Inc.",5848.68,94,,percent of total billed charges,,
Thyroidectomy,,25003247,LOCAL,Facility,Outpatient,,,,6222,5288.7,1783.2252,6222,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,5606.022,90.1,,percent of total billed charges,,
Thyroidectomy,,25003247,LOCAL,Facility,Inpatient,,,,6222,5288.7,1783.2252,6222,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Thyroidectomy,,25003247,LOCAL,Facility,Both,,,,6222,5288.7,1783.2252,6222,"Preferred One Administrative Services, INC.",PPO,6134.892,98.6,,percent of total billed charges,,
Thyroidectomy,,25003247,LOCAL,Facility,Outpatient,,,,6222,5288.7,1783.2252,6222,PrimeWest Health,Minnesota Senior Health Options (MSHO),3201.219,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Thyroidectomy,,25003247,LOCAL,Facility,Inpatient,,,,6222,5288.7,1783.2252,6222,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Thyroidectomy,,25003247,LOCAL,Facility,Outpatient,,,,6222,5288.7,1783.2252,6222,PrimeWest Health,MinnesotaCare,3195.6192,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Thyroidectomy,,25003247,LOCAL,Facility,Inpatient,,,,6222,5288.7,1783.2252,6222,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Thyroidectomy,,25003247,LOCAL,Facility,Both,,,,6222,5288.7,1783.2252,6222,Sanford Health Plan,Sanford Health Plan,5724.24,92,,percent of total billed charges,,
Thyroidectomy,,25003247,LOCAL,Facility,Outpatient,,,,6222,5288.7,1783.2252,6222,"UCare Health, Inc.",Individual & Family Plan,3506.097,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Thyroidectomy,,25003247,LOCAL,Facility,Inpatient,,,,6222,5288.7,1783.2252,6222,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Thyroidectomy,,25003247,LOCAL,Facility,Outpatient,,,,6222,5288.7,1783.2252,6222,"UCare Health, Inc.",Medical Assistance,3140.2434,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Thyroidectomy,,25003247,LOCAL,Facility,Inpatient,,,,6222,5288.7,1783.2252,6222,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Thyroidectomy,,25003247,LOCAL,Facility,Outpatient,,,,6222,5288.7,1783.2252,6222,"UCare Health, Inc.",Medicare Advantage,3140.2434,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Thyroidectomy,,25003247,LOCAL,Facility,Inpatient,,,,6222,5288.7,1783.2252,6222,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Thyroidectomy,,25003247,LOCAL,Facility,Outpatient,,,,6222,5288.7,1783.2252,6222,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),3140.2434,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Thyroidectomy,,25003247,LOCAL,Facility,Inpatient,,,,6222,5288.7,1783.2252,6222,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Thyroidectomy,,25003247,LOCAL,Facility,Both,,,,6222,5288.7,1783.2252,6222,UnitedHealthcare,Individual & Family,5848.68,94,,percent of total billed charges,,
Thyroidectomy,,25003247,LOCAL,Facility,Outpatient,,,,6222,5288.7,1783.2252,6222,UnitedHealthcare,Medicare Advantage,3048.78,49,,percent of total billed charges,,
Thyroidectomy,,25003247,LOCAL,Facility,Inpatient,,,,6222,5288.7,1783.2252,6222,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Thyroidectomy,,25003247,LOCAL,Facility,Outpatient,,,,6222,5288.7,1783.2252,6222,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2986.56,48,,percent of total billed charges,,100% of DHS outpatient percentage
Thyroidectomy,,25003247,LOCAL,Facility,Inpatient,,,,6222,5288.7,1783.2252,6222,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Tonsilectomy & Adenoidectomy,,25003275,LOCAL,Facility,Both,,,,4590,3901.5,1315.494,4590,Aetna,Commercial,4222.8,92,,percent of total billed charges,,
Tonsilectomy & Adenoidectomy,,25003275,LOCAL,Facility,Outpatient,,,,4590,3901.5,1315.494,4590,Aetna,Medicare Advantage,2249.1,49,,percent of total billed charges,,
Tonsilectomy & Adenoidectomy,,25003275,LOCAL,Facility,Inpatient,,,,4590,3901.5,1315.494,4590,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Tonsilectomy & Adenoidectomy,,25003275,LOCAL,Facility,Both,,,,4590,3901.5,1315.494,4590,Aetna,PPO,4268.7,93,,percent of total billed charges,,
Tonsilectomy & Adenoidectomy,,25003275,LOCAL,Facility,Both,,,,4590,3901.5,1315.494,4590,America's PPO,America's PPO,4407.777,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Tonsilectomy & Adenoidectomy,,25003275,LOCAL,Facility,Both,,,,4590,3901.5,1315.494,4590,BlueCross BlueShield Minnesota, Federal Employee Program,4516.56,98.4,,percent of total billed charges,,
Tonsilectomy & Adenoidectomy,,25003275,LOCAL,Facility,Both,,,,4590,3901.5,1315.494,4590,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,4590,100,,percent of total billed charges,,
Tonsilectomy & Adenoidectomy,,25003275,LOCAL,Facility,Both,,,,4590,3901.5,1315.494,4590,BlueCross BlueShield Minnesota,High Value Network Plan,4131,90,,percent of total billed charges,,
Tonsilectomy & Adenoidectomy,,25003275,LOCAL,Facility,Outpatient,,,,4590,3901.5,1315.494,4590,BlueCross BlueShield Minnesota,Medicare Advantage,2249.1,49,,percent of total billed charges,,
Tonsilectomy & Adenoidectomy,,25003275,LOCAL,Facility,Inpatient,,,,4590,3901.5,1315.494,4590,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Tonsilectomy & Adenoidectomy,,25003275,LOCAL,Facility,Both,,,,4590,3901.5,1315.494,4590,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4065.363,88.57,,percent of total billed charges,,
Tonsilectomy & Adenoidectomy,,25003275,LOCAL,Facility,Both,,,,4590,3901.5,1315.494,4590,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1315.494,28.66,,percent of total billed charges,,
Tonsilectomy & Adenoidectomy,,25003275,LOCAL,Facility,Outpatient,,,,4590,3901.5,1315.494,4590,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2249.1,49,,percent of total billed charges,,
Tonsilectomy & Adenoidectomy,,25003275,LOCAL,Facility,Inpatient,,,,4590,3901.5,1315.494,4590,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Tonsilectomy & Adenoidectomy,,25003275,LOCAL,Facility,Both,,,,4590,3901.5,1315.494,4590,CorVel,Worker's Compensation,4590,100,,percent of total billed charges,,
Tonsilectomy & Adenoidectomy,,25003275,LOCAL,Facility,Both,,,,4590,3901.5,1315.494,4590,First Health Group Corporation,First Health Network,4452.3,97,,percent of total billed charges,,
Tonsilectomy & Adenoidectomy,,25003275,LOCAL,Facility,Both,,,,4590,3901.5,1315.494,4590,"Health Partners, Inc.",Commercial,4342.14,94.6,,percent of total billed charges,,
Tonsilectomy & Adenoidectomy,,25003275,LOCAL,Facility,Outpatient,,,,4590,3901.5,1315.494,4590,"Health Partners, Inc.",Medicare Advantage,2249.1,49,,percent of total billed charges,,
Tonsilectomy & Adenoidectomy,,25003275,LOCAL,Facility,Inpatient,,,,4590,3901.5,1315.494,4590,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Tonsilectomy & Adenoidectomy,,25003275,LOCAL,Facility,Both,,,,4590,3901.5,1315.494,4590,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),2754,60,,percent of total billed charges,,
Tonsilectomy & Adenoidectomy,,25003275,LOCAL,Facility,Both,,,,4590,3901.5,1315.494,4590,"Health Partners, Inc.",State of Minnesota Advantage Program,3740.85,81.5,,percent of total billed charges,,
Tonsilectomy & Adenoidectomy,,25003275,LOCAL,Facility,Both,,,,4590,3901.5,1315.494,4590,"Health Partners, Inc.",State Public Programs,2295,50,,percent of total billed charges,,
Tonsilectomy & Adenoidectomy,,25003275,LOCAL,Facility,Both,,,,4590,3901.5,1315.494,4590,Humana Insurance Company,Commercial PPO,4360.5,95,,percent of total billed charges,,
Tonsilectomy & Adenoidectomy,,25003275,LOCAL,Facility,Outpatient,,,,4590,3901.5,1315.494,4590,Humana Insurance Company,Medicare PPO,2249.1,49,,percent of total billed charges,,
Tonsilectomy & Adenoidectomy,,25003275,LOCAL,Facility,Inpatient,,,,4590,3901.5,1315.494,4590,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Tonsilectomy & Adenoidectomy,,25003275,LOCAL,Facility,Both,,,,4590,3901.5,1315.494,4590,Medica,Individual & Family,4548.69,99.1,,percent of total billed charges,,
Tonsilectomy & Adenoidectomy,,25003275,LOCAL,Facility,Outpatient,,,,4590,3901.5,1315.494,4590,Medica,Medica Advantage Solution,2285.82,49.8,,percent of total billed charges,,
Tonsilectomy & Adenoidectomy,,25003275,LOCAL,Facility,Inpatient,,,,4590,3901.5,1315.494,4590,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Tonsilectomy & Adenoidectomy,,25003275,LOCAL,Facility,Outpatient,,,,4590,3901.5,1315.494,4590,Medica,Medical Assistance,2047.14,44.6,,percent of total billed charges,,
Tonsilectomy & Adenoidectomy,,25003275,LOCAL,Facility,Inpatient,,,,4590,3901.5,1315.494,4590,Medica,Medical Assistance,,,,,Included in per diem rate,
Tonsilectomy & Adenoidectomy,,25003275,LOCAL,Facility,Outpatient,,,,4590,3901.5,1315.494,4590,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2285.82,49.8,,percent of total billed charges,,
Tonsilectomy & Adenoidectomy,,25003275,LOCAL,Facility,Inpatient,,,,4590,3901.5,1315.494,4590,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Tonsilectomy & Adenoidectomy,,25003275,LOCAL,Facility,Both,,,,4590,3901.5,1315.494,4590,"Multiplan, Inc.","Multiplan, Inc.",4314.6,94,,percent of total billed charges,,
Tonsilectomy & Adenoidectomy,,25003275,LOCAL,Facility,Outpatient,,,,4590,3901.5,1315.494,4590,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4135.59,90.1,,percent of total billed charges,,
Tonsilectomy & Adenoidectomy,,25003275,LOCAL,Facility,Inpatient,,,,4590,3901.5,1315.494,4590,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Tonsilectomy & Adenoidectomy,,25003275,LOCAL,Facility,Both,,,,4590,3901.5,1315.494,4590,"Preferred One Administrative Services, INC.",PPO,4525.74,98.6,,percent of total billed charges,,
Tonsilectomy & Adenoidectomy,,25003275,LOCAL,Facility,Outpatient,,,,4590,3901.5,1315.494,4590,PrimeWest Health,Minnesota Senior Health Options (MSHO),2361.555,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Tonsilectomy & Adenoidectomy,,25003275,LOCAL,Facility,Inpatient,,,,4590,3901.5,1315.494,4590,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Tonsilectomy & Adenoidectomy,,25003275,LOCAL,Facility,Outpatient,,,,4590,3901.5,1315.494,4590,PrimeWest Health,MinnesotaCare,2357.424,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Tonsilectomy & Adenoidectomy,,25003275,LOCAL,Facility,Inpatient,,,,4590,3901.5,1315.494,4590,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Tonsilectomy & Adenoidectomy,,25003275,LOCAL,Facility,Both,,,,4590,3901.5,1315.494,4590,Sanford Health Plan,Sanford Health Plan,4222.8,92,,percent of total billed charges,,
Tonsilectomy & Adenoidectomy,,25003275,LOCAL,Facility,Outpatient,,,,4590,3901.5,1315.494,4590,"UCare Health, Inc.",Individual & Family Plan,2586.465,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Tonsilectomy & Adenoidectomy,,25003275,LOCAL,Facility,Inpatient,,,,4590,3901.5,1315.494,4590,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Tonsilectomy & Adenoidectomy,,25003275,LOCAL,Facility,Outpatient,,,,4590,3901.5,1315.494,4590,"UCare Health, Inc.",Medical Assistance,2316.573,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Tonsilectomy & Adenoidectomy,,25003275,LOCAL,Facility,Inpatient,,,,4590,3901.5,1315.494,4590,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Tonsilectomy & Adenoidectomy,,25003275,LOCAL,Facility,Outpatient,,,,4590,3901.5,1315.494,4590,"UCare Health, Inc.",Medicare Advantage,2316.573,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Tonsilectomy & Adenoidectomy,,25003275,LOCAL,Facility,Inpatient,,,,4590,3901.5,1315.494,4590,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Tonsilectomy & Adenoidectomy,,25003275,LOCAL,Facility,Outpatient,,,,4590,3901.5,1315.494,4590,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2316.573,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Tonsilectomy & Adenoidectomy,,25003275,LOCAL,Facility,Inpatient,,,,4590,3901.5,1315.494,4590,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Tonsilectomy & Adenoidectomy,,25003275,LOCAL,Facility,Both,,,,4590,3901.5,1315.494,4590,UnitedHealthcare,Individual & Family,4314.6,94,,percent of total billed charges,,
Tonsilectomy & Adenoidectomy,,25003275,LOCAL,Facility,Outpatient,,,,4590,3901.5,1315.494,4590,UnitedHealthcare,Medicare Advantage,2249.1,49,,percent of total billed charges,,
Tonsilectomy & Adenoidectomy,,25003275,LOCAL,Facility,Inpatient,,,,4590,3901.5,1315.494,4590,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Tonsilectomy & Adenoidectomy,,25003275,LOCAL,Facility,Outpatient,,,,4590,3901.5,1315.494,4590,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2203.2,48,,percent of total billed charges,,100% of DHS outpatient percentage
Tonsilectomy & Adenoidectomy,,25003275,LOCAL,Facility,Inpatient,,,,4590,3901.5,1315.494,4590,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Tonsillectomy,,25003288,LOCAL,Facility,Both,,,,3978,3381.3,1140.0948,3978,Aetna,Commercial,3659.76,92,,percent of total billed charges,,
Tonsillectomy,,25003288,LOCAL,Facility,Outpatient,,,,3978,3381.3,1140.0948,3978,Aetna,Medicare Advantage,1949.22,49,,percent of total billed charges,,
Tonsillectomy,,25003288,LOCAL,Facility,Inpatient,,,,3978,3381.3,1140.0948,3978,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Tonsillectomy,,25003288,LOCAL,Facility,Both,,,,3978,3381.3,1140.0948,3978,Aetna,PPO,3699.54,93,,percent of total billed charges,,
Tonsillectomy,,25003288,LOCAL,Facility,Both,,,,3978,3381.3,1140.0948,3978,America's PPO,America's PPO,3820.0734,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Tonsillectomy,,25003288,LOCAL,Facility,Both,,,,3978,3381.3,1140.0948,3978,BlueCross BlueShield Minnesota, Federal Employee Program,3914.352,98.4,,percent of total billed charges,,
Tonsillectomy,,25003288,LOCAL,Facility,Both,,,,3978,3381.3,1140.0948,3978,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,3978,100,,percent of total billed charges,,
Tonsillectomy,,25003288,LOCAL,Facility,Both,,,,3978,3381.3,1140.0948,3978,BlueCross BlueShield Minnesota,High Value Network Plan,3580.2,90,,percent of total billed charges,,
Tonsillectomy,,25003288,LOCAL,Facility,Outpatient,,,,3978,3381.3,1140.0948,3978,BlueCross BlueShield Minnesota,Medicare Advantage,1949.22,49,,percent of total billed charges,,
Tonsillectomy,,25003288,LOCAL,Facility,Inpatient,,,,3978,3381.3,1140.0948,3978,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Tonsillectomy,,25003288,LOCAL,Facility,Both,,,,3978,3381.3,1140.0948,3978,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,3523.3146,88.57,,percent of total billed charges,,
Tonsillectomy,,25003288,LOCAL,Facility,Both,,,,3978,3381.3,1140.0948,3978,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1140.0948,28.66,,percent of total billed charges,,
Tonsillectomy,,25003288,LOCAL,Facility,Outpatient,,,,3978,3381.3,1140.0948,3978,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1949.22,49,,percent of total billed charges,,
Tonsillectomy,,25003288,LOCAL,Facility,Inpatient,,,,3978,3381.3,1140.0948,3978,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Tonsillectomy,,25003288,LOCAL,Facility,Both,,,,3978,3381.3,1140.0948,3978,CorVel,Worker's Compensation,3978,100,,percent of total billed charges,,
Tonsillectomy,,25003288,LOCAL,Facility,Both,,,,3978,3381.3,1140.0948,3978,First Health Group Corporation,First Health Network,3858.66,97,,percent of total billed charges,,
Tonsillectomy,,25003288,LOCAL,Facility,Both,,,,3978,3381.3,1140.0948,3978,"Health Partners, Inc.",Commercial,3763.188,94.6,,percent of total billed charges,,
Tonsillectomy,,25003288,LOCAL,Facility,Outpatient,,,,3978,3381.3,1140.0948,3978,"Health Partners, Inc.",Medicare Advantage,1949.22,49,,percent of total billed charges,,
Tonsillectomy,,25003288,LOCAL,Facility,Inpatient,,,,3978,3381.3,1140.0948,3978,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Tonsillectomy,,25003288,LOCAL,Facility,Both,,,,3978,3381.3,1140.0948,3978,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),2386.8,60,,percent of total billed charges,,
Tonsillectomy,,25003288,LOCAL,Facility,Both,,,,3978,3381.3,1140.0948,3978,"Health Partners, Inc.",State of Minnesota Advantage Program,3242.07,81.5,,percent of total billed charges,,
Tonsillectomy,,25003288,LOCAL,Facility,Both,,,,3978,3381.3,1140.0948,3978,"Health Partners, Inc.",State Public Programs,1989,50,,percent of total billed charges,,
Tonsillectomy,,25003288,LOCAL,Facility,Both,,,,3978,3381.3,1140.0948,3978,Humana Insurance Company,Commercial PPO,3779.1,95,,percent of total billed charges,,
Tonsillectomy,,25003288,LOCAL,Facility,Outpatient,,,,3978,3381.3,1140.0948,3978,Humana Insurance Company,Medicare PPO,1949.22,49,,percent of total billed charges,,
Tonsillectomy,,25003288,LOCAL,Facility,Inpatient,,,,3978,3381.3,1140.0948,3978,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Tonsillectomy,,25003288,LOCAL,Facility,Both,,,,3978,3381.3,1140.0948,3978,Medica,Individual & Family,3942.198,99.1,,percent of total billed charges,,
Tonsillectomy,,25003288,LOCAL,Facility,Outpatient,,,,3978,3381.3,1140.0948,3978,Medica,Medica Advantage Solution,1981.044,49.8,,percent of total billed charges,,
Tonsillectomy,,25003288,LOCAL,Facility,Inpatient,,,,3978,3381.3,1140.0948,3978,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Tonsillectomy,,25003288,LOCAL,Facility,Outpatient,,,,3978,3381.3,1140.0948,3978,Medica,Medical Assistance,1774.188,44.6,,percent of total billed charges,,
Tonsillectomy,,25003288,LOCAL,Facility,Inpatient,,,,3978,3381.3,1140.0948,3978,Medica,Medical Assistance,,,,,Included in per diem rate,
Tonsillectomy,,25003288,LOCAL,Facility,Outpatient,,,,3978,3381.3,1140.0948,3978,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1981.044,49.8,,percent of total billed charges,,
Tonsillectomy,,25003288,LOCAL,Facility,Inpatient,,,,3978,3381.3,1140.0948,3978,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Tonsillectomy,,25003288,LOCAL,Facility,Both,,,,3978,3381.3,1140.0948,3978,"Multiplan, Inc.","Multiplan, Inc.",3739.32,94,,percent of total billed charges,,
Tonsillectomy,,25003288,LOCAL,Facility,Outpatient,,,,3978,3381.3,1140.0948,3978,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,3584.178,90.1,,percent of total billed charges,,
Tonsillectomy,,25003288,LOCAL,Facility,Inpatient,,,,3978,3381.3,1140.0948,3978,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Tonsillectomy,,25003288,LOCAL,Facility,Both,,,,3978,3381.3,1140.0948,3978,"Preferred One Administrative Services, INC.",PPO,3922.308,98.6,,percent of total billed charges,,
Tonsillectomy,,25003288,LOCAL,Facility,Outpatient,,,,3978,3381.3,1140.0948,3978,PrimeWest Health,Minnesota Senior Health Options (MSHO),2046.681,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Tonsillectomy,,25003288,LOCAL,Facility,Inpatient,,,,3978,3381.3,1140.0948,3978,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Tonsillectomy,,25003288,LOCAL,Facility,Outpatient,,,,3978,3381.3,1140.0948,3978,PrimeWest Health,MinnesotaCare,2043.1008,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Tonsillectomy,,25003288,LOCAL,Facility,Inpatient,,,,3978,3381.3,1140.0948,3978,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Tonsillectomy,,25003288,LOCAL,Facility,Both,,,,3978,3381.3,1140.0948,3978,Sanford Health Plan,Sanford Health Plan,3659.76,92,,percent of total billed charges,,
Tonsillectomy,,25003288,LOCAL,Facility,Outpatient,,,,3978,3381.3,1140.0948,3978,"UCare Health, Inc.",Individual & Family Plan,2241.603,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Tonsillectomy,,25003288,LOCAL,Facility,Inpatient,,,,3978,3381.3,1140.0948,3978,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Tonsillectomy,,25003288,LOCAL,Facility,Outpatient,,,,3978,3381.3,1140.0948,3978,"UCare Health, Inc.",Medical Assistance,2007.6966,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Tonsillectomy,,25003288,LOCAL,Facility,Inpatient,,,,3978,3381.3,1140.0948,3978,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Tonsillectomy,,25003288,LOCAL,Facility,Outpatient,,,,3978,3381.3,1140.0948,3978,"UCare Health, Inc.",Medicare Advantage,2007.6966,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Tonsillectomy,,25003288,LOCAL,Facility,Inpatient,,,,3978,3381.3,1140.0948,3978,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Tonsillectomy,,25003288,LOCAL,Facility,Outpatient,,,,3978,3381.3,1140.0948,3978,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2007.6966,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Tonsillectomy,,25003288,LOCAL,Facility,Inpatient,,,,3978,3381.3,1140.0948,3978,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Tonsillectomy,,25003288,LOCAL,Facility,Both,,,,3978,3381.3,1140.0948,3978,UnitedHealthcare,Individual & Family,3739.32,94,,percent of total billed charges,,
Tonsillectomy,,25003288,LOCAL,Facility,Outpatient,,,,3978,3381.3,1140.0948,3978,UnitedHealthcare,Medicare Advantage,1949.22,49,,percent of total billed charges,,
Tonsillectomy,,25003288,LOCAL,Facility,Inpatient,,,,3978,3381.3,1140.0948,3978,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Tonsillectomy,,25003288,LOCAL,Facility,Outpatient,,,,3978,3381.3,1140.0948,3978,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1909.44,48,,percent of total billed charges,,100% of DHS outpatient percentage
Tonsillectomy,,25003288,LOCAL,Facility,Inpatient,,,,3978,3381.3,1140.0948,3978,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Transurethral Prostratectomy,,25003326,LOCAL,Facility,Both,,,,8160,6936,2338.656,8160,Aetna,Commercial,7507.2,92,,percent of total billed charges,,
Transurethral Prostratectomy,,25003326,LOCAL,Facility,Outpatient,,,,8160,6936,2338.656,8160,Aetna,Medicare Advantage,3998.4,49,,percent of total billed charges,,
Transurethral Prostratectomy,,25003326,LOCAL,Facility,Inpatient,,,,8160,6936,2338.656,8160,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Transurethral Prostratectomy,,25003326,LOCAL,Facility,Both,,,,8160,6936,2338.656,8160,Aetna,PPO,7588.8,93,,percent of total billed charges,,
Transurethral Prostratectomy,,25003326,LOCAL,Facility,Both,,,,8160,6936,2338.656,8160,America's PPO,America's PPO,7836.048,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Transurethral Prostratectomy,,25003326,LOCAL,Facility,Both,,,,8160,6936,2338.656,8160,BlueCross BlueShield Minnesota, Federal Employee Program,8029.44,98.4,,percent of total billed charges,,
Transurethral Prostratectomy,,25003326,LOCAL,Facility,Both,,,,8160,6936,2338.656,8160,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,8160,100,,percent of total billed charges,,
Transurethral Prostratectomy,,25003326,LOCAL,Facility,Both,,,,8160,6936,2338.656,8160,BlueCross BlueShield Minnesota,High Value Network Plan,7344,90,,percent of total billed charges,,
Transurethral Prostratectomy,,25003326,LOCAL,Facility,Outpatient,,,,8160,6936,2338.656,8160,BlueCross BlueShield Minnesota,Medicare Advantage,3998.4,49,,percent of total billed charges,,
Transurethral Prostratectomy,,25003326,LOCAL,Facility,Inpatient,,,,8160,6936,2338.656,8160,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Transurethral Prostratectomy,,25003326,LOCAL,Facility,Both,,,,8160,6936,2338.656,8160,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,7227.312,88.57,,percent of total billed charges,,
Transurethral Prostratectomy,,25003326,LOCAL,Facility,Both,,,,8160,6936,2338.656,8160,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,2338.656,28.66,,percent of total billed charges,,
Transurethral Prostratectomy,,25003326,LOCAL,Facility,Outpatient,,,,8160,6936,2338.656,8160,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),3998.4,49,,percent of total billed charges,,
Transurethral Prostratectomy,,25003326,LOCAL,Facility,Inpatient,,,,8160,6936,2338.656,8160,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Transurethral Prostratectomy,,25003326,LOCAL,Facility,Both,,,,8160,6936,2338.656,8160,CorVel,Worker's Compensation,8160,100,,percent of total billed charges,,
Transurethral Prostratectomy,,25003326,LOCAL,Facility,Both,,,,8160,6936,2338.656,8160,First Health Group Corporation,First Health Network,7915.2,97,,percent of total billed charges,,
Transurethral Prostratectomy,,25003326,LOCAL,Facility,Both,,,,8160,6936,2338.656,8160,"Health Partners, Inc.",Commercial,7719.36,94.6,,percent of total billed charges,,
Transurethral Prostratectomy,,25003326,LOCAL,Facility,Outpatient,,,,8160,6936,2338.656,8160,"Health Partners, Inc.",Medicare Advantage,3998.4,49,,percent of total billed charges,,
Transurethral Prostratectomy,,25003326,LOCAL,Facility,Inpatient,,,,8160,6936,2338.656,8160,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Transurethral Prostratectomy,,25003326,LOCAL,Facility,Both,,,,8160,6936,2338.656,8160,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),4896,60,,percent of total billed charges,,
Transurethral Prostratectomy,,25003326,LOCAL,Facility,Both,,,,8160,6936,2338.656,8160,"Health Partners, Inc.",State of Minnesota Advantage Program,6650.4,81.5,,percent of total billed charges,,
Transurethral Prostratectomy,,25003326,LOCAL,Facility,Both,,,,8160,6936,2338.656,8160,"Health Partners, Inc.",State Public Programs,4080,50,,percent of total billed charges,,
Transurethral Prostratectomy,,25003326,LOCAL,Facility,Both,,,,8160,6936,2338.656,8160,Humana Insurance Company,Commercial PPO,7752,95,,percent of total billed charges,,
Transurethral Prostratectomy,,25003326,LOCAL,Facility,Outpatient,,,,8160,6936,2338.656,8160,Humana Insurance Company,Medicare PPO,3998.4,49,,percent of total billed charges,,
Transurethral Prostratectomy,,25003326,LOCAL,Facility,Inpatient,,,,8160,6936,2338.656,8160,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Transurethral Prostratectomy,,25003326,LOCAL,Facility,Both,,,,8160,6936,2338.656,8160,Medica,Individual & Family,8086.56,99.1,,percent of total billed charges,,
Transurethral Prostratectomy,,25003326,LOCAL,Facility,Outpatient,,,,8160,6936,2338.656,8160,Medica,Medica Advantage Solution,4063.68,49.8,,percent of total billed charges,,
Transurethral Prostratectomy,,25003326,LOCAL,Facility,Inpatient,,,,8160,6936,2338.656,8160,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Transurethral Prostratectomy,,25003326,LOCAL,Facility,Outpatient,,,,8160,6936,2338.656,8160,Medica,Medical Assistance,3639.36,44.6,,percent of total billed charges,,
Transurethral Prostratectomy,,25003326,LOCAL,Facility,Inpatient,,,,8160,6936,2338.656,8160,Medica,Medical Assistance,,,,,Included in per diem rate,
Transurethral Prostratectomy,,25003326,LOCAL,Facility,Outpatient,,,,8160,6936,2338.656,8160,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,4063.68,49.8,,percent of total billed charges,,
Transurethral Prostratectomy,,25003326,LOCAL,Facility,Inpatient,,,,8160,6936,2338.656,8160,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Transurethral Prostratectomy,,25003326,LOCAL,Facility,Both,,,,8160,6936,2338.656,8160,"Multiplan, Inc.","Multiplan, Inc.",7670.4,94,,percent of total billed charges,,
Transurethral Prostratectomy,,25003326,LOCAL,Facility,Outpatient,,,,8160,6936,2338.656,8160,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,7352.16,90.1,,percent of total billed charges,,
Transurethral Prostratectomy,,25003326,LOCAL,Facility,Inpatient,,,,8160,6936,2338.656,8160,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Transurethral Prostratectomy,,25003326,LOCAL,Facility,Both,,,,8160,6936,2338.656,8160,"Preferred One Administrative Services, INC.",PPO,8045.76,98.6,,percent of total billed charges,,
Transurethral Prostratectomy,,25003326,LOCAL,Facility,Outpatient,,,,8160,6936,2338.656,8160,PrimeWest Health,Minnesota Senior Health Options (MSHO),4198.32,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Transurethral Prostratectomy,,25003326,LOCAL,Facility,Inpatient,,,,8160,6936,2338.656,8160,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Transurethral Prostratectomy,,25003326,LOCAL,Facility,Outpatient,,,,8160,6936,2338.656,8160,PrimeWest Health,MinnesotaCare,4190.976,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Transurethral Prostratectomy,,25003326,LOCAL,Facility,Inpatient,,,,8160,6936,2338.656,8160,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Transurethral Prostratectomy,,25003326,LOCAL,Facility,Both,,,,8160,6936,2338.656,8160,Sanford Health Plan,Sanford Health Plan,7507.2,92,,percent of total billed charges,,
Transurethral Prostratectomy,,25003326,LOCAL,Facility,Outpatient,,,,8160,6936,2338.656,8160,"UCare Health, Inc.",Individual & Family Plan,4598.16,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Transurethral Prostratectomy,,25003326,LOCAL,Facility,Inpatient,,,,8160,6936,2338.656,8160,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Transurethral Prostratectomy,,25003326,LOCAL,Facility,Outpatient,,,,8160,6936,2338.656,8160,"UCare Health, Inc.",Medical Assistance,4118.352,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Transurethral Prostratectomy,,25003326,LOCAL,Facility,Inpatient,,,,8160,6936,2338.656,8160,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Transurethral Prostratectomy,,25003326,LOCAL,Facility,Outpatient,,,,8160,6936,2338.656,8160,"UCare Health, Inc.",Medicare Advantage,4118.352,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Transurethral Prostratectomy,,25003326,LOCAL,Facility,Inpatient,,,,8160,6936,2338.656,8160,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Transurethral Prostratectomy,,25003326,LOCAL,Facility,Outpatient,,,,8160,6936,2338.656,8160,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),4118.352,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Transurethral Prostratectomy,,25003326,LOCAL,Facility,Inpatient,,,,8160,6936,2338.656,8160,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Transurethral Prostratectomy,,25003326,LOCAL,Facility,Both,,,,8160,6936,2338.656,8160,UnitedHealthcare,Individual & Family,7670.4,94,,percent of total billed charges,,
Transurethral Prostratectomy,,25003326,LOCAL,Facility,Outpatient,,,,8160,6936,2338.656,8160,UnitedHealthcare,Medicare Advantage,3998.4,49,,percent of total billed charges,,
Transurethral Prostratectomy,,25003326,LOCAL,Facility,Inpatient,,,,8160,6936,2338.656,8160,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Transurethral Prostratectomy,,25003326,LOCAL,Facility,Outpatient,,,,8160,6936,2338.656,8160,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,3916.8,48,,percent of total billed charges,,100% of DHS outpatient percentage
Transurethral Prostratectomy,,25003326,LOCAL,Facility,Inpatient,,,,8160,6936,2338.656,8160,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Trigger Finger Release,,25003349,LOCAL,Facility,Both,,,,3596,3056.6,1030.6136,3596,Aetna,Commercial,3308.32,92,,percent of total billed charges,,
Trigger Finger Release,,25003349,LOCAL,Facility,Outpatient,,,,3596,3056.6,1030.6136,3596,Aetna,Medicare Advantage,1762.04,49,,percent of total billed charges,,
Trigger Finger Release,,25003349,LOCAL,Facility,Inpatient,,,,3596,3056.6,1030.6136,3596,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Trigger Finger Release,,25003349,LOCAL,Facility,Both,,,,3596,3056.6,1030.6136,3596,Aetna,PPO,3344.28,93,,percent of total billed charges,,
Trigger Finger Release,,25003349,LOCAL,Facility,Both,,,,3596,3056.6,1030.6136,3596,America's PPO,America's PPO,3453.2388,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Trigger Finger Release,,25003349,LOCAL,Facility,Both,,,,3596,3056.6,1030.6136,3596,BlueCross BlueShield Minnesota, Federal Employee Program,3538.464,98.4,,percent of total billed charges,,
Trigger Finger Release,,25003349,LOCAL,Facility,Both,,,,3596,3056.6,1030.6136,3596,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,3596,100,,percent of total billed charges,,
Trigger Finger Release,,25003349,LOCAL,Facility,Both,,,,3596,3056.6,1030.6136,3596,BlueCross BlueShield Minnesota,High Value Network Plan,3236.4,90,,percent of total billed charges,,
Trigger Finger Release,,25003349,LOCAL,Facility,Outpatient,,,,3596,3056.6,1030.6136,3596,BlueCross BlueShield Minnesota,Medicare Advantage,1762.04,49,,percent of total billed charges,,
Trigger Finger Release,,25003349,LOCAL,Facility,Inpatient,,,,3596,3056.6,1030.6136,3596,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Trigger Finger Release,,25003349,LOCAL,Facility,Both,,,,3596,3056.6,1030.6136,3596,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,3184.9772,88.57,,percent of total billed charges,,
Trigger Finger Release,,25003349,LOCAL,Facility,Both,,,,3596,3056.6,1030.6136,3596,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1030.6136,28.66,,percent of total billed charges,,
Trigger Finger Release,,25003349,LOCAL,Facility,Outpatient,,,,3596,3056.6,1030.6136,3596,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1762.04,49,,percent of total billed charges,,
Trigger Finger Release,,25003349,LOCAL,Facility,Inpatient,,,,3596,3056.6,1030.6136,3596,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Trigger Finger Release,,25003349,LOCAL,Facility,Both,,,,3596,3056.6,1030.6136,3596,CorVel,Worker's Compensation,3596,100,,percent of total billed charges,,
Trigger Finger Release,,25003349,LOCAL,Facility,Both,,,,3596,3056.6,1030.6136,3596,First Health Group Corporation,First Health Network,3488.12,97,,percent of total billed charges,,
Trigger Finger Release,,25003349,LOCAL,Facility,Both,,,,3596,3056.6,1030.6136,3596,"Health Partners, Inc.",Commercial,3401.816,94.6,,percent of total billed charges,,
Trigger Finger Release,,25003349,LOCAL,Facility,Outpatient,,,,3596,3056.6,1030.6136,3596,"Health Partners, Inc.",Medicare Advantage,1762.04,49,,percent of total billed charges,,
Trigger Finger Release,,25003349,LOCAL,Facility,Inpatient,,,,3596,3056.6,1030.6136,3596,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Trigger Finger Release,,25003349,LOCAL,Facility,Both,,,,3596,3056.6,1030.6136,3596,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),2157.6,60,,percent of total billed charges,,
Trigger Finger Release,,25003349,LOCAL,Facility,Both,,,,3596,3056.6,1030.6136,3596,"Health Partners, Inc.",State of Minnesota Advantage Program,2930.74,81.5,,percent of total billed charges,,
Trigger Finger Release,,25003349,LOCAL,Facility,Both,,,,3596,3056.6,1030.6136,3596,"Health Partners, Inc.",State Public Programs,1798,50,,percent of total billed charges,,
Trigger Finger Release,,25003349,LOCAL,Facility,Both,,,,3596,3056.6,1030.6136,3596,Humana Insurance Company,Commercial PPO,3416.2,95,,percent of total billed charges,,
Trigger Finger Release,,25003349,LOCAL,Facility,Outpatient,,,,3596,3056.6,1030.6136,3596,Humana Insurance Company,Medicare PPO,1762.04,49,,percent of total billed charges,,
Trigger Finger Release,,25003349,LOCAL,Facility,Inpatient,,,,3596,3056.6,1030.6136,3596,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Trigger Finger Release,,25003349,LOCAL,Facility,Both,,,,3596,3056.6,1030.6136,3596,Medica,Individual & Family,3563.636,99.1,,percent of total billed charges,,
Trigger Finger Release,,25003349,LOCAL,Facility,Outpatient,,,,3596,3056.6,1030.6136,3596,Medica,Medica Advantage Solution,1790.808,49.8,,percent of total billed charges,,
Trigger Finger Release,,25003349,LOCAL,Facility,Inpatient,,,,3596,3056.6,1030.6136,3596,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Trigger Finger Release,,25003349,LOCAL,Facility,Outpatient,,,,3596,3056.6,1030.6136,3596,Medica,Medical Assistance,1603.816,44.6,,percent of total billed charges,,
Trigger Finger Release,,25003349,LOCAL,Facility,Inpatient,,,,3596,3056.6,1030.6136,3596,Medica,Medical Assistance,,,,,Included in per diem rate,
Trigger Finger Release,,25003349,LOCAL,Facility,Outpatient,,,,3596,3056.6,1030.6136,3596,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1790.808,49.8,,percent of total billed charges,,
Trigger Finger Release,,25003349,LOCAL,Facility,Inpatient,,,,3596,3056.6,1030.6136,3596,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Trigger Finger Release,,25003349,LOCAL,Facility,Both,,,,3596,3056.6,1030.6136,3596,"Multiplan, Inc.","Multiplan, Inc.",3380.24,94,,percent of total billed charges,,
Trigger Finger Release,,25003349,LOCAL,Facility,Outpatient,,,,3596,3056.6,1030.6136,3596,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,3239.996,90.1,,percent of total billed charges,,
Trigger Finger Release,,25003349,LOCAL,Facility,Inpatient,,,,3596,3056.6,1030.6136,3596,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Trigger Finger Release,,25003349,LOCAL,Facility,Both,,,,3596,3056.6,1030.6136,3596,"Preferred One Administrative Services, INC.",PPO,3545.656,98.6,,percent of total billed charges,,
Trigger Finger Release,,25003349,LOCAL,Facility,Outpatient,,,,3596,3056.6,1030.6136,3596,PrimeWest Health,Minnesota Senior Health Options (MSHO),1850.142,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Trigger Finger Release,,25003349,LOCAL,Facility,Inpatient,,,,3596,3056.6,1030.6136,3596,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Trigger Finger Release,,25003349,LOCAL,Facility,Outpatient,,,,3596,3056.6,1030.6136,3596,PrimeWest Health,MinnesotaCare,1846.9056,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Trigger Finger Release,,25003349,LOCAL,Facility,Inpatient,,,,3596,3056.6,1030.6136,3596,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Trigger Finger Release,,25003349,LOCAL,Facility,Both,,,,3596,3056.6,1030.6136,3596,Sanford Health Plan,Sanford Health Plan,3308.32,92,,percent of total billed charges,,
Trigger Finger Release,,25003349,LOCAL,Facility,Outpatient,,,,3596,3056.6,1030.6136,3596,"UCare Health, Inc.",Individual & Family Plan,2026.346,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Trigger Finger Release,,25003349,LOCAL,Facility,Inpatient,,,,3596,3056.6,1030.6136,3596,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Trigger Finger Release,,25003349,LOCAL,Facility,Outpatient,,,,3596,3056.6,1030.6136,3596,"UCare Health, Inc.",Medical Assistance,1814.9012,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Trigger Finger Release,,25003349,LOCAL,Facility,Inpatient,,,,3596,3056.6,1030.6136,3596,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Trigger Finger Release,,25003349,LOCAL,Facility,Outpatient,,,,3596,3056.6,1030.6136,3596,"UCare Health, Inc.",Medicare Advantage,1814.9012,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Trigger Finger Release,,25003349,LOCAL,Facility,Inpatient,,,,3596,3056.6,1030.6136,3596,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Trigger Finger Release,,25003349,LOCAL,Facility,Outpatient,,,,3596,3056.6,1030.6136,3596,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1814.9012,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Trigger Finger Release,,25003349,LOCAL,Facility,Inpatient,,,,3596,3056.6,1030.6136,3596,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Trigger Finger Release,,25003349,LOCAL,Facility,Both,,,,3596,3056.6,1030.6136,3596,UnitedHealthcare,Individual & Family,3380.24,94,,percent of total billed charges,,
Trigger Finger Release,,25003349,LOCAL,Facility,Outpatient,,,,3596,3056.6,1030.6136,3596,UnitedHealthcare,Medicare Advantage,1762.04,49,,percent of total billed charges,,
Trigger Finger Release,,25003349,LOCAL,Facility,Inpatient,,,,3596,3056.6,1030.6136,3596,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Trigger Finger Release,,25003349,LOCAL,Facility,Outpatient,,,,3596,3056.6,1030.6136,3596,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1726.08,48,,percent of total billed charges,,100% of DHS outpatient percentage
Trigger Finger Release,,25003349,LOCAL,Facility,Inpatient,,,,3596,3056.6,1030.6136,3596,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Tubal Ligation,,25003360,LOCAL,Facility,Both,,,,1224,1040.4,350.7984,1224,Aetna,Commercial,1126.08,92,,percent of total billed charges,,
Tubal Ligation,,25003360,LOCAL,Facility,Outpatient,,,,1224,1040.4,350.7984,1224,Aetna,Medicare Advantage,599.76,49,,percent of total billed charges,,
Tubal Ligation,,25003360,LOCAL,Facility,Inpatient,,,,1224,1040.4,350.7984,1224,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Tubal Ligation,,25003360,LOCAL,Facility,Both,,,,1224,1040.4,350.7984,1224,Aetna,PPO,1138.32,93,,percent of total billed charges,,
Tubal Ligation,,25003360,LOCAL,Facility,Both,,,,1224,1040.4,350.7984,1224,America's PPO,America's PPO,1175.4072,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Tubal Ligation,,25003360,LOCAL,Facility,Both,,,,1224,1040.4,350.7984,1224,BlueCross BlueShield Minnesota, Federal Employee Program,1204.416,98.4,,percent of total billed charges,,
Tubal Ligation,,25003360,LOCAL,Facility,Both,,,,1224,1040.4,350.7984,1224,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1224,100,,percent of total billed charges,,
Tubal Ligation,,25003360,LOCAL,Facility,Both,,,,1224,1040.4,350.7984,1224,BlueCross BlueShield Minnesota,High Value Network Plan,1101.6,90,,percent of total billed charges,,
Tubal Ligation,,25003360,LOCAL,Facility,Outpatient,,,,1224,1040.4,350.7984,1224,BlueCross BlueShield Minnesota,Medicare Advantage,599.76,49,,percent of total billed charges,,
Tubal Ligation,,25003360,LOCAL,Facility,Inpatient,,,,1224,1040.4,350.7984,1224,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Tubal Ligation,,25003360,LOCAL,Facility,Both,,,,1224,1040.4,350.7984,1224,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1084.0968,88.57,,percent of total billed charges,,
Tubal Ligation,,25003360,LOCAL,Facility,Both,,,,1224,1040.4,350.7984,1224,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,350.7984,28.66,,percent of total billed charges,,
Tubal Ligation,,25003360,LOCAL,Facility,Outpatient,,,,1224,1040.4,350.7984,1224,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),599.76,49,,percent of total billed charges,,
Tubal Ligation,,25003360,LOCAL,Facility,Inpatient,,,,1224,1040.4,350.7984,1224,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Tubal Ligation,,25003360,LOCAL,Facility,Both,,,,1224,1040.4,350.7984,1224,CorVel,Worker's Compensation,1224,100,,percent of total billed charges,,
Tubal Ligation,,25003360,LOCAL,Facility,Both,,,,1224,1040.4,350.7984,1224,First Health Group Corporation,First Health Network,1187.28,97,,percent of total billed charges,,
Tubal Ligation,,25003360,LOCAL,Facility,Both,,,,1224,1040.4,350.7984,1224,"Health Partners, Inc.",Commercial,1157.904,94.6,,percent of total billed charges,,
Tubal Ligation,,25003360,LOCAL,Facility,Outpatient,,,,1224,1040.4,350.7984,1224,"Health Partners, Inc.",Medicare Advantage,599.76,49,,percent of total billed charges,,
Tubal Ligation,,25003360,LOCAL,Facility,Inpatient,,,,1224,1040.4,350.7984,1224,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Tubal Ligation,,25003360,LOCAL,Facility,Both,,,,1224,1040.4,350.7984,1224,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),734.4,60,,percent of total billed charges,,
Tubal Ligation,,25003360,LOCAL,Facility,Both,,,,1224,1040.4,350.7984,1224,"Health Partners, Inc.",State of Minnesota Advantage Program,997.56,81.5,,percent of total billed charges,,
Tubal Ligation,,25003360,LOCAL,Facility,Both,,,,1224,1040.4,350.7984,1224,"Health Partners, Inc.",State Public Programs,612,50,,percent of total billed charges,,
Tubal Ligation,,25003360,LOCAL,Facility,Both,,,,1224,1040.4,350.7984,1224,Humana Insurance Company,Commercial PPO,1162.8,95,,percent of total billed charges,,
Tubal Ligation,,25003360,LOCAL,Facility,Outpatient,,,,1224,1040.4,350.7984,1224,Humana Insurance Company,Medicare PPO,599.76,49,,percent of total billed charges,,
Tubal Ligation,,25003360,LOCAL,Facility,Inpatient,,,,1224,1040.4,350.7984,1224,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Tubal Ligation,,25003360,LOCAL,Facility,Both,,,,1224,1040.4,350.7984,1224,Medica,Individual & Family,1212.984,99.1,,percent of total billed charges,,
Tubal Ligation,,25003360,LOCAL,Facility,Outpatient,,,,1224,1040.4,350.7984,1224,Medica,Medica Advantage Solution,609.552,49.8,,percent of total billed charges,,
Tubal Ligation,,25003360,LOCAL,Facility,Inpatient,,,,1224,1040.4,350.7984,1224,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Tubal Ligation,,25003360,LOCAL,Facility,Outpatient,,,,1224,1040.4,350.7984,1224,Medica,Medical Assistance,545.904,44.6,,percent of total billed charges,,
Tubal Ligation,,25003360,LOCAL,Facility,Inpatient,,,,1224,1040.4,350.7984,1224,Medica,Medical Assistance,,,,,Included in per diem rate,
Tubal Ligation,,25003360,LOCAL,Facility,Outpatient,,,,1224,1040.4,350.7984,1224,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,609.552,49.8,,percent of total billed charges,,
Tubal Ligation,,25003360,LOCAL,Facility,Inpatient,,,,1224,1040.4,350.7984,1224,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Tubal Ligation,,25003360,LOCAL,Facility,Both,,,,1224,1040.4,350.7984,1224,"Multiplan, Inc.","Multiplan, Inc.",1150.56,94,,percent of total billed charges,,
Tubal Ligation,,25003360,LOCAL,Facility,Outpatient,,,,1224,1040.4,350.7984,1224,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1102.824,90.1,,percent of total billed charges,,
Tubal Ligation,,25003360,LOCAL,Facility,Inpatient,,,,1224,1040.4,350.7984,1224,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Tubal Ligation,,25003360,LOCAL,Facility,Both,,,,1224,1040.4,350.7984,1224,"Preferred One Administrative Services, INC.",PPO,1206.864,98.6,,percent of total billed charges,,
Tubal Ligation,,25003360,LOCAL,Facility,Outpatient,,,,1224,1040.4,350.7984,1224,PrimeWest Health,Minnesota Senior Health Options (MSHO),629.748,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Tubal Ligation,,25003360,LOCAL,Facility,Inpatient,,,,1224,1040.4,350.7984,1224,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Tubal Ligation,,25003360,LOCAL,Facility,Outpatient,,,,1224,1040.4,350.7984,1224,PrimeWest Health,MinnesotaCare,628.6464,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Tubal Ligation,,25003360,LOCAL,Facility,Inpatient,,,,1224,1040.4,350.7984,1224,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Tubal Ligation,,25003360,LOCAL,Facility,Both,,,,1224,1040.4,350.7984,1224,Sanford Health Plan,Sanford Health Plan,1126.08,92,,percent of total billed charges,,
Tubal Ligation,,25003360,LOCAL,Facility,Outpatient,,,,1224,1040.4,350.7984,1224,"UCare Health, Inc.",Individual & Family Plan,689.724,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Tubal Ligation,,25003360,LOCAL,Facility,Inpatient,,,,1224,1040.4,350.7984,1224,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Tubal Ligation,,25003360,LOCAL,Facility,Outpatient,,,,1224,1040.4,350.7984,1224,"UCare Health, Inc.",Medical Assistance,617.7528,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Tubal Ligation,,25003360,LOCAL,Facility,Inpatient,,,,1224,1040.4,350.7984,1224,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Tubal Ligation,,25003360,LOCAL,Facility,Outpatient,,,,1224,1040.4,350.7984,1224,"UCare Health, Inc.",Medicare Advantage,617.7528,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Tubal Ligation,,25003360,LOCAL,Facility,Inpatient,,,,1224,1040.4,350.7984,1224,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Tubal Ligation,,25003360,LOCAL,Facility,Outpatient,,,,1224,1040.4,350.7984,1224,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),617.7528,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Tubal Ligation,,25003360,LOCAL,Facility,Inpatient,,,,1224,1040.4,350.7984,1224,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Tubal Ligation,,25003360,LOCAL,Facility,Both,,,,1224,1040.4,350.7984,1224,UnitedHealthcare,Individual & Family,1150.56,94,,percent of total billed charges,,
Tubal Ligation,,25003360,LOCAL,Facility,Outpatient,,,,1224,1040.4,350.7984,1224,UnitedHealthcare,Medicare Advantage,599.76,49,,percent of total billed charges,,
Tubal Ligation,,25003360,LOCAL,Facility,Inpatient,,,,1224,1040.4,350.7984,1224,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Tubal Ligation,,25003360,LOCAL,Facility,Outpatient,,,,1224,1040.4,350.7984,1224,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,587.52,48,,percent of total billed charges,,100% of DHS outpatient percentage
Tubal Ligation,,25003360,LOCAL,Facility,Inpatient,,,,1224,1040.4,350.7984,1224,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Vasectomy,,25003452,LOCAL,Facility,Both,,,,1785,1517.25,511.581,1785,Aetna,Commercial,1642.2,92,,percent of total billed charges,,
Vasectomy,,25003452,LOCAL,Facility,Outpatient,,,,1785,1517.25,511.581,1785,Aetna,Medicare Advantage,874.65,49,,percent of total billed charges,,
Vasectomy,,25003452,LOCAL,Facility,Inpatient,,,,1785,1517.25,511.581,1785,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Vasectomy,,25003452,LOCAL,Facility,Both,,,,1785,1517.25,511.581,1785,Aetna,PPO,1660.05,93,,percent of total billed charges,,
Vasectomy,,25003452,LOCAL,Facility,Both,,,,1785,1517.25,511.581,1785,America's PPO,America's PPO,1714.1355,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Vasectomy,,25003452,LOCAL,Facility,Both,,,,1785,1517.25,511.581,1785,BlueCross BlueShield Minnesota, Federal Employee Program,1756.44,98.4,,percent of total billed charges,,
Vasectomy,,25003452,LOCAL,Facility,Both,,,,1785,1517.25,511.581,1785,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1785,100,,percent of total billed charges,,
Vasectomy,,25003452,LOCAL,Facility,Both,,,,1785,1517.25,511.581,1785,BlueCross BlueShield Minnesota,High Value Network Plan,1606.5,90,,percent of total billed charges,,
Vasectomy,,25003452,LOCAL,Facility,Outpatient,,,,1785,1517.25,511.581,1785,BlueCross BlueShield Minnesota,Medicare Advantage,874.65,49,,percent of total billed charges,,
Vasectomy,,25003452,LOCAL,Facility,Inpatient,,,,1785,1517.25,511.581,1785,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Vasectomy,,25003452,LOCAL,Facility,Both,,,,1785,1517.25,511.581,1785,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1580.9745,88.57,,percent of total billed charges,,
Vasectomy,,25003452,LOCAL,Facility,Both,,,,1785,1517.25,511.581,1785,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,511.581,28.66,,percent of total billed charges,,
Vasectomy,,25003452,LOCAL,Facility,Outpatient,,,,1785,1517.25,511.581,1785,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),874.65,49,,percent of total billed charges,,
Vasectomy,,25003452,LOCAL,Facility,Inpatient,,,,1785,1517.25,511.581,1785,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Vasectomy,,25003452,LOCAL,Facility,Both,,,,1785,1517.25,511.581,1785,CorVel,Worker's Compensation,1785,100,,percent of total billed charges,,
Vasectomy,,25003452,LOCAL,Facility,Both,,,,1785,1517.25,511.581,1785,First Health Group Corporation,First Health Network,1731.45,97,,percent of total billed charges,,
Vasectomy,,25003452,LOCAL,Facility,Both,,,,1785,1517.25,511.581,1785,"Health Partners, Inc.",Commercial,1688.61,94.6,,percent of total billed charges,,
Vasectomy,,25003452,LOCAL,Facility,Outpatient,,,,1785,1517.25,511.581,1785,"Health Partners, Inc.",Medicare Advantage,874.65,49,,percent of total billed charges,,
Vasectomy,,25003452,LOCAL,Facility,Inpatient,,,,1785,1517.25,511.581,1785,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Vasectomy,,25003452,LOCAL,Facility,Both,,,,1785,1517.25,511.581,1785,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1071,60,,percent of total billed charges,,
Vasectomy,,25003452,LOCAL,Facility,Both,,,,1785,1517.25,511.581,1785,"Health Partners, Inc.",State of Minnesota Advantage Program,1454.775,81.5,,percent of total billed charges,,
Vasectomy,,25003452,LOCAL,Facility,Both,,,,1785,1517.25,511.581,1785,"Health Partners, Inc.",State Public Programs,892.5,50,,percent of total billed charges,,
Vasectomy,,25003452,LOCAL,Facility,Both,,,,1785,1517.25,511.581,1785,Humana Insurance Company,Commercial PPO,1695.75,95,,percent of total billed charges,,
Vasectomy,,25003452,LOCAL,Facility,Outpatient,,,,1785,1517.25,511.581,1785,Humana Insurance Company,Medicare PPO,874.65,49,,percent of total billed charges,,
Vasectomy,,25003452,LOCAL,Facility,Inpatient,,,,1785,1517.25,511.581,1785,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Vasectomy,,25003452,LOCAL,Facility,Both,,,,1785,1517.25,511.581,1785,Medica,Individual & Family,1768.935,99.1,,percent of total billed charges,,
Vasectomy,,25003452,LOCAL,Facility,Outpatient,,,,1785,1517.25,511.581,1785,Medica,Medica Advantage Solution,888.93,49.8,,percent of total billed charges,,
Vasectomy,,25003452,LOCAL,Facility,Inpatient,,,,1785,1517.25,511.581,1785,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Vasectomy,,25003452,LOCAL,Facility,Outpatient,,,,1785,1517.25,511.581,1785,Medica,Medical Assistance,796.11,44.6,,percent of total billed charges,,
Vasectomy,,25003452,LOCAL,Facility,Inpatient,,,,1785,1517.25,511.581,1785,Medica,Medical Assistance,,,,,Included in per diem rate,
Vasectomy,,25003452,LOCAL,Facility,Outpatient,,,,1785,1517.25,511.581,1785,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,888.93,49.8,,percent of total billed charges,,
Vasectomy,,25003452,LOCAL,Facility,Inpatient,,,,1785,1517.25,511.581,1785,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Vasectomy,,25003452,LOCAL,Facility,Both,,,,1785,1517.25,511.581,1785,"Multiplan, Inc.","Multiplan, Inc.",1677.9,94,,percent of total billed charges,,
Vasectomy,,25003452,LOCAL,Facility,Outpatient,,,,1785,1517.25,511.581,1785,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1608.285,90.1,,percent of total billed charges,,
Vasectomy,,25003452,LOCAL,Facility,Inpatient,,,,1785,1517.25,511.581,1785,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Vasectomy,,25003452,LOCAL,Facility,Both,,,,1785,1517.25,511.581,1785,"Preferred One Administrative Services, INC.",PPO,1760.01,98.6,,percent of total billed charges,,
Vasectomy,,25003452,LOCAL,Facility,Outpatient,,,,1785,1517.25,511.581,1785,PrimeWest Health,Minnesota Senior Health Options (MSHO),918.3825,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Vasectomy,,25003452,LOCAL,Facility,Inpatient,,,,1785,1517.25,511.581,1785,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Vasectomy,,25003452,LOCAL,Facility,Outpatient,,,,1785,1517.25,511.581,1785,PrimeWest Health,MinnesotaCare,916.776,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Vasectomy,,25003452,LOCAL,Facility,Inpatient,,,,1785,1517.25,511.581,1785,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Vasectomy,,25003452,LOCAL,Facility,Both,,,,1785,1517.25,511.581,1785,Sanford Health Plan,Sanford Health Plan,1642.2,92,,percent of total billed charges,,
Vasectomy,,25003452,LOCAL,Facility,Outpatient,,,,1785,1517.25,511.581,1785,"UCare Health, Inc.",Individual & Family Plan,1005.8475,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Vasectomy,,25003452,LOCAL,Facility,Inpatient,,,,1785,1517.25,511.581,1785,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Vasectomy,,25003452,LOCAL,Facility,Outpatient,,,,1785,1517.25,511.581,1785,"UCare Health, Inc.",Medical Assistance,900.8895,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Vasectomy,,25003452,LOCAL,Facility,Inpatient,,,,1785,1517.25,511.581,1785,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Vasectomy,,25003452,LOCAL,Facility,Outpatient,,,,1785,1517.25,511.581,1785,"UCare Health, Inc.",Medicare Advantage,900.8895,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Vasectomy,,25003452,LOCAL,Facility,Inpatient,,,,1785,1517.25,511.581,1785,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Vasectomy,,25003452,LOCAL,Facility,Outpatient,,,,1785,1517.25,511.581,1785,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),900.8895,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Vasectomy,,25003452,LOCAL,Facility,Inpatient,,,,1785,1517.25,511.581,1785,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Vasectomy,,25003452,LOCAL,Facility,Both,,,,1785,1517.25,511.581,1785,UnitedHealthcare,Individual & Family,1677.9,94,,percent of total billed charges,,
Vasectomy,,25003452,LOCAL,Facility,Outpatient,,,,1785,1517.25,511.581,1785,UnitedHealthcare,Medicare Advantage,874.65,49,,percent of total billed charges,,
Vasectomy,,25003452,LOCAL,Facility,Inpatient,,,,1785,1517.25,511.581,1785,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Vasectomy,,25003452,LOCAL,Facility,Outpatient,,,,1785,1517.25,511.581,1785,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,856.8,48,,percent of total billed charges,,100% of DHS outpatient percentage
Vasectomy,,25003452,LOCAL,Facility,Inpatient,,,,1785,1517.25,511.581,1785,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Stab Phlebectomy,,25003693,LOCAL,Facility,Both,,,,2550,2167.5,730.83,2550,Aetna,Commercial,2346,92,,percent of total billed charges,,
Stab Phlebectomy,,25003693,LOCAL,Facility,Outpatient,,,,2550,2167.5,730.83,2550,Aetna,Medicare Advantage,1249.5,49,,percent of total billed charges,,
Stab Phlebectomy,,25003693,LOCAL,Facility,Inpatient,,,,2550,2167.5,730.83,2550,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Stab Phlebectomy,,25003693,LOCAL,Facility,Both,,,,2550,2167.5,730.83,2550,Aetna,PPO,2371.5,93,,percent of total billed charges,,
Stab Phlebectomy,,25003693,LOCAL,Facility,Both,,,,2550,2167.5,730.83,2550,America's PPO,America's PPO,2448.765,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Stab Phlebectomy,,25003693,LOCAL,Facility,Both,,,,2550,2167.5,730.83,2550,BlueCross BlueShield Minnesota, Federal Employee Program,2509.2,98.4,,percent of total billed charges,,
Stab Phlebectomy,,25003693,LOCAL,Facility,Both,,,,2550,2167.5,730.83,2550,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,2550,100,,percent of total billed charges,,
Stab Phlebectomy,,25003693,LOCAL,Facility,Both,,,,2550,2167.5,730.83,2550,BlueCross BlueShield Minnesota,High Value Network Plan,2295,90,,percent of total billed charges,,
Stab Phlebectomy,,25003693,LOCAL,Facility,Outpatient,,,,2550,2167.5,730.83,2550,BlueCross BlueShield Minnesota,Medicare Advantage,1249.5,49,,percent of total billed charges,,
Stab Phlebectomy,,25003693,LOCAL,Facility,Inpatient,,,,2550,2167.5,730.83,2550,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Stab Phlebectomy,,25003693,LOCAL,Facility,Both,,,,2550,2167.5,730.83,2550,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,2258.535,88.57,,percent of total billed charges,,
Stab Phlebectomy,,25003693,LOCAL,Facility,Both,,,,2550,2167.5,730.83,2550,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,730.83,28.66,,percent of total billed charges,,
Stab Phlebectomy,,25003693,LOCAL,Facility,Outpatient,,,,2550,2167.5,730.83,2550,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1249.5,49,,percent of total billed charges,,
Stab Phlebectomy,,25003693,LOCAL,Facility,Inpatient,,,,2550,2167.5,730.83,2550,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Stab Phlebectomy,,25003693,LOCAL,Facility,Both,,,,2550,2167.5,730.83,2550,CorVel,Worker's Compensation,2550,100,,percent of total billed charges,,
Stab Phlebectomy,,25003693,LOCAL,Facility,Both,,,,2550,2167.5,730.83,2550,First Health Group Corporation,First Health Network,2473.5,97,,percent of total billed charges,,
Stab Phlebectomy,,25003693,LOCAL,Facility,Both,,,,2550,2167.5,730.83,2550,"Health Partners, Inc.",Commercial,2412.3,94.6,,percent of total billed charges,,
Stab Phlebectomy,,25003693,LOCAL,Facility,Outpatient,,,,2550,2167.5,730.83,2550,"Health Partners, Inc.",Medicare Advantage,1249.5,49,,percent of total billed charges,,
Stab Phlebectomy,,25003693,LOCAL,Facility,Inpatient,,,,2550,2167.5,730.83,2550,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Stab Phlebectomy,,25003693,LOCAL,Facility,Both,,,,2550,2167.5,730.83,2550,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1530,60,,percent of total billed charges,,
Stab Phlebectomy,,25003693,LOCAL,Facility,Both,,,,2550,2167.5,730.83,2550,"Health Partners, Inc.",State of Minnesota Advantage Program,2078.25,81.5,,percent of total billed charges,,
Stab Phlebectomy,,25003693,LOCAL,Facility,Both,,,,2550,2167.5,730.83,2550,"Health Partners, Inc.",State Public Programs,1275,50,,percent of total billed charges,,
Stab Phlebectomy,,25003693,LOCAL,Facility,Both,,,,2550,2167.5,730.83,2550,Humana Insurance Company,Commercial PPO,2422.5,95,,percent of total billed charges,,
Stab Phlebectomy,,25003693,LOCAL,Facility,Outpatient,,,,2550,2167.5,730.83,2550,Humana Insurance Company,Medicare PPO,1249.5,49,,percent of total billed charges,,
Stab Phlebectomy,,25003693,LOCAL,Facility,Inpatient,,,,2550,2167.5,730.83,2550,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Stab Phlebectomy,,25003693,LOCAL,Facility,Both,,,,2550,2167.5,730.83,2550,Medica,Individual & Family,2527.05,99.1,,percent of total billed charges,,
Stab Phlebectomy,,25003693,LOCAL,Facility,Outpatient,,,,2550,2167.5,730.83,2550,Medica,Medica Advantage Solution,1269.9,49.8,,percent of total billed charges,,
Stab Phlebectomy,,25003693,LOCAL,Facility,Inpatient,,,,2550,2167.5,730.83,2550,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Stab Phlebectomy,,25003693,LOCAL,Facility,Outpatient,,,,2550,2167.5,730.83,2550,Medica,Medical Assistance,1137.3,44.6,,percent of total billed charges,,
Stab Phlebectomy,,25003693,LOCAL,Facility,Inpatient,,,,2550,2167.5,730.83,2550,Medica,Medical Assistance,,,,,Included in per diem rate,
Stab Phlebectomy,,25003693,LOCAL,Facility,Outpatient,,,,2550,2167.5,730.83,2550,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1269.9,49.8,,percent of total billed charges,,
Stab Phlebectomy,,25003693,LOCAL,Facility,Inpatient,,,,2550,2167.5,730.83,2550,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Stab Phlebectomy,,25003693,LOCAL,Facility,Both,,,,2550,2167.5,730.83,2550,"Multiplan, Inc.","Multiplan, Inc.",2397,94,,percent of total billed charges,,
Stab Phlebectomy,,25003693,LOCAL,Facility,Outpatient,,,,2550,2167.5,730.83,2550,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,2297.55,90.1,,percent of total billed charges,,
Stab Phlebectomy,,25003693,LOCAL,Facility,Inpatient,,,,2550,2167.5,730.83,2550,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Stab Phlebectomy,,25003693,LOCAL,Facility,Both,,,,2550,2167.5,730.83,2550,"Preferred One Administrative Services, INC.",PPO,2514.3,98.6,,percent of total billed charges,,
Stab Phlebectomy,,25003693,LOCAL,Facility,Outpatient,,,,2550,2167.5,730.83,2550,PrimeWest Health,Minnesota Senior Health Options (MSHO),1311.975,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Stab Phlebectomy,,25003693,LOCAL,Facility,Inpatient,,,,2550,2167.5,730.83,2550,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Stab Phlebectomy,,25003693,LOCAL,Facility,Outpatient,,,,2550,2167.5,730.83,2550,PrimeWest Health,MinnesotaCare,1309.68,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Stab Phlebectomy,,25003693,LOCAL,Facility,Inpatient,,,,2550,2167.5,730.83,2550,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Stab Phlebectomy,,25003693,LOCAL,Facility,Both,,,,2550,2167.5,730.83,2550,Sanford Health Plan,Sanford Health Plan,2346,92,,percent of total billed charges,,
Stab Phlebectomy,,25003693,LOCAL,Facility,Outpatient,,,,2550,2167.5,730.83,2550,"UCare Health, Inc.",Individual & Family Plan,1436.925,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Stab Phlebectomy,,25003693,LOCAL,Facility,Inpatient,,,,2550,2167.5,730.83,2550,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Stab Phlebectomy,,25003693,LOCAL,Facility,Outpatient,,,,2550,2167.5,730.83,2550,"UCare Health, Inc.",Medical Assistance,1286.985,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Stab Phlebectomy,,25003693,LOCAL,Facility,Inpatient,,,,2550,2167.5,730.83,2550,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Stab Phlebectomy,,25003693,LOCAL,Facility,Outpatient,,,,2550,2167.5,730.83,2550,"UCare Health, Inc.",Medicare Advantage,1286.985,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Stab Phlebectomy,,25003693,LOCAL,Facility,Inpatient,,,,2550,2167.5,730.83,2550,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Stab Phlebectomy,,25003693,LOCAL,Facility,Outpatient,,,,2550,2167.5,730.83,2550,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1286.985,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Stab Phlebectomy,,25003693,LOCAL,Facility,Inpatient,,,,2550,2167.5,730.83,2550,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Stab Phlebectomy,,25003693,LOCAL,Facility,Both,,,,2550,2167.5,730.83,2550,UnitedHealthcare,Individual & Family,2397,94,,percent of total billed charges,,
Stab Phlebectomy,,25003693,LOCAL,Facility,Outpatient,,,,2550,2167.5,730.83,2550,UnitedHealthcare,Medicare Advantage,1249.5,49,,percent of total billed charges,,
Stab Phlebectomy,,25003693,LOCAL,Facility,Inpatient,,,,2550,2167.5,730.83,2550,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Stab Phlebectomy,,25003693,LOCAL,Facility,Outpatient,,,,2550,2167.5,730.83,2550,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1224,48,,percent of total billed charges,,100% of DHS outpatient percentage
Stab Phlebectomy,,25003693,LOCAL,Facility,Inpatient,,,,2550,2167.5,730.83,2550,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Tonsillectomy (Age 12 Or Over),,25003704,LOCAL,Facility,Both,,,,3978,3381.3,1140.0948,3978,Aetna,Commercial,3659.76,92,,percent of total billed charges,,
Tonsillectomy (Age 12 Or Over),,25003704,LOCAL,Facility,Outpatient,,,,3978,3381.3,1140.0948,3978,Aetna,Medicare Advantage,1949.22,49,,percent of total billed charges,,
Tonsillectomy (Age 12 Or Over),,25003704,LOCAL,Facility,Inpatient,,,,3978,3381.3,1140.0948,3978,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Tonsillectomy (Age 12 Or Over),,25003704,LOCAL,Facility,Both,,,,3978,3381.3,1140.0948,3978,Aetna,PPO,3699.54,93,,percent of total billed charges,,
Tonsillectomy (Age 12 Or Over),,25003704,LOCAL,Facility,Both,,,,3978,3381.3,1140.0948,3978,America's PPO,America's PPO,3820.0734,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Tonsillectomy (Age 12 Or Over),,25003704,LOCAL,Facility,Both,,,,3978,3381.3,1140.0948,3978,BlueCross BlueShield Minnesota, Federal Employee Program,3914.352,98.4,,percent of total billed charges,,
Tonsillectomy (Age 12 Or Over),,25003704,LOCAL,Facility,Both,,,,3978,3381.3,1140.0948,3978,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,3978,100,,percent of total billed charges,,
Tonsillectomy (Age 12 Or Over),,25003704,LOCAL,Facility,Both,,,,3978,3381.3,1140.0948,3978,BlueCross BlueShield Minnesota,High Value Network Plan,3580.2,90,,percent of total billed charges,,
Tonsillectomy (Age 12 Or Over),,25003704,LOCAL,Facility,Outpatient,,,,3978,3381.3,1140.0948,3978,BlueCross BlueShield Minnesota,Medicare Advantage,1949.22,49,,percent of total billed charges,,
Tonsillectomy (Age 12 Or Over),,25003704,LOCAL,Facility,Inpatient,,,,3978,3381.3,1140.0948,3978,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Tonsillectomy (Age 12 Or Over),,25003704,LOCAL,Facility,Both,,,,3978,3381.3,1140.0948,3978,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,3523.3146,88.57,,percent of total billed charges,,
Tonsillectomy (Age 12 Or Over),,25003704,LOCAL,Facility,Both,,,,3978,3381.3,1140.0948,3978,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1140.0948,28.66,,percent of total billed charges,,
Tonsillectomy (Age 12 Or Over),,25003704,LOCAL,Facility,Outpatient,,,,3978,3381.3,1140.0948,3978,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1949.22,49,,percent of total billed charges,,
Tonsillectomy (Age 12 Or Over),,25003704,LOCAL,Facility,Inpatient,,,,3978,3381.3,1140.0948,3978,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Tonsillectomy (Age 12 Or Over),,25003704,LOCAL,Facility,Both,,,,3978,3381.3,1140.0948,3978,CorVel,Worker's Compensation,3978,100,,percent of total billed charges,,
Tonsillectomy (Age 12 Or Over),,25003704,LOCAL,Facility,Both,,,,3978,3381.3,1140.0948,3978,First Health Group Corporation,First Health Network,3858.66,97,,percent of total billed charges,,
Tonsillectomy (Age 12 Or Over),,25003704,LOCAL,Facility,Both,,,,3978,3381.3,1140.0948,3978,"Health Partners, Inc.",Commercial,3763.188,94.6,,percent of total billed charges,,
Tonsillectomy (Age 12 Or Over),,25003704,LOCAL,Facility,Outpatient,,,,3978,3381.3,1140.0948,3978,"Health Partners, Inc.",Medicare Advantage,1949.22,49,,percent of total billed charges,,
Tonsillectomy (Age 12 Or Over),,25003704,LOCAL,Facility,Inpatient,,,,3978,3381.3,1140.0948,3978,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Tonsillectomy (Age 12 Or Over),,25003704,LOCAL,Facility,Both,,,,3978,3381.3,1140.0948,3978,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),2386.8,60,,percent of total billed charges,,
Tonsillectomy (Age 12 Or Over),,25003704,LOCAL,Facility,Both,,,,3978,3381.3,1140.0948,3978,"Health Partners, Inc.",State of Minnesota Advantage Program,3242.07,81.5,,percent of total billed charges,,
Tonsillectomy (Age 12 Or Over),,25003704,LOCAL,Facility,Both,,,,3978,3381.3,1140.0948,3978,"Health Partners, Inc.",State Public Programs,1989,50,,percent of total billed charges,,
Tonsillectomy (Age 12 Or Over),,25003704,LOCAL,Facility,Both,,,,3978,3381.3,1140.0948,3978,Humana Insurance Company,Commercial PPO,3779.1,95,,percent of total billed charges,,
Tonsillectomy (Age 12 Or Over),,25003704,LOCAL,Facility,Outpatient,,,,3978,3381.3,1140.0948,3978,Humana Insurance Company,Medicare PPO,1949.22,49,,percent of total billed charges,,
Tonsillectomy (Age 12 Or Over),,25003704,LOCAL,Facility,Inpatient,,,,3978,3381.3,1140.0948,3978,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Tonsillectomy (Age 12 Or Over),,25003704,LOCAL,Facility,Both,,,,3978,3381.3,1140.0948,3978,Medica,Individual & Family,3942.198,99.1,,percent of total billed charges,,
Tonsillectomy (Age 12 Or Over),,25003704,LOCAL,Facility,Outpatient,,,,3978,3381.3,1140.0948,3978,Medica,Medica Advantage Solution,1981.044,49.8,,percent of total billed charges,,
Tonsillectomy (Age 12 Or Over),,25003704,LOCAL,Facility,Inpatient,,,,3978,3381.3,1140.0948,3978,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Tonsillectomy (Age 12 Or Over),,25003704,LOCAL,Facility,Outpatient,,,,3978,3381.3,1140.0948,3978,Medica,Medical Assistance,1774.188,44.6,,percent of total billed charges,,
Tonsillectomy (Age 12 Or Over),,25003704,LOCAL,Facility,Inpatient,,,,3978,3381.3,1140.0948,3978,Medica,Medical Assistance,,,,,Included in per diem rate,
Tonsillectomy (Age 12 Or Over),,25003704,LOCAL,Facility,Outpatient,,,,3978,3381.3,1140.0948,3978,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1981.044,49.8,,percent of total billed charges,,
Tonsillectomy (Age 12 Or Over),,25003704,LOCAL,Facility,Inpatient,,,,3978,3381.3,1140.0948,3978,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Tonsillectomy (Age 12 Or Over),,25003704,LOCAL,Facility,Both,,,,3978,3381.3,1140.0948,3978,"Multiplan, Inc.","Multiplan, Inc.",3739.32,94,,percent of total billed charges,,
Tonsillectomy (Age 12 Or Over),,25003704,LOCAL,Facility,Outpatient,,,,3978,3381.3,1140.0948,3978,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,3584.178,90.1,,percent of total billed charges,,
Tonsillectomy (Age 12 Or Over),,25003704,LOCAL,Facility,Inpatient,,,,3978,3381.3,1140.0948,3978,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Tonsillectomy (Age 12 Or Over),,25003704,LOCAL,Facility,Both,,,,3978,3381.3,1140.0948,3978,"Preferred One Administrative Services, INC.",PPO,3922.308,98.6,,percent of total billed charges,,
Tonsillectomy (Age 12 Or Over),,25003704,LOCAL,Facility,Outpatient,,,,3978,3381.3,1140.0948,3978,PrimeWest Health,Minnesota Senior Health Options (MSHO),2046.681,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Tonsillectomy (Age 12 Or Over),,25003704,LOCAL,Facility,Inpatient,,,,3978,3381.3,1140.0948,3978,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Tonsillectomy (Age 12 Or Over),,25003704,LOCAL,Facility,Outpatient,,,,3978,3381.3,1140.0948,3978,PrimeWest Health,MinnesotaCare,2043.1008,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Tonsillectomy (Age 12 Or Over),,25003704,LOCAL,Facility,Inpatient,,,,3978,3381.3,1140.0948,3978,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Tonsillectomy (Age 12 Or Over),,25003704,LOCAL,Facility,Both,,,,3978,3381.3,1140.0948,3978,Sanford Health Plan,Sanford Health Plan,3659.76,92,,percent of total billed charges,,
Tonsillectomy (Age 12 Or Over),,25003704,LOCAL,Facility,Outpatient,,,,3978,3381.3,1140.0948,3978,"UCare Health, Inc.",Individual & Family Plan,2241.603,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Tonsillectomy (Age 12 Or Over),,25003704,LOCAL,Facility,Inpatient,,,,3978,3381.3,1140.0948,3978,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Tonsillectomy (Age 12 Or Over),,25003704,LOCAL,Facility,Outpatient,,,,3978,3381.3,1140.0948,3978,"UCare Health, Inc.",Medical Assistance,2007.6966,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Tonsillectomy (Age 12 Or Over),,25003704,LOCAL,Facility,Inpatient,,,,3978,3381.3,1140.0948,3978,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Tonsillectomy (Age 12 Or Over),,25003704,LOCAL,Facility,Outpatient,,,,3978,3381.3,1140.0948,3978,"UCare Health, Inc.",Medicare Advantage,2007.6966,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Tonsillectomy (Age 12 Or Over),,25003704,LOCAL,Facility,Inpatient,,,,3978,3381.3,1140.0948,3978,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Tonsillectomy (Age 12 Or Over),,25003704,LOCAL,Facility,Outpatient,,,,3978,3381.3,1140.0948,3978,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2007.6966,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Tonsillectomy (Age 12 Or Over),,25003704,LOCAL,Facility,Inpatient,,,,3978,3381.3,1140.0948,3978,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Tonsillectomy (Age 12 Or Over),,25003704,LOCAL,Facility,Both,,,,3978,3381.3,1140.0948,3978,UnitedHealthcare,Individual & Family,3739.32,94,,percent of total billed charges,,
Tonsillectomy (Age 12 Or Over),,25003704,LOCAL,Facility,Outpatient,,,,3978,3381.3,1140.0948,3978,UnitedHealthcare,Medicare Advantage,1949.22,49,,percent of total billed charges,,
Tonsillectomy (Age 12 Or Over),,25003704,LOCAL,Facility,Inpatient,,,,3978,3381.3,1140.0948,3978,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Tonsillectomy (Age 12 Or Over),,25003704,LOCAL,Facility,Outpatient,,,,3978,3381.3,1140.0948,3978,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1909.44,48,,percent of total billed charges,,100% of DHS outpatient percentage
Tonsillectomy (Age 12 Or Over),,25003704,LOCAL,Facility,Inpatient,,,,3978,3381.3,1140.0948,3978,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Debridement Wound,,25003784,LOCAL,Facility,Both,,,,1938,1647.3,555.4308,1938,Aetna,Commercial,1782.96,92,,percent of total billed charges,,
Debridement Wound,,25003784,LOCAL,Facility,Outpatient,,,,1938,1647.3,555.4308,1938,Aetna,Medicare Advantage,949.62,49,,percent of total billed charges,,
Debridement Wound,,25003784,LOCAL,Facility,Inpatient,,,,1938,1647.3,555.4308,1938,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Debridement Wound,,25003784,LOCAL,Facility,Both,,,,1938,1647.3,555.4308,1938,Aetna,PPO,1802.34,93,,percent of total billed charges,,
Debridement Wound,,25003784,LOCAL,Facility,Both,,,,1938,1647.3,555.4308,1938,America's PPO,America's PPO,1861.0614,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Debridement Wound,,25003784,LOCAL,Facility,Both,,,,1938,1647.3,555.4308,1938,BlueCross BlueShield Minnesota, Federal Employee Program,1906.992,98.4,,percent of total billed charges,,
Debridement Wound,,25003784,LOCAL,Facility,Both,,,,1938,1647.3,555.4308,1938,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1938,100,,percent of total billed charges,,
Debridement Wound,,25003784,LOCAL,Facility,Both,,,,1938,1647.3,555.4308,1938,BlueCross BlueShield Minnesota,High Value Network Plan,1744.2,90,,percent of total billed charges,,
Debridement Wound,,25003784,LOCAL,Facility,Outpatient,,,,1938,1647.3,555.4308,1938,BlueCross BlueShield Minnesota,Medicare Advantage,949.62,49,,percent of total billed charges,,
Debridement Wound,,25003784,LOCAL,Facility,Inpatient,,,,1938,1647.3,555.4308,1938,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Debridement Wound,,25003784,LOCAL,Facility,Both,,,,1938,1647.3,555.4308,1938,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1716.4866,88.57,,percent of total billed charges,,
Debridement Wound,,25003784,LOCAL,Facility,Both,,,,1938,1647.3,555.4308,1938,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,555.4308,28.66,,percent of total billed charges,,
Debridement Wound,,25003784,LOCAL,Facility,Outpatient,,,,1938,1647.3,555.4308,1938,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),949.62,49,,percent of total billed charges,,
Debridement Wound,,25003784,LOCAL,Facility,Inpatient,,,,1938,1647.3,555.4308,1938,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Debridement Wound,,25003784,LOCAL,Facility,Both,,,,1938,1647.3,555.4308,1938,CorVel,Worker's Compensation,1938,100,,percent of total billed charges,,
Debridement Wound,,25003784,LOCAL,Facility,Both,,,,1938,1647.3,555.4308,1938,First Health Group Corporation,First Health Network,1879.86,97,,percent of total billed charges,,
Debridement Wound,,25003784,LOCAL,Facility,Both,,,,1938,1647.3,555.4308,1938,"Health Partners, Inc.",Commercial,1833.348,94.6,,percent of total billed charges,,
Debridement Wound,,25003784,LOCAL,Facility,Outpatient,,,,1938,1647.3,555.4308,1938,"Health Partners, Inc.",Medicare Advantage,949.62,49,,percent of total billed charges,,
Debridement Wound,,25003784,LOCAL,Facility,Inpatient,,,,1938,1647.3,555.4308,1938,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Debridement Wound,,25003784,LOCAL,Facility,Both,,,,1938,1647.3,555.4308,1938,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1162.8,60,,percent of total billed charges,,
Debridement Wound,,25003784,LOCAL,Facility,Both,,,,1938,1647.3,555.4308,1938,"Health Partners, Inc.",State of Minnesota Advantage Program,1579.47,81.5,,percent of total billed charges,,
Debridement Wound,,25003784,LOCAL,Facility,Both,,,,1938,1647.3,555.4308,1938,"Health Partners, Inc.",State Public Programs,969,50,,percent of total billed charges,,
Debridement Wound,,25003784,LOCAL,Facility,Both,,,,1938,1647.3,555.4308,1938,Humana Insurance Company,Commercial PPO,1841.1,95,,percent of total billed charges,,
Debridement Wound,,25003784,LOCAL,Facility,Outpatient,,,,1938,1647.3,555.4308,1938,Humana Insurance Company,Medicare PPO,949.62,49,,percent of total billed charges,,
Debridement Wound,,25003784,LOCAL,Facility,Inpatient,,,,1938,1647.3,555.4308,1938,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Debridement Wound,,25003784,LOCAL,Facility,Both,,,,1938,1647.3,555.4308,1938,Medica,Individual & Family,1920.558,99.1,,percent of total billed charges,,
Debridement Wound,,25003784,LOCAL,Facility,Outpatient,,,,1938,1647.3,555.4308,1938,Medica,Medica Advantage Solution,965.124,49.8,,percent of total billed charges,,
Debridement Wound,,25003784,LOCAL,Facility,Inpatient,,,,1938,1647.3,555.4308,1938,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Debridement Wound,,25003784,LOCAL,Facility,Outpatient,,,,1938,1647.3,555.4308,1938,Medica,Medical Assistance,864.348,44.6,,percent of total billed charges,,
Debridement Wound,,25003784,LOCAL,Facility,Inpatient,,,,1938,1647.3,555.4308,1938,Medica,Medical Assistance,,,,,Included in per diem rate,
Debridement Wound,,25003784,LOCAL,Facility,Outpatient,,,,1938,1647.3,555.4308,1938,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,965.124,49.8,,percent of total billed charges,,
Debridement Wound,,25003784,LOCAL,Facility,Inpatient,,,,1938,1647.3,555.4308,1938,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Debridement Wound,,25003784,LOCAL,Facility,Both,,,,1938,1647.3,555.4308,1938,"Multiplan, Inc.","Multiplan, Inc.",1821.72,94,,percent of total billed charges,,
Debridement Wound,,25003784,LOCAL,Facility,Outpatient,,,,1938,1647.3,555.4308,1938,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1746.138,90.1,,percent of total billed charges,,
Debridement Wound,,25003784,LOCAL,Facility,Inpatient,,,,1938,1647.3,555.4308,1938,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Debridement Wound,,25003784,LOCAL,Facility,Both,,,,1938,1647.3,555.4308,1938,"Preferred One Administrative Services, INC.",PPO,1910.868,98.6,,percent of total billed charges,,
Debridement Wound,,25003784,LOCAL,Facility,Outpatient,,,,1938,1647.3,555.4308,1938,PrimeWest Health,Minnesota Senior Health Options (MSHO),997.101,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Debridement Wound,,25003784,LOCAL,Facility,Inpatient,,,,1938,1647.3,555.4308,1938,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Debridement Wound,,25003784,LOCAL,Facility,Outpatient,,,,1938,1647.3,555.4308,1938,PrimeWest Health,MinnesotaCare,995.3568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Debridement Wound,,25003784,LOCAL,Facility,Inpatient,,,,1938,1647.3,555.4308,1938,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Debridement Wound,,25003784,LOCAL,Facility,Both,,,,1938,1647.3,555.4308,1938,Sanford Health Plan,Sanford Health Plan,1782.96,92,,percent of total billed charges,,
Debridement Wound,,25003784,LOCAL,Facility,Outpatient,,,,1938,1647.3,555.4308,1938,"UCare Health, Inc.",Individual & Family Plan,1092.063,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Debridement Wound,,25003784,LOCAL,Facility,Inpatient,,,,1938,1647.3,555.4308,1938,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Debridement Wound,,25003784,LOCAL,Facility,Outpatient,,,,1938,1647.3,555.4308,1938,"UCare Health, Inc.",Medical Assistance,978.1086,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Debridement Wound,,25003784,LOCAL,Facility,Inpatient,,,,1938,1647.3,555.4308,1938,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Debridement Wound,,25003784,LOCAL,Facility,Outpatient,,,,1938,1647.3,555.4308,1938,"UCare Health, Inc.",Medicare Advantage,978.1086,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Debridement Wound,,25003784,LOCAL,Facility,Inpatient,,,,1938,1647.3,555.4308,1938,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Debridement Wound,,25003784,LOCAL,Facility,Outpatient,,,,1938,1647.3,555.4308,1938,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),978.1086,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Debridement Wound,,25003784,LOCAL,Facility,Inpatient,,,,1938,1647.3,555.4308,1938,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Debridement Wound,,25003784,LOCAL,Facility,Both,,,,1938,1647.3,555.4308,1938,UnitedHealthcare,Individual & Family,1821.72,94,,percent of total billed charges,,
Debridement Wound,,25003784,LOCAL,Facility,Outpatient,,,,1938,1647.3,555.4308,1938,UnitedHealthcare,Medicare Advantage,949.62,49,,percent of total billed charges,,
Debridement Wound,,25003784,LOCAL,Facility,Inpatient,,,,1938,1647.3,555.4308,1938,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Debridement Wound,,25003784,LOCAL,Facility,Outpatient,,,,1938,1647.3,555.4308,1938,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,930.24,48,,percent of total billed charges,,100% of DHS outpatient percentage
Debridement Wound,,25003784,LOCAL,Facility,Inpatient,,,,1938,1647.3,555.4308,1938,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Excision Of Squamous Cell < 2 Cm,,25003791,LOCAL,Facility,Both,,,,510,433.5,146.166,510,Aetna,Commercial,469.2,92,,percent of total billed charges,,
Excision Of Squamous Cell < 2 Cm,,25003791,LOCAL,Facility,Outpatient,,,,510,433.5,146.166,510,Aetna,Medicare Advantage,249.9,49,,percent of total billed charges,,
Excision Of Squamous Cell < 2 Cm,,25003791,LOCAL,Facility,Inpatient,,,,510,433.5,146.166,510,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Excision Of Squamous Cell < 2 Cm,,25003791,LOCAL,Facility,Both,,,,510,433.5,146.166,510,Aetna,PPO,474.3,93,,percent of total billed charges,,
Excision Of Squamous Cell < 2 Cm,,25003791,LOCAL,Facility,Both,,,,510,433.5,146.166,510,America's PPO,America's PPO,489.753,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Excision Of Squamous Cell < 2 Cm,,25003791,LOCAL,Facility,Both,,,,510,433.5,146.166,510,BlueCross BlueShield Minnesota, Federal Employee Program,501.84,98.4,,percent of total billed charges,,
Excision Of Squamous Cell < 2 Cm,,25003791,LOCAL,Facility,Both,,,,510,433.5,146.166,510,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,510,100,,percent of total billed charges,,
Excision Of Squamous Cell < 2 Cm,,25003791,LOCAL,Facility,Both,,,,510,433.5,146.166,510,BlueCross BlueShield Minnesota,High Value Network Plan,459,90,,percent of total billed charges,,
Excision Of Squamous Cell < 2 Cm,,25003791,LOCAL,Facility,Outpatient,,,,510,433.5,146.166,510,BlueCross BlueShield Minnesota,Medicare Advantage,249.9,49,,percent of total billed charges,,
Excision Of Squamous Cell < 2 Cm,,25003791,LOCAL,Facility,Inpatient,,,,510,433.5,146.166,510,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Excision Of Squamous Cell < 2 Cm,,25003791,LOCAL,Facility,Both,,,,510,433.5,146.166,510,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,451.707,88.57,,percent of total billed charges,,
Excision Of Squamous Cell < 2 Cm,,25003791,LOCAL,Facility,Both,,,,510,433.5,146.166,510,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,146.166,28.66,,percent of total billed charges,,
Excision Of Squamous Cell < 2 Cm,,25003791,LOCAL,Facility,Outpatient,,,,510,433.5,146.166,510,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),249.9,49,,percent of total billed charges,,
Excision Of Squamous Cell < 2 Cm,,25003791,LOCAL,Facility,Inpatient,,,,510,433.5,146.166,510,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Excision Of Squamous Cell < 2 Cm,,25003791,LOCAL,Facility,Both,,,,510,433.5,146.166,510,CorVel,Worker's Compensation,510,100,,percent of total billed charges,,
Excision Of Squamous Cell < 2 Cm,,25003791,LOCAL,Facility,Both,,,,510,433.5,146.166,510,First Health Group Corporation,First Health Network,494.7,97,,percent of total billed charges,,
Excision Of Squamous Cell < 2 Cm,,25003791,LOCAL,Facility,Both,,,,510,433.5,146.166,510,"Health Partners, Inc.",Commercial,482.46,94.6,,percent of total billed charges,,
Excision Of Squamous Cell < 2 Cm,,25003791,LOCAL,Facility,Outpatient,,,,510,433.5,146.166,510,"Health Partners, Inc.",Medicare Advantage,249.9,49,,percent of total billed charges,,
Excision Of Squamous Cell < 2 Cm,,25003791,LOCAL,Facility,Inpatient,,,,510,433.5,146.166,510,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Excision Of Squamous Cell < 2 Cm,,25003791,LOCAL,Facility,Both,,,,510,433.5,146.166,510,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),306,60,,percent of total billed charges,,
Excision Of Squamous Cell < 2 Cm,,25003791,LOCAL,Facility,Both,,,,510,433.5,146.166,510,"Health Partners, Inc.",State of Minnesota Advantage Program,415.65,81.5,,percent of total billed charges,,
Excision Of Squamous Cell < 2 Cm,,25003791,LOCAL,Facility,Both,,,,510,433.5,146.166,510,"Health Partners, Inc.",State Public Programs,255,50,,percent of total billed charges,,
Excision Of Squamous Cell < 2 Cm,,25003791,LOCAL,Facility,Both,,,,510,433.5,146.166,510,Humana Insurance Company,Commercial PPO,484.5,95,,percent of total billed charges,,
Excision Of Squamous Cell < 2 Cm,,25003791,LOCAL,Facility,Outpatient,,,,510,433.5,146.166,510,Humana Insurance Company,Medicare PPO,249.9,49,,percent of total billed charges,,
Excision Of Squamous Cell < 2 Cm,,25003791,LOCAL,Facility,Inpatient,,,,510,433.5,146.166,510,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Excision Of Squamous Cell < 2 Cm,,25003791,LOCAL,Facility,Both,,,,510,433.5,146.166,510,Medica,Individual & Family,505.41,99.1,,percent of total billed charges,,
Excision Of Squamous Cell < 2 Cm,,25003791,LOCAL,Facility,Outpatient,,,,510,433.5,146.166,510,Medica,Medica Advantage Solution,253.98,49.8,,percent of total billed charges,,
Excision Of Squamous Cell < 2 Cm,,25003791,LOCAL,Facility,Inpatient,,,,510,433.5,146.166,510,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Excision Of Squamous Cell < 2 Cm,,25003791,LOCAL,Facility,Outpatient,,,,510,433.5,146.166,510,Medica,Medical Assistance,227.46,44.6,,percent of total billed charges,,
Excision Of Squamous Cell < 2 Cm,,25003791,LOCAL,Facility,Inpatient,,,,510,433.5,146.166,510,Medica,Medical Assistance,,,,,Included in per diem rate,
Excision Of Squamous Cell < 2 Cm,,25003791,LOCAL,Facility,Outpatient,,,,510,433.5,146.166,510,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,253.98,49.8,,percent of total billed charges,,
Excision Of Squamous Cell < 2 Cm,,25003791,LOCAL,Facility,Inpatient,,,,510,433.5,146.166,510,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Excision Of Squamous Cell < 2 Cm,,25003791,LOCAL,Facility,Both,,,,510,433.5,146.166,510,"Multiplan, Inc.","Multiplan, Inc.",479.4,94,,percent of total billed charges,,
Excision Of Squamous Cell < 2 Cm,,25003791,LOCAL,Facility,Outpatient,,,,510,433.5,146.166,510,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,459.51,90.1,,percent of total billed charges,,
Excision Of Squamous Cell < 2 Cm,,25003791,LOCAL,Facility,Inpatient,,,,510,433.5,146.166,510,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Excision Of Squamous Cell < 2 Cm,,25003791,LOCAL,Facility,Both,,,,510,433.5,146.166,510,"Preferred One Administrative Services, INC.",PPO,502.86,98.6,,percent of total billed charges,,
Excision Of Squamous Cell < 2 Cm,,25003791,LOCAL,Facility,Outpatient,,,,510,433.5,146.166,510,PrimeWest Health,Minnesota Senior Health Options (MSHO),262.395,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Excision Of Squamous Cell < 2 Cm,,25003791,LOCAL,Facility,Inpatient,,,,510,433.5,146.166,510,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Excision Of Squamous Cell < 2 Cm,,25003791,LOCAL,Facility,Outpatient,,,,510,433.5,146.166,510,PrimeWest Health,MinnesotaCare,261.936,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Excision Of Squamous Cell < 2 Cm,,25003791,LOCAL,Facility,Inpatient,,,,510,433.5,146.166,510,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Excision Of Squamous Cell < 2 Cm,,25003791,LOCAL,Facility,Both,,,,510,433.5,146.166,510,Sanford Health Plan,Sanford Health Plan,469.2,92,,percent of total billed charges,,
Excision Of Squamous Cell < 2 Cm,,25003791,LOCAL,Facility,Outpatient,,,,510,433.5,146.166,510,"UCare Health, Inc.",Individual & Family Plan,287.385,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Excision Of Squamous Cell < 2 Cm,,25003791,LOCAL,Facility,Inpatient,,,,510,433.5,146.166,510,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Excision Of Squamous Cell < 2 Cm,,25003791,LOCAL,Facility,Outpatient,,,,510,433.5,146.166,510,"UCare Health, Inc.",Medical Assistance,257.397,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Excision Of Squamous Cell < 2 Cm,,25003791,LOCAL,Facility,Inpatient,,,,510,433.5,146.166,510,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Excision Of Squamous Cell < 2 Cm,,25003791,LOCAL,Facility,Outpatient,,,,510,433.5,146.166,510,"UCare Health, Inc.",Medicare Advantage,257.397,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Excision Of Squamous Cell < 2 Cm,,25003791,LOCAL,Facility,Inpatient,,,,510,433.5,146.166,510,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Excision Of Squamous Cell < 2 Cm,,25003791,LOCAL,Facility,Outpatient,,,,510,433.5,146.166,510,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),257.397,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Excision Of Squamous Cell < 2 Cm,,25003791,LOCAL,Facility,Inpatient,,,,510,433.5,146.166,510,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Excision Of Squamous Cell < 2 Cm,,25003791,LOCAL,Facility,Both,,,,510,433.5,146.166,510,UnitedHealthcare,Individual & Family,479.4,94,,percent of total billed charges,,
Excision Of Squamous Cell < 2 Cm,,25003791,LOCAL,Facility,Outpatient,,,,510,433.5,146.166,510,UnitedHealthcare,Medicare Advantage,249.9,49,,percent of total billed charges,,
Excision Of Squamous Cell < 2 Cm,,25003791,LOCAL,Facility,Inpatient,,,,510,433.5,146.166,510,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Excision Of Squamous Cell < 2 Cm,,25003791,LOCAL,Facility,Outpatient,,,,510,433.5,146.166,510,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,244.8,48,,percent of total billed charges,,100% of DHS outpatient percentage
Excision Of Squamous Cell < 2 Cm,,25003791,LOCAL,Facility,Inpatient,,,,510,433.5,146.166,510,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Hernia Repair Incisional, Includes Mesh When Used",,25003812,LOCAL,Facility,Both,,,,3871,3290.35,1109.4286,3871,Aetna,Commercial,3561.32,92,,percent of total billed charges,,
"Hernia Repair Incisional, Includes Mesh When Used",,25003812,LOCAL,Facility,Outpatient,,,,3871,3290.35,1109.4286,3871,Aetna,Medicare Advantage,1896.79,49,,percent of total billed charges,,
"Hernia Repair Incisional, Includes Mesh When Used",,25003812,LOCAL,Facility,Inpatient,,,,3871,3290.35,1109.4286,3871,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Hernia Repair Incisional, Includes Mesh When Used",,25003812,LOCAL,Facility,Both,,,,3871,3290.35,1109.4286,3871,Aetna,PPO,3600.03,93,,percent of total billed charges,,
"Hernia Repair Incisional, Includes Mesh When Used",,25003812,LOCAL,Facility,Both,,,,3871,3290.35,1109.4286,3871,America's PPO,America's PPO,3717.3213,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Hernia Repair Incisional, Includes Mesh When Used",,25003812,LOCAL,Facility,Both,,,,3871,3290.35,1109.4286,3871,BlueCross BlueShield Minnesota, Federal Employee Program,3809.064,98.4,,percent of total billed charges,,
"Hernia Repair Incisional, Includes Mesh When Used",,25003812,LOCAL,Facility,Both,,,,3871,3290.35,1109.4286,3871,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,3871,100,,percent of total billed charges,,
"Hernia Repair Incisional, Includes Mesh When Used",,25003812,LOCAL,Facility,Both,,,,3871,3290.35,1109.4286,3871,BlueCross BlueShield Minnesota,High Value Network Plan,3483.9,90,,percent of total billed charges,,
"Hernia Repair Incisional, Includes Mesh When Used",,25003812,LOCAL,Facility,Outpatient,,,,3871,3290.35,1109.4286,3871,BlueCross BlueShield Minnesota,Medicare Advantage,1896.79,49,,percent of total billed charges,,
"Hernia Repair Incisional, Includes Mesh When Used",,25003812,LOCAL,Facility,Inpatient,,,,3871,3290.35,1109.4286,3871,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Hernia Repair Incisional, Includes Mesh When Used",,25003812,LOCAL,Facility,Both,,,,3871,3290.35,1109.4286,3871,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,3428.5447,88.57,,percent of total billed charges,,
"Hernia Repair Incisional, Includes Mesh When Used",,25003812,LOCAL,Facility,Both,,,,3871,3290.35,1109.4286,3871,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1109.4286,28.66,,percent of total billed charges,,
"Hernia Repair Incisional, Includes Mesh When Used",,25003812,LOCAL,Facility,Outpatient,,,,3871,3290.35,1109.4286,3871,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1896.79,49,,percent of total billed charges,,
"Hernia Repair Incisional, Includes Mesh When Used",,25003812,LOCAL,Facility,Inpatient,,,,3871,3290.35,1109.4286,3871,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Hernia Repair Incisional, Includes Mesh When Used",,25003812,LOCAL,Facility,Both,,,,3871,3290.35,1109.4286,3871,CorVel,Worker's Compensation,3871,100,,percent of total billed charges,,
"Hernia Repair Incisional, Includes Mesh When Used",,25003812,LOCAL,Facility,Both,,,,3871,3290.35,1109.4286,3871,First Health Group Corporation,First Health Network,3754.87,97,,percent of total billed charges,,
"Hernia Repair Incisional, Includes Mesh When Used",,25003812,LOCAL,Facility,Both,,,,3871,3290.35,1109.4286,3871,"Health Partners, Inc.",Commercial,3661.966,94.6,,percent of total billed charges,,
"Hernia Repair Incisional, Includes Mesh When Used",,25003812,LOCAL,Facility,Outpatient,,,,3871,3290.35,1109.4286,3871,"Health Partners, Inc.",Medicare Advantage,1896.79,49,,percent of total billed charges,,
"Hernia Repair Incisional, Includes Mesh When Used",,25003812,LOCAL,Facility,Inpatient,,,,3871,3290.35,1109.4286,3871,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Hernia Repair Incisional, Includes Mesh When Used",,25003812,LOCAL,Facility,Both,,,,3871,3290.35,1109.4286,3871,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),2322.6,60,,percent of total billed charges,,
"Hernia Repair Incisional, Includes Mesh When Used",,25003812,LOCAL,Facility,Both,,,,3871,3290.35,1109.4286,3871,"Health Partners, Inc.",State of Minnesota Advantage Program,3154.865,81.5,,percent of total billed charges,,
"Hernia Repair Incisional, Includes Mesh When Used",,25003812,LOCAL,Facility,Both,,,,3871,3290.35,1109.4286,3871,"Health Partners, Inc.",State Public Programs,1935.5,50,,percent of total billed charges,,
"Hernia Repair Incisional, Includes Mesh When Used",,25003812,LOCAL,Facility,Both,,,,3871,3290.35,1109.4286,3871,Humana Insurance Company,Commercial PPO,3677.45,95,,percent of total billed charges,,
"Hernia Repair Incisional, Includes Mesh When Used",,25003812,LOCAL,Facility,Outpatient,,,,3871,3290.35,1109.4286,3871,Humana Insurance Company,Medicare PPO,1896.79,49,,percent of total billed charges,,
"Hernia Repair Incisional, Includes Mesh When Used",,25003812,LOCAL,Facility,Inpatient,,,,3871,3290.35,1109.4286,3871,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Hernia Repair Incisional, Includes Mesh When Used",,25003812,LOCAL,Facility,Both,,,,3871,3290.35,1109.4286,3871,Medica,Individual & Family,3836.161,99.1,,percent of total billed charges,,
"Hernia Repair Incisional, Includes Mesh When Used",,25003812,LOCAL,Facility,Outpatient,,,,3871,3290.35,1109.4286,3871,Medica,Medica Advantage Solution,1927.758,49.8,,percent of total billed charges,,
"Hernia Repair Incisional, Includes Mesh When Used",,25003812,LOCAL,Facility,Inpatient,,,,3871,3290.35,1109.4286,3871,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Hernia Repair Incisional, Includes Mesh When Used",,25003812,LOCAL,Facility,Outpatient,,,,3871,3290.35,1109.4286,3871,Medica,Medical Assistance,1726.466,44.6,,percent of total billed charges,,
"Hernia Repair Incisional, Includes Mesh When Used",,25003812,LOCAL,Facility,Inpatient,,,,3871,3290.35,1109.4286,3871,Medica,Medical Assistance,,,,,Included in per diem rate,
"Hernia Repair Incisional, Includes Mesh When Used",,25003812,LOCAL,Facility,Outpatient,,,,3871,3290.35,1109.4286,3871,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1927.758,49.8,,percent of total billed charges,,
"Hernia Repair Incisional, Includes Mesh When Used",,25003812,LOCAL,Facility,Inpatient,,,,3871,3290.35,1109.4286,3871,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Hernia Repair Incisional, Includes Mesh When Used",,25003812,LOCAL,Facility,Both,,,,3871,3290.35,1109.4286,3871,"Multiplan, Inc.","Multiplan, Inc.",3638.74,94,,percent of total billed charges,,
"Hernia Repair Incisional, Includes Mesh When Used",,25003812,LOCAL,Facility,Outpatient,,,,3871,3290.35,1109.4286,3871,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,3487.771,90.1,,percent of total billed charges,,
"Hernia Repair Incisional, Includes Mesh When Used",,25003812,LOCAL,Facility,Inpatient,,,,3871,3290.35,1109.4286,3871,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Hernia Repair Incisional, Includes Mesh When Used",,25003812,LOCAL,Facility,Both,,,,3871,3290.35,1109.4286,3871,"Preferred One Administrative Services, INC.",PPO,3816.806,98.6,,percent of total billed charges,,
"Hernia Repair Incisional, Includes Mesh When Used",,25003812,LOCAL,Facility,Outpatient,,,,3871,3290.35,1109.4286,3871,PrimeWest Health,Minnesota Senior Health Options (MSHO),1991.6295,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Hernia Repair Incisional, Includes Mesh When Used",,25003812,LOCAL,Facility,Inpatient,,,,3871,3290.35,1109.4286,3871,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Hernia Repair Incisional, Includes Mesh When Used",,25003812,LOCAL,Facility,Outpatient,,,,3871,3290.35,1109.4286,3871,PrimeWest Health,MinnesotaCare,1988.1456,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Hernia Repair Incisional, Includes Mesh When Used",,25003812,LOCAL,Facility,Inpatient,,,,3871,3290.35,1109.4286,3871,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Hernia Repair Incisional, Includes Mesh When Used",,25003812,LOCAL,Facility,Both,,,,3871,3290.35,1109.4286,3871,Sanford Health Plan,Sanford Health Plan,3561.32,92,,percent of total billed charges,,
"Hernia Repair Incisional, Includes Mesh When Used",,25003812,LOCAL,Facility,Outpatient,,,,3871,3290.35,1109.4286,3871,"UCare Health, Inc.",Individual & Family Plan,2181.3085,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Hernia Repair Incisional, Includes Mesh When Used",,25003812,LOCAL,Facility,Inpatient,,,,3871,3290.35,1109.4286,3871,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Hernia Repair Incisional, Includes Mesh When Used",,25003812,LOCAL,Facility,Outpatient,,,,3871,3290.35,1109.4286,3871,"UCare Health, Inc.",Medical Assistance,1953.6937,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Hernia Repair Incisional, Includes Mesh When Used",,25003812,LOCAL,Facility,Inpatient,,,,3871,3290.35,1109.4286,3871,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Hernia Repair Incisional, Includes Mesh When Used",,25003812,LOCAL,Facility,Outpatient,,,,3871,3290.35,1109.4286,3871,"UCare Health, Inc.",Medicare Advantage,1953.6937,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Hernia Repair Incisional, Includes Mesh When Used",,25003812,LOCAL,Facility,Inpatient,,,,3871,3290.35,1109.4286,3871,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Hernia Repair Incisional, Includes Mesh When Used",,25003812,LOCAL,Facility,Outpatient,,,,3871,3290.35,1109.4286,3871,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1953.6937,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Hernia Repair Incisional, Includes Mesh When Used",,25003812,LOCAL,Facility,Inpatient,,,,3871,3290.35,1109.4286,3871,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Hernia Repair Incisional, Includes Mesh When Used",,25003812,LOCAL,Facility,Both,,,,3871,3290.35,1109.4286,3871,UnitedHealthcare,Individual & Family,3638.74,94,,percent of total billed charges,,
"Hernia Repair Incisional, Includes Mesh When Used",,25003812,LOCAL,Facility,Outpatient,,,,3871,3290.35,1109.4286,3871,UnitedHealthcare,Medicare Advantage,1896.79,49,,percent of total billed charges,,
"Hernia Repair Incisional, Includes Mesh When Used",,25003812,LOCAL,Facility,Inpatient,,,,3871,3290.35,1109.4286,3871,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Hernia Repair Incisional, Includes Mesh When Used",,25003812,LOCAL,Facility,Outpatient,,,,3871,3290.35,1109.4286,3871,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1858.08,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Hernia Repair Incisional, Includes Mesh When Used",,25003812,LOCAL,Facility,Inpatient,,,,3871,3290.35,1109.4286,3871,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Repair Of Rectocele,,25003827,LOCAL,Facility,Both,,,,2448,2080.8,701.5968,2448,Aetna,Commercial,2252.16,92,,percent of total billed charges,,
Repair Of Rectocele,,25003827,LOCAL,Facility,Outpatient,,,,2448,2080.8,701.5968,2448,Aetna,Medicare Advantage,1199.52,49,,percent of total billed charges,,
Repair Of Rectocele,,25003827,LOCAL,Facility,Inpatient,,,,2448,2080.8,701.5968,2448,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Repair Of Rectocele,,25003827,LOCAL,Facility,Both,,,,2448,2080.8,701.5968,2448,Aetna,PPO,2276.64,93,,percent of total billed charges,,
Repair Of Rectocele,,25003827,LOCAL,Facility,Both,,,,2448,2080.8,701.5968,2448,America's PPO,America's PPO,2350.8144,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Repair Of Rectocele,,25003827,LOCAL,Facility,Both,,,,2448,2080.8,701.5968,2448,BlueCross BlueShield Minnesota, Federal Employee Program,2408.832,98.4,,percent of total billed charges,,
Repair Of Rectocele,,25003827,LOCAL,Facility,Both,,,,2448,2080.8,701.5968,2448,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,2448,100,,percent of total billed charges,,
Repair Of Rectocele,,25003827,LOCAL,Facility,Both,,,,2448,2080.8,701.5968,2448,BlueCross BlueShield Minnesota,High Value Network Plan,2203.2,90,,percent of total billed charges,,
Repair Of Rectocele,,25003827,LOCAL,Facility,Outpatient,,,,2448,2080.8,701.5968,2448,BlueCross BlueShield Minnesota,Medicare Advantage,1199.52,49,,percent of total billed charges,,
Repair Of Rectocele,,25003827,LOCAL,Facility,Inpatient,,,,2448,2080.8,701.5968,2448,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Repair Of Rectocele,,25003827,LOCAL,Facility,Both,,,,2448,2080.8,701.5968,2448,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,2168.1936,88.57,,percent of total billed charges,,
Repair Of Rectocele,,25003827,LOCAL,Facility,Both,,,,2448,2080.8,701.5968,2448,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,701.5968,28.66,,percent of total billed charges,,
Repair Of Rectocele,,25003827,LOCAL,Facility,Outpatient,,,,2448,2080.8,701.5968,2448,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1199.52,49,,percent of total billed charges,,
Repair Of Rectocele,,25003827,LOCAL,Facility,Inpatient,,,,2448,2080.8,701.5968,2448,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Repair Of Rectocele,,25003827,LOCAL,Facility,Both,,,,2448,2080.8,701.5968,2448,CorVel,Worker's Compensation,2448,100,,percent of total billed charges,,
Repair Of Rectocele,,25003827,LOCAL,Facility,Both,,,,2448,2080.8,701.5968,2448,First Health Group Corporation,First Health Network,2374.56,97,,percent of total billed charges,,
Repair Of Rectocele,,25003827,LOCAL,Facility,Both,,,,2448,2080.8,701.5968,2448,"Health Partners, Inc.",Commercial,2315.808,94.6,,percent of total billed charges,,
Repair Of Rectocele,,25003827,LOCAL,Facility,Outpatient,,,,2448,2080.8,701.5968,2448,"Health Partners, Inc.",Medicare Advantage,1199.52,49,,percent of total billed charges,,
Repair Of Rectocele,,25003827,LOCAL,Facility,Inpatient,,,,2448,2080.8,701.5968,2448,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Repair Of Rectocele,,25003827,LOCAL,Facility,Both,,,,2448,2080.8,701.5968,2448,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1468.8,60,,percent of total billed charges,,
Repair Of Rectocele,,25003827,LOCAL,Facility,Both,,,,2448,2080.8,701.5968,2448,"Health Partners, Inc.",State of Minnesota Advantage Program,1995.12,81.5,,percent of total billed charges,,
Repair Of Rectocele,,25003827,LOCAL,Facility,Both,,,,2448,2080.8,701.5968,2448,"Health Partners, Inc.",State Public Programs,1224,50,,percent of total billed charges,,
Repair Of Rectocele,,25003827,LOCAL,Facility,Both,,,,2448,2080.8,701.5968,2448,Humana Insurance Company,Commercial PPO,2325.6,95,,percent of total billed charges,,
Repair Of Rectocele,,25003827,LOCAL,Facility,Outpatient,,,,2448,2080.8,701.5968,2448,Humana Insurance Company,Medicare PPO,1199.52,49,,percent of total billed charges,,
Repair Of Rectocele,,25003827,LOCAL,Facility,Inpatient,,,,2448,2080.8,701.5968,2448,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Repair Of Rectocele,,25003827,LOCAL,Facility,Both,,,,2448,2080.8,701.5968,2448,Medica,Individual & Family,2425.968,99.1,,percent of total billed charges,,
Repair Of Rectocele,,25003827,LOCAL,Facility,Outpatient,,,,2448,2080.8,701.5968,2448,Medica,Medica Advantage Solution,1219.104,49.8,,percent of total billed charges,,
Repair Of Rectocele,,25003827,LOCAL,Facility,Inpatient,,,,2448,2080.8,701.5968,2448,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Repair Of Rectocele,,25003827,LOCAL,Facility,Outpatient,,,,2448,2080.8,701.5968,2448,Medica,Medical Assistance,1091.808,44.6,,percent of total billed charges,,
Repair Of Rectocele,,25003827,LOCAL,Facility,Inpatient,,,,2448,2080.8,701.5968,2448,Medica,Medical Assistance,,,,,Included in per diem rate,
Repair Of Rectocele,,25003827,LOCAL,Facility,Outpatient,,,,2448,2080.8,701.5968,2448,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1219.104,49.8,,percent of total billed charges,,
Repair Of Rectocele,,25003827,LOCAL,Facility,Inpatient,,,,2448,2080.8,701.5968,2448,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Repair Of Rectocele,,25003827,LOCAL,Facility,Both,,,,2448,2080.8,701.5968,2448,"Multiplan, Inc.","Multiplan, Inc.",2301.12,94,,percent of total billed charges,,
Repair Of Rectocele,,25003827,LOCAL,Facility,Outpatient,,,,2448,2080.8,701.5968,2448,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,2205.648,90.1,,percent of total billed charges,,
Repair Of Rectocele,,25003827,LOCAL,Facility,Inpatient,,,,2448,2080.8,701.5968,2448,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Repair Of Rectocele,,25003827,LOCAL,Facility,Both,,,,2448,2080.8,701.5968,2448,"Preferred One Administrative Services, INC.",PPO,2413.728,98.6,,percent of total billed charges,,
Repair Of Rectocele,,25003827,LOCAL,Facility,Outpatient,,,,2448,2080.8,701.5968,2448,PrimeWest Health,Minnesota Senior Health Options (MSHO),1259.496,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Repair Of Rectocele,,25003827,LOCAL,Facility,Inpatient,,,,2448,2080.8,701.5968,2448,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Repair Of Rectocele,,25003827,LOCAL,Facility,Outpatient,,,,2448,2080.8,701.5968,2448,PrimeWest Health,MinnesotaCare,1257.2928,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Repair Of Rectocele,,25003827,LOCAL,Facility,Inpatient,,,,2448,2080.8,701.5968,2448,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Repair Of Rectocele,,25003827,LOCAL,Facility,Both,,,,2448,2080.8,701.5968,2448,Sanford Health Plan,Sanford Health Plan,2252.16,92,,percent of total billed charges,,
Repair Of Rectocele,,25003827,LOCAL,Facility,Outpatient,,,,2448,2080.8,701.5968,2448,"UCare Health, Inc.",Individual & Family Plan,1379.448,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Repair Of Rectocele,,25003827,LOCAL,Facility,Inpatient,,,,2448,2080.8,701.5968,2448,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Repair Of Rectocele,,25003827,LOCAL,Facility,Outpatient,,,,2448,2080.8,701.5968,2448,"UCare Health, Inc.",Medical Assistance,1235.5056,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Repair Of Rectocele,,25003827,LOCAL,Facility,Inpatient,,,,2448,2080.8,701.5968,2448,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Repair Of Rectocele,,25003827,LOCAL,Facility,Outpatient,,,,2448,2080.8,701.5968,2448,"UCare Health, Inc.",Medicare Advantage,1235.5056,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Repair Of Rectocele,,25003827,LOCAL,Facility,Inpatient,,,,2448,2080.8,701.5968,2448,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Repair Of Rectocele,,25003827,LOCAL,Facility,Outpatient,,,,2448,2080.8,701.5968,2448,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1235.5056,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Repair Of Rectocele,,25003827,LOCAL,Facility,Inpatient,,,,2448,2080.8,701.5968,2448,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Repair Of Rectocele,,25003827,LOCAL,Facility,Both,,,,2448,2080.8,701.5968,2448,UnitedHealthcare,Individual & Family,2301.12,94,,percent of total billed charges,,
Repair Of Rectocele,,25003827,LOCAL,Facility,Outpatient,,,,2448,2080.8,701.5968,2448,UnitedHealthcare,Medicare Advantage,1199.52,49,,percent of total billed charges,,
Repair Of Rectocele,,25003827,LOCAL,Facility,Inpatient,,,,2448,2080.8,701.5968,2448,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Repair Of Rectocele,,25003827,LOCAL,Facility,Outpatient,,,,2448,2080.8,701.5968,2448,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1175.04,48,,percent of total billed charges,,100% of DHS outpatient percentage
Repair Of Rectocele,,25003827,LOCAL,Facility,Inpatient,,,,2448,2080.8,701.5968,2448,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Foreign Body Retrieval,,25003877,LOCAL,Facility,Both,,,,689,585.65,197.4674,689,Aetna,Commercial,633.88,92,,percent of total billed charges,,
Foreign Body Retrieval,,25003877,LOCAL,Facility,Outpatient,,,,689,585.65,197.4674,689,Aetna,Medicare Advantage,337.61,49,,percent of total billed charges,,
Foreign Body Retrieval,,25003877,LOCAL,Facility,Inpatient,,,,689,585.65,197.4674,689,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Foreign Body Retrieval,,25003877,LOCAL,Facility,Both,,,,689,585.65,197.4674,689,Aetna,PPO,640.77,93,,percent of total billed charges,,
Foreign Body Retrieval,,25003877,LOCAL,Facility,Both,,,,689,585.65,197.4674,689,America's PPO,America's PPO,661.6467,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Foreign Body Retrieval,,25003877,LOCAL,Facility,Both,,,,689,585.65,197.4674,689,BlueCross BlueShield Minnesota, Federal Employee Program,677.976,98.4,,percent of total billed charges,,
Foreign Body Retrieval,,25003877,LOCAL,Facility,Both,,,,689,585.65,197.4674,689,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,689,100,,percent of total billed charges,,
Foreign Body Retrieval,,25003877,LOCAL,Facility,Both,,,,689,585.65,197.4674,689,BlueCross BlueShield Minnesota,High Value Network Plan,620.1,90,,percent of total billed charges,,
Foreign Body Retrieval,,25003877,LOCAL,Facility,Outpatient,,,,689,585.65,197.4674,689,BlueCross BlueShield Minnesota,Medicare Advantage,337.61,49,,percent of total billed charges,,
Foreign Body Retrieval,,25003877,LOCAL,Facility,Inpatient,,,,689,585.65,197.4674,689,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Foreign Body Retrieval,,25003877,LOCAL,Facility,Both,,,,689,585.65,197.4674,689,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,610.2473,88.57,,percent of total billed charges,,
Foreign Body Retrieval,,25003877,LOCAL,Facility,Both,,,,689,585.65,197.4674,689,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,197.4674,28.66,,percent of total billed charges,,
Foreign Body Retrieval,,25003877,LOCAL,Facility,Outpatient,,,,689,585.65,197.4674,689,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),337.61,49,,percent of total billed charges,,
Foreign Body Retrieval,,25003877,LOCAL,Facility,Inpatient,,,,689,585.65,197.4674,689,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Foreign Body Retrieval,,25003877,LOCAL,Facility,Both,,,,689,585.65,197.4674,689,CorVel,Worker's Compensation,689,100,,percent of total billed charges,,
Foreign Body Retrieval,,25003877,LOCAL,Facility,Both,,,,689,585.65,197.4674,689,First Health Group Corporation,First Health Network,668.33,97,,percent of total billed charges,,
Foreign Body Retrieval,,25003877,LOCAL,Facility,Both,,,,689,585.65,197.4674,689,"Health Partners, Inc.",Commercial,651.794,94.6,,percent of total billed charges,,
Foreign Body Retrieval,,25003877,LOCAL,Facility,Outpatient,,,,689,585.65,197.4674,689,"Health Partners, Inc.",Medicare Advantage,337.61,49,,percent of total billed charges,,
Foreign Body Retrieval,,25003877,LOCAL,Facility,Inpatient,,,,689,585.65,197.4674,689,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Foreign Body Retrieval,,25003877,LOCAL,Facility,Both,,,,689,585.65,197.4674,689,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),413.4,60,,percent of total billed charges,,
Foreign Body Retrieval,,25003877,LOCAL,Facility,Both,,,,689,585.65,197.4674,689,"Health Partners, Inc.",State of Minnesota Advantage Program,561.535,81.5,,percent of total billed charges,,
Foreign Body Retrieval,,25003877,LOCAL,Facility,Both,,,,689,585.65,197.4674,689,"Health Partners, Inc.",State Public Programs,344.5,50,,percent of total billed charges,,
Foreign Body Retrieval,,25003877,LOCAL,Facility,Both,,,,689,585.65,197.4674,689,Humana Insurance Company,Commercial PPO,654.55,95,,percent of total billed charges,,
Foreign Body Retrieval,,25003877,LOCAL,Facility,Outpatient,,,,689,585.65,197.4674,689,Humana Insurance Company,Medicare PPO,337.61,49,,percent of total billed charges,,
Foreign Body Retrieval,,25003877,LOCAL,Facility,Inpatient,,,,689,585.65,197.4674,689,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Foreign Body Retrieval,,25003877,LOCAL,Facility,Both,,,,689,585.65,197.4674,689,Medica,Individual & Family,682.799,99.1,,percent of total billed charges,,
Foreign Body Retrieval,,25003877,LOCAL,Facility,Outpatient,,,,689,585.65,197.4674,689,Medica,Medica Advantage Solution,343.122,49.8,,percent of total billed charges,,
Foreign Body Retrieval,,25003877,LOCAL,Facility,Inpatient,,,,689,585.65,197.4674,689,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Foreign Body Retrieval,,25003877,LOCAL,Facility,Outpatient,,,,689,585.65,197.4674,689,Medica,Medical Assistance,307.294,44.6,,percent of total billed charges,,
Foreign Body Retrieval,,25003877,LOCAL,Facility,Inpatient,,,,689,585.65,197.4674,689,Medica,Medical Assistance,,,,,Included in per diem rate,
Foreign Body Retrieval,,25003877,LOCAL,Facility,Outpatient,,,,689,585.65,197.4674,689,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,343.122,49.8,,percent of total billed charges,,
Foreign Body Retrieval,,25003877,LOCAL,Facility,Inpatient,,,,689,585.65,197.4674,689,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Foreign Body Retrieval,,25003877,LOCAL,Facility,Both,,,,689,585.65,197.4674,689,"Multiplan, Inc.","Multiplan, Inc.",647.66,94,,percent of total billed charges,,
Foreign Body Retrieval,,25003877,LOCAL,Facility,Outpatient,,,,689,585.65,197.4674,689,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,620.789,90.1,,percent of total billed charges,,
Foreign Body Retrieval,,25003877,LOCAL,Facility,Inpatient,,,,689,585.65,197.4674,689,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Foreign Body Retrieval,,25003877,LOCAL,Facility,Both,,,,689,585.65,197.4674,689,"Preferred One Administrative Services, INC.",PPO,679.354,98.6,,percent of total billed charges,,
Foreign Body Retrieval,,25003877,LOCAL,Facility,Outpatient,,,,689,585.65,197.4674,689,PrimeWest Health,Minnesota Senior Health Options (MSHO),354.4905,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Foreign Body Retrieval,,25003877,LOCAL,Facility,Inpatient,,,,689,585.65,197.4674,689,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Foreign Body Retrieval,,25003877,LOCAL,Facility,Outpatient,,,,689,585.65,197.4674,689,PrimeWest Health,MinnesotaCare,353.8704,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Foreign Body Retrieval,,25003877,LOCAL,Facility,Inpatient,,,,689,585.65,197.4674,689,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Foreign Body Retrieval,,25003877,LOCAL,Facility,Both,,,,689,585.65,197.4674,689,Sanford Health Plan,Sanford Health Plan,633.88,92,,percent of total billed charges,,
Foreign Body Retrieval,,25003877,LOCAL,Facility,Outpatient,,,,689,585.65,197.4674,689,"UCare Health, Inc.",Individual & Family Plan,388.2515,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Foreign Body Retrieval,,25003877,LOCAL,Facility,Inpatient,,,,689,585.65,197.4674,689,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Foreign Body Retrieval,,25003877,LOCAL,Facility,Outpatient,,,,689,585.65,197.4674,689,"UCare Health, Inc.",Medical Assistance,347.7383,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Foreign Body Retrieval,,25003877,LOCAL,Facility,Inpatient,,,,689,585.65,197.4674,689,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Foreign Body Retrieval,,25003877,LOCAL,Facility,Outpatient,,,,689,585.65,197.4674,689,"UCare Health, Inc.",Medicare Advantage,347.7383,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Foreign Body Retrieval,,25003877,LOCAL,Facility,Inpatient,,,,689,585.65,197.4674,689,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Foreign Body Retrieval,,25003877,LOCAL,Facility,Outpatient,,,,689,585.65,197.4674,689,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),347.7383,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Foreign Body Retrieval,,25003877,LOCAL,Facility,Inpatient,,,,689,585.65,197.4674,689,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Foreign Body Retrieval,,25003877,LOCAL,Facility,Both,,,,689,585.65,197.4674,689,UnitedHealthcare,Individual & Family,647.66,94,,percent of total billed charges,,
Foreign Body Retrieval,,25003877,LOCAL,Facility,Outpatient,,,,689,585.65,197.4674,689,UnitedHealthcare,Medicare Advantage,337.61,49,,percent of total billed charges,,
Foreign Body Retrieval,,25003877,LOCAL,Facility,Inpatient,,,,689,585.65,197.4674,689,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Foreign Body Retrieval,,25003877,LOCAL,Facility,Outpatient,,,,689,585.65,197.4674,689,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,330.72,48,,percent of total billed charges,,100% of DHS outpatient percentage
Foreign Body Retrieval,,25003877,LOCAL,Facility,Inpatient,,,,689,585.65,197.4674,689,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Bunionectomy,,25004031,LOCAL,Facility,Both,,,,5942,5050.7,1702.9772,5942,Aetna,Commercial,5466.64,92,,percent of total billed charges,,
Bunionectomy,,25004031,LOCAL,Facility,Outpatient,,,,5942,5050.7,1702.9772,5942,Aetna,Medicare Advantage,2911.58,49,,percent of total billed charges,,
Bunionectomy,,25004031,LOCAL,Facility,Inpatient,,,,5942,5050.7,1702.9772,5942,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Bunionectomy,,25004031,LOCAL,Facility,Both,,,,5942,5050.7,1702.9772,5942,Aetna,PPO,5526.06,93,,percent of total billed charges,,
Bunionectomy,,25004031,LOCAL,Facility,Both,,,,5942,5050.7,1702.9772,5942,America's PPO,America's PPO,5706.1026,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Bunionectomy,,25004031,LOCAL,Facility,Both,,,,5942,5050.7,1702.9772,5942,BlueCross BlueShield Minnesota, Federal Employee Program,5846.928,98.4,,percent of total billed charges,,
Bunionectomy,,25004031,LOCAL,Facility,Both,,,,5942,5050.7,1702.9772,5942,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5942,100,,percent of total billed charges,,
Bunionectomy,,25004031,LOCAL,Facility,Both,,,,5942,5050.7,1702.9772,5942,BlueCross BlueShield Minnesota,High Value Network Plan,5347.8,90,,percent of total billed charges,,
Bunionectomy,,25004031,LOCAL,Facility,Outpatient,,,,5942,5050.7,1702.9772,5942,BlueCross BlueShield Minnesota,Medicare Advantage,2911.58,49,,percent of total billed charges,,
Bunionectomy,,25004031,LOCAL,Facility,Inpatient,,,,5942,5050.7,1702.9772,5942,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Bunionectomy,,25004031,LOCAL,Facility,Both,,,,5942,5050.7,1702.9772,5942,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,5262.8294,88.57,,percent of total billed charges,,
Bunionectomy,,25004031,LOCAL,Facility,Both,,,,5942,5050.7,1702.9772,5942,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1702.9772,28.66,,percent of total billed charges,,
Bunionectomy,,25004031,LOCAL,Facility,Outpatient,,,,5942,5050.7,1702.9772,5942,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2911.58,49,,percent of total billed charges,,
Bunionectomy,,25004031,LOCAL,Facility,Inpatient,,,,5942,5050.7,1702.9772,5942,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Bunionectomy,,25004031,LOCAL,Facility,Both,,,,5942,5050.7,1702.9772,5942,CorVel,Worker's Compensation,5942,100,,percent of total billed charges,,
Bunionectomy,,25004031,LOCAL,Facility,Both,,,,5942,5050.7,1702.9772,5942,First Health Group Corporation,First Health Network,5763.74,97,,percent of total billed charges,,
Bunionectomy,,25004031,LOCAL,Facility,Both,,,,5942,5050.7,1702.9772,5942,"Health Partners, Inc.",Commercial,5621.132,94.6,,percent of total billed charges,,
Bunionectomy,,25004031,LOCAL,Facility,Outpatient,,,,5942,5050.7,1702.9772,5942,"Health Partners, Inc.",Medicare Advantage,2911.58,49,,percent of total billed charges,,
Bunionectomy,,25004031,LOCAL,Facility,Inpatient,,,,5942,5050.7,1702.9772,5942,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Bunionectomy,,25004031,LOCAL,Facility,Both,,,,5942,5050.7,1702.9772,5942,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3565.2,60,,percent of total billed charges,,
Bunionectomy,,25004031,LOCAL,Facility,Both,,,,5942,5050.7,1702.9772,5942,"Health Partners, Inc.",State of Minnesota Advantage Program,4842.73,81.5,,percent of total billed charges,,
Bunionectomy,,25004031,LOCAL,Facility,Both,,,,5942,5050.7,1702.9772,5942,"Health Partners, Inc.",State Public Programs,2971,50,,percent of total billed charges,,
Bunionectomy,,25004031,LOCAL,Facility,Both,,,,5942,5050.7,1702.9772,5942,Humana Insurance Company,Commercial PPO,5644.9,95,,percent of total billed charges,,
Bunionectomy,,25004031,LOCAL,Facility,Outpatient,,,,5942,5050.7,1702.9772,5942,Humana Insurance Company,Medicare PPO,2911.58,49,,percent of total billed charges,,
Bunionectomy,,25004031,LOCAL,Facility,Inpatient,,,,5942,5050.7,1702.9772,5942,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Bunionectomy,,25004031,LOCAL,Facility,Both,,,,5942,5050.7,1702.9772,5942,Medica,Individual & Family,5888.522,99.1,,percent of total billed charges,,
Bunionectomy,,25004031,LOCAL,Facility,Outpatient,,,,5942,5050.7,1702.9772,5942,Medica,Medica Advantage Solution,2959.116,49.8,,percent of total billed charges,,
Bunionectomy,,25004031,LOCAL,Facility,Inpatient,,,,5942,5050.7,1702.9772,5942,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Bunionectomy,,25004031,LOCAL,Facility,Outpatient,,,,5942,5050.7,1702.9772,5942,Medica,Medical Assistance,2650.132,44.6,,percent of total billed charges,,
Bunionectomy,,25004031,LOCAL,Facility,Inpatient,,,,5942,5050.7,1702.9772,5942,Medica,Medical Assistance,,,,,Included in per diem rate,
Bunionectomy,,25004031,LOCAL,Facility,Outpatient,,,,5942,5050.7,1702.9772,5942,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2959.116,49.8,,percent of total billed charges,,
Bunionectomy,,25004031,LOCAL,Facility,Inpatient,,,,5942,5050.7,1702.9772,5942,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Bunionectomy,,25004031,LOCAL,Facility,Both,,,,5942,5050.7,1702.9772,5942,"Multiplan, Inc.","Multiplan, Inc.",5585.48,94,,percent of total billed charges,,
Bunionectomy,,25004031,LOCAL,Facility,Outpatient,,,,5942,5050.7,1702.9772,5942,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,5353.742,90.1,,percent of total billed charges,,
Bunionectomy,,25004031,LOCAL,Facility,Inpatient,,,,5942,5050.7,1702.9772,5942,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Bunionectomy,,25004031,LOCAL,Facility,Both,,,,5942,5050.7,1702.9772,5942,"Preferred One Administrative Services, INC.",PPO,5858.812,98.6,,percent of total billed charges,,
Bunionectomy,,25004031,LOCAL,Facility,Outpatient,,,,5942,5050.7,1702.9772,5942,PrimeWest Health,Minnesota Senior Health Options (MSHO),3057.159,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Bunionectomy,,25004031,LOCAL,Facility,Inpatient,,,,5942,5050.7,1702.9772,5942,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Bunionectomy,,25004031,LOCAL,Facility,Outpatient,,,,5942,5050.7,1702.9772,5942,PrimeWest Health,MinnesotaCare,3051.8112,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Bunionectomy,,25004031,LOCAL,Facility,Inpatient,,,,5942,5050.7,1702.9772,5942,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Bunionectomy,,25004031,LOCAL,Facility,Both,,,,5942,5050.7,1702.9772,5942,Sanford Health Plan,Sanford Health Plan,5466.64,92,,percent of total billed charges,,
Bunionectomy,,25004031,LOCAL,Facility,Outpatient,,,,5942,5050.7,1702.9772,5942,"UCare Health, Inc.",Individual & Family Plan,3348.317,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Bunionectomy,,25004031,LOCAL,Facility,Inpatient,,,,5942,5050.7,1702.9772,5942,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Bunionectomy,,25004031,LOCAL,Facility,Outpatient,,,,5942,5050.7,1702.9772,5942,"UCare Health, Inc.",Medical Assistance,2998.9274,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Bunionectomy,,25004031,LOCAL,Facility,Inpatient,,,,5942,5050.7,1702.9772,5942,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Bunionectomy,,25004031,LOCAL,Facility,Outpatient,,,,5942,5050.7,1702.9772,5942,"UCare Health, Inc.",Medicare Advantage,2998.9274,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Bunionectomy,,25004031,LOCAL,Facility,Inpatient,,,,5942,5050.7,1702.9772,5942,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Bunionectomy,,25004031,LOCAL,Facility,Outpatient,,,,5942,5050.7,1702.9772,5942,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2998.9274,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Bunionectomy,,25004031,LOCAL,Facility,Inpatient,,,,5942,5050.7,1702.9772,5942,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Bunionectomy,,25004031,LOCAL,Facility,Both,,,,5942,5050.7,1702.9772,5942,UnitedHealthcare,Individual & Family,5585.48,94,,percent of total billed charges,,
Bunionectomy,,25004031,LOCAL,Facility,Outpatient,,,,5942,5050.7,1702.9772,5942,UnitedHealthcare,Medicare Advantage,2911.58,49,,percent of total billed charges,,
Bunionectomy,,25004031,LOCAL,Facility,Inpatient,,,,5942,5050.7,1702.9772,5942,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Bunionectomy,,25004031,LOCAL,Facility,Outpatient,,,,5942,5050.7,1702.9772,5942,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2852.16,48,,percent of total billed charges,,100% of DHS outpatient percentage
Bunionectomy,,25004031,LOCAL,Facility,Inpatient,,,,5942,5050.7,1702.9772,5942,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Adenoidectomy < 12 Years Old,,25004103,LOCAL,Facility,Both,,,,3570,3034.5,1023.162,3570,Aetna,Commercial,3284.4,92,,percent of total billed charges,,
Adenoidectomy < 12 Years Old,,25004103,LOCAL,Facility,Outpatient,,,,3570,3034.5,1023.162,3570,Aetna,Medicare Advantage,1749.3,49,,percent of total billed charges,,
Adenoidectomy < 12 Years Old,,25004103,LOCAL,Facility,Inpatient,,,,3570,3034.5,1023.162,3570,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Adenoidectomy < 12 Years Old,,25004103,LOCAL,Facility,Both,,,,3570,3034.5,1023.162,3570,Aetna,PPO,3320.1,93,,percent of total billed charges,,
Adenoidectomy < 12 Years Old,,25004103,LOCAL,Facility,Both,,,,3570,3034.5,1023.162,3570,America's PPO,America's PPO,3428.271,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Adenoidectomy < 12 Years Old,,25004103,LOCAL,Facility,Both,,,,3570,3034.5,1023.162,3570,BlueCross BlueShield Minnesota, Federal Employee Program,3512.88,98.4,,percent of total billed charges,,
Adenoidectomy < 12 Years Old,,25004103,LOCAL,Facility,Both,,,,3570,3034.5,1023.162,3570,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,3570,100,,percent of total billed charges,,
Adenoidectomy < 12 Years Old,,25004103,LOCAL,Facility,Both,,,,3570,3034.5,1023.162,3570,BlueCross BlueShield Minnesota,High Value Network Plan,3213,90,,percent of total billed charges,,
Adenoidectomy < 12 Years Old,,25004103,LOCAL,Facility,Outpatient,,,,3570,3034.5,1023.162,3570,BlueCross BlueShield Minnesota,Medicare Advantage,1749.3,49,,percent of total billed charges,,
Adenoidectomy < 12 Years Old,,25004103,LOCAL,Facility,Inpatient,,,,3570,3034.5,1023.162,3570,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Adenoidectomy < 12 Years Old,,25004103,LOCAL,Facility,Both,,,,3570,3034.5,1023.162,3570,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,3161.949,88.57,,percent of total billed charges,,
Adenoidectomy < 12 Years Old,,25004103,LOCAL,Facility,Both,,,,3570,3034.5,1023.162,3570,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1023.162,28.66,,percent of total billed charges,,
Adenoidectomy < 12 Years Old,,25004103,LOCAL,Facility,Outpatient,,,,3570,3034.5,1023.162,3570,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1749.3,49,,percent of total billed charges,,
Adenoidectomy < 12 Years Old,,25004103,LOCAL,Facility,Inpatient,,,,3570,3034.5,1023.162,3570,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Adenoidectomy < 12 Years Old,,25004103,LOCAL,Facility,Both,,,,3570,3034.5,1023.162,3570,CorVel,Worker's Compensation,3570,100,,percent of total billed charges,,
Adenoidectomy < 12 Years Old,,25004103,LOCAL,Facility,Both,,,,3570,3034.5,1023.162,3570,First Health Group Corporation,First Health Network,3462.9,97,,percent of total billed charges,,
Adenoidectomy < 12 Years Old,,25004103,LOCAL,Facility,Both,,,,3570,3034.5,1023.162,3570,"Health Partners, Inc.",Commercial,3377.22,94.6,,percent of total billed charges,,
Adenoidectomy < 12 Years Old,,25004103,LOCAL,Facility,Outpatient,,,,3570,3034.5,1023.162,3570,"Health Partners, Inc.",Medicare Advantage,1749.3,49,,percent of total billed charges,,
Adenoidectomy < 12 Years Old,,25004103,LOCAL,Facility,Inpatient,,,,3570,3034.5,1023.162,3570,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Adenoidectomy < 12 Years Old,,25004103,LOCAL,Facility,Both,,,,3570,3034.5,1023.162,3570,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),2142,60,,percent of total billed charges,,
Adenoidectomy < 12 Years Old,,25004103,LOCAL,Facility,Both,,,,3570,3034.5,1023.162,3570,"Health Partners, Inc.",State of Minnesota Advantage Program,2909.55,81.5,,percent of total billed charges,,
Adenoidectomy < 12 Years Old,,25004103,LOCAL,Facility,Both,,,,3570,3034.5,1023.162,3570,"Health Partners, Inc.",State Public Programs,1785,50,,percent of total billed charges,,
Adenoidectomy < 12 Years Old,,25004103,LOCAL,Facility,Both,,,,3570,3034.5,1023.162,3570,Humana Insurance Company,Commercial PPO,3391.5,95,,percent of total billed charges,,
Adenoidectomy < 12 Years Old,,25004103,LOCAL,Facility,Outpatient,,,,3570,3034.5,1023.162,3570,Humana Insurance Company,Medicare PPO,1749.3,49,,percent of total billed charges,,
Adenoidectomy < 12 Years Old,,25004103,LOCAL,Facility,Inpatient,,,,3570,3034.5,1023.162,3570,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Adenoidectomy < 12 Years Old,,25004103,LOCAL,Facility,Both,,,,3570,3034.5,1023.162,3570,Medica,Individual & Family,3537.87,99.1,,percent of total billed charges,,
Adenoidectomy < 12 Years Old,,25004103,LOCAL,Facility,Outpatient,,,,3570,3034.5,1023.162,3570,Medica,Medica Advantage Solution,1777.86,49.8,,percent of total billed charges,,
Adenoidectomy < 12 Years Old,,25004103,LOCAL,Facility,Inpatient,,,,3570,3034.5,1023.162,3570,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Adenoidectomy < 12 Years Old,,25004103,LOCAL,Facility,Outpatient,,,,3570,3034.5,1023.162,3570,Medica,Medical Assistance,1592.22,44.6,,percent of total billed charges,,
Adenoidectomy < 12 Years Old,,25004103,LOCAL,Facility,Inpatient,,,,3570,3034.5,1023.162,3570,Medica,Medical Assistance,,,,,Included in per diem rate,
Adenoidectomy < 12 Years Old,,25004103,LOCAL,Facility,Outpatient,,,,3570,3034.5,1023.162,3570,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1777.86,49.8,,percent of total billed charges,,
Adenoidectomy < 12 Years Old,,25004103,LOCAL,Facility,Inpatient,,,,3570,3034.5,1023.162,3570,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Adenoidectomy < 12 Years Old,,25004103,LOCAL,Facility,Both,,,,3570,3034.5,1023.162,3570,"Multiplan, Inc.","Multiplan, Inc.",3355.8,94,,percent of total billed charges,,
Adenoidectomy < 12 Years Old,,25004103,LOCAL,Facility,Outpatient,,,,3570,3034.5,1023.162,3570,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,3216.57,90.1,,percent of total billed charges,,
Adenoidectomy < 12 Years Old,,25004103,LOCAL,Facility,Inpatient,,,,3570,3034.5,1023.162,3570,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Adenoidectomy < 12 Years Old,,25004103,LOCAL,Facility,Both,,,,3570,3034.5,1023.162,3570,"Preferred One Administrative Services, INC.",PPO,3520.02,98.6,,percent of total billed charges,,
Adenoidectomy < 12 Years Old,,25004103,LOCAL,Facility,Outpatient,,,,3570,3034.5,1023.162,3570,PrimeWest Health,Minnesota Senior Health Options (MSHO),1836.765,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Adenoidectomy < 12 Years Old,,25004103,LOCAL,Facility,Inpatient,,,,3570,3034.5,1023.162,3570,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Adenoidectomy < 12 Years Old,,25004103,LOCAL,Facility,Outpatient,,,,3570,3034.5,1023.162,3570,PrimeWest Health,MinnesotaCare,1833.552,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Adenoidectomy < 12 Years Old,,25004103,LOCAL,Facility,Inpatient,,,,3570,3034.5,1023.162,3570,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Adenoidectomy < 12 Years Old,,25004103,LOCAL,Facility,Both,,,,3570,3034.5,1023.162,3570,Sanford Health Plan,Sanford Health Plan,3284.4,92,,percent of total billed charges,,
Adenoidectomy < 12 Years Old,,25004103,LOCAL,Facility,Outpatient,,,,3570,3034.5,1023.162,3570,"UCare Health, Inc.",Individual & Family Plan,2011.695,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Adenoidectomy < 12 Years Old,,25004103,LOCAL,Facility,Inpatient,,,,3570,3034.5,1023.162,3570,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Adenoidectomy < 12 Years Old,,25004103,LOCAL,Facility,Outpatient,,,,3570,3034.5,1023.162,3570,"UCare Health, Inc.",Medical Assistance,1801.779,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Adenoidectomy < 12 Years Old,,25004103,LOCAL,Facility,Inpatient,,,,3570,3034.5,1023.162,3570,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Adenoidectomy < 12 Years Old,,25004103,LOCAL,Facility,Outpatient,,,,3570,3034.5,1023.162,3570,"UCare Health, Inc.",Medicare Advantage,1801.779,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Adenoidectomy < 12 Years Old,,25004103,LOCAL,Facility,Inpatient,,,,3570,3034.5,1023.162,3570,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Adenoidectomy < 12 Years Old,,25004103,LOCAL,Facility,Outpatient,,,,3570,3034.5,1023.162,3570,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1801.779,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Adenoidectomy < 12 Years Old,,25004103,LOCAL,Facility,Inpatient,,,,3570,3034.5,1023.162,3570,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Adenoidectomy < 12 Years Old,,25004103,LOCAL,Facility,Both,,,,3570,3034.5,1023.162,3570,UnitedHealthcare,Individual & Family,3355.8,94,,percent of total billed charges,,
Adenoidectomy < 12 Years Old,,25004103,LOCAL,Facility,Outpatient,,,,3570,3034.5,1023.162,3570,UnitedHealthcare,Medicare Advantage,1749.3,49,,percent of total billed charges,,
Adenoidectomy < 12 Years Old,,25004103,LOCAL,Facility,Inpatient,,,,3570,3034.5,1023.162,3570,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Adenoidectomy < 12 Years Old,,25004103,LOCAL,Facility,Outpatient,,,,3570,3034.5,1023.162,3570,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1713.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
Adenoidectomy < 12 Years Old,,25004103,LOCAL,Facility,Inpatient,,,,3570,3034.5,1023.162,3570,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Adenoidectomy 12 Yrs & Over,,25004116,LOCAL,Facility,Both,,,,3570,3034.5,1023.162,3570,Aetna,Commercial,3284.4,92,,percent of total billed charges,,
Adenoidectomy 12 Yrs & Over,,25004116,LOCAL,Facility,Outpatient,,,,3570,3034.5,1023.162,3570,Aetna,Medicare Advantage,1749.3,49,,percent of total billed charges,,
Adenoidectomy 12 Yrs & Over,,25004116,LOCAL,Facility,Inpatient,,,,3570,3034.5,1023.162,3570,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Adenoidectomy 12 Yrs & Over,,25004116,LOCAL,Facility,Both,,,,3570,3034.5,1023.162,3570,Aetna,PPO,3320.1,93,,percent of total billed charges,,
Adenoidectomy 12 Yrs & Over,,25004116,LOCAL,Facility,Both,,,,3570,3034.5,1023.162,3570,America's PPO,America's PPO,3428.271,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Adenoidectomy 12 Yrs & Over,,25004116,LOCAL,Facility,Both,,,,3570,3034.5,1023.162,3570,BlueCross BlueShield Minnesota, Federal Employee Program,3512.88,98.4,,percent of total billed charges,,
Adenoidectomy 12 Yrs & Over,,25004116,LOCAL,Facility,Both,,,,3570,3034.5,1023.162,3570,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,3570,100,,percent of total billed charges,,
Adenoidectomy 12 Yrs & Over,,25004116,LOCAL,Facility,Both,,,,3570,3034.5,1023.162,3570,BlueCross BlueShield Minnesota,High Value Network Plan,3213,90,,percent of total billed charges,,
Adenoidectomy 12 Yrs & Over,,25004116,LOCAL,Facility,Outpatient,,,,3570,3034.5,1023.162,3570,BlueCross BlueShield Minnesota,Medicare Advantage,1749.3,49,,percent of total billed charges,,
Adenoidectomy 12 Yrs & Over,,25004116,LOCAL,Facility,Inpatient,,,,3570,3034.5,1023.162,3570,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Adenoidectomy 12 Yrs & Over,,25004116,LOCAL,Facility,Both,,,,3570,3034.5,1023.162,3570,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,3161.949,88.57,,percent of total billed charges,,
Adenoidectomy 12 Yrs & Over,,25004116,LOCAL,Facility,Both,,,,3570,3034.5,1023.162,3570,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1023.162,28.66,,percent of total billed charges,,
Adenoidectomy 12 Yrs & Over,,25004116,LOCAL,Facility,Outpatient,,,,3570,3034.5,1023.162,3570,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1749.3,49,,percent of total billed charges,,
Adenoidectomy 12 Yrs & Over,,25004116,LOCAL,Facility,Inpatient,,,,3570,3034.5,1023.162,3570,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Adenoidectomy 12 Yrs & Over,,25004116,LOCAL,Facility,Both,,,,3570,3034.5,1023.162,3570,CorVel,Worker's Compensation,3570,100,,percent of total billed charges,,
Adenoidectomy 12 Yrs & Over,,25004116,LOCAL,Facility,Both,,,,3570,3034.5,1023.162,3570,First Health Group Corporation,First Health Network,3462.9,97,,percent of total billed charges,,
Adenoidectomy 12 Yrs & Over,,25004116,LOCAL,Facility,Both,,,,3570,3034.5,1023.162,3570,"Health Partners, Inc.",Commercial,3377.22,94.6,,percent of total billed charges,,
Adenoidectomy 12 Yrs & Over,,25004116,LOCAL,Facility,Outpatient,,,,3570,3034.5,1023.162,3570,"Health Partners, Inc.",Medicare Advantage,1749.3,49,,percent of total billed charges,,
Adenoidectomy 12 Yrs & Over,,25004116,LOCAL,Facility,Inpatient,,,,3570,3034.5,1023.162,3570,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Adenoidectomy 12 Yrs & Over,,25004116,LOCAL,Facility,Both,,,,3570,3034.5,1023.162,3570,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),2142,60,,percent of total billed charges,,
Adenoidectomy 12 Yrs & Over,,25004116,LOCAL,Facility,Both,,,,3570,3034.5,1023.162,3570,"Health Partners, Inc.",State of Minnesota Advantage Program,2909.55,81.5,,percent of total billed charges,,
Adenoidectomy 12 Yrs & Over,,25004116,LOCAL,Facility,Both,,,,3570,3034.5,1023.162,3570,"Health Partners, Inc.",State Public Programs,1785,50,,percent of total billed charges,,
Adenoidectomy 12 Yrs & Over,,25004116,LOCAL,Facility,Both,,,,3570,3034.5,1023.162,3570,Humana Insurance Company,Commercial PPO,3391.5,95,,percent of total billed charges,,
Adenoidectomy 12 Yrs & Over,,25004116,LOCAL,Facility,Outpatient,,,,3570,3034.5,1023.162,3570,Humana Insurance Company,Medicare PPO,1749.3,49,,percent of total billed charges,,
Adenoidectomy 12 Yrs & Over,,25004116,LOCAL,Facility,Inpatient,,,,3570,3034.5,1023.162,3570,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Adenoidectomy 12 Yrs & Over,,25004116,LOCAL,Facility,Both,,,,3570,3034.5,1023.162,3570,Medica,Individual & Family,3537.87,99.1,,percent of total billed charges,,
Adenoidectomy 12 Yrs & Over,,25004116,LOCAL,Facility,Outpatient,,,,3570,3034.5,1023.162,3570,Medica,Medica Advantage Solution,1777.86,49.8,,percent of total billed charges,,
Adenoidectomy 12 Yrs & Over,,25004116,LOCAL,Facility,Inpatient,,,,3570,3034.5,1023.162,3570,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Adenoidectomy 12 Yrs & Over,,25004116,LOCAL,Facility,Outpatient,,,,3570,3034.5,1023.162,3570,Medica,Medical Assistance,1592.22,44.6,,percent of total billed charges,,
Adenoidectomy 12 Yrs & Over,,25004116,LOCAL,Facility,Inpatient,,,,3570,3034.5,1023.162,3570,Medica,Medical Assistance,,,,,Included in per diem rate,
Adenoidectomy 12 Yrs & Over,,25004116,LOCAL,Facility,Outpatient,,,,3570,3034.5,1023.162,3570,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1777.86,49.8,,percent of total billed charges,,
Adenoidectomy 12 Yrs & Over,,25004116,LOCAL,Facility,Inpatient,,,,3570,3034.5,1023.162,3570,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Adenoidectomy 12 Yrs & Over,,25004116,LOCAL,Facility,Both,,,,3570,3034.5,1023.162,3570,"Multiplan, Inc.","Multiplan, Inc.",3355.8,94,,percent of total billed charges,,
Adenoidectomy 12 Yrs & Over,,25004116,LOCAL,Facility,Outpatient,,,,3570,3034.5,1023.162,3570,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,3216.57,90.1,,percent of total billed charges,,
Adenoidectomy 12 Yrs & Over,,25004116,LOCAL,Facility,Inpatient,,,,3570,3034.5,1023.162,3570,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Adenoidectomy 12 Yrs & Over,,25004116,LOCAL,Facility,Both,,,,3570,3034.5,1023.162,3570,"Preferred One Administrative Services, INC.",PPO,3520.02,98.6,,percent of total billed charges,,
Adenoidectomy 12 Yrs & Over,,25004116,LOCAL,Facility,Outpatient,,,,3570,3034.5,1023.162,3570,PrimeWest Health,Minnesota Senior Health Options (MSHO),1836.765,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Adenoidectomy 12 Yrs & Over,,25004116,LOCAL,Facility,Inpatient,,,,3570,3034.5,1023.162,3570,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Adenoidectomy 12 Yrs & Over,,25004116,LOCAL,Facility,Outpatient,,,,3570,3034.5,1023.162,3570,PrimeWest Health,MinnesotaCare,1833.552,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Adenoidectomy 12 Yrs & Over,,25004116,LOCAL,Facility,Inpatient,,,,3570,3034.5,1023.162,3570,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Adenoidectomy 12 Yrs & Over,,25004116,LOCAL,Facility,Both,,,,3570,3034.5,1023.162,3570,Sanford Health Plan,Sanford Health Plan,3284.4,92,,percent of total billed charges,,
Adenoidectomy 12 Yrs & Over,,25004116,LOCAL,Facility,Outpatient,,,,3570,3034.5,1023.162,3570,"UCare Health, Inc.",Individual & Family Plan,2011.695,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Adenoidectomy 12 Yrs & Over,,25004116,LOCAL,Facility,Inpatient,,,,3570,3034.5,1023.162,3570,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Adenoidectomy 12 Yrs & Over,,25004116,LOCAL,Facility,Outpatient,,,,3570,3034.5,1023.162,3570,"UCare Health, Inc.",Medical Assistance,1801.779,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Adenoidectomy 12 Yrs & Over,,25004116,LOCAL,Facility,Inpatient,,,,3570,3034.5,1023.162,3570,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Adenoidectomy 12 Yrs & Over,,25004116,LOCAL,Facility,Outpatient,,,,3570,3034.5,1023.162,3570,"UCare Health, Inc.",Medicare Advantage,1801.779,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Adenoidectomy 12 Yrs & Over,,25004116,LOCAL,Facility,Inpatient,,,,3570,3034.5,1023.162,3570,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Adenoidectomy 12 Yrs & Over,,25004116,LOCAL,Facility,Outpatient,,,,3570,3034.5,1023.162,3570,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1801.779,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Adenoidectomy 12 Yrs & Over,,25004116,LOCAL,Facility,Inpatient,,,,3570,3034.5,1023.162,3570,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Adenoidectomy 12 Yrs & Over,,25004116,LOCAL,Facility,Both,,,,3570,3034.5,1023.162,3570,UnitedHealthcare,Individual & Family,3355.8,94,,percent of total billed charges,,
Adenoidectomy 12 Yrs & Over,,25004116,LOCAL,Facility,Outpatient,,,,3570,3034.5,1023.162,3570,UnitedHealthcare,Medicare Advantage,1749.3,49,,percent of total billed charges,,
Adenoidectomy 12 Yrs & Over,,25004116,LOCAL,Facility,Inpatient,,,,3570,3034.5,1023.162,3570,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Adenoidectomy 12 Yrs & Over,,25004116,LOCAL,Facility,Outpatient,,,,3570,3034.5,1023.162,3570,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1713.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
Adenoidectomy 12 Yrs & Over,,25004116,LOCAL,Facility,Inpatient,,,,3570,3034.5,1023.162,3570,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Septoplasty,,25004167,LOCAL,Facility,Both,,,,3468,2947.8,993.9288,3468,Aetna,Commercial,3190.56,92,,percent of total billed charges,,
Septoplasty,,25004167,LOCAL,Facility,Outpatient,,,,3468,2947.8,993.9288,3468,Aetna,Medicare Advantage,1699.32,49,,percent of total billed charges,,
Septoplasty,,25004167,LOCAL,Facility,Inpatient,,,,3468,2947.8,993.9288,3468,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Septoplasty,,25004167,LOCAL,Facility,Both,,,,3468,2947.8,993.9288,3468,Aetna,PPO,3225.24,93,,percent of total billed charges,,
Septoplasty,,25004167,LOCAL,Facility,Both,,,,3468,2947.8,993.9288,3468,America's PPO,America's PPO,3330.3204,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Septoplasty,,25004167,LOCAL,Facility,Both,,,,3468,2947.8,993.9288,3468,BlueCross BlueShield Minnesota, Federal Employee Program,3412.512,98.4,,percent of total billed charges,,
Septoplasty,,25004167,LOCAL,Facility,Both,,,,3468,2947.8,993.9288,3468,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,3468,100,,percent of total billed charges,,
Septoplasty,,25004167,LOCAL,Facility,Both,,,,3468,2947.8,993.9288,3468,BlueCross BlueShield Minnesota,High Value Network Plan,3121.2,90,,percent of total billed charges,,
Septoplasty,,25004167,LOCAL,Facility,Outpatient,,,,3468,2947.8,993.9288,3468,BlueCross BlueShield Minnesota,Medicare Advantage,1699.32,49,,percent of total billed charges,,
Septoplasty,,25004167,LOCAL,Facility,Inpatient,,,,3468,2947.8,993.9288,3468,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Septoplasty,,25004167,LOCAL,Facility,Both,,,,3468,2947.8,993.9288,3468,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,3071.6076,88.57,,percent of total billed charges,,
Septoplasty,,25004167,LOCAL,Facility,Both,,,,3468,2947.8,993.9288,3468,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,993.9288,28.66,,percent of total billed charges,,
Septoplasty,,25004167,LOCAL,Facility,Outpatient,,,,3468,2947.8,993.9288,3468,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1699.32,49,,percent of total billed charges,,
Septoplasty,,25004167,LOCAL,Facility,Inpatient,,,,3468,2947.8,993.9288,3468,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Septoplasty,,25004167,LOCAL,Facility,Both,,,,3468,2947.8,993.9288,3468,CorVel,Worker's Compensation,3468,100,,percent of total billed charges,,
Septoplasty,,25004167,LOCAL,Facility,Both,,,,3468,2947.8,993.9288,3468,First Health Group Corporation,First Health Network,3363.96,97,,percent of total billed charges,,
Septoplasty,,25004167,LOCAL,Facility,Both,,,,3468,2947.8,993.9288,3468,"Health Partners, Inc.",Commercial,3280.728,94.6,,percent of total billed charges,,
Septoplasty,,25004167,LOCAL,Facility,Outpatient,,,,3468,2947.8,993.9288,3468,"Health Partners, Inc.",Medicare Advantage,1699.32,49,,percent of total billed charges,,
Septoplasty,,25004167,LOCAL,Facility,Inpatient,,,,3468,2947.8,993.9288,3468,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Septoplasty,,25004167,LOCAL,Facility,Both,,,,3468,2947.8,993.9288,3468,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),2080.8,60,,percent of total billed charges,,
Septoplasty,,25004167,LOCAL,Facility,Both,,,,3468,2947.8,993.9288,3468,"Health Partners, Inc.",State of Minnesota Advantage Program,2826.42,81.5,,percent of total billed charges,,
Septoplasty,,25004167,LOCAL,Facility,Both,,,,3468,2947.8,993.9288,3468,"Health Partners, Inc.",State Public Programs,1734,50,,percent of total billed charges,,
Septoplasty,,25004167,LOCAL,Facility,Both,,,,3468,2947.8,993.9288,3468,Humana Insurance Company,Commercial PPO,3294.6,95,,percent of total billed charges,,
Septoplasty,,25004167,LOCAL,Facility,Outpatient,,,,3468,2947.8,993.9288,3468,Humana Insurance Company,Medicare PPO,1699.32,49,,percent of total billed charges,,
Septoplasty,,25004167,LOCAL,Facility,Inpatient,,,,3468,2947.8,993.9288,3468,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Septoplasty,,25004167,LOCAL,Facility,Both,,,,3468,2947.8,993.9288,3468,Medica,Individual & Family,3436.788,99.1,,percent of total billed charges,,
Septoplasty,,25004167,LOCAL,Facility,Outpatient,,,,3468,2947.8,993.9288,3468,Medica,Medica Advantage Solution,1727.064,49.8,,percent of total billed charges,,
Septoplasty,,25004167,LOCAL,Facility,Inpatient,,,,3468,2947.8,993.9288,3468,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Septoplasty,,25004167,LOCAL,Facility,Outpatient,,,,3468,2947.8,993.9288,3468,Medica,Medical Assistance,1546.728,44.6,,percent of total billed charges,,
Septoplasty,,25004167,LOCAL,Facility,Inpatient,,,,3468,2947.8,993.9288,3468,Medica,Medical Assistance,,,,,Included in per diem rate,
Septoplasty,,25004167,LOCAL,Facility,Outpatient,,,,3468,2947.8,993.9288,3468,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1727.064,49.8,,percent of total billed charges,,
Septoplasty,,25004167,LOCAL,Facility,Inpatient,,,,3468,2947.8,993.9288,3468,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Septoplasty,,25004167,LOCAL,Facility,Both,,,,3468,2947.8,993.9288,3468,"Multiplan, Inc.","Multiplan, Inc.",3259.92,94,,percent of total billed charges,,
Septoplasty,,25004167,LOCAL,Facility,Outpatient,,,,3468,2947.8,993.9288,3468,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,3124.668,90.1,,percent of total billed charges,,
Septoplasty,,25004167,LOCAL,Facility,Inpatient,,,,3468,2947.8,993.9288,3468,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Septoplasty,,25004167,LOCAL,Facility,Both,,,,3468,2947.8,993.9288,3468,"Preferred One Administrative Services, INC.",PPO,3419.448,98.6,,percent of total billed charges,,
Septoplasty,,25004167,LOCAL,Facility,Outpatient,,,,3468,2947.8,993.9288,3468,PrimeWest Health,Minnesota Senior Health Options (MSHO),1784.286,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Septoplasty,,25004167,LOCAL,Facility,Inpatient,,,,3468,2947.8,993.9288,3468,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Septoplasty,,25004167,LOCAL,Facility,Outpatient,,,,3468,2947.8,993.9288,3468,PrimeWest Health,MinnesotaCare,1781.1648,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Septoplasty,,25004167,LOCAL,Facility,Inpatient,,,,3468,2947.8,993.9288,3468,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Septoplasty,,25004167,LOCAL,Facility,Both,,,,3468,2947.8,993.9288,3468,Sanford Health Plan,Sanford Health Plan,3190.56,92,,percent of total billed charges,,
Septoplasty,,25004167,LOCAL,Facility,Outpatient,,,,3468,2947.8,993.9288,3468,"UCare Health, Inc.",Individual & Family Plan,1954.218,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Septoplasty,,25004167,LOCAL,Facility,Inpatient,,,,3468,2947.8,993.9288,3468,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Septoplasty,,25004167,LOCAL,Facility,Outpatient,,,,3468,2947.8,993.9288,3468,"UCare Health, Inc.",Medical Assistance,1750.2996,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Septoplasty,,25004167,LOCAL,Facility,Inpatient,,,,3468,2947.8,993.9288,3468,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Septoplasty,,25004167,LOCAL,Facility,Outpatient,,,,3468,2947.8,993.9288,3468,"UCare Health, Inc.",Medicare Advantage,1750.2996,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Septoplasty,,25004167,LOCAL,Facility,Inpatient,,,,3468,2947.8,993.9288,3468,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Septoplasty,,25004167,LOCAL,Facility,Outpatient,,,,3468,2947.8,993.9288,3468,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1750.2996,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Septoplasty,,25004167,LOCAL,Facility,Inpatient,,,,3468,2947.8,993.9288,3468,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Septoplasty,,25004167,LOCAL,Facility,Both,,,,3468,2947.8,993.9288,3468,UnitedHealthcare,Individual & Family,3259.92,94,,percent of total billed charges,,
Septoplasty,,25004167,LOCAL,Facility,Outpatient,,,,3468,2947.8,993.9288,3468,UnitedHealthcare,Medicare Advantage,1699.32,49,,percent of total billed charges,,
Septoplasty,,25004167,LOCAL,Facility,Inpatient,,,,3468,2947.8,993.9288,3468,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Septoplasty,,25004167,LOCAL,Facility,Outpatient,,,,3468,2947.8,993.9288,3468,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1664.64,48,,percent of total billed charges,,100% of DHS outpatient percentage
Septoplasty,,25004167,LOCAL,Facility,Inpatient,,,,3468,2947.8,993.9288,3468,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Laryngoscopy,,25004172,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,Aetna,Commercial,2064.48,92,,percent of total billed charges,,
Laryngoscopy,,25004172,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,Aetna,Medicare Advantage,1099.56,49,,percent of total billed charges,,
Laryngoscopy,,25004172,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Laryngoscopy,,25004172,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,Aetna,PPO,2086.92,93,,percent of total billed charges,,
Laryngoscopy,,25004172,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,America's PPO,America's PPO,2154.9132,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Laryngoscopy,,25004172,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,BlueCross BlueShield Minnesota, Federal Employee Program,2208.096,98.4,,percent of total billed charges,,
Laryngoscopy,,25004172,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,2244,100,,percent of total billed charges,,
Laryngoscopy,,25004172,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,BlueCross BlueShield Minnesota,High Value Network Plan,2019.6,90,,percent of total billed charges,,
Laryngoscopy,,25004172,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,BlueCross BlueShield Minnesota,Medicare Advantage,1099.56,49,,percent of total billed charges,,
Laryngoscopy,,25004172,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Laryngoscopy,,25004172,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1987.5108,88.57,,percent of total billed charges,,
Laryngoscopy,,25004172,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,643.1304,28.66,,percent of total billed charges,,
Laryngoscopy,,25004172,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1099.56,49,,percent of total billed charges,,
Laryngoscopy,,25004172,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Laryngoscopy,,25004172,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,CorVel,Worker's Compensation,2244,100,,percent of total billed charges,,
Laryngoscopy,,25004172,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,First Health Group Corporation,First Health Network,2176.68,97,,percent of total billed charges,,
Laryngoscopy,,25004172,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,"Health Partners, Inc.",Commercial,2122.824,94.6,,percent of total billed charges,,
Laryngoscopy,,25004172,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,"Health Partners, Inc.",Medicare Advantage,1099.56,49,,percent of total billed charges,,
Laryngoscopy,,25004172,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Laryngoscopy,,25004172,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1346.4,60,,percent of total billed charges,,
Laryngoscopy,,25004172,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,"Health Partners, Inc.",State of Minnesota Advantage Program,1828.86,81.5,,percent of total billed charges,,
Laryngoscopy,,25004172,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,"Health Partners, Inc.",State Public Programs,1122,50,,percent of total billed charges,,
Laryngoscopy,,25004172,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,Humana Insurance Company,Commercial PPO,2131.8,95,,percent of total billed charges,,
Laryngoscopy,,25004172,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,Humana Insurance Company,Medicare PPO,1099.56,49,,percent of total billed charges,,
Laryngoscopy,,25004172,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Laryngoscopy,,25004172,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,Medica,Individual & Family,2223.804,99.1,,percent of total billed charges,,
Laryngoscopy,,25004172,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,Medica,Medica Advantage Solution,1117.512,49.8,,percent of total billed charges,,
Laryngoscopy,,25004172,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Laryngoscopy,,25004172,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,Medica,Medical Assistance,1000.824,44.6,,percent of total billed charges,,
Laryngoscopy,,25004172,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,Medica,Medical Assistance,,,,,Included in per diem rate,
Laryngoscopy,,25004172,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1117.512,49.8,,percent of total billed charges,,
Laryngoscopy,,25004172,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Laryngoscopy,,25004172,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,"Multiplan, Inc.","Multiplan, Inc.",2109.36,94,,percent of total billed charges,,
Laryngoscopy,,25004172,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,2021.844,90.1,,percent of total billed charges,,
Laryngoscopy,,25004172,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Laryngoscopy,,25004172,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,"Preferred One Administrative Services, INC.",PPO,2212.584,98.6,,percent of total billed charges,,
Laryngoscopy,,25004172,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,PrimeWest Health,Minnesota Senior Health Options (MSHO),1154.538,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Laryngoscopy,,25004172,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Laryngoscopy,,25004172,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,PrimeWest Health,MinnesotaCare,1152.5184,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Laryngoscopy,,25004172,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Laryngoscopy,,25004172,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,Sanford Health Plan,Sanford Health Plan,2064.48,92,,percent of total billed charges,,
Laryngoscopy,,25004172,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,"UCare Health, Inc.",Individual & Family Plan,1264.494,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Laryngoscopy,,25004172,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Laryngoscopy,,25004172,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,"UCare Health, Inc.",Medical Assistance,1132.5468,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Laryngoscopy,,25004172,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Laryngoscopy,,25004172,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,"UCare Health, Inc.",Medicare Advantage,1132.5468,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Laryngoscopy,,25004172,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Laryngoscopy,,25004172,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1132.5468,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Laryngoscopy,,25004172,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Laryngoscopy,,25004172,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,UnitedHealthcare,Individual & Family,2109.36,94,,percent of total billed charges,,
Laryngoscopy,,25004172,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,UnitedHealthcare,Medicare Advantage,1099.56,49,,percent of total billed charges,,
Laryngoscopy,,25004172,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Laryngoscopy,,25004172,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1077.12,48,,percent of total billed charges,,100% of DHS outpatient percentage
Laryngoscopy,,25004172,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Hernia Repair, Ventral Incisional Open",,25004257,LOCAL,Facility,Both,,,,4641,3944.85,1330.1106,4641,Aetna,Commercial,4269.72,92,,percent of total billed charges,,
"Hernia Repair, Ventral Incisional Open",,25004257,LOCAL,Facility,Outpatient,,,,4641,3944.85,1330.1106,4641,Aetna,Medicare Advantage,2274.09,49,,percent of total billed charges,,
"Hernia Repair, Ventral Incisional Open",,25004257,LOCAL,Facility,Inpatient,,,,4641,3944.85,1330.1106,4641,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Hernia Repair, Ventral Incisional Open",,25004257,LOCAL,Facility,Both,,,,4641,3944.85,1330.1106,4641,Aetna,PPO,4316.13,93,,percent of total billed charges,,
"Hernia Repair, Ventral Incisional Open",,25004257,LOCAL,Facility,Both,,,,4641,3944.85,1330.1106,4641,America's PPO,America's PPO,4456.7523,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Hernia Repair, Ventral Incisional Open",,25004257,LOCAL,Facility,Both,,,,4641,3944.85,1330.1106,4641,BlueCross BlueShield Minnesota, Federal Employee Program,4566.744,98.4,,percent of total billed charges,,
"Hernia Repair, Ventral Incisional Open",,25004257,LOCAL,Facility,Both,,,,4641,3944.85,1330.1106,4641,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,4641,100,,percent of total billed charges,,
"Hernia Repair, Ventral Incisional Open",,25004257,LOCAL,Facility,Both,,,,4641,3944.85,1330.1106,4641,BlueCross BlueShield Minnesota,High Value Network Plan,4176.9,90,,percent of total billed charges,,
"Hernia Repair, Ventral Incisional Open",,25004257,LOCAL,Facility,Outpatient,,,,4641,3944.85,1330.1106,4641,BlueCross BlueShield Minnesota,Medicare Advantage,2274.09,49,,percent of total billed charges,,
"Hernia Repair, Ventral Incisional Open",,25004257,LOCAL,Facility,Inpatient,,,,4641,3944.85,1330.1106,4641,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Hernia Repair, Ventral Incisional Open",,25004257,LOCAL,Facility,Both,,,,4641,3944.85,1330.1106,4641,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4110.5337,88.57,,percent of total billed charges,,
"Hernia Repair, Ventral Incisional Open",,25004257,LOCAL,Facility,Both,,,,4641,3944.85,1330.1106,4641,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1330.1106,28.66,,percent of total billed charges,,
"Hernia Repair, Ventral Incisional Open",,25004257,LOCAL,Facility,Outpatient,,,,4641,3944.85,1330.1106,4641,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2274.09,49,,percent of total billed charges,,
"Hernia Repair, Ventral Incisional Open",,25004257,LOCAL,Facility,Inpatient,,,,4641,3944.85,1330.1106,4641,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Hernia Repair, Ventral Incisional Open",,25004257,LOCAL,Facility,Both,,,,4641,3944.85,1330.1106,4641,CorVel,Worker's Compensation,4641,100,,percent of total billed charges,,
"Hernia Repair, Ventral Incisional Open",,25004257,LOCAL,Facility,Both,,,,4641,3944.85,1330.1106,4641,First Health Group Corporation,First Health Network,4501.77,97,,percent of total billed charges,,
"Hernia Repair, Ventral Incisional Open",,25004257,LOCAL,Facility,Both,,,,4641,3944.85,1330.1106,4641,"Health Partners, Inc.",Commercial,4390.386,94.6,,percent of total billed charges,,
"Hernia Repair, Ventral Incisional Open",,25004257,LOCAL,Facility,Outpatient,,,,4641,3944.85,1330.1106,4641,"Health Partners, Inc.",Medicare Advantage,2274.09,49,,percent of total billed charges,,
"Hernia Repair, Ventral Incisional Open",,25004257,LOCAL,Facility,Inpatient,,,,4641,3944.85,1330.1106,4641,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Hernia Repair, Ventral Incisional Open",,25004257,LOCAL,Facility,Both,,,,4641,3944.85,1330.1106,4641,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),2784.6,60,,percent of total billed charges,,
"Hernia Repair, Ventral Incisional Open",,25004257,LOCAL,Facility,Both,,,,4641,3944.85,1330.1106,4641,"Health Partners, Inc.",State of Minnesota Advantage Program,3782.415,81.5,,percent of total billed charges,,
"Hernia Repair, Ventral Incisional Open",,25004257,LOCAL,Facility,Both,,,,4641,3944.85,1330.1106,4641,"Health Partners, Inc.",State Public Programs,2320.5,50,,percent of total billed charges,,
"Hernia Repair, Ventral Incisional Open",,25004257,LOCAL,Facility,Both,,,,4641,3944.85,1330.1106,4641,Humana Insurance Company,Commercial PPO,4408.95,95,,percent of total billed charges,,
"Hernia Repair, Ventral Incisional Open",,25004257,LOCAL,Facility,Outpatient,,,,4641,3944.85,1330.1106,4641,Humana Insurance Company,Medicare PPO,2274.09,49,,percent of total billed charges,,
"Hernia Repair, Ventral Incisional Open",,25004257,LOCAL,Facility,Inpatient,,,,4641,3944.85,1330.1106,4641,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Hernia Repair, Ventral Incisional Open",,25004257,LOCAL,Facility,Both,,,,4641,3944.85,1330.1106,4641,Medica,Individual & Family,4599.231,99.1,,percent of total billed charges,,
"Hernia Repair, Ventral Incisional Open",,25004257,LOCAL,Facility,Outpatient,,,,4641,3944.85,1330.1106,4641,Medica,Medica Advantage Solution,2311.218,49.8,,percent of total billed charges,,
"Hernia Repair, Ventral Incisional Open",,25004257,LOCAL,Facility,Inpatient,,,,4641,3944.85,1330.1106,4641,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Hernia Repair, Ventral Incisional Open",,25004257,LOCAL,Facility,Outpatient,,,,4641,3944.85,1330.1106,4641,Medica,Medical Assistance,2069.886,44.6,,percent of total billed charges,,
"Hernia Repair, Ventral Incisional Open",,25004257,LOCAL,Facility,Inpatient,,,,4641,3944.85,1330.1106,4641,Medica,Medical Assistance,,,,,Included in per diem rate,
"Hernia Repair, Ventral Incisional Open",,25004257,LOCAL,Facility,Outpatient,,,,4641,3944.85,1330.1106,4641,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2311.218,49.8,,percent of total billed charges,,
"Hernia Repair, Ventral Incisional Open",,25004257,LOCAL,Facility,Inpatient,,,,4641,3944.85,1330.1106,4641,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Hernia Repair, Ventral Incisional Open",,25004257,LOCAL,Facility,Both,,,,4641,3944.85,1330.1106,4641,"Multiplan, Inc.","Multiplan, Inc.",4362.54,94,,percent of total billed charges,,
"Hernia Repair, Ventral Incisional Open",,25004257,LOCAL,Facility,Outpatient,,,,4641,3944.85,1330.1106,4641,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4181.541,90.1,,percent of total billed charges,,
"Hernia Repair, Ventral Incisional Open",,25004257,LOCAL,Facility,Inpatient,,,,4641,3944.85,1330.1106,4641,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Hernia Repair, Ventral Incisional Open",,25004257,LOCAL,Facility,Both,,,,4641,3944.85,1330.1106,4641,"Preferred One Administrative Services, INC.",PPO,4576.026,98.6,,percent of total billed charges,,
"Hernia Repair, Ventral Incisional Open",,25004257,LOCAL,Facility,Outpatient,,,,4641,3944.85,1330.1106,4641,PrimeWest Health,Minnesota Senior Health Options (MSHO),2387.7945,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Hernia Repair, Ventral Incisional Open",,25004257,LOCAL,Facility,Inpatient,,,,4641,3944.85,1330.1106,4641,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Hernia Repair, Ventral Incisional Open",,25004257,LOCAL,Facility,Outpatient,,,,4641,3944.85,1330.1106,4641,PrimeWest Health,MinnesotaCare,2383.6176,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Hernia Repair, Ventral Incisional Open",,25004257,LOCAL,Facility,Inpatient,,,,4641,3944.85,1330.1106,4641,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Hernia Repair, Ventral Incisional Open",,25004257,LOCAL,Facility,Both,,,,4641,3944.85,1330.1106,4641,Sanford Health Plan,Sanford Health Plan,4269.72,92,,percent of total billed charges,,
"Hernia Repair, Ventral Incisional Open",,25004257,LOCAL,Facility,Outpatient,,,,4641,3944.85,1330.1106,4641,"UCare Health, Inc.",Individual & Family Plan,2615.2035,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Hernia Repair, Ventral Incisional Open",,25004257,LOCAL,Facility,Inpatient,,,,4641,3944.85,1330.1106,4641,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Hernia Repair, Ventral Incisional Open",,25004257,LOCAL,Facility,Outpatient,,,,4641,3944.85,1330.1106,4641,"UCare Health, Inc.",Medical Assistance,2342.3127,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Hernia Repair, Ventral Incisional Open",,25004257,LOCAL,Facility,Inpatient,,,,4641,3944.85,1330.1106,4641,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Hernia Repair, Ventral Incisional Open",,25004257,LOCAL,Facility,Outpatient,,,,4641,3944.85,1330.1106,4641,"UCare Health, Inc.",Medicare Advantage,2342.3127,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Hernia Repair, Ventral Incisional Open",,25004257,LOCAL,Facility,Inpatient,,,,4641,3944.85,1330.1106,4641,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Hernia Repair, Ventral Incisional Open",,25004257,LOCAL,Facility,Outpatient,,,,4641,3944.85,1330.1106,4641,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2342.3127,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Hernia Repair, Ventral Incisional Open",,25004257,LOCAL,Facility,Inpatient,,,,4641,3944.85,1330.1106,4641,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Hernia Repair, Ventral Incisional Open",,25004257,LOCAL,Facility,Both,,,,4641,3944.85,1330.1106,4641,UnitedHealthcare,Individual & Family,4362.54,94,,percent of total billed charges,,
"Hernia Repair, Ventral Incisional Open",,25004257,LOCAL,Facility,Outpatient,,,,4641,3944.85,1330.1106,4641,UnitedHealthcare,Medicare Advantage,2274.09,49,,percent of total billed charges,,
"Hernia Repair, Ventral Incisional Open",,25004257,LOCAL,Facility,Inpatient,,,,4641,3944.85,1330.1106,4641,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Hernia Repair, Ventral Incisional Open",,25004257,LOCAL,Facility,Outpatient,,,,4641,3944.85,1330.1106,4641,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2227.68,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Hernia Repair, Ventral Incisional Open",,25004257,LOCAL,Facility,Inpatient,,,,4641,3944.85,1330.1106,4641,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Rhinoplasty,,25004373,LOCAL,Facility,Both,,,,3468,2947.8,993.9288,3468,Aetna,Commercial,3190.56,92,,percent of total billed charges,,
Rhinoplasty,,25004373,LOCAL,Facility,Outpatient,,,,3468,2947.8,993.9288,3468,Aetna,Medicare Advantage,1699.32,49,,percent of total billed charges,,
Rhinoplasty,,25004373,LOCAL,Facility,Inpatient,,,,3468,2947.8,993.9288,3468,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Rhinoplasty,,25004373,LOCAL,Facility,Both,,,,3468,2947.8,993.9288,3468,Aetna,PPO,3225.24,93,,percent of total billed charges,,
Rhinoplasty,,25004373,LOCAL,Facility,Both,,,,3468,2947.8,993.9288,3468,America's PPO,America's PPO,3330.3204,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Rhinoplasty,,25004373,LOCAL,Facility,Both,,,,3468,2947.8,993.9288,3468,BlueCross BlueShield Minnesota, Federal Employee Program,3412.512,98.4,,percent of total billed charges,,
Rhinoplasty,,25004373,LOCAL,Facility,Both,,,,3468,2947.8,993.9288,3468,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,3468,100,,percent of total billed charges,,
Rhinoplasty,,25004373,LOCAL,Facility,Both,,,,3468,2947.8,993.9288,3468,BlueCross BlueShield Minnesota,High Value Network Plan,3121.2,90,,percent of total billed charges,,
Rhinoplasty,,25004373,LOCAL,Facility,Outpatient,,,,3468,2947.8,993.9288,3468,BlueCross BlueShield Minnesota,Medicare Advantage,1699.32,49,,percent of total billed charges,,
Rhinoplasty,,25004373,LOCAL,Facility,Inpatient,,,,3468,2947.8,993.9288,3468,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Rhinoplasty,,25004373,LOCAL,Facility,Both,,,,3468,2947.8,993.9288,3468,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,3071.6076,88.57,,percent of total billed charges,,
Rhinoplasty,,25004373,LOCAL,Facility,Both,,,,3468,2947.8,993.9288,3468,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,993.9288,28.66,,percent of total billed charges,,
Rhinoplasty,,25004373,LOCAL,Facility,Outpatient,,,,3468,2947.8,993.9288,3468,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1699.32,49,,percent of total billed charges,,
Rhinoplasty,,25004373,LOCAL,Facility,Inpatient,,,,3468,2947.8,993.9288,3468,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Rhinoplasty,,25004373,LOCAL,Facility,Both,,,,3468,2947.8,993.9288,3468,CorVel,Worker's Compensation,3468,100,,percent of total billed charges,,
Rhinoplasty,,25004373,LOCAL,Facility,Both,,,,3468,2947.8,993.9288,3468,First Health Group Corporation,First Health Network,3363.96,97,,percent of total billed charges,,
Rhinoplasty,,25004373,LOCAL,Facility,Both,,,,3468,2947.8,993.9288,3468,"Health Partners, Inc.",Commercial,3280.728,94.6,,percent of total billed charges,,
Rhinoplasty,,25004373,LOCAL,Facility,Outpatient,,,,3468,2947.8,993.9288,3468,"Health Partners, Inc.",Medicare Advantage,1699.32,49,,percent of total billed charges,,
Rhinoplasty,,25004373,LOCAL,Facility,Inpatient,,,,3468,2947.8,993.9288,3468,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Rhinoplasty,,25004373,LOCAL,Facility,Both,,,,3468,2947.8,993.9288,3468,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),2080.8,60,,percent of total billed charges,,
Rhinoplasty,,25004373,LOCAL,Facility,Both,,,,3468,2947.8,993.9288,3468,"Health Partners, Inc.",State of Minnesota Advantage Program,2826.42,81.5,,percent of total billed charges,,
Rhinoplasty,,25004373,LOCAL,Facility,Both,,,,3468,2947.8,993.9288,3468,"Health Partners, Inc.",State Public Programs,1734,50,,percent of total billed charges,,
Rhinoplasty,,25004373,LOCAL,Facility,Both,,,,3468,2947.8,993.9288,3468,Humana Insurance Company,Commercial PPO,3294.6,95,,percent of total billed charges,,
Rhinoplasty,,25004373,LOCAL,Facility,Outpatient,,,,3468,2947.8,993.9288,3468,Humana Insurance Company,Medicare PPO,1699.32,49,,percent of total billed charges,,
Rhinoplasty,,25004373,LOCAL,Facility,Inpatient,,,,3468,2947.8,993.9288,3468,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Rhinoplasty,,25004373,LOCAL,Facility,Both,,,,3468,2947.8,993.9288,3468,Medica,Individual & Family,3436.788,99.1,,percent of total billed charges,,
Rhinoplasty,,25004373,LOCAL,Facility,Outpatient,,,,3468,2947.8,993.9288,3468,Medica,Medica Advantage Solution,1727.064,49.8,,percent of total billed charges,,
Rhinoplasty,,25004373,LOCAL,Facility,Inpatient,,,,3468,2947.8,993.9288,3468,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Rhinoplasty,,25004373,LOCAL,Facility,Outpatient,,,,3468,2947.8,993.9288,3468,Medica,Medical Assistance,1546.728,44.6,,percent of total billed charges,,
Rhinoplasty,,25004373,LOCAL,Facility,Inpatient,,,,3468,2947.8,993.9288,3468,Medica,Medical Assistance,,,,,Included in per diem rate,
Rhinoplasty,,25004373,LOCAL,Facility,Outpatient,,,,3468,2947.8,993.9288,3468,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1727.064,49.8,,percent of total billed charges,,
Rhinoplasty,,25004373,LOCAL,Facility,Inpatient,,,,3468,2947.8,993.9288,3468,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Rhinoplasty,,25004373,LOCAL,Facility,Both,,,,3468,2947.8,993.9288,3468,"Multiplan, Inc.","Multiplan, Inc.",3259.92,94,,percent of total billed charges,,
Rhinoplasty,,25004373,LOCAL,Facility,Outpatient,,,,3468,2947.8,993.9288,3468,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,3124.668,90.1,,percent of total billed charges,,
Rhinoplasty,,25004373,LOCAL,Facility,Inpatient,,,,3468,2947.8,993.9288,3468,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Rhinoplasty,,25004373,LOCAL,Facility,Both,,,,3468,2947.8,993.9288,3468,"Preferred One Administrative Services, INC.",PPO,3419.448,98.6,,percent of total billed charges,,
Rhinoplasty,,25004373,LOCAL,Facility,Outpatient,,,,3468,2947.8,993.9288,3468,PrimeWest Health,Minnesota Senior Health Options (MSHO),1784.286,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Rhinoplasty,,25004373,LOCAL,Facility,Inpatient,,,,3468,2947.8,993.9288,3468,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Rhinoplasty,,25004373,LOCAL,Facility,Outpatient,,,,3468,2947.8,993.9288,3468,PrimeWest Health,MinnesotaCare,1781.1648,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Rhinoplasty,,25004373,LOCAL,Facility,Inpatient,,,,3468,2947.8,993.9288,3468,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Rhinoplasty,,25004373,LOCAL,Facility,Both,,,,3468,2947.8,993.9288,3468,Sanford Health Plan,Sanford Health Plan,3190.56,92,,percent of total billed charges,,
Rhinoplasty,,25004373,LOCAL,Facility,Outpatient,,,,3468,2947.8,993.9288,3468,"UCare Health, Inc.",Individual & Family Plan,1954.218,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Rhinoplasty,,25004373,LOCAL,Facility,Inpatient,,,,3468,2947.8,993.9288,3468,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Rhinoplasty,,25004373,LOCAL,Facility,Outpatient,,,,3468,2947.8,993.9288,3468,"UCare Health, Inc.",Medical Assistance,1750.2996,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Rhinoplasty,,25004373,LOCAL,Facility,Inpatient,,,,3468,2947.8,993.9288,3468,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Rhinoplasty,,25004373,LOCAL,Facility,Outpatient,,,,3468,2947.8,993.9288,3468,"UCare Health, Inc.",Medicare Advantage,1750.2996,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Rhinoplasty,,25004373,LOCAL,Facility,Inpatient,,,,3468,2947.8,993.9288,3468,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Rhinoplasty,,25004373,LOCAL,Facility,Outpatient,,,,3468,2947.8,993.9288,3468,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1750.2996,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Rhinoplasty,,25004373,LOCAL,Facility,Inpatient,,,,3468,2947.8,993.9288,3468,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Rhinoplasty,,25004373,LOCAL,Facility,Both,,,,3468,2947.8,993.9288,3468,UnitedHealthcare,Individual & Family,3259.92,94,,percent of total billed charges,,
Rhinoplasty,,25004373,LOCAL,Facility,Outpatient,,,,3468,2947.8,993.9288,3468,UnitedHealthcare,Medicare Advantage,1699.32,49,,percent of total billed charges,,
Rhinoplasty,,25004373,LOCAL,Facility,Inpatient,,,,3468,2947.8,993.9288,3468,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Rhinoplasty,,25004373,LOCAL,Facility,Outpatient,,,,3468,2947.8,993.9288,3468,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1664.64,48,,percent of total billed charges,,100% of DHS outpatient percentage
Rhinoplasty,,25004373,LOCAL,Facility,Inpatient,,,,3468,2947.8,993.9288,3468,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Colostomy/Transverse Colostomy,,25004485,LOCAL,Facility,Both,,,,4182,3554.7,1198.5612,4182,Aetna,Commercial,3847.44,92,,percent of total billed charges,,
Colostomy/Transverse Colostomy,,25004485,LOCAL,Facility,Outpatient,,,,4182,3554.7,1198.5612,4182,Aetna,Medicare Advantage,2049.18,49,,percent of total billed charges,,
Colostomy/Transverse Colostomy,,25004485,LOCAL,Facility,Inpatient,,,,4182,3554.7,1198.5612,4182,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Colostomy/Transverse Colostomy,,25004485,LOCAL,Facility,Both,,,,4182,3554.7,1198.5612,4182,Aetna,PPO,3889.26,93,,percent of total billed charges,,
Colostomy/Transverse Colostomy,,25004485,LOCAL,Facility,Both,,,,4182,3554.7,1198.5612,4182,America's PPO,America's PPO,4015.9746,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Colostomy/Transverse Colostomy,,25004485,LOCAL,Facility,Both,,,,4182,3554.7,1198.5612,4182,BlueCross BlueShield Minnesota, Federal Employee Program,4115.088,98.4,,percent of total billed charges,,
Colostomy/Transverse Colostomy,,25004485,LOCAL,Facility,Both,,,,4182,3554.7,1198.5612,4182,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,4182,100,,percent of total billed charges,,
Colostomy/Transverse Colostomy,,25004485,LOCAL,Facility,Both,,,,4182,3554.7,1198.5612,4182,BlueCross BlueShield Minnesota,High Value Network Plan,3763.8,90,,percent of total billed charges,,
Colostomy/Transverse Colostomy,,25004485,LOCAL,Facility,Outpatient,,,,4182,3554.7,1198.5612,4182,BlueCross BlueShield Minnesota,Medicare Advantage,2049.18,49,,percent of total billed charges,,
Colostomy/Transverse Colostomy,,25004485,LOCAL,Facility,Inpatient,,,,4182,3554.7,1198.5612,4182,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Colostomy/Transverse Colostomy,,25004485,LOCAL,Facility,Both,,,,4182,3554.7,1198.5612,4182,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,3703.9974,88.57,,percent of total billed charges,,
Colostomy/Transverse Colostomy,,25004485,LOCAL,Facility,Both,,,,4182,3554.7,1198.5612,4182,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1198.5612,28.66,,percent of total billed charges,,
Colostomy/Transverse Colostomy,,25004485,LOCAL,Facility,Outpatient,,,,4182,3554.7,1198.5612,4182,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2049.18,49,,percent of total billed charges,,
Colostomy/Transverse Colostomy,,25004485,LOCAL,Facility,Inpatient,,,,4182,3554.7,1198.5612,4182,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Colostomy/Transverse Colostomy,,25004485,LOCAL,Facility,Both,,,,4182,3554.7,1198.5612,4182,CorVel,Worker's Compensation,4182,100,,percent of total billed charges,,
Colostomy/Transverse Colostomy,,25004485,LOCAL,Facility,Both,,,,4182,3554.7,1198.5612,4182,First Health Group Corporation,First Health Network,4056.54,97,,percent of total billed charges,,
Colostomy/Transverse Colostomy,,25004485,LOCAL,Facility,Both,,,,4182,3554.7,1198.5612,4182,"Health Partners, Inc.",Commercial,3956.172,94.6,,percent of total billed charges,,
Colostomy/Transverse Colostomy,,25004485,LOCAL,Facility,Outpatient,,,,4182,3554.7,1198.5612,4182,"Health Partners, Inc.",Medicare Advantage,2049.18,49,,percent of total billed charges,,
Colostomy/Transverse Colostomy,,25004485,LOCAL,Facility,Inpatient,,,,4182,3554.7,1198.5612,4182,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Colostomy/Transverse Colostomy,,25004485,LOCAL,Facility,Both,,,,4182,3554.7,1198.5612,4182,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),2509.2,60,,percent of total billed charges,,
Colostomy/Transverse Colostomy,,25004485,LOCAL,Facility,Both,,,,4182,3554.7,1198.5612,4182,"Health Partners, Inc.",State of Minnesota Advantage Program,3408.33,81.5,,percent of total billed charges,,
Colostomy/Transverse Colostomy,,25004485,LOCAL,Facility,Both,,,,4182,3554.7,1198.5612,4182,"Health Partners, Inc.",State Public Programs,2091,50,,percent of total billed charges,,
Colostomy/Transverse Colostomy,,25004485,LOCAL,Facility,Both,,,,4182,3554.7,1198.5612,4182,Humana Insurance Company,Commercial PPO,3972.9,95,,percent of total billed charges,,
Colostomy/Transverse Colostomy,,25004485,LOCAL,Facility,Outpatient,,,,4182,3554.7,1198.5612,4182,Humana Insurance Company,Medicare PPO,2049.18,49,,percent of total billed charges,,
Colostomy/Transverse Colostomy,,25004485,LOCAL,Facility,Inpatient,,,,4182,3554.7,1198.5612,4182,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Colostomy/Transverse Colostomy,,25004485,LOCAL,Facility,Both,,,,4182,3554.7,1198.5612,4182,Medica,Individual & Family,4144.362,99.1,,percent of total billed charges,,
Colostomy/Transverse Colostomy,,25004485,LOCAL,Facility,Outpatient,,,,4182,3554.7,1198.5612,4182,Medica,Medica Advantage Solution,2082.636,49.8,,percent of total billed charges,,
Colostomy/Transverse Colostomy,,25004485,LOCAL,Facility,Inpatient,,,,4182,3554.7,1198.5612,4182,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Colostomy/Transverse Colostomy,,25004485,LOCAL,Facility,Outpatient,,,,4182,3554.7,1198.5612,4182,Medica,Medical Assistance,1865.172,44.6,,percent of total billed charges,,
Colostomy/Transverse Colostomy,,25004485,LOCAL,Facility,Inpatient,,,,4182,3554.7,1198.5612,4182,Medica,Medical Assistance,,,,,Included in per diem rate,
Colostomy/Transverse Colostomy,,25004485,LOCAL,Facility,Outpatient,,,,4182,3554.7,1198.5612,4182,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2082.636,49.8,,percent of total billed charges,,
Colostomy/Transverse Colostomy,,25004485,LOCAL,Facility,Inpatient,,,,4182,3554.7,1198.5612,4182,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Colostomy/Transverse Colostomy,,25004485,LOCAL,Facility,Both,,,,4182,3554.7,1198.5612,4182,"Multiplan, Inc.","Multiplan, Inc.",3931.08,94,,percent of total billed charges,,
Colostomy/Transverse Colostomy,,25004485,LOCAL,Facility,Outpatient,,,,4182,3554.7,1198.5612,4182,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,3767.982,90.1,,percent of total billed charges,,
Colostomy/Transverse Colostomy,,25004485,LOCAL,Facility,Inpatient,,,,4182,3554.7,1198.5612,4182,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Colostomy/Transverse Colostomy,,25004485,LOCAL,Facility,Both,,,,4182,3554.7,1198.5612,4182,"Preferred One Administrative Services, INC.",PPO,4123.452,98.6,,percent of total billed charges,,
Colostomy/Transverse Colostomy,,25004485,LOCAL,Facility,Outpatient,,,,4182,3554.7,1198.5612,4182,PrimeWest Health,Minnesota Senior Health Options (MSHO),2151.639,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Colostomy/Transverse Colostomy,,25004485,LOCAL,Facility,Inpatient,,,,4182,3554.7,1198.5612,4182,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Colostomy/Transverse Colostomy,,25004485,LOCAL,Facility,Outpatient,,,,4182,3554.7,1198.5612,4182,PrimeWest Health,MinnesotaCare,2147.8752,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Colostomy/Transverse Colostomy,,25004485,LOCAL,Facility,Inpatient,,,,4182,3554.7,1198.5612,4182,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Colostomy/Transverse Colostomy,,25004485,LOCAL,Facility,Both,,,,4182,3554.7,1198.5612,4182,Sanford Health Plan,Sanford Health Plan,3847.44,92,,percent of total billed charges,,
Colostomy/Transverse Colostomy,,25004485,LOCAL,Facility,Outpatient,,,,4182,3554.7,1198.5612,4182,"UCare Health, Inc.",Individual & Family Plan,2356.557,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Colostomy/Transverse Colostomy,,25004485,LOCAL,Facility,Inpatient,,,,4182,3554.7,1198.5612,4182,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Colostomy/Transverse Colostomy,,25004485,LOCAL,Facility,Outpatient,,,,4182,3554.7,1198.5612,4182,"UCare Health, Inc.",Medical Assistance,2110.6554,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Colostomy/Transverse Colostomy,,25004485,LOCAL,Facility,Inpatient,,,,4182,3554.7,1198.5612,4182,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Colostomy/Transverse Colostomy,,25004485,LOCAL,Facility,Outpatient,,,,4182,3554.7,1198.5612,4182,"UCare Health, Inc.",Medicare Advantage,2110.6554,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Colostomy/Transverse Colostomy,,25004485,LOCAL,Facility,Inpatient,,,,4182,3554.7,1198.5612,4182,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Colostomy/Transverse Colostomy,,25004485,LOCAL,Facility,Outpatient,,,,4182,3554.7,1198.5612,4182,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2110.6554,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Colostomy/Transverse Colostomy,,25004485,LOCAL,Facility,Inpatient,,,,4182,3554.7,1198.5612,4182,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Colostomy/Transverse Colostomy,,25004485,LOCAL,Facility,Both,,,,4182,3554.7,1198.5612,4182,UnitedHealthcare,Individual & Family,3931.08,94,,percent of total billed charges,,
Colostomy/Transverse Colostomy,,25004485,LOCAL,Facility,Outpatient,,,,4182,3554.7,1198.5612,4182,UnitedHealthcare,Medicare Advantage,2049.18,49,,percent of total billed charges,,
Colostomy/Transverse Colostomy,,25004485,LOCAL,Facility,Inpatient,,,,4182,3554.7,1198.5612,4182,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Colostomy/Transverse Colostomy,,25004485,LOCAL,Facility,Outpatient,,,,4182,3554.7,1198.5612,4182,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2007.36,48,,percent of total billed charges,,100% of DHS outpatient percentage
Colostomy/Transverse Colostomy,,25004485,LOCAL,Facility,Inpatient,,,,4182,3554.7,1198.5612,4182,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Ovarian Cystectomy,,25004513,LOCAL,Facility,Both,,,,3825,3251.25,1096.245,3825,Aetna,Commercial,3519,92,,percent of total billed charges,,
Ovarian Cystectomy,,25004513,LOCAL,Facility,Outpatient,,,,3825,3251.25,1096.245,3825,Aetna,Medicare Advantage,1874.25,49,,percent of total billed charges,,
Ovarian Cystectomy,,25004513,LOCAL,Facility,Inpatient,,,,3825,3251.25,1096.245,3825,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Ovarian Cystectomy,,25004513,LOCAL,Facility,Both,,,,3825,3251.25,1096.245,3825,Aetna,PPO,3557.25,93,,percent of total billed charges,,
Ovarian Cystectomy,,25004513,LOCAL,Facility,Both,,,,3825,3251.25,1096.245,3825,America's PPO,America's PPO,3673.1475,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Ovarian Cystectomy,,25004513,LOCAL,Facility,Both,,,,3825,3251.25,1096.245,3825,BlueCross BlueShield Minnesota, Federal Employee Program,3763.8,98.4,,percent of total billed charges,,
Ovarian Cystectomy,,25004513,LOCAL,Facility,Both,,,,3825,3251.25,1096.245,3825,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,3825,100,,percent of total billed charges,,
Ovarian Cystectomy,,25004513,LOCAL,Facility,Both,,,,3825,3251.25,1096.245,3825,BlueCross BlueShield Minnesota,High Value Network Plan,3442.5,90,,percent of total billed charges,,
Ovarian Cystectomy,,25004513,LOCAL,Facility,Outpatient,,,,3825,3251.25,1096.245,3825,BlueCross BlueShield Minnesota,Medicare Advantage,1874.25,49,,percent of total billed charges,,
Ovarian Cystectomy,,25004513,LOCAL,Facility,Inpatient,,,,3825,3251.25,1096.245,3825,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Ovarian Cystectomy,,25004513,LOCAL,Facility,Both,,,,3825,3251.25,1096.245,3825,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,3387.8025,88.57,,percent of total billed charges,,
Ovarian Cystectomy,,25004513,LOCAL,Facility,Both,,,,3825,3251.25,1096.245,3825,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1096.245,28.66,,percent of total billed charges,,
Ovarian Cystectomy,,25004513,LOCAL,Facility,Outpatient,,,,3825,3251.25,1096.245,3825,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1874.25,49,,percent of total billed charges,,
Ovarian Cystectomy,,25004513,LOCAL,Facility,Inpatient,,,,3825,3251.25,1096.245,3825,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Ovarian Cystectomy,,25004513,LOCAL,Facility,Both,,,,3825,3251.25,1096.245,3825,CorVel,Worker's Compensation,3825,100,,percent of total billed charges,,
Ovarian Cystectomy,,25004513,LOCAL,Facility,Both,,,,3825,3251.25,1096.245,3825,First Health Group Corporation,First Health Network,3710.25,97,,percent of total billed charges,,
Ovarian Cystectomy,,25004513,LOCAL,Facility,Both,,,,3825,3251.25,1096.245,3825,"Health Partners, Inc.",Commercial,3618.45,94.6,,percent of total billed charges,,
Ovarian Cystectomy,,25004513,LOCAL,Facility,Outpatient,,,,3825,3251.25,1096.245,3825,"Health Partners, Inc.",Medicare Advantage,1874.25,49,,percent of total billed charges,,
Ovarian Cystectomy,,25004513,LOCAL,Facility,Inpatient,,,,3825,3251.25,1096.245,3825,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ovarian Cystectomy,,25004513,LOCAL,Facility,Both,,,,3825,3251.25,1096.245,3825,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),2295,60,,percent of total billed charges,,
Ovarian Cystectomy,,25004513,LOCAL,Facility,Both,,,,3825,3251.25,1096.245,3825,"Health Partners, Inc.",State of Minnesota Advantage Program,3117.375,81.5,,percent of total billed charges,,
Ovarian Cystectomy,,25004513,LOCAL,Facility,Both,,,,3825,3251.25,1096.245,3825,"Health Partners, Inc.",State Public Programs,1912.5,50,,percent of total billed charges,,
Ovarian Cystectomy,,25004513,LOCAL,Facility,Both,,,,3825,3251.25,1096.245,3825,Humana Insurance Company,Commercial PPO,3633.75,95,,percent of total billed charges,,
Ovarian Cystectomy,,25004513,LOCAL,Facility,Outpatient,,,,3825,3251.25,1096.245,3825,Humana Insurance Company,Medicare PPO,1874.25,49,,percent of total billed charges,,
Ovarian Cystectomy,,25004513,LOCAL,Facility,Inpatient,,,,3825,3251.25,1096.245,3825,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Ovarian Cystectomy,,25004513,LOCAL,Facility,Both,,,,3825,3251.25,1096.245,3825,Medica,Individual & Family,3790.575,99.1,,percent of total billed charges,,
Ovarian Cystectomy,,25004513,LOCAL,Facility,Outpatient,,,,3825,3251.25,1096.245,3825,Medica,Medica Advantage Solution,1904.85,49.8,,percent of total billed charges,,
Ovarian Cystectomy,,25004513,LOCAL,Facility,Inpatient,,,,3825,3251.25,1096.245,3825,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Ovarian Cystectomy,,25004513,LOCAL,Facility,Outpatient,,,,3825,3251.25,1096.245,3825,Medica,Medical Assistance,1705.95,44.6,,percent of total billed charges,,
Ovarian Cystectomy,,25004513,LOCAL,Facility,Inpatient,,,,3825,3251.25,1096.245,3825,Medica,Medical Assistance,,,,,Included in per diem rate,
Ovarian Cystectomy,,25004513,LOCAL,Facility,Outpatient,,,,3825,3251.25,1096.245,3825,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1904.85,49.8,,percent of total billed charges,,
Ovarian Cystectomy,,25004513,LOCAL,Facility,Inpatient,,,,3825,3251.25,1096.245,3825,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Ovarian Cystectomy,,25004513,LOCAL,Facility,Both,,,,3825,3251.25,1096.245,3825,"Multiplan, Inc.","Multiplan, Inc.",3595.5,94,,percent of total billed charges,,
Ovarian Cystectomy,,25004513,LOCAL,Facility,Outpatient,,,,3825,3251.25,1096.245,3825,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,3446.325,90.1,,percent of total billed charges,,
Ovarian Cystectomy,,25004513,LOCAL,Facility,Inpatient,,,,3825,3251.25,1096.245,3825,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Ovarian Cystectomy,,25004513,LOCAL,Facility,Both,,,,3825,3251.25,1096.245,3825,"Preferred One Administrative Services, INC.",PPO,3771.45,98.6,,percent of total billed charges,,
Ovarian Cystectomy,,25004513,LOCAL,Facility,Outpatient,,,,3825,3251.25,1096.245,3825,PrimeWest Health,Minnesota Senior Health Options (MSHO),1967.9625,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Ovarian Cystectomy,,25004513,LOCAL,Facility,Inpatient,,,,3825,3251.25,1096.245,3825,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ovarian Cystectomy,,25004513,LOCAL,Facility,Outpatient,,,,3825,3251.25,1096.245,3825,PrimeWest Health,MinnesotaCare,1964.52,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Ovarian Cystectomy,,25004513,LOCAL,Facility,Inpatient,,,,3825,3251.25,1096.245,3825,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Ovarian Cystectomy,,25004513,LOCAL,Facility,Both,,,,3825,3251.25,1096.245,3825,Sanford Health Plan,Sanford Health Plan,3519,92,,percent of total billed charges,,
Ovarian Cystectomy,,25004513,LOCAL,Facility,Outpatient,,,,3825,3251.25,1096.245,3825,"UCare Health, Inc.",Individual & Family Plan,2155.3875,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Ovarian Cystectomy,,25004513,LOCAL,Facility,Inpatient,,,,3825,3251.25,1096.245,3825,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Ovarian Cystectomy,,25004513,LOCAL,Facility,Outpatient,,,,3825,3251.25,1096.245,3825,"UCare Health, Inc.",Medical Assistance,1930.4775,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ovarian Cystectomy,,25004513,LOCAL,Facility,Inpatient,,,,3825,3251.25,1096.245,3825,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Ovarian Cystectomy,,25004513,LOCAL,Facility,Outpatient,,,,3825,3251.25,1096.245,3825,"UCare Health, Inc.",Medicare Advantage,1930.4775,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ovarian Cystectomy,,25004513,LOCAL,Facility,Inpatient,,,,3825,3251.25,1096.245,3825,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ovarian Cystectomy,,25004513,LOCAL,Facility,Outpatient,,,,3825,3251.25,1096.245,3825,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1930.4775,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ovarian Cystectomy,,25004513,LOCAL,Facility,Inpatient,,,,3825,3251.25,1096.245,3825,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ovarian Cystectomy,,25004513,LOCAL,Facility,Both,,,,3825,3251.25,1096.245,3825,UnitedHealthcare,Individual & Family,3595.5,94,,percent of total billed charges,,
Ovarian Cystectomy,,25004513,LOCAL,Facility,Outpatient,,,,3825,3251.25,1096.245,3825,UnitedHealthcare,Medicare Advantage,1874.25,49,,percent of total billed charges,,
Ovarian Cystectomy,,25004513,LOCAL,Facility,Inpatient,,,,3825,3251.25,1096.245,3825,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Ovarian Cystectomy,,25004513,LOCAL,Facility,Outpatient,,,,3825,3251.25,1096.245,3825,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1836,48,,percent of total billed charges,,100% of DHS outpatient percentage
Ovarian Cystectomy,,25004513,LOCAL,Facility,Inpatient,,,,3825,3251.25,1096.245,3825,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Thoracentesis,,25004581,LOCAL,Facility,Both,,,,1122,953.7,321.5652,1122,Aetna,Commercial,1032.24,92,,percent of total billed charges,,
Thoracentesis,,25004581,LOCAL,Facility,Outpatient,,,,1122,953.7,321.5652,1122,Aetna,Medicare Advantage,549.78,49,,percent of total billed charges,,
Thoracentesis,,25004581,LOCAL,Facility,Inpatient,,,,1122,953.7,321.5652,1122,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Thoracentesis,,25004581,LOCAL,Facility,Both,,,,1122,953.7,321.5652,1122,Aetna,PPO,1043.46,93,,percent of total billed charges,,
Thoracentesis,,25004581,LOCAL,Facility,Both,,,,1122,953.7,321.5652,1122,America's PPO,America's PPO,1077.4566,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Thoracentesis,,25004581,LOCAL,Facility,Both,,,,1122,953.7,321.5652,1122,BlueCross BlueShield Minnesota, Federal Employee Program,1104.048,98.4,,percent of total billed charges,,
Thoracentesis,,25004581,LOCAL,Facility,Both,,,,1122,953.7,321.5652,1122,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1122,100,,percent of total billed charges,,
Thoracentesis,,25004581,LOCAL,Facility,Both,,,,1122,953.7,321.5652,1122,BlueCross BlueShield Minnesota,High Value Network Plan,1009.8,90,,percent of total billed charges,,
Thoracentesis,,25004581,LOCAL,Facility,Outpatient,,,,1122,953.7,321.5652,1122,BlueCross BlueShield Minnesota,Medicare Advantage,549.78,49,,percent of total billed charges,,
Thoracentesis,,25004581,LOCAL,Facility,Inpatient,,,,1122,953.7,321.5652,1122,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Thoracentesis,,25004581,LOCAL,Facility,Both,,,,1122,953.7,321.5652,1122,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,993.7554,88.57,,percent of total billed charges,,
Thoracentesis,,25004581,LOCAL,Facility,Both,,,,1122,953.7,321.5652,1122,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,321.5652,28.66,,percent of total billed charges,,
Thoracentesis,,25004581,LOCAL,Facility,Outpatient,,,,1122,953.7,321.5652,1122,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),549.78,49,,percent of total billed charges,,
Thoracentesis,,25004581,LOCAL,Facility,Inpatient,,,,1122,953.7,321.5652,1122,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Thoracentesis,,25004581,LOCAL,Facility,Both,,,,1122,953.7,321.5652,1122,CorVel,Worker's Compensation,1122,100,,percent of total billed charges,,
Thoracentesis,,25004581,LOCAL,Facility,Both,,,,1122,953.7,321.5652,1122,First Health Group Corporation,First Health Network,1088.34,97,,percent of total billed charges,,
Thoracentesis,,25004581,LOCAL,Facility,Both,,,,1122,953.7,321.5652,1122,"Health Partners, Inc.",Commercial,1061.412,94.6,,percent of total billed charges,,
Thoracentesis,,25004581,LOCAL,Facility,Outpatient,,,,1122,953.7,321.5652,1122,"Health Partners, Inc.",Medicare Advantage,549.78,49,,percent of total billed charges,,
Thoracentesis,,25004581,LOCAL,Facility,Inpatient,,,,1122,953.7,321.5652,1122,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Thoracentesis,,25004581,LOCAL,Facility,Both,,,,1122,953.7,321.5652,1122,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),673.2,60,,percent of total billed charges,,
Thoracentesis,,25004581,LOCAL,Facility,Both,,,,1122,953.7,321.5652,1122,"Health Partners, Inc.",State of Minnesota Advantage Program,914.43,81.5,,percent of total billed charges,,
Thoracentesis,,25004581,LOCAL,Facility,Both,,,,1122,953.7,321.5652,1122,"Health Partners, Inc.",State Public Programs,561,50,,percent of total billed charges,,
Thoracentesis,,25004581,LOCAL,Facility,Both,,,,1122,953.7,321.5652,1122,Humana Insurance Company,Commercial PPO,1065.9,95,,percent of total billed charges,,
Thoracentesis,,25004581,LOCAL,Facility,Outpatient,,,,1122,953.7,321.5652,1122,Humana Insurance Company,Medicare PPO,549.78,49,,percent of total billed charges,,
Thoracentesis,,25004581,LOCAL,Facility,Inpatient,,,,1122,953.7,321.5652,1122,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Thoracentesis,,25004581,LOCAL,Facility,Both,,,,1122,953.7,321.5652,1122,Medica,Individual & Family,1111.902,99.1,,percent of total billed charges,,
Thoracentesis,,25004581,LOCAL,Facility,Outpatient,,,,1122,953.7,321.5652,1122,Medica,Medica Advantage Solution,558.756,49.8,,percent of total billed charges,,
Thoracentesis,,25004581,LOCAL,Facility,Inpatient,,,,1122,953.7,321.5652,1122,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Thoracentesis,,25004581,LOCAL,Facility,Outpatient,,,,1122,953.7,321.5652,1122,Medica,Medical Assistance,500.412,44.6,,percent of total billed charges,,
Thoracentesis,,25004581,LOCAL,Facility,Inpatient,,,,1122,953.7,321.5652,1122,Medica,Medical Assistance,,,,,Included in per diem rate,
Thoracentesis,,25004581,LOCAL,Facility,Outpatient,,,,1122,953.7,321.5652,1122,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,558.756,49.8,,percent of total billed charges,,
Thoracentesis,,25004581,LOCAL,Facility,Inpatient,,,,1122,953.7,321.5652,1122,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Thoracentesis,,25004581,LOCAL,Facility,Both,,,,1122,953.7,321.5652,1122,"Multiplan, Inc.","Multiplan, Inc.",1054.68,94,,percent of total billed charges,,
Thoracentesis,,25004581,LOCAL,Facility,Outpatient,,,,1122,953.7,321.5652,1122,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1010.922,90.1,,percent of total billed charges,,
Thoracentesis,,25004581,LOCAL,Facility,Inpatient,,,,1122,953.7,321.5652,1122,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Thoracentesis,,25004581,LOCAL,Facility,Both,,,,1122,953.7,321.5652,1122,"Preferred One Administrative Services, INC.",PPO,1106.292,98.6,,percent of total billed charges,,
Thoracentesis,,25004581,LOCAL,Facility,Outpatient,,,,1122,953.7,321.5652,1122,PrimeWest Health,Minnesota Senior Health Options (MSHO),577.269,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Thoracentesis,,25004581,LOCAL,Facility,Inpatient,,,,1122,953.7,321.5652,1122,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Thoracentesis,,25004581,LOCAL,Facility,Outpatient,,,,1122,953.7,321.5652,1122,PrimeWest Health,MinnesotaCare,576.2592,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Thoracentesis,,25004581,LOCAL,Facility,Inpatient,,,,1122,953.7,321.5652,1122,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Thoracentesis,,25004581,LOCAL,Facility,Both,,,,1122,953.7,321.5652,1122,Sanford Health Plan,Sanford Health Plan,1032.24,92,,percent of total billed charges,,
Thoracentesis,,25004581,LOCAL,Facility,Outpatient,,,,1122,953.7,321.5652,1122,"UCare Health, Inc.",Individual & Family Plan,632.247,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Thoracentesis,,25004581,LOCAL,Facility,Inpatient,,,,1122,953.7,321.5652,1122,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Thoracentesis,,25004581,LOCAL,Facility,Outpatient,,,,1122,953.7,321.5652,1122,"UCare Health, Inc.",Medical Assistance,566.2734,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Thoracentesis,,25004581,LOCAL,Facility,Inpatient,,,,1122,953.7,321.5652,1122,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Thoracentesis,,25004581,LOCAL,Facility,Outpatient,,,,1122,953.7,321.5652,1122,"UCare Health, Inc.",Medicare Advantage,566.2734,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Thoracentesis,,25004581,LOCAL,Facility,Inpatient,,,,1122,953.7,321.5652,1122,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Thoracentesis,,25004581,LOCAL,Facility,Outpatient,,,,1122,953.7,321.5652,1122,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),566.2734,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Thoracentesis,,25004581,LOCAL,Facility,Inpatient,,,,1122,953.7,321.5652,1122,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Thoracentesis,,25004581,LOCAL,Facility,Both,,,,1122,953.7,321.5652,1122,UnitedHealthcare,Individual & Family,1054.68,94,,percent of total billed charges,,
Thoracentesis,,25004581,LOCAL,Facility,Outpatient,,,,1122,953.7,321.5652,1122,UnitedHealthcare,Medicare Advantage,549.78,49,,percent of total billed charges,,
Thoracentesis,,25004581,LOCAL,Facility,Inpatient,,,,1122,953.7,321.5652,1122,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Thoracentesis,,25004581,LOCAL,Facility,Outpatient,,,,1122,953.7,321.5652,1122,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,538.56,48,,percent of total billed charges,,100% of DHS outpatient percentage
Thoracentesis,,25004581,LOCAL,Facility,Inpatient,,,,1122,953.7,321.5652,1122,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Minor Repair Laceration/Lesion/Fb Rmvl,,25004611,LOCAL,Facility,Both,,,,408,346.8,116.9328,408,Aetna,Commercial,375.36,92,,percent of total billed charges,,
Minor Repair Laceration/Lesion/Fb Rmvl,,25004611,LOCAL,Facility,Outpatient,,,,408,346.8,116.9328,408,Aetna,Medicare Advantage,199.92,49,,percent of total billed charges,,
Minor Repair Laceration/Lesion/Fb Rmvl,,25004611,LOCAL,Facility,Inpatient,,,,408,346.8,116.9328,408,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Minor Repair Laceration/Lesion/Fb Rmvl,,25004611,LOCAL,Facility,Both,,,,408,346.8,116.9328,408,Aetna,PPO,379.44,93,,percent of total billed charges,,
Minor Repair Laceration/Lesion/Fb Rmvl,,25004611,LOCAL,Facility,Both,,,,408,346.8,116.9328,408,America's PPO,America's PPO,391.8024,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Minor Repair Laceration/Lesion/Fb Rmvl,,25004611,LOCAL,Facility,Both,,,,408,346.8,116.9328,408,BlueCross BlueShield Minnesota, Federal Employee Program,401.472,98.4,,percent of total billed charges,,
Minor Repair Laceration/Lesion/Fb Rmvl,,25004611,LOCAL,Facility,Both,,,,408,346.8,116.9328,408,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,408,100,,percent of total billed charges,,
Minor Repair Laceration/Lesion/Fb Rmvl,,25004611,LOCAL,Facility,Both,,,,408,346.8,116.9328,408,BlueCross BlueShield Minnesota,High Value Network Plan,367.2,90,,percent of total billed charges,,
Minor Repair Laceration/Lesion/Fb Rmvl,,25004611,LOCAL,Facility,Outpatient,,,,408,346.8,116.9328,408,BlueCross BlueShield Minnesota,Medicare Advantage,199.92,49,,percent of total billed charges,,
Minor Repair Laceration/Lesion/Fb Rmvl,,25004611,LOCAL,Facility,Inpatient,,,,408,346.8,116.9328,408,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Minor Repair Laceration/Lesion/Fb Rmvl,,25004611,LOCAL,Facility,Both,,,,408,346.8,116.9328,408,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,361.3656,88.57,,percent of total billed charges,,
Minor Repair Laceration/Lesion/Fb Rmvl,,25004611,LOCAL,Facility,Both,,,,408,346.8,116.9328,408,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,116.9328,28.66,,percent of total billed charges,,
Minor Repair Laceration/Lesion/Fb Rmvl,,25004611,LOCAL,Facility,Outpatient,,,,408,346.8,116.9328,408,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),199.92,49,,percent of total billed charges,,
Minor Repair Laceration/Lesion/Fb Rmvl,,25004611,LOCAL,Facility,Inpatient,,,,408,346.8,116.9328,408,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Minor Repair Laceration/Lesion/Fb Rmvl,,25004611,LOCAL,Facility,Both,,,,408,346.8,116.9328,408,CorVel,Worker's Compensation,408,100,,percent of total billed charges,,
Minor Repair Laceration/Lesion/Fb Rmvl,,25004611,LOCAL,Facility,Both,,,,408,346.8,116.9328,408,First Health Group Corporation,First Health Network,395.76,97,,percent of total billed charges,,
Minor Repair Laceration/Lesion/Fb Rmvl,,25004611,LOCAL,Facility,Both,,,,408,346.8,116.9328,408,"Health Partners, Inc.",Commercial,385.968,94.6,,percent of total billed charges,,
Minor Repair Laceration/Lesion/Fb Rmvl,,25004611,LOCAL,Facility,Outpatient,,,,408,346.8,116.9328,408,"Health Partners, Inc.",Medicare Advantage,199.92,49,,percent of total billed charges,,
Minor Repair Laceration/Lesion/Fb Rmvl,,25004611,LOCAL,Facility,Inpatient,,,,408,346.8,116.9328,408,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Minor Repair Laceration/Lesion/Fb Rmvl,,25004611,LOCAL,Facility,Both,,,,408,346.8,116.9328,408,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),244.8,60,,percent of total billed charges,,
Minor Repair Laceration/Lesion/Fb Rmvl,,25004611,LOCAL,Facility,Both,,,,408,346.8,116.9328,408,"Health Partners, Inc.",State of Minnesota Advantage Program,332.52,81.5,,percent of total billed charges,,
Minor Repair Laceration/Lesion/Fb Rmvl,,25004611,LOCAL,Facility,Both,,,,408,346.8,116.9328,408,"Health Partners, Inc.",State Public Programs,204,50,,percent of total billed charges,,
Minor Repair Laceration/Lesion/Fb Rmvl,,25004611,LOCAL,Facility,Both,,,,408,346.8,116.9328,408,Humana Insurance Company,Commercial PPO,387.6,95,,percent of total billed charges,,
Minor Repair Laceration/Lesion/Fb Rmvl,,25004611,LOCAL,Facility,Outpatient,,,,408,346.8,116.9328,408,Humana Insurance Company,Medicare PPO,199.92,49,,percent of total billed charges,,
Minor Repair Laceration/Lesion/Fb Rmvl,,25004611,LOCAL,Facility,Inpatient,,,,408,346.8,116.9328,408,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Minor Repair Laceration/Lesion/Fb Rmvl,,25004611,LOCAL,Facility,Both,,,,408,346.8,116.9328,408,Medica,Individual & Family,404.328,99.1,,percent of total billed charges,,
Minor Repair Laceration/Lesion/Fb Rmvl,,25004611,LOCAL,Facility,Outpatient,,,,408,346.8,116.9328,408,Medica,Medica Advantage Solution,203.184,49.8,,percent of total billed charges,,
Minor Repair Laceration/Lesion/Fb Rmvl,,25004611,LOCAL,Facility,Inpatient,,,,408,346.8,116.9328,408,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Minor Repair Laceration/Lesion/Fb Rmvl,,25004611,LOCAL,Facility,Outpatient,,,,408,346.8,116.9328,408,Medica,Medical Assistance,181.968,44.6,,percent of total billed charges,,
Minor Repair Laceration/Lesion/Fb Rmvl,,25004611,LOCAL,Facility,Inpatient,,,,408,346.8,116.9328,408,Medica,Medical Assistance,,,,,Included in per diem rate,
Minor Repair Laceration/Lesion/Fb Rmvl,,25004611,LOCAL,Facility,Outpatient,,,,408,346.8,116.9328,408,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,203.184,49.8,,percent of total billed charges,,
Minor Repair Laceration/Lesion/Fb Rmvl,,25004611,LOCAL,Facility,Inpatient,,,,408,346.8,116.9328,408,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Minor Repair Laceration/Lesion/Fb Rmvl,,25004611,LOCAL,Facility,Both,,,,408,346.8,116.9328,408,"Multiplan, Inc.","Multiplan, Inc.",383.52,94,,percent of total billed charges,,
Minor Repair Laceration/Lesion/Fb Rmvl,,25004611,LOCAL,Facility,Outpatient,,,,408,346.8,116.9328,408,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,367.608,90.1,,percent of total billed charges,,
Minor Repair Laceration/Lesion/Fb Rmvl,,25004611,LOCAL,Facility,Inpatient,,,,408,346.8,116.9328,408,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Minor Repair Laceration/Lesion/Fb Rmvl,,25004611,LOCAL,Facility,Both,,,,408,346.8,116.9328,408,"Preferred One Administrative Services, INC.",PPO,402.288,98.6,,percent of total billed charges,,
Minor Repair Laceration/Lesion/Fb Rmvl,,25004611,LOCAL,Facility,Outpatient,,,,408,346.8,116.9328,408,PrimeWest Health,Minnesota Senior Health Options (MSHO),209.916,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Minor Repair Laceration/Lesion/Fb Rmvl,,25004611,LOCAL,Facility,Inpatient,,,,408,346.8,116.9328,408,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Minor Repair Laceration/Lesion/Fb Rmvl,,25004611,LOCAL,Facility,Outpatient,,,,408,346.8,116.9328,408,PrimeWest Health,MinnesotaCare,209.5488,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Minor Repair Laceration/Lesion/Fb Rmvl,,25004611,LOCAL,Facility,Inpatient,,,,408,346.8,116.9328,408,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Minor Repair Laceration/Lesion/Fb Rmvl,,25004611,LOCAL,Facility,Both,,,,408,346.8,116.9328,408,Sanford Health Plan,Sanford Health Plan,375.36,92,,percent of total billed charges,,
Minor Repair Laceration/Lesion/Fb Rmvl,,25004611,LOCAL,Facility,Outpatient,,,,408,346.8,116.9328,408,"UCare Health, Inc.",Individual & Family Plan,229.908,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Minor Repair Laceration/Lesion/Fb Rmvl,,25004611,LOCAL,Facility,Inpatient,,,,408,346.8,116.9328,408,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Minor Repair Laceration/Lesion/Fb Rmvl,,25004611,LOCAL,Facility,Outpatient,,,,408,346.8,116.9328,408,"UCare Health, Inc.",Medical Assistance,205.9176,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Minor Repair Laceration/Lesion/Fb Rmvl,,25004611,LOCAL,Facility,Inpatient,,,,408,346.8,116.9328,408,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Minor Repair Laceration/Lesion/Fb Rmvl,,25004611,LOCAL,Facility,Outpatient,,,,408,346.8,116.9328,408,"UCare Health, Inc.",Medicare Advantage,205.9176,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Minor Repair Laceration/Lesion/Fb Rmvl,,25004611,LOCAL,Facility,Inpatient,,,,408,346.8,116.9328,408,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Minor Repair Laceration/Lesion/Fb Rmvl,,25004611,LOCAL,Facility,Outpatient,,,,408,346.8,116.9328,408,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),205.9176,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Minor Repair Laceration/Lesion/Fb Rmvl,,25004611,LOCAL,Facility,Inpatient,,,,408,346.8,116.9328,408,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Minor Repair Laceration/Lesion/Fb Rmvl,,25004611,LOCAL,Facility,Both,,,,408,346.8,116.9328,408,UnitedHealthcare,Individual & Family,383.52,94,,percent of total billed charges,,
Minor Repair Laceration/Lesion/Fb Rmvl,,25004611,LOCAL,Facility,Outpatient,,,,408,346.8,116.9328,408,UnitedHealthcare,Medicare Advantage,199.92,49,,percent of total billed charges,,
Minor Repair Laceration/Lesion/Fb Rmvl,,25004611,LOCAL,Facility,Inpatient,,,,408,346.8,116.9328,408,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Minor Repair Laceration/Lesion/Fb Rmvl,,25004611,LOCAL,Facility,Outpatient,,,,408,346.8,116.9328,408,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,195.84,48,,percent of total billed charges,,100% of DHS outpatient percentage
Minor Repair Laceration/Lesion/Fb Rmvl,,25004611,LOCAL,Facility,Inpatient,,,,408,346.8,116.9328,408,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Chest Tube Insertion W/Sedation (Or),,25004649,LOCAL,Facility,Both,,,,1326,1127.1,380.0316,1326,Aetna,Commercial,1219.92,92,,percent of total billed charges,,
Chest Tube Insertion W/Sedation (Or),,25004649,LOCAL,Facility,Outpatient,,,,1326,1127.1,380.0316,1326,Aetna,Medicare Advantage,649.74,49,,percent of total billed charges,,
Chest Tube Insertion W/Sedation (Or),,25004649,LOCAL,Facility,Inpatient,,,,1326,1127.1,380.0316,1326,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Chest Tube Insertion W/Sedation (Or),,25004649,LOCAL,Facility,Both,,,,1326,1127.1,380.0316,1326,Aetna,PPO,1233.18,93,,percent of total billed charges,,
Chest Tube Insertion W/Sedation (Or),,25004649,LOCAL,Facility,Both,,,,1326,1127.1,380.0316,1326,America's PPO,America's PPO,1273.3578,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Chest Tube Insertion W/Sedation (Or),,25004649,LOCAL,Facility,Both,,,,1326,1127.1,380.0316,1326,BlueCross BlueShield Minnesota, Federal Employee Program,1304.784,98.4,,percent of total billed charges,,
Chest Tube Insertion W/Sedation (Or),,25004649,LOCAL,Facility,Both,,,,1326,1127.1,380.0316,1326,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1326,100,,percent of total billed charges,,
Chest Tube Insertion W/Sedation (Or),,25004649,LOCAL,Facility,Both,,,,1326,1127.1,380.0316,1326,BlueCross BlueShield Minnesota,High Value Network Plan,1193.4,90,,percent of total billed charges,,
Chest Tube Insertion W/Sedation (Or),,25004649,LOCAL,Facility,Outpatient,,,,1326,1127.1,380.0316,1326,BlueCross BlueShield Minnesota,Medicare Advantage,649.74,49,,percent of total billed charges,,
Chest Tube Insertion W/Sedation (Or),,25004649,LOCAL,Facility,Inpatient,,,,1326,1127.1,380.0316,1326,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Chest Tube Insertion W/Sedation (Or),,25004649,LOCAL,Facility,Both,,,,1326,1127.1,380.0316,1326,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1174.4382,88.57,,percent of total billed charges,,
Chest Tube Insertion W/Sedation (Or),,25004649,LOCAL,Facility,Both,,,,1326,1127.1,380.0316,1326,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,380.0316,28.66,,percent of total billed charges,,
Chest Tube Insertion W/Sedation (Or),,25004649,LOCAL,Facility,Outpatient,,,,1326,1127.1,380.0316,1326,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),649.74,49,,percent of total billed charges,,
Chest Tube Insertion W/Sedation (Or),,25004649,LOCAL,Facility,Inpatient,,,,1326,1127.1,380.0316,1326,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Chest Tube Insertion W/Sedation (Or),,25004649,LOCAL,Facility,Both,,,,1326,1127.1,380.0316,1326,CorVel,Worker's Compensation,1326,100,,percent of total billed charges,,
Chest Tube Insertion W/Sedation (Or),,25004649,LOCAL,Facility,Both,,,,1326,1127.1,380.0316,1326,First Health Group Corporation,First Health Network,1286.22,97,,percent of total billed charges,,
Chest Tube Insertion W/Sedation (Or),,25004649,LOCAL,Facility,Both,,,,1326,1127.1,380.0316,1326,"Health Partners, Inc.",Commercial,1254.396,94.6,,percent of total billed charges,,
Chest Tube Insertion W/Sedation (Or),,25004649,LOCAL,Facility,Outpatient,,,,1326,1127.1,380.0316,1326,"Health Partners, Inc.",Medicare Advantage,649.74,49,,percent of total billed charges,,
Chest Tube Insertion W/Sedation (Or),,25004649,LOCAL,Facility,Inpatient,,,,1326,1127.1,380.0316,1326,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Chest Tube Insertion W/Sedation (Or),,25004649,LOCAL,Facility,Both,,,,1326,1127.1,380.0316,1326,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),795.6,60,,percent of total billed charges,,
Chest Tube Insertion W/Sedation (Or),,25004649,LOCAL,Facility,Both,,,,1326,1127.1,380.0316,1326,"Health Partners, Inc.",State of Minnesota Advantage Program,1080.69,81.5,,percent of total billed charges,,
Chest Tube Insertion W/Sedation (Or),,25004649,LOCAL,Facility,Both,,,,1326,1127.1,380.0316,1326,"Health Partners, Inc.",State Public Programs,663,50,,percent of total billed charges,,
Chest Tube Insertion W/Sedation (Or),,25004649,LOCAL,Facility,Both,,,,1326,1127.1,380.0316,1326,Humana Insurance Company,Commercial PPO,1259.7,95,,percent of total billed charges,,
Chest Tube Insertion W/Sedation (Or),,25004649,LOCAL,Facility,Outpatient,,,,1326,1127.1,380.0316,1326,Humana Insurance Company,Medicare PPO,649.74,49,,percent of total billed charges,,
Chest Tube Insertion W/Sedation (Or),,25004649,LOCAL,Facility,Inpatient,,,,1326,1127.1,380.0316,1326,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Chest Tube Insertion W/Sedation (Or),,25004649,LOCAL,Facility,Both,,,,1326,1127.1,380.0316,1326,Medica,Individual & Family,1314.066,99.1,,percent of total billed charges,,
Chest Tube Insertion W/Sedation (Or),,25004649,LOCAL,Facility,Outpatient,,,,1326,1127.1,380.0316,1326,Medica,Medica Advantage Solution,660.348,49.8,,percent of total billed charges,,
Chest Tube Insertion W/Sedation (Or),,25004649,LOCAL,Facility,Inpatient,,,,1326,1127.1,380.0316,1326,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Chest Tube Insertion W/Sedation (Or),,25004649,LOCAL,Facility,Outpatient,,,,1326,1127.1,380.0316,1326,Medica,Medical Assistance,591.396,44.6,,percent of total billed charges,,
Chest Tube Insertion W/Sedation (Or),,25004649,LOCAL,Facility,Inpatient,,,,1326,1127.1,380.0316,1326,Medica,Medical Assistance,,,,,Included in per diem rate,
Chest Tube Insertion W/Sedation (Or),,25004649,LOCAL,Facility,Outpatient,,,,1326,1127.1,380.0316,1326,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,660.348,49.8,,percent of total billed charges,,
Chest Tube Insertion W/Sedation (Or),,25004649,LOCAL,Facility,Inpatient,,,,1326,1127.1,380.0316,1326,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Chest Tube Insertion W/Sedation (Or),,25004649,LOCAL,Facility,Both,,,,1326,1127.1,380.0316,1326,"Multiplan, Inc.","Multiplan, Inc.",1246.44,94,,percent of total billed charges,,
Chest Tube Insertion W/Sedation (Or),,25004649,LOCAL,Facility,Outpatient,,,,1326,1127.1,380.0316,1326,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1194.726,90.1,,percent of total billed charges,,
Chest Tube Insertion W/Sedation (Or),,25004649,LOCAL,Facility,Inpatient,,,,1326,1127.1,380.0316,1326,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Chest Tube Insertion W/Sedation (Or),,25004649,LOCAL,Facility,Both,,,,1326,1127.1,380.0316,1326,"Preferred One Administrative Services, INC.",PPO,1307.436,98.6,,percent of total billed charges,,
Chest Tube Insertion W/Sedation (Or),,25004649,LOCAL,Facility,Outpatient,,,,1326,1127.1,380.0316,1326,PrimeWest Health,Minnesota Senior Health Options (MSHO),682.227,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Chest Tube Insertion W/Sedation (Or),,25004649,LOCAL,Facility,Inpatient,,,,1326,1127.1,380.0316,1326,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Chest Tube Insertion W/Sedation (Or),,25004649,LOCAL,Facility,Outpatient,,,,1326,1127.1,380.0316,1326,PrimeWest Health,MinnesotaCare,681.0336,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Chest Tube Insertion W/Sedation (Or),,25004649,LOCAL,Facility,Inpatient,,,,1326,1127.1,380.0316,1326,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Chest Tube Insertion W/Sedation (Or),,25004649,LOCAL,Facility,Both,,,,1326,1127.1,380.0316,1326,Sanford Health Plan,Sanford Health Plan,1219.92,92,,percent of total billed charges,,
Chest Tube Insertion W/Sedation (Or),,25004649,LOCAL,Facility,Outpatient,,,,1326,1127.1,380.0316,1326,"UCare Health, Inc.",Individual & Family Plan,747.201,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Chest Tube Insertion W/Sedation (Or),,25004649,LOCAL,Facility,Inpatient,,,,1326,1127.1,380.0316,1326,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Chest Tube Insertion W/Sedation (Or),,25004649,LOCAL,Facility,Outpatient,,,,1326,1127.1,380.0316,1326,"UCare Health, Inc.",Medical Assistance,669.2322,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Chest Tube Insertion W/Sedation (Or),,25004649,LOCAL,Facility,Inpatient,,,,1326,1127.1,380.0316,1326,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Chest Tube Insertion W/Sedation (Or),,25004649,LOCAL,Facility,Outpatient,,,,1326,1127.1,380.0316,1326,"UCare Health, Inc.",Medicare Advantage,669.2322,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Chest Tube Insertion W/Sedation (Or),,25004649,LOCAL,Facility,Inpatient,,,,1326,1127.1,380.0316,1326,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Chest Tube Insertion W/Sedation (Or),,25004649,LOCAL,Facility,Outpatient,,,,1326,1127.1,380.0316,1326,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),669.2322,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Chest Tube Insertion W/Sedation (Or),,25004649,LOCAL,Facility,Inpatient,,,,1326,1127.1,380.0316,1326,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Chest Tube Insertion W/Sedation (Or),,25004649,LOCAL,Facility,Both,,,,1326,1127.1,380.0316,1326,UnitedHealthcare,Individual & Family,1246.44,94,,percent of total billed charges,,
Chest Tube Insertion W/Sedation (Or),,25004649,LOCAL,Facility,Outpatient,,,,1326,1127.1,380.0316,1326,UnitedHealthcare,Medicare Advantage,649.74,49,,percent of total billed charges,,
Chest Tube Insertion W/Sedation (Or),,25004649,LOCAL,Facility,Inpatient,,,,1326,1127.1,380.0316,1326,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Chest Tube Insertion W/Sedation (Or),,25004649,LOCAL,Facility,Outpatient,,,,1326,1127.1,380.0316,1326,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,636.48,48,,percent of total billed charges,,100% of DHS outpatient percentage
Chest Tube Insertion W/Sedation (Or),,25004649,LOCAL,Facility,Inpatient,,,,1326,1127.1,380.0316,1326,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Arthrodesis Of Foot,,25004795,LOCAL,Facility,Both,,,,2805,2384.25,803.913,2805,Aetna,Commercial,2580.6,92,,percent of total billed charges,,
Arthrodesis Of Foot,,25004795,LOCAL,Facility,Outpatient,,,,2805,2384.25,803.913,2805,Aetna,Medicare Advantage,1374.45,49,,percent of total billed charges,,
Arthrodesis Of Foot,,25004795,LOCAL,Facility,Inpatient,,,,2805,2384.25,803.913,2805,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Arthrodesis Of Foot,,25004795,LOCAL,Facility,Both,,,,2805,2384.25,803.913,2805,Aetna,PPO,2608.65,93,,percent of total billed charges,,
Arthrodesis Of Foot,,25004795,LOCAL,Facility,Both,,,,2805,2384.25,803.913,2805,America's PPO,America's PPO,2693.6415,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Arthrodesis Of Foot,,25004795,LOCAL,Facility,Both,,,,2805,2384.25,803.913,2805,BlueCross BlueShield Minnesota, Federal Employee Program,2760.12,98.4,,percent of total billed charges,,
Arthrodesis Of Foot,,25004795,LOCAL,Facility,Both,,,,2805,2384.25,803.913,2805,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,2805,100,,percent of total billed charges,,
Arthrodesis Of Foot,,25004795,LOCAL,Facility,Both,,,,2805,2384.25,803.913,2805,BlueCross BlueShield Minnesota,High Value Network Plan,2524.5,90,,percent of total billed charges,,
Arthrodesis Of Foot,,25004795,LOCAL,Facility,Outpatient,,,,2805,2384.25,803.913,2805,BlueCross BlueShield Minnesota,Medicare Advantage,1374.45,49,,percent of total billed charges,,
Arthrodesis Of Foot,,25004795,LOCAL,Facility,Inpatient,,,,2805,2384.25,803.913,2805,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Arthrodesis Of Foot,,25004795,LOCAL,Facility,Both,,,,2805,2384.25,803.913,2805,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,2484.3885,88.57,,percent of total billed charges,,
Arthrodesis Of Foot,,25004795,LOCAL,Facility,Both,,,,2805,2384.25,803.913,2805,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,803.913,28.66,,percent of total billed charges,,
Arthrodesis Of Foot,,25004795,LOCAL,Facility,Outpatient,,,,2805,2384.25,803.913,2805,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1374.45,49,,percent of total billed charges,,
Arthrodesis Of Foot,,25004795,LOCAL,Facility,Inpatient,,,,2805,2384.25,803.913,2805,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Arthrodesis Of Foot,,25004795,LOCAL,Facility,Both,,,,2805,2384.25,803.913,2805,CorVel,Worker's Compensation,2805,100,,percent of total billed charges,,
Arthrodesis Of Foot,,25004795,LOCAL,Facility,Both,,,,2805,2384.25,803.913,2805,First Health Group Corporation,First Health Network,2720.85,97,,percent of total billed charges,,
Arthrodesis Of Foot,,25004795,LOCAL,Facility,Both,,,,2805,2384.25,803.913,2805,"Health Partners, Inc.",Commercial,2653.53,94.6,,percent of total billed charges,,
Arthrodesis Of Foot,,25004795,LOCAL,Facility,Outpatient,,,,2805,2384.25,803.913,2805,"Health Partners, Inc.",Medicare Advantage,1374.45,49,,percent of total billed charges,,
Arthrodesis Of Foot,,25004795,LOCAL,Facility,Inpatient,,,,2805,2384.25,803.913,2805,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Arthrodesis Of Foot,,25004795,LOCAL,Facility,Both,,,,2805,2384.25,803.913,2805,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1683,60,,percent of total billed charges,,
Arthrodesis Of Foot,,25004795,LOCAL,Facility,Both,,,,2805,2384.25,803.913,2805,"Health Partners, Inc.",State of Minnesota Advantage Program,2286.075,81.5,,percent of total billed charges,,
Arthrodesis Of Foot,,25004795,LOCAL,Facility,Both,,,,2805,2384.25,803.913,2805,"Health Partners, Inc.",State Public Programs,1402.5,50,,percent of total billed charges,,
Arthrodesis Of Foot,,25004795,LOCAL,Facility,Both,,,,2805,2384.25,803.913,2805,Humana Insurance Company,Commercial PPO,2664.75,95,,percent of total billed charges,,
Arthrodesis Of Foot,,25004795,LOCAL,Facility,Outpatient,,,,2805,2384.25,803.913,2805,Humana Insurance Company,Medicare PPO,1374.45,49,,percent of total billed charges,,
Arthrodesis Of Foot,,25004795,LOCAL,Facility,Inpatient,,,,2805,2384.25,803.913,2805,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Arthrodesis Of Foot,,25004795,LOCAL,Facility,Both,,,,2805,2384.25,803.913,2805,Medica,Individual & Family,2779.755,99.1,,percent of total billed charges,,
Arthrodesis Of Foot,,25004795,LOCAL,Facility,Outpatient,,,,2805,2384.25,803.913,2805,Medica,Medica Advantage Solution,1396.89,49.8,,percent of total billed charges,,
Arthrodesis Of Foot,,25004795,LOCAL,Facility,Inpatient,,,,2805,2384.25,803.913,2805,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Arthrodesis Of Foot,,25004795,LOCAL,Facility,Outpatient,,,,2805,2384.25,803.913,2805,Medica,Medical Assistance,1251.03,44.6,,percent of total billed charges,,
Arthrodesis Of Foot,,25004795,LOCAL,Facility,Inpatient,,,,2805,2384.25,803.913,2805,Medica,Medical Assistance,,,,,Included in per diem rate,
Arthrodesis Of Foot,,25004795,LOCAL,Facility,Outpatient,,,,2805,2384.25,803.913,2805,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1396.89,49.8,,percent of total billed charges,,
Arthrodesis Of Foot,,25004795,LOCAL,Facility,Inpatient,,,,2805,2384.25,803.913,2805,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Arthrodesis Of Foot,,25004795,LOCAL,Facility,Both,,,,2805,2384.25,803.913,2805,"Multiplan, Inc.","Multiplan, Inc.",2636.7,94,,percent of total billed charges,,
Arthrodesis Of Foot,,25004795,LOCAL,Facility,Outpatient,,,,2805,2384.25,803.913,2805,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,2527.305,90.1,,percent of total billed charges,,
Arthrodesis Of Foot,,25004795,LOCAL,Facility,Inpatient,,,,2805,2384.25,803.913,2805,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Arthrodesis Of Foot,,25004795,LOCAL,Facility,Both,,,,2805,2384.25,803.913,2805,"Preferred One Administrative Services, INC.",PPO,2765.73,98.6,,percent of total billed charges,,
Arthrodesis Of Foot,,25004795,LOCAL,Facility,Outpatient,,,,2805,2384.25,803.913,2805,PrimeWest Health,Minnesota Senior Health Options (MSHO),1443.1725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Arthrodesis Of Foot,,25004795,LOCAL,Facility,Inpatient,,,,2805,2384.25,803.913,2805,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Arthrodesis Of Foot,,25004795,LOCAL,Facility,Outpatient,,,,2805,2384.25,803.913,2805,PrimeWest Health,MinnesotaCare,1440.648,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Arthrodesis Of Foot,,25004795,LOCAL,Facility,Inpatient,,,,2805,2384.25,803.913,2805,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Arthrodesis Of Foot,,25004795,LOCAL,Facility,Both,,,,2805,2384.25,803.913,2805,Sanford Health Plan,Sanford Health Plan,2580.6,92,,percent of total billed charges,,
Arthrodesis Of Foot,,25004795,LOCAL,Facility,Outpatient,,,,2805,2384.25,803.913,2805,"UCare Health, Inc.",Individual & Family Plan,1580.6175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Arthrodesis Of Foot,,25004795,LOCAL,Facility,Inpatient,,,,2805,2384.25,803.913,2805,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Arthrodesis Of Foot,,25004795,LOCAL,Facility,Outpatient,,,,2805,2384.25,803.913,2805,"UCare Health, Inc.",Medical Assistance,1415.6835,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Arthrodesis Of Foot,,25004795,LOCAL,Facility,Inpatient,,,,2805,2384.25,803.913,2805,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Arthrodesis Of Foot,,25004795,LOCAL,Facility,Outpatient,,,,2805,2384.25,803.913,2805,"UCare Health, Inc.",Medicare Advantage,1415.6835,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Arthrodesis Of Foot,,25004795,LOCAL,Facility,Inpatient,,,,2805,2384.25,803.913,2805,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Arthrodesis Of Foot,,25004795,LOCAL,Facility,Outpatient,,,,2805,2384.25,803.913,2805,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1415.6835,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Arthrodesis Of Foot,,25004795,LOCAL,Facility,Inpatient,,,,2805,2384.25,803.913,2805,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Arthrodesis Of Foot,,25004795,LOCAL,Facility,Both,,,,2805,2384.25,803.913,2805,UnitedHealthcare,Individual & Family,2636.7,94,,percent of total billed charges,,
Arthrodesis Of Foot,,25004795,LOCAL,Facility,Outpatient,,,,2805,2384.25,803.913,2805,UnitedHealthcare,Medicare Advantage,1374.45,49,,percent of total billed charges,,
Arthrodesis Of Foot,,25004795,LOCAL,Facility,Inpatient,,,,2805,2384.25,803.913,2805,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Arthrodesis Of Foot,,25004795,LOCAL,Facility,Outpatient,,,,2805,2384.25,803.913,2805,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1346.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
Arthrodesis Of Foot,,25004795,LOCAL,Facility,Inpatient,,,,2805,2384.25,803.913,2805,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Excision Cyst/Lipoma,,25005059,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,Aetna,Commercial,2064.48,92,,percent of total billed charges,,
Excision Cyst/Lipoma,,25005059,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,Aetna,Medicare Advantage,1099.56,49,,percent of total billed charges,,
Excision Cyst/Lipoma,,25005059,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Excision Cyst/Lipoma,,25005059,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,Aetna,PPO,2086.92,93,,percent of total billed charges,,
Excision Cyst/Lipoma,,25005059,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,America's PPO,America's PPO,2154.9132,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Excision Cyst/Lipoma,,25005059,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,BlueCross BlueShield Minnesota, Federal Employee Program,2208.096,98.4,,percent of total billed charges,,
Excision Cyst/Lipoma,,25005059,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,2244,100,,percent of total billed charges,,
Excision Cyst/Lipoma,,25005059,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,BlueCross BlueShield Minnesota,High Value Network Plan,2019.6,90,,percent of total billed charges,,
Excision Cyst/Lipoma,,25005059,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,BlueCross BlueShield Minnesota,Medicare Advantage,1099.56,49,,percent of total billed charges,,
Excision Cyst/Lipoma,,25005059,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Excision Cyst/Lipoma,,25005059,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1987.5108,88.57,,percent of total billed charges,,
Excision Cyst/Lipoma,,25005059,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,643.1304,28.66,,percent of total billed charges,,
Excision Cyst/Lipoma,,25005059,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1099.56,49,,percent of total billed charges,,
Excision Cyst/Lipoma,,25005059,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Excision Cyst/Lipoma,,25005059,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,CorVel,Worker's Compensation,2244,100,,percent of total billed charges,,
Excision Cyst/Lipoma,,25005059,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,First Health Group Corporation,First Health Network,2176.68,97,,percent of total billed charges,,
Excision Cyst/Lipoma,,25005059,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,"Health Partners, Inc.",Commercial,2122.824,94.6,,percent of total billed charges,,
Excision Cyst/Lipoma,,25005059,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,"Health Partners, Inc.",Medicare Advantage,1099.56,49,,percent of total billed charges,,
Excision Cyst/Lipoma,,25005059,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Excision Cyst/Lipoma,,25005059,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1346.4,60,,percent of total billed charges,,
Excision Cyst/Lipoma,,25005059,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,"Health Partners, Inc.",State of Minnesota Advantage Program,1828.86,81.5,,percent of total billed charges,,
Excision Cyst/Lipoma,,25005059,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,"Health Partners, Inc.",State Public Programs,1122,50,,percent of total billed charges,,
Excision Cyst/Lipoma,,25005059,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,Humana Insurance Company,Commercial PPO,2131.8,95,,percent of total billed charges,,
Excision Cyst/Lipoma,,25005059,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,Humana Insurance Company,Medicare PPO,1099.56,49,,percent of total billed charges,,
Excision Cyst/Lipoma,,25005059,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Excision Cyst/Lipoma,,25005059,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,Medica,Individual & Family,2223.804,99.1,,percent of total billed charges,,
Excision Cyst/Lipoma,,25005059,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,Medica,Medica Advantage Solution,1117.512,49.8,,percent of total billed charges,,
Excision Cyst/Lipoma,,25005059,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Excision Cyst/Lipoma,,25005059,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,Medica,Medical Assistance,1000.824,44.6,,percent of total billed charges,,
Excision Cyst/Lipoma,,25005059,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,Medica,Medical Assistance,,,,,Included in per diem rate,
Excision Cyst/Lipoma,,25005059,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1117.512,49.8,,percent of total billed charges,,
Excision Cyst/Lipoma,,25005059,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Excision Cyst/Lipoma,,25005059,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,"Multiplan, Inc.","Multiplan, Inc.",2109.36,94,,percent of total billed charges,,
Excision Cyst/Lipoma,,25005059,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,2021.844,90.1,,percent of total billed charges,,
Excision Cyst/Lipoma,,25005059,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Excision Cyst/Lipoma,,25005059,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,"Preferred One Administrative Services, INC.",PPO,2212.584,98.6,,percent of total billed charges,,
Excision Cyst/Lipoma,,25005059,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,PrimeWest Health,Minnesota Senior Health Options (MSHO),1154.538,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Excision Cyst/Lipoma,,25005059,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Excision Cyst/Lipoma,,25005059,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,PrimeWest Health,MinnesotaCare,1152.5184,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Excision Cyst/Lipoma,,25005059,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Excision Cyst/Lipoma,,25005059,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,Sanford Health Plan,Sanford Health Plan,2064.48,92,,percent of total billed charges,,
Excision Cyst/Lipoma,,25005059,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,"UCare Health, Inc.",Individual & Family Plan,1264.494,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Excision Cyst/Lipoma,,25005059,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Excision Cyst/Lipoma,,25005059,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,"UCare Health, Inc.",Medical Assistance,1132.5468,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Excision Cyst/Lipoma,,25005059,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Excision Cyst/Lipoma,,25005059,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,"UCare Health, Inc.",Medicare Advantage,1132.5468,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Excision Cyst/Lipoma,,25005059,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Excision Cyst/Lipoma,,25005059,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1132.5468,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Excision Cyst/Lipoma,,25005059,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Excision Cyst/Lipoma,,25005059,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,UnitedHealthcare,Individual & Family,2109.36,94,,percent of total billed charges,,
Excision Cyst/Lipoma,,25005059,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,UnitedHealthcare,Medicare Advantage,1099.56,49,,percent of total billed charges,,
Excision Cyst/Lipoma,,25005059,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Excision Cyst/Lipoma,,25005059,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1077.12,48,,percent of total billed charges,,100% of DHS outpatient percentage
Excision Cyst/Lipoma,,25005059,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Excision Nail Matrix Finger/Toe,,25005131,LOCAL,Facility,Both,,,,1275,1083.75,365.415,1275,Aetna,Commercial,1173,92,,percent of total billed charges,,
Excision Nail Matrix Finger/Toe,,25005131,LOCAL,Facility,Outpatient,,,,1275,1083.75,365.415,1275,Aetna,Medicare Advantage,624.75,49,,percent of total billed charges,,
Excision Nail Matrix Finger/Toe,,25005131,LOCAL,Facility,Inpatient,,,,1275,1083.75,365.415,1275,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Excision Nail Matrix Finger/Toe,,25005131,LOCAL,Facility,Both,,,,1275,1083.75,365.415,1275,Aetna,PPO,1185.75,93,,percent of total billed charges,,
Excision Nail Matrix Finger/Toe,,25005131,LOCAL,Facility,Both,,,,1275,1083.75,365.415,1275,America's PPO,America's PPO,1224.3825,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Excision Nail Matrix Finger/Toe,,25005131,LOCAL,Facility,Both,,,,1275,1083.75,365.415,1275,BlueCross BlueShield Minnesota, Federal Employee Program,1254.6,98.4,,percent of total billed charges,,
Excision Nail Matrix Finger/Toe,,25005131,LOCAL,Facility,Both,,,,1275,1083.75,365.415,1275,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1275,100,,percent of total billed charges,,
Excision Nail Matrix Finger/Toe,,25005131,LOCAL,Facility,Both,,,,1275,1083.75,365.415,1275,BlueCross BlueShield Minnesota,High Value Network Plan,1147.5,90,,percent of total billed charges,,
Excision Nail Matrix Finger/Toe,,25005131,LOCAL,Facility,Outpatient,,,,1275,1083.75,365.415,1275,BlueCross BlueShield Minnesota,Medicare Advantage,624.75,49,,percent of total billed charges,,
Excision Nail Matrix Finger/Toe,,25005131,LOCAL,Facility,Inpatient,,,,1275,1083.75,365.415,1275,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Excision Nail Matrix Finger/Toe,,25005131,LOCAL,Facility,Both,,,,1275,1083.75,365.415,1275,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1129.2675,88.57,,percent of total billed charges,,
Excision Nail Matrix Finger/Toe,,25005131,LOCAL,Facility,Both,,,,1275,1083.75,365.415,1275,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,365.415,28.66,,percent of total billed charges,,
Excision Nail Matrix Finger/Toe,,25005131,LOCAL,Facility,Outpatient,,,,1275,1083.75,365.415,1275,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),624.75,49,,percent of total billed charges,,
Excision Nail Matrix Finger/Toe,,25005131,LOCAL,Facility,Inpatient,,,,1275,1083.75,365.415,1275,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Excision Nail Matrix Finger/Toe,,25005131,LOCAL,Facility,Both,,,,1275,1083.75,365.415,1275,CorVel,Worker's Compensation,1275,100,,percent of total billed charges,,
Excision Nail Matrix Finger/Toe,,25005131,LOCAL,Facility,Both,,,,1275,1083.75,365.415,1275,First Health Group Corporation,First Health Network,1236.75,97,,percent of total billed charges,,
Excision Nail Matrix Finger/Toe,,25005131,LOCAL,Facility,Both,,,,1275,1083.75,365.415,1275,"Health Partners, Inc.",Commercial,1206.15,94.6,,percent of total billed charges,,
Excision Nail Matrix Finger/Toe,,25005131,LOCAL,Facility,Outpatient,,,,1275,1083.75,365.415,1275,"Health Partners, Inc.",Medicare Advantage,624.75,49,,percent of total billed charges,,
Excision Nail Matrix Finger/Toe,,25005131,LOCAL,Facility,Inpatient,,,,1275,1083.75,365.415,1275,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Excision Nail Matrix Finger/Toe,,25005131,LOCAL,Facility,Both,,,,1275,1083.75,365.415,1275,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),765,60,,percent of total billed charges,,
Excision Nail Matrix Finger/Toe,,25005131,LOCAL,Facility,Both,,,,1275,1083.75,365.415,1275,"Health Partners, Inc.",State of Minnesota Advantage Program,1039.125,81.5,,percent of total billed charges,,
Excision Nail Matrix Finger/Toe,,25005131,LOCAL,Facility,Both,,,,1275,1083.75,365.415,1275,"Health Partners, Inc.",State Public Programs,637.5,50,,percent of total billed charges,,
Excision Nail Matrix Finger/Toe,,25005131,LOCAL,Facility,Both,,,,1275,1083.75,365.415,1275,Humana Insurance Company,Commercial PPO,1211.25,95,,percent of total billed charges,,
Excision Nail Matrix Finger/Toe,,25005131,LOCAL,Facility,Outpatient,,,,1275,1083.75,365.415,1275,Humana Insurance Company,Medicare PPO,624.75,49,,percent of total billed charges,,
Excision Nail Matrix Finger/Toe,,25005131,LOCAL,Facility,Inpatient,,,,1275,1083.75,365.415,1275,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Excision Nail Matrix Finger/Toe,,25005131,LOCAL,Facility,Both,,,,1275,1083.75,365.415,1275,Medica,Individual & Family,1263.525,99.1,,percent of total billed charges,,
Excision Nail Matrix Finger/Toe,,25005131,LOCAL,Facility,Outpatient,,,,1275,1083.75,365.415,1275,Medica,Medica Advantage Solution,634.95,49.8,,percent of total billed charges,,
Excision Nail Matrix Finger/Toe,,25005131,LOCAL,Facility,Inpatient,,,,1275,1083.75,365.415,1275,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Excision Nail Matrix Finger/Toe,,25005131,LOCAL,Facility,Outpatient,,,,1275,1083.75,365.415,1275,Medica,Medical Assistance,568.65,44.6,,percent of total billed charges,,
Excision Nail Matrix Finger/Toe,,25005131,LOCAL,Facility,Inpatient,,,,1275,1083.75,365.415,1275,Medica,Medical Assistance,,,,,Included in per diem rate,
Excision Nail Matrix Finger/Toe,,25005131,LOCAL,Facility,Outpatient,,,,1275,1083.75,365.415,1275,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,634.95,49.8,,percent of total billed charges,,
Excision Nail Matrix Finger/Toe,,25005131,LOCAL,Facility,Inpatient,,,,1275,1083.75,365.415,1275,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Excision Nail Matrix Finger/Toe,,25005131,LOCAL,Facility,Both,,,,1275,1083.75,365.415,1275,"Multiplan, Inc.","Multiplan, Inc.",1198.5,94,,percent of total billed charges,,
Excision Nail Matrix Finger/Toe,,25005131,LOCAL,Facility,Outpatient,,,,1275,1083.75,365.415,1275,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1148.775,90.1,,percent of total billed charges,,
Excision Nail Matrix Finger/Toe,,25005131,LOCAL,Facility,Inpatient,,,,1275,1083.75,365.415,1275,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Excision Nail Matrix Finger/Toe,,25005131,LOCAL,Facility,Both,,,,1275,1083.75,365.415,1275,"Preferred One Administrative Services, INC.",PPO,1257.15,98.6,,percent of total billed charges,,
Excision Nail Matrix Finger/Toe,,25005131,LOCAL,Facility,Outpatient,,,,1275,1083.75,365.415,1275,PrimeWest Health,Minnesota Senior Health Options (MSHO),655.9875,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Excision Nail Matrix Finger/Toe,,25005131,LOCAL,Facility,Inpatient,,,,1275,1083.75,365.415,1275,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Excision Nail Matrix Finger/Toe,,25005131,LOCAL,Facility,Outpatient,,,,1275,1083.75,365.415,1275,PrimeWest Health,MinnesotaCare,654.84,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Excision Nail Matrix Finger/Toe,,25005131,LOCAL,Facility,Inpatient,,,,1275,1083.75,365.415,1275,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Excision Nail Matrix Finger/Toe,,25005131,LOCAL,Facility,Both,,,,1275,1083.75,365.415,1275,Sanford Health Plan,Sanford Health Plan,1173,92,,percent of total billed charges,,
Excision Nail Matrix Finger/Toe,,25005131,LOCAL,Facility,Outpatient,,,,1275,1083.75,365.415,1275,"UCare Health, Inc.",Individual & Family Plan,718.4625,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Excision Nail Matrix Finger/Toe,,25005131,LOCAL,Facility,Inpatient,,,,1275,1083.75,365.415,1275,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Excision Nail Matrix Finger/Toe,,25005131,LOCAL,Facility,Outpatient,,,,1275,1083.75,365.415,1275,"UCare Health, Inc.",Medical Assistance,643.4925,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Excision Nail Matrix Finger/Toe,,25005131,LOCAL,Facility,Inpatient,,,,1275,1083.75,365.415,1275,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Excision Nail Matrix Finger/Toe,,25005131,LOCAL,Facility,Outpatient,,,,1275,1083.75,365.415,1275,"UCare Health, Inc.",Medicare Advantage,643.4925,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Excision Nail Matrix Finger/Toe,,25005131,LOCAL,Facility,Inpatient,,,,1275,1083.75,365.415,1275,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Excision Nail Matrix Finger/Toe,,25005131,LOCAL,Facility,Outpatient,,,,1275,1083.75,365.415,1275,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),643.4925,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Excision Nail Matrix Finger/Toe,,25005131,LOCAL,Facility,Inpatient,,,,1275,1083.75,365.415,1275,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Excision Nail Matrix Finger/Toe,,25005131,LOCAL,Facility,Both,,,,1275,1083.75,365.415,1275,UnitedHealthcare,Individual & Family,1198.5,94,,percent of total billed charges,,
Excision Nail Matrix Finger/Toe,,25005131,LOCAL,Facility,Outpatient,,,,1275,1083.75,365.415,1275,UnitedHealthcare,Medicare Advantage,624.75,49,,percent of total billed charges,,
Excision Nail Matrix Finger/Toe,,25005131,LOCAL,Facility,Inpatient,,,,1275,1083.75,365.415,1275,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Excision Nail Matrix Finger/Toe,,25005131,LOCAL,Facility,Outpatient,,,,1275,1083.75,365.415,1275,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,612,48,,percent of total billed charges,,100% of DHS outpatient percentage
Excision Nail Matrix Finger/Toe,,25005131,LOCAL,Facility,Inpatient,,,,1275,1083.75,365.415,1275,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Excision Of Tonsil Tag,,25005160,LOCAL,Facility,Both,,,,3366,2861.1,964.6956,3366,Aetna,Commercial,3096.72,92,,percent of total billed charges,,
Excision Of Tonsil Tag,,25005160,LOCAL,Facility,Outpatient,,,,3366,2861.1,964.6956,3366,Aetna,Medicare Advantage,1649.34,49,,percent of total billed charges,,
Excision Of Tonsil Tag,,25005160,LOCAL,Facility,Inpatient,,,,3366,2861.1,964.6956,3366,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Excision Of Tonsil Tag,,25005160,LOCAL,Facility,Both,,,,3366,2861.1,964.6956,3366,Aetna,PPO,3130.38,93,,percent of total billed charges,,
Excision Of Tonsil Tag,,25005160,LOCAL,Facility,Both,,,,3366,2861.1,964.6956,3366,America's PPO,America's PPO,3232.3698,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Excision Of Tonsil Tag,,25005160,LOCAL,Facility,Both,,,,3366,2861.1,964.6956,3366,BlueCross BlueShield Minnesota, Federal Employee Program,3312.144,98.4,,percent of total billed charges,,
Excision Of Tonsil Tag,,25005160,LOCAL,Facility,Both,,,,3366,2861.1,964.6956,3366,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,3366,100,,percent of total billed charges,,
Excision Of Tonsil Tag,,25005160,LOCAL,Facility,Both,,,,3366,2861.1,964.6956,3366,BlueCross BlueShield Minnesota,High Value Network Plan,3029.4,90,,percent of total billed charges,,
Excision Of Tonsil Tag,,25005160,LOCAL,Facility,Outpatient,,,,3366,2861.1,964.6956,3366,BlueCross BlueShield Minnesota,Medicare Advantage,1649.34,49,,percent of total billed charges,,
Excision Of Tonsil Tag,,25005160,LOCAL,Facility,Inpatient,,,,3366,2861.1,964.6956,3366,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Excision Of Tonsil Tag,,25005160,LOCAL,Facility,Both,,,,3366,2861.1,964.6956,3366,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,2981.2662,88.57,,percent of total billed charges,,
Excision Of Tonsil Tag,,25005160,LOCAL,Facility,Both,,,,3366,2861.1,964.6956,3366,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,964.6956,28.66,,percent of total billed charges,,
Excision Of Tonsil Tag,,25005160,LOCAL,Facility,Outpatient,,,,3366,2861.1,964.6956,3366,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1649.34,49,,percent of total billed charges,,
Excision Of Tonsil Tag,,25005160,LOCAL,Facility,Inpatient,,,,3366,2861.1,964.6956,3366,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Excision Of Tonsil Tag,,25005160,LOCAL,Facility,Both,,,,3366,2861.1,964.6956,3366,CorVel,Worker's Compensation,3366,100,,percent of total billed charges,,
Excision Of Tonsil Tag,,25005160,LOCAL,Facility,Both,,,,3366,2861.1,964.6956,3366,First Health Group Corporation,First Health Network,3265.02,97,,percent of total billed charges,,
Excision Of Tonsil Tag,,25005160,LOCAL,Facility,Both,,,,3366,2861.1,964.6956,3366,"Health Partners, Inc.",Commercial,3184.236,94.6,,percent of total billed charges,,
Excision Of Tonsil Tag,,25005160,LOCAL,Facility,Outpatient,,,,3366,2861.1,964.6956,3366,"Health Partners, Inc.",Medicare Advantage,1649.34,49,,percent of total billed charges,,
Excision Of Tonsil Tag,,25005160,LOCAL,Facility,Inpatient,,,,3366,2861.1,964.6956,3366,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Excision Of Tonsil Tag,,25005160,LOCAL,Facility,Both,,,,3366,2861.1,964.6956,3366,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),2019.6,60,,percent of total billed charges,,
Excision Of Tonsil Tag,,25005160,LOCAL,Facility,Both,,,,3366,2861.1,964.6956,3366,"Health Partners, Inc.",State of Minnesota Advantage Program,2743.29,81.5,,percent of total billed charges,,
Excision Of Tonsil Tag,,25005160,LOCAL,Facility,Both,,,,3366,2861.1,964.6956,3366,"Health Partners, Inc.",State Public Programs,1683,50,,percent of total billed charges,,
Excision Of Tonsil Tag,,25005160,LOCAL,Facility,Both,,,,3366,2861.1,964.6956,3366,Humana Insurance Company,Commercial PPO,3197.7,95,,percent of total billed charges,,
Excision Of Tonsil Tag,,25005160,LOCAL,Facility,Outpatient,,,,3366,2861.1,964.6956,3366,Humana Insurance Company,Medicare PPO,1649.34,49,,percent of total billed charges,,
Excision Of Tonsil Tag,,25005160,LOCAL,Facility,Inpatient,,,,3366,2861.1,964.6956,3366,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Excision Of Tonsil Tag,,25005160,LOCAL,Facility,Both,,,,3366,2861.1,964.6956,3366,Medica,Individual & Family,3335.706,99.1,,percent of total billed charges,,
Excision Of Tonsil Tag,,25005160,LOCAL,Facility,Outpatient,,,,3366,2861.1,964.6956,3366,Medica,Medica Advantage Solution,1676.268,49.8,,percent of total billed charges,,
Excision Of Tonsil Tag,,25005160,LOCAL,Facility,Inpatient,,,,3366,2861.1,964.6956,3366,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Excision Of Tonsil Tag,,25005160,LOCAL,Facility,Outpatient,,,,3366,2861.1,964.6956,3366,Medica,Medical Assistance,1501.236,44.6,,percent of total billed charges,,
Excision Of Tonsil Tag,,25005160,LOCAL,Facility,Inpatient,,,,3366,2861.1,964.6956,3366,Medica,Medical Assistance,,,,,Included in per diem rate,
Excision Of Tonsil Tag,,25005160,LOCAL,Facility,Outpatient,,,,3366,2861.1,964.6956,3366,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1676.268,49.8,,percent of total billed charges,,
Excision Of Tonsil Tag,,25005160,LOCAL,Facility,Inpatient,,,,3366,2861.1,964.6956,3366,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Excision Of Tonsil Tag,,25005160,LOCAL,Facility,Both,,,,3366,2861.1,964.6956,3366,"Multiplan, Inc.","Multiplan, Inc.",3164.04,94,,percent of total billed charges,,
Excision Of Tonsil Tag,,25005160,LOCAL,Facility,Outpatient,,,,3366,2861.1,964.6956,3366,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,3032.766,90.1,,percent of total billed charges,,
Excision Of Tonsil Tag,,25005160,LOCAL,Facility,Inpatient,,,,3366,2861.1,964.6956,3366,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Excision Of Tonsil Tag,,25005160,LOCAL,Facility,Both,,,,3366,2861.1,964.6956,3366,"Preferred One Administrative Services, INC.",PPO,3318.876,98.6,,percent of total billed charges,,
Excision Of Tonsil Tag,,25005160,LOCAL,Facility,Outpatient,,,,3366,2861.1,964.6956,3366,PrimeWest Health,Minnesota Senior Health Options (MSHO),1731.807,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Excision Of Tonsil Tag,,25005160,LOCAL,Facility,Inpatient,,,,3366,2861.1,964.6956,3366,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Excision Of Tonsil Tag,,25005160,LOCAL,Facility,Outpatient,,,,3366,2861.1,964.6956,3366,PrimeWest Health,MinnesotaCare,1728.7776,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Excision Of Tonsil Tag,,25005160,LOCAL,Facility,Inpatient,,,,3366,2861.1,964.6956,3366,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Excision Of Tonsil Tag,,25005160,LOCAL,Facility,Both,,,,3366,2861.1,964.6956,3366,Sanford Health Plan,Sanford Health Plan,3096.72,92,,percent of total billed charges,,
Excision Of Tonsil Tag,,25005160,LOCAL,Facility,Outpatient,,,,3366,2861.1,964.6956,3366,"UCare Health, Inc.",Individual & Family Plan,1896.741,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Excision Of Tonsil Tag,,25005160,LOCAL,Facility,Inpatient,,,,3366,2861.1,964.6956,3366,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Excision Of Tonsil Tag,,25005160,LOCAL,Facility,Outpatient,,,,3366,2861.1,964.6956,3366,"UCare Health, Inc.",Medical Assistance,1698.8202,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Excision Of Tonsil Tag,,25005160,LOCAL,Facility,Inpatient,,,,3366,2861.1,964.6956,3366,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Excision Of Tonsil Tag,,25005160,LOCAL,Facility,Outpatient,,,,3366,2861.1,964.6956,3366,"UCare Health, Inc.",Medicare Advantage,1698.8202,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Excision Of Tonsil Tag,,25005160,LOCAL,Facility,Inpatient,,,,3366,2861.1,964.6956,3366,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Excision Of Tonsil Tag,,25005160,LOCAL,Facility,Outpatient,,,,3366,2861.1,964.6956,3366,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1698.8202,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Excision Of Tonsil Tag,,25005160,LOCAL,Facility,Inpatient,,,,3366,2861.1,964.6956,3366,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Excision Of Tonsil Tag,,25005160,LOCAL,Facility,Both,,,,3366,2861.1,964.6956,3366,UnitedHealthcare,Individual & Family,3164.04,94,,percent of total billed charges,,
Excision Of Tonsil Tag,,25005160,LOCAL,Facility,Outpatient,,,,3366,2861.1,964.6956,3366,UnitedHealthcare,Medicare Advantage,1649.34,49,,percent of total billed charges,,
Excision Of Tonsil Tag,,25005160,LOCAL,Facility,Inpatient,,,,3366,2861.1,964.6956,3366,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Excision Of Tonsil Tag,,25005160,LOCAL,Facility,Outpatient,,,,3366,2861.1,964.6956,3366,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1615.68,48,,percent of total billed charges,,100% of DHS outpatient percentage
Excision Of Tonsil Tag,,25005160,LOCAL,Facility,Inpatient,,,,3366,2861.1,964.6956,3366,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Oopherectomy,,25005392,LOCAL,Facility,Both,,,,3672,3121.2,1052.3952,3672,Aetna,Commercial,3378.24,92,,percent of total billed charges,,
Oopherectomy,,25005392,LOCAL,Facility,Outpatient,,,,3672,3121.2,1052.3952,3672,Aetna,Medicare Advantage,1799.28,49,,percent of total billed charges,,
Oopherectomy,,25005392,LOCAL,Facility,Inpatient,,,,3672,3121.2,1052.3952,3672,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Oopherectomy,,25005392,LOCAL,Facility,Both,,,,3672,3121.2,1052.3952,3672,Aetna,PPO,3414.96,93,,percent of total billed charges,,
Oopherectomy,,25005392,LOCAL,Facility,Both,,,,3672,3121.2,1052.3952,3672,America's PPO,America's PPO,3526.2216,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Oopherectomy,,25005392,LOCAL,Facility,Both,,,,3672,3121.2,1052.3952,3672,BlueCross BlueShield Minnesota, Federal Employee Program,3613.248,98.4,,percent of total billed charges,,
Oopherectomy,,25005392,LOCAL,Facility,Both,,,,3672,3121.2,1052.3952,3672,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,3672,100,,percent of total billed charges,,
Oopherectomy,,25005392,LOCAL,Facility,Both,,,,3672,3121.2,1052.3952,3672,BlueCross BlueShield Minnesota,High Value Network Plan,3304.8,90,,percent of total billed charges,,
Oopherectomy,,25005392,LOCAL,Facility,Outpatient,,,,3672,3121.2,1052.3952,3672,BlueCross BlueShield Minnesota,Medicare Advantage,1799.28,49,,percent of total billed charges,,
Oopherectomy,,25005392,LOCAL,Facility,Inpatient,,,,3672,3121.2,1052.3952,3672,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Oopherectomy,,25005392,LOCAL,Facility,Both,,,,3672,3121.2,1052.3952,3672,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,3252.2904,88.57,,percent of total billed charges,,
Oopherectomy,,25005392,LOCAL,Facility,Both,,,,3672,3121.2,1052.3952,3672,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1052.3952,28.66,,percent of total billed charges,,
Oopherectomy,,25005392,LOCAL,Facility,Outpatient,,,,3672,3121.2,1052.3952,3672,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1799.28,49,,percent of total billed charges,,
Oopherectomy,,25005392,LOCAL,Facility,Inpatient,,,,3672,3121.2,1052.3952,3672,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Oopherectomy,,25005392,LOCAL,Facility,Both,,,,3672,3121.2,1052.3952,3672,CorVel,Worker's Compensation,3672,100,,percent of total billed charges,,
Oopherectomy,,25005392,LOCAL,Facility,Both,,,,3672,3121.2,1052.3952,3672,First Health Group Corporation,First Health Network,3561.84,97,,percent of total billed charges,,
Oopherectomy,,25005392,LOCAL,Facility,Both,,,,3672,3121.2,1052.3952,3672,"Health Partners, Inc.",Commercial,3473.712,94.6,,percent of total billed charges,,
Oopherectomy,,25005392,LOCAL,Facility,Outpatient,,,,3672,3121.2,1052.3952,3672,"Health Partners, Inc.",Medicare Advantage,1799.28,49,,percent of total billed charges,,
Oopherectomy,,25005392,LOCAL,Facility,Inpatient,,,,3672,3121.2,1052.3952,3672,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Oopherectomy,,25005392,LOCAL,Facility,Both,,,,3672,3121.2,1052.3952,3672,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),2203.2,60,,percent of total billed charges,,
Oopherectomy,,25005392,LOCAL,Facility,Both,,,,3672,3121.2,1052.3952,3672,"Health Partners, Inc.",State of Minnesota Advantage Program,2992.68,81.5,,percent of total billed charges,,
Oopherectomy,,25005392,LOCAL,Facility,Both,,,,3672,3121.2,1052.3952,3672,"Health Partners, Inc.",State Public Programs,1836,50,,percent of total billed charges,,
Oopherectomy,,25005392,LOCAL,Facility,Both,,,,3672,3121.2,1052.3952,3672,Humana Insurance Company,Commercial PPO,3488.4,95,,percent of total billed charges,,
Oopherectomy,,25005392,LOCAL,Facility,Outpatient,,,,3672,3121.2,1052.3952,3672,Humana Insurance Company,Medicare PPO,1799.28,49,,percent of total billed charges,,
Oopherectomy,,25005392,LOCAL,Facility,Inpatient,,,,3672,3121.2,1052.3952,3672,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Oopherectomy,,25005392,LOCAL,Facility,Both,,,,3672,3121.2,1052.3952,3672,Medica,Individual & Family,3638.952,99.1,,percent of total billed charges,,
Oopherectomy,,25005392,LOCAL,Facility,Outpatient,,,,3672,3121.2,1052.3952,3672,Medica,Medica Advantage Solution,1828.656,49.8,,percent of total billed charges,,
Oopherectomy,,25005392,LOCAL,Facility,Inpatient,,,,3672,3121.2,1052.3952,3672,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Oopherectomy,,25005392,LOCAL,Facility,Outpatient,,,,3672,3121.2,1052.3952,3672,Medica,Medical Assistance,1637.712,44.6,,percent of total billed charges,,
Oopherectomy,,25005392,LOCAL,Facility,Inpatient,,,,3672,3121.2,1052.3952,3672,Medica,Medical Assistance,,,,,Included in per diem rate,
Oopherectomy,,25005392,LOCAL,Facility,Outpatient,,,,3672,3121.2,1052.3952,3672,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1828.656,49.8,,percent of total billed charges,,
Oopherectomy,,25005392,LOCAL,Facility,Inpatient,,,,3672,3121.2,1052.3952,3672,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Oopherectomy,,25005392,LOCAL,Facility,Both,,,,3672,3121.2,1052.3952,3672,"Multiplan, Inc.","Multiplan, Inc.",3451.68,94,,percent of total billed charges,,
Oopherectomy,,25005392,LOCAL,Facility,Outpatient,,,,3672,3121.2,1052.3952,3672,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,3308.472,90.1,,percent of total billed charges,,
Oopherectomy,,25005392,LOCAL,Facility,Inpatient,,,,3672,3121.2,1052.3952,3672,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Oopherectomy,,25005392,LOCAL,Facility,Both,,,,3672,3121.2,1052.3952,3672,"Preferred One Administrative Services, INC.",PPO,3620.592,98.6,,percent of total billed charges,,
Oopherectomy,,25005392,LOCAL,Facility,Outpatient,,,,3672,3121.2,1052.3952,3672,PrimeWest Health,Minnesota Senior Health Options (MSHO),1889.244,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Oopherectomy,,25005392,LOCAL,Facility,Inpatient,,,,3672,3121.2,1052.3952,3672,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Oopherectomy,,25005392,LOCAL,Facility,Outpatient,,,,3672,3121.2,1052.3952,3672,PrimeWest Health,MinnesotaCare,1885.9392,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Oopherectomy,,25005392,LOCAL,Facility,Inpatient,,,,3672,3121.2,1052.3952,3672,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Oopherectomy,,25005392,LOCAL,Facility,Both,,,,3672,3121.2,1052.3952,3672,Sanford Health Plan,Sanford Health Plan,3378.24,92,,percent of total billed charges,,
Oopherectomy,,25005392,LOCAL,Facility,Outpatient,,,,3672,3121.2,1052.3952,3672,"UCare Health, Inc.",Individual & Family Plan,2069.172,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Oopherectomy,,25005392,LOCAL,Facility,Inpatient,,,,3672,3121.2,1052.3952,3672,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Oopherectomy,,25005392,LOCAL,Facility,Outpatient,,,,3672,3121.2,1052.3952,3672,"UCare Health, Inc.",Medical Assistance,1853.2584,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Oopherectomy,,25005392,LOCAL,Facility,Inpatient,,,,3672,3121.2,1052.3952,3672,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Oopherectomy,,25005392,LOCAL,Facility,Outpatient,,,,3672,3121.2,1052.3952,3672,"UCare Health, Inc.",Medicare Advantage,1853.2584,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Oopherectomy,,25005392,LOCAL,Facility,Inpatient,,,,3672,3121.2,1052.3952,3672,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Oopherectomy,,25005392,LOCAL,Facility,Outpatient,,,,3672,3121.2,1052.3952,3672,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1853.2584,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Oopherectomy,,25005392,LOCAL,Facility,Inpatient,,,,3672,3121.2,1052.3952,3672,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Oopherectomy,,25005392,LOCAL,Facility,Both,,,,3672,3121.2,1052.3952,3672,UnitedHealthcare,Individual & Family,3451.68,94,,percent of total billed charges,,
Oopherectomy,,25005392,LOCAL,Facility,Outpatient,,,,3672,3121.2,1052.3952,3672,UnitedHealthcare,Medicare Advantage,1799.28,49,,percent of total billed charges,,
Oopherectomy,,25005392,LOCAL,Facility,Inpatient,,,,3672,3121.2,1052.3952,3672,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Oopherectomy,,25005392,LOCAL,Facility,Outpatient,,,,3672,3121.2,1052.3952,3672,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1762.56,48,,percent of total billed charges,,100% of DHS outpatient percentage
Oopherectomy,,25005392,LOCAL,Facility,Inpatient,,,,3672,3121.2,1052.3952,3672,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Removal Of Ear Tube(S),,25005552,LOCAL,Facility,Both,,,,1964,1669.4,562.8824,1964,Aetna,Commercial,1806.88,92,,percent of total billed charges,,
Removal Of Ear Tube(S),,25005552,LOCAL,Facility,Outpatient,,,,1964,1669.4,562.8824,1964,Aetna,Medicare Advantage,962.36,49,,percent of total billed charges,,
Removal Of Ear Tube(S),,25005552,LOCAL,Facility,Inpatient,,,,1964,1669.4,562.8824,1964,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Removal Of Ear Tube(S),,25005552,LOCAL,Facility,Both,,,,1964,1669.4,562.8824,1964,Aetna,PPO,1826.52,93,,percent of total billed charges,,
Removal Of Ear Tube(S),,25005552,LOCAL,Facility,Both,,,,1964,1669.4,562.8824,1964,America's PPO,America's PPO,1886.0292,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Removal Of Ear Tube(S),,25005552,LOCAL,Facility,Both,,,,1964,1669.4,562.8824,1964,BlueCross BlueShield Minnesota, Federal Employee Program,1932.576,98.4,,percent of total billed charges,,
Removal Of Ear Tube(S),,25005552,LOCAL,Facility,Both,,,,1964,1669.4,562.8824,1964,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1964,100,,percent of total billed charges,,
Removal Of Ear Tube(S),,25005552,LOCAL,Facility,Both,,,,1964,1669.4,562.8824,1964,BlueCross BlueShield Minnesota,High Value Network Plan,1767.6,90,,percent of total billed charges,,
Removal Of Ear Tube(S),,25005552,LOCAL,Facility,Outpatient,,,,1964,1669.4,562.8824,1964,BlueCross BlueShield Minnesota,Medicare Advantage,962.36,49,,percent of total billed charges,,
Removal Of Ear Tube(S),,25005552,LOCAL,Facility,Inpatient,,,,1964,1669.4,562.8824,1964,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Removal Of Ear Tube(S),,25005552,LOCAL,Facility,Both,,,,1964,1669.4,562.8824,1964,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1739.5148,88.57,,percent of total billed charges,,
Removal Of Ear Tube(S),,25005552,LOCAL,Facility,Both,,,,1964,1669.4,562.8824,1964,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,562.8824,28.66,,percent of total billed charges,,
Removal Of Ear Tube(S),,25005552,LOCAL,Facility,Outpatient,,,,1964,1669.4,562.8824,1964,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),962.36,49,,percent of total billed charges,,
Removal Of Ear Tube(S),,25005552,LOCAL,Facility,Inpatient,,,,1964,1669.4,562.8824,1964,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Removal Of Ear Tube(S),,25005552,LOCAL,Facility,Both,,,,1964,1669.4,562.8824,1964,CorVel,Worker's Compensation,1964,100,,percent of total billed charges,,
Removal Of Ear Tube(S),,25005552,LOCAL,Facility,Both,,,,1964,1669.4,562.8824,1964,First Health Group Corporation,First Health Network,1905.08,97,,percent of total billed charges,,
Removal Of Ear Tube(S),,25005552,LOCAL,Facility,Both,,,,1964,1669.4,562.8824,1964,"Health Partners, Inc.",Commercial,1857.944,94.6,,percent of total billed charges,,
Removal Of Ear Tube(S),,25005552,LOCAL,Facility,Outpatient,,,,1964,1669.4,562.8824,1964,"Health Partners, Inc.",Medicare Advantage,962.36,49,,percent of total billed charges,,
Removal Of Ear Tube(S),,25005552,LOCAL,Facility,Inpatient,,,,1964,1669.4,562.8824,1964,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Removal Of Ear Tube(S),,25005552,LOCAL,Facility,Both,,,,1964,1669.4,562.8824,1964,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1178.4,60,,percent of total billed charges,,
Removal Of Ear Tube(S),,25005552,LOCAL,Facility,Both,,,,1964,1669.4,562.8824,1964,"Health Partners, Inc.",State of Minnesota Advantage Program,1600.66,81.5,,percent of total billed charges,,
Removal Of Ear Tube(S),,25005552,LOCAL,Facility,Both,,,,1964,1669.4,562.8824,1964,"Health Partners, Inc.",State Public Programs,982,50,,percent of total billed charges,,
Removal Of Ear Tube(S),,25005552,LOCAL,Facility,Both,,,,1964,1669.4,562.8824,1964,Humana Insurance Company,Commercial PPO,1865.8,95,,percent of total billed charges,,
Removal Of Ear Tube(S),,25005552,LOCAL,Facility,Outpatient,,,,1964,1669.4,562.8824,1964,Humana Insurance Company,Medicare PPO,962.36,49,,percent of total billed charges,,
Removal Of Ear Tube(S),,25005552,LOCAL,Facility,Inpatient,,,,1964,1669.4,562.8824,1964,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Removal Of Ear Tube(S),,25005552,LOCAL,Facility,Both,,,,1964,1669.4,562.8824,1964,Medica,Individual & Family,1946.324,99.1,,percent of total billed charges,,
Removal Of Ear Tube(S),,25005552,LOCAL,Facility,Outpatient,,,,1964,1669.4,562.8824,1964,Medica,Medica Advantage Solution,978.072,49.8,,percent of total billed charges,,
Removal Of Ear Tube(S),,25005552,LOCAL,Facility,Inpatient,,,,1964,1669.4,562.8824,1964,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Removal Of Ear Tube(S),,25005552,LOCAL,Facility,Outpatient,,,,1964,1669.4,562.8824,1964,Medica,Medical Assistance,875.944,44.6,,percent of total billed charges,,
Removal Of Ear Tube(S),,25005552,LOCAL,Facility,Inpatient,,,,1964,1669.4,562.8824,1964,Medica,Medical Assistance,,,,,Included in per diem rate,
Removal Of Ear Tube(S),,25005552,LOCAL,Facility,Outpatient,,,,1964,1669.4,562.8824,1964,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,978.072,49.8,,percent of total billed charges,,
Removal Of Ear Tube(S),,25005552,LOCAL,Facility,Inpatient,,,,1964,1669.4,562.8824,1964,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Removal Of Ear Tube(S),,25005552,LOCAL,Facility,Both,,,,1964,1669.4,562.8824,1964,"Multiplan, Inc.","Multiplan, Inc.",1846.16,94,,percent of total billed charges,,
Removal Of Ear Tube(S),,25005552,LOCAL,Facility,Outpatient,,,,1964,1669.4,562.8824,1964,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1769.564,90.1,,percent of total billed charges,,
Removal Of Ear Tube(S),,25005552,LOCAL,Facility,Inpatient,,,,1964,1669.4,562.8824,1964,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Removal Of Ear Tube(S),,25005552,LOCAL,Facility,Both,,,,1964,1669.4,562.8824,1964,"Preferred One Administrative Services, INC.",PPO,1936.504,98.6,,percent of total billed charges,,
Removal Of Ear Tube(S),,25005552,LOCAL,Facility,Outpatient,,,,1964,1669.4,562.8824,1964,PrimeWest Health,Minnesota Senior Health Options (MSHO),1010.478,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Removal Of Ear Tube(S),,25005552,LOCAL,Facility,Inpatient,,,,1964,1669.4,562.8824,1964,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Removal Of Ear Tube(S),,25005552,LOCAL,Facility,Outpatient,,,,1964,1669.4,562.8824,1964,PrimeWest Health,MinnesotaCare,1008.7104,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Removal Of Ear Tube(S),,25005552,LOCAL,Facility,Inpatient,,,,1964,1669.4,562.8824,1964,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Removal Of Ear Tube(S),,25005552,LOCAL,Facility,Both,,,,1964,1669.4,562.8824,1964,Sanford Health Plan,Sanford Health Plan,1806.88,92,,percent of total billed charges,,
Removal Of Ear Tube(S),,25005552,LOCAL,Facility,Outpatient,,,,1964,1669.4,562.8824,1964,"UCare Health, Inc.",Individual & Family Plan,1106.714,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Removal Of Ear Tube(S),,25005552,LOCAL,Facility,Inpatient,,,,1964,1669.4,562.8824,1964,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Removal Of Ear Tube(S),,25005552,LOCAL,Facility,Outpatient,,,,1964,1669.4,562.8824,1964,"UCare Health, Inc.",Medical Assistance,991.2308,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Removal Of Ear Tube(S),,25005552,LOCAL,Facility,Inpatient,,,,1964,1669.4,562.8824,1964,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Removal Of Ear Tube(S),,25005552,LOCAL,Facility,Outpatient,,,,1964,1669.4,562.8824,1964,"UCare Health, Inc.",Medicare Advantage,991.2308,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Removal Of Ear Tube(S),,25005552,LOCAL,Facility,Inpatient,,,,1964,1669.4,562.8824,1964,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Removal Of Ear Tube(S),,25005552,LOCAL,Facility,Outpatient,,,,1964,1669.4,562.8824,1964,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),991.2308,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Removal Of Ear Tube(S),,25005552,LOCAL,Facility,Inpatient,,,,1964,1669.4,562.8824,1964,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Removal Of Ear Tube(S),,25005552,LOCAL,Facility,Both,,,,1964,1669.4,562.8824,1964,UnitedHealthcare,Individual & Family,1846.16,94,,percent of total billed charges,,
Removal Of Ear Tube(S),,25005552,LOCAL,Facility,Outpatient,,,,1964,1669.4,562.8824,1964,UnitedHealthcare,Medicare Advantage,962.36,49,,percent of total billed charges,,
Removal Of Ear Tube(S),,25005552,LOCAL,Facility,Inpatient,,,,1964,1669.4,562.8824,1964,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Removal Of Ear Tube(S),,25005552,LOCAL,Facility,Outpatient,,,,1964,1669.4,562.8824,1964,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,942.72,48,,percent of total billed charges,,100% of DHS outpatient percentage
Removal Of Ear Tube(S),,25005552,LOCAL,Facility,Inpatient,,,,1964,1669.4,562.8824,1964,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Tympanoplasty,,25005772,LOCAL,Facility,Both,,,,1020,867,292.332,1020,Aetna,Commercial,938.4,92,,percent of total billed charges,,
Tympanoplasty,,25005772,LOCAL,Facility,Outpatient,,,,1020,867,292.332,1020,Aetna,Medicare Advantage,499.8,49,,percent of total billed charges,,
Tympanoplasty,,25005772,LOCAL,Facility,Inpatient,,,,1020,867,292.332,1020,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Tympanoplasty,,25005772,LOCAL,Facility,Both,,,,1020,867,292.332,1020,Aetna,PPO,948.6,93,,percent of total billed charges,,
Tympanoplasty,,25005772,LOCAL,Facility,Both,,,,1020,867,292.332,1020,America's PPO,America's PPO,979.506,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Tympanoplasty,,25005772,LOCAL,Facility,Both,,,,1020,867,292.332,1020,BlueCross BlueShield Minnesota, Federal Employee Program,1003.68,98.4,,percent of total billed charges,,
Tympanoplasty,,25005772,LOCAL,Facility,Both,,,,1020,867,292.332,1020,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1020,100,,percent of total billed charges,,
Tympanoplasty,,25005772,LOCAL,Facility,Both,,,,1020,867,292.332,1020,BlueCross BlueShield Minnesota,High Value Network Plan,918,90,,percent of total billed charges,,
Tympanoplasty,,25005772,LOCAL,Facility,Outpatient,,,,1020,867,292.332,1020,BlueCross BlueShield Minnesota,Medicare Advantage,499.8,49,,percent of total billed charges,,
Tympanoplasty,,25005772,LOCAL,Facility,Inpatient,,,,1020,867,292.332,1020,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Tympanoplasty,,25005772,LOCAL,Facility,Both,,,,1020,867,292.332,1020,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,903.414,88.57,,percent of total billed charges,,
Tympanoplasty,,25005772,LOCAL,Facility,Both,,,,1020,867,292.332,1020,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,292.332,28.66,,percent of total billed charges,,
Tympanoplasty,,25005772,LOCAL,Facility,Outpatient,,,,1020,867,292.332,1020,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),499.8,49,,percent of total billed charges,,
Tympanoplasty,,25005772,LOCAL,Facility,Inpatient,,,,1020,867,292.332,1020,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Tympanoplasty,,25005772,LOCAL,Facility,Both,,,,1020,867,292.332,1020,CorVel,Worker's Compensation,1020,100,,percent of total billed charges,,
Tympanoplasty,,25005772,LOCAL,Facility,Both,,,,1020,867,292.332,1020,First Health Group Corporation,First Health Network,989.4,97,,percent of total billed charges,,
Tympanoplasty,,25005772,LOCAL,Facility,Both,,,,1020,867,292.332,1020,"Health Partners, Inc.",Commercial,964.92,94.6,,percent of total billed charges,,
Tympanoplasty,,25005772,LOCAL,Facility,Outpatient,,,,1020,867,292.332,1020,"Health Partners, Inc.",Medicare Advantage,499.8,49,,percent of total billed charges,,
Tympanoplasty,,25005772,LOCAL,Facility,Inpatient,,,,1020,867,292.332,1020,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Tympanoplasty,,25005772,LOCAL,Facility,Both,,,,1020,867,292.332,1020,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),612,60,,percent of total billed charges,,
Tympanoplasty,,25005772,LOCAL,Facility,Both,,,,1020,867,292.332,1020,"Health Partners, Inc.",State of Minnesota Advantage Program,831.3,81.5,,percent of total billed charges,,
Tympanoplasty,,25005772,LOCAL,Facility,Both,,,,1020,867,292.332,1020,"Health Partners, Inc.",State Public Programs,510,50,,percent of total billed charges,,
Tympanoplasty,,25005772,LOCAL,Facility,Both,,,,1020,867,292.332,1020,Humana Insurance Company,Commercial PPO,969,95,,percent of total billed charges,,
Tympanoplasty,,25005772,LOCAL,Facility,Outpatient,,,,1020,867,292.332,1020,Humana Insurance Company,Medicare PPO,499.8,49,,percent of total billed charges,,
Tympanoplasty,,25005772,LOCAL,Facility,Inpatient,,,,1020,867,292.332,1020,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Tympanoplasty,,25005772,LOCAL,Facility,Both,,,,1020,867,292.332,1020,Medica,Individual & Family,1010.82,99.1,,percent of total billed charges,,
Tympanoplasty,,25005772,LOCAL,Facility,Outpatient,,,,1020,867,292.332,1020,Medica,Medica Advantage Solution,507.96,49.8,,percent of total billed charges,,
Tympanoplasty,,25005772,LOCAL,Facility,Inpatient,,,,1020,867,292.332,1020,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Tympanoplasty,,25005772,LOCAL,Facility,Outpatient,,,,1020,867,292.332,1020,Medica,Medical Assistance,454.92,44.6,,percent of total billed charges,,
Tympanoplasty,,25005772,LOCAL,Facility,Inpatient,,,,1020,867,292.332,1020,Medica,Medical Assistance,,,,,Included in per diem rate,
Tympanoplasty,,25005772,LOCAL,Facility,Outpatient,,,,1020,867,292.332,1020,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,507.96,49.8,,percent of total billed charges,,
Tympanoplasty,,25005772,LOCAL,Facility,Inpatient,,,,1020,867,292.332,1020,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Tympanoplasty,,25005772,LOCAL,Facility,Both,,,,1020,867,292.332,1020,"Multiplan, Inc.","Multiplan, Inc.",958.8,94,,percent of total billed charges,,
Tympanoplasty,,25005772,LOCAL,Facility,Outpatient,,,,1020,867,292.332,1020,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,919.02,90.1,,percent of total billed charges,,
Tympanoplasty,,25005772,LOCAL,Facility,Inpatient,,,,1020,867,292.332,1020,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Tympanoplasty,,25005772,LOCAL,Facility,Both,,,,1020,867,292.332,1020,"Preferred One Administrative Services, INC.",PPO,1005.72,98.6,,percent of total billed charges,,
Tympanoplasty,,25005772,LOCAL,Facility,Outpatient,,,,1020,867,292.332,1020,PrimeWest Health,Minnesota Senior Health Options (MSHO),524.79,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Tympanoplasty,,25005772,LOCAL,Facility,Inpatient,,,,1020,867,292.332,1020,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Tympanoplasty,,25005772,LOCAL,Facility,Outpatient,,,,1020,867,292.332,1020,PrimeWest Health,MinnesotaCare,523.872,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Tympanoplasty,,25005772,LOCAL,Facility,Inpatient,,,,1020,867,292.332,1020,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Tympanoplasty,,25005772,LOCAL,Facility,Both,,,,1020,867,292.332,1020,Sanford Health Plan,Sanford Health Plan,938.4,92,,percent of total billed charges,,
Tympanoplasty,,25005772,LOCAL,Facility,Outpatient,,,,1020,867,292.332,1020,"UCare Health, Inc.",Individual & Family Plan,574.77,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Tympanoplasty,,25005772,LOCAL,Facility,Inpatient,,,,1020,867,292.332,1020,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Tympanoplasty,,25005772,LOCAL,Facility,Outpatient,,,,1020,867,292.332,1020,"UCare Health, Inc.",Medical Assistance,514.794,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Tympanoplasty,,25005772,LOCAL,Facility,Inpatient,,,,1020,867,292.332,1020,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Tympanoplasty,,25005772,LOCAL,Facility,Outpatient,,,,1020,867,292.332,1020,"UCare Health, Inc.",Medicare Advantage,514.794,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Tympanoplasty,,25005772,LOCAL,Facility,Inpatient,,,,1020,867,292.332,1020,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Tympanoplasty,,25005772,LOCAL,Facility,Outpatient,,,,1020,867,292.332,1020,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),514.794,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Tympanoplasty,,25005772,LOCAL,Facility,Inpatient,,,,1020,867,292.332,1020,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Tympanoplasty,,25005772,LOCAL,Facility,Both,,,,1020,867,292.332,1020,UnitedHealthcare,Individual & Family,958.8,94,,percent of total billed charges,,
Tympanoplasty,,25005772,LOCAL,Facility,Outpatient,,,,1020,867,292.332,1020,UnitedHealthcare,Medicare Advantage,499.8,49,,percent of total billed charges,,
Tympanoplasty,,25005772,LOCAL,Facility,Inpatient,,,,1020,867,292.332,1020,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Tympanoplasty,,25005772,LOCAL,Facility,Outpatient,,,,1020,867,292.332,1020,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,489.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
Tympanoplasty,,25005772,LOCAL,Facility,Inpatient,,,,1020,867,292.332,1020,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Biopsy Of Prostate W/Sedation,,25005812,LOCAL,Facility,Both,,,,1734,1473.9,496.9644,1734,Aetna,Commercial,1595.28,92,,percent of total billed charges,,
Biopsy Of Prostate W/Sedation,,25005812,LOCAL,Facility,Outpatient,,,,1734,1473.9,496.9644,1734,Aetna,Medicare Advantage,849.66,49,,percent of total billed charges,,
Biopsy Of Prostate W/Sedation,,25005812,LOCAL,Facility,Inpatient,,,,1734,1473.9,496.9644,1734,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Biopsy Of Prostate W/Sedation,,25005812,LOCAL,Facility,Both,,,,1734,1473.9,496.9644,1734,Aetna,PPO,1612.62,93,,percent of total billed charges,,
Biopsy Of Prostate W/Sedation,,25005812,LOCAL,Facility,Both,,,,1734,1473.9,496.9644,1734,America's PPO,America's PPO,1665.1602,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Biopsy Of Prostate W/Sedation,,25005812,LOCAL,Facility,Both,,,,1734,1473.9,496.9644,1734,BlueCross BlueShield Minnesota, Federal Employee Program,1706.256,98.4,,percent of total billed charges,,
Biopsy Of Prostate W/Sedation,,25005812,LOCAL,Facility,Both,,,,1734,1473.9,496.9644,1734,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1734,100,,percent of total billed charges,,
Biopsy Of Prostate W/Sedation,,25005812,LOCAL,Facility,Both,,,,1734,1473.9,496.9644,1734,BlueCross BlueShield Minnesota,High Value Network Plan,1560.6,90,,percent of total billed charges,,
Biopsy Of Prostate W/Sedation,,25005812,LOCAL,Facility,Outpatient,,,,1734,1473.9,496.9644,1734,BlueCross BlueShield Minnesota,Medicare Advantage,849.66,49,,percent of total billed charges,,
Biopsy Of Prostate W/Sedation,,25005812,LOCAL,Facility,Inpatient,,,,1734,1473.9,496.9644,1734,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Biopsy Of Prostate W/Sedation,,25005812,LOCAL,Facility,Both,,,,1734,1473.9,496.9644,1734,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1535.8038,88.57,,percent of total billed charges,,
Biopsy Of Prostate W/Sedation,,25005812,LOCAL,Facility,Both,,,,1734,1473.9,496.9644,1734,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,496.9644,28.66,,percent of total billed charges,,
Biopsy Of Prostate W/Sedation,,25005812,LOCAL,Facility,Outpatient,,,,1734,1473.9,496.9644,1734,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),849.66,49,,percent of total billed charges,,
Biopsy Of Prostate W/Sedation,,25005812,LOCAL,Facility,Inpatient,,,,1734,1473.9,496.9644,1734,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Biopsy Of Prostate W/Sedation,,25005812,LOCAL,Facility,Both,,,,1734,1473.9,496.9644,1734,CorVel,Worker's Compensation,1734,100,,percent of total billed charges,,
Biopsy Of Prostate W/Sedation,,25005812,LOCAL,Facility,Both,,,,1734,1473.9,496.9644,1734,First Health Group Corporation,First Health Network,1681.98,97,,percent of total billed charges,,
Biopsy Of Prostate W/Sedation,,25005812,LOCAL,Facility,Both,,,,1734,1473.9,496.9644,1734,"Health Partners, Inc.",Commercial,1640.364,94.6,,percent of total billed charges,,
Biopsy Of Prostate W/Sedation,,25005812,LOCAL,Facility,Outpatient,,,,1734,1473.9,496.9644,1734,"Health Partners, Inc.",Medicare Advantage,849.66,49,,percent of total billed charges,,
Biopsy Of Prostate W/Sedation,,25005812,LOCAL,Facility,Inpatient,,,,1734,1473.9,496.9644,1734,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Biopsy Of Prostate W/Sedation,,25005812,LOCAL,Facility,Both,,,,1734,1473.9,496.9644,1734,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1040.4,60,,percent of total billed charges,,
Biopsy Of Prostate W/Sedation,,25005812,LOCAL,Facility,Both,,,,1734,1473.9,496.9644,1734,"Health Partners, Inc.",State of Minnesota Advantage Program,1413.21,81.5,,percent of total billed charges,,
Biopsy Of Prostate W/Sedation,,25005812,LOCAL,Facility,Both,,,,1734,1473.9,496.9644,1734,"Health Partners, Inc.",State Public Programs,867,50,,percent of total billed charges,,
Biopsy Of Prostate W/Sedation,,25005812,LOCAL,Facility,Both,,,,1734,1473.9,496.9644,1734,Humana Insurance Company,Commercial PPO,1647.3,95,,percent of total billed charges,,
Biopsy Of Prostate W/Sedation,,25005812,LOCAL,Facility,Outpatient,,,,1734,1473.9,496.9644,1734,Humana Insurance Company,Medicare PPO,849.66,49,,percent of total billed charges,,
Biopsy Of Prostate W/Sedation,,25005812,LOCAL,Facility,Inpatient,,,,1734,1473.9,496.9644,1734,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Biopsy Of Prostate W/Sedation,,25005812,LOCAL,Facility,Both,,,,1734,1473.9,496.9644,1734,Medica,Individual & Family,1718.394,99.1,,percent of total billed charges,,
Biopsy Of Prostate W/Sedation,,25005812,LOCAL,Facility,Outpatient,,,,1734,1473.9,496.9644,1734,Medica,Medica Advantage Solution,863.532,49.8,,percent of total billed charges,,
Biopsy Of Prostate W/Sedation,,25005812,LOCAL,Facility,Inpatient,,,,1734,1473.9,496.9644,1734,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Biopsy Of Prostate W/Sedation,,25005812,LOCAL,Facility,Outpatient,,,,1734,1473.9,496.9644,1734,Medica,Medical Assistance,773.364,44.6,,percent of total billed charges,,
Biopsy Of Prostate W/Sedation,,25005812,LOCAL,Facility,Inpatient,,,,1734,1473.9,496.9644,1734,Medica,Medical Assistance,,,,,Included in per diem rate,
Biopsy Of Prostate W/Sedation,,25005812,LOCAL,Facility,Outpatient,,,,1734,1473.9,496.9644,1734,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,863.532,49.8,,percent of total billed charges,,
Biopsy Of Prostate W/Sedation,,25005812,LOCAL,Facility,Inpatient,,,,1734,1473.9,496.9644,1734,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Biopsy Of Prostate W/Sedation,,25005812,LOCAL,Facility,Both,,,,1734,1473.9,496.9644,1734,"Multiplan, Inc.","Multiplan, Inc.",1629.96,94,,percent of total billed charges,,
Biopsy Of Prostate W/Sedation,,25005812,LOCAL,Facility,Outpatient,,,,1734,1473.9,496.9644,1734,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1562.334,90.1,,percent of total billed charges,,
Biopsy Of Prostate W/Sedation,,25005812,LOCAL,Facility,Inpatient,,,,1734,1473.9,496.9644,1734,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Biopsy Of Prostate W/Sedation,,25005812,LOCAL,Facility,Both,,,,1734,1473.9,496.9644,1734,"Preferred One Administrative Services, INC.",PPO,1709.724,98.6,,percent of total billed charges,,
Biopsy Of Prostate W/Sedation,,25005812,LOCAL,Facility,Outpatient,,,,1734,1473.9,496.9644,1734,PrimeWest Health,Minnesota Senior Health Options (MSHO),892.143,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Biopsy Of Prostate W/Sedation,,25005812,LOCAL,Facility,Inpatient,,,,1734,1473.9,496.9644,1734,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Biopsy Of Prostate W/Sedation,,25005812,LOCAL,Facility,Outpatient,,,,1734,1473.9,496.9644,1734,PrimeWest Health,MinnesotaCare,890.5824,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Biopsy Of Prostate W/Sedation,,25005812,LOCAL,Facility,Inpatient,,,,1734,1473.9,496.9644,1734,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Biopsy Of Prostate W/Sedation,,25005812,LOCAL,Facility,Both,,,,1734,1473.9,496.9644,1734,Sanford Health Plan,Sanford Health Plan,1595.28,92,,percent of total billed charges,,
Biopsy Of Prostate W/Sedation,,25005812,LOCAL,Facility,Outpatient,,,,1734,1473.9,496.9644,1734,"UCare Health, Inc.",Individual & Family Plan,977.109,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Biopsy Of Prostate W/Sedation,,25005812,LOCAL,Facility,Inpatient,,,,1734,1473.9,496.9644,1734,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Biopsy Of Prostate W/Sedation,,25005812,LOCAL,Facility,Outpatient,,,,1734,1473.9,496.9644,1734,"UCare Health, Inc.",Medical Assistance,875.1498,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Biopsy Of Prostate W/Sedation,,25005812,LOCAL,Facility,Inpatient,,,,1734,1473.9,496.9644,1734,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Biopsy Of Prostate W/Sedation,,25005812,LOCAL,Facility,Outpatient,,,,1734,1473.9,496.9644,1734,"UCare Health, Inc.",Medicare Advantage,875.1498,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Biopsy Of Prostate W/Sedation,,25005812,LOCAL,Facility,Inpatient,,,,1734,1473.9,496.9644,1734,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Biopsy Of Prostate W/Sedation,,25005812,LOCAL,Facility,Outpatient,,,,1734,1473.9,496.9644,1734,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),875.1498,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Biopsy Of Prostate W/Sedation,,25005812,LOCAL,Facility,Inpatient,,,,1734,1473.9,496.9644,1734,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Biopsy Of Prostate W/Sedation,,25005812,LOCAL,Facility,Both,,,,1734,1473.9,496.9644,1734,UnitedHealthcare,Individual & Family,1629.96,94,,percent of total billed charges,,
Biopsy Of Prostate W/Sedation,,25005812,LOCAL,Facility,Outpatient,,,,1734,1473.9,496.9644,1734,UnitedHealthcare,Medicare Advantage,849.66,49,,percent of total billed charges,,
Biopsy Of Prostate W/Sedation,,25005812,LOCAL,Facility,Inpatient,,,,1734,1473.9,496.9644,1734,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Biopsy Of Prostate W/Sedation,,25005812,LOCAL,Facility,Outpatient,,,,1734,1473.9,496.9644,1734,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,832.32,48,,percent of total billed charges,,100% of DHS outpatient percentage
Biopsy Of Prostate W/Sedation,,25005812,LOCAL,Facility,Inpatient,,,,1734,1473.9,496.9644,1734,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Gastroscopy,,25005883,LOCAL,Facility,Both,,,,1505,1279.25,431.333,1505,Aetna,Commercial,1384.6,92,,percent of total billed charges,,
Gastroscopy,,25005883,LOCAL,Facility,Outpatient,,,,1505,1279.25,431.333,1505,Aetna,Medicare Advantage,737.45,49,,percent of total billed charges,,
Gastroscopy,,25005883,LOCAL,Facility,Inpatient,,,,1505,1279.25,431.333,1505,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Gastroscopy,,25005883,LOCAL,Facility,Both,,,,1505,1279.25,431.333,1505,Aetna,PPO,1399.65,93,,percent of total billed charges,,
Gastroscopy,,25005883,LOCAL,Facility,Both,,,,1505,1279.25,431.333,1505,America's PPO,America's PPO,1445.2515,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Gastroscopy,,25005883,LOCAL,Facility,Both,,,,1505,1279.25,431.333,1505,BlueCross BlueShield Minnesota, Federal Employee Program,1480.92,98.4,,percent of total billed charges,,
Gastroscopy,,25005883,LOCAL,Facility,Both,,,,1505,1279.25,431.333,1505,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1505,100,,percent of total billed charges,,
Gastroscopy,,25005883,LOCAL,Facility,Both,,,,1505,1279.25,431.333,1505,BlueCross BlueShield Minnesota,High Value Network Plan,1354.5,90,,percent of total billed charges,,
Gastroscopy,,25005883,LOCAL,Facility,Outpatient,,,,1505,1279.25,431.333,1505,BlueCross BlueShield Minnesota,Medicare Advantage,737.45,49,,percent of total billed charges,,
Gastroscopy,,25005883,LOCAL,Facility,Inpatient,,,,1505,1279.25,431.333,1505,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Gastroscopy,,25005883,LOCAL,Facility,Both,,,,1505,1279.25,431.333,1505,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1332.9785,88.57,,percent of total billed charges,,
Gastroscopy,,25005883,LOCAL,Facility,Both,,,,1505,1279.25,431.333,1505,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,431.333,28.66,,percent of total billed charges,,
Gastroscopy,,25005883,LOCAL,Facility,Outpatient,,,,1505,1279.25,431.333,1505,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),737.45,49,,percent of total billed charges,,
Gastroscopy,,25005883,LOCAL,Facility,Inpatient,,,,1505,1279.25,431.333,1505,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Gastroscopy,,25005883,LOCAL,Facility,Both,,,,1505,1279.25,431.333,1505,CorVel,Worker's Compensation,1505,100,,percent of total billed charges,,
Gastroscopy,,25005883,LOCAL,Facility,Both,,,,1505,1279.25,431.333,1505,First Health Group Corporation,First Health Network,1459.85,97,,percent of total billed charges,,
Gastroscopy,,25005883,LOCAL,Facility,Both,,,,1505,1279.25,431.333,1505,"Health Partners, Inc.",Commercial,1423.73,94.6,,percent of total billed charges,,
Gastroscopy,,25005883,LOCAL,Facility,Outpatient,,,,1505,1279.25,431.333,1505,"Health Partners, Inc.",Medicare Advantage,737.45,49,,percent of total billed charges,,
Gastroscopy,,25005883,LOCAL,Facility,Inpatient,,,,1505,1279.25,431.333,1505,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Gastroscopy,,25005883,LOCAL,Facility,Both,,,,1505,1279.25,431.333,1505,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),903,60,,percent of total billed charges,,
Gastroscopy,,25005883,LOCAL,Facility,Both,,,,1505,1279.25,431.333,1505,"Health Partners, Inc.",State of Minnesota Advantage Program,1226.575,81.5,,percent of total billed charges,,
Gastroscopy,,25005883,LOCAL,Facility,Both,,,,1505,1279.25,431.333,1505,"Health Partners, Inc.",State Public Programs,752.5,50,,percent of total billed charges,,
Gastroscopy,,25005883,LOCAL,Facility,Both,,,,1505,1279.25,431.333,1505,Humana Insurance Company,Commercial PPO,1429.75,95,,percent of total billed charges,,
Gastroscopy,,25005883,LOCAL,Facility,Outpatient,,,,1505,1279.25,431.333,1505,Humana Insurance Company,Medicare PPO,737.45,49,,percent of total billed charges,,
Gastroscopy,,25005883,LOCAL,Facility,Inpatient,,,,1505,1279.25,431.333,1505,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Gastroscopy,,25005883,LOCAL,Facility,Both,,,,1505,1279.25,431.333,1505,Medica,Individual & Family,1491.455,99.1,,percent of total billed charges,,
Gastroscopy,,25005883,LOCAL,Facility,Outpatient,,,,1505,1279.25,431.333,1505,Medica,Medica Advantage Solution,749.49,49.8,,percent of total billed charges,,
Gastroscopy,,25005883,LOCAL,Facility,Inpatient,,,,1505,1279.25,431.333,1505,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Gastroscopy,,25005883,LOCAL,Facility,Outpatient,,,,1505,1279.25,431.333,1505,Medica,Medical Assistance,671.23,44.6,,percent of total billed charges,,
Gastroscopy,,25005883,LOCAL,Facility,Inpatient,,,,1505,1279.25,431.333,1505,Medica,Medical Assistance,,,,,Included in per diem rate,
Gastroscopy,,25005883,LOCAL,Facility,Outpatient,,,,1505,1279.25,431.333,1505,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,749.49,49.8,,percent of total billed charges,,
Gastroscopy,,25005883,LOCAL,Facility,Inpatient,,,,1505,1279.25,431.333,1505,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Gastroscopy,,25005883,LOCAL,Facility,Both,,,,1505,1279.25,431.333,1505,"Multiplan, Inc.","Multiplan, Inc.",1414.7,94,,percent of total billed charges,,
Gastroscopy,,25005883,LOCAL,Facility,Outpatient,,,,1505,1279.25,431.333,1505,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1356.005,90.1,,percent of total billed charges,,
Gastroscopy,,25005883,LOCAL,Facility,Inpatient,,,,1505,1279.25,431.333,1505,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Gastroscopy,,25005883,LOCAL,Facility,Both,,,,1505,1279.25,431.333,1505,"Preferred One Administrative Services, INC.",PPO,1483.93,98.6,,percent of total billed charges,,
Gastroscopy,,25005883,LOCAL,Facility,Outpatient,,,,1505,1279.25,431.333,1505,PrimeWest Health,Minnesota Senior Health Options (MSHO),774.3225,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Gastroscopy,,25005883,LOCAL,Facility,Inpatient,,,,1505,1279.25,431.333,1505,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Gastroscopy,,25005883,LOCAL,Facility,Outpatient,,,,1505,1279.25,431.333,1505,PrimeWest Health,MinnesotaCare,772.968,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Gastroscopy,,25005883,LOCAL,Facility,Inpatient,,,,1505,1279.25,431.333,1505,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Gastroscopy,,25005883,LOCAL,Facility,Both,,,,1505,1279.25,431.333,1505,Sanford Health Plan,Sanford Health Plan,1384.6,92,,percent of total billed charges,,
Gastroscopy,,25005883,LOCAL,Facility,Outpatient,,,,1505,1279.25,431.333,1505,"UCare Health, Inc.",Individual & Family Plan,848.0675,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Gastroscopy,,25005883,LOCAL,Facility,Inpatient,,,,1505,1279.25,431.333,1505,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Gastroscopy,,25005883,LOCAL,Facility,Outpatient,,,,1505,1279.25,431.333,1505,"UCare Health, Inc.",Medical Assistance,759.5735,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Gastroscopy,,25005883,LOCAL,Facility,Inpatient,,,,1505,1279.25,431.333,1505,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Gastroscopy,,25005883,LOCAL,Facility,Outpatient,,,,1505,1279.25,431.333,1505,"UCare Health, Inc.",Medicare Advantage,759.5735,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Gastroscopy,,25005883,LOCAL,Facility,Inpatient,,,,1505,1279.25,431.333,1505,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Gastroscopy,,25005883,LOCAL,Facility,Outpatient,,,,1505,1279.25,431.333,1505,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),759.5735,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Gastroscopy,,25005883,LOCAL,Facility,Inpatient,,,,1505,1279.25,431.333,1505,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Gastroscopy,,25005883,LOCAL,Facility,Both,,,,1505,1279.25,431.333,1505,UnitedHealthcare,Individual & Family,1414.7,94,,percent of total billed charges,,
Gastroscopy,,25005883,LOCAL,Facility,Outpatient,,,,1505,1279.25,431.333,1505,UnitedHealthcare,Medicare Advantage,737.45,49,,percent of total billed charges,,
Gastroscopy,,25005883,LOCAL,Facility,Inpatient,,,,1505,1279.25,431.333,1505,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Gastroscopy,,25005883,LOCAL,Facility,Outpatient,,,,1505,1279.25,431.333,1505,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,722.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
Gastroscopy,,25005883,LOCAL,Facility,Inpatient,,,,1505,1279.25,431.333,1505,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Septorhinoplasty,,25006354,LOCAL,Facility,Both,,,,3468,2947.8,993.9288,3468,Aetna,Commercial,3190.56,92,,percent of total billed charges,,
Septorhinoplasty,,25006354,LOCAL,Facility,Outpatient,,,,3468,2947.8,993.9288,3468,Aetna,Medicare Advantage,1699.32,49,,percent of total billed charges,,
Septorhinoplasty,,25006354,LOCAL,Facility,Inpatient,,,,3468,2947.8,993.9288,3468,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Septorhinoplasty,,25006354,LOCAL,Facility,Both,,,,3468,2947.8,993.9288,3468,Aetna,PPO,3225.24,93,,percent of total billed charges,,
Septorhinoplasty,,25006354,LOCAL,Facility,Both,,,,3468,2947.8,993.9288,3468,America's PPO,America's PPO,3330.3204,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Septorhinoplasty,,25006354,LOCAL,Facility,Both,,,,3468,2947.8,993.9288,3468,BlueCross BlueShield Minnesota, Federal Employee Program,3412.512,98.4,,percent of total billed charges,,
Septorhinoplasty,,25006354,LOCAL,Facility,Both,,,,3468,2947.8,993.9288,3468,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,3468,100,,percent of total billed charges,,
Septorhinoplasty,,25006354,LOCAL,Facility,Both,,,,3468,2947.8,993.9288,3468,BlueCross BlueShield Minnesota,High Value Network Plan,3121.2,90,,percent of total billed charges,,
Septorhinoplasty,,25006354,LOCAL,Facility,Outpatient,,,,3468,2947.8,993.9288,3468,BlueCross BlueShield Minnesota,Medicare Advantage,1699.32,49,,percent of total billed charges,,
Septorhinoplasty,,25006354,LOCAL,Facility,Inpatient,,,,3468,2947.8,993.9288,3468,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Septorhinoplasty,,25006354,LOCAL,Facility,Both,,,,3468,2947.8,993.9288,3468,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,3071.6076,88.57,,percent of total billed charges,,
Septorhinoplasty,,25006354,LOCAL,Facility,Both,,,,3468,2947.8,993.9288,3468,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,993.9288,28.66,,percent of total billed charges,,
Septorhinoplasty,,25006354,LOCAL,Facility,Outpatient,,,,3468,2947.8,993.9288,3468,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1699.32,49,,percent of total billed charges,,
Septorhinoplasty,,25006354,LOCAL,Facility,Inpatient,,,,3468,2947.8,993.9288,3468,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Septorhinoplasty,,25006354,LOCAL,Facility,Both,,,,3468,2947.8,993.9288,3468,CorVel,Worker's Compensation,3468,100,,percent of total billed charges,,
Septorhinoplasty,,25006354,LOCAL,Facility,Both,,,,3468,2947.8,993.9288,3468,First Health Group Corporation,First Health Network,3363.96,97,,percent of total billed charges,,
Septorhinoplasty,,25006354,LOCAL,Facility,Both,,,,3468,2947.8,993.9288,3468,"Health Partners, Inc.",Commercial,3280.728,94.6,,percent of total billed charges,,
Septorhinoplasty,,25006354,LOCAL,Facility,Outpatient,,,,3468,2947.8,993.9288,3468,"Health Partners, Inc.",Medicare Advantage,1699.32,49,,percent of total billed charges,,
Septorhinoplasty,,25006354,LOCAL,Facility,Inpatient,,,,3468,2947.8,993.9288,3468,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Septorhinoplasty,,25006354,LOCAL,Facility,Both,,,,3468,2947.8,993.9288,3468,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),2080.8,60,,percent of total billed charges,,
Septorhinoplasty,,25006354,LOCAL,Facility,Both,,,,3468,2947.8,993.9288,3468,"Health Partners, Inc.",State of Minnesota Advantage Program,2826.42,81.5,,percent of total billed charges,,
Septorhinoplasty,,25006354,LOCAL,Facility,Both,,,,3468,2947.8,993.9288,3468,"Health Partners, Inc.",State Public Programs,1734,50,,percent of total billed charges,,
Septorhinoplasty,,25006354,LOCAL,Facility,Both,,,,3468,2947.8,993.9288,3468,Humana Insurance Company,Commercial PPO,3294.6,95,,percent of total billed charges,,
Septorhinoplasty,,25006354,LOCAL,Facility,Outpatient,,,,3468,2947.8,993.9288,3468,Humana Insurance Company,Medicare PPO,1699.32,49,,percent of total billed charges,,
Septorhinoplasty,,25006354,LOCAL,Facility,Inpatient,,,,3468,2947.8,993.9288,3468,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Septorhinoplasty,,25006354,LOCAL,Facility,Both,,,,3468,2947.8,993.9288,3468,Medica,Individual & Family,3436.788,99.1,,percent of total billed charges,,
Septorhinoplasty,,25006354,LOCAL,Facility,Outpatient,,,,3468,2947.8,993.9288,3468,Medica,Medica Advantage Solution,1727.064,49.8,,percent of total billed charges,,
Septorhinoplasty,,25006354,LOCAL,Facility,Inpatient,,,,3468,2947.8,993.9288,3468,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Septorhinoplasty,,25006354,LOCAL,Facility,Outpatient,,,,3468,2947.8,993.9288,3468,Medica,Medical Assistance,1546.728,44.6,,percent of total billed charges,,
Septorhinoplasty,,25006354,LOCAL,Facility,Inpatient,,,,3468,2947.8,993.9288,3468,Medica,Medical Assistance,,,,,Included in per diem rate,
Septorhinoplasty,,25006354,LOCAL,Facility,Outpatient,,,,3468,2947.8,993.9288,3468,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1727.064,49.8,,percent of total billed charges,,
Septorhinoplasty,,25006354,LOCAL,Facility,Inpatient,,,,3468,2947.8,993.9288,3468,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Septorhinoplasty,,25006354,LOCAL,Facility,Both,,,,3468,2947.8,993.9288,3468,"Multiplan, Inc.","Multiplan, Inc.",3259.92,94,,percent of total billed charges,,
Septorhinoplasty,,25006354,LOCAL,Facility,Outpatient,,,,3468,2947.8,993.9288,3468,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,3124.668,90.1,,percent of total billed charges,,
Septorhinoplasty,,25006354,LOCAL,Facility,Inpatient,,,,3468,2947.8,993.9288,3468,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Septorhinoplasty,,25006354,LOCAL,Facility,Both,,,,3468,2947.8,993.9288,3468,"Preferred One Administrative Services, INC.",PPO,3419.448,98.6,,percent of total billed charges,,
Septorhinoplasty,,25006354,LOCAL,Facility,Outpatient,,,,3468,2947.8,993.9288,3468,PrimeWest Health,Minnesota Senior Health Options (MSHO),1784.286,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Septorhinoplasty,,25006354,LOCAL,Facility,Inpatient,,,,3468,2947.8,993.9288,3468,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Septorhinoplasty,,25006354,LOCAL,Facility,Outpatient,,,,3468,2947.8,993.9288,3468,PrimeWest Health,MinnesotaCare,1781.1648,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Septorhinoplasty,,25006354,LOCAL,Facility,Inpatient,,,,3468,2947.8,993.9288,3468,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Septorhinoplasty,,25006354,LOCAL,Facility,Both,,,,3468,2947.8,993.9288,3468,Sanford Health Plan,Sanford Health Plan,3190.56,92,,percent of total billed charges,,
Septorhinoplasty,,25006354,LOCAL,Facility,Outpatient,,,,3468,2947.8,993.9288,3468,"UCare Health, Inc.",Individual & Family Plan,1954.218,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Septorhinoplasty,,25006354,LOCAL,Facility,Inpatient,,,,3468,2947.8,993.9288,3468,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Septorhinoplasty,,25006354,LOCAL,Facility,Outpatient,,,,3468,2947.8,993.9288,3468,"UCare Health, Inc.",Medical Assistance,1750.2996,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Septorhinoplasty,,25006354,LOCAL,Facility,Inpatient,,,,3468,2947.8,993.9288,3468,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Septorhinoplasty,,25006354,LOCAL,Facility,Outpatient,,,,3468,2947.8,993.9288,3468,"UCare Health, Inc.",Medicare Advantage,1750.2996,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Septorhinoplasty,,25006354,LOCAL,Facility,Inpatient,,,,3468,2947.8,993.9288,3468,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Septorhinoplasty,,25006354,LOCAL,Facility,Outpatient,,,,3468,2947.8,993.9288,3468,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1750.2996,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Septorhinoplasty,,25006354,LOCAL,Facility,Inpatient,,,,3468,2947.8,993.9288,3468,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Septorhinoplasty,,25006354,LOCAL,Facility,Both,,,,3468,2947.8,993.9288,3468,UnitedHealthcare,Individual & Family,3259.92,94,,percent of total billed charges,,
Septorhinoplasty,,25006354,LOCAL,Facility,Outpatient,,,,3468,2947.8,993.9288,3468,UnitedHealthcare,Medicare Advantage,1699.32,49,,percent of total billed charges,,
Septorhinoplasty,,25006354,LOCAL,Facility,Inpatient,,,,3468,2947.8,993.9288,3468,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Septorhinoplasty,,25006354,LOCAL,Facility,Outpatient,,,,3468,2947.8,993.9288,3468,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1664.64,48,,percent of total billed charges,,100% of DHS outpatient percentage
Septorhinoplasty,,25006354,LOCAL,Facility,Inpatient,,,,3468,2947.8,993.9288,3468,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Hernia Repair Umbilical Laparoscopic,,25006386,LOCAL,Facility,Both,,,,4667,3966.95,1337.5622,4667,Aetna,Commercial,4293.64,92,,percent of total billed charges,,
Hernia Repair Umbilical Laparoscopic,,25006386,LOCAL,Facility,Outpatient,,,,4667,3966.95,1337.5622,4667,Aetna,Medicare Advantage,2286.83,49,,percent of total billed charges,,
Hernia Repair Umbilical Laparoscopic,,25006386,LOCAL,Facility,Inpatient,,,,4667,3966.95,1337.5622,4667,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Hernia Repair Umbilical Laparoscopic,,25006386,LOCAL,Facility,Both,,,,4667,3966.95,1337.5622,4667,Aetna,PPO,4340.31,93,,percent of total billed charges,,
Hernia Repair Umbilical Laparoscopic,,25006386,LOCAL,Facility,Both,,,,4667,3966.95,1337.5622,4667,America's PPO,America's PPO,4481.7201,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Hernia Repair Umbilical Laparoscopic,,25006386,LOCAL,Facility,Both,,,,4667,3966.95,1337.5622,4667,BlueCross BlueShield Minnesota, Federal Employee Program,4592.328,98.4,,percent of total billed charges,,
Hernia Repair Umbilical Laparoscopic,,25006386,LOCAL,Facility,Both,,,,4667,3966.95,1337.5622,4667,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,4667,100,,percent of total billed charges,,
Hernia Repair Umbilical Laparoscopic,,25006386,LOCAL,Facility,Both,,,,4667,3966.95,1337.5622,4667,BlueCross BlueShield Minnesota,High Value Network Plan,4200.3,90,,percent of total billed charges,,
Hernia Repair Umbilical Laparoscopic,,25006386,LOCAL,Facility,Outpatient,,,,4667,3966.95,1337.5622,4667,BlueCross BlueShield Minnesota,Medicare Advantage,2286.83,49,,percent of total billed charges,,
Hernia Repair Umbilical Laparoscopic,,25006386,LOCAL,Facility,Inpatient,,,,4667,3966.95,1337.5622,4667,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Hernia Repair Umbilical Laparoscopic,,25006386,LOCAL,Facility,Both,,,,4667,3966.95,1337.5622,4667,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4133.5619,88.57,,percent of total billed charges,,
Hernia Repair Umbilical Laparoscopic,,25006386,LOCAL,Facility,Both,,,,4667,3966.95,1337.5622,4667,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1337.5622,28.66,,percent of total billed charges,,
Hernia Repair Umbilical Laparoscopic,,25006386,LOCAL,Facility,Outpatient,,,,4667,3966.95,1337.5622,4667,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2286.83,49,,percent of total billed charges,,
Hernia Repair Umbilical Laparoscopic,,25006386,LOCAL,Facility,Inpatient,,,,4667,3966.95,1337.5622,4667,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Hernia Repair Umbilical Laparoscopic,,25006386,LOCAL,Facility,Both,,,,4667,3966.95,1337.5622,4667,CorVel,Worker's Compensation,4667,100,,percent of total billed charges,,
Hernia Repair Umbilical Laparoscopic,,25006386,LOCAL,Facility,Both,,,,4667,3966.95,1337.5622,4667,First Health Group Corporation,First Health Network,4526.99,97,,percent of total billed charges,,
Hernia Repair Umbilical Laparoscopic,,25006386,LOCAL,Facility,Both,,,,4667,3966.95,1337.5622,4667,"Health Partners, Inc.",Commercial,4414.982,94.6,,percent of total billed charges,,
Hernia Repair Umbilical Laparoscopic,,25006386,LOCAL,Facility,Outpatient,,,,4667,3966.95,1337.5622,4667,"Health Partners, Inc.",Medicare Advantage,2286.83,49,,percent of total billed charges,,
Hernia Repair Umbilical Laparoscopic,,25006386,LOCAL,Facility,Inpatient,,,,4667,3966.95,1337.5622,4667,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Hernia Repair Umbilical Laparoscopic,,25006386,LOCAL,Facility,Both,,,,4667,3966.95,1337.5622,4667,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),2800.2,60,,percent of total billed charges,,
Hernia Repair Umbilical Laparoscopic,,25006386,LOCAL,Facility,Both,,,,4667,3966.95,1337.5622,4667,"Health Partners, Inc.",State of Minnesota Advantage Program,3803.605,81.5,,percent of total billed charges,,
Hernia Repair Umbilical Laparoscopic,,25006386,LOCAL,Facility,Both,,,,4667,3966.95,1337.5622,4667,"Health Partners, Inc.",State Public Programs,2333.5,50,,percent of total billed charges,,
Hernia Repair Umbilical Laparoscopic,,25006386,LOCAL,Facility,Both,,,,4667,3966.95,1337.5622,4667,Humana Insurance Company,Commercial PPO,4433.65,95,,percent of total billed charges,,
Hernia Repair Umbilical Laparoscopic,,25006386,LOCAL,Facility,Outpatient,,,,4667,3966.95,1337.5622,4667,Humana Insurance Company,Medicare PPO,2286.83,49,,percent of total billed charges,,
Hernia Repair Umbilical Laparoscopic,,25006386,LOCAL,Facility,Inpatient,,,,4667,3966.95,1337.5622,4667,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Hernia Repair Umbilical Laparoscopic,,25006386,LOCAL,Facility,Both,,,,4667,3966.95,1337.5622,4667,Medica,Individual & Family,4624.997,99.1,,percent of total billed charges,,
Hernia Repair Umbilical Laparoscopic,,25006386,LOCAL,Facility,Outpatient,,,,4667,3966.95,1337.5622,4667,Medica,Medica Advantage Solution,2324.166,49.8,,percent of total billed charges,,
Hernia Repair Umbilical Laparoscopic,,25006386,LOCAL,Facility,Inpatient,,,,4667,3966.95,1337.5622,4667,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Hernia Repair Umbilical Laparoscopic,,25006386,LOCAL,Facility,Outpatient,,,,4667,3966.95,1337.5622,4667,Medica,Medical Assistance,2081.482,44.6,,percent of total billed charges,,
Hernia Repair Umbilical Laparoscopic,,25006386,LOCAL,Facility,Inpatient,,,,4667,3966.95,1337.5622,4667,Medica,Medical Assistance,,,,,Included in per diem rate,
Hernia Repair Umbilical Laparoscopic,,25006386,LOCAL,Facility,Outpatient,,,,4667,3966.95,1337.5622,4667,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2324.166,49.8,,percent of total billed charges,,
Hernia Repair Umbilical Laparoscopic,,25006386,LOCAL,Facility,Inpatient,,,,4667,3966.95,1337.5622,4667,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Hernia Repair Umbilical Laparoscopic,,25006386,LOCAL,Facility,Both,,,,4667,3966.95,1337.5622,4667,"Multiplan, Inc.","Multiplan, Inc.",4386.98,94,,percent of total billed charges,,
Hernia Repair Umbilical Laparoscopic,,25006386,LOCAL,Facility,Outpatient,,,,4667,3966.95,1337.5622,4667,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4204.967,90.1,,percent of total billed charges,,
Hernia Repair Umbilical Laparoscopic,,25006386,LOCAL,Facility,Inpatient,,,,4667,3966.95,1337.5622,4667,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Hernia Repair Umbilical Laparoscopic,,25006386,LOCAL,Facility,Both,,,,4667,3966.95,1337.5622,4667,"Preferred One Administrative Services, INC.",PPO,4601.662,98.6,,percent of total billed charges,,
Hernia Repair Umbilical Laparoscopic,,25006386,LOCAL,Facility,Outpatient,,,,4667,3966.95,1337.5622,4667,PrimeWest Health,Minnesota Senior Health Options (MSHO),2401.1715,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Hernia Repair Umbilical Laparoscopic,,25006386,LOCAL,Facility,Inpatient,,,,4667,3966.95,1337.5622,4667,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Hernia Repair Umbilical Laparoscopic,,25006386,LOCAL,Facility,Outpatient,,,,4667,3966.95,1337.5622,4667,PrimeWest Health,MinnesotaCare,2396.9712,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Hernia Repair Umbilical Laparoscopic,,25006386,LOCAL,Facility,Inpatient,,,,4667,3966.95,1337.5622,4667,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Hernia Repair Umbilical Laparoscopic,,25006386,LOCAL,Facility,Both,,,,4667,3966.95,1337.5622,4667,Sanford Health Plan,Sanford Health Plan,4293.64,92,,percent of total billed charges,,
Hernia Repair Umbilical Laparoscopic,,25006386,LOCAL,Facility,Outpatient,,,,4667,3966.95,1337.5622,4667,"UCare Health, Inc.",Individual & Family Plan,2629.8545,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Hernia Repair Umbilical Laparoscopic,,25006386,LOCAL,Facility,Inpatient,,,,4667,3966.95,1337.5622,4667,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Hernia Repair Umbilical Laparoscopic,,25006386,LOCAL,Facility,Outpatient,,,,4667,3966.95,1337.5622,4667,"UCare Health, Inc.",Medical Assistance,2355.4349,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Hernia Repair Umbilical Laparoscopic,,25006386,LOCAL,Facility,Inpatient,,,,4667,3966.95,1337.5622,4667,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Hernia Repair Umbilical Laparoscopic,,25006386,LOCAL,Facility,Outpatient,,,,4667,3966.95,1337.5622,4667,"UCare Health, Inc.",Medicare Advantage,2355.4349,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Hernia Repair Umbilical Laparoscopic,,25006386,LOCAL,Facility,Inpatient,,,,4667,3966.95,1337.5622,4667,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Hernia Repair Umbilical Laparoscopic,,25006386,LOCAL,Facility,Outpatient,,,,4667,3966.95,1337.5622,4667,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2355.4349,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Hernia Repair Umbilical Laparoscopic,,25006386,LOCAL,Facility,Inpatient,,,,4667,3966.95,1337.5622,4667,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Hernia Repair Umbilical Laparoscopic,,25006386,LOCAL,Facility,Both,,,,4667,3966.95,1337.5622,4667,UnitedHealthcare,Individual & Family,4386.98,94,,percent of total billed charges,,
Hernia Repair Umbilical Laparoscopic,,25006386,LOCAL,Facility,Outpatient,,,,4667,3966.95,1337.5622,4667,UnitedHealthcare,Medicare Advantage,2286.83,49,,percent of total billed charges,,
Hernia Repair Umbilical Laparoscopic,,25006386,LOCAL,Facility,Inpatient,,,,4667,3966.95,1337.5622,4667,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Hernia Repair Umbilical Laparoscopic,,25006386,LOCAL,Facility,Outpatient,,,,4667,3966.95,1337.5622,4667,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2240.16,48,,percent of total billed charges,,100% of DHS outpatient percentage
Hernia Repair Umbilical Laparoscopic,,25006386,LOCAL,Facility,Inpatient,,,,4667,3966.95,1337.5622,4667,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Urethral Dilitation,,25006581,LOCAL,Facility,Both,,,,2290,1946.5,656.314,2290,Aetna,Commercial,2106.8,92,,percent of total billed charges,,
Urethral Dilitation,,25006581,LOCAL,Facility,Outpatient,,,,2290,1946.5,656.314,2290,Aetna,Medicare Advantage,1122.1,49,,percent of total billed charges,,
Urethral Dilitation,,25006581,LOCAL,Facility,Inpatient,,,,2290,1946.5,656.314,2290,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Urethral Dilitation,,25006581,LOCAL,Facility,Both,,,,2290,1946.5,656.314,2290,Aetna,PPO,2129.7,93,,percent of total billed charges,,
Urethral Dilitation,,25006581,LOCAL,Facility,Both,,,,2290,1946.5,656.314,2290,America's PPO,America's PPO,2199.087,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Urethral Dilitation,,25006581,LOCAL,Facility,Both,,,,2290,1946.5,656.314,2290,BlueCross BlueShield Minnesota, Federal Employee Program,2253.36,98.4,,percent of total billed charges,,
Urethral Dilitation,,25006581,LOCAL,Facility,Both,,,,2290,1946.5,656.314,2290,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,2290,100,,percent of total billed charges,,
Urethral Dilitation,,25006581,LOCAL,Facility,Both,,,,2290,1946.5,656.314,2290,BlueCross BlueShield Minnesota,High Value Network Plan,2061,90,,percent of total billed charges,,
Urethral Dilitation,,25006581,LOCAL,Facility,Outpatient,,,,2290,1946.5,656.314,2290,BlueCross BlueShield Minnesota,Medicare Advantage,1122.1,49,,percent of total billed charges,,
Urethral Dilitation,,25006581,LOCAL,Facility,Inpatient,,,,2290,1946.5,656.314,2290,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Urethral Dilitation,,25006581,LOCAL,Facility,Both,,,,2290,1946.5,656.314,2290,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,2028.253,88.57,,percent of total billed charges,,
Urethral Dilitation,,25006581,LOCAL,Facility,Both,,,,2290,1946.5,656.314,2290,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,656.314,28.66,,percent of total billed charges,,
Urethral Dilitation,,25006581,LOCAL,Facility,Outpatient,,,,2290,1946.5,656.314,2290,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1122.1,49,,percent of total billed charges,,
Urethral Dilitation,,25006581,LOCAL,Facility,Inpatient,,,,2290,1946.5,656.314,2290,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Urethral Dilitation,,25006581,LOCAL,Facility,Both,,,,2290,1946.5,656.314,2290,CorVel,Worker's Compensation,2290,100,,percent of total billed charges,,
Urethral Dilitation,,25006581,LOCAL,Facility,Both,,,,2290,1946.5,656.314,2290,First Health Group Corporation,First Health Network,2221.3,97,,percent of total billed charges,,
Urethral Dilitation,,25006581,LOCAL,Facility,Both,,,,2290,1946.5,656.314,2290,"Health Partners, Inc.",Commercial,2166.34,94.6,,percent of total billed charges,,
Urethral Dilitation,,25006581,LOCAL,Facility,Outpatient,,,,2290,1946.5,656.314,2290,"Health Partners, Inc.",Medicare Advantage,1122.1,49,,percent of total billed charges,,
Urethral Dilitation,,25006581,LOCAL,Facility,Inpatient,,,,2290,1946.5,656.314,2290,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Urethral Dilitation,,25006581,LOCAL,Facility,Both,,,,2290,1946.5,656.314,2290,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1374,60,,percent of total billed charges,,
Urethral Dilitation,,25006581,LOCAL,Facility,Both,,,,2290,1946.5,656.314,2290,"Health Partners, Inc.",State of Minnesota Advantage Program,1866.35,81.5,,percent of total billed charges,,
Urethral Dilitation,,25006581,LOCAL,Facility,Both,,,,2290,1946.5,656.314,2290,"Health Partners, Inc.",State Public Programs,1145,50,,percent of total billed charges,,
Urethral Dilitation,,25006581,LOCAL,Facility,Both,,,,2290,1946.5,656.314,2290,Humana Insurance Company,Commercial PPO,2175.5,95,,percent of total billed charges,,
Urethral Dilitation,,25006581,LOCAL,Facility,Outpatient,,,,2290,1946.5,656.314,2290,Humana Insurance Company,Medicare PPO,1122.1,49,,percent of total billed charges,,
Urethral Dilitation,,25006581,LOCAL,Facility,Inpatient,,,,2290,1946.5,656.314,2290,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Urethral Dilitation,,25006581,LOCAL,Facility,Both,,,,2290,1946.5,656.314,2290,Medica,Individual & Family,2269.39,99.1,,percent of total billed charges,,
Urethral Dilitation,,25006581,LOCAL,Facility,Outpatient,,,,2290,1946.5,656.314,2290,Medica,Medica Advantage Solution,1140.42,49.8,,percent of total billed charges,,
Urethral Dilitation,,25006581,LOCAL,Facility,Inpatient,,,,2290,1946.5,656.314,2290,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Urethral Dilitation,,25006581,LOCAL,Facility,Outpatient,,,,2290,1946.5,656.314,2290,Medica,Medical Assistance,1021.34,44.6,,percent of total billed charges,,
Urethral Dilitation,,25006581,LOCAL,Facility,Inpatient,,,,2290,1946.5,656.314,2290,Medica,Medical Assistance,,,,,Included in per diem rate,
Urethral Dilitation,,25006581,LOCAL,Facility,Outpatient,,,,2290,1946.5,656.314,2290,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1140.42,49.8,,percent of total billed charges,,
Urethral Dilitation,,25006581,LOCAL,Facility,Inpatient,,,,2290,1946.5,656.314,2290,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Urethral Dilitation,,25006581,LOCAL,Facility,Both,,,,2290,1946.5,656.314,2290,"Multiplan, Inc.","Multiplan, Inc.",2152.6,94,,percent of total billed charges,,
Urethral Dilitation,,25006581,LOCAL,Facility,Outpatient,,,,2290,1946.5,656.314,2290,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,2063.29,90.1,,percent of total billed charges,,
Urethral Dilitation,,25006581,LOCAL,Facility,Inpatient,,,,2290,1946.5,656.314,2290,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Urethral Dilitation,,25006581,LOCAL,Facility,Both,,,,2290,1946.5,656.314,2290,"Preferred One Administrative Services, INC.",PPO,2257.94,98.6,,percent of total billed charges,,
Urethral Dilitation,,25006581,LOCAL,Facility,Outpatient,,,,2290,1946.5,656.314,2290,PrimeWest Health,Minnesota Senior Health Options (MSHO),1178.205,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Urethral Dilitation,,25006581,LOCAL,Facility,Inpatient,,,,2290,1946.5,656.314,2290,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Urethral Dilitation,,25006581,LOCAL,Facility,Outpatient,,,,2290,1946.5,656.314,2290,PrimeWest Health,MinnesotaCare,1176.144,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Urethral Dilitation,,25006581,LOCAL,Facility,Inpatient,,,,2290,1946.5,656.314,2290,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Urethral Dilitation,,25006581,LOCAL,Facility,Both,,,,2290,1946.5,656.314,2290,Sanford Health Plan,Sanford Health Plan,2106.8,92,,percent of total billed charges,,
Urethral Dilitation,,25006581,LOCAL,Facility,Outpatient,,,,2290,1946.5,656.314,2290,"UCare Health, Inc.",Individual & Family Plan,1290.415,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Urethral Dilitation,,25006581,LOCAL,Facility,Inpatient,,,,2290,1946.5,656.314,2290,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Urethral Dilitation,,25006581,LOCAL,Facility,Outpatient,,,,2290,1946.5,656.314,2290,"UCare Health, Inc.",Medical Assistance,1155.763,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Urethral Dilitation,,25006581,LOCAL,Facility,Inpatient,,,,2290,1946.5,656.314,2290,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Urethral Dilitation,,25006581,LOCAL,Facility,Outpatient,,,,2290,1946.5,656.314,2290,"UCare Health, Inc.",Medicare Advantage,1155.763,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Urethral Dilitation,,25006581,LOCAL,Facility,Inpatient,,,,2290,1946.5,656.314,2290,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Urethral Dilitation,,25006581,LOCAL,Facility,Outpatient,,,,2290,1946.5,656.314,2290,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1155.763,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Urethral Dilitation,,25006581,LOCAL,Facility,Inpatient,,,,2290,1946.5,656.314,2290,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Urethral Dilitation,,25006581,LOCAL,Facility,Both,,,,2290,1946.5,656.314,2290,UnitedHealthcare,Individual & Family,2152.6,94,,percent of total billed charges,,
Urethral Dilitation,,25006581,LOCAL,Facility,Outpatient,,,,2290,1946.5,656.314,2290,UnitedHealthcare,Medicare Advantage,1122.1,49,,percent of total billed charges,,
Urethral Dilitation,,25006581,LOCAL,Facility,Inpatient,,,,2290,1946.5,656.314,2290,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Urethral Dilitation,,25006581,LOCAL,Facility,Outpatient,,,,2290,1946.5,656.314,2290,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1099.2,48,,percent of total billed charges,,100% of DHS outpatient percentage
Urethral Dilitation,,25006581,LOCAL,Facility,Inpatient,,,,2290,1946.5,656.314,2290,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Osteotomy Of Other Phalanges, Any Toe",,25006724,LOCAL,Facility,Both,,,,3698,3143.3,1059.8468,3698,Aetna,Commercial,3402.16,92,,percent of total billed charges,,
"Osteotomy Of Other Phalanges, Any Toe",,25006724,LOCAL,Facility,Outpatient,,,,3698,3143.3,1059.8468,3698,Aetna,Medicare Advantage,1812.02,49,,percent of total billed charges,,
"Osteotomy Of Other Phalanges, Any Toe",,25006724,LOCAL,Facility,Inpatient,,,,3698,3143.3,1059.8468,3698,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Osteotomy Of Other Phalanges, Any Toe",,25006724,LOCAL,Facility,Both,,,,3698,3143.3,1059.8468,3698,Aetna,PPO,3439.14,93,,percent of total billed charges,,
"Osteotomy Of Other Phalanges, Any Toe",,25006724,LOCAL,Facility,Both,,,,3698,3143.3,1059.8468,3698,America's PPO,America's PPO,3551.1894,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Osteotomy Of Other Phalanges, Any Toe",,25006724,LOCAL,Facility,Both,,,,3698,3143.3,1059.8468,3698,BlueCross BlueShield Minnesota, Federal Employee Program,3638.832,98.4,,percent of total billed charges,,
"Osteotomy Of Other Phalanges, Any Toe",,25006724,LOCAL,Facility,Both,,,,3698,3143.3,1059.8468,3698,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,3698,100,,percent of total billed charges,,
"Osteotomy Of Other Phalanges, Any Toe",,25006724,LOCAL,Facility,Both,,,,3698,3143.3,1059.8468,3698,BlueCross BlueShield Minnesota,High Value Network Plan,3328.2,90,,percent of total billed charges,,
"Osteotomy Of Other Phalanges, Any Toe",,25006724,LOCAL,Facility,Outpatient,,,,3698,3143.3,1059.8468,3698,BlueCross BlueShield Minnesota,Medicare Advantage,1812.02,49,,percent of total billed charges,,
"Osteotomy Of Other Phalanges, Any Toe",,25006724,LOCAL,Facility,Inpatient,,,,3698,3143.3,1059.8468,3698,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Osteotomy Of Other Phalanges, Any Toe",,25006724,LOCAL,Facility,Both,,,,3698,3143.3,1059.8468,3698,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,3275.3186,88.57,,percent of total billed charges,,
"Osteotomy Of Other Phalanges, Any Toe",,25006724,LOCAL,Facility,Both,,,,3698,3143.3,1059.8468,3698,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1059.8468,28.66,,percent of total billed charges,,
"Osteotomy Of Other Phalanges, Any Toe",,25006724,LOCAL,Facility,Outpatient,,,,3698,3143.3,1059.8468,3698,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1812.02,49,,percent of total billed charges,,
"Osteotomy Of Other Phalanges, Any Toe",,25006724,LOCAL,Facility,Inpatient,,,,3698,3143.3,1059.8468,3698,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Osteotomy Of Other Phalanges, Any Toe",,25006724,LOCAL,Facility,Both,,,,3698,3143.3,1059.8468,3698,CorVel,Worker's Compensation,3698,100,,percent of total billed charges,,
"Osteotomy Of Other Phalanges, Any Toe",,25006724,LOCAL,Facility,Both,,,,3698,3143.3,1059.8468,3698,First Health Group Corporation,First Health Network,3587.06,97,,percent of total billed charges,,
"Osteotomy Of Other Phalanges, Any Toe",,25006724,LOCAL,Facility,Both,,,,3698,3143.3,1059.8468,3698,"Health Partners, Inc.",Commercial,3498.308,94.6,,percent of total billed charges,,
"Osteotomy Of Other Phalanges, Any Toe",,25006724,LOCAL,Facility,Outpatient,,,,3698,3143.3,1059.8468,3698,"Health Partners, Inc.",Medicare Advantage,1812.02,49,,percent of total billed charges,,
"Osteotomy Of Other Phalanges, Any Toe",,25006724,LOCAL,Facility,Inpatient,,,,3698,3143.3,1059.8468,3698,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Osteotomy Of Other Phalanges, Any Toe",,25006724,LOCAL,Facility,Both,,,,3698,3143.3,1059.8468,3698,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),2218.8,60,,percent of total billed charges,,
"Osteotomy Of Other Phalanges, Any Toe",,25006724,LOCAL,Facility,Both,,,,3698,3143.3,1059.8468,3698,"Health Partners, Inc.",State of Minnesota Advantage Program,3013.87,81.5,,percent of total billed charges,,
"Osteotomy Of Other Phalanges, Any Toe",,25006724,LOCAL,Facility,Both,,,,3698,3143.3,1059.8468,3698,"Health Partners, Inc.",State Public Programs,1849,50,,percent of total billed charges,,
"Osteotomy Of Other Phalanges, Any Toe",,25006724,LOCAL,Facility,Both,,,,3698,3143.3,1059.8468,3698,Humana Insurance Company,Commercial PPO,3513.1,95,,percent of total billed charges,,
"Osteotomy Of Other Phalanges, Any Toe",,25006724,LOCAL,Facility,Outpatient,,,,3698,3143.3,1059.8468,3698,Humana Insurance Company,Medicare PPO,1812.02,49,,percent of total billed charges,,
"Osteotomy Of Other Phalanges, Any Toe",,25006724,LOCAL,Facility,Inpatient,,,,3698,3143.3,1059.8468,3698,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Osteotomy Of Other Phalanges, Any Toe",,25006724,LOCAL,Facility,Both,,,,3698,3143.3,1059.8468,3698,Medica,Individual & Family,3664.718,99.1,,percent of total billed charges,,
"Osteotomy Of Other Phalanges, Any Toe",,25006724,LOCAL,Facility,Outpatient,,,,3698,3143.3,1059.8468,3698,Medica,Medica Advantage Solution,1841.604,49.8,,percent of total billed charges,,
"Osteotomy Of Other Phalanges, Any Toe",,25006724,LOCAL,Facility,Inpatient,,,,3698,3143.3,1059.8468,3698,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Osteotomy Of Other Phalanges, Any Toe",,25006724,LOCAL,Facility,Outpatient,,,,3698,3143.3,1059.8468,3698,Medica,Medical Assistance,1649.308,44.6,,percent of total billed charges,,
"Osteotomy Of Other Phalanges, Any Toe",,25006724,LOCAL,Facility,Inpatient,,,,3698,3143.3,1059.8468,3698,Medica,Medical Assistance,,,,,Included in per diem rate,
"Osteotomy Of Other Phalanges, Any Toe",,25006724,LOCAL,Facility,Outpatient,,,,3698,3143.3,1059.8468,3698,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1841.604,49.8,,percent of total billed charges,,
"Osteotomy Of Other Phalanges, Any Toe",,25006724,LOCAL,Facility,Inpatient,,,,3698,3143.3,1059.8468,3698,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Osteotomy Of Other Phalanges, Any Toe",,25006724,LOCAL,Facility,Both,,,,3698,3143.3,1059.8468,3698,"Multiplan, Inc.","Multiplan, Inc.",3476.12,94,,percent of total billed charges,,
"Osteotomy Of Other Phalanges, Any Toe",,25006724,LOCAL,Facility,Outpatient,,,,3698,3143.3,1059.8468,3698,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,3331.898,90.1,,percent of total billed charges,,
"Osteotomy Of Other Phalanges, Any Toe",,25006724,LOCAL,Facility,Inpatient,,,,3698,3143.3,1059.8468,3698,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Osteotomy Of Other Phalanges, Any Toe",,25006724,LOCAL,Facility,Both,,,,3698,3143.3,1059.8468,3698,"Preferred One Administrative Services, INC.",PPO,3646.228,98.6,,percent of total billed charges,,
"Osteotomy Of Other Phalanges, Any Toe",,25006724,LOCAL,Facility,Outpatient,,,,3698,3143.3,1059.8468,3698,PrimeWest Health,Minnesota Senior Health Options (MSHO),1902.621,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Osteotomy Of Other Phalanges, Any Toe",,25006724,LOCAL,Facility,Inpatient,,,,3698,3143.3,1059.8468,3698,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Osteotomy Of Other Phalanges, Any Toe",,25006724,LOCAL,Facility,Outpatient,,,,3698,3143.3,1059.8468,3698,PrimeWest Health,MinnesotaCare,1899.2928,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Osteotomy Of Other Phalanges, Any Toe",,25006724,LOCAL,Facility,Inpatient,,,,3698,3143.3,1059.8468,3698,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Osteotomy Of Other Phalanges, Any Toe",,25006724,LOCAL,Facility,Both,,,,3698,3143.3,1059.8468,3698,Sanford Health Plan,Sanford Health Plan,3402.16,92,,percent of total billed charges,,
"Osteotomy Of Other Phalanges, Any Toe",,25006724,LOCAL,Facility,Outpatient,,,,3698,3143.3,1059.8468,3698,"UCare Health, Inc.",Individual & Family Plan,2083.823,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Osteotomy Of Other Phalanges, Any Toe",,25006724,LOCAL,Facility,Inpatient,,,,3698,3143.3,1059.8468,3698,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Osteotomy Of Other Phalanges, Any Toe",,25006724,LOCAL,Facility,Outpatient,,,,3698,3143.3,1059.8468,3698,"UCare Health, Inc.",Medical Assistance,1866.3806,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Osteotomy Of Other Phalanges, Any Toe",,25006724,LOCAL,Facility,Inpatient,,,,3698,3143.3,1059.8468,3698,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Osteotomy Of Other Phalanges, Any Toe",,25006724,LOCAL,Facility,Outpatient,,,,3698,3143.3,1059.8468,3698,"UCare Health, Inc.",Medicare Advantage,1866.3806,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Osteotomy Of Other Phalanges, Any Toe",,25006724,LOCAL,Facility,Inpatient,,,,3698,3143.3,1059.8468,3698,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Osteotomy Of Other Phalanges, Any Toe",,25006724,LOCAL,Facility,Outpatient,,,,3698,3143.3,1059.8468,3698,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1866.3806,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Osteotomy Of Other Phalanges, Any Toe",,25006724,LOCAL,Facility,Inpatient,,,,3698,3143.3,1059.8468,3698,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Osteotomy Of Other Phalanges, Any Toe",,25006724,LOCAL,Facility,Both,,,,3698,3143.3,1059.8468,3698,UnitedHealthcare,Individual & Family,3476.12,94,,percent of total billed charges,,
"Osteotomy Of Other Phalanges, Any Toe",,25006724,LOCAL,Facility,Outpatient,,,,3698,3143.3,1059.8468,3698,UnitedHealthcare,Medicare Advantage,1812.02,49,,percent of total billed charges,,
"Osteotomy Of Other Phalanges, Any Toe",,25006724,LOCAL,Facility,Inpatient,,,,3698,3143.3,1059.8468,3698,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Osteotomy Of Other Phalanges, Any Toe",,25006724,LOCAL,Facility,Outpatient,,,,3698,3143.3,1059.8468,3698,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1775.04,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Osteotomy Of Other Phalanges, Any Toe",,25006724,LOCAL,Facility,Inpatient,,,,3698,3143.3,1059.8468,3698,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Repair Rectal Prolapse,,25006753,LOCAL,Facility,Both,,,,3672,3121.2,1052.3952,3672,Aetna,Commercial,3378.24,92,,percent of total billed charges,,
Repair Rectal Prolapse,,25006753,LOCAL,Facility,Outpatient,,,,3672,3121.2,1052.3952,3672,Aetna,Medicare Advantage,1799.28,49,,percent of total billed charges,,
Repair Rectal Prolapse,,25006753,LOCAL,Facility,Inpatient,,,,3672,3121.2,1052.3952,3672,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Repair Rectal Prolapse,,25006753,LOCAL,Facility,Both,,,,3672,3121.2,1052.3952,3672,Aetna,PPO,3414.96,93,,percent of total billed charges,,
Repair Rectal Prolapse,,25006753,LOCAL,Facility,Both,,,,3672,3121.2,1052.3952,3672,America's PPO,America's PPO,3526.2216,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Repair Rectal Prolapse,,25006753,LOCAL,Facility,Both,,,,3672,3121.2,1052.3952,3672,BlueCross BlueShield Minnesota, Federal Employee Program,3613.248,98.4,,percent of total billed charges,,
Repair Rectal Prolapse,,25006753,LOCAL,Facility,Both,,,,3672,3121.2,1052.3952,3672,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,3672,100,,percent of total billed charges,,
Repair Rectal Prolapse,,25006753,LOCAL,Facility,Both,,,,3672,3121.2,1052.3952,3672,BlueCross BlueShield Minnesota,High Value Network Plan,3304.8,90,,percent of total billed charges,,
Repair Rectal Prolapse,,25006753,LOCAL,Facility,Outpatient,,,,3672,3121.2,1052.3952,3672,BlueCross BlueShield Minnesota,Medicare Advantage,1799.28,49,,percent of total billed charges,,
Repair Rectal Prolapse,,25006753,LOCAL,Facility,Inpatient,,,,3672,3121.2,1052.3952,3672,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Repair Rectal Prolapse,,25006753,LOCAL,Facility,Both,,,,3672,3121.2,1052.3952,3672,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,3252.2904,88.57,,percent of total billed charges,,
Repair Rectal Prolapse,,25006753,LOCAL,Facility,Both,,,,3672,3121.2,1052.3952,3672,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1052.3952,28.66,,percent of total billed charges,,
Repair Rectal Prolapse,,25006753,LOCAL,Facility,Outpatient,,,,3672,3121.2,1052.3952,3672,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1799.28,49,,percent of total billed charges,,
Repair Rectal Prolapse,,25006753,LOCAL,Facility,Inpatient,,,,3672,3121.2,1052.3952,3672,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Repair Rectal Prolapse,,25006753,LOCAL,Facility,Both,,,,3672,3121.2,1052.3952,3672,CorVel,Worker's Compensation,3672,100,,percent of total billed charges,,
Repair Rectal Prolapse,,25006753,LOCAL,Facility,Both,,,,3672,3121.2,1052.3952,3672,First Health Group Corporation,First Health Network,3561.84,97,,percent of total billed charges,,
Repair Rectal Prolapse,,25006753,LOCAL,Facility,Both,,,,3672,3121.2,1052.3952,3672,"Health Partners, Inc.",Commercial,3473.712,94.6,,percent of total billed charges,,
Repair Rectal Prolapse,,25006753,LOCAL,Facility,Outpatient,,,,3672,3121.2,1052.3952,3672,"Health Partners, Inc.",Medicare Advantage,1799.28,49,,percent of total billed charges,,
Repair Rectal Prolapse,,25006753,LOCAL,Facility,Inpatient,,,,3672,3121.2,1052.3952,3672,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Repair Rectal Prolapse,,25006753,LOCAL,Facility,Both,,,,3672,3121.2,1052.3952,3672,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),2203.2,60,,percent of total billed charges,,
Repair Rectal Prolapse,,25006753,LOCAL,Facility,Both,,,,3672,3121.2,1052.3952,3672,"Health Partners, Inc.",State of Minnesota Advantage Program,2992.68,81.5,,percent of total billed charges,,
Repair Rectal Prolapse,,25006753,LOCAL,Facility,Both,,,,3672,3121.2,1052.3952,3672,"Health Partners, Inc.",State Public Programs,1836,50,,percent of total billed charges,,
Repair Rectal Prolapse,,25006753,LOCAL,Facility,Both,,,,3672,3121.2,1052.3952,3672,Humana Insurance Company,Commercial PPO,3488.4,95,,percent of total billed charges,,
Repair Rectal Prolapse,,25006753,LOCAL,Facility,Outpatient,,,,3672,3121.2,1052.3952,3672,Humana Insurance Company,Medicare PPO,1799.28,49,,percent of total billed charges,,
Repair Rectal Prolapse,,25006753,LOCAL,Facility,Inpatient,,,,3672,3121.2,1052.3952,3672,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Repair Rectal Prolapse,,25006753,LOCAL,Facility,Both,,,,3672,3121.2,1052.3952,3672,Medica,Individual & Family,3638.952,99.1,,percent of total billed charges,,
Repair Rectal Prolapse,,25006753,LOCAL,Facility,Outpatient,,,,3672,3121.2,1052.3952,3672,Medica,Medica Advantage Solution,1828.656,49.8,,percent of total billed charges,,
Repair Rectal Prolapse,,25006753,LOCAL,Facility,Inpatient,,,,3672,3121.2,1052.3952,3672,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Repair Rectal Prolapse,,25006753,LOCAL,Facility,Outpatient,,,,3672,3121.2,1052.3952,3672,Medica,Medical Assistance,1637.712,44.6,,percent of total billed charges,,
Repair Rectal Prolapse,,25006753,LOCAL,Facility,Inpatient,,,,3672,3121.2,1052.3952,3672,Medica,Medical Assistance,,,,,Included in per diem rate,
Repair Rectal Prolapse,,25006753,LOCAL,Facility,Outpatient,,,,3672,3121.2,1052.3952,3672,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1828.656,49.8,,percent of total billed charges,,
Repair Rectal Prolapse,,25006753,LOCAL,Facility,Inpatient,,,,3672,3121.2,1052.3952,3672,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Repair Rectal Prolapse,,25006753,LOCAL,Facility,Both,,,,3672,3121.2,1052.3952,3672,"Multiplan, Inc.","Multiplan, Inc.",3451.68,94,,percent of total billed charges,,
Repair Rectal Prolapse,,25006753,LOCAL,Facility,Outpatient,,,,3672,3121.2,1052.3952,3672,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,3308.472,90.1,,percent of total billed charges,,
Repair Rectal Prolapse,,25006753,LOCAL,Facility,Inpatient,,,,3672,3121.2,1052.3952,3672,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Repair Rectal Prolapse,,25006753,LOCAL,Facility,Both,,,,3672,3121.2,1052.3952,3672,"Preferred One Administrative Services, INC.",PPO,3620.592,98.6,,percent of total billed charges,,
Repair Rectal Prolapse,,25006753,LOCAL,Facility,Outpatient,,,,3672,3121.2,1052.3952,3672,PrimeWest Health,Minnesota Senior Health Options (MSHO),1889.244,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Repair Rectal Prolapse,,25006753,LOCAL,Facility,Inpatient,,,,3672,3121.2,1052.3952,3672,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Repair Rectal Prolapse,,25006753,LOCAL,Facility,Outpatient,,,,3672,3121.2,1052.3952,3672,PrimeWest Health,MinnesotaCare,1885.9392,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Repair Rectal Prolapse,,25006753,LOCAL,Facility,Inpatient,,,,3672,3121.2,1052.3952,3672,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Repair Rectal Prolapse,,25006753,LOCAL,Facility,Both,,,,3672,3121.2,1052.3952,3672,Sanford Health Plan,Sanford Health Plan,3378.24,92,,percent of total billed charges,,
Repair Rectal Prolapse,,25006753,LOCAL,Facility,Outpatient,,,,3672,3121.2,1052.3952,3672,"UCare Health, Inc.",Individual & Family Plan,2069.172,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Repair Rectal Prolapse,,25006753,LOCAL,Facility,Inpatient,,,,3672,3121.2,1052.3952,3672,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Repair Rectal Prolapse,,25006753,LOCAL,Facility,Outpatient,,,,3672,3121.2,1052.3952,3672,"UCare Health, Inc.",Medical Assistance,1853.2584,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Repair Rectal Prolapse,,25006753,LOCAL,Facility,Inpatient,,,,3672,3121.2,1052.3952,3672,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Repair Rectal Prolapse,,25006753,LOCAL,Facility,Outpatient,,,,3672,3121.2,1052.3952,3672,"UCare Health, Inc.",Medicare Advantage,1853.2584,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Repair Rectal Prolapse,,25006753,LOCAL,Facility,Inpatient,,,,3672,3121.2,1052.3952,3672,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Repair Rectal Prolapse,,25006753,LOCAL,Facility,Outpatient,,,,3672,3121.2,1052.3952,3672,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1853.2584,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Repair Rectal Prolapse,,25006753,LOCAL,Facility,Inpatient,,,,3672,3121.2,1052.3952,3672,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Repair Rectal Prolapse,,25006753,LOCAL,Facility,Both,,,,3672,3121.2,1052.3952,3672,UnitedHealthcare,Individual & Family,3451.68,94,,percent of total billed charges,,
Repair Rectal Prolapse,,25006753,LOCAL,Facility,Outpatient,,,,3672,3121.2,1052.3952,3672,UnitedHealthcare,Medicare Advantage,1799.28,49,,percent of total billed charges,,
Repair Rectal Prolapse,,25006753,LOCAL,Facility,Inpatient,,,,3672,3121.2,1052.3952,3672,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Repair Rectal Prolapse,,25006753,LOCAL,Facility,Outpatient,,,,3672,3121.2,1052.3952,3672,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1762.56,48,,percent of total billed charges,,100% of DHS outpatient percentage
Repair Rectal Prolapse,,25006753,LOCAL,Facility,Inpatient,,,,3672,3121.2,1052.3952,3672,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Removal Of Iud,,25007216,LOCAL,Facility,Both,,,,1530,1300.5,438.498,1530,Aetna,Commercial,1407.6,92,,percent of total billed charges,,
Removal Of Iud,,25007216,LOCAL,Facility,Outpatient,,,,1530,1300.5,438.498,1530,Aetna,Medicare Advantage,749.7,49,,percent of total billed charges,,
Removal Of Iud,,25007216,LOCAL,Facility,Inpatient,,,,1530,1300.5,438.498,1530,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Removal Of Iud,,25007216,LOCAL,Facility,Both,,,,1530,1300.5,438.498,1530,Aetna,PPO,1422.9,93,,percent of total billed charges,,
Removal Of Iud,,25007216,LOCAL,Facility,Both,,,,1530,1300.5,438.498,1530,America's PPO,America's PPO,1469.259,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Removal Of Iud,,25007216,LOCAL,Facility,Both,,,,1530,1300.5,438.498,1530,BlueCross BlueShield Minnesota, Federal Employee Program,1505.52,98.4,,percent of total billed charges,,
Removal Of Iud,,25007216,LOCAL,Facility,Both,,,,1530,1300.5,438.498,1530,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1530,100,,percent of total billed charges,,
Removal Of Iud,,25007216,LOCAL,Facility,Both,,,,1530,1300.5,438.498,1530,BlueCross BlueShield Minnesota,High Value Network Plan,1377,90,,percent of total billed charges,,
Removal Of Iud,,25007216,LOCAL,Facility,Outpatient,,,,1530,1300.5,438.498,1530,BlueCross BlueShield Minnesota,Medicare Advantage,749.7,49,,percent of total billed charges,,
Removal Of Iud,,25007216,LOCAL,Facility,Inpatient,,,,1530,1300.5,438.498,1530,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Removal Of Iud,,25007216,LOCAL,Facility,Both,,,,1530,1300.5,438.498,1530,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1355.121,88.57,,percent of total billed charges,,
Removal Of Iud,,25007216,LOCAL,Facility,Both,,,,1530,1300.5,438.498,1530,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,438.498,28.66,,percent of total billed charges,,
Removal Of Iud,,25007216,LOCAL,Facility,Outpatient,,,,1530,1300.5,438.498,1530,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),749.7,49,,percent of total billed charges,,
Removal Of Iud,,25007216,LOCAL,Facility,Inpatient,,,,1530,1300.5,438.498,1530,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Removal Of Iud,,25007216,LOCAL,Facility,Both,,,,1530,1300.5,438.498,1530,CorVel,Worker's Compensation,1530,100,,percent of total billed charges,,
Removal Of Iud,,25007216,LOCAL,Facility,Both,,,,1530,1300.5,438.498,1530,First Health Group Corporation,First Health Network,1484.1,97,,percent of total billed charges,,
Removal Of Iud,,25007216,LOCAL,Facility,Both,,,,1530,1300.5,438.498,1530,"Health Partners, Inc.",Commercial,1447.38,94.6,,percent of total billed charges,,
Removal Of Iud,,25007216,LOCAL,Facility,Outpatient,,,,1530,1300.5,438.498,1530,"Health Partners, Inc.",Medicare Advantage,749.7,49,,percent of total billed charges,,
Removal Of Iud,,25007216,LOCAL,Facility,Inpatient,,,,1530,1300.5,438.498,1530,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Removal Of Iud,,25007216,LOCAL,Facility,Both,,,,1530,1300.5,438.498,1530,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),918,60,,percent of total billed charges,,
Removal Of Iud,,25007216,LOCAL,Facility,Both,,,,1530,1300.5,438.498,1530,"Health Partners, Inc.",State of Minnesota Advantage Program,1246.95,81.5,,percent of total billed charges,,
Removal Of Iud,,25007216,LOCAL,Facility,Both,,,,1530,1300.5,438.498,1530,"Health Partners, Inc.",State Public Programs,765,50,,percent of total billed charges,,
Removal Of Iud,,25007216,LOCAL,Facility,Both,,,,1530,1300.5,438.498,1530,Humana Insurance Company,Commercial PPO,1453.5,95,,percent of total billed charges,,
Removal Of Iud,,25007216,LOCAL,Facility,Outpatient,,,,1530,1300.5,438.498,1530,Humana Insurance Company,Medicare PPO,749.7,49,,percent of total billed charges,,
Removal Of Iud,,25007216,LOCAL,Facility,Inpatient,,,,1530,1300.5,438.498,1530,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Removal Of Iud,,25007216,LOCAL,Facility,Both,,,,1530,1300.5,438.498,1530,Medica,Individual & Family,1516.23,99.1,,percent of total billed charges,,
Removal Of Iud,,25007216,LOCAL,Facility,Outpatient,,,,1530,1300.5,438.498,1530,Medica,Medica Advantage Solution,761.94,49.8,,percent of total billed charges,,
Removal Of Iud,,25007216,LOCAL,Facility,Inpatient,,,,1530,1300.5,438.498,1530,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Removal Of Iud,,25007216,LOCAL,Facility,Outpatient,,,,1530,1300.5,438.498,1530,Medica,Medical Assistance,682.38,44.6,,percent of total billed charges,,
Removal Of Iud,,25007216,LOCAL,Facility,Inpatient,,,,1530,1300.5,438.498,1530,Medica,Medical Assistance,,,,,Included in per diem rate,
Removal Of Iud,,25007216,LOCAL,Facility,Outpatient,,,,1530,1300.5,438.498,1530,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,761.94,49.8,,percent of total billed charges,,
Removal Of Iud,,25007216,LOCAL,Facility,Inpatient,,,,1530,1300.5,438.498,1530,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Removal Of Iud,,25007216,LOCAL,Facility,Both,,,,1530,1300.5,438.498,1530,"Multiplan, Inc.","Multiplan, Inc.",1438.2,94,,percent of total billed charges,,
Removal Of Iud,,25007216,LOCAL,Facility,Outpatient,,,,1530,1300.5,438.498,1530,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1378.53,90.1,,percent of total billed charges,,
Removal Of Iud,,25007216,LOCAL,Facility,Inpatient,,,,1530,1300.5,438.498,1530,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Removal Of Iud,,25007216,LOCAL,Facility,Both,,,,1530,1300.5,438.498,1530,"Preferred One Administrative Services, INC.",PPO,1508.58,98.6,,percent of total billed charges,,
Removal Of Iud,,25007216,LOCAL,Facility,Outpatient,,,,1530,1300.5,438.498,1530,PrimeWest Health,Minnesota Senior Health Options (MSHO),787.185,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Removal Of Iud,,25007216,LOCAL,Facility,Inpatient,,,,1530,1300.5,438.498,1530,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Removal Of Iud,,25007216,LOCAL,Facility,Outpatient,,,,1530,1300.5,438.498,1530,PrimeWest Health,MinnesotaCare,785.808,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Removal Of Iud,,25007216,LOCAL,Facility,Inpatient,,,,1530,1300.5,438.498,1530,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Removal Of Iud,,25007216,LOCAL,Facility,Both,,,,1530,1300.5,438.498,1530,Sanford Health Plan,Sanford Health Plan,1407.6,92,,percent of total billed charges,,
Removal Of Iud,,25007216,LOCAL,Facility,Outpatient,,,,1530,1300.5,438.498,1530,"UCare Health, Inc.",Individual & Family Plan,862.155,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Removal Of Iud,,25007216,LOCAL,Facility,Inpatient,,,,1530,1300.5,438.498,1530,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Removal Of Iud,,25007216,LOCAL,Facility,Outpatient,,,,1530,1300.5,438.498,1530,"UCare Health, Inc.",Medical Assistance,772.191,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Removal Of Iud,,25007216,LOCAL,Facility,Inpatient,,,,1530,1300.5,438.498,1530,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Removal Of Iud,,25007216,LOCAL,Facility,Outpatient,,,,1530,1300.5,438.498,1530,"UCare Health, Inc.",Medicare Advantage,772.191,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Removal Of Iud,,25007216,LOCAL,Facility,Inpatient,,,,1530,1300.5,438.498,1530,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Removal Of Iud,,25007216,LOCAL,Facility,Outpatient,,,,1530,1300.5,438.498,1530,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),772.191,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Removal Of Iud,,25007216,LOCAL,Facility,Inpatient,,,,1530,1300.5,438.498,1530,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Removal Of Iud,,25007216,LOCAL,Facility,Both,,,,1530,1300.5,438.498,1530,UnitedHealthcare,Individual & Family,1438.2,94,,percent of total billed charges,,
Removal Of Iud,,25007216,LOCAL,Facility,Outpatient,,,,1530,1300.5,438.498,1530,UnitedHealthcare,Medicare Advantage,749.7,49,,percent of total billed charges,,
Removal Of Iud,,25007216,LOCAL,Facility,Inpatient,,,,1530,1300.5,438.498,1530,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Removal Of Iud,,25007216,LOCAL,Facility,Outpatient,,,,1530,1300.5,438.498,1530,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,734.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
Removal Of Iud,,25007216,LOCAL,Facility,Inpatient,,,,1530,1300.5,438.498,1530,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Excision Of Malignant Lesion,,25007286,LOCAL,Facility,Both,,,,1887,1603.95,540.8142,1887,Aetna,Commercial,1736.04,92,,percent of total billed charges,,
Excision Of Malignant Lesion,,25007286,LOCAL,Facility,Outpatient,,,,1887,1603.95,540.8142,1887,Aetna,Medicare Advantage,924.63,49,,percent of total billed charges,,
Excision Of Malignant Lesion,,25007286,LOCAL,Facility,Inpatient,,,,1887,1603.95,540.8142,1887,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Excision Of Malignant Lesion,,25007286,LOCAL,Facility,Both,,,,1887,1603.95,540.8142,1887,Aetna,PPO,1754.91,93,,percent of total billed charges,,
Excision Of Malignant Lesion,,25007286,LOCAL,Facility,Both,,,,1887,1603.95,540.8142,1887,America's PPO,America's PPO,1812.0861,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Excision Of Malignant Lesion,,25007286,LOCAL,Facility,Both,,,,1887,1603.95,540.8142,1887,BlueCross BlueShield Minnesota, Federal Employee Program,1856.808,98.4,,percent of total billed charges,,
Excision Of Malignant Lesion,,25007286,LOCAL,Facility,Both,,,,1887,1603.95,540.8142,1887,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1887,100,,percent of total billed charges,,
Excision Of Malignant Lesion,,25007286,LOCAL,Facility,Both,,,,1887,1603.95,540.8142,1887,BlueCross BlueShield Minnesota,High Value Network Plan,1698.3,90,,percent of total billed charges,,
Excision Of Malignant Lesion,,25007286,LOCAL,Facility,Outpatient,,,,1887,1603.95,540.8142,1887,BlueCross BlueShield Minnesota,Medicare Advantage,924.63,49,,percent of total billed charges,,
Excision Of Malignant Lesion,,25007286,LOCAL,Facility,Inpatient,,,,1887,1603.95,540.8142,1887,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Excision Of Malignant Lesion,,25007286,LOCAL,Facility,Both,,,,1887,1603.95,540.8142,1887,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1671.3159,88.57,,percent of total billed charges,,
Excision Of Malignant Lesion,,25007286,LOCAL,Facility,Both,,,,1887,1603.95,540.8142,1887,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,540.8142,28.66,,percent of total billed charges,,
Excision Of Malignant Lesion,,25007286,LOCAL,Facility,Outpatient,,,,1887,1603.95,540.8142,1887,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),924.63,49,,percent of total billed charges,,
Excision Of Malignant Lesion,,25007286,LOCAL,Facility,Inpatient,,,,1887,1603.95,540.8142,1887,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Excision Of Malignant Lesion,,25007286,LOCAL,Facility,Both,,,,1887,1603.95,540.8142,1887,CorVel,Worker's Compensation,1887,100,,percent of total billed charges,,
Excision Of Malignant Lesion,,25007286,LOCAL,Facility,Both,,,,1887,1603.95,540.8142,1887,First Health Group Corporation,First Health Network,1830.39,97,,percent of total billed charges,,
Excision Of Malignant Lesion,,25007286,LOCAL,Facility,Both,,,,1887,1603.95,540.8142,1887,"Health Partners, Inc.",Commercial,1785.102,94.6,,percent of total billed charges,,
Excision Of Malignant Lesion,,25007286,LOCAL,Facility,Outpatient,,,,1887,1603.95,540.8142,1887,"Health Partners, Inc.",Medicare Advantage,924.63,49,,percent of total billed charges,,
Excision Of Malignant Lesion,,25007286,LOCAL,Facility,Inpatient,,,,1887,1603.95,540.8142,1887,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Excision Of Malignant Lesion,,25007286,LOCAL,Facility,Both,,,,1887,1603.95,540.8142,1887,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1132.2,60,,percent of total billed charges,,
Excision Of Malignant Lesion,,25007286,LOCAL,Facility,Both,,,,1887,1603.95,540.8142,1887,"Health Partners, Inc.",State of Minnesota Advantage Program,1537.905,81.5,,percent of total billed charges,,
Excision Of Malignant Lesion,,25007286,LOCAL,Facility,Both,,,,1887,1603.95,540.8142,1887,"Health Partners, Inc.",State Public Programs,943.5,50,,percent of total billed charges,,
Excision Of Malignant Lesion,,25007286,LOCAL,Facility,Both,,,,1887,1603.95,540.8142,1887,Humana Insurance Company,Commercial PPO,1792.65,95,,percent of total billed charges,,
Excision Of Malignant Lesion,,25007286,LOCAL,Facility,Outpatient,,,,1887,1603.95,540.8142,1887,Humana Insurance Company,Medicare PPO,924.63,49,,percent of total billed charges,,
Excision Of Malignant Lesion,,25007286,LOCAL,Facility,Inpatient,,,,1887,1603.95,540.8142,1887,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Excision Of Malignant Lesion,,25007286,LOCAL,Facility,Both,,,,1887,1603.95,540.8142,1887,Medica,Individual & Family,1870.017,99.1,,percent of total billed charges,,
Excision Of Malignant Lesion,,25007286,LOCAL,Facility,Outpatient,,,,1887,1603.95,540.8142,1887,Medica,Medica Advantage Solution,939.726,49.8,,percent of total billed charges,,
Excision Of Malignant Lesion,,25007286,LOCAL,Facility,Inpatient,,,,1887,1603.95,540.8142,1887,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Excision Of Malignant Lesion,,25007286,LOCAL,Facility,Outpatient,,,,1887,1603.95,540.8142,1887,Medica,Medical Assistance,841.602,44.6,,percent of total billed charges,,
Excision Of Malignant Lesion,,25007286,LOCAL,Facility,Inpatient,,,,1887,1603.95,540.8142,1887,Medica,Medical Assistance,,,,,Included in per diem rate,
Excision Of Malignant Lesion,,25007286,LOCAL,Facility,Outpatient,,,,1887,1603.95,540.8142,1887,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,939.726,49.8,,percent of total billed charges,,
Excision Of Malignant Lesion,,25007286,LOCAL,Facility,Inpatient,,,,1887,1603.95,540.8142,1887,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Excision Of Malignant Lesion,,25007286,LOCAL,Facility,Both,,,,1887,1603.95,540.8142,1887,"Multiplan, Inc.","Multiplan, Inc.",1773.78,94,,percent of total billed charges,,
Excision Of Malignant Lesion,,25007286,LOCAL,Facility,Outpatient,,,,1887,1603.95,540.8142,1887,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1700.187,90.1,,percent of total billed charges,,
Excision Of Malignant Lesion,,25007286,LOCAL,Facility,Inpatient,,,,1887,1603.95,540.8142,1887,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Excision Of Malignant Lesion,,25007286,LOCAL,Facility,Both,,,,1887,1603.95,540.8142,1887,"Preferred One Administrative Services, INC.",PPO,1860.582,98.6,,percent of total billed charges,,
Excision Of Malignant Lesion,,25007286,LOCAL,Facility,Outpatient,,,,1887,1603.95,540.8142,1887,PrimeWest Health,Minnesota Senior Health Options (MSHO),970.8615,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Excision Of Malignant Lesion,,25007286,LOCAL,Facility,Inpatient,,,,1887,1603.95,540.8142,1887,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Excision Of Malignant Lesion,,25007286,LOCAL,Facility,Outpatient,,,,1887,1603.95,540.8142,1887,PrimeWest Health,MinnesotaCare,969.1632,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Excision Of Malignant Lesion,,25007286,LOCAL,Facility,Inpatient,,,,1887,1603.95,540.8142,1887,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Excision Of Malignant Lesion,,25007286,LOCAL,Facility,Both,,,,1887,1603.95,540.8142,1887,Sanford Health Plan,Sanford Health Plan,1736.04,92,,percent of total billed charges,,
Excision Of Malignant Lesion,,25007286,LOCAL,Facility,Outpatient,,,,1887,1603.95,540.8142,1887,"UCare Health, Inc.",Individual & Family Plan,1063.3245,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Excision Of Malignant Lesion,,25007286,LOCAL,Facility,Inpatient,,,,1887,1603.95,540.8142,1887,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Excision Of Malignant Lesion,,25007286,LOCAL,Facility,Outpatient,,,,1887,1603.95,540.8142,1887,"UCare Health, Inc.",Medical Assistance,952.3689,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Excision Of Malignant Lesion,,25007286,LOCAL,Facility,Inpatient,,,,1887,1603.95,540.8142,1887,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Excision Of Malignant Lesion,,25007286,LOCAL,Facility,Outpatient,,,,1887,1603.95,540.8142,1887,"UCare Health, Inc.",Medicare Advantage,952.3689,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Excision Of Malignant Lesion,,25007286,LOCAL,Facility,Inpatient,,,,1887,1603.95,540.8142,1887,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Excision Of Malignant Lesion,,25007286,LOCAL,Facility,Outpatient,,,,1887,1603.95,540.8142,1887,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),952.3689,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Excision Of Malignant Lesion,,25007286,LOCAL,Facility,Inpatient,,,,1887,1603.95,540.8142,1887,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Excision Of Malignant Lesion,,25007286,LOCAL,Facility,Both,,,,1887,1603.95,540.8142,1887,UnitedHealthcare,Individual & Family,1773.78,94,,percent of total billed charges,,
Excision Of Malignant Lesion,,25007286,LOCAL,Facility,Outpatient,,,,1887,1603.95,540.8142,1887,UnitedHealthcare,Medicare Advantage,924.63,49,,percent of total billed charges,,
Excision Of Malignant Lesion,,25007286,LOCAL,Facility,Inpatient,,,,1887,1603.95,540.8142,1887,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Excision Of Malignant Lesion,,25007286,LOCAL,Facility,Outpatient,,,,1887,1603.95,540.8142,1887,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,905.76,48,,percent of total billed charges,,100% of DHS outpatient percentage
Excision Of Malignant Lesion,,25007286,LOCAL,Facility,Inpatient,,,,1887,1603.95,540.8142,1887,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Laparoscopic Surgical Repair Of Incisional Hernia Includes Mesh When Used,,25007404,LOCAL,Facility,Both,,,,4616,3923.6,1322.9456,4616,Aetna,Commercial,4246.72,92,,percent of total billed charges,,
Laparoscopic Surgical Repair Of Incisional Hernia Includes Mesh When Used,,25007404,LOCAL,Facility,Outpatient,,,,4616,3923.6,1322.9456,4616,Aetna,Medicare Advantage,2261.84,49,,percent of total billed charges,,
Laparoscopic Surgical Repair Of Incisional Hernia Includes Mesh When Used,,25007404,LOCAL,Facility,Inpatient,,,,4616,3923.6,1322.9456,4616,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Laparoscopic Surgical Repair Of Incisional Hernia Includes Mesh When Used,,25007404,LOCAL,Facility,Both,,,,4616,3923.6,1322.9456,4616,Aetna,PPO,4292.88,93,,percent of total billed charges,,
Laparoscopic Surgical Repair Of Incisional Hernia Includes Mesh When Used,,25007404,LOCAL,Facility,Both,,,,4616,3923.6,1322.9456,4616,America's PPO,America's PPO,4432.7448,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Laparoscopic Surgical Repair Of Incisional Hernia Includes Mesh When Used,,25007404,LOCAL,Facility,Both,,,,4616,3923.6,1322.9456,4616,BlueCross BlueShield Minnesota, Federal Employee Program,4542.144,98.4,,percent of total billed charges,,
Laparoscopic Surgical Repair Of Incisional Hernia Includes Mesh When Used,,25007404,LOCAL,Facility,Both,,,,4616,3923.6,1322.9456,4616,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,4616,100,,percent of total billed charges,,
Laparoscopic Surgical Repair Of Incisional Hernia Includes Mesh When Used,,25007404,LOCAL,Facility,Both,,,,4616,3923.6,1322.9456,4616,BlueCross BlueShield Minnesota,High Value Network Plan,4154.4,90,,percent of total billed charges,,
Laparoscopic Surgical Repair Of Incisional Hernia Includes Mesh When Used,,25007404,LOCAL,Facility,Outpatient,,,,4616,3923.6,1322.9456,4616,BlueCross BlueShield Minnesota,Medicare Advantage,2261.84,49,,percent of total billed charges,,
Laparoscopic Surgical Repair Of Incisional Hernia Includes Mesh When Used,,25007404,LOCAL,Facility,Inpatient,,,,4616,3923.6,1322.9456,4616,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Laparoscopic Surgical Repair Of Incisional Hernia Includes Mesh When Used,,25007404,LOCAL,Facility,Both,,,,4616,3923.6,1322.9456,4616,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4088.3912,88.57,,percent of total billed charges,,
Laparoscopic Surgical Repair Of Incisional Hernia Includes Mesh When Used,,25007404,LOCAL,Facility,Both,,,,4616,3923.6,1322.9456,4616,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1322.9456,28.66,,percent of total billed charges,,
Laparoscopic Surgical Repair Of Incisional Hernia Includes Mesh When Used,,25007404,LOCAL,Facility,Outpatient,,,,4616,3923.6,1322.9456,4616,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2261.84,49,,percent of total billed charges,,
Laparoscopic Surgical Repair Of Incisional Hernia Includes Mesh When Used,,25007404,LOCAL,Facility,Inpatient,,,,4616,3923.6,1322.9456,4616,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Laparoscopic Surgical Repair Of Incisional Hernia Includes Mesh When Used,,25007404,LOCAL,Facility,Both,,,,4616,3923.6,1322.9456,4616,CorVel,Worker's Compensation,4616,100,,percent of total billed charges,,
Laparoscopic Surgical Repair Of Incisional Hernia Includes Mesh When Used,,25007404,LOCAL,Facility,Both,,,,4616,3923.6,1322.9456,4616,First Health Group Corporation,First Health Network,4477.52,97,,percent of total billed charges,,
Laparoscopic Surgical Repair Of Incisional Hernia Includes Mesh When Used,,25007404,LOCAL,Facility,Both,,,,4616,3923.6,1322.9456,4616,"Health Partners, Inc.",Commercial,4366.736,94.6,,percent of total billed charges,,
Laparoscopic Surgical Repair Of Incisional Hernia Includes Mesh When Used,,25007404,LOCAL,Facility,Outpatient,,,,4616,3923.6,1322.9456,4616,"Health Partners, Inc.",Medicare Advantage,2261.84,49,,percent of total billed charges,,
Laparoscopic Surgical Repair Of Incisional Hernia Includes Mesh When Used,,25007404,LOCAL,Facility,Inpatient,,,,4616,3923.6,1322.9456,4616,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Laparoscopic Surgical Repair Of Incisional Hernia Includes Mesh When Used,,25007404,LOCAL,Facility,Both,,,,4616,3923.6,1322.9456,4616,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),2769.6,60,,percent of total billed charges,,
Laparoscopic Surgical Repair Of Incisional Hernia Includes Mesh When Used,,25007404,LOCAL,Facility,Both,,,,4616,3923.6,1322.9456,4616,"Health Partners, Inc.",State of Minnesota Advantage Program,3762.04,81.5,,percent of total billed charges,,
Laparoscopic Surgical Repair Of Incisional Hernia Includes Mesh When Used,,25007404,LOCAL,Facility,Both,,,,4616,3923.6,1322.9456,4616,"Health Partners, Inc.",State Public Programs,2308,50,,percent of total billed charges,,
Laparoscopic Surgical Repair Of Incisional Hernia Includes Mesh When Used,,25007404,LOCAL,Facility,Both,,,,4616,3923.6,1322.9456,4616,Humana Insurance Company,Commercial PPO,4385.2,95,,percent of total billed charges,,
Laparoscopic Surgical Repair Of Incisional Hernia Includes Mesh When Used,,25007404,LOCAL,Facility,Outpatient,,,,4616,3923.6,1322.9456,4616,Humana Insurance Company,Medicare PPO,2261.84,49,,percent of total billed charges,,
Laparoscopic Surgical Repair Of Incisional Hernia Includes Mesh When Used,,25007404,LOCAL,Facility,Inpatient,,,,4616,3923.6,1322.9456,4616,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Laparoscopic Surgical Repair Of Incisional Hernia Includes Mesh When Used,,25007404,LOCAL,Facility,Both,,,,4616,3923.6,1322.9456,4616,Medica,Individual & Family,4574.456,99.1,,percent of total billed charges,,
Laparoscopic Surgical Repair Of Incisional Hernia Includes Mesh When Used,,25007404,LOCAL,Facility,Outpatient,,,,4616,3923.6,1322.9456,4616,Medica,Medica Advantage Solution,2298.768,49.8,,percent of total billed charges,,
Laparoscopic Surgical Repair Of Incisional Hernia Includes Mesh When Used,,25007404,LOCAL,Facility,Inpatient,,,,4616,3923.6,1322.9456,4616,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Laparoscopic Surgical Repair Of Incisional Hernia Includes Mesh When Used,,25007404,LOCAL,Facility,Outpatient,,,,4616,3923.6,1322.9456,4616,Medica,Medical Assistance,2058.736,44.6,,percent of total billed charges,,
Laparoscopic Surgical Repair Of Incisional Hernia Includes Mesh When Used,,25007404,LOCAL,Facility,Inpatient,,,,4616,3923.6,1322.9456,4616,Medica,Medical Assistance,,,,,Included in per diem rate,
Laparoscopic Surgical Repair Of Incisional Hernia Includes Mesh When Used,,25007404,LOCAL,Facility,Outpatient,,,,4616,3923.6,1322.9456,4616,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2298.768,49.8,,percent of total billed charges,,
Laparoscopic Surgical Repair Of Incisional Hernia Includes Mesh When Used,,25007404,LOCAL,Facility,Inpatient,,,,4616,3923.6,1322.9456,4616,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Laparoscopic Surgical Repair Of Incisional Hernia Includes Mesh When Used,,25007404,LOCAL,Facility,Both,,,,4616,3923.6,1322.9456,4616,"Multiplan, Inc.","Multiplan, Inc.",4339.04,94,,percent of total billed charges,,
Laparoscopic Surgical Repair Of Incisional Hernia Includes Mesh When Used,,25007404,LOCAL,Facility,Outpatient,,,,4616,3923.6,1322.9456,4616,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4159.016,90.1,,percent of total billed charges,,
Laparoscopic Surgical Repair Of Incisional Hernia Includes Mesh When Used,,25007404,LOCAL,Facility,Inpatient,,,,4616,3923.6,1322.9456,4616,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Laparoscopic Surgical Repair Of Incisional Hernia Includes Mesh When Used,,25007404,LOCAL,Facility,Both,,,,4616,3923.6,1322.9456,4616,"Preferred One Administrative Services, INC.",PPO,4551.376,98.6,,percent of total billed charges,,
Laparoscopic Surgical Repair Of Incisional Hernia Includes Mesh When Used,,25007404,LOCAL,Facility,Outpatient,,,,4616,3923.6,1322.9456,4616,PrimeWest Health,Minnesota Senior Health Options (MSHO),2374.932,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Laparoscopic Surgical Repair Of Incisional Hernia Includes Mesh When Used,,25007404,LOCAL,Facility,Inpatient,,,,4616,3923.6,1322.9456,4616,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Laparoscopic Surgical Repair Of Incisional Hernia Includes Mesh When Used,,25007404,LOCAL,Facility,Outpatient,,,,4616,3923.6,1322.9456,4616,PrimeWest Health,MinnesotaCare,2370.7776,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Laparoscopic Surgical Repair Of Incisional Hernia Includes Mesh When Used,,25007404,LOCAL,Facility,Inpatient,,,,4616,3923.6,1322.9456,4616,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Laparoscopic Surgical Repair Of Incisional Hernia Includes Mesh When Used,,25007404,LOCAL,Facility,Both,,,,4616,3923.6,1322.9456,4616,Sanford Health Plan,Sanford Health Plan,4246.72,92,,percent of total billed charges,,
Laparoscopic Surgical Repair Of Incisional Hernia Includes Mesh When Used,,25007404,LOCAL,Facility,Outpatient,,,,4616,3923.6,1322.9456,4616,"UCare Health, Inc.",Individual & Family Plan,2601.116,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Laparoscopic Surgical Repair Of Incisional Hernia Includes Mesh When Used,,25007404,LOCAL,Facility,Inpatient,,,,4616,3923.6,1322.9456,4616,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Laparoscopic Surgical Repair Of Incisional Hernia Includes Mesh When Used,,25007404,LOCAL,Facility,Outpatient,,,,4616,3923.6,1322.9456,4616,"UCare Health, Inc.",Medical Assistance,2329.6952,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Laparoscopic Surgical Repair Of Incisional Hernia Includes Mesh When Used,,25007404,LOCAL,Facility,Inpatient,,,,4616,3923.6,1322.9456,4616,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Laparoscopic Surgical Repair Of Incisional Hernia Includes Mesh When Used,,25007404,LOCAL,Facility,Outpatient,,,,4616,3923.6,1322.9456,4616,"UCare Health, Inc.",Medicare Advantage,2329.6952,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Laparoscopic Surgical Repair Of Incisional Hernia Includes Mesh When Used,,25007404,LOCAL,Facility,Inpatient,,,,4616,3923.6,1322.9456,4616,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Laparoscopic Surgical Repair Of Incisional Hernia Includes Mesh When Used,,25007404,LOCAL,Facility,Outpatient,,,,4616,3923.6,1322.9456,4616,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2329.6952,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Laparoscopic Surgical Repair Of Incisional Hernia Includes Mesh When Used,,25007404,LOCAL,Facility,Inpatient,,,,4616,3923.6,1322.9456,4616,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Laparoscopic Surgical Repair Of Incisional Hernia Includes Mesh When Used,,25007404,LOCAL,Facility,Both,,,,4616,3923.6,1322.9456,4616,UnitedHealthcare,Individual & Family,4339.04,94,,percent of total billed charges,,
Laparoscopic Surgical Repair Of Incisional Hernia Includes Mesh When Used,,25007404,LOCAL,Facility,Outpatient,,,,4616,3923.6,1322.9456,4616,UnitedHealthcare,Medicare Advantage,2261.84,49,,percent of total billed charges,,
Laparoscopic Surgical Repair Of Incisional Hernia Includes Mesh When Used,,25007404,LOCAL,Facility,Inpatient,,,,4616,3923.6,1322.9456,4616,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Laparoscopic Surgical Repair Of Incisional Hernia Includes Mesh When Used,,25007404,LOCAL,Facility,Outpatient,,,,4616,3923.6,1322.9456,4616,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2215.68,48,,percent of total billed charges,,100% of DHS outpatient percentage
Laparoscopic Surgical Repair Of Incisional Hernia Includes Mesh When Used,,25007404,LOCAL,Facility,Inpatient,,,,4616,3923.6,1322.9456,4616,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Total Abdominal Hysterectomy,,25007480,LOCAL,Facility,Both,,,,4692,3988.2,1344.7272,4692,Aetna,Commercial,4316.64,92,,percent of total billed charges,,
Total Abdominal Hysterectomy,,25007480,LOCAL,Facility,Outpatient,,,,4692,3988.2,1344.7272,4692,Aetna,Medicare Advantage,2299.08,49,,percent of total billed charges,,
Total Abdominal Hysterectomy,,25007480,LOCAL,Facility,Inpatient,,,,4692,3988.2,1344.7272,4692,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Total Abdominal Hysterectomy,,25007480,LOCAL,Facility,Both,,,,4692,3988.2,1344.7272,4692,Aetna,PPO,4363.56,93,,percent of total billed charges,,
Total Abdominal Hysterectomy,,25007480,LOCAL,Facility,Both,,,,4692,3988.2,1344.7272,4692,America's PPO,America's PPO,4505.7276,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Total Abdominal Hysterectomy,,25007480,LOCAL,Facility,Both,,,,4692,3988.2,1344.7272,4692,BlueCross BlueShield Minnesota, Federal Employee Program,4616.928,98.4,,percent of total billed charges,,
Total Abdominal Hysterectomy,,25007480,LOCAL,Facility,Both,,,,4692,3988.2,1344.7272,4692,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,4692,100,,percent of total billed charges,,
Total Abdominal Hysterectomy,,25007480,LOCAL,Facility,Both,,,,4692,3988.2,1344.7272,4692,BlueCross BlueShield Minnesota,High Value Network Plan,4222.8,90,,percent of total billed charges,,
Total Abdominal Hysterectomy,,25007480,LOCAL,Facility,Outpatient,,,,4692,3988.2,1344.7272,4692,BlueCross BlueShield Minnesota,Medicare Advantage,2299.08,49,,percent of total billed charges,,
Total Abdominal Hysterectomy,,25007480,LOCAL,Facility,Inpatient,,,,4692,3988.2,1344.7272,4692,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Total Abdominal Hysterectomy,,25007480,LOCAL,Facility,Both,,,,4692,3988.2,1344.7272,4692,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4155.7044,88.57,,percent of total billed charges,,
Total Abdominal Hysterectomy,,25007480,LOCAL,Facility,Both,,,,4692,3988.2,1344.7272,4692,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1344.7272,28.66,,percent of total billed charges,,
Total Abdominal Hysterectomy,,25007480,LOCAL,Facility,Outpatient,,,,4692,3988.2,1344.7272,4692,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2299.08,49,,percent of total billed charges,,
Total Abdominal Hysterectomy,,25007480,LOCAL,Facility,Inpatient,,,,4692,3988.2,1344.7272,4692,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Total Abdominal Hysterectomy,,25007480,LOCAL,Facility,Both,,,,4692,3988.2,1344.7272,4692,CorVel,Worker's Compensation,4692,100,,percent of total billed charges,,
Total Abdominal Hysterectomy,,25007480,LOCAL,Facility,Both,,,,4692,3988.2,1344.7272,4692,First Health Group Corporation,First Health Network,4551.24,97,,percent of total billed charges,,
Total Abdominal Hysterectomy,,25007480,LOCAL,Facility,Both,,,,4692,3988.2,1344.7272,4692,"Health Partners, Inc.",Commercial,4438.632,94.6,,percent of total billed charges,,
Total Abdominal Hysterectomy,,25007480,LOCAL,Facility,Outpatient,,,,4692,3988.2,1344.7272,4692,"Health Partners, Inc.",Medicare Advantage,2299.08,49,,percent of total billed charges,,
Total Abdominal Hysterectomy,,25007480,LOCAL,Facility,Inpatient,,,,4692,3988.2,1344.7272,4692,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Total Abdominal Hysterectomy,,25007480,LOCAL,Facility,Both,,,,4692,3988.2,1344.7272,4692,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),2815.2,60,,percent of total billed charges,,
Total Abdominal Hysterectomy,,25007480,LOCAL,Facility,Both,,,,4692,3988.2,1344.7272,4692,"Health Partners, Inc.",State of Minnesota Advantage Program,3823.98,81.5,,percent of total billed charges,,
Total Abdominal Hysterectomy,,25007480,LOCAL,Facility,Both,,,,4692,3988.2,1344.7272,4692,"Health Partners, Inc.",State Public Programs,2346,50,,percent of total billed charges,,
Total Abdominal Hysterectomy,,25007480,LOCAL,Facility,Both,,,,4692,3988.2,1344.7272,4692,Humana Insurance Company,Commercial PPO,4457.4,95,,percent of total billed charges,,
Total Abdominal Hysterectomy,,25007480,LOCAL,Facility,Outpatient,,,,4692,3988.2,1344.7272,4692,Humana Insurance Company,Medicare PPO,2299.08,49,,percent of total billed charges,,
Total Abdominal Hysterectomy,,25007480,LOCAL,Facility,Inpatient,,,,4692,3988.2,1344.7272,4692,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Total Abdominal Hysterectomy,,25007480,LOCAL,Facility,Both,,,,4692,3988.2,1344.7272,4692,Medica,Individual & Family,4649.772,99.1,,percent of total billed charges,,
Total Abdominal Hysterectomy,,25007480,LOCAL,Facility,Outpatient,,,,4692,3988.2,1344.7272,4692,Medica,Medica Advantage Solution,2336.616,49.8,,percent of total billed charges,,
Total Abdominal Hysterectomy,,25007480,LOCAL,Facility,Inpatient,,,,4692,3988.2,1344.7272,4692,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Total Abdominal Hysterectomy,,25007480,LOCAL,Facility,Outpatient,,,,4692,3988.2,1344.7272,4692,Medica,Medical Assistance,2092.632,44.6,,percent of total billed charges,,
Total Abdominal Hysterectomy,,25007480,LOCAL,Facility,Inpatient,,,,4692,3988.2,1344.7272,4692,Medica,Medical Assistance,,,,,Included in per diem rate,
Total Abdominal Hysterectomy,,25007480,LOCAL,Facility,Outpatient,,,,4692,3988.2,1344.7272,4692,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2336.616,49.8,,percent of total billed charges,,
Total Abdominal Hysterectomy,,25007480,LOCAL,Facility,Inpatient,,,,4692,3988.2,1344.7272,4692,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Total Abdominal Hysterectomy,,25007480,LOCAL,Facility,Both,,,,4692,3988.2,1344.7272,4692,"Multiplan, Inc.","Multiplan, Inc.",4410.48,94,,percent of total billed charges,,
Total Abdominal Hysterectomy,,25007480,LOCAL,Facility,Outpatient,,,,4692,3988.2,1344.7272,4692,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4227.492,90.1,,percent of total billed charges,,
Total Abdominal Hysterectomy,,25007480,LOCAL,Facility,Inpatient,,,,4692,3988.2,1344.7272,4692,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Total Abdominal Hysterectomy,,25007480,LOCAL,Facility,Both,,,,4692,3988.2,1344.7272,4692,"Preferred One Administrative Services, INC.",PPO,4626.312,98.6,,percent of total billed charges,,
Total Abdominal Hysterectomy,,25007480,LOCAL,Facility,Outpatient,,,,4692,3988.2,1344.7272,4692,PrimeWest Health,Minnesota Senior Health Options (MSHO),2414.034,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Total Abdominal Hysterectomy,,25007480,LOCAL,Facility,Inpatient,,,,4692,3988.2,1344.7272,4692,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Total Abdominal Hysterectomy,,25007480,LOCAL,Facility,Outpatient,,,,4692,3988.2,1344.7272,4692,PrimeWest Health,MinnesotaCare,2409.8112,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Total Abdominal Hysterectomy,,25007480,LOCAL,Facility,Inpatient,,,,4692,3988.2,1344.7272,4692,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Total Abdominal Hysterectomy,,25007480,LOCAL,Facility,Both,,,,4692,3988.2,1344.7272,4692,Sanford Health Plan,Sanford Health Plan,4316.64,92,,percent of total billed charges,,
Total Abdominal Hysterectomy,,25007480,LOCAL,Facility,Outpatient,,,,4692,3988.2,1344.7272,4692,"UCare Health, Inc.",Individual & Family Plan,2643.942,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Total Abdominal Hysterectomy,,25007480,LOCAL,Facility,Inpatient,,,,4692,3988.2,1344.7272,4692,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Total Abdominal Hysterectomy,,25007480,LOCAL,Facility,Outpatient,,,,4692,3988.2,1344.7272,4692,"UCare Health, Inc.",Medical Assistance,2368.0524,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Total Abdominal Hysterectomy,,25007480,LOCAL,Facility,Inpatient,,,,4692,3988.2,1344.7272,4692,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Total Abdominal Hysterectomy,,25007480,LOCAL,Facility,Outpatient,,,,4692,3988.2,1344.7272,4692,"UCare Health, Inc.",Medicare Advantage,2368.0524,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Total Abdominal Hysterectomy,,25007480,LOCAL,Facility,Inpatient,,,,4692,3988.2,1344.7272,4692,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Total Abdominal Hysterectomy,,25007480,LOCAL,Facility,Outpatient,,,,4692,3988.2,1344.7272,4692,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2368.0524,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Total Abdominal Hysterectomy,,25007480,LOCAL,Facility,Inpatient,,,,4692,3988.2,1344.7272,4692,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Total Abdominal Hysterectomy,,25007480,LOCAL,Facility,Both,,,,4692,3988.2,1344.7272,4692,UnitedHealthcare,Individual & Family,4410.48,94,,percent of total billed charges,,
Total Abdominal Hysterectomy,,25007480,LOCAL,Facility,Outpatient,,,,4692,3988.2,1344.7272,4692,UnitedHealthcare,Medicare Advantage,2299.08,49,,percent of total billed charges,,
Total Abdominal Hysterectomy,,25007480,LOCAL,Facility,Inpatient,,,,4692,3988.2,1344.7272,4692,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Total Abdominal Hysterectomy,,25007480,LOCAL,Facility,Outpatient,,,,4692,3988.2,1344.7272,4692,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2252.16,48,,percent of total billed charges,,100% of DHS outpatient percentage
Total Abdominal Hysterectomy,,25007480,LOCAL,Facility,Inpatient,,,,4692,3988.2,1344.7272,4692,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Excision Benign Lesion,,25007553,LOCAL,Facility,Both,,,,1964,1669.4,562.8824,1964,Aetna,Commercial,1806.88,92,,percent of total billed charges,,
Excision Benign Lesion,,25007553,LOCAL,Facility,Outpatient,,,,1964,1669.4,562.8824,1964,Aetna,Medicare Advantage,962.36,49,,percent of total billed charges,,
Excision Benign Lesion,,25007553,LOCAL,Facility,Inpatient,,,,1964,1669.4,562.8824,1964,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Excision Benign Lesion,,25007553,LOCAL,Facility,Both,,,,1964,1669.4,562.8824,1964,Aetna,PPO,1826.52,93,,percent of total billed charges,,
Excision Benign Lesion,,25007553,LOCAL,Facility,Both,,,,1964,1669.4,562.8824,1964,America's PPO,America's PPO,1886.0292,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Excision Benign Lesion,,25007553,LOCAL,Facility,Both,,,,1964,1669.4,562.8824,1964,BlueCross BlueShield Minnesota, Federal Employee Program,1932.576,98.4,,percent of total billed charges,,
Excision Benign Lesion,,25007553,LOCAL,Facility,Both,,,,1964,1669.4,562.8824,1964,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1964,100,,percent of total billed charges,,
Excision Benign Lesion,,25007553,LOCAL,Facility,Both,,,,1964,1669.4,562.8824,1964,BlueCross BlueShield Minnesota,High Value Network Plan,1767.6,90,,percent of total billed charges,,
Excision Benign Lesion,,25007553,LOCAL,Facility,Outpatient,,,,1964,1669.4,562.8824,1964,BlueCross BlueShield Minnesota,Medicare Advantage,962.36,49,,percent of total billed charges,,
Excision Benign Lesion,,25007553,LOCAL,Facility,Inpatient,,,,1964,1669.4,562.8824,1964,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Excision Benign Lesion,,25007553,LOCAL,Facility,Both,,,,1964,1669.4,562.8824,1964,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1739.5148,88.57,,percent of total billed charges,,
Excision Benign Lesion,,25007553,LOCAL,Facility,Both,,,,1964,1669.4,562.8824,1964,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,562.8824,28.66,,percent of total billed charges,,
Excision Benign Lesion,,25007553,LOCAL,Facility,Outpatient,,,,1964,1669.4,562.8824,1964,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),962.36,49,,percent of total billed charges,,
Excision Benign Lesion,,25007553,LOCAL,Facility,Inpatient,,,,1964,1669.4,562.8824,1964,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Excision Benign Lesion,,25007553,LOCAL,Facility,Both,,,,1964,1669.4,562.8824,1964,CorVel,Worker's Compensation,1964,100,,percent of total billed charges,,
Excision Benign Lesion,,25007553,LOCAL,Facility,Both,,,,1964,1669.4,562.8824,1964,First Health Group Corporation,First Health Network,1905.08,97,,percent of total billed charges,,
Excision Benign Lesion,,25007553,LOCAL,Facility,Both,,,,1964,1669.4,562.8824,1964,"Health Partners, Inc.",Commercial,1857.944,94.6,,percent of total billed charges,,
Excision Benign Lesion,,25007553,LOCAL,Facility,Outpatient,,,,1964,1669.4,562.8824,1964,"Health Partners, Inc.",Medicare Advantage,962.36,49,,percent of total billed charges,,
Excision Benign Lesion,,25007553,LOCAL,Facility,Inpatient,,,,1964,1669.4,562.8824,1964,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Excision Benign Lesion,,25007553,LOCAL,Facility,Both,,,,1964,1669.4,562.8824,1964,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1178.4,60,,percent of total billed charges,,
Excision Benign Lesion,,25007553,LOCAL,Facility,Both,,,,1964,1669.4,562.8824,1964,"Health Partners, Inc.",State of Minnesota Advantage Program,1600.66,81.5,,percent of total billed charges,,
Excision Benign Lesion,,25007553,LOCAL,Facility,Both,,,,1964,1669.4,562.8824,1964,"Health Partners, Inc.",State Public Programs,982,50,,percent of total billed charges,,
Excision Benign Lesion,,25007553,LOCAL,Facility,Both,,,,1964,1669.4,562.8824,1964,Humana Insurance Company,Commercial PPO,1865.8,95,,percent of total billed charges,,
Excision Benign Lesion,,25007553,LOCAL,Facility,Outpatient,,,,1964,1669.4,562.8824,1964,Humana Insurance Company,Medicare PPO,962.36,49,,percent of total billed charges,,
Excision Benign Lesion,,25007553,LOCAL,Facility,Inpatient,,,,1964,1669.4,562.8824,1964,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Excision Benign Lesion,,25007553,LOCAL,Facility,Both,,,,1964,1669.4,562.8824,1964,Medica,Individual & Family,1946.324,99.1,,percent of total billed charges,,
Excision Benign Lesion,,25007553,LOCAL,Facility,Outpatient,,,,1964,1669.4,562.8824,1964,Medica,Medica Advantage Solution,978.072,49.8,,percent of total billed charges,,
Excision Benign Lesion,,25007553,LOCAL,Facility,Inpatient,,,,1964,1669.4,562.8824,1964,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Excision Benign Lesion,,25007553,LOCAL,Facility,Outpatient,,,,1964,1669.4,562.8824,1964,Medica,Medical Assistance,875.944,44.6,,percent of total billed charges,,
Excision Benign Lesion,,25007553,LOCAL,Facility,Inpatient,,,,1964,1669.4,562.8824,1964,Medica,Medical Assistance,,,,,Included in per diem rate,
Excision Benign Lesion,,25007553,LOCAL,Facility,Outpatient,,,,1964,1669.4,562.8824,1964,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,978.072,49.8,,percent of total billed charges,,
Excision Benign Lesion,,25007553,LOCAL,Facility,Inpatient,,,,1964,1669.4,562.8824,1964,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Excision Benign Lesion,,25007553,LOCAL,Facility,Both,,,,1964,1669.4,562.8824,1964,"Multiplan, Inc.","Multiplan, Inc.",1846.16,94,,percent of total billed charges,,
Excision Benign Lesion,,25007553,LOCAL,Facility,Outpatient,,,,1964,1669.4,562.8824,1964,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1769.564,90.1,,percent of total billed charges,,
Excision Benign Lesion,,25007553,LOCAL,Facility,Inpatient,,,,1964,1669.4,562.8824,1964,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Excision Benign Lesion,,25007553,LOCAL,Facility,Both,,,,1964,1669.4,562.8824,1964,"Preferred One Administrative Services, INC.",PPO,1936.504,98.6,,percent of total billed charges,,
Excision Benign Lesion,,25007553,LOCAL,Facility,Outpatient,,,,1964,1669.4,562.8824,1964,PrimeWest Health,Minnesota Senior Health Options (MSHO),1010.478,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Excision Benign Lesion,,25007553,LOCAL,Facility,Inpatient,,,,1964,1669.4,562.8824,1964,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Excision Benign Lesion,,25007553,LOCAL,Facility,Outpatient,,,,1964,1669.4,562.8824,1964,PrimeWest Health,MinnesotaCare,1008.7104,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Excision Benign Lesion,,25007553,LOCAL,Facility,Inpatient,,,,1964,1669.4,562.8824,1964,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Excision Benign Lesion,,25007553,LOCAL,Facility,Both,,,,1964,1669.4,562.8824,1964,Sanford Health Plan,Sanford Health Plan,1806.88,92,,percent of total billed charges,,
Excision Benign Lesion,,25007553,LOCAL,Facility,Outpatient,,,,1964,1669.4,562.8824,1964,"UCare Health, Inc.",Individual & Family Plan,1106.714,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Excision Benign Lesion,,25007553,LOCAL,Facility,Inpatient,,,,1964,1669.4,562.8824,1964,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Excision Benign Lesion,,25007553,LOCAL,Facility,Outpatient,,,,1964,1669.4,562.8824,1964,"UCare Health, Inc.",Medical Assistance,991.2308,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Excision Benign Lesion,,25007553,LOCAL,Facility,Inpatient,,,,1964,1669.4,562.8824,1964,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Excision Benign Lesion,,25007553,LOCAL,Facility,Outpatient,,,,1964,1669.4,562.8824,1964,"UCare Health, Inc.",Medicare Advantage,991.2308,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Excision Benign Lesion,,25007553,LOCAL,Facility,Inpatient,,,,1964,1669.4,562.8824,1964,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Excision Benign Lesion,,25007553,LOCAL,Facility,Outpatient,,,,1964,1669.4,562.8824,1964,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),991.2308,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Excision Benign Lesion,,25007553,LOCAL,Facility,Inpatient,,,,1964,1669.4,562.8824,1964,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Excision Benign Lesion,,25007553,LOCAL,Facility,Both,,,,1964,1669.4,562.8824,1964,UnitedHealthcare,Individual & Family,1846.16,94,,percent of total billed charges,,
Excision Benign Lesion,,25007553,LOCAL,Facility,Outpatient,,,,1964,1669.4,562.8824,1964,UnitedHealthcare,Medicare Advantage,962.36,49,,percent of total billed charges,,
Excision Benign Lesion,,25007553,LOCAL,Facility,Inpatient,,,,1964,1669.4,562.8824,1964,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Excision Benign Lesion,,25007553,LOCAL,Facility,Outpatient,,,,1964,1669.4,562.8824,1964,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,942.72,48,,percent of total billed charges,,100% of DHS outpatient percentage
Excision Benign Lesion,,25007553,LOCAL,Facility,Inpatient,,,,1964,1669.4,562.8824,1964,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Blepharoplasty Bilateral,,25007894,LOCAL,Facility,Both,,,,1836,1560.6,526.1976,1836,Aetna,Commercial,1689.12,92,,percent of total billed charges,,
Blepharoplasty Bilateral,,25007894,LOCAL,Facility,Outpatient,,,,1836,1560.6,526.1976,1836,Aetna,Medicare Advantage,899.64,49,,percent of total billed charges,,
Blepharoplasty Bilateral,,25007894,LOCAL,Facility,Inpatient,,,,1836,1560.6,526.1976,1836,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Blepharoplasty Bilateral,,25007894,LOCAL,Facility,Both,,,,1836,1560.6,526.1976,1836,Aetna,PPO,1707.48,93,,percent of total billed charges,,
Blepharoplasty Bilateral,,25007894,LOCAL,Facility,Both,,,,1836,1560.6,526.1976,1836,America's PPO,America's PPO,1763.1108,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Blepharoplasty Bilateral,,25007894,LOCAL,Facility,Both,,,,1836,1560.6,526.1976,1836,BlueCross BlueShield Minnesota, Federal Employee Program,1806.624,98.4,,percent of total billed charges,,
Blepharoplasty Bilateral,,25007894,LOCAL,Facility,Both,,,,1836,1560.6,526.1976,1836,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1836,100,,percent of total billed charges,,
Blepharoplasty Bilateral,,25007894,LOCAL,Facility,Both,,,,1836,1560.6,526.1976,1836,BlueCross BlueShield Minnesota,High Value Network Plan,1652.4,90,,percent of total billed charges,,
Blepharoplasty Bilateral,,25007894,LOCAL,Facility,Outpatient,,,,1836,1560.6,526.1976,1836,BlueCross BlueShield Minnesota,Medicare Advantage,899.64,49,,percent of total billed charges,,
Blepharoplasty Bilateral,,25007894,LOCAL,Facility,Inpatient,,,,1836,1560.6,526.1976,1836,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Blepharoplasty Bilateral,,25007894,LOCAL,Facility,Both,,,,1836,1560.6,526.1976,1836,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1626.1452,88.57,,percent of total billed charges,,
Blepharoplasty Bilateral,,25007894,LOCAL,Facility,Both,,,,1836,1560.6,526.1976,1836,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,526.1976,28.66,,percent of total billed charges,,
Blepharoplasty Bilateral,,25007894,LOCAL,Facility,Outpatient,,,,1836,1560.6,526.1976,1836,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),899.64,49,,percent of total billed charges,,
Blepharoplasty Bilateral,,25007894,LOCAL,Facility,Inpatient,,,,1836,1560.6,526.1976,1836,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Blepharoplasty Bilateral,,25007894,LOCAL,Facility,Both,,,,1836,1560.6,526.1976,1836,CorVel,Worker's Compensation,1836,100,,percent of total billed charges,,
Blepharoplasty Bilateral,,25007894,LOCAL,Facility,Both,,,,1836,1560.6,526.1976,1836,First Health Group Corporation,First Health Network,1780.92,97,,percent of total billed charges,,
Blepharoplasty Bilateral,,25007894,LOCAL,Facility,Both,,,,1836,1560.6,526.1976,1836,"Health Partners, Inc.",Commercial,1736.856,94.6,,percent of total billed charges,,
Blepharoplasty Bilateral,,25007894,LOCAL,Facility,Outpatient,,,,1836,1560.6,526.1976,1836,"Health Partners, Inc.",Medicare Advantage,899.64,49,,percent of total billed charges,,
Blepharoplasty Bilateral,,25007894,LOCAL,Facility,Inpatient,,,,1836,1560.6,526.1976,1836,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Blepharoplasty Bilateral,,25007894,LOCAL,Facility,Both,,,,1836,1560.6,526.1976,1836,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1101.6,60,,percent of total billed charges,,
Blepharoplasty Bilateral,,25007894,LOCAL,Facility,Both,,,,1836,1560.6,526.1976,1836,"Health Partners, Inc.",State of Minnesota Advantage Program,1496.34,81.5,,percent of total billed charges,,
Blepharoplasty Bilateral,,25007894,LOCAL,Facility,Both,,,,1836,1560.6,526.1976,1836,"Health Partners, Inc.",State Public Programs,918,50,,percent of total billed charges,,
Blepharoplasty Bilateral,,25007894,LOCAL,Facility,Both,,,,1836,1560.6,526.1976,1836,Humana Insurance Company,Commercial PPO,1744.2,95,,percent of total billed charges,,
Blepharoplasty Bilateral,,25007894,LOCAL,Facility,Outpatient,,,,1836,1560.6,526.1976,1836,Humana Insurance Company,Medicare PPO,899.64,49,,percent of total billed charges,,
Blepharoplasty Bilateral,,25007894,LOCAL,Facility,Inpatient,,,,1836,1560.6,526.1976,1836,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Blepharoplasty Bilateral,,25007894,LOCAL,Facility,Both,,,,1836,1560.6,526.1976,1836,Medica,Individual & Family,1819.476,99.1,,percent of total billed charges,,
Blepharoplasty Bilateral,,25007894,LOCAL,Facility,Outpatient,,,,1836,1560.6,526.1976,1836,Medica,Medica Advantage Solution,914.328,49.8,,percent of total billed charges,,
Blepharoplasty Bilateral,,25007894,LOCAL,Facility,Inpatient,,,,1836,1560.6,526.1976,1836,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Blepharoplasty Bilateral,,25007894,LOCAL,Facility,Outpatient,,,,1836,1560.6,526.1976,1836,Medica,Medical Assistance,818.856,44.6,,percent of total billed charges,,
Blepharoplasty Bilateral,,25007894,LOCAL,Facility,Inpatient,,,,1836,1560.6,526.1976,1836,Medica,Medical Assistance,,,,,Included in per diem rate,
Blepharoplasty Bilateral,,25007894,LOCAL,Facility,Outpatient,,,,1836,1560.6,526.1976,1836,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,914.328,49.8,,percent of total billed charges,,
Blepharoplasty Bilateral,,25007894,LOCAL,Facility,Inpatient,,,,1836,1560.6,526.1976,1836,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Blepharoplasty Bilateral,,25007894,LOCAL,Facility,Both,,,,1836,1560.6,526.1976,1836,"Multiplan, Inc.","Multiplan, Inc.",1725.84,94,,percent of total billed charges,,
Blepharoplasty Bilateral,,25007894,LOCAL,Facility,Outpatient,,,,1836,1560.6,526.1976,1836,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1654.236,90.1,,percent of total billed charges,,
Blepharoplasty Bilateral,,25007894,LOCAL,Facility,Inpatient,,,,1836,1560.6,526.1976,1836,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Blepharoplasty Bilateral,,25007894,LOCAL,Facility,Both,,,,1836,1560.6,526.1976,1836,"Preferred One Administrative Services, INC.",PPO,1810.296,98.6,,percent of total billed charges,,
Blepharoplasty Bilateral,,25007894,LOCAL,Facility,Outpatient,,,,1836,1560.6,526.1976,1836,PrimeWest Health,Minnesota Senior Health Options (MSHO),944.622,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Blepharoplasty Bilateral,,25007894,LOCAL,Facility,Inpatient,,,,1836,1560.6,526.1976,1836,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Blepharoplasty Bilateral,,25007894,LOCAL,Facility,Outpatient,,,,1836,1560.6,526.1976,1836,PrimeWest Health,MinnesotaCare,942.9696,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Blepharoplasty Bilateral,,25007894,LOCAL,Facility,Inpatient,,,,1836,1560.6,526.1976,1836,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Blepharoplasty Bilateral,,25007894,LOCAL,Facility,Both,,,,1836,1560.6,526.1976,1836,Sanford Health Plan,Sanford Health Plan,1689.12,92,,percent of total billed charges,,
Blepharoplasty Bilateral,,25007894,LOCAL,Facility,Outpatient,,,,1836,1560.6,526.1976,1836,"UCare Health, Inc.",Individual & Family Plan,1034.586,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Blepharoplasty Bilateral,,25007894,LOCAL,Facility,Inpatient,,,,1836,1560.6,526.1976,1836,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Blepharoplasty Bilateral,,25007894,LOCAL,Facility,Outpatient,,,,1836,1560.6,526.1976,1836,"UCare Health, Inc.",Medical Assistance,926.6292,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Blepharoplasty Bilateral,,25007894,LOCAL,Facility,Inpatient,,,,1836,1560.6,526.1976,1836,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Blepharoplasty Bilateral,,25007894,LOCAL,Facility,Outpatient,,,,1836,1560.6,526.1976,1836,"UCare Health, Inc.",Medicare Advantage,926.6292,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Blepharoplasty Bilateral,,25007894,LOCAL,Facility,Inpatient,,,,1836,1560.6,526.1976,1836,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Blepharoplasty Bilateral,,25007894,LOCAL,Facility,Outpatient,,,,1836,1560.6,526.1976,1836,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),926.6292,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Blepharoplasty Bilateral,,25007894,LOCAL,Facility,Inpatient,,,,1836,1560.6,526.1976,1836,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Blepharoplasty Bilateral,,25007894,LOCAL,Facility,Both,,,,1836,1560.6,526.1976,1836,UnitedHealthcare,Individual & Family,1725.84,94,,percent of total billed charges,,
Blepharoplasty Bilateral,,25007894,LOCAL,Facility,Outpatient,,,,1836,1560.6,526.1976,1836,UnitedHealthcare,Medicare Advantage,899.64,49,,percent of total billed charges,,
Blepharoplasty Bilateral,,25007894,LOCAL,Facility,Inpatient,,,,1836,1560.6,526.1976,1836,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Blepharoplasty Bilateral,,25007894,LOCAL,Facility,Outpatient,,,,1836,1560.6,526.1976,1836,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,881.28,48,,percent of total billed charges,,100% of DHS outpatient percentage
Blepharoplasty Bilateral,,25007894,LOCAL,Facility,Inpatient,,,,1836,1560.6,526.1976,1836,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Myringotomy With Tubes; Bilateral,,25007989,LOCAL,Facility,Both,,,,1938,1647.3,555.4308,1938,Aetna,Commercial,1782.96,92,,percent of total billed charges,,
Myringotomy With Tubes; Bilateral,,25007989,LOCAL,Facility,Outpatient,,,,1938,1647.3,555.4308,1938,Aetna,Medicare Advantage,949.62,49,,percent of total billed charges,,
Myringotomy With Tubes; Bilateral,,25007989,LOCAL,Facility,Inpatient,,,,1938,1647.3,555.4308,1938,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Myringotomy With Tubes; Bilateral,,25007989,LOCAL,Facility,Both,,,,1938,1647.3,555.4308,1938,Aetna,PPO,1802.34,93,,percent of total billed charges,,
Myringotomy With Tubes; Bilateral,,25007989,LOCAL,Facility,Both,,,,1938,1647.3,555.4308,1938,America's PPO,America's PPO,1861.0614,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Myringotomy With Tubes; Bilateral,,25007989,LOCAL,Facility,Both,,,,1938,1647.3,555.4308,1938,BlueCross BlueShield Minnesota, Federal Employee Program,1906.992,98.4,,percent of total billed charges,,
Myringotomy With Tubes; Bilateral,,25007989,LOCAL,Facility,Both,,,,1938,1647.3,555.4308,1938,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1938,100,,percent of total billed charges,,
Myringotomy With Tubes; Bilateral,,25007989,LOCAL,Facility,Both,,,,1938,1647.3,555.4308,1938,BlueCross BlueShield Minnesota,High Value Network Plan,1744.2,90,,percent of total billed charges,,
Myringotomy With Tubes; Bilateral,,25007989,LOCAL,Facility,Outpatient,,,,1938,1647.3,555.4308,1938,BlueCross BlueShield Minnesota,Medicare Advantage,949.62,49,,percent of total billed charges,,
Myringotomy With Tubes; Bilateral,,25007989,LOCAL,Facility,Inpatient,,,,1938,1647.3,555.4308,1938,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Myringotomy With Tubes; Bilateral,,25007989,LOCAL,Facility,Both,,,,1938,1647.3,555.4308,1938,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1716.4866,88.57,,percent of total billed charges,,
Myringotomy With Tubes; Bilateral,,25007989,LOCAL,Facility,Both,,,,1938,1647.3,555.4308,1938,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,555.4308,28.66,,percent of total billed charges,,
Myringotomy With Tubes; Bilateral,,25007989,LOCAL,Facility,Outpatient,,,,1938,1647.3,555.4308,1938,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),949.62,49,,percent of total billed charges,,
Myringotomy With Tubes; Bilateral,,25007989,LOCAL,Facility,Inpatient,,,,1938,1647.3,555.4308,1938,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Myringotomy With Tubes; Bilateral,,25007989,LOCAL,Facility,Both,,,,1938,1647.3,555.4308,1938,CorVel,Worker's Compensation,1938,100,,percent of total billed charges,,
Myringotomy With Tubes; Bilateral,,25007989,LOCAL,Facility,Both,,,,1938,1647.3,555.4308,1938,First Health Group Corporation,First Health Network,1879.86,97,,percent of total billed charges,,
Myringotomy With Tubes; Bilateral,,25007989,LOCAL,Facility,Both,,,,1938,1647.3,555.4308,1938,"Health Partners, Inc.",Commercial,1833.348,94.6,,percent of total billed charges,,
Myringotomy With Tubes; Bilateral,,25007989,LOCAL,Facility,Outpatient,,,,1938,1647.3,555.4308,1938,"Health Partners, Inc.",Medicare Advantage,949.62,49,,percent of total billed charges,,
Myringotomy With Tubes; Bilateral,,25007989,LOCAL,Facility,Inpatient,,,,1938,1647.3,555.4308,1938,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Myringotomy With Tubes; Bilateral,,25007989,LOCAL,Facility,Both,,,,1938,1647.3,555.4308,1938,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1162.8,60,,percent of total billed charges,,
Myringotomy With Tubes; Bilateral,,25007989,LOCAL,Facility,Both,,,,1938,1647.3,555.4308,1938,"Health Partners, Inc.",State of Minnesota Advantage Program,1579.47,81.5,,percent of total billed charges,,
Myringotomy With Tubes; Bilateral,,25007989,LOCAL,Facility,Both,,,,1938,1647.3,555.4308,1938,"Health Partners, Inc.",State Public Programs,969,50,,percent of total billed charges,,
Myringotomy With Tubes; Bilateral,,25007989,LOCAL,Facility,Both,,,,1938,1647.3,555.4308,1938,Humana Insurance Company,Commercial PPO,1841.1,95,,percent of total billed charges,,
Myringotomy With Tubes; Bilateral,,25007989,LOCAL,Facility,Outpatient,,,,1938,1647.3,555.4308,1938,Humana Insurance Company,Medicare PPO,949.62,49,,percent of total billed charges,,
Myringotomy With Tubes; Bilateral,,25007989,LOCAL,Facility,Inpatient,,,,1938,1647.3,555.4308,1938,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Myringotomy With Tubes; Bilateral,,25007989,LOCAL,Facility,Both,,,,1938,1647.3,555.4308,1938,Medica,Individual & Family,1920.558,99.1,,percent of total billed charges,,
Myringotomy With Tubes; Bilateral,,25007989,LOCAL,Facility,Outpatient,,,,1938,1647.3,555.4308,1938,Medica,Medica Advantage Solution,965.124,49.8,,percent of total billed charges,,
Myringotomy With Tubes; Bilateral,,25007989,LOCAL,Facility,Inpatient,,,,1938,1647.3,555.4308,1938,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Myringotomy With Tubes; Bilateral,,25007989,LOCAL,Facility,Outpatient,,,,1938,1647.3,555.4308,1938,Medica,Medical Assistance,864.348,44.6,,percent of total billed charges,,
Myringotomy With Tubes; Bilateral,,25007989,LOCAL,Facility,Inpatient,,,,1938,1647.3,555.4308,1938,Medica,Medical Assistance,,,,,Included in per diem rate,
Myringotomy With Tubes; Bilateral,,25007989,LOCAL,Facility,Outpatient,,,,1938,1647.3,555.4308,1938,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,965.124,49.8,,percent of total billed charges,,
Myringotomy With Tubes; Bilateral,,25007989,LOCAL,Facility,Inpatient,,,,1938,1647.3,555.4308,1938,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Myringotomy With Tubes; Bilateral,,25007989,LOCAL,Facility,Both,,,,1938,1647.3,555.4308,1938,"Multiplan, Inc.","Multiplan, Inc.",1821.72,94,,percent of total billed charges,,
Myringotomy With Tubes; Bilateral,,25007989,LOCAL,Facility,Outpatient,,,,1938,1647.3,555.4308,1938,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1746.138,90.1,,percent of total billed charges,,
Myringotomy With Tubes; Bilateral,,25007989,LOCAL,Facility,Inpatient,,,,1938,1647.3,555.4308,1938,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Myringotomy With Tubes; Bilateral,,25007989,LOCAL,Facility,Both,,,,1938,1647.3,555.4308,1938,"Preferred One Administrative Services, INC.",PPO,1910.868,98.6,,percent of total billed charges,,
Myringotomy With Tubes; Bilateral,,25007989,LOCAL,Facility,Outpatient,,,,1938,1647.3,555.4308,1938,PrimeWest Health,Minnesota Senior Health Options (MSHO),997.101,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Myringotomy With Tubes; Bilateral,,25007989,LOCAL,Facility,Inpatient,,,,1938,1647.3,555.4308,1938,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Myringotomy With Tubes; Bilateral,,25007989,LOCAL,Facility,Outpatient,,,,1938,1647.3,555.4308,1938,PrimeWest Health,MinnesotaCare,995.3568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Myringotomy With Tubes; Bilateral,,25007989,LOCAL,Facility,Inpatient,,,,1938,1647.3,555.4308,1938,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Myringotomy With Tubes; Bilateral,,25007989,LOCAL,Facility,Both,,,,1938,1647.3,555.4308,1938,Sanford Health Plan,Sanford Health Plan,1782.96,92,,percent of total billed charges,,
Myringotomy With Tubes; Bilateral,,25007989,LOCAL,Facility,Outpatient,,,,1938,1647.3,555.4308,1938,"UCare Health, Inc.",Individual & Family Plan,1092.063,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Myringotomy With Tubes; Bilateral,,25007989,LOCAL,Facility,Inpatient,,,,1938,1647.3,555.4308,1938,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Myringotomy With Tubes; Bilateral,,25007989,LOCAL,Facility,Outpatient,,,,1938,1647.3,555.4308,1938,"UCare Health, Inc.",Medical Assistance,978.1086,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Myringotomy With Tubes; Bilateral,,25007989,LOCAL,Facility,Inpatient,,,,1938,1647.3,555.4308,1938,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Myringotomy With Tubes; Bilateral,,25007989,LOCAL,Facility,Outpatient,,,,1938,1647.3,555.4308,1938,"UCare Health, Inc.",Medicare Advantage,978.1086,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Myringotomy With Tubes; Bilateral,,25007989,LOCAL,Facility,Inpatient,,,,1938,1647.3,555.4308,1938,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Myringotomy With Tubes; Bilateral,,25007989,LOCAL,Facility,Outpatient,,,,1938,1647.3,555.4308,1938,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),978.1086,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Myringotomy With Tubes; Bilateral,,25007989,LOCAL,Facility,Inpatient,,,,1938,1647.3,555.4308,1938,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Myringotomy With Tubes; Bilateral,,25007989,LOCAL,Facility,Both,,,,1938,1647.3,555.4308,1938,UnitedHealthcare,Individual & Family,1821.72,94,,percent of total billed charges,,
Myringotomy With Tubes; Bilateral,,25007989,LOCAL,Facility,Outpatient,,,,1938,1647.3,555.4308,1938,UnitedHealthcare,Medicare Advantage,949.62,49,,percent of total billed charges,,
Myringotomy With Tubes; Bilateral,,25007989,LOCAL,Facility,Inpatient,,,,1938,1647.3,555.4308,1938,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Myringotomy With Tubes; Bilateral,,25007989,LOCAL,Facility,Outpatient,,,,1938,1647.3,555.4308,1938,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,930.24,48,,percent of total billed charges,,100% of DHS outpatient percentage
Myringotomy With Tubes; Bilateral,,25007989,LOCAL,Facility,Inpatient,,,,1938,1647.3,555.4308,1938,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Excision Of Submandibular Gland,,25009075,LOCAL,Facility,Both,,,,4437,3771.45,1271.6442,4437,Aetna,Commercial,4082.04,92,,percent of total billed charges,,
Excision Of Submandibular Gland,,25009075,LOCAL,Facility,Outpatient,,,,4437,3771.45,1271.6442,4437,Aetna,Medicare Advantage,2174.13,49,,percent of total billed charges,,
Excision Of Submandibular Gland,,25009075,LOCAL,Facility,Inpatient,,,,4437,3771.45,1271.6442,4437,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Excision Of Submandibular Gland,,25009075,LOCAL,Facility,Both,,,,4437,3771.45,1271.6442,4437,Aetna,PPO,4126.41,93,,percent of total billed charges,,
Excision Of Submandibular Gland,,25009075,LOCAL,Facility,Both,,,,4437,3771.45,1271.6442,4437,America's PPO,America's PPO,4260.8511,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Excision Of Submandibular Gland,,25009075,LOCAL,Facility,Both,,,,4437,3771.45,1271.6442,4437,BlueCross BlueShield Minnesota, Federal Employee Program,4366.008,98.4,,percent of total billed charges,,
Excision Of Submandibular Gland,,25009075,LOCAL,Facility,Both,,,,4437,3771.45,1271.6442,4437,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,4437,100,,percent of total billed charges,,
Excision Of Submandibular Gland,,25009075,LOCAL,Facility,Both,,,,4437,3771.45,1271.6442,4437,BlueCross BlueShield Minnesota,High Value Network Plan,3993.3,90,,percent of total billed charges,,
Excision Of Submandibular Gland,,25009075,LOCAL,Facility,Outpatient,,,,4437,3771.45,1271.6442,4437,BlueCross BlueShield Minnesota,Medicare Advantage,2174.13,49,,percent of total billed charges,,
Excision Of Submandibular Gland,,25009075,LOCAL,Facility,Inpatient,,,,4437,3771.45,1271.6442,4437,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Excision Of Submandibular Gland,,25009075,LOCAL,Facility,Both,,,,4437,3771.45,1271.6442,4437,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,3929.8509,88.57,,percent of total billed charges,,
Excision Of Submandibular Gland,,25009075,LOCAL,Facility,Both,,,,4437,3771.45,1271.6442,4437,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1271.6442,28.66,,percent of total billed charges,,
Excision Of Submandibular Gland,,25009075,LOCAL,Facility,Outpatient,,,,4437,3771.45,1271.6442,4437,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2174.13,49,,percent of total billed charges,,
Excision Of Submandibular Gland,,25009075,LOCAL,Facility,Inpatient,,,,4437,3771.45,1271.6442,4437,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Excision Of Submandibular Gland,,25009075,LOCAL,Facility,Both,,,,4437,3771.45,1271.6442,4437,CorVel,Worker's Compensation,4437,100,,percent of total billed charges,,
Excision Of Submandibular Gland,,25009075,LOCAL,Facility,Both,,,,4437,3771.45,1271.6442,4437,First Health Group Corporation,First Health Network,4303.89,97,,percent of total billed charges,,
Excision Of Submandibular Gland,,25009075,LOCAL,Facility,Both,,,,4437,3771.45,1271.6442,4437,"Health Partners, Inc.",Commercial,4197.402,94.6,,percent of total billed charges,,
Excision Of Submandibular Gland,,25009075,LOCAL,Facility,Outpatient,,,,4437,3771.45,1271.6442,4437,"Health Partners, Inc.",Medicare Advantage,2174.13,49,,percent of total billed charges,,
Excision Of Submandibular Gland,,25009075,LOCAL,Facility,Inpatient,,,,4437,3771.45,1271.6442,4437,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Excision Of Submandibular Gland,,25009075,LOCAL,Facility,Both,,,,4437,3771.45,1271.6442,4437,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),2662.2,60,,percent of total billed charges,,
Excision Of Submandibular Gland,,25009075,LOCAL,Facility,Both,,,,4437,3771.45,1271.6442,4437,"Health Partners, Inc.",State of Minnesota Advantage Program,3616.155,81.5,,percent of total billed charges,,
Excision Of Submandibular Gland,,25009075,LOCAL,Facility,Both,,,,4437,3771.45,1271.6442,4437,"Health Partners, Inc.",State Public Programs,2218.5,50,,percent of total billed charges,,
Excision Of Submandibular Gland,,25009075,LOCAL,Facility,Both,,,,4437,3771.45,1271.6442,4437,Humana Insurance Company,Commercial PPO,4215.15,95,,percent of total billed charges,,
Excision Of Submandibular Gland,,25009075,LOCAL,Facility,Outpatient,,,,4437,3771.45,1271.6442,4437,Humana Insurance Company,Medicare PPO,2174.13,49,,percent of total billed charges,,
Excision Of Submandibular Gland,,25009075,LOCAL,Facility,Inpatient,,,,4437,3771.45,1271.6442,4437,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Excision Of Submandibular Gland,,25009075,LOCAL,Facility,Both,,,,4437,3771.45,1271.6442,4437,Medica,Individual & Family,4397.067,99.1,,percent of total billed charges,,
Excision Of Submandibular Gland,,25009075,LOCAL,Facility,Outpatient,,,,4437,3771.45,1271.6442,4437,Medica,Medica Advantage Solution,2209.626,49.8,,percent of total billed charges,,
Excision Of Submandibular Gland,,25009075,LOCAL,Facility,Inpatient,,,,4437,3771.45,1271.6442,4437,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Excision Of Submandibular Gland,,25009075,LOCAL,Facility,Outpatient,,,,4437,3771.45,1271.6442,4437,Medica,Medical Assistance,1978.902,44.6,,percent of total billed charges,,
Excision Of Submandibular Gland,,25009075,LOCAL,Facility,Inpatient,,,,4437,3771.45,1271.6442,4437,Medica,Medical Assistance,,,,,Included in per diem rate,
Excision Of Submandibular Gland,,25009075,LOCAL,Facility,Outpatient,,,,4437,3771.45,1271.6442,4437,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2209.626,49.8,,percent of total billed charges,,
Excision Of Submandibular Gland,,25009075,LOCAL,Facility,Inpatient,,,,4437,3771.45,1271.6442,4437,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Excision Of Submandibular Gland,,25009075,LOCAL,Facility,Both,,,,4437,3771.45,1271.6442,4437,"Multiplan, Inc.","Multiplan, Inc.",4170.78,94,,percent of total billed charges,,
Excision Of Submandibular Gland,,25009075,LOCAL,Facility,Outpatient,,,,4437,3771.45,1271.6442,4437,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,3997.737,90.1,,percent of total billed charges,,
Excision Of Submandibular Gland,,25009075,LOCAL,Facility,Inpatient,,,,4437,3771.45,1271.6442,4437,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Excision Of Submandibular Gland,,25009075,LOCAL,Facility,Both,,,,4437,3771.45,1271.6442,4437,"Preferred One Administrative Services, INC.",PPO,4374.882,98.6,,percent of total billed charges,,
Excision Of Submandibular Gland,,25009075,LOCAL,Facility,Outpatient,,,,4437,3771.45,1271.6442,4437,PrimeWest Health,Minnesota Senior Health Options (MSHO),2282.8365,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Excision Of Submandibular Gland,,25009075,LOCAL,Facility,Inpatient,,,,4437,3771.45,1271.6442,4437,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Excision Of Submandibular Gland,,25009075,LOCAL,Facility,Outpatient,,,,4437,3771.45,1271.6442,4437,PrimeWest Health,MinnesotaCare,2278.8432,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Excision Of Submandibular Gland,,25009075,LOCAL,Facility,Inpatient,,,,4437,3771.45,1271.6442,4437,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Excision Of Submandibular Gland,,25009075,LOCAL,Facility,Both,,,,4437,3771.45,1271.6442,4437,Sanford Health Plan,Sanford Health Plan,4082.04,92,,percent of total billed charges,,
Excision Of Submandibular Gland,,25009075,LOCAL,Facility,Outpatient,,,,4437,3771.45,1271.6442,4437,"UCare Health, Inc.",Individual & Family Plan,2500.2495,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Excision Of Submandibular Gland,,25009075,LOCAL,Facility,Inpatient,,,,4437,3771.45,1271.6442,4437,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Excision Of Submandibular Gland,,25009075,LOCAL,Facility,Outpatient,,,,4437,3771.45,1271.6442,4437,"UCare Health, Inc.",Medical Assistance,2239.3539,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Excision Of Submandibular Gland,,25009075,LOCAL,Facility,Inpatient,,,,4437,3771.45,1271.6442,4437,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Excision Of Submandibular Gland,,25009075,LOCAL,Facility,Outpatient,,,,4437,3771.45,1271.6442,4437,"UCare Health, Inc.",Medicare Advantage,2239.3539,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Excision Of Submandibular Gland,,25009075,LOCAL,Facility,Inpatient,,,,4437,3771.45,1271.6442,4437,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Excision Of Submandibular Gland,,25009075,LOCAL,Facility,Outpatient,,,,4437,3771.45,1271.6442,4437,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2239.3539,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Excision Of Submandibular Gland,,25009075,LOCAL,Facility,Inpatient,,,,4437,3771.45,1271.6442,4437,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Excision Of Submandibular Gland,,25009075,LOCAL,Facility,Both,,,,4437,3771.45,1271.6442,4437,UnitedHealthcare,Individual & Family,4170.78,94,,percent of total billed charges,,
Excision Of Submandibular Gland,,25009075,LOCAL,Facility,Outpatient,,,,4437,3771.45,1271.6442,4437,UnitedHealthcare,Medicare Advantage,2174.13,49,,percent of total billed charges,,
Excision Of Submandibular Gland,,25009075,LOCAL,Facility,Inpatient,,,,4437,3771.45,1271.6442,4437,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Excision Of Submandibular Gland,,25009075,LOCAL,Facility,Outpatient,,,,4437,3771.45,1271.6442,4437,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2129.76,48,,percent of total billed charges,,100% of DHS outpatient percentage
Excision Of Submandibular Gland,,25009075,LOCAL,Facility,Inpatient,,,,4437,3771.45,1271.6442,4437,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Wound Repair, Intermediate; 2.6 - 7.5 Cm",,25009112,LOCAL,Facility,Both,,,,867,736.95,248.4822,867,Aetna,Commercial,797.64,92,,percent of total billed charges,,
"Wound Repair, Intermediate; 2.6 - 7.5 Cm",,25009112,LOCAL,Facility,Outpatient,,,,867,736.95,248.4822,867,Aetna,Medicare Advantage,424.83,49,,percent of total billed charges,,
"Wound Repair, Intermediate; 2.6 - 7.5 Cm",,25009112,LOCAL,Facility,Inpatient,,,,867,736.95,248.4822,867,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Wound Repair, Intermediate; 2.6 - 7.5 Cm",,25009112,LOCAL,Facility,Both,,,,867,736.95,248.4822,867,Aetna,PPO,806.31,93,,percent of total billed charges,,
"Wound Repair, Intermediate; 2.6 - 7.5 Cm",,25009112,LOCAL,Facility,Both,,,,867,736.95,248.4822,867,America's PPO,America's PPO,832.5801,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Wound Repair, Intermediate; 2.6 - 7.5 Cm",,25009112,LOCAL,Facility,Both,,,,867,736.95,248.4822,867,BlueCross BlueShield Minnesota, Federal Employee Program,853.128,98.4,,percent of total billed charges,,
"Wound Repair, Intermediate; 2.6 - 7.5 Cm",,25009112,LOCAL,Facility,Both,,,,867,736.95,248.4822,867,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,867,100,,percent of total billed charges,,
"Wound Repair, Intermediate; 2.6 - 7.5 Cm",,25009112,LOCAL,Facility,Both,,,,867,736.95,248.4822,867,BlueCross BlueShield Minnesota,High Value Network Plan,780.3,90,,percent of total billed charges,,
"Wound Repair, Intermediate; 2.6 - 7.5 Cm",,25009112,LOCAL,Facility,Outpatient,,,,867,736.95,248.4822,867,BlueCross BlueShield Minnesota,Medicare Advantage,424.83,49,,percent of total billed charges,,
"Wound Repair, Intermediate; 2.6 - 7.5 Cm",,25009112,LOCAL,Facility,Inpatient,,,,867,736.95,248.4822,867,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Wound Repair, Intermediate; 2.6 - 7.5 Cm",,25009112,LOCAL,Facility,Both,,,,867,736.95,248.4822,867,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,767.9019,88.57,,percent of total billed charges,,
"Wound Repair, Intermediate; 2.6 - 7.5 Cm",,25009112,LOCAL,Facility,Both,,,,867,736.95,248.4822,867,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,248.4822,28.66,,percent of total billed charges,,
"Wound Repair, Intermediate; 2.6 - 7.5 Cm",,25009112,LOCAL,Facility,Outpatient,,,,867,736.95,248.4822,867,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),424.83,49,,percent of total billed charges,,
"Wound Repair, Intermediate; 2.6 - 7.5 Cm",,25009112,LOCAL,Facility,Inpatient,,,,867,736.95,248.4822,867,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Wound Repair, Intermediate; 2.6 - 7.5 Cm",,25009112,LOCAL,Facility,Both,,,,867,736.95,248.4822,867,CorVel,Worker's Compensation,867,100,,percent of total billed charges,,
"Wound Repair, Intermediate; 2.6 - 7.5 Cm",,25009112,LOCAL,Facility,Both,,,,867,736.95,248.4822,867,First Health Group Corporation,First Health Network,840.99,97,,percent of total billed charges,,
"Wound Repair, Intermediate; 2.6 - 7.5 Cm",,25009112,LOCAL,Facility,Both,,,,867,736.95,248.4822,867,"Health Partners, Inc.",Commercial,820.182,94.6,,percent of total billed charges,,
"Wound Repair, Intermediate; 2.6 - 7.5 Cm",,25009112,LOCAL,Facility,Outpatient,,,,867,736.95,248.4822,867,"Health Partners, Inc.",Medicare Advantage,424.83,49,,percent of total billed charges,,
"Wound Repair, Intermediate; 2.6 - 7.5 Cm",,25009112,LOCAL,Facility,Inpatient,,,,867,736.95,248.4822,867,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Wound Repair, Intermediate; 2.6 - 7.5 Cm",,25009112,LOCAL,Facility,Both,,,,867,736.95,248.4822,867,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),520.2,60,,percent of total billed charges,,
"Wound Repair, Intermediate; 2.6 - 7.5 Cm",,25009112,LOCAL,Facility,Both,,,,867,736.95,248.4822,867,"Health Partners, Inc.",State of Minnesota Advantage Program,706.605,81.5,,percent of total billed charges,,
"Wound Repair, Intermediate; 2.6 - 7.5 Cm",,25009112,LOCAL,Facility,Both,,,,867,736.95,248.4822,867,"Health Partners, Inc.",State Public Programs,433.5,50,,percent of total billed charges,,
"Wound Repair, Intermediate; 2.6 - 7.5 Cm",,25009112,LOCAL,Facility,Both,,,,867,736.95,248.4822,867,Humana Insurance Company,Commercial PPO,823.65,95,,percent of total billed charges,,
"Wound Repair, Intermediate; 2.6 - 7.5 Cm",,25009112,LOCAL,Facility,Outpatient,,,,867,736.95,248.4822,867,Humana Insurance Company,Medicare PPO,424.83,49,,percent of total billed charges,,
"Wound Repair, Intermediate; 2.6 - 7.5 Cm",,25009112,LOCAL,Facility,Inpatient,,,,867,736.95,248.4822,867,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Wound Repair, Intermediate; 2.6 - 7.5 Cm",,25009112,LOCAL,Facility,Both,,,,867,736.95,248.4822,867,Medica,Individual & Family,859.197,99.1,,percent of total billed charges,,
"Wound Repair, Intermediate; 2.6 - 7.5 Cm",,25009112,LOCAL,Facility,Outpatient,,,,867,736.95,248.4822,867,Medica,Medica Advantage Solution,431.766,49.8,,percent of total billed charges,,
"Wound Repair, Intermediate; 2.6 - 7.5 Cm",,25009112,LOCAL,Facility,Inpatient,,,,867,736.95,248.4822,867,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Wound Repair, Intermediate; 2.6 - 7.5 Cm",,25009112,LOCAL,Facility,Outpatient,,,,867,736.95,248.4822,867,Medica,Medical Assistance,386.682,44.6,,percent of total billed charges,,
"Wound Repair, Intermediate; 2.6 - 7.5 Cm",,25009112,LOCAL,Facility,Inpatient,,,,867,736.95,248.4822,867,Medica,Medical Assistance,,,,,Included in per diem rate,
"Wound Repair, Intermediate; 2.6 - 7.5 Cm",,25009112,LOCAL,Facility,Outpatient,,,,867,736.95,248.4822,867,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,431.766,49.8,,percent of total billed charges,,
"Wound Repair, Intermediate; 2.6 - 7.5 Cm",,25009112,LOCAL,Facility,Inpatient,,,,867,736.95,248.4822,867,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Wound Repair, Intermediate; 2.6 - 7.5 Cm",,25009112,LOCAL,Facility,Both,,,,867,736.95,248.4822,867,"Multiplan, Inc.","Multiplan, Inc.",814.98,94,,percent of total billed charges,,
"Wound Repair, Intermediate; 2.6 - 7.5 Cm",,25009112,LOCAL,Facility,Outpatient,,,,867,736.95,248.4822,867,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,781.167,90.1,,percent of total billed charges,,
"Wound Repair, Intermediate; 2.6 - 7.5 Cm",,25009112,LOCAL,Facility,Inpatient,,,,867,736.95,248.4822,867,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Wound Repair, Intermediate; 2.6 - 7.5 Cm",,25009112,LOCAL,Facility,Both,,,,867,736.95,248.4822,867,"Preferred One Administrative Services, INC.",PPO,854.862,98.6,,percent of total billed charges,,
"Wound Repair, Intermediate; 2.6 - 7.5 Cm",,25009112,LOCAL,Facility,Outpatient,,,,867,736.95,248.4822,867,PrimeWest Health,Minnesota Senior Health Options (MSHO),446.0715,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Wound Repair, Intermediate; 2.6 - 7.5 Cm",,25009112,LOCAL,Facility,Inpatient,,,,867,736.95,248.4822,867,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Wound Repair, Intermediate; 2.6 - 7.5 Cm",,25009112,LOCAL,Facility,Outpatient,,,,867,736.95,248.4822,867,PrimeWest Health,MinnesotaCare,445.2912,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Wound Repair, Intermediate; 2.6 - 7.5 Cm",,25009112,LOCAL,Facility,Inpatient,,,,867,736.95,248.4822,867,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Wound Repair, Intermediate; 2.6 - 7.5 Cm",,25009112,LOCAL,Facility,Both,,,,867,736.95,248.4822,867,Sanford Health Plan,Sanford Health Plan,797.64,92,,percent of total billed charges,,
"Wound Repair, Intermediate; 2.6 - 7.5 Cm",,25009112,LOCAL,Facility,Outpatient,,,,867,736.95,248.4822,867,"UCare Health, Inc.",Individual & Family Plan,488.5545,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Wound Repair, Intermediate; 2.6 - 7.5 Cm",,25009112,LOCAL,Facility,Inpatient,,,,867,736.95,248.4822,867,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Wound Repair, Intermediate; 2.6 - 7.5 Cm",,25009112,LOCAL,Facility,Outpatient,,,,867,736.95,248.4822,867,"UCare Health, Inc.",Medical Assistance,437.5749,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Wound Repair, Intermediate; 2.6 - 7.5 Cm",,25009112,LOCAL,Facility,Inpatient,,,,867,736.95,248.4822,867,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Wound Repair, Intermediate; 2.6 - 7.5 Cm",,25009112,LOCAL,Facility,Outpatient,,,,867,736.95,248.4822,867,"UCare Health, Inc.",Medicare Advantage,437.5749,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Wound Repair, Intermediate; 2.6 - 7.5 Cm",,25009112,LOCAL,Facility,Inpatient,,,,867,736.95,248.4822,867,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Wound Repair, Intermediate; 2.6 - 7.5 Cm",,25009112,LOCAL,Facility,Outpatient,,,,867,736.95,248.4822,867,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),437.5749,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Wound Repair, Intermediate; 2.6 - 7.5 Cm",,25009112,LOCAL,Facility,Inpatient,,,,867,736.95,248.4822,867,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Wound Repair, Intermediate; 2.6 - 7.5 Cm",,25009112,LOCAL,Facility,Both,,,,867,736.95,248.4822,867,UnitedHealthcare,Individual & Family,814.98,94,,percent of total billed charges,,
"Wound Repair, Intermediate; 2.6 - 7.5 Cm",,25009112,LOCAL,Facility,Outpatient,,,,867,736.95,248.4822,867,UnitedHealthcare,Medicare Advantage,424.83,49,,percent of total billed charges,,
"Wound Repair, Intermediate; 2.6 - 7.5 Cm",,25009112,LOCAL,Facility,Inpatient,,,,867,736.95,248.4822,867,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Wound Repair, Intermediate; 2.6 - 7.5 Cm",,25009112,LOCAL,Facility,Outpatient,,,,867,736.95,248.4822,867,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,416.16,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Wound Repair, Intermediate; 2.6 - 7.5 Cm",,25009112,LOCAL,Facility,Inpatient,,,,867,736.95,248.4822,867,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Radiofrequency Ablation,,25009183,LOCAL,Facility,Both,,,,6120,5202,1753.992,6120,Aetna,Commercial,5630.4,92,,percent of total billed charges,,
Radiofrequency Ablation,,25009183,LOCAL,Facility,Outpatient,,,,6120,5202,1753.992,6120,Aetna,Medicare Advantage,2998.8,49,,percent of total billed charges,,
Radiofrequency Ablation,,25009183,LOCAL,Facility,Inpatient,,,,6120,5202,1753.992,6120,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Radiofrequency Ablation,,25009183,LOCAL,Facility,Both,,,,6120,5202,1753.992,6120,Aetna,PPO,5691.6,93,,percent of total billed charges,,
Radiofrequency Ablation,,25009183,LOCAL,Facility,Both,,,,6120,5202,1753.992,6120,America's PPO,America's PPO,5877.036,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Radiofrequency Ablation,,25009183,LOCAL,Facility,Both,,,,6120,5202,1753.992,6120,BlueCross BlueShield Minnesota, Federal Employee Program,6022.08,98.4,,percent of total billed charges,,
Radiofrequency Ablation,,25009183,LOCAL,Facility,Both,,,,6120,5202,1753.992,6120,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,6120,100,,percent of total billed charges,,
Radiofrequency Ablation,,25009183,LOCAL,Facility,Both,,,,6120,5202,1753.992,6120,BlueCross BlueShield Minnesota,High Value Network Plan,5508,90,,percent of total billed charges,,
Radiofrequency Ablation,,25009183,LOCAL,Facility,Outpatient,,,,6120,5202,1753.992,6120,BlueCross BlueShield Minnesota,Medicare Advantage,2998.8,49,,percent of total billed charges,,
Radiofrequency Ablation,,25009183,LOCAL,Facility,Inpatient,,,,6120,5202,1753.992,6120,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Radiofrequency Ablation,,25009183,LOCAL,Facility,Both,,,,6120,5202,1753.992,6120,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,5420.484,88.57,,percent of total billed charges,,
Radiofrequency Ablation,,25009183,LOCAL,Facility,Both,,,,6120,5202,1753.992,6120,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1753.992,28.66,,percent of total billed charges,,
Radiofrequency Ablation,,25009183,LOCAL,Facility,Outpatient,,,,6120,5202,1753.992,6120,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2998.8,49,,percent of total billed charges,,
Radiofrequency Ablation,,25009183,LOCAL,Facility,Inpatient,,,,6120,5202,1753.992,6120,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Radiofrequency Ablation,,25009183,LOCAL,Facility,Both,,,,6120,5202,1753.992,6120,CorVel,Worker's Compensation,6120,100,,percent of total billed charges,,
Radiofrequency Ablation,,25009183,LOCAL,Facility,Both,,,,6120,5202,1753.992,6120,First Health Group Corporation,First Health Network,5936.4,97,,percent of total billed charges,,
Radiofrequency Ablation,,25009183,LOCAL,Facility,Both,,,,6120,5202,1753.992,6120,"Health Partners, Inc.",Commercial,5789.52,94.6,,percent of total billed charges,,
Radiofrequency Ablation,,25009183,LOCAL,Facility,Outpatient,,,,6120,5202,1753.992,6120,"Health Partners, Inc.",Medicare Advantage,2998.8,49,,percent of total billed charges,,
Radiofrequency Ablation,,25009183,LOCAL,Facility,Inpatient,,,,6120,5202,1753.992,6120,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Radiofrequency Ablation,,25009183,LOCAL,Facility,Both,,,,6120,5202,1753.992,6120,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3672,60,,percent of total billed charges,,
Radiofrequency Ablation,,25009183,LOCAL,Facility,Both,,,,6120,5202,1753.992,6120,"Health Partners, Inc.",State of Minnesota Advantage Program,4987.8,81.5,,percent of total billed charges,,
Radiofrequency Ablation,,25009183,LOCAL,Facility,Both,,,,6120,5202,1753.992,6120,"Health Partners, Inc.",State Public Programs,3060,50,,percent of total billed charges,,
Radiofrequency Ablation,,25009183,LOCAL,Facility,Both,,,,6120,5202,1753.992,6120,Humana Insurance Company,Commercial PPO,5814,95,,percent of total billed charges,,
Radiofrequency Ablation,,25009183,LOCAL,Facility,Outpatient,,,,6120,5202,1753.992,6120,Humana Insurance Company,Medicare PPO,2998.8,49,,percent of total billed charges,,
Radiofrequency Ablation,,25009183,LOCAL,Facility,Inpatient,,,,6120,5202,1753.992,6120,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Radiofrequency Ablation,,25009183,LOCAL,Facility,Both,,,,6120,5202,1753.992,6120,Medica,Individual & Family,6064.92,99.1,,percent of total billed charges,,
Radiofrequency Ablation,,25009183,LOCAL,Facility,Outpatient,,,,6120,5202,1753.992,6120,Medica,Medica Advantage Solution,3047.76,49.8,,percent of total billed charges,,
Radiofrequency Ablation,,25009183,LOCAL,Facility,Inpatient,,,,6120,5202,1753.992,6120,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Radiofrequency Ablation,,25009183,LOCAL,Facility,Outpatient,,,,6120,5202,1753.992,6120,Medica,Medical Assistance,2729.52,44.6,,percent of total billed charges,,
Radiofrequency Ablation,,25009183,LOCAL,Facility,Inpatient,,,,6120,5202,1753.992,6120,Medica,Medical Assistance,,,,,Included in per diem rate,
Radiofrequency Ablation,,25009183,LOCAL,Facility,Outpatient,,,,6120,5202,1753.992,6120,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,3047.76,49.8,,percent of total billed charges,,
Radiofrequency Ablation,,25009183,LOCAL,Facility,Inpatient,,,,6120,5202,1753.992,6120,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Radiofrequency Ablation,,25009183,LOCAL,Facility,Both,,,,6120,5202,1753.992,6120,"Multiplan, Inc.","Multiplan, Inc.",5752.8,94,,percent of total billed charges,,
Radiofrequency Ablation,,25009183,LOCAL,Facility,Outpatient,,,,6120,5202,1753.992,6120,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,5514.12,90.1,,percent of total billed charges,,
Radiofrequency Ablation,,25009183,LOCAL,Facility,Inpatient,,,,6120,5202,1753.992,6120,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Radiofrequency Ablation,,25009183,LOCAL,Facility,Both,,,,6120,5202,1753.992,6120,"Preferred One Administrative Services, INC.",PPO,6034.32,98.6,,percent of total billed charges,,
Radiofrequency Ablation,,25009183,LOCAL,Facility,Outpatient,,,,6120,5202,1753.992,6120,PrimeWest Health,Minnesota Senior Health Options (MSHO),3148.74,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Radiofrequency Ablation,,25009183,LOCAL,Facility,Inpatient,,,,6120,5202,1753.992,6120,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Radiofrequency Ablation,,25009183,LOCAL,Facility,Outpatient,,,,6120,5202,1753.992,6120,PrimeWest Health,MinnesotaCare,3143.232,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Radiofrequency Ablation,,25009183,LOCAL,Facility,Inpatient,,,,6120,5202,1753.992,6120,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Radiofrequency Ablation,,25009183,LOCAL,Facility,Both,,,,6120,5202,1753.992,6120,Sanford Health Plan,Sanford Health Plan,5630.4,92,,percent of total billed charges,,
Radiofrequency Ablation,,25009183,LOCAL,Facility,Outpatient,,,,6120,5202,1753.992,6120,"UCare Health, Inc.",Individual & Family Plan,3448.62,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Radiofrequency Ablation,,25009183,LOCAL,Facility,Inpatient,,,,6120,5202,1753.992,6120,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Radiofrequency Ablation,,25009183,LOCAL,Facility,Outpatient,,,,6120,5202,1753.992,6120,"UCare Health, Inc.",Medical Assistance,3088.764,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Radiofrequency Ablation,,25009183,LOCAL,Facility,Inpatient,,,,6120,5202,1753.992,6120,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Radiofrequency Ablation,,25009183,LOCAL,Facility,Outpatient,,,,6120,5202,1753.992,6120,"UCare Health, Inc.",Medicare Advantage,3088.764,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Radiofrequency Ablation,,25009183,LOCAL,Facility,Inpatient,,,,6120,5202,1753.992,6120,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Radiofrequency Ablation,,25009183,LOCAL,Facility,Outpatient,,,,6120,5202,1753.992,6120,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),3088.764,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Radiofrequency Ablation,,25009183,LOCAL,Facility,Inpatient,,,,6120,5202,1753.992,6120,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Radiofrequency Ablation,,25009183,LOCAL,Facility,Both,,,,6120,5202,1753.992,6120,UnitedHealthcare,Individual & Family,5752.8,94,,percent of total billed charges,,
Radiofrequency Ablation,,25009183,LOCAL,Facility,Outpatient,,,,6120,5202,1753.992,6120,UnitedHealthcare,Medicare Advantage,2998.8,49,,percent of total billed charges,,
Radiofrequency Ablation,,25009183,LOCAL,Facility,Inpatient,,,,6120,5202,1753.992,6120,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Radiofrequency Ablation,,25009183,LOCAL,Facility,Outpatient,,,,6120,5202,1753.992,6120,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2937.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
Radiofrequency Ablation,,25009183,LOCAL,Facility,Inpatient,,,,6120,5202,1753.992,6120,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Suprapubic Catheter Placement,,25009203,LOCAL,Facility,Both,,,,2300,1955,659.18,2300,Aetna,Commercial,2116,92,,percent of total billed charges,,
Suprapubic Catheter Placement,,25009203,LOCAL,Facility,Outpatient,,,,2300,1955,659.18,2300,Aetna,Medicare Advantage,1127,49,,percent of total billed charges,,
Suprapubic Catheter Placement,,25009203,LOCAL,Facility,Inpatient,,,,2300,1955,659.18,2300,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Suprapubic Catheter Placement,,25009203,LOCAL,Facility,Both,,,,2300,1955,659.18,2300,Aetna,PPO,2139,93,,percent of total billed charges,,
Suprapubic Catheter Placement,,25009203,LOCAL,Facility,Both,,,,2300,1955,659.18,2300,America's PPO,America's PPO,2208.69,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Suprapubic Catheter Placement,,25009203,LOCAL,Facility,Both,,,,2300,1955,659.18,2300,BlueCross BlueShield Minnesota, Federal Employee Program,2263.2,98.4,,percent of total billed charges,,
Suprapubic Catheter Placement,,25009203,LOCAL,Facility,Both,,,,2300,1955,659.18,2300,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,2300,100,,percent of total billed charges,,
Suprapubic Catheter Placement,,25009203,LOCAL,Facility,Both,,,,2300,1955,659.18,2300,BlueCross BlueShield Minnesota,High Value Network Plan,2070,90,,percent of total billed charges,,
Suprapubic Catheter Placement,,25009203,LOCAL,Facility,Outpatient,,,,2300,1955,659.18,2300,BlueCross BlueShield Minnesota,Medicare Advantage,1127,49,,percent of total billed charges,,
Suprapubic Catheter Placement,,25009203,LOCAL,Facility,Inpatient,,,,2300,1955,659.18,2300,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Suprapubic Catheter Placement,,25009203,LOCAL,Facility,Both,,,,2300,1955,659.18,2300,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,2037.11,88.57,,percent of total billed charges,,
Suprapubic Catheter Placement,,25009203,LOCAL,Facility,Both,,,,2300,1955,659.18,2300,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,659.18,28.66,,percent of total billed charges,,
Suprapubic Catheter Placement,,25009203,LOCAL,Facility,Outpatient,,,,2300,1955,659.18,2300,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1127,49,,percent of total billed charges,,
Suprapubic Catheter Placement,,25009203,LOCAL,Facility,Inpatient,,,,2300,1955,659.18,2300,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Suprapubic Catheter Placement,,25009203,LOCAL,Facility,Both,,,,2300,1955,659.18,2300,CorVel,Worker's Compensation,2300,100,,percent of total billed charges,,
Suprapubic Catheter Placement,,25009203,LOCAL,Facility,Both,,,,2300,1955,659.18,2300,First Health Group Corporation,First Health Network,2231,97,,percent of total billed charges,,
Suprapubic Catheter Placement,,25009203,LOCAL,Facility,Both,,,,2300,1955,659.18,2300,"Health Partners, Inc.",Commercial,2175.8,94.6,,percent of total billed charges,,
Suprapubic Catheter Placement,,25009203,LOCAL,Facility,Outpatient,,,,2300,1955,659.18,2300,"Health Partners, Inc.",Medicare Advantage,1127,49,,percent of total billed charges,,
Suprapubic Catheter Placement,,25009203,LOCAL,Facility,Inpatient,,,,2300,1955,659.18,2300,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Suprapubic Catheter Placement,,25009203,LOCAL,Facility,Both,,,,2300,1955,659.18,2300,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1380,60,,percent of total billed charges,,
Suprapubic Catheter Placement,,25009203,LOCAL,Facility,Both,,,,2300,1955,659.18,2300,"Health Partners, Inc.",State of Minnesota Advantage Program,1874.5,81.5,,percent of total billed charges,,
Suprapubic Catheter Placement,,25009203,LOCAL,Facility,Both,,,,2300,1955,659.18,2300,"Health Partners, Inc.",State Public Programs,1150,50,,percent of total billed charges,,
Suprapubic Catheter Placement,,25009203,LOCAL,Facility,Both,,,,2300,1955,659.18,2300,Humana Insurance Company,Commercial PPO,2185,95,,percent of total billed charges,,
Suprapubic Catheter Placement,,25009203,LOCAL,Facility,Outpatient,,,,2300,1955,659.18,2300,Humana Insurance Company,Medicare PPO,1127,49,,percent of total billed charges,,
Suprapubic Catheter Placement,,25009203,LOCAL,Facility,Inpatient,,,,2300,1955,659.18,2300,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Suprapubic Catheter Placement,,25009203,LOCAL,Facility,Both,,,,2300,1955,659.18,2300,Medica,Individual & Family,2279.3,99.1,,percent of total billed charges,,
Suprapubic Catheter Placement,,25009203,LOCAL,Facility,Outpatient,,,,2300,1955,659.18,2300,Medica,Medica Advantage Solution,1145.4,49.8,,percent of total billed charges,,
Suprapubic Catheter Placement,,25009203,LOCAL,Facility,Inpatient,,,,2300,1955,659.18,2300,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Suprapubic Catheter Placement,,25009203,LOCAL,Facility,Outpatient,,,,2300,1955,659.18,2300,Medica,Medical Assistance,1025.8,44.6,,percent of total billed charges,,
Suprapubic Catheter Placement,,25009203,LOCAL,Facility,Inpatient,,,,2300,1955,659.18,2300,Medica,Medical Assistance,,,,,Included in per diem rate,
Suprapubic Catheter Placement,,25009203,LOCAL,Facility,Outpatient,,,,2300,1955,659.18,2300,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1145.4,49.8,,percent of total billed charges,,
Suprapubic Catheter Placement,,25009203,LOCAL,Facility,Inpatient,,,,2300,1955,659.18,2300,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Suprapubic Catheter Placement,,25009203,LOCAL,Facility,Both,,,,2300,1955,659.18,2300,"Multiplan, Inc.","Multiplan, Inc.",2162,94,,percent of total billed charges,,
Suprapubic Catheter Placement,,25009203,LOCAL,Facility,Outpatient,,,,2300,1955,659.18,2300,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,2072.3,90.1,,percent of total billed charges,,
Suprapubic Catheter Placement,,25009203,LOCAL,Facility,Inpatient,,,,2300,1955,659.18,2300,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Suprapubic Catheter Placement,,25009203,LOCAL,Facility,Both,,,,2300,1955,659.18,2300,"Preferred One Administrative Services, INC.",PPO,2267.8,98.6,,percent of total billed charges,,
Suprapubic Catheter Placement,,25009203,LOCAL,Facility,Outpatient,,,,2300,1955,659.18,2300,PrimeWest Health,Minnesota Senior Health Options (MSHO),1183.35,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Suprapubic Catheter Placement,,25009203,LOCAL,Facility,Inpatient,,,,2300,1955,659.18,2300,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Suprapubic Catheter Placement,,25009203,LOCAL,Facility,Outpatient,,,,2300,1955,659.18,2300,PrimeWest Health,MinnesotaCare,1181.28,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Suprapubic Catheter Placement,,25009203,LOCAL,Facility,Inpatient,,,,2300,1955,659.18,2300,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Suprapubic Catheter Placement,,25009203,LOCAL,Facility,Both,,,,2300,1955,659.18,2300,Sanford Health Plan,Sanford Health Plan,2116,92,,percent of total billed charges,,
Suprapubic Catheter Placement,,25009203,LOCAL,Facility,Outpatient,,,,2300,1955,659.18,2300,"UCare Health, Inc.",Individual & Family Plan,1296.05,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Suprapubic Catheter Placement,,25009203,LOCAL,Facility,Inpatient,,,,2300,1955,659.18,2300,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Suprapubic Catheter Placement,,25009203,LOCAL,Facility,Outpatient,,,,2300,1955,659.18,2300,"UCare Health, Inc.",Medical Assistance,1160.81,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Suprapubic Catheter Placement,,25009203,LOCAL,Facility,Inpatient,,,,2300,1955,659.18,2300,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Suprapubic Catheter Placement,,25009203,LOCAL,Facility,Outpatient,,,,2300,1955,659.18,2300,"UCare Health, Inc.",Medicare Advantage,1160.81,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Suprapubic Catheter Placement,,25009203,LOCAL,Facility,Inpatient,,,,2300,1955,659.18,2300,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Suprapubic Catheter Placement,,25009203,LOCAL,Facility,Outpatient,,,,2300,1955,659.18,2300,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1160.81,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Suprapubic Catheter Placement,,25009203,LOCAL,Facility,Inpatient,,,,2300,1955,659.18,2300,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Suprapubic Catheter Placement,,25009203,LOCAL,Facility,Both,,,,2300,1955,659.18,2300,UnitedHealthcare,Individual & Family,2162,94,,percent of total billed charges,,
Suprapubic Catheter Placement,,25009203,LOCAL,Facility,Outpatient,,,,2300,1955,659.18,2300,UnitedHealthcare,Medicare Advantage,1127,49,,percent of total billed charges,,
Suprapubic Catheter Placement,,25009203,LOCAL,Facility,Inpatient,,,,2300,1955,659.18,2300,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Suprapubic Catheter Placement,,25009203,LOCAL,Facility,Outpatient,,,,2300,1955,659.18,2300,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1104,48,,percent of total billed charges,,100% of DHS outpatient percentage
Suprapubic Catheter Placement,,25009203,LOCAL,Facility,Inpatient,,,,2300,1955,659.18,2300,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Major Procedure In Or,,25009227,LOCAL,Facility,Both,,,,714,606.9,204.6324,714,Aetna,Commercial,656.88,92,,percent of total billed charges,,
Major Procedure In Or,,25009227,LOCAL,Facility,Outpatient,,,,714,606.9,204.6324,714,Aetna,Medicare Advantage,349.86,49,,percent of total billed charges,,
Major Procedure In Or,,25009227,LOCAL,Facility,Inpatient,,,,714,606.9,204.6324,714,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Major Procedure In Or,,25009227,LOCAL,Facility,Both,,,,714,606.9,204.6324,714,Aetna,PPO,664.02,93,,percent of total billed charges,,
Major Procedure In Or,,25009227,LOCAL,Facility,Both,,,,714,606.9,204.6324,714,America's PPO,America's PPO,685.6542,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Major Procedure In Or,,25009227,LOCAL,Facility,Both,,,,714,606.9,204.6324,714,BlueCross BlueShield Minnesota, Federal Employee Program,702.576,98.4,,percent of total billed charges,,
Major Procedure In Or,,25009227,LOCAL,Facility,Both,,,,714,606.9,204.6324,714,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,714,100,,percent of total billed charges,,
Major Procedure In Or,,25009227,LOCAL,Facility,Both,,,,714,606.9,204.6324,714,BlueCross BlueShield Minnesota,High Value Network Plan,642.6,90,,percent of total billed charges,,
Major Procedure In Or,,25009227,LOCAL,Facility,Outpatient,,,,714,606.9,204.6324,714,BlueCross BlueShield Minnesota,Medicare Advantage,349.86,49,,percent of total billed charges,,
Major Procedure In Or,,25009227,LOCAL,Facility,Inpatient,,,,714,606.9,204.6324,714,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Major Procedure In Or,,25009227,LOCAL,Facility,Both,,,,714,606.9,204.6324,714,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,632.3898,88.57,,percent of total billed charges,,
Major Procedure In Or,,25009227,LOCAL,Facility,Both,,,,714,606.9,204.6324,714,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,204.6324,28.66,,percent of total billed charges,,
Major Procedure In Or,,25009227,LOCAL,Facility,Outpatient,,,,714,606.9,204.6324,714,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),349.86,49,,percent of total billed charges,,
Major Procedure In Or,,25009227,LOCAL,Facility,Inpatient,,,,714,606.9,204.6324,714,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Major Procedure In Or,,25009227,LOCAL,Facility,Both,,,,714,606.9,204.6324,714,CorVel,Worker's Compensation,714,100,,percent of total billed charges,,
Major Procedure In Or,,25009227,LOCAL,Facility,Both,,,,714,606.9,204.6324,714,First Health Group Corporation,First Health Network,692.58,97,,percent of total billed charges,,
Major Procedure In Or,,25009227,LOCAL,Facility,Both,,,,714,606.9,204.6324,714,"Health Partners, Inc.",Commercial,675.444,94.6,,percent of total billed charges,,
Major Procedure In Or,,25009227,LOCAL,Facility,Outpatient,,,,714,606.9,204.6324,714,"Health Partners, Inc.",Medicare Advantage,349.86,49,,percent of total billed charges,,
Major Procedure In Or,,25009227,LOCAL,Facility,Inpatient,,,,714,606.9,204.6324,714,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Major Procedure In Or,,25009227,LOCAL,Facility,Both,,,,714,606.9,204.6324,714,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),428.4,60,,percent of total billed charges,,
Major Procedure In Or,,25009227,LOCAL,Facility,Both,,,,714,606.9,204.6324,714,"Health Partners, Inc.",State of Minnesota Advantage Program,581.91,81.5,,percent of total billed charges,,
Major Procedure In Or,,25009227,LOCAL,Facility,Both,,,,714,606.9,204.6324,714,"Health Partners, Inc.",State Public Programs,357,50,,percent of total billed charges,,
Major Procedure In Or,,25009227,LOCAL,Facility,Both,,,,714,606.9,204.6324,714,Humana Insurance Company,Commercial PPO,678.3,95,,percent of total billed charges,,
Major Procedure In Or,,25009227,LOCAL,Facility,Outpatient,,,,714,606.9,204.6324,714,Humana Insurance Company,Medicare PPO,349.86,49,,percent of total billed charges,,
Major Procedure In Or,,25009227,LOCAL,Facility,Inpatient,,,,714,606.9,204.6324,714,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Major Procedure In Or,,25009227,LOCAL,Facility,Both,,,,714,606.9,204.6324,714,Medica,Individual & Family,707.574,99.1,,percent of total billed charges,,
Major Procedure In Or,,25009227,LOCAL,Facility,Outpatient,,,,714,606.9,204.6324,714,Medica,Medica Advantage Solution,355.572,49.8,,percent of total billed charges,,
Major Procedure In Or,,25009227,LOCAL,Facility,Inpatient,,,,714,606.9,204.6324,714,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Major Procedure In Or,,25009227,LOCAL,Facility,Outpatient,,,,714,606.9,204.6324,714,Medica,Medical Assistance,318.444,44.6,,percent of total billed charges,,
Major Procedure In Or,,25009227,LOCAL,Facility,Inpatient,,,,714,606.9,204.6324,714,Medica,Medical Assistance,,,,,Included in per diem rate,
Major Procedure In Or,,25009227,LOCAL,Facility,Outpatient,,,,714,606.9,204.6324,714,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,355.572,49.8,,percent of total billed charges,,
Major Procedure In Or,,25009227,LOCAL,Facility,Inpatient,,,,714,606.9,204.6324,714,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Major Procedure In Or,,25009227,LOCAL,Facility,Both,,,,714,606.9,204.6324,714,"Multiplan, Inc.","Multiplan, Inc.",671.16,94,,percent of total billed charges,,
Major Procedure In Or,,25009227,LOCAL,Facility,Outpatient,,,,714,606.9,204.6324,714,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,643.314,90.1,,percent of total billed charges,,
Major Procedure In Or,,25009227,LOCAL,Facility,Inpatient,,,,714,606.9,204.6324,714,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Major Procedure In Or,,25009227,LOCAL,Facility,Both,,,,714,606.9,204.6324,714,"Preferred One Administrative Services, INC.",PPO,704.004,98.6,,percent of total billed charges,,
Major Procedure In Or,,25009227,LOCAL,Facility,Outpatient,,,,714,606.9,204.6324,714,PrimeWest Health,Minnesota Senior Health Options (MSHO),367.353,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Major Procedure In Or,,25009227,LOCAL,Facility,Inpatient,,,,714,606.9,204.6324,714,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Major Procedure In Or,,25009227,LOCAL,Facility,Outpatient,,,,714,606.9,204.6324,714,PrimeWest Health,MinnesotaCare,366.7104,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Major Procedure In Or,,25009227,LOCAL,Facility,Inpatient,,,,714,606.9,204.6324,714,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Major Procedure In Or,,25009227,LOCAL,Facility,Both,,,,714,606.9,204.6324,714,Sanford Health Plan,Sanford Health Plan,656.88,92,,percent of total billed charges,,
Major Procedure In Or,,25009227,LOCAL,Facility,Outpatient,,,,714,606.9,204.6324,714,"UCare Health, Inc.",Individual & Family Plan,402.339,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Major Procedure In Or,,25009227,LOCAL,Facility,Inpatient,,,,714,606.9,204.6324,714,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Major Procedure In Or,,25009227,LOCAL,Facility,Outpatient,,,,714,606.9,204.6324,714,"UCare Health, Inc.",Medical Assistance,360.3558,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Major Procedure In Or,,25009227,LOCAL,Facility,Inpatient,,,,714,606.9,204.6324,714,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Major Procedure In Or,,25009227,LOCAL,Facility,Outpatient,,,,714,606.9,204.6324,714,"UCare Health, Inc.",Medicare Advantage,360.3558,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Major Procedure In Or,,25009227,LOCAL,Facility,Inpatient,,,,714,606.9,204.6324,714,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Major Procedure In Or,,25009227,LOCAL,Facility,Outpatient,,,,714,606.9,204.6324,714,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),360.3558,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Major Procedure In Or,,25009227,LOCAL,Facility,Inpatient,,,,714,606.9,204.6324,714,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Major Procedure In Or,,25009227,LOCAL,Facility,Both,,,,714,606.9,204.6324,714,UnitedHealthcare,Individual & Family,671.16,94,,percent of total billed charges,,
Major Procedure In Or,,25009227,LOCAL,Facility,Outpatient,,,,714,606.9,204.6324,714,UnitedHealthcare,Medicare Advantage,349.86,49,,percent of total billed charges,,
Major Procedure In Or,,25009227,LOCAL,Facility,Inpatient,,,,714,606.9,204.6324,714,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Major Procedure In Or,,25009227,LOCAL,Facility,Outpatient,,,,714,606.9,204.6324,714,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,342.72,48,,percent of total billed charges,,100% of DHS outpatient percentage
Major Procedure In Or,,25009227,LOCAL,Facility,Inpatient,,,,714,606.9,204.6324,714,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Lymph Node Biopsy,,25009301,LOCAL,Facility,Both,,,,1785,1517.25,511.581,1785,Aetna,Commercial,1642.2,92,,percent of total billed charges,,
Lymph Node Biopsy,,25009301,LOCAL,Facility,Outpatient,,,,1785,1517.25,511.581,1785,Aetna,Medicare Advantage,874.65,49,,percent of total billed charges,,
Lymph Node Biopsy,,25009301,LOCAL,Facility,Inpatient,,,,1785,1517.25,511.581,1785,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Lymph Node Biopsy,,25009301,LOCAL,Facility,Both,,,,1785,1517.25,511.581,1785,Aetna,PPO,1660.05,93,,percent of total billed charges,,
Lymph Node Biopsy,,25009301,LOCAL,Facility,Both,,,,1785,1517.25,511.581,1785,America's PPO,America's PPO,1714.1355,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Lymph Node Biopsy,,25009301,LOCAL,Facility,Both,,,,1785,1517.25,511.581,1785,BlueCross BlueShield Minnesota, Federal Employee Program,1756.44,98.4,,percent of total billed charges,,
Lymph Node Biopsy,,25009301,LOCAL,Facility,Both,,,,1785,1517.25,511.581,1785,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1785,100,,percent of total billed charges,,
Lymph Node Biopsy,,25009301,LOCAL,Facility,Both,,,,1785,1517.25,511.581,1785,BlueCross BlueShield Minnesota,High Value Network Plan,1606.5,90,,percent of total billed charges,,
Lymph Node Biopsy,,25009301,LOCAL,Facility,Outpatient,,,,1785,1517.25,511.581,1785,BlueCross BlueShield Minnesota,Medicare Advantage,874.65,49,,percent of total billed charges,,
Lymph Node Biopsy,,25009301,LOCAL,Facility,Inpatient,,,,1785,1517.25,511.581,1785,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Lymph Node Biopsy,,25009301,LOCAL,Facility,Both,,,,1785,1517.25,511.581,1785,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1580.9745,88.57,,percent of total billed charges,,
Lymph Node Biopsy,,25009301,LOCAL,Facility,Both,,,,1785,1517.25,511.581,1785,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,511.581,28.66,,percent of total billed charges,,
Lymph Node Biopsy,,25009301,LOCAL,Facility,Outpatient,,,,1785,1517.25,511.581,1785,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),874.65,49,,percent of total billed charges,,
Lymph Node Biopsy,,25009301,LOCAL,Facility,Inpatient,,,,1785,1517.25,511.581,1785,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Lymph Node Biopsy,,25009301,LOCAL,Facility,Both,,,,1785,1517.25,511.581,1785,CorVel,Worker's Compensation,1785,100,,percent of total billed charges,,
Lymph Node Biopsy,,25009301,LOCAL,Facility,Both,,,,1785,1517.25,511.581,1785,First Health Group Corporation,First Health Network,1731.45,97,,percent of total billed charges,,
Lymph Node Biopsy,,25009301,LOCAL,Facility,Both,,,,1785,1517.25,511.581,1785,"Health Partners, Inc.",Commercial,1688.61,94.6,,percent of total billed charges,,
Lymph Node Biopsy,,25009301,LOCAL,Facility,Outpatient,,,,1785,1517.25,511.581,1785,"Health Partners, Inc.",Medicare Advantage,874.65,49,,percent of total billed charges,,
Lymph Node Biopsy,,25009301,LOCAL,Facility,Inpatient,,,,1785,1517.25,511.581,1785,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Lymph Node Biopsy,,25009301,LOCAL,Facility,Both,,,,1785,1517.25,511.581,1785,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1071,60,,percent of total billed charges,,
Lymph Node Biopsy,,25009301,LOCAL,Facility,Both,,,,1785,1517.25,511.581,1785,"Health Partners, Inc.",State of Minnesota Advantage Program,1454.775,81.5,,percent of total billed charges,,
Lymph Node Biopsy,,25009301,LOCAL,Facility,Both,,,,1785,1517.25,511.581,1785,"Health Partners, Inc.",State Public Programs,892.5,50,,percent of total billed charges,,
Lymph Node Biopsy,,25009301,LOCAL,Facility,Both,,,,1785,1517.25,511.581,1785,Humana Insurance Company,Commercial PPO,1695.75,95,,percent of total billed charges,,
Lymph Node Biopsy,,25009301,LOCAL,Facility,Outpatient,,,,1785,1517.25,511.581,1785,Humana Insurance Company,Medicare PPO,874.65,49,,percent of total billed charges,,
Lymph Node Biopsy,,25009301,LOCAL,Facility,Inpatient,,,,1785,1517.25,511.581,1785,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Lymph Node Biopsy,,25009301,LOCAL,Facility,Both,,,,1785,1517.25,511.581,1785,Medica,Individual & Family,1768.935,99.1,,percent of total billed charges,,
Lymph Node Biopsy,,25009301,LOCAL,Facility,Outpatient,,,,1785,1517.25,511.581,1785,Medica,Medica Advantage Solution,888.93,49.8,,percent of total billed charges,,
Lymph Node Biopsy,,25009301,LOCAL,Facility,Inpatient,,,,1785,1517.25,511.581,1785,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Lymph Node Biopsy,,25009301,LOCAL,Facility,Outpatient,,,,1785,1517.25,511.581,1785,Medica,Medical Assistance,796.11,44.6,,percent of total billed charges,,
Lymph Node Biopsy,,25009301,LOCAL,Facility,Inpatient,,,,1785,1517.25,511.581,1785,Medica,Medical Assistance,,,,,Included in per diem rate,
Lymph Node Biopsy,,25009301,LOCAL,Facility,Outpatient,,,,1785,1517.25,511.581,1785,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,888.93,49.8,,percent of total billed charges,,
Lymph Node Biopsy,,25009301,LOCAL,Facility,Inpatient,,,,1785,1517.25,511.581,1785,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Lymph Node Biopsy,,25009301,LOCAL,Facility,Both,,,,1785,1517.25,511.581,1785,"Multiplan, Inc.","Multiplan, Inc.",1677.9,94,,percent of total billed charges,,
Lymph Node Biopsy,,25009301,LOCAL,Facility,Outpatient,,,,1785,1517.25,511.581,1785,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1608.285,90.1,,percent of total billed charges,,
Lymph Node Biopsy,,25009301,LOCAL,Facility,Inpatient,,,,1785,1517.25,511.581,1785,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Lymph Node Biopsy,,25009301,LOCAL,Facility,Both,,,,1785,1517.25,511.581,1785,"Preferred One Administrative Services, INC.",PPO,1760.01,98.6,,percent of total billed charges,,
Lymph Node Biopsy,,25009301,LOCAL,Facility,Outpatient,,,,1785,1517.25,511.581,1785,PrimeWest Health,Minnesota Senior Health Options (MSHO),918.3825,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Lymph Node Biopsy,,25009301,LOCAL,Facility,Inpatient,,,,1785,1517.25,511.581,1785,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Lymph Node Biopsy,,25009301,LOCAL,Facility,Outpatient,,,,1785,1517.25,511.581,1785,PrimeWest Health,MinnesotaCare,916.776,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Lymph Node Biopsy,,25009301,LOCAL,Facility,Inpatient,,,,1785,1517.25,511.581,1785,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Lymph Node Biopsy,,25009301,LOCAL,Facility,Both,,,,1785,1517.25,511.581,1785,Sanford Health Plan,Sanford Health Plan,1642.2,92,,percent of total billed charges,,
Lymph Node Biopsy,,25009301,LOCAL,Facility,Outpatient,,,,1785,1517.25,511.581,1785,"UCare Health, Inc.",Individual & Family Plan,1005.8475,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Lymph Node Biopsy,,25009301,LOCAL,Facility,Inpatient,,,,1785,1517.25,511.581,1785,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Lymph Node Biopsy,,25009301,LOCAL,Facility,Outpatient,,,,1785,1517.25,511.581,1785,"UCare Health, Inc.",Medical Assistance,900.8895,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Lymph Node Biopsy,,25009301,LOCAL,Facility,Inpatient,,,,1785,1517.25,511.581,1785,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Lymph Node Biopsy,,25009301,LOCAL,Facility,Outpatient,,,,1785,1517.25,511.581,1785,"UCare Health, Inc.",Medicare Advantage,900.8895,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Lymph Node Biopsy,,25009301,LOCAL,Facility,Inpatient,,,,1785,1517.25,511.581,1785,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Lymph Node Biopsy,,25009301,LOCAL,Facility,Outpatient,,,,1785,1517.25,511.581,1785,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),900.8895,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Lymph Node Biopsy,,25009301,LOCAL,Facility,Inpatient,,,,1785,1517.25,511.581,1785,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Lymph Node Biopsy,,25009301,LOCAL,Facility,Both,,,,1785,1517.25,511.581,1785,UnitedHealthcare,Individual & Family,1677.9,94,,percent of total billed charges,,
Lymph Node Biopsy,,25009301,LOCAL,Facility,Outpatient,,,,1785,1517.25,511.581,1785,UnitedHealthcare,Medicare Advantage,874.65,49,,percent of total billed charges,,
Lymph Node Biopsy,,25009301,LOCAL,Facility,Inpatient,,,,1785,1517.25,511.581,1785,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Lymph Node Biopsy,,25009301,LOCAL,Facility,Outpatient,,,,1785,1517.25,511.581,1785,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,856.8,48,,percent of total billed charges,,100% of DHS outpatient percentage
Lymph Node Biopsy,,25009301,LOCAL,Facility,Inpatient,,,,1785,1517.25,511.581,1785,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Needle Aspiration,,25009313,LOCAL,Facility,Both,,,,1836,1560.6,526.1976,1836,Aetna,Commercial,1689.12,92,,percent of total billed charges,,
Needle Aspiration,,25009313,LOCAL,Facility,Outpatient,,,,1836,1560.6,526.1976,1836,Aetna,Medicare Advantage,899.64,49,,percent of total billed charges,,
Needle Aspiration,,25009313,LOCAL,Facility,Inpatient,,,,1836,1560.6,526.1976,1836,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Needle Aspiration,,25009313,LOCAL,Facility,Both,,,,1836,1560.6,526.1976,1836,Aetna,PPO,1707.48,93,,percent of total billed charges,,
Needle Aspiration,,25009313,LOCAL,Facility,Both,,,,1836,1560.6,526.1976,1836,America's PPO,America's PPO,1763.1108,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Needle Aspiration,,25009313,LOCAL,Facility,Both,,,,1836,1560.6,526.1976,1836,BlueCross BlueShield Minnesota, Federal Employee Program,1806.624,98.4,,percent of total billed charges,,
Needle Aspiration,,25009313,LOCAL,Facility,Both,,,,1836,1560.6,526.1976,1836,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1836,100,,percent of total billed charges,,
Needle Aspiration,,25009313,LOCAL,Facility,Both,,,,1836,1560.6,526.1976,1836,BlueCross BlueShield Minnesota,High Value Network Plan,1652.4,90,,percent of total billed charges,,
Needle Aspiration,,25009313,LOCAL,Facility,Outpatient,,,,1836,1560.6,526.1976,1836,BlueCross BlueShield Minnesota,Medicare Advantage,899.64,49,,percent of total billed charges,,
Needle Aspiration,,25009313,LOCAL,Facility,Inpatient,,,,1836,1560.6,526.1976,1836,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Needle Aspiration,,25009313,LOCAL,Facility,Both,,,,1836,1560.6,526.1976,1836,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1626.1452,88.57,,percent of total billed charges,,
Needle Aspiration,,25009313,LOCAL,Facility,Both,,,,1836,1560.6,526.1976,1836,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,526.1976,28.66,,percent of total billed charges,,
Needle Aspiration,,25009313,LOCAL,Facility,Outpatient,,,,1836,1560.6,526.1976,1836,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),899.64,49,,percent of total billed charges,,
Needle Aspiration,,25009313,LOCAL,Facility,Inpatient,,,,1836,1560.6,526.1976,1836,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Needle Aspiration,,25009313,LOCAL,Facility,Both,,,,1836,1560.6,526.1976,1836,CorVel,Worker's Compensation,1836,100,,percent of total billed charges,,
Needle Aspiration,,25009313,LOCAL,Facility,Both,,,,1836,1560.6,526.1976,1836,First Health Group Corporation,First Health Network,1780.92,97,,percent of total billed charges,,
Needle Aspiration,,25009313,LOCAL,Facility,Both,,,,1836,1560.6,526.1976,1836,"Health Partners, Inc.",Commercial,1736.856,94.6,,percent of total billed charges,,
Needle Aspiration,,25009313,LOCAL,Facility,Outpatient,,,,1836,1560.6,526.1976,1836,"Health Partners, Inc.",Medicare Advantage,899.64,49,,percent of total billed charges,,
Needle Aspiration,,25009313,LOCAL,Facility,Inpatient,,,,1836,1560.6,526.1976,1836,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Needle Aspiration,,25009313,LOCAL,Facility,Both,,,,1836,1560.6,526.1976,1836,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1101.6,60,,percent of total billed charges,,
Needle Aspiration,,25009313,LOCAL,Facility,Both,,,,1836,1560.6,526.1976,1836,"Health Partners, Inc.",State of Minnesota Advantage Program,1496.34,81.5,,percent of total billed charges,,
Needle Aspiration,,25009313,LOCAL,Facility,Both,,,,1836,1560.6,526.1976,1836,"Health Partners, Inc.",State Public Programs,918,50,,percent of total billed charges,,
Needle Aspiration,,25009313,LOCAL,Facility,Both,,,,1836,1560.6,526.1976,1836,Humana Insurance Company,Commercial PPO,1744.2,95,,percent of total billed charges,,
Needle Aspiration,,25009313,LOCAL,Facility,Outpatient,,,,1836,1560.6,526.1976,1836,Humana Insurance Company,Medicare PPO,899.64,49,,percent of total billed charges,,
Needle Aspiration,,25009313,LOCAL,Facility,Inpatient,,,,1836,1560.6,526.1976,1836,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Needle Aspiration,,25009313,LOCAL,Facility,Both,,,,1836,1560.6,526.1976,1836,Medica,Individual & Family,1819.476,99.1,,percent of total billed charges,,
Needle Aspiration,,25009313,LOCAL,Facility,Outpatient,,,,1836,1560.6,526.1976,1836,Medica,Medica Advantage Solution,914.328,49.8,,percent of total billed charges,,
Needle Aspiration,,25009313,LOCAL,Facility,Inpatient,,,,1836,1560.6,526.1976,1836,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Needle Aspiration,,25009313,LOCAL,Facility,Outpatient,,,,1836,1560.6,526.1976,1836,Medica,Medical Assistance,818.856,44.6,,percent of total billed charges,,
Needle Aspiration,,25009313,LOCAL,Facility,Inpatient,,,,1836,1560.6,526.1976,1836,Medica,Medical Assistance,,,,,Included in per diem rate,
Needle Aspiration,,25009313,LOCAL,Facility,Outpatient,,,,1836,1560.6,526.1976,1836,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,914.328,49.8,,percent of total billed charges,,
Needle Aspiration,,25009313,LOCAL,Facility,Inpatient,,,,1836,1560.6,526.1976,1836,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Needle Aspiration,,25009313,LOCAL,Facility,Both,,,,1836,1560.6,526.1976,1836,"Multiplan, Inc.","Multiplan, Inc.",1725.84,94,,percent of total billed charges,,
Needle Aspiration,,25009313,LOCAL,Facility,Outpatient,,,,1836,1560.6,526.1976,1836,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1654.236,90.1,,percent of total billed charges,,
Needle Aspiration,,25009313,LOCAL,Facility,Inpatient,,,,1836,1560.6,526.1976,1836,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Needle Aspiration,,25009313,LOCAL,Facility,Both,,,,1836,1560.6,526.1976,1836,"Preferred One Administrative Services, INC.",PPO,1810.296,98.6,,percent of total billed charges,,
Needle Aspiration,,25009313,LOCAL,Facility,Outpatient,,,,1836,1560.6,526.1976,1836,PrimeWest Health,Minnesota Senior Health Options (MSHO),944.622,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Needle Aspiration,,25009313,LOCAL,Facility,Inpatient,,,,1836,1560.6,526.1976,1836,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Needle Aspiration,,25009313,LOCAL,Facility,Outpatient,,,,1836,1560.6,526.1976,1836,PrimeWest Health,MinnesotaCare,942.9696,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Needle Aspiration,,25009313,LOCAL,Facility,Inpatient,,,,1836,1560.6,526.1976,1836,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Needle Aspiration,,25009313,LOCAL,Facility,Both,,,,1836,1560.6,526.1976,1836,Sanford Health Plan,Sanford Health Plan,1689.12,92,,percent of total billed charges,,
Needle Aspiration,,25009313,LOCAL,Facility,Outpatient,,,,1836,1560.6,526.1976,1836,"UCare Health, Inc.",Individual & Family Plan,1034.586,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Needle Aspiration,,25009313,LOCAL,Facility,Inpatient,,,,1836,1560.6,526.1976,1836,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Needle Aspiration,,25009313,LOCAL,Facility,Outpatient,,,,1836,1560.6,526.1976,1836,"UCare Health, Inc.",Medical Assistance,926.6292,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Needle Aspiration,,25009313,LOCAL,Facility,Inpatient,,,,1836,1560.6,526.1976,1836,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Needle Aspiration,,25009313,LOCAL,Facility,Outpatient,,,,1836,1560.6,526.1976,1836,"UCare Health, Inc.",Medicare Advantage,926.6292,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Needle Aspiration,,25009313,LOCAL,Facility,Inpatient,,,,1836,1560.6,526.1976,1836,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Needle Aspiration,,25009313,LOCAL,Facility,Outpatient,,,,1836,1560.6,526.1976,1836,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),926.6292,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Needle Aspiration,,25009313,LOCAL,Facility,Inpatient,,,,1836,1560.6,526.1976,1836,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Needle Aspiration,,25009313,LOCAL,Facility,Both,,,,1836,1560.6,526.1976,1836,UnitedHealthcare,Individual & Family,1725.84,94,,percent of total billed charges,,
Needle Aspiration,,25009313,LOCAL,Facility,Outpatient,,,,1836,1560.6,526.1976,1836,UnitedHealthcare,Medicare Advantage,899.64,49,,percent of total billed charges,,
Needle Aspiration,,25009313,LOCAL,Facility,Inpatient,,,,1836,1560.6,526.1976,1836,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Needle Aspiration,,25009313,LOCAL,Facility,Outpatient,,,,1836,1560.6,526.1976,1836,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,881.28,48,,percent of total billed charges,,100% of DHS outpatient percentage
Needle Aspiration,,25009313,LOCAL,Facility,Inpatient,,,,1836,1560.6,526.1976,1836,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Exploratory Laparoscopy,,25009516,LOCAL,Facility,Both,,,,4692,3988.2,1344.7272,4692,Aetna,Commercial,4316.64,92,,percent of total billed charges,,
Exploratory Laparoscopy,,25009516,LOCAL,Facility,Outpatient,,,,4692,3988.2,1344.7272,4692,Aetna,Medicare Advantage,2299.08,49,,percent of total billed charges,,
Exploratory Laparoscopy,,25009516,LOCAL,Facility,Inpatient,,,,4692,3988.2,1344.7272,4692,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Exploratory Laparoscopy,,25009516,LOCAL,Facility,Both,,,,4692,3988.2,1344.7272,4692,Aetna,PPO,4363.56,93,,percent of total billed charges,,
Exploratory Laparoscopy,,25009516,LOCAL,Facility,Both,,,,4692,3988.2,1344.7272,4692,America's PPO,America's PPO,4505.7276,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Exploratory Laparoscopy,,25009516,LOCAL,Facility,Both,,,,4692,3988.2,1344.7272,4692,BlueCross BlueShield Minnesota, Federal Employee Program,4616.928,98.4,,percent of total billed charges,,
Exploratory Laparoscopy,,25009516,LOCAL,Facility,Both,,,,4692,3988.2,1344.7272,4692,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,4692,100,,percent of total billed charges,,
Exploratory Laparoscopy,,25009516,LOCAL,Facility,Both,,,,4692,3988.2,1344.7272,4692,BlueCross BlueShield Minnesota,High Value Network Plan,4222.8,90,,percent of total billed charges,,
Exploratory Laparoscopy,,25009516,LOCAL,Facility,Outpatient,,,,4692,3988.2,1344.7272,4692,BlueCross BlueShield Minnesota,Medicare Advantage,2299.08,49,,percent of total billed charges,,
Exploratory Laparoscopy,,25009516,LOCAL,Facility,Inpatient,,,,4692,3988.2,1344.7272,4692,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Exploratory Laparoscopy,,25009516,LOCAL,Facility,Both,,,,4692,3988.2,1344.7272,4692,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4155.7044,88.57,,percent of total billed charges,,
Exploratory Laparoscopy,,25009516,LOCAL,Facility,Both,,,,4692,3988.2,1344.7272,4692,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1344.7272,28.66,,percent of total billed charges,,
Exploratory Laparoscopy,,25009516,LOCAL,Facility,Outpatient,,,,4692,3988.2,1344.7272,4692,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2299.08,49,,percent of total billed charges,,
Exploratory Laparoscopy,,25009516,LOCAL,Facility,Inpatient,,,,4692,3988.2,1344.7272,4692,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Exploratory Laparoscopy,,25009516,LOCAL,Facility,Both,,,,4692,3988.2,1344.7272,4692,CorVel,Worker's Compensation,4692,100,,percent of total billed charges,,
Exploratory Laparoscopy,,25009516,LOCAL,Facility,Both,,,,4692,3988.2,1344.7272,4692,First Health Group Corporation,First Health Network,4551.24,97,,percent of total billed charges,,
Exploratory Laparoscopy,,25009516,LOCAL,Facility,Both,,,,4692,3988.2,1344.7272,4692,"Health Partners, Inc.",Commercial,4438.632,94.6,,percent of total billed charges,,
Exploratory Laparoscopy,,25009516,LOCAL,Facility,Outpatient,,,,4692,3988.2,1344.7272,4692,"Health Partners, Inc.",Medicare Advantage,2299.08,49,,percent of total billed charges,,
Exploratory Laparoscopy,,25009516,LOCAL,Facility,Inpatient,,,,4692,3988.2,1344.7272,4692,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Exploratory Laparoscopy,,25009516,LOCAL,Facility,Both,,,,4692,3988.2,1344.7272,4692,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),2815.2,60,,percent of total billed charges,,
Exploratory Laparoscopy,,25009516,LOCAL,Facility,Both,,,,4692,3988.2,1344.7272,4692,"Health Partners, Inc.",State of Minnesota Advantage Program,3823.98,81.5,,percent of total billed charges,,
Exploratory Laparoscopy,,25009516,LOCAL,Facility,Both,,,,4692,3988.2,1344.7272,4692,"Health Partners, Inc.",State Public Programs,2346,50,,percent of total billed charges,,
Exploratory Laparoscopy,,25009516,LOCAL,Facility,Both,,,,4692,3988.2,1344.7272,4692,Humana Insurance Company,Commercial PPO,4457.4,95,,percent of total billed charges,,
Exploratory Laparoscopy,,25009516,LOCAL,Facility,Outpatient,,,,4692,3988.2,1344.7272,4692,Humana Insurance Company,Medicare PPO,2299.08,49,,percent of total billed charges,,
Exploratory Laparoscopy,,25009516,LOCAL,Facility,Inpatient,,,,4692,3988.2,1344.7272,4692,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Exploratory Laparoscopy,,25009516,LOCAL,Facility,Both,,,,4692,3988.2,1344.7272,4692,Medica,Individual & Family,4649.772,99.1,,percent of total billed charges,,
Exploratory Laparoscopy,,25009516,LOCAL,Facility,Outpatient,,,,4692,3988.2,1344.7272,4692,Medica,Medica Advantage Solution,2336.616,49.8,,percent of total billed charges,,
Exploratory Laparoscopy,,25009516,LOCAL,Facility,Inpatient,,,,4692,3988.2,1344.7272,4692,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Exploratory Laparoscopy,,25009516,LOCAL,Facility,Outpatient,,,,4692,3988.2,1344.7272,4692,Medica,Medical Assistance,2092.632,44.6,,percent of total billed charges,,
Exploratory Laparoscopy,,25009516,LOCAL,Facility,Inpatient,,,,4692,3988.2,1344.7272,4692,Medica,Medical Assistance,,,,,Included in per diem rate,
Exploratory Laparoscopy,,25009516,LOCAL,Facility,Outpatient,,,,4692,3988.2,1344.7272,4692,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2336.616,49.8,,percent of total billed charges,,
Exploratory Laparoscopy,,25009516,LOCAL,Facility,Inpatient,,,,4692,3988.2,1344.7272,4692,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Exploratory Laparoscopy,,25009516,LOCAL,Facility,Both,,,,4692,3988.2,1344.7272,4692,"Multiplan, Inc.","Multiplan, Inc.",4410.48,94,,percent of total billed charges,,
Exploratory Laparoscopy,,25009516,LOCAL,Facility,Outpatient,,,,4692,3988.2,1344.7272,4692,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4227.492,90.1,,percent of total billed charges,,
Exploratory Laparoscopy,,25009516,LOCAL,Facility,Inpatient,,,,4692,3988.2,1344.7272,4692,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Exploratory Laparoscopy,,25009516,LOCAL,Facility,Both,,,,4692,3988.2,1344.7272,4692,"Preferred One Administrative Services, INC.",PPO,4626.312,98.6,,percent of total billed charges,,
Exploratory Laparoscopy,,25009516,LOCAL,Facility,Outpatient,,,,4692,3988.2,1344.7272,4692,PrimeWest Health,Minnesota Senior Health Options (MSHO),2414.034,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Exploratory Laparoscopy,,25009516,LOCAL,Facility,Inpatient,,,,4692,3988.2,1344.7272,4692,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Exploratory Laparoscopy,,25009516,LOCAL,Facility,Outpatient,,,,4692,3988.2,1344.7272,4692,PrimeWest Health,MinnesotaCare,2409.8112,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Exploratory Laparoscopy,,25009516,LOCAL,Facility,Inpatient,,,,4692,3988.2,1344.7272,4692,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Exploratory Laparoscopy,,25009516,LOCAL,Facility,Both,,,,4692,3988.2,1344.7272,4692,Sanford Health Plan,Sanford Health Plan,4316.64,92,,percent of total billed charges,,
Exploratory Laparoscopy,,25009516,LOCAL,Facility,Outpatient,,,,4692,3988.2,1344.7272,4692,"UCare Health, Inc.",Individual & Family Plan,2643.942,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Exploratory Laparoscopy,,25009516,LOCAL,Facility,Inpatient,,,,4692,3988.2,1344.7272,4692,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Exploratory Laparoscopy,,25009516,LOCAL,Facility,Outpatient,,,,4692,3988.2,1344.7272,4692,"UCare Health, Inc.",Medical Assistance,2368.0524,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Exploratory Laparoscopy,,25009516,LOCAL,Facility,Inpatient,,,,4692,3988.2,1344.7272,4692,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Exploratory Laparoscopy,,25009516,LOCAL,Facility,Outpatient,,,,4692,3988.2,1344.7272,4692,"UCare Health, Inc.",Medicare Advantage,2368.0524,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Exploratory Laparoscopy,,25009516,LOCAL,Facility,Inpatient,,,,4692,3988.2,1344.7272,4692,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Exploratory Laparoscopy,,25009516,LOCAL,Facility,Outpatient,,,,4692,3988.2,1344.7272,4692,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2368.0524,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Exploratory Laparoscopy,,25009516,LOCAL,Facility,Inpatient,,,,4692,3988.2,1344.7272,4692,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Exploratory Laparoscopy,,25009516,LOCAL,Facility,Both,,,,4692,3988.2,1344.7272,4692,UnitedHealthcare,Individual & Family,4410.48,94,,percent of total billed charges,,
Exploratory Laparoscopy,,25009516,LOCAL,Facility,Outpatient,,,,4692,3988.2,1344.7272,4692,UnitedHealthcare,Medicare Advantage,2299.08,49,,percent of total billed charges,,
Exploratory Laparoscopy,,25009516,LOCAL,Facility,Inpatient,,,,4692,3988.2,1344.7272,4692,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Exploratory Laparoscopy,,25009516,LOCAL,Facility,Outpatient,,,,4692,3988.2,1344.7272,4692,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2252.16,48,,percent of total billed charges,,100% of DHS outpatient percentage
Exploratory Laparoscopy,,25009516,LOCAL,Facility,Inpatient,,,,4692,3988.2,1344.7272,4692,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Cystoscopy W Transurethral Resection Of Bladder Tumor,,25009953,LOCAL,Facility,Both,,,,1556,1322.6,445.9496,1556,Aetna,Commercial,1431.52,92,,percent of total billed charges,,
Cystoscopy W Transurethral Resection Of Bladder Tumor,,25009953,LOCAL,Facility,Outpatient,,,,1556,1322.6,445.9496,1556,Aetna,Medicare Advantage,762.44,49,,percent of total billed charges,,
Cystoscopy W Transurethral Resection Of Bladder Tumor,,25009953,LOCAL,Facility,Inpatient,,,,1556,1322.6,445.9496,1556,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Cystoscopy W Transurethral Resection Of Bladder Tumor,,25009953,LOCAL,Facility,Both,,,,1556,1322.6,445.9496,1556,Aetna,PPO,1447.08,93,,percent of total billed charges,,
Cystoscopy W Transurethral Resection Of Bladder Tumor,,25009953,LOCAL,Facility,Both,,,,1556,1322.6,445.9496,1556,America's PPO,America's PPO,1494.2268,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Cystoscopy W Transurethral Resection Of Bladder Tumor,,25009953,LOCAL,Facility,Both,,,,1556,1322.6,445.9496,1556,BlueCross BlueShield Minnesota, Federal Employee Program,1531.104,98.4,,percent of total billed charges,,
Cystoscopy W Transurethral Resection Of Bladder Tumor,,25009953,LOCAL,Facility,Both,,,,1556,1322.6,445.9496,1556,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1556,100,,percent of total billed charges,,
Cystoscopy W Transurethral Resection Of Bladder Tumor,,25009953,LOCAL,Facility,Both,,,,1556,1322.6,445.9496,1556,BlueCross BlueShield Minnesota,High Value Network Plan,1400.4,90,,percent of total billed charges,,
Cystoscopy W Transurethral Resection Of Bladder Tumor,,25009953,LOCAL,Facility,Outpatient,,,,1556,1322.6,445.9496,1556,BlueCross BlueShield Minnesota,Medicare Advantage,762.44,49,,percent of total billed charges,,
Cystoscopy W Transurethral Resection Of Bladder Tumor,,25009953,LOCAL,Facility,Inpatient,,,,1556,1322.6,445.9496,1556,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Cystoscopy W Transurethral Resection Of Bladder Tumor,,25009953,LOCAL,Facility,Both,,,,1556,1322.6,445.9496,1556,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1378.1492,88.57,,percent of total billed charges,,
Cystoscopy W Transurethral Resection Of Bladder Tumor,,25009953,LOCAL,Facility,Both,,,,1556,1322.6,445.9496,1556,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,445.9496,28.66,,percent of total billed charges,,
Cystoscopy W Transurethral Resection Of Bladder Tumor,,25009953,LOCAL,Facility,Outpatient,,,,1556,1322.6,445.9496,1556,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),762.44,49,,percent of total billed charges,,
Cystoscopy W Transurethral Resection Of Bladder Tumor,,25009953,LOCAL,Facility,Inpatient,,,,1556,1322.6,445.9496,1556,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Cystoscopy W Transurethral Resection Of Bladder Tumor,,25009953,LOCAL,Facility,Both,,,,1556,1322.6,445.9496,1556,CorVel,Worker's Compensation,1556,100,,percent of total billed charges,,
Cystoscopy W Transurethral Resection Of Bladder Tumor,,25009953,LOCAL,Facility,Both,,,,1556,1322.6,445.9496,1556,First Health Group Corporation,First Health Network,1509.32,97,,percent of total billed charges,,
Cystoscopy W Transurethral Resection Of Bladder Tumor,,25009953,LOCAL,Facility,Both,,,,1556,1322.6,445.9496,1556,"Health Partners, Inc.",Commercial,1471.976,94.6,,percent of total billed charges,,
Cystoscopy W Transurethral Resection Of Bladder Tumor,,25009953,LOCAL,Facility,Outpatient,,,,1556,1322.6,445.9496,1556,"Health Partners, Inc.",Medicare Advantage,762.44,49,,percent of total billed charges,,
Cystoscopy W Transurethral Resection Of Bladder Tumor,,25009953,LOCAL,Facility,Inpatient,,,,1556,1322.6,445.9496,1556,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Cystoscopy W Transurethral Resection Of Bladder Tumor,,25009953,LOCAL,Facility,Both,,,,1556,1322.6,445.9496,1556,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),933.6,60,,percent of total billed charges,,
Cystoscopy W Transurethral Resection Of Bladder Tumor,,25009953,LOCAL,Facility,Both,,,,1556,1322.6,445.9496,1556,"Health Partners, Inc.",State of Minnesota Advantage Program,1268.14,81.5,,percent of total billed charges,,
Cystoscopy W Transurethral Resection Of Bladder Tumor,,25009953,LOCAL,Facility,Both,,,,1556,1322.6,445.9496,1556,"Health Partners, Inc.",State Public Programs,778,50,,percent of total billed charges,,
Cystoscopy W Transurethral Resection Of Bladder Tumor,,25009953,LOCAL,Facility,Both,,,,1556,1322.6,445.9496,1556,Humana Insurance Company,Commercial PPO,1478.2,95,,percent of total billed charges,,
Cystoscopy W Transurethral Resection Of Bladder Tumor,,25009953,LOCAL,Facility,Outpatient,,,,1556,1322.6,445.9496,1556,Humana Insurance Company,Medicare PPO,762.44,49,,percent of total billed charges,,
Cystoscopy W Transurethral Resection Of Bladder Tumor,,25009953,LOCAL,Facility,Inpatient,,,,1556,1322.6,445.9496,1556,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Cystoscopy W Transurethral Resection Of Bladder Tumor,,25009953,LOCAL,Facility,Both,,,,1556,1322.6,445.9496,1556,Medica,Individual & Family,1541.996,99.1,,percent of total billed charges,,
Cystoscopy W Transurethral Resection Of Bladder Tumor,,25009953,LOCAL,Facility,Outpatient,,,,1556,1322.6,445.9496,1556,Medica,Medica Advantage Solution,774.888,49.8,,percent of total billed charges,,
Cystoscopy W Transurethral Resection Of Bladder Tumor,,25009953,LOCAL,Facility,Inpatient,,,,1556,1322.6,445.9496,1556,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Cystoscopy W Transurethral Resection Of Bladder Tumor,,25009953,LOCAL,Facility,Outpatient,,,,1556,1322.6,445.9496,1556,Medica,Medical Assistance,693.976,44.6,,percent of total billed charges,,
Cystoscopy W Transurethral Resection Of Bladder Tumor,,25009953,LOCAL,Facility,Inpatient,,,,1556,1322.6,445.9496,1556,Medica,Medical Assistance,,,,,Included in per diem rate,
Cystoscopy W Transurethral Resection Of Bladder Tumor,,25009953,LOCAL,Facility,Outpatient,,,,1556,1322.6,445.9496,1556,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,774.888,49.8,,percent of total billed charges,,
Cystoscopy W Transurethral Resection Of Bladder Tumor,,25009953,LOCAL,Facility,Inpatient,,,,1556,1322.6,445.9496,1556,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Cystoscopy W Transurethral Resection Of Bladder Tumor,,25009953,LOCAL,Facility,Both,,,,1556,1322.6,445.9496,1556,"Multiplan, Inc.","Multiplan, Inc.",1462.64,94,,percent of total billed charges,,
Cystoscopy W Transurethral Resection Of Bladder Tumor,,25009953,LOCAL,Facility,Outpatient,,,,1556,1322.6,445.9496,1556,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1401.956,90.1,,percent of total billed charges,,
Cystoscopy W Transurethral Resection Of Bladder Tumor,,25009953,LOCAL,Facility,Inpatient,,,,1556,1322.6,445.9496,1556,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Cystoscopy W Transurethral Resection Of Bladder Tumor,,25009953,LOCAL,Facility,Both,,,,1556,1322.6,445.9496,1556,"Preferred One Administrative Services, INC.",PPO,1534.216,98.6,,percent of total billed charges,,
Cystoscopy W Transurethral Resection Of Bladder Tumor,,25009953,LOCAL,Facility,Outpatient,,,,1556,1322.6,445.9496,1556,PrimeWest Health,Minnesota Senior Health Options (MSHO),800.562,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Cystoscopy W Transurethral Resection Of Bladder Tumor,,25009953,LOCAL,Facility,Inpatient,,,,1556,1322.6,445.9496,1556,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Cystoscopy W Transurethral Resection Of Bladder Tumor,,25009953,LOCAL,Facility,Outpatient,,,,1556,1322.6,445.9496,1556,PrimeWest Health,MinnesotaCare,799.1616,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Cystoscopy W Transurethral Resection Of Bladder Tumor,,25009953,LOCAL,Facility,Inpatient,,,,1556,1322.6,445.9496,1556,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Cystoscopy W Transurethral Resection Of Bladder Tumor,,25009953,LOCAL,Facility,Both,,,,1556,1322.6,445.9496,1556,Sanford Health Plan,Sanford Health Plan,1431.52,92,,percent of total billed charges,,
Cystoscopy W Transurethral Resection Of Bladder Tumor,,25009953,LOCAL,Facility,Outpatient,,,,1556,1322.6,445.9496,1556,"UCare Health, Inc.",Individual & Family Plan,876.806,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Cystoscopy W Transurethral Resection Of Bladder Tumor,,25009953,LOCAL,Facility,Inpatient,,,,1556,1322.6,445.9496,1556,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Cystoscopy W Transurethral Resection Of Bladder Tumor,,25009953,LOCAL,Facility,Outpatient,,,,1556,1322.6,445.9496,1556,"UCare Health, Inc.",Medical Assistance,785.3132,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Cystoscopy W Transurethral Resection Of Bladder Tumor,,25009953,LOCAL,Facility,Inpatient,,,,1556,1322.6,445.9496,1556,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Cystoscopy W Transurethral Resection Of Bladder Tumor,,25009953,LOCAL,Facility,Outpatient,,,,1556,1322.6,445.9496,1556,"UCare Health, Inc.",Medicare Advantage,785.3132,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Cystoscopy W Transurethral Resection Of Bladder Tumor,,25009953,LOCAL,Facility,Inpatient,,,,1556,1322.6,445.9496,1556,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Cystoscopy W Transurethral Resection Of Bladder Tumor,,25009953,LOCAL,Facility,Outpatient,,,,1556,1322.6,445.9496,1556,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),785.3132,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Cystoscopy W Transurethral Resection Of Bladder Tumor,,25009953,LOCAL,Facility,Inpatient,,,,1556,1322.6,445.9496,1556,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Cystoscopy W Transurethral Resection Of Bladder Tumor,,25009953,LOCAL,Facility,Both,,,,1556,1322.6,445.9496,1556,UnitedHealthcare,Individual & Family,1462.64,94,,percent of total billed charges,,
Cystoscopy W Transurethral Resection Of Bladder Tumor,,25009953,LOCAL,Facility,Outpatient,,,,1556,1322.6,445.9496,1556,UnitedHealthcare,Medicare Advantage,762.44,49,,percent of total billed charges,,
Cystoscopy W Transurethral Resection Of Bladder Tumor,,25009953,LOCAL,Facility,Inpatient,,,,1556,1322.6,445.9496,1556,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Cystoscopy W Transurethral Resection Of Bladder Tumor,,25009953,LOCAL,Facility,Outpatient,,,,1556,1322.6,445.9496,1556,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,746.88,48,,percent of total billed charges,,100% of DHS outpatient percentage
Cystoscopy W Transurethral Resection Of Bladder Tumor,,25009953,LOCAL,Facility,Inpatient,,,,1556,1322.6,445.9496,1556,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Cystourethroscopy W Chemodenervation Of Bladder,,25009974,LOCAL,Facility,Both,,,,1907,1620.95,546.5462,1907,Aetna,Commercial,1754.44,92,,percent of total billed charges,,
Cystourethroscopy W Chemodenervation Of Bladder,,25009974,LOCAL,Facility,Outpatient,,,,1907,1620.95,546.5462,1907,Aetna,Medicare Advantage,934.43,49,,percent of total billed charges,,
Cystourethroscopy W Chemodenervation Of Bladder,,25009974,LOCAL,Facility,Inpatient,,,,1907,1620.95,546.5462,1907,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Cystourethroscopy W Chemodenervation Of Bladder,,25009974,LOCAL,Facility,Both,,,,1907,1620.95,546.5462,1907,Aetna,PPO,1773.51,93,,percent of total billed charges,,
Cystourethroscopy W Chemodenervation Of Bladder,,25009974,LOCAL,Facility,Both,,,,1907,1620.95,546.5462,1907,America's PPO,America's PPO,1831.2921,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Cystourethroscopy W Chemodenervation Of Bladder,,25009974,LOCAL,Facility,Both,,,,1907,1620.95,546.5462,1907,BlueCross BlueShield Minnesota, Federal Employee Program,1876.488,98.4,,percent of total billed charges,,
Cystourethroscopy W Chemodenervation Of Bladder,,25009974,LOCAL,Facility,Both,,,,1907,1620.95,546.5462,1907,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1907,100,,percent of total billed charges,,
Cystourethroscopy W Chemodenervation Of Bladder,,25009974,LOCAL,Facility,Both,,,,1907,1620.95,546.5462,1907,BlueCross BlueShield Minnesota,High Value Network Plan,1716.3,90,,percent of total billed charges,,
Cystourethroscopy W Chemodenervation Of Bladder,,25009974,LOCAL,Facility,Outpatient,,,,1907,1620.95,546.5462,1907,BlueCross BlueShield Minnesota,Medicare Advantage,934.43,49,,percent of total billed charges,,
Cystourethroscopy W Chemodenervation Of Bladder,,25009974,LOCAL,Facility,Inpatient,,,,1907,1620.95,546.5462,1907,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Cystourethroscopy W Chemodenervation Of Bladder,,25009974,LOCAL,Facility,Both,,,,1907,1620.95,546.5462,1907,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1689.0299,88.57,,percent of total billed charges,,
Cystourethroscopy W Chemodenervation Of Bladder,,25009974,LOCAL,Facility,Both,,,,1907,1620.95,546.5462,1907,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,546.5462,28.66,,percent of total billed charges,,
Cystourethroscopy W Chemodenervation Of Bladder,,25009974,LOCAL,Facility,Outpatient,,,,1907,1620.95,546.5462,1907,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),934.43,49,,percent of total billed charges,,
Cystourethroscopy W Chemodenervation Of Bladder,,25009974,LOCAL,Facility,Inpatient,,,,1907,1620.95,546.5462,1907,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Cystourethroscopy W Chemodenervation Of Bladder,,25009974,LOCAL,Facility,Both,,,,1907,1620.95,546.5462,1907,CorVel,Worker's Compensation,1907,100,,percent of total billed charges,,
Cystourethroscopy W Chemodenervation Of Bladder,,25009974,LOCAL,Facility,Both,,,,1907,1620.95,546.5462,1907,First Health Group Corporation,First Health Network,1849.79,97,,percent of total billed charges,,
Cystourethroscopy W Chemodenervation Of Bladder,,25009974,LOCAL,Facility,Both,,,,1907,1620.95,546.5462,1907,"Health Partners, Inc.",Commercial,1804.022,94.6,,percent of total billed charges,,
Cystourethroscopy W Chemodenervation Of Bladder,,25009974,LOCAL,Facility,Outpatient,,,,1907,1620.95,546.5462,1907,"Health Partners, Inc.",Medicare Advantage,934.43,49,,percent of total billed charges,,
Cystourethroscopy W Chemodenervation Of Bladder,,25009974,LOCAL,Facility,Inpatient,,,,1907,1620.95,546.5462,1907,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Cystourethroscopy W Chemodenervation Of Bladder,,25009974,LOCAL,Facility,Both,,,,1907,1620.95,546.5462,1907,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1144.2,60,,percent of total billed charges,,
Cystourethroscopy W Chemodenervation Of Bladder,,25009974,LOCAL,Facility,Both,,,,1907,1620.95,546.5462,1907,"Health Partners, Inc.",State of Minnesota Advantage Program,1554.205,81.5,,percent of total billed charges,,
Cystourethroscopy W Chemodenervation Of Bladder,,25009974,LOCAL,Facility,Both,,,,1907,1620.95,546.5462,1907,"Health Partners, Inc.",State Public Programs,953.5,50,,percent of total billed charges,,
Cystourethroscopy W Chemodenervation Of Bladder,,25009974,LOCAL,Facility,Both,,,,1907,1620.95,546.5462,1907,Humana Insurance Company,Commercial PPO,1811.65,95,,percent of total billed charges,,
Cystourethroscopy W Chemodenervation Of Bladder,,25009974,LOCAL,Facility,Outpatient,,,,1907,1620.95,546.5462,1907,Humana Insurance Company,Medicare PPO,934.43,49,,percent of total billed charges,,
Cystourethroscopy W Chemodenervation Of Bladder,,25009974,LOCAL,Facility,Inpatient,,,,1907,1620.95,546.5462,1907,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Cystourethroscopy W Chemodenervation Of Bladder,,25009974,LOCAL,Facility,Both,,,,1907,1620.95,546.5462,1907,Medica,Individual & Family,1889.837,99.1,,percent of total billed charges,,
Cystourethroscopy W Chemodenervation Of Bladder,,25009974,LOCAL,Facility,Outpatient,,,,1907,1620.95,546.5462,1907,Medica,Medica Advantage Solution,949.686,49.8,,percent of total billed charges,,
Cystourethroscopy W Chemodenervation Of Bladder,,25009974,LOCAL,Facility,Inpatient,,,,1907,1620.95,546.5462,1907,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Cystourethroscopy W Chemodenervation Of Bladder,,25009974,LOCAL,Facility,Outpatient,,,,1907,1620.95,546.5462,1907,Medica,Medical Assistance,850.522,44.6,,percent of total billed charges,,
Cystourethroscopy W Chemodenervation Of Bladder,,25009974,LOCAL,Facility,Inpatient,,,,1907,1620.95,546.5462,1907,Medica,Medical Assistance,,,,,Included in per diem rate,
Cystourethroscopy W Chemodenervation Of Bladder,,25009974,LOCAL,Facility,Outpatient,,,,1907,1620.95,546.5462,1907,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,949.686,49.8,,percent of total billed charges,,
Cystourethroscopy W Chemodenervation Of Bladder,,25009974,LOCAL,Facility,Inpatient,,,,1907,1620.95,546.5462,1907,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Cystourethroscopy W Chemodenervation Of Bladder,,25009974,LOCAL,Facility,Both,,,,1907,1620.95,546.5462,1907,"Multiplan, Inc.","Multiplan, Inc.",1792.58,94,,percent of total billed charges,,
Cystourethroscopy W Chemodenervation Of Bladder,,25009974,LOCAL,Facility,Outpatient,,,,1907,1620.95,546.5462,1907,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1718.207,90.1,,percent of total billed charges,,
Cystourethroscopy W Chemodenervation Of Bladder,,25009974,LOCAL,Facility,Inpatient,,,,1907,1620.95,546.5462,1907,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Cystourethroscopy W Chemodenervation Of Bladder,,25009974,LOCAL,Facility,Both,,,,1907,1620.95,546.5462,1907,"Preferred One Administrative Services, INC.",PPO,1880.302,98.6,,percent of total billed charges,,
Cystourethroscopy W Chemodenervation Of Bladder,,25009974,LOCAL,Facility,Outpatient,,,,1907,1620.95,546.5462,1907,PrimeWest Health,Minnesota Senior Health Options (MSHO),981.1515,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Cystourethroscopy W Chemodenervation Of Bladder,,25009974,LOCAL,Facility,Inpatient,,,,1907,1620.95,546.5462,1907,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Cystourethroscopy W Chemodenervation Of Bladder,,25009974,LOCAL,Facility,Outpatient,,,,1907,1620.95,546.5462,1907,PrimeWest Health,MinnesotaCare,979.4352,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Cystourethroscopy W Chemodenervation Of Bladder,,25009974,LOCAL,Facility,Inpatient,,,,1907,1620.95,546.5462,1907,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Cystourethroscopy W Chemodenervation Of Bladder,,25009974,LOCAL,Facility,Both,,,,1907,1620.95,546.5462,1907,Sanford Health Plan,Sanford Health Plan,1754.44,92,,percent of total billed charges,,
Cystourethroscopy W Chemodenervation Of Bladder,,25009974,LOCAL,Facility,Outpatient,,,,1907,1620.95,546.5462,1907,"UCare Health, Inc.",Individual & Family Plan,1074.5945,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Cystourethroscopy W Chemodenervation Of Bladder,,25009974,LOCAL,Facility,Inpatient,,,,1907,1620.95,546.5462,1907,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Cystourethroscopy W Chemodenervation Of Bladder,,25009974,LOCAL,Facility,Outpatient,,,,1907,1620.95,546.5462,1907,"UCare Health, Inc.",Medical Assistance,962.4629,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Cystourethroscopy W Chemodenervation Of Bladder,,25009974,LOCAL,Facility,Inpatient,,,,1907,1620.95,546.5462,1907,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Cystourethroscopy W Chemodenervation Of Bladder,,25009974,LOCAL,Facility,Outpatient,,,,1907,1620.95,546.5462,1907,"UCare Health, Inc.",Medicare Advantage,962.4629,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Cystourethroscopy W Chemodenervation Of Bladder,,25009974,LOCAL,Facility,Inpatient,,,,1907,1620.95,546.5462,1907,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Cystourethroscopy W Chemodenervation Of Bladder,,25009974,LOCAL,Facility,Outpatient,,,,1907,1620.95,546.5462,1907,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),962.4629,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Cystourethroscopy W Chemodenervation Of Bladder,,25009974,LOCAL,Facility,Inpatient,,,,1907,1620.95,546.5462,1907,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Cystourethroscopy W Chemodenervation Of Bladder,,25009974,LOCAL,Facility,Both,,,,1907,1620.95,546.5462,1907,UnitedHealthcare,Individual & Family,1792.58,94,,percent of total billed charges,,
Cystourethroscopy W Chemodenervation Of Bladder,,25009974,LOCAL,Facility,Outpatient,,,,1907,1620.95,546.5462,1907,UnitedHealthcare,Medicare Advantage,934.43,49,,percent of total billed charges,,
Cystourethroscopy W Chemodenervation Of Bladder,,25009974,LOCAL,Facility,Inpatient,,,,1907,1620.95,546.5462,1907,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Cystourethroscopy W Chemodenervation Of Bladder,,25009974,LOCAL,Facility,Outpatient,,,,1907,1620.95,546.5462,1907,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,915.36,48,,percent of total billed charges,,100% of DHS outpatient percentage
Cystourethroscopy W Chemodenervation Of Bladder,,25009974,LOCAL,Facility,Inpatient,,,,1907,1620.95,546.5462,1907,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Cystourethroscopy, W/Ureteroscopy And/Or Pyeloscopy;W/ Lithotripsy Including Insertion Of Indwelling Stent",,25009990,LOCAL,Facility,Both,,,,8160,6936,2338.656,8160,Aetna,Commercial,7507.2,92,,percent of total billed charges,,
"Cystourethroscopy, W/Ureteroscopy And/Or Pyeloscopy;W/ Lithotripsy Including Insertion Of Indwelling Stent",,25009990,LOCAL,Facility,Outpatient,,,,8160,6936,2338.656,8160,Aetna,Medicare Advantage,3998.4,49,,percent of total billed charges,,
"Cystourethroscopy, W/Ureteroscopy And/Or Pyeloscopy;W/ Lithotripsy Including Insertion Of Indwelling Stent",,25009990,LOCAL,Facility,Inpatient,,,,8160,6936,2338.656,8160,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Cystourethroscopy, W/Ureteroscopy And/Or Pyeloscopy;W/ Lithotripsy Including Insertion Of Indwelling Stent",,25009990,LOCAL,Facility,Both,,,,8160,6936,2338.656,8160,Aetna,PPO,7588.8,93,,percent of total billed charges,,
"Cystourethroscopy, W/Ureteroscopy And/Or Pyeloscopy;W/ Lithotripsy Including Insertion Of Indwelling Stent",,25009990,LOCAL,Facility,Both,,,,8160,6936,2338.656,8160,America's PPO,America's PPO,7836.048,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Cystourethroscopy, W/Ureteroscopy And/Or Pyeloscopy;W/ Lithotripsy Including Insertion Of Indwelling Stent",,25009990,LOCAL,Facility,Both,,,,8160,6936,2338.656,8160,BlueCross BlueShield Minnesota, Federal Employee Program,8029.44,98.4,,percent of total billed charges,,
"Cystourethroscopy, W/Ureteroscopy And/Or Pyeloscopy;W/ Lithotripsy Including Insertion Of Indwelling Stent",,25009990,LOCAL,Facility,Both,,,,8160,6936,2338.656,8160,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,8160,100,,percent of total billed charges,,
"Cystourethroscopy, W/Ureteroscopy And/Or Pyeloscopy;W/ Lithotripsy Including Insertion Of Indwelling Stent",,25009990,LOCAL,Facility,Both,,,,8160,6936,2338.656,8160,BlueCross BlueShield Minnesota,High Value Network Plan,7344,90,,percent of total billed charges,,
"Cystourethroscopy, W/Ureteroscopy And/Or Pyeloscopy;W/ Lithotripsy Including Insertion Of Indwelling Stent",,25009990,LOCAL,Facility,Outpatient,,,,8160,6936,2338.656,8160,BlueCross BlueShield Minnesota,Medicare Advantage,3998.4,49,,percent of total billed charges,,
"Cystourethroscopy, W/Ureteroscopy And/Or Pyeloscopy;W/ Lithotripsy Including Insertion Of Indwelling Stent",,25009990,LOCAL,Facility,Inpatient,,,,8160,6936,2338.656,8160,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Cystourethroscopy, W/Ureteroscopy And/Or Pyeloscopy;W/ Lithotripsy Including Insertion Of Indwelling Stent",,25009990,LOCAL,Facility,Both,,,,8160,6936,2338.656,8160,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,7227.312,88.57,,percent of total billed charges,,
"Cystourethroscopy, W/Ureteroscopy And/Or Pyeloscopy;W/ Lithotripsy Including Insertion Of Indwelling Stent",,25009990,LOCAL,Facility,Both,,,,8160,6936,2338.656,8160,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,2338.656,28.66,,percent of total billed charges,,
"Cystourethroscopy, W/Ureteroscopy And/Or Pyeloscopy;W/ Lithotripsy Including Insertion Of Indwelling Stent",,25009990,LOCAL,Facility,Outpatient,,,,8160,6936,2338.656,8160,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),3998.4,49,,percent of total billed charges,,
"Cystourethroscopy, W/Ureteroscopy And/Or Pyeloscopy;W/ Lithotripsy Including Insertion Of Indwelling Stent",,25009990,LOCAL,Facility,Inpatient,,,,8160,6936,2338.656,8160,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Cystourethroscopy, W/Ureteroscopy And/Or Pyeloscopy;W/ Lithotripsy Including Insertion Of Indwelling Stent",,25009990,LOCAL,Facility,Both,,,,8160,6936,2338.656,8160,CorVel,Worker's Compensation,8160,100,,percent of total billed charges,,
"Cystourethroscopy, W/Ureteroscopy And/Or Pyeloscopy;W/ Lithotripsy Including Insertion Of Indwelling Stent",,25009990,LOCAL,Facility,Both,,,,8160,6936,2338.656,8160,First Health Group Corporation,First Health Network,7915.2,97,,percent of total billed charges,,
"Cystourethroscopy, W/Ureteroscopy And/Or Pyeloscopy;W/ Lithotripsy Including Insertion Of Indwelling Stent",,25009990,LOCAL,Facility,Both,,,,8160,6936,2338.656,8160,"Health Partners, Inc.",Commercial,7719.36,94.6,,percent of total billed charges,,
"Cystourethroscopy, W/Ureteroscopy And/Or Pyeloscopy;W/ Lithotripsy Including Insertion Of Indwelling Stent",,25009990,LOCAL,Facility,Outpatient,,,,8160,6936,2338.656,8160,"Health Partners, Inc.",Medicare Advantage,3998.4,49,,percent of total billed charges,,
"Cystourethroscopy, W/Ureteroscopy And/Or Pyeloscopy;W/ Lithotripsy Including Insertion Of Indwelling Stent",,25009990,LOCAL,Facility,Inpatient,,,,8160,6936,2338.656,8160,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Cystourethroscopy, W/Ureteroscopy And/Or Pyeloscopy;W/ Lithotripsy Including Insertion Of Indwelling Stent",,25009990,LOCAL,Facility,Both,,,,8160,6936,2338.656,8160,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),4896,60,,percent of total billed charges,,
"Cystourethroscopy, W/Ureteroscopy And/Or Pyeloscopy;W/ Lithotripsy Including Insertion Of Indwelling Stent",,25009990,LOCAL,Facility,Both,,,,8160,6936,2338.656,8160,"Health Partners, Inc.",State of Minnesota Advantage Program,6650.4,81.5,,percent of total billed charges,,
"Cystourethroscopy, W/Ureteroscopy And/Or Pyeloscopy;W/ Lithotripsy Including Insertion Of Indwelling Stent",,25009990,LOCAL,Facility,Both,,,,8160,6936,2338.656,8160,"Health Partners, Inc.",State Public Programs,4080,50,,percent of total billed charges,,
"Cystourethroscopy, W/Ureteroscopy And/Or Pyeloscopy;W/ Lithotripsy Including Insertion Of Indwelling Stent",,25009990,LOCAL,Facility,Both,,,,8160,6936,2338.656,8160,Humana Insurance Company,Commercial PPO,7752,95,,percent of total billed charges,,
"Cystourethroscopy, W/Ureteroscopy And/Or Pyeloscopy;W/ Lithotripsy Including Insertion Of Indwelling Stent",,25009990,LOCAL,Facility,Outpatient,,,,8160,6936,2338.656,8160,Humana Insurance Company,Medicare PPO,3998.4,49,,percent of total billed charges,,
"Cystourethroscopy, W/Ureteroscopy And/Or Pyeloscopy;W/ Lithotripsy Including Insertion Of Indwelling Stent",,25009990,LOCAL,Facility,Inpatient,,,,8160,6936,2338.656,8160,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Cystourethroscopy, W/Ureteroscopy And/Or Pyeloscopy;W/ Lithotripsy Including Insertion Of Indwelling Stent",,25009990,LOCAL,Facility,Both,,,,8160,6936,2338.656,8160,Medica,Individual & Family,8086.56,99.1,,percent of total billed charges,,
"Cystourethroscopy, W/Ureteroscopy And/Or Pyeloscopy;W/ Lithotripsy Including Insertion Of Indwelling Stent",,25009990,LOCAL,Facility,Outpatient,,,,8160,6936,2338.656,8160,Medica,Medica Advantage Solution,4063.68,49.8,,percent of total billed charges,,
"Cystourethroscopy, W/Ureteroscopy And/Or Pyeloscopy;W/ Lithotripsy Including Insertion Of Indwelling Stent",,25009990,LOCAL,Facility,Inpatient,,,,8160,6936,2338.656,8160,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Cystourethroscopy, W/Ureteroscopy And/Or Pyeloscopy;W/ Lithotripsy Including Insertion Of Indwelling Stent",,25009990,LOCAL,Facility,Outpatient,,,,8160,6936,2338.656,8160,Medica,Medical Assistance,3639.36,44.6,,percent of total billed charges,,
"Cystourethroscopy, W/Ureteroscopy And/Or Pyeloscopy;W/ Lithotripsy Including Insertion Of Indwelling Stent",,25009990,LOCAL,Facility,Inpatient,,,,8160,6936,2338.656,8160,Medica,Medical Assistance,,,,,Included in per diem rate,
"Cystourethroscopy, W/Ureteroscopy And/Or Pyeloscopy;W/ Lithotripsy Including Insertion Of Indwelling Stent",,25009990,LOCAL,Facility,Outpatient,,,,8160,6936,2338.656,8160,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,4063.68,49.8,,percent of total billed charges,,
"Cystourethroscopy, W/Ureteroscopy And/Or Pyeloscopy;W/ Lithotripsy Including Insertion Of Indwelling Stent",,25009990,LOCAL,Facility,Inpatient,,,,8160,6936,2338.656,8160,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Cystourethroscopy, W/Ureteroscopy And/Or Pyeloscopy;W/ Lithotripsy Including Insertion Of Indwelling Stent",,25009990,LOCAL,Facility,Both,,,,8160,6936,2338.656,8160,"Multiplan, Inc.","Multiplan, Inc.",7670.4,94,,percent of total billed charges,,
"Cystourethroscopy, W/Ureteroscopy And/Or Pyeloscopy;W/ Lithotripsy Including Insertion Of Indwelling Stent",,25009990,LOCAL,Facility,Outpatient,,,,8160,6936,2338.656,8160,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,7352.16,90.1,,percent of total billed charges,,
"Cystourethroscopy, W/Ureteroscopy And/Or Pyeloscopy;W/ Lithotripsy Including Insertion Of Indwelling Stent",,25009990,LOCAL,Facility,Inpatient,,,,8160,6936,2338.656,8160,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Cystourethroscopy, W/Ureteroscopy And/Or Pyeloscopy;W/ Lithotripsy Including Insertion Of Indwelling Stent",,25009990,LOCAL,Facility,Both,,,,8160,6936,2338.656,8160,"Preferred One Administrative Services, INC.",PPO,8045.76,98.6,,percent of total billed charges,,
"Cystourethroscopy, W/Ureteroscopy And/Or Pyeloscopy;W/ Lithotripsy Including Insertion Of Indwelling Stent",,25009990,LOCAL,Facility,Outpatient,,,,8160,6936,2338.656,8160,PrimeWest Health,Minnesota Senior Health Options (MSHO),4198.32,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Cystourethroscopy, W/Ureteroscopy And/Or Pyeloscopy;W/ Lithotripsy Including Insertion Of Indwelling Stent",,25009990,LOCAL,Facility,Inpatient,,,,8160,6936,2338.656,8160,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Cystourethroscopy, W/Ureteroscopy And/Or Pyeloscopy;W/ Lithotripsy Including Insertion Of Indwelling Stent",,25009990,LOCAL,Facility,Outpatient,,,,8160,6936,2338.656,8160,PrimeWest Health,MinnesotaCare,4190.976,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Cystourethroscopy, W/Ureteroscopy And/Or Pyeloscopy;W/ Lithotripsy Including Insertion Of Indwelling Stent",,25009990,LOCAL,Facility,Inpatient,,,,8160,6936,2338.656,8160,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Cystourethroscopy, W/Ureteroscopy And/Or Pyeloscopy;W/ Lithotripsy Including Insertion Of Indwelling Stent",,25009990,LOCAL,Facility,Both,,,,8160,6936,2338.656,8160,Sanford Health Plan,Sanford Health Plan,7507.2,92,,percent of total billed charges,,
"Cystourethroscopy, W/Ureteroscopy And/Or Pyeloscopy;W/ Lithotripsy Including Insertion Of Indwelling Stent",,25009990,LOCAL,Facility,Outpatient,,,,8160,6936,2338.656,8160,"UCare Health, Inc.",Individual & Family Plan,4598.16,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Cystourethroscopy, W/Ureteroscopy And/Or Pyeloscopy;W/ Lithotripsy Including Insertion Of Indwelling Stent",,25009990,LOCAL,Facility,Inpatient,,,,8160,6936,2338.656,8160,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Cystourethroscopy, W/Ureteroscopy And/Or Pyeloscopy;W/ Lithotripsy Including Insertion Of Indwelling Stent",,25009990,LOCAL,Facility,Outpatient,,,,8160,6936,2338.656,8160,"UCare Health, Inc.",Medical Assistance,4118.352,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Cystourethroscopy, W/Ureteroscopy And/Or Pyeloscopy;W/ Lithotripsy Including Insertion Of Indwelling Stent",,25009990,LOCAL,Facility,Inpatient,,,,8160,6936,2338.656,8160,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Cystourethroscopy, W/Ureteroscopy And/Or Pyeloscopy;W/ Lithotripsy Including Insertion Of Indwelling Stent",,25009990,LOCAL,Facility,Outpatient,,,,8160,6936,2338.656,8160,"UCare Health, Inc.",Medicare Advantage,4118.352,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Cystourethroscopy, W/Ureteroscopy And/Or Pyeloscopy;W/ Lithotripsy Including Insertion Of Indwelling Stent",,25009990,LOCAL,Facility,Inpatient,,,,8160,6936,2338.656,8160,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Cystourethroscopy, W/Ureteroscopy And/Or Pyeloscopy;W/ Lithotripsy Including Insertion Of Indwelling Stent",,25009990,LOCAL,Facility,Outpatient,,,,8160,6936,2338.656,8160,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),4118.352,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Cystourethroscopy, W/Ureteroscopy And/Or Pyeloscopy;W/ Lithotripsy Including Insertion Of Indwelling Stent",,25009990,LOCAL,Facility,Inpatient,,,,8160,6936,2338.656,8160,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Cystourethroscopy, W/Ureteroscopy And/Or Pyeloscopy;W/ Lithotripsy Including Insertion Of Indwelling Stent",,25009990,LOCAL,Facility,Both,,,,8160,6936,2338.656,8160,UnitedHealthcare,Individual & Family,7670.4,94,,percent of total billed charges,,
"Cystourethroscopy, W/Ureteroscopy And/Or Pyeloscopy;W/ Lithotripsy Including Insertion Of Indwelling Stent",,25009990,LOCAL,Facility,Outpatient,,,,8160,6936,2338.656,8160,UnitedHealthcare,Medicare Advantage,3998.4,49,,percent of total billed charges,,
"Cystourethroscopy, W/Ureteroscopy And/Or Pyeloscopy;W/ Lithotripsy Including Insertion Of Indwelling Stent",,25009990,LOCAL,Facility,Inpatient,,,,8160,6936,2338.656,8160,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Cystourethroscopy, W/Ureteroscopy And/Or Pyeloscopy;W/ Lithotripsy Including Insertion Of Indwelling Stent",,25009990,LOCAL,Facility,Outpatient,,,,8160,6936,2338.656,8160,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,3916.8,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Cystourethroscopy, W/Ureteroscopy And/Or Pyeloscopy;W/ Lithotripsy Including Insertion Of Indwelling Stent",,25009990,LOCAL,Facility,Inpatient,,,,8160,6936,2338.656,8160,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Cystocele Repair,,25010051,LOCAL,Facility,Both,,,,4080,3468,1169.328,4080,Aetna,Commercial,3753.6,92,,percent of total billed charges,,
Cystocele Repair,,25010051,LOCAL,Facility,Outpatient,,,,4080,3468,1169.328,4080,Aetna,Medicare Advantage,1999.2,49,,percent of total billed charges,,
Cystocele Repair,,25010051,LOCAL,Facility,Inpatient,,,,4080,3468,1169.328,4080,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Cystocele Repair,,25010051,LOCAL,Facility,Both,,,,4080,3468,1169.328,4080,Aetna,PPO,3794.4,93,,percent of total billed charges,,
Cystocele Repair,,25010051,LOCAL,Facility,Both,,,,4080,3468,1169.328,4080,America's PPO,America's PPO,3918.024,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Cystocele Repair,,25010051,LOCAL,Facility,Both,,,,4080,3468,1169.328,4080,BlueCross BlueShield Minnesota, Federal Employee Program,4014.72,98.4,,percent of total billed charges,,
Cystocele Repair,,25010051,LOCAL,Facility,Both,,,,4080,3468,1169.328,4080,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,4080,100,,percent of total billed charges,,
Cystocele Repair,,25010051,LOCAL,Facility,Both,,,,4080,3468,1169.328,4080,BlueCross BlueShield Minnesota,High Value Network Plan,3672,90,,percent of total billed charges,,
Cystocele Repair,,25010051,LOCAL,Facility,Outpatient,,,,4080,3468,1169.328,4080,BlueCross BlueShield Minnesota,Medicare Advantage,1999.2,49,,percent of total billed charges,,
Cystocele Repair,,25010051,LOCAL,Facility,Inpatient,,,,4080,3468,1169.328,4080,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Cystocele Repair,,25010051,LOCAL,Facility,Both,,,,4080,3468,1169.328,4080,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,3613.656,88.57,,percent of total billed charges,,
Cystocele Repair,,25010051,LOCAL,Facility,Both,,,,4080,3468,1169.328,4080,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1169.328,28.66,,percent of total billed charges,,
Cystocele Repair,,25010051,LOCAL,Facility,Outpatient,,,,4080,3468,1169.328,4080,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1999.2,49,,percent of total billed charges,,
Cystocele Repair,,25010051,LOCAL,Facility,Inpatient,,,,4080,3468,1169.328,4080,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Cystocele Repair,,25010051,LOCAL,Facility,Both,,,,4080,3468,1169.328,4080,CorVel,Worker's Compensation,4080,100,,percent of total billed charges,,
Cystocele Repair,,25010051,LOCAL,Facility,Both,,,,4080,3468,1169.328,4080,First Health Group Corporation,First Health Network,3957.6,97,,percent of total billed charges,,
Cystocele Repair,,25010051,LOCAL,Facility,Both,,,,4080,3468,1169.328,4080,"Health Partners, Inc.",Commercial,3859.68,94.6,,percent of total billed charges,,
Cystocele Repair,,25010051,LOCAL,Facility,Outpatient,,,,4080,3468,1169.328,4080,"Health Partners, Inc.",Medicare Advantage,1999.2,49,,percent of total billed charges,,
Cystocele Repair,,25010051,LOCAL,Facility,Inpatient,,,,4080,3468,1169.328,4080,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Cystocele Repair,,25010051,LOCAL,Facility,Both,,,,4080,3468,1169.328,4080,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),2448,60,,percent of total billed charges,,
Cystocele Repair,,25010051,LOCAL,Facility,Both,,,,4080,3468,1169.328,4080,"Health Partners, Inc.",State of Minnesota Advantage Program,3325.2,81.5,,percent of total billed charges,,
Cystocele Repair,,25010051,LOCAL,Facility,Both,,,,4080,3468,1169.328,4080,"Health Partners, Inc.",State Public Programs,2040,50,,percent of total billed charges,,
Cystocele Repair,,25010051,LOCAL,Facility,Both,,,,4080,3468,1169.328,4080,Humana Insurance Company,Commercial PPO,3876,95,,percent of total billed charges,,
Cystocele Repair,,25010051,LOCAL,Facility,Outpatient,,,,4080,3468,1169.328,4080,Humana Insurance Company,Medicare PPO,1999.2,49,,percent of total billed charges,,
Cystocele Repair,,25010051,LOCAL,Facility,Inpatient,,,,4080,3468,1169.328,4080,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Cystocele Repair,,25010051,LOCAL,Facility,Both,,,,4080,3468,1169.328,4080,Medica,Individual & Family,4043.28,99.1,,percent of total billed charges,,
Cystocele Repair,,25010051,LOCAL,Facility,Outpatient,,,,4080,3468,1169.328,4080,Medica,Medica Advantage Solution,2031.84,49.8,,percent of total billed charges,,
Cystocele Repair,,25010051,LOCAL,Facility,Inpatient,,,,4080,3468,1169.328,4080,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Cystocele Repair,,25010051,LOCAL,Facility,Outpatient,,,,4080,3468,1169.328,4080,Medica,Medical Assistance,1819.68,44.6,,percent of total billed charges,,
Cystocele Repair,,25010051,LOCAL,Facility,Inpatient,,,,4080,3468,1169.328,4080,Medica,Medical Assistance,,,,,Included in per diem rate,
Cystocele Repair,,25010051,LOCAL,Facility,Outpatient,,,,4080,3468,1169.328,4080,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2031.84,49.8,,percent of total billed charges,,
Cystocele Repair,,25010051,LOCAL,Facility,Inpatient,,,,4080,3468,1169.328,4080,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Cystocele Repair,,25010051,LOCAL,Facility,Both,,,,4080,3468,1169.328,4080,"Multiplan, Inc.","Multiplan, Inc.",3835.2,94,,percent of total billed charges,,
Cystocele Repair,,25010051,LOCAL,Facility,Outpatient,,,,4080,3468,1169.328,4080,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,3676.08,90.1,,percent of total billed charges,,
Cystocele Repair,,25010051,LOCAL,Facility,Inpatient,,,,4080,3468,1169.328,4080,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Cystocele Repair,,25010051,LOCAL,Facility,Both,,,,4080,3468,1169.328,4080,"Preferred One Administrative Services, INC.",PPO,4022.88,98.6,,percent of total billed charges,,
Cystocele Repair,,25010051,LOCAL,Facility,Outpatient,,,,4080,3468,1169.328,4080,PrimeWest Health,Minnesota Senior Health Options (MSHO),2099.16,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Cystocele Repair,,25010051,LOCAL,Facility,Inpatient,,,,4080,3468,1169.328,4080,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Cystocele Repair,,25010051,LOCAL,Facility,Outpatient,,,,4080,3468,1169.328,4080,PrimeWest Health,MinnesotaCare,2095.488,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Cystocele Repair,,25010051,LOCAL,Facility,Inpatient,,,,4080,3468,1169.328,4080,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Cystocele Repair,,25010051,LOCAL,Facility,Both,,,,4080,3468,1169.328,4080,Sanford Health Plan,Sanford Health Plan,3753.6,92,,percent of total billed charges,,
Cystocele Repair,,25010051,LOCAL,Facility,Outpatient,,,,4080,3468,1169.328,4080,"UCare Health, Inc.",Individual & Family Plan,2299.08,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Cystocele Repair,,25010051,LOCAL,Facility,Inpatient,,,,4080,3468,1169.328,4080,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Cystocele Repair,,25010051,LOCAL,Facility,Outpatient,,,,4080,3468,1169.328,4080,"UCare Health, Inc.",Medical Assistance,2059.176,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Cystocele Repair,,25010051,LOCAL,Facility,Inpatient,,,,4080,3468,1169.328,4080,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Cystocele Repair,,25010051,LOCAL,Facility,Outpatient,,,,4080,3468,1169.328,4080,"UCare Health, Inc.",Medicare Advantage,2059.176,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Cystocele Repair,,25010051,LOCAL,Facility,Inpatient,,,,4080,3468,1169.328,4080,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Cystocele Repair,,25010051,LOCAL,Facility,Outpatient,,,,4080,3468,1169.328,4080,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2059.176,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Cystocele Repair,,25010051,LOCAL,Facility,Inpatient,,,,4080,3468,1169.328,4080,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Cystocele Repair,,25010051,LOCAL,Facility,Both,,,,4080,3468,1169.328,4080,UnitedHealthcare,Individual & Family,3835.2,94,,percent of total billed charges,,
Cystocele Repair,,25010051,LOCAL,Facility,Outpatient,,,,4080,3468,1169.328,4080,UnitedHealthcare,Medicare Advantage,1999.2,49,,percent of total billed charges,,
Cystocele Repair,,25010051,LOCAL,Facility,Inpatient,,,,4080,3468,1169.328,4080,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Cystocele Repair,,25010051,LOCAL,Facility,Outpatient,,,,4080,3468,1169.328,4080,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1958.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
Cystocele Repair,,25010051,LOCAL,Facility,Inpatient,,,,4080,3468,1169.328,4080,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Total Knee,,25010170,LOCAL,Facility,Both,,,,4692,3988.2,1344.7272,4692,Aetna,Commercial,4316.64,92,,percent of total billed charges,,
Total Knee,,25010170,LOCAL,Facility,Outpatient,,,,4692,3988.2,1344.7272,4692,Aetna,Medicare Advantage,2299.08,49,,percent of total billed charges,,
Total Knee,,25010170,LOCAL,Facility,Inpatient,,,,4692,3988.2,1344.7272,4692,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Total Knee,,25010170,LOCAL,Facility,Both,,,,4692,3988.2,1344.7272,4692,Aetna,PPO,4363.56,93,,percent of total billed charges,,
Total Knee,,25010170,LOCAL,Facility,Both,,,,4692,3988.2,1344.7272,4692,America's PPO,America's PPO,4505.7276,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Total Knee,,25010170,LOCAL,Facility,Both,,,,4692,3988.2,1344.7272,4692,BlueCross BlueShield Minnesota, Federal Employee Program,4616.928,98.4,,percent of total billed charges,,
Total Knee,,25010170,LOCAL,Facility,Both,,,,4692,3988.2,1344.7272,4692,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,4692,100,,percent of total billed charges,,
Total Knee,,25010170,LOCAL,Facility,Both,,,,4692,3988.2,1344.7272,4692,BlueCross BlueShield Minnesota,High Value Network Plan,4222.8,90,,percent of total billed charges,,
Total Knee,,25010170,LOCAL,Facility,Outpatient,,,,4692,3988.2,1344.7272,4692,BlueCross BlueShield Minnesota,Medicare Advantage,2299.08,49,,percent of total billed charges,,
Total Knee,,25010170,LOCAL,Facility,Inpatient,,,,4692,3988.2,1344.7272,4692,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Total Knee,,25010170,LOCAL,Facility,Both,,,,4692,3988.2,1344.7272,4692,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4155.7044,88.57,,percent of total billed charges,,
Total Knee,,25010170,LOCAL,Facility,Both,,,,4692,3988.2,1344.7272,4692,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1344.7272,28.66,,percent of total billed charges,,
Total Knee,,25010170,LOCAL,Facility,Outpatient,,,,4692,3988.2,1344.7272,4692,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2299.08,49,,percent of total billed charges,,
Total Knee,,25010170,LOCAL,Facility,Inpatient,,,,4692,3988.2,1344.7272,4692,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Total Knee,,25010170,LOCAL,Facility,Both,,,,4692,3988.2,1344.7272,4692,CorVel,Worker's Compensation,4692,100,,percent of total billed charges,,
Total Knee,,25010170,LOCAL,Facility,Both,,,,4692,3988.2,1344.7272,4692,First Health Group Corporation,First Health Network,4551.24,97,,percent of total billed charges,,
Total Knee,,25010170,LOCAL,Facility,Both,,,,4692,3988.2,1344.7272,4692,"Health Partners, Inc.",Commercial,4438.632,94.6,,percent of total billed charges,,
Total Knee,,25010170,LOCAL,Facility,Outpatient,,,,4692,3988.2,1344.7272,4692,"Health Partners, Inc.",Medicare Advantage,2299.08,49,,percent of total billed charges,,
Total Knee,,25010170,LOCAL,Facility,Inpatient,,,,4692,3988.2,1344.7272,4692,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Total Knee,,25010170,LOCAL,Facility,Both,,,,4692,3988.2,1344.7272,4692,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),2815.2,60,,percent of total billed charges,,
Total Knee,,25010170,LOCAL,Facility,Both,,,,4692,3988.2,1344.7272,4692,"Health Partners, Inc.",State of Minnesota Advantage Program,3823.98,81.5,,percent of total billed charges,,
Total Knee,,25010170,LOCAL,Facility,Both,,,,4692,3988.2,1344.7272,4692,"Health Partners, Inc.",State Public Programs,2346,50,,percent of total billed charges,,
Total Knee,,25010170,LOCAL,Facility,Both,,,,4692,3988.2,1344.7272,4692,Humana Insurance Company,Commercial PPO,4457.4,95,,percent of total billed charges,,
Total Knee,,25010170,LOCAL,Facility,Outpatient,,,,4692,3988.2,1344.7272,4692,Humana Insurance Company,Medicare PPO,2299.08,49,,percent of total billed charges,,
Total Knee,,25010170,LOCAL,Facility,Inpatient,,,,4692,3988.2,1344.7272,4692,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Total Knee,,25010170,LOCAL,Facility,Both,,,,4692,3988.2,1344.7272,4692,Medica,Individual & Family,4649.772,99.1,,percent of total billed charges,,
Total Knee,,25010170,LOCAL,Facility,Outpatient,,,,4692,3988.2,1344.7272,4692,Medica,Medica Advantage Solution,2336.616,49.8,,percent of total billed charges,,
Total Knee,,25010170,LOCAL,Facility,Inpatient,,,,4692,3988.2,1344.7272,4692,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Total Knee,,25010170,LOCAL,Facility,Outpatient,,,,4692,3988.2,1344.7272,4692,Medica,Medical Assistance,2092.632,44.6,,percent of total billed charges,,
Total Knee,,25010170,LOCAL,Facility,Inpatient,,,,4692,3988.2,1344.7272,4692,Medica,Medical Assistance,,,,,Included in per diem rate,
Total Knee,,25010170,LOCAL,Facility,Outpatient,,,,4692,3988.2,1344.7272,4692,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2336.616,49.8,,percent of total billed charges,,
Total Knee,,25010170,LOCAL,Facility,Inpatient,,,,4692,3988.2,1344.7272,4692,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Total Knee,,25010170,LOCAL,Facility,Both,,,,4692,3988.2,1344.7272,4692,"Multiplan, Inc.","Multiplan, Inc.",4410.48,94,,percent of total billed charges,,
Total Knee,,25010170,LOCAL,Facility,Outpatient,,,,4692,3988.2,1344.7272,4692,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4227.492,90.1,,percent of total billed charges,,
Total Knee,,25010170,LOCAL,Facility,Inpatient,,,,4692,3988.2,1344.7272,4692,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Total Knee,,25010170,LOCAL,Facility,Both,,,,4692,3988.2,1344.7272,4692,"Preferred One Administrative Services, INC.",PPO,4626.312,98.6,,percent of total billed charges,,
Total Knee,,25010170,LOCAL,Facility,Outpatient,,,,4692,3988.2,1344.7272,4692,PrimeWest Health,Minnesota Senior Health Options (MSHO),2414.034,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Total Knee,,25010170,LOCAL,Facility,Inpatient,,,,4692,3988.2,1344.7272,4692,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Total Knee,,25010170,LOCAL,Facility,Outpatient,,,,4692,3988.2,1344.7272,4692,PrimeWest Health,MinnesotaCare,2409.8112,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Total Knee,,25010170,LOCAL,Facility,Inpatient,,,,4692,3988.2,1344.7272,4692,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Total Knee,,25010170,LOCAL,Facility,Both,,,,4692,3988.2,1344.7272,4692,Sanford Health Plan,Sanford Health Plan,4316.64,92,,percent of total billed charges,,
Total Knee,,25010170,LOCAL,Facility,Outpatient,,,,4692,3988.2,1344.7272,4692,"UCare Health, Inc.",Individual & Family Plan,2643.942,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Total Knee,,25010170,LOCAL,Facility,Inpatient,,,,4692,3988.2,1344.7272,4692,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Total Knee,,25010170,LOCAL,Facility,Outpatient,,,,4692,3988.2,1344.7272,4692,"UCare Health, Inc.",Medical Assistance,2368.0524,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Total Knee,,25010170,LOCAL,Facility,Inpatient,,,,4692,3988.2,1344.7272,4692,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Total Knee,,25010170,LOCAL,Facility,Outpatient,,,,4692,3988.2,1344.7272,4692,"UCare Health, Inc.",Medicare Advantage,2368.0524,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Total Knee,,25010170,LOCAL,Facility,Inpatient,,,,4692,3988.2,1344.7272,4692,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Total Knee,,25010170,LOCAL,Facility,Outpatient,,,,4692,3988.2,1344.7272,4692,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2368.0524,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Total Knee,,25010170,LOCAL,Facility,Inpatient,,,,4692,3988.2,1344.7272,4692,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Total Knee,,25010170,LOCAL,Facility,Both,,,,4692,3988.2,1344.7272,4692,UnitedHealthcare,Individual & Family,4410.48,94,,percent of total billed charges,,
Total Knee,,25010170,LOCAL,Facility,Outpatient,,,,4692,3988.2,1344.7272,4692,UnitedHealthcare,Medicare Advantage,2299.08,49,,percent of total billed charges,,
Total Knee,,25010170,LOCAL,Facility,Inpatient,,,,4692,3988.2,1344.7272,4692,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Total Knee,,25010170,LOCAL,Facility,Outpatient,,,,4692,3988.2,1344.7272,4692,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2252.16,48,,percent of total billed charges,,100% of DHS outpatient percentage
Total Knee,,25010170,LOCAL,Facility,Inpatient,,,,4692,3988.2,1344.7272,4692,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Tenotomy Of Elbow,,25010416,LOCAL,Facility,Both,,,,663,563.55,190.0158,663,Aetna,Commercial,609.96,92,,percent of total billed charges,,
Tenotomy Of Elbow,,25010416,LOCAL,Facility,Outpatient,,,,663,563.55,190.0158,663,Aetna,Medicare Advantage,324.87,49,,percent of total billed charges,,
Tenotomy Of Elbow,,25010416,LOCAL,Facility,Inpatient,,,,663,563.55,190.0158,663,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Tenotomy Of Elbow,,25010416,LOCAL,Facility,Both,,,,663,563.55,190.0158,663,Aetna,PPO,616.59,93,,percent of total billed charges,,
Tenotomy Of Elbow,,25010416,LOCAL,Facility,Both,,,,663,563.55,190.0158,663,America's PPO,America's PPO,636.6789,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Tenotomy Of Elbow,,25010416,LOCAL,Facility,Both,,,,663,563.55,190.0158,663,BlueCross BlueShield Minnesota, Federal Employee Program,652.392,98.4,,percent of total billed charges,,
Tenotomy Of Elbow,,25010416,LOCAL,Facility,Both,,,,663,563.55,190.0158,663,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,663,100,,percent of total billed charges,,
Tenotomy Of Elbow,,25010416,LOCAL,Facility,Both,,,,663,563.55,190.0158,663,BlueCross BlueShield Minnesota,High Value Network Plan,596.7,90,,percent of total billed charges,,
Tenotomy Of Elbow,,25010416,LOCAL,Facility,Outpatient,,,,663,563.55,190.0158,663,BlueCross BlueShield Minnesota,Medicare Advantage,324.87,49,,percent of total billed charges,,
Tenotomy Of Elbow,,25010416,LOCAL,Facility,Inpatient,,,,663,563.55,190.0158,663,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Tenotomy Of Elbow,,25010416,LOCAL,Facility,Both,,,,663,563.55,190.0158,663,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,587.2191,88.57,,percent of total billed charges,,
Tenotomy Of Elbow,,25010416,LOCAL,Facility,Both,,,,663,563.55,190.0158,663,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,190.0158,28.66,,percent of total billed charges,,
Tenotomy Of Elbow,,25010416,LOCAL,Facility,Outpatient,,,,663,563.55,190.0158,663,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),324.87,49,,percent of total billed charges,,
Tenotomy Of Elbow,,25010416,LOCAL,Facility,Inpatient,,,,663,563.55,190.0158,663,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Tenotomy Of Elbow,,25010416,LOCAL,Facility,Both,,,,663,563.55,190.0158,663,CorVel,Worker's Compensation,663,100,,percent of total billed charges,,
Tenotomy Of Elbow,,25010416,LOCAL,Facility,Both,,,,663,563.55,190.0158,663,First Health Group Corporation,First Health Network,643.11,97,,percent of total billed charges,,
Tenotomy Of Elbow,,25010416,LOCAL,Facility,Both,,,,663,563.55,190.0158,663,"Health Partners, Inc.",Commercial,627.198,94.6,,percent of total billed charges,,
Tenotomy Of Elbow,,25010416,LOCAL,Facility,Outpatient,,,,663,563.55,190.0158,663,"Health Partners, Inc.",Medicare Advantage,324.87,49,,percent of total billed charges,,
Tenotomy Of Elbow,,25010416,LOCAL,Facility,Inpatient,,,,663,563.55,190.0158,663,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Tenotomy Of Elbow,,25010416,LOCAL,Facility,Both,,,,663,563.55,190.0158,663,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),397.8,60,,percent of total billed charges,,
Tenotomy Of Elbow,,25010416,LOCAL,Facility,Both,,,,663,563.55,190.0158,663,"Health Partners, Inc.",State of Minnesota Advantage Program,540.345,81.5,,percent of total billed charges,,
Tenotomy Of Elbow,,25010416,LOCAL,Facility,Both,,,,663,563.55,190.0158,663,"Health Partners, Inc.",State Public Programs,331.5,50,,percent of total billed charges,,
Tenotomy Of Elbow,,25010416,LOCAL,Facility,Both,,,,663,563.55,190.0158,663,Humana Insurance Company,Commercial PPO,629.85,95,,percent of total billed charges,,
Tenotomy Of Elbow,,25010416,LOCAL,Facility,Outpatient,,,,663,563.55,190.0158,663,Humana Insurance Company,Medicare PPO,324.87,49,,percent of total billed charges,,
Tenotomy Of Elbow,,25010416,LOCAL,Facility,Inpatient,,,,663,563.55,190.0158,663,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Tenotomy Of Elbow,,25010416,LOCAL,Facility,Both,,,,663,563.55,190.0158,663,Medica,Individual & Family,657.033,99.1,,percent of total billed charges,,
Tenotomy Of Elbow,,25010416,LOCAL,Facility,Outpatient,,,,663,563.55,190.0158,663,Medica,Medica Advantage Solution,330.174,49.8,,percent of total billed charges,,
Tenotomy Of Elbow,,25010416,LOCAL,Facility,Inpatient,,,,663,563.55,190.0158,663,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Tenotomy Of Elbow,,25010416,LOCAL,Facility,Outpatient,,,,663,563.55,190.0158,663,Medica,Medical Assistance,295.698,44.6,,percent of total billed charges,,
Tenotomy Of Elbow,,25010416,LOCAL,Facility,Inpatient,,,,663,563.55,190.0158,663,Medica,Medical Assistance,,,,,Included in per diem rate,
Tenotomy Of Elbow,,25010416,LOCAL,Facility,Outpatient,,,,663,563.55,190.0158,663,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,330.174,49.8,,percent of total billed charges,,
Tenotomy Of Elbow,,25010416,LOCAL,Facility,Inpatient,,,,663,563.55,190.0158,663,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Tenotomy Of Elbow,,25010416,LOCAL,Facility,Both,,,,663,563.55,190.0158,663,"Multiplan, Inc.","Multiplan, Inc.",623.22,94,,percent of total billed charges,,
Tenotomy Of Elbow,,25010416,LOCAL,Facility,Outpatient,,,,663,563.55,190.0158,663,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,597.363,90.1,,percent of total billed charges,,
Tenotomy Of Elbow,,25010416,LOCAL,Facility,Inpatient,,,,663,563.55,190.0158,663,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Tenotomy Of Elbow,,25010416,LOCAL,Facility,Both,,,,663,563.55,190.0158,663,"Preferred One Administrative Services, INC.",PPO,653.718,98.6,,percent of total billed charges,,
Tenotomy Of Elbow,,25010416,LOCAL,Facility,Outpatient,,,,663,563.55,190.0158,663,PrimeWest Health,Minnesota Senior Health Options (MSHO),341.1135,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Tenotomy Of Elbow,,25010416,LOCAL,Facility,Inpatient,,,,663,563.55,190.0158,663,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Tenotomy Of Elbow,,25010416,LOCAL,Facility,Outpatient,,,,663,563.55,190.0158,663,PrimeWest Health,MinnesotaCare,340.5168,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Tenotomy Of Elbow,,25010416,LOCAL,Facility,Inpatient,,,,663,563.55,190.0158,663,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Tenotomy Of Elbow,,25010416,LOCAL,Facility,Both,,,,663,563.55,190.0158,663,Sanford Health Plan,Sanford Health Plan,609.96,92,,percent of total billed charges,,
Tenotomy Of Elbow,,25010416,LOCAL,Facility,Outpatient,,,,663,563.55,190.0158,663,"UCare Health, Inc.",Individual & Family Plan,373.6005,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Tenotomy Of Elbow,,25010416,LOCAL,Facility,Inpatient,,,,663,563.55,190.0158,663,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Tenotomy Of Elbow,,25010416,LOCAL,Facility,Outpatient,,,,663,563.55,190.0158,663,"UCare Health, Inc.",Medical Assistance,334.6161,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Tenotomy Of Elbow,,25010416,LOCAL,Facility,Inpatient,,,,663,563.55,190.0158,663,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Tenotomy Of Elbow,,25010416,LOCAL,Facility,Outpatient,,,,663,563.55,190.0158,663,"UCare Health, Inc.",Medicare Advantage,334.6161,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Tenotomy Of Elbow,,25010416,LOCAL,Facility,Inpatient,,,,663,563.55,190.0158,663,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Tenotomy Of Elbow,,25010416,LOCAL,Facility,Outpatient,,,,663,563.55,190.0158,663,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),334.6161,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Tenotomy Of Elbow,,25010416,LOCAL,Facility,Inpatient,,,,663,563.55,190.0158,663,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Tenotomy Of Elbow,,25010416,LOCAL,Facility,Both,,,,663,563.55,190.0158,663,UnitedHealthcare,Individual & Family,623.22,94,,percent of total billed charges,,
Tenotomy Of Elbow,,25010416,LOCAL,Facility,Outpatient,,,,663,563.55,190.0158,663,UnitedHealthcare,Medicare Advantage,324.87,49,,percent of total billed charges,,
Tenotomy Of Elbow,,25010416,LOCAL,Facility,Inpatient,,,,663,563.55,190.0158,663,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Tenotomy Of Elbow,,25010416,LOCAL,Facility,Outpatient,,,,663,563.55,190.0158,663,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,318.24,48,,percent of total billed charges,,100% of DHS outpatient percentage
Tenotomy Of Elbow,,25010416,LOCAL,Facility,Inpatient,,,,663,563.55,190.0158,663,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
I&D Facial Abscess Simple Or Single,,25010550,LOCAL,Facility,Both,,,,1907,1620.95,546.5462,1907,Aetna,Commercial,1754.44,92,,percent of total billed charges,,
I&D Facial Abscess Simple Or Single,,25010550,LOCAL,Facility,Outpatient,,,,1907,1620.95,546.5462,1907,Aetna,Medicare Advantage,934.43,49,,percent of total billed charges,,
I&D Facial Abscess Simple Or Single,,25010550,LOCAL,Facility,Inpatient,,,,1907,1620.95,546.5462,1907,Aetna,Medicare Advantage,,,,,Included in per diem rate,
I&D Facial Abscess Simple Or Single,,25010550,LOCAL,Facility,Both,,,,1907,1620.95,546.5462,1907,Aetna,PPO,1773.51,93,,percent of total billed charges,,
I&D Facial Abscess Simple Or Single,,25010550,LOCAL,Facility,Both,,,,1907,1620.95,546.5462,1907,America's PPO,America's PPO,1831.2921,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
I&D Facial Abscess Simple Or Single,,25010550,LOCAL,Facility,Both,,,,1907,1620.95,546.5462,1907,BlueCross BlueShield Minnesota, Federal Employee Program,1876.488,98.4,,percent of total billed charges,,
I&D Facial Abscess Simple Or Single,,25010550,LOCAL,Facility,Both,,,,1907,1620.95,546.5462,1907,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1907,100,,percent of total billed charges,,
I&D Facial Abscess Simple Or Single,,25010550,LOCAL,Facility,Both,,,,1907,1620.95,546.5462,1907,BlueCross BlueShield Minnesota,High Value Network Plan,1716.3,90,,percent of total billed charges,,
I&D Facial Abscess Simple Or Single,,25010550,LOCAL,Facility,Outpatient,,,,1907,1620.95,546.5462,1907,BlueCross BlueShield Minnesota,Medicare Advantage,934.43,49,,percent of total billed charges,,
I&D Facial Abscess Simple Or Single,,25010550,LOCAL,Facility,Inpatient,,,,1907,1620.95,546.5462,1907,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
I&D Facial Abscess Simple Or Single,,25010550,LOCAL,Facility,Both,,,,1907,1620.95,546.5462,1907,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1689.0299,88.57,,percent of total billed charges,,
I&D Facial Abscess Simple Or Single,,25010550,LOCAL,Facility,Both,,,,1907,1620.95,546.5462,1907,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,546.5462,28.66,,percent of total billed charges,,
I&D Facial Abscess Simple Or Single,,25010550,LOCAL,Facility,Outpatient,,,,1907,1620.95,546.5462,1907,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),934.43,49,,percent of total billed charges,,
I&D Facial Abscess Simple Or Single,,25010550,LOCAL,Facility,Inpatient,,,,1907,1620.95,546.5462,1907,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
I&D Facial Abscess Simple Or Single,,25010550,LOCAL,Facility,Both,,,,1907,1620.95,546.5462,1907,CorVel,Worker's Compensation,1907,100,,percent of total billed charges,,
I&D Facial Abscess Simple Or Single,,25010550,LOCAL,Facility,Both,,,,1907,1620.95,546.5462,1907,First Health Group Corporation,First Health Network,1849.79,97,,percent of total billed charges,,
I&D Facial Abscess Simple Or Single,,25010550,LOCAL,Facility,Both,,,,1907,1620.95,546.5462,1907,"Health Partners, Inc.",Commercial,1804.022,94.6,,percent of total billed charges,,
I&D Facial Abscess Simple Or Single,,25010550,LOCAL,Facility,Outpatient,,,,1907,1620.95,546.5462,1907,"Health Partners, Inc.",Medicare Advantage,934.43,49,,percent of total billed charges,,
I&D Facial Abscess Simple Or Single,,25010550,LOCAL,Facility,Inpatient,,,,1907,1620.95,546.5462,1907,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
I&D Facial Abscess Simple Or Single,,25010550,LOCAL,Facility,Both,,,,1907,1620.95,546.5462,1907,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1144.2,60,,percent of total billed charges,,
I&D Facial Abscess Simple Or Single,,25010550,LOCAL,Facility,Both,,,,1907,1620.95,546.5462,1907,"Health Partners, Inc.",State of Minnesota Advantage Program,1554.205,81.5,,percent of total billed charges,,
I&D Facial Abscess Simple Or Single,,25010550,LOCAL,Facility,Both,,,,1907,1620.95,546.5462,1907,"Health Partners, Inc.",State Public Programs,953.5,50,,percent of total billed charges,,
I&D Facial Abscess Simple Or Single,,25010550,LOCAL,Facility,Both,,,,1907,1620.95,546.5462,1907,Humana Insurance Company,Commercial PPO,1811.65,95,,percent of total billed charges,,
I&D Facial Abscess Simple Or Single,,25010550,LOCAL,Facility,Outpatient,,,,1907,1620.95,546.5462,1907,Humana Insurance Company,Medicare PPO,934.43,49,,percent of total billed charges,,
I&D Facial Abscess Simple Or Single,,25010550,LOCAL,Facility,Inpatient,,,,1907,1620.95,546.5462,1907,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
I&D Facial Abscess Simple Or Single,,25010550,LOCAL,Facility,Both,,,,1907,1620.95,546.5462,1907,Medica,Individual & Family,1889.837,99.1,,percent of total billed charges,,
I&D Facial Abscess Simple Or Single,,25010550,LOCAL,Facility,Outpatient,,,,1907,1620.95,546.5462,1907,Medica,Medica Advantage Solution,949.686,49.8,,percent of total billed charges,,
I&D Facial Abscess Simple Or Single,,25010550,LOCAL,Facility,Inpatient,,,,1907,1620.95,546.5462,1907,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
I&D Facial Abscess Simple Or Single,,25010550,LOCAL,Facility,Outpatient,,,,1907,1620.95,546.5462,1907,Medica,Medical Assistance,850.522,44.6,,percent of total billed charges,,
I&D Facial Abscess Simple Or Single,,25010550,LOCAL,Facility,Inpatient,,,,1907,1620.95,546.5462,1907,Medica,Medical Assistance,,,,,Included in per diem rate,
I&D Facial Abscess Simple Or Single,,25010550,LOCAL,Facility,Outpatient,,,,1907,1620.95,546.5462,1907,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,949.686,49.8,,percent of total billed charges,,
I&D Facial Abscess Simple Or Single,,25010550,LOCAL,Facility,Inpatient,,,,1907,1620.95,546.5462,1907,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
I&D Facial Abscess Simple Or Single,,25010550,LOCAL,Facility,Both,,,,1907,1620.95,546.5462,1907,"Multiplan, Inc.","Multiplan, Inc.",1792.58,94,,percent of total billed charges,,
I&D Facial Abscess Simple Or Single,,25010550,LOCAL,Facility,Outpatient,,,,1907,1620.95,546.5462,1907,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1718.207,90.1,,percent of total billed charges,,
I&D Facial Abscess Simple Or Single,,25010550,LOCAL,Facility,Inpatient,,,,1907,1620.95,546.5462,1907,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
I&D Facial Abscess Simple Or Single,,25010550,LOCAL,Facility,Both,,,,1907,1620.95,546.5462,1907,"Preferred One Administrative Services, INC.",PPO,1880.302,98.6,,percent of total billed charges,,
I&D Facial Abscess Simple Or Single,,25010550,LOCAL,Facility,Outpatient,,,,1907,1620.95,546.5462,1907,PrimeWest Health,Minnesota Senior Health Options (MSHO),981.1515,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
I&D Facial Abscess Simple Or Single,,25010550,LOCAL,Facility,Inpatient,,,,1907,1620.95,546.5462,1907,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
I&D Facial Abscess Simple Or Single,,25010550,LOCAL,Facility,Outpatient,,,,1907,1620.95,546.5462,1907,PrimeWest Health,MinnesotaCare,979.4352,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
I&D Facial Abscess Simple Or Single,,25010550,LOCAL,Facility,Inpatient,,,,1907,1620.95,546.5462,1907,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
I&D Facial Abscess Simple Or Single,,25010550,LOCAL,Facility,Both,,,,1907,1620.95,546.5462,1907,Sanford Health Plan,Sanford Health Plan,1754.44,92,,percent of total billed charges,,
I&D Facial Abscess Simple Or Single,,25010550,LOCAL,Facility,Outpatient,,,,1907,1620.95,546.5462,1907,"UCare Health, Inc.",Individual & Family Plan,1074.5945,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
I&D Facial Abscess Simple Or Single,,25010550,LOCAL,Facility,Inpatient,,,,1907,1620.95,546.5462,1907,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
I&D Facial Abscess Simple Or Single,,25010550,LOCAL,Facility,Outpatient,,,,1907,1620.95,546.5462,1907,"UCare Health, Inc.",Medical Assistance,962.4629,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
I&D Facial Abscess Simple Or Single,,25010550,LOCAL,Facility,Inpatient,,,,1907,1620.95,546.5462,1907,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
I&D Facial Abscess Simple Or Single,,25010550,LOCAL,Facility,Outpatient,,,,1907,1620.95,546.5462,1907,"UCare Health, Inc.",Medicare Advantage,962.4629,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
I&D Facial Abscess Simple Or Single,,25010550,LOCAL,Facility,Inpatient,,,,1907,1620.95,546.5462,1907,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
I&D Facial Abscess Simple Or Single,,25010550,LOCAL,Facility,Outpatient,,,,1907,1620.95,546.5462,1907,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),962.4629,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
I&D Facial Abscess Simple Or Single,,25010550,LOCAL,Facility,Inpatient,,,,1907,1620.95,546.5462,1907,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
I&D Facial Abscess Simple Or Single,,25010550,LOCAL,Facility,Both,,,,1907,1620.95,546.5462,1907,UnitedHealthcare,Individual & Family,1792.58,94,,percent of total billed charges,,
I&D Facial Abscess Simple Or Single,,25010550,LOCAL,Facility,Outpatient,,,,1907,1620.95,546.5462,1907,UnitedHealthcare,Medicare Advantage,934.43,49,,percent of total billed charges,,
I&D Facial Abscess Simple Or Single,,25010550,LOCAL,Facility,Inpatient,,,,1907,1620.95,546.5462,1907,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
I&D Facial Abscess Simple Or Single,,25010550,LOCAL,Facility,Outpatient,,,,1907,1620.95,546.5462,1907,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,915.36,48,,percent of total billed charges,,100% of DHS outpatient percentage
I&D Facial Abscess Simple Or Single,,25010550,LOCAL,Facility,Inpatient,,,,1907,1620.95,546.5462,1907,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Myringotomy With Tubes Unilateral,,25011574,LOCAL,Facility,Both,,,,1938,1647.3,555.4308,1938,Aetna,Commercial,1782.96,92,,percent of total billed charges,,
Myringotomy With Tubes Unilateral,,25011574,LOCAL,Facility,Outpatient,,,,1938,1647.3,555.4308,1938,Aetna,Medicare Advantage,949.62,49,,percent of total billed charges,,
Myringotomy With Tubes Unilateral,,25011574,LOCAL,Facility,Inpatient,,,,1938,1647.3,555.4308,1938,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Myringotomy With Tubes Unilateral,,25011574,LOCAL,Facility,Both,,,,1938,1647.3,555.4308,1938,Aetna,PPO,1802.34,93,,percent of total billed charges,,
Myringotomy With Tubes Unilateral,,25011574,LOCAL,Facility,Both,,,,1938,1647.3,555.4308,1938,America's PPO,America's PPO,1861.0614,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Myringotomy With Tubes Unilateral,,25011574,LOCAL,Facility,Both,,,,1938,1647.3,555.4308,1938,BlueCross BlueShield Minnesota, Federal Employee Program,1906.992,98.4,,percent of total billed charges,,
Myringotomy With Tubes Unilateral,,25011574,LOCAL,Facility,Both,,,,1938,1647.3,555.4308,1938,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1938,100,,percent of total billed charges,,
Myringotomy With Tubes Unilateral,,25011574,LOCAL,Facility,Both,,,,1938,1647.3,555.4308,1938,BlueCross BlueShield Minnesota,High Value Network Plan,1744.2,90,,percent of total billed charges,,
Myringotomy With Tubes Unilateral,,25011574,LOCAL,Facility,Outpatient,,,,1938,1647.3,555.4308,1938,BlueCross BlueShield Minnesota,Medicare Advantage,949.62,49,,percent of total billed charges,,
Myringotomy With Tubes Unilateral,,25011574,LOCAL,Facility,Inpatient,,,,1938,1647.3,555.4308,1938,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Myringotomy With Tubes Unilateral,,25011574,LOCAL,Facility,Both,,,,1938,1647.3,555.4308,1938,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1716.4866,88.57,,percent of total billed charges,,
Myringotomy With Tubes Unilateral,,25011574,LOCAL,Facility,Both,,,,1938,1647.3,555.4308,1938,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,555.4308,28.66,,percent of total billed charges,,
Myringotomy With Tubes Unilateral,,25011574,LOCAL,Facility,Outpatient,,,,1938,1647.3,555.4308,1938,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),949.62,49,,percent of total billed charges,,
Myringotomy With Tubes Unilateral,,25011574,LOCAL,Facility,Inpatient,,,,1938,1647.3,555.4308,1938,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Myringotomy With Tubes Unilateral,,25011574,LOCAL,Facility,Both,,,,1938,1647.3,555.4308,1938,CorVel,Worker's Compensation,1938,100,,percent of total billed charges,,
Myringotomy With Tubes Unilateral,,25011574,LOCAL,Facility,Both,,,,1938,1647.3,555.4308,1938,First Health Group Corporation,First Health Network,1879.86,97,,percent of total billed charges,,
Myringotomy With Tubes Unilateral,,25011574,LOCAL,Facility,Both,,,,1938,1647.3,555.4308,1938,"Health Partners, Inc.",Commercial,1833.348,94.6,,percent of total billed charges,,
Myringotomy With Tubes Unilateral,,25011574,LOCAL,Facility,Outpatient,,,,1938,1647.3,555.4308,1938,"Health Partners, Inc.",Medicare Advantage,949.62,49,,percent of total billed charges,,
Myringotomy With Tubes Unilateral,,25011574,LOCAL,Facility,Inpatient,,,,1938,1647.3,555.4308,1938,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Myringotomy With Tubes Unilateral,,25011574,LOCAL,Facility,Both,,,,1938,1647.3,555.4308,1938,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1162.8,60,,percent of total billed charges,,
Myringotomy With Tubes Unilateral,,25011574,LOCAL,Facility,Both,,,,1938,1647.3,555.4308,1938,"Health Partners, Inc.",State of Minnesota Advantage Program,1579.47,81.5,,percent of total billed charges,,
Myringotomy With Tubes Unilateral,,25011574,LOCAL,Facility,Both,,,,1938,1647.3,555.4308,1938,"Health Partners, Inc.",State Public Programs,969,50,,percent of total billed charges,,
Myringotomy With Tubes Unilateral,,25011574,LOCAL,Facility,Both,,,,1938,1647.3,555.4308,1938,Humana Insurance Company,Commercial PPO,1841.1,95,,percent of total billed charges,,
Myringotomy With Tubes Unilateral,,25011574,LOCAL,Facility,Outpatient,,,,1938,1647.3,555.4308,1938,Humana Insurance Company,Medicare PPO,949.62,49,,percent of total billed charges,,
Myringotomy With Tubes Unilateral,,25011574,LOCAL,Facility,Inpatient,,,,1938,1647.3,555.4308,1938,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Myringotomy With Tubes Unilateral,,25011574,LOCAL,Facility,Both,,,,1938,1647.3,555.4308,1938,Medica,Individual & Family,1920.558,99.1,,percent of total billed charges,,
Myringotomy With Tubes Unilateral,,25011574,LOCAL,Facility,Outpatient,,,,1938,1647.3,555.4308,1938,Medica,Medica Advantage Solution,965.124,49.8,,percent of total billed charges,,
Myringotomy With Tubes Unilateral,,25011574,LOCAL,Facility,Inpatient,,,,1938,1647.3,555.4308,1938,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Myringotomy With Tubes Unilateral,,25011574,LOCAL,Facility,Outpatient,,,,1938,1647.3,555.4308,1938,Medica,Medical Assistance,864.348,44.6,,percent of total billed charges,,
Myringotomy With Tubes Unilateral,,25011574,LOCAL,Facility,Inpatient,,,,1938,1647.3,555.4308,1938,Medica,Medical Assistance,,,,,Included in per diem rate,
Myringotomy With Tubes Unilateral,,25011574,LOCAL,Facility,Outpatient,,,,1938,1647.3,555.4308,1938,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,965.124,49.8,,percent of total billed charges,,
Myringotomy With Tubes Unilateral,,25011574,LOCAL,Facility,Inpatient,,,,1938,1647.3,555.4308,1938,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Myringotomy With Tubes Unilateral,,25011574,LOCAL,Facility,Both,,,,1938,1647.3,555.4308,1938,"Multiplan, Inc.","Multiplan, Inc.",1821.72,94,,percent of total billed charges,,
Myringotomy With Tubes Unilateral,,25011574,LOCAL,Facility,Outpatient,,,,1938,1647.3,555.4308,1938,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1746.138,90.1,,percent of total billed charges,,
Myringotomy With Tubes Unilateral,,25011574,LOCAL,Facility,Inpatient,,,,1938,1647.3,555.4308,1938,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Myringotomy With Tubes Unilateral,,25011574,LOCAL,Facility,Both,,,,1938,1647.3,555.4308,1938,"Preferred One Administrative Services, INC.",PPO,1910.868,98.6,,percent of total billed charges,,
Myringotomy With Tubes Unilateral,,25011574,LOCAL,Facility,Outpatient,,,,1938,1647.3,555.4308,1938,PrimeWest Health,Minnesota Senior Health Options (MSHO),997.101,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Myringotomy With Tubes Unilateral,,25011574,LOCAL,Facility,Inpatient,,,,1938,1647.3,555.4308,1938,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Myringotomy With Tubes Unilateral,,25011574,LOCAL,Facility,Outpatient,,,,1938,1647.3,555.4308,1938,PrimeWest Health,MinnesotaCare,995.3568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Myringotomy With Tubes Unilateral,,25011574,LOCAL,Facility,Inpatient,,,,1938,1647.3,555.4308,1938,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Myringotomy With Tubes Unilateral,,25011574,LOCAL,Facility,Both,,,,1938,1647.3,555.4308,1938,Sanford Health Plan,Sanford Health Plan,1782.96,92,,percent of total billed charges,,
Myringotomy With Tubes Unilateral,,25011574,LOCAL,Facility,Outpatient,,,,1938,1647.3,555.4308,1938,"UCare Health, Inc.",Individual & Family Plan,1092.063,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Myringotomy With Tubes Unilateral,,25011574,LOCAL,Facility,Inpatient,,,,1938,1647.3,555.4308,1938,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Myringotomy With Tubes Unilateral,,25011574,LOCAL,Facility,Outpatient,,,,1938,1647.3,555.4308,1938,"UCare Health, Inc.",Medical Assistance,978.1086,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Myringotomy With Tubes Unilateral,,25011574,LOCAL,Facility,Inpatient,,,,1938,1647.3,555.4308,1938,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Myringotomy With Tubes Unilateral,,25011574,LOCAL,Facility,Outpatient,,,,1938,1647.3,555.4308,1938,"UCare Health, Inc.",Medicare Advantage,978.1086,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Myringotomy With Tubes Unilateral,,25011574,LOCAL,Facility,Inpatient,,,,1938,1647.3,555.4308,1938,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Myringotomy With Tubes Unilateral,,25011574,LOCAL,Facility,Outpatient,,,,1938,1647.3,555.4308,1938,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),978.1086,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Myringotomy With Tubes Unilateral,,25011574,LOCAL,Facility,Inpatient,,,,1938,1647.3,555.4308,1938,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Myringotomy With Tubes Unilateral,,25011574,LOCAL,Facility,Both,,,,1938,1647.3,555.4308,1938,UnitedHealthcare,Individual & Family,1821.72,94,,percent of total billed charges,,
Myringotomy With Tubes Unilateral,,25011574,LOCAL,Facility,Outpatient,,,,1938,1647.3,555.4308,1938,UnitedHealthcare,Medicare Advantage,949.62,49,,percent of total billed charges,,
Myringotomy With Tubes Unilateral,,25011574,LOCAL,Facility,Inpatient,,,,1938,1647.3,555.4308,1938,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Myringotomy With Tubes Unilateral,,25011574,LOCAL,Facility,Outpatient,,,,1938,1647.3,555.4308,1938,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,930.24,48,,percent of total billed charges,,100% of DHS outpatient percentage
Myringotomy With Tubes Unilateral,,25011574,LOCAL,Facility,Inpatient,,,,1938,1647.3,555.4308,1938,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Uvulopalatopharyngoplasty (Uppp),,25011661,LOCAL,Facility,Both,,,,4488,3814.8,1286.2608,4488,Aetna,Commercial,4128.96,92,,percent of total billed charges,,
Uvulopalatopharyngoplasty (Uppp),,25011661,LOCAL,Facility,Outpatient,,,,4488,3814.8,1286.2608,4488,Aetna,Medicare Advantage,2199.12,49,,percent of total billed charges,,
Uvulopalatopharyngoplasty (Uppp),,25011661,LOCAL,Facility,Inpatient,,,,4488,3814.8,1286.2608,4488,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Uvulopalatopharyngoplasty (Uppp),,25011661,LOCAL,Facility,Both,,,,4488,3814.8,1286.2608,4488,Aetna,PPO,4173.84,93,,percent of total billed charges,,
Uvulopalatopharyngoplasty (Uppp),,25011661,LOCAL,Facility,Both,,,,4488,3814.8,1286.2608,4488,America's PPO,America's PPO,4309.8264,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Uvulopalatopharyngoplasty (Uppp),,25011661,LOCAL,Facility,Both,,,,4488,3814.8,1286.2608,4488,BlueCross BlueShield Minnesota, Federal Employee Program,4416.192,98.4,,percent of total billed charges,,
Uvulopalatopharyngoplasty (Uppp),,25011661,LOCAL,Facility,Both,,,,4488,3814.8,1286.2608,4488,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,4488,100,,percent of total billed charges,,
Uvulopalatopharyngoplasty (Uppp),,25011661,LOCAL,Facility,Both,,,,4488,3814.8,1286.2608,4488,BlueCross BlueShield Minnesota,High Value Network Plan,4039.2,90,,percent of total billed charges,,
Uvulopalatopharyngoplasty (Uppp),,25011661,LOCAL,Facility,Outpatient,,,,4488,3814.8,1286.2608,4488,BlueCross BlueShield Minnesota,Medicare Advantage,2199.12,49,,percent of total billed charges,,
Uvulopalatopharyngoplasty (Uppp),,25011661,LOCAL,Facility,Inpatient,,,,4488,3814.8,1286.2608,4488,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Uvulopalatopharyngoplasty (Uppp),,25011661,LOCAL,Facility,Both,,,,4488,3814.8,1286.2608,4488,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,3975.0216,88.57,,percent of total billed charges,,
Uvulopalatopharyngoplasty (Uppp),,25011661,LOCAL,Facility,Both,,,,4488,3814.8,1286.2608,4488,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1286.2608,28.66,,percent of total billed charges,,
Uvulopalatopharyngoplasty (Uppp),,25011661,LOCAL,Facility,Outpatient,,,,4488,3814.8,1286.2608,4488,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2199.12,49,,percent of total billed charges,,
Uvulopalatopharyngoplasty (Uppp),,25011661,LOCAL,Facility,Inpatient,,,,4488,3814.8,1286.2608,4488,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Uvulopalatopharyngoplasty (Uppp),,25011661,LOCAL,Facility,Both,,,,4488,3814.8,1286.2608,4488,CorVel,Worker's Compensation,4488,100,,percent of total billed charges,,
Uvulopalatopharyngoplasty (Uppp),,25011661,LOCAL,Facility,Both,,,,4488,3814.8,1286.2608,4488,First Health Group Corporation,First Health Network,4353.36,97,,percent of total billed charges,,
Uvulopalatopharyngoplasty (Uppp),,25011661,LOCAL,Facility,Both,,,,4488,3814.8,1286.2608,4488,"Health Partners, Inc.",Commercial,4245.648,94.6,,percent of total billed charges,,
Uvulopalatopharyngoplasty (Uppp),,25011661,LOCAL,Facility,Outpatient,,,,4488,3814.8,1286.2608,4488,"Health Partners, Inc.",Medicare Advantage,2199.12,49,,percent of total billed charges,,
Uvulopalatopharyngoplasty (Uppp),,25011661,LOCAL,Facility,Inpatient,,,,4488,3814.8,1286.2608,4488,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Uvulopalatopharyngoplasty (Uppp),,25011661,LOCAL,Facility,Both,,,,4488,3814.8,1286.2608,4488,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),2692.8,60,,percent of total billed charges,,
Uvulopalatopharyngoplasty (Uppp),,25011661,LOCAL,Facility,Both,,,,4488,3814.8,1286.2608,4488,"Health Partners, Inc.",State of Minnesota Advantage Program,3657.72,81.5,,percent of total billed charges,,
Uvulopalatopharyngoplasty (Uppp),,25011661,LOCAL,Facility,Both,,,,4488,3814.8,1286.2608,4488,"Health Partners, Inc.",State Public Programs,2244,50,,percent of total billed charges,,
Uvulopalatopharyngoplasty (Uppp),,25011661,LOCAL,Facility,Both,,,,4488,3814.8,1286.2608,4488,Humana Insurance Company,Commercial PPO,4263.6,95,,percent of total billed charges,,
Uvulopalatopharyngoplasty (Uppp),,25011661,LOCAL,Facility,Outpatient,,,,4488,3814.8,1286.2608,4488,Humana Insurance Company,Medicare PPO,2199.12,49,,percent of total billed charges,,
Uvulopalatopharyngoplasty (Uppp),,25011661,LOCAL,Facility,Inpatient,,,,4488,3814.8,1286.2608,4488,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Uvulopalatopharyngoplasty (Uppp),,25011661,LOCAL,Facility,Both,,,,4488,3814.8,1286.2608,4488,Medica,Individual & Family,4447.608,99.1,,percent of total billed charges,,
Uvulopalatopharyngoplasty (Uppp),,25011661,LOCAL,Facility,Outpatient,,,,4488,3814.8,1286.2608,4488,Medica,Medica Advantage Solution,2235.024,49.8,,percent of total billed charges,,
Uvulopalatopharyngoplasty (Uppp),,25011661,LOCAL,Facility,Inpatient,,,,4488,3814.8,1286.2608,4488,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Uvulopalatopharyngoplasty (Uppp),,25011661,LOCAL,Facility,Outpatient,,,,4488,3814.8,1286.2608,4488,Medica,Medical Assistance,2001.648,44.6,,percent of total billed charges,,
Uvulopalatopharyngoplasty (Uppp),,25011661,LOCAL,Facility,Inpatient,,,,4488,3814.8,1286.2608,4488,Medica,Medical Assistance,,,,,Included in per diem rate,
Uvulopalatopharyngoplasty (Uppp),,25011661,LOCAL,Facility,Outpatient,,,,4488,3814.8,1286.2608,4488,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2235.024,49.8,,percent of total billed charges,,
Uvulopalatopharyngoplasty (Uppp),,25011661,LOCAL,Facility,Inpatient,,,,4488,3814.8,1286.2608,4488,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Uvulopalatopharyngoplasty (Uppp),,25011661,LOCAL,Facility,Both,,,,4488,3814.8,1286.2608,4488,"Multiplan, Inc.","Multiplan, Inc.",4218.72,94,,percent of total billed charges,,
Uvulopalatopharyngoplasty (Uppp),,25011661,LOCAL,Facility,Outpatient,,,,4488,3814.8,1286.2608,4488,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4043.688,90.1,,percent of total billed charges,,
Uvulopalatopharyngoplasty (Uppp),,25011661,LOCAL,Facility,Inpatient,,,,4488,3814.8,1286.2608,4488,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Uvulopalatopharyngoplasty (Uppp),,25011661,LOCAL,Facility,Both,,,,4488,3814.8,1286.2608,4488,"Preferred One Administrative Services, INC.",PPO,4425.168,98.6,,percent of total billed charges,,
Uvulopalatopharyngoplasty (Uppp),,25011661,LOCAL,Facility,Outpatient,,,,4488,3814.8,1286.2608,4488,PrimeWest Health,Minnesota Senior Health Options (MSHO),2309.076,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Uvulopalatopharyngoplasty (Uppp),,25011661,LOCAL,Facility,Inpatient,,,,4488,3814.8,1286.2608,4488,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Uvulopalatopharyngoplasty (Uppp),,25011661,LOCAL,Facility,Outpatient,,,,4488,3814.8,1286.2608,4488,PrimeWest Health,MinnesotaCare,2305.0368,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Uvulopalatopharyngoplasty (Uppp),,25011661,LOCAL,Facility,Inpatient,,,,4488,3814.8,1286.2608,4488,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Uvulopalatopharyngoplasty (Uppp),,25011661,LOCAL,Facility,Both,,,,4488,3814.8,1286.2608,4488,Sanford Health Plan,Sanford Health Plan,4128.96,92,,percent of total billed charges,,
Uvulopalatopharyngoplasty (Uppp),,25011661,LOCAL,Facility,Outpatient,,,,4488,3814.8,1286.2608,4488,"UCare Health, Inc.",Individual & Family Plan,2528.988,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Uvulopalatopharyngoplasty (Uppp),,25011661,LOCAL,Facility,Inpatient,,,,4488,3814.8,1286.2608,4488,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Uvulopalatopharyngoplasty (Uppp),,25011661,LOCAL,Facility,Outpatient,,,,4488,3814.8,1286.2608,4488,"UCare Health, Inc.",Medical Assistance,2265.0936,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Uvulopalatopharyngoplasty (Uppp),,25011661,LOCAL,Facility,Inpatient,,,,4488,3814.8,1286.2608,4488,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Uvulopalatopharyngoplasty (Uppp),,25011661,LOCAL,Facility,Outpatient,,,,4488,3814.8,1286.2608,4488,"UCare Health, Inc.",Medicare Advantage,2265.0936,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Uvulopalatopharyngoplasty (Uppp),,25011661,LOCAL,Facility,Inpatient,,,,4488,3814.8,1286.2608,4488,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Uvulopalatopharyngoplasty (Uppp),,25011661,LOCAL,Facility,Outpatient,,,,4488,3814.8,1286.2608,4488,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2265.0936,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Uvulopalatopharyngoplasty (Uppp),,25011661,LOCAL,Facility,Inpatient,,,,4488,3814.8,1286.2608,4488,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Uvulopalatopharyngoplasty (Uppp),,25011661,LOCAL,Facility,Both,,,,4488,3814.8,1286.2608,4488,UnitedHealthcare,Individual & Family,4218.72,94,,percent of total billed charges,,
Uvulopalatopharyngoplasty (Uppp),,25011661,LOCAL,Facility,Outpatient,,,,4488,3814.8,1286.2608,4488,UnitedHealthcare,Medicare Advantage,2199.12,49,,percent of total billed charges,,
Uvulopalatopharyngoplasty (Uppp),,25011661,LOCAL,Facility,Inpatient,,,,4488,3814.8,1286.2608,4488,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Uvulopalatopharyngoplasty (Uppp),,25011661,LOCAL,Facility,Outpatient,,,,4488,3814.8,1286.2608,4488,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2154.24,48,,percent of total billed charges,,100% of DHS outpatient percentage
Uvulopalatopharyngoplasty (Uppp),,25011661,LOCAL,Facility,Inpatient,,,,4488,3814.8,1286.2608,4488,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Turbinoplasty,,25011705,LOCAL,Facility,Both,,,,3468,2947.8,993.9288,3468,Aetna,Commercial,3190.56,92,,percent of total billed charges,,
Turbinoplasty,,25011705,LOCAL,Facility,Outpatient,,,,3468,2947.8,993.9288,3468,Aetna,Medicare Advantage,1699.32,49,,percent of total billed charges,,
Turbinoplasty,,25011705,LOCAL,Facility,Inpatient,,,,3468,2947.8,993.9288,3468,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Turbinoplasty,,25011705,LOCAL,Facility,Both,,,,3468,2947.8,993.9288,3468,Aetna,PPO,3225.24,93,,percent of total billed charges,,
Turbinoplasty,,25011705,LOCAL,Facility,Both,,,,3468,2947.8,993.9288,3468,America's PPO,America's PPO,3330.3204,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Turbinoplasty,,25011705,LOCAL,Facility,Both,,,,3468,2947.8,993.9288,3468,BlueCross BlueShield Minnesota, Federal Employee Program,3412.512,98.4,,percent of total billed charges,,
Turbinoplasty,,25011705,LOCAL,Facility,Both,,,,3468,2947.8,993.9288,3468,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,3468,100,,percent of total billed charges,,
Turbinoplasty,,25011705,LOCAL,Facility,Both,,,,3468,2947.8,993.9288,3468,BlueCross BlueShield Minnesota,High Value Network Plan,3121.2,90,,percent of total billed charges,,
Turbinoplasty,,25011705,LOCAL,Facility,Outpatient,,,,3468,2947.8,993.9288,3468,BlueCross BlueShield Minnesota,Medicare Advantage,1699.32,49,,percent of total billed charges,,
Turbinoplasty,,25011705,LOCAL,Facility,Inpatient,,,,3468,2947.8,993.9288,3468,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Turbinoplasty,,25011705,LOCAL,Facility,Both,,,,3468,2947.8,993.9288,3468,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,3071.6076,88.57,,percent of total billed charges,,
Turbinoplasty,,25011705,LOCAL,Facility,Both,,,,3468,2947.8,993.9288,3468,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,993.9288,28.66,,percent of total billed charges,,
Turbinoplasty,,25011705,LOCAL,Facility,Outpatient,,,,3468,2947.8,993.9288,3468,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1699.32,49,,percent of total billed charges,,
Turbinoplasty,,25011705,LOCAL,Facility,Inpatient,,,,3468,2947.8,993.9288,3468,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Turbinoplasty,,25011705,LOCAL,Facility,Both,,,,3468,2947.8,993.9288,3468,CorVel,Worker's Compensation,3468,100,,percent of total billed charges,,
Turbinoplasty,,25011705,LOCAL,Facility,Both,,,,3468,2947.8,993.9288,3468,First Health Group Corporation,First Health Network,3363.96,97,,percent of total billed charges,,
Turbinoplasty,,25011705,LOCAL,Facility,Both,,,,3468,2947.8,993.9288,3468,"Health Partners, Inc.",Commercial,3280.728,94.6,,percent of total billed charges,,
Turbinoplasty,,25011705,LOCAL,Facility,Outpatient,,,,3468,2947.8,993.9288,3468,"Health Partners, Inc.",Medicare Advantage,1699.32,49,,percent of total billed charges,,
Turbinoplasty,,25011705,LOCAL,Facility,Inpatient,,,,3468,2947.8,993.9288,3468,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Turbinoplasty,,25011705,LOCAL,Facility,Both,,,,3468,2947.8,993.9288,3468,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),2080.8,60,,percent of total billed charges,,
Turbinoplasty,,25011705,LOCAL,Facility,Both,,,,3468,2947.8,993.9288,3468,"Health Partners, Inc.",State of Minnesota Advantage Program,2826.42,81.5,,percent of total billed charges,,
Turbinoplasty,,25011705,LOCAL,Facility,Both,,,,3468,2947.8,993.9288,3468,"Health Partners, Inc.",State Public Programs,1734,50,,percent of total billed charges,,
Turbinoplasty,,25011705,LOCAL,Facility,Both,,,,3468,2947.8,993.9288,3468,Humana Insurance Company,Commercial PPO,3294.6,95,,percent of total billed charges,,
Turbinoplasty,,25011705,LOCAL,Facility,Outpatient,,,,3468,2947.8,993.9288,3468,Humana Insurance Company,Medicare PPO,1699.32,49,,percent of total billed charges,,
Turbinoplasty,,25011705,LOCAL,Facility,Inpatient,,,,3468,2947.8,993.9288,3468,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Turbinoplasty,,25011705,LOCAL,Facility,Both,,,,3468,2947.8,993.9288,3468,Medica,Individual & Family,3436.788,99.1,,percent of total billed charges,,
Turbinoplasty,,25011705,LOCAL,Facility,Outpatient,,,,3468,2947.8,993.9288,3468,Medica,Medica Advantage Solution,1727.064,49.8,,percent of total billed charges,,
Turbinoplasty,,25011705,LOCAL,Facility,Inpatient,,,,3468,2947.8,993.9288,3468,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Turbinoplasty,,25011705,LOCAL,Facility,Outpatient,,,,3468,2947.8,993.9288,3468,Medica,Medical Assistance,1546.728,44.6,,percent of total billed charges,,
Turbinoplasty,,25011705,LOCAL,Facility,Inpatient,,,,3468,2947.8,993.9288,3468,Medica,Medical Assistance,,,,,Included in per diem rate,
Turbinoplasty,,25011705,LOCAL,Facility,Outpatient,,,,3468,2947.8,993.9288,3468,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1727.064,49.8,,percent of total billed charges,,
Turbinoplasty,,25011705,LOCAL,Facility,Inpatient,,,,3468,2947.8,993.9288,3468,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Turbinoplasty,,25011705,LOCAL,Facility,Both,,,,3468,2947.8,993.9288,3468,"Multiplan, Inc.","Multiplan, Inc.",3259.92,94,,percent of total billed charges,,
Turbinoplasty,,25011705,LOCAL,Facility,Outpatient,,,,3468,2947.8,993.9288,3468,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,3124.668,90.1,,percent of total billed charges,,
Turbinoplasty,,25011705,LOCAL,Facility,Inpatient,,,,3468,2947.8,993.9288,3468,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Turbinoplasty,,25011705,LOCAL,Facility,Both,,,,3468,2947.8,993.9288,3468,"Preferred One Administrative Services, INC.",PPO,3419.448,98.6,,percent of total billed charges,,
Turbinoplasty,,25011705,LOCAL,Facility,Outpatient,,,,3468,2947.8,993.9288,3468,PrimeWest Health,Minnesota Senior Health Options (MSHO),1784.286,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Turbinoplasty,,25011705,LOCAL,Facility,Inpatient,,,,3468,2947.8,993.9288,3468,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Turbinoplasty,,25011705,LOCAL,Facility,Outpatient,,,,3468,2947.8,993.9288,3468,PrimeWest Health,MinnesotaCare,1781.1648,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Turbinoplasty,,25011705,LOCAL,Facility,Inpatient,,,,3468,2947.8,993.9288,3468,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Turbinoplasty,,25011705,LOCAL,Facility,Both,,,,3468,2947.8,993.9288,3468,Sanford Health Plan,Sanford Health Plan,3190.56,92,,percent of total billed charges,,
Turbinoplasty,,25011705,LOCAL,Facility,Outpatient,,,,3468,2947.8,993.9288,3468,"UCare Health, Inc.",Individual & Family Plan,1954.218,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Turbinoplasty,,25011705,LOCAL,Facility,Inpatient,,,,3468,2947.8,993.9288,3468,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Turbinoplasty,,25011705,LOCAL,Facility,Outpatient,,,,3468,2947.8,993.9288,3468,"UCare Health, Inc.",Medical Assistance,1750.2996,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Turbinoplasty,,25011705,LOCAL,Facility,Inpatient,,,,3468,2947.8,993.9288,3468,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Turbinoplasty,,25011705,LOCAL,Facility,Outpatient,,,,3468,2947.8,993.9288,3468,"UCare Health, Inc.",Medicare Advantage,1750.2996,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Turbinoplasty,,25011705,LOCAL,Facility,Inpatient,,,,3468,2947.8,993.9288,3468,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Turbinoplasty,,25011705,LOCAL,Facility,Outpatient,,,,3468,2947.8,993.9288,3468,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1750.2996,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Turbinoplasty,,25011705,LOCAL,Facility,Inpatient,,,,3468,2947.8,993.9288,3468,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Turbinoplasty,,25011705,LOCAL,Facility,Both,,,,3468,2947.8,993.9288,3468,UnitedHealthcare,Individual & Family,3259.92,94,,percent of total billed charges,,
Turbinoplasty,,25011705,LOCAL,Facility,Outpatient,,,,3468,2947.8,993.9288,3468,UnitedHealthcare,Medicare Advantage,1699.32,49,,percent of total billed charges,,
Turbinoplasty,,25011705,LOCAL,Facility,Inpatient,,,,3468,2947.8,993.9288,3468,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Turbinoplasty,,25011705,LOCAL,Facility,Outpatient,,,,3468,2947.8,993.9288,3468,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1664.64,48,,percent of total billed charges,,100% of DHS outpatient percentage
Turbinoplasty,,25011705,LOCAL,Facility,Inpatient,,,,3468,2947.8,993.9288,3468,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Punch Biopsy,,25012179,LOCAL,Facility,Both,,,,306,260.1,87.6996,306,Aetna,Commercial,281.52,92,,percent of total billed charges,,
Punch Biopsy,,25012179,LOCAL,Facility,Outpatient,,,,306,260.1,87.6996,306,Aetna,Medicare Advantage,149.94,49,,percent of total billed charges,,
Punch Biopsy,,25012179,LOCAL,Facility,Inpatient,,,,306,260.1,87.6996,306,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Punch Biopsy,,25012179,LOCAL,Facility,Both,,,,306,260.1,87.6996,306,Aetna,PPO,284.58,93,,percent of total billed charges,,
Punch Biopsy,,25012179,LOCAL,Facility,Both,,,,306,260.1,87.6996,306,America's PPO,America's PPO,293.8518,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Punch Biopsy,,25012179,LOCAL,Facility,Both,,,,306,260.1,87.6996,306,BlueCross BlueShield Minnesota, Federal Employee Program,301.104,98.4,,percent of total billed charges,,
Punch Biopsy,,25012179,LOCAL,Facility,Both,,,,306,260.1,87.6996,306,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,306,100,,percent of total billed charges,,
Punch Biopsy,,25012179,LOCAL,Facility,Both,,,,306,260.1,87.6996,306,BlueCross BlueShield Minnesota,High Value Network Plan,275.4,90,,percent of total billed charges,,
Punch Biopsy,,25012179,LOCAL,Facility,Outpatient,,,,306,260.1,87.6996,306,BlueCross BlueShield Minnesota,Medicare Advantage,149.94,49,,percent of total billed charges,,
Punch Biopsy,,25012179,LOCAL,Facility,Inpatient,,,,306,260.1,87.6996,306,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Punch Biopsy,,25012179,LOCAL,Facility,Both,,,,306,260.1,87.6996,306,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,271.0242,88.57,,percent of total billed charges,,
Punch Biopsy,,25012179,LOCAL,Facility,Both,,,,306,260.1,87.6996,306,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,87.6996,28.66,,percent of total billed charges,,
Punch Biopsy,,25012179,LOCAL,Facility,Outpatient,,,,306,260.1,87.6996,306,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),149.94,49,,percent of total billed charges,,
Punch Biopsy,,25012179,LOCAL,Facility,Inpatient,,,,306,260.1,87.6996,306,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Punch Biopsy,,25012179,LOCAL,Facility,Both,,,,306,260.1,87.6996,306,CorVel,Worker's Compensation,306,100,,percent of total billed charges,,
Punch Biopsy,,25012179,LOCAL,Facility,Both,,,,306,260.1,87.6996,306,First Health Group Corporation,First Health Network,296.82,97,,percent of total billed charges,,
Punch Biopsy,,25012179,LOCAL,Facility,Both,,,,306,260.1,87.6996,306,"Health Partners, Inc.",Commercial,289.476,94.6,,percent of total billed charges,,
Punch Biopsy,,25012179,LOCAL,Facility,Outpatient,,,,306,260.1,87.6996,306,"Health Partners, Inc.",Medicare Advantage,149.94,49,,percent of total billed charges,,
Punch Biopsy,,25012179,LOCAL,Facility,Inpatient,,,,306,260.1,87.6996,306,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Punch Biopsy,,25012179,LOCAL,Facility,Both,,,,306,260.1,87.6996,306,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),183.6,60,,percent of total billed charges,,
Punch Biopsy,,25012179,LOCAL,Facility,Both,,,,306,260.1,87.6996,306,"Health Partners, Inc.",State of Minnesota Advantage Program,249.39,81.5,,percent of total billed charges,,
Punch Biopsy,,25012179,LOCAL,Facility,Both,,,,306,260.1,87.6996,306,"Health Partners, Inc.",State Public Programs,153,50,,percent of total billed charges,,
Punch Biopsy,,25012179,LOCAL,Facility,Both,,,,306,260.1,87.6996,306,Humana Insurance Company,Commercial PPO,290.7,95,,percent of total billed charges,,
Punch Biopsy,,25012179,LOCAL,Facility,Outpatient,,,,306,260.1,87.6996,306,Humana Insurance Company,Medicare PPO,149.94,49,,percent of total billed charges,,
Punch Biopsy,,25012179,LOCAL,Facility,Inpatient,,,,306,260.1,87.6996,306,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Punch Biopsy,,25012179,LOCAL,Facility,Both,,,,306,260.1,87.6996,306,Medica,Individual & Family,303.246,99.1,,percent of total billed charges,,
Punch Biopsy,,25012179,LOCAL,Facility,Outpatient,,,,306,260.1,87.6996,306,Medica,Medica Advantage Solution,152.388,49.8,,percent of total billed charges,,
Punch Biopsy,,25012179,LOCAL,Facility,Inpatient,,,,306,260.1,87.6996,306,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Punch Biopsy,,25012179,LOCAL,Facility,Outpatient,,,,306,260.1,87.6996,306,Medica,Medical Assistance,136.476,44.6,,percent of total billed charges,,
Punch Biopsy,,25012179,LOCAL,Facility,Inpatient,,,,306,260.1,87.6996,306,Medica,Medical Assistance,,,,,Included in per diem rate,
Punch Biopsy,,25012179,LOCAL,Facility,Outpatient,,,,306,260.1,87.6996,306,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,152.388,49.8,,percent of total billed charges,,
Punch Biopsy,,25012179,LOCAL,Facility,Inpatient,,,,306,260.1,87.6996,306,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Punch Biopsy,,25012179,LOCAL,Facility,Both,,,,306,260.1,87.6996,306,"Multiplan, Inc.","Multiplan, Inc.",287.64,94,,percent of total billed charges,,
Punch Biopsy,,25012179,LOCAL,Facility,Outpatient,,,,306,260.1,87.6996,306,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,275.706,90.1,,percent of total billed charges,,
Punch Biopsy,,25012179,LOCAL,Facility,Inpatient,,,,306,260.1,87.6996,306,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Punch Biopsy,,25012179,LOCAL,Facility,Both,,,,306,260.1,87.6996,306,"Preferred One Administrative Services, INC.",PPO,301.716,98.6,,percent of total billed charges,,
Punch Biopsy,,25012179,LOCAL,Facility,Outpatient,,,,306,260.1,87.6996,306,PrimeWest Health,Minnesota Senior Health Options (MSHO),157.437,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Punch Biopsy,,25012179,LOCAL,Facility,Inpatient,,,,306,260.1,87.6996,306,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Punch Biopsy,,25012179,LOCAL,Facility,Outpatient,,,,306,260.1,87.6996,306,PrimeWest Health,MinnesotaCare,157.1616,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Punch Biopsy,,25012179,LOCAL,Facility,Inpatient,,,,306,260.1,87.6996,306,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Punch Biopsy,,25012179,LOCAL,Facility,Both,,,,306,260.1,87.6996,306,Sanford Health Plan,Sanford Health Plan,281.52,92,,percent of total billed charges,,
Punch Biopsy,,25012179,LOCAL,Facility,Outpatient,,,,306,260.1,87.6996,306,"UCare Health, Inc.",Individual & Family Plan,172.431,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Punch Biopsy,,25012179,LOCAL,Facility,Inpatient,,,,306,260.1,87.6996,306,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Punch Biopsy,,25012179,LOCAL,Facility,Outpatient,,,,306,260.1,87.6996,306,"UCare Health, Inc.",Medical Assistance,154.4382,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Punch Biopsy,,25012179,LOCAL,Facility,Inpatient,,,,306,260.1,87.6996,306,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Punch Biopsy,,25012179,LOCAL,Facility,Outpatient,,,,306,260.1,87.6996,306,"UCare Health, Inc.",Medicare Advantage,154.4382,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Punch Biopsy,,25012179,LOCAL,Facility,Inpatient,,,,306,260.1,87.6996,306,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Punch Biopsy,,25012179,LOCAL,Facility,Outpatient,,,,306,260.1,87.6996,306,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),154.4382,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Punch Biopsy,,25012179,LOCAL,Facility,Inpatient,,,,306,260.1,87.6996,306,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Punch Biopsy,,25012179,LOCAL,Facility,Both,,,,306,260.1,87.6996,306,UnitedHealthcare,Individual & Family,287.64,94,,percent of total billed charges,,
Punch Biopsy,,25012179,LOCAL,Facility,Outpatient,,,,306,260.1,87.6996,306,UnitedHealthcare,Medicare Advantage,149.94,49,,percent of total billed charges,,
Punch Biopsy,,25012179,LOCAL,Facility,Inpatient,,,,306,260.1,87.6996,306,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Punch Biopsy,,25012179,LOCAL,Facility,Outpatient,,,,306,260.1,87.6996,306,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,146.88,48,,percent of total billed charges,,100% of DHS outpatient percentage
Punch Biopsy,,25012179,LOCAL,Facility,Inpatient,,,,306,260.1,87.6996,306,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Dilation Of Suprapubic Catheter,,25012180,LOCAL,Facility,Both,,,,1020,867,292.332,1020,Aetna,Commercial,938.4,92,,percent of total billed charges,,
Dilation Of Suprapubic Catheter,,25012180,LOCAL,Facility,Outpatient,,,,1020,867,292.332,1020,Aetna,Medicare Advantage,499.8,49,,percent of total billed charges,,
Dilation Of Suprapubic Catheter,,25012180,LOCAL,Facility,Inpatient,,,,1020,867,292.332,1020,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Dilation Of Suprapubic Catheter,,25012180,LOCAL,Facility,Both,,,,1020,867,292.332,1020,Aetna,PPO,948.6,93,,percent of total billed charges,,
Dilation Of Suprapubic Catheter,,25012180,LOCAL,Facility,Both,,,,1020,867,292.332,1020,America's PPO,America's PPO,979.506,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Dilation Of Suprapubic Catheter,,25012180,LOCAL,Facility,Both,,,,1020,867,292.332,1020,BlueCross BlueShield Minnesota, Federal Employee Program,1003.68,98.4,,percent of total billed charges,,
Dilation Of Suprapubic Catheter,,25012180,LOCAL,Facility,Both,,,,1020,867,292.332,1020,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1020,100,,percent of total billed charges,,
Dilation Of Suprapubic Catheter,,25012180,LOCAL,Facility,Both,,,,1020,867,292.332,1020,BlueCross BlueShield Minnesota,High Value Network Plan,918,90,,percent of total billed charges,,
Dilation Of Suprapubic Catheter,,25012180,LOCAL,Facility,Outpatient,,,,1020,867,292.332,1020,BlueCross BlueShield Minnesota,Medicare Advantage,499.8,49,,percent of total billed charges,,
Dilation Of Suprapubic Catheter,,25012180,LOCAL,Facility,Inpatient,,,,1020,867,292.332,1020,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Dilation Of Suprapubic Catheter,,25012180,LOCAL,Facility,Both,,,,1020,867,292.332,1020,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,903.414,88.57,,percent of total billed charges,,
Dilation Of Suprapubic Catheter,,25012180,LOCAL,Facility,Both,,,,1020,867,292.332,1020,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,292.332,28.66,,percent of total billed charges,,
Dilation Of Suprapubic Catheter,,25012180,LOCAL,Facility,Outpatient,,,,1020,867,292.332,1020,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),499.8,49,,percent of total billed charges,,
Dilation Of Suprapubic Catheter,,25012180,LOCAL,Facility,Inpatient,,,,1020,867,292.332,1020,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Dilation Of Suprapubic Catheter,,25012180,LOCAL,Facility,Both,,,,1020,867,292.332,1020,CorVel,Worker's Compensation,1020,100,,percent of total billed charges,,
Dilation Of Suprapubic Catheter,,25012180,LOCAL,Facility,Both,,,,1020,867,292.332,1020,First Health Group Corporation,First Health Network,989.4,97,,percent of total billed charges,,
Dilation Of Suprapubic Catheter,,25012180,LOCAL,Facility,Both,,,,1020,867,292.332,1020,"Health Partners, Inc.",Commercial,964.92,94.6,,percent of total billed charges,,
Dilation Of Suprapubic Catheter,,25012180,LOCAL,Facility,Outpatient,,,,1020,867,292.332,1020,"Health Partners, Inc.",Medicare Advantage,499.8,49,,percent of total billed charges,,
Dilation Of Suprapubic Catheter,,25012180,LOCAL,Facility,Inpatient,,,,1020,867,292.332,1020,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Dilation Of Suprapubic Catheter,,25012180,LOCAL,Facility,Both,,,,1020,867,292.332,1020,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),612,60,,percent of total billed charges,,
Dilation Of Suprapubic Catheter,,25012180,LOCAL,Facility,Both,,,,1020,867,292.332,1020,"Health Partners, Inc.",State of Minnesota Advantage Program,831.3,81.5,,percent of total billed charges,,
Dilation Of Suprapubic Catheter,,25012180,LOCAL,Facility,Both,,,,1020,867,292.332,1020,"Health Partners, Inc.",State Public Programs,510,50,,percent of total billed charges,,
Dilation Of Suprapubic Catheter,,25012180,LOCAL,Facility,Both,,,,1020,867,292.332,1020,Humana Insurance Company,Commercial PPO,969,95,,percent of total billed charges,,
Dilation Of Suprapubic Catheter,,25012180,LOCAL,Facility,Outpatient,,,,1020,867,292.332,1020,Humana Insurance Company,Medicare PPO,499.8,49,,percent of total billed charges,,
Dilation Of Suprapubic Catheter,,25012180,LOCAL,Facility,Inpatient,,,,1020,867,292.332,1020,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Dilation Of Suprapubic Catheter,,25012180,LOCAL,Facility,Both,,,,1020,867,292.332,1020,Medica,Individual & Family,1010.82,99.1,,percent of total billed charges,,
Dilation Of Suprapubic Catheter,,25012180,LOCAL,Facility,Outpatient,,,,1020,867,292.332,1020,Medica,Medica Advantage Solution,507.96,49.8,,percent of total billed charges,,
Dilation Of Suprapubic Catheter,,25012180,LOCAL,Facility,Inpatient,,,,1020,867,292.332,1020,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Dilation Of Suprapubic Catheter,,25012180,LOCAL,Facility,Outpatient,,,,1020,867,292.332,1020,Medica,Medical Assistance,454.92,44.6,,percent of total billed charges,,
Dilation Of Suprapubic Catheter,,25012180,LOCAL,Facility,Inpatient,,,,1020,867,292.332,1020,Medica,Medical Assistance,,,,,Included in per diem rate,
Dilation Of Suprapubic Catheter,,25012180,LOCAL,Facility,Outpatient,,,,1020,867,292.332,1020,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,507.96,49.8,,percent of total billed charges,,
Dilation Of Suprapubic Catheter,,25012180,LOCAL,Facility,Inpatient,,,,1020,867,292.332,1020,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Dilation Of Suprapubic Catheter,,25012180,LOCAL,Facility,Both,,,,1020,867,292.332,1020,"Multiplan, Inc.","Multiplan, Inc.",958.8,94,,percent of total billed charges,,
Dilation Of Suprapubic Catheter,,25012180,LOCAL,Facility,Outpatient,,,,1020,867,292.332,1020,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,919.02,90.1,,percent of total billed charges,,
Dilation Of Suprapubic Catheter,,25012180,LOCAL,Facility,Inpatient,,,,1020,867,292.332,1020,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Dilation Of Suprapubic Catheter,,25012180,LOCAL,Facility,Both,,,,1020,867,292.332,1020,"Preferred One Administrative Services, INC.",PPO,1005.72,98.6,,percent of total billed charges,,
Dilation Of Suprapubic Catheter,,25012180,LOCAL,Facility,Outpatient,,,,1020,867,292.332,1020,PrimeWest Health,Minnesota Senior Health Options (MSHO),524.79,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Dilation Of Suprapubic Catheter,,25012180,LOCAL,Facility,Inpatient,,,,1020,867,292.332,1020,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Dilation Of Suprapubic Catheter,,25012180,LOCAL,Facility,Outpatient,,,,1020,867,292.332,1020,PrimeWest Health,MinnesotaCare,523.872,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Dilation Of Suprapubic Catheter,,25012180,LOCAL,Facility,Inpatient,,,,1020,867,292.332,1020,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Dilation Of Suprapubic Catheter,,25012180,LOCAL,Facility,Both,,,,1020,867,292.332,1020,Sanford Health Plan,Sanford Health Plan,938.4,92,,percent of total billed charges,,
Dilation Of Suprapubic Catheter,,25012180,LOCAL,Facility,Outpatient,,,,1020,867,292.332,1020,"UCare Health, Inc.",Individual & Family Plan,574.77,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Dilation Of Suprapubic Catheter,,25012180,LOCAL,Facility,Inpatient,,,,1020,867,292.332,1020,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Dilation Of Suprapubic Catheter,,25012180,LOCAL,Facility,Outpatient,,,,1020,867,292.332,1020,"UCare Health, Inc.",Medical Assistance,514.794,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Dilation Of Suprapubic Catheter,,25012180,LOCAL,Facility,Inpatient,,,,1020,867,292.332,1020,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Dilation Of Suprapubic Catheter,,25012180,LOCAL,Facility,Outpatient,,,,1020,867,292.332,1020,"UCare Health, Inc.",Medicare Advantage,514.794,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Dilation Of Suprapubic Catheter,,25012180,LOCAL,Facility,Inpatient,,,,1020,867,292.332,1020,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Dilation Of Suprapubic Catheter,,25012180,LOCAL,Facility,Outpatient,,,,1020,867,292.332,1020,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),514.794,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Dilation Of Suprapubic Catheter,,25012180,LOCAL,Facility,Inpatient,,,,1020,867,292.332,1020,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Dilation Of Suprapubic Catheter,,25012180,LOCAL,Facility,Both,,,,1020,867,292.332,1020,UnitedHealthcare,Individual & Family,958.8,94,,percent of total billed charges,,
Dilation Of Suprapubic Catheter,,25012180,LOCAL,Facility,Outpatient,,,,1020,867,292.332,1020,UnitedHealthcare,Medicare Advantage,499.8,49,,percent of total billed charges,,
Dilation Of Suprapubic Catheter,,25012180,LOCAL,Facility,Inpatient,,,,1020,867,292.332,1020,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Dilation Of Suprapubic Catheter,,25012180,LOCAL,Facility,Outpatient,,,,1020,867,292.332,1020,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,489.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
Dilation Of Suprapubic Catheter,,25012180,LOCAL,Facility,Inpatient,,,,1020,867,292.332,1020,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Mitomycin Intravesical Instillation,,25012192,LOCAL,Facility,Both,,,,510,433.5,146.166,510,Aetna,Commercial,469.2,92,,percent of total billed charges,,
Mitomycin Intravesical Instillation,,25012192,LOCAL,Facility,Outpatient,,,,510,433.5,146.166,510,Aetna,Medicare Advantage,249.9,49,,percent of total billed charges,,
Mitomycin Intravesical Instillation,,25012192,LOCAL,Facility,Inpatient,,,,510,433.5,146.166,510,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Mitomycin Intravesical Instillation,,25012192,LOCAL,Facility,Both,,,,510,433.5,146.166,510,Aetna,PPO,474.3,93,,percent of total billed charges,,
Mitomycin Intravesical Instillation,,25012192,LOCAL,Facility,Both,,,,510,433.5,146.166,510,America's PPO,America's PPO,489.753,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Mitomycin Intravesical Instillation,,25012192,LOCAL,Facility,Both,,,,510,433.5,146.166,510,BlueCross BlueShield Minnesota, Federal Employee Program,501.84,98.4,,percent of total billed charges,,
Mitomycin Intravesical Instillation,,25012192,LOCAL,Facility,Both,,,,510,433.5,146.166,510,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,510,100,,percent of total billed charges,,
Mitomycin Intravesical Instillation,,25012192,LOCAL,Facility,Both,,,,510,433.5,146.166,510,BlueCross BlueShield Minnesota,High Value Network Plan,459,90,,percent of total billed charges,,
Mitomycin Intravesical Instillation,,25012192,LOCAL,Facility,Outpatient,,,,510,433.5,146.166,510,BlueCross BlueShield Minnesota,Medicare Advantage,249.9,49,,percent of total billed charges,,
Mitomycin Intravesical Instillation,,25012192,LOCAL,Facility,Inpatient,,,,510,433.5,146.166,510,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Mitomycin Intravesical Instillation,,25012192,LOCAL,Facility,Both,,,,510,433.5,146.166,510,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,451.707,88.57,,percent of total billed charges,,
Mitomycin Intravesical Instillation,,25012192,LOCAL,Facility,Both,,,,510,433.5,146.166,510,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,146.166,28.66,,percent of total billed charges,,
Mitomycin Intravesical Instillation,,25012192,LOCAL,Facility,Outpatient,,,,510,433.5,146.166,510,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),249.9,49,,percent of total billed charges,,
Mitomycin Intravesical Instillation,,25012192,LOCAL,Facility,Inpatient,,,,510,433.5,146.166,510,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Mitomycin Intravesical Instillation,,25012192,LOCAL,Facility,Both,,,,510,433.5,146.166,510,CorVel,Worker's Compensation,510,100,,percent of total billed charges,,
Mitomycin Intravesical Instillation,,25012192,LOCAL,Facility,Both,,,,510,433.5,146.166,510,First Health Group Corporation,First Health Network,494.7,97,,percent of total billed charges,,
Mitomycin Intravesical Instillation,,25012192,LOCAL,Facility,Both,,,,510,433.5,146.166,510,"Health Partners, Inc.",Commercial,482.46,94.6,,percent of total billed charges,,
Mitomycin Intravesical Instillation,,25012192,LOCAL,Facility,Outpatient,,,,510,433.5,146.166,510,"Health Partners, Inc.",Medicare Advantage,249.9,49,,percent of total billed charges,,
Mitomycin Intravesical Instillation,,25012192,LOCAL,Facility,Inpatient,,,,510,433.5,146.166,510,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mitomycin Intravesical Instillation,,25012192,LOCAL,Facility,Both,,,,510,433.5,146.166,510,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),306,60,,percent of total billed charges,,
Mitomycin Intravesical Instillation,,25012192,LOCAL,Facility,Both,,,,510,433.5,146.166,510,"Health Partners, Inc.",State of Minnesota Advantage Program,415.65,81.5,,percent of total billed charges,,
Mitomycin Intravesical Instillation,,25012192,LOCAL,Facility,Both,,,,510,433.5,146.166,510,"Health Partners, Inc.",State Public Programs,255,50,,percent of total billed charges,,
Mitomycin Intravesical Instillation,,25012192,LOCAL,Facility,Both,,,,510,433.5,146.166,510,Humana Insurance Company,Commercial PPO,484.5,95,,percent of total billed charges,,
Mitomycin Intravesical Instillation,,25012192,LOCAL,Facility,Outpatient,,,,510,433.5,146.166,510,Humana Insurance Company,Medicare PPO,249.9,49,,percent of total billed charges,,
Mitomycin Intravesical Instillation,,25012192,LOCAL,Facility,Inpatient,,,,510,433.5,146.166,510,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Mitomycin Intravesical Instillation,,25012192,LOCAL,Facility,Both,,,,510,433.5,146.166,510,Medica,Individual & Family,505.41,99.1,,percent of total billed charges,,
Mitomycin Intravesical Instillation,,25012192,LOCAL,Facility,Outpatient,,,,510,433.5,146.166,510,Medica,Medica Advantage Solution,253.98,49.8,,percent of total billed charges,,
Mitomycin Intravesical Instillation,,25012192,LOCAL,Facility,Inpatient,,,,510,433.5,146.166,510,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Mitomycin Intravesical Instillation,,25012192,LOCAL,Facility,Outpatient,,,,510,433.5,146.166,510,Medica,Medical Assistance,227.46,44.6,,percent of total billed charges,,
Mitomycin Intravesical Instillation,,25012192,LOCAL,Facility,Inpatient,,,,510,433.5,146.166,510,Medica,Medical Assistance,,,,,Included in per diem rate,
Mitomycin Intravesical Instillation,,25012192,LOCAL,Facility,Outpatient,,,,510,433.5,146.166,510,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,253.98,49.8,,percent of total billed charges,,
Mitomycin Intravesical Instillation,,25012192,LOCAL,Facility,Inpatient,,,,510,433.5,146.166,510,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Mitomycin Intravesical Instillation,,25012192,LOCAL,Facility,Both,,,,510,433.5,146.166,510,"Multiplan, Inc.","Multiplan, Inc.",479.4,94,,percent of total billed charges,,
Mitomycin Intravesical Instillation,,25012192,LOCAL,Facility,Outpatient,,,,510,433.5,146.166,510,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,459.51,90.1,,percent of total billed charges,,
Mitomycin Intravesical Instillation,,25012192,LOCAL,Facility,Inpatient,,,,510,433.5,146.166,510,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Mitomycin Intravesical Instillation,,25012192,LOCAL,Facility,Both,,,,510,433.5,146.166,510,"Preferred One Administrative Services, INC.",PPO,502.86,98.6,,percent of total billed charges,,
Mitomycin Intravesical Instillation,,25012192,LOCAL,Facility,Outpatient,,,,510,433.5,146.166,510,PrimeWest Health,Minnesota Senior Health Options (MSHO),262.395,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Mitomycin Intravesical Instillation,,25012192,LOCAL,Facility,Inpatient,,,,510,433.5,146.166,510,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mitomycin Intravesical Instillation,,25012192,LOCAL,Facility,Outpatient,,,,510,433.5,146.166,510,PrimeWest Health,MinnesotaCare,261.936,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Mitomycin Intravesical Instillation,,25012192,LOCAL,Facility,Inpatient,,,,510,433.5,146.166,510,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Mitomycin Intravesical Instillation,,25012192,LOCAL,Facility,Both,,,,510,433.5,146.166,510,Sanford Health Plan,Sanford Health Plan,469.2,92,,percent of total billed charges,,
Mitomycin Intravesical Instillation,,25012192,LOCAL,Facility,Outpatient,,,,510,433.5,146.166,510,"UCare Health, Inc.",Individual & Family Plan,287.385,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Mitomycin Intravesical Instillation,,25012192,LOCAL,Facility,Inpatient,,,,510,433.5,146.166,510,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Mitomycin Intravesical Instillation,,25012192,LOCAL,Facility,Outpatient,,,,510,433.5,146.166,510,"UCare Health, Inc.",Medical Assistance,257.397,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mitomycin Intravesical Instillation,,25012192,LOCAL,Facility,Inpatient,,,,510,433.5,146.166,510,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Mitomycin Intravesical Instillation,,25012192,LOCAL,Facility,Outpatient,,,,510,433.5,146.166,510,"UCare Health, Inc.",Medicare Advantage,257.397,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mitomycin Intravesical Instillation,,25012192,LOCAL,Facility,Inpatient,,,,510,433.5,146.166,510,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mitomycin Intravesical Instillation,,25012192,LOCAL,Facility,Outpatient,,,,510,433.5,146.166,510,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),257.397,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mitomycin Intravesical Instillation,,25012192,LOCAL,Facility,Inpatient,,,,510,433.5,146.166,510,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mitomycin Intravesical Instillation,,25012192,LOCAL,Facility,Both,,,,510,433.5,146.166,510,UnitedHealthcare,Individual & Family,479.4,94,,percent of total billed charges,,
Mitomycin Intravesical Instillation,,25012192,LOCAL,Facility,Outpatient,,,,510,433.5,146.166,510,UnitedHealthcare,Medicare Advantage,249.9,49,,percent of total billed charges,,
Mitomycin Intravesical Instillation,,25012192,LOCAL,Facility,Inpatient,,,,510,433.5,146.166,510,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Mitomycin Intravesical Instillation,,25012192,LOCAL,Facility,Outpatient,,,,510,433.5,146.166,510,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,244.8,48,,percent of total billed charges,,100% of DHS outpatient percentage
Mitomycin Intravesical Instillation,,25012192,LOCAL,Facility,Inpatient,,,,510,433.5,146.166,510,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Uroplasty With Macroplastique,,25012203,LOCAL,Facility,Both,,,,1224,1040.4,350.7984,1224,Aetna,Commercial,1126.08,92,,percent of total billed charges,,
Uroplasty With Macroplastique,,25012203,LOCAL,Facility,Outpatient,,,,1224,1040.4,350.7984,1224,Aetna,Medicare Advantage,599.76,49,,percent of total billed charges,,
Uroplasty With Macroplastique,,25012203,LOCAL,Facility,Inpatient,,,,1224,1040.4,350.7984,1224,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Uroplasty With Macroplastique,,25012203,LOCAL,Facility,Both,,,,1224,1040.4,350.7984,1224,Aetna,PPO,1138.32,93,,percent of total billed charges,,
Uroplasty With Macroplastique,,25012203,LOCAL,Facility,Both,,,,1224,1040.4,350.7984,1224,America's PPO,America's PPO,1175.4072,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Uroplasty With Macroplastique,,25012203,LOCAL,Facility,Both,,,,1224,1040.4,350.7984,1224,BlueCross BlueShield Minnesota, Federal Employee Program,1204.416,98.4,,percent of total billed charges,,
Uroplasty With Macroplastique,,25012203,LOCAL,Facility,Both,,,,1224,1040.4,350.7984,1224,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1224,100,,percent of total billed charges,,
Uroplasty With Macroplastique,,25012203,LOCAL,Facility,Both,,,,1224,1040.4,350.7984,1224,BlueCross BlueShield Minnesota,High Value Network Plan,1101.6,90,,percent of total billed charges,,
Uroplasty With Macroplastique,,25012203,LOCAL,Facility,Outpatient,,,,1224,1040.4,350.7984,1224,BlueCross BlueShield Minnesota,Medicare Advantage,599.76,49,,percent of total billed charges,,
Uroplasty With Macroplastique,,25012203,LOCAL,Facility,Inpatient,,,,1224,1040.4,350.7984,1224,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Uroplasty With Macroplastique,,25012203,LOCAL,Facility,Both,,,,1224,1040.4,350.7984,1224,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1084.0968,88.57,,percent of total billed charges,,
Uroplasty With Macroplastique,,25012203,LOCAL,Facility,Both,,,,1224,1040.4,350.7984,1224,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,350.7984,28.66,,percent of total billed charges,,
Uroplasty With Macroplastique,,25012203,LOCAL,Facility,Outpatient,,,,1224,1040.4,350.7984,1224,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),599.76,49,,percent of total billed charges,,
Uroplasty With Macroplastique,,25012203,LOCAL,Facility,Inpatient,,,,1224,1040.4,350.7984,1224,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Uroplasty With Macroplastique,,25012203,LOCAL,Facility,Both,,,,1224,1040.4,350.7984,1224,CorVel,Worker's Compensation,1224,100,,percent of total billed charges,,
Uroplasty With Macroplastique,,25012203,LOCAL,Facility,Both,,,,1224,1040.4,350.7984,1224,First Health Group Corporation,First Health Network,1187.28,97,,percent of total billed charges,,
Uroplasty With Macroplastique,,25012203,LOCAL,Facility,Both,,,,1224,1040.4,350.7984,1224,"Health Partners, Inc.",Commercial,1157.904,94.6,,percent of total billed charges,,
Uroplasty With Macroplastique,,25012203,LOCAL,Facility,Outpatient,,,,1224,1040.4,350.7984,1224,"Health Partners, Inc.",Medicare Advantage,599.76,49,,percent of total billed charges,,
Uroplasty With Macroplastique,,25012203,LOCAL,Facility,Inpatient,,,,1224,1040.4,350.7984,1224,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Uroplasty With Macroplastique,,25012203,LOCAL,Facility,Both,,,,1224,1040.4,350.7984,1224,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),734.4,60,,percent of total billed charges,,
Uroplasty With Macroplastique,,25012203,LOCAL,Facility,Both,,,,1224,1040.4,350.7984,1224,"Health Partners, Inc.",State of Minnesota Advantage Program,997.56,81.5,,percent of total billed charges,,
Uroplasty With Macroplastique,,25012203,LOCAL,Facility,Both,,,,1224,1040.4,350.7984,1224,"Health Partners, Inc.",State Public Programs,612,50,,percent of total billed charges,,
Uroplasty With Macroplastique,,25012203,LOCAL,Facility,Both,,,,1224,1040.4,350.7984,1224,Humana Insurance Company,Commercial PPO,1162.8,95,,percent of total billed charges,,
Uroplasty With Macroplastique,,25012203,LOCAL,Facility,Outpatient,,,,1224,1040.4,350.7984,1224,Humana Insurance Company,Medicare PPO,599.76,49,,percent of total billed charges,,
Uroplasty With Macroplastique,,25012203,LOCAL,Facility,Inpatient,,,,1224,1040.4,350.7984,1224,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Uroplasty With Macroplastique,,25012203,LOCAL,Facility,Both,,,,1224,1040.4,350.7984,1224,Medica,Individual & Family,1212.984,99.1,,percent of total billed charges,,
Uroplasty With Macroplastique,,25012203,LOCAL,Facility,Outpatient,,,,1224,1040.4,350.7984,1224,Medica,Medica Advantage Solution,609.552,49.8,,percent of total billed charges,,
Uroplasty With Macroplastique,,25012203,LOCAL,Facility,Inpatient,,,,1224,1040.4,350.7984,1224,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Uroplasty With Macroplastique,,25012203,LOCAL,Facility,Outpatient,,,,1224,1040.4,350.7984,1224,Medica,Medical Assistance,545.904,44.6,,percent of total billed charges,,
Uroplasty With Macroplastique,,25012203,LOCAL,Facility,Inpatient,,,,1224,1040.4,350.7984,1224,Medica,Medical Assistance,,,,,Included in per diem rate,
Uroplasty With Macroplastique,,25012203,LOCAL,Facility,Outpatient,,,,1224,1040.4,350.7984,1224,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,609.552,49.8,,percent of total billed charges,,
Uroplasty With Macroplastique,,25012203,LOCAL,Facility,Inpatient,,,,1224,1040.4,350.7984,1224,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Uroplasty With Macroplastique,,25012203,LOCAL,Facility,Both,,,,1224,1040.4,350.7984,1224,"Multiplan, Inc.","Multiplan, Inc.",1150.56,94,,percent of total billed charges,,
Uroplasty With Macroplastique,,25012203,LOCAL,Facility,Outpatient,,,,1224,1040.4,350.7984,1224,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1102.824,90.1,,percent of total billed charges,,
Uroplasty With Macroplastique,,25012203,LOCAL,Facility,Inpatient,,,,1224,1040.4,350.7984,1224,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Uroplasty With Macroplastique,,25012203,LOCAL,Facility,Both,,,,1224,1040.4,350.7984,1224,"Preferred One Administrative Services, INC.",PPO,1206.864,98.6,,percent of total billed charges,,
Uroplasty With Macroplastique,,25012203,LOCAL,Facility,Outpatient,,,,1224,1040.4,350.7984,1224,PrimeWest Health,Minnesota Senior Health Options (MSHO),629.748,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Uroplasty With Macroplastique,,25012203,LOCAL,Facility,Inpatient,,,,1224,1040.4,350.7984,1224,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Uroplasty With Macroplastique,,25012203,LOCAL,Facility,Outpatient,,,,1224,1040.4,350.7984,1224,PrimeWest Health,MinnesotaCare,628.6464,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Uroplasty With Macroplastique,,25012203,LOCAL,Facility,Inpatient,,,,1224,1040.4,350.7984,1224,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Uroplasty With Macroplastique,,25012203,LOCAL,Facility,Both,,,,1224,1040.4,350.7984,1224,Sanford Health Plan,Sanford Health Plan,1126.08,92,,percent of total billed charges,,
Uroplasty With Macroplastique,,25012203,LOCAL,Facility,Outpatient,,,,1224,1040.4,350.7984,1224,"UCare Health, Inc.",Individual & Family Plan,689.724,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Uroplasty With Macroplastique,,25012203,LOCAL,Facility,Inpatient,,,,1224,1040.4,350.7984,1224,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Uroplasty With Macroplastique,,25012203,LOCAL,Facility,Outpatient,,,,1224,1040.4,350.7984,1224,"UCare Health, Inc.",Medical Assistance,617.7528,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Uroplasty With Macroplastique,,25012203,LOCAL,Facility,Inpatient,,,,1224,1040.4,350.7984,1224,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Uroplasty With Macroplastique,,25012203,LOCAL,Facility,Outpatient,,,,1224,1040.4,350.7984,1224,"UCare Health, Inc.",Medicare Advantage,617.7528,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Uroplasty With Macroplastique,,25012203,LOCAL,Facility,Inpatient,,,,1224,1040.4,350.7984,1224,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Uroplasty With Macroplastique,,25012203,LOCAL,Facility,Outpatient,,,,1224,1040.4,350.7984,1224,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),617.7528,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Uroplasty With Macroplastique,,25012203,LOCAL,Facility,Inpatient,,,,1224,1040.4,350.7984,1224,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Uroplasty With Macroplastique,,25012203,LOCAL,Facility,Both,,,,1224,1040.4,350.7984,1224,UnitedHealthcare,Individual & Family,1150.56,94,,percent of total billed charges,,
Uroplasty With Macroplastique,,25012203,LOCAL,Facility,Outpatient,,,,1224,1040.4,350.7984,1224,UnitedHealthcare,Medicare Advantage,599.76,49,,percent of total billed charges,,
Uroplasty With Macroplastique,,25012203,LOCAL,Facility,Inpatient,,,,1224,1040.4,350.7984,1224,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Uroplasty With Macroplastique,,25012203,LOCAL,Facility,Outpatient,,,,1224,1040.4,350.7984,1224,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,587.52,48,,percent of total billed charges,,100% of DHS outpatient percentage
Uroplasty With Macroplastique,,25012203,LOCAL,Facility,Inpatient,,,,1224,1040.4,350.7984,1224,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Jones Procedure,,25012559,LOCAL,Facility,Both,,,,1326,1127.1,380.0316,1326,Aetna,Commercial,1219.92,92,,percent of total billed charges,,
Jones Procedure,,25012559,LOCAL,Facility,Outpatient,,,,1326,1127.1,380.0316,1326,Aetna,Medicare Advantage,649.74,49,,percent of total billed charges,,
Jones Procedure,,25012559,LOCAL,Facility,Inpatient,,,,1326,1127.1,380.0316,1326,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Jones Procedure,,25012559,LOCAL,Facility,Both,,,,1326,1127.1,380.0316,1326,Aetna,PPO,1233.18,93,,percent of total billed charges,,
Jones Procedure,,25012559,LOCAL,Facility,Both,,,,1326,1127.1,380.0316,1326,America's PPO,America's PPO,1273.3578,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Jones Procedure,,25012559,LOCAL,Facility,Both,,,,1326,1127.1,380.0316,1326,BlueCross BlueShield Minnesota, Federal Employee Program,1304.784,98.4,,percent of total billed charges,,
Jones Procedure,,25012559,LOCAL,Facility,Both,,,,1326,1127.1,380.0316,1326,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1326,100,,percent of total billed charges,,
Jones Procedure,,25012559,LOCAL,Facility,Both,,,,1326,1127.1,380.0316,1326,BlueCross BlueShield Minnesota,High Value Network Plan,1193.4,90,,percent of total billed charges,,
Jones Procedure,,25012559,LOCAL,Facility,Outpatient,,,,1326,1127.1,380.0316,1326,BlueCross BlueShield Minnesota,Medicare Advantage,649.74,49,,percent of total billed charges,,
Jones Procedure,,25012559,LOCAL,Facility,Inpatient,,,,1326,1127.1,380.0316,1326,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Jones Procedure,,25012559,LOCAL,Facility,Both,,,,1326,1127.1,380.0316,1326,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1174.4382,88.57,,percent of total billed charges,,
Jones Procedure,,25012559,LOCAL,Facility,Both,,,,1326,1127.1,380.0316,1326,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,380.0316,28.66,,percent of total billed charges,,
Jones Procedure,,25012559,LOCAL,Facility,Outpatient,,,,1326,1127.1,380.0316,1326,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),649.74,49,,percent of total billed charges,,
Jones Procedure,,25012559,LOCAL,Facility,Inpatient,,,,1326,1127.1,380.0316,1326,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Jones Procedure,,25012559,LOCAL,Facility,Both,,,,1326,1127.1,380.0316,1326,CorVel,Worker's Compensation,1326,100,,percent of total billed charges,,
Jones Procedure,,25012559,LOCAL,Facility,Both,,,,1326,1127.1,380.0316,1326,First Health Group Corporation,First Health Network,1286.22,97,,percent of total billed charges,,
Jones Procedure,,25012559,LOCAL,Facility,Both,,,,1326,1127.1,380.0316,1326,"Health Partners, Inc.",Commercial,1254.396,94.6,,percent of total billed charges,,
Jones Procedure,,25012559,LOCAL,Facility,Outpatient,,,,1326,1127.1,380.0316,1326,"Health Partners, Inc.",Medicare Advantage,649.74,49,,percent of total billed charges,,
Jones Procedure,,25012559,LOCAL,Facility,Inpatient,,,,1326,1127.1,380.0316,1326,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Jones Procedure,,25012559,LOCAL,Facility,Both,,,,1326,1127.1,380.0316,1326,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),795.6,60,,percent of total billed charges,,
Jones Procedure,,25012559,LOCAL,Facility,Both,,,,1326,1127.1,380.0316,1326,"Health Partners, Inc.",State of Minnesota Advantage Program,1080.69,81.5,,percent of total billed charges,,
Jones Procedure,,25012559,LOCAL,Facility,Both,,,,1326,1127.1,380.0316,1326,"Health Partners, Inc.",State Public Programs,663,50,,percent of total billed charges,,
Jones Procedure,,25012559,LOCAL,Facility,Both,,,,1326,1127.1,380.0316,1326,Humana Insurance Company,Commercial PPO,1259.7,95,,percent of total billed charges,,
Jones Procedure,,25012559,LOCAL,Facility,Outpatient,,,,1326,1127.1,380.0316,1326,Humana Insurance Company,Medicare PPO,649.74,49,,percent of total billed charges,,
Jones Procedure,,25012559,LOCAL,Facility,Inpatient,,,,1326,1127.1,380.0316,1326,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Jones Procedure,,25012559,LOCAL,Facility,Both,,,,1326,1127.1,380.0316,1326,Medica,Individual & Family,1314.066,99.1,,percent of total billed charges,,
Jones Procedure,,25012559,LOCAL,Facility,Outpatient,,,,1326,1127.1,380.0316,1326,Medica,Medica Advantage Solution,660.348,49.8,,percent of total billed charges,,
Jones Procedure,,25012559,LOCAL,Facility,Inpatient,,,,1326,1127.1,380.0316,1326,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Jones Procedure,,25012559,LOCAL,Facility,Outpatient,,,,1326,1127.1,380.0316,1326,Medica,Medical Assistance,591.396,44.6,,percent of total billed charges,,
Jones Procedure,,25012559,LOCAL,Facility,Inpatient,,,,1326,1127.1,380.0316,1326,Medica,Medical Assistance,,,,,Included in per diem rate,
Jones Procedure,,25012559,LOCAL,Facility,Outpatient,,,,1326,1127.1,380.0316,1326,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,660.348,49.8,,percent of total billed charges,,
Jones Procedure,,25012559,LOCAL,Facility,Inpatient,,,,1326,1127.1,380.0316,1326,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Jones Procedure,,25012559,LOCAL,Facility,Both,,,,1326,1127.1,380.0316,1326,"Multiplan, Inc.","Multiplan, Inc.",1246.44,94,,percent of total billed charges,,
Jones Procedure,,25012559,LOCAL,Facility,Outpatient,,,,1326,1127.1,380.0316,1326,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1194.726,90.1,,percent of total billed charges,,
Jones Procedure,,25012559,LOCAL,Facility,Inpatient,,,,1326,1127.1,380.0316,1326,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Jones Procedure,,25012559,LOCAL,Facility,Both,,,,1326,1127.1,380.0316,1326,"Preferred One Administrative Services, INC.",PPO,1307.436,98.6,,percent of total billed charges,,
Jones Procedure,,25012559,LOCAL,Facility,Outpatient,,,,1326,1127.1,380.0316,1326,PrimeWest Health,Minnesota Senior Health Options (MSHO),682.227,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Jones Procedure,,25012559,LOCAL,Facility,Inpatient,,,,1326,1127.1,380.0316,1326,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Jones Procedure,,25012559,LOCAL,Facility,Outpatient,,,,1326,1127.1,380.0316,1326,PrimeWest Health,MinnesotaCare,681.0336,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Jones Procedure,,25012559,LOCAL,Facility,Inpatient,,,,1326,1127.1,380.0316,1326,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Jones Procedure,,25012559,LOCAL,Facility,Both,,,,1326,1127.1,380.0316,1326,Sanford Health Plan,Sanford Health Plan,1219.92,92,,percent of total billed charges,,
Jones Procedure,,25012559,LOCAL,Facility,Outpatient,,,,1326,1127.1,380.0316,1326,"UCare Health, Inc.",Individual & Family Plan,747.201,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Jones Procedure,,25012559,LOCAL,Facility,Inpatient,,,,1326,1127.1,380.0316,1326,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Jones Procedure,,25012559,LOCAL,Facility,Outpatient,,,,1326,1127.1,380.0316,1326,"UCare Health, Inc.",Medical Assistance,669.2322,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Jones Procedure,,25012559,LOCAL,Facility,Inpatient,,,,1326,1127.1,380.0316,1326,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Jones Procedure,,25012559,LOCAL,Facility,Outpatient,,,,1326,1127.1,380.0316,1326,"UCare Health, Inc.",Medicare Advantage,669.2322,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Jones Procedure,,25012559,LOCAL,Facility,Inpatient,,,,1326,1127.1,380.0316,1326,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Jones Procedure,,25012559,LOCAL,Facility,Outpatient,,,,1326,1127.1,380.0316,1326,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),669.2322,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Jones Procedure,,25012559,LOCAL,Facility,Inpatient,,,,1326,1127.1,380.0316,1326,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Jones Procedure,,25012559,LOCAL,Facility,Both,,,,1326,1127.1,380.0316,1326,UnitedHealthcare,Individual & Family,1246.44,94,,percent of total billed charges,,
Jones Procedure,,25012559,LOCAL,Facility,Outpatient,,,,1326,1127.1,380.0316,1326,UnitedHealthcare,Medicare Advantage,649.74,49,,percent of total billed charges,,
Jones Procedure,,25012559,LOCAL,Facility,Inpatient,,,,1326,1127.1,380.0316,1326,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Jones Procedure,,25012559,LOCAL,Facility,Outpatient,,,,1326,1127.1,380.0316,1326,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,636.48,48,,percent of total billed charges,,100% of DHS outpatient percentage
Jones Procedure,,25012559,LOCAL,Facility,Inpatient,,,,1326,1127.1,380.0316,1326,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Excision, Prepatellar Bursa",,25012603,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,Aetna,Commercial,2064.48,92,,percent of total billed charges,,
"Excision, Prepatellar Bursa",,25012603,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,Aetna,Medicare Advantage,1099.56,49,,percent of total billed charges,,
"Excision, Prepatellar Bursa",,25012603,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Excision, Prepatellar Bursa",,25012603,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,Aetna,PPO,2086.92,93,,percent of total billed charges,,
"Excision, Prepatellar Bursa",,25012603,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,America's PPO,America's PPO,2154.9132,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Excision, Prepatellar Bursa",,25012603,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,BlueCross BlueShield Minnesota, Federal Employee Program,2208.096,98.4,,percent of total billed charges,,
"Excision, Prepatellar Bursa",,25012603,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,2244,100,,percent of total billed charges,,
"Excision, Prepatellar Bursa",,25012603,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,BlueCross BlueShield Minnesota,High Value Network Plan,2019.6,90,,percent of total billed charges,,
"Excision, Prepatellar Bursa",,25012603,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,BlueCross BlueShield Minnesota,Medicare Advantage,1099.56,49,,percent of total billed charges,,
"Excision, Prepatellar Bursa",,25012603,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Excision, Prepatellar Bursa",,25012603,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1987.5108,88.57,,percent of total billed charges,,
"Excision, Prepatellar Bursa",,25012603,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,643.1304,28.66,,percent of total billed charges,,
"Excision, Prepatellar Bursa",,25012603,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1099.56,49,,percent of total billed charges,,
"Excision, Prepatellar Bursa",,25012603,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Excision, Prepatellar Bursa",,25012603,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,CorVel,Worker's Compensation,2244,100,,percent of total billed charges,,
"Excision, Prepatellar Bursa",,25012603,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,First Health Group Corporation,First Health Network,2176.68,97,,percent of total billed charges,,
"Excision, Prepatellar Bursa",,25012603,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,"Health Partners, Inc.",Commercial,2122.824,94.6,,percent of total billed charges,,
"Excision, Prepatellar Bursa",,25012603,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,"Health Partners, Inc.",Medicare Advantage,1099.56,49,,percent of total billed charges,,
"Excision, Prepatellar Bursa",,25012603,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Excision, Prepatellar Bursa",,25012603,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1346.4,60,,percent of total billed charges,,
"Excision, Prepatellar Bursa",,25012603,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,"Health Partners, Inc.",State of Minnesota Advantage Program,1828.86,81.5,,percent of total billed charges,,
"Excision, Prepatellar Bursa",,25012603,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,"Health Partners, Inc.",State Public Programs,1122,50,,percent of total billed charges,,
"Excision, Prepatellar Bursa",,25012603,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,Humana Insurance Company,Commercial PPO,2131.8,95,,percent of total billed charges,,
"Excision, Prepatellar Bursa",,25012603,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,Humana Insurance Company,Medicare PPO,1099.56,49,,percent of total billed charges,,
"Excision, Prepatellar Bursa",,25012603,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Excision, Prepatellar Bursa",,25012603,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,Medica,Individual & Family,2223.804,99.1,,percent of total billed charges,,
"Excision, Prepatellar Bursa",,25012603,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,Medica,Medica Advantage Solution,1117.512,49.8,,percent of total billed charges,,
"Excision, Prepatellar Bursa",,25012603,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Excision, Prepatellar Bursa",,25012603,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,Medica,Medical Assistance,1000.824,44.6,,percent of total billed charges,,
"Excision, Prepatellar Bursa",,25012603,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,Medica,Medical Assistance,,,,,Included in per diem rate,
"Excision, Prepatellar Bursa",,25012603,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1117.512,49.8,,percent of total billed charges,,
"Excision, Prepatellar Bursa",,25012603,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Excision, Prepatellar Bursa",,25012603,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,"Multiplan, Inc.","Multiplan, Inc.",2109.36,94,,percent of total billed charges,,
"Excision, Prepatellar Bursa",,25012603,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,2021.844,90.1,,percent of total billed charges,,
"Excision, Prepatellar Bursa",,25012603,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Excision, Prepatellar Bursa",,25012603,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,"Preferred One Administrative Services, INC.",PPO,2212.584,98.6,,percent of total billed charges,,
"Excision, Prepatellar Bursa",,25012603,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,PrimeWest Health,Minnesota Senior Health Options (MSHO),1154.538,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Excision, Prepatellar Bursa",,25012603,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Excision, Prepatellar Bursa",,25012603,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,PrimeWest Health,MinnesotaCare,1152.5184,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Excision, Prepatellar Bursa",,25012603,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Excision, Prepatellar Bursa",,25012603,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,Sanford Health Plan,Sanford Health Plan,2064.48,92,,percent of total billed charges,,
"Excision, Prepatellar Bursa",,25012603,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,"UCare Health, Inc.",Individual & Family Plan,1264.494,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Excision, Prepatellar Bursa",,25012603,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Excision, Prepatellar Bursa",,25012603,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,"UCare Health, Inc.",Medical Assistance,1132.5468,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Excision, Prepatellar Bursa",,25012603,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Excision, Prepatellar Bursa",,25012603,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,"UCare Health, Inc.",Medicare Advantage,1132.5468,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Excision, Prepatellar Bursa",,25012603,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Excision, Prepatellar Bursa",,25012603,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1132.5468,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Excision, Prepatellar Bursa",,25012603,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Excision, Prepatellar Bursa",,25012603,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,UnitedHealthcare,Individual & Family,2109.36,94,,percent of total billed charges,,
"Excision, Prepatellar Bursa",,25012603,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,UnitedHealthcare,Medicare Advantage,1099.56,49,,percent of total billed charges,,
"Excision, Prepatellar Bursa",,25012603,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Excision, Prepatellar Bursa",,25012603,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1077.12,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Excision, Prepatellar Bursa",,25012603,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Aspiration Of Hydrocele,,25013858,LOCAL,Facility,Both,,,,1530,1300.5,438.498,1530,Aetna,Commercial,1407.6,92,,percent of total billed charges,,
Aspiration Of Hydrocele,,25013858,LOCAL,Facility,Outpatient,,,,1530,1300.5,438.498,1530,Aetna,Medicare Advantage,749.7,49,,percent of total billed charges,,
Aspiration Of Hydrocele,,25013858,LOCAL,Facility,Inpatient,,,,1530,1300.5,438.498,1530,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Aspiration Of Hydrocele,,25013858,LOCAL,Facility,Both,,,,1530,1300.5,438.498,1530,Aetna,PPO,1422.9,93,,percent of total billed charges,,
Aspiration Of Hydrocele,,25013858,LOCAL,Facility,Both,,,,1530,1300.5,438.498,1530,America's PPO,America's PPO,1469.259,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Aspiration Of Hydrocele,,25013858,LOCAL,Facility,Both,,,,1530,1300.5,438.498,1530,BlueCross BlueShield Minnesota, Federal Employee Program,1505.52,98.4,,percent of total billed charges,,
Aspiration Of Hydrocele,,25013858,LOCAL,Facility,Both,,,,1530,1300.5,438.498,1530,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1530,100,,percent of total billed charges,,
Aspiration Of Hydrocele,,25013858,LOCAL,Facility,Both,,,,1530,1300.5,438.498,1530,BlueCross BlueShield Minnesota,High Value Network Plan,1377,90,,percent of total billed charges,,
Aspiration Of Hydrocele,,25013858,LOCAL,Facility,Outpatient,,,,1530,1300.5,438.498,1530,BlueCross BlueShield Minnesota,Medicare Advantage,749.7,49,,percent of total billed charges,,
Aspiration Of Hydrocele,,25013858,LOCAL,Facility,Inpatient,,,,1530,1300.5,438.498,1530,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Aspiration Of Hydrocele,,25013858,LOCAL,Facility,Both,,,,1530,1300.5,438.498,1530,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1355.121,88.57,,percent of total billed charges,,
Aspiration Of Hydrocele,,25013858,LOCAL,Facility,Both,,,,1530,1300.5,438.498,1530,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,438.498,28.66,,percent of total billed charges,,
Aspiration Of Hydrocele,,25013858,LOCAL,Facility,Outpatient,,,,1530,1300.5,438.498,1530,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),749.7,49,,percent of total billed charges,,
Aspiration Of Hydrocele,,25013858,LOCAL,Facility,Inpatient,,,,1530,1300.5,438.498,1530,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Aspiration Of Hydrocele,,25013858,LOCAL,Facility,Both,,,,1530,1300.5,438.498,1530,CorVel,Worker's Compensation,1530,100,,percent of total billed charges,,
Aspiration Of Hydrocele,,25013858,LOCAL,Facility,Both,,,,1530,1300.5,438.498,1530,First Health Group Corporation,First Health Network,1484.1,97,,percent of total billed charges,,
Aspiration Of Hydrocele,,25013858,LOCAL,Facility,Both,,,,1530,1300.5,438.498,1530,"Health Partners, Inc.",Commercial,1447.38,94.6,,percent of total billed charges,,
Aspiration Of Hydrocele,,25013858,LOCAL,Facility,Outpatient,,,,1530,1300.5,438.498,1530,"Health Partners, Inc.",Medicare Advantage,749.7,49,,percent of total billed charges,,
Aspiration Of Hydrocele,,25013858,LOCAL,Facility,Inpatient,,,,1530,1300.5,438.498,1530,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Aspiration Of Hydrocele,,25013858,LOCAL,Facility,Both,,,,1530,1300.5,438.498,1530,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),918,60,,percent of total billed charges,,
Aspiration Of Hydrocele,,25013858,LOCAL,Facility,Both,,,,1530,1300.5,438.498,1530,"Health Partners, Inc.",State of Minnesota Advantage Program,1246.95,81.5,,percent of total billed charges,,
Aspiration Of Hydrocele,,25013858,LOCAL,Facility,Both,,,,1530,1300.5,438.498,1530,"Health Partners, Inc.",State Public Programs,765,50,,percent of total billed charges,,
Aspiration Of Hydrocele,,25013858,LOCAL,Facility,Both,,,,1530,1300.5,438.498,1530,Humana Insurance Company,Commercial PPO,1453.5,95,,percent of total billed charges,,
Aspiration Of Hydrocele,,25013858,LOCAL,Facility,Outpatient,,,,1530,1300.5,438.498,1530,Humana Insurance Company,Medicare PPO,749.7,49,,percent of total billed charges,,
Aspiration Of Hydrocele,,25013858,LOCAL,Facility,Inpatient,,,,1530,1300.5,438.498,1530,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Aspiration Of Hydrocele,,25013858,LOCAL,Facility,Both,,,,1530,1300.5,438.498,1530,Medica,Individual & Family,1516.23,99.1,,percent of total billed charges,,
Aspiration Of Hydrocele,,25013858,LOCAL,Facility,Outpatient,,,,1530,1300.5,438.498,1530,Medica,Medica Advantage Solution,761.94,49.8,,percent of total billed charges,,
Aspiration Of Hydrocele,,25013858,LOCAL,Facility,Inpatient,,,,1530,1300.5,438.498,1530,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Aspiration Of Hydrocele,,25013858,LOCAL,Facility,Outpatient,,,,1530,1300.5,438.498,1530,Medica,Medical Assistance,682.38,44.6,,percent of total billed charges,,
Aspiration Of Hydrocele,,25013858,LOCAL,Facility,Inpatient,,,,1530,1300.5,438.498,1530,Medica,Medical Assistance,,,,,Included in per diem rate,
Aspiration Of Hydrocele,,25013858,LOCAL,Facility,Outpatient,,,,1530,1300.5,438.498,1530,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,761.94,49.8,,percent of total billed charges,,
Aspiration Of Hydrocele,,25013858,LOCAL,Facility,Inpatient,,,,1530,1300.5,438.498,1530,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Aspiration Of Hydrocele,,25013858,LOCAL,Facility,Both,,,,1530,1300.5,438.498,1530,"Multiplan, Inc.","Multiplan, Inc.",1438.2,94,,percent of total billed charges,,
Aspiration Of Hydrocele,,25013858,LOCAL,Facility,Outpatient,,,,1530,1300.5,438.498,1530,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1378.53,90.1,,percent of total billed charges,,
Aspiration Of Hydrocele,,25013858,LOCAL,Facility,Inpatient,,,,1530,1300.5,438.498,1530,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Aspiration Of Hydrocele,,25013858,LOCAL,Facility,Both,,,,1530,1300.5,438.498,1530,"Preferred One Administrative Services, INC.",PPO,1508.58,98.6,,percent of total billed charges,,
Aspiration Of Hydrocele,,25013858,LOCAL,Facility,Outpatient,,,,1530,1300.5,438.498,1530,PrimeWest Health,Minnesota Senior Health Options (MSHO),787.185,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Aspiration Of Hydrocele,,25013858,LOCAL,Facility,Inpatient,,,,1530,1300.5,438.498,1530,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Aspiration Of Hydrocele,,25013858,LOCAL,Facility,Outpatient,,,,1530,1300.5,438.498,1530,PrimeWest Health,MinnesotaCare,785.808,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Aspiration Of Hydrocele,,25013858,LOCAL,Facility,Inpatient,,,,1530,1300.5,438.498,1530,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Aspiration Of Hydrocele,,25013858,LOCAL,Facility,Both,,,,1530,1300.5,438.498,1530,Sanford Health Plan,Sanford Health Plan,1407.6,92,,percent of total billed charges,,
Aspiration Of Hydrocele,,25013858,LOCAL,Facility,Outpatient,,,,1530,1300.5,438.498,1530,"UCare Health, Inc.",Individual & Family Plan,862.155,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Aspiration Of Hydrocele,,25013858,LOCAL,Facility,Inpatient,,,,1530,1300.5,438.498,1530,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Aspiration Of Hydrocele,,25013858,LOCAL,Facility,Outpatient,,,,1530,1300.5,438.498,1530,"UCare Health, Inc.",Medical Assistance,772.191,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Aspiration Of Hydrocele,,25013858,LOCAL,Facility,Inpatient,,,,1530,1300.5,438.498,1530,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Aspiration Of Hydrocele,,25013858,LOCAL,Facility,Outpatient,,,,1530,1300.5,438.498,1530,"UCare Health, Inc.",Medicare Advantage,772.191,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Aspiration Of Hydrocele,,25013858,LOCAL,Facility,Inpatient,,,,1530,1300.5,438.498,1530,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Aspiration Of Hydrocele,,25013858,LOCAL,Facility,Outpatient,,,,1530,1300.5,438.498,1530,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),772.191,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Aspiration Of Hydrocele,,25013858,LOCAL,Facility,Inpatient,,,,1530,1300.5,438.498,1530,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Aspiration Of Hydrocele,,25013858,LOCAL,Facility,Both,,,,1530,1300.5,438.498,1530,UnitedHealthcare,Individual & Family,1438.2,94,,percent of total billed charges,,
Aspiration Of Hydrocele,,25013858,LOCAL,Facility,Outpatient,,,,1530,1300.5,438.498,1530,UnitedHealthcare,Medicare Advantage,749.7,49,,percent of total billed charges,,
Aspiration Of Hydrocele,,25013858,LOCAL,Facility,Inpatient,,,,1530,1300.5,438.498,1530,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Aspiration Of Hydrocele,,25013858,LOCAL,Facility,Outpatient,,,,1530,1300.5,438.498,1530,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,734.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
Aspiration Of Hydrocele,,25013858,LOCAL,Facility,Inpatient,,,,1530,1300.5,438.498,1530,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Hemorrhoidopexy, Stapling",,25014187,LOCAL,Facility,Both,,,,1632,1387.2,467.7312,1632,Aetna,Commercial,1501.44,92,,percent of total billed charges,,
"Hemorrhoidopexy, Stapling",,25014187,LOCAL,Facility,Outpatient,,,,1632,1387.2,467.7312,1632,Aetna,Medicare Advantage,799.68,49,,percent of total billed charges,,
"Hemorrhoidopexy, Stapling",,25014187,LOCAL,Facility,Inpatient,,,,1632,1387.2,467.7312,1632,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Hemorrhoidopexy, Stapling",,25014187,LOCAL,Facility,Both,,,,1632,1387.2,467.7312,1632,Aetna,PPO,1517.76,93,,percent of total billed charges,,
"Hemorrhoidopexy, Stapling",,25014187,LOCAL,Facility,Both,,,,1632,1387.2,467.7312,1632,America's PPO,America's PPO,1567.2096,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Hemorrhoidopexy, Stapling",,25014187,LOCAL,Facility,Both,,,,1632,1387.2,467.7312,1632,BlueCross BlueShield Minnesota, Federal Employee Program,1605.888,98.4,,percent of total billed charges,,
"Hemorrhoidopexy, Stapling",,25014187,LOCAL,Facility,Both,,,,1632,1387.2,467.7312,1632,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1632,100,,percent of total billed charges,,
"Hemorrhoidopexy, Stapling",,25014187,LOCAL,Facility,Both,,,,1632,1387.2,467.7312,1632,BlueCross BlueShield Minnesota,High Value Network Plan,1468.8,90,,percent of total billed charges,,
"Hemorrhoidopexy, Stapling",,25014187,LOCAL,Facility,Outpatient,,,,1632,1387.2,467.7312,1632,BlueCross BlueShield Minnesota,Medicare Advantage,799.68,49,,percent of total billed charges,,
"Hemorrhoidopexy, Stapling",,25014187,LOCAL,Facility,Inpatient,,,,1632,1387.2,467.7312,1632,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Hemorrhoidopexy, Stapling",,25014187,LOCAL,Facility,Both,,,,1632,1387.2,467.7312,1632,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1445.4624,88.57,,percent of total billed charges,,
"Hemorrhoidopexy, Stapling",,25014187,LOCAL,Facility,Both,,,,1632,1387.2,467.7312,1632,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,467.7312,28.66,,percent of total billed charges,,
"Hemorrhoidopexy, Stapling",,25014187,LOCAL,Facility,Outpatient,,,,1632,1387.2,467.7312,1632,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),799.68,49,,percent of total billed charges,,
"Hemorrhoidopexy, Stapling",,25014187,LOCAL,Facility,Inpatient,,,,1632,1387.2,467.7312,1632,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Hemorrhoidopexy, Stapling",,25014187,LOCAL,Facility,Both,,,,1632,1387.2,467.7312,1632,CorVel,Worker's Compensation,1632,100,,percent of total billed charges,,
"Hemorrhoidopexy, Stapling",,25014187,LOCAL,Facility,Both,,,,1632,1387.2,467.7312,1632,First Health Group Corporation,First Health Network,1583.04,97,,percent of total billed charges,,
"Hemorrhoidopexy, Stapling",,25014187,LOCAL,Facility,Both,,,,1632,1387.2,467.7312,1632,"Health Partners, Inc.",Commercial,1543.872,94.6,,percent of total billed charges,,
"Hemorrhoidopexy, Stapling",,25014187,LOCAL,Facility,Outpatient,,,,1632,1387.2,467.7312,1632,"Health Partners, Inc.",Medicare Advantage,799.68,49,,percent of total billed charges,,
"Hemorrhoidopexy, Stapling",,25014187,LOCAL,Facility,Inpatient,,,,1632,1387.2,467.7312,1632,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Hemorrhoidopexy, Stapling",,25014187,LOCAL,Facility,Both,,,,1632,1387.2,467.7312,1632,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),979.2,60,,percent of total billed charges,,
"Hemorrhoidopexy, Stapling",,25014187,LOCAL,Facility,Both,,,,1632,1387.2,467.7312,1632,"Health Partners, Inc.",State of Minnesota Advantage Program,1330.08,81.5,,percent of total billed charges,,
"Hemorrhoidopexy, Stapling",,25014187,LOCAL,Facility,Both,,,,1632,1387.2,467.7312,1632,"Health Partners, Inc.",State Public Programs,816,50,,percent of total billed charges,,
"Hemorrhoidopexy, Stapling",,25014187,LOCAL,Facility,Both,,,,1632,1387.2,467.7312,1632,Humana Insurance Company,Commercial PPO,1550.4,95,,percent of total billed charges,,
"Hemorrhoidopexy, Stapling",,25014187,LOCAL,Facility,Outpatient,,,,1632,1387.2,467.7312,1632,Humana Insurance Company,Medicare PPO,799.68,49,,percent of total billed charges,,
"Hemorrhoidopexy, Stapling",,25014187,LOCAL,Facility,Inpatient,,,,1632,1387.2,467.7312,1632,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Hemorrhoidopexy, Stapling",,25014187,LOCAL,Facility,Both,,,,1632,1387.2,467.7312,1632,Medica,Individual & Family,1617.312,99.1,,percent of total billed charges,,
"Hemorrhoidopexy, Stapling",,25014187,LOCAL,Facility,Outpatient,,,,1632,1387.2,467.7312,1632,Medica,Medica Advantage Solution,812.736,49.8,,percent of total billed charges,,
"Hemorrhoidopexy, Stapling",,25014187,LOCAL,Facility,Inpatient,,,,1632,1387.2,467.7312,1632,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Hemorrhoidopexy, Stapling",,25014187,LOCAL,Facility,Outpatient,,,,1632,1387.2,467.7312,1632,Medica,Medical Assistance,727.872,44.6,,percent of total billed charges,,
"Hemorrhoidopexy, Stapling",,25014187,LOCAL,Facility,Inpatient,,,,1632,1387.2,467.7312,1632,Medica,Medical Assistance,,,,,Included in per diem rate,
"Hemorrhoidopexy, Stapling",,25014187,LOCAL,Facility,Outpatient,,,,1632,1387.2,467.7312,1632,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,812.736,49.8,,percent of total billed charges,,
"Hemorrhoidopexy, Stapling",,25014187,LOCAL,Facility,Inpatient,,,,1632,1387.2,467.7312,1632,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Hemorrhoidopexy, Stapling",,25014187,LOCAL,Facility,Both,,,,1632,1387.2,467.7312,1632,"Multiplan, Inc.","Multiplan, Inc.",1534.08,94,,percent of total billed charges,,
"Hemorrhoidopexy, Stapling",,25014187,LOCAL,Facility,Outpatient,,,,1632,1387.2,467.7312,1632,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1470.432,90.1,,percent of total billed charges,,
"Hemorrhoidopexy, Stapling",,25014187,LOCAL,Facility,Inpatient,,,,1632,1387.2,467.7312,1632,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Hemorrhoidopexy, Stapling",,25014187,LOCAL,Facility,Both,,,,1632,1387.2,467.7312,1632,"Preferred One Administrative Services, INC.",PPO,1609.152,98.6,,percent of total billed charges,,
"Hemorrhoidopexy, Stapling",,25014187,LOCAL,Facility,Outpatient,,,,1632,1387.2,467.7312,1632,PrimeWest Health,Minnesota Senior Health Options (MSHO),839.664,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Hemorrhoidopexy, Stapling",,25014187,LOCAL,Facility,Inpatient,,,,1632,1387.2,467.7312,1632,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Hemorrhoidopexy, Stapling",,25014187,LOCAL,Facility,Outpatient,,,,1632,1387.2,467.7312,1632,PrimeWest Health,MinnesotaCare,838.1952,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Hemorrhoidopexy, Stapling",,25014187,LOCAL,Facility,Inpatient,,,,1632,1387.2,467.7312,1632,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Hemorrhoidopexy, Stapling",,25014187,LOCAL,Facility,Both,,,,1632,1387.2,467.7312,1632,Sanford Health Plan,Sanford Health Plan,1501.44,92,,percent of total billed charges,,
"Hemorrhoidopexy, Stapling",,25014187,LOCAL,Facility,Outpatient,,,,1632,1387.2,467.7312,1632,"UCare Health, Inc.",Individual & Family Plan,919.632,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Hemorrhoidopexy, Stapling",,25014187,LOCAL,Facility,Inpatient,,,,1632,1387.2,467.7312,1632,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Hemorrhoidopexy, Stapling",,25014187,LOCAL,Facility,Outpatient,,,,1632,1387.2,467.7312,1632,"UCare Health, Inc.",Medical Assistance,823.6704,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Hemorrhoidopexy, Stapling",,25014187,LOCAL,Facility,Inpatient,,,,1632,1387.2,467.7312,1632,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Hemorrhoidopexy, Stapling",,25014187,LOCAL,Facility,Outpatient,,,,1632,1387.2,467.7312,1632,"UCare Health, Inc.",Medicare Advantage,823.6704,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Hemorrhoidopexy, Stapling",,25014187,LOCAL,Facility,Inpatient,,,,1632,1387.2,467.7312,1632,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Hemorrhoidopexy, Stapling",,25014187,LOCAL,Facility,Outpatient,,,,1632,1387.2,467.7312,1632,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),823.6704,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Hemorrhoidopexy, Stapling",,25014187,LOCAL,Facility,Inpatient,,,,1632,1387.2,467.7312,1632,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Hemorrhoidopexy, Stapling",,25014187,LOCAL,Facility,Both,,,,1632,1387.2,467.7312,1632,UnitedHealthcare,Individual & Family,1534.08,94,,percent of total billed charges,,
"Hemorrhoidopexy, Stapling",,25014187,LOCAL,Facility,Outpatient,,,,1632,1387.2,467.7312,1632,UnitedHealthcare,Medicare Advantage,799.68,49,,percent of total billed charges,,
"Hemorrhoidopexy, Stapling",,25014187,LOCAL,Facility,Inpatient,,,,1632,1387.2,467.7312,1632,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Hemorrhoidopexy, Stapling",,25014187,LOCAL,Facility,Outpatient,,,,1632,1387.2,467.7312,1632,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,783.36,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Hemorrhoidopexy, Stapling",,25014187,LOCAL,Facility,Inpatient,,,,1632,1387.2,467.7312,1632,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Core Biopsy Breast, One Lesion",,25015547,LOCAL,Facility,Both,,,,1785,1517.25,511.581,1785,Aetna,Commercial,1642.2,92,,percent of total billed charges,,
"Core Biopsy Breast, One Lesion",,25015547,LOCAL,Facility,Outpatient,,,,1785,1517.25,511.581,1785,Aetna,Medicare Advantage,874.65,49,,percent of total billed charges,,
"Core Biopsy Breast, One Lesion",,25015547,LOCAL,Facility,Inpatient,,,,1785,1517.25,511.581,1785,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Core Biopsy Breast, One Lesion",,25015547,LOCAL,Facility,Both,,,,1785,1517.25,511.581,1785,Aetna,PPO,1660.05,93,,percent of total billed charges,,
"Core Biopsy Breast, One Lesion",,25015547,LOCAL,Facility,Both,,,,1785,1517.25,511.581,1785,America's PPO,America's PPO,1714.1355,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Core Biopsy Breast, One Lesion",,25015547,LOCAL,Facility,Both,,,,1785,1517.25,511.581,1785,BlueCross BlueShield Minnesota, Federal Employee Program,1756.44,98.4,,percent of total billed charges,,
"Core Biopsy Breast, One Lesion",,25015547,LOCAL,Facility,Both,,,,1785,1517.25,511.581,1785,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1785,100,,percent of total billed charges,,
"Core Biopsy Breast, One Lesion",,25015547,LOCAL,Facility,Both,,,,1785,1517.25,511.581,1785,BlueCross BlueShield Minnesota,High Value Network Plan,1606.5,90,,percent of total billed charges,,
"Core Biopsy Breast, One Lesion",,25015547,LOCAL,Facility,Outpatient,,,,1785,1517.25,511.581,1785,BlueCross BlueShield Minnesota,Medicare Advantage,874.65,49,,percent of total billed charges,,
"Core Biopsy Breast, One Lesion",,25015547,LOCAL,Facility,Inpatient,,,,1785,1517.25,511.581,1785,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Core Biopsy Breast, One Lesion",,25015547,LOCAL,Facility,Both,,,,1785,1517.25,511.581,1785,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1580.9745,88.57,,percent of total billed charges,,
"Core Biopsy Breast, One Lesion",,25015547,LOCAL,Facility,Both,,,,1785,1517.25,511.581,1785,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,511.581,28.66,,percent of total billed charges,,
"Core Biopsy Breast, One Lesion",,25015547,LOCAL,Facility,Outpatient,,,,1785,1517.25,511.581,1785,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),874.65,49,,percent of total billed charges,,
"Core Biopsy Breast, One Lesion",,25015547,LOCAL,Facility,Inpatient,,,,1785,1517.25,511.581,1785,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Core Biopsy Breast, One Lesion",,25015547,LOCAL,Facility,Both,,,,1785,1517.25,511.581,1785,CorVel,Worker's Compensation,1785,100,,percent of total billed charges,,
"Core Biopsy Breast, One Lesion",,25015547,LOCAL,Facility,Both,,,,1785,1517.25,511.581,1785,First Health Group Corporation,First Health Network,1731.45,97,,percent of total billed charges,,
"Core Biopsy Breast, One Lesion",,25015547,LOCAL,Facility,Both,,,,1785,1517.25,511.581,1785,"Health Partners, Inc.",Commercial,1688.61,94.6,,percent of total billed charges,,
"Core Biopsy Breast, One Lesion",,25015547,LOCAL,Facility,Outpatient,,,,1785,1517.25,511.581,1785,"Health Partners, Inc.",Medicare Advantage,874.65,49,,percent of total billed charges,,
"Core Biopsy Breast, One Lesion",,25015547,LOCAL,Facility,Inpatient,,,,1785,1517.25,511.581,1785,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Core Biopsy Breast, One Lesion",,25015547,LOCAL,Facility,Both,,,,1785,1517.25,511.581,1785,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1071,60,,percent of total billed charges,,
"Core Biopsy Breast, One Lesion",,25015547,LOCAL,Facility,Both,,,,1785,1517.25,511.581,1785,"Health Partners, Inc.",State of Minnesota Advantage Program,1454.775,81.5,,percent of total billed charges,,
"Core Biopsy Breast, One Lesion",,25015547,LOCAL,Facility,Both,,,,1785,1517.25,511.581,1785,"Health Partners, Inc.",State Public Programs,892.5,50,,percent of total billed charges,,
"Core Biopsy Breast, One Lesion",,25015547,LOCAL,Facility,Both,,,,1785,1517.25,511.581,1785,Humana Insurance Company,Commercial PPO,1695.75,95,,percent of total billed charges,,
"Core Biopsy Breast, One Lesion",,25015547,LOCAL,Facility,Outpatient,,,,1785,1517.25,511.581,1785,Humana Insurance Company,Medicare PPO,874.65,49,,percent of total billed charges,,
"Core Biopsy Breast, One Lesion",,25015547,LOCAL,Facility,Inpatient,,,,1785,1517.25,511.581,1785,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Core Biopsy Breast, One Lesion",,25015547,LOCAL,Facility,Both,,,,1785,1517.25,511.581,1785,Medica,Individual & Family,1768.935,99.1,,percent of total billed charges,,
"Core Biopsy Breast, One Lesion",,25015547,LOCAL,Facility,Outpatient,,,,1785,1517.25,511.581,1785,Medica,Medica Advantage Solution,888.93,49.8,,percent of total billed charges,,
"Core Biopsy Breast, One Lesion",,25015547,LOCAL,Facility,Inpatient,,,,1785,1517.25,511.581,1785,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Core Biopsy Breast, One Lesion",,25015547,LOCAL,Facility,Outpatient,,,,1785,1517.25,511.581,1785,Medica,Medical Assistance,796.11,44.6,,percent of total billed charges,,
"Core Biopsy Breast, One Lesion",,25015547,LOCAL,Facility,Inpatient,,,,1785,1517.25,511.581,1785,Medica,Medical Assistance,,,,,Included in per diem rate,
"Core Biopsy Breast, One Lesion",,25015547,LOCAL,Facility,Outpatient,,,,1785,1517.25,511.581,1785,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,888.93,49.8,,percent of total billed charges,,
"Core Biopsy Breast, One Lesion",,25015547,LOCAL,Facility,Inpatient,,,,1785,1517.25,511.581,1785,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Core Biopsy Breast, One Lesion",,25015547,LOCAL,Facility,Both,,,,1785,1517.25,511.581,1785,"Multiplan, Inc.","Multiplan, Inc.",1677.9,94,,percent of total billed charges,,
"Core Biopsy Breast, One Lesion",,25015547,LOCAL,Facility,Outpatient,,,,1785,1517.25,511.581,1785,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1608.285,90.1,,percent of total billed charges,,
"Core Biopsy Breast, One Lesion",,25015547,LOCAL,Facility,Inpatient,,,,1785,1517.25,511.581,1785,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Core Biopsy Breast, One Lesion",,25015547,LOCAL,Facility,Both,,,,1785,1517.25,511.581,1785,"Preferred One Administrative Services, INC.",PPO,1760.01,98.6,,percent of total billed charges,,
"Core Biopsy Breast, One Lesion",,25015547,LOCAL,Facility,Outpatient,,,,1785,1517.25,511.581,1785,PrimeWest Health,Minnesota Senior Health Options (MSHO),918.3825,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Core Biopsy Breast, One Lesion",,25015547,LOCAL,Facility,Inpatient,,,,1785,1517.25,511.581,1785,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Core Biopsy Breast, One Lesion",,25015547,LOCAL,Facility,Outpatient,,,,1785,1517.25,511.581,1785,PrimeWest Health,MinnesotaCare,916.776,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Core Biopsy Breast, One Lesion",,25015547,LOCAL,Facility,Inpatient,,,,1785,1517.25,511.581,1785,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Core Biopsy Breast, One Lesion",,25015547,LOCAL,Facility,Both,,,,1785,1517.25,511.581,1785,Sanford Health Plan,Sanford Health Plan,1642.2,92,,percent of total billed charges,,
"Core Biopsy Breast, One Lesion",,25015547,LOCAL,Facility,Outpatient,,,,1785,1517.25,511.581,1785,"UCare Health, Inc.",Individual & Family Plan,1005.8475,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Core Biopsy Breast, One Lesion",,25015547,LOCAL,Facility,Inpatient,,,,1785,1517.25,511.581,1785,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Core Biopsy Breast, One Lesion",,25015547,LOCAL,Facility,Outpatient,,,,1785,1517.25,511.581,1785,"UCare Health, Inc.",Medical Assistance,900.8895,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Core Biopsy Breast, One Lesion",,25015547,LOCAL,Facility,Inpatient,,,,1785,1517.25,511.581,1785,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Core Biopsy Breast, One Lesion",,25015547,LOCAL,Facility,Outpatient,,,,1785,1517.25,511.581,1785,"UCare Health, Inc.",Medicare Advantage,900.8895,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Core Biopsy Breast, One Lesion",,25015547,LOCAL,Facility,Inpatient,,,,1785,1517.25,511.581,1785,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Core Biopsy Breast, One Lesion",,25015547,LOCAL,Facility,Outpatient,,,,1785,1517.25,511.581,1785,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),900.8895,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Core Biopsy Breast, One Lesion",,25015547,LOCAL,Facility,Inpatient,,,,1785,1517.25,511.581,1785,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Core Biopsy Breast, One Lesion",,25015547,LOCAL,Facility,Both,,,,1785,1517.25,511.581,1785,UnitedHealthcare,Individual & Family,1677.9,94,,percent of total billed charges,,
"Core Biopsy Breast, One Lesion",,25015547,LOCAL,Facility,Outpatient,,,,1785,1517.25,511.581,1785,UnitedHealthcare,Medicare Advantage,874.65,49,,percent of total billed charges,,
"Core Biopsy Breast, One Lesion",,25015547,LOCAL,Facility,Inpatient,,,,1785,1517.25,511.581,1785,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Core Biopsy Breast, One Lesion",,25015547,LOCAL,Facility,Outpatient,,,,1785,1517.25,511.581,1785,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,856.8,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Core Biopsy Breast, One Lesion",,25015547,LOCAL,Facility,Inpatient,,,,1785,1517.25,511.581,1785,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Core Biopsy, Breast, Each Additional Lesion",,25015551,LOCAL,Facility,Both,,,,510,433.5,146.166,510,Aetna,Commercial,469.2,92,,percent of total billed charges,,
"Core Biopsy, Breast, Each Additional Lesion",,25015551,LOCAL,Facility,Outpatient,,,,510,433.5,146.166,510,Aetna,Medicare Advantage,249.9,49,,percent of total billed charges,,
"Core Biopsy, Breast, Each Additional Lesion",,25015551,LOCAL,Facility,Inpatient,,,,510,433.5,146.166,510,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Core Biopsy, Breast, Each Additional Lesion",,25015551,LOCAL,Facility,Both,,,,510,433.5,146.166,510,Aetna,PPO,474.3,93,,percent of total billed charges,,
"Core Biopsy, Breast, Each Additional Lesion",,25015551,LOCAL,Facility,Both,,,,510,433.5,146.166,510,America's PPO,America's PPO,489.753,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Core Biopsy, Breast, Each Additional Lesion",,25015551,LOCAL,Facility,Both,,,,510,433.5,146.166,510,BlueCross BlueShield Minnesota, Federal Employee Program,501.84,98.4,,percent of total billed charges,,
"Core Biopsy, Breast, Each Additional Lesion",,25015551,LOCAL,Facility,Both,,,,510,433.5,146.166,510,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,510,100,,percent of total billed charges,,
"Core Biopsy, Breast, Each Additional Lesion",,25015551,LOCAL,Facility,Both,,,,510,433.5,146.166,510,BlueCross BlueShield Minnesota,High Value Network Plan,459,90,,percent of total billed charges,,
"Core Biopsy, Breast, Each Additional Lesion",,25015551,LOCAL,Facility,Outpatient,,,,510,433.5,146.166,510,BlueCross BlueShield Minnesota,Medicare Advantage,249.9,49,,percent of total billed charges,,
"Core Biopsy, Breast, Each Additional Lesion",,25015551,LOCAL,Facility,Inpatient,,,,510,433.5,146.166,510,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Core Biopsy, Breast, Each Additional Lesion",,25015551,LOCAL,Facility,Both,,,,510,433.5,146.166,510,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,451.707,88.57,,percent of total billed charges,,
"Core Biopsy, Breast, Each Additional Lesion",,25015551,LOCAL,Facility,Both,,,,510,433.5,146.166,510,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,146.166,28.66,,percent of total billed charges,,
"Core Biopsy, Breast, Each Additional Lesion",,25015551,LOCAL,Facility,Outpatient,,,,510,433.5,146.166,510,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),249.9,49,,percent of total billed charges,,
"Core Biopsy, Breast, Each Additional Lesion",,25015551,LOCAL,Facility,Inpatient,,,,510,433.5,146.166,510,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Core Biopsy, Breast, Each Additional Lesion",,25015551,LOCAL,Facility,Both,,,,510,433.5,146.166,510,CorVel,Worker's Compensation,510,100,,percent of total billed charges,,
"Core Biopsy, Breast, Each Additional Lesion",,25015551,LOCAL,Facility,Both,,,,510,433.5,146.166,510,First Health Group Corporation,First Health Network,494.7,97,,percent of total billed charges,,
"Core Biopsy, Breast, Each Additional Lesion",,25015551,LOCAL,Facility,Both,,,,510,433.5,146.166,510,"Health Partners, Inc.",Commercial,482.46,94.6,,percent of total billed charges,,
"Core Biopsy, Breast, Each Additional Lesion",,25015551,LOCAL,Facility,Outpatient,,,,510,433.5,146.166,510,"Health Partners, Inc.",Medicare Advantage,249.9,49,,percent of total billed charges,,
"Core Biopsy, Breast, Each Additional Lesion",,25015551,LOCAL,Facility,Inpatient,,,,510,433.5,146.166,510,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Core Biopsy, Breast, Each Additional Lesion",,25015551,LOCAL,Facility,Both,,,,510,433.5,146.166,510,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),306,60,,percent of total billed charges,,
"Core Biopsy, Breast, Each Additional Lesion",,25015551,LOCAL,Facility,Both,,,,510,433.5,146.166,510,"Health Partners, Inc.",State of Minnesota Advantage Program,415.65,81.5,,percent of total billed charges,,
"Core Biopsy, Breast, Each Additional Lesion",,25015551,LOCAL,Facility,Both,,,,510,433.5,146.166,510,"Health Partners, Inc.",State Public Programs,255,50,,percent of total billed charges,,
"Core Biopsy, Breast, Each Additional Lesion",,25015551,LOCAL,Facility,Both,,,,510,433.5,146.166,510,Humana Insurance Company,Commercial PPO,484.5,95,,percent of total billed charges,,
"Core Biopsy, Breast, Each Additional Lesion",,25015551,LOCAL,Facility,Outpatient,,,,510,433.5,146.166,510,Humana Insurance Company,Medicare PPO,249.9,49,,percent of total billed charges,,
"Core Biopsy, Breast, Each Additional Lesion",,25015551,LOCAL,Facility,Inpatient,,,,510,433.5,146.166,510,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Core Biopsy, Breast, Each Additional Lesion",,25015551,LOCAL,Facility,Both,,,,510,433.5,146.166,510,Medica,Individual & Family,505.41,99.1,,percent of total billed charges,,
"Core Biopsy, Breast, Each Additional Lesion",,25015551,LOCAL,Facility,Outpatient,,,,510,433.5,146.166,510,Medica,Medica Advantage Solution,253.98,49.8,,percent of total billed charges,,
"Core Biopsy, Breast, Each Additional Lesion",,25015551,LOCAL,Facility,Inpatient,,,,510,433.5,146.166,510,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Core Biopsy, Breast, Each Additional Lesion",,25015551,LOCAL,Facility,Outpatient,,,,510,433.5,146.166,510,Medica,Medical Assistance,227.46,44.6,,percent of total billed charges,,
"Core Biopsy, Breast, Each Additional Lesion",,25015551,LOCAL,Facility,Inpatient,,,,510,433.5,146.166,510,Medica,Medical Assistance,,,,,Included in per diem rate,
"Core Biopsy, Breast, Each Additional Lesion",,25015551,LOCAL,Facility,Outpatient,,,,510,433.5,146.166,510,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,253.98,49.8,,percent of total billed charges,,
"Core Biopsy, Breast, Each Additional Lesion",,25015551,LOCAL,Facility,Inpatient,,,,510,433.5,146.166,510,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Core Biopsy, Breast, Each Additional Lesion",,25015551,LOCAL,Facility,Both,,,,510,433.5,146.166,510,"Multiplan, Inc.","Multiplan, Inc.",479.4,94,,percent of total billed charges,,
"Core Biopsy, Breast, Each Additional Lesion",,25015551,LOCAL,Facility,Outpatient,,,,510,433.5,146.166,510,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,459.51,90.1,,percent of total billed charges,,
"Core Biopsy, Breast, Each Additional Lesion",,25015551,LOCAL,Facility,Inpatient,,,,510,433.5,146.166,510,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Core Biopsy, Breast, Each Additional Lesion",,25015551,LOCAL,Facility,Both,,,,510,433.5,146.166,510,"Preferred One Administrative Services, INC.",PPO,502.86,98.6,,percent of total billed charges,,
"Core Biopsy, Breast, Each Additional Lesion",,25015551,LOCAL,Facility,Outpatient,,,,510,433.5,146.166,510,PrimeWest Health,Minnesota Senior Health Options (MSHO),262.395,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Core Biopsy, Breast, Each Additional Lesion",,25015551,LOCAL,Facility,Inpatient,,,,510,433.5,146.166,510,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Core Biopsy, Breast, Each Additional Lesion",,25015551,LOCAL,Facility,Outpatient,,,,510,433.5,146.166,510,PrimeWest Health,MinnesotaCare,261.936,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Core Biopsy, Breast, Each Additional Lesion",,25015551,LOCAL,Facility,Inpatient,,,,510,433.5,146.166,510,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Core Biopsy, Breast, Each Additional Lesion",,25015551,LOCAL,Facility,Both,,,,510,433.5,146.166,510,Sanford Health Plan,Sanford Health Plan,469.2,92,,percent of total billed charges,,
"Core Biopsy, Breast, Each Additional Lesion",,25015551,LOCAL,Facility,Outpatient,,,,510,433.5,146.166,510,"UCare Health, Inc.",Individual & Family Plan,287.385,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Core Biopsy, Breast, Each Additional Lesion",,25015551,LOCAL,Facility,Inpatient,,,,510,433.5,146.166,510,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Core Biopsy, Breast, Each Additional Lesion",,25015551,LOCAL,Facility,Outpatient,,,,510,433.5,146.166,510,"UCare Health, Inc.",Medical Assistance,257.397,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Core Biopsy, Breast, Each Additional Lesion",,25015551,LOCAL,Facility,Inpatient,,,,510,433.5,146.166,510,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Core Biopsy, Breast, Each Additional Lesion",,25015551,LOCAL,Facility,Outpatient,,,,510,433.5,146.166,510,"UCare Health, Inc.",Medicare Advantage,257.397,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Core Biopsy, Breast, Each Additional Lesion",,25015551,LOCAL,Facility,Inpatient,,,,510,433.5,146.166,510,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Core Biopsy, Breast, Each Additional Lesion",,25015551,LOCAL,Facility,Outpatient,,,,510,433.5,146.166,510,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),257.397,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Core Biopsy, Breast, Each Additional Lesion",,25015551,LOCAL,Facility,Inpatient,,,,510,433.5,146.166,510,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Core Biopsy, Breast, Each Additional Lesion",,25015551,LOCAL,Facility,Both,,,,510,433.5,146.166,510,UnitedHealthcare,Individual & Family,479.4,94,,percent of total billed charges,,
"Core Biopsy, Breast, Each Additional Lesion",,25015551,LOCAL,Facility,Outpatient,,,,510,433.5,146.166,510,UnitedHealthcare,Medicare Advantage,249.9,49,,percent of total billed charges,,
"Core Biopsy, Breast, Each Additional Lesion",,25015551,LOCAL,Facility,Inpatient,,,,510,433.5,146.166,510,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Core Biopsy, Breast, Each Additional Lesion",,25015551,LOCAL,Facility,Outpatient,,,,510,433.5,146.166,510,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,244.8,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Core Biopsy, Breast, Each Additional Lesion",,25015551,LOCAL,Facility,Inpatient,,,,510,433.5,146.166,510,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Image Guided Fluid Collection,,25022572,LOCAL,Facility,Both,,,,2550,2167.5,730.83,2550,Aetna,Commercial,2346,92,,percent of total billed charges,,
Image Guided Fluid Collection,,25022572,LOCAL,Facility,Outpatient,,,,2550,2167.5,730.83,2550,Aetna,Medicare Advantage,1249.5,49,,percent of total billed charges,,
Image Guided Fluid Collection,,25022572,LOCAL,Facility,Inpatient,,,,2550,2167.5,730.83,2550,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Image Guided Fluid Collection,,25022572,LOCAL,Facility,Both,,,,2550,2167.5,730.83,2550,Aetna,PPO,2371.5,93,,percent of total billed charges,,
Image Guided Fluid Collection,,25022572,LOCAL,Facility,Both,,,,2550,2167.5,730.83,2550,America's PPO,America's PPO,2448.765,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Image Guided Fluid Collection,,25022572,LOCAL,Facility,Both,,,,2550,2167.5,730.83,2550,BlueCross BlueShield Minnesota, Federal Employee Program,2509.2,98.4,,percent of total billed charges,,
Image Guided Fluid Collection,,25022572,LOCAL,Facility,Both,,,,2550,2167.5,730.83,2550,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,2550,100,,percent of total billed charges,,
Image Guided Fluid Collection,,25022572,LOCAL,Facility,Both,,,,2550,2167.5,730.83,2550,BlueCross BlueShield Minnesota,High Value Network Plan,2295,90,,percent of total billed charges,,
Image Guided Fluid Collection,,25022572,LOCAL,Facility,Outpatient,,,,2550,2167.5,730.83,2550,BlueCross BlueShield Minnesota,Medicare Advantage,1249.5,49,,percent of total billed charges,,
Image Guided Fluid Collection,,25022572,LOCAL,Facility,Inpatient,,,,2550,2167.5,730.83,2550,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Image Guided Fluid Collection,,25022572,LOCAL,Facility,Both,,,,2550,2167.5,730.83,2550,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,2258.535,88.57,,percent of total billed charges,,
Image Guided Fluid Collection,,25022572,LOCAL,Facility,Both,,,,2550,2167.5,730.83,2550,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,730.83,28.66,,percent of total billed charges,,
Image Guided Fluid Collection,,25022572,LOCAL,Facility,Outpatient,,,,2550,2167.5,730.83,2550,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1249.5,49,,percent of total billed charges,,
Image Guided Fluid Collection,,25022572,LOCAL,Facility,Inpatient,,,,2550,2167.5,730.83,2550,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Image Guided Fluid Collection,,25022572,LOCAL,Facility,Both,,,,2550,2167.5,730.83,2550,CorVel,Worker's Compensation,2550,100,,percent of total billed charges,,
Image Guided Fluid Collection,,25022572,LOCAL,Facility,Both,,,,2550,2167.5,730.83,2550,First Health Group Corporation,First Health Network,2473.5,97,,percent of total billed charges,,
Image Guided Fluid Collection,,25022572,LOCAL,Facility,Both,,,,2550,2167.5,730.83,2550,"Health Partners, Inc.",Commercial,2412.3,94.6,,percent of total billed charges,,
Image Guided Fluid Collection,,25022572,LOCAL,Facility,Outpatient,,,,2550,2167.5,730.83,2550,"Health Partners, Inc.",Medicare Advantage,1249.5,49,,percent of total billed charges,,
Image Guided Fluid Collection,,25022572,LOCAL,Facility,Inpatient,,,,2550,2167.5,730.83,2550,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Image Guided Fluid Collection,,25022572,LOCAL,Facility,Both,,,,2550,2167.5,730.83,2550,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1530,60,,percent of total billed charges,,
Image Guided Fluid Collection,,25022572,LOCAL,Facility,Both,,,,2550,2167.5,730.83,2550,"Health Partners, Inc.",State of Minnesota Advantage Program,2078.25,81.5,,percent of total billed charges,,
Image Guided Fluid Collection,,25022572,LOCAL,Facility,Both,,,,2550,2167.5,730.83,2550,"Health Partners, Inc.",State Public Programs,1275,50,,percent of total billed charges,,
Image Guided Fluid Collection,,25022572,LOCAL,Facility,Both,,,,2550,2167.5,730.83,2550,Humana Insurance Company,Commercial PPO,2422.5,95,,percent of total billed charges,,
Image Guided Fluid Collection,,25022572,LOCAL,Facility,Outpatient,,,,2550,2167.5,730.83,2550,Humana Insurance Company,Medicare PPO,1249.5,49,,percent of total billed charges,,
Image Guided Fluid Collection,,25022572,LOCAL,Facility,Inpatient,,,,2550,2167.5,730.83,2550,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Image Guided Fluid Collection,,25022572,LOCAL,Facility,Both,,,,2550,2167.5,730.83,2550,Medica,Individual & Family,2527.05,99.1,,percent of total billed charges,,
Image Guided Fluid Collection,,25022572,LOCAL,Facility,Outpatient,,,,2550,2167.5,730.83,2550,Medica,Medica Advantage Solution,1269.9,49.8,,percent of total billed charges,,
Image Guided Fluid Collection,,25022572,LOCAL,Facility,Inpatient,,,,2550,2167.5,730.83,2550,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Image Guided Fluid Collection,,25022572,LOCAL,Facility,Outpatient,,,,2550,2167.5,730.83,2550,Medica,Medical Assistance,1137.3,44.6,,percent of total billed charges,,
Image Guided Fluid Collection,,25022572,LOCAL,Facility,Inpatient,,,,2550,2167.5,730.83,2550,Medica,Medical Assistance,,,,,Included in per diem rate,
Image Guided Fluid Collection,,25022572,LOCAL,Facility,Outpatient,,,,2550,2167.5,730.83,2550,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1269.9,49.8,,percent of total billed charges,,
Image Guided Fluid Collection,,25022572,LOCAL,Facility,Inpatient,,,,2550,2167.5,730.83,2550,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Image Guided Fluid Collection,,25022572,LOCAL,Facility,Both,,,,2550,2167.5,730.83,2550,"Multiplan, Inc.","Multiplan, Inc.",2397,94,,percent of total billed charges,,
Image Guided Fluid Collection,,25022572,LOCAL,Facility,Outpatient,,,,2550,2167.5,730.83,2550,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,2297.55,90.1,,percent of total billed charges,,
Image Guided Fluid Collection,,25022572,LOCAL,Facility,Inpatient,,,,2550,2167.5,730.83,2550,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Image Guided Fluid Collection,,25022572,LOCAL,Facility,Both,,,,2550,2167.5,730.83,2550,"Preferred One Administrative Services, INC.",PPO,2514.3,98.6,,percent of total billed charges,,
Image Guided Fluid Collection,,25022572,LOCAL,Facility,Outpatient,,,,2550,2167.5,730.83,2550,PrimeWest Health,Minnesota Senior Health Options (MSHO),1311.975,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Image Guided Fluid Collection,,25022572,LOCAL,Facility,Inpatient,,,,2550,2167.5,730.83,2550,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Image Guided Fluid Collection,,25022572,LOCAL,Facility,Outpatient,,,,2550,2167.5,730.83,2550,PrimeWest Health,MinnesotaCare,1309.68,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Image Guided Fluid Collection,,25022572,LOCAL,Facility,Inpatient,,,,2550,2167.5,730.83,2550,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Image Guided Fluid Collection,,25022572,LOCAL,Facility,Both,,,,2550,2167.5,730.83,2550,Sanford Health Plan,Sanford Health Plan,2346,92,,percent of total billed charges,,
Image Guided Fluid Collection,,25022572,LOCAL,Facility,Outpatient,,,,2550,2167.5,730.83,2550,"UCare Health, Inc.",Individual & Family Plan,1436.925,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Image Guided Fluid Collection,,25022572,LOCAL,Facility,Inpatient,,,,2550,2167.5,730.83,2550,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Image Guided Fluid Collection,,25022572,LOCAL,Facility,Outpatient,,,,2550,2167.5,730.83,2550,"UCare Health, Inc.",Medical Assistance,1286.985,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Image Guided Fluid Collection,,25022572,LOCAL,Facility,Inpatient,,,,2550,2167.5,730.83,2550,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Image Guided Fluid Collection,,25022572,LOCAL,Facility,Outpatient,,,,2550,2167.5,730.83,2550,"UCare Health, Inc.",Medicare Advantage,1286.985,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Image Guided Fluid Collection,,25022572,LOCAL,Facility,Inpatient,,,,2550,2167.5,730.83,2550,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Image Guided Fluid Collection,,25022572,LOCAL,Facility,Outpatient,,,,2550,2167.5,730.83,2550,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1286.985,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Image Guided Fluid Collection,,25022572,LOCAL,Facility,Inpatient,,,,2550,2167.5,730.83,2550,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Image Guided Fluid Collection,,25022572,LOCAL,Facility,Both,,,,2550,2167.5,730.83,2550,UnitedHealthcare,Individual & Family,2397,94,,percent of total billed charges,,
Image Guided Fluid Collection,,25022572,LOCAL,Facility,Outpatient,,,,2550,2167.5,730.83,2550,UnitedHealthcare,Medicare Advantage,1249.5,49,,percent of total billed charges,,
Image Guided Fluid Collection,,25022572,LOCAL,Facility,Inpatient,,,,2550,2167.5,730.83,2550,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Image Guided Fluid Collection,,25022572,LOCAL,Facility,Outpatient,,,,2550,2167.5,730.83,2550,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1224,48,,percent of total billed charges,,100% of DHS outpatient percentage
Image Guided Fluid Collection,,25022572,LOCAL,Facility,Inpatient,,,,2550,2167.5,730.83,2550,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Image Guided Fluid Collection Drainage By Catheter,,25022627,LOCAL,Facility,Both,,,,1907,1620.95,546.5462,1907,Aetna,Commercial,1754.44,92,,percent of total billed charges,,
Image Guided Fluid Collection Drainage By Catheter,,25022627,LOCAL,Facility,Outpatient,,,,1907,1620.95,546.5462,1907,Aetna,Medicare Advantage,934.43,49,,percent of total billed charges,,
Image Guided Fluid Collection Drainage By Catheter,,25022627,LOCAL,Facility,Inpatient,,,,1907,1620.95,546.5462,1907,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Image Guided Fluid Collection Drainage By Catheter,,25022627,LOCAL,Facility,Both,,,,1907,1620.95,546.5462,1907,Aetna,PPO,1773.51,93,,percent of total billed charges,,
Image Guided Fluid Collection Drainage By Catheter,,25022627,LOCAL,Facility,Both,,,,1907,1620.95,546.5462,1907,America's PPO,America's PPO,1831.2921,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Image Guided Fluid Collection Drainage By Catheter,,25022627,LOCAL,Facility,Both,,,,1907,1620.95,546.5462,1907,BlueCross BlueShield Minnesota, Federal Employee Program,1876.488,98.4,,percent of total billed charges,,
Image Guided Fluid Collection Drainage By Catheter,,25022627,LOCAL,Facility,Both,,,,1907,1620.95,546.5462,1907,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1907,100,,percent of total billed charges,,
Image Guided Fluid Collection Drainage By Catheter,,25022627,LOCAL,Facility,Both,,,,1907,1620.95,546.5462,1907,BlueCross BlueShield Minnesota,High Value Network Plan,1716.3,90,,percent of total billed charges,,
Image Guided Fluid Collection Drainage By Catheter,,25022627,LOCAL,Facility,Outpatient,,,,1907,1620.95,546.5462,1907,BlueCross BlueShield Minnesota,Medicare Advantage,934.43,49,,percent of total billed charges,,
Image Guided Fluid Collection Drainage By Catheter,,25022627,LOCAL,Facility,Inpatient,,,,1907,1620.95,546.5462,1907,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Image Guided Fluid Collection Drainage By Catheter,,25022627,LOCAL,Facility,Both,,,,1907,1620.95,546.5462,1907,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1689.0299,88.57,,percent of total billed charges,,
Image Guided Fluid Collection Drainage By Catheter,,25022627,LOCAL,Facility,Both,,,,1907,1620.95,546.5462,1907,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,546.5462,28.66,,percent of total billed charges,,
Image Guided Fluid Collection Drainage By Catheter,,25022627,LOCAL,Facility,Outpatient,,,,1907,1620.95,546.5462,1907,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),934.43,49,,percent of total billed charges,,
Image Guided Fluid Collection Drainage By Catheter,,25022627,LOCAL,Facility,Inpatient,,,,1907,1620.95,546.5462,1907,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Image Guided Fluid Collection Drainage By Catheter,,25022627,LOCAL,Facility,Both,,,,1907,1620.95,546.5462,1907,CorVel,Worker's Compensation,1907,100,,percent of total billed charges,,
Image Guided Fluid Collection Drainage By Catheter,,25022627,LOCAL,Facility,Both,,,,1907,1620.95,546.5462,1907,First Health Group Corporation,First Health Network,1849.79,97,,percent of total billed charges,,
Image Guided Fluid Collection Drainage By Catheter,,25022627,LOCAL,Facility,Both,,,,1907,1620.95,546.5462,1907,"Health Partners, Inc.",Commercial,1804.022,94.6,,percent of total billed charges,,
Image Guided Fluid Collection Drainage By Catheter,,25022627,LOCAL,Facility,Outpatient,,,,1907,1620.95,546.5462,1907,"Health Partners, Inc.",Medicare Advantage,934.43,49,,percent of total billed charges,,
Image Guided Fluid Collection Drainage By Catheter,,25022627,LOCAL,Facility,Inpatient,,,,1907,1620.95,546.5462,1907,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Image Guided Fluid Collection Drainage By Catheter,,25022627,LOCAL,Facility,Both,,,,1907,1620.95,546.5462,1907,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1144.2,60,,percent of total billed charges,,
Image Guided Fluid Collection Drainage By Catheter,,25022627,LOCAL,Facility,Both,,,,1907,1620.95,546.5462,1907,"Health Partners, Inc.",State of Minnesota Advantage Program,1554.205,81.5,,percent of total billed charges,,
Image Guided Fluid Collection Drainage By Catheter,,25022627,LOCAL,Facility,Both,,,,1907,1620.95,546.5462,1907,"Health Partners, Inc.",State Public Programs,953.5,50,,percent of total billed charges,,
Image Guided Fluid Collection Drainage By Catheter,,25022627,LOCAL,Facility,Both,,,,1907,1620.95,546.5462,1907,Humana Insurance Company,Commercial PPO,1811.65,95,,percent of total billed charges,,
Image Guided Fluid Collection Drainage By Catheter,,25022627,LOCAL,Facility,Outpatient,,,,1907,1620.95,546.5462,1907,Humana Insurance Company,Medicare PPO,934.43,49,,percent of total billed charges,,
Image Guided Fluid Collection Drainage By Catheter,,25022627,LOCAL,Facility,Inpatient,,,,1907,1620.95,546.5462,1907,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Image Guided Fluid Collection Drainage By Catheter,,25022627,LOCAL,Facility,Both,,,,1907,1620.95,546.5462,1907,Medica,Individual & Family,1889.837,99.1,,percent of total billed charges,,
Image Guided Fluid Collection Drainage By Catheter,,25022627,LOCAL,Facility,Outpatient,,,,1907,1620.95,546.5462,1907,Medica,Medica Advantage Solution,949.686,49.8,,percent of total billed charges,,
Image Guided Fluid Collection Drainage By Catheter,,25022627,LOCAL,Facility,Inpatient,,,,1907,1620.95,546.5462,1907,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Image Guided Fluid Collection Drainage By Catheter,,25022627,LOCAL,Facility,Outpatient,,,,1907,1620.95,546.5462,1907,Medica,Medical Assistance,850.522,44.6,,percent of total billed charges,,
Image Guided Fluid Collection Drainage By Catheter,,25022627,LOCAL,Facility,Inpatient,,,,1907,1620.95,546.5462,1907,Medica,Medical Assistance,,,,,Included in per diem rate,
Image Guided Fluid Collection Drainage By Catheter,,25022627,LOCAL,Facility,Outpatient,,,,1907,1620.95,546.5462,1907,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,949.686,49.8,,percent of total billed charges,,
Image Guided Fluid Collection Drainage By Catheter,,25022627,LOCAL,Facility,Inpatient,,,,1907,1620.95,546.5462,1907,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Image Guided Fluid Collection Drainage By Catheter,,25022627,LOCAL,Facility,Both,,,,1907,1620.95,546.5462,1907,"Multiplan, Inc.","Multiplan, Inc.",1792.58,94,,percent of total billed charges,,
Image Guided Fluid Collection Drainage By Catheter,,25022627,LOCAL,Facility,Outpatient,,,,1907,1620.95,546.5462,1907,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1718.207,90.1,,percent of total billed charges,,
Image Guided Fluid Collection Drainage By Catheter,,25022627,LOCAL,Facility,Inpatient,,,,1907,1620.95,546.5462,1907,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Image Guided Fluid Collection Drainage By Catheter,,25022627,LOCAL,Facility,Both,,,,1907,1620.95,546.5462,1907,"Preferred One Administrative Services, INC.",PPO,1880.302,98.6,,percent of total billed charges,,
Image Guided Fluid Collection Drainage By Catheter,,25022627,LOCAL,Facility,Outpatient,,,,1907,1620.95,546.5462,1907,PrimeWest Health,Minnesota Senior Health Options (MSHO),981.1515,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Image Guided Fluid Collection Drainage By Catheter,,25022627,LOCAL,Facility,Inpatient,,,,1907,1620.95,546.5462,1907,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Image Guided Fluid Collection Drainage By Catheter,,25022627,LOCAL,Facility,Outpatient,,,,1907,1620.95,546.5462,1907,PrimeWest Health,MinnesotaCare,979.4352,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Image Guided Fluid Collection Drainage By Catheter,,25022627,LOCAL,Facility,Inpatient,,,,1907,1620.95,546.5462,1907,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Image Guided Fluid Collection Drainage By Catheter,,25022627,LOCAL,Facility,Both,,,,1907,1620.95,546.5462,1907,Sanford Health Plan,Sanford Health Plan,1754.44,92,,percent of total billed charges,,
Image Guided Fluid Collection Drainage By Catheter,,25022627,LOCAL,Facility,Outpatient,,,,1907,1620.95,546.5462,1907,"UCare Health, Inc.",Individual & Family Plan,1074.5945,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Image Guided Fluid Collection Drainage By Catheter,,25022627,LOCAL,Facility,Inpatient,,,,1907,1620.95,546.5462,1907,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Image Guided Fluid Collection Drainage By Catheter,,25022627,LOCAL,Facility,Outpatient,,,,1907,1620.95,546.5462,1907,"UCare Health, Inc.",Medical Assistance,962.4629,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Image Guided Fluid Collection Drainage By Catheter,,25022627,LOCAL,Facility,Inpatient,,,,1907,1620.95,546.5462,1907,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Image Guided Fluid Collection Drainage By Catheter,,25022627,LOCAL,Facility,Outpatient,,,,1907,1620.95,546.5462,1907,"UCare Health, Inc.",Medicare Advantage,962.4629,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Image Guided Fluid Collection Drainage By Catheter,,25022627,LOCAL,Facility,Inpatient,,,,1907,1620.95,546.5462,1907,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Image Guided Fluid Collection Drainage By Catheter,,25022627,LOCAL,Facility,Outpatient,,,,1907,1620.95,546.5462,1907,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),962.4629,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Image Guided Fluid Collection Drainage By Catheter,,25022627,LOCAL,Facility,Inpatient,,,,1907,1620.95,546.5462,1907,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Image Guided Fluid Collection Drainage By Catheter,,25022627,LOCAL,Facility,Both,,,,1907,1620.95,546.5462,1907,UnitedHealthcare,Individual & Family,1792.58,94,,percent of total billed charges,,
Image Guided Fluid Collection Drainage By Catheter,,25022627,LOCAL,Facility,Outpatient,,,,1907,1620.95,546.5462,1907,UnitedHealthcare,Medicare Advantage,934.43,49,,percent of total billed charges,,
Image Guided Fluid Collection Drainage By Catheter,,25022627,LOCAL,Facility,Inpatient,,,,1907,1620.95,546.5462,1907,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Image Guided Fluid Collection Drainage By Catheter,,25022627,LOCAL,Facility,Outpatient,,,,1907,1620.95,546.5462,1907,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,915.36,48,,percent of total billed charges,,100% of DHS outpatient percentage
Image Guided Fluid Collection Drainage By Catheter,,25022627,LOCAL,Facility,Inpatient,,,,1907,1620.95,546.5462,1907,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Cystoscopy With Basket Stone Extraction,,25023638,LOCAL,Facility,Both,,,,4590,3901.5,1315.494,4590,Aetna,Commercial,4222.8,92,,percent of total billed charges,,
Cystoscopy With Basket Stone Extraction,,25023638,LOCAL,Facility,Outpatient,,,,4590,3901.5,1315.494,4590,Aetna,Medicare Advantage,2249.1,49,,percent of total billed charges,,
Cystoscopy With Basket Stone Extraction,,25023638,LOCAL,Facility,Inpatient,,,,4590,3901.5,1315.494,4590,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Cystoscopy With Basket Stone Extraction,,25023638,LOCAL,Facility,Both,,,,4590,3901.5,1315.494,4590,Aetna,PPO,4268.7,93,,percent of total billed charges,,
Cystoscopy With Basket Stone Extraction,,25023638,LOCAL,Facility,Both,,,,4590,3901.5,1315.494,4590,America's PPO,America's PPO,4407.777,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Cystoscopy With Basket Stone Extraction,,25023638,LOCAL,Facility,Both,,,,4590,3901.5,1315.494,4590,BlueCross BlueShield Minnesota, Federal Employee Program,4516.56,98.4,,percent of total billed charges,,
Cystoscopy With Basket Stone Extraction,,25023638,LOCAL,Facility,Both,,,,4590,3901.5,1315.494,4590,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,4590,100,,percent of total billed charges,,
Cystoscopy With Basket Stone Extraction,,25023638,LOCAL,Facility,Both,,,,4590,3901.5,1315.494,4590,BlueCross BlueShield Minnesota,High Value Network Plan,4131,90,,percent of total billed charges,,
Cystoscopy With Basket Stone Extraction,,25023638,LOCAL,Facility,Outpatient,,,,4590,3901.5,1315.494,4590,BlueCross BlueShield Minnesota,Medicare Advantage,2249.1,49,,percent of total billed charges,,
Cystoscopy With Basket Stone Extraction,,25023638,LOCAL,Facility,Inpatient,,,,4590,3901.5,1315.494,4590,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Cystoscopy With Basket Stone Extraction,,25023638,LOCAL,Facility,Both,,,,4590,3901.5,1315.494,4590,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4065.363,88.57,,percent of total billed charges,,
Cystoscopy With Basket Stone Extraction,,25023638,LOCAL,Facility,Both,,,,4590,3901.5,1315.494,4590,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1315.494,28.66,,percent of total billed charges,,
Cystoscopy With Basket Stone Extraction,,25023638,LOCAL,Facility,Outpatient,,,,4590,3901.5,1315.494,4590,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2249.1,49,,percent of total billed charges,,
Cystoscopy With Basket Stone Extraction,,25023638,LOCAL,Facility,Inpatient,,,,4590,3901.5,1315.494,4590,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Cystoscopy With Basket Stone Extraction,,25023638,LOCAL,Facility,Both,,,,4590,3901.5,1315.494,4590,CorVel,Worker's Compensation,4590,100,,percent of total billed charges,,
Cystoscopy With Basket Stone Extraction,,25023638,LOCAL,Facility,Both,,,,4590,3901.5,1315.494,4590,First Health Group Corporation,First Health Network,4452.3,97,,percent of total billed charges,,
Cystoscopy With Basket Stone Extraction,,25023638,LOCAL,Facility,Both,,,,4590,3901.5,1315.494,4590,"Health Partners, Inc.",Commercial,4342.14,94.6,,percent of total billed charges,,
Cystoscopy With Basket Stone Extraction,,25023638,LOCAL,Facility,Outpatient,,,,4590,3901.5,1315.494,4590,"Health Partners, Inc.",Medicare Advantage,2249.1,49,,percent of total billed charges,,
Cystoscopy With Basket Stone Extraction,,25023638,LOCAL,Facility,Inpatient,,,,4590,3901.5,1315.494,4590,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Cystoscopy With Basket Stone Extraction,,25023638,LOCAL,Facility,Both,,,,4590,3901.5,1315.494,4590,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),2754,60,,percent of total billed charges,,
Cystoscopy With Basket Stone Extraction,,25023638,LOCAL,Facility,Both,,,,4590,3901.5,1315.494,4590,"Health Partners, Inc.",State of Minnesota Advantage Program,3740.85,81.5,,percent of total billed charges,,
Cystoscopy With Basket Stone Extraction,,25023638,LOCAL,Facility,Both,,,,4590,3901.5,1315.494,4590,"Health Partners, Inc.",State Public Programs,2295,50,,percent of total billed charges,,
Cystoscopy With Basket Stone Extraction,,25023638,LOCAL,Facility,Both,,,,4590,3901.5,1315.494,4590,Humana Insurance Company,Commercial PPO,4360.5,95,,percent of total billed charges,,
Cystoscopy With Basket Stone Extraction,,25023638,LOCAL,Facility,Outpatient,,,,4590,3901.5,1315.494,4590,Humana Insurance Company,Medicare PPO,2249.1,49,,percent of total billed charges,,
Cystoscopy With Basket Stone Extraction,,25023638,LOCAL,Facility,Inpatient,,,,4590,3901.5,1315.494,4590,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Cystoscopy With Basket Stone Extraction,,25023638,LOCAL,Facility,Both,,,,4590,3901.5,1315.494,4590,Medica,Individual & Family,4548.69,99.1,,percent of total billed charges,,
Cystoscopy With Basket Stone Extraction,,25023638,LOCAL,Facility,Outpatient,,,,4590,3901.5,1315.494,4590,Medica,Medica Advantage Solution,2285.82,49.8,,percent of total billed charges,,
Cystoscopy With Basket Stone Extraction,,25023638,LOCAL,Facility,Inpatient,,,,4590,3901.5,1315.494,4590,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Cystoscopy With Basket Stone Extraction,,25023638,LOCAL,Facility,Outpatient,,,,4590,3901.5,1315.494,4590,Medica,Medical Assistance,2047.14,44.6,,percent of total billed charges,,
Cystoscopy With Basket Stone Extraction,,25023638,LOCAL,Facility,Inpatient,,,,4590,3901.5,1315.494,4590,Medica,Medical Assistance,,,,,Included in per diem rate,
Cystoscopy With Basket Stone Extraction,,25023638,LOCAL,Facility,Outpatient,,,,4590,3901.5,1315.494,4590,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2285.82,49.8,,percent of total billed charges,,
Cystoscopy With Basket Stone Extraction,,25023638,LOCAL,Facility,Inpatient,,,,4590,3901.5,1315.494,4590,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Cystoscopy With Basket Stone Extraction,,25023638,LOCAL,Facility,Both,,,,4590,3901.5,1315.494,4590,"Multiplan, Inc.","Multiplan, Inc.",4314.6,94,,percent of total billed charges,,
Cystoscopy With Basket Stone Extraction,,25023638,LOCAL,Facility,Outpatient,,,,4590,3901.5,1315.494,4590,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4135.59,90.1,,percent of total billed charges,,
Cystoscopy With Basket Stone Extraction,,25023638,LOCAL,Facility,Inpatient,,,,4590,3901.5,1315.494,4590,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Cystoscopy With Basket Stone Extraction,,25023638,LOCAL,Facility,Both,,,,4590,3901.5,1315.494,4590,"Preferred One Administrative Services, INC.",PPO,4525.74,98.6,,percent of total billed charges,,
Cystoscopy With Basket Stone Extraction,,25023638,LOCAL,Facility,Outpatient,,,,4590,3901.5,1315.494,4590,PrimeWest Health,Minnesota Senior Health Options (MSHO),2361.555,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Cystoscopy With Basket Stone Extraction,,25023638,LOCAL,Facility,Inpatient,,,,4590,3901.5,1315.494,4590,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Cystoscopy With Basket Stone Extraction,,25023638,LOCAL,Facility,Outpatient,,,,4590,3901.5,1315.494,4590,PrimeWest Health,MinnesotaCare,2357.424,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Cystoscopy With Basket Stone Extraction,,25023638,LOCAL,Facility,Inpatient,,,,4590,3901.5,1315.494,4590,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Cystoscopy With Basket Stone Extraction,,25023638,LOCAL,Facility,Both,,,,4590,3901.5,1315.494,4590,Sanford Health Plan,Sanford Health Plan,4222.8,92,,percent of total billed charges,,
Cystoscopy With Basket Stone Extraction,,25023638,LOCAL,Facility,Outpatient,,,,4590,3901.5,1315.494,4590,"UCare Health, Inc.",Individual & Family Plan,2586.465,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Cystoscopy With Basket Stone Extraction,,25023638,LOCAL,Facility,Inpatient,,,,4590,3901.5,1315.494,4590,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Cystoscopy With Basket Stone Extraction,,25023638,LOCAL,Facility,Outpatient,,,,4590,3901.5,1315.494,4590,"UCare Health, Inc.",Medical Assistance,2316.573,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Cystoscopy With Basket Stone Extraction,,25023638,LOCAL,Facility,Inpatient,,,,4590,3901.5,1315.494,4590,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Cystoscopy With Basket Stone Extraction,,25023638,LOCAL,Facility,Outpatient,,,,4590,3901.5,1315.494,4590,"UCare Health, Inc.",Medicare Advantage,2316.573,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Cystoscopy With Basket Stone Extraction,,25023638,LOCAL,Facility,Inpatient,,,,4590,3901.5,1315.494,4590,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Cystoscopy With Basket Stone Extraction,,25023638,LOCAL,Facility,Outpatient,,,,4590,3901.5,1315.494,4590,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2316.573,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Cystoscopy With Basket Stone Extraction,,25023638,LOCAL,Facility,Inpatient,,,,4590,3901.5,1315.494,4590,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Cystoscopy With Basket Stone Extraction,,25023638,LOCAL,Facility,Both,,,,4590,3901.5,1315.494,4590,UnitedHealthcare,Individual & Family,4314.6,94,,percent of total billed charges,,
Cystoscopy With Basket Stone Extraction,,25023638,LOCAL,Facility,Outpatient,,,,4590,3901.5,1315.494,4590,UnitedHealthcare,Medicare Advantage,2249.1,49,,percent of total billed charges,,
Cystoscopy With Basket Stone Extraction,,25023638,LOCAL,Facility,Inpatient,,,,4590,3901.5,1315.494,4590,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Cystoscopy With Basket Stone Extraction,,25023638,LOCAL,Facility,Outpatient,,,,4590,3901.5,1315.494,4590,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2203.2,48,,percent of total billed charges,,100% of DHS outpatient percentage
Cystoscopy With Basket Stone Extraction,,25023638,LOCAL,Facility,Inpatient,,,,4590,3901.5,1315.494,4590,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Regional Anesthesia Charge,,26000004,LOCAL,Facility,Both,,,,663,563.55,190.0158,663,Aetna,Commercial,609.96,92,,percent of total billed charges,,
Regional Anesthesia Charge,,26000004,LOCAL,Facility,Outpatient,,,,663,563.55,190.0158,663,Aetna,Medicare Advantage,324.87,49,,percent of total billed charges,,
Regional Anesthesia Charge,,26000004,LOCAL,Facility,Inpatient,,,,663,563.55,190.0158,663,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Regional Anesthesia Charge,,26000004,LOCAL,Facility,Both,,,,663,563.55,190.0158,663,Aetna,PPO,616.59,93,,percent of total billed charges,,
Regional Anesthesia Charge,,26000004,LOCAL,Facility,Both,,,,663,563.55,190.0158,663,America's PPO,America's PPO,636.6789,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Regional Anesthesia Charge,,26000004,LOCAL,Facility,Both,,,,663,563.55,190.0158,663,BlueCross BlueShield Minnesota, Federal Employee Program,652.392,98.4,,percent of total billed charges,,
Regional Anesthesia Charge,,26000004,LOCAL,Facility,Both,,,,663,563.55,190.0158,663,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,663,100,,percent of total billed charges,,
Regional Anesthesia Charge,,26000004,LOCAL,Facility,Both,,,,663,563.55,190.0158,663,BlueCross BlueShield Minnesota,High Value Network Plan,596.7,90,,percent of total billed charges,,
Regional Anesthesia Charge,,26000004,LOCAL,Facility,Outpatient,,,,663,563.55,190.0158,663,BlueCross BlueShield Minnesota,Medicare Advantage,324.87,49,,percent of total billed charges,,
Regional Anesthesia Charge,,26000004,LOCAL,Facility,Inpatient,,,,663,563.55,190.0158,663,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Regional Anesthesia Charge,,26000004,LOCAL,Facility,Both,,,,663,563.55,190.0158,663,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,587.2191,88.57,,percent of total billed charges,,
Regional Anesthesia Charge,,26000004,LOCAL,Facility,Both,,,,663,563.55,190.0158,663,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,190.0158,28.66,,percent of total billed charges,,
Regional Anesthesia Charge,,26000004,LOCAL,Facility,Outpatient,,,,663,563.55,190.0158,663,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),324.87,49,,percent of total billed charges,,
Regional Anesthesia Charge,,26000004,LOCAL,Facility,Inpatient,,,,663,563.55,190.0158,663,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Regional Anesthesia Charge,,26000004,LOCAL,Facility,Both,,,,663,563.55,190.0158,663,CorVel,Worker's Compensation,663,100,,percent of total billed charges,,
Regional Anesthesia Charge,,26000004,LOCAL,Facility,Both,,,,663,563.55,190.0158,663,First Health Group Corporation,First Health Network,643.11,97,,percent of total billed charges,,
Regional Anesthesia Charge,,26000004,LOCAL,Facility,Both,,,,663,563.55,190.0158,663,"Health Partners, Inc.",Commercial,627.198,94.6,,percent of total billed charges,,
Regional Anesthesia Charge,,26000004,LOCAL,Facility,Outpatient,,,,663,563.55,190.0158,663,"Health Partners, Inc.",Medicare Advantage,324.87,49,,percent of total billed charges,,
Regional Anesthesia Charge,,26000004,LOCAL,Facility,Inpatient,,,,663,563.55,190.0158,663,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Regional Anesthesia Charge,,26000004,LOCAL,Facility,Both,,,,663,563.55,190.0158,663,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),397.8,60,,percent of total billed charges,,
Regional Anesthesia Charge,,26000004,LOCAL,Facility,Both,,,,663,563.55,190.0158,663,"Health Partners, Inc.",State of Minnesota Advantage Program,540.345,81.5,,percent of total billed charges,,
Regional Anesthesia Charge,,26000004,LOCAL,Facility,Both,,,,663,563.55,190.0158,663,"Health Partners, Inc.",State Public Programs,331.5,50,,percent of total billed charges,,
Regional Anesthesia Charge,,26000004,LOCAL,Facility,Both,,,,663,563.55,190.0158,663,Humana Insurance Company,Commercial PPO,629.85,95,,percent of total billed charges,,
Regional Anesthesia Charge,,26000004,LOCAL,Facility,Outpatient,,,,663,563.55,190.0158,663,Humana Insurance Company,Medicare PPO,324.87,49,,percent of total billed charges,,
Regional Anesthesia Charge,,26000004,LOCAL,Facility,Inpatient,,,,663,563.55,190.0158,663,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Regional Anesthesia Charge,,26000004,LOCAL,Facility,Both,,,,663,563.55,190.0158,663,Medica,Individual & Family,657.033,99.1,,percent of total billed charges,,
Regional Anesthesia Charge,,26000004,LOCAL,Facility,Outpatient,,,,663,563.55,190.0158,663,Medica,Medica Advantage Solution,330.174,49.8,,percent of total billed charges,,
Regional Anesthesia Charge,,26000004,LOCAL,Facility,Inpatient,,,,663,563.55,190.0158,663,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Regional Anesthesia Charge,,26000004,LOCAL,Facility,Outpatient,,,,663,563.55,190.0158,663,Medica,Medical Assistance,295.698,44.6,,percent of total billed charges,,
Regional Anesthesia Charge,,26000004,LOCAL,Facility,Inpatient,,,,663,563.55,190.0158,663,Medica,Medical Assistance,,,,,Included in per diem rate,
Regional Anesthesia Charge,,26000004,LOCAL,Facility,Outpatient,,,,663,563.55,190.0158,663,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,330.174,49.8,,percent of total billed charges,,
Regional Anesthesia Charge,,26000004,LOCAL,Facility,Inpatient,,,,663,563.55,190.0158,663,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Regional Anesthesia Charge,,26000004,LOCAL,Facility,Both,,,,663,563.55,190.0158,663,"Multiplan, Inc.","Multiplan, Inc.",623.22,94,,percent of total billed charges,,
Regional Anesthesia Charge,,26000004,LOCAL,Facility,Outpatient,,,,663,563.55,190.0158,663,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,597.363,90.1,,percent of total billed charges,,
Regional Anesthesia Charge,,26000004,LOCAL,Facility,Inpatient,,,,663,563.55,190.0158,663,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Regional Anesthesia Charge,,26000004,LOCAL,Facility,Both,,,,663,563.55,190.0158,663,"Preferred One Administrative Services, INC.",PPO,653.718,98.6,,percent of total billed charges,,
Regional Anesthesia Charge,,26000004,LOCAL,Facility,Outpatient,,,,663,563.55,190.0158,663,PrimeWest Health,Minnesota Senior Health Options (MSHO),341.1135,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Regional Anesthesia Charge,,26000004,LOCAL,Facility,Inpatient,,,,663,563.55,190.0158,663,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Regional Anesthesia Charge,,26000004,LOCAL,Facility,Outpatient,,,,663,563.55,190.0158,663,PrimeWest Health,MinnesotaCare,340.5168,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Regional Anesthesia Charge,,26000004,LOCAL,Facility,Inpatient,,,,663,563.55,190.0158,663,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Regional Anesthesia Charge,,26000004,LOCAL,Facility,Both,,,,663,563.55,190.0158,663,Sanford Health Plan,Sanford Health Plan,609.96,92,,percent of total billed charges,,
Regional Anesthesia Charge,,26000004,LOCAL,Facility,Outpatient,,,,663,563.55,190.0158,663,"UCare Health, Inc.",Individual & Family Plan,373.6005,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Regional Anesthesia Charge,,26000004,LOCAL,Facility,Inpatient,,,,663,563.55,190.0158,663,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Regional Anesthesia Charge,,26000004,LOCAL,Facility,Outpatient,,,,663,563.55,190.0158,663,"UCare Health, Inc.",Medical Assistance,334.6161,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Regional Anesthesia Charge,,26000004,LOCAL,Facility,Inpatient,,,,663,563.55,190.0158,663,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Regional Anesthesia Charge,,26000004,LOCAL,Facility,Outpatient,,,,663,563.55,190.0158,663,"UCare Health, Inc.",Medicare Advantage,334.6161,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Regional Anesthesia Charge,,26000004,LOCAL,Facility,Inpatient,,,,663,563.55,190.0158,663,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Regional Anesthesia Charge,,26000004,LOCAL,Facility,Outpatient,,,,663,563.55,190.0158,663,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),334.6161,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Regional Anesthesia Charge,,26000004,LOCAL,Facility,Inpatient,,,,663,563.55,190.0158,663,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Regional Anesthesia Charge,,26000004,LOCAL,Facility,Both,,,,663,563.55,190.0158,663,UnitedHealthcare,Individual & Family,623.22,94,,percent of total billed charges,,
Regional Anesthesia Charge,,26000004,LOCAL,Facility,Outpatient,,,,663,563.55,190.0158,663,UnitedHealthcare,Medicare Advantage,324.87,49,,percent of total billed charges,,
Regional Anesthesia Charge,,26000004,LOCAL,Facility,Inpatient,,,,663,563.55,190.0158,663,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Regional Anesthesia Charge,,26000004,LOCAL,Facility,Outpatient,,,,663,563.55,190.0158,663,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,318.24,48,,percent of total billed charges,,100% of DHS outpatient percentage
Regional Anesthesia Charge,,26000004,LOCAL,Facility,Inpatient,,,,663,563.55,190.0158,663,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
General Anesthesia Charge,,26000018,LOCAL,Facility,Both,,,,663,563.55,190.0158,663,Aetna,Commercial,609.96,92,,percent of total billed charges,,
General Anesthesia Charge,,26000018,LOCAL,Facility,Outpatient,,,,663,563.55,190.0158,663,Aetna,Medicare Advantage,324.87,49,,percent of total billed charges,,
General Anesthesia Charge,,26000018,LOCAL,Facility,Inpatient,,,,663,563.55,190.0158,663,Aetna,Medicare Advantage,,,,,Included in per diem rate,
General Anesthesia Charge,,26000018,LOCAL,Facility,Both,,,,663,563.55,190.0158,663,Aetna,PPO,616.59,93,,percent of total billed charges,,
General Anesthesia Charge,,26000018,LOCAL,Facility,Both,,,,663,563.55,190.0158,663,America's PPO,America's PPO,636.6789,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
General Anesthesia Charge,,26000018,LOCAL,Facility,Both,,,,663,563.55,190.0158,663,BlueCross BlueShield Minnesota, Federal Employee Program,652.392,98.4,,percent of total billed charges,,
General Anesthesia Charge,,26000018,LOCAL,Facility,Both,,,,663,563.55,190.0158,663,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,663,100,,percent of total billed charges,,
General Anesthesia Charge,,26000018,LOCAL,Facility,Both,,,,663,563.55,190.0158,663,BlueCross BlueShield Minnesota,High Value Network Plan,596.7,90,,percent of total billed charges,,
General Anesthesia Charge,,26000018,LOCAL,Facility,Outpatient,,,,663,563.55,190.0158,663,BlueCross BlueShield Minnesota,Medicare Advantage,324.87,49,,percent of total billed charges,,
General Anesthesia Charge,,26000018,LOCAL,Facility,Inpatient,,,,663,563.55,190.0158,663,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
General Anesthesia Charge,,26000018,LOCAL,Facility,Both,,,,663,563.55,190.0158,663,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,587.2191,88.57,,percent of total billed charges,,
General Anesthesia Charge,,26000018,LOCAL,Facility,Both,,,,663,563.55,190.0158,663,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,190.0158,28.66,,percent of total billed charges,,
General Anesthesia Charge,,26000018,LOCAL,Facility,Outpatient,,,,663,563.55,190.0158,663,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),324.87,49,,percent of total billed charges,,
General Anesthesia Charge,,26000018,LOCAL,Facility,Inpatient,,,,663,563.55,190.0158,663,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
General Anesthesia Charge,,26000018,LOCAL,Facility,Both,,,,663,563.55,190.0158,663,CorVel,Worker's Compensation,663,100,,percent of total billed charges,,
General Anesthesia Charge,,26000018,LOCAL,Facility,Both,,,,663,563.55,190.0158,663,First Health Group Corporation,First Health Network,643.11,97,,percent of total billed charges,,
General Anesthesia Charge,,26000018,LOCAL,Facility,Both,,,,663,563.55,190.0158,663,"Health Partners, Inc.",Commercial,627.198,94.6,,percent of total billed charges,,
General Anesthesia Charge,,26000018,LOCAL,Facility,Outpatient,,,,663,563.55,190.0158,663,"Health Partners, Inc.",Medicare Advantage,324.87,49,,percent of total billed charges,,
General Anesthesia Charge,,26000018,LOCAL,Facility,Inpatient,,,,663,563.55,190.0158,663,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
General Anesthesia Charge,,26000018,LOCAL,Facility,Both,,,,663,563.55,190.0158,663,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),397.8,60,,percent of total billed charges,,
General Anesthesia Charge,,26000018,LOCAL,Facility,Both,,,,663,563.55,190.0158,663,"Health Partners, Inc.",State of Minnesota Advantage Program,540.345,81.5,,percent of total billed charges,,
General Anesthesia Charge,,26000018,LOCAL,Facility,Both,,,,663,563.55,190.0158,663,"Health Partners, Inc.",State Public Programs,331.5,50,,percent of total billed charges,,
General Anesthesia Charge,,26000018,LOCAL,Facility,Both,,,,663,563.55,190.0158,663,Humana Insurance Company,Commercial PPO,629.85,95,,percent of total billed charges,,
General Anesthesia Charge,,26000018,LOCAL,Facility,Outpatient,,,,663,563.55,190.0158,663,Humana Insurance Company,Medicare PPO,324.87,49,,percent of total billed charges,,
General Anesthesia Charge,,26000018,LOCAL,Facility,Inpatient,,,,663,563.55,190.0158,663,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
General Anesthesia Charge,,26000018,LOCAL,Facility,Both,,,,663,563.55,190.0158,663,Medica,Individual & Family,657.033,99.1,,percent of total billed charges,,
General Anesthesia Charge,,26000018,LOCAL,Facility,Outpatient,,,,663,563.55,190.0158,663,Medica,Medica Advantage Solution,330.174,49.8,,percent of total billed charges,,
General Anesthesia Charge,,26000018,LOCAL,Facility,Inpatient,,,,663,563.55,190.0158,663,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
General Anesthesia Charge,,26000018,LOCAL,Facility,Outpatient,,,,663,563.55,190.0158,663,Medica,Medical Assistance,295.698,44.6,,percent of total billed charges,,
General Anesthesia Charge,,26000018,LOCAL,Facility,Inpatient,,,,663,563.55,190.0158,663,Medica,Medical Assistance,,,,,Included in per diem rate,
General Anesthesia Charge,,26000018,LOCAL,Facility,Outpatient,,,,663,563.55,190.0158,663,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,330.174,49.8,,percent of total billed charges,,
General Anesthesia Charge,,26000018,LOCAL,Facility,Inpatient,,,,663,563.55,190.0158,663,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
General Anesthesia Charge,,26000018,LOCAL,Facility,Both,,,,663,563.55,190.0158,663,"Multiplan, Inc.","Multiplan, Inc.",623.22,94,,percent of total billed charges,,
General Anesthesia Charge,,26000018,LOCAL,Facility,Outpatient,,,,663,563.55,190.0158,663,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,597.363,90.1,,percent of total billed charges,,
General Anesthesia Charge,,26000018,LOCAL,Facility,Inpatient,,,,663,563.55,190.0158,663,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
General Anesthesia Charge,,26000018,LOCAL,Facility,Both,,,,663,563.55,190.0158,663,"Preferred One Administrative Services, INC.",PPO,653.718,98.6,,percent of total billed charges,,
General Anesthesia Charge,,26000018,LOCAL,Facility,Outpatient,,,,663,563.55,190.0158,663,PrimeWest Health,Minnesota Senior Health Options (MSHO),341.1135,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
General Anesthesia Charge,,26000018,LOCAL,Facility,Inpatient,,,,663,563.55,190.0158,663,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
General Anesthesia Charge,,26000018,LOCAL,Facility,Outpatient,,,,663,563.55,190.0158,663,PrimeWest Health,MinnesotaCare,340.5168,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
General Anesthesia Charge,,26000018,LOCAL,Facility,Inpatient,,,,663,563.55,190.0158,663,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
General Anesthesia Charge,,26000018,LOCAL,Facility,Both,,,,663,563.55,190.0158,663,Sanford Health Plan,Sanford Health Plan,609.96,92,,percent of total billed charges,,
General Anesthesia Charge,,26000018,LOCAL,Facility,Outpatient,,,,663,563.55,190.0158,663,"UCare Health, Inc.",Individual & Family Plan,373.6005,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
General Anesthesia Charge,,26000018,LOCAL,Facility,Inpatient,,,,663,563.55,190.0158,663,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
General Anesthesia Charge,,26000018,LOCAL,Facility,Outpatient,,,,663,563.55,190.0158,663,"UCare Health, Inc.",Medical Assistance,334.6161,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
General Anesthesia Charge,,26000018,LOCAL,Facility,Inpatient,,,,663,563.55,190.0158,663,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
General Anesthesia Charge,,26000018,LOCAL,Facility,Outpatient,,,,663,563.55,190.0158,663,"UCare Health, Inc.",Medicare Advantage,334.6161,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
General Anesthesia Charge,,26000018,LOCAL,Facility,Inpatient,,,,663,563.55,190.0158,663,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
General Anesthesia Charge,,26000018,LOCAL,Facility,Outpatient,,,,663,563.55,190.0158,663,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),334.6161,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
General Anesthesia Charge,,26000018,LOCAL,Facility,Inpatient,,,,663,563.55,190.0158,663,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
General Anesthesia Charge,,26000018,LOCAL,Facility,Both,,,,663,563.55,190.0158,663,UnitedHealthcare,Individual & Family,623.22,94,,percent of total billed charges,,
General Anesthesia Charge,,26000018,LOCAL,Facility,Outpatient,,,,663,563.55,190.0158,663,UnitedHealthcare,Medicare Advantage,324.87,49,,percent of total billed charges,,
General Anesthesia Charge,,26000018,LOCAL,Facility,Inpatient,,,,663,563.55,190.0158,663,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
General Anesthesia Charge,,26000018,LOCAL,Facility,Outpatient,,,,663,563.55,190.0158,663,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,318.24,48,,percent of total billed charges,,100% of DHS outpatient percentage
General Anesthesia Charge,,26000018,LOCAL,Facility,Inpatient,,,,663,563.55,190.0158,663,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Monitored Anesthesia,,26000060,LOCAL,Facility,Both,,,,663,563.55,190.0158,663,Aetna,Commercial,609.96,92,,percent of total billed charges,,
Monitored Anesthesia,,26000060,LOCAL,Facility,Outpatient,,,,663,563.55,190.0158,663,Aetna,Medicare Advantage,324.87,49,,percent of total billed charges,,
Monitored Anesthesia,,26000060,LOCAL,Facility,Inpatient,,,,663,563.55,190.0158,663,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Monitored Anesthesia,,26000060,LOCAL,Facility,Both,,,,663,563.55,190.0158,663,Aetna,PPO,616.59,93,,percent of total billed charges,,
Monitored Anesthesia,,26000060,LOCAL,Facility,Both,,,,663,563.55,190.0158,663,America's PPO,America's PPO,636.6789,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Monitored Anesthesia,,26000060,LOCAL,Facility,Both,,,,663,563.55,190.0158,663,BlueCross BlueShield Minnesota, Federal Employee Program,652.392,98.4,,percent of total billed charges,,
Monitored Anesthesia,,26000060,LOCAL,Facility,Both,,,,663,563.55,190.0158,663,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,663,100,,percent of total billed charges,,
Monitored Anesthesia,,26000060,LOCAL,Facility,Both,,,,663,563.55,190.0158,663,BlueCross BlueShield Minnesota,High Value Network Plan,596.7,90,,percent of total billed charges,,
Monitored Anesthesia,,26000060,LOCAL,Facility,Outpatient,,,,663,563.55,190.0158,663,BlueCross BlueShield Minnesota,Medicare Advantage,324.87,49,,percent of total billed charges,,
Monitored Anesthesia,,26000060,LOCAL,Facility,Inpatient,,,,663,563.55,190.0158,663,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Monitored Anesthesia,,26000060,LOCAL,Facility,Both,,,,663,563.55,190.0158,663,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,587.2191,88.57,,percent of total billed charges,,
Monitored Anesthesia,,26000060,LOCAL,Facility,Both,,,,663,563.55,190.0158,663,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,190.0158,28.66,,percent of total billed charges,,
Monitored Anesthesia,,26000060,LOCAL,Facility,Outpatient,,,,663,563.55,190.0158,663,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),324.87,49,,percent of total billed charges,,
Monitored Anesthesia,,26000060,LOCAL,Facility,Inpatient,,,,663,563.55,190.0158,663,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Monitored Anesthesia,,26000060,LOCAL,Facility,Both,,,,663,563.55,190.0158,663,CorVel,Worker's Compensation,663,100,,percent of total billed charges,,
Monitored Anesthesia,,26000060,LOCAL,Facility,Both,,,,663,563.55,190.0158,663,First Health Group Corporation,First Health Network,643.11,97,,percent of total billed charges,,
Monitored Anesthesia,,26000060,LOCAL,Facility,Both,,,,663,563.55,190.0158,663,"Health Partners, Inc.",Commercial,627.198,94.6,,percent of total billed charges,,
Monitored Anesthesia,,26000060,LOCAL,Facility,Outpatient,,,,663,563.55,190.0158,663,"Health Partners, Inc.",Medicare Advantage,324.87,49,,percent of total billed charges,,
Monitored Anesthesia,,26000060,LOCAL,Facility,Inpatient,,,,663,563.55,190.0158,663,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Monitored Anesthesia,,26000060,LOCAL,Facility,Both,,,,663,563.55,190.0158,663,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),397.8,60,,percent of total billed charges,,
Monitored Anesthesia,,26000060,LOCAL,Facility,Both,,,,663,563.55,190.0158,663,"Health Partners, Inc.",State of Minnesota Advantage Program,540.345,81.5,,percent of total billed charges,,
Monitored Anesthesia,,26000060,LOCAL,Facility,Both,,,,663,563.55,190.0158,663,"Health Partners, Inc.",State Public Programs,331.5,50,,percent of total billed charges,,
Monitored Anesthesia,,26000060,LOCAL,Facility,Both,,,,663,563.55,190.0158,663,Humana Insurance Company,Commercial PPO,629.85,95,,percent of total billed charges,,
Monitored Anesthesia,,26000060,LOCAL,Facility,Outpatient,,,,663,563.55,190.0158,663,Humana Insurance Company,Medicare PPO,324.87,49,,percent of total billed charges,,
Monitored Anesthesia,,26000060,LOCAL,Facility,Inpatient,,,,663,563.55,190.0158,663,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Monitored Anesthesia,,26000060,LOCAL,Facility,Both,,,,663,563.55,190.0158,663,Medica,Individual & Family,657.033,99.1,,percent of total billed charges,,
Monitored Anesthesia,,26000060,LOCAL,Facility,Outpatient,,,,663,563.55,190.0158,663,Medica,Medica Advantage Solution,330.174,49.8,,percent of total billed charges,,
Monitored Anesthesia,,26000060,LOCAL,Facility,Inpatient,,,,663,563.55,190.0158,663,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Monitored Anesthesia,,26000060,LOCAL,Facility,Outpatient,,,,663,563.55,190.0158,663,Medica,Medical Assistance,295.698,44.6,,percent of total billed charges,,
Monitored Anesthesia,,26000060,LOCAL,Facility,Inpatient,,,,663,563.55,190.0158,663,Medica,Medical Assistance,,,,,Included in per diem rate,
Monitored Anesthesia,,26000060,LOCAL,Facility,Outpatient,,,,663,563.55,190.0158,663,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,330.174,49.8,,percent of total billed charges,,
Monitored Anesthesia,,26000060,LOCAL,Facility,Inpatient,,,,663,563.55,190.0158,663,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Monitored Anesthesia,,26000060,LOCAL,Facility,Both,,,,663,563.55,190.0158,663,"Multiplan, Inc.","Multiplan, Inc.",623.22,94,,percent of total billed charges,,
Monitored Anesthesia,,26000060,LOCAL,Facility,Outpatient,,,,663,563.55,190.0158,663,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,597.363,90.1,,percent of total billed charges,,
Monitored Anesthesia,,26000060,LOCAL,Facility,Inpatient,,,,663,563.55,190.0158,663,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Monitored Anesthesia,,26000060,LOCAL,Facility,Both,,,,663,563.55,190.0158,663,"Preferred One Administrative Services, INC.",PPO,653.718,98.6,,percent of total billed charges,,
Monitored Anesthesia,,26000060,LOCAL,Facility,Outpatient,,,,663,563.55,190.0158,663,PrimeWest Health,Minnesota Senior Health Options (MSHO),341.1135,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Monitored Anesthesia,,26000060,LOCAL,Facility,Inpatient,,,,663,563.55,190.0158,663,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Monitored Anesthesia,,26000060,LOCAL,Facility,Outpatient,,,,663,563.55,190.0158,663,PrimeWest Health,MinnesotaCare,340.5168,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Monitored Anesthesia,,26000060,LOCAL,Facility,Inpatient,,,,663,563.55,190.0158,663,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Monitored Anesthesia,,26000060,LOCAL,Facility,Both,,,,663,563.55,190.0158,663,Sanford Health Plan,Sanford Health Plan,609.96,92,,percent of total billed charges,,
Monitored Anesthesia,,26000060,LOCAL,Facility,Outpatient,,,,663,563.55,190.0158,663,"UCare Health, Inc.",Individual & Family Plan,373.6005,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Monitored Anesthesia,,26000060,LOCAL,Facility,Inpatient,,,,663,563.55,190.0158,663,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Monitored Anesthesia,,26000060,LOCAL,Facility,Outpatient,,,,663,563.55,190.0158,663,"UCare Health, Inc.",Medical Assistance,334.6161,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Monitored Anesthesia,,26000060,LOCAL,Facility,Inpatient,,,,663,563.55,190.0158,663,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Monitored Anesthesia,,26000060,LOCAL,Facility,Outpatient,,,,663,563.55,190.0158,663,"UCare Health, Inc.",Medicare Advantage,334.6161,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Monitored Anesthesia,,26000060,LOCAL,Facility,Inpatient,,,,663,563.55,190.0158,663,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Monitored Anesthesia,,26000060,LOCAL,Facility,Outpatient,,,,663,563.55,190.0158,663,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),334.6161,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Monitored Anesthesia,,26000060,LOCAL,Facility,Inpatient,,,,663,563.55,190.0158,663,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Monitored Anesthesia,,26000060,LOCAL,Facility,Both,,,,663,563.55,190.0158,663,UnitedHealthcare,Individual & Family,623.22,94,,percent of total billed charges,,
Monitored Anesthesia,,26000060,LOCAL,Facility,Outpatient,,,,663,563.55,190.0158,663,UnitedHealthcare,Medicare Advantage,324.87,49,,percent of total billed charges,,
Monitored Anesthesia,,26000060,LOCAL,Facility,Inpatient,,,,663,563.55,190.0158,663,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Monitored Anesthesia,,26000060,LOCAL,Facility,Outpatient,,,,663,563.55,190.0158,663,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,318.24,48,,percent of total billed charges,,100% of DHS outpatient percentage
Monitored Anesthesia,,26000060,LOCAL,Facility,Inpatient,,,,663,563.55,190.0158,663,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Anesthesia Block Procedure,,26000084,LOCAL,Facility,Both,,,,663,563.55,190.0158,663,Aetna,Commercial,609.96,92,,percent of total billed charges,,
Anesthesia Block Procedure,,26000084,LOCAL,Facility,Outpatient,,,,663,563.55,190.0158,663,Aetna,Medicare Advantage,324.87,49,,percent of total billed charges,,
Anesthesia Block Procedure,,26000084,LOCAL,Facility,Inpatient,,,,663,563.55,190.0158,663,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Anesthesia Block Procedure,,26000084,LOCAL,Facility,Both,,,,663,563.55,190.0158,663,Aetna,PPO,616.59,93,,percent of total billed charges,,
Anesthesia Block Procedure,,26000084,LOCAL,Facility,Both,,,,663,563.55,190.0158,663,America's PPO,America's PPO,636.6789,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Anesthesia Block Procedure,,26000084,LOCAL,Facility,Both,,,,663,563.55,190.0158,663,BlueCross BlueShield Minnesota, Federal Employee Program,652.392,98.4,,percent of total billed charges,,
Anesthesia Block Procedure,,26000084,LOCAL,Facility,Both,,,,663,563.55,190.0158,663,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,663,100,,percent of total billed charges,,
Anesthesia Block Procedure,,26000084,LOCAL,Facility,Both,,,,663,563.55,190.0158,663,BlueCross BlueShield Minnesota,High Value Network Plan,596.7,90,,percent of total billed charges,,
Anesthesia Block Procedure,,26000084,LOCAL,Facility,Outpatient,,,,663,563.55,190.0158,663,BlueCross BlueShield Minnesota,Medicare Advantage,324.87,49,,percent of total billed charges,,
Anesthesia Block Procedure,,26000084,LOCAL,Facility,Inpatient,,,,663,563.55,190.0158,663,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Anesthesia Block Procedure,,26000084,LOCAL,Facility,Both,,,,663,563.55,190.0158,663,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,587.2191,88.57,,percent of total billed charges,,
Anesthesia Block Procedure,,26000084,LOCAL,Facility,Both,,,,663,563.55,190.0158,663,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,190.0158,28.66,,percent of total billed charges,,
Anesthesia Block Procedure,,26000084,LOCAL,Facility,Outpatient,,,,663,563.55,190.0158,663,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),324.87,49,,percent of total billed charges,,
Anesthesia Block Procedure,,26000084,LOCAL,Facility,Inpatient,,,,663,563.55,190.0158,663,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Anesthesia Block Procedure,,26000084,LOCAL,Facility,Both,,,,663,563.55,190.0158,663,CorVel,Worker's Compensation,663,100,,percent of total billed charges,,
Anesthesia Block Procedure,,26000084,LOCAL,Facility,Both,,,,663,563.55,190.0158,663,First Health Group Corporation,First Health Network,643.11,97,,percent of total billed charges,,
Anesthesia Block Procedure,,26000084,LOCAL,Facility,Both,,,,663,563.55,190.0158,663,"Health Partners, Inc.",Commercial,627.198,94.6,,percent of total billed charges,,
Anesthesia Block Procedure,,26000084,LOCAL,Facility,Outpatient,,,,663,563.55,190.0158,663,"Health Partners, Inc.",Medicare Advantage,324.87,49,,percent of total billed charges,,
Anesthesia Block Procedure,,26000084,LOCAL,Facility,Inpatient,,,,663,563.55,190.0158,663,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Anesthesia Block Procedure,,26000084,LOCAL,Facility,Both,,,,663,563.55,190.0158,663,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),397.8,60,,percent of total billed charges,,
Anesthesia Block Procedure,,26000084,LOCAL,Facility,Both,,,,663,563.55,190.0158,663,"Health Partners, Inc.",State of Minnesota Advantage Program,540.345,81.5,,percent of total billed charges,,
Anesthesia Block Procedure,,26000084,LOCAL,Facility,Both,,,,663,563.55,190.0158,663,"Health Partners, Inc.",State Public Programs,331.5,50,,percent of total billed charges,,
Anesthesia Block Procedure,,26000084,LOCAL,Facility,Both,,,,663,563.55,190.0158,663,Humana Insurance Company,Commercial PPO,629.85,95,,percent of total billed charges,,
Anesthesia Block Procedure,,26000084,LOCAL,Facility,Outpatient,,,,663,563.55,190.0158,663,Humana Insurance Company,Medicare PPO,324.87,49,,percent of total billed charges,,
Anesthesia Block Procedure,,26000084,LOCAL,Facility,Inpatient,,,,663,563.55,190.0158,663,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Anesthesia Block Procedure,,26000084,LOCAL,Facility,Both,,,,663,563.55,190.0158,663,Medica,Individual & Family,657.033,99.1,,percent of total billed charges,,
Anesthesia Block Procedure,,26000084,LOCAL,Facility,Outpatient,,,,663,563.55,190.0158,663,Medica,Medica Advantage Solution,330.174,49.8,,percent of total billed charges,,
Anesthesia Block Procedure,,26000084,LOCAL,Facility,Inpatient,,,,663,563.55,190.0158,663,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Anesthesia Block Procedure,,26000084,LOCAL,Facility,Outpatient,,,,663,563.55,190.0158,663,Medica,Medical Assistance,295.698,44.6,,percent of total billed charges,,
Anesthesia Block Procedure,,26000084,LOCAL,Facility,Inpatient,,,,663,563.55,190.0158,663,Medica,Medical Assistance,,,,,Included in per diem rate,
Anesthesia Block Procedure,,26000084,LOCAL,Facility,Outpatient,,,,663,563.55,190.0158,663,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,330.174,49.8,,percent of total billed charges,,
Anesthesia Block Procedure,,26000084,LOCAL,Facility,Inpatient,,,,663,563.55,190.0158,663,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Anesthesia Block Procedure,,26000084,LOCAL,Facility,Both,,,,663,563.55,190.0158,663,"Multiplan, Inc.","Multiplan, Inc.",623.22,94,,percent of total billed charges,,
Anesthesia Block Procedure,,26000084,LOCAL,Facility,Outpatient,,,,663,563.55,190.0158,663,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,597.363,90.1,,percent of total billed charges,,
Anesthesia Block Procedure,,26000084,LOCAL,Facility,Inpatient,,,,663,563.55,190.0158,663,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Anesthesia Block Procedure,,26000084,LOCAL,Facility,Both,,,,663,563.55,190.0158,663,"Preferred One Administrative Services, INC.",PPO,653.718,98.6,,percent of total billed charges,,
Anesthesia Block Procedure,,26000084,LOCAL,Facility,Outpatient,,,,663,563.55,190.0158,663,PrimeWest Health,Minnesota Senior Health Options (MSHO),341.1135,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Anesthesia Block Procedure,,26000084,LOCAL,Facility,Inpatient,,,,663,563.55,190.0158,663,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Anesthesia Block Procedure,,26000084,LOCAL,Facility,Outpatient,,,,663,563.55,190.0158,663,PrimeWest Health,MinnesotaCare,340.5168,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Anesthesia Block Procedure,,26000084,LOCAL,Facility,Inpatient,,,,663,563.55,190.0158,663,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Anesthesia Block Procedure,,26000084,LOCAL,Facility,Both,,,,663,563.55,190.0158,663,Sanford Health Plan,Sanford Health Plan,609.96,92,,percent of total billed charges,,
Anesthesia Block Procedure,,26000084,LOCAL,Facility,Outpatient,,,,663,563.55,190.0158,663,"UCare Health, Inc.",Individual & Family Plan,373.6005,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Anesthesia Block Procedure,,26000084,LOCAL,Facility,Inpatient,,,,663,563.55,190.0158,663,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Anesthesia Block Procedure,,26000084,LOCAL,Facility,Outpatient,,,,663,563.55,190.0158,663,"UCare Health, Inc.",Medical Assistance,334.6161,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Anesthesia Block Procedure,,26000084,LOCAL,Facility,Inpatient,,,,663,563.55,190.0158,663,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Anesthesia Block Procedure,,26000084,LOCAL,Facility,Outpatient,,,,663,563.55,190.0158,663,"UCare Health, Inc.",Medicare Advantage,334.6161,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Anesthesia Block Procedure,,26000084,LOCAL,Facility,Inpatient,,,,663,563.55,190.0158,663,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Anesthesia Block Procedure,,26000084,LOCAL,Facility,Outpatient,,,,663,563.55,190.0158,663,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),334.6161,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Anesthesia Block Procedure,,26000084,LOCAL,Facility,Inpatient,,,,663,563.55,190.0158,663,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Anesthesia Block Procedure,,26000084,LOCAL,Facility,Both,,,,663,563.55,190.0158,663,UnitedHealthcare,Individual & Family,623.22,94,,percent of total billed charges,,
Anesthesia Block Procedure,,26000084,LOCAL,Facility,Outpatient,,,,663,563.55,190.0158,663,UnitedHealthcare,Medicare Advantage,324.87,49,,percent of total billed charges,,
Anesthesia Block Procedure,,26000084,LOCAL,Facility,Inpatient,,,,663,563.55,190.0158,663,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Anesthesia Block Procedure,,26000084,LOCAL,Facility,Outpatient,,,,663,563.55,190.0158,663,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,318.24,48,,percent of total billed charges,,100% of DHS outpatient percentage
Anesthesia Block Procedure,,26000084,LOCAL,Facility,Inpatient,,,,663,563.55,190.0158,663,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Circumcision,,35000616,LOCAL,Facility,Both,,,,663,563.55,190.0158,663,Aetna,Commercial,609.96,92,,percent of total billed charges,,
Circumcision,,35000616,LOCAL,Facility,Outpatient,,,,663,563.55,190.0158,663,Aetna,Medicare Advantage,324.87,49,,percent of total billed charges,,
Circumcision,,35000616,LOCAL,Facility,Inpatient,,,,663,563.55,190.0158,663,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Circumcision,,35000616,LOCAL,Facility,Both,,,,663,563.55,190.0158,663,Aetna,PPO,616.59,93,,percent of total billed charges,,
Circumcision,,35000616,LOCAL,Facility,Both,,,,663,563.55,190.0158,663,America's PPO,America's PPO,636.6789,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Circumcision,,35000616,LOCAL,Facility,Both,,,,663,563.55,190.0158,663,BlueCross BlueShield Minnesota, Federal Employee Program,652.392,98.4,,percent of total billed charges,,
Circumcision,,35000616,LOCAL,Facility,Both,,,,663,563.55,190.0158,663,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,663,100,,percent of total billed charges,,
Circumcision,,35000616,LOCAL,Facility,Both,,,,663,563.55,190.0158,663,BlueCross BlueShield Minnesota,High Value Network Plan,596.7,90,,percent of total billed charges,,
Circumcision,,35000616,LOCAL,Facility,Outpatient,,,,663,563.55,190.0158,663,BlueCross BlueShield Minnesota,Medicare Advantage,324.87,49,,percent of total billed charges,,
Circumcision,,35000616,LOCAL,Facility,Inpatient,,,,663,563.55,190.0158,663,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Circumcision,,35000616,LOCAL,Facility,Both,,,,663,563.55,190.0158,663,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,587.2191,88.57,,percent of total billed charges,,
Circumcision,,35000616,LOCAL,Facility,Both,,,,663,563.55,190.0158,663,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,190.0158,28.66,,percent of total billed charges,,
Circumcision,,35000616,LOCAL,Facility,Outpatient,,,,663,563.55,190.0158,663,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),324.87,49,,percent of total billed charges,,
Circumcision,,35000616,LOCAL,Facility,Inpatient,,,,663,563.55,190.0158,663,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Circumcision,,35000616,LOCAL,Facility,Both,,,,663,563.55,190.0158,663,CorVel,Worker's Compensation,663,100,,percent of total billed charges,,
Circumcision,,35000616,LOCAL,Facility,Both,,,,663,563.55,190.0158,663,First Health Group Corporation,First Health Network,643.11,97,,percent of total billed charges,,
Circumcision,,35000616,LOCAL,Facility,Both,,,,663,563.55,190.0158,663,"Health Partners, Inc.",Commercial,627.198,94.6,,percent of total billed charges,,
Circumcision,,35000616,LOCAL,Facility,Outpatient,,,,663,563.55,190.0158,663,"Health Partners, Inc.",Medicare Advantage,324.87,49,,percent of total billed charges,,
Circumcision,,35000616,LOCAL,Facility,Inpatient,,,,663,563.55,190.0158,663,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Circumcision,,35000616,LOCAL,Facility,Both,,,,663,563.55,190.0158,663,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),397.8,60,,percent of total billed charges,,
Circumcision,,35000616,LOCAL,Facility,Both,,,,663,563.55,190.0158,663,"Health Partners, Inc.",State of Minnesota Advantage Program,540.345,81.5,,percent of total billed charges,,
Circumcision,,35000616,LOCAL,Facility,Both,,,,663,563.55,190.0158,663,"Health Partners, Inc.",State Public Programs,331.5,50,,percent of total billed charges,,
Circumcision,,35000616,LOCAL,Facility,Both,,,,663,563.55,190.0158,663,Humana Insurance Company,Commercial PPO,629.85,95,,percent of total billed charges,,
Circumcision,,35000616,LOCAL,Facility,Outpatient,,,,663,563.55,190.0158,663,Humana Insurance Company,Medicare PPO,324.87,49,,percent of total billed charges,,
Circumcision,,35000616,LOCAL,Facility,Inpatient,,,,663,563.55,190.0158,663,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Circumcision,,35000616,LOCAL,Facility,Both,,,,663,563.55,190.0158,663,Medica,Individual & Family,657.033,99.1,,percent of total billed charges,,
Circumcision,,35000616,LOCAL,Facility,Outpatient,,,,663,563.55,190.0158,663,Medica,Medica Advantage Solution,330.174,49.8,,percent of total billed charges,,
Circumcision,,35000616,LOCAL,Facility,Inpatient,,,,663,563.55,190.0158,663,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Circumcision,,35000616,LOCAL,Facility,Outpatient,,,,663,563.55,190.0158,663,Medica,Medical Assistance,295.698,44.6,,percent of total billed charges,,
Circumcision,,35000616,LOCAL,Facility,Inpatient,,,,663,563.55,190.0158,663,Medica,Medical Assistance,,,,,Included in per diem rate,
Circumcision,,35000616,LOCAL,Facility,Outpatient,,,,663,563.55,190.0158,663,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,330.174,49.8,,percent of total billed charges,,
Circumcision,,35000616,LOCAL,Facility,Inpatient,,,,663,563.55,190.0158,663,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Circumcision,,35000616,LOCAL,Facility,Both,,,,663,563.55,190.0158,663,"Multiplan, Inc.","Multiplan, Inc.",623.22,94,,percent of total billed charges,,
Circumcision,,35000616,LOCAL,Facility,Outpatient,,,,663,563.55,190.0158,663,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,597.363,90.1,,percent of total billed charges,,
Circumcision,,35000616,LOCAL,Facility,Inpatient,,,,663,563.55,190.0158,663,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Circumcision,,35000616,LOCAL,Facility,Both,,,,663,563.55,190.0158,663,"Preferred One Administrative Services, INC.",PPO,653.718,98.6,,percent of total billed charges,,
Circumcision,,35000616,LOCAL,Facility,Outpatient,,,,663,563.55,190.0158,663,PrimeWest Health,Minnesota Senior Health Options (MSHO),341.1135,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Circumcision,,35000616,LOCAL,Facility,Inpatient,,,,663,563.55,190.0158,663,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Circumcision,,35000616,LOCAL,Facility,Outpatient,,,,663,563.55,190.0158,663,PrimeWest Health,MinnesotaCare,340.5168,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Circumcision,,35000616,LOCAL,Facility,Inpatient,,,,663,563.55,190.0158,663,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Circumcision,,35000616,LOCAL,Facility,Both,,,,663,563.55,190.0158,663,Sanford Health Plan,Sanford Health Plan,609.96,92,,percent of total billed charges,,
Circumcision,,35000616,LOCAL,Facility,Outpatient,,,,663,563.55,190.0158,663,"UCare Health, Inc.",Individual & Family Plan,373.6005,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Circumcision,,35000616,LOCAL,Facility,Inpatient,,,,663,563.55,190.0158,663,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Circumcision,,35000616,LOCAL,Facility,Outpatient,,,,663,563.55,190.0158,663,"UCare Health, Inc.",Medical Assistance,334.6161,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Circumcision,,35000616,LOCAL,Facility,Inpatient,,,,663,563.55,190.0158,663,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Circumcision,,35000616,LOCAL,Facility,Outpatient,,,,663,563.55,190.0158,663,"UCare Health, Inc.",Medicare Advantage,334.6161,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Circumcision,,35000616,LOCAL,Facility,Inpatient,,,,663,563.55,190.0158,663,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Circumcision,,35000616,LOCAL,Facility,Outpatient,,,,663,563.55,190.0158,663,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),334.6161,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Circumcision,,35000616,LOCAL,Facility,Inpatient,,,,663,563.55,190.0158,663,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Circumcision,,35000616,LOCAL,Facility,Both,,,,663,563.55,190.0158,663,UnitedHealthcare,Individual & Family,623.22,94,,percent of total billed charges,,
Circumcision,,35000616,LOCAL,Facility,Outpatient,,,,663,563.55,190.0158,663,UnitedHealthcare,Medicare Advantage,324.87,49,,percent of total billed charges,,
Circumcision,,35000616,LOCAL,Facility,Inpatient,,,,663,563.55,190.0158,663,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Circumcision,,35000616,LOCAL,Facility,Outpatient,,,,663,563.55,190.0158,663,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,318.24,48,,percent of total billed charges,,100% of DHS outpatient percentage
Circumcision,,35000616,LOCAL,Facility,Inpatient,,,,663,563.55,190.0158,663,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Labor Care Level 1,,35000832,LOCAL,Facility,Both,,,,1428,1213.8,409.2648,1428,Aetna,Commercial,1313.76,92,,percent of total billed charges,,
Labor Care Level 1,,35000832,LOCAL,Facility,Outpatient,,,,1428,1213.8,409.2648,1428,Aetna,Medicare Advantage,699.72,49,,percent of total billed charges,,
Labor Care Level 1,,35000832,LOCAL,Facility,Inpatient,,,,1428,1213.8,409.2648,1428,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Labor Care Level 1,,35000832,LOCAL,Facility,Both,,,,1428,1213.8,409.2648,1428,Aetna,PPO,1328.04,93,,percent of total billed charges,,
Labor Care Level 1,,35000832,LOCAL,Facility,Both,,,,1428,1213.8,409.2648,1428,America's PPO,America's PPO,1371.3084,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Labor Care Level 1,,35000832,LOCAL,Facility,Both,,,,1428,1213.8,409.2648,1428,BlueCross BlueShield Minnesota, Federal Employee Program,1405.152,98.4,,percent of total billed charges,,
Labor Care Level 1,,35000832,LOCAL,Facility,Both,,,,1428,1213.8,409.2648,1428,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1428,100,,percent of total billed charges,,
Labor Care Level 1,,35000832,LOCAL,Facility,Both,,,,1428,1213.8,409.2648,1428,BlueCross BlueShield Minnesota,High Value Network Plan,1285.2,90,,percent of total billed charges,,
Labor Care Level 1,,35000832,LOCAL,Facility,Outpatient,,,,1428,1213.8,409.2648,1428,BlueCross BlueShield Minnesota,Medicare Advantage,699.72,49,,percent of total billed charges,,
Labor Care Level 1,,35000832,LOCAL,Facility,Inpatient,,,,1428,1213.8,409.2648,1428,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Labor Care Level 1,,35000832,LOCAL,Facility,Both,,,,1428,1213.8,409.2648,1428,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1264.7796,88.57,,percent of total billed charges,,
Labor Care Level 1,,35000832,LOCAL,Facility,Both,,,,1428,1213.8,409.2648,1428,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,409.2648,28.66,,percent of total billed charges,,
Labor Care Level 1,,35000832,LOCAL,Facility,Outpatient,,,,1428,1213.8,409.2648,1428,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),699.72,49,,percent of total billed charges,,
Labor Care Level 1,,35000832,LOCAL,Facility,Inpatient,,,,1428,1213.8,409.2648,1428,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Labor Care Level 1,,35000832,LOCAL,Facility,Both,,,,1428,1213.8,409.2648,1428,CorVel,Worker's Compensation,1428,100,,percent of total billed charges,,
Labor Care Level 1,,35000832,LOCAL,Facility,Both,,,,1428,1213.8,409.2648,1428,First Health Group Corporation,First Health Network,1385.16,97,,percent of total billed charges,,
Labor Care Level 1,,35000832,LOCAL,Facility,Both,,,,1428,1213.8,409.2648,1428,"Health Partners, Inc.",Commercial,1350.888,94.6,,percent of total billed charges,,
Labor Care Level 1,,35000832,LOCAL,Facility,Outpatient,,,,1428,1213.8,409.2648,1428,"Health Partners, Inc.",Medicare Advantage,699.72,49,,percent of total billed charges,,
Labor Care Level 1,,35000832,LOCAL,Facility,Inpatient,,,,1428,1213.8,409.2648,1428,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Labor Care Level 1,,35000832,LOCAL,Facility,Both,,,,1428,1213.8,409.2648,1428,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),856.8,60,,percent of total billed charges,,
Labor Care Level 1,,35000832,LOCAL,Facility,Both,,,,1428,1213.8,409.2648,1428,"Health Partners, Inc.",State of Minnesota Advantage Program,1163.82,81.5,,percent of total billed charges,,
Labor Care Level 1,,35000832,LOCAL,Facility,Both,,,,1428,1213.8,409.2648,1428,"Health Partners, Inc.",State Public Programs,714,50,,percent of total billed charges,,
Labor Care Level 1,,35000832,LOCAL,Facility,Both,,,,1428,1213.8,409.2648,1428,Humana Insurance Company,Commercial PPO,1356.6,95,,percent of total billed charges,,
Labor Care Level 1,,35000832,LOCAL,Facility,Outpatient,,,,1428,1213.8,409.2648,1428,Humana Insurance Company,Medicare PPO,699.72,49,,percent of total billed charges,,
Labor Care Level 1,,35000832,LOCAL,Facility,Inpatient,,,,1428,1213.8,409.2648,1428,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Labor Care Level 1,,35000832,LOCAL,Facility,Both,,,,1428,1213.8,409.2648,1428,Medica,Individual & Family,1415.148,99.1,,percent of total billed charges,,
Labor Care Level 1,,35000832,LOCAL,Facility,Outpatient,,,,1428,1213.8,409.2648,1428,Medica,Medica Advantage Solution,711.144,49.8,,percent of total billed charges,,
Labor Care Level 1,,35000832,LOCAL,Facility,Inpatient,,,,1428,1213.8,409.2648,1428,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Labor Care Level 1,,35000832,LOCAL,Facility,Outpatient,,,,1428,1213.8,409.2648,1428,Medica,Medical Assistance,636.888,44.6,,percent of total billed charges,,
Labor Care Level 1,,35000832,LOCAL,Facility,Inpatient,,,,1428,1213.8,409.2648,1428,Medica,Medical Assistance,,,,,Included in per diem rate,
Labor Care Level 1,,35000832,LOCAL,Facility,Outpatient,,,,1428,1213.8,409.2648,1428,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,711.144,49.8,,percent of total billed charges,,
Labor Care Level 1,,35000832,LOCAL,Facility,Inpatient,,,,1428,1213.8,409.2648,1428,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Labor Care Level 1,,35000832,LOCAL,Facility,Both,,,,1428,1213.8,409.2648,1428,"Multiplan, Inc.","Multiplan, Inc.",1342.32,94,,percent of total billed charges,,
Labor Care Level 1,,35000832,LOCAL,Facility,Outpatient,,,,1428,1213.8,409.2648,1428,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1286.628,90.1,,percent of total billed charges,,
Labor Care Level 1,,35000832,LOCAL,Facility,Inpatient,,,,1428,1213.8,409.2648,1428,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Labor Care Level 1,,35000832,LOCAL,Facility,Both,,,,1428,1213.8,409.2648,1428,"Preferred One Administrative Services, INC.",PPO,1408.008,98.6,,percent of total billed charges,,
Labor Care Level 1,,35000832,LOCAL,Facility,Outpatient,,,,1428,1213.8,409.2648,1428,PrimeWest Health,Minnesota Senior Health Options (MSHO),734.706,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Labor Care Level 1,,35000832,LOCAL,Facility,Inpatient,,,,1428,1213.8,409.2648,1428,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Labor Care Level 1,,35000832,LOCAL,Facility,Outpatient,,,,1428,1213.8,409.2648,1428,PrimeWest Health,MinnesotaCare,733.4208,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Labor Care Level 1,,35000832,LOCAL,Facility,Inpatient,,,,1428,1213.8,409.2648,1428,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Labor Care Level 1,,35000832,LOCAL,Facility,Both,,,,1428,1213.8,409.2648,1428,Sanford Health Plan,Sanford Health Plan,1313.76,92,,percent of total billed charges,,
Labor Care Level 1,,35000832,LOCAL,Facility,Outpatient,,,,1428,1213.8,409.2648,1428,"UCare Health, Inc.",Individual & Family Plan,804.678,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Labor Care Level 1,,35000832,LOCAL,Facility,Inpatient,,,,1428,1213.8,409.2648,1428,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Labor Care Level 1,,35000832,LOCAL,Facility,Outpatient,,,,1428,1213.8,409.2648,1428,"UCare Health, Inc.",Medical Assistance,720.7116,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Labor Care Level 1,,35000832,LOCAL,Facility,Inpatient,,,,1428,1213.8,409.2648,1428,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Labor Care Level 1,,35000832,LOCAL,Facility,Outpatient,,,,1428,1213.8,409.2648,1428,"UCare Health, Inc.",Medicare Advantage,720.7116,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Labor Care Level 1,,35000832,LOCAL,Facility,Inpatient,,,,1428,1213.8,409.2648,1428,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Labor Care Level 1,,35000832,LOCAL,Facility,Outpatient,,,,1428,1213.8,409.2648,1428,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),720.7116,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Labor Care Level 1,,35000832,LOCAL,Facility,Inpatient,,,,1428,1213.8,409.2648,1428,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Labor Care Level 1,,35000832,LOCAL,Facility,Both,,,,1428,1213.8,409.2648,1428,UnitedHealthcare,Individual & Family,1342.32,94,,percent of total billed charges,,
Labor Care Level 1,,35000832,LOCAL,Facility,Outpatient,,,,1428,1213.8,409.2648,1428,UnitedHealthcare,Medicare Advantage,699.72,49,,percent of total billed charges,,
Labor Care Level 1,,35000832,LOCAL,Facility,Inpatient,,,,1428,1213.8,409.2648,1428,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Labor Care Level 1,,35000832,LOCAL,Facility,Outpatient,,,,1428,1213.8,409.2648,1428,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,685.44,48,,percent of total billed charges,,100% of DHS outpatient percentage
Labor Care Level 1,,35000832,LOCAL,Facility,Inpatient,,,,1428,1213.8,409.2648,1428,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Labor Care Level 2,,35000846,LOCAL,Facility,Both,,,,1785,1517.25,511.581,1785,Aetna,Commercial,1642.2,92,,percent of total billed charges,,
Labor Care Level 2,,35000846,LOCAL,Facility,Outpatient,,,,1785,1517.25,511.581,1785,Aetna,Medicare Advantage,874.65,49,,percent of total billed charges,,
Labor Care Level 2,,35000846,LOCAL,Facility,Inpatient,,,,1785,1517.25,511.581,1785,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Labor Care Level 2,,35000846,LOCAL,Facility,Both,,,,1785,1517.25,511.581,1785,Aetna,PPO,1660.05,93,,percent of total billed charges,,
Labor Care Level 2,,35000846,LOCAL,Facility,Both,,,,1785,1517.25,511.581,1785,America's PPO,America's PPO,1714.1355,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Labor Care Level 2,,35000846,LOCAL,Facility,Both,,,,1785,1517.25,511.581,1785,BlueCross BlueShield Minnesota, Federal Employee Program,1756.44,98.4,,percent of total billed charges,,
Labor Care Level 2,,35000846,LOCAL,Facility,Both,,,,1785,1517.25,511.581,1785,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1785,100,,percent of total billed charges,,
Labor Care Level 2,,35000846,LOCAL,Facility,Both,,,,1785,1517.25,511.581,1785,BlueCross BlueShield Minnesota,High Value Network Plan,1606.5,90,,percent of total billed charges,,
Labor Care Level 2,,35000846,LOCAL,Facility,Outpatient,,,,1785,1517.25,511.581,1785,BlueCross BlueShield Minnesota,Medicare Advantage,874.65,49,,percent of total billed charges,,
Labor Care Level 2,,35000846,LOCAL,Facility,Inpatient,,,,1785,1517.25,511.581,1785,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Labor Care Level 2,,35000846,LOCAL,Facility,Both,,,,1785,1517.25,511.581,1785,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1580.9745,88.57,,percent of total billed charges,,
Labor Care Level 2,,35000846,LOCAL,Facility,Both,,,,1785,1517.25,511.581,1785,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,511.581,28.66,,percent of total billed charges,,
Labor Care Level 2,,35000846,LOCAL,Facility,Outpatient,,,,1785,1517.25,511.581,1785,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),874.65,49,,percent of total billed charges,,
Labor Care Level 2,,35000846,LOCAL,Facility,Inpatient,,,,1785,1517.25,511.581,1785,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Labor Care Level 2,,35000846,LOCAL,Facility,Both,,,,1785,1517.25,511.581,1785,CorVel,Worker's Compensation,1785,100,,percent of total billed charges,,
Labor Care Level 2,,35000846,LOCAL,Facility,Both,,,,1785,1517.25,511.581,1785,First Health Group Corporation,First Health Network,1731.45,97,,percent of total billed charges,,
Labor Care Level 2,,35000846,LOCAL,Facility,Both,,,,1785,1517.25,511.581,1785,"Health Partners, Inc.",Commercial,1688.61,94.6,,percent of total billed charges,,
Labor Care Level 2,,35000846,LOCAL,Facility,Outpatient,,,,1785,1517.25,511.581,1785,"Health Partners, Inc.",Medicare Advantage,874.65,49,,percent of total billed charges,,
Labor Care Level 2,,35000846,LOCAL,Facility,Inpatient,,,,1785,1517.25,511.581,1785,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Labor Care Level 2,,35000846,LOCAL,Facility,Both,,,,1785,1517.25,511.581,1785,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1071,60,,percent of total billed charges,,
Labor Care Level 2,,35000846,LOCAL,Facility,Both,,,,1785,1517.25,511.581,1785,"Health Partners, Inc.",State of Minnesota Advantage Program,1454.775,81.5,,percent of total billed charges,,
Labor Care Level 2,,35000846,LOCAL,Facility,Both,,,,1785,1517.25,511.581,1785,"Health Partners, Inc.",State Public Programs,892.5,50,,percent of total billed charges,,
Labor Care Level 2,,35000846,LOCAL,Facility,Both,,,,1785,1517.25,511.581,1785,Humana Insurance Company,Commercial PPO,1695.75,95,,percent of total billed charges,,
Labor Care Level 2,,35000846,LOCAL,Facility,Outpatient,,,,1785,1517.25,511.581,1785,Humana Insurance Company,Medicare PPO,874.65,49,,percent of total billed charges,,
Labor Care Level 2,,35000846,LOCAL,Facility,Inpatient,,,,1785,1517.25,511.581,1785,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Labor Care Level 2,,35000846,LOCAL,Facility,Both,,,,1785,1517.25,511.581,1785,Medica,Individual & Family,1768.935,99.1,,percent of total billed charges,,
Labor Care Level 2,,35000846,LOCAL,Facility,Outpatient,,,,1785,1517.25,511.581,1785,Medica,Medica Advantage Solution,888.93,49.8,,percent of total billed charges,,
Labor Care Level 2,,35000846,LOCAL,Facility,Inpatient,,,,1785,1517.25,511.581,1785,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Labor Care Level 2,,35000846,LOCAL,Facility,Outpatient,,,,1785,1517.25,511.581,1785,Medica,Medical Assistance,796.11,44.6,,percent of total billed charges,,
Labor Care Level 2,,35000846,LOCAL,Facility,Inpatient,,,,1785,1517.25,511.581,1785,Medica,Medical Assistance,,,,,Included in per diem rate,
Labor Care Level 2,,35000846,LOCAL,Facility,Outpatient,,,,1785,1517.25,511.581,1785,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,888.93,49.8,,percent of total billed charges,,
Labor Care Level 2,,35000846,LOCAL,Facility,Inpatient,,,,1785,1517.25,511.581,1785,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Labor Care Level 2,,35000846,LOCAL,Facility,Both,,,,1785,1517.25,511.581,1785,"Multiplan, Inc.","Multiplan, Inc.",1677.9,94,,percent of total billed charges,,
Labor Care Level 2,,35000846,LOCAL,Facility,Outpatient,,,,1785,1517.25,511.581,1785,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1608.285,90.1,,percent of total billed charges,,
Labor Care Level 2,,35000846,LOCAL,Facility,Inpatient,,,,1785,1517.25,511.581,1785,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Labor Care Level 2,,35000846,LOCAL,Facility,Both,,,,1785,1517.25,511.581,1785,"Preferred One Administrative Services, INC.",PPO,1760.01,98.6,,percent of total billed charges,,
Labor Care Level 2,,35000846,LOCAL,Facility,Outpatient,,,,1785,1517.25,511.581,1785,PrimeWest Health,Minnesota Senior Health Options (MSHO),918.3825,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Labor Care Level 2,,35000846,LOCAL,Facility,Inpatient,,,,1785,1517.25,511.581,1785,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Labor Care Level 2,,35000846,LOCAL,Facility,Outpatient,,,,1785,1517.25,511.581,1785,PrimeWest Health,MinnesotaCare,916.776,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Labor Care Level 2,,35000846,LOCAL,Facility,Inpatient,,,,1785,1517.25,511.581,1785,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Labor Care Level 2,,35000846,LOCAL,Facility,Both,,,,1785,1517.25,511.581,1785,Sanford Health Plan,Sanford Health Plan,1642.2,92,,percent of total billed charges,,
Labor Care Level 2,,35000846,LOCAL,Facility,Outpatient,,,,1785,1517.25,511.581,1785,"UCare Health, Inc.",Individual & Family Plan,1005.8475,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Labor Care Level 2,,35000846,LOCAL,Facility,Inpatient,,,,1785,1517.25,511.581,1785,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Labor Care Level 2,,35000846,LOCAL,Facility,Outpatient,,,,1785,1517.25,511.581,1785,"UCare Health, Inc.",Medical Assistance,900.8895,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Labor Care Level 2,,35000846,LOCAL,Facility,Inpatient,,,,1785,1517.25,511.581,1785,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Labor Care Level 2,,35000846,LOCAL,Facility,Outpatient,,,,1785,1517.25,511.581,1785,"UCare Health, Inc.",Medicare Advantage,900.8895,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Labor Care Level 2,,35000846,LOCAL,Facility,Inpatient,,,,1785,1517.25,511.581,1785,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Labor Care Level 2,,35000846,LOCAL,Facility,Outpatient,,,,1785,1517.25,511.581,1785,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),900.8895,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Labor Care Level 2,,35000846,LOCAL,Facility,Inpatient,,,,1785,1517.25,511.581,1785,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Labor Care Level 2,,35000846,LOCAL,Facility,Both,,,,1785,1517.25,511.581,1785,UnitedHealthcare,Individual & Family,1677.9,94,,percent of total billed charges,,
Labor Care Level 2,,35000846,LOCAL,Facility,Outpatient,,,,1785,1517.25,511.581,1785,UnitedHealthcare,Medicare Advantage,874.65,49,,percent of total billed charges,,
Labor Care Level 2,,35000846,LOCAL,Facility,Inpatient,,,,1785,1517.25,511.581,1785,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Labor Care Level 2,,35000846,LOCAL,Facility,Outpatient,,,,1785,1517.25,511.581,1785,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,856.8,48,,percent of total billed charges,,100% of DHS outpatient percentage
Labor Care Level 2,,35000846,LOCAL,Facility,Inpatient,,,,1785,1517.25,511.581,1785,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Labor Care Level 3,,35000851,LOCAL,Facility,Both,,,,2040,1734,584.664,2040,Aetna,Commercial,1876.8,92,,percent of total billed charges,,
Labor Care Level 3,,35000851,LOCAL,Facility,Outpatient,,,,2040,1734,584.664,2040,Aetna,Medicare Advantage,999.6,49,,percent of total billed charges,,
Labor Care Level 3,,35000851,LOCAL,Facility,Inpatient,,,,2040,1734,584.664,2040,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Labor Care Level 3,,35000851,LOCAL,Facility,Both,,,,2040,1734,584.664,2040,Aetna,PPO,1897.2,93,,percent of total billed charges,,
Labor Care Level 3,,35000851,LOCAL,Facility,Both,,,,2040,1734,584.664,2040,America's PPO,America's PPO,1959.012,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Labor Care Level 3,,35000851,LOCAL,Facility,Both,,,,2040,1734,584.664,2040,BlueCross BlueShield Minnesota, Federal Employee Program,2007.36,98.4,,percent of total billed charges,,
Labor Care Level 3,,35000851,LOCAL,Facility,Both,,,,2040,1734,584.664,2040,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,2040,100,,percent of total billed charges,,
Labor Care Level 3,,35000851,LOCAL,Facility,Both,,,,2040,1734,584.664,2040,BlueCross BlueShield Minnesota,High Value Network Plan,1836,90,,percent of total billed charges,,
Labor Care Level 3,,35000851,LOCAL,Facility,Outpatient,,,,2040,1734,584.664,2040,BlueCross BlueShield Minnesota,Medicare Advantage,999.6,49,,percent of total billed charges,,
Labor Care Level 3,,35000851,LOCAL,Facility,Inpatient,,,,2040,1734,584.664,2040,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Labor Care Level 3,,35000851,LOCAL,Facility,Both,,,,2040,1734,584.664,2040,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1806.828,88.57,,percent of total billed charges,,
Labor Care Level 3,,35000851,LOCAL,Facility,Both,,,,2040,1734,584.664,2040,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,584.664,28.66,,percent of total billed charges,,
Labor Care Level 3,,35000851,LOCAL,Facility,Outpatient,,,,2040,1734,584.664,2040,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),999.6,49,,percent of total billed charges,,
Labor Care Level 3,,35000851,LOCAL,Facility,Inpatient,,,,2040,1734,584.664,2040,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Labor Care Level 3,,35000851,LOCAL,Facility,Both,,,,2040,1734,584.664,2040,CorVel,Worker's Compensation,2040,100,,percent of total billed charges,,
Labor Care Level 3,,35000851,LOCAL,Facility,Both,,,,2040,1734,584.664,2040,First Health Group Corporation,First Health Network,1978.8,97,,percent of total billed charges,,
Labor Care Level 3,,35000851,LOCAL,Facility,Both,,,,2040,1734,584.664,2040,"Health Partners, Inc.",Commercial,1929.84,94.6,,percent of total billed charges,,
Labor Care Level 3,,35000851,LOCAL,Facility,Outpatient,,,,2040,1734,584.664,2040,"Health Partners, Inc.",Medicare Advantage,999.6,49,,percent of total billed charges,,
Labor Care Level 3,,35000851,LOCAL,Facility,Inpatient,,,,2040,1734,584.664,2040,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Labor Care Level 3,,35000851,LOCAL,Facility,Both,,,,2040,1734,584.664,2040,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1224,60,,percent of total billed charges,,
Labor Care Level 3,,35000851,LOCAL,Facility,Both,,,,2040,1734,584.664,2040,"Health Partners, Inc.",State of Minnesota Advantage Program,1662.6,81.5,,percent of total billed charges,,
Labor Care Level 3,,35000851,LOCAL,Facility,Both,,,,2040,1734,584.664,2040,"Health Partners, Inc.",State Public Programs,1020,50,,percent of total billed charges,,
Labor Care Level 3,,35000851,LOCAL,Facility,Both,,,,2040,1734,584.664,2040,Humana Insurance Company,Commercial PPO,1938,95,,percent of total billed charges,,
Labor Care Level 3,,35000851,LOCAL,Facility,Outpatient,,,,2040,1734,584.664,2040,Humana Insurance Company,Medicare PPO,999.6,49,,percent of total billed charges,,
Labor Care Level 3,,35000851,LOCAL,Facility,Inpatient,,,,2040,1734,584.664,2040,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Labor Care Level 3,,35000851,LOCAL,Facility,Both,,,,2040,1734,584.664,2040,Medica,Individual & Family,2021.64,99.1,,percent of total billed charges,,
Labor Care Level 3,,35000851,LOCAL,Facility,Outpatient,,,,2040,1734,584.664,2040,Medica,Medica Advantage Solution,1015.92,49.8,,percent of total billed charges,,
Labor Care Level 3,,35000851,LOCAL,Facility,Inpatient,,,,2040,1734,584.664,2040,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Labor Care Level 3,,35000851,LOCAL,Facility,Outpatient,,,,2040,1734,584.664,2040,Medica,Medical Assistance,909.84,44.6,,percent of total billed charges,,
Labor Care Level 3,,35000851,LOCAL,Facility,Inpatient,,,,2040,1734,584.664,2040,Medica,Medical Assistance,,,,,Included in per diem rate,
Labor Care Level 3,,35000851,LOCAL,Facility,Outpatient,,,,2040,1734,584.664,2040,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1015.92,49.8,,percent of total billed charges,,
Labor Care Level 3,,35000851,LOCAL,Facility,Inpatient,,,,2040,1734,584.664,2040,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Labor Care Level 3,,35000851,LOCAL,Facility,Both,,,,2040,1734,584.664,2040,"Multiplan, Inc.","Multiplan, Inc.",1917.6,94,,percent of total billed charges,,
Labor Care Level 3,,35000851,LOCAL,Facility,Outpatient,,,,2040,1734,584.664,2040,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1838.04,90.1,,percent of total billed charges,,
Labor Care Level 3,,35000851,LOCAL,Facility,Inpatient,,,,2040,1734,584.664,2040,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Labor Care Level 3,,35000851,LOCAL,Facility,Both,,,,2040,1734,584.664,2040,"Preferred One Administrative Services, INC.",PPO,2011.44,98.6,,percent of total billed charges,,
Labor Care Level 3,,35000851,LOCAL,Facility,Outpatient,,,,2040,1734,584.664,2040,PrimeWest Health,Minnesota Senior Health Options (MSHO),1049.58,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Labor Care Level 3,,35000851,LOCAL,Facility,Inpatient,,,,2040,1734,584.664,2040,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Labor Care Level 3,,35000851,LOCAL,Facility,Outpatient,,,,2040,1734,584.664,2040,PrimeWest Health,MinnesotaCare,1047.744,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Labor Care Level 3,,35000851,LOCAL,Facility,Inpatient,,,,2040,1734,584.664,2040,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Labor Care Level 3,,35000851,LOCAL,Facility,Both,,,,2040,1734,584.664,2040,Sanford Health Plan,Sanford Health Plan,1876.8,92,,percent of total billed charges,,
Labor Care Level 3,,35000851,LOCAL,Facility,Outpatient,,,,2040,1734,584.664,2040,"UCare Health, Inc.",Individual & Family Plan,1149.54,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Labor Care Level 3,,35000851,LOCAL,Facility,Inpatient,,,,2040,1734,584.664,2040,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Labor Care Level 3,,35000851,LOCAL,Facility,Outpatient,,,,2040,1734,584.664,2040,"UCare Health, Inc.",Medical Assistance,1029.588,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Labor Care Level 3,,35000851,LOCAL,Facility,Inpatient,,,,2040,1734,584.664,2040,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Labor Care Level 3,,35000851,LOCAL,Facility,Outpatient,,,,2040,1734,584.664,2040,"UCare Health, Inc.",Medicare Advantage,1029.588,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Labor Care Level 3,,35000851,LOCAL,Facility,Inpatient,,,,2040,1734,584.664,2040,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Labor Care Level 3,,35000851,LOCAL,Facility,Outpatient,,,,2040,1734,584.664,2040,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1029.588,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Labor Care Level 3,,35000851,LOCAL,Facility,Inpatient,,,,2040,1734,584.664,2040,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Labor Care Level 3,,35000851,LOCAL,Facility,Both,,,,2040,1734,584.664,2040,UnitedHealthcare,Individual & Family,1917.6,94,,percent of total billed charges,,
Labor Care Level 3,,35000851,LOCAL,Facility,Outpatient,,,,2040,1734,584.664,2040,UnitedHealthcare,Medicare Advantage,999.6,49,,percent of total billed charges,,
Labor Care Level 3,,35000851,LOCAL,Facility,Inpatient,,,,2040,1734,584.664,2040,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Labor Care Level 3,,35000851,LOCAL,Facility,Outpatient,,,,2040,1734,584.664,2040,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,979.2,48,,percent of total billed charges,,100% of DHS outpatient percentage
Labor Care Level 3,,35000851,LOCAL,Facility,Inpatient,,,,2040,1734,584.664,2040,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Delivery,,35001227,LOCAL,Facility,Both,,,,2040,1734,584.664,2040,Aetna,Commercial,1876.8,92,,percent of total billed charges,,
Delivery,,35001227,LOCAL,Facility,Outpatient,,,,2040,1734,584.664,2040,Aetna,Medicare Advantage,999.6,49,,percent of total billed charges,,
Delivery,,35001227,LOCAL,Facility,Inpatient,,,,2040,1734,584.664,2040,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Delivery,,35001227,LOCAL,Facility,Both,,,,2040,1734,584.664,2040,Aetna,PPO,1897.2,93,,percent of total billed charges,,
Delivery,,35001227,LOCAL,Facility,Both,,,,2040,1734,584.664,2040,America's PPO,America's PPO,1959.012,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Delivery,,35001227,LOCAL,Facility,Both,,,,2040,1734,584.664,2040,BlueCross BlueShield Minnesota, Federal Employee Program,2007.36,98.4,,percent of total billed charges,,
Delivery,,35001227,LOCAL,Facility,Both,,,,2040,1734,584.664,2040,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,2040,100,,percent of total billed charges,,
Delivery,,35001227,LOCAL,Facility,Both,,,,2040,1734,584.664,2040,BlueCross BlueShield Minnesota,High Value Network Plan,1836,90,,percent of total billed charges,,
Delivery,,35001227,LOCAL,Facility,Outpatient,,,,2040,1734,584.664,2040,BlueCross BlueShield Minnesota,Medicare Advantage,999.6,49,,percent of total billed charges,,
Delivery,,35001227,LOCAL,Facility,Inpatient,,,,2040,1734,584.664,2040,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Delivery,,35001227,LOCAL,Facility,Both,,,,2040,1734,584.664,2040,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1806.828,88.57,,percent of total billed charges,,
Delivery,,35001227,LOCAL,Facility,Both,,,,2040,1734,584.664,2040,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,584.664,28.66,,percent of total billed charges,,
Delivery,,35001227,LOCAL,Facility,Outpatient,,,,2040,1734,584.664,2040,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),999.6,49,,percent of total billed charges,,
Delivery,,35001227,LOCAL,Facility,Inpatient,,,,2040,1734,584.664,2040,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Delivery,,35001227,LOCAL,Facility,Both,,,,2040,1734,584.664,2040,CorVel,Worker's Compensation,2040,100,,percent of total billed charges,,
Delivery,,35001227,LOCAL,Facility,Both,,,,2040,1734,584.664,2040,First Health Group Corporation,First Health Network,1978.8,97,,percent of total billed charges,,
Delivery,,35001227,LOCAL,Facility,Both,,,,2040,1734,584.664,2040,"Health Partners, Inc.",Commercial,1929.84,94.6,,percent of total billed charges,,
Delivery,,35001227,LOCAL,Facility,Outpatient,,,,2040,1734,584.664,2040,"Health Partners, Inc.",Medicare Advantage,999.6,49,,percent of total billed charges,,
Delivery,,35001227,LOCAL,Facility,Inpatient,,,,2040,1734,584.664,2040,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Delivery,,35001227,LOCAL,Facility,Both,,,,2040,1734,584.664,2040,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1224,60,,percent of total billed charges,,
Delivery,,35001227,LOCAL,Facility,Both,,,,2040,1734,584.664,2040,"Health Partners, Inc.",State of Minnesota Advantage Program,1662.6,81.5,,percent of total billed charges,,
Delivery,,35001227,LOCAL,Facility,Both,,,,2040,1734,584.664,2040,"Health Partners, Inc.",State Public Programs,1020,50,,percent of total billed charges,,
Delivery,,35001227,LOCAL,Facility,Both,,,,2040,1734,584.664,2040,Humana Insurance Company,Commercial PPO,1938,95,,percent of total billed charges,,
Delivery,,35001227,LOCAL,Facility,Outpatient,,,,2040,1734,584.664,2040,Humana Insurance Company,Medicare PPO,999.6,49,,percent of total billed charges,,
Delivery,,35001227,LOCAL,Facility,Inpatient,,,,2040,1734,584.664,2040,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Delivery,,35001227,LOCAL,Facility,Both,,,,2040,1734,584.664,2040,Medica,Individual & Family,2021.64,99.1,,percent of total billed charges,,
Delivery,,35001227,LOCAL,Facility,Outpatient,,,,2040,1734,584.664,2040,Medica,Medica Advantage Solution,1015.92,49.8,,percent of total billed charges,,
Delivery,,35001227,LOCAL,Facility,Inpatient,,,,2040,1734,584.664,2040,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Delivery,,35001227,LOCAL,Facility,Outpatient,,,,2040,1734,584.664,2040,Medica,Medical Assistance,909.84,44.6,,percent of total billed charges,,
Delivery,,35001227,LOCAL,Facility,Inpatient,,,,2040,1734,584.664,2040,Medica,Medical Assistance,,,,,Included in per diem rate,
Delivery,,35001227,LOCAL,Facility,Outpatient,,,,2040,1734,584.664,2040,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1015.92,49.8,,percent of total billed charges,,
Delivery,,35001227,LOCAL,Facility,Inpatient,,,,2040,1734,584.664,2040,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Delivery,,35001227,LOCAL,Facility,Both,,,,2040,1734,584.664,2040,"Multiplan, Inc.","Multiplan, Inc.",1917.6,94,,percent of total billed charges,,
Delivery,,35001227,LOCAL,Facility,Outpatient,,,,2040,1734,584.664,2040,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1838.04,90.1,,percent of total billed charges,,
Delivery,,35001227,LOCAL,Facility,Inpatient,,,,2040,1734,584.664,2040,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Delivery,,35001227,LOCAL,Facility,Both,,,,2040,1734,584.664,2040,"Preferred One Administrative Services, INC.",PPO,2011.44,98.6,,percent of total billed charges,,
Delivery,,35001227,LOCAL,Facility,Outpatient,,,,2040,1734,584.664,2040,PrimeWest Health,Minnesota Senior Health Options (MSHO),1049.58,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Delivery,,35001227,LOCAL,Facility,Inpatient,,,,2040,1734,584.664,2040,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Delivery,,35001227,LOCAL,Facility,Outpatient,,,,2040,1734,584.664,2040,PrimeWest Health,MinnesotaCare,1047.744,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Delivery,,35001227,LOCAL,Facility,Inpatient,,,,2040,1734,584.664,2040,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Delivery,,35001227,LOCAL,Facility,Both,,,,2040,1734,584.664,2040,Sanford Health Plan,Sanford Health Plan,1876.8,92,,percent of total billed charges,,
Delivery,,35001227,LOCAL,Facility,Outpatient,,,,2040,1734,584.664,2040,"UCare Health, Inc.",Individual & Family Plan,1149.54,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Delivery,,35001227,LOCAL,Facility,Inpatient,,,,2040,1734,584.664,2040,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Delivery,,35001227,LOCAL,Facility,Outpatient,,,,2040,1734,584.664,2040,"UCare Health, Inc.",Medical Assistance,1029.588,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Delivery,,35001227,LOCAL,Facility,Inpatient,,,,2040,1734,584.664,2040,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Delivery,,35001227,LOCAL,Facility,Outpatient,,,,2040,1734,584.664,2040,"UCare Health, Inc.",Medicare Advantage,1029.588,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Delivery,,35001227,LOCAL,Facility,Inpatient,,,,2040,1734,584.664,2040,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Delivery,,35001227,LOCAL,Facility,Outpatient,,,,2040,1734,584.664,2040,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1029.588,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Delivery,,35001227,LOCAL,Facility,Inpatient,,,,2040,1734,584.664,2040,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Delivery,,35001227,LOCAL,Facility,Both,,,,2040,1734,584.664,2040,UnitedHealthcare,Individual & Family,1917.6,94,,percent of total billed charges,,
Delivery,,35001227,LOCAL,Facility,Outpatient,,,,2040,1734,584.664,2040,UnitedHealthcare,Medicare Advantage,999.6,49,,percent of total billed charges,,
Delivery,,35001227,LOCAL,Facility,Inpatient,,,,2040,1734,584.664,2040,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Delivery,,35001227,LOCAL,Facility,Outpatient,,,,2040,1734,584.664,2040,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,979.2,48,,percent of total billed charges,,100% of DHS outpatient percentage
Delivery,,35001227,LOCAL,Facility,Inpatient,,,,2040,1734,584.664,2040,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Drain Or Inject Joint Bursa,,38000242,LOCAL,Facility,Outpatient,,,,281,238.85,80.5346,281,Aetna,Commercial,258.52,92,,percent of total billed charges,,
Drain Or Inject Joint Bursa,,38000242,LOCAL,Facility,Outpatient,,,,281,238.85,80.5346,281,Aetna,Medicare Advantage,137.69,49,,percent of total billed charges,,
Drain Or Inject Joint Bursa,,38000242,LOCAL,Facility,Outpatient,,,,281,238.85,80.5346,281,Aetna,PPO,261.33,93,,percent of total billed charges,,
Drain Or Inject Joint Bursa,,38000242,LOCAL,Facility,Outpatient,,,,281,238.85,80.5346,281,America's PPO,America's PPO,269.8443,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Drain Or Inject Joint Bursa,,38000242,LOCAL,Facility,Outpatient,,,,281,238.85,80.5346,281,BlueCross BlueShield Minnesota, Federal Employee Program,276.504,98.4,,percent of total billed charges,,
Drain Or Inject Joint Bursa,,38000242,LOCAL,Facility,Outpatient,,,,281,238.85,80.5346,281,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,281,100,,percent of total billed charges,,
Drain Or Inject Joint Bursa,,38000242,LOCAL,Facility,Outpatient,,,,281,238.85,80.5346,281,BlueCross BlueShield Minnesota,High Value Network Plan,252.9,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
Drain Or Inject Joint Bursa,,38000242,LOCAL,Facility,Outpatient,,,,281,238.85,80.5346,281,BlueCross BlueShield Minnesota,Medicare Advantage,137.69,49,,percent of total billed charges,,
Drain Or Inject Joint Bursa,,38000242,LOCAL,Facility,Outpatient,,,,281,238.85,80.5346,281,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,80.5346,28.66,,percent of total billed charges,,
Drain Or Inject Joint Bursa,,38000242,LOCAL,Facility,Outpatient,,,,281,238.85,80.5346,281,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),137.69,49,,percent of total billed charges,,
Drain Or Inject Joint Bursa,,38000242,LOCAL,Facility,Outpatient,,,,281,238.85,80.5346,281,CorVel,Worker's Compensation,281,100,,percent of total billed charges,,
Drain Or Inject Joint Bursa,,38000242,LOCAL,Facility,Outpatient,,,,281,238.85,80.5346,281,First Health Group Corporation,First Health Network,272.57,97,,percent of total billed charges,,
Drain Or Inject Joint Bursa,,38000242,LOCAL,Facility,Outpatient,,,,281,238.85,80.5346,281,"Health Partners, Inc.",Commercial,265.826,94.6,,percent of total billed charges,,
Drain Or Inject Joint Bursa,,38000242,LOCAL,Facility,Outpatient,,,,281,238.85,80.5346,281,"Health Partners, Inc.",Medicare Advantage,137.69,49,,percent of total billed charges,,
Drain Or Inject Joint Bursa,,38000242,LOCAL,Facility,Outpatient,,,,281,238.85,80.5346,281,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),168.6,60,,percent of total billed charges,,
Drain Or Inject Joint Bursa,,38000242,LOCAL,Facility,Outpatient,,,,281,238.85,80.5346,281,"Health Partners, Inc.",State of Minnesota Advantage Program,229.015,81.5,,percent of total billed charges,,
Drain Or Inject Joint Bursa,,38000242,LOCAL,Facility,Outpatient,,,,281,238.85,80.5346,281,"Health Partners, Inc.",State Public Programs,140.5,50,,percent of total billed charges,,
Drain Or Inject Joint Bursa,,38000242,LOCAL,Facility,Outpatient,,,,281,238.85,80.5346,281,Humana Insurance Company,Commercial PPO,266.95,95,,percent of total billed charges,,
Drain Or Inject Joint Bursa,,38000242,LOCAL,Facility,Outpatient,,,,281,238.85,80.5346,281,Humana Insurance Company,Medicare PPO,137.69,49,,percent of total billed charges,,
Drain Or Inject Joint Bursa,,38000242,LOCAL,Facility,Outpatient,,,,281,238.85,80.5346,281,Medica,Individual & Family,261.892,93.2,,percent of total billed charges,,
Drain Or Inject Joint Bursa,,38000242,LOCAL,Facility,Outpatient,,,,281,238.85,80.5346,281,Medica,Medica Advantage Solution,139.938,49.8,,percent of total billed charges,,
Drain Or Inject Joint Bursa,,38000242,LOCAL,Facility,Outpatient,,,,281,238.85,80.5346,281,Medica,Medical Assistance,125.326,44.6,,percent of total billed charges,,
Drain Or Inject Joint Bursa,,38000242,LOCAL,Facility,Outpatient,,,,281,238.85,80.5346,281,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,139.938,49.8,,percent of total billed charges,,
Drain Or Inject Joint Bursa,,38000242,LOCAL,Facility,Outpatient,,,,281,238.85,80.5346,281,"Multiplan, Inc.","Multiplan, Inc.",264.14,94,,percent of total billed charges,,
Drain Or Inject Joint Bursa,,38000242,LOCAL,Facility,Outpatient,,,,281,238.85,80.5346,281,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,253.181,90.1,,percent of total billed charges,,
Drain Or Inject Joint Bursa,,38000242,LOCAL,Facility,Outpatient,,,,281,238.85,80.5346,281,"Preferred One Administrative Services, INC.",PPO,277.066,98.6,,percent of total billed charges,,
Drain Or Inject Joint Bursa,,38000242,LOCAL,Facility,Outpatient,,,,281,238.85,80.5346,281,PrimeWest Health,Minnesota Senior Health Options (MSHO),144.5745,51.45,,percent of total billed charges,,
Drain Or Inject Joint Bursa,,38000242,LOCAL,Facility,Outpatient,,,,281,238.85,80.5346,281,PrimeWest Health,MinnesotaCare,144.3216,51.36,,percent of total billed charges,,
Drain Or Inject Joint Bursa,,38000242,LOCAL,Facility,Outpatient,,,,281,238.85,80.5346,281,Sanford Health Plan,Sanford Health Plan,258.52,92,,percent of total billed charges,,
Drain Or Inject Joint Bursa,,38000242,LOCAL,Facility,Outpatient,,,,281,238.85,80.5346,281,"UCare Health, Inc.",Individual & Family Plan,158.3435,56.35,,percent of total billed charges,,
Drain Or Inject Joint Bursa,,38000242,LOCAL,Facility,Outpatient,,,,281,238.85,80.5346,281,"UCare Health, Inc.",Medical Assistance,141.8207,50.47,,percent of total billed charges,,
Drain Or Inject Joint Bursa,,38000242,LOCAL,Facility,Outpatient,,,,281,238.85,80.5346,281,"UCare Health, Inc.",Medicare Advantage,141.8207,50.47,,percent of total billed charges,,
Drain Or Inject Joint Bursa,,38000242,LOCAL,Facility,Outpatient,,,,281,238.85,80.5346,281,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),141.8207,50.47,,percent of total billed charges,,
Drain Or Inject Joint Bursa,,38000242,LOCAL,Facility,Outpatient,,,,281,238.85,80.5346,281,UnitedHealthcare,Individual & Family,264.14,94,,percent of total billed charges,,
Drain Or Inject Joint Bursa,,38000242,LOCAL,Facility,Outpatient,,,,281,238.85,80.5346,281,UnitedHealthcare,Medicare Advantage,137.69,49,,percent of total billed charges,,
Drain Or Inject Joint Bursa,,38000242,LOCAL,Facility,Outpatient,,,,281,238.85,80.5346,281,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,134.88,48,,percent of total billed charges,,100% of DHS outpatient percentage
Ed Procedure - Intermediate,,38000346,LOCAL,Facility,Outpatient,,,,357,303.45,102.3162,357,Aetna,Commercial,328.44,92,,percent of total billed charges,,
Ed Procedure - Intermediate,,38000346,LOCAL,Facility,Outpatient,,,,357,303.45,102.3162,357,Aetna,Medicare Advantage,174.93,49,,percent of total billed charges,,
Ed Procedure - Intermediate,,38000346,LOCAL,Facility,Outpatient,,,,357,303.45,102.3162,357,Aetna,PPO,332.01,93,,percent of total billed charges,,
Ed Procedure - Intermediate,,38000346,LOCAL,Facility,Outpatient,,,,357,303.45,102.3162,357,America's PPO,America's PPO,342.8271,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Ed Procedure - Intermediate,,38000346,LOCAL,Facility,Outpatient,,,,357,303.45,102.3162,357,BlueCross BlueShield Minnesota, Federal Employee Program,351.288,98.4,,percent of total billed charges,,
Ed Procedure - Intermediate,,38000346,LOCAL,Facility,Outpatient,,,,357,303.45,102.3162,357,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,357,100,,percent of total billed charges,,
Ed Procedure - Intermediate,,38000346,LOCAL,Facility,Outpatient,,,,357,303.45,102.3162,357,BlueCross BlueShield Minnesota,High Value Network Plan,321.3,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
Ed Procedure - Intermediate,,38000346,LOCAL,Facility,Outpatient,,,,357,303.45,102.3162,357,BlueCross BlueShield Minnesota,Medicare Advantage,174.93,49,,percent of total billed charges,,
Ed Procedure - Intermediate,,38000346,LOCAL,Facility,Outpatient,,,,357,303.45,102.3162,357,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,102.3162,28.66,,percent of total billed charges,,
Ed Procedure - Intermediate,,38000346,LOCAL,Facility,Outpatient,,,,357,303.45,102.3162,357,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),174.93,49,,percent of total billed charges,,
Ed Procedure - Intermediate,,38000346,LOCAL,Facility,Outpatient,,,,357,303.45,102.3162,357,CorVel,Worker's Compensation,357,100,,percent of total billed charges,,
Ed Procedure - Intermediate,,38000346,LOCAL,Facility,Outpatient,,,,357,303.45,102.3162,357,First Health Group Corporation,First Health Network,346.29,97,,percent of total billed charges,,
Ed Procedure - Intermediate,,38000346,LOCAL,Facility,Outpatient,,,,357,303.45,102.3162,357,"Health Partners, Inc.",Commercial,337.722,94.6,,percent of total billed charges,,
Ed Procedure - Intermediate,,38000346,LOCAL,Facility,Outpatient,,,,357,303.45,102.3162,357,"Health Partners, Inc.",Medicare Advantage,174.93,49,,percent of total billed charges,,
Ed Procedure - Intermediate,,38000346,LOCAL,Facility,Outpatient,,,,357,303.45,102.3162,357,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),214.2,60,,percent of total billed charges,,
Ed Procedure - Intermediate,,38000346,LOCAL,Facility,Outpatient,,,,357,303.45,102.3162,357,"Health Partners, Inc.",State of Minnesota Advantage Program,290.955,81.5,,percent of total billed charges,,
Ed Procedure - Intermediate,,38000346,LOCAL,Facility,Outpatient,,,,357,303.45,102.3162,357,"Health Partners, Inc.",State Public Programs,178.5,50,,percent of total billed charges,,
Ed Procedure - Intermediate,,38000346,LOCAL,Facility,Outpatient,,,,357,303.45,102.3162,357,Humana Insurance Company,Commercial PPO,339.15,95,,percent of total billed charges,,
Ed Procedure - Intermediate,,38000346,LOCAL,Facility,Outpatient,,,,357,303.45,102.3162,357,Humana Insurance Company,Medicare PPO,174.93,49,,percent of total billed charges,,
Ed Procedure - Intermediate,,38000346,LOCAL,Facility,Outpatient,,,,357,303.45,102.3162,357,Medica,Individual & Family,332.724,93.2,,percent of total billed charges,,
Ed Procedure - Intermediate,,38000346,LOCAL,Facility,Outpatient,,,,357,303.45,102.3162,357,Medica,Medica Advantage Solution,177.786,49.8,,percent of total billed charges,,
Ed Procedure - Intermediate,,38000346,LOCAL,Facility,Outpatient,,,,357,303.45,102.3162,357,Medica,Medical Assistance,159.222,44.6,,percent of total billed charges,,
Ed Procedure - Intermediate,,38000346,LOCAL,Facility,Outpatient,,,,357,303.45,102.3162,357,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,177.786,49.8,,percent of total billed charges,,
Ed Procedure - Intermediate,,38000346,LOCAL,Facility,Outpatient,,,,357,303.45,102.3162,357,"Multiplan, Inc.","Multiplan, Inc.",335.58,94,,percent of total billed charges,,
Ed Procedure - Intermediate,,38000346,LOCAL,Facility,Outpatient,,,,357,303.45,102.3162,357,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,321.657,90.1,,percent of total billed charges,,
Ed Procedure - Intermediate,,38000346,LOCAL,Facility,Outpatient,,,,357,303.45,102.3162,357,"Preferred One Administrative Services, INC.",PPO,352.002,98.6,,percent of total billed charges,,
Ed Procedure - Intermediate,,38000346,LOCAL,Facility,Outpatient,,,,357,303.45,102.3162,357,PrimeWest Health,Minnesota Senior Health Options (MSHO),183.6765,51.45,,percent of total billed charges,,
Ed Procedure - Intermediate,,38000346,LOCAL,Facility,Outpatient,,,,357,303.45,102.3162,357,PrimeWest Health,MinnesotaCare,183.3552,51.36,,percent of total billed charges,,
Ed Procedure - Intermediate,,38000346,LOCAL,Facility,Outpatient,,,,357,303.45,102.3162,357,Sanford Health Plan,Sanford Health Plan,328.44,92,,percent of total billed charges,,
Ed Procedure - Intermediate,,38000346,LOCAL,Facility,Outpatient,,,,357,303.45,102.3162,357,"UCare Health, Inc.",Individual & Family Plan,201.1695,56.35,,percent of total billed charges,,
Ed Procedure - Intermediate,,38000346,LOCAL,Facility,Outpatient,,,,357,303.45,102.3162,357,"UCare Health, Inc.",Medical Assistance,180.1779,50.47,,percent of total billed charges,,
Ed Procedure - Intermediate,,38000346,LOCAL,Facility,Outpatient,,,,357,303.45,102.3162,357,"UCare Health, Inc.",Medicare Advantage,180.1779,50.47,,percent of total billed charges,,
Ed Procedure - Intermediate,,38000346,LOCAL,Facility,Outpatient,,,,357,303.45,102.3162,357,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),180.1779,50.47,,percent of total billed charges,,
Ed Procedure - Intermediate,,38000346,LOCAL,Facility,Outpatient,,,,357,303.45,102.3162,357,UnitedHealthcare,Individual & Family,335.58,94,,percent of total billed charges,,
Ed Procedure - Intermediate,,38000346,LOCAL,Facility,Outpatient,,,,357,303.45,102.3162,357,UnitedHealthcare,Medicare Advantage,174.93,49,,percent of total billed charges,,
Ed Procedure - Intermediate,,38000346,LOCAL,Facility,Outpatient,,,,357,303.45,102.3162,357,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,171.36,48,,percent of total billed charges,,100% of DHS outpatient percentage
Ed Procedure - Major,,38000350,LOCAL,Facility,Outpatient,,,,765,650.25,219.249,765,Aetna,Commercial,703.8,92,,percent of total billed charges,,
Ed Procedure - Major,,38000350,LOCAL,Facility,Outpatient,,,,765,650.25,219.249,765,Aetna,Medicare Advantage,374.85,49,,percent of total billed charges,,
Ed Procedure - Major,,38000350,LOCAL,Facility,Outpatient,,,,765,650.25,219.249,765,Aetna,PPO,711.45,93,,percent of total billed charges,,
Ed Procedure - Major,,38000350,LOCAL,Facility,Outpatient,,,,765,650.25,219.249,765,America's PPO,America's PPO,734.6295,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Ed Procedure - Major,,38000350,LOCAL,Facility,Outpatient,,,,765,650.25,219.249,765,BlueCross BlueShield Minnesota, Federal Employee Program,752.76,98.4,,percent of total billed charges,,
Ed Procedure - Major,,38000350,LOCAL,Facility,Outpatient,,,,765,650.25,219.249,765,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,765,100,,percent of total billed charges,,
Ed Procedure - Major,,38000350,LOCAL,Facility,Outpatient,,,,765,650.25,219.249,765,BlueCross BlueShield Minnesota,High Value Network Plan,688.5,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
Ed Procedure - Major,,38000350,LOCAL,Facility,Outpatient,,,,765,650.25,219.249,765,BlueCross BlueShield Minnesota,Medicare Advantage,374.85,49,,percent of total billed charges,,
Ed Procedure - Major,,38000350,LOCAL,Facility,Outpatient,,,,765,650.25,219.249,765,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,219.249,28.66,,percent of total billed charges,,
Ed Procedure - Major,,38000350,LOCAL,Facility,Outpatient,,,,765,650.25,219.249,765,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),374.85,49,,percent of total billed charges,,
Ed Procedure - Major,,38000350,LOCAL,Facility,Outpatient,,,,765,650.25,219.249,765,CorVel,Worker's Compensation,765,100,,percent of total billed charges,,
Ed Procedure - Major,,38000350,LOCAL,Facility,Outpatient,,,,765,650.25,219.249,765,First Health Group Corporation,First Health Network,742.05,97,,percent of total billed charges,,
Ed Procedure - Major,,38000350,LOCAL,Facility,Outpatient,,,,765,650.25,219.249,765,"Health Partners, Inc.",Commercial,723.69,94.6,,percent of total billed charges,,
Ed Procedure - Major,,38000350,LOCAL,Facility,Outpatient,,,,765,650.25,219.249,765,"Health Partners, Inc.",Medicare Advantage,374.85,49,,percent of total billed charges,,
Ed Procedure - Major,,38000350,LOCAL,Facility,Outpatient,,,,765,650.25,219.249,765,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),459,60,,percent of total billed charges,,
Ed Procedure - Major,,38000350,LOCAL,Facility,Outpatient,,,,765,650.25,219.249,765,"Health Partners, Inc.",State of Minnesota Advantage Program,623.475,81.5,,percent of total billed charges,,
Ed Procedure - Major,,38000350,LOCAL,Facility,Outpatient,,,,765,650.25,219.249,765,"Health Partners, Inc.",State Public Programs,382.5,50,,percent of total billed charges,,
Ed Procedure - Major,,38000350,LOCAL,Facility,Outpatient,,,,765,650.25,219.249,765,Humana Insurance Company,Commercial PPO,726.75,95,,percent of total billed charges,,
Ed Procedure - Major,,38000350,LOCAL,Facility,Outpatient,,,,765,650.25,219.249,765,Humana Insurance Company,Medicare PPO,374.85,49,,percent of total billed charges,,
Ed Procedure - Major,,38000350,LOCAL,Facility,Outpatient,,,,765,650.25,219.249,765,Medica,Individual & Family,712.98,93.2,,percent of total billed charges,,
Ed Procedure - Major,,38000350,LOCAL,Facility,Outpatient,,,,765,650.25,219.249,765,Medica,Medica Advantage Solution,380.97,49.8,,percent of total billed charges,,
Ed Procedure - Major,,38000350,LOCAL,Facility,Outpatient,,,,765,650.25,219.249,765,Medica,Medical Assistance,341.19,44.6,,percent of total billed charges,,
Ed Procedure - Major,,38000350,LOCAL,Facility,Outpatient,,,,765,650.25,219.249,765,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,380.97,49.8,,percent of total billed charges,,
Ed Procedure - Major,,38000350,LOCAL,Facility,Outpatient,,,,765,650.25,219.249,765,"Multiplan, Inc.","Multiplan, Inc.",719.1,94,,percent of total billed charges,,
Ed Procedure - Major,,38000350,LOCAL,Facility,Outpatient,,,,765,650.25,219.249,765,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,689.265,90.1,,percent of total billed charges,,
Ed Procedure - Major,,38000350,LOCAL,Facility,Outpatient,,,,765,650.25,219.249,765,"Preferred One Administrative Services, INC.",PPO,754.29,98.6,,percent of total billed charges,,
Ed Procedure - Major,,38000350,LOCAL,Facility,Outpatient,,,,765,650.25,219.249,765,PrimeWest Health,Minnesota Senior Health Options (MSHO),393.5925,51.45,,percent of total billed charges,,
Ed Procedure - Major,,38000350,LOCAL,Facility,Outpatient,,,,765,650.25,219.249,765,PrimeWest Health,MinnesotaCare,392.904,51.36,,percent of total billed charges,,
Ed Procedure - Major,,38000350,LOCAL,Facility,Outpatient,,,,765,650.25,219.249,765,Sanford Health Plan,Sanford Health Plan,703.8,92,,percent of total billed charges,,
Ed Procedure - Major,,38000350,LOCAL,Facility,Outpatient,,,,765,650.25,219.249,765,"UCare Health, Inc.",Individual & Family Plan,431.0775,56.35,,percent of total billed charges,,
Ed Procedure - Major,,38000350,LOCAL,Facility,Outpatient,,,,765,650.25,219.249,765,"UCare Health, Inc.",Medical Assistance,386.0955,50.47,,percent of total billed charges,,
Ed Procedure - Major,,38000350,LOCAL,Facility,Outpatient,,,,765,650.25,219.249,765,"UCare Health, Inc.",Medicare Advantage,386.0955,50.47,,percent of total billed charges,,
Ed Procedure - Major,,38000350,LOCAL,Facility,Outpatient,,,,765,650.25,219.249,765,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),386.0955,50.47,,percent of total billed charges,,
Ed Procedure - Major,,38000350,LOCAL,Facility,Outpatient,,,,765,650.25,219.249,765,UnitedHealthcare,Individual & Family,719.1,94,,percent of total billed charges,,
Ed Procedure - Major,,38000350,LOCAL,Facility,Outpatient,,,,765,650.25,219.249,765,UnitedHealthcare,Medicare Advantage,374.85,49,,percent of total billed charges,,
Ed Procedure - Major,,38000350,LOCAL,Facility,Outpatient,,,,765,650.25,219.249,765,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,367.2,48,,percent of total billed charges,,100% of DHS outpatient percentage
Ed Procedure - Minor,,38000362,LOCAL,Facility,Outpatient,,,,128,108.8,36.6848,128,Aetna,Commercial,117.76,92,,percent of total billed charges,,
Ed Procedure - Minor,,38000362,LOCAL,Facility,Outpatient,,,,128,108.8,36.6848,128,Aetna,Medicare Advantage,62.72,49,,percent of total billed charges,,
Ed Procedure - Minor,,38000362,LOCAL,Facility,Outpatient,,,,128,108.8,36.6848,128,Aetna,PPO,119.04,93,,percent of total billed charges,,
Ed Procedure - Minor,,38000362,LOCAL,Facility,Outpatient,,,,128,108.8,36.6848,128,America's PPO,America's PPO,122.9184,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Ed Procedure - Minor,,38000362,LOCAL,Facility,Outpatient,,,,128,108.8,36.6848,128,BlueCross BlueShield Minnesota, Federal Employee Program,125.952,98.4,,percent of total billed charges,,
Ed Procedure - Minor,,38000362,LOCAL,Facility,Outpatient,,,,128,108.8,36.6848,128,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,128,100,,percent of total billed charges,,
Ed Procedure - Minor,,38000362,LOCAL,Facility,Outpatient,,,,128,108.8,36.6848,128,BlueCross BlueShield Minnesota,High Value Network Plan,115.2,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
Ed Procedure - Minor,,38000362,LOCAL,Facility,Outpatient,,,,128,108.8,36.6848,128,BlueCross BlueShield Minnesota,Medicare Advantage,62.72,49,,percent of total billed charges,,
Ed Procedure - Minor,,38000362,LOCAL,Facility,Outpatient,,,,128,108.8,36.6848,128,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,36.6848,28.66,,percent of total billed charges,,
Ed Procedure - Minor,,38000362,LOCAL,Facility,Outpatient,,,,128,108.8,36.6848,128,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),62.72,49,,percent of total billed charges,,
Ed Procedure - Minor,,38000362,LOCAL,Facility,Outpatient,,,,128,108.8,36.6848,128,CorVel,Worker's Compensation,128,100,,percent of total billed charges,,
Ed Procedure - Minor,,38000362,LOCAL,Facility,Outpatient,,,,128,108.8,36.6848,128,First Health Group Corporation,First Health Network,124.16,97,,percent of total billed charges,,
Ed Procedure - Minor,,38000362,LOCAL,Facility,Outpatient,,,,128,108.8,36.6848,128,"Health Partners, Inc.",Commercial,121.088,94.6,,percent of total billed charges,,
Ed Procedure - Minor,,38000362,LOCAL,Facility,Outpatient,,,,128,108.8,36.6848,128,"Health Partners, Inc.",Medicare Advantage,62.72,49,,percent of total billed charges,,
Ed Procedure - Minor,,38000362,LOCAL,Facility,Outpatient,,,,128,108.8,36.6848,128,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),76.8,60,,percent of total billed charges,,
Ed Procedure - Minor,,38000362,LOCAL,Facility,Outpatient,,,,128,108.8,36.6848,128,"Health Partners, Inc.",State of Minnesota Advantage Program,104.32,81.5,,percent of total billed charges,,
Ed Procedure - Minor,,38000362,LOCAL,Facility,Outpatient,,,,128,108.8,36.6848,128,"Health Partners, Inc.",State Public Programs,64,50,,percent of total billed charges,,
Ed Procedure - Minor,,38000362,LOCAL,Facility,Outpatient,,,,128,108.8,36.6848,128,Humana Insurance Company,Commercial PPO,121.6,95,,percent of total billed charges,,
Ed Procedure - Minor,,38000362,LOCAL,Facility,Outpatient,,,,128,108.8,36.6848,128,Humana Insurance Company,Medicare PPO,62.72,49,,percent of total billed charges,,
Ed Procedure - Minor,,38000362,LOCAL,Facility,Outpatient,,,,128,108.8,36.6848,128,Medica,Individual & Family,119.296,93.2,,percent of total billed charges,,
Ed Procedure - Minor,,38000362,LOCAL,Facility,Outpatient,,,,128,108.8,36.6848,128,Medica,Medica Advantage Solution,63.744,49.8,,percent of total billed charges,,
Ed Procedure - Minor,,38000362,LOCAL,Facility,Outpatient,,,,128,108.8,36.6848,128,Medica,Medical Assistance,57.088,44.6,,percent of total billed charges,,
Ed Procedure - Minor,,38000362,LOCAL,Facility,Outpatient,,,,128,108.8,36.6848,128,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,63.744,49.8,,percent of total billed charges,,
Ed Procedure - Minor,,38000362,LOCAL,Facility,Outpatient,,,,128,108.8,36.6848,128,"Multiplan, Inc.","Multiplan, Inc.",120.32,94,,percent of total billed charges,,
Ed Procedure - Minor,,38000362,LOCAL,Facility,Outpatient,,,,128,108.8,36.6848,128,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,115.328,90.1,,percent of total billed charges,,
Ed Procedure - Minor,,38000362,LOCAL,Facility,Outpatient,,,,128,108.8,36.6848,128,"Preferred One Administrative Services, INC.",PPO,126.208,98.6,,percent of total billed charges,,
Ed Procedure - Minor,,38000362,LOCAL,Facility,Outpatient,,,,128,108.8,36.6848,128,PrimeWest Health,Minnesota Senior Health Options (MSHO),65.856,51.45,,percent of total billed charges,,
Ed Procedure - Minor,,38000362,LOCAL,Facility,Outpatient,,,,128,108.8,36.6848,128,PrimeWest Health,MinnesotaCare,65.7408,51.36,,percent of total billed charges,,
Ed Procedure - Minor,,38000362,LOCAL,Facility,Outpatient,,,,128,108.8,36.6848,128,Sanford Health Plan,Sanford Health Plan,117.76,92,,percent of total billed charges,,
Ed Procedure - Minor,,38000362,LOCAL,Facility,Outpatient,,,,128,108.8,36.6848,128,"UCare Health, Inc.",Individual & Family Plan,72.128,56.35,,percent of total billed charges,,
Ed Procedure - Minor,,38000362,LOCAL,Facility,Outpatient,,,,128,108.8,36.6848,128,"UCare Health, Inc.",Medical Assistance,64.6016,50.47,,percent of total billed charges,,
Ed Procedure - Minor,,38000362,LOCAL,Facility,Outpatient,,,,128,108.8,36.6848,128,"UCare Health, Inc.",Medicare Advantage,64.6016,50.47,,percent of total billed charges,,
Ed Procedure - Minor,,38000362,LOCAL,Facility,Outpatient,,,,128,108.8,36.6848,128,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),64.6016,50.47,,percent of total billed charges,,
Ed Procedure - Minor,,38000362,LOCAL,Facility,Outpatient,,,,128,108.8,36.6848,128,UnitedHealthcare,Individual & Family,120.32,94,,percent of total billed charges,,
Ed Procedure - Minor,,38000362,LOCAL,Facility,Outpatient,,,,128,108.8,36.6848,128,UnitedHealthcare,Medicare Advantage,62.72,49,,percent of total billed charges,,
Ed Procedure - Minor,,38000362,LOCAL,Facility,Outpatient,,,,128,108.8,36.6848,128,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,61.44,48,,percent of total billed charges,,100% of DHS outpatient percentage
Intubation Airway - Emergency Insertion,,38000841,LOCAL,Facility,Outpatient,,,,179,152.15,51.3014,179,Aetna,Commercial,164.68,92,,percent of total billed charges,,
Intubation Airway - Emergency Insertion,,38000841,LOCAL,Facility,Outpatient,,,,179,152.15,51.3014,179,Aetna,Medicare Advantage,87.71,49,,percent of total billed charges,,
Intubation Airway - Emergency Insertion,,38000841,LOCAL,Facility,Outpatient,,,,179,152.15,51.3014,179,Aetna,PPO,166.47,93,,percent of total billed charges,,
Intubation Airway - Emergency Insertion,,38000841,LOCAL,Facility,Outpatient,,,,179,152.15,51.3014,179,America's PPO,America's PPO,171.8937,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Intubation Airway - Emergency Insertion,,38000841,LOCAL,Facility,Outpatient,,,,179,152.15,51.3014,179,BlueCross BlueShield Minnesota, Federal Employee Program,176.136,98.4,,percent of total billed charges,,
Intubation Airway - Emergency Insertion,,38000841,LOCAL,Facility,Outpatient,,,,179,152.15,51.3014,179,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,179,100,,percent of total billed charges,,
Intubation Airway - Emergency Insertion,,38000841,LOCAL,Facility,Outpatient,,,,179,152.15,51.3014,179,BlueCross BlueShield Minnesota,High Value Network Plan,161.1,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
Intubation Airway - Emergency Insertion,,38000841,LOCAL,Facility,Outpatient,,,,179,152.15,51.3014,179,BlueCross BlueShield Minnesota,Medicare Advantage,87.71,49,,percent of total billed charges,,
Intubation Airway - Emergency Insertion,,38000841,LOCAL,Facility,Outpatient,,,,179,152.15,51.3014,179,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,51.3014,28.66,,percent of total billed charges,,
Intubation Airway - Emergency Insertion,,38000841,LOCAL,Facility,Outpatient,,,,179,152.15,51.3014,179,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),87.71,49,,percent of total billed charges,,
Intubation Airway - Emergency Insertion,,38000841,LOCAL,Facility,Outpatient,,,,179,152.15,51.3014,179,CorVel,Worker's Compensation,179,100,,percent of total billed charges,,
Intubation Airway - Emergency Insertion,,38000841,LOCAL,Facility,Outpatient,,,,179,152.15,51.3014,179,First Health Group Corporation,First Health Network,173.63,97,,percent of total billed charges,,
Intubation Airway - Emergency Insertion,,38000841,LOCAL,Facility,Outpatient,,,,179,152.15,51.3014,179,"Health Partners, Inc.",Commercial,169.334,94.6,,percent of total billed charges,,
Intubation Airway - Emergency Insertion,,38000841,LOCAL,Facility,Outpatient,,,,179,152.15,51.3014,179,"Health Partners, Inc.",Medicare Advantage,87.71,49,,percent of total billed charges,,
Intubation Airway - Emergency Insertion,,38000841,LOCAL,Facility,Outpatient,,,,179,152.15,51.3014,179,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),107.4,60,,percent of total billed charges,,
Intubation Airway - Emergency Insertion,,38000841,LOCAL,Facility,Outpatient,,,,179,152.15,51.3014,179,"Health Partners, Inc.",State of Minnesota Advantage Program,145.885,81.5,,percent of total billed charges,,
Intubation Airway - Emergency Insertion,,38000841,LOCAL,Facility,Outpatient,,,,179,152.15,51.3014,179,"Health Partners, Inc.",State Public Programs,89.5,50,,percent of total billed charges,,
Intubation Airway - Emergency Insertion,,38000841,LOCAL,Facility,Outpatient,,,,179,152.15,51.3014,179,Humana Insurance Company,Commercial PPO,170.05,95,,percent of total billed charges,,
Intubation Airway - Emergency Insertion,,38000841,LOCAL,Facility,Outpatient,,,,179,152.15,51.3014,179,Humana Insurance Company,Medicare PPO,87.71,49,,percent of total billed charges,,
Intubation Airway - Emergency Insertion,,38000841,LOCAL,Facility,Outpatient,,,,179,152.15,51.3014,179,Medica,Individual & Family,166.828,93.2,,percent of total billed charges,,
Intubation Airway - Emergency Insertion,,38000841,LOCAL,Facility,Outpatient,,,,179,152.15,51.3014,179,Medica,Medica Advantage Solution,89.142,49.8,,percent of total billed charges,,
Intubation Airway - Emergency Insertion,,38000841,LOCAL,Facility,Outpatient,,,,179,152.15,51.3014,179,Medica,Medical Assistance,79.834,44.6,,percent of total billed charges,,
Intubation Airway - Emergency Insertion,,38000841,LOCAL,Facility,Outpatient,,,,179,152.15,51.3014,179,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,89.142,49.8,,percent of total billed charges,,
Intubation Airway - Emergency Insertion,,38000841,LOCAL,Facility,Outpatient,,,,179,152.15,51.3014,179,"Multiplan, Inc.","Multiplan, Inc.",168.26,94,,percent of total billed charges,,
Intubation Airway - Emergency Insertion,,38000841,LOCAL,Facility,Outpatient,,,,179,152.15,51.3014,179,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,161.279,90.1,,percent of total billed charges,,
Intubation Airway - Emergency Insertion,,38000841,LOCAL,Facility,Outpatient,,,,179,152.15,51.3014,179,"Preferred One Administrative Services, INC.",PPO,176.494,98.6,,percent of total billed charges,,
Intubation Airway - Emergency Insertion,,38000841,LOCAL,Facility,Outpatient,,,,179,152.15,51.3014,179,PrimeWest Health,Minnesota Senior Health Options (MSHO),92.0955,51.45,,percent of total billed charges,,
Intubation Airway - Emergency Insertion,,38000841,LOCAL,Facility,Outpatient,,,,179,152.15,51.3014,179,PrimeWest Health,MinnesotaCare,91.9344,51.36,,percent of total billed charges,,
Intubation Airway - Emergency Insertion,,38000841,LOCAL,Facility,Outpatient,,,,179,152.15,51.3014,179,Sanford Health Plan,Sanford Health Plan,164.68,92,,percent of total billed charges,,
Intubation Airway - Emergency Insertion,,38000841,LOCAL,Facility,Outpatient,,,,179,152.15,51.3014,179,"UCare Health, Inc.",Individual & Family Plan,100.8665,56.35,,percent of total billed charges,,
Intubation Airway - Emergency Insertion,,38000841,LOCAL,Facility,Outpatient,,,,179,152.15,51.3014,179,"UCare Health, Inc.",Medical Assistance,90.3413,50.47,,percent of total billed charges,,
Intubation Airway - Emergency Insertion,,38000841,LOCAL,Facility,Outpatient,,,,179,152.15,51.3014,179,"UCare Health, Inc.",Medicare Advantage,90.3413,50.47,,percent of total billed charges,,
Intubation Airway - Emergency Insertion,,38000841,LOCAL,Facility,Outpatient,,,,179,152.15,51.3014,179,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),90.3413,50.47,,percent of total billed charges,,
Intubation Airway - Emergency Insertion,,38000841,LOCAL,Facility,Outpatient,,,,179,152.15,51.3014,179,UnitedHealthcare,Individual & Family,168.26,94,,percent of total billed charges,,
Intubation Airway - Emergency Insertion,,38000841,LOCAL,Facility,Outpatient,,,,179,152.15,51.3014,179,UnitedHealthcare,Medicare Advantage,87.71,49,,percent of total billed charges,,
Intubation Airway - Emergency Insertion,,38000841,LOCAL,Facility,Outpatient,,,,179,152.15,51.3014,179,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,85.92,48,,percent of total billed charges,,100% of DHS outpatient percentage
VISCOAT .75ML,,57000002,LOCAL,Facility,Both,,,,210,178.5,60.186,210,Aetna,Commercial,193.2,92,,percent of total billed charges,,
VISCOAT .75ML,,57000002,LOCAL,Facility,Outpatient,,,,210,178.5,60.186,210,Aetna,Medicare Advantage,102.9,49,,percent of total billed charges,,
VISCOAT .75ML,,57000002,LOCAL,Facility,Inpatient,,,,210,178.5,60.186,210,Aetna,Medicare Advantage,,,,,Included in per diem rate,
VISCOAT .75ML,,57000002,LOCAL,Facility,Both,,,,210,178.5,60.186,210,Aetna,PPO,195.3,93,,percent of total billed charges,,
VISCOAT .75ML,,57000002,LOCAL,Facility,Both,,,,210,178.5,60.186,210,America's PPO,America's PPO,201.663,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
VISCOAT .75ML,,57000002,LOCAL,Facility,Both,,,,210,178.5,60.186,210,BlueCross BlueShield Minnesota, Federal Employee Program,206.64,98.4,,percent of total billed charges,,
VISCOAT .75ML,,57000002,LOCAL,Facility,Both,,,,210,178.5,60.186,210,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,210,100,,percent of total billed charges,,
VISCOAT .75ML,,57000002,LOCAL,Facility,Both,,,,210,178.5,60.186,210,BlueCross BlueShield Minnesota,High Value Network Plan,189,90,,percent of total billed charges,,
VISCOAT .75ML,,57000002,LOCAL,Facility,Outpatient,,,,210,178.5,60.186,210,BlueCross BlueShield Minnesota,Medicare Advantage,102.9,49,,percent of total billed charges,,
VISCOAT .75ML,,57000002,LOCAL,Facility,Inpatient,,,,210,178.5,60.186,210,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
VISCOAT .75ML,,57000002,LOCAL,Facility,Both,,,,210,178.5,60.186,210,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,185.997,88.57,,percent of total billed charges,,
VISCOAT .75ML,,57000002,LOCAL,Facility,Both,,,,210,178.5,60.186,210,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,60.186,28.66,,percent of total billed charges,,
VISCOAT .75ML,,57000002,LOCAL,Facility,Outpatient,,,,210,178.5,60.186,210,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),102.9,49,,percent of total billed charges,,
VISCOAT .75ML,,57000002,LOCAL,Facility,Inpatient,,,,210,178.5,60.186,210,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
VISCOAT .75ML,,57000002,LOCAL,Facility,Both,,,,210,178.5,60.186,210,CorVel,Worker's Compensation,210,100,,percent of total billed charges,,
VISCOAT .75ML,,57000002,LOCAL,Facility,Both,,,,210,178.5,60.186,210,First Health Group Corporation,First Health Network,203.7,97,,percent of total billed charges,,
VISCOAT .75ML,,57000002,LOCAL,Facility,Both,,,,210,178.5,60.186,210,"Health Partners, Inc.",Commercial,198.66,94.6,,percent of total billed charges,,
VISCOAT .75ML,,57000002,LOCAL,Facility,Outpatient,,,,210,178.5,60.186,210,"Health Partners, Inc.",Medicare Advantage,102.9,49,,percent of total billed charges,,
VISCOAT .75ML,,57000002,LOCAL,Facility,Inpatient,,,,210,178.5,60.186,210,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
VISCOAT .75ML,,57000002,LOCAL,Facility,Both,,,,210,178.5,60.186,210,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),126,60,,percent of total billed charges,,
VISCOAT .75ML,,57000002,LOCAL,Facility,Both,,,,210,178.5,60.186,210,"Health Partners, Inc.",State of Minnesota Advantage Program,171.15,81.5,,percent of total billed charges,,
VISCOAT .75ML,,57000002,LOCAL,Facility,Both,,,,210,178.5,60.186,210,"Health Partners, Inc.",State Public Programs,105,50,,percent of total billed charges,,
VISCOAT .75ML,,57000002,LOCAL,Facility,Both,,,,210,178.5,60.186,210,Humana Insurance Company,Commercial PPO,199.5,95,,percent of total billed charges,,
VISCOAT .75ML,,57000002,LOCAL,Facility,Outpatient,,,,210,178.5,60.186,210,Humana Insurance Company,Medicare PPO,102.9,49,,percent of total billed charges,,
VISCOAT .75ML,,57000002,LOCAL,Facility,Inpatient,,,,210,178.5,60.186,210,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
VISCOAT .75ML,,57000002,LOCAL,Facility,Both,,,,210,178.5,60.186,210,Medica,Individual & Family,208.11,99.1,,percent of total billed charges,,
VISCOAT .75ML,,57000002,LOCAL,Facility,Outpatient,,,,210,178.5,60.186,210,Medica,Medica Advantage Solution,104.58,49.8,,percent of total billed charges,,
VISCOAT .75ML,,57000002,LOCAL,Facility,Inpatient,,,,210,178.5,60.186,210,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
VISCOAT .75ML,,57000002,LOCAL,Facility,Outpatient,,,,210,178.5,60.186,210,Medica,Medical Assistance,93.66,44.6,,percent of total billed charges,,
VISCOAT .75ML,,57000002,LOCAL,Facility,Inpatient,,,,210,178.5,60.186,210,Medica,Medical Assistance,,,,,Included in per diem rate,
VISCOAT .75ML,,57000002,LOCAL,Facility,Outpatient,,,,210,178.5,60.186,210,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,104.58,49.8,,percent of total billed charges,,
VISCOAT .75ML,,57000002,LOCAL,Facility,Inpatient,,,,210,178.5,60.186,210,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
VISCOAT .75ML,,57000002,LOCAL,Facility,Both,,,,210,178.5,60.186,210,"Multiplan, Inc.","Multiplan, Inc.",197.4,94,,percent of total billed charges,,
VISCOAT .75ML,,57000002,LOCAL,Facility,Outpatient,,,,210,178.5,60.186,210,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,189.21,90.1,,percent of total billed charges,,
VISCOAT .75ML,,57000002,LOCAL,Facility,Inpatient,,,,210,178.5,60.186,210,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
VISCOAT .75ML,,57000002,LOCAL,Facility,Both,,,,210,178.5,60.186,210,"Preferred One Administrative Services, INC.",PPO,207.06,98.6,,percent of total billed charges,,
VISCOAT .75ML,,57000002,LOCAL,Facility,Outpatient,,,,210,178.5,60.186,210,PrimeWest Health,Minnesota Senior Health Options (MSHO),108.045,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
VISCOAT .75ML,,57000002,LOCAL,Facility,Inpatient,,,,210,178.5,60.186,210,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
VISCOAT .75ML,,57000002,LOCAL,Facility,Outpatient,,,,210,178.5,60.186,210,PrimeWest Health,MinnesotaCare,107.856,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
VISCOAT .75ML,,57000002,LOCAL,Facility,Inpatient,,,,210,178.5,60.186,210,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
VISCOAT .75ML,,57000002,LOCAL,Facility,Both,,,,210,178.5,60.186,210,Sanford Health Plan,Sanford Health Plan,193.2,92,,percent of total billed charges,,
VISCOAT .75ML,,57000002,LOCAL,Facility,Outpatient,,,,210,178.5,60.186,210,"UCare Health, Inc.",Individual & Family Plan,118.335,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
VISCOAT .75ML,,57000002,LOCAL,Facility,Inpatient,,,,210,178.5,60.186,210,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
VISCOAT .75ML,,57000002,LOCAL,Facility,Outpatient,,,,210,178.5,60.186,210,"UCare Health, Inc.",Medical Assistance,105.987,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
VISCOAT .75ML,,57000002,LOCAL,Facility,Inpatient,,,,210,178.5,60.186,210,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
VISCOAT .75ML,,57000002,LOCAL,Facility,Outpatient,,,,210,178.5,60.186,210,"UCare Health, Inc.",Medicare Advantage,105.987,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
VISCOAT .75ML,,57000002,LOCAL,Facility,Inpatient,,,,210,178.5,60.186,210,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
VISCOAT .75ML,,57000002,LOCAL,Facility,Outpatient,,,,210,178.5,60.186,210,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),105.987,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
VISCOAT .75ML,,57000002,LOCAL,Facility,Inpatient,,,,210,178.5,60.186,210,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
VISCOAT .75ML,,57000002,LOCAL,Facility,Both,,,,210,178.5,60.186,210,UnitedHealthcare,Individual & Family,197.4,94,,percent of total billed charges,,
VISCOAT .75ML,,57000002,LOCAL,Facility,Outpatient,,,,210,178.5,60.186,210,UnitedHealthcare,Medicare Advantage,102.9,49,,percent of total billed charges,,
VISCOAT .75ML,,57000002,LOCAL,Facility,Inpatient,,,,210,178.5,60.186,210,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
VISCOAT .75ML,,57000002,LOCAL,Facility,Outpatient,,,,210,178.5,60.186,210,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,100.8,48,,percent of total billed charges,,100% of DHS outpatient percentage
VISCOAT .75ML,,57000002,LOCAL,Facility,Inpatient,,,,210,178.5,60.186,210,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
CRUTCHES ADULT,,57000019,LOCAL,Facility,Both,,,,42.7,36.295,12.23782,42.7,Aetna,Commercial,39.284,92,,percent of total billed charges,,
CRUTCHES ADULT,,57000019,LOCAL,Facility,Outpatient,,,,42.7,36.295,12.23782,42.7,Aetna,Medicare Advantage,20.923,49,,percent of total billed charges,,
CRUTCHES ADULT,,57000019,LOCAL,Facility,Inpatient,,,,42.7,36.295,12.23782,42.7,Aetna,Medicare Advantage,,,,,Included in per diem rate,
CRUTCHES ADULT,,57000019,LOCAL,Facility,Both,,,,42.7,36.295,12.23782,42.7,Aetna,PPO,39.711,93,,percent of total billed charges,,
CRUTCHES ADULT,,57000019,LOCAL,Facility,Both,,,,42.7,36.295,12.23782,42.7,America's PPO,America's PPO,41.00481,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
CRUTCHES ADULT,,57000019,LOCAL,Facility,Both,,,,42.7,36.295,12.23782,42.7,BlueCross BlueShield Minnesota, Federal Employee Program,42.0168,98.4,,percent of total billed charges,,
CRUTCHES ADULT,,57000019,LOCAL,Facility,Both,,,,42.7,36.295,12.23782,42.7,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,42.7,100,,percent of total billed charges,,
CRUTCHES ADULT,,57000019,LOCAL,Facility,Both,,,,42.7,36.295,12.23782,42.7,BlueCross BlueShield Minnesota,High Value Network Plan,38.43,90,,percent of total billed charges,,
CRUTCHES ADULT,,57000019,LOCAL,Facility,Outpatient,,,,42.7,36.295,12.23782,42.7,BlueCross BlueShield Minnesota,Medicare Advantage,20.923,49,,percent of total billed charges,,
CRUTCHES ADULT,,57000019,LOCAL,Facility,Inpatient,,,,42.7,36.295,12.23782,42.7,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
CRUTCHES ADULT,,57000019,LOCAL,Facility,Both,,,,42.7,36.295,12.23782,42.7,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,37.81939,88.57,,percent of total billed charges,,
CRUTCHES ADULT,,57000019,LOCAL,Facility,Both,,,,42.7,36.295,12.23782,42.7,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,12.23782,28.66,,percent of total billed charges,,
CRUTCHES ADULT,,57000019,LOCAL,Facility,Outpatient,,,,42.7,36.295,12.23782,42.7,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),20.923,49,,percent of total billed charges,,
CRUTCHES ADULT,,57000019,LOCAL,Facility,Inpatient,,,,42.7,36.295,12.23782,42.7,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
CRUTCHES ADULT,,57000019,LOCAL,Facility,Both,,,,42.7,36.295,12.23782,42.7,CorVel,Worker's Compensation,42.7,100,,percent of total billed charges,,
CRUTCHES ADULT,,57000019,LOCAL,Facility,Both,,,,42.7,36.295,12.23782,42.7,First Health Group Corporation,First Health Network,41.419,97,,percent of total billed charges,,
CRUTCHES ADULT,,57000019,LOCAL,Facility,Both,,,,42.7,36.295,12.23782,42.7,"Health Partners, Inc.",Commercial,40.3942,94.6,,percent of total billed charges,,
CRUTCHES ADULT,,57000019,LOCAL,Facility,Outpatient,,,,42.7,36.295,12.23782,42.7,"Health Partners, Inc.",Medicare Advantage,20.923,49,,percent of total billed charges,,
CRUTCHES ADULT,,57000019,LOCAL,Facility,Inpatient,,,,42.7,36.295,12.23782,42.7,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CRUTCHES ADULT,,57000019,LOCAL,Facility,Both,,,,42.7,36.295,12.23782,42.7,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),25.62,60,,percent of total billed charges,,
CRUTCHES ADULT,,57000019,LOCAL,Facility,Both,,,,42.7,36.295,12.23782,42.7,"Health Partners, Inc.",State of Minnesota Advantage Program,34.8005,81.5,,percent of total billed charges,,
CRUTCHES ADULT,,57000019,LOCAL,Facility,Both,,,,42.7,36.295,12.23782,42.7,"Health Partners, Inc.",State Public Programs,21.35,50,,percent of total billed charges,,
CRUTCHES ADULT,,57000019,LOCAL,Facility,Both,,,,42.7,36.295,12.23782,42.7,Humana Insurance Company,Commercial PPO,40.565,95,,percent of total billed charges,,
CRUTCHES ADULT,,57000019,LOCAL,Facility,Outpatient,,,,42.7,36.295,12.23782,42.7,Humana Insurance Company,Medicare PPO,20.923,49,,percent of total billed charges,,
CRUTCHES ADULT,,57000019,LOCAL,Facility,Inpatient,,,,42.7,36.295,12.23782,42.7,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
CRUTCHES ADULT,,57000019,LOCAL,Facility,Both,,,,42.7,36.295,12.23782,42.7,Medica,Individual & Family,42.3157,99.1,,percent of total billed charges,,
CRUTCHES ADULT,,57000019,LOCAL,Facility,Outpatient,,,,42.7,36.295,12.23782,42.7,Medica,Medica Advantage Solution,21.2646,49.8,,percent of total billed charges,,
CRUTCHES ADULT,,57000019,LOCAL,Facility,Inpatient,,,,42.7,36.295,12.23782,42.7,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
CRUTCHES ADULT,,57000019,LOCAL,Facility,Outpatient,,,,42.7,36.295,12.23782,42.7,Medica,Medical Assistance,19.0442,44.6,,percent of total billed charges,,
CRUTCHES ADULT,,57000019,LOCAL,Facility,Inpatient,,,,42.7,36.295,12.23782,42.7,Medica,Medical Assistance,,,,,Included in per diem rate,
CRUTCHES ADULT,,57000019,LOCAL,Facility,Outpatient,,,,42.7,36.295,12.23782,42.7,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,21.2646,49.8,,percent of total billed charges,,
CRUTCHES ADULT,,57000019,LOCAL,Facility,Inpatient,,,,42.7,36.295,12.23782,42.7,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
CRUTCHES ADULT,,57000019,LOCAL,Facility,Both,,,,42.7,36.295,12.23782,42.7,"Multiplan, Inc.","Multiplan, Inc.",40.138,94,,percent of total billed charges,,
CRUTCHES ADULT,,57000019,LOCAL,Facility,Outpatient,,,,42.7,36.295,12.23782,42.7,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,38.4727,90.1,,percent of total billed charges,,
CRUTCHES ADULT,,57000019,LOCAL,Facility,Inpatient,,,,42.7,36.295,12.23782,42.7,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
CRUTCHES ADULT,,57000019,LOCAL,Facility,Both,,,,42.7,36.295,12.23782,42.7,"Preferred One Administrative Services, INC.",PPO,42.1022,98.6,,percent of total billed charges,,
CRUTCHES ADULT,,57000019,LOCAL,Facility,Outpatient,,,,42.7,36.295,12.23782,42.7,PrimeWest Health,Minnesota Senior Health Options (MSHO),21.96915,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
CRUTCHES ADULT,,57000019,LOCAL,Facility,Inpatient,,,,42.7,36.295,12.23782,42.7,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CRUTCHES ADULT,,57000019,LOCAL,Facility,Outpatient,,,,42.7,36.295,12.23782,42.7,PrimeWest Health,MinnesotaCare,21.93072,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
CRUTCHES ADULT,,57000019,LOCAL,Facility,Inpatient,,,,42.7,36.295,12.23782,42.7,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
CRUTCHES ADULT,,57000019,LOCAL,Facility,Both,,,,42.7,36.295,12.23782,42.7,Sanford Health Plan,Sanford Health Plan,39.284,92,,percent of total billed charges,,
CRUTCHES ADULT,,57000019,LOCAL,Facility,Outpatient,,,,42.7,36.295,12.23782,42.7,"UCare Health, Inc.",Individual & Family Plan,24.06145,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
CRUTCHES ADULT,,57000019,LOCAL,Facility,Inpatient,,,,42.7,36.295,12.23782,42.7,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
CRUTCHES ADULT,,57000019,LOCAL,Facility,Outpatient,,,,42.7,36.295,12.23782,42.7,"UCare Health, Inc.",Medical Assistance,21.55069,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CRUTCHES ADULT,,57000019,LOCAL,Facility,Inpatient,,,,42.7,36.295,12.23782,42.7,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
CRUTCHES ADULT,,57000019,LOCAL,Facility,Outpatient,,,,42.7,36.295,12.23782,42.7,"UCare Health, Inc.",Medicare Advantage,21.55069,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CRUTCHES ADULT,,57000019,LOCAL,Facility,Inpatient,,,,42.7,36.295,12.23782,42.7,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CRUTCHES ADULT,,57000019,LOCAL,Facility,Outpatient,,,,42.7,36.295,12.23782,42.7,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),21.55069,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CRUTCHES ADULT,,57000019,LOCAL,Facility,Inpatient,,,,42.7,36.295,12.23782,42.7,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CRUTCHES ADULT,,57000019,LOCAL,Facility,Both,,,,42.7,36.295,12.23782,42.7,UnitedHealthcare,Individual & Family,40.138,94,,percent of total billed charges,,
CRUTCHES ADULT,,57000019,LOCAL,Facility,Outpatient,,,,42.7,36.295,12.23782,42.7,UnitedHealthcare,Medicare Advantage,20.923,49,,percent of total billed charges,,
CRUTCHES ADULT,,57000019,LOCAL,Facility,Inpatient,,,,42.7,36.295,12.23782,42.7,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
CRUTCHES ADULT,,57000019,LOCAL,Facility,Outpatient,,,,42.7,36.295,12.23782,42.7,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,20.496,48,,percent of total billed charges,,100% of DHS outpatient percentage
CRUTCHES ADULT,,57000019,LOCAL,Facility,Inpatient,,,,42.7,36.295,12.23782,42.7,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
GOWN PATIENT BEARPAW ADLT STND,,57000019,LOCAL,Facility,Both,,,,51.48,43.758,14.754168,51.48,Aetna,Commercial,47.3616,92,,percent of total billed charges,,
GOWN PATIENT BEARPAW ADLT STND,,57000019,LOCAL,Facility,Outpatient,,,,51.48,43.758,14.754168,51.48,Aetna,Medicare Advantage,25.2252,49,,percent of total billed charges,,
GOWN PATIENT BEARPAW ADLT STND,,57000019,LOCAL,Facility,Inpatient,,,,51.48,43.758,14.754168,51.48,Aetna,Medicare Advantage,,,,,Included in per diem rate,
GOWN PATIENT BEARPAW ADLT STND,,57000019,LOCAL,Facility,Both,,,,51.48,43.758,14.754168,51.48,Aetna,PPO,47.8764,93,,percent of total billed charges,,
GOWN PATIENT BEARPAW ADLT STND,,57000019,LOCAL,Facility,Both,,,,51.48,43.758,14.754168,51.48,America's PPO,America's PPO,49.436244,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
GOWN PATIENT BEARPAW ADLT STND,,57000019,LOCAL,Facility,Both,,,,51.48,43.758,14.754168,51.48,BlueCross BlueShield Minnesota, Federal Employee Program,50.65632,98.4,,percent of total billed charges,,
GOWN PATIENT BEARPAW ADLT STND,,57000019,LOCAL,Facility,Both,,,,51.48,43.758,14.754168,51.48,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,51.48,100,,percent of total billed charges,,
GOWN PATIENT BEARPAW ADLT STND,,57000019,LOCAL,Facility,Both,,,,51.48,43.758,14.754168,51.48,BlueCross BlueShield Minnesota,High Value Network Plan,46.332,90,,percent of total billed charges,,
GOWN PATIENT BEARPAW ADLT STND,,57000019,LOCAL,Facility,Outpatient,,,,51.48,43.758,14.754168,51.48,BlueCross BlueShield Minnesota,Medicare Advantage,25.2252,49,,percent of total billed charges,,
GOWN PATIENT BEARPAW ADLT STND,,57000019,LOCAL,Facility,Inpatient,,,,51.48,43.758,14.754168,51.48,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
GOWN PATIENT BEARPAW ADLT STND,,57000019,LOCAL,Facility,Both,,,,51.48,43.758,14.754168,51.48,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,45.595836,88.57,,percent of total billed charges,,
GOWN PATIENT BEARPAW ADLT STND,,57000019,LOCAL,Facility,Both,,,,51.48,43.758,14.754168,51.48,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,14.754168,28.66,,percent of total billed charges,,
GOWN PATIENT BEARPAW ADLT STND,,57000019,LOCAL,Facility,Outpatient,,,,51.48,43.758,14.754168,51.48,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),25.2252,49,,percent of total billed charges,,
GOWN PATIENT BEARPAW ADLT STND,,57000019,LOCAL,Facility,Inpatient,,,,51.48,43.758,14.754168,51.48,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
GOWN PATIENT BEARPAW ADLT STND,,57000019,LOCAL,Facility,Both,,,,51.48,43.758,14.754168,51.48,CorVel,Worker's Compensation,51.48,100,,percent of total billed charges,,
GOWN PATIENT BEARPAW ADLT STND,,57000019,LOCAL,Facility,Both,,,,51.48,43.758,14.754168,51.48,First Health Group Corporation,First Health Network,49.9356,97,,percent of total billed charges,,
GOWN PATIENT BEARPAW ADLT STND,,57000019,LOCAL,Facility,Both,,,,51.48,43.758,14.754168,51.48,"Health Partners, Inc.",Commercial,48.70008,94.6,,percent of total billed charges,,
GOWN PATIENT BEARPAW ADLT STND,,57000019,LOCAL,Facility,Outpatient,,,,51.48,43.758,14.754168,51.48,"Health Partners, Inc.",Medicare Advantage,25.2252,49,,percent of total billed charges,,
GOWN PATIENT BEARPAW ADLT STND,,57000019,LOCAL,Facility,Inpatient,,,,51.48,43.758,14.754168,51.48,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
GOWN PATIENT BEARPAW ADLT STND,,57000019,LOCAL,Facility,Both,,,,51.48,43.758,14.754168,51.48,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),30.888,60,,percent of total billed charges,,
GOWN PATIENT BEARPAW ADLT STND,,57000019,LOCAL,Facility,Both,,,,51.48,43.758,14.754168,51.48,"Health Partners, Inc.",State of Minnesota Advantage Program,41.9562,81.5,,percent of total billed charges,,
GOWN PATIENT BEARPAW ADLT STND,,57000019,LOCAL,Facility,Both,,,,51.48,43.758,14.754168,51.48,"Health Partners, Inc.",State Public Programs,25.74,50,,percent of total billed charges,,
GOWN PATIENT BEARPAW ADLT STND,,57000019,LOCAL,Facility,Both,,,,51.48,43.758,14.754168,51.48,Humana Insurance Company,Commercial PPO,48.906,95,,percent of total billed charges,,
GOWN PATIENT BEARPAW ADLT STND,,57000019,LOCAL,Facility,Outpatient,,,,51.48,43.758,14.754168,51.48,Humana Insurance Company,Medicare PPO,25.2252,49,,percent of total billed charges,,
GOWN PATIENT BEARPAW ADLT STND,,57000019,LOCAL,Facility,Inpatient,,,,51.48,43.758,14.754168,51.48,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
GOWN PATIENT BEARPAW ADLT STND,,57000019,LOCAL,Facility,Both,,,,51.48,43.758,14.754168,51.48,Medica,Individual & Family,51.01668,99.1,,percent of total billed charges,,
GOWN PATIENT BEARPAW ADLT STND,,57000019,LOCAL,Facility,Outpatient,,,,51.48,43.758,14.754168,51.48,Medica,Medica Advantage Solution,25.63704,49.8,,percent of total billed charges,,
GOWN PATIENT BEARPAW ADLT STND,,57000019,LOCAL,Facility,Inpatient,,,,51.48,43.758,14.754168,51.48,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
GOWN PATIENT BEARPAW ADLT STND,,57000019,LOCAL,Facility,Outpatient,,,,51.48,43.758,14.754168,51.48,Medica,Medical Assistance,22.96008,44.6,,percent of total billed charges,,
GOWN PATIENT BEARPAW ADLT STND,,57000019,LOCAL,Facility,Inpatient,,,,51.48,43.758,14.754168,51.48,Medica,Medical Assistance,,,,,Included in per diem rate,
GOWN PATIENT BEARPAW ADLT STND,,57000019,LOCAL,Facility,Outpatient,,,,51.48,43.758,14.754168,51.48,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,25.63704,49.8,,percent of total billed charges,,
GOWN PATIENT BEARPAW ADLT STND,,57000019,LOCAL,Facility,Inpatient,,,,51.48,43.758,14.754168,51.48,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
GOWN PATIENT BEARPAW ADLT STND,,57000019,LOCAL,Facility,Both,,,,51.48,43.758,14.754168,51.48,"Multiplan, Inc.","Multiplan, Inc.",48.3912,94,,percent of total billed charges,,
GOWN PATIENT BEARPAW ADLT STND,,57000019,LOCAL,Facility,Outpatient,,,,51.48,43.758,14.754168,51.48,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,46.38348,90.1,,percent of total billed charges,,
GOWN PATIENT BEARPAW ADLT STND,,57000019,LOCAL,Facility,Inpatient,,,,51.48,43.758,14.754168,51.48,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
GOWN PATIENT BEARPAW ADLT STND,,57000019,LOCAL,Facility,Both,,,,51.48,43.758,14.754168,51.48,"Preferred One Administrative Services, INC.",PPO,50.75928,98.6,,percent of total billed charges,,
GOWN PATIENT BEARPAW ADLT STND,,57000019,LOCAL,Facility,Outpatient,,,,51.48,43.758,14.754168,51.48,PrimeWest Health,Minnesota Senior Health Options (MSHO),26.48646,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
GOWN PATIENT BEARPAW ADLT STND,,57000019,LOCAL,Facility,Inpatient,,,,51.48,43.758,14.754168,51.48,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
GOWN PATIENT BEARPAW ADLT STND,,57000019,LOCAL,Facility,Outpatient,,,,51.48,43.758,14.754168,51.48,PrimeWest Health,MinnesotaCare,26.440128,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
GOWN PATIENT BEARPAW ADLT STND,,57000019,LOCAL,Facility,Inpatient,,,,51.48,43.758,14.754168,51.48,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
GOWN PATIENT BEARPAW ADLT STND,,57000019,LOCAL,Facility,Both,,,,51.48,43.758,14.754168,51.48,Sanford Health Plan,Sanford Health Plan,47.3616,92,,percent of total billed charges,,
GOWN PATIENT BEARPAW ADLT STND,,57000019,LOCAL,Facility,Outpatient,,,,51.48,43.758,14.754168,51.48,"UCare Health, Inc.",Individual & Family Plan,29.00898,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
GOWN PATIENT BEARPAW ADLT STND,,57000019,LOCAL,Facility,Inpatient,,,,51.48,43.758,14.754168,51.48,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
GOWN PATIENT BEARPAW ADLT STND,,57000019,LOCAL,Facility,Outpatient,,,,51.48,43.758,14.754168,51.48,"UCare Health, Inc.",Medical Assistance,25.981956,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
GOWN PATIENT BEARPAW ADLT STND,,57000019,LOCAL,Facility,Inpatient,,,,51.48,43.758,14.754168,51.48,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
GOWN PATIENT BEARPAW ADLT STND,,57000019,LOCAL,Facility,Outpatient,,,,51.48,43.758,14.754168,51.48,"UCare Health, Inc.",Medicare Advantage,25.981956,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
GOWN PATIENT BEARPAW ADLT STND,,57000019,LOCAL,Facility,Inpatient,,,,51.48,43.758,14.754168,51.48,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
GOWN PATIENT BEARPAW ADLT STND,,57000019,LOCAL,Facility,Outpatient,,,,51.48,43.758,14.754168,51.48,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),25.981956,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
GOWN PATIENT BEARPAW ADLT STND,,57000019,LOCAL,Facility,Inpatient,,,,51.48,43.758,14.754168,51.48,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
GOWN PATIENT BEARPAW ADLT STND,,57000019,LOCAL,Facility,Both,,,,51.48,43.758,14.754168,51.48,UnitedHealthcare,Individual & Family,48.3912,94,,percent of total billed charges,,
GOWN PATIENT BEARPAW ADLT STND,,57000019,LOCAL,Facility,Outpatient,,,,51.48,43.758,14.754168,51.48,UnitedHealthcare,Medicare Advantage,25.2252,49,,percent of total billed charges,,
GOWN PATIENT BEARPAW ADLT STND,,57000019,LOCAL,Facility,Inpatient,,,,51.48,43.758,14.754168,51.48,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
GOWN PATIENT BEARPAW ADLT STND,,57000019,LOCAL,Facility,Outpatient,,,,51.48,43.758,14.754168,51.48,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,24.7104,48,,percent of total billed charges,,100% of DHS outpatient percentage
GOWN PATIENT BEARPAW ADLT STND,,57000019,LOCAL,Facility,Inpatient,,,,51.48,43.758,14.754168,51.48,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
18FR CATH TRAY,,57000023,LOCAL,Facility,Both,,,,35.3,30.005,10.11698,35.3,Aetna,Commercial,32.476,92,,percent of total billed charges,,
18FR CATH TRAY,,57000023,LOCAL,Facility,Outpatient,,,,35.3,30.005,10.11698,35.3,Aetna,Medicare Advantage,17.297,49,,percent of total billed charges,,
18FR CATH TRAY,,57000023,LOCAL,Facility,Inpatient,,,,35.3,30.005,10.11698,35.3,Aetna,Medicare Advantage,,,,,Included in per diem rate,
18FR CATH TRAY,,57000023,LOCAL,Facility,Both,,,,35.3,30.005,10.11698,35.3,Aetna,PPO,32.829,93,,percent of total billed charges,,
18FR CATH TRAY,,57000023,LOCAL,Facility,Both,,,,35.3,30.005,10.11698,35.3,America's PPO,America's PPO,33.89859,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
18FR CATH TRAY,,57000023,LOCAL,Facility,Both,,,,35.3,30.005,10.11698,35.3,BlueCross BlueShield Minnesota, Federal Employee Program,34.7352,98.4,,percent of total billed charges,,
18FR CATH TRAY,,57000023,LOCAL,Facility,Both,,,,35.3,30.005,10.11698,35.3,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,35.3,100,,percent of total billed charges,,
18FR CATH TRAY,,57000023,LOCAL,Facility,Both,,,,35.3,30.005,10.11698,35.3,BlueCross BlueShield Minnesota,High Value Network Plan,31.77,90,,percent of total billed charges,,
18FR CATH TRAY,,57000023,LOCAL,Facility,Outpatient,,,,35.3,30.005,10.11698,35.3,BlueCross BlueShield Minnesota,Medicare Advantage,17.297,49,,percent of total billed charges,,
18FR CATH TRAY,,57000023,LOCAL,Facility,Inpatient,,,,35.3,30.005,10.11698,35.3,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
18FR CATH TRAY,,57000023,LOCAL,Facility,Both,,,,35.3,30.005,10.11698,35.3,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,31.26521,88.57,,percent of total billed charges,,
18FR CATH TRAY,,57000023,LOCAL,Facility,Both,,,,35.3,30.005,10.11698,35.3,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,10.11698,28.66,,percent of total billed charges,,
18FR CATH TRAY,,57000023,LOCAL,Facility,Outpatient,,,,35.3,30.005,10.11698,35.3,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),17.297,49,,percent of total billed charges,,
18FR CATH TRAY,,57000023,LOCAL,Facility,Inpatient,,,,35.3,30.005,10.11698,35.3,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
18FR CATH TRAY,,57000023,LOCAL,Facility,Both,,,,35.3,30.005,10.11698,35.3,CorVel,Worker's Compensation,35.3,100,,percent of total billed charges,,
18FR CATH TRAY,,57000023,LOCAL,Facility,Both,,,,35.3,30.005,10.11698,35.3,First Health Group Corporation,First Health Network,34.241,97,,percent of total billed charges,,
18FR CATH TRAY,,57000023,LOCAL,Facility,Both,,,,35.3,30.005,10.11698,35.3,"Health Partners, Inc.",Commercial,33.3938,94.6,,percent of total billed charges,,
18FR CATH TRAY,,57000023,LOCAL,Facility,Outpatient,,,,35.3,30.005,10.11698,35.3,"Health Partners, Inc.",Medicare Advantage,17.297,49,,percent of total billed charges,,
18FR CATH TRAY,,57000023,LOCAL,Facility,Inpatient,,,,35.3,30.005,10.11698,35.3,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
18FR CATH TRAY,,57000023,LOCAL,Facility,Both,,,,35.3,30.005,10.11698,35.3,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),21.18,60,,percent of total billed charges,,
18FR CATH TRAY,,57000023,LOCAL,Facility,Both,,,,35.3,30.005,10.11698,35.3,"Health Partners, Inc.",State of Minnesota Advantage Program,28.7695,81.5,,percent of total billed charges,,
18FR CATH TRAY,,57000023,LOCAL,Facility,Both,,,,35.3,30.005,10.11698,35.3,"Health Partners, Inc.",State Public Programs,17.65,50,,percent of total billed charges,,
18FR CATH TRAY,,57000023,LOCAL,Facility,Both,,,,35.3,30.005,10.11698,35.3,Humana Insurance Company,Commercial PPO,33.535,95,,percent of total billed charges,,
18FR CATH TRAY,,57000023,LOCAL,Facility,Outpatient,,,,35.3,30.005,10.11698,35.3,Humana Insurance Company,Medicare PPO,17.297,49,,percent of total billed charges,,
18FR CATH TRAY,,57000023,LOCAL,Facility,Inpatient,,,,35.3,30.005,10.11698,35.3,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
18FR CATH TRAY,,57000023,LOCAL,Facility,Both,,,,35.3,30.005,10.11698,35.3,Medica,Individual & Family,34.9823,99.1,,percent of total billed charges,,
18FR CATH TRAY,,57000023,LOCAL,Facility,Outpatient,,,,35.3,30.005,10.11698,35.3,Medica,Medica Advantage Solution,17.5794,49.8,,percent of total billed charges,,
18FR CATH TRAY,,57000023,LOCAL,Facility,Inpatient,,,,35.3,30.005,10.11698,35.3,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
18FR CATH TRAY,,57000023,LOCAL,Facility,Outpatient,,,,35.3,30.005,10.11698,35.3,Medica,Medical Assistance,15.7438,44.6,,percent of total billed charges,,
18FR CATH TRAY,,57000023,LOCAL,Facility,Inpatient,,,,35.3,30.005,10.11698,35.3,Medica,Medical Assistance,,,,,Included in per diem rate,
18FR CATH TRAY,,57000023,LOCAL,Facility,Outpatient,,,,35.3,30.005,10.11698,35.3,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,17.5794,49.8,,percent of total billed charges,,
18FR CATH TRAY,,57000023,LOCAL,Facility,Inpatient,,,,35.3,30.005,10.11698,35.3,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
18FR CATH TRAY,,57000023,LOCAL,Facility,Both,,,,35.3,30.005,10.11698,35.3,"Multiplan, Inc.","Multiplan, Inc.",33.182,94,,percent of total billed charges,,
18FR CATH TRAY,,57000023,LOCAL,Facility,Outpatient,,,,35.3,30.005,10.11698,35.3,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,31.8053,90.1,,percent of total billed charges,,
18FR CATH TRAY,,57000023,LOCAL,Facility,Inpatient,,,,35.3,30.005,10.11698,35.3,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
18FR CATH TRAY,,57000023,LOCAL,Facility,Both,,,,35.3,30.005,10.11698,35.3,"Preferred One Administrative Services, INC.",PPO,34.8058,98.6,,percent of total billed charges,,
18FR CATH TRAY,,57000023,LOCAL,Facility,Outpatient,,,,35.3,30.005,10.11698,35.3,PrimeWest Health,Minnesota Senior Health Options (MSHO),18.16185,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
18FR CATH TRAY,,57000023,LOCAL,Facility,Inpatient,,,,35.3,30.005,10.11698,35.3,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
18FR CATH TRAY,,57000023,LOCAL,Facility,Outpatient,,,,35.3,30.005,10.11698,35.3,PrimeWest Health,MinnesotaCare,18.13008,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
18FR CATH TRAY,,57000023,LOCAL,Facility,Inpatient,,,,35.3,30.005,10.11698,35.3,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
18FR CATH TRAY,,57000023,LOCAL,Facility,Both,,,,35.3,30.005,10.11698,35.3,Sanford Health Plan,Sanford Health Plan,32.476,92,,percent of total billed charges,,
18FR CATH TRAY,,57000023,LOCAL,Facility,Outpatient,,,,35.3,30.005,10.11698,35.3,"UCare Health, Inc.",Individual & Family Plan,19.89155,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
18FR CATH TRAY,,57000023,LOCAL,Facility,Inpatient,,,,35.3,30.005,10.11698,35.3,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
18FR CATH TRAY,,57000023,LOCAL,Facility,Outpatient,,,,35.3,30.005,10.11698,35.3,"UCare Health, Inc.",Medical Assistance,17.81591,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
18FR CATH TRAY,,57000023,LOCAL,Facility,Inpatient,,,,35.3,30.005,10.11698,35.3,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
18FR CATH TRAY,,57000023,LOCAL,Facility,Outpatient,,,,35.3,30.005,10.11698,35.3,"UCare Health, Inc.",Medicare Advantage,17.81591,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
18FR CATH TRAY,,57000023,LOCAL,Facility,Inpatient,,,,35.3,30.005,10.11698,35.3,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
18FR CATH TRAY,,57000023,LOCAL,Facility,Outpatient,,,,35.3,30.005,10.11698,35.3,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),17.81591,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
18FR CATH TRAY,,57000023,LOCAL,Facility,Inpatient,,,,35.3,30.005,10.11698,35.3,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
18FR CATH TRAY,,57000023,LOCAL,Facility,Both,,,,35.3,30.005,10.11698,35.3,UnitedHealthcare,Individual & Family,33.182,94,,percent of total billed charges,,
18FR CATH TRAY,,57000023,LOCAL,Facility,Outpatient,,,,35.3,30.005,10.11698,35.3,UnitedHealthcare,Medicare Advantage,17.297,49,,percent of total billed charges,,
18FR CATH TRAY,,57000023,LOCAL,Facility,Inpatient,,,,35.3,30.005,10.11698,35.3,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
18FR CATH TRAY,,57000023,LOCAL,Facility,Outpatient,,,,35.3,30.005,10.11698,35.3,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,16.944,48,,percent of total billed charges,,100% of DHS outpatient percentage
18FR CATH TRAY,,57000023,LOCAL,Facility,Inpatient,,,,35.3,30.005,10.11698,35.3,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
ADHESIVE CLOSURE - LIQUIBAND,,57000023,LOCAL,Facility,Both,,,,83.32,70.822,23.879512,83.32,Aetna,Commercial,76.6544,92,,percent of total billed charges,,
ADHESIVE CLOSURE - LIQUIBAND,,57000023,LOCAL,Facility,Outpatient,,,,83.32,70.822,23.879512,83.32,Aetna,Medicare Advantage,40.8268,49,,percent of total billed charges,,
ADHESIVE CLOSURE - LIQUIBAND,,57000023,LOCAL,Facility,Inpatient,,,,83.32,70.822,23.879512,83.32,Aetna,Medicare Advantage,,,,,Included in per diem rate,
ADHESIVE CLOSURE - LIQUIBAND,,57000023,LOCAL,Facility,Both,,,,83.32,70.822,23.879512,83.32,Aetna,PPO,77.4876,93,,percent of total billed charges,,
ADHESIVE CLOSURE - LIQUIBAND,,57000023,LOCAL,Facility,Both,,,,83.32,70.822,23.879512,83.32,America's PPO,America's PPO,80.012196,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
ADHESIVE CLOSURE - LIQUIBAND,,57000023,LOCAL,Facility,Both,,,,83.32,70.822,23.879512,83.32,BlueCross BlueShield Minnesota, Federal Employee Program,81.98688,98.4,,percent of total billed charges,,
ADHESIVE CLOSURE - LIQUIBAND,,57000023,LOCAL,Facility,Both,,,,83.32,70.822,23.879512,83.32,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,83.32,100,,percent of total billed charges,,
ADHESIVE CLOSURE - LIQUIBAND,,57000023,LOCAL,Facility,Both,,,,83.32,70.822,23.879512,83.32,BlueCross BlueShield Minnesota,High Value Network Plan,74.988,90,,percent of total billed charges,,
ADHESIVE CLOSURE - LIQUIBAND,,57000023,LOCAL,Facility,Outpatient,,,,83.32,70.822,23.879512,83.32,BlueCross BlueShield Minnesota,Medicare Advantage,40.8268,49,,percent of total billed charges,,
ADHESIVE CLOSURE - LIQUIBAND,,57000023,LOCAL,Facility,Inpatient,,,,83.32,70.822,23.879512,83.32,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
ADHESIVE CLOSURE - LIQUIBAND,,57000023,LOCAL,Facility,Both,,,,83.32,70.822,23.879512,83.32,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,73.796524,88.57,,percent of total billed charges,,
ADHESIVE CLOSURE - LIQUIBAND,,57000023,LOCAL,Facility,Both,,,,83.32,70.822,23.879512,83.32,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,23.879512,28.66,,percent of total billed charges,,
ADHESIVE CLOSURE - LIQUIBAND,,57000023,LOCAL,Facility,Outpatient,,,,83.32,70.822,23.879512,83.32,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),40.8268,49,,percent of total billed charges,,
ADHESIVE CLOSURE - LIQUIBAND,,57000023,LOCAL,Facility,Inpatient,,,,83.32,70.822,23.879512,83.32,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
ADHESIVE CLOSURE - LIQUIBAND,,57000023,LOCAL,Facility,Both,,,,83.32,70.822,23.879512,83.32,CorVel,Worker's Compensation,83.32,100,,percent of total billed charges,,
ADHESIVE CLOSURE - LIQUIBAND,,57000023,LOCAL,Facility,Both,,,,83.32,70.822,23.879512,83.32,First Health Group Corporation,First Health Network,80.8204,97,,percent of total billed charges,,
ADHESIVE CLOSURE - LIQUIBAND,,57000023,LOCAL,Facility,Both,,,,83.32,70.822,23.879512,83.32,"Health Partners, Inc.",Commercial,78.82072,94.6,,percent of total billed charges,,
ADHESIVE CLOSURE - LIQUIBAND,,57000023,LOCAL,Facility,Outpatient,,,,83.32,70.822,23.879512,83.32,"Health Partners, Inc.",Medicare Advantage,40.8268,49,,percent of total billed charges,,
ADHESIVE CLOSURE - LIQUIBAND,,57000023,LOCAL,Facility,Inpatient,,,,83.32,70.822,23.879512,83.32,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ADHESIVE CLOSURE - LIQUIBAND,,57000023,LOCAL,Facility,Both,,,,83.32,70.822,23.879512,83.32,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),49.992,60,,percent of total billed charges,,
ADHESIVE CLOSURE - LIQUIBAND,,57000023,LOCAL,Facility,Both,,,,83.32,70.822,23.879512,83.32,"Health Partners, Inc.",State of Minnesota Advantage Program,67.9058,81.5,,percent of total billed charges,,
ADHESIVE CLOSURE - LIQUIBAND,,57000023,LOCAL,Facility,Both,,,,83.32,70.822,23.879512,83.32,"Health Partners, Inc.",State Public Programs,41.66,50,,percent of total billed charges,,
ADHESIVE CLOSURE - LIQUIBAND,,57000023,LOCAL,Facility,Both,,,,83.32,70.822,23.879512,83.32,Humana Insurance Company,Commercial PPO,79.154,95,,percent of total billed charges,,
ADHESIVE CLOSURE - LIQUIBAND,,57000023,LOCAL,Facility,Outpatient,,,,83.32,70.822,23.879512,83.32,Humana Insurance Company,Medicare PPO,40.8268,49,,percent of total billed charges,,
ADHESIVE CLOSURE - LIQUIBAND,,57000023,LOCAL,Facility,Inpatient,,,,83.32,70.822,23.879512,83.32,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
ADHESIVE CLOSURE - LIQUIBAND,,57000023,LOCAL,Facility,Both,,,,83.32,70.822,23.879512,83.32,Medica,Individual & Family,82.57012,99.1,,percent of total billed charges,,
ADHESIVE CLOSURE - LIQUIBAND,,57000023,LOCAL,Facility,Outpatient,,,,83.32,70.822,23.879512,83.32,Medica,Medica Advantage Solution,41.49336,49.8,,percent of total billed charges,,
ADHESIVE CLOSURE - LIQUIBAND,,57000023,LOCAL,Facility,Inpatient,,,,83.32,70.822,23.879512,83.32,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
ADHESIVE CLOSURE - LIQUIBAND,,57000023,LOCAL,Facility,Outpatient,,,,83.32,70.822,23.879512,83.32,Medica,Medical Assistance,37.16072,44.6,,percent of total billed charges,,
ADHESIVE CLOSURE - LIQUIBAND,,57000023,LOCAL,Facility,Inpatient,,,,83.32,70.822,23.879512,83.32,Medica,Medical Assistance,,,,,Included in per diem rate,
ADHESIVE CLOSURE - LIQUIBAND,,57000023,LOCAL,Facility,Outpatient,,,,83.32,70.822,23.879512,83.32,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,41.49336,49.8,,percent of total billed charges,,
ADHESIVE CLOSURE - LIQUIBAND,,57000023,LOCAL,Facility,Inpatient,,,,83.32,70.822,23.879512,83.32,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
ADHESIVE CLOSURE - LIQUIBAND,,57000023,LOCAL,Facility,Both,,,,83.32,70.822,23.879512,83.32,"Multiplan, Inc.","Multiplan, Inc.",78.3208,94,,percent of total billed charges,,
ADHESIVE CLOSURE - LIQUIBAND,,57000023,LOCAL,Facility,Outpatient,,,,83.32,70.822,23.879512,83.32,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,75.07132,90.1,,percent of total billed charges,,
ADHESIVE CLOSURE - LIQUIBAND,,57000023,LOCAL,Facility,Inpatient,,,,83.32,70.822,23.879512,83.32,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
ADHESIVE CLOSURE - LIQUIBAND,,57000023,LOCAL,Facility,Both,,,,83.32,70.822,23.879512,83.32,"Preferred One Administrative Services, INC.",PPO,82.15352,98.6,,percent of total billed charges,,
ADHESIVE CLOSURE - LIQUIBAND,,57000023,LOCAL,Facility,Outpatient,,,,83.32,70.822,23.879512,83.32,PrimeWest Health,Minnesota Senior Health Options (MSHO),42.86814,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
ADHESIVE CLOSURE - LIQUIBAND,,57000023,LOCAL,Facility,Inpatient,,,,83.32,70.822,23.879512,83.32,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ADHESIVE CLOSURE - LIQUIBAND,,57000023,LOCAL,Facility,Outpatient,,,,83.32,70.822,23.879512,83.32,PrimeWest Health,MinnesotaCare,42.793152,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
ADHESIVE CLOSURE - LIQUIBAND,,57000023,LOCAL,Facility,Inpatient,,,,83.32,70.822,23.879512,83.32,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
ADHESIVE CLOSURE - LIQUIBAND,,57000023,LOCAL,Facility,Both,,,,83.32,70.822,23.879512,83.32,Sanford Health Plan,Sanford Health Plan,76.6544,92,,percent of total billed charges,,
ADHESIVE CLOSURE - LIQUIBAND,,57000023,LOCAL,Facility,Outpatient,,,,83.32,70.822,23.879512,83.32,"UCare Health, Inc.",Individual & Family Plan,46.95082,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
ADHESIVE CLOSURE - LIQUIBAND,,57000023,LOCAL,Facility,Inpatient,,,,83.32,70.822,23.879512,83.32,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
ADHESIVE CLOSURE - LIQUIBAND,,57000023,LOCAL,Facility,Outpatient,,,,83.32,70.822,23.879512,83.32,"UCare Health, Inc.",Medical Assistance,42.051604,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ADHESIVE CLOSURE - LIQUIBAND,,57000023,LOCAL,Facility,Inpatient,,,,83.32,70.822,23.879512,83.32,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
ADHESIVE CLOSURE - LIQUIBAND,,57000023,LOCAL,Facility,Outpatient,,,,83.32,70.822,23.879512,83.32,"UCare Health, Inc.",Medicare Advantage,42.051604,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ADHESIVE CLOSURE - LIQUIBAND,,57000023,LOCAL,Facility,Inpatient,,,,83.32,70.822,23.879512,83.32,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ADHESIVE CLOSURE - LIQUIBAND,,57000023,LOCAL,Facility,Outpatient,,,,83.32,70.822,23.879512,83.32,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),42.051604,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ADHESIVE CLOSURE - LIQUIBAND,,57000023,LOCAL,Facility,Inpatient,,,,83.32,70.822,23.879512,83.32,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ADHESIVE CLOSURE - LIQUIBAND,,57000023,LOCAL,Facility,Both,,,,83.32,70.822,23.879512,83.32,UnitedHealthcare,Individual & Family,78.3208,94,,percent of total billed charges,,
ADHESIVE CLOSURE - LIQUIBAND,,57000023,LOCAL,Facility,Outpatient,,,,83.32,70.822,23.879512,83.32,UnitedHealthcare,Medicare Advantage,40.8268,49,,percent of total billed charges,,
ADHESIVE CLOSURE - LIQUIBAND,,57000023,LOCAL,Facility,Inpatient,,,,83.32,70.822,23.879512,83.32,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
ADHESIVE CLOSURE - LIQUIBAND,,57000023,LOCAL,Facility,Outpatient,,,,83.32,70.822,23.879512,83.32,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,39.9936,48,,percent of total billed charges,,100% of DHS outpatient percentage
ADHESIVE CLOSURE - LIQUIBAND,,57000023,LOCAL,Facility,Inpatient,,,,83.32,70.822,23.879512,83.32,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
CATHETER SUPRAPUBIC CHIOU 20FR INTRODUCER  075920 / G15469,,57000023,LOCAL,Facility,Both,,,,350.31,297.7635,100.398846,350.31,Aetna,Commercial,322.2852,92,,percent of total billed charges,,
CATHETER SUPRAPUBIC CHIOU 20FR INTRODUCER  075920 / G15469,,57000023,LOCAL,Facility,Outpatient,,,,350.31,297.7635,100.398846,350.31,Aetna,Medicare Advantage,171.6519,49,,percent of total billed charges,,
CATHETER SUPRAPUBIC CHIOU 20FR INTRODUCER  075920 / G15469,,57000023,LOCAL,Facility,Inpatient,,,,350.31,297.7635,100.398846,350.31,Aetna,Medicare Advantage,,,,,Included in per diem rate,
CATHETER SUPRAPUBIC CHIOU 20FR INTRODUCER  075920 / G15469,,57000023,LOCAL,Facility,Both,,,,350.31,297.7635,100.398846,350.31,Aetna,PPO,325.7883,93,,percent of total billed charges,,
CATHETER SUPRAPUBIC CHIOU 20FR INTRODUCER  075920 / G15469,,57000023,LOCAL,Facility,Both,,,,350.31,297.7635,100.398846,350.31,America's PPO,America's PPO,336.402693,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
CATHETER SUPRAPUBIC CHIOU 20FR INTRODUCER  075920 / G15469,,57000023,LOCAL,Facility,Both,,,,350.31,297.7635,100.398846,350.31,BlueCross BlueShield Minnesota, Federal Employee Program,344.70504,98.4,,percent of total billed charges,,
CATHETER SUPRAPUBIC CHIOU 20FR INTRODUCER  075920 / G15469,,57000023,LOCAL,Facility,Both,,,,350.31,297.7635,100.398846,350.31,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,350.31,100,,percent of total billed charges,,
CATHETER SUPRAPUBIC CHIOU 20FR INTRODUCER  075920 / G15469,,57000023,LOCAL,Facility,Both,,,,350.31,297.7635,100.398846,350.31,BlueCross BlueShield Minnesota,High Value Network Plan,315.279,90,,percent of total billed charges,,
CATHETER SUPRAPUBIC CHIOU 20FR INTRODUCER  075920 / G15469,,57000023,LOCAL,Facility,Outpatient,,,,350.31,297.7635,100.398846,350.31,BlueCross BlueShield Minnesota,Medicare Advantage,171.6519,49,,percent of total billed charges,,
CATHETER SUPRAPUBIC CHIOU 20FR INTRODUCER  075920 / G15469,,57000023,LOCAL,Facility,Inpatient,,,,350.31,297.7635,100.398846,350.31,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
CATHETER SUPRAPUBIC CHIOU 20FR INTRODUCER  075920 / G15469,,57000023,LOCAL,Facility,Both,,,,350.31,297.7635,100.398846,350.31,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,310.269567,88.57,,percent of total billed charges,,
CATHETER SUPRAPUBIC CHIOU 20FR INTRODUCER  075920 / G15469,,57000023,LOCAL,Facility,Both,,,,350.31,297.7635,100.398846,350.31,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,100.398846,28.66,,percent of total billed charges,,
CATHETER SUPRAPUBIC CHIOU 20FR INTRODUCER  075920 / G15469,,57000023,LOCAL,Facility,Outpatient,,,,350.31,297.7635,100.398846,350.31,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),171.6519,49,,percent of total billed charges,,
CATHETER SUPRAPUBIC CHIOU 20FR INTRODUCER  075920 / G15469,,57000023,LOCAL,Facility,Inpatient,,,,350.31,297.7635,100.398846,350.31,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
CATHETER SUPRAPUBIC CHIOU 20FR INTRODUCER  075920 / G15469,,57000023,LOCAL,Facility,Both,,,,350.31,297.7635,100.398846,350.31,CorVel,Worker's Compensation,350.31,100,,percent of total billed charges,,
CATHETER SUPRAPUBIC CHIOU 20FR INTRODUCER  075920 / G15469,,57000023,LOCAL,Facility,Both,,,,350.31,297.7635,100.398846,350.31,First Health Group Corporation,First Health Network,339.8007,97,,percent of total billed charges,,
CATHETER SUPRAPUBIC CHIOU 20FR INTRODUCER  075920 / G15469,,57000023,LOCAL,Facility,Both,,,,350.31,297.7635,100.398846,350.31,"Health Partners, Inc.",Commercial,331.39326,94.6,,percent of total billed charges,,
CATHETER SUPRAPUBIC CHIOU 20FR INTRODUCER  075920 / G15469,,57000023,LOCAL,Facility,Outpatient,,,,350.31,297.7635,100.398846,350.31,"Health Partners, Inc.",Medicare Advantage,171.6519,49,,percent of total billed charges,,
CATHETER SUPRAPUBIC CHIOU 20FR INTRODUCER  075920 / G15469,,57000023,LOCAL,Facility,Inpatient,,,,350.31,297.7635,100.398846,350.31,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CATHETER SUPRAPUBIC CHIOU 20FR INTRODUCER  075920 / G15469,,57000023,LOCAL,Facility,Both,,,,350.31,297.7635,100.398846,350.31,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),210.186,60,,percent of total billed charges,,
CATHETER SUPRAPUBIC CHIOU 20FR INTRODUCER  075920 / G15469,,57000023,LOCAL,Facility,Both,,,,350.31,297.7635,100.398846,350.31,"Health Partners, Inc.",State of Minnesota Advantage Program,285.50265,81.5,,percent of total billed charges,,
CATHETER SUPRAPUBIC CHIOU 20FR INTRODUCER  075920 / G15469,,57000023,LOCAL,Facility,Both,,,,350.31,297.7635,100.398846,350.31,"Health Partners, Inc.",State Public Programs,175.155,50,,percent of total billed charges,,
CATHETER SUPRAPUBIC CHIOU 20FR INTRODUCER  075920 / G15469,,57000023,LOCAL,Facility,Both,,,,350.31,297.7635,100.398846,350.31,Humana Insurance Company,Commercial PPO,332.7945,95,,percent of total billed charges,,
CATHETER SUPRAPUBIC CHIOU 20FR INTRODUCER  075920 / G15469,,57000023,LOCAL,Facility,Outpatient,,,,350.31,297.7635,100.398846,350.31,Humana Insurance Company,Medicare PPO,171.6519,49,,percent of total billed charges,,
CATHETER SUPRAPUBIC CHIOU 20FR INTRODUCER  075920 / G15469,,57000023,LOCAL,Facility,Inpatient,,,,350.31,297.7635,100.398846,350.31,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
CATHETER SUPRAPUBIC CHIOU 20FR INTRODUCER  075920 / G15469,,57000023,LOCAL,Facility,Both,,,,350.31,297.7635,100.398846,350.31,Medica,Individual & Family,347.15721,99.1,,percent of total billed charges,,
CATHETER SUPRAPUBIC CHIOU 20FR INTRODUCER  075920 / G15469,,57000023,LOCAL,Facility,Outpatient,,,,350.31,297.7635,100.398846,350.31,Medica,Medica Advantage Solution,174.45438,49.8,,percent of total billed charges,,
CATHETER SUPRAPUBIC CHIOU 20FR INTRODUCER  075920 / G15469,,57000023,LOCAL,Facility,Inpatient,,,,350.31,297.7635,100.398846,350.31,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
CATHETER SUPRAPUBIC CHIOU 20FR INTRODUCER  075920 / G15469,,57000023,LOCAL,Facility,Outpatient,,,,350.31,297.7635,100.398846,350.31,Medica,Medical Assistance,156.23826,44.6,,percent of total billed charges,,
CATHETER SUPRAPUBIC CHIOU 20FR INTRODUCER  075920 / G15469,,57000023,LOCAL,Facility,Inpatient,,,,350.31,297.7635,100.398846,350.31,Medica,Medical Assistance,,,,,Included in per diem rate,
CATHETER SUPRAPUBIC CHIOU 20FR INTRODUCER  075920 / G15469,,57000023,LOCAL,Facility,Outpatient,,,,350.31,297.7635,100.398846,350.31,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,174.45438,49.8,,percent of total billed charges,,
CATHETER SUPRAPUBIC CHIOU 20FR INTRODUCER  075920 / G15469,,57000023,LOCAL,Facility,Inpatient,,,,350.31,297.7635,100.398846,350.31,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
CATHETER SUPRAPUBIC CHIOU 20FR INTRODUCER  075920 / G15469,,57000023,LOCAL,Facility,Both,,,,350.31,297.7635,100.398846,350.31,"Multiplan, Inc.","Multiplan, Inc.",329.2914,94,,percent of total billed charges,,
CATHETER SUPRAPUBIC CHIOU 20FR INTRODUCER  075920 / G15469,,57000023,LOCAL,Facility,Outpatient,,,,350.31,297.7635,100.398846,350.31,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,315.62931,90.1,,percent of total billed charges,,
CATHETER SUPRAPUBIC CHIOU 20FR INTRODUCER  075920 / G15469,,57000023,LOCAL,Facility,Inpatient,,,,350.31,297.7635,100.398846,350.31,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
CATHETER SUPRAPUBIC CHIOU 20FR INTRODUCER  075920 / G15469,,57000023,LOCAL,Facility,Both,,,,350.31,297.7635,100.398846,350.31,"Preferred One Administrative Services, INC.",PPO,345.40566,98.6,,percent of total billed charges,,
CATHETER SUPRAPUBIC CHIOU 20FR INTRODUCER  075920 / G15469,,57000023,LOCAL,Facility,Outpatient,,,,350.31,297.7635,100.398846,350.31,PrimeWest Health,Minnesota Senior Health Options (MSHO),180.234495,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
CATHETER SUPRAPUBIC CHIOU 20FR INTRODUCER  075920 / G15469,,57000023,LOCAL,Facility,Inpatient,,,,350.31,297.7635,100.398846,350.31,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CATHETER SUPRAPUBIC CHIOU 20FR INTRODUCER  075920 / G15469,,57000023,LOCAL,Facility,Outpatient,,,,350.31,297.7635,100.398846,350.31,PrimeWest Health,MinnesotaCare,179.919216,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
CATHETER SUPRAPUBIC CHIOU 20FR INTRODUCER  075920 / G15469,,57000023,LOCAL,Facility,Inpatient,,,,350.31,297.7635,100.398846,350.31,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
CATHETER SUPRAPUBIC CHIOU 20FR INTRODUCER  075920 / G15469,,57000023,LOCAL,Facility,Both,,,,350.31,297.7635,100.398846,350.31,Sanford Health Plan,Sanford Health Plan,322.2852,92,,percent of total billed charges,,
CATHETER SUPRAPUBIC CHIOU 20FR INTRODUCER  075920 / G15469,,57000023,LOCAL,Facility,Outpatient,,,,350.31,297.7635,100.398846,350.31,"UCare Health, Inc.",Individual & Family Plan,197.399685,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
CATHETER SUPRAPUBIC CHIOU 20FR INTRODUCER  075920 / G15469,,57000023,LOCAL,Facility,Inpatient,,,,350.31,297.7635,100.398846,350.31,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
CATHETER SUPRAPUBIC CHIOU 20FR INTRODUCER  075920 / G15469,,57000023,LOCAL,Facility,Outpatient,,,,350.31,297.7635,100.398846,350.31,"UCare Health, Inc.",Medical Assistance,176.801457,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CATHETER SUPRAPUBIC CHIOU 20FR INTRODUCER  075920 / G15469,,57000023,LOCAL,Facility,Inpatient,,,,350.31,297.7635,100.398846,350.31,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
CATHETER SUPRAPUBIC CHIOU 20FR INTRODUCER  075920 / G15469,,57000023,LOCAL,Facility,Outpatient,,,,350.31,297.7635,100.398846,350.31,"UCare Health, Inc.",Medicare Advantage,176.801457,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CATHETER SUPRAPUBIC CHIOU 20FR INTRODUCER  075920 / G15469,,57000023,LOCAL,Facility,Inpatient,,,,350.31,297.7635,100.398846,350.31,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CATHETER SUPRAPUBIC CHIOU 20FR INTRODUCER  075920 / G15469,,57000023,LOCAL,Facility,Outpatient,,,,350.31,297.7635,100.398846,350.31,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),176.801457,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CATHETER SUPRAPUBIC CHIOU 20FR INTRODUCER  075920 / G15469,,57000023,LOCAL,Facility,Inpatient,,,,350.31,297.7635,100.398846,350.31,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CATHETER SUPRAPUBIC CHIOU 20FR INTRODUCER  075920 / G15469,,57000023,LOCAL,Facility,Both,,,,350.31,297.7635,100.398846,350.31,UnitedHealthcare,Individual & Family,329.2914,94,,percent of total billed charges,,
CATHETER SUPRAPUBIC CHIOU 20FR INTRODUCER  075920 / G15469,,57000023,LOCAL,Facility,Outpatient,,,,350.31,297.7635,100.398846,350.31,UnitedHealthcare,Medicare Advantage,171.6519,49,,percent of total billed charges,,
CATHETER SUPRAPUBIC CHIOU 20FR INTRODUCER  075920 / G15469,,57000023,LOCAL,Facility,Inpatient,,,,350.31,297.7635,100.398846,350.31,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
CATHETER SUPRAPUBIC CHIOU 20FR INTRODUCER  075920 / G15469,,57000023,LOCAL,Facility,Outpatient,,,,350.31,297.7635,100.398846,350.31,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,168.1488,48,,percent of total billed charges,,100% of DHS outpatient percentage
CATHETER SUPRAPUBIC CHIOU 20FR INTRODUCER  075920 / G15469,,57000023,LOCAL,Facility,Inpatient,,,,350.31,297.7635,100.398846,350.31,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
CATHETER URETERAL TIGERTAIL FLEX TIP 5FR X 70CM BARD TRIAL  139005,,57000023,LOCAL,Facility,Both,,,,120.32,102.272,34.483712,120.32,Aetna,Commercial,110.6944,92,,percent of total billed charges,,
CATHETER URETERAL TIGERTAIL FLEX TIP 5FR X 70CM BARD TRIAL  139005,,57000023,LOCAL,Facility,Outpatient,,,,120.32,102.272,34.483712,120.32,Aetna,Medicare Advantage,58.9568,49,,percent of total billed charges,,
CATHETER URETERAL TIGERTAIL FLEX TIP 5FR X 70CM BARD TRIAL  139005,,57000023,LOCAL,Facility,Inpatient,,,,120.32,102.272,34.483712,120.32,Aetna,Medicare Advantage,,,,,Included in per diem rate,
CATHETER URETERAL TIGERTAIL FLEX TIP 5FR X 70CM BARD TRIAL  139005,,57000023,LOCAL,Facility,Both,,,,120.32,102.272,34.483712,120.32,Aetna,PPO,111.8976,93,,percent of total billed charges,,
CATHETER URETERAL TIGERTAIL FLEX TIP 5FR X 70CM BARD TRIAL  139005,,57000023,LOCAL,Facility,Both,,,,120.32,102.272,34.483712,120.32,America's PPO,America's PPO,115.543296,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
CATHETER URETERAL TIGERTAIL FLEX TIP 5FR X 70CM BARD TRIAL  139005,,57000023,LOCAL,Facility,Both,,,,120.32,102.272,34.483712,120.32,BlueCross BlueShield Minnesota, Federal Employee Program,118.39488,98.4,,percent of total billed charges,,
CATHETER URETERAL TIGERTAIL FLEX TIP 5FR X 70CM BARD TRIAL  139005,,57000023,LOCAL,Facility,Both,,,,120.32,102.272,34.483712,120.32,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,120.32,100,,percent of total billed charges,,
CATHETER URETERAL TIGERTAIL FLEX TIP 5FR X 70CM BARD TRIAL  139005,,57000023,LOCAL,Facility,Both,,,,120.32,102.272,34.483712,120.32,BlueCross BlueShield Minnesota,High Value Network Plan,108.288,90,,percent of total billed charges,,
CATHETER URETERAL TIGERTAIL FLEX TIP 5FR X 70CM BARD TRIAL  139005,,57000023,LOCAL,Facility,Outpatient,,,,120.32,102.272,34.483712,120.32,BlueCross BlueShield Minnesota,Medicare Advantage,58.9568,49,,percent of total billed charges,,
CATHETER URETERAL TIGERTAIL FLEX TIP 5FR X 70CM BARD TRIAL  139005,,57000023,LOCAL,Facility,Inpatient,,,,120.32,102.272,34.483712,120.32,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
CATHETER URETERAL TIGERTAIL FLEX TIP 5FR X 70CM BARD TRIAL  139005,,57000023,LOCAL,Facility,Both,,,,120.32,102.272,34.483712,120.32,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,106.567424,88.57,,percent of total billed charges,,
CATHETER URETERAL TIGERTAIL FLEX TIP 5FR X 70CM BARD TRIAL  139005,,57000023,LOCAL,Facility,Both,,,,120.32,102.272,34.483712,120.32,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,34.483712,28.66,,percent of total billed charges,,
CATHETER URETERAL TIGERTAIL FLEX TIP 5FR X 70CM BARD TRIAL  139005,,57000023,LOCAL,Facility,Outpatient,,,,120.32,102.272,34.483712,120.32,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),58.9568,49,,percent of total billed charges,,
CATHETER URETERAL TIGERTAIL FLEX TIP 5FR X 70CM BARD TRIAL  139005,,57000023,LOCAL,Facility,Inpatient,,,,120.32,102.272,34.483712,120.32,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
CATHETER URETERAL TIGERTAIL FLEX TIP 5FR X 70CM BARD TRIAL  139005,,57000023,LOCAL,Facility,Both,,,,120.32,102.272,34.483712,120.32,CorVel,Worker's Compensation,120.32,100,,percent of total billed charges,,
CATHETER URETERAL TIGERTAIL FLEX TIP 5FR X 70CM BARD TRIAL  139005,,57000023,LOCAL,Facility,Both,,,,120.32,102.272,34.483712,120.32,First Health Group Corporation,First Health Network,116.7104,97,,percent of total billed charges,,
CATHETER URETERAL TIGERTAIL FLEX TIP 5FR X 70CM BARD TRIAL  139005,,57000023,LOCAL,Facility,Both,,,,120.32,102.272,34.483712,120.32,"Health Partners, Inc.",Commercial,113.82272,94.6,,percent of total billed charges,,
CATHETER URETERAL TIGERTAIL FLEX TIP 5FR X 70CM BARD TRIAL  139005,,57000023,LOCAL,Facility,Outpatient,,,,120.32,102.272,34.483712,120.32,"Health Partners, Inc.",Medicare Advantage,58.9568,49,,percent of total billed charges,,
CATHETER URETERAL TIGERTAIL FLEX TIP 5FR X 70CM BARD TRIAL  139005,,57000023,LOCAL,Facility,Inpatient,,,,120.32,102.272,34.483712,120.32,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CATHETER URETERAL TIGERTAIL FLEX TIP 5FR X 70CM BARD TRIAL  139005,,57000023,LOCAL,Facility,Both,,,,120.32,102.272,34.483712,120.32,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),72.192,60,,percent of total billed charges,,
CATHETER URETERAL TIGERTAIL FLEX TIP 5FR X 70CM BARD TRIAL  139005,,57000023,LOCAL,Facility,Both,,,,120.32,102.272,34.483712,120.32,"Health Partners, Inc.",State of Minnesota Advantage Program,98.0608,81.5,,percent of total billed charges,,
CATHETER URETERAL TIGERTAIL FLEX TIP 5FR X 70CM BARD TRIAL  139005,,57000023,LOCAL,Facility,Both,,,,120.32,102.272,34.483712,120.32,"Health Partners, Inc.",State Public Programs,60.16,50,,percent of total billed charges,,
CATHETER URETERAL TIGERTAIL FLEX TIP 5FR X 70CM BARD TRIAL  139005,,57000023,LOCAL,Facility,Both,,,,120.32,102.272,34.483712,120.32,Humana Insurance Company,Commercial PPO,114.304,95,,percent of total billed charges,,
CATHETER URETERAL TIGERTAIL FLEX TIP 5FR X 70CM BARD TRIAL  139005,,57000023,LOCAL,Facility,Outpatient,,,,120.32,102.272,34.483712,120.32,Humana Insurance Company,Medicare PPO,58.9568,49,,percent of total billed charges,,
CATHETER URETERAL TIGERTAIL FLEX TIP 5FR X 70CM BARD TRIAL  139005,,57000023,LOCAL,Facility,Inpatient,,,,120.32,102.272,34.483712,120.32,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
CATHETER URETERAL TIGERTAIL FLEX TIP 5FR X 70CM BARD TRIAL  139005,,57000023,LOCAL,Facility,Both,,,,120.32,102.272,34.483712,120.32,Medica,Individual & Family,119.23712,99.1,,percent of total billed charges,,
CATHETER URETERAL TIGERTAIL FLEX TIP 5FR X 70CM BARD TRIAL  139005,,57000023,LOCAL,Facility,Outpatient,,,,120.32,102.272,34.483712,120.32,Medica,Medica Advantage Solution,59.91936,49.8,,percent of total billed charges,,
CATHETER URETERAL TIGERTAIL FLEX TIP 5FR X 70CM BARD TRIAL  139005,,57000023,LOCAL,Facility,Inpatient,,,,120.32,102.272,34.483712,120.32,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
CATHETER URETERAL TIGERTAIL FLEX TIP 5FR X 70CM BARD TRIAL  139005,,57000023,LOCAL,Facility,Outpatient,,,,120.32,102.272,34.483712,120.32,Medica,Medical Assistance,53.66272,44.6,,percent of total billed charges,,
CATHETER URETERAL TIGERTAIL FLEX TIP 5FR X 70CM BARD TRIAL  139005,,57000023,LOCAL,Facility,Inpatient,,,,120.32,102.272,34.483712,120.32,Medica,Medical Assistance,,,,,Included in per diem rate,
CATHETER URETERAL TIGERTAIL FLEX TIP 5FR X 70CM BARD TRIAL  139005,,57000023,LOCAL,Facility,Outpatient,,,,120.32,102.272,34.483712,120.32,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,59.91936,49.8,,percent of total billed charges,,
CATHETER URETERAL TIGERTAIL FLEX TIP 5FR X 70CM BARD TRIAL  139005,,57000023,LOCAL,Facility,Inpatient,,,,120.32,102.272,34.483712,120.32,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
CATHETER URETERAL TIGERTAIL FLEX TIP 5FR X 70CM BARD TRIAL  139005,,57000023,LOCAL,Facility,Both,,,,120.32,102.272,34.483712,120.32,"Multiplan, Inc.","Multiplan, Inc.",113.1008,94,,percent of total billed charges,,
CATHETER URETERAL TIGERTAIL FLEX TIP 5FR X 70CM BARD TRIAL  139005,,57000023,LOCAL,Facility,Outpatient,,,,120.32,102.272,34.483712,120.32,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,108.40832,90.1,,percent of total billed charges,,
CATHETER URETERAL TIGERTAIL FLEX TIP 5FR X 70CM BARD TRIAL  139005,,57000023,LOCAL,Facility,Inpatient,,,,120.32,102.272,34.483712,120.32,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
CATHETER URETERAL TIGERTAIL FLEX TIP 5FR X 70CM BARD TRIAL  139005,,57000023,LOCAL,Facility,Both,,,,120.32,102.272,34.483712,120.32,"Preferred One Administrative Services, INC.",PPO,118.63552,98.6,,percent of total billed charges,,
CATHETER URETERAL TIGERTAIL FLEX TIP 5FR X 70CM BARD TRIAL  139005,,57000023,LOCAL,Facility,Outpatient,,,,120.32,102.272,34.483712,120.32,PrimeWest Health,Minnesota Senior Health Options (MSHO),61.90464,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
CATHETER URETERAL TIGERTAIL FLEX TIP 5FR X 70CM BARD TRIAL  139005,,57000023,LOCAL,Facility,Inpatient,,,,120.32,102.272,34.483712,120.32,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CATHETER URETERAL TIGERTAIL FLEX TIP 5FR X 70CM BARD TRIAL  139005,,57000023,LOCAL,Facility,Outpatient,,,,120.32,102.272,34.483712,120.32,PrimeWest Health,MinnesotaCare,61.796352,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
CATHETER URETERAL TIGERTAIL FLEX TIP 5FR X 70CM BARD TRIAL  139005,,57000023,LOCAL,Facility,Inpatient,,,,120.32,102.272,34.483712,120.32,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
CATHETER URETERAL TIGERTAIL FLEX TIP 5FR X 70CM BARD TRIAL  139005,,57000023,LOCAL,Facility,Both,,,,120.32,102.272,34.483712,120.32,Sanford Health Plan,Sanford Health Plan,110.6944,92,,percent of total billed charges,,
CATHETER URETERAL TIGERTAIL FLEX TIP 5FR X 70CM BARD TRIAL  139005,,57000023,LOCAL,Facility,Outpatient,,,,120.32,102.272,34.483712,120.32,"UCare Health, Inc.",Individual & Family Plan,67.80032,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
CATHETER URETERAL TIGERTAIL FLEX TIP 5FR X 70CM BARD TRIAL  139005,,57000023,LOCAL,Facility,Inpatient,,,,120.32,102.272,34.483712,120.32,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
CATHETER URETERAL TIGERTAIL FLEX TIP 5FR X 70CM BARD TRIAL  139005,,57000023,LOCAL,Facility,Outpatient,,,,120.32,102.272,34.483712,120.32,"UCare Health, Inc.",Medical Assistance,60.725504,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CATHETER URETERAL TIGERTAIL FLEX TIP 5FR X 70CM BARD TRIAL  139005,,57000023,LOCAL,Facility,Inpatient,,,,120.32,102.272,34.483712,120.32,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
CATHETER URETERAL TIGERTAIL FLEX TIP 5FR X 70CM BARD TRIAL  139005,,57000023,LOCAL,Facility,Outpatient,,,,120.32,102.272,34.483712,120.32,"UCare Health, Inc.",Medicare Advantage,60.725504,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CATHETER URETERAL TIGERTAIL FLEX TIP 5FR X 70CM BARD TRIAL  139005,,57000023,LOCAL,Facility,Inpatient,,,,120.32,102.272,34.483712,120.32,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CATHETER URETERAL TIGERTAIL FLEX TIP 5FR X 70CM BARD TRIAL  139005,,57000023,LOCAL,Facility,Outpatient,,,,120.32,102.272,34.483712,120.32,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),60.725504,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CATHETER URETERAL TIGERTAIL FLEX TIP 5FR X 70CM BARD TRIAL  139005,,57000023,LOCAL,Facility,Inpatient,,,,120.32,102.272,34.483712,120.32,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CATHETER URETERAL TIGERTAIL FLEX TIP 5FR X 70CM BARD TRIAL  139005,,57000023,LOCAL,Facility,Both,,,,120.32,102.272,34.483712,120.32,UnitedHealthcare,Individual & Family,113.1008,94,,percent of total billed charges,,
CATHETER URETERAL TIGERTAIL FLEX TIP 5FR X 70CM BARD TRIAL  139005,,57000023,LOCAL,Facility,Outpatient,,,,120.32,102.272,34.483712,120.32,UnitedHealthcare,Medicare Advantage,58.9568,49,,percent of total billed charges,,
CATHETER URETERAL TIGERTAIL FLEX TIP 5FR X 70CM BARD TRIAL  139005,,57000023,LOCAL,Facility,Inpatient,,,,120.32,102.272,34.483712,120.32,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
CATHETER URETERAL TIGERTAIL FLEX TIP 5FR X 70CM BARD TRIAL  139005,,57000023,LOCAL,Facility,Outpatient,,,,120.32,102.272,34.483712,120.32,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,57.7536,48,,percent of total billed charges,,100% of DHS outpatient percentage
CATHETER URETERAL TIGERTAIL FLEX TIP 5FR X 70CM BARD TRIAL  139005,,57000023,LOCAL,Facility,Inpatient,,,,120.32,102.272,34.483712,120.32,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
CLEARIFY VISUALIZATION SYSTEM COVIDIEN 21-345,,57000023,LOCAL,Facility,Both,,,,210,178.5,60.186,210,Aetna,Commercial,193.2,92,,percent of total billed charges,,
CLEARIFY VISUALIZATION SYSTEM COVIDIEN 21-345,,57000023,LOCAL,Facility,Outpatient,,,,210,178.5,60.186,210,Aetna,Medicare Advantage,102.9,49,,percent of total billed charges,,
CLEARIFY VISUALIZATION SYSTEM COVIDIEN 21-345,,57000023,LOCAL,Facility,Inpatient,,,,210,178.5,60.186,210,Aetna,Medicare Advantage,,,,,Included in per diem rate,
CLEARIFY VISUALIZATION SYSTEM COVIDIEN 21-345,,57000023,LOCAL,Facility,Both,,,,210,178.5,60.186,210,Aetna,PPO,195.3,93,,percent of total billed charges,,
CLEARIFY VISUALIZATION SYSTEM COVIDIEN 21-345,,57000023,LOCAL,Facility,Both,,,,210,178.5,60.186,210,America's PPO,America's PPO,201.663,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
CLEARIFY VISUALIZATION SYSTEM COVIDIEN 21-345,,57000023,LOCAL,Facility,Both,,,,210,178.5,60.186,210,BlueCross BlueShield Minnesota, Federal Employee Program,206.64,98.4,,percent of total billed charges,,
CLEARIFY VISUALIZATION SYSTEM COVIDIEN 21-345,,57000023,LOCAL,Facility,Both,,,,210,178.5,60.186,210,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,210,100,,percent of total billed charges,,
CLEARIFY VISUALIZATION SYSTEM COVIDIEN 21-345,,57000023,LOCAL,Facility,Both,,,,210,178.5,60.186,210,BlueCross BlueShield Minnesota,High Value Network Plan,189,90,,percent of total billed charges,,
CLEARIFY VISUALIZATION SYSTEM COVIDIEN 21-345,,57000023,LOCAL,Facility,Outpatient,,,,210,178.5,60.186,210,BlueCross BlueShield Minnesota,Medicare Advantage,102.9,49,,percent of total billed charges,,
CLEARIFY VISUALIZATION SYSTEM COVIDIEN 21-345,,57000023,LOCAL,Facility,Inpatient,,,,210,178.5,60.186,210,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
CLEARIFY VISUALIZATION SYSTEM COVIDIEN 21-345,,57000023,LOCAL,Facility,Both,,,,210,178.5,60.186,210,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,185.997,88.57,,percent of total billed charges,,
CLEARIFY VISUALIZATION SYSTEM COVIDIEN 21-345,,57000023,LOCAL,Facility,Both,,,,210,178.5,60.186,210,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,60.186,28.66,,percent of total billed charges,,
CLEARIFY VISUALIZATION SYSTEM COVIDIEN 21-345,,57000023,LOCAL,Facility,Outpatient,,,,210,178.5,60.186,210,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),102.9,49,,percent of total billed charges,,
CLEARIFY VISUALIZATION SYSTEM COVIDIEN 21-345,,57000023,LOCAL,Facility,Inpatient,,,,210,178.5,60.186,210,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
CLEARIFY VISUALIZATION SYSTEM COVIDIEN 21-345,,57000023,LOCAL,Facility,Both,,,,210,178.5,60.186,210,CorVel,Worker's Compensation,210,100,,percent of total billed charges,,
CLEARIFY VISUALIZATION SYSTEM COVIDIEN 21-345,,57000023,LOCAL,Facility,Both,,,,210,178.5,60.186,210,First Health Group Corporation,First Health Network,203.7,97,,percent of total billed charges,,
CLEARIFY VISUALIZATION SYSTEM COVIDIEN 21-345,,57000023,LOCAL,Facility,Both,,,,210,178.5,60.186,210,"Health Partners, Inc.",Commercial,198.66,94.6,,percent of total billed charges,,
CLEARIFY VISUALIZATION SYSTEM COVIDIEN 21-345,,57000023,LOCAL,Facility,Outpatient,,,,210,178.5,60.186,210,"Health Partners, Inc.",Medicare Advantage,102.9,49,,percent of total billed charges,,
CLEARIFY VISUALIZATION SYSTEM COVIDIEN 21-345,,57000023,LOCAL,Facility,Inpatient,,,,210,178.5,60.186,210,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CLEARIFY VISUALIZATION SYSTEM COVIDIEN 21-345,,57000023,LOCAL,Facility,Both,,,,210,178.5,60.186,210,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),126,60,,percent of total billed charges,,
CLEARIFY VISUALIZATION SYSTEM COVIDIEN 21-345,,57000023,LOCAL,Facility,Both,,,,210,178.5,60.186,210,"Health Partners, Inc.",State of Minnesota Advantage Program,171.15,81.5,,percent of total billed charges,,
CLEARIFY VISUALIZATION SYSTEM COVIDIEN 21-345,,57000023,LOCAL,Facility,Both,,,,210,178.5,60.186,210,"Health Partners, Inc.",State Public Programs,105,50,,percent of total billed charges,,
CLEARIFY VISUALIZATION SYSTEM COVIDIEN 21-345,,57000023,LOCAL,Facility,Both,,,,210,178.5,60.186,210,Humana Insurance Company,Commercial PPO,199.5,95,,percent of total billed charges,,
CLEARIFY VISUALIZATION SYSTEM COVIDIEN 21-345,,57000023,LOCAL,Facility,Outpatient,,,,210,178.5,60.186,210,Humana Insurance Company,Medicare PPO,102.9,49,,percent of total billed charges,,
CLEARIFY VISUALIZATION SYSTEM COVIDIEN 21-345,,57000023,LOCAL,Facility,Inpatient,,,,210,178.5,60.186,210,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
CLEARIFY VISUALIZATION SYSTEM COVIDIEN 21-345,,57000023,LOCAL,Facility,Both,,,,210,178.5,60.186,210,Medica,Individual & Family,208.11,99.1,,percent of total billed charges,,
CLEARIFY VISUALIZATION SYSTEM COVIDIEN 21-345,,57000023,LOCAL,Facility,Outpatient,,,,210,178.5,60.186,210,Medica,Medica Advantage Solution,104.58,49.8,,percent of total billed charges,,
CLEARIFY VISUALIZATION SYSTEM COVIDIEN 21-345,,57000023,LOCAL,Facility,Inpatient,,,,210,178.5,60.186,210,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
CLEARIFY VISUALIZATION SYSTEM COVIDIEN 21-345,,57000023,LOCAL,Facility,Outpatient,,,,210,178.5,60.186,210,Medica,Medical Assistance,93.66,44.6,,percent of total billed charges,,
CLEARIFY VISUALIZATION SYSTEM COVIDIEN 21-345,,57000023,LOCAL,Facility,Inpatient,,,,210,178.5,60.186,210,Medica,Medical Assistance,,,,,Included in per diem rate,
CLEARIFY VISUALIZATION SYSTEM COVIDIEN 21-345,,57000023,LOCAL,Facility,Outpatient,,,,210,178.5,60.186,210,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,104.58,49.8,,percent of total billed charges,,
CLEARIFY VISUALIZATION SYSTEM COVIDIEN 21-345,,57000023,LOCAL,Facility,Inpatient,,,,210,178.5,60.186,210,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
CLEARIFY VISUALIZATION SYSTEM COVIDIEN 21-345,,57000023,LOCAL,Facility,Both,,,,210,178.5,60.186,210,"Multiplan, Inc.","Multiplan, Inc.",197.4,94,,percent of total billed charges,,
CLEARIFY VISUALIZATION SYSTEM COVIDIEN 21-345,,57000023,LOCAL,Facility,Outpatient,,,,210,178.5,60.186,210,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,189.21,90.1,,percent of total billed charges,,
CLEARIFY VISUALIZATION SYSTEM COVIDIEN 21-345,,57000023,LOCAL,Facility,Inpatient,,,,210,178.5,60.186,210,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
CLEARIFY VISUALIZATION SYSTEM COVIDIEN 21-345,,57000023,LOCAL,Facility,Both,,,,210,178.5,60.186,210,"Preferred One Administrative Services, INC.",PPO,207.06,98.6,,percent of total billed charges,,
CLEARIFY VISUALIZATION SYSTEM COVIDIEN 21-345,,57000023,LOCAL,Facility,Outpatient,,,,210,178.5,60.186,210,PrimeWest Health,Minnesota Senior Health Options (MSHO),108.045,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
CLEARIFY VISUALIZATION SYSTEM COVIDIEN 21-345,,57000023,LOCAL,Facility,Inpatient,,,,210,178.5,60.186,210,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CLEARIFY VISUALIZATION SYSTEM COVIDIEN 21-345,,57000023,LOCAL,Facility,Outpatient,,,,210,178.5,60.186,210,PrimeWest Health,MinnesotaCare,107.856,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
CLEARIFY VISUALIZATION SYSTEM COVIDIEN 21-345,,57000023,LOCAL,Facility,Inpatient,,,,210,178.5,60.186,210,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
CLEARIFY VISUALIZATION SYSTEM COVIDIEN 21-345,,57000023,LOCAL,Facility,Both,,,,210,178.5,60.186,210,Sanford Health Plan,Sanford Health Plan,193.2,92,,percent of total billed charges,,
CLEARIFY VISUALIZATION SYSTEM COVIDIEN 21-345,,57000023,LOCAL,Facility,Outpatient,,,,210,178.5,60.186,210,"UCare Health, Inc.",Individual & Family Plan,118.335,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
CLEARIFY VISUALIZATION SYSTEM COVIDIEN 21-345,,57000023,LOCAL,Facility,Inpatient,,,,210,178.5,60.186,210,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
CLEARIFY VISUALIZATION SYSTEM COVIDIEN 21-345,,57000023,LOCAL,Facility,Outpatient,,,,210,178.5,60.186,210,"UCare Health, Inc.",Medical Assistance,105.987,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CLEARIFY VISUALIZATION SYSTEM COVIDIEN 21-345,,57000023,LOCAL,Facility,Inpatient,,,,210,178.5,60.186,210,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
CLEARIFY VISUALIZATION SYSTEM COVIDIEN 21-345,,57000023,LOCAL,Facility,Outpatient,,,,210,178.5,60.186,210,"UCare Health, Inc.",Medicare Advantage,105.987,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CLEARIFY VISUALIZATION SYSTEM COVIDIEN 21-345,,57000023,LOCAL,Facility,Inpatient,,,,210,178.5,60.186,210,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CLEARIFY VISUALIZATION SYSTEM COVIDIEN 21-345,,57000023,LOCAL,Facility,Outpatient,,,,210,178.5,60.186,210,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),105.987,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CLEARIFY VISUALIZATION SYSTEM COVIDIEN 21-345,,57000023,LOCAL,Facility,Inpatient,,,,210,178.5,60.186,210,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CLEARIFY VISUALIZATION SYSTEM COVIDIEN 21-345,,57000023,LOCAL,Facility,Both,,,,210,178.5,60.186,210,UnitedHealthcare,Individual & Family,197.4,94,,percent of total billed charges,,
CLEARIFY VISUALIZATION SYSTEM COVIDIEN 21-345,,57000023,LOCAL,Facility,Outpatient,,,,210,178.5,60.186,210,UnitedHealthcare,Medicare Advantage,102.9,49,,percent of total billed charges,,
CLEARIFY VISUALIZATION SYSTEM COVIDIEN 21-345,,57000023,LOCAL,Facility,Inpatient,,,,210,178.5,60.186,210,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
CLEARIFY VISUALIZATION SYSTEM COVIDIEN 21-345,,57000023,LOCAL,Facility,Outpatient,,,,210,178.5,60.186,210,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,100.8,48,,percent of total billed charges,,100% of DHS outpatient percentage
CLEARIFY VISUALIZATION SYSTEM COVIDIEN 21-345,,57000023,LOCAL,Facility,Inpatient,,,,210,178.5,60.186,210,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
COLLAR BUTTON TUBE,,57000023,LOCAL,Facility,Both,,,,51.3,43.605,14.70258,51.3,Aetna,Commercial,47.196,92,,percent of total billed charges,,
COLLAR BUTTON TUBE,,57000023,LOCAL,Facility,Outpatient,,,,51.3,43.605,14.70258,51.3,Aetna,Medicare Advantage,25.137,49,,percent of total billed charges,,
COLLAR BUTTON TUBE,,57000023,LOCAL,Facility,Inpatient,,,,51.3,43.605,14.70258,51.3,Aetna,Medicare Advantage,,,,,Included in per diem rate,
COLLAR BUTTON TUBE,,57000023,LOCAL,Facility,Both,,,,51.3,43.605,14.70258,51.3,Aetna,PPO,47.709,93,,percent of total billed charges,,
COLLAR BUTTON TUBE,,57000023,LOCAL,Facility,Both,,,,51.3,43.605,14.70258,51.3,America's PPO,America's PPO,49.26339,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
COLLAR BUTTON TUBE,,57000023,LOCAL,Facility,Both,,,,51.3,43.605,14.70258,51.3,BlueCross BlueShield Minnesota, Federal Employee Program,50.4792,98.4,,percent of total billed charges,,
COLLAR BUTTON TUBE,,57000023,LOCAL,Facility,Both,,,,51.3,43.605,14.70258,51.3,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,51.3,100,,percent of total billed charges,,
COLLAR BUTTON TUBE,,57000023,LOCAL,Facility,Both,,,,51.3,43.605,14.70258,51.3,BlueCross BlueShield Minnesota,High Value Network Plan,46.17,90,,percent of total billed charges,,
COLLAR BUTTON TUBE,,57000023,LOCAL,Facility,Outpatient,,,,51.3,43.605,14.70258,51.3,BlueCross BlueShield Minnesota,Medicare Advantage,25.137,49,,percent of total billed charges,,
COLLAR BUTTON TUBE,,57000023,LOCAL,Facility,Inpatient,,,,51.3,43.605,14.70258,51.3,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
COLLAR BUTTON TUBE,,57000023,LOCAL,Facility,Both,,,,51.3,43.605,14.70258,51.3,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,45.43641,88.57,,percent of total billed charges,,
COLLAR BUTTON TUBE,,57000023,LOCAL,Facility,Both,,,,51.3,43.605,14.70258,51.3,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,14.70258,28.66,,percent of total billed charges,,
COLLAR BUTTON TUBE,,57000023,LOCAL,Facility,Outpatient,,,,51.3,43.605,14.70258,51.3,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),25.137,49,,percent of total billed charges,,
COLLAR BUTTON TUBE,,57000023,LOCAL,Facility,Inpatient,,,,51.3,43.605,14.70258,51.3,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
COLLAR BUTTON TUBE,,57000023,LOCAL,Facility,Both,,,,51.3,43.605,14.70258,51.3,CorVel,Worker's Compensation,51.3,100,,percent of total billed charges,,
COLLAR BUTTON TUBE,,57000023,LOCAL,Facility,Both,,,,51.3,43.605,14.70258,51.3,First Health Group Corporation,First Health Network,49.761,97,,percent of total billed charges,,
COLLAR BUTTON TUBE,,57000023,LOCAL,Facility,Both,,,,51.3,43.605,14.70258,51.3,"Health Partners, Inc.",Commercial,48.5298,94.6,,percent of total billed charges,,
COLLAR BUTTON TUBE,,57000023,LOCAL,Facility,Outpatient,,,,51.3,43.605,14.70258,51.3,"Health Partners, Inc.",Medicare Advantage,25.137,49,,percent of total billed charges,,
COLLAR BUTTON TUBE,,57000023,LOCAL,Facility,Inpatient,,,,51.3,43.605,14.70258,51.3,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
COLLAR BUTTON TUBE,,57000023,LOCAL,Facility,Both,,,,51.3,43.605,14.70258,51.3,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),30.78,60,,percent of total billed charges,,
COLLAR BUTTON TUBE,,57000023,LOCAL,Facility,Both,,,,51.3,43.605,14.70258,51.3,"Health Partners, Inc.",State of Minnesota Advantage Program,41.8095,81.5,,percent of total billed charges,,
COLLAR BUTTON TUBE,,57000023,LOCAL,Facility,Both,,,,51.3,43.605,14.70258,51.3,"Health Partners, Inc.",State Public Programs,25.65,50,,percent of total billed charges,,
COLLAR BUTTON TUBE,,57000023,LOCAL,Facility,Both,,,,51.3,43.605,14.70258,51.3,Humana Insurance Company,Commercial PPO,48.735,95,,percent of total billed charges,,
COLLAR BUTTON TUBE,,57000023,LOCAL,Facility,Outpatient,,,,51.3,43.605,14.70258,51.3,Humana Insurance Company,Medicare PPO,25.137,49,,percent of total billed charges,,
COLLAR BUTTON TUBE,,57000023,LOCAL,Facility,Inpatient,,,,51.3,43.605,14.70258,51.3,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
COLLAR BUTTON TUBE,,57000023,LOCAL,Facility,Both,,,,51.3,43.605,14.70258,51.3,Medica,Individual & Family,50.8383,99.1,,percent of total billed charges,,
COLLAR BUTTON TUBE,,57000023,LOCAL,Facility,Outpatient,,,,51.3,43.605,14.70258,51.3,Medica,Medica Advantage Solution,25.5474,49.8,,percent of total billed charges,,
COLLAR BUTTON TUBE,,57000023,LOCAL,Facility,Inpatient,,,,51.3,43.605,14.70258,51.3,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
COLLAR BUTTON TUBE,,57000023,LOCAL,Facility,Outpatient,,,,51.3,43.605,14.70258,51.3,Medica,Medical Assistance,22.8798,44.6,,percent of total billed charges,,
COLLAR BUTTON TUBE,,57000023,LOCAL,Facility,Inpatient,,,,51.3,43.605,14.70258,51.3,Medica,Medical Assistance,,,,,Included in per diem rate,
COLLAR BUTTON TUBE,,57000023,LOCAL,Facility,Outpatient,,,,51.3,43.605,14.70258,51.3,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,25.5474,49.8,,percent of total billed charges,,
COLLAR BUTTON TUBE,,57000023,LOCAL,Facility,Inpatient,,,,51.3,43.605,14.70258,51.3,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
COLLAR BUTTON TUBE,,57000023,LOCAL,Facility,Both,,,,51.3,43.605,14.70258,51.3,"Multiplan, Inc.","Multiplan, Inc.",48.222,94,,percent of total billed charges,,
COLLAR BUTTON TUBE,,57000023,LOCAL,Facility,Outpatient,,,,51.3,43.605,14.70258,51.3,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,46.2213,90.1,,percent of total billed charges,,
COLLAR BUTTON TUBE,,57000023,LOCAL,Facility,Inpatient,,,,51.3,43.605,14.70258,51.3,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
COLLAR BUTTON TUBE,,57000023,LOCAL,Facility,Both,,,,51.3,43.605,14.70258,51.3,"Preferred One Administrative Services, INC.",PPO,50.5818,98.6,,percent of total billed charges,,
COLLAR BUTTON TUBE,,57000023,LOCAL,Facility,Outpatient,,,,51.3,43.605,14.70258,51.3,PrimeWest Health,Minnesota Senior Health Options (MSHO),26.39385,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
COLLAR BUTTON TUBE,,57000023,LOCAL,Facility,Inpatient,,,,51.3,43.605,14.70258,51.3,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
COLLAR BUTTON TUBE,,57000023,LOCAL,Facility,Outpatient,,,,51.3,43.605,14.70258,51.3,PrimeWest Health,MinnesotaCare,26.34768,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
COLLAR BUTTON TUBE,,57000023,LOCAL,Facility,Inpatient,,,,51.3,43.605,14.70258,51.3,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
COLLAR BUTTON TUBE,,57000023,LOCAL,Facility,Both,,,,51.3,43.605,14.70258,51.3,Sanford Health Plan,Sanford Health Plan,47.196,92,,percent of total billed charges,,
COLLAR BUTTON TUBE,,57000023,LOCAL,Facility,Outpatient,,,,51.3,43.605,14.70258,51.3,"UCare Health, Inc.",Individual & Family Plan,28.90755,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
COLLAR BUTTON TUBE,,57000023,LOCAL,Facility,Inpatient,,,,51.3,43.605,14.70258,51.3,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
COLLAR BUTTON TUBE,,57000023,LOCAL,Facility,Outpatient,,,,51.3,43.605,14.70258,51.3,"UCare Health, Inc.",Medical Assistance,25.89111,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
COLLAR BUTTON TUBE,,57000023,LOCAL,Facility,Inpatient,,,,51.3,43.605,14.70258,51.3,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
COLLAR BUTTON TUBE,,57000023,LOCAL,Facility,Outpatient,,,,51.3,43.605,14.70258,51.3,"UCare Health, Inc.",Medicare Advantage,25.89111,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
COLLAR BUTTON TUBE,,57000023,LOCAL,Facility,Inpatient,,,,51.3,43.605,14.70258,51.3,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
COLLAR BUTTON TUBE,,57000023,LOCAL,Facility,Outpatient,,,,51.3,43.605,14.70258,51.3,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),25.89111,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
COLLAR BUTTON TUBE,,57000023,LOCAL,Facility,Inpatient,,,,51.3,43.605,14.70258,51.3,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
COLLAR BUTTON TUBE,,57000023,LOCAL,Facility,Both,,,,51.3,43.605,14.70258,51.3,UnitedHealthcare,Individual & Family,48.222,94,,percent of total billed charges,,
COLLAR BUTTON TUBE,,57000023,LOCAL,Facility,Outpatient,,,,51.3,43.605,14.70258,51.3,UnitedHealthcare,Medicare Advantage,25.137,49,,percent of total billed charges,,
COLLAR BUTTON TUBE,,57000023,LOCAL,Facility,Inpatient,,,,51.3,43.605,14.70258,51.3,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
COLLAR BUTTON TUBE,,57000023,LOCAL,Facility,Outpatient,,,,51.3,43.605,14.70258,51.3,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,24.624,48,,percent of total billed charges,,100% of DHS outpatient percentage
COLLAR BUTTON TUBE,,57000023,LOCAL,Facility,Inpatient,,,,51.3,43.605,14.70258,51.3,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
DRESSING COBAN 6 INCH,,57000023,LOCAL,Facility,Both,,,,63,53.55,18.0558,63,Aetna,Commercial,57.96,92,,percent of total billed charges,,
DRESSING COBAN 6 INCH,,57000023,LOCAL,Facility,Outpatient,,,,63,53.55,18.0558,63,Aetna,Medicare Advantage,30.87,49,,percent of total billed charges,,
DRESSING COBAN 6 INCH,,57000023,LOCAL,Facility,Inpatient,,,,63,53.55,18.0558,63,Aetna,Medicare Advantage,,,,,Included in per diem rate,
DRESSING COBAN 6 INCH,,57000023,LOCAL,Facility,Both,,,,63,53.55,18.0558,63,Aetna,PPO,58.59,93,,percent of total billed charges,,
DRESSING COBAN 6 INCH,,57000023,LOCAL,Facility,Both,,,,63,53.55,18.0558,63,America's PPO,America's PPO,60.4989,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
DRESSING COBAN 6 INCH,,57000023,LOCAL,Facility,Both,,,,63,53.55,18.0558,63,BlueCross BlueShield Minnesota, Federal Employee Program,61.992,98.4,,percent of total billed charges,,
DRESSING COBAN 6 INCH,,57000023,LOCAL,Facility,Both,,,,63,53.55,18.0558,63,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,63,100,,percent of total billed charges,,
DRESSING COBAN 6 INCH,,57000023,LOCAL,Facility,Both,,,,63,53.55,18.0558,63,BlueCross BlueShield Minnesota,High Value Network Plan,56.7,90,,percent of total billed charges,,
DRESSING COBAN 6 INCH,,57000023,LOCAL,Facility,Outpatient,,,,63,53.55,18.0558,63,BlueCross BlueShield Minnesota,Medicare Advantage,30.87,49,,percent of total billed charges,,
DRESSING COBAN 6 INCH,,57000023,LOCAL,Facility,Inpatient,,,,63,53.55,18.0558,63,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
DRESSING COBAN 6 INCH,,57000023,LOCAL,Facility,Both,,,,63,53.55,18.0558,63,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,55.7991,88.57,,percent of total billed charges,,
DRESSING COBAN 6 INCH,,57000023,LOCAL,Facility,Both,,,,63,53.55,18.0558,63,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,18.0558,28.66,,percent of total billed charges,,
DRESSING COBAN 6 INCH,,57000023,LOCAL,Facility,Outpatient,,,,63,53.55,18.0558,63,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),30.87,49,,percent of total billed charges,,
DRESSING COBAN 6 INCH,,57000023,LOCAL,Facility,Inpatient,,,,63,53.55,18.0558,63,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
DRESSING COBAN 6 INCH,,57000023,LOCAL,Facility,Both,,,,63,53.55,18.0558,63,CorVel,Worker's Compensation,63,100,,percent of total billed charges,,
DRESSING COBAN 6 INCH,,57000023,LOCAL,Facility,Both,,,,63,53.55,18.0558,63,First Health Group Corporation,First Health Network,61.11,97,,percent of total billed charges,,
DRESSING COBAN 6 INCH,,57000023,LOCAL,Facility,Both,,,,63,53.55,18.0558,63,"Health Partners, Inc.",Commercial,59.598,94.6,,percent of total billed charges,,
DRESSING COBAN 6 INCH,,57000023,LOCAL,Facility,Outpatient,,,,63,53.55,18.0558,63,"Health Partners, Inc.",Medicare Advantage,30.87,49,,percent of total billed charges,,
DRESSING COBAN 6 INCH,,57000023,LOCAL,Facility,Inpatient,,,,63,53.55,18.0558,63,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DRESSING COBAN 6 INCH,,57000023,LOCAL,Facility,Both,,,,63,53.55,18.0558,63,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),37.8,60,,percent of total billed charges,,
DRESSING COBAN 6 INCH,,57000023,LOCAL,Facility,Both,,,,63,53.55,18.0558,63,"Health Partners, Inc.",State of Minnesota Advantage Program,51.345,81.5,,percent of total billed charges,,
DRESSING COBAN 6 INCH,,57000023,LOCAL,Facility,Both,,,,63,53.55,18.0558,63,"Health Partners, Inc.",State Public Programs,31.5,50,,percent of total billed charges,,
DRESSING COBAN 6 INCH,,57000023,LOCAL,Facility,Both,,,,63,53.55,18.0558,63,Humana Insurance Company,Commercial PPO,59.85,95,,percent of total billed charges,,
DRESSING COBAN 6 INCH,,57000023,LOCAL,Facility,Outpatient,,,,63,53.55,18.0558,63,Humana Insurance Company,Medicare PPO,30.87,49,,percent of total billed charges,,
DRESSING COBAN 6 INCH,,57000023,LOCAL,Facility,Inpatient,,,,63,53.55,18.0558,63,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
DRESSING COBAN 6 INCH,,57000023,LOCAL,Facility,Both,,,,63,53.55,18.0558,63,Medica,Individual & Family,62.433,99.1,,percent of total billed charges,,
DRESSING COBAN 6 INCH,,57000023,LOCAL,Facility,Outpatient,,,,63,53.55,18.0558,63,Medica,Medica Advantage Solution,31.374,49.8,,percent of total billed charges,,
DRESSING COBAN 6 INCH,,57000023,LOCAL,Facility,Inpatient,,,,63,53.55,18.0558,63,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
DRESSING COBAN 6 INCH,,57000023,LOCAL,Facility,Outpatient,,,,63,53.55,18.0558,63,Medica,Medical Assistance,28.098,44.6,,percent of total billed charges,,
DRESSING COBAN 6 INCH,,57000023,LOCAL,Facility,Inpatient,,,,63,53.55,18.0558,63,Medica,Medical Assistance,,,,,Included in per diem rate,
DRESSING COBAN 6 INCH,,57000023,LOCAL,Facility,Outpatient,,,,63,53.55,18.0558,63,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,31.374,49.8,,percent of total billed charges,,
DRESSING COBAN 6 INCH,,57000023,LOCAL,Facility,Inpatient,,,,63,53.55,18.0558,63,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
DRESSING COBAN 6 INCH,,57000023,LOCAL,Facility,Both,,,,63,53.55,18.0558,63,"Multiplan, Inc.","Multiplan, Inc.",59.22,94,,percent of total billed charges,,
DRESSING COBAN 6 INCH,,57000023,LOCAL,Facility,Outpatient,,,,63,53.55,18.0558,63,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,56.763,90.1,,percent of total billed charges,,
DRESSING COBAN 6 INCH,,57000023,LOCAL,Facility,Inpatient,,,,63,53.55,18.0558,63,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
DRESSING COBAN 6 INCH,,57000023,LOCAL,Facility,Both,,,,63,53.55,18.0558,63,"Preferred One Administrative Services, INC.",PPO,62.118,98.6,,percent of total billed charges,,
DRESSING COBAN 6 INCH,,57000023,LOCAL,Facility,Outpatient,,,,63,53.55,18.0558,63,PrimeWest Health,Minnesota Senior Health Options (MSHO),32.4135,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
DRESSING COBAN 6 INCH,,57000023,LOCAL,Facility,Inpatient,,,,63,53.55,18.0558,63,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DRESSING COBAN 6 INCH,,57000023,LOCAL,Facility,Outpatient,,,,63,53.55,18.0558,63,PrimeWest Health,MinnesotaCare,32.3568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
DRESSING COBAN 6 INCH,,57000023,LOCAL,Facility,Inpatient,,,,63,53.55,18.0558,63,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
DRESSING COBAN 6 INCH,,57000023,LOCAL,Facility,Both,,,,63,53.55,18.0558,63,Sanford Health Plan,Sanford Health Plan,57.96,92,,percent of total billed charges,,
DRESSING COBAN 6 INCH,,57000023,LOCAL,Facility,Outpatient,,,,63,53.55,18.0558,63,"UCare Health, Inc.",Individual & Family Plan,35.5005,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
DRESSING COBAN 6 INCH,,57000023,LOCAL,Facility,Inpatient,,,,63,53.55,18.0558,63,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
DRESSING COBAN 6 INCH,,57000023,LOCAL,Facility,Outpatient,,,,63,53.55,18.0558,63,"UCare Health, Inc.",Medical Assistance,31.7961,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DRESSING COBAN 6 INCH,,57000023,LOCAL,Facility,Inpatient,,,,63,53.55,18.0558,63,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
DRESSING COBAN 6 INCH,,57000023,LOCAL,Facility,Outpatient,,,,63,53.55,18.0558,63,"UCare Health, Inc.",Medicare Advantage,31.7961,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DRESSING COBAN 6 INCH,,57000023,LOCAL,Facility,Inpatient,,,,63,53.55,18.0558,63,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DRESSING COBAN 6 INCH,,57000023,LOCAL,Facility,Outpatient,,,,63,53.55,18.0558,63,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),31.7961,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DRESSING COBAN 6 INCH,,57000023,LOCAL,Facility,Inpatient,,,,63,53.55,18.0558,63,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DRESSING COBAN 6 INCH,,57000023,LOCAL,Facility,Both,,,,63,53.55,18.0558,63,UnitedHealthcare,Individual & Family,59.22,94,,percent of total billed charges,,
DRESSING COBAN 6 INCH,,57000023,LOCAL,Facility,Outpatient,,,,63,53.55,18.0558,63,UnitedHealthcare,Medicare Advantage,30.87,49,,percent of total billed charges,,
DRESSING COBAN 6 INCH,,57000023,LOCAL,Facility,Inpatient,,,,63,53.55,18.0558,63,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
DRESSING COBAN 6 INCH,,57000023,LOCAL,Facility,Outpatient,,,,63,53.55,18.0558,63,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,30.24,48,,percent of total billed charges,,100% of DHS outpatient percentage
DRESSING COBAN 6 INCH,,57000023,LOCAL,Facility,Inpatient,,,,63,53.55,18.0558,63,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
DRESSING OPTIFOAM GENTLE 4 INCH X 10 INCH,,57000023,LOCAL,Facility,Both,,,,176.6,150.11,50.61356,176.6,Aetna,Commercial,162.472,92,,percent of total billed charges,,
DRESSING OPTIFOAM GENTLE 4 INCH X 10 INCH,,57000023,LOCAL,Facility,Outpatient,,,,176.6,150.11,50.61356,176.6,Aetna,Medicare Advantage,86.534,49,,percent of total billed charges,,
DRESSING OPTIFOAM GENTLE 4 INCH X 10 INCH,,57000023,LOCAL,Facility,Inpatient,,,,176.6,150.11,50.61356,176.6,Aetna,Medicare Advantage,,,,,Included in per diem rate,
DRESSING OPTIFOAM GENTLE 4 INCH X 10 INCH,,57000023,LOCAL,Facility,Both,,,,176.6,150.11,50.61356,176.6,Aetna,PPO,164.238,93,,percent of total billed charges,,
DRESSING OPTIFOAM GENTLE 4 INCH X 10 INCH,,57000023,LOCAL,Facility,Both,,,,176.6,150.11,50.61356,176.6,America's PPO,America's PPO,169.58898,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
DRESSING OPTIFOAM GENTLE 4 INCH X 10 INCH,,57000023,LOCAL,Facility,Both,,,,176.6,150.11,50.61356,176.6,BlueCross BlueShield Minnesota, Federal Employee Program,173.7744,98.4,,percent of total billed charges,,
DRESSING OPTIFOAM GENTLE 4 INCH X 10 INCH,,57000023,LOCAL,Facility,Both,,,,176.6,150.11,50.61356,176.6,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,176.6,100,,percent of total billed charges,,
DRESSING OPTIFOAM GENTLE 4 INCH X 10 INCH,,57000023,LOCAL,Facility,Both,,,,176.6,150.11,50.61356,176.6,BlueCross BlueShield Minnesota,High Value Network Plan,158.94,90,,percent of total billed charges,,
DRESSING OPTIFOAM GENTLE 4 INCH X 10 INCH,,57000023,LOCAL,Facility,Outpatient,,,,176.6,150.11,50.61356,176.6,BlueCross BlueShield Minnesota,Medicare Advantage,86.534,49,,percent of total billed charges,,
DRESSING OPTIFOAM GENTLE 4 INCH X 10 INCH,,57000023,LOCAL,Facility,Inpatient,,,,176.6,150.11,50.61356,176.6,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
DRESSING OPTIFOAM GENTLE 4 INCH X 10 INCH,,57000023,LOCAL,Facility,Both,,,,176.6,150.11,50.61356,176.6,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,156.41462,88.57,,percent of total billed charges,,
DRESSING OPTIFOAM GENTLE 4 INCH X 10 INCH,,57000023,LOCAL,Facility,Both,,,,176.6,150.11,50.61356,176.6,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,50.61356,28.66,,percent of total billed charges,,
DRESSING OPTIFOAM GENTLE 4 INCH X 10 INCH,,57000023,LOCAL,Facility,Outpatient,,,,176.6,150.11,50.61356,176.6,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),86.534,49,,percent of total billed charges,,
DRESSING OPTIFOAM GENTLE 4 INCH X 10 INCH,,57000023,LOCAL,Facility,Inpatient,,,,176.6,150.11,50.61356,176.6,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
DRESSING OPTIFOAM GENTLE 4 INCH X 10 INCH,,57000023,LOCAL,Facility,Both,,,,176.6,150.11,50.61356,176.6,CorVel,Worker's Compensation,176.6,100,,percent of total billed charges,,
DRESSING OPTIFOAM GENTLE 4 INCH X 10 INCH,,57000023,LOCAL,Facility,Both,,,,176.6,150.11,50.61356,176.6,First Health Group Corporation,First Health Network,171.302,97,,percent of total billed charges,,
DRESSING OPTIFOAM GENTLE 4 INCH X 10 INCH,,57000023,LOCAL,Facility,Both,,,,176.6,150.11,50.61356,176.6,"Health Partners, Inc.",Commercial,167.0636,94.6,,percent of total billed charges,,
DRESSING OPTIFOAM GENTLE 4 INCH X 10 INCH,,57000023,LOCAL,Facility,Outpatient,,,,176.6,150.11,50.61356,176.6,"Health Partners, Inc.",Medicare Advantage,86.534,49,,percent of total billed charges,,
DRESSING OPTIFOAM GENTLE 4 INCH X 10 INCH,,57000023,LOCAL,Facility,Inpatient,,,,176.6,150.11,50.61356,176.6,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DRESSING OPTIFOAM GENTLE 4 INCH X 10 INCH,,57000023,LOCAL,Facility,Both,,,,176.6,150.11,50.61356,176.6,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),105.96,60,,percent of total billed charges,,
DRESSING OPTIFOAM GENTLE 4 INCH X 10 INCH,,57000023,LOCAL,Facility,Both,,,,176.6,150.11,50.61356,176.6,"Health Partners, Inc.",State of Minnesota Advantage Program,143.929,81.5,,percent of total billed charges,,
DRESSING OPTIFOAM GENTLE 4 INCH X 10 INCH,,57000023,LOCAL,Facility,Both,,,,176.6,150.11,50.61356,176.6,"Health Partners, Inc.",State Public Programs,88.3,50,,percent of total billed charges,,
DRESSING OPTIFOAM GENTLE 4 INCH X 10 INCH,,57000023,LOCAL,Facility,Both,,,,176.6,150.11,50.61356,176.6,Humana Insurance Company,Commercial PPO,167.77,95,,percent of total billed charges,,
DRESSING OPTIFOAM GENTLE 4 INCH X 10 INCH,,57000023,LOCAL,Facility,Outpatient,,,,176.6,150.11,50.61356,176.6,Humana Insurance Company,Medicare PPO,86.534,49,,percent of total billed charges,,
DRESSING OPTIFOAM GENTLE 4 INCH X 10 INCH,,57000023,LOCAL,Facility,Inpatient,,,,176.6,150.11,50.61356,176.6,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
DRESSING OPTIFOAM GENTLE 4 INCH X 10 INCH,,57000023,LOCAL,Facility,Both,,,,176.6,150.11,50.61356,176.6,Medica,Individual & Family,175.0106,99.1,,percent of total billed charges,,
DRESSING OPTIFOAM GENTLE 4 INCH X 10 INCH,,57000023,LOCAL,Facility,Outpatient,,,,176.6,150.11,50.61356,176.6,Medica,Medica Advantage Solution,87.9468,49.8,,percent of total billed charges,,
DRESSING OPTIFOAM GENTLE 4 INCH X 10 INCH,,57000023,LOCAL,Facility,Inpatient,,,,176.6,150.11,50.61356,176.6,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
DRESSING OPTIFOAM GENTLE 4 INCH X 10 INCH,,57000023,LOCAL,Facility,Outpatient,,,,176.6,150.11,50.61356,176.6,Medica,Medical Assistance,78.7636,44.6,,percent of total billed charges,,
DRESSING OPTIFOAM GENTLE 4 INCH X 10 INCH,,57000023,LOCAL,Facility,Inpatient,,,,176.6,150.11,50.61356,176.6,Medica,Medical Assistance,,,,,Included in per diem rate,
DRESSING OPTIFOAM GENTLE 4 INCH X 10 INCH,,57000023,LOCAL,Facility,Outpatient,,,,176.6,150.11,50.61356,176.6,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,87.9468,49.8,,percent of total billed charges,,
DRESSING OPTIFOAM GENTLE 4 INCH X 10 INCH,,57000023,LOCAL,Facility,Inpatient,,,,176.6,150.11,50.61356,176.6,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
DRESSING OPTIFOAM GENTLE 4 INCH X 10 INCH,,57000023,LOCAL,Facility,Both,,,,176.6,150.11,50.61356,176.6,"Multiplan, Inc.","Multiplan, Inc.",166.004,94,,percent of total billed charges,,
DRESSING OPTIFOAM GENTLE 4 INCH X 10 INCH,,57000023,LOCAL,Facility,Outpatient,,,,176.6,150.11,50.61356,176.6,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,159.1166,90.1,,percent of total billed charges,,
DRESSING OPTIFOAM GENTLE 4 INCH X 10 INCH,,57000023,LOCAL,Facility,Inpatient,,,,176.6,150.11,50.61356,176.6,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
DRESSING OPTIFOAM GENTLE 4 INCH X 10 INCH,,57000023,LOCAL,Facility,Both,,,,176.6,150.11,50.61356,176.6,"Preferred One Administrative Services, INC.",PPO,174.1276,98.6,,percent of total billed charges,,
DRESSING OPTIFOAM GENTLE 4 INCH X 10 INCH,,57000023,LOCAL,Facility,Outpatient,,,,176.6,150.11,50.61356,176.6,PrimeWest Health,Minnesota Senior Health Options (MSHO),90.8607,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
DRESSING OPTIFOAM GENTLE 4 INCH X 10 INCH,,57000023,LOCAL,Facility,Inpatient,,,,176.6,150.11,50.61356,176.6,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DRESSING OPTIFOAM GENTLE 4 INCH X 10 INCH,,57000023,LOCAL,Facility,Outpatient,,,,176.6,150.11,50.61356,176.6,PrimeWest Health,MinnesotaCare,90.70176,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
DRESSING OPTIFOAM GENTLE 4 INCH X 10 INCH,,57000023,LOCAL,Facility,Inpatient,,,,176.6,150.11,50.61356,176.6,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
DRESSING OPTIFOAM GENTLE 4 INCH X 10 INCH,,57000023,LOCAL,Facility,Both,,,,176.6,150.11,50.61356,176.6,Sanford Health Plan,Sanford Health Plan,162.472,92,,percent of total billed charges,,
DRESSING OPTIFOAM GENTLE 4 INCH X 10 INCH,,57000023,LOCAL,Facility,Outpatient,,,,176.6,150.11,50.61356,176.6,"UCare Health, Inc.",Individual & Family Plan,99.5141,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
DRESSING OPTIFOAM GENTLE 4 INCH X 10 INCH,,57000023,LOCAL,Facility,Inpatient,,,,176.6,150.11,50.61356,176.6,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
DRESSING OPTIFOAM GENTLE 4 INCH X 10 INCH,,57000023,LOCAL,Facility,Outpatient,,,,176.6,150.11,50.61356,176.6,"UCare Health, Inc.",Medical Assistance,89.13002,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DRESSING OPTIFOAM GENTLE 4 INCH X 10 INCH,,57000023,LOCAL,Facility,Inpatient,,,,176.6,150.11,50.61356,176.6,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
DRESSING OPTIFOAM GENTLE 4 INCH X 10 INCH,,57000023,LOCAL,Facility,Outpatient,,,,176.6,150.11,50.61356,176.6,"UCare Health, Inc.",Medicare Advantage,89.13002,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DRESSING OPTIFOAM GENTLE 4 INCH X 10 INCH,,57000023,LOCAL,Facility,Inpatient,,,,176.6,150.11,50.61356,176.6,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DRESSING OPTIFOAM GENTLE 4 INCH X 10 INCH,,57000023,LOCAL,Facility,Outpatient,,,,176.6,150.11,50.61356,176.6,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),89.13002,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DRESSING OPTIFOAM GENTLE 4 INCH X 10 INCH,,57000023,LOCAL,Facility,Inpatient,,,,176.6,150.11,50.61356,176.6,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DRESSING OPTIFOAM GENTLE 4 INCH X 10 INCH,,57000023,LOCAL,Facility,Both,,,,176.6,150.11,50.61356,176.6,UnitedHealthcare,Individual & Family,166.004,94,,percent of total billed charges,,
DRESSING OPTIFOAM GENTLE 4 INCH X 10 INCH,,57000023,LOCAL,Facility,Outpatient,,,,176.6,150.11,50.61356,176.6,UnitedHealthcare,Medicare Advantage,86.534,49,,percent of total billed charges,,
DRESSING OPTIFOAM GENTLE 4 INCH X 10 INCH,,57000023,LOCAL,Facility,Inpatient,,,,176.6,150.11,50.61356,176.6,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
DRESSING OPTIFOAM GENTLE 4 INCH X 10 INCH,,57000023,LOCAL,Facility,Outpatient,,,,176.6,150.11,50.61356,176.6,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,84.768,48,,percent of total billed charges,,100% of DHS outpatient percentage
DRESSING OPTIFOAM GENTLE 4 INCH X 10 INCH,,57000023,LOCAL,Facility,Inpatient,,,,176.6,150.11,50.61356,176.6,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
DRESSING OPTIFOAM GENTLE 4 INCH X 8 INCHES,,57000023,LOCAL,Facility,Both,,,,139.04,118.184,39.848864,139.04,Aetna,Commercial,127.9168,92,,percent of total billed charges,,
DRESSING OPTIFOAM GENTLE 4 INCH X 8 INCHES,,57000023,LOCAL,Facility,Outpatient,,,,139.04,118.184,39.848864,139.04,Aetna,Medicare Advantage,68.1296,49,,percent of total billed charges,,
DRESSING OPTIFOAM GENTLE 4 INCH X 8 INCHES,,57000023,LOCAL,Facility,Inpatient,,,,139.04,118.184,39.848864,139.04,Aetna,Medicare Advantage,,,,,Included in per diem rate,
DRESSING OPTIFOAM GENTLE 4 INCH X 8 INCHES,,57000023,LOCAL,Facility,Both,,,,139.04,118.184,39.848864,139.04,Aetna,PPO,129.3072,93,,percent of total billed charges,,
DRESSING OPTIFOAM GENTLE 4 INCH X 8 INCHES,,57000023,LOCAL,Facility,Both,,,,139.04,118.184,39.848864,139.04,America's PPO,America's PPO,133.520112,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
DRESSING OPTIFOAM GENTLE 4 INCH X 8 INCHES,,57000023,LOCAL,Facility,Both,,,,139.04,118.184,39.848864,139.04,BlueCross BlueShield Minnesota, Federal Employee Program,136.81536,98.4,,percent of total billed charges,,
DRESSING OPTIFOAM GENTLE 4 INCH X 8 INCHES,,57000023,LOCAL,Facility,Both,,,,139.04,118.184,39.848864,139.04,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,139.04,100,,percent of total billed charges,,
DRESSING OPTIFOAM GENTLE 4 INCH X 8 INCHES,,57000023,LOCAL,Facility,Both,,,,139.04,118.184,39.848864,139.04,BlueCross BlueShield Minnesota,High Value Network Plan,125.136,90,,percent of total billed charges,,
DRESSING OPTIFOAM GENTLE 4 INCH X 8 INCHES,,57000023,LOCAL,Facility,Outpatient,,,,139.04,118.184,39.848864,139.04,BlueCross BlueShield Minnesota,Medicare Advantage,68.1296,49,,percent of total billed charges,,
DRESSING OPTIFOAM GENTLE 4 INCH X 8 INCHES,,57000023,LOCAL,Facility,Inpatient,,,,139.04,118.184,39.848864,139.04,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
DRESSING OPTIFOAM GENTLE 4 INCH X 8 INCHES,,57000023,LOCAL,Facility,Both,,,,139.04,118.184,39.848864,139.04,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,123.147728,88.57,,percent of total billed charges,,
DRESSING OPTIFOAM GENTLE 4 INCH X 8 INCHES,,57000023,LOCAL,Facility,Both,,,,139.04,118.184,39.848864,139.04,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,39.848864,28.66,,percent of total billed charges,,
DRESSING OPTIFOAM GENTLE 4 INCH X 8 INCHES,,57000023,LOCAL,Facility,Outpatient,,,,139.04,118.184,39.848864,139.04,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),68.1296,49,,percent of total billed charges,,
DRESSING OPTIFOAM GENTLE 4 INCH X 8 INCHES,,57000023,LOCAL,Facility,Inpatient,,,,139.04,118.184,39.848864,139.04,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
DRESSING OPTIFOAM GENTLE 4 INCH X 8 INCHES,,57000023,LOCAL,Facility,Both,,,,139.04,118.184,39.848864,139.04,CorVel,Worker's Compensation,139.04,100,,percent of total billed charges,,
DRESSING OPTIFOAM GENTLE 4 INCH X 8 INCHES,,57000023,LOCAL,Facility,Both,,,,139.04,118.184,39.848864,139.04,First Health Group Corporation,First Health Network,134.8688,97,,percent of total billed charges,,
DRESSING OPTIFOAM GENTLE 4 INCH X 8 INCHES,,57000023,LOCAL,Facility,Both,,,,139.04,118.184,39.848864,139.04,"Health Partners, Inc.",Commercial,131.53184,94.6,,percent of total billed charges,,
DRESSING OPTIFOAM GENTLE 4 INCH X 8 INCHES,,57000023,LOCAL,Facility,Outpatient,,,,139.04,118.184,39.848864,139.04,"Health Partners, Inc.",Medicare Advantage,68.1296,49,,percent of total billed charges,,
DRESSING OPTIFOAM GENTLE 4 INCH X 8 INCHES,,57000023,LOCAL,Facility,Inpatient,,,,139.04,118.184,39.848864,139.04,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DRESSING OPTIFOAM GENTLE 4 INCH X 8 INCHES,,57000023,LOCAL,Facility,Both,,,,139.04,118.184,39.848864,139.04,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),83.424,60,,percent of total billed charges,,
DRESSING OPTIFOAM GENTLE 4 INCH X 8 INCHES,,57000023,LOCAL,Facility,Both,,,,139.04,118.184,39.848864,139.04,"Health Partners, Inc.",State of Minnesota Advantage Program,113.3176,81.5,,percent of total billed charges,,
DRESSING OPTIFOAM GENTLE 4 INCH X 8 INCHES,,57000023,LOCAL,Facility,Both,,,,139.04,118.184,39.848864,139.04,"Health Partners, Inc.",State Public Programs,69.52,50,,percent of total billed charges,,
DRESSING OPTIFOAM GENTLE 4 INCH X 8 INCHES,,57000023,LOCAL,Facility,Both,,,,139.04,118.184,39.848864,139.04,Humana Insurance Company,Commercial PPO,132.088,95,,percent of total billed charges,,
DRESSING OPTIFOAM GENTLE 4 INCH X 8 INCHES,,57000023,LOCAL,Facility,Outpatient,,,,139.04,118.184,39.848864,139.04,Humana Insurance Company,Medicare PPO,68.1296,49,,percent of total billed charges,,
DRESSING OPTIFOAM GENTLE 4 INCH X 8 INCHES,,57000023,LOCAL,Facility,Inpatient,,,,139.04,118.184,39.848864,139.04,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
DRESSING OPTIFOAM GENTLE 4 INCH X 8 INCHES,,57000023,LOCAL,Facility,Both,,,,139.04,118.184,39.848864,139.04,Medica,Individual & Family,137.78864,99.1,,percent of total billed charges,,
DRESSING OPTIFOAM GENTLE 4 INCH X 8 INCHES,,57000023,LOCAL,Facility,Outpatient,,,,139.04,118.184,39.848864,139.04,Medica,Medica Advantage Solution,69.24192,49.8,,percent of total billed charges,,
DRESSING OPTIFOAM GENTLE 4 INCH X 8 INCHES,,57000023,LOCAL,Facility,Inpatient,,,,139.04,118.184,39.848864,139.04,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
DRESSING OPTIFOAM GENTLE 4 INCH X 8 INCHES,,57000023,LOCAL,Facility,Outpatient,,,,139.04,118.184,39.848864,139.04,Medica,Medical Assistance,62.01184,44.6,,percent of total billed charges,,
DRESSING OPTIFOAM GENTLE 4 INCH X 8 INCHES,,57000023,LOCAL,Facility,Inpatient,,,,139.04,118.184,39.848864,139.04,Medica,Medical Assistance,,,,,Included in per diem rate,
DRESSING OPTIFOAM GENTLE 4 INCH X 8 INCHES,,57000023,LOCAL,Facility,Outpatient,,,,139.04,118.184,39.848864,139.04,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,69.24192,49.8,,percent of total billed charges,,
DRESSING OPTIFOAM GENTLE 4 INCH X 8 INCHES,,57000023,LOCAL,Facility,Inpatient,,,,139.04,118.184,39.848864,139.04,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
DRESSING OPTIFOAM GENTLE 4 INCH X 8 INCHES,,57000023,LOCAL,Facility,Both,,,,139.04,118.184,39.848864,139.04,"Multiplan, Inc.","Multiplan, Inc.",130.6976,94,,percent of total billed charges,,
DRESSING OPTIFOAM GENTLE 4 INCH X 8 INCHES,,57000023,LOCAL,Facility,Outpatient,,,,139.04,118.184,39.848864,139.04,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,125.27504,90.1,,percent of total billed charges,,
DRESSING OPTIFOAM GENTLE 4 INCH X 8 INCHES,,57000023,LOCAL,Facility,Inpatient,,,,139.04,118.184,39.848864,139.04,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
DRESSING OPTIFOAM GENTLE 4 INCH X 8 INCHES,,57000023,LOCAL,Facility,Both,,,,139.04,118.184,39.848864,139.04,"Preferred One Administrative Services, INC.",PPO,137.09344,98.6,,percent of total billed charges,,
DRESSING OPTIFOAM GENTLE 4 INCH X 8 INCHES,,57000023,LOCAL,Facility,Outpatient,,,,139.04,118.184,39.848864,139.04,PrimeWest Health,Minnesota Senior Health Options (MSHO),71.53608,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
DRESSING OPTIFOAM GENTLE 4 INCH X 8 INCHES,,57000023,LOCAL,Facility,Inpatient,,,,139.04,118.184,39.848864,139.04,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DRESSING OPTIFOAM GENTLE 4 INCH X 8 INCHES,,57000023,LOCAL,Facility,Outpatient,,,,139.04,118.184,39.848864,139.04,PrimeWest Health,MinnesotaCare,71.410944,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
DRESSING OPTIFOAM GENTLE 4 INCH X 8 INCHES,,57000023,LOCAL,Facility,Inpatient,,,,139.04,118.184,39.848864,139.04,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
DRESSING OPTIFOAM GENTLE 4 INCH X 8 INCHES,,57000023,LOCAL,Facility,Both,,,,139.04,118.184,39.848864,139.04,Sanford Health Plan,Sanford Health Plan,127.9168,92,,percent of total billed charges,,
DRESSING OPTIFOAM GENTLE 4 INCH X 8 INCHES,,57000023,LOCAL,Facility,Outpatient,,,,139.04,118.184,39.848864,139.04,"UCare Health, Inc.",Individual & Family Plan,78.34904,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
DRESSING OPTIFOAM GENTLE 4 INCH X 8 INCHES,,57000023,LOCAL,Facility,Inpatient,,,,139.04,118.184,39.848864,139.04,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
DRESSING OPTIFOAM GENTLE 4 INCH X 8 INCHES,,57000023,LOCAL,Facility,Outpatient,,,,139.04,118.184,39.848864,139.04,"UCare Health, Inc.",Medical Assistance,70.173488,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DRESSING OPTIFOAM GENTLE 4 INCH X 8 INCHES,,57000023,LOCAL,Facility,Inpatient,,,,139.04,118.184,39.848864,139.04,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
DRESSING OPTIFOAM GENTLE 4 INCH X 8 INCHES,,57000023,LOCAL,Facility,Outpatient,,,,139.04,118.184,39.848864,139.04,"UCare Health, Inc.",Medicare Advantage,70.173488,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DRESSING OPTIFOAM GENTLE 4 INCH X 8 INCHES,,57000023,LOCAL,Facility,Inpatient,,,,139.04,118.184,39.848864,139.04,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DRESSING OPTIFOAM GENTLE 4 INCH X 8 INCHES,,57000023,LOCAL,Facility,Outpatient,,,,139.04,118.184,39.848864,139.04,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),70.173488,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DRESSING OPTIFOAM GENTLE 4 INCH X 8 INCHES,,57000023,LOCAL,Facility,Inpatient,,,,139.04,118.184,39.848864,139.04,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DRESSING OPTIFOAM GENTLE 4 INCH X 8 INCHES,,57000023,LOCAL,Facility,Both,,,,139.04,118.184,39.848864,139.04,UnitedHealthcare,Individual & Family,130.6976,94,,percent of total billed charges,,
DRESSING OPTIFOAM GENTLE 4 INCH X 8 INCHES,,57000023,LOCAL,Facility,Outpatient,,,,139.04,118.184,39.848864,139.04,UnitedHealthcare,Medicare Advantage,68.1296,49,,percent of total billed charges,,
DRESSING OPTIFOAM GENTLE 4 INCH X 8 INCHES,,57000023,LOCAL,Facility,Inpatient,,,,139.04,118.184,39.848864,139.04,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
DRESSING OPTIFOAM GENTLE 4 INCH X 8 INCHES,,57000023,LOCAL,Facility,Outpatient,,,,139.04,118.184,39.848864,139.04,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,66.7392,48,,percent of total billed charges,,100% of DHS outpatient percentage
DRESSING OPTIFOAM GENTLE 4 INCH X 8 INCHES,,57000023,LOCAL,Facility,Inpatient,,,,139.04,118.184,39.848864,139.04,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
DRESSING SPLINT DENVER NASAL SMALL/MEDIUM,,57000023,LOCAL,Facility,Both,,,,286.405,243.44425,82.083673,286.405,Aetna,Commercial,263.4926,92,,percent of total billed charges,,
DRESSING SPLINT DENVER NASAL SMALL/MEDIUM,,57000023,LOCAL,Facility,Outpatient,,,,286.405,243.44425,82.083673,286.405,Aetna,Medicare Advantage,140.33845,49,,percent of total billed charges,,
DRESSING SPLINT DENVER NASAL SMALL/MEDIUM,,57000023,LOCAL,Facility,Inpatient,,,,286.405,243.44425,82.083673,286.405,Aetna,Medicare Advantage,,,,,Included in per diem rate,
DRESSING SPLINT DENVER NASAL SMALL/MEDIUM,,57000023,LOCAL,Facility,Both,,,,286.405,243.44425,82.083673,286.405,Aetna,PPO,266.35665,93,,percent of total billed charges,,
DRESSING SPLINT DENVER NASAL SMALL/MEDIUM,,57000023,LOCAL,Facility,Both,,,,286.405,243.44425,82.083673,286.405,America's PPO,America's PPO,275.0347215,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
DRESSING SPLINT DENVER NASAL SMALL/MEDIUM,,57000023,LOCAL,Facility,Both,,,,286.405,243.44425,82.083673,286.405,BlueCross BlueShield Minnesota, Federal Employee Program,281.82252,98.4,,percent of total billed charges,,
DRESSING SPLINT DENVER NASAL SMALL/MEDIUM,,57000023,LOCAL,Facility,Both,,,,286.405,243.44425,82.083673,286.405,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,286.405,100,,percent of total billed charges,,
DRESSING SPLINT DENVER NASAL SMALL/MEDIUM,,57000023,LOCAL,Facility,Both,,,,286.405,243.44425,82.083673,286.405,BlueCross BlueShield Minnesota,High Value Network Plan,257.7645,90,,percent of total billed charges,,
DRESSING SPLINT DENVER NASAL SMALL/MEDIUM,,57000023,LOCAL,Facility,Outpatient,,,,286.405,243.44425,82.083673,286.405,BlueCross BlueShield Minnesota,Medicare Advantage,140.33845,49,,percent of total billed charges,,
DRESSING SPLINT DENVER NASAL SMALL/MEDIUM,,57000023,LOCAL,Facility,Inpatient,,,,286.405,243.44425,82.083673,286.405,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
DRESSING SPLINT DENVER NASAL SMALL/MEDIUM,,57000023,LOCAL,Facility,Both,,,,286.405,243.44425,82.083673,286.405,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,253.6689085,88.57,,percent of total billed charges,,
DRESSING SPLINT DENVER NASAL SMALL/MEDIUM,,57000023,LOCAL,Facility,Both,,,,286.405,243.44425,82.083673,286.405,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,82.083673,28.66,,percent of total billed charges,,
DRESSING SPLINT DENVER NASAL SMALL/MEDIUM,,57000023,LOCAL,Facility,Outpatient,,,,286.405,243.44425,82.083673,286.405,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),140.33845,49,,percent of total billed charges,,
DRESSING SPLINT DENVER NASAL SMALL/MEDIUM,,57000023,LOCAL,Facility,Inpatient,,,,286.405,243.44425,82.083673,286.405,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
DRESSING SPLINT DENVER NASAL SMALL/MEDIUM,,57000023,LOCAL,Facility,Both,,,,286.405,243.44425,82.083673,286.405,CorVel,Worker's Compensation,286.405,100,,percent of total billed charges,,
DRESSING SPLINT DENVER NASAL SMALL/MEDIUM,,57000023,LOCAL,Facility,Both,,,,286.405,243.44425,82.083673,286.405,First Health Group Corporation,First Health Network,277.81285,97,,percent of total billed charges,,
DRESSING SPLINT DENVER NASAL SMALL/MEDIUM,,57000023,LOCAL,Facility,Both,,,,286.405,243.44425,82.083673,286.405,"Health Partners, Inc.",Commercial,270.93913,94.6,,percent of total billed charges,,
DRESSING SPLINT DENVER NASAL SMALL/MEDIUM,,57000023,LOCAL,Facility,Outpatient,,,,286.405,243.44425,82.083673,286.405,"Health Partners, Inc.",Medicare Advantage,140.33845,49,,percent of total billed charges,,
DRESSING SPLINT DENVER NASAL SMALL/MEDIUM,,57000023,LOCAL,Facility,Inpatient,,,,286.405,243.44425,82.083673,286.405,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DRESSING SPLINT DENVER NASAL SMALL/MEDIUM,,57000023,LOCAL,Facility,Both,,,,286.405,243.44425,82.083673,286.405,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),171.843,60,,percent of total billed charges,,
DRESSING SPLINT DENVER NASAL SMALL/MEDIUM,,57000023,LOCAL,Facility,Both,,,,286.405,243.44425,82.083673,286.405,"Health Partners, Inc.",State of Minnesota Advantage Program,233.420075,81.5,,percent of total billed charges,,
DRESSING SPLINT DENVER NASAL SMALL/MEDIUM,,57000023,LOCAL,Facility,Both,,,,286.405,243.44425,82.083673,286.405,"Health Partners, Inc.",State Public Programs,143.2025,50,,percent of total billed charges,,
DRESSING SPLINT DENVER NASAL SMALL/MEDIUM,,57000023,LOCAL,Facility,Both,,,,286.405,243.44425,82.083673,286.405,Humana Insurance Company,Commercial PPO,272.08475,95,,percent of total billed charges,,
DRESSING SPLINT DENVER NASAL SMALL/MEDIUM,,57000023,LOCAL,Facility,Outpatient,,,,286.405,243.44425,82.083673,286.405,Humana Insurance Company,Medicare PPO,140.33845,49,,percent of total billed charges,,
DRESSING SPLINT DENVER NASAL SMALL/MEDIUM,,57000023,LOCAL,Facility,Inpatient,,,,286.405,243.44425,82.083673,286.405,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
DRESSING SPLINT DENVER NASAL SMALL/MEDIUM,,57000023,LOCAL,Facility,Both,,,,286.405,243.44425,82.083673,286.405,Medica,Individual & Family,283.827355,99.1,,percent of total billed charges,,
DRESSING SPLINT DENVER NASAL SMALL/MEDIUM,,57000023,LOCAL,Facility,Outpatient,,,,286.405,243.44425,82.083673,286.405,Medica,Medica Advantage Solution,142.62969,49.8,,percent of total billed charges,,
DRESSING SPLINT DENVER NASAL SMALL/MEDIUM,,57000023,LOCAL,Facility,Inpatient,,,,286.405,243.44425,82.083673,286.405,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
DRESSING SPLINT DENVER NASAL SMALL/MEDIUM,,57000023,LOCAL,Facility,Outpatient,,,,286.405,243.44425,82.083673,286.405,Medica,Medical Assistance,127.73663,44.6,,percent of total billed charges,,
DRESSING SPLINT DENVER NASAL SMALL/MEDIUM,,57000023,LOCAL,Facility,Inpatient,,,,286.405,243.44425,82.083673,286.405,Medica,Medical Assistance,,,,,Included in per diem rate,
DRESSING SPLINT DENVER NASAL SMALL/MEDIUM,,57000023,LOCAL,Facility,Outpatient,,,,286.405,243.44425,82.083673,286.405,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,142.62969,49.8,,percent of total billed charges,,
DRESSING SPLINT DENVER NASAL SMALL/MEDIUM,,57000023,LOCAL,Facility,Inpatient,,,,286.405,243.44425,82.083673,286.405,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
DRESSING SPLINT DENVER NASAL SMALL/MEDIUM,,57000023,LOCAL,Facility,Both,,,,286.405,243.44425,82.083673,286.405,"Multiplan, Inc.","Multiplan, Inc.",269.2207,94,,percent of total billed charges,,
DRESSING SPLINT DENVER NASAL SMALL/MEDIUM,,57000023,LOCAL,Facility,Outpatient,,,,286.405,243.44425,82.083673,286.405,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,258.050905,90.1,,percent of total billed charges,,
DRESSING SPLINT DENVER NASAL SMALL/MEDIUM,,57000023,LOCAL,Facility,Inpatient,,,,286.405,243.44425,82.083673,286.405,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
DRESSING SPLINT DENVER NASAL SMALL/MEDIUM,,57000023,LOCAL,Facility,Both,,,,286.405,243.44425,82.083673,286.405,"Preferred One Administrative Services, INC.",PPO,282.39533,98.6,,percent of total billed charges,,
DRESSING SPLINT DENVER NASAL SMALL/MEDIUM,,57000023,LOCAL,Facility,Outpatient,,,,286.405,243.44425,82.083673,286.405,PrimeWest Health,Minnesota Senior Health Options (MSHO),147.3553725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
DRESSING SPLINT DENVER NASAL SMALL/MEDIUM,,57000023,LOCAL,Facility,Inpatient,,,,286.405,243.44425,82.083673,286.405,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DRESSING SPLINT DENVER NASAL SMALL/MEDIUM,,57000023,LOCAL,Facility,Outpatient,,,,286.405,243.44425,82.083673,286.405,PrimeWest Health,MinnesotaCare,147.097608,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
DRESSING SPLINT DENVER NASAL SMALL/MEDIUM,,57000023,LOCAL,Facility,Inpatient,,,,286.405,243.44425,82.083673,286.405,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
DRESSING SPLINT DENVER NASAL SMALL/MEDIUM,,57000023,LOCAL,Facility,Both,,,,286.405,243.44425,82.083673,286.405,Sanford Health Plan,Sanford Health Plan,263.4926,92,,percent of total billed charges,,
DRESSING SPLINT DENVER NASAL SMALL/MEDIUM,,57000023,LOCAL,Facility,Outpatient,,,,286.405,243.44425,82.083673,286.405,"UCare Health, Inc.",Individual & Family Plan,161.3892175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
DRESSING SPLINT DENVER NASAL SMALL/MEDIUM,,57000023,LOCAL,Facility,Inpatient,,,,286.405,243.44425,82.083673,286.405,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
DRESSING SPLINT DENVER NASAL SMALL/MEDIUM,,57000023,LOCAL,Facility,Outpatient,,,,286.405,243.44425,82.083673,286.405,"UCare Health, Inc.",Medical Assistance,144.5486035,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DRESSING SPLINT DENVER NASAL SMALL/MEDIUM,,57000023,LOCAL,Facility,Inpatient,,,,286.405,243.44425,82.083673,286.405,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
DRESSING SPLINT DENVER NASAL SMALL/MEDIUM,,57000023,LOCAL,Facility,Outpatient,,,,286.405,243.44425,82.083673,286.405,"UCare Health, Inc.",Medicare Advantage,144.5486035,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DRESSING SPLINT DENVER NASAL SMALL/MEDIUM,,57000023,LOCAL,Facility,Inpatient,,,,286.405,243.44425,82.083673,286.405,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DRESSING SPLINT DENVER NASAL SMALL/MEDIUM,,57000023,LOCAL,Facility,Outpatient,,,,286.405,243.44425,82.083673,286.405,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),144.5486035,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DRESSING SPLINT DENVER NASAL SMALL/MEDIUM,,57000023,LOCAL,Facility,Inpatient,,,,286.405,243.44425,82.083673,286.405,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DRESSING SPLINT DENVER NASAL SMALL/MEDIUM,,57000023,LOCAL,Facility,Both,,,,286.405,243.44425,82.083673,286.405,UnitedHealthcare,Individual & Family,269.2207,94,,percent of total billed charges,,
DRESSING SPLINT DENVER NASAL SMALL/MEDIUM,,57000023,LOCAL,Facility,Outpatient,,,,286.405,243.44425,82.083673,286.405,UnitedHealthcare,Medicare Advantage,140.33845,49,,percent of total billed charges,,
DRESSING SPLINT DENVER NASAL SMALL/MEDIUM,,57000023,LOCAL,Facility,Inpatient,,,,286.405,243.44425,82.083673,286.405,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
DRESSING SPLINT DENVER NASAL SMALL/MEDIUM,,57000023,LOCAL,Facility,Outpatient,,,,286.405,243.44425,82.083673,286.405,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,137.4744,48,,percent of total billed charges,,100% of DHS outpatient percentage
DRESSING SPLINT DENVER NASAL SMALL/MEDIUM,,57000023,LOCAL,Facility,Inpatient,,,,286.405,243.44425,82.083673,286.405,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"DVT CALF SLEEVE, LARGE",,57000023,LOCAL,Facility,Both,,,,193.28,164.288,55.394048,193.28,Aetna,Commercial,177.8176,92,,percent of total billed charges,,
"DVT CALF SLEEVE, LARGE",,57000023,LOCAL,Facility,Outpatient,,,,193.28,164.288,55.394048,193.28,Aetna,Medicare Advantage,94.7072,49,,percent of total billed charges,,
"DVT CALF SLEEVE, LARGE",,57000023,LOCAL,Facility,Inpatient,,,,193.28,164.288,55.394048,193.28,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"DVT CALF SLEEVE, LARGE",,57000023,LOCAL,Facility,Both,,,,193.28,164.288,55.394048,193.28,Aetna,PPO,179.7504,93,,percent of total billed charges,,
"DVT CALF SLEEVE, LARGE",,57000023,LOCAL,Facility,Both,,,,193.28,164.288,55.394048,193.28,America's PPO,America's PPO,185.606784,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"DVT CALF SLEEVE, LARGE",,57000023,LOCAL,Facility,Both,,,,193.28,164.288,55.394048,193.28,BlueCross BlueShield Minnesota, Federal Employee Program,190.18752,98.4,,percent of total billed charges,,
"DVT CALF SLEEVE, LARGE",,57000023,LOCAL,Facility,Both,,,,193.28,164.288,55.394048,193.28,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,193.28,100,,percent of total billed charges,,
"DVT CALF SLEEVE, LARGE",,57000023,LOCAL,Facility,Both,,,,193.28,164.288,55.394048,193.28,BlueCross BlueShield Minnesota,High Value Network Plan,173.952,90,,percent of total billed charges,,
"DVT CALF SLEEVE, LARGE",,57000023,LOCAL,Facility,Outpatient,,,,193.28,164.288,55.394048,193.28,BlueCross BlueShield Minnesota,Medicare Advantage,94.7072,49,,percent of total billed charges,,
"DVT CALF SLEEVE, LARGE",,57000023,LOCAL,Facility,Inpatient,,,,193.28,164.288,55.394048,193.28,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"DVT CALF SLEEVE, LARGE",,57000023,LOCAL,Facility,Both,,,,193.28,164.288,55.394048,193.28,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,171.188096,88.57,,percent of total billed charges,,
"DVT CALF SLEEVE, LARGE",,57000023,LOCAL,Facility,Both,,,,193.28,164.288,55.394048,193.28,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,55.394048,28.66,,percent of total billed charges,,
"DVT CALF SLEEVE, LARGE",,57000023,LOCAL,Facility,Outpatient,,,,193.28,164.288,55.394048,193.28,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),94.7072,49,,percent of total billed charges,,
"DVT CALF SLEEVE, LARGE",,57000023,LOCAL,Facility,Inpatient,,,,193.28,164.288,55.394048,193.28,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"DVT CALF SLEEVE, LARGE",,57000023,LOCAL,Facility,Both,,,,193.28,164.288,55.394048,193.28,CorVel,Worker's Compensation,193.28,100,,percent of total billed charges,,
"DVT CALF SLEEVE, LARGE",,57000023,LOCAL,Facility,Both,,,,193.28,164.288,55.394048,193.28,First Health Group Corporation,First Health Network,187.4816,97,,percent of total billed charges,,
"DVT CALF SLEEVE, LARGE",,57000023,LOCAL,Facility,Both,,,,193.28,164.288,55.394048,193.28,"Health Partners, Inc.",Commercial,182.84288,94.6,,percent of total billed charges,,
"DVT CALF SLEEVE, LARGE",,57000023,LOCAL,Facility,Outpatient,,,,193.28,164.288,55.394048,193.28,"Health Partners, Inc.",Medicare Advantage,94.7072,49,,percent of total billed charges,,
"DVT CALF SLEEVE, LARGE",,57000023,LOCAL,Facility,Inpatient,,,,193.28,164.288,55.394048,193.28,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"DVT CALF SLEEVE, LARGE",,57000023,LOCAL,Facility,Both,,,,193.28,164.288,55.394048,193.28,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),115.968,60,,percent of total billed charges,,
"DVT CALF SLEEVE, LARGE",,57000023,LOCAL,Facility,Both,,,,193.28,164.288,55.394048,193.28,"Health Partners, Inc.",State of Minnesota Advantage Program,157.5232,81.5,,percent of total billed charges,,
"DVT CALF SLEEVE, LARGE",,57000023,LOCAL,Facility,Both,,,,193.28,164.288,55.394048,193.28,"Health Partners, Inc.",State Public Programs,96.64,50,,percent of total billed charges,,
"DVT CALF SLEEVE, LARGE",,57000023,LOCAL,Facility,Both,,,,193.28,164.288,55.394048,193.28,Humana Insurance Company,Commercial PPO,183.616,95,,percent of total billed charges,,
"DVT CALF SLEEVE, LARGE",,57000023,LOCAL,Facility,Outpatient,,,,193.28,164.288,55.394048,193.28,Humana Insurance Company,Medicare PPO,94.7072,49,,percent of total billed charges,,
"DVT CALF SLEEVE, LARGE",,57000023,LOCAL,Facility,Inpatient,,,,193.28,164.288,55.394048,193.28,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"DVT CALF SLEEVE, LARGE",,57000023,LOCAL,Facility,Both,,,,193.28,164.288,55.394048,193.28,Medica,Individual & Family,191.54048,99.1,,percent of total billed charges,,
"DVT CALF SLEEVE, LARGE",,57000023,LOCAL,Facility,Outpatient,,,,193.28,164.288,55.394048,193.28,Medica,Medica Advantage Solution,96.25344,49.8,,percent of total billed charges,,
"DVT CALF SLEEVE, LARGE",,57000023,LOCAL,Facility,Inpatient,,,,193.28,164.288,55.394048,193.28,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"DVT CALF SLEEVE, LARGE",,57000023,LOCAL,Facility,Outpatient,,,,193.28,164.288,55.394048,193.28,Medica,Medical Assistance,86.20288,44.6,,percent of total billed charges,,
"DVT CALF SLEEVE, LARGE",,57000023,LOCAL,Facility,Inpatient,,,,193.28,164.288,55.394048,193.28,Medica,Medical Assistance,,,,,Included in per diem rate,
"DVT CALF SLEEVE, LARGE",,57000023,LOCAL,Facility,Outpatient,,,,193.28,164.288,55.394048,193.28,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,96.25344,49.8,,percent of total billed charges,,
"DVT CALF SLEEVE, LARGE",,57000023,LOCAL,Facility,Inpatient,,,,193.28,164.288,55.394048,193.28,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"DVT CALF SLEEVE, LARGE",,57000023,LOCAL,Facility,Both,,,,193.28,164.288,55.394048,193.28,"Multiplan, Inc.","Multiplan, Inc.",181.6832,94,,percent of total billed charges,,
"DVT CALF SLEEVE, LARGE",,57000023,LOCAL,Facility,Outpatient,,,,193.28,164.288,55.394048,193.28,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,174.14528,90.1,,percent of total billed charges,,
"DVT CALF SLEEVE, LARGE",,57000023,LOCAL,Facility,Inpatient,,,,193.28,164.288,55.394048,193.28,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"DVT CALF SLEEVE, LARGE",,57000023,LOCAL,Facility,Both,,,,193.28,164.288,55.394048,193.28,"Preferred One Administrative Services, INC.",PPO,190.57408,98.6,,percent of total billed charges,,
"DVT CALF SLEEVE, LARGE",,57000023,LOCAL,Facility,Outpatient,,,,193.28,164.288,55.394048,193.28,PrimeWest Health,Minnesota Senior Health Options (MSHO),99.44256,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"DVT CALF SLEEVE, LARGE",,57000023,LOCAL,Facility,Inpatient,,,,193.28,164.288,55.394048,193.28,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"DVT CALF SLEEVE, LARGE",,57000023,LOCAL,Facility,Outpatient,,,,193.28,164.288,55.394048,193.28,PrimeWest Health,MinnesotaCare,99.268608,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"DVT CALF SLEEVE, LARGE",,57000023,LOCAL,Facility,Inpatient,,,,193.28,164.288,55.394048,193.28,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"DVT CALF SLEEVE, LARGE",,57000023,LOCAL,Facility,Both,,,,193.28,164.288,55.394048,193.28,Sanford Health Plan,Sanford Health Plan,177.8176,92,,percent of total billed charges,,
"DVT CALF SLEEVE, LARGE",,57000023,LOCAL,Facility,Outpatient,,,,193.28,164.288,55.394048,193.28,"UCare Health, Inc.",Individual & Family Plan,108.91328,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"DVT CALF SLEEVE, LARGE",,57000023,LOCAL,Facility,Inpatient,,,,193.28,164.288,55.394048,193.28,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"DVT CALF SLEEVE, LARGE",,57000023,LOCAL,Facility,Outpatient,,,,193.28,164.288,55.394048,193.28,"UCare Health, Inc.",Medical Assistance,97.548416,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"DVT CALF SLEEVE, LARGE",,57000023,LOCAL,Facility,Inpatient,,,,193.28,164.288,55.394048,193.28,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"DVT CALF SLEEVE, LARGE",,57000023,LOCAL,Facility,Outpatient,,,,193.28,164.288,55.394048,193.28,"UCare Health, Inc.",Medicare Advantage,97.548416,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"DVT CALF SLEEVE, LARGE",,57000023,LOCAL,Facility,Inpatient,,,,193.28,164.288,55.394048,193.28,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"DVT CALF SLEEVE, LARGE",,57000023,LOCAL,Facility,Outpatient,,,,193.28,164.288,55.394048,193.28,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),97.548416,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"DVT CALF SLEEVE, LARGE",,57000023,LOCAL,Facility,Inpatient,,,,193.28,164.288,55.394048,193.28,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"DVT CALF SLEEVE, LARGE",,57000023,LOCAL,Facility,Both,,,,193.28,164.288,55.394048,193.28,UnitedHealthcare,Individual & Family,181.6832,94,,percent of total billed charges,,
"DVT CALF SLEEVE, LARGE",,57000023,LOCAL,Facility,Outpatient,,,,193.28,164.288,55.394048,193.28,UnitedHealthcare,Medicare Advantage,94.7072,49,,percent of total billed charges,,
"DVT CALF SLEEVE, LARGE",,57000023,LOCAL,Facility,Inpatient,,,,193.28,164.288,55.394048,193.28,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"DVT CALF SLEEVE, LARGE",,57000023,LOCAL,Facility,Outpatient,,,,193.28,164.288,55.394048,193.28,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,92.7744,48,,percent of total billed charges,,100% of DHS outpatient percentage
"DVT CALF SLEEVE, LARGE",,57000023,LOCAL,Facility,Inpatient,,,,193.28,164.288,55.394048,193.28,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
EASYFUSE DYNAMIC COMPRESSION SYS/ DISP INST PK  WRIGHT MED FFSP1530,,57000023,LOCAL,Facility,Both,,,,1296,1101.6,371.4336,1296,Aetna,Commercial,1192.32,92,,percent of total billed charges,,
EASYFUSE DYNAMIC COMPRESSION SYS/ DISP INST PK  WRIGHT MED FFSP1530,,57000023,LOCAL,Facility,Outpatient,,,,1296,1101.6,371.4336,1296,Aetna,Medicare Advantage,635.04,49,,percent of total billed charges,,
EASYFUSE DYNAMIC COMPRESSION SYS/ DISP INST PK  WRIGHT MED FFSP1530,,57000023,LOCAL,Facility,Inpatient,,,,1296,1101.6,371.4336,1296,Aetna,Medicare Advantage,,,,,Included in per diem rate,
EASYFUSE DYNAMIC COMPRESSION SYS/ DISP INST PK  WRIGHT MED FFSP1530,,57000023,LOCAL,Facility,Both,,,,1296,1101.6,371.4336,1296,Aetna,PPO,1205.28,93,,percent of total billed charges,,
EASYFUSE DYNAMIC COMPRESSION SYS/ DISP INST PK  WRIGHT MED FFSP1530,,57000023,LOCAL,Facility,Both,,,,1296,1101.6,371.4336,1296,America's PPO,America's PPO,1244.5488,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
EASYFUSE DYNAMIC COMPRESSION SYS/ DISP INST PK  WRIGHT MED FFSP1530,,57000023,LOCAL,Facility,Both,,,,1296,1101.6,371.4336,1296,BlueCross BlueShield Minnesota, Federal Employee Program,1275.264,98.4,,percent of total billed charges,,
EASYFUSE DYNAMIC COMPRESSION SYS/ DISP INST PK  WRIGHT MED FFSP1530,,57000023,LOCAL,Facility,Both,,,,1296,1101.6,371.4336,1296,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1296,100,,percent of total billed charges,,
EASYFUSE DYNAMIC COMPRESSION SYS/ DISP INST PK  WRIGHT MED FFSP1530,,57000023,LOCAL,Facility,Both,,,,1296,1101.6,371.4336,1296,BlueCross BlueShield Minnesota,High Value Network Plan,1166.4,90,,percent of total billed charges,,
EASYFUSE DYNAMIC COMPRESSION SYS/ DISP INST PK  WRIGHT MED FFSP1530,,57000023,LOCAL,Facility,Outpatient,,,,1296,1101.6,371.4336,1296,BlueCross BlueShield Minnesota,Medicare Advantage,635.04,49,,percent of total billed charges,,
EASYFUSE DYNAMIC COMPRESSION SYS/ DISP INST PK  WRIGHT MED FFSP1530,,57000023,LOCAL,Facility,Inpatient,,,,1296,1101.6,371.4336,1296,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
EASYFUSE DYNAMIC COMPRESSION SYS/ DISP INST PK  WRIGHT MED FFSP1530,,57000023,LOCAL,Facility,Both,,,,1296,1101.6,371.4336,1296,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1147.8672,88.57,,percent of total billed charges,,
EASYFUSE DYNAMIC COMPRESSION SYS/ DISP INST PK  WRIGHT MED FFSP1530,,57000023,LOCAL,Facility,Both,,,,1296,1101.6,371.4336,1296,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,371.4336,28.66,,percent of total billed charges,,
EASYFUSE DYNAMIC COMPRESSION SYS/ DISP INST PK  WRIGHT MED FFSP1530,,57000023,LOCAL,Facility,Outpatient,,,,1296,1101.6,371.4336,1296,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),635.04,49,,percent of total billed charges,,
EASYFUSE DYNAMIC COMPRESSION SYS/ DISP INST PK  WRIGHT MED FFSP1530,,57000023,LOCAL,Facility,Inpatient,,,,1296,1101.6,371.4336,1296,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
EASYFUSE DYNAMIC COMPRESSION SYS/ DISP INST PK  WRIGHT MED FFSP1530,,57000023,LOCAL,Facility,Both,,,,1296,1101.6,371.4336,1296,CorVel,Worker's Compensation,1296,100,,percent of total billed charges,,
EASYFUSE DYNAMIC COMPRESSION SYS/ DISP INST PK  WRIGHT MED FFSP1530,,57000023,LOCAL,Facility,Both,,,,1296,1101.6,371.4336,1296,First Health Group Corporation,First Health Network,1257.12,97,,percent of total billed charges,,
EASYFUSE DYNAMIC COMPRESSION SYS/ DISP INST PK  WRIGHT MED FFSP1530,,57000023,LOCAL,Facility,Both,,,,1296,1101.6,371.4336,1296,"Health Partners, Inc.",Commercial,1226.016,94.6,,percent of total billed charges,,
EASYFUSE DYNAMIC COMPRESSION SYS/ DISP INST PK  WRIGHT MED FFSP1530,,57000023,LOCAL,Facility,Outpatient,,,,1296,1101.6,371.4336,1296,"Health Partners, Inc.",Medicare Advantage,635.04,49,,percent of total billed charges,,
EASYFUSE DYNAMIC COMPRESSION SYS/ DISP INST PK  WRIGHT MED FFSP1530,,57000023,LOCAL,Facility,Inpatient,,,,1296,1101.6,371.4336,1296,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
EASYFUSE DYNAMIC COMPRESSION SYS/ DISP INST PK  WRIGHT MED FFSP1530,,57000023,LOCAL,Facility,Both,,,,1296,1101.6,371.4336,1296,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),777.6,60,,percent of total billed charges,,
EASYFUSE DYNAMIC COMPRESSION SYS/ DISP INST PK  WRIGHT MED FFSP1530,,57000023,LOCAL,Facility,Both,,,,1296,1101.6,371.4336,1296,"Health Partners, Inc.",State of Minnesota Advantage Program,1056.24,81.5,,percent of total billed charges,,
EASYFUSE DYNAMIC COMPRESSION SYS/ DISP INST PK  WRIGHT MED FFSP1530,,57000023,LOCAL,Facility,Both,,,,1296,1101.6,371.4336,1296,"Health Partners, Inc.",State Public Programs,648,50,,percent of total billed charges,,
EASYFUSE DYNAMIC COMPRESSION SYS/ DISP INST PK  WRIGHT MED FFSP1530,,57000023,LOCAL,Facility,Both,,,,1296,1101.6,371.4336,1296,Humana Insurance Company,Commercial PPO,1231.2,95,,percent of total billed charges,,
EASYFUSE DYNAMIC COMPRESSION SYS/ DISP INST PK  WRIGHT MED FFSP1530,,57000023,LOCAL,Facility,Outpatient,,,,1296,1101.6,371.4336,1296,Humana Insurance Company,Medicare PPO,635.04,49,,percent of total billed charges,,
EASYFUSE DYNAMIC COMPRESSION SYS/ DISP INST PK  WRIGHT MED FFSP1530,,57000023,LOCAL,Facility,Inpatient,,,,1296,1101.6,371.4336,1296,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
EASYFUSE DYNAMIC COMPRESSION SYS/ DISP INST PK  WRIGHT MED FFSP1530,,57000023,LOCAL,Facility,Both,,,,1296,1101.6,371.4336,1296,Medica,Individual & Family,1284.336,99.1,,percent of total billed charges,,
EASYFUSE DYNAMIC COMPRESSION SYS/ DISP INST PK  WRIGHT MED FFSP1530,,57000023,LOCAL,Facility,Outpatient,,,,1296,1101.6,371.4336,1296,Medica,Medica Advantage Solution,645.408,49.8,,percent of total billed charges,,
EASYFUSE DYNAMIC COMPRESSION SYS/ DISP INST PK  WRIGHT MED FFSP1530,,57000023,LOCAL,Facility,Inpatient,,,,1296,1101.6,371.4336,1296,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
EASYFUSE DYNAMIC COMPRESSION SYS/ DISP INST PK  WRIGHT MED FFSP1530,,57000023,LOCAL,Facility,Outpatient,,,,1296,1101.6,371.4336,1296,Medica,Medical Assistance,578.016,44.6,,percent of total billed charges,,
EASYFUSE DYNAMIC COMPRESSION SYS/ DISP INST PK  WRIGHT MED FFSP1530,,57000023,LOCAL,Facility,Inpatient,,,,1296,1101.6,371.4336,1296,Medica,Medical Assistance,,,,,Included in per diem rate,
EASYFUSE DYNAMIC COMPRESSION SYS/ DISP INST PK  WRIGHT MED FFSP1530,,57000023,LOCAL,Facility,Outpatient,,,,1296,1101.6,371.4336,1296,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,645.408,49.8,,percent of total billed charges,,
EASYFUSE DYNAMIC COMPRESSION SYS/ DISP INST PK  WRIGHT MED FFSP1530,,57000023,LOCAL,Facility,Inpatient,,,,1296,1101.6,371.4336,1296,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
EASYFUSE DYNAMIC COMPRESSION SYS/ DISP INST PK  WRIGHT MED FFSP1530,,57000023,LOCAL,Facility,Both,,,,1296,1101.6,371.4336,1296,"Multiplan, Inc.","Multiplan, Inc.",1218.24,94,,percent of total billed charges,,
EASYFUSE DYNAMIC COMPRESSION SYS/ DISP INST PK  WRIGHT MED FFSP1530,,57000023,LOCAL,Facility,Outpatient,,,,1296,1101.6,371.4336,1296,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1167.696,90.1,,percent of total billed charges,,
EASYFUSE DYNAMIC COMPRESSION SYS/ DISP INST PK  WRIGHT MED FFSP1530,,57000023,LOCAL,Facility,Inpatient,,,,1296,1101.6,371.4336,1296,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
EASYFUSE DYNAMIC COMPRESSION SYS/ DISP INST PK  WRIGHT MED FFSP1530,,57000023,LOCAL,Facility,Both,,,,1296,1101.6,371.4336,1296,"Preferred One Administrative Services, INC.",PPO,1277.856,98.6,,percent of total billed charges,,
EASYFUSE DYNAMIC COMPRESSION SYS/ DISP INST PK  WRIGHT MED FFSP1530,,57000023,LOCAL,Facility,Outpatient,,,,1296,1101.6,371.4336,1296,PrimeWest Health,Minnesota Senior Health Options (MSHO),666.792,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
EASYFUSE DYNAMIC COMPRESSION SYS/ DISP INST PK  WRIGHT MED FFSP1530,,57000023,LOCAL,Facility,Inpatient,,,,1296,1101.6,371.4336,1296,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
EASYFUSE DYNAMIC COMPRESSION SYS/ DISP INST PK  WRIGHT MED FFSP1530,,57000023,LOCAL,Facility,Outpatient,,,,1296,1101.6,371.4336,1296,PrimeWest Health,MinnesotaCare,665.6256,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
EASYFUSE DYNAMIC COMPRESSION SYS/ DISP INST PK  WRIGHT MED FFSP1530,,57000023,LOCAL,Facility,Inpatient,,,,1296,1101.6,371.4336,1296,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
EASYFUSE DYNAMIC COMPRESSION SYS/ DISP INST PK  WRIGHT MED FFSP1530,,57000023,LOCAL,Facility,Both,,,,1296,1101.6,371.4336,1296,Sanford Health Plan,Sanford Health Plan,1192.32,92,,percent of total billed charges,,
EASYFUSE DYNAMIC COMPRESSION SYS/ DISP INST PK  WRIGHT MED FFSP1530,,57000023,LOCAL,Facility,Outpatient,,,,1296,1101.6,371.4336,1296,"UCare Health, Inc.",Individual & Family Plan,730.296,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
EASYFUSE DYNAMIC COMPRESSION SYS/ DISP INST PK  WRIGHT MED FFSP1530,,57000023,LOCAL,Facility,Inpatient,,,,1296,1101.6,371.4336,1296,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
EASYFUSE DYNAMIC COMPRESSION SYS/ DISP INST PK  WRIGHT MED FFSP1530,,57000023,LOCAL,Facility,Outpatient,,,,1296,1101.6,371.4336,1296,"UCare Health, Inc.",Medical Assistance,654.0912,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
EASYFUSE DYNAMIC COMPRESSION SYS/ DISP INST PK  WRIGHT MED FFSP1530,,57000023,LOCAL,Facility,Inpatient,,,,1296,1101.6,371.4336,1296,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
EASYFUSE DYNAMIC COMPRESSION SYS/ DISP INST PK  WRIGHT MED FFSP1530,,57000023,LOCAL,Facility,Outpatient,,,,1296,1101.6,371.4336,1296,"UCare Health, Inc.",Medicare Advantage,654.0912,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
EASYFUSE DYNAMIC COMPRESSION SYS/ DISP INST PK  WRIGHT MED FFSP1530,,57000023,LOCAL,Facility,Inpatient,,,,1296,1101.6,371.4336,1296,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
EASYFUSE DYNAMIC COMPRESSION SYS/ DISP INST PK  WRIGHT MED FFSP1530,,57000023,LOCAL,Facility,Outpatient,,,,1296,1101.6,371.4336,1296,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),654.0912,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
EASYFUSE DYNAMIC COMPRESSION SYS/ DISP INST PK  WRIGHT MED FFSP1530,,57000023,LOCAL,Facility,Inpatient,,,,1296,1101.6,371.4336,1296,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
EASYFUSE DYNAMIC COMPRESSION SYS/ DISP INST PK  WRIGHT MED FFSP1530,,57000023,LOCAL,Facility,Both,,,,1296,1101.6,371.4336,1296,UnitedHealthcare,Individual & Family,1218.24,94,,percent of total billed charges,,
EASYFUSE DYNAMIC COMPRESSION SYS/ DISP INST PK  WRIGHT MED FFSP1530,,57000023,LOCAL,Facility,Outpatient,,,,1296,1101.6,371.4336,1296,UnitedHealthcare,Medicare Advantage,635.04,49,,percent of total billed charges,,
EASYFUSE DYNAMIC COMPRESSION SYS/ DISP INST PK  WRIGHT MED FFSP1530,,57000023,LOCAL,Facility,Inpatient,,,,1296,1101.6,371.4336,1296,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
EASYFUSE DYNAMIC COMPRESSION SYS/ DISP INST PK  WRIGHT MED FFSP1530,,57000023,LOCAL,Facility,Outpatient,,,,1296,1101.6,371.4336,1296,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,622.08,48,,percent of total billed charges,,100% of DHS outpatient percentage
EASYFUSE DYNAMIC COMPRESSION SYS/ DISP INST PK  WRIGHT MED FFSP1530,,57000023,LOCAL,Facility,Inpatient,,,,1296,1101.6,371.4336,1296,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
FORCEPS BIOPSY (DISP) LG 2.8MM W/NDL RADIAL JAW  M00513330,,57000023,LOCAL,Facility,Both,,,,300.75,255.6375,86.19495,300.75,Aetna,Commercial,276.69,92,,percent of total billed charges,,
FORCEPS BIOPSY (DISP) LG 2.8MM W/NDL RADIAL JAW  M00513330,,57000023,LOCAL,Facility,Outpatient,,,,300.75,255.6375,86.19495,300.75,Aetna,Medicare Advantage,147.3675,49,,percent of total billed charges,,
FORCEPS BIOPSY (DISP) LG 2.8MM W/NDL RADIAL JAW  M00513330,,57000023,LOCAL,Facility,Inpatient,,,,300.75,255.6375,86.19495,300.75,Aetna,Medicare Advantage,,,,,Included in per diem rate,
FORCEPS BIOPSY (DISP) LG 2.8MM W/NDL RADIAL JAW  M00513330,,57000023,LOCAL,Facility,Both,,,,300.75,255.6375,86.19495,300.75,Aetna,PPO,279.6975,93,,percent of total billed charges,,
FORCEPS BIOPSY (DISP) LG 2.8MM W/NDL RADIAL JAW  M00513330,,57000023,LOCAL,Facility,Both,,,,300.75,255.6375,86.19495,300.75,America's PPO,America's PPO,288.810225,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
FORCEPS BIOPSY (DISP) LG 2.8MM W/NDL RADIAL JAW  M00513330,,57000023,LOCAL,Facility,Both,,,,300.75,255.6375,86.19495,300.75,BlueCross BlueShield Minnesota, Federal Employee Program,295.938,98.4,,percent of total billed charges,,
FORCEPS BIOPSY (DISP) LG 2.8MM W/NDL RADIAL JAW  M00513330,,57000023,LOCAL,Facility,Both,,,,300.75,255.6375,86.19495,300.75,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,300.75,100,,percent of total billed charges,,
FORCEPS BIOPSY (DISP) LG 2.8MM W/NDL RADIAL JAW  M00513330,,57000023,LOCAL,Facility,Both,,,,300.75,255.6375,86.19495,300.75,BlueCross BlueShield Minnesota,High Value Network Plan,270.675,90,,percent of total billed charges,,
FORCEPS BIOPSY (DISP) LG 2.8MM W/NDL RADIAL JAW  M00513330,,57000023,LOCAL,Facility,Outpatient,,,,300.75,255.6375,86.19495,300.75,BlueCross BlueShield Minnesota,Medicare Advantage,147.3675,49,,percent of total billed charges,,
FORCEPS BIOPSY (DISP) LG 2.8MM W/NDL RADIAL JAW  M00513330,,57000023,LOCAL,Facility,Inpatient,,,,300.75,255.6375,86.19495,300.75,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
FORCEPS BIOPSY (DISP) LG 2.8MM W/NDL RADIAL JAW  M00513330,,57000023,LOCAL,Facility,Both,,,,300.75,255.6375,86.19495,300.75,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,266.374275,88.57,,percent of total billed charges,,
FORCEPS BIOPSY (DISP) LG 2.8MM W/NDL RADIAL JAW  M00513330,,57000023,LOCAL,Facility,Both,,,,300.75,255.6375,86.19495,300.75,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,86.19495,28.66,,percent of total billed charges,,
FORCEPS BIOPSY (DISP) LG 2.8MM W/NDL RADIAL JAW  M00513330,,57000023,LOCAL,Facility,Outpatient,,,,300.75,255.6375,86.19495,300.75,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),147.3675,49,,percent of total billed charges,,
FORCEPS BIOPSY (DISP) LG 2.8MM W/NDL RADIAL JAW  M00513330,,57000023,LOCAL,Facility,Inpatient,,,,300.75,255.6375,86.19495,300.75,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
FORCEPS BIOPSY (DISP) LG 2.8MM W/NDL RADIAL JAW  M00513330,,57000023,LOCAL,Facility,Both,,,,300.75,255.6375,86.19495,300.75,CorVel,Worker's Compensation,300.75,100,,percent of total billed charges,,
FORCEPS BIOPSY (DISP) LG 2.8MM W/NDL RADIAL JAW  M00513330,,57000023,LOCAL,Facility,Both,,,,300.75,255.6375,86.19495,300.75,First Health Group Corporation,First Health Network,291.7275,97,,percent of total billed charges,,
FORCEPS BIOPSY (DISP) LG 2.8MM W/NDL RADIAL JAW  M00513330,,57000023,LOCAL,Facility,Both,,,,300.75,255.6375,86.19495,300.75,"Health Partners, Inc.",Commercial,284.5095,94.6,,percent of total billed charges,,
FORCEPS BIOPSY (DISP) LG 2.8MM W/NDL RADIAL JAW  M00513330,,57000023,LOCAL,Facility,Outpatient,,,,300.75,255.6375,86.19495,300.75,"Health Partners, Inc.",Medicare Advantage,147.3675,49,,percent of total billed charges,,
FORCEPS BIOPSY (DISP) LG 2.8MM W/NDL RADIAL JAW  M00513330,,57000023,LOCAL,Facility,Inpatient,,,,300.75,255.6375,86.19495,300.75,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
FORCEPS BIOPSY (DISP) LG 2.8MM W/NDL RADIAL JAW  M00513330,,57000023,LOCAL,Facility,Both,,,,300.75,255.6375,86.19495,300.75,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),180.45,60,,percent of total billed charges,,
FORCEPS BIOPSY (DISP) LG 2.8MM W/NDL RADIAL JAW  M00513330,,57000023,LOCAL,Facility,Both,,,,300.75,255.6375,86.19495,300.75,"Health Partners, Inc.",State of Minnesota Advantage Program,245.11125,81.5,,percent of total billed charges,,
FORCEPS BIOPSY (DISP) LG 2.8MM W/NDL RADIAL JAW  M00513330,,57000023,LOCAL,Facility,Both,,,,300.75,255.6375,86.19495,300.75,"Health Partners, Inc.",State Public Programs,150.375,50,,percent of total billed charges,,
FORCEPS BIOPSY (DISP) LG 2.8MM W/NDL RADIAL JAW  M00513330,,57000023,LOCAL,Facility,Both,,,,300.75,255.6375,86.19495,300.75,Humana Insurance Company,Commercial PPO,285.7125,95,,percent of total billed charges,,
FORCEPS BIOPSY (DISP) LG 2.8MM W/NDL RADIAL JAW  M00513330,,57000023,LOCAL,Facility,Outpatient,,,,300.75,255.6375,86.19495,300.75,Humana Insurance Company,Medicare PPO,147.3675,49,,percent of total billed charges,,
FORCEPS BIOPSY (DISP) LG 2.8MM W/NDL RADIAL JAW  M00513330,,57000023,LOCAL,Facility,Inpatient,,,,300.75,255.6375,86.19495,300.75,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
FORCEPS BIOPSY (DISP) LG 2.8MM W/NDL RADIAL JAW  M00513330,,57000023,LOCAL,Facility,Both,,,,300.75,255.6375,86.19495,300.75,Medica,Individual & Family,298.04325,99.1,,percent of total billed charges,,
FORCEPS BIOPSY (DISP) LG 2.8MM W/NDL RADIAL JAW  M00513330,,57000023,LOCAL,Facility,Outpatient,,,,300.75,255.6375,86.19495,300.75,Medica,Medica Advantage Solution,149.7735,49.8,,percent of total billed charges,,
FORCEPS BIOPSY (DISP) LG 2.8MM W/NDL RADIAL JAW  M00513330,,57000023,LOCAL,Facility,Inpatient,,,,300.75,255.6375,86.19495,300.75,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
FORCEPS BIOPSY (DISP) LG 2.8MM W/NDL RADIAL JAW  M00513330,,57000023,LOCAL,Facility,Outpatient,,,,300.75,255.6375,86.19495,300.75,Medica,Medical Assistance,134.1345,44.6,,percent of total billed charges,,
FORCEPS BIOPSY (DISP) LG 2.8MM W/NDL RADIAL JAW  M00513330,,57000023,LOCAL,Facility,Inpatient,,,,300.75,255.6375,86.19495,300.75,Medica,Medical Assistance,,,,,Included in per diem rate,
FORCEPS BIOPSY (DISP) LG 2.8MM W/NDL RADIAL JAW  M00513330,,57000023,LOCAL,Facility,Outpatient,,,,300.75,255.6375,86.19495,300.75,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,149.7735,49.8,,percent of total billed charges,,
FORCEPS BIOPSY (DISP) LG 2.8MM W/NDL RADIAL JAW  M00513330,,57000023,LOCAL,Facility,Inpatient,,,,300.75,255.6375,86.19495,300.75,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
FORCEPS BIOPSY (DISP) LG 2.8MM W/NDL RADIAL JAW  M00513330,,57000023,LOCAL,Facility,Both,,,,300.75,255.6375,86.19495,300.75,"Multiplan, Inc.","Multiplan, Inc.",282.705,94,,percent of total billed charges,,
FORCEPS BIOPSY (DISP) LG 2.8MM W/NDL RADIAL JAW  M00513330,,57000023,LOCAL,Facility,Outpatient,,,,300.75,255.6375,86.19495,300.75,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,270.97575,90.1,,percent of total billed charges,,
FORCEPS BIOPSY (DISP) LG 2.8MM W/NDL RADIAL JAW  M00513330,,57000023,LOCAL,Facility,Inpatient,,,,300.75,255.6375,86.19495,300.75,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
FORCEPS BIOPSY (DISP) LG 2.8MM W/NDL RADIAL JAW  M00513330,,57000023,LOCAL,Facility,Both,,,,300.75,255.6375,86.19495,300.75,"Preferred One Administrative Services, INC.",PPO,296.5395,98.6,,percent of total billed charges,,
FORCEPS BIOPSY (DISP) LG 2.8MM W/NDL RADIAL JAW  M00513330,,57000023,LOCAL,Facility,Outpatient,,,,300.75,255.6375,86.19495,300.75,PrimeWest Health,Minnesota Senior Health Options (MSHO),154.735875,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
FORCEPS BIOPSY (DISP) LG 2.8MM W/NDL RADIAL JAW  M00513330,,57000023,LOCAL,Facility,Inpatient,,,,300.75,255.6375,86.19495,300.75,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
FORCEPS BIOPSY (DISP) LG 2.8MM W/NDL RADIAL JAW  M00513330,,57000023,LOCAL,Facility,Outpatient,,,,300.75,255.6375,86.19495,300.75,PrimeWest Health,MinnesotaCare,154.4652,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
FORCEPS BIOPSY (DISP) LG 2.8MM W/NDL RADIAL JAW  M00513330,,57000023,LOCAL,Facility,Inpatient,,,,300.75,255.6375,86.19495,300.75,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
FORCEPS BIOPSY (DISP) LG 2.8MM W/NDL RADIAL JAW  M00513330,,57000023,LOCAL,Facility,Both,,,,300.75,255.6375,86.19495,300.75,Sanford Health Plan,Sanford Health Plan,276.69,92,,percent of total billed charges,,
FORCEPS BIOPSY (DISP) LG 2.8MM W/NDL RADIAL JAW  M00513330,,57000023,LOCAL,Facility,Outpatient,,,,300.75,255.6375,86.19495,300.75,"UCare Health, Inc.",Individual & Family Plan,169.472625,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
FORCEPS BIOPSY (DISP) LG 2.8MM W/NDL RADIAL JAW  M00513330,,57000023,LOCAL,Facility,Inpatient,,,,300.75,255.6375,86.19495,300.75,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
FORCEPS BIOPSY (DISP) LG 2.8MM W/NDL RADIAL JAW  M00513330,,57000023,LOCAL,Facility,Outpatient,,,,300.75,255.6375,86.19495,300.75,"UCare Health, Inc.",Medical Assistance,151.788525,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FORCEPS BIOPSY (DISP) LG 2.8MM W/NDL RADIAL JAW  M00513330,,57000023,LOCAL,Facility,Inpatient,,,,300.75,255.6375,86.19495,300.75,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
FORCEPS BIOPSY (DISP) LG 2.8MM W/NDL RADIAL JAW  M00513330,,57000023,LOCAL,Facility,Outpatient,,,,300.75,255.6375,86.19495,300.75,"UCare Health, Inc.",Medicare Advantage,151.788525,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FORCEPS BIOPSY (DISP) LG 2.8MM W/NDL RADIAL JAW  M00513330,,57000023,LOCAL,Facility,Inpatient,,,,300.75,255.6375,86.19495,300.75,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
FORCEPS BIOPSY (DISP) LG 2.8MM W/NDL RADIAL JAW  M00513330,,57000023,LOCAL,Facility,Outpatient,,,,300.75,255.6375,86.19495,300.75,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),151.788525,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FORCEPS BIOPSY (DISP) LG 2.8MM W/NDL RADIAL JAW  M00513330,,57000023,LOCAL,Facility,Inpatient,,,,300.75,255.6375,86.19495,300.75,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
FORCEPS BIOPSY (DISP) LG 2.8MM W/NDL RADIAL JAW  M00513330,,57000023,LOCAL,Facility,Both,,,,300.75,255.6375,86.19495,300.75,UnitedHealthcare,Individual & Family,282.705,94,,percent of total billed charges,,
FORCEPS BIOPSY (DISP) LG 2.8MM W/NDL RADIAL JAW  M00513330,,57000023,LOCAL,Facility,Outpatient,,,,300.75,255.6375,86.19495,300.75,UnitedHealthcare,Medicare Advantage,147.3675,49,,percent of total billed charges,,
FORCEPS BIOPSY (DISP) LG 2.8MM W/NDL RADIAL JAW  M00513330,,57000023,LOCAL,Facility,Inpatient,,,,300.75,255.6375,86.19495,300.75,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
FORCEPS BIOPSY (DISP) LG 2.8MM W/NDL RADIAL JAW  M00513330,,57000023,LOCAL,Facility,Outpatient,,,,300.75,255.6375,86.19495,300.75,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,144.36,48,,percent of total billed charges,,100% of DHS outpatient percentage
FORCEPS BIOPSY (DISP) LG 2.8MM W/NDL RADIAL JAW  M00513330,,57000023,LOCAL,Facility,Inpatient,,,,300.75,255.6375,86.19495,300.75,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
GASTRO BALLOON 18X19X20 CRE,,57000023,LOCAL,Facility,Both,,,,835,709.75,239.311,835,Aetna,Commercial,768.2,92,,percent of total billed charges,,
GASTRO BALLOON 18X19X20 CRE,,57000023,LOCAL,Facility,Outpatient,,,,835,709.75,239.311,835,Aetna,Medicare Advantage,409.15,49,,percent of total billed charges,,
GASTRO BALLOON 18X19X20 CRE,,57000023,LOCAL,Facility,Inpatient,,,,835,709.75,239.311,835,Aetna,Medicare Advantage,,,,,Included in per diem rate,
GASTRO BALLOON 18X19X20 CRE,,57000023,LOCAL,Facility,Both,,,,835,709.75,239.311,835,Aetna,PPO,776.55,93,,percent of total billed charges,,
GASTRO BALLOON 18X19X20 CRE,,57000023,LOCAL,Facility,Both,,,,835,709.75,239.311,835,America's PPO,America's PPO,801.8505,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
GASTRO BALLOON 18X19X20 CRE,,57000023,LOCAL,Facility,Both,,,,835,709.75,239.311,835,BlueCross BlueShield Minnesota, Federal Employee Program,821.64,98.4,,percent of total billed charges,,
GASTRO BALLOON 18X19X20 CRE,,57000023,LOCAL,Facility,Both,,,,835,709.75,239.311,835,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,835,100,,percent of total billed charges,,
GASTRO BALLOON 18X19X20 CRE,,57000023,LOCAL,Facility,Both,,,,835,709.75,239.311,835,BlueCross BlueShield Minnesota,High Value Network Plan,751.5,90,,percent of total billed charges,,
GASTRO BALLOON 18X19X20 CRE,,57000023,LOCAL,Facility,Outpatient,,,,835,709.75,239.311,835,BlueCross BlueShield Minnesota,Medicare Advantage,409.15,49,,percent of total billed charges,,
GASTRO BALLOON 18X19X20 CRE,,57000023,LOCAL,Facility,Inpatient,,,,835,709.75,239.311,835,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
GASTRO BALLOON 18X19X20 CRE,,57000023,LOCAL,Facility,Both,,,,835,709.75,239.311,835,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,739.5595,88.57,,percent of total billed charges,,
GASTRO BALLOON 18X19X20 CRE,,57000023,LOCAL,Facility,Both,,,,835,709.75,239.311,835,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,239.311,28.66,,percent of total billed charges,,
GASTRO BALLOON 18X19X20 CRE,,57000023,LOCAL,Facility,Outpatient,,,,835,709.75,239.311,835,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),409.15,49,,percent of total billed charges,,
GASTRO BALLOON 18X19X20 CRE,,57000023,LOCAL,Facility,Inpatient,,,,835,709.75,239.311,835,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
GASTRO BALLOON 18X19X20 CRE,,57000023,LOCAL,Facility,Both,,,,835,709.75,239.311,835,CorVel,Worker's Compensation,835,100,,percent of total billed charges,,
GASTRO BALLOON 18X19X20 CRE,,57000023,LOCAL,Facility,Both,,,,835,709.75,239.311,835,First Health Group Corporation,First Health Network,809.95,97,,percent of total billed charges,,
GASTRO BALLOON 18X19X20 CRE,,57000023,LOCAL,Facility,Both,,,,835,709.75,239.311,835,"Health Partners, Inc.",Commercial,789.91,94.6,,percent of total billed charges,,
GASTRO BALLOON 18X19X20 CRE,,57000023,LOCAL,Facility,Outpatient,,,,835,709.75,239.311,835,"Health Partners, Inc.",Medicare Advantage,409.15,49,,percent of total billed charges,,
GASTRO BALLOON 18X19X20 CRE,,57000023,LOCAL,Facility,Inpatient,,,,835,709.75,239.311,835,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
GASTRO BALLOON 18X19X20 CRE,,57000023,LOCAL,Facility,Both,,,,835,709.75,239.311,835,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),501,60,,percent of total billed charges,,
GASTRO BALLOON 18X19X20 CRE,,57000023,LOCAL,Facility,Both,,,,835,709.75,239.311,835,"Health Partners, Inc.",State of Minnesota Advantage Program,680.525,81.5,,percent of total billed charges,,
GASTRO BALLOON 18X19X20 CRE,,57000023,LOCAL,Facility,Both,,,,835,709.75,239.311,835,"Health Partners, Inc.",State Public Programs,417.5,50,,percent of total billed charges,,
GASTRO BALLOON 18X19X20 CRE,,57000023,LOCAL,Facility,Both,,,,835,709.75,239.311,835,Humana Insurance Company,Commercial PPO,793.25,95,,percent of total billed charges,,
GASTRO BALLOON 18X19X20 CRE,,57000023,LOCAL,Facility,Outpatient,,,,835,709.75,239.311,835,Humana Insurance Company,Medicare PPO,409.15,49,,percent of total billed charges,,
GASTRO BALLOON 18X19X20 CRE,,57000023,LOCAL,Facility,Inpatient,,,,835,709.75,239.311,835,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
GASTRO BALLOON 18X19X20 CRE,,57000023,LOCAL,Facility,Both,,,,835,709.75,239.311,835,Medica,Individual & Family,827.485,99.1,,percent of total billed charges,,
GASTRO BALLOON 18X19X20 CRE,,57000023,LOCAL,Facility,Outpatient,,,,835,709.75,239.311,835,Medica,Medica Advantage Solution,415.83,49.8,,percent of total billed charges,,
GASTRO BALLOON 18X19X20 CRE,,57000023,LOCAL,Facility,Inpatient,,,,835,709.75,239.311,835,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
GASTRO BALLOON 18X19X20 CRE,,57000023,LOCAL,Facility,Outpatient,,,,835,709.75,239.311,835,Medica,Medical Assistance,372.41,44.6,,percent of total billed charges,,
GASTRO BALLOON 18X19X20 CRE,,57000023,LOCAL,Facility,Inpatient,,,,835,709.75,239.311,835,Medica,Medical Assistance,,,,,Included in per diem rate,
GASTRO BALLOON 18X19X20 CRE,,57000023,LOCAL,Facility,Outpatient,,,,835,709.75,239.311,835,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,415.83,49.8,,percent of total billed charges,,
GASTRO BALLOON 18X19X20 CRE,,57000023,LOCAL,Facility,Inpatient,,,,835,709.75,239.311,835,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
GASTRO BALLOON 18X19X20 CRE,,57000023,LOCAL,Facility,Both,,,,835,709.75,239.311,835,"Multiplan, Inc.","Multiplan, Inc.",784.9,94,,percent of total billed charges,,
GASTRO BALLOON 18X19X20 CRE,,57000023,LOCAL,Facility,Outpatient,,,,835,709.75,239.311,835,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,752.335,90.1,,percent of total billed charges,,
GASTRO BALLOON 18X19X20 CRE,,57000023,LOCAL,Facility,Inpatient,,,,835,709.75,239.311,835,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
GASTRO BALLOON 18X19X20 CRE,,57000023,LOCAL,Facility,Both,,,,835,709.75,239.311,835,"Preferred One Administrative Services, INC.",PPO,823.31,98.6,,percent of total billed charges,,
GASTRO BALLOON 18X19X20 CRE,,57000023,LOCAL,Facility,Outpatient,,,,835,709.75,239.311,835,PrimeWest Health,Minnesota Senior Health Options (MSHO),429.6075,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
GASTRO BALLOON 18X19X20 CRE,,57000023,LOCAL,Facility,Inpatient,,,,835,709.75,239.311,835,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
GASTRO BALLOON 18X19X20 CRE,,57000023,LOCAL,Facility,Outpatient,,,,835,709.75,239.311,835,PrimeWest Health,MinnesotaCare,428.856,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
GASTRO BALLOON 18X19X20 CRE,,57000023,LOCAL,Facility,Inpatient,,,,835,709.75,239.311,835,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
GASTRO BALLOON 18X19X20 CRE,,57000023,LOCAL,Facility,Both,,,,835,709.75,239.311,835,Sanford Health Plan,Sanford Health Plan,768.2,92,,percent of total billed charges,,
GASTRO BALLOON 18X19X20 CRE,,57000023,LOCAL,Facility,Outpatient,,,,835,709.75,239.311,835,"UCare Health, Inc.",Individual & Family Plan,470.5225,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
GASTRO BALLOON 18X19X20 CRE,,57000023,LOCAL,Facility,Inpatient,,,,835,709.75,239.311,835,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
GASTRO BALLOON 18X19X20 CRE,,57000023,LOCAL,Facility,Outpatient,,,,835,709.75,239.311,835,"UCare Health, Inc.",Medical Assistance,421.4245,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
GASTRO BALLOON 18X19X20 CRE,,57000023,LOCAL,Facility,Inpatient,,,,835,709.75,239.311,835,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
GASTRO BALLOON 18X19X20 CRE,,57000023,LOCAL,Facility,Outpatient,,,,835,709.75,239.311,835,"UCare Health, Inc.",Medicare Advantage,421.4245,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
GASTRO BALLOON 18X19X20 CRE,,57000023,LOCAL,Facility,Inpatient,,,,835,709.75,239.311,835,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
GASTRO BALLOON 18X19X20 CRE,,57000023,LOCAL,Facility,Outpatient,,,,835,709.75,239.311,835,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),421.4245,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
GASTRO BALLOON 18X19X20 CRE,,57000023,LOCAL,Facility,Inpatient,,,,835,709.75,239.311,835,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
GASTRO BALLOON 18X19X20 CRE,,57000023,LOCAL,Facility,Both,,,,835,709.75,239.311,835,UnitedHealthcare,Individual & Family,784.9,94,,percent of total billed charges,,
GASTRO BALLOON 18X19X20 CRE,,57000023,LOCAL,Facility,Outpatient,,,,835,709.75,239.311,835,UnitedHealthcare,Medicare Advantage,409.15,49,,percent of total billed charges,,
GASTRO BALLOON 18X19X20 CRE,,57000023,LOCAL,Facility,Inpatient,,,,835,709.75,239.311,835,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
GASTRO BALLOON 18X19X20 CRE,,57000023,LOCAL,Facility,Outpatient,,,,835,709.75,239.311,835,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,400.8,48,,percent of total billed charges,,100% of DHS outpatient percentage
GASTRO BALLOON 18X19X20 CRE,,57000023,LOCAL,Facility,Inpatient,,,,835,709.75,239.311,835,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
GASTROSTOMY FEEDING TUBE 20FR,,57000023,LOCAL,Facility,Both,,,,91.2,77.52,26.13792,91.2,Aetna,Commercial,83.904,92,,percent of total billed charges,,
GASTROSTOMY FEEDING TUBE 20FR,,57000023,LOCAL,Facility,Outpatient,,,,91.2,77.52,26.13792,91.2,Aetna,Medicare Advantage,44.688,49,,percent of total billed charges,,
GASTROSTOMY FEEDING TUBE 20FR,,57000023,LOCAL,Facility,Inpatient,,,,91.2,77.52,26.13792,91.2,Aetna,Medicare Advantage,,,,,Included in per diem rate,
GASTROSTOMY FEEDING TUBE 20FR,,57000023,LOCAL,Facility,Both,,,,91.2,77.52,26.13792,91.2,Aetna,PPO,84.816,93,,percent of total billed charges,,
GASTROSTOMY FEEDING TUBE 20FR,,57000023,LOCAL,Facility,Both,,,,91.2,77.52,26.13792,91.2,America's PPO,America's PPO,87.57936,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
GASTROSTOMY FEEDING TUBE 20FR,,57000023,LOCAL,Facility,Both,,,,91.2,77.52,26.13792,91.2,BlueCross BlueShield Minnesota, Federal Employee Program,89.7408,98.4,,percent of total billed charges,,
GASTROSTOMY FEEDING TUBE 20FR,,57000023,LOCAL,Facility,Both,,,,91.2,77.52,26.13792,91.2,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,91.2,100,,percent of total billed charges,,
GASTROSTOMY FEEDING TUBE 20FR,,57000023,LOCAL,Facility,Both,,,,91.2,77.52,26.13792,91.2,BlueCross BlueShield Minnesota,High Value Network Plan,82.08,90,,percent of total billed charges,,
GASTROSTOMY FEEDING TUBE 20FR,,57000023,LOCAL,Facility,Outpatient,,,,91.2,77.52,26.13792,91.2,BlueCross BlueShield Minnesota,Medicare Advantage,44.688,49,,percent of total billed charges,,
GASTROSTOMY FEEDING TUBE 20FR,,57000023,LOCAL,Facility,Inpatient,,,,91.2,77.52,26.13792,91.2,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
GASTROSTOMY FEEDING TUBE 20FR,,57000023,LOCAL,Facility,Both,,,,91.2,77.52,26.13792,91.2,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,80.77584,88.57,,percent of total billed charges,,
GASTROSTOMY FEEDING TUBE 20FR,,57000023,LOCAL,Facility,Both,,,,91.2,77.52,26.13792,91.2,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,26.13792,28.66,,percent of total billed charges,,
GASTROSTOMY FEEDING TUBE 20FR,,57000023,LOCAL,Facility,Outpatient,,,,91.2,77.52,26.13792,91.2,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),44.688,49,,percent of total billed charges,,
GASTROSTOMY FEEDING TUBE 20FR,,57000023,LOCAL,Facility,Inpatient,,,,91.2,77.52,26.13792,91.2,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
GASTROSTOMY FEEDING TUBE 20FR,,57000023,LOCAL,Facility,Both,,,,91.2,77.52,26.13792,91.2,CorVel,Worker's Compensation,91.2,100,,percent of total billed charges,,
GASTROSTOMY FEEDING TUBE 20FR,,57000023,LOCAL,Facility,Both,,,,91.2,77.52,26.13792,91.2,First Health Group Corporation,First Health Network,88.464,97,,percent of total billed charges,,
GASTROSTOMY FEEDING TUBE 20FR,,57000023,LOCAL,Facility,Both,,,,91.2,77.52,26.13792,91.2,"Health Partners, Inc.",Commercial,86.2752,94.6,,percent of total billed charges,,
GASTROSTOMY FEEDING TUBE 20FR,,57000023,LOCAL,Facility,Outpatient,,,,91.2,77.52,26.13792,91.2,"Health Partners, Inc.",Medicare Advantage,44.688,49,,percent of total billed charges,,
GASTROSTOMY FEEDING TUBE 20FR,,57000023,LOCAL,Facility,Inpatient,,,,91.2,77.52,26.13792,91.2,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
GASTROSTOMY FEEDING TUBE 20FR,,57000023,LOCAL,Facility,Both,,,,91.2,77.52,26.13792,91.2,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),54.72,60,,percent of total billed charges,,
GASTROSTOMY FEEDING TUBE 20FR,,57000023,LOCAL,Facility,Both,,,,91.2,77.52,26.13792,91.2,"Health Partners, Inc.",State of Minnesota Advantage Program,74.328,81.5,,percent of total billed charges,,
GASTROSTOMY FEEDING TUBE 20FR,,57000023,LOCAL,Facility,Both,,,,91.2,77.52,26.13792,91.2,"Health Partners, Inc.",State Public Programs,45.6,50,,percent of total billed charges,,
GASTROSTOMY FEEDING TUBE 20FR,,57000023,LOCAL,Facility,Both,,,,91.2,77.52,26.13792,91.2,Humana Insurance Company,Commercial PPO,86.64,95,,percent of total billed charges,,
GASTROSTOMY FEEDING TUBE 20FR,,57000023,LOCAL,Facility,Outpatient,,,,91.2,77.52,26.13792,91.2,Humana Insurance Company,Medicare PPO,44.688,49,,percent of total billed charges,,
GASTROSTOMY FEEDING TUBE 20FR,,57000023,LOCAL,Facility,Inpatient,,,,91.2,77.52,26.13792,91.2,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
GASTROSTOMY FEEDING TUBE 20FR,,57000023,LOCAL,Facility,Both,,,,91.2,77.52,26.13792,91.2,Medica,Individual & Family,90.3792,99.1,,percent of total billed charges,,
GASTROSTOMY FEEDING TUBE 20FR,,57000023,LOCAL,Facility,Outpatient,,,,91.2,77.52,26.13792,91.2,Medica,Medica Advantage Solution,45.4176,49.8,,percent of total billed charges,,
GASTROSTOMY FEEDING TUBE 20FR,,57000023,LOCAL,Facility,Inpatient,,,,91.2,77.52,26.13792,91.2,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
GASTROSTOMY FEEDING TUBE 20FR,,57000023,LOCAL,Facility,Outpatient,,,,91.2,77.52,26.13792,91.2,Medica,Medical Assistance,40.6752,44.6,,percent of total billed charges,,
GASTROSTOMY FEEDING TUBE 20FR,,57000023,LOCAL,Facility,Inpatient,,,,91.2,77.52,26.13792,91.2,Medica,Medical Assistance,,,,,Included in per diem rate,
GASTROSTOMY FEEDING TUBE 20FR,,57000023,LOCAL,Facility,Outpatient,,,,91.2,77.52,26.13792,91.2,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,45.4176,49.8,,percent of total billed charges,,
GASTROSTOMY FEEDING TUBE 20FR,,57000023,LOCAL,Facility,Inpatient,,,,91.2,77.52,26.13792,91.2,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
GASTROSTOMY FEEDING TUBE 20FR,,57000023,LOCAL,Facility,Both,,,,91.2,77.52,26.13792,91.2,"Multiplan, Inc.","Multiplan, Inc.",85.728,94,,percent of total billed charges,,
GASTROSTOMY FEEDING TUBE 20FR,,57000023,LOCAL,Facility,Outpatient,,,,91.2,77.52,26.13792,91.2,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,82.1712,90.1,,percent of total billed charges,,
GASTROSTOMY FEEDING TUBE 20FR,,57000023,LOCAL,Facility,Inpatient,,,,91.2,77.52,26.13792,91.2,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
GASTROSTOMY FEEDING TUBE 20FR,,57000023,LOCAL,Facility,Both,,,,91.2,77.52,26.13792,91.2,"Preferred One Administrative Services, INC.",PPO,89.9232,98.6,,percent of total billed charges,,
GASTROSTOMY FEEDING TUBE 20FR,,57000023,LOCAL,Facility,Outpatient,,,,91.2,77.52,26.13792,91.2,PrimeWest Health,Minnesota Senior Health Options (MSHO),46.9224,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
GASTROSTOMY FEEDING TUBE 20FR,,57000023,LOCAL,Facility,Inpatient,,,,91.2,77.52,26.13792,91.2,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
GASTROSTOMY FEEDING TUBE 20FR,,57000023,LOCAL,Facility,Outpatient,,,,91.2,77.52,26.13792,91.2,PrimeWest Health,MinnesotaCare,46.84032,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
GASTROSTOMY FEEDING TUBE 20FR,,57000023,LOCAL,Facility,Inpatient,,,,91.2,77.52,26.13792,91.2,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
GASTROSTOMY FEEDING TUBE 20FR,,57000023,LOCAL,Facility,Both,,,,91.2,77.52,26.13792,91.2,Sanford Health Plan,Sanford Health Plan,83.904,92,,percent of total billed charges,,
GASTROSTOMY FEEDING TUBE 20FR,,57000023,LOCAL,Facility,Outpatient,,,,91.2,77.52,26.13792,91.2,"UCare Health, Inc.",Individual & Family Plan,51.3912,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
GASTROSTOMY FEEDING TUBE 20FR,,57000023,LOCAL,Facility,Inpatient,,,,91.2,77.52,26.13792,91.2,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
GASTROSTOMY FEEDING TUBE 20FR,,57000023,LOCAL,Facility,Outpatient,,,,91.2,77.52,26.13792,91.2,"UCare Health, Inc.",Medical Assistance,46.02864,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
GASTROSTOMY FEEDING TUBE 20FR,,57000023,LOCAL,Facility,Inpatient,,,,91.2,77.52,26.13792,91.2,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
GASTROSTOMY FEEDING TUBE 20FR,,57000023,LOCAL,Facility,Outpatient,,,,91.2,77.52,26.13792,91.2,"UCare Health, Inc.",Medicare Advantage,46.02864,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
GASTROSTOMY FEEDING TUBE 20FR,,57000023,LOCAL,Facility,Inpatient,,,,91.2,77.52,26.13792,91.2,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
GASTROSTOMY FEEDING TUBE 20FR,,57000023,LOCAL,Facility,Outpatient,,,,91.2,77.52,26.13792,91.2,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),46.02864,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
GASTROSTOMY FEEDING TUBE 20FR,,57000023,LOCAL,Facility,Inpatient,,,,91.2,77.52,26.13792,91.2,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
GASTROSTOMY FEEDING TUBE 20FR,,57000023,LOCAL,Facility,Both,,,,91.2,77.52,26.13792,91.2,UnitedHealthcare,Individual & Family,85.728,94,,percent of total billed charges,,
GASTROSTOMY FEEDING TUBE 20FR,,57000023,LOCAL,Facility,Outpatient,,,,91.2,77.52,26.13792,91.2,UnitedHealthcare,Medicare Advantage,44.688,49,,percent of total billed charges,,
GASTROSTOMY FEEDING TUBE 20FR,,57000023,LOCAL,Facility,Inpatient,,,,91.2,77.52,26.13792,91.2,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
GASTROSTOMY FEEDING TUBE 20FR,,57000023,LOCAL,Facility,Outpatient,,,,91.2,77.52,26.13792,91.2,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,43.776,48,,percent of total billed charges,,100% of DHS outpatient percentage
GASTROSTOMY FEEDING TUBE 20FR,,57000023,LOCAL,Facility,Inpatient,,,,91.2,77.52,26.13792,91.2,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
INSUFFLATION TUBING,,57000023,LOCAL,Facility,Both,,,,89.28,75.888,25.587648,89.28,Aetna,Commercial,82.1376,92,,percent of total billed charges,,
INSUFFLATION TUBING,,57000023,LOCAL,Facility,Outpatient,,,,89.28,75.888,25.587648,89.28,Aetna,Medicare Advantage,43.7472,49,,percent of total billed charges,,
INSUFFLATION TUBING,,57000023,LOCAL,Facility,Inpatient,,,,89.28,75.888,25.587648,89.28,Aetna,Medicare Advantage,,,,,Included in per diem rate,
INSUFFLATION TUBING,,57000023,LOCAL,Facility,Both,,,,89.28,75.888,25.587648,89.28,Aetna,PPO,83.0304,93,,percent of total billed charges,,
INSUFFLATION TUBING,,57000023,LOCAL,Facility,Both,,,,89.28,75.888,25.587648,89.28,America's PPO,America's PPO,85.735584,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
INSUFFLATION TUBING,,57000023,LOCAL,Facility,Both,,,,89.28,75.888,25.587648,89.28,BlueCross BlueShield Minnesota, Federal Employee Program,87.85152,98.4,,percent of total billed charges,,
INSUFFLATION TUBING,,57000023,LOCAL,Facility,Both,,,,89.28,75.888,25.587648,89.28,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,89.28,100,,percent of total billed charges,,
INSUFFLATION TUBING,,57000023,LOCAL,Facility,Both,,,,89.28,75.888,25.587648,89.28,BlueCross BlueShield Minnesota,High Value Network Plan,80.352,90,,percent of total billed charges,,
INSUFFLATION TUBING,,57000023,LOCAL,Facility,Outpatient,,,,89.28,75.888,25.587648,89.28,BlueCross BlueShield Minnesota,Medicare Advantage,43.7472,49,,percent of total billed charges,,
INSUFFLATION TUBING,,57000023,LOCAL,Facility,Inpatient,,,,89.28,75.888,25.587648,89.28,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
INSUFFLATION TUBING,,57000023,LOCAL,Facility,Both,,,,89.28,75.888,25.587648,89.28,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,79.075296,88.57,,percent of total billed charges,,
INSUFFLATION TUBING,,57000023,LOCAL,Facility,Both,,,,89.28,75.888,25.587648,89.28,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,25.587648,28.66,,percent of total billed charges,,
INSUFFLATION TUBING,,57000023,LOCAL,Facility,Outpatient,,,,89.28,75.888,25.587648,89.28,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),43.7472,49,,percent of total billed charges,,
INSUFFLATION TUBING,,57000023,LOCAL,Facility,Inpatient,,,,89.28,75.888,25.587648,89.28,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
INSUFFLATION TUBING,,57000023,LOCAL,Facility,Both,,,,89.28,75.888,25.587648,89.28,CorVel,Worker's Compensation,89.28,100,,percent of total billed charges,,
INSUFFLATION TUBING,,57000023,LOCAL,Facility,Both,,,,89.28,75.888,25.587648,89.28,First Health Group Corporation,First Health Network,86.6016,97,,percent of total billed charges,,
INSUFFLATION TUBING,,57000023,LOCAL,Facility,Both,,,,89.28,75.888,25.587648,89.28,"Health Partners, Inc.",Commercial,84.45888,94.6,,percent of total billed charges,,
INSUFFLATION TUBING,,57000023,LOCAL,Facility,Outpatient,,,,89.28,75.888,25.587648,89.28,"Health Partners, Inc.",Medicare Advantage,43.7472,49,,percent of total billed charges,,
INSUFFLATION TUBING,,57000023,LOCAL,Facility,Inpatient,,,,89.28,75.888,25.587648,89.28,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
INSUFFLATION TUBING,,57000023,LOCAL,Facility,Both,,,,89.28,75.888,25.587648,89.28,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),53.568,60,,percent of total billed charges,,
INSUFFLATION TUBING,,57000023,LOCAL,Facility,Both,,,,89.28,75.888,25.587648,89.28,"Health Partners, Inc.",State of Minnesota Advantage Program,72.7632,81.5,,percent of total billed charges,,
INSUFFLATION TUBING,,57000023,LOCAL,Facility,Both,,,,89.28,75.888,25.587648,89.28,"Health Partners, Inc.",State Public Programs,44.64,50,,percent of total billed charges,,
INSUFFLATION TUBING,,57000023,LOCAL,Facility,Both,,,,89.28,75.888,25.587648,89.28,Humana Insurance Company,Commercial PPO,84.816,95,,percent of total billed charges,,
INSUFFLATION TUBING,,57000023,LOCAL,Facility,Outpatient,,,,89.28,75.888,25.587648,89.28,Humana Insurance Company,Medicare PPO,43.7472,49,,percent of total billed charges,,
INSUFFLATION TUBING,,57000023,LOCAL,Facility,Inpatient,,,,89.28,75.888,25.587648,89.28,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
INSUFFLATION TUBING,,57000023,LOCAL,Facility,Both,,,,89.28,75.888,25.587648,89.28,Medica,Individual & Family,88.47648,99.1,,percent of total billed charges,,
INSUFFLATION TUBING,,57000023,LOCAL,Facility,Outpatient,,,,89.28,75.888,25.587648,89.28,Medica,Medica Advantage Solution,44.46144,49.8,,percent of total billed charges,,
INSUFFLATION TUBING,,57000023,LOCAL,Facility,Inpatient,,,,89.28,75.888,25.587648,89.28,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
INSUFFLATION TUBING,,57000023,LOCAL,Facility,Outpatient,,,,89.28,75.888,25.587648,89.28,Medica,Medical Assistance,39.81888,44.6,,percent of total billed charges,,
INSUFFLATION TUBING,,57000023,LOCAL,Facility,Inpatient,,,,89.28,75.888,25.587648,89.28,Medica,Medical Assistance,,,,,Included in per diem rate,
INSUFFLATION TUBING,,57000023,LOCAL,Facility,Outpatient,,,,89.28,75.888,25.587648,89.28,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,44.46144,49.8,,percent of total billed charges,,
INSUFFLATION TUBING,,57000023,LOCAL,Facility,Inpatient,,,,89.28,75.888,25.587648,89.28,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
INSUFFLATION TUBING,,57000023,LOCAL,Facility,Both,,,,89.28,75.888,25.587648,89.28,"Multiplan, Inc.","Multiplan, Inc.",83.9232,94,,percent of total billed charges,,
INSUFFLATION TUBING,,57000023,LOCAL,Facility,Outpatient,,,,89.28,75.888,25.587648,89.28,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,80.44128,90.1,,percent of total billed charges,,
INSUFFLATION TUBING,,57000023,LOCAL,Facility,Inpatient,,,,89.28,75.888,25.587648,89.28,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
INSUFFLATION TUBING,,57000023,LOCAL,Facility,Both,,,,89.28,75.888,25.587648,89.28,"Preferred One Administrative Services, INC.",PPO,88.03008,98.6,,percent of total billed charges,,
INSUFFLATION TUBING,,57000023,LOCAL,Facility,Outpatient,,,,89.28,75.888,25.587648,89.28,PrimeWest Health,Minnesota Senior Health Options (MSHO),45.93456,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
INSUFFLATION TUBING,,57000023,LOCAL,Facility,Inpatient,,,,89.28,75.888,25.587648,89.28,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
INSUFFLATION TUBING,,57000023,LOCAL,Facility,Outpatient,,,,89.28,75.888,25.587648,89.28,PrimeWest Health,MinnesotaCare,45.854208,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
INSUFFLATION TUBING,,57000023,LOCAL,Facility,Inpatient,,,,89.28,75.888,25.587648,89.28,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
INSUFFLATION TUBING,,57000023,LOCAL,Facility,Both,,,,89.28,75.888,25.587648,89.28,Sanford Health Plan,Sanford Health Plan,82.1376,92,,percent of total billed charges,,
INSUFFLATION TUBING,,57000023,LOCAL,Facility,Outpatient,,,,89.28,75.888,25.587648,89.28,"UCare Health, Inc.",Individual & Family Plan,50.30928,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
INSUFFLATION TUBING,,57000023,LOCAL,Facility,Inpatient,,,,89.28,75.888,25.587648,89.28,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
INSUFFLATION TUBING,,57000023,LOCAL,Facility,Outpatient,,,,89.28,75.888,25.587648,89.28,"UCare Health, Inc.",Medical Assistance,45.059616,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
INSUFFLATION TUBING,,57000023,LOCAL,Facility,Inpatient,,,,89.28,75.888,25.587648,89.28,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
INSUFFLATION TUBING,,57000023,LOCAL,Facility,Outpatient,,,,89.28,75.888,25.587648,89.28,"UCare Health, Inc.",Medicare Advantage,45.059616,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
INSUFFLATION TUBING,,57000023,LOCAL,Facility,Inpatient,,,,89.28,75.888,25.587648,89.28,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
INSUFFLATION TUBING,,57000023,LOCAL,Facility,Outpatient,,,,89.28,75.888,25.587648,89.28,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),45.059616,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
INSUFFLATION TUBING,,57000023,LOCAL,Facility,Inpatient,,,,89.28,75.888,25.587648,89.28,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
INSUFFLATION TUBING,,57000023,LOCAL,Facility,Both,,,,89.28,75.888,25.587648,89.28,UnitedHealthcare,Individual & Family,83.9232,94,,percent of total billed charges,,
INSUFFLATION TUBING,,57000023,LOCAL,Facility,Outpatient,,,,89.28,75.888,25.587648,89.28,UnitedHealthcare,Medicare Advantage,43.7472,49,,percent of total billed charges,,
INSUFFLATION TUBING,,57000023,LOCAL,Facility,Inpatient,,,,89.28,75.888,25.587648,89.28,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
INSUFFLATION TUBING,,57000023,LOCAL,Facility,Outpatient,,,,89.28,75.888,25.587648,89.28,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,42.8544,48,,percent of total billed charges,,100% of DHS outpatient percentage
INSUFFLATION TUBING,,57000023,LOCAL,Facility,Inpatient,,,,89.28,75.888,25.587648,89.28,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
INTEGRA OROTRACHEAL INJECTION NEEDLE,,57000023,LOCAL,Facility,Both,,,,128,108.8,36.6848,128,Aetna,Commercial,117.76,92,,percent of total billed charges,,
INTEGRA OROTRACHEAL INJECTION NEEDLE,,57000023,LOCAL,Facility,Outpatient,,,,128,108.8,36.6848,128,Aetna,Medicare Advantage,62.72,49,,percent of total billed charges,,
INTEGRA OROTRACHEAL INJECTION NEEDLE,,57000023,LOCAL,Facility,Inpatient,,,,128,108.8,36.6848,128,Aetna,Medicare Advantage,,,,,Included in per diem rate,
INTEGRA OROTRACHEAL INJECTION NEEDLE,,57000023,LOCAL,Facility,Both,,,,128,108.8,36.6848,128,Aetna,PPO,119.04,93,,percent of total billed charges,,
INTEGRA OROTRACHEAL INJECTION NEEDLE,,57000023,LOCAL,Facility,Both,,,,128,108.8,36.6848,128,America's PPO,America's PPO,122.9184,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
INTEGRA OROTRACHEAL INJECTION NEEDLE,,57000023,LOCAL,Facility,Both,,,,128,108.8,36.6848,128,BlueCross BlueShield Minnesota, Federal Employee Program,125.952,98.4,,percent of total billed charges,,
INTEGRA OROTRACHEAL INJECTION NEEDLE,,57000023,LOCAL,Facility,Both,,,,128,108.8,36.6848,128,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,128,100,,percent of total billed charges,,
INTEGRA OROTRACHEAL INJECTION NEEDLE,,57000023,LOCAL,Facility,Both,,,,128,108.8,36.6848,128,BlueCross BlueShield Minnesota,High Value Network Plan,115.2,90,,percent of total billed charges,,
INTEGRA OROTRACHEAL INJECTION NEEDLE,,57000023,LOCAL,Facility,Outpatient,,,,128,108.8,36.6848,128,BlueCross BlueShield Minnesota,Medicare Advantage,62.72,49,,percent of total billed charges,,
INTEGRA OROTRACHEAL INJECTION NEEDLE,,57000023,LOCAL,Facility,Inpatient,,,,128,108.8,36.6848,128,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
INTEGRA OROTRACHEAL INJECTION NEEDLE,,57000023,LOCAL,Facility,Both,,,,128,108.8,36.6848,128,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,113.3696,88.57,,percent of total billed charges,,
INTEGRA OROTRACHEAL INJECTION NEEDLE,,57000023,LOCAL,Facility,Both,,,,128,108.8,36.6848,128,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,36.6848,28.66,,percent of total billed charges,,
INTEGRA OROTRACHEAL INJECTION NEEDLE,,57000023,LOCAL,Facility,Outpatient,,,,128,108.8,36.6848,128,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),62.72,49,,percent of total billed charges,,
INTEGRA OROTRACHEAL INJECTION NEEDLE,,57000023,LOCAL,Facility,Inpatient,,,,128,108.8,36.6848,128,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
INTEGRA OROTRACHEAL INJECTION NEEDLE,,57000023,LOCAL,Facility,Both,,,,128,108.8,36.6848,128,CorVel,Worker's Compensation,128,100,,percent of total billed charges,,
INTEGRA OROTRACHEAL INJECTION NEEDLE,,57000023,LOCAL,Facility,Both,,,,128,108.8,36.6848,128,First Health Group Corporation,First Health Network,124.16,97,,percent of total billed charges,,
INTEGRA OROTRACHEAL INJECTION NEEDLE,,57000023,LOCAL,Facility,Both,,,,128,108.8,36.6848,128,"Health Partners, Inc.",Commercial,121.088,94.6,,percent of total billed charges,,
INTEGRA OROTRACHEAL INJECTION NEEDLE,,57000023,LOCAL,Facility,Outpatient,,,,128,108.8,36.6848,128,"Health Partners, Inc.",Medicare Advantage,62.72,49,,percent of total billed charges,,
INTEGRA OROTRACHEAL INJECTION NEEDLE,,57000023,LOCAL,Facility,Inpatient,,,,128,108.8,36.6848,128,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
INTEGRA OROTRACHEAL INJECTION NEEDLE,,57000023,LOCAL,Facility,Both,,,,128,108.8,36.6848,128,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),76.8,60,,percent of total billed charges,,
INTEGRA OROTRACHEAL INJECTION NEEDLE,,57000023,LOCAL,Facility,Both,,,,128,108.8,36.6848,128,"Health Partners, Inc.",State of Minnesota Advantage Program,104.32,81.5,,percent of total billed charges,,
INTEGRA OROTRACHEAL INJECTION NEEDLE,,57000023,LOCAL,Facility,Both,,,,128,108.8,36.6848,128,"Health Partners, Inc.",State Public Programs,64,50,,percent of total billed charges,,
INTEGRA OROTRACHEAL INJECTION NEEDLE,,57000023,LOCAL,Facility,Both,,,,128,108.8,36.6848,128,Humana Insurance Company,Commercial PPO,121.6,95,,percent of total billed charges,,
INTEGRA OROTRACHEAL INJECTION NEEDLE,,57000023,LOCAL,Facility,Outpatient,,,,128,108.8,36.6848,128,Humana Insurance Company,Medicare PPO,62.72,49,,percent of total billed charges,,
INTEGRA OROTRACHEAL INJECTION NEEDLE,,57000023,LOCAL,Facility,Inpatient,,,,128,108.8,36.6848,128,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
INTEGRA OROTRACHEAL INJECTION NEEDLE,,57000023,LOCAL,Facility,Both,,,,128,108.8,36.6848,128,Medica,Individual & Family,126.848,99.1,,percent of total billed charges,,
INTEGRA OROTRACHEAL INJECTION NEEDLE,,57000023,LOCAL,Facility,Outpatient,,,,128,108.8,36.6848,128,Medica,Medica Advantage Solution,63.744,49.8,,percent of total billed charges,,
INTEGRA OROTRACHEAL INJECTION NEEDLE,,57000023,LOCAL,Facility,Inpatient,,,,128,108.8,36.6848,128,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
INTEGRA OROTRACHEAL INJECTION NEEDLE,,57000023,LOCAL,Facility,Outpatient,,,,128,108.8,36.6848,128,Medica,Medical Assistance,57.088,44.6,,percent of total billed charges,,
INTEGRA OROTRACHEAL INJECTION NEEDLE,,57000023,LOCAL,Facility,Inpatient,,,,128,108.8,36.6848,128,Medica,Medical Assistance,,,,,Included in per diem rate,
INTEGRA OROTRACHEAL INJECTION NEEDLE,,57000023,LOCAL,Facility,Outpatient,,,,128,108.8,36.6848,128,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,63.744,49.8,,percent of total billed charges,,
INTEGRA OROTRACHEAL INJECTION NEEDLE,,57000023,LOCAL,Facility,Inpatient,,,,128,108.8,36.6848,128,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
INTEGRA OROTRACHEAL INJECTION NEEDLE,,57000023,LOCAL,Facility,Both,,,,128,108.8,36.6848,128,"Multiplan, Inc.","Multiplan, Inc.",120.32,94,,percent of total billed charges,,
INTEGRA OROTRACHEAL INJECTION NEEDLE,,57000023,LOCAL,Facility,Outpatient,,,,128,108.8,36.6848,128,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,115.328,90.1,,percent of total billed charges,,
INTEGRA OROTRACHEAL INJECTION NEEDLE,,57000023,LOCAL,Facility,Inpatient,,,,128,108.8,36.6848,128,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
INTEGRA OROTRACHEAL INJECTION NEEDLE,,57000023,LOCAL,Facility,Both,,,,128,108.8,36.6848,128,"Preferred One Administrative Services, INC.",PPO,126.208,98.6,,percent of total billed charges,,
INTEGRA OROTRACHEAL INJECTION NEEDLE,,57000023,LOCAL,Facility,Outpatient,,,,128,108.8,36.6848,128,PrimeWest Health,Minnesota Senior Health Options (MSHO),65.856,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
INTEGRA OROTRACHEAL INJECTION NEEDLE,,57000023,LOCAL,Facility,Inpatient,,,,128,108.8,36.6848,128,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
INTEGRA OROTRACHEAL INJECTION NEEDLE,,57000023,LOCAL,Facility,Outpatient,,,,128,108.8,36.6848,128,PrimeWest Health,MinnesotaCare,65.7408,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
INTEGRA OROTRACHEAL INJECTION NEEDLE,,57000023,LOCAL,Facility,Inpatient,,,,128,108.8,36.6848,128,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
INTEGRA OROTRACHEAL INJECTION NEEDLE,,57000023,LOCAL,Facility,Both,,,,128,108.8,36.6848,128,Sanford Health Plan,Sanford Health Plan,117.76,92,,percent of total billed charges,,
INTEGRA OROTRACHEAL INJECTION NEEDLE,,57000023,LOCAL,Facility,Outpatient,,,,128,108.8,36.6848,128,"UCare Health, Inc.",Individual & Family Plan,72.128,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
INTEGRA OROTRACHEAL INJECTION NEEDLE,,57000023,LOCAL,Facility,Inpatient,,,,128,108.8,36.6848,128,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
INTEGRA OROTRACHEAL INJECTION NEEDLE,,57000023,LOCAL,Facility,Outpatient,,,,128,108.8,36.6848,128,"UCare Health, Inc.",Medical Assistance,64.6016,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
INTEGRA OROTRACHEAL INJECTION NEEDLE,,57000023,LOCAL,Facility,Inpatient,,,,128,108.8,36.6848,128,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
INTEGRA OROTRACHEAL INJECTION NEEDLE,,57000023,LOCAL,Facility,Outpatient,,,,128,108.8,36.6848,128,"UCare Health, Inc.",Medicare Advantage,64.6016,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
INTEGRA OROTRACHEAL INJECTION NEEDLE,,57000023,LOCAL,Facility,Inpatient,,,,128,108.8,36.6848,128,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
INTEGRA OROTRACHEAL INJECTION NEEDLE,,57000023,LOCAL,Facility,Outpatient,,,,128,108.8,36.6848,128,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),64.6016,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
INTEGRA OROTRACHEAL INJECTION NEEDLE,,57000023,LOCAL,Facility,Inpatient,,,,128,108.8,36.6848,128,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
INTEGRA OROTRACHEAL INJECTION NEEDLE,,57000023,LOCAL,Facility,Both,,,,128,108.8,36.6848,128,UnitedHealthcare,Individual & Family,120.32,94,,percent of total billed charges,,
INTEGRA OROTRACHEAL INJECTION NEEDLE,,57000023,LOCAL,Facility,Outpatient,,,,128,108.8,36.6848,128,UnitedHealthcare,Medicare Advantage,62.72,49,,percent of total billed charges,,
INTEGRA OROTRACHEAL INJECTION NEEDLE,,57000023,LOCAL,Facility,Inpatient,,,,128,108.8,36.6848,128,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
INTEGRA OROTRACHEAL INJECTION NEEDLE,,57000023,LOCAL,Facility,Outpatient,,,,128,108.8,36.6848,128,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,61.44,48,,percent of total billed charges,,100% of DHS outpatient percentage
INTEGRA OROTRACHEAL INJECTION NEEDLE,,57000023,LOCAL,Facility,Inpatient,,,,128,108.8,36.6848,128,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Medivator endogator endoscopy irrigation tubing,,57000023,LOCAL,Facility,Both,,,,67.5,57.375,19.3455,67.5,Aetna,Commercial,62.1,92,,percent of total billed charges,,
Medivator endogator endoscopy irrigation tubing,,57000023,LOCAL,Facility,Outpatient,,,,67.5,57.375,19.3455,67.5,Aetna,Medicare Advantage,33.075,49,,percent of total billed charges,,
Medivator endogator endoscopy irrigation tubing,,57000023,LOCAL,Facility,Inpatient,,,,67.5,57.375,19.3455,67.5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Medivator endogator endoscopy irrigation tubing,,57000023,LOCAL,Facility,Both,,,,67.5,57.375,19.3455,67.5,Aetna,PPO,62.775,93,,percent of total billed charges,,
Medivator endogator endoscopy irrigation tubing,,57000023,LOCAL,Facility,Both,,,,67.5,57.375,19.3455,67.5,America's PPO,America's PPO,64.82025,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Medivator endogator endoscopy irrigation tubing,,57000023,LOCAL,Facility,Both,,,,67.5,57.375,19.3455,67.5,BlueCross BlueShield Minnesota, Federal Employee Program,66.42,98.4,,percent of total billed charges,,
Medivator endogator endoscopy irrigation tubing,,57000023,LOCAL,Facility,Both,,,,67.5,57.375,19.3455,67.5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,67.5,100,,percent of total billed charges,,
Medivator endogator endoscopy irrigation tubing,,57000023,LOCAL,Facility,Both,,,,67.5,57.375,19.3455,67.5,BlueCross BlueShield Minnesota,High Value Network Plan,60.75,90,,percent of total billed charges,,
Medivator endogator endoscopy irrigation tubing,,57000023,LOCAL,Facility,Outpatient,,,,67.5,57.375,19.3455,67.5,BlueCross BlueShield Minnesota,Medicare Advantage,33.075,49,,percent of total billed charges,,
Medivator endogator endoscopy irrigation tubing,,57000023,LOCAL,Facility,Inpatient,,,,67.5,57.375,19.3455,67.5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Medivator endogator endoscopy irrigation tubing,,57000023,LOCAL,Facility,Both,,,,67.5,57.375,19.3455,67.5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,59.78475,88.57,,percent of total billed charges,,
Medivator endogator endoscopy irrigation tubing,,57000023,LOCAL,Facility,Both,,,,67.5,57.375,19.3455,67.5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,19.3455,28.66,,percent of total billed charges,,
Medivator endogator endoscopy irrigation tubing,,57000023,LOCAL,Facility,Outpatient,,,,67.5,57.375,19.3455,67.5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),33.075,49,,percent of total billed charges,,
Medivator endogator endoscopy irrigation tubing,,57000023,LOCAL,Facility,Inpatient,,,,67.5,57.375,19.3455,67.5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Medivator endogator endoscopy irrigation tubing,,57000023,LOCAL,Facility,Both,,,,67.5,57.375,19.3455,67.5,CorVel,Worker's Compensation,67.5,100,,percent of total billed charges,,
Medivator endogator endoscopy irrigation tubing,,57000023,LOCAL,Facility,Both,,,,67.5,57.375,19.3455,67.5,First Health Group Corporation,First Health Network,65.475,97,,percent of total billed charges,,
Medivator endogator endoscopy irrigation tubing,,57000023,LOCAL,Facility,Both,,,,67.5,57.375,19.3455,67.5,"Health Partners, Inc.",Commercial,63.855,94.6,,percent of total billed charges,,
Medivator endogator endoscopy irrigation tubing,,57000023,LOCAL,Facility,Outpatient,,,,67.5,57.375,19.3455,67.5,"Health Partners, Inc.",Medicare Advantage,33.075,49,,percent of total billed charges,,
Medivator endogator endoscopy irrigation tubing,,57000023,LOCAL,Facility,Inpatient,,,,67.5,57.375,19.3455,67.5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Medivator endogator endoscopy irrigation tubing,,57000023,LOCAL,Facility,Both,,,,67.5,57.375,19.3455,67.5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),40.5,60,,percent of total billed charges,,
Medivator endogator endoscopy irrigation tubing,,57000023,LOCAL,Facility,Both,,,,67.5,57.375,19.3455,67.5,"Health Partners, Inc.",State of Minnesota Advantage Program,55.0125,81.5,,percent of total billed charges,,
Medivator endogator endoscopy irrigation tubing,,57000023,LOCAL,Facility,Both,,,,67.5,57.375,19.3455,67.5,"Health Partners, Inc.",State Public Programs,33.75,50,,percent of total billed charges,,
Medivator endogator endoscopy irrigation tubing,,57000023,LOCAL,Facility,Both,,,,67.5,57.375,19.3455,67.5,Humana Insurance Company,Commercial PPO,64.125,95,,percent of total billed charges,,
Medivator endogator endoscopy irrigation tubing,,57000023,LOCAL,Facility,Outpatient,,,,67.5,57.375,19.3455,67.5,Humana Insurance Company,Medicare PPO,33.075,49,,percent of total billed charges,,
Medivator endogator endoscopy irrigation tubing,,57000023,LOCAL,Facility,Inpatient,,,,67.5,57.375,19.3455,67.5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Medivator endogator endoscopy irrigation tubing,,57000023,LOCAL,Facility,Both,,,,67.5,57.375,19.3455,67.5,Medica,Individual & Family,66.8925,99.1,,percent of total billed charges,,
Medivator endogator endoscopy irrigation tubing,,57000023,LOCAL,Facility,Outpatient,,,,67.5,57.375,19.3455,67.5,Medica,Medica Advantage Solution,33.615,49.8,,percent of total billed charges,,
Medivator endogator endoscopy irrigation tubing,,57000023,LOCAL,Facility,Inpatient,,,,67.5,57.375,19.3455,67.5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Medivator endogator endoscopy irrigation tubing,,57000023,LOCAL,Facility,Outpatient,,,,67.5,57.375,19.3455,67.5,Medica,Medical Assistance,30.105,44.6,,percent of total billed charges,,
Medivator endogator endoscopy irrigation tubing,,57000023,LOCAL,Facility,Inpatient,,,,67.5,57.375,19.3455,67.5,Medica,Medical Assistance,,,,,Included in per diem rate,
Medivator endogator endoscopy irrigation tubing,,57000023,LOCAL,Facility,Outpatient,,,,67.5,57.375,19.3455,67.5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,33.615,49.8,,percent of total billed charges,,
Medivator endogator endoscopy irrigation tubing,,57000023,LOCAL,Facility,Inpatient,,,,67.5,57.375,19.3455,67.5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Medivator endogator endoscopy irrigation tubing,,57000023,LOCAL,Facility,Both,,,,67.5,57.375,19.3455,67.5,"Multiplan, Inc.","Multiplan, Inc.",63.45,94,,percent of total billed charges,,
Medivator endogator endoscopy irrigation tubing,,57000023,LOCAL,Facility,Outpatient,,,,67.5,57.375,19.3455,67.5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,60.8175,90.1,,percent of total billed charges,,
Medivator endogator endoscopy irrigation tubing,,57000023,LOCAL,Facility,Inpatient,,,,67.5,57.375,19.3455,67.5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Medivator endogator endoscopy irrigation tubing,,57000023,LOCAL,Facility,Both,,,,67.5,57.375,19.3455,67.5,"Preferred One Administrative Services, INC.",PPO,66.555,98.6,,percent of total billed charges,,
Medivator endogator endoscopy irrigation tubing,,57000023,LOCAL,Facility,Outpatient,,,,67.5,57.375,19.3455,67.5,PrimeWest Health,Minnesota Senior Health Options (MSHO),34.72875,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Medivator endogator endoscopy irrigation tubing,,57000023,LOCAL,Facility,Inpatient,,,,67.5,57.375,19.3455,67.5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Medivator endogator endoscopy irrigation tubing,,57000023,LOCAL,Facility,Outpatient,,,,67.5,57.375,19.3455,67.5,PrimeWest Health,MinnesotaCare,34.668,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Medivator endogator endoscopy irrigation tubing,,57000023,LOCAL,Facility,Inpatient,,,,67.5,57.375,19.3455,67.5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Medivator endogator endoscopy irrigation tubing,,57000023,LOCAL,Facility,Both,,,,67.5,57.375,19.3455,67.5,Sanford Health Plan,Sanford Health Plan,62.1,92,,percent of total billed charges,,
Medivator endogator endoscopy irrigation tubing,,57000023,LOCAL,Facility,Outpatient,,,,67.5,57.375,19.3455,67.5,"UCare Health, Inc.",Individual & Family Plan,38.03625,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Medivator endogator endoscopy irrigation tubing,,57000023,LOCAL,Facility,Inpatient,,,,67.5,57.375,19.3455,67.5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Medivator endogator endoscopy irrigation tubing,,57000023,LOCAL,Facility,Outpatient,,,,67.5,57.375,19.3455,67.5,"UCare Health, Inc.",Medical Assistance,34.06725,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Medivator endogator endoscopy irrigation tubing,,57000023,LOCAL,Facility,Inpatient,,,,67.5,57.375,19.3455,67.5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Medivator endogator endoscopy irrigation tubing,,57000023,LOCAL,Facility,Outpatient,,,,67.5,57.375,19.3455,67.5,"UCare Health, Inc.",Medicare Advantage,34.06725,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Medivator endogator endoscopy irrigation tubing,,57000023,LOCAL,Facility,Inpatient,,,,67.5,57.375,19.3455,67.5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Medivator endogator endoscopy irrigation tubing,,57000023,LOCAL,Facility,Outpatient,,,,67.5,57.375,19.3455,67.5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),34.06725,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Medivator endogator endoscopy irrigation tubing,,57000023,LOCAL,Facility,Inpatient,,,,67.5,57.375,19.3455,67.5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Medivator endogator endoscopy irrigation tubing,,57000023,LOCAL,Facility,Both,,,,67.5,57.375,19.3455,67.5,UnitedHealthcare,Individual & Family,63.45,94,,percent of total billed charges,,
Medivator endogator endoscopy irrigation tubing,,57000023,LOCAL,Facility,Outpatient,,,,67.5,57.375,19.3455,67.5,UnitedHealthcare,Medicare Advantage,33.075,49,,percent of total billed charges,,
Medivator endogator endoscopy irrigation tubing,,57000023,LOCAL,Facility,Inpatient,,,,67.5,57.375,19.3455,67.5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Medivator endogator endoscopy irrigation tubing,,57000023,LOCAL,Facility,Outpatient,,,,67.5,57.375,19.3455,67.5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,32.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
Medivator endogator endoscopy irrigation tubing,,57000023,LOCAL,Facility,Inpatient,,,,67.5,57.375,19.3455,67.5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
MINERAL OIL - 10 ML BOTTLE,,57000023,LOCAL,Facility,Both,,,,63.405,53.89425,18.171873,63.405,Aetna,Commercial,58.3326,92,,percent of total billed charges,,
MINERAL OIL - 10 ML BOTTLE,,57000023,LOCAL,Facility,Outpatient,,,,63.405,53.89425,18.171873,63.405,Aetna,Medicare Advantage,31.06845,49,,percent of total billed charges,,
MINERAL OIL - 10 ML BOTTLE,,57000023,LOCAL,Facility,Inpatient,,,,63.405,53.89425,18.171873,63.405,Aetna,Medicare Advantage,,,,,Included in per diem rate,
MINERAL OIL - 10 ML BOTTLE,,57000023,LOCAL,Facility,Both,,,,63.405,53.89425,18.171873,63.405,Aetna,PPO,58.96665,93,,percent of total billed charges,,
MINERAL OIL - 10 ML BOTTLE,,57000023,LOCAL,Facility,Both,,,,63.405,53.89425,18.171873,63.405,America's PPO,America's PPO,60.8878215,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
MINERAL OIL - 10 ML BOTTLE,,57000023,LOCAL,Facility,Both,,,,63.405,53.89425,18.171873,63.405,BlueCross BlueShield Minnesota, Federal Employee Program,62.39052,98.4,,percent of total billed charges,,
MINERAL OIL - 10 ML BOTTLE,,57000023,LOCAL,Facility,Both,,,,63.405,53.89425,18.171873,63.405,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,63.405,100,,percent of total billed charges,,
MINERAL OIL - 10 ML BOTTLE,,57000023,LOCAL,Facility,Both,,,,63.405,53.89425,18.171873,63.405,BlueCross BlueShield Minnesota,High Value Network Plan,57.0645,90,,percent of total billed charges,,
MINERAL OIL - 10 ML BOTTLE,,57000023,LOCAL,Facility,Outpatient,,,,63.405,53.89425,18.171873,63.405,BlueCross BlueShield Minnesota,Medicare Advantage,31.06845,49,,percent of total billed charges,,
MINERAL OIL - 10 ML BOTTLE,,57000023,LOCAL,Facility,Inpatient,,,,63.405,53.89425,18.171873,63.405,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
MINERAL OIL - 10 ML BOTTLE,,57000023,LOCAL,Facility,Both,,,,63.405,53.89425,18.171873,63.405,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,56.1578085,88.57,,percent of total billed charges,,
MINERAL OIL - 10 ML BOTTLE,,57000023,LOCAL,Facility,Both,,,,63.405,53.89425,18.171873,63.405,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,18.171873,28.66,,percent of total billed charges,,
MINERAL OIL - 10 ML BOTTLE,,57000023,LOCAL,Facility,Outpatient,,,,63.405,53.89425,18.171873,63.405,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),31.06845,49,,percent of total billed charges,,
MINERAL OIL - 10 ML BOTTLE,,57000023,LOCAL,Facility,Inpatient,,,,63.405,53.89425,18.171873,63.405,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
MINERAL OIL - 10 ML BOTTLE,,57000023,LOCAL,Facility,Both,,,,63.405,53.89425,18.171873,63.405,CorVel,Worker's Compensation,63.405,100,,percent of total billed charges,,
MINERAL OIL - 10 ML BOTTLE,,57000023,LOCAL,Facility,Both,,,,63.405,53.89425,18.171873,63.405,First Health Group Corporation,First Health Network,61.50285,97,,percent of total billed charges,,
MINERAL OIL - 10 ML BOTTLE,,57000023,LOCAL,Facility,Both,,,,63.405,53.89425,18.171873,63.405,"Health Partners, Inc.",Commercial,59.98113,94.6,,percent of total billed charges,,
MINERAL OIL - 10 ML BOTTLE,,57000023,LOCAL,Facility,Outpatient,,,,63.405,53.89425,18.171873,63.405,"Health Partners, Inc.",Medicare Advantage,31.06845,49,,percent of total billed charges,,
MINERAL OIL - 10 ML BOTTLE,,57000023,LOCAL,Facility,Inpatient,,,,63.405,53.89425,18.171873,63.405,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
MINERAL OIL - 10 ML BOTTLE,,57000023,LOCAL,Facility,Both,,,,63.405,53.89425,18.171873,63.405,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),38.043,60,,percent of total billed charges,,
MINERAL OIL - 10 ML BOTTLE,,57000023,LOCAL,Facility,Both,,,,63.405,53.89425,18.171873,63.405,"Health Partners, Inc.",State of Minnesota Advantage Program,51.675075,81.5,,percent of total billed charges,,
MINERAL OIL - 10 ML BOTTLE,,57000023,LOCAL,Facility,Both,,,,63.405,53.89425,18.171873,63.405,"Health Partners, Inc.",State Public Programs,31.7025,50,,percent of total billed charges,,
MINERAL OIL - 10 ML BOTTLE,,57000023,LOCAL,Facility,Both,,,,63.405,53.89425,18.171873,63.405,Humana Insurance Company,Commercial PPO,60.23475,95,,percent of total billed charges,,
MINERAL OIL - 10 ML BOTTLE,,57000023,LOCAL,Facility,Outpatient,,,,63.405,53.89425,18.171873,63.405,Humana Insurance Company,Medicare PPO,31.06845,49,,percent of total billed charges,,
MINERAL OIL - 10 ML BOTTLE,,57000023,LOCAL,Facility,Inpatient,,,,63.405,53.89425,18.171873,63.405,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
MINERAL OIL - 10 ML BOTTLE,,57000023,LOCAL,Facility,Both,,,,63.405,53.89425,18.171873,63.405,Medica,Individual & Family,62.834355,99.1,,percent of total billed charges,,
MINERAL OIL - 10 ML BOTTLE,,57000023,LOCAL,Facility,Outpatient,,,,63.405,53.89425,18.171873,63.405,Medica,Medica Advantage Solution,31.57569,49.8,,percent of total billed charges,,
MINERAL OIL - 10 ML BOTTLE,,57000023,LOCAL,Facility,Inpatient,,,,63.405,53.89425,18.171873,63.405,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
MINERAL OIL - 10 ML BOTTLE,,57000023,LOCAL,Facility,Outpatient,,,,63.405,53.89425,18.171873,63.405,Medica,Medical Assistance,28.27863,44.6,,percent of total billed charges,,
MINERAL OIL - 10 ML BOTTLE,,57000023,LOCAL,Facility,Inpatient,,,,63.405,53.89425,18.171873,63.405,Medica,Medical Assistance,,,,,Included in per diem rate,
MINERAL OIL - 10 ML BOTTLE,,57000023,LOCAL,Facility,Outpatient,,,,63.405,53.89425,18.171873,63.405,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,31.57569,49.8,,percent of total billed charges,,
MINERAL OIL - 10 ML BOTTLE,,57000023,LOCAL,Facility,Inpatient,,,,63.405,53.89425,18.171873,63.405,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
MINERAL OIL - 10 ML BOTTLE,,57000023,LOCAL,Facility,Both,,,,63.405,53.89425,18.171873,63.405,"Multiplan, Inc.","Multiplan, Inc.",59.6007,94,,percent of total billed charges,,
MINERAL OIL - 10 ML BOTTLE,,57000023,LOCAL,Facility,Outpatient,,,,63.405,53.89425,18.171873,63.405,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,57.127905,90.1,,percent of total billed charges,,
MINERAL OIL - 10 ML BOTTLE,,57000023,LOCAL,Facility,Inpatient,,,,63.405,53.89425,18.171873,63.405,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
MINERAL OIL - 10 ML BOTTLE,,57000023,LOCAL,Facility,Both,,,,63.405,53.89425,18.171873,63.405,"Preferred One Administrative Services, INC.",PPO,62.51733,98.6,,percent of total billed charges,,
MINERAL OIL - 10 ML BOTTLE,,57000023,LOCAL,Facility,Outpatient,,,,63.405,53.89425,18.171873,63.405,PrimeWest Health,Minnesota Senior Health Options (MSHO),32.6218725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
MINERAL OIL - 10 ML BOTTLE,,57000023,LOCAL,Facility,Inpatient,,,,63.405,53.89425,18.171873,63.405,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
MINERAL OIL - 10 ML BOTTLE,,57000023,LOCAL,Facility,Outpatient,,,,63.405,53.89425,18.171873,63.405,PrimeWest Health,MinnesotaCare,32.564808,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
MINERAL OIL - 10 ML BOTTLE,,57000023,LOCAL,Facility,Inpatient,,,,63.405,53.89425,18.171873,63.405,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
MINERAL OIL - 10 ML BOTTLE,,57000023,LOCAL,Facility,Both,,,,63.405,53.89425,18.171873,63.405,Sanford Health Plan,Sanford Health Plan,58.3326,92,,percent of total billed charges,,
MINERAL OIL - 10 ML BOTTLE,,57000023,LOCAL,Facility,Outpatient,,,,63.405,53.89425,18.171873,63.405,"UCare Health, Inc.",Individual & Family Plan,35.7287175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
MINERAL OIL - 10 ML BOTTLE,,57000023,LOCAL,Facility,Inpatient,,,,63.405,53.89425,18.171873,63.405,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
MINERAL OIL - 10 ML BOTTLE,,57000023,LOCAL,Facility,Outpatient,,,,63.405,53.89425,18.171873,63.405,"UCare Health, Inc.",Medical Assistance,32.0005035,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MINERAL OIL - 10 ML BOTTLE,,57000023,LOCAL,Facility,Inpatient,,,,63.405,53.89425,18.171873,63.405,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
MINERAL OIL - 10 ML BOTTLE,,57000023,LOCAL,Facility,Outpatient,,,,63.405,53.89425,18.171873,63.405,"UCare Health, Inc.",Medicare Advantage,32.0005035,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MINERAL OIL - 10 ML BOTTLE,,57000023,LOCAL,Facility,Inpatient,,,,63.405,53.89425,18.171873,63.405,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
MINERAL OIL - 10 ML BOTTLE,,57000023,LOCAL,Facility,Outpatient,,,,63.405,53.89425,18.171873,63.405,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),32.0005035,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MINERAL OIL - 10 ML BOTTLE,,57000023,LOCAL,Facility,Inpatient,,,,63.405,53.89425,18.171873,63.405,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
MINERAL OIL - 10 ML BOTTLE,,57000023,LOCAL,Facility,Both,,,,63.405,53.89425,18.171873,63.405,UnitedHealthcare,Individual & Family,59.6007,94,,percent of total billed charges,,
MINERAL OIL - 10 ML BOTTLE,,57000023,LOCAL,Facility,Outpatient,,,,63.405,53.89425,18.171873,63.405,UnitedHealthcare,Medicare Advantage,31.06845,49,,percent of total billed charges,,
MINERAL OIL - 10 ML BOTTLE,,57000023,LOCAL,Facility,Inpatient,,,,63.405,53.89425,18.171873,63.405,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
MINERAL OIL - 10 ML BOTTLE,,57000023,LOCAL,Facility,Outpatient,,,,63.405,53.89425,18.171873,63.405,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,30.4344,48,,percent of total billed charges,,100% of DHS outpatient percentage
MINERAL OIL - 10 ML BOTTLE,,57000023,LOCAL,Facility,Inpatient,,,,63.405,53.89425,18.171873,63.405,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
NEEDLE ECHO 360 STIM 20GA X 4IN  333648,,57000023,LOCAL,Facility,Both,,,,49.5,42.075,14.1867,49.5,Aetna,Commercial,45.54,92,,percent of total billed charges,,
NEEDLE ECHO 360 STIM 20GA X 4IN  333648,,57000023,LOCAL,Facility,Outpatient,,,,49.5,42.075,14.1867,49.5,Aetna,Medicare Advantage,24.255,49,,percent of total billed charges,,
NEEDLE ECHO 360 STIM 20GA X 4IN  333648,,57000023,LOCAL,Facility,Inpatient,,,,49.5,42.075,14.1867,49.5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
NEEDLE ECHO 360 STIM 20GA X 4IN  333648,,57000023,LOCAL,Facility,Both,,,,49.5,42.075,14.1867,49.5,Aetna,PPO,46.035,93,,percent of total billed charges,,
NEEDLE ECHO 360 STIM 20GA X 4IN  333648,,57000023,LOCAL,Facility,Both,,,,49.5,42.075,14.1867,49.5,America's PPO,America's PPO,47.53485,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
NEEDLE ECHO 360 STIM 20GA X 4IN  333648,,57000023,LOCAL,Facility,Both,,,,49.5,42.075,14.1867,49.5,BlueCross BlueShield Minnesota, Federal Employee Program,48.708,98.4,,percent of total billed charges,,
NEEDLE ECHO 360 STIM 20GA X 4IN  333648,,57000023,LOCAL,Facility,Both,,,,49.5,42.075,14.1867,49.5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,49.5,100,,percent of total billed charges,,
NEEDLE ECHO 360 STIM 20GA X 4IN  333648,,57000023,LOCAL,Facility,Both,,,,49.5,42.075,14.1867,49.5,BlueCross BlueShield Minnesota,High Value Network Plan,44.55,90,,percent of total billed charges,,
NEEDLE ECHO 360 STIM 20GA X 4IN  333648,,57000023,LOCAL,Facility,Outpatient,,,,49.5,42.075,14.1867,49.5,BlueCross BlueShield Minnesota,Medicare Advantage,24.255,49,,percent of total billed charges,,
NEEDLE ECHO 360 STIM 20GA X 4IN  333648,,57000023,LOCAL,Facility,Inpatient,,,,49.5,42.075,14.1867,49.5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
NEEDLE ECHO 360 STIM 20GA X 4IN  333648,,57000023,LOCAL,Facility,Both,,,,49.5,42.075,14.1867,49.5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,43.84215,88.57,,percent of total billed charges,,
NEEDLE ECHO 360 STIM 20GA X 4IN  333648,,57000023,LOCAL,Facility,Both,,,,49.5,42.075,14.1867,49.5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,14.1867,28.66,,percent of total billed charges,,
NEEDLE ECHO 360 STIM 20GA X 4IN  333648,,57000023,LOCAL,Facility,Outpatient,,,,49.5,42.075,14.1867,49.5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),24.255,49,,percent of total billed charges,,
NEEDLE ECHO 360 STIM 20GA X 4IN  333648,,57000023,LOCAL,Facility,Inpatient,,,,49.5,42.075,14.1867,49.5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
NEEDLE ECHO 360 STIM 20GA X 4IN  333648,,57000023,LOCAL,Facility,Both,,,,49.5,42.075,14.1867,49.5,CorVel,Worker's Compensation,49.5,100,,percent of total billed charges,,
NEEDLE ECHO 360 STIM 20GA X 4IN  333648,,57000023,LOCAL,Facility,Both,,,,49.5,42.075,14.1867,49.5,First Health Group Corporation,First Health Network,48.015,97,,percent of total billed charges,,
NEEDLE ECHO 360 STIM 20GA X 4IN  333648,,57000023,LOCAL,Facility,Both,,,,49.5,42.075,14.1867,49.5,"Health Partners, Inc.",Commercial,46.827,94.6,,percent of total billed charges,,
NEEDLE ECHO 360 STIM 20GA X 4IN  333648,,57000023,LOCAL,Facility,Outpatient,,,,49.5,42.075,14.1867,49.5,"Health Partners, Inc.",Medicare Advantage,24.255,49,,percent of total billed charges,,
NEEDLE ECHO 360 STIM 20GA X 4IN  333648,,57000023,LOCAL,Facility,Inpatient,,,,49.5,42.075,14.1867,49.5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
NEEDLE ECHO 360 STIM 20GA X 4IN  333648,,57000023,LOCAL,Facility,Both,,,,49.5,42.075,14.1867,49.5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),29.7,60,,percent of total billed charges,,
NEEDLE ECHO 360 STIM 20GA X 4IN  333648,,57000023,LOCAL,Facility,Both,,,,49.5,42.075,14.1867,49.5,"Health Partners, Inc.",State of Minnesota Advantage Program,40.3425,81.5,,percent of total billed charges,,
NEEDLE ECHO 360 STIM 20GA X 4IN  333648,,57000023,LOCAL,Facility,Both,,,,49.5,42.075,14.1867,49.5,"Health Partners, Inc.",State Public Programs,24.75,50,,percent of total billed charges,,
NEEDLE ECHO 360 STIM 20GA X 4IN  333648,,57000023,LOCAL,Facility,Both,,,,49.5,42.075,14.1867,49.5,Humana Insurance Company,Commercial PPO,47.025,95,,percent of total billed charges,,
NEEDLE ECHO 360 STIM 20GA X 4IN  333648,,57000023,LOCAL,Facility,Outpatient,,,,49.5,42.075,14.1867,49.5,Humana Insurance Company,Medicare PPO,24.255,49,,percent of total billed charges,,
NEEDLE ECHO 360 STIM 20GA X 4IN  333648,,57000023,LOCAL,Facility,Inpatient,,,,49.5,42.075,14.1867,49.5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
NEEDLE ECHO 360 STIM 20GA X 4IN  333648,,57000023,LOCAL,Facility,Both,,,,49.5,42.075,14.1867,49.5,Medica,Individual & Family,49.0545,99.1,,percent of total billed charges,,
NEEDLE ECHO 360 STIM 20GA X 4IN  333648,,57000023,LOCAL,Facility,Outpatient,,,,49.5,42.075,14.1867,49.5,Medica,Medica Advantage Solution,24.651,49.8,,percent of total billed charges,,
NEEDLE ECHO 360 STIM 20GA X 4IN  333648,,57000023,LOCAL,Facility,Inpatient,,,,49.5,42.075,14.1867,49.5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
NEEDLE ECHO 360 STIM 20GA X 4IN  333648,,57000023,LOCAL,Facility,Outpatient,,,,49.5,42.075,14.1867,49.5,Medica,Medical Assistance,22.077,44.6,,percent of total billed charges,,
NEEDLE ECHO 360 STIM 20GA X 4IN  333648,,57000023,LOCAL,Facility,Inpatient,,,,49.5,42.075,14.1867,49.5,Medica,Medical Assistance,,,,,Included in per diem rate,
NEEDLE ECHO 360 STIM 20GA X 4IN  333648,,57000023,LOCAL,Facility,Outpatient,,,,49.5,42.075,14.1867,49.5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,24.651,49.8,,percent of total billed charges,,
NEEDLE ECHO 360 STIM 20GA X 4IN  333648,,57000023,LOCAL,Facility,Inpatient,,,,49.5,42.075,14.1867,49.5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
NEEDLE ECHO 360 STIM 20GA X 4IN  333648,,57000023,LOCAL,Facility,Both,,,,49.5,42.075,14.1867,49.5,"Multiplan, Inc.","Multiplan, Inc.",46.53,94,,percent of total billed charges,,
NEEDLE ECHO 360 STIM 20GA X 4IN  333648,,57000023,LOCAL,Facility,Outpatient,,,,49.5,42.075,14.1867,49.5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,44.5995,90.1,,percent of total billed charges,,
NEEDLE ECHO 360 STIM 20GA X 4IN  333648,,57000023,LOCAL,Facility,Inpatient,,,,49.5,42.075,14.1867,49.5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
NEEDLE ECHO 360 STIM 20GA X 4IN  333648,,57000023,LOCAL,Facility,Both,,,,49.5,42.075,14.1867,49.5,"Preferred One Administrative Services, INC.",PPO,48.807,98.6,,percent of total billed charges,,
NEEDLE ECHO 360 STIM 20GA X 4IN  333648,,57000023,LOCAL,Facility,Outpatient,,,,49.5,42.075,14.1867,49.5,PrimeWest Health,Minnesota Senior Health Options (MSHO),25.46775,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
NEEDLE ECHO 360 STIM 20GA X 4IN  333648,,57000023,LOCAL,Facility,Inpatient,,,,49.5,42.075,14.1867,49.5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
NEEDLE ECHO 360 STIM 20GA X 4IN  333648,,57000023,LOCAL,Facility,Outpatient,,,,49.5,42.075,14.1867,49.5,PrimeWest Health,MinnesotaCare,25.4232,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
NEEDLE ECHO 360 STIM 20GA X 4IN  333648,,57000023,LOCAL,Facility,Inpatient,,,,49.5,42.075,14.1867,49.5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
NEEDLE ECHO 360 STIM 20GA X 4IN  333648,,57000023,LOCAL,Facility,Both,,,,49.5,42.075,14.1867,49.5,Sanford Health Plan,Sanford Health Plan,45.54,92,,percent of total billed charges,,
NEEDLE ECHO 360 STIM 20GA X 4IN  333648,,57000023,LOCAL,Facility,Outpatient,,,,49.5,42.075,14.1867,49.5,"UCare Health, Inc.",Individual & Family Plan,27.89325,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
NEEDLE ECHO 360 STIM 20GA X 4IN  333648,,57000023,LOCAL,Facility,Inpatient,,,,49.5,42.075,14.1867,49.5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
NEEDLE ECHO 360 STIM 20GA X 4IN  333648,,57000023,LOCAL,Facility,Outpatient,,,,49.5,42.075,14.1867,49.5,"UCare Health, Inc.",Medical Assistance,24.98265,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
NEEDLE ECHO 360 STIM 20GA X 4IN  333648,,57000023,LOCAL,Facility,Inpatient,,,,49.5,42.075,14.1867,49.5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
NEEDLE ECHO 360 STIM 20GA X 4IN  333648,,57000023,LOCAL,Facility,Outpatient,,,,49.5,42.075,14.1867,49.5,"UCare Health, Inc.",Medicare Advantage,24.98265,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
NEEDLE ECHO 360 STIM 20GA X 4IN  333648,,57000023,LOCAL,Facility,Inpatient,,,,49.5,42.075,14.1867,49.5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
NEEDLE ECHO 360 STIM 20GA X 4IN  333648,,57000023,LOCAL,Facility,Outpatient,,,,49.5,42.075,14.1867,49.5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),24.98265,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
NEEDLE ECHO 360 STIM 20GA X 4IN  333648,,57000023,LOCAL,Facility,Inpatient,,,,49.5,42.075,14.1867,49.5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
NEEDLE ECHO 360 STIM 20GA X 4IN  333648,,57000023,LOCAL,Facility,Both,,,,49.5,42.075,14.1867,49.5,UnitedHealthcare,Individual & Family,46.53,94,,percent of total billed charges,,
NEEDLE ECHO 360 STIM 20GA X 4IN  333648,,57000023,LOCAL,Facility,Outpatient,,,,49.5,42.075,14.1867,49.5,UnitedHealthcare,Medicare Advantage,24.255,49,,percent of total billed charges,,
NEEDLE ECHO 360 STIM 20GA X 4IN  333648,,57000023,LOCAL,Facility,Inpatient,,,,49.5,42.075,14.1867,49.5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
NEEDLE ECHO 360 STIM 20GA X 4IN  333648,,57000023,LOCAL,Facility,Outpatient,,,,49.5,42.075,14.1867,49.5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,23.76,48,,percent of total billed charges,,100% of DHS outpatient percentage
NEEDLE ECHO 360 STIM 20GA X 4IN  333648,,57000023,LOCAL,Facility,Inpatient,,,,49.5,42.075,14.1867,49.5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
NEEDLE INJETAK LABORIE FLEXIBLE DIS201,,57000023,LOCAL,Facility,Both,,,,283.5,240.975,81.2511,283.5,Aetna,Commercial,260.82,92,,percent of total billed charges,,
NEEDLE INJETAK LABORIE FLEXIBLE DIS201,,57000023,LOCAL,Facility,Outpatient,,,,283.5,240.975,81.2511,283.5,Aetna,Medicare Advantage,138.915,49,,percent of total billed charges,,
NEEDLE INJETAK LABORIE FLEXIBLE DIS201,,57000023,LOCAL,Facility,Inpatient,,,,283.5,240.975,81.2511,283.5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
NEEDLE INJETAK LABORIE FLEXIBLE DIS201,,57000023,LOCAL,Facility,Both,,,,283.5,240.975,81.2511,283.5,Aetna,PPO,263.655,93,,percent of total billed charges,,
NEEDLE INJETAK LABORIE FLEXIBLE DIS201,,57000023,LOCAL,Facility,Both,,,,283.5,240.975,81.2511,283.5,America's PPO,America's PPO,272.24505,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
NEEDLE INJETAK LABORIE FLEXIBLE DIS201,,57000023,LOCAL,Facility,Both,,,,283.5,240.975,81.2511,283.5,BlueCross BlueShield Minnesota, Federal Employee Program,278.964,98.4,,percent of total billed charges,,
NEEDLE INJETAK LABORIE FLEXIBLE DIS201,,57000023,LOCAL,Facility,Both,,,,283.5,240.975,81.2511,283.5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,283.5,100,,percent of total billed charges,,
NEEDLE INJETAK LABORIE FLEXIBLE DIS201,,57000023,LOCAL,Facility,Both,,,,283.5,240.975,81.2511,283.5,BlueCross BlueShield Minnesota,High Value Network Plan,255.15,90,,percent of total billed charges,,
NEEDLE INJETAK LABORIE FLEXIBLE DIS201,,57000023,LOCAL,Facility,Outpatient,,,,283.5,240.975,81.2511,283.5,BlueCross BlueShield Minnesota,Medicare Advantage,138.915,49,,percent of total billed charges,,
NEEDLE INJETAK LABORIE FLEXIBLE DIS201,,57000023,LOCAL,Facility,Inpatient,,,,283.5,240.975,81.2511,283.5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
NEEDLE INJETAK LABORIE FLEXIBLE DIS201,,57000023,LOCAL,Facility,Both,,,,283.5,240.975,81.2511,283.5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,251.09595,88.57,,percent of total billed charges,,
NEEDLE INJETAK LABORIE FLEXIBLE DIS201,,57000023,LOCAL,Facility,Both,,,,283.5,240.975,81.2511,283.5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,81.2511,28.66,,percent of total billed charges,,
NEEDLE INJETAK LABORIE FLEXIBLE DIS201,,57000023,LOCAL,Facility,Outpatient,,,,283.5,240.975,81.2511,283.5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),138.915,49,,percent of total billed charges,,
NEEDLE INJETAK LABORIE FLEXIBLE DIS201,,57000023,LOCAL,Facility,Inpatient,,,,283.5,240.975,81.2511,283.5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
NEEDLE INJETAK LABORIE FLEXIBLE DIS201,,57000023,LOCAL,Facility,Both,,,,283.5,240.975,81.2511,283.5,CorVel,Worker's Compensation,283.5,100,,percent of total billed charges,,
NEEDLE INJETAK LABORIE FLEXIBLE DIS201,,57000023,LOCAL,Facility,Both,,,,283.5,240.975,81.2511,283.5,First Health Group Corporation,First Health Network,274.995,97,,percent of total billed charges,,
NEEDLE INJETAK LABORIE FLEXIBLE DIS201,,57000023,LOCAL,Facility,Both,,,,283.5,240.975,81.2511,283.5,"Health Partners, Inc.",Commercial,268.191,94.6,,percent of total billed charges,,
NEEDLE INJETAK LABORIE FLEXIBLE DIS201,,57000023,LOCAL,Facility,Outpatient,,,,283.5,240.975,81.2511,283.5,"Health Partners, Inc.",Medicare Advantage,138.915,49,,percent of total billed charges,,
NEEDLE INJETAK LABORIE FLEXIBLE DIS201,,57000023,LOCAL,Facility,Inpatient,,,,283.5,240.975,81.2511,283.5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
NEEDLE INJETAK LABORIE FLEXIBLE DIS201,,57000023,LOCAL,Facility,Both,,,,283.5,240.975,81.2511,283.5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),170.1,60,,percent of total billed charges,,
NEEDLE INJETAK LABORIE FLEXIBLE DIS201,,57000023,LOCAL,Facility,Both,,,,283.5,240.975,81.2511,283.5,"Health Partners, Inc.",State of Minnesota Advantage Program,231.0525,81.5,,percent of total billed charges,,
NEEDLE INJETAK LABORIE FLEXIBLE DIS201,,57000023,LOCAL,Facility,Both,,,,283.5,240.975,81.2511,283.5,"Health Partners, Inc.",State Public Programs,141.75,50,,percent of total billed charges,,
NEEDLE INJETAK LABORIE FLEXIBLE DIS201,,57000023,LOCAL,Facility,Both,,,,283.5,240.975,81.2511,283.5,Humana Insurance Company,Commercial PPO,269.325,95,,percent of total billed charges,,
NEEDLE INJETAK LABORIE FLEXIBLE DIS201,,57000023,LOCAL,Facility,Outpatient,,,,283.5,240.975,81.2511,283.5,Humana Insurance Company,Medicare PPO,138.915,49,,percent of total billed charges,,
NEEDLE INJETAK LABORIE FLEXIBLE DIS201,,57000023,LOCAL,Facility,Inpatient,,,,283.5,240.975,81.2511,283.5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
NEEDLE INJETAK LABORIE FLEXIBLE DIS201,,57000023,LOCAL,Facility,Both,,,,283.5,240.975,81.2511,283.5,Medica,Individual & Family,280.9485,99.1,,percent of total billed charges,,
NEEDLE INJETAK LABORIE FLEXIBLE DIS201,,57000023,LOCAL,Facility,Outpatient,,,,283.5,240.975,81.2511,283.5,Medica,Medica Advantage Solution,141.183,49.8,,percent of total billed charges,,
NEEDLE INJETAK LABORIE FLEXIBLE DIS201,,57000023,LOCAL,Facility,Inpatient,,,,283.5,240.975,81.2511,283.5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
NEEDLE INJETAK LABORIE FLEXIBLE DIS201,,57000023,LOCAL,Facility,Outpatient,,,,283.5,240.975,81.2511,283.5,Medica,Medical Assistance,126.441,44.6,,percent of total billed charges,,
NEEDLE INJETAK LABORIE FLEXIBLE DIS201,,57000023,LOCAL,Facility,Inpatient,,,,283.5,240.975,81.2511,283.5,Medica,Medical Assistance,,,,,Included in per diem rate,
NEEDLE INJETAK LABORIE FLEXIBLE DIS201,,57000023,LOCAL,Facility,Outpatient,,,,283.5,240.975,81.2511,283.5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,141.183,49.8,,percent of total billed charges,,
NEEDLE INJETAK LABORIE FLEXIBLE DIS201,,57000023,LOCAL,Facility,Inpatient,,,,283.5,240.975,81.2511,283.5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
NEEDLE INJETAK LABORIE FLEXIBLE DIS201,,57000023,LOCAL,Facility,Both,,,,283.5,240.975,81.2511,283.5,"Multiplan, Inc.","Multiplan, Inc.",266.49,94,,percent of total billed charges,,
NEEDLE INJETAK LABORIE FLEXIBLE DIS201,,57000023,LOCAL,Facility,Outpatient,,,,283.5,240.975,81.2511,283.5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,255.4335,90.1,,percent of total billed charges,,
NEEDLE INJETAK LABORIE FLEXIBLE DIS201,,57000023,LOCAL,Facility,Inpatient,,,,283.5,240.975,81.2511,283.5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
NEEDLE INJETAK LABORIE FLEXIBLE DIS201,,57000023,LOCAL,Facility,Both,,,,283.5,240.975,81.2511,283.5,"Preferred One Administrative Services, INC.",PPO,279.531,98.6,,percent of total billed charges,,
NEEDLE INJETAK LABORIE FLEXIBLE DIS201,,57000023,LOCAL,Facility,Outpatient,,,,283.5,240.975,81.2511,283.5,PrimeWest Health,Minnesota Senior Health Options (MSHO),145.86075,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
NEEDLE INJETAK LABORIE FLEXIBLE DIS201,,57000023,LOCAL,Facility,Inpatient,,,,283.5,240.975,81.2511,283.5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
NEEDLE INJETAK LABORIE FLEXIBLE DIS201,,57000023,LOCAL,Facility,Outpatient,,,,283.5,240.975,81.2511,283.5,PrimeWest Health,MinnesotaCare,145.6056,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
NEEDLE INJETAK LABORIE FLEXIBLE DIS201,,57000023,LOCAL,Facility,Inpatient,,,,283.5,240.975,81.2511,283.5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
NEEDLE INJETAK LABORIE FLEXIBLE DIS201,,57000023,LOCAL,Facility,Both,,,,283.5,240.975,81.2511,283.5,Sanford Health Plan,Sanford Health Plan,260.82,92,,percent of total billed charges,,
NEEDLE INJETAK LABORIE FLEXIBLE DIS201,,57000023,LOCAL,Facility,Outpatient,,,,283.5,240.975,81.2511,283.5,"UCare Health, Inc.",Individual & Family Plan,159.75225,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
NEEDLE INJETAK LABORIE FLEXIBLE DIS201,,57000023,LOCAL,Facility,Inpatient,,,,283.5,240.975,81.2511,283.5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
NEEDLE INJETAK LABORIE FLEXIBLE DIS201,,57000023,LOCAL,Facility,Outpatient,,,,283.5,240.975,81.2511,283.5,"UCare Health, Inc.",Medical Assistance,143.08245,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
NEEDLE INJETAK LABORIE FLEXIBLE DIS201,,57000023,LOCAL,Facility,Inpatient,,,,283.5,240.975,81.2511,283.5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
NEEDLE INJETAK LABORIE FLEXIBLE DIS201,,57000023,LOCAL,Facility,Outpatient,,,,283.5,240.975,81.2511,283.5,"UCare Health, Inc.",Medicare Advantage,143.08245,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
NEEDLE INJETAK LABORIE FLEXIBLE DIS201,,57000023,LOCAL,Facility,Inpatient,,,,283.5,240.975,81.2511,283.5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
NEEDLE INJETAK LABORIE FLEXIBLE DIS201,,57000023,LOCAL,Facility,Outpatient,,,,283.5,240.975,81.2511,283.5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),143.08245,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
NEEDLE INJETAK LABORIE FLEXIBLE DIS201,,57000023,LOCAL,Facility,Inpatient,,,,283.5,240.975,81.2511,283.5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
NEEDLE INJETAK LABORIE FLEXIBLE DIS201,,57000023,LOCAL,Facility,Both,,,,283.5,240.975,81.2511,283.5,UnitedHealthcare,Individual & Family,266.49,94,,percent of total billed charges,,
NEEDLE INJETAK LABORIE FLEXIBLE DIS201,,57000023,LOCAL,Facility,Outpatient,,,,283.5,240.975,81.2511,283.5,UnitedHealthcare,Medicare Advantage,138.915,49,,percent of total billed charges,,
NEEDLE INJETAK LABORIE FLEXIBLE DIS201,,57000023,LOCAL,Facility,Inpatient,,,,283.5,240.975,81.2511,283.5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
NEEDLE INJETAK LABORIE FLEXIBLE DIS201,,57000023,LOCAL,Facility,Outpatient,,,,283.5,240.975,81.2511,283.5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,136.08,48,,percent of total billed charges,,100% of DHS outpatient percentage
NEEDLE INJETAK LABORIE FLEXIBLE DIS201,,57000023,LOCAL,Facility,Inpatient,,,,283.5,240.975,81.2511,283.5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
NEEDLE INTERJECT 25G,,57000023,LOCAL,Facility,Both,,,,239.4,203.49,68.61204,239.4,Aetna,Commercial,220.248,92,,percent of total billed charges,,
NEEDLE INTERJECT 25G,,57000023,LOCAL,Facility,Outpatient,,,,239.4,203.49,68.61204,239.4,Aetna,Medicare Advantage,117.306,49,,percent of total billed charges,,
NEEDLE INTERJECT 25G,,57000023,LOCAL,Facility,Inpatient,,,,239.4,203.49,68.61204,239.4,Aetna,Medicare Advantage,,,,,Included in per diem rate,
NEEDLE INTERJECT 25G,,57000023,LOCAL,Facility,Both,,,,239.4,203.49,68.61204,239.4,Aetna,PPO,222.642,93,,percent of total billed charges,,
NEEDLE INTERJECT 25G,,57000023,LOCAL,Facility,Both,,,,239.4,203.49,68.61204,239.4,America's PPO,America's PPO,229.89582,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
NEEDLE INTERJECT 25G,,57000023,LOCAL,Facility,Both,,,,239.4,203.49,68.61204,239.4,BlueCross BlueShield Minnesota, Federal Employee Program,235.5696,98.4,,percent of total billed charges,,
NEEDLE INTERJECT 25G,,57000023,LOCAL,Facility,Both,,,,239.4,203.49,68.61204,239.4,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,239.4,100,,percent of total billed charges,,
NEEDLE INTERJECT 25G,,57000023,LOCAL,Facility,Both,,,,239.4,203.49,68.61204,239.4,BlueCross BlueShield Minnesota,High Value Network Plan,215.46,90,,percent of total billed charges,,
NEEDLE INTERJECT 25G,,57000023,LOCAL,Facility,Outpatient,,,,239.4,203.49,68.61204,239.4,BlueCross BlueShield Minnesota,Medicare Advantage,117.306,49,,percent of total billed charges,,
NEEDLE INTERJECT 25G,,57000023,LOCAL,Facility,Inpatient,,,,239.4,203.49,68.61204,239.4,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
NEEDLE INTERJECT 25G,,57000023,LOCAL,Facility,Both,,,,239.4,203.49,68.61204,239.4,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,212.03658,88.57,,percent of total billed charges,,
NEEDLE INTERJECT 25G,,57000023,LOCAL,Facility,Both,,,,239.4,203.49,68.61204,239.4,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,68.61204,28.66,,percent of total billed charges,,
NEEDLE INTERJECT 25G,,57000023,LOCAL,Facility,Outpatient,,,,239.4,203.49,68.61204,239.4,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),117.306,49,,percent of total billed charges,,
NEEDLE INTERJECT 25G,,57000023,LOCAL,Facility,Inpatient,,,,239.4,203.49,68.61204,239.4,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
NEEDLE INTERJECT 25G,,57000023,LOCAL,Facility,Both,,,,239.4,203.49,68.61204,239.4,CorVel,Worker's Compensation,239.4,100,,percent of total billed charges,,
NEEDLE INTERJECT 25G,,57000023,LOCAL,Facility,Both,,,,239.4,203.49,68.61204,239.4,First Health Group Corporation,First Health Network,232.218,97,,percent of total billed charges,,
NEEDLE INTERJECT 25G,,57000023,LOCAL,Facility,Both,,,,239.4,203.49,68.61204,239.4,"Health Partners, Inc.",Commercial,226.4724,94.6,,percent of total billed charges,,
NEEDLE INTERJECT 25G,,57000023,LOCAL,Facility,Outpatient,,,,239.4,203.49,68.61204,239.4,"Health Partners, Inc.",Medicare Advantage,117.306,49,,percent of total billed charges,,
NEEDLE INTERJECT 25G,,57000023,LOCAL,Facility,Inpatient,,,,239.4,203.49,68.61204,239.4,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
NEEDLE INTERJECT 25G,,57000023,LOCAL,Facility,Both,,,,239.4,203.49,68.61204,239.4,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),143.64,60,,percent of total billed charges,,
NEEDLE INTERJECT 25G,,57000023,LOCAL,Facility,Both,,,,239.4,203.49,68.61204,239.4,"Health Partners, Inc.",State of Minnesota Advantage Program,195.111,81.5,,percent of total billed charges,,
NEEDLE INTERJECT 25G,,57000023,LOCAL,Facility,Both,,,,239.4,203.49,68.61204,239.4,"Health Partners, Inc.",State Public Programs,119.7,50,,percent of total billed charges,,
NEEDLE INTERJECT 25G,,57000023,LOCAL,Facility,Both,,,,239.4,203.49,68.61204,239.4,Humana Insurance Company,Commercial PPO,227.43,95,,percent of total billed charges,,
NEEDLE INTERJECT 25G,,57000023,LOCAL,Facility,Outpatient,,,,239.4,203.49,68.61204,239.4,Humana Insurance Company,Medicare PPO,117.306,49,,percent of total billed charges,,
NEEDLE INTERJECT 25G,,57000023,LOCAL,Facility,Inpatient,,,,239.4,203.49,68.61204,239.4,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
NEEDLE INTERJECT 25G,,57000023,LOCAL,Facility,Both,,,,239.4,203.49,68.61204,239.4,Medica,Individual & Family,237.2454,99.1,,percent of total billed charges,,
NEEDLE INTERJECT 25G,,57000023,LOCAL,Facility,Outpatient,,,,239.4,203.49,68.61204,239.4,Medica,Medica Advantage Solution,119.2212,49.8,,percent of total billed charges,,
NEEDLE INTERJECT 25G,,57000023,LOCAL,Facility,Inpatient,,,,239.4,203.49,68.61204,239.4,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
NEEDLE INTERJECT 25G,,57000023,LOCAL,Facility,Outpatient,,,,239.4,203.49,68.61204,239.4,Medica,Medical Assistance,106.7724,44.6,,percent of total billed charges,,
NEEDLE INTERJECT 25G,,57000023,LOCAL,Facility,Inpatient,,,,239.4,203.49,68.61204,239.4,Medica,Medical Assistance,,,,,Included in per diem rate,
NEEDLE INTERJECT 25G,,57000023,LOCAL,Facility,Outpatient,,,,239.4,203.49,68.61204,239.4,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,119.2212,49.8,,percent of total billed charges,,
NEEDLE INTERJECT 25G,,57000023,LOCAL,Facility,Inpatient,,,,239.4,203.49,68.61204,239.4,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
NEEDLE INTERJECT 25G,,57000023,LOCAL,Facility,Both,,,,239.4,203.49,68.61204,239.4,"Multiplan, Inc.","Multiplan, Inc.",225.036,94,,percent of total billed charges,,
NEEDLE INTERJECT 25G,,57000023,LOCAL,Facility,Outpatient,,,,239.4,203.49,68.61204,239.4,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,215.6994,90.1,,percent of total billed charges,,
NEEDLE INTERJECT 25G,,57000023,LOCAL,Facility,Inpatient,,,,239.4,203.49,68.61204,239.4,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
NEEDLE INTERJECT 25G,,57000023,LOCAL,Facility,Both,,,,239.4,203.49,68.61204,239.4,"Preferred One Administrative Services, INC.",PPO,236.0484,98.6,,percent of total billed charges,,
NEEDLE INTERJECT 25G,,57000023,LOCAL,Facility,Outpatient,,,,239.4,203.49,68.61204,239.4,PrimeWest Health,Minnesota Senior Health Options (MSHO),123.1713,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
NEEDLE INTERJECT 25G,,57000023,LOCAL,Facility,Inpatient,,,,239.4,203.49,68.61204,239.4,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
NEEDLE INTERJECT 25G,,57000023,LOCAL,Facility,Outpatient,,,,239.4,203.49,68.61204,239.4,PrimeWest Health,MinnesotaCare,122.95584,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
NEEDLE INTERJECT 25G,,57000023,LOCAL,Facility,Inpatient,,,,239.4,203.49,68.61204,239.4,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
NEEDLE INTERJECT 25G,,57000023,LOCAL,Facility,Both,,,,239.4,203.49,68.61204,239.4,Sanford Health Plan,Sanford Health Plan,220.248,92,,percent of total billed charges,,
NEEDLE INTERJECT 25G,,57000023,LOCAL,Facility,Outpatient,,,,239.4,203.49,68.61204,239.4,"UCare Health, Inc.",Individual & Family Plan,134.9019,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
NEEDLE INTERJECT 25G,,57000023,LOCAL,Facility,Inpatient,,,,239.4,203.49,68.61204,239.4,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
NEEDLE INTERJECT 25G,,57000023,LOCAL,Facility,Outpatient,,,,239.4,203.49,68.61204,239.4,"UCare Health, Inc.",Medical Assistance,120.82518,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
NEEDLE INTERJECT 25G,,57000023,LOCAL,Facility,Inpatient,,,,239.4,203.49,68.61204,239.4,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
NEEDLE INTERJECT 25G,,57000023,LOCAL,Facility,Outpatient,,,,239.4,203.49,68.61204,239.4,"UCare Health, Inc.",Medicare Advantage,120.82518,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
NEEDLE INTERJECT 25G,,57000023,LOCAL,Facility,Inpatient,,,,239.4,203.49,68.61204,239.4,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
NEEDLE INTERJECT 25G,,57000023,LOCAL,Facility,Outpatient,,,,239.4,203.49,68.61204,239.4,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),120.82518,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
NEEDLE INTERJECT 25G,,57000023,LOCAL,Facility,Inpatient,,,,239.4,203.49,68.61204,239.4,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
NEEDLE INTERJECT 25G,,57000023,LOCAL,Facility,Both,,,,239.4,203.49,68.61204,239.4,UnitedHealthcare,Individual & Family,225.036,94,,percent of total billed charges,,
NEEDLE INTERJECT 25G,,57000023,LOCAL,Facility,Outpatient,,,,239.4,203.49,68.61204,239.4,UnitedHealthcare,Medicare Advantage,117.306,49,,percent of total billed charges,,
NEEDLE INTERJECT 25G,,57000023,LOCAL,Facility,Inpatient,,,,239.4,203.49,68.61204,239.4,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
NEEDLE INTERJECT 25G,,57000023,LOCAL,Facility,Outpatient,,,,239.4,203.49,68.61204,239.4,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,114.912,48,,percent of total billed charges,,100% of DHS outpatient percentage
NEEDLE INTERJECT 25G,,57000023,LOCAL,Facility,Inpatient,,,,239.4,203.49,68.61204,239.4,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
NET POLY RETRIVAL 2.5MM DISP,,57000023,LOCAL,Facility,Both,,,,329,279.65,94.2914,329,Aetna,Commercial,302.68,92,,percent of total billed charges,,
NET POLY RETRIVAL 2.5MM DISP,,57000023,LOCAL,Facility,Outpatient,,,,329,279.65,94.2914,329,Aetna,Medicare Advantage,161.21,49,,percent of total billed charges,,
NET POLY RETRIVAL 2.5MM DISP,,57000023,LOCAL,Facility,Inpatient,,,,329,279.65,94.2914,329,Aetna,Medicare Advantage,,,,,Included in per diem rate,
NET POLY RETRIVAL 2.5MM DISP,,57000023,LOCAL,Facility,Both,,,,329,279.65,94.2914,329,Aetna,PPO,305.97,93,,percent of total billed charges,,
NET POLY RETRIVAL 2.5MM DISP,,57000023,LOCAL,Facility,Both,,,,329,279.65,94.2914,329,America's PPO,America's PPO,315.9387,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
NET POLY RETRIVAL 2.5MM DISP,,57000023,LOCAL,Facility,Both,,,,329,279.65,94.2914,329,BlueCross BlueShield Minnesota, Federal Employee Program,323.736,98.4,,percent of total billed charges,,
NET POLY RETRIVAL 2.5MM DISP,,57000023,LOCAL,Facility,Both,,,,329,279.65,94.2914,329,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,329,100,,percent of total billed charges,,
NET POLY RETRIVAL 2.5MM DISP,,57000023,LOCAL,Facility,Both,,,,329,279.65,94.2914,329,BlueCross BlueShield Minnesota,High Value Network Plan,296.1,90,,percent of total billed charges,,
NET POLY RETRIVAL 2.5MM DISP,,57000023,LOCAL,Facility,Outpatient,,,,329,279.65,94.2914,329,BlueCross BlueShield Minnesota,Medicare Advantage,161.21,49,,percent of total billed charges,,
NET POLY RETRIVAL 2.5MM DISP,,57000023,LOCAL,Facility,Inpatient,,,,329,279.65,94.2914,329,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
NET POLY RETRIVAL 2.5MM DISP,,57000023,LOCAL,Facility,Both,,,,329,279.65,94.2914,329,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,291.3953,88.57,,percent of total billed charges,,
NET POLY RETRIVAL 2.5MM DISP,,57000023,LOCAL,Facility,Both,,,,329,279.65,94.2914,329,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,94.2914,28.66,,percent of total billed charges,,
NET POLY RETRIVAL 2.5MM DISP,,57000023,LOCAL,Facility,Outpatient,,,,329,279.65,94.2914,329,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),161.21,49,,percent of total billed charges,,
NET POLY RETRIVAL 2.5MM DISP,,57000023,LOCAL,Facility,Inpatient,,,,329,279.65,94.2914,329,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
NET POLY RETRIVAL 2.5MM DISP,,57000023,LOCAL,Facility,Both,,,,329,279.65,94.2914,329,CorVel,Worker's Compensation,329,100,,percent of total billed charges,,
NET POLY RETRIVAL 2.5MM DISP,,57000023,LOCAL,Facility,Both,,,,329,279.65,94.2914,329,First Health Group Corporation,First Health Network,319.13,97,,percent of total billed charges,,
NET POLY RETRIVAL 2.5MM DISP,,57000023,LOCAL,Facility,Both,,,,329,279.65,94.2914,329,"Health Partners, Inc.",Commercial,311.234,94.6,,percent of total billed charges,,
NET POLY RETRIVAL 2.5MM DISP,,57000023,LOCAL,Facility,Outpatient,,,,329,279.65,94.2914,329,"Health Partners, Inc.",Medicare Advantage,161.21,49,,percent of total billed charges,,
NET POLY RETRIVAL 2.5MM DISP,,57000023,LOCAL,Facility,Inpatient,,,,329,279.65,94.2914,329,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
NET POLY RETRIVAL 2.5MM DISP,,57000023,LOCAL,Facility,Both,,,,329,279.65,94.2914,329,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),197.4,60,,percent of total billed charges,,
NET POLY RETRIVAL 2.5MM DISP,,57000023,LOCAL,Facility,Both,,,,329,279.65,94.2914,329,"Health Partners, Inc.",State of Minnesota Advantage Program,268.135,81.5,,percent of total billed charges,,
NET POLY RETRIVAL 2.5MM DISP,,57000023,LOCAL,Facility,Both,,,,329,279.65,94.2914,329,"Health Partners, Inc.",State Public Programs,164.5,50,,percent of total billed charges,,
NET POLY RETRIVAL 2.5MM DISP,,57000023,LOCAL,Facility,Both,,,,329,279.65,94.2914,329,Humana Insurance Company,Commercial PPO,312.55,95,,percent of total billed charges,,
NET POLY RETRIVAL 2.5MM DISP,,57000023,LOCAL,Facility,Outpatient,,,,329,279.65,94.2914,329,Humana Insurance Company,Medicare PPO,161.21,49,,percent of total billed charges,,
NET POLY RETRIVAL 2.5MM DISP,,57000023,LOCAL,Facility,Inpatient,,,,329,279.65,94.2914,329,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
NET POLY RETRIVAL 2.5MM DISP,,57000023,LOCAL,Facility,Both,,,,329,279.65,94.2914,329,Medica,Individual & Family,326.039,99.1,,percent of total billed charges,,
NET POLY RETRIVAL 2.5MM DISP,,57000023,LOCAL,Facility,Outpatient,,,,329,279.65,94.2914,329,Medica,Medica Advantage Solution,163.842,49.8,,percent of total billed charges,,
NET POLY RETRIVAL 2.5MM DISP,,57000023,LOCAL,Facility,Inpatient,,,,329,279.65,94.2914,329,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
NET POLY RETRIVAL 2.5MM DISP,,57000023,LOCAL,Facility,Outpatient,,,,329,279.65,94.2914,329,Medica,Medical Assistance,146.734,44.6,,percent of total billed charges,,
NET POLY RETRIVAL 2.5MM DISP,,57000023,LOCAL,Facility,Inpatient,,,,329,279.65,94.2914,329,Medica,Medical Assistance,,,,,Included in per diem rate,
NET POLY RETRIVAL 2.5MM DISP,,57000023,LOCAL,Facility,Outpatient,,,,329,279.65,94.2914,329,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,163.842,49.8,,percent of total billed charges,,
NET POLY RETRIVAL 2.5MM DISP,,57000023,LOCAL,Facility,Inpatient,,,,329,279.65,94.2914,329,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
NET POLY RETRIVAL 2.5MM DISP,,57000023,LOCAL,Facility,Both,,,,329,279.65,94.2914,329,"Multiplan, Inc.","Multiplan, Inc.",309.26,94,,percent of total billed charges,,
NET POLY RETRIVAL 2.5MM DISP,,57000023,LOCAL,Facility,Outpatient,,,,329,279.65,94.2914,329,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,296.429,90.1,,percent of total billed charges,,
NET POLY RETRIVAL 2.5MM DISP,,57000023,LOCAL,Facility,Inpatient,,,,329,279.65,94.2914,329,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
NET POLY RETRIVAL 2.5MM DISP,,57000023,LOCAL,Facility,Both,,,,329,279.65,94.2914,329,"Preferred One Administrative Services, INC.",PPO,324.394,98.6,,percent of total billed charges,,
NET POLY RETRIVAL 2.5MM DISP,,57000023,LOCAL,Facility,Outpatient,,,,329,279.65,94.2914,329,PrimeWest Health,Minnesota Senior Health Options (MSHO),169.2705,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
NET POLY RETRIVAL 2.5MM DISP,,57000023,LOCAL,Facility,Inpatient,,,,329,279.65,94.2914,329,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
NET POLY RETRIVAL 2.5MM DISP,,57000023,LOCAL,Facility,Outpatient,,,,329,279.65,94.2914,329,PrimeWest Health,MinnesotaCare,168.9744,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
NET POLY RETRIVAL 2.5MM DISP,,57000023,LOCAL,Facility,Inpatient,,,,329,279.65,94.2914,329,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
NET POLY RETRIVAL 2.5MM DISP,,57000023,LOCAL,Facility,Both,,,,329,279.65,94.2914,329,Sanford Health Plan,Sanford Health Plan,302.68,92,,percent of total billed charges,,
NET POLY RETRIVAL 2.5MM DISP,,57000023,LOCAL,Facility,Outpatient,,,,329,279.65,94.2914,329,"UCare Health, Inc.",Individual & Family Plan,185.3915,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
NET POLY RETRIVAL 2.5MM DISP,,57000023,LOCAL,Facility,Inpatient,,,,329,279.65,94.2914,329,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
NET POLY RETRIVAL 2.5MM DISP,,57000023,LOCAL,Facility,Outpatient,,,,329,279.65,94.2914,329,"UCare Health, Inc.",Medical Assistance,166.0463,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
NET POLY RETRIVAL 2.5MM DISP,,57000023,LOCAL,Facility,Inpatient,,,,329,279.65,94.2914,329,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
NET POLY RETRIVAL 2.5MM DISP,,57000023,LOCAL,Facility,Outpatient,,,,329,279.65,94.2914,329,"UCare Health, Inc.",Medicare Advantage,166.0463,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
NET POLY RETRIVAL 2.5MM DISP,,57000023,LOCAL,Facility,Inpatient,,,,329,279.65,94.2914,329,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
NET POLY RETRIVAL 2.5MM DISP,,57000023,LOCAL,Facility,Outpatient,,,,329,279.65,94.2914,329,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),166.0463,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
NET POLY RETRIVAL 2.5MM DISP,,57000023,LOCAL,Facility,Inpatient,,,,329,279.65,94.2914,329,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
NET POLY RETRIVAL 2.5MM DISP,,57000023,LOCAL,Facility,Both,,,,329,279.65,94.2914,329,UnitedHealthcare,Individual & Family,309.26,94,,percent of total billed charges,,
NET POLY RETRIVAL 2.5MM DISP,,57000023,LOCAL,Facility,Outpatient,,,,329,279.65,94.2914,329,UnitedHealthcare,Medicare Advantage,161.21,49,,percent of total billed charges,,
NET POLY RETRIVAL 2.5MM DISP,,57000023,LOCAL,Facility,Inpatient,,,,329,279.65,94.2914,329,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
NET POLY RETRIVAL 2.5MM DISP,,57000023,LOCAL,Facility,Outpatient,,,,329,279.65,94.2914,329,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,157.92,48,,percent of total billed charges,,100% of DHS outpatient percentage
NET POLY RETRIVAL 2.5MM DISP,,57000023,LOCAL,Facility,Inpatient,,,,329,279.65,94.2914,329,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Olympus HF cable, monopolar 4m single use",,57000023,LOCAL,Facility,Both,,,,377.94,321.249,108.317604,377.94,Aetna,Commercial,347.7048,92,,percent of total billed charges,,
"Olympus HF cable, monopolar 4m single use",,57000023,LOCAL,Facility,Outpatient,,,,377.94,321.249,108.317604,377.94,Aetna,Medicare Advantage,185.1906,49,,percent of total billed charges,,
"Olympus HF cable, monopolar 4m single use",,57000023,LOCAL,Facility,Inpatient,,,,377.94,321.249,108.317604,377.94,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Olympus HF cable, monopolar 4m single use",,57000023,LOCAL,Facility,Both,,,,377.94,321.249,108.317604,377.94,Aetna,PPO,351.4842,93,,percent of total billed charges,,
"Olympus HF cable, monopolar 4m single use",,57000023,LOCAL,Facility,Both,,,,377.94,321.249,108.317604,377.94,America's PPO,America's PPO,362.935782,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Olympus HF cable, monopolar 4m single use",,57000023,LOCAL,Facility,Both,,,,377.94,321.249,108.317604,377.94,BlueCross BlueShield Minnesota, Federal Employee Program,371.89296,98.4,,percent of total billed charges,,
"Olympus HF cable, monopolar 4m single use",,57000023,LOCAL,Facility,Both,,,,377.94,321.249,108.317604,377.94,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,377.94,100,,percent of total billed charges,,
"Olympus HF cable, monopolar 4m single use",,57000023,LOCAL,Facility,Both,,,,377.94,321.249,108.317604,377.94,BlueCross BlueShield Minnesota,High Value Network Plan,340.146,90,,percent of total billed charges,,
"Olympus HF cable, monopolar 4m single use",,57000023,LOCAL,Facility,Outpatient,,,,377.94,321.249,108.317604,377.94,BlueCross BlueShield Minnesota,Medicare Advantage,185.1906,49,,percent of total billed charges,,
"Olympus HF cable, monopolar 4m single use",,57000023,LOCAL,Facility,Inpatient,,,,377.94,321.249,108.317604,377.94,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Olympus HF cable, monopolar 4m single use",,57000023,LOCAL,Facility,Both,,,,377.94,321.249,108.317604,377.94,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,334.741458,88.57,,percent of total billed charges,,
"Olympus HF cable, monopolar 4m single use",,57000023,LOCAL,Facility,Both,,,,377.94,321.249,108.317604,377.94,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,108.317604,28.66,,percent of total billed charges,,
"Olympus HF cable, monopolar 4m single use",,57000023,LOCAL,Facility,Outpatient,,,,377.94,321.249,108.317604,377.94,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),185.1906,49,,percent of total billed charges,,
"Olympus HF cable, monopolar 4m single use",,57000023,LOCAL,Facility,Inpatient,,,,377.94,321.249,108.317604,377.94,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Olympus HF cable, monopolar 4m single use",,57000023,LOCAL,Facility,Both,,,,377.94,321.249,108.317604,377.94,CorVel,Worker's Compensation,377.94,100,,percent of total billed charges,,
"Olympus HF cable, monopolar 4m single use",,57000023,LOCAL,Facility,Both,,,,377.94,321.249,108.317604,377.94,First Health Group Corporation,First Health Network,366.6018,97,,percent of total billed charges,,
"Olympus HF cable, monopolar 4m single use",,57000023,LOCAL,Facility,Both,,,,377.94,321.249,108.317604,377.94,"Health Partners, Inc.",Commercial,357.53124,94.6,,percent of total billed charges,,
"Olympus HF cable, monopolar 4m single use",,57000023,LOCAL,Facility,Outpatient,,,,377.94,321.249,108.317604,377.94,"Health Partners, Inc.",Medicare Advantage,185.1906,49,,percent of total billed charges,,
"Olympus HF cable, monopolar 4m single use",,57000023,LOCAL,Facility,Inpatient,,,,377.94,321.249,108.317604,377.94,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Olympus HF cable, monopolar 4m single use",,57000023,LOCAL,Facility,Both,,,,377.94,321.249,108.317604,377.94,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),226.764,60,,percent of total billed charges,,
"Olympus HF cable, monopolar 4m single use",,57000023,LOCAL,Facility,Both,,,,377.94,321.249,108.317604,377.94,"Health Partners, Inc.",State of Minnesota Advantage Program,308.0211,81.5,,percent of total billed charges,,
"Olympus HF cable, monopolar 4m single use",,57000023,LOCAL,Facility,Both,,,,377.94,321.249,108.317604,377.94,"Health Partners, Inc.",State Public Programs,188.97,50,,percent of total billed charges,,
"Olympus HF cable, monopolar 4m single use",,57000023,LOCAL,Facility,Both,,,,377.94,321.249,108.317604,377.94,Humana Insurance Company,Commercial PPO,359.043,95,,percent of total billed charges,,
"Olympus HF cable, monopolar 4m single use",,57000023,LOCAL,Facility,Outpatient,,,,377.94,321.249,108.317604,377.94,Humana Insurance Company,Medicare PPO,185.1906,49,,percent of total billed charges,,
"Olympus HF cable, monopolar 4m single use",,57000023,LOCAL,Facility,Inpatient,,,,377.94,321.249,108.317604,377.94,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Olympus HF cable, monopolar 4m single use",,57000023,LOCAL,Facility,Both,,,,377.94,321.249,108.317604,377.94,Medica,Individual & Family,374.53854,99.1,,percent of total billed charges,,
"Olympus HF cable, monopolar 4m single use",,57000023,LOCAL,Facility,Outpatient,,,,377.94,321.249,108.317604,377.94,Medica,Medica Advantage Solution,188.21412,49.8,,percent of total billed charges,,
"Olympus HF cable, monopolar 4m single use",,57000023,LOCAL,Facility,Inpatient,,,,377.94,321.249,108.317604,377.94,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Olympus HF cable, monopolar 4m single use",,57000023,LOCAL,Facility,Outpatient,,,,377.94,321.249,108.317604,377.94,Medica,Medical Assistance,168.56124,44.6,,percent of total billed charges,,
"Olympus HF cable, monopolar 4m single use",,57000023,LOCAL,Facility,Inpatient,,,,377.94,321.249,108.317604,377.94,Medica,Medical Assistance,,,,,Included in per diem rate,
"Olympus HF cable, monopolar 4m single use",,57000023,LOCAL,Facility,Outpatient,,,,377.94,321.249,108.317604,377.94,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,188.21412,49.8,,percent of total billed charges,,
"Olympus HF cable, monopolar 4m single use",,57000023,LOCAL,Facility,Inpatient,,,,377.94,321.249,108.317604,377.94,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Olympus HF cable, monopolar 4m single use",,57000023,LOCAL,Facility,Both,,,,377.94,321.249,108.317604,377.94,"Multiplan, Inc.","Multiplan, Inc.",355.2636,94,,percent of total billed charges,,
"Olympus HF cable, monopolar 4m single use",,57000023,LOCAL,Facility,Outpatient,,,,377.94,321.249,108.317604,377.94,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,340.52394,90.1,,percent of total billed charges,,
"Olympus HF cable, monopolar 4m single use",,57000023,LOCAL,Facility,Inpatient,,,,377.94,321.249,108.317604,377.94,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Olympus HF cable, monopolar 4m single use",,57000023,LOCAL,Facility,Both,,,,377.94,321.249,108.317604,377.94,"Preferred One Administrative Services, INC.",PPO,372.64884,98.6,,percent of total billed charges,,
"Olympus HF cable, monopolar 4m single use",,57000023,LOCAL,Facility,Outpatient,,,,377.94,321.249,108.317604,377.94,PrimeWest Health,Minnesota Senior Health Options (MSHO),194.45013,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Olympus HF cable, monopolar 4m single use",,57000023,LOCAL,Facility,Inpatient,,,,377.94,321.249,108.317604,377.94,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Olympus HF cable, monopolar 4m single use",,57000023,LOCAL,Facility,Outpatient,,,,377.94,321.249,108.317604,377.94,PrimeWest Health,MinnesotaCare,194.109984,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Olympus HF cable, monopolar 4m single use",,57000023,LOCAL,Facility,Inpatient,,,,377.94,321.249,108.317604,377.94,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Olympus HF cable, monopolar 4m single use",,57000023,LOCAL,Facility,Both,,,,377.94,321.249,108.317604,377.94,Sanford Health Plan,Sanford Health Plan,347.7048,92,,percent of total billed charges,,
"Olympus HF cable, monopolar 4m single use",,57000023,LOCAL,Facility,Outpatient,,,,377.94,321.249,108.317604,377.94,"UCare Health, Inc.",Individual & Family Plan,212.96919,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Olympus HF cable, monopolar 4m single use",,57000023,LOCAL,Facility,Inpatient,,,,377.94,321.249,108.317604,377.94,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Olympus HF cable, monopolar 4m single use",,57000023,LOCAL,Facility,Outpatient,,,,377.94,321.249,108.317604,377.94,"UCare Health, Inc.",Medical Assistance,190.746318,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Olympus HF cable, monopolar 4m single use",,57000023,LOCAL,Facility,Inpatient,,,,377.94,321.249,108.317604,377.94,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Olympus HF cable, monopolar 4m single use",,57000023,LOCAL,Facility,Outpatient,,,,377.94,321.249,108.317604,377.94,"UCare Health, Inc.",Medicare Advantage,190.746318,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Olympus HF cable, monopolar 4m single use",,57000023,LOCAL,Facility,Inpatient,,,,377.94,321.249,108.317604,377.94,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Olympus HF cable, monopolar 4m single use",,57000023,LOCAL,Facility,Outpatient,,,,377.94,321.249,108.317604,377.94,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),190.746318,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Olympus HF cable, monopolar 4m single use",,57000023,LOCAL,Facility,Inpatient,,,,377.94,321.249,108.317604,377.94,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Olympus HF cable, monopolar 4m single use",,57000023,LOCAL,Facility,Both,,,,377.94,321.249,108.317604,377.94,UnitedHealthcare,Individual & Family,355.2636,94,,percent of total billed charges,,
"Olympus HF cable, monopolar 4m single use",,57000023,LOCAL,Facility,Outpatient,,,,377.94,321.249,108.317604,377.94,UnitedHealthcare,Medicare Advantage,185.1906,49,,percent of total billed charges,,
"Olympus HF cable, monopolar 4m single use",,57000023,LOCAL,Facility,Inpatient,,,,377.94,321.249,108.317604,377.94,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Olympus HF cable, monopolar 4m single use",,57000023,LOCAL,Facility,Outpatient,,,,377.94,321.249,108.317604,377.94,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,181.4112,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Olympus HF cable, monopolar 4m single use",,57000023,LOCAL,Facility,Inpatient,,,,377.94,321.249,108.317604,377.94,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Olympus HF-resection electrode, loop, 24F",,57000023,LOCAL,Facility,Both,,,,527.5,448.375,151.1815,527.5,Aetna,Commercial,485.3,92,,percent of total billed charges,,
"Olympus HF-resection electrode, loop, 24F",,57000023,LOCAL,Facility,Outpatient,,,,527.5,448.375,151.1815,527.5,Aetna,Medicare Advantage,258.475,49,,percent of total billed charges,,
"Olympus HF-resection electrode, loop, 24F",,57000023,LOCAL,Facility,Inpatient,,,,527.5,448.375,151.1815,527.5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Olympus HF-resection electrode, loop, 24F",,57000023,LOCAL,Facility,Both,,,,527.5,448.375,151.1815,527.5,Aetna,PPO,490.575,93,,percent of total billed charges,,
"Olympus HF-resection electrode, loop, 24F",,57000023,LOCAL,Facility,Both,,,,527.5,448.375,151.1815,527.5,America's PPO,America's PPO,506.55825,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Olympus HF-resection electrode, loop, 24F",,57000023,LOCAL,Facility,Both,,,,527.5,448.375,151.1815,527.5,BlueCross BlueShield Minnesota, Federal Employee Program,519.06,98.4,,percent of total billed charges,,
"Olympus HF-resection electrode, loop, 24F",,57000023,LOCAL,Facility,Both,,,,527.5,448.375,151.1815,527.5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,527.5,100,,percent of total billed charges,,
"Olympus HF-resection electrode, loop, 24F",,57000023,LOCAL,Facility,Both,,,,527.5,448.375,151.1815,527.5,BlueCross BlueShield Minnesota,High Value Network Plan,474.75,90,,percent of total billed charges,,
"Olympus HF-resection electrode, loop, 24F",,57000023,LOCAL,Facility,Outpatient,,,,527.5,448.375,151.1815,527.5,BlueCross BlueShield Minnesota,Medicare Advantage,258.475,49,,percent of total billed charges,,
"Olympus HF-resection electrode, loop, 24F",,57000023,LOCAL,Facility,Inpatient,,,,527.5,448.375,151.1815,527.5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Olympus HF-resection electrode, loop, 24F",,57000023,LOCAL,Facility,Both,,,,527.5,448.375,151.1815,527.5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,467.20675,88.57,,percent of total billed charges,,
"Olympus HF-resection electrode, loop, 24F",,57000023,LOCAL,Facility,Both,,,,527.5,448.375,151.1815,527.5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,151.1815,28.66,,percent of total billed charges,,
"Olympus HF-resection electrode, loop, 24F",,57000023,LOCAL,Facility,Outpatient,,,,527.5,448.375,151.1815,527.5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),258.475,49,,percent of total billed charges,,
"Olympus HF-resection electrode, loop, 24F",,57000023,LOCAL,Facility,Inpatient,,,,527.5,448.375,151.1815,527.5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Olympus HF-resection electrode, loop, 24F",,57000023,LOCAL,Facility,Both,,,,527.5,448.375,151.1815,527.5,CorVel,Worker's Compensation,527.5,100,,percent of total billed charges,,
"Olympus HF-resection electrode, loop, 24F",,57000023,LOCAL,Facility,Both,,,,527.5,448.375,151.1815,527.5,First Health Group Corporation,First Health Network,511.675,97,,percent of total billed charges,,
"Olympus HF-resection electrode, loop, 24F",,57000023,LOCAL,Facility,Both,,,,527.5,448.375,151.1815,527.5,"Health Partners, Inc.",Commercial,499.015,94.6,,percent of total billed charges,,
"Olympus HF-resection electrode, loop, 24F",,57000023,LOCAL,Facility,Outpatient,,,,527.5,448.375,151.1815,527.5,"Health Partners, Inc.",Medicare Advantage,258.475,49,,percent of total billed charges,,
"Olympus HF-resection electrode, loop, 24F",,57000023,LOCAL,Facility,Inpatient,,,,527.5,448.375,151.1815,527.5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Olympus HF-resection electrode, loop, 24F",,57000023,LOCAL,Facility,Both,,,,527.5,448.375,151.1815,527.5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),316.5,60,,percent of total billed charges,,
"Olympus HF-resection electrode, loop, 24F",,57000023,LOCAL,Facility,Both,,,,527.5,448.375,151.1815,527.5,"Health Partners, Inc.",State of Minnesota Advantage Program,429.9125,81.5,,percent of total billed charges,,
"Olympus HF-resection electrode, loop, 24F",,57000023,LOCAL,Facility,Both,,,,527.5,448.375,151.1815,527.5,"Health Partners, Inc.",State Public Programs,263.75,50,,percent of total billed charges,,
"Olympus HF-resection electrode, loop, 24F",,57000023,LOCAL,Facility,Both,,,,527.5,448.375,151.1815,527.5,Humana Insurance Company,Commercial PPO,501.125,95,,percent of total billed charges,,
"Olympus HF-resection electrode, loop, 24F",,57000023,LOCAL,Facility,Outpatient,,,,527.5,448.375,151.1815,527.5,Humana Insurance Company,Medicare PPO,258.475,49,,percent of total billed charges,,
"Olympus HF-resection electrode, loop, 24F",,57000023,LOCAL,Facility,Inpatient,,,,527.5,448.375,151.1815,527.5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Olympus HF-resection electrode, loop, 24F",,57000023,LOCAL,Facility,Both,,,,527.5,448.375,151.1815,527.5,Medica,Individual & Family,522.7525,99.1,,percent of total billed charges,,
"Olympus HF-resection electrode, loop, 24F",,57000023,LOCAL,Facility,Outpatient,,,,527.5,448.375,151.1815,527.5,Medica,Medica Advantage Solution,262.695,49.8,,percent of total billed charges,,
"Olympus HF-resection electrode, loop, 24F",,57000023,LOCAL,Facility,Inpatient,,,,527.5,448.375,151.1815,527.5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Olympus HF-resection electrode, loop, 24F",,57000023,LOCAL,Facility,Outpatient,,,,527.5,448.375,151.1815,527.5,Medica,Medical Assistance,235.265,44.6,,percent of total billed charges,,
"Olympus HF-resection electrode, loop, 24F",,57000023,LOCAL,Facility,Inpatient,,,,527.5,448.375,151.1815,527.5,Medica,Medical Assistance,,,,,Included in per diem rate,
"Olympus HF-resection electrode, loop, 24F",,57000023,LOCAL,Facility,Outpatient,,,,527.5,448.375,151.1815,527.5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,262.695,49.8,,percent of total billed charges,,
"Olympus HF-resection electrode, loop, 24F",,57000023,LOCAL,Facility,Inpatient,,,,527.5,448.375,151.1815,527.5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Olympus HF-resection electrode, loop, 24F",,57000023,LOCAL,Facility,Both,,,,527.5,448.375,151.1815,527.5,"Multiplan, Inc.","Multiplan, Inc.",495.85,94,,percent of total billed charges,,
"Olympus HF-resection electrode, loop, 24F",,57000023,LOCAL,Facility,Outpatient,,,,527.5,448.375,151.1815,527.5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,475.2775,90.1,,percent of total billed charges,,
"Olympus HF-resection electrode, loop, 24F",,57000023,LOCAL,Facility,Inpatient,,,,527.5,448.375,151.1815,527.5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Olympus HF-resection electrode, loop, 24F",,57000023,LOCAL,Facility,Both,,,,527.5,448.375,151.1815,527.5,"Preferred One Administrative Services, INC.",PPO,520.115,98.6,,percent of total billed charges,,
"Olympus HF-resection electrode, loop, 24F",,57000023,LOCAL,Facility,Outpatient,,,,527.5,448.375,151.1815,527.5,PrimeWest Health,Minnesota Senior Health Options (MSHO),271.39875,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Olympus HF-resection electrode, loop, 24F",,57000023,LOCAL,Facility,Inpatient,,,,527.5,448.375,151.1815,527.5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Olympus HF-resection electrode, loop, 24F",,57000023,LOCAL,Facility,Outpatient,,,,527.5,448.375,151.1815,527.5,PrimeWest Health,MinnesotaCare,270.924,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Olympus HF-resection electrode, loop, 24F",,57000023,LOCAL,Facility,Inpatient,,,,527.5,448.375,151.1815,527.5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Olympus HF-resection electrode, loop, 24F",,57000023,LOCAL,Facility,Both,,,,527.5,448.375,151.1815,527.5,Sanford Health Plan,Sanford Health Plan,485.3,92,,percent of total billed charges,,
"Olympus HF-resection electrode, loop, 24F",,57000023,LOCAL,Facility,Outpatient,,,,527.5,448.375,151.1815,527.5,"UCare Health, Inc.",Individual & Family Plan,297.24625,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Olympus HF-resection electrode, loop, 24F",,57000023,LOCAL,Facility,Inpatient,,,,527.5,448.375,151.1815,527.5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Olympus HF-resection electrode, loop, 24F",,57000023,LOCAL,Facility,Outpatient,,,,527.5,448.375,151.1815,527.5,"UCare Health, Inc.",Medical Assistance,266.22925,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Olympus HF-resection electrode, loop, 24F",,57000023,LOCAL,Facility,Inpatient,,,,527.5,448.375,151.1815,527.5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Olympus HF-resection electrode, loop, 24F",,57000023,LOCAL,Facility,Outpatient,,,,527.5,448.375,151.1815,527.5,"UCare Health, Inc.",Medicare Advantage,266.22925,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Olympus HF-resection electrode, loop, 24F",,57000023,LOCAL,Facility,Inpatient,,,,527.5,448.375,151.1815,527.5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Olympus HF-resection electrode, loop, 24F",,57000023,LOCAL,Facility,Outpatient,,,,527.5,448.375,151.1815,527.5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),266.22925,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Olympus HF-resection electrode, loop, 24F",,57000023,LOCAL,Facility,Inpatient,,,,527.5,448.375,151.1815,527.5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Olympus HF-resection electrode, loop, 24F",,57000023,LOCAL,Facility,Both,,,,527.5,448.375,151.1815,527.5,UnitedHealthcare,Individual & Family,495.85,94,,percent of total billed charges,,
"Olympus HF-resection electrode, loop, 24F",,57000023,LOCAL,Facility,Outpatient,,,,527.5,448.375,151.1815,527.5,UnitedHealthcare,Medicare Advantage,258.475,49,,percent of total billed charges,,
"Olympus HF-resection electrode, loop, 24F",,57000023,LOCAL,Facility,Inpatient,,,,527.5,448.375,151.1815,527.5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Olympus HF-resection electrode, loop, 24F",,57000023,LOCAL,Facility,Outpatient,,,,527.5,448.375,151.1815,527.5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,253.2,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Olympus HF-resection electrode, loop, 24F",,57000023,LOCAL,Facility,Inpatient,,,,527.5,448.375,151.1815,527.5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
PACK EYE   MEDLINE,,57000023,LOCAL,Facility,Both,,,,115.76,98.396,33.176816,115.76,Aetna,Commercial,106.4992,92,,percent of total billed charges,,
PACK EYE   MEDLINE,,57000023,LOCAL,Facility,Outpatient,,,,115.76,98.396,33.176816,115.76,Aetna,Medicare Advantage,56.7224,49,,percent of total billed charges,,
PACK EYE   MEDLINE,,57000023,LOCAL,Facility,Inpatient,,,,115.76,98.396,33.176816,115.76,Aetna,Medicare Advantage,,,,,Included in per diem rate,
PACK EYE   MEDLINE,,57000023,LOCAL,Facility,Both,,,,115.76,98.396,33.176816,115.76,Aetna,PPO,107.6568,93,,percent of total billed charges,,
PACK EYE   MEDLINE,,57000023,LOCAL,Facility,Both,,,,115.76,98.396,33.176816,115.76,America's PPO,America's PPO,111.164328,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
PACK EYE   MEDLINE,,57000023,LOCAL,Facility,Both,,,,115.76,98.396,33.176816,115.76,BlueCross BlueShield Minnesota, Federal Employee Program,113.90784,98.4,,percent of total billed charges,,
PACK EYE   MEDLINE,,57000023,LOCAL,Facility,Both,,,,115.76,98.396,33.176816,115.76,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,115.76,100,,percent of total billed charges,,
PACK EYE   MEDLINE,,57000023,LOCAL,Facility,Both,,,,115.76,98.396,33.176816,115.76,BlueCross BlueShield Minnesota,High Value Network Plan,104.184,90,,percent of total billed charges,,
PACK EYE   MEDLINE,,57000023,LOCAL,Facility,Outpatient,,,,115.76,98.396,33.176816,115.76,BlueCross BlueShield Minnesota,Medicare Advantage,56.7224,49,,percent of total billed charges,,
PACK EYE   MEDLINE,,57000023,LOCAL,Facility,Inpatient,,,,115.76,98.396,33.176816,115.76,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
PACK EYE   MEDLINE,,57000023,LOCAL,Facility,Both,,,,115.76,98.396,33.176816,115.76,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,102.528632,88.57,,percent of total billed charges,,
PACK EYE   MEDLINE,,57000023,LOCAL,Facility,Both,,,,115.76,98.396,33.176816,115.76,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,33.176816,28.66,,percent of total billed charges,,
PACK EYE   MEDLINE,,57000023,LOCAL,Facility,Outpatient,,,,115.76,98.396,33.176816,115.76,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),56.7224,49,,percent of total billed charges,,
PACK EYE   MEDLINE,,57000023,LOCAL,Facility,Inpatient,,,,115.76,98.396,33.176816,115.76,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
PACK EYE   MEDLINE,,57000023,LOCAL,Facility,Both,,,,115.76,98.396,33.176816,115.76,CorVel,Worker's Compensation,115.76,100,,percent of total billed charges,,
PACK EYE   MEDLINE,,57000023,LOCAL,Facility,Both,,,,115.76,98.396,33.176816,115.76,First Health Group Corporation,First Health Network,112.2872,97,,percent of total billed charges,,
PACK EYE   MEDLINE,,57000023,LOCAL,Facility,Both,,,,115.76,98.396,33.176816,115.76,"Health Partners, Inc.",Commercial,109.50896,94.6,,percent of total billed charges,,
PACK EYE   MEDLINE,,57000023,LOCAL,Facility,Outpatient,,,,115.76,98.396,33.176816,115.76,"Health Partners, Inc.",Medicare Advantage,56.7224,49,,percent of total billed charges,,
PACK EYE   MEDLINE,,57000023,LOCAL,Facility,Inpatient,,,,115.76,98.396,33.176816,115.76,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PACK EYE   MEDLINE,,57000023,LOCAL,Facility,Both,,,,115.76,98.396,33.176816,115.76,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),69.456,60,,percent of total billed charges,,
PACK EYE   MEDLINE,,57000023,LOCAL,Facility,Both,,,,115.76,98.396,33.176816,115.76,"Health Partners, Inc.",State of Minnesota Advantage Program,94.3444,81.5,,percent of total billed charges,,
PACK EYE   MEDLINE,,57000023,LOCAL,Facility,Both,,,,115.76,98.396,33.176816,115.76,"Health Partners, Inc.",State Public Programs,57.88,50,,percent of total billed charges,,
PACK EYE   MEDLINE,,57000023,LOCAL,Facility,Both,,,,115.76,98.396,33.176816,115.76,Humana Insurance Company,Commercial PPO,109.972,95,,percent of total billed charges,,
PACK EYE   MEDLINE,,57000023,LOCAL,Facility,Outpatient,,,,115.76,98.396,33.176816,115.76,Humana Insurance Company,Medicare PPO,56.7224,49,,percent of total billed charges,,
PACK EYE   MEDLINE,,57000023,LOCAL,Facility,Inpatient,,,,115.76,98.396,33.176816,115.76,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
PACK EYE   MEDLINE,,57000023,LOCAL,Facility,Both,,,,115.76,98.396,33.176816,115.76,Medica,Individual & Family,114.71816,99.1,,percent of total billed charges,,
PACK EYE   MEDLINE,,57000023,LOCAL,Facility,Outpatient,,,,115.76,98.396,33.176816,115.76,Medica,Medica Advantage Solution,57.64848,49.8,,percent of total billed charges,,
PACK EYE   MEDLINE,,57000023,LOCAL,Facility,Inpatient,,,,115.76,98.396,33.176816,115.76,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
PACK EYE   MEDLINE,,57000023,LOCAL,Facility,Outpatient,,,,115.76,98.396,33.176816,115.76,Medica,Medical Assistance,51.62896,44.6,,percent of total billed charges,,
PACK EYE   MEDLINE,,57000023,LOCAL,Facility,Inpatient,,,,115.76,98.396,33.176816,115.76,Medica,Medical Assistance,,,,,Included in per diem rate,
PACK EYE   MEDLINE,,57000023,LOCAL,Facility,Outpatient,,,,115.76,98.396,33.176816,115.76,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,57.64848,49.8,,percent of total billed charges,,
PACK EYE   MEDLINE,,57000023,LOCAL,Facility,Inpatient,,,,115.76,98.396,33.176816,115.76,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
PACK EYE   MEDLINE,,57000023,LOCAL,Facility,Both,,,,115.76,98.396,33.176816,115.76,"Multiplan, Inc.","Multiplan, Inc.",108.8144,94,,percent of total billed charges,,
PACK EYE   MEDLINE,,57000023,LOCAL,Facility,Outpatient,,,,115.76,98.396,33.176816,115.76,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,104.29976,90.1,,percent of total billed charges,,
PACK EYE   MEDLINE,,57000023,LOCAL,Facility,Inpatient,,,,115.76,98.396,33.176816,115.76,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
PACK EYE   MEDLINE,,57000023,LOCAL,Facility,Both,,,,115.76,98.396,33.176816,115.76,"Preferred One Administrative Services, INC.",PPO,114.13936,98.6,,percent of total billed charges,,
PACK EYE   MEDLINE,,57000023,LOCAL,Facility,Outpatient,,,,115.76,98.396,33.176816,115.76,PrimeWest Health,Minnesota Senior Health Options (MSHO),59.55852,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
PACK EYE   MEDLINE,,57000023,LOCAL,Facility,Inpatient,,,,115.76,98.396,33.176816,115.76,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PACK EYE   MEDLINE,,57000023,LOCAL,Facility,Outpatient,,,,115.76,98.396,33.176816,115.76,PrimeWest Health,MinnesotaCare,59.454336,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
PACK EYE   MEDLINE,,57000023,LOCAL,Facility,Inpatient,,,,115.76,98.396,33.176816,115.76,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
PACK EYE   MEDLINE,,57000023,LOCAL,Facility,Both,,,,115.76,98.396,33.176816,115.76,Sanford Health Plan,Sanford Health Plan,106.4992,92,,percent of total billed charges,,
PACK EYE   MEDLINE,,57000023,LOCAL,Facility,Outpatient,,,,115.76,98.396,33.176816,115.76,"UCare Health, Inc.",Individual & Family Plan,65.23076,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
PACK EYE   MEDLINE,,57000023,LOCAL,Facility,Inpatient,,,,115.76,98.396,33.176816,115.76,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
PACK EYE   MEDLINE,,57000023,LOCAL,Facility,Outpatient,,,,115.76,98.396,33.176816,115.76,"UCare Health, Inc.",Medical Assistance,58.424072,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PACK EYE   MEDLINE,,57000023,LOCAL,Facility,Inpatient,,,,115.76,98.396,33.176816,115.76,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
PACK EYE   MEDLINE,,57000023,LOCAL,Facility,Outpatient,,,,115.76,98.396,33.176816,115.76,"UCare Health, Inc.",Medicare Advantage,58.424072,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PACK EYE   MEDLINE,,57000023,LOCAL,Facility,Inpatient,,,,115.76,98.396,33.176816,115.76,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PACK EYE   MEDLINE,,57000023,LOCAL,Facility,Outpatient,,,,115.76,98.396,33.176816,115.76,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),58.424072,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PACK EYE   MEDLINE,,57000023,LOCAL,Facility,Inpatient,,,,115.76,98.396,33.176816,115.76,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PACK EYE   MEDLINE,,57000023,LOCAL,Facility,Both,,,,115.76,98.396,33.176816,115.76,UnitedHealthcare,Individual & Family,108.8144,94,,percent of total billed charges,,
PACK EYE   MEDLINE,,57000023,LOCAL,Facility,Outpatient,,,,115.76,98.396,33.176816,115.76,UnitedHealthcare,Medicare Advantage,56.7224,49,,percent of total billed charges,,
PACK EYE   MEDLINE,,57000023,LOCAL,Facility,Inpatient,,,,115.76,98.396,33.176816,115.76,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
PACK EYE   MEDLINE,,57000023,LOCAL,Facility,Outpatient,,,,115.76,98.396,33.176816,115.76,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,55.5648,48,,percent of total billed charges,,100% of DHS outpatient percentage
PACK EYE   MEDLINE,,57000023,LOCAL,Facility,Inpatient,,,,115.76,98.396,33.176816,115.76,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
PLASMA WAND EICA5872-01,,57000023,LOCAL,Facility,Both,,,,695,590.75,199.187,695,Aetna,Commercial,639.4,92,,percent of total billed charges,,
PLASMA WAND EICA5872-01,,57000023,LOCAL,Facility,Outpatient,,,,695,590.75,199.187,695,Aetna,Medicare Advantage,340.55,49,,percent of total billed charges,,
PLASMA WAND EICA5872-01,,57000023,LOCAL,Facility,Inpatient,,,,695,590.75,199.187,695,Aetna,Medicare Advantage,,,,,Included in per diem rate,
PLASMA WAND EICA5872-01,,57000023,LOCAL,Facility,Both,,,,695,590.75,199.187,695,Aetna,PPO,646.35,93,,percent of total billed charges,,
PLASMA WAND EICA5872-01,,57000023,LOCAL,Facility,Both,,,,695,590.75,199.187,695,America's PPO,America's PPO,667.4085,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
PLASMA WAND EICA5872-01,,57000023,LOCAL,Facility,Both,,,,695,590.75,199.187,695,BlueCross BlueShield Minnesota, Federal Employee Program,683.88,98.4,,percent of total billed charges,,
PLASMA WAND EICA5872-01,,57000023,LOCAL,Facility,Both,,,,695,590.75,199.187,695,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,695,100,,percent of total billed charges,,
PLASMA WAND EICA5872-01,,57000023,LOCAL,Facility,Both,,,,695,590.75,199.187,695,BlueCross BlueShield Minnesota,High Value Network Plan,625.5,90,,percent of total billed charges,,
PLASMA WAND EICA5872-01,,57000023,LOCAL,Facility,Outpatient,,,,695,590.75,199.187,695,BlueCross BlueShield Minnesota,Medicare Advantage,340.55,49,,percent of total billed charges,,
PLASMA WAND EICA5872-01,,57000023,LOCAL,Facility,Inpatient,,,,695,590.75,199.187,695,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
PLASMA WAND EICA5872-01,,57000023,LOCAL,Facility,Both,,,,695,590.75,199.187,695,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,615.5615,88.57,,percent of total billed charges,,
PLASMA WAND EICA5872-01,,57000023,LOCAL,Facility,Both,,,,695,590.75,199.187,695,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,199.187,28.66,,percent of total billed charges,,
PLASMA WAND EICA5872-01,,57000023,LOCAL,Facility,Outpatient,,,,695,590.75,199.187,695,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),340.55,49,,percent of total billed charges,,
PLASMA WAND EICA5872-01,,57000023,LOCAL,Facility,Inpatient,,,,695,590.75,199.187,695,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
PLASMA WAND EICA5872-01,,57000023,LOCAL,Facility,Both,,,,695,590.75,199.187,695,CorVel,Worker's Compensation,695,100,,percent of total billed charges,,
PLASMA WAND EICA5872-01,,57000023,LOCAL,Facility,Both,,,,695,590.75,199.187,695,First Health Group Corporation,First Health Network,674.15,97,,percent of total billed charges,,
PLASMA WAND EICA5872-01,,57000023,LOCAL,Facility,Both,,,,695,590.75,199.187,695,"Health Partners, Inc.",Commercial,657.47,94.6,,percent of total billed charges,,
PLASMA WAND EICA5872-01,,57000023,LOCAL,Facility,Outpatient,,,,695,590.75,199.187,695,"Health Partners, Inc.",Medicare Advantage,340.55,49,,percent of total billed charges,,
PLASMA WAND EICA5872-01,,57000023,LOCAL,Facility,Inpatient,,,,695,590.75,199.187,695,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PLASMA WAND EICA5872-01,,57000023,LOCAL,Facility,Both,,,,695,590.75,199.187,695,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),417,60,,percent of total billed charges,,
PLASMA WAND EICA5872-01,,57000023,LOCAL,Facility,Both,,,,695,590.75,199.187,695,"Health Partners, Inc.",State of Minnesota Advantage Program,566.425,81.5,,percent of total billed charges,,
PLASMA WAND EICA5872-01,,57000023,LOCAL,Facility,Both,,,,695,590.75,199.187,695,"Health Partners, Inc.",State Public Programs,347.5,50,,percent of total billed charges,,
PLASMA WAND EICA5872-01,,57000023,LOCAL,Facility,Both,,,,695,590.75,199.187,695,Humana Insurance Company,Commercial PPO,660.25,95,,percent of total billed charges,,
PLASMA WAND EICA5872-01,,57000023,LOCAL,Facility,Outpatient,,,,695,590.75,199.187,695,Humana Insurance Company,Medicare PPO,340.55,49,,percent of total billed charges,,
PLASMA WAND EICA5872-01,,57000023,LOCAL,Facility,Inpatient,,,,695,590.75,199.187,695,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
PLASMA WAND EICA5872-01,,57000023,LOCAL,Facility,Both,,,,695,590.75,199.187,695,Medica,Individual & Family,688.745,99.1,,percent of total billed charges,,
PLASMA WAND EICA5872-01,,57000023,LOCAL,Facility,Outpatient,,,,695,590.75,199.187,695,Medica,Medica Advantage Solution,346.11,49.8,,percent of total billed charges,,
PLASMA WAND EICA5872-01,,57000023,LOCAL,Facility,Inpatient,,,,695,590.75,199.187,695,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
PLASMA WAND EICA5872-01,,57000023,LOCAL,Facility,Outpatient,,,,695,590.75,199.187,695,Medica,Medical Assistance,309.97,44.6,,percent of total billed charges,,
PLASMA WAND EICA5872-01,,57000023,LOCAL,Facility,Inpatient,,,,695,590.75,199.187,695,Medica,Medical Assistance,,,,,Included in per diem rate,
PLASMA WAND EICA5872-01,,57000023,LOCAL,Facility,Outpatient,,,,695,590.75,199.187,695,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,346.11,49.8,,percent of total billed charges,,
PLASMA WAND EICA5872-01,,57000023,LOCAL,Facility,Inpatient,,,,695,590.75,199.187,695,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
PLASMA WAND EICA5872-01,,57000023,LOCAL,Facility,Both,,,,695,590.75,199.187,695,"Multiplan, Inc.","Multiplan, Inc.",653.3,94,,percent of total billed charges,,
PLASMA WAND EICA5872-01,,57000023,LOCAL,Facility,Outpatient,,,,695,590.75,199.187,695,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,626.195,90.1,,percent of total billed charges,,
PLASMA WAND EICA5872-01,,57000023,LOCAL,Facility,Inpatient,,,,695,590.75,199.187,695,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
PLASMA WAND EICA5872-01,,57000023,LOCAL,Facility,Both,,,,695,590.75,199.187,695,"Preferred One Administrative Services, INC.",PPO,685.27,98.6,,percent of total billed charges,,
PLASMA WAND EICA5872-01,,57000023,LOCAL,Facility,Outpatient,,,,695,590.75,199.187,695,PrimeWest Health,Minnesota Senior Health Options (MSHO),357.5775,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
PLASMA WAND EICA5872-01,,57000023,LOCAL,Facility,Inpatient,,,,695,590.75,199.187,695,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PLASMA WAND EICA5872-01,,57000023,LOCAL,Facility,Outpatient,,,,695,590.75,199.187,695,PrimeWest Health,MinnesotaCare,356.952,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
PLASMA WAND EICA5872-01,,57000023,LOCAL,Facility,Inpatient,,,,695,590.75,199.187,695,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
PLASMA WAND EICA5872-01,,57000023,LOCAL,Facility,Both,,,,695,590.75,199.187,695,Sanford Health Plan,Sanford Health Plan,639.4,92,,percent of total billed charges,,
PLASMA WAND EICA5872-01,,57000023,LOCAL,Facility,Outpatient,,,,695,590.75,199.187,695,"UCare Health, Inc.",Individual & Family Plan,391.6325,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
PLASMA WAND EICA5872-01,,57000023,LOCAL,Facility,Inpatient,,,,695,590.75,199.187,695,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
PLASMA WAND EICA5872-01,,57000023,LOCAL,Facility,Outpatient,,,,695,590.75,199.187,695,"UCare Health, Inc.",Medical Assistance,350.7665,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PLASMA WAND EICA5872-01,,57000023,LOCAL,Facility,Inpatient,,,,695,590.75,199.187,695,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
PLASMA WAND EICA5872-01,,57000023,LOCAL,Facility,Outpatient,,,,695,590.75,199.187,695,"UCare Health, Inc.",Medicare Advantage,350.7665,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PLASMA WAND EICA5872-01,,57000023,LOCAL,Facility,Inpatient,,,,695,590.75,199.187,695,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PLASMA WAND EICA5872-01,,57000023,LOCAL,Facility,Outpatient,,,,695,590.75,199.187,695,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),350.7665,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PLASMA WAND EICA5872-01,,57000023,LOCAL,Facility,Inpatient,,,,695,590.75,199.187,695,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PLASMA WAND EICA5872-01,,57000023,LOCAL,Facility,Both,,,,695,590.75,199.187,695,UnitedHealthcare,Individual & Family,653.3,94,,percent of total billed charges,,
PLASMA WAND EICA5872-01,,57000023,LOCAL,Facility,Outpatient,,,,695,590.75,199.187,695,UnitedHealthcare,Medicare Advantage,340.55,49,,percent of total billed charges,,
PLASMA WAND EICA5872-01,,57000023,LOCAL,Facility,Inpatient,,,,695,590.75,199.187,695,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
PLASMA WAND EICA5872-01,,57000023,LOCAL,Facility,Outpatient,,,,695,590.75,199.187,695,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,333.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
PLASMA WAND EICA5872-01,,57000023,LOCAL,Facility,Inpatient,,,,695,590.75,199.187,695,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"PROVISC, 0.55ML",,57000023,LOCAL,Facility,Both,,,,210,178.5,60.186,210,Aetna,Commercial,193.2,92,,percent of total billed charges,,
"PROVISC, 0.55ML",,57000023,LOCAL,Facility,Outpatient,,,,210,178.5,60.186,210,Aetna,Medicare Advantage,102.9,49,,percent of total billed charges,,
"PROVISC, 0.55ML",,57000023,LOCAL,Facility,Inpatient,,,,210,178.5,60.186,210,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"PROVISC, 0.55ML",,57000023,LOCAL,Facility,Both,,,,210,178.5,60.186,210,Aetna,PPO,195.3,93,,percent of total billed charges,,
"PROVISC, 0.55ML",,57000023,LOCAL,Facility,Both,,,,210,178.5,60.186,210,America's PPO,America's PPO,201.663,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"PROVISC, 0.55ML",,57000023,LOCAL,Facility,Both,,,,210,178.5,60.186,210,BlueCross BlueShield Minnesota, Federal Employee Program,206.64,98.4,,percent of total billed charges,,
"PROVISC, 0.55ML",,57000023,LOCAL,Facility,Both,,,,210,178.5,60.186,210,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,210,100,,percent of total billed charges,,
"PROVISC, 0.55ML",,57000023,LOCAL,Facility,Both,,,,210,178.5,60.186,210,BlueCross BlueShield Minnesota,High Value Network Plan,189,90,,percent of total billed charges,,
"PROVISC, 0.55ML",,57000023,LOCAL,Facility,Outpatient,,,,210,178.5,60.186,210,BlueCross BlueShield Minnesota,Medicare Advantage,102.9,49,,percent of total billed charges,,
"PROVISC, 0.55ML",,57000023,LOCAL,Facility,Inpatient,,,,210,178.5,60.186,210,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"PROVISC, 0.55ML",,57000023,LOCAL,Facility,Both,,,,210,178.5,60.186,210,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,185.997,88.57,,percent of total billed charges,,
"PROVISC, 0.55ML",,57000023,LOCAL,Facility,Both,,,,210,178.5,60.186,210,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,60.186,28.66,,percent of total billed charges,,
"PROVISC, 0.55ML",,57000023,LOCAL,Facility,Outpatient,,,,210,178.5,60.186,210,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),102.9,49,,percent of total billed charges,,
"PROVISC, 0.55ML",,57000023,LOCAL,Facility,Inpatient,,,,210,178.5,60.186,210,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"PROVISC, 0.55ML",,57000023,LOCAL,Facility,Both,,,,210,178.5,60.186,210,CorVel,Worker's Compensation,210,100,,percent of total billed charges,,
"PROVISC, 0.55ML",,57000023,LOCAL,Facility,Both,,,,210,178.5,60.186,210,First Health Group Corporation,First Health Network,203.7,97,,percent of total billed charges,,
"PROVISC, 0.55ML",,57000023,LOCAL,Facility,Both,,,,210,178.5,60.186,210,"Health Partners, Inc.",Commercial,198.66,94.6,,percent of total billed charges,,
"PROVISC, 0.55ML",,57000023,LOCAL,Facility,Outpatient,,,,210,178.5,60.186,210,"Health Partners, Inc.",Medicare Advantage,102.9,49,,percent of total billed charges,,
"PROVISC, 0.55ML",,57000023,LOCAL,Facility,Inpatient,,,,210,178.5,60.186,210,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"PROVISC, 0.55ML",,57000023,LOCAL,Facility,Both,,,,210,178.5,60.186,210,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),126,60,,percent of total billed charges,,
"PROVISC, 0.55ML",,57000023,LOCAL,Facility,Both,,,,210,178.5,60.186,210,"Health Partners, Inc.",State of Minnesota Advantage Program,171.15,81.5,,percent of total billed charges,,
"PROVISC, 0.55ML",,57000023,LOCAL,Facility,Both,,,,210,178.5,60.186,210,"Health Partners, Inc.",State Public Programs,105,50,,percent of total billed charges,,
"PROVISC, 0.55ML",,57000023,LOCAL,Facility,Both,,,,210,178.5,60.186,210,Humana Insurance Company,Commercial PPO,199.5,95,,percent of total billed charges,,
"PROVISC, 0.55ML",,57000023,LOCAL,Facility,Outpatient,,,,210,178.5,60.186,210,Humana Insurance Company,Medicare PPO,102.9,49,,percent of total billed charges,,
"PROVISC, 0.55ML",,57000023,LOCAL,Facility,Inpatient,,,,210,178.5,60.186,210,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"PROVISC, 0.55ML",,57000023,LOCAL,Facility,Both,,,,210,178.5,60.186,210,Medica,Individual & Family,208.11,99.1,,percent of total billed charges,,
"PROVISC, 0.55ML",,57000023,LOCAL,Facility,Outpatient,,,,210,178.5,60.186,210,Medica,Medica Advantage Solution,104.58,49.8,,percent of total billed charges,,
"PROVISC, 0.55ML",,57000023,LOCAL,Facility,Inpatient,,,,210,178.5,60.186,210,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"PROVISC, 0.55ML",,57000023,LOCAL,Facility,Outpatient,,,,210,178.5,60.186,210,Medica,Medical Assistance,93.66,44.6,,percent of total billed charges,,
"PROVISC, 0.55ML",,57000023,LOCAL,Facility,Inpatient,,,,210,178.5,60.186,210,Medica,Medical Assistance,,,,,Included in per diem rate,
"PROVISC, 0.55ML",,57000023,LOCAL,Facility,Outpatient,,,,210,178.5,60.186,210,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,104.58,49.8,,percent of total billed charges,,
"PROVISC, 0.55ML",,57000023,LOCAL,Facility,Inpatient,,,,210,178.5,60.186,210,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"PROVISC, 0.55ML",,57000023,LOCAL,Facility,Both,,,,210,178.5,60.186,210,"Multiplan, Inc.","Multiplan, Inc.",197.4,94,,percent of total billed charges,,
"PROVISC, 0.55ML",,57000023,LOCAL,Facility,Outpatient,,,,210,178.5,60.186,210,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,189.21,90.1,,percent of total billed charges,,
"PROVISC, 0.55ML",,57000023,LOCAL,Facility,Inpatient,,,,210,178.5,60.186,210,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"PROVISC, 0.55ML",,57000023,LOCAL,Facility,Both,,,,210,178.5,60.186,210,"Preferred One Administrative Services, INC.",PPO,207.06,98.6,,percent of total billed charges,,
"PROVISC, 0.55ML",,57000023,LOCAL,Facility,Outpatient,,,,210,178.5,60.186,210,PrimeWest Health,Minnesota Senior Health Options (MSHO),108.045,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"PROVISC, 0.55ML",,57000023,LOCAL,Facility,Inpatient,,,,210,178.5,60.186,210,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"PROVISC, 0.55ML",,57000023,LOCAL,Facility,Outpatient,,,,210,178.5,60.186,210,PrimeWest Health,MinnesotaCare,107.856,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"PROVISC, 0.55ML",,57000023,LOCAL,Facility,Inpatient,,,,210,178.5,60.186,210,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"PROVISC, 0.55ML",,57000023,LOCAL,Facility,Both,,,,210,178.5,60.186,210,Sanford Health Plan,Sanford Health Plan,193.2,92,,percent of total billed charges,,
"PROVISC, 0.55ML",,57000023,LOCAL,Facility,Outpatient,,,,210,178.5,60.186,210,"UCare Health, Inc.",Individual & Family Plan,118.335,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"PROVISC, 0.55ML",,57000023,LOCAL,Facility,Inpatient,,,,210,178.5,60.186,210,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"PROVISC, 0.55ML",,57000023,LOCAL,Facility,Outpatient,,,,210,178.5,60.186,210,"UCare Health, Inc.",Medical Assistance,105.987,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"PROVISC, 0.55ML",,57000023,LOCAL,Facility,Inpatient,,,,210,178.5,60.186,210,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"PROVISC, 0.55ML",,57000023,LOCAL,Facility,Outpatient,,,,210,178.5,60.186,210,"UCare Health, Inc.",Medicare Advantage,105.987,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"PROVISC, 0.55ML",,57000023,LOCAL,Facility,Inpatient,,,,210,178.5,60.186,210,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"PROVISC, 0.55ML",,57000023,LOCAL,Facility,Outpatient,,,,210,178.5,60.186,210,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),105.987,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"PROVISC, 0.55ML",,57000023,LOCAL,Facility,Inpatient,,,,210,178.5,60.186,210,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"PROVISC, 0.55ML",,57000023,LOCAL,Facility,Both,,,,210,178.5,60.186,210,UnitedHealthcare,Individual & Family,197.4,94,,percent of total billed charges,,
"PROVISC, 0.55ML",,57000023,LOCAL,Facility,Outpatient,,,,210,178.5,60.186,210,UnitedHealthcare,Medicare Advantage,102.9,49,,percent of total billed charges,,
"PROVISC, 0.55ML",,57000023,LOCAL,Facility,Inpatient,,,,210,178.5,60.186,210,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"PROVISC, 0.55ML",,57000023,LOCAL,Facility,Outpatient,,,,210,178.5,60.186,210,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,100.8,48,,percent of total billed charges,,100% of DHS outpatient percentage
"PROVISC, 0.55ML",,57000023,LOCAL,Facility,Inpatient,,,,210,178.5,60.186,210,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
SMOKE EVACUATOR TUBING,,57000023,LOCAL,Facility,Both,,,,119.16,101.286,34.151256,119.16,Aetna,Commercial,109.6272,92,,percent of total billed charges,,
SMOKE EVACUATOR TUBING,,57000023,LOCAL,Facility,Outpatient,,,,119.16,101.286,34.151256,119.16,Aetna,Medicare Advantage,58.3884,49,,percent of total billed charges,,
SMOKE EVACUATOR TUBING,,57000023,LOCAL,Facility,Inpatient,,,,119.16,101.286,34.151256,119.16,Aetna,Medicare Advantage,,,,,Included in per diem rate,
SMOKE EVACUATOR TUBING,,57000023,LOCAL,Facility,Both,,,,119.16,101.286,34.151256,119.16,Aetna,PPO,110.8188,93,,percent of total billed charges,,
SMOKE EVACUATOR TUBING,,57000023,LOCAL,Facility,Both,,,,119.16,101.286,34.151256,119.16,America's PPO,America's PPO,114.429348,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SMOKE EVACUATOR TUBING,,57000023,LOCAL,Facility,Both,,,,119.16,101.286,34.151256,119.16,BlueCross BlueShield Minnesota, Federal Employee Program,117.25344,98.4,,percent of total billed charges,,
SMOKE EVACUATOR TUBING,,57000023,LOCAL,Facility,Both,,,,119.16,101.286,34.151256,119.16,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,119.16,100,,percent of total billed charges,,
SMOKE EVACUATOR TUBING,,57000023,LOCAL,Facility,Both,,,,119.16,101.286,34.151256,119.16,BlueCross BlueShield Minnesota,High Value Network Plan,107.244,90,,percent of total billed charges,,
SMOKE EVACUATOR TUBING,,57000023,LOCAL,Facility,Outpatient,,,,119.16,101.286,34.151256,119.16,BlueCross BlueShield Minnesota,Medicare Advantage,58.3884,49,,percent of total billed charges,,
SMOKE EVACUATOR TUBING,,57000023,LOCAL,Facility,Inpatient,,,,119.16,101.286,34.151256,119.16,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
SMOKE EVACUATOR TUBING,,57000023,LOCAL,Facility,Both,,,,119.16,101.286,34.151256,119.16,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,105.540012,88.57,,percent of total billed charges,,
SMOKE EVACUATOR TUBING,,57000023,LOCAL,Facility,Both,,,,119.16,101.286,34.151256,119.16,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,34.151256,28.66,,percent of total billed charges,,
SMOKE EVACUATOR TUBING,,57000023,LOCAL,Facility,Outpatient,,,,119.16,101.286,34.151256,119.16,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),58.3884,49,,percent of total billed charges,,
SMOKE EVACUATOR TUBING,,57000023,LOCAL,Facility,Inpatient,,,,119.16,101.286,34.151256,119.16,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
SMOKE EVACUATOR TUBING,,57000023,LOCAL,Facility,Both,,,,119.16,101.286,34.151256,119.16,CorVel,Worker's Compensation,119.16,100,,percent of total billed charges,,
SMOKE EVACUATOR TUBING,,57000023,LOCAL,Facility,Both,,,,119.16,101.286,34.151256,119.16,First Health Group Corporation,First Health Network,115.5852,97,,percent of total billed charges,,
SMOKE EVACUATOR TUBING,,57000023,LOCAL,Facility,Both,,,,119.16,101.286,34.151256,119.16,"Health Partners, Inc.",Commercial,112.72536,94.6,,percent of total billed charges,,
SMOKE EVACUATOR TUBING,,57000023,LOCAL,Facility,Outpatient,,,,119.16,101.286,34.151256,119.16,"Health Partners, Inc.",Medicare Advantage,58.3884,49,,percent of total billed charges,,
SMOKE EVACUATOR TUBING,,57000023,LOCAL,Facility,Inpatient,,,,119.16,101.286,34.151256,119.16,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SMOKE EVACUATOR TUBING,,57000023,LOCAL,Facility,Both,,,,119.16,101.286,34.151256,119.16,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),71.496,60,,percent of total billed charges,,
SMOKE EVACUATOR TUBING,,57000023,LOCAL,Facility,Both,,,,119.16,101.286,34.151256,119.16,"Health Partners, Inc.",State of Minnesota Advantage Program,97.1154,81.5,,percent of total billed charges,,
SMOKE EVACUATOR TUBING,,57000023,LOCAL,Facility,Both,,,,119.16,101.286,34.151256,119.16,"Health Partners, Inc.",State Public Programs,59.58,50,,percent of total billed charges,,
SMOKE EVACUATOR TUBING,,57000023,LOCAL,Facility,Both,,,,119.16,101.286,34.151256,119.16,Humana Insurance Company,Commercial PPO,113.202,95,,percent of total billed charges,,
SMOKE EVACUATOR TUBING,,57000023,LOCAL,Facility,Outpatient,,,,119.16,101.286,34.151256,119.16,Humana Insurance Company,Medicare PPO,58.3884,49,,percent of total billed charges,,
SMOKE EVACUATOR TUBING,,57000023,LOCAL,Facility,Inpatient,,,,119.16,101.286,34.151256,119.16,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
SMOKE EVACUATOR TUBING,,57000023,LOCAL,Facility,Both,,,,119.16,101.286,34.151256,119.16,Medica,Individual & Family,118.08756,99.1,,percent of total billed charges,,
SMOKE EVACUATOR TUBING,,57000023,LOCAL,Facility,Outpatient,,,,119.16,101.286,34.151256,119.16,Medica,Medica Advantage Solution,59.34168,49.8,,percent of total billed charges,,
SMOKE EVACUATOR TUBING,,57000023,LOCAL,Facility,Inpatient,,,,119.16,101.286,34.151256,119.16,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
SMOKE EVACUATOR TUBING,,57000023,LOCAL,Facility,Outpatient,,,,119.16,101.286,34.151256,119.16,Medica,Medical Assistance,53.14536,44.6,,percent of total billed charges,,
SMOKE EVACUATOR TUBING,,57000023,LOCAL,Facility,Inpatient,,,,119.16,101.286,34.151256,119.16,Medica,Medical Assistance,,,,,Included in per diem rate,
SMOKE EVACUATOR TUBING,,57000023,LOCAL,Facility,Outpatient,,,,119.16,101.286,34.151256,119.16,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,59.34168,49.8,,percent of total billed charges,,
SMOKE EVACUATOR TUBING,,57000023,LOCAL,Facility,Inpatient,,,,119.16,101.286,34.151256,119.16,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
SMOKE EVACUATOR TUBING,,57000023,LOCAL,Facility,Both,,,,119.16,101.286,34.151256,119.16,"Multiplan, Inc.","Multiplan, Inc.",112.0104,94,,percent of total billed charges,,
SMOKE EVACUATOR TUBING,,57000023,LOCAL,Facility,Outpatient,,,,119.16,101.286,34.151256,119.16,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,107.36316,90.1,,percent of total billed charges,,
SMOKE EVACUATOR TUBING,,57000023,LOCAL,Facility,Inpatient,,,,119.16,101.286,34.151256,119.16,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
SMOKE EVACUATOR TUBING,,57000023,LOCAL,Facility,Both,,,,119.16,101.286,34.151256,119.16,"Preferred One Administrative Services, INC.",PPO,117.49176,98.6,,percent of total billed charges,,
SMOKE EVACUATOR TUBING,,57000023,LOCAL,Facility,Outpatient,,,,119.16,101.286,34.151256,119.16,PrimeWest Health,Minnesota Senior Health Options (MSHO),61.30782,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
SMOKE EVACUATOR TUBING,,57000023,LOCAL,Facility,Inpatient,,,,119.16,101.286,34.151256,119.16,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SMOKE EVACUATOR TUBING,,57000023,LOCAL,Facility,Outpatient,,,,119.16,101.286,34.151256,119.16,PrimeWest Health,MinnesotaCare,61.200576,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
SMOKE EVACUATOR TUBING,,57000023,LOCAL,Facility,Inpatient,,,,119.16,101.286,34.151256,119.16,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
SMOKE EVACUATOR TUBING,,57000023,LOCAL,Facility,Both,,,,119.16,101.286,34.151256,119.16,Sanford Health Plan,Sanford Health Plan,109.6272,92,,percent of total billed charges,,
SMOKE EVACUATOR TUBING,,57000023,LOCAL,Facility,Outpatient,,,,119.16,101.286,34.151256,119.16,"UCare Health, Inc.",Individual & Family Plan,67.14666,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
SMOKE EVACUATOR TUBING,,57000023,LOCAL,Facility,Inpatient,,,,119.16,101.286,34.151256,119.16,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
SMOKE EVACUATOR TUBING,,57000023,LOCAL,Facility,Outpatient,,,,119.16,101.286,34.151256,119.16,"UCare Health, Inc.",Medical Assistance,60.140052,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SMOKE EVACUATOR TUBING,,57000023,LOCAL,Facility,Inpatient,,,,119.16,101.286,34.151256,119.16,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
SMOKE EVACUATOR TUBING,,57000023,LOCAL,Facility,Outpatient,,,,119.16,101.286,34.151256,119.16,"UCare Health, Inc.",Medicare Advantage,60.140052,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SMOKE EVACUATOR TUBING,,57000023,LOCAL,Facility,Inpatient,,,,119.16,101.286,34.151256,119.16,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SMOKE EVACUATOR TUBING,,57000023,LOCAL,Facility,Outpatient,,,,119.16,101.286,34.151256,119.16,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),60.140052,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SMOKE EVACUATOR TUBING,,57000023,LOCAL,Facility,Inpatient,,,,119.16,101.286,34.151256,119.16,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SMOKE EVACUATOR TUBING,,57000023,LOCAL,Facility,Both,,,,119.16,101.286,34.151256,119.16,UnitedHealthcare,Individual & Family,112.0104,94,,percent of total billed charges,,
SMOKE EVACUATOR TUBING,,57000023,LOCAL,Facility,Outpatient,,,,119.16,101.286,34.151256,119.16,UnitedHealthcare,Medicare Advantage,58.3884,49,,percent of total billed charges,,
SMOKE EVACUATOR TUBING,,57000023,LOCAL,Facility,Inpatient,,,,119.16,101.286,34.151256,119.16,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
SMOKE EVACUATOR TUBING,,57000023,LOCAL,Facility,Outpatient,,,,119.16,101.286,34.151256,119.16,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,57.1968,48,,percent of total billed charges,,100% of DHS outpatient percentage
SMOKE EVACUATOR TUBING,,57000023,LOCAL,Facility,Inpatient,,,,119.16,101.286,34.151256,119.16,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
STAPLER GIA 80 3.8 MULTIFIRE    GIA8038S,,57000023,LOCAL,Facility,Both,,,,1028.16,873.936,294.670656,1028.16,Aetna,Commercial,945.9072,92,,percent of total billed charges,,
STAPLER GIA 80 3.8 MULTIFIRE    GIA8038S,,57000023,LOCAL,Facility,Outpatient,,,,1028.16,873.936,294.670656,1028.16,Aetna,Medicare Advantage,503.7984,49,,percent of total billed charges,,
STAPLER GIA 80 3.8 MULTIFIRE    GIA8038S,,57000023,LOCAL,Facility,Inpatient,,,,1028.16,873.936,294.670656,1028.16,Aetna,Medicare Advantage,,,,,Included in per diem rate,
STAPLER GIA 80 3.8 MULTIFIRE    GIA8038S,,57000023,LOCAL,Facility,Both,,,,1028.16,873.936,294.670656,1028.16,Aetna,PPO,956.1888,93,,percent of total billed charges,,
STAPLER GIA 80 3.8 MULTIFIRE    GIA8038S,,57000023,LOCAL,Facility,Both,,,,1028.16,873.936,294.670656,1028.16,America's PPO,America's PPO,987.342048,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
STAPLER GIA 80 3.8 MULTIFIRE    GIA8038S,,57000023,LOCAL,Facility,Both,,,,1028.16,873.936,294.670656,1028.16,BlueCross BlueShield Minnesota, Federal Employee Program,1011.70944,98.4,,percent of total billed charges,,
STAPLER GIA 80 3.8 MULTIFIRE    GIA8038S,,57000023,LOCAL,Facility,Both,,,,1028.16,873.936,294.670656,1028.16,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1028.16,100,,percent of total billed charges,,
STAPLER GIA 80 3.8 MULTIFIRE    GIA8038S,,57000023,LOCAL,Facility,Both,,,,1028.16,873.936,294.670656,1028.16,BlueCross BlueShield Minnesota,High Value Network Plan,925.344,90,,percent of total billed charges,,
STAPLER GIA 80 3.8 MULTIFIRE    GIA8038S,,57000023,LOCAL,Facility,Outpatient,,,,1028.16,873.936,294.670656,1028.16,BlueCross BlueShield Minnesota,Medicare Advantage,503.7984,49,,percent of total billed charges,,
STAPLER GIA 80 3.8 MULTIFIRE    GIA8038S,,57000023,LOCAL,Facility,Inpatient,,,,1028.16,873.936,294.670656,1028.16,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
STAPLER GIA 80 3.8 MULTIFIRE    GIA8038S,,57000023,LOCAL,Facility,Both,,,,1028.16,873.936,294.670656,1028.16,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,910.641312,88.57,,percent of total billed charges,,
STAPLER GIA 80 3.8 MULTIFIRE    GIA8038S,,57000023,LOCAL,Facility,Both,,,,1028.16,873.936,294.670656,1028.16,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,294.670656,28.66,,percent of total billed charges,,
STAPLER GIA 80 3.8 MULTIFIRE    GIA8038S,,57000023,LOCAL,Facility,Outpatient,,,,1028.16,873.936,294.670656,1028.16,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),503.7984,49,,percent of total billed charges,,
STAPLER GIA 80 3.8 MULTIFIRE    GIA8038S,,57000023,LOCAL,Facility,Inpatient,,,,1028.16,873.936,294.670656,1028.16,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
STAPLER GIA 80 3.8 MULTIFIRE    GIA8038S,,57000023,LOCAL,Facility,Both,,,,1028.16,873.936,294.670656,1028.16,CorVel,Worker's Compensation,1028.16,100,,percent of total billed charges,,
STAPLER GIA 80 3.8 MULTIFIRE    GIA8038S,,57000023,LOCAL,Facility,Both,,,,1028.16,873.936,294.670656,1028.16,First Health Group Corporation,First Health Network,997.3152,97,,percent of total billed charges,,
STAPLER GIA 80 3.8 MULTIFIRE    GIA8038S,,57000023,LOCAL,Facility,Both,,,,1028.16,873.936,294.670656,1028.16,"Health Partners, Inc.",Commercial,972.63936,94.6,,percent of total billed charges,,
STAPLER GIA 80 3.8 MULTIFIRE    GIA8038S,,57000023,LOCAL,Facility,Outpatient,,,,1028.16,873.936,294.670656,1028.16,"Health Partners, Inc.",Medicare Advantage,503.7984,49,,percent of total billed charges,,
STAPLER GIA 80 3.8 MULTIFIRE    GIA8038S,,57000023,LOCAL,Facility,Inpatient,,,,1028.16,873.936,294.670656,1028.16,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
STAPLER GIA 80 3.8 MULTIFIRE    GIA8038S,,57000023,LOCAL,Facility,Both,,,,1028.16,873.936,294.670656,1028.16,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),616.896,60,,percent of total billed charges,,
STAPLER GIA 80 3.8 MULTIFIRE    GIA8038S,,57000023,LOCAL,Facility,Both,,,,1028.16,873.936,294.670656,1028.16,"Health Partners, Inc.",State of Minnesota Advantage Program,837.9504,81.5,,percent of total billed charges,,
STAPLER GIA 80 3.8 MULTIFIRE    GIA8038S,,57000023,LOCAL,Facility,Both,,,,1028.16,873.936,294.670656,1028.16,"Health Partners, Inc.",State Public Programs,514.08,50,,percent of total billed charges,,
STAPLER GIA 80 3.8 MULTIFIRE    GIA8038S,,57000023,LOCAL,Facility,Both,,,,1028.16,873.936,294.670656,1028.16,Humana Insurance Company,Commercial PPO,976.752,95,,percent of total billed charges,,
STAPLER GIA 80 3.8 MULTIFIRE    GIA8038S,,57000023,LOCAL,Facility,Outpatient,,,,1028.16,873.936,294.670656,1028.16,Humana Insurance Company,Medicare PPO,503.7984,49,,percent of total billed charges,,
STAPLER GIA 80 3.8 MULTIFIRE    GIA8038S,,57000023,LOCAL,Facility,Inpatient,,,,1028.16,873.936,294.670656,1028.16,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
STAPLER GIA 80 3.8 MULTIFIRE    GIA8038S,,57000023,LOCAL,Facility,Both,,,,1028.16,873.936,294.670656,1028.16,Medica,Individual & Family,1018.90656,99.1,,percent of total billed charges,,
STAPLER GIA 80 3.8 MULTIFIRE    GIA8038S,,57000023,LOCAL,Facility,Outpatient,,,,1028.16,873.936,294.670656,1028.16,Medica,Medica Advantage Solution,512.02368,49.8,,percent of total billed charges,,
STAPLER GIA 80 3.8 MULTIFIRE    GIA8038S,,57000023,LOCAL,Facility,Inpatient,,,,1028.16,873.936,294.670656,1028.16,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
STAPLER GIA 80 3.8 MULTIFIRE    GIA8038S,,57000023,LOCAL,Facility,Outpatient,,,,1028.16,873.936,294.670656,1028.16,Medica,Medical Assistance,458.55936,44.6,,percent of total billed charges,,
STAPLER GIA 80 3.8 MULTIFIRE    GIA8038S,,57000023,LOCAL,Facility,Inpatient,,,,1028.16,873.936,294.670656,1028.16,Medica,Medical Assistance,,,,,Included in per diem rate,
STAPLER GIA 80 3.8 MULTIFIRE    GIA8038S,,57000023,LOCAL,Facility,Outpatient,,,,1028.16,873.936,294.670656,1028.16,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,512.02368,49.8,,percent of total billed charges,,
STAPLER GIA 80 3.8 MULTIFIRE    GIA8038S,,57000023,LOCAL,Facility,Inpatient,,,,1028.16,873.936,294.670656,1028.16,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
STAPLER GIA 80 3.8 MULTIFIRE    GIA8038S,,57000023,LOCAL,Facility,Both,,,,1028.16,873.936,294.670656,1028.16,"Multiplan, Inc.","Multiplan, Inc.",966.4704,94,,percent of total billed charges,,
STAPLER GIA 80 3.8 MULTIFIRE    GIA8038S,,57000023,LOCAL,Facility,Outpatient,,,,1028.16,873.936,294.670656,1028.16,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,926.37216,90.1,,percent of total billed charges,,
STAPLER GIA 80 3.8 MULTIFIRE    GIA8038S,,57000023,LOCAL,Facility,Inpatient,,,,1028.16,873.936,294.670656,1028.16,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
STAPLER GIA 80 3.8 MULTIFIRE    GIA8038S,,57000023,LOCAL,Facility,Both,,,,1028.16,873.936,294.670656,1028.16,"Preferred One Administrative Services, INC.",PPO,1013.76576,98.6,,percent of total billed charges,,
STAPLER GIA 80 3.8 MULTIFIRE    GIA8038S,,57000023,LOCAL,Facility,Outpatient,,,,1028.16,873.936,294.670656,1028.16,PrimeWest Health,Minnesota Senior Health Options (MSHO),528.98832,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
STAPLER GIA 80 3.8 MULTIFIRE    GIA8038S,,57000023,LOCAL,Facility,Inpatient,,,,1028.16,873.936,294.670656,1028.16,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
STAPLER GIA 80 3.8 MULTIFIRE    GIA8038S,,57000023,LOCAL,Facility,Outpatient,,,,1028.16,873.936,294.670656,1028.16,PrimeWest Health,MinnesotaCare,528.062976,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
STAPLER GIA 80 3.8 MULTIFIRE    GIA8038S,,57000023,LOCAL,Facility,Inpatient,,,,1028.16,873.936,294.670656,1028.16,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
STAPLER GIA 80 3.8 MULTIFIRE    GIA8038S,,57000023,LOCAL,Facility,Both,,,,1028.16,873.936,294.670656,1028.16,Sanford Health Plan,Sanford Health Plan,945.9072,92,,percent of total billed charges,,
STAPLER GIA 80 3.8 MULTIFIRE    GIA8038S,,57000023,LOCAL,Facility,Outpatient,,,,1028.16,873.936,294.670656,1028.16,"UCare Health, Inc.",Individual & Family Plan,579.36816,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
STAPLER GIA 80 3.8 MULTIFIRE    GIA8038S,,57000023,LOCAL,Facility,Inpatient,,,,1028.16,873.936,294.670656,1028.16,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
STAPLER GIA 80 3.8 MULTIFIRE    GIA8038S,,57000023,LOCAL,Facility,Outpatient,,,,1028.16,873.936,294.670656,1028.16,"UCare Health, Inc.",Medical Assistance,518.912352,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
STAPLER GIA 80 3.8 MULTIFIRE    GIA8038S,,57000023,LOCAL,Facility,Inpatient,,,,1028.16,873.936,294.670656,1028.16,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
STAPLER GIA 80 3.8 MULTIFIRE    GIA8038S,,57000023,LOCAL,Facility,Outpatient,,,,1028.16,873.936,294.670656,1028.16,"UCare Health, Inc.",Medicare Advantage,518.912352,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
STAPLER GIA 80 3.8 MULTIFIRE    GIA8038S,,57000023,LOCAL,Facility,Inpatient,,,,1028.16,873.936,294.670656,1028.16,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
STAPLER GIA 80 3.8 MULTIFIRE    GIA8038S,,57000023,LOCAL,Facility,Outpatient,,,,1028.16,873.936,294.670656,1028.16,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),518.912352,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
STAPLER GIA 80 3.8 MULTIFIRE    GIA8038S,,57000023,LOCAL,Facility,Inpatient,,,,1028.16,873.936,294.670656,1028.16,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
STAPLER GIA 80 3.8 MULTIFIRE    GIA8038S,,57000023,LOCAL,Facility,Both,,,,1028.16,873.936,294.670656,1028.16,UnitedHealthcare,Individual & Family,966.4704,94,,percent of total billed charges,,
STAPLER GIA 80 3.8 MULTIFIRE    GIA8038S,,57000023,LOCAL,Facility,Outpatient,,,,1028.16,873.936,294.670656,1028.16,UnitedHealthcare,Medicare Advantage,503.7984,49,,percent of total billed charges,,
STAPLER GIA 80 3.8 MULTIFIRE    GIA8038S,,57000023,LOCAL,Facility,Inpatient,,,,1028.16,873.936,294.670656,1028.16,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
STAPLER GIA 80 3.8 MULTIFIRE    GIA8038S,,57000023,LOCAL,Facility,Outpatient,,,,1028.16,873.936,294.670656,1028.16,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,493.5168,48,,percent of total billed charges,,100% of DHS outpatient percentage
STAPLER GIA 80 3.8 MULTIFIRE    GIA8038S,,57000023,LOCAL,Facility,Inpatient,,,,1028.16,873.936,294.670656,1028.16,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Stryker High Flow Insufflation Tubing,,57000023,LOCAL,Facility,Both,,,,108,91.8,30.9528,108,Aetna,Commercial,99.36,92,,percent of total billed charges,,
Stryker High Flow Insufflation Tubing,,57000023,LOCAL,Facility,Outpatient,,,,108,91.8,30.9528,108,Aetna,Medicare Advantage,52.92,49,,percent of total billed charges,,
Stryker High Flow Insufflation Tubing,,57000023,LOCAL,Facility,Inpatient,,,,108,91.8,30.9528,108,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Stryker High Flow Insufflation Tubing,,57000023,LOCAL,Facility,Both,,,,108,91.8,30.9528,108,Aetna,PPO,100.44,93,,percent of total billed charges,,
Stryker High Flow Insufflation Tubing,,57000023,LOCAL,Facility,Both,,,,108,91.8,30.9528,108,America's PPO,America's PPO,103.7124,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Stryker High Flow Insufflation Tubing,,57000023,LOCAL,Facility,Both,,,,108,91.8,30.9528,108,BlueCross BlueShield Minnesota, Federal Employee Program,106.272,98.4,,percent of total billed charges,,
Stryker High Flow Insufflation Tubing,,57000023,LOCAL,Facility,Both,,,,108,91.8,30.9528,108,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,108,100,,percent of total billed charges,,
Stryker High Flow Insufflation Tubing,,57000023,LOCAL,Facility,Both,,,,108,91.8,30.9528,108,BlueCross BlueShield Minnesota,High Value Network Plan,97.2,90,,percent of total billed charges,,
Stryker High Flow Insufflation Tubing,,57000023,LOCAL,Facility,Outpatient,,,,108,91.8,30.9528,108,BlueCross BlueShield Minnesota,Medicare Advantage,52.92,49,,percent of total billed charges,,
Stryker High Flow Insufflation Tubing,,57000023,LOCAL,Facility,Inpatient,,,,108,91.8,30.9528,108,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Stryker High Flow Insufflation Tubing,,57000023,LOCAL,Facility,Both,,,,108,91.8,30.9528,108,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,95.6556,88.57,,percent of total billed charges,,
Stryker High Flow Insufflation Tubing,,57000023,LOCAL,Facility,Both,,,,108,91.8,30.9528,108,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,30.9528,28.66,,percent of total billed charges,,
Stryker High Flow Insufflation Tubing,,57000023,LOCAL,Facility,Outpatient,,,,108,91.8,30.9528,108,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),52.92,49,,percent of total billed charges,,
Stryker High Flow Insufflation Tubing,,57000023,LOCAL,Facility,Inpatient,,,,108,91.8,30.9528,108,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Stryker High Flow Insufflation Tubing,,57000023,LOCAL,Facility,Both,,,,108,91.8,30.9528,108,CorVel,Worker's Compensation,108,100,,percent of total billed charges,,
Stryker High Flow Insufflation Tubing,,57000023,LOCAL,Facility,Both,,,,108,91.8,30.9528,108,First Health Group Corporation,First Health Network,104.76,97,,percent of total billed charges,,
Stryker High Flow Insufflation Tubing,,57000023,LOCAL,Facility,Both,,,,108,91.8,30.9528,108,"Health Partners, Inc.",Commercial,102.168,94.6,,percent of total billed charges,,
Stryker High Flow Insufflation Tubing,,57000023,LOCAL,Facility,Outpatient,,,,108,91.8,30.9528,108,"Health Partners, Inc.",Medicare Advantage,52.92,49,,percent of total billed charges,,
Stryker High Flow Insufflation Tubing,,57000023,LOCAL,Facility,Inpatient,,,,108,91.8,30.9528,108,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Stryker High Flow Insufflation Tubing,,57000023,LOCAL,Facility,Both,,,,108,91.8,30.9528,108,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),64.8,60,,percent of total billed charges,,
Stryker High Flow Insufflation Tubing,,57000023,LOCAL,Facility,Both,,,,108,91.8,30.9528,108,"Health Partners, Inc.",State of Minnesota Advantage Program,88.02,81.5,,percent of total billed charges,,
Stryker High Flow Insufflation Tubing,,57000023,LOCAL,Facility,Both,,,,108,91.8,30.9528,108,"Health Partners, Inc.",State Public Programs,54,50,,percent of total billed charges,,
Stryker High Flow Insufflation Tubing,,57000023,LOCAL,Facility,Both,,,,108,91.8,30.9528,108,Humana Insurance Company,Commercial PPO,102.6,95,,percent of total billed charges,,
Stryker High Flow Insufflation Tubing,,57000023,LOCAL,Facility,Outpatient,,,,108,91.8,30.9528,108,Humana Insurance Company,Medicare PPO,52.92,49,,percent of total billed charges,,
Stryker High Flow Insufflation Tubing,,57000023,LOCAL,Facility,Inpatient,,,,108,91.8,30.9528,108,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Stryker High Flow Insufflation Tubing,,57000023,LOCAL,Facility,Both,,,,108,91.8,30.9528,108,Medica,Individual & Family,107.028,99.1,,percent of total billed charges,,
Stryker High Flow Insufflation Tubing,,57000023,LOCAL,Facility,Outpatient,,,,108,91.8,30.9528,108,Medica,Medica Advantage Solution,53.784,49.8,,percent of total billed charges,,
Stryker High Flow Insufflation Tubing,,57000023,LOCAL,Facility,Inpatient,,,,108,91.8,30.9528,108,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Stryker High Flow Insufflation Tubing,,57000023,LOCAL,Facility,Outpatient,,,,108,91.8,30.9528,108,Medica,Medical Assistance,48.168,44.6,,percent of total billed charges,,
Stryker High Flow Insufflation Tubing,,57000023,LOCAL,Facility,Inpatient,,,,108,91.8,30.9528,108,Medica,Medical Assistance,,,,,Included in per diem rate,
Stryker High Flow Insufflation Tubing,,57000023,LOCAL,Facility,Outpatient,,,,108,91.8,30.9528,108,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,53.784,49.8,,percent of total billed charges,,
Stryker High Flow Insufflation Tubing,,57000023,LOCAL,Facility,Inpatient,,,,108,91.8,30.9528,108,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Stryker High Flow Insufflation Tubing,,57000023,LOCAL,Facility,Both,,,,108,91.8,30.9528,108,"Multiplan, Inc.","Multiplan, Inc.",101.52,94,,percent of total billed charges,,
Stryker High Flow Insufflation Tubing,,57000023,LOCAL,Facility,Outpatient,,,,108,91.8,30.9528,108,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,97.308,90.1,,percent of total billed charges,,
Stryker High Flow Insufflation Tubing,,57000023,LOCAL,Facility,Inpatient,,,,108,91.8,30.9528,108,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Stryker High Flow Insufflation Tubing,,57000023,LOCAL,Facility,Both,,,,108,91.8,30.9528,108,"Preferred One Administrative Services, INC.",PPO,106.488,98.6,,percent of total billed charges,,
Stryker High Flow Insufflation Tubing,,57000023,LOCAL,Facility,Outpatient,,,,108,91.8,30.9528,108,PrimeWest Health,Minnesota Senior Health Options (MSHO),55.566,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Stryker High Flow Insufflation Tubing,,57000023,LOCAL,Facility,Inpatient,,,,108,91.8,30.9528,108,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Stryker High Flow Insufflation Tubing,,57000023,LOCAL,Facility,Outpatient,,,,108,91.8,30.9528,108,PrimeWest Health,MinnesotaCare,55.4688,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Stryker High Flow Insufflation Tubing,,57000023,LOCAL,Facility,Inpatient,,,,108,91.8,30.9528,108,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Stryker High Flow Insufflation Tubing,,57000023,LOCAL,Facility,Both,,,,108,91.8,30.9528,108,Sanford Health Plan,Sanford Health Plan,99.36,92,,percent of total billed charges,,
Stryker High Flow Insufflation Tubing,,57000023,LOCAL,Facility,Outpatient,,,,108,91.8,30.9528,108,"UCare Health, Inc.",Individual & Family Plan,60.858,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Stryker High Flow Insufflation Tubing,,57000023,LOCAL,Facility,Inpatient,,,,108,91.8,30.9528,108,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Stryker High Flow Insufflation Tubing,,57000023,LOCAL,Facility,Outpatient,,,,108,91.8,30.9528,108,"UCare Health, Inc.",Medical Assistance,54.5076,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Stryker High Flow Insufflation Tubing,,57000023,LOCAL,Facility,Inpatient,,,,108,91.8,30.9528,108,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Stryker High Flow Insufflation Tubing,,57000023,LOCAL,Facility,Outpatient,,,,108,91.8,30.9528,108,"UCare Health, Inc.",Medicare Advantage,54.5076,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Stryker High Flow Insufflation Tubing,,57000023,LOCAL,Facility,Inpatient,,,,108,91.8,30.9528,108,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Stryker High Flow Insufflation Tubing,,57000023,LOCAL,Facility,Outpatient,,,,108,91.8,30.9528,108,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),54.5076,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Stryker High Flow Insufflation Tubing,,57000023,LOCAL,Facility,Inpatient,,,,108,91.8,30.9528,108,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Stryker High Flow Insufflation Tubing,,57000023,LOCAL,Facility,Both,,,,108,91.8,30.9528,108,UnitedHealthcare,Individual & Family,101.52,94,,percent of total billed charges,,
Stryker High Flow Insufflation Tubing,,57000023,LOCAL,Facility,Outpatient,,,,108,91.8,30.9528,108,UnitedHealthcare,Medicare Advantage,52.92,49,,percent of total billed charges,,
Stryker High Flow Insufflation Tubing,,57000023,LOCAL,Facility,Inpatient,,,,108,91.8,30.9528,108,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Stryker High Flow Insufflation Tubing,,57000023,LOCAL,Facility,Outpatient,,,,108,91.8,30.9528,108,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,51.84,48,,percent of total billed charges,,100% of DHS outpatient percentage
Stryker High Flow Insufflation Tubing,,57000023,LOCAL,Facility,Inpatient,,,,108,91.8,30.9528,108,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
SUTURE CHROMIC 3-0 SH  G122H,,57000023,LOCAL,Facility,Both,,,,40,34,11.464,40,Aetna,Commercial,36.8,92,,percent of total billed charges,,
SUTURE CHROMIC 3-0 SH  G122H,,57000023,LOCAL,Facility,Outpatient,,,,40,34,11.464,40,Aetna,Medicare Advantage,19.6,49,,percent of total billed charges,,
SUTURE CHROMIC 3-0 SH  G122H,,57000023,LOCAL,Facility,Inpatient,,,,40,34,11.464,40,Aetna,Medicare Advantage,,,,,Included in per diem rate,
SUTURE CHROMIC 3-0 SH  G122H,,57000023,LOCAL,Facility,Both,,,,40,34,11.464,40,Aetna,PPO,37.2,93,,percent of total billed charges,,
SUTURE CHROMIC 3-0 SH  G122H,,57000023,LOCAL,Facility,Both,,,,40,34,11.464,40,America's PPO,America's PPO,38.412,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SUTURE CHROMIC 3-0 SH  G122H,,57000023,LOCAL,Facility,Both,,,,40,34,11.464,40,BlueCross BlueShield Minnesota, Federal Employee Program,39.36,98.4,,percent of total billed charges,,
SUTURE CHROMIC 3-0 SH  G122H,,57000023,LOCAL,Facility,Both,,,,40,34,11.464,40,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,40,100,,percent of total billed charges,,
SUTURE CHROMIC 3-0 SH  G122H,,57000023,LOCAL,Facility,Both,,,,40,34,11.464,40,BlueCross BlueShield Minnesota,High Value Network Plan,36,90,,percent of total billed charges,,
SUTURE CHROMIC 3-0 SH  G122H,,57000023,LOCAL,Facility,Outpatient,,,,40,34,11.464,40,BlueCross BlueShield Minnesota,Medicare Advantage,19.6,49,,percent of total billed charges,,
SUTURE CHROMIC 3-0 SH  G122H,,57000023,LOCAL,Facility,Inpatient,,,,40,34,11.464,40,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
SUTURE CHROMIC 3-0 SH  G122H,,57000023,LOCAL,Facility,Both,,,,40,34,11.464,40,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,35.428,88.57,,percent of total billed charges,,
SUTURE CHROMIC 3-0 SH  G122H,,57000023,LOCAL,Facility,Both,,,,40,34,11.464,40,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,11.464,28.66,,percent of total billed charges,,
SUTURE CHROMIC 3-0 SH  G122H,,57000023,LOCAL,Facility,Outpatient,,,,40,34,11.464,40,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),19.6,49,,percent of total billed charges,,
SUTURE CHROMIC 3-0 SH  G122H,,57000023,LOCAL,Facility,Inpatient,,,,40,34,11.464,40,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
SUTURE CHROMIC 3-0 SH  G122H,,57000023,LOCAL,Facility,Both,,,,40,34,11.464,40,CorVel,Worker's Compensation,40,100,,percent of total billed charges,,
SUTURE CHROMIC 3-0 SH  G122H,,57000023,LOCAL,Facility,Both,,,,40,34,11.464,40,First Health Group Corporation,First Health Network,38.8,97,,percent of total billed charges,,
SUTURE CHROMIC 3-0 SH  G122H,,57000023,LOCAL,Facility,Both,,,,40,34,11.464,40,"Health Partners, Inc.",Commercial,37.84,94.6,,percent of total billed charges,,
SUTURE CHROMIC 3-0 SH  G122H,,57000023,LOCAL,Facility,Outpatient,,,,40,34,11.464,40,"Health Partners, Inc.",Medicare Advantage,19.6,49,,percent of total billed charges,,
SUTURE CHROMIC 3-0 SH  G122H,,57000023,LOCAL,Facility,Inpatient,,,,40,34,11.464,40,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE CHROMIC 3-0 SH  G122H,,57000023,LOCAL,Facility,Both,,,,40,34,11.464,40,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),24,60,,percent of total billed charges,,
SUTURE CHROMIC 3-0 SH  G122H,,57000023,LOCAL,Facility,Both,,,,40,34,11.464,40,"Health Partners, Inc.",State of Minnesota Advantage Program,32.6,81.5,,percent of total billed charges,,
SUTURE CHROMIC 3-0 SH  G122H,,57000023,LOCAL,Facility,Both,,,,40,34,11.464,40,"Health Partners, Inc.",State Public Programs,20,50,,percent of total billed charges,,
SUTURE CHROMIC 3-0 SH  G122H,,57000023,LOCAL,Facility,Both,,,,40,34,11.464,40,Humana Insurance Company,Commercial PPO,38,95,,percent of total billed charges,,
SUTURE CHROMIC 3-0 SH  G122H,,57000023,LOCAL,Facility,Outpatient,,,,40,34,11.464,40,Humana Insurance Company,Medicare PPO,19.6,49,,percent of total billed charges,,
SUTURE CHROMIC 3-0 SH  G122H,,57000023,LOCAL,Facility,Inpatient,,,,40,34,11.464,40,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
SUTURE CHROMIC 3-0 SH  G122H,,57000023,LOCAL,Facility,Both,,,,40,34,11.464,40,Medica,Individual & Family,39.64,99.1,,percent of total billed charges,,
SUTURE CHROMIC 3-0 SH  G122H,,57000023,LOCAL,Facility,Outpatient,,,,40,34,11.464,40,Medica,Medica Advantage Solution,19.92,49.8,,percent of total billed charges,,
SUTURE CHROMIC 3-0 SH  G122H,,57000023,LOCAL,Facility,Inpatient,,,,40,34,11.464,40,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
SUTURE CHROMIC 3-0 SH  G122H,,57000023,LOCAL,Facility,Outpatient,,,,40,34,11.464,40,Medica,Medical Assistance,17.84,44.6,,percent of total billed charges,,
SUTURE CHROMIC 3-0 SH  G122H,,57000023,LOCAL,Facility,Inpatient,,,,40,34,11.464,40,Medica,Medical Assistance,,,,,Included in per diem rate,
SUTURE CHROMIC 3-0 SH  G122H,,57000023,LOCAL,Facility,Outpatient,,,,40,34,11.464,40,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,19.92,49.8,,percent of total billed charges,,
SUTURE CHROMIC 3-0 SH  G122H,,57000023,LOCAL,Facility,Inpatient,,,,40,34,11.464,40,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
SUTURE CHROMIC 3-0 SH  G122H,,57000023,LOCAL,Facility,Both,,,,40,34,11.464,40,"Multiplan, Inc.","Multiplan, Inc.",37.6,94,,percent of total billed charges,,
SUTURE CHROMIC 3-0 SH  G122H,,57000023,LOCAL,Facility,Outpatient,,,,40,34,11.464,40,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,36.04,90.1,,percent of total billed charges,,
SUTURE CHROMIC 3-0 SH  G122H,,57000023,LOCAL,Facility,Inpatient,,,,40,34,11.464,40,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
SUTURE CHROMIC 3-0 SH  G122H,,57000023,LOCAL,Facility,Both,,,,40,34,11.464,40,"Preferred One Administrative Services, INC.",PPO,39.44,98.6,,percent of total billed charges,,
SUTURE CHROMIC 3-0 SH  G122H,,57000023,LOCAL,Facility,Outpatient,,,,40,34,11.464,40,PrimeWest Health,Minnesota Senior Health Options (MSHO),20.58,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
SUTURE CHROMIC 3-0 SH  G122H,,57000023,LOCAL,Facility,Inpatient,,,,40,34,11.464,40,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE CHROMIC 3-0 SH  G122H,,57000023,LOCAL,Facility,Outpatient,,,,40,34,11.464,40,PrimeWest Health,MinnesotaCare,20.544,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
SUTURE CHROMIC 3-0 SH  G122H,,57000023,LOCAL,Facility,Inpatient,,,,40,34,11.464,40,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
SUTURE CHROMIC 3-0 SH  G122H,,57000023,LOCAL,Facility,Both,,,,40,34,11.464,40,Sanford Health Plan,Sanford Health Plan,36.8,92,,percent of total billed charges,,
SUTURE CHROMIC 3-0 SH  G122H,,57000023,LOCAL,Facility,Outpatient,,,,40,34,11.464,40,"UCare Health, Inc.",Individual & Family Plan,22.54,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
SUTURE CHROMIC 3-0 SH  G122H,,57000023,LOCAL,Facility,Inpatient,,,,40,34,11.464,40,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
SUTURE CHROMIC 3-0 SH  G122H,,57000023,LOCAL,Facility,Outpatient,,,,40,34,11.464,40,"UCare Health, Inc.",Medical Assistance,20.188,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE CHROMIC 3-0 SH  G122H,,57000023,LOCAL,Facility,Inpatient,,,,40,34,11.464,40,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
SUTURE CHROMIC 3-0 SH  G122H,,57000023,LOCAL,Facility,Outpatient,,,,40,34,11.464,40,"UCare Health, Inc.",Medicare Advantage,20.188,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE CHROMIC 3-0 SH  G122H,,57000023,LOCAL,Facility,Inpatient,,,,40,34,11.464,40,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE CHROMIC 3-0 SH  G122H,,57000023,LOCAL,Facility,Outpatient,,,,40,34,11.464,40,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),20.188,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE CHROMIC 3-0 SH  G122H,,57000023,LOCAL,Facility,Inpatient,,,,40,34,11.464,40,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE CHROMIC 3-0 SH  G122H,,57000023,LOCAL,Facility,Both,,,,40,34,11.464,40,UnitedHealthcare,Individual & Family,37.6,94,,percent of total billed charges,,
SUTURE CHROMIC 3-0 SH  G122H,,57000023,LOCAL,Facility,Outpatient,,,,40,34,11.464,40,UnitedHealthcare,Medicare Advantage,19.6,49,,percent of total billed charges,,
SUTURE CHROMIC 3-0 SH  G122H,,57000023,LOCAL,Facility,Inpatient,,,,40,34,11.464,40,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
SUTURE CHROMIC 3-0 SH  G122H,,57000023,LOCAL,Facility,Outpatient,,,,40,34,11.464,40,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,19.2,48,,percent of total billed charges,,100% of DHS outpatient percentage
SUTURE CHROMIC 3-0 SH  G122H,,57000023,LOCAL,Facility,Inpatient,,,,40,34,11.464,40,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
SUTURE ETHILON 6-0 1698G,,57000023,LOCAL,Facility,Both,,,,89.235,75.84975,25.574751,89.235,Aetna,Commercial,82.0962,92,,percent of total billed charges,,
SUTURE ETHILON 6-0 1698G,,57000023,LOCAL,Facility,Outpatient,,,,89.235,75.84975,25.574751,89.235,Aetna,Medicare Advantage,43.72515,49,,percent of total billed charges,,
SUTURE ETHILON 6-0 1698G,,57000023,LOCAL,Facility,Inpatient,,,,89.235,75.84975,25.574751,89.235,Aetna,Medicare Advantage,,,,,Included in per diem rate,
SUTURE ETHILON 6-0 1698G,,57000023,LOCAL,Facility,Both,,,,89.235,75.84975,25.574751,89.235,Aetna,PPO,82.98855,93,,percent of total billed charges,,
SUTURE ETHILON 6-0 1698G,,57000023,LOCAL,Facility,Both,,,,89.235,75.84975,25.574751,89.235,America's PPO,America's PPO,85.6923705,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SUTURE ETHILON 6-0 1698G,,57000023,LOCAL,Facility,Both,,,,89.235,75.84975,25.574751,89.235,BlueCross BlueShield Minnesota, Federal Employee Program,87.80724,98.4,,percent of total billed charges,,
SUTURE ETHILON 6-0 1698G,,57000023,LOCAL,Facility,Both,,,,89.235,75.84975,25.574751,89.235,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,89.235,100,,percent of total billed charges,,
SUTURE ETHILON 6-0 1698G,,57000023,LOCAL,Facility,Both,,,,89.235,75.84975,25.574751,89.235,BlueCross BlueShield Minnesota,High Value Network Plan,80.3115,90,,percent of total billed charges,,
SUTURE ETHILON 6-0 1698G,,57000023,LOCAL,Facility,Outpatient,,,,89.235,75.84975,25.574751,89.235,BlueCross BlueShield Minnesota,Medicare Advantage,43.72515,49,,percent of total billed charges,,
SUTURE ETHILON 6-0 1698G,,57000023,LOCAL,Facility,Inpatient,,,,89.235,75.84975,25.574751,89.235,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
SUTURE ETHILON 6-0 1698G,,57000023,LOCAL,Facility,Both,,,,89.235,75.84975,25.574751,89.235,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,79.0354395,88.57,,percent of total billed charges,,
SUTURE ETHILON 6-0 1698G,,57000023,LOCAL,Facility,Both,,,,89.235,75.84975,25.574751,89.235,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,25.574751,28.66,,percent of total billed charges,,
SUTURE ETHILON 6-0 1698G,,57000023,LOCAL,Facility,Outpatient,,,,89.235,75.84975,25.574751,89.235,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),43.72515,49,,percent of total billed charges,,
SUTURE ETHILON 6-0 1698G,,57000023,LOCAL,Facility,Inpatient,,,,89.235,75.84975,25.574751,89.235,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
SUTURE ETHILON 6-0 1698G,,57000023,LOCAL,Facility,Both,,,,89.235,75.84975,25.574751,89.235,CorVel,Worker's Compensation,89.235,100,,percent of total billed charges,,
SUTURE ETHILON 6-0 1698G,,57000023,LOCAL,Facility,Both,,,,89.235,75.84975,25.574751,89.235,First Health Group Corporation,First Health Network,86.55795,97,,percent of total billed charges,,
SUTURE ETHILON 6-0 1698G,,57000023,LOCAL,Facility,Both,,,,89.235,75.84975,25.574751,89.235,"Health Partners, Inc.",Commercial,84.41631,94.6,,percent of total billed charges,,
SUTURE ETHILON 6-0 1698G,,57000023,LOCAL,Facility,Outpatient,,,,89.235,75.84975,25.574751,89.235,"Health Partners, Inc.",Medicare Advantage,43.72515,49,,percent of total billed charges,,
SUTURE ETHILON 6-0 1698G,,57000023,LOCAL,Facility,Inpatient,,,,89.235,75.84975,25.574751,89.235,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE ETHILON 6-0 1698G,,57000023,LOCAL,Facility,Both,,,,89.235,75.84975,25.574751,89.235,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),53.541,60,,percent of total billed charges,,
SUTURE ETHILON 6-0 1698G,,57000023,LOCAL,Facility,Both,,,,89.235,75.84975,25.574751,89.235,"Health Partners, Inc.",State of Minnesota Advantage Program,72.726525,81.5,,percent of total billed charges,,
SUTURE ETHILON 6-0 1698G,,57000023,LOCAL,Facility,Both,,,,89.235,75.84975,25.574751,89.235,"Health Partners, Inc.",State Public Programs,44.6175,50,,percent of total billed charges,,
SUTURE ETHILON 6-0 1698G,,57000023,LOCAL,Facility,Both,,,,89.235,75.84975,25.574751,89.235,Humana Insurance Company,Commercial PPO,84.77325,95,,percent of total billed charges,,
SUTURE ETHILON 6-0 1698G,,57000023,LOCAL,Facility,Outpatient,,,,89.235,75.84975,25.574751,89.235,Humana Insurance Company,Medicare PPO,43.72515,49,,percent of total billed charges,,
SUTURE ETHILON 6-0 1698G,,57000023,LOCAL,Facility,Inpatient,,,,89.235,75.84975,25.574751,89.235,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
SUTURE ETHILON 6-0 1698G,,57000023,LOCAL,Facility,Both,,,,89.235,75.84975,25.574751,89.235,Medica,Individual & Family,88.431885,99.1,,percent of total billed charges,,
SUTURE ETHILON 6-0 1698G,,57000023,LOCAL,Facility,Outpatient,,,,89.235,75.84975,25.574751,89.235,Medica,Medica Advantage Solution,44.43903,49.8,,percent of total billed charges,,
SUTURE ETHILON 6-0 1698G,,57000023,LOCAL,Facility,Inpatient,,,,89.235,75.84975,25.574751,89.235,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
SUTURE ETHILON 6-0 1698G,,57000023,LOCAL,Facility,Outpatient,,,,89.235,75.84975,25.574751,89.235,Medica,Medical Assistance,39.79881,44.6,,percent of total billed charges,,
SUTURE ETHILON 6-0 1698G,,57000023,LOCAL,Facility,Inpatient,,,,89.235,75.84975,25.574751,89.235,Medica,Medical Assistance,,,,,Included in per diem rate,
SUTURE ETHILON 6-0 1698G,,57000023,LOCAL,Facility,Outpatient,,,,89.235,75.84975,25.574751,89.235,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,44.43903,49.8,,percent of total billed charges,,
SUTURE ETHILON 6-0 1698G,,57000023,LOCAL,Facility,Inpatient,,,,89.235,75.84975,25.574751,89.235,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
SUTURE ETHILON 6-0 1698G,,57000023,LOCAL,Facility,Both,,,,89.235,75.84975,25.574751,89.235,"Multiplan, Inc.","Multiplan, Inc.",83.8809,94,,percent of total billed charges,,
SUTURE ETHILON 6-0 1698G,,57000023,LOCAL,Facility,Outpatient,,,,89.235,75.84975,25.574751,89.235,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,80.400735,90.1,,percent of total billed charges,,
SUTURE ETHILON 6-0 1698G,,57000023,LOCAL,Facility,Inpatient,,,,89.235,75.84975,25.574751,89.235,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
SUTURE ETHILON 6-0 1698G,,57000023,LOCAL,Facility,Both,,,,89.235,75.84975,25.574751,89.235,"Preferred One Administrative Services, INC.",PPO,87.98571,98.6,,percent of total billed charges,,
SUTURE ETHILON 6-0 1698G,,57000023,LOCAL,Facility,Outpatient,,,,89.235,75.84975,25.574751,89.235,PrimeWest Health,Minnesota Senior Health Options (MSHO),45.9114075,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
SUTURE ETHILON 6-0 1698G,,57000023,LOCAL,Facility,Inpatient,,,,89.235,75.84975,25.574751,89.235,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE ETHILON 6-0 1698G,,57000023,LOCAL,Facility,Outpatient,,,,89.235,75.84975,25.574751,89.235,PrimeWest Health,MinnesotaCare,45.831096,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
SUTURE ETHILON 6-0 1698G,,57000023,LOCAL,Facility,Inpatient,,,,89.235,75.84975,25.574751,89.235,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
SUTURE ETHILON 6-0 1698G,,57000023,LOCAL,Facility,Both,,,,89.235,75.84975,25.574751,89.235,Sanford Health Plan,Sanford Health Plan,82.0962,92,,percent of total billed charges,,
SUTURE ETHILON 6-0 1698G,,57000023,LOCAL,Facility,Outpatient,,,,89.235,75.84975,25.574751,89.235,"UCare Health, Inc.",Individual & Family Plan,50.2839225,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
SUTURE ETHILON 6-0 1698G,,57000023,LOCAL,Facility,Inpatient,,,,89.235,75.84975,25.574751,89.235,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
SUTURE ETHILON 6-0 1698G,,57000023,LOCAL,Facility,Outpatient,,,,89.235,75.84975,25.574751,89.235,"UCare Health, Inc.",Medical Assistance,45.0369045,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE ETHILON 6-0 1698G,,57000023,LOCAL,Facility,Inpatient,,,,89.235,75.84975,25.574751,89.235,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
SUTURE ETHILON 6-0 1698G,,57000023,LOCAL,Facility,Outpatient,,,,89.235,75.84975,25.574751,89.235,"UCare Health, Inc.",Medicare Advantage,45.0369045,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE ETHILON 6-0 1698G,,57000023,LOCAL,Facility,Inpatient,,,,89.235,75.84975,25.574751,89.235,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE ETHILON 6-0 1698G,,57000023,LOCAL,Facility,Outpatient,,,,89.235,75.84975,25.574751,89.235,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),45.0369045,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE ETHILON 6-0 1698G,,57000023,LOCAL,Facility,Inpatient,,,,89.235,75.84975,25.574751,89.235,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE ETHILON 6-0 1698G,,57000023,LOCAL,Facility,Both,,,,89.235,75.84975,25.574751,89.235,UnitedHealthcare,Individual & Family,83.8809,94,,percent of total billed charges,,
SUTURE ETHILON 6-0 1698G,,57000023,LOCAL,Facility,Outpatient,,,,89.235,75.84975,25.574751,89.235,UnitedHealthcare,Medicare Advantage,43.72515,49,,percent of total billed charges,,
SUTURE ETHILON 6-0 1698G,,57000023,LOCAL,Facility,Inpatient,,,,89.235,75.84975,25.574751,89.235,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
SUTURE ETHILON 6-0 1698G,,57000023,LOCAL,Facility,Outpatient,,,,89.235,75.84975,25.574751,89.235,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,42.8328,48,,percent of total billed charges,,100% of DHS outpatient percentage
SUTURE ETHILON 6-0 1698G,,57000023,LOCAL,Facility,Inpatient,,,,89.235,75.84975,25.574751,89.235,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
SUTURE MAXON 0 1X30IN GR TT-20/HGU-46,,57000023,LOCAL,Facility,Both,,,,64.35,54.6975,18.44271,64.35,Aetna,Commercial,59.202,92,,percent of total billed charges,,
SUTURE MAXON 0 1X30IN GR TT-20/HGU-46,,57000023,LOCAL,Facility,Outpatient,,,,64.35,54.6975,18.44271,64.35,Aetna,Medicare Advantage,31.5315,49,,percent of total billed charges,,
SUTURE MAXON 0 1X30IN GR TT-20/HGU-46,,57000023,LOCAL,Facility,Inpatient,,,,64.35,54.6975,18.44271,64.35,Aetna,Medicare Advantage,,,,,Included in per diem rate,
SUTURE MAXON 0 1X30IN GR TT-20/HGU-46,,57000023,LOCAL,Facility,Both,,,,64.35,54.6975,18.44271,64.35,Aetna,PPO,59.8455,93,,percent of total billed charges,,
SUTURE MAXON 0 1X30IN GR TT-20/HGU-46,,57000023,LOCAL,Facility,Both,,,,64.35,54.6975,18.44271,64.35,America's PPO,America's PPO,61.795305,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SUTURE MAXON 0 1X30IN GR TT-20/HGU-46,,57000023,LOCAL,Facility,Both,,,,64.35,54.6975,18.44271,64.35,BlueCross BlueShield Minnesota, Federal Employee Program,63.3204,98.4,,percent of total billed charges,,
SUTURE MAXON 0 1X30IN GR TT-20/HGU-46,,57000023,LOCAL,Facility,Both,,,,64.35,54.6975,18.44271,64.35,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,64.35,100,,percent of total billed charges,,
SUTURE MAXON 0 1X30IN GR TT-20/HGU-46,,57000023,LOCAL,Facility,Both,,,,64.35,54.6975,18.44271,64.35,BlueCross BlueShield Minnesota,High Value Network Plan,57.915,90,,percent of total billed charges,,
SUTURE MAXON 0 1X30IN GR TT-20/HGU-46,,57000023,LOCAL,Facility,Outpatient,,,,64.35,54.6975,18.44271,64.35,BlueCross BlueShield Minnesota,Medicare Advantage,31.5315,49,,percent of total billed charges,,
SUTURE MAXON 0 1X30IN GR TT-20/HGU-46,,57000023,LOCAL,Facility,Inpatient,,,,64.35,54.6975,18.44271,64.35,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
SUTURE MAXON 0 1X30IN GR TT-20/HGU-46,,57000023,LOCAL,Facility,Both,,,,64.35,54.6975,18.44271,64.35,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,56.994795,88.57,,percent of total billed charges,,
SUTURE MAXON 0 1X30IN GR TT-20/HGU-46,,57000023,LOCAL,Facility,Both,,,,64.35,54.6975,18.44271,64.35,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,18.44271,28.66,,percent of total billed charges,,
SUTURE MAXON 0 1X30IN GR TT-20/HGU-46,,57000023,LOCAL,Facility,Outpatient,,,,64.35,54.6975,18.44271,64.35,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),31.5315,49,,percent of total billed charges,,
SUTURE MAXON 0 1X30IN GR TT-20/HGU-46,,57000023,LOCAL,Facility,Inpatient,,,,64.35,54.6975,18.44271,64.35,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
SUTURE MAXON 0 1X30IN GR TT-20/HGU-46,,57000023,LOCAL,Facility,Both,,,,64.35,54.6975,18.44271,64.35,CorVel,Worker's Compensation,64.35,100,,percent of total billed charges,,
SUTURE MAXON 0 1X30IN GR TT-20/HGU-46,,57000023,LOCAL,Facility,Both,,,,64.35,54.6975,18.44271,64.35,First Health Group Corporation,First Health Network,62.4195,97,,percent of total billed charges,,
SUTURE MAXON 0 1X30IN GR TT-20/HGU-46,,57000023,LOCAL,Facility,Both,,,,64.35,54.6975,18.44271,64.35,"Health Partners, Inc.",Commercial,60.8751,94.6,,percent of total billed charges,,
SUTURE MAXON 0 1X30IN GR TT-20/HGU-46,,57000023,LOCAL,Facility,Outpatient,,,,64.35,54.6975,18.44271,64.35,"Health Partners, Inc.",Medicare Advantage,31.5315,49,,percent of total billed charges,,
SUTURE MAXON 0 1X30IN GR TT-20/HGU-46,,57000023,LOCAL,Facility,Inpatient,,,,64.35,54.6975,18.44271,64.35,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE MAXON 0 1X30IN GR TT-20/HGU-46,,57000023,LOCAL,Facility,Both,,,,64.35,54.6975,18.44271,64.35,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),38.61,60,,percent of total billed charges,,
SUTURE MAXON 0 1X30IN GR TT-20/HGU-46,,57000023,LOCAL,Facility,Both,,,,64.35,54.6975,18.44271,64.35,"Health Partners, Inc.",State of Minnesota Advantage Program,52.44525,81.5,,percent of total billed charges,,
SUTURE MAXON 0 1X30IN GR TT-20/HGU-46,,57000023,LOCAL,Facility,Both,,,,64.35,54.6975,18.44271,64.35,"Health Partners, Inc.",State Public Programs,32.175,50,,percent of total billed charges,,
SUTURE MAXON 0 1X30IN GR TT-20/HGU-46,,57000023,LOCAL,Facility,Both,,,,64.35,54.6975,18.44271,64.35,Humana Insurance Company,Commercial PPO,61.1325,95,,percent of total billed charges,,
SUTURE MAXON 0 1X30IN GR TT-20/HGU-46,,57000023,LOCAL,Facility,Outpatient,,,,64.35,54.6975,18.44271,64.35,Humana Insurance Company,Medicare PPO,31.5315,49,,percent of total billed charges,,
SUTURE MAXON 0 1X30IN GR TT-20/HGU-46,,57000023,LOCAL,Facility,Inpatient,,,,64.35,54.6975,18.44271,64.35,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
SUTURE MAXON 0 1X30IN GR TT-20/HGU-46,,57000023,LOCAL,Facility,Both,,,,64.35,54.6975,18.44271,64.35,Medica,Individual & Family,63.77085,99.1,,percent of total billed charges,,
SUTURE MAXON 0 1X30IN GR TT-20/HGU-46,,57000023,LOCAL,Facility,Outpatient,,,,64.35,54.6975,18.44271,64.35,Medica,Medica Advantage Solution,32.0463,49.8,,percent of total billed charges,,
SUTURE MAXON 0 1X30IN GR TT-20/HGU-46,,57000023,LOCAL,Facility,Inpatient,,,,64.35,54.6975,18.44271,64.35,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
SUTURE MAXON 0 1X30IN GR TT-20/HGU-46,,57000023,LOCAL,Facility,Outpatient,,,,64.35,54.6975,18.44271,64.35,Medica,Medical Assistance,28.7001,44.6,,percent of total billed charges,,
SUTURE MAXON 0 1X30IN GR TT-20/HGU-46,,57000023,LOCAL,Facility,Inpatient,,,,64.35,54.6975,18.44271,64.35,Medica,Medical Assistance,,,,,Included in per diem rate,
SUTURE MAXON 0 1X30IN GR TT-20/HGU-46,,57000023,LOCAL,Facility,Outpatient,,,,64.35,54.6975,18.44271,64.35,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,32.0463,49.8,,percent of total billed charges,,
SUTURE MAXON 0 1X30IN GR TT-20/HGU-46,,57000023,LOCAL,Facility,Inpatient,,,,64.35,54.6975,18.44271,64.35,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
SUTURE MAXON 0 1X30IN GR TT-20/HGU-46,,57000023,LOCAL,Facility,Both,,,,64.35,54.6975,18.44271,64.35,"Multiplan, Inc.","Multiplan, Inc.",60.489,94,,percent of total billed charges,,
SUTURE MAXON 0 1X30IN GR TT-20/HGU-46,,57000023,LOCAL,Facility,Outpatient,,,,64.35,54.6975,18.44271,64.35,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,57.97935,90.1,,percent of total billed charges,,
SUTURE MAXON 0 1X30IN GR TT-20/HGU-46,,57000023,LOCAL,Facility,Inpatient,,,,64.35,54.6975,18.44271,64.35,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
SUTURE MAXON 0 1X30IN GR TT-20/HGU-46,,57000023,LOCAL,Facility,Both,,,,64.35,54.6975,18.44271,64.35,"Preferred One Administrative Services, INC.",PPO,63.4491,98.6,,percent of total billed charges,,
SUTURE MAXON 0 1X30IN GR TT-20/HGU-46,,57000023,LOCAL,Facility,Outpatient,,,,64.35,54.6975,18.44271,64.35,PrimeWest Health,Minnesota Senior Health Options (MSHO),33.108075,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
SUTURE MAXON 0 1X30IN GR TT-20/HGU-46,,57000023,LOCAL,Facility,Inpatient,,,,64.35,54.6975,18.44271,64.35,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE MAXON 0 1X30IN GR TT-20/HGU-46,,57000023,LOCAL,Facility,Outpatient,,,,64.35,54.6975,18.44271,64.35,PrimeWest Health,MinnesotaCare,33.05016,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
SUTURE MAXON 0 1X30IN GR TT-20/HGU-46,,57000023,LOCAL,Facility,Inpatient,,,,64.35,54.6975,18.44271,64.35,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
SUTURE MAXON 0 1X30IN GR TT-20/HGU-46,,57000023,LOCAL,Facility,Both,,,,64.35,54.6975,18.44271,64.35,Sanford Health Plan,Sanford Health Plan,59.202,92,,percent of total billed charges,,
SUTURE MAXON 0 1X30IN GR TT-20/HGU-46,,57000023,LOCAL,Facility,Outpatient,,,,64.35,54.6975,18.44271,64.35,"UCare Health, Inc.",Individual & Family Plan,36.261225,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
SUTURE MAXON 0 1X30IN GR TT-20/HGU-46,,57000023,LOCAL,Facility,Inpatient,,,,64.35,54.6975,18.44271,64.35,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
SUTURE MAXON 0 1X30IN GR TT-20/HGU-46,,57000023,LOCAL,Facility,Outpatient,,,,64.35,54.6975,18.44271,64.35,"UCare Health, Inc.",Medical Assistance,32.477445,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE MAXON 0 1X30IN GR TT-20/HGU-46,,57000023,LOCAL,Facility,Inpatient,,,,64.35,54.6975,18.44271,64.35,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
SUTURE MAXON 0 1X30IN GR TT-20/HGU-46,,57000023,LOCAL,Facility,Outpatient,,,,64.35,54.6975,18.44271,64.35,"UCare Health, Inc.",Medicare Advantage,32.477445,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE MAXON 0 1X30IN GR TT-20/HGU-46,,57000023,LOCAL,Facility,Inpatient,,,,64.35,54.6975,18.44271,64.35,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE MAXON 0 1X30IN GR TT-20/HGU-46,,57000023,LOCAL,Facility,Outpatient,,,,64.35,54.6975,18.44271,64.35,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),32.477445,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE MAXON 0 1X30IN GR TT-20/HGU-46,,57000023,LOCAL,Facility,Inpatient,,,,64.35,54.6975,18.44271,64.35,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE MAXON 0 1X30IN GR TT-20/HGU-46,,57000023,LOCAL,Facility,Both,,,,64.35,54.6975,18.44271,64.35,UnitedHealthcare,Individual & Family,60.489,94,,percent of total billed charges,,
SUTURE MAXON 0 1X30IN GR TT-20/HGU-46,,57000023,LOCAL,Facility,Outpatient,,,,64.35,54.6975,18.44271,64.35,UnitedHealthcare,Medicare Advantage,31.5315,49,,percent of total billed charges,,
SUTURE MAXON 0 1X30IN GR TT-20/HGU-46,,57000023,LOCAL,Facility,Inpatient,,,,64.35,54.6975,18.44271,64.35,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
SUTURE MAXON 0 1X30IN GR TT-20/HGU-46,,57000023,LOCAL,Facility,Outpatient,,,,64.35,54.6975,18.44271,64.35,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,30.888,48,,percent of total billed charges,,100% of DHS outpatient percentage
SUTURE MAXON 0 1X30IN GR TT-20/HGU-46,,57000023,LOCAL,Facility,Inpatient,,,,64.35,54.6975,18.44271,64.35,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"VISCOAT, 0.5ML",,57000023,LOCAL,Facility,Both,,,,210,178.5,60.186,210,Aetna,Commercial,193.2,92,,percent of total billed charges,,
"VISCOAT, 0.5ML",,57000023,LOCAL,Facility,Outpatient,,,,210,178.5,60.186,210,Aetna,Medicare Advantage,102.9,49,,percent of total billed charges,,
"VISCOAT, 0.5ML",,57000023,LOCAL,Facility,Inpatient,,,,210,178.5,60.186,210,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"VISCOAT, 0.5ML",,57000023,LOCAL,Facility,Both,,,,210,178.5,60.186,210,Aetna,PPO,195.3,93,,percent of total billed charges,,
"VISCOAT, 0.5ML",,57000023,LOCAL,Facility,Both,,,,210,178.5,60.186,210,America's PPO,America's PPO,201.663,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"VISCOAT, 0.5ML",,57000023,LOCAL,Facility,Both,,,,210,178.5,60.186,210,BlueCross BlueShield Minnesota, Federal Employee Program,206.64,98.4,,percent of total billed charges,,
"VISCOAT, 0.5ML",,57000023,LOCAL,Facility,Both,,,,210,178.5,60.186,210,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,210,100,,percent of total billed charges,,
"VISCOAT, 0.5ML",,57000023,LOCAL,Facility,Both,,,,210,178.5,60.186,210,BlueCross BlueShield Minnesota,High Value Network Plan,189,90,,percent of total billed charges,,
"VISCOAT, 0.5ML",,57000023,LOCAL,Facility,Outpatient,,,,210,178.5,60.186,210,BlueCross BlueShield Minnesota,Medicare Advantage,102.9,49,,percent of total billed charges,,
"VISCOAT, 0.5ML",,57000023,LOCAL,Facility,Inpatient,,,,210,178.5,60.186,210,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"VISCOAT, 0.5ML",,57000023,LOCAL,Facility,Both,,,,210,178.5,60.186,210,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,185.997,88.57,,percent of total billed charges,,
"VISCOAT, 0.5ML",,57000023,LOCAL,Facility,Both,,,,210,178.5,60.186,210,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,60.186,28.66,,percent of total billed charges,,
"VISCOAT, 0.5ML",,57000023,LOCAL,Facility,Outpatient,,,,210,178.5,60.186,210,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),102.9,49,,percent of total billed charges,,
"VISCOAT, 0.5ML",,57000023,LOCAL,Facility,Inpatient,,,,210,178.5,60.186,210,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"VISCOAT, 0.5ML",,57000023,LOCAL,Facility,Both,,,,210,178.5,60.186,210,CorVel,Worker's Compensation,210,100,,percent of total billed charges,,
"VISCOAT, 0.5ML",,57000023,LOCAL,Facility,Both,,,,210,178.5,60.186,210,First Health Group Corporation,First Health Network,203.7,97,,percent of total billed charges,,
"VISCOAT, 0.5ML",,57000023,LOCAL,Facility,Both,,,,210,178.5,60.186,210,"Health Partners, Inc.",Commercial,198.66,94.6,,percent of total billed charges,,
"VISCOAT, 0.5ML",,57000023,LOCAL,Facility,Outpatient,,,,210,178.5,60.186,210,"Health Partners, Inc.",Medicare Advantage,102.9,49,,percent of total billed charges,,
"VISCOAT, 0.5ML",,57000023,LOCAL,Facility,Inpatient,,,,210,178.5,60.186,210,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"VISCOAT, 0.5ML",,57000023,LOCAL,Facility,Both,,,,210,178.5,60.186,210,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),126,60,,percent of total billed charges,,
"VISCOAT, 0.5ML",,57000023,LOCAL,Facility,Both,,,,210,178.5,60.186,210,"Health Partners, Inc.",State of Minnesota Advantage Program,171.15,81.5,,percent of total billed charges,,
"VISCOAT, 0.5ML",,57000023,LOCAL,Facility,Both,,,,210,178.5,60.186,210,"Health Partners, Inc.",State Public Programs,105,50,,percent of total billed charges,,
"VISCOAT, 0.5ML",,57000023,LOCAL,Facility,Both,,,,210,178.5,60.186,210,Humana Insurance Company,Commercial PPO,199.5,95,,percent of total billed charges,,
"VISCOAT, 0.5ML",,57000023,LOCAL,Facility,Outpatient,,,,210,178.5,60.186,210,Humana Insurance Company,Medicare PPO,102.9,49,,percent of total billed charges,,
"VISCOAT, 0.5ML",,57000023,LOCAL,Facility,Inpatient,,,,210,178.5,60.186,210,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"VISCOAT, 0.5ML",,57000023,LOCAL,Facility,Both,,,,210,178.5,60.186,210,Medica,Individual & Family,208.11,99.1,,percent of total billed charges,,
"VISCOAT, 0.5ML",,57000023,LOCAL,Facility,Outpatient,,,,210,178.5,60.186,210,Medica,Medica Advantage Solution,104.58,49.8,,percent of total billed charges,,
"VISCOAT, 0.5ML",,57000023,LOCAL,Facility,Inpatient,,,,210,178.5,60.186,210,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"VISCOAT, 0.5ML",,57000023,LOCAL,Facility,Outpatient,,,,210,178.5,60.186,210,Medica,Medical Assistance,93.66,44.6,,percent of total billed charges,,
"VISCOAT, 0.5ML",,57000023,LOCAL,Facility,Inpatient,,,,210,178.5,60.186,210,Medica,Medical Assistance,,,,,Included in per diem rate,
"VISCOAT, 0.5ML",,57000023,LOCAL,Facility,Outpatient,,,,210,178.5,60.186,210,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,104.58,49.8,,percent of total billed charges,,
"VISCOAT, 0.5ML",,57000023,LOCAL,Facility,Inpatient,,,,210,178.5,60.186,210,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"VISCOAT, 0.5ML",,57000023,LOCAL,Facility,Both,,,,210,178.5,60.186,210,"Multiplan, Inc.","Multiplan, Inc.",197.4,94,,percent of total billed charges,,
"VISCOAT, 0.5ML",,57000023,LOCAL,Facility,Outpatient,,,,210,178.5,60.186,210,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,189.21,90.1,,percent of total billed charges,,
"VISCOAT, 0.5ML",,57000023,LOCAL,Facility,Inpatient,,,,210,178.5,60.186,210,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"VISCOAT, 0.5ML",,57000023,LOCAL,Facility,Both,,,,210,178.5,60.186,210,"Preferred One Administrative Services, INC.",PPO,207.06,98.6,,percent of total billed charges,,
"VISCOAT, 0.5ML",,57000023,LOCAL,Facility,Outpatient,,,,210,178.5,60.186,210,PrimeWest Health,Minnesota Senior Health Options (MSHO),108.045,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"VISCOAT, 0.5ML",,57000023,LOCAL,Facility,Inpatient,,,,210,178.5,60.186,210,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"VISCOAT, 0.5ML",,57000023,LOCAL,Facility,Outpatient,,,,210,178.5,60.186,210,PrimeWest Health,MinnesotaCare,107.856,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"VISCOAT, 0.5ML",,57000023,LOCAL,Facility,Inpatient,,,,210,178.5,60.186,210,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"VISCOAT, 0.5ML",,57000023,LOCAL,Facility,Both,,,,210,178.5,60.186,210,Sanford Health Plan,Sanford Health Plan,193.2,92,,percent of total billed charges,,
"VISCOAT, 0.5ML",,57000023,LOCAL,Facility,Outpatient,,,,210,178.5,60.186,210,"UCare Health, Inc.",Individual & Family Plan,118.335,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"VISCOAT, 0.5ML",,57000023,LOCAL,Facility,Inpatient,,,,210,178.5,60.186,210,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"VISCOAT, 0.5ML",,57000023,LOCAL,Facility,Outpatient,,,,210,178.5,60.186,210,"UCare Health, Inc.",Medical Assistance,105.987,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"VISCOAT, 0.5ML",,57000023,LOCAL,Facility,Inpatient,,,,210,178.5,60.186,210,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"VISCOAT, 0.5ML",,57000023,LOCAL,Facility,Outpatient,,,,210,178.5,60.186,210,"UCare Health, Inc.",Medicare Advantage,105.987,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"VISCOAT, 0.5ML",,57000023,LOCAL,Facility,Inpatient,,,,210,178.5,60.186,210,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"VISCOAT, 0.5ML",,57000023,LOCAL,Facility,Outpatient,,,,210,178.5,60.186,210,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),105.987,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"VISCOAT, 0.5ML",,57000023,LOCAL,Facility,Inpatient,,,,210,178.5,60.186,210,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"VISCOAT, 0.5ML",,57000023,LOCAL,Facility,Both,,,,210,178.5,60.186,210,UnitedHealthcare,Individual & Family,197.4,94,,percent of total billed charges,,
"VISCOAT, 0.5ML",,57000023,LOCAL,Facility,Outpatient,,,,210,178.5,60.186,210,UnitedHealthcare,Medicare Advantage,102.9,49,,percent of total billed charges,,
"VISCOAT, 0.5ML",,57000023,LOCAL,Facility,Inpatient,,,,210,178.5,60.186,210,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"VISCOAT, 0.5ML",,57000023,LOCAL,Facility,Outpatient,,,,210,178.5,60.186,210,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,100.8,48,,percent of total billed charges,,100% of DHS outpatient percentage
"VISCOAT, 0.5ML",,57000023,LOCAL,Facility,Inpatient,,,,210,178.5,60.186,210,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
WAND COBLATOR-ENT PLASMA EVAC 70 XTRA W/CABLE,,57000023,LOCAL,Facility,Both,,,,695,590.75,199.187,695,Aetna,Commercial,639.4,92,,percent of total billed charges,,
WAND COBLATOR-ENT PLASMA EVAC 70 XTRA W/CABLE,,57000023,LOCAL,Facility,Outpatient,,,,695,590.75,199.187,695,Aetna,Medicare Advantage,340.55,49,,percent of total billed charges,,
WAND COBLATOR-ENT PLASMA EVAC 70 XTRA W/CABLE,,57000023,LOCAL,Facility,Inpatient,,,,695,590.75,199.187,695,Aetna,Medicare Advantage,,,,,Included in per diem rate,
WAND COBLATOR-ENT PLASMA EVAC 70 XTRA W/CABLE,,57000023,LOCAL,Facility,Both,,,,695,590.75,199.187,695,Aetna,PPO,646.35,93,,percent of total billed charges,,
WAND COBLATOR-ENT PLASMA EVAC 70 XTRA W/CABLE,,57000023,LOCAL,Facility,Both,,,,695,590.75,199.187,695,America's PPO,America's PPO,667.4085,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
WAND COBLATOR-ENT PLASMA EVAC 70 XTRA W/CABLE,,57000023,LOCAL,Facility,Both,,,,695,590.75,199.187,695,BlueCross BlueShield Minnesota, Federal Employee Program,683.88,98.4,,percent of total billed charges,,
WAND COBLATOR-ENT PLASMA EVAC 70 XTRA W/CABLE,,57000023,LOCAL,Facility,Both,,,,695,590.75,199.187,695,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,695,100,,percent of total billed charges,,
WAND COBLATOR-ENT PLASMA EVAC 70 XTRA W/CABLE,,57000023,LOCAL,Facility,Both,,,,695,590.75,199.187,695,BlueCross BlueShield Minnesota,High Value Network Plan,625.5,90,,percent of total billed charges,,
WAND COBLATOR-ENT PLASMA EVAC 70 XTRA W/CABLE,,57000023,LOCAL,Facility,Outpatient,,,,695,590.75,199.187,695,BlueCross BlueShield Minnesota,Medicare Advantage,340.55,49,,percent of total billed charges,,
WAND COBLATOR-ENT PLASMA EVAC 70 XTRA W/CABLE,,57000023,LOCAL,Facility,Inpatient,,,,695,590.75,199.187,695,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
WAND COBLATOR-ENT PLASMA EVAC 70 XTRA W/CABLE,,57000023,LOCAL,Facility,Both,,,,695,590.75,199.187,695,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,615.5615,88.57,,percent of total billed charges,,
WAND COBLATOR-ENT PLASMA EVAC 70 XTRA W/CABLE,,57000023,LOCAL,Facility,Both,,,,695,590.75,199.187,695,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,199.187,28.66,,percent of total billed charges,,
WAND COBLATOR-ENT PLASMA EVAC 70 XTRA W/CABLE,,57000023,LOCAL,Facility,Outpatient,,,,695,590.75,199.187,695,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),340.55,49,,percent of total billed charges,,
WAND COBLATOR-ENT PLASMA EVAC 70 XTRA W/CABLE,,57000023,LOCAL,Facility,Inpatient,,,,695,590.75,199.187,695,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
WAND COBLATOR-ENT PLASMA EVAC 70 XTRA W/CABLE,,57000023,LOCAL,Facility,Both,,,,695,590.75,199.187,695,CorVel,Worker's Compensation,695,100,,percent of total billed charges,,
WAND COBLATOR-ENT PLASMA EVAC 70 XTRA W/CABLE,,57000023,LOCAL,Facility,Both,,,,695,590.75,199.187,695,First Health Group Corporation,First Health Network,674.15,97,,percent of total billed charges,,
WAND COBLATOR-ENT PLASMA EVAC 70 XTRA W/CABLE,,57000023,LOCAL,Facility,Both,,,,695,590.75,199.187,695,"Health Partners, Inc.",Commercial,657.47,94.6,,percent of total billed charges,,
WAND COBLATOR-ENT PLASMA EVAC 70 XTRA W/CABLE,,57000023,LOCAL,Facility,Outpatient,,,,695,590.75,199.187,695,"Health Partners, Inc.",Medicare Advantage,340.55,49,,percent of total billed charges,,
WAND COBLATOR-ENT PLASMA EVAC 70 XTRA W/CABLE,,57000023,LOCAL,Facility,Inpatient,,,,695,590.75,199.187,695,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
WAND COBLATOR-ENT PLASMA EVAC 70 XTRA W/CABLE,,57000023,LOCAL,Facility,Both,,,,695,590.75,199.187,695,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),417,60,,percent of total billed charges,,
WAND COBLATOR-ENT PLASMA EVAC 70 XTRA W/CABLE,,57000023,LOCAL,Facility,Both,,,,695,590.75,199.187,695,"Health Partners, Inc.",State of Minnesota Advantage Program,566.425,81.5,,percent of total billed charges,,
WAND COBLATOR-ENT PLASMA EVAC 70 XTRA W/CABLE,,57000023,LOCAL,Facility,Both,,,,695,590.75,199.187,695,"Health Partners, Inc.",State Public Programs,347.5,50,,percent of total billed charges,,
WAND COBLATOR-ENT PLASMA EVAC 70 XTRA W/CABLE,,57000023,LOCAL,Facility,Both,,,,695,590.75,199.187,695,Humana Insurance Company,Commercial PPO,660.25,95,,percent of total billed charges,,
WAND COBLATOR-ENT PLASMA EVAC 70 XTRA W/CABLE,,57000023,LOCAL,Facility,Outpatient,,,,695,590.75,199.187,695,Humana Insurance Company,Medicare PPO,340.55,49,,percent of total billed charges,,
WAND COBLATOR-ENT PLASMA EVAC 70 XTRA W/CABLE,,57000023,LOCAL,Facility,Inpatient,,,,695,590.75,199.187,695,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
WAND COBLATOR-ENT PLASMA EVAC 70 XTRA W/CABLE,,57000023,LOCAL,Facility,Both,,,,695,590.75,199.187,695,Medica,Individual & Family,688.745,99.1,,percent of total billed charges,,
WAND COBLATOR-ENT PLASMA EVAC 70 XTRA W/CABLE,,57000023,LOCAL,Facility,Outpatient,,,,695,590.75,199.187,695,Medica,Medica Advantage Solution,346.11,49.8,,percent of total billed charges,,
WAND COBLATOR-ENT PLASMA EVAC 70 XTRA W/CABLE,,57000023,LOCAL,Facility,Inpatient,,,,695,590.75,199.187,695,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
WAND COBLATOR-ENT PLASMA EVAC 70 XTRA W/CABLE,,57000023,LOCAL,Facility,Outpatient,,,,695,590.75,199.187,695,Medica,Medical Assistance,309.97,44.6,,percent of total billed charges,,
WAND COBLATOR-ENT PLASMA EVAC 70 XTRA W/CABLE,,57000023,LOCAL,Facility,Inpatient,,,,695,590.75,199.187,695,Medica,Medical Assistance,,,,,Included in per diem rate,
WAND COBLATOR-ENT PLASMA EVAC 70 XTRA W/CABLE,,57000023,LOCAL,Facility,Outpatient,,,,695,590.75,199.187,695,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,346.11,49.8,,percent of total billed charges,,
WAND COBLATOR-ENT PLASMA EVAC 70 XTRA W/CABLE,,57000023,LOCAL,Facility,Inpatient,,,,695,590.75,199.187,695,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
WAND COBLATOR-ENT PLASMA EVAC 70 XTRA W/CABLE,,57000023,LOCAL,Facility,Both,,,,695,590.75,199.187,695,"Multiplan, Inc.","Multiplan, Inc.",653.3,94,,percent of total billed charges,,
WAND COBLATOR-ENT PLASMA EVAC 70 XTRA W/CABLE,,57000023,LOCAL,Facility,Outpatient,,,,695,590.75,199.187,695,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,626.195,90.1,,percent of total billed charges,,
WAND COBLATOR-ENT PLASMA EVAC 70 XTRA W/CABLE,,57000023,LOCAL,Facility,Inpatient,,,,695,590.75,199.187,695,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
WAND COBLATOR-ENT PLASMA EVAC 70 XTRA W/CABLE,,57000023,LOCAL,Facility,Both,,,,695,590.75,199.187,695,"Preferred One Administrative Services, INC.",PPO,685.27,98.6,,percent of total billed charges,,
WAND COBLATOR-ENT PLASMA EVAC 70 XTRA W/CABLE,,57000023,LOCAL,Facility,Outpatient,,,,695,590.75,199.187,695,PrimeWest Health,Minnesota Senior Health Options (MSHO),357.5775,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
WAND COBLATOR-ENT PLASMA EVAC 70 XTRA W/CABLE,,57000023,LOCAL,Facility,Inpatient,,,,695,590.75,199.187,695,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
WAND COBLATOR-ENT PLASMA EVAC 70 XTRA W/CABLE,,57000023,LOCAL,Facility,Outpatient,,,,695,590.75,199.187,695,PrimeWest Health,MinnesotaCare,356.952,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
WAND COBLATOR-ENT PLASMA EVAC 70 XTRA W/CABLE,,57000023,LOCAL,Facility,Inpatient,,,,695,590.75,199.187,695,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
WAND COBLATOR-ENT PLASMA EVAC 70 XTRA W/CABLE,,57000023,LOCAL,Facility,Both,,,,695,590.75,199.187,695,Sanford Health Plan,Sanford Health Plan,639.4,92,,percent of total billed charges,,
WAND COBLATOR-ENT PLASMA EVAC 70 XTRA W/CABLE,,57000023,LOCAL,Facility,Outpatient,,,,695,590.75,199.187,695,"UCare Health, Inc.",Individual & Family Plan,391.6325,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
WAND COBLATOR-ENT PLASMA EVAC 70 XTRA W/CABLE,,57000023,LOCAL,Facility,Inpatient,,,,695,590.75,199.187,695,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
WAND COBLATOR-ENT PLASMA EVAC 70 XTRA W/CABLE,,57000023,LOCAL,Facility,Outpatient,,,,695,590.75,199.187,695,"UCare Health, Inc.",Medical Assistance,350.7665,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
WAND COBLATOR-ENT PLASMA EVAC 70 XTRA W/CABLE,,57000023,LOCAL,Facility,Inpatient,,,,695,590.75,199.187,695,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
WAND COBLATOR-ENT PLASMA EVAC 70 XTRA W/CABLE,,57000023,LOCAL,Facility,Outpatient,,,,695,590.75,199.187,695,"UCare Health, Inc.",Medicare Advantage,350.7665,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
WAND COBLATOR-ENT PLASMA EVAC 70 XTRA W/CABLE,,57000023,LOCAL,Facility,Inpatient,,,,695,590.75,199.187,695,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
WAND COBLATOR-ENT PLASMA EVAC 70 XTRA W/CABLE,,57000023,LOCAL,Facility,Outpatient,,,,695,590.75,199.187,695,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),350.7665,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
WAND COBLATOR-ENT PLASMA EVAC 70 XTRA W/CABLE,,57000023,LOCAL,Facility,Inpatient,,,,695,590.75,199.187,695,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
WAND COBLATOR-ENT PLASMA EVAC 70 XTRA W/CABLE,,57000023,LOCAL,Facility,Both,,,,695,590.75,199.187,695,UnitedHealthcare,Individual & Family,653.3,94,,percent of total billed charges,,
WAND COBLATOR-ENT PLASMA EVAC 70 XTRA W/CABLE,,57000023,LOCAL,Facility,Outpatient,,,,695,590.75,199.187,695,UnitedHealthcare,Medicare Advantage,340.55,49,,percent of total billed charges,,
WAND COBLATOR-ENT PLASMA EVAC 70 XTRA W/CABLE,,57000023,LOCAL,Facility,Inpatient,,,,695,590.75,199.187,695,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
WAND COBLATOR-ENT PLASMA EVAC 70 XTRA W/CABLE,,57000023,LOCAL,Facility,Outpatient,,,,695,590.75,199.187,695,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,333.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
WAND COBLATOR-ENT PLASMA EVAC 70 XTRA W/CABLE,,57000023,LOCAL,Facility,Inpatient,,,,695,590.75,199.187,695,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Zimmer 90 Degree Cement Nozzle,,57000023,LOCAL,Facility,Both,,,,200,170,57.32,200,Aetna,Commercial,184,92,,percent of total billed charges,,
Zimmer 90 Degree Cement Nozzle,,57000023,LOCAL,Facility,Outpatient,,,,200,170,57.32,200,Aetna,Medicare Advantage,98,49,,percent of total billed charges,,
Zimmer 90 Degree Cement Nozzle,,57000023,LOCAL,Facility,Inpatient,,,,200,170,57.32,200,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Zimmer 90 Degree Cement Nozzle,,57000023,LOCAL,Facility,Both,,,,200,170,57.32,200,Aetna,PPO,186,93,,percent of total billed charges,,
Zimmer 90 Degree Cement Nozzle,,57000023,LOCAL,Facility,Both,,,,200,170,57.32,200,America's PPO,America's PPO,192.06,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Zimmer 90 Degree Cement Nozzle,,57000023,LOCAL,Facility,Both,,,,200,170,57.32,200,BlueCross BlueShield Minnesota, Federal Employee Program,196.8,98.4,,percent of total billed charges,,
Zimmer 90 Degree Cement Nozzle,,57000023,LOCAL,Facility,Both,,,,200,170,57.32,200,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,200,100,,percent of total billed charges,,
Zimmer 90 Degree Cement Nozzle,,57000023,LOCAL,Facility,Both,,,,200,170,57.32,200,BlueCross BlueShield Minnesota,High Value Network Plan,180,90,,percent of total billed charges,,
Zimmer 90 Degree Cement Nozzle,,57000023,LOCAL,Facility,Outpatient,,,,200,170,57.32,200,BlueCross BlueShield Minnesota,Medicare Advantage,98,49,,percent of total billed charges,,
Zimmer 90 Degree Cement Nozzle,,57000023,LOCAL,Facility,Inpatient,,,,200,170,57.32,200,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Zimmer 90 Degree Cement Nozzle,,57000023,LOCAL,Facility,Both,,,,200,170,57.32,200,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,177.14,88.57,,percent of total billed charges,,
Zimmer 90 Degree Cement Nozzle,,57000023,LOCAL,Facility,Both,,,,200,170,57.32,200,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,57.32,28.66,,percent of total billed charges,,
Zimmer 90 Degree Cement Nozzle,,57000023,LOCAL,Facility,Outpatient,,,,200,170,57.32,200,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),98,49,,percent of total billed charges,,
Zimmer 90 Degree Cement Nozzle,,57000023,LOCAL,Facility,Inpatient,,,,200,170,57.32,200,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Zimmer 90 Degree Cement Nozzle,,57000023,LOCAL,Facility,Both,,,,200,170,57.32,200,CorVel,Worker's Compensation,200,100,,percent of total billed charges,,
Zimmer 90 Degree Cement Nozzle,,57000023,LOCAL,Facility,Both,,,,200,170,57.32,200,First Health Group Corporation,First Health Network,194,97,,percent of total billed charges,,
Zimmer 90 Degree Cement Nozzle,,57000023,LOCAL,Facility,Both,,,,200,170,57.32,200,"Health Partners, Inc.",Commercial,189.2,94.6,,percent of total billed charges,,
Zimmer 90 Degree Cement Nozzle,,57000023,LOCAL,Facility,Outpatient,,,,200,170,57.32,200,"Health Partners, Inc.",Medicare Advantage,98,49,,percent of total billed charges,,
Zimmer 90 Degree Cement Nozzle,,57000023,LOCAL,Facility,Inpatient,,,,200,170,57.32,200,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Zimmer 90 Degree Cement Nozzle,,57000023,LOCAL,Facility,Both,,,,200,170,57.32,200,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),120,60,,percent of total billed charges,,
Zimmer 90 Degree Cement Nozzle,,57000023,LOCAL,Facility,Both,,,,200,170,57.32,200,"Health Partners, Inc.",State of Minnesota Advantage Program,163,81.5,,percent of total billed charges,,
Zimmer 90 Degree Cement Nozzle,,57000023,LOCAL,Facility,Both,,,,200,170,57.32,200,"Health Partners, Inc.",State Public Programs,100,50,,percent of total billed charges,,
Zimmer 90 Degree Cement Nozzle,,57000023,LOCAL,Facility,Both,,,,200,170,57.32,200,Humana Insurance Company,Commercial PPO,190,95,,percent of total billed charges,,
Zimmer 90 Degree Cement Nozzle,,57000023,LOCAL,Facility,Outpatient,,,,200,170,57.32,200,Humana Insurance Company,Medicare PPO,98,49,,percent of total billed charges,,
Zimmer 90 Degree Cement Nozzle,,57000023,LOCAL,Facility,Inpatient,,,,200,170,57.32,200,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Zimmer 90 Degree Cement Nozzle,,57000023,LOCAL,Facility,Both,,,,200,170,57.32,200,Medica,Individual & Family,198.2,99.1,,percent of total billed charges,,
Zimmer 90 Degree Cement Nozzle,,57000023,LOCAL,Facility,Outpatient,,,,200,170,57.32,200,Medica,Medica Advantage Solution,99.6,49.8,,percent of total billed charges,,
Zimmer 90 Degree Cement Nozzle,,57000023,LOCAL,Facility,Inpatient,,,,200,170,57.32,200,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Zimmer 90 Degree Cement Nozzle,,57000023,LOCAL,Facility,Outpatient,,,,200,170,57.32,200,Medica,Medical Assistance,89.2,44.6,,percent of total billed charges,,
Zimmer 90 Degree Cement Nozzle,,57000023,LOCAL,Facility,Inpatient,,,,200,170,57.32,200,Medica,Medical Assistance,,,,,Included in per diem rate,
Zimmer 90 Degree Cement Nozzle,,57000023,LOCAL,Facility,Outpatient,,,,200,170,57.32,200,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,99.6,49.8,,percent of total billed charges,,
Zimmer 90 Degree Cement Nozzle,,57000023,LOCAL,Facility,Inpatient,,,,200,170,57.32,200,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Zimmer 90 Degree Cement Nozzle,,57000023,LOCAL,Facility,Both,,,,200,170,57.32,200,"Multiplan, Inc.","Multiplan, Inc.",188,94,,percent of total billed charges,,
Zimmer 90 Degree Cement Nozzle,,57000023,LOCAL,Facility,Outpatient,,,,200,170,57.32,200,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,180.2,90.1,,percent of total billed charges,,
Zimmer 90 Degree Cement Nozzle,,57000023,LOCAL,Facility,Inpatient,,,,200,170,57.32,200,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Zimmer 90 Degree Cement Nozzle,,57000023,LOCAL,Facility,Both,,,,200,170,57.32,200,"Preferred One Administrative Services, INC.",PPO,197.2,98.6,,percent of total billed charges,,
Zimmer 90 Degree Cement Nozzle,,57000023,LOCAL,Facility,Outpatient,,,,200,170,57.32,200,PrimeWest Health,Minnesota Senior Health Options (MSHO),102.9,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Zimmer 90 Degree Cement Nozzle,,57000023,LOCAL,Facility,Inpatient,,,,200,170,57.32,200,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Zimmer 90 Degree Cement Nozzle,,57000023,LOCAL,Facility,Outpatient,,,,200,170,57.32,200,PrimeWest Health,MinnesotaCare,102.72,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Zimmer 90 Degree Cement Nozzle,,57000023,LOCAL,Facility,Inpatient,,,,200,170,57.32,200,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Zimmer 90 Degree Cement Nozzle,,57000023,LOCAL,Facility,Both,,,,200,170,57.32,200,Sanford Health Plan,Sanford Health Plan,184,92,,percent of total billed charges,,
Zimmer 90 Degree Cement Nozzle,,57000023,LOCAL,Facility,Outpatient,,,,200,170,57.32,200,"UCare Health, Inc.",Individual & Family Plan,112.7,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Zimmer 90 Degree Cement Nozzle,,57000023,LOCAL,Facility,Inpatient,,,,200,170,57.32,200,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Zimmer 90 Degree Cement Nozzle,,57000023,LOCAL,Facility,Outpatient,,,,200,170,57.32,200,"UCare Health, Inc.",Medical Assistance,100.94,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Zimmer 90 Degree Cement Nozzle,,57000023,LOCAL,Facility,Inpatient,,,,200,170,57.32,200,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Zimmer 90 Degree Cement Nozzle,,57000023,LOCAL,Facility,Outpatient,,,,200,170,57.32,200,"UCare Health, Inc.",Medicare Advantage,100.94,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Zimmer 90 Degree Cement Nozzle,,57000023,LOCAL,Facility,Inpatient,,,,200,170,57.32,200,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Zimmer 90 Degree Cement Nozzle,,57000023,LOCAL,Facility,Outpatient,,,,200,170,57.32,200,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),100.94,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Zimmer 90 Degree Cement Nozzle,,57000023,LOCAL,Facility,Inpatient,,,,200,170,57.32,200,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Zimmer 90 Degree Cement Nozzle,,57000023,LOCAL,Facility,Both,,,,200,170,57.32,200,UnitedHealthcare,Individual & Family,188,94,,percent of total billed charges,,
Zimmer 90 Degree Cement Nozzle,,57000023,LOCAL,Facility,Outpatient,,,,200,170,57.32,200,UnitedHealthcare,Medicare Advantage,98,49,,percent of total billed charges,,
Zimmer 90 Degree Cement Nozzle,,57000023,LOCAL,Facility,Inpatient,,,,200,170,57.32,200,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Zimmer 90 Degree Cement Nozzle,,57000023,LOCAL,Facility,Outpatient,,,,200,170,57.32,200,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,96,48,,percent of total billed charges,,100% of DHS outpatient percentage
Zimmer 90 Degree Cement Nozzle,,57000023,LOCAL,Facility,Inpatient,,,,200,170,57.32,200,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
BARD MESH PERFIX PLUG,,57002229,LOCAL,Facility,Both,,,,390,331.5,111.774,390,Aetna,Commercial,358.8,92,,percent of total billed charges,,
BARD MESH PERFIX PLUG,,57002229,LOCAL,Facility,Outpatient,,,,390,331.5,111.774,390,Aetna,Medicare Advantage,191.1,49,,percent of total billed charges,,
BARD MESH PERFIX PLUG,,57002229,LOCAL,Facility,Inpatient,,,,390,331.5,111.774,390,Aetna,Medicare Advantage,,,,,Included in per diem rate,
BARD MESH PERFIX PLUG,,57002229,LOCAL,Facility,Both,,,,390,331.5,111.774,390,Aetna,PPO,362.7,93,,percent of total billed charges,,
BARD MESH PERFIX PLUG,,57002229,LOCAL,Facility,Both,,,,390,331.5,111.774,390,America's PPO,America's PPO,374.517,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
BARD MESH PERFIX PLUG,,57002229,LOCAL,Facility,Both,,,,390,331.5,111.774,390,BlueCross BlueShield Minnesota, Federal Employee Program,383.76,98.4,,percent of total billed charges,,
BARD MESH PERFIX PLUG,,57002229,LOCAL,Facility,Both,,,,390,331.5,111.774,390,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,390,100,,percent of total billed charges,,
BARD MESH PERFIX PLUG,,57002229,LOCAL,Facility,Both,,,,390,331.5,111.774,390,BlueCross BlueShield Minnesota,High Value Network Plan,351,90,,percent of total billed charges,,
BARD MESH PERFIX PLUG,,57002229,LOCAL,Facility,Outpatient,,,,390,331.5,111.774,390,BlueCross BlueShield Minnesota,Medicare Advantage,191.1,49,,percent of total billed charges,,
BARD MESH PERFIX PLUG,,57002229,LOCAL,Facility,Inpatient,,,,390,331.5,111.774,390,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
BARD MESH PERFIX PLUG,,57002229,LOCAL,Facility,Both,,,,390,331.5,111.774,390,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,345.423,88.57,,percent of total billed charges,,
BARD MESH PERFIX PLUG,,57002229,LOCAL,Facility,Both,,,,390,331.5,111.774,390,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,111.774,28.66,,percent of total billed charges,,
BARD MESH PERFIX PLUG,,57002229,LOCAL,Facility,Outpatient,,,,390,331.5,111.774,390,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),191.1,49,,percent of total billed charges,,
BARD MESH PERFIX PLUG,,57002229,LOCAL,Facility,Inpatient,,,,390,331.5,111.774,390,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
BARD MESH PERFIX PLUG,,57002229,LOCAL,Facility,Both,,,,390,331.5,111.774,390,CorVel,Worker's Compensation,390,100,,percent of total billed charges,,
BARD MESH PERFIX PLUG,,57002229,LOCAL,Facility,Both,,,,390,331.5,111.774,390,First Health Group Corporation,First Health Network,378.3,97,,percent of total billed charges,,
BARD MESH PERFIX PLUG,,57002229,LOCAL,Facility,Both,,,,390,331.5,111.774,390,"Health Partners, Inc.",Commercial,368.94,94.6,,percent of total billed charges,,
BARD MESH PERFIX PLUG,,57002229,LOCAL,Facility,Outpatient,,,,390,331.5,111.774,390,"Health Partners, Inc.",Medicare Advantage,191.1,49,,percent of total billed charges,,
BARD MESH PERFIX PLUG,,57002229,LOCAL,Facility,Inpatient,,,,390,331.5,111.774,390,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
BARD MESH PERFIX PLUG,,57002229,LOCAL,Facility,Both,,,,390,331.5,111.774,390,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),234,60,,percent of total billed charges,,
BARD MESH PERFIX PLUG,,57002229,LOCAL,Facility,Both,,,,390,331.5,111.774,390,"Health Partners, Inc.",State of Minnesota Advantage Program,317.85,81.5,,percent of total billed charges,,
BARD MESH PERFIX PLUG,,57002229,LOCAL,Facility,Both,,,,390,331.5,111.774,390,"Health Partners, Inc.",State Public Programs,195,50,,percent of total billed charges,,
BARD MESH PERFIX PLUG,,57002229,LOCAL,Facility,Both,,,,390,331.5,111.774,390,Humana Insurance Company,Commercial PPO,370.5,95,,percent of total billed charges,,
BARD MESH PERFIX PLUG,,57002229,LOCAL,Facility,Outpatient,,,,390,331.5,111.774,390,Humana Insurance Company,Medicare PPO,191.1,49,,percent of total billed charges,,
BARD MESH PERFIX PLUG,,57002229,LOCAL,Facility,Inpatient,,,,390,331.5,111.774,390,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
BARD MESH PERFIX PLUG,,57002229,LOCAL,Facility,Both,,,,390,331.5,111.774,390,Medica,Individual & Family,386.49,99.1,,percent of total billed charges,,
BARD MESH PERFIX PLUG,,57002229,LOCAL,Facility,Outpatient,,,,390,331.5,111.774,390,Medica,Medica Advantage Solution,194.22,49.8,,percent of total billed charges,,
BARD MESH PERFIX PLUG,,57002229,LOCAL,Facility,Inpatient,,,,390,331.5,111.774,390,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
BARD MESH PERFIX PLUG,,57002229,LOCAL,Facility,Outpatient,,,,390,331.5,111.774,390,Medica,Medical Assistance,173.94,44.6,,percent of total billed charges,,
BARD MESH PERFIX PLUG,,57002229,LOCAL,Facility,Inpatient,,,,390,331.5,111.774,390,Medica,Medical Assistance,,,,,Included in per diem rate,
BARD MESH PERFIX PLUG,,57002229,LOCAL,Facility,Outpatient,,,,390,331.5,111.774,390,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,194.22,49.8,,percent of total billed charges,,
BARD MESH PERFIX PLUG,,57002229,LOCAL,Facility,Inpatient,,,,390,331.5,111.774,390,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
BARD MESH PERFIX PLUG,,57002229,LOCAL,Facility,Both,,,,390,331.5,111.774,390,"Multiplan, Inc.","Multiplan, Inc.",366.6,94,,percent of total billed charges,,
BARD MESH PERFIX PLUG,,57002229,LOCAL,Facility,Outpatient,,,,390,331.5,111.774,390,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,351.39,90.1,,percent of total billed charges,,
BARD MESH PERFIX PLUG,,57002229,LOCAL,Facility,Inpatient,,,,390,331.5,111.774,390,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
BARD MESH PERFIX PLUG,,57002229,LOCAL,Facility,Both,,,,390,331.5,111.774,390,"Preferred One Administrative Services, INC.",PPO,384.54,98.6,,percent of total billed charges,,
BARD MESH PERFIX PLUG,,57002229,LOCAL,Facility,Outpatient,,,,390,331.5,111.774,390,PrimeWest Health,Minnesota Senior Health Options (MSHO),200.655,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
BARD MESH PERFIX PLUG,,57002229,LOCAL,Facility,Inpatient,,,,390,331.5,111.774,390,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
BARD MESH PERFIX PLUG,,57002229,LOCAL,Facility,Outpatient,,,,390,331.5,111.774,390,PrimeWest Health,MinnesotaCare,200.304,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
BARD MESH PERFIX PLUG,,57002229,LOCAL,Facility,Inpatient,,,,390,331.5,111.774,390,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
BARD MESH PERFIX PLUG,,57002229,LOCAL,Facility,Both,,,,390,331.5,111.774,390,Sanford Health Plan,Sanford Health Plan,358.8,92,,percent of total billed charges,,
BARD MESH PERFIX PLUG,,57002229,LOCAL,Facility,Outpatient,,,,390,331.5,111.774,390,"UCare Health, Inc.",Individual & Family Plan,219.765,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
BARD MESH PERFIX PLUG,,57002229,LOCAL,Facility,Inpatient,,,,390,331.5,111.774,390,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
BARD MESH PERFIX PLUG,,57002229,LOCAL,Facility,Outpatient,,,,390,331.5,111.774,390,"UCare Health, Inc.",Medical Assistance,196.833,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BARD MESH PERFIX PLUG,,57002229,LOCAL,Facility,Inpatient,,,,390,331.5,111.774,390,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
BARD MESH PERFIX PLUG,,57002229,LOCAL,Facility,Outpatient,,,,390,331.5,111.774,390,"UCare Health, Inc.",Medicare Advantage,196.833,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BARD MESH PERFIX PLUG,,57002229,LOCAL,Facility,Inpatient,,,,390,331.5,111.774,390,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
BARD MESH PERFIX PLUG,,57002229,LOCAL,Facility,Outpatient,,,,390,331.5,111.774,390,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),196.833,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BARD MESH PERFIX PLUG,,57002229,LOCAL,Facility,Inpatient,,,,390,331.5,111.774,390,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
BARD MESH PERFIX PLUG,,57002229,LOCAL,Facility,Both,,,,390,331.5,111.774,390,UnitedHealthcare,Individual & Family,366.6,94,,percent of total billed charges,,
BARD MESH PERFIX PLUG,,57002229,LOCAL,Facility,Outpatient,,,,390,331.5,111.774,390,UnitedHealthcare,Medicare Advantage,191.1,49,,percent of total billed charges,,
BARD MESH PERFIX PLUG,,57002229,LOCAL,Facility,Inpatient,,,,390,331.5,111.774,390,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
BARD MESH PERFIX PLUG,,57002229,LOCAL,Facility,Outpatient,,,,390,331.5,111.774,390,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,187.2,48,,percent of total billed charges,,100% of DHS outpatient percentage
BARD MESH PERFIX PLUG,,57002229,LOCAL,Facility,Inpatient,,,,390,331.5,111.774,390,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
BIOMET GENTAMYCIN ANTIBIOTIC CEMENT 57002229,,57002229,LOCAL,Facility,Both,,,,737.5,626.875,211.3675,737.5,Aetna,Commercial,678.5,92,,percent of total billed charges,,
BIOMET GENTAMYCIN ANTIBIOTIC CEMENT 57002229,,57002229,LOCAL,Facility,Outpatient,,,,737.5,626.875,211.3675,737.5,Aetna,Medicare Advantage,361.375,49,,percent of total billed charges,,
BIOMET GENTAMYCIN ANTIBIOTIC CEMENT 57002229,,57002229,LOCAL,Facility,Inpatient,,,,737.5,626.875,211.3675,737.5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
BIOMET GENTAMYCIN ANTIBIOTIC CEMENT 57002229,,57002229,LOCAL,Facility,Both,,,,737.5,626.875,211.3675,737.5,Aetna,PPO,685.875,93,,percent of total billed charges,,
BIOMET GENTAMYCIN ANTIBIOTIC CEMENT 57002229,,57002229,LOCAL,Facility,Both,,,,737.5,626.875,211.3675,737.5,America's PPO,America's PPO,708.22125,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
BIOMET GENTAMYCIN ANTIBIOTIC CEMENT 57002229,,57002229,LOCAL,Facility,Both,,,,737.5,626.875,211.3675,737.5,BlueCross BlueShield Minnesota, Federal Employee Program,725.7,98.4,,percent of total billed charges,,
BIOMET GENTAMYCIN ANTIBIOTIC CEMENT 57002229,,57002229,LOCAL,Facility,Both,,,,737.5,626.875,211.3675,737.5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,737.5,100,,percent of total billed charges,,
BIOMET GENTAMYCIN ANTIBIOTIC CEMENT 57002229,,57002229,LOCAL,Facility,Both,,,,737.5,626.875,211.3675,737.5,BlueCross BlueShield Minnesota,High Value Network Plan,663.75,90,,percent of total billed charges,,
BIOMET GENTAMYCIN ANTIBIOTIC CEMENT 57002229,,57002229,LOCAL,Facility,Outpatient,,,,737.5,626.875,211.3675,737.5,BlueCross BlueShield Minnesota,Medicare Advantage,361.375,49,,percent of total billed charges,,
BIOMET GENTAMYCIN ANTIBIOTIC CEMENT 57002229,,57002229,LOCAL,Facility,Inpatient,,,,737.5,626.875,211.3675,737.5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
BIOMET GENTAMYCIN ANTIBIOTIC CEMENT 57002229,,57002229,LOCAL,Facility,Both,,,,737.5,626.875,211.3675,737.5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,653.20375,88.57,,percent of total billed charges,,
BIOMET GENTAMYCIN ANTIBIOTIC CEMENT 57002229,,57002229,LOCAL,Facility,Both,,,,737.5,626.875,211.3675,737.5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,211.3675,28.66,,percent of total billed charges,,
BIOMET GENTAMYCIN ANTIBIOTIC CEMENT 57002229,,57002229,LOCAL,Facility,Outpatient,,,,737.5,626.875,211.3675,737.5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),361.375,49,,percent of total billed charges,,
BIOMET GENTAMYCIN ANTIBIOTIC CEMENT 57002229,,57002229,LOCAL,Facility,Inpatient,,,,737.5,626.875,211.3675,737.5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
BIOMET GENTAMYCIN ANTIBIOTIC CEMENT 57002229,,57002229,LOCAL,Facility,Both,,,,737.5,626.875,211.3675,737.5,CorVel,Worker's Compensation,737.5,100,,percent of total billed charges,,
BIOMET GENTAMYCIN ANTIBIOTIC CEMENT 57002229,,57002229,LOCAL,Facility,Both,,,,737.5,626.875,211.3675,737.5,First Health Group Corporation,First Health Network,715.375,97,,percent of total billed charges,,
BIOMET GENTAMYCIN ANTIBIOTIC CEMENT 57002229,,57002229,LOCAL,Facility,Both,,,,737.5,626.875,211.3675,737.5,"Health Partners, Inc.",Commercial,697.675,94.6,,percent of total billed charges,,
BIOMET GENTAMYCIN ANTIBIOTIC CEMENT 57002229,,57002229,LOCAL,Facility,Outpatient,,,,737.5,626.875,211.3675,737.5,"Health Partners, Inc.",Medicare Advantage,361.375,49,,percent of total billed charges,,
BIOMET GENTAMYCIN ANTIBIOTIC CEMENT 57002229,,57002229,LOCAL,Facility,Inpatient,,,,737.5,626.875,211.3675,737.5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
BIOMET GENTAMYCIN ANTIBIOTIC CEMENT 57002229,,57002229,LOCAL,Facility,Both,,,,737.5,626.875,211.3675,737.5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),442.5,60,,percent of total billed charges,,
BIOMET GENTAMYCIN ANTIBIOTIC CEMENT 57002229,,57002229,LOCAL,Facility,Both,,,,737.5,626.875,211.3675,737.5,"Health Partners, Inc.",State of Minnesota Advantage Program,601.0625,81.5,,percent of total billed charges,,
BIOMET GENTAMYCIN ANTIBIOTIC CEMENT 57002229,,57002229,LOCAL,Facility,Both,,,,737.5,626.875,211.3675,737.5,"Health Partners, Inc.",State Public Programs,368.75,50,,percent of total billed charges,,
BIOMET GENTAMYCIN ANTIBIOTIC CEMENT 57002229,,57002229,LOCAL,Facility,Both,,,,737.5,626.875,211.3675,737.5,Humana Insurance Company,Commercial PPO,700.625,95,,percent of total billed charges,,
BIOMET GENTAMYCIN ANTIBIOTIC CEMENT 57002229,,57002229,LOCAL,Facility,Outpatient,,,,737.5,626.875,211.3675,737.5,Humana Insurance Company,Medicare PPO,361.375,49,,percent of total billed charges,,
BIOMET GENTAMYCIN ANTIBIOTIC CEMENT 57002229,,57002229,LOCAL,Facility,Inpatient,,,,737.5,626.875,211.3675,737.5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
BIOMET GENTAMYCIN ANTIBIOTIC CEMENT 57002229,,57002229,LOCAL,Facility,Both,,,,737.5,626.875,211.3675,737.5,Medica,Individual & Family,730.8625,99.1,,percent of total billed charges,,
BIOMET GENTAMYCIN ANTIBIOTIC CEMENT 57002229,,57002229,LOCAL,Facility,Outpatient,,,,737.5,626.875,211.3675,737.5,Medica,Medica Advantage Solution,367.275,49.8,,percent of total billed charges,,
BIOMET GENTAMYCIN ANTIBIOTIC CEMENT 57002229,,57002229,LOCAL,Facility,Inpatient,,,,737.5,626.875,211.3675,737.5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
BIOMET GENTAMYCIN ANTIBIOTIC CEMENT 57002229,,57002229,LOCAL,Facility,Outpatient,,,,737.5,626.875,211.3675,737.5,Medica,Medical Assistance,328.925,44.6,,percent of total billed charges,,
BIOMET GENTAMYCIN ANTIBIOTIC CEMENT 57002229,,57002229,LOCAL,Facility,Inpatient,,,,737.5,626.875,211.3675,737.5,Medica,Medical Assistance,,,,,Included in per diem rate,
BIOMET GENTAMYCIN ANTIBIOTIC CEMENT 57002229,,57002229,LOCAL,Facility,Outpatient,,,,737.5,626.875,211.3675,737.5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,367.275,49.8,,percent of total billed charges,,
BIOMET GENTAMYCIN ANTIBIOTIC CEMENT 57002229,,57002229,LOCAL,Facility,Inpatient,,,,737.5,626.875,211.3675,737.5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
BIOMET GENTAMYCIN ANTIBIOTIC CEMENT 57002229,,57002229,LOCAL,Facility,Both,,,,737.5,626.875,211.3675,737.5,"Multiplan, Inc.","Multiplan, Inc.",693.25,94,,percent of total billed charges,,
BIOMET GENTAMYCIN ANTIBIOTIC CEMENT 57002229,,57002229,LOCAL,Facility,Outpatient,,,,737.5,626.875,211.3675,737.5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,664.4875,90.1,,percent of total billed charges,,
BIOMET GENTAMYCIN ANTIBIOTIC CEMENT 57002229,,57002229,LOCAL,Facility,Inpatient,,,,737.5,626.875,211.3675,737.5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
BIOMET GENTAMYCIN ANTIBIOTIC CEMENT 57002229,,57002229,LOCAL,Facility,Both,,,,737.5,626.875,211.3675,737.5,"Preferred One Administrative Services, INC.",PPO,727.175,98.6,,percent of total billed charges,,
BIOMET GENTAMYCIN ANTIBIOTIC CEMENT 57002229,,57002229,LOCAL,Facility,Outpatient,,,,737.5,626.875,211.3675,737.5,PrimeWest Health,Minnesota Senior Health Options (MSHO),379.44375,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
BIOMET GENTAMYCIN ANTIBIOTIC CEMENT 57002229,,57002229,LOCAL,Facility,Inpatient,,,,737.5,626.875,211.3675,737.5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
BIOMET GENTAMYCIN ANTIBIOTIC CEMENT 57002229,,57002229,LOCAL,Facility,Outpatient,,,,737.5,626.875,211.3675,737.5,PrimeWest Health,MinnesotaCare,378.78,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
BIOMET GENTAMYCIN ANTIBIOTIC CEMENT 57002229,,57002229,LOCAL,Facility,Inpatient,,,,737.5,626.875,211.3675,737.5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
BIOMET GENTAMYCIN ANTIBIOTIC CEMENT 57002229,,57002229,LOCAL,Facility,Both,,,,737.5,626.875,211.3675,737.5,Sanford Health Plan,Sanford Health Plan,678.5,92,,percent of total billed charges,,
BIOMET GENTAMYCIN ANTIBIOTIC CEMENT 57002229,,57002229,LOCAL,Facility,Outpatient,,,,737.5,626.875,211.3675,737.5,"UCare Health, Inc.",Individual & Family Plan,415.58125,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
BIOMET GENTAMYCIN ANTIBIOTIC CEMENT 57002229,,57002229,LOCAL,Facility,Inpatient,,,,737.5,626.875,211.3675,737.5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
BIOMET GENTAMYCIN ANTIBIOTIC CEMENT 57002229,,57002229,LOCAL,Facility,Outpatient,,,,737.5,626.875,211.3675,737.5,"UCare Health, Inc.",Medical Assistance,372.21625,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BIOMET GENTAMYCIN ANTIBIOTIC CEMENT 57002229,,57002229,LOCAL,Facility,Inpatient,,,,737.5,626.875,211.3675,737.5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
BIOMET GENTAMYCIN ANTIBIOTIC CEMENT 57002229,,57002229,LOCAL,Facility,Outpatient,,,,737.5,626.875,211.3675,737.5,"UCare Health, Inc.",Medicare Advantage,372.21625,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BIOMET GENTAMYCIN ANTIBIOTIC CEMENT 57002229,,57002229,LOCAL,Facility,Inpatient,,,,737.5,626.875,211.3675,737.5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
BIOMET GENTAMYCIN ANTIBIOTIC CEMENT 57002229,,57002229,LOCAL,Facility,Outpatient,,,,737.5,626.875,211.3675,737.5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),372.21625,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BIOMET GENTAMYCIN ANTIBIOTIC CEMENT 57002229,,57002229,LOCAL,Facility,Inpatient,,,,737.5,626.875,211.3675,737.5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
BIOMET GENTAMYCIN ANTIBIOTIC CEMENT 57002229,,57002229,LOCAL,Facility,Both,,,,737.5,626.875,211.3675,737.5,UnitedHealthcare,Individual & Family,693.25,94,,percent of total billed charges,,
BIOMET GENTAMYCIN ANTIBIOTIC CEMENT 57002229,,57002229,LOCAL,Facility,Outpatient,,,,737.5,626.875,211.3675,737.5,UnitedHealthcare,Medicare Advantage,361.375,49,,percent of total billed charges,,
BIOMET GENTAMYCIN ANTIBIOTIC CEMENT 57002229,,57002229,LOCAL,Facility,Inpatient,,,,737.5,626.875,211.3675,737.5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
BIOMET GENTAMYCIN ANTIBIOTIC CEMENT 57002229,,57002229,LOCAL,Facility,Outpatient,,,,737.5,626.875,211.3675,737.5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,354,48,,percent of total billed charges,,100% of DHS outpatient percentage
BIOMET GENTAMYCIN ANTIBIOTIC CEMENT 57002229,,57002229,LOCAL,Facility,Inpatient,,,,737.5,626.875,211.3675,737.5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
CLIPS HEMOLOK (MED/LARGE) 5MM  544230,,57002229,LOCAL,Facility,Both,,,,215.74,183.379,61.831084,215.74,Aetna,Commercial,198.4808,92,,percent of total billed charges,,
CLIPS HEMOLOK (MED/LARGE) 5MM  544230,,57002229,LOCAL,Facility,Outpatient,,,,215.74,183.379,61.831084,215.74,Aetna,Medicare Advantage,105.7126,49,,percent of total billed charges,,
CLIPS HEMOLOK (MED/LARGE) 5MM  544230,,57002229,LOCAL,Facility,Inpatient,,,,215.74,183.379,61.831084,215.74,Aetna,Medicare Advantage,,,,,Included in per diem rate,
CLIPS HEMOLOK (MED/LARGE) 5MM  544230,,57002229,LOCAL,Facility,Both,,,,215.74,183.379,61.831084,215.74,Aetna,PPO,200.6382,93,,percent of total billed charges,,
CLIPS HEMOLOK (MED/LARGE) 5MM  544230,,57002229,LOCAL,Facility,Both,,,,215.74,183.379,61.831084,215.74,America's PPO,America's PPO,207.175122,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
CLIPS HEMOLOK (MED/LARGE) 5MM  544230,,57002229,LOCAL,Facility,Both,,,,215.74,183.379,61.831084,215.74,BlueCross BlueShield Minnesota, Federal Employee Program,212.28816,98.4,,percent of total billed charges,,
CLIPS HEMOLOK (MED/LARGE) 5MM  544230,,57002229,LOCAL,Facility,Both,,,,215.74,183.379,61.831084,215.74,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,215.74,100,,percent of total billed charges,,
CLIPS HEMOLOK (MED/LARGE) 5MM  544230,,57002229,LOCAL,Facility,Both,,,,215.74,183.379,61.831084,215.74,BlueCross BlueShield Minnesota,High Value Network Plan,194.166,90,,percent of total billed charges,,
CLIPS HEMOLOK (MED/LARGE) 5MM  544230,,57002229,LOCAL,Facility,Outpatient,,,,215.74,183.379,61.831084,215.74,BlueCross BlueShield Minnesota,Medicare Advantage,105.7126,49,,percent of total billed charges,,
CLIPS HEMOLOK (MED/LARGE) 5MM  544230,,57002229,LOCAL,Facility,Inpatient,,,,215.74,183.379,61.831084,215.74,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
CLIPS HEMOLOK (MED/LARGE) 5MM  544230,,57002229,LOCAL,Facility,Both,,,,215.74,183.379,61.831084,215.74,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,191.080918,88.57,,percent of total billed charges,,
CLIPS HEMOLOK (MED/LARGE) 5MM  544230,,57002229,LOCAL,Facility,Both,,,,215.74,183.379,61.831084,215.74,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,61.831084,28.66,,percent of total billed charges,,
CLIPS HEMOLOK (MED/LARGE) 5MM  544230,,57002229,LOCAL,Facility,Outpatient,,,,215.74,183.379,61.831084,215.74,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),105.7126,49,,percent of total billed charges,,
CLIPS HEMOLOK (MED/LARGE) 5MM  544230,,57002229,LOCAL,Facility,Inpatient,,,,215.74,183.379,61.831084,215.74,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
CLIPS HEMOLOK (MED/LARGE) 5MM  544230,,57002229,LOCAL,Facility,Both,,,,215.74,183.379,61.831084,215.74,CorVel,Worker's Compensation,215.74,100,,percent of total billed charges,,
CLIPS HEMOLOK (MED/LARGE) 5MM  544230,,57002229,LOCAL,Facility,Both,,,,215.74,183.379,61.831084,215.74,First Health Group Corporation,First Health Network,209.2678,97,,percent of total billed charges,,
CLIPS HEMOLOK (MED/LARGE) 5MM  544230,,57002229,LOCAL,Facility,Both,,,,215.74,183.379,61.831084,215.74,"Health Partners, Inc.",Commercial,204.09004,94.6,,percent of total billed charges,,
CLIPS HEMOLOK (MED/LARGE) 5MM  544230,,57002229,LOCAL,Facility,Outpatient,,,,215.74,183.379,61.831084,215.74,"Health Partners, Inc.",Medicare Advantage,105.7126,49,,percent of total billed charges,,
CLIPS HEMOLOK (MED/LARGE) 5MM  544230,,57002229,LOCAL,Facility,Inpatient,,,,215.74,183.379,61.831084,215.74,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CLIPS HEMOLOK (MED/LARGE) 5MM  544230,,57002229,LOCAL,Facility,Both,,,,215.74,183.379,61.831084,215.74,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),129.444,60,,percent of total billed charges,,
CLIPS HEMOLOK (MED/LARGE) 5MM  544230,,57002229,LOCAL,Facility,Both,,,,215.74,183.379,61.831084,215.74,"Health Partners, Inc.",State of Minnesota Advantage Program,175.8281,81.5,,percent of total billed charges,,
CLIPS HEMOLOK (MED/LARGE) 5MM  544230,,57002229,LOCAL,Facility,Both,,,,215.74,183.379,61.831084,215.74,"Health Partners, Inc.",State Public Programs,107.87,50,,percent of total billed charges,,
CLIPS HEMOLOK (MED/LARGE) 5MM  544230,,57002229,LOCAL,Facility,Both,,,,215.74,183.379,61.831084,215.74,Humana Insurance Company,Commercial PPO,204.953,95,,percent of total billed charges,,
CLIPS HEMOLOK (MED/LARGE) 5MM  544230,,57002229,LOCAL,Facility,Outpatient,,,,215.74,183.379,61.831084,215.74,Humana Insurance Company,Medicare PPO,105.7126,49,,percent of total billed charges,,
CLIPS HEMOLOK (MED/LARGE) 5MM  544230,,57002229,LOCAL,Facility,Inpatient,,,,215.74,183.379,61.831084,215.74,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
CLIPS HEMOLOK (MED/LARGE) 5MM  544230,,57002229,LOCAL,Facility,Both,,,,215.74,183.379,61.831084,215.74,Medica,Individual & Family,213.79834,99.1,,percent of total billed charges,,
CLIPS HEMOLOK (MED/LARGE) 5MM  544230,,57002229,LOCAL,Facility,Outpatient,,,,215.74,183.379,61.831084,215.74,Medica,Medica Advantage Solution,107.43852,49.8,,percent of total billed charges,,
CLIPS HEMOLOK (MED/LARGE) 5MM  544230,,57002229,LOCAL,Facility,Inpatient,,,,215.74,183.379,61.831084,215.74,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
CLIPS HEMOLOK (MED/LARGE) 5MM  544230,,57002229,LOCAL,Facility,Outpatient,,,,215.74,183.379,61.831084,215.74,Medica,Medical Assistance,96.22004,44.6,,percent of total billed charges,,
CLIPS HEMOLOK (MED/LARGE) 5MM  544230,,57002229,LOCAL,Facility,Inpatient,,,,215.74,183.379,61.831084,215.74,Medica,Medical Assistance,,,,,Included in per diem rate,
CLIPS HEMOLOK (MED/LARGE) 5MM  544230,,57002229,LOCAL,Facility,Outpatient,,,,215.74,183.379,61.831084,215.74,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,107.43852,49.8,,percent of total billed charges,,
CLIPS HEMOLOK (MED/LARGE) 5MM  544230,,57002229,LOCAL,Facility,Inpatient,,,,215.74,183.379,61.831084,215.74,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
CLIPS HEMOLOK (MED/LARGE) 5MM  544230,,57002229,LOCAL,Facility,Both,,,,215.74,183.379,61.831084,215.74,"Multiplan, Inc.","Multiplan, Inc.",202.7956,94,,percent of total billed charges,,
CLIPS HEMOLOK (MED/LARGE) 5MM  544230,,57002229,LOCAL,Facility,Outpatient,,,,215.74,183.379,61.831084,215.74,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,194.38174,90.1,,percent of total billed charges,,
CLIPS HEMOLOK (MED/LARGE) 5MM  544230,,57002229,LOCAL,Facility,Inpatient,,,,215.74,183.379,61.831084,215.74,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
CLIPS HEMOLOK (MED/LARGE) 5MM  544230,,57002229,LOCAL,Facility,Both,,,,215.74,183.379,61.831084,215.74,"Preferred One Administrative Services, INC.",PPO,212.71964,98.6,,percent of total billed charges,,
CLIPS HEMOLOK (MED/LARGE) 5MM  544230,,57002229,LOCAL,Facility,Outpatient,,,,215.74,183.379,61.831084,215.74,PrimeWest Health,Minnesota Senior Health Options (MSHO),110.99823,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
CLIPS HEMOLOK (MED/LARGE) 5MM  544230,,57002229,LOCAL,Facility,Inpatient,,,,215.74,183.379,61.831084,215.74,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CLIPS HEMOLOK (MED/LARGE) 5MM  544230,,57002229,LOCAL,Facility,Outpatient,,,,215.74,183.379,61.831084,215.74,PrimeWest Health,MinnesotaCare,110.804064,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
CLIPS HEMOLOK (MED/LARGE) 5MM  544230,,57002229,LOCAL,Facility,Inpatient,,,,215.74,183.379,61.831084,215.74,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
CLIPS HEMOLOK (MED/LARGE) 5MM  544230,,57002229,LOCAL,Facility,Both,,,,215.74,183.379,61.831084,215.74,Sanford Health Plan,Sanford Health Plan,198.4808,92,,percent of total billed charges,,
CLIPS HEMOLOK (MED/LARGE) 5MM  544230,,57002229,LOCAL,Facility,Outpatient,,,,215.74,183.379,61.831084,215.74,"UCare Health, Inc.",Individual & Family Plan,121.56949,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
CLIPS HEMOLOK (MED/LARGE) 5MM  544230,,57002229,LOCAL,Facility,Inpatient,,,,215.74,183.379,61.831084,215.74,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
CLIPS HEMOLOK (MED/LARGE) 5MM  544230,,57002229,LOCAL,Facility,Outpatient,,,,215.74,183.379,61.831084,215.74,"UCare Health, Inc.",Medical Assistance,108.883978,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CLIPS HEMOLOK (MED/LARGE) 5MM  544230,,57002229,LOCAL,Facility,Inpatient,,,,215.74,183.379,61.831084,215.74,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
CLIPS HEMOLOK (MED/LARGE) 5MM  544230,,57002229,LOCAL,Facility,Outpatient,,,,215.74,183.379,61.831084,215.74,"UCare Health, Inc.",Medicare Advantage,108.883978,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CLIPS HEMOLOK (MED/LARGE) 5MM  544230,,57002229,LOCAL,Facility,Inpatient,,,,215.74,183.379,61.831084,215.74,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CLIPS HEMOLOK (MED/LARGE) 5MM  544230,,57002229,LOCAL,Facility,Outpatient,,,,215.74,183.379,61.831084,215.74,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),108.883978,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CLIPS HEMOLOK (MED/LARGE) 5MM  544230,,57002229,LOCAL,Facility,Inpatient,,,,215.74,183.379,61.831084,215.74,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CLIPS HEMOLOK (MED/LARGE) 5MM  544230,,57002229,LOCAL,Facility,Both,,,,215.74,183.379,61.831084,215.74,UnitedHealthcare,Individual & Family,202.7956,94,,percent of total billed charges,,
CLIPS HEMOLOK (MED/LARGE) 5MM  544230,,57002229,LOCAL,Facility,Outpatient,,,,215.74,183.379,61.831084,215.74,UnitedHealthcare,Medicare Advantage,105.7126,49,,percent of total billed charges,,
CLIPS HEMOLOK (MED/LARGE) 5MM  544230,,57002229,LOCAL,Facility,Inpatient,,,,215.74,183.379,61.831084,215.74,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
CLIPS HEMOLOK (MED/LARGE) 5MM  544230,,57002229,LOCAL,Facility,Outpatient,,,,215.74,183.379,61.831084,215.74,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,103.5552,48,,percent of total billed charges,,100% of DHS outpatient percentage
CLIPS HEMOLOK (MED/LARGE) 5MM  544230,,57002229,LOCAL,Facility,Inpatient,,,,215.74,183.379,61.831084,215.74,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
CORETRAX D 40MM STERILE PACK,,57002229,LOCAL,Facility,Both,,,,10788.2,9169.97,3091.89812,10788.2,Aetna,Commercial,9925.144,92,,percent of total billed charges,,
CORETRAX D 40MM STERILE PACK,,57002229,LOCAL,Facility,Outpatient,,,,10788.2,9169.97,3091.89812,10788.2,Aetna,Medicare Advantage,5286.218,49,,percent of total billed charges,,
CORETRAX D 40MM STERILE PACK,,57002229,LOCAL,Facility,Inpatient,,,,10788.2,9169.97,3091.89812,10788.2,Aetna,Medicare Advantage,,,,,Included in per diem rate,
CORETRAX D 40MM STERILE PACK,,57002229,LOCAL,Facility,Both,,,,10788.2,9169.97,3091.89812,10788.2,Aetna,PPO,10033.026,93,,percent of total billed charges,,
CORETRAX D 40MM STERILE PACK,,57002229,LOCAL,Facility,Both,,,,10788.2,9169.97,3091.89812,10788.2,America's PPO,America's PPO,10359.90846,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
CORETRAX D 40MM STERILE PACK,,57002229,LOCAL,Facility,Both,,,,10788.2,9169.97,3091.89812,10788.2,BlueCross BlueShield Minnesota, Federal Employee Program,10615.5888,98.4,,percent of total billed charges,,
CORETRAX D 40MM STERILE PACK,,57002229,LOCAL,Facility,Both,,,,10788.2,9169.97,3091.89812,10788.2,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,10788.2,100,,percent of total billed charges,,
CORETRAX D 40MM STERILE PACK,,57002229,LOCAL,Facility,Both,,,,10788.2,9169.97,3091.89812,10788.2,BlueCross BlueShield Minnesota,High Value Network Plan,9709.38,90,,percent of total billed charges,,
CORETRAX D 40MM STERILE PACK,,57002229,LOCAL,Facility,Outpatient,,,,10788.2,9169.97,3091.89812,10788.2,BlueCross BlueShield Minnesota,Medicare Advantage,5286.218,49,,percent of total billed charges,,
CORETRAX D 40MM STERILE PACK,,57002229,LOCAL,Facility,Inpatient,,,,10788.2,9169.97,3091.89812,10788.2,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
CORETRAX D 40MM STERILE PACK,,57002229,LOCAL,Facility,Both,,,,10788.2,9169.97,3091.89812,10788.2,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,9555.10874,88.57,,percent of total billed charges,,
CORETRAX D 40MM STERILE PACK,,57002229,LOCAL,Facility,Both,,,,10788.2,9169.97,3091.89812,10788.2,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,3091.89812,28.66,,percent of total billed charges,,
CORETRAX D 40MM STERILE PACK,,57002229,LOCAL,Facility,Outpatient,,,,10788.2,9169.97,3091.89812,10788.2,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),5286.218,49,,percent of total billed charges,,
CORETRAX D 40MM STERILE PACK,,57002229,LOCAL,Facility,Inpatient,,,,10788.2,9169.97,3091.89812,10788.2,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
CORETRAX D 40MM STERILE PACK,,57002229,LOCAL,Facility,Both,,,,10788.2,9169.97,3091.89812,10788.2,CorVel,Worker's Compensation,10788.2,100,,percent of total billed charges,,
CORETRAX D 40MM STERILE PACK,,57002229,LOCAL,Facility,Both,,,,10788.2,9169.97,3091.89812,10788.2,First Health Group Corporation,First Health Network,10464.554,97,,percent of total billed charges,,
CORETRAX D 40MM STERILE PACK,,57002229,LOCAL,Facility,Both,,,,10788.2,9169.97,3091.89812,10788.2,"Health Partners, Inc.",Commercial,10205.6372,94.6,,percent of total billed charges,,
CORETRAX D 40MM STERILE PACK,,57002229,LOCAL,Facility,Outpatient,,,,10788.2,9169.97,3091.89812,10788.2,"Health Partners, Inc.",Medicare Advantage,5286.218,49,,percent of total billed charges,,
CORETRAX D 40MM STERILE PACK,,57002229,LOCAL,Facility,Inpatient,,,,10788.2,9169.97,3091.89812,10788.2,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CORETRAX D 40MM STERILE PACK,,57002229,LOCAL,Facility,Both,,,,10788.2,9169.97,3091.89812,10788.2,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),6472.92,60,,percent of total billed charges,,
CORETRAX D 40MM STERILE PACK,,57002229,LOCAL,Facility,Both,,,,10788.2,9169.97,3091.89812,10788.2,"Health Partners, Inc.",State of Minnesota Advantage Program,8792.383,81.5,,percent of total billed charges,,
CORETRAX D 40MM STERILE PACK,,57002229,LOCAL,Facility,Both,,,,10788.2,9169.97,3091.89812,10788.2,"Health Partners, Inc.",State Public Programs,5394.1,50,,percent of total billed charges,,
CORETRAX D 40MM STERILE PACK,,57002229,LOCAL,Facility,Both,,,,10788.2,9169.97,3091.89812,10788.2,Humana Insurance Company,Commercial PPO,10248.79,95,,percent of total billed charges,,
CORETRAX D 40MM STERILE PACK,,57002229,LOCAL,Facility,Outpatient,,,,10788.2,9169.97,3091.89812,10788.2,Humana Insurance Company,Medicare PPO,5286.218,49,,percent of total billed charges,,
CORETRAX D 40MM STERILE PACK,,57002229,LOCAL,Facility,Inpatient,,,,10788.2,9169.97,3091.89812,10788.2,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
CORETRAX D 40MM STERILE PACK,,57002229,LOCAL,Facility,Both,,,,10788.2,9169.97,3091.89812,10788.2,Medica,Individual & Family,10691.1062,99.1,,percent of total billed charges,,
CORETRAX D 40MM STERILE PACK,,57002229,LOCAL,Facility,Outpatient,,,,10788.2,9169.97,3091.89812,10788.2,Medica,Medica Advantage Solution,5372.5236,49.8,,percent of total billed charges,,
CORETRAX D 40MM STERILE PACK,,57002229,LOCAL,Facility,Inpatient,,,,10788.2,9169.97,3091.89812,10788.2,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
CORETRAX D 40MM STERILE PACK,,57002229,LOCAL,Facility,Outpatient,,,,10788.2,9169.97,3091.89812,10788.2,Medica,Medical Assistance,4811.5372,44.6,,percent of total billed charges,,
CORETRAX D 40MM STERILE PACK,,57002229,LOCAL,Facility,Inpatient,,,,10788.2,9169.97,3091.89812,10788.2,Medica,Medical Assistance,,,,,Included in per diem rate,
CORETRAX D 40MM STERILE PACK,,57002229,LOCAL,Facility,Outpatient,,,,10788.2,9169.97,3091.89812,10788.2,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,5372.5236,49.8,,percent of total billed charges,,
CORETRAX D 40MM STERILE PACK,,57002229,LOCAL,Facility,Inpatient,,,,10788.2,9169.97,3091.89812,10788.2,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
CORETRAX D 40MM STERILE PACK,,57002229,LOCAL,Facility,Both,,,,10788.2,9169.97,3091.89812,10788.2,"Multiplan, Inc.","Multiplan, Inc.",10140.908,94,,percent of total billed charges,,
CORETRAX D 40MM STERILE PACK,,57002229,LOCAL,Facility,Outpatient,,,,10788.2,9169.97,3091.89812,10788.2,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,9720.1682,90.1,,percent of total billed charges,,
CORETRAX D 40MM STERILE PACK,,57002229,LOCAL,Facility,Inpatient,,,,10788.2,9169.97,3091.89812,10788.2,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
CORETRAX D 40MM STERILE PACK,,57002229,LOCAL,Facility,Both,,,,10788.2,9169.97,3091.89812,10788.2,"Preferred One Administrative Services, INC.",PPO,10637.1652,98.6,,percent of total billed charges,,
CORETRAX D 40MM STERILE PACK,,57002229,LOCAL,Facility,Outpatient,,,,10788.2,9169.97,3091.89812,10788.2,PrimeWest Health,Minnesota Senior Health Options (MSHO),5550.5289,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
CORETRAX D 40MM STERILE PACK,,57002229,LOCAL,Facility,Inpatient,,,,10788.2,9169.97,3091.89812,10788.2,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CORETRAX D 40MM STERILE PACK,,57002229,LOCAL,Facility,Outpatient,,,,10788.2,9169.97,3091.89812,10788.2,PrimeWest Health,MinnesotaCare,5540.81952,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
CORETRAX D 40MM STERILE PACK,,57002229,LOCAL,Facility,Inpatient,,,,10788.2,9169.97,3091.89812,10788.2,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
CORETRAX D 40MM STERILE PACK,,57002229,LOCAL,Facility,Both,,,,10788.2,9169.97,3091.89812,10788.2,Sanford Health Plan,Sanford Health Plan,9925.144,92,,percent of total billed charges,,
CORETRAX D 40MM STERILE PACK,,57002229,LOCAL,Facility,Outpatient,,,,10788.2,9169.97,3091.89812,10788.2,"UCare Health, Inc.",Individual & Family Plan,6079.1507,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
CORETRAX D 40MM STERILE PACK,,57002229,LOCAL,Facility,Inpatient,,,,10788.2,9169.97,3091.89812,10788.2,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
CORETRAX D 40MM STERILE PACK,,57002229,LOCAL,Facility,Outpatient,,,,10788.2,9169.97,3091.89812,10788.2,"UCare Health, Inc.",Medical Assistance,5444.80454,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CORETRAX D 40MM STERILE PACK,,57002229,LOCAL,Facility,Inpatient,,,,10788.2,9169.97,3091.89812,10788.2,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
CORETRAX D 40MM STERILE PACK,,57002229,LOCAL,Facility,Outpatient,,,,10788.2,9169.97,3091.89812,10788.2,"UCare Health, Inc.",Medicare Advantage,5444.80454,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CORETRAX D 40MM STERILE PACK,,57002229,LOCAL,Facility,Inpatient,,,,10788.2,9169.97,3091.89812,10788.2,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CORETRAX D 40MM STERILE PACK,,57002229,LOCAL,Facility,Outpatient,,,,10788.2,9169.97,3091.89812,10788.2,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),5444.80454,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CORETRAX D 40MM STERILE PACK,,57002229,LOCAL,Facility,Inpatient,,,,10788.2,9169.97,3091.89812,10788.2,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CORETRAX D 40MM STERILE PACK,,57002229,LOCAL,Facility,Both,,,,10788.2,9169.97,3091.89812,10788.2,UnitedHealthcare,Individual & Family,10140.908,94,,percent of total billed charges,,
CORETRAX D 40MM STERILE PACK,,57002229,LOCAL,Facility,Outpatient,,,,10788.2,9169.97,3091.89812,10788.2,UnitedHealthcare,Medicare Advantage,5286.218,49,,percent of total billed charges,,
CORETRAX D 40MM STERILE PACK,,57002229,LOCAL,Facility,Inpatient,,,,10788.2,9169.97,3091.89812,10788.2,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
CORETRAX D 40MM STERILE PACK,,57002229,LOCAL,Facility,Outpatient,,,,10788.2,9169.97,3091.89812,10788.2,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,5178.336,48,,percent of total billed charges,,100% of DHS outpatient percentage
CORETRAX D 40MM STERILE PACK,,57002229,LOCAL,Facility,Inpatient,,,,10788.2,9169.97,3091.89812,10788.2,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
DBM PUTTY 5CC TENSIZ,,57002229,LOCAL,Facility,Both,,,,3697.5,3142.875,1059.7035,3697.5,Aetna,Commercial,3401.7,92,,percent of total billed charges,,
DBM PUTTY 5CC TENSIZ,,57002229,LOCAL,Facility,Outpatient,,,,3697.5,3142.875,1059.7035,3697.5,Aetna,Medicare Advantage,1811.775,49,,percent of total billed charges,,
DBM PUTTY 5CC TENSIZ,,57002229,LOCAL,Facility,Inpatient,,,,3697.5,3142.875,1059.7035,3697.5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
DBM PUTTY 5CC TENSIZ,,57002229,LOCAL,Facility,Both,,,,3697.5,3142.875,1059.7035,3697.5,Aetna,PPO,3438.675,93,,percent of total billed charges,,
DBM PUTTY 5CC TENSIZ,,57002229,LOCAL,Facility,Both,,,,3697.5,3142.875,1059.7035,3697.5,America's PPO,America's PPO,3550.70925,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
DBM PUTTY 5CC TENSIZ,,57002229,LOCAL,Facility,Both,,,,3697.5,3142.875,1059.7035,3697.5,BlueCross BlueShield Minnesota, Federal Employee Program,3638.34,98.4,,percent of total billed charges,,
DBM PUTTY 5CC TENSIZ,,57002229,LOCAL,Facility,Both,,,,3697.5,3142.875,1059.7035,3697.5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,3697.5,100,,percent of total billed charges,,
DBM PUTTY 5CC TENSIZ,,57002229,LOCAL,Facility,Both,,,,3697.5,3142.875,1059.7035,3697.5,BlueCross BlueShield Minnesota,High Value Network Plan,3327.75,90,,percent of total billed charges,,
DBM PUTTY 5CC TENSIZ,,57002229,LOCAL,Facility,Outpatient,,,,3697.5,3142.875,1059.7035,3697.5,BlueCross BlueShield Minnesota,Medicare Advantage,1811.775,49,,percent of total billed charges,,
DBM PUTTY 5CC TENSIZ,,57002229,LOCAL,Facility,Inpatient,,,,3697.5,3142.875,1059.7035,3697.5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
DBM PUTTY 5CC TENSIZ,,57002229,LOCAL,Facility,Both,,,,3697.5,3142.875,1059.7035,3697.5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,3274.87575,88.57,,percent of total billed charges,,
DBM PUTTY 5CC TENSIZ,,57002229,LOCAL,Facility,Both,,,,3697.5,3142.875,1059.7035,3697.5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1059.7035,28.66,,percent of total billed charges,,
DBM PUTTY 5CC TENSIZ,,57002229,LOCAL,Facility,Outpatient,,,,3697.5,3142.875,1059.7035,3697.5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1811.775,49,,percent of total billed charges,,
DBM PUTTY 5CC TENSIZ,,57002229,LOCAL,Facility,Inpatient,,,,3697.5,3142.875,1059.7035,3697.5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
DBM PUTTY 5CC TENSIZ,,57002229,LOCAL,Facility,Both,,,,3697.5,3142.875,1059.7035,3697.5,CorVel,Worker's Compensation,3697.5,100,,percent of total billed charges,,
DBM PUTTY 5CC TENSIZ,,57002229,LOCAL,Facility,Both,,,,3697.5,3142.875,1059.7035,3697.5,First Health Group Corporation,First Health Network,3586.575,97,,percent of total billed charges,,
DBM PUTTY 5CC TENSIZ,,57002229,LOCAL,Facility,Both,,,,3697.5,3142.875,1059.7035,3697.5,"Health Partners, Inc.",Commercial,3497.835,94.6,,percent of total billed charges,,
DBM PUTTY 5CC TENSIZ,,57002229,LOCAL,Facility,Outpatient,,,,3697.5,3142.875,1059.7035,3697.5,"Health Partners, Inc.",Medicare Advantage,1811.775,49,,percent of total billed charges,,
DBM PUTTY 5CC TENSIZ,,57002229,LOCAL,Facility,Inpatient,,,,3697.5,3142.875,1059.7035,3697.5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DBM PUTTY 5CC TENSIZ,,57002229,LOCAL,Facility,Both,,,,3697.5,3142.875,1059.7035,3697.5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),2218.5,60,,percent of total billed charges,,
DBM PUTTY 5CC TENSIZ,,57002229,LOCAL,Facility,Both,,,,3697.5,3142.875,1059.7035,3697.5,"Health Partners, Inc.",State of Minnesota Advantage Program,3013.4625,81.5,,percent of total billed charges,,
DBM PUTTY 5CC TENSIZ,,57002229,LOCAL,Facility,Both,,,,3697.5,3142.875,1059.7035,3697.5,"Health Partners, Inc.",State Public Programs,1848.75,50,,percent of total billed charges,,
DBM PUTTY 5CC TENSIZ,,57002229,LOCAL,Facility,Both,,,,3697.5,3142.875,1059.7035,3697.5,Humana Insurance Company,Commercial PPO,3512.625,95,,percent of total billed charges,,
DBM PUTTY 5CC TENSIZ,,57002229,LOCAL,Facility,Outpatient,,,,3697.5,3142.875,1059.7035,3697.5,Humana Insurance Company,Medicare PPO,1811.775,49,,percent of total billed charges,,
DBM PUTTY 5CC TENSIZ,,57002229,LOCAL,Facility,Inpatient,,,,3697.5,3142.875,1059.7035,3697.5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
DBM PUTTY 5CC TENSIZ,,57002229,LOCAL,Facility,Both,,,,3697.5,3142.875,1059.7035,3697.5,Medica,Individual & Family,3664.2225,99.1,,percent of total billed charges,,
DBM PUTTY 5CC TENSIZ,,57002229,LOCAL,Facility,Outpatient,,,,3697.5,3142.875,1059.7035,3697.5,Medica,Medica Advantage Solution,1841.355,49.8,,percent of total billed charges,,
DBM PUTTY 5CC TENSIZ,,57002229,LOCAL,Facility,Inpatient,,,,3697.5,3142.875,1059.7035,3697.5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
DBM PUTTY 5CC TENSIZ,,57002229,LOCAL,Facility,Outpatient,,,,3697.5,3142.875,1059.7035,3697.5,Medica,Medical Assistance,1649.085,44.6,,percent of total billed charges,,
DBM PUTTY 5CC TENSIZ,,57002229,LOCAL,Facility,Inpatient,,,,3697.5,3142.875,1059.7035,3697.5,Medica,Medical Assistance,,,,,Included in per diem rate,
DBM PUTTY 5CC TENSIZ,,57002229,LOCAL,Facility,Outpatient,,,,3697.5,3142.875,1059.7035,3697.5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1841.355,49.8,,percent of total billed charges,,
DBM PUTTY 5CC TENSIZ,,57002229,LOCAL,Facility,Inpatient,,,,3697.5,3142.875,1059.7035,3697.5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
DBM PUTTY 5CC TENSIZ,,57002229,LOCAL,Facility,Both,,,,3697.5,3142.875,1059.7035,3697.5,"Multiplan, Inc.","Multiplan, Inc.",3475.65,94,,percent of total billed charges,,
DBM PUTTY 5CC TENSIZ,,57002229,LOCAL,Facility,Outpatient,,,,3697.5,3142.875,1059.7035,3697.5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,3331.4475,90.1,,percent of total billed charges,,
DBM PUTTY 5CC TENSIZ,,57002229,LOCAL,Facility,Inpatient,,,,3697.5,3142.875,1059.7035,3697.5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
DBM PUTTY 5CC TENSIZ,,57002229,LOCAL,Facility,Both,,,,3697.5,3142.875,1059.7035,3697.5,"Preferred One Administrative Services, INC.",PPO,3645.735,98.6,,percent of total billed charges,,
DBM PUTTY 5CC TENSIZ,,57002229,LOCAL,Facility,Outpatient,,,,3697.5,3142.875,1059.7035,3697.5,PrimeWest Health,Minnesota Senior Health Options (MSHO),1902.36375,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
DBM PUTTY 5CC TENSIZ,,57002229,LOCAL,Facility,Inpatient,,,,3697.5,3142.875,1059.7035,3697.5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DBM PUTTY 5CC TENSIZ,,57002229,LOCAL,Facility,Outpatient,,,,3697.5,3142.875,1059.7035,3697.5,PrimeWest Health,MinnesotaCare,1899.036,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
DBM PUTTY 5CC TENSIZ,,57002229,LOCAL,Facility,Inpatient,,,,3697.5,3142.875,1059.7035,3697.5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
DBM PUTTY 5CC TENSIZ,,57002229,LOCAL,Facility,Both,,,,3697.5,3142.875,1059.7035,3697.5,Sanford Health Plan,Sanford Health Plan,3401.7,92,,percent of total billed charges,,
DBM PUTTY 5CC TENSIZ,,57002229,LOCAL,Facility,Outpatient,,,,3697.5,3142.875,1059.7035,3697.5,"UCare Health, Inc.",Individual & Family Plan,2083.54125,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
DBM PUTTY 5CC TENSIZ,,57002229,LOCAL,Facility,Inpatient,,,,3697.5,3142.875,1059.7035,3697.5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
DBM PUTTY 5CC TENSIZ,,57002229,LOCAL,Facility,Outpatient,,,,3697.5,3142.875,1059.7035,3697.5,"UCare Health, Inc.",Medical Assistance,1866.12825,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DBM PUTTY 5CC TENSIZ,,57002229,LOCAL,Facility,Inpatient,,,,3697.5,3142.875,1059.7035,3697.5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
DBM PUTTY 5CC TENSIZ,,57002229,LOCAL,Facility,Outpatient,,,,3697.5,3142.875,1059.7035,3697.5,"UCare Health, Inc.",Medicare Advantage,1866.12825,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DBM PUTTY 5CC TENSIZ,,57002229,LOCAL,Facility,Inpatient,,,,3697.5,3142.875,1059.7035,3697.5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DBM PUTTY 5CC TENSIZ,,57002229,LOCAL,Facility,Outpatient,,,,3697.5,3142.875,1059.7035,3697.5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1866.12825,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DBM PUTTY 5CC TENSIZ,,57002229,LOCAL,Facility,Inpatient,,,,3697.5,3142.875,1059.7035,3697.5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DBM PUTTY 5CC TENSIZ,,57002229,LOCAL,Facility,Both,,,,3697.5,3142.875,1059.7035,3697.5,UnitedHealthcare,Individual & Family,3475.65,94,,percent of total billed charges,,
DBM PUTTY 5CC TENSIZ,,57002229,LOCAL,Facility,Outpatient,,,,3697.5,3142.875,1059.7035,3697.5,UnitedHealthcare,Medicare Advantage,1811.775,49,,percent of total billed charges,,
DBM PUTTY 5CC TENSIZ,,57002229,LOCAL,Facility,Inpatient,,,,3697.5,3142.875,1059.7035,3697.5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
DBM PUTTY 5CC TENSIZ,,57002229,LOCAL,Facility,Outpatient,,,,3697.5,3142.875,1059.7035,3697.5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1774.8,48,,percent of total billed charges,,100% of DHS outpatient percentage
DBM PUTTY 5CC TENSIZ,,57002229,LOCAL,Facility,Inpatient,,,,3697.5,3142.875,1059.7035,3697.5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
DBM PUTTY W/CHIPS 5CC TENSIX,,57002229,LOCAL,Facility,Both,,,,4471,3800.35,1281.3886,4471,Aetna,Commercial,4113.32,92,,percent of total billed charges,,
DBM PUTTY W/CHIPS 5CC TENSIX,,57002229,LOCAL,Facility,Outpatient,,,,4471,3800.35,1281.3886,4471,Aetna,Medicare Advantage,2190.79,49,,percent of total billed charges,,
DBM PUTTY W/CHIPS 5CC TENSIX,,57002229,LOCAL,Facility,Inpatient,,,,4471,3800.35,1281.3886,4471,Aetna,Medicare Advantage,,,,,Included in per diem rate,
DBM PUTTY W/CHIPS 5CC TENSIX,,57002229,LOCAL,Facility,Both,,,,4471,3800.35,1281.3886,4471,Aetna,PPO,4158.03,93,,percent of total billed charges,,
DBM PUTTY W/CHIPS 5CC TENSIX,,57002229,LOCAL,Facility,Both,,,,4471,3800.35,1281.3886,4471,America's PPO,America's PPO,4293.5013,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
DBM PUTTY W/CHIPS 5CC TENSIX,,57002229,LOCAL,Facility,Both,,,,4471,3800.35,1281.3886,4471,BlueCross BlueShield Minnesota, Federal Employee Program,4399.464,98.4,,percent of total billed charges,,
DBM PUTTY W/CHIPS 5CC TENSIX,,57002229,LOCAL,Facility,Both,,,,4471,3800.35,1281.3886,4471,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,4471,100,,percent of total billed charges,,
DBM PUTTY W/CHIPS 5CC TENSIX,,57002229,LOCAL,Facility,Both,,,,4471,3800.35,1281.3886,4471,BlueCross BlueShield Minnesota,High Value Network Plan,4023.9,90,,percent of total billed charges,,
DBM PUTTY W/CHIPS 5CC TENSIX,,57002229,LOCAL,Facility,Outpatient,,,,4471,3800.35,1281.3886,4471,BlueCross BlueShield Minnesota,Medicare Advantage,2190.79,49,,percent of total billed charges,,
DBM PUTTY W/CHIPS 5CC TENSIX,,57002229,LOCAL,Facility,Inpatient,,,,4471,3800.35,1281.3886,4471,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
DBM PUTTY W/CHIPS 5CC TENSIX,,57002229,LOCAL,Facility,Both,,,,4471,3800.35,1281.3886,4471,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,3959.9647,88.57,,percent of total billed charges,,
DBM PUTTY W/CHIPS 5CC TENSIX,,57002229,LOCAL,Facility,Both,,,,4471,3800.35,1281.3886,4471,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1281.3886,28.66,,percent of total billed charges,,
DBM PUTTY W/CHIPS 5CC TENSIX,,57002229,LOCAL,Facility,Outpatient,,,,4471,3800.35,1281.3886,4471,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2190.79,49,,percent of total billed charges,,
DBM PUTTY W/CHIPS 5CC TENSIX,,57002229,LOCAL,Facility,Inpatient,,,,4471,3800.35,1281.3886,4471,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
DBM PUTTY W/CHIPS 5CC TENSIX,,57002229,LOCAL,Facility,Both,,,,4471,3800.35,1281.3886,4471,CorVel,Worker's Compensation,4471,100,,percent of total billed charges,,
DBM PUTTY W/CHIPS 5CC TENSIX,,57002229,LOCAL,Facility,Both,,,,4471,3800.35,1281.3886,4471,First Health Group Corporation,First Health Network,4336.87,97,,percent of total billed charges,,
DBM PUTTY W/CHIPS 5CC TENSIX,,57002229,LOCAL,Facility,Both,,,,4471,3800.35,1281.3886,4471,"Health Partners, Inc.",Commercial,4229.566,94.6,,percent of total billed charges,,
DBM PUTTY W/CHIPS 5CC TENSIX,,57002229,LOCAL,Facility,Outpatient,,,,4471,3800.35,1281.3886,4471,"Health Partners, Inc.",Medicare Advantage,2190.79,49,,percent of total billed charges,,
DBM PUTTY W/CHIPS 5CC TENSIX,,57002229,LOCAL,Facility,Inpatient,,,,4471,3800.35,1281.3886,4471,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DBM PUTTY W/CHIPS 5CC TENSIX,,57002229,LOCAL,Facility,Both,,,,4471,3800.35,1281.3886,4471,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),2682.6,60,,percent of total billed charges,,
DBM PUTTY W/CHIPS 5CC TENSIX,,57002229,LOCAL,Facility,Both,,,,4471,3800.35,1281.3886,4471,"Health Partners, Inc.",State of Minnesota Advantage Program,3643.865,81.5,,percent of total billed charges,,
DBM PUTTY W/CHIPS 5CC TENSIX,,57002229,LOCAL,Facility,Both,,,,4471,3800.35,1281.3886,4471,"Health Partners, Inc.",State Public Programs,2235.5,50,,percent of total billed charges,,
DBM PUTTY W/CHIPS 5CC TENSIX,,57002229,LOCAL,Facility,Both,,,,4471,3800.35,1281.3886,4471,Humana Insurance Company,Commercial PPO,4247.45,95,,percent of total billed charges,,
DBM PUTTY W/CHIPS 5CC TENSIX,,57002229,LOCAL,Facility,Outpatient,,,,4471,3800.35,1281.3886,4471,Humana Insurance Company,Medicare PPO,2190.79,49,,percent of total billed charges,,
DBM PUTTY W/CHIPS 5CC TENSIX,,57002229,LOCAL,Facility,Inpatient,,,,4471,3800.35,1281.3886,4471,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
DBM PUTTY W/CHIPS 5CC TENSIX,,57002229,LOCAL,Facility,Both,,,,4471,3800.35,1281.3886,4471,Medica,Individual & Family,4430.761,99.1,,percent of total billed charges,,
DBM PUTTY W/CHIPS 5CC TENSIX,,57002229,LOCAL,Facility,Outpatient,,,,4471,3800.35,1281.3886,4471,Medica,Medica Advantage Solution,2226.558,49.8,,percent of total billed charges,,
DBM PUTTY W/CHIPS 5CC TENSIX,,57002229,LOCAL,Facility,Inpatient,,,,4471,3800.35,1281.3886,4471,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
DBM PUTTY W/CHIPS 5CC TENSIX,,57002229,LOCAL,Facility,Outpatient,,,,4471,3800.35,1281.3886,4471,Medica,Medical Assistance,1994.066,44.6,,percent of total billed charges,,
DBM PUTTY W/CHIPS 5CC TENSIX,,57002229,LOCAL,Facility,Inpatient,,,,4471,3800.35,1281.3886,4471,Medica,Medical Assistance,,,,,Included in per diem rate,
DBM PUTTY W/CHIPS 5CC TENSIX,,57002229,LOCAL,Facility,Outpatient,,,,4471,3800.35,1281.3886,4471,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2226.558,49.8,,percent of total billed charges,,
DBM PUTTY W/CHIPS 5CC TENSIX,,57002229,LOCAL,Facility,Inpatient,,,,4471,3800.35,1281.3886,4471,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
DBM PUTTY W/CHIPS 5CC TENSIX,,57002229,LOCAL,Facility,Both,,,,4471,3800.35,1281.3886,4471,"Multiplan, Inc.","Multiplan, Inc.",4202.74,94,,percent of total billed charges,,
DBM PUTTY W/CHIPS 5CC TENSIX,,57002229,LOCAL,Facility,Outpatient,,,,4471,3800.35,1281.3886,4471,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4028.371,90.1,,percent of total billed charges,,
DBM PUTTY W/CHIPS 5CC TENSIX,,57002229,LOCAL,Facility,Inpatient,,,,4471,3800.35,1281.3886,4471,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
DBM PUTTY W/CHIPS 5CC TENSIX,,57002229,LOCAL,Facility,Both,,,,4471,3800.35,1281.3886,4471,"Preferred One Administrative Services, INC.",PPO,4408.406,98.6,,percent of total billed charges,,
DBM PUTTY W/CHIPS 5CC TENSIX,,57002229,LOCAL,Facility,Outpatient,,,,4471,3800.35,1281.3886,4471,PrimeWest Health,Minnesota Senior Health Options (MSHO),2300.3295,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
DBM PUTTY W/CHIPS 5CC TENSIX,,57002229,LOCAL,Facility,Inpatient,,,,4471,3800.35,1281.3886,4471,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DBM PUTTY W/CHIPS 5CC TENSIX,,57002229,LOCAL,Facility,Outpatient,,,,4471,3800.35,1281.3886,4471,PrimeWest Health,MinnesotaCare,2296.3056,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
DBM PUTTY W/CHIPS 5CC TENSIX,,57002229,LOCAL,Facility,Inpatient,,,,4471,3800.35,1281.3886,4471,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
DBM PUTTY W/CHIPS 5CC TENSIX,,57002229,LOCAL,Facility,Both,,,,4471,3800.35,1281.3886,4471,Sanford Health Plan,Sanford Health Plan,4113.32,92,,percent of total billed charges,,
DBM PUTTY W/CHIPS 5CC TENSIX,,57002229,LOCAL,Facility,Outpatient,,,,4471,3800.35,1281.3886,4471,"UCare Health, Inc.",Individual & Family Plan,2519.4085,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
DBM PUTTY W/CHIPS 5CC TENSIX,,57002229,LOCAL,Facility,Inpatient,,,,4471,3800.35,1281.3886,4471,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
DBM PUTTY W/CHIPS 5CC TENSIX,,57002229,LOCAL,Facility,Outpatient,,,,4471,3800.35,1281.3886,4471,"UCare Health, Inc.",Medical Assistance,2256.5137,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DBM PUTTY W/CHIPS 5CC TENSIX,,57002229,LOCAL,Facility,Inpatient,,,,4471,3800.35,1281.3886,4471,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
DBM PUTTY W/CHIPS 5CC TENSIX,,57002229,LOCAL,Facility,Outpatient,,,,4471,3800.35,1281.3886,4471,"UCare Health, Inc.",Medicare Advantage,2256.5137,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DBM PUTTY W/CHIPS 5CC TENSIX,,57002229,LOCAL,Facility,Inpatient,,,,4471,3800.35,1281.3886,4471,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DBM PUTTY W/CHIPS 5CC TENSIX,,57002229,LOCAL,Facility,Outpatient,,,,4471,3800.35,1281.3886,4471,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2256.5137,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DBM PUTTY W/CHIPS 5CC TENSIX,,57002229,LOCAL,Facility,Inpatient,,,,4471,3800.35,1281.3886,4471,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DBM PUTTY W/CHIPS 5CC TENSIX,,57002229,LOCAL,Facility,Both,,,,4471,3800.35,1281.3886,4471,UnitedHealthcare,Individual & Family,4202.74,94,,percent of total billed charges,,
DBM PUTTY W/CHIPS 5CC TENSIX,,57002229,LOCAL,Facility,Outpatient,,,,4471,3800.35,1281.3886,4471,UnitedHealthcare,Medicare Advantage,2190.79,49,,percent of total billed charges,,
DBM PUTTY W/CHIPS 5CC TENSIX,,57002229,LOCAL,Facility,Inpatient,,,,4471,3800.35,1281.3886,4471,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
DBM PUTTY W/CHIPS 5CC TENSIX,,57002229,LOCAL,Facility,Outpatient,,,,4471,3800.35,1281.3886,4471,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2146.08,48,,percent of total billed charges,,100% of DHS outpatient percentage
DBM PUTTY W/CHIPS 5CC TENSIX,,57002229,LOCAL,Facility,Inpatient,,,,4471,3800.35,1281.3886,4471,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"EASYFUSE DYNAMIC COMPRESSION SYSTEM NITI, PC GF 30 25MMX30MM",,57002229,LOCAL,Facility,Both,,,,5963.6,5069.06,1709.16776,5963.6,Aetna,Commercial,5486.512,92,,percent of total billed charges,,
"EASYFUSE DYNAMIC COMPRESSION SYSTEM NITI, PC GF 30 25MMX30MM",,57002229,LOCAL,Facility,Outpatient,,,,5963.6,5069.06,1709.16776,5963.6,Aetna,Medicare Advantage,2922.164,49,,percent of total billed charges,,
"EASYFUSE DYNAMIC COMPRESSION SYSTEM NITI, PC GF 30 25MMX30MM",,57002229,LOCAL,Facility,Inpatient,,,,5963.6,5069.06,1709.16776,5963.6,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"EASYFUSE DYNAMIC COMPRESSION SYSTEM NITI, PC GF 30 25MMX30MM",,57002229,LOCAL,Facility,Both,,,,5963.6,5069.06,1709.16776,5963.6,Aetna,PPO,5546.148,93,,percent of total billed charges,,
"EASYFUSE DYNAMIC COMPRESSION SYSTEM NITI, PC GF 30 25MMX30MM",,57002229,LOCAL,Facility,Both,,,,5963.6,5069.06,1709.16776,5963.6,America's PPO,America's PPO,5726.84508,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"EASYFUSE DYNAMIC COMPRESSION SYSTEM NITI, PC GF 30 25MMX30MM",,57002229,LOCAL,Facility,Both,,,,5963.6,5069.06,1709.16776,5963.6,BlueCross BlueShield Minnesota, Federal Employee Program,5868.1824,98.4,,percent of total billed charges,,
"EASYFUSE DYNAMIC COMPRESSION SYSTEM NITI, PC GF 30 25MMX30MM",,57002229,LOCAL,Facility,Both,,,,5963.6,5069.06,1709.16776,5963.6,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5963.6,100,,percent of total billed charges,,
"EASYFUSE DYNAMIC COMPRESSION SYSTEM NITI, PC GF 30 25MMX30MM",,57002229,LOCAL,Facility,Both,,,,5963.6,5069.06,1709.16776,5963.6,BlueCross BlueShield Minnesota,High Value Network Plan,5367.24,90,,percent of total billed charges,,
"EASYFUSE DYNAMIC COMPRESSION SYSTEM NITI, PC GF 30 25MMX30MM",,57002229,LOCAL,Facility,Outpatient,,,,5963.6,5069.06,1709.16776,5963.6,BlueCross BlueShield Minnesota,Medicare Advantage,2922.164,49,,percent of total billed charges,,
"EASYFUSE DYNAMIC COMPRESSION SYSTEM NITI, PC GF 30 25MMX30MM",,57002229,LOCAL,Facility,Inpatient,,,,5963.6,5069.06,1709.16776,5963.6,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"EASYFUSE DYNAMIC COMPRESSION SYSTEM NITI, PC GF 30 25MMX30MM",,57002229,LOCAL,Facility,Both,,,,5963.6,5069.06,1709.16776,5963.6,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,5281.96052,88.57,,percent of total billed charges,,
"EASYFUSE DYNAMIC COMPRESSION SYSTEM NITI, PC GF 30 25MMX30MM",,57002229,LOCAL,Facility,Both,,,,5963.6,5069.06,1709.16776,5963.6,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1709.16776,28.66,,percent of total billed charges,,
"EASYFUSE DYNAMIC COMPRESSION SYSTEM NITI, PC GF 30 25MMX30MM",,57002229,LOCAL,Facility,Outpatient,,,,5963.6,5069.06,1709.16776,5963.6,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2922.164,49,,percent of total billed charges,,
"EASYFUSE DYNAMIC COMPRESSION SYSTEM NITI, PC GF 30 25MMX30MM",,57002229,LOCAL,Facility,Inpatient,,,,5963.6,5069.06,1709.16776,5963.6,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"EASYFUSE DYNAMIC COMPRESSION SYSTEM NITI, PC GF 30 25MMX30MM",,57002229,LOCAL,Facility,Both,,,,5963.6,5069.06,1709.16776,5963.6,CorVel,Worker's Compensation,5963.6,100,,percent of total billed charges,,
"EASYFUSE DYNAMIC COMPRESSION SYSTEM NITI, PC GF 30 25MMX30MM",,57002229,LOCAL,Facility,Both,,,,5963.6,5069.06,1709.16776,5963.6,First Health Group Corporation,First Health Network,5784.692,97,,percent of total billed charges,,
"EASYFUSE DYNAMIC COMPRESSION SYSTEM NITI, PC GF 30 25MMX30MM",,57002229,LOCAL,Facility,Both,,,,5963.6,5069.06,1709.16776,5963.6,"Health Partners, Inc.",Commercial,5641.5656,94.6,,percent of total billed charges,,
"EASYFUSE DYNAMIC COMPRESSION SYSTEM NITI, PC GF 30 25MMX30MM",,57002229,LOCAL,Facility,Outpatient,,,,5963.6,5069.06,1709.16776,5963.6,"Health Partners, Inc.",Medicare Advantage,2922.164,49,,percent of total billed charges,,
"EASYFUSE DYNAMIC COMPRESSION SYSTEM NITI, PC GF 30 25MMX30MM",,57002229,LOCAL,Facility,Inpatient,,,,5963.6,5069.06,1709.16776,5963.6,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"EASYFUSE DYNAMIC COMPRESSION SYSTEM NITI, PC GF 30 25MMX30MM",,57002229,LOCAL,Facility,Both,,,,5963.6,5069.06,1709.16776,5963.6,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3578.16,60,,percent of total billed charges,,
"EASYFUSE DYNAMIC COMPRESSION SYSTEM NITI, PC GF 30 25MMX30MM",,57002229,LOCAL,Facility,Both,,,,5963.6,5069.06,1709.16776,5963.6,"Health Partners, Inc.",State of Minnesota Advantage Program,4860.334,81.5,,percent of total billed charges,,
"EASYFUSE DYNAMIC COMPRESSION SYSTEM NITI, PC GF 30 25MMX30MM",,57002229,LOCAL,Facility,Both,,,,5963.6,5069.06,1709.16776,5963.6,"Health Partners, Inc.",State Public Programs,2981.8,50,,percent of total billed charges,,
"EASYFUSE DYNAMIC COMPRESSION SYSTEM NITI, PC GF 30 25MMX30MM",,57002229,LOCAL,Facility,Both,,,,5963.6,5069.06,1709.16776,5963.6,Humana Insurance Company,Commercial PPO,5665.42,95,,percent of total billed charges,,
"EASYFUSE DYNAMIC COMPRESSION SYSTEM NITI, PC GF 30 25MMX30MM",,57002229,LOCAL,Facility,Outpatient,,,,5963.6,5069.06,1709.16776,5963.6,Humana Insurance Company,Medicare PPO,2922.164,49,,percent of total billed charges,,
"EASYFUSE DYNAMIC COMPRESSION SYSTEM NITI, PC GF 30 25MMX30MM",,57002229,LOCAL,Facility,Inpatient,,,,5963.6,5069.06,1709.16776,5963.6,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"EASYFUSE DYNAMIC COMPRESSION SYSTEM NITI, PC GF 30 25MMX30MM",,57002229,LOCAL,Facility,Both,,,,5963.6,5069.06,1709.16776,5963.6,Medica,Individual & Family,5909.9276,99.1,,percent of total billed charges,,
"EASYFUSE DYNAMIC COMPRESSION SYSTEM NITI, PC GF 30 25MMX30MM",,57002229,LOCAL,Facility,Outpatient,,,,5963.6,5069.06,1709.16776,5963.6,Medica,Medica Advantage Solution,2969.8728,49.8,,percent of total billed charges,,
"EASYFUSE DYNAMIC COMPRESSION SYSTEM NITI, PC GF 30 25MMX30MM",,57002229,LOCAL,Facility,Inpatient,,,,5963.6,5069.06,1709.16776,5963.6,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"EASYFUSE DYNAMIC COMPRESSION SYSTEM NITI, PC GF 30 25MMX30MM",,57002229,LOCAL,Facility,Outpatient,,,,5963.6,5069.06,1709.16776,5963.6,Medica,Medical Assistance,2659.7656,44.6,,percent of total billed charges,,
"EASYFUSE DYNAMIC COMPRESSION SYSTEM NITI, PC GF 30 25MMX30MM",,57002229,LOCAL,Facility,Inpatient,,,,5963.6,5069.06,1709.16776,5963.6,Medica,Medical Assistance,,,,,Included in per diem rate,
"EASYFUSE DYNAMIC COMPRESSION SYSTEM NITI, PC GF 30 25MMX30MM",,57002229,LOCAL,Facility,Outpatient,,,,5963.6,5069.06,1709.16776,5963.6,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2969.8728,49.8,,percent of total billed charges,,
"EASYFUSE DYNAMIC COMPRESSION SYSTEM NITI, PC GF 30 25MMX30MM",,57002229,LOCAL,Facility,Inpatient,,,,5963.6,5069.06,1709.16776,5963.6,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"EASYFUSE DYNAMIC COMPRESSION SYSTEM NITI, PC GF 30 25MMX30MM",,57002229,LOCAL,Facility,Both,,,,5963.6,5069.06,1709.16776,5963.6,"Multiplan, Inc.","Multiplan, Inc.",5605.784,94,,percent of total billed charges,,
"EASYFUSE DYNAMIC COMPRESSION SYSTEM NITI, PC GF 30 25MMX30MM",,57002229,LOCAL,Facility,Outpatient,,,,5963.6,5069.06,1709.16776,5963.6,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,5373.2036,90.1,,percent of total billed charges,,
"EASYFUSE DYNAMIC COMPRESSION SYSTEM NITI, PC GF 30 25MMX30MM",,57002229,LOCAL,Facility,Inpatient,,,,5963.6,5069.06,1709.16776,5963.6,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"EASYFUSE DYNAMIC COMPRESSION SYSTEM NITI, PC GF 30 25MMX30MM",,57002229,LOCAL,Facility,Both,,,,5963.6,5069.06,1709.16776,5963.6,"Preferred One Administrative Services, INC.",PPO,5880.1096,98.6,,percent of total billed charges,,
"EASYFUSE DYNAMIC COMPRESSION SYSTEM NITI, PC GF 30 25MMX30MM",,57002229,LOCAL,Facility,Outpatient,,,,5963.6,5069.06,1709.16776,5963.6,PrimeWest Health,Minnesota Senior Health Options (MSHO),3068.2722,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"EASYFUSE DYNAMIC COMPRESSION SYSTEM NITI, PC GF 30 25MMX30MM",,57002229,LOCAL,Facility,Inpatient,,,,5963.6,5069.06,1709.16776,5963.6,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"EASYFUSE DYNAMIC COMPRESSION SYSTEM NITI, PC GF 30 25MMX30MM",,57002229,LOCAL,Facility,Outpatient,,,,5963.6,5069.06,1709.16776,5963.6,PrimeWest Health,MinnesotaCare,3062.90496,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"EASYFUSE DYNAMIC COMPRESSION SYSTEM NITI, PC GF 30 25MMX30MM",,57002229,LOCAL,Facility,Inpatient,,,,5963.6,5069.06,1709.16776,5963.6,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"EASYFUSE DYNAMIC COMPRESSION SYSTEM NITI, PC GF 30 25MMX30MM",,57002229,LOCAL,Facility,Both,,,,5963.6,5069.06,1709.16776,5963.6,Sanford Health Plan,Sanford Health Plan,5486.512,92,,percent of total billed charges,,
"EASYFUSE DYNAMIC COMPRESSION SYSTEM NITI, PC GF 30 25MMX30MM",,57002229,LOCAL,Facility,Outpatient,,,,5963.6,5069.06,1709.16776,5963.6,"UCare Health, Inc.",Individual & Family Plan,3360.4886,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"EASYFUSE DYNAMIC COMPRESSION SYSTEM NITI, PC GF 30 25MMX30MM",,57002229,LOCAL,Facility,Inpatient,,,,5963.6,5069.06,1709.16776,5963.6,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"EASYFUSE DYNAMIC COMPRESSION SYSTEM NITI, PC GF 30 25MMX30MM",,57002229,LOCAL,Facility,Outpatient,,,,5963.6,5069.06,1709.16776,5963.6,"UCare Health, Inc.",Medical Assistance,3009.82892,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"EASYFUSE DYNAMIC COMPRESSION SYSTEM NITI, PC GF 30 25MMX30MM",,57002229,LOCAL,Facility,Inpatient,,,,5963.6,5069.06,1709.16776,5963.6,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"EASYFUSE DYNAMIC COMPRESSION SYSTEM NITI, PC GF 30 25MMX30MM",,57002229,LOCAL,Facility,Outpatient,,,,5963.6,5069.06,1709.16776,5963.6,"UCare Health, Inc.",Medicare Advantage,3009.82892,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"EASYFUSE DYNAMIC COMPRESSION SYSTEM NITI, PC GF 30 25MMX30MM",,57002229,LOCAL,Facility,Inpatient,,,,5963.6,5069.06,1709.16776,5963.6,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"EASYFUSE DYNAMIC COMPRESSION SYSTEM NITI, PC GF 30 25MMX30MM",,57002229,LOCAL,Facility,Outpatient,,,,5963.6,5069.06,1709.16776,5963.6,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),3009.82892,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"EASYFUSE DYNAMIC COMPRESSION SYSTEM NITI, PC GF 30 25MMX30MM",,57002229,LOCAL,Facility,Inpatient,,,,5963.6,5069.06,1709.16776,5963.6,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"EASYFUSE DYNAMIC COMPRESSION SYSTEM NITI, PC GF 30 25MMX30MM",,57002229,LOCAL,Facility,Both,,,,5963.6,5069.06,1709.16776,5963.6,UnitedHealthcare,Individual & Family,5605.784,94,,percent of total billed charges,,
"EASYFUSE DYNAMIC COMPRESSION SYSTEM NITI, PC GF 30 25MMX30MM",,57002229,LOCAL,Facility,Outpatient,,,,5963.6,5069.06,1709.16776,5963.6,UnitedHealthcare,Medicare Advantage,2922.164,49,,percent of total billed charges,,
"EASYFUSE DYNAMIC COMPRESSION SYSTEM NITI, PC GF 30 25MMX30MM",,57002229,LOCAL,Facility,Inpatient,,,,5963.6,5069.06,1709.16776,5963.6,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"EASYFUSE DYNAMIC COMPRESSION SYSTEM NITI, PC GF 30 25MMX30MM",,57002229,LOCAL,Facility,Outpatient,,,,5963.6,5069.06,1709.16776,5963.6,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2862.528,48,,percent of total billed charges,,100% of DHS outpatient percentage
"EASYFUSE DYNAMIC COMPRESSION SYSTEM NITI, PC GF 30 25MMX30MM",,57002229,LOCAL,Facility,Inpatient,,,,5963.6,5069.06,1709.16776,5963.6,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
HEADED SCREW 2.5MM X 20MM,,57002229,LOCAL,Facility,Both,,,,945,803.25,270.837,945,Aetna,Commercial,869.4,92,,percent of total billed charges,,
HEADED SCREW 2.5MM X 20MM,,57002229,LOCAL,Facility,Outpatient,,,,945,803.25,270.837,945,Aetna,Medicare Advantage,463.05,49,,percent of total billed charges,,
HEADED SCREW 2.5MM X 20MM,,57002229,LOCAL,Facility,Inpatient,,,,945,803.25,270.837,945,Aetna,Medicare Advantage,,,,,Included in per diem rate,
HEADED SCREW 2.5MM X 20MM,,57002229,LOCAL,Facility,Both,,,,945,803.25,270.837,945,Aetna,PPO,878.85,93,,percent of total billed charges,,
HEADED SCREW 2.5MM X 20MM,,57002229,LOCAL,Facility,Both,,,,945,803.25,270.837,945,America's PPO,America's PPO,907.4835,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
HEADED SCREW 2.5MM X 20MM,,57002229,LOCAL,Facility,Both,,,,945,803.25,270.837,945,BlueCross BlueShield Minnesota, Federal Employee Program,929.88,98.4,,percent of total billed charges,,
HEADED SCREW 2.5MM X 20MM,,57002229,LOCAL,Facility,Both,,,,945,803.25,270.837,945,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,945,100,,percent of total billed charges,,
HEADED SCREW 2.5MM X 20MM,,57002229,LOCAL,Facility,Both,,,,945,803.25,270.837,945,BlueCross BlueShield Minnesota,High Value Network Plan,850.5,90,,percent of total billed charges,,
HEADED SCREW 2.5MM X 20MM,,57002229,LOCAL,Facility,Outpatient,,,,945,803.25,270.837,945,BlueCross BlueShield Minnesota,Medicare Advantage,463.05,49,,percent of total billed charges,,
HEADED SCREW 2.5MM X 20MM,,57002229,LOCAL,Facility,Inpatient,,,,945,803.25,270.837,945,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
HEADED SCREW 2.5MM X 20MM,,57002229,LOCAL,Facility,Both,,,,945,803.25,270.837,945,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,836.9865,88.57,,percent of total billed charges,,
HEADED SCREW 2.5MM X 20MM,,57002229,LOCAL,Facility,Both,,,,945,803.25,270.837,945,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,270.837,28.66,,percent of total billed charges,,
HEADED SCREW 2.5MM X 20MM,,57002229,LOCAL,Facility,Outpatient,,,,945,803.25,270.837,945,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),463.05,49,,percent of total billed charges,,
HEADED SCREW 2.5MM X 20MM,,57002229,LOCAL,Facility,Inpatient,,,,945,803.25,270.837,945,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
HEADED SCREW 2.5MM X 20MM,,57002229,LOCAL,Facility,Both,,,,945,803.25,270.837,945,CorVel,Worker's Compensation,945,100,,percent of total billed charges,,
HEADED SCREW 2.5MM X 20MM,,57002229,LOCAL,Facility,Both,,,,945,803.25,270.837,945,First Health Group Corporation,First Health Network,916.65,97,,percent of total billed charges,,
HEADED SCREW 2.5MM X 20MM,,57002229,LOCAL,Facility,Both,,,,945,803.25,270.837,945,"Health Partners, Inc.",Commercial,893.97,94.6,,percent of total billed charges,,
HEADED SCREW 2.5MM X 20MM,,57002229,LOCAL,Facility,Outpatient,,,,945,803.25,270.837,945,"Health Partners, Inc.",Medicare Advantage,463.05,49,,percent of total billed charges,,
HEADED SCREW 2.5MM X 20MM,,57002229,LOCAL,Facility,Inpatient,,,,945,803.25,270.837,945,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
HEADED SCREW 2.5MM X 20MM,,57002229,LOCAL,Facility,Both,,,,945,803.25,270.837,945,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),567,60,,percent of total billed charges,,
HEADED SCREW 2.5MM X 20MM,,57002229,LOCAL,Facility,Both,,,,945,803.25,270.837,945,"Health Partners, Inc.",State of Minnesota Advantage Program,770.175,81.5,,percent of total billed charges,,
HEADED SCREW 2.5MM X 20MM,,57002229,LOCAL,Facility,Both,,,,945,803.25,270.837,945,"Health Partners, Inc.",State Public Programs,472.5,50,,percent of total billed charges,,
HEADED SCREW 2.5MM X 20MM,,57002229,LOCAL,Facility,Both,,,,945,803.25,270.837,945,Humana Insurance Company,Commercial PPO,897.75,95,,percent of total billed charges,,
HEADED SCREW 2.5MM X 20MM,,57002229,LOCAL,Facility,Outpatient,,,,945,803.25,270.837,945,Humana Insurance Company,Medicare PPO,463.05,49,,percent of total billed charges,,
HEADED SCREW 2.5MM X 20MM,,57002229,LOCAL,Facility,Inpatient,,,,945,803.25,270.837,945,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
HEADED SCREW 2.5MM X 20MM,,57002229,LOCAL,Facility,Both,,,,945,803.25,270.837,945,Medica,Individual & Family,936.495,99.1,,percent of total billed charges,,
HEADED SCREW 2.5MM X 20MM,,57002229,LOCAL,Facility,Outpatient,,,,945,803.25,270.837,945,Medica,Medica Advantage Solution,470.61,49.8,,percent of total billed charges,,
HEADED SCREW 2.5MM X 20MM,,57002229,LOCAL,Facility,Inpatient,,,,945,803.25,270.837,945,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
HEADED SCREW 2.5MM X 20MM,,57002229,LOCAL,Facility,Outpatient,,,,945,803.25,270.837,945,Medica,Medical Assistance,421.47,44.6,,percent of total billed charges,,
HEADED SCREW 2.5MM X 20MM,,57002229,LOCAL,Facility,Inpatient,,,,945,803.25,270.837,945,Medica,Medical Assistance,,,,,Included in per diem rate,
HEADED SCREW 2.5MM X 20MM,,57002229,LOCAL,Facility,Outpatient,,,,945,803.25,270.837,945,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,470.61,49.8,,percent of total billed charges,,
HEADED SCREW 2.5MM X 20MM,,57002229,LOCAL,Facility,Inpatient,,,,945,803.25,270.837,945,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
HEADED SCREW 2.5MM X 20MM,,57002229,LOCAL,Facility,Both,,,,945,803.25,270.837,945,"Multiplan, Inc.","Multiplan, Inc.",888.3,94,,percent of total billed charges,,
HEADED SCREW 2.5MM X 20MM,,57002229,LOCAL,Facility,Outpatient,,,,945,803.25,270.837,945,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,851.445,90.1,,percent of total billed charges,,
HEADED SCREW 2.5MM X 20MM,,57002229,LOCAL,Facility,Inpatient,,,,945,803.25,270.837,945,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
HEADED SCREW 2.5MM X 20MM,,57002229,LOCAL,Facility,Both,,,,945,803.25,270.837,945,"Preferred One Administrative Services, INC.",PPO,931.77,98.6,,percent of total billed charges,,
HEADED SCREW 2.5MM X 20MM,,57002229,LOCAL,Facility,Outpatient,,,,945,803.25,270.837,945,PrimeWest Health,Minnesota Senior Health Options (MSHO),486.2025,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
HEADED SCREW 2.5MM X 20MM,,57002229,LOCAL,Facility,Inpatient,,,,945,803.25,270.837,945,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
HEADED SCREW 2.5MM X 20MM,,57002229,LOCAL,Facility,Outpatient,,,,945,803.25,270.837,945,PrimeWest Health,MinnesotaCare,485.352,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
HEADED SCREW 2.5MM X 20MM,,57002229,LOCAL,Facility,Inpatient,,,,945,803.25,270.837,945,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
HEADED SCREW 2.5MM X 20MM,,57002229,LOCAL,Facility,Both,,,,945,803.25,270.837,945,Sanford Health Plan,Sanford Health Plan,869.4,92,,percent of total billed charges,,
HEADED SCREW 2.5MM X 20MM,,57002229,LOCAL,Facility,Outpatient,,,,945,803.25,270.837,945,"UCare Health, Inc.",Individual & Family Plan,532.5075,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
HEADED SCREW 2.5MM X 20MM,,57002229,LOCAL,Facility,Inpatient,,,,945,803.25,270.837,945,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
HEADED SCREW 2.5MM X 20MM,,57002229,LOCAL,Facility,Outpatient,,,,945,803.25,270.837,945,"UCare Health, Inc.",Medical Assistance,476.9415,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
HEADED SCREW 2.5MM X 20MM,,57002229,LOCAL,Facility,Inpatient,,,,945,803.25,270.837,945,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
HEADED SCREW 2.5MM X 20MM,,57002229,LOCAL,Facility,Outpatient,,,,945,803.25,270.837,945,"UCare Health, Inc.",Medicare Advantage,476.9415,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
HEADED SCREW 2.5MM X 20MM,,57002229,LOCAL,Facility,Inpatient,,,,945,803.25,270.837,945,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
HEADED SCREW 2.5MM X 20MM,,57002229,LOCAL,Facility,Outpatient,,,,945,803.25,270.837,945,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),476.9415,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
HEADED SCREW 2.5MM X 20MM,,57002229,LOCAL,Facility,Inpatient,,,,945,803.25,270.837,945,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
HEADED SCREW 2.5MM X 20MM,,57002229,LOCAL,Facility,Both,,,,945,803.25,270.837,945,UnitedHealthcare,Individual & Family,888.3,94,,percent of total billed charges,,
HEADED SCREW 2.5MM X 20MM,,57002229,LOCAL,Facility,Outpatient,,,,945,803.25,270.837,945,UnitedHealthcare,Medicare Advantage,463.05,49,,percent of total billed charges,,
HEADED SCREW 2.5MM X 20MM,,57002229,LOCAL,Facility,Inpatient,,,,945,803.25,270.837,945,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
HEADED SCREW 2.5MM X 20MM,,57002229,LOCAL,Facility,Outpatient,,,,945,803.25,270.837,945,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,453.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
HEADED SCREW 2.5MM X 20MM,,57002229,LOCAL,Facility,Inpatient,,,,945,803.25,270.837,945,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
K WIRE 0.9X150 BLUNT TROCAR ORTHOLOC 3D  WRIGHT MED DSDS1009,,57002229,LOCAL,Facility,Both,,,,206.5,175.525,59.1829,206.5,Aetna,Commercial,189.98,92,,percent of total billed charges,,
K WIRE 0.9X150 BLUNT TROCAR ORTHOLOC 3D  WRIGHT MED DSDS1009,,57002229,LOCAL,Facility,Outpatient,,,,206.5,175.525,59.1829,206.5,Aetna,Medicare Advantage,101.185,49,,percent of total billed charges,,
K WIRE 0.9X150 BLUNT TROCAR ORTHOLOC 3D  WRIGHT MED DSDS1009,,57002229,LOCAL,Facility,Inpatient,,,,206.5,175.525,59.1829,206.5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
K WIRE 0.9X150 BLUNT TROCAR ORTHOLOC 3D  WRIGHT MED DSDS1009,,57002229,LOCAL,Facility,Both,,,,206.5,175.525,59.1829,206.5,Aetna,PPO,192.045,93,,percent of total billed charges,,
K WIRE 0.9X150 BLUNT TROCAR ORTHOLOC 3D  WRIGHT MED DSDS1009,,57002229,LOCAL,Facility,Both,,,,206.5,175.525,59.1829,206.5,America's PPO,America's PPO,198.30195,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
K WIRE 0.9X150 BLUNT TROCAR ORTHOLOC 3D  WRIGHT MED DSDS1009,,57002229,LOCAL,Facility,Both,,,,206.5,175.525,59.1829,206.5,BlueCross BlueShield Minnesota, Federal Employee Program,203.196,98.4,,percent of total billed charges,,
K WIRE 0.9X150 BLUNT TROCAR ORTHOLOC 3D  WRIGHT MED DSDS1009,,57002229,LOCAL,Facility,Both,,,,206.5,175.525,59.1829,206.5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,206.5,100,,percent of total billed charges,,
K WIRE 0.9X150 BLUNT TROCAR ORTHOLOC 3D  WRIGHT MED DSDS1009,,57002229,LOCAL,Facility,Both,,,,206.5,175.525,59.1829,206.5,BlueCross BlueShield Minnesota,High Value Network Plan,185.85,90,,percent of total billed charges,,
K WIRE 0.9X150 BLUNT TROCAR ORTHOLOC 3D  WRIGHT MED DSDS1009,,57002229,LOCAL,Facility,Outpatient,,,,206.5,175.525,59.1829,206.5,BlueCross BlueShield Minnesota,Medicare Advantage,101.185,49,,percent of total billed charges,,
K WIRE 0.9X150 BLUNT TROCAR ORTHOLOC 3D  WRIGHT MED DSDS1009,,57002229,LOCAL,Facility,Inpatient,,,,206.5,175.525,59.1829,206.5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
K WIRE 0.9X150 BLUNT TROCAR ORTHOLOC 3D  WRIGHT MED DSDS1009,,57002229,LOCAL,Facility,Both,,,,206.5,175.525,59.1829,206.5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,182.89705,88.57,,percent of total billed charges,,
K WIRE 0.9X150 BLUNT TROCAR ORTHOLOC 3D  WRIGHT MED DSDS1009,,57002229,LOCAL,Facility,Both,,,,206.5,175.525,59.1829,206.5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,59.1829,28.66,,percent of total billed charges,,
K WIRE 0.9X150 BLUNT TROCAR ORTHOLOC 3D  WRIGHT MED DSDS1009,,57002229,LOCAL,Facility,Outpatient,,,,206.5,175.525,59.1829,206.5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),101.185,49,,percent of total billed charges,,
K WIRE 0.9X150 BLUNT TROCAR ORTHOLOC 3D  WRIGHT MED DSDS1009,,57002229,LOCAL,Facility,Inpatient,,,,206.5,175.525,59.1829,206.5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
K WIRE 0.9X150 BLUNT TROCAR ORTHOLOC 3D  WRIGHT MED DSDS1009,,57002229,LOCAL,Facility,Both,,,,206.5,175.525,59.1829,206.5,CorVel,Worker's Compensation,206.5,100,,percent of total billed charges,,
K WIRE 0.9X150 BLUNT TROCAR ORTHOLOC 3D  WRIGHT MED DSDS1009,,57002229,LOCAL,Facility,Both,,,,206.5,175.525,59.1829,206.5,First Health Group Corporation,First Health Network,200.305,97,,percent of total billed charges,,
K WIRE 0.9X150 BLUNT TROCAR ORTHOLOC 3D  WRIGHT MED DSDS1009,,57002229,LOCAL,Facility,Both,,,,206.5,175.525,59.1829,206.5,"Health Partners, Inc.",Commercial,195.349,94.6,,percent of total billed charges,,
K WIRE 0.9X150 BLUNT TROCAR ORTHOLOC 3D  WRIGHT MED DSDS1009,,57002229,LOCAL,Facility,Outpatient,,,,206.5,175.525,59.1829,206.5,"Health Partners, Inc.",Medicare Advantage,101.185,49,,percent of total billed charges,,
K WIRE 0.9X150 BLUNT TROCAR ORTHOLOC 3D  WRIGHT MED DSDS1009,,57002229,LOCAL,Facility,Inpatient,,,,206.5,175.525,59.1829,206.5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
K WIRE 0.9X150 BLUNT TROCAR ORTHOLOC 3D  WRIGHT MED DSDS1009,,57002229,LOCAL,Facility,Both,,,,206.5,175.525,59.1829,206.5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),123.9,60,,percent of total billed charges,,
K WIRE 0.9X150 BLUNT TROCAR ORTHOLOC 3D  WRIGHT MED DSDS1009,,57002229,LOCAL,Facility,Both,,,,206.5,175.525,59.1829,206.5,"Health Partners, Inc.",State of Minnesota Advantage Program,168.2975,81.5,,percent of total billed charges,,
K WIRE 0.9X150 BLUNT TROCAR ORTHOLOC 3D  WRIGHT MED DSDS1009,,57002229,LOCAL,Facility,Both,,,,206.5,175.525,59.1829,206.5,"Health Partners, Inc.",State Public Programs,103.25,50,,percent of total billed charges,,
K WIRE 0.9X150 BLUNT TROCAR ORTHOLOC 3D  WRIGHT MED DSDS1009,,57002229,LOCAL,Facility,Both,,,,206.5,175.525,59.1829,206.5,Humana Insurance Company,Commercial PPO,196.175,95,,percent of total billed charges,,
K WIRE 0.9X150 BLUNT TROCAR ORTHOLOC 3D  WRIGHT MED DSDS1009,,57002229,LOCAL,Facility,Outpatient,,,,206.5,175.525,59.1829,206.5,Humana Insurance Company,Medicare PPO,101.185,49,,percent of total billed charges,,
K WIRE 0.9X150 BLUNT TROCAR ORTHOLOC 3D  WRIGHT MED DSDS1009,,57002229,LOCAL,Facility,Inpatient,,,,206.5,175.525,59.1829,206.5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
K WIRE 0.9X150 BLUNT TROCAR ORTHOLOC 3D  WRIGHT MED DSDS1009,,57002229,LOCAL,Facility,Both,,,,206.5,175.525,59.1829,206.5,Medica,Individual & Family,204.6415,99.1,,percent of total billed charges,,
K WIRE 0.9X150 BLUNT TROCAR ORTHOLOC 3D  WRIGHT MED DSDS1009,,57002229,LOCAL,Facility,Outpatient,,,,206.5,175.525,59.1829,206.5,Medica,Medica Advantage Solution,102.837,49.8,,percent of total billed charges,,
K WIRE 0.9X150 BLUNT TROCAR ORTHOLOC 3D  WRIGHT MED DSDS1009,,57002229,LOCAL,Facility,Inpatient,,,,206.5,175.525,59.1829,206.5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
K WIRE 0.9X150 BLUNT TROCAR ORTHOLOC 3D  WRIGHT MED DSDS1009,,57002229,LOCAL,Facility,Outpatient,,,,206.5,175.525,59.1829,206.5,Medica,Medical Assistance,92.099,44.6,,percent of total billed charges,,
K WIRE 0.9X150 BLUNT TROCAR ORTHOLOC 3D  WRIGHT MED DSDS1009,,57002229,LOCAL,Facility,Inpatient,,,,206.5,175.525,59.1829,206.5,Medica,Medical Assistance,,,,,Included in per diem rate,
K WIRE 0.9X150 BLUNT TROCAR ORTHOLOC 3D  WRIGHT MED DSDS1009,,57002229,LOCAL,Facility,Outpatient,,,,206.5,175.525,59.1829,206.5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,102.837,49.8,,percent of total billed charges,,
K WIRE 0.9X150 BLUNT TROCAR ORTHOLOC 3D  WRIGHT MED DSDS1009,,57002229,LOCAL,Facility,Inpatient,,,,206.5,175.525,59.1829,206.5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
K WIRE 0.9X150 BLUNT TROCAR ORTHOLOC 3D  WRIGHT MED DSDS1009,,57002229,LOCAL,Facility,Both,,,,206.5,175.525,59.1829,206.5,"Multiplan, Inc.","Multiplan, Inc.",194.11,94,,percent of total billed charges,,
K WIRE 0.9X150 BLUNT TROCAR ORTHOLOC 3D  WRIGHT MED DSDS1009,,57002229,LOCAL,Facility,Outpatient,,,,206.5,175.525,59.1829,206.5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,186.0565,90.1,,percent of total billed charges,,
K WIRE 0.9X150 BLUNT TROCAR ORTHOLOC 3D  WRIGHT MED DSDS1009,,57002229,LOCAL,Facility,Inpatient,,,,206.5,175.525,59.1829,206.5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
K WIRE 0.9X150 BLUNT TROCAR ORTHOLOC 3D  WRIGHT MED DSDS1009,,57002229,LOCAL,Facility,Both,,,,206.5,175.525,59.1829,206.5,"Preferred One Administrative Services, INC.",PPO,203.609,98.6,,percent of total billed charges,,
K WIRE 0.9X150 BLUNT TROCAR ORTHOLOC 3D  WRIGHT MED DSDS1009,,57002229,LOCAL,Facility,Outpatient,,,,206.5,175.525,59.1829,206.5,PrimeWest Health,Minnesota Senior Health Options (MSHO),106.24425,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
K WIRE 0.9X150 BLUNT TROCAR ORTHOLOC 3D  WRIGHT MED DSDS1009,,57002229,LOCAL,Facility,Inpatient,,,,206.5,175.525,59.1829,206.5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
K WIRE 0.9X150 BLUNT TROCAR ORTHOLOC 3D  WRIGHT MED DSDS1009,,57002229,LOCAL,Facility,Outpatient,,,,206.5,175.525,59.1829,206.5,PrimeWest Health,MinnesotaCare,106.0584,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
K WIRE 0.9X150 BLUNT TROCAR ORTHOLOC 3D  WRIGHT MED DSDS1009,,57002229,LOCAL,Facility,Inpatient,,,,206.5,175.525,59.1829,206.5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
K WIRE 0.9X150 BLUNT TROCAR ORTHOLOC 3D  WRIGHT MED DSDS1009,,57002229,LOCAL,Facility,Both,,,,206.5,175.525,59.1829,206.5,Sanford Health Plan,Sanford Health Plan,189.98,92,,percent of total billed charges,,
K WIRE 0.9X150 BLUNT TROCAR ORTHOLOC 3D  WRIGHT MED DSDS1009,,57002229,LOCAL,Facility,Outpatient,,,,206.5,175.525,59.1829,206.5,"UCare Health, Inc.",Individual & Family Plan,116.36275,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
K WIRE 0.9X150 BLUNT TROCAR ORTHOLOC 3D  WRIGHT MED DSDS1009,,57002229,LOCAL,Facility,Inpatient,,,,206.5,175.525,59.1829,206.5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
K WIRE 0.9X150 BLUNT TROCAR ORTHOLOC 3D  WRIGHT MED DSDS1009,,57002229,LOCAL,Facility,Outpatient,,,,206.5,175.525,59.1829,206.5,"UCare Health, Inc.",Medical Assistance,104.22055,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
K WIRE 0.9X150 BLUNT TROCAR ORTHOLOC 3D  WRIGHT MED DSDS1009,,57002229,LOCAL,Facility,Inpatient,,,,206.5,175.525,59.1829,206.5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
K WIRE 0.9X150 BLUNT TROCAR ORTHOLOC 3D  WRIGHT MED DSDS1009,,57002229,LOCAL,Facility,Outpatient,,,,206.5,175.525,59.1829,206.5,"UCare Health, Inc.",Medicare Advantage,104.22055,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
K WIRE 0.9X150 BLUNT TROCAR ORTHOLOC 3D  WRIGHT MED DSDS1009,,57002229,LOCAL,Facility,Inpatient,,,,206.5,175.525,59.1829,206.5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
K WIRE 0.9X150 BLUNT TROCAR ORTHOLOC 3D  WRIGHT MED DSDS1009,,57002229,LOCAL,Facility,Outpatient,,,,206.5,175.525,59.1829,206.5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),104.22055,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
K WIRE 0.9X150 BLUNT TROCAR ORTHOLOC 3D  WRIGHT MED DSDS1009,,57002229,LOCAL,Facility,Inpatient,,,,206.5,175.525,59.1829,206.5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
K WIRE 0.9X150 BLUNT TROCAR ORTHOLOC 3D  WRIGHT MED DSDS1009,,57002229,LOCAL,Facility,Both,,,,206.5,175.525,59.1829,206.5,UnitedHealthcare,Individual & Family,194.11,94,,percent of total billed charges,,
K WIRE 0.9X150 BLUNT TROCAR ORTHOLOC 3D  WRIGHT MED DSDS1009,,57002229,LOCAL,Facility,Outpatient,,,,206.5,175.525,59.1829,206.5,UnitedHealthcare,Medicare Advantage,101.185,49,,percent of total billed charges,,
K WIRE 0.9X150 BLUNT TROCAR ORTHOLOC 3D  WRIGHT MED DSDS1009,,57002229,LOCAL,Facility,Inpatient,,,,206.5,175.525,59.1829,206.5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
K WIRE 0.9X150 BLUNT TROCAR ORTHOLOC 3D  WRIGHT MED DSDS1009,,57002229,LOCAL,Facility,Outpatient,,,,206.5,175.525,59.1829,206.5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,99.12,48,,percent of total billed charges,,100% of DHS outpatient percentage
K WIRE 0.9X150 BLUNT TROCAR ORTHOLOC 3D  WRIGHT MED DSDS1009,,57002229,LOCAL,Facility,Inpatient,,,,206.5,175.525,59.1829,206.5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
K-WIRE 1.1 X150MM BLUNT/TROCAR  WRIGHT MED DSDS1011,,57002229,LOCAL,Facility,Both,,,,224,190.4,64.1984,224,Aetna,Commercial,206.08,92,,percent of total billed charges,,
K-WIRE 1.1 X150MM BLUNT/TROCAR  WRIGHT MED DSDS1011,,57002229,LOCAL,Facility,Outpatient,,,,224,190.4,64.1984,224,Aetna,Medicare Advantage,109.76,49,,percent of total billed charges,,
K-WIRE 1.1 X150MM BLUNT/TROCAR  WRIGHT MED DSDS1011,,57002229,LOCAL,Facility,Inpatient,,,,224,190.4,64.1984,224,Aetna,Medicare Advantage,,,,,Included in per diem rate,
K-WIRE 1.1 X150MM BLUNT/TROCAR  WRIGHT MED DSDS1011,,57002229,LOCAL,Facility,Both,,,,224,190.4,64.1984,224,Aetna,PPO,208.32,93,,percent of total billed charges,,
K-WIRE 1.1 X150MM BLUNT/TROCAR  WRIGHT MED DSDS1011,,57002229,LOCAL,Facility,Both,,,,224,190.4,64.1984,224,America's PPO,America's PPO,215.1072,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
K-WIRE 1.1 X150MM BLUNT/TROCAR  WRIGHT MED DSDS1011,,57002229,LOCAL,Facility,Both,,,,224,190.4,64.1984,224,BlueCross BlueShield Minnesota, Federal Employee Program,220.416,98.4,,percent of total billed charges,,
K-WIRE 1.1 X150MM BLUNT/TROCAR  WRIGHT MED DSDS1011,,57002229,LOCAL,Facility,Both,,,,224,190.4,64.1984,224,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,224,100,,percent of total billed charges,,
K-WIRE 1.1 X150MM BLUNT/TROCAR  WRIGHT MED DSDS1011,,57002229,LOCAL,Facility,Both,,,,224,190.4,64.1984,224,BlueCross BlueShield Minnesota,High Value Network Plan,201.6,90,,percent of total billed charges,,
K-WIRE 1.1 X150MM BLUNT/TROCAR  WRIGHT MED DSDS1011,,57002229,LOCAL,Facility,Outpatient,,,,224,190.4,64.1984,224,BlueCross BlueShield Minnesota,Medicare Advantage,109.76,49,,percent of total billed charges,,
K-WIRE 1.1 X150MM BLUNT/TROCAR  WRIGHT MED DSDS1011,,57002229,LOCAL,Facility,Inpatient,,,,224,190.4,64.1984,224,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
K-WIRE 1.1 X150MM BLUNT/TROCAR  WRIGHT MED DSDS1011,,57002229,LOCAL,Facility,Both,,,,224,190.4,64.1984,224,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,198.3968,88.57,,percent of total billed charges,,
K-WIRE 1.1 X150MM BLUNT/TROCAR  WRIGHT MED DSDS1011,,57002229,LOCAL,Facility,Both,,,,224,190.4,64.1984,224,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,64.1984,28.66,,percent of total billed charges,,
K-WIRE 1.1 X150MM BLUNT/TROCAR  WRIGHT MED DSDS1011,,57002229,LOCAL,Facility,Outpatient,,,,224,190.4,64.1984,224,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),109.76,49,,percent of total billed charges,,
K-WIRE 1.1 X150MM BLUNT/TROCAR  WRIGHT MED DSDS1011,,57002229,LOCAL,Facility,Inpatient,,,,224,190.4,64.1984,224,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
K-WIRE 1.1 X150MM BLUNT/TROCAR  WRIGHT MED DSDS1011,,57002229,LOCAL,Facility,Both,,,,224,190.4,64.1984,224,CorVel,Worker's Compensation,224,100,,percent of total billed charges,,
K-WIRE 1.1 X150MM BLUNT/TROCAR  WRIGHT MED DSDS1011,,57002229,LOCAL,Facility,Both,,,,224,190.4,64.1984,224,First Health Group Corporation,First Health Network,217.28,97,,percent of total billed charges,,
K-WIRE 1.1 X150MM BLUNT/TROCAR  WRIGHT MED DSDS1011,,57002229,LOCAL,Facility,Both,,,,224,190.4,64.1984,224,"Health Partners, Inc.",Commercial,211.904,94.6,,percent of total billed charges,,
K-WIRE 1.1 X150MM BLUNT/TROCAR  WRIGHT MED DSDS1011,,57002229,LOCAL,Facility,Outpatient,,,,224,190.4,64.1984,224,"Health Partners, Inc.",Medicare Advantage,109.76,49,,percent of total billed charges,,
K-WIRE 1.1 X150MM BLUNT/TROCAR  WRIGHT MED DSDS1011,,57002229,LOCAL,Facility,Inpatient,,,,224,190.4,64.1984,224,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
K-WIRE 1.1 X150MM BLUNT/TROCAR  WRIGHT MED DSDS1011,,57002229,LOCAL,Facility,Both,,,,224,190.4,64.1984,224,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),134.4,60,,percent of total billed charges,,
K-WIRE 1.1 X150MM BLUNT/TROCAR  WRIGHT MED DSDS1011,,57002229,LOCAL,Facility,Both,,,,224,190.4,64.1984,224,"Health Partners, Inc.",State of Minnesota Advantage Program,182.56,81.5,,percent of total billed charges,,
K-WIRE 1.1 X150MM BLUNT/TROCAR  WRIGHT MED DSDS1011,,57002229,LOCAL,Facility,Both,,,,224,190.4,64.1984,224,"Health Partners, Inc.",State Public Programs,112,50,,percent of total billed charges,,
K-WIRE 1.1 X150MM BLUNT/TROCAR  WRIGHT MED DSDS1011,,57002229,LOCAL,Facility,Both,,,,224,190.4,64.1984,224,Humana Insurance Company,Commercial PPO,212.8,95,,percent of total billed charges,,
K-WIRE 1.1 X150MM BLUNT/TROCAR  WRIGHT MED DSDS1011,,57002229,LOCAL,Facility,Outpatient,,,,224,190.4,64.1984,224,Humana Insurance Company,Medicare PPO,109.76,49,,percent of total billed charges,,
K-WIRE 1.1 X150MM BLUNT/TROCAR  WRIGHT MED DSDS1011,,57002229,LOCAL,Facility,Inpatient,,,,224,190.4,64.1984,224,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
K-WIRE 1.1 X150MM BLUNT/TROCAR  WRIGHT MED DSDS1011,,57002229,LOCAL,Facility,Both,,,,224,190.4,64.1984,224,Medica,Individual & Family,221.984,99.1,,percent of total billed charges,,
K-WIRE 1.1 X150MM BLUNT/TROCAR  WRIGHT MED DSDS1011,,57002229,LOCAL,Facility,Outpatient,,,,224,190.4,64.1984,224,Medica,Medica Advantage Solution,111.552,49.8,,percent of total billed charges,,
K-WIRE 1.1 X150MM BLUNT/TROCAR  WRIGHT MED DSDS1011,,57002229,LOCAL,Facility,Inpatient,,,,224,190.4,64.1984,224,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
K-WIRE 1.1 X150MM BLUNT/TROCAR  WRIGHT MED DSDS1011,,57002229,LOCAL,Facility,Outpatient,,,,224,190.4,64.1984,224,Medica,Medical Assistance,99.904,44.6,,percent of total billed charges,,
K-WIRE 1.1 X150MM BLUNT/TROCAR  WRIGHT MED DSDS1011,,57002229,LOCAL,Facility,Inpatient,,,,224,190.4,64.1984,224,Medica,Medical Assistance,,,,,Included in per diem rate,
K-WIRE 1.1 X150MM BLUNT/TROCAR  WRIGHT MED DSDS1011,,57002229,LOCAL,Facility,Outpatient,,,,224,190.4,64.1984,224,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,111.552,49.8,,percent of total billed charges,,
K-WIRE 1.1 X150MM BLUNT/TROCAR  WRIGHT MED DSDS1011,,57002229,LOCAL,Facility,Inpatient,,,,224,190.4,64.1984,224,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
K-WIRE 1.1 X150MM BLUNT/TROCAR  WRIGHT MED DSDS1011,,57002229,LOCAL,Facility,Both,,,,224,190.4,64.1984,224,"Multiplan, Inc.","Multiplan, Inc.",210.56,94,,percent of total billed charges,,
K-WIRE 1.1 X150MM BLUNT/TROCAR  WRIGHT MED DSDS1011,,57002229,LOCAL,Facility,Outpatient,,,,224,190.4,64.1984,224,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,201.824,90.1,,percent of total billed charges,,
K-WIRE 1.1 X150MM BLUNT/TROCAR  WRIGHT MED DSDS1011,,57002229,LOCAL,Facility,Inpatient,,,,224,190.4,64.1984,224,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
K-WIRE 1.1 X150MM BLUNT/TROCAR  WRIGHT MED DSDS1011,,57002229,LOCAL,Facility,Both,,,,224,190.4,64.1984,224,"Preferred One Administrative Services, INC.",PPO,220.864,98.6,,percent of total billed charges,,
K-WIRE 1.1 X150MM BLUNT/TROCAR  WRIGHT MED DSDS1011,,57002229,LOCAL,Facility,Outpatient,,,,224,190.4,64.1984,224,PrimeWest Health,Minnesota Senior Health Options (MSHO),115.248,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
K-WIRE 1.1 X150MM BLUNT/TROCAR  WRIGHT MED DSDS1011,,57002229,LOCAL,Facility,Inpatient,,,,224,190.4,64.1984,224,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
K-WIRE 1.1 X150MM BLUNT/TROCAR  WRIGHT MED DSDS1011,,57002229,LOCAL,Facility,Outpatient,,,,224,190.4,64.1984,224,PrimeWest Health,MinnesotaCare,115.0464,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
K-WIRE 1.1 X150MM BLUNT/TROCAR  WRIGHT MED DSDS1011,,57002229,LOCAL,Facility,Inpatient,,,,224,190.4,64.1984,224,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
K-WIRE 1.1 X150MM BLUNT/TROCAR  WRIGHT MED DSDS1011,,57002229,LOCAL,Facility,Both,,,,224,190.4,64.1984,224,Sanford Health Plan,Sanford Health Plan,206.08,92,,percent of total billed charges,,
K-WIRE 1.1 X150MM BLUNT/TROCAR  WRIGHT MED DSDS1011,,57002229,LOCAL,Facility,Outpatient,,,,224,190.4,64.1984,224,"UCare Health, Inc.",Individual & Family Plan,126.224,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
K-WIRE 1.1 X150MM BLUNT/TROCAR  WRIGHT MED DSDS1011,,57002229,LOCAL,Facility,Inpatient,,,,224,190.4,64.1984,224,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
K-WIRE 1.1 X150MM BLUNT/TROCAR  WRIGHT MED DSDS1011,,57002229,LOCAL,Facility,Outpatient,,,,224,190.4,64.1984,224,"UCare Health, Inc.",Medical Assistance,113.0528,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
K-WIRE 1.1 X150MM BLUNT/TROCAR  WRIGHT MED DSDS1011,,57002229,LOCAL,Facility,Inpatient,,,,224,190.4,64.1984,224,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
K-WIRE 1.1 X150MM BLUNT/TROCAR  WRIGHT MED DSDS1011,,57002229,LOCAL,Facility,Outpatient,,,,224,190.4,64.1984,224,"UCare Health, Inc.",Medicare Advantage,113.0528,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
K-WIRE 1.1 X150MM BLUNT/TROCAR  WRIGHT MED DSDS1011,,57002229,LOCAL,Facility,Inpatient,,,,224,190.4,64.1984,224,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
K-WIRE 1.1 X150MM BLUNT/TROCAR  WRIGHT MED DSDS1011,,57002229,LOCAL,Facility,Outpatient,,,,224,190.4,64.1984,224,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),113.0528,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
K-WIRE 1.1 X150MM BLUNT/TROCAR  WRIGHT MED DSDS1011,,57002229,LOCAL,Facility,Inpatient,,,,224,190.4,64.1984,224,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
K-WIRE 1.1 X150MM BLUNT/TROCAR  WRIGHT MED DSDS1011,,57002229,LOCAL,Facility,Both,,,,224,190.4,64.1984,224,UnitedHealthcare,Individual & Family,210.56,94,,percent of total billed charges,,
K-WIRE 1.1 X150MM BLUNT/TROCAR  WRIGHT MED DSDS1011,,57002229,LOCAL,Facility,Outpatient,,,,224,190.4,64.1984,224,UnitedHealthcare,Medicare Advantage,109.76,49,,percent of total billed charges,,
K-WIRE 1.1 X150MM BLUNT/TROCAR  WRIGHT MED DSDS1011,,57002229,LOCAL,Facility,Inpatient,,,,224,190.4,64.1984,224,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
K-WIRE 1.1 X150MM BLUNT/TROCAR  WRIGHT MED DSDS1011,,57002229,LOCAL,Facility,Outpatient,,,,224,190.4,64.1984,224,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,107.52,48,,percent of total billed charges,,100% of DHS outpatient percentage
K-WIRE 1.1 X150MM BLUNT/TROCAR  WRIGHT MED DSDS1011,,57002229,LOCAL,Facility,Inpatient,,,,224,190.4,64.1984,224,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
MESH Parietene Keyhole 15x17,,57002229,LOCAL,Facility,Both,,,,887.5,754.375,254.3575,887.5,Aetna,Commercial,816.5,92,,percent of total billed charges,,
MESH Parietene Keyhole 15x17,,57002229,LOCAL,Facility,Outpatient,,,,887.5,754.375,254.3575,887.5,Aetna,Medicare Advantage,434.875,49,,percent of total billed charges,,
MESH Parietene Keyhole 15x17,,57002229,LOCAL,Facility,Inpatient,,,,887.5,754.375,254.3575,887.5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
MESH Parietene Keyhole 15x17,,57002229,LOCAL,Facility,Both,,,,887.5,754.375,254.3575,887.5,Aetna,PPO,825.375,93,,percent of total billed charges,,
MESH Parietene Keyhole 15x17,,57002229,LOCAL,Facility,Both,,,,887.5,754.375,254.3575,887.5,America's PPO,America's PPO,852.26625,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
MESH Parietene Keyhole 15x17,,57002229,LOCAL,Facility,Both,,,,887.5,754.375,254.3575,887.5,BlueCross BlueShield Minnesota, Federal Employee Program,873.3,98.4,,percent of total billed charges,,
MESH Parietene Keyhole 15x17,,57002229,LOCAL,Facility,Both,,,,887.5,754.375,254.3575,887.5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,887.5,100,,percent of total billed charges,,
MESH Parietene Keyhole 15x17,,57002229,LOCAL,Facility,Both,,,,887.5,754.375,254.3575,887.5,BlueCross BlueShield Minnesota,High Value Network Plan,798.75,90,,percent of total billed charges,,
MESH Parietene Keyhole 15x17,,57002229,LOCAL,Facility,Outpatient,,,,887.5,754.375,254.3575,887.5,BlueCross BlueShield Minnesota,Medicare Advantage,434.875,49,,percent of total billed charges,,
MESH Parietene Keyhole 15x17,,57002229,LOCAL,Facility,Inpatient,,,,887.5,754.375,254.3575,887.5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
MESH Parietene Keyhole 15x17,,57002229,LOCAL,Facility,Both,,,,887.5,754.375,254.3575,887.5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,786.05875,88.57,,percent of total billed charges,,
MESH Parietene Keyhole 15x17,,57002229,LOCAL,Facility,Both,,,,887.5,754.375,254.3575,887.5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,254.3575,28.66,,percent of total billed charges,,
MESH Parietene Keyhole 15x17,,57002229,LOCAL,Facility,Outpatient,,,,887.5,754.375,254.3575,887.5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),434.875,49,,percent of total billed charges,,
MESH Parietene Keyhole 15x17,,57002229,LOCAL,Facility,Inpatient,,,,887.5,754.375,254.3575,887.5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
MESH Parietene Keyhole 15x17,,57002229,LOCAL,Facility,Both,,,,887.5,754.375,254.3575,887.5,CorVel,Worker's Compensation,887.5,100,,percent of total billed charges,,
MESH Parietene Keyhole 15x17,,57002229,LOCAL,Facility,Both,,,,887.5,754.375,254.3575,887.5,First Health Group Corporation,First Health Network,860.875,97,,percent of total billed charges,,
MESH Parietene Keyhole 15x17,,57002229,LOCAL,Facility,Both,,,,887.5,754.375,254.3575,887.5,"Health Partners, Inc.",Commercial,839.575,94.6,,percent of total billed charges,,
MESH Parietene Keyhole 15x17,,57002229,LOCAL,Facility,Outpatient,,,,887.5,754.375,254.3575,887.5,"Health Partners, Inc.",Medicare Advantage,434.875,49,,percent of total billed charges,,
MESH Parietene Keyhole 15x17,,57002229,LOCAL,Facility,Inpatient,,,,887.5,754.375,254.3575,887.5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
MESH Parietene Keyhole 15x17,,57002229,LOCAL,Facility,Both,,,,887.5,754.375,254.3575,887.5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),532.5,60,,percent of total billed charges,,
MESH Parietene Keyhole 15x17,,57002229,LOCAL,Facility,Both,,,,887.5,754.375,254.3575,887.5,"Health Partners, Inc.",State of Minnesota Advantage Program,723.3125,81.5,,percent of total billed charges,,
MESH Parietene Keyhole 15x17,,57002229,LOCAL,Facility,Both,,,,887.5,754.375,254.3575,887.5,"Health Partners, Inc.",State Public Programs,443.75,50,,percent of total billed charges,,
MESH Parietene Keyhole 15x17,,57002229,LOCAL,Facility,Both,,,,887.5,754.375,254.3575,887.5,Humana Insurance Company,Commercial PPO,843.125,95,,percent of total billed charges,,
MESH Parietene Keyhole 15x17,,57002229,LOCAL,Facility,Outpatient,,,,887.5,754.375,254.3575,887.5,Humana Insurance Company,Medicare PPO,434.875,49,,percent of total billed charges,,
MESH Parietene Keyhole 15x17,,57002229,LOCAL,Facility,Inpatient,,,,887.5,754.375,254.3575,887.5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
MESH Parietene Keyhole 15x17,,57002229,LOCAL,Facility,Both,,,,887.5,754.375,254.3575,887.5,Medica,Individual & Family,879.5125,99.1,,percent of total billed charges,,
MESH Parietene Keyhole 15x17,,57002229,LOCAL,Facility,Outpatient,,,,887.5,754.375,254.3575,887.5,Medica,Medica Advantage Solution,441.975,49.8,,percent of total billed charges,,
MESH Parietene Keyhole 15x17,,57002229,LOCAL,Facility,Inpatient,,,,887.5,754.375,254.3575,887.5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
MESH Parietene Keyhole 15x17,,57002229,LOCAL,Facility,Outpatient,,,,887.5,754.375,254.3575,887.5,Medica,Medical Assistance,395.825,44.6,,percent of total billed charges,,
MESH Parietene Keyhole 15x17,,57002229,LOCAL,Facility,Inpatient,,,,887.5,754.375,254.3575,887.5,Medica,Medical Assistance,,,,,Included in per diem rate,
MESH Parietene Keyhole 15x17,,57002229,LOCAL,Facility,Outpatient,,,,887.5,754.375,254.3575,887.5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,441.975,49.8,,percent of total billed charges,,
MESH Parietene Keyhole 15x17,,57002229,LOCAL,Facility,Inpatient,,,,887.5,754.375,254.3575,887.5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
MESH Parietene Keyhole 15x17,,57002229,LOCAL,Facility,Both,,,,887.5,754.375,254.3575,887.5,"Multiplan, Inc.","Multiplan, Inc.",834.25,94,,percent of total billed charges,,
MESH Parietene Keyhole 15x17,,57002229,LOCAL,Facility,Outpatient,,,,887.5,754.375,254.3575,887.5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,799.6375,90.1,,percent of total billed charges,,
MESH Parietene Keyhole 15x17,,57002229,LOCAL,Facility,Inpatient,,,,887.5,754.375,254.3575,887.5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
MESH Parietene Keyhole 15x17,,57002229,LOCAL,Facility,Both,,,,887.5,754.375,254.3575,887.5,"Preferred One Administrative Services, INC.",PPO,875.075,98.6,,percent of total billed charges,,
MESH Parietene Keyhole 15x17,,57002229,LOCAL,Facility,Outpatient,,,,887.5,754.375,254.3575,887.5,PrimeWest Health,Minnesota Senior Health Options (MSHO),456.61875,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
MESH Parietene Keyhole 15x17,,57002229,LOCAL,Facility,Inpatient,,,,887.5,754.375,254.3575,887.5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
MESH Parietene Keyhole 15x17,,57002229,LOCAL,Facility,Outpatient,,,,887.5,754.375,254.3575,887.5,PrimeWest Health,MinnesotaCare,455.82,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
MESH Parietene Keyhole 15x17,,57002229,LOCAL,Facility,Inpatient,,,,887.5,754.375,254.3575,887.5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
MESH Parietene Keyhole 15x17,,57002229,LOCAL,Facility,Both,,,,887.5,754.375,254.3575,887.5,Sanford Health Plan,Sanford Health Plan,816.5,92,,percent of total billed charges,,
MESH Parietene Keyhole 15x17,,57002229,LOCAL,Facility,Outpatient,,,,887.5,754.375,254.3575,887.5,"UCare Health, Inc.",Individual & Family Plan,500.10625,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
MESH Parietene Keyhole 15x17,,57002229,LOCAL,Facility,Inpatient,,,,887.5,754.375,254.3575,887.5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
MESH Parietene Keyhole 15x17,,57002229,LOCAL,Facility,Outpatient,,,,887.5,754.375,254.3575,887.5,"UCare Health, Inc.",Medical Assistance,447.92125,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MESH Parietene Keyhole 15x17,,57002229,LOCAL,Facility,Inpatient,,,,887.5,754.375,254.3575,887.5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
MESH Parietene Keyhole 15x17,,57002229,LOCAL,Facility,Outpatient,,,,887.5,754.375,254.3575,887.5,"UCare Health, Inc.",Medicare Advantage,447.92125,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MESH Parietene Keyhole 15x17,,57002229,LOCAL,Facility,Inpatient,,,,887.5,754.375,254.3575,887.5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
MESH Parietene Keyhole 15x17,,57002229,LOCAL,Facility,Outpatient,,,,887.5,754.375,254.3575,887.5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),447.92125,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MESH Parietene Keyhole 15x17,,57002229,LOCAL,Facility,Inpatient,,,,887.5,754.375,254.3575,887.5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
MESH Parietene Keyhole 15x17,,57002229,LOCAL,Facility,Both,,,,887.5,754.375,254.3575,887.5,UnitedHealthcare,Individual & Family,834.25,94,,percent of total billed charges,,
MESH Parietene Keyhole 15x17,,57002229,LOCAL,Facility,Outpatient,,,,887.5,754.375,254.3575,887.5,UnitedHealthcare,Medicare Advantage,434.875,49,,percent of total billed charges,,
MESH Parietene Keyhole 15x17,,57002229,LOCAL,Facility,Inpatient,,,,887.5,754.375,254.3575,887.5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
MESH Parietene Keyhole 15x17,,57002229,LOCAL,Facility,Outpatient,,,,887.5,754.375,254.3575,887.5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,426,48,,percent of total billed charges,,100% of DHS outpatient percentage
MESH Parietene Keyhole 15x17,,57002229,LOCAL,Facility,Inpatient,,,,887.5,754.375,254.3575,887.5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
MESH Plug Perfix Size Medium 1.3x1.55,,57002229,LOCAL,Facility,Both,,,,390,331.5,111.774,390,Aetna,Commercial,358.8,92,,percent of total billed charges,,
MESH Plug Perfix Size Medium 1.3x1.55,,57002229,LOCAL,Facility,Outpatient,,,,390,331.5,111.774,390,Aetna,Medicare Advantage,191.1,49,,percent of total billed charges,,
MESH Plug Perfix Size Medium 1.3x1.55,,57002229,LOCAL,Facility,Inpatient,,,,390,331.5,111.774,390,Aetna,Medicare Advantage,,,,,Included in per diem rate,
MESH Plug Perfix Size Medium 1.3x1.55,,57002229,LOCAL,Facility,Both,,,,390,331.5,111.774,390,Aetna,PPO,362.7,93,,percent of total billed charges,,
MESH Plug Perfix Size Medium 1.3x1.55,,57002229,LOCAL,Facility,Both,,,,390,331.5,111.774,390,America's PPO,America's PPO,374.517,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
MESH Plug Perfix Size Medium 1.3x1.55,,57002229,LOCAL,Facility,Both,,,,390,331.5,111.774,390,BlueCross BlueShield Minnesota, Federal Employee Program,383.76,98.4,,percent of total billed charges,,
MESH Plug Perfix Size Medium 1.3x1.55,,57002229,LOCAL,Facility,Both,,,,390,331.5,111.774,390,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,390,100,,percent of total billed charges,,
MESH Plug Perfix Size Medium 1.3x1.55,,57002229,LOCAL,Facility,Both,,,,390,331.5,111.774,390,BlueCross BlueShield Minnesota,High Value Network Plan,351,90,,percent of total billed charges,,
MESH Plug Perfix Size Medium 1.3x1.55,,57002229,LOCAL,Facility,Outpatient,,,,390,331.5,111.774,390,BlueCross BlueShield Minnesota,Medicare Advantage,191.1,49,,percent of total billed charges,,
MESH Plug Perfix Size Medium 1.3x1.55,,57002229,LOCAL,Facility,Inpatient,,,,390,331.5,111.774,390,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
MESH Plug Perfix Size Medium 1.3x1.55,,57002229,LOCAL,Facility,Both,,,,390,331.5,111.774,390,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,345.423,88.57,,percent of total billed charges,,
MESH Plug Perfix Size Medium 1.3x1.55,,57002229,LOCAL,Facility,Both,,,,390,331.5,111.774,390,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,111.774,28.66,,percent of total billed charges,,
MESH Plug Perfix Size Medium 1.3x1.55,,57002229,LOCAL,Facility,Outpatient,,,,390,331.5,111.774,390,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),191.1,49,,percent of total billed charges,,
MESH Plug Perfix Size Medium 1.3x1.55,,57002229,LOCAL,Facility,Inpatient,,,,390,331.5,111.774,390,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
MESH Plug Perfix Size Medium 1.3x1.55,,57002229,LOCAL,Facility,Both,,,,390,331.5,111.774,390,CorVel,Worker's Compensation,390,100,,percent of total billed charges,,
MESH Plug Perfix Size Medium 1.3x1.55,,57002229,LOCAL,Facility,Both,,,,390,331.5,111.774,390,First Health Group Corporation,First Health Network,378.3,97,,percent of total billed charges,,
MESH Plug Perfix Size Medium 1.3x1.55,,57002229,LOCAL,Facility,Both,,,,390,331.5,111.774,390,"Health Partners, Inc.",Commercial,368.94,94.6,,percent of total billed charges,,
MESH Plug Perfix Size Medium 1.3x1.55,,57002229,LOCAL,Facility,Outpatient,,,,390,331.5,111.774,390,"Health Partners, Inc.",Medicare Advantage,191.1,49,,percent of total billed charges,,
MESH Plug Perfix Size Medium 1.3x1.55,,57002229,LOCAL,Facility,Inpatient,,,,390,331.5,111.774,390,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
MESH Plug Perfix Size Medium 1.3x1.55,,57002229,LOCAL,Facility,Both,,,,390,331.5,111.774,390,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),234,60,,percent of total billed charges,,
MESH Plug Perfix Size Medium 1.3x1.55,,57002229,LOCAL,Facility,Both,,,,390,331.5,111.774,390,"Health Partners, Inc.",State of Minnesota Advantage Program,317.85,81.5,,percent of total billed charges,,
MESH Plug Perfix Size Medium 1.3x1.55,,57002229,LOCAL,Facility,Both,,,,390,331.5,111.774,390,"Health Partners, Inc.",State Public Programs,195,50,,percent of total billed charges,,
MESH Plug Perfix Size Medium 1.3x1.55,,57002229,LOCAL,Facility,Both,,,,390,331.5,111.774,390,Humana Insurance Company,Commercial PPO,370.5,95,,percent of total billed charges,,
MESH Plug Perfix Size Medium 1.3x1.55,,57002229,LOCAL,Facility,Outpatient,,,,390,331.5,111.774,390,Humana Insurance Company,Medicare PPO,191.1,49,,percent of total billed charges,,
MESH Plug Perfix Size Medium 1.3x1.55,,57002229,LOCAL,Facility,Inpatient,,,,390,331.5,111.774,390,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
MESH Plug Perfix Size Medium 1.3x1.55,,57002229,LOCAL,Facility,Both,,,,390,331.5,111.774,390,Medica,Individual & Family,386.49,99.1,,percent of total billed charges,,
MESH Plug Perfix Size Medium 1.3x1.55,,57002229,LOCAL,Facility,Outpatient,,,,390,331.5,111.774,390,Medica,Medica Advantage Solution,194.22,49.8,,percent of total billed charges,,
MESH Plug Perfix Size Medium 1.3x1.55,,57002229,LOCAL,Facility,Inpatient,,,,390,331.5,111.774,390,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
MESH Plug Perfix Size Medium 1.3x1.55,,57002229,LOCAL,Facility,Outpatient,,,,390,331.5,111.774,390,Medica,Medical Assistance,173.94,44.6,,percent of total billed charges,,
MESH Plug Perfix Size Medium 1.3x1.55,,57002229,LOCAL,Facility,Inpatient,,,,390,331.5,111.774,390,Medica,Medical Assistance,,,,,Included in per diem rate,
MESH Plug Perfix Size Medium 1.3x1.55,,57002229,LOCAL,Facility,Outpatient,,,,390,331.5,111.774,390,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,194.22,49.8,,percent of total billed charges,,
MESH Plug Perfix Size Medium 1.3x1.55,,57002229,LOCAL,Facility,Inpatient,,,,390,331.5,111.774,390,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
MESH Plug Perfix Size Medium 1.3x1.55,,57002229,LOCAL,Facility,Both,,,,390,331.5,111.774,390,"Multiplan, Inc.","Multiplan, Inc.",366.6,94,,percent of total billed charges,,
MESH Plug Perfix Size Medium 1.3x1.55,,57002229,LOCAL,Facility,Outpatient,,,,390,331.5,111.774,390,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,351.39,90.1,,percent of total billed charges,,
MESH Plug Perfix Size Medium 1.3x1.55,,57002229,LOCAL,Facility,Inpatient,,,,390,331.5,111.774,390,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
MESH Plug Perfix Size Medium 1.3x1.55,,57002229,LOCAL,Facility,Both,,,,390,331.5,111.774,390,"Preferred One Administrative Services, INC.",PPO,384.54,98.6,,percent of total billed charges,,
MESH Plug Perfix Size Medium 1.3x1.55,,57002229,LOCAL,Facility,Outpatient,,,,390,331.5,111.774,390,PrimeWest Health,Minnesota Senior Health Options (MSHO),200.655,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
MESH Plug Perfix Size Medium 1.3x1.55,,57002229,LOCAL,Facility,Inpatient,,,,390,331.5,111.774,390,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
MESH Plug Perfix Size Medium 1.3x1.55,,57002229,LOCAL,Facility,Outpatient,,,,390,331.5,111.774,390,PrimeWest Health,MinnesotaCare,200.304,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
MESH Plug Perfix Size Medium 1.3x1.55,,57002229,LOCAL,Facility,Inpatient,,,,390,331.5,111.774,390,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
MESH Plug Perfix Size Medium 1.3x1.55,,57002229,LOCAL,Facility,Both,,,,390,331.5,111.774,390,Sanford Health Plan,Sanford Health Plan,358.8,92,,percent of total billed charges,,
MESH Plug Perfix Size Medium 1.3x1.55,,57002229,LOCAL,Facility,Outpatient,,,,390,331.5,111.774,390,"UCare Health, Inc.",Individual & Family Plan,219.765,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
MESH Plug Perfix Size Medium 1.3x1.55,,57002229,LOCAL,Facility,Inpatient,,,,390,331.5,111.774,390,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
MESH Plug Perfix Size Medium 1.3x1.55,,57002229,LOCAL,Facility,Outpatient,,,,390,331.5,111.774,390,"UCare Health, Inc.",Medical Assistance,196.833,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MESH Plug Perfix Size Medium 1.3x1.55,,57002229,LOCAL,Facility,Inpatient,,,,390,331.5,111.774,390,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
MESH Plug Perfix Size Medium 1.3x1.55,,57002229,LOCAL,Facility,Outpatient,,,,390,331.5,111.774,390,"UCare Health, Inc.",Medicare Advantage,196.833,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MESH Plug Perfix Size Medium 1.3x1.55,,57002229,LOCAL,Facility,Inpatient,,,,390,331.5,111.774,390,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
MESH Plug Perfix Size Medium 1.3x1.55,,57002229,LOCAL,Facility,Outpatient,,,,390,331.5,111.774,390,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),196.833,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MESH Plug Perfix Size Medium 1.3x1.55,,57002229,LOCAL,Facility,Inpatient,,,,390,331.5,111.774,390,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
MESH Plug Perfix Size Medium 1.3x1.55,,57002229,LOCAL,Facility,Both,,,,390,331.5,111.774,390,UnitedHealthcare,Individual & Family,366.6,94,,percent of total billed charges,,
MESH Plug Perfix Size Medium 1.3x1.55,,57002229,LOCAL,Facility,Outpatient,,,,390,331.5,111.774,390,UnitedHealthcare,Medicare Advantage,191.1,49,,percent of total billed charges,,
MESH Plug Perfix Size Medium 1.3x1.55,,57002229,LOCAL,Facility,Inpatient,,,,390,331.5,111.774,390,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
MESH Plug Perfix Size Medium 1.3x1.55,,57002229,LOCAL,Facility,Outpatient,,,,390,331.5,111.774,390,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,187.2,48,,percent of total billed charges,,100% of DHS outpatient percentage
MESH Plug Perfix Size Medium 1.3x1.55,,57002229,LOCAL,Facility,Inpatient,,,,390,331.5,111.774,390,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
PSN ASF CPS 12mm VE L 6-9EF,,57002229,LOCAL,Facility,Both,,,,4481.625,3809.38125,1284.433725,4481.625,Aetna,Commercial,4123.095,92,,percent of total billed charges,,
PSN ASF CPS 12mm VE L 6-9EF,,57002229,LOCAL,Facility,Outpatient,,,,4481.625,3809.38125,1284.433725,4481.625,Aetna,Medicare Advantage,2195.99625,49,,percent of total billed charges,,
PSN ASF CPS 12mm VE L 6-9EF,,57002229,LOCAL,Facility,Inpatient,,,,4481.625,3809.38125,1284.433725,4481.625,Aetna,Medicare Advantage,,,,,Included in per diem rate,
PSN ASF CPS 12mm VE L 6-9EF,,57002229,LOCAL,Facility,Both,,,,4481.625,3809.38125,1284.433725,4481.625,Aetna,PPO,4167.91125,93,,percent of total billed charges,,
PSN ASF CPS 12mm VE L 6-9EF,,57002229,LOCAL,Facility,Both,,,,4481.625,3809.38125,1284.433725,4481.625,America's PPO,America's PPO,4303.704488,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
PSN ASF CPS 12mm VE L 6-9EF,,57002229,LOCAL,Facility,Both,,,,4481.625,3809.38125,1284.433725,4481.625,BlueCross BlueShield Minnesota, Federal Employee Program,4409.919,98.4,,percent of total billed charges,,
PSN ASF CPS 12mm VE L 6-9EF,,57002229,LOCAL,Facility,Both,,,,4481.625,3809.38125,1284.433725,4481.625,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,4481.625,100,,percent of total billed charges,,
PSN ASF CPS 12mm VE L 6-9EF,,57002229,LOCAL,Facility,Both,,,,4481.625,3809.38125,1284.433725,4481.625,BlueCross BlueShield Minnesota,High Value Network Plan,4033.4625,90,,percent of total billed charges,,
PSN ASF CPS 12mm VE L 6-9EF,,57002229,LOCAL,Facility,Outpatient,,,,4481.625,3809.38125,1284.433725,4481.625,BlueCross BlueShield Minnesota,Medicare Advantage,2195.99625,49,,percent of total billed charges,,
PSN ASF CPS 12mm VE L 6-9EF,,57002229,LOCAL,Facility,Inpatient,,,,4481.625,3809.38125,1284.433725,4481.625,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
PSN ASF CPS 12mm VE L 6-9EF,,57002229,LOCAL,Facility,Both,,,,4481.625,3809.38125,1284.433725,4481.625,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,3969.375263,88.57,,percent of total billed charges,,
PSN ASF CPS 12mm VE L 6-9EF,,57002229,LOCAL,Facility,Both,,,,4481.625,3809.38125,1284.433725,4481.625,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1284.433725,28.66,,percent of total billed charges,,
PSN ASF CPS 12mm VE L 6-9EF,,57002229,LOCAL,Facility,Outpatient,,,,4481.625,3809.38125,1284.433725,4481.625,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2195.99625,49,,percent of total billed charges,,
PSN ASF CPS 12mm VE L 6-9EF,,57002229,LOCAL,Facility,Inpatient,,,,4481.625,3809.38125,1284.433725,4481.625,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
PSN ASF CPS 12mm VE L 6-9EF,,57002229,LOCAL,Facility,Both,,,,4481.625,3809.38125,1284.433725,4481.625,CorVel,Worker's Compensation,4481.625,100,,percent of total billed charges,,
PSN ASF CPS 12mm VE L 6-9EF,,57002229,LOCAL,Facility,Both,,,,4481.625,3809.38125,1284.433725,4481.625,First Health Group Corporation,First Health Network,4347.17625,97,,percent of total billed charges,,
PSN ASF CPS 12mm VE L 6-9EF,,57002229,LOCAL,Facility,Both,,,,4481.625,3809.38125,1284.433725,4481.625,"Health Partners, Inc.",Commercial,4239.61725,94.6,,percent of total billed charges,,
PSN ASF CPS 12mm VE L 6-9EF,,57002229,LOCAL,Facility,Outpatient,,,,4481.625,3809.38125,1284.433725,4481.625,"Health Partners, Inc.",Medicare Advantage,2195.99625,49,,percent of total billed charges,,
PSN ASF CPS 12mm VE L 6-9EF,,57002229,LOCAL,Facility,Inpatient,,,,4481.625,3809.38125,1284.433725,4481.625,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PSN ASF CPS 12mm VE L 6-9EF,,57002229,LOCAL,Facility,Both,,,,4481.625,3809.38125,1284.433725,4481.625,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),2688.975,60,,percent of total billed charges,,
PSN ASF CPS 12mm VE L 6-9EF,,57002229,LOCAL,Facility,Both,,,,4481.625,3809.38125,1284.433725,4481.625,"Health Partners, Inc.",State of Minnesota Advantage Program,3652.524375,81.5,,percent of total billed charges,,
PSN ASF CPS 12mm VE L 6-9EF,,57002229,LOCAL,Facility,Both,,,,4481.625,3809.38125,1284.433725,4481.625,"Health Partners, Inc.",State Public Programs,2240.8125,50,,percent of total billed charges,,
PSN ASF CPS 12mm VE L 6-9EF,,57002229,LOCAL,Facility,Both,,,,4481.625,3809.38125,1284.433725,4481.625,Humana Insurance Company,Commercial PPO,4257.54375,95,,percent of total billed charges,,
PSN ASF CPS 12mm VE L 6-9EF,,57002229,LOCAL,Facility,Outpatient,,,,4481.625,3809.38125,1284.433725,4481.625,Humana Insurance Company,Medicare PPO,2195.99625,49,,percent of total billed charges,,
PSN ASF CPS 12mm VE L 6-9EF,,57002229,LOCAL,Facility,Inpatient,,,,4481.625,3809.38125,1284.433725,4481.625,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
PSN ASF CPS 12mm VE L 6-9EF,,57002229,LOCAL,Facility,Both,,,,4481.625,3809.38125,1284.433725,4481.625,Medica,Individual & Family,4441.290375,99.1,,percent of total billed charges,,
PSN ASF CPS 12mm VE L 6-9EF,,57002229,LOCAL,Facility,Outpatient,,,,4481.625,3809.38125,1284.433725,4481.625,Medica,Medica Advantage Solution,2231.84925,49.8,,percent of total billed charges,,
PSN ASF CPS 12mm VE L 6-9EF,,57002229,LOCAL,Facility,Inpatient,,,,4481.625,3809.38125,1284.433725,4481.625,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
PSN ASF CPS 12mm VE L 6-9EF,,57002229,LOCAL,Facility,Outpatient,,,,4481.625,3809.38125,1284.433725,4481.625,Medica,Medical Assistance,1998.80475,44.6,,percent of total billed charges,,
PSN ASF CPS 12mm VE L 6-9EF,,57002229,LOCAL,Facility,Inpatient,,,,4481.625,3809.38125,1284.433725,4481.625,Medica,Medical Assistance,,,,,Included in per diem rate,
PSN ASF CPS 12mm VE L 6-9EF,,57002229,LOCAL,Facility,Outpatient,,,,4481.625,3809.38125,1284.433725,4481.625,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2231.84925,49.8,,percent of total billed charges,,
PSN ASF CPS 12mm VE L 6-9EF,,57002229,LOCAL,Facility,Inpatient,,,,4481.625,3809.38125,1284.433725,4481.625,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
PSN ASF CPS 12mm VE L 6-9EF,,57002229,LOCAL,Facility,Both,,,,4481.625,3809.38125,1284.433725,4481.625,"Multiplan, Inc.","Multiplan, Inc.",4212.7275,94,,percent of total billed charges,,
PSN ASF CPS 12mm VE L 6-9EF,,57002229,LOCAL,Facility,Outpatient,,,,4481.625,3809.38125,1284.433725,4481.625,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4037.944125,90.1,,percent of total billed charges,,
PSN ASF CPS 12mm VE L 6-9EF,,57002229,LOCAL,Facility,Inpatient,,,,4481.625,3809.38125,1284.433725,4481.625,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
PSN ASF CPS 12mm VE L 6-9EF,,57002229,LOCAL,Facility,Both,,,,4481.625,3809.38125,1284.433725,4481.625,"Preferred One Administrative Services, INC.",PPO,4418.88225,98.6,,percent of total billed charges,,
PSN ASF CPS 12mm VE L 6-9EF,,57002229,LOCAL,Facility,Outpatient,,,,4481.625,3809.38125,1284.433725,4481.625,PrimeWest Health,Minnesota Senior Health Options (MSHO),2305.796063,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
PSN ASF CPS 12mm VE L 6-9EF,,57002229,LOCAL,Facility,Inpatient,,,,4481.625,3809.38125,1284.433725,4481.625,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PSN ASF CPS 12mm VE L 6-9EF,,57002229,LOCAL,Facility,Outpatient,,,,4481.625,3809.38125,1284.433725,4481.625,PrimeWest Health,MinnesotaCare,2301.7626,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
PSN ASF CPS 12mm VE L 6-9EF,,57002229,LOCAL,Facility,Inpatient,,,,4481.625,3809.38125,1284.433725,4481.625,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
PSN ASF CPS 12mm VE L 6-9EF,,57002229,LOCAL,Facility,Both,,,,4481.625,3809.38125,1284.433725,4481.625,Sanford Health Plan,Sanford Health Plan,4123.095,92,,percent of total billed charges,,
PSN ASF CPS 12mm VE L 6-9EF,,57002229,LOCAL,Facility,Outpatient,,,,4481.625,3809.38125,1284.433725,4481.625,"UCare Health, Inc.",Individual & Family Plan,2525.395688,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
PSN ASF CPS 12mm VE L 6-9EF,,57002229,LOCAL,Facility,Inpatient,,,,4481.625,3809.38125,1284.433725,4481.625,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
PSN ASF CPS 12mm VE L 6-9EF,,57002229,LOCAL,Facility,Outpatient,,,,4481.625,3809.38125,1284.433725,4481.625,"UCare Health, Inc.",Medical Assistance,2261.876138,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PSN ASF CPS 12mm VE L 6-9EF,,57002229,LOCAL,Facility,Inpatient,,,,4481.625,3809.38125,1284.433725,4481.625,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
PSN ASF CPS 12mm VE L 6-9EF,,57002229,LOCAL,Facility,Outpatient,,,,4481.625,3809.38125,1284.433725,4481.625,"UCare Health, Inc.",Medicare Advantage,2261.876138,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PSN ASF CPS 12mm VE L 6-9EF,,57002229,LOCAL,Facility,Inpatient,,,,4481.625,3809.38125,1284.433725,4481.625,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PSN ASF CPS 12mm VE L 6-9EF,,57002229,LOCAL,Facility,Outpatient,,,,4481.625,3809.38125,1284.433725,4481.625,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2261.876138,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PSN ASF CPS 12mm VE L 6-9EF,,57002229,LOCAL,Facility,Inpatient,,,,4481.625,3809.38125,1284.433725,4481.625,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PSN ASF CPS 12mm VE L 6-9EF,,57002229,LOCAL,Facility,Both,,,,4481.625,3809.38125,1284.433725,4481.625,UnitedHealthcare,Individual & Family,4212.7275,94,,percent of total billed charges,,
PSN ASF CPS 12mm VE L 6-9EF,,57002229,LOCAL,Facility,Outpatient,,,,4481.625,3809.38125,1284.433725,4481.625,UnitedHealthcare,Medicare Advantage,2195.99625,49,,percent of total billed charges,,
PSN ASF CPS 12mm VE L 6-9EF,,57002229,LOCAL,Facility,Inpatient,,,,4481.625,3809.38125,1284.433725,4481.625,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
PSN ASF CPS 12mm VE L 6-9EF,,57002229,LOCAL,Facility,Outpatient,,,,4481.625,3809.38125,1284.433725,4481.625,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2151.18,48,,percent of total billed charges,,100% of DHS outpatient percentage
PSN ASF CPS 12mm VE L 6-9EF,,57002229,LOCAL,Facility,Inpatient,,,,4481.625,3809.38125,1284.433725,4481.625,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
PSN ASF PS 10mm VE R 10-12GH,,57002229,LOCAL,Facility,Both,,,,2826.25,2402.3125,810.00325,2826.25,Aetna,Commercial,2600.15,92,,percent of total billed charges,,
PSN ASF PS 10mm VE R 10-12GH,,57002229,LOCAL,Facility,Outpatient,,,,2826.25,2402.3125,810.00325,2826.25,Aetna,Medicare Advantage,1384.8625,49,,percent of total billed charges,,
PSN ASF PS 10mm VE R 10-12GH,,57002229,LOCAL,Facility,Inpatient,,,,2826.25,2402.3125,810.00325,2826.25,Aetna,Medicare Advantage,,,,,Included in per diem rate,
PSN ASF PS 10mm VE R 10-12GH,,57002229,LOCAL,Facility,Both,,,,2826.25,2402.3125,810.00325,2826.25,Aetna,PPO,2628.4125,93,,percent of total billed charges,,
PSN ASF PS 10mm VE R 10-12GH,,57002229,LOCAL,Facility,Both,,,,2826.25,2402.3125,810.00325,2826.25,America's PPO,America's PPO,2714.047875,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
PSN ASF PS 10mm VE R 10-12GH,,57002229,LOCAL,Facility,Both,,,,2826.25,2402.3125,810.00325,2826.25,BlueCross BlueShield Minnesota, Federal Employee Program,2781.03,98.4,,percent of total billed charges,,
PSN ASF PS 10mm VE R 10-12GH,,57002229,LOCAL,Facility,Both,,,,2826.25,2402.3125,810.00325,2826.25,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,2826.25,100,,percent of total billed charges,,
PSN ASF PS 10mm VE R 10-12GH,,57002229,LOCAL,Facility,Both,,,,2826.25,2402.3125,810.00325,2826.25,BlueCross BlueShield Minnesota,High Value Network Plan,2543.625,90,,percent of total billed charges,,
PSN ASF PS 10mm VE R 10-12GH,,57002229,LOCAL,Facility,Outpatient,,,,2826.25,2402.3125,810.00325,2826.25,BlueCross BlueShield Minnesota,Medicare Advantage,1384.8625,49,,percent of total billed charges,,
PSN ASF PS 10mm VE R 10-12GH,,57002229,LOCAL,Facility,Inpatient,,,,2826.25,2402.3125,810.00325,2826.25,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
PSN ASF PS 10mm VE R 10-12GH,,57002229,LOCAL,Facility,Both,,,,2826.25,2402.3125,810.00325,2826.25,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,2503.209625,88.57,,percent of total billed charges,,
PSN ASF PS 10mm VE R 10-12GH,,57002229,LOCAL,Facility,Both,,,,2826.25,2402.3125,810.00325,2826.25,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,810.00325,28.66,,percent of total billed charges,,
PSN ASF PS 10mm VE R 10-12GH,,57002229,LOCAL,Facility,Outpatient,,,,2826.25,2402.3125,810.00325,2826.25,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1384.8625,49,,percent of total billed charges,,
PSN ASF PS 10mm VE R 10-12GH,,57002229,LOCAL,Facility,Inpatient,,,,2826.25,2402.3125,810.00325,2826.25,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
PSN ASF PS 10mm VE R 10-12GH,,57002229,LOCAL,Facility,Both,,,,2826.25,2402.3125,810.00325,2826.25,CorVel,Worker's Compensation,2826.25,100,,percent of total billed charges,,
PSN ASF PS 10mm VE R 10-12GH,,57002229,LOCAL,Facility,Both,,,,2826.25,2402.3125,810.00325,2826.25,First Health Group Corporation,First Health Network,2741.4625,97,,percent of total billed charges,,
PSN ASF PS 10mm VE R 10-12GH,,57002229,LOCAL,Facility,Both,,,,2826.25,2402.3125,810.00325,2826.25,"Health Partners, Inc.",Commercial,2673.6325,94.6,,percent of total billed charges,,
PSN ASF PS 10mm VE R 10-12GH,,57002229,LOCAL,Facility,Outpatient,,,,2826.25,2402.3125,810.00325,2826.25,"Health Partners, Inc.",Medicare Advantage,1384.8625,49,,percent of total billed charges,,
PSN ASF PS 10mm VE R 10-12GH,,57002229,LOCAL,Facility,Inpatient,,,,2826.25,2402.3125,810.00325,2826.25,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PSN ASF PS 10mm VE R 10-12GH,,57002229,LOCAL,Facility,Both,,,,2826.25,2402.3125,810.00325,2826.25,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1695.75,60,,percent of total billed charges,,
PSN ASF PS 10mm VE R 10-12GH,,57002229,LOCAL,Facility,Both,,,,2826.25,2402.3125,810.00325,2826.25,"Health Partners, Inc.",State of Minnesota Advantage Program,2303.39375,81.5,,percent of total billed charges,,
PSN ASF PS 10mm VE R 10-12GH,,57002229,LOCAL,Facility,Both,,,,2826.25,2402.3125,810.00325,2826.25,"Health Partners, Inc.",State Public Programs,1413.125,50,,percent of total billed charges,,
PSN ASF PS 10mm VE R 10-12GH,,57002229,LOCAL,Facility,Both,,,,2826.25,2402.3125,810.00325,2826.25,Humana Insurance Company,Commercial PPO,2684.9375,95,,percent of total billed charges,,
PSN ASF PS 10mm VE R 10-12GH,,57002229,LOCAL,Facility,Outpatient,,,,2826.25,2402.3125,810.00325,2826.25,Humana Insurance Company,Medicare PPO,1384.8625,49,,percent of total billed charges,,
PSN ASF PS 10mm VE R 10-12GH,,57002229,LOCAL,Facility,Inpatient,,,,2826.25,2402.3125,810.00325,2826.25,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
PSN ASF PS 10mm VE R 10-12GH,,57002229,LOCAL,Facility,Both,,,,2826.25,2402.3125,810.00325,2826.25,Medica,Individual & Family,2800.81375,99.1,,percent of total billed charges,,
PSN ASF PS 10mm VE R 10-12GH,,57002229,LOCAL,Facility,Outpatient,,,,2826.25,2402.3125,810.00325,2826.25,Medica,Medica Advantage Solution,1407.4725,49.8,,percent of total billed charges,,
PSN ASF PS 10mm VE R 10-12GH,,57002229,LOCAL,Facility,Inpatient,,,,2826.25,2402.3125,810.00325,2826.25,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
PSN ASF PS 10mm VE R 10-12GH,,57002229,LOCAL,Facility,Outpatient,,,,2826.25,2402.3125,810.00325,2826.25,Medica,Medical Assistance,1260.5075,44.6,,percent of total billed charges,,
PSN ASF PS 10mm VE R 10-12GH,,57002229,LOCAL,Facility,Inpatient,,,,2826.25,2402.3125,810.00325,2826.25,Medica,Medical Assistance,,,,,Included in per diem rate,
PSN ASF PS 10mm VE R 10-12GH,,57002229,LOCAL,Facility,Outpatient,,,,2826.25,2402.3125,810.00325,2826.25,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1407.4725,49.8,,percent of total billed charges,,
PSN ASF PS 10mm VE R 10-12GH,,57002229,LOCAL,Facility,Inpatient,,,,2826.25,2402.3125,810.00325,2826.25,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
PSN ASF PS 10mm VE R 10-12GH,,57002229,LOCAL,Facility,Both,,,,2826.25,2402.3125,810.00325,2826.25,"Multiplan, Inc.","Multiplan, Inc.",2656.675,94,,percent of total billed charges,,
PSN ASF PS 10mm VE R 10-12GH,,57002229,LOCAL,Facility,Outpatient,,,,2826.25,2402.3125,810.00325,2826.25,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,2546.45125,90.1,,percent of total billed charges,,
PSN ASF PS 10mm VE R 10-12GH,,57002229,LOCAL,Facility,Inpatient,,,,2826.25,2402.3125,810.00325,2826.25,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
PSN ASF PS 10mm VE R 10-12GH,,57002229,LOCAL,Facility,Both,,,,2826.25,2402.3125,810.00325,2826.25,"Preferred One Administrative Services, INC.",PPO,2786.6825,98.6,,percent of total billed charges,,
PSN ASF PS 10mm VE R 10-12GH,,57002229,LOCAL,Facility,Outpatient,,,,2826.25,2402.3125,810.00325,2826.25,PrimeWest Health,Minnesota Senior Health Options (MSHO),1454.105625,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
PSN ASF PS 10mm VE R 10-12GH,,57002229,LOCAL,Facility,Inpatient,,,,2826.25,2402.3125,810.00325,2826.25,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PSN ASF PS 10mm VE R 10-12GH,,57002229,LOCAL,Facility,Outpatient,,,,2826.25,2402.3125,810.00325,2826.25,PrimeWest Health,MinnesotaCare,1451.562,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
PSN ASF PS 10mm VE R 10-12GH,,57002229,LOCAL,Facility,Inpatient,,,,2826.25,2402.3125,810.00325,2826.25,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
PSN ASF PS 10mm VE R 10-12GH,,57002229,LOCAL,Facility,Both,,,,2826.25,2402.3125,810.00325,2826.25,Sanford Health Plan,Sanford Health Plan,2600.15,92,,percent of total billed charges,,
PSN ASF PS 10mm VE R 10-12GH,,57002229,LOCAL,Facility,Outpatient,,,,2826.25,2402.3125,810.00325,2826.25,"UCare Health, Inc.",Individual & Family Plan,1592.591875,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
PSN ASF PS 10mm VE R 10-12GH,,57002229,LOCAL,Facility,Inpatient,,,,2826.25,2402.3125,810.00325,2826.25,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
PSN ASF PS 10mm VE R 10-12GH,,57002229,LOCAL,Facility,Outpatient,,,,2826.25,2402.3125,810.00325,2826.25,"UCare Health, Inc.",Medical Assistance,1426.408375,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PSN ASF PS 10mm VE R 10-12GH,,57002229,LOCAL,Facility,Inpatient,,,,2826.25,2402.3125,810.00325,2826.25,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
PSN ASF PS 10mm VE R 10-12GH,,57002229,LOCAL,Facility,Outpatient,,,,2826.25,2402.3125,810.00325,2826.25,"UCare Health, Inc.",Medicare Advantage,1426.408375,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PSN ASF PS 10mm VE R 10-12GH,,57002229,LOCAL,Facility,Inpatient,,,,2826.25,2402.3125,810.00325,2826.25,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PSN ASF PS 10mm VE R 10-12GH,,57002229,LOCAL,Facility,Outpatient,,,,2826.25,2402.3125,810.00325,2826.25,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1426.408375,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PSN ASF PS 10mm VE R 10-12GH,,57002229,LOCAL,Facility,Inpatient,,,,2826.25,2402.3125,810.00325,2826.25,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PSN ASF PS 10mm VE R 10-12GH,,57002229,LOCAL,Facility,Both,,,,2826.25,2402.3125,810.00325,2826.25,UnitedHealthcare,Individual & Family,2656.675,94,,percent of total billed charges,,
PSN ASF PS 10mm VE R 10-12GH,,57002229,LOCAL,Facility,Outpatient,,,,2826.25,2402.3125,810.00325,2826.25,UnitedHealthcare,Medicare Advantage,1384.8625,49,,percent of total billed charges,,
PSN ASF PS 10mm VE R 10-12GH,,57002229,LOCAL,Facility,Inpatient,,,,2826.25,2402.3125,810.00325,2826.25,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
PSN ASF PS 10mm VE R 10-12GH,,57002229,LOCAL,Facility,Outpatient,,,,2826.25,2402.3125,810.00325,2826.25,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1356.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
PSN ASF PS 10mm VE R 10-12GH,,57002229,LOCAL,Facility,Inpatient,,,,2826.25,2402.3125,810.00325,2826.25,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
PSN ASF PS 14MM VE R 6-9 EF,,57002229,LOCAL,Facility,Both,,,,2826.25,2402.3125,810.00325,2826.25,Aetna,Commercial,2600.15,92,,percent of total billed charges,,
PSN ASF PS 14MM VE R 6-9 EF,,57002229,LOCAL,Facility,Outpatient,,,,2826.25,2402.3125,810.00325,2826.25,Aetna,Medicare Advantage,1384.8625,49,,percent of total billed charges,,
PSN ASF PS 14MM VE R 6-9 EF,,57002229,LOCAL,Facility,Inpatient,,,,2826.25,2402.3125,810.00325,2826.25,Aetna,Medicare Advantage,,,,,Included in per diem rate,
PSN ASF PS 14MM VE R 6-9 EF,,57002229,LOCAL,Facility,Both,,,,2826.25,2402.3125,810.00325,2826.25,Aetna,PPO,2628.4125,93,,percent of total billed charges,,
PSN ASF PS 14MM VE R 6-9 EF,,57002229,LOCAL,Facility,Both,,,,2826.25,2402.3125,810.00325,2826.25,America's PPO,America's PPO,2714.047875,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
PSN ASF PS 14MM VE R 6-9 EF,,57002229,LOCAL,Facility,Both,,,,2826.25,2402.3125,810.00325,2826.25,BlueCross BlueShield Minnesota, Federal Employee Program,2781.03,98.4,,percent of total billed charges,,
PSN ASF PS 14MM VE R 6-9 EF,,57002229,LOCAL,Facility,Both,,,,2826.25,2402.3125,810.00325,2826.25,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,2826.25,100,,percent of total billed charges,,
PSN ASF PS 14MM VE R 6-9 EF,,57002229,LOCAL,Facility,Both,,,,2826.25,2402.3125,810.00325,2826.25,BlueCross BlueShield Minnesota,High Value Network Plan,2543.625,90,,percent of total billed charges,,
PSN ASF PS 14MM VE R 6-9 EF,,57002229,LOCAL,Facility,Outpatient,,,,2826.25,2402.3125,810.00325,2826.25,BlueCross BlueShield Minnesota,Medicare Advantage,1384.8625,49,,percent of total billed charges,,
PSN ASF PS 14MM VE R 6-9 EF,,57002229,LOCAL,Facility,Inpatient,,,,2826.25,2402.3125,810.00325,2826.25,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
PSN ASF PS 14MM VE R 6-9 EF,,57002229,LOCAL,Facility,Both,,,,2826.25,2402.3125,810.00325,2826.25,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,2503.209625,88.57,,percent of total billed charges,,
PSN ASF PS 14MM VE R 6-9 EF,,57002229,LOCAL,Facility,Both,,,,2826.25,2402.3125,810.00325,2826.25,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,810.00325,28.66,,percent of total billed charges,,
PSN ASF PS 14MM VE R 6-9 EF,,57002229,LOCAL,Facility,Outpatient,,,,2826.25,2402.3125,810.00325,2826.25,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1384.8625,49,,percent of total billed charges,,
PSN ASF PS 14MM VE R 6-9 EF,,57002229,LOCAL,Facility,Inpatient,,,,2826.25,2402.3125,810.00325,2826.25,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
PSN ASF PS 14MM VE R 6-9 EF,,57002229,LOCAL,Facility,Both,,,,2826.25,2402.3125,810.00325,2826.25,CorVel,Worker's Compensation,2826.25,100,,percent of total billed charges,,
PSN ASF PS 14MM VE R 6-9 EF,,57002229,LOCAL,Facility,Both,,,,2826.25,2402.3125,810.00325,2826.25,First Health Group Corporation,First Health Network,2741.4625,97,,percent of total billed charges,,
PSN ASF PS 14MM VE R 6-9 EF,,57002229,LOCAL,Facility,Both,,,,2826.25,2402.3125,810.00325,2826.25,"Health Partners, Inc.",Commercial,2673.6325,94.6,,percent of total billed charges,,
PSN ASF PS 14MM VE R 6-9 EF,,57002229,LOCAL,Facility,Outpatient,,,,2826.25,2402.3125,810.00325,2826.25,"Health Partners, Inc.",Medicare Advantage,1384.8625,49,,percent of total billed charges,,
PSN ASF PS 14MM VE R 6-9 EF,,57002229,LOCAL,Facility,Inpatient,,,,2826.25,2402.3125,810.00325,2826.25,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PSN ASF PS 14MM VE R 6-9 EF,,57002229,LOCAL,Facility,Both,,,,2826.25,2402.3125,810.00325,2826.25,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1695.75,60,,percent of total billed charges,,
PSN ASF PS 14MM VE R 6-9 EF,,57002229,LOCAL,Facility,Both,,,,2826.25,2402.3125,810.00325,2826.25,"Health Partners, Inc.",State of Minnesota Advantage Program,2303.39375,81.5,,percent of total billed charges,,
PSN ASF PS 14MM VE R 6-9 EF,,57002229,LOCAL,Facility,Both,,,,2826.25,2402.3125,810.00325,2826.25,"Health Partners, Inc.",State Public Programs,1413.125,50,,percent of total billed charges,,
PSN ASF PS 14MM VE R 6-9 EF,,57002229,LOCAL,Facility,Both,,,,2826.25,2402.3125,810.00325,2826.25,Humana Insurance Company,Commercial PPO,2684.9375,95,,percent of total billed charges,,
PSN ASF PS 14MM VE R 6-9 EF,,57002229,LOCAL,Facility,Outpatient,,,,2826.25,2402.3125,810.00325,2826.25,Humana Insurance Company,Medicare PPO,1384.8625,49,,percent of total billed charges,,
PSN ASF PS 14MM VE R 6-9 EF,,57002229,LOCAL,Facility,Inpatient,,,,2826.25,2402.3125,810.00325,2826.25,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
PSN ASF PS 14MM VE R 6-9 EF,,57002229,LOCAL,Facility,Both,,,,2826.25,2402.3125,810.00325,2826.25,Medica,Individual & Family,2800.81375,99.1,,percent of total billed charges,,
PSN ASF PS 14MM VE R 6-9 EF,,57002229,LOCAL,Facility,Outpatient,,,,2826.25,2402.3125,810.00325,2826.25,Medica,Medica Advantage Solution,1407.4725,49.8,,percent of total billed charges,,
PSN ASF PS 14MM VE R 6-9 EF,,57002229,LOCAL,Facility,Inpatient,,,,2826.25,2402.3125,810.00325,2826.25,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
PSN ASF PS 14MM VE R 6-9 EF,,57002229,LOCAL,Facility,Outpatient,,,,2826.25,2402.3125,810.00325,2826.25,Medica,Medical Assistance,1260.5075,44.6,,percent of total billed charges,,
PSN ASF PS 14MM VE R 6-9 EF,,57002229,LOCAL,Facility,Inpatient,,,,2826.25,2402.3125,810.00325,2826.25,Medica,Medical Assistance,,,,,Included in per diem rate,
PSN ASF PS 14MM VE R 6-9 EF,,57002229,LOCAL,Facility,Outpatient,,,,2826.25,2402.3125,810.00325,2826.25,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1407.4725,49.8,,percent of total billed charges,,
PSN ASF PS 14MM VE R 6-9 EF,,57002229,LOCAL,Facility,Inpatient,,,,2826.25,2402.3125,810.00325,2826.25,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
PSN ASF PS 14MM VE R 6-9 EF,,57002229,LOCAL,Facility,Both,,,,2826.25,2402.3125,810.00325,2826.25,"Multiplan, Inc.","Multiplan, Inc.",2656.675,94,,percent of total billed charges,,
PSN ASF PS 14MM VE R 6-9 EF,,57002229,LOCAL,Facility,Outpatient,,,,2826.25,2402.3125,810.00325,2826.25,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,2546.45125,90.1,,percent of total billed charges,,
PSN ASF PS 14MM VE R 6-9 EF,,57002229,LOCAL,Facility,Inpatient,,,,2826.25,2402.3125,810.00325,2826.25,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
PSN ASF PS 14MM VE R 6-9 EF,,57002229,LOCAL,Facility,Both,,,,2826.25,2402.3125,810.00325,2826.25,"Preferred One Administrative Services, INC.",PPO,2786.6825,98.6,,percent of total billed charges,,
PSN ASF PS 14MM VE R 6-9 EF,,57002229,LOCAL,Facility,Outpatient,,,,2826.25,2402.3125,810.00325,2826.25,PrimeWest Health,Minnesota Senior Health Options (MSHO),1454.105625,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
PSN ASF PS 14MM VE R 6-9 EF,,57002229,LOCAL,Facility,Inpatient,,,,2826.25,2402.3125,810.00325,2826.25,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PSN ASF PS 14MM VE R 6-9 EF,,57002229,LOCAL,Facility,Outpatient,,,,2826.25,2402.3125,810.00325,2826.25,PrimeWest Health,MinnesotaCare,1451.562,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
PSN ASF PS 14MM VE R 6-9 EF,,57002229,LOCAL,Facility,Inpatient,,,,2826.25,2402.3125,810.00325,2826.25,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
PSN ASF PS 14MM VE R 6-9 EF,,57002229,LOCAL,Facility,Both,,,,2826.25,2402.3125,810.00325,2826.25,Sanford Health Plan,Sanford Health Plan,2600.15,92,,percent of total billed charges,,
PSN ASF PS 14MM VE R 6-9 EF,,57002229,LOCAL,Facility,Outpatient,,,,2826.25,2402.3125,810.00325,2826.25,"UCare Health, Inc.",Individual & Family Plan,1592.591875,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
PSN ASF PS 14MM VE R 6-9 EF,,57002229,LOCAL,Facility,Inpatient,,,,2826.25,2402.3125,810.00325,2826.25,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
PSN ASF PS 14MM VE R 6-9 EF,,57002229,LOCAL,Facility,Outpatient,,,,2826.25,2402.3125,810.00325,2826.25,"UCare Health, Inc.",Medical Assistance,1426.408375,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PSN ASF PS 14MM VE R 6-9 EF,,57002229,LOCAL,Facility,Inpatient,,,,2826.25,2402.3125,810.00325,2826.25,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
PSN ASF PS 14MM VE R 6-9 EF,,57002229,LOCAL,Facility,Outpatient,,,,2826.25,2402.3125,810.00325,2826.25,"UCare Health, Inc.",Medicare Advantage,1426.408375,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PSN ASF PS 14MM VE R 6-9 EF,,57002229,LOCAL,Facility,Inpatient,,,,2826.25,2402.3125,810.00325,2826.25,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PSN ASF PS 14MM VE R 6-9 EF,,57002229,LOCAL,Facility,Outpatient,,,,2826.25,2402.3125,810.00325,2826.25,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1426.408375,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PSN ASF PS 14MM VE R 6-9 EF,,57002229,LOCAL,Facility,Inpatient,,,,2826.25,2402.3125,810.00325,2826.25,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PSN ASF PS 14MM VE R 6-9 EF,,57002229,LOCAL,Facility,Both,,,,2826.25,2402.3125,810.00325,2826.25,UnitedHealthcare,Individual & Family,2656.675,94,,percent of total billed charges,,
PSN ASF PS 14MM VE R 6-9 EF,,57002229,LOCAL,Facility,Outpatient,,,,2826.25,2402.3125,810.00325,2826.25,UnitedHealthcare,Medicare Advantage,1384.8625,49,,percent of total billed charges,,
PSN ASF PS 14MM VE R 6-9 EF,,57002229,LOCAL,Facility,Inpatient,,,,2826.25,2402.3125,810.00325,2826.25,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
PSN ASF PS 14MM VE R 6-9 EF,,57002229,LOCAL,Facility,Outpatient,,,,2826.25,2402.3125,810.00325,2826.25,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1356.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
PSN ASF PS 14MM VE R 6-9 EF,,57002229,LOCAL,Facility,Inpatient,,,,2826.25,2402.3125,810.00325,2826.25,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
PSN FEM PS CMT CCR NRW SZ8 L,,57002229,LOCAL,Facility,Both,,,,6298.5,5353.725,1805.1501,6298.5,Aetna,Commercial,5794.62,92,,percent of total billed charges,,
PSN FEM PS CMT CCR NRW SZ8 L,,57002229,LOCAL,Facility,Outpatient,,,,6298.5,5353.725,1805.1501,6298.5,Aetna,Medicare Advantage,3086.265,49,,percent of total billed charges,,
PSN FEM PS CMT CCR NRW SZ8 L,,57002229,LOCAL,Facility,Inpatient,,,,6298.5,5353.725,1805.1501,6298.5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
PSN FEM PS CMT CCR NRW SZ8 L,,57002229,LOCAL,Facility,Both,,,,6298.5,5353.725,1805.1501,6298.5,Aetna,PPO,5857.605,93,,percent of total billed charges,,
PSN FEM PS CMT CCR NRW SZ8 L,,57002229,LOCAL,Facility,Both,,,,6298.5,5353.725,1805.1501,6298.5,America's PPO,America's PPO,6048.44955,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
PSN FEM PS CMT CCR NRW SZ8 L,,57002229,LOCAL,Facility,Both,,,,6298.5,5353.725,1805.1501,6298.5,BlueCross BlueShield Minnesota, Federal Employee Program,6197.724,98.4,,percent of total billed charges,,
PSN FEM PS CMT CCR NRW SZ8 L,,57002229,LOCAL,Facility,Both,,,,6298.5,5353.725,1805.1501,6298.5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,6298.5,100,,percent of total billed charges,,
PSN FEM PS CMT CCR NRW SZ8 L,,57002229,LOCAL,Facility,Both,,,,6298.5,5353.725,1805.1501,6298.5,BlueCross BlueShield Minnesota,High Value Network Plan,5668.65,90,,percent of total billed charges,,
PSN FEM PS CMT CCR NRW SZ8 L,,57002229,LOCAL,Facility,Outpatient,,,,6298.5,5353.725,1805.1501,6298.5,BlueCross BlueShield Minnesota,Medicare Advantage,3086.265,49,,percent of total billed charges,,
PSN FEM PS CMT CCR NRW SZ8 L,,57002229,LOCAL,Facility,Inpatient,,,,6298.5,5353.725,1805.1501,6298.5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
PSN FEM PS CMT CCR NRW SZ8 L,,57002229,LOCAL,Facility,Both,,,,6298.5,5353.725,1805.1501,6298.5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,5578.58145,88.57,,percent of total billed charges,,
PSN FEM PS CMT CCR NRW SZ8 L,,57002229,LOCAL,Facility,Both,,,,6298.5,5353.725,1805.1501,6298.5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1805.1501,28.66,,percent of total billed charges,,
PSN FEM PS CMT CCR NRW SZ8 L,,57002229,LOCAL,Facility,Outpatient,,,,6298.5,5353.725,1805.1501,6298.5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),3086.265,49,,percent of total billed charges,,
PSN FEM PS CMT CCR NRW SZ8 L,,57002229,LOCAL,Facility,Inpatient,,,,6298.5,5353.725,1805.1501,6298.5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
PSN FEM PS CMT CCR NRW SZ8 L,,57002229,LOCAL,Facility,Both,,,,6298.5,5353.725,1805.1501,6298.5,CorVel,Worker's Compensation,6298.5,100,,percent of total billed charges,,
PSN FEM PS CMT CCR NRW SZ8 L,,57002229,LOCAL,Facility,Both,,,,6298.5,5353.725,1805.1501,6298.5,First Health Group Corporation,First Health Network,6109.545,97,,percent of total billed charges,,
PSN FEM PS CMT CCR NRW SZ8 L,,57002229,LOCAL,Facility,Both,,,,6298.5,5353.725,1805.1501,6298.5,"Health Partners, Inc.",Commercial,5958.381,94.6,,percent of total billed charges,,
PSN FEM PS CMT CCR NRW SZ8 L,,57002229,LOCAL,Facility,Outpatient,,,,6298.5,5353.725,1805.1501,6298.5,"Health Partners, Inc.",Medicare Advantage,3086.265,49,,percent of total billed charges,,
PSN FEM PS CMT CCR NRW SZ8 L,,57002229,LOCAL,Facility,Inpatient,,,,6298.5,5353.725,1805.1501,6298.5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PSN FEM PS CMT CCR NRW SZ8 L,,57002229,LOCAL,Facility,Both,,,,6298.5,5353.725,1805.1501,6298.5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3779.1,60,,percent of total billed charges,,
PSN FEM PS CMT CCR NRW SZ8 L,,57002229,LOCAL,Facility,Both,,,,6298.5,5353.725,1805.1501,6298.5,"Health Partners, Inc.",State of Minnesota Advantage Program,5133.2775,81.5,,percent of total billed charges,,
PSN FEM PS CMT CCR NRW SZ8 L,,57002229,LOCAL,Facility,Both,,,,6298.5,5353.725,1805.1501,6298.5,"Health Partners, Inc.",State Public Programs,3149.25,50,,percent of total billed charges,,
PSN FEM PS CMT CCR NRW SZ8 L,,57002229,LOCAL,Facility,Both,,,,6298.5,5353.725,1805.1501,6298.5,Humana Insurance Company,Commercial PPO,5983.575,95,,percent of total billed charges,,
PSN FEM PS CMT CCR NRW SZ8 L,,57002229,LOCAL,Facility,Outpatient,,,,6298.5,5353.725,1805.1501,6298.5,Humana Insurance Company,Medicare PPO,3086.265,49,,percent of total billed charges,,
PSN FEM PS CMT CCR NRW SZ8 L,,57002229,LOCAL,Facility,Inpatient,,,,6298.5,5353.725,1805.1501,6298.5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
PSN FEM PS CMT CCR NRW SZ8 L,,57002229,LOCAL,Facility,Both,,,,6298.5,5353.725,1805.1501,6298.5,Medica,Individual & Family,6241.8135,99.1,,percent of total billed charges,,
PSN FEM PS CMT CCR NRW SZ8 L,,57002229,LOCAL,Facility,Outpatient,,,,6298.5,5353.725,1805.1501,6298.5,Medica,Medica Advantage Solution,3136.653,49.8,,percent of total billed charges,,
PSN FEM PS CMT CCR NRW SZ8 L,,57002229,LOCAL,Facility,Inpatient,,,,6298.5,5353.725,1805.1501,6298.5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
PSN FEM PS CMT CCR NRW SZ8 L,,57002229,LOCAL,Facility,Outpatient,,,,6298.5,5353.725,1805.1501,6298.5,Medica,Medical Assistance,2809.131,44.6,,percent of total billed charges,,
PSN FEM PS CMT CCR NRW SZ8 L,,57002229,LOCAL,Facility,Inpatient,,,,6298.5,5353.725,1805.1501,6298.5,Medica,Medical Assistance,,,,,Included in per diem rate,
PSN FEM PS CMT CCR NRW SZ8 L,,57002229,LOCAL,Facility,Outpatient,,,,6298.5,5353.725,1805.1501,6298.5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,3136.653,49.8,,percent of total billed charges,,
PSN FEM PS CMT CCR NRW SZ8 L,,57002229,LOCAL,Facility,Inpatient,,,,6298.5,5353.725,1805.1501,6298.5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
PSN FEM PS CMT CCR NRW SZ8 L,,57002229,LOCAL,Facility,Both,,,,6298.5,5353.725,1805.1501,6298.5,"Multiplan, Inc.","Multiplan, Inc.",5920.59,94,,percent of total billed charges,,
PSN FEM PS CMT CCR NRW SZ8 L,,57002229,LOCAL,Facility,Outpatient,,,,6298.5,5353.725,1805.1501,6298.5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,5674.9485,90.1,,percent of total billed charges,,
PSN FEM PS CMT CCR NRW SZ8 L,,57002229,LOCAL,Facility,Inpatient,,,,6298.5,5353.725,1805.1501,6298.5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
PSN FEM PS CMT CCR NRW SZ8 L,,57002229,LOCAL,Facility,Both,,,,6298.5,5353.725,1805.1501,6298.5,"Preferred One Administrative Services, INC.",PPO,6210.321,98.6,,percent of total billed charges,,
PSN FEM PS CMT CCR NRW SZ8 L,,57002229,LOCAL,Facility,Outpatient,,,,6298.5,5353.725,1805.1501,6298.5,PrimeWest Health,Minnesota Senior Health Options (MSHO),3240.57825,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
PSN FEM PS CMT CCR NRW SZ8 L,,57002229,LOCAL,Facility,Inpatient,,,,6298.5,5353.725,1805.1501,6298.5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PSN FEM PS CMT CCR NRW SZ8 L,,57002229,LOCAL,Facility,Outpatient,,,,6298.5,5353.725,1805.1501,6298.5,PrimeWest Health,MinnesotaCare,3234.9096,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
PSN FEM PS CMT CCR NRW SZ8 L,,57002229,LOCAL,Facility,Inpatient,,,,6298.5,5353.725,1805.1501,6298.5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
PSN FEM PS CMT CCR NRW SZ8 L,,57002229,LOCAL,Facility,Both,,,,6298.5,5353.725,1805.1501,6298.5,Sanford Health Plan,Sanford Health Plan,5794.62,92,,percent of total billed charges,,
PSN FEM PS CMT CCR NRW SZ8 L,,57002229,LOCAL,Facility,Outpatient,,,,6298.5,5353.725,1805.1501,6298.5,"UCare Health, Inc.",Individual & Family Plan,3549.20475,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
PSN FEM PS CMT CCR NRW SZ8 L,,57002229,LOCAL,Facility,Inpatient,,,,6298.5,5353.725,1805.1501,6298.5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
PSN FEM PS CMT CCR NRW SZ8 L,,57002229,LOCAL,Facility,Outpatient,,,,6298.5,5353.725,1805.1501,6298.5,"UCare Health, Inc.",Medical Assistance,3178.85295,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PSN FEM PS CMT CCR NRW SZ8 L,,57002229,LOCAL,Facility,Inpatient,,,,6298.5,5353.725,1805.1501,6298.5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
PSN FEM PS CMT CCR NRW SZ8 L,,57002229,LOCAL,Facility,Outpatient,,,,6298.5,5353.725,1805.1501,6298.5,"UCare Health, Inc.",Medicare Advantage,3178.85295,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PSN FEM PS CMT CCR NRW SZ8 L,,57002229,LOCAL,Facility,Inpatient,,,,6298.5,5353.725,1805.1501,6298.5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PSN FEM PS CMT CCR NRW SZ8 L,,57002229,LOCAL,Facility,Outpatient,,,,6298.5,5353.725,1805.1501,6298.5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),3178.85295,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PSN FEM PS CMT CCR NRW SZ8 L,,57002229,LOCAL,Facility,Inpatient,,,,6298.5,5353.725,1805.1501,6298.5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PSN FEM PS CMT CCR NRW SZ8 L,,57002229,LOCAL,Facility,Both,,,,6298.5,5353.725,1805.1501,6298.5,UnitedHealthcare,Individual & Family,5920.59,94,,percent of total billed charges,,
PSN FEM PS CMT CCR NRW SZ8 L,,57002229,LOCAL,Facility,Outpatient,,,,6298.5,5353.725,1805.1501,6298.5,UnitedHealthcare,Medicare Advantage,3086.265,49,,percent of total billed charges,,
PSN FEM PS CMT CCR NRW SZ8 L,,57002229,LOCAL,Facility,Inpatient,,,,6298.5,5353.725,1805.1501,6298.5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
PSN FEM PS CMT CCR NRW SZ8 L,,57002229,LOCAL,Facility,Outpatient,,,,6298.5,5353.725,1805.1501,6298.5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,3023.28,48,,percent of total billed charges,,100% of DHS outpatient percentage
PSN FEM PS CMT CCR NRW SZ8 L,,57002229,LOCAL,Facility,Inpatient,,,,6298.5,5353.725,1805.1501,6298.5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
PSN FEM PS CMT CCR STD SZ10 R,,57002229,LOCAL,Facility,Both,,,,6298.5,5353.725,1805.1501,6298.5,Aetna,Commercial,5794.62,92,,percent of total billed charges,,
PSN FEM PS CMT CCR STD SZ10 R,,57002229,LOCAL,Facility,Outpatient,,,,6298.5,5353.725,1805.1501,6298.5,Aetna,Medicare Advantage,3086.265,49,,percent of total billed charges,,
PSN FEM PS CMT CCR STD SZ10 R,,57002229,LOCAL,Facility,Inpatient,,,,6298.5,5353.725,1805.1501,6298.5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
PSN FEM PS CMT CCR STD SZ10 R,,57002229,LOCAL,Facility,Both,,,,6298.5,5353.725,1805.1501,6298.5,Aetna,PPO,5857.605,93,,percent of total billed charges,,
PSN FEM PS CMT CCR STD SZ10 R,,57002229,LOCAL,Facility,Both,,,,6298.5,5353.725,1805.1501,6298.5,America's PPO,America's PPO,6048.44955,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
PSN FEM PS CMT CCR STD SZ10 R,,57002229,LOCAL,Facility,Both,,,,6298.5,5353.725,1805.1501,6298.5,BlueCross BlueShield Minnesota, Federal Employee Program,6197.724,98.4,,percent of total billed charges,,
PSN FEM PS CMT CCR STD SZ10 R,,57002229,LOCAL,Facility,Both,,,,6298.5,5353.725,1805.1501,6298.5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,6298.5,100,,percent of total billed charges,,
PSN FEM PS CMT CCR STD SZ10 R,,57002229,LOCAL,Facility,Both,,,,6298.5,5353.725,1805.1501,6298.5,BlueCross BlueShield Minnesota,High Value Network Plan,5668.65,90,,percent of total billed charges,,
PSN FEM PS CMT CCR STD SZ10 R,,57002229,LOCAL,Facility,Outpatient,,,,6298.5,5353.725,1805.1501,6298.5,BlueCross BlueShield Minnesota,Medicare Advantage,3086.265,49,,percent of total billed charges,,
PSN FEM PS CMT CCR STD SZ10 R,,57002229,LOCAL,Facility,Inpatient,,,,6298.5,5353.725,1805.1501,6298.5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
PSN FEM PS CMT CCR STD SZ10 R,,57002229,LOCAL,Facility,Both,,,,6298.5,5353.725,1805.1501,6298.5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,5578.58145,88.57,,percent of total billed charges,,
PSN FEM PS CMT CCR STD SZ10 R,,57002229,LOCAL,Facility,Both,,,,6298.5,5353.725,1805.1501,6298.5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1805.1501,28.66,,percent of total billed charges,,
PSN FEM PS CMT CCR STD SZ10 R,,57002229,LOCAL,Facility,Outpatient,,,,6298.5,5353.725,1805.1501,6298.5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),3086.265,49,,percent of total billed charges,,
PSN FEM PS CMT CCR STD SZ10 R,,57002229,LOCAL,Facility,Inpatient,,,,6298.5,5353.725,1805.1501,6298.5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
PSN FEM PS CMT CCR STD SZ10 R,,57002229,LOCAL,Facility,Both,,,,6298.5,5353.725,1805.1501,6298.5,CorVel,Worker's Compensation,6298.5,100,,percent of total billed charges,,
PSN FEM PS CMT CCR STD SZ10 R,,57002229,LOCAL,Facility,Both,,,,6298.5,5353.725,1805.1501,6298.5,First Health Group Corporation,First Health Network,6109.545,97,,percent of total billed charges,,
PSN FEM PS CMT CCR STD SZ10 R,,57002229,LOCAL,Facility,Both,,,,6298.5,5353.725,1805.1501,6298.5,"Health Partners, Inc.",Commercial,5958.381,94.6,,percent of total billed charges,,
PSN FEM PS CMT CCR STD SZ10 R,,57002229,LOCAL,Facility,Outpatient,,,,6298.5,5353.725,1805.1501,6298.5,"Health Partners, Inc.",Medicare Advantage,3086.265,49,,percent of total billed charges,,
PSN FEM PS CMT CCR STD SZ10 R,,57002229,LOCAL,Facility,Inpatient,,,,6298.5,5353.725,1805.1501,6298.5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PSN FEM PS CMT CCR STD SZ10 R,,57002229,LOCAL,Facility,Both,,,,6298.5,5353.725,1805.1501,6298.5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3779.1,60,,percent of total billed charges,,
PSN FEM PS CMT CCR STD SZ10 R,,57002229,LOCAL,Facility,Both,,,,6298.5,5353.725,1805.1501,6298.5,"Health Partners, Inc.",State of Minnesota Advantage Program,5133.2775,81.5,,percent of total billed charges,,
PSN FEM PS CMT CCR STD SZ10 R,,57002229,LOCAL,Facility,Both,,,,6298.5,5353.725,1805.1501,6298.5,"Health Partners, Inc.",State Public Programs,3149.25,50,,percent of total billed charges,,
PSN FEM PS CMT CCR STD SZ10 R,,57002229,LOCAL,Facility,Both,,,,6298.5,5353.725,1805.1501,6298.5,Humana Insurance Company,Commercial PPO,5983.575,95,,percent of total billed charges,,
PSN FEM PS CMT CCR STD SZ10 R,,57002229,LOCAL,Facility,Outpatient,,,,6298.5,5353.725,1805.1501,6298.5,Humana Insurance Company,Medicare PPO,3086.265,49,,percent of total billed charges,,
PSN FEM PS CMT CCR STD SZ10 R,,57002229,LOCAL,Facility,Inpatient,,,,6298.5,5353.725,1805.1501,6298.5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
PSN FEM PS CMT CCR STD SZ10 R,,57002229,LOCAL,Facility,Both,,,,6298.5,5353.725,1805.1501,6298.5,Medica,Individual & Family,6241.8135,99.1,,percent of total billed charges,,
PSN FEM PS CMT CCR STD SZ10 R,,57002229,LOCAL,Facility,Outpatient,,,,6298.5,5353.725,1805.1501,6298.5,Medica,Medica Advantage Solution,3136.653,49.8,,percent of total billed charges,,
PSN FEM PS CMT CCR STD SZ10 R,,57002229,LOCAL,Facility,Inpatient,,,,6298.5,5353.725,1805.1501,6298.5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
PSN FEM PS CMT CCR STD SZ10 R,,57002229,LOCAL,Facility,Outpatient,,,,6298.5,5353.725,1805.1501,6298.5,Medica,Medical Assistance,2809.131,44.6,,percent of total billed charges,,
PSN FEM PS CMT CCR STD SZ10 R,,57002229,LOCAL,Facility,Inpatient,,,,6298.5,5353.725,1805.1501,6298.5,Medica,Medical Assistance,,,,,Included in per diem rate,
PSN FEM PS CMT CCR STD SZ10 R,,57002229,LOCAL,Facility,Outpatient,,,,6298.5,5353.725,1805.1501,6298.5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,3136.653,49.8,,percent of total billed charges,,
PSN FEM PS CMT CCR STD SZ10 R,,57002229,LOCAL,Facility,Inpatient,,,,6298.5,5353.725,1805.1501,6298.5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
PSN FEM PS CMT CCR STD SZ10 R,,57002229,LOCAL,Facility,Both,,,,6298.5,5353.725,1805.1501,6298.5,"Multiplan, Inc.","Multiplan, Inc.",5920.59,94,,percent of total billed charges,,
PSN FEM PS CMT CCR STD SZ10 R,,57002229,LOCAL,Facility,Outpatient,,,,6298.5,5353.725,1805.1501,6298.5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,5674.9485,90.1,,percent of total billed charges,,
PSN FEM PS CMT CCR STD SZ10 R,,57002229,LOCAL,Facility,Inpatient,,,,6298.5,5353.725,1805.1501,6298.5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
PSN FEM PS CMT CCR STD SZ10 R,,57002229,LOCAL,Facility,Both,,,,6298.5,5353.725,1805.1501,6298.5,"Preferred One Administrative Services, INC.",PPO,6210.321,98.6,,percent of total billed charges,,
PSN FEM PS CMT CCR STD SZ10 R,,57002229,LOCAL,Facility,Outpatient,,,,6298.5,5353.725,1805.1501,6298.5,PrimeWest Health,Minnesota Senior Health Options (MSHO),3240.57825,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
PSN FEM PS CMT CCR STD SZ10 R,,57002229,LOCAL,Facility,Inpatient,,,,6298.5,5353.725,1805.1501,6298.5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PSN FEM PS CMT CCR STD SZ10 R,,57002229,LOCAL,Facility,Outpatient,,,,6298.5,5353.725,1805.1501,6298.5,PrimeWest Health,MinnesotaCare,3234.9096,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
PSN FEM PS CMT CCR STD SZ10 R,,57002229,LOCAL,Facility,Inpatient,,,,6298.5,5353.725,1805.1501,6298.5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
PSN FEM PS CMT CCR STD SZ10 R,,57002229,LOCAL,Facility,Both,,,,6298.5,5353.725,1805.1501,6298.5,Sanford Health Plan,Sanford Health Plan,5794.62,92,,percent of total billed charges,,
PSN FEM PS CMT CCR STD SZ10 R,,57002229,LOCAL,Facility,Outpatient,,,,6298.5,5353.725,1805.1501,6298.5,"UCare Health, Inc.",Individual & Family Plan,3549.20475,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
PSN FEM PS CMT CCR STD SZ10 R,,57002229,LOCAL,Facility,Inpatient,,,,6298.5,5353.725,1805.1501,6298.5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
PSN FEM PS CMT CCR STD SZ10 R,,57002229,LOCAL,Facility,Outpatient,,,,6298.5,5353.725,1805.1501,6298.5,"UCare Health, Inc.",Medical Assistance,3178.85295,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PSN FEM PS CMT CCR STD SZ10 R,,57002229,LOCAL,Facility,Inpatient,,,,6298.5,5353.725,1805.1501,6298.5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
PSN FEM PS CMT CCR STD SZ10 R,,57002229,LOCAL,Facility,Outpatient,,,,6298.5,5353.725,1805.1501,6298.5,"UCare Health, Inc.",Medicare Advantage,3178.85295,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PSN FEM PS CMT CCR STD SZ10 R,,57002229,LOCAL,Facility,Inpatient,,,,6298.5,5353.725,1805.1501,6298.5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PSN FEM PS CMT CCR STD SZ10 R,,57002229,LOCAL,Facility,Outpatient,,,,6298.5,5353.725,1805.1501,6298.5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),3178.85295,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PSN FEM PS CMT CCR STD SZ10 R,,57002229,LOCAL,Facility,Inpatient,,,,6298.5,5353.725,1805.1501,6298.5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PSN FEM PS CMT CCR STD SZ10 R,,57002229,LOCAL,Facility,Both,,,,6298.5,5353.725,1805.1501,6298.5,UnitedHealthcare,Individual & Family,5920.59,94,,percent of total billed charges,,
PSN FEM PS CMT CCR STD SZ10 R,,57002229,LOCAL,Facility,Outpatient,,,,6298.5,5353.725,1805.1501,6298.5,UnitedHealthcare,Medicare Advantage,3086.265,49,,percent of total billed charges,,
PSN FEM PS CMT CCR STD SZ10 R,,57002229,LOCAL,Facility,Inpatient,,,,6298.5,5353.725,1805.1501,6298.5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
PSN FEM PS CMT CCR STD SZ10 R,,57002229,LOCAL,Facility,Outpatient,,,,6298.5,5353.725,1805.1501,6298.5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,3023.28,48,,percent of total billed charges,,100% of DHS outpatient percentage
PSN FEM PS CMT CCR STD SZ10 R,,57002229,LOCAL,Facility,Inpatient,,,,6298.5,5353.725,1805.1501,6298.5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
PSN FEM PS CMT CCR STD SZ9 R,,57002229,LOCAL,Facility,Both,,,,6298.5,5353.725,1805.1501,6298.5,Aetna,Commercial,5794.62,92,,percent of total billed charges,,
PSN FEM PS CMT CCR STD SZ9 R,,57002229,LOCAL,Facility,Outpatient,,,,6298.5,5353.725,1805.1501,6298.5,Aetna,Medicare Advantage,3086.265,49,,percent of total billed charges,,
PSN FEM PS CMT CCR STD SZ9 R,,57002229,LOCAL,Facility,Inpatient,,,,6298.5,5353.725,1805.1501,6298.5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
PSN FEM PS CMT CCR STD SZ9 R,,57002229,LOCAL,Facility,Both,,,,6298.5,5353.725,1805.1501,6298.5,Aetna,PPO,5857.605,93,,percent of total billed charges,,
PSN FEM PS CMT CCR STD SZ9 R,,57002229,LOCAL,Facility,Both,,,,6298.5,5353.725,1805.1501,6298.5,America's PPO,America's PPO,6048.44955,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
PSN FEM PS CMT CCR STD SZ9 R,,57002229,LOCAL,Facility,Both,,,,6298.5,5353.725,1805.1501,6298.5,BlueCross BlueShield Minnesota, Federal Employee Program,6197.724,98.4,,percent of total billed charges,,
PSN FEM PS CMT CCR STD SZ9 R,,57002229,LOCAL,Facility,Both,,,,6298.5,5353.725,1805.1501,6298.5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,6298.5,100,,percent of total billed charges,,
PSN FEM PS CMT CCR STD SZ9 R,,57002229,LOCAL,Facility,Both,,,,6298.5,5353.725,1805.1501,6298.5,BlueCross BlueShield Minnesota,High Value Network Plan,5668.65,90,,percent of total billed charges,,
PSN FEM PS CMT CCR STD SZ9 R,,57002229,LOCAL,Facility,Outpatient,,,,6298.5,5353.725,1805.1501,6298.5,BlueCross BlueShield Minnesota,Medicare Advantage,3086.265,49,,percent of total billed charges,,
PSN FEM PS CMT CCR STD SZ9 R,,57002229,LOCAL,Facility,Inpatient,,,,6298.5,5353.725,1805.1501,6298.5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
PSN FEM PS CMT CCR STD SZ9 R,,57002229,LOCAL,Facility,Both,,,,6298.5,5353.725,1805.1501,6298.5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,5578.58145,88.57,,percent of total billed charges,,
PSN FEM PS CMT CCR STD SZ9 R,,57002229,LOCAL,Facility,Both,,,,6298.5,5353.725,1805.1501,6298.5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1805.1501,28.66,,percent of total billed charges,,
PSN FEM PS CMT CCR STD SZ9 R,,57002229,LOCAL,Facility,Outpatient,,,,6298.5,5353.725,1805.1501,6298.5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),3086.265,49,,percent of total billed charges,,
PSN FEM PS CMT CCR STD SZ9 R,,57002229,LOCAL,Facility,Inpatient,,,,6298.5,5353.725,1805.1501,6298.5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
PSN FEM PS CMT CCR STD SZ9 R,,57002229,LOCAL,Facility,Both,,,,6298.5,5353.725,1805.1501,6298.5,CorVel,Worker's Compensation,6298.5,100,,percent of total billed charges,,
PSN FEM PS CMT CCR STD SZ9 R,,57002229,LOCAL,Facility,Both,,,,6298.5,5353.725,1805.1501,6298.5,First Health Group Corporation,First Health Network,6109.545,97,,percent of total billed charges,,
PSN FEM PS CMT CCR STD SZ9 R,,57002229,LOCAL,Facility,Both,,,,6298.5,5353.725,1805.1501,6298.5,"Health Partners, Inc.",Commercial,5958.381,94.6,,percent of total billed charges,,
PSN FEM PS CMT CCR STD SZ9 R,,57002229,LOCAL,Facility,Outpatient,,,,6298.5,5353.725,1805.1501,6298.5,"Health Partners, Inc.",Medicare Advantage,3086.265,49,,percent of total billed charges,,
PSN FEM PS CMT CCR STD SZ9 R,,57002229,LOCAL,Facility,Inpatient,,,,6298.5,5353.725,1805.1501,6298.5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PSN FEM PS CMT CCR STD SZ9 R,,57002229,LOCAL,Facility,Both,,,,6298.5,5353.725,1805.1501,6298.5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3779.1,60,,percent of total billed charges,,
PSN FEM PS CMT CCR STD SZ9 R,,57002229,LOCAL,Facility,Both,,,,6298.5,5353.725,1805.1501,6298.5,"Health Partners, Inc.",State of Minnesota Advantage Program,5133.2775,81.5,,percent of total billed charges,,
PSN FEM PS CMT CCR STD SZ9 R,,57002229,LOCAL,Facility,Both,,,,6298.5,5353.725,1805.1501,6298.5,"Health Partners, Inc.",State Public Programs,3149.25,50,,percent of total billed charges,,
PSN FEM PS CMT CCR STD SZ9 R,,57002229,LOCAL,Facility,Both,,,,6298.5,5353.725,1805.1501,6298.5,Humana Insurance Company,Commercial PPO,5983.575,95,,percent of total billed charges,,
PSN FEM PS CMT CCR STD SZ9 R,,57002229,LOCAL,Facility,Outpatient,,,,6298.5,5353.725,1805.1501,6298.5,Humana Insurance Company,Medicare PPO,3086.265,49,,percent of total billed charges,,
PSN FEM PS CMT CCR STD SZ9 R,,57002229,LOCAL,Facility,Inpatient,,,,6298.5,5353.725,1805.1501,6298.5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
PSN FEM PS CMT CCR STD SZ9 R,,57002229,LOCAL,Facility,Both,,,,6298.5,5353.725,1805.1501,6298.5,Medica,Individual & Family,6241.8135,99.1,,percent of total billed charges,,
PSN FEM PS CMT CCR STD SZ9 R,,57002229,LOCAL,Facility,Outpatient,,,,6298.5,5353.725,1805.1501,6298.5,Medica,Medica Advantage Solution,3136.653,49.8,,percent of total billed charges,,
PSN FEM PS CMT CCR STD SZ9 R,,57002229,LOCAL,Facility,Inpatient,,,,6298.5,5353.725,1805.1501,6298.5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
PSN FEM PS CMT CCR STD SZ9 R,,57002229,LOCAL,Facility,Outpatient,,,,6298.5,5353.725,1805.1501,6298.5,Medica,Medical Assistance,2809.131,44.6,,percent of total billed charges,,
PSN FEM PS CMT CCR STD SZ9 R,,57002229,LOCAL,Facility,Inpatient,,,,6298.5,5353.725,1805.1501,6298.5,Medica,Medical Assistance,,,,,Included in per diem rate,
PSN FEM PS CMT CCR STD SZ9 R,,57002229,LOCAL,Facility,Outpatient,,,,6298.5,5353.725,1805.1501,6298.5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,3136.653,49.8,,percent of total billed charges,,
PSN FEM PS CMT CCR STD SZ9 R,,57002229,LOCAL,Facility,Inpatient,,,,6298.5,5353.725,1805.1501,6298.5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
PSN FEM PS CMT CCR STD SZ9 R,,57002229,LOCAL,Facility,Both,,,,6298.5,5353.725,1805.1501,6298.5,"Multiplan, Inc.","Multiplan, Inc.",5920.59,94,,percent of total billed charges,,
PSN FEM PS CMT CCR STD SZ9 R,,57002229,LOCAL,Facility,Outpatient,,,,6298.5,5353.725,1805.1501,6298.5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,5674.9485,90.1,,percent of total billed charges,,
PSN FEM PS CMT CCR STD SZ9 R,,57002229,LOCAL,Facility,Inpatient,,,,6298.5,5353.725,1805.1501,6298.5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
PSN FEM PS CMT CCR STD SZ9 R,,57002229,LOCAL,Facility,Both,,,,6298.5,5353.725,1805.1501,6298.5,"Preferred One Administrative Services, INC.",PPO,6210.321,98.6,,percent of total billed charges,,
PSN FEM PS CMT CCR STD SZ9 R,,57002229,LOCAL,Facility,Outpatient,,,,6298.5,5353.725,1805.1501,6298.5,PrimeWest Health,Minnesota Senior Health Options (MSHO),3240.57825,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
PSN FEM PS CMT CCR STD SZ9 R,,57002229,LOCAL,Facility,Inpatient,,,,6298.5,5353.725,1805.1501,6298.5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PSN FEM PS CMT CCR STD SZ9 R,,57002229,LOCAL,Facility,Outpatient,,,,6298.5,5353.725,1805.1501,6298.5,PrimeWest Health,MinnesotaCare,3234.9096,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
PSN FEM PS CMT CCR STD SZ9 R,,57002229,LOCAL,Facility,Inpatient,,,,6298.5,5353.725,1805.1501,6298.5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
PSN FEM PS CMT CCR STD SZ9 R,,57002229,LOCAL,Facility,Both,,,,6298.5,5353.725,1805.1501,6298.5,Sanford Health Plan,Sanford Health Plan,5794.62,92,,percent of total billed charges,,
PSN FEM PS CMT CCR STD SZ9 R,,57002229,LOCAL,Facility,Outpatient,,,,6298.5,5353.725,1805.1501,6298.5,"UCare Health, Inc.",Individual & Family Plan,3549.20475,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
PSN FEM PS CMT CCR STD SZ9 R,,57002229,LOCAL,Facility,Inpatient,,,,6298.5,5353.725,1805.1501,6298.5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
PSN FEM PS CMT CCR STD SZ9 R,,57002229,LOCAL,Facility,Outpatient,,,,6298.5,5353.725,1805.1501,6298.5,"UCare Health, Inc.",Medical Assistance,3178.85295,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PSN FEM PS CMT CCR STD SZ9 R,,57002229,LOCAL,Facility,Inpatient,,,,6298.5,5353.725,1805.1501,6298.5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
PSN FEM PS CMT CCR STD SZ9 R,,57002229,LOCAL,Facility,Outpatient,,,,6298.5,5353.725,1805.1501,6298.5,"UCare Health, Inc.",Medicare Advantage,3178.85295,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PSN FEM PS CMT CCR STD SZ9 R,,57002229,LOCAL,Facility,Inpatient,,,,6298.5,5353.725,1805.1501,6298.5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PSN FEM PS CMT CCR STD SZ9 R,,57002229,LOCAL,Facility,Outpatient,,,,6298.5,5353.725,1805.1501,6298.5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),3178.85295,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PSN FEM PS CMT CCR STD SZ9 R,,57002229,LOCAL,Facility,Inpatient,,,,6298.5,5353.725,1805.1501,6298.5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PSN FEM PS CMT CCR STD SZ9 R,,57002229,LOCAL,Facility,Both,,,,6298.5,5353.725,1805.1501,6298.5,UnitedHealthcare,Individual & Family,5920.59,94,,percent of total billed charges,,
PSN FEM PS CMT CCR STD SZ9 R,,57002229,LOCAL,Facility,Outpatient,,,,6298.5,5353.725,1805.1501,6298.5,UnitedHealthcare,Medicare Advantage,3086.265,49,,percent of total billed charges,,
PSN FEM PS CMT CCR STD SZ9 R,,57002229,LOCAL,Facility,Inpatient,,,,6298.5,5353.725,1805.1501,6298.5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
PSN FEM PS CMT CCR STD SZ9 R,,57002229,LOCAL,Facility,Outpatient,,,,6298.5,5353.725,1805.1501,6298.5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,3023.28,48,,percent of total billed charges,,100% of DHS outpatient percentage
PSN FEM PS CMT CCR STD SZ9 R,,57002229,LOCAL,Facility,Inpatient,,,,6298.5,5353.725,1805.1501,6298.5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
PSN TIB STEM 5 DEG SZ F R,,57002229,LOCAL,Facility,Both,,,,2745.5,2333.675,786.8603,2745.5,Aetna,Commercial,2525.86,92,,percent of total billed charges,,
PSN TIB STEM 5 DEG SZ F R,,57002229,LOCAL,Facility,Outpatient,,,,2745.5,2333.675,786.8603,2745.5,Aetna,Medicare Advantage,1345.295,49,,percent of total billed charges,,
PSN TIB STEM 5 DEG SZ F R,,57002229,LOCAL,Facility,Inpatient,,,,2745.5,2333.675,786.8603,2745.5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
PSN TIB STEM 5 DEG SZ F R,,57002229,LOCAL,Facility,Both,,,,2745.5,2333.675,786.8603,2745.5,Aetna,PPO,2553.315,93,,percent of total billed charges,,
PSN TIB STEM 5 DEG SZ F R,,57002229,LOCAL,Facility,Both,,,,2745.5,2333.675,786.8603,2745.5,America's PPO,America's PPO,2636.50365,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
PSN TIB STEM 5 DEG SZ F R,,57002229,LOCAL,Facility,Both,,,,2745.5,2333.675,786.8603,2745.5,BlueCross BlueShield Minnesota, Federal Employee Program,2701.572,98.4,,percent of total billed charges,,
PSN TIB STEM 5 DEG SZ F R,,57002229,LOCAL,Facility,Both,,,,2745.5,2333.675,786.8603,2745.5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,2745.5,100,,percent of total billed charges,,
PSN TIB STEM 5 DEG SZ F R,,57002229,LOCAL,Facility,Both,,,,2745.5,2333.675,786.8603,2745.5,BlueCross BlueShield Minnesota,High Value Network Plan,2470.95,90,,percent of total billed charges,,
PSN TIB STEM 5 DEG SZ F R,,57002229,LOCAL,Facility,Outpatient,,,,2745.5,2333.675,786.8603,2745.5,BlueCross BlueShield Minnesota,Medicare Advantage,1345.295,49,,percent of total billed charges,,
PSN TIB STEM 5 DEG SZ F R,,57002229,LOCAL,Facility,Inpatient,,,,2745.5,2333.675,786.8603,2745.5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
PSN TIB STEM 5 DEG SZ F R,,57002229,LOCAL,Facility,Both,,,,2745.5,2333.675,786.8603,2745.5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,2431.68935,88.57,,percent of total billed charges,,
PSN TIB STEM 5 DEG SZ F R,,57002229,LOCAL,Facility,Both,,,,2745.5,2333.675,786.8603,2745.5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,786.8603,28.66,,percent of total billed charges,,
PSN TIB STEM 5 DEG SZ F R,,57002229,LOCAL,Facility,Outpatient,,,,2745.5,2333.675,786.8603,2745.5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1345.295,49,,percent of total billed charges,,
PSN TIB STEM 5 DEG SZ F R,,57002229,LOCAL,Facility,Inpatient,,,,2745.5,2333.675,786.8603,2745.5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
PSN TIB STEM 5 DEG SZ F R,,57002229,LOCAL,Facility,Both,,,,2745.5,2333.675,786.8603,2745.5,CorVel,Worker's Compensation,2745.5,100,,percent of total billed charges,,
PSN TIB STEM 5 DEG SZ F R,,57002229,LOCAL,Facility,Both,,,,2745.5,2333.675,786.8603,2745.5,First Health Group Corporation,First Health Network,2663.135,97,,percent of total billed charges,,
PSN TIB STEM 5 DEG SZ F R,,57002229,LOCAL,Facility,Both,,,,2745.5,2333.675,786.8603,2745.5,"Health Partners, Inc.",Commercial,2597.243,94.6,,percent of total billed charges,,
PSN TIB STEM 5 DEG SZ F R,,57002229,LOCAL,Facility,Outpatient,,,,2745.5,2333.675,786.8603,2745.5,"Health Partners, Inc.",Medicare Advantage,1345.295,49,,percent of total billed charges,,
PSN TIB STEM 5 DEG SZ F R,,57002229,LOCAL,Facility,Inpatient,,,,2745.5,2333.675,786.8603,2745.5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PSN TIB STEM 5 DEG SZ F R,,57002229,LOCAL,Facility,Both,,,,2745.5,2333.675,786.8603,2745.5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1647.3,60,,percent of total billed charges,,
PSN TIB STEM 5 DEG SZ F R,,57002229,LOCAL,Facility,Both,,,,2745.5,2333.675,786.8603,2745.5,"Health Partners, Inc.",State of Minnesota Advantage Program,2237.5825,81.5,,percent of total billed charges,,
PSN TIB STEM 5 DEG SZ F R,,57002229,LOCAL,Facility,Both,,,,2745.5,2333.675,786.8603,2745.5,"Health Partners, Inc.",State Public Programs,1372.75,50,,percent of total billed charges,,
PSN TIB STEM 5 DEG SZ F R,,57002229,LOCAL,Facility,Both,,,,2745.5,2333.675,786.8603,2745.5,Humana Insurance Company,Commercial PPO,2608.225,95,,percent of total billed charges,,
PSN TIB STEM 5 DEG SZ F R,,57002229,LOCAL,Facility,Outpatient,,,,2745.5,2333.675,786.8603,2745.5,Humana Insurance Company,Medicare PPO,1345.295,49,,percent of total billed charges,,
PSN TIB STEM 5 DEG SZ F R,,57002229,LOCAL,Facility,Inpatient,,,,2745.5,2333.675,786.8603,2745.5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
PSN TIB STEM 5 DEG SZ F R,,57002229,LOCAL,Facility,Both,,,,2745.5,2333.675,786.8603,2745.5,Medica,Individual & Family,2720.7905,99.1,,percent of total billed charges,,
PSN TIB STEM 5 DEG SZ F R,,57002229,LOCAL,Facility,Outpatient,,,,2745.5,2333.675,786.8603,2745.5,Medica,Medica Advantage Solution,1367.259,49.8,,percent of total billed charges,,
PSN TIB STEM 5 DEG SZ F R,,57002229,LOCAL,Facility,Inpatient,,,,2745.5,2333.675,786.8603,2745.5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
PSN TIB STEM 5 DEG SZ F R,,57002229,LOCAL,Facility,Outpatient,,,,2745.5,2333.675,786.8603,2745.5,Medica,Medical Assistance,1224.493,44.6,,percent of total billed charges,,
PSN TIB STEM 5 DEG SZ F R,,57002229,LOCAL,Facility,Inpatient,,,,2745.5,2333.675,786.8603,2745.5,Medica,Medical Assistance,,,,,Included in per diem rate,
PSN TIB STEM 5 DEG SZ F R,,57002229,LOCAL,Facility,Outpatient,,,,2745.5,2333.675,786.8603,2745.5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1367.259,49.8,,percent of total billed charges,,
PSN TIB STEM 5 DEG SZ F R,,57002229,LOCAL,Facility,Inpatient,,,,2745.5,2333.675,786.8603,2745.5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
PSN TIB STEM 5 DEG SZ F R,,57002229,LOCAL,Facility,Both,,,,2745.5,2333.675,786.8603,2745.5,"Multiplan, Inc.","Multiplan, Inc.",2580.77,94,,percent of total billed charges,,
PSN TIB STEM 5 DEG SZ F R,,57002229,LOCAL,Facility,Outpatient,,,,2745.5,2333.675,786.8603,2745.5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,2473.6955,90.1,,percent of total billed charges,,
PSN TIB STEM 5 DEG SZ F R,,57002229,LOCAL,Facility,Inpatient,,,,2745.5,2333.675,786.8603,2745.5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
PSN TIB STEM 5 DEG SZ F R,,57002229,LOCAL,Facility,Both,,,,2745.5,2333.675,786.8603,2745.5,"Preferred One Administrative Services, INC.",PPO,2707.063,98.6,,percent of total billed charges,,
PSN TIB STEM 5 DEG SZ F R,,57002229,LOCAL,Facility,Outpatient,,,,2745.5,2333.675,786.8603,2745.5,PrimeWest Health,Minnesota Senior Health Options (MSHO),1412.55975,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
PSN TIB STEM 5 DEG SZ F R,,57002229,LOCAL,Facility,Inpatient,,,,2745.5,2333.675,786.8603,2745.5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PSN TIB STEM 5 DEG SZ F R,,57002229,LOCAL,Facility,Outpatient,,,,2745.5,2333.675,786.8603,2745.5,PrimeWest Health,MinnesotaCare,1410.0888,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
PSN TIB STEM 5 DEG SZ F R,,57002229,LOCAL,Facility,Inpatient,,,,2745.5,2333.675,786.8603,2745.5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
PSN TIB STEM 5 DEG SZ F R,,57002229,LOCAL,Facility,Both,,,,2745.5,2333.675,786.8603,2745.5,Sanford Health Plan,Sanford Health Plan,2525.86,92,,percent of total billed charges,,
PSN TIB STEM 5 DEG SZ F R,,57002229,LOCAL,Facility,Outpatient,,,,2745.5,2333.675,786.8603,2745.5,"UCare Health, Inc.",Individual & Family Plan,1547.08925,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
PSN TIB STEM 5 DEG SZ F R,,57002229,LOCAL,Facility,Inpatient,,,,2745.5,2333.675,786.8603,2745.5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
PSN TIB STEM 5 DEG SZ F R,,57002229,LOCAL,Facility,Outpatient,,,,2745.5,2333.675,786.8603,2745.5,"UCare Health, Inc.",Medical Assistance,1385.65385,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PSN TIB STEM 5 DEG SZ F R,,57002229,LOCAL,Facility,Inpatient,,,,2745.5,2333.675,786.8603,2745.5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
PSN TIB STEM 5 DEG SZ F R,,57002229,LOCAL,Facility,Outpatient,,,,2745.5,2333.675,786.8603,2745.5,"UCare Health, Inc.",Medicare Advantage,1385.65385,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PSN TIB STEM 5 DEG SZ F R,,57002229,LOCAL,Facility,Inpatient,,,,2745.5,2333.675,786.8603,2745.5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PSN TIB STEM 5 DEG SZ F R,,57002229,LOCAL,Facility,Outpatient,,,,2745.5,2333.675,786.8603,2745.5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1385.65385,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PSN TIB STEM 5 DEG SZ F R,,57002229,LOCAL,Facility,Inpatient,,,,2745.5,2333.675,786.8603,2745.5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PSN TIB STEM 5 DEG SZ F R,,57002229,LOCAL,Facility,Both,,,,2745.5,2333.675,786.8603,2745.5,UnitedHealthcare,Individual & Family,2580.77,94,,percent of total billed charges,,
PSN TIB STEM 5 DEG SZ F R,,57002229,LOCAL,Facility,Outpatient,,,,2745.5,2333.675,786.8603,2745.5,UnitedHealthcare,Medicare Advantage,1345.295,49,,percent of total billed charges,,
PSN TIB STEM 5 DEG SZ F R,,57002229,LOCAL,Facility,Inpatient,,,,2745.5,2333.675,786.8603,2745.5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
PSN TIB STEM 5 DEG SZ F R,,57002229,LOCAL,Facility,Outpatient,,,,2745.5,2333.675,786.8603,2745.5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1317.84,48,,percent of total billed charges,,100% of DHS outpatient percentage
PSN TIB STEM 5 DEG SZ F R,,57002229,LOCAL,Facility,Inpatient,,,,2745.5,2333.675,786.8603,2745.5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
PSN TIB STM 5 DEG SZ H R,,57002229,LOCAL,Facility,Both,,,,2745.5,2333.675,786.8603,2745.5,Aetna,Commercial,2525.86,92,,percent of total billed charges,,
PSN TIB STM 5 DEG SZ H R,,57002229,LOCAL,Facility,Outpatient,,,,2745.5,2333.675,786.8603,2745.5,Aetna,Medicare Advantage,1345.295,49,,percent of total billed charges,,
PSN TIB STM 5 DEG SZ H R,,57002229,LOCAL,Facility,Inpatient,,,,2745.5,2333.675,786.8603,2745.5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
PSN TIB STM 5 DEG SZ H R,,57002229,LOCAL,Facility,Both,,,,2745.5,2333.675,786.8603,2745.5,Aetna,PPO,2553.315,93,,percent of total billed charges,,
PSN TIB STM 5 DEG SZ H R,,57002229,LOCAL,Facility,Both,,,,2745.5,2333.675,786.8603,2745.5,America's PPO,America's PPO,2636.50365,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
PSN TIB STM 5 DEG SZ H R,,57002229,LOCAL,Facility,Both,,,,2745.5,2333.675,786.8603,2745.5,BlueCross BlueShield Minnesota, Federal Employee Program,2701.572,98.4,,percent of total billed charges,,
PSN TIB STM 5 DEG SZ H R,,57002229,LOCAL,Facility,Both,,,,2745.5,2333.675,786.8603,2745.5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,2745.5,100,,percent of total billed charges,,
PSN TIB STM 5 DEG SZ H R,,57002229,LOCAL,Facility,Both,,,,2745.5,2333.675,786.8603,2745.5,BlueCross BlueShield Minnesota,High Value Network Plan,2470.95,90,,percent of total billed charges,,
PSN TIB STM 5 DEG SZ H R,,57002229,LOCAL,Facility,Outpatient,,,,2745.5,2333.675,786.8603,2745.5,BlueCross BlueShield Minnesota,Medicare Advantage,1345.295,49,,percent of total billed charges,,
PSN TIB STM 5 DEG SZ H R,,57002229,LOCAL,Facility,Inpatient,,,,2745.5,2333.675,786.8603,2745.5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
PSN TIB STM 5 DEG SZ H R,,57002229,LOCAL,Facility,Both,,,,2745.5,2333.675,786.8603,2745.5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,2431.68935,88.57,,percent of total billed charges,,
PSN TIB STM 5 DEG SZ H R,,57002229,LOCAL,Facility,Both,,,,2745.5,2333.675,786.8603,2745.5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,786.8603,28.66,,percent of total billed charges,,
PSN TIB STM 5 DEG SZ H R,,57002229,LOCAL,Facility,Outpatient,,,,2745.5,2333.675,786.8603,2745.5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1345.295,49,,percent of total billed charges,,
PSN TIB STM 5 DEG SZ H R,,57002229,LOCAL,Facility,Inpatient,,,,2745.5,2333.675,786.8603,2745.5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
PSN TIB STM 5 DEG SZ H R,,57002229,LOCAL,Facility,Both,,,,2745.5,2333.675,786.8603,2745.5,CorVel,Worker's Compensation,2745.5,100,,percent of total billed charges,,
PSN TIB STM 5 DEG SZ H R,,57002229,LOCAL,Facility,Both,,,,2745.5,2333.675,786.8603,2745.5,First Health Group Corporation,First Health Network,2663.135,97,,percent of total billed charges,,
PSN TIB STM 5 DEG SZ H R,,57002229,LOCAL,Facility,Both,,,,2745.5,2333.675,786.8603,2745.5,"Health Partners, Inc.",Commercial,2597.243,94.6,,percent of total billed charges,,
PSN TIB STM 5 DEG SZ H R,,57002229,LOCAL,Facility,Outpatient,,,,2745.5,2333.675,786.8603,2745.5,"Health Partners, Inc.",Medicare Advantage,1345.295,49,,percent of total billed charges,,
PSN TIB STM 5 DEG SZ H R,,57002229,LOCAL,Facility,Inpatient,,,,2745.5,2333.675,786.8603,2745.5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PSN TIB STM 5 DEG SZ H R,,57002229,LOCAL,Facility,Both,,,,2745.5,2333.675,786.8603,2745.5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1647.3,60,,percent of total billed charges,,
PSN TIB STM 5 DEG SZ H R,,57002229,LOCAL,Facility,Both,,,,2745.5,2333.675,786.8603,2745.5,"Health Partners, Inc.",State of Minnesota Advantage Program,2237.5825,81.5,,percent of total billed charges,,
PSN TIB STM 5 DEG SZ H R,,57002229,LOCAL,Facility,Both,,,,2745.5,2333.675,786.8603,2745.5,"Health Partners, Inc.",State Public Programs,1372.75,50,,percent of total billed charges,,
PSN TIB STM 5 DEG SZ H R,,57002229,LOCAL,Facility,Both,,,,2745.5,2333.675,786.8603,2745.5,Humana Insurance Company,Commercial PPO,2608.225,95,,percent of total billed charges,,
PSN TIB STM 5 DEG SZ H R,,57002229,LOCAL,Facility,Outpatient,,,,2745.5,2333.675,786.8603,2745.5,Humana Insurance Company,Medicare PPO,1345.295,49,,percent of total billed charges,,
PSN TIB STM 5 DEG SZ H R,,57002229,LOCAL,Facility,Inpatient,,,,2745.5,2333.675,786.8603,2745.5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
PSN TIB STM 5 DEG SZ H R,,57002229,LOCAL,Facility,Both,,,,2745.5,2333.675,786.8603,2745.5,Medica,Individual & Family,2720.7905,99.1,,percent of total billed charges,,
PSN TIB STM 5 DEG SZ H R,,57002229,LOCAL,Facility,Outpatient,,,,2745.5,2333.675,786.8603,2745.5,Medica,Medica Advantage Solution,1367.259,49.8,,percent of total billed charges,,
PSN TIB STM 5 DEG SZ H R,,57002229,LOCAL,Facility,Inpatient,,,,2745.5,2333.675,786.8603,2745.5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
PSN TIB STM 5 DEG SZ H R,,57002229,LOCAL,Facility,Outpatient,,,,2745.5,2333.675,786.8603,2745.5,Medica,Medical Assistance,1224.493,44.6,,percent of total billed charges,,
PSN TIB STM 5 DEG SZ H R,,57002229,LOCAL,Facility,Inpatient,,,,2745.5,2333.675,786.8603,2745.5,Medica,Medical Assistance,,,,,Included in per diem rate,
PSN TIB STM 5 DEG SZ H R,,57002229,LOCAL,Facility,Outpatient,,,,2745.5,2333.675,786.8603,2745.5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1367.259,49.8,,percent of total billed charges,,
PSN TIB STM 5 DEG SZ H R,,57002229,LOCAL,Facility,Inpatient,,,,2745.5,2333.675,786.8603,2745.5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
PSN TIB STM 5 DEG SZ H R,,57002229,LOCAL,Facility,Both,,,,2745.5,2333.675,786.8603,2745.5,"Multiplan, Inc.","Multiplan, Inc.",2580.77,94,,percent of total billed charges,,
PSN TIB STM 5 DEG SZ H R,,57002229,LOCAL,Facility,Outpatient,,,,2745.5,2333.675,786.8603,2745.5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,2473.6955,90.1,,percent of total billed charges,,
PSN TIB STM 5 DEG SZ H R,,57002229,LOCAL,Facility,Inpatient,,,,2745.5,2333.675,786.8603,2745.5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
PSN TIB STM 5 DEG SZ H R,,57002229,LOCAL,Facility,Both,,,,2745.5,2333.675,786.8603,2745.5,"Preferred One Administrative Services, INC.",PPO,2707.063,98.6,,percent of total billed charges,,
PSN TIB STM 5 DEG SZ H R,,57002229,LOCAL,Facility,Outpatient,,,,2745.5,2333.675,786.8603,2745.5,PrimeWest Health,Minnesota Senior Health Options (MSHO),1412.55975,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
PSN TIB STM 5 DEG SZ H R,,57002229,LOCAL,Facility,Inpatient,,,,2745.5,2333.675,786.8603,2745.5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PSN TIB STM 5 DEG SZ H R,,57002229,LOCAL,Facility,Outpatient,,,,2745.5,2333.675,786.8603,2745.5,PrimeWest Health,MinnesotaCare,1410.0888,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
PSN TIB STM 5 DEG SZ H R,,57002229,LOCAL,Facility,Inpatient,,,,2745.5,2333.675,786.8603,2745.5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
PSN TIB STM 5 DEG SZ H R,,57002229,LOCAL,Facility,Both,,,,2745.5,2333.675,786.8603,2745.5,Sanford Health Plan,Sanford Health Plan,2525.86,92,,percent of total billed charges,,
PSN TIB STM 5 DEG SZ H R,,57002229,LOCAL,Facility,Outpatient,,,,2745.5,2333.675,786.8603,2745.5,"UCare Health, Inc.",Individual & Family Plan,1547.08925,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
PSN TIB STM 5 DEG SZ H R,,57002229,LOCAL,Facility,Inpatient,,,,2745.5,2333.675,786.8603,2745.5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
PSN TIB STM 5 DEG SZ H R,,57002229,LOCAL,Facility,Outpatient,,,,2745.5,2333.675,786.8603,2745.5,"UCare Health, Inc.",Medical Assistance,1385.65385,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PSN TIB STM 5 DEG SZ H R,,57002229,LOCAL,Facility,Inpatient,,,,2745.5,2333.675,786.8603,2745.5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
PSN TIB STM 5 DEG SZ H R,,57002229,LOCAL,Facility,Outpatient,,,,2745.5,2333.675,786.8603,2745.5,"UCare Health, Inc.",Medicare Advantage,1385.65385,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PSN TIB STM 5 DEG SZ H R,,57002229,LOCAL,Facility,Inpatient,,,,2745.5,2333.675,786.8603,2745.5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PSN TIB STM 5 DEG SZ H R,,57002229,LOCAL,Facility,Outpatient,,,,2745.5,2333.675,786.8603,2745.5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1385.65385,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PSN TIB STM 5 DEG SZ H R,,57002229,LOCAL,Facility,Inpatient,,,,2745.5,2333.675,786.8603,2745.5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PSN TIB STM 5 DEG SZ H R,,57002229,LOCAL,Facility,Both,,,,2745.5,2333.675,786.8603,2745.5,UnitedHealthcare,Individual & Family,2580.77,94,,percent of total billed charges,,
PSN TIB STM 5 DEG SZ H R,,57002229,LOCAL,Facility,Outpatient,,,,2745.5,2333.675,786.8603,2745.5,UnitedHealthcare,Medicare Advantage,1345.295,49,,percent of total billed charges,,
PSN TIB STM 5 DEG SZ H R,,57002229,LOCAL,Facility,Inpatient,,,,2745.5,2333.675,786.8603,2745.5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
PSN TIB STM 5 DEG SZ H R,,57002229,LOCAL,Facility,Outpatient,,,,2745.5,2333.675,786.8603,2745.5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1317.84,48,,percent of total billed charges,,100% of DHS outpatient percentage
PSN TIB STM 5 DEG SZ H R,,57002229,LOCAL,Facility,Inpatient,,,,2745.5,2333.675,786.8603,2745.5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
SCREW HEADED 2.5X22MM,,57002229,LOCAL,Facility,Both,,,,945,803.25,270.837,945,Aetna,Commercial,869.4,92,,percent of total billed charges,,
SCREW HEADED 2.5X22MM,,57002229,LOCAL,Facility,Outpatient,,,,945,803.25,270.837,945,Aetna,Medicare Advantage,463.05,49,,percent of total billed charges,,
SCREW HEADED 2.5X22MM,,57002229,LOCAL,Facility,Inpatient,,,,945,803.25,270.837,945,Aetna,Medicare Advantage,,,,,Included in per diem rate,
SCREW HEADED 2.5X22MM,,57002229,LOCAL,Facility,Both,,,,945,803.25,270.837,945,Aetna,PPO,878.85,93,,percent of total billed charges,,
SCREW HEADED 2.5X22MM,,57002229,LOCAL,Facility,Both,,,,945,803.25,270.837,945,America's PPO,America's PPO,907.4835,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SCREW HEADED 2.5X22MM,,57002229,LOCAL,Facility,Both,,,,945,803.25,270.837,945,BlueCross BlueShield Minnesota, Federal Employee Program,929.88,98.4,,percent of total billed charges,,
SCREW HEADED 2.5X22MM,,57002229,LOCAL,Facility,Both,,,,945,803.25,270.837,945,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,945,100,,percent of total billed charges,,
SCREW HEADED 2.5X22MM,,57002229,LOCAL,Facility,Both,,,,945,803.25,270.837,945,BlueCross BlueShield Minnesota,High Value Network Plan,850.5,90,,percent of total billed charges,,
SCREW HEADED 2.5X22MM,,57002229,LOCAL,Facility,Outpatient,,,,945,803.25,270.837,945,BlueCross BlueShield Minnesota,Medicare Advantage,463.05,49,,percent of total billed charges,,
SCREW HEADED 2.5X22MM,,57002229,LOCAL,Facility,Inpatient,,,,945,803.25,270.837,945,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
SCREW HEADED 2.5X22MM,,57002229,LOCAL,Facility,Both,,,,945,803.25,270.837,945,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,836.9865,88.57,,percent of total billed charges,,
SCREW HEADED 2.5X22MM,,57002229,LOCAL,Facility,Both,,,,945,803.25,270.837,945,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,270.837,28.66,,percent of total billed charges,,
SCREW HEADED 2.5X22MM,,57002229,LOCAL,Facility,Outpatient,,,,945,803.25,270.837,945,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),463.05,49,,percent of total billed charges,,
SCREW HEADED 2.5X22MM,,57002229,LOCAL,Facility,Inpatient,,,,945,803.25,270.837,945,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
SCREW HEADED 2.5X22MM,,57002229,LOCAL,Facility,Both,,,,945,803.25,270.837,945,CorVel,Worker's Compensation,945,100,,percent of total billed charges,,
SCREW HEADED 2.5X22MM,,57002229,LOCAL,Facility,Both,,,,945,803.25,270.837,945,First Health Group Corporation,First Health Network,916.65,97,,percent of total billed charges,,
SCREW HEADED 2.5X22MM,,57002229,LOCAL,Facility,Both,,,,945,803.25,270.837,945,"Health Partners, Inc.",Commercial,893.97,94.6,,percent of total billed charges,,
SCREW HEADED 2.5X22MM,,57002229,LOCAL,Facility,Outpatient,,,,945,803.25,270.837,945,"Health Partners, Inc.",Medicare Advantage,463.05,49,,percent of total billed charges,,
SCREW HEADED 2.5X22MM,,57002229,LOCAL,Facility,Inpatient,,,,945,803.25,270.837,945,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SCREW HEADED 2.5X22MM,,57002229,LOCAL,Facility,Both,,,,945,803.25,270.837,945,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),567,60,,percent of total billed charges,,
SCREW HEADED 2.5X22MM,,57002229,LOCAL,Facility,Both,,,,945,803.25,270.837,945,"Health Partners, Inc.",State of Minnesota Advantage Program,770.175,81.5,,percent of total billed charges,,
SCREW HEADED 2.5X22MM,,57002229,LOCAL,Facility,Both,,,,945,803.25,270.837,945,"Health Partners, Inc.",State Public Programs,472.5,50,,percent of total billed charges,,
SCREW HEADED 2.5X22MM,,57002229,LOCAL,Facility,Both,,,,945,803.25,270.837,945,Humana Insurance Company,Commercial PPO,897.75,95,,percent of total billed charges,,
SCREW HEADED 2.5X22MM,,57002229,LOCAL,Facility,Outpatient,,,,945,803.25,270.837,945,Humana Insurance Company,Medicare PPO,463.05,49,,percent of total billed charges,,
SCREW HEADED 2.5X22MM,,57002229,LOCAL,Facility,Inpatient,,,,945,803.25,270.837,945,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
SCREW HEADED 2.5X22MM,,57002229,LOCAL,Facility,Both,,,,945,803.25,270.837,945,Medica,Individual & Family,936.495,99.1,,percent of total billed charges,,
SCREW HEADED 2.5X22MM,,57002229,LOCAL,Facility,Outpatient,,,,945,803.25,270.837,945,Medica,Medica Advantage Solution,470.61,49.8,,percent of total billed charges,,
SCREW HEADED 2.5X22MM,,57002229,LOCAL,Facility,Inpatient,,,,945,803.25,270.837,945,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
SCREW HEADED 2.5X22MM,,57002229,LOCAL,Facility,Outpatient,,,,945,803.25,270.837,945,Medica,Medical Assistance,421.47,44.6,,percent of total billed charges,,
SCREW HEADED 2.5X22MM,,57002229,LOCAL,Facility,Inpatient,,,,945,803.25,270.837,945,Medica,Medical Assistance,,,,,Included in per diem rate,
SCREW HEADED 2.5X22MM,,57002229,LOCAL,Facility,Outpatient,,,,945,803.25,270.837,945,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,470.61,49.8,,percent of total billed charges,,
SCREW HEADED 2.5X22MM,,57002229,LOCAL,Facility,Inpatient,,,,945,803.25,270.837,945,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
SCREW HEADED 2.5X22MM,,57002229,LOCAL,Facility,Both,,,,945,803.25,270.837,945,"Multiplan, Inc.","Multiplan, Inc.",888.3,94,,percent of total billed charges,,
SCREW HEADED 2.5X22MM,,57002229,LOCAL,Facility,Outpatient,,,,945,803.25,270.837,945,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,851.445,90.1,,percent of total billed charges,,
SCREW HEADED 2.5X22MM,,57002229,LOCAL,Facility,Inpatient,,,,945,803.25,270.837,945,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
SCREW HEADED 2.5X22MM,,57002229,LOCAL,Facility,Both,,,,945,803.25,270.837,945,"Preferred One Administrative Services, INC.",PPO,931.77,98.6,,percent of total billed charges,,
SCREW HEADED 2.5X22MM,,57002229,LOCAL,Facility,Outpatient,,,,945,803.25,270.837,945,PrimeWest Health,Minnesota Senior Health Options (MSHO),486.2025,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
SCREW HEADED 2.5X22MM,,57002229,LOCAL,Facility,Inpatient,,,,945,803.25,270.837,945,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SCREW HEADED 2.5X22MM,,57002229,LOCAL,Facility,Outpatient,,,,945,803.25,270.837,945,PrimeWest Health,MinnesotaCare,485.352,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
SCREW HEADED 2.5X22MM,,57002229,LOCAL,Facility,Inpatient,,,,945,803.25,270.837,945,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
SCREW HEADED 2.5X22MM,,57002229,LOCAL,Facility,Both,,,,945,803.25,270.837,945,Sanford Health Plan,Sanford Health Plan,869.4,92,,percent of total billed charges,,
SCREW HEADED 2.5X22MM,,57002229,LOCAL,Facility,Outpatient,,,,945,803.25,270.837,945,"UCare Health, Inc.",Individual & Family Plan,532.5075,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
SCREW HEADED 2.5X22MM,,57002229,LOCAL,Facility,Inpatient,,,,945,803.25,270.837,945,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
SCREW HEADED 2.5X22MM,,57002229,LOCAL,Facility,Outpatient,,,,945,803.25,270.837,945,"UCare Health, Inc.",Medical Assistance,476.9415,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SCREW HEADED 2.5X22MM,,57002229,LOCAL,Facility,Inpatient,,,,945,803.25,270.837,945,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
SCREW HEADED 2.5X22MM,,57002229,LOCAL,Facility,Outpatient,,,,945,803.25,270.837,945,"UCare Health, Inc.",Medicare Advantage,476.9415,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SCREW HEADED 2.5X22MM,,57002229,LOCAL,Facility,Inpatient,,,,945,803.25,270.837,945,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SCREW HEADED 2.5X22MM,,57002229,LOCAL,Facility,Outpatient,,,,945,803.25,270.837,945,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),476.9415,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SCREW HEADED 2.5X22MM,,57002229,LOCAL,Facility,Inpatient,,,,945,803.25,270.837,945,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SCREW HEADED 2.5X22MM,,57002229,LOCAL,Facility,Both,,,,945,803.25,270.837,945,UnitedHealthcare,Individual & Family,888.3,94,,percent of total billed charges,,
SCREW HEADED 2.5X22MM,,57002229,LOCAL,Facility,Outpatient,,,,945,803.25,270.837,945,UnitedHealthcare,Medicare Advantage,463.05,49,,percent of total billed charges,,
SCREW HEADED 2.5X22MM,,57002229,LOCAL,Facility,Inpatient,,,,945,803.25,270.837,945,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
SCREW HEADED 2.5X22MM,,57002229,LOCAL,Facility,Outpatient,,,,945,803.25,270.837,945,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,453.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
SCREW HEADED 2.5X22MM,,57002229,LOCAL,Facility,Inpatient,,,,945,803.25,270.837,945,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
SCREW HEADED 2.5X24MM,,57002229,LOCAL,Facility,Both,,,,945,803.25,270.837,945,Aetna,Commercial,869.4,92,,percent of total billed charges,,
SCREW HEADED 2.5X24MM,,57002229,LOCAL,Facility,Outpatient,,,,945,803.25,270.837,945,Aetna,Medicare Advantage,463.05,49,,percent of total billed charges,,
SCREW HEADED 2.5X24MM,,57002229,LOCAL,Facility,Inpatient,,,,945,803.25,270.837,945,Aetna,Medicare Advantage,,,,,Included in per diem rate,
SCREW HEADED 2.5X24MM,,57002229,LOCAL,Facility,Both,,,,945,803.25,270.837,945,Aetna,PPO,878.85,93,,percent of total billed charges,,
SCREW HEADED 2.5X24MM,,57002229,LOCAL,Facility,Both,,,,945,803.25,270.837,945,America's PPO,America's PPO,907.4835,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SCREW HEADED 2.5X24MM,,57002229,LOCAL,Facility,Both,,,,945,803.25,270.837,945,BlueCross BlueShield Minnesota, Federal Employee Program,929.88,98.4,,percent of total billed charges,,
SCREW HEADED 2.5X24MM,,57002229,LOCAL,Facility,Both,,,,945,803.25,270.837,945,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,945,100,,percent of total billed charges,,
SCREW HEADED 2.5X24MM,,57002229,LOCAL,Facility,Both,,,,945,803.25,270.837,945,BlueCross BlueShield Minnesota,High Value Network Plan,850.5,90,,percent of total billed charges,,
SCREW HEADED 2.5X24MM,,57002229,LOCAL,Facility,Outpatient,,,,945,803.25,270.837,945,BlueCross BlueShield Minnesota,Medicare Advantage,463.05,49,,percent of total billed charges,,
SCREW HEADED 2.5X24MM,,57002229,LOCAL,Facility,Inpatient,,,,945,803.25,270.837,945,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
SCREW HEADED 2.5X24MM,,57002229,LOCAL,Facility,Both,,,,945,803.25,270.837,945,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,836.9865,88.57,,percent of total billed charges,,
SCREW HEADED 2.5X24MM,,57002229,LOCAL,Facility,Both,,,,945,803.25,270.837,945,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,270.837,28.66,,percent of total billed charges,,
SCREW HEADED 2.5X24MM,,57002229,LOCAL,Facility,Outpatient,,,,945,803.25,270.837,945,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),463.05,49,,percent of total billed charges,,
SCREW HEADED 2.5X24MM,,57002229,LOCAL,Facility,Inpatient,,,,945,803.25,270.837,945,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
SCREW HEADED 2.5X24MM,,57002229,LOCAL,Facility,Both,,,,945,803.25,270.837,945,CorVel,Worker's Compensation,945,100,,percent of total billed charges,,
SCREW HEADED 2.5X24MM,,57002229,LOCAL,Facility,Both,,,,945,803.25,270.837,945,First Health Group Corporation,First Health Network,916.65,97,,percent of total billed charges,,
SCREW HEADED 2.5X24MM,,57002229,LOCAL,Facility,Both,,,,945,803.25,270.837,945,"Health Partners, Inc.",Commercial,893.97,94.6,,percent of total billed charges,,
SCREW HEADED 2.5X24MM,,57002229,LOCAL,Facility,Outpatient,,,,945,803.25,270.837,945,"Health Partners, Inc.",Medicare Advantage,463.05,49,,percent of total billed charges,,
SCREW HEADED 2.5X24MM,,57002229,LOCAL,Facility,Inpatient,,,,945,803.25,270.837,945,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SCREW HEADED 2.5X24MM,,57002229,LOCAL,Facility,Both,,,,945,803.25,270.837,945,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),567,60,,percent of total billed charges,,
SCREW HEADED 2.5X24MM,,57002229,LOCAL,Facility,Both,,,,945,803.25,270.837,945,"Health Partners, Inc.",State of Minnesota Advantage Program,770.175,81.5,,percent of total billed charges,,
SCREW HEADED 2.5X24MM,,57002229,LOCAL,Facility,Both,,,,945,803.25,270.837,945,"Health Partners, Inc.",State Public Programs,472.5,50,,percent of total billed charges,,
SCREW HEADED 2.5X24MM,,57002229,LOCAL,Facility,Both,,,,945,803.25,270.837,945,Humana Insurance Company,Commercial PPO,897.75,95,,percent of total billed charges,,
SCREW HEADED 2.5X24MM,,57002229,LOCAL,Facility,Outpatient,,,,945,803.25,270.837,945,Humana Insurance Company,Medicare PPO,463.05,49,,percent of total billed charges,,
SCREW HEADED 2.5X24MM,,57002229,LOCAL,Facility,Inpatient,,,,945,803.25,270.837,945,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
SCREW HEADED 2.5X24MM,,57002229,LOCAL,Facility,Both,,,,945,803.25,270.837,945,Medica,Individual & Family,936.495,99.1,,percent of total billed charges,,
SCREW HEADED 2.5X24MM,,57002229,LOCAL,Facility,Outpatient,,,,945,803.25,270.837,945,Medica,Medica Advantage Solution,470.61,49.8,,percent of total billed charges,,
SCREW HEADED 2.5X24MM,,57002229,LOCAL,Facility,Inpatient,,,,945,803.25,270.837,945,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
SCREW HEADED 2.5X24MM,,57002229,LOCAL,Facility,Outpatient,,,,945,803.25,270.837,945,Medica,Medical Assistance,421.47,44.6,,percent of total billed charges,,
SCREW HEADED 2.5X24MM,,57002229,LOCAL,Facility,Inpatient,,,,945,803.25,270.837,945,Medica,Medical Assistance,,,,,Included in per diem rate,
SCREW HEADED 2.5X24MM,,57002229,LOCAL,Facility,Outpatient,,,,945,803.25,270.837,945,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,470.61,49.8,,percent of total billed charges,,
SCREW HEADED 2.5X24MM,,57002229,LOCAL,Facility,Inpatient,,,,945,803.25,270.837,945,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
SCREW HEADED 2.5X24MM,,57002229,LOCAL,Facility,Both,,,,945,803.25,270.837,945,"Multiplan, Inc.","Multiplan, Inc.",888.3,94,,percent of total billed charges,,
SCREW HEADED 2.5X24MM,,57002229,LOCAL,Facility,Outpatient,,,,945,803.25,270.837,945,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,851.445,90.1,,percent of total billed charges,,
SCREW HEADED 2.5X24MM,,57002229,LOCAL,Facility,Inpatient,,,,945,803.25,270.837,945,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
SCREW HEADED 2.5X24MM,,57002229,LOCAL,Facility,Both,,,,945,803.25,270.837,945,"Preferred One Administrative Services, INC.",PPO,931.77,98.6,,percent of total billed charges,,
SCREW HEADED 2.5X24MM,,57002229,LOCAL,Facility,Outpatient,,,,945,803.25,270.837,945,PrimeWest Health,Minnesota Senior Health Options (MSHO),486.2025,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
SCREW HEADED 2.5X24MM,,57002229,LOCAL,Facility,Inpatient,,,,945,803.25,270.837,945,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SCREW HEADED 2.5X24MM,,57002229,LOCAL,Facility,Outpatient,,,,945,803.25,270.837,945,PrimeWest Health,MinnesotaCare,485.352,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
SCREW HEADED 2.5X24MM,,57002229,LOCAL,Facility,Inpatient,,,,945,803.25,270.837,945,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
SCREW HEADED 2.5X24MM,,57002229,LOCAL,Facility,Both,,,,945,803.25,270.837,945,Sanford Health Plan,Sanford Health Plan,869.4,92,,percent of total billed charges,,
SCREW HEADED 2.5X24MM,,57002229,LOCAL,Facility,Outpatient,,,,945,803.25,270.837,945,"UCare Health, Inc.",Individual & Family Plan,532.5075,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
SCREW HEADED 2.5X24MM,,57002229,LOCAL,Facility,Inpatient,,,,945,803.25,270.837,945,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
SCREW HEADED 2.5X24MM,,57002229,LOCAL,Facility,Outpatient,,,,945,803.25,270.837,945,"UCare Health, Inc.",Medical Assistance,476.9415,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SCREW HEADED 2.5X24MM,,57002229,LOCAL,Facility,Inpatient,,,,945,803.25,270.837,945,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
SCREW HEADED 2.5X24MM,,57002229,LOCAL,Facility,Outpatient,,,,945,803.25,270.837,945,"UCare Health, Inc.",Medicare Advantage,476.9415,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SCREW HEADED 2.5X24MM,,57002229,LOCAL,Facility,Inpatient,,,,945,803.25,270.837,945,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SCREW HEADED 2.5X24MM,,57002229,LOCAL,Facility,Outpatient,,,,945,803.25,270.837,945,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),476.9415,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SCREW HEADED 2.5X24MM,,57002229,LOCAL,Facility,Inpatient,,,,945,803.25,270.837,945,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SCREW HEADED 2.5X24MM,,57002229,LOCAL,Facility,Both,,,,945,803.25,270.837,945,UnitedHealthcare,Individual & Family,888.3,94,,percent of total billed charges,,
SCREW HEADED 2.5X24MM,,57002229,LOCAL,Facility,Outpatient,,,,945,803.25,270.837,945,UnitedHealthcare,Medicare Advantage,463.05,49,,percent of total billed charges,,
SCREW HEADED 2.5X24MM,,57002229,LOCAL,Facility,Inpatient,,,,945,803.25,270.837,945,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
SCREW HEADED 2.5X24MM,,57002229,LOCAL,Facility,Outpatient,,,,945,803.25,270.837,945,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,453.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
SCREW HEADED 2.5X24MM,,57002229,LOCAL,Facility,Inpatient,,,,945,803.25,270.837,945,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
SCREW Headed Dartfire 3.0X28,,57002229,LOCAL,Facility,Both,,,,975,828.75,279.435,975,Aetna,Commercial,897,92,,percent of total billed charges,,
SCREW Headed Dartfire 3.0X28,,57002229,LOCAL,Facility,Outpatient,,,,975,828.75,279.435,975,Aetna,Medicare Advantage,477.75,49,,percent of total billed charges,,
SCREW Headed Dartfire 3.0X28,,57002229,LOCAL,Facility,Inpatient,,,,975,828.75,279.435,975,Aetna,Medicare Advantage,,,,,Included in per diem rate,
SCREW Headed Dartfire 3.0X28,,57002229,LOCAL,Facility,Both,,,,975,828.75,279.435,975,Aetna,PPO,906.75,93,,percent of total billed charges,,
SCREW Headed Dartfire 3.0X28,,57002229,LOCAL,Facility,Both,,,,975,828.75,279.435,975,America's PPO,America's PPO,936.2925,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SCREW Headed Dartfire 3.0X28,,57002229,LOCAL,Facility,Both,,,,975,828.75,279.435,975,BlueCross BlueShield Minnesota, Federal Employee Program,959.4,98.4,,percent of total billed charges,,
SCREW Headed Dartfire 3.0X28,,57002229,LOCAL,Facility,Both,,,,975,828.75,279.435,975,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,975,100,,percent of total billed charges,,
SCREW Headed Dartfire 3.0X28,,57002229,LOCAL,Facility,Both,,,,975,828.75,279.435,975,BlueCross BlueShield Minnesota,High Value Network Plan,877.5,90,,percent of total billed charges,,
SCREW Headed Dartfire 3.0X28,,57002229,LOCAL,Facility,Outpatient,,,,975,828.75,279.435,975,BlueCross BlueShield Minnesota,Medicare Advantage,477.75,49,,percent of total billed charges,,
SCREW Headed Dartfire 3.0X28,,57002229,LOCAL,Facility,Inpatient,,,,975,828.75,279.435,975,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
SCREW Headed Dartfire 3.0X28,,57002229,LOCAL,Facility,Both,,,,975,828.75,279.435,975,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,863.5575,88.57,,percent of total billed charges,,
SCREW Headed Dartfire 3.0X28,,57002229,LOCAL,Facility,Both,,,,975,828.75,279.435,975,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,279.435,28.66,,percent of total billed charges,,
SCREW Headed Dartfire 3.0X28,,57002229,LOCAL,Facility,Outpatient,,,,975,828.75,279.435,975,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),477.75,49,,percent of total billed charges,,
SCREW Headed Dartfire 3.0X28,,57002229,LOCAL,Facility,Inpatient,,,,975,828.75,279.435,975,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
SCREW Headed Dartfire 3.0X28,,57002229,LOCAL,Facility,Both,,,,975,828.75,279.435,975,CorVel,Worker's Compensation,975,100,,percent of total billed charges,,
SCREW Headed Dartfire 3.0X28,,57002229,LOCAL,Facility,Both,,,,975,828.75,279.435,975,First Health Group Corporation,First Health Network,945.75,97,,percent of total billed charges,,
SCREW Headed Dartfire 3.0X28,,57002229,LOCAL,Facility,Both,,,,975,828.75,279.435,975,"Health Partners, Inc.",Commercial,922.35,94.6,,percent of total billed charges,,
SCREW Headed Dartfire 3.0X28,,57002229,LOCAL,Facility,Outpatient,,,,975,828.75,279.435,975,"Health Partners, Inc.",Medicare Advantage,477.75,49,,percent of total billed charges,,
SCREW Headed Dartfire 3.0X28,,57002229,LOCAL,Facility,Inpatient,,,,975,828.75,279.435,975,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SCREW Headed Dartfire 3.0X28,,57002229,LOCAL,Facility,Both,,,,975,828.75,279.435,975,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),585,60,,percent of total billed charges,,
SCREW Headed Dartfire 3.0X28,,57002229,LOCAL,Facility,Both,,,,975,828.75,279.435,975,"Health Partners, Inc.",State of Minnesota Advantage Program,794.625,81.5,,percent of total billed charges,,
SCREW Headed Dartfire 3.0X28,,57002229,LOCAL,Facility,Both,,,,975,828.75,279.435,975,"Health Partners, Inc.",State Public Programs,487.5,50,,percent of total billed charges,,
SCREW Headed Dartfire 3.0X28,,57002229,LOCAL,Facility,Both,,,,975,828.75,279.435,975,Humana Insurance Company,Commercial PPO,926.25,95,,percent of total billed charges,,
SCREW Headed Dartfire 3.0X28,,57002229,LOCAL,Facility,Outpatient,,,,975,828.75,279.435,975,Humana Insurance Company,Medicare PPO,477.75,49,,percent of total billed charges,,
SCREW Headed Dartfire 3.0X28,,57002229,LOCAL,Facility,Inpatient,,,,975,828.75,279.435,975,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
SCREW Headed Dartfire 3.0X28,,57002229,LOCAL,Facility,Both,,,,975,828.75,279.435,975,Medica,Individual & Family,966.225,99.1,,percent of total billed charges,,
SCREW Headed Dartfire 3.0X28,,57002229,LOCAL,Facility,Outpatient,,,,975,828.75,279.435,975,Medica,Medica Advantage Solution,485.55,49.8,,percent of total billed charges,,
SCREW Headed Dartfire 3.0X28,,57002229,LOCAL,Facility,Inpatient,,,,975,828.75,279.435,975,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
SCREW Headed Dartfire 3.0X28,,57002229,LOCAL,Facility,Outpatient,,,,975,828.75,279.435,975,Medica,Medical Assistance,434.85,44.6,,percent of total billed charges,,
SCREW Headed Dartfire 3.0X28,,57002229,LOCAL,Facility,Inpatient,,,,975,828.75,279.435,975,Medica,Medical Assistance,,,,,Included in per diem rate,
SCREW Headed Dartfire 3.0X28,,57002229,LOCAL,Facility,Outpatient,,,,975,828.75,279.435,975,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,485.55,49.8,,percent of total billed charges,,
SCREW Headed Dartfire 3.0X28,,57002229,LOCAL,Facility,Inpatient,,,,975,828.75,279.435,975,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
SCREW Headed Dartfire 3.0X28,,57002229,LOCAL,Facility,Both,,,,975,828.75,279.435,975,"Multiplan, Inc.","Multiplan, Inc.",916.5,94,,percent of total billed charges,,
SCREW Headed Dartfire 3.0X28,,57002229,LOCAL,Facility,Outpatient,,,,975,828.75,279.435,975,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,878.475,90.1,,percent of total billed charges,,
SCREW Headed Dartfire 3.0X28,,57002229,LOCAL,Facility,Inpatient,,,,975,828.75,279.435,975,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
SCREW Headed Dartfire 3.0X28,,57002229,LOCAL,Facility,Both,,,,975,828.75,279.435,975,"Preferred One Administrative Services, INC.",PPO,961.35,98.6,,percent of total billed charges,,
SCREW Headed Dartfire 3.0X28,,57002229,LOCAL,Facility,Outpatient,,,,975,828.75,279.435,975,PrimeWest Health,Minnesota Senior Health Options (MSHO),501.6375,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
SCREW Headed Dartfire 3.0X28,,57002229,LOCAL,Facility,Inpatient,,,,975,828.75,279.435,975,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SCREW Headed Dartfire 3.0X28,,57002229,LOCAL,Facility,Outpatient,,,,975,828.75,279.435,975,PrimeWest Health,MinnesotaCare,500.76,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
SCREW Headed Dartfire 3.0X28,,57002229,LOCAL,Facility,Inpatient,,,,975,828.75,279.435,975,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
SCREW Headed Dartfire 3.0X28,,57002229,LOCAL,Facility,Both,,,,975,828.75,279.435,975,Sanford Health Plan,Sanford Health Plan,897,92,,percent of total billed charges,,
SCREW Headed Dartfire 3.0X28,,57002229,LOCAL,Facility,Outpatient,,,,975,828.75,279.435,975,"UCare Health, Inc.",Individual & Family Plan,549.4125,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
SCREW Headed Dartfire 3.0X28,,57002229,LOCAL,Facility,Inpatient,,,,975,828.75,279.435,975,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
SCREW Headed Dartfire 3.0X28,,57002229,LOCAL,Facility,Outpatient,,,,975,828.75,279.435,975,"UCare Health, Inc.",Medical Assistance,492.0825,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SCREW Headed Dartfire 3.0X28,,57002229,LOCAL,Facility,Inpatient,,,,975,828.75,279.435,975,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
SCREW Headed Dartfire 3.0X28,,57002229,LOCAL,Facility,Outpatient,,,,975,828.75,279.435,975,"UCare Health, Inc.",Medicare Advantage,492.0825,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SCREW Headed Dartfire 3.0X28,,57002229,LOCAL,Facility,Inpatient,,,,975,828.75,279.435,975,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SCREW Headed Dartfire 3.0X28,,57002229,LOCAL,Facility,Outpatient,,,,975,828.75,279.435,975,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),492.0825,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SCREW Headed Dartfire 3.0X28,,57002229,LOCAL,Facility,Inpatient,,,,975,828.75,279.435,975,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SCREW Headed Dartfire 3.0X28,,57002229,LOCAL,Facility,Both,,,,975,828.75,279.435,975,UnitedHealthcare,Individual & Family,916.5,94,,percent of total billed charges,,
SCREW Headed Dartfire 3.0X28,,57002229,LOCAL,Facility,Outpatient,,,,975,828.75,279.435,975,UnitedHealthcare,Medicare Advantage,477.75,49,,percent of total billed charges,,
SCREW Headed Dartfire 3.0X28,,57002229,LOCAL,Facility,Inpatient,,,,975,828.75,279.435,975,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
SCREW Headed Dartfire 3.0X28,,57002229,LOCAL,Facility,Outpatient,,,,975,828.75,279.435,975,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,468,48,,percent of total billed charges,,100% of DHS outpatient percentage
SCREW Headed Dartfire 3.0X28,,57002229,LOCAL,Facility,Inpatient,,,,975,828.75,279.435,975,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Scheduled Procedure Minor,,58001940,LOCAL,Facility,Both,,,,408,346.8,116.9328,408,Aetna,Commercial,375.36,92,,percent of total billed charges,,
Scheduled Procedure Minor,,58001940,LOCAL,Facility,Outpatient,,,,408,346.8,116.9328,408,Aetna,Medicare Advantage,199.92,49,,percent of total billed charges,,
Scheduled Procedure Minor,,58001940,LOCAL,Facility,Inpatient,,,,408,346.8,116.9328,408,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Scheduled Procedure Minor,,58001940,LOCAL,Facility,Both,,,,408,346.8,116.9328,408,Aetna,PPO,379.44,93,,percent of total billed charges,,
Scheduled Procedure Minor,,58001940,LOCAL,Facility,Both,,,,408,346.8,116.9328,408,America's PPO,America's PPO,391.8024,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Scheduled Procedure Minor,,58001940,LOCAL,Facility,Both,,,,408,346.8,116.9328,408,BlueCross BlueShield Minnesota, Federal Employee Program,401.472,98.4,,percent of total billed charges,,
Scheduled Procedure Minor,,58001940,LOCAL,Facility,Both,,,,408,346.8,116.9328,408,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,408,100,,percent of total billed charges,,
Scheduled Procedure Minor,,58001940,LOCAL,Facility,Both,,,,408,346.8,116.9328,408,BlueCross BlueShield Minnesota,High Value Network Plan,367.2,90,,percent of total billed charges,,
Scheduled Procedure Minor,,58001940,LOCAL,Facility,Outpatient,,,,408,346.8,116.9328,408,BlueCross BlueShield Minnesota,Medicare Advantage,199.92,49,,percent of total billed charges,,
Scheduled Procedure Minor,,58001940,LOCAL,Facility,Inpatient,,,,408,346.8,116.9328,408,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Scheduled Procedure Minor,,58001940,LOCAL,Facility,Both,,,,408,346.8,116.9328,408,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,361.3656,88.57,,percent of total billed charges,,
Scheduled Procedure Minor,,58001940,LOCAL,Facility,Both,,,,408,346.8,116.9328,408,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,116.9328,28.66,,percent of total billed charges,,
Scheduled Procedure Minor,,58001940,LOCAL,Facility,Outpatient,,,,408,346.8,116.9328,408,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),199.92,49,,percent of total billed charges,,
Scheduled Procedure Minor,,58001940,LOCAL,Facility,Inpatient,,,,408,346.8,116.9328,408,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Scheduled Procedure Minor,,58001940,LOCAL,Facility,Both,,,,408,346.8,116.9328,408,CorVel,Worker's Compensation,408,100,,percent of total billed charges,,
Scheduled Procedure Minor,,58001940,LOCAL,Facility,Both,,,,408,346.8,116.9328,408,First Health Group Corporation,First Health Network,395.76,97,,percent of total billed charges,,
Scheduled Procedure Minor,,58001940,LOCAL,Facility,Both,,,,408,346.8,116.9328,408,"Health Partners, Inc.",Commercial,385.968,94.6,,percent of total billed charges,,
Scheduled Procedure Minor,,58001940,LOCAL,Facility,Outpatient,,,,408,346.8,116.9328,408,"Health Partners, Inc.",Medicare Advantage,199.92,49,,percent of total billed charges,,
Scheduled Procedure Minor,,58001940,LOCAL,Facility,Inpatient,,,,408,346.8,116.9328,408,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Scheduled Procedure Minor,,58001940,LOCAL,Facility,Both,,,,408,346.8,116.9328,408,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),244.8,60,,percent of total billed charges,,
Scheduled Procedure Minor,,58001940,LOCAL,Facility,Both,,,,408,346.8,116.9328,408,"Health Partners, Inc.",State of Minnesota Advantage Program,332.52,81.5,,percent of total billed charges,,
Scheduled Procedure Minor,,58001940,LOCAL,Facility,Both,,,,408,346.8,116.9328,408,"Health Partners, Inc.",State Public Programs,204,50,,percent of total billed charges,,
Scheduled Procedure Minor,,58001940,LOCAL,Facility,Both,,,,408,346.8,116.9328,408,Humana Insurance Company,Commercial PPO,387.6,95,,percent of total billed charges,,
Scheduled Procedure Minor,,58001940,LOCAL,Facility,Outpatient,,,,408,346.8,116.9328,408,Humana Insurance Company,Medicare PPO,199.92,49,,percent of total billed charges,,
Scheduled Procedure Minor,,58001940,LOCAL,Facility,Inpatient,,,,408,346.8,116.9328,408,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Scheduled Procedure Minor,,58001940,LOCAL,Facility,Both,,,,408,346.8,116.9328,408,Medica,Individual & Family,404.328,99.1,,percent of total billed charges,,
Scheduled Procedure Minor,,58001940,LOCAL,Facility,Outpatient,,,,408,346.8,116.9328,408,Medica,Medica Advantage Solution,203.184,49.8,,percent of total billed charges,,
Scheduled Procedure Minor,,58001940,LOCAL,Facility,Inpatient,,,,408,346.8,116.9328,408,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Scheduled Procedure Minor,,58001940,LOCAL,Facility,Outpatient,,,,408,346.8,116.9328,408,Medica,Medical Assistance,181.968,44.6,,percent of total billed charges,,
Scheduled Procedure Minor,,58001940,LOCAL,Facility,Inpatient,,,,408,346.8,116.9328,408,Medica,Medical Assistance,,,,,Included in per diem rate,
Scheduled Procedure Minor,,58001940,LOCAL,Facility,Outpatient,,,,408,346.8,116.9328,408,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,203.184,49.8,,percent of total billed charges,,
Scheduled Procedure Minor,,58001940,LOCAL,Facility,Inpatient,,,,408,346.8,116.9328,408,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Scheduled Procedure Minor,,58001940,LOCAL,Facility,Both,,,,408,346.8,116.9328,408,"Multiplan, Inc.","Multiplan, Inc.",383.52,94,,percent of total billed charges,,
Scheduled Procedure Minor,,58001940,LOCAL,Facility,Outpatient,,,,408,346.8,116.9328,408,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,367.608,90.1,,percent of total billed charges,,
Scheduled Procedure Minor,,58001940,LOCAL,Facility,Inpatient,,,,408,346.8,116.9328,408,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Scheduled Procedure Minor,,58001940,LOCAL,Facility,Both,,,,408,346.8,116.9328,408,"Preferred One Administrative Services, INC.",PPO,402.288,98.6,,percent of total billed charges,,
Scheduled Procedure Minor,,58001940,LOCAL,Facility,Outpatient,,,,408,346.8,116.9328,408,PrimeWest Health,Minnesota Senior Health Options (MSHO),209.916,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Scheduled Procedure Minor,,58001940,LOCAL,Facility,Inpatient,,,,408,346.8,116.9328,408,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Scheduled Procedure Minor,,58001940,LOCAL,Facility,Outpatient,,,,408,346.8,116.9328,408,PrimeWest Health,MinnesotaCare,209.5488,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Scheduled Procedure Minor,,58001940,LOCAL,Facility,Inpatient,,,,408,346.8,116.9328,408,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Scheduled Procedure Minor,,58001940,LOCAL,Facility,Both,,,,408,346.8,116.9328,408,Sanford Health Plan,Sanford Health Plan,375.36,92,,percent of total billed charges,,
Scheduled Procedure Minor,,58001940,LOCAL,Facility,Outpatient,,,,408,346.8,116.9328,408,"UCare Health, Inc.",Individual & Family Plan,229.908,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Scheduled Procedure Minor,,58001940,LOCAL,Facility,Inpatient,,,,408,346.8,116.9328,408,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Scheduled Procedure Minor,,58001940,LOCAL,Facility,Outpatient,,,,408,346.8,116.9328,408,"UCare Health, Inc.",Medical Assistance,205.9176,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Scheduled Procedure Minor,,58001940,LOCAL,Facility,Inpatient,,,,408,346.8,116.9328,408,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Scheduled Procedure Minor,,58001940,LOCAL,Facility,Outpatient,,,,408,346.8,116.9328,408,"UCare Health, Inc.",Medicare Advantage,205.9176,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Scheduled Procedure Minor,,58001940,LOCAL,Facility,Inpatient,,,,408,346.8,116.9328,408,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Scheduled Procedure Minor,,58001940,LOCAL,Facility,Outpatient,,,,408,346.8,116.9328,408,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),205.9176,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Scheduled Procedure Minor,,58001940,LOCAL,Facility,Inpatient,,,,408,346.8,116.9328,408,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Scheduled Procedure Minor,,58001940,LOCAL,Facility,Both,,,,408,346.8,116.9328,408,UnitedHealthcare,Individual & Family,383.52,94,,percent of total billed charges,,
Scheduled Procedure Minor,,58001940,LOCAL,Facility,Outpatient,,,,408,346.8,116.9328,408,UnitedHealthcare,Medicare Advantage,199.92,49,,percent of total billed charges,,
Scheduled Procedure Minor,,58001940,LOCAL,Facility,Inpatient,,,,408,346.8,116.9328,408,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Scheduled Procedure Minor,,58001940,LOCAL,Facility,Outpatient,,,,408,346.8,116.9328,408,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,195.84,48,,percent of total billed charges,,100% of DHS outpatient percentage
Scheduled Procedure Minor,,58001940,LOCAL,Facility,Inpatient,,,,408,346.8,116.9328,408,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Scheduled Procedure Intermediate,,58001953,LOCAL,Facility,Both,,,,561,476.85,160.7826,561,Aetna,Commercial,516.12,92,,percent of total billed charges,,
Scheduled Procedure Intermediate,,58001953,LOCAL,Facility,Outpatient,,,,561,476.85,160.7826,561,Aetna,Medicare Advantage,274.89,49,,percent of total billed charges,,
Scheduled Procedure Intermediate,,58001953,LOCAL,Facility,Inpatient,,,,561,476.85,160.7826,561,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Scheduled Procedure Intermediate,,58001953,LOCAL,Facility,Both,,,,561,476.85,160.7826,561,Aetna,PPO,521.73,93,,percent of total billed charges,,
Scheduled Procedure Intermediate,,58001953,LOCAL,Facility,Both,,,,561,476.85,160.7826,561,America's PPO,America's PPO,538.7283,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Scheduled Procedure Intermediate,,58001953,LOCAL,Facility,Both,,,,561,476.85,160.7826,561,BlueCross BlueShield Minnesota, Federal Employee Program,552.024,98.4,,percent of total billed charges,,
Scheduled Procedure Intermediate,,58001953,LOCAL,Facility,Both,,,,561,476.85,160.7826,561,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,561,100,,percent of total billed charges,,
Scheduled Procedure Intermediate,,58001953,LOCAL,Facility,Both,,,,561,476.85,160.7826,561,BlueCross BlueShield Minnesota,High Value Network Plan,504.9,90,,percent of total billed charges,,
Scheduled Procedure Intermediate,,58001953,LOCAL,Facility,Outpatient,,,,561,476.85,160.7826,561,BlueCross BlueShield Minnesota,Medicare Advantage,274.89,49,,percent of total billed charges,,
Scheduled Procedure Intermediate,,58001953,LOCAL,Facility,Inpatient,,,,561,476.85,160.7826,561,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Scheduled Procedure Intermediate,,58001953,LOCAL,Facility,Both,,,,561,476.85,160.7826,561,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,496.8777,88.57,,percent of total billed charges,,
Scheduled Procedure Intermediate,,58001953,LOCAL,Facility,Both,,,,561,476.85,160.7826,561,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,160.7826,28.66,,percent of total billed charges,,
Scheduled Procedure Intermediate,,58001953,LOCAL,Facility,Outpatient,,,,561,476.85,160.7826,561,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),274.89,49,,percent of total billed charges,,
Scheduled Procedure Intermediate,,58001953,LOCAL,Facility,Inpatient,,,,561,476.85,160.7826,561,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Scheduled Procedure Intermediate,,58001953,LOCAL,Facility,Both,,,,561,476.85,160.7826,561,CorVel,Worker's Compensation,561,100,,percent of total billed charges,,
Scheduled Procedure Intermediate,,58001953,LOCAL,Facility,Both,,,,561,476.85,160.7826,561,First Health Group Corporation,First Health Network,544.17,97,,percent of total billed charges,,
Scheduled Procedure Intermediate,,58001953,LOCAL,Facility,Both,,,,561,476.85,160.7826,561,"Health Partners, Inc.",Commercial,530.706,94.6,,percent of total billed charges,,
Scheduled Procedure Intermediate,,58001953,LOCAL,Facility,Outpatient,,,,561,476.85,160.7826,561,"Health Partners, Inc.",Medicare Advantage,274.89,49,,percent of total billed charges,,
Scheduled Procedure Intermediate,,58001953,LOCAL,Facility,Inpatient,,,,561,476.85,160.7826,561,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Scheduled Procedure Intermediate,,58001953,LOCAL,Facility,Both,,,,561,476.85,160.7826,561,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),336.6,60,,percent of total billed charges,,
Scheduled Procedure Intermediate,,58001953,LOCAL,Facility,Both,,,,561,476.85,160.7826,561,"Health Partners, Inc.",State of Minnesota Advantage Program,457.215,81.5,,percent of total billed charges,,
Scheduled Procedure Intermediate,,58001953,LOCAL,Facility,Both,,,,561,476.85,160.7826,561,"Health Partners, Inc.",State Public Programs,280.5,50,,percent of total billed charges,,
Scheduled Procedure Intermediate,,58001953,LOCAL,Facility,Both,,,,561,476.85,160.7826,561,Humana Insurance Company,Commercial PPO,532.95,95,,percent of total billed charges,,
Scheduled Procedure Intermediate,,58001953,LOCAL,Facility,Outpatient,,,,561,476.85,160.7826,561,Humana Insurance Company,Medicare PPO,274.89,49,,percent of total billed charges,,
Scheduled Procedure Intermediate,,58001953,LOCAL,Facility,Inpatient,,,,561,476.85,160.7826,561,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Scheduled Procedure Intermediate,,58001953,LOCAL,Facility,Both,,,,561,476.85,160.7826,561,Medica,Individual & Family,555.951,99.1,,percent of total billed charges,,
Scheduled Procedure Intermediate,,58001953,LOCAL,Facility,Outpatient,,,,561,476.85,160.7826,561,Medica,Medica Advantage Solution,279.378,49.8,,percent of total billed charges,,
Scheduled Procedure Intermediate,,58001953,LOCAL,Facility,Inpatient,,,,561,476.85,160.7826,561,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Scheduled Procedure Intermediate,,58001953,LOCAL,Facility,Outpatient,,,,561,476.85,160.7826,561,Medica,Medical Assistance,250.206,44.6,,percent of total billed charges,,
Scheduled Procedure Intermediate,,58001953,LOCAL,Facility,Inpatient,,,,561,476.85,160.7826,561,Medica,Medical Assistance,,,,,Included in per diem rate,
Scheduled Procedure Intermediate,,58001953,LOCAL,Facility,Outpatient,,,,561,476.85,160.7826,561,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,279.378,49.8,,percent of total billed charges,,
Scheduled Procedure Intermediate,,58001953,LOCAL,Facility,Inpatient,,,,561,476.85,160.7826,561,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Scheduled Procedure Intermediate,,58001953,LOCAL,Facility,Both,,,,561,476.85,160.7826,561,"Multiplan, Inc.","Multiplan, Inc.",527.34,94,,percent of total billed charges,,
Scheduled Procedure Intermediate,,58001953,LOCAL,Facility,Outpatient,,,,561,476.85,160.7826,561,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,505.461,90.1,,percent of total billed charges,,
Scheduled Procedure Intermediate,,58001953,LOCAL,Facility,Inpatient,,,,561,476.85,160.7826,561,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Scheduled Procedure Intermediate,,58001953,LOCAL,Facility,Both,,,,561,476.85,160.7826,561,"Preferred One Administrative Services, INC.",PPO,553.146,98.6,,percent of total billed charges,,
Scheduled Procedure Intermediate,,58001953,LOCAL,Facility,Outpatient,,,,561,476.85,160.7826,561,PrimeWest Health,Minnesota Senior Health Options (MSHO),288.6345,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Scheduled Procedure Intermediate,,58001953,LOCAL,Facility,Inpatient,,,,561,476.85,160.7826,561,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Scheduled Procedure Intermediate,,58001953,LOCAL,Facility,Outpatient,,,,561,476.85,160.7826,561,PrimeWest Health,MinnesotaCare,288.1296,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Scheduled Procedure Intermediate,,58001953,LOCAL,Facility,Inpatient,,,,561,476.85,160.7826,561,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Scheduled Procedure Intermediate,,58001953,LOCAL,Facility,Both,,,,561,476.85,160.7826,561,Sanford Health Plan,Sanford Health Plan,516.12,92,,percent of total billed charges,,
Scheduled Procedure Intermediate,,58001953,LOCAL,Facility,Outpatient,,,,561,476.85,160.7826,561,"UCare Health, Inc.",Individual & Family Plan,316.1235,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Scheduled Procedure Intermediate,,58001953,LOCAL,Facility,Inpatient,,,,561,476.85,160.7826,561,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Scheduled Procedure Intermediate,,58001953,LOCAL,Facility,Outpatient,,,,561,476.85,160.7826,561,"UCare Health, Inc.",Medical Assistance,283.1367,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Scheduled Procedure Intermediate,,58001953,LOCAL,Facility,Inpatient,,,,561,476.85,160.7826,561,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Scheduled Procedure Intermediate,,58001953,LOCAL,Facility,Outpatient,,,,561,476.85,160.7826,561,"UCare Health, Inc.",Medicare Advantage,283.1367,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Scheduled Procedure Intermediate,,58001953,LOCAL,Facility,Inpatient,,,,561,476.85,160.7826,561,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Scheduled Procedure Intermediate,,58001953,LOCAL,Facility,Outpatient,,,,561,476.85,160.7826,561,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),283.1367,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Scheduled Procedure Intermediate,,58001953,LOCAL,Facility,Inpatient,,,,561,476.85,160.7826,561,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Scheduled Procedure Intermediate,,58001953,LOCAL,Facility,Both,,,,561,476.85,160.7826,561,UnitedHealthcare,Individual & Family,527.34,94,,percent of total billed charges,,
Scheduled Procedure Intermediate,,58001953,LOCAL,Facility,Outpatient,,,,561,476.85,160.7826,561,UnitedHealthcare,Medicare Advantage,274.89,49,,percent of total billed charges,,
Scheduled Procedure Intermediate,,58001953,LOCAL,Facility,Inpatient,,,,561,476.85,160.7826,561,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Scheduled Procedure Intermediate,,58001953,LOCAL,Facility,Outpatient,,,,561,476.85,160.7826,561,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,269.28,48,,percent of total billed charges,,100% of DHS outpatient percentage
Scheduled Procedure Intermediate,,58001953,LOCAL,Facility,Inpatient,,,,561,476.85,160.7826,561,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Scheduled Procedure Major,,58001965,LOCAL,Facility,Both,,,,714,606.9,204.6324,714,Aetna,Commercial,656.88,92,,percent of total billed charges,,
Scheduled Procedure Major,,58001965,LOCAL,Facility,Outpatient,,,,714,606.9,204.6324,714,Aetna,Medicare Advantage,349.86,49,,percent of total billed charges,,
Scheduled Procedure Major,,58001965,LOCAL,Facility,Inpatient,,,,714,606.9,204.6324,714,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Scheduled Procedure Major,,58001965,LOCAL,Facility,Both,,,,714,606.9,204.6324,714,Aetna,PPO,664.02,93,,percent of total billed charges,,
Scheduled Procedure Major,,58001965,LOCAL,Facility,Both,,,,714,606.9,204.6324,714,America's PPO,America's PPO,685.6542,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Scheduled Procedure Major,,58001965,LOCAL,Facility,Both,,,,714,606.9,204.6324,714,BlueCross BlueShield Minnesota, Federal Employee Program,702.576,98.4,,percent of total billed charges,,
Scheduled Procedure Major,,58001965,LOCAL,Facility,Both,,,,714,606.9,204.6324,714,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,714,100,,percent of total billed charges,,
Scheduled Procedure Major,,58001965,LOCAL,Facility,Both,,,,714,606.9,204.6324,714,BlueCross BlueShield Minnesota,High Value Network Plan,642.6,90,,percent of total billed charges,,
Scheduled Procedure Major,,58001965,LOCAL,Facility,Outpatient,,,,714,606.9,204.6324,714,BlueCross BlueShield Minnesota,Medicare Advantage,349.86,49,,percent of total billed charges,,
Scheduled Procedure Major,,58001965,LOCAL,Facility,Inpatient,,,,714,606.9,204.6324,714,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Scheduled Procedure Major,,58001965,LOCAL,Facility,Both,,,,714,606.9,204.6324,714,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,632.3898,88.57,,percent of total billed charges,,
Scheduled Procedure Major,,58001965,LOCAL,Facility,Both,,,,714,606.9,204.6324,714,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,204.6324,28.66,,percent of total billed charges,,
Scheduled Procedure Major,,58001965,LOCAL,Facility,Outpatient,,,,714,606.9,204.6324,714,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),349.86,49,,percent of total billed charges,,
Scheduled Procedure Major,,58001965,LOCAL,Facility,Inpatient,,,,714,606.9,204.6324,714,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Scheduled Procedure Major,,58001965,LOCAL,Facility,Both,,,,714,606.9,204.6324,714,CorVel,Worker's Compensation,714,100,,percent of total billed charges,,
Scheduled Procedure Major,,58001965,LOCAL,Facility,Both,,,,714,606.9,204.6324,714,First Health Group Corporation,First Health Network,692.58,97,,percent of total billed charges,,
Scheduled Procedure Major,,58001965,LOCAL,Facility,Both,,,,714,606.9,204.6324,714,"Health Partners, Inc.",Commercial,675.444,94.6,,percent of total billed charges,,
Scheduled Procedure Major,,58001965,LOCAL,Facility,Outpatient,,,,714,606.9,204.6324,714,"Health Partners, Inc.",Medicare Advantage,349.86,49,,percent of total billed charges,,
Scheduled Procedure Major,,58001965,LOCAL,Facility,Inpatient,,,,714,606.9,204.6324,714,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Scheduled Procedure Major,,58001965,LOCAL,Facility,Both,,,,714,606.9,204.6324,714,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),428.4,60,,percent of total billed charges,,
Scheduled Procedure Major,,58001965,LOCAL,Facility,Both,,,,714,606.9,204.6324,714,"Health Partners, Inc.",State of Minnesota Advantage Program,581.91,81.5,,percent of total billed charges,,
Scheduled Procedure Major,,58001965,LOCAL,Facility,Both,,,,714,606.9,204.6324,714,"Health Partners, Inc.",State Public Programs,357,50,,percent of total billed charges,,
Scheduled Procedure Major,,58001965,LOCAL,Facility,Both,,,,714,606.9,204.6324,714,Humana Insurance Company,Commercial PPO,678.3,95,,percent of total billed charges,,
Scheduled Procedure Major,,58001965,LOCAL,Facility,Outpatient,,,,714,606.9,204.6324,714,Humana Insurance Company,Medicare PPO,349.86,49,,percent of total billed charges,,
Scheduled Procedure Major,,58001965,LOCAL,Facility,Inpatient,,,,714,606.9,204.6324,714,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Scheduled Procedure Major,,58001965,LOCAL,Facility,Both,,,,714,606.9,204.6324,714,Medica,Individual & Family,707.574,99.1,,percent of total billed charges,,
Scheduled Procedure Major,,58001965,LOCAL,Facility,Outpatient,,,,714,606.9,204.6324,714,Medica,Medica Advantage Solution,355.572,49.8,,percent of total billed charges,,
Scheduled Procedure Major,,58001965,LOCAL,Facility,Inpatient,,,,714,606.9,204.6324,714,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Scheduled Procedure Major,,58001965,LOCAL,Facility,Outpatient,,,,714,606.9,204.6324,714,Medica,Medical Assistance,318.444,44.6,,percent of total billed charges,,
Scheduled Procedure Major,,58001965,LOCAL,Facility,Inpatient,,,,714,606.9,204.6324,714,Medica,Medical Assistance,,,,,Included in per diem rate,
Scheduled Procedure Major,,58001965,LOCAL,Facility,Outpatient,,,,714,606.9,204.6324,714,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,355.572,49.8,,percent of total billed charges,,
Scheduled Procedure Major,,58001965,LOCAL,Facility,Inpatient,,,,714,606.9,204.6324,714,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Scheduled Procedure Major,,58001965,LOCAL,Facility,Both,,,,714,606.9,204.6324,714,"Multiplan, Inc.","Multiplan, Inc.",671.16,94,,percent of total billed charges,,
Scheduled Procedure Major,,58001965,LOCAL,Facility,Outpatient,,,,714,606.9,204.6324,714,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,643.314,90.1,,percent of total billed charges,,
Scheduled Procedure Major,,58001965,LOCAL,Facility,Inpatient,,,,714,606.9,204.6324,714,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Scheduled Procedure Major,,58001965,LOCAL,Facility,Both,,,,714,606.9,204.6324,714,"Preferred One Administrative Services, INC.",PPO,704.004,98.6,,percent of total billed charges,,
Scheduled Procedure Major,,58001965,LOCAL,Facility,Outpatient,,,,714,606.9,204.6324,714,PrimeWest Health,Minnesota Senior Health Options (MSHO),367.353,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Scheduled Procedure Major,,58001965,LOCAL,Facility,Inpatient,,,,714,606.9,204.6324,714,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Scheduled Procedure Major,,58001965,LOCAL,Facility,Outpatient,,,,714,606.9,204.6324,714,PrimeWest Health,MinnesotaCare,366.7104,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Scheduled Procedure Major,,58001965,LOCAL,Facility,Inpatient,,,,714,606.9,204.6324,714,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Scheduled Procedure Major,,58001965,LOCAL,Facility,Both,,,,714,606.9,204.6324,714,Sanford Health Plan,Sanford Health Plan,656.88,92,,percent of total billed charges,,
Scheduled Procedure Major,,58001965,LOCAL,Facility,Outpatient,,,,714,606.9,204.6324,714,"UCare Health, Inc.",Individual & Family Plan,402.339,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Scheduled Procedure Major,,58001965,LOCAL,Facility,Inpatient,,,,714,606.9,204.6324,714,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Scheduled Procedure Major,,58001965,LOCAL,Facility,Outpatient,,,,714,606.9,204.6324,714,"UCare Health, Inc.",Medical Assistance,360.3558,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Scheduled Procedure Major,,58001965,LOCAL,Facility,Inpatient,,,,714,606.9,204.6324,714,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Scheduled Procedure Major,,58001965,LOCAL,Facility,Outpatient,,,,714,606.9,204.6324,714,"UCare Health, Inc.",Medicare Advantage,360.3558,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Scheduled Procedure Major,,58001965,LOCAL,Facility,Inpatient,,,,714,606.9,204.6324,714,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Scheduled Procedure Major,,58001965,LOCAL,Facility,Outpatient,,,,714,606.9,204.6324,714,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),360.3558,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Scheduled Procedure Major,,58001965,LOCAL,Facility,Inpatient,,,,714,606.9,204.6324,714,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Scheduled Procedure Major,,58001965,LOCAL,Facility,Both,,,,714,606.9,204.6324,714,UnitedHealthcare,Individual & Family,671.16,94,,percent of total billed charges,,
Scheduled Procedure Major,,58001965,LOCAL,Facility,Outpatient,,,,714,606.9,204.6324,714,UnitedHealthcare,Medicare Advantage,349.86,49,,percent of total billed charges,,
Scheduled Procedure Major,,58001965,LOCAL,Facility,Inpatient,,,,714,606.9,204.6324,714,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Scheduled Procedure Major,,58001965,LOCAL,Facility,Outpatient,,,,714,606.9,204.6324,714,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,342.72,48,,percent of total billed charges,,100% of DHS outpatient percentage
Scheduled Procedure Major,,58001965,LOCAL,Facility,Inpatient,,,,714,606.9,204.6324,714,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Colonoscopy,,58001972,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,Aetna,Commercial,2064.48,92,,percent of total billed charges,,
Colonoscopy,,58001972,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,Aetna,Medicare Advantage,1099.56,49,,percent of total billed charges,,
Colonoscopy,,58001972,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Colonoscopy,,58001972,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,Aetna,PPO,2086.92,93,,percent of total billed charges,,
Colonoscopy,,58001972,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,America's PPO,America's PPO,2154.9132,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Colonoscopy,,58001972,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,BlueCross BlueShield Minnesota, Federal Employee Program,2208.096,98.4,,percent of total billed charges,,
Colonoscopy,,58001972,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,2244,100,,percent of total billed charges,,
Colonoscopy,,58001972,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,BlueCross BlueShield Minnesota,High Value Network Plan,2019.6,90,,percent of total billed charges,,
Colonoscopy,,58001972,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,BlueCross BlueShield Minnesota,Medicare Advantage,1099.56,49,,percent of total billed charges,,
Colonoscopy,,58001972,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Colonoscopy,,58001972,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1987.5108,88.57,,percent of total billed charges,,
Colonoscopy,,58001972,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,643.1304,28.66,,percent of total billed charges,,
Colonoscopy,,58001972,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1099.56,49,,percent of total billed charges,,
Colonoscopy,,58001972,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Colonoscopy,,58001972,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,CorVel,Worker's Compensation,2244,100,,percent of total billed charges,,
Colonoscopy,,58001972,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,First Health Group Corporation,First Health Network,2176.68,97,,percent of total billed charges,,
Colonoscopy,,58001972,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,"Health Partners, Inc.",Commercial,2122.824,94.6,,percent of total billed charges,,
Colonoscopy,,58001972,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,"Health Partners, Inc.",Medicare Advantage,1099.56,49,,percent of total billed charges,,
Colonoscopy,,58001972,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Colonoscopy,,58001972,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1346.4,60,,percent of total billed charges,,
Colonoscopy,,58001972,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,"Health Partners, Inc.",State of Minnesota Advantage Program,1828.86,81.5,,percent of total billed charges,,
Colonoscopy,,58001972,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,"Health Partners, Inc.",State Public Programs,1122,50,,percent of total billed charges,,
Colonoscopy,,58001972,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,Humana Insurance Company,Commercial PPO,2131.8,95,,percent of total billed charges,,
Colonoscopy,,58001972,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,Humana Insurance Company,Medicare PPO,1099.56,49,,percent of total billed charges,,
Colonoscopy,,58001972,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Colonoscopy,,58001972,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,Medica,Individual & Family,2223.804,99.1,,percent of total billed charges,,
Colonoscopy,,58001972,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,Medica,Medica Advantage Solution,1117.512,49.8,,percent of total billed charges,,
Colonoscopy,,58001972,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Colonoscopy,,58001972,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,Medica,Medical Assistance,1000.824,44.6,,percent of total billed charges,,
Colonoscopy,,58001972,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,Medica,Medical Assistance,,,,,Included in per diem rate,
Colonoscopy,,58001972,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1117.512,49.8,,percent of total billed charges,,
Colonoscopy,,58001972,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Colonoscopy,,58001972,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,"Multiplan, Inc.","Multiplan, Inc.",2109.36,94,,percent of total billed charges,,
Colonoscopy,,58001972,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,2021.844,90.1,,percent of total billed charges,,
Colonoscopy,,58001972,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Colonoscopy,,58001972,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,"Preferred One Administrative Services, INC.",PPO,2212.584,98.6,,percent of total billed charges,,
Colonoscopy,,58001972,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,PrimeWest Health,Minnesota Senior Health Options (MSHO),1154.538,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Colonoscopy,,58001972,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Colonoscopy,,58001972,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,PrimeWest Health,MinnesotaCare,1152.5184,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Colonoscopy,,58001972,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Colonoscopy,,58001972,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,Sanford Health Plan,Sanford Health Plan,2064.48,92,,percent of total billed charges,,
Colonoscopy,,58001972,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,"UCare Health, Inc.",Individual & Family Plan,1264.494,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Colonoscopy,,58001972,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Colonoscopy,,58001972,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,"UCare Health, Inc.",Medical Assistance,1132.5468,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Colonoscopy,,58001972,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Colonoscopy,,58001972,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,"UCare Health, Inc.",Medicare Advantage,1132.5468,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Colonoscopy,,58001972,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Colonoscopy,,58001972,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1132.5468,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Colonoscopy,,58001972,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Colonoscopy,,58001972,LOCAL,Facility,Both,,,,2244,1907.4,643.1304,2244,UnitedHealthcare,Individual & Family,2109.36,94,,percent of total billed charges,,
Colonoscopy,,58001972,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,UnitedHealthcare,Medicare Advantage,1099.56,49,,percent of total billed charges,,
Colonoscopy,,58001972,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Colonoscopy,,58001972,LOCAL,Facility,Outpatient,,,,2244,1907.4,643.1304,2244,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1077.12,48,,percent of total billed charges,,100% of DHS outpatient percentage
Colonoscopy,,58001972,LOCAL,Facility,Inpatient,,,,2244,1907.4,643.1304,2244,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Colonoscopy With Biopsy,,58002822,LOCAL,Facility,Both,,,,2805,2384.25,803.913,2805,Aetna,Commercial,2580.6,92,,percent of total billed charges,,
Colonoscopy With Biopsy,,58002822,LOCAL,Facility,Outpatient,,,,2805,2384.25,803.913,2805,Aetna,Medicare Advantage,1374.45,49,,percent of total billed charges,,
Colonoscopy With Biopsy,,58002822,LOCAL,Facility,Inpatient,,,,2805,2384.25,803.913,2805,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Colonoscopy With Biopsy,,58002822,LOCAL,Facility,Both,,,,2805,2384.25,803.913,2805,Aetna,PPO,2608.65,93,,percent of total billed charges,,
Colonoscopy With Biopsy,,58002822,LOCAL,Facility,Both,,,,2805,2384.25,803.913,2805,America's PPO,America's PPO,2693.6415,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Colonoscopy With Biopsy,,58002822,LOCAL,Facility,Both,,,,2805,2384.25,803.913,2805,BlueCross BlueShield Minnesota, Federal Employee Program,2760.12,98.4,,percent of total billed charges,,
Colonoscopy With Biopsy,,58002822,LOCAL,Facility,Both,,,,2805,2384.25,803.913,2805,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,2805,100,,percent of total billed charges,,
Colonoscopy With Biopsy,,58002822,LOCAL,Facility,Both,,,,2805,2384.25,803.913,2805,BlueCross BlueShield Minnesota,High Value Network Plan,2524.5,90,,percent of total billed charges,,
Colonoscopy With Biopsy,,58002822,LOCAL,Facility,Outpatient,,,,2805,2384.25,803.913,2805,BlueCross BlueShield Minnesota,Medicare Advantage,1374.45,49,,percent of total billed charges,,
Colonoscopy With Biopsy,,58002822,LOCAL,Facility,Inpatient,,,,2805,2384.25,803.913,2805,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Colonoscopy With Biopsy,,58002822,LOCAL,Facility,Both,,,,2805,2384.25,803.913,2805,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,2484.3885,88.57,,percent of total billed charges,,
Colonoscopy With Biopsy,,58002822,LOCAL,Facility,Both,,,,2805,2384.25,803.913,2805,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,803.913,28.66,,percent of total billed charges,,
Colonoscopy With Biopsy,,58002822,LOCAL,Facility,Outpatient,,,,2805,2384.25,803.913,2805,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1374.45,49,,percent of total billed charges,,
Colonoscopy With Biopsy,,58002822,LOCAL,Facility,Inpatient,,,,2805,2384.25,803.913,2805,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Colonoscopy With Biopsy,,58002822,LOCAL,Facility,Both,,,,2805,2384.25,803.913,2805,CorVel,Worker's Compensation,2805,100,,percent of total billed charges,,
Colonoscopy With Biopsy,,58002822,LOCAL,Facility,Both,,,,2805,2384.25,803.913,2805,First Health Group Corporation,First Health Network,2720.85,97,,percent of total billed charges,,
Colonoscopy With Biopsy,,58002822,LOCAL,Facility,Both,,,,2805,2384.25,803.913,2805,"Health Partners, Inc.",Commercial,2653.53,94.6,,percent of total billed charges,,
Colonoscopy With Biopsy,,58002822,LOCAL,Facility,Outpatient,,,,2805,2384.25,803.913,2805,"Health Partners, Inc.",Medicare Advantage,1374.45,49,,percent of total billed charges,,
Colonoscopy With Biopsy,,58002822,LOCAL,Facility,Inpatient,,,,2805,2384.25,803.913,2805,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Colonoscopy With Biopsy,,58002822,LOCAL,Facility,Both,,,,2805,2384.25,803.913,2805,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1683,60,,percent of total billed charges,,
Colonoscopy With Biopsy,,58002822,LOCAL,Facility,Both,,,,2805,2384.25,803.913,2805,"Health Partners, Inc.",State of Minnesota Advantage Program,2286.075,81.5,,percent of total billed charges,,
Colonoscopy With Biopsy,,58002822,LOCAL,Facility,Both,,,,2805,2384.25,803.913,2805,"Health Partners, Inc.",State Public Programs,1402.5,50,,percent of total billed charges,,
Colonoscopy With Biopsy,,58002822,LOCAL,Facility,Both,,,,2805,2384.25,803.913,2805,Humana Insurance Company,Commercial PPO,2664.75,95,,percent of total billed charges,,
Colonoscopy With Biopsy,,58002822,LOCAL,Facility,Outpatient,,,,2805,2384.25,803.913,2805,Humana Insurance Company,Medicare PPO,1374.45,49,,percent of total billed charges,,
Colonoscopy With Biopsy,,58002822,LOCAL,Facility,Inpatient,,,,2805,2384.25,803.913,2805,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Colonoscopy With Biopsy,,58002822,LOCAL,Facility,Both,,,,2805,2384.25,803.913,2805,Medica,Individual & Family,2779.755,99.1,,percent of total billed charges,,
Colonoscopy With Biopsy,,58002822,LOCAL,Facility,Outpatient,,,,2805,2384.25,803.913,2805,Medica,Medica Advantage Solution,1396.89,49.8,,percent of total billed charges,,
Colonoscopy With Biopsy,,58002822,LOCAL,Facility,Inpatient,,,,2805,2384.25,803.913,2805,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Colonoscopy With Biopsy,,58002822,LOCAL,Facility,Outpatient,,,,2805,2384.25,803.913,2805,Medica,Medical Assistance,1251.03,44.6,,percent of total billed charges,,
Colonoscopy With Biopsy,,58002822,LOCAL,Facility,Inpatient,,,,2805,2384.25,803.913,2805,Medica,Medical Assistance,,,,,Included in per diem rate,
Colonoscopy With Biopsy,,58002822,LOCAL,Facility,Outpatient,,,,2805,2384.25,803.913,2805,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1396.89,49.8,,percent of total billed charges,,
Colonoscopy With Biopsy,,58002822,LOCAL,Facility,Inpatient,,,,2805,2384.25,803.913,2805,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Colonoscopy With Biopsy,,58002822,LOCAL,Facility,Both,,,,2805,2384.25,803.913,2805,"Multiplan, Inc.","Multiplan, Inc.",2636.7,94,,percent of total billed charges,,
Colonoscopy With Biopsy,,58002822,LOCAL,Facility,Outpatient,,,,2805,2384.25,803.913,2805,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,2527.305,90.1,,percent of total billed charges,,
Colonoscopy With Biopsy,,58002822,LOCAL,Facility,Inpatient,,,,2805,2384.25,803.913,2805,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Colonoscopy With Biopsy,,58002822,LOCAL,Facility,Both,,,,2805,2384.25,803.913,2805,"Preferred One Administrative Services, INC.",PPO,2765.73,98.6,,percent of total billed charges,,
Colonoscopy With Biopsy,,58002822,LOCAL,Facility,Outpatient,,,,2805,2384.25,803.913,2805,PrimeWest Health,Minnesota Senior Health Options (MSHO),1443.1725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Colonoscopy With Biopsy,,58002822,LOCAL,Facility,Inpatient,,,,2805,2384.25,803.913,2805,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Colonoscopy With Biopsy,,58002822,LOCAL,Facility,Outpatient,,,,2805,2384.25,803.913,2805,PrimeWest Health,MinnesotaCare,1440.648,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Colonoscopy With Biopsy,,58002822,LOCAL,Facility,Inpatient,,,,2805,2384.25,803.913,2805,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Colonoscopy With Biopsy,,58002822,LOCAL,Facility,Both,,,,2805,2384.25,803.913,2805,Sanford Health Plan,Sanford Health Plan,2580.6,92,,percent of total billed charges,,
Colonoscopy With Biopsy,,58002822,LOCAL,Facility,Outpatient,,,,2805,2384.25,803.913,2805,"UCare Health, Inc.",Individual & Family Plan,1580.6175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Colonoscopy With Biopsy,,58002822,LOCAL,Facility,Inpatient,,,,2805,2384.25,803.913,2805,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Colonoscopy With Biopsy,,58002822,LOCAL,Facility,Outpatient,,,,2805,2384.25,803.913,2805,"UCare Health, Inc.",Medical Assistance,1415.6835,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Colonoscopy With Biopsy,,58002822,LOCAL,Facility,Inpatient,,,,2805,2384.25,803.913,2805,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Colonoscopy With Biopsy,,58002822,LOCAL,Facility,Outpatient,,,,2805,2384.25,803.913,2805,"UCare Health, Inc.",Medicare Advantage,1415.6835,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Colonoscopy With Biopsy,,58002822,LOCAL,Facility,Inpatient,,,,2805,2384.25,803.913,2805,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Colonoscopy With Biopsy,,58002822,LOCAL,Facility,Outpatient,,,,2805,2384.25,803.913,2805,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1415.6835,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Colonoscopy With Biopsy,,58002822,LOCAL,Facility,Inpatient,,,,2805,2384.25,803.913,2805,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Colonoscopy With Biopsy,,58002822,LOCAL,Facility,Both,,,,2805,2384.25,803.913,2805,UnitedHealthcare,Individual & Family,2636.7,94,,percent of total billed charges,,
Colonoscopy With Biopsy,,58002822,LOCAL,Facility,Outpatient,,,,2805,2384.25,803.913,2805,UnitedHealthcare,Medicare Advantage,1374.45,49,,percent of total billed charges,,
Colonoscopy With Biopsy,,58002822,LOCAL,Facility,Inpatient,,,,2805,2384.25,803.913,2805,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Colonoscopy With Biopsy,,58002822,LOCAL,Facility,Outpatient,,,,2805,2384.25,803.913,2805,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1346.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
Colonoscopy With Biopsy,,58002822,LOCAL,Facility,Inpatient,,,,2805,2384.25,803.913,2805,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Egd With Biopsy,,58002836,LOCAL,Facility,Both,,,,2805,2384.25,803.913,2805,Aetna,Commercial,2580.6,92,,percent of total billed charges,,
Egd With Biopsy,,58002836,LOCAL,Facility,Outpatient,,,,2805,2384.25,803.913,2805,Aetna,Medicare Advantage,1374.45,49,,percent of total billed charges,,
Egd With Biopsy,,58002836,LOCAL,Facility,Inpatient,,,,2805,2384.25,803.913,2805,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Egd With Biopsy,,58002836,LOCAL,Facility,Both,,,,2805,2384.25,803.913,2805,Aetna,PPO,2608.65,93,,percent of total billed charges,,
Egd With Biopsy,,58002836,LOCAL,Facility,Both,,,,2805,2384.25,803.913,2805,America's PPO,America's PPO,2693.6415,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Egd With Biopsy,,58002836,LOCAL,Facility,Both,,,,2805,2384.25,803.913,2805,BlueCross BlueShield Minnesota, Federal Employee Program,2760.12,98.4,,percent of total billed charges,,
Egd With Biopsy,,58002836,LOCAL,Facility,Both,,,,2805,2384.25,803.913,2805,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,2805,100,,percent of total billed charges,,
Egd With Biopsy,,58002836,LOCAL,Facility,Both,,,,2805,2384.25,803.913,2805,BlueCross BlueShield Minnesota,High Value Network Plan,2524.5,90,,percent of total billed charges,,
Egd With Biopsy,,58002836,LOCAL,Facility,Outpatient,,,,2805,2384.25,803.913,2805,BlueCross BlueShield Minnesota,Medicare Advantage,1374.45,49,,percent of total billed charges,,
Egd With Biopsy,,58002836,LOCAL,Facility,Inpatient,,,,2805,2384.25,803.913,2805,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Egd With Biopsy,,58002836,LOCAL,Facility,Both,,,,2805,2384.25,803.913,2805,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,2484.3885,88.57,,percent of total billed charges,,
Egd With Biopsy,,58002836,LOCAL,Facility,Both,,,,2805,2384.25,803.913,2805,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,803.913,28.66,,percent of total billed charges,,
Egd With Biopsy,,58002836,LOCAL,Facility,Outpatient,,,,2805,2384.25,803.913,2805,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1374.45,49,,percent of total billed charges,,
Egd With Biopsy,,58002836,LOCAL,Facility,Inpatient,,,,2805,2384.25,803.913,2805,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Egd With Biopsy,,58002836,LOCAL,Facility,Both,,,,2805,2384.25,803.913,2805,CorVel,Worker's Compensation,2805,100,,percent of total billed charges,,
Egd With Biopsy,,58002836,LOCAL,Facility,Both,,,,2805,2384.25,803.913,2805,First Health Group Corporation,First Health Network,2720.85,97,,percent of total billed charges,,
Egd With Biopsy,,58002836,LOCAL,Facility,Both,,,,2805,2384.25,803.913,2805,"Health Partners, Inc.",Commercial,2653.53,94.6,,percent of total billed charges,,
Egd With Biopsy,,58002836,LOCAL,Facility,Outpatient,,,,2805,2384.25,803.913,2805,"Health Partners, Inc.",Medicare Advantage,1374.45,49,,percent of total billed charges,,
Egd With Biopsy,,58002836,LOCAL,Facility,Inpatient,,,,2805,2384.25,803.913,2805,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Egd With Biopsy,,58002836,LOCAL,Facility,Both,,,,2805,2384.25,803.913,2805,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1683,60,,percent of total billed charges,,
Egd With Biopsy,,58002836,LOCAL,Facility,Both,,,,2805,2384.25,803.913,2805,"Health Partners, Inc.",State of Minnesota Advantage Program,2286.075,81.5,,percent of total billed charges,,
Egd With Biopsy,,58002836,LOCAL,Facility,Both,,,,2805,2384.25,803.913,2805,"Health Partners, Inc.",State Public Programs,1402.5,50,,percent of total billed charges,,
Egd With Biopsy,,58002836,LOCAL,Facility,Both,,,,2805,2384.25,803.913,2805,Humana Insurance Company,Commercial PPO,2664.75,95,,percent of total billed charges,,
Egd With Biopsy,,58002836,LOCAL,Facility,Outpatient,,,,2805,2384.25,803.913,2805,Humana Insurance Company,Medicare PPO,1374.45,49,,percent of total billed charges,,
Egd With Biopsy,,58002836,LOCAL,Facility,Inpatient,,,,2805,2384.25,803.913,2805,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Egd With Biopsy,,58002836,LOCAL,Facility,Both,,,,2805,2384.25,803.913,2805,Medica,Individual & Family,2779.755,99.1,,percent of total billed charges,,
Egd With Biopsy,,58002836,LOCAL,Facility,Outpatient,,,,2805,2384.25,803.913,2805,Medica,Medica Advantage Solution,1396.89,49.8,,percent of total billed charges,,
Egd With Biopsy,,58002836,LOCAL,Facility,Inpatient,,,,2805,2384.25,803.913,2805,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Egd With Biopsy,,58002836,LOCAL,Facility,Outpatient,,,,2805,2384.25,803.913,2805,Medica,Medical Assistance,1251.03,44.6,,percent of total billed charges,,
Egd With Biopsy,,58002836,LOCAL,Facility,Inpatient,,,,2805,2384.25,803.913,2805,Medica,Medical Assistance,,,,,Included in per diem rate,
Egd With Biopsy,,58002836,LOCAL,Facility,Outpatient,,,,2805,2384.25,803.913,2805,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1396.89,49.8,,percent of total billed charges,,
Egd With Biopsy,,58002836,LOCAL,Facility,Inpatient,,,,2805,2384.25,803.913,2805,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Egd With Biopsy,,58002836,LOCAL,Facility,Both,,,,2805,2384.25,803.913,2805,"Multiplan, Inc.","Multiplan, Inc.",2636.7,94,,percent of total billed charges,,
Egd With Biopsy,,58002836,LOCAL,Facility,Outpatient,,,,2805,2384.25,803.913,2805,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,2527.305,90.1,,percent of total billed charges,,
Egd With Biopsy,,58002836,LOCAL,Facility,Inpatient,,,,2805,2384.25,803.913,2805,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Egd With Biopsy,,58002836,LOCAL,Facility,Both,,,,2805,2384.25,803.913,2805,"Preferred One Administrative Services, INC.",PPO,2765.73,98.6,,percent of total billed charges,,
Egd With Biopsy,,58002836,LOCAL,Facility,Outpatient,,,,2805,2384.25,803.913,2805,PrimeWest Health,Minnesota Senior Health Options (MSHO),1443.1725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Egd With Biopsy,,58002836,LOCAL,Facility,Inpatient,,,,2805,2384.25,803.913,2805,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Egd With Biopsy,,58002836,LOCAL,Facility,Outpatient,,,,2805,2384.25,803.913,2805,PrimeWest Health,MinnesotaCare,1440.648,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Egd With Biopsy,,58002836,LOCAL,Facility,Inpatient,,,,2805,2384.25,803.913,2805,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Egd With Biopsy,,58002836,LOCAL,Facility,Both,,,,2805,2384.25,803.913,2805,Sanford Health Plan,Sanford Health Plan,2580.6,92,,percent of total billed charges,,
Egd With Biopsy,,58002836,LOCAL,Facility,Outpatient,,,,2805,2384.25,803.913,2805,"UCare Health, Inc.",Individual & Family Plan,1580.6175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Egd With Biopsy,,58002836,LOCAL,Facility,Inpatient,,,,2805,2384.25,803.913,2805,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Egd With Biopsy,,58002836,LOCAL,Facility,Outpatient,,,,2805,2384.25,803.913,2805,"UCare Health, Inc.",Medical Assistance,1415.6835,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Egd With Biopsy,,58002836,LOCAL,Facility,Inpatient,,,,2805,2384.25,803.913,2805,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Egd With Biopsy,,58002836,LOCAL,Facility,Outpatient,,,,2805,2384.25,803.913,2805,"UCare Health, Inc.",Medicare Advantage,1415.6835,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Egd With Biopsy,,58002836,LOCAL,Facility,Inpatient,,,,2805,2384.25,803.913,2805,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Egd With Biopsy,,58002836,LOCAL,Facility,Outpatient,,,,2805,2384.25,803.913,2805,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1415.6835,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Egd With Biopsy,,58002836,LOCAL,Facility,Inpatient,,,,2805,2384.25,803.913,2805,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Egd With Biopsy,,58002836,LOCAL,Facility,Both,,,,2805,2384.25,803.913,2805,UnitedHealthcare,Individual & Family,2636.7,94,,percent of total billed charges,,
Egd With Biopsy,,58002836,LOCAL,Facility,Outpatient,,,,2805,2384.25,803.913,2805,UnitedHealthcare,Medicare Advantage,1374.45,49,,percent of total billed charges,,
Egd With Biopsy,,58002836,LOCAL,Facility,Inpatient,,,,2805,2384.25,803.913,2805,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Egd With Biopsy,,58002836,LOCAL,Facility,Outpatient,,,,2805,2384.25,803.913,2805,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1346.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
Egd With Biopsy,,58002836,LOCAL,Facility,Inpatient,,,,2805,2384.25,803.913,2805,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Epidermal Injection,,58004758,LOCAL,Facility,Both,,,,612,520.2,175.3992,612,Aetna,Commercial,563.04,92,,percent of total billed charges,,
Epidermal Injection,,58004758,LOCAL,Facility,Outpatient,,,,612,520.2,175.3992,612,Aetna,Medicare Advantage,299.88,49,,percent of total billed charges,,
Epidermal Injection,,58004758,LOCAL,Facility,Inpatient,,,,612,520.2,175.3992,612,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Epidermal Injection,,58004758,LOCAL,Facility,Both,,,,612,520.2,175.3992,612,Aetna,PPO,569.16,93,,percent of total billed charges,,
Epidermal Injection,,58004758,LOCAL,Facility,Both,,,,612,520.2,175.3992,612,America's PPO,America's PPO,587.7036,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Epidermal Injection,,58004758,LOCAL,Facility,Both,,,,612,520.2,175.3992,612,BlueCross BlueShield Minnesota, Federal Employee Program,602.208,98.4,,percent of total billed charges,,
Epidermal Injection,,58004758,LOCAL,Facility,Both,,,,612,520.2,175.3992,612,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,612,100,,percent of total billed charges,,
Epidermal Injection,,58004758,LOCAL,Facility,Both,,,,612,520.2,175.3992,612,BlueCross BlueShield Minnesota,High Value Network Plan,550.8,90,,percent of total billed charges,,
Epidermal Injection,,58004758,LOCAL,Facility,Outpatient,,,,612,520.2,175.3992,612,BlueCross BlueShield Minnesota,Medicare Advantage,299.88,49,,percent of total billed charges,,
Epidermal Injection,,58004758,LOCAL,Facility,Inpatient,,,,612,520.2,175.3992,612,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Epidermal Injection,,58004758,LOCAL,Facility,Both,,,,612,520.2,175.3992,612,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,542.0484,88.57,,percent of total billed charges,,
Epidermal Injection,,58004758,LOCAL,Facility,Both,,,,612,520.2,175.3992,612,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,175.3992,28.66,,percent of total billed charges,,
Epidermal Injection,,58004758,LOCAL,Facility,Outpatient,,,,612,520.2,175.3992,612,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),299.88,49,,percent of total billed charges,,
Epidermal Injection,,58004758,LOCAL,Facility,Inpatient,,,,612,520.2,175.3992,612,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Epidermal Injection,,58004758,LOCAL,Facility,Both,,,,612,520.2,175.3992,612,CorVel,Worker's Compensation,612,100,,percent of total billed charges,,
Epidermal Injection,,58004758,LOCAL,Facility,Both,,,,612,520.2,175.3992,612,First Health Group Corporation,First Health Network,593.64,97,,percent of total billed charges,,
Epidermal Injection,,58004758,LOCAL,Facility,Both,,,,612,520.2,175.3992,612,"Health Partners, Inc.",Commercial,578.952,94.6,,percent of total billed charges,,
Epidermal Injection,,58004758,LOCAL,Facility,Outpatient,,,,612,520.2,175.3992,612,"Health Partners, Inc.",Medicare Advantage,299.88,49,,percent of total billed charges,,
Epidermal Injection,,58004758,LOCAL,Facility,Inpatient,,,,612,520.2,175.3992,612,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Epidermal Injection,,58004758,LOCAL,Facility,Both,,,,612,520.2,175.3992,612,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),367.2,60,,percent of total billed charges,,
Epidermal Injection,,58004758,LOCAL,Facility,Both,,,,612,520.2,175.3992,612,"Health Partners, Inc.",State of Minnesota Advantage Program,498.78,81.5,,percent of total billed charges,,
Epidermal Injection,,58004758,LOCAL,Facility,Both,,,,612,520.2,175.3992,612,"Health Partners, Inc.",State Public Programs,306,50,,percent of total billed charges,,
Epidermal Injection,,58004758,LOCAL,Facility,Both,,,,612,520.2,175.3992,612,Humana Insurance Company,Commercial PPO,581.4,95,,percent of total billed charges,,
Epidermal Injection,,58004758,LOCAL,Facility,Outpatient,,,,612,520.2,175.3992,612,Humana Insurance Company,Medicare PPO,299.88,49,,percent of total billed charges,,
Epidermal Injection,,58004758,LOCAL,Facility,Inpatient,,,,612,520.2,175.3992,612,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Epidermal Injection,,58004758,LOCAL,Facility,Both,,,,612,520.2,175.3992,612,Medica,Individual & Family,606.492,99.1,,percent of total billed charges,,
Epidermal Injection,,58004758,LOCAL,Facility,Outpatient,,,,612,520.2,175.3992,612,Medica,Medica Advantage Solution,304.776,49.8,,percent of total billed charges,,
Epidermal Injection,,58004758,LOCAL,Facility,Inpatient,,,,612,520.2,175.3992,612,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Epidermal Injection,,58004758,LOCAL,Facility,Outpatient,,,,612,520.2,175.3992,612,Medica,Medical Assistance,272.952,44.6,,percent of total billed charges,,
Epidermal Injection,,58004758,LOCAL,Facility,Inpatient,,,,612,520.2,175.3992,612,Medica,Medical Assistance,,,,,Included in per diem rate,
Epidermal Injection,,58004758,LOCAL,Facility,Outpatient,,,,612,520.2,175.3992,612,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,304.776,49.8,,percent of total billed charges,,
Epidermal Injection,,58004758,LOCAL,Facility,Inpatient,,,,612,520.2,175.3992,612,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Epidermal Injection,,58004758,LOCAL,Facility,Both,,,,612,520.2,175.3992,612,"Multiplan, Inc.","Multiplan, Inc.",575.28,94,,percent of total billed charges,,
Epidermal Injection,,58004758,LOCAL,Facility,Outpatient,,,,612,520.2,175.3992,612,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,551.412,90.1,,percent of total billed charges,,
Epidermal Injection,,58004758,LOCAL,Facility,Inpatient,,,,612,520.2,175.3992,612,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Epidermal Injection,,58004758,LOCAL,Facility,Both,,,,612,520.2,175.3992,612,"Preferred One Administrative Services, INC.",PPO,603.432,98.6,,percent of total billed charges,,
Epidermal Injection,,58004758,LOCAL,Facility,Outpatient,,,,612,520.2,175.3992,612,PrimeWest Health,Minnesota Senior Health Options (MSHO),314.874,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Epidermal Injection,,58004758,LOCAL,Facility,Inpatient,,,,612,520.2,175.3992,612,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Epidermal Injection,,58004758,LOCAL,Facility,Outpatient,,,,612,520.2,175.3992,612,PrimeWest Health,MinnesotaCare,314.3232,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Epidermal Injection,,58004758,LOCAL,Facility,Inpatient,,,,612,520.2,175.3992,612,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Epidermal Injection,,58004758,LOCAL,Facility,Both,,,,612,520.2,175.3992,612,Sanford Health Plan,Sanford Health Plan,563.04,92,,percent of total billed charges,,
Epidermal Injection,,58004758,LOCAL,Facility,Outpatient,,,,612,520.2,175.3992,612,"UCare Health, Inc.",Individual & Family Plan,344.862,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Epidermal Injection,,58004758,LOCAL,Facility,Inpatient,,,,612,520.2,175.3992,612,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Epidermal Injection,,58004758,LOCAL,Facility,Outpatient,,,,612,520.2,175.3992,612,"UCare Health, Inc.",Medical Assistance,308.8764,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Epidermal Injection,,58004758,LOCAL,Facility,Inpatient,,,,612,520.2,175.3992,612,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Epidermal Injection,,58004758,LOCAL,Facility,Outpatient,,,,612,520.2,175.3992,612,"UCare Health, Inc.",Medicare Advantage,308.8764,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Epidermal Injection,,58004758,LOCAL,Facility,Inpatient,,,,612,520.2,175.3992,612,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Epidermal Injection,,58004758,LOCAL,Facility,Outpatient,,,,612,520.2,175.3992,612,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),308.8764,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Epidermal Injection,,58004758,LOCAL,Facility,Inpatient,,,,612,520.2,175.3992,612,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Epidermal Injection,,58004758,LOCAL,Facility,Both,,,,612,520.2,175.3992,612,UnitedHealthcare,Individual & Family,575.28,94,,percent of total billed charges,,
Epidermal Injection,,58004758,LOCAL,Facility,Outpatient,,,,612,520.2,175.3992,612,UnitedHealthcare,Medicare Advantage,299.88,49,,percent of total billed charges,,
Epidermal Injection,,58004758,LOCAL,Facility,Inpatient,,,,612,520.2,175.3992,612,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Epidermal Injection,,58004758,LOCAL,Facility,Outpatient,,,,612,520.2,175.3992,612,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,293.76,48,,percent of total billed charges,,100% of DHS outpatient percentage
Epidermal Injection,,58004758,LOCAL,Facility,Inpatient,,,,612,520.2,175.3992,612,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Epidural Injection,,58004760,LOCAL,Facility,Both,,,,449,381.65,128.6834,449,Aetna,Commercial,413.08,92,,percent of total billed charges,,
Epidural Injection,,58004760,LOCAL,Facility,Outpatient,,,,449,381.65,128.6834,449,Aetna,Medicare Advantage,220.01,49,,percent of total billed charges,,
Epidural Injection,,58004760,LOCAL,Facility,Inpatient,,,,449,381.65,128.6834,449,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Epidural Injection,,58004760,LOCAL,Facility,Both,,,,449,381.65,128.6834,449,Aetna,PPO,417.57,93,,percent of total billed charges,,
Epidural Injection,,58004760,LOCAL,Facility,Both,,,,449,381.65,128.6834,449,America's PPO,America's PPO,431.1747,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Epidural Injection,,58004760,LOCAL,Facility,Both,,,,449,381.65,128.6834,449,BlueCross BlueShield Minnesota, Federal Employee Program,441.816,98.4,,percent of total billed charges,,
Epidural Injection,,58004760,LOCAL,Facility,Both,,,,449,381.65,128.6834,449,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,449,100,,percent of total billed charges,,
Epidural Injection,,58004760,LOCAL,Facility,Both,,,,449,381.65,128.6834,449,BlueCross BlueShield Minnesota,High Value Network Plan,404.1,90,,percent of total billed charges,,
Epidural Injection,,58004760,LOCAL,Facility,Outpatient,,,,449,381.65,128.6834,449,BlueCross BlueShield Minnesota,Medicare Advantage,220.01,49,,percent of total billed charges,,
Epidural Injection,,58004760,LOCAL,Facility,Inpatient,,,,449,381.65,128.6834,449,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Epidural Injection,,58004760,LOCAL,Facility,Both,,,,449,381.65,128.6834,449,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,397.6793,88.57,,percent of total billed charges,,
Epidural Injection,,58004760,LOCAL,Facility,Both,,,,449,381.65,128.6834,449,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,128.6834,28.66,,percent of total billed charges,,
Epidural Injection,,58004760,LOCAL,Facility,Outpatient,,,,449,381.65,128.6834,449,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),220.01,49,,percent of total billed charges,,
Epidural Injection,,58004760,LOCAL,Facility,Inpatient,,,,449,381.65,128.6834,449,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Epidural Injection,,58004760,LOCAL,Facility,Both,,,,449,381.65,128.6834,449,CorVel,Worker's Compensation,449,100,,percent of total billed charges,,
Epidural Injection,,58004760,LOCAL,Facility,Both,,,,449,381.65,128.6834,449,First Health Group Corporation,First Health Network,435.53,97,,percent of total billed charges,,
Epidural Injection,,58004760,LOCAL,Facility,Both,,,,449,381.65,128.6834,449,"Health Partners, Inc.",Commercial,424.754,94.6,,percent of total billed charges,,
Epidural Injection,,58004760,LOCAL,Facility,Outpatient,,,,449,381.65,128.6834,449,"Health Partners, Inc.",Medicare Advantage,220.01,49,,percent of total billed charges,,
Epidural Injection,,58004760,LOCAL,Facility,Inpatient,,,,449,381.65,128.6834,449,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Epidural Injection,,58004760,LOCAL,Facility,Both,,,,449,381.65,128.6834,449,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),269.4,60,,percent of total billed charges,,
Epidural Injection,,58004760,LOCAL,Facility,Both,,,,449,381.65,128.6834,449,"Health Partners, Inc.",State of Minnesota Advantage Program,365.935,81.5,,percent of total billed charges,,
Epidural Injection,,58004760,LOCAL,Facility,Both,,,,449,381.65,128.6834,449,"Health Partners, Inc.",State Public Programs,224.5,50,,percent of total billed charges,,
Epidural Injection,,58004760,LOCAL,Facility,Both,,,,449,381.65,128.6834,449,Humana Insurance Company,Commercial PPO,426.55,95,,percent of total billed charges,,
Epidural Injection,,58004760,LOCAL,Facility,Outpatient,,,,449,381.65,128.6834,449,Humana Insurance Company,Medicare PPO,220.01,49,,percent of total billed charges,,
Epidural Injection,,58004760,LOCAL,Facility,Inpatient,,,,449,381.65,128.6834,449,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Epidural Injection,,58004760,LOCAL,Facility,Both,,,,449,381.65,128.6834,449,Medica,Individual & Family,444.959,99.1,,percent of total billed charges,,
Epidural Injection,,58004760,LOCAL,Facility,Outpatient,,,,449,381.65,128.6834,449,Medica,Medica Advantage Solution,223.602,49.8,,percent of total billed charges,,
Epidural Injection,,58004760,LOCAL,Facility,Inpatient,,,,449,381.65,128.6834,449,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Epidural Injection,,58004760,LOCAL,Facility,Outpatient,,,,449,381.65,128.6834,449,Medica,Medical Assistance,200.254,44.6,,percent of total billed charges,,
Epidural Injection,,58004760,LOCAL,Facility,Inpatient,,,,449,381.65,128.6834,449,Medica,Medical Assistance,,,,,Included in per diem rate,
Epidural Injection,,58004760,LOCAL,Facility,Outpatient,,,,449,381.65,128.6834,449,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,223.602,49.8,,percent of total billed charges,,
Epidural Injection,,58004760,LOCAL,Facility,Inpatient,,,,449,381.65,128.6834,449,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Epidural Injection,,58004760,LOCAL,Facility,Both,,,,449,381.65,128.6834,449,"Multiplan, Inc.","Multiplan, Inc.",422.06,94,,percent of total billed charges,,
Epidural Injection,,58004760,LOCAL,Facility,Outpatient,,,,449,381.65,128.6834,449,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,404.549,90.1,,percent of total billed charges,,
Epidural Injection,,58004760,LOCAL,Facility,Inpatient,,,,449,381.65,128.6834,449,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Epidural Injection,,58004760,LOCAL,Facility,Both,,,,449,381.65,128.6834,449,"Preferred One Administrative Services, INC.",PPO,442.714,98.6,,percent of total billed charges,,
Epidural Injection,,58004760,LOCAL,Facility,Outpatient,,,,449,381.65,128.6834,449,PrimeWest Health,Minnesota Senior Health Options (MSHO),231.0105,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Epidural Injection,,58004760,LOCAL,Facility,Inpatient,,,,449,381.65,128.6834,449,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Epidural Injection,,58004760,LOCAL,Facility,Outpatient,,,,449,381.65,128.6834,449,PrimeWest Health,MinnesotaCare,230.6064,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Epidural Injection,,58004760,LOCAL,Facility,Inpatient,,,,449,381.65,128.6834,449,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Epidural Injection,,58004760,LOCAL,Facility,Both,,,,449,381.65,128.6834,449,Sanford Health Plan,Sanford Health Plan,413.08,92,,percent of total billed charges,,
Epidural Injection,,58004760,LOCAL,Facility,Outpatient,,,,449,381.65,128.6834,449,"UCare Health, Inc.",Individual & Family Plan,253.0115,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Epidural Injection,,58004760,LOCAL,Facility,Inpatient,,,,449,381.65,128.6834,449,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Epidural Injection,,58004760,LOCAL,Facility,Outpatient,,,,449,381.65,128.6834,449,"UCare Health, Inc.",Medical Assistance,226.6103,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Epidural Injection,,58004760,LOCAL,Facility,Inpatient,,,,449,381.65,128.6834,449,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Epidural Injection,,58004760,LOCAL,Facility,Outpatient,,,,449,381.65,128.6834,449,"UCare Health, Inc.",Medicare Advantage,226.6103,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Epidural Injection,,58004760,LOCAL,Facility,Inpatient,,,,449,381.65,128.6834,449,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Epidural Injection,,58004760,LOCAL,Facility,Outpatient,,,,449,381.65,128.6834,449,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),226.6103,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Epidural Injection,,58004760,LOCAL,Facility,Inpatient,,,,449,381.65,128.6834,449,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Epidural Injection,,58004760,LOCAL,Facility,Both,,,,449,381.65,128.6834,449,UnitedHealthcare,Individual & Family,422.06,94,,percent of total billed charges,,
Epidural Injection,,58004760,LOCAL,Facility,Outpatient,,,,449,381.65,128.6834,449,UnitedHealthcare,Medicare Advantage,220.01,49,,percent of total billed charges,,
Epidural Injection,,58004760,LOCAL,Facility,Inpatient,,,,449,381.65,128.6834,449,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Epidural Injection,,58004760,LOCAL,Facility,Outpatient,,,,449,381.65,128.6834,449,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,215.52,48,,percent of total billed charges,,100% of DHS outpatient percentage
Epidural Injection,,58004760,LOCAL,Facility,Inpatient,,,,449,381.65,128.6834,449,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Housing Services-Escort Fee,,66000715,LOCAL,Facility,Both,,,,15,12.75,4.299,15,Aetna,Commercial,13.8,92,,percent of total billed charges,,
Housing Services-Escort Fee,,66000715,LOCAL,Facility,Outpatient,,,,15,12.75,4.299,15,Aetna,Medicare Advantage,7.35,49,,percent of total billed charges,,
Housing Services-Escort Fee,,66000715,LOCAL,Facility,Inpatient,,,,15,12.75,4.299,15,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Housing Services-Escort Fee,,66000715,LOCAL,Facility,Both,,,,15,12.75,4.299,15,Aetna,PPO,13.95,93,,percent of total billed charges,,
Housing Services-Escort Fee,,66000715,LOCAL,Facility,Both,,,,15,12.75,4.299,15,America's PPO,America's PPO,14.4045,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Housing Services-Escort Fee,,66000715,LOCAL,Facility,Both,,,,15,12.75,4.299,15,BlueCross BlueShield Minnesota, Federal Employee Program,14.76,98.4,,percent of total billed charges,,
Housing Services-Escort Fee,,66000715,LOCAL,Facility,Both,,,,15,12.75,4.299,15,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,15,100,,percent of total billed charges,,
Housing Services-Escort Fee,,66000715,LOCAL,Facility,Both,,,,15,12.75,4.299,15,BlueCross BlueShield Minnesota,High Value Network Plan,13.5,90,,percent of total billed charges,,
Housing Services-Escort Fee,,66000715,LOCAL,Facility,Outpatient,,,,15,12.75,4.299,15,BlueCross BlueShield Minnesota,Medicare Advantage,7.35,49,,percent of total billed charges,,
Housing Services-Escort Fee,,66000715,LOCAL,Facility,Inpatient,,,,15,12.75,4.299,15,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Housing Services-Escort Fee,,66000715,LOCAL,Facility,Both,,,,15,12.75,4.299,15,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,13.2855,88.57,,percent of total billed charges,,
Housing Services-Escort Fee,,66000715,LOCAL,Facility,Both,,,,15,12.75,4.299,15,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,4.299,28.66,,percent of total billed charges,,
Housing Services-Escort Fee,,66000715,LOCAL,Facility,Outpatient,,,,15,12.75,4.299,15,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),7.35,49,,percent of total billed charges,,
Housing Services-Escort Fee,,66000715,LOCAL,Facility,Inpatient,,,,15,12.75,4.299,15,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Housing Services-Escort Fee,,66000715,LOCAL,Facility,Both,,,,15,12.75,4.299,15,CorVel,Worker's Compensation,15,100,,percent of total billed charges,,
Housing Services-Escort Fee,,66000715,LOCAL,Facility,Both,,,,15,12.75,4.299,15,First Health Group Corporation,First Health Network,14.55,97,,percent of total billed charges,,
Housing Services-Escort Fee,,66000715,LOCAL,Facility,Both,,,,15,12.75,4.299,15,"Health Partners, Inc.",Commercial,14.19,94.6,,percent of total billed charges,,
Housing Services-Escort Fee,,66000715,LOCAL,Facility,Outpatient,,,,15,12.75,4.299,15,"Health Partners, Inc.",Medicare Advantage,7.35,49,,percent of total billed charges,,
Housing Services-Escort Fee,,66000715,LOCAL,Facility,Inpatient,,,,15,12.75,4.299,15,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Housing Services-Escort Fee,,66000715,LOCAL,Facility,Both,,,,15,12.75,4.299,15,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),9,60,,percent of total billed charges,,
Housing Services-Escort Fee,,66000715,LOCAL,Facility,Both,,,,15,12.75,4.299,15,"Health Partners, Inc.",State of Minnesota Advantage Program,12.225,81.5,,percent of total billed charges,,
Housing Services-Escort Fee,,66000715,LOCAL,Facility,Both,,,,15,12.75,4.299,15,"Health Partners, Inc.",State Public Programs,7.5,50,,percent of total billed charges,,
Housing Services-Escort Fee,,66000715,LOCAL,Facility,Both,,,,15,12.75,4.299,15,Humana Insurance Company,Commercial PPO,14.25,95,,percent of total billed charges,,
Housing Services-Escort Fee,,66000715,LOCAL,Facility,Outpatient,,,,15,12.75,4.299,15,Humana Insurance Company,Medicare PPO,7.35,49,,percent of total billed charges,,
Housing Services-Escort Fee,,66000715,LOCAL,Facility,Inpatient,,,,15,12.75,4.299,15,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Housing Services-Escort Fee,,66000715,LOCAL,Facility,Both,,,,15,12.75,4.299,15,Medica,Individual & Family,14.865,99.1,,percent of total billed charges,,
Housing Services-Escort Fee,,66000715,LOCAL,Facility,Outpatient,,,,15,12.75,4.299,15,Medica,Medica Advantage Solution,7.47,49.8,,percent of total billed charges,,
Housing Services-Escort Fee,,66000715,LOCAL,Facility,Inpatient,,,,15,12.75,4.299,15,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Housing Services-Escort Fee,,66000715,LOCAL,Facility,Outpatient,,,,15,12.75,4.299,15,Medica,Medical Assistance,6.69,44.6,,percent of total billed charges,,
Housing Services-Escort Fee,,66000715,LOCAL,Facility,Inpatient,,,,15,12.75,4.299,15,Medica,Medical Assistance,,,,,Included in per diem rate,
Housing Services-Escort Fee,,66000715,LOCAL,Facility,Outpatient,,,,15,12.75,4.299,15,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,7.47,49.8,,percent of total billed charges,,
Housing Services-Escort Fee,,66000715,LOCAL,Facility,Inpatient,,,,15,12.75,4.299,15,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Housing Services-Escort Fee,,66000715,LOCAL,Facility,Both,,,,15,12.75,4.299,15,"Multiplan, Inc.","Multiplan, Inc.",14.1,94,,percent of total billed charges,,
Housing Services-Escort Fee,,66000715,LOCAL,Facility,Outpatient,,,,15,12.75,4.299,15,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,13.515,90.1,,percent of total billed charges,,
Housing Services-Escort Fee,,66000715,LOCAL,Facility,Inpatient,,,,15,12.75,4.299,15,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Housing Services-Escort Fee,,66000715,LOCAL,Facility,Both,,,,15,12.75,4.299,15,"Preferred One Administrative Services, INC.",PPO,14.79,98.6,,percent of total billed charges,,
Housing Services-Escort Fee,,66000715,LOCAL,Facility,Outpatient,,,,15,12.75,4.299,15,PrimeWest Health,Minnesota Senior Health Options (MSHO),7.7175,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Housing Services-Escort Fee,,66000715,LOCAL,Facility,Inpatient,,,,15,12.75,4.299,15,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Housing Services-Escort Fee,,66000715,LOCAL,Facility,Outpatient,,,,15,12.75,4.299,15,PrimeWest Health,MinnesotaCare,7.704,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Housing Services-Escort Fee,,66000715,LOCAL,Facility,Inpatient,,,,15,12.75,4.299,15,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Housing Services-Escort Fee,,66000715,LOCAL,Facility,Both,,,,15,12.75,4.299,15,Sanford Health Plan,Sanford Health Plan,13.8,92,,percent of total billed charges,,
Housing Services-Escort Fee,,66000715,LOCAL,Facility,Outpatient,,,,15,12.75,4.299,15,"UCare Health, Inc.",Individual & Family Plan,8.4525,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Housing Services-Escort Fee,,66000715,LOCAL,Facility,Inpatient,,,,15,12.75,4.299,15,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Housing Services-Escort Fee,,66000715,LOCAL,Facility,Outpatient,,,,15,12.75,4.299,15,"UCare Health, Inc.",Medical Assistance,7.5705,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Housing Services-Escort Fee,,66000715,LOCAL,Facility,Inpatient,,,,15,12.75,4.299,15,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Housing Services-Escort Fee,,66000715,LOCAL,Facility,Outpatient,,,,15,12.75,4.299,15,"UCare Health, Inc.",Medicare Advantage,7.5705,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Housing Services-Escort Fee,,66000715,LOCAL,Facility,Inpatient,,,,15,12.75,4.299,15,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Housing Services-Escort Fee,,66000715,LOCAL,Facility,Outpatient,,,,15,12.75,4.299,15,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),7.5705,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Housing Services-Escort Fee,,66000715,LOCAL,Facility,Inpatient,,,,15,12.75,4.299,15,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Housing Services-Escort Fee,,66000715,LOCAL,Facility,Both,,,,15,12.75,4.299,15,UnitedHealthcare,Individual & Family,14.1,94,,percent of total billed charges,,
Housing Services-Escort Fee,,66000715,LOCAL,Facility,Outpatient,,,,15,12.75,4.299,15,UnitedHealthcare,Medicare Advantage,7.35,49,,percent of total billed charges,,
Housing Services-Escort Fee,,66000715,LOCAL,Facility,Inpatient,,,,15,12.75,4.299,15,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Housing Services-Escort Fee,,66000715,LOCAL,Facility,Outpatient,,,,15,12.75,4.299,15,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,7.2,48,,percent of total billed charges,,100% of DHS outpatient percentage
Housing Services-Escort Fee,,66000715,LOCAL,Facility,Inpatient,,,,15,12.75,4.299,15,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Room Rate Medical/Surgical Mhs,,72160016,LOCAL,Facility,Inpatient,,,,1905,1619.25,545.973,4030.89,Aetna,Commercial,1752.6,92,,percent of total billed charges,,
Room Rate Medical/Surgical Mhs,,72160016,LOCAL,Facility,Inpatient,,,,1905,1619.25,545.973,4030.89,Aetna,Medicare Advantage,3505.12,,,Per diem,All inclusive rate,
Room Rate Medical/Surgical Mhs,,72160016,LOCAL,Facility,Inpatient,,,,1905,1619.25,545.973,4030.89,Aetna,PPO,1771.65,93,,percent of total billed charges,,
Room Rate Medical/Surgical Mhs,,72160016,LOCAL,Facility,Inpatient,,,,1905,1619.25,545.973,4030.89,America's PPO,America's PPO,1829.3715,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Room Rate Medical/Surgical Mhs,,72160016,LOCAL,Facility,Inpatient,,,,1905,1619.25,545.973,4030.89,BlueCross BlueShield Minnesota, Federal Employee Program,1874.901,98.4,,percent of total billed charges,,
Room Rate Medical/Surgical Mhs,,72160016,LOCAL,Facility,Inpatient,,,,1905,1619.25,545.973,4030.89,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1905,100,,percent of total billed charges,,
Room Rate Medical/Surgical Mhs,,72160016,LOCAL,Facility,Inpatient,,,,1905,1619.25,545.973,4030.89,BlueCross BlueShield Minnesota,High Value Network Plan,1714.5,90,,percent of total billed charges,,
Room Rate Medical/Surgical Mhs,,72160016,LOCAL,Facility,Inpatient,,,,1905,1619.25,545.973,4030.89,BlueCross BlueShield Minnesota,Medicare Advantage,3505.12,,,Per diem,,All inclusive rate
Room Rate Medical/Surgical Mhs,,72160016,LOCAL,Facility,Inpatient,,,,1905,1619.25,545.973,4030.89,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1687.2585,88.57,,percent of total billed charges,,
Room Rate Medical/Surgical Mhs,,72160016,LOCAL,Facility,Inpatient,,,,1905,1619.25,545.973,4030.89,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,545.973,28.66,,percent of total billed charges,,
Room Rate Medical/Surgical Mhs,,72160016,LOCAL,Facility,Inpatient,,,,1905,1619.25,545.973,4030.89,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),3505.12,,,Per diem,,All inclusive rate
Room Rate Medical/Surgical Mhs,,72160016,LOCAL,Facility,Inpatient,,,,1905,1619.25,545.973,4030.89,CorVel,Worker's Compensation,1905,100,,percent of total billed charges,,
Room Rate Medical/Surgical Mhs,,72160016,LOCAL,Facility,Inpatient,,,,1905,1619.25,545.973,4030.89,First Health Group Corporation,First Health Network,1847.85,,,Per diem,,All inclusive rate
Room Rate Medical/Surgical Mhs,,72160016,LOCAL,Facility,Inpatient,,,,1905,1619.25,545.973,4030.89,"Health Partners, Inc.",Commercial,1802.13,94.6,,percent of total billed charges,,
Room Rate Medical/Surgical Mhs,,72160016,LOCAL,Facility,Inpatient,,,,1905,1619.25,545.973,4030.89,"Health Partners, Inc.",Medicare Advantage,3505.12,,,Per diem,,All inclusive rate
Room Rate Medical/Surgical Mhs,,72160016,LOCAL,Facility,Inpatient,,,,1905,1619.25,545.973,4030.89,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1143,60,,percent of total billed charges,,
Room Rate Medical/Surgical Mhs,,72160016,LOCAL,Facility,Inpatient,,,,1905,1619.25,545.973,4030.89,"Health Partners, Inc.",State of Minnesota Advantage Program,1552.575,81.5,,percent of total billed charges,,
Room Rate Medical/Surgical Mhs,,72160016,LOCAL,Facility,Inpatient,,,,1905,1619.25,545.973,4030.89,"Health Partners, Inc.",State Public Programs,952.5,50,,percent of total billed charges,,
Room Rate Medical/Surgical Mhs,,72160016,LOCAL,Facility,Inpatient,,,,1905,1619.25,545.973,4030.89,Humana Insurance Company,Commercial PPO,1809.75,95,,percent of total billed charges,,
Room Rate Medical/Surgical Mhs,,72160016,LOCAL,Facility,Inpatient,,,,1905,1619.25,545.973,4030.89,Humana Insurance Company,Medicare PPO,3505.12,,,Per diem,,All inclusive rate
Room Rate Medical/Surgical Mhs,,72160016,LOCAL,Facility,Inpatient,,,,1905,1619.25,545.973,4030.89,Medica,Individual & Family,1887.855,99.1,,percent of total billed charges,,
Room Rate Medical/Surgical Mhs,,72160016,LOCAL,Facility,Inpatient,,,,1905,1619.25,545.973,4030.89,Medica,Medica Advantage Solution,3505.12,,,Per diem,,All inclusive rate
Room Rate Medical/Surgical Mhs,,72160016,LOCAL,Facility,Inpatient,,,,1905,1619.25,545.973,4030.89,Medica,Medical Assistance,1794,,,Per diem,,All inclusive rate
Room Rate Medical/Surgical Mhs,,72160016,LOCAL,Facility,Inpatient,,,,1905,1619.25,545.973,4030.89,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,3505.12,,,Per diem,,All inclusive rate
Room Rate Medical/Surgical Mhs,,72160016,LOCAL,Facility,Inpatient,,,,1905,1619.25,545.973,4030.89,"Multiplan, Inc.","Multiplan, Inc.",1790.7,94,,percent of total billed charges,,
Room Rate Medical/Surgical Mhs,,72160016,LOCAL,Facility,Inpatient,,,,1905,1619.25,545.973,4030.89,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,See DRG lines,
Room Rate Medical/Surgical Mhs,,72160016,LOCAL,Facility,Inpatient,,,,1905,1619.25,545.973,4030.89,"Preferred One Administrative Services, INC.",PPO,1878.33,98.6,,percent of total billed charges,,
Room Rate Medical/Surgical Mhs,,72160016,LOCAL,Facility,Inpatient,,,,1905,1619.25,545.973,4030.89,PrimeWest Health,Minnesota Senior Health Options (MSHO),3680.38,,,Per diem,,All inclusive rate
Room Rate Medical/Surgical Mhs,,72160016,LOCAL,Facility,Inpatient,,,,1905,1619.25,545.973,4030.89,PrimeWest Health,MinnesotaCare,2070.45,,,Per diem,,
Room Rate Medical/Surgical Mhs,,72160016,LOCAL,Facility,Inpatient,,,,1905,1619.25,545.973,4030.89,Sanford Health Plan,Sanford Health Plan,1752.6,92,,percent of total billed charges,,
Room Rate Medical/Surgical Mhs,,72160016,LOCAL,Facility,Inpatient,,,,1905,1619.25,545.973,4030.89,"UCare Health, Inc.",Individual & Family Plan,4030.89,,,Per diem,All inclusive rate,115% of Medicare per diem rate
Room Rate Medical/Surgical Mhs,,72160016,LOCAL,Facility,Inpatient,,,,1905,1619.25,545.973,4030.89,"UCare Health, Inc.",Medical Assistance,1935,,,Per diem,,All inclusive rate
Room Rate Medical/Surgical Mhs,,72160016,LOCAL,Facility,Inpatient,,,,1905,1619.25,545.973,4030.89,"UCare Health, Inc.",Medicare Advantage,3610.27,,,Per diem,,All inclusive rate
Room Rate Medical/Surgical Mhs,,72160016,LOCAL,Facility,Inpatient,,,,1905,1619.25,545.973,4030.89,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),3610.27,,,Per diem,,103% of Medicare per diem rate
Room Rate Medical/Surgical Mhs,,72160016,LOCAL,Facility,Inpatient,,,,1905,1619.25,545.973,4030.89,UnitedHealthcare,Individual & Family,1790.7,94,,percent of total billed charges,,
Room Rate Medical/Surgical Mhs,,72160016,LOCAL,Facility,Inpatient,,,,1905,1619.25,545.973,4030.89,UnitedHealthcare,Medicare Advantage,3505.12,,,Per diem,All inclusive rate,
Room Rate Medical/Surgical Mhs,,72160016,LOCAL,Facility,Inpatient,,,,1905,1619.25,545.973,4030.89,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1935,,,Per diem,All inclusive rate,
Room Rate Room Rate Special Care Medical/Surgical Mhs,,72160029,LOCAL,Facility,Inpatient,,,,2490,2116.5,713.634,4030.89,Aetna,Commercial,2290.8,92,,percent of total billed charges,,
Room Rate Room Rate Special Care Medical/Surgical Mhs,,72160029,LOCAL,Facility,Inpatient,,,,2490,2116.5,713.634,4030.89,Aetna,Medicare Advantage,3505.12,,,Per diem,All inclusive rate,
Room Rate Room Rate Special Care Medical/Surgical Mhs,,72160029,LOCAL,Facility,Inpatient,,,,2490,2116.5,713.634,4030.89,Aetna,PPO,2315.7,93,,percent of total billed charges,,
Room Rate Room Rate Special Care Medical/Surgical Mhs,,72160029,LOCAL,Facility,Inpatient,,,,2490,2116.5,713.634,4030.89,America's PPO,America's PPO,2391.147,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Room Rate Room Rate Special Care Medical/Surgical Mhs,,72160029,LOCAL,Facility,Inpatient,,,,2490,2116.5,713.634,4030.89,BlueCross BlueShield Minnesota, Federal Employee Program,2450.658,98.4,,percent of total billed charges,,
Room Rate Room Rate Special Care Medical/Surgical Mhs,,72160029,LOCAL,Facility,Inpatient,,,,2490,2116.5,713.634,4030.89,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,2490,100,,percent of total billed charges,,
Room Rate Room Rate Special Care Medical/Surgical Mhs,,72160029,LOCAL,Facility,Inpatient,,,,2490,2116.5,713.634,4030.89,BlueCross BlueShield Minnesota,High Value Network Plan,2241,90,,percent of total billed charges,,
Room Rate Room Rate Special Care Medical/Surgical Mhs,,72160029,LOCAL,Facility,Inpatient,,,,2490,2116.5,713.634,4030.89,BlueCross BlueShield Minnesota,Medicare Advantage,3505.12,,,Per diem,,All inclusive rate
Room Rate Room Rate Special Care Medical/Surgical Mhs,,72160029,LOCAL,Facility,Inpatient,,,,2490,2116.5,713.634,4030.89,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,2205.393,88.57,,percent of total billed charges,,
Room Rate Room Rate Special Care Medical/Surgical Mhs,,72160029,LOCAL,Facility,Inpatient,,,,2490,2116.5,713.634,4030.89,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,713.634,28.66,,percent of total billed charges,,
Room Rate Room Rate Special Care Medical/Surgical Mhs,,72160029,LOCAL,Facility,Inpatient,,,,2490,2116.5,713.634,4030.89,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),3505.12,,,Per diem,,All inclusive rate
Room Rate Room Rate Special Care Medical/Surgical Mhs,,72160029,LOCAL,Facility,Inpatient,,,,2490,2116.5,713.634,4030.89,CorVel,Worker's Compensation,2490,100,,percent of total billed charges,,
Room Rate Room Rate Special Care Medical/Surgical Mhs,,72160029,LOCAL,Facility,Inpatient,,,,2490,2116.5,713.634,4030.89,First Health Group Corporation,First Health Network,2415.3,,,Per diem,,All inclusive rate
Room Rate Room Rate Special Care Medical/Surgical Mhs,,72160029,LOCAL,Facility,Inpatient,,,,2490,2116.5,713.634,4030.89,"Health Partners, Inc.",Commercial,2355.54,94.6,,percent of total billed charges,,
Room Rate Room Rate Special Care Medical/Surgical Mhs,,72160029,LOCAL,Facility,Inpatient,,,,2490,2116.5,713.634,4030.89,"Health Partners, Inc.",Medicare Advantage,3505.12,,,Per diem,,All inclusive rate
Room Rate Room Rate Special Care Medical/Surgical Mhs,,72160029,LOCAL,Facility,Inpatient,,,,2490,2116.5,713.634,4030.89,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1494,60,,percent of total billed charges,,
Room Rate Room Rate Special Care Medical/Surgical Mhs,,72160029,LOCAL,Facility,Inpatient,,,,2490,2116.5,713.634,4030.89,"Health Partners, Inc.",State of Minnesota Advantage Program,2029.35,81.5,,percent of total billed charges,,
Room Rate Room Rate Special Care Medical/Surgical Mhs,,72160029,LOCAL,Facility,Inpatient,,,,2490,2116.5,713.634,4030.89,"Health Partners, Inc.",State Public Programs,1245,50,,percent of total billed charges,,
Room Rate Room Rate Special Care Medical/Surgical Mhs,,72160029,LOCAL,Facility,Inpatient,,,,2490,2116.5,713.634,4030.89,Humana Insurance Company,Commercial PPO,2365.5,95,,percent of total billed charges,,
Room Rate Room Rate Special Care Medical/Surgical Mhs,,72160029,LOCAL,Facility,Inpatient,,,,2490,2116.5,713.634,4030.89,Humana Insurance Company,Medicare PPO,3505.12,,,Per diem,,All inclusive rate
Room Rate Room Rate Special Care Medical/Surgical Mhs,,72160029,LOCAL,Facility,Inpatient,,,,2490,2116.5,713.634,4030.89,Medica,Individual & Family,2467.59,99.1,,percent of total billed charges,,
Room Rate Room Rate Special Care Medical/Surgical Mhs,,72160029,LOCAL,Facility,Inpatient,,,,2490,2116.5,713.634,4030.89,Medica,Medica Advantage Solution,3505.12,,,Per diem,,All inclusive rate
Room Rate Room Rate Special Care Medical/Surgical Mhs,,72160029,LOCAL,Facility,Inpatient,,,,2490,2116.5,713.634,4030.89,Medica,Medical Assistance,1794,,,Per diem,,All inclusive rate
Room Rate Room Rate Special Care Medical/Surgical Mhs,,72160029,LOCAL,Facility,Inpatient,,,,2490,2116.5,713.634,4030.89,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,3505.12,,,Per diem,,All inclusive rate
Room Rate Room Rate Special Care Medical/Surgical Mhs,,72160029,LOCAL,Facility,Inpatient,,,,2490,2116.5,713.634,4030.89,"Multiplan, Inc.","Multiplan, Inc.",2340.6,94,,percent of total billed charges,,
Room Rate Room Rate Special Care Medical/Surgical Mhs,,72160029,LOCAL,Facility,Inpatient,,,,2490,2116.5,713.634,4030.89,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,See DRG lines,
Room Rate Room Rate Special Care Medical/Surgical Mhs,,72160029,LOCAL,Facility,Inpatient,,,,2490,2116.5,713.634,4030.89,"Preferred One Administrative Services, INC.",PPO,2455.14,98.6,,percent of total billed charges,,
Room Rate Room Rate Special Care Medical/Surgical Mhs,,72160029,LOCAL,Facility,Inpatient,,,,2490,2116.5,713.634,4030.89,PrimeWest Health,Minnesota Senior Health Options (MSHO),3680.38,,,Per diem,,All inclusive rate
Room Rate Room Rate Special Care Medical/Surgical Mhs,,72160029,LOCAL,Facility,Inpatient,,,,2490,2116.5,713.634,4030.89,PrimeWest Health,MinnesotaCare,2070.45,,,Per diem,,
Room Rate Room Rate Special Care Medical/Surgical Mhs,,72160029,LOCAL,Facility,Inpatient,,,,2490,2116.5,713.634,4030.89,Sanford Health Plan,Sanford Health Plan,2290.8,92,,percent of total billed charges,,
Room Rate Room Rate Special Care Medical/Surgical Mhs,,72160029,LOCAL,Facility,Inpatient,,,,2490,2116.5,713.634,4030.89,"UCare Health, Inc.",Individual & Family Plan,4030.89,,,Per diem,All inclusive rate,115% of Medicare per diem rate
Room Rate Room Rate Special Care Medical/Surgical Mhs,,72160029,LOCAL,Facility,Inpatient,,,,2490,2116.5,713.634,4030.89,"UCare Health, Inc.",Medical Assistance,1935,,,Per diem,,All inclusive rate
Room Rate Room Rate Special Care Medical/Surgical Mhs,,72160029,LOCAL,Facility,Inpatient,,,,2490,2116.5,713.634,4030.89,"UCare Health, Inc.",Medicare Advantage,3610.27,,,Per diem,,All inclusive rate
Room Rate Room Rate Special Care Medical/Surgical Mhs,,72160029,LOCAL,Facility,Inpatient,,,,2490,2116.5,713.634,4030.89,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),3610.27,,,Per diem,,103% of Medicare per diem rate
Room Rate Room Rate Special Care Medical/Surgical Mhs,,72160029,LOCAL,Facility,Inpatient,,,,2490,2116.5,713.634,4030.89,UnitedHealthcare,Individual & Family,2340.6,,,percent of total billed charges,,
Room Rate Room Rate Special Care Medical/Surgical Mhs,,72160029,LOCAL,Facility,Inpatient,,,,2490,2116.5,713.634,4030.89,UnitedHealthcare,Medicare Advantage,3505.12,,,Per diem,All inclusive rate,
Room Rate Room Rate Special Care Medical/Surgical Mhs,,72160029,LOCAL,Facility,Inpatient,,,,2490,2116.5,713.634,4030.89,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1935,,,Per diem,All inclusive rate,
Room Rate Swing Bed Mhs,,72160042,LOCAL,Facility,Inpatient,,,,1265,1075.25,759,3582.7,Aetna,Medicare Advantage,3115.39,,,Per diem,All inclusive rate,
Room Rate Swing Bed Mhs,,72160042,LOCAL,Facility,Inpatient,,,,1265,1075.25,759,3582.7,America's PPO,America's PPO,1214.7795,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Room Rate Swing Bed Mhs,,72160042,LOCAL,Facility,Inpatient,,,,1265,1075.25,759,3582.7,BlueCross BlueShield Minnesota, Federal Employee Program,1058.299,83.66,,percent of total billed charges,,
Room Rate Swing Bed Mhs,,72160042,LOCAL,Facility,Inpatient,,,,1265,1075.25,759,3582.7,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1075.25,85,,percent of total billed charges,,
Room Rate Swing Bed Mhs,,72160042,LOCAL,Facility,Inpatient,,,,1265,1075.25,759,3582.7,BlueCross BlueShield Minnesota,High Value Network Plan,967.725,76.5,,percent of total billed charges,,
Room Rate Swing Bed Mhs,,72160042,LOCAL,Facility,Inpatient,,,,1265,1075.25,759,3582.7,BlueCross BlueShield Minnesota,Medicare Advantage,3115.39,,,Per diem,,All inclusive rate
Room Rate Swing Bed Mhs,,72160042,LOCAL,Facility,Inpatient,,,,1265,1075.25,759,3582.7,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,885.5,70,,percent of total billed charges,,
Room Rate Swing Bed Mhs,,72160042,LOCAL,Facility,Inpatient,,,,1265,1075.25,759,3582.7,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),3115.39,,,Per diem,,All inclusive rate
Room Rate Swing Bed Mhs,,72160042,LOCAL,Facility,Inpatient,,,,1265,1075.25,759,3582.7,"Health Partners, Inc.",Medicare Advantage,3115.39,,,Per diem,,All inclusive rate
Room Rate Swing Bed Mhs,,72160042,LOCAL,Facility,Inpatient,,,,1265,1075.25,759,3582.7,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),759,60,,percent of total billed charges,,
Room Rate Swing Bed Mhs,,72160042,LOCAL,Facility,Inpatient,,,,1265,1075.25,759,3582.7,Humana Insurance Company,Medicare PPO,3115.39,,,Per diem,,All inclusive rate
Room Rate Swing Bed Mhs,,72160042,LOCAL,Facility,Inpatient,,,,1265,1075.25,759,3582.7,Medica,Medica Advantage Solution,3115.39,,,Per diem,,All inclusive rate
Room Rate Swing Bed Mhs,,72160042,LOCAL,Facility,Inpatient,,,,1265,1075.25,759,3582.7,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,3115.39,,,Per diem,,All inclusive rate
Room Rate Swing Bed Mhs,,72160042,LOCAL,Facility,Inpatient,,,,1265,1075.25,759,3582.7,PrimeWest Health,Minnesota Senior Health Options (MSHO),3271.16,,,Per diem,All inclusive rate,105% of Medicare per diem rate
Room Rate Swing Bed Mhs,,72160042,LOCAL,Facility,Inpatient,,,,1265,1075.25,759,3582.7,"UCare Health, Inc.",Individual & Family Plan,3582.7,,,Per diem,All inclusive rate,115% of Medicare per diem rate
Room Rate Swing Bed Mhs,,72160042,LOCAL,Facility,Inpatient,,,,1265,1075.25,759,3582.7,"UCare Health, Inc.",Medicare Advantage,3208.85,,,Per diem,All inclusive rate,103% of Medicare per diem rate
Room Rate Swing Bed Mhs,,72160042,LOCAL,Facility,Inpatient,,,,1265,1075.25,759,3582.7,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),3208.85,,,Per diem,All inclusive rate,103% of Medicare per diem rate
Room Rate Swing Bed Mhs,,72160042,LOCAL,Facility,Inpatient,,,,1265,1075.25,759,3582.7,UnitedHealthcare,Medicare Advantage,3115.39,,,Per diem,All inclusive rate,100% of Medicare per diem rate
Room Rate Special Care Swing Bed Mhs,,72160051,LOCAL,Facility,Inpatient,,,,1850,1572.5,1110,3582.7,Aetna,Medicare Advantage,3115.39,,,Per diem,All inclusive rate,
Room Rate Special Care Swing Bed Mhs,,72160051,LOCAL,Facility,Inpatient,,,,1850,1572.5,1110,3582.7,America's PPO,America's PPO,1776.555,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Room Rate Special Care Swing Bed Mhs,,72160051,LOCAL,Facility,Inpatient,,,,1850,1572.5,1110,3582.7,BlueCross BlueShield Minnesota, Federal Employee Program,1547.71,83.66,,percent of total billed charges,,
Room Rate Special Care Swing Bed Mhs,,72160051,LOCAL,Facility,Inpatient,,,,1850,1572.5,1110,3582.7,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1572.5,85,,percent of total billed charges,,
Room Rate Special Care Swing Bed Mhs,,72160051,LOCAL,Facility,Inpatient,,,,1850,1572.5,1110,3582.7,BlueCross BlueShield Minnesota,High Value Network Plan,1415.25,76.5,,percent of total billed charges,,
Room Rate Special Care Swing Bed Mhs,,72160051,LOCAL,Facility,Inpatient,,,,1850,1572.5,1110,3582.7,BlueCross BlueShield Minnesota,Medicare Advantage,3115.39,,,Per diem,,All inclusive rate
Room Rate Special Care Swing Bed Mhs,,72160051,LOCAL,Facility,Inpatient,,,,1850,1572.5,1110,3582.7,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1295,70,,percent of total billed charges,,
Room Rate Special Care Swing Bed Mhs,,72160051,LOCAL,Facility,Inpatient,,,,1850,1572.5,1110,3582.7,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),3115.39,,,Per diem,,All inclusive rate
Room Rate Special Care Swing Bed Mhs,,72160051,LOCAL,Facility,Inpatient,,,,1850,1572.5,1110,3582.7,"Health Partners, Inc.",Medicare Advantage,3115.39,,,Per diem,,All inclusive rate
Room Rate Special Care Swing Bed Mhs,,72160051,LOCAL,Facility,Inpatient,,,,1850,1572.5,1110,3582.7,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1110,60,,percent of total billed charges,,
Room Rate Special Care Swing Bed Mhs,,72160051,LOCAL,Facility,Inpatient,,,,1850,1572.5,1110,3582.7,Humana Insurance Company,Medicare PPO,3115.39,,,Per diem,,All inclusive rate
Room Rate Special Care Swing Bed Mhs,,72160051,LOCAL,Facility,Inpatient,,,,1850,1572.5,1110,3582.7,Medica,Medica Advantage Solution,3115.39,,,Per diem,,All inclusive rate
Room Rate Special Care Swing Bed Mhs,,72160051,LOCAL,Facility,Inpatient,,,,1850,1572.5,1110,3582.7,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,3115.39,,,Per diem,,All inclusive rate
Room Rate Special Care Swing Bed Mhs,,72160051,LOCAL,Facility,Inpatient,,,,1850,1572.5,1110,3582.7,PrimeWest Health,Minnesota Senior Health Options (MSHO),3271.16,,,Per diem,All inclusive rate,105% of Medicare per diem rate
Room Rate Special Care Swing Bed Mhs,,72160051,LOCAL,Facility,Inpatient,,,,1850,1572.5,1110,3582.7,"UCare Health, Inc.",Individual & Family Plan,3582.7,,,Per diem,All inclusive rate,115% of Medicare per diem rate
Room Rate Special Care Swing Bed Mhs,,72160051,LOCAL,Facility,Inpatient,,,,1850,1572.5,1110,3582.7,"UCare Health, Inc.",Medicare Advantage,3208.85,,,Per diem,All inclusive rate,103% of Medicare per diem rate
Room Rate Special Care Swing Bed Mhs,,72160051,LOCAL,Facility,Inpatient,,,,1850,1572.5,1110,3582.7,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),3208.85,,,Per diem,All inclusive rate,103% of Medicare per diem rate
Room Rate Special Care Swing Bed Mhs,,72160051,LOCAL,Facility,Inpatient,,,,1850,1572.5,1110,3582.7,UnitedHealthcare,Medicare Advantage,3115.39,,,Per diem,All inclusive rate,100% of Medicare per diem rate
Room Rate Respite Mhs,,72160067,LOCAL,Facility,Inpatient,,,,475,403.75,475,475,Aetna,Commercial,475,,,Other,Not covered by insurance,
Room Rate Respite Mhs,,72160067,LOCAL,Facility,Inpatient,,,,475,403.75,475,475,Aetna,Medicare Advantage,475,,,Other,Not covered by insurance,
Room Rate Respite Mhs,,72160067,LOCAL,Facility,Inpatient,,,,475,403.75,475,475,Aetna,PPO,475,,,Other,Not covered by insurance,
Room Rate Respite Mhs,,72160067,LOCAL,Facility,Inpatient,,,,475,403.75,475,475,America's PPO,America's PPO,475,,,Other,Not covered by insurance,
Room Rate Respite Mhs,,72160067,LOCAL,Facility,Inpatient,,,,475,403.75,475,475,BlueCross BlueShield Minnesota, Federal Employee Program,475,83.66,,percent of total billed charges,,Not covered by insurance
Room Rate Respite Mhs,,72160067,LOCAL,Facility,Inpatient,,,,475,403.75,475,475,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,475,,,Other,Not covered by insurance,
Room Rate Respite Mhs,,72160067,LOCAL,Facility,Inpatient,,,,475,403.75,475,475,BlueCross BlueShield Minnesota,High Value Network Plan,475,,,Other,Not covered by insurance,
Room Rate Respite Mhs,,72160067,LOCAL,Facility,Inpatient,,,,475,403.75,475,475,BlueCross BlueShield Minnesota,Medicare Advantage,475,,,Other,Not covered by insurance,
Room Rate Respite Mhs,,72160067,LOCAL,Facility,Inpatient,,,,475,403.75,475,475,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,475,,,Other,Not covered by insurance,
Room Rate Respite Mhs,,72160067,LOCAL,Facility,Inpatient,,,,475,403.75,475,475,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,475,,,Other,Not covered by insurance,
Room Rate Respite Mhs,,72160067,LOCAL,Facility,Inpatient,,,,475,403.75,475,475,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),475,,,Other,Not covered by insurance,
Room Rate Respite Mhs,,72160067,LOCAL,Facility,Inpatient,,,,475,403.75,475,475,CorVel,Worker's Compensation,475,,,Other,Not covered by insurance,
Room Rate Respite Mhs,,72160067,LOCAL,Facility,Inpatient,,,,475,403.75,475,475,First Health Group Corporation,First Health Network,475,,,Other,Not covered by insurance,
Room Rate Respite Mhs,,72160067,LOCAL,Facility,Inpatient,,,,475,403.75,475,475,"Health Partners, Inc.",Commercial,475,,,Other,Not covered by insurance,
Room Rate Respite Mhs,,72160067,LOCAL,Facility,Inpatient,,,,475,403.75,475,475,"Health Partners, Inc.",Medicare Advantage,475,,,Other,Not covered by insurance,
Room Rate Respite Mhs,,72160067,LOCAL,Facility,Inpatient,,,,475,403.75,475,475,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),475,,,Other,Not covered by insurance,
Room Rate Respite Mhs,,72160067,LOCAL,Facility,Inpatient,,,,475,403.75,475,475,"Health Partners, Inc.",State of Minnesota Advantage Program,475,,,Other,Not covered by insurance,
Room Rate Respite Mhs,,72160067,LOCAL,Facility,Inpatient,,,,475,403.75,475,475,"Health Partners, Inc.",State Public Programs,475,,,Other,Not covered by insurance,
Room Rate Respite Mhs,,72160067,LOCAL,Facility,Inpatient,,,,475,403.75,475,475,Humana Insurance Company,Commercial PPO,475,,,Other,Not covered by insurance,
Room Rate Respite Mhs,,72160067,LOCAL,Facility,Inpatient,,,,475,403.75,475,475,Humana Insurance Company,Medicare PPO,475,,,Other,Not covered by insurance,
Room Rate Respite Mhs,,72160067,LOCAL,Facility,Inpatient,,,,475,403.75,475,475,Medica,Individual & Family,475,,,Other,Not covered by insurance,
Room Rate Respite Mhs,,72160067,LOCAL,Facility,Inpatient,,,,475,403.75,475,475,Medica,Medica Advantage Solution,475,,,Other,Not covered by insurance,
Room Rate Respite Mhs,,72160067,LOCAL,Facility,Inpatient,,,,475,403.75,475,475,Medica,Medical Assistance,475,,,Other,Not covered by insurance,
Room Rate Respite Mhs,,72160067,LOCAL,Facility,Inpatient,,,,475,403.75,475,475,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,475,,,Other,Not covered by insurance,
Room Rate Respite Mhs,,72160067,LOCAL,Facility,Inpatient,,,,475,403.75,475,475,"Multiplan, Inc.","Multiplan, Inc.",475,,,Other,Not covered by insurance,
Room Rate Respite Mhs,,72160067,LOCAL,Facility,Inpatient,,,,475,403.75,475,475,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,475,,,Other,Not covered by insurance,
Room Rate Respite Mhs,,72160067,LOCAL,Facility,Inpatient,,,,475,403.75,475,475,"Preferred One Administrative Services, INC.",PPO,475,,,Other,Not covered by insurance,
Room Rate Respite Mhs,,72160067,LOCAL,Facility,Inpatient,,,,475,403.75,475,475,PrimeWest Health,Minnesota Senior Health Options (MSHO),475,,,Other,Not covered by insurance,
Room Rate Respite Mhs,,72160067,LOCAL,Facility,Inpatient,,,,475,403.75,475,475,PrimeWest Health,MinnesotaCare,475,,,Other,Not covered by insurance,
Room Rate Respite Mhs,,72160067,LOCAL,Facility,Inpatient,,,,475,403.75,475,475,Sanford Health Plan,Sanford Health Plan,475,,,Other,Not covered by insurance,
Room Rate Respite Mhs,,72160067,LOCAL,Facility,Inpatient,,,,475,403.75,475,475,"UCare Health, Inc.",Individual & Family Plan,475,,,Other,Not covered by insurance,
Room Rate Respite Mhs,,72160067,LOCAL,Facility,Inpatient,,,,475,403.75,475,475,"UCare Health, Inc.",Medical Assistance,475,,,Other,Not covered by insurance,
Room Rate Respite Mhs,,72160067,LOCAL,Facility,Inpatient,,,,475,403.75,475,475,"UCare Health, Inc.",Medicare Advantage,475,,,Other,Not covered by insurance,
Room Rate Respite Mhs,,72160067,LOCAL,Facility,Inpatient,,,,475,403.75,475,475,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),475,,,Other,Not covered by insurance,
Room Rate Respite Mhs,,72160067,LOCAL,Facility,Inpatient,,,,475,403.75,475,475,UnitedHealthcare,Individual & Family,475,,,Other,Not covered by insurance,
Room Rate Respite Mhs,,72160067,LOCAL,Facility,Inpatient,,,,475,403.75,475,475,UnitedHealthcare,Medicare Advantage,475,,,Other,Not covered by insurance,
Room Rate Respite Mhs,,72160067,LOCAL,Facility,Inpatient,,,,475,403.75,475,475,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,475,,,Other,Not covered by insurance,
Room Rate Obstetrics Mhs,,72160085,LOCAL,Facility,Inpatient,,,,1905,1619.25,545.973,4030.89,Aetna,Commercial,1752.6,92,,percent of total billed charges,,
Room Rate Obstetrics Mhs,,72160085,LOCAL,Facility,Inpatient,,,,1905,1619.25,545.973,4030.89,Aetna,Medicare Advantage,3505.12,,,Per diem,All inclusive rate,
Room Rate Obstetrics Mhs,,72160085,LOCAL,Facility,Inpatient,,,,1905,1619.25,545.973,4030.89,Aetna,PPO,1771.65,93,,percent of total billed charges,,
Room Rate Obstetrics Mhs,,72160085,LOCAL,Facility,Inpatient,,,,1905,1619.25,545.973,4030.89,America's PPO,America's PPO,1829.3715,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Room Rate Obstetrics Mhs,,72160085,LOCAL,Facility,Inpatient,,,,1905,1619.25,545.973,4030.89,BlueCross BlueShield Minnesota, Federal Employee Program,1874.901,98.4,,percent of total billed charges,,
Room Rate Obstetrics Mhs,,72160085,LOCAL,Facility,Inpatient,,,,1905,1619.25,545.973,4030.89,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1905,100,,percent of total billed charges,,
Room Rate Obstetrics Mhs,,72160085,LOCAL,Facility,Inpatient,,,,1905,1619.25,545.973,4030.89,BlueCross BlueShield Minnesota,High Value Network Plan,1714.5,90,,percent of total billed charges,,
Room Rate Obstetrics Mhs,,72160085,LOCAL,Facility,Inpatient,,,,1905,1619.25,545.973,4030.89,BlueCross BlueShield Minnesota,Medicare Advantage,3505.12,,,Per diem,,All inclusive rate
Room Rate Obstetrics Mhs,,72160085,LOCAL,Facility,Inpatient,,,,1905,1619.25,545.973,4030.89,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1687.2585,88.57,,percent of total billed charges,,
Room Rate Obstetrics Mhs,,72160085,LOCAL,Facility,Inpatient,,,,1905,1619.25,545.973,4030.89,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,545.973,28.66,,percent of total billed charges,,
Room Rate Obstetrics Mhs,,72160085,LOCAL,Facility,Inpatient,,,,1905,1619.25,545.973,4030.89,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),3505.12,,,Per diem,,All inclusive rate
Room Rate Obstetrics Mhs,,72160085,LOCAL,Facility,Inpatient,,,,1905,1619.25,545.973,4030.89,CorVel,Worker's Compensation,1905,100,,percent of total billed charges,,
Room Rate Obstetrics Mhs,,72160085,LOCAL,Facility,Inpatient,,,,1905,1619.25,545.973,4030.89,First Health Group Corporation,First Health Network,1847.85,,,Per diem,,All inclusive rate
Room Rate Obstetrics Mhs,,72160085,LOCAL,Facility,Inpatient,,,,1905,1619.25,545.973,4030.89,"Health Partners, Inc.",Commercial,1802.13,94.6,,percent of total billed charges,,
Room Rate Obstetrics Mhs,,72160085,LOCAL,Facility,Inpatient,,,,1905,1619.25,545.973,4030.89,"Health Partners, Inc.",Medicare Advantage,3505.12,,,Per diem,,All inclusive rate
Room Rate Obstetrics Mhs,,72160085,LOCAL,Facility,Inpatient,,,,1905,1619.25,545.973,4030.89,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1143,60,,percent of total billed charges,,
Room Rate Obstetrics Mhs,,72160085,LOCAL,Facility,Inpatient,,,,1905,1619.25,545.973,4030.89,"Health Partners, Inc.",State of Minnesota Advantage Program,1552.575,81.5,,percent of total billed charges,,
Room Rate Obstetrics Mhs,,72160085,LOCAL,Facility,Inpatient,,,,1905,1619.25,545.973,4030.89,"Health Partners, Inc.",State Public Programs,952.5,50,,percent of total billed charges,,
Room Rate Obstetrics Mhs,,72160085,LOCAL,Facility,Inpatient,,,,1905,1619.25,545.973,4030.89,Humana Insurance Company,Commercial PPO,1809.75,95,,percent of total billed charges,,
Room Rate Obstetrics Mhs,,72160085,LOCAL,Facility,Inpatient,,,,1905,1619.25,545.973,4030.89,Humana Insurance Company,Medicare PPO,3505.12,,,Per diem,,All inclusive rate
Room Rate Obstetrics Mhs,,72160085,LOCAL,Facility,Inpatient,,,,1905,1619.25,545.973,4030.89,Medica,Individual & Family,1887.855,99.1,,percent of total billed charges,,
Room Rate Obstetrics Mhs,,72160085,LOCAL,Facility,Inpatient,,,,1905,1619.25,545.973,4030.89,Medica,Medica Advantage Solution,3505.12,,,Per diem,,All inclusive rate
Room Rate Obstetrics Mhs,,72160085,LOCAL,Facility,Inpatient,,,,1905,1619.25,545.973,4030.89,Medica,Medical Assistance,1794,,,Per diem,,All inclusive rate
Room Rate Obstetrics Mhs,,72160085,LOCAL,Facility,Inpatient,,,,1905,1619.25,545.973,4030.89,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,3505.12,,,Per diem,,All inclusive rate
Room Rate Obstetrics Mhs,,72160085,LOCAL,Facility,Inpatient,,,,1905,1619.25,545.973,4030.89,"Multiplan, Inc.","Multiplan, Inc.",1790.7,94,,percent of total billed charges,,
Room Rate Obstetrics Mhs,,72160085,LOCAL,Facility,Inpatient,,,,1905,1619.25,545.973,4030.89,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,See DRG lines,
Room Rate Obstetrics Mhs,,72160085,LOCAL,Facility,Inpatient,,,,1905,1619.25,545.973,4030.89,"Preferred One Administrative Services, INC.",PPO,1878.33,98.6,,percent of total billed charges,,
Room Rate Obstetrics Mhs,,72160085,LOCAL,Facility,Inpatient,,,,1905,1619.25,545.973,4030.89,PrimeWest Health,Minnesota Senior Health Options (MSHO),3680.38,,,Per diem,,All inclusive rate
Room Rate Obstetrics Mhs,,72160085,LOCAL,Facility,Inpatient,,,,1905,1619.25,545.973,4030.89,PrimeWest Health,MinnesotaCare,2070.45,,,Per diem,,
Room Rate Obstetrics Mhs,,72160085,LOCAL,Facility,Inpatient,,,,1905,1619.25,545.973,4030.89,Sanford Health Plan,Sanford Health Plan,1752.6,92,,percent of total billed charges,,
Room Rate Obstetrics Mhs,,72160085,LOCAL,Facility,Inpatient,,,,1905,1619.25,545.973,4030.89,"UCare Health, Inc.",Individual & Family Plan,4030.89,,,Per diem,All inclusive rate,115% of Medicare per diem rate
Room Rate Obstetrics Mhs,,72160085,LOCAL,Facility,Inpatient,,,,1905,1619.25,545.973,4030.89,"UCare Health, Inc.",Medical Assistance,1935,,,Per diem,,All inclusive rate
Room Rate Obstetrics Mhs,,72160085,LOCAL,Facility,Inpatient,,,,1905,1619.25,545.973,4030.89,"UCare Health, Inc.",Medicare Advantage,3610.27,,,Per diem,,All inclusive rate
Room Rate Obstetrics Mhs,,72160085,LOCAL,Facility,Inpatient,,,,1905,1619.25,545.973,4030.89,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),3610.27,,,Per diem,,103% of Medicare per diem rate
Room Rate Obstetrics Mhs,,72160085,LOCAL,Facility,Inpatient,,,,1905,1619.25,545.973,4030.89,UnitedHealthcare,Individual & Family,1790.7,,,percent of total billed charges,,
Room Rate Obstetrics Mhs,,72160085,LOCAL,Facility,Inpatient,,,,1905,1619.25,545.973,4030.89,UnitedHealthcare,Medicare Advantage,3505.12,,,Per diem,All inclusive rate,
Room Rate Obstetrics Mhs,,72160085,LOCAL,Facility,Inpatient,,,,1905,1619.25,545.973,4030.89,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1935,,,Per diem,All inclusive rate,
Room Rate Nursery Mhs,,72160090,LOCAL,Facility,Inpatient,,,,975,828.75,279.435,4030.89,Aetna,Commercial,897,92,,percent of total billed charges,,
Room Rate Nursery Mhs,,72160090,LOCAL,Facility,Inpatient,,,,975,828.75,279.435,4030.89,Aetna,Medicare Advantage,3505.12,,,Per diem,All inclusive rate,
Room Rate Nursery Mhs,,72160090,LOCAL,Facility,Inpatient,,,,975,828.75,279.435,4030.89,Aetna,PPO,906.75,93,,percent of total billed charges,,
Room Rate Nursery Mhs,,72160090,LOCAL,Facility,Inpatient,,,,975,828.75,279.435,4030.89,America's PPO,America's PPO,936.2925,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Room Rate Nursery Mhs,,72160090,LOCAL,Facility,Inpatient,,,,975,828.75,279.435,4030.89,BlueCross BlueShield Minnesota, Federal Employee Program,959.595,98.4,,percent of total billed charges,,
Room Rate Nursery Mhs,,72160090,LOCAL,Facility,Inpatient,,,,975,828.75,279.435,4030.89,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,975,100,,percent of total billed charges,,
Room Rate Nursery Mhs,,72160090,LOCAL,Facility,Inpatient,,,,975,828.75,279.435,4030.89,BlueCross BlueShield Minnesota,High Value Network Plan,877.5,90,,percent of total billed charges,,
Room Rate Nursery Mhs,,72160090,LOCAL,Facility,Inpatient,,,,975,828.75,279.435,4030.89,BlueCross BlueShield Minnesota,Medicare Advantage,3505.12,,,Per diem,,All inclusive rate
Room Rate Nursery Mhs,,72160090,LOCAL,Facility,Inpatient,,,,975,828.75,279.435,4030.89,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,863.5575,88.57,,percent of total billed charges,,
Room Rate Nursery Mhs,,72160090,LOCAL,Facility,Inpatient,,,,975,828.75,279.435,4030.89,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,279.435,28.66,,percent of total billed charges,,
Room Rate Nursery Mhs,,72160090,LOCAL,Facility,Inpatient,,,,975,828.75,279.435,4030.89,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),3505.12,,,Per diem,,All inclusive rate
Room Rate Nursery Mhs,,72160090,LOCAL,Facility,Inpatient,,,,975,828.75,279.435,4030.89,CorVel,Worker's Compensation,975,100,,percent of total billed charges,,
Room Rate Nursery Mhs,,72160090,LOCAL,Facility,Inpatient,,,,975,828.75,279.435,4030.89,First Health Group Corporation,First Health Network,945.75,,,Per diem,,All inclusive rate
Room Rate Nursery Mhs,,72160090,LOCAL,Facility,Inpatient,,,,975,828.75,279.435,4030.89,"Health Partners, Inc.",Commercial,922.35,94.6,,percent of total billed charges,,
Room Rate Nursery Mhs,,72160090,LOCAL,Facility,Inpatient,,,,975,828.75,279.435,4030.89,"Health Partners, Inc.",Medicare Advantage,3505.12,,,Per diem,,All inclusive rate
Room Rate Nursery Mhs,,72160090,LOCAL,Facility,Inpatient,,,,975,828.75,279.435,4030.89,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),585,60,,percent of total billed charges,,
Room Rate Nursery Mhs,,72160090,LOCAL,Facility,Inpatient,,,,975,828.75,279.435,4030.89,"Health Partners, Inc.",State of Minnesota Advantage Program,794.625,81.5,,percent of total billed charges,,
Room Rate Nursery Mhs,,72160090,LOCAL,Facility,Inpatient,,,,975,828.75,279.435,4030.89,"Health Partners, Inc.",State Public Programs,487.5,50,,percent of total billed charges,,
Room Rate Nursery Mhs,,72160090,LOCAL,Facility,Inpatient,,,,975,828.75,279.435,4030.89,Humana Insurance Company,Commercial PPO,926.25,95,,percent of total billed charges,,
Room Rate Nursery Mhs,,72160090,LOCAL,Facility,Inpatient,,,,975,828.75,279.435,4030.89,Humana Insurance Company,Medicare PPO,3505.12,,,Per diem,,All inclusive rate
Room Rate Nursery Mhs,,72160090,LOCAL,Facility,Inpatient,,,,975,828.75,279.435,4030.89,Medica,Individual & Family,966.225,99.1,,percent of total billed charges,,
Room Rate Nursery Mhs,,72160090,LOCAL,Facility,Inpatient,,,,975,828.75,279.435,4030.89,Medica,Medica Advantage Solution,3505.12,,,Per diem,,All inclusive rate
Room Rate Nursery Mhs,,72160090,LOCAL,Facility,Inpatient,,,,975,828.75,279.435,4030.89,Medica,Medical Assistance,1794,,,Per diem,,All inclusive rate
Room Rate Nursery Mhs,,72160090,LOCAL,Facility,Inpatient,,,,975,828.75,279.435,4030.89,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,3505.12,,,Per diem,,All inclusive rate
Room Rate Nursery Mhs,,72160090,LOCAL,Facility,Inpatient,,,,975,828.75,279.435,4030.89,"Multiplan, Inc.","Multiplan, Inc.",916.5,94,,percent of total billed charges,,
Room Rate Nursery Mhs,,72160090,LOCAL,Facility,Inpatient,,,,975,828.75,279.435,4030.89,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,See DRG lines,
Room Rate Nursery Mhs,,72160090,LOCAL,Facility,Inpatient,,,,975,828.75,279.435,4030.89,"Preferred One Administrative Services, INC.",PPO,961.35,98.6,,percent of total billed charges,,
Room Rate Nursery Mhs,,72160090,LOCAL,Facility,Inpatient,,,,975,828.75,279.435,4030.89,PrimeWest Health,Minnesota Senior Health Options (MSHO),3680.38,,,Per diem,,All inclusive rate
Room Rate Nursery Mhs,,72160090,LOCAL,Facility,Inpatient,,,,975,828.75,279.435,4030.89,PrimeWest Health,MinnesotaCare,2070.45,,,Per diem,,
Room Rate Nursery Mhs,,72160090,LOCAL,Facility,Inpatient,,,,975,828.75,279.435,4030.89,Sanford Health Plan,Sanford Health Plan,897,92,,percent of total billed charges,,
Room Rate Nursery Mhs,,72160090,LOCAL,Facility,Inpatient,,,,975,828.75,279.435,4030.89,"UCare Health, Inc.",Individual & Family Plan,4030.89,,,Per diem,All inclusive rate,115% of Medicare per diem rate
Room Rate Nursery Mhs,,72160090,LOCAL,Facility,Inpatient,,,,975,828.75,279.435,4030.89,"UCare Health, Inc.",Medical Assistance,1935,,,Per diem,,All inclusive rate
Room Rate Nursery Mhs,,72160090,LOCAL,Facility,Inpatient,,,,975,828.75,279.435,4030.89,"UCare Health, Inc.",Medicare Advantage,3610.27,,,Per diem,,All inclusive rate
Room Rate Nursery Mhs,,72160090,LOCAL,Facility,Inpatient,,,,975,828.75,279.435,4030.89,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),3610.27,,,Per diem,,103% of Medicare per diem rate
Room Rate Nursery Mhs,,72160090,LOCAL,Facility,Inpatient,,,,975,828.75,279.435,4030.89,UnitedHealthcare,Individual & Family,916.5,,,percent of total billed charges,,
Room Rate Nursery Mhs,,72160090,LOCAL,Facility,Inpatient,,,,975,828.75,279.435,4030.89,UnitedHealthcare,Medicare Advantage,3505.12,,,Per diem,All inclusive rate,
Room Rate Nursery Mhs,,72160090,LOCAL,Facility,Inpatient,,,,975,828.75,279.435,4030.89,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1935,,,Per diem,All inclusive rate,
Pf Anes Fee (CRNA) per unit,,80001268,LOCAL,Professional,Both,,,,204,173.4,58.4664,204,Aetna,Commercial,173.4,85,,percent of total billed charges,,
Pf Anes Fee (CRNA) per unit,,80001268,LOCAL,Professional,Both,,,,204,173.4,58.4664,204,Aetna,Medicare Advantage,99.96,49,,percent of total billed charges,,
Pf Anes Fee (CRNA) per unit,,80001268,LOCAL,Professional,Both,,,,204,173.4,58.4664,204,Aetna,PPO,189.72,93,,percent of total billed charges,,
Pf Anes Fee (CRNA) per unit,,80001268,LOCAL,Professional,Both,,,,204,173.4,58.4664,204,America's PPO,America's PPO,174.2976,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Pf Anes Fee (CRNA) per unit,,80001268,LOCAL,Professional,Both,,,,204,173.4,58.4664,204,BlueCross BlueShield Minnesota, Federal Employee Program,200.736,98.4,,percent of total billed charges,,
Pf Anes Fee (CRNA) per unit,,80001268,LOCAL,Professional,Both,,,,204,173.4,58.4664,204,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,204,100,,percent of total billed charges,,
Pf Anes Fee (CRNA) per unit,,80001268,LOCAL,Professional,Both,,,,204,173.4,58.4664,204,BlueCross BlueShield Minnesota,High Value Network Plan,183.6,90,,percent of total billed charges,,
Pf Anes Fee (CRNA) per unit,,80001268,LOCAL,Professional,Outpatient,,,,204,173.4,58.4664,204,BlueCross BlueShield Minnesota,Medicare Advantage,99.96,49,,percent of total billed charges,,
Pf Anes Fee (CRNA) per unit,,80001268,LOCAL,Professional,Inpatient,,,,204,173.4,58.4664,204,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,,Included in per diem rate
Pf Anes Fee (CRNA) per unit,,80001268,LOCAL,Professional,Both,,,,204,173.4,58.4664,204,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,180.6828,88.57,,percent of total billed charges,,
Pf Anes Fee (CRNA) per unit,,80001268,LOCAL,Professional,Both,,,,204,173.4,58.4664,204,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,58.4664,28.66,,percent of total billed charges,,
Pf Anes Fee (CRNA) per unit,,80001268,LOCAL,Professional,Outpatient,,,,204,173.4,58.4664,204,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),99.96,49,,percent of total billed charges,,
Pf Anes Fee (CRNA) per unit,,80001268,LOCAL,Professional,Inpatient,,,,204,173.4,58.4664,204,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Pf Anes Fee (CRNA) per unit,,80001268,LOCAL,Professional,Both,,,,204,173.4,58.4664,204,CorVel,Worker's Compensation,204,100,,percent of total billed charges,,
Pf Anes Fee (CRNA) per unit,,80001268,LOCAL,Professional,Both,,,,204,173.4,58.4664,204,First Health Group Corporation,First Health Network,197.88,97,,percent of total billed charges,,
Pf Anes Fee (CRNA) per unit,,80001268,LOCAL,Professional,Both,,,,204,173.4,58.4664,204,"Health Partners, Inc.",Commercial,192.984,94.6,,percent of total billed charges,,
Pf Anes Fee (CRNA) per unit,,80001268,LOCAL,Professional,Outpatient,,,,204,173.4,58.4664,204,"Health Partners, Inc.",Medicare Advantage,99.96,49,,percent of total billed charges,,
Pf Anes Fee (CRNA) per unit,,80001268,LOCAL,Professional,Both,,,,204,173.4,58.4664,204,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),122.4,59.99,,percent of total billed charges,,
Pf Anes Fee (CRNA) per unit,,80001268,LOCAL,Professional,Both,,,,204,173.4,58.4664,204,"Health Partners, Inc.",State of Minnesota Advantage Program,166.26,81.5,,percent of total billed charges,,
Pf Anes Fee (CRNA) per unit,,80001268,LOCAL,Professional,Both,,,,204,173.4,58.4664,204,"Health Partners, Inc.",State Public Programs,102,50,,percent of total billed charges,,
Pf Anes Fee (CRNA) per unit,,80001268,LOCAL,Professional,Both,,,,204,173.4,58.4664,204,Humana Insurance Company,Commercial PPO,193.8,95,,percent of total billed charges,,
Pf Anes Fee (CRNA) per unit,,80001268,LOCAL,Professional,Outpatient,,,,204,173.4,58.4664,204,Humana Insurance Company,Medicare PPO,99.96,49,,percent of total billed charges,,
Pf Anes Fee (CRNA) per unit,,80001268,LOCAL,Professional,Inpatient,,,,204,173.4,58.4664,204,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Pf Anes Fee (CRNA) per unit,,80001268,LOCAL,Professional,Both,,,,204,173.4,58.4664,204,Medica,Individual & Family,202.164,99.1,,percent of total billed charges,,
Pf Anes Fee (CRNA) per unit,,80001268,LOCAL,Professional,Outpatient,,,,204,173.4,58.4664,204,Medica,Medica Advantage Solution,101.592,49.8,,percent of total billed charges,,
Pf Anes Fee (CRNA) per unit,,80001268,LOCAL,Professional,Inpatient,,,,204,173.4,58.4664,204,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Pf Anes Fee (CRNA) per unit,,80001268,LOCAL,Professional,Outpatient,,,,204,173.4,58.4664,204,Medica,Medical Assistance,90.984,44.6,,percent of total billed charges,,
Pf Anes Fee (CRNA) per unit,,80001268,LOCAL,Professional,Inpatient,,,,204,173.4,58.4664,204,Medica,Medical Assistance,,,,,Included in per diem rate,
Pf Anes Fee (CRNA) per unit,,80001268,LOCAL,Professional,Outpatient,,,,204,173.4,58.4664,204,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,101.592,49.8,,percent of total billed charges,,
Pf Anes Fee (CRNA) per unit,,80001268,LOCAL,Professional,Inpatient,,,,204,173.4,58.4664,204,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Pf Anes Fee (CRNA) per unit,,80001268,LOCAL,Professional,Both,,,,204,173.4,58.4664,204,"Multiplan, Inc.","Multiplan, Inc.",191.76,94,,percent of total billed charges,,
Pf Anes Fee (CRNA) per unit,,80001268,LOCAL,Professional,Outpatient,,,,204,173.4,58.4664,204,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,183.804,90.1,,percent of total billed charges,,
Pf Anes Fee (CRNA) per unit,,80001268,LOCAL,Professional,Inpatient,,,,204,173.4,58.4664,204,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Pf Anes Fee (CRNA) per unit,,80001268,LOCAL,Professional,Both,,,,204,173.4,58.4664,204,"Preferred One Administrative Services, INC.",PPO,201.144,98.6,,percent of total billed charges,,
Pf Anes Fee (CRNA) per unit,,80001268,LOCAL,Professional,Outpatient,,,,204,173.4,58.4664,204,PrimeWest Health,Minnesota Senior Health Options (MSHO),104.958,51.45,,percent of total billed charges,,105% of Medicare outpatient percentage
Pf Anes Fee (CRNA) per unit,,80001268,LOCAL,Professional,Inpatient,,,,204,173.4,58.4664,204,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Pf Anes Fee (CRNA) per unit,,80001268,LOCAL,Professional,Outpatient,,,,204,173.4,58.4664,204,PrimeWest Health,MinnesotaCare,104.77,51.36,,Fee schedule,,
Pf Anes Fee (CRNA) per unit,,80001268,LOCAL,Professional,Inpatient,,,,204,173.4,58.4664,204,PrimeWest Health,MinnesotaCare,,,,Conversion factor,See specific anesthesia code for pricing,
Pf Anes Fee (CRNA) per unit,,80001268,LOCAL,Professional,Both,,,,204,173.4,58.4664,204,Sanford Health Plan,Sanford Health Plan,187.68,92,,percent of total billed charges,,
Pf Anes Fee (CRNA) per unit,,80001268,LOCAL,Professional,Outpatient,,,,204,173.4,58.4664,204,"UCare Health, Inc.",Individual & Family Plan,114.954,56.35,,percent of total billed charges,,
Pf Anes Fee (CRNA) per unit,,80001268,LOCAL,Professional,Inpatient,,,,204,173.4,58.4664,204,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Pf Anes Fee (CRNA) per unit,,80001268,LOCAL,Professional,Outpatient,,,,204,173.4,58.4664,204,"UCare Health, Inc.",Medical Assistance,102.9588,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Pf Anes Fee (CRNA) per unit,,80001268,LOCAL,Professional,Inpatient,,,,204,173.4,58.4664,204,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Pf Anes Fee (CRNA) per unit,,80001268,LOCAL,Professional,Outpatient,,,,204,173.4,58.4664,204,"UCare Health, Inc.",Medicare Advantage,102.9588,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Pf Anes Fee (CRNA) per unit,,80001268,LOCAL,Professional,Inpatient,,,,204,173.4,58.4664,204,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Pf Anes Fee (CRNA) per unit,,80001268,LOCAL,Professional,Outpatient,,,,204,173.4,58.4664,204,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),102.9588,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Pf Anes Fee (CRNA) per unit,,80001268,LOCAL,Professional,Inpatient,,,,204,173.4,58.4664,204,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Pf Anes Fee (CRNA) per unit,,80001268,LOCAL,Professional,Both,,,,204,173.4,58.4664,204,UnitedHealthcare,Individual & Family,191.76,94,,percent of total billed charges,,
Pf Anes Fee (CRNA) per unit,,80001268,LOCAL,Professional,Outpatient,,,,204,173.4,58.4664,204,UnitedHealthcare,Medicare Advantage,99.96,49,,percent of total billed charges,,
Pf Anes Fee (CRNA) per unit,,80001268,LOCAL,Professional,Inpatient,,,,204,173.4,58.4664,204,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Pf Anes Fee (CRNA) per unit,,80001268,LOCAL,Professional,Outpatient,,,,204,173.4,58.4664,204,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,97.92,48,,percent of total billed charges,,100% of DHS outpatient percentage
Pf Anes Fee (CRNA) per unit,,80001268,LOCAL,Professional,Inpatient,,,,204,173.4,58.4664,204,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Qiastat Respiratory Pathogen Panel,,0223U,CPT,Facility,Both,,,,430,365.5,123.238,430,Aetna,Commercial,395.6,92,,percent of total billed charges,,
Qiastat Respiratory Pathogen Panel,,0223U,CPT,Facility,Outpatient,,,,430,365.5,123.238,430,Aetna,Medicare Advantage,210.7,49,,percent of total billed charges,,
Qiastat Respiratory Pathogen Panel,,0223U,CPT,Facility,Inpatient,,,,430,365.5,123.238,430,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Qiastat Respiratory Pathogen Panel,,0223U,CPT,Facility,Both,,,,430,365.5,123.238,430,Aetna,PPO,399.9,93,,percent of total billed charges,,
Qiastat Respiratory Pathogen Panel,,0223U,CPT,Facility,Both,,,,430,365.5,123.238,430,America's PPO,America's PPO,412.929,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Qiastat Respiratory Pathogen Panel,,0223U,CPT,Facility,Both,,,,430,365.5,123.238,430,BlueCross BlueShield Minnesota, Federal Employee Program,423.12,98.4,,percent of total billed charges,,
Qiastat Respiratory Pathogen Panel,,0223U,CPT,Facility,Both,,,,430,365.5,123.238,430,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,430,100,,percent of total billed charges,,
Qiastat Respiratory Pathogen Panel,,0223U,CPT,Facility,Both,,,,430,365.5,123.238,430,BlueCross BlueShield Minnesota,High Value Network Plan,387,90,,percent of total billed charges,,
Qiastat Respiratory Pathogen Panel,,0223U,CPT,Facility,Outpatient,,,,430,365.5,123.238,430,BlueCross BlueShield Minnesota,Medicare Advantage,210.7,49,,percent of total billed charges,,
Qiastat Respiratory Pathogen Panel,,0223U,CPT,Facility,Inpatient,,,,430,365.5,123.238,430,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Qiastat Respiratory Pathogen Panel,,0223U,CPT,Facility,Both,,,,430,365.5,123.238,430,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,380.851,88.57,,percent of total billed charges,,
Qiastat Respiratory Pathogen Panel,,0223U,CPT,Facility,Both,,,,430,365.5,123.238,430,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,123.238,28.66,,percent of total billed charges,,
Qiastat Respiratory Pathogen Panel,,0223U,CPT,Facility,Outpatient,,,,430,365.5,123.238,430,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),210.7,49,,percent of total billed charges,,
Qiastat Respiratory Pathogen Panel,,0223U,CPT,Facility,Inpatient,,,,430,365.5,123.238,430,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Qiastat Respiratory Pathogen Panel,,0223U,CPT,Facility,Both,,,,430,365.5,123.238,430,CorVel,Worker's Compensation,430,100,,percent of total billed charges,,
Qiastat Respiratory Pathogen Panel,,0223U,CPT,Facility,Both,,,,430,365.5,123.238,430,First Health Group Corporation,First Health Network,417.1,97,,percent of total billed charges,,
Qiastat Respiratory Pathogen Panel,,0223U,CPT,Facility,Both,,,,430,365.5,123.238,430,"Health Partners, Inc.",Commercial,406.78,94.6,,percent of total billed charges,,
Qiastat Respiratory Pathogen Panel,,0223U,CPT,Facility,Outpatient,,,,430,365.5,123.238,430,"Health Partners, Inc.",Medicare Advantage,210.7,49,,percent of total billed charges,,
Qiastat Respiratory Pathogen Panel,,0223U,CPT,Facility,Inpatient,,,,430,365.5,123.238,430,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Qiastat Respiratory Pathogen Panel,,0223U,CPT,Facility,Both,,,,430,365.5,123.238,430,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),258,60,,percent of total billed charges,,
Qiastat Respiratory Pathogen Panel,,0223U,CPT,Facility,Both,,,,430,365.5,123.238,430,"Health Partners, Inc.",State of Minnesota Advantage Program,350.45,81.5,,percent of total billed charges,,
Qiastat Respiratory Pathogen Panel,,0223U,CPT,Facility,Both,,,,430,365.5,123.238,430,"Health Partners, Inc.",State Public Programs,215,50,,percent of total billed charges,,
Qiastat Respiratory Pathogen Panel,,0223U,CPT,Facility,Both,,,,430,365.5,123.238,430,Humana Insurance Company,Commercial PPO,408.5,95,,percent of total billed charges,,
Qiastat Respiratory Pathogen Panel,,0223U,CPT,Facility,Outpatient,,,,430,365.5,123.238,430,Humana Insurance Company,Medicare PPO,210.7,49,,percent of total billed charges,,
Qiastat Respiratory Pathogen Panel,,0223U,CPT,Facility,Inpatient,,,,430,365.5,123.238,430,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Qiastat Respiratory Pathogen Panel,,0223U,CPT,Facility,Both,,,,430,365.5,123.238,430,Medica,Individual & Family,426.13,99.1,,percent of total billed charges,,
Qiastat Respiratory Pathogen Panel,,0223U,CPT,Facility,Outpatient,,,,430,365.5,123.238,430,Medica,Medica Advantage Solution,214.14,49.8,,percent of total billed charges,,
Qiastat Respiratory Pathogen Panel,,0223U,CPT,Facility,Inpatient,,,,430,365.5,123.238,430,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Qiastat Respiratory Pathogen Panel,,0223U,CPT,Facility,Outpatient,,,,430,365.5,123.238,430,Medica,Medical Assistance,191.78,44.6,,percent of total billed charges,,
Qiastat Respiratory Pathogen Panel,,0223U,CPT,Facility,Inpatient,,,,430,365.5,123.238,430,Medica,Medical Assistance,,,,,Included in per diem rate,
Qiastat Respiratory Pathogen Panel,,0223U,CPT,Facility,Outpatient,,,,430,365.5,123.238,430,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,214.14,49.8,,percent of total billed charges,,
Qiastat Respiratory Pathogen Panel,,0223U,CPT,Facility,Inpatient,,,,430,365.5,123.238,430,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Qiastat Respiratory Pathogen Panel,,0223U,CPT,Facility,Both,,,,430,365.5,123.238,430,"Multiplan, Inc.","Multiplan, Inc.",404.2,94,,percent of total billed charges,,
Qiastat Respiratory Pathogen Panel,,0223U,CPT,Facility,Outpatient,,,,430,365.5,123.238,430,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,371.52,86.4,,percent of total billed charges,,
Qiastat Respiratory Pathogen Panel,,0223U,CPT,Facility,Inpatient,,,,430,365.5,123.238,430,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Qiastat Respiratory Pathogen Panel,,0223U,CPT,Facility,Both,,,,430,365.5,123.238,430,"Preferred One Administrative Services, INC.",PPO,423.98,98.6,,percent of total billed charges,,
Qiastat Respiratory Pathogen Panel,,0223U,CPT,Facility,Outpatient,,,,430,365.5,123.238,430,PrimeWest Health,Minnesota Senior Health Options (MSHO),221.235,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Qiastat Respiratory Pathogen Panel,,0223U,CPT,Facility,Inpatient,,,,430,365.5,123.238,430,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Qiastat Respiratory Pathogen Panel,,0223U,CPT,Facility,Outpatient,,,,430,365.5,123.238,430,PrimeWest Health,MinnesotaCare,220.848,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Qiastat Respiratory Pathogen Panel,,0223U,CPT,Facility,Inpatient,,,,430,365.5,123.238,430,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Qiastat Respiratory Pathogen Panel,,0223U,CPT,Facility,Both,,,,430,365.5,123.238,430,Sanford Health Plan,Sanford Health Plan,395.6,92,,percent of total billed charges,,
Qiastat Respiratory Pathogen Panel,,0223U,CPT,Facility,Outpatient,,,,430,365.5,123.238,430,"UCare Health, Inc.",Individual & Family Plan,242.305,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Qiastat Respiratory Pathogen Panel,,0223U,CPT,Facility,Inpatient,,,,430,365.5,123.238,430,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Qiastat Respiratory Pathogen Panel,,0223U,CPT,Facility,Outpatient,,,,430,365.5,123.238,430,"UCare Health, Inc.",Medical Assistance,217.021,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Qiastat Respiratory Pathogen Panel,,0223U,CPT,Facility,Inpatient,,,,430,365.5,123.238,430,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Qiastat Respiratory Pathogen Panel,,0223U,CPT,Facility,Outpatient,,,,430,365.5,123.238,430,"UCare Health, Inc.",Medicare Advantage,217.021,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Qiastat Respiratory Pathogen Panel,,0223U,CPT,Facility,Inpatient,,,,430,365.5,123.238,430,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Qiastat Respiratory Pathogen Panel,,0223U,CPT,Facility,Outpatient,,,,430,365.5,123.238,430,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),217.021,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Qiastat Respiratory Pathogen Panel,,0223U,CPT,Facility,Inpatient,,,,430,365.5,123.238,430,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Qiastat Respiratory Pathogen Panel,,0223U,CPT,Facility,Both,,,,430,365.5,123.238,430,UnitedHealthcare,Individual & Family,404.2,94,,percent of total billed charges,,
Qiastat Respiratory Pathogen Panel,,0223U,CPT,Facility,Outpatient,,,,430,365.5,123.238,430,UnitedHealthcare,Medicare Advantage,210.7,49,,percent of total billed charges,,
Qiastat Respiratory Pathogen Panel,,0223U,CPT,Facility,Inpatient,,,,430,365.5,123.238,430,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Qiastat Respiratory Pathogen Panel,,0223U,CPT,Facility,Outpatient,,,,430,365.5,123.238,430,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,206.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
Qiastat Respiratory Pathogen Panel,,0223U,CPT,Facility,Inpatient,,,,430,365.5,123.238,430,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
INTRO SHEATH CLOSURE FAST MICRO 7FR 7CM MIS-7F07,,A4212,HCPCS,Facility,Both,,,,122,103.7,34.9652,122,Aetna,Commercial,112.24,92,,percent of total billed charges,,
INTRO SHEATH CLOSURE FAST MICRO 7FR 7CM MIS-7F07,,A4212,HCPCS,Facility,Outpatient,,,,122,103.7,34.9652,122,Aetna,Medicare Advantage,59.78,49,,percent of total billed charges,,
INTRO SHEATH CLOSURE FAST MICRO 7FR 7CM MIS-7F07,,A4212,HCPCS,Facility,Inpatient,,,,122,103.7,34.9652,122,Aetna,Medicare Advantage,,,,,Included in per diem rate,
INTRO SHEATH CLOSURE FAST MICRO 7FR 7CM MIS-7F07,,A4212,HCPCS,Facility,Both,,,,122,103.7,34.9652,122,Aetna,PPO,113.46,93,,percent of total billed charges,,
INTRO SHEATH CLOSURE FAST MICRO 7FR 7CM MIS-7F07,,A4212,HCPCS,Facility,Both,,,,122,103.7,34.9652,122,America's PPO,America's PPO,117.1566,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
INTRO SHEATH CLOSURE FAST MICRO 7FR 7CM MIS-7F07,,A4212,HCPCS,Facility,Both,,,,122,103.7,34.9652,122,BlueCross BlueShield Minnesota, Federal Employee Program,120.048,98.4,,percent of total billed charges,,
INTRO SHEATH CLOSURE FAST MICRO 7FR 7CM MIS-7F07,,A4212,HCPCS,Facility,Both,,,,122,103.7,34.9652,122,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,122,100,,percent of total billed charges,,
INTRO SHEATH CLOSURE FAST MICRO 7FR 7CM MIS-7F07,,A4212,HCPCS,Facility,Both,,,,122,103.7,34.9652,122,BlueCross BlueShield Minnesota,High Value Network Plan,109.8,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
INTRO SHEATH CLOSURE FAST MICRO 7FR 7CM MIS-7F07,,A4212,HCPCS,Facility,Outpatient,,,,122,103.7,34.9652,122,BlueCross BlueShield Minnesota,Medicare Advantage,59.78,49,,percent of total billed charges,,
INTRO SHEATH CLOSURE FAST MICRO 7FR 7CM MIS-7F07,,A4212,HCPCS,Facility,Inpatient,,,,122,103.7,34.9652,122,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
INTRO SHEATH CLOSURE FAST MICRO 7FR 7CM MIS-7F07,,A4212,HCPCS,Facility,Both,,,,122,103.7,34.9652,122,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,108.0554,88.57,,percent of total billed charges,,
INTRO SHEATH CLOSURE FAST MICRO 7FR 7CM MIS-7F07,,A4212,HCPCS,Facility,Both,,,,122,103.7,34.9652,122,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,34.9652,28.66,,percent of total billed charges,,
INTRO SHEATH CLOSURE FAST MICRO 7FR 7CM MIS-7F07,,A4212,HCPCS,Facility,Outpatient,,,,122,103.7,34.9652,122,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),59.78,49,,percent of total billed charges,,
INTRO SHEATH CLOSURE FAST MICRO 7FR 7CM MIS-7F07,,A4212,HCPCS,Facility,Inpatient,,,,122,103.7,34.9652,122,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
INTRO SHEATH CLOSURE FAST MICRO 7FR 7CM MIS-7F07,,A4212,HCPCS,Facility,Both,,,,122,103.7,34.9652,122,CorVel,Worker's Compensation,122,100,,percent of total billed charges,,
INTRO SHEATH CLOSURE FAST MICRO 7FR 7CM MIS-7F07,,A4212,HCPCS,Facility,Both,,,,122,103.7,34.9652,122,First Health Group Corporation,First Health Network,118.34,97,,percent of total billed charges,,
INTRO SHEATH CLOSURE FAST MICRO 7FR 7CM MIS-7F07,,A4212,HCPCS,Facility,Both,,,,122,103.7,34.9652,122,"Health Partners, Inc.",Commercial,115.412,94.6,,percent of total billed charges,,
INTRO SHEATH CLOSURE FAST MICRO 7FR 7CM MIS-7F07,,A4212,HCPCS,Facility,Outpatient,,,,122,103.7,34.9652,122,"Health Partners, Inc.",Medicare Advantage,59.78,49,,percent of total billed charges,,
INTRO SHEATH CLOSURE FAST MICRO 7FR 7CM MIS-7F07,,A4212,HCPCS,Facility,Inpatient,,,,122,103.7,34.9652,122,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
INTRO SHEATH CLOSURE FAST MICRO 7FR 7CM MIS-7F07,,A4212,HCPCS,Facility,Both,,,,122,103.7,34.9652,122,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),73.2,60,,percent of total billed charges,,
INTRO SHEATH CLOSURE FAST MICRO 7FR 7CM MIS-7F07,,A4212,HCPCS,Facility,Both,,,,122,103.7,34.9652,122,"Health Partners, Inc.",State of Minnesota Advantage Program,99.43,81.5,,percent of total billed charges,,
INTRO SHEATH CLOSURE FAST MICRO 7FR 7CM MIS-7F07,,A4212,HCPCS,Facility,Both,,,,122,103.7,34.9652,122,"Health Partners, Inc.",State Public Programs,61,50,,percent of total billed charges,,
INTRO SHEATH CLOSURE FAST MICRO 7FR 7CM MIS-7F07,,A4212,HCPCS,Facility,Both,,,,122,103.7,34.9652,122,Humana Insurance Company,Commercial PPO,115.9,95,,percent of total billed charges,,
INTRO SHEATH CLOSURE FAST MICRO 7FR 7CM MIS-7F07,,A4212,HCPCS,Facility,Outpatient,,,,122,103.7,34.9652,122,Humana Insurance Company,Medicare PPO,59.78,49,,percent of total billed charges,,
INTRO SHEATH CLOSURE FAST MICRO 7FR 7CM MIS-7F07,,A4212,HCPCS,Facility,Inpatient,,,,122,103.7,34.9652,122,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
INTRO SHEATH CLOSURE FAST MICRO 7FR 7CM MIS-7F07,,A4212,HCPCS,Facility,Both,,,,122,103.7,34.9652,122,Medica,Individual & Family,120.902,99.1,,percent of total billed charges,,
INTRO SHEATH CLOSURE FAST MICRO 7FR 7CM MIS-7F07,,A4212,HCPCS,Facility,Outpatient,,,,122,103.7,34.9652,122,Medica,Medica Advantage Solution,60.756,49.8,,percent of total billed charges,,
INTRO SHEATH CLOSURE FAST MICRO 7FR 7CM MIS-7F07,,A4212,HCPCS,Facility,Inpatient,,,,122,103.7,34.9652,122,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
INTRO SHEATH CLOSURE FAST MICRO 7FR 7CM MIS-7F07,,A4212,HCPCS,Facility,Outpatient,,,,122,103.7,34.9652,122,Medica,Medical Assistance,54.412,44.6,,percent of total billed charges,,
INTRO SHEATH CLOSURE FAST MICRO 7FR 7CM MIS-7F07,,A4212,HCPCS,Facility,Inpatient,,,,122,103.7,34.9652,122,Medica,Medical Assistance,,,,,Included in per diem rate,
INTRO SHEATH CLOSURE FAST MICRO 7FR 7CM MIS-7F07,,A4212,HCPCS,Facility,Outpatient,,,,122,103.7,34.9652,122,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,60.756,49.8,,percent of total billed charges,,
INTRO SHEATH CLOSURE FAST MICRO 7FR 7CM MIS-7F07,,A4212,HCPCS,Facility,Inpatient,,,,122,103.7,34.9652,122,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
INTRO SHEATH CLOSURE FAST MICRO 7FR 7CM MIS-7F07,,A4212,HCPCS,Facility,Both,,,,122,103.7,34.9652,122,"Multiplan, Inc.","Multiplan, Inc.",114.68,94,,percent of total billed charges,,
INTRO SHEATH CLOSURE FAST MICRO 7FR 7CM MIS-7F07,,A4212,HCPCS,Facility,Outpatient,,,,122,103.7,34.9652,122,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,109.922,90.1,,percent of total billed charges,,
INTRO SHEATH CLOSURE FAST MICRO 7FR 7CM MIS-7F07,,A4212,HCPCS,Facility,Inpatient,,,,122,103.7,34.9652,122,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
INTRO SHEATH CLOSURE FAST MICRO 7FR 7CM MIS-7F07,,A4212,HCPCS,Facility,Both,,,,122,103.7,34.9652,122,"Preferred One Administrative Services, INC.",PPO,120.292,98.6,,percent of total billed charges,,
INTRO SHEATH CLOSURE FAST MICRO 7FR 7CM MIS-7F07,,A4212,HCPCS,Facility,Outpatient,,,,122,103.7,34.9652,122,PrimeWest Health,Minnesota Senior Health Options (MSHO),62.769,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
INTRO SHEATH CLOSURE FAST MICRO 7FR 7CM MIS-7F07,,A4212,HCPCS,Facility,Inpatient,,,,122,103.7,34.9652,122,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
INTRO SHEATH CLOSURE FAST MICRO 7FR 7CM MIS-7F07,,A4212,HCPCS,Facility,Outpatient,,,,122,103.7,34.9652,122,PrimeWest Health,MinnesotaCare,62.6592,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
INTRO SHEATH CLOSURE FAST MICRO 7FR 7CM MIS-7F07,,A4212,HCPCS,Facility,Inpatient,,,,122,103.7,34.9652,122,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
INTRO SHEATH CLOSURE FAST MICRO 7FR 7CM MIS-7F07,,A4212,HCPCS,Facility,Both,,,,122,103.7,34.9652,122,Sanford Health Plan,Sanford Health Plan,112.24,92,,percent of total billed charges,,
INTRO SHEATH CLOSURE FAST MICRO 7FR 7CM MIS-7F07,,A4212,HCPCS,Facility,Outpatient,,,,122,103.7,34.9652,122,"UCare Health, Inc.",Individual & Family Plan,68.747,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
INTRO SHEATH CLOSURE FAST MICRO 7FR 7CM MIS-7F07,,A4212,HCPCS,Facility,Inpatient,,,,122,103.7,34.9652,122,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
INTRO SHEATH CLOSURE FAST MICRO 7FR 7CM MIS-7F07,,A4212,HCPCS,Facility,Outpatient,,,,122,103.7,34.9652,122,"UCare Health, Inc.",Medical Assistance,61.5734,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
INTRO SHEATH CLOSURE FAST MICRO 7FR 7CM MIS-7F07,,A4212,HCPCS,Facility,Inpatient,,,,122,103.7,34.9652,122,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
INTRO SHEATH CLOSURE FAST MICRO 7FR 7CM MIS-7F07,,A4212,HCPCS,Facility,Outpatient,,,,122,103.7,34.9652,122,"UCare Health, Inc.",Medicare Advantage,61.5734,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
INTRO SHEATH CLOSURE FAST MICRO 7FR 7CM MIS-7F07,,A4212,HCPCS,Facility,Inpatient,,,,122,103.7,34.9652,122,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
INTRO SHEATH CLOSURE FAST MICRO 7FR 7CM MIS-7F07,,A4212,HCPCS,Facility,Outpatient,,,,122,103.7,34.9652,122,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),61.5734,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
INTRO SHEATH CLOSURE FAST MICRO 7FR 7CM MIS-7F07,,A4212,HCPCS,Facility,Inpatient,,,,122,103.7,34.9652,122,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
INTRO SHEATH CLOSURE FAST MICRO 7FR 7CM MIS-7F07,,A4212,HCPCS,Facility,Both,,,,122,103.7,34.9652,122,UnitedHealthcare,Individual & Family,114.68,94,,percent of total billed charges,,
INTRO SHEATH CLOSURE FAST MICRO 7FR 7CM MIS-7F07,,A4212,HCPCS,Facility,Outpatient,,,,122,103.7,34.9652,122,UnitedHealthcare,Medicare Advantage,59.78,49,,percent of total billed charges,,
INTRO SHEATH CLOSURE FAST MICRO 7FR 7CM MIS-7F07,,A4212,HCPCS,Facility,Inpatient,,,,122,103.7,34.9652,122,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
INTRO SHEATH CLOSURE FAST MICRO 7FR 7CM MIS-7F07,,A4212,HCPCS,Facility,Outpatient,,,,122,103.7,34.9652,122,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,58.56,48,,percent of total billed charges,,100% of DHS outpatient percentage
INTRO SHEATH CLOSURE FAST MICRO 7FR 7CM MIS-7F07,,A4212,HCPCS,Facility,Inpatient,,,,122,103.7,34.9652,122,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Sup Ez Needle,,A4212,HCPCS,Facility,Both,,,,561,476.85,160.7826,561,Aetna,Commercial,516.12,92,,percent of total billed charges,,
Sup Ez Needle,,A4212,HCPCS,Facility,Outpatient,,,,561,476.85,160.7826,561,Aetna,Medicare Advantage,274.89,49,,percent of total billed charges,,
Sup Ez Needle,,A4212,HCPCS,Facility,Inpatient,,,,561,476.85,160.7826,561,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Sup Ez Needle,,A4212,HCPCS,Facility,Both,,,,561,476.85,160.7826,561,Aetna,PPO,521.73,93,,percent of total billed charges,,
Sup Ez Needle,,A4212,HCPCS,Facility,Both,,,,561,476.85,160.7826,561,America's PPO,America's PPO,538.7283,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Sup Ez Needle,,A4212,HCPCS,Facility,Both,,,,561,476.85,160.7826,561,BlueCross BlueShield Minnesota, Federal Employee Program,552.024,98.4,,percent of total billed charges,,
Sup Ez Needle,,A4212,HCPCS,Facility,Both,,,,561,476.85,160.7826,561,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,561,100,,percent of total billed charges,,
Sup Ez Needle,,A4212,HCPCS,Facility,Both,,,,561,476.85,160.7826,561,BlueCross BlueShield Minnesota,High Value Network Plan,504.9,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
Sup Ez Needle,,A4212,HCPCS,Facility,Outpatient,,,,561,476.85,160.7826,561,BlueCross BlueShield Minnesota,Medicare Advantage,274.89,49,,percent of total billed charges,,
Sup Ez Needle,,A4212,HCPCS,Facility,Inpatient,,,,561,476.85,160.7826,561,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Sup Ez Needle,,A4212,HCPCS,Facility,Both,,,,561,476.85,160.7826,561,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,496.8777,88.57,,percent of total billed charges,,
Sup Ez Needle,,A4212,HCPCS,Facility,Both,,,,561,476.85,160.7826,561,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,160.7826,28.66,,percent of total billed charges,,
Sup Ez Needle,,A4212,HCPCS,Facility,Outpatient,,,,561,476.85,160.7826,561,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),274.89,49,,percent of total billed charges,,
Sup Ez Needle,,A4212,HCPCS,Facility,Inpatient,,,,561,476.85,160.7826,561,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Sup Ez Needle,,A4212,HCPCS,Facility,Both,,,,561,476.85,160.7826,561,CorVel,Worker's Compensation,561,100,,percent of total billed charges,,
Sup Ez Needle,,A4212,HCPCS,Facility,Both,,,,561,476.85,160.7826,561,First Health Group Corporation,First Health Network,544.17,97,,percent of total billed charges,,
Sup Ez Needle,,A4212,HCPCS,Facility,Both,,,,561,476.85,160.7826,561,"Health Partners, Inc.",Commercial,530.706,94.6,,percent of total billed charges,,
Sup Ez Needle,,A4212,HCPCS,Facility,Outpatient,,,,561,476.85,160.7826,561,"Health Partners, Inc.",Medicare Advantage,274.89,49,,percent of total billed charges,,
Sup Ez Needle,,A4212,HCPCS,Facility,Inpatient,,,,561,476.85,160.7826,561,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Ez Needle,,A4212,HCPCS,Facility,Both,,,,561,476.85,160.7826,561,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),336.6,60,,percent of total billed charges,,
Sup Ez Needle,,A4212,HCPCS,Facility,Both,,,,561,476.85,160.7826,561,"Health Partners, Inc.",State of Minnesota Advantage Program,457.215,81.5,,percent of total billed charges,,
Sup Ez Needle,,A4212,HCPCS,Facility,Both,,,,561,476.85,160.7826,561,"Health Partners, Inc.",State Public Programs,280.5,50,,percent of total billed charges,,
Sup Ez Needle,,A4212,HCPCS,Facility,Both,,,,561,476.85,160.7826,561,Humana Insurance Company,Commercial PPO,532.95,95,,percent of total billed charges,,
Sup Ez Needle,,A4212,HCPCS,Facility,Outpatient,,,,561,476.85,160.7826,561,Humana Insurance Company,Medicare PPO,274.89,49,,percent of total billed charges,,
Sup Ez Needle,,A4212,HCPCS,Facility,Inpatient,,,,561,476.85,160.7826,561,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Sup Ez Needle,,A4212,HCPCS,Facility,Both,,,,561,476.85,160.7826,561,Medica,Individual & Family,555.951,99.1,,percent of total billed charges,,
Sup Ez Needle,,A4212,HCPCS,Facility,Outpatient,,,,561,476.85,160.7826,561,Medica,Medica Advantage Solution,279.378,49.8,,percent of total billed charges,,
Sup Ez Needle,,A4212,HCPCS,Facility,Inpatient,,,,561,476.85,160.7826,561,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Sup Ez Needle,,A4212,HCPCS,Facility,Outpatient,,,,561,476.85,160.7826,561,Medica,Medical Assistance,250.206,44.6,,percent of total billed charges,,
Sup Ez Needle,,A4212,HCPCS,Facility,Inpatient,,,,561,476.85,160.7826,561,Medica,Medical Assistance,,,,,Included in per diem rate,
Sup Ez Needle,,A4212,HCPCS,Facility,Outpatient,,,,561,476.85,160.7826,561,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,279.378,49.8,,percent of total billed charges,,
Sup Ez Needle,,A4212,HCPCS,Facility,Inpatient,,,,561,476.85,160.7826,561,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Sup Ez Needle,,A4212,HCPCS,Facility,Both,,,,561,476.85,160.7826,561,"Multiplan, Inc.","Multiplan, Inc.",527.34,94,,percent of total billed charges,,
Sup Ez Needle,,A4212,HCPCS,Facility,Outpatient,,,,561,476.85,160.7826,561,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,505.461,90.1,,percent of total billed charges,,
Sup Ez Needle,,A4212,HCPCS,Facility,Inpatient,,,,561,476.85,160.7826,561,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Sup Ez Needle,,A4212,HCPCS,Facility,Both,,,,561,476.85,160.7826,561,"Preferred One Administrative Services, INC.",PPO,553.146,98.6,,percent of total billed charges,,
Sup Ez Needle,,A4212,HCPCS,Facility,Outpatient,,,,561,476.85,160.7826,561,PrimeWest Health,Minnesota Senior Health Options (MSHO),288.6345,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Sup Ez Needle,,A4212,HCPCS,Facility,Inpatient,,,,561,476.85,160.7826,561,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Ez Needle,,A4212,HCPCS,Facility,Outpatient,,,,561,476.85,160.7826,561,PrimeWest Health,MinnesotaCare,288.1296,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Sup Ez Needle,,A4212,HCPCS,Facility,Inpatient,,,,561,476.85,160.7826,561,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Sup Ez Needle,,A4212,HCPCS,Facility,Both,,,,561,476.85,160.7826,561,Sanford Health Plan,Sanford Health Plan,516.12,92,,percent of total billed charges,,
Sup Ez Needle,,A4212,HCPCS,Facility,Outpatient,,,,561,476.85,160.7826,561,"UCare Health, Inc.",Individual & Family Plan,316.1235,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Sup Ez Needle,,A4212,HCPCS,Facility,Inpatient,,,,561,476.85,160.7826,561,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Sup Ez Needle,,A4212,HCPCS,Facility,Outpatient,,,,561,476.85,160.7826,561,"UCare Health, Inc.",Medical Assistance,283.1367,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Ez Needle,,A4212,HCPCS,Facility,Inpatient,,,,561,476.85,160.7826,561,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Sup Ez Needle,,A4212,HCPCS,Facility,Outpatient,,,,561,476.85,160.7826,561,"UCare Health, Inc.",Medicare Advantage,283.1367,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Ez Needle,,A4212,HCPCS,Facility,Inpatient,,,,561,476.85,160.7826,561,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Ez Needle,,A4212,HCPCS,Facility,Outpatient,,,,561,476.85,160.7826,561,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),283.1367,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Ez Needle,,A4212,HCPCS,Facility,Inpatient,,,,561,476.85,160.7826,561,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Ez Needle,,A4212,HCPCS,Facility,Both,,,,561,476.85,160.7826,561,UnitedHealthcare,Individual & Family,527.34,94,,percent of total billed charges,,
Sup Ez Needle,,A4212,HCPCS,Facility,Outpatient,,,,561,476.85,160.7826,561,UnitedHealthcare,Medicare Advantage,274.89,49,,percent of total billed charges,,
Sup Ez Needle,,A4212,HCPCS,Facility,Inpatient,,,,561,476.85,160.7826,561,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Sup Ez Needle,,A4212,HCPCS,Facility,Outpatient,,,,561,476.85,160.7826,561,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,269.28,48,,percent of total billed charges,,100% of DHS outpatient percentage
Sup Ez Needle,,A4212,HCPCS,Facility,Inpatient,,,,561,476.85,160.7826,561,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Sup Needle Gripper,,A4212,HCPCS,Facility,Both,,,,47,39.95,13.4702,47,Aetna,Commercial,43.24,92,,percent of total billed charges,,
Sup Needle Gripper,,A4212,HCPCS,Facility,Outpatient,,,,47,39.95,13.4702,47,Aetna,Medicare Advantage,23.03,49,,percent of total billed charges,,
Sup Needle Gripper,,A4212,HCPCS,Facility,Inpatient,,,,47,39.95,13.4702,47,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Sup Needle Gripper,,A4212,HCPCS,Facility,Both,,,,47,39.95,13.4702,47,Aetna,PPO,43.71,93,,percent of total billed charges,,
Sup Needle Gripper,,A4212,HCPCS,Facility,Both,,,,47,39.95,13.4702,47,America's PPO,America's PPO,45.1341,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Sup Needle Gripper,,A4212,HCPCS,Facility,Both,,,,47,39.95,13.4702,47,BlueCross BlueShield Minnesota, Federal Employee Program,46.248,98.4,,percent of total billed charges,,
Sup Needle Gripper,,A4212,HCPCS,Facility,Both,,,,47,39.95,13.4702,47,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,47,100,,percent of total billed charges,,
Sup Needle Gripper,,A4212,HCPCS,Facility,Both,,,,47,39.95,13.4702,47,BlueCross BlueShield Minnesota,High Value Network Plan,42.3,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
Sup Needle Gripper,,A4212,HCPCS,Facility,Outpatient,,,,47,39.95,13.4702,47,BlueCross BlueShield Minnesota,Medicare Advantage,23.03,49,,percent of total billed charges,,
Sup Needle Gripper,,A4212,HCPCS,Facility,Inpatient,,,,47,39.95,13.4702,47,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Sup Needle Gripper,,A4212,HCPCS,Facility,Both,,,,47,39.95,13.4702,47,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,41.6279,88.57,,percent of total billed charges,,
Sup Needle Gripper,,A4212,HCPCS,Facility,Both,,,,47,39.95,13.4702,47,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,13.4702,28.66,,percent of total billed charges,,
Sup Needle Gripper,,A4212,HCPCS,Facility,Outpatient,,,,47,39.95,13.4702,47,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),23.03,49,,percent of total billed charges,,
Sup Needle Gripper,,A4212,HCPCS,Facility,Inpatient,,,,47,39.95,13.4702,47,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Sup Needle Gripper,,A4212,HCPCS,Facility,Both,,,,47,39.95,13.4702,47,CorVel,Worker's Compensation,47,100,,percent of total billed charges,,
Sup Needle Gripper,,A4212,HCPCS,Facility,Both,,,,47,39.95,13.4702,47,First Health Group Corporation,First Health Network,45.59,97,,percent of total billed charges,,
Sup Needle Gripper,,A4212,HCPCS,Facility,Both,,,,47,39.95,13.4702,47,"Health Partners, Inc.",Commercial,44.462,94.6,,percent of total billed charges,,
Sup Needle Gripper,,A4212,HCPCS,Facility,Outpatient,,,,47,39.95,13.4702,47,"Health Partners, Inc.",Medicare Advantage,23.03,49,,percent of total billed charges,,
Sup Needle Gripper,,A4212,HCPCS,Facility,Inpatient,,,,47,39.95,13.4702,47,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Needle Gripper,,A4212,HCPCS,Facility,Both,,,,47,39.95,13.4702,47,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),28.2,60,,percent of total billed charges,,
Sup Needle Gripper,,A4212,HCPCS,Facility,Both,,,,47,39.95,13.4702,47,"Health Partners, Inc.",State of Minnesota Advantage Program,38.305,81.5,,percent of total billed charges,,
Sup Needle Gripper,,A4212,HCPCS,Facility,Both,,,,47,39.95,13.4702,47,"Health Partners, Inc.",State Public Programs,23.5,50,,percent of total billed charges,,
Sup Needle Gripper,,A4212,HCPCS,Facility,Both,,,,47,39.95,13.4702,47,Humana Insurance Company,Commercial PPO,44.65,95,,percent of total billed charges,,
Sup Needle Gripper,,A4212,HCPCS,Facility,Outpatient,,,,47,39.95,13.4702,47,Humana Insurance Company,Medicare PPO,23.03,49,,percent of total billed charges,,
Sup Needle Gripper,,A4212,HCPCS,Facility,Inpatient,,,,47,39.95,13.4702,47,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Sup Needle Gripper,,A4212,HCPCS,Facility,Both,,,,47,39.95,13.4702,47,Medica,Individual & Family,46.577,99.1,,percent of total billed charges,,
Sup Needle Gripper,,A4212,HCPCS,Facility,Outpatient,,,,47,39.95,13.4702,47,Medica,Medica Advantage Solution,23.406,49.8,,percent of total billed charges,,
Sup Needle Gripper,,A4212,HCPCS,Facility,Inpatient,,,,47,39.95,13.4702,47,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Sup Needle Gripper,,A4212,HCPCS,Facility,Outpatient,,,,47,39.95,13.4702,47,Medica,Medical Assistance,20.962,44.6,,percent of total billed charges,,
Sup Needle Gripper,,A4212,HCPCS,Facility,Inpatient,,,,47,39.95,13.4702,47,Medica,Medical Assistance,,,,,Included in per diem rate,
Sup Needle Gripper,,A4212,HCPCS,Facility,Outpatient,,,,47,39.95,13.4702,47,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,23.406,49.8,,percent of total billed charges,,
Sup Needle Gripper,,A4212,HCPCS,Facility,Inpatient,,,,47,39.95,13.4702,47,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Sup Needle Gripper,,A4212,HCPCS,Facility,Both,,,,47,39.95,13.4702,47,"Multiplan, Inc.","Multiplan, Inc.",44.18,94,,percent of total billed charges,,
Sup Needle Gripper,,A4212,HCPCS,Facility,Outpatient,,,,47,39.95,13.4702,47,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,42.347,90.1,,percent of total billed charges,,
Sup Needle Gripper,,A4212,HCPCS,Facility,Inpatient,,,,47,39.95,13.4702,47,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Sup Needle Gripper,,A4212,HCPCS,Facility,Both,,,,47,39.95,13.4702,47,"Preferred One Administrative Services, INC.",PPO,46.342,98.6,,percent of total billed charges,,
Sup Needle Gripper,,A4212,HCPCS,Facility,Outpatient,,,,47,39.95,13.4702,47,PrimeWest Health,Minnesota Senior Health Options (MSHO),24.1815,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Sup Needle Gripper,,A4212,HCPCS,Facility,Inpatient,,,,47,39.95,13.4702,47,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Needle Gripper,,A4212,HCPCS,Facility,Outpatient,,,,47,39.95,13.4702,47,PrimeWest Health,MinnesotaCare,24.1392,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Sup Needle Gripper,,A4212,HCPCS,Facility,Inpatient,,,,47,39.95,13.4702,47,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Sup Needle Gripper,,A4212,HCPCS,Facility,Both,,,,47,39.95,13.4702,47,Sanford Health Plan,Sanford Health Plan,43.24,92,,percent of total billed charges,,
Sup Needle Gripper,,A4212,HCPCS,Facility,Outpatient,,,,47,39.95,13.4702,47,"UCare Health, Inc.",Individual & Family Plan,26.4845,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Sup Needle Gripper,,A4212,HCPCS,Facility,Inpatient,,,,47,39.95,13.4702,47,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Sup Needle Gripper,,A4212,HCPCS,Facility,Outpatient,,,,47,39.95,13.4702,47,"UCare Health, Inc.",Medical Assistance,23.7209,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Needle Gripper,,A4212,HCPCS,Facility,Inpatient,,,,47,39.95,13.4702,47,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Sup Needle Gripper,,A4212,HCPCS,Facility,Outpatient,,,,47,39.95,13.4702,47,"UCare Health, Inc.",Medicare Advantage,23.7209,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Needle Gripper,,A4212,HCPCS,Facility,Inpatient,,,,47,39.95,13.4702,47,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Needle Gripper,,A4212,HCPCS,Facility,Outpatient,,,,47,39.95,13.4702,47,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),23.7209,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Needle Gripper,,A4212,HCPCS,Facility,Inpatient,,,,47,39.95,13.4702,47,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Needle Gripper,,A4212,HCPCS,Facility,Both,,,,47,39.95,13.4702,47,UnitedHealthcare,Individual & Family,44.18,94,,percent of total billed charges,,
Sup Needle Gripper,,A4212,HCPCS,Facility,Outpatient,,,,47,39.95,13.4702,47,UnitedHealthcare,Medicare Advantage,23.03,49,,percent of total billed charges,,
Sup Needle Gripper,,A4212,HCPCS,Facility,Inpatient,,,,47,39.95,13.4702,47,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Sup Needle Gripper,,A4212,HCPCS,Facility,Outpatient,,,,47,39.95,13.4702,47,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,22.56,48,,percent of total billed charges,,100% of DHS outpatient percentage
Sup Needle Gripper,,A4212,HCPCS,Facility,Inpatient,,,,47,39.95,13.4702,47,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
BIOPSY NEEDLE MONOPTY 16GA X 9CM  211610,,A4215,HCPCS,Facility,Both,,,,140.88,119.748,40.376208,140.88,Aetna,Commercial,129.6096,92,,percent of total billed charges,,
BIOPSY NEEDLE MONOPTY 16GA X 9CM  211610,,A4215,HCPCS,Facility,Outpatient,,,,140.88,119.748,40.376208,140.88,Aetna,Medicare Advantage,69.0312,49,,percent of total billed charges,,
BIOPSY NEEDLE MONOPTY 16GA X 9CM  211610,,A4215,HCPCS,Facility,Inpatient,,,,140.88,119.748,40.376208,140.88,Aetna,Medicare Advantage,,,,,Included in per diem rate,
BIOPSY NEEDLE MONOPTY 16GA X 9CM  211610,,A4215,HCPCS,Facility,Both,,,,140.88,119.748,40.376208,140.88,Aetna,PPO,131.0184,93,,percent of total billed charges,,
BIOPSY NEEDLE MONOPTY 16GA X 9CM  211610,,A4215,HCPCS,Facility,Both,,,,140.88,119.748,40.376208,140.88,America's PPO,America's PPO,135.287064,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
BIOPSY NEEDLE MONOPTY 16GA X 9CM  211610,,A4215,HCPCS,Facility,Both,,,,140.88,119.748,40.376208,140.88,BlueCross BlueShield Minnesota, Federal Employee Program,138.62592,98.4,,percent of total billed charges,,
BIOPSY NEEDLE MONOPTY 16GA X 9CM  211610,,A4215,HCPCS,Facility,Both,,,,140.88,119.748,40.376208,140.88,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,140.88,100,,percent of total billed charges,,
BIOPSY NEEDLE MONOPTY 16GA X 9CM  211610,,A4215,HCPCS,Facility,Both,,,,140.88,119.748,40.376208,140.88,BlueCross BlueShield Minnesota,High Value Network Plan,126.792,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
BIOPSY NEEDLE MONOPTY 16GA X 9CM  211610,,A4215,HCPCS,Facility,Outpatient,,,,140.88,119.748,40.376208,140.88,BlueCross BlueShield Minnesota,Medicare Advantage,69.0312,49,,percent of total billed charges,,
BIOPSY NEEDLE MONOPTY 16GA X 9CM  211610,,A4215,HCPCS,Facility,Inpatient,,,,140.88,119.748,40.376208,140.88,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
BIOPSY NEEDLE MONOPTY 16GA X 9CM  211610,,A4215,HCPCS,Facility,Both,,,,140.88,119.748,40.376208,140.88,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,124.777416,88.57,,percent of total billed charges,,
BIOPSY NEEDLE MONOPTY 16GA X 9CM  211610,,A4215,HCPCS,Facility,Both,,,,140.88,119.748,40.376208,140.88,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,40.376208,28.66,,percent of total billed charges,,
BIOPSY NEEDLE MONOPTY 16GA X 9CM  211610,,A4215,HCPCS,Facility,Outpatient,,,,140.88,119.748,40.376208,140.88,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),69.0312,49,,percent of total billed charges,,
BIOPSY NEEDLE MONOPTY 16GA X 9CM  211610,,A4215,HCPCS,Facility,Inpatient,,,,140.88,119.748,40.376208,140.88,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
BIOPSY NEEDLE MONOPTY 16GA X 9CM  211610,,A4215,HCPCS,Facility,Both,,,,140.88,119.748,40.376208,140.88,CorVel,Worker's Compensation,140.88,100,,percent of total billed charges,,
BIOPSY NEEDLE MONOPTY 16GA X 9CM  211610,,A4215,HCPCS,Facility,Both,,,,140.88,119.748,40.376208,140.88,First Health Group Corporation,First Health Network,136.6536,97,,percent of total billed charges,,
BIOPSY NEEDLE MONOPTY 16GA X 9CM  211610,,A4215,HCPCS,Facility,Both,,,,140.88,119.748,40.376208,140.88,"Health Partners, Inc.",Commercial,133.27248,94.6,,percent of total billed charges,,
BIOPSY NEEDLE MONOPTY 16GA X 9CM  211610,,A4215,HCPCS,Facility,Outpatient,,,,140.88,119.748,40.376208,140.88,"Health Partners, Inc.",Medicare Advantage,69.0312,49,,percent of total billed charges,,
BIOPSY NEEDLE MONOPTY 16GA X 9CM  211610,,A4215,HCPCS,Facility,Inpatient,,,,140.88,119.748,40.376208,140.88,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
BIOPSY NEEDLE MONOPTY 16GA X 9CM  211610,,A4215,HCPCS,Facility,Both,,,,140.88,119.748,40.376208,140.88,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),84.528,60,,percent of total billed charges,,
BIOPSY NEEDLE MONOPTY 16GA X 9CM  211610,,A4215,HCPCS,Facility,Both,,,,140.88,119.748,40.376208,140.88,"Health Partners, Inc.",State of Minnesota Advantage Program,114.8172,81.5,,percent of total billed charges,,
BIOPSY NEEDLE MONOPTY 16GA X 9CM  211610,,A4215,HCPCS,Facility,Both,,,,140.88,119.748,40.376208,140.88,"Health Partners, Inc.",State Public Programs,70.44,50,,percent of total billed charges,,
BIOPSY NEEDLE MONOPTY 16GA X 9CM  211610,,A4215,HCPCS,Facility,Both,,,,140.88,119.748,40.376208,140.88,Humana Insurance Company,Commercial PPO,133.836,95,,percent of total billed charges,,
BIOPSY NEEDLE MONOPTY 16GA X 9CM  211610,,A4215,HCPCS,Facility,Outpatient,,,,140.88,119.748,40.376208,140.88,Humana Insurance Company,Medicare PPO,69.0312,49,,percent of total billed charges,,
BIOPSY NEEDLE MONOPTY 16GA X 9CM  211610,,A4215,HCPCS,Facility,Inpatient,,,,140.88,119.748,40.376208,140.88,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
BIOPSY NEEDLE MONOPTY 16GA X 9CM  211610,,A4215,HCPCS,Facility,Both,,,,140.88,119.748,40.376208,140.88,Medica,Individual & Family,139.61208,99.1,,percent of total billed charges,,
BIOPSY NEEDLE MONOPTY 16GA X 9CM  211610,,A4215,HCPCS,Facility,Outpatient,,,,140.88,119.748,40.376208,140.88,Medica,Medica Advantage Solution,70.15824,49.8,,percent of total billed charges,,
BIOPSY NEEDLE MONOPTY 16GA X 9CM  211610,,A4215,HCPCS,Facility,Inpatient,,,,140.88,119.748,40.376208,140.88,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
BIOPSY NEEDLE MONOPTY 16GA X 9CM  211610,,A4215,HCPCS,Facility,Outpatient,,,,140.88,119.748,40.376208,140.88,Medica,Medical Assistance,62.83248,44.6,,percent of total billed charges,,
BIOPSY NEEDLE MONOPTY 16GA X 9CM  211610,,A4215,HCPCS,Facility,Inpatient,,,,140.88,119.748,40.376208,140.88,Medica,Medical Assistance,,,,,Included in per diem rate,
BIOPSY NEEDLE MONOPTY 16GA X 9CM  211610,,A4215,HCPCS,Facility,Outpatient,,,,140.88,119.748,40.376208,140.88,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,70.15824,49.8,,percent of total billed charges,,
BIOPSY NEEDLE MONOPTY 16GA X 9CM  211610,,A4215,HCPCS,Facility,Inpatient,,,,140.88,119.748,40.376208,140.88,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
BIOPSY NEEDLE MONOPTY 16GA X 9CM  211610,,A4215,HCPCS,Facility,Both,,,,140.88,119.748,40.376208,140.88,"Multiplan, Inc.","Multiplan, Inc.",132.4272,94,,percent of total billed charges,,
BIOPSY NEEDLE MONOPTY 16GA X 9CM  211610,,A4215,HCPCS,Facility,Outpatient,,,,140.88,119.748,40.376208,140.88,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,126.93288,90.1,,percent of total billed charges,,
BIOPSY NEEDLE MONOPTY 16GA X 9CM  211610,,A4215,HCPCS,Facility,Inpatient,,,,140.88,119.748,40.376208,140.88,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
BIOPSY NEEDLE MONOPTY 16GA X 9CM  211610,,A4215,HCPCS,Facility,Both,,,,140.88,119.748,40.376208,140.88,"Preferred One Administrative Services, INC.",PPO,138.90768,98.6,,percent of total billed charges,,
BIOPSY NEEDLE MONOPTY 16GA X 9CM  211610,,A4215,HCPCS,Facility,Outpatient,,,,140.88,119.748,40.376208,140.88,PrimeWest Health,Minnesota Senior Health Options (MSHO),72.48276,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
BIOPSY NEEDLE MONOPTY 16GA X 9CM  211610,,A4215,HCPCS,Facility,Inpatient,,,,140.88,119.748,40.376208,140.88,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
BIOPSY NEEDLE MONOPTY 16GA X 9CM  211610,,A4215,HCPCS,Facility,Outpatient,,,,140.88,119.748,40.376208,140.88,PrimeWest Health,MinnesotaCare,72.355968,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
BIOPSY NEEDLE MONOPTY 16GA X 9CM  211610,,A4215,HCPCS,Facility,Inpatient,,,,140.88,119.748,40.376208,140.88,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
BIOPSY NEEDLE MONOPTY 16GA X 9CM  211610,,A4215,HCPCS,Facility,Both,,,,140.88,119.748,40.376208,140.88,Sanford Health Plan,Sanford Health Plan,129.6096,92,,percent of total billed charges,,
BIOPSY NEEDLE MONOPTY 16GA X 9CM  211610,,A4215,HCPCS,Facility,Outpatient,,,,140.88,119.748,40.376208,140.88,"UCare Health, Inc.",Individual & Family Plan,79.38588,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
BIOPSY NEEDLE MONOPTY 16GA X 9CM  211610,,A4215,HCPCS,Facility,Inpatient,,,,140.88,119.748,40.376208,140.88,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
BIOPSY NEEDLE MONOPTY 16GA X 9CM  211610,,A4215,HCPCS,Facility,Outpatient,,,,140.88,119.748,40.376208,140.88,"UCare Health, Inc.",Medical Assistance,71.102136,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BIOPSY NEEDLE MONOPTY 16GA X 9CM  211610,,A4215,HCPCS,Facility,Inpatient,,,,140.88,119.748,40.376208,140.88,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
BIOPSY NEEDLE MONOPTY 16GA X 9CM  211610,,A4215,HCPCS,Facility,Outpatient,,,,140.88,119.748,40.376208,140.88,"UCare Health, Inc.",Medicare Advantage,71.102136,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BIOPSY NEEDLE MONOPTY 16GA X 9CM  211610,,A4215,HCPCS,Facility,Inpatient,,,,140.88,119.748,40.376208,140.88,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
BIOPSY NEEDLE MONOPTY 16GA X 9CM  211610,,A4215,HCPCS,Facility,Outpatient,,,,140.88,119.748,40.376208,140.88,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),71.102136,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BIOPSY NEEDLE MONOPTY 16GA X 9CM  211610,,A4215,HCPCS,Facility,Inpatient,,,,140.88,119.748,40.376208,140.88,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
BIOPSY NEEDLE MONOPTY 16GA X 9CM  211610,,A4215,HCPCS,Facility,Both,,,,140.88,119.748,40.376208,140.88,UnitedHealthcare,Individual & Family,132.4272,94,,percent of total billed charges,,
BIOPSY NEEDLE MONOPTY 16GA X 9CM  211610,,A4215,HCPCS,Facility,Outpatient,,,,140.88,119.748,40.376208,140.88,UnitedHealthcare,Medicare Advantage,69.0312,49,,percent of total billed charges,,
BIOPSY NEEDLE MONOPTY 16GA X 9CM  211610,,A4215,HCPCS,Facility,Inpatient,,,,140.88,119.748,40.376208,140.88,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
BIOPSY NEEDLE MONOPTY 16GA X 9CM  211610,,A4215,HCPCS,Facility,Outpatient,,,,140.88,119.748,40.376208,140.88,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,67.6224,48,,percent of total billed charges,,100% of DHS outpatient percentage
BIOPSY NEEDLE MONOPTY 16GA X 9CM  211610,,A4215,HCPCS,Facility,Inpatient,,,,140.88,119.748,40.376208,140.88,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
CATHETER CHOLANGIOGRAM PREVIEW CC019,,A4215,HCPCS,Facility,Both,,,,236.25,200.8125,67.70925,236.25,Aetna,Commercial,217.35,92,,percent of total billed charges,,
CATHETER CHOLANGIOGRAM PREVIEW CC019,,A4215,HCPCS,Facility,Outpatient,,,,236.25,200.8125,67.70925,236.25,Aetna,Medicare Advantage,115.7625,49,,percent of total billed charges,,
CATHETER CHOLANGIOGRAM PREVIEW CC019,,A4215,HCPCS,Facility,Inpatient,,,,236.25,200.8125,67.70925,236.25,Aetna,Medicare Advantage,,,,,Included in per diem rate,
CATHETER CHOLANGIOGRAM PREVIEW CC019,,A4215,HCPCS,Facility,Both,,,,236.25,200.8125,67.70925,236.25,Aetna,PPO,219.7125,93,,percent of total billed charges,,
CATHETER CHOLANGIOGRAM PREVIEW CC019,,A4215,HCPCS,Facility,Both,,,,236.25,200.8125,67.70925,236.25,America's PPO,America's PPO,226.870875,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
CATHETER CHOLANGIOGRAM PREVIEW CC019,,A4215,HCPCS,Facility,Both,,,,236.25,200.8125,67.70925,236.25,BlueCross BlueShield Minnesota, Federal Employee Program,232.47,98.4,,percent of total billed charges,,
CATHETER CHOLANGIOGRAM PREVIEW CC019,,A4215,HCPCS,Facility,Both,,,,236.25,200.8125,67.70925,236.25,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,236.25,100,,percent of total billed charges,,
CATHETER CHOLANGIOGRAM PREVIEW CC019,,A4215,HCPCS,Facility,Both,,,,236.25,200.8125,67.70925,236.25,BlueCross BlueShield Minnesota,High Value Network Plan,212.625,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
CATHETER CHOLANGIOGRAM PREVIEW CC019,,A4215,HCPCS,Facility,Outpatient,,,,236.25,200.8125,67.70925,236.25,BlueCross BlueShield Minnesota,Medicare Advantage,115.7625,49,,percent of total billed charges,,
CATHETER CHOLANGIOGRAM PREVIEW CC019,,A4215,HCPCS,Facility,Inpatient,,,,236.25,200.8125,67.70925,236.25,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
CATHETER CHOLANGIOGRAM PREVIEW CC019,,A4215,HCPCS,Facility,Both,,,,236.25,200.8125,67.70925,236.25,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,209.246625,88.57,,percent of total billed charges,,
CATHETER CHOLANGIOGRAM PREVIEW CC019,,A4215,HCPCS,Facility,Both,,,,236.25,200.8125,67.70925,236.25,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,67.70925,28.66,,percent of total billed charges,,
CATHETER CHOLANGIOGRAM PREVIEW CC019,,A4215,HCPCS,Facility,Outpatient,,,,236.25,200.8125,67.70925,236.25,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),115.7625,49,,percent of total billed charges,,
CATHETER CHOLANGIOGRAM PREVIEW CC019,,A4215,HCPCS,Facility,Inpatient,,,,236.25,200.8125,67.70925,236.25,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
CATHETER CHOLANGIOGRAM PREVIEW CC019,,A4215,HCPCS,Facility,Both,,,,236.25,200.8125,67.70925,236.25,CorVel,Worker's Compensation,236.25,100,,percent of total billed charges,,
CATHETER CHOLANGIOGRAM PREVIEW CC019,,A4215,HCPCS,Facility,Both,,,,236.25,200.8125,67.70925,236.25,First Health Group Corporation,First Health Network,229.1625,97,,percent of total billed charges,,
CATHETER CHOLANGIOGRAM PREVIEW CC019,,A4215,HCPCS,Facility,Both,,,,236.25,200.8125,67.70925,236.25,"Health Partners, Inc.",Commercial,223.4925,94.6,,percent of total billed charges,,
CATHETER CHOLANGIOGRAM PREVIEW CC019,,A4215,HCPCS,Facility,Outpatient,,,,236.25,200.8125,67.70925,236.25,"Health Partners, Inc.",Medicare Advantage,115.7625,49,,percent of total billed charges,,
CATHETER CHOLANGIOGRAM PREVIEW CC019,,A4215,HCPCS,Facility,Inpatient,,,,236.25,200.8125,67.70925,236.25,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CATHETER CHOLANGIOGRAM PREVIEW CC019,,A4215,HCPCS,Facility,Both,,,,236.25,200.8125,67.70925,236.25,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),141.75,60,,percent of total billed charges,,
CATHETER CHOLANGIOGRAM PREVIEW CC019,,A4215,HCPCS,Facility,Both,,,,236.25,200.8125,67.70925,236.25,"Health Partners, Inc.",State of Minnesota Advantage Program,192.54375,81.5,,percent of total billed charges,,
CATHETER CHOLANGIOGRAM PREVIEW CC019,,A4215,HCPCS,Facility,Both,,,,236.25,200.8125,67.70925,236.25,"Health Partners, Inc.",State Public Programs,118.125,50,,percent of total billed charges,,
CATHETER CHOLANGIOGRAM PREVIEW CC019,,A4215,HCPCS,Facility,Both,,,,236.25,200.8125,67.70925,236.25,Humana Insurance Company,Commercial PPO,224.4375,95,,percent of total billed charges,,
CATHETER CHOLANGIOGRAM PREVIEW CC019,,A4215,HCPCS,Facility,Outpatient,,,,236.25,200.8125,67.70925,236.25,Humana Insurance Company,Medicare PPO,115.7625,49,,percent of total billed charges,,
CATHETER CHOLANGIOGRAM PREVIEW CC019,,A4215,HCPCS,Facility,Inpatient,,,,236.25,200.8125,67.70925,236.25,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
CATHETER CHOLANGIOGRAM PREVIEW CC019,,A4215,HCPCS,Facility,Both,,,,236.25,200.8125,67.70925,236.25,Medica,Individual & Family,234.12375,99.1,,percent of total billed charges,,
CATHETER CHOLANGIOGRAM PREVIEW CC019,,A4215,HCPCS,Facility,Outpatient,,,,236.25,200.8125,67.70925,236.25,Medica,Medica Advantage Solution,117.6525,49.8,,percent of total billed charges,,
CATHETER CHOLANGIOGRAM PREVIEW CC019,,A4215,HCPCS,Facility,Inpatient,,,,236.25,200.8125,67.70925,236.25,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
CATHETER CHOLANGIOGRAM PREVIEW CC019,,A4215,HCPCS,Facility,Outpatient,,,,236.25,200.8125,67.70925,236.25,Medica,Medical Assistance,105.3675,44.6,,percent of total billed charges,,
CATHETER CHOLANGIOGRAM PREVIEW CC019,,A4215,HCPCS,Facility,Inpatient,,,,236.25,200.8125,67.70925,236.25,Medica,Medical Assistance,,,,,Included in per diem rate,
CATHETER CHOLANGIOGRAM PREVIEW CC019,,A4215,HCPCS,Facility,Outpatient,,,,236.25,200.8125,67.70925,236.25,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,117.6525,49.8,,percent of total billed charges,,
CATHETER CHOLANGIOGRAM PREVIEW CC019,,A4215,HCPCS,Facility,Inpatient,,,,236.25,200.8125,67.70925,236.25,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
CATHETER CHOLANGIOGRAM PREVIEW CC019,,A4215,HCPCS,Facility,Both,,,,236.25,200.8125,67.70925,236.25,"Multiplan, Inc.","Multiplan, Inc.",222.075,94,,percent of total billed charges,,
CATHETER CHOLANGIOGRAM PREVIEW CC019,,A4215,HCPCS,Facility,Outpatient,,,,236.25,200.8125,67.70925,236.25,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,212.86125,90.1,,percent of total billed charges,,
CATHETER CHOLANGIOGRAM PREVIEW CC019,,A4215,HCPCS,Facility,Inpatient,,,,236.25,200.8125,67.70925,236.25,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
CATHETER CHOLANGIOGRAM PREVIEW CC019,,A4215,HCPCS,Facility,Both,,,,236.25,200.8125,67.70925,236.25,"Preferred One Administrative Services, INC.",PPO,232.9425,98.6,,percent of total billed charges,,
CATHETER CHOLANGIOGRAM PREVIEW CC019,,A4215,HCPCS,Facility,Outpatient,,,,236.25,200.8125,67.70925,236.25,PrimeWest Health,Minnesota Senior Health Options (MSHO),121.550625,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
CATHETER CHOLANGIOGRAM PREVIEW CC019,,A4215,HCPCS,Facility,Inpatient,,,,236.25,200.8125,67.70925,236.25,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CATHETER CHOLANGIOGRAM PREVIEW CC019,,A4215,HCPCS,Facility,Outpatient,,,,236.25,200.8125,67.70925,236.25,PrimeWest Health,MinnesotaCare,121.338,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
CATHETER CHOLANGIOGRAM PREVIEW CC019,,A4215,HCPCS,Facility,Inpatient,,,,236.25,200.8125,67.70925,236.25,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
CATHETER CHOLANGIOGRAM PREVIEW CC019,,A4215,HCPCS,Facility,Both,,,,236.25,200.8125,67.70925,236.25,Sanford Health Plan,Sanford Health Plan,217.35,92,,percent of total billed charges,,
CATHETER CHOLANGIOGRAM PREVIEW CC019,,A4215,HCPCS,Facility,Outpatient,,,,236.25,200.8125,67.70925,236.25,"UCare Health, Inc.",Individual & Family Plan,133.126875,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
CATHETER CHOLANGIOGRAM PREVIEW CC019,,A4215,HCPCS,Facility,Inpatient,,,,236.25,200.8125,67.70925,236.25,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
CATHETER CHOLANGIOGRAM PREVIEW CC019,,A4215,HCPCS,Facility,Outpatient,,,,236.25,200.8125,67.70925,236.25,"UCare Health, Inc.",Medical Assistance,119.235375,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CATHETER CHOLANGIOGRAM PREVIEW CC019,,A4215,HCPCS,Facility,Inpatient,,,,236.25,200.8125,67.70925,236.25,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
CATHETER CHOLANGIOGRAM PREVIEW CC019,,A4215,HCPCS,Facility,Outpatient,,,,236.25,200.8125,67.70925,236.25,"UCare Health, Inc.",Medicare Advantage,119.235375,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CATHETER CHOLANGIOGRAM PREVIEW CC019,,A4215,HCPCS,Facility,Inpatient,,,,236.25,200.8125,67.70925,236.25,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CATHETER CHOLANGIOGRAM PREVIEW CC019,,A4215,HCPCS,Facility,Outpatient,,,,236.25,200.8125,67.70925,236.25,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),119.235375,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CATHETER CHOLANGIOGRAM PREVIEW CC019,,A4215,HCPCS,Facility,Inpatient,,,,236.25,200.8125,67.70925,236.25,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CATHETER CHOLANGIOGRAM PREVIEW CC019,,A4215,HCPCS,Facility,Both,,,,236.25,200.8125,67.70925,236.25,UnitedHealthcare,Individual & Family,222.075,94,,percent of total billed charges,,
CATHETER CHOLANGIOGRAM PREVIEW CC019,,A4215,HCPCS,Facility,Outpatient,,,,236.25,200.8125,67.70925,236.25,UnitedHealthcare,Medicare Advantage,115.7625,49,,percent of total billed charges,,
CATHETER CHOLANGIOGRAM PREVIEW CC019,,A4215,HCPCS,Facility,Inpatient,,,,236.25,200.8125,67.70925,236.25,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
CATHETER CHOLANGIOGRAM PREVIEW CC019,,A4215,HCPCS,Facility,Outpatient,,,,236.25,200.8125,67.70925,236.25,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,113.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
CATHETER CHOLANGIOGRAM PREVIEW CC019,,A4215,HCPCS,Facility,Inpatient,,,,236.25,200.8125,67.70925,236.25,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"DELIVERY NEEDLE, 8GX11CM, CLOSED TIP",,A4215,HCPCS,Facility,Both,,,,805,684.25,230.713,805,Aetna,Commercial,740.6,92,,percent of total billed charges,,
"DELIVERY NEEDLE, 8GX11CM, CLOSED TIP",,A4215,HCPCS,Facility,Outpatient,,,,805,684.25,230.713,805,Aetna,Medicare Advantage,394.45,49,,percent of total billed charges,,
"DELIVERY NEEDLE, 8GX11CM, CLOSED TIP",,A4215,HCPCS,Facility,Inpatient,,,,805,684.25,230.713,805,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"DELIVERY NEEDLE, 8GX11CM, CLOSED TIP",,A4215,HCPCS,Facility,Both,,,,805,684.25,230.713,805,Aetna,PPO,748.65,93,,percent of total billed charges,,
"DELIVERY NEEDLE, 8GX11CM, CLOSED TIP",,A4215,HCPCS,Facility,Both,,,,805,684.25,230.713,805,America's PPO,America's PPO,773.0415,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"DELIVERY NEEDLE, 8GX11CM, CLOSED TIP",,A4215,HCPCS,Facility,Both,,,,805,684.25,230.713,805,BlueCross BlueShield Minnesota, Federal Employee Program,792.12,98.4,,percent of total billed charges,,
"DELIVERY NEEDLE, 8GX11CM, CLOSED TIP",,A4215,HCPCS,Facility,Both,,,,805,684.25,230.713,805,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,805,100,,percent of total billed charges,,
"DELIVERY NEEDLE, 8GX11CM, CLOSED TIP",,A4215,HCPCS,Facility,Both,,,,805,684.25,230.713,805,BlueCross BlueShield Minnesota,High Value Network Plan,724.5,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
"DELIVERY NEEDLE, 8GX11CM, CLOSED TIP",,A4215,HCPCS,Facility,Outpatient,,,,805,684.25,230.713,805,BlueCross BlueShield Minnesota,Medicare Advantage,394.45,49,,percent of total billed charges,,
"DELIVERY NEEDLE, 8GX11CM, CLOSED TIP",,A4215,HCPCS,Facility,Inpatient,,,,805,684.25,230.713,805,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"DELIVERY NEEDLE, 8GX11CM, CLOSED TIP",,A4215,HCPCS,Facility,Both,,,,805,684.25,230.713,805,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,712.9885,88.57,,percent of total billed charges,,
"DELIVERY NEEDLE, 8GX11CM, CLOSED TIP",,A4215,HCPCS,Facility,Both,,,,805,684.25,230.713,805,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,230.713,28.66,,percent of total billed charges,,
"DELIVERY NEEDLE, 8GX11CM, CLOSED TIP",,A4215,HCPCS,Facility,Outpatient,,,,805,684.25,230.713,805,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),394.45,49,,percent of total billed charges,,
"DELIVERY NEEDLE, 8GX11CM, CLOSED TIP",,A4215,HCPCS,Facility,Inpatient,,,,805,684.25,230.713,805,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"DELIVERY NEEDLE, 8GX11CM, CLOSED TIP",,A4215,HCPCS,Facility,Both,,,,805,684.25,230.713,805,CorVel,Worker's Compensation,805,100,,percent of total billed charges,,
"DELIVERY NEEDLE, 8GX11CM, CLOSED TIP",,A4215,HCPCS,Facility,Both,,,,805,684.25,230.713,805,First Health Group Corporation,First Health Network,780.85,97,,percent of total billed charges,,
"DELIVERY NEEDLE, 8GX11CM, CLOSED TIP",,A4215,HCPCS,Facility,Both,,,,805,684.25,230.713,805,"Health Partners, Inc.",Commercial,761.53,94.6,,percent of total billed charges,,
"DELIVERY NEEDLE, 8GX11CM, CLOSED TIP",,A4215,HCPCS,Facility,Outpatient,,,,805,684.25,230.713,805,"Health Partners, Inc.",Medicare Advantage,394.45,49,,percent of total billed charges,,
"DELIVERY NEEDLE, 8GX11CM, CLOSED TIP",,A4215,HCPCS,Facility,Inpatient,,,,805,684.25,230.713,805,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"DELIVERY NEEDLE, 8GX11CM, CLOSED TIP",,A4215,HCPCS,Facility,Both,,,,805,684.25,230.713,805,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),483,60,,percent of total billed charges,,
"DELIVERY NEEDLE, 8GX11CM, CLOSED TIP",,A4215,HCPCS,Facility,Both,,,,805,684.25,230.713,805,"Health Partners, Inc.",State of Minnesota Advantage Program,656.075,81.5,,percent of total billed charges,,
"DELIVERY NEEDLE, 8GX11CM, CLOSED TIP",,A4215,HCPCS,Facility,Both,,,,805,684.25,230.713,805,"Health Partners, Inc.",State Public Programs,402.5,50,,percent of total billed charges,,
"DELIVERY NEEDLE, 8GX11CM, CLOSED TIP",,A4215,HCPCS,Facility,Both,,,,805,684.25,230.713,805,Humana Insurance Company,Commercial PPO,764.75,95,,percent of total billed charges,,
"DELIVERY NEEDLE, 8GX11CM, CLOSED TIP",,A4215,HCPCS,Facility,Outpatient,,,,805,684.25,230.713,805,Humana Insurance Company,Medicare PPO,394.45,49,,percent of total billed charges,,
"DELIVERY NEEDLE, 8GX11CM, CLOSED TIP",,A4215,HCPCS,Facility,Inpatient,,,,805,684.25,230.713,805,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"DELIVERY NEEDLE, 8GX11CM, CLOSED TIP",,A4215,HCPCS,Facility,Both,,,,805,684.25,230.713,805,Medica,Individual & Family,797.755,99.1,,percent of total billed charges,,
"DELIVERY NEEDLE, 8GX11CM, CLOSED TIP",,A4215,HCPCS,Facility,Outpatient,,,,805,684.25,230.713,805,Medica,Medica Advantage Solution,400.89,49.8,,percent of total billed charges,,
"DELIVERY NEEDLE, 8GX11CM, CLOSED TIP",,A4215,HCPCS,Facility,Inpatient,,,,805,684.25,230.713,805,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"DELIVERY NEEDLE, 8GX11CM, CLOSED TIP",,A4215,HCPCS,Facility,Outpatient,,,,805,684.25,230.713,805,Medica,Medical Assistance,359.03,44.6,,percent of total billed charges,,
"DELIVERY NEEDLE, 8GX11CM, CLOSED TIP",,A4215,HCPCS,Facility,Inpatient,,,,805,684.25,230.713,805,Medica,Medical Assistance,,,,,Included in per diem rate,
"DELIVERY NEEDLE, 8GX11CM, CLOSED TIP",,A4215,HCPCS,Facility,Outpatient,,,,805,684.25,230.713,805,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,400.89,49.8,,percent of total billed charges,,
"DELIVERY NEEDLE, 8GX11CM, CLOSED TIP",,A4215,HCPCS,Facility,Inpatient,,,,805,684.25,230.713,805,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"DELIVERY NEEDLE, 8GX11CM, CLOSED TIP",,A4215,HCPCS,Facility,Both,,,,805,684.25,230.713,805,"Multiplan, Inc.","Multiplan, Inc.",756.7,94,,percent of total billed charges,,
"DELIVERY NEEDLE, 8GX11CM, CLOSED TIP",,A4215,HCPCS,Facility,Outpatient,,,,805,684.25,230.713,805,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,725.305,90.1,,percent of total billed charges,,
"DELIVERY NEEDLE, 8GX11CM, CLOSED TIP",,A4215,HCPCS,Facility,Inpatient,,,,805,684.25,230.713,805,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"DELIVERY NEEDLE, 8GX11CM, CLOSED TIP",,A4215,HCPCS,Facility,Both,,,,805,684.25,230.713,805,"Preferred One Administrative Services, INC.",PPO,793.73,98.6,,percent of total billed charges,,
"DELIVERY NEEDLE, 8GX11CM, CLOSED TIP",,A4215,HCPCS,Facility,Outpatient,,,,805,684.25,230.713,805,PrimeWest Health,Minnesota Senior Health Options (MSHO),414.1725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"DELIVERY NEEDLE, 8GX11CM, CLOSED TIP",,A4215,HCPCS,Facility,Inpatient,,,,805,684.25,230.713,805,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"DELIVERY NEEDLE, 8GX11CM, CLOSED TIP",,A4215,HCPCS,Facility,Outpatient,,,,805,684.25,230.713,805,PrimeWest Health,MinnesotaCare,413.448,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"DELIVERY NEEDLE, 8GX11CM, CLOSED TIP",,A4215,HCPCS,Facility,Inpatient,,,,805,684.25,230.713,805,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"DELIVERY NEEDLE, 8GX11CM, CLOSED TIP",,A4215,HCPCS,Facility,Both,,,,805,684.25,230.713,805,Sanford Health Plan,Sanford Health Plan,740.6,92,,percent of total billed charges,,
"DELIVERY NEEDLE, 8GX11CM, CLOSED TIP",,A4215,HCPCS,Facility,Outpatient,,,,805,684.25,230.713,805,"UCare Health, Inc.",Individual & Family Plan,453.6175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"DELIVERY NEEDLE, 8GX11CM, CLOSED TIP",,A4215,HCPCS,Facility,Inpatient,,,,805,684.25,230.713,805,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"DELIVERY NEEDLE, 8GX11CM, CLOSED TIP",,A4215,HCPCS,Facility,Outpatient,,,,805,684.25,230.713,805,"UCare Health, Inc.",Medical Assistance,406.2835,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"DELIVERY NEEDLE, 8GX11CM, CLOSED TIP",,A4215,HCPCS,Facility,Inpatient,,,,805,684.25,230.713,805,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"DELIVERY NEEDLE, 8GX11CM, CLOSED TIP",,A4215,HCPCS,Facility,Outpatient,,,,805,684.25,230.713,805,"UCare Health, Inc.",Medicare Advantage,406.2835,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"DELIVERY NEEDLE, 8GX11CM, CLOSED TIP",,A4215,HCPCS,Facility,Inpatient,,,,805,684.25,230.713,805,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"DELIVERY NEEDLE, 8GX11CM, CLOSED TIP",,A4215,HCPCS,Facility,Outpatient,,,,805,684.25,230.713,805,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),406.2835,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"DELIVERY NEEDLE, 8GX11CM, CLOSED TIP",,A4215,HCPCS,Facility,Inpatient,,,,805,684.25,230.713,805,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"DELIVERY NEEDLE, 8GX11CM, CLOSED TIP",,A4215,HCPCS,Facility,Both,,,,805,684.25,230.713,805,UnitedHealthcare,Individual & Family,756.7,94,,percent of total billed charges,,
"DELIVERY NEEDLE, 8GX11CM, CLOSED TIP",,A4215,HCPCS,Facility,Outpatient,,,,805,684.25,230.713,805,UnitedHealthcare,Medicare Advantage,394.45,49,,percent of total billed charges,,
"DELIVERY NEEDLE, 8GX11CM, CLOSED TIP",,A4215,HCPCS,Facility,Inpatient,,,,805,684.25,230.713,805,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"DELIVERY NEEDLE, 8GX11CM, CLOSED TIP",,A4215,HCPCS,Facility,Outpatient,,,,805,684.25,230.713,805,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,386.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
"DELIVERY NEEDLE, 8GX11CM, CLOSED TIP",,A4215,HCPCS,Facility,Inpatient,,,,805,684.25,230.713,805,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
KUMAR NEEDLE,,A4215,HCPCS,Facility,Both,,,,236.25,200.8125,67.70925,236.25,Aetna,Commercial,217.35,92,,percent of total billed charges,,
KUMAR NEEDLE,,A4215,HCPCS,Facility,Outpatient,,,,236.25,200.8125,67.70925,236.25,Aetna,Medicare Advantage,115.7625,49,,percent of total billed charges,,
KUMAR NEEDLE,,A4215,HCPCS,Facility,Inpatient,,,,236.25,200.8125,67.70925,236.25,Aetna,Medicare Advantage,,,,,Included in per diem rate,
KUMAR NEEDLE,,A4215,HCPCS,Facility,Both,,,,236.25,200.8125,67.70925,236.25,Aetna,PPO,219.7125,93,,percent of total billed charges,,
KUMAR NEEDLE,,A4215,HCPCS,Facility,Both,,,,236.25,200.8125,67.70925,236.25,America's PPO,America's PPO,226.870875,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
KUMAR NEEDLE,,A4215,HCPCS,Facility,Both,,,,236.25,200.8125,67.70925,236.25,BlueCross BlueShield Minnesota, Federal Employee Program,232.47,98.4,,percent of total billed charges,,
KUMAR NEEDLE,,A4215,HCPCS,Facility,Both,,,,236.25,200.8125,67.70925,236.25,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,236.25,100,,percent of total billed charges,,
KUMAR NEEDLE,,A4215,HCPCS,Facility,Both,,,,236.25,200.8125,67.70925,236.25,BlueCross BlueShield Minnesota,High Value Network Plan,212.625,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
KUMAR NEEDLE,,A4215,HCPCS,Facility,Outpatient,,,,236.25,200.8125,67.70925,236.25,BlueCross BlueShield Minnesota,Medicare Advantage,115.7625,49,,percent of total billed charges,,
KUMAR NEEDLE,,A4215,HCPCS,Facility,Inpatient,,,,236.25,200.8125,67.70925,236.25,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
KUMAR NEEDLE,,A4215,HCPCS,Facility,Both,,,,236.25,200.8125,67.70925,236.25,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,209.246625,88.57,,percent of total billed charges,,
KUMAR NEEDLE,,A4215,HCPCS,Facility,Both,,,,236.25,200.8125,67.70925,236.25,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,67.70925,28.66,,percent of total billed charges,,
KUMAR NEEDLE,,A4215,HCPCS,Facility,Outpatient,,,,236.25,200.8125,67.70925,236.25,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),115.7625,49,,percent of total billed charges,,
KUMAR NEEDLE,,A4215,HCPCS,Facility,Inpatient,,,,236.25,200.8125,67.70925,236.25,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
KUMAR NEEDLE,,A4215,HCPCS,Facility,Both,,,,236.25,200.8125,67.70925,236.25,CorVel,Worker's Compensation,236.25,100,,percent of total billed charges,,
KUMAR NEEDLE,,A4215,HCPCS,Facility,Both,,,,236.25,200.8125,67.70925,236.25,First Health Group Corporation,First Health Network,229.1625,97,,percent of total billed charges,,
KUMAR NEEDLE,,A4215,HCPCS,Facility,Both,,,,236.25,200.8125,67.70925,236.25,"Health Partners, Inc.",Commercial,223.4925,94.6,,percent of total billed charges,,
KUMAR NEEDLE,,A4215,HCPCS,Facility,Outpatient,,,,236.25,200.8125,67.70925,236.25,"Health Partners, Inc.",Medicare Advantage,115.7625,49,,percent of total billed charges,,
KUMAR NEEDLE,,A4215,HCPCS,Facility,Inpatient,,,,236.25,200.8125,67.70925,236.25,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
KUMAR NEEDLE,,A4215,HCPCS,Facility,Both,,,,236.25,200.8125,67.70925,236.25,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),141.75,60,,percent of total billed charges,,
KUMAR NEEDLE,,A4215,HCPCS,Facility,Both,,,,236.25,200.8125,67.70925,236.25,"Health Partners, Inc.",State of Minnesota Advantage Program,192.54375,81.5,,percent of total billed charges,,
KUMAR NEEDLE,,A4215,HCPCS,Facility,Both,,,,236.25,200.8125,67.70925,236.25,"Health Partners, Inc.",State Public Programs,118.125,50,,percent of total billed charges,,
KUMAR NEEDLE,,A4215,HCPCS,Facility,Both,,,,236.25,200.8125,67.70925,236.25,Humana Insurance Company,Commercial PPO,224.4375,95,,percent of total billed charges,,
KUMAR NEEDLE,,A4215,HCPCS,Facility,Outpatient,,,,236.25,200.8125,67.70925,236.25,Humana Insurance Company,Medicare PPO,115.7625,49,,percent of total billed charges,,
KUMAR NEEDLE,,A4215,HCPCS,Facility,Inpatient,,,,236.25,200.8125,67.70925,236.25,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
KUMAR NEEDLE,,A4215,HCPCS,Facility,Both,,,,236.25,200.8125,67.70925,236.25,Medica,Individual & Family,234.12375,99.1,,percent of total billed charges,,
KUMAR NEEDLE,,A4215,HCPCS,Facility,Outpatient,,,,236.25,200.8125,67.70925,236.25,Medica,Medica Advantage Solution,117.6525,49.8,,percent of total billed charges,,
KUMAR NEEDLE,,A4215,HCPCS,Facility,Inpatient,,,,236.25,200.8125,67.70925,236.25,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
KUMAR NEEDLE,,A4215,HCPCS,Facility,Outpatient,,,,236.25,200.8125,67.70925,236.25,Medica,Medical Assistance,105.3675,44.6,,percent of total billed charges,,
KUMAR NEEDLE,,A4215,HCPCS,Facility,Inpatient,,,,236.25,200.8125,67.70925,236.25,Medica,Medical Assistance,,,,,Included in per diem rate,
KUMAR NEEDLE,,A4215,HCPCS,Facility,Outpatient,,,,236.25,200.8125,67.70925,236.25,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,117.6525,49.8,,percent of total billed charges,,
KUMAR NEEDLE,,A4215,HCPCS,Facility,Inpatient,,,,236.25,200.8125,67.70925,236.25,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
KUMAR NEEDLE,,A4215,HCPCS,Facility,Both,,,,236.25,200.8125,67.70925,236.25,"Multiplan, Inc.","Multiplan, Inc.",222.075,94,,percent of total billed charges,,
KUMAR NEEDLE,,A4215,HCPCS,Facility,Outpatient,,,,236.25,200.8125,67.70925,236.25,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,212.86125,90.1,,percent of total billed charges,,
KUMAR NEEDLE,,A4215,HCPCS,Facility,Inpatient,,,,236.25,200.8125,67.70925,236.25,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
KUMAR NEEDLE,,A4215,HCPCS,Facility,Both,,,,236.25,200.8125,67.70925,236.25,"Preferred One Administrative Services, INC.",PPO,232.9425,98.6,,percent of total billed charges,,
KUMAR NEEDLE,,A4215,HCPCS,Facility,Outpatient,,,,236.25,200.8125,67.70925,236.25,PrimeWest Health,Minnesota Senior Health Options (MSHO),121.550625,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
KUMAR NEEDLE,,A4215,HCPCS,Facility,Inpatient,,,,236.25,200.8125,67.70925,236.25,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
KUMAR NEEDLE,,A4215,HCPCS,Facility,Outpatient,,,,236.25,200.8125,67.70925,236.25,PrimeWest Health,MinnesotaCare,121.338,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
KUMAR NEEDLE,,A4215,HCPCS,Facility,Inpatient,,,,236.25,200.8125,67.70925,236.25,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
KUMAR NEEDLE,,A4215,HCPCS,Facility,Both,,,,236.25,200.8125,67.70925,236.25,Sanford Health Plan,Sanford Health Plan,217.35,92,,percent of total billed charges,,
KUMAR NEEDLE,,A4215,HCPCS,Facility,Outpatient,,,,236.25,200.8125,67.70925,236.25,"UCare Health, Inc.",Individual & Family Plan,133.126875,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
KUMAR NEEDLE,,A4215,HCPCS,Facility,Inpatient,,,,236.25,200.8125,67.70925,236.25,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
KUMAR NEEDLE,,A4215,HCPCS,Facility,Outpatient,,,,236.25,200.8125,67.70925,236.25,"UCare Health, Inc.",Medical Assistance,119.235375,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
KUMAR NEEDLE,,A4215,HCPCS,Facility,Inpatient,,,,236.25,200.8125,67.70925,236.25,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
KUMAR NEEDLE,,A4215,HCPCS,Facility,Outpatient,,,,236.25,200.8125,67.70925,236.25,"UCare Health, Inc.",Medicare Advantage,119.235375,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
KUMAR NEEDLE,,A4215,HCPCS,Facility,Inpatient,,,,236.25,200.8125,67.70925,236.25,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
KUMAR NEEDLE,,A4215,HCPCS,Facility,Outpatient,,,,236.25,200.8125,67.70925,236.25,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),119.235375,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
KUMAR NEEDLE,,A4215,HCPCS,Facility,Inpatient,,,,236.25,200.8125,67.70925,236.25,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
KUMAR NEEDLE,,A4215,HCPCS,Facility,Both,,,,236.25,200.8125,67.70925,236.25,UnitedHealthcare,Individual & Family,222.075,94,,percent of total billed charges,,
KUMAR NEEDLE,,A4215,HCPCS,Facility,Outpatient,,,,236.25,200.8125,67.70925,236.25,UnitedHealthcare,Medicare Advantage,115.7625,49,,percent of total billed charges,,
KUMAR NEEDLE,,A4215,HCPCS,Facility,Inpatient,,,,236.25,200.8125,67.70925,236.25,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
KUMAR NEEDLE,,A4215,HCPCS,Facility,Outpatient,,,,236.25,200.8125,67.70925,236.25,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,113.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
KUMAR NEEDLE,,A4215,HCPCS,Facility,Inpatient,,,,236.25,200.8125,67.70925,236.25,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
MONOPTY NEEDLE 18GA,,A4215,HCPCS,Facility,Both,,,,301.21,256.0285,86.326786,301.21,Aetna,Commercial,277.1132,92,,percent of total billed charges,,
MONOPTY NEEDLE 18GA,,A4215,HCPCS,Facility,Outpatient,,,,301.21,256.0285,86.326786,301.21,Aetna,Medicare Advantage,147.5929,49,,percent of total billed charges,,
MONOPTY NEEDLE 18GA,,A4215,HCPCS,Facility,Inpatient,,,,301.21,256.0285,86.326786,301.21,Aetna,Medicare Advantage,,,,,Included in per diem rate,
MONOPTY NEEDLE 18GA,,A4215,HCPCS,Facility,Both,,,,301.21,256.0285,86.326786,301.21,Aetna,PPO,280.1253,93,,percent of total billed charges,,
MONOPTY NEEDLE 18GA,,A4215,HCPCS,Facility,Both,,,,301.21,256.0285,86.326786,301.21,America's PPO,America's PPO,289.251963,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
MONOPTY NEEDLE 18GA,,A4215,HCPCS,Facility,Both,,,,301.21,256.0285,86.326786,301.21,BlueCross BlueShield Minnesota, Federal Employee Program,296.39064,98.4,,percent of total billed charges,,
MONOPTY NEEDLE 18GA,,A4215,HCPCS,Facility,Both,,,,301.21,256.0285,86.326786,301.21,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,301.21,100,,percent of total billed charges,,
MONOPTY NEEDLE 18GA,,A4215,HCPCS,Facility,Both,,,,301.21,256.0285,86.326786,301.21,BlueCross BlueShield Minnesota,High Value Network Plan,271.089,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
MONOPTY NEEDLE 18GA,,A4215,HCPCS,Facility,Outpatient,,,,301.21,256.0285,86.326786,301.21,BlueCross BlueShield Minnesota,Medicare Advantage,147.5929,49,,percent of total billed charges,,
MONOPTY NEEDLE 18GA,,A4215,HCPCS,Facility,Inpatient,,,,301.21,256.0285,86.326786,301.21,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
MONOPTY NEEDLE 18GA,,A4215,HCPCS,Facility,Both,,,,301.21,256.0285,86.326786,301.21,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,266.781697,88.57,,percent of total billed charges,,
MONOPTY NEEDLE 18GA,,A4215,HCPCS,Facility,Both,,,,301.21,256.0285,86.326786,301.21,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,86.326786,28.66,,percent of total billed charges,,
MONOPTY NEEDLE 18GA,,A4215,HCPCS,Facility,Outpatient,,,,301.21,256.0285,86.326786,301.21,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),147.5929,49,,percent of total billed charges,,
MONOPTY NEEDLE 18GA,,A4215,HCPCS,Facility,Inpatient,,,,301.21,256.0285,86.326786,301.21,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
MONOPTY NEEDLE 18GA,,A4215,HCPCS,Facility,Both,,,,301.21,256.0285,86.326786,301.21,CorVel,Worker's Compensation,301.21,100,,percent of total billed charges,,
MONOPTY NEEDLE 18GA,,A4215,HCPCS,Facility,Both,,,,301.21,256.0285,86.326786,301.21,First Health Group Corporation,First Health Network,292.1737,97,,percent of total billed charges,,
MONOPTY NEEDLE 18GA,,A4215,HCPCS,Facility,Both,,,,301.21,256.0285,86.326786,301.21,"Health Partners, Inc.",Commercial,284.94466,94.6,,percent of total billed charges,,
MONOPTY NEEDLE 18GA,,A4215,HCPCS,Facility,Outpatient,,,,301.21,256.0285,86.326786,301.21,"Health Partners, Inc.",Medicare Advantage,147.5929,49,,percent of total billed charges,,
MONOPTY NEEDLE 18GA,,A4215,HCPCS,Facility,Inpatient,,,,301.21,256.0285,86.326786,301.21,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
MONOPTY NEEDLE 18GA,,A4215,HCPCS,Facility,Both,,,,301.21,256.0285,86.326786,301.21,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),180.726,60,,percent of total billed charges,,
MONOPTY NEEDLE 18GA,,A4215,HCPCS,Facility,Both,,,,301.21,256.0285,86.326786,301.21,"Health Partners, Inc.",State of Minnesota Advantage Program,245.48615,81.5,,percent of total billed charges,,
MONOPTY NEEDLE 18GA,,A4215,HCPCS,Facility,Both,,,,301.21,256.0285,86.326786,301.21,"Health Partners, Inc.",State Public Programs,150.605,50,,percent of total billed charges,,
MONOPTY NEEDLE 18GA,,A4215,HCPCS,Facility,Both,,,,301.21,256.0285,86.326786,301.21,Humana Insurance Company,Commercial PPO,286.1495,95,,percent of total billed charges,,
MONOPTY NEEDLE 18GA,,A4215,HCPCS,Facility,Outpatient,,,,301.21,256.0285,86.326786,301.21,Humana Insurance Company,Medicare PPO,147.5929,49,,percent of total billed charges,,
MONOPTY NEEDLE 18GA,,A4215,HCPCS,Facility,Inpatient,,,,301.21,256.0285,86.326786,301.21,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
MONOPTY NEEDLE 18GA,,A4215,HCPCS,Facility,Both,,,,301.21,256.0285,86.326786,301.21,Medica,Individual & Family,298.49911,99.1,,percent of total billed charges,,
MONOPTY NEEDLE 18GA,,A4215,HCPCS,Facility,Outpatient,,,,301.21,256.0285,86.326786,301.21,Medica,Medica Advantage Solution,150.00258,49.8,,percent of total billed charges,,
MONOPTY NEEDLE 18GA,,A4215,HCPCS,Facility,Inpatient,,,,301.21,256.0285,86.326786,301.21,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
MONOPTY NEEDLE 18GA,,A4215,HCPCS,Facility,Outpatient,,,,301.21,256.0285,86.326786,301.21,Medica,Medical Assistance,134.33966,44.6,,percent of total billed charges,,
MONOPTY NEEDLE 18GA,,A4215,HCPCS,Facility,Inpatient,,,,301.21,256.0285,86.326786,301.21,Medica,Medical Assistance,,,,,Included in per diem rate,
MONOPTY NEEDLE 18GA,,A4215,HCPCS,Facility,Outpatient,,,,301.21,256.0285,86.326786,301.21,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,150.00258,49.8,,percent of total billed charges,,
MONOPTY NEEDLE 18GA,,A4215,HCPCS,Facility,Inpatient,,,,301.21,256.0285,86.326786,301.21,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
MONOPTY NEEDLE 18GA,,A4215,HCPCS,Facility,Both,,,,301.21,256.0285,86.326786,301.21,"Multiplan, Inc.","Multiplan, Inc.",283.1374,94,,percent of total billed charges,,
MONOPTY NEEDLE 18GA,,A4215,HCPCS,Facility,Outpatient,,,,301.21,256.0285,86.326786,301.21,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,271.39021,90.1,,percent of total billed charges,,
MONOPTY NEEDLE 18GA,,A4215,HCPCS,Facility,Inpatient,,,,301.21,256.0285,86.326786,301.21,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
MONOPTY NEEDLE 18GA,,A4215,HCPCS,Facility,Both,,,,301.21,256.0285,86.326786,301.21,"Preferred One Administrative Services, INC.",PPO,296.99306,98.6,,percent of total billed charges,,
MONOPTY NEEDLE 18GA,,A4215,HCPCS,Facility,Outpatient,,,,301.21,256.0285,86.326786,301.21,PrimeWest Health,Minnesota Senior Health Options (MSHO),154.972545,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
MONOPTY NEEDLE 18GA,,A4215,HCPCS,Facility,Inpatient,,,,301.21,256.0285,86.326786,301.21,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
MONOPTY NEEDLE 18GA,,A4215,HCPCS,Facility,Outpatient,,,,301.21,256.0285,86.326786,301.21,PrimeWest Health,MinnesotaCare,154.701456,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
MONOPTY NEEDLE 18GA,,A4215,HCPCS,Facility,Inpatient,,,,301.21,256.0285,86.326786,301.21,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
MONOPTY NEEDLE 18GA,,A4215,HCPCS,Facility,Both,,,,301.21,256.0285,86.326786,301.21,Sanford Health Plan,Sanford Health Plan,277.1132,92,,percent of total billed charges,,
MONOPTY NEEDLE 18GA,,A4215,HCPCS,Facility,Outpatient,,,,301.21,256.0285,86.326786,301.21,"UCare Health, Inc.",Individual & Family Plan,169.731835,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
MONOPTY NEEDLE 18GA,,A4215,HCPCS,Facility,Inpatient,,,,301.21,256.0285,86.326786,301.21,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
MONOPTY NEEDLE 18GA,,A4215,HCPCS,Facility,Outpatient,,,,301.21,256.0285,86.326786,301.21,"UCare Health, Inc.",Medical Assistance,152.020687,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MONOPTY NEEDLE 18GA,,A4215,HCPCS,Facility,Inpatient,,,,301.21,256.0285,86.326786,301.21,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
MONOPTY NEEDLE 18GA,,A4215,HCPCS,Facility,Outpatient,,,,301.21,256.0285,86.326786,301.21,"UCare Health, Inc.",Medicare Advantage,152.020687,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MONOPTY NEEDLE 18GA,,A4215,HCPCS,Facility,Inpatient,,,,301.21,256.0285,86.326786,301.21,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
MONOPTY NEEDLE 18GA,,A4215,HCPCS,Facility,Outpatient,,,,301.21,256.0285,86.326786,301.21,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),152.020687,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MONOPTY NEEDLE 18GA,,A4215,HCPCS,Facility,Inpatient,,,,301.21,256.0285,86.326786,301.21,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
MONOPTY NEEDLE 18GA,,A4215,HCPCS,Facility,Both,,,,301.21,256.0285,86.326786,301.21,UnitedHealthcare,Individual & Family,283.1374,94,,percent of total billed charges,,
MONOPTY NEEDLE 18GA,,A4215,HCPCS,Facility,Outpatient,,,,301.21,256.0285,86.326786,301.21,UnitedHealthcare,Medicare Advantage,147.5929,49,,percent of total billed charges,,
MONOPTY NEEDLE 18GA,,A4215,HCPCS,Facility,Inpatient,,,,301.21,256.0285,86.326786,301.21,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
MONOPTY NEEDLE 18GA,,A4215,HCPCS,Facility,Outpatient,,,,301.21,256.0285,86.326786,301.21,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,144.5808,48,,percent of total billed charges,,100% of DHS outpatient percentage
MONOPTY NEEDLE 18GA,,A4215,HCPCS,Facility,Inpatient,,,,301.21,256.0285,86.326786,301.21,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
NASAL IMPLANT SYS LATERA   SPIROX LATSYS01,,A4215,HCPCS,Facility,Both,,,,3284.4,2791.74,941.30904,3284.4,Aetna,Commercial,3021.648,92,,percent of total billed charges,,
NASAL IMPLANT SYS LATERA   SPIROX LATSYS01,,A4215,HCPCS,Facility,Outpatient,,,,3284.4,2791.74,941.30904,3284.4,Aetna,Medicare Advantage,1609.356,49,,percent of total billed charges,,
NASAL IMPLANT SYS LATERA   SPIROX LATSYS01,,A4215,HCPCS,Facility,Inpatient,,,,3284.4,2791.74,941.30904,3284.4,Aetna,Medicare Advantage,,,,,Included in per diem rate,
NASAL IMPLANT SYS LATERA   SPIROX LATSYS01,,A4215,HCPCS,Facility,Both,,,,3284.4,2791.74,941.30904,3284.4,Aetna,PPO,3054.492,93,,percent of total billed charges,,
NASAL IMPLANT SYS LATERA   SPIROX LATSYS01,,A4215,HCPCS,Facility,Both,,,,3284.4,2791.74,941.30904,3284.4,America's PPO,America's PPO,3154.00932,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
NASAL IMPLANT SYS LATERA   SPIROX LATSYS01,,A4215,HCPCS,Facility,Both,,,,3284.4,2791.74,941.30904,3284.4,BlueCross BlueShield Minnesota, Federal Employee Program,3231.8496,98.4,,percent of total billed charges,,
NASAL IMPLANT SYS LATERA   SPIROX LATSYS01,,A4215,HCPCS,Facility,Both,,,,3284.4,2791.74,941.30904,3284.4,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,3284.4,100,,percent of total billed charges,,
NASAL IMPLANT SYS LATERA   SPIROX LATSYS01,,A4215,HCPCS,Facility,Both,,,,3284.4,2791.74,941.30904,3284.4,BlueCross BlueShield Minnesota,High Value Network Plan,2955.96,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
NASAL IMPLANT SYS LATERA   SPIROX LATSYS01,,A4215,HCPCS,Facility,Outpatient,,,,3284.4,2791.74,941.30904,3284.4,BlueCross BlueShield Minnesota,Medicare Advantage,1609.356,49,,percent of total billed charges,,
NASAL IMPLANT SYS LATERA   SPIROX LATSYS01,,A4215,HCPCS,Facility,Inpatient,,,,3284.4,2791.74,941.30904,3284.4,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
NASAL IMPLANT SYS LATERA   SPIROX LATSYS01,,A4215,HCPCS,Facility,Both,,,,3284.4,2791.74,941.30904,3284.4,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,2908.99308,88.57,,percent of total billed charges,,
NASAL IMPLANT SYS LATERA   SPIROX LATSYS01,,A4215,HCPCS,Facility,Both,,,,3284.4,2791.74,941.30904,3284.4,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,941.30904,28.66,,percent of total billed charges,,
NASAL IMPLANT SYS LATERA   SPIROX LATSYS01,,A4215,HCPCS,Facility,Outpatient,,,,3284.4,2791.74,941.30904,3284.4,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1609.356,49,,percent of total billed charges,,
NASAL IMPLANT SYS LATERA   SPIROX LATSYS01,,A4215,HCPCS,Facility,Inpatient,,,,3284.4,2791.74,941.30904,3284.4,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
NASAL IMPLANT SYS LATERA   SPIROX LATSYS01,,A4215,HCPCS,Facility,Both,,,,3284.4,2791.74,941.30904,3284.4,CorVel,Worker's Compensation,3284.4,100,,percent of total billed charges,,
NASAL IMPLANT SYS LATERA   SPIROX LATSYS01,,A4215,HCPCS,Facility,Both,,,,3284.4,2791.74,941.30904,3284.4,First Health Group Corporation,First Health Network,3185.868,97,,percent of total billed charges,,
NASAL IMPLANT SYS LATERA   SPIROX LATSYS01,,A4215,HCPCS,Facility,Both,,,,3284.4,2791.74,941.30904,3284.4,"Health Partners, Inc.",Commercial,3107.0424,94.6,,percent of total billed charges,,
NASAL IMPLANT SYS LATERA   SPIROX LATSYS01,,A4215,HCPCS,Facility,Outpatient,,,,3284.4,2791.74,941.30904,3284.4,"Health Partners, Inc.",Medicare Advantage,1609.356,49,,percent of total billed charges,,
NASAL IMPLANT SYS LATERA   SPIROX LATSYS01,,A4215,HCPCS,Facility,Inpatient,,,,3284.4,2791.74,941.30904,3284.4,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
NASAL IMPLANT SYS LATERA   SPIROX LATSYS01,,A4215,HCPCS,Facility,Both,,,,3284.4,2791.74,941.30904,3284.4,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1970.64,60,,percent of total billed charges,,
NASAL IMPLANT SYS LATERA   SPIROX LATSYS01,,A4215,HCPCS,Facility,Both,,,,3284.4,2791.74,941.30904,3284.4,"Health Partners, Inc.",State of Minnesota Advantage Program,2676.786,81.5,,percent of total billed charges,,
NASAL IMPLANT SYS LATERA   SPIROX LATSYS01,,A4215,HCPCS,Facility,Both,,,,3284.4,2791.74,941.30904,3284.4,"Health Partners, Inc.",State Public Programs,1642.2,50,,percent of total billed charges,,
NASAL IMPLANT SYS LATERA   SPIROX LATSYS01,,A4215,HCPCS,Facility,Both,,,,3284.4,2791.74,941.30904,3284.4,Humana Insurance Company,Commercial PPO,3120.18,95,,percent of total billed charges,,
NASAL IMPLANT SYS LATERA   SPIROX LATSYS01,,A4215,HCPCS,Facility,Outpatient,,,,3284.4,2791.74,941.30904,3284.4,Humana Insurance Company,Medicare PPO,1609.356,49,,percent of total billed charges,,
NASAL IMPLANT SYS LATERA   SPIROX LATSYS01,,A4215,HCPCS,Facility,Inpatient,,,,3284.4,2791.74,941.30904,3284.4,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
NASAL IMPLANT SYS LATERA   SPIROX LATSYS01,,A4215,HCPCS,Facility,Both,,,,3284.4,2791.74,941.30904,3284.4,Medica,Individual & Family,3254.8404,99.1,,percent of total billed charges,,
NASAL IMPLANT SYS LATERA   SPIROX LATSYS01,,A4215,HCPCS,Facility,Outpatient,,,,3284.4,2791.74,941.30904,3284.4,Medica,Medica Advantage Solution,1635.6312,49.8,,percent of total billed charges,,
NASAL IMPLANT SYS LATERA   SPIROX LATSYS01,,A4215,HCPCS,Facility,Inpatient,,,,3284.4,2791.74,941.30904,3284.4,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
NASAL IMPLANT SYS LATERA   SPIROX LATSYS01,,A4215,HCPCS,Facility,Outpatient,,,,3284.4,2791.74,941.30904,3284.4,Medica,Medical Assistance,1464.8424,44.6,,percent of total billed charges,,
NASAL IMPLANT SYS LATERA   SPIROX LATSYS01,,A4215,HCPCS,Facility,Inpatient,,,,3284.4,2791.74,941.30904,3284.4,Medica,Medical Assistance,,,,,Included in per diem rate,
NASAL IMPLANT SYS LATERA   SPIROX LATSYS01,,A4215,HCPCS,Facility,Outpatient,,,,3284.4,2791.74,941.30904,3284.4,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1635.6312,49.8,,percent of total billed charges,,
NASAL IMPLANT SYS LATERA   SPIROX LATSYS01,,A4215,HCPCS,Facility,Inpatient,,,,3284.4,2791.74,941.30904,3284.4,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
NASAL IMPLANT SYS LATERA   SPIROX LATSYS01,,A4215,HCPCS,Facility,Both,,,,3284.4,2791.74,941.30904,3284.4,"Multiplan, Inc.","Multiplan, Inc.",3087.336,94,,percent of total billed charges,,
NASAL IMPLANT SYS LATERA   SPIROX LATSYS01,,A4215,HCPCS,Facility,Outpatient,,,,3284.4,2791.74,941.30904,3284.4,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,2959.2444,90.1,,percent of total billed charges,,
NASAL IMPLANT SYS LATERA   SPIROX LATSYS01,,A4215,HCPCS,Facility,Inpatient,,,,3284.4,2791.74,941.30904,3284.4,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
NASAL IMPLANT SYS LATERA   SPIROX LATSYS01,,A4215,HCPCS,Facility,Both,,,,3284.4,2791.74,941.30904,3284.4,"Preferred One Administrative Services, INC.",PPO,3238.4184,98.6,,percent of total billed charges,,
NASAL IMPLANT SYS LATERA   SPIROX LATSYS01,,A4215,HCPCS,Facility,Outpatient,,,,3284.4,2791.74,941.30904,3284.4,PrimeWest Health,Minnesota Senior Health Options (MSHO),1689.8238,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
NASAL IMPLANT SYS LATERA   SPIROX LATSYS01,,A4215,HCPCS,Facility,Inpatient,,,,3284.4,2791.74,941.30904,3284.4,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
NASAL IMPLANT SYS LATERA   SPIROX LATSYS01,,A4215,HCPCS,Facility,Outpatient,,,,3284.4,2791.74,941.30904,3284.4,PrimeWest Health,MinnesotaCare,1686.86784,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
NASAL IMPLANT SYS LATERA   SPIROX LATSYS01,,A4215,HCPCS,Facility,Inpatient,,,,3284.4,2791.74,941.30904,3284.4,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
NASAL IMPLANT SYS LATERA   SPIROX LATSYS01,,A4215,HCPCS,Facility,Both,,,,3284.4,2791.74,941.30904,3284.4,Sanford Health Plan,Sanford Health Plan,3021.648,92,,percent of total billed charges,,
NASAL IMPLANT SYS LATERA   SPIROX LATSYS01,,A4215,HCPCS,Facility,Outpatient,,,,3284.4,2791.74,941.30904,3284.4,"UCare Health, Inc.",Individual & Family Plan,1850.7594,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
NASAL IMPLANT SYS LATERA   SPIROX LATSYS01,,A4215,HCPCS,Facility,Inpatient,,,,3284.4,2791.74,941.30904,3284.4,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
NASAL IMPLANT SYS LATERA   SPIROX LATSYS01,,A4215,HCPCS,Facility,Outpatient,,,,3284.4,2791.74,941.30904,3284.4,"UCare Health, Inc.",Medical Assistance,1657.63668,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
NASAL IMPLANT SYS LATERA   SPIROX LATSYS01,,A4215,HCPCS,Facility,Inpatient,,,,3284.4,2791.74,941.30904,3284.4,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
NASAL IMPLANT SYS LATERA   SPIROX LATSYS01,,A4215,HCPCS,Facility,Outpatient,,,,3284.4,2791.74,941.30904,3284.4,"UCare Health, Inc.",Medicare Advantage,1657.63668,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
NASAL IMPLANT SYS LATERA   SPIROX LATSYS01,,A4215,HCPCS,Facility,Inpatient,,,,3284.4,2791.74,941.30904,3284.4,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
NASAL IMPLANT SYS LATERA   SPIROX LATSYS01,,A4215,HCPCS,Facility,Outpatient,,,,3284.4,2791.74,941.30904,3284.4,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1657.63668,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
NASAL IMPLANT SYS LATERA   SPIROX LATSYS01,,A4215,HCPCS,Facility,Inpatient,,,,3284.4,2791.74,941.30904,3284.4,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
NASAL IMPLANT SYS LATERA   SPIROX LATSYS01,,A4215,HCPCS,Facility,Both,,,,3284.4,2791.74,941.30904,3284.4,UnitedHealthcare,Individual & Family,3087.336,94,,percent of total billed charges,,
NASAL IMPLANT SYS LATERA   SPIROX LATSYS01,,A4215,HCPCS,Facility,Outpatient,,,,3284.4,2791.74,941.30904,3284.4,UnitedHealthcare,Medicare Advantage,1609.356,49,,percent of total billed charges,,
NASAL IMPLANT SYS LATERA   SPIROX LATSYS01,,A4215,HCPCS,Facility,Inpatient,,,,3284.4,2791.74,941.30904,3284.4,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
NASAL IMPLANT SYS LATERA   SPIROX LATSYS01,,A4215,HCPCS,Facility,Outpatient,,,,3284.4,2791.74,941.30904,3284.4,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1576.512,48,,percent of total billed charges,,100% of DHS outpatient percentage
NASAL IMPLANT SYS LATERA   SPIROX LATSYS01,,A4215,HCPCS,Facility,Inpatient,,,,3284.4,2791.74,941.30904,3284.4,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
NEEDLE BIOPSY,,A4215,HCPCS,Facility,Both,,,,238,202.3,68.2108,238,Aetna,Commercial,218.96,92,,percent of total billed charges,,
NEEDLE BIOPSY,,A4215,HCPCS,Facility,Outpatient,,,,238,202.3,68.2108,238,Aetna,Medicare Advantage,116.62,49,,percent of total billed charges,,
NEEDLE BIOPSY,,A4215,HCPCS,Facility,Inpatient,,,,238,202.3,68.2108,238,Aetna,Medicare Advantage,,,,,Included in per diem rate,
NEEDLE BIOPSY,,A4215,HCPCS,Facility,Both,,,,238,202.3,68.2108,238,Aetna,PPO,221.34,93,,percent of total billed charges,,
NEEDLE BIOPSY,,A4215,HCPCS,Facility,Both,,,,238,202.3,68.2108,238,America's PPO,America's PPO,228.5514,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
NEEDLE BIOPSY,,A4215,HCPCS,Facility,Both,,,,238,202.3,68.2108,238,BlueCross BlueShield Minnesota, Federal Employee Program,234.192,98.4,,percent of total billed charges,,
NEEDLE BIOPSY,,A4215,HCPCS,Facility,Both,,,,238,202.3,68.2108,238,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,238,100,,percent of total billed charges,,
NEEDLE BIOPSY,,A4215,HCPCS,Facility,Both,,,,238,202.3,68.2108,238,BlueCross BlueShield Minnesota,High Value Network Plan,214.2,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
NEEDLE BIOPSY,,A4215,HCPCS,Facility,Outpatient,,,,238,202.3,68.2108,238,BlueCross BlueShield Minnesota,Medicare Advantage,116.62,49,,percent of total billed charges,,
NEEDLE BIOPSY,,A4215,HCPCS,Facility,Inpatient,,,,238,202.3,68.2108,238,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
NEEDLE BIOPSY,,A4215,HCPCS,Facility,Both,,,,238,202.3,68.2108,238,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,210.7966,88.57,,percent of total billed charges,,
NEEDLE BIOPSY,,A4215,HCPCS,Facility,Both,,,,238,202.3,68.2108,238,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,68.2108,28.66,,percent of total billed charges,,
NEEDLE BIOPSY,,A4215,HCPCS,Facility,Outpatient,,,,238,202.3,68.2108,238,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),116.62,49,,percent of total billed charges,,
NEEDLE BIOPSY,,A4215,HCPCS,Facility,Inpatient,,,,238,202.3,68.2108,238,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
NEEDLE BIOPSY,,A4215,HCPCS,Facility,Both,,,,238,202.3,68.2108,238,CorVel,Worker's Compensation,238,100,,percent of total billed charges,,
NEEDLE BIOPSY,,A4215,HCPCS,Facility,Both,,,,238,202.3,68.2108,238,First Health Group Corporation,First Health Network,230.86,97,,percent of total billed charges,,
NEEDLE BIOPSY,,A4215,HCPCS,Facility,Both,,,,238,202.3,68.2108,238,"Health Partners, Inc.",Commercial,225.148,94.6,,percent of total billed charges,,
NEEDLE BIOPSY,,A4215,HCPCS,Facility,Outpatient,,,,238,202.3,68.2108,238,"Health Partners, Inc.",Medicare Advantage,116.62,49,,percent of total billed charges,,
NEEDLE BIOPSY,,A4215,HCPCS,Facility,Inpatient,,,,238,202.3,68.2108,238,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
NEEDLE BIOPSY,,A4215,HCPCS,Facility,Both,,,,238,202.3,68.2108,238,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),142.8,60,,percent of total billed charges,,
NEEDLE BIOPSY,,A4215,HCPCS,Facility,Both,,,,238,202.3,68.2108,238,"Health Partners, Inc.",State of Minnesota Advantage Program,193.97,81.5,,percent of total billed charges,,
NEEDLE BIOPSY,,A4215,HCPCS,Facility,Both,,,,238,202.3,68.2108,238,"Health Partners, Inc.",State Public Programs,119,50,,percent of total billed charges,,
NEEDLE BIOPSY,,A4215,HCPCS,Facility,Both,,,,238,202.3,68.2108,238,Humana Insurance Company,Commercial PPO,226.1,95,,percent of total billed charges,,
NEEDLE BIOPSY,,A4215,HCPCS,Facility,Outpatient,,,,238,202.3,68.2108,238,Humana Insurance Company,Medicare PPO,116.62,49,,percent of total billed charges,,
NEEDLE BIOPSY,,A4215,HCPCS,Facility,Inpatient,,,,238,202.3,68.2108,238,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
NEEDLE BIOPSY,,A4215,HCPCS,Facility,Both,,,,238,202.3,68.2108,238,Medica,Individual & Family,235.858,99.1,,percent of total billed charges,,
NEEDLE BIOPSY,,A4215,HCPCS,Facility,Outpatient,,,,238,202.3,68.2108,238,Medica,Medica Advantage Solution,118.524,49.8,,percent of total billed charges,,
NEEDLE BIOPSY,,A4215,HCPCS,Facility,Inpatient,,,,238,202.3,68.2108,238,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
NEEDLE BIOPSY,,A4215,HCPCS,Facility,Outpatient,,,,238,202.3,68.2108,238,Medica,Medical Assistance,106.148,44.6,,percent of total billed charges,,
NEEDLE BIOPSY,,A4215,HCPCS,Facility,Inpatient,,,,238,202.3,68.2108,238,Medica,Medical Assistance,,,,,Included in per diem rate,
NEEDLE BIOPSY,,A4215,HCPCS,Facility,Outpatient,,,,238,202.3,68.2108,238,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,118.524,49.8,,percent of total billed charges,,
NEEDLE BIOPSY,,A4215,HCPCS,Facility,Inpatient,,,,238,202.3,68.2108,238,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
NEEDLE BIOPSY,,A4215,HCPCS,Facility,Both,,,,238,202.3,68.2108,238,"Multiplan, Inc.","Multiplan, Inc.",223.72,94,,percent of total billed charges,,
NEEDLE BIOPSY,,A4215,HCPCS,Facility,Outpatient,,,,238,202.3,68.2108,238,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,214.438,90.1,,percent of total billed charges,,
NEEDLE BIOPSY,,A4215,HCPCS,Facility,Inpatient,,,,238,202.3,68.2108,238,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
NEEDLE BIOPSY,,A4215,HCPCS,Facility,Both,,,,238,202.3,68.2108,238,"Preferred One Administrative Services, INC.",PPO,234.668,98.6,,percent of total billed charges,,
NEEDLE BIOPSY,,A4215,HCPCS,Facility,Outpatient,,,,238,202.3,68.2108,238,PrimeWest Health,Minnesota Senior Health Options (MSHO),122.451,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
NEEDLE BIOPSY,,A4215,HCPCS,Facility,Inpatient,,,,238,202.3,68.2108,238,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
NEEDLE BIOPSY,,A4215,HCPCS,Facility,Outpatient,,,,238,202.3,68.2108,238,PrimeWest Health,MinnesotaCare,122.2368,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
NEEDLE BIOPSY,,A4215,HCPCS,Facility,Inpatient,,,,238,202.3,68.2108,238,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
NEEDLE BIOPSY,,A4215,HCPCS,Facility,Both,,,,238,202.3,68.2108,238,Sanford Health Plan,Sanford Health Plan,218.96,92,,percent of total billed charges,,
NEEDLE BIOPSY,,A4215,HCPCS,Facility,Outpatient,,,,238,202.3,68.2108,238,"UCare Health, Inc.",Individual & Family Plan,134.113,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
NEEDLE BIOPSY,,A4215,HCPCS,Facility,Inpatient,,,,238,202.3,68.2108,238,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
NEEDLE BIOPSY,,A4215,HCPCS,Facility,Outpatient,,,,238,202.3,68.2108,238,"UCare Health, Inc.",Medical Assistance,120.1186,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
NEEDLE BIOPSY,,A4215,HCPCS,Facility,Inpatient,,,,238,202.3,68.2108,238,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
NEEDLE BIOPSY,,A4215,HCPCS,Facility,Outpatient,,,,238,202.3,68.2108,238,"UCare Health, Inc.",Medicare Advantage,120.1186,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
NEEDLE BIOPSY,,A4215,HCPCS,Facility,Inpatient,,,,238,202.3,68.2108,238,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
NEEDLE BIOPSY,,A4215,HCPCS,Facility,Outpatient,,,,238,202.3,68.2108,238,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),120.1186,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
NEEDLE BIOPSY,,A4215,HCPCS,Facility,Inpatient,,,,238,202.3,68.2108,238,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
NEEDLE BIOPSY,,A4215,HCPCS,Facility,Both,,,,238,202.3,68.2108,238,UnitedHealthcare,Individual & Family,223.72,94,,percent of total billed charges,,
NEEDLE BIOPSY,,A4215,HCPCS,Facility,Outpatient,,,,238,202.3,68.2108,238,UnitedHealthcare,Medicare Advantage,116.62,49,,percent of total billed charges,,
NEEDLE BIOPSY,,A4215,HCPCS,Facility,Inpatient,,,,238,202.3,68.2108,238,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
NEEDLE BIOPSY,,A4215,HCPCS,Facility,Outpatient,,,,238,202.3,68.2108,238,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,114.24,48,,percent of total billed charges,,100% of DHS outpatient percentage
NEEDLE BIOPSY,,A4215,HCPCS,Facility,Inpatient,,,,238,202.3,68.2108,238,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
NEEDLE BONEE BLADDER INJECTION 35CM,,A4215,HCPCS,Facility,Both,,,,266,226.1,76.2356,266,Aetna,Commercial,244.72,92,,percent of total billed charges,,
NEEDLE BONEE BLADDER INJECTION 35CM,,A4215,HCPCS,Facility,Outpatient,,,,266,226.1,76.2356,266,Aetna,Medicare Advantage,130.34,49,,percent of total billed charges,,
NEEDLE BONEE BLADDER INJECTION 35CM,,A4215,HCPCS,Facility,Inpatient,,,,266,226.1,76.2356,266,Aetna,Medicare Advantage,,,,,Included in per diem rate,
NEEDLE BONEE BLADDER INJECTION 35CM,,A4215,HCPCS,Facility,Both,,,,266,226.1,76.2356,266,Aetna,PPO,247.38,93,,percent of total billed charges,,
NEEDLE BONEE BLADDER INJECTION 35CM,,A4215,HCPCS,Facility,Both,,,,266,226.1,76.2356,266,America's PPO,America's PPO,255.4398,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
NEEDLE BONEE BLADDER INJECTION 35CM,,A4215,HCPCS,Facility,Both,,,,266,226.1,76.2356,266,BlueCross BlueShield Minnesota, Federal Employee Program,261.744,98.4,,percent of total billed charges,,
NEEDLE BONEE BLADDER INJECTION 35CM,,A4215,HCPCS,Facility,Both,,,,266,226.1,76.2356,266,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,266,100,,percent of total billed charges,,
NEEDLE BONEE BLADDER INJECTION 35CM,,A4215,HCPCS,Facility,Both,,,,266,226.1,76.2356,266,BlueCross BlueShield Minnesota,High Value Network Plan,239.4,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
NEEDLE BONEE BLADDER INJECTION 35CM,,A4215,HCPCS,Facility,Outpatient,,,,266,226.1,76.2356,266,BlueCross BlueShield Minnesota,Medicare Advantage,130.34,49,,percent of total billed charges,,
NEEDLE BONEE BLADDER INJECTION 35CM,,A4215,HCPCS,Facility,Inpatient,,,,266,226.1,76.2356,266,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
NEEDLE BONEE BLADDER INJECTION 35CM,,A4215,HCPCS,Facility,Both,,,,266,226.1,76.2356,266,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,235.5962,88.57,,percent of total billed charges,,
NEEDLE BONEE BLADDER INJECTION 35CM,,A4215,HCPCS,Facility,Both,,,,266,226.1,76.2356,266,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,76.2356,28.66,,percent of total billed charges,,
NEEDLE BONEE BLADDER INJECTION 35CM,,A4215,HCPCS,Facility,Outpatient,,,,266,226.1,76.2356,266,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),130.34,49,,percent of total billed charges,,
NEEDLE BONEE BLADDER INJECTION 35CM,,A4215,HCPCS,Facility,Inpatient,,,,266,226.1,76.2356,266,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
NEEDLE BONEE BLADDER INJECTION 35CM,,A4215,HCPCS,Facility,Both,,,,266,226.1,76.2356,266,CorVel,Worker's Compensation,266,100,,percent of total billed charges,,
NEEDLE BONEE BLADDER INJECTION 35CM,,A4215,HCPCS,Facility,Both,,,,266,226.1,76.2356,266,First Health Group Corporation,First Health Network,258.02,97,,percent of total billed charges,,
NEEDLE BONEE BLADDER INJECTION 35CM,,A4215,HCPCS,Facility,Both,,,,266,226.1,76.2356,266,"Health Partners, Inc.",Commercial,251.636,94.6,,percent of total billed charges,,
NEEDLE BONEE BLADDER INJECTION 35CM,,A4215,HCPCS,Facility,Outpatient,,,,266,226.1,76.2356,266,"Health Partners, Inc.",Medicare Advantage,130.34,49,,percent of total billed charges,,
NEEDLE BONEE BLADDER INJECTION 35CM,,A4215,HCPCS,Facility,Inpatient,,,,266,226.1,76.2356,266,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
NEEDLE BONEE BLADDER INJECTION 35CM,,A4215,HCPCS,Facility,Both,,,,266,226.1,76.2356,266,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),159.6,60,,percent of total billed charges,,
NEEDLE BONEE BLADDER INJECTION 35CM,,A4215,HCPCS,Facility,Both,,,,266,226.1,76.2356,266,"Health Partners, Inc.",State of Minnesota Advantage Program,216.79,81.5,,percent of total billed charges,,
NEEDLE BONEE BLADDER INJECTION 35CM,,A4215,HCPCS,Facility,Both,,,,266,226.1,76.2356,266,"Health Partners, Inc.",State Public Programs,133,50,,percent of total billed charges,,
NEEDLE BONEE BLADDER INJECTION 35CM,,A4215,HCPCS,Facility,Both,,,,266,226.1,76.2356,266,Humana Insurance Company,Commercial PPO,252.7,95,,percent of total billed charges,,
NEEDLE BONEE BLADDER INJECTION 35CM,,A4215,HCPCS,Facility,Outpatient,,,,266,226.1,76.2356,266,Humana Insurance Company,Medicare PPO,130.34,49,,percent of total billed charges,,
NEEDLE BONEE BLADDER INJECTION 35CM,,A4215,HCPCS,Facility,Inpatient,,,,266,226.1,76.2356,266,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
NEEDLE BONEE BLADDER INJECTION 35CM,,A4215,HCPCS,Facility,Both,,,,266,226.1,76.2356,266,Medica,Individual & Family,263.606,99.1,,percent of total billed charges,,
NEEDLE BONEE BLADDER INJECTION 35CM,,A4215,HCPCS,Facility,Outpatient,,,,266,226.1,76.2356,266,Medica,Medica Advantage Solution,132.468,49.8,,percent of total billed charges,,
NEEDLE BONEE BLADDER INJECTION 35CM,,A4215,HCPCS,Facility,Inpatient,,,,266,226.1,76.2356,266,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
NEEDLE BONEE BLADDER INJECTION 35CM,,A4215,HCPCS,Facility,Outpatient,,,,266,226.1,76.2356,266,Medica,Medical Assistance,118.636,44.6,,percent of total billed charges,,
NEEDLE BONEE BLADDER INJECTION 35CM,,A4215,HCPCS,Facility,Inpatient,,,,266,226.1,76.2356,266,Medica,Medical Assistance,,,,,Included in per diem rate,
NEEDLE BONEE BLADDER INJECTION 35CM,,A4215,HCPCS,Facility,Outpatient,,,,266,226.1,76.2356,266,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,132.468,49.8,,percent of total billed charges,,
NEEDLE BONEE BLADDER INJECTION 35CM,,A4215,HCPCS,Facility,Inpatient,,,,266,226.1,76.2356,266,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
NEEDLE BONEE BLADDER INJECTION 35CM,,A4215,HCPCS,Facility,Both,,,,266,226.1,76.2356,266,"Multiplan, Inc.","Multiplan, Inc.",250.04,94,,percent of total billed charges,,
NEEDLE BONEE BLADDER INJECTION 35CM,,A4215,HCPCS,Facility,Outpatient,,,,266,226.1,76.2356,266,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,239.666,90.1,,percent of total billed charges,,
NEEDLE BONEE BLADDER INJECTION 35CM,,A4215,HCPCS,Facility,Inpatient,,,,266,226.1,76.2356,266,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
NEEDLE BONEE BLADDER INJECTION 35CM,,A4215,HCPCS,Facility,Both,,,,266,226.1,76.2356,266,"Preferred One Administrative Services, INC.",PPO,262.276,98.6,,percent of total billed charges,,
NEEDLE BONEE BLADDER INJECTION 35CM,,A4215,HCPCS,Facility,Outpatient,,,,266,226.1,76.2356,266,PrimeWest Health,Minnesota Senior Health Options (MSHO),136.857,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
NEEDLE BONEE BLADDER INJECTION 35CM,,A4215,HCPCS,Facility,Inpatient,,,,266,226.1,76.2356,266,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
NEEDLE BONEE BLADDER INJECTION 35CM,,A4215,HCPCS,Facility,Outpatient,,,,266,226.1,76.2356,266,PrimeWest Health,MinnesotaCare,136.6176,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
NEEDLE BONEE BLADDER INJECTION 35CM,,A4215,HCPCS,Facility,Inpatient,,,,266,226.1,76.2356,266,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
NEEDLE BONEE BLADDER INJECTION 35CM,,A4215,HCPCS,Facility,Both,,,,266,226.1,76.2356,266,Sanford Health Plan,Sanford Health Plan,244.72,92,,percent of total billed charges,,
NEEDLE BONEE BLADDER INJECTION 35CM,,A4215,HCPCS,Facility,Outpatient,,,,266,226.1,76.2356,266,"UCare Health, Inc.",Individual & Family Plan,149.891,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
NEEDLE BONEE BLADDER INJECTION 35CM,,A4215,HCPCS,Facility,Inpatient,,,,266,226.1,76.2356,266,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
NEEDLE BONEE BLADDER INJECTION 35CM,,A4215,HCPCS,Facility,Outpatient,,,,266,226.1,76.2356,266,"UCare Health, Inc.",Medical Assistance,134.2502,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
NEEDLE BONEE BLADDER INJECTION 35CM,,A4215,HCPCS,Facility,Inpatient,,,,266,226.1,76.2356,266,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
NEEDLE BONEE BLADDER INJECTION 35CM,,A4215,HCPCS,Facility,Outpatient,,,,266,226.1,76.2356,266,"UCare Health, Inc.",Medicare Advantage,134.2502,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
NEEDLE BONEE BLADDER INJECTION 35CM,,A4215,HCPCS,Facility,Inpatient,,,,266,226.1,76.2356,266,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
NEEDLE BONEE BLADDER INJECTION 35CM,,A4215,HCPCS,Facility,Outpatient,,,,266,226.1,76.2356,266,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),134.2502,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
NEEDLE BONEE BLADDER INJECTION 35CM,,A4215,HCPCS,Facility,Inpatient,,,,266,226.1,76.2356,266,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
NEEDLE BONEE BLADDER INJECTION 35CM,,A4215,HCPCS,Facility,Both,,,,266,226.1,76.2356,266,UnitedHealthcare,Individual & Family,250.04,94,,percent of total billed charges,,
NEEDLE BONEE BLADDER INJECTION 35CM,,A4215,HCPCS,Facility,Outpatient,,,,266,226.1,76.2356,266,UnitedHealthcare,Medicare Advantage,130.34,49,,percent of total billed charges,,
NEEDLE BONEE BLADDER INJECTION 35CM,,A4215,HCPCS,Facility,Inpatient,,,,266,226.1,76.2356,266,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
NEEDLE BONEE BLADDER INJECTION 35CM,,A4215,HCPCS,Facility,Outpatient,,,,266,226.1,76.2356,266,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,127.68,48,,percent of total billed charges,,100% of DHS outpatient percentage
NEEDLE BONEE BLADDER INJECTION 35CM,,A4215,HCPCS,Facility,Inpatient,,,,266,226.1,76.2356,266,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
NEEDLE INSUFFLATION STEP 14GA   S100000,,A4215,HCPCS,Facility,Both,,,,70.56,59.976,20.222496,70.56,Aetna,Commercial,64.9152,92,,percent of total billed charges,,
NEEDLE INSUFFLATION STEP 14GA   S100000,,A4215,HCPCS,Facility,Outpatient,,,,70.56,59.976,20.222496,70.56,Aetna,Medicare Advantage,34.5744,49,,percent of total billed charges,,
NEEDLE INSUFFLATION STEP 14GA   S100000,,A4215,HCPCS,Facility,Inpatient,,,,70.56,59.976,20.222496,70.56,Aetna,Medicare Advantage,,,,,Included in per diem rate,
NEEDLE INSUFFLATION STEP 14GA   S100000,,A4215,HCPCS,Facility,Both,,,,70.56,59.976,20.222496,70.56,Aetna,PPO,65.6208,93,,percent of total billed charges,,
NEEDLE INSUFFLATION STEP 14GA   S100000,,A4215,HCPCS,Facility,Both,,,,70.56,59.976,20.222496,70.56,America's PPO,America's PPO,67.758768,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
NEEDLE INSUFFLATION STEP 14GA   S100000,,A4215,HCPCS,Facility,Both,,,,70.56,59.976,20.222496,70.56,BlueCross BlueShield Minnesota, Federal Employee Program,69.43104,98.4,,percent of total billed charges,,
NEEDLE INSUFFLATION STEP 14GA   S100000,,A4215,HCPCS,Facility,Both,,,,70.56,59.976,20.222496,70.56,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,70.56,100,,percent of total billed charges,,
NEEDLE INSUFFLATION STEP 14GA   S100000,,A4215,HCPCS,Facility,Both,,,,70.56,59.976,20.222496,70.56,BlueCross BlueShield Minnesota,High Value Network Plan,63.504,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
NEEDLE INSUFFLATION STEP 14GA   S100000,,A4215,HCPCS,Facility,Outpatient,,,,70.56,59.976,20.222496,70.56,BlueCross BlueShield Minnesota,Medicare Advantage,34.5744,49,,percent of total billed charges,,
NEEDLE INSUFFLATION STEP 14GA   S100000,,A4215,HCPCS,Facility,Inpatient,,,,70.56,59.976,20.222496,70.56,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
NEEDLE INSUFFLATION STEP 14GA   S100000,,A4215,HCPCS,Facility,Both,,,,70.56,59.976,20.222496,70.56,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,62.494992,88.57,,percent of total billed charges,,
NEEDLE INSUFFLATION STEP 14GA   S100000,,A4215,HCPCS,Facility,Both,,,,70.56,59.976,20.222496,70.56,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,20.222496,28.66,,percent of total billed charges,,
NEEDLE INSUFFLATION STEP 14GA   S100000,,A4215,HCPCS,Facility,Outpatient,,,,70.56,59.976,20.222496,70.56,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),34.5744,49,,percent of total billed charges,,
NEEDLE INSUFFLATION STEP 14GA   S100000,,A4215,HCPCS,Facility,Inpatient,,,,70.56,59.976,20.222496,70.56,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
NEEDLE INSUFFLATION STEP 14GA   S100000,,A4215,HCPCS,Facility,Both,,,,70.56,59.976,20.222496,70.56,CorVel,Worker's Compensation,70.56,100,,percent of total billed charges,,
NEEDLE INSUFFLATION STEP 14GA   S100000,,A4215,HCPCS,Facility,Both,,,,70.56,59.976,20.222496,70.56,First Health Group Corporation,First Health Network,68.4432,97,,percent of total billed charges,,
NEEDLE INSUFFLATION STEP 14GA   S100000,,A4215,HCPCS,Facility,Both,,,,70.56,59.976,20.222496,70.56,"Health Partners, Inc.",Commercial,66.74976,94.6,,percent of total billed charges,,
NEEDLE INSUFFLATION STEP 14GA   S100000,,A4215,HCPCS,Facility,Outpatient,,,,70.56,59.976,20.222496,70.56,"Health Partners, Inc.",Medicare Advantage,34.5744,49,,percent of total billed charges,,
NEEDLE INSUFFLATION STEP 14GA   S100000,,A4215,HCPCS,Facility,Inpatient,,,,70.56,59.976,20.222496,70.56,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
NEEDLE INSUFFLATION STEP 14GA   S100000,,A4215,HCPCS,Facility,Both,,,,70.56,59.976,20.222496,70.56,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),42.336,60,,percent of total billed charges,,
NEEDLE INSUFFLATION STEP 14GA   S100000,,A4215,HCPCS,Facility,Both,,,,70.56,59.976,20.222496,70.56,"Health Partners, Inc.",State of Minnesota Advantage Program,57.5064,81.5,,percent of total billed charges,,
NEEDLE INSUFFLATION STEP 14GA   S100000,,A4215,HCPCS,Facility,Both,,,,70.56,59.976,20.222496,70.56,"Health Partners, Inc.",State Public Programs,35.28,50,,percent of total billed charges,,
NEEDLE INSUFFLATION STEP 14GA   S100000,,A4215,HCPCS,Facility,Both,,,,70.56,59.976,20.222496,70.56,Humana Insurance Company,Commercial PPO,67.032,95,,percent of total billed charges,,
NEEDLE INSUFFLATION STEP 14GA   S100000,,A4215,HCPCS,Facility,Outpatient,,,,70.56,59.976,20.222496,70.56,Humana Insurance Company,Medicare PPO,34.5744,49,,percent of total billed charges,,
NEEDLE INSUFFLATION STEP 14GA   S100000,,A4215,HCPCS,Facility,Inpatient,,,,70.56,59.976,20.222496,70.56,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
NEEDLE INSUFFLATION STEP 14GA   S100000,,A4215,HCPCS,Facility,Both,,,,70.56,59.976,20.222496,70.56,Medica,Individual & Family,69.92496,99.1,,percent of total billed charges,,
NEEDLE INSUFFLATION STEP 14GA   S100000,,A4215,HCPCS,Facility,Outpatient,,,,70.56,59.976,20.222496,70.56,Medica,Medica Advantage Solution,35.13888,49.8,,percent of total billed charges,,
NEEDLE INSUFFLATION STEP 14GA   S100000,,A4215,HCPCS,Facility,Inpatient,,,,70.56,59.976,20.222496,70.56,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
NEEDLE INSUFFLATION STEP 14GA   S100000,,A4215,HCPCS,Facility,Outpatient,,,,70.56,59.976,20.222496,70.56,Medica,Medical Assistance,31.46976,44.6,,percent of total billed charges,,
NEEDLE INSUFFLATION STEP 14GA   S100000,,A4215,HCPCS,Facility,Inpatient,,,,70.56,59.976,20.222496,70.56,Medica,Medical Assistance,,,,,Included in per diem rate,
NEEDLE INSUFFLATION STEP 14GA   S100000,,A4215,HCPCS,Facility,Outpatient,,,,70.56,59.976,20.222496,70.56,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,35.13888,49.8,,percent of total billed charges,,
NEEDLE INSUFFLATION STEP 14GA   S100000,,A4215,HCPCS,Facility,Inpatient,,,,70.56,59.976,20.222496,70.56,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
NEEDLE INSUFFLATION STEP 14GA   S100000,,A4215,HCPCS,Facility,Both,,,,70.56,59.976,20.222496,70.56,"Multiplan, Inc.","Multiplan, Inc.",66.3264,94,,percent of total billed charges,,
NEEDLE INSUFFLATION STEP 14GA   S100000,,A4215,HCPCS,Facility,Outpatient,,,,70.56,59.976,20.222496,70.56,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,63.57456,90.1,,percent of total billed charges,,
NEEDLE INSUFFLATION STEP 14GA   S100000,,A4215,HCPCS,Facility,Inpatient,,,,70.56,59.976,20.222496,70.56,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
NEEDLE INSUFFLATION STEP 14GA   S100000,,A4215,HCPCS,Facility,Both,,,,70.56,59.976,20.222496,70.56,"Preferred One Administrative Services, INC.",PPO,69.57216,98.6,,percent of total billed charges,,
NEEDLE INSUFFLATION STEP 14GA   S100000,,A4215,HCPCS,Facility,Outpatient,,,,70.56,59.976,20.222496,70.56,PrimeWest Health,Minnesota Senior Health Options (MSHO),36.30312,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
NEEDLE INSUFFLATION STEP 14GA   S100000,,A4215,HCPCS,Facility,Inpatient,,,,70.56,59.976,20.222496,70.56,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
NEEDLE INSUFFLATION STEP 14GA   S100000,,A4215,HCPCS,Facility,Outpatient,,,,70.56,59.976,20.222496,70.56,PrimeWest Health,MinnesotaCare,36.239616,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
NEEDLE INSUFFLATION STEP 14GA   S100000,,A4215,HCPCS,Facility,Inpatient,,,,70.56,59.976,20.222496,70.56,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
NEEDLE INSUFFLATION STEP 14GA   S100000,,A4215,HCPCS,Facility,Both,,,,70.56,59.976,20.222496,70.56,Sanford Health Plan,Sanford Health Plan,64.9152,92,,percent of total billed charges,,
NEEDLE INSUFFLATION STEP 14GA   S100000,,A4215,HCPCS,Facility,Outpatient,,,,70.56,59.976,20.222496,70.56,"UCare Health, Inc.",Individual & Family Plan,39.76056,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
NEEDLE INSUFFLATION STEP 14GA   S100000,,A4215,HCPCS,Facility,Inpatient,,,,70.56,59.976,20.222496,70.56,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
NEEDLE INSUFFLATION STEP 14GA   S100000,,A4215,HCPCS,Facility,Outpatient,,,,70.56,59.976,20.222496,70.56,"UCare Health, Inc.",Medical Assistance,35.611632,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
NEEDLE INSUFFLATION STEP 14GA   S100000,,A4215,HCPCS,Facility,Inpatient,,,,70.56,59.976,20.222496,70.56,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
NEEDLE INSUFFLATION STEP 14GA   S100000,,A4215,HCPCS,Facility,Outpatient,,,,70.56,59.976,20.222496,70.56,"UCare Health, Inc.",Medicare Advantage,35.611632,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
NEEDLE INSUFFLATION STEP 14GA   S100000,,A4215,HCPCS,Facility,Inpatient,,,,70.56,59.976,20.222496,70.56,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
NEEDLE INSUFFLATION STEP 14GA   S100000,,A4215,HCPCS,Facility,Outpatient,,,,70.56,59.976,20.222496,70.56,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),35.611632,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
NEEDLE INSUFFLATION STEP 14GA   S100000,,A4215,HCPCS,Facility,Inpatient,,,,70.56,59.976,20.222496,70.56,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
NEEDLE INSUFFLATION STEP 14GA   S100000,,A4215,HCPCS,Facility,Both,,,,70.56,59.976,20.222496,70.56,UnitedHealthcare,Individual & Family,66.3264,94,,percent of total billed charges,,
NEEDLE INSUFFLATION STEP 14GA   S100000,,A4215,HCPCS,Facility,Outpatient,,,,70.56,59.976,20.222496,70.56,UnitedHealthcare,Medicare Advantage,34.5744,49,,percent of total billed charges,,
NEEDLE INSUFFLATION STEP 14GA   S100000,,A4215,HCPCS,Facility,Inpatient,,,,70.56,59.976,20.222496,70.56,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
NEEDLE INSUFFLATION STEP 14GA   S100000,,A4215,HCPCS,Facility,Outpatient,,,,70.56,59.976,20.222496,70.56,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,33.8688,48,,percent of total billed charges,,100% of DHS outpatient percentage
NEEDLE INSUFFLATION STEP 14GA   S100000,,A4215,HCPCS,Facility,Inpatient,,,,70.56,59.976,20.222496,70.56,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
NEEDLE INTERJECT CLEAR 25GA  240CM  BOSTON SCI  M00518310,,A4215,HCPCS,Facility,Both,,,,239.4,203.49,68.61204,239.4,Aetna,Commercial,220.248,92,,percent of total billed charges,,
NEEDLE INTERJECT CLEAR 25GA  240CM  BOSTON SCI  M00518310,,A4215,HCPCS,Facility,Outpatient,,,,239.4,203.49,68.61204,239.4,Aetna,Medicare Advantage,117.306,49,,percent of total billed charges,,
NEEDLE INTERJECT CLEAR 25GA  240CM  BOSTON SCI  M00518310,,A4215,HCPCS,Facility,Inpatient,,,,239.4,203.49,68.61204,239.4,Aetna,Medicare Advantage,,,,,Included in per diem rate,
NEEDLE INTERJECT CLEAR 25GA  240CM  BOSTON SCI  M00518310,,A4215,HCPCS,Facility,Both,,,,239.4,203.49,68.61204,239.4,Aetna,PPO,222.642,93,,percent of total billed charges,,
NEEDLE INTERJECT CLEAR 25GA  240CM  BOSTON SCI  M00518310,,A4215,HCPCS,Facility,Both,,,,239.4,203.49,68.61204,239.4,America's PPO,America's PPO,229.89582,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
NEEDLE INTERJECT CLEAR 25GA  240CM  BOSTON SCI  M00518310,,A4215,HCPCS,Facility,Both,,,,239.4,203.49,68.61204,239.4,BlueCross BlueShield Minnesota, Federal Employee Program,235.5696,98.4,,percent of total billed charges,,
NEEDLE INTERJECT CLEAR 25GA  240CM  BOSTON SCI  M00518310,,A4215,HCPCS,Facility,Both,,,,239.4,203.49,68.61204,239.4,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,239.4,100,,percent of total billed charges,,
NEEDLE INTERJECT CLEAR 25GA  240CM  BOSTON SCI  M00518310,,A4215,HCPCS,Facility,Both,,,,239.4,203.49,68.61204,239.4,BlueCross BlueShield Minnesota,High Value Network Plan,215.46,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
NEEDLE INTERJECT CLEAR 25GA  240CM  BOSTON SCI  M00518310,,A4215,HCPCS,Facility,Outpatient,,,,239.4,203.49,68.61204,239.4,BlueCross BlueShield Minnesota,Medicare Advantage,117.306,49,,percent of total billed charges,,
NEEDLE INTERJECT CLEAR 25GA  240CM  BOSTON SCI  M00518310,,A4215,HCPCS,Facility,Inpatient,,,,239.4,203.49,68.61204,239.4,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
NEEDLE INTERJECT CLEAR 25GA  240CM  BOSTON SCI  M00518310,,A4215,HCPCS,Facility,Both,,,,239.4,203.49,68.61204,239.4,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,212.03658,88.57,,percent of total billed charges,,
NEEDLE INTERJECT CLEAR 25GA  240CM  BOSTON SCI  M00518310,,A4215,HCPCS,Facility,Both,,,,239.4,203.49,68.61204,239.4,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,68.61204,28.66,,percent of total billed charges,,
NEEDLE INTERJECT CLEAR 25GA  240CM  BOSTON SCI  M00518310,,A4215,HCPCS,Facility,Outpatient,,,,239.4,203.49,68.61204,239.4,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),117.306,49,,percent of total billed charges,,
NEEDLE INTERJECT CLEAR 25GA  240CM  BOSTON SCI  M00518310,,A4215,HCPCS,Facility,Inpatient,,,,239.4,203.49,68.61204,239.4,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
NEEDLE INTERJECT CLEAR 25GA  240CM  BOSTON SCI  M00518310,,A4215,HCPCS,Facility,Both,,,,239.4,203.49,68.61204,239.4,CorVel,Worker's Compensation,239.4,100,,percent of total billed charges,,
NEEDLE INTERJECT CLEAR 25GA  240CM  BOSTON SCI  M00518310,,A4215,HCPCS,Facility,Both,,,,239.4,203.49,68.61204,239.4,First Health Group Corporation,First Health Network,232.218,97,,percent of total billed charges,,
NEEDLE INTERJECT CLEAR 25GA  240CM  BOSTON SCI  M00518310,,A4215,HCPCS,Facility,Both,,,,239.4,203.49,68.61204,239.4,"Health Partners, Inc.",Commercial,226.4724,94.6,,percent of total billed charges,,
NEEDLE INTERJECT CLEAR 25GA  240CM  BOSTON SCI  M00518310,,A4215,HCPCS,Facility,Outpatient,,,,239.4,203.49,68.61204,239.4,"Health Partners, Inc.",Medicare Advantage,117.306,49,,percent of total billed charges,,
NEEDLE INTERJECT CLEAR 25GA  240CM  BOSTON SCI  M00518310,,A4215,HCPCS,Facility,Inpatient,,,,239.4,203.49,68.61204,239.4,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
NEEDLE INTERJECT CLEAR 25GA  240CM  BOSTON SCI  M00518310,,A4215,HCPCS,Facility,Both,,,,239.4,203.49,68.61204,239.4,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),143.64,60,,percent of total billed charges,,
NEEDLE INTERJECT CLEAR 25GA  240CM  BOSTON SCI  M00518310,,A4215,HCPCS,Facility,Both,,,,239.4,203.49,68.61204,239.4,"Health Partners, Inc.",State of Minnesota Advantage Program,195.111,81.5,,percent of total billed charges,,
NEEDLE INTERJECT CLEAR 25GA  240CM  BOSTON SCI  M00518310,,A4215,HCPCS,Facility,Both,,,,239.4,203.49,68.61204,239.4,"Health Partners, Inc.",State Public Programs,119.7,50,,percent of total billed charges,,
NEEDLE INTERJECT CLEAR 25GA  240CM  BOSTON SCI  M00518310,,A4215,HCPCS,Facility,Both,,,,239.4,203.49,68.61204,239.4,Humana Insurance Company,Commercial PPO,227.43,95,,percent of total billed charges,,
NEEDLE INTERJECT CLEAR 25GA  240CM  BOSTON SCI  M00518310,,A4215,HCPCS,Facility,Outpatient,,,,239.4,203.49,68.61204,239.4,Humana Insurance Company,Medicare PPO,117.306,49,,percent of total billed charges,,
NEEDLE INTERJECT CLEAR 25GA  240CM  BOSTON SCI  M00518310,,A4215,HCPCS,Facility,Inpatient,,,,239.4,203.49,68.61204,239.4,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
NEEDLE INTERJECT CLEAR 25GA  240CM  BOSTON SCI  M00518310,,A4215,HCPCS,Facility,Both,,,,239.4,203.49,68.61204,239.4,Medica,Individual & Family,237.2454,99.1,,percent of total billed charges,,
NEEDLE INTERJECT CLEAR 25GA  240CM  BOSTON SCI  M00518310,,A4215,HCPCS,Facility,Outpatient,,,,239.4,203.49,68.61204,239.4,Medica,Medica Advantage Solution,119.2212,49.8,,percent of total billed charges,,
NEEDLE INTERJECT CLEAR 25GA  240CM  BOSTON SCI  M00518310,,A4215,HCPCS,Facility,Inpatient,,,,239.4,203.49,68.61204,239.4,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
NEEDLE INTERJECT CLEAR 25GA  240CM  BOSTON SCI  M00518310,,A4215,HCPCS,Facility,Outpatient,,,,239.4,203.49,68.61204,239.4,Medica,Medical Assistance,106.7724,44.6,,percent of total billed charges,,
NEEDLE INTERJECT CLEAR 25GA  240CM  BOSTON SCI  M00518310,,A4215,HCPCS,Facility,Inpatient,,,,239.4,203.49,68.61204,239.4,Medica,Medical Assistance,,,,,Included in per diem rate,
NEEDLE INTERJECT CLEAR 25GA  240CM  BOSTON SCI  M00518310,,A4215,HCPCS,Facility,Outpatient,,,,239.4,203.49,68.61204,239.4,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,119.2212,49.8,,percent of total billed charges,,
NEEDLE INTERJECT CLEAR 25GA  240CM  BOSTON SCI  M00518310,,A4215,HCPCS,Facility,Inpatient,,,,239.4,203.49,68.61204,239.4,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
NEEDLE INTERJECT CLEAR 25GA  240CM  BOSTON SCI  M00518310,,A4215,HCPCS,Facility,Both,,,,239.4,203.49,68.61204,239.4,"Multiplan, Inc.","Multiplan, Inc.",225.036,94,,percent of total billed charges,,
NEEDLE INTERJECT CLEAR 25GA  240CM  BOSTON SCI  M00518310,,A4215,HCPCS,Facility,Outpatient,,,,239.4,203.49,68.61204,239.4,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,215.6994,90.1,,percent of total billed charges,,
NEEDLE INTERJECT CLEAR 25GA  240CM  BOSTON SCI  M00518310,,A4215,HCPCS,Facility,Inpatient,,,,239.4,203.49,68.61204,239.4,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
NEEDLE INTERJECT CLEAR 25GA  240CM  BOSTON SCI  M00518310,,A4215,HCPCS,Facility,Both,,,,239.4,203.49,68.61204,239.4,"Preferred One Administrative Services, INC.",PPO,236.0484,98.6,,percent of total billed charges,,
NEEDLE INTERJECT CLEAR 25GA  240CM  BOSTON SCI  M00518310,,A4215,HCPCS,Facility,Outpatient,,,,239.4,203.49,68.61204,239.4,PrimeWest Health,Minnesota Senior Health Options (MSHO),123.1713,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
NEEDLE INTERJECT CLEAR 25GA  240CM  BOSTON SCI  M00518310,,A4215,HCPCS,Facility,Inpatient,,,,239.4,203.49,68.61204,239.4,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
NEEDLE INTERJECT CLEAR 25GA  240CM  BOSTON SCI  M00518310,,A4215,HCPCS,Facility,Outpatient,,,,239.4,203.49,68.61204,239.4,PrimeWest Health,MinnesotaCare,122.95584,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
NEEDLE INTERJECT CLEAR 25GA  240CM  BOSTON SCI  M00518310,,A4215,HCPCS,Facility,Inpatient,,,,239.4,203.49,68.61204,239.4,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
NEEDLE INTERJECT CLEAR 25GA  240CM  BOSTON SCI  M00518310,,A4215,HCPCS,Facility,Both,,,,239.4,203.49,68.61204,239.4,Sanford Health Plan,Sanford Health Plan,220.248,92,,percent of total billed charges,,
NEEDLE INTERJECT CLEAR 25GA  240CM  BOSTON SCI  M00518310,,A4215,HCPCS,Facility,Outpatient,,,,239.4,203.49,68.61204,239.4,"UCare Health, Inc.",Individual & Family Plan,134.9019,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
NEEDLE INTERJECT CLEAR 25GA  240CM  BOSTON SCI  M00518310,,A4215,HCPCS,Facility,Inpatient,,,,239.4,203.49,68.61204,239.4,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
NEEDLE INTERJECT CLEAR 25GA  240CM  BOSTON SCI  M00518310,,A4215,HCPCS,Facility,Outpatient,,,,239.4,203.49,68.61204,239.4,"UCare Health, Inc.",Medical Assistance,120.82518,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
NEEDLE INTERJECT CLEAR 25GA  240CM  BOSTON SCI  M00518310,,A4215,HCPCS,Facility,Inpatient,,,,239.4,203.49,68.61204,239.4,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
NEEDLE INTERJECT CLEAR 25GA  240CM  BOSTON SCI  M00518310,,A4215,HCPCS,Facility,Outpatient,,,,239.4,203.49,68.61204,239.4,"UCare Health, Inc.",Medicare Advantage,120.82518,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
NEEDLE INTERJECT CLEAR 25GA  240CM  BOSTON SCI  M00518310,,A4215,HCPCS,Facility,Inpatient,,,,239.4,203.49,68.61204,239.4,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
NEEDLE INTERJECT CLEAR 25GA  240CM  BOSTON SCI  M00518310,,A4215,HCPCS,Facility,Outpatient,,,,239.4,203.49,68.61204,239.4,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),120.82518,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
NEEDLE INTERJECT CLEAR 25GA  240CM  BOSTON SCI  M00518310,,A4215,HCPCS,Facility,Inpatient,,,,239.4,203.49,68.61204,239.4,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
NEEDLE INTERJECT CLEAR 25GA  240CM  BOSTON SCI  M00518310,,A4215,HCPCS,Facility,Both,,,,239.4,203.49,68.61204,239.4,UnitedHealthcare,Individual & Family,225.036,94,,percent of total billed charges,,
NEEDLE INTERJECT CLEAR 25GA  240CM  BOSTON SCI  M00518310,,A4215,HCPCS,Facility,Outpatient,,,,239.4,203.49,68.61204,239.4,UnitedHealthcare,Medicare Advantage,117.306,49,,percent of total billed charges,,
NEEDLE INTERJECT CLEAR 25GA  240CM  BOSTON SCI  M00518310,,A4215,HCPCS,Facility,Inpatient,,,,239.4,203.49,68.61204,239.4,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
NEEDLE INTERJECT CLEAR 25GA  240CM  BOSTON SCI  M00518310,,A4215,HCPCS,Facility,Outpatient,,,,239.4,203.49,68.61204,239.4,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,114.912,48,,percent of total billed charges,,100% of DHS outpatient percentage
NEEDLE INTERJECT CLEAR 25GA  240CM  BOSTON SCI  M00518310,,A4215,HCPCS,Facility,Inpatient,,,,239.4,203.49,68.61204,239.4,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
NEEDLE MACROPLASTIQUE COGENTIX RIGID ENDOSCOPIC MRN-420,,A4215,HCPCS,Facility,Both,,,,120,102,34.392,120,Aetna,Commercial,110.4,92,,percent of total billed charges,,
NEEDLE MACROPLASTIQUE COGENTIX RIGID ENDOSCOPIC MRN-420,,A4215,HCPCS,Facility,Outpatient,,,,120,102,34.392,120,Aetna,Medicare Advantage,58.8,49,,percent of total billed charges,,
NEEDLE MACROPLASTIQUE COGENTIX RIGID ENDOSCOPIC MRN-420,,A4215,HCPCS,Facility,Inpatient,,,,120,102,34.392,120,Aetna,Medicare Advantage,,,,,Included in per diem rate,
NEEDLE MACROPLASTIQUE COGENTIX RIGID ENDOSCOPIC MRN-420,,A4215,HCPCS,Facility,Both,,,,120,102,34.392,120,Aetna,PPO,111.6,93,,percent of total billed charges,,
NEEDLE MACROPLASTIQUE COGENTIX RIGID ENDOSCOPIC MRN-420,,A4215,HCPCS,Facility,Both,,,,120,102,34.392,120,America's PPO,America's PPO,115.236,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
NEEDLE MACROPLASTIQUE COGENTIX RIGID ENDOSCOPIC MRN-420,,A4215,HCPCS,Facility,Both,,,,120,102,34.392,120,BlueCross BlueShield Minnesota, Federal Employee Program,118.08,98.4,,percent of total billed charges,,
NEEDLE MACROPLASTIQUE COGENTIX RIGID ENDOSCOPIC MRN-420,,A4215,HCPCS,Facility,Both,,,,120,102,34.392,120,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,120,100,,percent of total billed charges,,
NEEDLE MACROPLASTIQUE COGENTIX RIGID ENDOSCOPIC MRN-420,,A4215,HCPCS,Facility,Both,,,,120,102,34.392,120,BlueCross BlueShield Minnesota,High Value Network Plan,108,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
NEEDLE MACROPLASTIQUE COGENTIX RIGID ENDOSCOPIC MRN-420,,A4215,HCPCS,Facility,Outpatient,,,,120,102,34.392,120,BlueCross BlueShield Minnesota,Medicare Advantage,58.8,49,,percent of total billed charges,,
NEEDLE MACROPLASTIQUE COGENTIX RIGID ENDOSCOPIC MRN-420,,A4215,HCPCS,Facility,Inpatient,,,,120,102,34.392,120,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
NEEDLE MACROPLASTIQUE COGENTIX RIGID ENDOSCOPIC MRN-420,,A4215,HCPCS,Facility,Both,,,,120,102,34.392,120,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,106.284,88.57,,percent of total billed charges,,
NEEDLE MACROPLASTIQUE COGENTIX RIGID ENDOSCOPIC MRN-420,,A4215,HCPCS,Facility,Both,,,,120,102,34.392,120,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,34.392,28.66,,percent of total billed charges,,
NEEDLE MACROPLASTIQUE COGENTIX RIGID ENDOSCOPIC MRN-420,,A4215,HCPCS,Facility,Outpatient,,,,120,102,34.392,120,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),58.8,49,,percent of total billed charges,,
NEEDLE MACROPLASTIQUE COGENTIX RIGID ENDOSCOPIC MRN-420,,A4215,HCPCS,Facility,Inpatient,,,,120,102,34.392,120,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
NEEDLE MACROPLASTIQUE COGENTIX RIGID ENDOSCOPIC MRN-420,,A4215,HCPCS,Facility,Both,,,,120,102,34.392,120,CorVel,Worker's Compensation,120,100,,percent of total billed charges,,
NEEDLE MACROPLASTIQUE COGENTIX RIGID ENDOSCOPIC MRN-420,,A4215,HCPCS,Facility,Both,,,,120,102,34.392,120,First Health Group Corporation,First Health Network,116.4,97,,percent of total billed charges,,
NEEDLE MACROPLASTIQUE COGENTIX RIGID ENDOSCOPIC MRN-420,,A4215,HCPCS,Facility,Both,,,,120,102,34.392,120,"Health Partners, Inc.",Commercial,113.52,94.6,,percent of total billed charges,,
NEEDLE MACROPLASTIQUE COGENTIX RIGID ENDOSCOPIC MRN-420,,A4215,HCPCS,Facility,Outpatient,,,,120,102,34.392,120,"Health Partners, Inc.",Medicare Advantage,58.8,49,,percent of total billed charges,,
NEEDLE MACROPLASTIQUE COGENTIX RIGID ENDOSCOPIC MRN-420,,A4215,HCPCS,Facility,Inpatient,,,,120,102,34.392,120,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
NEEDLE MACROPLASTIQUE COGENTIX RIGID ENDOSCOPIC MRN-420,,A4215,HCPCS,Facility,Both,,,,120,102,34.392,120,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),72,60,,percent of total billed charges,,
NEEDLE MACROPLASTIQUE COGENTIX RIGID ENDOSCOPIC MRN-420,,A4215,HCPCS,Facility,Both,,,,120,102,34.392,120,"Health Partners, Inc.",State of Minnesota Advantage Program,97.8,81.5,,percent of total billed charges,,
NEEDLE MACROPLASTIQUE COGENTIX RIGID ENDOSCOPIC MRN-420,,A4215,HCPCS,Facility,Both,,,,120,102,34.392,120,"Health Partners, Inc.",State Public Programs,60,50,,percent of total billed charges,,
NEEDLE MACROPLASTIQUE COGENTIX RIGID ENDOSCOPIC MRN-420,,A4215,HCPCS,Facility,Both,,,,120,102,34.392,120,Humana Insurance Company,Commercial PPO,114,95,,percent of total billed charges,,
NEEDLE MACROPLASTIQUE COGENTIX RIGID ENDOSCOPIC MRN-420,,A4215,HCPCS,Facility,Outpatient,,,,120,102,34.392,120,Humana Insurance Company,Medicare PPO,58.8,49,,percent of total billed charges,,
NEEDLE MACROPLASTIQUE COGENTIX RIGID ENDOSCOPIC MRN-420,,A4215,HCPCS,Facility,Inpatient,,,,120,102,34.392,120,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
NEEDLE MACROPLASTIQUE COGENTIX RIGID ENDOSCOPIC MRN-420,,A4215,HCPCS,Facility,Both,,,,120,102,34.392,120,Medica,Individual & Family,118.92,99.1,,percent of total billed charges,,
NEEDLE MACROPLASTIQUE COGENTIX RIGID ENDOSCOPIC MRN-420,,A4215,HCPCS,Facility,Outpatient,,,,120,102,34.392,120,Medica,Medica Advantage Solution,59.76,49.8,,percent of total billed charges,,
NEEDLE MACROPLASTIQUE COGENTIX RIGID ENDOSCOPIC MRN-420,,A4215,HCPCS,Facility,Inpatient,,,,120,102,34.392,120,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
NEEDLE MACROPLASTIQUE COGENTIX RIGID ENDOSCOPIC MRN-420,,A4215,HCPCS,Facility,Outpatient,,,,120,102,34.392,120,Medica,Medical Assistance,53.52,44.6,,percent of total billed charges,,
NEEDLE MACROPLASTIQUE COGENTIX RIGID ENDOSCOPIC MRN-420,,A4215,HCPCS,Facility,Inpatient,,,,120,102,34.392,120,Medica,Medical Assistance,,,,,Included in per diem rate,
NEEDLE MACROPLASTIQUE COGENTIX RIGID ENDOSCOPIC MRN-420,,A4215,HCPCS,Facility,Outpatient,,,,120,102,34.392,120,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,59.76,49.8,,percent of total billed charges,,
NEEDLE MACROPLASTIQUE COGENTIX RIGID ENDOSCOPIC MRN-420,,A4215,HCPCS,Facility,Inpatient,,,,120,102,34.392,120,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
NEEDLE MACROPLASTIQUE COGENTIX RIGID ENDOSCOPIC MRN-420,,A4215,HCPCS,Facility,Both,,,,120,102,34.392,120,"Multiplan, Inc.","Multiplan, Inc.",112.8,94,,percent of total billed charges,,
NEEDLE MACROPLASTIQUE COGENTIX RIGID ENDOSCOPIC MRN-420,,A4215,HCPCS,Facility,Outpatient,,,,120,102,34.392,120,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,108.12,90.1,,percent of total billed charges,,
NEEDLE MACROPLASTIQUE COGENTIX RIGID ENDOSCOPIC MRN-420,,A4215,HCPCS,Facility,Inpatient,,,,120,102,34.392,120,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
NEEDLE MACROPLASTIQUE COGENTIX RIGID ENDOSCOPIC MRN-420,,A4215,HCPCS,Facility,Both,,,,120,102,34.392,120,"Preferred One Administrative Services, INC.",PPO,118.32,98.6,,percent of total billed charges,,
NEEDLE MACROPLASTIQUE COGENTIX RIGID ENDOSCOPIC MRN-420,,A4215,HCPCS,Facility,Outpatient,,,,120,102,34.392,120,PrimeWest Health,Minnesota Senior Health Options (MSHO),61.74,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
NEEDLE MACROPLASTIQUE COGENTIX RIGID ENDOSCOPIC MRN-420,,A4215,HCPCS,Facility,Inpatient,,,,120,102,34.392,120,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
NEEDLE MACROPLASTIQUE COGENTIX RIGID ENDOSCOPIC MRN-420,,A4215,HCPCS,Facility,Outpatient,,,,120,102,34.392,120,PrimeWest Health,MinnesotaCare,61.632,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
NEEDLE MACROPLASTIQUE COGENTIX RIGID ENDOSCOPIC MRN-420,,A4215,HCPCS,Facility,Inpatient,,,,120,102,34.392,120,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
NEEDLE MACROPLASTIQUE COGENTIX RIGID ENDOSCOPIC MRN-420,,A4215,HCPCS,Facility,Both,,,,120,102,34.392,120,Sanford Health Plan,Sanford Health Plan,110.4,92,,percent of total billed charges,,
NEEDLE MACROPLASTIQUE COGENTIX RIGID ENDOSCOPIC MRN-420,,A4215,HCPCS,Facility,Outpatient,,,,120,102,34.392,120,"UCare Health, Inc.",Individual & Family Plan,67.62,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
NEEDLE MACROPLASTIQUE COGENTIX RIGID ENDOSCOPIC MRN-420,,A4215,HCPCS,Facility,Inpatient,,,,120,102,34.392,120,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
NEEDLE MACROPLASTIQUE COGENTIX RIGID ENDOSCOPIC MRN-420,,A4215,HCPCS,Facility,Outpatient,,,,120,102,34.392,120,"UCare Health, Inc.",Medical Assistance,60.564,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
NEEDLE MACROPLASTIQUE COGENTIX RIGID ENDOSCOPIC MRN-420,,A4215,HCPCS,Facility,Inpatient,,,,120,102,34.392,120,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
NEEDLE MACROPLASTIQUE COGENTIX RIGID ENDOSCOPIC MRN-420,,A4215,HCPCS,Facility,Outpatient,,,,120,102,34.392,120,"UCare Health, Inc.",Medicare Advantage,60.564,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
NEEDLE MACROPLASTIQUE COGENTIX RIGID ENDOSCOPIC MRN-420,,A4215,HCPCS,Facility,Inpatient,,,,120,102,34.392,120,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
NEEDLE MACROPLASTIQUE COGENTIX RIGID ENDOSCOPIC MRN-420,,A4215,HCPCS,Facility,Outpatient,,,,120,102,34.392,120,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),60.564,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
NEEDLE MACROPLASTIQUE COGENTIX RIGID ENDOSCOPIC MRN-420,,A4215,HCPCS,Facility,Inpatient,,,,120,102,34.392,120,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
NEEDLE MACROPLASTIQUE COGENTIX RIGID ENDOSCOPIC MRN-420,,A4215,HCPCS,Facility,Both,,,,120,102,34.392,120,UnitedHealthcare,Individual & Family,112.8,94,,percent of total billed charges,,
NEEDLE MACROPLASTIQUE COGENTIX RIGID ENDOSCOPIC MRN-420,,A4215,HCPCS,Facility,Outpatient,,,,120,102,34.392,120,UnitedHealthcare,Medicare Advantage,58.8,49,,percent of total billed charges,,
NEEDLE MACROPLASTIQUE COGENTIX RIGID ENDOSCOPIC MRN-420,,A4215,HCPCS,Facility,Inpatient,,,,120,102,34.392,120,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
NEEDLE MACROPLASTIQUE COGENTIX RIGID ENDOSCOPIC MRN-420,,A4215,HCPCS,Facility,Outpatient,,,,120,102,34.392,120,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,57.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
NEEDLE MACROPLASTIQUE COGENTIX RIGID ENDOSCOPIC MRN-420,,A4215,HCPCS,Facility,Inpatient,,,,120,102,34.392,120,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
NEEDLE SPINAL QUINCKE 22GA X 7 INCH  405149,,A4215,HCPCS,Facility,Both,,,,25.4,21.59,7.27964,25.4,Aetna,Commercial,23.368,92,,percent of total billed charges,,
NEEDLE SPINAL QUINCKE 22GA X 7 INCH  405149,,A4215,HCPCS,Facility,Outpatient,,,,25.4,21.59,7.27964,25.4,Aetna,Medicare Advantage,12.446,49,,percent of total billed charges,,
NEEDLE SPINAL QUINCKE 22GA X 7 INCH  405149,,A4215,HCPCS,Facility,Inpatient,,,,25.4,21.59,7.27964,25.4,Aetna,Medicare Advantage,,,,,Included in per diem rate,
NEEDLE SPINAL QUINCKE 22GA X 7 INCH  405149,,A4215,HCPCS,Facility,Both,,,,25.4,21.59,7.27964,25.4,Aetna,PPO,23.622,93,,percent of total billed charges,,
NEEDLE SPINAL QUINCKE 22GA X 7 INCH  405149,,A4215,HCPCS,Facility,Both,,,,25.4,21.59,7.27964,25.4,America's PPO,America's PPO,24.39162,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
NEEDLE SPINAL QUINCKE 22GA X 7 INCH  405149,,A4215,HCPCS,Facility,Both,,,,25.4,21.59,7.27964,25.4,BlueCross BlueShield Minnesota, Federal Employee Program,24.9936,98.4,,percent of total billed charges,,
NEEDLE SPINAL QUINCKE 22GA X 7 INCH  405149,,A4215,HCPCS,Facility,Both,,,,25.4,21.59,7.27964,25.4,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,25.4,100,,percent of total billed charges,,
NEEDLE SPINAL QUINCKE 22GA X 7 INCH  405149,,A4215,HCPCS,Facility,Both,,,,25.4,21.59,7.27964,25.4,BlueCross BlueShield Minnesota,High Value Network Plan,22.86,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
NEEDLE SPINAL QUINCKE 22GA X 7 INCH  405149,,A4215,HCPCS,Facility,Outpatient,,,,25.4,21.59,7.27964,25.4,BlueCross BlueShield Minnesota,Medicare Advantage,12.446,49,,percent of total billed charges,,
NEEDLE SPINAL QUINCKE 22GA X 7 INCH  405149,,A4215,HCPCS,Facility,Inpatient,,,,25.4,21.59,7.27964,25.4,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
NEEDLE SPINAL QUINCKE 22GA X 7 INCH  405149,,A4215,HCPCS,Facility,Both,,,,25.4,21.59,7.27964,25.4,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,22.49678,88.57,,percent of total billed charges,,
NEEDLE SPINAL QUINCKE 22GA X 7 INCH  405149,,A4215,HCPCS,Facility,Both,,,,25.4,21.59,7.27964,25.4,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,7.27964,28.66,,percent of total billed charges,,
NEEDLE SPINAL QUINCKE 22GA X 7 INCH  405149,,A4215,HCPCS,Facility,Outpatient,,,,25.4,21.59,7.27964,25.4,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),12.446,49,,percent of total billed charges,,
NEEDLE SPINAL QUINCKE 22GA X 7 INCH  405149,,A4215,HCPCS,Facility,Inpatient,,,,25.4,21.59,7.27964,25.4,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
NEEDLE SPINAL QUINCKE 22GA X 7 INCH  405149,,A4215,HCPCS,Facility,Both,,,,25.4,21.59,7.27964,25.4,CorVel,Worker's Compensation,25.4,100,,percent of total billed charges,,
NEEDLE SPINAL QUINCKE 22GA X 7 INCH  405149,,A4215,HCPCS,Facility,Both,,,,25.4,21.59,7.27964,25.4,First Health Group Corporation,First Health Network,24.638,97,,percent of total billed charges,,
NEEDLE SPINAL QUINCKE 22GA X 7 INCH  405149,,A4215,HCPCS,Facility,Both,,,,25.4,21.59,7.27964,25.4,"Health Partners, Inc.",Commercial,24.0284,94.6,,percent of total billed charges,,
NEEDLE SPINAL QUINCKE 22GA X 7 INCH  405149,,A4215,HCPCS,Facility,Outpatient,,,,25.4,21.59,7.27964,25.4,"Health Partners, Inc.",Medicare Advantage,12.446,49,,percent of total billed charges,,
NEEDLE SPINAL QUINCKE 22GA X 7 INCH  405149,,A4215,HCPCS,Facility,Inpatient,,,,25.4,21.59,7.27964,25.4,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
NEEDLE SPINAL QUINCKE 22GA X 7 INCH  405149,,A4215,HCPCS,Facility,Both,,,,25.4,21.59,7.27964,25.4,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),15.24,60,,percent of total billed charges,,
NEEDLE SPINAL QUINCKE 22GA X 7 INCH  405149,,A4215,HCPCS,Facility,Both,,,,25.4,21.59,7.27964,25.4,"Health Partners, Inc.",State of Minnesota Advantage Program,20.701,81.5,,percent of total billed charges,,
NEEDLE SPINAL QUINCKE 22GA X 7 INCH  405149,,A4215,HCPCS,Facility,Both,,,,25.4,21.59,7.27964,25.4,"Health Partners, Inc.",State Public Programs,12.7,50,,percent of total billed charges,,
NEEDLE SPINAL QUINCKE 22GA X 7 INCH  405149,,A4215,HCPCS,Facility,Both,,,,25.4,21.59,7.27964,25.4,Humana Insurance Company,Commercial PPO,24.13,95,,percent of total billed charges,,
NEEDLE SPINAL QUINCKE 22GA X 7 INCH  405149,,A4215,HCPCS,Facility,Outpatient,,,,25.4,21.59,7.27964,25.4,Humana Insurance Company,Medicare PPO,12.446,49,,percent of total billed charges,,
NEEDLE SPINAL QUINCKE 22GA X 7 INCH  405149,,A4215,HCPCS,Facility,Inpatient,,,,25.4,21.59,7.27964,25.4,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
NEEDLE SPINAL QUINCKE 22GA X 7 INCH  405149,,A4215,HCPCS,Facility,Both,,,,25.4,21.59,7.27964,25.4,Medica,Individual & Family,25.1714,99.1,,percent of total billed charges,,
NEEDLE SPINAL QUINCKE 22GA X 7 INCH  405149,,A4215,HCPCS,Facility,Outpatient,,,,25.4,21.59,7.27964,25.4,Medica,Medica Advantage Solution,12.6492,49.8,,percent of total billed charges,,
NEEDLE SPINAL QUINCKE 22GA X 7 INCH  405149,,A4215,HCPCS,Facility,Inpatient,,,,25.4,21.59,7.27964,25.4,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
NEEDLE SPINAL QUINCKE 22GA X 7 INCH  405149,,A4215,HCPCS,Facility,Outpatient,,,,25.4,21.59,7.27964,25.4,Medica,Medical Assistance,11.3284,44.6,,percent of total billed charges,,
NEEDLE SPINAL QUINCKE 22GA X 7 INCH  405149,,A4215,HCPCS,Facility,Inpatient,,,,25.4,21.59,7.27964,25.4,Medica,Medical Assistance,,,,,Included in per diem rate,
NEEDLE SPINAL QUINCKE 22GA X 7 INCH  405149,,A4215,HCPCS,Facility,Outpatient,,,,25.4,21.59,7.27964,25.4,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,12.6492,49.8,,percent of total billed charges,,
NEEDLE SPINAL QUINCKE 22GA X 7 INCH  405149,,A4215,HCPCS,Facility,Inpatient,,,,25.4,21.59,7.27964,25.4,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
NEEDLE SPINAL QUINCKE 22GA X 7 INCH  405149,,A4215,HCPCS,Facility,Both,,,,25.4,21.59,7.27964,25.4,"Multiplan, Inc.","Multiplan, Inc.",23.876,94,,percent of total billed charges,,
NEEDLE SPINAL QUINCKE 22GA X 7 INCH  405149,,A4215,HCPCS,Facility,Outpatient,,,,25.4,21.59,7.27964,25.4,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,22.8854,90.1,,percent of total billed charges,,
NEEDLE SPINAL QUINCKE 22GA X 7 INCH  405149,,A4215,HCPCS,Facility,Inpatient,,,,25.4,21.59,7.27964,25.4,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
NEEDLE SPINAL QUINCKE 22GA X 7 INCH  405149,,A4215,HCPCS,Facility,Both,,,,25.4,21.59,7.27964,25.4,"Preferred One Administrative Services, INC.",PPO,25.0444,98.6,,percent of total billed charges,,
NEEDLE SPINAL QUINCKE 22GA X 7 INCH  405149,,A4215,HCPCS,Facility,Outpatient,,,,25.4,21.59,7.27964,25.4,PrimeWest Health,Minnesota Senior Health Options (MSHO),13.0683,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
NEEDLE SPINAL QUINCKE 22GA X 7 INCH  405149,,A4215,HCPCS,Facility,Inpatient,,,,25.4,21.59,7.27964,25.4,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
NEEDLE SPINAL QUINCKE 22GA X 7 INCH  405149,,A4215,HCPCS,Facility,Outpatient,,,,25.4,21.59,7.27964,25.4,PrimeWest Health,MinnesotaCare,13.04544,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
NEEDLE SPINAL QUINCKE 22GA X 7 INCH  405149,,A4215,HCPCS,Facility,Inpatient,,,,25.4,21.59,7.27964,25.4,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
NEEDLE SPINAL QUINCKE 22GA X 7 INCH  405149,,A4215,HCPCS,Facility,Both,,,,25.4,21.59,7.27964,25.4,Sanford Health Plan,Sanford Health Plan,23.368,92,,percent of total billed charges,,
NEEDLE SPINAL QUINCKE 22GA X 7 INCH  405149,,A4215,HCPCS,Facility,Outpatient,,,,25.4,21.59,7.27964,25.4,"UCare Health, Inc.",Individual & Family Plan,14.3129,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
NEEDLE SPINAL QUINCKE 22GA X 7 INCH  405149,,A4215,HCPCS,Facility,Inpatient,,,,25.4,21.59,7.27964,25.4,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
NEEDLE SPINAL QUINCKE 22GA X 7 INCH  405149,,A4215,HCPCS,Facility,Outpatient,,,,25.4,21.59,7.27964,25.4,"UCare Health, Inc.",Medical Assistance,12.81938,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
NEEDLE SPINAL QUINCKE 22GA X 7 INCH  405149,,A4215,HCPCS,Facility,Inpatient,,,,25.4,21.59,7.27964,25.4,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
NEEDLE SPINAL QUINCKE 22GA X 7 INCH  405149,,A4215,HCPCS,Facility,Outpatient,,,,25.4,21.59,7.27964,25.4,"UCare Health, Inc.",Medicare Advantage,12.81938,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
NEEDLE SPINAL QUINCKE 22GA X 7 INCH  405149,,A4215,HCPCS,Facility,Inpatient,,,,25.4,21.59,7.27964,25.4,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
NEEDLE SPINAL QUINCKE 22GA X 7 INCH  405149,,A4215,HCPCS,Facility,Outpatient,,,,25.4,21.59,7.27964,25.4,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),12.81938,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
NEEDLE SPINAL QUINCKE 22GA X 7 INCH  405149,,A4215,HCPCS,Facility,Inpatient,,,,25.4,21.59,7.27964,25.4,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
NEEDLE SPINAL QUINCKE 22GA X 7 INCH  405149,,A4215,HCPCS,Facility,Both,,,,25.4,21.59,7.27964,25.4,UnitedHealthcare,Individual & Family,23.876,94,,percent of total billed charges,,
NEEDLE SPINAL QUINCKE 22GA X 7 INCH  405149,,A4215,HCPCS,Facility,Outpatient,,,,25.4,21.59,7.27964,25.4,UnitedHealthcare,Medicare Advantage,12.446,49,,percent of total billed charges,,
NEEDLE SPINAL QUINCKE 22GA X 7 INCH  405149,,A4215,HCPCS,Facility,Inpatient,,,,25.4,21.59,7.27964,25.4,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
NEEDLE SPINAL QUINCKE 22GA X 7 INCH  405149,,A4215,HCPCS,Facility,Outpatient,,,,25.4,21.59,7.27964,25.4,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,12.192,48,,percent of total billed charges,,100% of DHS outpatient percentage
NEEDLE SPINAL QUINCKE 22GA X 7 INCH  405149,,A4215,HCPCS,Facility,Inpatient,,,,25.4,21.59,7.27964,25.4,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
NEEDLE STIMUPLEX CTD 21GA X 100MM,,A4215,HCPCS,Facility,Both,,,,72,61.2,20.6352,72,Aetna,Commercial,66.24,92,,percent of total billed charges,,
NEEDLE STIMUPLEX CTD 21GA X 100MM,,A4215,HCPCS,Facility,Outpatient,,,,72,61.2,20.6352,72,Aetna,Medicare Advantage,35.28,49,,percent of total billed charges,,
NEEDLE STIMUPLEX CTD 21GA X 100MM,,A4215,HCPCS,Facility,Inpatient,,,,72,61.2,20.6352,72,Aetna,Medicare Advantage,,,,,Included in per diem rate,
NEEDLE STIMUPLEX CTD 21GA X 100MM,,A4215,HCPCS,Facility,Both,,,,72,61.2,20.6352,72,Aetna,PPO,66.96,93,,percent of total billed charges,,
NEEDLE STIMUPLEX CTD 21GA X 100MM,,A4215,HCPCS,Facility,Both,,,,72,61.2,20.6352,72,America's PPO,America's PPO,69.1416,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
NEEDLE STIMUPLEX CTD 21GA X 100MM,,A4215,HCPCS,Facility,Both,,,,72,61.2,20.6352,72,BlueCross BlueShield Minnesota, Federal Employee Program,70.848,98.4,,percent of total billed charges,,
NEEDLE STIMUPLEX CTD 21GA X 100MM,,A4215,HCPCS,Facility,Both,,,,72,61.2,20.6352,72,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,72,100,,percent of total billed charges,,
NEEDLE STIMUPLEX CTD 21GA X 100MM,,A4215,HCPCS,Facility,Both,,,,72,61.2,20.6352,72,BlueCross BlueShield Minnesota,High Value Network Plan,64.8,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
NEEDLE STIMUPLEX CTD 21GA X 100MM,,A4215,HCPCS,Facility,Outpatient,,,,72,61.2,20.6352,72,BlueCross BlueShield Minnesota,Medicare Advantage,35.28,49,,percent of total billed charges,,
NEEDLE STIMUPLEX CTD 21GA X 100MM,,A4215,HCPCS,Facility,Inpatient,,,,72,61.2,20.6352,72,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
NEEDLE STIMUPLEX CTD 21GA X 100MM,,A4215,HCPCS,Facility,Both,,,,72,61.2,20.6352,72,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,63.7704,88.57,,percent of total billed charges,,
NEEDLE STIMUPLEX CTD 21GA X 100MM,,A4215,HCPCS,Facility,Both,,,,72,61.2,20.6352,72,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,20.6352,28.66,,percent of total billed charges,,
NEEDLE STIMUPLEX CTD 21GA X 100MM,,A4215,HCPCS,Facility,Outpatient,,,,72,61.2,20.6352,72,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),35.28,49,,percent of total billed charges,,
NEEDLE STIMUPLEX CTD 21GA X 100MM,,A4215,HCPCS,Facility,Inpatient,,,,72,61.2,20.6352,72,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
NEEDLE STIMUPLEX CTD 21GA X 100MM,,A4215,HCPCS,Facility,Both,,,,72,61.2,20.6352,72,CorVel,Worker's Compensation,72,100,,percent of total billed charges,,
NEEDLE STIMUPLEX CTD 21GA X 100MM,,A4215,HCPCS,Facility,Both,,,,72,61.2,20.6352,72,First Health Group Corporation,First Health Network,69.84,97,,percent of total billed charges,,
NEEDLE STIMUPLEX CTD 21GA X 100MM,,A4215,HCPCS,Facility,Both,,,,72,61.2,20.6352,72,"Health Partners, Inc.",Commercial,68.112,94.6,,percent of total billed charges,,
NEEDLE STIMUPLEX CTD 21GA X 100MM,,A4215,HCPCS,Facility,Outpatient,,,,72,61.2,20.6352,72,"Health Partners, Inc.",Medicare Advantage,35.28,49,,percent of total billed charges,,
NEEDLE STIMUPLEX CTD 21GA X 100MM,,A4215,HCPCS,Facility,Inpatient,,,,72,61.2,20.6352,72,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
NEEDLE STIMUPLEX CTD 21GA X 100MM,,A4215,HCPCS,Facility,Both,,,,72,61.2,20.6352,72,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),43.2,60,,percent of total billed charges,,
NEEDLE STIMUPLEX CTD 21GA X 100MM,,A4215,HCPCS,Facility,Both,,,,72,61.2,20.6352,72,"Health Partners, Inc.",State of Minnesota Advantage Program,58.68,81.5,,percent of total billed charges,,
NEEDLE STIMUPLEX CTD 21GA X 100MM,,A4215,HCPCS,Facility,Both,,,,72,61.2,20.6352,72,"Health Partners, Inc.",State Public Programs,36,50,,percent of total billed charges,,
NEEDLE STIMUPLEX CTD 21GA X 100MM,,A4215,HCPCS,Facility,Both,,,,72,61.2,20.6352,72,Humana Insurance Company,Commercial PPO,68.4,95,,percent of total billed charges,,
NEEDLE STIMUPLEX CTD 21GA X 100MM,,A4215,HCPCS,Facility,Outpatient,,,,72,61.2,20.6352,72,Humana Insurance Company,Medicare PPO,35.28,49,,percent of total billed charges,,
NEEDLE STIMUPLEX CTD 21GA X 100MM,,A4215,HCPCS,Facility,Inpatient,,,,72,61.2,20.6352,72,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
NEEDLE STIMUPLEX CTD 21GA X 100MM,,A4215,HCPCS,Facility,Both,,,,72,61.2,20.6352,72,Medica,Individual & Family,71.352,99.1,,percent of total billed charges,,
NEEDLE STIMUPLEX CTD 21GA X 100MM,,A4215,HCPCS,Facility,Outpatient,,,,72,61.2,20.6352,72,Medica,Medica Advantage Solution,35.856,49.8,,percent of total billed charges,,
NEEDLE STIMUPLEX CTD 21GA X 100MM,,A4215,HCPCS,Facility,Inpatient,,,,72,61.2,20.6352,72,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
NEEDLE STIMUPLEX CTD 21GA X 100MM,,A4215,HCPCS,Facility,Outpatient,,,,72,61.2,20.6352,72,Medica,Medical Assistance,32.112,44.6,,percent of total billed charges,,
NEEDLE STIMUPLEX CTD 21GA X 100MM,,A4215,HCPCS,Facility,Inpatient,,,,72,61.2,20.6352,72,Medica,Medical Assistance,,,,,Included in per diem rate,
NEEDLE STIMUPLEX CTD 21GA X 100MM,,A4215,HCPCS,Facility,Outpatient,,,,72,61.2,20.6352,72,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,35.856,49.8,,percent of total billed charges,,
NEEDLE STIMUPLEX CTD 21GA X 100MM,,A4215,HCPCS,Facility,Inpatient,,,,72,61.2,20.6352,72,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
NEEDLE STIMUPLEX CTD 21GA X 100MM,,A4215,HCPCS,Facility,Both,,,,72,61.2,20.6352,72,"Multiplan, Inc.","Multiplan, Inc.",67.68,94,,percent of total billed charges,,
NEEDLE STIMUPLEX CTD 21GA X 100MM,,A4215,HCPCS,Facility,Outpatient,,,,72,61.2,20.6352,72,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,64.872,90.1,,percent of total billed charges,,
NEEDLE STIMUPLEX CTD 21GA X 100MM,,A4215,HCPCS,Facility,Inpatient,,,,72,61.2,20.6352,72,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
NEEDLE STIMUPLEX CTD 21GA X 100MM,,A4215,HCPCS,Facility,Both,,,,72,61.2,20.6352,72,"Preferred One Administrative Services, INC.",PPO,70.992,98.6,,percent of total billed charges,,
NEEDLE STIMUPLEX CTD 21GA X 100MM,,A4215,HCPCS,Facility,Outpatient,,,,72,61.2,20.6352,72,PrimeWest Health,Minnesota Senior Health Options (MSHO),37.044,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
NEEDLE STIMUPLEX CTD 21GA X 100MM,,A4215,HCPCS,Facility,Inpatient,,,,72,61.2,20.6352,72,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
NEEDLE STIMUPLEX CTD 21GA X 100MM,,A4215,HCPCS,Facility,Outpatient,,,,72,61.2,20.6352,72,PrimeWest Health,MinnesotaCare,36.9792,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
NEEDLE STIMUPLEX CTD 21GA X 100MM,,A4215,HCPCS,Facility,Inpatient,,,,72,61.2,20.6352,72,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
NEEDLE STIMUPLEX CTD 21GA X 100MM,,A4215,HCPCS,Facility,Both,,,,72,61.2,20.6352,72,Sanford Health Plan,Sanford Health Plan,66.24,92,,percent of total billed charges,,
NEEDLE STIMUPLEX CTD 21GA X 100MM,,A4215,HCPCS,Facility,Outpatient,,,,72,61.2,20.6352,72,"UCare Health, Inc.",Individual & Family Plan,40.572,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
NEEDLE STIMUPLEX CTD 21GA X 100MM,,A4215,HCPCS,Facility,Inpatient,,,,72,61.2,20.6352,72,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
NEEDLE STIMUPLEX CTD 21GA X 100MM,,A4215,HCPCS,Facility,Outpatient,,,,72,61.2,20.6352,72,"UCare Health, Inc.",Medical Assistance,36.3384,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
NEEDLE STIMUPLEX CTD 21GA X 100MM,,A4215,HCPCS,Facility,Inpatient,,,,72,61.2,20.6352,72,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
NEEDLE STIMUPLEX CTD 21GA X 100MM,,A4215,HCPCS,Facility,Outpatient,,,,72,61.2,20.6352,72,"UCare Health, Inc.",Medicare Advantage,36.3384,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
NEEDLE STIMUPLEX CTD 21GA X 100MM,,A4215,HCPCS,Facility,Inpatient,,,,72,61.2,20.6352,72,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
NEEDLE STIMUPLEX CTD 21GA X 100MM,,A4215,HCPCS,Facility,Outpatient,,,,72,61.2,20.6352,72,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),36.3384,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
NEEDLE STIMUPLEX CTD 21GA X 100MM,,A4215,HCPCS,Facility,Inpatient,,,,72,61.2,20.6352,72,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
NEEDLE STIMUPLEX CTD 21GA X 100MM,,A4215,HCPCS,Facility,Both,,,,72,61.2,20.6352,72,UnitedHealthcare,Individual & Family,67.68,94,,percent of total billed charges,,
NEEDLE STIMUPLEX CTD 21GA X 100MM,,A4215,HCPCS,Facility,Outpatient,,,,72,61.2,20.6352,72,UnitedHealthcare,Medicare Advantage,35.28,49,,percent of total billed charges,,
NEEDLE STIMUPLEX CTD 21GA X 100MM,,A4215,HCPCS,Facility,Inpatient,,,,72,61.2,20.6352,72,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
NEEDLE STIMUPLEX CTD 21GA X 100MM,,A4215,HCPCS,Facility,Outpatient,,,,72,61.2,20.6352,72,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,34.56,48,,percent of total billed charges,,100% of DHS outpatient percentage
NEEDLE STIMUPLEX CTD 21GA X 100MM,,A4215,HCPCS,Facility,Inpatient,,,,72,61.2,20.6352,72,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Sup Spinal Tray,,A4215,HCPCS,Facility,Both,,,,80,68,22.928,80,Aetna,Commercial,73.6,92,,percent of total billed charges,,
Sup Spinal Tray,,A4215,HCPCS,Facility,Outpatient,,,,80,68,22.928,80,Aetna,Medicare Advantage,39.2,49,,percent of total billed charges,,
Sup Spinal Tray,,A4215,HCPCS,Facility,Inpatient,,,,80,68,22.928,80,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Sup Spinal Tray,,A4215,HCPCS,Facility,Both,,,,80,68,22.928,80,Aetna,PPO,74.4,93,,percent of total billed charges,,
Sup Spinal Tray,,A4215,HCPCS,Facility,Both,,,,80,68,22.928,80,America's PPO,America's PPO,76.824,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Sup Spinal Tray,,A4215,HCPCS,Facility,Both,,,,80,68,22.928,80,BlueCross BlueShield Minnesota, Federal Employee Program,78.72,98.4,,percent of total billed charges,,
Sup Spinal Tray,,A4215,HCPCS,Facility,Both,,,,80,68,22.928,80,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,80,100,,percent of total billed charges,,
Sup Spinal Tray,,A4215,HCPCS,Facility,Both,,,,80,68,22.928,80,BlueCross BlueShield Minnesota,High Value Network Plan,72,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
Sup Spinal Tray,,A4215,HCPCS,Facility,Outpatient,,,,80,68,22.928,80,BlueCross BlueShield Minnesota,Medicare Advantage,39.2,49,,percent of total billed charges,,
Sup Spinal Tray,,A4215,HCPCS,Facility,Inpatient,,,,80,68,22.928,80,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Sup Spinal Tray,,A4215,HCPCS,Facility,Both,,,,80,68,22.928,80,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,70.856,88.57,,percent of total billed charges,,
Sup Spinal Tray,,A4215,HCPCS,Facility,Both,,,,80,68,22.928,80,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,22.928,28.66,,percent of total billed charges,,
Sup Spinal Tray,,A4215,HCPCS,Facility,Outpatient,,,,80,68,22.928,80,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),39.2,49,,percent of total billed charges,,
Sup Spinal Tray,,A4215,HCPCS,Facility,Inpatient,,,,80,68,22.928,80,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Sup Spinal Tray,,A4215,HCPCS,Facility,Both,,,,80,68,22.928,80,CorVel,Worker's Compensation,80,100,,percent of total billed charges,,
Sup Spinal Tray,,A4215,HCPCS,Facility,Both,,,,80,68,22.928,80,First Health Group Corporation,First Health Network,77.6,97,,percent of total billed charges,,
Sup Spinal Tray,,A4215,HCPCS,Facility,Both,,,,80,68,22.928,80,"Health Partners, Inc.",Commercial,75.68,94.6,,percent of total billed charges,,
Sup Spinal Tray,,A4215,HCPCS,Facility,Outpatient,,,,80,68,22.928,80,"Health Partners, Inc.",Medicare Advantage,39.2,49,,percent of total billed charges,,
Sup Spinal Tray,,A4215,HCPCS,Facility,Inpatient,,,,80,68,22.928,80,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Spinal Tray,,A4215,HCPCS,Facility,Both,,,,80,68,22.928,80,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),48,60,,percent of total billed charges,,
Sup Spinal Tray,,A4215,HCPCS,Facility,Both,,,,80,68,22.928,80,"Health Partners, Inc.",State of Minnesota Advantage Program,65.2,81.5,,percent of total billed charges,,
Sup Spinal Tray,,A4215,HCPCS,Facility,Both,,,,80,68,22.928,80,"Health Partners, Inc.",State Public Programs,40,50,,percent of total billed charges,,
Sup Spinal Tray,,A4215,HCPCS,Facility,Both,,,,80,68,22.928,80,Humana Insurance Company,Commercial PPO,76,95,,percent of total billed charges,,
Sup Spinal Tray,,A4215,HCPCS,Facility,Outpatient,,,,80,68,22.928,80,Humana Insurance Company,Medicare PPO,39.2,49,,percent of total billed charges,,
Sup Spinal Tray,,A4215,HCPCS,Facility,Inpatient,,,,80,68,22.928,80,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Sup Spinal Tray,,A4215,HCPCS,Facility,Both,,,,80,68,22.928,80,Medica,Individual & Family,79.28,99.1,,percent of total billed charges,,
Sup Spinal Tray,,A4215,HCPCS,Facility,Outpatient,,,,80,68,22.928,80,Medica,Medica Advantage Solution,39.84,49.8,,percent of total billed charges,,
Sup Spinal Tray,,A4215,HCPCS,Facility,Inpatient,,,,80,68,22.928,80,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Sup Spinal Tray,,A4215,HCPCS,Facility,Outpatient,,,,80,68,22.928,80,Medica,Medical Assistance,35.68,44.6,,percent of total billed charges,,
Sup Spinal Tray,,A4215,HCPCS,Facility,Inpatient,,,,80,68,22.928,80,Medica,Medical Assistance,,,,,Included in per diem rate,
Sup Spinal Tray,,A4215,HCPCS,Facility,Outpatient,,,,80,68,22.928,80,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,39.84,49.8,,percent of total billed charges,,
Sup Spinal Tray,,A4215,HCPCS,Facility,Inpatient,,,,80,68,22.928,80,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Sup Spinal Tray,,A4215,HCPCS,Facility,Both,,,,80,68,22.928,80,"Multiplan, Inc.","Multiplan, Inc.",75.2,94,,percent of total billed charges,,
Sup Spinal Tray,,A4215,HCPCS,Facility,Outpatient,,,,80,68,22.928,80,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,72.08,90.1,,percent of total billed charges,,
Sup Spinal Tray,,A4215,HCPCS,Facility,Inpatient,,,,80,68,22.928,80,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Sup Spinal Tray,,A4215,HCPCS,Facility,Both,,,,80,68,22.928,80,"Preferred One Administrative Services, INC.",PPO,78.88,98.6,,percent of total billed charges,,
Sup Spinal Tray,,A4215,HCPCS,Facility,Outpatient,,,,80,68,22.928,80,PrimeWest Health,Minnesota Senior Health Options (MSHO),41.16,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Sup Spinal Tray,,A4215,HCPCS,Facility,Inpatient,,,,80,68,22.928,80,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Spinal Tray,,A4215,HCPCS,Facility,Outpatient,,,,80,68,22.928,80,PrimeWest Health,MinnesotaCare,41.088,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Sup Spinal Tray,,A4215,HCPCS,Facility,Inpatient,,,,80,68,22.928,80,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Sup Spinal Tray,,A4215,HCPCS,Facility,Both,,,,80,68,22.928,80,Sanford Health Plan,Sanford Health Plan,73.6,92,,percent of total billed charges,,
Sup Spinal Tray,,A4215,HCPCS,Facility,Outpatient,,,,80,68,22.928,80,"UCare Health, Inc.",Individual & Family Plan,45.08,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Sup Spinal Tray,,A4215,HCPCS,Facility,Inpatient,,,,80,68,22.928,80,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Sup Spinal Tray,,A4215,HCPCS,Facility,Outpatient,,,,80,68,22.928,80,"UCare Health, Inc.",Medical Assistance,40.376,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Spinal Tray,,A4215,HCPCS,Facility,Inpatient,,,,80,68,22.928,80,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Sup Spinal Tray,,A4215,HCPCS,Facility,Outpatient,,,,80,68,22.928,80,"UCare Health, Inc.",Medicare Advantage,40.376,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Spinal Tray,,A4215,HCPCS,Facility,Inpatient,,,,80,68,22.928,80,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Spinal Tray,,A4215,HCPCS,Facility,Outpatient,,,,80,68,22.928,80,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),40.376,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Spinal Tray,,A4215,HCPCS,Facility,Inpatient,,,,80,68,22.928,80,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Spinal Tray,,A4215,HCPCS,Facility,Both,,,,80,68,22.928,80,UnitedHealthcare,Individual & Family,75.2,94,,percent of total billed charges,,
Sup Spinal Tray,,A4215,HCPCS,Facility,Outpatient,,,,80,68,22.928,80,UnitedHealthcare,Medicare Advantage,39.2,49,,percent of total billed charges,,
Sup Spinal Tray,,A4215,HCPCS,Facility,Inpatient,,,,80,68,22.928,80,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Sup Spinal Tray,,A4215,HCPCS,Facility,Outpatient,,,,80,68,22.928,80,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,38.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
Sup Spinal Tray,,A4215,HCPCS,Facility,Inpatient,,,,80,68,22.928,80,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
DURAPREP M8630,,A4245,HCPCS,Facility,Both,,,,25.75,21.8875,7.37995,25.75,Aetna,Commercial,23.69,92,,percent of total billed charges,,
DURAPREP M8630,,A4245,HCPCS,Facility,Outpatient,,,,25.75,21.8875,7.37995,25.75,Aetna,Medicare Advantage,12.6175,49,,percent of total billed charges,,
DURAPREP M8630,,A4245,HCPCS,Facility,Inpatient,,,,25.75,21.8875,7.37995,25.75,Aetna,Medicare Advantage,,,,,Included in per diem rate,
DURAPREP M8630,,A4245,HCPCS,Facility,Both,,,,25.75,21.8875,7.37995,25.75,Aetna,PPO,23.9475,93,,percent of total billed charges,,
DURAPREP M8630,,A4245,HCPCS,Facility,Both,,,,25.75,21.8875,7.37995,25.75,America's PPO,America's PPO,24.727725,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
DURAPREP M8630,,A4245,HCPCS,Facility,Both,,,,25.75,21.8875,7.37995,25.75,BlueCross BlueShield Minnesota, Federal Employee Program,25.338,98.4,,percent of total billed charges,,
DURAPREP M8630,,A4245,HCPCS,Facility,Both,,,,25.75,21.8875,7.37995,25.75,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,25.75,100,,percent of total billed charges,,
DURAPREP M8630,,A4245,HCPCS,Facility,Both,,,,25.75,21.8875,7.37995,25.75,BlueCross BlueShield Minnesota,High Value Network Plan,23.175,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
DURAPREP M8630,,A4245,HCPCS,Facility,Outpatient,,,,25.75,21.8875,7.37995,25.75,BlueCross BlueShield Minnesota,Medicare Advantage,12.6175,49,,percent of total billed charges,,
DURAPREP M8630,,A4245,HCPCS,Facility,Inpatient,,,,25.75,21.8875,7.37995,25.75,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
DURAPREP M8630,,A4245,HCPCS,Facility,Both,,,,25.75,21.8875,7.37995,25.75,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,22.806775,88.57,,percent of total billed charges,,
DURAPREP M8630,,A4245,HCPCS,Facility,Both,,,,25.75,21.8875,7.37995,25.75,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,7.37995,28.66,,percent of total billed charges,,
DURAPREP M8630,,A4245,HCPCS,Facility,Outpatient,,,,25.75,21.8875,7.37995,25.75,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),12.6175,49,,percent of total billed charges,,
DURAPREP M8630,,A4245,HCPCS,Facility,Inpatient,,,,25.75,21.8875,7.37995,25.75,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
DURAPREP M8630,,A4245,HCPCS,Facility,Both,,,,25.75,21.8875,7.37995,25.75,CorVel,Worker's Compensation,25.75,100,,percent of total billed charges,,
DURAPREP M8630,,A4245,HCPCS,Facility,Both,,,,25.75,21.8875,7.37995,25.75,First Health Group Corporation,First Health Network,24.9775,97,,percent of total billed charges,,
DURAPREP M8630,,A4245,HCPCS,Facility,Both,,,,25.75,21.8875,7.37995,25.75,"Health Partners, Inc.",Commercial,24.3595,94.6,,percent of total billed charges,,
DURAPREP M8630,,A4245,HCPCS,Facility,Outpatient,,,,25.75,21.8875,7.37995,25.75,"Health Partners, Inc.",Medicare Advantage,12.6175,49,,percent of total billed charges,,
DURAPREP M8630,,A4245,HCPCS,Facility,Inpatient,,,,25.75,21.8875,7.37995,25.75,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DURAPREP M8630,,A4245,HCPCS,Facility,Both,,,,25.75,21.8875,7.37995,25.75,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),15.45,60,,percent of total billed charges,,
DURAPREP M8630,,A4245,HCPCS,Facility,Both,,,,25.75,21.8875,7.37995,25.75,"Health Partners, Inc.",State of Minnesota Advantage Program,20.98625,81.5,,percent of total billed charges,,
DURAPREP M8630,,A4245,HCPCS,Facility,Both,,,,25.75,21.8875,7.37995,25.75,"Health Partners, Inc.",State Public Programs,12.875,50,,percent of total billed charges,,
DURAPREP M8630,,A4245,HCPCS,Facility,Both,,,,25.75,21.8875,7.37995,25.75,Humana Insurance Company,Commercial PPO,24.4625,95,,percent of total billed charges,,
DURAPREP M8630,,A4245,HCPCS,Facility,Outpatient,,,,25.75,21.8875,7.37995,25.75,Humana Insurance Company,Medicare PPO,12.6175,49,,percent of total billed charges,,
DURAPREP M8630,,A4245,HCPCS,Facility,Inpatient,,,,25.75,21.8875,7.37995,25.75,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
DURAPREP M8630,,A4245,HCPCS,Facility,Both,,,,25.75,21.8875,7.37995,25.75,Medica,Individual & Family,25.51825,99.1,,percent of total billed charges,,
DURAPREP M8630,,A4245,HCPCS,Facility,Outpatient,,,,25.75,21.8875,7.37995,25.75,Medica,Medica Advantage Solution,12.8235,49.8,,percent of total billed charges,,
DURAPREP M8630,,A4245,HCPCS,Facility,Inpatient,,,,25.75,21.8875,7.37995,25.75,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
DURAPREP M8630,,A4245,HCPCS,Facility,Outpatient,,,,25.75,21.8875,7.37995,25.75,Medica,Medical Assistance,11.4845,44.6,,percent of total billed charges,,
DURAPREP M8630,,A4245,HCPCS,Facility,Inpatient,,,,25.75,21.8875,7.37995,25.75,Medica,Medical Assistance,,,,,Included in per diem rate,
DURAPREP M8630,,A4245,HCPCS,Facility,Outpatient,,,,25.75,21.8875,7.37995,25.75,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,12.8235,49.8,,percent of total billed charges,,
DURAPREP M8630,,A4245,HCPCS,Facility,Inpatient,,,,25.75,21.8875,7.37995,25.75,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
DURAPREP M8630,,A4245,HCPCS,Facility,Both,,,,25.75,21.8875,7.37995,25.75,"Multiplan, Inc.","Multiplan, Inc.",24.205,94,,percent of total billed charges,,
DURAPREP M8630,,A4245,HCPCS,Facility,Outpatient,,,,25.75,21.8875,7.37995,25.75,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,23.20075,90.1,,percent of total billed charges,,
DURAPREP M8630,,A4245,HCPCS,Facility,Inpatient,,,,25.75,21.8875,7.37995,25.75,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
DURAPREP M8630,,A4245,HCPCS,Facility,Both,,,,25.75,21.8875,7.37995,25.75,"Preferred One Administrative Services, INC.",PPO,25.3895,98.6,,percent of total billed charges,,
DURAPREP M8630,,A4245,HCPCS,Facility,Outpatient,,,,25.75,21.8875,7.37995,25.75,PrimeWest Health,Minnesota Senior Health Options (MSHO),13.248375,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
DURAPREP M8630,,A4245,HCPCS,Facility,Inpatient,,,,25.75,21.8875,7.37995,25.75,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DURAPREP M8630,,A4245,HCPCS,Facility,Outpatient,,,,25.75,21.8875,7.37995,25.75,PrimeWest Health,MinnesotaCare,13.2252,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
DURAPREP M8630,,A4245,HCPCS,Facility,Inpatient,,,,25.75,21.8875,7.37995,25.75,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
DURAPREP M8630,,A4245,HCPCS,Facility,Both,,,,25.75,21.8875,7.37995,25.75,Sanford Health Plan,Sanford Health Plan,23.69,92,,percent of total billed charges,,
DURAPREP M8630,,A4245,HCPCS,Facility,Outpatient,,,,25.75,21.8875,7.37995,25.75,"UCare Health, Inc.",Individual & Family Plan,14.510125,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
DURAPREP M8630,,A4245,HCPCS,Facility,Inpatient,,,,25.75,21.8875,7.37995,25.75,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
DURAPREP M8630,,A4245,HCPCS,Facility,Outpatient,,,,25.75,21.8875,7.37995,25.75,"UCare Health, Inc.",Medical Assistance,12.996025,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DURAPREP M8630,,A4245,HCPCS,Facility,Inpatient,,,,25.75,21.8875,7.37995,25.75,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
DURAPREP M8630,,A4245,HCPCS,Facility,Outpatient,,,,25.75,21.8875,7.37995,25.75,"UCare Health, Inc.",Medicare Advantage,12.996025,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DURAPREP M8630,,A4245,HCPCS,Facility,Inpatient,,,,25.75,21.8875,7.37995,25.75,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DURAPREP M8630,,A4245,HCPCS,Facility,Outpatient,,,,25.75,21.8875,7.37995,25.75,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),12.996025,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DURAPREP M8630,,A4245,HCPCS,Facility,Inpatient,,,,25.75,21.8875,7.37995,25.75,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DURAPREP M8630,,A4245,HCPCS,Facility,Both,,,,25.75,21.8875,7.37995,25.75,UnitedHealthcare,Individual & Family,24.205,94,,percent of total billed charges,,
DURAPREP M8630,,A4245,HCPCS,Facility,Outpatient,,,,25.75,21.8875,7.37995,25.75,UnitedHealthcare,Medicare Advantage,12.6175,49,,percent of total billed charges,,
DURAPREP M8630,,A4245,HCPCS,Facility,Inpatient,,,,25.75,21.8875,7.37995,25.75,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
DURAPREP M8630,,A4245,HCPCS,Facility,Outpatient,,,,25.75,21.8875,7.37995,25.75,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,12.36,48,,percent of total billed charges,,100% of DHS outpatient percentage
DURAPREP M8630,,A4245,HCPCS,Facility,Inpatient,,,,25.75,21.8875,7.37995,25.75,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
CHLORAPREP TINTED 26 ML,,A4248,HCPCS,Facility,Both,,,,32.85,27.9225,9.41481,32.85,Aetna,Commercial,30.222,92,,percent of total billed charges,,
CHLORAPREP TINTED 26 ML,,A4248,HCPCS,Facility,Outpatient,,,,32.85,27.9225,9.41481,32.85,Aetna,Medicare Advantage,16.0965,49,,percent of total billed charges,,
CHLORAPREP TINTED 26 ML,,A4248,HCPCS,Facility,Inpatient,,,,32.85,27.9225,9.41481,32.85,Aetna,Medicare Advantage,,,,,Included in per diem rate,
CHLORAPREP TINTED 26 ML,,A4248,HCPCS,Facility,Both,,,,32.85,27.9225,9.41481,32.85,Aetna,PPO,30.5505,93,,percent of total billed charges,,
CHLORAPREP TINTED 26 ML,,A4248,HCPCS,Facility,Both,,,,32.85,27.9225,9.41481,32.85,America's PPO,America's PPO,31.545855,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
CHLORAPREP TINTED 26 ML,,A4248,HCPCS,Facility,Both,,,,32.85,27.9225,9.41481,32.85,BlueCross BlueShield Minnesota, Federal Employee Program,32.3244,98.4,,percent of total billed charges,,
CHLORAPREP TINTED 26 ML,,A4248,HCPCS,Facility,Both,,,,32.85,27.9225,9.41481,32.85,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,32.85,100,,percent of total billed charges,,
CHLORAPREP TINTED 26 ML,,A4248,HCPCS,Facility,Both,,,,32.85,27.9225,9.41481,32.85,BlueCross BlueShield Minnesota,High Value Network Plan,29.565,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
CHLORAPREP TINTED 26 ML,,A4248,HCPCS,Facility,Outpatient,,,,32.85,27.9225,9.41481,32.85,BlueCross BlueShield Minnesota,Medicare Advantage,16.0965,49,,percent of total billed charges,,
CHLORAPREP TINTED 26 ML,,A4248,HCPCS,Facility,Inpatient,,,,32.85,27.9225,9.41481,32.85,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
CHLORAPREP TINTED 26 ML,,A4248,HCPCS,Facility,Both,,,,32.85,27.9225,9.41481,32.85,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,29.095245,88.57,,percent of total billed charges,,
CHLORAPREP TINTED 26 ML,,A4248,HCPCS,Facility,Both,,,,32.85,27.9225,9.41481,32.85,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,9.41481,28.66,,percent of total billed charges,,
CHLORAPREP TINTED 26 ML,,A4248,HCPCS,Facility,Outpatient,,,,32.85,27.9225,9.41481,32.85,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),16.0965,49,,percent of total billed charges,,
CHLORAPREP TINTED 26 ML,,A4248,HCPCS,Facility,Inpatient,,,,32.85,27.9225,9.41481,32.85,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
CHLORAPREP TINTED 26 ML,,A4248,HCPCS,Facility,Both,,,,32.85,27.9225,9.41481,32.85,CorVel,Worker's Compensation,32.85,100,,percent of total billed charges,,
CHLORAPREP TINTED 26 ML,,A4248,HCPCS,Facility,Both,,,,32.85,27.9225,9.41481,32.85,First Health Group Corporation,First Health Network,31.8645,97,,percent of total billed charges,,
CHLORAPREP TINTED 26 ML,,A4248,HCPCS,Facility,Both,,,,32.85,27.9225,9.41481,32.85,"Health Partners, Inc.",Commercial,31.0761,94.6,,percent of total billed charges,,
CHLORAPREP TINTED 26 ML,,A4248,HCPCS,Facility,Outpatient,,,,32.85,27.9225,9.41481,32.85,"Health Partners, Inc.",Medicare Advantage,16.0965,49,,percent of total billed charges,,
CHLORAPREP TINTED 26 ML,,A4248,HCPCS,Facility,Inpatient,,,,32.85,27.9225,9.41481,32.85,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CHLORAPREP TINTED 26 ML,,A4248,HCPCS,Facility,Both,,,,32.85,27.9225,9.41481,32.85,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),19.71,60,,percent of total billed charges,,
CHLORAPREP TINTED 26 ML,,A4248,HCPCS,Facility,Both,,,,32.85,27.9225,9.41481,32.85,"Health Partners, Inc.",State of Minnesota Advantage Program,26.77275,81.5,,percent of total billed charges,,
CHLORAPREP TINTED 26 ML,,A4248,HCPCS,Facility,Both,,,,32.85,27.9225,9.41481,32.85,"Health Partners, Inc.",State Public Programs,16.425,50,,percent of total billed charges,,
CHLORAPREP TINTED 26 ML,,A4248,HCPCS,Facility,Both,,,,32.85,27.9225,9.41481,32.85,Humana Insurance Company,Commercial PPO,31.2075,95,,percent of total billed charges,,
CHLORAPREP TINTED 26 ML,,A4248,HCPCS,Facility,Outpatient,,,,32.85,27.9225,9.41481,32.85,Humana Insurance Company,Medicare PPO,16.0965,49,,percent of total billed charges,,
CHLORAPREP TINTED 26 ML,,A4248,HCPCS,Facility,Inpatient,,,,32.85,27.9225,9.41481,32.85,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
CHLORAPREP TINTED 26 ML,,A4248,HCPCS,Facility,Both,,,,32.85,27.9225,9.41481,32.85,Medica,Individual & Family,32.55435,99.1,,percent of total billed charges,,
CHLORAPREP TINTED 26 ML,,A4248,HCPCS,Facility,Outpatient,,,,32.85,27.9225,9.41481,32.85,Medica,Medica Advantage Solution,16.3593,49.8,,percent of total billed charges,,
CHLORAPREP TINTED 26 ML,,A4248,HCPCS,Facility,Inpatient,,,,32.85,27.9225,9.41481,32.85,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
CHLORAPREP TINTED 26 ML,,A4248,HCPCS,Facility,Outpatient,,,,32.85,27.9225,9.41481,32.85,Medica,Medical Assistance,14.6511,44.6,,percent of total billed charges,,
CHLORAPREP TINTED 26 ML,,A4248,HCPCS,Facility,Inpatient,,,,32.85,27.9225,9.41481,32.85,Medica,Medical Assistance,,,,,Included in per diem rate,
CHLORAPREP TINTED 26 ML,,A4248,HCPCS,Facility,Outpatient,,,,32.85,27.9225,9.41481,32.85,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,16.3593,49.8,,percent of total billed charges,,
CHLORAPREP TINTED 26 ML,,A4248,HCPCS,Facility,Inpatient,,,,32.85,27.9225,9.41481,32.85,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
CHLORAPREP TINTED 26 ML,,A4248,HCPCS,Facility,Both,,,,32.85,27.9225,9.41481,32.85,"Multiplan, Inc.","Multiplan, Inc.",30.879,94,,percent of total billed charges,,
CHLORAPREP TINTED 26 ML,,A4248,HCPCS,Facility,Outpatient,,,,32.85,27.9225,9.41481,32.85,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,29.59785,90.1,,percent of total billed charges,,
CHLORAPREP TINTED 26 ML,,A4248,HCPCS,Facility,Inpatient,,,,32.85,27.9225,9.41481,32.85,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
CHLORAPREP TINTED 26 ML,,A4248,HCPCS,Facility,Both,,,,32.85,27.9225,9.41481,32.85,"Preferred One Administrative Services, INC.",PPO,32.3901,98.6,,percent of total billed charges,,
CHLORAPREP TINTED 26 ML,,A4248,HCPCS,Facility,Outpatient,,,,32.85,27.9225,9.41481,32.85,PrimeWest Health,Minnesota Senior Health Options (MSHO),16.901325,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
CHLORAPREP TINTED 26 ML,,A4248,HCPCS,Facility,Inpatient,,,,32.85,27.9225,9.41481,32.85,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CHLORAPREP TINTED 26 ML,,A4248,HCPCS,Facility,Outpatient,,,,32.85,27.9225,9.41481,32.85,PrimeWest Health,MinnesotaCare,16.87176,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
CHLORAPREP TINTED 26 ML,,A4248,HCPCS,Facility,Inpatient,,,,32.85,27.9225,9.41481,32.85,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
CHLORAPREP TINTED 26 ML,,A4248,HCPCS,Facility,Both,,,,32.85,27.9225,9.41481,32.85,Sanford Health Plan,Sanford Health Plan,30.222,92,,percent of total billed charges,,
CHLORAPREP TINTED 26 ML,,A4248,HCPCS,Facility,Outpatient,,,,32.85,27.9225,9.41481,32.85,"UCare Health, Inc.",Individual & Family Plan,18.510975,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
CHLORAPREP TINTED 26 ML,,A4248,HCPCS,Facility,Inpatient,,,,32.85,27.9225,9.41481,32.85,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
CHLORAPREP TINTED 26 ML,,A4248,HCPCS,Facility,Outpatient,,,,32.85,27.9225,9.41481,32.85,"UCare Health, Inc.",Medical Assistance,16.579395,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CHLORAPREP TINTED 26 ML,,A4248,HCPCS,Facility,Inpatient,,,,32.85,27.9225,9.41481,32.85,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
CHLORAPREP TINTED 26 ML,,A4248,HCPCS,Facility,Outpatient,,,,32.85,27.9225,9.41481,32.85,"UCare Health, Inc.",Medicare Advantage,16.579395,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CHLORAPREP TINTED 26 ML,,A4248,HCPCS,Facility,Inpatient,,,,32.85,27.9225,9.41481,32.85,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CHLORAPREP TINTED 26 ML,,A4248,HCPCS,Facility,Outpatient,,,,32.85,27.9225,9.41481,32.85,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),16.579395,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CHLORAPREP TINTED 26 ML,,A4248,HCPCS,Facility,Inpatient,,,,32.85,27.9225,9.41481,32.85,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CHLORAPREP TINTED 26 ML,,A4248,HCPCS,Facility,Both,,,,32.85,27.9225,9.41481,32.85,UnitedHealthcare,Individual & Family,30.879,94,,percent of total billed charges,,
CHLORAPREP TINTED 26 ML,,A4248,HCPCS,Facility,Outpatient,,,,32.85,27.9225,9.41481,32.85,UnitedHealthcare,Medicare Advantage,16.0965,49,,percent of total billed charges,,
CHLORAPREP TINTED 26 ML,,A4248,HCPCS,Facility,Inpatient,,,,32.85,27.9225,9.41481,32.85,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
CHLORAPREP TINTED 26 ML,,A4248,HCPCS,Facility,Outpatient,,,,32.85,27.9225,9.41481,32.85,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,15.768,48,,percent of total billed charges,,100% of DHS outpatient percentage
CHLORAPREP TINTED 26 ML,,A4248,HCPCS,Facility,Inpatient,,,,32.85,27.9225,9.41481,32.85,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Sup Prep Tray,,A4248,HCPCS,Facility,Both,,,,41,34.85,11.7506,41,Aetna,Commercial,37.72,92,,percent of total billed charges,,
Sup Prep Tray,,A4248,HCPCS,Facility,Outpatient,,,,41,34.85,11.7506,41,Aetna,Medicare Advantage,20.09,49,,percent of total billed charges,,
Sup Prep Tray,,A4248,HCPCS,Facility,Inpatient,,,,41,34.85,11.7506,41,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Sup Prep Tray,,A4248,HCPCS,Facility,Both,,,,41,34.85,11.7506,41,Aetna,PPO,38.13,93,,percent of total billed charges,,
Sup Prep Tray,,A4248,HCPCS,Facility,Both,,,,41,34.85,11.7506,41,America's PPO,America's PPO,39.3723,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Sup Prep Tray,,A4248,HCPCS,Facility,Both,,,,41,34.85,11.7506,41,BlueCross BlueShield Minnesota, Federal Employee Program,40.344,98.4,,percent of total billed charges,,
Sup Prep Tray,,A4248,HCPCS,Facility,Both,,,,41,34.85,11.7506,41,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,41,100,,percent of total billed charges,,
Sup Prep Tray,,A4248,HCPCS,Facility,Both,,,,41,34.85,11.7506,41,BlueCross BlueShield Minnesota,High Value Network Plan,36.9,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
Sup Prep Tray,,A4248,HCPCS,Facility,Outpatient,,,,41,34.85,11.7506,41,BlueCross BlueShield Minnesota,Medicare Advantage,20.09,49,,percent of total billed charges,,
Sup Prep Tray,,A4248,HCPCS,Facility,Inpatient,,,,41,34.85,11.7506,41,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Sup Prep Tray,,A4248,HCPCS,Facility,Both,,,,41,34.85,11.7506,41,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,36.3137,88.57,,percent of total billed charges,,
Sup Prep Tray,,A4248,HCPCS,Facility,Both,,,,41,34.85,11.7506,41,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,11.7506,28.66,,percent of total billed charges,,
Sup Prep Tray,,A4248,HCPCS,Facility,Outpatient,,,,41,34.85,11.7506,41,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),20.09,49,,percent of total billed charges,,
Sup Prep Tray,,A4248,HCPCS,Facility,Inpatient,,,,41,34.85,11.7506,41,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Sup Prep Tray,,A4248,HCPCS,Facility,Both,,,,41,34.85,11.7506,41,CorVel,Worker's Compensation,41,100,,percent of total billed charges,,
Sup Prep Tray,,A4248,HCPCS,Facility,Both,,,,41,34.85,11.7506,41,First Health Group Corporation,First Health Network,39.77,97,,percent of total billed charges,,
Sup Prep Tray,,A4248,HCPCS,Facility,Both,,,,41,34.85,11.7506,41,"Health Partners, Inc.",Commercial,38.786,94.6,,percent of total billed charges,,
Sup Prep Tray,,A4248,HCPCS,Facility,Outpatient,,,,41,34.85,11.7506,41,"Health Partners, Inc.",Medicare Advantage,20.09,49,,percent of total billed charges,,
Sup Prep Tray,,A4248,HCPCS,Facility,Inpatient,,,,41,34.85,11.7506,41,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Prep Tray,,A4248,HCPCS,Facility,Both,,,,41,34.85,11.7506,41,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),24.6,60,,percent of total billed charges,,
Sup Prep Tray,,A4248,HCPCS,Facility,Both,,,,41,34.85,11.7506,41,"Health Partners, Inc.",State of Minnesota Advantage Program,33.415,81.5,,percent of total billed charges,,
Sup Prep Tray,,A4248,HCPCS,Facility,Both,,,,41,34.85,11.7506,41,"Health Partners, Inc.",State Public Programs,20.5,50,,percent of total billed charges,,
Sup Prep Tray,,A4248,HCPCS,Facility,Both,,,,41,34.85,11.7506,41,Humana Insurance Company,Commercial PPO,38.95,95,,percent of total billed charges,,
Sup Prep Tray,,A4248,HCPCS,Facility,Outpatient,,,,41,34.85,11.7506,41,Humana Insurance Company,Medicare PPO,20.09,49,,percent of total billed charges,,
Sup Prep Tray,,A4248,HCPCS,Facility,Inpatient,,,,41,34.85,11.7506,41,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Sup Prep Tray,,A4248,HCPCS,Facility,Both,,,,41,34.85,11.7506,41,Medica,Individual & Family,40.631,99.1,,percent of total billed charges,,
Sup Prep Tray,,A4248,HCPCS,Facility,Outpatient,,,,41,34.85,11.7506,41,Medica,Medica Advantage Solution,20.418,49.8,,percent of total billed charges,,
Sup Prep Tray,,A4248,HCPCS,Facility,Inpatient,,,,41,34.85,11.7506,41,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Sup Prep Tray,,A4248,HCPCS,Facility,Outpatient,,,,41,34.85,11.7506,41,Medica,Medical Assistance,18.286,44.6,,percent of total billed charges,,
Sup Prep Tray,,A4248,HCPCS,Facility,Inpatient,,,,41,34.85,11.7506,41,Medica,Medical Assistance,,,,,Included in per diem rate,
Sup Prep Tray,,A4248,HCPCS,Facility,Outpatient,,,,41,34.85,11.7506,41,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,20.418,49.8,,percent of total billed charges,,
Sup Prep Tray,,A4248,HCPCS,Facility,Inpatient,,,,41,34.85,11.7506,41,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Sup Prep Tray,,A4248,HCPCS,Facility,Both,,,,41,34.85,11.7506,41,"Multiplan, Inc.","Multiplan, Inc.",38.54,94,,percent of total billed charges,,
Sup Prep Tray,,A4248,HCPCS,Facility,Outpatient,,,,41,34.85,11.7506,41,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,36.941,90.1,,percent of total billed charges,,
Sup Prep Tray,,A4248,HCPCS,Facility,Inpatient,,,,41,34.85,11.7506,41,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Sup Prep Tray,,A4248,HCPCS,Facility,Both,,,,41,34.85,11.7506,41,"Preferred One Administrative Services, INC.",PPO,40.426,98.6,,percent of total billed charges,,
Sup Prep Tray,,A4248,HCPCS,Facility,Outpatient,,,,41,34.85,11.7506,41,PrimeWest Health,Minnesota Senior Health Options (MSHO),21.0945,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Sup Prep Tray,,A4248,HCPCS,Facility,Inpatient,,,,41,34.85,11.7506,41,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Prep Tray,,A4248,HCPCS,Facility,Outpatient,,,,41,34.85,11.7506,41,PrimeWest Health,MinnesotaCare,21.0576,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Sup Prep Tray,,A4248,HCPCS,Facility,Inpatient,,,,41,34.85,11.7506,41,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Sup Prep Tray,,A4248,HCPCS,Facility,Both,,,,41,34.85,11.7506,41,Sanford Health Plan,Sanford Health Plan,37.72,92,,percent of total billed charges,,
Sup Prep Tray,,A4248,HCPCS,Facility,Outpatient,,,,41,34.85,11.7506,41,"UCare Health, Inc.",Individual & Family Plan,23.1035,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Sup Prep Tray,,A4248,HCPCS,Facility,Inpatient,,,,41,34.85,11.7506,41,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Sup Prep Tray,,A4248,HCPCS,Facility,Outpatient,,,,41,34.85,11.7506,41,"UCare Health, Inc.",Medical Assistance,20.6927,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Prep Tray,,A4248,HCPCS,Facility,Inpatient,,,,41,34.85,11.7506,41,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Sup Prep Tray,,A4248,HCPCS,Facility,Outpatient,,,,41,34.85,11.7506,41,"UCare Health, Inc.",Medicare Advantage,20.6927,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Prep Tray,,A4248,HCPCS,Facility,Inpatient,,,,41,34.85,11.7506,41,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Prep Tray,,A4248,HCPCS,Facility,Outpatient,,,,41,34.85,11.7506,41,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),20.6927,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Prep Tray,,A4248,HCPCS,Facility,Inpatient,,,,41,34.85,11.7506,41,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Prep Tray,,A4248,HCPCS,Facility,Both,,,,41,34.85,11.7506,41,UnitedHealthcare,Individual & Family,38.54,94,,percent of total billed charges,,
Sup Prep Tray,,A4248,HCPCS,Facility,Outpatient,,,,41,34.85,11.7506,41,UnitedHealthcare,Medicare Advantage,20.09,49,,percent of total billed charges,,
Sup Prep Tray,,A4248,HCPCS,Facility,Inpatient,,,,41,34.85,11.7506,41,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Sup Prep Tray,,A4248,HCPCS,Facility,Outpatient,,,,41,34.85,11.7506,41,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,19.68,48,,percent of total billed charges,,100% of DHS outpatient percentage
Sup Prep Tray,,A4248,HCPCS,Facility,Inpatient,,,,41,34.85,11.7506,41,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Sup Cath Complete 18 Fr,,A4314,HCPCS,Facility,Both,,,,39,33.15,11.1774,39,Aetna,Commercial,35.88,92,,percent of total billed charges,,
Sup Cath Complete 18 Fr,,A4314,HCPCS,Facility,Outpatient,,,,39,33.15,11.1774,39,Aetna,Medicare Advantage,19.11,49,,percent of total billed charges,,
Sup Cath Complete 18 Fr,,A4314,HCPCS,Facility,Inpatient,,,,39,33.15,11.1774,39,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Sup Cath Complete 18 Fr,,A4314,HCPCS,Facility,Both,,,,39,33.15,11.1774,39,Aetna,PPO,36.27,93,,percent of total billed charges,,
Sup Cath Complete 18 Fr,,A4314,HCPCS,Facility,Both,,,,39,33.15,11.1774,39,America's PPO,America's PPO,37.4517,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Sup Cath Complete 18 Fr,,A4314,HCPCS,Facility,Both,,,,39,33.15,11.1774,39,BlueCross BlueShield Minnesota, Federal Employee Program,38.376,98.4,,percent of total billed charges,,
Sup Cath Complete 18 Fr,,A4314,HCPCS,Facility,Both,,,,39,33.15,11.1774,39,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,39,100,,percent of total billed charges,,
Sup Cath Complete 18 Fr,,A4314,HCPCS,Facility,Both,,,,39,33.15,11.1774,39,BlueCross BlueShield Minnesota,High Value Network Plan,35.1,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
Sup Cath Complete 18 Fr,,A4314,HCPCS,Facility,Outpatient,,,,39,33.15,11.1774,39,BlueCross BlueShield Minnesota,Medicare Advantage,19.11,49,,percent of total billed charges,,
Sup Cath Complete 18 Fr,,A4314,HCPCS,Facility,Inpatient,,,,39,33.15,11.1774,39,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Sup Cath Complete 18 Fr,,A4314,HCPCS,Facility,Both,,,,39,33.15,11.1774,39,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,34.5423,88.57,,percent of total billed charges,,
Sup Cath Complete 18 Fr,,A4314,HCPCS,Facility,Both,,,,39,33.15,11.1774,39,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,11.1774,28.66,,percent of total billed charges,,
Sup Cath Complete 18 Fr,,A4314,HCPCS,Facility,Outpatient,,,,39,33.15,11.1774,39,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),19.11,49,,percent of total billed charges,,
Sup Cath Complete 18 Fr,,A4314,HCPCS,Facility,Inpatient,,,,39,33.15,11.1774,39,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Sup Cath Complete 18 Fr,,A4314,HCPCS,Facility,Both,,,,39,33.15,11.1774,39,CorVel,Worker's Compensation,39,100,,percent of total billed charges,,
Sup Cath Complete 18 Fr,,A4314,HCPCS,Facility,Both,,,,39,33.15,11.1774,39,First Health Group Corporation,First Health Network,37.83,97,,percent of total billed charges,,
Sup Cath Complete 18 Fr,,A4314,HCPCS,Facility,Both,,,,39,33.15,11.1774,39,"Health Partners, Inc.",Commercial,36.894,94.6,,percent of total billed charges,,
Sup Cath Complete 18 Fr,,A4314,HCPCS,Facility,Outpatient,,,,39,33.15,11.1774,39,"Health Partners, Inc.",Medicare Advantage,19.11,49,,percent of total billed charges,,
Sup Cath Complete 18 Fr,,A4314,HCPCS,Facility,Inpatient,,,,39,33.15,11.1774,39,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Cath Complete 18 Fr,,A4314,HCPCS,Facility,Both,,,,39,33.15,11.1774,39,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),23.4,60,,percent of total billed charges,,
Sup Cath Complete 18 Fr,,A4314,HCPCS,Facility,Both,,,,39,33.15,11.1774,39,"Health Partners, Inc.",State of Minnesota Advantage Program,31.785,81.5,,percent of total billed charges,,
Sup Cath Complete 18 Fr,,A4314,HCPCS,Facility,Both,,,,39,33.15,11.1774,39,"Health Partners, Inc.",State Public Programs,19.5,50,,percent of total billed charges,,
Sup Cath Complete 18 Fr,,A4314,HCPCS,Facility,Both,,,,39,33.15,11.1774,39,Humana Insurance Company,Commercial PPO,37.05,95,,percent of total billed charges,,
Sup Cath Complete 18 Fr,,A4314,HCPCS,Facility,Outpatient,,,,39,33.15,11.1774,39,Humana Insurance Company,Medicare PPO,19.11,49,,percent of total billed charges,,
Sup Cath Complete 18 Fr,,A4314,HCPCS,Facility,Inpatient,,,,39,33.15,11.1774,39,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Sup Cath Complete 18 Fr,,A4314,HCPCS,Facility,Both,,,,39,33.15,11.1774,39,Medica,Individual & Family,38.649,99.1,,percent of total billed charges,,
Sup Cath Complete 18 Fr,,A4314,HCPCS,Facility,Outpatient,,,,39,33.15,11.1774,39,Medica,Medica Advantage Solution,19.422,49.8,,percent of total billed charges,,
Sup Cath Complete 18 Fr,,A4314,HCPCS,Facility,Inpatient,,,,39,33.15,11.1774,39,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Sup Cath Complete 18 Fr,,A4314,HCPCS,Facility,Outpatient,,,,39,33.15,11.1774,39,Medica,Medical Assistance,17.394,44.6,,percent of total billed charges,,
Sup Cath Complete 18 Fr,,A4314,HCPCS,Facility,Inpatient,,,,39,33.15,11.1774,39,Medica,Medical Assistance,,,,,Included in per diem rate,
Sup Cath Complete 18 Fr,,A4314,HCPCS,Facility,Outpatient,,,,39,33.15,11.1774,39,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,19.422,49.8,,percent of total billed charges,,
Sup Cath Complete 18 Fr,,A4314,HCPCS,Facility,Inpatient,,,,39,33.15,11.1774,39,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Sup Cath Complete 18 Fr,,A4314,HCPCS,Facility,Both,,,,39,33.15,11.1774,39,"Multiplan, Inc.","Multiplan, Inc.",36.66,94,,percent of total billed charges,,
Sup Cath Complete 18 Fr,,A4314,HCPCS,Facility,Outpatient,,,,39,33.15,11.1774,39,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,35.139,90.1,,percent of total billed charges,,
Sup Cath Complete 18 Fr,,A4314,HCPCS,Facility,Inpatient,,,,39,33.15,11.1774,39,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Sup Cath Complete 18 Fr,,A4314,HCPCS,Facility,Both,,,,39,33.15,11.1774,39,"Preferred One Administrative Services, INC.",PPO,38.454,98.6,,percent of total billed charges,,
Sup Cath Complete 18 Fr,,A4314,HCPCS,Facility,Outpatient,,,,39,33.15,11.1774,39,PrimeWest Health,Minnesota Senior Health Options (MSHO),20.0655,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Sup Cath Complete 18 Fr,,A4314,HCPCS,Facility,Inpatient,,,,39,33.15,11.1774,39,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Cath Complete 18 Fr,,A4314,HCPCS,Facility,Outpatient,,,,39,33.15,11.1774,39,PrimeWest Health,MinnesotaCare,20.0304,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Sup Cath Complete 18 Fr,,A4314,HCPCS,Facility,Inpatient,,,,39,33.15,11.1774,39,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Sup Cath Complete 18 Fr,,A4314,HCPCS,Facility,Both,,,,39,33.15,11.1774,39,Sanford Health Plan,Sanford Health Plan,35.88,92,,percent of total billed charges,,
Sup Cath Complete 18 Fr,,A4314,HCPCS,Facility,Outpatient,,,,39,33.15,11.1774,39,"UCare Health, Inc.",Individual & Family Plan,21.9765,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Sup Cath Complete 18 Fr,,A4314,HCPCS,Facility,Inpatient,,,,39,33.15,11.1774,39,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Sup Cath Complete 18 Fr,,A4314,HCPCS,Facility,Outpatient,,,,39,33.15,11.1774,39,"UCare Health, Inc.",Medical Assistance,19.6833,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Cath Complete 18 Fr,,A4314,HCPCS,Facility,Inpatient,,,,39,33.15,11.1774,39,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Sup Cath Complete 18 Fr,,A4314,HCPCS,Facility,Outpatient,,,,39,33.15,11.1774,39,"UCare Health, Inc.",Medicare Advantage,19.6833,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Cath Complete 18 Fr,,A4314,HCPCS,Facility,Inpatient,,,,39,33.15,11.1774,39,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Cath Complete 18 Fr,,A4314,HCPCS,Facility,Outpatient,,,,39,33.15,11.1774,39,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),19.6833,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Cath Complete 18 Fr,,A4314,HCPCS,Facility,Inpatient,,,,39,33.15,11.1774,39,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Cath Complete 18 Fr,,A4314,HCPCS,Facility,Both,,,,39,33.15,11.1774,39,UnitedHealthcare,Individual & Family,36.66,94,,percent of total billed charges,,
Sup Cath Complete 18 Fr,,A4314,HCPCS,Facility,Outpatient,,,,39,33.15,11.1774,39,UnitedHealthcare,Medicare Advantage,19.11,49,,percent of total billed charges,,
Sup Cath Complete 18 Fr,,A4314,HCPCS,Facility,Inpatient,,,,39,33.15,11.1774,39,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Sup Cath Complete 18 Fr,,A4314,HCPCS,Facility,Outpatient,,,,39,33.15,11.1774,39,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,18.72,48,,percent of total billed charges,,100% of DHS outpatient percentage
Sup Cath Complete 18 Fr,,A4314,HCPCS,Facility,Inpatient,,,,39,33.15,11.1774,39,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
TRAY CATH FOLEY 16 FR,,A4315,HCPCS,Facility,Both,,,,35.3,30.005,10.11698,35.3,Aetna,Commercial,32.476,92,,percent of total billed charges,,
TRAY CATH FOLEY 16 FR,,A4315,HCPCS,Facility,Outpatient,,,,35.3,30.005,10.11698,35.3,Aetna,Medicare Advantage,17.297,49,,percent of total billed charges,,
TRAY CATH FOLEY 16 FR,,A4315,HCPCS,Facility,Inpatient,,,,35.3,30.005,10.11698,35.3,Aetna,Medicare Advantage,,,,,Included in per diem rate,
TRAY CATH FOLEY 16 FR,,A4315,HCPCS,Facility,Both,,,,35.3,30.005,10.11698,35.3,Aetna,PPO,32.829,93,,percent of total billed charges,,
TRAY CATH FOLEY 16 FR,,A4315,HCPCS,Facility,Both,,,,35.3,30.005,10.11698,35.3,America's PPO,America's PPO,33.89859,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
TRAY CATH FOLEY 16 FR,,A4315,HCPCS,Facility,Both,,,,35.3,30.005,10.11698,35.3,BlueCross BlueShield Minnesota, Federal Employee Program,34.7352,98.4,,percent of total billed charges,,
TRAY CATH FOLEY 16 FR,,A4315,HCPCS,Facility,Both,,,,35.3,30.005,10.11698,35.3,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,35.3,100,,percent of total billed charges,,
TRAY CATH FOLEY 16 FR,,A4315,HCPCS,Facility,Both,,,,35.3,30.005,10.11698,35.3,BlueCross BlueShield Minnesota,High Value Network Plan,31.77,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
TRAY CATH FOLEY 16 FR,,A4315,HCPCS,Facility,Outpatient,,,,35.3,30.005,10.11698,35.3,BlueCross BlueShield Minnesota,Medicare Advantage,17.297,49,,percent of total billed charges,,
TRAY CATH FOLEY 16 FR,,A4315,HCPCS,Facility,Inpatient,,,,35.3,30.005,10.11698,35.3,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
TRAY CATH FOLEY 16 FR,,A4315,HCPCS,Facility,Both,,,,35.3,30.005,10.11698,35.3,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,31.26521,88.57,,percent of total billed charges,,
TRAY CATH FOLEY 16 FR,,A4315,HCPCS,Facility,Both,,,,35.3,30.005,10.11698,35.3,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,10.11698,28.66,,percent of total billed charges,,
TRAY CATH FOLEY 16 FR,,A4315,HCPCS,Facility,Outpatient,,,,35.3,30.005,10.11698,35.3,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),17.297,49,,percent of total billed charges,,
TRAY CATH FOLEY 16 FR,,A4315,HCPCS,Facility,Inpatient,,,,35.3,30.005,10.11698,35.3,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
TRAY CATH FOLEY 16 FR,,A4315,HCPCS,Facility,Both,,,,35.3,30.005,10.11698,35.3,CorVel,Worker's Compensation,35.3,100,,percent of total billed charges,,
TRAY CATH FOLEY 16 FR,,A4315,HCPCS,Facility,Both,,,,35.3,30.005,10.11698,35.3,First Health Group Corporation,First Health Network,34.241,97,,percent of total billed charges,,
TRAY CATH FOLEY 16 FR,,A4315,HCPCS,Facility,Both,,,,35.3,30.005,10.11698,35.3,"Health Partners, Inc.",Commercial,33.3938,94.6,,percent of total billed charges,,
TRAY CATH FOLEY 16 FR,,A4315,HCPCS,Facility,Outpatient,,,,35.3,30.005,10.11698,35.3,"Health Partners, Inc.",Medicare Advantage,17.297,49,,percent of total billed charges,,
TRAY CATH FOLEY 16 FR,,A4315,HCPCS,Facility,Inpatient,,,,35.3,30.005,10.11698,35.3,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
TRAY CATH FOLEY 16 FR,,A4315,HCPCS,Facility,Both,,,,35.3,30.005,10.11698,35.3,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),21.18,60,,percent of total billed charges,,
TRAY CATH FOLEY 16 FR,,A4315,HCPCS,Facility,Both,,,,35.3,30.005,10.11698,35.3,"Health Partners, Inc.",State of Minnesota Advantage Program,28.7695,81.5,,percent of total billed charges,,
TRAY CATH FOLEY 16 FR,,A4315,HCPCS,Facility,Both,,,,35.3,30.005,10.11698,35.3,"Health Partners, Inc.",State Public Programs,17.65,50,,percent of total billed charges,,
TRAY CATH FOLEY 16 FR,,A4315,HCPCS,Facility,Both,,,,35.3,30.005,10.11698,35.3,Humana Insurance Company,Commercial PPO,33.535,95,,percent of total billed charges,,
TRAY CATH FOLEY 16 FR,,A4315,HCPCS,Facility,Outpatient,,,,35.3,30.005,10.11698,35.3,Humana Insurance Company,Medicare PPO,17.297,49,,percent of total billed charges,,
TRAY CATH FOLEY 16 FR,,A4315,HCPCS,Facility,Inpatient,,,,35.3,30.005,10.11698,35.3,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
TRAY CATH FOLEY 16 FR,,A4315,HCPCS,Facility,Both,,,,35.3,30.005,10.11698,35.3,Medica,Individual & Family,34.9823,99.1,,percent of total billed charges,,
TRAY CATH FOLEY 16 FR,,A4315,HCPCS,Facility,Outpatient,,,,35.3,30.005,10.11698,35.3,Medica,Medica Advantage Solution,17.5794,49.8,,percent of total billed charges,,
TRAY CATH FOLEY 16 FR,,A4315,HCPCS,Facility,Inpatient,,,,35.3,30.005,10.11698,35.3,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
TRAY CATH FOLEY 16 FR,,A4315,HCPCS,Facility,Outpatient,,,,35.3,30.005,10.11698,35.3,Medica,Medical Assistance,15.7438,44.6,,percent of total billed charges,,
TRAY CATH FOLEY 16 FR,,A4315,HCPCS,Facility,Inpatient,,,,35.3,30.005,10.11698,35.3,Medica,Medical Assistance,,,,,Included in per diem rate,
TRAY CATH FOLEY 16 FR,,A4315,HCPCS,Facility,Outpatient,,,,35.3,30.005,10.11698,35.3,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,17.5794,49.8,,percent of total billed charges,,
TRAY CATH FOLEY 16 FR,,A4315,HCPCS,Facility,Inpatient,,,,35.3,30.005,10.11698,35.3,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
TRAY CATH FOLEY 16 FR,,A4315,HCPCS,Facility,Both,,,,35.3,30.005,10.11698,35.3,"Multiplan, Inc.","Multiplan, Inc.",33.182,94,,percent of total billed charges,,
TRAY CATH FOLEY 16 FR,,A4315,HCPCS,Facility,Outpatient,,,,35.3,30.005,10.11698,35.3,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,31.8053,90.1,,percent of total billed charges,,
TRAY CATH FOLEY 16 FR,,A4315,HCPCS,Facility,Inpatient,,,,35.3,30.005,10.11698,35.3,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
TRAY CATH FOLEY 16 FR,,A4315,HCPCS,Facility,Both,,,,35.3,30.005,10.11698,35.3,"Preferred One Administrative Services, INC.",PPO,34.8058,98.6,,percent of total billed charges,,
TRAY CATH FOLEY 16 FR,,A4315,HCPCS,Facility,Outpatient,,,,35.3,30.005,10.11698,35.3,PrimeWest Health,Minnesota Senior Health Options (MSHO),18.16185,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
TRAY CATH FOLEY 16 FR,,A4315,HCPCS,Facility,Inpatient,,,,35.3,30.005,10.11698,35.3,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
TRAY CATH FOLEY 16 FR,,A4315,HCPCS,Facility,Outpatient,,,,35.3,30.005,10.11698,35.3,PrimeWest Health,MinnesotaCare,18.13008,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
TRAY CATH FOLEY 16 FR,,A4315,HCPCS,Facility,Inpatient,,,,35.3,30.005,10.11698,35.3,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
TRAY CATH FOLEY 16 FR,,A4315,HCPCS,Facility,Both,,,,35.3,30.005,10.11698,35.3,Sanford Health Plan,Sanford Health Plan,32.476,92,,percent of total billed charges,,
TRAY CATH FOLEY 16 FR,,A4315,HCPCS,Facility,Outpatient,,,,35.3,30.005,10.11698,35.3,"UCare Health, Inc.",Individual & Family Plan,19.89155,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
TRAY CATH FOLEY 16 FR,,A4315,HCPCS,Facility,Inpatient,,,,35.3,30.005,10.11698,35.3,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
TRAY CATH FOLEY 16 FR,,A4315,HCPCS,Facility,Outpatient,,,,35.3,30.005,10.11698,35.3,"UCare Health, Inc.",Medical Assistance,17.81591,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TRAY CATH FOLEY 16 FR,,A4315,HCPCS,Facility,Inpatient,,,,35.3,30.005,10.11698,35.3,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
TRAY CATH FOLEY 16 FR,,A4315,HCPCS,Facility,Outpatient,,,,35.3,30.005,10.11698,35.3,"UCare Health, Inc.",Medicare Advantage,17.81591,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TRAY CATH FOLEY 16 FR,,A4315,HCPCS,Facility,Inpatient,,,,35.3,30.005,10.11698,35.3,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
TRAY CATH FOLEY 16 FR,,A4315,HCPCS,Facility,Outpatient,,,,35.3,30.005,10.11698,35.3,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),17.81591,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TRAY CATH FOLEY 16 FR,,A4315,HCPCS,Facility,Inpatient,,,,35.3,30.005,10.11698,35.3,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
TRAY CATH FOLEY 16 FR,,A4315,HCPCS,Facility,Both,,,,35.3,30.005,10.11698,35.3,UnitedHealthcare,Individual & Family,33.182,94,,percent of total billed charges,,
TRAY CATH FOLEY 16 FR,,A4315,HCPCS,Facility,Outpatient,,,,35.3,30.005,10.11698,35.3,UnitedHealthcare,Medicare Advantage,17.297,49,,percent of total billed charges,,
TRAY CATH FOLEY 16 FR,,A4315,HCPCS,Facility,Inpatient,,,,35.3,30.005,10.11698,35.3,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
TRAY CATH FOLEY 16 FR,,A4315,HCPCS,Facility,Outpatient,,,,35.3,30.005,10.11698,35.3,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,16.944,48,,percent of total billed charges,,100% of DHS outpatient percentage
TRAY CATH FOLEY 16 FR,,A4315,HCPCS,Facility,Inpatient,,,,35.3,30.005,10.11698,35.3,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
DILATOR URETHRAL S-CURVE (SET)  COOK 073701-CD / G32789,,A4335,HCPCS,Facility,Both,,,,796.25,676.8125,228.20525,796.25,Aetna,Commercial,732.55,92,,percent of total billed charges,,
DILATOR URETHRAL S-CURVE (SET)  COOK 073701-CD / G32789,,A4335,HCPCS,Facility,Outpatient,,,,796.25,676.8125,228.20525,796.25,Aetna,Medicare Advantage,390.1625,49,,percent of total billed charges,,
DILATOR URETHRAL S-CURVE (SET)  COOK 073701-CD / G32789,,A4335,HCPCS,Facility,Inpatient,,,,796.25,676.8125,228.20525,796.25,Aetna,Medicare Advantage,,,,,Included in per diem rate,
DILATOR URETHRAL S-CURVE (SET)  COOK 073701-CD / G32789,,A4335,HCPCS,Facility,Both,,,,796.25,676.8125,228.20525,796.25,Aetna,PPO,740.5125,93,,percent of total billed charges,,
DILATOR URETHRAL S-CURVE (SET)  COOK 073701-CD / G32789,,A4335,HCPCS,Facility,Both,,,,796.25,676.8125,228.20525,796.25,America's PPO,America's PPO,764.638875,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
DILATOR URETHRAL S-CURVE (SET)  COOK 073701-CD / G32789,,A4335,HCPCS,Facility,Both,,,,796.25,676.8125,228.20525,796.25,BlueCross BlueShield Minnesota, Federal Employee Program,783.51,98.4,,percent of total billed charges,,
DILATOR URETHRAL S-CURVE (SET)  COOK 073701-CD / G32789,,A4335,HCPCS,Facility,Both,,,,796.25,676.8125,228.20525,796.25,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,796.25,100,,percent of total billed charges,,
DILATOR URETHRAL S-CURVE (SET)  COOK 073701-CD / G32789,,A4335,HCPCS,Facility,Both,,,,796.25,676.8125,228.20525,796.25,BlueCross BlueShield Minnesota,High Value Network Plan,716.625,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
DILATOR URETHRAL S-CURVE (SET)  COOK 073701-CD / G32789,,A4335,HCPCS,Facility,Outpatient,,,,796.25,676.8125,228.20525,796.25,BlueCross BlueShield Minnesota,Medicare Advantage,390.1625,49,,percent of total billed charges,,
DILATOR URETHRAL S-CURVE (SET)  COOK 073701-CD / G32789,,A4335,HCPCS,Facility,Inpatient,,,,796.25,676.8125,228.20525,796.25,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
DILATOR URETHRAL S-CURVE (SET)  COOK 073701-CD / G32789,,A4335,HCPCS,Facility,Both,,,,796.25,676.8125,228.20525,796.25,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,705.238625,88.57,,percent of total billed charges,,
DILATOR URETHRAL S-CURVE (SET)  COOK 073701-CD / G32789,,A4335,HCPCS,Facility,Both,,,,796.25,676.8125,228.20525,796.25,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,228.20525,28.66,,percent of total billed charges,,
DILATOR URETHRAL S-CURVE (SET)  COOK 073701-CD / G32789,,A4335,HCPCS,Facility,Outpatient,,,,796.25,676.8125,228.20525,796.25,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),390.1625,49,,percent of total billed charges,,
DILATOR URETHRAL S-CURVE (SET)  COOK 073701-CD / G32789,,A4335,HCPCS,Facility,Inpatient,,,,796.25,676.8125,228.20525,796.25,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
DILATOR URETHRAL S-CURVE (SET)  COOK 073701-CD / G32789,,A4335,HCPCS,Facility,Both,,,,796.25,676.8125,228.20525,796.25,CorVel,Worker's Compensation,796.25,100,,percent of total billed charges,,
DILATOR URETHRAL S-CURVE (SET)  COOK 073701-CD / G32789,,A4335,HCPCS,Facility,Both,,,,796.25,676.8125,228.20525,796.25,First Health Group Corporation,First Health Network,772.3625,97,,percent of total billed charges,,
DILATOR URETHRAL S-CURVE (SET)  COOK 073701-CD / G32789,,A4335,HCPCS,Facility,Both,,,,796.25,676.8125,228.20525,796.25,"Health Partners, Inc.",Commercial,753.2525,94.6,,percent of total billed charges,,
DILATOR URETHRAL S-CURVE (SET)  COOK 073701-CD / G32789,,A4335,HCPCS,Facility,Outpatient,,,,796.25,676.8125,228.20525,796.25,"Health Partners, Inc.",Medicare Advantage,390.1625,49,,percent of total billed charges,,
DILATOR URETHRAL S-CURVE (SET)  COOK 073701-CD / G32789,,A4335,HCPCS,Facility,Inpatient,,,,796.25,676.8125,228.20525,796.25,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DILATOR URETHRAL S-CURVE (SET)  COOK 073701-CD / G32789,,A4335,HCPCS,Facility,Both,,,,796.25,676.8125,228.20525,796.25,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),477.75,60,,percent of total billed charges,,
DILATOR URETHRAL S-CURVE (SET)  COOK 073701-CD / G32789,,A4335,HCPCS,Facility,Both,,,,796.25,676.8125,228.20525,796.25,"Health Partners, Inc.",State of Minnesota Advantage Program,648.94375,81.5,,percent of total billed charges,,
DILATOR URETHRAL S-CURVE (SET)  COOK 073701-CD / G32789,,A4335,HCPCS,Facility,Both,,,,796.25,676.8125,228.20525,796.25,"Health Partners, Inc.",State Public Programs,398.125,50,,percent of total billed charges,,
DILATOR URETHRAL S-CURVE (SET)  COOK 073701-CD / G32789,,A4335,HCPCS,Facility,Both,,,,796.25,676.8125,228.20525,796.25,Humana Insurance Company,Commercial PPO,756.4375,95,,percent of total billed charges,,
DILATOR URETHRAL S-CURVE (SET)  COOK 073701-CD / G32789,,A4335,HCPCS,Facility,Outpatient,,,,796.25,676.8125,228.20525,796.25,Humana Insurance Company,Medicare PPO,390.1625,49,,percent of total billed charges,,
DILATOR URETHRAL S-CURVE (SET)  COOK 073701-CD / G32789,,A4335,HCPCS,Facility,Inpatient,,,,796.25,676.8125,228.20525,796.25,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
DILATOR URETHRAL S-CURVE (SET)  COOK 073701-CD / G32789,,A4335,HCPCS,Facility,Both,,,,796.25,676.8125,228.20525,796.25,Medica,Individual & Family,789.08375,99.1,,percent of total billed charges,,
DILATOR URETHRAL S-CURVE (SET)  COOK 073701-CD / G32789,,A4335,HCPCS,Facility,Outpatient,,,,796.25,676.8125,228.20525,796.25,Medica,Medica Advantage Solution,396.5325,49.8,,percent of total billed charges,,
DILATOR URETHRAL S-CURVE (SET)  COOK 073701-CD / G32789,,A4335,HCPCS,Facility,Inpatient,,,,796.25,676.8125,228.20525,796.25,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
DILATOR URETHRAL S-CURVE (SET)  COOK 073701-CD / G32789,,A4335,HCPCS,Facility,Outpatient,,,,796.25,676.8125,228.20525,796.25,Medica,Medical Assistance,355.1275,44.6,,percent of total billed charges,,
DILATOR URETHRAL S-CURVE (SET)  COOK 073701-CD / G32789,,A4335,HCPCS,Facility,Inpatient,,,,796.25,676.8125,228.20525,796.25,Medica,Medical Assistance,,,,,Included in per diem rate,
DILATOR URETHRAL S-CURVE (SET)  COOK 073701-CD / G32789,,A4335,HCPCS,Facility,Outpatient,,,,796.25,676.8125,228.20525,796.25,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,396.5325,49.8,,percent of total billed charges,,
DILATOR URETHRAL S-CURVE (SET)  COOK 073701-CD / G32789,,A4335,HCPCS,Facility,Inpatient,,,,796.25,676.8125,228.20525,796.25,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
DILATOR URETHRAL S-CURVE (SET)  COOK 073701-CD / G32789,,A4335,HCPCS,Facility,Both,,,,796.25,676.8125,228.20525,796.25,"Multiplan, Inc.","Multiplan, Inc.",748.475,94,,percent of total billed charges,,
DILATOR URETHRAL S-CURVE (SET)  COOK 073701-CD / G32789,,A4335,HCPCS,Facility,Outpatient,,,,796.25,676.8125,228.20525,796.25,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,717.42125,90.1,,percent of total billed charges,,
DILATOR URETHRAL S-CURVE (SET)  COOK 073701-CD / G32789,,A4335,HCPCS,Facility,Inpatient,,,,796.25,676.8125,228.20525,796.25,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
DILATOR URETHRAL S-CURVE (SET)  COOK 073701-CD / G32789,,A4335,HCPCS,Facility,Both,,,,796.25,676.8125,228.20525,796.25,"Preferred One Administrative Services, INC.",PPO,785.1025,98.6,,percent of total billed charges,,
DILATOR URETHRAL S-CURVE (SET)  COOK 073701-CD / G32789,,A4335,HCPCS,Facility,Outpatient,,,,796.25,676.8125,228.20525,796.25,PrimeWest Health,Minnesota Senior Health Options (MSHO),409.670625,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
DILATOR URETHRAL S-CURVE (SET)  COOK 073701-CD / G32789,,A4335,HCPCS,Facility,Inpatient,,,,796.25,676.8125,228.20525,796.25,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DILATOR URETHRAL S-CURVE (SET)  COOK 073701-CD / G32789,,A4335,HCPCS,Facility,Outpatient,,,,796.25,676.8125,228.20525,796.25,PrimeWest Health,MinnesotaCare,408.954,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
DILATOR URETHRAL S-CURVE (SET)  COOK 073701-CD / G32789,,A4335,HCPCS,Facility,Inpatient,,,,796.25,676.8125,228.20525,796.25,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
DILATOR URETHRAL S-CURVE (SET)  COOK 073701-CD / G32789,,A4335,HCPCS,Facility,Both,,,,796.25,676.8125,228.20525,796.25,Sanford Health Plan,Sanford Health Plan,732.55,92,,percent of total billed charges,,
DILATOR URETHRAL S-CURVE (SET)  COOK 073701-CD / G32789,,A4335,HCPCS,Facility,Outpatient,,,,796.25,676.8125,228.20525,796.25,"UCare Health, Inc.",Individual & Family Plan,448.686875,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
DILATOR URETHRAL S-CURVE (SET)  COOK 073701-CD / G32789,,A4335,HCPCS,Facility,Inpatient,,,,796.25,676.8125,228.20525,796.25,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
DILATOR URETHRAL S-CURVE (SET)  COOK 073701-CD / G32789,,A4335,HCPCS,Facility,Outpatient,,,,796.25,676.8125,228.20525,796.25,"UCare Health, Inc.",Medical Assistance,401.867375,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DILATOR URETHRAL S-CURVE (SET)  COOK 073701-CD / G32789,,A4335,HCPCS,Facility,Inpatient,,,,796.25,676.8125,228.20525,796.25,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
DILATOR URETHRAL S-CURVE (SET)  COOK 073701-CD / G32789,,A4335,HCPCS,Facility,Outpatient,,,,796.25,676.8125,228.20525,796.25,"UCare Health, Inc.",Medicare Advantage,401.867375,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DILATOR URETHRAL S-CURVE (SET)  COOK 073701-CD / G32789,,A4335,HCPCS,Facility,Inpatient,,,,796.25,676.8125,228.20525,796.25,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DILATOR URETHRAL S-CURVE (SET)  COOK 073701-CD / G32789,,A4335,HCPCS,Facility,Outpatient,,,,796.25,676.8125,228.20525,796.25,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),401.867375,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DILATOR URETHRAL S-CURVE (SET)  COOK 073701-CD / G32789,,A4335,HCPCS,Facility,Inpatient,,,,796.25,676.8125,228.20525,796.25,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DILATOR URETHRAL S-CURVE (SET)  COOK 073701-CD / G32789,,A4335,HCPCS,Facility,Both,,,,796.25,676.8125,228.20525,796.25,UnitedHealthcare,Individual & Family,748.475,94,,percent of total billed charges,,
DILATOR URETHRAL S-CURVE (SET)  COOK 073701-CD / G32789,,A4335,HCPCS,Facility,Outpatient,,,,796.25,676.8125,228.20525,796.25,UnitedHealthcare,Medicare Advantage,390.1625,49,,percent of total billed charges,,
DILATOR URETHRAL S-CURVE (SET)  COOK 073701-CD / G32789,,A4335,HCPCS,Facility,Inpatient,,,,796.25,676.8125,228.20525,796.25,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
DILATOR URETHRAL S-CURVE (SET)  COOK 073701-CD / G32789,,A4335,HCPCS,Facility,Outpatient,,,,796.25,676.8125,228.20525,796.25,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,382.2,48,,percent of total billed charges,,100% of DHS outpatient percentage
DILATOR URETHRAL S-CURVE (SET)  COOK 073701-CD / G32789,,A4335,HCPCS,Facility,Inpatient,,,,796.25,676.8125,228.20525,796.25,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Sup Coude Tip Catheter,,A4340,HCPCS,Facility,Both,,,,55,46.75,15.763,55,Aetna,Commercial,50.6,92,,percent of total billed charges,,
Sup Coude Tip Catheter,,A4340,HCPCS,Facility,Outpatient,,,,55,46.75,15.763,55,Aetna,Medicare Advantage,26.95,49,,percent of total billed charges,,
Sup Coude Tip Catheter,,A4340,HCPCS,Facility,Inpatient,,,,55,46.75,15.763,55,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Sup Coude Tip Catheter,,A4340,HCPCS,Facility,Both,,,,55,46.75,15.763,55,Aetna,PPO,51.15,93,,percent of total billed charges,,
Sup Coude Tip Catheter,,A4340,HCPCS,Facility,Both,,,,55,46.75,15.763,55,America's PPO,America's PPO,52.8165,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Sup Coude Tip Catheter,,A4340,HCPCS,Facility,Both,,,,55,46.75,15.763,55,BlueCross BlueShield Minnesota, Federal Employee Program,54.12,98.4,,percent of total billed charges,,
Sup Coude Tip Catheter,,A4340,HCPCS,Facility,Both,,,,55,46.75,15.763,55,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,55,100,,percent of total billed charges,,
Sup Coude Tip Catheter,,A4340,HCPCS,Facility,Both,,,,55,46.75,15.763,55,BlueCross BlueShield Minnesota,High Value Network Plan,49.5,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
Sup Coude Tip Catheter,,A4340,HCPCS,Facility,Outpatient,,,,55,46.75,15.763,55,BlueCross BlueShield Minnesota,Medicare Advantage,26.95,49,,percent of total billed charges,,
Sup Coude Tip Catheter,,A4340,HCPCS,Facility,Inpatient,,,,55,46.75,15.763,55,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Sup Coude Tip Catheter,,A4340,HCPCS,Facility,Both,,,,55,46.75,15.763,55,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,48.7135,88.57,,percent of total billed charges,,
Sup Coude Tip Catheter,,A4340,HCPCS,Facility,Both,,,,55,46.75,15.763,55,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,15.763,28.66,,percent of total billed charges,,
Sup Coude Tip Catheter,,A4340,HCPCS,Facility,Outpatient,,,,55,46.75,15.763,55,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),26.95,49,,percent of total billed charges,,
Sup Coude Tip Catheter,,A4340,HCPCS,Facility,Inpatient,,,,55,46.75,15.763,55,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Sup Coude Tip Catheter,,A4340,HCPCS,Facility,Both,,,,55,46.75,15.763,55,CorVel,Worker's Compensation,55,100,,percent of total billed charges,,
Sup Coude Tip Catheter,,A4340,HCPCS,Facility,Both,,,,55,46.75,15.763,55,First Health Group Corporation,First Health Network,53.35,97,,percent of total billed charges,,
Sup Coude Tip Catheter,,A4340,HCPCS,Facility,Both,,,,55,46.75,15.763,55,"Health Partners, Inc.",Commercial,52.03,94.6,,percent of total billed charges,,
Sup Coude Tip Catheter,,A4340,HCPCS,Facility,Outpatient,,,,55,46.75,15.763,55,"Health Partners, Inc.",Medicare Advantage,26.95,49,,percent of total billed charges,,
Sup Coude Tip Catheter,,A4340,HCPCS,Facility,Inpatient,,,,55,46.75,15.763,55,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Coude Tip Catheter,,A4340,HCPCS,Facility,Both,,,,55,46.75,15.763,55,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),33,60,,percent of total billed charges,,
Sup Coude Tip Catheter,,A4340,HCPCS,Facility,Both,,,,55,46.75,15.763,55,"Health Partners, Inc.",State of Minnesota Advantage Program,44.825,81.5,,percent of total billed charges,,
Sup Coude Tip Catheter,,A4340,HCPCS,Facility,Both,,,,55,46.75,15.763,55,"Health Partners, Inc.",State Public Programs,27.5,50,,percent of total billed charges,,
Sup Coude Tip Catheter,,A4340,HCPCS,Facility,Both,,,,55,46.75,15.763,55,Humana Insurance Company,Commercial PPO,52.25,95,,percent of total billed charges,,
Sup Coude Tip Catheter,,A4340,HCPCS,Facility,Outpatient,,,,55,46.75,15.763,55,Humana Insurance Company,Medicare PPO,26.95,49,,percent of total billed charges,,
Sup Coude Tip Catheter,,A4340,HCPCS,Facility,Inpatient,,,,55,46.75,15.763,55,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Sup Coude Tip Catheter,,A4340,HCPCS,Facility,Both,,,,55,46.75,15.763,55,Medica,Individual & Family,54.505,99.1,,percent of total billed charges,,
Sup Coude Tip Catheter,,A4340,HCPCS,Facility,Outpatient,,,,55,46.75,15.763,55,Medica,Medica Advantage Solution,27.39,49.8,,percent of total billed charges,,
Sup Coude Tip Catheter,,A4340,HCPCS,Facility,Inpatient,,,,55,46.75,15.763,55,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Sup Coude Tip Catheter,,A4340,HCPCS,Facility,Outpatient,,,,55,46.75,15.763,55,Medica,Medical Assistance,24.53,44.6,,percent of total billed charges,,
Sup Coude Tip Catheter,,A4340,HCPCS,Facility,Inpatient,,,,55,46.75,15.763,55,Medica,Medical Assistance,,,,,Included in per diem rate,
Sup Coude Tip Catheter,,A4340,HCPCS,Facility,Outpatient,,,,55,46.75,15.763,55,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,27.39,49.8,,percent of total billed charges,,
Sup Coude Tip Catheter,,A4340,HCPCS,Facility,Inpatient,,,,55,46.75,15.763,55,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Sup Coude Tip Catheter,,A4340,HCPCS,Facility,Both,,,,55,46.75,15.763,55,"Multiplan, Inc.","Multiplan, Inc.",51.7,94,,percent of total billed charges,,
Sup Coude Tip Catheter,,A4340,HCPCS,Facility,Outpatient,,,,55,46.75,15.763,55,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,49.555,90.1,,percent of total billed charges,,
Sup Coude Tip Catheter,,A4340,HCPCS,Facility,Inpatient,,,,55,46.75,15.763,55,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Sup Coude Tip Catheter,,A4340,HCPCS,Facility,Both,,,,55,46.75,15.763,55,"Preferred One Administrative Services, INC.",PPO,54.23,98.6,,percent of total billed charges,,
Sup Coude Tip Catheter,,A4340,HCPCS,Facility,Outpatient,,,,55,46.75,15.763,55,PrimeWest Health,Minnesota Senior Health Options (MSHO),28.2975,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Sup Coude Tip Catheter,,A4340,HCPCS,Facility,Inpatient,,,,55,46.75,15.763,55,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Coude Tip Catheter,,A4340,HCPCS,Facility,Outpatient,,,,55,46.75,15.763,55,PrimeWest Health,MinnesotaCare,28.248,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Sup Coude Tip Catheter,,A4340,HCPCS,Facility,Inpatient,,,,55,46.75,15.763,55,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Sup Coude Tip Catheter,,A4340,HCPCS,Facility,Both,,,,55,46.75,15.763,55,Sanford Health Plan,Sanford Health Plan,50.6,92,,percent of total billed charges,,
Sup Coude Tip Catheter,,A4340,HCPCS,Facility,Outpatient,,,,55,46.75,15.763,55,"UCare Health, Inc.",Individual & Family Plan,30.9925,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Sup Coude Tip Catheter,,A4340,HCPCS,Facility,Inpatient,,,,55,46.75,15.763,55,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Sup Coude Tip Catheter,,A4340,HCPCS,Facility,Outpatient,,,,55,46.75,15.763,55,"UCare Health, Inc.",Medical Assistance,27.7585,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Coude Tip Catheter,,A4340,HCPCS,Facility,Inpatient,,,,55,46.75,15.763,55,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Sup Coude Tip Catheter,,A4340,HCPCS,Facility,Outpatient,,,,55,46.75,15.763,55,"UCare Health, Inc.",Medicare Advantage,27.7585,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Coude Tip Catheter,,A4340,HCPCS,Facility,Inpatient,,,,55,46.75,15.763,55,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Coude Tip Catheter,,A4340,HCPCS,Facility,Outpatient,,,,55,46.75,15.763,55,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),27.7585,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Coude Tip Catheter,,A4340,HCPCS,Facility,Inpatient,,,,55,46.75,15.763,55,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Coude Tip Catheter,,A4340,HCPCS,Facility,Both,,,,55,46.75,15.763,55,UnitedHealthcare,Individual & Family,51.7,94,,percent of total billed charges,,
Sup Coude Tip Catheter,,A4340,HCPCS,Facility,Outpatient,,,,55,46.75,15.763,55,UnitedHealthcare,Medicare Advantage,26.95,49,,percent of total billed charges,,
Sup Coude Tip Catheter,,A4340,HCPCS,Facility,Inpatient,,,,55,46.75,15.763,55,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Sup Coude Tip Catheter,,A4340,HCPCS,Facility,Outpatient,,,,55,46.75,15.763,55,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,26.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
Sup Coude Tip Catheter,,A4340,HCPCS,Facility,Inpatient,,,,55,46.75,15.763,55,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Sup Coude Tip Catheter,,A4352,HCPCS,Facility,Both,,,,55,46.75,15.763,55,Aetna,Commercial,50.6,92,,percent of total billed charges,,
Sup Coude Tip Catheter,,A4352,HCPCS,Facility,Outpatient,,,,55,46.75,15.763,55,Aetna,Medicare Advantage,26.95,49,,percent of total billed charges,,
Sup Coude Tip Catheter,,A4352,HCPCS,Facility,Inpatient,,,,55,46.75,15.763,55,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Sup Coude Tip Catheter,,A4352,HCPCS,Facility,Both,,,,55,46.75,15.763,55,Aetna,PPO,51.15,93,,percent of total billed charges,,
Sup Coude Tip Catheter,,A4352,HCPCS,Facility,Both,,,,55,46.75,15.763,55,America's PPO,America's PPO,52.8165,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Sup Coude Tip Catheter,,A4352,HCPCS,Facility,Both,,,,55,46.75,15.763,55,BlueCross BlueShield Minnesota, Federal Employee Program,54.12,98.4,,percent of total billed charges,,
Sup Coude Tip Catheter,,A4352,HCPCS,Facility,Both,,,,55,46.75,15.763,55,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,55,100,,percent of total billed charges,,
Sup Coude Tip Catheter,,A4352,HCPCS,Facility,Both,,,,55,46.75,15.763,55,BlueCross BlueShield Minnesota,High Value Network Plan,49.5,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
Sup Coude Tip Catheter,,A4352,HCPCS,Facility,Outpatient,,,,55,46.75,15.763,55,BlueCross BlueShield Minnesota,Medicare Advantage,26.95,49,,percent of total billed charges,,
Sup Coude Tip Catheter,,A4352,HCPCS,Facility,Inpatient,,,,55,46.75,15.763,55,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Sup Coude Tip Catheter,,A4352,HCPCS,Facility,Both,,,,55,46.75,15.763,55,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,48.7135,88.57,,percent of total billed charges,,
Sup Coude Tip Catheter,,A4352,HCPCS,Facility,Both,,,,55,46.75,15.763,55,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,15.763,28.66,,percent of total billed charges,,
Sup Coude Tip Catheter,,A4352,HCPCS,Facility,Outpatient,,,,55,46.75,15.763,55,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),26.95,49,,percent of total billed charges,,
Sup Coude Tip Catheter,,A4352,HCPCS,Facility,Inpatient,,,,55,46.75,15.763,55,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Sup Coude Tip Catheter,,A4352,HCPCS,Facility,Both,,,,55,46.75,15.763,55,CorVel,Worker's Compensation,55,100,,percent of total billed charges,,
Sup Coude Tip Catheter,,A4352,HCPCS,Facility,Both,,,,55,46.75,15.763,55,First Health Group Corporation,First Health Network,53.35,97,,percent of total billed charges,,
Sup Coude Tip Catheter,,A4352,HCPCS,Facility,Both,,,,55,46.75,15.763,55,"Health Partners, Inc.",Commercial,52.03,94.6,,percent of total billed charges,,
Sup Coude Tip Catheter,,A4352,HCPCS,Facility,Outpatient,,,,55,46.75,15.763,55,"Health Partners, Inc.",Medicare Advantage,26.95,49,,percent of total billed charges,,
Sup Coude Tip Catheter,,A4352,HCPCS,Facility,Inpatient,,,,55,46.75,15.763,55,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Coude Tip Catheter,,A4352,HCPCS,Facility,Both,,,,55,46.75,15.763,55,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),33,60,,percent of total billed charges,,
Sup Coude Tip Catheter,,A4352,HCPCS,Facility,Both,,,,55,46.75,15.763,55,"Health Partners, Inc.",State of Minnesota Advantage Program,44.825,81.5,,percent of total billed charges,,
Sup Coude Tip Catheter,,A4352,HCPCS,Facility,Both,,,,55,46.75,15.763,55,"Health Partners, Inc.",State Public Programs,27.5,50,,percent of total billed charges,,
Sup Coude Tip Catheter,,A4352,HCPCS,Facility,Both,,,,55,46.75,15.763,55,Humana Insurance Company,Commercial PPO,52.25,95,,percent of total billed charges,,
Sup Coude Tip Catheter,,A4352,HCPCS,Facility,Outpatient,,,,55,46.75,15.763,55,Humana Insurance Company,Medicare PPO,26.95,49,,percent of total billed charges,,
Sup Coude Tip Catheter,,A4352,HCPCS,Facility,Inpatient,,,,55,46.75,15.763,55,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Sup Coude Tip Catheter,,A4352,HCPCS,Facility,Both,,,,55,46.75,15.763,55,Medica,Individual & Family,54.505,99.1,,percent of total billed charges,,
Sup Coude Tip Catheter,,A4352,HCPCS,Facility,Outpatient,,,,55,46.75,15.763,55,Medica,Medica Advantage Solution,27.39,49.8,,percent of total billed charges,,
Sup Coude Tip Catheter,,A4352,HCPCS,Facility,Inpatient,,,,55,46.75,15.763,55,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Sup Coude Tip Catheter,,A4352,HCPCS,Facility,Outpatient,,,,55,46.75,15.763,55,Medica,Medical Assistance,24.53,44.6,,percent of total billed charges,,
Sup Coude Tip Catheter,,A4352,HCPCS,Facility,Inpatient,,,,55,46.75,15.763,55,Medica,Medical Assistance,,,,,Included in per diem rate,
Sup Coude Tip Catheter,,A4352,HCPCS,Facility,Outpatient,,,,55,46.75,15.763,55,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,27.39,49.8,,percent of total billed charges,,
Sup Coude Tip Catheter,,A4352,HCPCS,Facility,Inpatient,,,,55,46.75,15.763,55,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Sup Coude Tip Catheter,,A4352,HCPCS,Facility,Both,,,,55,46.75,15.763,55,"Multiplan, Inc.","Multiplan, Inc.",51.7,94,,percent of total billed charges,,
Sup Coude Tip Catheter,,A4352,HCPCS,Facility,Outpatient,,,,55,46.75,15.763,55,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,49.555,90.1,,percent of total billed charges,,
Sup Coude Tip Catheter,,A4352,HCPCS,Facility,Inpatient,,,,55,46.75,15.763,55,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Sup Coude Tip Catheter,,A4352,HCPCS,Facility,Both,,,,55,46.75,15.763,55,"Preferred One Administrative Services, INC.",PPO,54.23,98.6,,percent of total billed charges,,
Sup Coude Tip Catheter,,A4352,HCPCS,Facility,Outpatient,,,,55,46.75,15.763,55,PrimeWest Health,Minnesota Senior Health Options (MSHO),28.2975,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Sup Coude Tip Catheter,,A4352,HCPCS,Facility,Inpatient,,,,55,46.75,15.763,55,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Coude Tip Catheter,,A4352,HCPCS,Facility,Outpatient,,,,55,46.75,15.763,55,PrimeWest Health,MinnesotaCare,28.248,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Sup Coude Tip Catheter,,A4352,HCPCS,Facility,Inpatient,,,,55,46.75,15.763,55,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Sup Coude Tip Catheter,,A4352,HCPCS,Facility,Both,,,,55,46.75,15.763,55,Sanford Health Plan,Sanford Health Plan,50.6,92,,percent of total billed charges,,
Sup Coude Tip Catheter,,A4352,HCPCS,Facility,Outpatient,,,,55,46.75,15.763,55,"UCare Health, Inc.",Individual & Family Plan,30.9925,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Sup Coude Tip Catheter,,A4352,HCPCS,Facility,Inpatient,,,,55,46.75,15.763,55,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Sup Coude Tip Catheter,,A4352,HCPCS,Facility,Outpatient,,,,55,46.75,15.763,55,"UCare Health, Inc.",Medical Assistance,27.7585,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Coude Tip Catheter,,A4352,HCPCS,Facility,Inpatient,,,,55,46.75,15.763,55,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Sup Coude Tip Catheter,,A4352,HCPCS,Facility,Outpatient,,,,55,46.75,15.763,55,"UCare Health, Inc.",Medicare Advantage,27.7585,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Coude Tip Catheter,,A4352,HCPCS,Facility,Inpatient,,,,55,46.75,15.763,55,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Coude Tip Catheter,,A4352,HCPCS,Facility,Outpatient,,,,55,46.75,15.763,55,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),27.7585,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Coude Tip Catheter,,A4352,HCPCS,Facility,Inpatient,,,,55,46.75,15.763,55,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Coude Tip Catheter,,A4352,HCPCS,Facility,Both,,,,55,46.75,15.763,55,UnitedHealthcare,Individual & Family,51.7,94,,percent of total billed charges,,
Sup Coude Tip Catheter,,A4352,HCPCS,Facility,Outpatient,,,,55,46.75,15.763,55,UnitedHealthcare,Medicare Advantage,26.95,49,,percent of total billed charges,,
Sup Coude Tip Catheter,,A4352,HCPCS,Facility,Inpatient,,,,55,46.75,15.763,55,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Sup Coude Tip Catheter,,A4352,HCPCS,Facility,Outpatient,,,,55,46.75,15.763,55,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,26.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
Sup Coude Tip Catheter,,A4352,HCPCS,Facility,Inpatient,,,,55,46.75,15.763,55,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Sup Set Admin Irrigation Cysto,,A4355,HCPCS,Facility,Both,,,,19,16.15,5.4454,19,Aetna,Commercial,17.48,92,,percent of total billed charges,,
Sup Set Admin Irrigation Cysto,,A4355,HCPCS,Facility,Outpatient,,,,19,16.15,5.4454,19,Aetna,Medicare Advantage,9.31,49,,percent of total billed charges,,
Sup Set Admin Irrigation Cysto,,A4355,HCPCS,Facility,Inpatient,,,,19,16.15,5.4454,19,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Sup Set Admin Irrigation Cysto,,A4355,HCPCS,Facility,Both,,,,19,16.15,5.4454,19,Aetna,PPO,17.67,93,,percent of total billed charges,,
Sup Set Admin Irrigation Cysto,,A4355,HCPCS,Facility,Both,,,,19,16.15,5.4454,19,America's PPO,America's PPO,18.2457,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Sup Set Admin Irrigation Cysto,,A4355,HCPCS,Facility,Both,,,,19,16.15,5.4454,19,BlueCross BlueShield Minnesota, Federal Employee Program,18.696,98.4,,percent of total billed charges,,
Sup Set Admin Irrigation Cysto,,A4355,HCPCS,Facility,Both,,,,19,16.15,5.4454,19,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,19,100,,percent of total billed charges,,
Sup Set Admin Irrigation Cysto,,A4355,HCPCS,Facility,Both,,,,19,16.15,5.4454,19,BlueCross BlueShield Minnesota,High Value Network Plan,17.1,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
Sup Set Admin Irrigation Cysto,,A4355,HCPCS,Facility,Outpatient,,,,19,16.15,5.4454,19,BlueCross BlueShield Minnesota,Medicare Advantage,9.31,49,,percent of total billed charges,,
Sup Set Admin Irrigation Cysto,,A4355,HCPCS,Facility,Inpatient,,,,19,16.15,5.4454,19,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Sup Set Admin Irrigation Cysto,,A4355,HCPCS,Facility,Both,,,,19,16.15,5.4454,19,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,16.8283,88.57,,percent of total billed charges,,
Sup Set Admin Irrigation Cysto,,A4355,HCPCS,Facility,Both,,,,19,16.15,5.4454,19,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,5.4454,28.66,,percent of total billed charges,,
Sup Set Admin Irrigation Cysto,,A4355,HCPCS,Facility,Outpatient,,,,19,16.15,5.4454,19,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),9.31,49,,percent of total billed charges,,
Sup Set Admin Irrigation Cysto,,A4355,HCPCS,Facility,Inpatient,,,,19,16.15,5.4454,19,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Sup Set Admin Irrigation Cysto,,A4355,HCPCS,Facility,Both,,,,19,16.15,5.4454,19,CorVel,Worker's Compensation,19,100,,percent of total billed charges,,
Sup Set Admin Irrigation Cysto,,A4355,HCPCS,Facility,Both,,,,19,16.15,5.4454,19,First Health Group Corporation,First Health Network,18.43,97,,percent of total billed charges,,
Sup Set Admin Irrigation Cysto,,A4355,HCPCS,Facility,Both,,,,19,16.15,5.4454,19,"Health Partners, Inc.",Commercial,17.974,94.6,,percent of total billed charges,,
Sup Set Admin Irrigation Cysto,,A4355,HCPCS,Facility,Outpatient,,,,19,16.15,5.4454,19,"Health Partners, Inc.",Medicare Advantage,9.31,49,,percent of total billed charges,,
Sup Set Admin Irrigation Cysto,,A4355,HCPCS,Facility,Inpatient,,,,19,16.15,5.4454,19,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Set Admin Irrigation Cysto,,A4355,HCPCS,Facility,Both,,,,19,16.15,5.4454,19,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),11.4,60,,percent of total billed charges,,
Sup Set Admin Irrigation Cysto,,A4355,HCPCS,Facility,Both,,,,19,16.15,5.4454,19,"Health Partners, Inc.",State of Minnesota Advantage Program,15.485,81.5,,percent of total billed charges,,
Sup Set Admin Irrigation Cysto,,A4355,HCPCS,Facility,Both,,,,19,16.15,5.4454,19,"Health Partners, Inc.",State Public Programs,9.5,50,,percent of total billed charges,,
Sup Set Admin Irrigation Cysto,,A4355,HCPCS,Facility,Both,,,,19,16.15,5.4454,19,Humana Insurance Company,Commercial PPO,18.05,95,,percent of total billed charges,,
Sup Set Admin Irrigation Cysto,,A4355,HCPCS,Facility,Outpatient,,,,19,16.15,5.4454,19,Humana Insurance Company,Medicare PPO,9.31,49,,percent of total billed charges,,
Sup Set Admin Irrigation Cysto,,A4355,HCPCS,Facility,Inpatient,,,,19,16.15,5.4454,19,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Sup Set Admin Irrigation Cysto,,A4355,HCPCS,Facility,Both,,,,19,16.15,5.4454,19,Medica,Individual & Family,18.829,99.1,,percent of total billed charges,,
Sup Set Admin Irrigation Cysto,,A4355,HCPCS,Facility,Outpatient,,,,19,16.15,5.4454,19,Medica,Medica Advantage Solution,9.462,49.8,,percent of total billed charges,,
Sup Set Admin Irrigation Cysto,,A4355,HCPCS,Facility,Inpatient,,,,19,16.15,5.4454,19,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Sup Set Admin Irrigation Cysto,,A4355,HCPCS,Facility,Outpatient,,,,19,16.15,5.4454,19,Medica,Medical Assistance,8.474,44.6,,percent of total billed charges,,
Sup Set Admin Irrigation Cysto,,A4355,HCPCS,Facility,Inpatient,,,,19,16.15,5.4454,19,Medica,Medical Assistance,,,,,Included in per diem rate,
Sup Set Admin Irrigation Cysto,,A4355,HCPCS,Facility,Outpatient,,,,19,16.15,5.4454,19,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,9.462,49.8,,percent of total billed charges,,
Sup Set Admin Irrigation Cysto,,A4355,HCPCS,Facility,Inpatient,,,,19,16.15,5.4454,19,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Sup Set Admin Irrigation Cysto,,A4355,HCPCS,Facility,Both,,,,19,16.15,5.4454,19,"Multiplan, Inc.","Multiplan, Inc.",17.86,94,,percent of total billed charges,,
Sup Set Admin Irrigation Cysto,,A4355,HCPCS,Facility,Outpatient,,,,19,16.15,5.4454,19,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,17.119,90.1,,percent of total billed charges,,
Sup Set Admin Irrigation Cysto,,A4355,HCPCS,Facility,Inpatient,,,,19,16.15,5.4454,19,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Sup Set Admin Irrigation Cysto,,A4355,HCPCS,Facility,Both,,,,19,16.15,5.4454,19,"Preferred One Administrative Services, INC.",PPO,18.734,98.6,,percent of total billed charges,,
Sup Set Admin Irrigation Cysto,,A4355,HCPCS,Facility,Outpatient,,,,19,16.15,5.4454,19,PrimeWest Health,Minnesota Senior Health Options (MSHO),9.7755,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Sup Set Admin Irrigation Cysto,,A4355,HCPCS,Facility,Inpatient,,,,19,16.15,5.4454,19,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Set Admin Irrigation Cysto,,A4355,HCPCS,Facility,Outpatient,,,,19,16.15,5.4454,19,PrimeWest Health,MinnesotaCare,9.7584,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Sup Set Admin Irrigation Cysto,,A4355,HCPCS,Facility,Inpatient,,,,19,16.15,5.4454,19,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Sup Set Admin Irrigation Cysto,,A4355,HCPCS,Facility,Both,,,,19,16.15,5.4454,19,Sanford Health Plan,Sanford Health Plan,17.48,92,,percent of total billed charges,,
Sup Set Admin Irrigation Cysto,,A4355,HCPCS,Facility,Outpatient,,,,19,16.15,5.4454,19,"UCare Health, Inc.",Individual & Family Plan,10.7065,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Sup Set Admin Irrigation Cysto,,A4355,HCPCS,Facility,Inpatient,,,,19,16.15,5.4454,19,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Sup Set Admin Irrigation Cysto,,A4355,HCPCS,Facility,Outpatient,,,,19,16.15,5.4454,19,"UCare Health, Inc.",Medical Assistance,9.5893,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Set Admin Irrigation Cysto,,A4355,HCPCS,Facility,Inpatient,,,,19,16.15,5.4454,19,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Sup Set Admin Irrigation Cysto,,A4355,HCPCS,Facility,Outpatient,,,,19,16.15,5.4454,19,"UCare Health, Inc.",Medicare Advantage,9.5893,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Set Admin Irrigation Cysto,,A4355,HCPCS,Facility,Inpatient,,,,19,16.15,5.4454,19,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Set Admin Irrigation Cysto,,A4355,HCPCS,Facility,Outpatient,,,,19,16.15,5.4454,19,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),9.5893,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Set Admin Irrigation Cysto,,A4355,HCPCS,Facility,Inpatient,,,,19,16.15,5.4454,19,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Set Admin Irrigation Cysto,,A4355,HCPCS,Facility,Both,,,,19,16.15,5.4454,19,UnitedHealthcare,Individual & Family,17.86,94,,percent of total billed charges,,
Sup Set Admin Irrigation Cysto,,A4355,HCPCS,Facility,Outpatient,,,,19,16.15,5.4454,19,UnitedHealthcare,Medicare Advantage,9.31,49,,percent of total billed charges,,
Sup Set Admin Irrigation Cysto,,A4355,HCPCS,Facility,Inpatient,,,,19,16.15,5.4454,19,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Sup Set Admin Irrigation Cysto,,A4355,HCPCS,Facility,Outpatient,,,,19,16.15,5.4454,19,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,9.12,48,,percent of total billed charges,,100% of DHS outpatient percentage
Sup Set Admin Irrigation Cysto,,A4355,HCPCS,Facility,Inpatient,,,,19,16.15,5.4454,19,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
TUBING ARTHROSCOPY 4 SPIKE GRAVITY  STRYKER  350-195-004,,A4355,HCPCS,Facility,Both,,,,97.68,83.028,27.995088,97.68,Aetna,Commercial,89.8656,92,,percent of total billed charges,,
TUBING ARTHROSCOPY 4 SPIKE GRAVITY  STRYKER  350-195-004,,A4355,HCPCS,Facility,Outpatient,,,,97.68,83.028,27.995088,97.68,Aetna,Medicare Advantage,47.8632,49,,percent of total billed charges,,
TUBING ARTHROSCOPY 4 SPIKE GRAVITY  STRYKER  350-195-004,,A4355,HCPCS,Facility,Inpatient,,,,97.68,83.028,27.995088,97.68,Aetna,Medicare Advantage,,,,,Included in per diem rate,
TUBING ARTHROSCOPY 4 SPIKE GRAVITY  STRYKER  350-195-004,,A4355,HCPCS,Facility,Both,,,,97.68,83.028,27.995088,97.68,Aetna,PPO,90.8424,93,,percent of total billed charges,,
TUBING ARTHROSCOPY 4 SPIKE GRAVITY  STRYKER  350-195-004,,A4355,HCPCS,Facility,Both,,,,97.68,83.028,27.995088,97.68,America's PPO,America's PPO,93.802104,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
TUBING ARTHROSCOPY 4 SPIKE GRAVITY  STRYKER  350-195-004,,A4355,HCPCS,Facility,Both,,,,97.68,83.028,27.995088,97.68,BlueCross BlueShield Minnesota, Federal Employee Program,96.11712,98.4,,percent of total billed charges,,
TUBING ARTHROSCOPY 4 SPIKE GRAVITY  STRYKER  350-195-004,,A4355,HCPCS,Facility,Both,,,,97.68,83.028,27.995088,97.68,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,97.68,100,,percent of total billed charges,,
TUBING ARTHROSCOPY 4 SPIKE GRAVITY  STRYKER  350-195-004,,A4355,HCPCS,Facility,Both,,,,97.68,83.028,27.995088,97.68,BlueCross BlueShield Minnesota,High Value Network Plan,87.912,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
TUBING ARTHROSCOPY 4 SPIKE GRAVITY  STRYKER  350-195-004,,A4355,HCPCS,Facility,Outpatient,,,,97.68,83.028,27.995088,97.68,BlueCross BlueShield Minnesota,Medicare Advantage,47.8632,49,,percent of total billed charges,,
TUBING ARTHROSCOPY 4 SPIKE GRAVITY  STRYKER  350-195-004,,A4355,HCPCS,Facility,Inpatient,,,,97.68,83.028,27.995088,97.68,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
TUBING ARTHROSCOPY 4 SPIKE GRAVITY  STRYKER  350-195-004,,A4355,HCPCS,Facility,Both,,,,97.68,83.028,27.995088,97.68,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,86.515176,88.57,,percent of total billed charges,,
TUBING ARTHROSCOPY 4 SPIKE GRAVITY  STRYKER  350-195-004,,A4355,HCPCS,Facility,Both,,,,97.68,83.028,27.995088,97.68,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,27.995088,28.66,,percent of total billed charges,,
TUBING ARTHROSCOPY 4 SPIKE GRAVITY  STRYKER  350-195-004,,A4355,HCPCS,Facility,Outpatient,,,,97.68,83.028,27.995088,97.68,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),47.8632,49,,percent of total billed charges,,
TUBING ARTHROSCOPY 4 SPIKE GRAVITY  STRYKER  350-195-004,,A4355,HCPCS,Facility,Inpatient,,,,97.68,83.028,27.995088,97.68,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
TUBING ARTHROSCOPY 4 SPIKE GRAVITY  STRYKER  350-195-004,,A4355,HCPCS,Facility,Both,,,,97.68,83.028,27.995088,97.68,CorVel,Worker's Compensation,97.68,100,,percent of total billed charges,,
TUBING ARTHROSCOPY 4 SPIKE GRAVITY  STRYKER  350-195-004,,A4355,HCPCS,Facility,Both,,,,97.68,83.028,27.995088,97.68,First Health Group Corporation,First Health Network,94.7496,97,,percent of total billed charges,,
TUBING ARTHROSCOPY 4 SPIKE GRAVITY  STRYKER  350-195-004,,A4355,HCPCS,Facility,Both,,,,97.68,83.028,27.995088,97.68,"Health Partners, Inc.",Commercial,92.40528,94.6,,percent of total billed charges,,
TUBING ARTHROSCOPY 4 SPIKE GRAVITY  STRYKER  350-195-004,,A4355,HCPCS,Facility,Outpatient,,,,97.68,83.028,27.995088,97.68,"Health Partners, Inc.",Medicare Advantage,47.8632,49,,percent of total billed charges,,
TUBING ARTHROSCOPY 4 SPIKE GRAVITY  STRYKER  350-195-004,,A4355,HCPCS,Facility,Inpatient,,,,97.68,83.028,27.995088,97.68,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
TUBING ARTHROSCOPY 4 SPIKE GRAVITY  STRYKER  350-195-004,,A4355,HCPCS,Facility,Both,,,,97.68,83.028,27.995088,97.68,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),58.608,60,,percent of total billed charges,,
TUBING ARTHROSCOPY 4 SPIKE GRAVITY  STRYKER  350-195-004,,A4355,HCPCS,Facility,Both,,,,97.68,83.028,27.995088,97.68,"Health Partners, Inc.",State of Minnesota Advantage Program,79.6092,81.5,,percent of total billed charges,,
TUBING ARTHROSCOPY 4 SPIKE GRAVITY  STRYKER  350-195-004,,A4355,HCPCS,Facility,Both,,,,97.68,83.028,27.995088,97.68,"Health Partners, Inc.",State Public Programs,48.84,50,,percent of total billed charges,,
TUBING ARTHROSCOPY 4 SPIKE GRAVITY  STRYKER  350-195-004,,A4355,HCPCS,Facility,Both,,,,97.68,83.028,27.995088,97.68,Humana Insurance Company,Commercial PPO,92.796,95,,percent of total billed charges,,
TUBING ARTHROSCOPY 4 SPIKE GRAVITY  STRYKER  350-195-004,,A4355,HCPCS,Facility,Outpatient,,,,97.68,83.028,27.995088,97.68,Humana Insurance Company,Medicare PPO,47.8632,49,,percent of total billed charges,,
TUBING ARTHROSCOPY 4 SPIKE GRAVITY  STRYKER  350-195-004,,A4355,HCPCS,Facility,Inpatient,,,,97.68,83.028,27.995088,97.68,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
TUBING ARTHROSCOPY 4 SPIKE GRAVITY  STRYKER  350-195-004,,A4355,HCPCS,Facility,Both,,,,97.68,83.028,27.995088,97.68,Medica,Individual & Family,96.80088,99.1,,percent of total billed charges,,
TUBING ARTHROSCOPY 4 SPIKE GRAVITY  STRYKER  350-195-004,,A4355,HCPCS,Facility,Outpatient,,,,97.68,83.028,27.995088,97.68,Medica,Medica Advantage Solution,48.64464,49.8,,percent of total billed charges,,
TUBING ARTHROSCOPY 4 SPIKE GRAVITY  STRYKER  350-195-004,,A4355,HCPCS,Facility,Inpatient,,,,97.68,83.028,27.995088,97.68,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
TUBING ARTHROSCOPY 4 SPIKE GRAVITY  STRYKER  350-195-004,,A4355,HCPCS,Facility,Outpatient,,,,97.68,83.028,27.995088,97.68,Medica,Medical Assistance,43.56528,44.6,,percent of total billed charges,,
TUBING ARTHROSCOPY 4 SPIKE GRAVITY  STRYKER  350-195-004,,A4355,HCPCS,Facility,Inpatient,,,,97.68,83.028,27.995088,97.68,Medica,Medical Assistance,,,,,Included in per diem rate,
TUBING ARTHROSCOPY 4 SPIKE GRAVITY  STRYKER  350-195-004,,A4355,HCPCS,Facility,Outpatient,,,,97.68,83.028,27.995088,97.68,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,48.64464,49.8,,percent of total billed charges,,
TUBING ARTHROSCOPY 4 SPIKE GRAVITY  STRYKER  350-195-004,,A4355,HCPCS,Facility,Inpatient,,,,97.68,83.028,27.995088,97.68,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
TUBING ARTHROSCOPY 4 SPIKE GRAVITY  STRYKER  350-195-004,,A4355,HCPCS,Facility,Both,,,,97.68,83.028,27.995088,97.68,"Multiplan, Inc.","Multiplan, Inc.",91.8192,94,,percent of total billed charges,,
TUBING ARTHROSCOPY 4 SPIKE GRAVITY  STRYKER  350-195-004,,A4355,HCPCS,Facility,Outpatient,,,,97.68,83.028,27.995088,97.68,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,88.00968,90.1,,percent of total billed charges,,
TUBING ARTHROSCOPY 4 SPIKE GRAVITY  STRYKER  350-195-004,,A4355,HCPCS,Facility,Inpatient,,,,97.68,83.028,27.995088,97.68,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
TUBING ARTHROSCOPY 4 SPIKE GRAVITY  STRYKER  350-195-004,,A4355,HCPCS,Facility,Both,,,,97.68,83.028,27.995088,97.68,"Preferred One Administrative Services, INC.",PPO,96.31248,98.6,,percent of total billed charges,,
TUBING ARTHROSCOPY 4 SPIKE GRAVITY  STRYKER  350-195-004,,A4355,HCPCS,Facility,Outpatient,,,,97.68,83.028,27.995088,97.68,PrimeWest Health,Minnesota Senior Health Options (MSHO),50.25636,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
TUBING ARTHROSCOPY 4 SPIKE GRAVITY  STRYKER  350-195-004,,A4355,HCPCS,Facility,Inpatient,,,,97.68,83.028,27.995088,97.68,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
TUBING ARTHROSCOPY 4 SPIKE GRAVITY  STRYKER  350-195-004,,A4355,HCPCS,Facility,Outpatient,,,,97.68,83.028,27.995088,97.68,PrimeWest Health,MinnesotaCare,50.168448,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
TUBING ARTHROSCOPY 4 SPIKE GRAVITY  STRYKER  350-195-004,,A4355,HCPCS,Facility,Inpatient,,,,97.68,83.028,27.995088,97.68,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
TUBING ARTHROSCOPY 4 SPIKE GRAVITY  STRYKER  350-195-004,,A4355,HCPCS,Facility,Both,,,,97.68,83.028,27.995088,97.68,Sanford Health Plan,Sanford Health Plan,89.8656,92,,percent of total billed charges,,
TUBING ARTHROSCOPY 4 SPIKE GRAVITY  STRYKER  350-195-004,,A4355,HCPCS,Facility,Outpatient,,,,97.68,83.028,27.995088,97.68,"UCare Health, Inc.",Individual & Family Plan,55.04268,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
TUBING ARTHROSCOPY 4 SPIKE GRAVITY  STRYKER  350-195-004,,A4355,HCPCS,Facility,Inpatient,,,,97.68,83.028,27.995088,97.68,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
TUBING ARTHROSCOPY 4 SPIKE GRAVITY  STRYKER  350-195-004,,A4355,HCPCS,Facility,Outpatient,,,,97.68,83.028,27.995088,97.68,"UCare Health, Inc.",Medical Assistance,49.299096,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TUBING ARTHROSCOPY 4 SPIKE GRAVITY  STRYKER  350-195-004,,A4355,HCPCS,Facility,Inpatient,,,,97.68,83.028,27.995088,97.68,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
TUBING ARTHROSCOPY 4 SPIKE GRAVITY  STRYKER  350-195-004,,A4355,HCPCS,Facility,Outpatient,,,,97.68,83.028,27.995088,97.68,"UCare Health, Inc.",Medicare Advantage,49.299096,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TUBING ARTHROSCOPY 4 SPIKE GRAVITY  STRYKER  350-195-004,,A4355,HCPCS,Facility,Inpatient,,,,97.68,83.028,27.995088,97.68,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
TUBING ARTHROSCOPY 4 SPIKE GRAVITY  STRYKER  350-195-004,,A4355,HCPCS,Facility,Outpatient,,,,97.68,83.028,27.995088,97.68,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),49.299096,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TUBING ARTHROSCOPY 4 SPIKE GRAVITY  STRYKER  350-195-004,,A4355,HCPCS,Facility,Inpatient,,,,97.68,83.028,27.995088,97.68,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
TUBING ARTHROSCOPY 4 SPIKE GRAVITY  STRYKER  350-195-004,,A4355,HCPCS,Facility,Both,,,,97.68,83.028,27.995088,97.68,UnitedHealthcare,Individual & Family,91.8192,94,,percent of total billed charges,,
TUBING ARTHROSCOPY 4 SPIKE GRAVITY  STRYKER  350-195-004,,A4355,HCPCS,Facility,Outpatient,,,,97.68,83.028,27.995088,97.68,UnitedHealthcare,Medicare Advantage,47.8632,49,,percent of total billed charges,,
TUBING ARTHROSCOPY 4 SPIKE GRAVITY  STRYKER  350-195-004,,A4355,HCPCS,Facility,Inpatient,,,,97.68,83.028,27.995088,97.68,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
TUBING ARTHROSCOPY 4 SPIKE GRAVITY  STRYKER  350-195-004,,A4355,HCPCS,Facility,Outpatient,,,,97.68,83.028,27.995088,97.68,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,46.8864,48,,percent of total billed charges,,100% of DHS outpatient percentage
TUBING ARTHROSCOPY 4 SPIKE GRAVITY  STRYKER  350-195-004,,A4355,HCPCS,Facility,Inpatient,,,,97.68,83.028,27.995088,97.68,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
TUBING CYSTO/IRRIG PIERCE PIN NON-VENT,,A4355,HCPCS,Facility,Both,,,,46.575,39.58875,13.348395,46.575,Aetna,Commercial,42.849,92,,percent of total billed charges,,
TUBING CYSTO/IRRIG PIERCE PIN NON-VENT,,A4355,HCPCS,Facility,Outpatient,,,,46.575,39.58875,13.348395,46.575,Aetna,Medicare Advantage,22.82175,49,,percent of total billed charges,,
TUBING CYSTO/IRRIG PIERCE PIN NON-VENT,,A4355,HCPCS,Facility,Inpatient,,,,46.575,39.58875,13.348395,46.575,Aetna,Medicare Advantage,,,,,Included in per diem rate,
TUBING CYSTO/IRRIG PIERCE PIN NON-VENT,,A4355,HCPCS,Facility,Both,,,,46.575,39.58875,13.348395,46.575,Aetna,PPO,43.31475,93,,percent of total billed charges,,
TUBING CYSTO/IRRIG PIERCE PIN NON-VENT,,A4355,HCPCS,Facility,Both,,,,46.575,39.58875,13.348395,46.575,America's PPO,America's PPO,44.7259725,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
TUBING CYSTO/IRRIG PIERCE PIN NON-VENT,,A4355,HCPCS,Facility,Both,,,,46.575,39.58875,13.348395,46.575,BlueCross BlueShield Minnesota, Federal Employee Program,45.8298,98.4,,percent of total billed charges,,
TUBING CYSTO/IRRIG PIERCE PIN NON-VENT,,A4355,HCPCS,Facility,Both,,,,46.575,39.58875,13.348395,46.575,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,46.575,100,,percent of total billed charges,,
TUBING CYSTO/IRRIG PIERCE PIN NON-VENT,,A4355,HCPCS,Facility,Both,,,,46.575,39.58875,13.348395,46.575,BlueCross BlueShield Minnesota,High Value Network Plan,41.9175,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
TUBING CYSTO/IRRIG PIERCE PIN NON-VENT,,A4355,HCPCS,Facility,Outpatient,,,,46.575,39.58875,13.348395,46.575,BlueCross BlueShield Minnesota,Medicare Advantage,22.82175,49,,percent of total billed charges,,
TUBING CYSTO/IRRIG PIERCE PIN NON-VENT,,A4355,HCPCS,Facility,Inpatient,,,,46.575,39.58875,13.348395,46.575,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
TUBING CYSTO/IRRIG PIERCE PIN NON-VENT,,A4355,HCPCS,Facility,Both,,,,46.575,39.58875,13.348395,46.575,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,41.2514775,88.57,,percent of total billed charges,,
TUBING CYSTO/IRRIG PIERCE PIN NON-VENT,,A4355,HCPCS,Facility,Both,,,,46.575,39.58875,13.348395,46.575,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,13.348395,28.66,,percent of total billed charges,,
TUBING CYSTO/IRRIG PIERCE PIN NON-VENT,,A4355,HCPCS,Facility,Outpatient,,,,46.575,39.58875,13.348395,46.575,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),22.82175,49,,percent of total billed charges,,
TUBING CYSTO/IRRIG PIERCE PIN NON-VENT,,A4355,HCPCS,Facility,Inpatient,,,,46.575,39.58875,13.348395,46.575,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
TUBING CYSTO/IRRIG PIERCE PIN NON-VENT,,A4355,HCPCS,Facility,Both,,,,46.575,39.58875,13.348395,46.575,CorVel,Worker's Compensation,46.575,100,,percent of total billed charges,,
TUBING CYSTO/IRRIG PIERCE PIN NON-VENT,,A4355,HCPCS,Facility,Both,,,,46.575,39.58875,13.348395,46.575,First Health Group Corporation,First Health Network,45.17775,97,,percent of total billed charges,,
TUBING CYSTO/IRRIG PIERCE PIN NON-VENT,,A4355,HCPCS,Facility,Both,,,,46.575,39.58875,13.348395,46.575,"Health Partners, Inc.",Commercial,44.05995,94.6,,percent of total billed charges,,
TUBING CYSTO/IRRIG PIERCE PIN NON-VENT,,A4355,HCPCS,Facility,Outpatient,,,,46.575,39.58875,13.348395,46.575,"Health Partners, Inc.",Medicare Advantage,22.82175,49,,percent of total billed charges,,
TUBING CYSTO/IRRIG PIERCE PIN NON-VENT,,A4355,HCPCS,Facility,Inpatient,,,,46.575,39.58875,13.348395,46.575,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
TUBING CYSTO/IRRIG PIERCE PIN NON-VENT,,A4355,HCPCS,Facility,Both,,,,46.575,39.58875,13.348395,46.575,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),27.945,60,,percent of total billed charges,,
TUBING CYSTO/IRRIG PIERCE PIN NON-VENT,,A4355,HCPCS,Facility,Both,,,,46.575,39.58875,13.348395,46.575,"Health Partners, Inc.",State of Minnesota Advantage Program,37.958625,81.5,,percent of total billed charges,,
TUBING CYSTO/IRRIG PIERCE PIN NON-VENT,,A4355,HCPCS,Facility,Both,,,,46.575,39.58875,13.348395,46.575,"Health Partners, Inc.",State Public Programs,23.2875,50,,percent of total billed charges,,
TUBING CYSTO/IRRIG PIERCE PIN NON-VENT,,A4355,HCPCS,Facility,Both,,,,46.575,39.58875,13.348395,46.575,Humana Insurance Company,Commercial PPO,44.24625,95,,percent of total billed charges,,
TUBING CYSTO/IRRIG PIERCE PIN NON-VENT,,A4355,HCPCS,Facility,Outpatient,,,,46.575,39.58875,13.348395,46.575,Humana Insurance Company,Medicare PPO,22.82175,49,,percent of total billed charges,,
TUBING CYSTO/IRRIG PIERCE PIN NON-VENT,,A4355,HCPCS,Facility,Inpatient,,,,46.575,39.58875,13.348395,46.575,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
TUBING CYSTO/IRRIG PIERCE PIN NON-VENT,,A4355,HCPCS,Facility,Both,,,,46.575,39.58875,13.348395,46.575,Medica,Individual & Family,46.155825,99.1,,percent of total billed charges,,
TUBING CYSTO/IRRIG PIERCE PIN NON-VENT,,A4355,HCPCS,Facility,Outpatient,,,,46.575,39.58875,13.348395,46.575,Medica,Medica Advantage Solution,23.19435,49.8,,percent of total billed charges,,
TUBING CYSTO/IRRIG PIERCE PIN NON-VENT,,A4355,HCPCS,Facility,Inpatient,,,,46.575,39.58875,13.348395,46.575,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
TUBING CYSTO/IRRIG PIERCE PIN NON-VENT,,A4355,HCPCS,Facility,Outpatient,,,,46.575,39.58875,13.348395,46.575,Medica,Medical Assistance,20.77245,44.6,,percent of total billed charges,,
TUBING CYSTO/IRRIG PIERCE PIN NON-VENT,,A4355,HCPCS,Facility,Inpatient,,,,46.575,39.58875,13.348395,46.575,Medica,Medical Assistance,,,,,Included in per diem rate,
TUBING CYSTO/IRRIG PIERCE PIN NON-VENT,,A4355,HCPCS,Facility,Outpatient,,,,46.575,39.58875,13.348395,46.575,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,23.19435,49.8,,percent of total billed charges,,
TUBING CYSTO/IRRIG PIERCE PIN NON-VENT,,A4355,HCPCS,Facility,Inpatient,,,,46.575,39.58875,13.348395,46.575,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
TUBING CYSTO/IRRIG PIERCE PIN NON-VENT,,A4355,HCPCS,Facility,Both,,,,46.575,39.58875,13.348395,46.575,"Multiplan, Inc.","Multiplan, Inc.",43.7805,94,,percent of total billed charges,,
TUBING CYSTO/IRRIG PIERCE PIN NON-VENT,,A4355,HCPCS,Facility,Outpatient,,,,46.575,39.58875,13.348395,46.575,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,41.964075,90.1,,percent of total billed charges,,
TUBING CYSTO/IRRIG PIERCE PIN NON-VENT,,A4355,HCPCS,Facility,Inpatient,,,,46.575,39.58875,13.348395,46.575,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
TUBING CYSTO/IRRIG PIERCE PIN NON-VENT,,A4355,HCPCS,Facility,Both,,,,46.575,39.58875,13.348395,46.575,"Preferred One Administrative Services, INC.",PPO,45.92295,98.6,,percent of total billed charges,,
TUBING CYSTO/IRRIG PIERCE PIN NON-VENT,,A4355,HCPCS,Facility,Outpatient,,,,46.575,39.58875,13.348395,46.575,PrimeWest Health,Minnesota Senior Health Options (MSHO),23.9628375,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
TUBING CYSTO/IRRIG PIERCE PIN NON-VENT,,A4355,HCPCS,Facility,Inpatient,,,,46.575,39.58875,13.348395,46.575,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
TUBING CYSTO/IRRIG PIERCE PIN NON-VENT,,A4355,HCPCS,Facility,Outpatient,,,,46.575,39.58875,13.348395,46.575,PrimeWest Health,MinnesotaCare,23.92092,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
TUBING CYSTO/IRRIG PIERCE PIN NON-VENT,,A4355,HCPCS,Facility,Inpatient,,,,46.575,39.58875,13.348395,46.575,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
TUBING CYSTO/IRRIG PIERCE PIN NON-VENT,,A4355,HCPCS,Facility,Both,,,,46.575,39.58875,13.348395,46.575,Sanford Health Plan,Sanford Health Plan,42.849,92,,percent of total billed charges,,
TUBING CYSTO/IRRIG PIERCE PIN NON-VENT,,A4355,HCPCS,Facility,Outpatient,,,,46.575,39.58875,13.348395,46.575,"UCare Health, Inc.",Individual & Family Plan,26.2450125,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
TUBING CYSTO/IRRIG PIERCE PIN NON-VENT,,A4355,HCPCS,Facility,Inpatient,,,,46.575,39.58875,13.348395,46.575,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
TUBING CYSTO/IRRIG PIERCE PIN NON-VENT,,A4355,HCPCS,Facility,Outpatient,,,,46.575,39.58875,13.348395,46.575,"UCare Health, Inc.",Medical Assistance,23.5064025,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TUBING CYSTO/IRRIG PIERCE PIN NON-VENT,,A4355,HCPCS,Facility,Inpatient,,,,46.575,39.58875,13.348395,46.575,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
TUBING CYSTO/IRRIG PIERCE PIN NON-VENT,,A4355,HCPCS,Facility,Outpatient,,,,46.575,39.58875,13.348395,46.575,"UCare Health, Inc.",Medicare Advantage,23.5064025,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TUBING CYSTO/IRRIG PIERCE PIN NON-VENT,,A4355,HCPCS,Facility,Inpatient,,,,46.575,39.58875,13.348395,46.575,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
TUBING CYSTO/IRRIG PIERCE PIN NON-VENT,,A4355,HCPCS,Facility,Outpatient,,,,46.575,39.58875,13.348395,46.575,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),23.5064025,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TUBING CYSTO/IRRIG PIERCE PIN NON-VENT,,A4355,HCPCS,Facility,Inpatient,,,,46.575,39.58875,13.348395,46.575,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
TUBING CYSTO/IRRIG PIERCE PIN NON-VENT,,A4355,HCPCS,Facility,Both,,,,46.575,39.58875,13.348395,46.575,UnitedHealthcare,Individual & Family,43.7805,94,,percent of total billed charges,,
TUBING CYSTO/IRRIG PIERCE PIN NON-VENT,,A4355,HCPCS,Facility,Outpatient,,,,46.575,39.58875,13.348395,46.575,UnitedHealthcare,Medicare Advantage,22.82175,49,,percent of total billed charges,,
TUBING CYSTO/IRRIG PIERCE PIN NON-VENT,,A4355,HCPCS,Facility,Inpatient,,,,46.575,39.58875,13.348395,46.575,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
TUBING CYSTO/IRRIG PIERCE PIN NON-VENT,,A4355,HCPCS,Facility,Outpatient,,,,46.575,39.58875,13.348395,46.575,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,22.356,48,,percent of total billed charges,,100% of DHS outpatient percentage
TUBING CYSTO/IRRIG PIERCE PIN NON-VENT,,A4355,HCPCS,Facility,Inpatient,,,,46.575,39.58875,13.348395,46.575,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
TUBING TUR Y TYPE-IRRIGATION W/SIGHT,,A4355,HCPCS,Facility,Both,,,,31.2,26.52,8.94192,31.2,Aetna,Commercial,28.704,92,,percent of total billed charges,,
TUBING TUR Y TYPE-IRRIGATION W/SIGHT,,A4355,HCPCS,Facility,Outpatient,,,,31.2,26.52,8.94192,31.2,Aetna,Medicare Advantage,15.288,49,,percent of total billed charges,,
TUBING TUR Y TYPE-IRRIGATION W/SIGHT,,A4355,HCPCS,Facility,Inpatient,,,,31.2,26.52,8.94192,31.2,Aetna,Medicare Advantage,,,,,Included in per diem rate,
TUBING TUR Y TYPE-IRRIGATION W/SIGHT,,A4355,HCPCS,Facility,Both,,,,31.2,26.52,8.94192,31.2,Aetna,PPO,29.016,93,,percent of total billed charges,,
TUBING TUR Y TYPE-IRRIGATION W/SIGHT,,A4355,HCPCS,Facility,Both,,,,31.2,26.52,8.94192,31.2,America's PPO,America's PPO,29.96136,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
TUBING TUR Y TYPE-IRRIGATION W/SIGHT,,A4355,HCPCS,Facility,Both,,,,31.2,26.52,8.94192,31.2,BlueCross BlueShield Minnesota, Federal Employee Program,30.7008,98.4,,percent of total billed charges,,
TUBING TUR Y TYPE-IRRIGATION W/SIGHT,,A4355,HCPCS,Facility,Both,,,,31.2,26.52,8.94192,31.2,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,31.2,100,,percent of total billed charges,,
TUBING TUR Y TYPE-IRRIGATION W/SIGHT,,A4355,HCPCS,Facility,Both,,,,31.2,26.52,8.94192,31.2,BlueCross BlueShield Minnesota,High Value Network Plan,28.08,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
TUBING TUR Y TYPE-IRRIGATION W/SIGHT,,A4355,HCPCS,Facility,Outpatient,,,,31.2,26.52,8.94192,31.2,BlueCross BlueShield Minnesota,Medicare Advantage,15.288,49,,percent of total billed charges,,
TUBING TUR Y TYPE-IRRIGATION W/SIGHT,,A4355,HCPCS,Facility,Inpatient,,,,31.2,26.52,8.94192,31.2,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
TUBING TUR Y TYPE-IRRIGATION W/SIGHT,,A4355,HCPCS,Facility,Both,,,,31.2,26.52,8.94192,31.2,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,27.63384,88.57,,percent of total billed charges,,
TUBING TUR Y TYPE-IRRIGATION W/SIGHT,,A4355,HCPCS,Facility,Both,,,,31.2,26.52,8.94192,31.2,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,8.94192,28.66,,percent of total billed charges,,
TUBING TUR Y TYPE-IRRIGATION W/SIGHT,,A4355,HCPCS,Facility,Outpatient,,,,31.2,26.52,8.94192,31.2,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),15.288,49,,percent of total billed charges,,
TUBING TUR Y TYPE-IRRIGATION W/SIGHT,,A4355,HCPCS,Facility,Inpatient,,,,31.2,26.52,8.94192,31.2,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
TUBING TUR Y TYPE-IRRIGATION W/SIGHT,,A4355,HCPCS,Facility,Both,,,,31.2,26.52,8.94192,31.2,CorVel,Worker's Compensation,31.2,100,,percent of total billed charges,,
TUBING TUR Y TYPE-IRRIGATION W/SIGHT,,A4355,HCPCS,Facility,Both,,,,31.2,26.52,8.94192,31.2,First Health Group Corporation,First Health Network,30.264,97,,percent of total billed charges,,
TUBING TUR Y TYPE-IRRIGATION W/SIGHT,,A4355,HCPCS,Facility,Both,,,,31.2,26.52,8.94192,31.2,"Health Partners, Inc.",Commercial,29.5152,94.6,,percent of total billed charges,,
TUBING TUR Y TYPE-IRRIGATION W/SIGHT,,A4355,HCPCS,Facility,Outpatient,,,,31.2,26.52,8.94192,31.2,"Health Partners, Inc.",Medicare Advantage,15.288,49,,percent of total billed charges,,
TUBING TUR Y TYPE-IRRIGATION W/SIGHT,,A4355,HCPCS,Facility,Inpatient,,,,31.2,26.52,8.94192,31.2,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
TUBING TUR Y TYPE-IRRIGATION W/SIGHT,,A4355,HCPCS,Facility,Both,,,,31.2,26.52,8.94192,31.2,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),18.72,60,,percent of total billed charges,,
TUBING TUR Y TYPE-IRRIGATION W/SIGHT,,A4355,HCPCS,Facility,Both,,,,31.2,26.52,8.94192,31.2,"Health Partners, Inc.",State of Minnesota Advantage Program,25.428,81.5,,percent of total billed charges,,
TUBING TUR Y TYPE-IRRIGATION W/SIGHT,,A4355,HCPCS,Facility,Both,,,,31.2,26.52,8.94192,31.2,"Health Partners, Inc.",State Public Programs,15.6,50,,percent of total billed charges,,
TUBING TUR Y TYPE-IRRIGATION W/SIGHT,,A4355,HCPCS,Facility,Both,,,,31.2,26.52,8.94192,31.2,Humana Insurance Company,Commercial PPO,29.64,95,,percent of total billed charges,,
TUBING TUR Y TYPE-IRRIGATION W/SIGHT,,A4355,HCPCS,Facility,Outpatient,,,,31.2,26.52,8.94192,31.2,Humana Insurance Company,Medicare PPO,15.288,49,,percent of total billed charges,,
TUBING TUR Y TYPE-IRRIGATION W/SIGHT,,A4355,HCPCS,Facility,Inpatient,,,,31.2,26.52,8.94192,31.2,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
TUBING TUR Y TYPE-IRRIGATION W/SIGHT,,A4355,HCPCS,Facility,Both,,,,31.2,26.52,8.94192,31.2,Medica,Individual & Family,30.9192,99.1,,percent of total billed charges,,
TUBING TUR Y TYPE-IRRIGATION W/SIGHT,,A4355,HCPCS,Facility,Outpatient,,,,31.2,26.52,8.94192,31.2,Medica,Medica Advantage Solution,15.5376,49.8,,percent of total billed charges,,
TUBING TUR Y TYPE-IRRIGATION W/SIGHT,,A4355,HCPCS,Facility,Inpatient,,,,31.2,26.52,8.94192,31.2,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
TUBING TUR Y TYPE-IRRIGATION W/SIGHT,,A4355,HCPCS,Facility,Outpatient,,,,31.2,26.52,8.94192,31.2,Medica,Medical Assistance,13.9152,44.6,,percent of total billed charges,,
TUBING TUR Y TYPE-IRRIGATION W/SIGHT,,A4355,HCPCS,Facility,Inpatient,,,,31.2,26.52,8.94192,31.2,Medica,Medical Assistance,,,,,Included in per diem rate,
TUBING TUR Y TYPE-IRRIGATION W/SIGHT,,A4355,HCPCS,Facility,Outpatient,,,,31.2,26.52,8.94192,31.2,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,15.5376,49.8,,percent of total billed charges,,
TUBING TUR Y TYPE-IRRIGATION W/SIGHT,,A4355,HCPCS,Facility,Inpatient,,,,31.2,26.52,8.94192,31.2,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
TUBING TUR Y TYPE-IRRIGATION W/SIGHT,,A4355,HCPCS,Facility,Both,,,,31.2,26.52,8.94192,31.2,"Multiplan, Inc.","Multiplan, Inc.",29.328,94,,percent of total billed charges,,
TUBING TUR Y TYPE-IRRIGATION W/SIGHT,,A4355,HCPCS,Facility,Outpatient,,,,31.2,26.52,8.94192,31.2,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,28.1112,90.1,,percent of total billed charges,,
TUBING TUR Y TYPE-IRRIGATION W/SIGHT,,A4355,HCPCS,Facility,Inpatient,,,,31.2,26.52,8.94192,31.2,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
TUBING TUR Y TYPE-IRRIGATION W/SIGHT,,A4355,HCPCS,Facility,Both,,,,31.2,26.52,8.94192,31.2,"Preferred One Administrative Services, INC.",PPO,30.7632,98.6,,percent of total billed charges,,
TUBING TUR Y TYPE-IRRIGATION W/SIGHT,,A4355,HCPCS,Facility,Outpatient,,,,31.2,26.52,8.94192,31.2,PrimeWest Health,Minnesota Senior Health Options (MSHO),16.0524,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
TUBING TUR Y TYPE-IRRIGATION W/SIGHT,,A4355,HCPCS,Facility,Inpatient,,,,31.2,26.52,8.94192,31.2,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
TUBING TUR Y TYPE-IRRIGATION W/SIGHT,,A4355,HCPCS,Facility,Outpatient,,,,31.2,26.52,8.94192,31.2,PrimeWest Health,MinnesotaCare,16.02432,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
TUBING TUR Y TYPE-IRRIGATION W/SIGHT,,A4355,HCPCS,Facility,Inpatient,,,,31.2,26.52,8.94192,31.2,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
TUBING TUR Y TYPE-IRRIGATION W/SIGHT,,A4355,HCPCS,Facility,Both,,,,31.2,26.52,8.94192,31.2,Sanford Health Plan,Sanford Health Plan,28.704,92,,percent of total billed charges,,
TUBING TUR Y TYPE-IRRIGATION W/SIGHT,,A4355,HCPCS,Facility,Outpatient,,,,31.2,26.52,8.94192,31.2,"UCare Health, Inc.",Individual & Family Plan,17.5812,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
TUBING TUR Y TYPE-IRRIGATION W/SIGHT,,A4355,HCPCS,Facility,Inpatient,,,,31.2,26.52,8.94192,31.2,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
TUBING TUR Y TYPE-IRRIGATION W/SIGHT,,A4355,HCPCS,Facility,Outpatient,,,,31.2,26.52,8.94192,31.2,"UCare Health, Inc.",Medical Assistance,15.74664,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TUBING TUR Y TYPE-IRRIGATION W/SIGHT,,A4355,HCPCS,Facility,Inpatient,,,,31.2,26.52,8.94192,31.2,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
TUBING TUR Y TYPE-IRRIGATION W/SIGHT,,A4355,HCPCS,Facility,Outpatient,,,,31.2,26.52,8.94192,31.2,"UCare Health, Inc.",Medicare Advantage,15.74664,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TUBING TUR Y TYPE-IRRIGATION W/SIGHT,,A4355,HCPCS,Facility,Inpatient,,,,31.2,26.52,8.94192,31.2,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
TUBING TUR Y TYPE-IRRIGATION W/SIGHT,,A4355,HCPCS,Facility,Outpatient,,,,31.2,26.52,8.94192,31.2,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),15.74664,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TUBING TUR Y TYPE-IRRIGATION W/SIGHT,,A4355,HCPCS,Facility,Inpatient,,,,31.2,26.52,8.94192,31.2,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
TUBING TUR Y TYPE-IRRIGATION W/SIGHT,,A4355,HCPCS,Facility,Both,,,,31.2,26.52,8.94192,31.2,UnitedHealthcare,Individual & Family,29.328,94,,percent of total billed charges,,
TUBING TUR Y TYPE-IRRIGATION W/SIGHT,,A4355,HCPCS,Facility,Outpatient,,,,31.2,26.52,8.94192,31.2,UnitedHealthcare,Medicare Advantage,15.288,49,,percent of total billed charges,,
TUBING TUR Y TYPE-IRRIGATION W/SIGHT,,A4355,HCPCS,Facility,Inpatient,,,,31.2,26.52,8.94192,31.2,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
TUBING TUR Y TYPE-IRRIGATION W/SIGHT,,A4355,HCPCS,Facility,Outpatient,,,,31.2,26.52,8.94192,31.2,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,14.976,48,,percent of total billed charges,,100% of DHS outpatient percentage
TUBING TUR Y TYPE-IRRIGATION W/SIGHT,,A4355,HCPCS,Facility,Inpatient,,,,31.2,26.52,8.94192,31.2,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Sup Urinary Drainage Bag Bard,,A4357,HCPCS,Facility,Both,,,,10,8.5,2.866,10,Aetna,Commercial,9.2,92,,percent of total billed charges,,
Sup Urinary Drainage Bag Bard,,A4357,HCPCS,Facility,Outpatient,,,,10,8.5,2.866,10,Aetna,Medicare Advantage,4.9,49,,percent of total billed charges,,
Sup Urinary Drainage Bag Bard,,A4357,HCPCS,Facility,Inpatient,,,,10,8.5,2.866,10,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Sup Urinary Drainage Bag Bard,,A4357,HCPCS,Facility,Both,,,,10,8.5,2.866,10,Aetna,PPO,9.3,93,,percent of total billed charges,,
Sup Urinary Drainage Bag Bard,,A4357,HCPCS,Facility,Both,,,,10,8.5,2.866,10,America's PPO,America's PPO,9.603,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Sup Urinary Drainage Bag Bard,,A4357,HCPCS,Facility,Both,,,,10,8.5,2.866,10,BlueCross BlueShield Minnesota, Federal Employee Program,9.84,98.4,,percent of total billed charges,,
Sup Urinary Drainage Bag Bard,,A4357,HCPCS,Facility,Both,,,,10,8.5,2.866,10,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,10,100,,percent of total billed charges,,
Sup Urinary Drainage Bag Bard,,A4357,HCPCS,Facility,Both,,,,10,8.5,2.866,10,BlueCross BlueShield Minnesota,High Value Network Plan,9,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
Sup Urinary Drainage Bag Bard,,A4357,HCPCS,Facility,Outpatient,,,,10,8.5,2.866,10,BlueCross BlueShield Minnesota,Medicare Advantage,4.9,49,,percent of total billed charges,,
Sup Urinary Drainage Bag Bard,,A4357,HCPCS,Facility,Inpatient,,,,10,8.5,2.866,10,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Sup Urinary Drainage Bag Bard,,A4357,HCPCS,Facility,Both,,,,10,8.5,2.866,10,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,8.857,88.57,,percent of total billed charges,,
Sup Urinary Drainage Bag Bard,,A4357,HCPCS,Facility,Both,,,,10,8.5,2.866,10,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,2.866,28.66,,percent of total billed charges,,
Sup Urinary Drainage Bag Bard,,A4357,HCPCS,Facility,Outpatient,,,,10,8.5,2.866,10,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),4.9,49,,percent of total billed charges,,
Sup Urinary Drainage Bag Bard,,A4357,HCPCS,Facility,Inpatient,,,,10,8.5,2.866,10,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Sup Urinary Drainage Bag Bard,,A4357,HCPCS,Facility,Both,,,,10,8.5,2.866,10,CorVel,Worker's Compensation,10,100,,percent of total billed charges,,
Sup Urinary Drainage Bag Bard,,A4357,HCPCS,Facility,Both,,,,10,8.5,2.866,10,First Health Group Corporation,First Health Network,9.7,97,,percent of total billed charges,,
Sup Urinary Drainage Bag Bard,,A4357,HCPCS,Facility,Both,,,,10,8.5,2.866,10,"Health Partners, Inc.",Commercial,9.46,94.6,,percent of total billed charges,,
Sup Urinary Drainage Bag Bard,,A4357,HCPCS,Facility,Outpatient,,,,10,8.5,2.866,10,"Health Partners, Inc.",Medicare Advantage,4.9,49,,percent of total billed charges,,
Sup Urinary Drainage Bag Bard,,A4357,HCPCS,Facility,Inpatient,,,,10,8.5,2.866,10,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Urinary Drainage Bag Bard,,A4357,HCPCS,Facility,Both,,,,10,8.5,2.866,10,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),6,60,,percent of total billed charges,,
Sup Urinary Drainage Bag Bard,,A4357,HCPCS,Facility,Both,,,,10,8.5,2.866,10,"Health Partners, Inc.",State of Minnesota Advantage Program,8.15,81.5,,percent of total billed charges,,
Sup Urinary Drainage Bag Bard,,A4357,HCPCS,Facility,Both,,,,10,8.5,2.866,10,"Health Partners, Inc.",State Public Programs,5,50,,percent of total billed charges,,
Sup Urinary Drainage Bag Bard,,A4357,HCPCS,Facility,Both,,,,10,8.5,2.866,10,Humana Insurance Company,Commercial PPO,9.5,95,,percent of total billed charges,,
Sup Urinary Drainage Bag Bard,,A4357,HCPCS,Facility,Outpatient,,,,10,8.5,2.866,10,Humana Insurance Company,Medicare PPO,4.9,49,,percent of total billed charges,,
Sup Urinary Drainage Bag Bard,,A4357,HCPCS,Facility,Inpatient,,,,10,8.5,2.866,10,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Sup Urinary Drainage Bag Bard,,A4357,HCPCS,Facility,Both,,,,10,8.5,2.866,10,Medica,Individual & Family,9.91,99.1,,percent of total billed charges,,
Sup Urinary Drainage Bag Bard,,A4357,HCPCS,Facility,Outpatient,,,,10,8.5,2.866,10,Medica,Medica Advantage Solution,4.98,49.8,,percent of total billed charges,,
Sup Urinary Drainage Bag Bard,,A4357,HCPCS,Facility,Inpatient,,,,10,8.5,2.866,10,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Sup Urinary Drainage Bag Bard,,A4357,HCPCS,Facility,Outpatient,,,,10,8.5,2.866,10,Medica,Medical Assistance,4.46,44.6,,percent of total billed charges,,
Sup Urinary Drainage Bag Bard,,A4357,HCPCS,Facility,Inpatient,,,,10,8.5,2.866,10,Medica,Medical Assistance,,,,,Included in per diem rate,
Sup Urinary Drainage Bag Bard,,A4357,HCPCS,Facility,Outpatient,,,,10,8.5,2.866,10,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,4.98,49.8,,percent of total billed charges,,
Sup Urinary Drainage Bag Bard,,A4357,HCPCS,Facility,Inpatient,,,,10,8.5,2.866,10,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Sup Urinary Drainage Bag Bard,,A4357,HCPCS,Facility,Both,,,,10,8.5,2.866,10,"Multiplan, Inc.","Multiplan, Inc.",9.4,94,,percent of total billed charges,,
Sup Urinary Drainage Bag Bard,,A4357,HCPCS,Facility,Outpatient,,,,10,8.5,2.866,10,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,9.01,90.1,,percent of total billed charges,,
Sup Urinary Drainage Bag Bard,,A4357,HCPCS,Facility,Inpatient,,,,10,8.5,2.866,10,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Sup Urinary Drainage Bag Bard,,A4357,HCPCS,Facility,Both,,,,10,8.5,2.866,10,"Preferred One Administrative Services, INC.",PPO,9.86,98.6,,percent of total billed charges,,
Sup Urinary Drainage Bag Bard,,A4357,HCPCS,Facility,Outpatient,,,,10,8.5,2.866,10,PrimeWest Health,Minnesota Senior Health Options (MSHO),5.145,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Sup Urinary Drainage Bag Bard,,A4357,HCPCS,Facility,Inpatient,,,,10,8.5,2.866,10,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Urinary Drainage Bag Bard,,A4357,HCPCS,Facility,Outpatient,,,,10,8.5,2.866,10,PrimeWest Health,MinnesotaCare,5.136,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Sup Urinary Drainage Bag Bard,,A4357,HCPCS,Facility,Inpatient,,,,10,8.5,2.866,10,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Sup Urinary Drainage Bag Bard,,A4357,HCPCS,Facility,Both,,,,10,8.5,2.866,10,Sanford Health Plan,Sanford Health Plan,9.2,92,,percent of total billed charges,,
Sup Urinary Drainage Bag Bard,,A4357,HCPCS,Facility,Outpatient,,,,10,8.5,2.866,10,"UCare Health, Inc.",Individual & Family Plan,5.635,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Sup Urinary Drainage Bag Bard,,A4357,HCPCS,Facility,Inpatient,,,,10,8.5,2.866,10,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Sup Urinary Drainage Bag Bard,,A4357,HCPCS,Facility,Outpatient,,,,10,8.5,2.866,10,"UCare Health, Inc.",Medical Assistance,5.047,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Urinary Drainage Bag Bard,,A4357,HCPCS,Facility,Inpatient,,,,10,8.5,2.866,10,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Sup Urinary Drainage Bag Bard,,A4357,HCPCS,Facility,Outpatient,,,,10,8.5,2.866,10,"UCare Health, Inc.",Medicare Advantage,5.047,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Urinary Drainage Bag Bard,,A4357,HCPCS,Facility,Inpatient,,,,10,8.5,2.866,10,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Urinary Drainage Bag Bard,,A4357,HCPCS,Facility,Outpatient,,,,10,8.5,2.866,10,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),5.047,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Urinary Drainage Bag Bard,,A4357,HCPCS,Facility,Inpatient,,,,10,8.5,2.866,10,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Urinary Drainage Bag Bard,,A4357,HCPCS,Facility,Both,,,,10,8.5,2.866,10,UnitedHealthcare,Individual & Family,9.4,94,,percent of total billed charges,,
Sup Urinary Drainage Bag Bard,,A4357,HCPCS,Facility,Outpatient,,,,10,8.5,2.866,10,UnitedHealthcare,Medicare Advantage,4.9,49,,percent of total billed charges,,
Sup Urinary Drainage Bag Bard,,A4357,HCPCS,Facility,Inpatient,,,,10,8.5,2.866,10,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Sup Urinary Drainage Bag Bard,,A4357,HCPCS,Facility,Outpatient,,,,10,8.5,2.866,10,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,4.8,48,,percent of total billed charges,,100% of DHS outpatient percentage
Sup Urinary Drainage Bag Bard,,A4357,HCPCS,Facility,Inpatient,,,,10,8.5,2.866,10,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Sup Liquiband Tissue Adhesive,,A4364,HCPCS,Facility,Both,,,,80,68,22.928,80,Aetna,Commercial,73.6,92,,percent of total billed charges,,
Sup Liquiband Tissue Adhesive,,A4364,HCPCS,Facility,Outpatient,,,,80,68,22.928,80,Aetna,Medicare Advantage,39.2,49,,percent of total billed charges,,
Sup Liquiband Tissue Adhesive,,A4364,HCPCS,Facility,Inpatient,,,,80,68,22.928,80,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Sup Liquiband Tissue Adhesive,,A4364,HCPCS,Facility,Both,,,,80,68,22.928,80,Aetna,PPO,74.4,93,,percent of total billed charges,,
Sup Liquiband Tissue Adhesive,,A4364,HCPCS,Facility,Both,,,,80,68,22.928,80,America's PPO,America's PPO,76.824,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Sup Liquiband Tissue Adhesive,,A4364,HCPCS,Facility,Both,,,,80,68,22.928,80,BlueCross BlueShield Minnesota, Federal Employee Program,78.72,98.4,,percent of total billed charges,,
Sup Liquiband Tissue Adhesive,,A4364,HCPCS,Facility,Both,,,,80,68,22.928,80,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,80,100,,percent of total billed charges,,
Sup Liquiband Tissue Adhesive,,A4364,HCPCS,Facility,Both,,,,80,68,22.928,80,BlueCross BlueShield Minnesota,High Value Network Plan,72,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
Sup Liquiband Tissue Adhesive,,A4364,HCPCS,Facility,Outpatient,,,,80,68,22.928,80,BlueCross BlueShield Minnesota,Medicare Advantage,39.2,49,,percent of total billed charges,,
Sup Liquiband Tissue Adhesive,,A4364,HCPCS,Facility,Inpatient,,,,80,68,22.928,80,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Sup Liquiband Tissue Adhesive,,A4364,HCPCS,Facility,Both,,,,80,68,22.928,80,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,70.856,88.57,,percent of total billed charges,,
Sup Liquiband Tissue Adhesive,,A4364,HCPCS,Facility,Both,,,,80,68,22.928,80,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,22.928,28.66,,percent of total billed charges,,
Sup Liquiband Tissue Adhesive,,A4364,HCPCS,Facility,Outpatient,,,,80,68,22.928,80,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),39.2,49,,percent of total billed charges,,
Sup Liquiband Tissue Adhesive,,A4364,HCPCS,Facility,Inpatient,,,,80,68,22.928,80,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Sup Liquiband Tissue Adhesive,,A4364,HCPCS,Facility,Both,,,,80,68,22.928,80,CorVel,Worker's Compensation,80,100,,percent of total billed charges,,
Sup Liquiband Tissue Adhesive,,A4364,HCPCS,Facility,Both,,,,80,68,22.928,80,First Health Group Corporation,First Health Network,77.6,97,,percent of total billed charges,,
Sup Liquiband Tissue Adhesive,,A4364,HCPCS,Facility,Both,,,,80,68,22.928,80,"Health Partners, Inc.",Commercial,75.68,94.6,,percent of total billed charges,,
Sup Liquiband Tissue Adhesive,,A4364,HCPCS,Facility,Outpatient,,,,80,68,22.928,80,"Health Partners, Inc.",Medicare Advantage,39.2,49,,percent of total billed charges,,
Sup Liquiband Tissue Adhesive,,A4364,HCPCS,Facility,Inpatient,,,,80,68,22.928,80,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Liquiband Tissue Adhesive,,A4364,HCPCS,Facility,Both,,,,80,68,22.928,80,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),48,60,,percent of total billed charges,,
Sup Liquiband Tissue Adhesive,,A4364,HCPCS,Facility,Both,,,,80,68,22.928,80,"Health Partners, Inc.",State of Minnesota Advantage Program,65.2,81.5,,percent of total billed charges,,
Sup Liquiband Tissue Adhesive,,A4364,HCPCS,Facility,Both,,,,80,68,22.928,80,"Health Partners, Inc.",State Public Programs,40,50,,percent of total billed charges,,
Sup Liquiband Tissue Adhesive,,A4364,HCPCS,Facility,Both,,,,80,68,22.928,80,Humana Insurance Company,Commercial PPO,76,95,,percent of total billed charges,,
Sup Liquiband Tissue Adhesive,,A4364,HCPCS,Facility,Outpatient,,,,80,68,22.928,80,Humana Insurance Company,Medicare PPO,39.2,49,,percent of total billed charges,,
Sup Liquiband Tissue Adhesive,,A4364,HCPCS,Facility,Inpatient,,,,80,68,22.928,80,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Sup Liquiband Tissue Adhesive,,A4364,HCPCS,Facility,Both,,,,80,68,22.928,80,Medica,Individual & Family,79.28,99.1,,percent of total billed charges,,
Sup Liquiband Tissue Adhesive,,A4364,HCPCS,Facility,Outpatient,,,,80,68,22.928,80,Medica,Medica Advantage Solution,39.84,49.8,,percent of total billed charges,,
Sup Liquiband Tissue Adhesive,,A4364,HCPCS,Facility,Inpatient,,,,80,68,22.928,80,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Sup Liquiband Tissue Adhesive,,A4364,HCPCS,Facility,Outpatient,,,,80,68,22.928,80,Medica,Medical Assistance,35.68,44.6,,percent of total billed charges,,
Sup Liquiband Tissue Adhesive,,A4364,HCPCS,Facility,Inpatient,,,,80,68,22.928,80,Medica,Medical Assistance,,,,,Included in per diem rate,
Sup Liquiband Tissue Adhesive,,A4364,HCPCS,Facility,Outpatient,,,,80,68,22.928,80,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,39.84,49.8,,percent of total billed charges,,
Sup Liquiband Tissue Adhesive,,A4364,HCPCS,Facility,Inpatient,,,,80,68,22.928,80,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Sup Liquiband Tissue Adhesive,,A4364,HCPCS,Facility,Both,,,,80,68,22.928,80,"Multiplan, Inc.","Multiplan, Inc.",75.2,94,,percent of total billed charges,,
Sup Liquiband Tissue Adhesive,,A4364,HCPCS,Facility,Outpatient,,,,80,68,22.928,80,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,72.08,90.1,,percent of total billed charges,,
Sup Liquiband Tissue Adhesive,,A4364,HCPCS,Facility,Inpatient,,,,80,68,22.928,80,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Sup Liquiband Tissue Adhesive,,A4364,HCPCS,Facility,Both,,,,80,68,22.928,80,"Preferred One Administrative Services, INC.",PPO,78.88,98.6,,percent of total billed charges,,
Sup Liquiband Tissue Adhesive,,A4364,HCPCS,Facility,Outpatient,,,,80,68,22.928,80,PrimeWest Health,Minnesota Senior Health Options (MSHO),41.16,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Sup Liquiband Tissue Adhesive,,A4364,HCPCS,Facility,Inpatient,,,,80,68,22.928,80,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Liquiband Tissue Adhesive,,A4364,HCPCS,Facility,Outpatient,,,,80,68,22.928,80,PrimeWest Health,MinnesotaCare,41.088,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Sup Liquiband Tissue Adhesive,,A4364,HCPCS,Facility,Inpatient,,,,80,68,22.928,80,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Sup Liquiband Tissue Adhesive,,A4364,HCPCS,Facility,Both,,,,80,68,22.928,80,Sanford Health Plan,Sanford Health Plan,73.6,92,,percent of total billed charges,,
Sup Liquiband Tissue Adhesive,,A4364,HCPCS,Facility,Outpatient,,,,80,68,22.928,80,"UCare Health, Inc.",Individual & Family Plan,45.08,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Sup Liquiband Tissue Adhesive,,A4364,HCPCS,Facility,Inpatient,,,,80,68,22.928,80,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Sup Liquiband Tissue Adhesive,,A4364,HCPCS,Facility,Outpatient,,,,80,68,22.928,80,"UCare Health, Inc.",Medical Assistance,40.376,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Liquiband Tissue Adhesive,,A4364,HCPCS,Facility,Inpatient,,,,80,68,22.928,80,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Sup Liquiband Tissue Adhesive,,A4364,HCPCS,Facility,Outpatient,,,,80,68,22.928,80,"UCare Health, Inc.",Medicare Advantage,40.376,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Liquiband Tissue Adhesive,,A4364,HCPCS,Facility,Inpatient,,,,80,68,22.928,80,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Liquiband Tissue Adhesive,,A4364,HCPCS,Facility,Outpatient,,,,80,68,22.928,80,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),40.376,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Liquiband Tissue Adhesive,,A4364,HCPCS,Facility,Inpatient,,,,80,68,22.928,80,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Liquiband Tissue Adhesive,,A4364,HCPCS,Facility,Both,,,,80,68,22.928,80,UnitedHealthcare,Individual & Family,75.2,94,,percent of total billed charges,,
Sup Liquiband Tissue Adhesive,,A4364,HCPCS,Facility,Outpatient,,,,80,68,22.928,80,UnitedHealthcare,Medicare Advantage,39.2,49,,percent of total billed charges,,
Sup Liquiband Tissue Adhesive,,A4364,HCPCS,Facility,Inpatient,,,,80,68,22.928,80,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Sup Liquiband Tissue Adhesive,,A4364,HCPCS,Facility,Outpatient,,,,80,68,22.928,80,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,38.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
Sup Liquiband Tissue Adhesive,,A4364,HCPCS,Facility,Inpatient,,,,80,68,22.928,80,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Sup Ostomy Skin Bar Pwd,,A4371,HCPCS,Facility,Both,,,,20.89,17.7565,5.987074,20.89,Aetna,Commercial,19.2188,92,,percent of total billed charges,,
Sup Ostomy Skin Bar Pwd,,A4371,HCPCS,Facility,Outpatient,,,,20.89,17.7565,5.987074,20.89,Aetna,Medicare Advantage,10.2361,49,,percent of total billed charges,,
Sup Ostomy Skin Bar Pwd,,A4371,HCPCS,Facility,Inpatient,,,,20.89,17.7565,5.987074,20.89,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Sup Ostomy Skin Bar Pwd,,A4371,HCPCS,Facility,Both,,,,20.89,17.7565,5.987074,20.89,Aetna,PPO,19.4277,93,,percent of total billed charges,,
Sup Ostomy Skin Bar Pwd,,A4371,HCPCS,Facility,Both,,,,20.89,17.7565,5.987074,20.89,America's PPO,America's PPO,20.060667,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Sup Ostomy Skin Bar Pwd,,A4371,HCPCS,Facility,Both,,,,20.89,17.7565,5.987074,20.89,BlueCross BlueShield Minnesota, Federal Employee Program,20.55576,98.4,,percent of total billed charges,,
Sup Ostomy Skin Bar Pwd,,A4371,HCPCS,Facility,Both,,,,20.89,17.7565,5.987074,20.89,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,20.89,100,,percent of total billed charges,,
Sup Ostomy Skin Bar Pwd,,A4371,HCPCS,Facility,Both,,,,20.89,17.7565,5.987074,20.89,BlueCross BlueShield Minnesota,High Value Network Plan,18.801,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
Sup Ostomy Skin Bar Pwd,,A4371,HCPCS,Facility,Outpatient,,,,20.89,17.7565,5.987074,20.89,BlueCross BlueShield Minnesota,Medicare Advantage,10.2361,49,,percent of total billed charges,,
Sup Ostomy Skin Bar Pwd,,A4371,HCPCS,Facility,Inpatient,,,,20.89,17.7565,5.987074,20.89,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Sup Ostomy Skin Bar Pwd,,A4371,HCPCS,Facility,Both,,,,20.89,17.7565,5.987074,20.89,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,18.502273,88.57,,percent of total billed charges,,
Sup Ostomy Skin Bar Pwd,,A4371,HCPCS,Facility,Both,,,,20.89,17.7565,5.987074,20.89,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,5.987074,28.66,,percent of total billed charges,,
Sup Ostomy Skin Bar Pwd,,A4371,HCPCS,Facility,Outpatient,,,,20.89,17.7565,5.987074,20.89,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),10.2361,49,,percent of total billed charges,,
Sup Ostomy Skin Bar Pwd,,A4371,HCPCS,Facility,Inpatient,,,,20.89,17.7565,5.987074,20.89,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Sup Ostomy Skin Bar Pwd,,A4371,HCPCS,Facility,Both,,,,20.89,17.7565,5.987074,20.89,CorVel,Worker's Compensation,20.89,100,,percent of total billed charges,,
Sup Ostomy Skin Bar Pwd,,A4371,HCPCS,Facility,Both,,,,20.89,17.7565,5.987074,20.89,First Health Group Corporation,First Health Network,20.2633,97,,percent of total billed charges,,
Sup Ostomy Skin Bar Pwd,,A4371,HCPCS,Facility,Both,,,,20.89,17.7565,5.987074,20.89,"Health Partners, Inc.",Commercial,19.76194,94.6,,percent of total billed charges,,
Sup Ostomy Skin Bar Pwd,,A4371,HCPCS,Facility,Outpatient,,,,20.89,17.7565,5.987074,20.89,"Health Partners, Inc.",Medicare Advantage,10.2361,49,,percent of total billed charges,,
Sup Ostomy Skin Bar Pwd,,A4371,HCPCS,Facility,Inpatient,,,,20.89,17.7565,5.987074,20.89,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Ostomy Skin Bar Pwd,,A4371,HCPCS,Facility,Both,,,,20.89,17.7565,5.987074,20.89,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),12.534,60,,percent of total billed charges,,
Sup Ostomy Skin Bar Pwd,,A4371,HCPCS,Facility,Both,,,,20.89,17.7565,5.987074,20.89,"Health Partners, Inc.",State of Minnesota Advantage Program,17.02535,81.5,,percent of total billed charges,,
Sup Ostomy Skin Bar Pwd,,A4371,HCPCS,Facility,Both,,,,20.89,17.7565,5.987074,20.89,"Health Partners, Inc.",State Public Programs,10.445,50,,percent of total billed charges,,
Sup Ostomy Skin Bar Pwd,,A4371,HCPCS,Facility,Both,,,,20.89,17.7565,5.987074,20.89,Humana Insurance Company,Commercial PPO,19.8455,95,,percent of total billed charges,,
Sup Ostomy Skin Bar Pwd,,A4371,HCPCS,Facility,Outpatient,,,,20.89,17.7565,5.987074,20.89,Humana Insurance Company,Medicare PPO,10.2361,49,,percent of total billed charges,,
Sup Ostomy Skin Bar Pwd,,A4371,HCPCS,Facility,Inpatient,,,,20.89,17.7565,5.987074,20.89,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Sup Ostomy Skin Bar Pwd,,A4371,HCPCS,Facility,Both,,,,20.89,17.7565,5.987074,20.89,Medica,Individual & Family,20.70199,99.1,,percent of total billed charges,,
Sup Ostomy Skin Bar Pwd,,A4371,HCPCS,Facility,Outpatient,,,,20.89,17.7565,5.987074,20.89,Medica,Medica Advantage Solution,10.40322,49.8,,percent of total billed charges,,
Sup Ostomy Skin Bar Pwd,,A4371,HCPCS,Facility,Inpatient,,,,20.89,17.7565,5.987074,20.89,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Sup Ostomy Skin Bar Pwd,,A4371,HCPCS,Facility,Outpatient,,,,20.89,17.7565,5.987074,20.89,Medica,Medical Assistance,9.31694,44.6,,percent of total billed charges,,
Sup Ostomy Skin Bar Pwd,,A4371,HCPCS,Facility,Inpatient,,,,20.89,17.7565,5.987074,20.89,Medica,Medical Assistance,,,,,Included in per diem rate,
Sup Ostomy Skin Bar Pwd,,A4371,HCPCS,Facility,Outpatient,,,,20.89,17.7565,5.987074,20.89,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,10.40322,49.8,,percent of total billed charges,,
Sup Ostomy Skin Bar Pwd,,A4371,HCPCS,Facility,Inpatient,,,,20.89,17.7565,5.987074,20.89,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Sup Ostomy Skin Bar Pwd,,A4371,HCPCS,Facility,Both,,,,20.89,17.7565,5.987074,20.89,"Multiplan, Inc.","Multiplan, Inc.",19.6366,94,,percent of total billed charges,,
Sup Ostomy Skin Bar Pwd,,A4371,HCPCS,Facility,Outpatient,,,,20.89,17.7565,5.987074,20.89,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,18.82189,90.1,,percent of total billed charges,,
Sup Ostomy Skin Bar Pwd,,A4371,HCPCS,Facility,Inpatient,,,,20.89,17.7565,5.987074,20.89,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Sup Ostomy Skin Bar Pwd,,A4371,HCPCS,Facility,Both,,,,20.89,17.7565,5.987074,20.89,"Preferred One Administrative Services, INC.",PPO,20.59754,98.6,,percent of total billed charges,,
Sup Ostomy Skin Bar Pwd,,A4371,HCPCS,Facility,Outpatient,,,,20.89,17.7565,5.987074,20.89,PrimeWest Health,Minnesota Senior Health Options (MSHO),10.747905,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Sup Ostomy Skin Bar Pwd,,A4371,HCPCS,Facility,Inpatient,,,,20.89,17.7565,5.987074,20.89,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Ostomy Skin Bar Pwd,,A4371,HCPCS,Facility,Outpatient,,,,20.89,17.7565,5.987074,20.89,PrimeWest Health,MinnesotaCare,10.729104,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Sup Ostomy Skin Bar Pwd,,A4371,HCPCS,Facility,Inpatient,,,,20.89,17.7565,5.987074,20.89,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Sup Ostomy Skin Bar Pwd,,A4371,HCPCS,Facility,Both,,,,20.89,17.7565,5.987074,20.89,Sanford Health Plan,Sanford Health Plan,19.2188,92,,percent of total billed charges,,
Sup Ostomy Skin Bar Pwd,,A4371,HCPCS,Facility,Outpatient,,,,20.89,17.7565,5.987074,20.89,"UCare Health, Inc.",Individual & Family Plan,11.771515,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Sup Ostomy Skin Bar Pwd,,A4371,HCPCS,Facility,Inpatient,,,,20.89,17.7565,5.987074,20.89,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Sup Ostomy Skin Bar Pwd,,A4371,HCPCS,Facility,Outpatient,,,,20.89,17.7565,5.987074,20.89,"UCare Health, Inc.",Medical Assistance,10.543183,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Ostomy Skin Bar Pwd,,A4371,HCPCS,Facility,Inpatient,,,,20.89,17.7565,5.987074,20.89,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Sup Ostomy Skin Bar Pwd,,A4371,HCPCS,Facility,Outpatient,,,,20.89,17.7565,5.987074,20.89,"UCare Health, Inc.",Medicare Advantage,10.543183,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Ostomy Skin Bar Pwd,,A4371,HCPCS,Facility,Inpatient,,,,20.89,17.7565,5.987074,20.89,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Ostomy Skin Bar Pwd,,A4371,HCPCS,Facility,Outpatient,,,,20.89,17.7565,5.987074,20.89,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),10.543183,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Ostomy Skin Bar Pwd,,A4371,HCPCS,Facility,Inpatient,,,,20.89,17.7565,5.987074,20.89,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Ostomy Skin Bar Pwd,,A4371,HCPCS,Facility,Both,,,,20.89,17.7565,5.987074,20.89,UnitedHealthcare,Individual & Family,19.6366,94,,percent of total billed charges,,
Sup Ostomy Skin Bar Pwd,,A4371,HCPCS,Facility,Outpatient,,,,20.89,17.7565,5.987074,20.89,UnitedHealthcare,Medicare Advantage,10.2361,49,,percent of total billed charges,,
Sup Ostomy Skin Bar Pwd,,A4371,HCPCS,Facility,Inpatient,,,,20.89,17.7565,5.987074,20.89,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Sup Ostomy Skin Bar Pwd,,A4371,HCPCS,Facility,Outpatient,,,,20.89,17.7565,5.987074,20.89,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,10.0272,48,,percent of total billed charges,,100% of DHS outpatient percentage
Sup Ostomy Skin Bar Pwd,,A4371,HCPCS,Facility,Inpatient,,,,20.89,17.7565,5.987074,20.89,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Sup Medipore H Tape 1,,A4450,HCPCS,Facility,Both,,,,23.66,20.111,6.780956,23.66,Aetna,Commercial,21.7672,92,,percent of total billed charges,,
Sup Medipore H Tape 1,,A4450,HCPCS,Facility,Outpatient,,,,23.66,20.111,6.780956,23.66,Aetna,Medicare Advantage,11.5934,49,,percent of total billed charges,,
Sup Medipore H Tape 1,,A4450,HCPCS,Facility,Inpatient,,,,23.66,20.111,6.780956,23.66,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Sup Medipore H Tape 1,,A4450,HCPCS,Facility,Both,,,,23.66,20.111,6.780956,23.66,Aetna,PPO,22.0038,93,,percent of total billed charges,,
Sup Medipore H Tape 1,,A4450,HCPCS,Facility,Both,,,,23.66,20.111,6.780956,23.66,America's PPO,America's PPO,22.720698,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Sup Medipore H Tape 1,,A4450,HCPCS,Facility,Both,,,,23.66,20.111,6.780956,23.66,BlueCross BlueShield Minnesota, Federal Employee Program,23.28144,98.4,,percent of total billed charges,,
Sup Medipore H Tape 1,,A4450,HCPCS,Facility,Both,,,,23.66,20.111,6.780956,23.66,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,23.66,100,,percent of total billed charges,,
Sup Medipore H Tape 1,,A4450,HCPCS,Facility,Both,,,,23.66,20.111,6.780956,23.66,BlueCross BlueShield Minnesota,High Value Network Plan,21.294,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
Sup Medipore H Tape 1,,A4450,HCPCS,Facility,Outpatient,,,,23.66,20.111,6.780956,23.66,BlueCross BlueShield Minnesota,Medicare Advantage,11.5934,49,,percent of total billed charges,,
Sup Medipore H Tape 1,,A4450,HCPCS,Facility,Inpatient,,,,23.66,20.111,6.780956,23.66,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Sup Medipore H Tape 1,,A4450,HCPCS,Facility,Both,,,,23.66,20.111,6.780956,23.66,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,20.955662,88.57,,percent of total billed charges,,
Sup Medipore H Tape 1,,A4450,HCPCS,Facility,Both,,,,23.66,20.111,6.780956,23.66,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,6.780956,28.66,,percent of total billed charges,,
Sup Medipore H Tape 1,,A4450,HCPCS,Facility,Outpatient,,,,23.66,20.111,6.780956,23.66,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),11.5934,49,,percent of total billed charges,,
Sup Medipore H Tape 1,,A4450,HCPCS,Facility,Inpatient,,,,23.66,20.111,6.780956,23.66,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Sup Medipore H Tape 1,,A4450,HCPCS,Facility,Both,,,,23.66,20.111,6.780956,23.66,CorVel,Worker's Compensation,23.66,100,,percent of total billed charges,,
Sup Medipore H Tape 1,,A4450,HCPCS,Facility,Both,,,,23.66,20.111,6.780956,23.66,First Health Group Corporation,First Health Network,22.9502,97,,percent of total billed charges,,
Sup Medipore H Tape 1,,A4450,HCPCS,Facility,Both,,,,23.66,20.111,6.780956,23.66,"Health Partners, Inc.",Commercial,22.38236,94.6,,percent of total billed charges,,
Sup Medipore H Tape 1,,A4450,HCPCS,Facility,Outpatient,,,,23.66,20.111,6.780956,23.66,"Health Partners, Inc.",Medicare Advantage,11.5934,49,,percent of total billed charges,,
Sup Medipore H Tape 1,,A4450,HCPCS,Facility,Inpatient,,,,23.66,20.111,6.780956,23.66,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Medipore H Tape 1,,A4450,HCPCS,Facility,Both,,,,23.66,20.111,6.780956,23.66,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),14.196,60,,percent of total billed charges,,
Sup Medipore H Tape 1,,A4450,HCPCS,Facility,Both,,,,23.66,20.111,6.780956,23.66,"Health Partners, Inc.",State of Minnesota Advantage Program,19.2829,81.5,,percent of total billed charges,,
Sup Medipore H Tape 1,,A4450,HCPCS,Facility,Both,,,,23.66,20.111,6.780956,23.66,"Health Partners, Inc.",State Public Programs,11.83,50,,percent of total billed charges,,
Sup Medipore H Tape 1,,A4450,HCPCS,Facility,Both,,,,23.66,20.111,6.780956,23.66,Humana Insurance Company,Commercial PPO,22.477,95,,percent of total billed charges,,
Sup Medipore H Tape 1,,A4450,HCPCS,Facility,Outpatient,,,,23.66,20.111,6.780956,23.66,Humana Insurance Company,Medicare PPO,11.5934,49,,percent of total billed charges,,
Sup Medipore H Tape 1,,A4450,HCPCS,Facility,Inpatient,,,,23.66,20.111,6.780956,23.66,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Sup Medipore H Tape 1,,A4450,HCPCS,Facility,Both,,,,23.66,20.111,6.780956,23.66,Medica,Individual & Family,23.44706,99.1,,percent of total billed charges,,
Sup Medipore H Tape 1,,A4450,HCPCS,Facility,Outpatient,,,,23.66,20.111,6.780956,23.66,Medica,Medica Advantage Solution,11.78268,49.8,,percent of total billed charges,,
Sup Medipore H Tape 1,,A4450,HCPCS,Facility,Inpatient,,,,23.66,20.111,6.780956,23.66,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Sup Medipore H Tape 1,,A4450,HCPCS,Facility,Outpatient,,,,23.66,20.111,6.780956,23.66,Medica,Medical Assistance,10.55236,44.6,,percent of total billed charges,,
Sup Medipore H Tape 1,,A4450,HCPCS,Facility,Inpatient,,,,23.66,20.111,6.780956,23.66,Medica,Medical Assistance,,,,,Included in per diem rate,
Sup Medipore H Tape 1,,A4450,HCPCS,Facility,Outpatient,,,,23.66,20.111,6.780956,23.66,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,11.78268,49.8,,percent of total billed charges,,
Sup Medipore H Tape 1,,A4450,HCPCS,Facility,Inpatient,,,,23.66,20.111,6.780956,23.66,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Sup Medipore H Tape 1,,A4450,HCPCS,Facility,Both,,,,23.66,20.111,6.780956,23.66,"Multiplan, Inc.","Multiplan, Inc.",22.2404,94,,percent of total billed charges,,
Sup Medipore H Tape 1,,A4450,HCPCS,Facility,Outpatient,,,,23.66,20.111,6.780956,23.66,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,21.31766,90.1,,percent of total billed charges,,
Sup Medipore H Tape 1,,A4450,HCPCS,Facility,Inpatient,,,,23.66,20.111,6.780956,23.66,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Sup Medipore H Tape 1,,A4450,HCPCS,Facility,Both,,,,23.66,20.111,6.780956,23.66,"Preferred One Administrative Services, INC.",PPO,23.32876,98.6,,percent of total billed charges,,
Sup Medipore H Tape 1,,A4450,HCPCS,Facility,Outpatient,,,,23.66,20.111,6.780956,23.66,PrimeWest Health,Minnesota Senior Health Options (MSHO),12.17307,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Sup Medipore H Tape 1,,A4450,HCPCS,Facility,Inpatient,,,,23.66,20.111,6.780956,23.66,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Medipore H Tape 1,,A4450,HCPCS,Facility,Outpatient,,,,23.66,20.111,6.780956,23.66,PrimeWest Health,MinnesotaCare,12.151776,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Sup Medipore H Tape 1,,A4450,HCPCS,Facility,Inpatient,,,,23.66,20.111,6.780956,23.66,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Sup Medipore H Tape 1,,A4450,HCPCS,Facility,Both,,,,23.66,20.111,6.780956,23.66,Sanford Health Plan,Sanford Health Plan,21.7672,92,,percent of total billed charges,,
Sup Medipore H Tape 1,,A4450,HCPCS,Facility,Outpatient,,,,23.66,20.111,6.780956,23.66,"UCare Health, Inc.",Individual & Family Plan,13.33241,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Sup Medipore H Tape 1,,A4450,HCPCS,Facility,Inpatient,,,,23.66,20.111,6.780956,23.66,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Sup Medipore H Tape 1,,A4450,HCPCS,Facility,Outpatient,,,,23.66,20.111,6.780956,23.66,"UCare Health, Inc.",Medical Assistance,11.941202,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Medipore H Tape 1,,A4450,HCPCS,Facility,Inpatient,,,,23.66,20.111,6.780956,23.66,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Sup Medipore H Tape 1,,A4450,HCPCS,Facility,Outpatient,,,,23.66,20.111,6.780956,23.66,"UCare Health, Inc.",Medicare Advantage,11.941202,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Medipore H Tape 1,,A4450,HCPCS,Facility,Inpatient,,,,23.66,20.111,6.780956,23.66,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Medipore H Tape 1,,A4450,HCPCS,Facility,Outpatient,,,,23.66,20.111,6.780956,23.66,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),11.941202,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Medipore H Tape 1,,A4450,HCPCS,Facility,Inpatient,,,,23.66,20.111,6.780956,23.66,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Medipore H Tape 1,,A4450,HCPCS,Facility,Both,,,,23.66,20.111,6.780956,23.66,UnitedHealthcare,Individual & Family,22.2404,94,,percent of total billed charges,,
Sup Medipore H Tape 1,,A4450,HCPCS,Facility,Outpatient,,,,23.66,20.111,6.780956,23.66,UnitedHealthcare,Medicare Advantage,11.5934,49,,percent of total billed charges,,
Sup Medipore H Tape 1,,A4450,HCPCS,Facility,Inpatient,,,,23.66,20.111,6.780956,23.66,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Sup Medipore H Tape 1,,A4450,HCPCS,Facility,Outpatient,,,,23.66,20.111,6.780956,23.66,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,11.3568,48,,percent of total billed charges,,100% of DHS outpatient percentage
Sup Medipore H Tape 1,,A4450,HCPCS,Facility,Inpatient,,,,23.66,20.111,6.780956,23.66,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Sup Medipore H Tape 2,,A4450,HCPCS,Facility,Both,,,,23.66,20.111,6.780956,23.66,Aetna,Commercial,21.7672,92,,percent of total billed charges,,
Sup Medipore H Tape 2,,A4450,HCPCS,Facility,Outpatient,,,,23.66,20.111,6.780956,23.66,Aetna,Medicare Advantage,11.5934,49,,percent of total billed charges,,
Sup Medipore H Tape 2,,A4450,HCPCS,Facility,Inpatient,,,,23.66,20.111,6.780956,23.66,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Sup Medipore H Tape 2,,A4450,HCPCS,Facility,Both,,,,23.66,20.111,6.780956,23.66,Aetna,PPO,22.0038,93,,percent of total billed charges,,
Sup Medipore H Tape 2,,A4450,HCPCS,Facility,Both,,,,23.66,20.111,6.780956,23.66,America's PPO,America's PPO,22.720698,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Sup Medipore H Tape 2,,A4450,HCPCS,Facility,Both,,,,23.66,20.111,6.780956,23.66,BlueCross BlueShield Minnesota, Federal Employee Program,23.28144,98.4,,percent of total billed charges,,
Sup Medipore H Tape 2,,A4450,HCPCS,Facility,Both,,,,23.66,20.111,6.780956,23.66,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,23.66,100,,percent of total billed charges,,
Sup Medipore H Tape 2,,A4450,HCPCS,Facility,Both,,,,23.66,20.111,6.780956,23.66,BlueCross BlueShield Minnesota,High Value Network Plan,21.294,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
Sup Medipore H Tape 2,,A4450,HCPCS,Facility,Outpatient,,,,23.66,20.111,6.780956,23.66,BlueCross BlueShield Minnesota,Medicare Advantage,11.5934,49,,percent of total billed charges,,
Sup Medipore H Tape 2,,A4450,HCPCS,Facility,Inpatient,,,,23.66,20.111,6.780956,23.66,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Sup Medipore H Tape 2,,A4450,HCPCS,Facility,Both,,,,23.66,20.111,6.780956,23.66,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,20.955662,88.57,,percent of total billed charges,,
Sup Medipore H Tape 2,,A4450,HCPCS,Facility,Both,,,,23.66,20.111,6.780956,23.66,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,6.780956,28.66,,percent of total billed charges,,
Sup Medipore H Tape 2,,A4450,HCPCS,Facility,Outpatient,,,,23.66,20.111,6.780956,23.66,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),11.5934,49,,percent of total billed charges,,
Sup Medipore H Tape 2,,A4450,HCPCS,Facility,Inpatient,,,,23.66,20.111,6.780956,23.66,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Sup Medipore H Tape 2,,A4450,HCPCS,Facility,Both,,,,23.66,20.111,6.780956,23.66,CorVel,Worker's Compensation,23.66,100,,percent of total billed charges,,
Sup Medipore H Tape 2,,A4450,HCPCS,Facility,Both,,,,23.66,20.111,6.780956,23.66,First Health Group Corporation,First Health Network,22.9502,97,,percent of total billed charges,,
Sup Medipore H Tape 2,,A4450,HCPCS,Facility,Both,,,,23.66,20.111,6.780956,23.66,"Health Partners, Inc.",Commercial,22.38236,94.6,,percent of total billed charges,,
Sup Medipore H Tape 2,,A4450,HCPCS,Facility,Outpatient,,,,23.66,20.111,6.780956,23.66,"Health Partners, Inc.",Medicare Advantage,11.5934,49,,percent of total billed charges,,
Sup Medipore H Tape 2,,A4450,HCPCS,Facility,Inpatient,,,,23.66,20.111,6.780956,23.66,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Medipore H Tape 2,,A4450,HCPCS,Facility,Both,,,,23.66,20.111,6.780956,23.66,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),14.196,60,,percent of total billed charges,,
Sup Medipore H Tape 2,,A4450,HCPCS,Facility,Both,,,,23.66,20.111,6.780956,23.66,"Health Partners, Inc.",State of Minnesota Advantage Program,19.2829,81.5,,percent of total billed charges,,
Sup Medipore H Tape 2,,A4450,HCPCS,Facility,Both,,,,23.66,20.111,6.780956,23.66,"Health Partners, Inc.",State Public Programs,11.83,50,,percent of total billed charges,,
Sup Medipore H Tape 2,,A4450,HCPCS,Facility,Both,,,,23.66,20.111,6.780956,23.66,Humana Insurance Company,Commercial PPO,22.477,95,,percent of total billed charges,,
Sup Medipore H Tape 2,,A4450,HCPCS,Facility,Outpatient,,,,23.66,20.111,6.780956,23.66,Humana Insurance Company,Medicare PPO,11.5934,49,,percent of total billed charges,,
Sup Medipore H Tape 2,,A4450,HCPCS,Facility,Inpatient,,,,23.66,20.111,6.780956,23.66,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Sup Medipore H Tape 2,,A4450,HCPCS,Facility,Both,,,,23.66,20.111,6.780956,23.66,Medica,Individual & Family,23.44706,99.1,,percent of total billed charges,,
Sup Medipore H Tape 2,,A4450,HCPCS,Facility,Outpatient,,,,23.66,20.111,6.780956,23.66,Medica,Medica Advantage Solution,11.78268,49.8,,percent of total billed charges,,
Sup Medipore H Tape 2,,A4450,HCPCS,Facility,Inpatient,,,,23.66,20.111,6.780956,23.66,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Sup Medipore H Tape 2,,A4450,HCPCS,Facility,Outpatient,,,,23.66,20.111,6.780956,23.66,Medica,Medical Assistance,10.55236,44.6,,percent of total billed charges,,
Sup Medipore H Tape 2,,A4450,HCPCS,Facility,Inpatient,,,,23.66,20.111,6.780956,23.66,Medica,Medical Assistance,,,,,Included in per diem rate,
Sup Medipore H Tape 2,,A4450,HCPCS,Facility,Outpatient,,,,23.66,20.111,6.780956,23.66,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,11.78268,49.8,,percent of total billed charges,,
Sup Medipore H Tape 2,,A4450,HCPCS,Facility,Inpatient,,,,23.66,20.111,6.780956,23.66,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Sup Medipore H Tape 2,,A4450,HCPCS,Facility,Both,,,,23.66,20.111,6.780956,23.66,"Multiplan, Inc.","Multiplan, Inc.",22.2404,94,,percent of total billed charges,,
Sup Medipore H Tape 2,,A4450,HCPCS,Facility,Outpatient,,,,23.66,20.111,6.780956,23.66,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,21.31766,90.1,,percent of total billed charges,,
Sup Medipore H Tape 2,,A4450,HCPCS,Facility,Inpatient,,,,23.66,20.111,6.780956,23.66,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Sup Medipore H Tape 2,,A4450,HCPCS,Facility,Both,,,,23.66,20.111,6.780956,23.66,"Preferred One Administrative Services, INC.",PPO,23.32876,98.6,,percent of total billed charges,,
Sup Medipore H Tape 2,,A4450,HCPCS,Facility,Outpatient,,,,23.66,20.111,6.780956,23.66,PrimeWest Health,Minnesota Senior Health Options (MSHO),12.17307,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Sup Medipore H Tape 2,,A4450,HCPCS,Facility,Inpatient,,,,23.66,20.111,6.780956,23.66,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Medipore H Tape 2,,A4450,HCPCS,Facility,Outpatient,,,,23.66,20.111,6.780956,23.66,PrimeWest Health,MinnesotaCare,12.151776,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Sup Medipore H Tape 2,,A4450,HCPCS,Facility,Inpatient,,,,23.66,20.111,6.780956,23.66,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Sup Medipore H Tape 2,,A4450,HCPCS,Facility,Both,,,,23.66,20.111,6.780956,23.66,Sanford Health Plan,Sanford Health Plan,21.7672,92,,percent of total billed charges,,
Sup Medipore H Tape 2,,A4450,HCPCS,Facility,Outpatient,,,,23.66,20.111,6.780956,23.66,"UCare Health, Inc.",Individual & Family Plan,13.33241,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Sup Medipore H Tape 2,,A4450,HCPCS,Facility,Inpatient,,,,23.66,20.111,6.780956,23.66,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Sup Medipore H Tape 2,,A4450,HCPCS,Facility,Outpatient,,,,23.66,20.111,6.780956,23.66,"UCare Health, Inc.",Medical Assistance,11.941202,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Medipore H Tape 2,,A4450,HCPCS,Facility,Inpatient,,,,23.66,20.111,6.780956,23.66,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Sup Medipore H Tape 2,,A4450,HCPCS,Facility,Outpatient,,,,23.66,20.111,6.780956,23.66,"UCare Health, Inc.",Medicare Advantage,11.941202,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Medipore H Tape 2,,A4450,HCPCS,Facility,Inpatient,,,,23.66,20.111,6.780956,23.66,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Medipore H Tape 2,,A4450,HCPCS,Facility,Outpatient,,,,23.66,20.111,6.780956,23.66,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),11.941202,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Medipore H Tape 2,,A4450,HCPCS,Facility,Inpatient,,,,23.66,20.111,6.780956,23.66,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Medipore H Tape 2,,A4450,HCPCS,Facility,Both,,,,23.66,20.111,6.780956,23.66,UnitedHealthcare,Individual & Family,22.2404,94,,percent of total billed charges,,
Sup Medipore H Tape 2,,A4450,HCPCS,Facility,Outpatient,,,,23.66,20.111,6.780956,23.66,UnitedHealthcare,Medicare Advantage,11.5934,49,,percent of total billed charges,,
Sup Medipore H Tape 2,,A4450,HCPCS,Facility,Inpatient,,,,23.66,20.111,6.780956,23.66,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Sup Medipore H Tape 2,,A4450,HCPCS,Facility,Outpatient,,,,23.66,20.111,6.780956,23.66,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,11.3568,48,,percent of total billed charges,,100% of DHS outpatient percentage
Sup Medipore H Tape 2,,A4450,HCPCS,Facility,Inpatient,,,,23.66,20.111,6.780956,23.66,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Sup Enema Bag Reuseable,,A4458,HCPCS,Facility,Both,,,,10,8.5,2.866,10,Aetna,Commercial,9.2,92,,percent of total billed charges,,
Sup Enema Bag Reuseable,,A4458,HCPCS,Facility,Outpatient,,,,10,8.5,2.866,10,Aetna,Medicare Advantage,4.9,49,,percent of total billed charges,,
Sup Enema Bag Reuseable,,A4458,HCPCS,Facility,Inpatient,,,,10,8.5,2.866,10,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Sup Enema Bag Reuseable,,A4458,HCPCS,Facility,Both,,,,10,8.5,2.866,10,Aetna,PPO,9.3,93,,percent of total billed charges,,
Sup Enema Bag Reuseable,,A4458,HCPCS,Facility,Both,,,,10,8.5,2.866,10,America's PPO,America's PPO,9.603,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Sup Enema Bag Reuseable,,A4458,HCPCS,Facility,Both,,,,10,8.5,2.866,10,BlueCross BlueShield Minnesota, Federal Employee Program,9.84,98.4,,percent of total billed charges,,
Sup Enema Bag Reuseable,,A4458,HCPCS,Facility,Both,,,,10,8.5,2.866,10,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,10,100,,percent of total billed charges,,
Sup Enema Bag Reuseable,,A4458,HCPCS,Facility,Both,,,,10,8.5,2.866,10,BlueCross BlueShield Minnesota,High Value Network Plan,9,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
Sup Enema Bag Reuseable,,A4458,HCPCS,Facility,Outpatient,,,,10,8.5,2.866,10,BlueCross BlueShield Minnesota,Medicare Advantage,4.9,49,,percent of total billed charges,,
Sup Enema Bag Reuseable,,A4458,HCPCS,Facility,Inpatient,,,,10,8.5,2.866,10,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Sup Enema Bag Reuseable,,A4458,HCPCS,Facility,Both,,,,10,8.5,2.866,10,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,8.857,88.57,,percent of total billed charges,,
Sup Enema Bag Reuseable,,A4458,HCPCS,Facility,Both,,,,10,8.5,2.866,10,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,2.866,28.66,,percent of total billed charges,,
Sup Enema Bag Reuseable,,A4458,HCPCS,Facility,Outpatient,,,,10,8.5,2.866,10,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),4.9,49,,percent of total billed charges,,
Sup Enema Bag Reuseable,,A4458,HCPCS,Facility,Inpatient,,,,10,8.5,2.866,10,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Sup Enema Bag Reuseable,,A4458,HCPCS,Facility,Both,,,,10,8.5,2.866,10,CorVel,Worker's Compensation,10,100,,percent of total billed charges,,
Sup Enema Bag Reuseable,,A4458,HCPCS,Facility,Both,,,,10,8.5,2.866,10,First Health Group Corporation,First Health Network,9.7,97,,percent of total billed charges,,
Sup Enema Bag Reuseable,,A4458,HCPCS,Facility,Both,,,,10,8.5,2.866,10,"Health Partners, Inc.",Commercial,9.46,94.6,,percent of total billed charges,,
Sup Enema Bag Reuseable,,A4458,HCPCS,Facility,Outpatient,,,,10,8.5,2.866,10,"Health Partners, Inc.",Medicare Advantage,4.9,49,,percent of total billed charges,,
Sup Enema Bag Reuseable,,A4458,HCPCS,Facility,Inpatient,,,,10,8.5,2.866,10,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Enema Bag Reuseable,,A4458,HCPCS,Facility,Both,,,,10,8.5,2.866,10,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),6,60,,percent of total billed charges,,
Sup Enema Bag Reuseable,,A4458,HCPCS,Facility,Both,,,,10,8.5,2.866,10,"Health Partners, Inc.",State of Minnesota Advantage Program,8.15,81.5,,percent of total billed charges,,
Sup Enema Bag Reuseable,,A4458,HCPCS,Facility,Both,,,,10,8.5,2.866,10,"Health Partners, Inc.",State Public Programs,5,50,,percent of total billed charges,,
Sup Enema Bag Reuseable,,A4458,HCPCS,Facility,Both,,,,10,8.5,2.866,10,Humana Insurance Company,Commercial PPO,9.5,95,,percent of total billed charges,,
Sup Enema Bag Reuseable,,A4458,HCPCS,Facility,Outpatient,,,,10,8.5,2.866,10,Humana Insurance Company,Medicare PPO,4.9,49,,percent of total billed charges,,
Sup Enema Bag Reuseable,,A4458,HCPCS,Facility,Inpatient,,,,10,8.5,2.866,10,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Sup Enema Bag Reuseable,,A4458,HCPCS,Facility,Both,,,,10,8.5,2.866,10,Medica,Individual & Family,9.91,99.1,,percent of total billed charges,,
Sup Enema Bag Reuseable,,A4458,HCPCS,Facility,Outpatient,,,,10,8.5,2.866,10,Medica,Medica Advantage Solution,4.98,49.8,,percent of total billed charges,,
Sup Enema Bag Reuseable,,A4458,HCPCS,Facility,Inpatient,,,,10,8.5,2.866,10,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Sup Enema Bag Reuseable,,A4458,HCPCS,Facility,Outpatient,,,,10,8.5,2.866,10,Medica,Medical Assistance,4.46,44.6,,percent of total billed charges,,
Sup Enema Bag Reuseable,,A4458,HCPCS,Facility,Inpatient,,,,10,8.5,2.866,10,Medica,Medical Assistance,,,,,Included in per diem rate,
Sup Enema Bag Reuseable,,A4458,HCPCS,Facility,Outpatient,,,,10,8.5,2.866,10,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,4.98,49.8,,percent of total billed charges,,
Sup Enema Bag Reuseable,,A4458,HCPCS,Facility,Inpatient,,,,10,8.5,2.866,10,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Sup Enema Bag Reuseable,,A4458,HCPCS,Facility,Both,,,,10,8.5,2.866,10,"Multiplan, Inc.","Multiplan, Inc.",9.4,94,,percent of total billed charges,,
Sup Enema Bag Reuseable,,A4458,HCPCS,Facility,Outpatient,,,,10,8.5,2.866,10,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,9.01,90.1,,percent of total billed charges,,
Sup Enema Bag Reuseable,,A4458,HCPCS,Facility,Inpatient,,,,10,8.5,2.866,10,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Sup Enema Bag Reuseable,,A4458,HCPCS,Facility,Both,,,,10,8.5,2.866,10,"Preferred One Administrative Services, INC.",PPO,9.86,98.6,,percent of total billed charges,,
Sup Enema Bag Reuseable,,A4458,HCPCS,Facility,Outpatient,,,,10,8.5,2.866,10,PrimeWest Health,Minnesota Senior Health Options (MSHO),5.145,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Sup Enema Bag Reuseable,,A4458,HCPCS,Facility,Inpatient,,,,10,8.5,2.866,10,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Enema Bag Reuseable,,A4458,HCPCS,Facility,Outpatient,,,,10,8.5,2.866,10,PrimeWest Health,MinnesotaCare,5.136,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Sup Enema Bag Reuseable,,A4458,HCPCS,Facility,Inpatient,,,,10,8.5,2.866,10,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Sup Enema Bag Reuseable,,A4458,HCPCS,Facility,Both,,,,10,8.5,2.866,10,Sanford Health Plan,Sanford Health Plan,9.2,92,,percent of total billed charges,,
Sup Enema Bag Reuseable,,A4458,HCPCS,Facility,Outpatient,,,,10,8.5,2.866,10,"UCare Health, Inc.",Individual & Family Plan,5.635,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Sup Enema Bag Reuseable,,A4458,HCPCS,Facility,Inpatient,,,,10,8.5,2.866,10,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Sup Enema Bag Reuseable,,A4458,HCPCS,Facility,Outpatient,,,,10,8.5,2.866,10,"UCare Health, Inc.",Medical Assistance,5.047,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Enema Bag Reuseable,,A4458,HCPCS,Facility,Inpatient,,,,10,8.5,2.866,10,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Sup Enema Bag Reuseable,,A4458,HCPCS,Facility,Outpatient,,,,10,8.5,2.866,10,"UCare Health, Inc.",Medicare Advantage,5.047,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Enema Bag Reuseable,,A4458,HCPCS,Facility,Inpatient,,,,10,8.5,2.866,10,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Enema Bag Reuseable,,A4458,HCPCS,Facility,Outpatient,,,,10,8.5,2.866,10,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),5.047,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Enema Bag Reuseable,,A4458,HCPCS,Facility,Inpatient,,,,10,8.5,2.866,10,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Enema Bag Reuseable,,A4458,HCPCS,Facility,Both,,,,10,8.5,2.866,10,UnitedHealthcare,Individual & Family,9.4,94,,percent of total billed charges,,
Sup Enema Bag Reuseable,,A4458,HCPCS,Facility,Outpatient,,,,10,8.5,2.866,10,UnitedHealthcare,Medicare Advantage,4.9,49,,percent of total billed charges,,
Sup Enema Bag Reuseable,,A4458,HCPCS,Facility,Inpatient,,,,10,8.5,2.866,10,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Sup Enema Bag Reuseable,,A4458,HCPCS,Facility,Outpatient,,,,10,8.5,2.866,10,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,4.8,48,,percent of total billed charges,,100% of DHS outpatient percentage
Sup Enema Bag Reuseable,,A4458,HCPCS,Facility,Inpatient,,,,10,8.5,2.866,10,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
BLANKET UPPER BODY,,A4467,HCPCS,Facility,Both,,,,43.85,37.2725,12.56741,43.85,Aetna,Commercial,40.342,92,,percent of total billed charges,,
BLANKET UPPER BODY,,A4467,HCPCS,Facility,Outpatient,,,,43.85,37.2725,12.56741,43.85,Aetna,Medicare Advantage,21.4865,49,,percent of total billed charges,,
BLANKET UPPER BODY,,A4467,HCPCS,Facility,Inpatient,,,,43.85,37.2725,12.56741,43.85,Aetna,Medicare Advantage,,,,,Included in per diem rate,
BLANKET UPPER BODY,,A4467,HCPCS,Facility,Both,,,,43.85,37.2725,12.56741,43.85,Aetna,PPO,40.7805,93,,percent of total billed charges,,
BLANKET UPPER BODY,,A4467,HCPCS,Facility,Both,,,,43.85,37.2725,12.56741,43.85,America's PPO,America's PPO,42.109155,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
BLANKET UPPER BODY,,A4467,HCPCS,Facility,Both,,,,43.85,37.2725,12.56741,43.85,BlueCross BlueShield Minnesota, Federal Employee Program,43.1484,98.4,,percent of total billed charges,,
BLANKET UPPER BODY,,A4467,HCPCS,Facility,Both,,,,43.85,37.2725,12.56741,43.85,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,43.85,100,,percent of total billed charges,,
BLANKET UPPER BODY,,A4467,HCPCS,Facility,Both,,,,43.85,37.2725,12.56741,43.85,BlueCross BlueShield Minnesota,High Value Network Plan,39.465,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
BLANKET UPPER BODY,,A4467,HCPCS,Facility,Outpatient,,,,43.85,37.2725,12.56741,43.85,BlueCross BlueShield Minnesota,Medicare Advantage,21.4865,49,,percent of total billed charges,,
BLANKET UPPER BODY,,A4467,HCPCS,Facility,Inpatient,,,,43.85,37.2725,12.56741,43.85,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
BLANKET UPPER BODY,,A4467,HCPCS,Facility,Both,,,,43.85,37.2725,12.56741,43.85,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,38.837945,88.57,,percent of total billed charges,,
BLANKET UPPER BODY,,A4467,HCPCS,Facility,Both,,,,43.85,37.2725,12.56741,43.85,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,12.56741,28.66,,percent of total billed charges,,
BLANKET UPPER BODY,,A4467,HCPCS,Facility,Outpatient,,,,43.85,37.2725,12.56741,43.85,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),21.4865,49,,percent of total billed charges,,
BLANKET UPPER BODY,,A4467,HCPCS,Facility,Inpatient,,,,43.85,37.2725,12.56741,43.85,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
BLANKET UPPER BODY,,A4467,HCPCS,Facility,Both,,,,43.85,37.2725,12.56741,43.85,CorVel,Worker's Compensation,43.85,100,,percent of total billed charges,,
BLANKET UPPER BODY,,A4467,HCPCS,Facility,Both,,,,43.85,37.2725,12.56741,43.85,First Health Group Corporation,First Health Network,42.5345,97,,percent of total billed charges,,
BLANKET UPPER BODY,,A4467,HCPCS,Facility,Both,,,,43.85,37.2725,12.56741,43.85,"Health Partners, Inc.",Commercial,41.4821,94.6,,percent of total billed charges,,
BLANKET UPPER BODY,,A4467,HCPCS,Facility,Outpatient,,,,43.85,37.2725,12.56741,43.85,"Health Partners, Inc.",Medicare Advantage,21.4865,49,,percent of total billed charges,,
BLANKET UPPER BODY,,A4467,HCPCS,Facility,Inpatient,,,,43.85,37.2725,12.56741,43.85,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
BLANKET UPPER BODY,,A4467,HCPCS,Facility,Both,,,,43.85,37.2725,12.56741,43.85,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),26.31,60,,percent of total billed charges,,
BLANKET UPPER BODY,,A4467,HCPCS,Facility,Both,,,,43.85,37.2725,12.56741,43.85,"Health Partners, Inc.",State of Minnesota Advantage Program,35.73775,81.5,,percent of total billed charges,,
BLANKET UPPER BODY,,A4467,HCPCS,Facility,Both,,,,43.85,37.2725,12.56741,43.85,"Health Partners, Inc.",State Public Programs,21.925,50,,percent of total billed charges,,
BLANKET UPPER BODY,,A4467,HCPCS,Facility,Both,,,,43.85,37.2725,12.56741,43.85,Humana Insurance Company,Commercial PPO,41.6575,95,,percent of total billed charges,,
BLANKET UPPER BODY,,A4467,HCPCS,Facility,Outpatient,,,,43.85,37.2725,12.56741,43.85,Humana Insurance Company,Medicare PPO,21.4865,49,,percent of total billed charges,,
BLANKET UPPER BODY,,A4467,HCPCS,Facility,Inpatient,,,,43.85,37.2725,12.56741,43.85,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
BLANKET UPPER BODY,,A4467,HCPCS,Facility,Both,,,,43.85,37.2725,12.56741,43.85,Medica,Individual & Family,43.45535,99.1,,percent of total billed charges,,
BLANKET UPPER BODY,,A4467,HCPCS,Facility,Outpatient,,,,43.85,37.2725,12.56741,43.85,Medica,Medica Advantage Solution,21.8373,49.8,,percent of total billed charges,,
BLANKET UPPER BODY,,A4467,HCPCS,Facility,Inpatient,,,,43.85,37.2725,12.56741,43.85,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
BLANKET UPPER BODY,,A4467,HCPCS,Facility,Outpatient,,,,43.85,37.2725,12.56741,43.85,Medica,Medical Assistance,19.5571,44.6,,percent of total billed charges,,
BLANKET UPPER BODY,,A4467,HCPCS,Facility,Inpatient,,,,43.85,37.2725,12.56741,43.85,Medica,Medical Assistance,,,,,Included in per diem rate,
BLANKET UPPER BODY,,A4467,HCPCS,Facility,Outpatient,,,,43.85,37.2725,12.56741,43.85,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,21.8373,49.8,,percent of total billed charges,,
BLANKET UPPER BODY,,A4467,HCPCS,Facility,Inpatient,,,,43.85,37.2725,12.56741,43.85,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
BLANKET UPPER BODY,,A4467,HCPCS,Facility,Both,,,,43.85,37.2725,12.56741,43.85,"Multiplan, Inc.","Multiplan, Inc.",41.219,94,,percent of total billed charges,,
BLANKET UPPER BODY,,A4467,HCPCS,Facility,Outpatient,,,,43.85,37.2725,12.56741,43.85,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,39.50885,90.1,,percent of total billed charges,,
BLANKET UPPER BODY,,A4467,HCPCS,Facility,Inpatient,,,,43.85,37.2725,12.56741,43.85,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
BLANKET UPPER BODY,,A4467,HCPCS,Facility,Both,,,,43.85,37.2725,12.56741,43.85,"Preferred One Administrative Services, INC.",PPO,43.2361,98.6,,percent of total billed charges,,
BLANKET UPPER BODY,,A4467,HCPCS,Facility,Outpatient,,,,43.85,37.2725,12.56741,43.85,PrimeWest Health,Minnesota Senior Health Options (MSHO),22.560825,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
BLANKET UPPER BODY,,A4467,HCPCS,Facility,Inpatient,,,,43.85,37.2725,12.56741,43.85,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
BLANKET UPPER BODY,,A4467,HCPCS,Facility,Outpatient,,,,43.85,37.2725,12.56741,43.85,PrimeWest Health,MinnesotaCare,22.52136,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
BLANKET UPPER BODY,,A4467,HCPCS,Facility,Inpatient,,,,43.85,37.2725,12.56741,43.85,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
BLANKET UPPER BODY,,A4467,HCPCS,Facility,Both,,,,43.85,37.2725,12.56741,43.85,Sanford Health Plan,Sanford Health Plan,40.342,92,,percent of total billed charges,,
BLANKET UPPER BODY,,A4467,HCPCS,Facility,Outpatient,,,,43.85,37.2725,12.56741,43.85,"UCare Health, Inc.",Individual & Family Plan,24.709475,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
BLANKET UPPER BODY,,A4467,HCPCS,Facility,Inpatient,,,,43.85,37.2725,12.56741,43.85,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
BLANKET UPPER BODY,,A4467,HCPCS,Facility,Outpatient,,,,43.85,37.2725,12.56741,43.85,"UCare Health, Inc.",Medical Assistance,22.131095,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BLANKET UPPER BODY,,A4467,HCPCS,Facility,Inpatient,,,,43.85,37.2725,12.56741,43.85,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
BLANKET UPPER BODY,,A4467,HCPCS,Facility,Outpatient,,,,43.85,37.2725,12.56741,43.85,"UCare Health, Inc.",Medicare Advantage,22.131095,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BLANKET UPPER BODY,,A4467,HCPCS,Facility,Inpatient,,,,43.85,37.2725,12.56741,43.85,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
BLANKET UPPER BODY,,A4467,HCPCS,Facility,Outpatient,,,,43.85,37.2725,12.56741,43.85,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),22.131095,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BLANKET UPPER BODY,,A4467,HCPCS,Facility,Inpatient,,,,43.85,37.2725,12.56741,43.85,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
BLANKET UPPER BODY,,A4467,HCPCS,Facility,Both,,,,43.85,37.2725,12.56741,43.85,UnitedHealthcare,Individual & Family,41.219,94,,percent of total billed charges,,
BLANKET UPPER BODY,,A4467,HCPCS,Facility,Outpatient,,,,43.85,37.2725,12.56741,43.85,UnitedHealthcare,Medicare Advantage,21.4865,49,,percent of total billed charges,,
BLANKET UPPER BODY,,A4467,HCPCS,Facility,Inpatient,,,,43.85,37.2725,12.56741,43.85,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
BLANKET UPPER BODY,,A4467,HCPCS,Facility,Outpatient,,,,43.85,37.2725,12.56741,43.85,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,21.048,48,,percent of total billed charges,,100% of DHS outpatient percentage
BLANKET UPPER BODY,,A4467,HCPCS,Facility,Inpatient,,,,43.85,37.2725,12.56741,43.85,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Sup Rib Belts,,A4467,HCPCS,Facility,Both,,,,28,23.8,8.0248,28,Aetna,Commercial,25.76,92,,percent of total billed charges,,
Sup Rib Belts,,A4467,HCPCS,Facility,Outpatient,,,,28,23.8,8.0248,28,Aetna,Medicare Advantage,13.72,49,,percent of total billed charges,,
Sup Rib Belts,,A4467,HCPCS,Facility,Inpatient,,,,28,23.8,8.0248,28,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Sup Rib Belts,,A4467,HCPCS,Facility,Both,,,,28,23.8,8.0248,28,Aetna,PPO,26.04,93,,percent of total billed charges,,
Sup Rib Belts,,A4467,HCPCS,Facility,Both,,,,28,23.8,8.0248,28,America's PPO,America's PPO,26.8884,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Sup Rib Belts,,A4467,HCPCS,Facility,Both,,,,28,23.8,8.0248,28,BlueCross BlueShield Minnesota, Federal Employee Program,27.552,98.4,,percent of total billed charges,,
Sup Rib Belts,,A4467,HCPCS,Facility,Both,,,,28,23.8,8.0248,28,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,28,100,,percent of total billed charges,,
Sup Rib Belts,,A4467,HCPCS,Facility,Both,,,,28,23.8,8.0248,28,BlueCross BlueShield Minnesota,High Value Network Plan,25.2,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
Sup Rib Belts,,A4467,HCPCS,Facility,Outpatient,,,,28,23.8,8.0248,28,BlueCross BlueShield Minnesota,Medicare Advantage,13.72,49,,percent of total billed charges,,
Sup Rib Belts,,A4467,HCPCS,Facility,Inpatient,,,,28,23.8,8.0248,28,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Sup Rib Belts,,A4467,HCPCS,Facility,Both,,,,28,23.8,8.0248,28,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,24.7996,88.57,,percent of total billed charges,,
Sup Rib Belts,,A4467,HCPCS,Facility,Both,,,,28,23.8,8.0248,28,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,8.0248,28.66,,percent of total billed charges,,
Sup Rib Belts,,A4467,HCPCS,Facility,Outpatient,,,,28,23.8,8.0248,28,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),13.72,49,,percent of total billed charges,,
Sup Rib Belts,,A4467,HCPCS,Facility,Inpatient,,,,28,23.8,8.0248,28,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Sup Rib Belts,,A4467,HCPCS,Facility,Both,,,,28,23.8,8.0248,28,CorVel,Worker's Compensation,28,100,,percent of total billed charges,,
Sup Rib Belts,,A4467,HCPCS,Facility,Both,,,,28,23.8,8.0248,28,First Health Group Corporation,First Health Network,27.16,97,,percent of total billed charges,,
Sup Rib Belts,,A4467,HCPCS,Facility,Both,,,,28,23.8,8.0248,28,"Health Partners, Inc.",Commercial,26.488,94.6,,percent of total billed charges,,
Sup Rib Belts,,A4467,HCPCS,Facility,Outpatient,,,,28,23.8,8.0248,28,"Health Partners, Inc.",Medicare Advantage,13.72,49,,percent of total billed charges,,
Sup Rib Belts,,A4467,HCPCS,Facility,Inpatient,,,,28,23.8,8.0248,28,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Rib Belts,,A4467,HCPCS,Facility,Both,,,,28,23.8,8.0248,28,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),16.8,60,,percent of total billed charges,,
Sup Rib Belts,,A4467,HCPCS,Facility,Both,,,,28,23.8,8.0248,28,"Health Partners, Inc.",State of Minnesota Advantage Program,22.82,81.5,,percent of total billed charges,,
Sup Rib Belts,,A4467,HCPCS,Facility,Both,,,,28,23.8,8.0248,28,"Health Partners, Inc.",State Public Programs,14,50,,percent of total billed charges,,
Sup Rib Belts,,A4467,HCPCS,Facility,Both,,,,28,23.8,8.0248,28,Humana Insurance Company,Commercial PPO,26.6,95,,percent of total billed charges,,
Sup Rib Belts,,A4467,HCPCS,Facility,Outpatient,,,,28,23.8,8.0248,28,Humana Insurance Company,Medicare PPO,13.72,49,,percent of total billed charges,,
Sup Rib Belts,,A4467,HCPCS,Facility,Inpatient,,,,28,23.8,8.0248,28,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Sup Rib Belts,,A4467,HCPCS,Facility,Both,,,,28,23.8,8.0248,28,Medica,Individual & Family,27.748,99.1,,percent of total billed charges,,
Sup Rib Belts,,A4467,HCPCS,Facility,Outpatient,,,,28,23.8,8.0248,28,Medica,Medica Advantage Solution,13.944,49.8,,percent of total billed charges,,
Sup Rib Belts,,A4467,HCPCS,Facility,Inpatient,,,,28,23.8,8.0248,28,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Sup Rib Belts,,A4467,HCPCS,Facility,Outpatient,,,,28,23.8,8.0248,28,Medica,Medical Assistance,12.488,44.6,,percent of total billed charges,,
Sup Rib Belts,,A4467,HCPCS,Facility,Inpatient,,,,28,23.8,8.0248,28,Medica,Medical Assistance,,,,,Included in per diem rate,
Sup Rib Belts,,A4467,HCPCS,Facility,Outpatient,,,,28,23.8,8.0248,28,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,13.944,49.8,,percent of total billed charges,,
Sup Rib Belts,,A4467,HCPCS,Facility,Inpatient,,,,28,23.8,8.0248,28,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Sup Rib Belts,,A4467,HCPCS,Facility,Both,,,,28,23.8,8.0248,28,"Multiplan, Inc.","Multiplan, Inc.",26.32,94,,percent of total billed charges,,
Sup Rib Belts,,A4467,HCPCS,Facility,Outpatient,,,,28,23.8,8.0248,28,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,25.228,90.1,,percent of total billed charges,,
Sup Rib Belts,,A4467,HCPCS,Facility,Inpatient,,,,28,23.8,8.0248,28,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Sup Rib Belts,,A4467,HCPCS,Facility,Both,,,,28,23.8,8.0248,28,"Preferred One Administrative Services, INC.",PPO,27.608,98.6,,percent of total billed charges,,
Sup Rib Belts,,A4467,HCPCS,Facility,Outpatient,,,,28,23.8,8.0248,28,PrimeWest Health,Minnesota Senior Health Options (MSHO),14.406,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Sup Rib Belts,,A4467,HCPCS,Facility,Inpatient,,,,28,23.8,8.0248,28,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Rib Belts,,A4467,HCPCS,Facility,Outpatient,,,,28,23.8,8.0248,28,PrimeWest Health,MinnesotaCare,14.3808,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Sup Rib Belts,,A4467,HCPCS,Facility,Inpatient,,,,28,23.8,8.0248,28,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Sup Rib Belts,,A4467,HCPCS,Facility,Both,,,,28,23.8,8.0248,28,Sanford Health Plan,Sanford Health Plan,25.76,92,,percent of total billed charges,,
Sup Rib Belts,,A4467,HCPCS,Facility,Outpatient,,,,28,23.8,8.0248,28,"UCare Health, Inc.",Individual & Family Plan,15.778,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Sup Rib Belts,,A4467,HCPCS,Facility,Inpatient,,,,28,23.8,8.0248,28,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Sup Rib Belts,,A4467,HCPCS,Facility,Outpatient,,,,28,23.8,8.0248,28,"UCare Health, Inc.",Medical Assistance,14.1316,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Rib Belts,,A4467,HCPCS,Facility,Inpatient,,,,28,23.8,8.0248,28,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Sup Rib Belts,,A4467,HCPCS,Facility,Outpatient,,,,28,23.8,8.0248,28,"UCare Health, Inc.",Medicare Advantage,14.1316,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Rib Belts,,A4467,HCPCS,Facility,Inpatient,,,,28,23.8,8.0248,28,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Rib Belts,,A4467,HCPCS,Facility,Outpatient,,,,28,23.8,8.0248,28,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),14.1316,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Rib Belts,,A4467,HCPCS,Facility,Inpatient,,,,28,23.8,8.0248,28,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Rib Belts,,A4467,HCPCS,Facility,Both,,,,28,23.8,8.0248,28,UnitedHealthcare,Individual & Family,26.32,94,,percent of total billed charges,,
Sup Rib Belts,,A4467,HCPCS,Facility,Outpatient,,,,28,23.8,8.0248,28,UnitedHealthcare,Medicare Advantage,13.72,49,,percent of total billed charges,,
Sup Rib Belts,,A4467,HCPCS,Facility,Inpatient,,,,28,23.8,8.0248,28,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Sup Rib Belts,,A4467,HCPCS,Facility,Outpatient,,,,28,23.8,8.0248,28,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,13.44,48,,percent of total billed charges,,100% of DHS outpatient percentage
Sup Rib Belts,,A4467,HCPCS,Facility,Inpatient,,,,28,23.8,8.0248,28,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Sup Ted Knee,,A4500,HCPCS,Facility,Both,,,,45,38.25,12.897,45,Aetna,Commercial,41.4,92,,percent of total billed charges,,
Sup Ted Knee,,A4500,HCPCS,Facility,Outpatient,,,,45,38.25,12.897,45,Aetna,Medicare Advantage,22.05,49,,percent of total billed charges,,
Sup Ted Knee,,A4500,HCPCS,Facility,Inpatient,,,,45,38.25,12.897,45,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Sup Ted Knee,,A4500,HCPCS,Facility,Both,,,,45,38.25,12.897,45,Aetna,PPO,41.85,93,,percent of total billed charges,,
Sup Ted Knee,,A4500,HCPCS,Facility,Both,,,,45,38.25,12.897,45,America's PPO,America's PPO,43.2135,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Sup Ted Knee,,A4500,HCPCS,Facility,Both,,,,45,38.25,12.897,45,BlueCross BlueShield Minnesota, Federal Employee Program,44.28,98.4,,percent of total billed charges,,
Sup Ted Knee,,A4500,HCPCS,Facility,Both,,,,45,38.25,12.897,45,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,45,100,,percent of total billed charges,,
Sup Ted Knee,,A4500,HCPCS,Facility,Both,,,,45,38.25,12.897,45,BlueCross BlueShield Minnesota,High Value Network Plan,40.5,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
Sup Ted Knee,,A4500,HCPCS,Facility,Outpatient,,,,45,38.25,12.897,45,BlueCross BlueShield Minnesota,Medicare Advantage,22.05,49,,percent of total billed charges,,
Sup Ted Knee,,A4500,HCPCS,Facility,Inpatient,,,,45,38.25,12.897,45,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Sup Ted Knee,,A4500,HCPCS,Facility,Both,,,,45,38.25,12.897,45,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,39.8565,88.57,,percent of total billed charges,,
Sup Ted Knee,,A4500,HCPCS,Facility,Both,,,,45,38.25,12.897,45,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,12.897,28.66,,percent of total billed charges,,
Sup Ted Knee,,A4500,HCPCS,Facility,Outpatient,,,,45,38.25,12.897,45,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),22.05,49,,percent of total billed charges,,
Sup Ted Knee,,A4500,HCPCS,Facility,Inpatient,,,,45,38.25,12.897,45,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Sup Ted Knee,,A4500,HCPCS,Facility,Both,,,,45,38.25,12.897,45,CorVel,Worker's Compensation,45,100,,percent of total billed charges,,
Sup Ted Knee,,A4500,HCPCS,Facility,Both,,,,45,38.25,12.897,45,First Health Group Corporation,First Health Network,43.65,97,,percent of total billed charges,,
Sup Ted Knee,,A4500,HCPCS,Facility,Both,,,,45,38.25,12.897,45,"Health Partners, Inc.",Commercial,42.57,94.6,,percent of total billed charges,,
Sup Ted Knee,,A4500,HCPCS,Facility,Outpatient,,,,45,38.25,12.897,45,"Health Partners, Inc.",Medicare Advantage,22.05,49,,percent of total billed charges,,
Sup Ted Knee,,A4500,HCPCS,Facility,Inpatient,,,,45,38.25,12.897,45,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Ted Knee,,A4500,HCPCS,Facility,Both,,,,45,38.25,12.897,45,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),27,60,,percent of total billed charges,,
Sup Ted Knee,,A4500,HCPCS,Facility,Both,,,,45,38.25,12.897,45,"Health Partners, Inc.",State of Minnesota Advantage Program,36.675,81.5,,percent of total billed charges,,
Sup Ted Knee,,A4500,HCPCS,Facility,Both,,,,45,38.25,12.897,45,"Health Partners, Inc.",State Public Programs,22.5,50,,percent of total billed charges,,
Sup Ted Knee,,A4500,HCPCS,Facility,Both,,,,45,38.25,12.897,45,Humana Insurance Company,Commercial PPO,42.75,95,,percent of total billed charges,,
Sup Ted Knee,,A4500,HCPCS,Facility,Outpatient,,,,45,38.25,12.897,45,Humana Insurance Company,Medicare PPO,22.05,49,,percent of total billed charges,,
Sup Ted Knee,,A4500,HCPCS,Facility,Inpatient,,,,45,38.25,12.897,45,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Sup Ted Knee,,A4500,HCPCS,Facility,Both,,,,45,38.25,12.897,45,Medica,Individual & Family,44.595,99.1,,percent of total billed charges,,
Sup Ted Knee,,A4500,HCPCS,Facility,Outpatient,,,,45,38.25,12.897,45,Medica,Medica Advantage Solution,22.41,49.8,,percent of total billed charges,,
Sup Ted Knee,,A4500,HCPCS,Facility,Inpatient,,,,45,38.25,12.897,45,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Sup Ted Knee,,A4500,HCPCS,Facility,Outpatient,,,,45,38.25,12.897,45,Medica,Medical Assistance,20.07,44.6,,percent of total billed charges,,
Sup Ted Knee,,A4500,HCPCS,Facility,Inpatient,,,,45,38.25,12.897,45,Medica,Medical Assistance,,,,,Included in per diem rate,
Sup Ted Knee,,A4500,HCPCS,Facility,Outpatient,,,,45,38.25,12.897,45,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,22.41,49.8,,percent of total billed charges,,
Sup Ted Knee,,A4500,HCPCS,Facility,Inpatient,,,,45,38.25,12.897,45,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Sup Ted Knee,,A4500,HCPCS,Facility,Both,,,,45,38.25,12.897,45,"Multiplan, Inc.","Multiplan, Inc.",42.3,94,,percent of total billed charges,,
Sup Ted Knee,,A4500,HCPCS,Facility,Outpatient,,,,45,38.25,12.897,45,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,40.545,90.1,,percent of total billed charges,,
Sup Ted Knee,,A4500,HCPCS,Facility,Inpatient,,,,45,38.25,12.897,45,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Sup Ted Knee,,A4500,HCPCS,Facility,Both,,,,45,38.25,12.897,45,"Preferred One Administrative Services, INC.",PPO,44.37,98.6,,percent of total billed charges,,
Sup Ted Knee,,A4500,HCPCS,Facility,Outpatient,,,,45,38.25,12.897,45,PrimeWest Health,Minnesota Senior Health Options (MSHO),23.1525,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Sup Ted Knee,,A4500,HCPCS,Facility,Inpatient,,,,45,38.25,12.897,45,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Ted Knee,,A4500,HCPCS,Facility,Outpatient,,,,45,38.25,12.897,45,PrimeWest Health,MinnesotaCare,23.112,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Sup Ted Knee,,A4500,HCPCS,Facility,Inpatient,,,,45,38.25,12.897,45,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Sup Ted Knee,,A4500,HCPCS,Facility,Both,,,,45,38.25,12.897,45,Sanford Health Plan,Sanford Health Plan,41.4,92,,percent of total billed charges,,
Sup Ted Knee,,A4500,HCPCS,Facility,Outpatient,,,,45,38.25,12.897,45,"UCare Health, Inc.",Individual & Family Plan,25.3575,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Sup Ted Knee,,A4500,HCPCS,Facility,Inpatient,,,,45,38.25,12.897,45,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Sup Ted Knee,,A4500,HCPCS,Facility,Outpatient,,,,45,38.25,12.897,45,"UCare Health, Inc.",Medical Assistance,22.7115,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Ted Knee,,A4500,HCPCS,Facility,Inpatient,,,,45,38.25,12.897,45,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Sup Ted Knee,,A4500,HCPCS,Facility,Outpatient,,,,45,38.25,12.897,45,"UCare Health, Inc.",Medicare Advantage,22.7115,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Ted Knee,,A4500,HCPCS,Facility,Inpatient,,,,45,38.25,12.897,45,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Ted Knee,,A4500,HCPCS,Facility,Outpatient,,,,45,38.25,12.897,45,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),22.7115,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Ted Knee,,A4500,HCPCS,Facility,Inpatient,,,,45,38.25,12.897,45,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Ted Knee,,A4500,HCPCS,Facility,Both,,,,45,38.25,12.897,45,UnitedHealthcare,Individual & Family,42.3,94,,percent of total billed charges,,
Sup Ted Knee,,A4500,HCPCS,Facility,Outpatient,,,,45,38.25,12.897,45,UnitedHealthcare,Medicare Advantage,22.05,49,,percent of total billed charges,,
Sup Ted Knee,,A4500,HCPCS,Facility,Inpatient,,,,45,38.25,12.897,45,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Sup Ted Knee,,A4500,HCPCS,Facility,Outpatient,,,,45,38.25,12.897,45,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,21.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
Sup Ted Knee,,A4500,HCPCS,Facility,Inpatient,,,,45,38.25,12.897,45,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
PICC TRAY,,A4550,HCPCS,Facility,Both,,,,1032.98,878.033,296.052068,1032.98,Aetna,Commercial,950.3416,92,,percent of total billed charges,,
PICC TRAY,,A4550,HCPCS,Facility,Outpatient,,,,1032.98,878.033,296.052068,1032.98,Aetna,Medicare Advantage,506.1602,49,,percent of total billed charges,,
PICC TRAY,,A4550,HCPCS,Facility,Inpatient,,,,1032.98,878.033,296.052068,1032.98,Aetna,Medicare Advantage,,,,,Included in per diem rate,
PICC TRAY,,A4550,HCPCS,Facility,Both,,,,1032.98,878.033,296.052068,1032.98,Aetna,PPO,960.6714,93,,percent of total billed charges,,
PICC TRAY,,A4550,HCPCS,Facility,Both,,,,1032.98,878.033,296.052068,1032.98,America's PPO,America's PPO,991.970694,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
PICC TRAY,,A4550,HCPCS,Facility,Both,,,,1032.98,878.033,296.052068,1032.98,BlueCross BlueShield Minnesota, Federal Employee Program,1016.45232,98.4,,percent of total billed charges,,
PICC TRAY,,A4550,HCPCS,Facility,Both,,,,1032.98,878.033,296.052068,1032.98,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1032.98,100,,percent of total billed charges,,
PICC TRAY,,A4550,HCPCS,Facility,Both,,,,1032.98,878.033,296.052068,1032.98,BlueCross BlueShield Minnesota,High Value Network Plan,929.682,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
PICC TRAY,,A4550,HCPCS,Facility,Outpatient,,,,1032.98,878.033,296.052068,1032.98,BlueCross BlueShield Minnesota,Medicare Advantage,506.1602,49,,percent of total billed charges,,
PICC TRAY,,A4550,HCPCS,Facility,Inpatient,,,,1032.98,878.033,296.052068,1032.98,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
PICC TRAY,,A4550,HCPCS,Facility,Both,,,,1032.98,878.033,296.052068,1032.98,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,914.910386,88.57,,percent of total billed charges,,
PICC TRAY,,A4550,HCPCS,Facility,Both,,,,1032.98,878.033,296.052068,1032.98,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,296.052068,28.66,,percent of total billed charges,,
PICC TRAY,,A4550,HCPCS,Facility,Outpatient,,,,1032.98,878.033,296.052068,1032.98,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),506.1602,49,,percent of total billed charges,,
PICC TRAY,,A4550,HCPCS,Facility,Inpatient,,,,1032.98,878.033,296.052068,1032.98,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
PICC TRAY,,A4550,HCPCS,Facility,Both,,,,1032.98,878.033,296.052068,1032.98,CorVel,Worker's Compensation,1032.98,100,,percent of total billed charges,,
PICC TRAY,,A4550,HCPCS,Facility,Both,,,,1032.98,878.033,296.052068,1032.98,First Health Group Corporation,First Health Network,1001.9906,97,,percent of total billed charges,,
PICC TRAY,,A4550,HCPCS,Facility,Both,,,,1032.98,878.033,296.052068,1032.98,"Health Partners, Inc.",Commercial,977.19908,94.6,,percent of total billed charges,,
PICC TRAY,,A4550,HCPCS,Facility,Outpatient,,,,1032.98,878.033,296.052068,1032.98,"Health Partners, Inc.",Medicare Advantage,506.1602,49,,percent of total billed charges,,
PICC TRAY,,A4550,HCPCS,Facility,Inpatient,,,,1032.98,878.033,296.052068,1032.98,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PICC TRAY,,A4550,HCPCS,Facility,Both,,,,1032.98,878.033,296.052068,1032.98,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),619.788,60,,percent of total billed charges,,
PICC TRAY,,A4550,HCPCS,Facility,Both,,,,1032.98,878.033,296.052068,1032.98,"Health Partners, Inc.",State of Minnesota Advantage Program,841.8787,81.5,,percent of total billed charges,,
PICC TRAY,,A4550,HCPCS,Facility,Both,,,,1032.98,878.033,296.052068,1032.98,"Health Partners, Inc.",State Public Programs,516.49,50,,percent of total billed charges,,
PICC TRAY,,A4550,HCPCS,Facility,Both,,,,1032.98,878.033,296.052068,1032.98,Humana Insurance Company,Commercial PPO,981.331,95,,percent of total billed charges,,
PICC TRAY,,A4550,HCPCS,Facility,Outpatient,,,,1032.98,878.033,296.052068,1032.98,Humana Insurance Company,Medicare PPO,506.1602,49,,percent of total billed charges,,
PICC TRAY,,A4550,HCPCS,Facility,Inpatient,,,,1032.98,878.033,296.052068,1032.98,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
PICC TRAY,,A4550,HCPCS,Facility,Both,,,,1032.98,878.033,296.052068,1032.98,Medica,Individual & Family,1023.68318,99.1,,percent of total billed charges,,
PICC TRAY,,A4550,HCPCS,Facility,Outpatient,,,,1032.98,878.033,296.052068,1032.98,Medica,Medica Advantage Solution,514.42404,49.8,,percent of total billed charges,,
PICC TRAY,,A4550,HCPCS,Facility,Inpatient,,,,1032.98,878.033,296.052068,1032.98,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
PICC TRAY,,A4550,HCPCS,Facility,Outpatient,,,,1032.98,878.033,296.052068,1032.98,Medica,Medical Assistance,460.70908,44.6,,percent of total billed charges,,
PICC TRAY,,A4550,HCPCS,Facility,Inpatient,,,,1032.98,878.033,296.052068,1032.98,Medica,Medical Assistance,,,,,Included in per diem rate,
PICC TRAY,,A4550,HCPCS,Facility,Outpatient,,,,1032.98,878.033,296.052068,1032.98,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,514.42404,49.8,,percent of total billed charges,,
PICC TRAY,,A4550,HCPCS,Facility,Inpatient,,,,1032.98,878.033,296.052068,1032.98,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
PICC TRAY,,A4550,HCPCS,Facility,Both,,,,1032.98,878.033,296.052068,1032.98,"Multiplan, Inc.","Multiplan, Inc.",971.0012,94,,percent of total billed charges,,
PICC TRAY,,A4550,HCPCS,Facility,Outpatient,,,,1032.98,878.033,296.052068,1032.98,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,930.71498,90.1,,percent of total billed charges,,
PICC TRAY,,A4550,HCPCS,Facility,Inpatient,,,,1032.98,878.033,296.052068,1032.98,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
PICC TRAY,,A4550,HCPCS,Facility,Both,,,,1032.98,878.033,296.052068,1032.98,"Preferred One Administrative Services, INC.",PPO,1018.51828,98.6,,percent of total billed charges,,
PICC TRAY,,A4550,HCPCS,Facility,Outpatient,,,,1032.98,878.033,296.052068,1032.98,PrimeWest Health,Minnesota Senior Health Options (MSHO),531.46821,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
PICC TRAY,,A4550,HCPCS,Facility,Inpatient,,,,1032.98,878.033,296.052068,1032.98,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PICC TRAY,,A4550,HCPCS,Facility,Outpatient,,,,1032.98,878.033,296.052068,1032.98,PrimeWest Health,MinnesotaCare,530.538528,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
PICC TRAY,,A4550,HCPCS,Facility,Inpatient,,,,1032.98,878.033,296.052068,1032.98,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
PICC TRAY,,A4550,HCPCS,Facility,Both,,,,1032.98,878.033,296.052068,1032.98,Sanford Health Plan,Sanford Health Plan,950.3416,92,,percent of total billed charges,,
PICC TRAY,,A4550,HCPCS,Facility,Outpatient,,,,1032.98,878.033,296.052068,1032.98,"UCare Health, Inc.",Individual & Family Plan,582.08423,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
PICC TRAY,,A4550,HCPCS,Facility,Inpatient,,,,1032.98,878.033,296.052068,1032.98,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
PICC TRAY,,A4550,HCPCS,Facility,Outpatient,,,,1032.98,878.033,296.052068,1032.98,"UCare Health, Inc.",Medical Assistance,521.345006,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PICC TRAY,,A4550,HCPCS,Facility,Inpatient,,,,1032.98,878.033,296.052068,1032.98,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
PICC TRAY,,A4550,HCPCS,Facility,Outpatient,,,,1032.98,878.033,296.052068,1032.98,"UCare Health, Inc.",Medicare Advantage,521.345006,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PICC TRAY,,A4550,HCPCS,Facility,Inpatient,,,,1032.98,878.033,296.052068,1032.98,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PICC TRAY,,A4550,HCPCS,Facility,Outpatient,,,,1032.98,878.033,296.052068,1032.98,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),521.345006,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PICC TRAY,,A4550,HCPCS,Facility,Inpatient,,,,1032.98,878.033,296.052068,1032.98,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PICC TRAY,,A4550,HCPCS,Facility,Both,,,,1032.98,878.033,296.052068,1032.98,UnitedHealthcare,Individual & Family,971.0012,94,,percent of total billed charges,,
PICC TRAY,,A4550,HCPCS,Facility,Outpatient,,,,1032.98,878.033,296.052068,1032.98,UnitedHealthcare,Medicare Advantage,506.1602,49,,percent of total billed charges,,
PICC TRAY,,A4550,HCPCS,Facility,Inpatient,,,,1032.98,878.033,296.052068,1032.98,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
PICC TRAY,,A4550,HCPCS,Facility,Outpatient,,,,1032.98,878.033,296.052068,1032.98,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,495.8304,48,,percent of total billed charges,,100% of DHS outpatient percentage
PICC TRAY,,A4550,HCPCS,Facility,Inpatient,,,,1032.98,878.033,296.052068,1032.98,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
SPINAL TRAY,,A4550,HCPCS,Facility,Both,,,,173.8,147.73,49.81108,173.8,Aetna,Commercial,159.896,92,,percent of total billed charges,,
SPINAL TRAY,,A4550,HCPCS,Facility,Outpatient,,,,173.8,147.73,49.81108,173.8,Aetna,Medicare Advantage,85.162,49,,percent of total billed charges,,
SPINAL TRAY,,A4550,HCPCS,Facility,Inpatient,,,,173.8,147.73,49.81108,173.8,Aetna,Medicare Advantage,,,,,Included in per diem rate,
SPINAL TRAY,,A4550,HCPCS,Facility,Both,,,,173.8,147.73,49.81108,173.8,Aetna,PPO,161.634,93,,percent of total billed charges,,
SPINAL TRAY,,A4550,HCPCS,Facility,Both,,,,173.8,147.73,49.81108,173.8,America's PPO,America's PPO,166.90014,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SPINAL TRAY,,A4550,HCPCS,Facility,Both,,,,173.8,147.73,49.81108,173.8,BlueCross BlueShield Minnesota, Federal Employee Program,171.0192,98.4,,percent of total billed charges,,
SPINAL TRAY,,A4550,HCPCS,Facility,Both,,,,173.8,147.73,49.81108,173.8,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,173.8,100,,percent of total billed charges,,
SPINAL TRAY,,A4550,HCPCS,Facility,Both,,,,173.8,147.73,49.81108,173.8,BlueCross BlueShield Minnesota,High Value Network Plan,156.42,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
SPINAL TRAY,,A4550,HCPCS,Facility,Outpatient,,,,173.8,147.73,49.81108,173.8,BlueCross BlueShield Minnesota,Medicare Advantage,85.162,49,,percent of total billed charges,,
SPINAL TRAY,,A4550,HCPCS,Facility,Inpatient,,,,173.8,147.73,49.81108,173.8,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
SPINAL TRAY,,A4550,HCPCS,Facility,Both,,,,173.8,147.73,49.81108,173.8,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,153.93466,88.57,,percent of total billed charges,,
SPINAL TRAY,,A4550,HCPCS,Facility,Both,,,,173.8,147.73,49.81108,173.8,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,49.81108,28.66,,percent of total billed charges,,
SPINAL TRAY,,A4550,HCPCS,Facility,Outpatient,,,,173.8,147.73,49.81108,173.8,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),85.162,49,,percent of total billed charges,,
SPINAL TRAY,,A4550,HCPCS,Facility,Inpatient,,,,173.8,147.73,49.81108,173.8,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
SPINAL TRAY,,A4550,HCPCS,Facility,Both,,,,173.8,147.73,49.81108,173.8,CorVel,Worker's Compensation,173.8,100,,percent of total billed charges,,
SPINAL TRAY,,A4550,HCPCS,Facility,Both,,,,173.8,147.73,49.81108,173.8,First Health Group Corporation,First Health Network,168.586,97,,percent of total billed charges,,
SPINAL TRAY,,A4550,HCPCS,Facility,Both,,,,173.8,147.73,49.81108,173.8,"Health Partners, Inc.",Commercial,164.4148,94.6,,percent of total billed charges,,
SPINAL TRAY,,A4550,HCPCS,Facility,Outpatient,,,,173.8,147.73,49.81108,173.8,"Health Partners, Inc.",Medicare Advantage,85.162,49,,percent of total billed charges,,
SPINAL TRAY,,A4550,HCPCS,Facility,Inpatient,,,,173.8,147.73,49.81108,173.8,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SPINAL TRAY,,A4550,HCPCS,Facility,Both,,,,173.8,147.73,49.81108,173.8,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),104.28,60,,percent of total billed charges,,
SPINAL TRAY,,A4550,HCPCS,Facility,Both,,,,173.8,147.73,49.81108,173.8,"Health Partners, Inc.",State of Minnesota Advantage Program,141.647,81.5,,percent of total billed charges,,
SPINAL TRAY,,A4550,HCPCS,Facility,Both,,,,173.8,147.73,49.81108,173.8,"Health Partners, Inc.",State Public Programs,86.9,50,,percent of total billed charges,,
SPINAL TRAY,,A4550,HCPCS,Facility,Both,,,,173.8,147.73,49.81108,173.8,Humana Insurance Company,Commercial PPO,165.11,95,,percent of total billed charges,,
SPINAL TRAY,,A4550,HCPCS,Facility,Outpatient,,,,173.8,147.73,49.81108,173.8,Humana Insurance Company,Medicare PPO,85.162,49,,percent of total billed charges,,
SPINAL TRAY,,A4550,HCPCS,Facility,Inpatient,,,,173.8,147.73,49.81108,173.8,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
SPINAL TRAY,,A4550,HCPCS,Facility,Both,,,,173.8,147.73,49.81108,173.8,Medica,Individual & Family,172.2358,99.1,,percent of total billed charges,,
SPINAL TRAY,,A4550,HCPCS,Facility,Outpatient,,,,173.8,147.73,49.81108,173.8,Medica,Medica Advantage Solution,86.5524,49.8,,percent of total billed charges,,
SPINAL TRAY,,A4550,HCPCS,Facility,Inpatient,,,,173.8,147.73,49.81108,173.8,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
SPINAL TRAY,,A4550,HCPCS,Facility,Outpatient,,,,173.8,147.73,49.81108,173.8,Medica,Medical Assistance,77.5148,44.6,,percent of total billed charges,,
SPINAL TRAY,,A4550,HCPCS,Facility,Inpatient,,,,173.8,147.73,49.81108,173.8,Medica,Medical Assistance,,,,,Included in per diem rate,
SPINAL TRAY,,A4550,HCPCS,Facility,Outpatient,,,,173.8,147.73,49.81108,173.8,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,86.5524,49.8,,percent of total billed charges,,
SPINAL TRAY,,A4550,HCPCS,Facility,Inpatient,,,,173.8,147.73,49.81108,173.8,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
SPINAL TRAY,,A4550,HCPCS,Facility,Both,,,,173.8,147.73,49.81108,173.8,"Multiplan, Inc.","Multiplan, Inc.",163.372,94,,percent of total billed charges,,
SPINAL TRAY,,A4550,HCPCS,Facility,Outpatient,,,,173.8,147.73,49.81108,173.8,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,156.5938,90.1,,percent of total billed charges,,
SPINAL TRAY,,A4550,HCPCS,Facility,Inpatient,,,,173.8,147.73,49.81108,173.8,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
SPINAL TRAY,,A4550,HCPCS,Facility,Both,,,,173.8,147.73,49.81108,173.8,"Preferred One Administrative Services, INC.",PPO,171.3668,98.6,,percent of total billed charges,,
SPINAL TRAY,,A4550,HCPCS,Facility,Outpatient,,,,173.8,147.73,49.81108,173.8,PrimeWest Health,Minnesota Senior Health Options (MSHO),89.4201,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
SPINAL TRAY,,A4550,HCPCS,Facility,Inpatient,,,,173.8,147.73,49.81108,173.8,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SPINAL TRAY,,A4550,HCPCS,Facility,Outpatient,,,,173.8,147.73,49.81108,173.8,PrimeWest Health,MinnesotaCare,89.26368,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
SPINAL TRAY,,A4550,HCPCS,Facility,Inpatient,,,,173.8,147.73,49.81108,173.8,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
SPINAL TRAY,,A4550,HCPCS,Facility,Both,,,,173.8,147.73,49.81108,173.8,Sanford Health Plan,Sanford Health Plan,159.896,92,,percent of total billed charges,,
SPINAL TRAY,,A4550,HCPCS,Facility,Outpatient,,,,173.8,147.73,49.81108,173.8,"UCare Health, Inc.",Individual & Family Plan,97.9363,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
SPINAL TRAY,,A4550,HCPCS,Facility,Inpatient,,,,173.8,147.73,49.81108,173.8,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
SPINAL TRAY,,A4550,HCPCS,Facility,Outpatient,,,,173.8,147.73,49.81108,173.8,"UCare Health, Inc.",Medical Assistance,87.71686,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SPINAL TRAY,,A4550,HCPCS,Facility,Inpatient,,,,173.8,147.73,49.81108,173.8,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
SPINAL TRAY,,A4550,HCPCS,Facility,Outpatient,,,,173.8,147.73,49.81108,173.8,"UCare Health, Inc.",Medicare Advantage,87.71686,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SPINAL TRAY,,A4550,HCPCS,Facility,Inpatient,,,,173.8,147.73,49.81108,173.8,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SPINAL TRAY,,A4550,HCPCS,Facility,Outpatient,,,,173.8,147.73,49.81108,173.8,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),87.71686,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SPINAL TRAY,,A4550,HCPCS,Facility,Inpatient,,,,173.8,147.73,49.81108,173.8,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SPINAL TRAY,,A4550,HCPCS,Facility,Both,,,,173.8,147.73,49.81108,173.8,UnitedHealthcare,Individual & Family,163.372,94,,percent of total billed charges,,
SPINAL TRAY,,A4550,HCPCS,Facility,Outpatient,,,,173.8,147.73,49.81108,173.8,UnitedHealthcare,Medicare Advantage,85.162,49,,percent of total billed charges,,
SPINAL TRAY,,A4550,HCPCS,Facility,Inpatient,,,,173.8,147.73,49.81108,173.8,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
SPINAL TRAY,,A4550,HCPCS,Facility,Outpatient,,,,173.8,147.73,49.81108,173.8,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,83.424,48,,percent of total billed charges,,100% of DHS outpatient percentage
SPINAL TRAY,,A4550,HCPCS,Facility,Inpatient,,,,173.8,147.73,49.81108,173.8,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
SPINAL/EPIDURAL ANESTHESIA TRAY,,A4550,HCPCS,Facility,Both,,,,262.57,223.1845,75.252562,262.57,Aetna,Commercial,241.5644,92,,percent of total billed charges,,
SPINAL/EPIDURAL ANESTHESIA TRAY,,A4550,HCPCS,Facility,Outpatient,,,,262.57,223.1845,75.252562,262.57,Aetna,Medicare Advantage,128.6593,49,,percent of total billed charges,,
SPINAL/EPIDURAL ANESTHESIA TRAY,,A4550,HCPCS,Facility,Inpatient,,,,262.57,223.1845,75.252562,262.57,Aetna,Medicare Advantage,,,,,Included in per diem rate,
SPINAL/EPIDURAL ANESTHESIA TRAY,,A4550,HCPCS,Facility,Both,,,,262.57,223.1845,75.252562,262.57,Aetna,PPO,244.1901,93,,percent of total billed charges,,
SPINAL/EPIDURAL ANESTHESIA TRAY,,A4550,HCPCS,Facility,Both,,,,262.57,223.1845,75.252562,262.57,America's PPO,America's PPO,252.145971,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SPINAL/EPIDURAL ANESTHESIA TRAY,,A4550,HCPCS,Facility,Both,,,,262.57,223.1845,75.252562,262.57,BlueCross BlueShield Minnesota, Federal Employee Program,258.36888,98.4,,percent of total billed charges,,
SPINAL/EPIDURAL ANESTHESIA TRAY,,A4550,HCPCS,Facility,Both,,,,262.57,223.1845,75.252562,262.57,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,262.57,100,,percent of total billed charges,,
SPINAL/EPIDURAL ANESTHESIA TRAY,,A4550,HCPCS,Facility,Both,,,,262.57,223.1845,75.252562,262.57,BlueCross BlueShield Minnesota,High Value Network Plan,236.313,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
SPINAL/EPIDURAL ANESTHESIA TRAY,,A4550,HCPCS,Facility,Outpatient,,,,262.57,223.1845,75.252562,262.57,BlueCross BlueShield Minnesota,Medicare Advantage,128.6593,49,,percent of total billed charges,,
SPINAL/EPIDURAL ANESTHESIA TRAY,,A4550,HCPCS,Facility,Inpatient,,,,262.57,223.1845,75.252562,262.57,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
SPINAL/EPIDURAL ANESTHESIA TRAY,,A4550,HCPCS,Facility,Both,,,,262.57,223.1845,75.252562,262.57,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,232.558249,88.57,,percent of total billed charges,,
SPINAL/EPIDURAL ANESTHESIA TRAY,,A4550,HCPCS,Facility,Both,,,,262.57,223.1845,75.252562,262.57,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,75.252562,28.66,,percent of total billed charges,,
SPINAL/EPIDURAL ANESTHESIA TRAY,,A4550,HCPCS,Facility,Outpatient,,,,262.57,223.1845,75.252562,262.57,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),128.6593,49,,percent of total billed charges,,
SPINAL/EPIDURAL ANESTHESIA TRAY,,A4550,HCPCS,Facility,Inpatient,,,,262.57,223.1845,75.252562,262.57,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
SPINAL/EPIDURAL ANESTHESIA TRAY,,A4550,HCPCS,Facility,Both,,,,262.57,223.1845,75.252562,262.57,CorVel,Worker's Compensation,262.57,100,,percent of total billed charges,,
SPINAL/EPIDURAL ANESTHESIA TRAY,,A4550,HCPCS,Facility,Both,,,,262.57,223.1845,75.252562,262.57,First Health Group Corporation,First Health Network,254.6929,97,,percent of total billed charges,,
SPINAL/EPIDURAL ANESTHESIA TRAY,,A4550,HCPCS,Facility,Both,,,,262.57,223.1845,75.252562,262.57,"Health Partners, Inc.",Commercial,248.39122,94.6,,percent of total billed charges,,
SPINAL/EPIDURAL ANESTHESIA TRAY,,A4550,HCPCS,Facility,Outpatient,,,,262.57,223.1845,75.252562,262.57,"Health Partners, Inc.",Medicare Advantage,128.6593,49,,percent of total billed charges,,
SPINAL/EPIDURAL ANESTHESIA TRAY,,A4550,HCPCS,Facility,Inpatient,,,,262.57,223.1845,75.252562,262.57,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SPINAL/EPIDURAL ANESTHESIA TRAY,,A4550,HCPCS,Facility,Both,,,,262.57,223.1845,75.252562,262.57,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),157.542,60,,percent of total billed charges,,
SPINAL/EPIDURAL ANESTHESIA TRAY,,A4550,HCPCS,Facility,Both,,,,262.57,223.1845,75.252562,262.57,"Health Partners, Inc.",State of Minnesota Advantage Program,213.99455,81.5,,percent of total billed charges,,
SPINAL/EPIDURAL ANESTHESIA TRAY,,A4550,HCPCS,Facility,Both,,,,262.57,223.1845,75.252562,262.57,"Health Partners, Inc.",State Public Programs,131.285,50,,percent of total billed charges,,
SPINAL/EPIDURAL ANESTHESIA TRAY,,A4550,HCPCS,Facility,Both,,,,262.57,223.1845,75.252562,262.57,Humana Insurance Company,Commercial PPO,249.4415,95,,percent of total billed charges,,
SPINAL/EPIDURAL ANESTHESIA TRAY,,A4550,HCPCS,Facility,Outpatient,,,,262.57,223.1845,75.252562,262.57,Humana Insurance Company,Medicare PPO,128.6593,49,,percent of total billed charges,,
SPINAL/EPIDURAL ANESTHESIA TRAY,,A4550,HCPCS,Facility,Inpatient,,,,262.57,223.1845,75.252562,262.57,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
SPINAL/EPIDURAL ANESTHESIA TRAY,,A4550,HCPCS,Facility,Both,,,,262.57,223.1845,75.252562,262.57,Medica,Individual & Family,260.20687,99.1,,percent of total billed charges,,
SPINAL/EPIDURAL ANESTHESIA TRAY,,A4550,HCPCS,Facility,Outpatient,,,,262.57,223.1845,75.252562,262.57,Medica,Medica Advantage Solution,130.75986,49.8,,percent of total billed charges,,
SPINAL/EPIDURAL ANESTHESIA TRAY,,A4550,HCPCS,Facility,Inpatient,,,,262.57,223.1845,75.252562,262.57,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
SPINAL/EPIDURAL ANESTHESIA TRAY,,A4550,HCPCS,Facility,Outpatient,,,,262.57,223.1845,75.252562,262.57,Medica,Medical Assistance,117.10622,44.6,,percent of total billed charges,,
SPINAL/EPIDURAL ANESTHESIA TRAY,,A4550,HCPCS,Facility,Inpatient,,,,262.57,223.1845,75.252562,262.57,Medica,Medical Assistance,,,,,Included in per diem rate,
SPINAL/EPIDURAL ANESTHESIA TRAY,,A4550,HCPCS,Facility,Outpatient,,,,262.57,223.1845,75.252562,262.57,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,130.75986,49.8,,percent of total billed charges,,
SPINAL/EPIDURAL ANESTHESIA TRAY,,A4550,HCPCS,Facility,Inpatient,,,,262.57,223.1845,75.252562,262.57,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
SPINAL/EPIDURAL ANESTHESIA TRAY,,A4550,HCPCS,Facility,Both,,,,262.57,223.1845,75.252562,262.57,"Multiplan, Inc.","Multiplan, Inc.",246.8158,94,,percent of total billed charges,,
SPINAL/EPIDURAL ANESTHESIA TRAY,,A4550,HCPCS,Facility,Outpatient,,,,262.57,223.1845,75.252562,262.57,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,236.57557,90.1,,percent of total billed charges,,
SPINAL/EPIDURAL ANESTHESIA TRAY,,A4550,HCPCS,Facility,Inpatient,,,,262.57,223.1845,75.252562,262.57,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
SPINAL/EPIDURAL ANESTHESIA TRAY,,A4550,HCPCS,Facility,Both,,,,262.57,223.1845,75.252562,262.57,"Preferred One Administrative Services, INC.",PPO,258.89402,98.6,,percent of total billed charges,,
SPINAL/EPIDURAL ANESTHESIA TRAY,,A4550,HCPCS,Facility,Outpatient,,,,262.57,223.1845,75.252562,262.57,PrimeWest Health,Minnesota Senior Health Options (MSHO),135.092265,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
SPINAL/EPIDURAL ANESTHESIA TRAY,,A4550,HCPCS,Facility,Inpatient,,,,262.57,223.1845,75.252562,262.57,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SPINAL/EPIDURAL ANESTHESIA TRAY,,A4550,HCPCS,Facility,Outpatient,,,,262.57,223.1845,75.252562,262.57,PrimeWest Health,MinnesotaCare,134.855952,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
SPINAL/EPIDURAL ANESTHESIA TRAY,,A4550,HCPCS,Facility,Inpatient,,,,262.57,223.1845,75.252562,262.57,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
SPINAL/EPIDURAL ANESTHESIA TRAY,,A4550,HCPCS,Facility,Both,,,,262.57,223.1845,75.252562,262.57,Sanford Health Plan,Sanford Health Plan,241.5644,92,,percent of total billed charges,,
SPINAL/EPIDURAL ANESTHESIA TRAY,,A4550,HCPCS,Facility,Outpatient,,,,262.57,223.1845,75.252562,262.57,"UCare Health, Inc.",Individual & Family Plan,147.958195,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
SPINAL/EPIDURAL ANESTHESIA TRAY,,A4550,HCPCS,Facility,Inpatient,,,,262.57,223.1845,75.252562,262.57,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
SPINAL/EPIDURAL ANESTHESIA TRAY,,A4550,HCPCS,Facility,Outpatient,,,,262.57,223.1845,75.252562,262.57,"UCare Health, Inc.",Medical Assistance,132.519079,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SPINAL/EPIDURAL ANESTHESIA TRAY,,A4550,HCPCS,Facility,Inpatient,,,,262.57,223.1845,75.252562,262.57,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
SPINAL/EPIDURAL ANESTHESIA TRAY,,A4550,HCPCS,Facility,Outpatient,,,,262.57,223.1845,75.252562,262.57,"UCare Health, Inc.",Medicare Advantage,132.519079,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SPINAL/EPIDURAL ANESTHESIA TRAY,,A4550,HCPCS,Facility,Inpatient,,,,262.57,223.1845,75.252562,262.57,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SPINAL/EPIDURAL ANESTHESIA TRAY,,A4550,HCPCS,Facility,Outpatient,,,,262.57,223.1845,75.252562,262.57,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),132.519079,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SPINAL/EPIDURAL ANESTHESIA TRAY,,A4550,HCPCS,Facility,Inpatient,,,,262.57,223.1845,75.252562,262.57,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SPINAL/EPIDURAL ANESTHESIA TRAY,,A4550,HCPCS,Facility,Both,,,,262.57,223.1845,75.252562,262.57,UnitedHealthcare,Individual & Family,246.8158,94,,percent of total billed charges,,
SPINAL/EPIDURAL ANESTHESIA TRAY,,A4550,HCPCS,Facility,Outpatient,,,,262.57,223.1845,75.252562,262.57,UnitedHealthcare,Medicare Advantage,128.6593,49,,percent of total billed charges,,
SPINAL/EPIDURAL ANESTHESIA TRAY,,A4550,HCPCS,Facility,Inpatient,,,,262.57,223.1845,75.252562,262.57,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
SPINAL/EPIDURAL ANESTHESIA TRAY,,A4550,HCPCS,Facility,Outpatient,,,,262.57,223.1845,75.252562,262.57,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,126.0336,48,,percent of total billed charges,,100% of DHS outpatient percentage
SPINAL/EPIDURAL ANESTHESIA TRAY,,A4550,HCPCS,Facility,Inpatient,,,,262.57,223.1845,75.252562,262.57,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Sup Iv Tray,,A4550,HCPCS,Facility,Both,,,,102,86.7,29.2332,102,Aetna,Commercial,93.84,92,,percent of total billed charges,,
Sup Iv Tray,,A4550,HCPCS,Facility,Outpatient,,,,102,86.7,29.2332,102,Aetna,Medicare Advantage,49.98,49,,percent of total billed charges,,
Sup Iv Tray,,A4550,HCPCS,Facility,Inpatient,,,,102,86.7,29.2332,102,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Sup Iv Tray,,A4550,HCPCS,Facility,Both,,,,102,86.7,29.2332,102,Aetna,PPO,94.86,93,,percent of total billed charges,,
Sup Iv Tray,,A4550,HCPCS,Facility,Both,,,,102,86.7,29.2332,102,America's PPO,America's PPO,97.9506,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Sup Iv Tray,,A4550,HCPCS,Facility,Both,,,,102,86.7,29.2332,102,BlueCross BlueShield Minnesota, Federal Employee Program,100.368,98.4,,percent of total billed charges,,
Sup Iv Tray,,A4550,HCPCS,Facility,Both,,,,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,102,100,,percent of total billed charges,,
Sup Iv Tray,,A4550,HCPCS,Facility,Both,,,,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,High Value Network Plan,91.8,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
Sup Iv Tray,,A4550,HCPCS,Facility,Outpatient,,,,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,Medicare Advantage,49.98,49,,percent of total billed charges,,
Sup Iv Tray,,A4550,HCPCS,Facility,Inpatient,,,,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Sup Iv Tray,,A4550,HCPCS,Facility,Both,,,,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,90.3414,88.57,,percent of total billed charges,,
Sup Iv Tray,,A4550,HCPCS,Facility,Both,,,,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,29.2332,28.66,,percent of total billed charges,,
Sup Iv Tray,,A4550,HCPCS,Facility,Outpatient,,,,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),49.98,49,,percent of total billed charges,,
Sup Iv Tray,,A4550,HCPCS,Facility,Inpatient,,,,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Sup Iv Tray,,A4550,HCPCS,Facility,Both,,,,102,86.7,29.2332,102,CorVel,Worker's Compensation,102,100,,percent of total billed charges,,
Sup Iv Tray,,A4550,HCPCS,Facility,Both,,,,102,86.7,29.2332,102,First Health Group Corporation,First Health Network,98.94,97,,percent of total billed charges,,
Sup Iv Tray,,A4550,HCPCS,Facility,Both,,,,102,86.7,29.2332,102,"Health Partners, Inc.",Commercial,96.492,94.6,,percent of total billed charges,,
Sup Iv Tray,,A4550,HCPCS,Facility,Outpatient,,,,102,86.7,29.2332,102,"Health Partners, Inc.",Medicare Advantage,49.98,49,,percent of total billed charges,,
Sup Iv Tray,,A4550,HCPCS,Facility,Inpatient,,,,102,86.7,29.2332,102,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Iv Tray,,A4550,HCPCS,Facility,Both,,,,102,86.7,29.2332,102,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),61.2,60,,percent of total billed charges,,
Sup Iv Tray,,A4550,HCPCS,Facility,Both,,,,102,86.7,29.2332,102,"Health Partners, Inc.",State of Minnesota Advantage Program,83.13,81.5,,percent of total billed charges,,
Sup Iv Tray,,A4550,HCPCS,Facility,Both,,,,102,86.7,29.2332,102,"Health Partners, Inc.",State Public Programs,51,50,,percent of total billed charges,,
Sup Iv Tray,,A4550,HCPCS,Facility,Both,,,,102,86.7,29.2332,102,Humana Insurance Company,Commercial PPO,96.9,95,,percent of total billed charges,,
Sup Iv Tray,,A4550,HCPCS,Facility,Outpatient,,,,102,86.7,29.2332,102,Humana Insurance Company,Medicare PPO,49.98,49,,percent of total billed charges,,
Sup Iv Tray,,A4550,HCPCS,Facility,Inpatient,,,,102,86.7,29.2332,102,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Sup Iv Tray,,A4550,HCPCS,Facility,Both,,,,102,86.7,29.2332,102,Medica,Individual & Family,101.082,99.1,,percent of total billed charges,,
Sup Iv Tray,,A4550,HCPCS,Facility,Outpatient,,,,102,86.7,29.2332,102,Medica,Medica Advantage Solution,50.796,49.8,,percent of total billed charges,,
Sup Iv Tray,,A4550,HCPCS,Facility,Inpatient,,,,102,86.7,29.2332,102,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Sup Iv Tray,,A4550,HCPCS,Facility,Outpatient,,,,102,86.7,29.2332,102,Medica,Medical Assistance,45.492,44.6,,percent of total billed charges,,
Sup Iv Tray,,A4550,HCPCS,Facility,Inpatient,,,,102,86.7,29.2332,102,Medica,Medical Assistance,,,,,Included in per diem rate,
Sup Iv Tray,,A4550,HCPCS,Facility,Outpatient,,,,102,86.7,29.2332,102,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,50.796,49.8,,percent of total billed charges,,
Sup Iv Tray,,A4550,HCPCS,Facility,Inpatient,,,,102,86.7,29.2332,102,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Sup Iv Tray,,A4550,HCPCS,Facility,Both,,,,102,86.7,29.2332,102,"Multiplan, Inc.","Multiplan, Inc.",95.88,94,,percent of total billed charges,,
Sup Iv Tray,,A4550,HCPCS,Facility,Outpatient,,,,102,86.7,29.2332,102,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,91.902,90.1,,percent of total billed charges,,
Sup Iv Tray,,A4550,HCPCS,Facility,Inpatient,,,,102,86.7,29.2332,102,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Sup Iv Tray,,A4550,HCPCS,Facility,Both,,,,102,86.7,29.2332,102,"Preferred One Administrative Services, INC.",PPO,100.572,98.6,,percent of total billed charges,,
Sup Iv Tray,,A4550,HCPCS,Facility,Outpatient,,,,102,86.7,29.2332,102,PrimeWest Health,Minnesota Senior Health Options (MSHO),52.479,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Sup Iv Tray,,A4550,HCPCS,Facility,Inpatient,,,,102,86.7,29.2332,102,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Iv Tray,,A4550,HCPCS,Facility,Outpatient,,,,102,86.7,29.2332,102,PrimeWest Health,MinnesotaCare,52.3872,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Sup Iv Tray,,A4550,HCPCS,Facility,Inpatient,,,,102,86.7,29.2332,102,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Sup Iv Tray,,A4550,HCPCS,Facility,Both,,,,102,86.7,29.2332,102,Sanford Health Plan,Sanford Health Plan,93.84,92,,percent of total billed charges,,
Sup Iv Tray,,A4550,HCPCS,Facility,Outpatient,,,,102,86.7,29.2332,102,"UCare Health, Inc.",Individual & Family Plan,57.477,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Sup Iv Tray,,A4550,HCPCS,Facility,Inpatient,,,,102,86.7,29.2332,102,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Sup Iv Tray,,A4550,HCPCS,Facility,Outpatient,,,,102,86.7,29.2332,102,"UCare Health, Inc.",Medical Assistance,51.4794,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Iv Tray,,A4550,HCPCS,Facility,Inpatient,,,,102,86.7,29.2332,102,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Sup Iv Tray,,A4550,HCPCS,Facility,Outpatient,,,,102,86.7,29.2332,102,"UCare Health, Inc.",Medicare Advantage,51.4794,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Iv Tray,,A4550,HCPCS,Facility,Inpatient,,,,102,86.7,29.2332,102,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Iv Tray,,A4550,HCPCS,Facility,Outpatient,,,,102,86.7,29.2332,102,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),51.4794,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Iv Tray,,A4550,HCPCS,Facility,Inpatient,,,,102,86.7,29.2332,102,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Iv Tray,,A4550,HCPCS,Facility,Both,,,,102,86.7,29.2332,102,UnitedHealthcare,Individual & Family,95.88,94,,percent of total billed charges,,
Sup Iv Tray,,A4550,HCPCS,Facility,Outpatient,,,,102,86.7,29.2332,102,UnitedHealthcare,Medicare Advantage,49.98,49,,percent of total billed charges,,
Sup Iv Tray,,A4550,HCPCS,Facility,Inpatient,,,,102,86.7,29.2332,102,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Sup Iv Tray,,A4550,HCPCS,Facility,Outpatient,,,,102,86.7,29.2332,102,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,48.96,48,,percent of total billed charges,,100% of DHS outpatient percentage
Sup Iv Tray,,A4550,HCPCS,Facility,Inpatient,,,,102,86.7,29.2332,102,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Sup Ob Tray,,A4550,HCPCS,Facility,Both,,,,69,58.65,19.7754,69,Aetna,Commercial,63.48,92,,percent of total billed charges,,
Sup Ob Tray,,A4550,HCPCS,Facility,Outpatient,,,,69,58.65,19.7754,69,Aetna,Medicare Advantage,33.81,49,,percent of total billed charges,,
Sup Ob Tray,,A4550,HCPCS,Facility,Inpatient,,,,69,58.65,19.7754,69,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Sup Ob Tray,,A4550,HCPCS,Facility,Both,,,,69,58.65,19.7754,69,Aetna,PPO,64.17,93,,percent of total billed charges,,
Sup Ob Tray,,A4550,HCPCS,Facility,Both,,,,69,58.65,19.7754,69,America's PPO,America's PPO,66.2607,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Sup Ob Tray,,A4550,HCPCS,Facility,Both,,,,69,58.65,19.7754,69,BlueCross BlueShield Minnesota, Federal Employee Program,67.896,98.4,,percent of total billed charges,,
Sup Ob Tray,,A4550,HCPCS,Facility,Both,,,,69,58.65,19.7754,69,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,69,100,,percent of total billed charges,,
Sup Ob Tray,,A4550,HCPCS,Facility,Both,,,,69,58.65,19.7754,69,BlueCross BlueShield Minnesota,High Value Network Plan,62.1,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
Sup Ob Tray,,A4550,HCPCS,Facility,Outpatient,,,,69,58.65,19.7754,69,BlueCross BlueShield Minnesota,Medicare Advantage,33.81,49,,percent of total billed charges,,
Sup Ob Tray,,A4550,HCPCS,Facility,Inpatient,,,,69,58.65,19.7754,69,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Sup Ob Tray,,A4550,HCPCS,Facility,Both,,,,69,58.65,19.7754,69,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,61.1133,88.57,,percent of total billed charges,,
Sup Ob Tray,,A4550,HCPCS,Facility,Both,,,,69,58.65,19.7754,69,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,19.7754,28.66,,percent of total billed charges,,
Sup Ob Tray,,A4550,HCPCS,Facility,Outpatient,,,,69,58.65,19.7754,69,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),33.81,49,,percent of total billed charges,,
Sup Ob Tray,,A4550,HCPCS,Facility,Inpatient,,,,69,58.65,19.7754,69,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Sup Ob Tray,,A4550,HCPCS,Facility,Both,,,,69,58.65,19.7754,69,CorVel,Worker's Compensation,69,100,,percent of total billed charges,,
Sup Ob Tray,,A4550,HCPCS,Facility,Both,,,,69,58.65,19.7754,69,First Health Group Corporation,First Health Network,66.93,97,,percent of total billed charges,,
Sup Ob Tray,,A4550,HCPCS,Facility,Both,,,,69,58.65,19.7754,69,"Health Partners, Inc.",Commercial,65.274,94.6,,percent of total billed charges,,
Sup Ob Tray,,A4550,HCPCS,Facility,Outpatient,,,,69,58.65,19.7754,69,"Health Partners, Inc.",Medicare Advantage,33.81,49,,percent of total billed charges,,
Sup Ob Tray,,A4550,HCPCS,Facility,Inpatient,,,,69,58.65,19.7754,69,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Ob Tray,,A4550,HCPCS,Facility,Both,,,,69,58.65,19.7754,69,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),41.4,60,,percent of total billed charges,,
Sup Ob Tray,,A4550,HCPCS,Facility,Both,,,,69,58.65,19.7754,69,"Health Partners, Inc.",State of Minnesota Advantage Program,56.235,81.5,,percent of total billed charges,,
Sup Ob Tray,,A4550,HCPCS,Facility,Both,,,,69,58.65,19.7754,69,"Health Partners, Inc.",State Public Programs,34.5,50,,percent of total billed charges,,
Sup Ob Tray,,A4550,HCPCS,Facility,Both,,,,69,58.65,19.7754,69,Humana Insurance Company,Commercial PPO,65.55,95,,percent of total billed charges,,
Sup Ob Tray,,A4550,HCPCS,Facility,Outpatient,,,,69,58.65,19.7754,69,Humana Insurance Company,Medicare PPO,33.81,49,,percent of total billed charges,,
Sup Ob Tray,,A4550,HCPCS,Facility,Inpatient,,,,69,58.65,19.7754,69,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Sup Ob Tray,,A4550,HCPCS,Facility,Both,,,,69,58.65,19.7754,69,Medica,Individual & Family,68.379,99.1,,percent of total billed charges,,
Sup Ob Tray,,A4550,HCPCS,Facility,Outpatient,,,,69,58.65,19.7754,69,Medica,Medica Advantage Solution,34.362,49.8,,percent of total billed charges,,
Sup Ob Tray,,A4550,HCPCS,Facility,Inpatient,,,,69,58.65,19.7754,69,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Sup Ob Tray,,A4550,HCPCS,Facility,Outpatient,,,,69,58.65,19.7754,69,Medica,Medical Assistance,30.774,44.6,,percent of total billed charges,,
Sup Ob Tray,,A4550,HCPCS,Facility,Inpatient,,,,69,58.65,19.7754,69,Medica,Medical Assistance,,,,,Included in per diem rate,
Sup Ob Tray,,A4550,HCPCS,Facility,Outpatient,,,,69,58.65,19.7754,69,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,34.362,49.8,,percent of total billed charges,,
Sup Ob Tray,,A4550,HCPCS,Facility,Inpatient,,,,69,58.65,19.7754,69,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Sup Ob Tray,,A4550,HCPCS,Facility,Both,,,,69,58.65,19.7754,69,"Multiplan, Inc.","Multiplan, Inc.",64.86,94,,percent of total billed charges,,
Sup Ob Tray,,A4550,HCPCS,Facility,Outpatient,,,,69,58.65,19.7754,69,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,62.169,90.1,,percent of total billed charges,,
Sup Ob Tray,,A4550,HCPCS,Facility,Inpatient,,,,69,58.65,19.7754,69,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Sup Ob Tray,,A4550,HCPCS,Facility,Both,,,,69,58.65,19.7754,69,"Preferred One Administrative Services, INC.",PPO,68.034,98.6,,percent of total billed charges,,
Sup Ob Tray,,A4550,HCPCS,Facility,Outpatient,,,,69,58.65,19.7754,69,PrimeWest Health,Minnesota Senior Health Options (MSHO),35.5005,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Sup Ob Tray,,A4550,HCPCS,Facility,Inpatient,,,,69,58.65,19.7754,69,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Ob Tray,,A4550,HCPCS,Facility,Outpatient,,,,69,58.65,19.7754,69,PrimeWest Health,MinnesotaCare,35.4384,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Sup Ob Tray,,A4550,HCPCS,Facility,Inpatient,,,,69,58.65,19.7754,69,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Sup Ob Tray,,A4550,HCPCS,Facility,Both,,,,69,58.65,19.7754,69,Sanford Health Plan,Sanford Health Plan,63.48,92,,percent of total billed charges,,
Sup Ob Tray,,A4550,HCPCS,Facility,Outpatient,,,,69,58.65,19.7754,69,"UCare Health, Inc.",Individual & Family Plan,38.8815,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Sup Ob Tray,,A4550,HCPCS,Facility,Inpatient,,,,69,58.65,19.7754,69,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Sup Ob Tray,,A4550,HCPCS,Facility,Outpatient,,,,69,58.65,19.7754,69,"UCare Health, Inc.",Medical Assistance,34.8243,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Ob Tray,,A4550,HCPCS,Facility,Inpatient,,,,69,58.65,19.7754,69,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Sup Ob Tray,,A4550,HCPCS,Facility,Outpatient,,,,69,58.65,19.7754,69,"UCare Health, Inc.",Medicare Advantage,34.8243,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Ob Tray,,A4550,HCPCS,Facility,Inpatient,,,,69,58.65,19.7754,69,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Ob Tray,,A4550,HCPCS,Facility,Outpatient,,,,69,58.65,19.7754,69,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),34.8243,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Ob Tray,,A4550,HCPCS,Facility,Inpatient,,,,69,58.65,19.7754,69,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Ob Tray,,A4550,HCPCS,Facility,Both,,,,69,58.65,19.7754,69,UnitedHealthcare,Individual & Family,64.86,94,,percent of total billed charges,,
Sup Ob Tray,,A4550,HCPCS,Facility,Outpatient,,,,69,58.65,19.7754,69,UnitedHealthcare,Medicare Advantage,33.81,49,,percent of total billed charges,,
Sup Ob Tray,,A4550,HCPCS,Facility,Inpatient,,,,69,58.65,19.7754,69,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Sup Ob Tray,,A4550,HCPCS,Facility,Outpatient,,,,69,58.65,19.7754,69,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,33.12,48,,percent of total billed charges,,100% of DHS outpatient percentage
Sup Ob Tray,,A4550,HCPCS,Facility,Inpatient,,,,69,58.65,19.7754,69,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Sup Prep Tray,,A4550,HCPCS,Facility,Both,,,,41,34.85,11.7506,41,Aetna,Commercial,37.72,92,,percent of total billed charges,,
Sup Prep Tray,,A4550,HCPCS,Facility,Outpatient,,,,41,34.85,11.7506,41,Aetna,Medicare Advantage,20.09,49,,percent of total billed charges,,
Sup Prep Tray,,A4550,HCPCS,Facility,Inpatient,,,,41,34.85,11.7506,41,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Sup Prep Tray,,A4550,HCPCS,Facility,Both,,,,41,34.85,11.7506,41,Aetna,PPO,38.13,93,,percent of total billed charges,,
Sup Prep Tray,,A4550,HCPCS,Facility,Both,,,,41,34.85,11.7506,41,America's PPO,America's PPO,39.3723,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Sup Prep Tray,,A4550,HCPCS,Facility,Both,,,,41,34.85,11.7506,41,BlueCross BlueShield Minnesota, Federal Employee Program,40.344,98.4,,percent of total billed charges,,
Sup Prep Tray,,A4550,HCPCS,Facility,Both,,,,41,34.85,11.7506,41,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,41,100,,percent of total billed charges,,
Sup Prep Tray,,A4550,HCPCS,Facility,Both,,,,41,34.85,11.7506,41,BlueCross BlueShield Minnesota,High Value Network Plan,36.9,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
Sup Prep Tray,,A4550,HCPCS,Facility,Outpatient,,,,41,34.85,11.7506,41,BlueCross BlueShield Minnesota,Medicare Advantage,20.09,49,,percent of total billed charges,,
Sup Prep Tray,,A4550,HCPCS,Facility,Inpatient,,,,41,34.85,11.7506,41,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Sup Prep Tray,,A4550,HCPCS,Facility,Both,,,,41,34.85,11.7506,41,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,36.3137,88.57,,percent of total billed charges,,
Sup Prep Tray,,A4550,HCPCS,Facility,Both,,,,41,34.85,11.7506,41,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,11.7506,28.66,,percent of total billed charges,,
Sup Prep Tray,,A4550,HCPCS,Facility,Outpatient,,,,41,34.85,11.7506,41,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),20.09,49,,percent of total billed charges,,
Sup Prep Tray,,A4550,HCPCS,Facility,Inpatient,,,,41,34.85,11.7506,41,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Sup Prep Tray,,A4550,HCPCS,Facility,Both,,,,41,34.85,11.7506,41,CorVel,Worker's Compensation,41,100,,percent of total billed charges,,
Sup Prep Tray,,A4550,HCPCS,Facility,Both,,,,41,34.85,11.7506,41,First Health Group Corporation,First Health Network,39.77,97,,percent of total billed charges,,
Sup Prep Tray,,A4550,HCPCS,Facility,Both,,,,41,34.85,11.7506,41,"Health Partners, Inc.",Commercial,38.786,94.6,,percent of total billed charges,,
Sup Prep Tray,,A4550,HCPCS,Facility,Outpatient,,,,41,34.85,11.7506,41,"Health Partners, Inc.",Medicare Advantage,20.09,49,,percent of total billed charges,,
Sup Prep Tray,,A4550,HCPCS,Facility,Inpatient,,,,41,34.85,11.7506,41,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Prep Tray,,A4550,HCPCS,Facility,Both,,,,41,34.85,11.7506,41,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),24.6,60,,percent of total billed charges,,
Sup Prep Tray,,A4550,HCPCS,Facility,Both,,,,41,34.85,11.7506,41,"Health Partners, Inc.",State of Minnesota Advantage Program,33.415,81.5,,percent of total billed charges,,
Sup Prep Tray,,A4550,HCPCS,Facility,Both,,,,41,34.85,11.7506,41,"Health Partners, Inc.",State Public Programs,20.5,50,,percent of total billed charges,,
Sup Prep Tray,,A4550,HCPCS,Facility,Both,,,,41,34.85,11.7506,41,Humana Insurance Company,Commercial PPO,38.95,95,,percent of total billed charges,,
Sup Prep Tray,,A4550,HCPCS,Facility,Outpatient,,,,41,34.85,11.7506,41,Humana Insurance Company,Medicare PPO,20.09,49,,percent of total billed charges,,
Sup Prep Tray,,A4550,HCPCS,Facility,Inpatient,,,,41,34.85,11.7506,41,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Sup Prep Tray,,A4550,HCPCS,Facility,Both,,,,41,34.85,11.7506,41,Medica,Individual & Family,40.631,99.1,,percent of total billed charges,,
Sup Prep Tray,,A4550,HCPCS,Facility,Outpatient,,,,41,34.85,11.7506,41,Medica,Medica Advantage Solution,20.418,49.8,,percent of total billed charges,,
Sup Prep Tray,,A4550,HCPCS,Facility,Inpatient,,,,41,34.85,11.7506,41,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Sup Prep Tray,,A4550,HCPCS,Facility,Outpatient,,,,41,34.85,11.7506,41,Medica,Medical Assistance,18.286,44.6,,percent of total billed charges,,
Sup Prep Tray,,A4550,HCPCS,Facility,Inpatient,,,,41,34.85,11.7506,41,Medica,Medical Assistance,,,,,Included in per diem rate,
Sup Prep Tray,,A4550,HCPCS,Facility,Outpatient,,,,41,34.85,11.7506,41,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,20.418,49.8,,percent of total billed charges,,
Sup Prep Tray,,A4550,HCPCS,Facility,Inpatient,,,,41,34.85,11.7506,41,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Sup Prep Tray,,A4550,HCPCS,Facility,Both,,,,41,34.85,11.7506,41,"Multiplan, Inc.","Multiplan, Inc.",38.54,94,,percent of total billed charges,,
Sup Prep Tray,,A4550,HCPCS,Facility,Outpatient,,,,41,34.85,11.7506,41,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,36.941,90.1,,percent of total billed charges,,
Sup Prep Tray,,A4550,HCPCS,Facility,Inpatient,,,,41,34.85,11.7506,41,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Sup Prep Tray,,A4550,HCPCS,Facility,Both,,,,41,34.85,11.7506,41,"Preferred One Administrative Services, INC.",PPO,40.426,98.6,,percent of total billed charges,,
Sup Prep Tray,,A4550,HCPCS,Facility,Outpatient,,,,41,34.85,11.7506,41,PrimeWest Health,Minnesota Senior Health Options (MSHO),21.0945,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Sup Prep Tray,,A4550,HCPCS,Facility,Inpatient,,,,41,34.85,11.7506,41,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Prep Tray,,A4550,HCPCS,Facility,Outpatient,,,,41,34.85,11.7506,41,PrimeWest Health,MinnesotaCare,21.0576,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Sup Prep Tray,,A4550,HCPCS,Facility,Inpatient,,,,41,34.85,11.7506,41,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Sup Prep Tray,,A4550,HCPCS,Facility,Both,,,,41,34.85,11.7506,41,Sanford Health Plan,Sanford Health Plan,37.72,92,,percent of total billed charges,,
Sup Prep Tray,,A4550,HCPCS,Facility,Outpatient,,,,41,34.85,11.7506,41,"UCare Health, Inc.",Individual & Family Plan,23.1035,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Sup Prep Tray,,A4550,HCPCS,Facility,Inpatient,,,,41,34.85,11.7506,41,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Sup Prep Tray,,A4550,HCPCS,Facility,Outpatient,,,,41,34.85,11.7506,41,"UCare Health, Inc.",Medical Assistance,20.6927,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Prep Tray,,A4550,HCPCS,Facility,Inpatient,,,,41,34.85,11.7506,41,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Sup Prep Tray,,A4550,HCPCS,Facility,Outpatient,,,,41,34.85,11.7506,41,"UCare Health, Inc.",Medicare Advantage,20.6927,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Prep Tray,,A4550,HCPCS,Facility,Inpatient,,,,41,34.85,11.7506,41,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Prep Tray,,A4550,HCPCS,Facility,Outpatient,,,,41,34.85,11.7506,41,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),20.6927,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Prep Tray,,A4550,HCPCS,Facility,Inpatient,,,,41,34.85,11.7506,41,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Prep Tray,,A4550,HCPCS,Facility,Both,,,,41,34.85,11.7506,41,UnitedHealthcare,Individual & Family,38.54,94,,percent of total billed charges,,
Sup Prep Tray,,A4550,HCPCS,Facility,Outpatient,,,,41,34.85,11.7506,41,UnitedHealthcare,Medicare Advantage,20.09,49,,percent of total billed charges,,
Sup Prep Tray,,A4550,HCPCS,Facility,Inpatient,,,,41,34.85,11.7506,41,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Sup Prep Tray,,A4550,HCPCS,Facility,Outpatient,,,,41,34.85,11.7506,41,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,19.68,48,,percent of total billed charges,,100% of DHS outpatient percentage
Sup Prep Tray,,A4550,HCPCS,Facility,Inpatient,,,,41,34.85,11.7506,41,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Sup Spinal Tray,,A4550,HCPCS,Facility,Both,,,,80,68,22.928,80,Aetna,Commercial,73.6,92,,percent of total billed charges,,
Sup Spinal Tray,,A4550,HCPCS,Facility,Outpatient,,,,80,68,22.928,80,Aetna,Medicare Advantage,39.2,49,,percent of total billed charges,,
Sup Spinal Tray,,A4550,HCPCS,Facility,Inpatient,,,,80,68,22.928,80,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Sup Spinal Tray,,A4550,HCPCS,Facility,Both,,,,80,68,22.928,80,Aetna,PPO,74.4,93,,percent of total billed charges,,
Sup Spinal Tray,,A4550,HCPCS,Facility,Both,,,,80,68,22.928,80,America's PPO,America's PPO,76.824,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Sup Spinal Tray,,A4550,HCPCS,Facility,Both,,,,80,68,22.928,80,BlueCross BlueShield Minnesota, Federal Employee Program,78.72,98.4,,percent of total billed charges,,
Sup Spinal Tray,,A4550,HCPCS,Facility,Both,,,,80,68,22.928,80,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,80,100,,percent of total billed charges,,
Sup Spinal Tray,,A4550,HCPCS,Facility,Both,,,,80,68,22.928,80,BlueCross BlueShield Minnesota,High Value Network Plan,72,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
Sup Spinal Tray,,A4550,HCPCS,Facility,Outpatient,,,,80,68,22.928,80,BlueCross BlueShield Minnesota,Medicare Advantage,39.2,49,,percent of total billed charges,,
Sup Spinal Tray,,A4550,HCPCS,Facility,Inpatient,,,,80,68,22.928,80,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Sup Spinal Tray,,A4550,HCPCS,Facility,Both,,,,80,68,22.928,80,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,70.856,88.57,,percent of total billed charges,,
Sup Spinal Tray,,A4550,HCPCS,Facility,Both,,,,80,68,22.928,80,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,22.928,28.66,,percent of total billed charges,,
Sup Spinal Tray,,A4550,HCPCS,Facility,Outpatient,,,,80,68,22.928,80,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),39.2,49,,percent of total billed charges,,
Sup Spinal Tray,,A4550,HCPCS,Facility,Inpatient,,,,80,68,22.928,80,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Sup Spinal Tray,,A4550,HCPCS,Facility,Both,,,,80,68,22.928,80,CorVel,Worker's Compensation,80,100,,percent of total billed charges,,
Sup Spinal Tray,,A4550,HCPCS,Facility,Both,,,,80,68,22.928,80,First Health Group Corporation,First Health Network,77.6,97,,percent of total billed charges,,
Sup Spinal Tray,,A4550,HCPCS,Facility,Both,,,,80,68,22.928,80,"Health Partners, Inc.",Commercial,75.68,94.6,,percent of total billed charges,,
Sup Spinal Tray,,A4550,HCPCS,Facility,Outpatient,,,,80,68,22.928,80,"Health Partners, Inc.",Medicare Advantage,39.2,49,,percent of total billed charges,,
Sup Spinal Tray,,A4550,HCPCS,Facility,Inpatient,,,,80,68,22.928,80,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Spinal Tray,,A4550,HCPCS,Facility,Both,,,,80,68,22.928,80,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),48,60,,percent of total billed charges,,
Sup Spinal Tray,,A4550,HCPCS,Facility,Both,,,,80,68,22.928,80,"Health Partners, Inc.",State of Minnesota Advantage Program,65.2,81.5,,percent of total billed charges,,
Sup Spinal Tray,,A4550,HCPCS,Facility,Both,,,,80,68,22.928,80,"Health Partners, Inc.",State Public Programs,40,50,,percent of total billed charges,,
Sup Spinal Tray,,A4550,HCPCS,Facility,Both,,,,80,68,22.928,80,Humana Insurance Company,Commercial PPO,76,95,,percent of total billed charges,,
Sup Spinal Tray,,A4550,HCPCS,Facility,Outpatient,,,,80,68,22.928,80,Humana Insurance Company,Medicare PPO,39.2,49,,percent of total billed charges,,
Sup Spinal Tray,,A4550,HCPCS,Facility,Inpatient,,,,80,68,22.928,80,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Sup Spinal Tray,,A4550,HCPCS,Facility,Both,,,,80,68,22.928,80,Medica,Individual & Family,79.28,99.1,,percent of total billed charges,,
Sup Spinal Tray,,A4550,HCPCS,Facility,Outpatient,,,,80,68,22.928,80,Medica,Medica Advantage Solution,39.84,49.8,,percent of total billed charges,,
Sup Spinal Tray,,A4550,HCPCS,Facility,Inpatient,,,,80,68,22.928,80,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Sup Spinal Tray,,A4550,HCPCS,Facility,Outpatient,,,,80,68,22.928,80,Medica,Medical Assistance,35.68,44.6,,percent of total billed charges,,
Sup Spinal Tray,,A4550,HCPCS,Facility,Inpatient,,,,80,68,22.928,80,Medica,Medical Assistance,,,,,Included in per diem rate,
Sup Spinal Tray,,A4550,HCPCS,Facility,Outpatient,,,,80,68,22.928,80,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,39.84,49.8,,percent of total billed charges,,
Sup Spinal Tray,,A4550,HCPCS,Facility,Inpatient,,,,80,68,22.928,80,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Sup Spinal Tray,,A4550,HCPCS,Facility,Both,,,,80,68,22.928,80,"Multiplan, Inc.","Multiplan, Inc.",75.2,94,,percent of total billed charges,,
Sup Spinal Tray,,A4550,HCPCS,Facility,Outpatient,,,,80,68,22.928,80,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,72.08,90.1,,percent of total billed charges,,
Sup Spinal Tray,,A4550,HCPCS,Facility,Inpatient,,,,80,68,22.928,80,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Sup Spinal Tray,,A4550,HCPCS,Facility,Both,,,,80,68,22.928,80,"Preferred One Administrative Services, INC.",PPO,78.88,98.6,,percent of total billed charges,,
Sup Spinal Tray,,A4550,HCPCS,Facility,Outpatient,,,,80,68,22.928,80,PrimeWest Health,Minnesota Senior Health Options (MSHO),41.16,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Sup Spinal Tray,,A4550,HCPCS,Facility,Inpatient,,,,80,68,22.928,80,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Spinal Tray,,A4550,HCPCS,Facility,Outpatient,,,,80,68,22.928,80,PrimeWest Health,MinnesotaCare,41.088,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Sup Spinal Tray,,A4550,HCPCS,Facility,Inpatient,,,,80,68,22.928,80,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Sup Spinal Tray,,A4550,HCPCS,Facility,Both,,,,80,68,22.928,80,Sanford Health Plan,Sanford Health Plan,73.6,92,,percent of total billed charges,,
Sup Spinal Tray,,A4550,HCPCS,Facility,Outpatient,,,,80,68,22.928,80,"UCare Health, Inc.",Individual & Family Plan,45.08,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Sup Spinal Tray,,A4550,HCPCS,Facility,Inpatient,,,,80,68,22.928,80,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Sup Spinal Tray,,A4550,HCPCS,Facility,Outpatient,,,,80,68,22.928,80,"UCare Health, Inc.",Medical Assistance,40.376,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Spinal Tray,,A4550,HCPCS,Facility,Inpatient,,,,80,68,22.928,80,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Sup Spinal Tray,,A4550,HCPCS,Facility,Outpatient,,,,80,68,22.928,80,"UCare Health, Inc.",Medicare Advantage,40.376,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Spinal Tray,,A4550,HCPCS,Facility,Inpatient,,,,80,68,22.928,80,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Spinal Tray,,A4550,HCPCS,Facility,Outpatient,,,,80,68,22.928,80,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),40.376,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Spinal Tray,,A4550,HCPCS,Facility,Inpatient,,,,80,68,22.928,80,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Spinal Tray,,A4550,HCPCS,Facility,Both,,,,80,68,22.928,80,UnitedHealthcare,Individual & Family,75.2,94,,percent of total billed charges,,
Sup Spinal Tray,,A4550,HCPCS,Facility,Outpatient,,,,80,68,22.928,80,UnitedHealthcare,Medicare Advantage,39.2,49,,percent of total billed charges,,
Sup Spinal Tray,,A4550,HCPCS,Facility,Inpatient,,,,80,68,22.928,80,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Sup Spinal Tray,,A4550,HCPCS,Facility,Outpatient,,,,80,68,22.928,80,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,38.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
Sup Spinal Tray,,A4550,HCPCS,Facility,Inpatient,,,,80,68,22.928,80,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Sup Thoracentesis Tray,,A4550,HCPCS,Facility,Both,,,,131,111.35,37.5446,131,Aetna,Commercial,120.52,92,,percent of total billed charges,,
Sup Thoracentesis Tray,,A4550,HCPCS,Facility,Outpatient,,,,131,111.35,37.5446,131,Aetna,Medicare Advantage,64.19,49,,percent of total billed charges,,
Sup Thoracentesis Tray,,A4550,HCPCS,Facility,Inpatient,,,,131,111.35,37.5446,131,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Sup Thoracentesis Tray,,A4550,HCPCS,Facility,Both,,,,131,111.35,37.5446,131,Aetna,PPO,121.83,93,,percent of total billed charges,,
Sup Thoracentesis Tray,,A4550,HCPCS,Facility,Both,,,,131,111.35,37.5446,131,America's PPO,America's PPO,125.7993,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Sup Thoracentesis Tray,,A4550,HCPCS,Facility,Both,,,,131,111.35,37.5446,131,BlueCross BlueShield Minnesota, Federal Employee Program,128.904,98.4,,percent of total billed charges,,
Sup Thoracentesis Tray,,A4550,HCPCS,Facility,Both,,,,131,111.35,37.5446,131,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,131,100,,percent of total billed charges,,
Sup Thoracentesis Tray,,A4550,HCPCS,Facility,Both,,,,131,111.35,37.5446,131,BlueCross BlueShield Minnesota,High Value Network Plan,117.9,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
Sup Thoracentesis Tray,,A4550,HCPCS,Facility,Outpatient,,,,131,111.35,37.5446,131,BlueCross BlueShield Minnesota,Medicare Advantage,64.19,49,,percent of total billed charges,,
Sup Thoracentesis Tray,,A4550,HCPCS,Facility,Inpatient,,,,131,111.35,37.5446,131,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Sup Thoracentesis Tray,,A4550,HCPCS,Facility,Both,,,,131,111.35,37.5446,131,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,116.0267,88.57,,percent of total billed charges,,
Sup Thoracentesis Tray,,A4550,HCPCS,Facility,Both,,,,131,111.35,37.5446,131,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,37.5446,28.66,,percent of total billed charges,,
Sup Thoracentesis Tray,,A4550,HCPCS,Facility,Outpatient,,,,131,111.35,37.5446,131,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),64.19,49,,percent of total billed charges,,
Sup Thoracentesis Tray,,A4550,HCPCS,Facility,Inpatient,,,,131,111.35,37.5446,131,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Sup Thoracentesis Tray,,A4550,HCPCS,Facility,Both,,,,131,111.35,37.5446,131,CorVel,Worker's Compensation,131,100,,percent of total billed charges,,
Sup Thoracentesis Tray,,A4550,HCPCS,Facility,Both,,,,131,111.35,37.5446,131,First Health Group Corporation,First Health Network,127.07,97,,percent of total billed charges,,
Sup Thoracentesis Tray,,A4550,HCPCS,Facility,Both,,,,131,111.35,37.5446,131,"Health Partners, Inc.",Commercial,123.926,94.6,,percent of total billed charges,,
Sup Thoracentesis Tray,,A4550,HCPCS,Facility,Outpatient,,,,131,111.35,37.5446,131,"Health Partners, Inc.",Medicare Advantage,64.19,49,,percent of total billed charges,,
Sup Thoracentesis Tray,,A4550,HCPCS,Facility,Inpatient,,,,131,111.35,37.5446,131,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Thoracentesis Tray,,A4550,HCPCS,Facility,Both,,,,131,111.35,37.5446,131,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),78.6,60,,percent of total billed charges,,
Sup Thoracentesis Tray,,A4550,HCPCS,Facility,Both,,,,131,111.35,37.5446,131,"Health Partners, Inc.",State of Minnesota Advantage Program,106.765,81.5,,percent of total billed charges,,
Sup Thoracentesis Tray,,A4550,HCPCS,Facility,Both,,,,131,111.35,37.5446,131,"Health Partners, Inc.",State Public Programs,65.5,50,,percent of total billed charges,,
Sup Thoracentesis Tray,,A4550,HCPCS,Facility,Both,,,,131,111.35,37.5446,131,Humana Insurance Company,Commercial PPO,124.45,95,,percent of total billed charges,,
Sup Thoracentesis Tray,,A4550,HCPCS,Facility,Outpatient,,,,131,111.35,37.5446,131,Humana Insurance Company,Medicare PPO,64.19,49,,percent of total billed charges,,
Sup Thoracentesis Tray,,A4550,HCPCS,Facility,Inpatient,,,,131,111.35,37.5446,131,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Sup Thoracentesis Tray,,A4550,HCPCS,Facility,Both,,,,131,111.35,37.5446,131,Medica,Individual & Family,129.821,99.1,,percent of total billed charges,,
Sup Thoracentesis Tray,,A4550,HCPCS,Facility,Outpatient,,,,131,111.35,37.5446,131,Medica,Medica Advantage Solution,65.238,49.8,,percent of total billed charges,,
Sup Thoracentesis Tray,,A4550,HCPCS,Facility,Inpatient,,,,131,111.35,37.5446,131,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Sup Thoracentesis Tray,,A4550,HCPCS,Facility,Outpatient,,,,131,111.35,37.5446,131,Medica,Medical Assistance,58.426,44.6,,percent of total billed charges,,
Sup Thoracentesis Tray,,A4550,HCPCS,Facility,Inpatient,,,,131,111.35,37.5446,131,Medica,Medical Assistance,,,,,Included in per diem rate,
Sup Thoracentesis Tray,,A4550,HCPCS,Facility,Outpatient,,,,131,111.35,37.5446,131,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,65.238,49.8,,percent of total billed charges,,
Sup Thoracentesis Tray,,A4550,HCPCS,Facility,Inpatient,,,,131,111.35,37.5446,131,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Sup Thoracentesis Tray,,A4550,HCPCS,Facility,Both,,,,131,111.35,37.5446,131,"Multiplan, Inc.","Multiplan, Inc.",123.14,94,,percent of total billed charges,,
Sup Thoracentesis Tray,,A4550,HCPCS,Facility,Outpatient,,,,131,111.35,37.5446,131,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,118.031,90.1,,percent of total billed charges,,
Sup Thoracentesis Tray,,A4550,HCPCS,Facility,Inpatient,,,,131,111.35,37.5446,131,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Sup Thoracentesis Tray,,A4550,HCPCS,Facility,Both,,,,131,111.35,37.5446,131,"Preferred One Administrative Services, INC.",PPO,129.166,98.6,,percent of total billed charges,,
Sup Thoracentesis Tray,,A4550,HCPCS,Facility,Outpatient,,,,131,111.35,37.5446,131,PrimeWest Health,Minnesota Senior Health Options (MSHO),67.3995,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Sup Thoracentesis Tray,,A4550,HCPCS,Facility,Inpatient,,,,131,111.35,37.5446,131,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Thoracentesis Tray,,A4550,HCPCS,Facility,Outpatient,,,,131,111.35,37.5446,131,PrimeWest Health,MinnesotaCare,67.2816,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Sup Thoracentesis Tray,,A4550,HCPCS,Facility,Inpatient,,,,131,111.35,37.5446,131,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Sup Thoracentesis Tray,,A4550,HCPCS,Facility,Both,,,,131,111.35,37.5446,131,Sanford Health Plan,Sanford Health Plan,120.52,92,,percent of total billed charges,,
Sup Thoracentesis Tray,,A4550,HCPCS,Facility,Outpatient,,,,131,111.35,37.5446,131,"UCare Health, Inc.",Individual & Family Plan,73.8185,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Sup Thoracentesis Tray,,A4550,HCPCS,Facility,Inpatient,,,,131,111.35,37.5446,131,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Sup Thoracentesis Tray,,A4550,HCPCS,Facility,Outpatient,,,,131,111.35,37.5446,131,"UCare Health, Inc.",Medical Assistance,66.1157,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Thoracentesis Tray,,A4550,HCPCS,Facility,Inpatient,,,,131,111.35,37.5446,131,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Sup Thoracentesis Tray,,A4550,HCPCS,Facility,Outpatient,,,,131,111.35,37.5446,131,"UCare Health, Inc.",Medicare Advantage,66.1157,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Thoracentesis Tray,,A4550,HCPCS,Facility,Inpatient,,,,131,111.35,37.5446,131,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Thoracentesis Tray,,A4550,HCPCS,Facility,Outpatient,,,,131,111.35,37.5446,131,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),66.1157,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Thoracentesis Tray,,A4550,HCPCS,Facility,Inpatient,,,,131,111.35,37.5446,131,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Thoracentesis Tray,,A4550,HCPCS,Facility,Both,,,,131,111.35,37.5446,131,UnitedHealthcare,Individual & Family,123.14,94,,percent of total billed charges,,
Sup Thoracentesis Tray,,A4550,HCPCS,Facility,Outpatient,,,,131,111.35,37.5446,131,UnitedHealthcare,Medicare Advantage,64.19,49,,percent of total billed charges,,
Sup Thoracentesis Tray,,A4550,HCPCS,Facility,Inpatient,,,,131,111.35,37.5446,131,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Sup Thoracentesis Tray,,A4550,HCPCS,Facility,Outpatient,,,,131,111.35,37.5446,131,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,62.88,48,,percent of total billed charges,,100% of DHS outpatient percentage
Sup Thoracentesis Tray,,A4550,HCPCS,Facility,Inpatient,,,,131,111.35,37.5446,131,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
THORACENTESIS TRAY,,A4550,HCPCS,Facility,Both,,,,128.68,109.378,36.879688,128.68,Aetna,Commercial,118.3856,92,,percent of total billed charges,,
THORACENTESIS TRAY,,A4550,HCPCS,Facility,Outpatient,,,,128.68,109.378,36.879688,128.68,Aetna,Medicare Advantage,63.0532,49,,percent of total billed charges,,
THORACENTESIS TRAY,,A4550,HCPCS,Facility,Inpatient,,,,128.68,109.378,36.879688,128.68,Aetna,Medicare Advantage,,,,,Included in per diem rate,
THORACENTESIS TRAY,,A4550,HCPCS,Facility,Both,,,,128.68,109.378,36.879688,128.68,Aetna,PPO,119.6724,93,,percent of total billed charges,,
THORACENTESIS TRAY,,A4550,HCPCS,Facility,Both,,,,128.68,109.378,36.879688,128.68,America's PPO,America's PPO,123.571404,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
THORACENTESIS TRAY,,A4550,HCPCS,Facility,Both,,,,128.68,109.378,36.879688,128.68,BlueCross BlueShield Minnesota, Federal Employee Program,126.62112,98.4,,percent of total billed charges,,
THORACENTESIS TRAY,,A4550,HCPCS,Facility,Both,,,,128.68,109.378,36.879688,128.68,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,128.68,100,,percent of total billed charges,,
THORACENTESIS TRAY,,A4550,HCPCS,Facility,Both,,,,128.68,109.378,36.879688,128.68,BlueCross BlueShield Minnesota,High Value Network Plan,115.812,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
THORACENTESIS TRAY,,A4550,HCPCS,Facility,Outpatient,,,,128.68,109.378,36.879688,128.68,BlueCross BlueShield Minnesota,Medicare Advantage,63.0532,49,,percent of total billed charges,,
THORACENTESIS TRAY,,A4550,HCPCS,Facility,Inpatient,,,,128.68,109.378,36.879688,128.68,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
THORACENTESIS TRAY,,A4550,HCPCS,Facility,Both,,,,128.68,109.378,36.879688,128.68,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,113.971876,88.57,,percent of total billed charges,,
THORACENTESIS TRAY,,A4550,HCPCS,Facility,Both,,,,128.68,109.378,36.879688,128.68,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,36.879688,28.66,,percent of total billed charges,,
THORACENTESIS TRAY,,A4550,HCPCS,Facility,Outpatient,,,,128.68,109.378,36.879688,128.68,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),63.0532,49,,percent of total billed charges,,
THORACENTESIS TRAY,,A4550,HCPCS,Facility,Inpatient,,,,128.68,109.378,36.879688,128.68,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
THORACENTESIS TRAY,,A4550,HCPCS,Facility,Both,,,,128.68,109.378,36.879688,128.68,CorVel,Worker's Compensation,128.68,100,,percent of total billed charges,,
THORACENTESIS TRAY,,A4550,HCPCS,Facility,Both,,,,128.68,109.378,36.879688,128.68,First Health Group Corporation,First Health Network,124.8196,97,,percent of total billed charges,,
THORACENTESIS TRAY,,A4550,HCPCS,Facility,Both,,,,128.68,109.378,36.879688,128.68,"Health Partners, Inc.",Commercial,121.73128,94.6,,percent of total billed charges,,
THORACENTESIS TRAY,,A4550,HCPCS,Facility,Outpatient,,,,128.68,109.378,36.879688,128.68,"Health Partners, Inc.",Medicare Advantage,63.0532,49,,percent of total billed charges,,
THORACENTESIS TRAY,,A4550,HCPCS,Facility,Inpatient,,,,128.68,109.378,36.879688,128.68,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
THORACENTESIS TRAY,,A4550,HCPCS,Facility,Both,,,,128.68,109.378,36.879688,128.68,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),77.208,60,,percent of total billed charges,,
THORACENTESIS TRAY,,A4550,HCPCS,Facility,Both,,,,128.68,109.378,36.879688,128.68,"Health Partners, Inc.",State of Minnesota Advantage Program,104.8742,81.5,,percent of total billed charges,,
THORACENTESIS TRAY,,A4550,HCPCS,Facility,Both,,,,128.68,109.378,36.879688,128.68,"Health Partners, Inc.",State Public Programs,64.34,50,,percent of total billed charges,,
THORACENTESIS TRAY,,A4550,HCPCS,Facility,Both,,,,128.68,109.378,36.879688,128.68,Humana Insurance Company,Commercial PPO,122.246,95,,percent of total billed charges,,
THORACENTESIS TRAY,,A4550,HCPCS,Facility,Outpatient,,,,128.68,109.378,36.879688,128.68,Humana Insurance Company,Medicare PPO,63.0532,49,,percent of total billed charges,,
THORACENTESIS TRAY,,A4550,HCPCS,Facility,Inpatient,,,,128.68,109.378,36.879688,128.68,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
THORACENTESIS TRAY,,A4550,HCPCS,Facility,Both,,,,128.68,109.378,36.879688,128.68,Medica,Individual & Family,127.52188,99.1,,percent of total billed charges,,
THORACENTESIS TRAY,,A4550,HCPCS,Facility,Outpatient,,,,128.68,109.378,36.879688,128.68,Medica,Medica Advantage Solution,64.08264,49.8,,percent of total billed charges,,
THORACENTESIS TRAY,,A4550,HCPCS,Facility,Inpatient,,,,128.68,109.378,36.879688,128.68,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
THORACENTESIS TRAY,,A4550,HCPCS,Facility,Outpatient,,,,128.68,109.378,36.879688,128.68,Medica,Medical Assistance,57.39128,44.6,,percent of total billed charges,,
THORACENTESIS TRAY,,A4550,HCPCS,Facility,Inpatient,,,,128.68,109.378,36.879688,128.68,Medica,Medical Assistance,,,,,Included in per diem rate,
THORACENTESIS TRAY,,A4550,HCPCS,Facility,Outpatient,,,,128.68,109.378,36.879688,128.68,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,64.08264,49.8,,percent of total billed charges,,
THORACENTESIS TRAY,,A4550,HCPCS,Facility,Inpatient,,,,128.68,109.378,36.879688,128.68,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
THORACENTESIS TRAY,,A4550,HCPCS,Facility,Both,,,,128.68,109.378,36.879688,128.68,"Multiplan, Inc.","Multiplan, Inc.",120.9592,94,,percent of total billed charges,,
THORACENTESIS TRAY,,A4550,HCPCS,Facility,Outpatient,,,,128.68,109.378,36.879688,128.68,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,115.94068,90.1,,percent of total billed charges,,
THORACENTESIS TRAY,,A4550,HCPCS,Facility,Inpatient,,,,128.68,109.378,36.879688,128.68,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
THORACENTESIS TRAY,,A4550,HCPCS,Facility,Both,,,,128.68,109.378,36.879688,128.68,"Preferred One Administrative Services, INC.",PPO,126.87848,98.6,,percent of total billed charges,,
THORACENTESIS TRAY,,A4550,HCPCS,Facility,Outpatient,,,,128.68,109.378,36.879688,128.68,PrimeWest Health,Minnesota Senior Health Options (MSHO),66.20586,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
THORACENTESIS TRAY,,A4550,HCPCS,Facility,Inpatient,,,,128.68,109.378,36.879688,128.68,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
THORACENTESIS TRAY,,A4550,HCPCS,Facility,Outpatient,,,,128.68,109.378,36.879688,128.68,PrimeWest Health,MinnesotaCare,66.090048,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
THORACENTESIS TRAY,,A4550,HCPCS,Facility,Inpatient,,,,128.68,109.378,36.879688,128.68,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
THORACENTESIS TRAY,,A4550,HCPCS,Facility,Both,,,,128.68,109.378,36.879688,128.68,Sanford Health Plan,Sanford Health Plan,118.3856,92,,percent of total billed charges,,
THORACENTESIS TRAY,,A4550,HCPCS,Facility,Outpatient,,,,128.68,109.378,36.879688,128.68,"UCare Health, Inc.",Individual & Family Plan,72.51118,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
THORACENTESIS TRAY,,A4550,HCPCS,Facility,Inpatient,,,,128.68,109.378,36.879688,128.68,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
THORACENTESIS TRAY,,A4550,HCPCS,Facility,Outpatient,,,,128.68,109.378,36.879688,128.68,"UCare Health, Inc.",Medical Assistance,64.944796,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
THORACENTESIS TRAY,,A4550,HCPCS,Facility,Inpatient,,,,128.68,109.378,36.879688,128.68,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
THORACENTESIS TRAY,,A4550,HCPCS,Facility,Outpatient,,,,128.68,109.378,36.879688,128.68,"UCare Health, Inc.",Medicare Advantage,64.944796,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
THORACENTESIS TRAY,,A4550,HCPCS,Facility,Inpatient,,,,128.68,109.378,36.879688,128.68,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
THORACENTESIS TRAY,,A4550,HCPCS,Facility,Outpatient,,,,128.68,109.378,36.879688,128.68,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),64.944796,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
THORACENTESIS TRAY,,A4550,HCPCS,Facility,Inpatient,,,,128.68,109.378,36.879688,128.68,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
THORACENTESIS TRAY,,A4550,HCPCS,Facility,Both,,,,128.68,109.378,36.879688,128.68,UnitedHealthcare,Individual & Family,120.9592,94,,percent of total billed charges,,
THORACENTESIS TRAY,,A4550,HCPCS,Facility,Outpatient,,,,128.68,109.378,36.879688,128.68,UnitedHealthcare,Medicare Advantage,63.0532,49,,percent of total billed charges,,
THORACENTESIS TRAY,,A4550,HCPCS,Facility,Inpatient,,,,128.68,109.378,36.879688,128.68,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
THORACENTESIS TRAY,,A4550,HCPCS,Facility,Outpatient,,,,128.68,109.378,36.879688,128.68,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,61.7664,48,,percent of total billed charges,,100% of DHS outpatient percentage
THORACENTESIS TRAY,,A4550,HCPCS,Facility,Inpatient,,,,128.68,109.378,36.879688,128.68,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
ELECTRODE LOOPS YELLOW  24FR CIRCON-ACMI MLE-24-015,,A4556,HCPCS,Facility,Both,,,,350.01,297.5085,100.312866,350.01,Aetna,Commercial,322.0092,92,,percent of total billed charges,,
ELECTRODE LOOPS YELLOW  24FR CIRCON-ACMI MLE-24-015,,A4556,HCPCS,Facility,Outpatient,,,,350.01,297.5085,100.312866,350.01,Aetna,Medicare Advantage,171.5049,49,,percent of total billed charges,,
ELECTRODE LOOPS YELLOW  24FR CIRCON-ACMI MLE-24-015,,A4556,HCPCS,Facility,Inpatient,,,,350.01,297.5085,100.312866,350.01,Aetna,Medicare Advantage,,,,,Included in per diem rate,
ELECTRODE LOOPS YELLOW  24FR CIRCON-ACMI MLE-24-015,,A4556,HCPCS,Facility,Both,,,,350.01,297.5085,100.312866,350.01,Aetna,PPO,325.5093,93,,percent of total billed charges,,
ELECTRODE LOOPS YELLOW  24FR CIRCON-ACMI MLE-24-015,,A4556,HCPCS,Facility,Both,,,,350.01,297.5085,100.312866,350.01,America's PPO,America's PPO,336.114603,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
ELECTRODE LOOPS YELLOW  24FR CIRCON-ACMI MLE-24-015,,A4556,HCPCS,Facility,Both,,,,350.01,297.5085,100.312866,350.01,BlueCross BlueShield Minnesota, Federal Employee Program,344.40984,98.4,,percent of total billed charges,,
ELECTRODE LOOPS YELLOW  24FR CIRCON-ACMI MLE-24-015,,A4556,HCPCS,Facility,Both,,,,350.01,297.5085,100.312866,350.01,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,350.01,100,,percent of total billed charges,,
ELECTRODE LOOPS YELLOW  24FR CIRCON-ACMI MLE-24-015,,A4556,HCPCS,Facility,Both,,,,350.01,297.5085,100.312866,350.01,BlueCross BlueShield Minnesota,High Value Network Plan,315.009,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
ELECTRODE LOOPS YELLOW  24FR CIRCON-ACMI MLE-24-015,,A4556,HCPCS,Facility,Outpatient,,,,350.01,297.5085,100.312866,350.01,BlueCross BlueShield Minnesota,Medicare Advantage,171.5049,49,,percent of total billed charges,,
ELECTRODE LOOPS YELLOW  24FR CIRCON-ACMI MLE-24-015,,A4556,HCPCS,Facility,Inpatient,,,,350.01,297.5085,100.312866,350.01,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
ELECTRODE LOOPS YELLOW  24FR CIRCON-ACMI MLE-24-015,,A4556,HCPCS,Facility,Both,,,,350.01,297.5085,100.312866,350.01,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,310.003857,88.57,,percent of total billed charges,,
ELECTRODE LOOPS YELLOW  24FR CIRCON-ACMI MLE-24-015,,A4556,HCPCS,Facility,Both,,,,350.01,297.5085,100.312866,350.01,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,100.312866,28.66,,percent of total billed charges,,
ELECTRODE LOOPS YELLOW  24FR CIRCON-ACMI MLE-24-015,,A4556,HCPCS,Facility,Outpatient,,,,350.01,297.5085,100.312866,350.01,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),171.5049,49,,percent of total billed charges,,
ELECTRODE LOOPS YELLOW  24FR CIRCON-ACMI MLE-24-015,,A4556,HCPCS,Facility,Inpatient,,,,350.01,297.5085,100.312866,350.01,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
ELECTRODE LOOPS YELLOW  24FR CIRCON-ACMI MLE-24-015,,A4556,HCPCS,Facility,Both,,,,350.01,297.5085,100.312866,350.01,CorVel,Worker's Compensation,350.01,100,,percent of total billed charges,,
ELECTRODE LOOPS YELLOW  24FR CIRCON-ACMI MLE-24-015,,A4556,HCPCS,Facility,Both,,,,350.01,297.5085,100.312866,350.01,First Health Group Corporation,First Health Network,339.5097,97,,percent of total billed charges,,
ELECTRODE LOOPS YELLOW  24FR CIRCON-ACMI MLE-24-015,,A4556,HCPCS,Facility,Both,,,,350.01,297.5085,100.312866,350.01,"Health Partners, Inc.",Commercial,331.10946,94.6,,percent of total billed charges,,
ELECTRODE LOOPS YELLOW  24FR CIRCON-ACMI MLE-24-015,,A4556,HCPCS,Facility,Outpatient,,,,350.01,297.5085,100.312866,350.01,"Health Partners, Inc.",Medicare Advantage,171.5049,49,,percent of total billed charges,,
ELECTRODE LOOPS YELLOW  24FR CIRCON-ACMI MLE-24-015,,A4556,HCPCS,Facility,Inpatient,,,,350.01,297.5085,100.312866,350.01,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ELECTRODE LOOPS YELLOW  24FR CIRCON-ACMI MLE-24-015,,A4556,HCPCS,Facility,Both,,,,350.01,297.5085,100.312866,350.01,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),210.006,60,,percent of total billed charges,,
ELECTRODE LOOPS YELLOW  24FR CIRCON-ACMI MLE-24-015,,A4556,HCPCS,Facility,Both,,,,350.01,297.5085,100.312866,350.01,"Health Partners, Inc.",State of Minnesota Advantage Program,285.25815,81.5,,percent of total billed charges,,
ELECTRODE LOOPS YELLOW  24FR CIRCON-ACMI MLE-24-015,,A4556,HCPCS,Facility,Both,,,,350.01,297.5085,100.312866,350.01,"Health Partners, Inc.",State Public Programs,175.005,50,,percent of total billed charges,,
ELECTRODE LOOPS YELLOW  24FR CIRCON-ACMI MLE-24-015,,A4556,HCPCS,Facility,Both,,,,350.01,297.5085,100.312866,350.01,Humana Insurance Company,Commercial PPO,332.5095,95,,percent of total billed charges,,
ELECTRODE LOOPS YELLOW  24FR CIRCON-ACMI MLE-24-015,,A4556,HCPCS,Facility,Outpatient,,,,350.01,297.5085,100.312866,350.01,Humana Insurance Company,Medicare PPO,171.5049,49,,percent of total billed charges,,
ELECTRODE LOOPS YELLOW  24FR CIRCON-ACMI MLE-24-015,,A4556,HCPCS,Facility,Inpatient,,,,350.01,297.5085,100.312866,350.01,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
ELECTRODE LOOPS YELLOW  24FR CIRCON-ACMI MLE-24-015,,A4556,HCPCS,Facility,Both,,,,350.01,297.5085,100.312866,350.01,Medica,Individual & Family,346.85991,99.1,,percent of total billed charges,,
ELECTRODE LOOPS YELLOW  24FR CIRCON-ACMI MLE-24-015,,A4556,HCPCS,Facility,Outpatient,,,,350.01,297.5085,100.312866,350.01,Medica,Medica Advantage Solution,174.30498,49.8,,percent of total billed charges,,
ELECTRODE LOOPS YELLOW  24FR CIRCON-ACMI MLE-24-015,,A4556,HCPCS,Facility,Inpatient,,,,350.01,297.5085,100.312866,350.01,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
ELECTRODE LOOPS YELLOW  24FR CIRCON-ACMI MLE-24-015,,A4556,HCPCS,Facility,Outpatient,,,,350.01,297.5085,100.312866,350.01,Medica,Medical Assistance,156.10446,44.6,,percent of total billed charges,,
ELECTRODE LOOPS YELLOW  24FR CIRCON-ACMI MLE-24-015,,A4556,HCPCS,Facility,Inpatient,,,,350.01,297.5085,100.312866,350.01,Medica,Medical Assistance,,,,,Included in per diem rate,
ELECTRODE LOOPS YELLOW  24FR CIRCON-ACMI MLE-24-015,,A4556,HCPCS,Facility,Outpatient,,,,350.01,297.5085,100.312866,350.01,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,174.30498,49.8,,percent of total billed charges,,
ELECTRODE LOOPS YELLOW  24FR CIRCON-ACMI MLE-24-015,,A4556,HCPCS,Facility,Inpatient,,,,350.01,297.5085,100.312866,350.01,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
ELECTRODE LOOPS YELLOW  24FR CIRCON-ACMI MLE-24-015,,A4556,HCPCS,Facility,Both,,,,350.01,297.5085,100.312866,350.01,"Multiplan, Inc.","Multiplan, Inc.",329.0094,94,,percent of total billed charges,,
ELECTRODE LOOPS YELLOW  24FR CIRCON-ACMI MLE-24-015,,A4556,HCPCS,Facility,Outpatient,,,,350.01,297.5085,100.312866,350.01,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,315.35901,90.1,,percent of total billed charges,,
ELECTRODE LOOPS YELLOW  24FR CIRCON-ACMI MLE-24-015,,A4556,HCPCS,Facility,Inpatient,,,,350.01,297.5085,100.312866,350.01,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
ELECTRODE LOOPS YELLOW  24FR CIRCON-ACMI MLE-24-015,,A4556,HCPCS,Facility,Both,,,,350.01,297.5085,100.312866,350.01,"Preferred One Administrative Services, INC.",PPO,345.10986,98.6,,percent of total billed charges,,
ELECTRODE LOOPS YELLOW  24FR CIRCON-ACMI MLE-24-015,,A4556,HCPCS,Facility,Outpatient,,,,350.01,297.5085,100.312866,350.01,PrimeWest Health,Minnesota Senior Health Options (MSHO),180.080145,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
ELECTRODE LOOPS YELLOW  24FR CIRCON-ACMI MLE-24-015,,A4556,HCPCS,Facility,Inpatient,,,,350.01,297.5085,100.312866,350.01,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ELECTRODE LOOPS YELLOW  24FR CIRCON-ACMI MLE-24-015,,A4556,HCPCS,Facility,Outpatient,,,,350.01,297.5085,100.312866,350.01,PrimeWest Health,MinnesotaCare,179.765136,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
ELECTRODE LOOPS YELLOW  24FR CIRCON-ACMI MLE-24-015,,A4556,HCPCS,Facility,Inpatient,,,,350.01,297.5085,100.312866,350.01,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
ELECTRODE LOOPS YELLOW  24FR CIRCON-ACMI MLE-24-015,,A4556,HCPCS,Facility,Both,,,,350.01,297.5085,100.312866,350.01,Sanford Health Plan,Sanford Health Plan,322.0092,92,,percent of total billed charges,,
ELECTRODE LOOPS YELLOW  24FR CIRCON-ACMI MLE-24-015,,A4556,HCPCS,Facility,Outpatient,,,,350.01,297.5085,100.312866,350.01,"UCare Health, Inc.",Individual & Family Plan,197.230635,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
ELECTRODE LOOPS YELLOW  24FR CIRCON-ACMI MLE-24-015,,A4556,HCPCS,Facility,Inpatient,,,,350.01,297.5085,100.312866,350.01,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
ELECTRODE LOOPS YELLOW  24FR CIRCON-ACMI MLE-24-015,,A4556,HCPCS,Facility,Outpatient,,,,350.01,297.5085,100.312866,350.01,"UCare Health, Inc.",Medical Assistance,176.650047,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ELECTRODE LOOPS YELLOW  24FR CIRCON-ACMI MLE-24-015,,A4556,HCPCS,Facility,Inpatient,,,,350.01,297.5085,100.312866,350.01,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
ELECTRODE LOOPS YELLOW  24FR CIRCON-ACMI MLE-24-015,,A4556,HCPCS,Facility,Outpatient,,,,350.01,297.5085,100.312866,350.01,"UCare Health, Inc.",Medicare Advantage,176.650047,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ELECTRODE LOOPS YELLOW  24FR CIRCON-ACMI MLE-24-015,,A4556,HCPCS,Facility,Inpatient,,,,350.01,297.5085,100.312866,350.01,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ELECTRODE LOOPS YELLOW  24FR CIRCON-ACMI MLE-24-015,,A4556,HCPCS,Facility,Outpatient,,,,350.01,297.5085,100.312866,350.01,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),176.650047,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ELECTRODE LOOPS YELLOW  24FR CIRCON-ACMI MLE-24-015,,A4556,HCPCS,Facility,Inpatient,,,,350.01,297.5085,100.312866,350.01,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ELECTRODE LOOPS YELLOW  24FR CIRCON-ACMI MLE-24-015,,A4556,HCPCS,Facility,Both,,,,350.01,297.5085,100.312866,350.01,UnitedHealthcare,Individual & Family,329.0094,94,,percent of total billed charges,,
ELECTRODE LOOPS YELLOW  24FR CIRCON-ACMI MLE-24-015,,A4556,HCPCS,Facility,Outpatient,,,,350.01,297.5085,100.312866,350.01,UnitedHealthcare,Medicare Advantage,171.5049,49,,percent of total billed charges,,
ELECTRODE LOOPS YELLOW  24FR CIRCON-ACMI MLE-24-015,,A4556,HCPCS,Facility,Inpatient,,,,350.01,297.5085,100.312866,350.01,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
ELECTRODE LOOPS YELLOW  24FR CIRCON-ACMI MLE-24-015,,A4556,HCPCS,Facility,Outpatient,,,,350.01,297.5085,100.312866,350.01,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,168.0048,48,,percent of total billed charges,,100% of DHS outpatient percentage
ELECTRODE LOOPS YELLOW  24FR CIRCON-ACMI MLE-24-015,,A4556,HCPCS,Facility,Inpatient,,,,350.01,297.5085,100.312866,350.01,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
ELECTRODE SERFAS CRUISE 90S,,A4556,HCPCS,Facility,Both,,,,494.43,420.2655,141.703638,494.43,Aetna,Commercial,454.8756,92,,percent of total billed charges,,
ELECTRODE SERFAS CRUISE 90S,,A4556,HCPCS,Facility,Outpatient,,,,494.43,420.2655,141.703638,494.43,Aetna,Medicare Advantage,242.2707,49,,percent of total billed charges,,
ELECTRODE SERFAS CRUISE 90S,,A4556,HCPCS,Facility,Inpatient,,,,494.43,420.2655,141.703638,494.43,Aetna,Medicare Advantage,,,,,Included in per diem rate,
ELECTRODE SERFAS CRUISE 90S,,A4556,HCPCS,Facility,Both,,,,494.43,420.2655,141.703638,494.43,Aetna,PPO,459.8199,93,,percent of total billed charges,,
ELECTRODE SERFAS CRUISE 90S,,A4556,HCPCS,Facility,Both,,,,494.43,420.2655,141.703638,494.43,America's PPO,America's PPO,474.801129,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
ELECTRODE SERFAS CRUISE 90S,,A4556,HCPCS,Facility,Both,,,,494.43,420.2655,141.703638,494.43,BlueCross BlueShield Minnesota, Federal Employee Program,486.51912,98.4,,percent of total billed charges,,
ELECTRODE SERFAS CRUISE 90S,,A4556,HCPCS,Facility,Both,,,,494.43,420.2655,141.703638,494.43,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,494.43,100,,percent of total billed charges,,
ELECTRODE SERFAS CRUISE 90S,,A4556,HCPCS,Facility,Both,,,,494.43,420.2655,141.703638,494.43,BlueCross BlueShield Minnesota,High Value Network Plan,444.987,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
ELECTRODE SERFAS CRUISE 90S,,A4556,HCPCS,Facility,Outpatient,,,,494.43,420.2655,141.703638,494.43,BlueCross BlueShield Minnesota,Medicare Advantage,242.2707,49,,percent of total billed charges,,
ELECTRODE SERFAS CRUISE 90S,,A4556,HCPCS,Facility,Inpatient,,,,494.43,420.2655,141.703638,494.43,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
ELECTRODE SERFAS CRUISE 90S,,A4556,HCPCS,Facility,Both,,,,494.43,420.2655,141.703638,494.43,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,437.916651,88.57,,percent of total billed charges,,
ELECTRODE SERFAS CRUISE 90S,,A4556,HCPCS,Facility,Both,,,,494.43,420.2655,141.703638,494.43,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,141.703638,28.66,,percent of total billed charges,,
ELECTRODE SERFAS CRUISE 90S,,A4556,HCPCS,Facility,Outpatient,,,,494.43,420.2655,141.703638,494.43,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),242.2707,49,,percent of total billed charges,,
ELECTRODE SERFAS CRUISE 90S,,A4556,HCPCS,Facility,Inpatient,,,,494.43,420.2655,141.703638,494.43,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
ELECTRODE SERFAS CRUISE 90S,,A4556,HCPCS,Facility,Both,,,,494.43,420.2655,141.703638,494.43,CorVel,Worker's Compensation,494.43,100,,percent of total billed charges,,
ELECTRODE SERFAS CRUISE 90S,,A4556,HCPCS,Facility,Both,,,,494.43,420.2655,141.703638,494.43,First Health Group Corporation,First Health Network,479.5971,97,,percent of total billed charges,,
ELECTRODE SERFAS CRUISE 90S,,A4556,HCPCS,Facility,Both,,,,494.43,420.2655,141.703638,494.43,"Health Partners, Inc.",Commercial,467.73078,94.6,,percent of total billed charges,,
ELECTRODE SERFAS CRUISE 90S,,A4556,HCPCS,Facility,Outpatient,,,,494.43,420.2655,141.703638,494.43,"Health Partners, Inc.",Medicare Advantage,242.2707,49,,percent of total billed charges,,
ELECTRODE SERFAS CRUISE 90S,,A4556,HCPCS,Facility,Inpatient,,,,494.43,420.2655,141.703638,494.43,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ELECTRODE SERFAS CRUISE 90S,,A4556,HCPCS,Facility,Both,,,,494.43,420.2655,141.703638,494.43,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),296.658,60,,percent of total billed charges,,
ELECTRODE SERFAS CRUISE 90S,,A4556,HCPCS,Facility,Both,,,,494.43,420.2655,141.703638,494.43,"Health Partners, Inc.",State of Minnesota Advantage Program,402.96045,81.5,,percent of total billed charges,,
ELECTRODE SERFAS CRUISE 90S,,A4556,HCPCS,Facility,Both,,,,494.43,420.2655,141.703638,494.43,"Health Partners, Inc.",State Public Programs,247.215,50,,percent of total billed charges,,
ELECTRODE SERFAS CRUISE 90S,,A4556,HCPCS,Facility,Both,,,,494.43,420.2655,141.703638,494.43,Humana Insurance Company,Commercial PPO,469.7085,95,,percent of total billed charges,,
ELECTRODE SERFAS CRUISE 90S,,A4556,HCPCS,Facility,Outpatient,,,,494.43,420.2655,141.703638,494.43,Humana Insurance Company,Medicare PPO,242.2707,49,,percent of total billed charges,,
ELECTRODE SERFAS CRUISE 90S,,A4556,HCPCS,Facility,Inpatient,,,,494.43,420.2655,141.703638,494.43,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
ELECTRODE SERFAS CRUISE 90S,,A4556,HCPCS,Facility,Both,,,,494.43,420.2655,141.703638,494.43,Medica,Individual & Family,489.98013,99.1,,percent of total billed charges,,
ELECTRODE SERFAS CRUISE 90S,,A4556,HCPCS,Facility,Outpatient,,,,494.43,420.2655,141.703638,494.43,Medica,Medica Advantage Solution,246.22614,49.8,,percent of total billed charges,,
ELECTRODE SERFAS CRUISE 90S,,A4556,HCPCS,Facility,Inpatient,,,,494.43,420.2655,141.703638,494.43,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
ELECTRODE SERFAS CRUISE 90S,,A4556,HCPCS,Facility,Outpatient,,,,494.43,420.2655,141.703638,494.43,Medica,Medical Assistance,220.51578,44.6,,percent of total billed charges,,
ELECTRODE SERFAS CRUISE 90S,,A4556,HCPCS,Facility,Inpatient,,,,494.43,420.2655,141.703638,494.43,Medica,Medical Assistance,,,,,Included in per diem rate,
ELECTRODE SERFAS CRUISE 90S,,A4556,HCPCS,Facility,Outpatient,,,,494.43,420.2655,141.703638,494.43,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,246.22614,49.8,,percent of total billed charges,,
ELECTRODE SERFAS CRUISE 90S,,A4556,HCPCS,Facility,Inpatient,,,,494.43,420.2655,141.703638,494.43,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
ELECTRODE SERFAS CRUISE 90S,,A4556,HCPCS,Facility,Both,,,,494.43,420.2655,141.703638,494.43,"Multiplan, Inc.","Multiplan, Inc.",464.7642,94,,percent of total billed charges,,
ELECTRODE SERFAS CRUISE 90S,,A4556,HCPCS,Facility,Outpatient,,,,494.43,420.2655,141.703638,494.43,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,445.48143,90.1,,percent of total billed charges,,
ELECTRODE SERFAS CRUISE 90S,,A4556,HCPCS,Facility,Inpatient,,,,494.43,420.2655,141.703638,494.43,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
ELECTRODE SERFAS CRUISE 90S,,A4556,HCPCS,Facility,Both,,,,494.43,420.2655,141.703638,494.43,"Preferred One Administrative Services, INC.",PPO,487.50798,98.6,,percent of total billed charges,,
ELECTRODE SERFAS CRUISE 90S,,A4556,HCPCS,Facility,Outpatient,,,,494.43,420.2655,141.703638,494.43,PrimeWest Health,Minnesota Senior Health Options (MSHO),254.384235,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
ELECTRODE SERFAS CRUISE 90S,,A4556,HCPCS,Facility,Inpatient,,,,494.43,420.2655,141.703638,494.43,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ELECTRODE SERFAS CRUISE 90S,,A4556,HCPCS,Facility,Outpatient,,,,494.43,420.2655,141.703638,494.43,PrimeWest Health,MinnesotaCare,253.939248,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
ELECTRODE SERFAS CRUISE 90S,,A4556,HCPCS,Facility,Inpatient,,,,494.43,420.2655,141.703638,494.43,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
ELECTRODE SERFAS CRUISE 90S,,A4556,HCPCS,Facility,Both,,,,494.43,420.2655,141.703638,494.43,Sanford Health Plan,Sanford Health Plan,454.8756,92,,percent of total billed charges,,
ELECTRODE SERFAS CRUISE 90S,,A4556,HCPCS,Facility,Outpatient,,,,494.43,420.2655,141.703638,494.43,"UCare Health, Inc.",Individual & Family Plan,278.611305,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
ELECTRODE SERFAS CRUISE 90S,,A4556,HCPCS,Facility,Inpatient,,,,494.43,420.2655,141.703638,494.43,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
ELECTRODE SERFAS CRUISE 90S,,A4556,HCPCS,Facility,Outpatient,,,,494.43,420.2655,141.703638,494.43,"UCare Health, Inc.",Medical Assistance,249.538821,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ELECTRODE SERFAS CRUISE 90S,,A4556,HCPCS,Facility,Inpatient,,,,494.43,420.2655,141.703638,494.43,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
ELECTRODE SERFAS CRUISE 90S,,A4556,HCPCS,Facility,Outpatient,,,,494.43,420.2655,141.703638,494.43,"UCare Health, Inc.",Medicare Advantage,249.538821,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ELECTRODE SERFAS CRUISE 90S,,A4556,HCPCS,Facility,Inpatient,,,,494.43,420.2655,141.703638,494.43,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ELECTRODE SERFAS CRUISE 90S,,A4556,HCPCS,Facility,Outpatient,,,,494.43,420.2655,141.703638,494.43,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),249.538821,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ELECTRODE SERFAS CRUISE 90S,,A4556,HCPCS,Facility,Inpatient,,,,494.43,420.2655,141.703638,494.43,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ELECTRODE SERFAS CRUISE 90S,,A4556,HCPCS,Facility,Both,,,,494.43,420.2655,141.703638,494.43,UnitedHealthcare,Individual & Family,464.7642,94,,percent of total billed charges,,
ELECTRODE SERFAS CRUISE 90S,,A4556,HCPCS,Facility,Outpatient,,,,494.43,420.2655,141.703638,494.43,UnitedHealthcare,Medicare Advantage,242.2707,49,,percent of total billed charges,,
ELECTRODE SERFAS CRUISE 90S,,A4556,HCPCS,Facility,Inpatient,,,,494.43,420.2655,141.703638,494.43,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
ELECTRODE SERFAS CRUISE 90S,,A4556,HCPCS,Facility,Outpatient,,,,494.43,420.2655,141.703638,494.43,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,237.3264,48,,percent of total billed charges,,100% of DHS outpatient percentage
ELECTRODE SERFAS CRUISE 90S,,A4556,HCPCS,Facility,Inpatient,,,,494.43,420.2655,141.703638,494.43,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Sup Pessary, Rubber, Any Type",,A4561,HCPCS,Facility,Both,,,,144,122.4,41.2704,144,Aetna,Commercial,132.48,92,,percent of total billed charges,,
"Sup Pessary, Rubber, Any Type",,A4561,HCPCS,Facility,Outpatient,,,,144,122.4,41.2704,144,Aetna,Medicare Advantage,70.56,49,,percent of total billed charges,,
"Sup Pessary, Rubber, Any Type",,A4561,HCPCS,Facility,Inpatient,,,,144,122.4,41.2704,144,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Sup Pessary, Rubber, Any Type",,A4561,HCPCS,Facility,Both,,,,144,122.4,41.2704,144,Aetna,PPO,133.92,93,,percent of total billed charges,,
"Sup Pessary, Rubber, Any Type",,A4561,HCPCS,Facility,Both,,,,144,122.4,41.2704,144,America's PPO,America's PPO,138.2832,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Sup Pessary, Rubber, Any Type",,A4561,HCPCS,Facility,Both,,,,144,122.4,41.2704,144,BlueCross BlueShield Minnesota, Federal Employee Program,141.696,98.4,,percent of total billed charges,,
"Sup Pessary, Rubber, Any Type",,A4561,HCPCS,Facility,Both,,,,144,122.4,41.2704,144,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,144,100,,percent of total billed charges,,
"Sup Pessary, Rubber, Any Type",,A4561,HCPCS,Facility,Both,,,,144,122.4,41.2704,144,BlueCross BlueShield Minnesota,High Value Network Plan,129.6,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
"Sup Pessary, Rubber, Any Type",,A4561,HCPCS,Facility,Outpatient,,,,144,122.4,41.2704,144,BlueCross BlueShield Minnesota,Medicare Advantage,70.56,49,,percent of total billed charges,,
"Sup Pessary, Rubber, Any Type",,A4561,HCPCS,Facility,Inpatient,,,,144,122.4,41.2704,144,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Sup Pessary, Rubber, Any Type",,A4561,HCPCS,Facility,Both,,,,144,122.4,41.2704,144,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,127.5408,88.57,,percent of total billed charges,,
"Sup Pessary, Rubber, Any Type",,A4561,HCPCS,Facility,Both,,,,144,122.4,41.2704,144,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,41.2704,28.66,,percent of total billed charges,,
"Sup Pessary, Rubber, Any Type",,A4561,HCPCS,Facility,Outpatient,,,,144,122.4,41.2704,144,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),70.56,49,,percent of total billed charges,,
"Sup Pessary, Rubber, Any Type",,A4561,HCPCS,Facility,Inpatient,,,,144,122.4,41.2704,144,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Sup Pessary, Rubber, Any Type",,A4561,HCPCS,Facility,Both,,,,144,122.4,41.2704,144,CorVel,Worker's Compensation,144,100,,percent of total billed charges,,
"Sup Pessary, Rubber, Any Type",,A4561,HCPCS,Facility,Both,,,,144,122.4,41.2704,144,First Health Group Corporation,First Health Network,139.68,97,,percent of total billed charges,,
"Sup Pessary, Rubber, Any Type",,A4561,HCPCS,Facility,Both,,,,144,122.4,41.2704,144,"Health Partners, Inc.",Commercial,136.224,94.6,,percent of total billed charges,,
"Sup Pessary, Rubber, Any Type",,A4561,HCPCS,Facility,Outpatient,,,,144,122.4,41.2704,144,"Health Partners, Inc.",Medicare Advantage,70.56,49,,percent of total billed charges,,
"Sup Pessary, Rubber, Any Type",,A4561,HCPCS,Facility,Inpatient,,,,144,122.4,41.2704,144,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Sup Pessary, Rubber, Any Type",,A4561,HCPCS,Facility,Both,,,,144,122.4,41.2704,144,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),86.4,60,,percent of total billed charges,,
"Sup Pessary, Rubber, Any Type",,A4561,HCPCS,Facility,Both,,,,144,122.4,41.2704,144,"Health Partners, Inc.",State of Minnesota Advantage Program,117.36,81.5,,percent of total billed charges,,
"Sup Pessary, Rubber, Any Type",,A4561,HCPCS,Facility,Both,,,,144,122.4,41.2704,144,"Health Partners, Inc.",State Public Programs,72,50,,percent of total billed charges,,
"Sup Pessary, Rubber, Any Type",,A4561,HCPCS,Facility,Both,,,,144,122.4,41.2704,144,Humana Insurance Company,Commercial PPO,136.8,95,,percent of total billed charges,,
"Sup Pessary, Rubber, Any Type",,A4561,HCPCS,Facility,Outpatient,,,,144,122.4,41.2704,144,Humana Insurance Company,Medicare PPO,70.56,49,,percent of total billed charges,,
"Sup Pessary, Rubber, Any Type",,A4561,HCPCS,Facility,Inpatient,,,,144,122.4,41.2704,144,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Sup Pessary, Rubber, Any Type",,A4561,HCPCS,Facility,Both,,,,144,122.4,41.2704,144,Medica,Individual & Family,142.704,99.1,,percent of total billed charges,,
"Sup Pessary, Rubber, Any Type",,A4561,HCPCS,Facility,Outpatient,,,,144,122.4,41.2704,144,Medica,Medica Advantage Solution,71.712,49.8,,percent of total billed charges,,
"Sup Pessary, Rubber, Any Type",,A4561,HCPCS,Facility,Inpatient,,,,144,122.4,41.2704,144,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Sup Pessary, Rubber, Any Type",,A4561,HCPCS,Facility,Outpatient,,,,144,122.4,41.2704,144,Medica,Medical Assistance,64.224,44.6,,percent of total billed charges,,
"Sup Pessary, Rubber, Any Type",,A4561,HCPCS,Facility,Inpatient,,,,144,122.4,41.2704,144,Medica,Medical Assistance,,,,,Included in per diem rate,
"Sup Pessary, Rubber, Any Type",,A4561,HCPCS,Facility,Outpatient,,,,144,122.4,41.2704,144,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,71.712,49.8,,percent of total billed charges,,
"Sup Pessary, Rubber, Any Type",,A4561,HCPCS,Facility,Inpatient,,,,144,122.4,41.2704,144,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Sup Pessary, Rubber, Any Type",,A4561,HCPCS,Facility,Both,,,,144,122.4,41.2704,144,"Multiplan, Inc.","Multiplan, Inc.",135.36,94,,percent of total billed charges,,
"Sup Pessary, Rubber, Any Type",,A4561,HCPCS,Facility,Outpatient,,,,144,122.4,41.2704,144,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,129.744,90.1,,percent of total billed charges,,
"Sup Pessary, Rubber, Any Type",,A4561,HCPCS,Facility,Inpatient,,,,144,122.4,41.2704,144,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Sup Pessary, Rubber, Any Type",,A4561,HCPCS,Facility,Both,,,,144,122.4,41.2704,144,"Preferred One Administrative Services, INC.",PPO,141.984,98.6,,percent of total billed charges,,
"Sup Pessary, Rubber, Any Type",,A4561,HCPCS,Facility,Outpatient,,,,144,122.4,41.2704,144,PrimeWest Health,Minnesota Senior Health Options (MSHO),74.088,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Sup Pessary, Rubber, Any Type",,A4561,HCPCS,Facility,Inpatient,,,,144,122.4,41.2704,144,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Sup Pessary, Rubber, Any Type",,A4561,HCPCS,Facility,Outpatient,,,,144,122.4,41.2704,144,PrimeWest Health,MinnesotaCare,73.9584,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Sup Pessary, Rubber, Any Type",,A4561,HCPCS,Facility,Inpatient,,,,144,122.4,41.2704,144,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Sup Pessary, Rubber, Any Type",,A4561,HCPCS,Facility,Both,,,,144,122.4,41.2704,144,Sanford Health Plan,Sanford Health Plan,132.48,92,,percent of total billed charges,,
"Sup Pessary, Rubber, Any Type",,A4561,HCPCS,Facility,Outpatient,,,,144,122.4,41.2704,144,"UCare Health, Inc.",Individual & Family Plan,81.144,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Sup Pessary, Rubber, Any Type",,A4561,HCPCS,Facility,Inpatient,,,,144,122.4,41.2704,144,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Sup Pessary, Rubber, Any Type",,A4561,HCPCS,Facility,Outpatient,,,,144,122.4,41.2704,144,"UCare Health, Inc.",Medical Assistance,72.6768,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Sup Pessary, Rubber, Any Type",,A4561,HCPCS,Facility,Inpatient,,,,144,122.4,41.2704,144,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Sup Pessary, Rubber, Any Type",,A4561,HCPCS,Facility,Outpatient,,,,144,122.4,41.2704,144,"UCare Health, Inc.",Medicare Advantage,72.6768,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Sup Pessary, Rubber, Any Type",,A4561,HCPCS,Facility,Inpatient,,,,144,122.4,41.2704,144,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Sup Pessary, Rubber, Any Type",,A4561,HCPCS,Facility,Outpatient,,,,144,122.4,41.2704,144,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),72.6768,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Sup Pessary, Rubber, Any Type",,A4561,HCPCS,Facility,Inpatient,,,,144,122.4,41.2704,144,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Sup Pessary, Rubber, Any Type",,A4561,HCPCS,Facility,Both,,,,144,122.4,41.2704,144,UnitedHealthcare,Individual & Family,135.36,94,,percent of total billed charges,,
"Sup Pessary, Rubber, Any Type",,A4561,HCPCS,Facility,Outpatient,,,,144,122.4,41.2704,144,UnitedHealthcare,Medicare Advantage,70.56,49,,percent of total billed charges,,
"Sup Pessary, Rubber, Any Type",,A4561,HCPCS,Facility,Inpatient,,,,144,122.4,41.2704,144,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Sup Pessary, Rubber, Any Type",,A4561,HCPCS,Facility,Outpatient,,,,144,122.4,41.2704,144,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,69.12,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Sup Pessary, Rubber, Any Type",,A4561,HCPCS,Facility,Inpatient,,,,144,122.4,41.2704,144,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Sup Arm Sling,,A4565,HCPCS,Facility,Both,,,,18,15.3,5.1588,18,Aetna,Commercial,16.56,92,,percent of total billed charges,,
Sup Arm Sling,,A4565,HCPCS,Facility,Outpatient,,,,18,15.3,5.1588,18,Aetna,Medicare Advantage,8.82,49,,percent of total billed charges,,
Sup Arm Sling,,A4565,HCPCS,Facility,Inpatient,,,,18,15.3,5.1588,18,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Sup Arm Sling,,A4565,HCPCS,Facility,Both,,,,18,15.3,5.1588,18,Aetna,PPO,16.74,93,,percent of total billed charges,,
Sup Arm Sling,,A4565,HCPCS,Facility,Both,,,,18,15.3,5.1588,18,America's PPO,America's PPO,17.2854,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Sup Arm Sling,,A4565,HCPCS,Facility,Both,,,,18,15.3,5.1588,18,BlueCross BlueShield Minnesota, Federal Employee Program,17.712,98.4,,percent of total billed charges,,
Sup Arm Sling,,A4565,HCPCS,Facility,Both,,,,18,15.3,5.1588,18,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,18,100,,percent of total billed charges,,
Sup Arm Sling,,A4565,HCPCS,Facility,Both,,,,18,15.3,5.1588,18,BlueCross BlueShield Minnesota,High Value Network Plan,16.2,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
Sup Arm Sling,,A4565,HCPCS,Facility,Outpatient,,,,18,15.3,5.1588,18,BlueCross BlueShield Minnesota,Medicare Advantage,8.82,49,,percent of total billed charges,,
Sup Arm Sling,,A4565,HCPCS,Facility,Inpatient,,,,18,15.3,5.1588,18,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Sup Arm Sling,,A4565,HCPCS,Facility,Both,,,,18,15.3,5.1588,18,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,15.9426,88.57,,percent of total billed charges,,
Sup Arm Sling,,A4565,HCPCS,Facility,Both,,,,18,15.3,5.1588,18,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,5.1588,28.66,,percent of total billed charges,,
Sup Arm Sling,,A4565,HCPCS,Facility,Outpatient,,,,18,15.3,5.1588,18,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),8.82,49,,percent of total billed charges,,
Sup Arm Sling,,A4565,HCPCS,Facility,Inpatient,,,,18,15.3,5.1588,18,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Sup Arm Sling,,A4565,HCPCS,Facility,Both,,,,18,15.3,5.1588,18,CorVel,Worker's Compensation,18,100,,percent of total billed charges,,
Sup Arm Sling,,A4565,HCPCS,Facility,Both,,,,18,15.3,5.1588,18,First Health Group Corporation,First Health Network,17.46,97,,percent of total billed charges,,
Sup Arm Sling,,A4565,HCPCS,Facility,Both,,,,18,15.3,5.1588,18,"Health Partners, Inc.",Commercial,17.028,94.6,,percent of total billed charges,,
Sup Arm Sling,,A4565,HCPCS,Facility,Outpatient,,,,18,15.3,5.1588,18,"Health Partners, Inc.",Medicare Advantage,8.82,49,,percent of total billed charges,,
Sup Arm Sling,,A4565,HCPCS,Facility,Inpatient,,,,18,15.3,5.1588,18,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Arm Sling,,A4565,HCPCS,Facility,Both,,,,18,15.3,5.1588,18,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),10.8,60,,percent of total billed charges,,
Sup Arm Sling,,A4565,HCPCS,Facility,Both,,,,18,15.3,5.1588,18,"Health Partners, Inc.",State of Minnesota Advantage Program,14.67,81.5,,percent of total billed charges,,
Sup Arm Sling,,A4565,HCPCS,Facility,Both,,,,18,15.3,5.1588,18,"Health Partners, Inc.",State Public Programs,9,50,,percent of total billed charges,,
Sup Arm Sling,,A4565,HCPCS,Facility,Both,,,,18,15.3,5.1588,18,Humana Insurance Company,Commercial PPO,17.1,95,,percent of total billed charges,,
Sup Arm Sling,,A4565,HCPCS,Facility,Outpatient,,,,18,15.3,5.1588,18,Humana Insurance Company,Medicare PPO,8.82,49,,percent of total billed charges,,
Sup Arm Sling,,A4565,HCPCS,Facility,Inpatient,,,,18,15.3,5.1588,18,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Sup Arm Sling,,A4565,HCPCS,Facility,Both,,,,18,15.3,5.1588,18,Medica,Individual & Family,17.838,99.1,,percent of total billed charges,,
Sup Arm Sling,,A4565,HCPCS,Facility,Outpatient,,,,18,15.3,5.1588,18,Medica,Medica Advantage Solution,8.964,49.8,,percent of total billed charges,,
Sup Arm Sling,,A4565,HCPCS,Facility,Inpatient,,,,18,15.3,5.1588,18,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Sup Arm Sling,,A4565,HCPCS,Facility,Outpatient,,,,18,15.3,5.1588,18,Medica,Medical Assistance,8.028,44.6,,percent of total billed charges,,
Sup Arm Sling,,A4565,HCPCS,Facility,Inpatient,,,,18,15.3,5.1588,18,Medica,Medical Assistance,,,,,Included in per diem rate,
Sup Arm Sling,,A4565,HCPCS,Facility,Outpatient,,,,18,15.3,5.1588,18,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,8.964,49.8,,percent of total billed charges,,
Sup Arm Sling,,A4565,HCPCS,Facility,Inpatient,,,,18,15.3,5.1588,18,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Sup Arm Sling,,A4565,HCPCS,Facility,Both,,,,18,15.3,5.1588,18,"Multiplan, Inc.","Multiplan, Inc.",16.92,94,,percent of total billed charges,,
Sup Arm Sling,,A4565,HCPCS,Facility,Outpatient,,,,18,15.3,5.1588,18,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,16.218,90.1,,percent of total billed charges,,
Sup Arm Sling,,A4565,HCPCS,Facility,Inpatient,,,,18,15.3,5.1588,18,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Sup Arm Sling,,A4565,HCPCS,Facility,Both,,,,18,15.3,5.1588,18,"Preferred One Administrative Services, INC.",PPO,17.748,98.6,,percent of total billed charges,,
Sup Arm Sling,,A4565,HCPCS,Facility,Outpatient,,,,18,15.3,5.1588,18,PrimeWest Health,Minnesota Senior Health Options (MSHO),9.261,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Sup Arm Sling,,A4565,HCPCS,Facility,Inpatient,,,,18,15.3,5.1588,18,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Arm Sling,,A4565,HCPCS,Facility,Outpatient,,,,18,15.3,5.1588,18,PrimeWest Health,MinnesotaCare,9.2448,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Sup Arm Sling,,A4565,HCPCS,Facility,Inpatient,,,,18,15.3,5.1588,18,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Sup Arm Sling,,A4565,HCPCS,Facility,Both,,,,18,15.3,5.1588,18,Sanford Health Plan,Sanford Health Plan,16.56,92,,percent of total billed charges,,
Sup Arm Sling,,A4565,HCPCS,Facility,Outpatient,,,,18,15.3,5.1588,18,"UCare Health, Inc.",Individual & Family Plan,10.143,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Sup Arm Sling,,A4565,HCPCS,Facility,Inpatient,,,,18,15.3,5.1588,18,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Sup Arm Sling,,A4565,HCPCS,Facility,Outpatient,,,,18,15.3,5.1588,18,"UCare Health, Inc.",Medical Assistance,9.0846,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Arm Sling,,A4565,HCPCS,Facility,Inpatient,,,,18,15.3,5.1588,18,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Sup Arm Sling,,A4565,HCPCS,Facility,Outpatient,,,,18,15.3,5.1588,18,"UCare Health, Inc.",Medicare Advantage,9.0846,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Arm Sling,,A4565,HCPCS,Facility,Inpatient,,,,18,15.3,5.1588,18,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Arm Sling,,A4565,HCPCS,Facility,Outpatient,,,,18,15.3,5.1588,18,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),9.0846,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Arm Sling,,A4565,HCPCS,Facility,Inpatient,,,,18,15.3,5.1588,18,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Arm Sling,,A4565,HCPCS,Facility,Both,,,,18,15.3,5.1588,18,UnitedHealthcare,Individual & Family,16.92,94,,percent of total billed charges,,
Sup Arm Sling,,A4565,HCPCS,Facility,Outpatient,,,,18,15.3,5.1588,18,UnitedHealthcare,Medicare Advantage,8.82,49,,percent of total billed charges,,
Sup Arm Sling,,A4565,HCPCS,Facility,Inpatient,,,,18,15.3,5.1588,18,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Sup Arm Sling,,A4565,HCPCS,Facility,Outpatient,,,,18,15.3,5.1588,18,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,8.64,48,,percent of total billed charges,,100% of DHS outpatient percentage
Sup Arm Sling,,A4565,HCPCS,Facility,Inpatient,,,,18,15.3,5.1588,18,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
DRESSING SPLINT DENVER NASAL LARGE,,A4570,HCPCS,Facility,Both,,,,219.975,186.97875,63.044835,219.975,Aetna,Commercial,202.377,92,,percent of total billed charges,,
DRESSING SPLINT DENVER NASAL LARGE,,A4570,HCPCS,Facility,Outpatient,,,,219.975,186.97875,63.044835,219.975,Aetna,Medicare Advantage,107.78775,49,,percent of total billed charges,,
DRESSING SPLINT DENVER NASAL LARGE,,A4570,HCPCS,Facility,Inpatient,,,,219.975,186.97875,63.044835,219.975,Aetna,Medicare Advantage,,,,,Included in per diem rate,
DRESSING SPLINT DENVER NASAL LARGE,,A4570,HCPCS,Facility,Both,,,,219.975,186.97875,63.044835,219.975,Aetna,PPO,204.57675,93,,percent of total billed charges,,
DRESSING SPLINT DENVER NASAL LARGE,,A4570,HCPCS,Facility,Both,,,,219.975,186.97875,63.044835,219.975,America's PPO,America's PPO,211.2419925,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
DRESSING SPLINT DENVER NASAL LARGE,,A4570,HCPCS,Facility,Both,,,,219.975,186.97875,63.044835,219.975,BlueCross BlueShield Minnesota, Federal Employee Program,216.4554,98.4,,percent of total billed charges,,
DRESSING SPLINT DENVER NASAL LARGE,,A4570,HCPCS,Facility,Both,,,,219.975,186.97875,63.044835,219.975,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,219.975,100,,percent of total billed charges,,
DRESSING SPLINT DENVER NASAL LARGE,,A4570,HCPCS,Facility,Both,,,,219.975,186.97875,63.044835,219.975,BlueCross BlueShield Minnesota,High Value Network Plan,197.9775,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
DRESSING SPLINT DENVER NASAL LARGE,,A4570,HCPCS,Facility,Outpatient,,,,219.975,186.97875,63.044835,219.975,BlueCross BlueShield Minnesota,Medicare Advantage,107.78775,49,,percent of total billed charges,,
DRESSING SPLINT DENVER NASAL LARGE,,A4570,HCPCS,Facility,Inpatient,,,,219.975,186.97875,63.044835,219.975,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
DRESSING SPLINT DENVER NASAL LARGE,,A4570,HCPCS,Facility,Both,,,,219.975,186.97875,63.044835,219.975,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,194.8318575,88.57,,percent of total billed charges,,
DRESSING SPLINT DENVER NASAL LARGE,,A4570,HCPCS,Facility,Both,,,,219.975,186.97875,63.044835,219.975,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,63.044835,28.66,,percent of total billed charges,,
DRESSING SPLINT DENVER NASAL LARGE,,A4570,HCPCS,Facility,Outpatient,,,,219.975,186.97875,63.044835,219.975,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),107.78775,49,,percent of total billed charges,,
DRESSING SPLINT DENVER NASAL LARGE,,A4570,HCPCS,Facility,Inpatient,,,,219.975,186.97875,63.044835,219.975,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
DRESSING SPLINT DENVER NASAL LARGE,,A4570,HCPCS,Facility,Both,,,,219.975,186.97875,63.044835,219.975,CorVel,Worker's Compensation,219.975,100,,percent of total billed charges,,
DRESSING SPLINT DENVER NASAL LARGE,,A4570,HCPCS,Facility,Both,,,,219.975,186.97875,63.044835,219.975,First Health Group Corporation,First Health Network,213.37575,97,,percent of total billed charges,,
DRESSING SPLINT DENVER NASAL LARGE,,A4570,HCPCS,Facility,Both,,,,219.975,186.97875,63.044835,219.975,"Health Partners, Inc.",Commercial,208.09635,94.6,,percent of total billed charges,,
DRESSING SPLINT DENVER NASAL LARGE,,A4570,HCPCS,Facility,Outpatient,,,,219.975,186.97875,63.044835,219.975,"Health Partners, Inc.",Medicare Advantage,107.78775,49,,percent of total billed charges,,
DRESSING SPLINT DENVER NASAL LARGE,,A4570,HCPCS,Facility,Inpatient,,,,219.975,186.97875,63.044835,219.975,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DRESSING SPLINT DENVER NASAL LARGE,,A4570,HCPCS,Facility,Both,,,,219.975,186.97875,63.044835,219.975,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),131.985,60,,percent of total billed charges,,
DRESSING SPLINT DENVER NASAL LARGE,,A4570,HCPCS,Facility,Both,,,,219.975,186.97875,63.044835,219.975,"Health Partners, Inc.",State of Minnesota Advantage Program,179.279625,81.5,,percent of total billed charges,,
DRESSING SPLINT DENVER NASAL LARGE,,A4570,HCPCS,Facility,Both,,,,219.975,186.97875,63.044835,219.975,"Health Partners, Inc.",State Public Programs,109.9875,50,,percent of total billed charges,,
DRESSING SPLINT DENVER NASAL LARGE,,A4570,HCPCS,Facility,Both,,,,219.975,186.97875,63.044835,219.975,Humana Insurance Company,Commercial PPO,208.97625,95,,percent of total billed charges,,
DRESSING SPLINT DENVER NASAL LARGE,,A4570,HCPCS,Facility,Outpatient,,,,219.975,186.97875,63.044835,219.975,Humana Insurance Company,Medicare PPO,107.78775,49,,percent of total billed charges,,
DRESSING SPLINT DENVER NASAL LARGE,,A4570,HCPCS,Facility,Inpatient,,,,219.975,186.97875,63.044835,219.975,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
DRESSING SPLINT DENVER NASAL LARGE,,A4570,HCPCS,Facility,Both,,,,219.975,186.97875,63.044835,219.975,Medica,Individual & Family,217.995225,99.1,,percent of total billed charges,,
DRESSING SPLINT DENVER NASAL LARGE,,A4570,HCPCS,Facility,Outpatient,,,,219.975,186.97875,63.044835,219.975,Medica,Medica Advantage Solution,109.54755,49.8,,percent of total billed charges,,
DRESSING SPLINT DENVER NASAL LARGE,,A4570,HCPCS,Facility,Inpatient,,,,219.975,186.97875,63.044835,219.975,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
DRESSING SPLINT DENVER NASAL LARGE,,A4570,HCPCS,Facility,Outpatient,,,,219.975,186.97875,63.044835,219.975,Medica,Medical Assistance,98.10885,44.6,,percent of total billed charges,,
DRESSING SPLINT DENVER NASAL LARGE,,A4570,HCPCS,Facility,Inpatient,,,,219.975,186.97875,63.044835,219.975,Medica,Medical Assistance,,,,,Included in per diem rate,
DRESSING SPLINT DENVER NASAL LARGE,,A4570,HCPCS,Facility,Outpatient,,,,219.975,186.97875,63.044835,219.975,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,109.54755,49.8,,percent of total billed charges,,
DRESSING SPLINT DENVER NASAL LARGE,,A4570,HCPCS,Facility,Inpatient,,,,219.975,186.97875,63.044835,219.975,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
DRESSING SPLINT DENVER NASAL LARGE,,A4570,HCPCS,Facility,Both,,,,219.975,186.97875,63.044835,219.975,"Multiplan, Inc.","Multiplan, Inc.",206.7765,94,,percent of total billed charges,,
DRESSING SPLINT DENVER NASAL LARGE,,A4570,HCPCS,Facility,Outpatient,,,,219.975,186.97875,63.044835,219.975,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,198.197475,90.1,,percent of total billed charges,,
DRESSING SPLINT DENVER NASAL LARGE,,A4570,HCPCS,Facility,Inpatient,,,,219.975,186.97875,63.044835,219.975,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
DRESSING SPLINT DENVER NASAL LARGE,,A4570,HCPCS,Facility,Both,,,,219.975,186.97875,63.044835,219.975,"Preferred One Administrative Services, INC.",PPO,216.89535,98.6,,percent of total billed charges,,
DRESSING SPLINT DENVER NASAL LARGE,,A4570,HCPCS,Facility,Outpatient,,,,219.975,186.97875,63.044835,219.975,PrimeWest Health,Minnesota Senior Health Options (MSHO),113.1771375,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
DRESSING SPLINT DENVER NASAL LARGE,,A4570,HCPCS,Facility,Inpatient,,,,219.975,186.97875,63.044835,219.975,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DRESSING SPLINT DENVER NASAL LARGE,,A4570,HCPCS,Facility,Outpatient,,,,219.975,186.97875,63.044835,219.975,PrimeWest Health,MinnesotaCare,112.97916,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
DRESSING SPLINT DENVER NASAL LARGE,,A4570,HCPCS,Facility,Inpatient,,,,219.975,186.97875,63.044835,219.975,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
DRESSING SPLINT DENVER NASAL LARGE,,A4570,HCPCS,Facility,Both,,,,219.975,186.97875,63.044835,219.975,Sanford Health Plan,Sanford Health Plan,202.377,92,,percent of total billed charges,,
DRESSING SPLINT DENVER NASAL LARGE,,A4570,HCPCS,Facility,Outpatient,,,,219.975,186.97875,63.044835,219.975,"UCare Health, Inc.",Individual & Family Plan,123.9559125,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
DRESSING SPLINT DENVER NASAL LARGE,,A4570,HCPCS,Facility,Inpatient,,,,219.975,186.97875,63.044835,219.975,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
DRESSING SPLINT DENVER NASAL LARGE,,A4570,HCPCS,Facility,Outpatient,,,,219.975,186.97875,63.044835,219.975,"UCare Health, Inc.",Medical Assistance,111.0213825,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DRESSING SPLINT DENVER NASAL LARGE,,A4570,HCPCS,Facility,Inpatient,,,,219.975,186.97875,63.044835,219.975,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
DRESSING SPLINT DENVER NASAL LARGE,,A4570,HCPCS,Facility,Outpatient,,,,219.975,186.97875,63.044835,219.975,"UCare Health, Inc.",Medicare Advantage,111.0213825,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DRESSING SPLINT DENVER NASAL LARGE,,A4570,HCPCS,Facility,Inpatient,,,,219.975,186.97875,63.044835,219.975,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DRESSING SPLINT DENVER NASAL LARGE,,A4570,HCPCS,Facility,Outpatient,,,,219.975,186.97875,63.044835,219.975,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),111.0213825,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DRESSING SPLINT DENVER NASAL LARGE,,A4570,HCPCS,Facility,Inpatient,,,,219.975,186.97875,63.044835,219.975,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DRESSING SPLINT DENVER NASAL LARGE,,A4570,HCPCS,Facility,Both,,,,219.975,186.97875,63.044835,219.975,UnitedHealthcare,Individual & Family,206.7765,94,,percent of total billed charges,,
DRESSING SPLINT DENVER NASAL LARGE,,A4570,HCPCS,Facility,Outpatient,,,,219.975,186.97875,63.044835,219.975,UnitedHealthcare,Medicare Advantage,107.78775,49,,percent of total billed charges,,
DRESSING SPLINT DENVER NASAL LARGE,,A4570,HCPCS,Facility,Inpatient,,,,219.975,186.97875,63.044835,219.975,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
DRESSING SPLINT DENVER NASAL LARGE,,A4570,HCPCS,Facility,Outpatient,,,,219.975,186.97875,63.044835,219.975,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,105.588,48,,percent of total billed charges,,100% of DHS outpatient percentage
DRESSING SPLINT DENVER NASAL LARGE,,A4570,HCPCS,Facility,Inpatient,,,,219.975,186.97875,63.044835,219.975,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
DRESSING SPLINT DENVER SM/MED  10-1500-05KS,,A4570,HCPCS,Facility,Both,,,,286.405,243.44425,82.083673,286.405,Aetna,Commercial,263.4926,92,,percent of total billed charges,,
DRESSING SPLINT DENVER SM/MED  10-1500-05KS,,A4570,HCPCS,Facility,Outpatient,,,,286.405,243.44425,82.083673,286.405,Aetna,Medicare Advantage,140.33845,49,,percent of total billed charges,,
DRESSING SPLINT DENVER SM/MED  10-1500-05KS,,A4570,HCPCS,Facility,Inpatient,,,,286.405,243.44425,82.083673,286.405,Aetna,Medicare Advantage,,,,,Included in per diem rate,
DRESSING SPLINT DENVER SM/MED  10-1500-05KS,,A4570,HCPCS,Facility,Both,,,,286.405,243.44425,82.083673,286.405,Aetna,PPO,266.35665,93,,percent of total billed charges,,
DRESSING SPLINT DENVER SM/MED  10-1500-05KS,,A4570,HCPCS,Facility,Both,,,,286.405,243.44425,82.083673,286.405,America's PPO,America's PPO,275.0347215,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
DRESSING SPLINT DENVER SM/MED  10-1500-05KS,,A4570,HCPCS,Facility,Both,,,,286.405,243.44425,82.083673,286.405,BlueCross BlueShield Minnesota, Federal Employee Program,281.82252,98.4,,percent of total billed charges,,
DRESSING SPLINT DENVER SM/MED  10-1500-05KS,,A4570,HCPCS,Facility,Both,,,,286.405,243.44425,82.083673,286.405,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,286.405,100,,percent of total billed charges,,
DRESSING SPLINT DENVER SM/MED  10-1500-05KS,,A4570,HCPCS,Facility,Both,,,,286.405,243.44425,82.083673,286.405,BlueCross BlueShield Minnesota,High Value Network Plan,257.7645,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
DRESSING SPLINT DENVER SM/MED  10-1500-05KS,,A4570,HCPCS,Facility,Outpatient,,,,286.405,243.44425,82.083673,286.405,BlueCross BlueShield Minnesota,Medicare Advantage,140.33845,49,,percent of total billed charges,,
DRESSING SPLINT DENVER SM/MED  10-1500-05KS,,A4570,HCPCS,Facility,Inpatient,,,,286.405,243.44425,82.083673,286.405,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
DRESSING SPLINT DENVER SM/MED  10-1500-05KS,,A4570,HCPCS,Facility,Both,,,,286.405,243.44425,82.083673,286.405,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,253.6689085,88.57,,percent of total billed charges,,
DRESSING SPLINT DENVER SM/MED  10-1500-05KS,,A4570,HCPCS,Facility,Both,,,,286.405,243.44425,82.083673,286.405,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,82.083673,28.66,,percent of total billed charges,,
DRESSING SPLINT DENVER SM/MED  10-1500-05KS,,A4570,HCPCS,Facility,Outpatient,,,,286.405,243.44425,82.083673,286.405,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),140.33845,49,,percent of total billed charges,,
DRESSING SPLINT DENVER SM/MED  10-1500-05KS,,A4570,HCPCS,Facility,Inpatient,,,,286.405,243.44425,82.083673,286.405,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
DRESSING SPLINT DENVER SM/MED  10-1500-05KS,,A4570,HCPCS,Facility,Both,,,,286.405,243.44425,82.083673,286.405,CorVel,Worker's Compensation,286.405,100,,percent of total billed charges,,
DRESSING SPLINT DENVER SM/MED  10-1500-05KS,,A4570,HCPCS,Facility,Both,,,,286.405,243.44425,82.083673,286.405,First Health Group Corporation,First Health Network,277.81285,97,,percent of total billed charges,,
DRESSING SPLINT DENVER SM/MED  10-1500-05KS,,A4570,HCPCS,Facility,Both,,,,286.405,243.44425,82.083673,286.405,"Health Partners, Inc.",Commercial,270.93913,94.6,,percent of total billed charges,,
DRESSING SPLINT DENVER SM/MED  10-1500-05KS,,A4570,HCPCS,Facility,Outpatient,,,,286.405,243.44425,82.083673,286.405,"Health Partners, Inc.",Medicare Advantage,140.33845,49,,percent of total billed charges,,
DRESSING SPLINT DENVER SM/MED  10-1500-05KS,,A4570,HCPCS,Facility,Inpatient,,,,286.405,243.44425,82.083673,286.405,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DRESSING SPLINT DENVER SM/MED  10-1500-05KS,,A4570,HCPCS,Facility,Both,,,,286.405,243.44425,82.083673,286.405,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),171.843,60,,percent of total billed charges,,
DRESSING SPLINT DENVER SM/MED  10-1500-05KS,,A4570,HCPCS,Facility,Both,,,,286.405,243.44425,82.083673,286.405,"Health Partners, Inc.",State of Minnesota Advantage Program,233.420075,81.5,,percent of total billed charges,,
DRESSING SPLINT DENVER SM/MED  10-1500-05KS,,A4570,HCPCS,Facility,Both,,,,286.405,243.44425,82.083673,286.405,"Health Partners, Inc.",State Public Programs,143.2025,50,,percent of total billed charges,,
DRESSING SPLINT DENVER SM/MED  10-1500-05KS,,A4570,HCPCS,Facility,Both,,,,286.405,243.44425,82.083673,286.405,Humana Insurance Company,Commercial PPO,272.08475,95,,percent of total billed charges,,
DRESSING SPLINT DENVER SM/MED  10-1500-05KS,,A4570,HCPCS,Facility,Outpatient,,,,286.405,243.44425,82.083673,286.405,Humana Insurance Company,Medicare PPO,140.33845,49,,percent of total billed charges,,
DRESSING SPLINT DENVER SM/MED  10-1500-05KS,,A4570,HCPCS,Facility,Inpatient,,,,286.405,243.44425,82.083673,286.405,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
DRESSING SPLINT DENVER SM/MED  10-1500-05KS,,A4570,HCPCS,Facility,Both,,,,286.405,243.44425,82.083673,286.405,Medica,Individual & Family,283.827355,99.1,,percent of total billed charges,,
DRESSING SPLINT DENVER SM/MED  10-1500-05KS,,A4570,HCPCS,Facility,Outpatient,,,,286.405,243.44425,82.083673,286.405,Medica,Medica Advantage Solution,142.62969,49.8,,percent of total billed charges,,
DRESSING SPLINT DENVER SM/MED  10-1500-05KS,,A4570,HCPCS,Facility,Inpatient,,,,286.405,243.44425,82.083673,286.405,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
DRESSING SPLINT DENVER SM/MED  10-1500-05KS,,A4570,HCPCS,Facility,Outpatient,,,,286.405,243.44425,82.083673,286.405,Medica,Medical Assistance,127.73663,44.6,,percent of total billed charges,,
DRESSING SPLINT DENVER SM/MED  10-1500-05KS,,A4570,HCPCS,Facility,Inpatient,,,,286.405,243.44425,82.083673,286.405,Medica,Medical Assistance,,,,,Included in per diem rate,
DRESSING SPLINT DENVER SM/MED  10-1500-05KS,,A4570,HCPCS,Facility,Outpatient,,,,286.405,243.44425,82.083673,286.405,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,142.62969,49.8,,percent of total billed charges,,
DRESSING SPLINT DENVER SM/MED  10-1500-05KS,,A4570,HCPCS,Facility,Inpatient,,,,286.405,243.44425,82.083673,286.405,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
DRESSING SPLINT DENVER SM/MED  10-1500-05KS,,A4570,HCPCS,Facility,Both,,,,286.405,243.44425,82.083673,286.405,"Multiplan, Inc.","Multiplan, Inc.",269.2207,94,,percent of total billed charges,,
DRESSING SPLINT DENVER SM/MED  10-1500-05KS,,A4570,HCPCS,Facility,Outpatient,,,,286.405,243.44425,82.083673,286.405,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,258.050905,90.1,,percent of total billed charges,,
DRESSING SPLINT DENVER SM/MED  10-1500-05KS,,A4570,HCPCS,Facility,Inpatient,,,,286.405,243.44425,82.083673,286.405,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
DRESSING SPLINT DENVER SM/MED  10-1500-05KS,,A4570,HCPCS,Facility,Both,,,,286.405,243.44425,82.083673,286.405,"Preferred One Administrative Services, INC.",PPO,282.39533,98.6,,percent of total billed charges,,
DRESSING SPLINT DENVER SM/MED  10-1500-05KS,,A4570,HCPCS,Facility,Outpatient,,,,286.405,243.44425,82.083673,286.405,PrimeWest Health,Minnesota Senior Health Options (MSHO),147.3553725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
DRESSING SPLINT DENVER SM/MED  10-1500-05KS,,A4570,HCPCS,Facility,Inpatient,,,,286.405,243.44425,82.083673,286.405,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DRESSING SPLINT DENVER SM/MED  10-1500-05KS,,A4570,HCPCS,Facility,Outpatient,,,,286.405,243.44425,82.083673,286.405,PrimeWest Health,MinnesotaCare,147.097608,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
DRESSING SPLINT DENVER SM/MED  10-1500-05KS,,A4570,HCPCS,Facility,Inpatient,,,,286.405,243.44425,82.083673,286.405,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
DRESSING SPLINT DENVER SM/MED  10-1500-05KS,,A4570,HCPCS,Facility,Both,,,,286.405,243.44425,82.083673,286.405,Sanford Health Plan,Sanford Health Plan,263.4926,92,,percent of total billed charges,,
DRESSING SPLINT DENVER SM/MED  10-1500-05KS,,A4570,HCPCS,Facility,Outpatient,,,,286.405,243.44425,82.083673,286.405,"UCare Health, Inc.",Individual & Family Plan,161.3892175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
DRESSING SPLINT DENVER SM/MED  10-1500-05KS,,A4570,HCPCS,Facility,Inpatient,,,,286.405,243.44425,82.083673,286.405,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
DRESSING SPLINT DENVER SM/MED  10-1500-05KS,,A4570,HCPCS,Facility,Outpatient,,,,286.405,243.44425,82.083673,286.405,"UCare Health, Inc.",Medical Assistance,144.5486035,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DRESSING SPLINT DENVER SM/MED  10-1500-05KS,,A4570,HCPCS,Facility,Inpatient,,,,286.405,243.44425,82.083673,286.405,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
DRESSING SPLINT DENVER SM/MED  10-1500-05KS,,A4570,HCPCS,Facility,Outpatient,,,,286.405,243.44425,82.083673,286.405,"UCare Health, Inc.",Medicare Advantage,144.5486035,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DRESSING SPLINT DENVER SM/MED  10-1500-05KS,,A4570,HCPCS,Facility,Inpatient,,,,286.405,243.44425,82.083673,286.405,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DRESSING SPLINT DENVER SM/MED  10-1500-05KS,,A4570,HCPCS,Facility,Outpatient,,,,286.405,243.44425,82.083673,286.405,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),144.5486035,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DRESSING SPLINT DENVER SM/MED  10-1500-05KS,,A4570,HCPCS,Facility,Inpatient,,,,286.405,243.44425,82.083673,286.405,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DRESSING SPLINT DENVER SM/MED  10-1500-05KS,,A4570,HCPCS,Facility,Both,,,,286.405,243.44425,82.083673,286.405,UnitedHealthcare,Individual & Family,269.2207,94,,percent of total billed charges,,
DRESSING SPLINT DENVER SM/MED  10-1500-05KS,,A4570,HCPCS,Facility,Outpatient,,,,286.405,243.44425,82.083673,286.405,UnitedHealthcare,Medicare Advantage,140.33845,49,,percent of total billed charges,,
DRESSING SPLINT DENVER SM/MED  10-1500-05KS,,A4570,HCPCS,Facility,Inpatient,,,,286.405,243.44425,82.083673,286.405,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
DRESSING SPLINT DENVER SM/MED  10-1500-05KS,,A4570,HCPCS,Facility,Outpatient,,,,286.405,243.44425,82.083673,286.405,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,137.4744,48,,percent of total billed charges,,100% of DHS outpatient percentage
DRESSING SPLINT DENVER SM/MED  10-1500-05KS,,A4570,HCPCS,Facility,Inpatient,,,,286.405,243.44425,82.083673,286.405,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
DRESSING SPLINT DOYLE NASAL,,A4570,HCPCS,Facility,Both,,,,379.14,322.269,108.661524,379.14,Aetna,Commercial,348.8088,92,,percent of total billed charges,,
DRESSING SPLINT DOYLE NASAL,,A4570,HCPCS,Facility,Outpatient,,,,379.14,322.269,108.661524,379.14,Aetna,Medicare Advantage,185.7786,49,,percent of total billed charges,,
DRESSING SPLINT DOYLE NASAL,,A4570,HCPCS,Facility,Inpatient,,,,379.14,322.269,108.661524,379.14,Aetna,Medicare Advantage,,,,,Included in per diem rate,
DRESSING SPLINT DOYLE NASAL,,A4570,HCPCS,Facility,Both,,,,379.14,322.269,108.661524,379.14,Aetna,PPO,352.6002,93,,percent of total billed charges,,
DRESSING SPLINT DOYLE NASAL,,A4570,HCPCS,Facility,Both,,,,379.14,322.269,108.661524,379.14,America's PPO,America's PPO,364.088142,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
DRESSING SPLINT DOYLE NASAL,,A4570,HCPCS,Facility,Both,,,,379.14,322.269,108.661524,379.14,BlueCross BlueShield Minnesota, Federal Employee Program,373.07376,98.4,,percent of total billed charges,,
DRESSING SPLINT DOYLE NASAL,,A4570,HCPCS,Facility,Both,,,,379.14,322.269,108.661524,379.14,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,379.14,100,,percent of total billed charges,,
DRESSING SPLINT DOYLE NASAL,,A4570,HCPCS,Facility,Both,,,,379.14,322.269,108.661524,379.14,BlueCross BlueShield Minnesota,High Value Network Plan,341.226,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
DRESSING SPLINT DOYLE NASAL,,A4570,HCPCS,Facility,Outpatient,,,,379.14,322.269,108.661524,379.14,BlueCross BlueShield Minnesota,Medicare Advantage,185.7786,49,,percent of total billed charges,,
DRESSING SPLINT DOYLE NASAL,,A4570,HCPCS,Facility,Inpatient,,,,379.14,322.269,108.661524,379.14,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
DRESSING SPLINT DOYLE NASAL,,A4570,HCPCS,Facility,Both,,,,379.14,322.269,108.661524,379.14,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,335.804298,88.57,,percent of total billed charges,,
DRESSING SPLINT DOYLE NASAL,,A4570,HCPCS,Facility,Both,,,,379.14,322.269,108.661524,379.14,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,108.661524,28.66,,percent of total billed charges,,
DRESSING SPLINT DOYLE NASAL,,A4570,HCPCS,Facility,Outpatient,,,,379.14,322.269,108.661524,379.14,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),185.7786,49,,percent of total billed charges,,
DRESSING SPLINT DOYLE NASAL,,A4570,HCPCS,Facility,Inpatient,,,,379.14,322.269,108.661524,379.14,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
DRESSING SPLINT DOYLE NASAL,,A4570,HCPCS,Facility,Both,,,,379.14,322.269,108.661524,379.14,CorVel,Worker's Compensation,379.14,100,,percent of total billed charges,,
DRESSING SPLINT DOYLE NASAL,,A4570,HCPCS,Facility,Both,,,,379.14,322.269,108.661524,379.14,First Health Group Corporation,First Health Network,367.7658,97,,percent of total billed charges,,
DRESSING SPLINT DOYLE NASAL,,A4570,HCPCS,Facility,Both,,,,379.14,322.269,108.661524,379.14,"Health Partners, Inc.",Commercial,358.66644,94.6,,percent of total billed charges,,
DRESSING SPLINT DOYLE NASAL,,A4570,HCPCS,Facility,Outpatient,,,,379.14,322.269,108.661524,379.14,"Health Partners, Inc.",Medicare Advantage,185.7786,49,,percent of total billed charges,,
DRESSING SPLINT DOYLE NASAL,,A4570,HCPCS,Facility,Inpatient,,,,379.14,322.269,108.661524,379.14,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DRESSING SPLINT DOYLE NASAL,,A4570,HCPCS,Facility,Both,,,,379.14,322.269,108.661524,379.14,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),227.484,60,,percent of total billed charges,,
DRESSING SPLINT DOYLE NASAL,,A4570,HCPCS,Facility,Both,,,,379.14,322.269,108.661524,379.14,"Health Partners, Inc.",State of Minnesota Advantage Program,308.9991,81.5,,percent of total billed charges,,
DRESSING SPLINT DOYLE NASAL,,A4570,HCPCS,Facility,Both,,,,379.14,322.269,108.661524,379.14,"Health Partners, Inc.",State Public Programs,189.57,50,,percent of total billed charges,,
DRESSING SPLINT DOYLE NASAL,,A4570,HCPCS,Facility,Both,,,,379.14,322.269,108.661524,379.14,Humana Insurance Company,Commercial PPO,360.183,95,,percent of total billed charges,,
DRESSING SPLINT DOYLE NASAL,,A4570,HCPCS,Facility,Outpatient,,,,379.14,322.269,108.661524,379.14,Humana Insurance Company,Medicare PPO,185.7786,49,,percent of total billed charges,,
DRESSING SPLINT DOYLE NASAL,,A4570,HCPCS,Facility,Inpatient,,,,379.14,322.269,108.661524,379.14,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
DRESSING SPLINT DOYLE NASAL,,A4570,HCPCS,Facility,Both,,,,379.14,322.269,108.661524,379.14,Medica,Individual & Family,375.72774,99.1,,percent of total billed charges,,
DRESSING SPLINT DOYLE NASAL,,A4570,HCPCS,Facility,Outpatient,,,,379.14,322.269,108.661524,379.14,Medica,Medica Advantage Solution,188.81172,49.8,,percent of total billed charges,,
DRESSING SPLINT DOYLE NASAL,,A4570,HCPCS,Facility,Inpatient,,,,379.14,322.269,108.661524,379.14,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
DRESSING SPLINT DOYLE NASAL,,A4570,HCPCS,Facility,Outpatient,,,,379.14,322.269,108.661524,379.14,Medica,Medical Assistance,169.09644,44.6,,percent of total billed charges,,
DRESSING SPLINT DOYLE NASAL,,A4570,HCPCS,Facility,Inpatient,,,,379.14,322.269,108.661524,379.14,Medica,Medical Assistance,,,,,Included in per diem rate,
DRESSING SPLINT DOYLE NASAL,,A4570,HCPCS,Facility,Outpatient,,,,379.14,322.269,108.661524,379.14,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,188.81172,49.8,,percent of total billed charges,,
DRESSING SPLINT DOYLE NASAL,,A4570,HCPCS,Facility,Inpatient,,,,379.14,322.269,108.661524,379.14,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
DRESSING SPLINT DOYLE NASAL,,A4570,HCPCS,Facility,Both,,,,379.14,322.269,108.661524,379.14,"Multiplan, Inc.","Multiplan, Inc.",356.3916,94,,percent of total billed charges,,
DRESSING SPLINT DOYLE NASAL,,A4570,HCPCS,Facility,Outpatient,,,,379.14,322.269,108.661524,379.14,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,341.60514,90.1,,percent of total billed charges,,
DRESSING SPLINT DOYLE NASAL,,A4570,HCPCS,Facility,Inpatient,,,,379.14,322.269,108.661524,379.14,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
DRESSING SPLINT DOYLE NASAL,,A4570,HCPCS,Facility,Both,,,,379.14,322.269,108.661524,379.14,"Preferred One Administrative Services, INC.",PPO,373.83204,98.6,,percent of total billed charges,,
DRESSING SPLINT DOYLE NASAL,,A4570,HCPCS,Facility,Outpatient,,,,379.14,322.269,108.661524,379.14,PrimeWest Health,Minnesota Senior Health Options (MSHO),195.06753,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
DRESSING SPLINT DOYLE NASAL,,A4570,HCPCS,Facility,Inpatient,,,,379.14,322.269,108.661524,379.14,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DRESSING SPLINT DOYLE NASAL,,A4570,HCPCS,Facility,Outpatient,,,,379.14,322.269,108.661524,379.14,PrimeWest Health,MinnesotaCare,194.726304,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
DRESSING SPLINT DOYLE NASAL,,A4570,HCPCS,Facility,Inpatient,,,,379.14,322.269,108.661524,379.14,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
DRESSING SPLINT DOYLE NASAL,,A4570,HCPCS,Facility,Both,,,,379.14,322.269,108.661524,379.14,Sanford Health Plan,Sanford Health Plan,348.8088,92,,percent of total billed charges,,
DRESSING SPLINT DOYLE NASAL,,A4570,HCPCS,Facility,Outpatient,,,,379.14,322.269,108.661524,379.14,"UCare Health, Inc.",Individual & Family Plan,213.64539,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
DRESSING SPLINT DOYLE NASAL,,A4570,HCPCS,Facility,Inpatient,,,,379.14,322.269,108.661524,379.14,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
DRESSING SPLINT DOYLE NASAL,,A4570,HCPCS,Facility,Outpatient,,,,379.14,322.269,108.661524,379.14,"UCare Health, Inc.",Medical Assistance,191.351958,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DRESSING SPLINT DOYLE NASAL,,A4570,HCPCS,Facility,Inpatient,,,,379.14,322.269,108.661524,379.14,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
DRESSING SPLINT DOYLE NASAL,,A4570,HCPCS,Facility,Outpatient,,,,379.14,322.269,108.661524,379.14,"UCare Health, Inc.",Medicare Advantage,191.351958,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DRESSING SPLINT DOYLE NASAL,,A4570,HCPCS,Facility,Inpatient,,,,379.14,322.269,108.661524,379.14,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DRESSING SPLINT DOYLE NASAL,,A4570,HCPCS,Facility,Outpatient,,,,379.14,322.269,108.661524,379.14,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),191.351958,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DRESSING SPLINT DOYLE NASAL,,A4570,HCPCS,Facility,Inpatient,,,,379.14,322.269,108.661524,379.14,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DRESSING SPLINT DOYLE NASAL,,A4570,HCPCS,Facility,Both,,,,379.14,322.269,108.661524,379.14,UnitedHealthcare,Individual & Family,356.3916,94,,percent of total billed charges,,
DRESSING SPLINT DOYLE NASAL,,A4570,HCPCS,Facility,Outpatient,,,,379.14,322.269,108.661524,379.14,UnitedHealthcare,Medicare Advantage,185.7786,49,,percent of total billed charges,,
DRESSING SPLINT DOYLE NASAL,,A4570,HCPCS,Facility,Inpatient,,,,379.14,322.269,108.661524,379.14,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
DRESSING SPLINT DOYLE NASAL,,A4570,HCPCS,Facility,Outpatient,,,,379.14,322.269,108.661524,379.14,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,181.9872,48,,percent of total billed charges,,100% of DHS outpatient percentage
DRESSING SPLINT DOYLE NASAL,,A4570,HCPCS,Facility,Inpatient,,,,379.14,322.269,108.661524,379.14,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Sup Brace Clavical,,A4570,HCPCS,Facility,Both,,,,30,25.5,8.598,30,Aetna,Commercial,27.6,92,,percent of total billed charges,,
Sup Brace Clavical,,A4570,HCPCS,Facility,Both,,,,30,25.5,8.598,30,Aetna,Commercial,27.6,92,,percent of total billed charges,,
Sup Brace Clavical,,A4570,HCPCS,Facility,Outpatient,,,,30,25.5,8.598,30,Aetna,Medicare Advantage,14.7,49,,percent of total billed charges,,
Sup Brace Clavical,,A4570,HCPCS,Facility,Outpatient,,,,30,25.5,8.598,30,Aetna,Medicare Advantage,14.7,49,,percent of total billed charges,,
Sup Brace Clavical,,A4570,HCPCS,Facility,Inpatient,,,,30,25.5,8.598,30,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Sup Brace Clavical,,A4570,HCPCS,Facility,Inpatient,,,,30,25.5,8.598,30,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Sup Brace Clavical,,A4570,HCPCS,Facility,Both,,,,30,25.5,8.598,30,Aetna,PPO,27.9,93,,percent of total billed charges,,
Sup Brace Clavical,,A4570,HCPCS,Facility,Both,,,,30,25.5,8.598,30,Aetna,PPO,27.9,93,,percent of total billed charges,,
Sup Brace Clavical,,A4570,HCPCS,Facility,Both,,,,30,25.5,8.598,30,America's PPO,America's PPO,28.809,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Sup Brace Clavical,,A4570,HCPCS,Facility,Both,,,,30,25.5,8.598,30,America's PPO,America's PPO,28.809,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Sup Brace Clavical,,A4570,HCPCS,Facility,Both,,,,30,25.5,8.598,30,BlueCross BlueShield Minnesota, Federal Employee Program,29.52,98.4,,percent of total billed charges,,
Sup Brace Clavical,,A4570,HCPCS,Facility,Both,,,,30,25.5,8.598,30,BlueCross BlueShield Minnesota, Federal Employee Program,29.52,98.4,,percent of total billed charges,,
Sup Brace Clavical,,A4570,HCPCS,Facility,Both,,,,30,25.5,8.598,30,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,30,100,,percent of total billed charges,,
Sup Brace Clavical,,A4570,HCPCS,Facility,Both,,,,30,25.5,8.598,30,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,30,100,,percent of total billed charges,,
Sup Brace Clavical,,A4570,HCPCS,Facility,Both,,,,30,25.5,8.598,30,BlueCross BlueShield Minnesota,High Value Network Plan,27,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
Sup Brace Clavical,,A4570,HCPCS,Facility,Both,,,,30,25.5,8.598,30,BlueCross BlueShield Minnesota,High Value Network Plan,27,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
Sup Brace Clavical,,A4570,HCPCS,Facility,Outpatient,,,,30,25.5,8.598,30,BlueCross BlueShield Minnesota,Medicare Advantage,14.7,49,,percent of total billed charges,,
Sup Brace Clavical,,A4570,HCPCS,Facility,Outpatient,,,,30,25.5,8.598,30,BlueCross BlueShield Minnesota,Medicare Advantage,14.7,49,,percent of total billed charges,,
Sup Brace Clavical,,A4570,HCPCS,Facility,Inpatient,,,,30,25.5,8.598,30,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Sup Brace Clavical,,A4570,HCPCS,Facility,Inpatient,,,,30,25.5,8.598,30,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Sup Brace Clavical,,A4570,HCPCS,Facility,Both,,,,30,25.5,8.598,30,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,26.571,88.57,,percent of total billed charges,,
Sup Brace Clavical,,A4570,HCPCS,Facility,Both,,,,30,25.5,8.598,30,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,26.571,88.57,,percent of total billed charges,,
Sup Brace Clavical,,A4570,HCPCS,Facility,Both,,,,30,25.5,8.598,30,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,8.598,28.66,,percent of total billed charges,,
Sup Brace Clavical,,A4570,HCPCS,Facility,Both,,,,30,25.5,8.598,30,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,8.598,28.66,,percent of total billed charges,,
Sup Brace Clavical,,A4570,HCPCS,Facility,Outpatient,,,,30,25.5,8.598,30,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),14.7,49,,percent of total billed charges,,
Sup Brace Clavical,,A4570,HCPCS,Facility,Outpatient,,,,30,25.5,8.598,30,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),14.7,49,,percent of total billed charges,,
Sup Brace Clavical,,A4570,HCPCS,Facility,Inpatient,,,,30,25.5,8.598,30,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Sup Brace Clavical,,A4570,HCPCS,Facility,Inpatient,,,,30,25.5,8.598,30,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Sup Brace Clavical,,A4570,HCPCS,Facility,Both,,,,30,25.5,8.598,30,CorVel,Worker's Compensation,30,100,,percent of total billed charges,,
Sup Brace Clavical,,A4570,HCPCS,Facility,Both,,,,30,25.5,8.598,30,CorVel,Worker's Compensation,30,100,,percent of total billed charges,,
Sup Brace Clavical,,A4570,HCPCS,Facility,Both,,,,30,25.5,8.598,30,First Health Group Corporation,First Health Network,29.1,97,,percent of total billed charges,,
Sup Brace Clavical,,A4570,HCPCS,Facility,Both,,,,30,25.5,8.598,30,First Health Group Corporation,First Health Network,29.1,97,,percent of total billed charges,,
Sup Brace Clavical,,A4570,HCPCS,Facility,Both,,,,30,25.5,8.598,30,"Health Partners, Inc.",Commercial,28.38,94.6,,percent of total billed charges,,
Sup Brace Clavical,,A4570,HCPCS,Facility,Both,,,,30,25.5,8.598,30,"Health Partners, Inc.",Commercial,28.38,94.6,,percent of total billed charges,,
Sup Brace Clavical,,A4570,HCPCS,Facility,Outpatient,,,,30,25.5,8.598,30,"Health Partners, Inc.",Medicare Advantage,14.7,49,,percent of total billed charges,,
Sup Brace Clavical,,A4570,HCPCS,Facility,Outpatient,,,,30,25.5,8.598,30,"Health Partners, Inc.",Medicare Advantage,14.7,49,,percent of total billed charges,,
Sup Brace Clavical,,A4570,HCPCS,Facility,Inpatient,,,,30,25.5,8.598,30,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Brace Clavical,,A4570,HCPCS,Facility,Inpatient,,,,30,25.5,8.598,30,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Brace Clavical,,A4570,HCPCS,Facility,Both,,,,30,25.5,8.598,30,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),18,60,,percent of total billed charges,,
Sup Brace Clavical,,A4570,HCPCS,Facility,Both,,,,30,25.5,8.598,30,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),18,60,,percent of total billed charges,,
Sup Brace Clavical,,A4570,HCPCS,Facility,Both,,,,30,25.5,8.598,30,"Health Partners, Inc.",State of Minnesota Advantage Program,24.45,81.5,,percent of total billed charges,,
Sup Brace Clavical,,A4570,HCPCS,Facility,Both,,,,30,25.5,8.598,30,"Health Partners, Inc.",State of Minnesota Advantage Program,24.45,81.5,,percent of total billed charges,,
Sup Brace Clavical,,A4570,HCPCS,Facility,Both,,,,30,25.5,8.598,30,"Health Partners, Inc.",State Public Programs,15,50,,percent of total billed charges,,
Sup Brace Clavical,,A4570,HCPCS,Facility,Both,,,,30,25.5,8.598,30,"Health Partners, Inc.",State Public Programs,15,50,,percent of total billed charges,,
Sup Brace Clavical,,A4570,HCPCS,Facility,Both,,,,30,25.5,8.598,30,Humana Insurance Company,Commercial PPO,28.5,95,,percent of total billed charges,,
Sup Brace Clavical,,A4570,HCPCS,Facility,Both,,,,30,25.5,8.598,30,Humana Insurance Company,Commercial PPO,28.5,95,,percent of total billed charges,,
Sup Brace Clavical,,A4570,HCPCS,Facility,Outpatient,,,,30,25.5,8.598,30,Humana Insurance Company,Medicare PPO,14.7,49,,percent of total billed charges,,
Sup Brace Clavical,,A4570,HCPCS,Facility,Outpatient,,,,30,25.5,8.598,30,Humana Insurance Company,Medicare PPO,14.7,49,,percent of total billed charges,,
Sup Brace Clavical,,A4570,HCPCS,Facility,Inpatient,,,,30,25.5,8.598,30,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Sup Brace Clavical,,A4570,HCPCS,Facility,Inpatient,,,,30,25.5,8.598,30,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Sup Brace Clavical,,A4570,HCPCS,Facility,Both,,,,30,25.5,8.598,30,Medica,Individual & Family,29.73,99.1,,percent of total billed charges,,
Sup Brace Clavical,,A4570,HCPCS,Facility,Both,,,,30,25.5,8.598,30,Medica,Individual & Family,29.73,99.1,,percent of total billed charges,,
Sup Brace Clavical,,A4570,HCPCS,Facility,Outpatient,,,,30,25.5,8.598,30,Medica,Medica Advantage Solution,14.94,49.8,,percent of total billed charges,,
Sup Brace Clavical,,A4570,HCPCS,Facility,Outpatient,,,,30,25.5,8.598,30,Medica,Medica Advantage Solution,14.94,49.8,,percent of total billed charges,,
Sup Brace Clavical,,A4570,HCPCS,Facility,Inpatient,,,,30,25.5,8.598,30,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Sup Brace Clavical,,A4570,HCPCS,Facility,Inpatient,,,,30,25.5,8.598,30,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Sup Brace Clavical,,A4570,HCPCS,Facility,Outpatient,,,,30,25.5,8.598,30,Medica,Medical Assistance,13.38,44.6,,percent of total billed charges,,
Sup Brace Clavical,,A4570,HCPCS,Facility,Outpatient,,,,30,25.5,8.598,30,Medica,Medical Assistance,13.38,44.6,,percent of total billed charges,,
Sup Brace Clavical,,A4570,HCPCS,Facility,Inpatient,,,,30,25.5,8.598,30,Medica,Medical Assistance,,,,,Included in per diem rate,
Sup Brace Clavical,,A4570,HCPCS,Facility,Inpatient,,,,30,25.5,8.598,30,Medica,Medical Assistance,,,,,Included in per diem rate,
Sup Brace Clavical,,A4570,HCPCS,Facility,Outpatient,,,,30,25.5,8.598,30,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,14.94,49.8,,percent of total billed charges,,
Sup Brace Clavical,,A4570,HCPCS,Facility,Outpatient,,,,30,25.5,8.598,30,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,14.94,49.8,,percent of total billed charges,,
Sup Brace Clavical,,A4570,HCPCS,Facility,Inpatient,,,,30,25.5,8.598,30,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Sup Brace Clavical,,A4570,HCPCS,Facility,Inpatient,,,,30,25.5,8.598,30,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Sup Brace Clavical,,A4570,HCPCS,Facility,Both,,,,30,25.5,8.598,30,"Multiplan, Inc.","Multiplan, Inc.",28.2,94,,percent of total billed charges,,
Sup Brace Clavical,,A4570,HCPCS,Facility,Both,,,,30,25.5,8.598,30,"Multiplan, Inc.","Multiplan, Inc.",28.2,94,,percent of total billed charges,,
Sup Brace Clavical,,A4570,HCPCS,Facility,Outpatient,,,,30,25.5,8.598,30,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,27.03,90.1,,percent of total billed charges,,
Sup Brace Clavical,,A4570,HCPCS,Facility,Outpatient,,,,30,25.5,8.598,30,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,27.03,90.1,,percent of total billed charges,,
Sup Brace Clavical,,A4570,HCPCS,Facility,Inpatient,,,,30,25.5,8.598,30,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Sup Brace Clavical,,A4570,HCPCS,Facility,Inpatient,,,,30,25.5,8.598,30,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Sup Brace Clavical,,A4570,HCPCS,Facility,Both,,,,30,25.5,8.598,30,"Preferred One Administrative Services, INC.",PPO,29.58,98.6,,percent of total billed charges,,
Sup Brace Clavical,,A4570,HCPCS,Facility,Both,,,,30,25.5,8.598,30,"Preferred One Administrative Services, INC.",PPO,29.58,98.6,,percent of total billed charges,,
Sup Brace Clavical,,A4570,HCPCS,Facility,Outpatient,,,,30,25.5,8.598,30,PrimeWest Health,Minnesota Senior Health Options (MSHO),15.435,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Sup Brace Clavical,,A4570,HCPCS,Facility,Outpatient,,,,30,25.5,8.598,30,PrimeWest Health,Minnesota Senior Health Options (MSHO),15.435,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Sup Brace Clavical,,A4570,HCPCS,Facility,Inpatient,,,,30,25.5,8.598,30,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Brace Clavical,,A4570,HCPCS,Facility,Inpatient,,,,30,25.5,8.598,30,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Brace Clavical,,A4570,HCPCS,Facility,Outpatient,,,,30,25.5,8.598,30,PrimeWest Health,MinnesotaCare,15.408,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Sup Brace Clavical,,A4570,HCPCS,Facility,Outpatient,,,,30,25.5,8.598,30,PrimeWest Health,MinnesotaCare,15.408,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Sup Brace Clavical,,A4570,HCPCS,Facility,Inpatient,,,,30,25.5,8.598,30,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Sup Brace Clavical,,A4570,HCPCS,Facility,Inpatient,,,,30,25.5,8.598,30,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Sup Brace Clavical,,A4570,HCPCS,Facility,Both,,,,30,25.5,8.598,30,Sanford Health Plan,Sanford Health Plan,27.6,92,,percent of total billed charges,,
Sup Brace Clavical,,A4570,HCPCS,Facility,Both,,,,30,25.5,8.598,30,Sanford Health Plan,Sanford Health Plan,27.6,92,,percent of total billed charges,,
Sup Brace Clavical,,A4570,HCPCS,Facility,Outpatient,,,,30,25.5,8.598,30,"UCare Health, Inc.",Individual & Family Plan,16.905,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Sup Brace Clavical,,A4570,HCPCS,Facility,Outpatient,,,,30,25.5,8.598,30,"UCare Health, Inc.",Individual & Family Plan,16.905,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Sup Brace Clavical,,A4570,HCPCS,Facility,Inpatient,,,,30,25.5,8.598,30,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Sup Brace Clavical,,A4570,HCPCS,Facility,Inpatient,,,,30,25.5,8.598,30,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Sup Brace Clavical,,A4570,HCPCS,Facility,Outpatient,,,,30,25.5,8.598,30,"UCare Health, Inc.",Medical Assistance,15.141,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Brace Clavical,,A4570,HCPCS,Facility,Outpatient,,,,30,25.5,8.598,30,"UCare Health, Inc.",Medical Assistance,15.141,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Brace Clavical,,A4570,HCPCS,Facility,Inpatient,,,,30,25.5,8.598,30,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Sup Brace Clavical,,A4570,HCPCS,Facility,Inpatient,,,,30,25.5,8.598,30,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Sup Brace Clavical,,A4570,HCPCS,Facility,Outpatient,,,,30,25.5,8.598,30,"UCare Health, Inc.",Medicare Advantage,15.141,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Brace Clavical,,A4570,HCPCS,Facility,Outpatient,,,,30,25.5,8.598,30,"UCare Health, Inc.",Medicare Advantage,15.141,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Brace Clavical,,A4570,HCPCS,Facility,Inpatient,,,,30,25.5,8.598,30,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Brace Clavical,,A4570,HCPCS,Facility,Inpatient,,,,30,25.5,8.598,30,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Brace Clavical,,A4570,HCPCS,Facility,Outpatient,,,,30,25.5,8.598,30,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),15.141,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Brace Clavical,,A4570,HCPCS,Facility,Outpatient,,,,30,25.5,8.598,30,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),15.141,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Brace Clavical,,A4570,HCPCS,Facility,Inpatient,,,,30,25.5,8.598,30,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Brace Clavical,,A4570,HCPCS,Facility,Inpatient,,,,30,25.5,8.598,30,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Brace Clavical,,A4570,HCPCS,Facility,Both,,,,30,25.5,8.598,30,UnitedHealthcare,Individual & Family,28.2,94,,percent of total billed charges,,
Sup Brace Clavical,,A4570,HCPCS,Facility,Both,,,,30,25.5,8.598,30,UnitedHealthcare,Individual & Family,28.2,94,,percent of total billed charges,,
Sup Brace Clavical,,A4570,HCPCS,Facility,Outpatient,,,,30,25.5,8.598,30,UnitedHealthcare,Medicare Advantage,14.7,49,,percent of total billed charges,,
Sup Brace Clavical,,A4570,HCPCS,Facility,Outpatient,,,,30,25.5,8.598,30,UnitedHealthcare,Medicare Advantage,14.7,49,,percent of total billed charges,,
Sup Brace Clavical,,A4570,HCPCS,Facility,Inpatient,,,,30,25.5,8.598,30,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Sup Brace Clavical,,A4570,HCPCS,Facility,Inpatient,,,,30,25.5,8.598,30,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Sup Brace Clavical,,A4570,HCPCS,Facility,Outpatient,,,,30,25.5,8.598,30,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,14.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
Sup Brace Clavical,,A4570,HCPCS,Facility,Outpatient,,,,30,25.5,8.598,30,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,14.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
Sup Brace Clavical,,A4570,HCPCS,Facility,Inpatient,,,,30,25.5,8.598,30,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Sup Brace Clavical,,A4570,HCPCS,Facility,Inpatient,,,,30,25.5,8.598,30,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Sup Brace Wrist,,A4570,HCPCS,Facility,Both,,,,38,32.3,10.8908,38,Aetna,Commercial,34.96,92,,percent of total billed charges,,
Sup Brace Wrist,,A4570,HCPCS,Facility,Outpatient,,,,38,32.3,10.8908,38,Aetna,Medicare Advantage,18.62,49,,percent of total billed charges,,
Sup Brace Wrist,,A4570,HCPCS,Facility,Inpatient,,,,38,32.3,10.8908,38,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Sup Brace Wrist,,A4570,HCPCS,Facility,Both,,,,38,32.3,10.8908,38,Aetna,PPO,35.34,93,,percent of total billed charges,,
Sup Brace Wrist,,A4570,HCPCS,Facility,Both,,,,38,32.3,10.8908,38,America's PPO,America's PPO,36.4914,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Sup Brace Wrist,,A4570,HCPCS,Facility,Both,,,,38,32.3,10.8908,38,BlueCross BlueShield Minnesota, Federal Employee Program,37.392,98.4,,percent of total billed charges,,
Sup Brace Wrist,,A4570,HCPCS,Facility,Both,,,,38,32.3,10.8908,38,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,38,100,,percent of total billed charges,,
Sup Brace Wrist,,A4570,HCPCS,Facility,Both,,,,38,32.3,10.8908,38,BlueCross BlueShield Minnesota,High Value Network Plan,34.2,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
Sup Brace Wrist,,A4570,HCPCS,Facility,Outpatient,,,,38,32.3,10.8908,38,BlueCross BlueShield Minnesota,Medicare Advantage,18.62,49,,percent of total billed charges,,
Sup Brace Wrist,,A4570,HCPCS,Facility,Inpatient,,,,38,32.3,10.8908,38,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Sup Brace Wrist,,A4570,HCPCS,Facility,Both,,,,38,32.3,10.8908,38,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,33.6566,88.57,,percent of total billed charges,,
Sup Brace Wrist,,A4570,HCPCS,Facility,Both,,,,38,32.3,10.8908,38,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,10.8908,28.66,,percent of total billed charges,,
Sup Brace Wrist,,A4570,HCPCS,Facility,Outpatient,,,,38,32.3,10.8908,38,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),18.62,49,,percent of total billed charges,,
Sup Brace Wrist,,A4570,HCPCS,Facility,Inpatient,,,,38,32.3,10.8908,38,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Sup Brace Wrist,,A4570,HCPCS,Facility,Both,,,,38,32.3,10.8908,38,CorVel,Worker's Compensation,38,100,,percent of total billed charges,,
Sup Brace Wrist,,A4570,HCPCS,Facility,Both,,,,38,32.3,10.8908,38,First Health Group Corporation,First Health Network,36.86,97,,percent of total billed charges,,
Sup Brace Wrist,,A4570,HCPCS,Facility,Both,,,,38,32.3,10.8908,38,"Health Partners, Inc.",Commercial,35.948,94.6,,percent of total billed charges,,
Sup Brace Wrist,,A4570,HCPCS,Facility,Outpatient,,,,38,32.3,10.8908,38,"Health Partners, Inc.",Medicare Advantage,18.62,49,,percent of total billed charges,,
Sup Brace Wrist,,A4570,HCPCS,Facility,Inpatient,,,,38,32.3,10.8908,38,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Brace Wrist,,A4570,HCPCS,Facility,Both,,,,38,32.3,10.8908,38,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),22.8,60,,percent of total billed charges,,
Sup Brace Wrist,,A4570,HCPCS,Facility,Both,,,,38,32.3,10.8908,38,"Health Partners, Inc.",State of Minnesota Advantage Program,30.97,81.5,,percent of total billed charges,,
Sup Brace Wrist,,A4570,HCPCS,Facility,Both,,,,38,32.3,10.8908,38,"Health Partners, Inc.",State Public Programs,19,50,,percent of total billed charges,,
Sup Brace Wrist,,A4570,HCPCS,Facility,Both,,,,38,32.3,10.8908,38,Humana Insurance Company,Commercial PPO,36.1,95,,percent of total billed charges,,
Sup Brace Wrist,,A4570,HCPCS,Facility,Outpatient,,,,38,32.3,10.8908,38,Humana Insurance Company,Medicare PPO,18.62,49,,percent of total billed charges,,
Sup Brace Wrist,,A4570,HCPCS,Facility,Inpatient,,,,38,32.3,10.8908,38,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Sup Brace Wrist,,A4570,HCPCS,Facility,Both,,,,38,32.3,10.8908,38,Medica,Individual & Family,37.658,99.1,,percent of total billed charges,,
Sup Brace Wrist,,A4570,HCPCS,Facility,Outpatient,,,,38,32.3,10.8908,38,Medica,Medica Advantage Solution,18.924,49.8,,percent of total billed charges,,
Sup Brace Wrist,,A4570,HCPCS,Facility,Inpatient,,,,38,32.3,10.8908,38,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Sup Brace Wrist,,A4570,HCPCS,Facility,Outpatient,,,,38,32.3,10.8908,38,Medica,Medical Assistance,16.948,44.6,,percent of total billed charges,,
Sup Brace Wrist,,A4570,HCPCS,Facility,Inpatient,,,,38,32.3,10.8908,38,Medica,Medical Assistance,,,,,Included in per diem rate,
Sup Brace Wrist,,A4570,HCPCS,Facility,Outpatient,,,,38,32.3,10.8908,38,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,18.924,49.8,,percent of total billed charges,,
Sup Brace Wrist,,A4570,HCPCS,Facility,Inpatient,,,,38,32.3,10.8908,38,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Sup Brace Wrist,,A4570,HCPCS,Facility,Both,,,,38,32.3,10.8908,38,"Multiplan, Inc.","Multiplan, Inc.",35.72,94,,percent of total billed charges,,
Sup Brace Wrist,,A4570,HCPCS,Facility,Outpatient,,,,38,32.3,10.8908,38,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,34.238,90.1,,percent of total billed charges,,
Sup Brace Wrist,,A4570,HCPCS,Facility,Inpatient,,,,38,32.3,10.8908,38,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Sup Brace Wrist,,A4570,HCPCS,Facility,Both,,,,38,32.3,10.8908,38,"Preferred One Administrative Services, INC.",PPO,37.468,98.6,,percent of total billed charges,,
Sup Brace Wrist,,A4570,HCPCS,Facility,Outpatient,,,,38,32.3,10.8908,38,PrimeWest Health,Minnesota Senior Health Options (MSHO),19.551,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Sup Brace Wrist,,A4570,HCPCS,Facility,Inpatient,,,,38,32.3,10.8908,38,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Brace Wrist,,A4570,HCPCS,Facility,Outpatient,,,,38,32.3,10.8908,38,PrimeWest Health,MinnesotaCare,19.5168,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Sup Brace Wrist,,A4570,HCPCS,Facility,Inpatient,,,,38,32.3,10.8908,38,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Sup Brace Wrist,,A4570,HCPCS,Facility,Both,,,,38,32.3,10.8908,38,Sanford Health Plan,Sanford Health Plan,34.96,92,,percent of total billed charges,,
Sup Brace Wrist,,A4570,HCPCS,Facility,Outpatient,,,,38,32.3,10.8908,38,"UCare Health, Inc.",Individual & Family Plan,21.413,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Sup Brace Wrist,,A4570,HCPCS,Facility,Inpatient,,,,38,32.3,10.8908,38,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Sup Brace Wrist,,A4570,HCPCS,Facility,Outpatient,,,,38,32.3,10.8908,38,"UCare Health, Inc.",Medical Assistance,19.1786,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Brace Wrist,,A4570,HCPCS,Facility,Inpatient,,,,38,32.3,10.8908,38,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Sup Brace Wrist,,A4570,HCPCS,Facility,Outpatient,,,,38,32.3,10.8908,38,"UCare Health, Inc.",Medicare Advantage,19.1786,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Brace Wrist,,A4570,HCPCS,Facility,Inpatient,,,,38,32.3,10.8908,38,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Brace Wrist,,A4570,HCPCS,Facility,Outpatient,,,,38,32.3,10.8908,38,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),19.1786,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Brace Wrist,,A4570,HCPCS,Facility,Inpatient,,,,38,32.3,10.8908,38,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Brace Wrist,,A4570,HCPCS,Facility,Both,,,,38,32.3,10.8908,38,UnitedHealthcare,Individual & Family,35.72,94,,percent of total billed charges,,
Sup Brace Wrist,,A4570,HCPCS,Facility,Outpatient,,,,38,32.3,10.8908,38,UnitedHealthcare,Medicare Advantage,18.62,49,,percent of total billed charges,,
Sup Brace Wrist,,A4570,HCPCS,Facility,Inpatient,,,,38,32.3,10.8908,38,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Sup Brace Wrist,,A4570,HCPCS,Facility,Outpatient,,,,38,32.3,10.8908,38,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,18.24,48,,percent of total billed charges,,100% of DHS outpatient percentage
Sup Brace Wrist,,A4570,HCPCS,Facility,Inpatient,,,,38,32.3,10.8908,38,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Sup Finger Splint,,A4570,HCPCS,Facility,Both,,,,15,12.75,4.299,15,Aetna,Commercial,13.8,92,,percent of total billed charges,,
Sup Finger Splint,,A4570,HCPCS,Facility,Outpatient,,,,15,12.75,4.299,15,Aetna,Medicare Advantage,7.35,49,,percent of total billed charges,,
Sup Finger Splint,,A4570,HCPCS,Facility,Inpatient,,,,15,12.75,4.299,15,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Sup Finger Splint,,A4570,HCPCS,Facility,Both,,,,15,12.75,4.299,15,Aetna,PPO,13.95,93,,percent of total billed charges,,
Sup Finger Splint,,A4570,HCPCS,Facility,Both,,,,15,12.75,4.299,15,America's PPO,America's PPO,14.4045,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Sup Finger Splint,,A4570,HCPCS,Facility,Both,,,,15,12.75,4.299,15,BlueCross BlueShield Minnesota, Federal Employee Program,14.76,98.4,,percent of total billed charges,,
Sup Finger Splint,,A4570,HCPCS,Facility,Both,,,,15,12.75,4.299,15,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,15,100,,percent of total billed charges,,
Sup Finger Splint,,A4570,HCPCS,Facility,Both,,,,15,12.75,4.299,15,BlueCross BlueShield Minnesota,High Value Network Plan,13.5,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
Sup Finger Splint,,A4570,HCPCS,Facility,Outpatient,,,,15,12.75,4.299,15,BlueCross BlueShield Minnesota,Medicare Advantage,7.35,49,,percent of total billed charges,,
Sup Finger Splint,,A4570,HCPCS,Facility,Inpatient,,,,15,12.75,4.299,15,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Sup Finger Splint,,A4570,HCPCS,Facility,Both,,,,15,12.75,4.299,15,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,13.2855,88.57,,percent of total billed charges,,
Sup Finger Splint,,A4570,HCPCS,Facility,Both,,,,15,12.75,4.299,15,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,4.299,28.66,,percent of total billed charges,,
Sup Finger Splint,,A4570,HCPCS,Facility,Outpatient,,,,15,12.75,4.299,15,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),7.35,49,,percent of total billed charges,,
Sup Finger Splint,,A4570,HCPCS,Facility,Inpatient,,,,15,12.75,4.299,15,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Sup Finger Splint,,A4570,HCPCS,Facility,Both,,,,15,12.75,4.299,15,CorVel,Worker's Compensation,15,100,,percent of total billed charges,,
Sup Finger Splint,,A4570,HCPCS,Facility,Both,,,,15,12.75,4.299,15,First Health Group Corporation,First Health Network,14.55,97,,percent of total billed charges,,
Sup Finger Splint,,A4570,HCPCS,Facility,Both,,,,15,12.75,4.299,15,"Health Partners, Inc.",Commercial,14.19,94.6,,percent of total billed charges,,
Sup Finger Splint,,A4570,HCPCS,Facility,Outpatient,,,,15,12.75,4.299,15,"Health Partners, Inc.",Medicare Advantage,7.35,49,,percent of total billed charges,,
Sup Finger Splint,,A4570,HCPCS,Facility,Inpatient,,,,15,12.75,4.299,15,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Finger Splint,,A4570,HCPCS,Facility,Both,,,,15,12.75,4.299,15,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),9,60,,percent of total billed charges,,
Sup Finger Splint,,A4570,HCPCS,Facility,Both,,,,15,12.75,4.299,15,"Health Partners, Inc.",State of Minnesota Advantage Program,12.225,81.5,,percent of total billed charges,,
Sup Finger Splint,,A4570,HCPCS,Facility,Both,,,,15,12.75,4.299,15,"Health Partners, Inc.",State Public Programs,7.5,50,,percent of total billed charges,,
Sup Finger Splint,,A4570,HCPCS,Facility,Both,,,,15,12.75,4.299,15,Humana Insurance Company,Commercial PPO,14.25,95,,percent of total billed charges,,
Sup Finger Splint,,A4570,HCPCS,Facility,Outpatient,,,,15,12.75,4.299,15,Humana Insurance Company,Medicare PPO,7.35,49,,percent of total billed charges,,
Sup Finger Splint,,A4570,HCPCS,Facility,Inpatient,,,,15,12.75,4.299,15,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Sup Finger Splint,,A4570,HCPCS,Facility,Both,,,,15,12.75,4.299,15,Medica,Individual & Family,14.865,99.1,,percent of total billed charges,,
Sup Finger Splint,,A4570,HCPCS,Facility,Outpatient,,,,15,12.75,4.299,15,Medica,Medica Advantage Solution,7.47,49.8,,percent of total billed charges,,
Sup Finger Splint,,A4570,HCPCS,Facility,Inpatient,,,,15,12.75,4.299,15,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Sup Finger Splint,,A4570,HCPCS,Facility,Outpatient,,,,15,12.75,4.299,15,Medica,Medical Assistance,6.69,44.6,,percent of total billed charges,,
Sup Finger Splint,,A4570,HCPCS,Facility,Inpatient,,,,15,12.75,4.299,15,Medica,Medical Assistance,,,,,Included in per diem rate,
Sup Finger Splint,,A4570,HCPCS,Facility,Outpatient,,,,15,12.75,4.299,15,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,7.47,49.8,,percent of total billed charges,,
Sup Finger Splint,,A4570,HCPCS,Facility,Inpatient,,,,15,12.75,4.299,15,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Sup Finger Splint,,A4570,HCPCS,Facility,Both,,,,15,12.75,4.299,15,"Multiplan, Inc.","Multiplan, Inc.",14.1,94,,percent of total billed charges,,
Sup Finger Splint,,A4570,HCPCS,Facility,Outpatient,,,,15,12.75,4.299,15,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,13.515,90.1,,percent of total billed charges,,
Sup Finger Splint,,A4570,HCPCS,Facility,Inpatient,,,,15,12.75,4.299,15,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Sup Finger Splint,,A4570,HCPCS,Facility,Both,,,,15,12.75,4.299,15,"Preferred One Administrative Services, INC.",PPO,14.79,98.6,,percent of total billed charges,,
Sup Finger Splint,,A4570,HCPCS,Facility,Outpatient,,,,15,12.75,4.299,15,PrimeWest Health,Minnesota Senior Health Options (MSHO),7.7175,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Sup Finger Splint,,A4570,HCPCS,Facility,Inpatient,,,,15,12.75,4.299,15,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Finger Splint,,A4570,HCPCS,Facility,Outpatient,,,,15,12.75,4.299,15,PrimeWest Health,MinnesotaCare,7.704,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Sup Finger Splint,,A4570,HCPCS,Facility,Inpatient,,,,15,12.75,4.299,15,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Sup Finger Splint,,A4570,HCPCS,Facility,Both,,,,15,12.75,4.299,15,Sanford Health Plan,Sanford Health Plan,13.8,92,,percent of total billed charges,,
Sup Finger Splint,,A4570,HCPCS,Facility,Outpatient,,,,15,12.75,4.299,15,"UCare Health, Inc.",Individual & Family Plan,8.4525,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Sup Finger Splint,,A4570,HCPCS,Facility,Inpatient,,,,15,12.75,4.299,15,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Sup Finger Splint,,A4570,HCPCS,Facility,Outpatient,,,,15,12.75,4.299,15,"UCare Health, Inc.",Medical Assistance,7.5705,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Finger Splint,,A4570,HCPCS,Facility,Inpatient,,,,15,12.75,4.299,15,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Sup Finger Splint,,A4570,HCPCS,Facility,Outpatient,,,,15,12.75,4.299,15,"UCare Health, Inc.",Medicare Advantage,7.5705,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Finger Splint,,A4570,HCPCS,Facility,Inpatient,,,,15,12.75,4.299,15,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Finger Splint,,A4570,HCPCS,Facility,Outpatient,,,,15,12.75,4.299,15,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),7.5705,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Finger Splint,,A4570,HCPCS,Facility,Inpatient,,,,15,12.75,4.299,15,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Finger Splint,,A4570,HCPCS,Facility,Both,,,,15,12.75,4.299,15,UnitedHealthcare,Individual & Family,14.1,94,,percent of total billed charges,,
Sup Finger Splint,,A4570,HCPCS,Facility,Outpatient,,,,15,12.75,4.299,15,UnitedHealthcare,Medicare Advantage,7.35,49,,percent of total billed charges,,
Sup Finger Splint,,A4570,HCPCS,Facility,Inpatient,,,,15,12.75,4.299,15,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Sup Finger Splint,,A4570,HCPCS,Facility,Outpatient,,,,15,12.75,4.299,15,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,7.2,48,,percent of total billed charges,,100% of DHS outpatient percentage
Sup Finger Splint,,A4570,HCPCS,Facility,Inpatient,,,,15,12.75,4.299,15,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Sup Tennis Elbow Splint,,A4570,HCPCS,Facility,Both,,,,12,10.2,3.4392,12,Aetna,Commercial,11.04,92,,percent of total billed charges,,
Sup Tennis Elbow Splint,,A4570,HCPCS,Facility,Outpatient,,,,12,10.2,3.4392,12,Aetna,Medicare Advantage,5.88,49,,percent of total billed charges,,
Sup Tennis Elbow Splint,,A4570,HCPCS,Facility,Inpatient,,,,12,10.2,3.4392,12,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Sup Tennis Elbow Splint,,A4570,HCPCS,Facility,Both,,,,12,10.2,3.4392,12,Aetna,PPO,11.16,93,,percent of total billed charges,,
Sup Tennis Elbow Splint,,A4570,HCPCS,Facility,Both,,,,12,10.2,3.4392,12,America's PPO,America's PPO,11.5236,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Sup Tennis Elbow Splint,,A4570,HCPCS,Facility,Both,,,,12,10.2,3.4392,12,BlueCross BlueShield Minnesota, Federal Employee Program,11.808,98.4,,percent of total billed charges,,
Sup Tennis Elbow Splint,,A4570,HCPCS,Facility,Both,,,,12,10.2,3.4392,12,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,12,100,,percent of total billed charges,,
Sup Tennis Elbow Splint,,A4570,HCPCS,Facility,Both,,,,12,10.2,3.4392,12,BlueCross BlueShield Minnesota,High Value Network Plan,10.8,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
Sup Tennis Elbow Splint,,A4570,HCPCS,Facility,Outpatient,,,,12,10.2,3.4392,12,BlueCross BlueShield Minnesota,Medicare Advantage,5.88,49,,percent of total billed charges,,
Sup Tennis Elbow Splint,,A4570,HCPCS,Facility,Inpatient,,,,12,10.2,3.4392,12,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Sup Tennis Elbow Splint,,A4570,HCPCS,Facility,Both,,,,12,10.2,3.4392,12,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,10.6284,88.57,,percent of total billed charges,,
Sup Tennis Elbow Splint,,A4570,HCPCS,Facility,Both,,,,12,10.2,3.4392,12,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,3.4392,28.66,,percent of total billed charges,,
Sup Tennis Elbow Splint,,A4570,HCPCS,Facility,Outpatient,,,,12,10.2,3.4392,12,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),5.88,49,,percent of total billed charges,,
Sup Tennis Elbow Splint,,A4570,HCPCS,Facility,Inpatient,,,,12,10.2,3.4392,12,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Sup Tennis Elbow Splint,,A4570,HCPCS,Facility,Both,,,,12,10.2,3.4392,12,CorVel,Worker's Compensation,12,100,,percent of total billed charges,,
Sup Tennis Elbow Splint,,A4570,HCPCS,Facility,Both,,,,12,10.2,3.4392,12,First Health Group Corporation,First Health Network,11.64,97,,percent of total billed charges,,
Sup Tennis Elbow Splint,,A4570,HCPCS,Facility,Both,,,,12,10.2,3.4392,12,"Health Partners, Inc.",Commercial,11.352,94.6,,percent of total billed charges,,
Sup Tennis Elbow Splint,,A4570,HCPCS,Facility,Outpatient,,,,12,10.2,3.4392,12,"Health Partners, Inc.",Medicare Advantage,5.88,49,,percent of total billed charges,,
Sup Tennis Elbow Splint,,A4570,HCPCS,Facility,Inpatient,,,,12,10.2,3.4392,12,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Tennis Elbow Splint,,A4570,HCPCS,Facility,Both,,,,12,10.2,3.4392,12,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),7.2,60,,percent of total billed charges,,
Sup Tennis Elbow Splint,,A4570,HCPCS,Facility,Both,,,,12,10.2,3.4392,12,"Health Partners, Inc.",State of Minnesota Advantage Program,9.78,81.5,,percent of total billed charges,,
Sup Tennis Elbow Splint,,A4570,HCPCS,Facility,Both,,,,12,10.2,3.4392,12,"Health Partners, Inc.",State Public Programs,6,50,,percent of total billed charges,,
Sup Tennis Elbow Splint,,A4570,HCPCS,Facility,Both,,,,12,10.2,3.4392,12,Humana Insurance Company,Commercial PPO,11.4,95,,percent of total billed charges,,
Sup Tennis Elbow Splint,,A4570,HCPCS,Facility,Outpatient,,,,12,10.2,3.4392,12,Humana Insurance Company,Medicare PPO,5.88,49,,percent of total billed charges,,
Sup Tennis Elbow Splint,,A4570,HCPCS,Facility,Inpatient,,,,12,10.2,3.4392,12,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Sup Tennis Elbow Splint,,A4570,HCPCS,Facility,Both,,,,12,10.2,3.4392,12,Medica,Individual & Family,11.892,99.1,,percent of total billed charges,,
Sup Tennis Elbow Splint,,A4570,HCPCS,Facility,Outpatient,,,,12,10.2,3.4392,12,Medica,Medica Advantage Solution,5.976,49.8,,percent of total billed charges,,
Sup Tennis Elbow Splint,,A4570,HCPCS,Facility,Inpatient,,,,12,10.2,3.4392,12,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Sup Tennis Elbow Splint,,A4570,HCPCS,Facility,Outpatient,,,,12,10.2,3.4392,12,Medica,Medical Assistance,5.352,44.6,,percent of total billed charges,,
Sup Tennis Elbow Splint,,A4570,HCPCS,Facility,Inpatient,,,,12,10.2,3.4392,12,Medica,Medical Assistance,,,,,Included in per diem rate,
Sup Tennis Elbow Splint,,A4570,HCPCS,Facility,Outpatient,,,,12,10.2,3.4392,12,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,5.976,49.8,,percent of total billed charges,,
Sup Tennis Elbow Splint,,A4570,HCPCS,Facility,Inpatient,,,,12,10.2,3.4392,12,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Sup Tennis Elbow Splint,,A4570,HCPCS,Facility,Both,,,,12,10.2,3.4392,12,"Multiplan, Inc.","Multiplan, Inc.",11.28,94,,percent of total billed charges,,
Sup Tennis Elbow Splint,,A4570,HCPCS,Facility,Outpatient,,,,12,10.2,3.4392,12,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,10.812,90.1,,percent of total billed charges,,
Sup Tennis Elbow Splint,,A4570,HCPCS,Facility,Inpatient,,,,12,10.2,3.4392,12,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Sup Tennis Elbow Splint,,A4570,HCPCS,Facility,Both,,,,12,10.2,3.4392,12,"Preferred One Administrative Services, INC.",PPO,11.832,98.6,,percent of total billed charges,,
Sup Tennis Elbow Splint,,A4570,HCPCS,Facility,Outpatient,,,,12,10.2,3.4392,12,PrimeWest Health,Minnesota Senior Health Options (MSHO),6.174,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Sup Tennis Elbow Splint,,A4570,HCPCS,Facility,Inpatient,,,,12,10.2,3.4392,12,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Tennis Elbow Splint,,A4570,HCPCS,Facility,Outpatient,,,,12,10.2,3.4392,12,PrimeWest Health,MinnesotaCare,6.1632,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Sup Tennis Elbow Splint,,A4570,HCPCS,Facility,Inpatient,,,,12,10.2,3.4392,12,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Sup Tennis Elbow Splint,,A4570,HCPCS,Facility,Both,,,,12,10.2,3.4392,12,Sanford Health Plan,Sanford Health Plan,11.04,92,,percent of total billed charges,,
Sup Tennis Elbow Splint,,A4570,HCPCS,Facility,Outpatient,,,,12,10.2,3.4392,12,"UCare Health, Inc.",Individual & Family Plan,6.762,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Sup Tennis Elbow Splint,,A4570,HCPCS,Facility,Inpatient,,,,12,10.2,3.4392,12,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Sup Tennis Elbow Splint,,A4570,HCPCS,Facility,Outpatient,,,,12,10.2,3.4392,12,"UCare Health, Inc.",Medical Assistance,6.0564,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Tennis Elbow Splint,,A4570,HCPCS,Facility,Inpatient,,,,12,10.2,3.4392,12,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Sup Tennis Elbow Splint,,A4570,HCPCS,Facility,Outpatient,,,,12,10.2,3.4392,12,"UCare Health, Inc.",Medicare Advantage,6.0564,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Tennis Elbow Splint,,A4570,HCPCS,Facility,Inpatient,,,,12,10.2,3.4392,12,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Tennis Elbow Splint,,A4570,HCPCS,Facility,Outpatient,,,,12,10.2,3.4392,12,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),6.0564,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Tennis Elbow Splint,,A4570,HCPCS,Facility,Inpatient,,,,12,10.2,3.4392,12,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Tennis Elbow Splint,,A4570,HCPCS,Facility,Both,,,,12,10.2,3.4392,12,UnitedHealthcare,Individual & Family,11.28,94,,percent of total billed charges,,
Sup Tennis Elbow Splint,,A4570,HCPCS,Facility,Outpatient,,,,12,10.2,3.4392,12,UnitedHealthcare,Medicare Advantage,5.88,49,,percent of total billed charges,,
Sup Tennis Elbow Splint,,A4570,HCPCS,Facility,Inpatient,,,,12,10.2,3.4392,12,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Sup Tennis Elbow Splint,,A4570,HCPCS,Facility,Outpatient,,,,12,10.2,3.4392,12,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,5.76,48,,percent of total billed charges,,100% of DHS outpatient percentage
Sup Tennis Elbow Splint,,A4570,HCPCS,Facility,Inpatient,,,,12,10.2,3.4392,12,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Sup Bandage Paste Unna Boot,,A4580,HCPCS,Facility,Both,,,,15,12.75,4.299,15,Aetna,Commercial,13.8,92,,percent of total billed charges,,
Sup Bandage Paste Unna Boot,,A4580,HCPCS,Facility,Outpatient,,,,15,12.75,4.299,15,Aetna,Medicare Advantage,7.35,49,,percent of total billed charges,,
Sup Bandage Paste Unna Boot,,A4580,HCPCS,Facility,Inpatient,,,,15,12.75,4.299,15,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Sup Bandage Paste Unna Boot,,A4580,HCPCS,Facility,Both,,,,15,12.75,4.299,15,Aetna,PPO,13.95,93,,percent of total billed charges,,
Sup Bandage Paste Unna Boot,,A4580,HCPCS,Facility,Both,,,,15,12.75,4.299,15,America's PPO,America's PPO,14.4045,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Sup Bandage Paste Unna Boot,,A4580,HCPCS,Facility,Both,,,,15,12.75,4.299,15,BlueCross BlueShield Minnesota, Federal Employee Program,14.76,98.4,,percent of total billed charges,,
Sup Bandage Paste Unna Boot,,A4580,HCPCS,Facility,Both,,,,15,12.75,4.299,15,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,15,100,,percent of total billed charges,,
Sup Bandage Paste Unna Boot,,A4580,HCPCS,Facility,Both,,,,15,12.75,4.299,15,BlueCross BlueShield Minnesota,High Value Network Plan,13.5,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
Sup Bandage Paste Unna Boot,,A4580,HCPCS,Facility,Outpatient,,,,15,12.75,4.299,15,BlueCross BlueShield Minnesota,Medicare Advantage,7.35,49,,percent of total billed charges,,
Sup Bandage Paste Unna Boot,,A4580,HCPCS,Facility,Inpatient,,,,15,12.75,4.299,15,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Sup Bandage Paste Unna Boot,,A4580,HCPCS,Facility,Both,,,,15,12.75,4.299,15,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,13.2855,88.57,,percent of total billed charges,,
Sup Bandage Paste Unna Boot,,A4580,HCPCS,Facility,Both,,,,15,12.75,4.299,15,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,4.299,28.66,,percent of total billed charges,,
Sup Bandage Paste Unna Boot,,A4580,HCPCS,Facility,Outpatient,,,,15,12.75,4.299,15,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),7.35,49,,percent of total billed charges,,
Sup Bandage Paste Unna Boot,,A4580,HCPCS,Facility,Inpatient,,,,15,12.75,4.299,15,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Sup Bandage Paste Unna Boot,,A4580,HCPCS,Facility,Both,,,,15,12.75,4.299,15,CorVel,Worker's Compensation,15,100,,percent of total billed charges,,
Sup Bandage Paste Unna Boot,,A4580,HCPCS,Facility,Both,,,,15,12.75,4.299,15,First Health Group Corporation,First Health Network,14.55,97,,percent of total billed charges,,
Sup Bandage Paste Unna Boot,,A4580,HCPCS,Facility,Both,,,,15,12.75,4.299,15,"Health Partners, Inc.",Commercial,14.19,94.6,,percent of total billed charges,,
Sup Bandage Paste Unna Boot,,A4580,HCPCS,Facility,Outpatient,,,,15,12.75,4.299,15,"Health Partners, Inc.",Medicare Advantage,7.35,49,,percent of total billed charges,,
Sup Bandage Paste Unna Boot,,A4580,HCPCS,Facility,Inpatient,,,,15,12.75,4.299,15,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Bandage Paste Unna Boot,,A4580,HCPCS,Facility,Both,,,,15,12.75,4.299,15,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),9,60,,percent of total billed charges,,
Sup Bandage Paste Unna Boot,,A4580,HCPCS,Facility,Both,,,,15,12.75,4.299,15,"Health Partners, Inc.",State of Minnesota Advantage Program,12.225,81.5,,percent of total billed charges,,
Sup Bandage Paste Unna Boot,,A4580,HCPCS,Facility,Both,,,,15,12.75,4.299,15,"Health Partners, Inc.",State Public Programs,7.5,50,,percent of total billed charges,,
Sup Bandage Paste Unna Boot,,A4580,HCPCS,Facility,Both,,,,15,12.75,4.299,15,Humana Insurance Company,Commercial PPO,14.25,95,,percent of total billed charges,,
Sup Bandage Paste Unna Boot,,A4580,HCPCS,Facility,Outpatient,,,,15,12.75,4.299,15,Humana Insurance Company,Medicare PPO,7.35,49,,percent of total billed charges,,
Sup Bandage Paste Unna Boot,,A4580,HCPCS,Facility,Inpatient,,,,15,12.75,4.299,15,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Sup Bandage Paste Unna Boot,,A4580,HCPCS,Facility,Both,,,,15,12.75,4.299,15,Medica,Individual & Family,14.865,99.1,,percent of total billed charges,,
Sup Bandage Paste Unna Boot,,A4580,HCPCS,Facility,Outpatient,,,,15,12.75,4.299,15,Medica,Medica Advantage Solution,7.47,49.8,,percent of total billed charges,,
Sup Bandage Paste Unna Boot,,A4580,HCPCS,Facility,Inpatient,,,,15,12.75,4.299,15,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Sup Bandage Paste Unna Boot,,A4580,HCPCS,Facility,Outpatient,,,,15,12.75,4.299,15,Medica,Medical Assistance,6.69,44.6,,percent of total billed charges,,
Sup Bandage Paste Unna Boot,,A4580,HCPCS,Facility,Inpatient,,,,15,12.75,4.299,15,Medica,Medical Assistance,,,,,Included in per diem rate,
Sup Bandage Paste Unna Boot,,A4580,HCPCS,Facility,Outpatient,,,,15,12.75,4.299,15,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,7.47,49.8,,percent of total billed charges,,
Sup Bandage Paste Unna Boot,,A4580,HCPCS,Facility,Inpatient,,,,15,12.75,4.299,15,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Sup Bandage Paste Unna Boot,,A4580,HCPCS,Facility,Both,,,,15,12.75,4.299,15,"Multiplan, Inc.","Multiplan, Inc.",14.1,94,,percent of total billed charges,,
Sup Bandage Paste Unna Boot,,A4580,HCPCS,Facility,Outpatient,,,,15,12.75,4.299,15,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,13.515,90.1,,percent of total billed charges,,
Sup Bandage Paste Unna Boot,,A4580,HCPCS,Facility,Inpatient,,,,15,12.75,4.299,15,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Sup Bandage Paste Unna Boot,,A4580,HCPCS,Facility,Both,,,,15,12.75,4.299,15,"Preferred One Administrative Services, INC.",PPO,14.79,98.6,,percent of total billed charges,,
Sup Bandage Paste Unna Boot,,A4580,HCPCS,Facility,Outpatient,,,,15,12.75,4.299,15,PrimeWest Health,Minnesota Senior Health Options (MSHO),7.7175,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Sup Bandage Paste Unna Boot,,A4580,HCPCS,Facility,Inpatient,,,,15,12.75,4.299,15,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Bandage Paste Unna Boot,,A4580,HCPCS,Facility,Outpatient,,,,15,12.75,4.299,15,PrimeWest Health,MinnesotaCare,7.704,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Sup Bandage Paste Unna Boot,,A4580,HCPCS,Facility,Inpatient,,,,15,12.75,4.299,15,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Sup Bandage Paste Unna Boot,,A4580,HCPCS,Facility,Both,,,,15,12.75,4.299,15,Sanford Health Plan,Sanford Health Plan,13.8,92,,percent of total billed charges,,
Sup Bandage Paste Unna Boot,,A4580,HCPCS,Facility,Outpatient,,,,15,12.75,4.299,15,"UCare Health, Inc.",Individual & Family Plan,8.4525,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Sup Bandage Paste Unna Boot,,A4580,HCPCS,Facility,Inpatient,,,,15,12.75,4.299,15,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Sup Bandage Paste Unna Boot,,A4580,HCPCS,Facility,Outpatient,,,,15,12.75,4.299,15,"UCare Health, Inc.",Medical Assistance,7.5705,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Bandage Paste Unna Boot,,A4580,HCPCS,Facility,Inpatient,,,,15,12.75,4.299,15,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Sup Bandage Paste Unna Boot,,A4580,HCPCS,Facility,Outpatient,,,,15,12.75,4.299,15,"UCare Health, Inc.",Medicare Advantage,7.5705,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Bandage Paste Unna Boot,,A4580,HCPCS,Facility,Inpatient,,,,15,12.75,4.299,15,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Bandage Paste Unna Boot,,A4580,HCPCS,Facility,Outpatient,,,,15,12.75,4.299,15,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),7.5705,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Bandage Paste Unna Boot,,A4580,HCPCS,Facility,Inpatient,,,,15,12.75,4.299,15,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Bandage Paste Unna Boot,,A4580,HCPCS,Facility,Both,,,,15,12.75,4.299,15,UnitedHealthcare,Individual & Family,14.1,94,,percent of total billed charges,,
Sup Bandage Paste Unna Boot,,A4580,HCPCS,Facility,Outpatient,,,,15,12.75,4.299,15,UnitedHealthcare,Medicare Advantage,7.35,49,,percent of total billed charges,,
Sup Bandage Paste Unna Boot,,A4580,HCPCS,Facility,Inpatient,,,,15,12.75,4.299,15,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Sup Bandage Paste Unna Boot,,A4580,HCPCS,Facility,Outpatient,,,,15,12.75,4.299,15,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,7.2,48,,percent of total billed charges,,100% of DHS outpatient percentage
Sup Bandage Paste Unna Boot,,A4580,HCPCS,Facility,Inpatient,,,,15,12.75,4.299,15,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Sup Short Leg Splint (Adult) Fiberglass,,A4590,HCPCS,Facility,Both,,,,46,39.1,13.1836,41.4,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,13.1836,28.66,,percent of total billed charges,,
Sup Short Leg Splint (Adult) Fiberglass,,A4590,HCPCS,Facility,Both,,,,46,39.1,13.1836,41.4,"Health Partners, Inc.",State Public Programs,23,50,,percent of total billed charges,,
Sup Short Leg Splint (Adult) Fiberglass,,A4590,HCPCS,Facility,Outpatient,,,,46,39.1,13.1836,41.4,Medica,Medical Assistance,20.516,44.6,,percent of total billed charges,,
Sup Short Leg Splint (Adult) Fiberglass,,A4590,HCPCS,Facility,Inpatient,,,,46,39.1,13.1836,41.4,Medica,Medical Assistance,,,,,Included in per diem rate,
Sup Short Leg Splint (Adult) Fiberglass,,A4590,HCPCS,Facility,Outpatient,,,,46,39.1,13.1836,41.4,PrimeWest Health,MinnesotaCare,23.6256,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Sup Short Leg Splint (Adult) Fiberglass,,A4590,HCPCS,Facility,Inpatient,,,,46,39.1,13.1836,41.4,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Sup Short Leg Splint (Adult) Fiberglass,,A4590,HCPCS,Facility,Outpatient,,,,46,39.1,13.1836,41.4,"UCare Health, Inc.",Medical Assistance,23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Short Leg Splint (Adult) Fiberglass,,A4590,HCPCS,Facility,Inpatient,,,,46,39.1,13.1836,41.4,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Sup Short Leg Splint (Adult) Fiberglass,,A4590,HCPCS,Facility,Outpatient,,,,46,39.1,13.1836,41.4,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,22.08,48,,percent of total billed charges,,100% of DHS outpatient percentage
Sup Short Leg Splint (Adult) Fiberglass,,A4590,HCPCS,Facility,Inpatient,,,,46,39.1,13.1836,41.4,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Sup Oxisensor,,A4606,HCPCS,Facility,Both,,,,85,72.25,24.361,85,Aetna,Commercial,78.2,92,,percent of total billed charges,,
Sup Oxisensor,,A4606,HCPCS,Facility,Outpatient,,,,85,72.25,24.361,85,Aetna,Medicare Advantage,41.65,49,,percent of total billed charges,,
Sup Oxisensor,,A4606,HCPCS,Facility,Inpatient,,,,85,72.25,24.361,85,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Sup Oxisensor,,A4606,HCPCS,Facility,Both,,,,85,72.25,24.361,85,Aetna,PPO,79.05,93,,percent of total billed charges,,
Sup Oxisensor,,A4606,HCPCS,Facility,Both,,,,85,72.25,24.361,85,America's PPO,America's PPO,81.6255,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Sup Oxisensor,,A4606,HCPCS,Facility,Both,,,,85,72.25,24.361,85,BlueCross BlueShield Minnesota, Federal Employee Program,83.64,98.4,,percent of total billed charges,,
Sup Oxisensor,,A4606,HCPCS,Facility,Both,,,,85,72.25,24.361,85,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,85,100,,percent of total billed charges,,
Sup Oxisensor,,A4606,HCPCS,Facility,Both,,,,85,72.25,24.361,85,BlueCross BlueShield Minnesota,High Value Network Plan,76.5,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
Sup Oxisensor,,A4606,HCPCS,Facility,Outpatient,,,,85,72.25,24.361,85,BlueCross BlueShield Minnesota,Medicare Advantage,41.65,49,,percent of total billed charges,,
Sup Oxisensor,,A4606,HCPCS,Facility,Inpatient,,,,85,72.25,24.361,85,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Sup Oxisensor,,A4606,HCPCS,Facility,Both,,,,85,72.25,24.361,85,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,75.2845,88.57,,percent of total billed charges,,
Sup Oxisensor,,A4606,HCPCS,Facility,Both,,,,85,72.25,24.361,85,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,24.361,28.66,,percent of total billed charges,,
Sup Oxisensor,,A4606,HCPCS,Facility,Outpatient,,,,85,72.25,24.361,85,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),41.65,49,,percent of total billed charges,,
Sup Oxisensor,,A4606,HCPCS,Facility,Inpatient,,,,85,72.25,24.361,85,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Sup Oxisensor,,A4606,HCPCS,Facility,Both,,,,85,72.25,24.361,85,CorVel,Worker's Compensation,85,100,,percent of total billed charges,,
Sup Oxisensor,,A4606,HCPCS,Facility,Both,,,,85,72.25,24.361,85,First Health Group Corporation,First Health Network,82.45,97,,percent of total billed charges,,
Sup Oxisensor,,A4606,HCPCS,Facility,Both,,,,85,72.25,24.361,85,"Health Partners, Inc.",Commercial,80.41,94.6,,percent of total billed charges,,
Sup Oxisensor,,A4606,HCPCS,Facility,Outpatient,,,,85,72.25,24.361,85,"Health Partners, Inc.",Medicare Advantage,41.65,49,,percent of total billed charges,,
Sup Oxisensor,,A4606,HCPCS,Facility,Inpatient,,,,85,72.25,24.361,85,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Oxisensor,,A4606,HCPCS,Facility,Both,,,,85,72.25,24.361,85,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),51,60,,percent of total billed charges,,
Sup Oxisensor,,A4606,HCPCS,Facility,Both,,,,85,72.25,24.361,85,"Health Partners, Inc.",State of Minnesota Advantage Program,69.275,81.5,,percent of total billed charges,,
Sup Oxisensor,,A4606,HCPCS,Facility,Both,,,,85,72.25,24.361,85,"Health Partners, Inc.",State Public Programs,42.5,50,,percent of total billed charges,,
Sup Oxisensor,,A4606,HCPCS,Facility,Both,,,,85,72.25,24.361,85,Humana Insurance Company,Commercial PPO,80.75,95,,percent of total billed charges,,
Sup Oxisensor,,A4606,HCPCS,Facility,Outpatient,,,,85,72.25,24.361,85,Humana Insurance Company,Medicare PPO,41.65,49,,percent of total billed charges,,
Sup Oxisensor,,A4606,HCPCS,Facility,Inpatient,,,,85,72.25,24.361,85,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Sup Oxisensor,,A4606,HCPCS,Facility,Both,,,,85,72.25,24.361,85,Medica,Individual & Family,84.235,99.1,,percent of total billed charges,,
Sup Oxisensor,,A4606,HCPCS,Facility,Outpatient,,,,85,72.25,24.361,85,Medica,Medica Advantage Solution,42.33,49.8,,percent of total billed charges,,
Sup Oxisensor,,A4606,HCPCS,Facility,Inpatient,,,,85,72.25,24.361,85,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Sup Oxisensor,,A4606,HCPCS,Facility,Outpatient,,,,85,72.25,24.361,85,Medica,Medical Assistance,37.91,44.6,,percent of total billed charges,,
Sup Oxisensor,,A4606,HCPCS,Facility,Inpatient,,,,85,72.25,24.361,85,Medica,Medical Assistance,,,,,Included in per diem rate,
Sup Oxisensor,,A4606,HCPCS,Facility,Outpatient,,,,85,72.25,24.361,85,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,42.33,49.8,,percent of total billed charges,,
Sup Oxisensor,,A4606,HCPCS,Facility,Inpatient,,,,85,72.25,24.361,85,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Sup Oxisensor,,A4606,HCPCS,Facility,Both,,,,85,72.25,24.361,85,"Multiplan, Inc.","Multiplan, Inc.",79.9,94,,percent of total billed charges,,
Sup Oxisensor,,A4606,HCPCS,Facility,Outpatient,,,,85,72.25,24.361,85,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,76.585,90.1,,percent of total billed charges,,
Sup Oxisensor,,A4606,HCPCS,Facility,Inpatient,,,,85,72.25,24.361,85,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Sup Oxisensor,,A4606,HCPCS,Facility,Both,,,,85,72.25,24.361,85,"Preferred One Administrative Services, INC.",PPO,83.81,98.6,,percent of total billed charges,,
Sup Oxisensor,,A4606,HCPCS,Facility,Outpatient,,,,85,72.25,24.361,85,PrimeWest Health,Minnesota Senior Health Options (MSHO),43.7325,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Sup Oxisensor,,A4606,HCPCS,Facility,Inpatient,,,,85,72.25,24.361,85,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Oxisensor,,A4606,HCPCS,Facility,Outpatient,,,,85,72.25,24.361,85,PrimeWest Health,MinnesotaCare,43.656,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Sup Oxisensor,,A4606,HCPCS,Facility,Inpatient,,,,85,72.25,24.361,85,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Sup Oxisensor,,A4606,HCPCS,Facility,Both,,,,85,72.25,24.361,85,Sanford Health Plan,Sanford Health Plan,78.2,92,,percent of total billed charges,,
Sup Oxisensor,,A4606,HCPCS,Facility,Outpatient,,,,85,72.25,24.361,85,"UCare Health, Inc.",Individual & Family Plan,47.8975,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Sup Oxisensor,,A4606,HCPCS,Facility,Inpatient,,,,85,72.25,24.361,85,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Sup Oxisensor,,A4606,HCPCS,Facility,Outpatient,,,,85,72.25,24.361,85,"UCare Health, Inc.",Medical Assistance,42.8995,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Oxisensor,,A4606,HCPCS,Facility,Inpatient,,,,85,72.25,24.361,85,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Sup Oxisensor,,A4606,HCPCS,Facility,Outpatient,,,,85,72.25,24.361,85,"UCare Health, Inc.",Medicare Advantage,42.8995,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Oxisensor,,A4606,HCPCS,Facility,Inpatient,,,,85,72.25,24.361,85,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Oxisensor,,A4606,HCPCS,Facility,Outpatient,,,,85,72.25,24.361,85,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),42.8995,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Oxisensor,,A4606,HCPCS,Facility,Inpatient,,,,85,72.25,24.361,85,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Oxisensor,,A4606,HCPCS,Facility,Both,,,,85,72.25,24.361,85,UnitedHealthcare,Individual & Family,79.9,94,,percent of total billed charges,,
Sup Oxisensor,,A4606,HCPCS,Facility,Outpatient,,,,85,72.25,24.361,85,UnitedHealthcare,Medicare Advantage,41.65,49,,percent of total billed charges,,
Sup Oxisensor,,A4606,HCPCS,Facility,Inpatient,,,,85,72.25,24.361,85,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Sup Oxisensor,,A4606,HCPCS,Facility,Outpatient,,,,85,72.25,24.361,85,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,40.8,48,,percent of total billed charges,,100% of DHS outpatient percentage
Sup Oxisensor,,A4606,HCPCS,Facility,Inpatient,,,,85,72.25,24.361,85,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Sup Cannula,,A4615,HCPCS,Facility,Both,,,,87,73.95,24.9342,87,Aetna,Commercial,80.04,92,,percent of total billed charges,,
Sup Cannula,,A4615,HCPCS,Facility,Outpatient,,,,87,73.95,24.9342,87,Aetna,Medicare Advantage,42.63,49,,percent of total billed charges,,
Sup Cannula,,A4615,HCPCS,Facility,Inpatient,,,,87,73.95,24.9342,87,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Sup Cannula,,A4615,HCPCS,Facility,Both,,,,87,73.95,24.9342,87,Aetna,PPO,80.91,93,,percent of total billed charges,,
Sup Cannula,,A4615,HCPCS,Facility,Both,,,,87,73.95,24.9342,87,America's PPO,America's PPO,83.5461,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Sup Cannula,,A4615,HCPCS,Facility,Both,,,,87,73.95,24.9342,87,BlueCross BlueShield Minnesota, Federal Employee Program,85.608,98.4,,percent of total billed charges,,
Sup Cannula,,A4615,HCPCS,Facility,Both,,,,87,73.95,24.9342,87,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,87,100,,percent of total billed charges,,
Sup Cannula,,A4615,HCPCS,Facility,Both,,,,87,73.95,24.9342,87,BlueCross BlueShield Minnesota,High Value Network Plan,78.3,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
Sup Cannula,,A4615,HCPCS,Facility,Outpatient,,,,87,73.95,24.9342,87,BlueCross BlueShield Minnesota,Medicare Advantage,42.63,49,,percent of total billed charges,,
Sup Cannula,,A4615,HCPCS,Facility,Inpatient,,,,87,73.95,24.9342,87,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Sup Cannula,,A4615,HCPCS,Facility,Both,,,,87,73.95,24.9342,87,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,77.0559,88.57,,percent of total billed charges,,
Sup Cannula,,A4615,HCPCS,Facility,Both,,,,87,73.95,24.9342,87,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,24.9342,28.66,,percent of total billed charges,,
Sup Cannula,,A4615,HCPCS,Facility,Outpatient,,,,87,73.95,24.9342,87,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),42.63,49,,percent of total billed charges,,
Sup Cannula,,A4615,HCPCS,Facility,Inpatient,,,,87,73.95,24.9342,87,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Sup Cannula,,A4615,HCPCS,Facility,Both,,,,87,73.95,24.9342,87,CorVel,Worker's Compensation,87,100,,percent of total billed charges,,
Sup Cannula,,A4615,HCPCS,Facility,Both,,,,87,73.95,24.9342,87,First Health Group Corporation,First Health Network,84.39,97,,percent of total billed charges,,
Sup Cannula,,A4615,HCPCS,Facility,Both,,,,87,73.95,24.9342,87,"Health Partners, Inc.",Commercial,82.302,94.6,,percent of total billed charges,,
Sup Cannula,,A4615,HCPCS,Facility,Outpatient,,,,87,73.95,24.9342,87,"Health Partners, Inc.",Medicare Advantage,42.63,49,,percent of total billed charges,,
Sup Cannula,,A4615,HCPCS,Facility,Inpatient,,,,87,73.95,24.9342,87,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Cannula,,A4615,HCPCS,Facility,Both,,,,87,73.95,24.9342,87,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),52.2,60,,percent of total billed charges,,
Sup Cannula,,A4615,HCPCS,Facility,Both,,,,87,73.95,24.9342,87,"Health Partners, Inc.",State of Minnesota Advantage Program,70.905,81.5,,percent of total billed charges,,
Sup Cannula,,A4615,HCPCS,Facility,Both,,,,87,73.95,24.9342,87,"Health Partners, Inc.",State Public Programs,43.5,50,,percent of total billed charges,,
Sup Cannula,,A4615,HCPCS,Facility,Both,,,,87,73.95,24.9342,87,Humana Insurance Company,Commercial PPO,82.65,95,,percent of total billed charges,,
Sup Cannula,,A4615,HCPCS,Facility,Outpatient,,,,87,73.95,24.9342,87,Humana Insurance Company,Medicare PPO,42.63,49,,percent of total billed charges,,
Sup Cannula,,A4615,HCPCS,Facility,Inpatient,,,,87,73.95,24.9342,87,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Sup Cannula,,A4615,HCPCS,Facility,Both,,,,87,73.95,24.9342,87,Medica,Individual & Family,86.217,99.1,,percent of total billed charges,,
Sup Cannula,,A4615,HCPCS,Facility,Outpatient,,,,87,73.95,24.9342,87,Medica,Medica Advantage Solution,43.326,49.8,,percent of total billed charges,,
Sup Cannula,,A4615,HCPCS,Facility,Inpatient,,,,87,73.95,24.9342,87,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Sup Cannula,,A4615,HCPCS,Facility,Outpatient,,,,87,73.95,24.9342,87,Medica,Medical Assistance,38.802,44.6,,percent of total billed charges,,
Sup Cannula,,A4615,HCPCS,Facility,Inpatient,,,,87,73.95,24.9342,87,Medica,Medical Assistance,,,,,Included in per diem rate,
Sup Cannula,,A4615,HCPCS,Facility,Outpatient,,,,87,73.95,24.9342,87,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,43.326,49.8,,percent of total billed charges,,
Sup Cannula,,A4615,HCPCS,Facility,Inpatient,,,,87,73.95,24.9342,87,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Sup Cannula,,A4615,HCPCS,Facility,Both,,,,87,73.95,24.9342,87,"Multiplan, Inc.","Multiplan, Inc.",81.78,94,,percent of total billed charges,,
Sup Cannula,,A4615,HCPCS,Facility,Outpatient,,,,87,73.95,24.9342,87,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,78.387,90.1,,percent of total billed charges,,
Sup Cannula,,A4615,HCPCS,Facility,Inpatient,,,,87,73.95,24.9342,87,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Sup Cannula,,A4615,HCPCS,Facility,Both,,,,87,73.95,24.9342,87,"Preferred One Administrative Services, INC.",PPO,85.782,98.6,,percent of total billed charges,,
Sup Cannula,,A4615,HCPCS,Facility,Outpatient,,,,87,73.95,24.9342,87,PrimeWest Health,Minnesota Senior Health Options (MSHO),44.7615,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Sup Cannula,,A4615,HCPCS,Facility,Inpatient,,,,87,73.95,24.9342,87,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Cannula,,A4615,HCPCS,Facility,Outpatient,,,,87,73.95,24.9342,87,PrimeWest Health,MinnesotaCare,44.6832,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Sup Cannula,,A4615,HCPCS,Facility,Inpatient,,,,87,73.95,24.9342,87,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Sup Cannula,,A4615,HCPCS,Facility,Both,,,,87,73.95,24.9342,87,Sanford Health Plan,Sanford Health Plan,80.04,92,,percent of total billed charges,,
Sup Cannula,,A4615,HCPCS,Facility,Outpatient,,,,87,73.95,24.9342,87,"UCare Health, Inc.",Individual & Family Plan,49.0245,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Sup Cannula,,A4615,HCPCS,Facility,Inpatient,,,,87,73.95,24.9342,87,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Sup Cannula,,A4615,HCPCS,Facility,Outpatient,,,,87,73.95,24.9342,87,"UCare Health, Inc.",Medical Assistance,43.9089,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Cannula,,A4615,HCPCS,Facility,Inpatient,,,,87,73.95,24.9342,87,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Sup Cannula,,A4615,HCPCS,Facility,Outpatient,,,,87,73.95,24.9342,87,"UCare Health, Inc.",Medicare Advantage,43.9089,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Cannula,,A4615,HCPCS,Facility,Inpatient,,,,87,73.95,24.9342,87,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Cannula,,A4615,HCPCS,Facility,Outpatient,,,,87,73.95,24.9342,87,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),43.9089,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Cannula,,A4615,HCPCS,Facility,Inpatient,,,,87,73.95,24.9342,87,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Cannula,,A4615,HCPCS,Facility,Both,,,,87,73.95,24.9342,87,UnitedHealthcare,Individual & Family,81.78,94,,percent of total billed charges,,
Sup Cannula,,A4615,HCPCS,Facility,Outpatient,,,,87,73.95,24.9342,87,UnitedHealthcare,Medicare Advantage,42.63,49,,percent of total billed charges,,
Sup Cannula,,A4615,HCPCS,Facility,Inpatient,,,,87,73.95,24.9342,87,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Sup Cannula,,A4615,HCPCS,Facility,Outpatient,,,,87,73.95,24.9342,87,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,41.76,48,,percent of total billed charges,,100% of DHS outpatient percentage
Sup Cannula,,A4615,HCPCS,Facility,Inpatient,,,,87,73.95,24.9342,87,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
2MM Set SCREW HEX DRIVER,,A4649,HCPCS,Facility,Both,,,,259.35,220.4475,74.32971,259.35,Aetna,Commercial,238.602,92,,percent of total billed charges,,
2MM Set SCREW HEX DRIVER,,A4649,HCPCS,Facility,Outpatient,,,,259.35,220.4475,74.32971,259.35,Aetna,Medicare Advantage,127.0815,49,,percent of total billed charges,,
2MM Set SCREW HEX DRIVER,,A4649,HCPCS,Facility,Inpatient,,,,259.35,220.4475,74.32971,259.35,Aetna,Medicare Advantage,,,,,Included in per diem rate,
2MM Set SCREW HEX DRIVER,,A4649,HCPCS,Facility,Both,,,,259.35,220.4475,74.32971,259.35,Aetna,PPO,241.1955,93,,percent of total billed charges,,
2MM Set SCREW HEX DRIVER,,A4649,HCPCS,Facility,Both,,,,259.35,220.4475,74.32971,259.35,America's PPO,America's PPO,249.053805,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
2MM Set SCREW HEX DRIVER,,A4649,HCPCS,Facility,Both,,,,259.35,220.4475,74.32971,259.35,BlueCross BlueShield Minnesota, Federal Employee Program,255.2004,98.4,,percent of total billed charges,,
2MM Set SCREW HEX DRIVER,,A4649,HCPCS,Facility,Both,,,,259.35,220.4475,74.32971,259.35,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,259.35,100,,percent of total billed charges,,
2MM Set SCREW HEX DRIVER,,A4649,HCPCS,Facility,Both,,,,259.35,220.4475,74.32971,259.35,BlueCross BlueShield Minnesota,High Value Network Plan,233.415,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
2MM Set SCREW HEX DRIVER,,A4649,HCPCS,Facility,Outpatient,,,,259.35,220.4475,74.32971,259.35,BlueCross BlueShield Minnesota,Medicare Advantage,127.0815,49,,percent of total billed charges,,
2MM Set SCREW HEX DRIVER,,A4649,HCPCS,Facility,Inpatient,,,,259.35,220.4475,74.32971,259.35,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
2MM Set SCREW HEX DRIVER,,A4649,HCPCS,Facility,Both,,,,259.35,220.4475,74.32971,259.35,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,229.706295,88.57,,percent of total billed charges,,
2MM Set SCREW HEX DRIVER,,A4649,HCPCS,Facility,Both,,,,259.35,220.4475,74.32971,259.35,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,74.32971,28.66,,percent of total billed charges,,
2MM Set SCREW HEX DRIVER,,A4649,HCPCS,Facility,Outpatient,,,,259.35,220.4475,74.32971,259.35,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),127.0815,49,,percent of total billed charges,,
2MM Set SCREW HEX DRIVER,,A4649,HCPCS,Facility,Inpatient,,,,259.35,220.4475,74.32971,259.35,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
2MM Set SCREW HEX DRIVER,,A4649,HCPCS,Facility,Both,,,,259.35,220.4475,74.32971,259.35,CorVel,Worker's Compensation,259.35,100,,percent of total billed charges,,
2MM Set SCREW HEX DRIVER,,A4649,HCPCS,Facility,Both,,,,259.35,220.4475,74.32971,259.35,First Health Group Corporation,First Health Network,251.5695,97,,percent of total billed charges,,
2MM Set SCREW HEX DRIVER,,A4649,HCPCS,Facility,Both,,,,259.35,220.4475,74.32971,259.35,"Health Partners, Inc.",Commercial,245.3451,94.6,,percent of total billed charges,,
2MM Set SCREW HEX DRIVER,,A4649,HCPCS,Facility,Outpatient,,,,259.35,220.4475,74.32971,259.35,"Health Partners, Inc.",Medicare Advantage,127.0815,49,,percent of total billed charges,,
2MM Set SCREW HEX DRIVER,,A4649,HCPCS,Facility,Inpatient,,,,259.35,220.4475,74.32971,259.35,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
2MM Set SCREW HEX DRIVER,,A4649,HCPCS,Facility,Both,,,,259.35,220.4475,74.32971,259.35,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),155.61,60,,percent of total billed charges,,
2MM Set SCREW HEX DRIVER,,A4649,HCPCS,Facility,Both,,,,259.35,220.4475,74.32971,259.35,"Health Partners, Inc.",State of Minnesota Advantage Program,211.37025,81.5,,percent of total billed charges,,
2MM Set SCREW HEX DRIVER,,A4649,HCPCS,Facility,Both,,,,259.35,220.4475,74.32971,259.35,"Health Partners, Inc.",State Public Programs,129.675,50,,percent of total billed charges,,
2MM Set SCREW HEX DRIVER,,A4649,HCPCS,Facility,Both,,,,259.35,220.4475,74.32971,259.35,Humana Insurance Company,Commercial PPO,246.3825,95,,percent of total billed charges,,
2MM Set SCREW HEX DRIVER,,A4649,HCPCS,Facility,Outpatient,,,,259.35,220.4475,74.32971,259.35,Humana Insurance Company,Medicare PPO,127.0815,49,,percent of total billed charges,,
2MM Set SCREW HEX DRIVER,,A4649,HCPCS,Facility,Inpatient,,,,259.35,220.4475,74.32971,259.35,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
2MM Set SCREW HEX DRIVER,,A4649,HCPCS,Facility,Both,,,,259.35,220.4475,74.32971,259.35,Medica,Individual & Family,257.01585,99.1,,percent of total billed charges,,
2MM Set SCREW HEX DRIVER,,A4649,HCPCS,Facility,Outpatient,,,,259.35,220.4475,74.32971,259.35,Medica,Medica Advantage Solution,129.1563,49.8,,percent of total billed charges,,
2MM Set SCREW HEX DRIVER,,A4649,HCPCS,Facility,Inpatient,,,,259.35,220.4475,74.32971,259.35,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
2MM Set SCREW HEX DRIVER,,A4649,HCPCS,Facility,Outpatient,,,,259.35,220.4475,74.32971,259.35,Medica,Medical Assistance,115.6701,44.6,,percent of total billed charges,,
2MM Set SCREW HEX DRIVER,,A4649,HCPCS,Facility,Inpatient,,,,259.35,220.4475,74.32971,259.35,Medica,Medical Assistance,,,,,Included in per diem rate,
2MM Set SCREW HEX DRIVER,,A4649,HCPCS,Facility,Outpatient,,,,259.35,220.4475,74.32971,259.35,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,129.1563,49.8,,percent of total billed charges,,
2MM Set SCREW HEX DRIVER,,A4649,HCPCS,Facility,Inpatient,,,,259.35,220.4475,74.32971,259.35,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
2MM Set SCREW HEX DRIVER,,A4649,HCPCS,Facility,Both,,,,259.35,220.4475,74.32971,259.35,"Multiplan, Inc.","Multiplan, Inc.",243.789,94,,percent of total billed charges,,
2MM Set SCREW HEX DRIVER,,A4649,HCPCS,Facility,Outpatient,,,,259.35,220.4475,74.32971,259.35,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,233.67435,90.1,,percent of total billed charges,,
2MM Set SCREW HEX DRIVER,,A4649,HCPCS,Facility,Inpatient,,,,259.35,220.4475,74.32971,259.35,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
2MM Set SCREW HEX DRIVER,,A4649,HCPCS,Facility,Both,,,,259.35,220.4475,74.32971,259.35,"Preferred One Administrative Services, INC.",PPO,255.7191,98.6,,percent of total billed charges,,
2MM Set SCREW HEX DRIVER,,A4649,HCPCS,Facility,Outpatient,,,,259.35,220.4475,74.32971,259.35,PrimeWest Health,Minnesota Senior Health Options (MSHO),133.435575,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
2MM Set SCREW HEX DRIVER,,A4649,HCPCS,Facility,Inpatient,,,,259.35,220.4475,74.32971,259.35,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
2MM Set SCREW HEX DRIVER,,A4649,HCPCS,Facility,Outpatient,,,,259.35,220.4475,74.32971,259.35,PrimeWest Health,MinnesotaCare,133.20216,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
2MM Set SCREW HEX DRIVER,,A4649,HCPCS,Facility,Inpatient,,,,259.35,220.4475,74.32971,259.35,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
2MM Set SCREW HEX DRIVER,,A4649,HCPCS,Facility,Both,,,,259.35,220.4475,74.32971,259.35,Sanford Health Plan,Sanford Health Plan,238.602,92,,percent of total billed charges,,
2MM Set SCREW HEX DRIVER,,A4649,HCPCS,Facility,Outpatient,,,,259.35,220.4475,74.32971,259.35,"UCare Health, Inc.",Individual & Family Plan,146.143725,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
2MM Set SCREW HEX DRIVER,,A4649,HCPCS,Facility,Inpatient,,,,259.35,220.4475,74.32971,259.35,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
2MM Set SCREW HEX DRIVER,,A4649,HCPCS,Facility,Outpatient,,,,259.35,220.4475,74.32971,259.35,"UCare Health, Inc.",Medical Assistance,130.893945,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
2MM Set SCREW HEX DRIVER,,A4649,HCPCS,Facility,Inpatient,,,,259.35,220.4475,74.32971,259.35,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
2MM Set SCREW HEX DRIVER,,A4649,HCPCS,Facility,Outpatient,,,,259.35,220.4475,74.32971,259.35,"UCare Health, Inc.",Medicare Advantage,130.893945,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
2MM Set SCREW HEX DRIVER,,A4649,HCPCS,Facility,Inpatient,,,,259.35,220.4475,74.32971,259.35,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
2MM Set SCREW HEX DRIVER,,A4649,HCPCS,Facility,Outpatient,,,,259.35,220.4475,74.32971,259.35,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),130.893945,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
2MM Set SCREW HEX DRIVER,,A4649,HCPCS,Facility,Inpatient,,,,259.35,220.4475,74.32971,259.35,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
2MM Set SCREW HEX DRIVER,,A4649,HCPCS,Facility,Both,,,,259.35,220.4475,74.32971,259.35,UnitedHealthcare,Individual & Family,243.789,94,,percent of total billed charges,,
2MM Set SCREW HEX DRIVER,,A4649,HCPCS,Facility,Outpatient,,,,259.35,220.4475,74.32971,259.35,UnitedHealthcare,Medicare Advantage,127.0815,49,,percent of total billed charges,,
2MM Set SCREW HEX DRIVER,,A4649,HCPCS,Facility,Inpatient,,,,259.35,220.4475,74.32971,259.35,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
2MM Set SCREW HEX DRIVER,,A4649,HCPCS,Facility,Outpatient,,,,259.35,220.4475,74.32971,259.35,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,124.488,48,,percent of total billed charges,,100% of DHS outpatient percentage
2MM Set SCREW HEX DRIVER,,A4649,HCPCS,Facility,Inpatient,,,,259.35,220.4475,74.32971,259.35,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
ABSORBATACK 5MM FIXATION DEVICE3,,A4649,HCPCS,Facility,Both,,,,972.5,826.625,278.7185,972.5,Aetna,Commercial,894.7,92,,percent of total billed charges,,
ABSORBATACK 5MM FIXATION DEVICE3,,A4649,HCPCS,Facility,Outpatient,,,,972.5,826.625,278.7185,972.5,Aetna,Medicare Advantage,476.525,49,,percent of total billed charges,,
ABSORBATACK 5MM FIXATION DEVICE3,,A4649,HCPCS,Facility,Inpatient,,,,972.5,826.625,278.7185,972.5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
ABSORBATACK 5MM FIXATION DEVICE3,,A4649,HCPCS,Facility,Both,,,,972.5,826.625,278.7185,972.5,Aetna,PPO,904.425,93,,percent of total billed charges,,
ABSORBATACK 5MM FIXATION DEVICE3,,A4649,HCPCS,Facility,Both,,,,972.5,826.625,278.7185,972.5,America's PPO,America's PPO,933.89175,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
ABSORBATACK 5MM FIXATION DEVICE3,,A4649,HCPCS,Facility,Both,,,,972.5,826.625,278.7185,972.5,BlueCross BlueShield Minnesota, Federal Employee Program,956.94,98.4,,percent of total billed charges,,
ABSORBATACK 5MM FIXATION DEVICE3,,A4649,HCPCS,Facility,Both,,,,972.5,826.625,278.7185,972.5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,972.5,100,,percent of total billed charges,,
ABSORBATACK 5MM FIXATION DEVICE3,,A4649,HCPCS,Facility,Both,,,,972.5,826.625,278.7185,972.5,BlueCross BlueShield Minnesota,High Value Network Plan,875.25,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
ABSORBATACK 5MM FIXATION DEVICE3,,A4649,HCPCS,Facility,Outpatient,,,,972.5,826.625,278.7185,972.5,BlueCross BlueShield Minnesota,Medicare Advantage,476.525,49,,percent of total billed charges,,
ABSORBATACK 5MM FIXATION DEVICE3,,A4649,HCPCS,Facility,Inpatient,,,,972.5,826.625,278.7185,972.5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
ABSORBATACK 5MM FIXATION DEVICE3,,A4649,HCPCS,Facility,Both,,,,972.5,826.625,278.7185,972.5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,861.34325,88.57,,percent of total billed charges,,
ABSORBATACK 5MM FIXATION DEVICE3,,A4649,HCPCS,Facility,Both,,,,972.5,826.625,278.7185,972.5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,278.7185,28.66,,percent of total billed charges,,
ABSORBATACK 5MM FIXATION DEVICE3,,A4649,HCPCS,Facility,Outpatient,,,,972.5,826.625,278.7185,972.5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),476.525,49,,percent of total billed charges,,
ABSORBATACK 5MM FIXATION DEVICE3,,A4649,HCPCS,Facility,Inpatient,,,,972.5,826.625,278.7185,972.5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
ABSORBATACK 5MM FIXATION DEVICE3,,A4649,HCPCS,Facility,Both,,,,972.5,826.625,278.7185,972.5,CorVel,Worker's Compensation,972.5,100,,percent of total billed charges,,
ABSORBATACK 5MM FIXATION DEVICE3,,A4649,HCPCS,Facility,Both,,,,972.5,826.625,278.7185,972.5,First Health Group Corporation,First Health Network,943.325,97,,percent of total billed charges,,
ABSORBATACK 5MM FIXATION DEVICE3,,A4649,HCPCS,Facility,Both,,,,972.5,826.625,278.7185,972.5,"Health Partners, Inc.",Commercial,919.985,94.6,,percent of total billed charges,,
ABSORBATACK 5MM FIXATION DEVICE3,,A4649,HCPCS,Facility,Outpatient,,,,972.5,826.625,278.7185,972.5,"Health Partners, Inc.",Medicare Advantage,476.525,49,,percent of total billed charges,,
ABSORBATACK 5MM FIXATION DEVICE3,,A4649,HCPCS,Facility,Inpatient,,,,972.5,826.625,278.7185,972.5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ABSORBATACK 5MM FIXATION DEVICE3,,A4649,HCPCS,Facility,Both,,,,972.5,826.625,278.7185,972.5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),583.5,60,,percent of total billed charges,,
ABSORBATACK 5MM FIXATION DEVICE3,,A4649,HCPCS,Facility,Both,,,,972.5,826.625,278.7185,972.5,"Health Partners, Inc.",State of Minnesota Advantage Program,792.5875,81.5,,percent of total billed charges,,
ABSORBATACK 5MM FIXATION DEVICE3,,A4649,HCPCS,Facility,Both,,,,972.5,826.625,278.7185,972.5,"Health Partners, Inc.",State Public Programs,486.25,50,,percent of total billed charges,,
ABSORBATACK 5MM FIXATION DEVICE3,,A4649,HCPCS,Facility,Both,,,,972.5,826.625,278.7185,972.5,Humana Insurance Company,Commercial PPO,923.875,95,,percent of total billed charges,,
ABSORBATACK 5MM FIXATION DEVICE3,,A4649,HCPCS,Facility,Outpatient,,,,972.5,826.625,278.7185,972.5,Humana Insurance Company,Medicare PPO,476.525,49,,percent of total billed charges,,
ABSORBATACK 5MM FIXATION DEVICE3,,A4649,HCPCS,Facility,Inpatient,,,,972.5,826.625,278.7185,972.5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
ABSORBATACK 5MM FIXATION DEVICE3,,A4649,HCPCS,Facility,Both,,,,972.5,826.625,278.7185,972.5,Medica,Individual & Family,963.7475,99.1,,percent of total billed charges,,
ABSORBATACK 5MM FIXATION DEVICE3,,A4649,HCPCS,Facility,Outpatient,,,,972.5,826.625,278.7185,972.5,Medica,Medica Advantage Solution,484.305,49.8,,percent of total billed charges,,
ABSORBATACK 5MM FIXATION DEVICE3,,A4649,HCPCS,Facility,Inpatient,,,,972.5,826.625,278.7185,972.5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
ABSORBATACK 5MM FIXATION DEVICE3,,A4649,HCPCS,Facility,Outpatient,,,,972.5,826.625,278.7185,972.5,Medica,Medical Assistance,433.735,44.6,,percent of total billed charges,,
ABSORBATACK 5MM FIXATION DEVICE3,,A4649,HCPCS,Facility,Inpatient,,,,972.5,826.625,278.7185,972.5,Medica,Medical Assistance,,,,,Included in per diem rate,
ABSORBATACK 5MM FIXATION DEVICE3,,A4649,HCPCS,Facility,Outpatient,,,,972.5,826.625,278.7185,972.5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,484.305,49.8,,percent of total billed charges,,
ABSORBATACK 5MM FIXATION DEVICE3,,A4649,HCPCS,Facility,Inpatient,,,,972.5,826.625,278.7185,972.5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
ABSORBATACK 5MM FIXATION DEVICE3,,A4649,HCPCS,Facility,Both,,,,972.5,826.625,278.7185,972.5,"Multiplan, Inc.","Multiplan, Inc.",914.15,94,,percent of total billed charges,,
ABSORBATACK 5MM FIXATION DEVICE3,,A4649,HCPCS,Facility,Outpatient,,,,972.5,826.625,278.7185,972.5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,876.2225,90.1,,percent of total billed charges,,
ABSORBATACK 5MM FIXATION DEVICE3,,A4649,HCPCS,Facility,Inpatient,,,,972.5,826.625,278.7185,972.5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
ABSORBATACK 5MM FIXATION DEVICE3,,A4649,HCPCS,Facility,Both,,,,972.5,826.625,278.7185,972.5,"Preferred One Administrative Services, INC.",PPO,958.885,98.6,,percent of total billed charges,,
ABSORBATACK 5MM FIXATION DEVICE3,,A4649,HCPCS,Facility,Outpatient,,,,972.5,826.625,278.7185,972.5,PrimeWest Health,Minnesota Senior Health Options (MSHO),500.35125,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
ABSORBATACK 5MM FIXATION DEVICE3,,A4649,HCPCS,Facility,Inpatient,,,,972.5,826.625,278.7185,972.5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ABSORBATACK 5MM FIXATION DEVICE3,,A4649,HCPCS,Facility,Outpatient,,,,972.5,826.625,278.7185,972.5,PrimeWest Health,MinnesotaCare,499.476,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
ABSORBATACK 5MM FIXATION DEVICE3,,A4649,HCPCS,Facility,Inpatient,,,,972.5,826.625,278.7185,972.5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
ABSORBATACK 5MM FIXATION DEVICE3,,A4649,HCPCS,Facility,Both,,,,972.5,826.625,278.7185,972.5,Sanford Health Plan,Sanford Health Plan,894.7,92,,percent of total billed charges,,
ABSORBATACK 5MM FIXATION DEVICE3,,A4649,HCPCS,Facility,Outpatient,,,,972.5,826.625,278.7185,972.5,"UCare Health, Inc.",Individual & Family Plan,548.00375,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
ABSORBATACK 5MM FIXATION DEVICE3,,A4649,HCPCS,Facility,Inpatient,,,,972.5,826.625,278.7185,972.5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
ABSORBATACK 5MM FIXATION DEVICE3,,A4649,HCPCS,Facility,Outpatient,,,,972.5,826.625,278.7185,972.5,"UCare Health, Inc.",Medical Assistance,490.82075,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ABSORBATACK 5MM FIXATION DEVICE3,,A4649,HCPCS,Facility,Inpatient,,,,972.5,826.625,278.7185,972.5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
ABSORBATACK 5MM FIXATION DEVICE3,,A4649,HCPCS,Facility,Outpatient,,,,972.5,826.625,278.7185,972.5,"UCare Health, Inc.",Medicare Advantage,490.82075,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ABSORBATACK 5MM FIXATION DEVICE3,,A4649,HCPCS,Facility,Inpatient,,,,972.5,826.625,278.7185,972.5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ABSORBATACK 5MM FIXATION DEVICE3,,A4649,HCPCS,Facility,Outpatient,,,,972.5,826.625,278.7185,972.5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),490.82075,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ABSORBATACK 5MM FIXATION DEVICE3,,A4649,HCPCS,Facility,Inpatient,,,,972.5,826.625,278.7185,972.5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ABSORBATACK 5MM FIXATION DEVICE3,,A4649,HCPCS,Facility,Both,,,,972.5,826.625,278.7185,972.5,UnitedHealthcare,Individual & Family,914.15,94,,percent of total billed charges,,
ABSORBATACK 5MM FIXATION DEVICE3,,A4649,HCPCS,Facility,Outpatient,,,,972.5,826.625,278.7185,972.5,UnitedHealthcare,Medicare Advantage,476.525,49,,percent of total billed charges,,
ABSORBATACK 5MM FIXATION DEVICE3,,A4649,HCPCS,Facility,Inpatient,,,,972.5,826.625,278.7185,972.5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
ABSORBATACK 5MM FIXATION DEVICE3,,A4649,HCPCS,Facility,Outpatient,,,,972.5,826.625,278.7185,972.5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,466.8,48,,percent of total billed charges,,100% of DHS outpatient percentage
ABSORBATACK 5MM FIXATION DEVICE3,,A4649,HCPCS,Facility,Inpatient,,,,972.5,826.625,278.7185,972.5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
ALL POLY PAT VE 38MM DIA,,A4649,HCPCS,Facility,Both,,,,1995,1695.75,571.767,1995,Aetna,Commercial,1835.4,92,,percent of total billed charges,,
ALL POLY PAT VE 38MM DIA,,A4649,HCPCS,Facility,Outpatient,,,,1995,1695.75,571.767,1995,Aetna,Medicare Advantage,977.55,49,,percent of total billed charges,,
ALL POLY PAT VE 38MM DIA,,A4649,HCPCS,Facility,Inpatient,,,,1995,1695.75,571.767,1995,Aetna,Medicare Advantage,,,,,Included in per diem rate,
ALL POLY PAT VE 38MM DIA,,A4649,HCPCS,Facility,Both,,,,1995,1695.75,571.767,1995,Aetna,PPO,1855.35,93,,percent of total billed charges,,
ALL POLY PAT VE 38MM DIA,,A4649,HCPCS,Facility,Both,,,,1995,1695.75,571.767,1995,America's PPO,America's PPO,1915.7985,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
ALL POLY PAT VE 38MM DIA,,A4649,HCPCS,Facility,Both,,,,1995,1695.75,571.767,1995,BlueCross BlueShield Minnesota, Federal Employee Program,1963.08,98.4,,percent of total billed charges,,
ALL POLY PAT VE 38MM DIA,,A4649,HCPCS,Facility,Both,,,,1995,1695.75,571.767,1995,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1995,100,,percent of total billed charges,,
ALL POLY PAT VE 38MM DIA,,A4649,HCPCS,Facility,Both,,,,1995,1695.75,571.767,1995,BlueCross BlueShield Minnesota,High Value Network Plan,1795.5,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
ALL POLY PAT VE 38MM DIA,,A4649,HCPCS,Facility,Outpatient,,,,1995,1695.75,571.767,1995,BlueCross BlueShield Minnesota,Medicare Advantage,977.55,49,,percent of total billed charges,,
ALL POLY PAT VE 38MM DIA,,A4649,HCPCS,Facility,Inpatient,,,,1995,1695.75,571.767,1995,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
ALL POLY PAT VE 38MM DIA,,A4649,HCPCS,Facility,Both,,,,1995,1695.75,571.767,1995,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1766.9715,88.57,,percent of total billed charges,,
ALL POLY PAT VE 38MM DIA,,A4649,HCPCS,Facility,Both,,,,1995,1695.75,571.767,1995,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,571.767,28.66,,percent of total billed charges,,
ALL POLY PAT VE 38MM DIA,,A4649,HCPCS,Facility,Outpatient,,,,1995,1695.75,571.767,1995,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),977.55,49,,percent of total billed charges,,
ALL POLY PAT VE 38MM DIA,,A4649,HCPCS,Facility,Inpatient,,,,1995,1695.75,571.767,1995,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
ALL POLY PAT VE 38MM DIA,,A4649,HCPCS,Facility,Both,,,,1995,1695.75,571.767,1995,CorVel,Worker's Compensation,1995,100,,percent of total billed charges,,
ALL POLY PAT VE 38MM DIA,,A4649,HCPCS,Facility,Both,,,,1995,1695.75,571.767,1995,First Health Group Corporation,First Health Network,1935.15,97,,percent of total billed charges,,
ALL POLY PAT VE 38MM DIA,,A4649,HCPCS,Facility,Both,,,,1995,1695.75,571.767,1995,"Health Partners, Inc.",Commercial,1887.27,94.6,,percent of total billed charges,,
ALL POLY PAT VE 38MM DIA,,A4649,HCPCS,Facility,Outpatient,,,,1995,1695.75,571.767,1995,"Health Partners, Inc.",Medicare Advantage,977.55,49,,percent of total billed charges,,
ALL POLY PAT VE 38MM DIA,,A4649,HCPCS,Facility,Inpatient,,,,1995,1695.75,571.767,1995,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ALL POLY PAT VE 38MM DIA,,A4649,HCPCS,Facility,Both,,,,1995,1695.75,571.767,1995,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1197,60,,percent of total billed charges,,
ALL POLY PAT VE 38MM DIA,,A4649,HCPCS,Facility,Both,,,,1995,1695.75,571.767,1995,"Health Partners, Inc.",State of Minnesota Advantage Program,1625.925,81.5,,percent of total billed charges,,
ALL POLY PAT VE 38MM DIA,,A4649,HCPCS,Facility,Both,,,,1995,1695.75,571.767,1995,"Health Partners, Inc.",State Public Programs,997.5,50,,percent of total billed charges,,
ALL POLY PAT VE 38MM DIA,,A4649,HCPCS,Facility,Both,,,,1995,1695.75,571.767,1995,Humana Insurance Company,Commercial PPO,1895.25,95,,percent of total billed charges,,
ALL POLY PAT VE 38MM DIA,,A4649,HCPCS,Facility,Outpatient,,,,1995,1695.75,571.767,1995,Humana Insurance Company,Medicare PPO,977.55,49,,percent of total billed charges,,
ALL POLY PAT VE 38MM DIA,,A4649,HCPCS,Facility,Inpatient,,,,1995,1695.75,571.767,1995,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
ALL POLY PAT VE 38MM DIA,,A4649,HCPCS,Facility,Both,,,,1995,1695.75,571.767,1995,Medica,Individual & Family,1977.045,99.1,,percent of total billed charges,,
ALL POLY PAT VE 38MM DIA,,A4649,HCPCS,Facility,Outpatient,,,,1995,1695.75,571.767,1995,Medica,Medica Advantage Solution,993.51,49.8,,percent of total billed charges,,
ALL POLY PAT VE 38MM DIA,,A4649,HCPCS,Facility,Inpatient,,,,1995,1695.75,571.767,1995,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
ALL POLY PAT VE 38MM DIA,,A4649,HCPCS,Facility,Outpatient,,,,1995,1695.75,571.767,1995,Medica,Medical Assistance,889.77,44.6,,percent of total billed charges,,
ALL POLY PAT VE 38MM DIA,,A4649,HCPCS,Facility,Inpatient,,,,1995,1695.75,571.767,1995,Medica,Medical Assistance,,,,,Included in per diem rate,
ALL POLY PAT VE 38MM DIA,,A4649,HCPCS,Facility,Outpatient,,,,1995,1695.75,571.767,1995,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,993.51,49.8,,percent of total billed charges,,
ALL POLY PAT VE 38MM DIA,,A4649,HCPCS,Facility,Inpatient,,,,1995,1695.75,571.767,1995,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
ALL POLY PAT VE 38MM DIA,,A4649,HCPCS,Facility,Both,,,,1995,1695.75,571.767,1995,"Multiplan, Inc.","Multiplan, Inc.",1875.3,94,,percent of total billed charges,,
ALL POLY PAT VE 38MM DIA,,A4649,HCPCS,Facility,Outpatient,,,,1995,1695.75,571.767,1995,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1797.495,90.1,,percent of total billed charges,,
ALL POLY PAT VE 38MM DIA,,A4649,HCPCS,Facility,Inpatient,,,,1995,1695.75,571.767,1995,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
ALL POLY PAT VE 38MM DIA,,A4649,HCPCS,Facility,Both,,,,1995,1695.75,571.767,1995,"Preferred One Administrative Services, INC.",PPO,1967.07,98.6,,percent of total billed charges,,
ALL POLY PAT VE 38MM DIA,,A4649,HCPCS,Facility,Outpatient,,,,1995,1695.75,571.767,1995,PrimeWest Health,Minnesota Senior Health Options (MSHO),1026.4275,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
ALL POLY PAT VE 38MM DIA,,A4649,HCPCS,Facility,Inpatient,,,,1995,1695.75,571.767,1995,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ALL POLY PAT VE 38MM DIA,,A4649,HCPCS,Facility,Outpatient,,,,1995,1695.75,571.767,1995,PrimeWest Health,MinnesotaCare,1024.632,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
ALL POLY PAT VE 38MM DIA,,A4649,HCPCS,Facility,Inpatient,,,,1995,1695.75,571.767,1995,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
ALL POLY PAT VE 38MM DIA,,A4649,HCPCS,Facility,Both,,,,1995,1695.75,571.767,1995,Sanford Health Plan,Sanford Health Plan,1835.4,92,,percent of total billed charges,,
ALL POLY PAT VE 38MM DIA,,A4649,HCPCS,Facility,Outpatient,,,,1995,1695.75,571.767,1995,"UCare Health, Inc.",Individual & Family Plan,1124.1825,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
ALL POLY PAT VE 38MM DIA,,A4649,HCPCS,Facility,Inpatient,,,,1995,1695.75,571.767,1995,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
ALL POLY PAT VE 38MM DIA,,A4649,HCPCS,Facility,Outpatient,,,,1995,1695.75,571.767,1995,"UCare Health, Inc.",Medical Assistance,1006.8765,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ALL POLY PAT VE 38MM DIA,,A4649,HCPCS,Facility,Inpatient,,,,1995,1695.75,571.767,1995,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
ALL POLY PAT VE 38MM DIA,,A4649,HCPCS,Facility,Outpatient,,,,1995,1695.75,571.767,1995,"UCare Health, Inc.",Medicare Advantage,1006.8765,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ALL POLY PAT VE 38MM DIA,,A4649,HCPCS,Facility,Inpatient,,,,1995,1695.75,571.767,1995,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ALL POLY PAT VE 38MM DIA,,A4649,HCPCS,Facility,Outpatient,,,,1995,1695.75,571.767,1995,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1006.8765,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ALL POLY PAT VE 38MM DIA,,A4649,HCPCS,Facility,Inpatient,,,,1995,1695.75,571.767,1995,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ALL POLY PAT VE 38MM DIA,,A4649,HCPCS,Facility,Both,,,,1995,1695.75,571.767,1995,UnitedHealthcare,Individual & Family,1875.3,94,,percent of total billed charges,,
ALL POLY PAT VE 38MM DIA,,A4649,HCPCS,Facility,Outpatient,,,,1995,1695.75,571.767,1995,UnitedHealthcare,Medicare Advantage,977.55,49,,percent of total billed charges,,
ALL POLY PAT VE 38MM DIA,,A4649,HCPCS,Facility,Inpatient,,,,1995,1695.75,571.767,1995,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
ALL POLY PAT VE 38MM DIA,,A4649,HCPCS,Facility,Outpatient,,,,1995,1695.75,571.767,1995,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,957.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
ALL POLY PAT VE 38MM DIA,,A4649,HCPCS,Facility,Inpatient,,,,1995,1695.75,571.767,1995,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
ANGLED TOMCAT BLADE  STRYKER 0380-545-150,,A4649,HCPCS,Facility,Both,,,,289.59,246.1515,82.996494,289.59,Aetna,Commercial,266.4228,92,,percent of total billed charges,,
ANGLED TOMCAT BLADE  STRYKER 0380-545-150,,A4649,HCPCS,Facility,Outpatient,,,,289.59,246.1515,82.996494,289.59,Aetna,Medicare Advantage,141.8991,49,,percent of total billed charges,,
ANGLED TOMCAT BLADE  STRYKER 0380-545-150,,A4649,HCPCS,Facility,Inpatient,,,,289.59,246.1515,82.996494,289.59,Aetna,Medicare Advantage,,,,,Included in per diem rate,
ANGLED TOMCAT BLADE  STRYKER 0380-545-150,,A4649,HCPCS,Facility,Both,,,,289.59,246.1515,82.996494,289.59,Aetna,PPO,269.3187,93,,percent of total billed charges,,
ANGLED TOMCAT BLADE  STRYKER 0380-545-150,,A4649,HCPCS,Facility,Both,,,,289.59,246.1515,82.996494,289.59,America's PPO,America's PPO,278.093277,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
ANGLED TOMCAT BLADE  STRYKER 0380-545-150,,A4649,HCPCS,Facility,Both,,,,289.59,246.1515,82.996494,289.59,BlueCross BlueShield Minnesota, Federal Employee Program,284.95656,98.4,,percent of total billed charges,,
ANGLED TOMCAT BLADE  STRYKER 0380-545-150,,A4649,HCPCS,Facility,Both,,,,289.59,246.1515,82.996494,289.59,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,289.59,100,,percent of total billed charges,,
ANGLED TOMCAT BLADE  STRYKER 0380-545-150,,A4649,HCPCS,Facility,Both,,,,289.59,246.1515,82.996494,289.59,BlueCross BlueShield Minnesota,High Value Network Plan,260.631,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
ANGLED TOMCAT BLADE  STRYKER 0380-545-150,,A4649,HCPCS,Facility,Outpatient,,,,289.59,246.1515,82.996494,289.59,BlueCross BlueShield Minnesota,Medicare Advantage,141.8991,49,,percent of total billed charges,,
ANGLED TOMCAT BLADE  STRYKER 0380-545-150,,A4649,HCPCS,Facility,Inpatient,,,,289.59,246.1515,82.996494,289.59,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
ANGLED TOMCAT BLADE  STRYKER 0380-545-150,,A4649,HCPCS,Facility,Both,,,,289.59,246.1515,82.996494,289.59,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,256.489863,88.57,,percent of total billed charges,,
ANGLED TOMCAT BLADE  STRYKER 0380-545-150,,A4649,HCPCS,Facility,Both,,,,289.59,246.1515,82.996494,289.59,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,82.996494,28.66,,percent of total billed charges,,
ANGLED TOMCAT BLADE  STRYKER 0380-545-150,,A4649,HCPCS,Facility,Outpatient,,,,289.59,246.1515,82.996494,289.59,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),141.8991,49,,percent of total billed charges,,
ANGLED TOMCAT BLADE  STRYKER 0380-545-150,,A4649,HCPCS,Facility,Inpatient,,,,289.59,246.1515,82.996494,289.59,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
ANGLED TOMCAT BLADE  STRYKER 0380-545-150,,A4649,HCPCS,Facility,Both,,,,289.59,246.1515,82.996494,289.59,CorVel,Worker's Compensation,289.59,100,,percent of total billed charges,,
ANGLED TOMCAT BLADE  STRYKER 0380-545-150,,A4649,HCPCS,Facility,Both,,,,289.59,246.1515,82.996494,289.59,First Health Group Corporation,First Health Network,280.9023,97,,percent of total billed charges,,
ANGLED TOMCAT BLADE  STRYKER 0380-545-150,,A4649,HCPCS,Facility,Both,,,,289.59,246.1515,82.996494,289.59,"Health Partners, Inc.",Commercial,273.95214,94.6,,percent of total billed charges,,
ANGLED TOMCAT BLADE  STRYKER 0380-545-150,,A4649,HCPCS,Facility,Outpatient,,,,289.59,246.1515,82.996494,289.59,"Health Partners, Inc.",Medicare Advantage,141.8991,49,,percent of total billed charges,,
ANGLED TOMCAT BLADE  STRYKER 0380-545-150,,A4649,HCPCS,Facility,Inpatient,,,,289.59,246.1515,82.996494,289.59,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ANGLED TOMCAT BLADE  STRYKER 0380-545-150,,A4649,HCPCS,Facility,Both,,,,289.59,246.1515,82.996494,289.59,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),173.754,60,,percent of total billed charges,,
ANGLED TOMCAT BLADE  STRYKER 0380-545-150,,A4649,HCPCS,Facility,Both,,,,289.59,246.1515,82.996494,289.59,"Health Partners, Inc.",State of Minnesota Advantage Program,236.01585,81.5,,percent of total billed charges,,
ANGLED TOMCAT BLADE  STRYKER 0380-545-150,,A4649,HCPCS,Facility,Both,,,,289.59,246.1515,82.996494,289.59,"Health Partners, Inc.",State Public Programs,144.795,50,,percent of total billed charges,,
ANGLED TOMCAT BLADE  STRYKER 0380-545-150,,A4649,HCPCS,Facility,Both,,,,289.59,246.1515,82.996494,289.59,Humana Insurance Company,Commercial PPO,275.1105,95,,percent of total billed charges,,
ANGLED TOMCAT BLADE  STRYKER 0380-545-150,,A4649,HCPCS,Facility,Outpatient,,,,289.59,246.1515,82.996494,289.59,Humana Insurance Company,Medicare PPO,141.8991,49,,percent of total billed charges,,
ANGLED TOMCAT BLADE  STRYKER 0380-545-150,,A4649,HCPCS,Facility,Inpatient,,,,289.59,246.1515,82.996494,289.59,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
ANGLED TOMCAT BLADE  STRYKER 0380-545-150,,A4649,HCPCS,Facility,Both,,,,289.59,246.1515,82.996494,289.59,Medica,Individual & Family,286.98369,99.1,,percent of total billed charges,,
ANGLED TOMCAT BLADE  STRYKER 0380-545-150,,A4649,HCPCS,Facility,Outpatient,,,,289.59,246.1515,82.996494,289.59,Medica,Medica Advantage Solution,144.21582,49.8,,percent of total billed charges,,
ANGLED TOMCAT BLADE  STRYKER 0380-545-150,,A4649,HCPCS,Facility,Inpatient,,,,289.59,246.1515,82.996494,289.59,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
ANGLED TOMCAT BLADE  STRYKER 0380-545-150,,A4649,HCPCS,Facility,Outpatient,,,,289.59,246.1515,82.996494,289.59,Medica,Medical Assistance,129.15714,44.6,,percent of total billed charges,,
ANGLED TOMCAT BLADE  STRYKER 0380-545-150,,A4649,HCPCS,Facility,Inpatient,,,,289.59,246.1515,82.996494,289.59,Medica,Medical Assistance,,,,,Included in per diem rate,
ANGLED TOMCAT BLADE  STRYKER 0380-545-150,,A4649,HCPCS,Facility,Outpatient,,,,289.59,246.1515,82.996494,289.59,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,144.21582,49.8,,percent of total billed charges,,
ANGLED TOMCAT BLADE  STRYKER 0380-545-150,,A4649,HCPCS,Facility,Inpatient,,,,289.59,246.1515,82.996494,289.59,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
ANGLED TOMCAT BLADE  STRYKER 0380-545-150,,A4649,HCPCS,Facility,Both,,,,289.59,246.1515,82.996494,289.59,"Multiplan, Inc.","Multiplan, Inc.",272.2146,94,,percent of total billed charges,,
ANGLED TOMCAT BLADE  STRYKER 0380-545-150,,A4649,HCPCS,Facility,Outpatient,,,,289.59,246.1515,82.996494,289.59,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,260.92059,90.1,,percent of total billed charges,,
ANGLED TOMCAT BLADE  STRYKER 0380-545-150,,A4649,HCPCS,Facility,Inpatient,,,,289.59,246.1515,82.996494,289.59,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
ANGLED TOMCAT BLADE  STRYKER 0380-545-150,,A4649,HCPCS,Facility,Both,,,,289.59,246.1515,82.996494,289.59,"Preferred One Administrative Services, INC.",PPO,285.53574,98.6,,percent of total billed charges,,
ANGLED TOMCAT BLADE  STRYKER 0380-545-150,,A4649,HCPCS,Facility,Outpatient,,,,289.59,246.1515,82.996494,289.59,PrimeWest Health,Minnesota Senior Health Options (MSHO),148.994055,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
ANGLED TOMCAT BLADE  STRYKER 0380-545-150,,A4649,HCPCS,Facility,Inpatient,,,,289.59,246.1515,82.996494,289.59,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ANGLED TOMCAT BLADE  STRYKER 0380-545-150,,A4649,HCPCS,Facility,Outpatient,,,,289.59,246.1515,82.996494,289.59,PrimeWest Health,MinnesotaCare,148.733424,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
ANGLED TOMCAT BLADE  STRYKER 0380-545-150,,A4649,HCPCS,Facility,Inpatient,,,,289.59,246.1515,82.996494,289.59,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
ANGLED TOMCAT BLADE  STRYKER 0380-545-150,,A4649,HCPCS,Facility,Both,,,,289.59,246.1515,82.996494,289.59,Sanford Health Plan,Sanford Health Plan,266.4228,92,,percent of total billed charges,,
ANGLED TOMCAT BLADE  STRYKER 0380-545-150,,A4649,HCPCS,Facility,Outpatient,,,,289.59,246.1515,82.996494,289.59,"UCare Health, Inc.",Individual & Family Plan,163.183965,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
ANGLED TOMCAT BLADE  STRYKER 0380-545-150,,A4649,HCPCS,Facility,Inpatient,,,,289.59,246.1515,82.996494,289.59,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
ANGLED TOMCAT BLADE  STRYKER 0380-545-150,,A4649,HCPCS,Facility,Outpatient,,,,289.59,246.1515,82.996494,289.59,"UCare Health, Inc.",Medical Assistance,146.156073,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ANGLED TOMCAT BLADE  STRYKER 0380-545-150,,A4649,HCPCS,Facility,Inpatient,,,,289.59,246.1515,82.996494,289.59,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
ANGLED TOMCAT BLADE  STRYKER 0380-545-150,,A4649,HCPCS,Facility,Outpatient,,,,289.59,246.1515,82.996494,289.59,"UCare Health, Inc.",Medicare Advantage,146.156073,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ANGLED TOMCAT BLADE  STRYKER 0380-545-150,,A4649,HCPCS,Facility,Inpatient,,,,289.59,246.1515,82.996494,289.59,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ANGLED TOMCAT BLADE  STRYKER 0380-545-150,,A4649,HCPCS,Facility,Outpatient,,,,289.59,246.1515,82.996494,289.59,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),146.156073,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ANGLED TOMCAT BLADE  STRYKER 0380-545-150,,A4649,HCPCS,Facility,Inpatient,,,,289.59,246.1515,82.996494,289.59,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ANGLED TOMCAT BLADE  STRYKER 0380-545-150,,A4649,HCPCS,Facility,Both,,,,289.59,246.1515,82.996494,289.59,UnitedHealthcare,Individual & Family,272.2146,94,,percent of total billed charges,,
ANGLED TOMCAT BLADE  STRYKER 0380-545-150,,A4649,HCPCS,Facility,Outpatient,,,,289.59,246.1515,82.996494,289.59,UnitedHealthcare,Medicare Advantage,141.8991,49,,percent of total billed charges,,
ANGLED TOMCAT BLADE  STRYKER 0380-545-150,,A4649,HCPCS,Facility,Inpatient,,,,289.59,246.1515,82.996494,289.59,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
ANGLED TOMCAT BLADE  STRYKER 0380-545-150,,A4649,HCPCS,Facility,Outpatient,,,,289.59,246.1515,82.996494,289.59,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,139.0032,48,,percent of total billed charges,,100% of DHS outpatient percentage
ANGLED TOMCAT BLADE  STRYKER 0380-545-150,,A4649,HCPCS,Facility,Inpatient,,,,289.59,246.1515,82.996494,289.59,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
ARTHRO SHAVER BLADE 4.0 ANGLES,,A4649,HCPCS,Facility,Both,,,,207.9,176.715,59.58414,207.9,Aetna,Commercial,191.268,92,,percent of total billed charges,,
ARTHRO SHAVER BLADE 4.0 ANGLES,,A4649,HCPCS,Facility,Outpatient,,,,207.9,176.715,59.58414,207.9,Aetna,Medicare Advantage,101.871,49,,percent of total billed charges,,
ARTHRO SHAVER BLADE 4.0 ANGLES,,A4649,HCPCS,Facility,Inpatient,,,,207.9,176.715,59.58414,207.9,Aetna,Medicare Advantage,,,,,Included in per diem rate,
ARTHRO SHAVER BLADE 4.0 ANGLES,,A4649,HCPCS,Facility,Both,,,,207.9,176.715,59.58414,207.9,Aetna,PPO,193.347,93,,percent of total billed charges,,
ARTHRO SHAVER BLADE 4.0 ANGLES,,A4649,HCPCS,Facility,Both,,,,207.9,176.715,59.58414,207.9,America's PPO,America's PPO,199.64637,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
ARTHRO SHAVER BLADE 4.0 ANGLES,,A4649,HCPCS,Facility,Both,,,,207.9,176.715,59.58414,207.9,BlueCross BlueShield Minnesota, Federal Employee Program,204.5736,98.4,,percent of total billed charges,,
ARTHRO SHAVER BLADE 4.0 ANGLES,,A4649,HCPCS,Facility,Both,,,,207.9,176.715,59.58414,207.9,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,207.9,100,,percent of total billed charges,,
ARTHRO SHAVER BLADE 4.0 ANGLES,,A4649,HCPCS,Facility,Both,,,,207.9,176.715,59.58414,207.9,BlueCross BlueShield Minnesota,High Value Network Plan,187.11,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
ARTHRO SHAVER BLADE 4.0 ANGLES,,A4649,HCPCS,Facility,Outpatient,,,,207.9,176.715,59.58414,207.9,BlueCross BlueShield Minnesota,Medicare Advantage,101.871,49,,percent of total billed charges,,
ARTHRO SHAVER BLADE 4.0 ANGLES,,A4649,HCPCS,Facility,Inpatient,,,,207.9,176.715,59.58414,207.9,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
ARTHRO SHAVER BLADE 4.0 ANGLES,,A4649,HCPCS,Facility,Both,,,,207.9,176.715,59.58414,207.9,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,184.13703,88.57,,percent of total billed charges,,
ARTHRO SHAVER BLADE 4.0 ANGLES,,A4649,HCPCS,Facility,Both,,,,207.9,176.715,59.58414,207.9,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,59.58414,28.66,,percent of total billed charges,,
ARTHRO SHAVER BLADE 4.0 ANGLES,,A4649,HCPCS,Facility,Outpatient,,,,207.9,176.715,59.58414,207.9,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),101.871,49,,percent of total billed charges,,
ARTHRO SHAVER BLADE 4.0 ANGLES,,A4649,HCPCS,Facility,Inpatient,,,,207.9,176.715,59.58414,207.9,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
ARTHRO SHAVER BLADE 4.0 ANGLES,,A4649,HCPCS,Facility,Both,,,,207.9,176.715,59.58414,207.9,CorVel,Worker's Compensation,207.9,100,,percent of total billed charges,,
ARTHRO SHAVER BLADE 4.0 ANGLES,,A4649,HCPCS,Facility,Both,,,,207.9,176.715,59.58414,207.9,First Health Group Corporation,First Health Network,201.663,97,,percent of total billed charges,,
ARTHRO SHAVER BLADE 4.0 ANGLES,,A4649,HCPCS,Facility,Both,,,,207.9,176.715,59.58414,207.9,"Health Partners, Inc.",Commercial,196.6734,94.6,,percent of total billed charges,,
ARTHRO SHAVER BLADE 4.0 ANGLES,,A4649,HCPCS,Facility,Outpatient,,,,207.9,176.715,59.58414,207.9,"Health Partners, Inc.",Medicare Advantage,101.871,49,,percent of total billed charges,,
ARTHRO SHAVER BLADE 4.0 ANGLES,,A4649,HCPCS,Facility,Inpatient,,,,207.9,176.715,59.58414,207.9,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ARTHRO SHAVER BLADE 4.0 ANGLES,,A4649,HCPCS,Facility,Both,,,,207.9,176.715,59.58414,207.9,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),124.74,60,,percent of total billed charges,,
ARTHRO SHAVER BLADE 4.0 ANGLES,,A4649,HCPCS,Facility,Both,,,,207.9,176.715,59.58414,207.9,"Health Partners, Inc.",State of Minnesota Advantage Program,169.4385,81.5,,percent of total billed charges,,
ARTHRO SHAVER BLADE 4.0 ANGLES,,A4649,HCPCS,Facility,Both,,,,207.9,176.715,59.58414,207.9,"Health Partners, Inc.",State Public Programs,103.95,50,,percent of total billed charges,,
ARTHRO SHAVER BLADE 4.0 ANGLES,,A4649,HCPCS,Facility,Both,,,,207.9,176.715,59.58414,207.9,Humana Insurance Company,Commercial PPO,197.505,95,,percent of total billed charges,,
ARTHRO SHAVER BLADE 4.0 ANGLES,,A4649,HCPCS,Facility,Outpatient,,,,207.9,176.715,59.58414,207.9,Humana Insurance Company,Medicare PPO,101.871,49,,percent of total billed charges,,
ARTHRO SHAVER BLADE 4.0 ANGLES,,A4649,HCPCS,Facility,Inpatient,,,,207.9,176.715,59.58414,207.9,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
ARTHRO SHAVER BLADE 4.0 ANGLES,,A4649,HCPCS,Facility,Both,,,,207.9,176.715,59.58414,207.9,Medica,Individual & Family,206.0289,99.1,,percent of total billed charges,,
ARTHRO SHAVER BLADE 4.0 ANGLES,,A4649,HCPCS,Facility,Outpatient,,,,207.9,176.715,59.58414,207.9,Medica,Medica Advantage Solution,103.5342,49.8,,percent of total billed charges,,
ARTHRO SHAVER BLADE 4.0 ANGLES,,A4649,HCPCS,Facility,Inpatient,,,,207.9,176.715,59.58414,207.9,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
ARTHRO SHAVER BLADE 4.0 ANGLES,,A4649,HCPCS,Facility,Outpatient,,,,207.9,176.715,59.58414,207.9,Medica,Medical Assistance,92.7234,44.6,,percent of total billed charges,,
ARTHRO SHAVER BLADE 4.0 ANGLES,,A4649,HCPCS,Facility,Inpatient,,,,207.9,176.715,59.58414,207.9,Medica,Medical Assistance,,,,,Included in per diem rate,
ARTHRO SHAVER BLADE 4.0 ANGLES,,A4649,HCPCS,Facility,Outpatient,,,,207.9,176.715,59.58414,207.9,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,103.5342,49.8,,percent of total billed charges,,
ARTHRO SHAVER BLADE 4.0 ANGLES,,A4649,HCPCS,Facility,Inpatient,,,,207.9,176.715,59.58414,207.9,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
ARTHRO SHAVER BLADE 4.0 ANGLES,,A4649,HCPCS,Facility,Both,,,,207.9,176.715,59.58414,207.9,"Multiplan, Inc.","Multiplan, Inc.",195.426,94,,percent of total billed charges,,
ARTHRO SHAVER BLADE 4.0 ANGLES,,A4649,HCPCS,Facility,Outpatient,,,,207.9,176.715,59.58414,207.9,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,187.3179,90.1,,percent of total billed charges,,
ARTHRO SHAVER BLADE 4.0 ANGLES,,A4649,HCPCS,Facility,Inpatient,,,,207.9,176.715,59.58414,207.9,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
ARTHRO SHAVER BLADE 4.0 ANGLES,,A4649,HCPCS,Facility,Both,,,,207.9,176.715,59.58414,207.9,"Preferred One Administrative Services, INC.",PPO,204.9894,98.6,,percent of total billed charges,,
ARTHRO SHAVER BLADE 4.0 ANGLES,,A4649,HCPCS,Facility,Outpatient,,,,207.9,176.715,59.58414,207.9,PrimeWest Health,Minnesota Senior Health Options (MSHO),106.96455,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
ARTHRO SHAVER BLADE 4.0 ANGLES,,A4649,HCPCS,Facility,Inpatient,,,,207.9,176.715,59.58414,207.9,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ARTHRO SHAVER BLADE 4.0 ANGLES,,A4649,HCPCS,Facility,Outpatient,,,,207.9,176.715,59.58414,207.9,PrimeWest Health,MinnesotaCare,106.77744,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
ARTHRO SHAVER BLADE 4.0 ANGLES,,A4649,HCPCS,Facility,Inpatient,,,,207.9,176.715,59.58414,207.9,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
ARTHRO SHAVER BLADE 4.0 ANGLES,,A4649,HCPCS,Facility,Both,,,,207.9,176.715,59.58414,207.9,Sanford Health Plan,Sanford Health Plan,191.268,92,,percent of total billed charges,,
ARTHRO SHAVER BLADE 4.0 ANGLES,,A4649,HCPCS,Facility,Outpatient,,,,207.9,176.715,59.58414,207.9,"UCare Health, Inc.",Individual & Family Plan,117.15165,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
ARTHRO SHAVER BLADE 4.0 ANGLES,,A4649,HCPCS,Facility,Inpatient,,,,207.9,176.715,59.58414,207.9,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
ARTHRO SHAVER BLADE 4.0 ANGLES,,A4649,HCPCS,Facility,Outpatient,,,,207.9,176.715,59.58414,207.9,"UCare Health, Inc.",Medical Assistance,104.92713,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ARTHRO SHAVER BLADE 4.0 ANGLES,,A4649,HCPCS,Facility,Inpatient,,,,207.9,176.715,59.58414,207.9,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
ARTHRO SHAVER BLADE 4.0 ANGLES,,A4649,HCPCS,Facility,Outpatient,,,,207.9,176.715,59.58414,207.9,"UCare Health, Inc.",Medicare Advantage,104.92713,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ARTHRO SHAVER BLADE 4.0 ANGLES,,A4649,HCPCS,Facility,Inpatient,,,,207.9,176.715,59.58414,207.9,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ARTHRO SHAVER BLADE 4.0 ANGLES,,A4649,HCPCS,Facility,Outpatient,,,,207.9,176.715,59.58414,207.9,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),104.92713,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ARTHRO SHAVER BLADE 4.0 ANGLES,,A4649,HCPCS,Facility,Inpatient,,,,207.9,176.715,59.58414,207.9,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ARTHRO SHAVER BLADE 4.0 ANGLES,,A4649,HCPCS,Facility,Both,,,,207.9,176.715,59.58414,207.9,UnitedHealthcare,Individual & Family,195.426,94,,percent of total billed charges,,
ARTHRO SHAVER BLADE 4.0 ANGLES,,A4649,HCPCS,Facility,Outpatient,,,,207.9,176.715,59.58414,207.9,UnitedHealthcare,Medicare Advantage,101.871,49,,percent of total billed charges,,
ARTHRO SHAVER BLADE 4.0 ANGLES,,A4649,HCPCS,Facility,Inpatient,,,,207.9,176.715,59.58414,207.9,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
ARTHRO SHAVER BLADE 4.0 ANGLES,,A4649,HCPCS,Facility,Outpatient,,,,207.9,176.715,59.58414,207.9,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,99.792,48,,percent of total billed charges,,100% of DHS outpatient percentage
ARTHRO SHAVER BLADE 4.0 ANGLES,,A4649,HCPCS,Facility,Inpatient,,,,207.9,176.715,59.58414,207.9,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
ARTHRO SHAVER BLADE 5.0 STRAIGHT,,A4649,HCPCS,Facility,Both,,,,252.875,214.94375,72.473975,252.875,Aetna,Commercial,232.645,92,,percent of total billed charges,,
ARTHRO SHAVER BLADE 5.0 STRAIGHT,,A4649,HCPCS,Facility,Outpatient,,,,252.875,214.94375,72.473975,252.875,Aetna,Medicare Advantage,123.90875,49,,percent of total billed charges,,
ARTHRO SHAVER BLADE 5.0 STRAIGHT,,A4649,HCPCS,Facility,Inpatient,,,,252.875,214.94375,72.473975,252.875,Aetna,Medicare Advantage,,,,,Included in per diem rate,
ARTHRO SHAVER BLADE 5.0 STRAIGHT,,A4649,HCPCS,Facility,Both,,,,252.875,214.94375,72.473975,252.875,Aetna,PPO,235.17375,93,,percent of total billed charges,,
ARTHRO SHAVER BLADE 5.0 STRAIGHT,,A4649,HCPCS,Facility,Both,,,,252.875,214.94375,72.473975,252.875,America's PPO,America's PPO,242.8358625,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
ARTHRO SHAVER BLADE 5.0 STRAIGHT,,A4649,HCPCS,Facility,Both,,,,252.875,214.94375,72.473975,252.875,BlueCross BlueShield Minnesota, Federal Employee Program,248.829,98.4,,percent of total billed charges,,
ARTHRO SHAVER BLADE 5.0 STRAIGHT,,A4649,HCPCS,Facility,Both,,,,252.875,214.94375,72.473975,252.875,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,252.875,100,,percent of total billed charges,,
ARTHRO SHAVER BLADE 5.0 STRAIGHT,,A4649,HCPCS,Facility,Both,,,,252.875,214.94375,72.473975,252.875,BlueCross BlueShield Minnesota,High Value Network Plan,227.5875,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
ARTHRO SHAVER BLADE 5.0 STRAIGHT,,A4649,HCPCS,Facility,Outpatient,,,,252.875,214.94375,72.473975,252.875,BlueCross BlueShield Minnesota,Medicare Advantage,123.90875,49,,percent of total billed charges,,
ARTHRO SHAVER BLADE 5.0 STRAIGHT,,A4649,HCPCS,Facility,Inpatient,,,,252.875,214.94375,72.473975,252.875,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
ARTHRO SHAVER BLADE 5.0 STRAIGHT,,A4649,HCPCS,Facility,Both,,,,252.875,214.94375,72.473975,252.875,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,223.9713875,88.57,,percent of total billed charges,,
ARTHRO SHAVER BLADE 5.0 STRAIGHT,,A4649,HCPCS,Facility,Both,,,,252.875,214.94375,72.473975,252.875,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,72.473975,28.66,,percent of total billed charges,,
ARTHRO SHAVER BLADE 5.0 STRAIGHT,,A4649,HCPCS,Facility,Outpatient,,,,252.875,214.94375,72.473975,252.875,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),123.90875,49,,percent of total billed charges,,
ARTHRO SHAVER BLADE 5.0 STRAIGHT,,A4649,HCPCS,Facility,Inpatient,,,,252.875,214.94375,72.473975,252.875,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
ARTHRO SHAVER BLADE 5.0 STRAIGHT,,A4649,HCPCS,Facility,Both,,,,252.875,214.94375,72.473975,252.875,CorVel,Worker's Compensation,252.875,100,,percent of total billed charges,,
ARTHRO SHAVER BLADE 5.0 STRAIGHT,,A4649,HCPCS,Facility,Both,,,,252.875,214.94375,72.473975,252.875,First Health Group Corporation,First Health Network,245.28875,97,,percent of total billed charges,,
ARTHRO SHAVER BLADE 5.0 STRAIGHT,,A4649,HCPCS,Facility,Both,,,,252.875,214.94375,72.473975,252.875,"Health Partners, Inc.",Commercial,239.21975,94.6,,percent of total billed charges,,
ARTHRO SHAVER BLADE 5.0 STRAIGHT,,A4649,HCPCS,Facility,Outpatient,,,,252.875,214.94375,72.473975,252.875,"Health Partners, Inc.",Medicare Advantage,123.90875,49,,percent of total billed charges,,
ARTHRO SHAVER BLADE 5.0 STRAIGHT,,A4649,HCPCS,Facility,Inpatient,,,,252.875,214.94375,72.473975,252.875,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ARTHRO SHAVER BLADE 5.0 STRAIGHT,,A4649,HCPCS,Facility,Both,,,,252.875,214.94375,72.473975,252.875,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),151.725,60,,percent of total billed charges,,
ARTHRO SHAVER BLADE 5.0 STRAIGHT,,A4649,HCPCS,Facility,Both,,,,252.875,214.94375,72.473975,252.875,"Health Partners, Inc.",State of Minnesota Advantage Program,206.093125,81.5,,percent of total billed charges,,
ARTHRO SHAVER BLADE 5.0 STRAIGHT,,A4649,HCPCS,Facility,Both,,,,252.875,214.94375,72.473975,252.875,"Health Partners, Inc.",State Public Programs,126.4375,50,,percent of total billed charges,,
ARTHRO SHAVER BLADE 5.0 STRAIGHT,,A4649,HCPCS,Facility,Both,,,,252.875,214.94375,72.473975,252.875,Humana Insurance Company,Commercial PPO,240.23125,95,,percent of total billed charges,,
ARTHRO SHAVER BLADE 5.0 STRAIGHT,,A4649,HCPCS,Facility,Outpatient,,,,252.875,214.94375,72.473975,252.875,Humana Insurance Company,Medicare PPO,123.90875,49,,percent of total billed charges,,
ARTHRO SHAVER BLADE 5.0 STRAIGHT,,A4649,HCPCS,Facility,Inpatient,,,,252.875,214.94375,72.473975,252.875,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
ARTHRO SHAVER BLADE 5.0 STRAIGHT,,A4649,HCPCS,Facility,Both,,,,252.875,214.94375,72.473975,252.875,Medica,Individual & Family,250.599125,99.1,,percent of total billed charges,,
ARTHRO SHAVER BLADE 5.0 STRAIGHT,,A4649,HCPCS,Facility,Outpatient,,,,252.875,214.94375,72.473975,252.875,Medica,Medica Advantage Solution,125.93175,49.8,,percent of total billed charges,,
ARTHRO SHAVER BLADE 5.0 STRAIGHT,,A4649,HCPCS,Facility,Inpatient,,,,252.875,214.94375,72.473975,252.875,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
ARTHRO SHAVER BLADE 5.0 STRAIGHT,,A4649,HCPCS,Facility,Outpatient,,,,252.875,214.94375,72.473975,252.875,Medica,Medical Assistance,112.78225,44.6,,percent of total billed charges,,
ARTHRO SHAVER BLADE 5.0 STRAIGHT,,A4649,HCPCS,Facility,Inpatient,,,,252.875,214.94375,72.473975,252.875,Medica,Medical Assistance,,,,,Included in per diem rate,
ARTHRO SHAVER BLADE 5.0 STRAIGHT,,A4649,HCPCS,Facility,Outpatient,,,,252.875,214.94375,72.473975,252.875,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,125.93175,49.8,,percent of total billed charges,,
ARTHRO SHAVER BLADE 5.0 STRAIGHT,,A4649,HCPCS,Facility,Inpatient,,,,252.875,214.94375,72.473975,252.875,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
ARTHRO SHAVER BLADE 5.0 STRAIGHT,,A4649,HCPCS,Facility,Both,,,,252.875,214.94375,72.473975,252.875,"Multiplan, Inc.","Multiplan, Inc.",237.7025,94,,percent of total billed charges,,
ARTHRO SHAVER BLADE 5.0 STRAIGHT,,A4649,HCPCS,Facility,Outpatient,,,,252.875,214.94375,72.473975,252.875,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,227.840375,90.1,,percent of total billed charges,,
ARTHRO SHAVER BLADE 5.0 STRAIGHT,,A4649,HCPCS,Facility,Inpatient,,,,252.875,214.94375,72.473975,252.875,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
ARTHRO SHAVER BLADE 5.0 STRAIGHT,,A4649,HCPCS,Facility,Both,,,,252.875,214.94375,72.473975,252.875,"Preferred One Administrative Services, INC.",PPO,249.33475,98.6,,percent of total billed charges,,
ARTHRO SHAVER BLADE 5.0 STRAIGHT,,A4649,HCPCS,Facility,Outpatient,,,,252.875,214.94375,72.473975,252.875,PrimeWest Health,Minnesota Senior Health Options (MSHO),130.1041875,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
ARTHRO SHAVER BLADE 5.0 STRAIGHT,,A4649,HCPCS,Facility,Inpatient,,,,252.875,214.94375,72.473975,252.875,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ARTHRO SHAVER BLADE 5.0 STRAIGHT,,A4649,HCPCS,Facility,Outpatient,,,,252.875,214.94375,72.473975,252.875,PrimeWest Health,MinnesotaCare,129.8766,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
ARTHRO SHAVER BLADE 5.0 STRAIGHT,,A4649,HCPCS,Facility,Inpatient,,,,252.875,214.94375,72.473975,252.875,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
ARTHRO SHAVER BLADE 5.0 STRAIGHT,,A4649,HCPCS,Facility,Both,,,,252.875,214.94375,72.473975,252.875,Sanford Health Plan,Sanford Health Plan,232.645,92,,percent of total billed charges,,
ARTHRO SHAVER BLADE 5.0 STRAIGHT,,A4649,HCPCS,Facility,Outpatient,,,,252.875,214.94375,72.473975,252.875,"UCare Health, Inc.",Individual & Family Plan,142.4950625,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
ARTHRO SHAVER BLADE 5.0 STRAIGHT,,A4649,HCPCS,Facility,Inpatient,,,,252.875,214.94375,72.473975,252.875,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
ARTHRO SHAVER BLADE 5.0 STRAIGHT,,A4649,HCPCS,Facility,Outpatient,,,,252.875,214.94375,72.473975,252.875,"UCare Health, Inc.",Medical Assistance,127.6260125,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ARTHRO SHAVER BLADE 5.0 STRAIGHT,,A4649,HCPCS,Facility,Inpatient,,,,252.875,214.94375,72.473975,252.875,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
ARTHRO SHAVER BLADE 5.0 STRAIGHT,,A4649,HCPCS,Facility,Outpatient,,,,252.875,214.94375,72.473975,252.875,"UCare Health, Inc.",Medicare Advantage,127.6260125,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ARTHRO SHAVER BLADE 5.0 STRAIGHT,,A4649,HCPCS,Facility,Inpatient,,,,252.875,214.94375,72.473975,252.875,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ARTHRO SHAVER BLADE 5.0 STRAIGHT,,A4649,HCPCS,Facility,Outpatient,,,,252.875,214.94375,72.473975,252.875,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),127.6260125,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ARTHRO SHAVER BLADE 5.0 STRAIGHT,,A4649,HCPCS,Facility,Inpatient,,,,252.875,214.94375,72.473975,252.875,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ARTHRO SHAVER BLADE 5.0 STRAIGHT,,A4649,HCPCS,Facility,Both,,,,252.875,214.94375,72.473975,252.875,UnitedHealthcare,Individual & Family,237.7025,94,,percent of total billed charges,,
ARTHRO SHAVER BLADE 5.0 STRAIGHT,,A4649,HCPCS,Facility,Outpatient,,,,252.875,214.94375,72.473975,252.875,UnitedHealthcare,Medicare Advantage,123.90875,49,,percent of total billed charges,,
ARTHRO SHAVER BLADE 5.0 STRAIGHT,,A4649,HCPCS,Facility,Inpatient,,,,252.875,214.94375,72.473975,252.875,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
ARTHRO SHAVER BLADE 5.0 STRAIGHT,,A4649,HCPCS,Facility,Outpatient,,,,252.875,214.94375,72.473975,252.875,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,121.38,48,,percent of total billed charges,,100% of DHS outpatient percentage
ARTHRO SHAVER BLADE 5.0 STRAIGHT,,A4649,HCPCS,Facility,Inpatient,,,,252.875,214.94375,72.473975,252.875,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
ARTHROSCOPY PACK,,A4649,HCPCS,Facility,Both,,,,300.66,255.561,86.169156,300.66,Aetna,Commercial,276.6072,92,,percent of total billed charges,,
ARTHROSCOPY PACK,,A4649,HCPCS,Facility,Outpatient,,,,300.66,255.561,86.169156,300.66,Aetna,Medicare Advantage,147.3234,49,,percent of total billed charges,,
ARTHROSCOPY PACK,,A4649,HCPCS,Facility,Inpatient,,,,300.66,255.561,86.169156,300.66,Aetna,Medicare Advantage,,,,,Included in per diem rate,
ARTHROSCOPY PACK,,A4649,HCPCS,Facility,Both,,,,300.66,255.561,86.169156,300.66,Aetna,PPO,279.6138,93,,percent of total billed charges,,
ARTHROSCOPY PACK,,A4649,HCPCS,Facility,Both,,,,300.66,255.561,86.169156,300.66,America's PPO,America's PPO,288.723798,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
ARTHROSCOPY PACK,,A4649,HCPCS,Facility,Both,,,,300.66,255.561,86.169156,300.66,BlueCross BlueShield Minnesota, Federal Employee Program,295.84944,98.4,,percent of total billed charges,,
ARTHROSCOPY PACK,,A4649,HCPCS,Facility,Both,,,,300.66,255.561,86.169156,300.66,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,300.66,100,,percent of total billed charges,,
ARTHROSCOPY PACK,,A4649,HCPCS,Facility,Both,,,,300.66,255.561,86.169156,300.66,BlueCross BlueShield Minnesota,High Value Network Plan,270.594,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
ARTHROSCOPY PACK,,A4649,HCPCS,Facility,Outpatient,,,,300.66,255.561,86.169156,300.66,BlueCross BlueShield Minnesota,Medicare Advantage,147.3234,49,,percent of total billed charges,,
ARTHROSCOPY PACK,,A4649,HCPCS,Facility,Inpatient,,,,300.66,255.561,86.169156,300.66,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
ARTHROSCOPY PACK,,A4649,HCPCS,Facility,Both,,,,300.66,255.561,86.169156,300.66,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,266.294562,88.57,,percent of total billed charges,,
ARTHROSCOPY PACK,,A4649,HCPCS,Facility,Both,,,,300.66,255.561,86.169156,300.66,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,86.169156,28.66,,percent of total billed charges,,
ARTHROSCOPY PACK,,A4649,HCPCS,Facility,Outpatient,,,,300.66,255.561,86.169156,300.66,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),147.3234,49,,percent of total billed charges,,
ARTHROSCOPY PACK,,A4649,HCPCS,Facility,Inpatient,,,,300.66,255.561,86.169156,300.66,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
ARTHROSCOPY PACK,,A4649,HCPCS,Facility,Both,,,,300.66,255.561,86.169156,300.66,CorVel,Worker's Compensation,300.66,100,,percent of total billed charges,,
ARTHROSCOPY PACK,,A4649,HCPCS,Facility,Both,,,,300.66,255.561,86.169156,300.66,First Health Group Corporation,First Health Network,291.6402,97,,percent of total billed charges,,
ARTHROSCOPY PACK,,A4649,HCPCS,Facility,Both,,,,300.66,255.561,86.169156,300.66,"Health Partners, Inc.",Commercial,284.42436,94.6,,percent of total billed charges,,
ARTHROSCOPY PACK,,A4649,HCPCS,Facility,Outpatient,,,,300.66,255.561,86.169156,300.66,"Health Partners, Inc.",Medicare Advantage,147.3234,49,,percent of total billed charges,,
ARTHROSCOPY PACK,,A4649,HCPCS,Facility,Inpatient,,,,300.66,255.561,86.169156,300.66,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ARTHROSCOPY PACK,,A4649,HCPCS,Facility,Both,,,,300.66,255.561,86.169156,300.66,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),180.396,60,,percent of total billed charges,,
ARTHROSCOPY PACK,,A4649,HCPCS,Facility,Both,,,,300.66,255.561,86.169156,300.66,"Health Partners, Inc.",State of Minnesota Advantage Program,245.0379,81.5,,percent of total billed charges,,
ARTHROSCOPY PACK,,A4649,HCPCS,Facility,Both,,,,300.66,255.561,86.169156,300.66,"Health Partners, Inc.",State Public Programs,150.33,50,,percent of total billed charges,,
ARTHROSCOPY PACK,,A4649,HCPCS,Facility,Both,,,,300.66,255.561,86.169156,300.66,Humana Insurance Company,Commercial PPO,285.627,95,,percent of total billed charges,,
ARTHROSCOPY PACK,,A4649,HCPCS,Facility,Outpatient,,,,300.66,255.561,86.169156,300.66,Humana Insurance Company,Medicare PPO,147.3234,49,,percent of total billed charges,,
ARTHROSCOPY PACK,,A4649,HCPCS,Facility,Inpatient,,,,300.66,255.561,86.169156,300.66,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
ARTHROSCOPY PACK,,A4649,HCPCS,Facility,Both,,,,300.66,255.561,86.169156,300.66,Medica,Individual & Family,297.95406,99.1,,percent of total billed charges,,
ARTHROSCOPY PACK,,A4649,HCPCS,Facility,Outpatient,,,,300.66,255.561,86.169156,300.66,Medica,Medica Advantage Solution,149.72868,49.8,,percent of total billed charges,,
ARTHROSCOPY PACK,,A4649,HCPCS,Facility,Inpatient,,,,300.66,255.561,86.169156,300.66,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
ARTHROSCOPY PACK,,A4649,HCPCS,Facility,Outpatient,,,,300.66,255.561,86.169156,300.66,Medica,Medical Assistance,134.09436,44.6,,percent of total billed charges,,
ARTHROSCOPY PACK,,A4649,HCPCS,Facility,Inpatient,,,,300.66,255.561,86.169156,300.66,Medica,Medical Assistance,,,,,Included in per diem rate,
ARTHROSCOPY PACK,,A4649,HCPCS,Facility,Outpatient,,,,300.66,255.561,86.169156,300.66,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,149.72868,49.8,,percent of total billed charges,,
ARTHROSCOPY PACK,,A4649,HCPCS,Facility,Inpatient,,,,300.66,255.561,86.169156,300.66,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
ARTHROSCOPY PACK,,A4649,HCPCS,Facility,Both,,,,300.66,255.561,86.169156,300.66,"Multiplan, Inc.","Multiplan, Inc.",282.6204,94,,percent of total billed charges,,
ARTHROSCOPY PACK,,A4649,HCPCS,Facility,Outpatient,,,,300.66,255.561,86.169156,300.66,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,270.89466,90.1,,percent of total billed charges,,
ARTHROSCOPY PACK,,A4649,HCPCS,Facility,Inpatient,,,,300.66,255.561,86.169156,300.66,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
ARTHROSCOPY PACK,,A4649,HCPCS,Facility,Both,,,,300.66,255.561,86.169156,300.66,"Preferred One Administrative Services, INC.",PPO,296.45076,98.6,,percent of total billed charges,,
ARTHROSCOPY PACK,,A4649,HCPCS,Facility,Outpatient,,,,300.66,255.561,86.169156,300.66,PrimeWest Health,Minnesota Senior Health Options (MSHO),154.68957,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
ARTHROSCOPY PACK,,A4649,HCPCS,Facility,Inpatient,,,,300.66,255.561,86.169156,300.66,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ARTHROSCOPY PACK,,A4649,HCPCS,Facility,Outpatient,,,,300.66,255.561,86.169156,300.66,PrimeWest Health,MinnesotaCare,154.418976,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
ARTHROSCOPY PACK,,A4649,HCPCS,Facility,Inpatient,,,,300.66,255.561,86.169156,300.66,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
ARTHROSCOPY PACK,,A4649,HCPCS,Facility,Both,,,,300.66,255.561,86.169156,300.66,Sanford Health Plan,Sanford Health Plan,276.6072,92,,percent of total billed charges,,
ARTHROSCOPY PACK,,A4649,HCPCS,Facility,Outpatient,,,,300.66,255.561,86.169156,300.66,"UCare Health, Inc.",Individual & Family Plan,169.42191,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
ARTHROSCOPY PACK,,A4649,HCPCS,Facility,Inpatient,,,,300.66,255.561,86.169156,300.66,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
ARTHROSCOPY PACK,,A4649,HCPCS,Facility,Outpatient,,,,300.66,255.561,86.169156,300.66,"UCare Health, Inc.",Medical Assistance,151.743102,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ARTHROSCOPY PACK,,A4649,HCPCS,Facility,Inpatient,,,,300.66,255.561,86.169156,300.66,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
ARTHROSCOPY PACK,,A4649,HCPCS,Facility,Outpatient,,,,300.66,255.561,86.169156,300.66,"UCare Health, Inc.",Medicare Advantage,151.743102,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ARTHROSCOPY PACK,,A4649,HCPCS,Facility,Inpatient,,,,300.66,255.561,86.169156,300.66,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ARTHROSCOPY PACK,,A4649,HCPCS,Facility,Outpatient,,,,300.66,255.561,86.169156,300.66,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),151.743102,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ARTHROSCOPY PACK,,A4649,HCPCS,Facility,Inpatient,,,,300.66,255.561,86.169156,300.66,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ARTHROSCOPY PACK,,A4649,HCPCS,Facility,Both,,,,300.66,255.561,86.169156,300.66,UnitedHealthcare,Individual & Family,282.6204,94,,percent of total billed charges,,
ARTHROSCOPY PACK,,A4649,HCPCS,Facility,Outpatient,,,,300.66,255.561,86.169156,300.66,UnitedHealthcare,Medicare Advantage,147.3234,49,,percent of total billed charges,,
ARTHROSCOPY PACK,,A4649,HCPCS,Facility,Inpatient,,,,300.66,255.561,86.169156,300.66,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
ARTHROSCOPY PACK,,A4649,HCPCS,Facility,Outpatient,,,,300.66,255.561,86.169156,300.66,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,144.3168,48,,percent of total billed charges,,100% of DHS outpatient percentage
ARTHROSCOPY PACK,,A4649,HCPCS,Facility,Inpatient,,,,300.66,255.561,86.169156,300.66,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
BLADE ANGLED AGGRESSIVE 4.0,,A4649,HCPCS,Facility,Both,,,,289.59,246.1515,82.996494,289.59,Aetna,Commercial,266.4228,92,,percent of total billed charges,,
BLADE ANGLED AGGRESSIVE 4.0,,A4649,HCPCS,Facility,Outpatient,,,,289.59,246.1515,82.996494,289.59,Aetna,Medicare Advantage,141.8991,49,,percent of total billed charges,,
BLADE ANGLED AGGRESSIVE 4.0,,A4649,HCPCS,Facility,Inpatient,,,,289.59,246.1515,82.996494,289.59,Aetna,Medicare Advantage,,,,,Included in per diem rate,
BLADE ANGLED AGGRESSIVE 4.0,,A4649,HCPCS,Facility,Both,,,,289.59,246.1515,82.996494,289.59,Aetna,PPO,269.3187,93,,percent of total billed charges,,
BLADE ANGLED AGGRESSIVE 4.0,,A4649,HCPCS,Facility,Both,,,,289.59,246.1515,82.996494,289.59,America's PPO,America's PPO,278.093277,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
BLADE ANGLED AGGRESSIVE 4.0,,A4649,HCPCS,Facility,Both,,,,289.59,246.1515,82.996494,289.59,BlueCross BlueShield Minnesota, Federal Employee Program,284.95656,98.4,,percent of total billed charges,,
BLADE ANGLED AGGRESSIVE 4.0,,A4649,HCPCS,Facility,Both,,,,289.59,246.1515,82.996494,289.59,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,289.59,100,,percent of total billed charges,,
BLADE ANGLED AGGRESSIVE 4.0,,A4649,HCPCS,Facility,Both,,,,289.59,246.1515,82.996494,289.59,BlueCross BlueShield Minnesota,High Value Network Plan,260.631,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
BLADE ANGLED AGGRESSIVE 4.0,,A4649,HCPCS,Facility,Outpatient,,,,289.59,246.1515,82.996494,289.59,BlueCross BlueShield Minnesota,Medicare Advantage,141.8991,49,,percent of total billed charges,,
BLADE ANGLED AGGRESSIVE 4.0,,A4649,HCPCS,Facility,Inpatient,,,,289.59,246.1515,82.996494,289.59,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
BLADE ANGLED AGGRESSIVE 4.0,,A4649,HCPCS,Facility,Both,,,,289.59,246.1515,82.996494,289.59,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,256.489863,88.57,,percent of total billed charges,,
BLADE ANGLED AGGRESSIVE 4.0,,A4649,HCPCS,Facility,Both,,,,289.59,246.1515,82.996494,289.59,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,82.996494,28.66,,percent of total billed charges,,
BLADE ANGLED AGGRESSIVE 4.0,,A4649,HCPCS,Facility,Outpatient,,,,289.59,246.1515,82.996494,289.59,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),141.8991,49,,percent of total billed charges,,
BLADE ANGLED AGGRESSIVE 4.0,,A4649,HCPCS,Facility,Inpatient,,,,289.59,246.1515,82.996494,289.59,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
BLADE ANGLED AGGRESSIVE 4.0,,A4649,HCPCS,Facility,Both,,,,289.59,246.1515,82.996494,289.59,CorVel,Worker's Compensation,289.59,100,,percent of total billed charges,,
BLADE ANGLED AGGRESSIVE 4.0,,A4649,HCPCS,Facility,Both,,,,289.59,246.1515,82.996494,289.59,First Health Group Corporation,First Health Network,280.9023,97,,percent of total billed charges,,
BLADE ANGLED AGGRESSIVE 4.0,,A4649,HCPCS,Facility,Both,,,,289.59,246.1515,82.996494,289.59,"Health Partners, Inc.",Commercial,273.95214,94.6,,percent of total billed charges,,
BLADE ANGLED AGGRESSIVE 4.0,,A4649,HCPCS,Facility,Outpatient,,,,289.59,246.1515,82.996494,289.59,"Health Partners, Inc.",Medicare Advantage,141.8991,49,,percent of total billed charges,,
BLADE ANGLED AGGRESSIVE 4.0,,A4649,HCPCS,Facility,Inpatient,,,,289.59,246.1515,82.996494,289.59,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
BLADE ANGLED AGGRESSIVE 4.0,,A4649,HCPCS,Facility,Both,,,,289.59,246.1515,82.996494,289.59,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),173.754,60,,percent of total billed charges,,
BLADE ANGLED AGGRESSIVE 4.0,,A4649,HCPCS,Facility,Both,,,,289.59,246.1515,82.996494,289.59,"Health Partners, Inc.",State of Minnesota Advantage Program,236.01585,81.5,,percent of total billed charges,,
BLADE ANGLED AGGRESSIVE 4.0,,A4649,HCPCS,Facility,Both,,,,289.59,246.1515,82.996494,289.59,"Health Partners, Inc.",State Public Programs,144.795,50,,percent of total billed charges,,
BLADE ANGLED AGGRESSIVE 4.0,,A4649,HCPCS,Facility,Both,,,,289.59,246.1515,82.996494,289.59,Humana Insurance Company,Commercial PPO,275.1105,95,,percent of total billed charges,,
BLADE ANGLED AGGRESSIVE 4.0,,A4649,HCPCS,Facility,Outpatient,,,,289.59,246.1515,82.996494,289.59,Humana Insurance Company,Medicare PPO,141.8991,49,,percent of total billed charges,,
BLADE ANGLED AGGRESSIVE 4.0,,A4649,HCPCS,Facility,Inpatient,,,,289.59,246.1515,82.996494,289.59,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
BLADE ANGLED AGGRESSIVE 4.0,,A4649,HCPCS,Facility,Both,,,,289.59,246.1515,82.996494,289.59,Medica,Individual & Family,286.98369,99.1,,percent of total billed charges,,
BLADE ANGLED AGGRESSIVE 4.0,,A4649,HCPCS,Facility,Outpatient,,,,289.59,246.1515,82.996494,289.59,Medica,Medica Advantage Solution,144.21582,49.8,,percent of total billed charges,,
BLADE ANGLED AGGRESSIVE 4.0,,A4649,HCPCS,Facility,Inpatient,,,,289.59,246.1515,82.996494,289.59,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
BLADE ANGLED AGGRESSIVE 4.0,,A4649,HCPCS,Facility,Outpatient,,,,289.59,246.1515,82.996494,289.59,Medica,Medical Assistance,129.15714,44.6,,percent of total billed charges,,
BLADE ANGLED AGGRESSIVE 4.0,,A4649,HCPCS,Facility,Inpatient,,,,289.59,246.1515,82.996494,289.59,Medica,Medical Assistance,,,,,Included in per diem rate,
BLADE ANGLED AGGRESSIVE 4.0,,A4649,HCPCS,Facility,Outpatient,,,,289.59,246.1515,82.996494,289.59,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,144.21582,49.8,,percent of total billed charges,,
BLADE ANGLED AGGRESSIVE 4.0,,A4649,HCPCS,Facility,Inpatient,,,,289.59,246.1515,82.996494,289.59,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
BLADE ANGLED AGGRESSIVE 4.0,,A4649,HCPCS,Facility,Both,,,,289.59,246.1515,82.996494,289.59,"Multiplan, Inc.","Multiplan, Inc.",272.2146,94,,percent of total billed charges,,
BLADE ANGLED AGGRESSIVE 4.0,,A4649,HCPCS,Facility,Outpatient,,,,289.59,246.1515,82.996494,289.59,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,260.92059,90.1,,percent of total billed charges,,
BLADE ANGLED AGGRESSIVE 4.0,,A4649,HCPCS,Facility,Inpatient,,,,289.59,246.1515,82.996494,289.59,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
BLADE ANGLED AGGRESSIVE 4.0,,A4649,HCPCS,Facility,Both,,,,289.59,246.1515,82.996494,289.59,"Preferred One Administrative Services, INC.",PPO,285.53574,98.6,,percent of total billed charges,,
BLADE ANGLED AGGRESSIVE 4.0,,A4649,HCPCS,Facility,Outpatient,,,,289.59,246.1515,82.996494,289.59,PrimeWest Health,Minnesota Senior Health Options (MSHO),148.994055,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
BLADE ANGLED AGGRESSIVE 4.0,,A4649,HCPCS,Facility,Inpatient,,,,289.59,246.1515,82.996494,289.59,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
BLADE ANGLED AGGRESSIVE 4.0,,A4649,HCPCS,Facility,Outpatient,,,,289.59,246.1515,82.996494,289.59,PrimeWest Health,MinnesotaCare,148.733424,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
BLADE ANGLED AGGRESSIVE 4.0,,A4649,HCPCS,Facility,Inpatient,,,,289.59,246.1515,82.996494,289.59,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
BLADE ANGLED AGGRESSIVE 4.0,,A4649,HCPCS,Facility,Both,,,,289.59,246.1515,82.996494,289.59,Sanford Health Plan,Sanford Health Plan,266.4228,92,,percent of total billed charges,,
BLADE ANGLED AGGRESSIVE 4.0,,A4649,HCPCS,Facility,Outpatient,,,,289.59,246.1515,82.996494,289.59,"UCare Health, Inc.",Individual & Family Plan,163.183965,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
BLADE ANGLED AGGRESSIVE 4.0,,A4649,HCPCS,Facility,Inpatient,,,,289.59,246.1515,82.996494,289.59,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
BLADE ANGLED AGGRESSIVE 4.0,,A4649,HCPCS,Facility,Outpatient,,,,289.59,246.1515,82.996494,289.59,"UCare Health, Inc.",Medical Assistance,146.156073,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BLADE ANGLED AGGRESSIVE 4.0,,A4649,HCPCS,Facility,Inpatient,,,,289.59,246.1515,82.996494,289.59,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
BLADE ANGLED AGGRESSIVE 4.0,,A4649,HCPCS,Facility,Outpatient,,,,289.59,246.1515,82.996494,289.59,"UCare Health, Inc.",Medicare Advantage,146.156073,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BLADE ANGLED AGGRESSIVE 4.0,,A4649,HCPCS,Facility,Inpatient,,,,289.59,246.1515,82.996494,289.59,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
BLADE ANGLED AGGRESSIVE 4.0,,A4649,HCPCS,Facility,Outpatient,,,,289.59,246.1515,82.996494,289.59,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),146.156073,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BLADE ANGLED AGGRESSIVE 4.0,,A4649,HCPCS,Facility,Inpatient,,,,289.59,246.1515,82.996494,289.59,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
BLADE ANGLED AGGRESSIVE 4.0,,A4649,HCPCS,Facility,Both,,,,289.59,246.1515,82.996494,289.59,UnitedHealthcare,Individual & Family,272.2146,94,,percent of total billed charges,,
BLADE ANGLED AGGRESSIVE 4.0,,A4649,HCPCS,Facility,Outpatient,,,,289.59,246.1515,82.996494,289.59,UnitedHealthcare,Medicare Advantage,141.8991,49,,percent of total billed charges,,
BLADE ANGLED AGGRESSIVE 4.0,,A4649,HCPCS,Facility,Inpatient,,,,289.59,246.1515,82.996494,289.59,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
BLADE ANGLED AGGRESSIVE 4.0,,A4649,HCPCS,Facility,Outpatient,,,,289.59,246.1515,82.996494,289.59,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,139.0032,48,,percent of total billed charges,,100% of DHS outpatient percentage
BLADE ANGLED AGGRESSIVE 4.0,,A4649,HCPCS,Facility,Inpatient,,,,289.59,246.1515,82.996494,289.59,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
BLADE COMMAND II NARROW LNG 2296-003-115,,A4649,HCPCS,Facility,Both,,,,210,178.5,60.186,210,Aetna,Commercial,193.2,92,,percent of total billed charges,,
BLADE COMMAND II NARROW LNG 2296-003-115,,A4649,HCPCS,Facility,Outpatient,,,,210,178.5,60.186,210,Aetna,Medicare Advantage,102.9,49,,percent of total billed charges,,
BLADE COMMAND II NARROW LNG 2296-003-115,,A4649,HCPCS,Facility,Inpatient,,,,210,178.5,60.186,210,Aetna,Medicare Advantage,,,,,Included in per diem rate,
BLADE COMMAND II NARROW LNG 2296-003-115,,A4649,HCPCS,Facility,Both,,,,210,178.5,60.186,210,Aetna,PPO,195.3,93,,percent of total billed charges,,
BLADE COMMAND II NARROW LNG 2296-003-115,,A4649,HCPCS,Facility,Both,,,,210,178.5,60.186,210,America's PPO,America's PPO,201.663,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
BLADE COMMAND II NARROW LNG 2296-003-115,,A4649,HCPCS,Facility,Both,,,,210,178.5,60.186,210,BlueCross BlueShield Minnesota, Federal Employee Program,206.64,98.4,,percent of total billed charges,,
BLADE COMMAND II NARROW LNG 2296-003-115,,A4649,HCPCS,Facility,Both,,,,210,178.5,60.186,210,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,210,100,,percent of total billed charges,,
BLADE COMMAND II NARROW LNG 2296-003-115,,A4649,HCPCS,Facility,Both,,,,210,178.5,60.186,210,BlueCross BlueShield Minnesota,High Value Network Plan,189,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
BLADE COMMAND II NARROW LNG 2296-003-115,,A4649,HCPCS,Facility,Outpatient,,,,210,178.5,60.186,210,BlueCross BlueShield Minnesota,Medicare Advantage,102.9,49,,percent of total billed charges,,
BLADE COMMAND II NARROW LNG 2296-003-115,,A4649,HCPCS,Facility,Inpatient,,,,210,178.5,60.186,210,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
BLADE COMMAND II NARROW LNG 2296-003-115,,A4649,HCPCS,Facility,Both,,,,210,178.5,60.186,210,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,185.997,88.57,,percent of total billed charges,,
BLADE COMMAND II NARROW LNG 2296-003-115,,A4649,HCPCS,Facility,Both,,,,210,178.5,60.186,210,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,60.186,28.66,,percent of total billed charges,,
BLADE COMMAND II NARROW LNG 2296-003-115,,A4649,HCPCS,Facility,Outpatient,,,,210,178.5,60.186,210,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),102.9,49,,percent of total billed charges,,
BLADE COMMAND II NARROW LNG 2296-003-115,,A4649,HCPCS,Facility,Inpatient,,,,210,178.5,60.186,210,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
BLADE COMMAND II NARROW LNG 2296-003-115,,A4649,HCPCS,Facility,Both,,,,210,178.5,60.186,210,CorVel,Worker's Compensation,210,100,,percent of total billed charges,,
BLADE COMMAND II NARROW LNG 2296-003-115,,A4649,HCPCS,Facility,Both,,,,210,178.5,60.186,210,First Health Group Corporation,First Health Network,203.7,97,,percent of total billed charges,,
BLADE COMMAND II NARROW LNG 2296-003-115,,A4649,HCPCS,Facility,Both,,,,210,178.5,60.186,210,"Health Partners, Inc.",Commercial,198.66,94.6,,percent of total billed charges,,
BLADE COMMAND II NARROW LNG 2296-003-115,,A4649,HCPCS,Facility,Outpatient,,,,210,178.5,60.186,210,"Health Partners, Inc.",Medicare Advantage,102.9,49,,percent of total billed charges,,
BLADE COMMAND II NARROW LNG 2296-003-115,,A4649,HCPCS,Facility,Inpatient,,,,210,178.5,60.186,210,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
BLADE COMMAND II NARROW LNG 2296-003-115,,A4649,HCPCS,Facility,Both,,,,210,178.5,60.186,210,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),126,60,,percent of total billed charges,,
BLADE COMMAND II NARROW LNG 2296-003-115,,A4649,HCPCS,Facility,Both,,,,210,178.5,60.186,210,"Health Partners, Inc.",State of Minnesota Advantage Program,171.15,81.5,,percent of total billed charges,,
BLADE COMMAND II NARROW LNG 2296-003-115,,A4649,HCPCS,Facility,Both,,,,210,178.5,60.186,210,"Health Partners, Inc.",State Public Programs,105,50,,percent of total billed charges,,
BLADE COMMAND II NARROW LNG 2296-003-115,,A4649,HCPCS,Facility,Both,,,,210,178.5,60.186,210,Humana Insurance Company,Commercial PPO,199.5,95,,percent of total billed charges,,
BLADE COMMAND II NARROW LNG 2296-003-115,,A4649,HCPCS,Facility,Outpatient,,,,210,178.5,60.186,210,Humana Insurance Company,Medicare PPO,102.9,49,,percent of total billed charges,,
BLADE COMMAND II NARROW LNG 2296-003-115,,A4649,HCPCS,Facility,Inpatient,,,,210,178.5,60.186,210,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
BLADE COMMAND II NARROW LNG 2296-003-115,,A4649,HCPCS,Facility,Both,,,,210,178.5,60.186,210,Medica,Individual & Family,208.11,99.1,,percent of total billed charges,,
BLADE COMMAND II NARROW LNG 2296-003-115,,A4649,HCPCS,Facility,Outpatient,,,,210,178.5,60.186,210,Medica,Medica Advantage Solution,104.58,49.8,,percent of total billed charges,,
BLADE COMMAND II NARROW LNG 2296-003-115,,A4649,HCPCS,Facility,Inpatient,,,,210,178.5,60.186,210,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
BLADE COMMAND II NARROW LNG 2296-003-115,,A4649,HCPCS,Facility,Outpatient,,,,210,178.5,60.186,210,Medica,Medical Assistance,93.66,44.6,,percent of total billed charges,,
BLADE COMMAND II NARROW LNG 2296-003-115,,A4649,HCPCS,Facility,Inpatient,,,,210,178.5,60.186,210,Medica,Medical Assistance,,,,,Included in per diem rate,
BLADE COMMAND II NARROW LNG 2296-003-115,,A4649,HCPCS,Facility,Outpatient,,,,210,178.5,60.186,210,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,104.58,49.8,,percent of total billed charges,,
BLADE COMMAND II NARROW LNG 2296-003-115,,A4649,HCPCS,Facility,Inpatient,,,,210,178.5,60.186,210,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
BLADE COMMAND II NARROW LNG 2296-003-115,,A4649,HCPCS,Facility,Both,,,,210,178.5,60.186,210,"Multiplan, Inc.","Multiplan, Inc.",197.4,94,,percent of total billed charges,,
BLADE COMMAND II NARROW LNG 2296-003-115,,A4649,HCPCS,Facility,Outpatient,,,,210,178.5,60.186,210,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,189.21,90.1,,percent of total billed charges,,
BLADE COMMAND II NARROW LNG 2296-003-115,,A4649,HCPCS,Facility,Inpatient,,,,210,178.5,60.186,210,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
BLADE COMMAND II NARROW LNG 2296-003-115,,A4649,HCPCS,Facility,Both,,,,210,178.5,60.186,210,"Preferred One Administrative Services, INC.",PPO,207.06,98.6,,percent of total billed charges,,
BLADE COMMAND II NARROW LNG 2296-003-115,,A4649,HCPCS,Facility,Outpatient,,,,210,178.5,60.186,210,PrimeWest Health,Minnesota Senior Health Options (MSHO),108.045,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
BLADE COMMAND II NARROW LNG 2296-003-115,,A4649,HCPCS,Facility,Inpatient,,,,210,178.5,60.186,210,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
BLADE COMMAND II NARROW LNG 2296-003-115,,A4649,HCPCS,Facility,Outpatient,,,,210,178.5,60.186,210,PrimeWest Health,MinnesotaCare,107.856,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
BLADE COMMAND II NARROW LNG 2296-003-115,,A4649,HCPCS,Facility,Inpatient,,,,210,178.5,60.186,210,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
BLADE COMMAND II NARROW LNG 2296-003-115,,A4649,HCPCS,Facility,Both,,,,210,178.5,60.186,210,Sanford Health Plan,Sanford Health Plan,193.2,92,,percent of total billed charges,,
BLADE COMMAND II NARROW LNG 2296-003-115,,A4649,HCPCS,Facility,Outpatient,,,,210,178.5,60.186,210,"UCare Health, Inc.",Individual & Family Plan,118.335,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
BLADE COMMAND II NARROW LNG 2296-003-115,,A4649,HCPCS,Facility,Inpatient,,,,210,178.5,60.186,210,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
BLADE COMMAND II NARROW LNG 2296-003-115,,A4649,HCPCS,Facility,Outpatient,,,,210,178.5,60.186,210,"UCare Health, Inc.",Medical Assistance,105.987,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BLADE COMMAND II NARROW LNG 2296-003-115,,A4649,HCPCS,Facility,Inpatient,,,,210,178.5,60.186,210,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
BLADE COMMAND II NARROW LNG 2296-003-115,,A4649,HCPCS,Facility,Outpatient,,,,210,178.5,60.186,210,"UCare Health, Inc.",Medicare Advantage,105.987,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BLADE COMMAND II NARROW LNG 2296-003-115,,A4649,HCPCS,Facility,Inpatient,,,,210,178.5,60.186,210,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
BLADE COMMAND II NARROW LNG 2296-003-115,,A4649,HCPCS,Facility,Outpatient,,,,210,178.5,60.186,210,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),105.987,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BLADE COMMAND II NARROW LNG 2296-003-115,,A4649,HCPCS,Facility,Inpatient,,,,210,178.5,60.186,210,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
BLADE COMMAND II NARROW LNG 2296-003-115,,A4649,HCPCS,Facility,Both,,,,210,178.5,60.186,210,UnitedHealthcare,Individual & Family,197.4,94,,percent of total billed charges,,
BLADE COMMAND II NARROW LNG 2296-003-115,,A4649,HCPCS,Facility,Outpatient,,,,210,178.5,60.186,210,UnitedHealthcare,Medicare Advantage,102.9,49,,percent of total billed charges,,
BLADE COMMAND II NARROW LNG 2296-003-115,,A4649,HCPCS,Facility,Inpatient,,,,210,178.5,60.186,210,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
BLADE COMMAND II NARROW LNG 2296-003-115,,A4649,HCPCS,Facility,Outpatient,,,,210,178.5,60.186,210,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,100.8,48,,percent of total billed charges,,100% of DHS outpatient percentage
BLADE COMMAND II NARROW LNG 2296-003-115,,A4649,HCPCS,Facility,Inpatient,,,,210,178.5,60.186,210,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
BLADE COMMAND II NARROW MED 2296-003-114,,A4649,HCPCS,Facility,Both,,,,210,178.5,60.186,210,Aetna,Commercial,193.2,92,,percent of total billed charges,,
BLADE COMMAND II NARROW MED 2296-003-114,,A4649,HCPCS,Facility,Outpatient,,,,210,178.5,60.186,210,Aetna,Medicare Advantage,102.9,49,,percent of total billed charges,,
BLADE COMMAND II NARROW MED 2296-003-114,,A4649,HCPCS,Facility,Inpatient,,,,210,178.5,60.186,210,Aetna,Medicare Advantage,,,,,Included in per diem rate,
BLADE COMMAND II NARROW MED 2296-003-114,,A4649,HCPCS,Facility,Both,,,,210,178.5,60.186,210,Aetna,PPO,195.3,93,,percent of total billed charges,,
BLADE COMMAND II NARROW MED 2296-003-114,,A4649,HCPCS,Facility,Both,,,,210,178.5,60.186,210,America's PPO,America's PPO,201.663,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
BLADE COMMAND II NARROW MED 2296-003-114,,A4649,HCPCS,Facility,Both,,,,210,178.5,60.186,210,BlueCross BlueShield Minnesota, Federal Employee Program,206.64,98.4,,percent of total billed charges,,
BLADE COMMAND II NARROW MED 2296-003-114,,A4649,HCPCS,Facility,Both,,,,210,178.5,60.186,210,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,210,100,,percent of total billed charges,,
BLADE COMMAND II NARROW MED 2296-003-114,,A4649,HCPCS,Facility,Both,,,,210,178.5,60.186,210,BlueCross BlueShield Minnesota,High Value Network Plan,189,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
BLADE COMMAND II NARROW MED 2296-003-114,,A4649,HCPCS,Facility,Outpatient,,,,210,178.5,60.186,210,BlueCross BlueShield Minnesota,Medicare Advantage,102.9,49,,percent of total billed charges,,
BLADE COMMAND II NARROW MED 2296-003-114,,A4649,HCPCS,Facility,Inpatient,,,,210,178.5,60.186,210,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
BLADE COMMAND II NARROW MED 2296-003-114,,A4649,HCPCS,Facility,Both,,,,210,178.5,60.186,210,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,185.997,88.57,,percent of total billed charges,,
BLADE COMMAND II NARROW MED 2296-003-114,,A4649,HCPCS,Facility,Both,,,,210,178.5,60.186,210,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,60.186,28.66,,percent of total billed charges,,
BLADE COMMAND II NARROW MED 2296-003-114,,A4649,HCPCS,Facility,Outpatient,,,,210,178.5,60.186,210,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),102.9,49,,percent of total billed charges,,
BLADE COMMAND II NARROW MED 2296-003-114,,A4649,HCPCS,Facility,Inpatient,,,,210,178.5,60.186,210,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
BLADE COMMAND II NARROW MED 2296-003-114,,A4649,HCPCS,Facility,Both,,,,210,178.5,60.186,210,CorVel,Worker's Compensation,210,100,,percent of total billed charges,,
BLADE COMMAND II NARROW MED 2296-003-114,,A4649,HCPCS,Facility,Both,,,,210,178.5,60.186,210,First Health Group Corporation,First Health Network,203.7,97,,percent of total billed charges,,
BLADE COMMAND II NARROW MED 2296-003-114,,A4649,HCPCS,Facility,Both,,,,210,178.5,60.186,210,"Health Partners, Inc.",Commercial,198.66,94.6,,percent of total billed charges,,
BLADE COMMAND II NARROW MED 2296-003-114,,A4649,HCPCS,Facility,Outpatient,,,,210,178.5,60.186,210,"Health Partners, Inc.",Medicare Advantage,102.9,49,,percent of total billed charges,,
BLADE COMMAND II NARROW MED 2296-003-114,,A4649,HCPCS,Facility,Inpatient,,,,210,178.5,60.186,210,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
BLADE COMMAND II NARROW MED 2296-003-114,,A4649,HCPCS,Facility,Both,,,,210,178.5,60.186,210,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),126,60,,percent of total billed charges,,
BLADE COMMAND II NARROW MED 2296-003-114,,A4649,HCPCS,Facility,Both,,,,210,178.5,60.186,210,"Health Partners, Inc.",State of Minnesota Advantage Program,171.15,81.5,,percent of total billed charges,,
BLADE COMMAND II NARROW MED 2296-003-114,,A4649,HCPCS,Facility,Both,,,,210,178.5,60.186,210,"Health Partners, Inc.",State Public Programs,105,50,,percent of total billed charges,,
BLADE COMMAND II NARROW MED 2296-003-114,,A4649,HCPCS,Facility,Both,,,,210,178.5,60.186,210,Humana Insurance Company,Commercial PPO,199.5,95,,percent of total billed charges,,
BLADE COMMAND II NARROW MED 2296-003-114,,A4649,HCPCS,Facility,Outpatient,,,,210,178.5,60.186,210,Humana Insurance Company,Medicare PPO,102.9,49,,percent of total billed charges,,
BLADE COMMAND II NARROW MED 2296-003-114,,A4649,HCPCS,Facility,Inpatient,,,,210,178.5,60.186,210,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
BLADE COMMAND II NARROW MED 2296-003-114,,A4649,HCPCS,Facility,Both,,,,210,178.5,60.186,210,Medica,Individual & Family,208.11,99.1,,percent of total billed charges,,
BLADE COMMAND II NARROW MED 2296-003-114,,A4649,HCPCS,Facility,Outpatient,,,,210,178.5,60.186,210,Medica,Medica Advantage Solution,104.58,49.8,,percent of total billed charges,,
BLADE COMMAND II NARROW MED 2296-003-114,,A4649,HCPCS,Facility,Inpatient,,,,210,178.5,60.186,210,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
BLADE COMMAND II NARROW MED 2296-003-114,,A4649,HCPCS,Facility,Outpatient,,,,210,178.5,60.186,210,Medica,Medical Assistance,93.66,44.6,,percent of total billed charges,,
BLADE COMMAND II NARROW MED 2296-003-114,,A4649,HCPCS,Facility,Inpatient,,,,210,178.5,60.186,210,Medica,Medical Assistance,,,,,Included in per diem rate,
BLADE COMMAND II NARROW MED 2296-003-114,,A4649,HCPCS,Facility,Outpatient,,,,210,178.5,60.186,210,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,104.58,49.8,,percent of total billed charges,,
BLADE COMMAND II NARROW MED 2296-003-114,,A4649,HCPCS,Facility,Inpatient,,,,210,178.5,60.186,210,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
BLADE COMMAND II NARROW MED 2296-003-114,,A4649,HCPCS,Facility,Both,,,,210,178.5,60.186,210,"Multiplan, Inc.","Multiplan, Inc.",197.4,94,,percent of total billed charges,,
BLADE COMMAND II NARROW MED 2296-003-114,,A4649,HCPCS,Facility,Outpatient,,,,210,178.5,60.186,210,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,189.21,90.1,,percent of total billed charges,,
BLADE COMMAND II NARROW MED 2296-003-114,,A4649,HCPCS,Facility,Inpatient,,,,210,178.5,60.186,210,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
BLADE COMMAND II NARROW MED 2296-003-114,,A4649,HCPCS,Facility,Both,,,,210,178.5,60.186,210,"Preferred One Administrative Services, INC.",PPO,207.06,98.6,,percent of total billed charges,,
BLADE COMMAND II NARROW MED 2296-003-114,,A4649,HCPCS,Facility,Outpatient,,,,210,178.5,60.186,210,PrimeWest Health,Minnesota Senior Health Options (MSHO),108.045,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
BLADE COMMAND II NARROW MED 2296-003-114,,A4649,HCPCS,Facility,Inpatient,,,,210,178.5,60.186,210,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
BLADE COMMAND II NARROW MED 2296-003-114,,A4649,HCPCS,Facility,Outpatient,,,,210,178.5,60.186,210,PrimeWest Health,MinnesotaCare,107.856,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
BLADE COMMAND II NARROW MED 2296-003-114,,A4649,HCPCS,Facility,Inpatient,,,,210,178.5,60.186,210,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
BLADE COMMAND II NARROW MED 2296-003-114,,A4649,HCPCS,Facility,Both,,,,210,178.5,60.186,210,Sanford Health Plan,Sanford Health Plan,193.2,92,,percent of total billed charges,,
BLADE COMMAND II NARROW MED 2296-003-114,,A4649,HCPCS,Facility,Outpatient,,,,210,178.5,60.186,210,"UCare Health, Inc.",Individual & Family Plan,118.335,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
BLADE COMMAND II NARROW MED 2296-003-114,,A4649,HCPCS,Facility,Inpatient,,,,210,178.5,60.186,210,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
BLADE COMMAND II NARROW MED 2296-003-114,,A4649,HCPCS,Facility,Outpatient,,,,210,178.5,60.186,210,"UCare Health, Inc.",Medical Assistance,105.987,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BLADE COMMAND II NARROW MED 2296-003-114,,A4649,HCPCS,Facility,Inpatient,,,,210,178.5,60.186,210,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
BLADE COMMAND II NARROW MED 2296-003-114,,A4649,HCPCS,Facility,Outpatient,,,,210,178.5,60.186,210,"UCare Health, Inc.",Medicare Advantage,105.987,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BLADE COMMAND II NARROW MED 2296-003-114,,A4649,HCPCS,Facility,Inpatient,,,,210,178.5,60.186,210,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
BLADE COMMAND II NARROW MED 2296-003-114,,A4649,HCPCS,Facility,Outpatient,,,,210,178.5,60.186,210,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),105.987,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BLADE COMMAND II NARROW MED 2296-003-114,,A4649,HCPCS,Facility,Inpatient,,,,210,178.5,60.186,210,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
BLADE COMMAND II NARROW MED 2296-003-114,,A4649,HCPCS,Facility,Both,,,,210,178.5,60.186,210,UnitedHealthcare,Individual & Family,197.4,94,,percent of total billed charges,,
BLADE COMMAND II NARROW MED 2296-003-114,,A4649,HCPCS,Facility,Outpatient,,,,210,178.5,60.186,210,UnitedHealthcare,Medicare Advantage,102.9,49,,percent of total billed charges,,
BLADE COMMAND II NARROW MED 2296-003-114,,A4649,HCPCS,Facility,Inpatient,,,,210,178.5,60.186,210,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
BLADE COMMAND II NARROW MED 2296-003-114,,A4649,HCPCS,Facility,Outpatient,,,,210,178.5,60.186,210,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,100.8,48,,percent of total billed charges,,100% of DHS outpatient percentage
BLADE COMMAND II NARROW MED 2296-003-114,,A4649,HCPCS,Facility,Inpatient,,,,210,178.5,60.186,210,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
BLADE DERMATOME ZIMMER,,A4649,HCPCS,Facility,Both,,,,160.64,136.544,46.039424,160.64,Aetna,Commercial,147.7888,92,,percent of total billed charges,,
BLADE DERMATOME ZIMMER,,A4649,HCPCS,Facility,Outpatient,,,,160.64,136.544,46.039424,160.64,Aetna,Medicare Advantage,78.7136,49,,percent of total billed charges,,
BLADE DERMATOME ZIMMER,,A4649,HCPCS,Facility,Inpatient,,,,160.64,136.544,46.039424,160.64,Aetna,Medicare Advantage,,,,,Included in per diem rate,
BLADE DERMATOME ZIMMER,,A4649,HCPCS,Facility,Both,,,,160.64,136.544,46.039424,160.64,Aetna,PPO,149.3952,93,,percent of total billed charges,,
BLADE DERMATOME ZIMMER,,A4649,HCPCS,Facility,Both,,,,160.64,136.544,46.039424,160.64,America's PPO,America's PPO,154.262592,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
BLADE DERMATOME ZIMMER,,A4649,HCPCS,Facility,Both,,,,160.64,136.544,46.039424,160.64,BlueCross BlueShield Minnesota, Federal Employee Program,158.06976,98.4,,percent of total billed charges,,
BLADE DERMATOME ZIMMER,,A4649,HCPCS,Facility,Both,,,,160.64,136.544,46.039424,160.64,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,160.64,100,,percent of total billed charges,,
BLADE DERMATOME ZIMMER,,A4649,HCPCS,Facility,Both,,,,160.64,136.544,46.039424,160.64,BlueCross BlueShield Minnesota,High Value Network Plan,144.576,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
BLADE DERMATOME ZIMMER,,A4649,HCPCS,Facility,Outpatient,,,,160.64,136.544,46.039424,160.64,BlueCross BlueShield Minnesota,Medicare Advantage,78.7136,49,,percent of total billed charges,,
BLADE DERMATOME ZIMMER,,A4649,HCPCS,Facility,Inpatient,,,,160.64,136.544,46.039424,160.64,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
BLADE DERMATOME ZIMMER,,A4649,HCPCS,Facility,Both,,,,160.64,136.544,46.039424,160.64,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,142.278848,88.57,,percent of total billed charges,,
BLADE DERMATOME ZIMMER,,A4649,HCPCS,Facility,Both,,,,160.64,136.544,46.039424,160.64,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,46.039424,28.66,,percent of total billed charges,,
BLADE DERMATOME ZIMMER,,A4649,HCPCS,Facility,Outpatient,,,,160.64,136.544,46.039424,160.64,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),78.7136,49,,percent of total billed charges,,
BLADE DERMATOME ZIMMER,,A4649,HCPCS,Facility,Inpatient,,,,160.64,136.544,46.039424,160.64,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
BLADE DERMATOME ZIMMER,,A4649,HCPCS,Facility,Both,,,,160.64,136.544,46.039424,160.64,CorVel,Worker's Compensation,160.64,100,,percent of total billed charges,,
BLADE DERMATOME ZIMMER,,A4649,HCPCS,Facility,Both,,,,160.64,136.544,46.039424,160.64,First Health Group Corporation,First Health Network,155.8208,97,,percent of total billed charges,,
BLADE DERMATOME ZIMMER,,A4649,HCPCS,Facility,Both,,,,160.64,136.544,46.039424,160.64,"Health Partners, Inc.",Commercial,151.96544,94.6,,percent of total billed charges,,
BLADE DERMATOME ZIMMER,,A4649,HCPCS,Facility,Outpatient,,,,160.64,136.544,46.039424,160.64,"Health Partners, Inc.",Medicare Advantage,78.7136,49,,percent of total billed charges,,
BLADE DERMATOME ZIMMER,,A4649,HCPCS,Facility,Inpatient,,,,160.64,136.544,46.039424,160.64,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
BLADE DERMATOME ZIMMER,,A4649,HCPCS,Facility,Both,,,,160.64,136.544,46.039424,160.64,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),96.384,60,,percent of total billed charges,,
BLADE DERMATOME ZIMMER,,A4649,HCPCS,Facility,Both,,,,160.64,136.544,46.039424,160.64,"Health Partners, Inc.",State of Minnesota Advantage Program,130.9216,81.5,,percent of total billed charges,,
BLADE DERMATOME ZIMMER,,A4649,HCPCS,Facility,Both,,,,160.64,136.544,46.039424,160.64,"Health Partners, Inc.",State Public Programs,80.32,50,,percent of total billed charges,,
BLADE DERMATOME ZIMMER,,A4649,HCPCS,Facility,Both,,,,160.64,136.544,46.039424,160.64,Humana Insurance Company,Commercial PPO,152.608,95,,percent of total billed charges,,
BLADE DERMATOME ZIMMER,,A4649,HCPCS,Facility,Outpatient,,,,160.64,136.544,46.039424,160.64,Humana Insurance Company,Medicare PPO,78.7136,49,,percent of total billed charges,,
BLADE DERMATOME ZIMMER,,A4649,HCPCS,Facility,Inpatient,,,,160.64,136.544,46.039424,160.64,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
BLADE DERMATOME ZIMMER,,A4649,HCPCS,Facility,Both,,,,160.64,136.544,46.039424,160.64,Medica,Individual & Family,159.19424,99.1,,percent of total billed charges,,
BLADE DERMATOME ZIMMER,,A4649,HCPCS,Facility,Outpatient,,,,160.64,136.544,46.039424,160.64,Medica,Medica Advantage Solution,79.99872,49.8,,percent of total billed charges,,
BLADE DERMATOME ZIMMER,,A4649,HCPCS,Facility,Inpatient,,,,160.64,136.544,46.039424,160.64,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
BLADE DERMATOME ZIMMER,,A4649,HCPCS,Facility,Outpatient,,,,160.64,136.544,46.039424,160.64,Medica,Medical Assistance,71.64544,44.6,,percent of total billed charges,,
BLADE DERMATOME ZIMMER,,A4649,HCPCS,Facility,Inpatient,,,,160.64,136.544,46.039424,160.64,Medica,Medical Assistance,,,,,Included in per diem rate,
BLADE DERMATOME ZIMMER,,A4649,HCPCS,Facility,Outpatient,,,,160.64,136.544,46.039424,160.64,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,79.99872,49.8,,percent of total billed charges,,
BLADE DERMATOME ZIMMER,,A4649,HCPCS,Facility,Inpatient,,,,160.64,136.544,46.039424,160.64,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
BLADE DERMATOME ZIMMER,,A4649,HCPCS,Facility,Both,,,,160.64,136.544,46.039424,160.64,"Multiplan, Inc.","Multiplan, Inc.",151.0016,94,,percent of total billed charges,,
BLADE DERMATOME ZIMMER,,A4649,HCPCS,Facility,Outpatient,,,,160.64,136.544,46.039424,160.64,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,144.73664,90.1,,percent of total billed charges,,
BLADE DERMATOME ZIMMER,,A4649,HCPCS,Facility,Inpatient,,,,160.64,136.544,46.039424,160.64,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
BLADE DERMATOME ZIMMER,,A4649,HCPCS,Facility,Both,,,,160.64,136.544,46.039424,160.64,"Preferred One Administrative Services, INC.",PPO,158.39104,98.6,,percent of total billed charges,,
BLADE DERMATOME ZIMMER,,A4649,HCPCS,Facility,Outpatient,,,,160.64,136.544,46.039424,160.64,PrimeWest Health,Minnesota Senior Health Options (MSHO),82.64928,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
BLADE DERMATOME ZIMMER,,A4649,HCPCS,Facility,Inpatient,,,,160.64,136.544,46.039424,160.64,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
BLADE DERMATOME ZIMMER,,A4649,HCPCS,Facility,Outpatient,,,,160.64,136.544,46.039424,160.64,PrimeWest Health,MinnesotaCare,82.504704,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
BLADE DERMATOME ZIMMER,,A4649,HCPCS,Facility,Inpatient,,,,160.64,136.544,46.039424,160.64,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
BLADE DERMATOME ZIMMER,,A4649,HCPCS,Facility,Both,,,,160.64,136.544,46.039424,160.64,Sanford Health Plan,Sanford Health Plan,147.7888,92,,percent of total billed charges,,
BLADE DERMATOME ZIMMER,,A4649,HCPCS,Facility,Outpatient,,,,160.64,136.544,46.039424,160.64,"UCare Health, Inc.",Individual & Family Plan,90.52064,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
BLADE DERMATOME ZIMMER,,A4649,HCPCS,Facility,Inpatient,,,,160.64,136.544,46.039424,160.64,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
BLADE DERMATOME ZIMMER,,A4649,HCPCS,Facility,Outpatient,,,,160.64,136.544,46.039424,160.64,"UCare Health, Inc.",Medical Assistance,81.075008,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BLADE DERMATOME ZIMMER,,A4649,HCPCS,Facility,Inpatient,,,,160.64,136.544,46.039424,160.64,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
BLADE DERMATOME ZIMMER,,A4649,HCPCS,Facility,Outpatient,,,,160.64,136.544,46.039424,160.64,"UCare Health, Inc.",Medicare Advantage,81.075008,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BLADE DERMATOME ZIMMER,,A4649,HCPCS,Facility,Inpatient,,,,160.64,136.544,46.039424,160.64,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
BLADE DERMATOME ZIMMER,,A4649,HCPCS,Facility,Outpatient,,,,160.64,136.544,46.039424,160.64,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),81.075008,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BLADE DERMATOME ZIMMER,,A4649,HCPCS,Facility,Inpatient,,,,160.64,136.544,46.039424,160.64,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
BLADE DERMATOME ZIMMER,,A4649,HCPCS,Facility,Both,,,,160.64,136.544,46.039424,160.64,UnitedHealthcare,Individual & Family,151.0016,94,,percent of total billed charges,,
BLADE DERMATOME ZIMMER,,A4649,HCPCS,Facility,Outpatient,,,,160.64,136.544,46.039424,160.64,UnitedHealthcare,Medicare Advantage,78.7136,49,,percent of total billed charges,,
BLADE DERMATOME ZIMMER,,A4649,HCPCS,Facility,Inpatient,,,,160.64,136.544,46.039424,160.64,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
BLADE DERMATOME ZIMMER,,A4649,HCPCS,Facility,Outpatient,,,,160.64,136.544,46.039424,160.64,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,77.1072,48,,percent of total billed charges,,100% of DHS outpatient percentage
BLADE DERMATOME ZIMMER,,A4649,HCPCS,Facility,Inpatient,,,,160.64,136.544,46.039424,160.64,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
BLADE MYRINGOTOMY,,A4649,HCPCS,Facility,Both,,,,48.555,41.27175,13.915863,48.555,Aetna,Commercial,44.6706,92,,percent of total billed charges,,
BLADE MYRINGOTOMY,,A4649,HCPCS,Facility,Outpatient,,,,48.555,41.27175,13.915863,48.555,Aetna,Medicare Advantage,23.79195,49,,percent of total billed charges,,
BLADE MYRINGOTOMY,,A4649,HCPCS,Facility,Inpatient,,,,48.555,41.27175,13.915863,48.555,Aetna,Medicare Advantage,,,,,Included in per diem rate,
BLADE MYRINGOTOMY,,A4649,HCPCS,Facility,Both,,,,48.555,41.27175,13.915863,48.555,Aetna,PPO,45.15615,93,,percent of total billed charges,,
BLADE MYRINGOTOMY,,A4649,HCPCS,Facility,Both,,,,48.555,41.27175,13.915863,48.555,America's PPO,America's PPO,46.6273665,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
BLADE MYRINGOTOMY,,A4649,HCPCS,Facility,Both,,,,48.555,41.27175,13.915863,48.555,BlueCross BlueShield Minnesota, Federal Employee Program,47.77812,98.4,,percent of total billed charges,,
BLADE MYRINGOTOMY,,A4649,HCPCS,Facility,Both,,,,48.555,41.27175,13.915863,48.555,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,48.555,100,,percent of total billed charges,,
BLADE MYRINGOTOMY,,A4649,HCPCS,Facility,Both,,,,48.555,41.27175,13.915863,48.555,BlueCross BlueShield Minnesota,High Value Network Plan,43.6995,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
BLADE MYRINGOTOMY,,A4649,HCPCS,Facility,Outpatient,,,,48.555,41.27175,13.915863,48.555,BlueCross BlueShield Minnesota,Medicare Advantage,23.79195,49,,percent of total billed charges,,
BLADE MYRINGOTOMY,,A4649,HCPCS,Facility,Inpatient,,,,48.555,41.27175,13.915863,48.555,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
BLADE MYRINGOTOMY,,A4649,HCPCS,Facility,Both,,,,48.555,41.27175,13.915863,48.555,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,43.0051635,88.57,,percent of total billed charges,,
BLADE MYRINGOTOMY,,A4649,HCPCS,Facility,Both,,,,48.555,41.27175,13.915863,48.555,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,13.915863,28.66,,percent of total billed charges,,
BLADE MYRINGOTOMY,,A4649,HCPCS,Facility,Outpatient,,,,48.555,41.27175,13.915863,48.555,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),23.79195,49,,percent of total billed charges,,
BLADE MYRINGOTOMY,,A4649,HCPCS,Facility,Inpatient,,,,48.555,41.27175,13.915863,48.555,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
BLADE MYRINGOTOMY,,A4649,HCPCS,Facility,Both,,,,48.555,41.27175,13.915863,48.555,CorVel,Worker's Compensation,48.555,100,,percent of total billed charges,,
BLADE MYRINGOTOMY,,A4649,HCPCS,Facility,Both,,,,48.555,41.27175,13.915863,48.555,First Health Group Corporation,First Health Network,47.09835,97,,percent of total billed charges,,
BLADE MYRINGOTOMY,,A4649,HCPCS,Facility,Both,,,,48.555,41.27175,13.915863,48.555,"Health Partners, Inc.",Commercial,45.93303,94.6,,percent of total billed charges,,
BLADE MYRINGOTOMY,,A4649,HCPCS,Facility,Outpatient,,,,48.555,41.27175,13.915863,48.555,"Health Partners, Inc.",Medicare Advantage,23.79195,49,,percent of total billed charges,,
BLADE MYRINGOTOMY,,A4649,HCPCS,Facility,Inpatient,,,,48.555,41.27175,13.915863,48.555,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
BLADE MYRINGOTOMY,,A4649,HCPCS,Facility,Both,,,,48.555,41.27175,13.915863,48.555,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),29.133,60,,percent of total billed charges,,
BLADE MYRINGOTOMY,,A4649,HCPCS,Facility,Both,,,,48.555,41.27175,13.915863,48.555,"Health Partners, Inc.",State of Minnesota Advantage Program,39.572325,81.5,,percent of total billed charges,,
BLADE MYRINGOTOMY,,A4649,HCPCS,Facility,Both,,,,48.555,41.27175,13.915863,48.555,"Health Partners, Inc.",State Public Programs,24.2775,50,,percent of total billed charges,,
BLADE MYRINGOTOMY,,A4649,HCPCS,Facility,Both,,,,48.555,41.27175,13.915863,48.555,Humana Insurance Company,Commercial PPO,46.12725,95,,percent of total billed charges,,
BLADE MYRINGOTOMY,,A4649,HCPCS,Facility,Outpatient,,,,48.555,41.27175,13.915863,48.555,Humana Insurance Company,Medicare PPO,23.79195,49,,percent of total billed charges,,
BLADE MYRINGOTOMY,,A4649,HCPCS,Facility,Inpatient,,,,48.555,41.27175,13.915863,48.555,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
BLADE MYRINGOTOMY,,A4649,HCPCS,Facility,Both,,,,48.555,41.27175,13.915863,48.555,Medica,Individual & Family,48.118005,99.1,,percent of total billed charges,,
BLADE MYRINGOTOMY,,A4649,HCPCS,Facility,Outpatient,,,,48.555,41.27175,13.915863,48.555,Medica,Medica Advantage Solution,24.18039,49.8,,percent of total billed charges,,
BLADE MYRINGOTOMY,,A4649,HCPCS,Facility,Inpatient,,,,48.555,41.27175,13.915863,48.555,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
BLADE MYRINGOTOMY,,A4649,HCPCS,Facility,Outpatient,,,,48.555,41.27175,13.915863,48.555,Medica,Medical Assistance,21.65553,44.6,,percent of total billed charges,,
BLADE MYRINGOTOMY,,A4649,HCPCS,Facility,Inpatient,,,,48.555,41.27175,13.915863,48.555,Medica,Medical Assistance,,,,,Included in per diem rate,
BLADE MYRINGOTOMY,,A4649,HCPCS,Facility,Outpatient,,,,48.555,41.27175,13.915863,48.555,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,24.18039,49.8,,percent of total billed charges,,
BLADE MYRINGOTOMY,,A4649,HCPCS,Facility,Inpatient,,,,48.555,41.27175,13.915863,48.555,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
BLADE MYRINGOTOMY,,A4649,HCPCS,Facility,Both,,,,48.555,41.27175,13.915863,48.555,"Multiplan, Inc.","Multiplan, Inc.",45.6417,94,,percent of total billed charges,,
BLADE MYRINGOTOMY,,A4649,HCPCS,Facility,Outpatient,,,,48.555,41.27175,13.915863,48.555,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,43.748055,90.1,,percent of total billed charges,,
BLADE MYRINGOTOMY,,A4649,HCPCS,Facility,Inpatient,,,,48.555,41.27175,13.915863,48.555,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
BLADE MYRINGOTOMY,,A4649,HCPCS,Facility,Both,,,,48.555,41.27175,13.915863,48.555,"Preferred One Administrative Services, INC.",PPO,47.87523,98.6,,percent of total billed charges,,
BLADE MYRINGOTOMY,,A4649,HCPCS,Facility,Outpatient,,,,48.555,41.27175,13.915863,48.555,PrimeWest Health,Minnesota Senior Health Options (MSHO),24.9815475,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
BLADE MYRINGOTOMY,,A4649,HCPCS,Facility,Inpatient,,,,48.555,41.27175,13.915863,48.555,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
BLADE MYRINGOTOMY,,A4649,HCPCS,Facility,Outpatient,,,,48.555,41.27175,13.915863,48.555,PrimeWest Health,MinnesotaCare,24.937848,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
BLADE MYRINGOTOMY,,A4649,HCPCS,Facility,Inpatient,,,,48.555,41.27175,13.915863,48.555,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
BLADE MYRINGOTOMY,,A4649,HCPCS,Facility,Both,,,,48.555,41.27175,13.915863,48.555,Sanford Health Plan,Sanford Health Plan,44.6706,92,,percent of total billed charges,,
BLADE MYRINGOTOMY,,A4649,HCPCS,Facility,Outpatient,,,,48.555,41.27175,13.915863,48.555,"UCare Health, Inc.",Individual & Family Plan,27.3607425,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
BLADE MYRINGOTOMY,,A4649,HCPCS,Facility,Inpatient,,,,48.555,41.27175,13.915863,48.555,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
BLADE MYRINGOTOMY,,A4649,HCPCS,Facility,Outpatient,,,,48.555,41.27175,13.915863,48.555,"UCare Health, Inc.",Medical Assistance,24.5057085,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BLADE MYRINGOTOMY,,A4649,HCPCS,Facility,Inpatient,,,,48.555,41.27175,13.915863,48.555,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
BLADE MYRINGOTOMY,,A4649,HCPCS,Facility,Outpatient,,,,48.555,41.27175,13.915863,48.555,"UCare Health, Inc.",Medicare Advantage,24.5057085,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BLADE MYRINGOTOMY,,A4649,HCPCS,Facility,Inpatient,,,,48.555,41.27175,13.915863,48.555,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
BLADE MYRINGOTOMY,,A4649,HCPCS,Facility,Outpatient,,,,48.555,41.27175,13.915863,48.555,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),24.5057085,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BLADE MYRINGOTOMY,,A4649,HCPCS,Facility,Inpatient,,,,48.555,41.27175,13.915863,48.555,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
BLADE MYRINGOTOMY,,A4649,HCPCS,Facility,Both,,,,48.555,41.27175,13.915863,48.555,UnitedHealthcare,Individual & Family,45.6417,94,,percent of total billed charges,,
BLADE MYRINGOTOMY,,A4649,HCPCS,Facility,Outpatient,,,,48.555,41.27175,13.915863,48.555,UnitedHealthcare,Medicare Advantage,23.79195,49,,percent of total billed charges,,
BLADE MYRINGOTOMY,,A4649,HCPCS,Facility,Inpatient,,,,48.555,41.27175,13.915863,48.555,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
BLADE MYRINGOTOMY,,A4649,HCPCS,Facility,Outpatient,,,,48.555,41.27175,13.915863,48.555,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,23.3064,48,,percent of total billed charges,,100% of DHS outpatient percentage
BLADE MYRINGOTOMY,,A4649,HCPCS,Facility,Inpatient,,,,48.555,41.27175,13.915863,48.555,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
BLADE PRECISION FALCON 190MM  STRYKER 6720-127-090,,A4649,HCPCS,Facility,Both,,,,1172.5,996.625,336.0385,1172.5,Aetna,Commercial,1078.7,92,,percent of total billed charges,,
BLADE PRECISION FALCON 190MM  STRYKER 6720-127-090,,A4649,HCPCS,Facility,Outpatient,,,,1172.5,996.625,336.0385,1172.5,Aetna,Medicare Advantage,574.525,49,,percent of total billed charges,,
BLADE PRECISION FALCON 190MM  STRYKER 6720-127-090,,A4649,HCPCS,Facility,Inpatient,,,,1172.5,996.625,336.0385,1172.5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
BLADE PRECISION FALCON 190MM  STRYKER 6720-127-090,,A4649,HCPCS,Facility,Both,,,,1172.5,996.625,336.0385,1172.5,Aetna,PPO,1090.425,93,,percent of total billed charges,,
BLADE PRECISION FALCON 190MM  STRYKER 6720-127-090,,A4649,HCPCS,Facility,Both,,,,1172.5,996.625,336.0385,1172.5,America's PPO,America's PPO,1125.95175,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
BLADE PRECISION FALCON 190MM  STRYKER 6720-127-090,,A4649,HCPCS,Facility,Both,,,,1172.5,996.625,336.0385,1172.5,BlueCross BlueShield Minnesota, Federal Employee Program,1153.74,98.4,,percent of total billed charges,,
BLADE PRECISION FALCON 190MM  STRYKER 6720-127-090,,A4649,HCPCS,Facility,Both,,,,1172.5,996.625,336.0385,1172.5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1172.5,100,,percent of total billed charges,,
BLADE PRECISION FALCON 190MM  STRYKER 6720-127-090,,A4649,HCPCS,Facility,Both,,,,1172.5,996.625,336.0385,1172.5,BlueCross BlueShield Minnesota,High Value Network Plan,1055.25,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
BLADE PRECISION FALCON 190MM  STRYKER 6720-127-090,,A4649,HCPCS,Facility,Outpatient,,,,1172.5,996.625,336.0385,1172.5,BlueCross BlueShield Minnesota,Medicare Advantage,574.525,49,,percent of total billed charges,,
BLADE PRECISION FALCON 190MM  STRYKER 6720-127-090,,A4649,HCPCS,Facility,Inpatient,,,,1172.5,996.625,336.0385,1172.5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
BLADE PRECISION FALCON 190MM  STRYKER 6720-127-090,,A4649,HCPCS,Facility,Both,,,,1172.5,996.625,336.0385,1172.5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1038.48325,88.57,,percent of total billed charges,,
BLADE PRECISION FALCON 190MM  STRYKER 6720-127-090,,A4649,HCPCS,Facility,Both,,,,1172.5,996.625,336.0385,1172.5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,336.0385,28.66,,percent of total billed charges,,
BLADE PRECISION FALCON 190MM  STRYKER 6720-127-090,,A4649,HCPCS,Facility,Outpatient,,,,1172.5,996.625,336.0385,1172.5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),574.525,49,,percent of total billed charges,,
BLADE PRECISION FALCON 190MM  STRYKER 6720-127-090,,A4649,HCPCS,Facility,Inpatient,,,,1172.5,996.625,336.0385,1172.5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
BLADE PRECISION FALCON 190MM  STRYKER 6720-127-090,,A4649,HCPCS,Facility,Both,,,,1172.5,996.625,336.0385,1172.5,CorVel,Worker's Compensation,1172.5,100,,percent of total billed charges,,
BLADE PRECISION FALCON 190MM  STRYKER 6720-127-090,,A4649,HCPCS,Facility,Both,,,,1172.5,996.625,336.0385,1172.5,First Health Group Corporation,First Health Network,1137.325,97,,percent of total billed charges,,
BLADE PRECISION FALCON 190MM  STRYKER 6720-127-090,,A4649,HCPCS,Facility,Both,,,,1172.5,996.625,336.0385,1172.5,"Health Partners, Inc.",Commercial,1109.185,94.6,,percent of total billed charges,,
BLADE PRECISION FALCON 190MM  STRYKER 6720-127-090,,A4649,HCPCS,Facility,Outpatient,,,,1172.5,996.625,336.0385,1172.5,"Health Partners, Inc.",Medicare Advantage,574.525,49,,percent of total billed charges,,
BLADE PRECISION FALCON 190MM  STRYKER 6720-127-090,,A4649,HCPCS,Facility,Inpatient,,,,1172.5,996.625,336.0385,1172.5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
BLADE PRECISION FALCON 190MM  STRYKER 6720-127-090,,A4649,HCPCS,Facility,Both,,,,1172.5,996.625,336.0385,1172.5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),703.5,60,,percent of total billed charges,,
BLADE PRECISION FALCON 190MM  STRYKER 6720-127-090,,A4649,HCPCS,Facility,Both,,,,1172.5,996.625,336.0385,1172.5,"Health Partners, Inc.",State of Minnesota Advantage Program,955.5875,81.5,,percent of total billed charges,,
BLADE PRECISION FALCON 190MM  STRYKER 6720-127-090,,A4649,HCPCS,Facility,Both,,,,1172.5,996.625,336.0385,1172.5,"Health Partners, Inc.",State Public Programs,586.25,50,,percent of total billed charges,,
BLADE PRECISION FALCON 190MM  STRYKER 6720-127-090,,A4649,HCPCS,Facility,Both,,,,1172.5,996.625,336.0385,1172.5,Humana Insurance Company,Commercial PPO,1113.875,95,,percent of total billed charges,,
BLADE PRECISION FALCON 190MM  STRYKER 6720-127-090,,A4649,HCPCS,Facility,Outpatient,,,,1172.5,996.625,336.0385,1172.5,Humana Insurance Company,Medicare PPO,574.525,49,,percent of total billed charges,,
BLADE PRECISION FALCON 190MM  STRYKER 6720-127-090,,A4649,HCPCS,Facility,Inpatient,,,,1172.5,996.625,336.0385,1172.5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
BLADE PRECISION FALCON 190MM  STRYKER 6720-127-090,,A4649,HCPCS,Facility,Both,,,,1172.5,996.625,336.0385,1172.5,Medica,Individual & Family,1161.9475,99.1,,percent of total billed charges,,
BLADE PRECISION FALCON 190MM  STRYKER 6720-127-090,,A4649,HCPCS,Facility,Outpatient,,,,1172.5,996.625,336.0385,1172.5,Medica,Medica Advantage Solution,583.905,49.8,,percent of total billed charges,,
BLADE PRECISION FALCON 190MM  STRYKER 6720-127-090,,A4649,HCPCS,Facility,Inpatient,,,,1172.5,996.625,336.0385,1172.5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
BLADE PRECISION FALCON 190MM  STRYKER 6720-127-090,,A4649,HCPCS,Facility,Outpatient,,,,1172.5,996.625,336.0385,1172.5,Medica,Medical Assistance,522.935,44.6,,percent of total billed charges,,
BLADE PRECISION FALCON 190MM  STRYKER 6720-127-090,,A4649,HCPCS,Facility,Inpatient,,,,1172.5,996.625,336.0385,1172.5,Medica,Medical Assistance,,,,,Included in per diem rate,
BLADE PRECISION FALCON 190MM  STRYKER 6720-127-090,,A4649,HCPCS,Facility,Outpatient,,,,1172.5,996.625,336.0385,1172.5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,583.905,49.8,,percent of total billed charges,,
BLADE PRECISION FALCON 190MM  STRYKER 6720-127-090,,A4649,HCPCS,Facility,Inpatient,,,,1172.5,996.625,336.0385,1172.5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
BLADE PRECISION FALCON 190MM  STRYKER 6720-127-090,,A4649,HCPCS,Facility,Both,,,,1172.5,996.625,336.0385,1172.5,"Multiplan, Inc.","Multiplan, Inc.",1102.15,94,,percent of total billed charges,,
BLADE PRECISION FALCON 190MM  STRYKER 6720-127-090,,A4649,HCPCS,Facility,Outpatient,,,,1172.5,996.625,336.0385,1172.5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1056.4225,90.1,,percent of total billed charges,,
BLADE PRECISION FALCON 190MM  STRYKER 6720-127-090,,A4649,HCPCS,Facility,Inpatient,,,,1172.5,996.625,336.0385,1172.5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
BLADE PRECISION FALCON 190MM  STRYKER 6720-127-090,,A4649,HCPCS,Facility,Both,,,,1172.5,996.625,336.0385,1172.5,"Preferred One Administrative Services, INC.",PPO,1156.085,98.6,,percent of total billed charges,,
BLADE PRECISION FALCON 190MM  STRYKER 6720-127-090,,A4649,HCPCS,Facility,Outpatient,,,,1172.5,996.625,336.0385,1172.5,PrimeWest Health,Minnesota Senior Health Options (MSHO),603.25125,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
BLADE PRECISION FALCON 190MM  STRYKER 6720-127-090,,A4649,HCPCS,Facility,Inpatient,,,,1172.5,996.625,336.0385,1172.5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
BLADE PRECISION FALCON 190MM  STRYKER 6720-127-090,,A4649,HCPCS,Facility,Outpatient,,,,1172.5,996.625,336.0385,1172.5,PrimeWest Health,MinnesotaCare,602.196,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
BLADE PRECISION FALCON 190MM  STRYKER 6720-127-090,,A4649,HCPCS,Facility,Inpatient,,,,1172.5,996.625,336.0385,1172.5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
BLADE PRECISION FALCON 190MM  STRYKER 6720-127-090,,A4649,HCPCS,Facility,Both,,,,1172.5,996.625,336.0385,1172.5,Sanford Health Plan,Sanford Health Plan,1078.7,92,,percent of total billed charges,,
BLADE PRECISION FALCON 190MM  STRYKER 6720-127-090,,A4649,HCPCS,Facility,Outpatient,,,,1172.5,996.625,336.0385,1172.5,"UCare Health, Inc.",Individual & Family Plan,660.70375,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
BLADE PRECISION FALCON 190MM  STRYKER 6720-127-090,,A4649,HCPCS,Facility,Inpatient,,,,1172.5,996.625,336.0385,1172.5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
BLADE PRECISION FALCON 190MM  STRYKER 6720-127-090,,A4649,HCPCS,Facility,Outpatient,,,,1172.5,996.625,336.0385,1172.5,"UCare Health, Inc.",Medical Assistance,591.76075,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BLADE PRECISION FALCON 190MM  STRYKER 6720-127-090,,A4649,HCPCS,Facility,Inpatient,,,,1172.5,996.625,336.0385,1172.5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
BLADE PRECISION FALCON 190MM  STRYKER 6720-127-090,,A4649,HCPCS,Facility,Outpatient,,,,1172.5,996.625,336.0385,1172.5,"UCare Health, Inc.",Medicare Advantage,591.76075,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BLADE PRECISION FALCON 190MM  STRYKER 6720-127-090,,A4649,HCPCS,Facility,Inpatient,,,,1172.5,996.625,336.0385,1172.5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
BLADE PRECISION FALCON 190MM  STRYKER 6720-127-090,,A4649,HCPCS,Facility,Outpatient,,,,1172.5,996.625,336.0385,1172.5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),591.76075,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BLADE PRECISION FALCON 190MM  STRYKER 6720-127-090,,A4649,HCPCS,Facility,Inpatient,,,,1172.5,996.625,336.0385,1172.5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
BLADE PRECISION FALCON 190MM  STRYKER 6720-127-090,,A4649,HCPCS,Facility,Both,,,,1172.5,996.625,336.0385,1172.5,UnitedHealthcare,Individual & Family,1102.15,94,,percent of total billed charges,,
BLADE PRECISION FALCON 190MM  STRYKER 6720-127-090,,A4649,HCPCS,Facility,Outpatient,,,,1172.5,996.625,336.0385,1172.5,UnitedHealthcare,Medicare Advantage,574.525,49,,percent of total billed charges,,
BLADE PRECISION FALCON 190MM  STRYKER 6720-127-090,,A4649,HCPCS,Facility,Inpatient,,,,1172.5,996.625,336.0385,1172.5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
BLADE PRECISION FALCON 190MM  STRYKER 6720-127-090,,A4649,HCPCS,Facility,Outpatient,,,,1172.5,996.625,336.0385,1172.5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,562.8,48,,percent of total billed charges,,100% of DHS outpatient percentage
BLADE PRECISION FALCON 190MM  STRYKER 6720-127-090,,A4649,HCPCS,Facility,Inpatient,,,,1172.5,996.625,336.0385,1172.5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
BLADE PRECISION FALCON 90MM  STRYKER 6725-127-090,,A4649,HCPCS,Facility,Both,,,,1172.5,996.625,336.0385,1172.5,Aetna,Commercial,1078.7,92,,percent of total billed charges,,
BLADE PRECISION FALCON 90MM  STRYKER 6725-127-090,,A4649,HCPCS,Facility,Outpatient,,,,1172.5,996.625,336.0385,1172.5,Aetna,Medicare Advantage,574.525,49,,percent of total billed charges,,
BLADE PRECISION FALCON 90MM  STRYKER 6725-127-090,,A4649,HCPCS,Facility,Inpatient,,,,1172.5,996.625,336.0385,1172.5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
BLADE PRECISION FALCON 90MM  STRYKER 6725-127-090,,A4649,HCPCS,Facility,Both,,,,1172.5,996.625,336.0385,1172.5,Aetna,PPO,1090.425,93,,percent of total billed charges,,
BLADE PRECISION FALCON 90MM  STRYKER 6725-127-090,,A4649,HCPCS,Facility,Both,,,,1172.5,996.625,336.0385,1172.5,America's PPO,America's PPO,1125.95175,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
BLADE PRECISION FALCON 90MM  STRYKER 6725-127-090,,A4649,HCPCS,Facility,Both,,,,1172.5,996.625,336.0385,1172.5,BlueCross BlueShield Minnesota, Federal Employee Program,1153.74,98.4,,percent of total billed charges,,
BLADE PRECISION FALCON 90MM  STRYKER 6725-127-090,,A4649,HCPCS,Facility,Both,,,,1172.5,996.625,336.0385,1172.5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1172.5,100,,percent of total billed charges,,
BLADE PRECISION FALCON 90MM  STRYKER 6725-127-090,,A4649,HCPCS,Facility,Both,,,,1172.5,996.625,336.0385,1172.5,BlueCross BlueShield Minnesota,High Value Network Plan,1055.25,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
BLADE PRECISION FALCON 90MM  STRYKER 6725-127-090,,A4649,HCPCS,Facility,Outpatient,,,,1172.5,996.625,336.0385,1172.5,BlueCross BlueShield Minnesota,Medicare Advantage,574.525,49,,percent of total billed charges,,
BLADE PRECISION FALCON 90MM  STRYKER 6725-127-090,,A4649,HCPCS,Facility,Inpatient,,,,1172.5,996.625,336.0385,1172.5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
BLADE PRECISION FALCON 90MM  STRYKER 6725-127-090,,A4649,HCPCS,Facility,Both,,,,1172.5,996.625,336.0385,1172.5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1038.48325,88.57,,percent of total billed charges,,
BLADE PRECISION FALCON 90MM  STRYKER 6725-127-090,,A4649,HCPCS,Facility,Both,,,,1172.5,996.625,336.0385,1172.5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,336.0385,28.66,,percent of total billed charges,,
BLADE PRECISION FALCON 90MM  STRYKER 6725-127-090,,A4649,HCPCS,Facility,Outpatient,,,,1172.5,996.625,336.0385,1172.5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),574.525,49,,percent of total billed charges,,
BLADE PRECISION FALCON 90MM  STRYKER 6725-127-090,,A4649,HCPCS,Facility,Inpatient,,,,1172.5,996.625,336.0385,1172.5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
BLADE PRECISION FALCON 90MM  STRYKER 6725-127-090,,A4649,HCPCS,Facility,Both,,,,1172.5,996.625,336.0385,1172.5,CorVel,Worker's Compensation,1172.5,100,,percent of total billed charges,,
BLADE PRECISION FALCON 90MM  STRYKER 6725-127-090,,A4649,HCPCS,Facility,Both,,,,1172.5,996.625,336.0385,1172.5,First Health Group Corporation,First Health Network,1137.325,97,,percent of total billed charges,,
BLADE PRECISION FALCON 90MM  STRYKER 6725-127-090,,A4649,HCPCS,Facility,Both,,,,1172.5,996.625,336.0385,1172.5,"Health Partners, Inc.",Commercial,1109.185,94.6,,percent of total billed charges,,
BLADE PRECISION FALCON 90MM  STRYKER 6725-127-090,,A4649,HCPCS,Facility,Outpatient,,,,1172.5,996.625,336.0385,1172.5,"Health Partners, Inc.",Medicare Advantage,574.525,49,,percent of total billed charges,,
BLADE PRECISION FALCON 90MM  STRYKER 6725-127-090,,A4649,HCPCS,Facility,Inpatient,,,,1172.5,996.625,336.0385,1172.5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
BLADE PRECISION FALCON 90MM  STRYKER 6725-127-090,,A4649,HCPCS,Facility,Both,,,,1172.5,996.625,336.0385,1172.5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),703.5,60,,percent of total billed charges,,
BLADE PRECISION FALCON 90MM  STRYKER 6725-127-090,,A4649,HCPCS,Facility,Both,,,,1172.5,996.625,336.0385,1172.5,"Health Partners, Inc.",State of Minnesota Advantage Program,955.5875,81.5,,percent of total billed charges,,
BLADE PRECISION FALCON 90MM  STRYKER 6725-127-090,,A4649,HCPCS,Facility,Both,,,,1172.5,996.625,336.0385,1172.5,"Health Partners, Inc.",State Public Programs,586.25,50,,percent of total billed charges,,
BLADE PRECISION FALCON 90MM  STRYKER 6725-127-090,,A4649,HCPCS,Facility,Both,,,,1172.5,996.625,336.0385,1172.5,Humana Insurance Company,Commercial PPO,1113.875,95,,percent of total billed charges,,
BLADE PRECISION FALCON 90MM  STRYKER 6725-127-090,,A4649,HCPCS,Facility,Outpatient,,,,1172.5,996.625,336.0385,1172.5,Humana Insurance Company,Medicare PPO,574.525,49,,percent of total billed charges,,
BLADE PRECISION FALCON 90MM  STRYKER 6725-127-090,,A4649,HCPCS,Facility,Inpatient,,,,1172.5,996.625,336.0385,1172.5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
BLADE PRECISION FALCON 90MM  STRYKER 6725-127-090,,A4649,HCPCS,Facility,Both,,,,1172.5,996.625,336.0385,1172.5,Medica,Individual & Family,1161.9475,99.1,,percent of total billed charges,,
BLADE PRECISION FALCON 90MM  STRYKER 6725-127-090,,A4649,HCPCS,Facility,Outpatient,,,,1172.5,996.625,336.0385,1172.5,Medica,Medica Advantage Solution,583.905,49.8,,percent of total billed charges,,
BLADE PRECISION FALCON 90MM  STRYKER 6725-127-090,,A4649,HCPCS,Facility,Inpatient,,,,1172.5,996.625,336.0385,1172.5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
BLADE PRECISION FALCON 90MM  STRYKER 6725-127-090,,A4649,HCPCS,Facility,Outpatient,,,,1172.5,996.625,336.0385,1172.5,Medica,Medical Assistance,522.935,44.6,,percent of total billed charges,,
BLADE PRECISION FALCON 90MM  STRYKER 6725-127-090,,A4649,HCPCS,Facility,Inpatient,,,,1172.5,996.625,336.0385,1172.5,Medica,Medical Assistance,,,,,Included in per diem rate,
BLADE PRECISION FALCON 90MM  STRYKER 6725-127-090,,A4649,HCPCS,Facility,Outpatient,,,,1172.5,996.625,336.0385,1172.5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,583.905,49.8,,percent of total billed charges,,
BLADE PRECISION FALCON 90MM  STRYKER 6725-127-090,,A4649,HCPCS,Facility,Inpatient,,,,1172.5,996.625,336.0385,1172.5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
BLADE PRECISION FALCON 90MM  STRYKER 6725-127-090,,A4649,HCPCS,Facility,Both,,,,1172.5,996.625,336.0385,1172.5,"Multiplan, Inc.","Multiplan, Inc.",1102.15,94,,percent of total billed charges,,
BLADE PRECISION FALCON 90MM  STRYKER 6725-127-090,,A4649,HCPCS,Facility,Outpatient,,,,1172.5,996.625,336.0385,1172.5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1056.4225,90.1,,percent of total billed charges,,
BLADE PRECISION FALCON 90MM  STRYKER 6725-127-090,,A4649,HCPCS,Facility,Inpatient,,,,1172.5,996.625,336.0385,1172.5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
BLADE PRECISION FALCON 90MM  STRYKER 6725-127-090,,A4649,HCPCS,Facility,Both,,,,1172.5,996.625,336.0385,1172.5,"Preferred One Administrative Services, INC.",PPO,1156.085,98.6,,percent of total billed charges,,
BLADE PRECISION FALCON 90MM  STRYKER 6725-127-090,,A4649,HCPCS,Facility,Outpatient,,,,1172.5,996.625,336.0385,1172.5,PrimeWest Health,Minnesota Senior Health Options (MSHO),603.25125,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
BLADE PRECISION FALCON 90MM  STRYKER 6725-127-090,,A4649,HCPCS,Facility,Inpatient,,,,1172.5,996.625,336.0385,1172.5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
BLADE PRECISION FALCON 90MM  STRYKER 6725-127-090,,A4649,HCPCS,Facility,Outpatient,,,,1172.5,996.625,336.0385,1172.5,PrimeWest Health,MinnesotaCare,602.196,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
BLADE PRECISION FALCON 90MM  STRYKER 6725-127-090,,A4649,HCPCS,Facility,Inpatient,,,,1172.5,996.625,336.0385,1172.5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
BLADE PRECISION FALCON 90MM  STRYKER 6725-127-090,,A4649,HCPCS,Facility,Both,,,,1172.5,996.625,336.0385,1172.5,Sanford Health Plan,Sanford Health Plan,1078.7,92,,percent of total billed charges,,
BLADE PRECISION FALCON 90MM  STRYKER 6725-127-090,,A4649,HCPCS,Facility,Outpatient,,,,1172.5,996.625,336.0385,1172.5,"UCare Health, Inc.",Individual & Family Plan,660.70375,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
BLADE PRECISION FALCON 90MM  STRYKER 6725-127-090,,A4649,HCPCS,Facility,Inpatient,,,,1172.5,996.625,336.0385,1172.5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
BLADE PRECISION FALCON 90MM  STRYKER 6725-127-090,,A4649,HCPCS,Facility,Outpatient,,,,1172.5,996.625,336.0385,1172.5,"UCare Health, Inc.",Medical Assistance,591.76075,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BLADE PRECISION FALCON 90MM  STRYKER 6725-127-090,,A4649,HCPCS,Facility,Inpatient,,,,1172.5,996.625,336.0385,1172.5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
BLADE PRECISION FALCON 90MM  STRYKER 6725-127-090,,A4649,HCPCS,Facility,Outpatient,,,,1172.5,996.625,336.0385,1172.5,"UCare Health, Inc.",Medicare Advantage,591.76075,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BLADE PRECISION FALCON 90MM  STRYKER 6725-127-090,,A4649,HCPCS,Facility,Inpatient,,,,1172.5,996.625,336.0385,1172.5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
BLADE PRECISION FALCON 90MM  STRYKER 6725-127-090,,A4649,HCPCS,Facility,Outpatient,,,,1172.5,996.625,336.0385,1172.5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),591.76075,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BLADE PRECISION FALCON 90MM  STRYKER 6725-127-090,,A4649,HCPCS,Facility,Inpatient,,,,1172.5,996.625,336.0385,1172.5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
BLADE PRECISION FALCON 90MM  STRYKER 6725-127-090,,A4649,HCPCS,Facility,Both,,,,1172.5,996.625,336.0385,1172.5,UnitedHealthcare,Individual & Family,1102.15,94,,percent of total billed charges,,
BLADE PRECISION FALCON 90MM  STRYKER 6725-127-090,,A4649,HCPCS,Facility,Outpatient,,,,1172.5,996.625,336.0385,1172.5,UnitedHealthcare,Medicare Advantage,574.525,49,,percent of total billed charges,,
BLADE PRECISION FALCON 90MM  STRYKER 6725-127-090,,A4649,HCPCS,Facility,Inpatient,,,,1172.5,996.625,336.0385,1172.5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
BLADE PRECISION FALCON 90MM  STRYKER 6725-127-090,,A4649,HCPCS,Facility,Outpatient,,,,1172.5,996.625,336.0385,1172.5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,562.8,48,,percent of total billed charges,,100% of DHS outpatient percentage
BLADE PRECISION FALCON 90MM  STRYKER 6725-127-090,,A4649,HCPCS,Facility,Inpatient,,,,1172.5,996.625,336.0385,1172.5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
BLADE RECIPROCATING SINGLE SIDED  326,,A4649,HCPCS,Facility,Both,,,,321,272.85,91.9986,321,Aetna,Commercial,295.32,92,,percent of total billed charges,,
BLADE RECIPROCATING SINGLE SIDED  326,,A4649,HCPCS,Facility,Outpatient,,,,321,272.85,91.9986,321,Aetna,Medicare Advantage,157.29,49,,percent of total billed charges,,
BLADE RECIPROCATING SINGLE SIDED  326,,A4649,HCPCS,Facility,Inpatient,,,,321,272.85,91.9986,321,Aetna,Medicare Advantage,,,,,Included in per diem rate,
BLADE RECIPROCATING SINGLE SIDED  326,,A4649,HCPCS,Facility,Both,,,,321,272.85,91.9986,321,Aetna,PPO,298.53,93,,percent of total billed charges,,
BLADE RECIPROCATING SINGLE SIDED  326,,A4649,HCPCS,Facility,Both,,,,321,272.85,91.9986,321,America's PPO,America's PPO,308.2563,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
BLADE RECIPROCATING SINGLE SIDED  326,,A4649,HCPCS,Facility,Both,,,,321,272.85,91.9986,321,BlueCross BlueShield Minnesota, Federal Employee Program,315.864,98.4,,percent of total billed charges,,
BLADE RECIPROCATING SINGLE SIDED  326,,A4649,HCPCS,Facility,Both,,,,321,272.85,91.9986,321,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,321,100,,percent of total billed charges,,
BLADE RECIPROCATING SINGLE SIDED  326,,A4649,HCPCS,Facility,Both,,,,321,272.85,91.9986,321,BlueCross BlueShield Minnesota,High Value Network Plan,288.9,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
BLADE RECIPROCATING SINGLE SIDED  326,,A4649,HCPCS,Facility,Outpatient,,,,321,272.85,91.9986,321,BlueCross BlueShield Minnesota,Medicare Advantage,157.29,49,,percent of total billed charges,,
BLADE RECIPROCATING SINGLE SIDED  326,,A4649,HCPCS,Facility,Inpatient,,,,321,272.85,91.9986,321,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
BLADE RECIPROCATING SINGLE SIDED  326,,A4649,HCPCS,Facility,Both,,,,321,272.85,91.9986,321,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,284.3097,88.57,,percent of total billed charges,,
BLADE RECIPROCATING SINGLE SIDED  326,,A4649,HCPCS,Facility,Both,,,,321,272.85,91.9986,321,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,91.9986,28.66,,percent of total billed charges,,
BLADE RECIPROCATING SINGLE SIDED  326,,A4649,HCPCS,Facility,Outpatient,,,,321,272.85,91.9986,321,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),157.29,49,,percent of total billed charges,,
BLADE RECIPROCATING SINGLE SIDED  326,,A4649,HCPCS,Facility,Inpatient,,,,321,272.85,91.9986,321,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
BLADE RECIPROCATING SINGLE SIDED  326,,A4649,HCPCS,Facility,Both,,,,321,272.85,91.9986,321,CorVel,Worker's Compensation,321,100,,percent of total billed charges,,
BLADE RECIPROCATING SINGLE SIDED  326,,A4649,HCPCS,Facility,Both,,,,321,272.85,91.9986,321,First Health Group Corporation,First Health Network,311.37,97,,percent of total billed charges,,
BLADE RECIPROCATING SINGLE SIDED  326,,A4649,HCPCS,Facility,Both,,,,321,272.85,91.9986,321,"Health Partners, Inc.",Commercial,303.666,94.6,,percent of total billed charges,,
BLADE RECIPROCATING SINGLE SIDED  326,,A4649,HCPCS,Facility,Outpatient,,,,321,272.85,91.9986,321,"Health Partners, Inc.",Medicare Advantage,157.29,49,,percent of total billed charges,,
BLADE RECIPROCATING SINGLE SIDED  326,,A4649,HCPCS,Facility,Inpatient,,,,321,272.85,91.9986,321,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
BLADE RECIPROCATING SINGLE SIDED  326,,A4649,HCPCS,Facility,Both,,,,321,272.85,91.9986,321,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),192.6,60,,percent of total billed charges,,
BLADE RECIPROCATING SINGLE SIDED  326,,A4649,HCPCS,Facility,Both,,,,321,272.85,91.9986,321,"Health Partners, Inc.",State of Minnesota Advantage Program,261.615,81.5,,percent of total billed charges,,
BLADE RECIPROCATING SINGLE SIDED  326,,A4649,HCPCS,Facility,Both,,,,321,272.85,91.9986,321,"Health Partners, Inc.",State Public Programs,160.5,50,,percent of total billed charges,,
BLADE RECIPROCATING SINGLE SIDED  326,,A4649,HCPCS,Facility,Both,,,,321,272.85,91.9986,321,Humana Insurance Company,Commercial PPO,304.95,95,,percent of total billed charges,,
BLADE RECIPROCATING SINGLE SIDED  326,,A4649,HCPCS,Facility,Outpatient,,,,321,272.85,91.9986,321,Humana Insurance Company,Medicare PPO,157.29,49,,percent of total billed charges,,
BLADE RECIPROCATING SINGLE SIDED  326,,A4649,HCPCS,Facility,Inpatient,,,,321,272.85,91.9986,321,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
BLADE RECIPROCATING SINGLE SIDED  326,,A4649,HCPCS,Facility,Both,,,,321,272.85,91.9986,321,Medica,Individual & Family,318.111,99.1,,percent of total billed charges,,
BLADE RECIPROCATING SINGLE SIDED  326,,A4649,HCPCS,Facility,Outpatient,,,,321,272.85,91.9986,321,Medica,Medica Advantage Solution,159.858,49.8,,percent of total billed charges,,
BLADE RECIPROCATING SINGLE SIDED  326,,A4649,HCPCS,Facility,Inpatient,,,,321,272.85,91.9986,321,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
BLADE RECIPROCATING SINGLE SIDED  326,,A4649,HCPCS,Facility,Outpatient,,,,321,272.85,91.9986,321,Medica,Medical Assistance,143.166,44.6,,percent of total billed charges,,
BLADE RECIPROCATING SINGLE SIDED  326,,A4649,HCPCS,Facility,Inpatient,,,,321,272.85,91.9986,321,Medica,Medical Assistance,,,,,Included in per diem rate,
BLADE RECIPROCATING SINGLE SIDED  326,,A4649,HCPCS,Facility,Outpatient,,,,321,272.85,91.9986,321,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,159.858,49.8,,percent of total billed charges,,
BLADE RECIPROCATING SINGLE SIDED  326,,A4649,HCPCS,Facility,Inpatient,,,,321,272.85,91.9986,321,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
BLADE RECIPROCATING SINGLE SIDED  326,,A4649,HCPCS,Facility,Both,,,,321,272.85,91.9986,321,"Multiplan, Inc.","Multiplan, Inc.",301.74,94,,percent of total billed charges,,
BLADE RECIPROCATING SINGLE SIDED  326,,A4649,HCPCS,Facility,Outpatient,,,,321,272.85,91.9986,321,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,289.221,90.1,,percent of total billed charges,,
BLADE RECIPROCATING SINGLE SIDED  326,,A4649,HCPCS,Facility,Inpatient,,,,321,272.85,91.9986,321,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
BLADE RECIPROCATING SINGLE SIDED  326,,A4649,HCPCS,Facility,Both,,,,321,272.85,91.9986,321,"Preferred One Administrative Services, INC.",PPO,316.506,98.6,,percent of total billed charges,,
BLADE RECIPROCATING SINGLE SIDED  326,,A4649,HCPCS,Facility,Outpatient,,,,321,272.85,91.9986,321,PrimeWest Health,Minnesota Senior Health Options (MSHO),165.1545,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
BLADE RECIPROCATING SINGLE SIDED  326,,A4649,HCPCS,Facility,Inpatient,,,,321,272.85,91.9986,321,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
BLADE RECIPROCATING SINGLE SIDED  326,,A4649,HCPCS,Facility,Outpatient,,,,321,272.85,91.9986,321,PrimeWest Health,MinnesotaCare,164.8656,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
BLADE RECIPROCATING SINGLE SIDED  326,,A4649,HCPCS,Facility,Inpatient,,,,321,272.85,91.9986,321,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
BLADE RECIPROCATING SINGLE SIDED  326,,A4649,HCPCS,Facility,Both,,,,321,272.85,91.9986,321,Sanford Health Plan,Sanford Health Plan,295.32,92,,percent of total billed charges,,
BLADE RECIPROCATING SINGLE SIDED  326,,A4649,HCPCS,Facility,Outpatient,,,,321,272.85,91.9986,321,"UCare Health, Inc.",Individual & Family Plan,180.8835,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
BLADE RECIPROCATING SINGLE SIDED  326,,A4649,HCPCS,Facility,Inpatient,,,,321,272.85,91.9986,321,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
BLADE RECIPROCATING SINGLE SIDED  326,,A4649,HCPCS,Facility,Outpatient,,,,321,272.85,91.9986,321,"UCare Health, Inc.",Medical Assistance,162.0087,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BLADE RECIPROCATING SINGLE SIDED  326,,A4649,HCPCS,Facility,Inpatient,,,,321,272.85,91.9986,321,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
BLADE RECIPROCATING SINGLE SIDED  326,,A4649,HCPCS,Facility,Outpatient,,,,321,272.85,91.9986,321,"UCare Health, Inc.",Medicare Advantage,162.0087,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BLADE RECIPROCATING SINGLE SIDED  326,,A4649,HCPCS,Facility,Inpatient,,,,321,272.85,91.9986,321,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
BLADE RECIPROCATING SINGLE SIDED  326,,A4649,HCPCS,Facility,Outpatient,,,,321,272.85,91.9986,321,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),162.0087,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BLADE RECIPROCATING SINGLE SIDED  326,,A4649,HCPCS,Facility,Inpatient,,,,321,272.85,91.9986,321,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
BLADE RECIPROCATING SINGLE SIDED  326,,A4649,HCPCS,Facility,Both,,,,321,272.85,91.9986,321,UnitedHealthcare,Individual & Family,301.74,94,,percent of total billed charges,,
BLADE RECIPROCATING SINGLE SIDED  326,,A4649,HCPCS,Facility,Outpatient,,,,321,272.85,91.9986,321,UnitedHealthcare,Medicare Advantage,157.29,49,,percent of total billed charges,,
BLADE RECIPROCATING SINGLE SIDED  326,,A4649,HCPCS,Facility,Inpatient,,,,321,272.85,91.9986,321,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
BLADE RECIPROCATING SINGLE SIDED  326,,A4649,HCPCS,Facility,Outpatient,,,,321,272.85,91.9986,321,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,154.08,48,,percent of total billed charges,,100% of DHS outpatient percentage
BLADE RECIPROCATING SINGLE SIDED  326,,A4649,HCPCS,Facility,Inpatient,,,,321,272.85,91.9986,321,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
BLADE Saggital 6.6 x 0.64 x 23mm,,A4649,HCPCS,Facility,Both,,,,330,280.5,94.578,330,Aetna,Commercial,303.6,92,,percent of total billed charges,,
BLADE Saggital 6.6 x 0.64 x 23mm,,A4649,HCPCS,Facility,Outpatient,,,,330,280.5,94.578,330,Aetna,Medicare Advantage,161.7,49,,percent of total billed charges,,
BLADE Saggital 6.6 x 0.64 x 23mm,,A4649,HCPCS,Facility,Inpatient,,,,330,280.5,94.578,330,Aetna,Medicare Advantage,,,,,Included in per diem rate,
BLADE Saggital 6.6 x 0.64 x 23mm,,A4649,HCPCS,Facility,Both,,,,330,280.5,94.578,330,Aetna,PPO,306.9,93,,percent of total billed charges,,
BLADE Saggital 6.6 x 0.64 x 23mm,,A4649,HCPCS,Facility,Both,,,,330,280.5,94.578,330,America's PPO,America's PPO,316.899,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
BLADE Saggital 6.6 x 0.64 x 23mm,,A4649,HCPCS,Facility,Both,,,,330,280.5,94.578,330,BlueCross BlueShield Minnesota, Federal Employee Program,324.72,98.4,,percent of total billed charges,,
BLADE Saggital 6.6 x 0.64 x 23mm,,A4649,HCPCS,Facility,Both,,,,330,280.5,94.578,330,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,330,100,,percent of total billed charges,,
BLADE Saggital 6.6 x 0.64 x 23mm,,A4649,HCPCS,Facility,Both,,,,330,280.5,94.578,330,BlueCross BlueShield Minnesota,High Value Network Plan,297,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
BLADE Saggital 6.6 x 0.64 x 23mm,,A4649,HCPCS,Facility,Outpatient,,,,330,280.5,94.578,330,BlueCross BlueShield Minnesota,Medicare Advantage,161.7,49,,percent of total billed charges,,
BLADE Saggital 6.6 x 0.64 x 23mm,,A4649,HCPCS,Facility,Inpatient,,,,330,280.5,94.578,330,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
BLADE Saggital 6.6 x 0.64 x 23mm,,A4649,HCPCS,Facility,Both,,,,330,280.5,94.578,330,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,292.281,88.57,,percent of total billed charges,,
BLADE Saggital 6.6 x 0.64 x 23mm,,A4649,HCPCS,Facility,Both,,,,330,280.5,94.578,330,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,94.578,28.66,,percent of total billed charges,,
BLADE Saggital 6.6 x 0.64 x 23mm,,A4649,HCPCS,Facility,Outpatient,,,,330,280.5,94.578,330,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),161.7,49,,percent of total billed charges,,
BLADE Saggital 6.6 x 0.64 x 23mm,,A4649,HCPCS,Facility,Inpatient,,,,330,280.5,94.578,330,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
BLADE Saggital 6.6 x 0.64 x 23mm,,A4649,HCPCS,Facility,Both,,,,330,280.5,94.578,330,CorVel,Worker's Compensation,330,100,,percent of total billed charges,,
BLADE Saggital 6.6 x 0.64 x 23mm,,A4649,HCPCS,Facility,Both,,,,330,280.5,94.578,330,First Health Group Corporation,First Health Network,320.1,97,,percent of total billed charges,,
BLADE Saggital 6.6 x 0.64 x 23mm,,A4649,HCPCS,Facility,Both,,,,330,280.5,94.578,330,"Health Partners, Inc.",Commercial,312.18,94.6,,percent of total billed charges,,
BLADE Saggital 6.6 x 0.64 x 23mm,,A4649,HCPCS,Facility,Outpatient,,,,330,280.5,94.578,330,"Health Partners, Inc.",Medicare Advantage,161.7,49,,percent of total billed charges,,
BLADE Saggital 6.6 x 0.64 x 23mm,,A4649,HCPCS,Facility,Inpatient,,,,330,280.5,94.578,330,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
BLADE Saggital 6.6 x 0.64 x 23mm,,A4649,HCPCS,Facility,Both,,,,330,280.5,94.578,330,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),198,60,,percent of total billed charges,,
BLADE Saggital 6.6 x 0.64 x 23mm,,A4649,HCPCS,Facility,Both,,,,330,280.5,94.578,330,"Health Partners, Inc.",State of Minnesota Advantage Program,268.95,81.5,,percent of total billed charges,,
BLADE Saggital 6.6 x 0.64 x 23mm,,A4649,HCPCS,Facility,Both,,,,330,280.5,94.578,330,"Health Partners, Inc.",State Public Programs,165,50,,percent of total billed charges,,
BLADE Saggital 6.6 x 0.64 x 23mm,,A4649,HCPCS,Facility,Both,,,,330,280.5,94.578,330,Humana Insurance Company,Commercial PPO,313.5,95,,percent of total billed charges,,
BLADE Saggital 6.6 x 0.64 x 23mm,,A4649,HCPCS,Facility,Outpatient,,,,330,280.5,94.578,330,Humana Insurance Company,Medicare PPO,161.7,49,,percent of total billed charges,,
BLADE Saggital 6.6 x 0.64 x 23mm,,A4649,HCPCS,Facility,Inpatient,,,,330,280.5,94.578,330,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
BLADE Saggital 6.6 x 0.64 x 23mm,,A4649,HCPCS,Facility,Both,,,,330,280.5,94.578,330,Medica,Individual & Family,327.03,99.1,,percent of total billed charges,,
BLADE Saggital 6.6 x 0.64 x 23mm,,A4649,HCPCS,Facility,Outpatient,,,,330,280.5,94.578,330,Medica,Medica Advantage Solution,164.34,49.8,,percent of total billed charges,,
BLADE Saggital 6.6 x 0.64 x 23mm,,A4649,HCPCS,Facility,Inpatient,,,,330,280.5,94.578,330,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
BLADE Saggital 6.6 x 0.64 x 23mm,,A4649,HCPCS,Facility,Outpatient,,,,330,280.5,94.578,330,Medica,Medical Assistance,147.18,44.6,,percent of total billed charges,,
BLADE Saggital 6.6 x 0.64 x 23mm,,A4649,HCPCS,Facility,Inpatient,,,,330,280.5,94.578,330,Medica,Medical Assistance,,,,,Included in per diem rate,
BLADE Saggital 6.6 x 0.64 x 23mm,,A4649,HCPCS,Facility,Outpatient,,,,330,280.5,94.578,330,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,164.34,49.8,,percent of total billed charges,,
BLADE Saggital 6.6 x 0.64 x 23mm,,A4649,HCPCS,Facility,Inpatient,,,,330,280.5,94.578,330,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
BLADE Saggital 6.6 x 0.64 x 23mm,,A4649,HCPCS,Facility,Both,,,,330,280.5,94.578,330,"Multiplan, Inc.","Multiplan, Inc.",310.2,94,,percent of total billed charges,,
BLADE Saggital 6.6 x 0.64 x 23mm,,A4649,HCPCS,Facility,Outpatient,,,,330,280.5,94.578,330,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,297.33,90.1,,percent of total billed charges,,
BLADE Saggital 6.6 x 0.64 x 23mm,,A4649,HCPCS,Facility,Inpatient,,,,330,280.5,94.578,330,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
BLADE Saggital 6.6 x 0.64 x 23mm,,A4649,HCPCS,Facility,Both,,,,330,280.5,94.578,330,"Preferred One Administrative Services, INC.",PPO,325.38,98.6,,percent of total billed charges,,
BLADE Saggital 6.6 x 0.64 x 23mm,,A4649,HCPCS,Facility,Outpatient,,,,330,280.5,94.578,330,PrimeWest Health,Minnesota Senior Health Options (MSHO),169.785,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
BLADE Saggital 6.6 x 0.64 x 23mm,,A4649,HCPCS,Facility,Inpatient,,,,330,280.5,94.578,330,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
BLADE Saggital 6.6 x 0.64 x 23mm,,A4649,HCPCS,Facility,Outpatient,,,,330,280.5,94.578,330,PrimeWest Health,MinnesotaCare,169.488,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
BLADE Saggital 6.6 x 0.64 x 23mm,,A4649,HCPCS,Facility,Inpatient,,,,330,280.5,94.578,330,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
BLADE Saggital 6.6 x 0.64 x 23mm,,A4649,HCPCS,Facility,Both,,,,330,280.5,94.578,330,Sanford Health Plan,Sanford Health Plan,303.6,92,,percent of total billed charges,,
BLADE Saggital 6.6 x 0.64 x 23mm,,A4649,HCPCS,Facility,Outpatient,,,,330,280.5,94.578,330,"UCare Health, Inc.",Individual & Family Plan,185.955,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
BLADE Saggital 6.6 x 0.64 x 23mm,,A4649,HCPCS,Facility,Inpatient,,,,330,280.5,94.578,330,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
BLADE Saggital 6.6 x 0.64 x 23mm,,A4649,HCPCS,Facility,Outpatient,,,,330,280.5,94.578,330,"UCare Health, Inc.",Medical Assistance,166.551,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BLADE Saggital 6.6 x 0.64 x 23mm,,A4649,HCPCS,Facility,Inpatient,,,,330,280.5,94.578,330,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
BLADE Saggital 6.6 x 0.64 x 23mm,,A4649,HCPCS,Facility,Outpatient,,,,330,280.5,94.578,330,"UCare Health, Inc.",Medicare Advantage,166.551,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BLADE Saggital 6.6 x 0.64 x 23mm,,A4649,HCPCS,Facility,Inpatient,,,,330,280.5,94.578,330,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
BLADE Saggital 6.6 x 0.64 x 23mm,,A4649,HCPCS,Facility,Outpatient,,,,330,280.5,94.578,330,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),166.551,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BLADE Saggital 6.6 x 0.64 x 23mm,,A4649,HCPCS,Facility,Inpatient,,,,330,280.5,94.578,330,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
BLADE Saggital 6.6 x 0.64 x 23mm,,A4649,HCPCS,Facility,Both,,,,330,280.5,94.578,330,UnitedHealthcare,Individual & Family,310.2,94,,percent of total billed charges,,
BLADE Saggital 6.6 x 0.64 x 23mm,,A4649,HCPCS,Facility,Outpatient,,,,330,280.5,94.578,330,UnitedHealthcare,Medicare Advantage,161.7,49,,percent of total billed charges,,
BLADE Saggital 6.6 x 0.64 x 23mm,,A4649,HCPCS,Facility,Inpatient,,,,330,280.5,94.578,330,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
BLADE Saggital 6.6 x 0.64 x 23mm,,A4649,HCPCS,Facility,Outpatient,,,,330,280.5,94.578,330,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,158.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
BLADE Saggital 6.6 x 0.64 x 23mm,,A4649,HCPCS,Facility,Inpatient,,,,330,280.5,94.578,330,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
BLUNTPORT,,A4649,HCPCS,Facility,Both,,,,140,119,40.124,140,Aetna,Commercial,128.8,92,,percent of total billed charges,,
BLUNTPORT,,A4649,HCPCS,Facility,Outpatient,,,,140,119,40.124,140,Aetna,Medicare Advantage,68.6,49,,percent of total billed charges,,
BLUNTPORT,,A4649,HCPCS,Facility,Inpatient,,,,140,119,40.124,140,Aetna,Medicare Advantage,,,,,Included in per diem rate,
BLUNTPORT,,A4649,HCPCS,Facility,Both,,,,140,119,40.124,140,Aetna,PPO,130.2,93,,percent of total billed charges,,
BLUNTPORT,,A4649,HCPCS,Facility,Both,,,,140,119,40.124,140,America's PPO,America's PPO,134.442,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
BLUNTPORT,,A4649,HCPCS,Facility,Both,,,,140,119,40.124,140,BlueCross BlueShield Minnesota, Federal Employee Program,137.76,98.4,,percent of total billed charges,,
BLUNTPORT,,A4649,HCPCS,Facility,Both,,,,140,119,40.124,140,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,140,100,,percent of total billed charges,,
BLUNTPORT,,A4649,HCPCS,Facility,Both,,,,140,119,40.124,140,BlueCross BlueShield Minnesota,High Value Network Plan,126,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
BLUNTPORT,,A4649,HCPCS,Facility,Outpatient,,,,140,119,40.124,140,BlueCross BlueShield Minnesota,Medicare Advantage,68.6,49,,percent of total billed charges,,
BLUNTPORT,,A4649,HCPCS,Facility,Inpatient,,,,140,119,40.124,140,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
BLUNTPORT,,A4649,HCPCS,Facility,Both,,,,140,119,40.124,140,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,123.998,88.57,,percent of total billed charges,,
BLUNTPORT,,A4649,HCPCS,Facility,Both,,,,140,119,40.124,140,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,40.124,28.66,,percent of total billed charges,,
BLUNTPORT,,A4649,HCPCS,Facility,Outpatient,,,,140,119,40.124,140,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),68.6,49,,percent of total billed charges,,
BLUNTPORT,,A4649,HCPCS,Facility,Inpatient,,,,140,119,40.124,140,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
BLUNTPORT,,A4649,HCPCS,Facility,Both,,,,140,119,40.124,140,CorVel,Worker's Compensation,140,100,,percent of total billed charges,,
BLUNTPORT,,A4649,HCPCS,Facility,Both,,,,140,119,40.124,140,First Health Group Corporation,First Health Network,135.8,97,,percent of total billed charges,,
BLUNTPORT,,A4649,HCPCS,Facility,Both,,,,140,119,40.124,140,"Health Partners, Inc.",Commercial,132.44,94.6,,percent of total billed charges,,
BLUNTPORT,,A4649,HCPCS,Facility,Outpatient,,,,140,119,40.124,140,"Health Partners, Inc.",Medicare Advantage,68.6,49,,percent of total billed charges,,
BLUNTPORT,,A4649,HCPCS,Facility,Inpatient,,,,140,119,40.124,140,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
BLUNTPORT,,A4649,HCPCS,Facility,Both,,,,140,119,40.124,140,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),84,60,,percent of total billed charges,,
BLUNTPORT,,A4649,HCPCS,Facility,Both,,,,140,119,40.124,140,"Health Partners, Inc.",State of Minnesota Advantage Program,114.1,81.5,,percent of total billed charges,,
BLUNTPORT,,A4649,HCPCS,Facility,Both,,,,140,119,40.124,140,"Health Partners, Inc.",State Public Programs,70,50,,percent of total billed charges,,
BLUNTPORT,,A4649,HCPCS,Facility,Both,,,,140,119,40.124,140,Humana Insurance Company,Commercial PPO,133,95,,percent of total billed charges,,
BLUNTPORT,,A4649,HCPCS,Facility,Outpatient,,,,140,119,40.124,140,Humana Insurance Company,Medicare PPO,68.6,49,,percent of total billed charges,,
BLUNTPORT,,A4649,HCPCS,Facility,Inpatient,,,,140,119,40.124,140,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
BLUNTPORT,,A4649,HCPCS,Facility,Both,,,,140,119,40.124,140,Medica,Individual & Family,138.74,99.1,,percent of total billed charges,,
BLUNTPORT,,A4649,HCPCS,Facility,Outpatient,,,,140,119,40.124,140,Medica,Medica Advantage Solution,69.72,49.8,,percent of total billed charges,,
BLUNTPORT,,A4649,HCPCS,Facility,Inpatient,,,,140,119,40.124,140,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
BLUNTPORT,,A4649,HCPCS,Facility,Outpatient,,,,140,119,40.124,140,Medica,Medical Assistance,62.44,44.6,,percent of total billed charges,,
BLUNTPORT,,A4649,HCPCS,Facility,Inpatient,,,,140,119,40.124,140,Medica,Medical Assistance,,,,,Included in per diem rate,
BLUNTPORT,,A4649,HCPCS,Facility,Outpatient,,,,140,119,40.124,140,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,69.72,49.8,,percent of total billed charges,,
BLUNTPORT,,A4649,HCPCS,Facility,Inpatient,,,,140,119,40.124,140,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
BLUNTPORT,,A4649,HCPCS,Facility,Both,,,,140,119,40.124,140,"Multiplan, Inc.","Multiplan, Inc.",131.6,94,,percent of total billed charges,,
BLUNTPORT,,A4649,HCPCS,Facility,Outpatient,,,,140,119,40.124,140,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,126.14,90.1,,percent of total billed charges,,
BLUNTPORT,,A4649,HCPCS,Facility,Inpatient,,,,140,119,40.124,140,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
BLUNTPORT,,A4649,HCPCS,Facility,Both,,,,140,119,40.124,140,"Preferred One Administrative Services, INC.",PPO,138.04,98.6,,percent of total billed charges,,
BLUNTPORT,,A4649,HCPCS,Facility,Outpatient,,,,140,119,40.124,140,PrimeWest Health,Minnesota Senior Health Options (MSHO),72.03,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
BLUNTPORT,,A4649,HCPCS,Facility,Inpatient,,,,140,119,40.124,140,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
BLUNTPORT,,A4649,HCPCS,Facility,Outpatient,,,,140,119,40.124,140,PrimeWest Health,MinnesotaCare,71.904,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
BLUNTPORT,,A4649,HCPCS,Facility,Inpatient,,,,140,119,40.124,140,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
BLUNTPORT,,A4649,HCPCS,Facility,Both,,,,140,119,40.124,140,Sanford Health Plan,Sanford Health Plan,128.8,92,,percent of total billed charges,,
BLUNTPORT,,A4649,HCPCS,Facility,Outpatient,,,,140,119,40.124,140,"UCare Health, Inc.",Individual & Family Plan,78.89,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
BLUNTPORT,,A4649,HCPCS,Facility,Inpatient,,,,140,119,40.124,140,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
BLUNTPORT,,A4649,HCPCS,Facility,Outpatient,,,,140,119,40.124,140,"UCare Health, Inc.",Medical Assistance,70.658,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BLUNTPORT,,A4649,HCPCS,Facility,Inpatient,,,,140,119,40.124,140,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
BLUNTPORT,,A4649,HCPCS,Facility,Outpatient,,,,140,119,40.124,140,"UCare Health, Inc.",Medicare Advantage,70.658,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BLUNTPORT,,A4649,HCPCS,Facility,Inpatient,,,,140,119,40.124,140,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
BLUNTPORT,,A4649,HCPCS,Facility,Outpatient,,,,140,119,40.124,140,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),70.658,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BLUNTPORT,,A4649,HCPCS,Facility,Inpatient,,,,140,119,40.124,140,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
BLUNTPORT,,A4649,HCPCS,Facility,Both,,,,140,119,40.124,140,UnitedHealthcare,Individual & Family,131.6,94,,percent of total billed charges,,
BLUNTPORT,,A4649,HCPCS,Facility,Outpatient,,,,140,119,40.124,140,UnitedHealthcare,Medicare Advantage,68.6,49,,percent of total billed charges,,
BLUNTPORT,,A4649,HCPCS,Facility,Inpatient,,,,140,119,40.124,140,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
BLUNTPORT,,A4649,HCPCS,Facility,Outpatient,,,,140,119,40.124,140,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,67.2,48,,percent of total billed charges,,100% of DHS outpatient percentage
BLUNTPORT,,A4649,HCPCS,Facility,Inpatient,,,,140,119,40.124,140,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
BONE WAX   ETHICON  W31G,,A4649,HCPCS,Facility,Both,,,,86.04,73.134,24.659064,86.04,Aetna,Commercial,79.1568,92,,percent of total billed charges,,
BONE WAX   ETHICON  W31G,,A4649,HCPCS,Facility,Outpatient,,,,86.04,73.134,24.659064,86.04,Aetna,Medicare Advantage,42.1596,49,,percent of total billed charges,,
BONE WAX   ETHICON  W31G,,A4649,HCPCS,Facility,Inpatient,,,,86.04,73.134,24.659064,86.04,Aetna,Medicare Advantage,,,,,Included in per diem rate,
BONE WAX   ETHICON  W31G,,A4649,HCPCS,Facility,Both,,,,86.04,73.134,24.659064,86.04,Aetna,PPO,80.0172,93,,percent of total billed charges,,
BONE WAX   ETHICON  W31G,,A4649,HCPCS,Facility,Both,,,,86.04,73.134,24.659064,86.04,America's PPO,America's PPO,82.624212,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
BONE WAX   ETHICON  W31G,,A4649,HCPCS,Facility,Both,,,,86.04,73.134,24.659064,86.04,BlueCross BlueShield Minnesota, Federal Employee Program,84.66336,98.4,,percent of total billed charges,,
BONE WAX   ETHICON  W31G,,A4649,HCPCS,Facility,Both,,,,86.04,73.134,24.659064,86.04,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,86.04,100,,percent of total billed charges,,
BONE WAX   ETHICON  W31G,,A4649,HCPCS,Facility,Both,,,,86.04,73.134,24.659064,86.04,BlueCross BlueShield Minnesota,High Value Network Plan,77.436,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
BONE WAX   ETHICON  W31G,,A4649,HCPCS,Facility,Outpatient,,,,86.04,73.134,24.659064,86.04,BlueCross BlueShield Minnesota,Medicare Advantage,42.1596,49,,percent of total billed charges,,
BONE WAX   ETHICON  W31G,,A4649,HCPCS,Facility,Inpatient,,,,86.04,73.134,24.659064,86.04,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
BONE WAX   ETHICON  W31G,,A4649,HCPCS,Facility,Both,,,,86.04,73.134,24.659064,86.04,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,76.205628,88.57,,percent of total billed charges,,
BONE WAX   ETHICON  W31G,,A4649,HCPCS,Facility,Both,,,,86.04,73.134,24.659064,86.04,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,24.659064,28.66,,percent of total billed charges,,
BONE WAX   ETHICON  W31G,,A4649,HCPCS,Facility,Outpatient,,,,86.04,73.134,24.659064,86.04,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),42.1596,49,,percent of total billed charges,,
BONE WAX   ETHICON  W31G,,A4649,HCPCS,Facility,Inpatient,,,,86.04,73.134,24.659064,86.04,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
BONE WAX   ETHICON  W31G,,A4649,HCPCS,Facility,Both,,,,86.04,73.134,24.659064,86.04,CorVel,Worker's Compensation,86.04,100,,percent of total billed charges,,
BONE WAX   ETHICON  W31G,,A4649,HCPCS,Facility,Both,,,,86.04,73.134,24.659064,86.04,First Health Group Corporation,First Health Network,83.4588,97,,percent of total billed charges,,
BONE WAX   ETHICON  W31G,,A4649,HCPCS,Facility,Both,,,,86.04,73.134,24.659064,86.04,"Health Partners, Inc.",Commercial,81.39384,94.6,,percent of total billed charges,,
BONE WAX   ETHICON  W31G,,A4649,HCPCS,Facility,Outpatient,,,,86.04,73.134,24.659064,86.04,"Health Partners, Inc.",Medicare Advantage,42.1596,49,,percent of total billed charges,,
BONE WAX   ETHICON  W31G,,A4649,HCPCS,Facility,Inpatient,,,,86.04,73.134,24.659064,86.04,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
BONE WAX   ETHICON  W31G,,A4649,HCPCS,Facility,Both,,,,86.04,73.134,24.659064,86.04,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),51.624,60,,percent of total billed charges,,
BONE WAX   ETHICON  W31G,,A4649,HCPCS,Facility,Both,,,,86.04,73.134,24.659064,86.04,"Health Partners, Inc.",State of Minnesota Advantage Program,70.1226,81.5,,percent of total billed charges,,
BONE WAX   ETHICON  W31G,,A4649,HCPCS,Facility,Both,,,,86.04,73.134,24.659064,86.04,"Health Partners, Inc.",State Public Programs,43.02,50,,percent of total billed charges,,
BONE WAX   ETHICON  W31G,,A4649,HCPCS,Facility,Both,,,,86.04,73.134,24.659064,86.04,Humana Insurance Company,Commercial PPO,81.738,95,,percent of total billed charges,,
BONE WAX   ETHICON  W31G,,A4649,HCPCS,Facility,Outpatient,,,,86.04,73.134,24.659064,86.04,Humana Insurance Company,Medicare PPO,42.1596,49,,percent of total billed charges,,
BONE WAX   ETHICON  W31G,,A4649,HCPCS,Facility,Inpatient,,,,86.04,73.134,24.659064,86.04,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
BONE WAX   ETHICON  W31G,,A4649,HCPCS,Facility,Both,,,,86.04,73.134,24.659064,86.04,Medica,Individual & Family,85.26564,99.1,,percent of total billed charges,,
BONE WAX   ETHICON  W31G,,A4649,HCPCS,Facility,Outpatient,,,,86.04,73.134,24.659064,86.04,Medica,Medica Advantage Solution,42.84792,49.8,,percent of total billed charges,,
BONE WAX   ETHICON  W31G,,A4649,HCPCS,Facility,Inpatient,,,,86.04,73.134,24.659064,86.04,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
BONE WAX   ETHICON  W31G,,A4649,HCPCS,Facility,Outpatient,,,,86.04,73.134,24.659064,86.04,Medica,Medical Assistance,38.37384,44.6,,percent of total billed charges,,
BONE WAX   ETHICON  W31G,,A4649,HCPCS,Facility,Inpatient,,,,86.04,73.134,24.659064,86.04,Medica,Medical Assistance,,,,,Included in per diem rate,
BONE WAX   ETHICON  W31G,,A4649,HCPCS,Facility,Outpatient,,,,86.04,73.134,24.659064,86.04,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,42.84792,49.8,,percent of total billed charges,,
BONE WAX   ETHICON  W31G,,A4649,HCPCS,Facility,Inpatient,,,,86.04,73.134,24.659064,86.04,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
BONE WAX   ETHICON  W31G,,A4649,HCPCS,Facility,Both,,,,86.04,73.134,24.659064,86.04,"Multiplan, Inc.","Multiplan, Inc.",80.8776,94,,percent of total billed charges,,
BONE WAX   ETHICON  W31G,,A4649,HCPCS,Facility,Outpatient,,,,86.04,73.134,24.659064,86.04,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,77.52204,90.1,,percent of total billed charges,,
BONE WAX   ETHICON  W31G,,A4649,HCPCS,Facility,Inpatient,,,,86.04,73.134,24.659064,86.04,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
BONE WAX   ETHICON  W31G,,A4649,HCPCS,Facility,Both,,,,86.04,73.134,24.659064,86.04,"Preferred One Administrative Services, INC.",PPO,84.83544,98.6,,percent of total billed charges,,
BONE WAX   ETHICON  W31G,,A4649,HCPCS,Facility,Outpatient,,,,86.04,73.134,24.659064,86.04,PrimeWest Health,Minnesota Senior Health Options (MSHO),44.26758,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
BONE WAX   ETHICON  W31G,,A4649,HCPCS,Facility,Inpatient,,,,86.04,73.134,24.659064,86.04,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
BONE WAX   ETHICON  W31G,,A4649,HCPCS,Facility,Outpatient,,,,86.04,73.134,24.659064,86.04,PrimeWest Health,MinnesotaCare,44.190144,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
BONE WAX   ETHICON  W31G,,A4649,HCPCS,Facility,Inpatient,,,,86.04,73.134,24.659064,86.04,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
BONE WAX   ETHICON  W31G,,A4649,HCPCS,Facility,Both,,,,86.04,73.134,24.659064,86.04,Sanford Health Plan,Sanford Health Plan,79.1568,92,,percent of total billed charges,,
BONE WAX   ETHICON  W31G,,A4649,HCPCS,Facility,Outpatient,,,,86.04,73.134,24.659064,86.04,"UCare Health, Inc.",Individual & Family Plan,48.48354,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
BONE WAX   ETHICON  W31G,,A4649,HCPCS,Facility,Inpatient,,,,86.04,73.134,24.659064,86.04,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
BONE WAX   ETHICON  W31G,,A4649,HCPCS,Facility,Outpatient,,,,86.04,73.134,24.659064,86.04,"UCare Health, Inc.",Medical Assistance,43.424388,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BONE WAX   ETHICON  W31G,,A4649,HCPCS,Facility,Inpatient,,,,86.04,73.134,24.659064,86.04,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
BONE WAX   ETHICON  W31G,,A4649,HCPCS,Facility,Outpatient,,,,86.04,73.134,24.659064,86.04,"UCare Health, Inc.",Medicare Advantage,43.424388,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BONE WAX   ETHICON  W31G,,A4649,HCPCS,Facility,Inpatient,,,,86.04,73.134,24.659064,86.04,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
BONE WAX   ETHICON  W31G,,A4649,HCPCS,Facility,Outpatient,,,,86.04,73.134,24.659064,86.04,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),43.424388,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BONE WAX   ETHICON  W31G,,A4649,HCPCS,Facility,Inpatient,,,,86.04,73.134,24.659064,86.04,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
BONE WAX   ETHICON  W31G,,A4649,HCPCS,Facility,Both,,,,86.04,73.134,24.659064,86.04,UnitedHealthcare,Individual & Family,80.8776,94,,percent of total billed charges,,
BONE WAX   ETHICON  W31G,,A4649,HCPCS,Facility,Outpatient,,,,86.04,73.134,24.659064,86.04,UnitedHealthcare,Medicare Advantage,42.1596,49,,percent of total billed charges,,
BONE WAX   ETHICON  W31G,,A4649,HCPCS,Facility,Inpatient,,,,86.04,73.134,24.659064,86.04,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
BONE WAX   ETHICON  W31G,,A4649,HCPCS,Facility,Outpatient,,,,86.04,73.134,24.659064,86.04,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,41.2992,48,,percent of total billed charges,,100% of DHS outpatient percentage
BONE WAX   ETHICON  W31G,,A4649,HCPCS,Facility,Inpatient,,,,86.04,73.134,24.659064,86.04,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
CANNULA DIALATOR 5MM W/SLEEVE,,A4649,HCPCS,Facility,Both,,,,179.27,152.3795,51.378782,179.27,Aetna,Commercial,164.9284,92,,percent of total billed charges,,
CANNULA DIALATOR 5MM W/SLEEVE,,A4649,HCPCS,Facility,Outpatient,,,,179.27,152.3795,51.378782,179.27,Aetna,Medicare Advantage,87.8423,49,,percent of total billed charges,,
CANNULA DIALATOR 5MM W/SLEEVE,,A4649,HCPCS,Facility,Inpatient,,,,179.27,152.3795,51.378782,179.27,Aetna,Medicare Advantage,,,,,Included in per diem rate,
CANNULA DIALATOR 5MM W/SLEEVE,,A4649,HCPCS,Facility,Both,,,,179.27,152.3795,51.378782,179.27,Aetna,PPO,166.7211,93,,percent of total billed charges,,
CANNULA DIALATOR 5MM W/SLEEVE,,A4649,HCPCS,Facility,Both,,,,179.27,152.3795,51.378782,179.27,America's PPO,America's PPO,172.152981,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
CANNULA DIALATOR 5MM W/SLEEVE,,A4649,HCPCS,Facility,Both,,,,179.27,152.3795,51.378782,179.27,BlueCross BlueShield Minnesota, Federal Employee Program,176.40168,98.4,,percent of total billed charges,,
CANNULA DIALATOR 5MM W/SLEEVE,,A4649,HCPCS,Facility,Both,,,,179.27,152.3795,51.378782,179.27,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,179.27,100,,percent of total billed charges,,
CANNULA DIALATOR 5MM W/SLEEVE,,A4649,HCPCS,Facility,Both,,,,179.27,152.3795,51.378782,179.27,BlueCross BlueShield Minnesota,High Value Network Plan,161.343,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
CANNULA DIALATOR 5MM W/SLEEVE,,A4649,HCPCS,Facility,Outpatient,,,,179.27,152.3795,51.378782,179.27,BlueCross BlueShield Minnesota,Medicare Advantage,87.8423,49,,percent of total billed charges,,
CANNULA DIALATOR 5MM W/SLEEVE,,A4649,HCPCS,Facility,Inpatient,,,,179.27,152.3795,51.378782,179.27,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
CANNULA DIALATOR 5MM W/SLEEVE,,A4649,HCPCS,Facility,Both,,,,179.27,152.3795,51.378782,179.27,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,158.779439,88.57,,percent of total billed charges,,
CANNULA DIALATOR 5MM W/SLEEVE,,A4649,HCPCS,Facility,Both,,,,179.27,152.3795,51.378782,179.27,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,51.378782,28.66,,percent of total billed charges,,
CANNULA DIALATOR 5MM W/SLEEVE,,A4649,HCPCS,Facility,Outpatient,,,,179.27,152.3795,51.378782,179.27,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),87.8423,49,,percent of total billed charges,,
CANNULA DIALATOR 5MM W/SLEEVE,,A4649,HCPCS,Facility,Inpatient,,,,179.27,152.3795,51.378782,179.27,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
CANNULA DIALATOR 5MM W/SLEEVE,,A4649,HCPCS,Facility,Both,,,,179.27,152.3795,51.378782,179.27,CorVel,Worker's Compensation,179.27,100,,percent of total billed charges,,
CANNULA DIALATOR 5MM W/SLEEVE,,A4649,HCPCS,Facility,Both,,,,179.27,152.3795,51.378782,179.27,First Health Group Corporation,First Health Network,173.8919,97,,percent of total billed charges,,
CANNULA DIALATOR 5MM W/SLEEVE,,A4649,HCPCS,Facility,Both,,,,179.27,152.3795,51.378782,179.27,"Health Partners, Inc.",Commercial,169.58942,94.6,,percent of total billed charges,,
CANNULA DIALATOR 5MM W/SLEEVE,,A4649,HCPCS,Facility,Outpatient,,,,179.27,152.3795,51.378782,179.27,"Health Partners, Inc.",Medicare Advantage,87.8423,49,,percent of total billed charges,,
CANNULA DIALATOR 5MM W/SLEEVE,,A4649,HCPCS,Facility,Inpatient,,,,179.27,152.3795,51.378782,179.27,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CANNULA DIALATOR 5MM W/SLEEVE,,A4649,HCPCS,Facility,Both,,,,179.27,152.3795,51.378782,179.27,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),107.562,60,,percent of total billed charges,,
CANNULA DIALATOR 5MM W/SLEEVE,,A4649,HCPCS,Facility,Both,,,,179.27,152.3795,51.378782,179.27,"Health Partners, Inc.",State of Minnesota Advantage Program,146.10505,81.5,,percent of total billed charges,,
CANNULA DIALATOR 5MM W/SLEEVE,,A4649,HCPCS,Facility,Both,,,,179.27,152.3795,51.378782,179.27,"Health Partners, Inc.",State Public Programs,89.635,50,,percent of total billed charges,,
CANNULA DIALATOR 5MM W/SLEEVE,,A4649,HCPCS,Facility,Both,,,,179.27,152.3795,51.378782,179.27,Humana Insurance Company,Commercial PPO,170.3065,95,,percent of total billed charges,,
CANNULA DIALATOR 5MM W/SLEEVE,,A4649,HCPCS,Facility,Outpatient,,,,179.27,152.3795,51.378782,179.27,Humana Insurance Company,Medicare PPO,87.8423,49,,percent of total billed charges,,
CANNULA DIALATOR 5MM W/SLEEVE,,A4649,HCPCS,Facility,Inpatient,,,,179.27,152.3795,51.378782,179.27,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
CANNULA DIALATOR 5MM W/SLEEVE,,A4649,HCPCS,Facility,Both,,,,179.27,152.3795,51.378782,179.27,Medica,Individual & Family,177.65657,99.1,,percent of total billed charges,,
CANNULA DIALATOR 5MM W/SLEEVE,,A4649,HCPCS,Facility,Outpatient,,,,179.27,152.3795,51.378782,179.27,Medica,Medica Advantage Solution,89.27646,49.8,,percent of total billed charges,,
CANNULA DIALATOR 5MM W/SLEEVE,,A4649,HCPCS,Facility,Inpatient,,,,179.27,152.3795,51.378782,179.27,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
CANNULA DIALATOR 5MM W/SLEEVE,,A4649,HCPCS,Facility,Outpatient,,,,179.27,152.3795,51.378782,179.27,Medica,Medical Assistance,79.95442,44.6,,percent of total billed charges,,
CANNULA DIALATOR 5MM W/SLEEVE,,A4649,HCPCS,Facility,Inpatient,,,,179.27,152.3795,51.378782,179.27,Medica,Medical Assistance,,,,,Included in per diem rate,
CANNULA DIALATOR 5MM W/SLEEVE,,A4649,HCPCS,Facility,Outpatient,,,,179.27,152.3795,51.378782,179.27,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,89.27646,49.8,,percent of total billed charges,,
CANNULA DIALATOR 5MM W/SLEEVE,,A4649,HCPCS,Facility,Inpatient,,,,179.27,152.3795,51.378782,179.27,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
CANNULA DIALATOR 5MM W/SLEEVE,,A4649,HCPCS,Facility,Both,,,,179.27,152.3795,51.378782,179.27,"Multiplan, Inc.","Multiplan, Inc.",168.5138,94,,percent of total billed charges,,
CANNULA DIALATOR 5MM W/SLEEVE,,A4649,HCPCS,Facility,Outpatient,,,,179.27,152.3795,51.378782,179.27,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,161.52227,90.1,,percent of total billed charges,,
CANNULA DIALATOR 5MM W/SLEEVE,,A4649,HCPCS,Facility,Inpatient,,,,179.27,152.3795,51.378782,179.27,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
CANNULA DIALATOR 5MM W/SLEEVE,,A4649,HCPCS,Facility,Both,,,,179.27,152.3795,51.378782,179.27,"Preferred One Administrative Services, INC.",PPO,176.76022,98.6,,percent of total billed charges,,
CANNULA DIALATOR 5MM W/SLEEVE,,A4649,HCPCS,Facility,Outpatient,,,,179.27,152.3795,51.378782,179.27,PrimeWest Health,Minnesota Senior Health Options (MSHO),92.234415,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
CANNULA DIALATOR 5MM W/SLEEVE,,A4649,HCPCS,Facility,Inpatient,,,,179.27,152.3795,51.378782,179.27,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CANNULA DIALATOR 5MM W/SLEEVE,,A4649,HCPCS,Facility,Outpatient,,,,179.27,152.3795,51.378782,179.27,PrimeWest Health,MinnesotaCare,92.073072,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
CANNULA DIALATOR 5MM W/SLEEVE,,A4649,HCPCS,Facility,Inpatient,,,,179.27,152.3795,51.378782,179.27,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
CANNULA DIALATOR 5MM W/SLEEVE,,A4649,HCPCS,Facility,Both,,,,179.27,152.3795,51.378782,179.27,Sanford Health Plan,Sanford Health Plan,164.9284,92,,percent of total billed charges,,
CANNULA DIALATOR 5MM W/SLEEVE,,A4649,HCPCS,Facility,Outpatient,,,,179.27,152.3795,51.378782,179.27,"UCare Health, Inc.",Individual & Family Plan,101.018645,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
CANNULA DIALATOR 5MM W/SLEEVE,,A4649,HCPCS,Facility,Inpatient,,,,179.27,152.3795,51.378782,179.27,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
CANNULA DIALATOR 5MM W/SLEEVE,,A4649,HCPCS,Facility,Outpatient,,,,179.27,152.3795,51.378782,179.27,"UCare Health, Inc.",Medical Assistance,90.477569,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CANNULA DIALATOR 5MM W/SLEEVE,,A4649,HCPCS,Facility,Inpatient,,,,179.27,152.3795,51.378782,179.27,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
CANNULA DIALATOR 5MM W/SLEEVE,,A4649,HCPCS,Facility,Outpatient,,,,179.27,152.3795,51.378782,179.27,"UCare Health, Inc.",Medicare Advantage,90.477569,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CANNULA DIALATOR 5MM W/SLEEVE,,A4649,HCPCS,Facility,Inpatient,,,,179.27,152.3795,51.378782,179.27,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CANNULA DIALATOR 5MM W/SLEEVE,,A4649,HCPCS,Facility,Outpatient,,,,179.27,152.3795,51.378782,179.27,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),90.477569,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CANNULA DIALATOR 5MM W/SLEEVE,,A4649,HCPCS,Facility,Inpatient,,,,179.27,152.3795,51.378782,179.27,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CANNULA DIALATOR 5MM W/SLEEVE,,A4649,HCPCS,Facility,Both,,,,179.27,152.3795,51.378782,179.27,UnitedHealthcare,Individual & Family,168.5138,94,,percent of total billed charges,,
CANNULA DIALATOR 5MM W/SLEEVE,,A4649,HCPCS,Facility,Outpatient,,,,179.27,152.3795,51.378782,179.27,UnitedHealthcare,Medicare Advantage,87.8423,49,,percent of total billed charges,,
CANNULA DIALATOR 5MM W/SLEEVE,,A4649,HCPCS,Facility,Inpatient,,,,179.27,152.3795,51.378782,179.27,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
CANNULA DIALATOR 5MM W/SLEEVE,,A4649,HCPCS,Facility,Outpatient,,,,179.27,152.3795,51.378782,179.27,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,86.0496,48,,percent of total billed charges,,100% of DHS outpatient percentage
CANNULA DIALATOR 5MM W/SLEEVE,,A4649,HCPCS,Facility,Inpatient,,,,179.27,152.3795,51.378782,179.27,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
CAUTERY PENCIL COATED W/BLADE TIP E2350H,,A4649,HCPCS,Facility,Both,,,,33.35,28.3475,9.55811,33.35,Aetna,Commercial,30.682,92,,percent of total billed charges,,
CAUTERY PENCIL COATED W/BLADE TIP E2350H,,A4649,HCPCS,Facility,Outpatient,,,,33.35,28.3475,9.55811,33.35,Aetna,Medicare Advantage,16.3415,49,,percent of total billed charges,,
CAUTERY PENCIL COATED W/BLADE TIP E2350H,,A4649,HCPCS,Facility,Inpatient,,,,33.35,28.3475,9.55811,33.35,Aetna,Medicare Advantage,,,,,Included in per diem rate,
CAUTERY PENCIL COATED W/BLADE TIP E2350H,,A4649,HCPCS,Facility,Both,,,,33.35,28.3475,9.55811,33.35,Aetna,PPO,31.0155,93,,percent of total billed charges,,
CAUTERY PENCIL COATED W/BLADE TIP E2350H,,A4649,HCPCS,Facility,Both,,,,33.35,28.3475,9.55811,33.35,America's PPO,America's PPO,32.026005,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
CAUTERY PENCIL COATED W/BLADE TIP E2350H,,A4649,HCPCS,Facility,Both,,,,33.35,28.3475,9.55811,33.35,BlueCross BlueShield Minnesota, Federal Employee Program,32.8164,98.4,,percent of total billed charges,,
CAUTERY PENCIL COATED W/BLADE TIP E2350H,,A4649,HCPCS,Facility,Both,,,,33.35,28.3475,9.55811,33.35,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,33.35,100,,percent of total billed charges,,
CAUTERY PENCIL COATED W/BLADE TIP E2350H,,A4649,HCPCS,Facility,Both,,,,33.35,28.3475,9.55811,33.35,BlueCross BlueShield Minnesota,High Value Network Plan,30.015,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
CAUTERY PENCIL COATED W/BLADE TIP E2350H,,A4649,HCPCS,Facility,Outpatient,,,,33.35,28.3475,9.55811,33.35,BlueCross BlueShield Minnesota,Medicare Advantage,16.3415,49,,percent of total billed charges,,
CAUTERY PENCIL COATED W/BLADE TIP E2350H,,A4649,HCPCS,Facility,Inpatient,,,,33.35,28.3475,9.55811,33.35,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
CAUTERY PENCIL COATED W/BLADE TIP E2350H,,A4649,HCPCS,Facility,Both,,,,33.35,28.3475,9.55811,33.35,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,29.538095,88.57,,percent of total billed charges,,
CAUTERY PENCIL COATED W/BLADE TIP E2350H,,A4649,HCPCS,Facility,Both,,,,33.35,28.3475,9.55811,33.35,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,9.55811,28.66,,percent of total billed charges,,
CAUTERY PENCIL COATED W/BLADE TIP E2350H,,A4649,HCPCS,Facility,Outpatient,,,,33.35,28.3475,9.55811,33.35,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),16.3415,49,,percent of total billed charges,,
CAUTERY PENCIL COATED W/BLADE TIP E2350H,,A4649,HCPCS,Facility,Inpatient,,,,33.35,28.3475,9.55811,33.35,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
CAUTERY PENCIL COATED W/BLADE TIP E2350H,,A4649,HCPCS,Facility,Both,,,,33.35,28.3475,9.55811,33.35,CorVel,Worker's Compensation,33.35,100,,percent of total billed charges,,
CAUTERY PENCIL COATED W/BLADE TIP E2350H,,A4649,HCPCS,Facility,Both,,,,33.35,28.3475,9.55811,33.35,First Health Group Corporation,First Health Network,32.3495,97,,percent of total billed charges,,
CAUTERY PENCIL COATED W/BLADE TIP E2350H,,A4649,HCPCS,Facility,Both,,,,33.35,28.3475,9.55811,33.35,"Health Partners, Inc.",Commercial,31.5491,94.6,,percent of total billed charges,,
CAUTERY PENCIL COATED W/BLADE TIP E2350H,,A4649,HCPCS,Facility,Outpatient,,,,33.35,28.3475,9.55811,33.35,"Health Partners, Inc.",Medicare Advantage,16.3415,49,,percent of total billed charges,,
CAUTERY PENCIL COATED W/BLADE TIP E2350H,,A4649,HCPCS,Facility,Inpatient,,,,33.35,28.3475,9.55811,33.35,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CAUTERY PENCIL COATED W/BLADE TIP E2350H,,A4649,HCPCS,Facility,Both,,,,33.35,28.3475,9.55811,33.35,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),20.01,60,,percent of total billed charges,,
CAUTERY PENCIL COATED W/BLADE TIP E2350H,,A4649,HCPCS,Facility,Both,,,,33.35,28.3475,9.55811,33.35,"Health Partners, Inc.",State of Minnesota Advantage Program,27.18025,81.5,,percent of total billed charges,,
CAUTERY PENCIL COATED W/BLADE TIP E2350H,,A4649,HCPCS,Facility,Both,,,,33.35,28.3475,9.55811,33.35,"Health Partners, Inc.",State Public Programs,16.675,50,,percent of total billed charges,,
CAUTERY PENCIL COATED W/BLADE TIP E2350H,,A4649,HCPCS,Facility,Both,,,,33.35,28.3475,9.55811,33.35,Humana Insurance Company,Commercial PPO,31.6825,95,,percent of total billed charges,,
CAUTERY PENCIL COATED W/BLADE TIP E2350H,,A4649,HCPCS,Facility,Outpatient,,,,33.35,28.3475,9.55811,33.35,Humana Insurance Company,Medicare PPO,16.3415,49,,percent of total billed charges,,
CAUTERY PENCIL COATED W/BLADE TIP E2350H,,A4649,HCPCS,Facility,Inpatient,,,,33.35,28.3475,9.55811,33.35,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
CAUTERY PENCIL COATED W/BLADE TIP E2350H,,A4649,HCPCS,Facility,Both,,,,33.35,28.3475,9.55811,33.35,Medica,Individual & Family,33.04985,99.1,,percent of total billed charges,,
CAUTERY PENCIL COATED W/BLADE TIP E2350H,,A4649,HCPCS,Facility,Outpatient,,,,33.35,28.3475,9.55811,33.35,Medica,Medica Advantage Solution,16.6083,49.8,,percent of total billed charges,,
CAUTERY PENCIL COATED W/BLADE TIP E2350H,,A4649,HCPCS,Facility,Inpatient,,,,33.35,28.3475,9.55811,33.35,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
CAUTERY PENCIL COATED W/BLADE TIP E2350H,,A4649,HCPCS,Facility,Outpatient,,,,33.35,28.3475,9.55811,33.35,Medica,Medical Assistance,14.8741,44.6,,percent of total billed charges,,
CAUTERY PENCIL COATED W/BLADE TIP E2350H,,A4649,HCPCS,Facility,Inpatient,,,,33.35,28.3475,9.55811,33.35,Medica,Medical Assistance,,,,,Included in per diem rate,
CAUTERY PENCIL COATED W/BLADE TIP E2350H,,A4649,HCPCS,Facility,Outpatient,,,,33.35,28.3475,9.55811,33.35,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,16.6083,49.8,,percent of total billed charges,,
CAUTERY PENCIL COATED W/BLADE TIP E2350H,,A4649,HCPCS,Facility,Inpatient,,,,33.35,28.3475,9.55811,33.35,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
CAUTERY PENCIL COATED W/BLADE TIP E2350H,,A4649,HCPCS,Facility,Both,,,,33.35,28.3475,9.55811,33.35,"Multiplan, Inc.","Multiplan, Inc.",31.349,94,,percent of total billed charges,,
CAUTERY PENCIL COATED W/BLADE TIP E2350H,,A4649,HCPCS,Facility,Outpatient,,,,33.35,28.3475,9.55811,33.35,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,30.04835,90.1,,percent of total billed charges,,
CAUTERY PENCIL COATED W/BLADE TIP E2350H,,A4649,HCPCS,Facility,Inpatient,,,,33.35,28.3475,9.55811,33.35,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
CAUTERY PENCIL COATED W/BLADE TIP E2350H,,A4649,HCPCS,Facility,Both,,,,33.35,28.3475,9.55811,33.35,"Preferred One Administrative Services, INC.",PPO,32.8831,98.6,,percent of total billed charges,,
CAUTERY PENCIL COATED W/BLADE TIP E2350H,,A4649,HCPCS,Facility,Outpatient,,,,33.35,28.3475,9.55811,33.35,PrimeWest Health,Minnesota Senior Health Options (MSHO),17.158575,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
CAUTERY PENCIL COATED W/BLADE TIP E2350H,,A4649,HCPCS,Facility,Inpatient,,,,33.35,28.3475,9.55811,33.35,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CAUTERY PENCIL COATED W/BLADE TIP E2350H,,A4649,HCPCS,Facility,Outpatient,,,,33.35,28.3475,9.55811,33.35,PrimeWest Health,MinnesotaCare,17.12856,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
CAUTERY PENCIL COATED W/BLADE TIP E2350H,,A4649,HCPCS,Facility,Inpatient,,,,33.35,28.3475,9.55811,33.35,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
CAUTERY PENCIL COATED W/BLADE TIP E2350H,,A4649,HCPCS,Facility,Both,,,,33.35,28.3475,9.55811,33.35,Sanford Health Plan,Sanford Health Plan,30.682,92,,percent of total billed charges,,
CAUTERY PENCIL COATED W/BLADE TIP E2350H,,A4649,HCPCS,Facility,Outpatient,,,,33.35,28.3475,9.55811,33.35,"UCare Health, Inc.",Individual & Family Plan,18.792725,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
CAUTERY PENCIL COATED W/BLADE TIP E2350H,,A4649,HCPCS,Facility,Inpatient,,,,33.35,28.3475,9.55811,33.35,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
CAUTERY PENCIL COATED W/BLADE TIP E2350H,,A4649,HCPCS,Facility,Outpatient,,,,33.35,28.3475,9.55811,33.35,"UCare Health, Inc.",Medical Assistance,16.831745,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CAUTERY PENCIL COATED W/BLADE TIP E2350H,,A4649,HCPCS,Facility,Inpatient,,,,33.35,28.3475,9.55811,33.35,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
CAUTERY PENCIL COATED W/BLADE TIP E2350H,,A4649,HCPCS,Facility,Outpatient,,,,33.35,28.3475,9.55811,33.35,"UCare Health, Inc.",Medicare Advantage,16.831745,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CAUTERY PENCIL COATED W/BLADE TIP E2350H,,A4649,HCPCS,Facility,Inpatient,,,,33.35,28.3475,9.55811,33.35,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CAUTERY PENCIL COATED W/BLADE TIP E2350H,,A4649,HCPCS,Facility,Outpatient,,,,33.35,28.3475,9.55811,33.35,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),16.831745,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CAUTERY PENCIL COATED W/BLADE TIP E2350H,,A4649,HCPCS,Facility,Inpatient,,,,33.35,28.3475,9.55811,33.35,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CAUTERY PENCIL COATED W/BLADE TIP E2350H,,A4649,HCPCS,Facility,Both,,,,33.35,28.3475,9.55811,33.35,UnitedHealthcare,Individual & Family,31.349,94,,percent of total billed charges,,
CAUTERY PENCIL COATED W/BLADE TIP E2350H,,A4649,HCPCS,Facility,Outpatient,,,,33.35,28.3475,9.55811,33.35,UnitedHealthcare,Medicare Advantage,16.3415,49,,percent of total billed charges,,
CAUTERY PENCIL COATED W/BLADE TIP E2350H,,A4649,HCPCS,Facility,Inpatient,,,,33.35,28.3475,9.55811,33.35,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
CAUTERY PENCIL COATED W/BLADE TIP E2350H,,A4649,HCPCS,Facility,Outpatient,,,,33.35,28.3475,9.55811,33.35,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,16.008,48,,percent of total billed charges,,100% of DHS outpatient percentage
CAUTERY PENCIL COATED W/BLADE TIP E2350H,,A4649,HCPCS,Facility,Inpatient,,,,33.35,28.3475,9.55811,33.35,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
CAUTERY SUCTION 10FR E2505,,A4649,HCPCS,Facility,Both,,,,42.9,36.465,12.29514,42.9,Aetna,Commercial,39.468,92,,percent of total billed charges,,
CAUTERY SUCTION 10FR E2505,,A4649,HCPCS,Facility,Outpatient,,,,42.9,36.465,12.29514,42.9,Aetna,Medicare Advantage,21.021,49,,percent of total billed charges,,
CAUTERY SUCTION 10FR E2505,,A4649,HCPCS,Facility,Inpatient,,,,42.9,36.465,12.29514,42.9,Aetna,Medicare Advantage,,,,,Included in per diem rate,
CAUTERY SUCTION 10FR E2505,,A4649,HCPCS,Facility,Both,,,,42.9,36.465,12.29514,42.9,Aetna,PPO,39.897,93,,percent of total billed charges,,
CAUTERY SUCTION 10FR E2505,,A4649,HCPCS,Facility,Both,,,,42.9,36.465,12.29514,42.9,America's PPO,America's PPO,41.19687,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
CAUTERY SUCTION 10FR E2505,,A4649,HCPCS,Facility,Both,,,,42.9,36.465,12.29514,42.9,BlueCross BlueShield Minnesota, Federal Employee Program,42.2136,98.4,,percent of total billed charges,,
CAUTERY SUCTION 10FR E2505,,A4649,HCPCS,Facility,Both,,,,42.9,36.465,12.29514,42.9,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,42.9,100,,percent of total billed charges,,
CAUTERY SUCTION 10FR E2505,,A4649,HCPCS,Facility,Both,,,,42.9,36.465,12.29514,42.9,BlueCross BlueShield Minnesota,High Value Network Plan,38.61,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
CAUTERY SUCTION 10FR E2505,,A4649,HCPCS,Facility,Outpatient,,,,42.9,36.465,12.29514,42.9,BlueCross BlueShield Minnesota,Medicare Advantage,21.021,49,,percent of total billed charges,,
CAUTERY SUCTION 10FR E2505,,A4649,HCPCS,Facility,Inpatient,,,,42.9,36.465,12.29514,42.9,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
CAUTERY SUCTION 10FR E2505,,A4649,HCPCS,Facility,Both,,,,42.9,36.465,12.29514,42.9,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,37.99653,88.57,,percent of total billed charges,,
CAUTERY SUCTION 10FR E2505,,A4649,HCPCS,Facility,Both,,,,42.9,36.465,12.29514,42.9,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,12.29514,28.66,,percent of total billed charges,,
CAUTERY SUCTION 10FR E2505,,A4649,HCPCS,Facility,Outpatient,,,,42.9,36.465,12.29514,42.9,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),21.021,49,,percent of total billed charges,,
CAUTERY SUCTION 10FR E2505,,A4649,HCPCS,Facility,Inpatient,,,,42.9,36.465,12.29514,42.9,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
CAUTERY SUCTION 10FR E2505,,A4649,HCPCS,Facility,Both,,,,42.9,36.465,12.29514,42.9,CorVel,Worker's Compensation,42.9,100,,percent of total billed charges,,
CAUTERY SUCTION 10FR E2505,,A4649,HCPCS,Facility,Both,,,,42.9,36.465,12.29514,42.9,First Health Group Corporation,First Health Network,41.613,97,,percent of total billed charges,,
CAUTERY SUCTION 10FR E2505,,A4649,HCPCS,Facility,Both,,,,42.9,36.465,12.29514,42.9,"Health Partners, Inc.",Commercial,40.5834,94.6,,percent of total billed charges,,
CAUTERY SUCTION 10FR E2505,,A4649,HCPCS,Facility,Outpatient,,,,42.9,36.465,12.29514,42.9,"Health Partners, Inc.",Medicare Advantage,21.021,49,,percent of total billed charges,,
CAUTERY SUCTION 10FR E2505,,A4649,HCPCS,Facility,Inpatient,,,,42.9,36.465,12.29514,42.9,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CAUTERY SUCTION 10FR E2505,,A4649,HCPCS,Facility,Both,,,,42.9,36.465,12.29514,42.9,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),25.74,60,,percent of total billed charges,,
CAUTERY SUCTION 10FR E2505,,A4649,HCPCS,Facility,Both,,,,42.9,36.465,12.29514,42.9,"Health Partners, Inc.",State of Minnesota Advantage Program,34.9635,81.5,,percent of total billed charges,,
CAUTERY SUCTION 10FR E2505,,A4649,HCPCS,Facility,Both,,,,42.9,36.465,12.29514,42.9,"Health Partners, Inc.",State Public Programs,21.45,50,,percent of total billed charges,,
CAUTERY SUCTION 10FR E2505,,A4649,HCPCS,Facility,Both,,,,42.9,36.465,12.29514,42.9,Humana Insurance Company,Commercial PPO,40.755,95,,percent of total billed charges,,
CAUTERY SUCTION 10FR E2505,,A4649,HCPCS,Facility,Outpatient,,,,42.9,36.465,12.29514,42.9,Humana Insurance Company,Medicare PPO,21.021,49,,percent of total billed charges,,
CAUTERY SUCTION 10FR E2505,,A4649,HCPCS,Facility,Inpatient,,,,42.9,36.465,12.29514,42.9,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
CAUTERY SUCTION 10FR E2505,,A4649,HCPCS,Facility,Both,,,,42.9,36.465,12.29514,42.9,Medica,Individual & Family,42.5139,99.1,,percent of total billed charges,,
CAUTERY SUCTION 10FR E2505,,A4649,HCPCS,Facility,Outpatient,,,,42.9,36.465,12.29514,42.9,Medica,Medica Advantage Solution,21.3642,49.8,,percent of total billed charges,,
CAUTERY SUCTION 10FR E2505,,A4649,HCPCS,Facility,Inpatient,,,,42.9,36.465,12.29514,42.9,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
CAUTERY SUCTION 10FR E2505,,A4649,HCPCS,Facility,Outpatient,,,,42.9,36.465,12.29514,42.9,Medica,Medical Assistance,19.1334,44.6,,percent of total billed charges,,
CAUTERY SUCTION 10FR E2505,,A4649,HCPCS,Facility,Inpatient,,,,42.9,36.465,12.29514,42.9,Medica,Medical Assistance,,,,,Included in per diem rate,
CAUTERY SUCTION 10FR E2505,,A4649,HCPCS,Facility,Outpatient,,,,42.9,36.465,12.29514,42.9,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,21.3642,49.8,,percent of total billed charges,,
CAUTERY SUCTION 10FR E2505,,A4649,HCPCS,Facility,Inpatient,,,,42.9,36.465,12.29514,42.9,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
CAUTERY SUCTION 10FR E2505,,A4649,HCPCS,Facility,Both,,,,42.9,36.465,12.29514,42.9,"Multiplan, Inc.","Multiplan, Inc.",40.326,94,,percent of total billed charges,,
CAUTERY SUCTION 10FR E2505,,A4649,HCPCS,Facility,Outpatient,,,,42.9,36.465,12.29514,42.9,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,38.6529,90.1,,percent of total billed charges,,
CAUTERY SUCTION 10FR E2505,,A4649,HCPCS,Facility,Inpatient,,,,42.9,36.465,12.29514,42.9,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
CAUTERY SUCTION 10FR E2505,,A4649,HCPCS,Facility,Both,,,,42.9,36.465,12.29514,42.9,"Preferred One Administrative Services, INC.",PPO,42.2994,98.6,,percent of total billed charges,,
CAUTERY SUCTION 10FR E2505,,A4649,HCPCS,Facility,Outpatient,,,,42.9,36.465,12.29514,42.9,PrimeWest Health,Minnesota Senior Health Options (MSHO),22.07205,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
CAUTERY SUCTION 10FR E2505,,A4649,HCPCS,Facility,Inpatient,,,,42.9,36.465,12.29514,42.9,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CAUTERY SUCTION 10FR E2505,,A4649,HCPCS,Facility,Outpatient,,,,42.9,36.465,12.29514,42.9,PrimeWest Health,MinnesotaCare,22.03344,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
CAUTERY SUCTION 10FR E2505,,A4649,HCPCS,Facility,Inpatient,,,,42.9,36.465,12.29514,42.9,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
CAUTERY SUCTION 10FR E2505,,A4649,HCPCS,Facility,Both,,,,42.9,36.465,12.29514,42.9,Sanford Health Plan,Sanford Health Plan,39.468,92,,percent of total billed charges,,
CAUTERY SUCTION 10FR E2505,,A4649,HCPCS,Facility,Outpatient,,,,42.9,36.465,12.29514,42.9,"UCare Health, Inc.",Individual & Family Plan,24.17415,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
CAUTERY SUCTION 10FR E2505,,A4649,HCPCS,Facility,Inpatient,,,,42.9,36.465,12.29514,42.9,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
CAUTERY SUCTION 10FR E2505,,A4649,HCPCS,Facility,Outpatient,,,,42.9,36.465,12.29514,42.9,"UCare Health, Inc.",Medical Assistance,21.65163,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CAUTERY SUCTION 10FR E2505,,A4649,HCPCS,Facility,Inpatient,,,,42.9,36.465,12.29514,42.9,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
CAUTERY SUCTION 10FR E2505,,A4649,HCPCS,Facility,Outpatient,,,,42.9,36.465,12.29514,42.9,"UCare Health, Inc.",Medicare Advantage,21.65163,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CAUTERY SUCTION 10FR E2505,,A4649,HCPCS,Facility,Inpatient,,,,42.9,36.465,12.29514,42.9,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CAUTERY SUCTION 10FR E2505,,A4649,HCPCS,Facility,Outpatient,,,,42.9,36.465,12.29514,42.9,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),21.65163,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CAUTERY SUCTION 10FR E2505,,A4649,HCPCS,Facility,Inpatient,,,,42.9,36.465,12.29514,42.9,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CAUTERY SUCTION 10FR E2505,,A4649,HCPCS,Facility,Both,,,,42.9,36.465,12.29514,42.9,UnitedHealthcare,Individual & Family,40.326,94,,percent of total billed charges,,
CAUTERY SUCTION 10FR E2505,,A4649,HCPCS,Facility,Outpatient,,,,42.9,36.465,12.29514,42.9,UnitedHealthcare,Medicare Advantage,21.021,49,,percent of total billed charges,,
CAUTERY SUCTION 10FR E2505,,A4649,HCPCS,Facility,Inpatient,,,,42.9,36.465,12.29514,42.9,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
CAUTERY SUCTION 10FR E2505,,A4649,HCPCS,Facility,Outpatient,,,,42.9,36.465,12.29514,42.9,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,20.592,48,,percent of total billed charges,,100% of DHS outpatient percentage
CAUTERY SUCTION 10FR E2505,,A4649,HCPCS,Facility,Inpatient,,,,42.9,36.465,12.29514,42.9,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
CEMENT BONE SIMPLEX FULL DOSAGE 6191-1-001/6191-1-010,,A4649,HCPCS,Facility,Both,,,,493.2,419.22,141.35112,493.2,Aetna,Commercial,453.744,92,,percent of total billed charges,,
CEMENT BONE SIMPLEX FULL DOSAGE 6191-1-001/6191-1-010,,A4649,HCPCS,Facility,Outpatient,,,,493.2,419.22,141.35112,493.2,Aetna,Medicare Advantage,241.668,49,,percent of total billed charges,,
CEMENT BONE SIMPLEX FULL DOSAGE 6191-1-001/6191-1-010,,A4649,HCPCS,Facility,Inpatient,,,,493.2,419.22,141.35112,493.2,Aetna,Medicare Advantage,,,,,Included in per diem rate,
CEMENT BONE SIMPLEX FULL DOSAGE 6191-1-001/6191-1-010,,A4649,HCPCS,Facility,Both,,,,493.2,419.22,141.35112,493.2,Aetna,PPO,458.676,93,,percent of total billed charges,,
CEMENT BONE SIMPLEX FULL DOSAGE 6191-1-001/6191-1-010,,A4649,HCPCS,Facility,Both,,,,493.2,419.22,141.35112,493.2,America's PPO,America's PPO,473.61996,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
CEMENT BONE SIMPLEX FULL DOSAGE 6191-1-001/6191-1-010,,A4649,HCPCS,Facility,Both,,,,493.2,419.22,141.35112,493.2,BlueCross BlueShield Minnesota, Federal Employee Program,485.3088,98.4,,percent of total billed charges,,
CEMENT BONE SIMPLEX FULL DOSAGE 6191-1-001/6191-1-010,,A4649,HCPCS,Facility,Both,,,,493.2,419.22,141.35112,493.2,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,493.2,100,,percent of total billed charges,,
CEMENT BONE SIMPLEX FULL DOSAGE 6191-1-001/6191-1-010,,A4649,HCPCS,Facility,Both,,,,493.2,419.22,141.35112,493.2,BlueCross BlueShield Minnesota,High Value Network Plan,443.88,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
CEMENT BONE SIMPLEX FULL DOSAGE 6191-1-001/6191-1-010,,A4649,HCPCS,Facility,Outpatient,,,,493.2,419.22,141.35112,493.2,BlueCross BlueShield Minnesota,Medicare Advantage,241.668,49,,percent of total billed charges,,
CEMENT BONE SIMPLEX FULL DOSAGE 6191-1-001/6191-1-010,,A4649,HCPCS,Facility,Inpatient,,,,493.2,419.22,141.35112,493.2,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
CEMENT BONE SIMPLEX FULL DOSAGE 6191-1-001/6191-1-010,,A4649,HCPCS,Facility,Both,,,,493.2,419.22,141.35112,493.2,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,436.82724,88.57,,percent of total billed charges,,
CEMENT BONE SIMPLEX FULL DOSAGE 6191-1-001/6191-1-010,,A4649,HCPCS,Facility,Both,,,,493.2,419.22,141.35112,493.2,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,141.35112,28.66,,percent of total billed charges,,
CEMENT BONE SIMPLEX FULL DOSAGE 6191-1-001/6191-1-010,,A4649,HCPCS,Facility,Outpatient,,,,493.2,419.22,141.35112,493.2,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),241.668,49,,percent of total billed charges,,
CEMENT BONE SIMPLEX FULL DOSAGE 6191-1-001/6191-1-010,,A4649,HCPCS,Facility,Inpatient,,,,493.2,419.22,141.35112,493.2,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
CEMENT BONE SIMPLEX FULL DOSAGE 6191-1-001/6191-1-010,,A4649,HCPCS,Facility,Both,,,,493.2,419.22,141.35112,493.2,CorVel,Worker's Compensation,493.2,100,,percent of total billed charges,,
CEMENT BONE SIMPLEX FULL DOSAGE 6191-1-001/6191-1-010,,A4649,HCPCS,Facility,Both,,,,493.2,419.22,141.35112,493.2,First Health Group Corporation,First Health Network,478.404,97,,percent of total billed charges,,
CEMENT BONE SIMPLEX FULL DOSAGE 6191-1-001/6191-1-010,,A4649,HCPCS,Facility,Both,,,,493.2,419.22,141.35112,493.2,"Health Partners, Inc.",Commercial,466.5672,94.6,,percent of total billed charges,,
CEMENT BONE SIMPLEX FULL DOSAGE 6191-1-001/6191-1-010,,A4649,HCPCS,Facility,Outpatient,,,,493.2,419.22,141.35112,493.2,"Health Partners, Inc.",Medicare Advantage,241.668,49,,percent of total billed charges,,
CEMENT BONE SIMPLEX FULL DOSAGE 6191-1-001/6191-1-010,,A4649,HCPCS,Facility,Inpatient,,,,493.2,419.22,141.35112,493.2,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CEMENT BONE SIMPLEX FULL DOSAGE 6191-1-001/6191-1-010,,A4649,HCPCS,Facility,Both,,,,493.2,419.22,141.35112,493.2,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),295.92,60,,percent of total billed charges,,
CEMENT BONE SIMPLEX FULL DOSAGE 6191-1-001/6191-1-010,,A4649,HCPCS,Facility,Both,,,,493.2,419.22,141.35112,493.2,"Health Partners, Inc.",State of Minnesota Advantage Program,401.958,81.5,,percent of total billed charges,,
CEMENT BONE SIMPLEX FULL DOSAGE 6191-1-001/6191-1-010,,A4649,HCPCS,Facility,Both,,,,493.2,419.22,141.35112,493.2,"Health Partners, Inc.",State Public Programs,246.6,50,,percent of total billed charges,,
CEMENT BONE SIMPLEX FULL DOSAGE 6191-1-001/6191-1-010,,A4649,HCPCS,Facility,Both,,,,493.2,419.22,141.35112,493.2,Humana Insurance Company,Commercial PPO,468.54,95,,percent of total billed charges,,
CEMENT BONE SIMPLEX FULL DOSAGE 6191-1-001/6191-1-010,,A4649,HCPCS,Facility,Outpatient,,,,493.2,419.22,141.35112,493.2,Humana Insurance Company,Medicare PPO,241.668,49,,percent of total billed charges,,
CEMENT BONE SIMPLEX FULL DOSAGE 6191-1-001/6191-1-010,,A4649,HCPCS,Facility,Inpatient,,,,493.2,419.22,141.35112,493.2,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
CEMENT BONE SIMPLEX FULL DOSAGE 6191-1-001/6191-1-010,,A4649,HCPCS,Facility,Both,,,,493.2,419.22,141.35112,493.2,Medica,Individual & Family,488.7612,99.1,,percent of total billed charges,,
CEMENT BONE SIMPLEX FULL DOSAGE 6191-1-001/6191-1-010,,A4649,HCPCS,Facility,Outpatient,,,,493.2,419.22,141.35112,493.2,Medica,Medica Advantage Solution,245.6136,49.8,,percent of total billed charges,,
CEMENT BONE SIMPLEX FULL DOSAGE 6191-1-001/6191-1-010,,A4649,HCPCS,Facility,Inpatient,,,,493.2,419.22,141.35112,493.2,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
CEMENT BONE SIMPLEX FULL DOSAGE 6191-1-001/6191-1-010,,A4649,HCPCS,Facility,Outpatient,,,,493.2,419.22,141.35112,493.2,Medica,Medical Assistance,219.9672,44.6,,percent of total billed charges,,
CEMENT BONE SIMPLEX FULL DOSAGE 6191-1-001/6191-1-010,,A4649,HCPCS,Facility,Inpatient,,,,493.2,419.22,141.35112,493.2,Medica,Medical Assistance,,,,,Included in per diem rate,
CEMENT BONE SIMPLEX FULL DOSAGE 6191-1-001/6191-1-010,,A4649,HCPCS,Facility,Outpatient,,,,493.2,419.22,141.35112,493.2,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,245.6136,49.8,,percent of total billed charges,,
CEMENT BONE SIMPLEX FULL DOSAGE 6191-1-001/6191-1-010,,A4649,HCPCS,Facility,Inpatient,,,,493.2,419.22,141.35112,493.2,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
CEMENT BONE SIMPLEX FULL DOSAGE 6191-1-001/6191-1-010,,A4649,HCPCS,Facility,Both,,,,493.2,419.22,141.35112,493.2,"Multiplan, Inc.","Multiplan, Inc.",463.608,94,,percent of total billed charges,,
CEMENT BONE SIMPLEX FULL DOSAGE 6191-1-001/6191-1-010,,A4649,HCPCS,Facility,Outpatient,,,,493.2,419.22,141.35112,493.2,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,444.3732,90.1,,percent of total billed charges,,
CEMENT BONE SIMPLEX FULL DOSAGE 6191-1-001/6191-1-010,,A4649,HCPCS,Facility,Inpatient,,,,493.2,419.22,141.35112,493.2,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
CEMENT BONE SIMPLEX FULL DOSAGE 6191-1-001/6191-1-010,,A4649,HCPCS,Facility,Both,,,,493.2,419.22,141.35112,493.2,"Preferred One Administrative Services, INC.",PPO,486.2952,98.6,,percent of total billed charges,,
CEMENT BONE SIMPLEX FULL DOSAGE 6191-1-001/6191-1-010,,A4649,HCPCS,Facility,Outpatient,,,,493.2,419.22,141.35112,493.2,PrimeWest Health,Minnesota Senior Health Options (MSHO),253.7514,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
CEMENT BONE SIMPLEX FULL DOSAGE 6191-1-001/6191-1-010,,A4649,HCPCS,Facility,Inpatient,,,,493.2,419.22,141.35112,493.2,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CEMENT BONE SIMPLEX FULL DOSAGE 6191-1-001/6191-1-010,,A4649,HCPCS,Facility,Outpatient,,,,493.2,419.22,141.35112,493.2,PrimeWest Health,MinnesotaCare,253.30752,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
CEMENT BONE SIMPLEX FULL DOSAGE 6191-1-001/6191-1-010,,A4649,HCPCS,Facility,Inpatient,,,,493.2,419.22,141.35112,493.2,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
CEMENT BONE SIMPLEX FULL DOSAGE 6191-1-001/6191-1-010,,A4649,HCPCS,Facility,Both,,,,493.2,419.22,141.35112,493.2,Sanford Health Plan,Sanford Health Plan,453.744,92,,percent of total billed charges,,
CEMENT BONE SIMPLEX FULL DOSAGE 6191-1-001/6191-1-010,,A4649,HCPCS,Facility,Outpatient,,,,493.2,419.22,141.35112,493.2,"UCare Health, Inc.",Individual & Family Plan,277.9182,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
CEMENT BONE SIMPLEX FULL DOSAGE 6191-1-001/6191-1-010,,A4649,HCPCS,Facility,Inpatient,,,,493.2,419.22,141.35112,493.2,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
CEMENT BONE SIMPLEX FULL DOSAGE 6191-1-001/6191-1-010,,A4649,HCPCS,Facility,Outpatient,,,,493.2,419.22,141.35112,493.2,"UCare Health, Inc.",Medical Assistance,248.91804,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CEMENT BONE SIMPLEX FULL DOSAGE 6191-1-001/6191-1-010,,A4649,HCPCS,Facility,Inpatient,,,,493.2,419.22,141.35112,493.2,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
CEMENT BONE SIMPLEX FULL DOSAGE 6191-1-001/6191-1-010,,A4649,HCPCS,Facility,Outpatient,,,,493.2,419.22,141.35112,493.2,"UCare Health, Inc.",Medicare Advantage,248.91804,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CEMENT BONE SIMPLEX FULL DOSAGE 6191-1-001/6191-1-010,,A4649,HCPCS,Facility,Inpatient,,,,493.2,419.22,141.35112,493.2,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CEMENT BONE SIMPLEX FULL DOSAGE 6191-1-001/6191-1-010,,A4649,HCPCS,Facility,Outpatient,,,,493.2,419.22,141.35112,493.2,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),248.91804,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CEMENT BONE SIMPLEX FULL DOSAGE 6191-1-001/6191-1-010,,A4649,HCPCS,Facility,Inpatient,,,,493.2,419.22,141.35112,493.2,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CEMENT BONE SIMPLEX FULL DOSAGE 6191-1-001/6191-1-010,,A4649,HCPCS,Facility,Both,,,,493.2,419.22,141.35112,493.2,UnitedHealthcare,Individual & Family,463.608,94,,percent of total billed charges,,
CEMENT BONE SIMPLEX FULL DOSAGE 6191-1-001/6191-1-010,,A4649,HCPCS,Facility,Outpatient,,,,493.2,419.22,141.35112,493.2,UnitedHealthcare,Medicare Advantage,241.668,49,,percent of total billed charges,,
CEMENT BONE SIMPLEX FULL DOSAGE 6191-1-001/6191-1-010,,A4649,HCPCS,Facility,Inpatient,,,,493.2,419.22,141.35112,493.2,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
CEMENT BONE SIMPLEX FULL DOSAGE 6191-1-001/6191-1-010,,A4649,HCPCS,Facility,Outpatient,,,,493.2,419.22,141.35112,493.2,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,236.736,48,,percent of total billed charges,,100% of DHS outpatient percentage
CEMENT BONE SIMPLEX FULL DOSAGE 6191-1-001/6191-1-010,,A4649,HCPCS,Facility,Inpatient,,,,493.2,419.22,141.35112,493.2,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
CORD DISPOSABLE ACTIVE CIRCON-ACMI DAC,,A4649,HCPCS,Facility,Both,,,,227.15,193.0775,65.10119,227.15,Aetna,Commercial,208.978,92,,percent of total billed charges,,
CORD DISPOSABLE ACTIVE CIRCON-ACMI DAC,,A4649,HCPCS,Facility,Outpatient,,,,227.15,193.0775,65.10119,227.15,Aetna,Medicare Advantage,111.3035,49,,percent of total billed charges,,
CORD DISPOSABLE ACTIVE CIRCON-ACMI DAC,,A4649,HCPCS,Facility,Inpatient,,,,227.15,193.0775,65.10119,227.15,Aetna,Medicare Advantage,,,,,Included in per diem rate,
CORD DISPOSABLE ACTIVE CIRCON-ACMI DAC,,A4649,HCPCS,Facility,Both,,,,227.15,193.0775,65.10119,227.15,Aetna,PPO,211.2495,93,,percent of total billed charges,,
CORD DISPOSABLE ACTIVE CIRCON-ACMI DAC,,A4649,HCPCS,Facility,Both,,,,227.15,193.0775,65.10119,227.15,America's PPO,America's PPO,218.132145,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
CORD DISPOSABLE ACTIVE CIRCON-ACMI DAC,,A4649,HCPCS,Facility,Both,,,,227.15,193.0775,65.10119,227.15,BlueCross BlueShield Minnesota, Federal Employee Program,223.5156,98.4,,percent of total billed charges,,
CORD DISPOSABLE ACTIVE CIRCON-ACMI DAC,,A4649,HCPCS,Facility,Both,,,,227.15,193.0775,65.10119,227.15,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,227.15,100,,percent of total billed charges,,
CORD DISPOSABLE ACTIVE CIRCON-ACMI DAC,,A4649,HCPCS,Facility,Both,,,,227.15,193.0775,65.10119,227.15,BlueCross BlueShield Minnesota,High Value Network Plan,204.435,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
CORD DISPOSABLE ACTIVE CIRCON-ACMI DAC,,A4649,HCPCS,Facility,Outpatient,,,,227.15,193.0775,65.10119,227.15,BlueCross BlueShield Minnesota,Medicare Advantage,111.3035,49,,percent of total billed charges,,
CORD DISPOSABLE ACTIVE CIRCON-ACMI DAC,,A4649,HCPCS,Facility,Inpatient,,,,227.15,193.0775,65.10119,227.15,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
CORD DISPOSABLE ACTIVE CIRCON-ACMI DAC,,A4649,HCPCS,Facility,Both,,,,227.15,193.0775,65.10119,227.15,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,201.186755,88.57,,percent of total billed charges,,
CORD DISPOSABLE ACTIVE CIRCON-ACMI DAC,,A4649,HCPCS,Facility,Both,,,,227.15,193.0775,65.10119,227.15,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,65.10119,28.66,,percent of total billed charges,,
CORD DISPOSABLE ACTIVE CIRCON-ACMI DAC,,A4649,HCPCS,Facility,Outpatient,,,,227.15,193.0775,65.10119,227.15,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),111.3035,49,,percent of total billed charges,,
CORD DISPOSABLE ACTIVE CIRCON-ACMI DAC,,A4649,HCPCS,Facility,Inpatient,,,,227.15,193.0775,65.10119,227.15,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
CORD DISPOSABLE ACTIVE CIRCON-ACMI DAC,,A4649,HCPCS,Facility,Both,,,,227.15,193.0775,65.10119,227.15,CorVel,Worker's Compensation,227.15,100,,percent of total billed charges,,
CORD DISPOSABLE ACTIVE CIRCON-ACMI DAC,,A4649,HCPCS,Facility,Both,,,,227.15,193.0775,65.10119,227.15,First Health Group Corporation,First Health Network,220.3355,97,,percent of total billed charges,,
CORD DISPOSABLE ACTIVE CIRCON-ACMI DAC,,A4649,HCPCS,Facility,Both,,,,227.15,193.0775,65.10119,227.15,"Health Partners, Inc.",Commercial,214.8839,94.6,,percent of total billed charges,,
CORD DISPOSABLE ACTIVE CIRCON-ACMI DAC,,A4649,HCPCS,Facility,Outpatient,,,,227.15,193.0775,65.10119,227.15,"Health Partners, Inc.",Medicare Advantage,111.3035,49,,percent of total billed charges,,
CORD DISPOSABLE ACTIVE CIRCON-ACMI DAC,,A4649,HCPCS,Facility,Inpatient,,,,227.15,193.0775,65.10119,227.15,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CORD DISPOSABLE ACTIVE CIRCON-ACMI DAC,,A4649,HCPCS,Facility,Both,,,,227.15,193.0775,65.10119,227.15,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),136.29,60,,percent of total billed charges,,
CORD DISPOSABLE ACTIVE CIRCON-ACMI DAC,,A4649,HCPCS,Facility,Both,,,,227.15,193.0775,65.10119,227.15,"Health Partners, Inc.",State of Minnesota Advantage Program,185.12725,81.5,,percent of total billed charges,,
CORD DISPOSABLE ACTIVE CIRCON-ACMI DAC,,A4649,HCPCS,Facility,Both,,,,227.15,193.0775,65.10119,227.15,"Health Partners, Inc.",State Public Programs,113.575,50,,percent of total billed charges,,
CORD DISPOSABLE ACTIVE CIRCON-ACMI DAC,,A4649,HCPCS,Facility,Both,,,,227.15,193.0775,65.10119,227.15,Humana Insurance Company,Commercial PPO,215.7925,95,,percent of total billed charges,,
CORD DISPOSABLE ACTIVE CIRCON-ACMI DAC,,A4649,HCPCS,Facility,Outpatient,,,,227.15,193.0775,65.10119,227.15,Humana Insurance Company,Medicare PPO,111.3035,49,,percent of total billed charges,,
CORD DISPOSABLE ACTIVE CIRCON-ACMI DAC,,A4649,HCPCS,Facility,Inpatient,,,,227.15,193.0775,65.10119,227.15,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
CORD DISPOSABLE ACTIVE CIRCON-ACMI DAC,,A4649,HCPCS,Facility,Both,,,,227.15,193.0775,65.10119,227.15,Medica,Individual & Family,225.10565,99.1,,percent of total billed charges,,
CORD DISPOSABLE ACTIVE CIRCON-ACMI DAC,,A4649,HCPCS,Facility,Outpatient,,,,227.15,193.0775,65.10119,227.15,Medica,Medica Advantage Solution,113.1207,49.8,,percent of total billed charges,,
CORD DISPOSABLE ACTIVE CIRCON-ACMI DAC,,A4649,HCPCS,Facility,Inpatient,,,,227.15,193.0775,65.10119,227.15,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
CORD DISPOSABLE ACTIVE CIRCON-ACMI DAC,,A4649,HCPCS,Facility,Outpatient,,,,227.15,193.0775,65.10119,227.15,Medica,Medical Assistance,101.3089,44.6,,percent of total billed charges,,
CORD DISPOSABLE ACTIVE CIRCON-ACMI DAC,,A4649,HCPCS,Facility,Inpatient,,,,227.15,193.0775,65.10119,227.15,Medica,Medical Assistance,,,,,Included in per diem rate,
CORD DISPOSABLE ACTIVE CIRCON-ACMI DAC,,A4649,HCPCS,Facility,Outpatient,,,,227.15,193.0775,65.10119,227.15,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,113.1207,49.8,,percent of total billed charges,,
CORD DISPOSABLE ACTIVE CIRCON-ACMI DAC,,A4649,HCPCS,Facility,Inpatient,,,,227.15,193.0775,65.10119,227.15,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
CORD DISPOSABLE ACTIVE CIRCON-ACMI DAC,,A4649,HCPCS,Facility,Both,,,,227.15,193.0775,65.10119,227.15,"Multiplan, Inc.","Multiplan, Inc.",213.521,94,,percent of total billed charges,,
CORD DISPOSABLE ACTIVE CIRCON-ACMI DAC,,A4649,HCPCS,Facility,Outpatient,,,,227.15,193.0775,65.10119,227.15,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,204.66215,90.1,,percent of total billed charges,,
CORD DISPOSABLE ACTIVE CIRCON-ACMI DAC,,A4649,HCPCS,Facility,Inpatient,,,,227.15,193.0775,65.10119,227.15,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
CORD DISPOSABLE ACTIVE CIRCON-ACMI DAC,,A4649,HCPCS,Facility,Both,,,,227.15,193.0775,65.10119,227.15,"Preferred One Administrative Services, INC.",PPO,223.9699,98.6,,percent of total billed charges,,
CORD DISPOSABLE ACTIVE CIRCON-ACMI DAC,,A4649,HCPCS,Facility,Outpatient,,,,227.15,193.0775,65.10119,227.15,PrimeWest Health,Minnesota Senior Health Options (MSHO),116.868675,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
CORD DISPOSABLE ACTIVE CIRCON-ACMI DAC,,A4649,HCPCS,Facility,Inpatient,,,,227.15,193.0775,65.10119,227.15,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CORD DISPOSABLE ACTIVE CIRCON-ACMI DAC,,A4649,HCPCS,Facility,Outpatient,,,,227.15,193.0775,65.10119,227.15,PrimeWest Health,MinnesotaCare,116.66424,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
CORD DISPOSABLE ACTIVE CIRCON-ACMI DAC,,A4649,HCPCS,Facility,Inpatient,,,,227.15,193.0775,65.10119,227.15,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
CORD DISPOSABLE ACTIVE CIRCON-ACMI DAC,,A4649,HCPCS,Facility,Both,,,,227.15,193.0775,65.10119,227.15,Sanford Health Plan,Sanford Health Plan,208.978,92,,percent of total billed charges,,
CORD DISPOSABLE ACTIVE CIRCON-ACMI DAC,,A4649,HCPCS,Facility,Outpatient,,,,227.15,193.0775,65.10119,227.15,"UCare Health, Inc.",Individual & Family Plan,127.999025,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
CORD DISPOSABLE ACTIVE CIRCON-ACMI DAC,,A4649,HCPCS,Facility,Inpatient,,,,227.15,193.0775,65.10119,227.15,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
CORD DISPOSABLE ACTIVE CIRCON-ACMI DAC,,A4649,HCPCS,Facility,Outpatient,,,,227.15,193.0775,65.10119,227.15,"UCare Health, Inc.",Medical Assistance,114.642605,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CORD DISPOSABLE ACTIVE CIRCON-ACMI DAC,,A4649,HCPCS,Facility,Inpatient,,,,227.15,193.0775,65.10119,227.15,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
CORD DISPOSABLE ACTIVE CIRCON-ACMI DAC,,A4649,HCPCS,Facility,Outpatient,,,,227.15,193.0775,65.10119,227.15,"UCare Health, Inc.",Medicare Advantage,114.642605,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CORD DISPOSABLE ACTIVE CIRCON-ACMI DAC,,A4649,HCPCS,Facility,Inpatient,,,,227.15,193.0775,65.10119,227.15,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CORD DISPOSABLE ACTIVE CIRCON-ACMI DAC,,A4649,HCPCS,Facility,Outpatient,,,,227.15,193.0775,65.10119,227.15,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),114.642605,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CORD DISPOSABLE ACTIVE CIRCON-ACMI DAC,,A4649,HCPCS,Facility,Inpatient,,,,227.15,193.0775,65.10119,227.15,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CORD DISPOSABLE ACTIVE CIRCON-ACMI DAC,,A4649,HCPCS,Facility,Both,,,,227.15,193.0775,65.10119,227.15,UnitedHealthcare,Individual & Family,213.521,94,,percent of total billed charges,,
CORD DISPOSABLE ACTIVE CIRCON-ACMI DAC,,A4649,HCPCS,Facility,Outpatient,,,,227.15,193.0775,65.10119,227.15,UnitedHealthcare,Medicare Advantage,111.3035,49,,percent of total billed charges,,
CORD DISPOSABLE ACTIVE CIRCON-ACMI DAC,,A4649,HCPCS,Facility,Inpatient,,,,227.15,193.0775,65.10119,227.15,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
CORD DISPOSABLE ACTIVE CIRCON-ACMI DAC,,A4649,HCPCS,Facility,Outpatient,,,,227.15,193.0775,65.10119,227.15,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,109.032,48,,percent of total billed charges,,100% of DHS outpatient percentage
CORD DISPOSABLE ACTIVE CIRCON-ACMI DAC,,A4649,HCPCS,Facility,Inpatient,,,,227.15,193.0775,65.10119,227.15,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
C-SECTION PACK,,A4649,HCPCS,Facility,Both,,,,167.84,142.664,48.102944,167.84,Aetna,Commercial,154.4128,92,,percent of total billed charges,,
C-SECTION PACK,,A4649,HCPCS,Facility,Outpatient,,,,167.84,142.664,48.102944,167.84,Aetna,Medicare Advantage,82.2416,49,,percent of total billed charges,,
C-SECTION PACK,,A4649,HCPCS,Facility,Inpatient,,,,167.84,142.664,48.102944,167.84,Aetna,Medicare Advantage,,,,,Included in per diem rate,
C-SECTION PACK,,A4649,HCPCS,Facility,Both,,,,167.84,142.664,48.102944,167.84,Aetna,PPO,156.0912,93,,percent of total billed charges,,
C-SECTION PACK,,A4649,HCPCS,Facility,Both,,,,167.84,142.664,48.102944,167.84,America's PPO,America's PPO,161.176752,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
C-SECTION PACK,,A4649,HCPCS,Facility,Both,,,,167.84,142.664,48.102944,167.84,BlueCross BlueShield Minnesota, Federal Employee Program,165.15456,98.4,,percent of total billed charges,,
C-SECTION PACK,,A4649,HCPCS,Facility,Both,,,,167.84,142.664,48.102944,167.84,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,167.84,100,,percent of total billed charges,,
C-SECTION PACK,,A4649,HCPCS,Facility,Both,,,,167.84,142.664,48.102944,167.84,BlueCross BlueShield Minnesota,High Value Network Plan,151.056,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
C-SECTION PACK,,A4649,HCPCS,Facility,Outpatient,,,,167.84,142.664,48.102944,167.84,BlueCross BlueShield Minnesota,Medicare Advantage,82.2416,49,,percent of total billed charges,,
C-SECTION PACK,,A4649,HCPCS,Facility,Inpatient,,,,167.84,142.664,48.102944,167.84,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
C-SECTION PACK,,A4649,HCPCS,Facility,Both,,,,167.84,142.664,48.102944,167.84,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,148.655888,88.57,,percent of total billed charges,,
C-SECTION PACK,,A4649,HCPCS,Facility,Both,,,,167.84,142.664,48.102944,167.84,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,48.102944,28.66,,percent of total billed charges,,
C-SECTION PACK,,A4649,HCPCS,Facility,Outpatient,,,,167.84,142.664,48.102944,167.84,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),82.2416,49,,percent of total billed charges,,
C-SECTION PACK,,A4649,HCPCS,Facility,Inpatient,,,,167.84,142.664,48.102944,167.84,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
C-SECTION PACK,,A4649,HCPCS,Facility,Both,,,,167.84,142.664,48.102944,167.84,CorVel,Worker's Compensation,167.84,100,,percent of total billed charges,,
C-SECTION PACK,,A4649,HCPCS,Facility,Both,,,,167.84,142.664,48.102944,167.84,First Health Group Corporation,First Health Network,162.8048,97,,percent of total billed charges,,
C-SECTION PACK,,A4649,HCPCS,Facility,Both,,,,167.84,142.664,48.102944,167.84,"Health Partners, Inc.",Commercial,158.77664,94.6,,percent of total billed charges,,
C-SECTION PACK,,A4649,HCPCS,Facility,Outpatient,,,,167.84,142.664,48.102944,167.84,"Health Partners, Inc.",Medicare Advantage,82.2416,49,,percent of total billed charges,,
C-SECTION PACK,,A4649,HCPCS,Facility,Inpatient,,,,167.84,142.664,48.102944,167.84,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
C-SECTION PACK,,A4649,HCPCS,Facility,Both,,,,167.84,142.664,48.102944,167.84,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),100.704,60,,percent of total billed charges,,
C-SECTION PACK,,A4649,HCPCS,Facility,Both,,,,167.84,142.664,48.102944,167.84,"Health Partners, Inc.",State of Minnesota Advantage Program,136.7896,81.5,,percent of total billed charges,,
C-SECTION PACK,,A4649,HCPCS,Facility,Both,,,,167.84,142.664,48.102944,167.84,"Health Partners, Inc.",State Public Programs,83.92,50,,percent of total billed charges,,
C-SECTION PACK,,A4649,HCPCS,Facility,Both,,,,167.84,142.664,48.102944,167.84,Humana Insurance Company,Commercial PPO,159.448,95,,percent of total billed charges,,
C-SECTION PACK,,A4649,HCPCS,Facility,Outpatient,,,,167.84,142.664,48.102944,167.84,Humana Insurance Company,Medicare PPO,82.2416,49,,percent of total billed charges,,
C-SECTION PACK,,A4649,HCPCS,Facility,Inpatient,,,,167.84,142.664,48.102944,167.84,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
C-SECTION PACK,,A4649,HCPCS,Facility,Both,,,,167.84,142.664,48.102944,167.84,Medica,Individual & Family,166.32944,99.1,,percent of total billed charges,,
C-SECTION PACK,,A4649,HCPCS,Facility,Outpatient,,,,167.84,142.664,48.102944,167.84,Medica,Medica Advantage Solution,83.58432,49.8,,percent of total billed charges,,
C-SECTION PACK,,A4649,HCPCS,Facility,Inpatient,,,,167.84,142.664,48.102944,167.84,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
C-SECTION PACK,,A4649,HCPCS,Facility,Outpatient,,,,167.84,142.664,48.102944,167.84,Medica,Medical Assistance,74.85664,44.6,,percent of total billed charges,,
C-SECTION PACK,,A4649,HCPCS,Facility,Inpatient,,,,167.84,142.664,48.102944,167.84,Medica,Medical Assistance,,,,,Included in per diem rate,
C-SECTION PACK,,A4649,HCPCS,Facility,Outpatient,,,,167.84,142.664,48.102944,167.84,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,83.58432,49.8,,percent of total billed charges,,
C-SECTION PACK,,A4649,HCPCS,Facility,Inpatient,,,,167.84,142.664,48.102944,167.84,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
C-SECTION PACK,,A4649,HCPCS,Facility,Both,,,,167.84,142.664,48.102944,167.84,"Multiplan, Inc.","Multiplan, Inc.",157.7696,94,,percent of total billed charges,,
C-SECTION PACK,,A4649,HCPCS,Facility,Outpatient,,,,167.84,142.664,48.102944,167.84,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,151.22384,90.1,,percent of total billed charges,,
C-SECTION PACK,,A4649,HCPCS,Facility,Inpatient,,,,167.84,142.664,48.102944,167.84,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
C-SECTION PACK,,A4649,HCPCS,Facility,Both,,,,167.84,142.664,48.102944,167.84,"Preferred One Administrative Services, INC.",PPO,165.49024,98.6,,percent of total billed charges,,
C-SECTION PACK,,A4649,HCPCS,Facility,Outpatient,,,,167.84,142.664,48.102944,167.84,PrimeWest Health,Minnesota Senior Health Options (MSHO),86.35368,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
C-SECTION PACK,,A4649,HCPCS,Facility,Inpatient,,,,167.84,142.664,48.102944,167.84,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
C-SECTION PACK,,A4649,HCPCS,Facility,Outpatient,,,,167.84,142.664,48.102944,167.84,PrimeWest Health,MinnesotaCare,86.202624,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
C-SECTION PACK,,A4649,HCPCS,Facility,Inpatient,,,,167.84,142.664,48.102944,167.84,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
C-SECTION PACK,,A4649,HCPCS,Facility,Both,,,,167.84,142.664,48.102944,167.84,Sanford Health Plan,Sanford Health Plan,154.4128,92,,percent of total billed charges,,
C-SECTION PACK,,A4649,HCPCS,Facility,Outpatient,,,,167.84,142.664,48.102944,167.84,"UCare Health, Inc.",Individual & Family Plan,94.57784,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
C-SECTION PACK,,A4649,HCPCS,Facility,Inpatient,,,,167.84,142.664,48.102944,167.84,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
C-SECTION PACK,,A4649,HCPCS,Facility,Outpatient,,,,167.84,142.664,48.102944,167.84,"UCare Health, Inc.",Medical Assistance,84.708848,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
C-SECTION PACK,,A4649,HCPCS,Facility,Inpatient,,,,167.84,142.664,48.102944,167.84,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
C-SECTION PACK,,A4649,HCPCS,Facility,Outpatient,,,,167.84,142.664,48.102944,167.84,"UCare Health, Inc.",Medicare Advantage,84.708848,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
C-SECTION PACK,,A4649,HCPCS,Facility,Inpatient,,,,167.84,142.664,48.102944,167.84,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
C-SECTION PACK,,A4649,HCPCS,Facility,Outpatient,,,,167.84,142.664,48.102944,167.84,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),84.708848,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
C-SECTION PACK,,A4649,HCPCS,Facility,Inpatient,,,,167.84,142.664,48.102944,167.84,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
C-SECTION PACK,,A4649,HCPCS,Facility,Both,,,,167.84,142.664,48.102944,167.84,UnitedHealthcare,Individual & Family,157.7696,94,,percent of total billed charges,,
C-SECTION PACK,,A4649,HCPCS,Facility,Outpatient,,,,167.84,142.664,48.102944,167.84,UnitedHealthcare,Medicare Advantage,82.2416,49,,percent of total billed charges,,
C-SECTION PACK,,A4649,HCPCS,Facility,Inpatient,,,,167.84,142.664,48.102944,167.84,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
C-SECTION PACK,,A4649,HCPCS,Facility,Outpatient,,,,167.84,142.664,48.102944,167.84,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,80.5632,48,,percent of total billed charges,,100% of DHS outpatient percentage
C-SECTION PACK,,A4649,HCPCS,Facility,Inpatient,,,,167.84,142.664,48.102944,167.84,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
CURETTE PLASTIC,,A4649,HCPCS,Facility,Both,,,,81.675,69.42375,23.408055,81.675,Aetna,Commercial,75.141,92,,percent of total billed charges,,
CURETTE PLASTIC,,A4649,HCPCS,Facility,Outpatient,,,,81.675,69.42375,23.408055,81.675,Aetna,Medicare Advantage,40.02075,49,,percent of total billed charges,,
CURETTE PLASTIC,,A4649,HCPCS,Facility,Inpatient,,,,81.675,69.42375,23.408055,81.675,Aetna,Medicare Advantage,,,,,Included in per diem rate,
CURETTE PLASTIC,,A4649,HCPCS,Facility,Both,,,,81.675,69.42375,23.408055,81.675,Aetna,PPO,75.95775,93,,percent of total billed charges,,
CURETTE PLASTIC,,A4649,HCPCS,Facility,Both,,,,81.675,69.42375,23.408055,81.675,America's PPO,America's PPO,78.4325025,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
CURETTE PLASTIC,,A4649,HCPCS,Facility,Both,,,,81.675,69.42375,23.408055,81.675,BlueCross BlueShield Minnesota, Federal Employee Program,80.3682,98.4,,percent of total billed charges,,
CURETTE PLASTIC,,A4649,HCPCS,Facility,Both,,,,81.675,69.42375,23.408055,81.675,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,81.675,100,,percent of total billed charges,,
CURETTE PLASTIC,,A4649,HCPCS,Facility,Both,,,,81.675,69.42375,23.408055,81.675,BlueCross BlueShield Minnesota,High Value Network Plan,73.5075,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
CURETTE PLASTIC,,A4649,HCPCS,Facility,Outpatient,,,,81.675,69.42375,23.408055,81.675,BlueCross BlueShield Minnesota,Medicare Advantage,40.02075,49,,percent of total billed charges,,
CURETTE PLASTIC,,A4649,HCPCS,Facility,Inpatient,,,,81.675,69.42375,23.408055,81.675,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
CURETTE PLASTIC,,A4649,HCPCS,Facility,Both,,,,81.675,69.42375,23.408055,81.675,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,72.3395475,88.57,,percent of total billed charges,,
CURETTE PLASTIC,,A4649,HCPCS,Facility,Both,,,,81.675,69.42375,23.408055,81.675,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,23.408055,28.66,,percent of total billed charges,,
CURETTE PLASTIC,,A4649,HCPCS,Facility,Outpatient,,,,81.675,69.42375,23.408055,81.675,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),40.02075,49,,percent of total billed charges,,
CURETTE PLASTIC,,A4649,HCPCS,Facility,Inpatient,,,,81.675,69.42375,23.408055,81.675,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
CURETTE PLASTIC,,A4649,HCPCS,Facility,Both,,,,81.675,69.42375,23.408055,81.675,CorVel,Worker's Compensation,81.675,100,,percent of total billed charges,,
CURETTE PLASTIC,,A4649,HCPCS,Facility,Both,,,,81.675,69.42375,23.408055,81.675,First Health Group Corporation,First Health Network,79.22475,97,,percent of total billed charges,,
CURETTE PLASTIC,,A4649,HCPCS,Facility,Both,,,,81.675,69.42375,23.408055,81.675,"Health Partners, Inc.",Commercial,77.26455,94.6,,percent of total billed charges,,
CURETTE PLASTIC,,A4649,HCPCS,Facility,Outpatient,,,,81.675,69.42375,23.408055,81.675,"Health Partners, Inc.",Medicare Advantage,40.02075,49,,percent of total billed charges,,
CURETTE PLASTIC,,A4649,HCPCS,Facility,Inpatient,,,,81.675,69.42375,23.408055,81.675,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CURETTE PLASTIC,,A4649,HCPCS,Facility,Both,,,,81.675,69.42375,23.408055,81.675,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),49.005,60,,percent of total billed charges,,
CURETTE PLASTIC,,A4649,HCPCS,Facility,Both,,,,81.675,69.42375,23.408055,81.675,"Health Partners, Inc.",State of Minnesota Advantage Program,66.565125,81.5,,percent of total billed charges,,
CURETTE PLASTIC,,A4649,HCPCS,Facility,Both,,,,81.675,69.42375,23.408055,81.675,"Health Partners, Inc.",State Public Programs,40.8375,50,,percent of total billed charges,,
CURETTE PLASTIC,,A4649,HCPCS,Facility,Both,,,,81.675,69.42375,23.408055,81.675,Humana Insurance Company,Commercial PPO,77.59125,95,,percent of total billed charges,,
CURETTE PLASTIC,,A4649,HCPCS,Facility,Outpatient,,,,81.675,69.42375,23.408055,81.675,Humana Insurance Company,Medicare PPO,40.02075,49,,percent of total billed charges,,
CURETTE PLASTIC,,A4649,HCPCS,Facility,Inpatient,,,,81.675,69.42375,23.408055,81.675,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
CURETTE PLASTIC,,A4649,HCPCS,Facility,Both,,,,81.675,69.42375,23.408055,81.675,Medica,Individual & Family,80.939925,99.1,,percent of total billed charges,,
CURETTE PLASTIC,,A4649,HCPCS,Facility,Outpatient,,,,81.675,69.42375,23.408055,81.675,Medica,Medica Advantage Solution,40.67415,49.8,,percent of total billed charges,,
CURETTE PLASTIC,,A4649,HCPCS,Facility,Inpatient,,,,81.675,69.42375,23.408055,81.675,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
CURETTE PLASTIC,,A4649,HCPCS,Facility,Outpatient,,,,81.675,69.42375,23.408055,81.675,Medica,Medical Assistance,36.42705,44.6,,percent of total billed charges,,
CURETTE PLASTIC,,A4649,HCPCS,Facility,Inpatient,,,,81.675,69.42375,23.408055,81.675,Medica,Medical Assistance,,,,,Included in per diem rate,
CURETTE PLASTIC,,A4649,HCPCS,Facility,Outpatient,,,,81.675,69.42375,23.408055,81.675,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,40.67415,49.8,,percent of total billed charges,,
CURETTE PLASTIC,,A4649,HCPCS,Facility,Inpatient,,,,81.675,69.42375,23.408055,81.675,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
CURETTE PLASTIC,,A4649,HCPCS,Facility,Both,,,,81.675,69.42375,23.408055,81.675,"Multiplan, Inc.","Multiplan, Inc.",76.7745,94,,percent of total billed charges,,
CURETTE PLASTIC,,A4649,HCPCS,Facility,Outpatient,,,,81.675,69.42375,23.408055,81.675,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,73.589175,90.1,,percent of total billed charges,,
CURETTE PLASTIC,,A4649,HCPCS,Facility,Inpatient,,,,81.675,69.42375,23.408055,81.675,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
CURETTE PLASTIC,,A4649,HCPCS,Facility,Both,,,,81.675,69.42375,23.408055,81.675,"Preferred One Administrative Services, INC.",PPO,80.53155,98.6,,percent of total billed charges,,
CURETTE PLASTIC,,A4649,HCPCS,Facility,Outpatient,,,,81.675,69.42375,23.408055,81.675,PrimeWest Health,Minnesota Senior Health Options (MSHO),42.0217875,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
CURETTE PLASTIC,,A4649,HCPCS,Facility,Inpatient,,,,81.675,69.42375,23.408055,81.675,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CURETTE PLASTIC,,A4649,HCPCS,Facility,Outpatient,,,,81.675,69.42375,23.408055,81.675,PrimeWest Health,MinnesotaCare,41.94828,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
CURETTE PLASTIC,,A4649,HCPCS,Facility,Inpatient,,,,81.675,69.42375,23.408055,81.675,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
CURETTE PLASTIC,,A4649,HCPCS,Facility,Both,,,,81.675,69.42375,23.408055,81.675,Sanford Health Plan,Sanford Health Plan,75.141,92,,percent of total billed charges,,
CURETTE PLASTIC,,A4649,HCPCS,Facility,Outpatient,,,,81.675,69.42375,23.408055,81.675,"UCare Health, Inc.",Individual & Family Plan,46.0238625,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
CURETTE PLASTIC,,A4649,HCPCS,Facility,Inpatient,,,,81.675,69.42375,23.408055,81.675,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
CURETTE PLASTIC,,A4649,HCPCS,Facility,Outpatient,,,,81.675,69.42375,23.408055,81.675,"UCare Health, Inc.",Medical Assistance,41.2213725,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CURETTE PLASTIC,,A4649,HCPCS,Facility,Inpatient,,,,81.675,69.42375,23.408055,81.675,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
CURETTE PLASTIC,,A4649,HCPCS,Facility,Outpatient,,,,81.675,69.42375,23.408055,81.675,"UCare Health, Inc.",Medicare Advantage,41.2213725,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CURETTE PLASTIC,,A4649,HCPCS,Facility,Inpatient,,,,81.675,69.42375,23.408055,81.675,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CURETTE PLASTIC,,A4649,HCPCS,Facility,Outpatient,,,,81.675,69.42375,23.408055,81.675,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),41.2213725,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CURETTE PLASTIC,,A4649,HCPCS,Facility,Inpatient,,,,81.675,69.42375,23.408055,81.675,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CURETTE PLASTIC,,A4649,HCPCS,Facility,Both,,,,81.675,69.42375,23.408055,81.675,UnitedHealthcare,Individual & Family,76.7745,94,,percent of total billed charges,,
CURETTE PLASTIC,,A4649,HCPCS,Facility,Outpatient,,,,81.675,69.42375,23.408055,81.675,UnitedHealthcare,Medicare Advantage,40.02075,49,,percent of total billed charges,,
CURETTE PLASTIC,,A4649,HCPCS,Facility,Inpatient,,,,81.675,69.42375,23.408055,81.675,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
CURETTE PLASTIC,,A4649,HCPCS,Facility,Outpatient,,,,81.675,69.42375,23.408055,81.675,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,39.204,48,,percent of total billed charges,,100% of DHS outpatient percentage
CURETTE PLASTIC,,A4649,HCPCS,Facility,Inpatient,,,,81.675,69.42375,23.408055,81.675,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
CYSTO PACK,,A4649,HCPCS,Facility,Both,,,,141.76,120.496,40.628416,141.76,Aetna,Commercial,130.4192,92,,percent of total billed charges,,
CYSTO PACK,,A4649,HCPCS,Facility,Outpatient,,,,141.76,120.496,40.628416,141.76,Aetna,Medicare Advantage,69.4624,49,,percent of total billed charges,,
CYSTO PACK,,A4649,HCPCS,Facility,Inpatient,,,,141.76,120.496,40.628416,141.76,Aetna,Medicare Advantage,,,,,Included in per diem rate,
CYSTO PACK,,A4649,HCPCS,Facility,Both,,,,141.76,120.496,40.628416,141.76,Aetna,PPO,131.8368,93,,percent of total billed charges,,
CYSTO PACK,,A4649,HCPCS,Facility,Both,,,,141.76,120.496,40.628416,141.76,America's PPO,America's PPO,136.132128,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
CYSTO PACK,,A4649,HCPCS,Facility,Both,,,,141.76,120.496,40.628416,141.76,BlueCross BlueShield Minnesota, Federal Employee Program,139.49184,98.4,,percent of total billed charges,,
CYSTO PACK,,A4649,HCPCS,Facility,Both,,,,141.76,120.496,40.628416,141.76,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,141.76,100,,percent of total billed charges,,
CYSTO PACK,,A4649,HCPCS,Facility,Both,,,,141.76,120.496,40.628416,141.76,BlueCross BlueShield Minnesota,High Value Network Plan,127.584,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
CYSTO PACK,,A4649,HCPCS,Facility,Outpatient,,,,141.76,120.496,40.628416,141.76,BlueCross BlueShield Minnesota,Medicare Advantage,69.4624,49,,percent of total billed charges,,
CYSTO PACK,,A4649,HCPCS,Facility,Inpatient,,,,141.76,120.496,40.628416,141.76,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
CYSTO PACK,,A4649,HCPCS,Facility,Both,,,,141.76,120.496,40.628416,141.76,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,125.556832,88.57,,percent of total billed charges,,
CYSTO PACK,,A4649,HCPCS,Facility,Both,,,,141.76,120.496,40.628416,141.76,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,40.628416,28.66,,percent of total billed charges,,
CYSTO PACK,,A4649,HCPCS,Facility,Outpatient,,,,141.76,120.496,40.628416,141.76,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),69.4624,49,,percent of total billed charges,,
CYSTO PACK,,A4649,HCPCS,Facility,Inpatient,,,,141.76,120.496,40.628416,141.76,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
CYSTO PACK,,A4649,HCPCS,Facility,Both,,,,141.76,120.496,40.628416,141.76,CorVel,Worker's Compensation,141.76,100,,percent of total billed charges,,
CYSTO PACK,,A4649,HCPCS,Facility,Both,,,,141.76,120.496,40.628416,141.76,First Health Group Corporation,First Health Network,137.5072,97,,percent of total billed charges,,
CYSTO PACK,,A4649,HCPCS,Facility,Both,,,,141.76,120.496,40.628416,141.76,"Health Partners, Inc.",Commercial,134.10496,94.6,,percent of total billed charges,,
CYSTO PACK,,A4649,HCPCS,Facility,Outpatient,,,,141.76,120.496,40.628416,141.76,"Health Partners, Inc.",Medicare Advantage,69.4624,49,,percent of total billed charges,,
CYSTO PACK,,A4649,HCPCS,Facility,Inpatient,,,,141.76,120.496,40.628416,141.76,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CYSTO PACK,,A4649,HCPCS,Facility,Both,,,,141.76,120.496,40.628416,141.76,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),85.056,60,,percent of total billed charges,,
CYSTO PACK,,A4649,HCPCS,Facility,Both,,,,141.76,120.496,40.628416,141.76,"Health Partners, Inc.",State of Minnesota Advantage Program,115.5344,81.5,,percent of total billed charges,,
CYSTO PACK,,A4649,HCPCS,Facility,Both,,,,141.76,120.496,40.628416,141.76,"Health Partners, Inc.",State Public Programs,70.88,50,,percent of total billed charges,,
CYSTO PACK,,A4649,HCPCS,Facility,Both,,,,141.76,120.496,40.628416,141.76,Humana Insurance Company,Commercial PPO,134.672,95,,percent of total billed charges,,
CYSTO PACK,,A4649,HCPCS,Facility,Outpatient,,,,141.76,120.496,40.628416,141.76,Humana Insurance Company,Medicare PPO,69.4624,49,,percent of total billed charges,,
CYSTO PACK,,A4649,HCPCS,Facility,Inpatient,,,,141.76,120.496,40.628416,141.76,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
CYSTO PACK,,A4649,HCPCS,Facility,Both,,,,141.76,120.496,40.628416,141.76,Medica,Individual & Family,140.48416,99.1,,percent of total billed charges,,
CYSTO PACK,,A4649,HCPCS,Facility,Outpatient,,,,141.76,120.496,40.628416,141.76,Medica,Medica Advantage Solution,70.59648,49.8,,percent of total billed charges,,
CYSTO PACK,,A4649,HCPCS,Facility,Inpatient,,,,141.76,120.496,40.628416,141.76,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
CYSTO PACK,,A4649,HCPCS,Facility,Outpatient,,,,141.76,120.496,40.628416,141.76,Medica,Medical Assistance,63.22496,44.6,,percent of total billed charges,,
CYSTO PACK,,A4649,HCPCS,Facility,Inpatient,,,,141.76,120.496,40.628416,141.76,Medica,Medical Assistance,,,,,Included in per diem rate,
CYSTO PACK,,A4649,HCPCS,Facility,Outpatient,,,,141.76,120.496,40.628416,141.76,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,70.59648,49.8,,percent of total billed charges,,
CYSTO PACK,,A4649,HCPCS,Facility,Inpatient,,,,141.76,120.496,40.628416,141.76,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
CYSTO PACK,,A4649,HCPCS,Facility,Both,,,,141.76,120.496,40.628416,141.76,"Multiplan, Inc.","Multiplan, Inc.",133.2544,94,,percent of total billed charges,,
CYSTO PACK,,A4649,HCPCS,Facility,Outpatient,,,,141.76,120.496,40.628416,141.76,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,127.72576,90.1,,percent of total billed charges,,
CYSTO PACK,,A4649,HCPCS,Facility,Inpatient,,,,141.76,120.496,40.628416,141.76,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
CYSTO PACK,,A4649,HCPCS,Facility,Both,,,,141.76,120.496,40.628416,141.76,"Preferred One Administrative Services, INC.",PPO,139.77536,98.6,,percent of total billed charges,,
CYSTO PACK,,A4649,HCPCS,Facility,Outpatient,,,,141.76,120.496,40.628416,141.76,PrimeWest Health,Minnesota Senior Health Options (MSHO),72.93552,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
CYSTO PACK,,A4649,HCPCS,Facility,Inpatient,,,,141.76,120.496,40.628416,141.76,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CYSTO PACK,,A4649,HCPCS,Facility,Outpatient,,,,141.76,120.496,40.628416,141.76,PrimeWest Health,MinnesotaCare,72.807936,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
CYSTO PACK,,A4649,HCPCS,Facility,Inpatient,,,,141.76,120.496,40.628416,141.76,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
CYSTO PACK,,A4649,HCPCS,Facility,Both,,,,141.76,120.496,40.628416,141.76,Sanford Health Plan,Sanford Health Plan,130.4192,92,,percent of total billed charges,,
CYSTO PACK,,A4649,HCPCS,Facility,Outpatient,,,,141.76,120.496,40.628416,141.76,"UCare Health, Inc.",Individual & Family Plan,79.88176,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
CYSTO PACK,,A4649,HCPCS,Facility,Inpatient,,,,141.76,120.496,40.628416,141.76,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
CYSTO PACK,,A4649,HCPCS,Facility,Outpatient,,,,141.76,120.496,40.628416,141.76,"UCare Health, Inc.",Medical Assistance,71.546272,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CYSTO PACK,,A4649,HCPCS,Facility,Inpatient,,,,141.76,120.496,40.628416,141.76,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
CYSTO PACK,,A4649,HCPCS,Facility,Outpatient,,,,141.76,120.496,40.628416,141.76,"UCare Health, Inc.",Medicare Advantage,71.546272,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CYSTO PACK,,A4649,HCPCS,Facility,Inpatient,,,,141.76,120.496,40.628416,141.76,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CYSTO PACK,,A4649,HCPCS,Facility,Outpatient,,,,141.76,120.496,40.628416,141.76,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),71.546272,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CYSTO PACK,,A4649,HCPCS,Facility,Inpatient,,,,141.76,120.496,40.628416,141.76,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CYSTO PACK,,A4649,HCPCS,Facility,Both,,,,141.76,120.496,40.628416,141.76,UnitedHealthcare,Individual & Family,133.2544,94,,percent of total billed charges,,
CYSTO PACK,,A4649,HCPCS,Facility,Outpatient,,,,141.76,120.496,40.628416,141.76,UnitedHealthcare,Medicare Advantage,69.4624,49,,percent of total billed charges,,
CYSTO PACK,,A4649,HCPCS,Facility,Inpatient,,,,141.76,120.496,40.628416,141.76,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
CYSTO PACK,,A4649,HCPCS,Facility,Outpatient,,,,141.76,120.496,40.628416,141.76,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,68.0448,48,,percent of total billed charges,,100% of DHS outpatient percentage
CYSTO PACK,,A4649,HCPCS,Facility,Inpatient,,,,141.76,120.496,40.628416,141.76,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
DISP LEG HOLDER,,A4649,HCPCS,Facility,Both,,,,140.92,119.782,40.387672,140.92,Aetna,Commercial,129.6464,92,,percent of total billed charges,,
DISP LEG HOLDER,,A4649,HCPCS,Facility,Outpatient,,,,140.92,119.782,40.387672,140.92,Aetna,Medicare Advantage,69.0508,49,,percent of total billed charges,,
DISP LEG HOLDER,,A4649,HCPCS,Facility,Inpatient,,,,140.92,119.782,40.387672,140.92,Aetna,Medicare Advantage,,,,,Included in per diem rate,
DISP LEG HOLDER,,A4649,HCPCS,Facility,Both,,,,140.92,119.782,40.387672,140.92,Aetna,PPO,131.0556,93,,percent of total billed charges,,
DISP LEG HOLDER,,A4649,HCPCS,Facility,Both,,,,140.92,119.782,40.387672,140.92,America's PPO,America's PPO,135.325476,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
DISP LEG HOLDER,,A4649,HCPCS,Facility,Both,,,,140.92,119.782,40.387672,140.92,BlueCross BlueShield Minnesota, Federal Employee Program,138.66528,98.4,,percent of total billed charges,,
DISP LEG HOLDER,,A4649,HCPCS,Facility,Both,,,,140.92,119.782,40.387672,140.92,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,140.92,100,,percent of total billed charges,,
DISP LEG HOLDER,,A4649,HCPCS,Facility,Both,,,,140.92,119.782,40.387672,140.92,BlueCross BlueShield Minnesota,High Value Network Plan,126.828,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
DISP LEG HOLDER,,A4649,HCPCS,Facility,Outpatient,,,,140.92,119.782,40.387672,140.92,BlueCross BlueShield Minnesota,Medicare Advantage,69.0508,49,,percent of total billed charges,,
DISP LEG HOLDER,,A4649,HCPCS,Facility,Inpatient,,,,140.92,119.782,40.387672,140.92,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
DISP LEG HOLDER,,A4649,HCPCS,Facility,Both,,,,140.92,119.782,40.387672,140.92,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,124.812844,88.57,,percent of total billed charges,,
DISP LEG HOLDER,,A4649,HCPCS,Facility,Both,,,,140.92,119.782,40.387672,140.92,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,40.387672,28.66,,percent of total billed charges,,
DISP LEG HOLDER,,A4649,HCPCS,Facility,Outpatient,,,,140.92,119.782,40.387672,140.92,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),69.0508,49,,percent of total billed charges,,
DISP LEG HOLDER,,A4649,HCPCS,Facility,Inpatient,,,,140.92,119.782,40.387672,140.92,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
DISP LEG HOLDER,,A4649,HCPCS,Facility,Both,,,,140.92,119.782,40.387672,140.92,CorVel,Worker's Compensation,140.92,100,,percent of total billed charges,,
DISP LEG HOLDER,,A4649,HCPCS,Facility,Both,,,,140.92,119.782,40.387672,140.92,First Health Group Corporation,First Health Network,136.6924,97,,percent of total billed charges,,
DISP LEG HOLDER,,A4649,HCPCS,Facility,Both,,,,140.92,119.782,40.387672,140.92,"Health Partners, Inc.",Commercial,133.31032,94.6,,percent of total billed charges,,
DISP LEG HOLDER,,A4649,HCPCS,Facility,Outpatient,,,,140.92,119.782,40.387672,140.92,"Health Partners, Inc.",Medicare Advantage,69.0508,49,,percent of total billed charges,,
DISP LEG HOLDER,,A4649,HCPCS,Facility,Inpatient,,,,140.92,119.782,40.387672,140.92,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DISP LEG HOLDER,,A4649,HCPCS,Facility,Both,,,,140.92,119.782,40.387672,140.92,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),84.552,60,,percent of total billed charges,,
DISP LEG HOLDER,,A4649,HCPCS,Facility,Both,,,,140.92,119.782,40.387672,140.92,"Health Partners, Inc.",State of Minnesota Advantage Program,114.8498,81.5,,percent of total billed charges,,
DISP LEG HOLDER,,A4649,HCPCS,Facility,Both,,,,140.92,119.782,40.387672,140.92,"Health Partners, Inc.",State Public Programs,70.46,50,,percent of total billed charges,,
DISP LEG HOLDER,,A4649,HCPCS,Facility,Both,,,,140.92,119.782,40.387672,140.92,Humana Insurance Company,Commercial PPO,133.874,95,,percent of total billed charges,,
DISP LEG HOLDER,,A4649,HCPCS,Facility,Outpatient,,,,140.92,119.782,40.387672,140.92,Humana Insurance Company,Medicare PPO,69.0508,49,,percent of total billed charges,,
DISP LEG HOLDER,,A4649,HCPCS,Facility,Inpatient,,,,140.92,119.782,40.387672,140.92,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
DISP LEG HOLDER,,A4649,HCPCS,Facility,Both,,,,140.92,119.782,40.387672,140.92,Medica,Individual & Family,139.65172,99.1,,percent of total billed charges,,
DISP LEG HOLDER,,A4649,HCPCS,Facility,Outpatient,,,,140.92,119.782,40.387672,140.92,Medica,Medica Advantage Solution,70.17816,49.8,,percent of total billed charges,,
DISP LEG HOLDER,,A4649,HCPCS,Facility,Inpatient,,,,140.92,119.782,40.387672,140.92,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
DISP LEG HOLDER,,A4649,HCPCS,Facility,Outpatient,,,,140.92,119.782,40.387672,140.92,Medica,Medical Assistance,62.85032,44.6,,percent of total billed charges,,
DISP LEG HOLDER,,A4649,HCPCS,Facility,Inpatient,,,,140.92,119.782,40.387672,140.92,Medica,Medical Assistance,,,,,Included in per diem rate,
DISP LEG HOLDER,,A4649,HCPCS,Facility,Outpatient,,,,140.92,119.782,40.387672,140.92,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,70.17816,49.8,,percent of total billed charges,,
DISP LEG HOLDER,,A4649,HCPCS,Facility,Inpatient,,,,140.92,119.782,40.387672,140.92,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
DISP LEG HOLDER,,A4649,HCPCS,Facility,Both,,,,140.92,119.782,40.387672,140.92,"Multiplan, Inc.","Multiplan, Inc.",132.4648,94,,percent of total billed charges,,
DISP LEG HOLDER,,A4649,HCPCS,Facility,Outpatient,,,,140.92,119.782,40.387672,140.92,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,126.96892,90.1,,percent of total billed charges,,
DISP LEG HOLDER,,A4649,HCPCS,Facility,Inpatient,,,,140.92,119.782,40.387672,140.92,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
DISP LEG HOLDER,,A4649,HCPCS,Facility,Both,,,,140.92,119.782,40.387672,140.92,"Preferred One Administrative Services, INC.",PPO,138.94712,98.6,,percent of total billed charges,,
DISP LEG HOLDER,,A4649,HCPCS,Facility,Outpatient,,,,140.92,119.782,40.387672,140.92,PrimeWest Health,Minnesota Senior Health Options (MSHO),72.50334,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
DISP LEG HOLDER,,A4649,HCPCS,Facility,Inpatient,,,,140.92,119.782,40.387672,140.92,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DISP LEG HOLDER,,A4649,HCPCS,Facility,Outpatient,,,,140.92,119.782,40.387672,140.92,PrimeWest Health,MinnesotaCare,72.376512,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
DISP LEG HOLDER,,A4649,HCPCS,Facility,Inpatient,,,,140.92,119.782,40.387672,140.92,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
DISP LEG HOLDER,,A4649,HCPCS,Facility,Both,,,,140.92,119.782,40.387672,140.92,Sanford Health Plan,Sanford Health Plan,129.6464,92,,percent of total billed charges,,
DISP LEG HOLDER,,A4649,HCPCS,Facility,Outpatient,,,,140.92,119.782,40.387672,140.92,"UCare Health, Inc.",Individual & Family Plan,79.40842,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
DISP LEG HOLDER,,A4649,HCPCS,Facility,Inpatient,,,,140.92,119.782,40.387672,140.92,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
DISP LEG HOLDER,,A4649,HCPCS,Facility,Outpatient,,,,140.92,119.782,40.387672,140.92,"UCare Health, Inc.",Medical Assistance,71.122324,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DISP LEG HOLDER,,A4649,HCPCS,Facility,Inpatient,,,,140.92,119.782,40.387672,140.92,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
DISP LEG HOLDER,,A4649,HCPCS,Facility,Outpatient,,,,140.92,119.782,40.387672,140.92,"UCare Health, Inc.",Medicare Advantage,71.122324,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DISP LEG HOLDER,,A4649,HCPCS,Facility,Inpatient,,,,140.92,119.782,40.387672,140.92,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DISP LEG HOLDER,,A4649,HCPCS,Facility,Outpatient,,,,140.92,119.782,40.387672,140.92,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),71.122324,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DISP LEG HOLDER,,A4649,HCPCS,Facility,Inpatient,,,,140.92,119.782,40.387672,140.92,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DISP LEG HOLDER,,A4649,HCPCS,Facility,Both,,,,140.92,119.782,40.387672,140.92,UnitedHealthcare,Individual & Family,132.4648,94,,percent of total billed charges,,
DISP LEG HOLDER,,A4649,HCPCS,Facility,Outpatient,,,,140.92,119.782,40.387672,140.92,UnitedHealthcare,Medicare Advantage,69.0508,49,,percent of total billed charges,,
DISP LEG HOLDER,,A4649,HCPCS,Facility,Inpatient,,,,140.92,119.782,40.387672,140.92,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
DISP LEG HOLDER,,A4649,HCPCS,Facility,Outpatient,,,,140.92,119.782,40.387672,140.92,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,67.6416,48,,percent of total billed charges,,100% of DHS outpatient percentage
DISP LEG HOLDER,,A4649,HCPCS,Facility,Inpatient,,,,140.92,119.782,40.387672,140.92,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
DRAPE IOBAN 60CMX60CM  6648EZ,,A4649,HCPCS,Facility,Both,,,,46.35,39.3975,13.28391,46.35,Aetna,Commercial,42.642,92,,percent of total billed charges,,
DRAPE IOBAN 60CMX60CM  6648EZ,,A4649,HCPCS,Facility,Outpatient,,,,46.35,39.3975,13.28391,46.35,Aetna,Medicare Advantage,22.7115,49,,percent of total billed charges,,
DRAPE IOBAN 60CMX60CM  6648EZ,,A4649,HCPCS,Facility,Inpatient,,,,46.35,39.3975,13.28391,46.35,Aetna,Medicare Advantage,,,,,Included in per diem rate,
DRAPE IOBAN 60CMX60CM  6648EZ,,A4649,HCPCS,Facility,Both,,,,46.35,39.3975,13.28391,46.35,Aetna,PPO,43.1055,93,,percent of total billed charges,,
DRAPE IOBAN 60CMX60CM  6648EZ,,A4649,HCPCS,Facility,Both,,,,46.35,39.3975,13.28391,46.35,America's PPO,America's PPO,44.509905,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
DRAPE IOBAN 60CMX60CM  6648EZ,,A4649,HCPCS,Facility,Both,,,,46.35,39.3975,13.28391,46.35,BlueCross BlueShield Minnesota, Federal Employee Program,45.6084,98.4,,percent of total billed charges,,
DRAPE IOBAN 60CMX60CM  6648EZ,,A4649,HCPCS,Facility,Both,,,,46.35,39.3975,13.28391,46.35,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,46.35,100,,percent of total billed charges,,
DRAPE IOBAN 60CMX60CM  6648EZ,,A4649,HCPCS,Facility,Both,,,,46.35,39.3975,13.28391,46.35,BlueCross BlueShield Minnesota,High Value Network Plan,41.715,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
DRAPE IOBAN 60CMX60CM  6648EZ,,A4649,HCPCS,Facility,Outpatient,,,,46.35,39.3975,13.28391,46.35,BlueCross BlueShield Minnesota,Medicare Advantage,22.7115,49,,percent of total billed charges,,
DRAPE IOBAN 60CMX60CM  6648EZ,,A4649,HCPCS,Facility,Inpatient,,,,46.35,39.3975,13.28391,46.35,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
DRAPE IOBAN 60CMX60CM  6648EZ,,A4649,HCPCS,Facility,Both,,,,46.35,39.3975,13.28391,46.35,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,41.052195,88.57,,percent of total billed charges,,
DRAPE IOBAN 60CMX60CM  6648EZ,,A4649,HCPCS,Facility,Both,,,,46.35,39.3975,13.28391,46.35,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,13.28391,28.66,,percent of total billed charges,,
DRAPE IOBAN 60CMX60CM  6648EZ,,A4649,HCPCS,Facility,Outpatient,,,,46.35,39.3975,13.28391,46.35,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),22.7115,49,,percent of total billed charges,,
DRAPE IOBAN 60CMX60CM  6648EZ,,A4649,HCPCS,Facility,Inpatient,,,,46.35,39.3975,13.28391,46.35,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
DRAPE IOBAN 60CMX60CM  6648EZ,,A4649,HCPCS,Facility,Both,,,,46.35,39.3975,13.28391,46.35,CorVel,Worker's Compensation,46.35,100,,percent of total billed charges,,
DRAPE IOBAN 60CMX60CM  6648EZ,,A4649,HCPCS,Facility,Both,,,,46.35,39.3975,13.28391,46.35,First Health Group Corporation,First Health Network,44.9595,97,,percent of total billed charges,,
DRAPE IOBAN 60CMX60CM  6648EZ,,A4649,HCPCS,Facility,Both,,,,46.35,39.3975,13.28391,46.35,"Health Partners, Inc.",Commercial,43.8471,94.6,,percent of total billed charges,,
DRAPE IOBAN 60CMX60CM  6648EZ,,A4649,HCPCS,Facility,Outpatient,,,,46.35,39.3975,13.28391,46.35,"Health Partners, Inc.",Medicare Advantage,22.7115,49,,percent of total billed charges,,
DRAPE IOBAN 60CMX60CM  6648EZ,,A4649,HCPCS,Facility,Inpatient,,,,46.35,39.3975,13.28391,46.35,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DRAPE IOBAN 60CMX60CM  6648EZ,,A4649,HCPCS,Facility,Both,,,,46.35,39.3975,13.28391,46.35,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),27.81,60,,percent of total billed charges,,
DRAPE IOBAN 60CMX60CM  6648EZ,,A4649,HCPCS,Facility,Both,,,,46.35,39.3975,13.28391,46.35,"Health Partners, Inc.",State of Minnesota Advantage Program,37.77525,81.5,,percent of total billed charges,,
DRAPE IOBAN 60CMX60CM  6648EZ,,A4649,HCPCS,Facility,Both,,,,46.35,39.3975,13.28391,46.35,"Health Partners, Inc.",State Public Programs,23.175,50,,percent of total billed charges,,
DRAPE IOBAN 60CMX60CM  6648EZ,,A4649,HCPCS,Facility,Both,,,,46.35,39.3975,13.28391,46.35,Humana Insurance Company,Commercial PPO,44.0325,95,,percent of total billed charges,,
DRAPE IOBAN 60CMX60CM  6648EZ,,A4649,HCPCS,Facility,Outpatient,,,,46.35,39.3975,13.28391,46.35,Humana Insurance Company,Medicare PPO,22.7115,49,,percent of total billed charges,,
DRAPE IOBAN 60CMX60CM  6648EZ,,A4649,HCPCS,Facility,Inpatient,,,,46.35,39.3975,13.28391,46.35,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
DRAPE IOBAN 60CMX60CM  6648EZ,,A4649,HCPCS,Facility,Both,,,,46.35,39.3975,13.28391,46.35,Medica,Individual & Family,45.93285,99.1,,percent of total billed charges,,
DRAPE IOBAN 60CMX60CM  6648EZ,,A4649,HCPCS,Facility,Outpatient,,,,46.35,39.3975,13.28391,46.35,Medica,Medica Advantage Solution,23.0823,49.8,,percent of total billed charges,,
DRAPE IOBAN 60CMX60CM  6648EZ,,A4649,HCPCS,Facility,Inpatient,,,,46.35,39.3975,13.28391,46.35,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
DRAPE IOBAN 60CMX60CM  6648EZ,,A4649,HCPCS,Facility,Outpatient,,,,46.35,39.3975,13.28391,46.35,Medica,Medical Assistance,20.6721,44.6,,percent of total billed charges,,
DRAPE IOBAN 60CMX60CM  6648EZ,,A4649,HCPCS,Facility,Inpatient,,,,46.35,39.3975,13.28391,46.35,Medica,Medical Assistance,,,,,Included in per diem rate,
DRAPE IOBAN 60CMX60CM  6648EZ,,A4649,HCPCS,Facility,Outpatient,,,,46.35,39.3975,13.28391,46.35,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,23.0823,49.8,,percent of total billed charges,,
DRAPE IOBAN 60CMX60CM  6648EZ,,A4649,HCPCS,Facility,Inpatient,,,,46.35,39.3975,13.28391,46.35,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
DRAPE IOBAN 60CMX60CM  6648EZ,,A4649,HCPCS,Facility,Both,,,,46.35,39.3975,13.28391,46.35,"Multiplan, Inc.","Multiplan, Inc.",43.569,94,,percent of total billed charges,,
DRAPE IOBAN 60CMX60CM  6648EZ,,A4649,HCPCS,Facility,Outpatient,,,,46.35,39.3975,13.28391,46.35,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,41.76135,90.1,,percent of total billed charges,,
DRAPE IOBAN 60CMX60CM  6648EZ,,A4649,HCPCS,Facility,Inpatient,,,,46.35,39.3975,13.28391,46.35,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
DRAPE IOBAN 60CMX60CM  6648EZ,,A4649,HCPCS,Facility,Both,,,,46.35,39.3975,13.28391,46.35,"Preferred One Administrative Services, INC.",PPO,45.7011,98.6,,percent of total billed charges,,
DRAPE IOBAN 60CMX60CM  6648EZ,,A4649,HCPCS,Facility,Outpatient,,,,46.35,39.3975,13.28391,46.35,PrimeWest Health,Minnesota Senior Health Options (MSHO),23.847075,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
DRAPE IOBAN 60CMX60CM  6648EZ,,A4649,HCPCS,Facility,Inpatient,,,,46.35,39.3975,13.28391,46.35,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DRAPE IOBAN 60CMX60CM  6648EZ,,A4649,HCPCS,Facility,Outpatient,,,,46.35,39.3975,13.28391,46.35,PrimeWest Health,MinnesotaCare,23.80536,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
DRAPE IOBAN 60CMX60CM  6648EZ,,A4649,HCPCS,Facility,Inpatient,,,,46.35,39.3975,13.28391,46.35,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
DRAPE IOBAN 60CMX60CM  6648EZ,,A4649,HCPCS,Facility,Both,,,,46.35,39.3975,13.28391,46.35,Sanford Health Plan,Sanford Health Plan,42.642,92,,percent of total billed charges,,
DRAPE IOBAN 60CMX60CM  6648EZ,,A4649,HCPCS,Facility,Outpatient,,,,46.35,39.3975,13.28391,46.35,"UCare Health, Inc.",Individual & Family Plan,26.118225,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
DRAPE IOBAN 60CMX60CM  6648EZ,,A4649,HCPCS,Facility,Inpatient,,,,46.35,39.3975,13.28391,46.35,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
DRAPE IOBAN 60CMX60CM  6648EZ,,A4649,HCPCS,Facility,Outpatient,,,,46.35,39.3975,13.28391,46.35,"UCare Health, Inc.",Medical Assistance,23.392845,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DRAPE IOBAN 60CMX60CM  6648EZ,,A4649,HCPCS,Facility,Inpatient,,,,46.35,39.3975,13.28391,46.35,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
DRAPE IOBAN 60CMX60CM  6648EZ,,A4649,HCPCS,Facility,Outpatient,,,,46.35,39.3975,13.28391,46.35,"UCare Health, Inc.",Medicare Advantage,23.392845,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DRAPE IOBAN 60CMX60CM  6648EZ,,A4649,HCPCS,Facility,Inpatient,,,,46.35,39.3975,13.28391,46.35,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DRAPE IOBAN 60CMX60CM  6648EZ,,A4649,HCPCS,Facility,Outpatient,,,,46.35,39.3975,13.28391,46.35,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),23.392845,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DRAPE IOBAN 60CMX60CM  6648EZ,,A4649,HCPCS,Facility,Inpatient,,,,46.35,39.3975,13.28391,46.35,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DRAPE IOBAN 60CMX60CM  6648EZ,,A4649,HCPCS,Facility,Both,,,,46.35,39.3975,13.28391,46.35,UnitedHealthcare,Individual & Family,43.569,94,,percent of total billed charges,,
DRAPE IOBAN 60CMX60CM  6648EZ,,A4649,HCPCS,Facility,Outpatient,,,,46.35,39.3975,13.28391,46.35,UnitedHealthcare,Medicare Advantage,22.7115,49,,percent of total billed charges,,
DRAPE IOBAN 60CMX60CM  6648EZ,,A4649,HCPCS,Facility,Inpatient,,,,46.35,39.3975,13.28391,46.35,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
DRAPE IOBAN 60CMX60CM  6648EZ,,A4649,HCPCS,Facility,Outpatient,,,,46.35,39.3975,13.28391,46.35,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,22.248,48,,percent of total billed charges,,100% of DHS outpatient percentage
DRAPE IOBAN 60CMX60CM  6648EZ,,A4649,HCPCS,Facility,Inpatient,,,,46.35,39.3975,13.28391,46.35,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
DRAPE LINGEMAN,,A4649,HCPCS,Facility,Both,,,,46.125,39.20625,13.219425,46.125,Aetna,Commercial,42.435,92,,percent of total billed charges,,
DRAPE LINGEMAN,,A4649,HCPCS,Facility,Outpatient,,,,46.125,39.20625,13.219425,46.125,Aetna,Medicare Advantage,22.60125,49,,percent of total billed charges,,
DRAPE LINGEMAN,,A4649,HCPCS,Facility,Inpatient,,,,46.125,39.20625,13.219425,46.125,Aetna,Medicare Advantage,,,,,Included in per diem rate,
DRAPE LINGEMAN,,A4649,HCPCS,Facility,Both,,,,46.125,39.20625,13.219425,46.125,Aetna,PPO,42.89625,93,,percent of total billed charges,,
DRAPE LINGEMAN,,A4649,HCPCS,Facility,Both,,,,46.125,39.20625,13.219425,46.125,America's PPO,America's PPO,44.2938375,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
DRAPE LINGEMAN,,A4649,HCPCS,Facility,Both,,,,46.125,39.20625,13.219425,46.125,BlueCross BlueShield Minnesota, Federal Employee Program,45.387,98.4,,percent of total billed charges,,
DRAPE LINGEMAN,,A4649,HCPCS,Facility,Both,,,,46.125,39.20625,13.219425,46.125,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,46.125,100,,percent of total billed charges,,
DRAPE LINGEMAN,,A4649,HCPCS,Facility,Both,,,,46.125,39.20625,13.219425,46.125,BlueCross BlueShield Minnesota,High Value Network Plan,41.5125,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
DRAPE LINGEMAN,,A4649,HCPCS,Facility,Outpatient,,,,46.125,39.20625,13.219425,46.125,BlueCross BlueShield Minnesota,Medicare Advantage,22.60125,49,,percent of total billed charges,,
DRAPE LINGEMAN,,A4649,HCPCS,Facility,Inpatient,,,,46.125,39.20625,13.219425,46.125,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
DRAPE LINGEMAN,,A4649,HCPCS,Facility,Both,,,,46.125,39.20625,13.219425,46.125,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,40.8529125,88.57,,percent of total billed charges,,
DRAPE LINGEMAN,,A4649,HCPCS,Facility,Both,,,,46.125,39.20625,13.219425,46.125,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,13.219425,28.66,,percent of total billed charges,,
DRAPE LINGEMAN,,A4649,HCPCS,Facility,Outpatient,,,,46.125,39.20625,13.219425,46.125,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),22.60125,49,,percent of total billed charges,,
DRAPE LINGEMAN,,A4649,HCPCS,Facility,Inpatient,,,,46.125,39.20625,13.219425,46.125,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
DRAPE LINGEMAN,,A4649,HCPCS,Facility,Both,,,,46.125,39.20625,13.219425,46.125,CorVel,Worker's Compensation,46.125,100,,percent of total billed charges,,
DRAPE LINGEMAN,,A4649,HCPCS,Facility,Both,,,,46.125,39.20625,13.219425,46.125,First Health Group Corporation,First Health Network,44.74125,97,,percent of total billed charges,,
DRAPE LINGEMAN,,A4649,HCPCS,Facility,Both,,,,46.125,39.20625,13.219425,46.125,"Health Partners, Inc.",Commercial,43.63425,94.6,,percent of total billed charges,,
DRAPE LINGEMAN,,A4649,HCPCS,Facility,Outpatient,,,,46.125,39.20625,13.219425,46.125,"Health Partners, Inc.",Medicare Advantage,22.60125,49,,percent of total billed charges,,
DRAPE LINGEMAN,,A4649,HCPCS,Facility,Inpatient,,,,46.125,39.20625,13.219425,46.125,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DRAPE LINGEMAN,,A4649,HCPCS,Facility,Both,,,,46.125,39.20625,13.219425,46.125,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),27.675,60,,percent of total billed charges,,
DRAPE LINGEMAN,,A4649,HCPCS,Facility,Both,,,,46.125,39.20625,13.219425,46.125,"Health Partners, Inc.",State of Minnesota Advantage Program,37.591875,81.5,,percent of total billed charges,,
DRAPE LINGEMAN,,A4649,HCPCS,Facility,Both,,,,46.125,39.20625,13.219425,46.125,"Health Partners, Inc.",State Public Programs,23.0625,50,,percent of total billed charges,,
DRAPE LINGEMAN,,A4649,HCPCS,Facility,Both,,,,46.125,39.20625,13.219425,46.125,Humana Insurance Company,Commercial PPO,43.81875,95,,percent of total billed charges,,
DRAPE LINGEMAN,,A4649,HCPCS,Facility,Outpatient,,,,46.125,39.20625,13.219425,46.125,Humana Insurance Company,Medicare PPO,22.60125,49,,percent of total billed charges,,
DRAPE LINGEMAN,,A4649,HCPCS,Facility,Inpatient,,,,46.125,39.20625,13.219425,46.125,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
DRAPE LINGEMAN,,A4649,HCPCS,Facility,Both,,,,46.125,39.20625,13.219425,46.125,Medica,Individual & Family,45.709875,99.1,,percent of total billed charges,,
DRAPE LINGEMAN,,A4649,HCPCS,Facility,Outpatient,,,,46.125,39.20625,13.219425,46.125,Medica,Medica Advantage Solution,22.97025,49.8,,percent of total billed charges,,
DRAPE LINGEMAN,,A4649,HCPCS,Facility,Inpatient,,,,46.125,39.20625,13.219425,46.125,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
DRAPE LINGEMAN,,A4649,HCPCS,Facility,Outpatient,,,,46.125,39.20625,13.219425,46.125,Medica,Medical Assistance,20.57175,44.6,,percent of total billed charges,,
DRAPE LINGEMAN,,A4649,HCPCS,Facility,Inpatient,,,,46.125,39.20625,13.219425,46.125,Medica,Medical Assistance,,,,,Included in per diem rate,
DRAPE LINGEMAN,,A4649,HCPCS,Facility,Outpatient,,,,46.125,39.20625,13.219425,46.125,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,22.97025,49.8,,percent of total billed charges,,
DRAPE LINGEMAN,,A4649,HCPCS,Facility,Inpatient,,,,46.125,39.20625,13.219425,46.125,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
DRAPE LINGEMAN,,A4649,HCPCS,Facility,Both,,,,46.125,39.20625,13.219425,46.125,"Multiplan, Inc.","Multiplan, Inc.",43.3575,94,,percent of total billed charges,,
DRAPE LINGEMAN,,A4649,HCPCS,Facility,Outpatient,,,,46.125,39.20625,13.219425,46.125,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,41.558625,90.1,,percent of total billed charges,,
DRAPE LINGEMAN,,A4649,HCPCS,Facility,Inpatient,,,,46.125,39.20625,13.219425,46.125,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
DRAPE LINGEMAN,,A4649,HCPCS,Facility,Both,,,,46.125,39.20625,13.219425,46.125,"Preferred One Administrative Services, INC.",PPO,45.47925,98.6,,percent of total billed charges,,
DRAPE LINGEMAN,,A4649,HCPCS,Facility,Outpatient,,,,46.125,39.20625,13.219425,46.125,PrimeWest Health,Minnesota Senior Health Options (MSHO),23.7313125,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
DRAPE LINGEMAN,,A4649,HCPCS,Facility,Inpatient,,,,46.125,39.20625,13.219425,46.125,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DRAPE LINGEMAN,,A4649,HCPCS,Facility,Outpatient,,,,46.125,39.20625,13.219425,46.125,PrimeWest Health,MinnesotaCare,23.6898,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
DRAPE LINGEMAN,,A4649,HCPCS,Facility,Inpatient,,,,46.125,39.20625,13.219425,46.125,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
DRAPE LINGEMAN,,A4649,HCPCS,Facility,Both,,,,46.125,39.20625,13.219425,46.125,Sanford Health Plan,Sanford Health Plan,42.435,92,,percent of total billed charges,,
DRAPE LINGEMAN,,A4649,HCPCS,Facility,Outpatient,,,,46.125,39.20625,13.219425,46.125,"UCare Health, Inc.",Individual & Family Plan,25.9914375,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
DRAPE LINGEMAN,,A4649,HCPCS,Facility,Inpatient,,,,46.125,39.20625,13.219425,46.125,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
DRAPE LINGEMAN,,A4649,HCPCS,Facility,Outpatient,,,,46.125,39.20625,13.219425,46.125,"UCare Health, Inc.",Medical Assistance,23.2792875,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DRAPE LINGEMAN,,A4649,HCPCS,Facility,Inpatient,,,,46.125,39.20625,13.219425,46.125,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
DRAPE LINGEMAN,,A4649,HCPCS,Facility,Outpatient,,,,46.125,39.20625,13.219425,46.125,"UCare Health, Inc.",Medicare Advantage,23.2792875,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DRAPE LINGEMAN,,A4649,HCPCS,Facility,Inpatient,,,,46.125,39.20625,13.219425,46.125,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DRAPE LINGEMAN,,A4649,HCPCS,Facility,Outpatient,,,,46.125,39.20625,13.219425,46.125,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),23.2792875,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DRAPE LINGEMAN,,A4649,HCPCS,Facility,Inpatient,,,,46.125,39.20625,13.219425,46.125,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DRAPE LINGEMAN,,A4649,HCPCS,Facility,Both,,,,46.125,39.20625,13.219425,46.125,UnitedHealthcare,Individual & Family,43.3575,94,,percent of total billed charges,,
DRAPE LINGEMAN,,A4649,HCPCS,Facility,Outpatient,,,,46.125,39.20625,13.219425,46.125,UnitedHealthcare,Medicare Advantage,22.60125,49,,percent of total billed charges,,
DRAPE LINGEMAN,,A4649,HCPCS,Facility,Inpatient,,,,46.125,39.20625,13.219425,46.125,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
DRAPE LINGEMAN,,A4649,HCPCS,Facility,Outpatient,,,,46.125,39.20625,13.219425,46.125,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,22.14,48,,percent of total billed charges,,100% of DHS outpatient percentage
DRAPE LINGEMAN,,A4649,HCPCS,Facility,Inpatient,,,,46.125,39.20625,13.219425,46.125,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
DRAPE MICROSCOPE OPMI ZEISS  ENT  4921CL,,A4649,HCPCS,Facility,Both,,,,78.57,66.7845,22.518162,78.57,Aetna,Commercial,72.2844,92,,percent of total billed charges,,
DRAPE MICROSCOPE OPMI ZEISS  ENT  4921CL,,A4649,HCPCS,Facility,Outpatient,,,,78.57,66.7845,22.518162,78.57,Aetna,Medicare Advantage,38.4993,49,,percent of total billed charges,,
DRAPE MICROSCOPE OPMI ZEISS  ENT  4921CL,,A4649,HCPCS,Facility,Inpatient,,,,78.57,66.7845,22.518162,78.57,Aetna,Medicare Advantage,,,,,Included in per diem rate,
DRAPE MICROSCOPE OPMI ZEISS  ENT  4921CL,,A4649,HCPCS,Facility,Both,,,,78.57,66.7845,22.518162,78.57,Aetna,PPO,73.0701,93,,percent of total billed charges,,
DRAPE MICROSCOPE OPMI ZEISS  ENT  4921CL,,A4649,HCPCS,Facility,Both,,,,78.57,66.7845,22.518162,78.57,America's PPO,America's PPO,75.450771,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
DRAPE MICROSCOPE OPMI ZEISS  ENT  4921CL,,A4649,HCPCS,Facility,Both,,,,78.57,66.7845,22.518162,78.57,BlueCross BlueShield Minnesota, Federal Employee Program,77.31288,98.4,,percent of total billed charges,,
DRAPE MICROSCOPE OPMI ZEISS  ENT  4921CL,,A4649,HCPCS,Facility,Both,,,,78.57,66.7845,22.518162,78.57,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,78.57,100,,percent of total billed charges,,
DRAPE MICROSCOPE OPMI ZEISS  ENT  4921CL,,A4649,HCPCS,Facility,Both,,,,78.57,66.7845,22.518162,78.57,BlueCross BlueShield Minnesota,High Value Network Plan,70.713,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
DRAPE MICROSCOPE OPMI ZEISS  ENT  4921CL,,A4649,HCPCS,Facility,Outpatient,,,,78.57,66.7845,22.518162,78.57,BlueCross BlueShield Minnesota,Medicare Advantage,38.4993,49,,percent of total billed charges,,
DRAPE MICROSCOPE OPMI ZEISS  ENT  4921CL,,A4649,HCPCS,Facility,Inpatient,,,,78.57,66.7845,22.518162,78.57,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
DRAPE MICROSCOPE OPMI ZEISS  ENT  4921CL,,A4649,HCPCS,Facility,Both,,,,78.57,66.7845,22.518162,78.57,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,69.589449,88.57,,percent of total billed charges,,
DRAPE MICROSCOPE OPMI ZEISS  ENT  4921CL,,A4649,HCPCS,Facility,Both,,,,78.57,66.7845,22.518162,78.57,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,22.518162,28.66,,percent of total billed charges,,
DRAPE MICROSCOPE OPMI ZEISS  ENT  4921CL,,A4649,HCPCS,Facility,Outpatient,,,,78.57,66.7845,22.518162,78.57,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),38.4993,49,,percent of total billed charges,,
DRAPE MICROSCOPE OPMI ZEISS  ENT  4921CL,,A4649,HCPCS,Facility,Inpatient,,,,78.57,66.7845,22.518162,78.57,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
DRAPE MICROSCOPE OPMI ZEISS  ENT  4921CL,,A4649,HCPCS,Facility,Both,,,,78.57,66.7845,22.518162,78.57,CorVel,Worker's Compensation,78.57,100,,percent of total billed charges,,
DRAPE MICROSCOPE OPMI ZEISS  ENT  4921CL,,A4649,HCPCS,Facility,Both,,,,78.57,66.7845,22.518162,78.57,First Health Group Corporation,First Health Network,76.2129,97,,percent of total billed charges,,
DRAPE MICROSCOPE OPMI ZEISS  ENT  4921CL,,A4649,HCPCS,Facility,Both,,,,78.57,66.7845,22.518162,78.57,"Health Partners, Inc.",Commercial,74.32722,94.6,,percent of total billed charges,,
DRAPE MICROSCOPE OPMI ZEISS  ENT  4921CL,,A4649,HCPCS,Facility,Outpatient,,,,78.57,66.7845,22.518162,78.57,"Health Partners, Inc.",Medicare Advantage,38.4993,49,,percent of total billed charges,,
DRAPE MICROSCOPE OPMI ZEISS  ENT  4921CL,,A4649,HCPCS,Facility,Inpatient,,,,78.57,66.7845,22.518162,78.57,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DRAPE MICROSCOPE OPMI ZEISS  ENT  4921CL,,A4649,HCPCS,Facility,Both,,,,78.57,66.7845,22.518162,78.57,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),47.142,60,,percent of total billed charges,,
DRAPE MICROSCOPE OPMI ZEISS  ENT  4921CL,,A4649,HCPCS,Facility,Both,,,,78.57,66.7845,22.518162,78.57,"Health Partners, Inc.",State of Minnesota Advantage Program,64.03455,81.5,,percent of total billed charges,,
DRAPE MICROSCOPE OPMI ZEISS  ENT  4921CL,,A4649,HCPCS,Facility,Both,,,,78.57,66.7845,22.518162,78.57,"Health Partners, Inc.",State Public Programs,39.285,50,,percent of total billed charges,,
DRAPE MICROSCOPE OPMI ZEISS  ENT  4921CL,,A4649,HCPCS,Facility,Both,,,,78.57,66.7845,22.518162,78.57,Humana Insurance Company,Commercial PPO,74.6415,95,,percent of total billed charges,,
DRAPE MICROSCOPE OPMI ZEISS  ENT  4921CL,,A4649,HCPCS,Facility,Outpatient,,,,78.57,66.7845,22.518162,78.57,Humana Insurance Company,Medicare PPO,38.4993,49,,percent of total billed charges,,
DRAPE MICROSCOPE OPMI ZEISS  ENT  4921CL,,A4649,HCPCS,Facility,Inpatient,,,,78.57,66.7845,22.518162,78.57,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
DRAPE MICROSCOPE OPMI ZEISS  ENT  4921CL,,A4649,HCPCS,Facility,Both,,,,78.57,66.7845,22.518162,78.57,Medica,Individual & Family,77.86287,99.1,,percent of total billed charges,,
DRAPE MICROSCOPE OPMI ZEISS  ENT  4921CL,,A4649,HCPCS,Facility,Outpatient,,,,78.57,66.7845,22.518162,78.57,Medica,Medica Advantage Solution,39.12786,49.8,,percent of total billed charges,,
DRAPE MICROSCOPE OPMI ZEISS  ENT  4921CL,,A4649,HCPCS,Facility,Inpatient,,,,78.57,66.7845,22.518162,78.57,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
DRAPE MICROSCOPE OPMI ZEISS  ENT  4921CL,,A4649,HCPCS,Facility,Outpatient,,,,78.57,66.7845,22.518162,78.57,Medica,Medical Assistance,35.04222,44.6,,percent of total billed charges,,
DRAPE MICROSCOPE OPMI ZEISS  ENT  4921CL,,A4649,HCPCS,Facility,Inpatient,,,,78.57,66.7845,22.518162,78.57,Medica,Medical Assistance,,,,,Included in per diem rate,
DRAPE MICROSCOPE OPMI ZEISS  ENT  4921CL,,A4649,HCPCS,Facility,Outpatient,,,,78.57,66.7845,22.518162,78.57,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,39.12786,49.8,,percent of total billed charges,,
DRAPE MICROSCOPE OPMI ZEISS  ENT  4921CL,,A4649,HCPCS,Facility,Inpatient,,,,78.57,66.7845,22.518162,78.57,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
DRAPE MICROSCOPE OPMI ZEISS  ENT  4921CL,,A4649,HCPCS,Facility,Both,,,,78.57,66.7845,22.518162,78.57,"Multiplan, Inc.","Multiplan, Inc.",73.8558,94,,percent of total billed charges,,
DRAPE MICROSCOPE OPMI ZEISS  ENT  4921CL,,A4649,HCPCS,Facility,Outpatient,,,,78.57,66.7845,22.518162,78.57,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,70.79157,90.1,,percent of total billed charges,,
DRAPE MICROSCOPE OPMI ZEISS  ENT  4921CL,,A4649,HCPCS,Facility,Inpatient,,,,78.57,66.7845,22.518162,78.57,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
DRAPE MICROSCOPE OPMI ZEISS  ENT  4921CL,,A4649,HCPCS,Facility,Both,,,,78.57,66.7845,22.518162,78.57,"Preferred One Administrative Services, INC.",PPO,77.47002,98.6,,percent of total billed charges,,
DRAPE MICROSCOPE OPMI ZEISS  ENT  4921CL,,A4649,HCPCS,Facility,Outpatient,,,,78.57,66.7845,22.518162,78.57,PrimeWest Health,Minnesota Senior Health Options (MSHO),40.424265,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
DRAPE MICROSCOPE OPMI ZEISS  ENT  4921CL,,A4649,HCPCS,Facility,Inpatient,,,,78.57,66.7845,22.518162,78.57,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DRAPE MICROSCOPE OPMI ZEISS  ENT  4921CL,,A4649,HCPCS,Facility,Outpatient,,,,78.57,66.7845,22.518162,78.57,PrimeWest Health,MinnesotaCare,40.353552,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
DRAPE MICROSCOPE OPMI ZEISS  ENT  4921CL,,A4649,HCPCS,Facility,Inpatient,,,,78.57,66.7845,22.518162,78.57,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
DRAPE MICROSCOPE OPMI ZEISS  ENT  4921CL,,A4649,HCPCS,Facility,Both,,,,78.57,66.7845,22.518162,78.57,Sanford Health Plan,Sanford Health Plan,72.2844,92,,percent of total billed charges,,
DRAPE MICROSCOPE OPMI ZEISS  ENT  4921CL,,A4649,HCPCS,Facility,Outpatient,,,,78.57,66.7845,22.518162,78.57,"UCare Health, Inc.",Individual & Family Plan,44.274195,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
DRAPE MICROSCOPE OPMI ZEISS  ENT  4921CL,,A4649,HCPCS,Facility,Inpatient,,,,78.57,66.7845,22.518162,78.57,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
DRAPE MICROSCOPE OPMI ZEISS  ENT  4921CL,,A4649,HCPCS,Facility,Outpatient,,,,78.57,66.7845,22.518162,78.57,"UCare Health, Inc.",Medical Assistance,39.654279,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DRAPE MICROSCOPE OPMI ZEISS  ENT  4921CL,,A4649,HCPCS,Facility,Inpatient,,,,78.57,66.7845,22.518162,78.57,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
DRAPE MICROSCOPE OPMI ZEISS  ENT  4921CL,,A4649,HCPCS,Facility,Outpatient,,,,78.57,66.7845,22.518162,78.57,"UCare Health, Inc.",Medicare Advantage,39.654279,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DRAPE MICROSCOPE OPMI ZEISS  ENT  4921CL,,A4649,HCPCS,Facility,Inpatient,,,,78.57,66.7845,22.518162,78.57,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DRAPE MICROSCOPE OPMI ZEISS  ENT  4921CL,,A4649,HCPCS,Facility,Outpatient,,,,78.57,66.7845,22.518162,78.57,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),39.654279,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DRAPE MICROSCOPE OPMI ZEISS  ENT  4921CL,,A4649,HCPCS,Facility,Inpatient,,,,78.57,66.7845,22.518162,78.57,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DRAPE MICROSCOPE OPMI ZEISS  ENT  4921CL,,A4649,HCPCS,Facility,Both,,,,78.57,66.7845,22.518162,78.57,UnitedHealthcare,Individual & Family,73.8558,94,,percent of total billed charges,,
DRAPE MICROSCOPE OPMI ZEISS  ENT  4921CL,,A4649,HCPCS,Facility,Outpatient,,,,78.57,66.7845,22.518162,78.57,UnitedHealthcare,Medicare Advantage,38.4993,49,,percent of total billed charges,,
DRAPE MICROSCOPE OPMI ZEISS  ENT  4921CL,,A4649,HCPCS,Facility,Inpatient,,,,78.57,66.7845,22.518162,78.57,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
DRAPE MICROSCOPE OPMI ZEISS  ENT  4921CL,,A4649,HCPCS,Facility,Outpatient,,,,78.57,66.7845,22.518162,78.57,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,37.7136,48,,percent of total billed charges,,100% of DHS outpatient percentage
DRAPE MICROSCOPE OPMI ZEISS  ENT  4921CL,,A4649,HCPCS,Facility,Inpatient,,,,78.57,66.7845,22.518162,78.57,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
DRAPE U 3M PLASTIC 47 X 51 CLEAR 1015,,A4649,HCPCS,Facility,Both,,,,25.75,21.8875,7.37995,25.75,Aetna,Commercial,23.69,92,,percent of total billed charges,,
DRAPE U 3M PLASTIC 47 X 51 CLEAR 1015,,A4649,HCPCS,Facility,Outpatient,,,,25.75,21.8875,7.37995,25.75,Aetna,Medicare Advantage,12.6175,49,,percent of total billed charges,,
DRAPE U 3M PLASTIC 47 X 51 CLEAR 1015,,A4649,HCPCS,Facility,Inpatient,,,,25.75,21.8875,7.37995,25.75,Aetna,Medicare Advantage,,,,,Included in per diem rate,
DRAPE U 3M PLASTIC 47 X 51 CLEAR 1015,,A4649,HCPCS,Facility,Both,,,,25.75,21.8875,7.37995,25.75,Aetna,PPO,23.9475,93,,percent of total billed charges,,
DRAPE U 3M PLASTIC 47 X 51 CLEAR 1015,,A4649,HCPCS,Facility,Both,,,,25.75,21.8875,7.37995,25.75,America's PPO,America's PPO,24.727725,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
DRAPE U 3M PLASTIC 47 X 51 CLEAR 1015,,A4649,HCPCS,Facility,Both,,,,25.75,21.8875,7.37995,25.75,BlueCross BlueShield Minnesota, Federal Employee Program,25.338,98.4,,percent of total billed charges,,
DRAPE U 3M PLASTIC 47 X 51 CLEAR 1015,,A4649,HCPCS,Facility,Both,,,,25.75,21.8875,7.37995,25.75,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,25.75,100,,percent of total billed charges,,
DRAPE U 3M PLASTIC 47 X 51 CLEAR 1015,,A4649,HCPCS,Facility,Both,,,,25.75,21.8875,7.37995,25.75,BlueCross BlueShield Minnesota,High Value Network Plan,23.175,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
DRAPE U 3M PLASTIC 47 X 51 CLEAR 1015,,A4649,HCPCS,Facility,Outpatient,,,,25.75,21.8875,7.37995,25.75,BlueCross BlueShield Minnesota,Medicare Advantage,12.6175,49,,percent of total billed charges,,
DRAPE U 3M PLASTIC 47 X 51 CLEAR 1015,,A4649,HCPCS,Facility,Inpatient,,,,25.75,21.8875,7.37995,25.75,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
DRAPE U 3M PLASTIC 47 X 51 CLEAR 1015,,A4649,HCPCS,Facility,Both,,,,25.75,21.8875,7.37995,25.75,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,22.806775,88.57,,percent of total billed charges,,
DRAPE U 3M PLASTIC 47 X 51 CLEAR 1015,,A4649,HCPCS,Facility,Both,,,,25.75,21.8875,7.37995,25.75,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,7.37995,28.66,,percent of total billed charges,,
DRAPE U 3M PLASTIC 47 X 51 CLEAR 1015,,A4649,HCPCS,Facility,Outpatient,,,,25.75,21.8875,7.37995,25.75,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),12.6175,49,,percent of total billed charges,,
DRAPE U 3M PLASTIC 47 X 51 CLEAR 1015,,A4649,HCPCS,Facility,Inpatient,,,,25.75,21.8875,7.37995,25.75,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
DRAPE U 3M PLASTIC 47 X 51 CLEAR 1015,,A4649,HCPCS,Facility,Both,,,,25.75,21.8875,7.37995,25.75,CorVel,Worker's Compensation,25.75,100,,percent of total billed charges,,
DRAPE U 3M PLASTIC 47 X 51 CLEAR 1015,,A4649,HCPCS,Facility,Both,,,,25.75,21.8875,7.37995,25.75,First Health Group Corporation,First Health Network,24.9775,97,,percent of total billed charges,,
DRAPE U 3M PLASTIC 47 X 51 CLEAR 1015,,A4649,HCPCS,Facility,Both,,,,25.75,21.8875,7.37995,25.75,"Health Partners, Inc.",Commercial,24.3595,94.6,,percent of total billed charges,,
DRAPE U 3M PLASTIC 47 X 51 CLEAR 1015,,A4649,HCPCS,Facility,Outpatient,,,,25.75,21.8875,7.37995,25.75,"Health Partners, Inc.",Medicare Advantage,12.6175,49,,percent of total billed charges,,
DRAPE U 3M PLASTIC 47 X 51 CLEAR 1015,,A4649,HCPCS,Facility,Inpatient,,,,25.75,21.8875,7.37995,25.75,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DRAPE U 3M PLASTIC 47 X 51 CLEAR 1015,,A4649,HCPCS,Facility,Both,,,,25.75,21.8875,7.37995,25.75,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),15.45,60,,percent of total billed charges,,
DRAPE U 3M PLASTIC 47 X 51 CLEAR 1015,,A4649,HCPCS,Facility,Both,,,,25.75,21.8875,7.37995,25.75,"Health Partners, Inc.",State of Minnesota Advantage Program,20.98625,81.5,,percent of total billed charges,,
DRAPE U 3M PLASTIC 47 X 51 CLEAR 1015,,A4649,HCPCS,Facility,Both,,,,25.75,21.8875,7.37995,25.75,"Health Partners, Inc.",State Public Programs,12.875,50,,percent of total billed charges,,
DRAPE U 3M PLASTIC 47 X 51 CLEAR 1015,,A4649,HCPCS,Facility,Both,,,,25.75,21.8875,7.37995,25.75,Humana Insurance Company,Commercial PPO,24.4625,95,,percent of total billed charges,,
DRAPE U 3M PLASTIC 47 X 51 CLEAR 1015,,A4649,HCPCS,Facility,Outpatient,,,,25.75,21.8875,7.37995,25.75,Humana Insurance Company,Medicare PPO,12.6175,49,,percent of total billed charges,,
DRAPE U 3M PLASTIC 47 X 51 CLEAR 1015,,A4649,HCPCS,Facility,Inpatient,,,,25.75,21.8875,7.37995,25.75,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
DRAPE U 3M PLASTIC 47 X 51 CLEAR 1015,,A4649,HCPCS,Facility,Both,,,,25.75,21.8875,7.37995,25.75,Medica,Individual & Family,25.51825,99.1,,percent of total billed charges,,
DRAPE U 3M PLASTIC 47 X 51 CLEAR 1015,,A4649,HCPCS,Facility,Outpatient,,,,25.75,21.8875,7.37995,25.75,Medica,Medica Advantage Solution,12.8235,49.8,,percent of total billed charges,,
DRAPE U 3M PLASTIC 47 X 51 CLEAR 1015,,A4649,HCPCS,Facility,Inpatient,,,,25.75,21.8875,7.37995,25.75,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
DRAPE U 3M PLASTIC 47 X 51 CLEAR 1015,,A4649,HCPCS,Facility,Outpatient,,,,25.75,21.8875,7.37995,25.75,Medica,Medical Assistance,11.4845,44.6,,percent of total billed charges,,
DRAPE U 3M PLASTIC 47 X 51 CLEAR 1015,,A4649,HCPCS,Facility,Inpatient,,,,25.75,21.8875,7.37995,25.75,Medica,Medical Assistance,,,,,Included in per diem rate,
DRAPE U 3M PLASTIC 47 X 51 CLEAR 1015,,A4649,HCPCS,Facility,Outpatient,,,,25.75,21.8875,7.37995,25.75,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,12.8235,49.8,,percent of total billed charges,,
DRAPE U 3M PLASTIC 47 X 51 CLEAR 1015,,A4649,HCPCS,Facility,Inpatient,,,,25.75,21.8875,7.37995,25.75,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
DRAPE U 3M PLASTIC 47 X 51 CLEAR 1015,,A4649,HCPCS,Facility,Both,,,,25.75,21.8875,7.37995,25.75,"Multiplan, Inc.","Multiplan, Inc.",24.205,94,,percent of total billed charges,,
DRAPE U 3M PLASTIC 47 X 51 CLEAR 1015,,A4649,HCPCS,Facility,Outpatient,,,,25.75,21.8875,7.37995,25.75,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,23.20075,90.1,,percent of total billed charges,,
DRAPE U 3M PLASTIC 47 X 51 CLEAR 1015,,A4649,HCPCS,Facility,Inpatient,,,,25.75,21.8875,7.37995,25.75,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
DRAPE U 3M PLASTIC 47 X 51 CLEAR 1015,,A4649,HCPCS,Facility,Both,,,,25.75,21.8875,7.37995,25.75,"Preferred One Administrative Services, INC.",PPO,25.3895,98.6,,percent of total billed charges,,
DRAPE U 3M PLASTIC 47 X 51 CLEAR 1015,,A4649,HCPCS,Facility,Outpatient,,,,25.75,21.8875,7.37995,25.75,PrimeWest Health,Minnesota Senior Health Options (MSHO),13.248375,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
DRAPE U 3M PLASTIC 47 X 51 CLEAR 1015,,A4649,HCPCS,Facility,Inpatient,,,,25.75,21.8875,7.37995,25.75,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DRAPE U 3M PLASTIC 47 X 51 CLEAR 1015,,A4649,HCPCS,Facility,Outpatient,,,,25.75,21.8875,7.37995,25.75,PrimeWest Health,MinnesotaCare,13.2252,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
DRAPE U 3M PLASTIC 47 X 51 CLEAR 1015,,A4649,HCPCS,Facility,Inpatient,,,,25.75,21.8875,7.37995,25.75,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
DRAPE U 3M PLASTIC 47 X 51 CLEAR 1015,,A4649,HCPCS,Facility,Both,,,,25.75,21.8875,7.37995,25.75,Sanford Health Plan,Sanford Health Plan,23.69,92,,percent of total billed charges,,
DRAPE U 3M PLASTIC 47 X 51 CLEAR 1015,,A4649,HCPCS,Facility,Outpatient,,,,25.75,21.8875,7.37995,25.75,"UCare Health, Inc.",Individual & Family Plan,14.510125,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
DRAPE U 3M PLASTIC 47 X 51 CLEAR 1015,,A4649,HCPCS,Facility,Inpatient,,,,25.75,21.8875,7.37995,25.75,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
DRAPE U 3M PLASTIC 47 X 51 CLEAR 1015,,A4649,HCPCS,Facility,Outpatient,,,,25.75,21.8875,7.37995,25.75,"UCare Health, Inc.",Medical Assistance,12.996025,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DRAPE U 3M PLASTIC 47 X 51 CLEAR 1015,,A4649,HCPCS,Facility,Inpatient,,,,25.75,21.8875,7.37995,25.75,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
DRAPE U 3M PLASTIC 47 X 51 CLEAR 1015,,A4649,HCPCS,Facility,Outpatient,,,,25.75,21.8875,7.37995,25.75,"UCare Health, Inc.",Medicare Advantage,12.996025,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DRAPE U 3M PLASTIC 47 X 51 CLEAR 1015,,A4649,HCPCS,Facility,Inpatient,,,,25.75,21.8875,7.37995,25.75,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DRAPE U 3M PLASTIC 47 X 51 CLEAR 1015,,A4649,HCPCS,Facility,Outpatient,,,,25.75,21.8875,7.37995,25.75,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),12.996025,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DRAPE U 3M PLASTIC 47 X 51 CLEAR 1015,,A4649,HCPCS,Facility,Inpatient,,,,25.75,21.8875,7.37995,25.75,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DRAPE U 3M PLASTIC 47 X 51 CLEAR 1015,,A4649,HCPCS,Facility,Both,,,,25.75,21.8875,7.37995,25.75,UnitedHealthcare,Individual & Family,24.205,94,,percent of total billed charges,,
DRAPE U 3M PLASTIC 47 X 51 CLEAR 1015,,A4649,HCPCS,Facility,Outpatient,,,,25.75,21.8875,7.37995,25.75,UnitedHealthcare,Medicare Advantage,12.6175,49,,percent of total billed charges,,
DRAPE U 3M PLASTIC 47 X 51 CLEAR 1015,,A4649,HCPCS,Facility,Inpatient,,,,25.75,21.8875,7.37995,25.75,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
DRAPE U 3M PLASTIC 47 X 51 CLEAR 1015,,A4649,HCPCS,Facility,Outpatient,,,,25.75,21.8875,7.37995,25.75,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,12.36,48,,percent of total billed charges,,100% of DHS outpatient percentage
DRAPE U 3M PLASTIC 47 X 51 CLEAR 1015,,A4649,HCPCS,Facility,Inpatient,,,,25.75,21.8875,7.37995,25.75,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
DRESSING SPLINT BREATHE EASY DOYLE,,A4649,HCPCS,Facility,Both,,,,90,76.5,25.794,90,Aetna,Commercial,82.8,92,,percent of total billed charges,,
DRESSING SPLINT BREATHE EASY DOYLE,,A4649,HCPCS,Facility,Outpatient,,,,90,76.5,25.794,90,Aetna,Medicare Advantage,44.1,49,,percent of total billed charges,,
DRESSING SPLINT BREATHE EASY DOYLE,,A4649,HCPCS,Facility,Inpatient,,,,90,76.5,25.794,90,Aetna,Medicare Advantage,,,,,Included in per diem rate,
DRESSING SPLINT BREATHE EASY DOYLE,,A4649,HCPCS,Facility,Both,,,,90,76.5,25.794,90,Aetna,PPO,83.7,93,,percent of total billed charges,,
DRESSING SPLINT BREATHE EASY DOYLE,,A4649,HCPCS,Facility,Both,,,,90,76.5,25.794,90,America's PPO,America's PPO,86.427,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
DRESSING SPLINT BREATHE EASY DOYLE,,A4649,HCPCS,Facility,Both,,,,90,76.5,25.794,90,BlueCross BlueShield Minnesota, Federal Employee Program,88.56,98.4,,percent of total billed charges,,
DRESSING SPLINT BREATHE EASY DOYLE,,A4649,HCPCS,Facility,Both,,,,90,76.5,25.794,90,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,90,100,,percent of total billed charges,,
DRESSING SPLINT BREATHE EASY DOYLE,,A4649,HCPCS,Facility,Both,,,,90,76.5,25.794,90,BlueCross BlueShield Minnesota,High Value Network Plan,81,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
DRESSING SPLINT BREATHE EASY DOYLE,,A4649,HCPCS,Facility,Outpatient,,,,90,76.5,25.794,90,BlueCross BlueShield Minnesota,Medicare Advantage,44.1,49,,percent of total billed charges,,
DRESSING SPLINT BREATHE EASY DOYLE,,A4649,HCPCS,Facility,Inpatient,,,,90,76.5,25.794,90,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
DRESSING SPLINT BREATHE EASY DOYLE,,A4649,HCPCS,Facility,Both,,,,90,76.5,25.794,90,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,79.713,88.57,,percent of total billed charges,,
DRESSING SPLINT BREATHE EASY DOYLE,,A4649,HCPCS,Facility,Both,,,,90,76.5,25.794,90,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,25.794,28.66,,percent of total billed charges,,
DRESSING SPLINT BREATHE EASY DOYLE,,A4649,HCPCS,Facility,Outpatient,,,,90,76.5,25.794,90,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),44.1,49,,percent of total billed charges,,
DRESSING SPLINT BREATHE EASY DOYLE,,A4649,HCPCS,Facility,Inpatient,,,,90,76.5,25.794,90,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
DRESSING SPLINT BREATHE EASY DOYLE,,A4649,HCPCS,Facility,Both,,,,90,76.5,25.794,90,CorVel,Worker's Compensation,90,100,,percent of total billed charges,,
DRESSING SPLINT BREATHE EASY DOYLE,,A4649,HCPCS,Facility,Both,,,,90,76.5,25.794,90,First Health Group Corporation,First Health Network,87.3,97,,percent of total billed charges,,
DRESSING SPLINT BREATHE EASY DOYLE,,A4649,HCPCS,Facility,Both,,,,90,76.5,25.794,90,"Health Partners, Inc.",Commercial,85.14,94.6,,percent of total billed charges,,
DRESSING SPLINT BREATHE EASY DOYLE,,A4649,HCPCS,Facility,Outpatient,,,,90,76.5,25.794,90,"Health Partners, Inc.",Medicare Advantage,44.1,49,,percent of total billed charges,,
DRESSING SPLINT BREATHE EASY DOYLE,,A4649,HCPCS,Facility,Inpatient,,,,90,76.5,25.794,90,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DRESSING SPLINT BREATHE EASY DOYLE,,A4649,HCPCS,Facility,Both,,,,90,76.5,25.794,90,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),54,60,,percent of total billed charges,,
DRESSING SPLINT BREATHE EASY DOYLE,,A4649,HCPCS,Facility,Both,,,,90,76.5,25.794,90,"Health Partners, Inc.",State of Minnesota Advantage Program,73.35,81.5,,percent of total billed charges,,
DRESSING SPLINT BREATHE EASY DOYLE,,A4649,HCPCS,Facility,Both,,,,90,76.5,25.794,90,"Health Partners, Inc.",State Public Programs,45,50,,percent of total billed charges,,
DRESSING SPLINT BREATHE EASY DOYLE,,A4649,HCPCS,Facility,Both,,,,90,76.5,25.794,90,Humana Insurance Company,Commercial PPO,85.5,95,,percent of total billed charges,,
DRESSING SPLINT BREATHE EASY DOYLE,,A4649,HCPCS,Facility,Outpatient,,,,90,76.5,25.794,90,Humana Insurance Company,Medicare PPO,44.1,49,,percent of total billed charges,,
DRESSING SPLINT BREATHE EASY DOYLE,,A4649,HCPCS,Facility,Inpatient,,,,90,76.5,25.794,90,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
DRESSING SPLINT BREATHE EASY DOYLE,,A4649,HCPCS,Facility,Both,,,,90,76.5,25.794,90,Medica,Individual & Family,89.19,99.1,,percent of total billed charges,,
DRESSING SPLINT BREATHE EASY DOYLE,,A4649,HCPCS,Facility,Outpatient,,,,90,76.5,25.794,90,Medica,Medica Advantage Solution,44.82,49.8,,percent of total billed charges,,
DRESSING SPLINT BREATHE EASY DOYLE,,A4649,HCPCS,Facility,Inpatient,,,,90,76.5,25.794,90,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
DRESSING SPLINT BREATHE EASY DOYLE,,A4649,HCPCS,Facility,Outpatient,,,,90,76.5,25.794,90,Medica,Medical Assistance,40.14,44.6,,percent of total billed charges,,
DRESSING SPLINT BREATHE EASY DOYLE,,A4649,HCPCS,Facility,Inpatient,,,,90,76.5,25.794,90,Medica,Medical Assistance,,,,,Included in per diem rate,
DRESSING SPLINT BREATHE EASY DOYLE,,A4649,HCPCS,Facility,Outpatient,,,,90,76.5,25.794,90,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,44.82,49.8,,percent of total billed charges,,
DRESSING SPLINT BREATHE EASY DOYLE,,A4649,HCPCS,Facility,Inpatient,,,,90,76.5,25.794,90,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
DRESSING SPLINT BREATHE EASY DOYLE,,A4649,HCPCS,Facility,Both,,,,90,76.5,25.794,90,"Multiplan, Inc.","Multiplan, Inc.",84.6,94,,percent of total billed charges,,
DRESSING SPLINT BREATHE EASY DOYLE,,A4649,HCPCS,Facility,Outpatient,,,,90,76.5,25.794,90,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,81.09,90.1,,percent of total billed charges,,
DRESSING SPLINT BREATHE EASY DOYLE,,A4649,HCPCS,Facility,Inpatient,,,,90,76.5,25.794,90,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
DRESSING SPLINT BREATHE EASY DOYLE,,A4649,HCPCS,Facility,Both,,,,90,76.5,25.794,90,"Preferred One Administrative Services, INC.",PPO,88.74,98.6,,percent of total billed charges,,
DRESSING SPLINT BREATHE EASY DOYLE,,A4649,HCPCS,Facility,Outpatient,,,,90,76.5,25.794,90,PrimeWest Health,Minnesota Senior Health Options (MSHO),46.305,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
DRESSING SPLINT BREATHE EASY DOYLE,,A4649,HCPCS,Facility,Inpatient,,,,90,76.5,25.794,90,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DRESSING SPLINT BREATHE EASY DOYLE,,A4649,HCPCS,Facility,Outpatient,,,,90,76.5,25.794,90,PrimeWest Health,MinnesotaCare,46.224,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
DRESSING SPLINT BREATHE EASY DOYLE,,A4649,HCPCS,Facility,Inpatient,,,,90,76.5,25.794,90,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
DRESSING SPLINT BREATHE EASY DOYLE,,A4649,HCPCS,Facility,Both,,,,90,76.5,25.794,90,Sanford Health Plan,Sanford Health Plan,82.8,92,,percent of total billed charges,,
DRESSING SPLINT BREATHE EASY DOYLE,,A4649,HCPCS,Facility,Outpatient,,,,90,76.5,25.794,90,"UCare Health, Inc.",Individual & Family Plan,50.715,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
DRESSING SPLINT BREATHE EASY DOYLE,,A4649,HCPCS,Facility,Inpatient,,,,90,76.5,25.794,90,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
DRESSING SPLINT BREATHE EASY DOYLE,,A4649,HCPCS,Facility,Outpatient,,,,90,76.5,25.794,90,"UCare Health, Inc.",Medical Assistance,45.423,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DRESSING SPLINT BREATHE EASY DOYLE,,A4649,HCPCS,Facility,Inpatient,,,,90,76.5,25.794,90,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
DRESSING SPLINT BREATHE EASY DOYLE,,A4649,HCPCS,Facility,Outpatient,,,,90,76.5,25.794,90,"UCare Health, Inc.",Medicare Advantage,45.423,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DRESSING SPLINT BREATHE EASY DOYLE,,A4649,HCPCS,Facility,Inpatient,,,,90,76.5,25.794,90,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DRESSING SPLINT BREATHE EASY DOYLE,,A4649,HCPCS,Facility,Outpatient,,,,90,76.5,25.794,90,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),45.423,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DRESSING SPLINT BREATHE EASY DOYLE,,A4649,HCPCS,Facility,Inpatient,,,,90,76.5,25.794,90,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DRESSING SPLINT BREATHE EASY DOYLE,,A4649,HCPCS,Facility,Both,,,,90,76.5,25.794,90,UnitedHealthcare,Individual & Family,84.6,94,,percent of total billed charges,,
DRESSING SPLINT BREATHE EASY DOYLE,,A4649,HCPCS,Facility,Outpatient,,,,90,76.5,25.794,90,UnitedHealthcare,Medicare Advantage,44.1,49,,percent of total billed charges,,
DRESSING SPLINT BREATHE EASY DOYLE,,A4649,HCPCS,Facility,Inpatient,,,,90,76.5,25.794,90,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
DRESSING SPLINT BREATHE EASY DOYLE,,A4649,HCPCS,Facility,Outpatient,,,,90,76.5,25.794,90,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,43.2,48,,percent of total billed charges,,100% of DHS outpatient percentage
DRESSING SPLINT BREATHE EASY DOYLE,,A4649,HCPCS,Facility,Inpatient,,,,90,76.5,25.794,90,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
DRILL 2.2MM,,A4649,HCPCS,Facility,Both,,,,727.5,618.375,208.5015,727.5,Aetna,Commercial,669.3,92,,percent of total billed charges,,
DRILL 2.2MM,,A4649,HCPCS,Facility,Outpatient,,,,727.5,618.375,208.5015,727.5,Aetna,Medicare Advantage,356.475,49,,percent of total billed charges,,
DRILL 2.2MM,,A4649,HCPCS,Facility,Inpatient,,,,727.5,618.375,208.5015,727.5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
DRILL 2.2MM,,A4649,HCPCS,Facility,Both,,,,727.5,618.375,208.5015,727.5,Aetna,PPO,676.575,93,,percent of total billed charges,,
DRILL 2.2MM,,A4649,HCPCS,Facility,Both,,,,727.5,618.375,208.5015,727.5,America's PPO,America's PPO,698.61825,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
DRILL 2.2MM,,A4649,HCPCS,Facility,Both,,,,727.5,618.375,208.5015,727.5,BlueCross BlueShield Minnesota, Federal Employee Program,715.86,98.4,,percent of total billed charges,,
DRILL 2.2MM,,A4649,HCPCS,Facility,Both,,,,727.5,618.375,208.5015,727.5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,727.5,100,,percent of total billed charges,,
DRILL 2.2MM,,A4649,HCPCS,Facility,Both,,,,727.5,618.375,208.5015,727.5,BlueCross BlueShield Minnesota,High Value Network Plan,654.75,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
DRILL 2.2MM,,A4649,HCPCS,Facility,Outpatient,,,,727.5,618.375,208.5015,727.5,BlueCross BlueShield Minnesota,Medicare Advantage,356.475,49,,percent of total billed charges,,
DRILL 2.2MM,,A4649,HCPCS,Facility,Inpatient,,,,727.5,618.375,208.5015,727.5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
DRILL 2.2MM,,A4649,HCPCS,Facility,Both,,,,727.5,618.375,208.5015,727.5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,644.34675,88.57,,percent of total billed charges,,
DRILL 2.2MM,,A4649,HCPCS,Facility,Both,,,,727.5,618.375,208.5015,727.5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,208.5015,28.66,,percent of total billed charges,,
DRILL 2.2MM,,A4649,HCPCS,Facility,Outpatient,,,,727.5,618.375,208.5015,727.5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),356.475,49,,percent of total billed charges,,
DRILL 2.2MM,,A4649,HCPCS,Facility,Inpatient,,,,727.5,618.375,208.5015,727.5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
DRILL 2.2MM,,A4649,HCPCS,Facility,Both,,,,727.5,618.375,208.5015,727.5,CorVel,Worker's Compensation,727.5,100,,percent of total billed charges,,
DRILL 2.2MM,,A4649,HCPCS,Facility,Both,,,,727.5,618.375,208.5015,727.5,First Health Group Corporation,First Health Network,705.675,97,,percent of total billed charges,,
DRILL 2.2MM,,A4649,HCPCS,Facility,Both,,,,727.5,618.375,208.5015,727.5,"Health Partners, Inc.",Commercial,688.215,94.6,,percent of total billed charges,,
DRILL 2.2MM,,A4649,HCPCS,Facility,Outpatient,,,,727.5,618.375,208.5015,727.5,"Health Partners, Inc.",Medicare Advantage,356.475,49,,percent of total billed charges,,
DRILL 2.2MM,,A4649,HCPCS,Facility,Inpatient,,,,727.5,618.375,208.5015,727.5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DRILL 2.2MM,,A4649,HCPCS,Facility,Both,,,,727.5,618.375,208.5015,727.5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),436.5,60,,percent of total billed charges,,
DRILL 2.2MM,,A4649,HCPCS,Facility,Both,,,,727.5,618.375,208.5015,727.5,"Health Partners, Inc.",State of Minnesota Advantage Program,592.9125,81.5,,percent of total billed charges,,
DRILL 2.2MM,,A4649,HCPCS,Facility,Both,,,,727.5,618.375,208.5015,727.5,"Health Partners, Inc.",State Public Programs,363.75,50,,percent of total billed charges,,
DRILL 2.2MM,,A4649,HCPCS,Facility,Both,,,,727.5,618.375,208.5015,727.5,Humana Insurance Company,Commercial PPO,691.125,95,,percent of total billed charges,,
DRILL 2.2MM,,A4649,HCPCS,Facility,Outpatient,,,,727.5,618.375,208.5015,727.5,Humana Insurance Company,Medicare PPO,356.475,49,,percent of total billed charges,,
DRILL 2.2MM,,A4649,HCPCS,Facility,Inpatient,,,,727.5,618.375,208.5015,727.5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
DRILL 2.2MM,,A4649,HCPCS,Facility,Both,,,,727.5,618.375,208.5015,727.5,Medica,Individual & Family,720.9525,99.1,,percent of total billed charges,,
DRILL 2.2MM,,A4649,HCPCS,Facility,Outpatient,,,,727.5,618.375,208.5015,727.5,Medica,Medica Advantage Solution,362.295,49.8,,percent of total billed charges,,
DRILL 2.2MM,,A4649,HCPCS,Facility,Inpatient,,,,727.5,618.375,208.5015,727.5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
DRILL 2.2MM,,A4649,HCPCS,Facility,Outpatient,,,,727.5,618.375,208.5015,727.5,Medica,Medical Assistance,324.465,44.6,,percent of total billed charges,,
DRILL 2.2MM,,A4649,HCPCS,Facility,Inpatient,,,,727.5,618.375,208.5015,727.5,Medica,Medical Assistance,,,,,Included in per diem rate,
DRILL 2.2MM,,A4649,HCPCS,Facility,Outpatient,,,,727.5,618.375,208.5015,727.5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,362.295,49.8,,percent of total billed charges,,
DRILL 2.2MM,,A4649,HCPCS,Facility,Inpatient,,,,727.5,618.375,208.5015,727.5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
DRILL 2.2MM,,A4649,HCPCS,Facility,Both,,,,727.5,618.375,208.5015,727.5,"Multiplan, Inc.","Multiplan, Inc.",683.85,94,,percent of total billed charges,,
DRILL 2.2MM,,A4649,HCPCS,Facility,Outpatient,,,,727.5,618.375,208.5015,727.5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,655.4775,90.1,,percent of total billed charges,,
DRILL 2.2MM,,A4649,HCPCS,Facility,Inpatient,,,,727.5,618.375,208.5015,727.5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
DRILL 2.2MM,,A4649,HCPCS,Facility,Both,,,,727.5,618.375,208.5015,727.5,"Preferred One Administrative Services, INC.",PPO,717.315,98.6,,percent of total billed charges,,
DRILL 2.2MM,,A4649,HCPCS,Facility,Outpatient,,,,727.5,618.375,208.5015,727.5,PrimeWest Health,Minnesota Senior Health Options (MSHO),374.29875,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
DRILL 2.2MM,,A4649,HCPCS,Facility,Inpatient,,,,727.5,618.375,208.5015,727.5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DRILL 2.2MM,,A4649,HCPCS,Facility,Outpatient,,,,727.5,618.375,208.5015,727.5,PrimeWest Health,MinnesotaCare,373.644,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
DRILL 2.2MM,,A4649,HCPCS,Facility,Inpatient,,,,727.5,618.375,208.5015,727.5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
DRILL 2.2MM,,A4649,HCPCS,Facility,Both,,,,727.5,618.375,208.5015,727.5,Sanford Health Plan,Sanford Health Plan,669.3,92,,percent of total billed charges,,
DRILL 2.2MM,,A4649,HCPCS,Facility,Outpatient,,,,727.5,618.375,208.5015,727.5,"UCare Health, Inc.",Individual & Family Plan,409.94625,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
DRILL 2.2MM,,A4649,HCPCS,Facility,Inpatient,,,,727.5,618.375,208.5015,727.5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
DRILL 2.2MM,,A4649,HCPCS,Facility,Outpatient,,,,727.5,618.375,208.5015,727.5,"UCare Health, Inc.",Medical Assistance,367.16925,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DRILL 2.2MM,,A4649,HCPCS,Facility,Inpatient,,,,727.5,618.375,208.5015,727.5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
DRILL 2.2MM,,A4649,HCPCS,Facility,Outpatient,,,,727.5,618.375,208.5015,727.5,"UCare Health, Inc.",Medicare Advantage,367.16925,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DRILL 2.2MM,,A4649,HCPCS,Facility,Inpatient,,,,727.5,618.375,208.5015,727.5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DRILL 2.2MM,,A4649,HCPCS,Facility,Outpatient,,,,727.5,618.375,208.5015,727.5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),367.16925,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DRILL 2.2MM,,A4649,HCPCS,Facility,Inpatient,,,,727.5,618.375,208.5015,727.5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DRILL 2.2MM,,A4649,HCPCS,Facility,Both,,,,727.5,618.375,208.5015,727.5,UnitedHealthcare,Individual & Family,683.85,94,,percent of total billed charges,,
DRILL 2.2MM,,A4649,HCPCS,Facility,Outpatient,,,,727.5,618.375,208.5015,727.5,UnitedHealthcare,Medicare Advantage,356.475,49,,percent of total billed charges,,
DRILL 2.2MM,,A4649,HCPCS,Facility,Inpatient,,,,727.5,618.375,208.5015,727.5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
DRILL 2.2MM,,A4649,HCPCS,Facility,Outpatient,,,,727.5,618.375,208.5015,727.5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,349.2,48,,percent of total billed charges,,100% of DHS outpatient percentage
DRILL 2.2MM,,A4649,HCPCS,Facility,Inpatient,,,,727.5,618.375,208.5015,727.5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
DRILL BIT 2.5X60  WRIGHT MED 58850025,,A4649,HCPCS,Facility,Both,,,,875,743.75,250.775,875,Aetna,Commercial,805,92,,percent of total billed charges,,
DRILL BIT 2.5X60  WRIGHT MED 58850025,,A4649,HCPCS,Facility,Outpatient,,,,875,743.75,250.775,875,Aetna,Medicare Advantage,428.75,49,,percent of total billed charges,,
DRILL BIT 2.5X60  WRIGHT MED 58850025,,A4649,HCPCS,Facility,Inpatient,,,,875,743.75,250.775,875,Aetna,Medicare Advantage,,,,,Included in per diem rate,
DRILL BIT 2.5X60  WRIGHT MED 58850025,,A4649,HCPCS,Facility,Both,,,,875,743.75,250.775,875,Aetna,PPO,813.75,93,,percent of total billed charges,,
DRILL BIT 2.5X60  WRIGHT MED 58850025,,A4649,HCPCS,Facility,Both,,,,875,743.75,250.775,875,America's PPO,America's PPO,840.2625,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
DRILL BIT 2.5X60  WRIGHT MED 58850025,,A4649,HCPCS,Facility,Both,,,,875,743.75,250.775,875,BlueCross BlueShield Minnesota, Federal Employee Program,861,98.4,,percent of total billed charges,,
DRILL BIT 2.5X60  WRIGHT MED 58850025,,A4649,HCPCS,Facility,Both,,,,875,743.75,250.775,875,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,875,100,,percent of total billed charges,,
DRILL BIT 2.5X60  WRIGHT MED 58850025,,A4649,HCPCS,Facility,Both,,,,875,743.75,250.775,875,BlueCross BlueShield Minnesota,High Value Network Plan,787.5,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
DRILL BIT 2.5X60  WRIGHT MED 58850025,,A4649,HCPCS,Facility,Outpatient,,,,875,743.75,250.775,875,BlueCross BlueShield Minnesota,Medicare Advantage,428.75,49,,percent of total billed charges,,
DRILL BIT 2.5X60  WRIGHT MED 58850025,,A4649,HCPCS,Facility,Inpatient,,,,875,743.75,250.775,875,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
DRILL BIT 2.5X60  WRIGHT MED 58850025,,A4649,HCPCS,Facility,Both,,,,875,743.75,250.775,875,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,774.9875,88.57,,percent of total billed charges,,
DRILL BIT 2.5X60  WRIGHT MED 58850025,,A4649,HCPCS,Facility,Both,,,,875,743.75,250.775,875,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,250.775,28.66,,percent of total billed charges,,
DRILL BIT 2.5X60  WRIGHT MED 58850025,,A4649,HCPCS,Facility,Outpatient,,,,875,743.75,250.775,875,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),428.75,49,,percent of total billed charges,,
DRILL BIT 2.5X60  WRIGHT MED 58850025,,A4649,HCPCS,Facility,Inpatient,,,,875,743.75,250.775,875,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
DRILL BIT 2.5X60  WRIGHT MED 58850025,,A4649,HCPCS,Facility,Both,,,,875,743.75,250.775,875,CorVel,Worker's Compensation,875,100,,percent of total billed charges,,
DRILL BIT 2.5X60  WRIGHT MED 58850025,,A4649,HCPCS,Facility,Both,,,,875,743.75,250.775,875,First Health Group Corporation,First Health Network,848.75,97,,percent of total billed charges,,
DRILL BIT 2.5X60  WRIGHT MED 58850025,,A4649,HCPCS,Facility,Both,,,,875,743.75,250.775,875,"Health Partners, Inc.",Commercial,827.75,94.6,,percent of total billed charges,,
DRILL BIT 2.5X60  WRIGHT MED 58850025,,A4649,HCPCS,Facility,Outpatient,,,,875,743.75,250.775,875,"Health Partners, Inc.",Medicare Advantage,428.75,49,,percent of total billed charges,,
DRILL BIT 2.5X60  WRIGHT MED 58850025,,A4649,HCPCS,Facility,Inpatient,,,,875,743.75,250.775,875,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DRILL BIT 2.5X60  WRIGHT MED 58850025,,A4649,HCPCS,Facility,Both,,,,875,743.75,250.775,875,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),525,60,,percent of total billed charges,,
DRILL BIT 2.5X60  WRIGHT MED 58850025,,A4649,HCPCS,Facility,Both,,,,875,743.75,250.775,875,"Health Partners, Inc.",State of Minnesota Advantage Program,713.125,81.5,,percent of total billed charges,,
DRILL BIT 2.5X60  WRIGHT MED 58850025,,A4649,HCPCS,Facility,Both,,,,875,743.75,250.775,875,"Health Partners, Inc.",State Public Programs,437.5,50,,percent of total billed charges,,
DRILL BIT 2.5X60  WRIGHT MED 58850025,,A4649,HCPCS,Facility,Both,,,,875,743.75,250.775,875,Humana Insurance Company,Commercial PPO,831.25,95,,percent of total billed charges,,
DRILL BIT 2.5X60  WRIGHT MED 58850025,,A4649,HCPCS,Facility,Outpatient,,,,875,743.75,250.775,875,Humana Insurance Company,Medicare PPO,428.75,49,,percent of total billed charges,,
DRILL BIT 2.5X60  WRIGHT MED 58850025,,A4649,HCPCS,Facility,Inpatient,,,,875,743.75,250.775,875,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
DRILL BIT 2.5X60  WRIGHT MED 58850025,,A4649,HCPCS,Facility,Both,,,,875,743.75,250.775,875,Medica,Individual & Family,867.125,99.1,,percent of total billed charges,,
DRILL BIT 2.5X60  WRIGHT MED 58850025,,A4649,HCPCS,Facility,Outpatient,,,,875,743.75,250.775,875,Medica,Medica Advantage Solution,435.75,49.8,,percent of total billed charges,,
DRILL BIT 2.5X60  WRIGHT MED 58850025,,A4649,HCPCS,Facility,Inpatient,,,,875,743.75,250.775,875,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
DRILL BIT 2.5X60  WRIGHT MED 58850025,,A4649,HCPCS,Facility,Outpatient,,,,875,743.75,250.775,875,Medica,Medical Assistance,390.25,44.6,,percent of total billed charges,,
DRILL BIT 2.5X60  WRIGHT MED 58850025,,A4649,HCPCS,Facility,Inpatient,,,,875,743.75,250.775,875,Medica,Medical Assistance,,,,,Included in per diem rate,
DRILL BIT 2.5X60  WRIGHT MED 58850025,,A4649,HCPCS,Facility,Outpatient,,,,875,743.75,250.775,875,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,435.75,49.8,,percent of total billed charges,,
DRILL BIT 2.5X60  WRIGHT MED 58850025,,A4649,HCPCS,Facility,Inpatient,,,,875,743.75,250.775,875,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
DRILL BIT 2.5X60  WRIGHT MED 58850025,,A4649,HCPCS,Facility,Both,,,,875,743.75,250.775,875,"Multiplan, Inc.","Multiplan, Inc.",822.5,94,,percent of total billed charges,,
DRILL BIT 2.5X60  WRIGHT MED 58850025,,A4649,HCPCS,Facility,Outpatient,,,,875,743.75,250.775,875,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,788.375,90.1,,percent of total billed charges,,
DRILL BIT 2.5X60  WRIGHT MED 58850025,,A4649,HCPCS,Facility,Inpatient,,,,875,743.75,250.775,875,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
DRILL BIT 2.5X60  WRIGHT MED 58850025,,A4649,HCPCS,Facility,Both,,,,875,743.75,250.775,875,"Preferred One Administrative Services, INC.",PPO,862.75,98.6,,percent of total billed charges,,
DRILL BIT 2.5X60  WRIGHT MED 58850025,,A4649,HCPCS,Facility,Outpatient,,,,875,743.75,250.775,875,PrimeWest Health,Minnesota Senior Health Options (MSHO),450.1875,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
DRILL BIT 2.5X60  WRIGHT MED 58850025,,A4649,HCPCS,Facility,Inpatient,,,,875,743.75,250.775,875,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DRILL BIT 2.5X60  WRIGHT MED 58850025,,A4649,HCPCS,Facility,Outpatient,,,,875,743.75,250.775,875,PrimeWest Health,MinnesotaCare,449.4,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
DRILL BIT 2.5X60  WRIGHT MED 58850025,,A4649,HCPCS,Facility,Inpatient,,,,875,743.75,250.775,875,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
DRILL BIT 2.5X60  WRIGHT MED 58850025,,A4649,HCPCS,Facility,Both,,,,875,743.75,250.775,875,Sanford Health Plan,Sanford Health Plan,805,92,,percent of total billed charges,,
DRILL BIT 2.5X60  WRIGHT MED 58850025,,A4649,HCPCS,Facility,Outpatient,,,,875,743.75,250.775,875,"UCare Health, Inc.",Individual & Family Plan,493.0625,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
DRILL BIT 2.5X60  WRIGHT MED 58850025,,A4649,HCPCS,Facility,Inpatient,,,,875,743.75,250.775,875,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
DRILL BIT 2.5X60  WRIGHT MED 58850025,,A4649,HCPCS,Facility,Outpatient,,,,875,743.75,250.775,875,"UCare Health, Inc.",Medical Assistance,441.6125,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DRILL BIT 2.5X60  WRIGHT MED 58850025,,A4649,HCPCS,Facility,Inpatient,,,,875,743.75,250.775,875,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
DRILL BIT 2.5X60  WRIGHT MED 58850025,,A4649,HCPCS,Facility,Outpatient,,,,875,743.75,250.775,875,"UCare Health, Inc.",Medicare Advantage,441.6125,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DRILL BIT 2.5X60  WRIGHT MED 58850025,,A4649,HCPCS,Facility,Inpatient,,,,875,743.75,250.775,875,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DRILL BIT 2.5X60  WRIGHT MED 58850025,,A4649,HCPCS,Facility,Outpatient,,,,875,743.75,250.775,875,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),441.6125,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DRILL BIT 2.5X60  WRIGHT MED 58850025,,A4649,HCPCS,Facility,Inpatient,,,,875,743.75,250.775,875,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DRILL BIT 2.5X60  WRIGHT MED 58850025,,A4649,HCPCS,Facility,Both,,,,875,743.75,250.775,875,UnitedHealthcare,Individual & Family,822.5,94,,percent of total billed charges,,
DRILL BIT 2.5X60  WRIGHT MED 58850025,,A4649,HCPCS,Facility,Outpatient,,,,875,743.75,250.775,875,UnitedHealthcare,Medicare Advantage,428.75,49,,percent of total billed charges,,
DRILL BIT 2.5X60  WRIGHT MED 58850025,,A4649,HCPCS,Facility,Inpatient,,,,875,743.75,250.775,875,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
DRILL BIT 2.5X60  WRIGHT MED 58850025,,A4649,HCPCS,Facility,Outpatient,,,,875,743.75,250.775,875,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,420,48,,percent of total billed charges,,100% of DHS outpatient percentage
DRILL BIT 2.5X60  WRIGHT MED 58850025,,A4649,HCPCS,Facility,Inpatient,,,,875,743.75,250.775,875,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
DRILL BIT DART-FIRE 2.0 CANN  WRIGHT MED DSDS0020,,A4649,HCPCS,Facility,Both,,,,875,743.75,250.775,875,Aetna,Commercial,805,92,,percent of total billed charges,,
DRILL BIT DART-FIRE 2.0 CANN  WRIGHT MED DSDS0020,,A4649,HCPCS,Facility,Outpatient,,,,875,743.75,250.775,875,Aetna,Medicare Advantage,428.75,49,,percent of total billed charges,,
DRILL BIT DART-FIRE 2.0 CANN  WRIGHT MED DSDS0020,,A4649,HCPCS,Facility,Inpatient,,,,875,743.75,250.775,875,Aetna,Medicare Advantage,,,,,Included in per diem rate,
DRILL BIT DART-FIRE 2.0 CANN  WRIGHT MED DSDS0020,,A4649,HCPCS,Facility,Both,,,,875,743.75,250.775,875,Aetna,PPO,813.75,93,,percent of total billed charges,,
DRILL BIT DART-FIRE 2.0 CANN  WRIGHT MED DSDS0020,,A4649,HCPCS,Facility,Both,,,,875,743.75,250.775,875,America's PPO,America's PPO,840.2625,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
DRILL BIT DART-FIRE 2.0 CANN  WRIGHT MED DSDS0020,,A4649,HCPCS,Facility,Both,,,,875,743.75,250.775,875,BlueCross BlueShield Minnesota, Federal Employee Program,861,98.4,,percent of total billed charges,,
DRILL BIT DART-FIRE 2.0 CANN  WRIGHT MED DSDS0020,,A4649,HCPCS,Facility,Both,,,,875,743.75,250.775,875,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,875,100,,percent of total billed charges,,
DRILL BIT DART-FIRE 2.0 CANN  WRIGHT MED DSDS0020,,A4649,HCPCS,Facility,Both,,,,875,743.75,250.775,875,BlueCross BlueShield Minnesota,High Value Network Plan,787.5,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
DRILL BIT DART-FIRE 2.0 CANN  WRIGHT MED DSDS0020,,A4649,HCPCS,Facility,Outpatient,,,,875,743.75,250.775,875,BlueCross BlueShield Minnesota,Medicare Advantage,428.75,49,,percent of total billed charges,,
DRILL BIT DART-FIRE 2.0 CANN  WRIGHT MED DSDS0020,,A4649,HCPCS,Facility,Inpatient,,,,875,743.75,250.775,875,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
DRILL BIT DART-FIRE 2.0 CANN  WRIGHT MED DSDS0020,,A4649,HCPCS,Facility,Both,,,,875,743.75,250.775,875,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,774.9875,88.57,,percent of total billed charges,,
DRILL BIT DART-FIRE 2.0 CANN  WRIGHT MED DSDS0020,,A4649,HCPCS,Facility,Both,,,,875,743.75,250.775,875,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,250.775,28.66,,percent of total billed charges,,
DRILL BIT DART-FIRE 2.0 CANN  WRIGHT MED DSDS0020,,A4649,HCPCS,Facility,Outpatient,,,,875,743.75,250.775,875,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),428.75,49,,percent of total billed charges,,
DRILL BIT DART-FIRE 2.0 CANN  WRIGHT MED DSDS0020,,A4649,HCPCS,Facility,Inpatient,,,,875,743.75,250.775,875,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
DRILL BIT DART-FIRE 2.0 CANN  WRIGHT MED DSDS0020,,A4649,HCPCS,Facility,Both,,,,875,743.75,250.775,875,CorVel,Worker's Compensation,875,100,,percent of total billed charges,,
DRILL BIT DART-FIRE 2.0 CANN  WRIGHT MED DSDS0020,,A4649,HCPCS,Facility,Both,,,,875,743.75,250.775,875,First Health Group Corporation,First Health Network,848.75,97,,percent of total billed charges,,
DRILL BIT DART-FIRE 2.0 CANN  WRIGHT MED DSDS0020,,A4649,HCPCS,Facility,Both,,,,875,743.75,250.775,875,"Health Partners, Inc.",Commercial,827.75,94.6,,percent of total billed charges,,
DRILL BIT DART-FIRE 2.0 CANN  WRIGHT MED DSDS0020,,A4649,HCPCS,Facility,Outpatient,,,,875,743.75,250.775,875,"Health Partners, Inc.",Medicare Advantage,428.75,49,,percent of total billed charges,,
DRILL BIT DART-FIRE 2.0 CANN  WRIGHT MED DSDS0020,,A4649,HCPCS,Facility,Inpatient,,,,875,743.75,250.775,875,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DRILL BIT DART-FIRE 2.0 CANN  WRIGHT MED DSDS0020,,A4649,HCPCS,Facility,Both,,,,875,743.75,250.775,875,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),525,60,,percent of total billed charges,,
DRILL BIT DART-FIRE 2.0 CANN  WRIGHT MED DSDS0020,,A4649,HCPCS,Facility,Both,,,,875,743.75,250.775,875,"Health Partners, Inc.",State of Minnesota Advantage Program,713.125,81.5,,percent of total billed charges,,
DRILL BIT DART-FIRE 2.0 CANN  WRIGHT MED DSDS0020,,A4649,HCPCS,Facility,Both,,,,875,743.75,250.775,875,"Health Partners, Inc.",State Public Programs,437.5,50,,percent of total billed charges,,
DRILL BIT DART-FIRE 2.0 CANN  WRIGHT MED DSDS0020,,A4649,HCPCS,Facility,Both,,,,875,743.75,250.775,875,Humana Insurance Company,Commercial PPO,831.25,95,,percent of total billed charges,,
DRILL BIT DART-FIRE 2.0 CANN  WRIGHT MED DSDS0020,,A4649,HCPCS,Facility,Outpatient,,,,875,743.75,250.775,875,Humana Insurance Company,Medicare PPO,428.75,49,,percent of total billed charges,,
DRILL BIT DART-FIRE 2.0 CANN  WRIGHT MED DSDS0020,,A4649,HCPCS,Facility,Inpatient,,,,875,743.75,250.775,875,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
DRILL BIT DART-FIRE 2.0 CANN  WRIGHT MED DSDS0020,,A4649,HCPCS,Facility,Both,,,,875,743.75,250.775,875,Medica,Individual & Family,867.125,99.1,,percent of total billed charges,,
DRILL BIT DART-FIRE 2.0 CANN  WRIGHT MED DSDS0020,,A4649,HCPCS,Facility,Outpatient,,,,875,743.75,250.775,875,Medica,Medica Advantage Solution,435.75,49.8,,percent of total billed charges,,
DRILL BIT DART-FIRE 2.0 CANN  WRIGHT MED DSDS0020,,A4649,HCPCS,Facility,Inpatient,,,,875,743.75,250.775,875,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
DRILL BIT DART-FIRE 2.0 CANN  WRIGHT MED DSDS0020,,A4649,HCPCS,Facility,Outpatient,,,,875,743.75,250.775,875,Medica,Medical Assistance,390.25,44.6,,percent of total billed charges,,
DRILL BIT DART-FIRE 2.0 CANN  WRIGHT MED DSDS0020,,A4649,HCPCS,Facility,Inpatient,,,,875,743.75,250.775,875,Medica,Medical Assistance,,,,,Included in per diem rate,
DRILL BIT DART-FIRE 2.0 CANN  WRIGHT MED DSDS0020,,A4649,HCPCS,Facility,Outpatient,,,,875,743.75,250.775,875,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,435.75,49.8,,percent of total billed charges,,
DRILL BIT DART-FIRE 2.0 CANN  WRIGHT MED DSDS0020,,A4649,HCPCS,Facility,Inpatient,,,,875,743.75,250.775,875,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
DRILL BIT DART-FIRE 2.0 CANN  WRIGHT MED DSDS0020,,A4649,HCPCS,Facility,Both,,,,875,743.75,250.775,875,"Multiplan, Inc.","Multiplan, Inc.",822.5,94,,percent of total billed charges,,
DRILL BIT DART-FIRE 2.0 CANN  WRIGHT MED DSDS0020,,A4649,HCPCS,Facility,Outpatient,,,,875,743.75,250.775,875,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,788.375,90.1,,percent of total billed charges,,
DRILL BIT DART-FIRE 2.0 CANN  WRIGHT MED DSDS0020,,A4649,HCPCS,Facility,Inpatient,,,,875,743.75,250.775,875,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
DRILL BIT DART-FIRE 2.0 CANN  WRIGHT MED DSDS0020,,A4649,HCPCS,Facility,Both,,,,875,743.75,250.775,875,"Preferred One Administrative Services, INC.",PPO,862.75,98.6,,percent of total billed charges,,
DRILL BIT DART-FIRE 2.0 CANN  WRIGHT MED DSDS0020,,A4649,HCPCS,Facility,Outpatient,,,,875,743.75,250.775,875,PrimeWest Health,Minnesota Senior Health Options (MSHO),450.1875,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
DRILL BIT DART-FIRE 2.0 CANN  WRIGHT MED DSDS0020,,A4649,HCPCS,Facility,Inpatient,,,,875,743.75,250.775,875,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DRILL BIT DART-FIRE 2.0 CANN  WRIGHT MED DSDS0020,,A4649,HCPCS,Facility,Outpatient,,,,875,743.75,250.775,875,PrimeWest Health,MinnesotaCare,449.4,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
DRILL BIT DART-FIRE 2.0 CANN  WRIGHT MED DSDS0020,,A4649,HCPCS,Facility,Inpatient,,,,875,743.75,250.775,875,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
DRILL BIT DART-FIRE 2.0 CANN  WRIGHT MED DSDS0020,,A4649,HCPCS,Facility,Both,,,,875,743.75,250.775,875,Sanford Health Plan,Sanford Health Plan,805,92,,percent of total billed charges,,
DRILL BIT DART-FIRE 2.0 CANN  WRIGHT MED DSDS0020,,A4649,HCPCS,Facility,Outpatient,,,,875,743.75,250.775,875,"UCare Health, Inc.",Individual & Family Plan,493.0625,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
DRILL BIT DART-FIRE 2.0 CANN  WRIGHT MED DSDS0020,,A4649,HCPCS,Facility,Inpatient,,,,875,743.75,250.775,875,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
DRILL BIT DART-FIRE 2.0 CANN  WRIGHT MED DSDS0020,,A4649,HCPCS,Facility,Outpatient,,,,875,743.75,250.775,875,"UCare Health, Inc.",Medical Assistance,441.6125,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DRILL BIT DART-FIRE 2.0 CANN  WRIGHT MED DSDS0020,,A4649,HCPCS,Facility,Inpatient,,,,875,743.75,250.775,875,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
DRILL BIT DART-FIRE 2.0 CANN  WRIGHT MED DSDS0020,,A4649,HCPCS,Facility,Outpatient,,,,875,743.75,250.775,875,"UCare Health, Inc.",Medicare Advantage,441.6125,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DRILL BIT DART-FIRE 2.0 CANN  WRIGHT MED DSDS0020,,A4649,HCPCS,Facility,Inpatient,,,,875,743.75,250.775,875,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DRILL BIT DART-FIRE 2.0 CANN  WRIGHT MED DSDS0020,,A4649,HCPCS,Facility,Outpatient,,,,875,743.75,250.775,875,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),441.6125,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DRILL BIT DART-FIRE 2.0 CANN  WRIGHT MED DSDS0020,,A4649,HCPCS,Facility,Inpatient,,,,875,743.75,250.775,875,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DRILL BIT DART-FIRE 2.0 CANN  WRIGHT MED DSDS0020,,A4649,HCPCS,Facility,Both,,,,875,743.75,250.775,875,UnitedHealthcare,Individual & Family,822.5,94,,percent of total billed charges,,
DRILL BIT DART-FIRE 2.0 CANN  WRIGHT MED DSDS0020,,A4649,HCPCS,Facility,Outpatient,,,,875,743.75,250.775,875,UnitedHealthcare,Medicare Advantage,428.75,49,,percent of total billed charges,,
DRILL BIT DART-FIRE 2.0 CANN  WRIGHT MED DSDS0020,,A4649,HCPCS,Facility,Inpatient,,,,875,743.75,250.775,875,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
DRILL BIT DART-FIRE 2.0 CANN  WRIGHT MED DSDS0020,,A4649,HCPCS,Facility,Outpatient,,,,875,743.75,250.775,875,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,420,48,,percent of total billed charges,,100% of DHS outpatient percentage
DRILL BIT DART-FIRE 2.0 CANN  WRIGHT MED DSDS0020,,A4649,HCPCS,Facility,Inpatient,,,,875,743.75,250.775,875,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
ELECTRODE NEEDLE COATED INSULATE  E1465,,A4649,HCPCS,Facility,Both,,,,25.7,21.845,7.36562,25.7,Aetna,Commercial,23.644,92,,percent of total billed charges,,
ELECTRODE NEEDLE COATED INSULATE  E1465,,A4649,HCPCS,Facility,Outpatient,,,,25.7,21.845,7.36562,25.7,Aetna,Medicare Advantage,12.593,49,,percent of total billed charges,,
ELECTRODE NEEDLE COATED INSULATE  E1465,,A4649,HCPCS,Facility,Inpatient,,,,25.7,21.845,7.36562,25.7,Aetna,Medicare Advantage,,,,,Included in per diem rate,
ELECTRODE NEEDLE COATED INSULATE  E1465,,A4649,HCPCS,Facility,Both,,,,25.7,21.845,7.36562,25.7,Aetna,PPO,23.901,93,,percent of total billed charges,,
ELECTRODE NEEDLE COATED INSULATE  E1465,,A4649,HCPCS,Facility,Both,,,,25.7,21.845,7.36562,25.7,America's PPO,America's PPO,24.67971,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
ELECTRODE NEEDLE COATED INSULATE  E1465,,A4649,HCPCS,Facility,Both,,,,25.7,21.845,7.36562,25.7,BlueCross BlueShield Minnesota, Federal Employee Program,25.2888,98.4,,percent of total billed charges,,
ELECTRODE NEEDLE COATED INSULATE  E1465,,A4649,HCPCS,Facility,Both,,,,25.7,21.845,7.36562,25.7,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,25.7,100,,percent of total billed charges,,
ELECTRODE NEEDLE COATED INSULATE  E1465,,A4649,HCPCS,Facility,Both,,,,25.7,21.845,7.36562,25.7,BlueCross BlueShield Minnesota,High Value Network Plan,23.13,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
ELECTRODE NEEDLE COATED INSULATE  E1465,,A4649,HCPCS,Facility,Outpatient,,,,25.7,21.845,7.36562,25.7,BlueCross BlueShield Minnesota,Medicare Advantage,12.593,49,,percent of total billed charges,,
ELECTRODE NEEDLE COATED INSULATE  E1465,,A4649,HCPCS,Facility,Inpatient,,,,25.7,21.845,7.36562,25.7,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
ELECTRODE NEEDLE COATED INSULATE  E1465,,A4649,HCPCS,Facility,Both,,,,25.7,21.845,7.36562,25.7,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,22.76249,88.57,,percent of total billed charges,,
ELECTRODE NEEDLE COATED INSULATE  E1465,,A4649,HCPCS,Facility,Both,,,,25.7,21.845,7.36562,25.7,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,7.36562,28.66,,percent of total billed charges,,
ELECTRODE NEEDLE COATED INSULATE  E1465,,A4649,HCPCS,Facility,Outpatient,,,,25.7,21.845,7.36562,25.7,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),12.593,49,,percent of total billed charges,,
ELECTRODE NEEDLE COATED INSULATE  E1465,,A4649,HCPCS,Facility,Inpatient,,,,25.7,21.845,7.36562,25.7,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
ELECTRODE NEEDLE COATED INSULATE  E1465,,A4649,HCPCS,Facility,Both,,,,25.7,21.845,7.36562,25.7,CorVel,Worker's Compensation,25.7,100,,percent of total billed charges,,
ELECTRODE NEEDLE COATED INSULATE  E1465,,A4649,HCPCS,Facility,Both,,,,25.7,21.845,7.36562,25.7,First Health Group Corporation,First Health Network,24.929,97,,percent of total billed charges,,
ELECTRODE NEEDLE COATED INSULATE  E1465,,A4649,HCPCS,Facility,Both,,,,25.7,21.845,7.36562,25.7,"Health Partners, Inc.",Commercial,24.3122,94.6,,percent of total billed charges,,
ELECTRODE NEEDLE COATED INSULATE  E1465,,A4649,HCPCS,Facility,Outpatient,,,,25.7,21.845,7.36562,25.7,"Health Partners, Inc.",Medicare Advantage,12.593,49,,percent of total billed charges,,
ELECTRODE NEEDLE COATED INSULATE  E1465,,A4649,HCPCS,Facility,Inpatient,,,,25.7,21.845,7.36562,25.7,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ELECTRODE NEEDLE COATED INSULATE  E1465,,A4649,HCPCS,Facility,Both,,,,25.7,21.845,7.36562,25.7,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),15.42,60,,percent of total billed charges,,
ELECTRODE NEEDLE COATED INSULATE  E1465,,A4649,HCPCS,Facility,Both,,,,25.7,21.845,7.36562,25.7,"Health Partners, Inc.",State of Minnesota Advantage Program,20.9455,81.5,,percent of total billed charges,,
ELECTRODE NEEDLE COATED INSULATE  E1465,,A4649,HCPCS,Facility,Both,,,,25.7,21.845,7.36562,25.7,"Health Partners, Inc.",State Public Programs,12.85,50,,percent of total billed charges,,
ELECTRODE NEEDLE COATED INSULATE  E1465,,A4649,HCPCS,Facility,Both,,,,25.7,21.845,7.36562,25.7,Humana Insurance Company,Commercial PPO,24.415,95,,percent of total billed charges,,
ELECTRODE NEEDLE COATED INSULATE  E1465,,A4649,HCPCS,Facility,Outpatient,,,,25.7,21.845,7.36562,25.7,Humana Insurance Company,Medicare PPO,12.593,49,,percent of total billed charges,,
ELECTRODE NEEDLE COATED INSULATE  E1465,,A4649,HCPCS,Facility,Inpatient,,,,25.7,21.845,7.36562,25.7,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
ELECTRODE NEEDLE COATED INSULATE  E1465,,A4649,HCPCS,Facility,Both,,,,25.7,21.845,7.36562,25.7,Medica,Individual & Family,25.4687,99.1,,percent of total billed charges,,
ELECTRODE NEEDLE COATED INSULATE  E1465,,A4649,HCPCS,Facility,Outpatient,,,,25.7,21.845,7.36562,25.7,Medica,Medica Advantage Solution,12.7986,49.8,,percent of total billed charges,,
ELECTRODE NEEDLE COATED INSULATE  E1465,,A4649,HCPCS,Facility,Inpatient,,,,25.7,21.845,7.36562,25.7,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
ELECTRODE NEEDLE COATED INSULATE  E1465,,A4649,HCPCS,Facility,Outpatient,,,,25.7,21.845,7.36562,25.7,Medica,Medical Assistance,11.4622,44.6,,percent of total billed charges,,
ELECTRODE NEEDLE COATED INSULATE  E1465,,A4649,HCPCS,Facility,Inpatient,,,,25.7,21.845,7.36562,25.7,Medica,Medical Assistance,,,,,Included in per diem rate,
ELECTRODE NEEDLE COATED INSULATE  E1465,,A4649,HCPCS,Facility,Outpatient,,,,25.7,21.845,7.36562,25.7,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,12.7986,49.8,,percent of total billed charges,,
ELECTRODE NEEDLE COATED INSULATE  E1465,,A4649,HCPCS,Facility,Inpatient,,,,25.7,21.845,7.36562,25.7,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
ELECTRODE NEEDLE COATED INSULATE  E1465,,A4649,HCPCS,Facility,Both,,,,25.7,21.845,7.36562,25.7,"Multiplan, Inc.","Multiplan, Inc.",24.158,94,,percent of total billed charges,,
ELECTRODE NEEDLE COATED INSULATE  E1465,,A4649,HCPCS,Facility,Outpatient,,,,25.7,21.845,7.36562,25.7,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,23.1557,90.1,,percent of total billed charges,,
ELECTRODE NEEDLE COATED INSULATE  E1465,,A4649,HCPCS,Facility,Inpatient,,,,25.7,21.845,7.36562,25.7,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
ELECTRODE NEEDLE COATED INSULATE  E1465,,A4649,HCPCS,Facility,Both,,,,25.7,21.845,7.36562,25.7,"Preferred One Administrative Services, INC.",PPO,25.3402,98.6,,percent of total billed charges,,
ELECTRODE NEEDLE COATED INSULATE  E1465,,A4649,HCPCS,Facility,Outpatient,,,,25.7,21.845,7.36562,25.7,PrimeWest Health,Minnesota Senior Health Options (MSHO),13.22265,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
ELECTRODE NEEDLE COATED INSULATE  E1465,,A4649,HCPCS,Facility,Inpatient,,,,25.7,21.845,7.36562,25.7,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ELECTRODE NEEDLE COATED INSULATE  E1465,,A4649,HCPCS,Facility,Outpatient,,,,25.7,21.845,7.36562,25.7,PrimeWest Health,MinnesotaCare,13.19952,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
ELECTRODE NEEDLE COATED INSULATE  E1465,,A4649,HCPCS,Facility,Inpatient,,,,25.7,21.845,7.36562,25.7,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
ELECTRODE NEEDLE COATED INSULATE  E1465,,A4649,HCPCS,Facility,Both,,,,25.7,21.845,7.36562,25.7,Sanford Health Plan,Sanford Health Plan,23.644,92,,percent of total billed charges,,
ELECTRODE NEEDLE COATED INSULATE  E1465,,A4649,HCPCS,Facility,Outpatient,,,,25.7,21.845,7.36562,25.7,"UCare Health, Inc.",Individual & Family Plan,14.48195,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
ELECTRODE NEEDLE COATED INSULATE  E1465,,A4649,HCPCS,Facility,Inpatient,,,,25.7,21.845,7.36562,25.7,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
ELECTRODE NEEDLE COATED INSULATE  E1465,,A4649,HCPCS,Facility,Outpatient,,,,25.7,21.845,7.36562,25.7,"UCare Health, Inc.",Medical Assistance,12.97079,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ELECTRODE NEEDLE COATED INSULATE  E1465,,A4649,HCPCS,Facility,Inpatient,,,,25.7,21.845,7.36562,25.7,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
ELECTRODE NEEDLE COATED INSULATE  E1465,,A4649,HCPCS,Facility,Outpatient,,,,25.7,21.845,7.36562,25.7,"UCare Health, Inc.",Medicare Advantage,12.97079,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ELECTRODE NEEDLE COATED INSULATE  E1465,,A4649,HCPCS,Facility,Inpatient,,,,25.7,21.845,7.36562,25.7,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ELECTRODE NEEDLE COATED INSULATE  E1465,,A4649,HCPCS,Facility,Outpatient,,,,25.7,21.845,7.36562,25.7,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),12.97079,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ELECTRODE NEEDLE COATED INSULATE  E1465,,A4649,HCPCS,Facility,Inpatient,,,,25.7,21.845,7.36562,25.7,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ELECTRODE NEEDLE COATED INSULATE  E1465,,A4649,HCPCS,Facility,Both,,,,25.7,21.845,7.36562,25.7,UnitedHealthcare,Individual & Family,24.158,94,,percent of total billed charges,,
ELECTRODE NEEDLE COATED INSULATE  E1465,,A4649,HCPCS,Facility,Outpatient,,,,25.7,21.845,7.36562,25.7,UnitedHealthcare,Medicare Advantage,12.593,49,,percent of total billed charges,,
ELECTRODE NEEDLE COATED INSULATE  E1465,,A4649,HCPCS,Facility,Inpatient,,,,25.7,21.845,7.36562,25.7,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
ELECTRODE NEEDLE COATED INSULATE  E1465,,A4649,HCPCS,Facility,Outpatient,,,,25.7,21.845,7.36562,25.7,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,12.336,48,,percent of total billed charges,,100% of DHS outpatient percentage
ELECTRODE NEEDLE COATED INSULATE  E1465,,A4649,HCPCS,Facility,Inpatient,,,,25.7,21.845,7.36562,25.7,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
ELECTROSURIG SUCTN/IRRIG INST,,A4649,HCPCS,Facility,Both,,,,170.8,145.18,48.95128,170.8,Aetna,Commercial,157.136,92,,percent of total billed charges,,
ELECTROSURIG SUCTN/IRRIG INST,,A4649,HCPCS,Facility,Outpatient,,,,170.8,145.18,48.95128,170.8,Aetna,Medicare Advantage,83.692,49,,percent of total billed charges,,
ELECTROSURIG SUCTN/IRRIG INST,,A4649,HCPCS,Facility,Inpatient,,,,170.8,145.18,48.95128,170.8,Aetna,Medicare Advantage,,,,,Included in per diem rate,
ELECTROSURIG SUCTN/IRRIG INST,,A4649,HCPCS,Facility,Both,,,,170.8,145.18,48.95128,170.8,Aetna,PPO,158.844,93,,percent of total billed charges,,
ELECTROSURIG SUCTN/IRRIG INST,,A4649,HCPCS,Facility,Both,,,,170.8,145.18,48.95128,170.8,America's PPO,America's PPO,164.01924,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
ELECTROSURIG SUCTN/IRRIG INST,,A4649,HCPCS,Facility,Both,,,,170.8,145.18,48.95128,170.8,BlueCross BlueShield Minnesota, Federal Employee Program,168.0672,98.4,,percent of total billed charges,,
ELECTROSURIG SUCTN/IRRIG INST,,A4649,HCPCS,Facility,Both,,,,170.8,145.18,48.95128,170.8,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,170.8,100,,percent of total billed charges,,
ELECTROSURIG SUCTN/IRRIG INST,,A4649,HCPCS,Facility,Both,,,,170.8,145.18,48.95128,170.8,BlueCross BlueShield Minnesota,High Value Network Plan,153.72,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
ELECTROSURIG SUCTN/IRRIG INST,,A4649,HCPCS,Facility,Outpatient,,,,170.8,145.18,48.95128,170.8,BlueCross BlueShield Minnesota,Medicare Advantage,83.692,49,,percent of total billed charges,,
ELECTROSURIG SUCTN/IRRIG INST,,A4649,HCPCS,Facility,Inpatient,,,,170.8,145.18,48.95128,170.8,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
ELECTROSURIG SUCTN/IRRIG INST,,A4649,HCPCS,Facility,Both,,,,170.8,145.18,48.95128,170.8,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,151.27756,88.57,,percent of total billed charges,,
ELECTROSURIG SUCTN/IRRIG INST,,A4649,HCPCS,Facility,Both,,,,170.8,145.18,48.95128,170.8,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,48.95128,28.66,,percent of total billed charges,,
ELECTROSURIG SUCTN/IRRIG INST,,A4649,HCPCS,Facility,Outpatient,,,,170.8,145.18,48.95128,170.8,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),83.692,49,,percent of total billed charges,,
ELECTROSURIG SUCTN/IRRIG INST,,A4649,HCPCS,Facility,Inpatient,,,,170.8,145.18,48.95128,170.8,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
ELECTROSURIG SUCTN/IRRIG INST,,A4649,HCPCS,Facility,Both,,,,170.8,145.18,48.95128,170.8,CorVel,Worker's Compensation,170.8,100,,percent of total billed charges,,
ELECTROSURIG SUCTN/IRRIG INST,,A4649,HCPCS,Facility,Both,,,,170.8,145.18,48.95128,170.8,First Health Group Corporation,First Health Network,165.676,97,,percent of total billed charges,,
ELECTROSURIG SUCTN/IRRIG INST,,A4649,HCPCS,Facility,Both,,,,170.8,145.18,48.95128,170.8,"Health Partners, Inc.",Commercial,161.5768,94.6,,percent of total billed charges,,
ELECTROSURIG SUCTN/IRRIG INST,,A4649,HCPCS,Facility,Outpatient,,,,170.8,145.18,48.95128,170.8,"Health Partners, Inc.",Medicare Advantage,83.692,49,,percent of total billed charges,,
ELECTROSURIG SUCTN/IRRIG INST,,A4649,HCPCS,Facility,Inpatient,,,,170.8,145.18,48.95128,170.8,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ELECTROSURIG SUCTN/IRRIG INST,,A4649,HCPCS,Facility,Both,,,,170.8,145.18,48.95128,170.8,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),102.48,60,,percent of total billed charges,,
ELECTROSURIG SUCTN/IRRIG INST,,A4649,HCPCS,Facility,Both,,,,170.8,145.18,48.95128,170.8,"Health Partners, Inc.",State of Minnesota Advantage Program,139.202,81.5,,percent of total billed charges,,
ELECTROSURIG SUCTN/IRRIG INST,,A4649,HCPCS,Facility,Both,,,,170.8,145.18,48.95128,170.8,"Health Partners, Inc.",State Public Programs,85.4,50,,percent of total billed charges,,
ELECTROSURIG SUCTN/IRRIG INST,,A4649,HCPCS,Facility,Both,,,,170.8,145.18,48.95128,170.8,Humana Insurance Company,Commercial PPO,162.26,95,,percent of total billed charges,,
ELECTROSURIG SUCTN/IRRIG INST,,A4649,HCPCS,Facility,Outpatient,,,,170.8,145.18,48.95128,170.8,Humana Insurance Company,Medicare PPO,83.692,49,,percent of total billed charges,,
ELECTROSURIG SUCTN/IRRIG INST,,A4649,HCPCS,Facility,Inpatient,,,,170.8,145.18,48.95128,170.8,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
ELECTROSURIG SUCTN/IRRIG INST,,A4649,HCPCS,Facility,Both,,,,170.8,145.18,48.95128,170.8,Medica,Individual & Family,169.2628,99.1,,percent of total billed charges,,
ELECTROSURIG SUCTN/IRRIG INST,,A4649,HCPCS,Facility,Outpatient,,,,170.8,145.18,48.95128,170.8,Medica,Medica Advantage Solution,85.0584,49.8,,percent of total billed charges,,
ELECTROSURIG SUCTN/IRRIG INST,,A4649,HCPCS,Facility,Inpatient,,,,170.8,145.18,48.95128,170.8,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
ELECTROSURIG SUCTN/IRRIG INST,,A4649,HCPCS,Facility,Outpatient,,,,170.8,145.18,48.95128,170.8,Medica,Medical Assistance,76.1768,44.6,,percent of total billed charges,,
ELECTROSURIG SUCTN/IRRIG INST,,A4649,HCPCS,Facility,Inpatient,,,,170.8,145.18,48.95128,170.8,Medica,Medical Assistance,,,,,Included in per diem rate,
ELECTROSURIG SUCTN/IRRIG INST,,A4649,HCPCS,Facility,Outpatient,,,,170.8,145.18,48.95128,170.8,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,85.0584,49.8,,percent of total billed charges,,
ELECTROSURIG SUCTN/IRRIG INST,,A4649,HCPCS,Facility,Inpatient,,,,170.8,145.18,48.95128,170.8,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
ELECTROSURIG SUCTN/IRRIG INST,,A4649,HCPCS,Facility,Both,,,,170.8,145.18,48.95128,170.8,"Multiplan, Inc.","Multiplan, Inc.",160.552,94,,percent of total billed charges,,
ELECTROSURIG SUCTN/IRRIG INST,,A4649,HCPCS,Facility,Outpatient,,,,170.8,145.18,48.95128,170.8,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,153.8908,90.1,,percent of total billed charges,,
ELECTROSURIG SUCTN/IRRIG INST,,A4649,HCPCS,Facility,Inpatient,,,,170.8,145.18,48.95128,170.8,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
ELECTROSURIG SUCTN/IRRIG INST,,A4649,HCPCS,Facility,Both,,,,170.8,145.18,48.95128,170.8,"Preferred One Administrative Services, INC.",PPO,168.4088,98.6,,percent of total billed charges,,
ELECTROSURIG SUCTN/IRRIG INST,,A4649,HCPCS,Facility,Outpatient,,,,170.8,145.18,48.95128,170.8,PrimeWest Health,Minnesota Senior Health Options (MSHO),87.8766,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
ELECTROSURIG SUCTN/IRRIG INST,,A4649,HCPCS,Facility,Inpatient,,,,170.8,145.18,48.95128,170.8,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ELECTROSURIG SUCTN/IRRIG INST,,A4649,HCPCS,Facility,Outpatient,,,,170.8,145.18,48.95128,170.8,PrimeWest Health,MinnesotaCare,87.72288,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
ELECTROSURIG SUCTN/IRRIG INST,,A4649,HCPCS,Facility,Inpatient,,,,170.8,145.18,48.95128,170.8,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
ELECTROSURIG SUCTN/IRRIG INST,,A4649,HCPCS,Facility,Both,,,,170.8,145.18,48.95128,170.8,Sanford Health Plan,Sanford Health Plan,157.136,92,,percent of total billed charges,,
ELECTROSURIG SUCTN/IRRIG INST,,A4649,HCPCS,Facility,Outpatient,,,,170.8,145.18,48.95128,170.8,"UCare Health, Inc.",Individual & Family Plan,96.2458,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
ELECTROSURIG SUCTN/IRRIG INST,,A4649,HCPCS,Facility,Inpatient,,,,170.8,145.18,48.95128,170.8,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
ELECTROSURIG SUCTN/IRRIG INST,,A4649,HCPCS,Facility,Outpatient,,,,170.8,145.18,48.95128,170.8,"UCare Health, Inc.",Medical Assistance,86.20276,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ELECTROSURIG SUCTN/IRRIG INST,,A4649,HCPCS,Facility,Inpatient,,,,170.8,145.18,48.95128,170.8,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
ELECTROSURIG SUCTN/IRRIG INST,,A4649,HCPCS,Facility,Outpatient,,,,170.8,145.18,48.95128,170.8,"UCare Health, Inc.",Medicare Advantage,86.20276,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ELECTROSURIG SUCTN/IRRIG INST,,A4649,HCPCS,Facility,Inpatient,,,,170.8,145.18,48.95128,170.8,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ELECTROSURIG SUCTN/IRRIG INST,,A4649,HCPCS,Facility,Outpatient,,,,170.8,145.18,48.95128,170.8,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),86.20276,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ELECTROSURIG SUCTN/IRRIG INST,,A4649,HCPCS,Facility,Inpatient,,,,170.8,145.18,48.95128,170.8,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ELECTROSURIG SUCTN/IRRIG INST,,A4649,HCPCS,Facility,Both,,,,170.8,145.18,48.95128,170.8,UnitedHealthcare,Individual & Family,160.552,94,,percent of total billed charges,,
ELECTROSURIG SUCTN/IRRIG INST,,A4649,HCPCS,Facility,Outpatient,,,,170.8,145.18,48.95128,170.8,UnitedHealthcare,Medicare Advantage,83.692,49,,percent of total billed charges,,
ELECTROSURIG SUCTN/IRRIG INST,,A4649,HCPCS,Facility,Inpatient,,,,170.8,145.18,48.95128,170.8,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
ELECTROSURIG SUCTN/IRRIG INST,,A4649,HCPCS,Facility,Outpatient,,,,170.8,145.18,48.95128,170.8,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,81.984,48,,percent of total billed charges,,100% of DHS outpatient percentage
ELECTROSURIG SUCTN/IRRIG INST,,A4649,HCPCS,Facility,Inpatient,,,,170.8,145.18,48.95128,170.8,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
ENDO CLIP 10MM (MED/LARGE)     176657,,A4649,HCPCS,Facility,Both,,,,297.815,253.14275,85.353779,297.815,Aetna,Commercial,273.9898,92,,percent of total billed charges,,
ENDO CLIP 10MM (MED/LARGE)     176657,,A4649,HCPCS,Facility,Outpatient,,,,297.815,253.14275,85.353779,297.815,Aetna,Medicare Advantage,145.92935,49,,percent of total billed charges,,
ENDO CLIP 10MM (MED/LARGE)     176657,,A4649,HCPCS,Facility,Inpatient,,,,297.815,253.14275,85.353779,297.815,Aetna,Medicare Advantage,,,,,Included in per diem rate,
ENDO CLIP 10MM (MED/LARGE)     176657,,A4649,HCPCS,Facility,Both,,,,297.815,253.14275,85.353779,297.815,Aetna,PPO,276.96795,93,,percent of total billed charges,,
ENDO CLIP 10MM (MED/LARGE)     176657,,A4649,HCPCS,Facility,Both,,,,297.815,253.14275,85.353779,297.815,America's PPO,America's PPO,285.9917445,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
ENDO CLIP 10MM (MED/LARGE)     176657,,A4649,HCPCS,Facility,Both,,,,297.815,253.14275,85.353779,297.815,BlueCross BlueShield Minnesota, Federal Employee Program,293.04996,98.4,,percent of total billed charges,,
ENDO CLIP 10MM (MED/LARGE)     176657,,A4649,HCPCS,Facility,Both,,,,297.815,253.14275,85.353779,297.815,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,297.815,100,,percent of total billed charges,,
ENDO CLIP 10MM (MED/LARGE)     176657,,A4649,HCPCS,Facility,Both,,,,297.815,253.14275,85.353779,297.815,BlueCross BlueShield Minnesota,High Value Network Plan,268.0335,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
ENDO CLIP 10MM (MED/LARGE)     176657,,A4649,HCPCS,Facility,Outpatient,,,,297.815,253.14275,85.353779,297.815,BlueCross BlueShield Minnesota,Medicare Advantage,145.92935,49,,percent of total billed charges,,
ENDO CLIP 10MM (MED/LARGE)     176657,,A4649,HCPCS,Facility,Inpatient,,,,297.815,253.14275,85.353779,297.815,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
ENDO CLIP 10MM (MED/LARGE)     176657,,A4649,HCPCS,Facility,Both,,,,297.815,253.14275,85.353779,297.815,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,263.7747455,88.57,,percent of total billed charges,,
ENDO CLIP 10MM (MED/LARGE)     176657,,A4649,HCPCS,Facility,Both,,,,297.815,253.14275,85.353779,297.815,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,85.353779,28.66,,percent of total billed charges,,
ENDO CLIP 10MM (MED/LARGE)     176657,,A4649,HCPCS,Facility,Outpatient,,,,297.815,253.14275,85.353779,297.815,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),145.92935,49,,percent of total billed charges,,
ENDO CLIP 10MM (MED/LARGE)     176657,,A4649,HCPCS,Facility,Inpatient,,,,297.815,253.14275,85.353779,297.815,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
ENDO CLIP 10MM (MED/LARGE)     176657,,A4649,HCPCS,Facility,Both,,,,297.815,253.14275,85.353779,297.815,CorVel,Worker's Compensation,297.815,100,,percent of total billed charges,,
ENDO CLIP 10MM (MED/LARGE)     176657,,A4649,HCPCS,Facility,Both,,,,297.815,253.14275,85.353779,297.815,First Health Group Corporation,First Health Network,288.88055,97,,percent of total billed charges,,
ENDO CLIP 10MM (MED/LARGE)     176657,,A4649,HCPCS,Facility,Both,,,,297.815,253.14275,85.353779,297.815,"Health Partners, Inc.",Commercial,281.73299,94.6,,percent of total billed charges,,
ENDO CLIP 10MM (MED/LARGE)     176657,,A4649,HCPCS,Facility,Outpatient,,,,297.815,253.14275,85.353779,297.815,"Health Partners, Inc.",Medicare Advantage,145.92935,49,,percent of total billed charges,,
ENDO CLIP 10MM (MED/LARGE)     176657,,A4649,HCPCS,Facility,Inpatient,,,,297.815,253.14275,85.353779,297.815,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ENDO CLIP 10MM (MED/LARGE)     176657,,A4649,HCPCS,Facility,Both,,,,297.815,253.14275,85.353779,297.815,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),178.689,60,,percent of total billed charges,,
ENDO CLIP 10MM (MED/LARGE)     176657,,A4649,HCPCS,Facility,Both,,,,297.815,253.14275,85.353779,297.815,"Health Partners, Inc.",State of Minnesota Advantage Program,242.719225,81.5,,percent of total billed charges,,
ENDO CLIP 10MM (MED/LARGE)     176657,,A4649,HCPCS,Facility,Both,,,,297.815,253.14275,85.353779,297.815,"Health Partners, Inc.",State Public Programs,148.9075,50,,percent of total billed charges,,
ENDO CLIP 10MM (MED/LARGE)     176657,,A4649,HCPCS,Facility,Both,,,,297.815,253.14275,85.353779,297.815,Humana Insurance Company,Commercial PPO,282.92425,95,,percent of total billed charges,,
ENDO CLIP 10MM (MED/LARGE)     176657,,A4649,HCPCS,Facility,Outpatient,,,,297.815,253.14275,85.353779,297.815,Humana Insurance Company,Medicare PPO,145.92935,49,,percent of total billed charges,,
ENDO CLIP 10MM (MED/LARGE)     176657,,A4649,HCPCS,Facility,Inpatient,,,,297.815,253.14275,85.353779,297.815,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
ENDO CLIP 10MM (MED/LARGE)     176657,,A4649,HCPCS,Facility,Both,,,,297.815,253.14275,85.353779,297.815,Medica,Individual & Family,295.134665,99.1,,percent of total billed charges,,
ENDO CLIP 10MM (MED/LARGE)     176657,,A4649,HCPCS,Facility,Outpatient,,,,297.815,253.14275,85.353779,297.815,Medica,Medica Advantage Solution,148.31187,49.8,,percent of total billed charges,,
ENDO CLIP 10MM (MED/LARGE)     176657,,A4649,HCPCS,Facility,Inpatient,,,,297.815,253.14275,85.353779,297.815,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
ENDO CLIP 10MM (MED/LARGE)     176657,,A4649,HCPCS,Facility,Outpatient,,,,297.815,253.14275,85.353779,297.815,Medica,Medical Assistance,132.82549,44.6,,percent of total billed charges,,
ENDO CLIP 10MM (MED/LARGE)     176657,,A4649,HCPCS,Facility,Inpatient,,,,297.815,253.14275,85.353779,297.815,Medica,Medical Assistance,,,,,Included in per diem rate,
ENDO CLIP 10MM (MED/LARGE)     176657,,A4649,HCPCS,Facility,Outpatient,,,,297.815,253.14275,85.353779,297.815,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,148.31187,49.8,,percent of total billed charges,,
ENDO CLIP 10MM (MED/LARGE)     176657,,A4649,HCPCS,Facility,Inpatient,,,,297.815,253.14275,85.353779,297.815,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
ENDO CLIP 10MM (MED/LARGE)     176657,,A4649,HCPCS,Facility,Both,,,,297.815,253.14275,85.353779,297.815,"Multiplan, Inc.","Multiplan, Inc.",279.9461,94,,percent of total billed charges,,
ENDO CLIP 10MM (MED/LARGE)     176657,,A4649,HCPCS,Facility,Outpatient,,,,297.815,253.14275,85.353779,297.815,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,268.331315,90.1,,percent of total billed charges,,
ENDO CLIP 10MM (MED/LARGE)     176657,,A4649,HCPCS,Facility,Inpatient,,,,297.815,253.14275,85.353779,297.815,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
ENDO CLIP 10MM (MED/LARGE)     176657,,A4649,HCPCS,Facility,Both,,,,297.815,253.14275,85.353779,297.815,"Preferred One Administrative Services, INC.",PPO,293.64559,98.6,,percent of total billed charges,,
ENDO CLIP 10MM (MED/LARGE)     176657,,A4649,HCPCS,Facility,Outpatient,,,,297.815,253.14275,85.353779,297.815,PrimeWest Health,Minnesota Senior Health Options (MSHO),153.2258175,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
ENDO CLIP 10MM (MED/LARGE)     176657,,A4649,HCPCS,Facility,Inpatient,,,,297.815,253.14275,85.353779,297.815,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ENDO CLIP 10MM (MED/LARGE)     176657,,A4649,HCPCS,Facility,Outpatient,,,,297.815,253.14275,85.353779,297.815,PrimeWest Health,MinnesotaCare,152.957784,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
ENDO CLIP 10MM (MED/LARGE)     176657,,A4649,HCPCS,Facility,Inpatient,,,,297.815,253.14275,85.353779,297.815,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
ENDO CLIP 10MM (MED/LARGE)     176657,,A4649,HCPCS,Facility,Both,,,,297.815,253.14275,85.353779,297.815,Sanford Health Plan,Sanford Health Plan,273.9898,92,,percent of total billed charges,,
ENDO CLIP 10MM (MED/LARGE)     176657,,A4649,HCPCS,Facility,Outpatient,,,,297.815,253.14275,85.353779,297.815,"UCare Health, Inc.",Individual & Family Plan,167.8187525,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
ENDO CLIP 10MM (MED/LARGE)     176657,,A4649,HCPCS,Facility,Inpatient,,,,297.815,253.14275,85.353779,297.815,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
ENDO CLIP 10MM (MED/LARGE)     176657,,A4649,HCPCS,Facility,Outpatient,,,,297.815,253.14275,85.353779,297.815,"UCare Health, Inc.",Medical Assistance,150.3072305,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ENDO CLIP 10MM (MED/LARGE)     176657,,A4649,HCPCS,Facility,Inpatient,,,,297.815,253.14275,85.353779,297.815,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
ENDO CLIP 10MM (MED/LARGE)     176657,,A4649,HCPCS,Facility,Outpatient,,,,297.815,253.14275,85.353779,297.815,"UCare Health, Inc.",Medicare Advantage,150.3072305,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ENDO CLIP 10MM (MED/LARGE)     176657,,A4649,HCPCS,Facility,Inpatient,,,,297.815,253.14275,85.353779,297.815,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ENDO CLIP 10MM (MED/LARGE)     176657,,A4649,HCPCS,Facility,Outpatient,,,,297.815,253.14275,85.353779,297.815,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),150.3072305,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ENDO CLIP 10MM (MED/LARGE)     176657,,A4649,HCPCS,Facility,Inpatient,,,,297.815,253.14275,85.353779,297.815,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ENDO CLIP 10MM (MED/LARGE)     176657,,A4649,HCPCS,Facility,Both,,,,297.815,253.14275,85.353779,297.815,UnitedHealthcare,Individual & Family,279.9461,94,,percent of total billed charges,,
ENDO CLIP 10MM (MED/LARGE)     176657,,A4649,HCPCS,Facility,Outpatient,,,,297.815,253.14275,85.353779,297.815,UnitedHealthcare,Medicare Advantage,145.92935,49,,percent of total billed charges,,
ENDO CLIP 10MM (MED/LARGE)     176657,,A4649,HCPCS,Facility,Inpatient,,,,297.815,253.14275,85.353779,297.815,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
ENDO CLIP 10MM (MED/LARGE)     176657,,A4649,HCPCS,Facility,Outpatient,,,,297.815,253.14275,85.353779,297.815,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,142.9512,48,,percent of total billed charges,,100% of DHS outpatient percentage
ENDO CLIP 10MM (MED/LARGE)     176657,,A4649,HCPCS,Facility,Inpatient,,,,297.815,253.14275,85.353779,297.815,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
ENDO CLIP 10MM L  (LARGE)  176625,,A4649,HCPCS,Facility,Both,,,,309.295,262.90075,88.643947,309.295,Aetna,Commercial,284.5514,92,,percent of total billed charges,,
ENDO CLIP 10MM L  (LARGE)  176625,,A4649,HCPCS,Facility,Outpatient,,,,309.295,262.90075,88.643947,309.295,Aetna,Medicare Advantage,151.55455,49,,percent of total billed charges,,
ENDO CLIP 10MM L  (LARGE)  176625,,A4649,HCPCS,Facility,Inpatient,,,,309.295,262.90075,88.643947,309.295,Aetna,Medicare Advantage,,,,,Included in per diem rate,
ENDO CLIP 10MM L  (LARGE)  176625,,A4649,HCPCS,Facility,Both,,,,309.295,262.90075,88.643947,309.295,Aetna,PPO,287.64435,93,,percent of total billed charges,,
ENDO CLIP 10MM L  (LARGE)  176625,,A4649,HCPCS,Facility,Both,,,,309.295,262.90075,88.643947,309.295,America's PPO,America's PPO,297.0159885,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
ENDO CLIP 10MM L  (LARGE)  176625,,A4649,HCPCS,Facility,Both,,,,309.295,262.90075,88.643947,309.295,BlueCross BlueShield Minnesota, Federal Employee Program,304.34628,98.4,,percent of total billed charges,,
ENDO CLIP 10MM L  (LARGE)  176625,,A4649,HCPCS,Facility,Both,,,,309.295,262.90075,88.643947,309.295,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,309.295,100,,percent of total billed charges,,
ENDO CLIP 10MM L  (LARGE)  176625,,A4649,HCPCS,Facility,Both,,,,309.295,262.90075,88.643947,309.295,BlueCross BlueShield Minnesota,High Value Network Plan,278.3655,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
ENDO CLIP 10MM L  (LARGE)  176625,,A4649,HCPCS,Facility,Outpatient,,,,309.295,262.90075,88.643947,309.295,BlueCross BlueShield Minnesota,Medicare Advantage,151.55455,49,,percent of total billed charges,,
ENDO CLIP 10MM L  (LARGE)  176625,,A4649,HCPCS,Facility,Inpatient,,,,309.295,262.90075,88.643947,309.295,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
ENDO CLIP 10MM L  (LARGE)  176625,,A4649,HCPCS,Facility,Both,,,,309.295,262.90075,88.643947,309.295,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,273.9425815,88.57,,percent of total billed charges,,
ENDO CLIP 10MM L  (LARGE)  176625,,A4649,HCPCS,Facility,Both,,,,309.295,262.90075,88.643947,309.295,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,88.643947,28.66,,percent of total billed charges,,
ENDO CLIP 10MM L  (LARGE)  176625,,A4649,HCPCS,Facility,Outpatient,,,,309.295,262.90075,88.643947,309.295,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),151.55455,49,,percent of total billed charges,,
ENDO CLIP 10MM L  (LARGE)  176625,,A4649,HCPCS,Facility,Inpatient,,,,309.295,262.90075,88.643947,309.295,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
ENDO CLIP 10MM L  (LARGE)  176625,,A4649,HCPCS,Facility,Both,,,,309.295,262.90075,88.643947,309.295,CorVel,Worker's Compensation,309.295,100,,percent of total billed charges,,
ENDO CLIP 10MM L  (LARGE)  176625,,A4649,HCPCS,Facility,Both,,,,309.295,262.90075,88.643947,309.295,First Health Group Corporation,First Health Network,300.01615,97,,percent of total billed charges,,
ENDO CLIP 10MM L  (LARGE)  176625,,A4649,HCPCS,Facility,Both,,,,309.295,262.90075,88.643947,309.295,"Health Partners, Inc.",Commercial,292.59307,94.6,,percent of total billed charges,,
ENDO CLIP 10MM L  (LARGE)  176625,,A4649,HCPCS,Facility,Outpatient,,,,309.295,262.90075,88.643947,309.295,"Health Partners, Inc.",Medicare Advantage,151.55455,49,,percent of total billed charges,,
ENDO CLIP 10MM L  (LARGE)  176625,,A4649,HCPCS,Facility,Inpatient,,,,309.295,262.90075,88.643947,309.295,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ENDO CLIP 10MM L  (LARGE)  176625,,A4649,HCPCS,Facility,Both,,,,309.295,262.90075,88.643947,309.295,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),185.577,60,,percent of total billed charges,,
ENDO CLIP 10MM L  (LARGE)  176625,,A4649,HCPCS,Facility,Both,,,,309.295,262.90075,88.643947,309.295,"Health Partners, Inc.",State of Minnesota Advantage Program,252.075425,81.5,,percent of total billed charges,,
ENDO CLIP 10MM L  (LARGE)  176625,,A4649,HCPCS,Facility,Both,,,,309.295,262.90075,88.643947,309.295,"Health Partners, Inc.",State Public Programs,154.6475,50,,percent of total billed charges,,
ENDO CLIP 10MM L  (LARGE)  176625,,A4649,HCPCS,Facility,Both,,,,309.295,262.90075,88.643947,309.295,Humana Insurance Company,Commercial PPO,293.83025,95,,percent of total billed charges,,
ENDO CLIP 10MM L  (LARGE)  176625,,A4649,HCPCS,Facility,Outpatient,,,,309.295,262.90075,88.643947,309.295,Humana Insurance Company,Medicare PPO,151.55455,49,,percent of total billed charges,,
ENDO CLIP 10MM L  (LARGE)  176625,,A4649,HCPCS,Facility,Inpatient,,,,309.295,262.90075,88.643947,309.295,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
ENDO CLIP 10MM L  (LARGE)  176625,,A4649,HCPCS,Facility,Both,,,,309.295,262.90075,88.643947,309.295,Medica,Individual & Family,306.511345,99.1,,percent of total billed charges,,
ENDO CLIP 10MM L  (LARGE)  176625,,A4649,HCPCS,Facility,Outpatient,,,,309.295,262.90075,88.643947,309.295,Medica,Medica Advantage Solution,154.02891,49.8,,percent of total billed charges,,
ENDO CLIP 10MM L  (LARGE)  176625,,A4649,HCPCS,Facility,Inpatient,,,,309.295,262.90075,88.643947,309.295,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
ENDO CLIP 10MM L  (LARGE)  176625,,A4649,HCPCS,Facility,Outpatient,,,,309.295,262.90075,88.643947,309.295,Medica,Medical Assistance,137.94557,44.6,,percent of total billed charges,,
ENDO CLIP 10MM L  (LARGE)  176625,,A4649,HCPCS,Facility,Inpatient,,,,309.295,262.90075,88.643947,309.295,Medica,Medical Assistance,,,,,Included in per diem rate,
ENDO CLIP 10MM L  (LARGE)  176625,,A4649,HCPCS,Facility,Outpatient,,,,309.295,262.90075,88.643947,309.295,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,154.02891,49.8,,percent of total billed charges,,
ENDO CLIP 10MM L  (LARGE)  176625,,A4649,HCPCS,Facility,Inpatient,,,,309.295,262.90075,88.643947,309.295,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
ENDO CLIP 10MM L  (LARGE)  176625,,A4649,HCPCS,Facility,Both,,,,309.295,262.90075,88.643947,309.295,"Multiplan, Inc.","Multiplan, Inc.",290.7373,94,,percent of total billed charges,,
ENDO CLIP 10MM L  (LARGE)  176625,,A4649,HCPCS,Facility,Outpatient,,,,309.295,262.90075,88.643947,309.295,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,278.674795,90.1,,percent of total billed charges,,
ENDO CLIP 10MM L  (LARGE)  176625,,A4649,HCPCS,Facility,Inpatient,,,,309.295,262.90075,88.643947,309.295,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
ENDO CLIP 10MM L  (LARGE)  176625,,A4649,HCPCS,Facility,Both,,,,309.295,262.90075,88.643947,309.295,"Preferred One Administrative Services, INC.",PPO,304.96487,98.6,,percent of total billed charges,,
ENDO CLIP 10MM L  (LARGE)  176625,,A4649,HCPCS,Facility,Outpatient,,,,309.295,262.90075,88.643947,309.295,PrimeWest Health,Minnesota Senior Health Options (MSHO),159.1322775,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
ENDO CLIP 10MM L  (LARGE)  176625,,A4649,HCPCS,Facility,Inpatient,,,,309.295,262.90075,88.643947,309.295,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ENDO CLIP 10MM L  (LARGE)  176625,,A4649,HCPCS,Facility,Outpatient,,,,309.295,262.90075,88.643947,309.295,PrimeWest Health,MinnesotaCare,158.853912,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
ENDO CLIP 10MM L  (LARGE)  176625,,A4649,HCPCS,Facility,Inpatient,,,,309.295,262.90075,88.643947,309.295,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
ENDO CLIP 10MM L  (LARGE)  176625,,A4649,HCPCS,Facility,Both,,,,309.295,262.90075,88.643947,309.295,Sanford Health Plan,Sanford Health Plan,284.5514,92,,percent of total billed charges,,
ENDO CLIP 10MM L  (LARGE)  176625,,A4649,HCPCS,Facility,Outpatient,,,,309.295,262.90075,88.643947,309.295,"UCare Health, Inc.",Individual & Family Plan,174.2877325,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
ENDO CLIP 10MM L  (LARGE)  176625,,A4649,HCPCS,Facility,Inpatient,,,,309.295,262.90075,88.643947,309.295,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
ENDO CLIP 10MM L  (LARGE)  176625,,A4649,HCPCS,Facility,Outpatient,,,,309.295,262.90075,88.643947,309.295,"UCare Health, Inc.",Medical Assistance,156.1011865,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ENDO CLIP 10MM L  (LARGE)  176625,,A4649,HCPCS,Facility,Inpatient,,,,309.295,262.90075,88.643947,309.295,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
ENDO CLIP 10MM L  (LARGE)  176625,,A4649,HCPCS,Facility,Outpatient,,,,309.295,262.90075,88.643947,309.295,"UCare Health, Inc.",Medicare Advantage,156.1011865,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ENDO CLIP 10MM L  (LARGE)  176625,,A4649,HCPCS,Facility,Inpatient,,,,309.295,262.90075,88.643947,309.295,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ENDO CLIP 10MM L  (LARGE)  176625,,A4649,HCPCS,Facility,Outpatient,,,,309.295,262.90075,88.643947,309.295,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),156.1011865,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ENDO CLIP 10MM L  (LARGE)  176625,,A4649,HCPCS,Facility,Inpatient,,,,309.295,262.90075,88.643947,309.295,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ENDO CLIP 10MM L  (LARGE)  176625,,A4649,HCPCS,Facility,Both,,,,309.295,262.90075,88.643947,309.295,UnitedHealthcare,Individual & Family,290.7373,94,,percent of total billed charges,,
ENDO CLIP 10MM L  (LARGE)  176625,,A4649,HCPCS,Facility,Outpatient,,,,309.295,262.90075,88.643947,309.295,UnitedHealthcare,Medicare Advantage,151.55455,49,,percent of total billed charges,,
ENDO CLIP 10MM L  (LARGE)  176625,,A4649,HCPCS,Facility,Inpatient,,,,309.295,262.90075,88.643947,309.295,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
ENDO CLIP 10MM L  (LARGE)  176625,,A4649,HCPCS,Facility,Outpatient,,,,309.295,262.90075,88.643947,309.295,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,148.4616,48,,percent of total billed charges,,100% of DHS outpatient percentage
ENDO CLIP 10MM L  (LARGE)  176625,,A4649,HCPCS,Facility,Inpatient,,,,309.295,262.90075,88.643947,309.295,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
ENDO GIA REFILL 030807L,,A4649,HCPCS,Facility,Both,,,,779.675,662.72375,223.454855,779.675,Aetna,Commercial,717.301,92,,percent of total billed charges,,
ENDO GIA REFILL 030807L,,A4649,HCPCS,Facility,Outpatient,,,,779.675,662.72375,223.454855,779.675,Aetna,Medicare Advantage,382.04075,49,,percent of total billed charges,,
ENDO GIA REFILL 030807L,,A4649,HCPCS,Facility,Inpatient,,,,779.675,662.72375,223.454855,779.675,Aetna,Medicare Advantage,,,,,Included in per diem rate,
ENDO GIA REFILL 030807L,,A4649,HCPCS,Facility,Both,,,,779.675,662.72375,223.454855,779.675,Aetna,PPO,725.09775,93,,percent of total billed charges,,
ENDO GIA REFILL 030807L,,A4649,HCPCS,Facility,Both,,,,779.675,662.72375,223.454855,779.675,America's PPO,America's PPO,748.7219025,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
ENDO GIA REFILL 030807L,,A4649,HCPCS,Facility,Both,,,,779.675,662.72375,223.454855,779.675,BlueCross BlueShield Minnesota, Federal Employee Program,767.2002,98.4,,percent of total billed charges,,
ENDO GIA REFILL 030807L,,A4649,HCPCS,Facility,Both,,,,779.675,662.72375,223.454855,779.675,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,779.675,100,,percent of total billed charges,,
ENDO GIA REFILL 030807L,,A4649,HCPCS,Facility,Both,,,,779.675,662.72375,223.454855,779.675,BlueCross BlueShield Minnesota,High Value Network Plan,701.7075,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
ENDO GIA REFILL 030807L,,A4649,HCPCS,Facility,Outpatient,,,,779.675,662.72375,223.454855,779.675,BlueCross BlueShield Minnesota,Medicare Advantage,382.04075,49,,percent of total billed charges,,
ENDO GIA REFILL 030807L,,A4649,HCPCS,Facility,Inpatient,,,,779.675,662.72375,223.454855,779.675,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
ENDO GIA REFILL 030807L,,A4649,HCPCS,Facility,Both,,,,779.675,662.72375,223.454855,779.675,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,690.5581475,88.57,,percent of total billed charges,,
ENDO GIA REFILL 030807L,,A4649,HCPCS,Facility,Both,,,,779.675,662.72375,223.454855,779.675,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,223.454855,28.66,,percent of total billed charges,,
ENDO GIA REFILL 030807L,,A4649,HCPCS,Facility,Outpatient,,,,779.675,662.72375,223.454855,779.675,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),382.04075,49,,percent of total billed charges,,
ENDO GIA REFILL 030807L,,A4649,HCPCS,Facility,Inpatient,,,,779.675,662.72375,223.454855,779.675,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
ENDO GIA REFILL 030807L,,A4649,HCPCS,Facility,Both,,,,779.675,662.72375,223.454855,779.675,CorVel,Worker's Compensation,779.675,100,,percent of total billed charges,,
ENDO GIA REFILL 030807L,,A4649,HCPCS,Facility,Both,,,,779.675,662.72375,223.454855,779.675,First Health Group Corporation,First Health Network,756.28475,97,,percent of total billed charges,,
ENDO GIA REFILL 030807L,,A4649,HCPCS,Facility,Both,,,,779.675,662.72375,223.454855,779.675,"Health Partners, Inc.",Commercial,737.57255,94.6,,percent of total billed charges,,
ENDO GIA REFILL 030807L,,A4649,HCPCS,Facility,Outpatient,,,,779.675,662.72375,223.454855,779.675,"Health Partners, Inc.",Medicare Advantage,382.04075,49,,percent of total billed charges,,
ENDO GIA REFILL 030807L,,A4649,HCPCS,Facility,Inpatient,,,,779.675,662.72375,223.454855,779.675,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ENDO GIA REFILL 030807L,,A4649,HCPCS,Facility,Both,,,,779.675,662.72375,223.454855,779.675,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),467.805,60,,percent of total billed charges,,
ENDO GIA REFILL 030807L,,A4649,HCPCS,Facility,Both,,,,779.675,662.72375,223.454855,779.675,"Health Partners, Inc.",State of Minnesota Advantage Program,635.435125,81.5,,percent of total billed charges,,
ENDO GIA REFILL 030807L,,A4649,HCPCS,Facility,Both,,,,779.675,662.72375,223.454855,779.675,"Health Partners, Inc.",State Public Programs,389.8375,50,,percent of total billed charges,,
ENDO GIA REFILL 030807L,,A4649,HCPCS,Facility,Both,,,,779.675,662.72375,223.454855,779.675,Humana Insurance Company,Commercial PPO,740.69125,95,,percent of total billed charges,,
ENDO GIA REFILL 030807L,,A4649,HCPCS,Facility,Outpatient,,,,779.675,662.72375,223.454855,779.675,Humana Insurance Company,Medicare PPO,382.04075,49,,percent of total billed charges,,
ENDO GIA REFILL 030807L,,A4649,HCPCS,Facility,Inpatient,,,,779.675,662.72375,223.454855,779.675,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
ENDO GIA REFILL 030807L,,A4649,HCPCS,Facility,Both,,,,779.675,662.72375,223.454855,779.675,Medica,Individual & Family,772.657925,99.1,,percent of total billed charges,,
ENDO GIA REFILL 030807L,,A4649,HCPCS,Facility,Outpatient,,,,779.675,662.72375,223.454855,779.675,Medica,Medica Advantage Solution,388.27815,49.8,,percent of total billed charges,,
ENDO GIA REFILL 030807L,,A4649,HCPCS,Facility,Inpatient,,,,779.675,662.72375,223.454855,779.675,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
ENDO GIA REFILL 030807L,,A4649,HCPCS,Facility,Outpatient,,,,779.675,662.72375,223.454855,779.675,Medica,Medical Assistance,347.73505,44.6,,percent of total billed charges,,
ENDO GIA REFILL 030807L,,A4649,HCPCS,Facility,Inpatient,,,,779.675,662.72375,223.454855,779.675,Medica,Medical Assistance,,,,,Included in per diem rate,
ENDO GIA REFILL 030807L,,A4649,HCPCS,Facility,Outpatient,,,,779.675,662.72375,223.454855,779.675,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,388.27815,49.8,,percent of total billed charges,,
ENDO GIA REFILL 030807L,,A4649,HCPCS,Facility,Inpatient,,,,779.675,662.72375,223.454855,779.675,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
ENDO GIA REFILL 030807L,,A4649,HCPCS,Facility,Both,,,,779.675,662.72375,223.454855,779.675,"Multiplan, Inc.","Multiplan, Inc.",732.8945,94,,percent of total billed charges,,
ENDO GIA REFILL 030807L,,A4649,HCPCS,Facility,Outpatient,,,,779.675,662.72375,223.454855,779.675,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,702.487175,90.1,,percent of total billed charges,,
ENDO GIA REFILL 030807L,,A4649,HCPCS,Facility,Inpatient,,,,779.675,662.72375,223.454855,779.675,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
ENDO GIA REFILL 030807L,,A4649,HCPCS,Facility,Both,,,,779.675,662.72375,223.454855,779.675,"Preferred One Administrative Services, INC.",PPO,768.75955,98.6,,percent of total billed charges,,
ENDO GIA REFILL 030807L,,A4649,HCPCS,Facility,Outpatient,,,,779.675,662.72375,223.454855,779.675,PrimeWest Health,Minnesota Senior Health Options (MSHO),401.1427875,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
ENDO GIA REFILL 030807L,,A4649,HCPCS,Facility,Inpatient,,,,779.675,662.72375,223.454855,779.675,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ENDO GIA REFILL 030807L,,A4649,HCPCS,Facility,Outpatient,,,,779.675,662.72375,223.454855,779.675,PrimeWest Health,MinnesotaCare,400.44108,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
ENDO GIA REFILL 030807L,,A4649,HCPCS,Facility,Inpatient,,,,779.675,662.72375,223.454855,779.675,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
ENDO GIA REFILL 030807L,,A4649,HCPCS,Facility,Both,,,,779.675,662.72375,223.454855,779.675,Sanford Health Plan,Sanford Health Plan,717.301,92,,percent of total billed charges,,
ENDO GIA REFILL 030807L,,A4649,HCPCS,Facility,Outpatient,,,,779.675,662.72375,223.454855,779.675,"UCare Health, Inc.",Individual & Family Plan,439.3468625,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
ENDO GIA REFILL 030807L,,A4649,HCPCS,Facility,Inpatient,,,,779.675,662.72375,223.454855,779.675,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
ENDO GIA REFILL 030807L,,A4649,HCPCS,Facility,Outpatient,,,,779.675,662.72375,223.454855,779.675,"UCare Health, Inc.",Medical Assistance,393.5019725,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ENDO GIA REFILL 030807L,,A4649,HCPCS,Facility,Inpatient,,,,779.675,662.72375,223.454855,779.675,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
ENDO GIA REFILL 030807L,,A4649,HCPCS,Facility,Outpatient,,,,779.675,662.72375,223.454855,779.675,"UCare Health, Inc.",Medicare Advantage,393.5019725,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ENDO GIA REFILL 030807L,,A4649,HCPCS,Facility,Inpatient,,,,779.675,662.72375,223.454855,779.675,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ENDO GIA REFILL 030807L,,A4649,HCPCS,Facility,Outpatient,,,,779.675,662.72375,223.454855,779.675,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),393.5019725,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ENDO GIA REFILL 030807L,,A4649,HCPCS,Facility,Inpatient,,,,779.675,662.72375,223.454855,779.675,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ENDO GIA REFILL 030807L,,A4649,HCPCS,Facility,Both,,,,779.675,662.72375,223.454855,779.675,UnitedHealthcare,Individual & Family,732.8945,94,,percent of total billed charges,,
ENDO GIA REFILL 030807L,,A4649,HCPCS,Facility,Outpatient,,,,779.675,662.72375,223.454855,779.675,UnitedHealthcare,Medicare Advantage,382.04075,49,,percent of total billed charges,,
ENDO GIA REFILL 030807L,,A4649,HCPCS,Facility,Inpatient,,,,779.675,662.72375,223.454855,779.675,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
ENDO GIA REFILL 030807L,,A4649,HCPCS,Facility,Outpatient,,,,779.675,662.72375,223.454855,779.675,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,374.244,48,,percent of total billed charges,,100% of DHS outpatient percentage
ENDO GIA REFILL 030807L,,A4649,HCPCS,Facility,Inpatient,,,,779.675,662.72375,223.454855,779.675,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"ENDO SCISSORS, HOOK",,A4649,HCPCS,Facility,Both,,,,164,139.4,47.0024,164,Aetna,Commercial,150.88,92,,percent of total billed charges,,
"ENDO SCISSORS, HOOK",,A4649,HCPCS,Facility,Outpatient,,,,164,139.4,47.0024,164,Aetna,Medicare Advantage,80.36,49,,percent of total billed charges,,
"ENDO SCISSORS, HOOK",,A4649,HCPCS,Facility,Inpatient,,,,164,139.4,47.0024,164,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"ENDO SCISSORS, HOOK",,A4649,HCPCS,Facility,Both,,,,164,139.4,47.0024,164,Aetna,PPO,152.52,93,,percent of total billed charges,,
"ENDO SCISSORS, HOOK",,A4649,HCPCS,Facility,Both,,,,164,139.4,47.0024,164,America's PPO,America's PPO,157.4892,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"ENDO SCISSORS, HOOK",,A4649,HCPCS,Facility,Both,,,,164,139.4,47.0024,164,BlueCross BlueShield Minnesota, Federal Employee Program,161.376,98.4,,percent of total billed charges,,
"ENDO SCISSORS, HOOK",,A4649,HCPCS,Facility,Both,,,,164,139.4,47.0024,164,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,164,100,,percent of total billed charges,,
"ENDO SCISSORS, HOOK",,A4649,HCPCS,Facility,Both,,,,164,139.4,47.0024,164,BlueCross BlueShield Minnesota,High Value Network Plan,147.6,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
"ENDO SCISSORS, HOOK",,A4649,HCPCS,Facility,Outpatient,,,,164,139.4,47.0024,164,BlueCross BlueShield Minnesota,Medicare Advantage,80.36,49,,percent of total billed charges,,
"ENDO SCISSORS, HOOK",,A4649,HCPCS,Facility,Inpatient,,,,164,139.4,47.0024,164,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"ENDO SCISSORS, HOOK",,A4649,HCPCS,Facility,Both,,,,164,139.4,47.0024,164,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,145.2548,88.57,,percent of total billed charges,,
"ENDO SCISSORS, HOOK",,A4649,HCPCS,Facility,Both,,,,164,139.4,47.0024,164,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,47.0024,28.66,,percent of total billed charges,,
"ENDO SCISSORS, HOOK",,A4649,HCPCS,Facility,Outpatient,,,,164,139.4,47.0024,164,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),80.36,49,,percent of total billed charges,,
"ENDO SCISSORS, HOOK",,A4649,HCPCS,Facility,Inpatient,,,,164,139.4,47.0024,164,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"ENDO SCISSORS, HOOK",,A4649,HCPCS,Facility,Both,,,,164,139.4,47.0024,164,CorVel,Worker's Compensation,164,100,,percent of total billed charges,,
"ENDO SCISSORS, HOOK",,A4649,HCPCS,Facility,Both,,,,164,139.4,47.0024,164,First Health Group Corporation,First Health Network,159.08,97,,percent of total billed charges,,
"ENDO SCISSORS, HOOK",,A4649,HCPCS,Facility,Both,,,,164,139.4,47.0024,164,"Health Partners, Inc.",Commercial,155.144,94.6,,percent of total billed charges,,
"ENDO SCISSORS, HOOK",,A4649,HCPCS,Facility,Outpatient,,,,164,139.4,47.0024,164,"Health Partners, Inc.",Medicare Advantage,80.36,49,,percent of total billed charges,,
"ENDO SCISSORS, HOOK",,A4649,HCPCS,Facility,Inpatient,,,,164,139.4,47.0024,164,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"ENDO SCISSORS, HOOK",,A4649,HCPCS,Facility,Both,,,,164,139.4,47.0024,164,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),98.4,60,,percent of total billed charges,,
"ENDO SCISSORS, HOOK",,A4649,HCPCS,Facility,Both,,,,164,139.4,47.0024,164,"Health Partners, Inc.",State of Minnesota Advantage Program,133.66,81.5,,percent of total billed charges,,
"ENDO SCISSORS, HOOK",,A4649,HCPCS,Facility,Both,,,,164,139.4,47.0024,164,"Health Partners, Inc.",State Public Programs,82,50,,percent of total billed charges,,
"ENDO SCISSORS, HOOK",,A4649,HCPCS,Facility,Both,,,,164,139.4,47.0024,164,Humana Insurance Company,Commercial PPO,155.8,95,,percent of total billed charges,,
"ENDO SCISSORS, HOOK",,A4649,HCPCS,Facility,Outpatient,,,,164,139.4,47.0024,164,Humana Insurance Company,Medicare PPO,80.36,49,,percent of total billed charges,,
"ENDO SCISSORS, HOOK",,A4649,HCPCS,Facility,Inpatient,,,,164,139.4,47.0024,164,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"ENDO SCISSORS, HOOK",,A4649,HCPCS,Facility,Both,,,,164,139.4,47.0024,164,Medica,Individual & Family,162.524,99.1,,percent of total billed charges,,
"ENDO SCISSORS, HOOK",,A4649,HCPCS,Facility,Outpatient,,,,164,139.4,47.0024,164,Medica,Medica Advantage Solution,81.672,49.8,,percent of total billed charges,,
"ENDO SCISSORS, HOOK",,A4649,HCPCS,Facility,Inpatient,,,,164,139.4,47.0024,164,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"ENDO SCISSORS, HOOK",,A4649,HCPCS,Facility,Outpatient,,,,164,139.4,47.0024,164,Medica,Medical Assistance,73.144,44.6,,percent of total billed charges,,
"ENDO SCISSORS, HOOK",,A4649,HCPCS,Facility,Inpatient,,,,164,139.4,47.0024,164,Medica,Medical Assistance,,,,,Included in per diem rate,
"ENDO SCISSORS, HOOK",,A4649,HCPCS,Facility,Outpatient,,,,164,139.4,47.0024,164,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,81.672,49.8,,percent of total billed charges,,
"ENDO SCISSORS, HOOK",,A4649,HCPCS,Facility,Inpatient,,,,164,139.4,47.0024,164,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"ENDO SCISSORS, HOOK",,A4649,HCPCS,Facility,Both,,,,164,139.4,47.0024,164,"Multiplan, Inc.","Multiplan, Inc.",154.16,94,,percent of total billed charges,,
"ENDO SCISSORS, HOOK",,A4649,HCPCS,Facility,Outpatient,,,,164,139.4,47.0024,164,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,147.764,90.1,,percent of total billed charges,,
"ENDO SCISSORS, HOOK",,A4649,HCPCS,Facility,Inpatient,,,,164,139.4,47.0024,164,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"ENDO SCISSORS, HOOK",,A4649,HCPCS,Facility,Both,,,,164,139.4,47.0024,164,"Preferred One Administrative Services, INC.",PPO,161.704,98.6,,percent of total billed charges,,
"ENDO SCISSORS, HOOK",,A4649,HCPCS,Facility,Outpatient,,,,164,139.4,47.0024,164,PrimeWest Health,Minnesota Senior Health Options (MSHO),84.378,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"ENDO SCISSORS, HOOK",,A4649,HCPCS,Facility,Inpatient,,,,164,139.4,47.0024,164,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"ENDO SCISSORS, HOOK",,A4649,HCPCS,Facility,Outpatient,,,,164,139.4,47.0024,164,PrimeWest Health,MinnesotaCare,84.2304,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"ENDO SCISSORS, HOOK",,A4649,HCPCS,Facility,Inpatient,,,,164,139.4,47.0024,164,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"ENDO SCISSORS, HOOK",,A4649,HCPCS,Facility,Both,,,,164,139.4,47.0024,164,Sanford Health Plan,Sanford Health Plan,150.88,92,,percent of total billed charges,,
"ENDO SCISSORS, HOOK",,A4649,HCPCS,Facility,Outpatient,,,,164,139.4,47.0024,164,"UCare Health, Inc.",Individual & Family Plan,92.414,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"ENDO SCISSORS, HOOK",,A4649,HCPCS,Facility,Inpatient,,,,164,139.4,47.0024,164,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"ENDO SCISSORS, HOOK",,A4649,HCPCS,Facility,Outpatient,,,,164,139.4,47.0024,164,"UCare Health, Inc.",Medical Assistance,82.7708,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"ENDO SCISSORS, HOOK",,A4649,HCPCS,Facility,Inpatient,,,,164,139.4,47.0024,164,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"ENDO SCISSORS, HOOK",,A4649,HCPCS,Facility,Outpatient,,,,164,139.4,47.0024,164,"UCare Health, Inc.",Medicare Advantage,82.7708,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"ENDO SCISSORS, HOOK",,A4649,HCPCS,Facility,Inpatient,,,,164,139.4,47.0024,164,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"ENDO SCISSORS, HOOK",,A4649,HCPCS,Facility,Outpatient,,,,164,139.4,47.0024,164,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),82.7708,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"ENDO SCISSORS, HOOK",,A4649,HCPCS,Facility,Inpatient,,,,164,139.4,47.0024,164,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"ENDO SCISSORS, HOOK",,A4649,HCPCS,Facility,Both,,,,164,139.4,47.0024,164,UnitedHealthcare,Individual & Family,154.16,94,,percent of total billed charges,,
"ENDO SCISSORS, HOOK",,A4649,HCPCS,Facility,Outpatient,,,,164,139.4,47.0024,164,UnitedHealthcare,Medicare Advantage,80.36,49,,percent of total billed charges,,
"ENDO SCISSORS, HOOK",,A4649,HCPCS,Facility,Inpatient,,,,164,139.4,47.0024,164,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"ENDO SCISSORS, HOOK",,A4649,HCPCS,Facility,Outpatient,,,,164,139.4,47.0024,164,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,78.72,48,,percent of total billed charges,,100% of DHS outpatient percentage
"ENDO SCISSORS, HOOK",,A4649,HCPCS,Facility,Inpatient,,,,164,139.4,47.0024,164,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
ENDO STITCH 10MM SUTURE DEVICE   173016,,A4649,HCPCS,Facility,Both,,,,497.25,422.6625,142.51185,497.25,Aetna,Commercial,457.47,92,,percent of total billed charges,,
ENDO STITCH 10MM SUTURE DEVICE   173016,,A4649,HCPCS,Facility,Outpatient,,,,497.25,422.6625,142.51185,497.25,Aetna,Medicare Advantage,243.6525,49,,percent of total billed charges,,
ENDO STITCH 10MM SUTURE DEVICE   173016,,A4649,HCPCS,Facility,Inpatient,,,,497.25,422.6625,142.51185,497.25,Aetna,Medicare Advantage,,,,,Included in per diem rate,
ENDO STITCH 10MM SUTURE DEVICE   173016,,A4649,HCPCS,Facility,Both,,,,497.25,422.6625,142.51185,497.25,Aetna,PPO,462.4425,93,,percent of total billed charges,,
ENDO STITCH 10MM SUTURE DEVICE   173016,,A4649,HCPCS,Facility,Both,,,,497.25,422.6625,142.51185,497.25,America's PPO,America's PPO,477.509175,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
ENDO STITCH 10MM SUTURE DEVICE   173016,,A4649,HCPCS,Facility,Both,,,,497.25,422.6625,142.51185,497.25,BlueCross BlueShield Minnesota, Federal Employee Program,489.294,98.4,,percent of total billed charges,,
ENDO STITCH 10MM SUTURE DEVICE   173016,,A4649,HCPCS,Facility,Both,,,,497.25,422.6625,142.51185,497.25,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,497.25,100,,percent of total billed charges,,
ENDO STITCH 10MM SUTURE DEVICE   173016,,A4649,HCPCS,Facility,Both,,,,497.25,422.6625,142.51185,497.25,BlueCross BlueShield Minnesota,High Value Network Plan,447.525,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
ENDO STITCH 10MM SUTURE DEVICE   173016,,A4649,HCPCS,Facility,Outpatient,,,,497.25,422.6625,142.51185,497.25,BlueCross BlueShield Minnesota,Medicare Advantage,243.6525,49,,percent of total billed charges,,
ENDO STITCH 10MM SUTURE DEVICE   173016,,A4649,HCPCS,Facility,Inpatient,,,,497.25,422.6625,142.51185,497.25,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
ENDO STITCH 10MM SUTURE DEVICE   173016,,A4649,HCPCS,Facility,Both,,,,497.25,422.6625,142.51185,497.25,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,440.414325,88.57,,percent of total billed charges,,
ENDO STITCH 10MM SUTURE DEVICE   173016,,A4649,HCPCS,Facility,Both,,,,497.25,422.6625,142.51185,497.25,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,142.51185,28.66,,percent of total billed charges,,
ENDO STITCH 10MM SUTURE DEVICE   173016,,A4649,HCPCS,Facility,Outpatient,,,,497.25,422.6625,142.51185,497.25,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),243.6525,49,,percent of total billed charges,,
ENDO STITCH 10MM SUTURE DEVICE   173016,,A4649,HCPCS,Facility,Inpatient,,,,497.25,422.6625,142.51185,497.25,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
ENDO STITCH 10MM SUTURE DEVICE   173016,,A4649,HCPCS,Facility,Both,,,,497.25,422.6625,142.51185,497.25,CorVel,Worker's Compensation,497.25,100,,percent of total billed charges,,
ENDO STITCH 10MM SUTURE DEVICE   173016,,A4649,HCPCS,Facility,Both,,,,497.25,422.6625,142.51185,497.25,First Health Group Corporation,First Health Network,482.3325,97,,percent of total billed charges,,
ENDO STITCH 10MM SUTURE DEVICE   173016,,A4649,HCPCS,Facility,Both,,,,497.25,422.6625,142.51185,497.25,"Health Partners, Inc.",Commercial,470.3985,94.6,,percent of total billed charges,,
ENDO STITCH 10MM SUTURE DEVICE   173016,,A4649,HCPCS,Facility,Outpatient,,,,497.25,422.6625,142.51185,497.25,"Health Partners, Inc.",Medicare Advantage,243.6525,49,,percent of total billed charges,,
ENDO STITCH 10MM SUTURE DEVICE   173016,,A4649,HCPCS,Facility,Inpatient,,,,497.25,422.6625,142.51185,497.25,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ENDO STITCH 10MM SUTURE DEVICE   173016,,A4649,HCPCS,Facility,Both,,,,497.25,422.6625,142.51185,497.25,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),298.35,60,,percent of total billed charges,,
ENDO STITCH 10MM SUTURE DEVICE   173016,,A4649,HCPCS,Facility,Both,,,,497.25,422.6625,142.51185,497.25,"Health Partners, Inc.",State of Minnesota Advantage Program,405.25875,81.5,,percent of total billed charges,,
ENDO STITCH 10MM SUTURE DEVICE   173016,,A4649,HCPCS,Facility,Both,,,,497.25,422.6625,142.51185,497.25,"Health Partners, Inc.",State Public Programs,248.625,50,,percent of total billed charges,,
ENDO STITCH 10MM SUTURE DEVICE   173016,,A4649,HCPCS,Facility,Both,,,,497.25,422.6625,142.51185,497.25,Humana Insurance Company,Commercial PPO,472.3875,95,,percent of total billed charges,,
ENDO STITCH 10MM SUTURE DEVICE   173016,,A4649,HCPCS,Facility,Outpatient,,,,497.25,422.6625,142.51185,497.25,Humana Insurance Company,Medicare PPO,243.6525,49,,percent of total billed charges,,
ENDO STITCH 10MM SUTURE DEVICE   173016,,A4649,HCPCS,Facility,Inpatient,,,,497.25,422.6625,142.51185,497.25,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
ENDO STITCH 10MM SUTURE DEVICE   173016,,A4649,HCPCS,Facility,Both,,,,497.25,422.6625,142.51185,497.25,Medica,Individual & Family,492.77475,99.1,,percent of total billed charges,,
ENDO STITCH 10MM SUTURE DEVICE   173016,,A4649,HCPCS,Facility,Outpatient,,,,497.25,422.6625,142.51185,497.25,Medica,Medica Advantage Solution,247.6305,49.8,,percent of total billed charges,,
ENDO STITCH 10MM SUTURE DEVICE   173016,,A4649,HCPCS,Facility,Inpatient,,,,497.25,422.6625,142.51185,497.25,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
ENDO STITCH 10MM SUTURE DEVICE   173016,,A4649,HCPCS,Facility,Outpatient,,,,497.25,422.6625,142.51185,497.25,Medica,Medical Assistance,221.7735,44.6,,percent of total billed charges,,
ENDO STITCH 10MM SUTURE DEVICE   173016,,A4649,HCPCS,Facility,Inpatient,,,,497.25,422.6625,142.51185,497.25,Medica,Medical Assistance,,,,,Included in per diem rate,
ENDO STITCH 10MM SUTURE DEVICE   173016,,A4649,HCPCS,Facility,Outpatient,,,,497.25,422.6625,142.51185,497.25,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,247.6305,49.8,,percent of total billed charges,,
ENDO STITCH 10MM SUTURE DEVICE   173016,,A4649,HCPCS,Facility,Inpatient,,,,497.25,422.6625,142.51185,497.25,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
ENDO STITCH 10MM SUTURE DEVICE   173016,,A4649,HCPCS,Facility,Both,,,,497.25,422.6625,142.51185,497.25,"Multiplan, Inc.","Multiplan, Inc.",467.415,94,,percent of total billed charges,,
ENDO STITCH 10MM SUTURE DEVICE   173016,,A4649,HCPCS,Facility,Outpatient,,,,497.25,422.6625,142.51185,497.25,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,448.02225,90.1,,percent of total billed charges,,
ENDO STITCH 10MM SUTURE DEVICE   173016,,A4649,HCPCS,Facility,Inpatient,,,,497.25,422.6625,142.51185,497.25,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
ENDO STITCH 10MM SUTURE DEVICE   173016,,A4649,HCPCS,Facility,Both,,,,497.25,422.6625,142.51185,497.25,"Preferred One Administrative Services, INC.",PPO,490.2885,98.6,,percent of total billed charges,,
ENDO STITCH 10MM SUTURE DEVICE   173016,,A4649,HCPCS,Facility,Outpatient,,,,497.25,422.6625,142.51185,497.25,PrimeWest Health,Minnesota Senior Health Options (MSHO),255.835125,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
ENDO STITCH 10MM SUTURE DEVICE   173016,,A4649,HCPCS,Facility,Inpatient,,,,497.25,422.6625,142.51185,497.25,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ENDO STITCH 10MM SUTURE DEVICE   173016,,A4649,HCPCS,Facility,Outpatient,,,,497.25,422.6625,142.51185,497.25,PrimeWest Health,MinnesotaCare,255.3876,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
ENDO STITCH 10MM SUTURE DEVICE   173016,,A4649,HCPCS,Facility,Inpatient,,,,497.25,422.6625,142.51185,497.25,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
ENDO STITCH 10MM SUTURE DEVICE   173016,,A4649,HCPCS,Facility,Both,,,,497.25,422.6625,142.51185,497.25,Sanford Health Plan,Sanford Health Plan,457.47,92,,percent of total billed charges,,
ENDO STITCH 10MM SUTURE DEVICE   173016,,A4649,HCPCS,Facility,Outpatient,,,,497.25,422.6625,142.51185,497.25,"UCare Health, Inc.",Individual & Family Plan,280.200375,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
ENDO STITCH 10MM SUTURE DEVICE   173016,,A4649,HCPCS,Facility,Inpatient,,,,497.25,422.6625,142.51185,497.25,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
ENDO STITCH 10MM SUTURE DEVICE   173016,,A4649,HCPCS,Facility,Outpatient,,,,497.25,422.6625,142.51185,497.25,"UCare Health, Inc.",Medical Assistance,250.962075,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ENDO STITCH 10MM SUTURE DEVICE   173016,,A4649,HCPCS,Facility,Inpatient,,,,497.25,422.6625,142.51185,497.25,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
ENDO STITCH 10MM SUTURE DEVICE   173016,,A4649,HCPCS,Facility,Outpatient,,,,497.25,422.6625,142.51185,497.25,"UCare Health, Inc.",Medicare Advantage,250.962075,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ENDO STITCH 10MM SUTURE DEVICE   173016,,A4649,HCPCS,Facility,Inpatient,,,,497.25,422.6625,142.51185,497.25,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ENDO STITCH 10MM SUTURE DEVICE   173016,,A4649,HCPCS,Facility,Outpatient,,,,497.25,422.6625,142.51185,497.25,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),250.962075,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ENDO STITCH 10MM SUTURE DEVICE   173016,,A4649,HCPCS,Facility,Inpatient,,,,497.25,422.6625,142.51185,497.25,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ENDO STITCH 10MM SUTURE DEVICE   173016,,A4649,HCPCS,Facility,Both,,,,497.25,422.6625,142.51185,497.25,UnitedHealthcare,Individual & Family,467.415,94,,percent of total billed charges,,
ENDO STITCH 10MM SUTURE DEVICE   173016,,A4649,HCPCS,Facility,Outpatient,,,,497.25,422.6625,142.51185,497.25,UnitedHealthcare,Medicare Advantage,243.6525,49,,percent of total billed charges,,
ENDO STITCH 10MM SUTURE DEVICE   173016,,A4649,HCPCS,Facility,Inpatient,,,,497.25,422.6625,142.51185,497.25,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
ENDO STITCH 10MM SUTURE DEVICE   173016,,A4649,HCPCS,Facility,Outpatient,,,,497.25,422.6625,142.51185,497.25,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,238.68,48,,percent of total billed charges,,100% of DHS outpatient percentage
ENDO STITCH 10MM SUTURE DEVICE   173016,,A4649,HCPCS,Facility,Inpatient,,,,497.25,422.6625,142.51185,497.25,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
ENDO STITCH SURGIDAC 2-0 SINGLE  173023,,A4649,HCPCS,Facility,Both,,,,215.32,183.022,61.710712,215.32,Aetna,Commercial,198.0944,92,,percent of total billed charges,,
ENDO STITCH SURGIDAC 2-0 SINGLE  173023,,A4649,HCPCS,Facility,Outpatient,,,,215.32,183.022,61.710712,215.32,Aetna,Medicare Advantage,105.5068,49,,percent of total billed charges,,
ENDO STITCH SURGIDAC 2-0 SINGLE  173023,,A4649,HCPCS,Facility,Inpatient,,,,215.32,183.022,61.710712,215.32,Aetna,Medicare Advantage,,,,,Included in per diem rate,
ENDO STITCH SURGIDAC 2-0 SINGLE  173023,,A4649,HCPCS,Facility,Both,,,,215.32,183.022,61.710712,215.32,Aetna,PPO,200.2476,93,,percent of total billed charges,,
ENDO STITCH SURGIDAC 2-0 SINGLE  173023,,A4649,HCPCS,Facility,Both,,,,215.32,183.022,61.710712,215.32,America's PPO,America's PPO,206.771796,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
ENDO STITCH SURGIDAC 2-0 SINGLE  173023,,A4649,HCPCS,Facility,Both,,,,215.32,183.022,61.710712,215.32,BlueCross BlueShield Minnesota, Federal Employee Program,211.87488,98.4,,percent of total billed charges,,
ENDO STITCH SURGIDAC 2-0 SINGLE  173023,,A4649,HCPCS,Facility,Both,,,,215.32,183.022,61.710712,215.32,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,215.32,100,,percent of total billed charges,,
ENDO STITCH SURGIDAC 2-0 SINGLE  173023,,A4649,HCPCS,Facility,Both,,,,215.32,183.022,61.710712,215.32,BlueCross BlueShield Minnesota,High Value Network Plan,193.788,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
ENDO STITCH SURGIDAC 2-0 SINGLE  173023,,A4649,HCPCS,Facility,Outpatient,,,,215.32,183.022,61.710712,215.32,BlueCross BlueShield Minnesota,Medicare Advantage,105.5068,49,,percent of total billed charges,,
ENDO STITCH SURGIDAC 2-0 SINGLE  173023,,A4649,HCPCS,Facility,Inpatient,,,,215.32,183.022,61.710712,215.32,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
ENDO STITCH SURGIDAC 2-0 SINGLE  173023,,A4649,HCPCS,Facility,Both,,,,215.32,183.022,61.710712,215.32,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,190.708924,88.57,,percent of total billed charges,,
ENDO STITCH SURGIDAC 2-0 SINGLE  173023,,A4649,HCPCS,Facility,Both,,,,215.32,183.022,61.710712,215.32,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,61.710712,28.66,,percent of total billed charges,,
ENDO STITCH SURGIDAC 2-0 SINGLE  173023,,A4649,HCPCS,Facility,Outpatient,,,,215.32,183.022,61.710712,215.32,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),105.5068,49,,percent of total billed charges,,
ENDO STITCH SURGIDAC 2-0 SINGLE  173023,,A4649,HCPCS,Facility,Inpatient,,,,215.32,183.022,61.710712,215.32,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
ENDO STITCH SURGIDAC 2-0 SINGLE  173023,,A4649,HCPCS,Facility,Both,,,,215.32,183.022,61.710712,215.32,CorVel,Worker's Compensation,215.32,100,,percent of total billed charges,,
ENDO STITCH SURGIDAC 2-0 SINGLE  173023,,A4649,HCPCS,Facility,Both,,,,215.32,183.022,61.710712,215.32,First Health Group Corporation,First Health Network,208.8604,97,,percent of total billed charges,,
ENDO STITCH SURGIDAC 2-0 SINGLE  173023,,A4649,HCPCS,Facility,Both,,,,215.32,183.022,61.710712,215.32,"Health Partners, Inc.",Commercial,203.69272,94.6,,percent of total billed charges,,
ENDO STITCH SURGIDAC 2-0 SINGLE  173023,,A4649,HCPCS,Facility,Outpatient,,,,215.32,183.022,61.710712,215.32,"Health Partners, Inc.",Medicare Advantage,105.5068,49,,percent of total billed charges,,
ENDO STITCH SURGIDAC 2-0 SINGLE  173023,,A4649,HCPCS,Facility,Inpatient,,,,215.32,183.022,61.710712,215.32,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ENDO STITCH SURGIDAC 2-0 SINGLE  173023,,A4649,HCPCS,Facility,Both,,,,215.32,183.022,61.710712,215.32,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),129.192,60,,percent of total billed charges,,
ENDO STITCH SURGIDAC 2-0 SINGLE  173023,,A4649,HCPCS,Facility,Both,,,,215.32,183.022,61.710712,215.32,"Health Partners, Inc.",State of Minnesota Advantage Program,175.4858,81.5,,percent of total billed charges,,
ENDO STITCH SURGIDAC 2-0 SINGLE  173023,,A4649,HCPCS,Facility,Both,,,,215.32,183.022,61.710712,215.32,"Health Partners, Inc.",State Public Programs,107.66,50,,percent of total billed charges,,
ENDO STITCH SURGIDAC 2-0 SINGLE  173023,,A4649,HCPCS,Facility,Both,,,,215.32,183.022,61.710712,215.32,Humana Insurance Company,Commercial PPO,204.554,95,,percent of total billed charges,,
ENDO STITCH SURGIDAC 2-0 SINGLE  173023,,A4649,HCPCS,Facility,Outpatient,,,,215.32,183.022,61.710712,215.32,Humana Insurance Company,Medicare PPO,105.5068,49,,percent of total billed charges,,
ENDO STITCH SURGIDAC 2-0 SINGLE  173023,,A4649,HCPCS,Facility,Inpatient,,,,215.32,183.022,61.710712,215.32,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
ENDO STITCH SURGIDAC 2-0 SINGLE  173023,,A4649,HCPCS,Facility,Both,,,,215.32,183.022,61.710712,215.32,Medica,Individual & Family,213.38212,99.1,,percent of total billed charges,,
ENDO STITCH SURGIDAC 2-0 SINGLE  173023,,A4649,HCPCS,Facility,Outpatient,,,,215.32,183.022,61.710712,215.32,Medica,Medica Advantage Solution,107.22936,49.8,,percent of total billed charges,,
ENDO STITCH SURGIDAC 2-0 SINGLE  173023,,A4649,HCPCS,Facility,Inpatient,,,,215.32,183.022,61.710712,215.32,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
ENDO STITCH SURGIDAC 2-0 SINGLE  173023,,A4649,HCPCS,Facility,Outpatient,,,,215.32,183.022,61.710712,215.32,Medica,Medical Assistance,96.03272,44.6,,percent of total billed charges,,
ENDO STITCH SURGIDAC 2-0 SINGLE  173023,,A4649,HCPCS,Facility,Inpatient,,,,215.32,183.022,61.710712,215.32,Medica,Medical Assistance,,,,,Included in per diem rate,
ENDO STITCH SURGIDAC 2-0 SINGLE  173023,,A4649,HCPCS,Facility,Outpatient,,,,215.32,183.022,61.710712,215.32,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,107.22936,49.8,,percent of total billed charges,,
ENDO STITCH SURGIDAC 2-0 SINGLE  173023,,A4649,HCPCS,Facility,Inpatient,,,,215.32,183.022,61.710712,215.32,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
ENDO STITCH SURGIDAC 2-0 SINGLE  173023,,A4649,HCPCS,Facility,Both,,,,215.32,183.022,61.710712,215.32,"Multiplan, Inc.","Multiplan, Inc.",202.4008,94,,percent of total billed charges,,
ENDO STITCH SURGIDAC 2-0 SINGLE  173023,,A4649,HCPCS,Facility,Outpatient,,,,215.32,183.022,61.710712,215.32,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,194.00332,90.1,,percent of total billed charges,,
ENDO STITCH SURGIDAC 2-0 SINGLE  173023,,A4649,HCPCS,Facility,Inpatient,,,,215.32,183.022,61.710712,215.32,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
ENDO STITCH SURGIDAC 2-0 SINGLE  173023,,A4649,HCPCS,Facility,Both,,,,215.32,183.022,61.710712,215.32,"Preferred One Administrative Services, INC.",PPO,212.30552,98.6,,percent of total billed charges,,
ENDO STITCH SURGIDAC 2-0 SINGLE  173023,,A4649,HCPCS,Facility,Outpatient,,,,215.32,183.022,61.710712,215.32,PrimeWest Health,Minnesota Senior Health Options (MSHO),110.78214,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
ENDO STITCH SURGIDAC 2-0 SINGLE  173023,,A4649,HCPCS,Facility,Inpatient,,,,215.32,183.022,61.710712,215.32,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ENDO STITCH SURGIDAC 2-0 SINGLE  173023,,A4649,HCPCS,Facility,Outpatient,,,,215.32,183.022,61.710712,215.32,PrimeWest Health,MinnesotaCare,110.588352,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
ENDO STITCH SURGIDAC 2-0 SINGLE  173023,,A4649,HCPCS,Facility,Inpatient,,,,215.32,183.022,61.710712,215.32,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
ENDO STITCH SURGIDAC 2-0 SINGLE  173023,,A4649,HCPCS,Facility,Both,,,,215.32,183.022,61.710712,215.32,Sanford Health Plan,Sanford Health Plan,198.0944,92,,percent of total billed charges,,
ENDO STITCH SURGIDAC 2-0 SINGLE  173023,,A4649,HCPCS,Facility,Outpatient,,,,215.32,183.022,61.710712,215.32,"UCare Health, Inc.",Individual & Family Plan,121.33282,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
ENDO STITCH SURGIDAC 2-0 SINGLE  173023,,A4649,HCPCS,Facility,Inpatient,,,,215.32,183.022,61.710712,215.32,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
ENDO STITCH SURGIDAC 2-0 SINGLE  173023,,A4649,HCPCS,Facility,Outpatient,,,,215.32,183.022,61.710712,215.32,"UCare Health, Inc.",Medical Assistance,108.672004,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ENDO STITCH SURGIDAC 2-0 SINGLE  173023,,A4649,HCPCS,Facility,Inpatient,,,,215.32,183.022,61.710712,215.32,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
ENDO STITCH SURGIDAC 2-0 SINGLE  173023,,A4649,HCPCS,Facility,Outpatient,,,,215.32,183.022,61.710712,215.32,"UCare Health, Inc.",Medicare Advantage,108.672004,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ENDO STITCH SURGIDAC 2-0 SINGLE  173023,,A4649,HCPCS,Facility,Inpatient,,,,215.32,183.022,61.710712,215.32,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ENDO STITCH SURGIDAC 2-0 SINGLE  173023,,A4649,HCPCS,Facility,Outpatient,,,,215.32,183.022,61.710712,215.32,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),108.672004,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ENDO STITCH SURGIDAC 2-0 SINGLE  173023,,A4649,HCPCS,Facility,Inpatient,,,,215.32,183.022,61.710712,215.32,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ENDO STITCH SURGIDAC 2-0 SINGLE  173023,,A4649,HCPCS,Facility,Both,,,,215.32,183.022,61.710712,215.32,UnitedHealthcare,Individual & Family,202.4008,94,,percent of total billed charges,,
ENDO STITCH SURGIDAC 2-0 SINGLE  173023,,A4649,HCPCS,Facility,Outpatient,,,,215.32,183.022,61.710712,215.32,UnitedHealthcare,Medicare Advantage,105.5068,49,,percent of total billed charges,,
ENDO STITCH SURGIDAC 2-0 SINGLE  173023,,A4649,HCPCS,Facility,Inpatient,,,,215.32,183.022,61.710712,215.32,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
ENDO STITCH SURGIDAC 2-0 SINGLE  173023,,A4649,HCPCS,Facility,Outpatient,,,,215.32,183.022,61.710712,215.32,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,103.3536,48,,percent of total billed charges,,100% of DHS outpatient percentage
ENDO STITCH SURGIDAC 2-0 SINGLE  173023,,A4649,HCPCS,Facility,Inpatient,,,,215.32,183.022,61.710712,215.32,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
ENDO STITCH SURGIDAC 2-0 TRIPLE  170044,,A4649,HCPCS,Facility,Both,,,,481.44,409.224,137.980704,481.44,Aetna,Commercial,442.9248,92,,percent of total billed charges,,
ENDO STITCH SURGIDAC 2-0 TRIPLE  170044,,A4649,HCPCS,Facility,Outpatient,,,,481.44,409.224,137.980704,481.44,Aetna,Medicare Advantage,235.9056,49,,percent of total billed charges,,
ENDO STITCH SURGIDAC 2-0 TRIPLE  170044,,A4649,HCPCS,Facility,Inpatient,,,,481.44,409.224,137.980704,481.44,Aetna,Medicare Advantage,,,,,Included in per diem rate,
ENDO STITCH SURGIDAC 2-0 TRIPLE  170044,,A4649,HCPCS,Facility,Both,,,,481.44,409.224,137.980704,481.44,Aetna,PPO,447.7392,93,,percent of total billed charges,,
ENDO STITCH SURGIDAC 2-0 TRIPLE  170044,,A4649,HCPCS,Facility,Both,,,,481.44,409.224,137.980704,481.44,America's PPO,America's PPO,462.326832,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
ENDO STITCH SURGIDAC 2-0 TRIPLE  170044,,A4649,HCPCS,Facility,Both,,,,481.44,409.224,137.980704,481.44,BlueCross BlueShield Minnesota, Federal Employee Program,473.73696,98.4,,percent of total billed charges,,
ENDO STITCH SURGIDAC 2-0 TRIPLE  170044,,A4649,HCPCS,Facility,Both,,,,481.44,409.224,137.980704,481.44,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,481.44,100,,percent of total billed charges,,
ENDO STITCH SURGIDAC 2-0 TRIPLE  170044,,A4649,HCPCS,Facility,Both,,,,481.44,409.224,137.980704,481.44,BlueCross BlueShield Minnesota,High Value Network Plan,433.296,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
ENDO STITCH SURGIDAC 2-0 TRIPLE  170044,,A4649,HCPCS,Facility,Outpatient,,,,481.44,409.224,137.980704,481.44,BlueCross BlueShield Minnesota,Medicare Advantage,235.9056,49,,percent of total billed charges,,
ENDO STITCH SURGIDAC 2-0 TRIPLE  170044,,A4649,HCPCS,Facility,Inpatient,,,,481.44,409.224,137.980704,481.44,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
ENDO STITCH SURGIDAC 2-0 TRIPLE  170044,,A4649,HCPCS,Facility,Both,,,,481.44,409.224,137.980704,481.44,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,426.411408,88.57,,percent of total billed charges,,
ENDO STITCH SURGIDAC 2-0 TRIPLE  170044,,A4649,HCPCS,Facility,Both,,,,481.44,409.224,137.980704,481.44,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,137.980704,28.66,,percent of total billed charges,,
ENDO STITCH SURGIDAC 2-0 TRIPLE  170044,,A4649,HCPCS,Facility,Outpatient,,,,481.44,409.224,137.980704,481.44,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),235.9056,49,,percent of total billed charges,,
ENDO STITCH SURGIDAC 2-0 TRIPLE  170044,,A4649,HCPCS,Facility,Inpatient,,,,481.44,409.224,137.980704,481.44,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
ENDO STITCH SURGIDAC 2-0 TRIPLE  170044,,A4649,HCPCS,Facility,Both,,,,481.44,409.224,137.980704,481.44,CorVel,Worker's Compensation,481.44,100,,percent of total billed charges,,
ENDO STITCH SURGIDAC 2-0 TRIPLE  170044,,A4649,HCPCS,Facility,Both,,,,481.44,409.224,137.980704,481.44,First Health Group Corporation,First Health Network,466.9968,97,,percent of total billed charges,,
ENDO STITCH SURGIDAC 2-0 TRIPLE  170044,,A4649,HCPCS,Facility,Both,,,,481.44,409.224,137.980704,481.44,"Health Partners, Inc.",Commercial,455.44224,94.6,,percent of total billed charges,,
ENDO STITCH SURGIDAC 2-0 TRIPLE  170044,,A4649,HCPCS,Facility,Outpatient,,,,481.44,409.224,137.980704,481.44,"Health Partners, Inc.",Medicare Advantage,235.9056,49,,percent of total billed charges,,
ENDO STITCH SURGIDAC 2-0 TRIPLE  170044,,A4649,HCPCS,Facility,Inpatient,,,,481.44,409.224,137.980704,481.44,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ENDO STITCH SURGIDAC 2-0 TRIPLE  170044,,A4649,HCPCS,Facility,Both,,,,481.44,409.224,137.980704,481.44,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),288.864,60,,percent of total billed charges,,
ENDO STITCH SURGIDAC 2-0 TRIPLE  170044,,A4649,HCPCS,Facility,Both,,,,481.44,409.224,137.980704,481.44,"Health Partners, Inc.",State of Minnesota Advantage Program,392.3736,81.5,,percent of total billed charges,,
ENDO STITCH SURGIDAC 2-0 TRIPLE  170044,,A4649,HCPCS,Facility,Both,,,,481.44,409.224,137.980704,481.44,"Health Partners, Inc.",State Public Programs,240.72,50,,percent of total billed charges,,
ENDO STITCH SURGIDAC 2-0 TRIPLE  170044,,A4649,HCPCS,Facility,Both,,,,481.44,409.224,137.980704,481.44,Humana Insurance Company,Commercial PPO,457.368,95,,percent of total billed charges,,
ENDO STITCH SURGIDAC 2-0 TRIPLE  170044,,A4649,HCPCS,Facility,Outpatient,,,,481.44,409.224,137.980704,481.44,Humana Insurance Company,Medicare PPO,235.9056,49,,percent of total billed charges,,
ENDO STITCH SURGIDAC 2-0 TRIPLE  170044,,A4649,HCPCS,Facility,Inpatient,,,,481.44,409.224,137.980704,481.44,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
ENDO STITCH SURGIDAC 2-0 TRIPLE  170044,,A4649,HCPCS,Facility,Both,,,,481.44,409.224,137.980704,481.44,Medica,Individual & Family,477.10704,99.1,,percent of total billed charges,,
ENDO STITCH SURGIDAC 2-0 TRIPLE  170044,,A4649,HCPCS,Facility,Outpatient,,,,481.44,409.224,137.980704,481.44,Medica,Medica Advantage Solution,239.75712,49.8,,percent of total billed charges,,
ENDO STITCH SURGIDAC 2-0 TRIPLE  170044,,A4649,HCPCS,Facility,Inpatient,,,,481.44,409.224,137.980704,481.44,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
ENDO STITCH SURGIDAC 2-0 TRIPLE  170044,,A4649,HCPCS,Facility,Outpatient,,,,481.44,409.224,137.980704,481.44,Medica,Medical Assistance,214.72224,44.6,,percent of total billed charges,,
ENDO STITCH SURGIDAC 2-0 TRIPLE  170044,,A4649,HCPCS,Facility,Inpatient,,,,481.44,409.224,137.980704,481.44,Medica,Medical Assistance,,,,,Included in per diem rate,
ENDO STITCH SURGIDAC 2-0 TRIPLE  170044,,A4649,HCPCS,Facility,Outpatient,,,,481.44,409.224,137.980704,481.44,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,239.75712,49.8,,percent of total billed charges,,
ENDO STITCH SURGIDAC 2-0 TRIPLE  170044,,A4649,HCPCS,Facility,Inpatient,,,,481.44,409.224,137.980704,481.44,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
ENDO STITCH SURGIDAC 2-0 TRIPLE  170044,,A4649,HCPCS,Facility,Both,,,,481.44,409.224,137.980704,481.44,"Multiplan, Inc.","Multiplan, Inc.",452.5536,94,,percent of total billed charges,,
ENDO STITCH SURGIDAC 2-0 TRIPLE  170044,,A4649,HCPCS,Facility,Outpatient,,,,481.44,409.224,137.980704,481.44,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,433.77744,90.1,,percent of total billed charges,,
ENDO STITCH SURGIDAC 2-0 TRIPLE  170044,,A4649,HCPCS,Facility,Inpatient,,,,481.44,409.224,137.980704,481.44,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
ENDO STITCH SURGIDAC 2-0 TRIPLE  170044,,A4649,HCPCS,Facility,Both,,,,481.44,409.224,137.980704,481.44,"Preferred One Administrative Services, INC.",PPO,474.69984,98.6,,percent of total billed charges,,
ENDO STITCH SURGIDAC 2-0 TRIPLE  170044,,A4649,HCPCS,Facility,Outpatient,,,,481.44,409.224,137.980704,481.44,PrimeWest Health,Minnesota Senior Health Options (MSHO),247.70088,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
ENDO STITCH SURGIDAC 2-0 TRIPLE  170044,,A4649,HCPCS,Facility,Inpatient,,,,481.44,409.224,137.980704,481.44,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ENDO STITCH SURGIDAC 2-0 TRIPLE  170044,,A4649,HCPCS,Facility,Outpatient,,,,481.44,409.224,137.980704,481.44,PrimeWest Health,MinnesotaCare,247.267584,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
ENDO STITCH SURGIDAC 2-0 TRIPLE  170044,,A4649,HCPCS,Facility,Inpatient,,,,481.44,409.224,137.980704,481.44,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
ENDO STITCH SURGIDAC 2-0 TRIPLE  170044,,A4649,HCPCS,Facility,Both,,,,481.44,409.224,137.980704,481.44,Sanford Health Plan,Sanford Health Plan,442.9248,92,,percent of total billed charges,,
ENDO STITCH SURGIDAC 2-0 TRIPLE  170044,,A4649,HCPCS,Facility,Outpatient,,,,481.44,409.224,137.980704,481.44,"UCare Health, Inc.",Individual & Family Plan,271.29144,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
ENDO STITCH SURGIDAC 2-0 TRIPLE  170044,,A4649,HCPCS,Facility,Inpatient,,,,481.44,409.224,137.980704,481.44,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
ENDO STITCH SURGIDAC 2-0 TRIPLE  170044,,A4649,HCPCS,Facility,Outpatient,,,,481.44,409.224,137.980704,481.44,"UCare Health, Inc.",Medical Assistance,242.982768,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ENDO STITCH SURGIDAC 2-0 TRIPLE  170044,,A4649,HCPCS,Facility,Inpatient,,,,481.44,409.224,137.980704,481.44,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
ENDO STITCH SURGIDAC 2-0 TRIPLE  170044,,A4649,HCPCS,Facility,Outpatient,,,,481.44,409.224,137.980704,481.44,"UCare Health, Inc.",Medicare Advantage,242.982768,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ENDO STITCH SURGIDAC 2-0 TRIPLE  170044,,A4649,HCPCS,Facility,Inpatient,,,,481.44,409.224,137.980704,481.44,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ENDO STITCH SURGIDAC 2-0 TRIPLE  170044,,A4649,HCPCS,Facility,Outpatient,,,,481.44,409.224,137.980704,481.44,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),242.982768,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ENDO STITCH SURGIDAC 2-0 TRIPLE  170044,,A4649,HCPCS,Facility,Inpatient,,,,481.44,409.224,137.980704,481.44,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ENDO STITCH SURGIDAC 2-0 TRIPLE  170044,,A4649,HCPCS,Facility,Both,,,,481.44,409.224,137.980704,481.44,UnitedHealthcare,Individual & Family,452.5536,94,,percent of total billed charges,,
ENDO STITCH SURGIDAC 2-0 TRIPLE  170044,,A4649,HCPCS,Facility,Outpatient,,,,481.44,409.224,137.980704,481.44,UnitedHealthcare,Medicare Advantage,235.9056,49,,percent of total billed charges,,
ENDO STITCH SURGIDAC 2-0 TRIPLE  170044,,A4649,HCPCS,Facility,Inpatient,,,,481.44,409.224,137.980704,481.44,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
ENDO STITCH SURGIDAC 2-0 TRIPLE  170044,,A4649,HCPCS,Facility,Outpatient,,,,481.44,409.224,137.980704,481.44,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,231.0912,48,,percent of total billed charges,,100% of DHS outpatient percentage
ENDO STITCH SURGIDAC 2-0 TRIPLE  170044,,A4649,HCPCS,Facility,Inpatient,,,,481.44,409.224,137.980704,481.44,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
ENDOGIA 30-3.5,,A4649,HCPCS,Facility,Both,,,,1230.32,1045.772,352.609712,1230.32,Aetna,Commercial,1131.8944,92,,percent of total billed charges,,
ENDOGIA 30-3.5,,A4649,HCPCS,Facility,Outpatient,,,,1230.32,1045.772,352.609712,1230.32,Aetna,Medicare Advantage,602.8568,49,,percent of total billed charges,,
ENDOGIA 30-3.5,,A4649,HCPCS,Facility,Inpatient,,,,1230.32,1045.772,352.609712,1230.32,Aetna,Medicare Advantage,,,,,Included in per diem rate,
ENDOGIA 30-3.5,,A4649,HCPCS,Facility,Both,,,,1230.32,1045.772,352.609712,1230.32,Aetna,PPO,1144.1976,93,,percent of total billed charges,,
ENDOGIA 30-3.5,,A4649,HCPCS,Facility,Both,,,,1230.32,1045.772,352.609712,1230.32,America's PPO,America's PPO,1181.476296,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
ENDOGIA 30-3.5,,A4649,HCPCS,Facility,Both,,,,1230.32,1045.772,352.609712,1230.32,BlueCross BlueShield Minnesota, Federal Employee Program,1210.63488,98.4,,percent of total billed charges,,
ENDOGIA 30-3.5,,A4649,HCPCS,Facility,Both,,,,1230.32,1045.772,352.609712,1230.32,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1230.32,100,,percent of total billed charges,,
ENDOGIA 30-3.5,,A4649,HCPCS,Facility,Both,,,,1230.32,1045.772,352.609712,1230.32,BlueCross BlueShield Minnesota,High Value Network Plan,1107.288,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
ENDOGIA 30-3.5,,A4649,HCPCS,Facility,Outpatient,,,,1230.32,1045.772,352.609712,1230.32,BlueCross BlueShield Minnesota,Medicare Advantage,602.8568,49,,percent of total billed charges,,
ENDOGIA 30-3.5,,A4649,HCPCS,Facility,Inpatient,,,,1230.32,1045.772,352.609712,1230.32,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
ENDOGIA 30-3.5,,A4649,HCPCS,Facility,Both,,,,1230.32,1045.772,352.609712,1230.32,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1089.694424,88.57,,percent of total billed charges,,
ENDOGIA 30-3.5,,A4649,HCPCS,Facility,Both,,,,1230.32,1045.772,352.609712,1230.32,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,352.609712,28.66,,percent of total billed charges,,
ENDOGIA 30-3.5,,A4649,HCPCS,Facility,Outpatient,,,,1230.32,1045.772,352.609712,1230.32,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),602.8568,49,,percent of total billed charges,,
ENDOGIA 30-3.5,,A4649,HCPCS,Facility,Inpatient,,,,1230.32,1045.772,352.609712,1230.32,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
ENDOGIA 30-3.5,,A4649,HCPCS,Facility,Both,,,,1230.32,1045.772,352.609712,1230.32,CorVel,Worker's Compensation,1230.32,100,,percent of total billed charges,,
ENDOGIA 30-3.5,,A4649,HCPCS,Facility,Both,,,,1230.32,1045.772,352.609712,1230.32,First Health Group Corporation,First Health Network,1193.4104,97,,percent of total billed charges,,
ENDOGIA 30-3.5,,A4649,HCPCS,Facility,Both,,,,1230.32,1045.772,352.609712,1230.32,"Health Partners, Inc.",Commercial,1163.88272,94.6,,percent of total billed charges,,
ENDOGIA 30-3.5,,A4649,HCPCS,Facility,Outpatient,,,,1230.32,1045.772,352.609712,1230.32,"Health Partners, Inc.",Medicare Advantage,602.8568,49,,percent of total billed charges,,
ENDOGIA 30-3.5,,A4649,HCPCS,Facility,Inpatient,,,,1230.32,1045.772,352.609712,1230.32,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ENDOGIA 30-3.5,,A4649,HCPCS,Facility,Both,,,,1230.32,1045.772,352.609712,1230.32,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),738.192,60,,percent of total billed charges,,
ENDOGIA 30-3.5,,A4649,HCPCS,Facility,Both,,,,1230.32,1045.772,352.609712,1230.32,"Health Partners, Inc.",State of Minnesota Advantage Program,1002.7108,81.5,,percent of total billed charges,,
ENDOGIA 30-3.5,,A4649,HCPCS,Facility,Both,,,,1230.32,1045.772,352.609712,1230.32,"Health Partners, Inc.",State Public Programs,615.16,50,,percent of total billed charges,,
ENDOGIA 30-3.5,,A4649,HCPCS,Facility,Both,,,,1230.32,1045.772,352.609712,1230.32,Humana Insurance Company,Commercial PPO,1168.804,95,,percent of total billed charges,,
ENDOGIA 30-3.5,,A4649,HCPCS,Facility,Outpatient,,,,1230.32,1045.772,352.609712,1230.32,Humana Insurance Company,Medicare PPO,602.8568,49,,percent of total billed charges,,
ENDOGIA 30-3.5,,A4649,HCPCS,Facility,Inpatient,,,,1230.32,1045.772,352.609712,1230.32,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
ENDOGIA 30-3.5,,A4649,HCPCS,Facility,Both,,,,1230.32,1045.772,352.609712,1230.32,Medica,Individual & Family,1219.24712,99.1,,percent of total billed charges,,
ENDOGIA 30-3.5,,A4649,HCPCS,Facility,Outpatient,,,,1230.32,1045.772,352.609712,1230.32,Medica,Medica Advantage Solution,612.69936,49.8,,percent of total billed charges,,
ENDOGIA 30-3.5,,A4649,HCPCS,Facility,Inpatient,,,,1230.32,1045.772,352.609712,1230.32,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
ENDOGIA 30-3.5,,A4649,HCPCS,Facility,Outpatient,,,,1230.32,1045.772,352.609712,1230.32,Medica,Medical Assistance,548.72272,44.6,,percent of total billed charges,,
ENDOGIA 30-3.5,,A4649,HCPCS,Facility,Inpatient,,,,1230.32,1045.772,352.609712,1230.32,Medica,Medical Assistance,,,,,Included in per diem rate,
ENDOGIA 30-3.5,,A4649,HCPCS,Facility,Outpatient,,,,1230.32,1045.772,352.609712,1230.32,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,612.69936,49.8,,percent of total billed charges,,
ENDOGIA 30-3.5,,A4649,HCPCS,Facility,Inpatient,,,,1230.32,1045.772,352.609712,1230.32,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
ENDOGIA 30-3.5,,A4649,HCPCS,Facility,Both,,,,1230.32,1045.772,352.609712,1230.32,"Multiplan, Inc.","Multiplan, Inc.",1156.5008,94,,percent of total billed charges,,
ENDOGIA 30-3.5,,A4649,HCPCS,Facility,Outpatient,,,,1230.32,1045.772,352.609712,1230.32,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1108.51832,90.1,,percent of total billed charges,,
ENDOGIA 30-3.5,,A4649,HCPCS,Facility,Inpatient,,,,1230.32,1045.772,352.609712,1230.32,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
ENDOGIA 30-3.5,,A4649,HCPCS,Facility,Both,,,,1230.32,1045.772,352.609712,1230.32,"Preferred One Administrative Services, INC.",PPO,1213.09552,98.6,,percent of total billed charges,,
ENDOGIA 30-3.5,,A4649,HCPCS,Facility,Outpatient,,,,1230.32,1045.772,352.609712,1230.32,PrimeWest Health,Minnesota Senior Health Options (MSHO),632.99964,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
ENDOGIA 30-3.5,,A4649,HCPCS,Facility,Inpatient,,,,1230.32,1045.772,352.609712,1230.32,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ENDOGIA 30-3.5,,A4649,HCPCS,Facility,Outpatient,,,,1230.32,1045.772,352.609712,1230.32,PrimeWest Health,MinnesotaCare,631.892352,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
ENDOGIA 30-3.5,,A4649,HCPCS,Facility,Inpatient,,,,1230.32,1045.772,352.609712,1230.32,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
ENDOGIA 30-3.5,,A4649,HCPCS,Facility,Both,,,,1230.32,1045.772,352.609712,1230.32,Sanford Health Plan,Sanford Health Plan,1131.8944,92,,percent of total billed charges,,
ENDOGIA 30-3.5,,A4649,HCPCS,Facility,Outpatient,,,,1230.32,1045.772,352.609712,1230.32,"UCare Health, Inc.",Individual & Family Plan,693.28532,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
ENDOGIA 30-3.5,,A4649,HCPCS,Facility,Inpatient,,,,1230.32,1045.772,352.609712,1230.32,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
ENDOGIA 30-3.5,,A4649,HCPCS,Facility,Outpatient,,,,1230.32,1045.772,352.609712,1230.32,"UCare Health, Inc.",Medical Assistance,620.942504,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ENDOGIA 30-3.5,,A4649,HCPCS,Facility,Inpatient,,,,1230.32,1045.772,352.609712,1230.32,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
ENDOGIA 30-3.5,,A4649,HCPCS,Facility,Outpatient,,,,1230.32,1045.772,352.609712,1230.32,"UCare Health, Inc.",Medicare Advantage,620.942504,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ENDOGIA 30-3.5,,A4649,HCPCS,Facility,Inpatient,,,,1230.32,1045.772,352.609712,1230.32,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ENDOGIA 30-3.5,,A4649,HCPCS,Facility,Outpatient,,,,1230.32,1045.772,352.609712,1230.32,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),620.942504,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ENDOGIA 30-3.5,,A4649,HCPCS,Facility,Inpatient,,,,1230.32,1045.772,352.609712,1230.32,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ENDOGIA 30-3.5,,A4649,HCPCS,Facility,Both,,,,1230.32,1045.772,352.609712,1230.32,UnitedHealthcare,Individual & Family,1156.5008,94,,percent of total billed charges,,
ENDOGIA 30-3.5,,A4649,HCPCS,Facility,Outpatient,,,,1230.32,1045.772,352.609712,1230.32,UnitedHealthcare,Medicare Advantage,602.8568,49,,percent of total billed charges,,
ENDOGIA 30-3.5,,A4649,HCPCS,Facility,Inpatient,,,,1230.32,1045.772,352.609712,1230.32,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
ENDOGIA 30-3.5,,A4649,HCPCS,Facility,Outpatient,,,,1230.32,1045.772,352.609712,1230.32,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,590.5536,48,,percent of total billed charges,,100% of DHS outpatient percentage
ENDOGIA 30-3.5,,A4649,HCPCS,Facility,Inpatient,,,,1230.32,1045.772,352.609712,1230.32,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
ENT PACKS,,A4649,HCPCS,Facility,Both,,,,113.24,96.254,32.454584,113.24,Aetna,Commercial,104.1808,92,,percent of total billed charges,,
ENT PACKS,,A4649,HCPCS,Facility,Outpatient,,,,113.24,96.254,32.454584,113.24,Aetna,Medicare Advantage,55.4876,49,,percent of total billed charges,,
ENT PACKS,,A4649,HCPCS,Facility,Inpatient,,,,113.24,96.254,32.454584,113.24,Aetna,Medicare Advantage,,,,,Included in per diem rate,
ENT PACKS,,A4649,HCPCS,Facility,Both,,,,113.24,96.254,32.454584,113.24,Aetna,PPO,105.3132,93,,percent of total billed charges,,
ENT PACKS,,A4649,HCPCS,Facility,Both,,,,113.24,96.254,32.454584,113.24,America's PPO,America's PPO,108.744372,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
ENT PACKS,,A4649,HCPCS,Facility,Both,,,,113.24,96.254,32.454584,113.24,BlueCross BlueShield Minnesota, Federal Employee Program,111.42816,98.4,,percent of total billed charges,,
ENT PACKS,,A4649,HCPCS,Facility,Both,,,,113.24,96.254,32.454584,113.24,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,113.24,100,,percent of total billed charges,,
ENT PACKS,,A4649,HCPCS,Facility,Both,,,,113.24,96.254,32.454584,113.24,BlueCross BlueShield Minnesota,High Value Network Plan,101.916,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
ENT PACKS,,A4649,HCPCS,Facility,Outpatient,,,,113.24,96.254,32.454584,113.24,BlueCross BlueShield Minnesota,Medicare Advantage,55.4876,49,,percent of total billed charges,,
ENT PACKS,,A4649,HCPCS,Facility,Inpatient,,,,113.24,96.254,32.454584,113.24,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
ENT PACKS,,A4649,HCPCS,Facility,Both,,,,113.24,96.254,32.454584,113.24,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,100.296668,88.57,,percent of total billed charges,,
ENT PACKS,,A4649,HCPCS,Facility,Both,,,,113.24,96.254,32.454584,113.24,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,32.454584,28.66,,percent of total billed charges,,
ENT PACKS,,A4649,HCPCS,Facility,Outpatient,,,,113.24,96.254,32.454584,113.24,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),55.4876,49,,percent of total billed charges,,
ENT PACKS,,A4649,HCPCS,Facility,Inpatient,,,,113.24,96.254,32.454584,113.24,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
ENT PACKS,,A4649,HCPCS,Facility,Both,,,,113.24,96.254,32.454584,113.24,CorVel,Worker's Compensation,113.24,100,,percent of total billed charges,,
ENT PACKS,,A4649,HCPCS,Facility,Both,,,,113.24,96.254,32.454584,113.24,First Health Group Corporation,First Health Network,109.8428,97,,percent of total billed charges,,
ENT PACKS,,A4649,HCPCS,Facility,Both,,,,113.24,96.254,32.454584,113.24,"Health Partners, Inc.",Commercial,107.12504,94.6,,percent of total billed charges,,
ENT PACKS,,A4649,HCPCS,Facility,Outpatient,,,,113.24,96.254,32.454584,113.24,"Health Partners, Inc.",Medicare Advantage,55.4876,49,,percent of total billed charges,,
ENT PACKS,,A4649,HCPCS,Facility,Inpatient,,,,113.24,96.254,32.454584,113.24,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ENT PACKS,,A4649,HCPCS,Facility,Both,,,,113.24,96.254,32.454584,113.24,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),67.944,60,,percent of total billed charges,,
ENT PACKS,,A4649,HCPCS,Facility,Both,,,,113.24,96.254,32.454584,113.24,"Health Partners, Inc.",State of Minnesota Advantage Program,92.2906,81.5,,percent of total billed charges,,
ENT PACKS,,A4649,HCPCS,Facility,Both,,,,113.24,96.254,32.454584,113.24,"Health Partners, Inc.",State Public Programs,56.62,50,,percent of total billed charges,,
ENT PACKS,,A4649,HCPCS,Facility,Both,,,,113.24,96.254,32.454584,113.24,Humana Insurance Company,Commercial PPO,107.578,95,,percent of total billed charges,,
ENT PACKS,,A4649,HCPCS,Facility,Outpatient,,,,113.24,96.254,32.454584,113.24,Humana Insurance Company,Medicare PPO,55.4876,49,,percent of total billed charges,,
ENT PACKS,,A4649,HCPCS,Facility,Inpatient,,,,113.24,96.254,32.454584,113.24,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
ENT PACKS,,A4649,HCPCS,Facility,Both,,,,113.24,96.254,32.454584,113.24,Medica,Individual & Family,112.22084,99.1,,percent of total billed charges,,
ENT PACKS,,A4649,HCPCS,Facility,Outpatient,,,,113.24,96.254,32.454584,113.24,Medica,Medica Advantage Solution,56.39352,49.8,,percent of total billed charges,,
ENT PACKS,,A4649,HCPCS,Facility,Inpatient,,,,113.24,96.254,32.454584,113.24,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
ENT PACKS,,A4649,HCPCS,Facility,Outpatient,,,,113.24,96.254,32.454584,113.24,Medica,Medical Assistance,50.50504,44.6,,percent of total billed charges,,
ENT PACKS,,A4649,HCPCS,Facility,Inpatient,,,,113.24,96.254,32.454584,113.24,Medica,Medical Assistance,,,,,Included in per diem rate,
ENT PACKS,,A4649,HCPCS,Facility,Outpatient,,,,113.24,96.254,32.454584,113.24,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,56.39352,49.8,,percent of total billed charges,,
ENT PACKS,,A4649,HCPCS,Facility,Inpatient,,,,113.24,96.254,32.454584,113.24,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
ENT PACKS,,A4649,HCPCS,Facility,Both,,,,113.24,96.254,32.454584,113.24,"Multiplan, Inc.","Multiplan, Inc.",106.4456,94,,percent of total billed charges,,
ENT PACKS,,A4649,HCPCS,Facility,Outpatient,,,,113.24,96.254,32.454584,113.24,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,102.02924,90.1,,percent of total billed charges,,
ENT PACKS,,A4649,HCPCS,Facility,Inpatient,,,,113.24,96.254,32.454584,113.24,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
ENT PACKS,,A4649,HCPCS,Facility,Both,,,,113.24,96.254,32.454584,113.24,"Preferred One Administrative Services, INC.",PPO,111.65464,98.6,,percent of total billed charges,,
ENT PACKS,,A4649,HCPCS,Facility,Outpatient,,,,113.24,96.254,32.454584,113.24,PrimeWest Health,Minnesota Senior Health Options (MSHO),58.26198,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
ENT PACKS,,A4649,HCPCS,Facility,Inpatient,,,,113.24,96.254,32.454584,113.24,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ENT PACKS,,A4649,HCPCS,Facility,Outpatient,,,,113.24,96.254,32.454584,113.24,PrimeWest Health,MinnesotaCare,58.160064,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
ENT PACKS,,A4649,HCPCS,Facility,Inpatient,,,,113.24,96.254,32.454584,113.24,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
ENT PACKS,,A4649,HCPCS,Facility,Both,,,,113.24,96.254,32.454584,113.24,Sanford Health Plan,Sanford Health Plan,104.1808,92,,percent of total billed charges,,
ENT PACKS,,A4649,HCPCS,Facility,Outpatient,,,,113.24,96.254,32.454584,113.24,"UCare Health, Inc.",Individual & Family Plan,63.81074,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
ENT PACKS,,A4649,HCPCS,Facility,Inpatient,,,,113.24,96.254,32.454584,113.24,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
ENT PACKS,,A4649,HCPCS,Facility,Outpatient,,,,113.24,96.254,32.454584,113.24,"UCare Health, Inc.",Medical Assistance,57.152228,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ENT PACKS,,A4649,HCPCS,Facility,Inpatient,,,,113.24,96.254,32.454584,113.24,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
ENT PACKS,,A4649,HCPCS,Facility,Outpatient,,,,113.24,96.254,32.454584,113.24,"UCare Health, Inc.",Medicare Advantage,57.152228,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ENT PACKS,,A4649,HCPCS,Facility,Inpatient,,,,113.24,96.254,32.454584,113.24,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ENT PACKS,,A4649,HCPCS,Facility,Outpatient,,,,113.24,96.254,32.454584,113.24,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),57.152228,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ENT PACKS,,A4649,HCPCS,Facility,Inpatient,,,,113.24,96.254,32.454584,113.24,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ENT PACKS,,A4649,HCPCS,Facility,Both,,,,113.24,96.254,32.454584,113.24,UnitedHealthcare,Individual & Family,106.4456,94,,percent of total billed charges,,
ENT PACKS,,A4649,HCPCS,Facility,Outpatient,,,,113.24,96.254,32.454584,113.24,UnitedHealthcare,Medicare Advantage,55.4876,49,,percent of total billed charges,,
ENT PACKS,,A4649,HCPCS,Facility,Inpatient,,,,113.24,96.254,32.454584,113.24,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
ENT PACKS,,A4649,HCPCS,Facility,Outpatient,,,,113.24,96.254,32.454584,113.24,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,54.3552,48,,percent of total billed charges,,100% of DHS outpatient percentage
ENT PACKS,,A4649,HCPCS,Facility,Inpatient,,,,113.24,96.254,32.454584,113.24,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
EVACUATOR BLADDER UROVAC M0067301250,,A4649,HCPCS,Facility,Both,,,,158.08,134.368,45.305728,158.08,Aetna,Commercial,145.4336,92,,percent of total billed charges,,
EVACUATOR BLADDER UROVAC M0067301250,,A4649,HCPCS,Facility,Outpatient,,,,158.08,134.368,45.305728,158.08,Aetna,Medicare Advantage,77.4592,49,,percent of total billed charges,,
EVACUATOR BLADDER UROVAC M0067301250,,A4649,HCPCS,Facility,Inpatient,,,,158.08,134.368,45.305728,158.08,Aetna,Medicare Advantage,,,,,Included in per diem rate,
EVACUATOR BLADDER UROVAC M0067301250,,A4649,HCPCS,Facility,Both,,,,158.08,134.368,45.305728,158.08,Aetna,PPO,147.0144,93,,percent of total billed charges,,
EVACUATOR BLADDER UROVAC M0067301250,,A4649,HCPCS,Facility,Both,,,,158.08,134.368,45.305728,158.08,America's PPO,America's PPO,151.804224,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
EVACUATOR BLADDER UROVAC M0067301250,,A4649,HCPCS,Facility,Both,,,,158.08,134.368,45.305728,158.08,BlueCross BlueShield Minnesota, Federal Employee Program,155.55072,98.4,,percent of total billed charges,,
EVACUATOR BLADDER UROVAC M0067301250,,A4649,HCPCS,Facility,Both,,,,158.08,134.368,45.305728,158.08,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,158.08,100,,percent of total billed charges,,
EVACUATOR BLADDER UROVAC M0067301250,,A4649,HCPCS,Facility,Both,,,,158.08,134.368,45.305728,158.08,BlueCross BlueShield Minnesota,High Value Network Plan,142.272,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
EVACUATOR BLADDER UROVAC M0067301250,,A4649,HCPCS,Facility,Outpatient,,,,158.08,134.368,45.305728,158.08,BlueCross BlueShield Minnesota,Medicare Advantage,77.4592,49,,percent of total billed charges,,
EVACUATOR BLADDER UROVAC M0067301250,,A4649,HCPCS,Facility,Inpatient,,,,158.08,134.368,45.305728,158.08,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
EVACUATOR BLADDER UROVAC M0067301250,,A4649,HCPCS,Facility,Both,,,,158.08,134.368,45.305728,158.08,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,140.011456,88.57,,percent of total billed charges,,
EVACUATOR BLADDER UROVAC M0067301250,,A4649,HCPCS,Facility,Both,,,,158.08,134.368,45.305728,158.08,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,45.305728,28.66,,percent of total billed charges,,
EVACUATOR BLADDER UROVAC M0067301250,,A4649,HCPCS,Facility,Outpatient,,,,158.08,134.368,45.305728,158.08,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),77.4592,49,,percent of total billed charges,,
EVACUATOR BLADDER UROVAC M0067301250,,A4649,HCPCS,Facility,Inpatient,,,,158.08,134.368,45.305728,158.08,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
EVACUATOR BLADDER UROVAC M0067301250,,A4649,HCPCS,Facility,Both,,,,158.08,134.368,45.305728,158.08,CorVel,Worker's Compensation,158.08,100,,percent of total billed charges,,
EVACUATOR BLADDER UROVAC M0067301250,,A4649,HCPCS,Facility,Both,,,,158.08,134.368,45.305728,158.08,First Health Group Corporation,First Health Network,153.3376,97,,percent of total billed charges,,
EVACUATOR BLADDER UROVAC M0067301250,,A4649,HCPCS,Facility,Both,,,,158.08,134.368,45.305728,158.08,"Health Partners, Inc.",Commercial,149.54368,94.6,,percent of total billed charges,,
EVACUATOR BLADDER UROVAC M0067301250,,A4649,HCPCS,Facility,Outpatient,,,,158.08,134.368,45.305728,158.08,"Health Partners, Inc.",Medicare Advantage,77.4592,49,,percent of total billed charges,,
EVACUATOR BLADDER UROVAC M0067301250,,A4649,HCPCS,Facility,Inpatient,,,,158.08,134.368,45.305728,158.08,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
EVACUATOR BLADDER UROVAC M0067301250,,A4649,HCPCS,Facility,Both,,,,158.08,134.368,45.305728,158.08,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),94.848,60,,percent of total billed charges,,
EVACUATOR BLADDER UROVAC M0067301250,,A4649,HCPCS,Facility,Both,,,,158.08,134.368,45.305728,158.08,"Health Partners, Inc.",State of Minnesota Advantage Program,128.8352,81.5,,percent of total billed charges,,
EVACUATOR BLADDER UROVAC M0067301250,,A4649,HCPCS,Facility,Both,,,,158.08,134.368,45.305728,158.08,"Health Partners, Inc.",State Public Programs,79.04,50,,percent of total billed charges,,
EVACUATOR BLADDER UROVAC M0067301250,,A4649,HCPCS,Facility,Both,,,,158.08,134.368,45.305728,158.08,Humana Insurance Company,Commercial PPO,150.176,95,,percent of total billed charges,,
EVACUATOR BLADDER UROVAC M0067301250,,A4649,HCPCS,Facility,Outpatient,,,,158.08,134.368,45.305728,158.08,Humana Insurance Company,Medicare PPO,77.4592,49,,percent of total billed charges,,
EVACUATOR BLADDER UROVAC M0067301250,,A4649,HCPCS,Facility,Inpatient,,,,158.08,134.368,45.305728,158.08,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
EVACUATOR BLADDER UROVAC M0067301250,,A4649,HCPCS,Facility,Both,,,,158.08,134.368,45.305728,158.08,Medica,Individual & Family,156.65728,99.1,,percent of total billed charges,,
EVACUATOR BLADDER UROVAC M0067301250,,A4649,HCPCS,Facility,Outpatient,,,,158.08,134.368,45.305728,158.08,Medica,Medica Advantage Solution,78.72384,49.8,,percent of total billed charges,,
EVACUATOR BLADDER UROVAC M0067301250,,A4649,HCPCS,Facility,Inpatient,,,,158.08,134.368,45.305728,158.08,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
EVACUATOR BLADDER UROVAC M0067301250,,A4649,HCPCS,Facility,Outpatient,,,,158.08,134.368,45.305728,158.08,Medica,Medical Assistance,70.50368,44.6,,percent of total billed charges,,
EVACUATOR BLADDER UROVAC M0067301250,,A4649,HCPCS,Facility,Inpatient,,,,158.08,134.368,45.305728,158.08,Medica,Medical Assistance,,,,,Included in per diem rate,
EVACUATOR BLADDER UROVAC M0067301250,,A4649,HCPCS,Facility,Outpatient,,,,158.08,134.368,45.305728,158.08,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,78.72384,49.8,,percent of total billed charges,,
EVACUATOR BLADDER UROVAC M0067301250,,A4649,HCPCS,Facility,Inpatient,,,,158.08,134.368,45.305728,158.08,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
EVACUATOR BLADDER UROVAC M0067301250,,A4649,HCPCS,Facility,Both,,,,158.08,134.368,45.305728,158.08,"Multiplan, Inc.","Multiplan, Inc.",148.5952,94,,percent of total billed charges,,
EVACUATOR BLADDER UROVAC M0067301250,,A4649,HCPCS,Facility,Outpatient,,,,158.08,134.368,45.305728,158.08,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,142.43008,90.1,,percent of total billed charges,,
EVACUATOR BLADDER UROVAC M0067301250,,A4649,HCPCS,Facility,Inpatient,,,,158.08,134.368,45.305728,158.08,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
EVACUATOR BLADDER UROVAC M0067301250,,A4649,HCPCS,Facility,Both,,,,158.08,134.368,45.305728,158.08,"Preferred One Administrative Services, INC.",PPO,155.86688,98.6,,percent of total billed charges,,
EVACUATOR BLADDER UROVAC M0067301250,,A4649,HCPCS,Facility,Outpatient,,,,158.08,134.368,45.305728,158.08,PrimeWest Health,Minnesota Senior Health Options (MSHO),81.33216,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
EVACUATOR BLADDER UROVAC M0067301250,,A4649,HCPCS,Facility,Inpatient,,,,158.08,134.368,45.305728,158.08,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
EVACUATOR BLADDER UROVAC M0067301250,,A4649,HCPCS,Facility,Outpatient,,,,158.08,134.368,45.305728,158.08,PrimeWest Health,MinnesotaCare,81.189888,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
EVACUATOR BLADDER UROVAC M0067301250,,A4649,HCPCS,Facility,Inpatient,,,,158.08,134.368,45.305728,158.08,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
EVACUATOR BLADDER UROVAC M0067301250,,A4649,HCPCS,Facility,Both,,,,158.08,134.368,45.305728,158.08,Sanford Health Plan,Sanford Health Plan,145.4336,92,,percent of total billed charges,,
EVACUATOR BLADDER UROVAC M0067301250,,A4649,HCPCS,Facility,Outpatient,,,,158.08,134.368,45.305728,158.08,"UCare Health, Inc.",Individual & Family Plan,89.07808,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
EVACUATOR BLADDER UROVAC M0067301250,,A4649,HCPCS,Facility,Inpatient,,,,158.08,134.368,45.305728,158.08,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
EVACUATOR BLADDER UROVAC M0067301250,,A4649,HCPCS,Facility,Outpatient,,,,158.08,134.368,45.305728,158.08,"UCare Health, Inc.",Medical Assistance,79.782976,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
EVACUATOR BLADDER UROVAC M0067301250,,A4649,HCPCS,Facility,Inpatient,,,,158.08,134.368,45.305728,158.08,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
EVACUATOR BLADDER UROVAC M0067301250,,A4649,HCPCS,Facility,Outpatient,,,,158.08,134.368,45.305728,158.08,"UCare Health, Inc.",Medicare Advantage,79.782976,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
EVACUATOR BLADDER UROVAC M0067301250,,A4649,HCPCS,Facility,Inpatient,,,,158.08,134.368,45.305728,158.08,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
EVACUATOR BLADDER UROVAC M0067301250,,A4649,HCPCS,Facility,Outpatient,,,,158.08,134.368,45.305728,158.08,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),79.782976,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
EVACUATOR BLADDER UROVAC M0067301250,,A4649,HCPCS,Facility,Inpatient,,,,158.08,134.368,45.305728,158.08,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
EVACUATOR BLADDER UROVAC M0067301250,,A4649,HCPCS,Facility,Both,,,,158.08,134.368,45.305728,158.08,UnitedHealthcare,Individual & Family,148.5952,94,,percent of total billed charges,,
EVACUATOR BLADDER UROVAC M0067301250,,A4649,HCPCS,Facility,Outpatient,,,,158.08,134.368,45.305728,158.08,UnitedHealthcare,Medicare Advantage,77.4592,49,,percent of total billed charges,,
EVACUATOR BLADDER UROVAC M0067301250,,A4649,HCPCS,Facility,Inpatient,,,,158.08,134.368,45.305728,158.08,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
EVACUATOR BLADDER UROVAC M0067301250,,A4649,HCPCS,Facility,Outpatient,,,,158.08,134.368,45.305728,158.08,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,75.8784,48,,percent of total billed charges,,100% of DHS outpatient percentage
EVACUATOR BLADDER UROVAC M0067301250,,A4649,HCPCS,Facility,Inpatient,,,,158.08,134.368,45.305728,158.08,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
EVAN'S WEDGE 12MM CORTICAL RIM,,A4649,HCPCS,Facility,Both,,,,5771.5,4905.775,1654.1119,5771.5,Aetna,Commercial,5309.78,92,,percent of total billed charges,,
EVAN'S WEDGE 12MM CORTICAL RIM,,A4649,HCPCS,Facility,Outpatient,,,,5771.5,4905.775,1654.1119,5771.5,Aetna,Medicare Advantage,2828.035,49,,percent of total billed charges,,
EVAN'S WEDGE 12MM CORTICAL RIM,,A4649,HCPCS,Facility,Inpatient,,,,5771.5,4905.775,1654.1119,5771.5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
EVAN'S WEDGE 12MM CORTICAL RIM,,A4649,HCPCS,Facility,Both,,,,5771.5,4905.775,1654.1119,5771.5,Aetna,PPO,5367.495,93,,percent of total billed charges,,
EVAN'S WEDGE 12MM CORTICAL RIM,,A4649,HCPCS,Facility,Both,,,,5771.5,4905.775,1654.1119,5771.5,America's PPO,America's PPO,5542.37145,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
EVAN'S WEDGE 12MM CORTICAL RIM,,A4649,HCPCS,Facility,Both,,,,5771.5,4905.775,1654.1119,5771.5,BlueCross BlueShield Minnesota, Federal Employee Program,5679.156,98.4,,percent of total billed charges,,
EVAN'S WEDGE 12MM CORTICAL RIM,,A4649,HCPCS,Facility,Both,,,,5771.5,4905.775,1654.1119,5771.5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5771.5,100,,percent of total billed charges,,
EVAN'S WEDGE 12MM CORTICAL RIM,,A4649,HCPCS,Facility,Both,,,,5771.5,4905.775,1654.1119,5771.5,BlueCross BlueShield Minnesota,High Value Network Plan,5194.35,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
EVAN'S WEDGE 12MM CORTICAL RIM,,A4649,HCPCS,Facility,Outpatient,,,,5771.5,4905.775,1654.1119,5771.5,BlueCross BlueShield Minnesota,Medicare Advantage,2828.035,49,,percent of total billed charges,,
EVAN'S WEDGE 12MM CORTICAL RIM,,A4649,HCPCS,Facility,Inpatient,,,,5771.5,4905.775,1654.1119,5771.5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
EVAN'S WEDGE 12MM CORTICAL RIM,,A4649,HCPCS,Facility,Both,,,,5771.5,4905.775,1654.1119,5771.5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,5111.81755,88.57,,percent of total billed charges,,
EVAN'S WEDGE 12MM CORTICAL RIM,,A4649,HCPCS,Facility,Both,,,,5771.5,4905.775,1654.1119,5771.5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1654.1119,28.66,,percent of total billed charges,,
EVAN'S WEDGE 12MM CORTICAL RIM,,A4649,HCPCS,Facility,Outpatient,,,,5771.5,4905.775,1654.1119,5771.5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2828.035,49,,percent of total billed charges,,
EVAN'S WEDGE 12MM CORTICAL RIM,,A4649,HCPCS,Facility,Inpatient,,,,5771.5,4905.775,1654.1119,5771.5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
EVAN'S WEDGE 12MM CORTICAL RIM,,A4649,HCPCS,Facility,Both,,,,5771.5,4905.775,1654.1119,5771.5,CorVel,Worker's Compensation,5771.5,100,,percent of total billed charges,,
EVAN'S WEDGE 12MM CORTICAL RIM,,A4649,HCPCS,Facility,Both,,,,5771.5,4905.775,1654.1119,5771.5,First Health Group Corporation,First Health Network,5598.355,97,,percent of total billed charges,,
EVAN'S WEDGE 12MM CORTICAL RIM,,A4649,HCPCS,Facility,Both,,,,5771.5,4905.775,1654.1119,5771.5,"Health Partners, Inc.",Commercial,5459.839,94.6,,percent of total billed charges,,
EVAN'S WEDGE 12MM CORTICAL RIM,,A4649,HCPCS,Facility,Outpatient,,,,5771.5,4905.775,1654.1119,5771.5,"Health Partners, Inc.",Medicare Advantage,2828.035,49,,percent of total billed charges,,
EVAN'S WEDGE 12MM CORTICAL RIM,,A4649,HCPCS,Facility,Inpatient,,,,5771.5,4905.775,1654.1119,5771.5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
EVAN'S WEDGE 12MM CORTICAL RIM,,A4649,HCPCS,Facility,Both,,,,5771.5,4905.775,1654.1119,5771.5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3462.9,60,,percent of total billed charges,,
EVAN'S WEDGE 12MM CORTICAL RIM,,A4649,HCPCS,Facility,Both,,,,5771.5,4905.775,1654.1119,5771.5,"Health Partners, Inc.",State of Minnesota Advantage Program,4703.7725,81.5,,percent of total billed charges,,
EVAN'S WEDGE 12MM CORTICAL RIM,,A4649,HCPCS,Facility,Both,,,,5771.5,4905.775,1654.1119,5771.5,"Health Partners, Inc.",State Public Programs,2885.75,50,,percent of total billed charges,,
EVAN'S WEDGE 12MM CORTICAL RIM,,A4649,HCPCS,Facility,Both,,,,5771.5,4905.775,1654.1119,5771.5,Humana Insurance Company,Commercial PPO,5482.925,95,,percent of total billed charges,,
EVAN'S WEDGE 12MM CORTICAL RIM,,A4649,HCPCS,Facility,Outpatient,,,,5771.5,4905.775,1654.1119,5771.5,Humana Insurance Company,Medicare PPO,2828.035,49,,percent of total billed charges,,
EVAN'S WEDGE 12MM CORTICAL RIM,,A4649,HCPCS,Facility,Inpatient,,,,5771.5,4905.775,1654.1119,5771.5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
EVAN'S WEDGE 12MM CORTICAL RIM,,A4649,HCPCS,Facility,Both,,,,5771.5,4905.775,1654.1119,5771.5,Medica,Individual & Family,5719.5565,99.1,,percent of total billed charges,,
EVAN'S WEDGE 12MM CORTICAL RIM,,A4649,HCPCS,Facility,Outpatient,,,,5771.5,4905.775,1654.1119,5771.5,Medica,Medica Advantage Solution,2874.207,49.8,,percent of total billed charges,,
EVAN'S WEDGE 12MM CORTICAL RIM,,A4649,HCPCS,Facility,Inpatient,,,,5771.5,4905.775,1654.1119,5771.5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
EVAN'S WEDGE 12MM CORTICAL RIM,,A4649,HCPCS,Facility,Outpatient,,,,5771.5,4905.775,1654.1119,5771.5,Medica,Medical Assistance,2574.089,44.6,,percent of total billed charges,,
EVAN'S WEDGE 12MM CORTICAL RIM,,A4649,HCPCS,Facility,Inpatient,,,,5771.5,4905.775,1654.1119,5771.5,Medica,Medical Assistance,,,,,Included in per diem rate,
EVAN'S WEDGE 12MM CORTICAL RIM,,A4649,HCPCS,Facility,Outpatient,,,,5771.5,4905.775,1654.1119,5771.5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2874.207,49.8,,percent of total billed charges,,
EVAN'S WEDGE 12MM CORTICAL RIM,,A4649,HCPCS,Facility,Inpatient,,,,5771.5,4905.775,1654.1119,5771.5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
EVAN'S WEDGE 12MM CORTICAL RIM,,A4649,HCPCS,Facility,Both,,,,5771.5,4905.775,1654.1119,5771.5,"Multiplan, Inc.","Multiplan, Inc.",5425.21,94,,percent of total billed charges,,
EVAN'S WEDGE 12MM CORTICAL RIM,,A4649,HCPCS,Facility,Outpatient,,,,5771.5,4905.775,1654.1119,5771.5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,5200.1215,90.1,,percent of total billed charges,,
EVAN'S WEDGE 12MM CORTICAL RIM,,A4649,HCPCS,Facility,Inpatient,,,,5771.5,4905.775,1654.1119,5771.5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
EVAN'S WEDGE 12MM CORTICAL RIM,,A4649,HCPCS,Facility,Both,,,,5771.5,4905.775,1654.1119,5771.5,"Preferred One Administrative Services, INC.",PPO,5690.699,98.6,,percent of total billed charges,,
EVAN'S WEDGE 12MM CORTICAL RIM,,A4649,HCPCS,Facility,Outpatient,,,,5771.5,4905.775,1654.1119,5771.5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2969.43675,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
EVAN'S WEDGE 12MM CORTICAL RIM,,A4649,HCPCS,Facility,Inpatient,,,,5771.5,4905.775,1654.1119,5771.5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
EVAN'S WEDGE 12MM CORTICAL RIM,,A4649,HCPCS,Facility,Outpatient,,,,5771.5,4905.775,1654.1119,5771.5,PrimeWest Health,MinnesotaCare,2964.2424,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
EVAN'S WEDGE 12MM CORTICAL RIM,,A4649,HCPCS,Facility,Inpatient,,,,5771.5,4905.775,1654.1119,5771.5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
EVAN'S WEDGE 12MM CORTICAL RIM,,A4649,HCPCS,Facility,Both,,,,5771.5,4905.775,1654.1119,5771.5,Sanford Health Plan,Sanford Health Plan,5309.78,92,,percent of total billed charges,,
EVAN'S WEDGE 12MM CORTICAL RIM,,A4649,HCPCS,Facility,Outpatient,,,,5771.5,4905.775,1654.1119,5771.5,"UCare Health, Inc.",Individual & Family Plan,3252.24025,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
EVAN'S WEDGE 12MM CORTICAL RIM,,A4649,HCPCS,Facility,Inpatient,,,,5771.5,4905.775,1654.1119,5771.5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
EVAN'S WEDGE 12MM CORTICAL RIM,,A4649,HCPCS,Facility,Outpatient,,,,5771.5,4905.775,1654.1119,5771.5,"UCare Health, Inc.",Medical Assistance,2912.87605,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
EVAN'S WEDGE 12MM CORTICAL RIM,,A4649,HCPCS,Facility,Inpatient,,,,5771.5,4905.775,1654.1119,5771.5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
EVAN'S WEDGE 12MM CORTICAL RIM,,A4649,HCPCS,Facility,Outpatient,,,,5771.5,4905.775,1654.1119,5771.5,"UCare Health, Inc.",Medicare Advantage,2912.87605,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
EVAN'S WEDGE 12MM CORTICAL RIM,,A4649,HCPCS,Facility,Inpatient,,,,5771.5,4905.775,1654.1119,5771.5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
EVAN'S WEDGE 12MM CORTICAL RIM,,A4649,HCPCS,Facility,Outpatient,,,,5771.5,4905.775,1654.1119,5771.5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2912.87605,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
EVAN'S WEDGE 12MM CORTICAL RIM,,A4649,HCPCS,Facility,Inpatient,,,,5771.5,4905.775,1654.1119,5771.5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
EVAN'S WEDGE 12MM CORTICAL RIM,,A4649,HCPCS,Facility,Both,,,,5771.5,4905.775,1654.1119,5771.5,UnitedHealthcare,Individual & Family,5425.21,94,,percent of total billed charges,,
EVAN'S WEDGE 12MM CORTICAL RIM,,A4649,HCPCS,Facility,Outpatient,,,,5771.5,4905.775,1654.1119,5771.5,UnitedHealthcare,Medicare Advantage,2828.035,49,,percent of total billed charges,,
EVAN'S WEDGE 12MM CORTICAL RIM,,A4649,HCPCS,Facility,Inpatient,,,,5771.5,4905.775,1654.1119,5771.5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
EVAN'S WEDGE 12MM CORTICAL RIM,,A4649,HCPCS,Facility,Outpatient,,,,5771.5,4905.775,1654.1119,5771.5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2770.32,48,,percent of total billed charges,,100% of DHS outpatient percentage
EVAN'S WEDGE 12MM CORTICAL RIM,,A4649,HCPCS,Facility,Inpatient,,,,5771.5,4905.775,1654.1119,5771.5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Eye Pack,,A4649,HCPCS,Facility,Both,,,,115.76,98.396,33.176816,115.76,Aetna,Commercial,106.4992,92,,percent of total billed charges,,
Eye Pack,,A4649,HCPCS,Facility,Outpatient,,,,115.76,98.396,33.176816,115.76,Aetna,Medicare Advantage,56.7224,49,,percent of total billed charges,,
Eye Pack,,A4649,HCPCS,Facility,Inpatient,,,,115.76,98.396,33.176816,115.76,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Eye Pack,,A4649,HCPCS,Facility,Both,,,,115.76,98.396,33.176816,115.76,Aetna,PPO,107.6568,93,,percent of total billed charges,,
Eye Pack,,A4649,HCPCS,Facility,Both,,,,115.76,98.396,33.176816,115.76,America's PPO,America's PPO,111.164328,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Eye Pack,,A4649,HCPCS,Facility,Both,,,,115.76,98.396,33.176816,115.76,BlueCross BlueShield Minnesota, Federal Employee Program,113.90784,98.4,,percent of total billed charges,,
Eye Pack,,A4649,HCPCS,Facility,Both,,,,115.76,98.396,33.176816,115.76,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,115.76,100,,percent of total billed charges,,
Eye Pack,,A4649,HCPCS,Facility,Both,,,,115.76,98.396,33.176816,115.76,BlueCross BlueShield Minnesota,High Value Network Plan,104.184,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
Eye Pack,,A4649,HCPCS,Facility,Outpatient,,,,115.76,98.396,33.176816,115.76,BlueCross BlueShield Minnesota,Medicare Advantage,56.7224,49,,percent of total billed charges,,
Eye Pack,,A4649,HCPCS,Facility,Inpatient,,,,115.76,98.396,33.176816,115.76,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Eye Pack,,A4649,HCPCS,Facility,Both,,,,115.76,98.396,33.176816,115.76,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,102.528632,88.57,,percent of total billed charges,,
Eye Pack,,A4649,HCPCS,Facility,Both,,,,115.76,98.396,33.176816,115.76,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,33.176816,28.66,,percent of total billed charges,,
Eye Pack,,A4649,HCPCS,Facility,Outpatient,,,,115.76,98.396,33.176816,115.76,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),56.7224,49,,percent of total billed charges,,
Eye Pack,,A4649,HCPCS,Facility,Inpatient,,,,115.76,98.396,33.176816,115.76,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Eye Pack,,A4649,HCPCS,Facility,Both,,,,115.76,98.396,33.176816,115.76,CorVel,Worker's Compensation,115.76,100,,percent of total billed charges,,
Eye Pack,,A4649,HCPCS,Facility,Both,,,,115.76,98.396,33.176816,115.76,First Health Group Corporation,First Health Network,112.2872,97,,percent of total billed charges,,
Eye Pack,,A4649,HCPCS,Facility,Both,,,,115.76,98.396,33.176816,115.76,"Health Partners, Inc.",Commercial,109.50896,94.6,,percent of total billed charges,,
Eye Pack,,A4649,HCPCS,Facility,Outpatient,,,,115.76,98.396,33.176816,115.76,"Health Partners, Inc.",Medicare Advantage,56.7224,49,,percent of total billed charges,,
Eye Pack,,A4649,HCPCS,Facility,Inpatient,,,,115.76,98.396,33.176816,115.76,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Eye Pack,,A4649,HCPCS,Facility,Both,,,,115.76,98.396,33.176816,115.76,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),69.456,60,,percent of total billed charges,,
Eye Pack,,A4649,HCPCS,Facility,Both,,,,115.76,98.396,33.176816,115.76,"Health Partners, Inc.",State of Minnesota Advantage Program,94.3444,81.5,,percent of total billed charges,,
Eye Pack,,A4649,HCPCS,Facility,Both,,,,115.76,98.396,33.176816,115.76,"Health Partners, Inc.",State Public Programs,57.88,50,,percent of total billed charges,,
Eye Pack,,A4649,HCPCS,Facility,Both,,,,115.76,98.396,33.176816,115.76,Humana Insurance Company,Commercial PPO,109.972,95,,percent of total billed charges,,
Eye Pack,,A4649,HCPCS,Facility,Outpatient,,,,115.76,98.396,33.176816,115.76,Humana Insurance Company,Medicare PPO,56.7224,49,,percent of total billed charges,,
Eye Pack,,A4649,HCPCS,Facility,Inpatient,,,,115.76,98.396,33.176816,115.76,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Eye Pack,,A4649,HCPCS,Facility,Both,,,,115.76,98.396,33.176816,115.76,Medica,Individual & Family,114.71816,99.1,,percent of total billed charges,,
Eye Pack,,A4649,HCPCS,Facility,Outpatient,,,,115.76,98.396,33.176816,115.76,Medica,Medica Advantage Solution,57.64848,49.8,,percent of total billed charges,,
Eye Pack,,A4649,HCPCS,Facility,Inpatient,,,,115.76,98.396,33.176816,115.76,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Eye Pack,,A4649,HCPCS,Facility,Outpatient,,,,115.76,98.396,33.176816,115.76,Medica,Medical Assistance,51.62896,44.6,,percent of total billed charges,,
Eye Pack,,A4649,HCPCS,Facility,Inpatient,,,,115.76,98.396,33.176816,115.76,Medica,Medical Assistance,,,,,Included in per diem rate,
Eye Pack,,A4649,HCPCS,Facility,Outpatient,,,,115.76,98.396,33.176816,115.76,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,57.64848,49.8,,percent of total billed charges,,
Eye Pack,,A4649,HCPCS,Facility,Inpatient,,,,115.76,98.396,33.176816,115.76,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Eye Pack,,A4649,HCPCS,Facility,Both,,,,115.76,98.396,33.176816,115.76,"Multiplan, Inc.","Multiplan, Inc.",108.8144,94,,percent of total billed charges,,
Eye Pack,,A4649,HCPCS,Facility,Outpatient,,,,115.76,98.396,33.176816,115.76,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,104.29976,90.1,,percent of total billed charges,,
Eye Pack,,A4649,HCPCS,Facility,Inpatient,,,,115.76,98.396,33.176816,115.76,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Eye Pack,,A4649,HCPCS,Facility,Both,,,,115.76,98.396,33.176816,115.76,"Preferred One Administrative Services, INC.",PPO,114.13936,98.6,,percent of total billed charges,,
Eye Pack,,A4649,HCPCS,Facility,Outpatient,,,,115.76,98.396,33.176816,115.76,PrimeWest Health,Minnesota Senior Health Options (MSHO),59.55852,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Eye Pack,,A4649,HCPCS,Facility,Inpatient,,,,115.76,98.396,33.176816,115.76,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Eye Pack,,A4649,HCPCS,Facility,Outpatient,,,,115.76,98.396,33.176816,115.76,PrimeWest Health,MinnesotaCare,59.454336,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Eye Pack,,A4649,HCPCS,Facility,Inpatient,,,,115.76,98.396,33.176816,115.76,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Eye Pack,,A4649,HCPCS,Facility,Both,,,,115.76,98.396,33.176816,115.76,Sanford Health Plan,Sanford Health Plan,106.4992,92,,percent of total billed charges,,
Eye Pack,,A4649,HCPCS,Facility,Outpatient,,,,115.76,98.396,33.176816,115.76,"UCare Health, Inc.",Individual & Family Plan,65.23076,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Eye Pack,,A4649,HCPCS,Facility,Inpatient,,,,115.76,98.396,33.176816,115.76,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Eye Pack,,A4649,HCPCS,Facility,Outpatient,,,,115.76,98.396,33.176816,115.76,"UCare Health, Inc.",Medical Assistance,58.424072,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Eye Pack,,A4649,HCPCS,Facility,Inpatient,,,,115.76,98.396,33.176816,115.76,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Eye Pack,,A4649,HCPCS,Facility,Outpatient,,,,115.76,98.396,33.176816,115.76,"UCare Health, Inc.",Medicare Advantage,58.424072,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Eye Pack,,A4649,HCPCS,Facility,Inpatient,,,,115.76,98.396,33.176816,115.76,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Eye Pack,,A4649,HCPCS,Facility,Outpatient,,,,115.76,98.396,33.176816,115.76,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),58.424072,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Eye Pack,,A4649,HCPCS,Facility,Inpatient,,,,115.76,98.396,33.176816,115.76,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Eye Pack,,A4649,HCPCS,Facility,Both,,,,115.76,98.396,33.176816,115.76,UnitedHealthcare,Individual & Family,108.8144,94,,percent of total billed charges,,
Eye Pack,,A4649,HCPCS,Facility,Outpatient,,,,115.76,98.396,33.176816,115.76,UnitedHealthcare,Medicare Advantage,56.7224,49,,percent of total billed charges,,
Eye Pack,,A4649,HCPCS,Facility,Inpatient,,,,115.76,98.396,33.176816,115.76,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Eye Pack,,A4649,HCPCS,Facility,Outpatient,,,,115.76,98.396,33.176816,115.76,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,55.5648,48,,percent of total billed charges,,100% of DHS outpatient percentage
Eye Pack,,A4649,HCPCS,Facility,Inpatient,,,,115.76,98.396,33.176816,115.76,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
FILSHIE CLIPS AVM-851J,,A4649,HCPCS,Facility,Both,,,,446.85,379.8225,128.06721,446.85,Aetna,Commercial,411.102,92,,percent of total billed charges,,
FILSHIE CLIPS AVM-851J,,A4649,HCPCS,Facility,Outpatient,,,,446.85,379.8225,128.06721,446.85,Aetna,Medicare Advantage,218.9565,49,,percent of total billed charges,,
FILSHIE CLIPS AVM-851J,,A4649,HCPCS,Facility,Inpatient,,,,446.85,379.8225,128.06721,446.85,Aetna,Medicare Advantage,,,,,Included in per diem rate,
FILSHIE CLIPS AVM-851J,,A4649,HCPCS,Facility,Both,,,,446.85,379.8225,128.06721,446.85,Aetna,PPO,415.5705,93,,percent of total billed charges,,
FILSHIE CLIPS AVM-851J,,A4649,HCPCS,Facility,Both,,,,446.85,379.8225,128.06721,446.85,America's PPO,America's PPO,429.110055,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
FILSHIE CLIPS AVM-851J,,A4649,HCPCS,Facility,Both,,,,446.85,379.8225,128.06721,446.85,BlueCross BlueShield Minnesota, Federal Employee Program,439.7004,98.4,,percent of total billed charges,,
FILSHIE CLIPS AVM-851J,,A4649,HCPCS,Facility,Both,,,,446.85,379.8225,128.06721,446.85,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,446.85,100,,percent of total billed charges,,
FILSHIE CLIPS AVM-851J,,A4649,HCPCS,Facility,Both,,,,446.85,379.8225,128.06721,446.85,BlueCross BlueShield Minnesota,High Value Network Plan,402.165,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
FILSHIE CLIPS AVM-851J,,A4649,HCPCS,Facility,Outpatient,,,,446.85,379.8225,128.06721,446.85,BlueCross BlueShield Minnesota,Medicare Advantage,218.9565,49,,percent of total billed charges,,
FILSHIE CLIPS AVM-851J,,A4649,HCPCS,Facility,Inpatient,,,,446.85,379.8225,128.06721,446.85,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
FILSHIE CLIPS AVM-851J,,A4649,HCPCS,Facility,Both,,,,446.85,379.8225,128.06721,446.85,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,395.775045,88.57,,percent of total billed charges,,
FILSHIE CLIPS AVM-851J,,A4649,HCPCS,Facility,Both,,,,446.85,379.8225,128.06721,446.85,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,128.06721,28.66,,percent of total billed charges,,
FILSHIE CLIPS AVM-851J,,A4649,HCPCS,Facility,Outpatient,,,,446.85,379.8225,128.06721,446.85,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),218.9565,49,,percent of total billed charges,,
FILSHIE CLIPS AVM-851J,,A4649,HCPCS,Facility,Inpatient,,,,446.85,379.8225,128.06721,446.85,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
FILSHIE CLIPS AVM-851J,,A4649,HCPCS,Facility,Both,,,,446.85,379.8225,128.06721,446.85,CorVel,Worker's Compensation,446.85,100,,percent of total billed charges,,
FILSHIE CLIPS AVM-851J,,A4649,HCPCS,Facility,Both,,,,446.85,379.8225,128.06721,446.85,First Health Group Corporation,First Health Network,433.4445,97,,percent of total billed charges,,
FILSHIE CLIPS AVM-851J,,A4649,HCPCS,Facility,Both,,,,446.85,379.8225,128.06721,446.85,"Health Partners, Inc.",Commercial,422.7201,94.6,,percent of total billed charges,,
FILSHIE CLIPS AVM-851J,,A4649,HCPCS,Facility,Outpatient,,,,446.85,379.8225,128.06721,446.85,"Health Partners, Inc.",Medicare Advantage,218.9565,49,,percent of total billed charges,,
FILSHIE CLIPS AVM-851J,,A4649,HCPCS,Facility,Inpatient,,,,446.85,379.8225,128.06721,446.85,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
FILSHIE CLIPS AVM-851J,,A4649,HCPCS,Facility,Both,,,,446.85,379.8225,128.06721,446.85,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),268.11,60,,percent of total billed charges,,
FILSHIE CLIPS AVM-851J,,A4649,HCPCS,Facility,Both,,,,446.85,379.8225,128.06721,446.85,"Health Partners, Inc.",State of Minnesota Advantage Program,364.18275,81.5,,percent of total billed charges,,
FILSHIE CLIPS AVM-851J,,A4649,HCPCS,Facility,Both,,,,446.85,379.8225,128.06721,446.85,"Health Partners, Inc.",State Public Programs,223.425,50,,percent of total billed charges,,
FILSHIE CLIPS AVM-851J,,A4649,HCPCS,Facility,Both,,,,446.85,379.8225,128.06721,446.85,Humana Insurance Company,Commercial PPO,424.5075,95,,percent of total billed charges,,
FILSHIE CLIPS AVM-851J,,A4649,HCPCS,Facility,Outpatient,,,,446.85,379.8225,128.06721,446.85,Humana Insurance Company,Medicare PPO,218.9565,49,,percent of total billed charges,,
FILSHIE CLIPS AVM-851J,,A4649,HCPCS,Facility,Inpatient,,,,446.85,379.8225,128.06721,446.85,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
FILSHIE CLIPS AVM-851J,,A4649,HCPCS,Facility,Both,,,,446.85,379.8225,128.06721,446.85,Medica,Individual & Family,442.82835,99.1,,percent of total billed charges,,
FILSHIE CLIPS AVM-851J,,A4649,HCPCS,Facility,Outpatient,,,,446.85,379.8225,128.06721,446.85,Medica,Medica Advantage Solution,222.5313,49.8,,percent of total billed charges,,
FILSHIE CLIPS AVM-851J,,A4649,HCPCS,Facility,Inpatient,,,,446.85,379.8225,128.06721,446.85,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
FILSHIE CLIPS AVM-851J,,A4649,HCPCS,Facility,Outpatient,,,,446.85,379.8225,128.06721,446.85,Medica,Medical Assistance,199.2951,44.6,,percent of total billed charges,,
FILSHIE CLIPS AVM-851J,,A4649,HCPCS,Facility,Inpatient,,,,446.85,379.8225,128.06721,446.85,Medica,Medical Assistance,,,,,Included in per diem rate,
FILSHIE CLIPS AVM-851J,,A4649,HCPCS,Facility,Outpatient,,,,446.85,379.8225,128.06721,446.85,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,222.5313,49.8,,percent of total billed charges,,
FILSHIE CLIPS AVM-851J,,A4649,HCPCS,Facility,Inpatient,,,,446.85,379.8225,128.06721,446.85,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
FILSHIE CLIPS AVM-851J,,A4649,HCPCS,Facility,Both,,,,446.85,379.8225,128.06721,446.85,"Multiplan, Inc.","Multiplan, Inc.",420.039,94,,percent of total billed charges,,
FILSHIE CLIPS AVM-851J,,A4649,HCPCS,Facility,Outpatient,,,,446.85,379.8225,128.06721,446.85,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,402.61185,90.1,,percent of total billed charges,,
FILSHIE CLIPS AVM-851J,,A4649,HCPCS,Facility,Inpatient,,,,446.85,379.8225,128.06721,446.85,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
FILSHIE CLIPS AVM-851J,,A4649,HCPCS,Facility,Both,,,,446.85,379.8225,128.06721,446.85,"Preferred One Administrative Services, INC.",PPO,440.5941,98.6,,percent of total billed charges,,
FILSHIE CLIPS AVM-851J,,A4649,HCPCS,Facility,Outpatient,,,,446.85,379.8225,128.06721,446.85,PrimeWest Health,Minnesota Senior Health Options (MSHO),229.904325,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
FILSHIE CLIPS AVM-851J,,A4649,HCPCS,Facility,Inpatient,,,,446.85,379.8225,128.06721,446.85,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
FILSHIE CLIPS AVM-851J,,A4649,HCPCS,Facility,Outpatient,,,,446.85,379.8225,128.06721,446.85,PrimeWest Health,MinnesotaCare,229.50216,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
FILSHIE CLIPS AVM-851J,,A4649,HCPCS,Facility,Inpatient,,,,446.85,379.8225,128.06721,446.85,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
FILSHIE CLIPS AVM-851J,,A4649,HCPCS,Facility,Both,,,,446.85,379.8225,128.06721,446.85,Sanford Health Plan,Sanford Health Plan,411.102,92,,percent of total billed charges,,
FILSHIE CLIPS AVM-851J,,A4649,HCPCS,Facility,Outpatient,,,,446.85,379.8225,128.06721,446.85,"UCare Health, Inc.",Individual & Family Plan,251.799975,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
FILSHIE CLIPS AVM-851J,,A4649,HCPCS,Facility,Inpatient,,,,446.85,379.8225,128.06721,446.85,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
FILSHIE CLIPS AVM-851J,,A4649,HCPCS,Facility,Outpatient,,,,446.85,379.8225,128.06721,446.85,"UCare Health, Inc.",Medical Assistance,225.525195,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FILSHIE CLIPS AVM-851J,,A4649,HCPCS,Facility,Inpatient,,,,446.85,379.8225,128.06721,446.85,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
FILSHIE CLIPS AVM-851J,,A4649,HCPCS,Facility,Outpatient,,,,446.85,379.8225,128.06721,446.85,"UCare Health, Inc.",Medicare Advantage,225.525195,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FILSHIE CLIPS AVM-851J,,A4649,HCPCS,Facility,Inpatient,,,,446.85,379.8225,128.06721,446.85,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
FILSHIE CLIPS AVM-851J,,A4649,HCPCS,Facility,Outpatient,,,,446.85,379.8225,128.06721,446.85,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),225.525195,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FILSHIE CLIPS AVM-851J,,A4649,HCPCS,Facility,Inpatient,,,,446.85,379.8225,128.06721,446.85,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
FILSHIE CLIPS AVM-851J,,A4649,HCPCS,Facility,Both,,,,446.85,379.8225,128.06721,446.85,UnitedHealthcare,Individual & Family,420.039,94,,percent of total billed charges,,
FILSHIE CLIPS AVM-851J,,A4649,HCPCS,Facility,Outpatient,,,,446.85,379.8225,128.06721,446.85,UnitedHealthcare,Medicare Advantage,218.9565,49,,percent of total billed charges,,
FILSHIE CLIPS AVM-851J,,A4649,HCPCS,Facility,Inpatient,,,,446.85,379.8225,128.06721,446.85,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
FILSHIE CLIPS AVM-851J,,A4649,HCPCS,Facility,Outpatient,,,,446.85,379.8225,128.06721,446.85,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,214.488,48,,percent of total billed charges,,100% of DHS outpatient percentage
FILSHIE CLIPS AVM-851J,,A4649,HCPCS,Facility,Inpatient,,,,446.85,379.8225,128.06721,446.85,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
FORCEPS BIPOLAR AQUAMANTYS 6.0  23-112-1,,A4649,HCPCS,Facility,Both,,,,523.85,445.2725,150.13541,523.85,Aetna,Commercial,481.942,92,,percent of total billed charges,,
FORCEPS BIPOLAR AQUAMANTYS 6.0  23-112-1,,A4649,HCPCS,Facility,Outpatient,,,,523.85,445.2725,150.13541,523.85,Aetna,Medicare Advantage,256.6865,49,,percent of total billed charges,,
FORCEPS BIPOLAR AQUAMANTYS 6.0  23-112-1,,A4649,HCPCS,Facility,Inpatient,,,,523.85,445.2725,150.13541,523.85,Aetna,Medicare Advantage,,,,,Included in per diem rate,
FORCEPS BIPOLAR AQUAMANTYS 6.0  23-112-1,,A4649,HCPCS,Facility,Both,,,,523.85,445.2725,150.13541,523.85,Aetna,PPO,487.1805,93,,percent of total billed charges,,
FORCEPS BIPOLAR AQUAMANTYS 6.0  23-112-1,,A4649,HCPCS,Facility,Both,,,,523.85,445.2725,150.13541,523.85,America's PPO,America's PPO,503.053155,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
FORCEPS BIPOLAR AQUAMANTYS 6.0  23-112-1,,A4649,HCPCS,Facility,Both,,,,523.85,445.2725,150.13541,523.85,BlueCross BlueShield Minnesota, Federal Employee Program,515.4684,98.4,,percent of total billed charges,,
FORCEPS BIPOLAR AQUAMANTYS 6.0  23-112-1,,A4649,HCPCS,Facility,Both,,,,523.85,445.2725,150.13541,523.85,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,523.85,100,,percent of total billed charges,,
FORCEPS BIPOLAR AQUAMANTYS 6.0  23-112-1,,A4649,HCPCS,Facility,Both,,,,523.85,445.2725,150.13541,523.85,BlueCross BlueShield Minnesota,High Value Network Plan,471.465,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
FORCEPS BIPOLAR AQUAMANTYS 6.0  23-112-1,,A4649,HCPCS,Facility,Outpatient,,,,523.85,445.2725,150.13541,523.85,BlueCross BlueShield Minnesota,Medicare Advantage,256.6865,49,,percent of total billed charges,,
FORCEPS BIPOLAR AQUAMANTYS 6.0  23-112-1,,A4649,HCPCS,Facility,Inpatient,,,,523.85,445.2725,150.13541,523.85,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
FORCEPS BIPOLAR AQUAMANTYS 6.0  23-112-1,,A4649,HCPCS,Facility,Both,,,,523.85,445.2725,150.13541,523.85,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,463.973945,88.57,,percent of total billed charges,,
FORCEPS BIPOLAR AQUAMANTYS 6.0  23-112-1,,A4649,HCPCS,Facility,Both,,,,523.85,445.2725,150.13541,523.85,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,150.13541,28.66,,percent of total billed charges,,
FORCEPS BIPOLAR AQUAMANTYS 6.0  23-112-1,,A4649,HCPCS,Facility,Outpatient,,,,523.85,445.2725,150.13541,523.85,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),256.6865,49,,percent of total billed charges,,
FORCEPS BIPOLAR AQUAMANTYS 6.0  23-112-1,,A4649,HCPCS,Facility,Inpatient,,,,523.85,445.2725,150.13541,523.85,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
FORCEPS BIPOLAR AQUAMANTYS 6.0  23-112-1,,A4649,HCPCS,Facility,Both,,,,523.85,445.2725,150.13541,523.85,CorVel,Worker's Compensation,523.85,100,,percent of total billed charges,,
FORCEPS BIPOLAR AQUAMANTYS 6.0  23-112-1,,A4649,HCPCS,Facility,Both,,,,523.85,445.2725,150.13541,523.85,First Health Group Corporation,First Health Network,508.1345,97,,percent of total billed charges,,
FORCEPS BIPOLAR AQUAMANTYS 6.0  23-112-1,,A4649,HCPCS,Facility,Both,,,,523.85,445.2725,150.13541,523.85,"Health Partners, Inc.",Commercial,495.5621,94.6,,percent of total billed charges,,
FORCEPS BIPOLAR AQUAMANTYS 6.0  23-112-1,,A4649,HCPCS,Facility,Outpatient,,,,523.85,445.2725,150.13541,523.85,"Health Partners, Inc.",Medicare Advantage,256.6865,49,,percent of total billed charges,,
FORCEPS BIPOLAR AQUAMANTYS 6.0  23-112-1,,A4649,HCPCS,Facility,Inpatient,,,,523.85,445.2725,150.13541,523.85,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
FORCEPS BIPOLAR AQUAMANTYS 6.0  23-112-1,,A4649,HCPCS,Facility,Both,,,,523.85,445.2725,150.13541,523.85,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),314.31,60,,percent of total billed charges,,
FORCEPS BIPOLAR AQUAMANTYS 6.0  23-112-1,,A4649,HCPCS,Facility,Both,,,,523.85,445.2725,150.13541,523.85,"Health Partners, Inc.",State of Minnesota Advantage Program,426.93775,81.5,,percent of total billed charges,,
FORCEPS BIPOLAR AQUAMANTYS 6.0  23-112-1,,A4649,HCPCS,Facility,Both,,,,523.85,445.2725,150.13541,523.85,"Health Partners, Inc.",State Public Programs,261.925,50,,percent of total billed charges,,
FORCEPS BIPOLAR AQUAMANTYS 6.0  23-112-1,,A4649,HCPCS,Facility,Both,,,,523.85,445.2725,150.13541,523.85,Humana Insurance Company,Commercial PPO,497.6575,95,,percent of total billed charges,,
FORCEPS BIPOLAR AQUAMANTYS 6.0  23-112-1,,A4649,HCPCS,Facility,Outpatient,,,,523.85,445.2725,150.13541,523.85,Humana Insurance Company,Medicare PPO,256.6865,49,,percent of total billed charges,,
FORCEPS BIPOLAR AQUAMANTYS 6.0  23-112-1,,A4649,HCPCS,Facility,Inpatient,,,,523.85,445.2725,150.13541,523.85,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
FORCEPS BIPOLAR AQUAMANTYS 6.0  23-112-1,,A4649,HCPCS,Facility,Both,,,,523.85,445.2725,150.13541,523.85,Medica,Individual & Family,519.13535,99.1,,percent of total billed charges,,
FORCEPS BIPOLAR AQUAMANTYS 6.0  23-112-1,,A4649,HCPCS,Facility,Outpatient,,,,523.85,445.2725,150.13541,523.85,Medica,Medica Advantage Solution,260.8773,49.8,,percent of total billed charges,,
FORCEPS BIPOLAR AQUAMANTYS 6.0  23-112-1,,A4649,HCPCS,Facility,Inpatient,,,,523.85,445.2725,150.13541,523.85,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
FORCEPS BIPOLAR AQUAMANTYS 6.0  23-112-1,,A4649,HCPCS,Facility,Outpatient,,,,523.85,445.2725,150.13541,523.85,Medica,Medical Assistance,233.6371,44.6,,percent of total billed charges,,
FORCEPS BIPOLAR AQUAMANTYS 6.0  23-112-1,,A4649,HCPCS,Facility,Inpatient,,,,523.85,445.2725,150.13541,523.85,Medica,Medical Assistance,,,,,Included in per diem rate,
FORCEPS BIPOLAR AQUAMANTYS 6.0  23-112-1,,A4649,HCPCS,Facility,Outpatient,,,,523.85,445.2725,150.13541,523.85,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,260.8773,49.8,,percent of total billed charges,,
FORCEPS BIPOLAR AQUAMANTYS 6.0  23-112-1,,A4649,HCPCS,Facility,Inpatient,,,,523.85,445.2725,150.13541,523.85,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
FORCEPS BIPOLAR AQUAMANTYS 6.0  23-112-1,,A4649,HCPCS,Facility,Both,,,,523.85,445.2725,150.13541,523.85,"Multiplan, Inc.","Multiplan, Inc.",492.419,94,,percent of total billed charges,,
FORCEPS BIPOLAR AQUAMANTYS 6.0  23-112-1,,A4649,HCPCS,Facility,Outpatient,,,,523.85,445.2725,150.13541,523.85,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,471.98885,90.1,,percent of total billed charges,,
FORCEPS BIPOLAR AQUAMANTYS 6.0  23-112-1,,A4649,HCPCS,Facility,Inpatient,,,,523.85,445.2725,150.13541,523.85,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
FORCEPS BIPOLAR AQUAMANTYS 6.0  23-112-1,,A4649,HCPCS,Facility,Both,,,,523.85,445.2725,150.13541,523.85,"Preferred One Administrative Services, INC.",PPO,516.5161,98.6,,percent of total billed charges,,
FORCEPS BIPOLAR AQUAMANTYS 6.0  23-112-1,,A4649,HCPCS,Facility,Outpatient,,,,523.85,445.2725,150.13541,523.85,PrimeWest Health,Minnesota Senior Health Options (MSHO),269.520825,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
FORCEPS BIPOLAR AQUAMANTYS 6.0  23-112-1,,A4649,HCPCS,Facility,Inpatient,,,,523.85,445.2725,150.13541,523.85,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
FORCEPS BIPOLAR AQUAMANTYS 6.0  23-112-1,,A4649,HCPCS,Facility,Outpatient,,,,523.85,445.2725,150.13541,523.85,PrimeWest Health,MinnesotaCare,269.04936,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
FORCEPS BIPOLAR AQUAMANTYS 6.0  23-112-1,,A4649,HCPCS,Facility,Inpatient,,,,523.85,445.2725,150.13541,523.85,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
FORCEPS BIPOLAR AQUAMANTYS 6.0  23-112-1,,A4649,HCPCS,Facility,Both,,,,523.85,445.2725,150.13541,523.85,Sanford Health Plan,Sanford Health Plan,481.942,92,,percent of total billed charges,,
FORCEPS BIPOLAR AQUAMANTYS 6.0  23-112-1,,A4649,HCPCS,Facility,Outpatient,,,,523.85,445.2725,150.13541,523.85,"UCare Health, Inc.",Individual & Family Plan,295.189475,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
FORCEPS BIPOLAR AQUAMANTYS 6.0  23-112-1,,A4649,HCPCS,Facility,Inpatient,,,,523.85,445.2725,150.13541,523.85,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
FORCEPS BIPOLAR AQUAMANTYS 6.0  23-112-1,,A4649,HCPCS,Facility,Outpatient,,,,523.85,445.2725,150.13541,523.85,"UCare Health, Inc.",Medical Assistance,264.387095,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FORCEPS BIPOLAR AQUAMANTYS 6.0  23-112-1,,A4649,HCPCS,Facility,Inpatient,,,,523.85,445.2725,150.13541,523.85,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
FORCEPS BIPOLAR AQUAMANTYS 6.0  23-112-1,,A4649,HCPCS,Facility,Outpatient,,,,523.85,445.2725,150.13541,523.85,"UCare Health, Inc.",Medicare Advantage,264.387095,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FORCEPS BIPOLAR AQUAMANTYS 6.0  23-112-1,,A4649,HCPCS,Facility,Inpatient,,,,523.85,445.2725,150.13541,523.85,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
FORCEPS BIPOLAR AQUAMANTYS 6.0  23-112-1,,A4649,HCPCS,Facility,Outpatient,,,,523.85,445.2725,150.13541,523.85,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),264.387095,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FORCEPS BIPOLAR AQUAMANTYS 6.0  23-112-1,,A4649,HCPCS,Facility,Inpatient,,,,523.85,445.2725,150.13541,523.85,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
FORCEPS BIPOLAR AQUAMANTYS 6.0  23-112-1,,A4649,HCPCS,Facility,Both,,,,523.85,445.2725,150.13541,523.85,UnitedHealthcare,Individual & Family,492.419,94,,percent of total billed charges,,
FORCEPS BIPOLAR AQUAMANTYS 6.0  23-112-1,,A4649,HCPCS,Facility,Outpatient,,,,523.85,445.2725,150.13541,523.85,UnitedHealthcare,Medicare Advantage,256.6865,49,,percent of total billed charges,,
FORCEPS BIPOLAR AQUAMANTYS 6.0  23-112-1,,A4649,HCPCS,Facility,Inpatient,,,,523.85,445.2725,150.13541,523.85,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
FORCEPS BIPOLAR AQUAMANTYS 6.0  23-112-1,,A4649,HCPCS,Facility,Outpatient,,,,523.85,445.2725,150.13541,523.85,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,251.448,48,,percent of total billed charges,,100% of DHS outpatient percentage
FORCEPS BIPOLAR AQUAMANTYS 6.0  23-112-1,,A4649,HCPCS,Facility,Inpatient,,,,523.85,445.2725,150.13541,523.85,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
FORCEPS GRASPING POLYGRAB,,A4649,HCPCS,Facility,Both,,,,273.035,232.07975,78.251831,273.035,Aetna,Commercial,251.1922,92,,percent of total billed charges,,
FORCEPS GRASPING POLYGRAB,,A4649,HCPCS,Facility,Outpatient,,,,273.035,232.07975,78.251831,273.035,Aetna,Medicare Advantage,133.78715,49,,percent of total billed charges,,
FORCEPS GRASPING POLYGRAB,,A4649,HCPCS,Facility,Inpatient,,,,273.035,232.07975,78.251831,273.035,Aetna,Medicare Advantage,,,,,Included in per diem rate,
FORCEPS GRASPING POLYGRAB,,A4649,HCPCS,Facility,Both,,,,273.035,232.07975,78.251831,273.035,Aetna,PPO,253.92255,93,,percent of total billed charges,,
FORCEPS GRASPING POLYGRAB,,A4649,HCPCS,Facility,Both,,,,273.035,232.07975,78.251831,273.035,America's PPO,America's PPO,262.1955105,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
FORCEPS GRASPING POLYGRAB,,A4649,HCPCS,Facility,Both,,,,273.035,232.07975,78.251831,273.035,BlueCross BlueShield Minnesota, Federal Employee Program,268.66644,98.4,,percent of total billed charges,,
FORCEPS GRASPING POLYGRAB,,A4649,HCPCS,Facility,Both,,,,273.035,232.07975,78.251831,273.035,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,273.035,100,,percent of total billed charges,,
FORCEPS GRASPING POLYGRAB,,A4649,HCPCS,Facility,Both,,,,273.035,232.07975,78.251831,273.035,BlueCross BlueShield Minnesota,High Value Network Plan,245.7315,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
FORCEPS GRASPING POLYGRAB,,A4649,HCPCS,Facility,Outpatient,,,,273.035,232.07975,78.251831,273.035,BlueCross BlueShield Minnesota,Medicare Advantage,133.78715,49,,percent of total billed charges,,
FORCEPS GRASPING POLYGRAB,,A4649,HCPCS,Facility,Inpatient,,,,273.035,232.07975,78.251831,273.035,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
FORCEPS GRASPING POLYGRAB,,A4649,HCPCS,Facility,Both,,,,273.035,232.07975,78.251831,273.035,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,241.8270995,88.57,,percent of total billed charges,,
FORCEPS GRASPING POLYGRAB,,A4649,HCPCS,Facility,Both,,,,273.035,232.07975,78.251831,273.035,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,78.251831,28.66,,percent of total billed charges,,
FORCEPS GRASPING POLYGRAB,,A4649,HCPCS,Facility,Outpatient,,,,273.035,232.07975,78.251831,273.035,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),133.78715,49,,percent of total billed charges,,
FORCEPS GRASPING POLYGRAB,,A4649,HCPCS,Facility,Inpatient,,,,273.035,232.07975,78.251831,273.035,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
FORCEPS GRASPING POLYGRAB,,A4649,HCPCS,Facility,Both,,,,273.035,232.07975,78.251831,273.035,CorVel,Worker's Compensation,273.035,100,,percent of total billed charges,,
FORCEPS GRASPING POLYGRAB,,A4649,HCPCS,Facility,Both,,,,273.035,232.07975,78.251831,273.035,First Health Group Corporation,First Health Network,264.84395,97,,percent of total billed charges,,
FORCEPS GRASPING POLYGRAB,,A4649,HCPCS,Facility,Both,,,,273.035,232.07975,78.251831,273.035,"Health Partners, Inc.",Commercial,258.29111,94.6,,percent of total billed charges,,
FORCEPS GRASPING POLYGRAB,,A4649,HCPCS,Facility,Outpatient,,,,273.035,232.07975,78.251831,273.035,"Health Partners, Inc.",Medicare Advantage,133.78715,49,,percent of total billed charges,,
FORCEPS GRASPING POLYGRAB,,A4649,HCPCS,Facility,Inpatient,,,,273.035,232.07975,78.251831,273.035,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
FORCEPS GRASPING POLYGRAB,,A4649,HCPCS,Facility,Both,,,,273.035,232.07975,78.251831,273.035,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),163.821,60,,percent of total billed charges,,
FORCEPS GRASPING POLYGRAB,,A4649,HCPCS,Facility,Both,,,,273.035,232.07975,78.251831,273.035,"Health Partners, Inc.",State of Minnesota Advantage Program,222.523525,81.5,,percent of total billed charges,,
FORCEPS GRASPING POLYGRAB,,A4649,HCPCS,Facility,Both,,,,273.035,232.07975,78.251831,273.035,"Health Partners, Inc.",State Public Programs,136.5175,50,,percent of total billed charges,,
FORCEPS GRASPING POLYGRAB,,A4649,HCPCS,Facility,Both,,,,273.035,232.07975,78.251831,273.035,Humana Insurance Company,Commercial PPO,259.38325,95,,percent of total billed charges,,
FORCEPS GRASPING POLYGRAB,,A4649,HCPCS,Facility,Outpatient,,,,273.035,232.07975,78.251831,273.035,Humana Insurance Company,Medicare PPO,133.78715,49,,percent of total billed charges,,
FORCEPS GRASPING POLYGRAB,,A4649,HCPCS,Facility,Inpatient,,,,273.035,232.07975,78.251831,273.035,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
FORCEPS GRASPING POLYGRAB,,A4649,HCPCS,Facility,Both,,,,273.035,232.07975,78.251831,273.035,Medica,Individual & Family,270.577685,99.1,,percent of total billed charges,,
FORCEPS GRASPING POLYGRAB,,A4649,HCPCS,Facility,Outpatient,,,,273.035,232.07975,78.251831,273.035,Medica,Medica Advantage Solution,135.97143,49.8,,percent of total billed charges,,
FORCEPS GRASPING POLYGRAB,,A4649,HCPCS,Facility,Inpatient,,,,273.035,232.07975,78.251831,273.035,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
FORCEPS GRASPING POLYGRAB,,A4649,HCPCS,Facility,Outpatient,,,,273.035,232.07975,78.251831,273.035,Medica,Medical Assistance,121.77361,44.6,,percent of total billed charges,,
FORCEPS GRASPING POLYGRAB,,A4649,HCPCS,Facility,Inpatient,,,,273.035,232.07975,78.251831,273.035,Medica,Medical Assistance,,,,,Included in per diem rate,
FORCEPS GRASPING POLYGRAB,,A4649,HCPCS,Facility,Outpatient,,,,273.035,232.07975,78.251831,273.035,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,135.97143,49.8,,percent of total billed charges,,
FORCEPS GRASPING POLYGRAB,,A4649,HCPCS,Facility,Inpatient,,,,273.035,232.07975,78.251831,273.035,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
FORCEPS GRASPING POLYGRAB,,A4649,HCPCS,Facility,Both,,,,273.035,232.07975,78.251831,273.035,"Multiplan, Inc.","Multiplan, Inc.",256.6529,94,,percent of total billed charges,,
FORCEPS GRASPING POLYGRAB,,A4649,HCPCS,Facility,Outpatient,,,,273.035,232.07975,78.251831,273.035,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,246.004535,90.1,,percent of total billed charges,,
FORCEPS GRASPING POLYGRAB,,A4649,HCPCS,Facility,Inpatient,,,,273.035,232.07975,78.251831,273.035,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
FORCEPS GRASPING POLYGRAB,,A4649,HCPCS,Facility,Both,,,,273.035,232.07975,78.251831,273.035,"Preferred One Administrative Services, INC.",PPO,269.21251,98.6,,percent of total billed charges,,
FORCEPS GRASPING POLYGRAB,,A4649,HCPCS,Facility,Outpatient,,,,273.035,232.07975,78.251831,273.035,PrimeWest Health,Minnesota Senior Health Options (MSHO),140.4765075,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
FORCEPS GRASPING POLYGRAB,,A4649,HCPCS,Facility,Inpatient,,,,273.035,232.07975,78.251831,273.035,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
FORCEPS GRASPING POLYGRAB,,A4649,HCPCS,Facility,Outpatient,,,,273.035,232.07975,78.251831,273.035,PrimeWest Health,MinnesotaCare,140.230776,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
FORCEPS GRASPING POLYGRAB,,A4649,HCPCS,Facility,Inpatient,,,,273.035,232.07975,78.251831,273.035,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
FORCEPS GRASPING POLYGRAB,,A4649,HCPCS,Facility,Both,,,,273.035,232.07975,78.251831,273.035,Sanford Health Plan,Sanford Health Plan,251.1922,92,,percent of total billed charges,,
FORCEPS GRASPING POLYGRAB,,A4649,HCPCS,Facility,Outpatient,,,,273.035,232.07975,78.251831,273.035,"UCare Health, Inc.",Individual & Family Plan,153.8552225,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
FORCEPS GRASPING POLYGRAB,,A4649,HCPCS,Facility,Inpatient,,,,273.035,232.07975,78.251831,273.035,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
FORCEPS GRASPING POLYGRAB,,A4649,HCPCS,Facility,Outpatient,,,,273.035,232.07975,78.251831,273.035,"UCare Health, Inc.",Medical Assistance,137.8007645,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FORCEPS GRASPING POLYGRAB,,A4649,HCPCS,Facility,Inpatient,,,,273.035,232.07975,78.251831,273.035,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
FORCEPS GRASPING POLYGRAB,,A4649,HCPCS,Facility,Outpatient,,,,273.035,232.07975,78.251831,273.035,"UCare Health, Inc.",Medicare Advantage,137.8007645,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FORCEPS GRASPING POLYGRAB,,A4649,HCPCS,Facility,Inpatient,,,,273.035,232.07975,78.251831,273.035,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
FORCEPS GRASPING POLYGRAB,,A4649,HCPCS,Facility,Outpatient,,,,273.035,232.07975,78.251831,273.035,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),137.8007645,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FORCEPS GRASPING POLYGRAB,,A4649,HCPCS,Facility,Inpatient,,,,273.035,232.07975,78.251831,273.035,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
FORCEPS GRASPING POLYGRAB,,A4649,HCPCS,Facility,Both,,,,273.035,232.07975,78.251831,273.035,UnitedHealthcare,Individual & Family,256.6529,94,,percent of total billed charges,,
FORCEPS GRASPING POLYGRAB,,A4649,HCPCS,Facility,Outpatient,,,,273.035,232.07975,78.251831,273.035,UnitedHealthcare,Medicare Advantage,133.78715,49,,percent of total billed charges,,
FORCEPS GRASPING POLYGRAB,,A4649,HCPCS,Facility,Inpatient,,,,273.035,232.07975,78.251831,273.035,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
FORCEPS GRASPING POLYGRAB,,A4649,HCPCS,Facility,Outpatient,,,,273.035,232.07975,78.251831,273.035,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,131.0568,48,,percent of total billed charges,,100% of DHS outpatient percentage
FORCEPS GRASPING POLYGRAB,,A4649,HCPCS,Facility,Inpatient,,,,273.035,232.07975,78.251831,273.035,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"FORCEPS, COLON BIOPSY",,A4649,HCPCS,Facility,Both,,,,50.265,42.72525,14.405949,50.265,Aetna,Commercial,46.2438,92,,percent of total billed charges,,
"FORCEPS, COLON BIOPSY",,A4649,HCPCS,Facility,Outpatient,,,,50.265,42.72525,14.405949,50.265,Aetna,Medicare Advantage,24.62985,49,,percent of total billed charges,,
"FORCEPS, COLON BIOPSY",,A4649,HCPCS,Facility,Inpatient,,,,50.265,42.72525,14.405949,50.265,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"FORCEPS, COLON BIOPSY",,A4649,HCPCS,Facility,Both,,,,50.265,42.72525,14.405949,50.265,Aetna,PPO,46.74645,93,,percent of total billed charges,,
"FORCEPS, COLON BIOPSY",,A4649,HCPCS,Facility,Both,,,,50.265,42.72525,14.405949,50.265,America's PPO,America's PPO,48.2694795,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"FORCEPS, COLON BIOPSY",,A4649,HCPCS,Facility,Both,,,,50.265,42.72525,14.405949,50.265,BlueCross BlueShield Minnesota, Federal Employee Program,49.46076,98.4,,percent of total billed charges,,
"FORCEPS, COLON BIOPSY",,A4649,HCPCS,Facility,Both,,,,50.265,42.72525,14.405949,50.265,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,50.265,100,,percent of total billed charges,,
"FORCEPS, COLON BIOPSY",,A4649,HCPCS,Facility,Both,,,,50.265,42.72525,14.405949,50.265,BlueCross BlueShield Minnesota,High Value Network Plan,45.2385,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
"FORCEPS, COLON BIOPSY",,A4649,HCPCS,Facility,Outpatient,,,,50.265,42.72525,14.405949,50.265,BlueCross BlueShield Minnesota,Medicare Advantage,24.62985,49,,percent of total billed charges,,
"FORCEPS, COLON BIOPSY",,A4649,HCPCS,Facility,Inpatient,,,,50.265,42.72525,14.405949,50.265,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"FORCEPS, COLON BIOPSY",,A4649,HCPCS,Facility,Both,,,,50.265,42.72525,14.405949,50.265,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,44.5197105,88.57,,percent of total billed charges,,
"FORCEPS, COLON BIOPSY",,A4649,HCPCS,Facility,Both,,,,50.265,42.72525,14.405949,50.265,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,14.405949,28.66,,percent of total billed charges,,
"FORCEPS, COLON BIOPSY",,A4649,HCPCS,Facility,Outpatient,,,,50.265,42.72525,14.405949,50.265,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),24.62985,49,,percent of total billed charges,,
"FORCEPS, COLON BIOPSY",,A4649,HCPCS,Facility,Inpatient,,,,50.265,42.72525,14.405949,50.265,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"FORCEPS, COLON BIOPSY",,A4649,HCPCS,Facility,Both,,,,50.265,42.72525,14.405949,50.265,CorVel,Worker's Compensation,50.265,100,,percent of total billed charges,,
"FORCEPS, COLON BIOPSY",,A4649,HCPCS,Facility,Both,,,,50.265,42.72525,14.405949,50.265,First Health Group Corporation,First Health Network,48.75705,97,,percent of total billed charges,,
"FORCEPS, COLON BIOPSY",,A4649,HCPCS,Facility,Both,,,,50.265,42.72525,14.405949,50.265,"Health Partners, Inc.",Commercial,47.55069,94.6,,percent of total billed charges,,
"FORCEPS, COLON BIOPSY",,A4649,HCPCS,Facility,Outpatient,,,,50.265,42.72525,14.405949,50.265,"Health Partners, Inc.",Medicare Advantage,24.62985,49,,percent of total billed charges,,
"FORCEPS, COLON BIOPSY",,A4649,HCPCS,Facility,Inpatient,,,,50.265,42.72525,14.405949,50.265,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"FORCEPS, COLON BIOPSY",,A4649,HCPCS,Facility,Both,,,,50.265,42.72525,14.405949,50.265,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),30.159,60,,percent of total billed charges,,
"FORCEPS, COLON BIOPSY",,A4649,HCPCS,Facility,Both,,,,50.265,42.72525,14.405949,50.265,"Health Partners, Inc.",State of Minnesota Advantage Program,40.965975,81.5,,percent of total billed charges,,
"FORCEPS, COLON BIOPSY",,A4649,HCPCS,Facility,Both,,,,50.265,42.72525,14.405949,50.265,"Health Partners, Inc.",State Public Programs,25.1325,50,,percent of total billed charges,,
"FORCEPS, COLON BIOPSY",,A4649,HCPCS,Facility,Both,,,,50.265,42.72525,14.405949,50.265,Humana Insurance Company,Commercial PPO,47.75175,95,,percent of total billed charges,,
"FORCEPS, COLON BIOPSY",,A4649,HCPCS,Facility,Outpatient,,,,50.265,42.72525,14.405949,50.265,Humana Insurance Company,Medicare PPO,24.62985,49,,percent of total billed charges,,
"FORCEPS, COLON BIOPSY",,A4649,HCPCS,Facility,Inpatient,,,,50.265,42.72525,14.405949,50.265,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"FORCEPS, COLON BIOPSY",,A4649,HCPCS,Facility,Both,,,,50.265,42.72525,14.405949,50.265,Medica,Individual & Family,49.812615,99.1,,percent of total billed charges,,
"FORCEPS, COLON BIOPSY",,A4649,HCPCS,Facility,Outpatient,,,,50.265,42.72525,14.405949,50.265,Medica,Medica Advantage Solution,25.03197,49.8,,percent of total billed charges,,
"FORCEPS, COLON BIOPSY",,A4649,HCPCS,Facility,Inpatient,,,,50.265,42.72525,14.405949,50.265,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"FORCEPS, COLON BIOPSY",,A4649,HCPCS,Facility,Outpatient,,,,50.265,42.72525,14.405949,50.265,Medica,Medical Assistance,22.41819,44.6,,percent of total billed charges,,
"FORCEPS, COLON BIOPSY",,A4649,HCPCS,Facility,Inpatient,,,,50.265,42.72525,14.405949,50.265,Medica,Medical Assistance,,,,,Included in per diem rate,
"FORCEPS, COLON BIOPSY",,A4649,HCPCS,Facility,Outpatient,,,,50.265,42.72525,14.405949,50.265,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,25.03197,49.8,,percent of total billed charges,,
"FORCEPS, COLON BIOPSY",,A4649,HCPCS,Facility,Inpatient,,,,50.265,42.72525,14.405949,50.265,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"FORCEPS, COLON BIOPSY",,A4649,HCPCS,Facility,Both,,,,50.265,42.72525,14.405949,50.265,"Multiplan, Inc.","Multiplan, Inc.",47.2491,94,,percent of total billed charges,,
"FORCEPS, COLON BIOPSY",,A4649,HCPCS,Facility,Outpatient,,,,50.265,42.72525,14.405949,50.265,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,45.288765,90.1,,percent of total billed charges,,
"FORCEPS, COLON BIOPSY",,A4649,HCPCS,Facility,Inpatient,,,,50.265,42.72525,14.405949,50.265,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"FORCEPS, COLON BIOPSY",,A4649,HCPCS,Facility,Both,,,,50.265,42.72525,14.405949,50.265,"Preferred One Administrative Services, INC.",PPO,49.56129,98.6,,percent of total billed charges,,
"FORCEPS, COLON BIOPSY",,A4649,HCPCS,Facility,Outpatient,,,,50.265,42.72525,14.405949,50.265,PrimeWest Health,Minnesota Senior Health Options (MSHO),25.8613425,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"FORCEPS, COLON BIOPSY",,A4649,HCPCS,Facility,Inpatient,,,,50.265,42.72525,14.405949,50.265,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"FORCEPS, COLON BIOPSY",,A4649,HCPCS,Facility,Outpatient,,,,50.265,42.72525,14.405949,50.265,PrimeWest Health,MinnesotaCare,25.816104,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"FORCEPS, COLON BIOPSY",,A4649,HCPCS,Facility,Inpatient,,,,50.265,42.72525,14.405949,50.265,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"FORCEPS, COLON BIOPSY",,A4649,HCPCS,Facility,Both,,,,50.265,42.72525,14.405949,50.265,Sanford Health Plan,Sanford Health Plan,46.2438,92,,percent of total billed charges,,
"FORCEPS, COLON BIOPSY",,A4649,HCPCS,Facility,Outpatient,,,,50.265,42.72525,14.405949,50.265,"UCare Health, Inc.",Individual & Family Plan,28.3243275,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"FORCEPS, COLON BIOPSY",,A4649,HCPCS,Facility,Inpatient,,,,50.265,42.72525,14.405949,50.265,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"FORCEPS, COLON BIOPSY",,A4649,HCPCS,Facility,Outpatient,,,,50.265,42.72525,14.405949,50.265,"UCare Health, Inc.",Medical Assistance,25.3687455,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"FORCEPS, COLON BIOPSY",,A4649,HCPCS,Facility,Inpatient,,,,50.265,42.72525,14.405949,50.265,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"FORCEPS, COLON BIOPSY",,A4649,HCPCS,Facility,Outpatient,,,,50.265,42.72525,14.405949,50.265,"UCare Health, Inc.",Medicare Advantage,25.3687455,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"FORCEPS, COLON BIOPSY",,A4649,HCPCS,Facility,Inpatient,,,,50.265,42.72525,14.405949,50.265,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"FORCEPS, COLON BIOPSY",,A4649,HCPCS,Facility,Outpatient,,,,50.265,42.72525,14.405949,50.265,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),25.3687455,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"FORCEPS, COLON BIOPSY",,A4649,HCPCS,Facility,Inpatient,,,,50.265,42.72525,14.405949,50.265,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"FORCEPS, COLON BIOPSY",,A4649,HCPCS,Facility,Both,,,,50.265,42.72525,14.405949,50.265,UnitedHealthcare,Individual & Family,47.2491,94,,percent of total billed charges,,
"FORCEPS, COLON BIOPSY",,A4649,HCPCS,Facility,Outpatient,,,,50.265,42.72525,14.405949,50.265,UnitedHealthcare,Medicare Advantage,24.62985,49,,percent of total billed charges,,
"FORCEPS, COLON BIOPSY",,A4649,HCPCS,Facility,Inpatient,,,,50.265,42.72525,14.405949,50.265,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"FORCEPS, COLON BIOPSY",,A4649,HCPCS,Facility,Outpatient,,,,50.265,42.72525,14.405949,50.265,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,24.1272,48,,percent of total billed charges,,100% of DHS outpatient percentage
"FORCEPS, COLON BIOPSY",,A4649,HCPCS,Facility,Inpatient,,,,50.265,42.72525,14.405949,50.265,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"FORCEPS, GASTRO BIOPSY",,A4649,HCPCS,Facility,Both,,,,50.265,42.72525,14.405949,50.265,Aetna,Commercial,46.2438,92,,percent of total billed charges,,
"FORCEPS, GASTRO BIOPSY",,A4649,HCPCS,Facility,Outpatient,,,,50.265,42.72525,14.405949,50.265,Aetna,Medicare Advantage,24.62985,49,,percent of total billed charges,,
"FORCEPS, GASTRO BIOPSY",,A4649,HCPCS,Facility,Inpatient,,,,50.265,42.72525,14.405949,50.265,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"FORCEPS, GASTRO BIOPSY",,A4649,HCPCS,Facility,Both,,,,50.265,42.72525,14.405949,50.265,Aetna,PPO,46.74645,93,,percent of total billed charges,,
"FORCEPS, GASTRO BIOPSY",,A4649,HCPCS,Facility,Both,,,,50.265,42.72525,14.405949,50.265,America's PPO,America's PPO,48.2694795,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"FORCEPS, GASTRO BIOPSY",,A4649,HCPCS,Facility,Both,,,,50.265,42.72525,14.405949,50.265,BlueCross BlueShield Minnesota, Federal Employee Program,49.46076,98.4,,percent of total billed charges,,
"FORCEPS, GASTRO BIOPSY",,A4649,HCPCS,Facility,Both,,,,50.265,42.72525,14.405949,50.265,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,50.265,100,,percent of total billed charges,,
"FORCEPS, GASTRO BIOPSY",,A4649,HCPCS,Facility,Both,,,,50.265,42.72525,14.405949,50.265,BlueCross BlueShield Minnesota,High Value Network Plan,45.2385,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
"FORCEPS, GASTRO BIOPSY",,A4649,HCPCS,Facility,Outpatient,,,,50.265,42.72525,14.405949,50.265,BlueCross BlueShield Minnesota,Medicare Advantage,24.62985,49,,percent of total billed charges,,
"FORCEPS, GASTRO BIOPSY",,A4649,HCPCS,Facility,Inpatient,,,,50.265,42.72525,14.405949,50.265,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"FORCEPS, GASTRO BIOPSY",,A4649,HCPCS,Facility,Both,,,,50.265,42.72525,14.405949,50.265,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,44.5197105,88.57,,percent of total billed charges,,
"FORCEPS, GASTRO BIOPSY",,A4649,HCPCS,Facility,Both,,,,50.265,42.72525,14.405949,50.265,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,14.405949,28.66,,percent of total billed charges,,
"FORCEPS, GASTRO BIOPSY",,A4649,HCPCS,Facility,Outpatient,,,,50.265,42.72525,14.405949,50.265,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),24.62985,49,,percent of total billed charges,,
"FORCEPS, GASTRO BIOPSY",,A4649,HCPCS,Facility,Inpatient,,,,50.265,42.72525,14.405949,50.265,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"FORCEPS, GASTRO BIOPSY",,A4649,HCPCS,Facility,Both,,,,50.265,42.72525,14.405949,50.265,CorVel,Worker's Compensation,50.265,100,,percent of total billed charges,,
"FORCEPS, GASTRO BIOPSY",,A4649,HCPCS,Facility,Both,,,,50.265,42.72525,14.405949,50.265,First Health Group Corporation,First Health Network,48.75705,97,,percent of total billed charges,,
"FORCEPS, GASTRO BIOPSY",,A4649,HCPCS,Facility,Both,,,,50.265,42.72525,14.405949,50.265,"Health Partners, Inc.",Commercial,47.55069,94.6,,percent of total billed charges,,
"FORCEPS, GASTRO BIOPSY",,A4649,HCPCS,Facility,Outpatient,,,,50.265,42.72525,14.405949,50.265,"Health Partners, Inc.",Medicare Advantage,24.62985,49,,percent of total billed charges,,
"FORCEPS, GASTRO BIOPSY",,A4649,HCPCS,Facility,Inpatient,,,,50.265,42.72525,14.405949,50.265,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"FORCEPS, GASTRO BIOPSY",,A4649,HCPCS,Facility,Both,,,,50.265,42.72525,14.405949,50.265,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),30.159,60,,percent of total billed charges,,
"FORCEPS, GASTRO BIOPSY",,A4649,HCPCS,Facility,Both,,,,50.265,42.72525,14.405949,50.265,"Health Partners, Inc.",State of Minnesota Advantage Program,40.965975,81.5,,percent of total billed charges,,
"FORCEPS, GASTRO BIOPSY",,A4649,HCPCS,Facility,Both,,,,50.265,42.72525,14.405949,50.265,"Health Partners, Inc.",State Public Programs,25.1325,50,,percent of total billed charges,,
"FORCEPS, GASTRO BIOPSY",,A4649,HCPCS,Facility,Both,,,,50.265,42.72525,14.405949,50.265,Humana Insurance Company,Commercial PPO,47.75175,95,,percent of total billed charges,,
"FORCEPS, GASTRO BIOPSY",,A4649,HCPCS,Facility,Outpatient,,,,50.265,42.72525,14.405949,50.265,Humana Insurance Company,Medicare PPO,24.62985,49,,percent of total billed charges,,
"FORCEPS, GASTRO BIOPSY",,A4649,HCPCS,Facility,Inpatient,,,,50.265,42.72525,14.405949,50.265,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"FORCEPS, GASTRO BIOPSY",,A4649,HCPCS,Facility,Both,,,,50.265,42.72525,14.405949,50.265,Medica,Individual & Family,49.812615,99.1,,percent of total billed charges,,
"FORCEPS, GASTRO BIOPSY",,A4649,HCPCS,Facility,Outpatient,,,,50.265,42.72525,14.405949,50.265,Medica,Medica Advantage Solution,25.03197,49.8,,percent of total billed charges,,
"FORCEPS, GASTRO BIOPSY",,A4649,HCPCS,Facility,Inpatient,,,,50.265,42.72525,14.405949,50.265,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"FORCEPS, GASTRO BIOPSY",,A4649,HCPCS,Facility,Outpatient,,,,50.265,42.72525,14.405949,50.265,Medica,Medical Assistance,22.41819,44.6,,percent of total billed charges,,
"FORCEPS, GASTRO BIOPSY",,A4649,HCPCS,Facility,Inpatient,,,,50.265,42.72525,14.405949,50.265,Medica,Medical Assistance,,,,,Included in per diem rate,
"FORCEPS, GASTRO BIOPSY",,A4649,HCPCS,Facility,Outpatient,,,,50.265,42.72525,14.405949,50.265,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,25.03197,49.8,,percent of total billed charges,,
"FORCEPS, GASTRO BIOPSY",,A4649,HCPCS,Facility,Inpatient,,,,50.265,42.72525,14.405949,50.265,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"FORCEPS, GASTRO BIOPSY",,A4649,HCPCS,Facility,Both,,,,50.265,42.72525,14.405949,50.265,"Multiplan, Inc.","Multiplan, Inc.",47.2491,94,,percent of total billed charges,,
"FORCEPS, GASTRO BIOPSY",,A4649,HCPCS,Facility,Outpatient,,,,50.265,42.72525,14.405949,50.265,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,45.288765,90.1,,percent of total billed charges,,
"FORCEPS, GASTRO BIOPSY",,A4649,HCPCS,Facility,Inpatient,,,,50.265,42.72525,14.405949,50.265,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"FORCEPS, GASTRO BIOPSY",,A4649,HCPCS,Facility,Both,,,,50.265,42.72525,14.405949,50.265,"Preferred One Administrative Services, INC.",PPO,49.56129,98.6,,percent of total billed charges,,
"FORCEPS, GASTRO BIOPSY",,A4649,HCPCS,Facility,Outpatient,,,,50.265,42.72525,14.405949,50.265,PrimeWest Health,Minnesota Senior Health Options (MSHO),25.8613425,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"FORCEPS, GASTRO BIOPSY",,A4649,HCPCS,Facility,Inpatient,,,,50.265,42.72525,14.405949,50.265,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"FORCEPS, GASTRO BIOPSY",,A4649,HCPCS,Facility,Outpatient,,,,50.265,42.72525,14.405949,50.265,PrimeWest Health,MinnesotaCare,25.816104,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"FORCEPS, GASTRO BIOPSY",,A4649,HCPCS,Facility,Inpatient,,,,50.265,42.72525,14.405949,50.265,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"FORCEPS, GASTRO BIOPSY",,A4649,HCPCS,Facility,Both,,,,50.265,42.72525,14.405949,50.265,Sanford Health Plan,Sanford Health Plan,46.2438,92,,percent of total billed charges,,
"FORCEPS, GASTRO BIOPSY",,A4649,HCPCS,Facility,Outpatient,,,,50.265,42.72525,14.405949,50.265,"UCare Health, Inc.",Individual & Family Plan,28.3243275,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"FORCEPS, GASTRO BIOPSY",,A4649,HCPCS,Facility,Inpatient,,,,50.265,42.72525,14.405949,50.265,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"FORCEPS, GASTRO BIOPSY",,A4649,HCPCS,Facility,Outpatient,,,,50.265,42.72525,14.405949,50.265,"UCare Health, Inc.",Medical Assistance,25.3687455,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"FORCEPS, GASTRO BIOPSY",,A4649,HCPCS,Facility,Inpatient,,,,50.265,42.72525,14.405949,50.265,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"FORCEPS, GASTRO BIOPSY",,A4649,HCPCS,Facility,Outpatient,,,,50.265,42.72525,14.405949,50.265,"UCare Health, Inc.",Medicare Advantage,25.3687455,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"FORCEPS, GASTRO BIOPSY",,A4649,HCPCS,Facility,Inpatient,,,,50.265,42.72525,14.405949,50.265,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"FORCEPS, GASTRO BIOPSY",,A4649,HCPCS,Facility,Outpatient,,,,50.265,42.72525,14.405949,50.265,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),25.3687455,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"FORCEPS, GASTRO BIOPSY",,A4649,HCPCS,Facility,Inpatient,,,,50.265,42.72525,14.405949,50.265,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"FORCEPS, GASTRO BIOPSY",,A4649,HCPCS,Facility,Both,,,,50.265,42.72525,14.405949,50.265,UnitedHealthcare,Individual & Family,47.2491,94,,percent of total billed charges,,
"FORCEPS, GASTRO BIOPSY",,A4649,HCPCS,Facility,Outpatient,,,,50.265,42.72525,14.405949,50.265,UnitedHealthcare,Medicare Advantage,24.62985,49,,percent of total billed charges,,
"FORCEPS, GASTRO BIOPSY",,A4649,HCPCS,Facility,Inpatient,,,,50.265,42.72525,14.405949,50.265,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"FORCEPS, GASTRO BIOPSY",,A4649,HCPCS,Facility,Outpatient,,,,50.265,42.72525,14.405949,50.265,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,24.1272,48,,percent of total billed charges,,100% of DHS outpatient percentage
"FORCEPS, GASTRO BIOPSY",,A4649,HCPCS,Facility,Inpatient,,,,50.265,42.72525,14.405949,50.265,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
FRASIER SUCTION 7FR,,A4649,HCPCS,Facility,Both,,,,29.3,24.905,8.39738,29.3,Aetna,Commercial,26.956,92,,percent of total billed charges,,
FRASIER SUCTION 7FR,,A4649,HCPCS,Facility,Outpatient,,,,29.3,24.905,8.39738,29.3,Aetna,Medicare Advantage,14.357,49,,percent of total billed charges,,
FRASIER SUCTION 7FR,,A4649,HCPCS,Facility,Inpatient,,,,29.3,24.905,8.39738,29.3,Aetna,Medicare Advantage,,,,,Included in per diem rate,
FRASIER SUCTION 7FR,,A4649,HCPCS,Facility,Both,,,,29.3,24.905,8.39738,29.3,Aetna,PPO,27.249,93,,percent of total billed charges,,
FRASIER SUCTION 7FR,,A4649,HCPCS,Facility,Both,,,,29.3,24.905,8.39738,29.3,America's PPO,America's PPO,28.13679,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
FRASIER SUCTION 7FR,,A4649,HCPCS,Facility,Both,,,,29.3,24.905,8.39738,29.3,BlueCross BlueShield Minnesota, Federal Employee Program,28.8312,98.4,,percent of total billed charges,,
FRASIER SUCTION 7FR,,A4649,HCPCS,Facility,Both,,,,29.3,24.905,8.39738,29.3,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,29.3,100,,percent of total billed charges,,
FRASIER SUCTION 7FR,,A4649,HCPCS,Facility,Both,,,,29.3,24.905,8.39738,29.3,BlueCross BlueShield Minnesota,High Value Network Plan,26.37,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
FRASIER SUCTION 7FR,,A4649,HCPCS,Facility,Outpatient,,,,29.3,24.905,8.39738,29.3,BlueCross BlueShield Minnesota,Medicare Advantage,14.357,49,,percent of total billed charges,,
FRASIER SUCTION 7FR,,A4649,HCPCS,Facility,Inpatient,,,,29.3,24.905,8.39738,29.3,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
FRASIER SUCTION 7FR,,A4649,HCPCS,Facility,Both,,,,29.3,24.905,8.39738,29.3,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,25.95101,88.57,,percent of total billed charges,,
FRASIER SUCTION 7FR,,A4649,HCPCS,Facility,Both,,,,29.3,24.905,8.39738,29.3,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,8.39738,28.66,,percent of total billed charges,,
FRASIER SUCTION 7FR,,A4649,HCPCS,Facility,Outpatient,,,,29.3,24.905,8.39738,29.3,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),14.357,49,,percent of total billed charges,,
FRASIER SUCTION 7FR,,A4649,HCPCS,Facility,Inpatient,,,,29.3,24.905,8.39738,29.3,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
FRASIER SUCTION 7FR,,A4649,HCPCS,Facility,Both,,,,29.3,24.905,8.39738,29.3,CorVel,Worker's Compensation,29.3,100,,percent of total billed charges,,
FRASIER SUCTION 7FR,,A4649,HCPCS,Facility,Both,,,,29.3,24.905,8.39738,29.3,First Health Group Corporation,First Health Network,28.421,97,,percent of total billed charges,,
FRASIER SUCTION 7FR,,A4649,HCPCS,Facility,Both,,,,29.3,24.905,8.39738,29.3,"Health Partners, Inc.",Commercial,27.7178,94.6,,percent of total billed charges,,
FRASIER SUCTION 7FR,,A4649,HCPCS,Facility,Outpatient,,,,29.3,24.905,8.39738,29.3,"Health Partners, Inc.",Medicare Advantage,14.357,49,,percent of total billed charges,,
FRASIER SUCTION 7FR,,A4649,HCPCS,Facility,Inpatient,,,,29.3,24.905,8.39738,29.3,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
FRASIER SUCTION 7FR,,A4649,HCPCS,Facility,Both,,,,29.3,24.905,8.39738,29.3,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),17.58,60,,percent of total billed charges,,
FRASIER SUCTION 7FR,,A4649,HCPCS,Facility,Both,,,,29.3,24.905,8.39738,29.3,"Health Partners, Inc.",State of Minnesota Advantage Program,23.8795,81.5,,percent of total billed charges,,
FRASIER SUCTION 7FR,,A4649,HCPCS,Facility,Both,,,,29.3,24.905,8.39738,29.3,"Health Partners, Inc.",State Public Programs,14.65,50,,percent of total billed charges,,
FRASIER SUCTION 7FR,,A4649,HCPCS,Facility,Both,,,,29.3,24.905,8.39738,29.3,Humana Insurance Company,Commercial PPO,27.835,95,,percent of total billed charges,,
FRASIER SUCTION 7FR,,A4649,HCPCS,Facility,Outpatient,,,,29.3,24.905,8.39738,29.3,Humana Insurance Company,Medicare PPO,14.357,49,,percent of total billed charges,,
FRASIER SUCTION 7FR,,A4649,HCPCS,Facility,Inpatient,,,,29.3,24.905,8.39738,29.3,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
FRASIER SUCTION 7FR,,A4649,HCPCS,Facility,Both,,,,29.3,24.905,8.39738,29.3,Medica,Individual & Family,29.0363,99.1,,percent of total billed charges,,
FRASIER SUCTION 7FR,,A4649,HCPCS,Facility,Outpatient,,,,29.3,24.905,8.39738,29.3,Medica,Medica Advantage Solution,14.5914,49.8,,percent of total billed charges,,
FRASIER SUCTION 7FR,,A4649,HCPCS,Facility,Inpatient,,,,29.3,24.905,8.39738,29.3,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
FRASIER SUCTION 7FR,,A4649,HCPCS,Facility,Outpatient,,,,29.3,24.905,8.39738,29.3,Medica,Medical Assistance,13.0678,44.6,,percent of total billed charges,,
FRASIER SUCTION 7FR,,A4649,HCPCS,Facility,Inpatient,,,,29.3,24.905,8.39738,29.3,Medica,Medical Assistance,,,,,Included in per diem rate,
FRASIER SUCTION 7FR,,A4649,HCPCS,Facility,Outpatient,,,,29.3,24.905,8.39738,29.3,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,14.5914,49.8,,percent of total billed charges,,
FRASIER SUCTION 7FR,,A4649,HCPCS,Facility,Inpatient,,,,29.3,24.905,8.39738,29.3,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
FRASIER SUCTION 7FR,,A4649,HCPCS,Facility,Both,,,,29.3,24.905,8.39738,29.3,"Multiplan, Inc.","Multiplan, Inc.",27.542,94,,percent of total billed charges,,
FRASIER SUCTION 7FR,,A4649,HCPCS,Facility,Outpatient,,,,29.3,24.905,8.39738,29.3,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,26.3993,90.1,,percent of total billed charges,,
FRASIER SUCTION 7FR,,A4649,HCPCS,Facility,Inpatient,,,,29.3,24.905,8.39738,29.3,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
FRASIER SUCTION 7FR,,A4649,HCPCS,Facility,Both,,,,29.3,24.905,8.39738,29.3,"Preferred One Administrative Services, INC.",PPO,28.8898,98.6,,percent of total billed charges,,
FRASIER SUCTION 7FR,,A4649,HCPCS,Facility,Outpatient,,,,29.3,24.905,8.39738,29.3,PrimeWest Health,Minnesota Senior Health Options (MSHO),15.07485,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
FRASIER SUCTION 7FR,,A4649,HCPCS,Facility,Inpatient,,,,29.3,24.905,8.39738,29.3,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
FRASIER SUCTION 7FR,,A4649,HCPCS,Facility,Outpatient,,,,29.3,24.905,8.39738,29.3,PrimeWest Health,MinnesotaCare,15.04848,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
FRASIER SUCTION 7FR,,A4649,HCPCS,Facility,Inpatient,,,,29.3,24.905,8.39738,29.3,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
FRASIER SUCTION 7FR,,A4649,HCPCS,Facility,Both,,,,29.3,24.905,8.39738,29.3,Sanford Health Plan,Sanford Health Plan,26.956,92,,percent of total billed charges,,
FRASIER SUCTION 7FR,,A4649,HCPCS,Facility,Outpatient,,,,29.3,24.905,8.39738,29.3,"UCare Health, Inc.",Individual & Family Plan,16.51055,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
FRASIER SUCTION 7FR,,A4649,HCPCS,Facility,Inpatient,,,,29.3,24.905,8.39738,29.3,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
FRASIER SUCTION 7FR,,A4649,HCPCS,Facility,Outpatient,,,,29.3,24.905,8.39738,29.3,"UCare Health, Inc.",Medical Assistance,14.78771,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FRASIER SUCTION 7FR,,A4649,HCPCS,Facility,Inpatient,,,,29.3,24.905,8.39738,29.3,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
FRASIER SUCTION 7FR,,A4649,HCPCS,Facility,Outpatient,,,,29.3,24.905,8.39738,29.3,"UCare Health, Inc.",Medicare Advantage,14.78771,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FRASIER SUCTION 7FR,,A4649,HCPCS,Facility,Inpatient,,,,29.3,24.905,8.39738,29.3,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
FRASIER SUCTION 7FR,,A4649,HCPCS,Facility,Outpatient,,,,29.3,24.905,8.39738,29.3,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),14.78771,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FRASIER SUCTION 7FR,,A4649,HCPCS,Facility,Inpatient,,,,29.3,24.905,8.39738,29.3,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
FRASIER SUCTION 7FR,,A4649,HCPCS,Facility,Both,,,,29.3,24.905,8.39738,29.3,UnitedHealthcare,Individual & Family,27.542,94,,percent of total billed charges,,
FRASIER SUCTION 7FR,,A4649,HCPCS,Facility,Outpatient,,,,29.3,24.905,8.39738,29.3,UnitedHealthcare,Medicare Advantage,14.357,49,,percent of total billed charges,,
FRASIER SUCTION 7FR,,A4649,HCPCS,Facility,Inpatient,,,,29.3,24.905,8.39738,29.3,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
FRASIER SUCTION 7FR,,A4649,HCPCS,Facility,Outpatient,,,,29.3,24.905,8.39738,29.3,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,14.064,48,,percent of total billed charges,,100% of DHS outpatient percentage
FRASIER SUCTION 7FR,,A4649,HCPCS,Facility,Inpatient,,,,29.3,24.905,8.39738,29.3,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
FRAZIER TIP SUCTION,,A4649,HCPCS,Facility,Both,,,,38.7,32.895,11.09142,38.7,Aetna,Commercial,35.604,92,,percent of total billed charges,,
FRAZIER TIP SUCTION,,A4649,HCPCS,Facility,Outpatient,,,,38.7,32.895,11.09142,38.7,Aetna,Medicare Advantage,18.963,49,,percent of total billed charges,,
FRAZIER TIP SUCTION,,A4649,HCPCS,Facility,Inpatient,,,,38.7,32.895,11.09142,38.7,Aetna,Medicare Advantage,,,,,Included in per diem rate,
FRAZIER TIP SUCTION,,A4649,HCPCS,Facility,Both,,,,38.7,32.895,11.09142,38.7,Aetna,PPO,35.991,93,,percent of total billed charges,,
FRAZIER TIP SUCTION,,A4649,HCPCS,Facility,Both,,,,38.7,32.895,11.09142,38.7,America's PPO,America's PPO,37.16361,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
FRAZIER TIP SUCTION,,A4649,HCPCS,Facility,Both,,,,38.7,32.895,11.09142,38.7,BlueCross BlueShield Minnesota, Federal Employee Program,38.0808,98.4,,percent of total billed charges,,
FRAZIER TIP SUCTION,,A4649,HCPCS,Facility,Both,,,,38.7,32.895,11.09142,38.7,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,38.7,100,,percent of total billed charges,,
FRAZIER TIP SUCTION,,A4649,HCPCS,Facility,Both,,,,38.7,32.895,11.09142,38.7,BlueCross BlueShield Minnesota,High Value Network Plan,34.83,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
FRAZIER TIP SUCTION,,A4649,HCPCS,Facility,Outpatient,,,,38.7,32.895,11.09142,38.7,BlueCross BlueShield Minnesota,Medicare Advantage,18.963,49,,percent of total billed charges,,
FRAZIER TIP SUCTION,,A4649,HCPCS,Facility,Inpatient,,,,38.7,32.895,11.09142,38.7,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
FRAZIER TIP SUCTION,,A4649,HCPCS,Facility,Both,,,,38.7,32.895,11.09142,38.7,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,34.27659,88.57,,percent of total billed charges,,
FRAZIER TIP SUCTION,,A4649,HCPCS,Facility,Both,,,,38.7,32.895,11.09142,38.7,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,11.09142,28.66,,percent of total billed charges,,
FRAZIER TIP SUCTION,,A4649,HCPCS,Facility,Outpatient,,,,38.7,32.895,11.09142,38.7,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),18.963,49,,percent of total billed charges,,
FRAZIER TIP SUCTION,,A4649,HCPCS,Facility,Inpatient,,,,38.7,32.895,11.09142,38.7,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
FRAZIER TIP SUCTION,,A4649,HCPCS,Facility,Both,,,,38.7,32.895,11.09142,38.7,CorVel,Worker's Compensation,38.7,100,,percent of total billed charges,,
FRAZIER TIP SUCTION,,A4649,HCPCS,Facility,Both,,,,38.7,32.895,11.09142,38.7,First Health Group Corporation,First Health Network,37.539,97,,percent of total billed charges,,
FRAZIER TIP SUCTION,,A4649,HCPCS,Facility,Both,,,,38.7,32.895,11.09142,38.7,"Health Partners, Inc.",Commercial,36.6102,94.6,,percent of total billed charges,,
FRAZIER TIP SUCTION,,A4649,HCPCS,Facility,Outpatient,,,,38.7,32.895,11.09142,38.7,"Health Partners, Inc.",Medicare Advantage,18.963,49,,percent of total billed charges,,
FRAZIER TIP SUCTION,,A4649,HCPCS,Facility,Inpatient,,,,38.7,32.895,11.09142,38.7,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
FRAZIER TIP SUCTION,,A4649,HCPCS,Facility,Both,,,,38.7,32.895,11.09142,38.7,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),23.22,60,,percent of total billed charges,,
FRAZIER TIP SUCTION,,A4649,HCPCS,Facility,Both,,,,38.7,32.895,11.09142,38.7,"Health Partners, Inc.",State of Minnesota Advantage Program,31.5405,81.5,,percent of total billed charges,,
FRAZIER TIP SUCTION,,A4649,HCPCS,Facility,Both,,,,38.7,32.895,11.09142,38.7,"Health Partners, Inc.",State Public Programs,19.35,50,,percent of total billed charges,,
FRAZIER TIP SUCTION,,A4649,HCPCS,Facility,Both,,,,38.7,32.895,11.09142,38.7,Humana Insurance Company,Commercial PPO,36.765,95,,percent of total billed charges,,
FRAZIER TIP SUCTION,,A4649,HCPCS,Facility,Outpatient,,,,38.7,32.895,11.09142,38.7,Humana Insurance Company,Medicare PPO,18.963,49,,percent of total billed charges,,
FRAZIER TIP SUCTION,,A4649,HCPCS,Facility,Inpatient,,,,38.7,32.895,11.09142,38.7,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
FRAZIER TIP SUCTION,,A4649,HCPCS,Facility,Both,,,,38.7,32.895,11.09142,38.7,Medica,Individual & Family,38.3517,99.1,,percent of total billed charges,,
FRAZIER TIP SUCTION,,A4649,HCPCS,Facility,Outpatient,,,,38.7,32.895,11.09142,38.7,Medica,Medica Advantage Solution,19.2726,49.8,,percent of total billed charges,,
FRAZIER TIP SUCTION,,A4649,HCPCS,Facility,Inpatient,,,,38.7,32.895,11.09142,38.7,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
FRAZIER TIP SUCTION,,A4649,HCPCS,Facility,Outpatient,,,,38.7,32.895,11.09142,38.7,Medica,Medical Assistance,17.2602,44.6,,percent of total billed charges,,
FRAZIER TIP SUCTION,,A4649,HCPCS,Facility,Inpatient,,,,38.7,32.895,11.09142,38.7,Medica,Medical Assistance,,,,,Included in per diem rate,
FRAZIER TIP SUCTION,,A4649,HCPCS,Facility,Outpatient,,,,38.7,32.895,11.09142,38.7,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,19.2726,49.8,,percent of total billed charges,,
FRAZIER TIP SUCTION,,A4649,HCPCS,Facility,Inpatient,,,,38.7,32.895,11.09142,38.7,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
FRAZIER TIP SUCTION,,A4649,HCPCS,Facility,Both,,,,38.7,32.895,11.09142,38.7,"Multiplan, Inc.","Multiplan, Inc.",36.378,94,,percent of total billed charges,,
FRAZIER TIP SUCTION,,A4649,HCPCS,Facility,Outpatient,,,,38.7,32.895,11.09142,38.7,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,34.8687,90.1,,percent of total billed charges,,
FRAZIER TIP SUCTION,,A4649,HCPCS,Facility,Inpatient,,,,38.7,32.895,11.09142,38.7,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
FRAZIER TIP SUCTION,,A4649,HCPCS,Facility,Both,,,,38.7,32.895,11.09142,38.7,"Preferred One Administrative Services, INC.",PPO,38.1582,98.6,,percent of total billed charges,,
FRAZIER TIP SUCTION,,A4649,HCPCS,Facility,Outpatient,,,,38.7,32.895,11.09142,38.7,PrimeWest Health,Minnesota Senior Health Options (MSHO),19.91115,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
FRAZIER TIP SUCTION,,A4649,HCPCS,Facility,Inpatient,,,,38.7,32.895,11.09142,38.7,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
FRAZIER TIP SUCTION,,A4649,HCPCS,Facility,Outpatient,,,,38.7,32.895,11.09142,38.7,PrimeWest Health,MinnesotaCare,19.87632,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
FRAZIER TIP SUCTION,,A4649,HCPCS,Facility,Inpatient,,,,38.7,32.895,11.09142,38.7,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
FRAZIER TIP SUCTION,,A4649,HCPCS,Facility,Both,,,,38.7,32.895,11.09142,38.7,Sanford Health Plan,Sanford Health Plan,35.604,92,,percent of total billed charges,,
FRAZIER TIP SUCTION,,A4649,HCPCS,Facility,Outpatient,,,,38.7,32.895,11.09142,38.7,"UCare Health, Inc.",Individual & Family Plan,21.80745,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
FRAZIER TIP SUCTION,,A4649,HCPCS,Facility,Inpatient,,,,38.7,32.895,11.09142,38.7,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
FRAZIER TIP SUCTION,,A4649,HCPCS,Facility,Outpatient,,,,38.7,32.895,11.09142,38.7,"UCare Health, Inc.",Medical Assistance,19.53189,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FRAZIER TIP SUCTION,,A4649,HCPCS,Facility,Inpatient,,,,38.7,32.895,11.09142,38.7,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
FRAZIER TIP SUCTION,,A4649,HCPCS,Facility,Outpatient,,,,38.7,32.895,11.09142,38.7,"UCare Health, Inc.",Medicare Advantage,19.53189,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FRAZIER TIP SUCTION,,A4649,HCPCS,Facility,Inpatient,,,,38.7,32.895,11.09142,38.7,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
FRAZIER TIP SUCTION,,A4649,HCPCS,Facility,Outpatient,,,,38.7,32.895,11.09142,38.7,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),19.53189,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FRAZIER TIP SUCTION,,A4649,HCPCS,Facility,Inpatient,,,,38.7,32.895,11.09142,38.7,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
FRAZIER TIP SUCTION,,A4649,HCPCS,Facility,Both,,,,38.7,32.895,11.09142,38.7,UnitedHealthcare,Individual & Family,36.378,94,,percent of total billed charges,,
FRAZIER TIP SUCTION,,A4649,HCPCS,Facility,Outpatient,,,,38.7,32.895,11.09142,38.7,UnitedHealthcare,Medicare Advantage,18.963,49,,percent of total billed charges,,
FRAZIER TIP SUCTION,,A4649,HCPCS,Facility,Inpatient,,,,38.7,32.895,11.09142,38.7,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
FRAZIER TIP SUCTION,,A4649,HCPCS,Facility,Outpatient,,,,38.7,32.895,11.09142,38.7,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,18.576,48,,percent of total billed charges,,100% of DHS outpatient percentage
FRAZIER TIP SUCTION,,A4649,HCPCS,Facility,Inpatient,,,,38.7,32.895,11.09142,38.7,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
FULGURATING ELECTRODE,,A4649,HCPCS,Facility,Both,,,,420,357,120.372,420,Aetna,Commercial,386.4,92,,percent of total billed charges,,
FULGURATING ELECTRODE,,A4649,HCPCS,Facility,Outpatient,,,,420,357,120.372,420,Aetna,Medicare Advantage,205.8,49,,percent of total billed charges,,
FULGURATING ELECTRODE,,A4649,HCPCS,Facility,Inpatient,,,,420,357,120.372,420,Aetna,Medicare Advantage,,,,,Included in per diem rate,
FULGURATING ELECTRODE,,A4649,HCPCS,Facility,Both,,,,420,357,120.372,420,Aetna,PPO,390.6,93,,percent of total billed charges,,
FULGURATING ELECTRODE,,A4649,HCPCS,Facility,Both,,,,420,357,120.372,420,America's PPO,America's PPO,403.326,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
FULGURATING ELECTRODE,,A4649,HCPCS,Facility,Both,,,,420,357,120.372,420,BlueCross BlueShield Minnesota, Federal Employee Program,413.28,98.4,,percent of total billed charges,,
FULGURATING ELECTRODE,,A4649,HCPCS,Facility,Both,,,,420,357,120.372,420,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,420,100,,percent of total billed charges,,
FULGURATING ELECTRODE,,A4649,HCPCS,Facility,Both,,,,420,357,120.372,420,BlueCross BlueShield Minnesota,High Value Network Plan,378,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
FULGURATING ELECTRODE,,A4649,HCPCS,Facility,Outpatient,,,,420,357,120.372,420,BlueCross BlueShield Minnesota,Medicare Advantage,205.8,49,,percent of total billed charges,,
FULGURATING ELECTRODE,,A4649,HCPCS,Facility,Inpatient,,,,420,357,120.372,420,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
FULGURATING ELECTRODE,,A4649,HCPCS,Facility,Both,,,,420,357,120.372,420,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,371.994,88.57,,percent of total billed charges,,
FULGURATING ELECTRODE,,A4649,HCPCS,Facility,Both,,,,420,357,120.372,420,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,120.372,28.66,,percent of total billed charges,,
FULGURATING ELECTRODE,,A4649,HCPCS,Facility,Outpatient,,,,420,357,120.372,420,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),205.8,49,,percent of total billed charges,,
FULGURATING ELECTRODE,,A4649,HCPCS,Facility,Inpatient,,,,420,357,120.372,420,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
FULGURATING ELECTRODE,,A4649,HCPCS,Facility,Both,,,,420,357,120.372,420,CorVel,Worker's Compensation,420,100,,percent of total billed charges,,
FULGURATING ELECTRODE,,A4649,HCPCS,Facility,Both,,,,420,357,120.372,420,First Health Group Corporation,First Health Network,407.4,97,,percent of total billed charges,,
FULGURATING ELECTRODE,,A4649,HCPCS,Facility,Both,,,,420,357,120.372,420,"Health Partners, Inc.",Commercial,397.32,94.6,,percent of total billed charges,,
FULGURATING ELECTRODE,,A4649,HCPCS,Facility,Outpatient,,,,420,357,120.372,420,"Health Partners, Inc.",Medicare Advantage,205.8,49,,percent of total billed charges,,
FULGURATING ELECTRODE,,A4649,HCPCS,Facility,Inpatient,,,,420,357,120.372,420,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
FULGURATING ELECTRODE,,A4649,HCPCS,Facility,Both,,,,420,357,120.372,420,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),252,60,,percent of total billed charges,,
FULGURATING ELECTRODE,,A4649,HCPCS,Facility,Both,,,,420,357,120.372,420,"Health Partners, Inc.",State of Minnesota Advantage Program,342.3,81.5,,percent of total billed charges,,
FULGURATING ELECTRODE,,A4649,HCPCS,Facility,Both,,,,420,357,120.372,420,"Health Partners, Inc.",State Public Programs,210,50,,percent of total billed charges,,
FULGURATING ELECTRODE,,A4649,HCPCS,Facility,Both,,,,420,357,120.372,420,Humana Insurance Company,Commercial PPO,399,95,,percent of total billed charges,,
FULGURATING ELECTRODE,,A4649,HCPCS,Facility,Outpatient,,,,420,357,120.372,420,Humana Insurance Company,Medicare PPO,205.8,49,,percent of total billed charges,,
FULGURATING ELECTRODE,,A4649,HCPCS,Facility,Inpatient,,,,420,357,120.372,420,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
FULGURATING ELECTRODE,,A4649,HCPCS,Facility,Both,,,,420,357,120.372,420,Medica,Individual & Family,416.22,99.1,,percent of total billed charges,,
FULGURATING ELECTRODE,,A4649,HCPCS,Facility,Outpatient,,,,420,357,120.372,420,Medica,Medica Advantage Solution,209.16,49.8,,percent of total billed charges,,
FULGURATING ELECTRODE,,A4649,HCPCS,Facility,Inpatient,,,,420,357,120.372,420,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
FULGURATING ELECTRODE,,A4649,HCPCS,Facility,Outpatient,,,,420,357,120.372,420,Medica,Medical Assistance,187.32,44.6,,percent of total billed charges,,
FULGURATING ELECTRODE,,A4649,HCPCS,Facility,Inpatient,,,,420,357,120.372,420,Medica,Medical Assistance,,,,,Included in per diem rate,
FULGURATING ELECTRODE,,A4649,HCPCS,Facility,Outpatient,,,,420,357,120.372,420,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,209.16,49.8,,percent of total billed charges,,
FULGURATING ELECTRODE,,A4649,HCPCS,Facility,Inpatient,,,,420,357,120.372,420,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
FULGURATING ELECTRODE,,A4649,HCPCS,Facility,Both,,,,420,357,120.372,420,"Multiplan, Inc.","Multiplan, Inc.",394.8,94,,percent of total billed charges,,
FULGURATING ELECTRODE,,A4649,HCPCS,Facility,Outpatient,,,,420,357,120.372,420,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,378.42,90.1,,percent of total billed charges,,
FULGURATING ELECTRODE,,A4649,HCPCS,Facility,Inpatient,,,,420,357,120.372,420,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
FULGURATING ELECTRODE,,A4649,HCPCS,Facility,Both,,,,420,357,120.372,420,"Preferred One Administrative Services, INC.",PPO,414.12,98.6,,percent of total billed charges,,
FULGURATING ELECTRODE,,A4649,HCPCS,Facility,Outpatient,,,,420,357,120.372,420,PrimeWest Health,Minnesota Senior Health Options (MSHO),216.09,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
FULGURATING ELECTRODE,,A4649,HCPCS,Facility,Inpatient,,,,420,357,120.372,420,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
FULGURATING ELECTRODE,,A4649,HCPCS,Facility,Outpatient,,,,420,357,120.372,420,PrimeWest Health,MinnesotaCare,215.712,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
FULGURATING ELECTRODE,,A4649,HCPCS,Facility,Inpatient,,,,420,357,120.372,420,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
FULGURATING ELECTRODE,,A4649,HCPCS,Facility,Both,,,,420,357,120.372,420,Sanford Health Plan,Sanford Health Plan,386.4,92,,percent of total billed charges,,
FULGURATING ELECTRODE,,A4649,HCPCS,Facility,Outpatient,,,,420,357,120.372,420,"UCare Health, Inc.",Individual & Family Plan,236.67,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
FULGURATING ELECTRODE,,A4649,HCPCS,Facility,Inpatient,,,,420,357,120.372,420,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
FULGURATING ELECTRODE,,A4649,HCPCS,Facility,Outpatient,,,,420,357,120.372,420,"UCare Health, Inc.",Medical Assistance,211.974,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FULGURATING ELECTRODE,,A4649,HCPCS,Facility,Inpatient,,,,420,357,120.372,420,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
FULGURATING ELECTRODE,,A4649,HCPCS,Facility,Outpatient,,,,420,357,120.372,420,"UCare Health, Inc.",Medicare Advantage,211.974,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FULGURATING ELECTRODE,,A4649,HCPCS,Facility,Inpatient,,,,420,357,120.372,420,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
FULGURATING ELECTRODE,,A4649,HCPCS,Facility,Outpatient,,,,420,357,120.372,420,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),211.974,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FULGURATING ELECTRODE,,A4649,HCPCS,Facility,Inpatient,,,,420,357,120.372,420,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
FULGURATING ELECTRODE,,A4649,HCPCS,Facility,Both,,,,420,357,120.372,420,UnitedHealthcare,Individual & Family,394.8,94,,percent of total billed charges,,
FULGURATING ELECTRODE,,A4649,HCPCS,Facility,Outpatient,,,,420,357,120.372,420,UnitedHealthcare,Medicare Advantage,205.8,49,,percent of total billed charges,,
FULGURATING ELECTRODE,,A4649,HCPCS,Facility,Inpatient,,,,420,357,120.372,420,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
FULGURATING ELECTRODE,,A4649,HCPCS,Facility,Outpatient,,,,420,357,120.372,420,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,201.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
FULGURATING ELECTRODE,,A4649,HCPCS,Facility,Inpatient,,,,420,357,120.372,420,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
GLYCINE 1.5% 3000ML,,A4649,HCPCS,Facility,Both,,,,73.08,62.118,20.944728,73.08,Aetna,Commercial,67.2336,92,,percent of total billed charges,,
GLYCINE 1.5% 3000ML,,A4649,HCPCS,Facility,Outpatient,,,,73.08,62.118,20.944728,73.08,Aetna,Medicare Advantage,35.8092,49,,percent of total billed charges,,
GLYCINE 1.5% 3000ML,,A4649,HCPCS,Facility,Inpatient,,,,73.08,62.118,20.944728,73.08,Aetna,Medicare Advantage,,,,,Included in per diem rate,
GLYCINE 1.5% 3000ML,,A4649,HCPCS,Facility,Both,,,,73.08,62.118,20.944728,73.08,Aetna,PPO,67.9644,93,,percent of total billed charges,,
GLYCINE 1.5% 3000ML,,A4649,HCPCS,Facility,Both,,,,73.08,62.118,20.944728,73.08,America's PPO,America's PPO,70.178724,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
GLYCINE 1.5% 3000ML,,A4649,HCPCS,Facility,Both,,,,73.08,62.118,20.944728,73.08,BlueCross BlueShield Minnesota, Federal Employee Program,71.91072,98.4,,percent of total billed charges,,
GLYCINE 1.5% 3000ML,,A4649,HCPCS,Facility,Both,,,,73.08,62.118,20.944728,73.08,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,73.08,100,,percent of total billed charges,,
GLYCINE 1.5% 3000ML,,A4649,HCPCS,Facility,Both,,,,73.08,62.118,20.944728,73.08,BlueCross BlueShield Minnesota,High Value Network Plan,65.772,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
GLYCINE 1.5% 3000ML,,A4649,HCPCS,Facility,Outpatient,,,,73.08,62.118,20.944728,73.08,BlueCross BlueShield Minnesota,Medicare Advantage,35.8092,49,,percent of total billed charges,,
GLYCINE 1.5% 3000ML,,A4649,HCPCS,Facility,Inpatient,,,,73.08,62.118,20.944728,73.08,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
GLYCINE 1.5% 3000ML,,A4649,HCPCS,Facility,Both,,,,73.08,62.118,20.944728,73.08,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,64.726956,88.57,,percent of total billed charges,,
GLYCINE 1.5% 3000ML,,A4649,HCPCS,Facility,Both,,,,73.08,62.118,20.944728,73.08,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,20.944728,28.66,,percent of total billed charges,,
GLYCINE 1.5% 3000ML,,A4649,HCPCS,Facility,Outpatient,,,,73.08,62.118,20.944728,73.08,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),35.8092,49,,percent of total billed charges,,
GLYCINE 1.5% 3000ML,,A4649,HCPCS,Facility,Inpatient,,,,73.08,62.118,20.944728,73.08,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
GLYCINE 1.5% 3000ML,,A4649,HCPCS,Facility,Both,,,,73.08,62.118,20.944728,73.08,CorVel,Worker's Compensation,73.08,100,,percent of total billed charges,,
GLYCINE 1.5% 3000ML,,A4649,HCPCS,Facility,Both,,,,73.08,62.118,20.944728,73.08,First Health Group Corporation,First Health Network,70.8876,97,,percent of total billed charges,,
GLYCINE 1.5% 3000ML,,A4649,HCPCS,Facility,Both,,,,73.08,62.118,20.944728,73.08,"Health Partners, Inc.",Commercial,69.13368,94.6,,percent of total billed charges,,
GLYCINE 1.5% 3000ML,,A4649,HCPCS,Facility,Outpatient,,,,73.08,62.118,20.944728,73.08,"Health Partners, Inc.",Medicare Advantage,35.8092,49,,percent of total billed charges,,
GLYCINE 1.5% 3000ML,,A4649,HCPCS,Facility,Inpatient,,,,73.08,62.118,20.944728,73.08,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
GLYCINE 1.5% 3000ML,,A4649,HCPCS,Facility,Both,,,,73.08,62.118,20.944728,73.08,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),43.848,60,,percent of total billed charges,,
GLYCINE 1.5% 3000ML,,A4649,HCPCS,Facility,Both,,,,73.08,62.118,20.944728,73.08,"Health Partners, Inc.",State of Minnesota Advantage Program,59.5602,81.5,,percent of total billed charges,,
GLYCINE 1.5% 3000ML,,A4649,HCPCS,Facility,Both,,,,73.08,62.118,20.944728,73.08,"Health Partners, Inc.",State Public Programs,36.54,50,,percent of total billed charges,,
GLYCINE 1.5% 3000ML,,A4649,HCPCS,Facility,Both,,,,73.08,62.118,20.944728,73.08,Humana Insurance Company,Commercial PPO,69.426,95,,percent of total billed charges,,
GLYCINE 1.5% 3000ML,,A4649,HCPCS,Facility,Outpatient,,,,73.08,62.118,20.944728,73.08,Humana Insurance Company,Medicare PPO,35.8092,49,,percent of total billed charges,,
GLYCINE 1.5% 3000ML,,A4649,HCPCS,Facility,Inpatient,,,,73.08,62.118,20.944728,73.08,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
GLYCINE 1.5% 3000ML,,A4649,HCPCS,Facility,Both,,,,73.08,62.118,20.944728,73.08,Medica,Individual & Family,72.42228,99.1,,percent of total billed charges,,
GLYCINE 1.5% 3000ML,,A4649,HCPCS,Facility,Outpatient,,,,73.08,62.118,20.944728,73.08,Medica,Medica Advantage Solution,36.39384,49.8,,percent of total billed charges,,
GLYCINE 1.5% 3000ML,,A4649,HCPCS,Facility,Inpatient,,,,73.08,62.118,20.944728,73.08,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
GLYCINE 1.5% 3000ML,,A4649,HCPCS,Facility,Outpatient,,,,73.08,62.118,20.944728,73.08,Medica,Medical Assistance,32.59368,44.6,,percent of total billed charges,,
GLYCINE 1.5% 3000ML,,A4649,HCPCS,Facility,Inpatient,,,,73.08,62.118,20.944728,73.08,Medica,Medical Assistance,,,,,Included in per diem rate,
GLYCINE 1.5% 3000ML,,A4649,HCPCS,Facility,Outpatient,,,,73.08,62.118,20.944728,73.08,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,36.39384,49.8,,percent of total billed charges,,
GLYCINE 1.5% 3000ML,,A4649,HCPCS,Facility,Inpatient,,,,73.08,62.118,20.944728,73.08,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
GLYCINE 1.5% 3000ML,,A4649,HCPCS,Facility,Both,,,,73.08,62.118,20.944728,73.08,"Multiplan, Inc.","Multiplan, Inc.",68.6952,94,,percent of total billed charges,,
GLYCINE 1.5% 3000ML,,A4649,HCPCS,Facility,Outpatient,,,,73.08,62.118,20.944728,73.08,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,65.84508,90.1,,percent of total billed charges,,
GLYCINE 1.5% 3000ML,,A4649,HCPCS,Facility,Inpatient,,,,73.08,62.118,20.944728,73.08,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
GLYCINE 1.5% 3000ML,,A4649,HCPCS,Facility,Both,,,,73.08,62.118,20.944728,73.08,"Preferred One Administrative Services, INC.",PPO,72.05688,98.6,,percent of total billed charges,,
GLYCINE 1.5% 3000ML,,A4649,HCPCS,Facility,Outpatient,,,,73.08,62.118,20.944728,73.08,PrimeWest Health,Minnesota Senior Health Options (MSHO),37.59966,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
GLYCINE 1.5% 3000ML,,A4649,HCPCS,Facility,Inpatient,,,,73.08,62.118,20.944728,73.08,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
GLYCINE 1.5% 3000ML,,A4649,HCPCS,Facility,Outpatient,,,,73.08,62.118,20.944728,73.08,PrimeWest Health,MinnesotaCare,37.533888,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
GLYCINE 1.5% 3000ML,,A4649,HCPCS,Facility,Inpatient,,,,73.08,62.118,20.944728,73.08,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
GLYCINE 1.5% 3000ML,,A4649,HCPCS,Facility,Both,,,,73.08,62.118,20.944728,73.08,Sanford Health Plan,Sanford Health Plan,67.2336,92,,percent of total billed charges,,
GLYCINE 1.5% 3000ML,,A4649,HCPCS,Facility,Outpatient,,,,73.08,62.118,20.944728,73.08,"UCare Health, Inc.",Individual & Family Plan,41.18058,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
GLYCINE 1.5% 3000ML,,A4649,HCPCS,Facility,Inpatient,,,,73.08,62.118,20.944728,73.08,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
GLYCINE 1.5% 3000ML,,A4649,HCPCS,Facility,Outpatient,,,,73.08,62.118,20.944728,73.08,"UCare Health, Inc.",Medical Assistance,36.883476,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
GLYCINE 1.5% 3000ML,,A4649,HCPCS,Facility,Inpatient,,,,73.08,62.118,20.944728,73.08,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
GLYCINE 1.5% 3000ML,,A4649,HCPCS,Facility,Outpatient,,,,73.08,62.118,20.944728,73.08,"UCare Health, Inc.",Medicare Advantage,36.883476,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
GLYCINE 1.5% 3000ML,,A4649,HCPCS,Facility,Inpatient,,,,73.08,62.118,20.944728,73.08,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
GLYCINE 1.5% 3000ML,,A4649,HCPCS,Facility,Outpatient,,,,73.08,62.118,20.944728,73.08,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),36.883476,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
GLYCINE 1.5% 3000ML,,A4649,HCPCS,Facility,Inpatient,,,,73.08,62.118,20.944728,73.08,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
GLYCINE 1.5% 3000ML,,A4649,HCPCS,Facility,Both,,,,73.08,62.118,20.944728,73.08,UnitedHealthcare,Individual & Family,68.6952,94,,percent of total billed charges,,
GLYCINE 1.5% 3000ML,,A4649,HCPCS,Facility,Outpatient,,,,73.08,62.118,20.944728,73.08,UnitedHealthcare,Medicare Advantage,35.8092,49,,percent of total billed charges,,
GLYCINE 1.5% 3000ML,,A4649,HCPCS,Facility,Inpatient,,,,73.08,62.118,20.944728,73.08,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
GLYCINE 1.5% 3000ML,,A4649,HCPCS,Facility,Outpatient,,,,73.08,62.118,20.944728,73.08,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,35.0784,48,,percent of total billed charges,,100% of DHS outpatient percentage
GLYCINE 1.5% 3000ML,,A4649,HCPCS,Facility,Inpatient,,,,73.08,62.118,20.944728,73.08,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
GROUND PAD PED/INFANT E7510-25  SCHPC,,A4649,HCPCS,Facility,Both,,,,25.6,21.76,7.33696,25.6,Aetna,Commercial,23.552,92,,percent of total billed charges,,
GROUND PAD PED/INFANT E7510-25  SCHPC,,A4649,HCPCS,Facility,Outpatient,,,,25.6,21.76,7.33696,25.6,Aetna,Medicare Advantage,12.544,49,,percent of total billed charges,,
GROUND PAD PED/INFANT E7510-25  SCHPC,,A4649,HCPCS,Facility,Inpatient,,,,25.6,21.76,7.33696,25.6,Aetna,Medicare Advantage,,,,,Included in per diem rate,
GROUND PAD PED/INFANT E7510-25  SCHPC,,A4649,HCPCS,Facility,Both,,,,25.6,21.76,7.33696,25.6,Aetna,PPO,23.808,93,,percent of total billed charges,,
GROUND PAD PED/INFANT E7510-25  SCHPC,,A4649,HCPCS,Facility,Both,,,,25.6,21.76,7.33696,25.6,America's PPO,America's PPO,24.58368,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
GROUND PAD PED/INFANT E7510-25  SCHPC,,A4649,HCPCS,Facility,Both,,,,25.6,21.76,7.33696,25.6,BlueCross BlueShield Minnesota, Federal Employee Program,25.1904,98.4,,percent of total billed charges,,
GROUND PAD PED/INFANT E7510-25  SCHPC,,A4649,HCPCS,Facility,Both,,,,25.6,21.76,7.33696,25.6,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,25.6,100,,percent of total billed charges,,
GROUND PAD PED/INFANT E7510-25  SCHPC,,A4649,HCPCS,Facility,Both,,,,25.6,21.76,7.33696,25.6,BlueCross BlueShield Minnesota,High Value Network Plan,23.04,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
GROUND PAD PED/INFANT E7510-25  SCHPC,,A4649,HCPCS,Facility,Outpatient,,,,25.6,21.76,7.33696,25.6,BlueCross BlueShield Minnesota,Medicare Advantage,12.544,49,,percent of total billed charges,,
GROUND PAD PED/INFANT E7510-25  SCHPC,,A4649,HCPCS,Facility,Inpatient,,,,25.6,21.76,7.33696,25.6,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
GROUND PAD PED/INFANT E7510-25  SCHPC,,A4649,HCPCS,Facility,Both,,,,25.6,21.76,7.33696,25.6,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,22.67392,88.57,,percent of total billed charges,,
GROUND PAD PED/INFANT E7510-25  SCHPC,,A4649,HCPCS,Facility,Both,,,,25.6,21.76,7.33696,25.6,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,7.33696,28.66,,percent of total billed charges,,
GROUND PAD PED/INFANT E7510-25  SCHPC,,A4649,HCPCS,Facility,Outpatient,,,,25.6,21.76,7.33696,25.6,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),12.544,49,,percent of total billed charges,,
GROUND PAD PED/INFANT E7510-25  SCHPC,,A4649,HCPCS,Facility,Inpatient,,,,25.6,21.76,7.33696,25.6,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
GROUND PAD PED/INFANT E7510-25  SCHPC,,A4649,HCPCS,Facility,Both,,,,25.6,21.76,7.33696,25.6,CorVel,Worker's Compensation,25.6,100,,percent of total billed charges,,
GROUND PAD PED/INFANT E7510-25  SCHPC,,A4649,HCPCS,Facility,Both,,,,25.6,21.76,7.33696,25.6,First Health Group Corporation,First Health Network,24.832,97,,percent of total billed charges,,
GROUND PAD PED/INFANT E7510-25  SCHPC,,A4649,HCPCS,Facility,Both,,,,25.6,21.76,7.33696,25.6,"Health Partners, Inc.",Commercial,24.2176,94.6,,percent of total billed charges,,
GROUND PAD PED/INFANT E7510-25  SCHPC,,A4649,HCPCS,Facility,Outpatient,,,,25.6,21.76,7.33696,25.6,"Health Partners, Inc.",Medicare Advantage,12.544,49,,percent of total billed charges,,
GROUND PAD PED/INFANT E7510-25  SCHPC,,A4649,HCPCS,Facility,Inpatient,,,,25.6,21.76,7.33696,25.6,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
GROUND PAD PED/INFANT E7510-25  SCHPC,,A4649,HCPCS,Facility,Both,,,,25.6,21.76,7.33696,25.6,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),15.36,60,,percent of total billed charges,,
GROUND PAD PED/INFANT E7510-25  SCHPC,,A4649,HCPCS,Facility,Both,,,,25.6,21.76,7.33696,25.6,"Health Partners, Inc.",State of Minnesota Advantage Program,20.864,81.5,,percent of total billed charges,,
GROUND PAD PED/INFANT E7510-25  SCHPC,,A4649,HCPCS,Facility,Both,,,,25.6,21.76,7.33696,25.6,"Health Partners, Inc.",State Public Programs,12.8,50,,percent of total billed charges,,
GROUND PAD PED/INFANT E7510-25  SCHPC,,A4649,HCPCS,Facility,Both,,,,25.6,21.76,7.33696,25.6,Humana Insurance Company,Commercial PPO,24.32,95,,percent of total billed charges,,
GROUND PAD PED/INFANT E7510-25  SCHPC,,A4649,HCPCS,Facility,Outpatient,,,,25.6,21.76,7.33696,25.6,Humana Insurance Company,Medicare PPO,12.544,49,,percent of total billed charges,,
GROUND PAD PED/INFANT E7510-25  SCHPC,,A4649,HCPCS,Facility,Inpatient,,,,25.6,21.76,7.33696,25.6,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
GROUND PAD PED/INFANT E7510-25  SCHPC,,A4649,HCPCS,Facility,Both,,,,25.6,21.76,7.33696,25.6,Medica,Individual & Family,25.3696,99.1,,percent of total billed charges,,
GROUND PAD PED/INFANT E7510-25  SCHPC,,A4649,HCPCS,Facility,Outpatient,,,,25.6,21.76,7.33696,25.6,Medica,Medica Advantage Solution,12.7488,49.8,,percent of total billed charges,,
GROUND PAD PED/INFANT E7510-25  SCHPC,,A4649,HCPCS,Facility,Inpatient,,,,25.6,21.76,7.33696,25.6,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
GROUND PAD PED/INFANT E7510-25  SCHPC,,A4649,HCPCS,Facility,Outpatient,,,,25.6,21.76,7.33696,25.6,Medica,Medical Assistance,11.4176,44.6,,percent of total billed charges,,
GROUND PAD PED/INFANT E7510-25  SCHPC,,A4649,HCPCS,Facility,Inpatient,,,,25.6,21.76,7.33696,25.6,Medica,Medical Assistance,,,,,Included in per diem rate,
GROUND PAD PED/INFANT E7510-25  SCHPC,,A4649,HCPCS,Facility,Outpatient,,,,25.6,21.76,7.33696,25.6,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,12.7488,49.8,,percent of total billed charges,,
GROUND PAD PED/INFANT E7510-25  SCHPC,,A4649,HCPCS,Facility,Inpatient,,,,25.6,21.76,7.33696,25.6,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
GROUND PAD PED/INFANT E7510-25  SCHPC,,A4649,HCPCS,Facility,Both,,,,25.6,21.76,7.33696,25.6,"Multiplan, Inc.","Multiplan, Inc.",24.064,94,,percent of total billed charges,,
GROUND PAD PED/INFANT E7510-25  SCHPC,,A4649,HCPCS,Facility,Outpatient,,,,25.6,21.76,7.33696,25.6,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,23.0656,90.1,,percent of total billed charges,,
GROUND PAD PED/INFANT E7510-25  SCHPC,,A4649,HCPCS,Facility,Inpatient,,,,25.6,21.76,7.33696,25.6,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
GROUND PAD PED/INFANT E7510-25  SCHPC,,A4649,HCPCS,Facility,Both,,,,25.6,21.76,7.33696,25.6,"Preferred One Administrative Services, INC.",PPO,25.2416,98.6,,percent of total billed charges,,
GROUND PAD PED/INFANT E7510-25  SCHPC,,A4649,HCPCS,Facility,Outpatient,,,,25.6,21.76,7.33696,25.6,PrimeWest Health,Minnesota Senior Health Options (MSHO),13.1712,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
GROUND PAD PED/INFANT E7510-25  SCHPC,,A4649,HCPCS,Facility,Inpatient,,,,25.6,21.76,7.33696,25.6,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
GROUND PAD PED/INFANT E7510-25  SCHPC,,A4649,HCPCS,Facility,Outpatient,,,,25.6,21.76,7.33696,25.6,PrimeWest Health,MinnesotaCare,13.14816,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
GROUND PAD PED/INFANT E7510-25  SCHPC,,A4649,HCPCS,Facility,Inpatient,,,,25.6,21.76,7.33696,25.6,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
GROUND PAD PED/INFANT E7510-25  SCHPC,,A4649,HCPCS,Facility,Both,,,,25.6,21.76,7.33696,25.6,Sanford Health Plan,Sanford Health Plan,23.552,92,,percent of total billed charges,,
GROUND PAD PED/INFANT E7510-25  SCHPC,,A4649,HCPCS,Facility,Outpatient,,,,25.6,21.76,7.33696,25.6,"UCare Health, Inc.",Individual & Family Plan,14.4256,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
GROUND PAD PED/INFANT E7510-25  SCHPC,,A4649,HCPCS,Facility,Inpatient,,,,25.6,21.76,7.33696,25.6,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
GROUND PAD PED/INFANT E7510-25  SCHPC,,A4649,HCPCS,Facility,Outpatient,,,,25.6,21.76,7.33696,25.6,"UCare Health, Inc.",Medical Assistance,12.92032,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
GROUND PAD PED/INFANT E7510-25  SCHPC,,A4649,HCPCS,Facility,Inpatient,,,,25.6,21.76,7.33696,25.6,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
GROUND PAD PED/INFANT E7510-25  SCHPC,,A4649,HCPCS,Facility,Outpatient,,,,25.6,21.76,7.33696,25.6,"UCare Health, Inc.",Medicare Advantage,12.92032,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
GROUND PAD PED/INFANT E7510-25  SCHPC,,A4649,HCPCS,Facility,Inpatient,,,,25.6,21.76,7.33696,25.6,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
GROUND PAD PED/INFANT E7510-25  SCHPC,,A4649,HCPCS,Facility,Outpatient,,,,25.6,21.76,7.33696,25.6,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),12.92032,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
GROUND PAD PED/INFANT E7510-25  SCHPC,,A4649,HCPCS,Facility,Inpatient,,,,25.6,21.76,7.33696,25.6,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
GROUND PAD PED/INFANT E7510-25  SCHPC,,A4649,HCPCS,Facility,Both,,,,25.6,21.76,7.33696,25.6,UnitedHealthcare,Individual & Family,24.064,94,,percent of total billed charges,,
GROUND PAD PED/INFANT E7510-25  SCHPC,,A4649,HCPCS,Facility,Outpatient,,,,25.6,21.76,7.33696,25.6,UnitedHealthcare,Medicare Advantage,12.544,49,,percent of total billed charges,,
GROUND PAD PED/INFANT E7510-25  SCHPC,,A4649,HCPCS,Facility,Inpatient,,,,25.6,21.76,7.33696,25.6,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
GROUND PAD PED/INFANT E7510-25  SCHPC,,A4649,HCPCS,Facility,Outpatient,,,,25.6,21.76,7.33696,25.6,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,12.288,48,,percent of total billed charges,,100% of DHS outpatient percentage
GROUND PAD PED/INFANT E7510-25  SCHPC,,A4649,HCPCS,Facility,Inpatient,,,,25.6,21.76,7.33696,25.6,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"GYRUS ACMI COLD KNIFE, SERRATED BLADE",,A4649,HCPCS,Facility,Both,,,,501.12,425.952,143.620992,501.12,Aetna,Commercial,461.0304,92,,percent of total billed charges,,
"GYRUS ACMI COLD KNIFE, SERRATED BLADE",,A4649,HCPCS,Facility,Outpatient,,,,501.12,425.952,143.620992,501.12,Aetna,Medicare Advantage,245.5488,49,,percent of total billed charges,,
"GYRUS ACMI COLD KNIFE, SERRATED BLADE",,A4649,HCPCS,Facility,Inpatient,,,,501.12,425.952,143.620992,501.12,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"GYRUS ACMI COLD KNIFE, SERRATED BLADE",,A4649,HCPCS,Facility,Both,,,,501.12,425.952,143.620992,501.12,Aetna,PPO,466.0416,93,,percent of total billed charges,,
"GYRUS ACMI COLD KNIFE, SERRATED BLADE",,A4649,HCPCS,Facility,Both,,,,501.12,425.952,143.620992,501.12,America's PPO,America's PPO,481.225536,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"GYRUS ACMI COLD KNIFE, SERRATED BLADE",,A4649,HCPCS,Facility,Both,,,,501.12,425.952,143.620992,501.12,BlueCross BlueShield Minnesota, Federal Employee Program,493.10208,98.4,,percent of total billed charges,,
"GYRUS ACMI COLD KNIFE, SERRATED BLADE",,A4649,HCPCS,Facility,Both,,,,501.12,425.952,143.620992,501.12,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,501.12,100,,percent of total billed charges,,
"GYRUS ACMI COLD KNIFE, SERRATED BLADE",,A4649,HCPCS,Facility,Both,,,,501.12,425.952,143.620992,501.12,BlueCross BlueShield Minnesota,High Value Network Plan,451.008,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
"GYRUS ACMI COLD KNIFE, SERRATED BLADE",,A4649,HCPCS,Facility,Outpatient,,,,501.12,425.952,143.620992,501.12,BlueCross BlueShield Minnesota,Medicare Advantage,245.5488,49,,percent of total billed charges,,
"GYRUS ACMI COLD KNIFE, SERRATED BLADE",,A4649,HCPCS,Facility,Inpatient,,,,501.12,425.952,143.620992,501.12,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"GYRUS ACMI COLD KNIFE, SERRATED BLADE",,A4649,HCPCS,Facility,Both,,,,501.12,425.952,143.620992,501.12,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,443.841984,88.57,,percent of total billed charges,,
"GYRUS ACMI COLD KNIFE, SERRATED BLADE",,A4649,HCPCS,Facility,Both,,,,501.12,425.952,143.620992,501.12,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,143.620992,28.66,,percent of total billed charges,,
"GYRUS ACMI COLD KNIFE, SERRATED BLADE",,A4649,HCPCS,Facility,Outpatient,,,,501.12,425.952,143.620992,501.12,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),245.5488,49,,percent of total billed charges,,
"GYRUS ACMI COLD KNIFE, SERRATED BLADE",,A4649,HCPCS,Facility,Inpatient,,,,501.12,425.952,143.620992,501.12,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"GYRUS ACMI COLD KNIFE, SERRATED BLADE",,A4649,HCPCS,Facility,Both,,,,501.12,425.952,143.620992,501.12,CorVel,Worker's Compensation,501.12,100,,percent of total billed charges,,
"GYRUS ACMI COLD KNIFE, SERRATED BLADE",,A4649,HCPCS,Facility,Both,,,,501.12,425.952,143.620992,501.12,First Health Group Corporation,First Health Network,486.0864,97,,percent of total billed charges,,
"GYRUS ACMI COLD KNIFE, SERRATED BLADE",,A4649,HCPCS,Facility,Both,,,,501.12,425.952,143.620992,501.12,"Health Partners, Inc.",Commercial,474.05952,94.6,,percent of total billed charges,,
"GYRUS ACMI COLD KNIFE, SERRATED BLADE",,A4649,HCPCS,Facility,Outpatient,,,,501.12,425.952,143.620992,501.12,"Health Partners, Inc.",Medicare Advantage,245.5488,49,,percent of total billed charges,,
"GYRUS ACMI COLD KNIFE, SERRATED BLADE",,A4649,HCPCS,Facility,Inpatient,,,,501.12,425.952,143.620992,501.12,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"GYRUS ACMI COLD KNIFE, SERRATED BLADE",,A4649,HCPCS,Facility,Both,,,,501.12,425.952,143.620992,501.12,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),300.672,60,,percent of total billed charges,,
"GYRUS ACMI COLD KNIFE, SERRATED BLADE",,A4649,HCPCS,Facility,Both,,,,501.12,425.952,143.620992,501.12,"Health Partners, Inc.",State of Minnesota Advantage Program,408.4128,81.5,,percent of total billed charges,,
"GYRUS ACMI COLD KNIFE, SERRATED BLADE",,A4649,HCPCS,Facility,Both,,,,501.12,425.952,143.620992,501.12,"Health Partners, Inc.",State Public Programs,250.56,50,,percent of total billed charges,,
"GYRUS ACMI COLD KNIFE, SERRATED BLADE",,A4649,HCPCS,Facility,Both,,,,501.12,425.952,143.620992,501.12,Humana Insurance Company,Commercial PPO,476.064,95,,percent of total billed charges,,
"GYRUS ACMI COLD KNIFE, SERRATED BLADE",,A4649,HCPCS,Facility,Outpatient,,,,501.12,425.952,143.620992,501.12,Humana Insurance Company,Medicare PPO,245.5488,49,,percent of total billed charges,,
"GYRUS ACMI COLD KNIFE, SERRATED BLADE",,A4649,HCPCS,Facility,Inpatient,,,,501.12,425.952,143.620992,501.12,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"GYRUS ACMI COLD KNIFE, SERRATED BLADE",,A4649,HCPCS,Facility,Both,,,,501.12,425.952,143.620992,501.12,Medica,Individual & Family,496.60992,99.1,,percent of total billed charges,,
"GYRUS ACMI COLD KNIFE, SERRATED BLADE",,A4649,HCPCS,Facility,Outpatient,,,,501.12,425.952,143.620992,501.12,Medica,Medica Advantage Solution,249.55776,49.8,,percent of total billed charges,,
"GYRUS ACMI COLD KNIFE, SERRATED BLADE",,A4649,HCPCS,Facility,Inpatient,,,,501.12,425.952,143.620992,501.12,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"GYRUS ACMI COLD KNIFE, SERRATED BLADE",,A4649,HCPCS,Facility,Outpatient,,,,501.12,425.952,143.620992,501.12,Medica,Medical Assistance,223.49952,44.6,,percent of total billed charges,,
"GYRUS ACMI COLD KNIFE, SERRATED BLADE",,A4649,HCPCS,Facility,Inpatient,,,,501.12,425.952,143.620992,501.12,Medica,Medical Assistance,,,,,Included in per diem rate,
"GYRUS ACMI COLD KNIFE, SERRATED BLADE",,A4649,HCPCS,Facility,Outpatient,,,,501.12,425.952,143.620992,501.12,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,249.55776,49.8,,percent of total billed charges,,
"GYRUS ACMI COLD KNIFE, SERRATED BLADE",,A4649,HCPCS,Facility,Inpatient,,,,501.12,425.952,143.620992,501.12,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"GYRUS ACMI COLD KNIFE, SERRATED BLADE",,A4649,HCPCS,Facility,Both,,,,501.12,425.952,143.620992,501.12,"Multiplan, Inc.","Multiplan, Inc.",471.0528,94,,percent of total billed charges,,
"GYRUS ACMI COLD KNIFE, SERRATED BLADE",,A4649,HCPCS,Facility,Outpatient,,,,501.12,425.952,143.620992,501.12,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,451.50912,90.1,,percent of total billed charges,,
"GYRUS ACMI COLD KNIFE, SERRATED BLADE",,A4649,HCPCS,Facility,Inpatient,,,,501.12,425.952,143.620992,501.12,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"GYRUS ACMI COLD KNIFE, SERRATED BLADE",,A4649,HCPCS,Facility,Both,,,,501.12,425.952,143.620992,501.12,"Preferred One Administrative Services, INC.",PPO,494.10432,98.6,,percent of total billed charges,,
"GYRUS ACMI COLD KNIFE, SERRATED BLADE",,A4649,HCPCS,Facility,Outpatient,,,,501.12,425.952,143.620992,501.12,PrimeWest Health,Minnesota Senior Health Options (MSHO),257.82624,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"GYRUS ACMI COLD KNIFE, SERRATED BLADE",,A4649,HCPCS,Facility,Inpatient,,,,501.12,425.952,143.620992,501.12,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"GYRUS ACMI COLD KNIFE, SERRATED BLADE",,A4649,HCPCS,Facility,Outpatient,,,,501.12,425.952,143.620992,501.12,PrimeWest Health,MinnesotaCare,257.375232,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"GYRUS ACMI COLD KNIFE, SERRATED BLADE",,A4649,HCPCS,Facility,Inpatient,,,,501.12,425.952,143.620992,501.12,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"GYRUS ACMI COLD KNIFE, SERRATED BLADE",,A4649,HCPCS,Facility,Both,,,,501.12,425.952,143.620992,501.12,Sanford Health Plan,Sanford Health Plan,461.0304,92,,percent of total billed charges,,
"GYRUS ACMI COLD KNIFE, SERRATED BLADE",,A4649,HCPCS,Facility,Outpatient,,,,501.12,425.952,143.620992,501.12,"UCare Health, Inc.",Individual & Family Plan,282.38112,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"GYRUS ACMI COLD KNIFE, SERRATED BLADE",,A4649,HCPCS,Facility,Inpatient,,,,501.12,425.952,143.620992,501.12,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"GYRUS ACMI COLD KNIFE, SERRATED BLADE",,A4649,HCPCS,Facility,Outpatient,,,,501.12,425.952,143.620992,501.12,"UCare Health, Inc.",Medical Assistance,252.915264,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"GYRUS ACMI COLD KNIFE, SERRATED BLADE",,A4649,HCPCS,Facility,Inpatient,,,,501.12,425.952,143.620992,501.12,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"GYRUS ACMI COLD KNIFE, SERRATED BLADE",,A4649,HCPCS,Facility,Outpatient,,,,501.12,425.952,143.620992,501.12,"UCare Health, Inc.",Medicare Advantage,252.915264,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"GYRUS ACMI COLD KNIFE, SERRATED BLADE",,A4649,HCPCS,Facility,Inpatient,,,,501.12,425.952,143.620992,501.12,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"GYRUS ACMI COLD KNIFE, SERRATED BLADE",,A4649,HCPCS,Facility,Outpatient,,,,501.12,425.952,143.620992,501.12,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),252.915264,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"GYRUS ACMI COLD KNIFE, SERRATED BLADE",,A4649,HCPCS,Facility,Inpatient,,,,501.12,425.952,143.620992,501.12,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"GYRUS ACMI COLD KNIFE, SERRATED BLADE",,A4649,HCPCS,Facility,Both,,,,501.12,425.952,143.620992,501.12,UnitedHealthcare,Individual & Family,471.0528,94,,percent of total billed charges,,
"GYRUS ACMI COLD KNIFE, SERRATED BLADE",,A4649,HCPCS,Facility,Outpatient,,,,501.12,425.952,143.620992,501.12,UnitedHealthcare,Medicare Advantage,245.5488,49,,percent of total billed charges,,
"GYRUS ACMI COLD KNIFE, SERRATED BLADE",,A4649,HCPCS,Facility,Inpatient,,,,501.12,425.952,143.620992,501.12,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"GYRUS ACMI COLD KNIFE, SERRATED BLADE",,A4649,HCPCS,Facility,Outpatient,,,,501.12,425.952,143.620992,501.12,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,240.5376,48,,percent of total billed charges,,100% of DHS outpatient percentage
"GYRUS ACMI COLD KNIFE, SERRATED BLADE",,A4649,HCPCS,Facility,Inpatient,,,,501.12,425.952,143.620992,501.12,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
HARMONIC FOCUS 9CM CRVD  HAR9F,,A4649,HCPCS,Facility,Both,,,,1175,998.75,336.755,1175,Aetna,Commercial,1081,92,,percent of total billed charges,,
HARMONIC FOCUS 9CM CRVD  HAR9F,,A4649,HCPCS,Facility,Outpatient,,,,1175,998.75,336.755,1175,Aetna,Medicare Advantage,575.75,49,,percent of total billed charges,,
HARMONIC FOCUS 9CM CRVD  HAR9F,,A4649,HCPCS,Facility,Inpatient,,,,1175,998.75,336.755,1175,Aetna,Medicare Advantage,,,,,Included in per diem rate,
HARMONIC FOCUS 9CM CRVD  HAR9F,,A4649,HCPCS,Facility,Both,,,,1175,998.75,336.755,1175,Aetna,PPO,1092.75,93,,percent of total billed charges,,
HARMONIC FOCUS 9CM CRVD  HAR9F,,A4649,HCPCS,Facility,Both,,,,1175,998.75,336.755,1175,America's PPO,America's PPO,1128.3525,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
HARMONIC FOCUS 9CM CRVD  HAR9F,,A4649,HCPCS,Facility,Both,,,,1175,998.75,336.755,1175,BlueCross BlueShield Minnesota, Federal Employee Program,1156.2,98.4,,percent of total billed charges,,
HARMONIC FOCUS 9CM CRVD  HAR9F,,A4649,HCPCS,Facility,Both,,,,1175,998.75,336.755,1175,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1175,100,,percent of total billed charges,,
HARMONIC FOCUS 9CM CRVD  HAR9F,,A4649,HCPCS,Facility,Both,,,,1175,998.75,336.755,1175,BlueCross BlueShield Minnesota,High Value Network Plan,1057.5,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
HARMONIC FOCUS 9CM CRVD  HAR9F,,A4649,HCPCS,Facility,Outpatient,,,,1175,998.75,336.755,1175,BlueCross BlueShield Minnesota,Medicare Advantage,575.75,49,,percent of total billed charges,,
HARMONIC FOCUS 9CM CRVD  HAR9F,,A4649,HCPCS,Facility,Inpatient,,,,1175,998.75,336.755,1175,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
HARMONIC FOCUS 9CM CRVD  HAR9F,,A4649,HCPCS,Facility,Both,,,,1175,998.75,336.755,1175,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1040.6975,88.57,,percent of total billed charges,,
HARMONIC FOCUS 9CM CRVD  HAR9F,,A4649,HCPCS,Facility,Both,,,,1175,998.75,336.755,1175,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,336.755,28.66,,percent of total billed charges,,
HARMONIC FOCUS 9CM CRVD  HAR9F,,A4649,HCPCS,Facility,Outpatient,,,,1175,998.75,336.755,1175,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),575.75,49,,percent of total billed charges,,
HARMONIC FOCUS 9CM CRVD  HAR9F,,A4649,HCPCS,Facility,Inpatient,,,,1175,998.75,336.755,1175,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
HARMONIC FOCUS 9CM CRVD  HAR9F,,A4649,HCPCS,Facility,Both,,,,1175,998.75,336.755,1175,CorVel,Worker's Compensation,1175,100,,percent of total billed charges,,
HARMONIC FOCUS 9CM CRVD  HAR9F,,A4649,HCPCS,Facility,Both,,,,1175,998.75,336.755,1175,First Health Group Corporation,First Health Network,1139.75,97,,percent of total billed charges,,
HARMONIC FOCUS 9CM CRVD  HAR9F,,A4649,HCPCS,Facility,Both,,,,1175,998.75,336.755,1175,"Health Partners, Inc.",Commercial,1111.55,94.6,,percent of total billed charges,,
HARMONIC FOCUS 9CM CRVD  HAR9F,,A4649,HCPCS,Facility,Outpatient,,,,1175,998.75,336.755,1175,"Health Partners, Inc.",Medicare Advantage,575.75,49,,percent of total billed charges,,
HARMONIC FOCUS 9CM CRVD  HAR9F,,A4649,HCPCS,Facility,Inpatient,,,,1175,998.75,336.755,1175,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
HARMONIC FOCUS 9CM CRVD  HAR9F,,A4649,HCPCS,Facility,Both,,,,1175,998.75,336.755,1175,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),705,60,,percent of total billed charges,,
HARMONIC FOCUS 9CM CRVD  HAR9F,,A4649,HCPCS,Facility,Both,,,,1175,998.75,336.755,1175,"Health Partners, Inc.",State of Minnesota Advantage Program,957.625,81.5,,percent of total billed charges,,
HARMONIC FOCUS 9CM CRVD  HAR9F,,A4649,HCPCS,Facility,Both,,,,1175,998.75,336.755,1175,"Health Partners, Inc.",State Public Programs,587.5,50,,percent of total billed charges,,
HARMONIC FOCUS 9CM CRVD  HAR9F,,A4649,HCPCS,Facility,Both,,,,1175,998.75,336.755,1175,Humana Insurance Company,Commercial PPO,1116.25,95,,percent of total billed charges,,
HARMONIC FOCUS 9CM CRVD  HAR9F,,A4649,HCPCS,Facility,Outpatient,,,,1175,998.75,336.755,1175,Humana Insurance Company,Medicare PPO,575.75,49,,percent of total billed charges,,
HARMONIC FOCUS 9CM CRVD  HAR9F,,A4649,HCPCS,Facility,Inpatient,,,,1175,998.75,336.755,1175,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
HARMONIC FOCUS 9CM CRVD  HAR9F,,A4649,HCPCS,Facility,Both,,,,1175,998.75,336.755,1175,Medica,Individual & Family,1164.425,99.1,,percent of total billed charges,,
HARMONIC FOCUS 9CM CRVD  HAR9F,,A4649,HCPCS,Facility,Outpatient,,,,1175,998.75,336.755,1175,Medica,Medica Advantage Solution,585.15,49.8,,percent of total billed charges,,
HARMONIC FOCUS 9CM CRVD  HAR9F,,A4649,HCPCS,Facility,Inpatient,,,,1175,998.75,336.755,1175,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
HARMONIC FOCUS 9CM CRVD  HAR9F,,A4649,HCPCS,Facility,Outpatient,,,,1175,998.75,336.755,1175,Medica,Medical Assistance,524.05,44.6,,percent of total billed charges,,
HARMONIC FOCUS 9CM CRVD  HAR9F,,A4649,HCPCS,Facility,Inpatient,,,,1175,998.75,336.755,1175,Medica,Medical Assistance,,,,,Included in per diem rate,
HARMONIC FOCUS 9CM CRVD  HAR9F,,A4649,HCPCS,Facility,Outpatient,,,,1175,998.75,336.755,1175,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,585.15,49.8,,percent of total billed charges,,
HARMONIC FOCUS 9CM CRVD  HAR9F,,A4649,HCPCS,Facility,Inpatient,,,,1175,998.75,336.755,1175,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
HARMONIC FOCUS 9CM CRVD  HAR9F,,A4649,HCPCS,Facility,Both,,,,1175,998.75,336.755,1175,"Multiplan, Inc.","Multiplan, Inc.",1104.5,94,,percent of total billed charges,,
HARMONIC FOCUS 9CM CRVD  HAR9F,,A4649,HCPCS,Facility,Outpatient,,,,1175,998.75,336.755,1175,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1058.675,90.1,,percent of total billed charges,,
HARMONIC FOCUS 9CM CRVD  HAR9F,,A4649,HCPCS,Facility,Inpatient,,,,1175,998.75,336.755,1175,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
HARMONIC FOCUS 9CM CRVD  HAR9F,,A4649,HCPCS,Facility,Both,,,,1175,998.75,336.755,1175,"Preferred One Administrative Services, INC.",PPO,1158.55,98.6,,percent of total billed charges,,
HARMONIC FOCUS 9CM CRVD  HAR9F,,A4649,HCPCS,Facility,Outpatient,,,,1175,998.75,336.755,1175,PrimeWest Health,Minnesota Senior Health Options (MSHO),604.5375,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
HARMONIC FOCUS 9CM CRVD  HAR9F,,A4649,HCPCS,Facility,Inpatient,,,,1175,998.75,336.755,1175,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
HARMONIC FOCUS 9CM CRVD  HAR9F,,A4649,HCPCS,Facility,Outpatient,,,,1175,998.75,336.755,1175,PrimeWest Health,MinnesotaCare,603.48,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
HARMONIC FOCUS 9CM CRVD  HAR9F,,A4649,HCPCS,Facility,Inpatient,,,,1175,998.75,336.755,1175,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
HARMONIC FOCUS 9CM CRVD  HAR9F,,A4649,HCPCS,Facility,Both,,,,1175,998.75,336.755,1175,Sanford Health Plan,Sanford Health Plan,1081,92,,percent of total billed charges,,
HARMONIC FOCUS 9CM CRVD  HAR9F,,A4649,HCPCS,Facility,Outpatient,,,,1175,998.75,336.755,1175,"UCare Health, Inc.",Individual & Family Plan,662.1125,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
HARMONIC FOCUS 9CM CRVD  HAR9F,,A4649,HCPCS,Facility,Inpatient,,,,1175,998.75,336.755,1175,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
HARMONIC FOCUS 9CM CRVD  HAR9F,,A4649,HCPCS,Facility,Outpatient,,,,1175,998.75,336.755,1175,"UCare Health, Inc.",Medical Assistance,593.0225,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
HARMONIC FOCUS 9CM CRVD  HAR9F,,A4649,HCPCS,Facility,Inpatient,,,,1175,998.75,336.755,1175,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
HARMONIC FOCUS 9CM CRVD  HAR9F,,A4649,HCPCS,Facility,Outpatient,,,,1175,998.75,336.755,1175,"UCare Health, Inc.",Medicare Advantage,593.0225,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
HARMONIC FOCUS 9CM CRVD  HAR9F,,A4649,HCPCS,Facility,Inpatient,,,,1175,998.75,336.755,1175,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
HARMONIC FOCUS 9CM CRVD  HAR9F,,A4649,HCPCS,Facility,Outpatient,,,,1175,998.75,336.755,1175,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),593.0225,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
HARMONIC FOCUS 9CM CRVD  HAR9F,,A4649,HCPCS,Facility,Inpatient,,,,1175,998.75,336.755,1175,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
HARMONIC FOCUS 9CM CRVD  HAR9F,,A4649,HCPCS,Facility,Both,,,,1175,998.75,336.755,1175,UnitedHealthcare,Individual & Family,1104.5,94,,percent of total billed charges,,
HARMONIC FOCUS 9CM CRVD  HAR9F,,A4649,HCPCS,Facility,Outpatient,,,,1175,998.75,336.755,1175,UnitedHealthcare,Medicare Advantage,575.75,49,,percent of total billed charges,,
HARMONIC FOCUS 9CM CRVD  HAR9F,,A4649,HCPCS,Facility,Inpatient,,,,1175,998.75,336.755,1175,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
HARMONIC FOCUS 9CM CRVD  HAR9F,,A4649,HCPCS,Facility,Outpatient,,,,1175,998.75,336.755,1175,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,564,48,,percent of total billed charges,,100% of DHS outpatient percentage
HARMONIC FOCUS 9CM CRVD  HAR9F,,A4649,HCPCS,Facility,Inpatient,,,,1175,998.75,336.755,1175,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
HARMONIC SCALPEL 23CM CURV HAR23,,A4649,HCPCS,Facility,Both,,,,950,807.5,272.27,950,Aetna,Commercial,874,92,,percent of total billed charges,,
HARMONIC SCALPEL 23CM CURV HAR23,,A4649,HCPCS,Facility,Outpatient,,,,950,807.5,272.27,950,Aetna,Medicare Advantage,465.5,49,,percent of total billed charges,,
HARMONIC SCALPEL 23CM CURV HAR23,,A4649,HCPCS,Facility,Inpatient,,,,950,807.5,272.27,950,Aetna,Medicare Advantage,,,,,Included in per diem rate,
HARMONIC SCALPEL 23CM CURV HAR23,,A4649,HCPCS,Facility,Both,,,,950,807.5,272.27,950,Aetna,PPO,883.5,93,,percent of total billed charges,,
HARMONIC SCALPEL 23CM CURV HAR23,,A4649,HCPCS,Facility,Both,,,,950,807.5,272.27,950,America's PPO,America's PPO,912.285,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
HARMONIC SCALPEL 23CM CURV HAR23,,A4649,HCPCS,Facility,Both,,,,950,807.5,272.27,950,BlueCross BlueShield Minnesota, Federal Employee Program,934.8,98.4,,percent of total billed charges,,
HARMONIC SCALPEL 23CM CURV HAR23,,A4649,HCPCS,Facility,Both,,,,950,807.5,272.27,950,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,950,100,,percent of total billed charges,,
HARMONIC SCALPEL 23CM CURV HAR23,,A4649,HCPCS,Facility,Both,,,,950,807.5,272.27,950,BlueCross BlueShield Minnesota,High Value Network Plan,855,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
HARMONIC SCALPEL 23CM CURV HAR23,,A4649,HCPCS,Facility,Outpatient,,,,950,807.5,272.27,950,BlueCross BlueShield Minnesota,Medicare Advantage,465.5,49,,percent of total billed charges,,
HARMONIC SCALPEL 23CM CURV HAR23,,A4649,HCPCS,Facility,Inpatient,,,,950,807.5,272.27,950,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
HARMONIC SCALPEL 23CM CURV HAR23,,A4649,HCPCS,Facility,Both,,,,950,807.5,272.27,950,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,841.415,88.57,,percent of total billed charges,,
HARMONIC SCALPEL 23CM CURV HAR23,,A4649,HCPCS,Facility,Both,,,,950,807.5,272.27,950,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,272.27,28.66,,percent of total billed charges,,
HARMONIC SCALPEL 23CM CURV HAR23,,A4649,HCPCS,Facility,Outpatient,,,,950,807.5,272.27,950,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),465.5,49,,percent of total billed charges,,
HARMONIC SCALPEL 23CM CURV HAR23,,A4649,HCPCS,Facility,Inpatient,,,,950,807.5,272.27,950,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
HARMONIC SCALPEL 23CM CURV HAR23,,A4649,HCPCS,Facility,Both,,,,950,807.5,272.27,950,CorVel,Worker's Compensation,950,100,,percent of total billed charges,,
HARMONIC SCALPEL 23CM CURV HAR23,,A4649,HCPCS,Facility,Both,,,,950,807.5,272.27,950,First Health Group Corporation,First Health Network,921.5,97,,percent of total billed charges,,
HARMONIC SCALPEL 23CM CURV HAR23,,A4649,HCPCS,Facility,Both,,,,950,807.5,272.27,950,"Health Partners, Inc.",Commercial,898.7,94.6,,percent of total billed charges,,
HARMONIC SCALPEL 23CM CURV HAR23,,A4649,HCPCS,Facility,Outpatient,,,,950,807.5,272.27,950,"Health Partners, Inc.",Medicare Advantage,465.5,49,,percent of total billed charges,,
HARMONIC SCALPEL 23CM CURV HAR23,,A4649,HCPCS,Facility,Inpatient,,,,950,807.5,272.27,950,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
HARMONIC SCALPEL 23CM CURV HAR23,,A4649,HCPCS,Facility,Both,,,,950,807.5,272.27,950,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),570,60,,percent of total billed charges,,
HARMONIC SCALPEL 23CM CURV HAR23,,A4649,HCPCS,Facility,Both,,,,950,807.5,272.27,950,"Health Partners, Inc.",State of Minnesota Advantage Program,774.25,81.5,,percent of total billed charges,,
HARMONIC SCALPEL 23CM CURV HAR23,,A4649,HCPCS,Facility,Both,,,,950,807.5,272.27,950,"Health Partners, Inc.",State Public Programs,475,50,,percent of total billed charges,,
HARMONIC SCALPEL 23CM CURV HAR23,,A4649,HCPCS,Facility,Both,,,,950,807.5,272.27,950,Humana Insurance Company,Commercial PPO,902.5,95,,percent of total billed charges,,
HARMONIC SCALPEL 23CM CURV HAR23,,A4649,HCPCS,Facility,Outpatient,,,,950,807.5,272.27,950,Humana Insurance Company,Medicare PPO,465.5,49,,percent of total billed charges,,
HARMONIC SCALPEL 23CM CURV HAR23,,A4649,HCPCS,Facility,Inpatient,,,,950,807.5,272.27,950,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
HARMONIC SCALPEL 23CM CURV HAR23,,A4649,HCPCS,Facility,Both,,,,950,807.5,272.27,950,Medica,Individual & Family,941.45,99.1,,percent of total billed charges,,
HARMONIC SCALPEL 23CM CURV HAR23,,A4649,HCPCS,Facility,Outpatient,,,,950,807.5,272.27,950,Medica,Medica Advantage Solution,473.1,49.8,,percent of total billed charges,,
HARMONIC SCALPEL 23CM CURV HAR23,,A4649,HCPCS,Facility,Inpatient,,,,950,807.5,272.27,950,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
HARMONIC SCALPEL 23CM CURV HAR23,,A4649,HCPCS,Facility,Outpatient,,,,950,807.5,272.27,950,Medica,Medical Assistance,423.7,44.6,,percent of total billed charges,,
HARMONIC SCALPEL 23CM CURV HAR23,,A4649,HCPCS,Facility,Inpatient,,,,950,807.5,272.27,950,Medica,Medical Assistance,,,,,Included in per diem rate,
HARMONIC SCALPEL 23CM CURV HAR23,,A4649,HCPCS,Facility,Outpatient,,,,950,807.5,272.27,950,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,473.1,49.8,,percent of total billed charges,,
HARMONIC SCALPEL 23CM CURV HAR23,,A4649,HCPCS,Facility,Inpatient,,,,950,807.5,272.27,950,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
HARMONIC SCALPEL 23CM CURV HAR23,,A4649,HCPCS,Facility,Both,,,,950,807.5,272.27,950,"Multiplan, Inc.","Multiplan, Inc.",893,94,,percent of total billed charges,,
HARMONIC SCALPEL 23CM CURV HAR23,,A4649,HCPCS,Facility,Outpatient,,,,950,807.5,272.27,950,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,855.95,90.1,,percent of total billed charges,,
HARMONIC SCALPEL 23CM CURV HAR23,,A4649,HCPCS,Facility,Inpatient,,,,950,807.5,272.27,950,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
HARMONIC SCALPEL 23CM CURV HAR23,,A4649,HCPCS,Facility,Both,,,,950,807.5,272.27,950,"Preferred One Administrative Services, INC.",PPO,936.7,98.6,,percent of total billed charges,,
HARMONIC SCALPEL 23CM CURV HAR23,,A4649,HCPCS,Facility,Outpatient,,,,950,807.5,272.27,950,PrimeWest Health,Minnesota Senior Health Options (MSHO),488.775,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
HARMONIC SCALPEL 23CM CURV HAR23,,A4649,HCPCS,Facility,Inpatient,,,,950,807.5,272.27,950,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
HARMONIC SCALPEL 23CM CURV HAR23,,A4649,HCPCS,Facility,Outpatient,,,,950,807.5,272.27,950,PrimeWest Health,MinnesotaCare,487.92,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
HARMONIC SCALPEL 23CM CURV HAR23,,A4649,HCPCS,Facility,Inpatient,,,,950,807.5,272.27,950,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
HARMONIC SCALPEL 23CM CURV HAR23,,A4649,HCPCS,Facility,Both,,,,950,807.5,272.27,950,Sanford Health Plan,Sanford Health Plan,874,92,,percent of total billed charges,,
HARMONIC SCALPEL 23CM CURV HAR23,,A4649,HCPCS,Facility,Outpatient,,,,950,807.5,272.27,950,"UCare Health, Inc.",Individual & Family Plan,535.325,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
HARMONIC SCALPEL 23CM CURV HAR23,,A4649,HCPCS,Facility,Inpatient,,,,950,807.5,272.27,950,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
HARMONIC SCALPEL 23CM CURV HAR23,,A4649,HCPCS,Facility,Outpatient,,,,950,807.5,272.27,950,"UCare Health, Inc.",Medical Assistance,479.465,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
HARMONIC SCALPEL 23CM CURV HAR23,,A4649,HCPCS,Facility,Inpatient,,,,950,807.5,272.27,950,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
HARMONIC SCALPEL 23CM CURV HAR23,,A4649,HCPCS,Facility,Outpatient,,,,950,807.5,272.27,950,"UCare Health, Inc.",Medicare Advantage,479.465,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
HARMONIC SCALPEL 23CM CURV HAR23,,A4649,HCPCS,Facility,Inpatient,,,,950,807.5,272.27,950,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
HARMONIC SCALPEL 23CM CURV HAR23,,A4649,HCPCS,Facility,Outpatient,,,,950,807.5,272.27,950,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),479.465,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
HARMONIC SCALPEL 23CM CURV HAR23,,A4649,HCPCS,Facility,Inpatient,,,,950,807.5,272.27,950,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
HARMONIC SCALPEL 23CM CURV HAR23,,A4649,HCPCS,Facility,Both,,,,950,807.5,272.27,950,UnitedHealthcare,Individual & Family,893,94,,percent of total billed charges,,
HARMONIC SCALPEL 23CM CURV HAR23,,A4649,HCPCS,Facility,Outpatient,,,,950,807.5,272.27,950,UnitedHealthcare,Medicare Advantage,465.5,49,,percent of total billed charges,,
HARMONIC SCALPEL 23CM CURV HAR23,,A4649,HCPCS,Facility,Inpatient,,,,950,807.5,272.27,950,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
HARMONIC SCALPEL 23CM CURV HAR23,,A4649,HCPCS,Facility,Outpatient,,,,950,807.5,272.27,950,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,456,48,,percent of total billed charges,,100% of DHS outpatient percentage
HARMONIC SCALPEL 23CM CURV HAR23,,A4649,HCPCS,Facility,Inpatient,,,,950,807.5,272.27,950,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
HARMONIC SCALPEL ACE 36CM  HAR36,,A4649,HCPCS,Facility,Both,,,,1090,926.5,312.394,1090,Aetna,Commercial,1002.8,92,,percent of total billed charges,,
HARMONIC SCALPEL ACE 36CM  HAR36,,A4649,HCPCS,Facility,Outpatient,,,,1090,926.5,312.394,1090,Aetna,Medicare Advantage,534.1,49,,percent of total billed charges,,
HARMONIC SCALPEL ACE 36CM  HAR36,,A4649,HCPCS,Facility,Inpatient,,,,1090,926.5,312.394,1090,Aetna,Medicare Advantage,,,,,Included in per diem rate,
HARMONIC SCALPEL ACE 36CM  HAR36,,A4649,HCPCS,Facility,Both,,,,1090,926.5,312.394,1090,Aetna,PPO,1013.7,93,,percent of total billed charges,,
HARMONIC SCALPEL ACE 36CM  HAR36,,A4649,HCPCS,Facility,Both,,,,1090,926.5,312.394,1090,America's PPO,America's PPO,1046.727,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
HARMONIC SCALPEL ACE 36CM  HAR36,,A4649,HCPCS,Facility,Both,,,,1090,926.5,312.394,1090,BlueCross BlueShield Minnesota, Federal Employee Program,1072.56,98.4,,percent of total billed charges,,
HARMONIC SCALPEL ACE 36CM  HAR36,,A4649,HCPCS,Facility,Both,,,,1090,926.5,312.394,1090,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1090,100,,percent of total billed charges,,
HARMONIC SCALPEL ACE 36CM  HAR36,,A4649,HCPCS,Facility,Both,,,,1090,926.5,312.394,1090,BlueCross BlueShield Minnesota,High Value Network Plan,981,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
HARMONIC SCALPEL ACE 36CM  HAR36,,A4649,HCPCS,Facility,Outpatient,,,,1090,926.5,312.394,1090,BlueCross BlueShield Minnesota,Medicare Advantage,534.1,49,,percent of total billed charges,,
HARMONIC SCALPEL ACE 36CM  HAR36,,A4649,HCPCS,Facility,Inpatient,,,,1090,926.5,312.394,1090,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
HARMONIC SCALPEL ACE 36CM  HAR36,,A4649,HCPCS,Facility,Both,,,,1090,926.5,312.394,1090,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,965.413,88.57,,percent of total billed charges,,
HARMONIC SCALPEL ACE 36CM  HAR36,,A4649,HCPCS,Facility,Both,,,,1090,926.5,312.394,1090,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,312.394,28.66,,percent of total billed charges,,
HARMONIC SCALPEL ACE 36CM  HAR36,,A4649,HCPCS,Facility,Outpatient,,,,1090,926.5,312.394,1090,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),534.1,49,,percent of total billed charges,,
HARMONIC SCALPEL ACE 36CM  HAR36,,A4649,HCPCS,Facility,Inpatient,,,,1090,926.5,312.394,1090,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
HARMONIC SCALPEL ACE 36CM  HAR36,,A4649,HCPCS,Facility,Both,,,,1090,926.5,312.394,1090,CorVel,Worker's Compensation,1090,100,,percent of total billed charges,,
HARMONIC SCALPEL ACE 36CM  HAR36,,A4649,HCPCS,Facility,Both,,,,1090,926.5,312.394,1090,First Health Group Corporation,First Health Network,1057.3,97,,percent of total billed charges,,
HARMONIC SCALPEL ACE 36CM  HAR36,,A4649,HCPCS,Facility,Both,,,,1090,926.5,312.394,1090,"Health Partners, Inc.",Commercial,1031.14,94.6,,percent of total billed charges,,
HARMONIC SCALPEL ACE 36CM  HAR36,,A4649,HCPCS,Facility,Outpatient,,,,1090,926.5,312.394,1090,"Health Partners, Inc.",Medicare Advantage,534.1,49,,percent of total billed charges,,
HARMONIC SCALPEL ACE 36CM  HAR36,,A4649,HCPCS,Facility,Inpatient,,,,1090,926.5,312.394,1090,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
HARMONIC SCALPEL ACE 36CM  HAR36,,A4649,HCPCS,Facility,Both,,,,1090,926.5,312.394,1090,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),654,60,,percent of total billed charges,,
HARMONIC SCALPEL ACE 36CM  HAR36,,A4649,HCPCS,Facility,Both,,,,1090,926.5,312.394,1090,"Health Partners, Inc.",State of Minnesota Advantage Program,888.35,81.5,,percent of total billed charges,,
HARMONIC SCALPEL ACE 36CM  HAR36,,A4649,HCPCS,Facility,Both,,,,1090,926.5,312.394,1090,"Health Partners, Inc.",State Public Programs,545,50,,percent of total billed charges,,
HARMONIC SCALPEL ACE 36CM  HAR36,,A4649,HCPCS,Facility,Both,,,,1090,926.5,312.394,1090,Humana Insurance Company,Commercial PPO,1035.5,95,,percent of total billed charges,,
HARMONIC SCALPEL ACE 36CM  HAR36,,A4649,HCPCS,Facility,Outpatient,,,,1090,926.5,312.394,1090,Humana Insurance Company,Medicare PPO,534.1,49,,percent of total billed charges,,
HARMONIC SCALPEL ACE 36CM  HAR36,,A4649,HCPCS,Facility,Inpatient,,,,1090,926.5,312.394,1090,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
HARMONIC SCALPEL ACE 36CM  HAR36,,A4649,HCPCS,Facility,Both,,,,1090,926.5,312.394,1090,Medica,Individual & Family,1080.19,99.1,,percent of total billed charges,,
HARMONIC SCALPEL ACE 36CM  HAR36,,A4649,HCPCS,Facility,Outpatient,,,,1090,926.5,312.394,1090,Medica,Medica Advantage Solution,542.82,49.8,,percent of total billed charges,,
HARMONIC SCALPEL ACE 36CM  HAR36,,A4649,HCPCS,Facility,Inpatient,,,,1090,926.5,312.394,1090,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
HARMONIC SCALPEL ACE 36CM  HAR36,,A4649,HCPCS,Facility,Outpatient,,,,1090,926.5,312.394,1090,Medica,Medical Assistance,486.14,44.6,,percent of total billed charges,,
HARMONIC SCALPEL ACE 36CM  HAR36,,A4649,HCPCS,Facility,Inpatient,,,,1090,926.5,312.394,1090,Medica,Medical Assistance,,,,,Included in per diem rate,
HARMONIC SCALPEL ACE 36CM  HAR36,,A4649,HCPCS,Facility,Outpatient,,,,1090,926.5,312.394,1090,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,542.82,49.8,,percent of total billed charges,,
HARMONIC SCALPEL ACE 36CM  HAR36,,A4649,HCPCS,Facility,Inpatient,,,,1090,926.5,312.394,1090,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
HARMONIC SCALPEL ACE 36CM  HAR36,,A4649,HCPCS,Facility,Both,,,,1090,926.5,312.394,1090,"Multiplan, Inc.","Multiplan, Inc.",1024.6,94,,percent of total billed charges,,
HARMONIC SCALPEL ACE 36CM  HAR36,,A4649,HCPCS,Facility,Outpatient,,,,1090,926.5,312.394,1090,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,982.09,90.1,,percent of total billed charges,,
HARMONIC SCALPEL ACE 36CM  HAR36,,A4649,HCPCS,Facility,Inpatient,,,,1090,926.5,312.394,1090,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
HARMONIC SCALPEL ACE 36CM  HAR36,,A4649,HCPCS,Facility,Both,,,,1090,926.5,312.394,1090,"Preferred One Administrative Services, INC.",PPO,1074.74,98.6,,percent of total billed charges,,
HARMONIC SCALPEL ACE 36CM  HAR36,,A4649,HCPCS,Facility,Outpatient,,,,1090,926.5,312.394,1090,PrimeWest Health,Minnesota Senior Health Options (MSHO),560.805,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
HARMONIC SCALPEL ACE 36CM  HAR36,,A4649,HCPCS,Facility,Inpatient,,,,1090,926.5,312.394,1090,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
HARMONIC SCALPEL ACE 36CM  HAR36,,A4649,HCPCS,Facility,Outpatient,,,,1090,926.5,312.394,1090,PrimeWest Health,MinnesotaCare,559.824,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
HARMONIC SCALPEL ACE 36CM  HAR36,,A4649,HCPCS,Facility,Inpatient,,,,1090,926.5,312.394,1090,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
HARMONIC SCALPEL ACE 36CM  HAR36,,A4649,HCPCS,Facility,Both,,,,1090,926.5,312.394,1090,Sanford Health Plan,Sanford Health Plan,1002.8,92,,percent of total billed charges,,
HARMONIC SCALPEL ACE 36CM  HAR36,,A4649,HCPCS,Facility,Outpatient,,,,1090,926.5,312.394,1090,"UCare Health, Inc.",Individual & Family Plan,614.215,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
HARMONIC SCALPEL ACE 36CM  HAR36,,A4649,HCPCS,Facility,Inpatient,,,,1090,926.5,312.394,1090,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
HARMONIC SCALPEL ACE 36CM  HAR36,,A4649,HCPCS,Facility,Outpatient,,,,1090,926.5,312.394,1090,"UCare Health, Inc.",Medical Assistance,550.123,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
HARMONIC SCALPEL ACE 36CM  HAR36,,A4649,HCPCS,Facility,Inpatient,,,,1090,926.5,312.394,1090,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
HARMONIC SCALPEL ACE 36CM  HAR36,,A4649,HCPCS,Facility,Outpatient,,,,1090,926.5,312.394,1090,"UCare Health, Inc.",Medicare Advantage,550.123,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
HARMONIC SCALPEL ACE 36CM  HAR36,,A4649,HCPCS,Facility,Inpatient,,,,1090,926.5,312.394,1090,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
HARMONIC SCALPEL ACE 36CM  HAR36,,A4649,HCPCS,Facility,Outpatient,,,,1090,926.5,312.394,1090,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),550.123,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
HARMONIC SCALPEL ACE 36CM  HAR36,,A4649,HCPCS,Facility,Inpatient,,,,1090,926.5,312.394,1090,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
HARMONIC SCALPEL ACE 36CM  HAR36,,A4649,HCPCS,Facility,Both,,,,1090,926.5,312.394,1090,UnitedHealthcare,Individual & Family,1024.6,94,,percent of total billed charges,,
HARMONIC SCALPEL ACE 36CM  HAR36,,A4649,HCPCS,Facility,Outpatient,,,,1090,926.5,312.394,1090,UnitedHealthcare,Medicare Advantage,534.1,49,,percent of total billed charges,,
HARMONIC SCALPEL ACE 36CM  HAR36,,A4649,HCPCS,Facility,Inpatient,,,,1090,926.5,312.394,1090,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
HARMONIC SCALPEL ACE 36CM  HAR36,,A4649,HCPCS,Facility,Outpatient,,,,1090,926.5,312.394,1090,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,523.2,48,,percent of total billed charges,,100% of DHS outpatient percentage
HARMONIC SCALPEL ACE 36CM  HAR36,,A4649,HCPCS,Facility,Inpatient,,,,1090,926.5,312.394,1090,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
HARMONIC SHEARS 14CM 5MM,,A4649,HCPCS,Facility,Both,,,,1187.02,1008.967,340.199932,1187.02,Aetna,Commercial,1092.0584,92,,percent of total billed charges,,
HARMONIC SHEARS 14CM 5MM,,A4649,HCPCS,Facility,Outpatient,,,,1187.02,1008.967,340.199932,1187.02,Aetna,Medicare Advantage,581.6398,49,,percent of total billed charges,,
HARMONIC SHEARS 14CM 5MM,,A4649,HCPCS,Facility,Inpatient,,,,1187.02,1008.967,340.199932,1187.02,Aetna,Medicare Advantage,,,,,Included in per diem rate,
HARMONIC SHEARS 14CM 5MM,,A4649,HCPCS,Facility,Both,,,,1187.02,1008.967,340.199932,1187.02,Aetna,PPO,1103.9286,93,,percent of total billed charges,,
HARMONIC SHEARS 14CM 5MM,,A4649,HCPCS,Facility,Both,,,,1187.02,1008.967,340.199932,1187.02,America's PPO,America's PPO,1139.895306,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
HARMONIC SHEARS 14CM 5MM,,A4649,HCPCS,Facility,Both,,,,1187.02,1008.967,340.199932,1187.02,BlueCross BlueShield Minnesota, Federal Employee Program,1168.02768,98.4,,percent of total billed charges,,
HARMONIC SHEARS 14CM 5MM,,A4649,HCPCS,Facility,Both,,,,1187.02,1008.967,340.199932,1187.02,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1187.02,100,,percent of total billed charges,,
HARMONIC SHEARS 14CM 5MM,,A4649,HCPCS,Facility,Both,,,,1187.02,1008.967,340.199932,1187.02,BlueCross BlueShield Minnesota,High Value Network Plan,1068.318,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
HARMONIC SHEARS 14CM 5MM,,A4649,HCPCS,Facility,Outpatient,,,,1187.02,1008.967,340.199932,1187.02,BlueCross BlueShield Minnesota,Medicare Advantage,581.6398,49,,percent of total billed charges,,
HARMONIC SHEARS 14CM 5MM,,A4649,HCPCS,Facility,Inpatient,,,,1187.02,1008.967,340.199932,1187.02,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
HARMONIC SHEARS 14CM 5MM,,A4649,HCPCS,Facility,Both,,,,1187.02,1008.967,340.199932,1187.02,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1051.343614,88.57,,percent of total billed charges,,
HARMONIC SHEARS 14CM 5MM,,A4649,HCPCS,Facility,Both,,,,1187.02,1008.967,340.199932,1187.02,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,340.199932,28.66,,percent of total billed charges,,
HARMONIC SHEARS 14CM 5MM,,A4649,HCPCS,Facility,Outpatient,,,,1187.02,1008.967,340.199932,1187.02,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),581.6398,49,,percent of total billed charges,,
HARMONIC SHEARS 14CM 5MM,,A4649,HCPCS,Facility,Inpatient,,,,1187.02,1008.967,340.199932,1187.02,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
HARMONIC SHEARS 14CM 5MM,,A4649,HCPCS,Facility,Both,,,,1187.02,1008.967,340.199932,1187.02,CorVel,Worker's Compensation,1187.02,100,,percent of total billed charges,,
HARMONIC SHEARS 14CM 5MM,,A4649,HCPCS,Facility,Both,,,,1187.02,1008.967,340.199932,1187.02,First Health Group Corporation,First Health Network,1151.4094,97,,percent of total billed charges,,
HARMONIC SHEARS 14CM 5MM,,A4649,HCPCS,Facility,Both,,,,1187.02,1008.967,340.199932,1187.02,"Health Partners, Inc.",Commercial,1122.92092,94.6,,percent of total billed charges,,
HARMONIC SHEARS 14CM 5MM,,A4649,HCPCS,Facility,Outpatient,,,,1187.02,1008.967,340.199932,1187.02,"Health Partners, Inc.",Medicare Advantage,581.6398,49,,percent of total billed charges,,
HARMONIC SHEARS 14CM 5MM,,A4649,HCPCS,Facility,Inpatient,,,,1187.02,1008.967,340.199932,1187.02,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
HARMONIC SHEARS 14CM 5MM,,A4649,HCPCS,Facility,Both,,,,1187.02,1008.967,340.199932,1187.02,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),712.212,60,,percent of total billed charges,,
HARMONIC SHEARS 14CM 5MM,,A4649,HCPCS,Facility,Both,,,,1187.02,1008.967,340.199932,1187.02,"Health Partners, Inc.",State of Minnesota Advantage Program,967.4213,81.5,,percent of total billed charges,,
HARMONIC SHEARS 14CM 5MM,,A4649,HCPCS,Facility,Both,,,,1187.02,1008.967,340.199932,1187.02,"Health Partners, Inc.",State Public Programs,593.51,50,,percent of total billed charges,,
HARMONIC SHEARS 14CM 5MM,,A4649,HCPCS,Facility,Both,,,,1187.02,1008.967,340.199932,1187.02,Humana Insurance Company,Commercial PPO,1127.669,95,,percent of total billed charges,,
HARMONIC SHEARS 14CM 5MM,,A4649,HCPCS,Facility,Outpatient,,,,1187.02,1008.967,340.199932,1187.02,Humana Insurance Company,Medicare PPO,581.6398,49,,percent of total billed charges,,
HARMONIC SHEARS 14CM 5MM,,A4649,HCPCS,Facility,Inpatient,,,,1187.02,1008.967,340.199932,1187.02,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
HARMONIC SHEARS 14CM 5MM,,A4649,HCPCS,Facility,Both,,,,1187.02,1008.967,340.199932,1187.02,Medica,Individual & Family,1176.33682,99.1,,percent of total billed charges,,
HARMONIC SHEARS 14CM 5MM,,A4649,HCPCS,Facility,Outpatient,,,,1187.02,1008.967,340.199932,1187.02,Medica,Medica Advantage Solution,591.13596,49.8,,percent of total billed charges,,
HARMONIC SHEARS 14CM 5MM,,A4649,HCPCS,Facility,Inpatient,,,,1187.02,1008.967,340.199932,1187.02,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
HARMONIC SHEARS 14CM 5MM,,A4649,HCPCS,Facility,Outpatient,,,,1187.02,1008.967,340.199932,1187.02,Medica,Medical Assistance,529.41092,44.6,,percent of total billed charges,,
HARMONIC SHEARS 14CM 5MM,,A4649,HCPCS,Facility,Inpatient,,,,1187.02,1008.967,340.199932,1187.02,Medica,Medical Assistance,,,,,Included in per diem rate,
HARMONIC SHEARS 14CM 5MM,,A4649,HCPCS,Facility,Outpatient,,,,1187.02,1008.967,340.199932,1187.02,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,591.13596,49.8,,percent of total billed charges,,
HARMONIC SHEARS 14CM 5MM,,A4649,HCPCS,Facility,Inpatient,,,,1187.02,1008.967,340.199932,1187.02,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
HARMONIC SHEARS 14CM 5MM,,A4649,HCPCS,Facility,Both,,,,1187.02,1008.967,340.199932,1187.02,"Multiplan, Inc.","Multiplan, Inc.",1115.7988,94,,percent of total billed charges,,
HARMONIC SHEARS 14CM 5MM,,A4649,HCPCS,Facility,Outpatient,,,,1187.02,1008.967,340.199932,1187.02,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1069.50502,90.1,,percent of total billed charges,,
HARMONIC SHEARS 14CM 5MM,,A4649,HCPCS,Facility,Inpatient,,,,1187.02,1008.967,340.199932,1187.02,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
HARMONIC SHEARS 14CM 5MM,,A4649,HCPCS,Facility,Both,,,,1187.02,1008.967,340.199932,1187.02,"Preferred One Administrative Services, INC.",PPO,1170.40172,98.6,,percent of total billed charges,,
HARMONIC SHEARS 14CM 5MM,,A4649,HCPCS,Facility,Outpatient,,,,1187.02,1008.967,340.199932,1187.02,PrimeWest Health,Minnesota Senior Health Options (MSHO),610.72179,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
HARMONIC SHEARS 14CM 5MM,,A4649,HCPCS,Facility,Inpatient,,,,1187.02,1008.967,340.199932,1187.02,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
HARMONIC SHEARS 14CM 5MM,,A4649,HCPCS,Facility,Outpatient,,,,1187.02,1008.967,340.199932,1187.02,PrimeWest Health,MinnesotaCare,609.653472,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
HARMONIC SHEARS 14CM 5MM,,A4649,HCPCS,Facility,Inpatient,,,,1187.02,1008.967,340.199932,1187.02,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
HARMONIC SHEARS 14CM 5MM,,A4649,HCPCS,Facility,Both,,,,1187.02,1008.967,340.199932,1187.02,Sanford Health Plan,Sanford Health Plan,1092.0584,92,,percent of total billed charges,,
HARMONIC SHEARS 14CM 5MM,,A4649,HCPCS,Facility,Outpatient,,,,1187.02,1008.967,340.199932,1187.02,"UCare Health, Inc.",Individual & Family Plan,668.88577,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
HARMONIC SHEARS 14CM 5MM,,A4649,HCPCS,Facility,Inpatient,,,,1187.02,1008.967,340.199932,1187.02,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
HARMONIC SHEARS 14CM 5MM,,A4649,HCPCS,Facility,Outpatient,,,,1187.02,1008.967,340.199932,1187.02,"UCare Health, Inc.",Medical Assistance,599.088994,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
HARMONIC SHEARS 14CM 5MM,,A4649,HCPCS,Facility,Inpatient,,,,1187.02,1008.967,340.199932,1187.02,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
HARMONIC SHEARS 14CM 5MM,,A4649,HCPCS,Facility,Outpatient,,,,1187.02,1008.967,340.199932,1187.02,"UCare Health, Inc.",Medicare Advantage,599.088994,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
HARMONIC SHEARS 14CM 5MM,,A4649,HCPCS,Facility,Inpatient,,,,1187.02,1008.967,340.199932,1187.02,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
HARMONIC SHEARS 14CM 5MM,,A4649,HCPCS,Facility,Outpatient,,,,1187.02,1008.967,340.199932,1187.02,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),599.088994,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
HARMONIC SHEARS 14CM 5MM,,A4649,HCPCS,Facility,Inpatient,,,,1187.02,1008.967,340.199932,1187.02,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
HARMONIC SHEARS 14CM 5MM,,A4649,HCPCS,Facility,Both,,,,1187.02,1008.967,340.199932,1187.02,UnitedHealthcare,Individual & Family,1115.7988,94,,percent of total billed charges,,
HARMONIC SHEARS 14CM 5MM,,A4649,HCPCS,Facility,Outpatient,,,,1187.02,1008.967,340.199932,1187.02,UnitedHealthcare,Medicare Advantage,581.6398,49,,percent of total billed charges,,
HARMONIC SHEARS 14CM 5MM,,A4649,HCPCS,Facility,Inpatient,,,,1187.02,1008.967,340.199932,1187.02,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
HARMONIC SHEARS 14CM 5MM,,A4649,HCPCS,Facility,Outpatient,,,,1187.02,1008.967,340.199932,1187.02,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,569.7696,48,,percent of total billed charges,,100% of DHS outpatient percentage
HARMONIC SHEARS 14CM 5MM,,A4649,HCPCS,Facility,Inpatient,,,,1187.02,1008.967,340.199932,1187.02,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
HEMOCLIP - LIGATING CLIP,,A4649,HCPCS,Facility,Both,,,,56.025,47.62125,16.056765,56.025,Aetna,Commercial,51.543,92,,percent of total billed charges,,
HEMOCLIP - LIGATING CLIP,,A4649,HCPCS,Facility,Outpatient,,,,56.025,47.62125,16.056765,56.025,Aetna,Medicare Advantage,27.45225,49,,percent of total billed charges,,
HEMOCLIP - LIGATING CLIP,,A4649,HCPCS,Facility,Inpatient,,,,56.025,47.62125,16.056765,56.025,Aetna,Medicare Advantage,,,,,Included in per diem rate,
HEMOCLIP - LIGATING CLIP,,A4649,HCPCS,Facility,Both,,,,56.025,47.62125,16.056765,56.025,Aetna,PPO,52.10325,93,,percent of total billed charges,,
HEMOCLIP - LIGATING CLIP,,A4649,HCPCS,Facility,Both,,,,56.025,47.62125,16.056765,56.025,America's PPO,America's PPO,53.8008075,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
HEMOCLIP - LIGATING CLIP,,A4649,HCPCS,Facility,Both,,,,56.025,47.62125,16.056765,56.025,BlueCross BlueShield Minnesota, Federal Employee Program,55.1286,98.4,,percent of total billed charges,,
HEMOCLIP - LIGATING CLIP,,A4649,HCPCS,Facility,Both,,,,56.025,47.62125,16.056765,56.025,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,56.025,100,,percent of total billed charges,,
HEMOCLIP - LIGATING CLIP,,A4649,HCPCS,Facility,Both,,,,56.025,47.62125,16.056765,56.025,BlueCross BlueShield Minnesota,High Value Network Plan,50.4225,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
HEMOCLIP - LIGATING CLIP,,A4649,HCPCS,Facility,Outpatient,,,,56.025,47.62125,16.056765,56.025,BlueCross BlueShield Minnesota,Medicare Advantage,27.45225,49,,percent of total billed charges,,
HEMOCLIP - LIGATING CLIP,,A4649,HCPCS,Facility,Inpatient,,,,56.025,47.62125,16.056765,56.025,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
HEMOCLIP - LIGATING CLIP,,A4649,HCPCS,Facility,Both,,,,56.025,47.62125,16.056765,56.025,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,49.6213425,88.57,,percent of total billed charges,,
HEMOCLIP - LIGATING CLIP,,A4649,HCPCS,Facility,Both,,,,56.025,47.62125,16.056765,56.025,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,16.056765,28.66,,percent of total billed charges,,
HEMOCLIP - LIGATING CLIP,,A4649,HCPCS,Facility,Outpatient,,,,56.025,47.62125,16.056765,56.025,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),27.45225,49,,percent of total billed charges,,
HEMOCLIP - LIGATING CLIP,,A4649,HCPCS,Facility,Inpatient,,,,56.025,47.62125,16.056765,56.025,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
HEMOCLIP - LIGATING CLIP,,A4649,HCPCS,Facility,Both,,,,56.025,47.62125,16.056765,56.025,CorVel,Worker's Compensation,56.025,100,,percent of total billed charges,,
HEMOCLIP - LIGATING CLIP,,A4649,HCPCS,Facility,Both,,,,56.025,47.62125,16.056765,56.025,First Health Group Corporation,First Health Network,54.34425,97,,percent of total billed charges,,
HEMOCLIP - LIGATING CLIP,,A4649,HCPCS,Facility,Both,,,,56.025,47.62125,16.056765,56.025,"Health Partners, Inc.",Commercial,52.99965,94.6,,percent of total billed charges,,
HEMOCLIP - LIGATING CLIP,,A4649,HCPCS,Facility,Outpatient,,,,56.025,47.62125,16.056765,56.025,"Health Partners, Inc.",Medicare Advantage,27.45225,49,,percent of total billed charges,,
HEMOCLIP - LIGATING CLIP,,A4649,HCPCS,Facility,Inpatient,,,,56.025,47.62125,16.056765,56.025,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
HEMOCLIP - LIGATING CLIP,,A4649,HCPCS,Facility,Both,,,,56.025,47.62125,16.056765,56.025,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),33.615,60,,percent of total billed charges,,
HEMOCLIP - LIGATING CLIP,,A4649,HCPCS,Facility,Both,,,,56.025,47.62125,16.056765,56.025,"Health Partners, Inc.",State of Minnesota Advantage Program,45.660375,81.5,,percent of total billed charges,,
HEMOCLIP - LIGATING CLIP,,A4649,HCPCS,Facility,Both,,,,56.025,47.62125,16.056765,56.025,"Health Partners, Inc.",State Public Programs,28.0125,50,,percent of total billed charges,,
HEMOCLIP - LIGATING CLIP,,A4649,HCPCS,Facility,Both,,,,56.025,47.62125,16.056765,56.025,Humana Insurance Company,Commercial PPO,53.22375,95,,percent of total billed charges,,
HEMOCLIP - LIGATING CLIP,,A4649,HCPCS,Facility,Outpatient,,,,56.025,47.62125,16.056765,56.025,Humana Insurance Company,Medicare PPO,27.45225,49,,percent of total billed charges,,
HEMOCLIP - LIGATING CLIP,,A4649,HCPCS,Facility,Inpatient,,,,56.025,47.62125,16.056765,56.025,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
HEMOCLIP - LIGATING CLIP,,A4649,HCPCS,Facility,Both,,,,56.025,47.62125,16.056765,56.025,Medica,Individual & Family,55.520775,99.1,,percent of total billed charges,,
HEMOCLIP - LIGATING CLIP,,A4649,HCPCS,Facility,Outpatient,,,,56.025,47.62125,16.056765,56.025,Medica,Medica Advantage Solution,27.90045,49.8,,percent of total billed charges,,
HEMOCLIP - LIGATING CLIP,,A4649,HCPCS,Facility,Inpatient,,,,56.025,47.62125,16.056765,56.025,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
HEMOCLIP - LIGATING CLIP,,A4649,HCPCS,Facility,Outpatient,,,,56.025,47.62125,16.056765,56.025,Medica,Medical Assistance,24.98715,44.6,,percent of total billed charges,,
HEMOCLIP - LIGATING CLIP,,A4649,HCPCS,Facility,Inpatient,,,,56.025,47.62125,16.056765,56.025,Medica,Medical Assistance,,,,,Included in per diem rate,
HEMOCLIP - LIGATING CLIP,,A4649,HCPCS,Facility,Outpatient,,,,56.025,47.62125,16.056765,56.025,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,27.90045,49.8,,percent of total billed charges,,
HEMOCLIP - LIGATING CLIP,,A4649,HCPCS,Facility,Inpatient,,,,56.025,47.62125,16.056765,56.025,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
HEMOCLIP - LIGATING CLIP,,A4649,HCPCS,Facility,Both,,,,56.025,47.62125,16.056765,56.025,"Multiplan, Inc.","Multiplan, Inc.",52.6635,94,,percent of total billed charges,,
HEMOCLIP - LIGATING CLIP,,A4649,HCPCS,Facility,Outpatient,,,,56.025,47.62125,16.056765,56.025,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,50.478525,90.1,,percent of total billed charges,,
HEMOCLIP - LIGATING CLIP,,A4649,HCPCS,Facility,Inpatient,,,,56.025,47.62125,16.056765,56.025,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
HEMOCLIP - LIGATING CLIP,,A4649,HCPCS,Facility,Both,,,,56.025,47.62125,16.056765,56.025,"Preferred One Administrative Services, INC.",PPO,55.24065,98.6,,percent of total billed charges,,
HEMOCLIP - LIGATING CLIP,,A4649,HCPCS,Facility,Outpatient,,,,56.025,47.62125,16.056765,56.025,PrimeWest Health,Minnesota Senior Health Options (MSHO),28.8248625,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
HEMOCLIP - LIGATING CLIP,,A4649,HCPCS,Facility,Inpatient,,,,56.025,47.62125,16.056765,56.025,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
HEMOCLIP - LIGATING CLIP,,A4649,HCPCS,Facility,Outpatient,,,,56.025,47.62125,16.056765,56.025,PrimeWest Health,MinnesotaCare,28.77444,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
HEMOCLIP - LIGATING CLIP,,A4649,HCPCS,Facility,Inpatient,,,,56.025,47.62125,16.056765,56.025,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
HEMOCLIP - LIGATING CLIP,,A4649,HCPCS,Facility,Both,,,,56.025,47.62125,16.056765,56.025,Sanford Health Plan,Sanford Health Plan,51.543,92,,percent of total billed charges,,
HEMOCLIP - LIGATING CLIP,,A4649,HCPCS,Facility,Outpatient,,,,56.025,47.62125,16.056765,56.025,"UCare Health, Inc.",Individual & Family Plan,31.5700875,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
HEMOCLIP - LIGATING CLIP,,A4649,HCPCS,Facility,Inpatient,,,,56.025,47.62125,16.056765,56.025,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
HEMOCLIP - LIGATING CLIP,,A4649,HCPCS,Facility,Outpatient,,,,56.025,47.62125,16.056765,56.025,"UCare Health, Inc.",Medical Assistance,28.2758175,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
HEMOCLIP - LIGATING CLIP,,A4649,HCPCS,Facility,Inpatient,,,,56.025,47.62125,16.056765,56.025,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
HEMOCLIP - LIGATING CLIP,,A4649,HCPCS,Facility,Outpatient,,,,56.025,47.62125,16.056765,56.025,"UCare Health, Inc.",Medicare Advantage,28.2758175,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
HEMOCLIP - LIGATING CLIP,,A4649,HCPCS,Facility,Inpatient,,,,56.025,47.62125,16.056765,56.025,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
HEMOCLIP - LIGATING CLIP,,A4649,HCPCS,Facility,Outpatient,,,,56.025,47.62125,16.056765,56.025,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),28.2758175,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
HEMOCLIP - LIGATING CLIP,,A4649,HCPCS,Facility,Inpatient,,,,56.025,47.62125,16.056765,56.025,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
HEMOCLIP - LIGATING CLIP,,A4649,HCPCS,Facility,Both,,,,56.025,47.62125,16.056765,56.025,UnitedHealthcare,Individual & Family,52.6635,94,,percent of total billed charges,,
HEMOCLIP - LIGATING CLIP,,A4649,HCPCS,Facility,Outpatient,,,,56.025,47.62125,16.056765,56.025,UnitedHealthcare,Medicare Advantage,27.45225,49,,percent of total billed charges,,
HEMOCLIP - LIGATING CLIP,,A4649,HCPCS,Facility,Inpatient,,,,56.025,47.62125,16.056765,56.025,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
HEMOCLIP - LIGATING CLIP,,A4649,HCPCS,Facility,Outpatient,,,,56.025,47.62125,16.056765,56.025,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,26.892,48,,percent of total billed charges,,100% of DHS outpatient percentage
HEMOCLIP - LIGATING CLIP,,A4649,HCPCS,Facility,Inpatient,,,,56.025,47.62125,16.056765,56.025,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
HEMOVAC 400ML,,A4649,HCPCS,Facility,Both,,,,177.68,151.028,50.923088,177.68,Aetna,Commercial,163.4656,92,,percent of total billed charges,,
HEMOVAC 400ML,,A4649,HCPCS,Facility,Outpatient,,,,177.68,151.028,50.923088,177.68,Aetna,Medicare Advantage,87.0632,49,,percent of total billed charges,,
HEMOVAC 400ML,,A4649,HCPCS,Facility,Inpatient,,,,177.68,151.028,50.923088,177.68,Aetna,Medicare Advantage,,,,,Included in per diem rate,
HEMOVAC 400ML,,A4649,HCPCS,Facility,Both,,,,177.68,151.028,50.923088,177.68,Aetna,PPO,165.2424,93,,percent of total billed charges,,
HEMOVAC 400ML,,A4649,HCPCS,Facility,Both,,,,177.68,151.028,50.923088,177.68,America's PPO,America's PPO,170.626104,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
HEMOVAC 400ML,,A4649,HCPCS,Facility,Both,,,,177.68,151.028,50.923088,177.68,BlueCross BlueShield Minnesota, Federal Employee Program,174.83712,98.4,,percent of total billed charges,,
HEMOVAC 400ML,,A4649,HCPCS,Facility,Both,,,,177.68,151.028,50.923088,177.68,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,177.68,100,,percent of total billed charges,,
HEMOVAC 400ML,,A4649,HCPCS,Facility,Both,,,,177.68,151.028,50.923088,177.68,BlueCross BlueShield Minnesota,High Value Network Plan,159.912,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
HEMOVAC 400ML,,A4649,HCPCS,Facility,Outpatient,,,,177.68,151.028,50.923088,177.68,BlueCross BlueShield Minnesota,Medicare Advantage,87.0632,49,,percent of total billed charges,,
HEMOVAC 400ML,,A4649,HCPCS,Facility,Inpatient,,,,177.68,151.028,50.923088,177.68,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
HEMOVAC 400ML,,A4649,HCPCS,Facility,Both,,,,177.68,151.028,50.923088,177.68,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,157.371176,88.57,,percent of total billed charges,,
HEMOVAC 400ML,,A4649,HCPCS,Facility,Both,,,,177.68,151.028,50.923088,177.68,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,50.923088,28.66,,percent of total billed charges,,
HEMOVAC 400ML,,A4649,HCPCS,Facility,Outpatient,,,,177.68,151.028,50.923088,177.68,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),87.0632,49,,percent of total billed charges,,
HEMOVAC 400ML,,A4649,HCPCS,Facility,Inpatient,,,,177.68,151.028,50.923088,177.68,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
HEMOVAC 400ML,,A4649,HCPCS,Facility,Both,,,,177.68,151.028,50.923088,177.68,CorVel,Worker's Compensation,177.68,100,,percent of total billed charges,,
HEMOVAC 400ML,,A4649,HCPCS,Facility,Both,,,,177.68,151.028,50.923088,177.68,First Health Group Corporation,First Health Network,172.3496,97,,percent of total billed charges,,
HEMOVAC 400ML,,A4649,HCPCS,Facility,Both,,,,177.68,151.028,50.923088,177.68,"Health Partners, Inc.",Commercial,168.08528,94.6,,percent of total billed charges,,
HEMOVAC 400ML,,A4649,HCPCS,Facility,Outpatient,,,,177.68,151.028,50.923088,177.68,"Health Partners, Inc.",Medicare Advantage,87.0632,49,,percent of total billed charges,,
HEMOVAC 400ML,,A4649,HCPCS,Facility,Inpatient,,,,177.68,151.028,50.923088,177.68,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
HEMOVAC 400ML,,A4649,HCPCS,Facility,Both,,,,177.68,151.028,50.923088,177.68,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),106.608,60,,percent of total billed charges,,
HEMOVAC 400ML,,A4649,HCPCS,Facility,Both,,,,177.68,151.028,50.923088,177.68,"Health Partners, Inc.",State of Minnesota Advantage Program,144.8092,81.5,,percent of total billed charges,,
HEMOVAC 400ML,,A4649,HCPCS,Facility,Both,,,,177.68,151.028,50.923088,177.68,"Health Partners, Inc.",State Public Programs,88.84,50,,percent of total billed charges,,
HEMOVAC 400ML,,A4649,HCPCS,Facility,Both,,,,177.68,151.028,50.923088,177.68,Humana Insurance Company,Commercial PPO,168.796,95,,percent of total billed charges,,
HEMOVAC 400ML,,A4649,HCPCS,Facility,Outpatient,,,,177.68,151.028,50.923088,177.68,Humana Insurance Company,Medicare PPO,87.0632,49,,percent of total billed charges,,
HEMOVAC 400ML,,A4649,HCPCS,Facility,Inpatient,,,,177.68,151.028,50.923088,177.68,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
HEMOVAC 400ML,,A4649,HCPCS,Facility,Both,,,,177.68,151.028,50.923088,177.68,Medica,Individual & Family,176.08088,99.1,,percent of total billed charges,,
HEMOVAC 400ML,,A4649,HCPCS,Facility,Outpatient,,,,177.68,151.028,50.923088,177.68,Medica,Medica Advantage Solution,88.48464,49.8,,percent of total billed charges,,
HEMOVAC 400ML,,A4649,HCPCS,Facility,Inpatient,,,,177.68,151.028,50.923088,177.68,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
HEMOVAC 400ML,,A4649,HCPCS,Facility,Outpatient,,,,177.68,151.028,50.923088,177.68,Medica,Medical Assistance,79.24528,44.6,,percent of total billed charges,,
HEMOVAC 400ML,,A4649,HCPCS,Facility,Inpatient,,,,177.68,151.028,50.923088,177.68,Medica,Medical Assistance,,,,,Included in per diem rate,
HEMOVAC 400ML,,A4649,HCPCS,Facility,Outpatient,,,,177.68,151.028,50.923088,177.68,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,88.48464,49.8,,percent of total billed charges,,
HEMOVAC 400ML,,A4649,HCPCS,Facility,Inpatient,,,,177.68,151.028,50.923088,177.68,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
HEMOVAC 400ML,,A4649,HCPCS,Facility,Both,,,,177.68,151.028,50.923088,177.68,"Multiplan, Inc.","Multiplan, Inc.",167.0192,94,,percent of total billed charges,,
HEMOVAC 400ML,,A4649,HCPCS,Facility,Outpatient,,,,177.68,151.028,50.923088,177.68,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,160.08968,90.1,,percent of total billed charges,,
HEMOVAC 400ML,,A4649,HCPCS,Facility,Inpatient,,,,177.68,151.028,50.923088,177.68,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
HEMOVAC 400ML,,A4649,HCPCS,Facility,Both,,,,177.68,151.028,50.923088,177.68,"Preferred One Administrative Services, INC.",PPO,175.19248,98.6,,percent of total billed charges,,
HEMOVAC 400ML,,A4649,HCPCS,Facility,Outpatient,,,,177.68,151.028,50.923088,177.68,PrimeWest Health,Minnesota Senior Health Options (MSHO),91.41636,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
HEMOVAC 400ML,,A4649,HCPCS,Facility,Inpatient,,,,177.68,151.028,50.923088,177.68,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
HEMOVAC 400ML,,A4649,HCPCS,Facility,Outpatient,,,,177.68,151.028,50.923088,177.68,PrimeWest Health,MinnesotaCare,91.256448,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
HEMOVAC 400ML,,A4649,HCPCS,Facility,Inpatient,,,,177.68,151.028,50.923088,177.68,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
HEMOVAC 400ML,,A4649,HCPCS,Facility,Both,,,,177.68,151.028,50.923088,177.68,Sanford Health Plan,Sanford Health Plan,163.4656,92,,percent of total billed charges,,
HEMOVAC 400ML,,A4649,HCPCS,Facility,Outpatient,,,,177.68,151.028,50.923088,177.68,"UCare Health, Inc.",Individual & Family Plan,100.12268,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
HEMOVAC 400ML,,A4649,HCPCS,Facility,Inpatient,,,,177.68,151.028,50.923088,177.68,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
HEMOVAC 400ML,,A4649,HCPCS,Facility,Outpatient,,,,177.68,151.028,50.923088,177.68,"UCare Health, Inc.",Medical Assistance,89.675096,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
HEMOVAC 400ML,,A4649,HCPCS,Facility,Inpatient,,,,177.68,151.028,50.923088,177.68,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
HEMOVAC 400ML,,A4649,HCPCS,Facility,Outpatient,,,,177.68,151.028,50.923088,177.68,"UCare Health, Inc.",Medicare Advantage,89.675096,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
HEMOVAC 400ML,,A4649,HCPCS,Facility,Inpatient,,,,177.68,151.028,50.923088,177.68,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
HEMOVAC 400ML,,A4649,HCPCS,Facility,Outpatient,,,,177.68,151.028,50.923088,177.68,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),89.675096,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
HEMOVAC 400ML,,A4649,HCPCS,Facility,Inpatient,,,,177.68,151.028,50.923088,177.68,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
HEMOVAC 400ML,,A4649,HCPCS,Facility,Both,,,,177.68,151.028,50.923088,177.68,UnitedHealthcare,Individual & Family,167.0192,94,,percent of total billed charges,,
HEMOVAC 400ML,,A4649,HCPCS,Facility,Outpatient,,,,177.68,151.028,50.923088,177.68,UnitedHealthcare,Medicare Advantage,87.0632,49,,percent of total billed charges,,
HEMOVAC 400ML,,A4649,HCPCS,Facility,Inpatient,,,,177.68,151.028,50.923088,177.68,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
HEMOVAC 400ML,,A4649,HCPCS,Facility,Outpatient,,,,177.68,151.028,50.923088,177.68,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,85.2864,48,,percent of total billed charges,,100% of DHS outpatient percentage
HEMOVAC 400ML,,A4649,HCPCS,Facility,Inpatient,,,,177.68,151.028,50.923088,177.68,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
HIGH FLOW II TUBESET FOR PNEUMO SURE,,A4649,HCPCS,Facility,Both,,,,89.28,75.888,25.587648,89.28,Aetna,Commercial,82.1376,92,,percent of total billed charges,,
HIGH FLOW II TUBESET FOR PNEUMO SURE,,A4649,HCPCS,Facility,Outpatient,,,,89.28,75.888,25.587648,89.28,Aetna,Medicare Advantage,43.7472,49,,percent of total billed charges,,
HIGH FLOW II TUBESET FOR PNEUMO SURE,,A4649,HCPCS,Facility,Inpatient,,,,89.28,75.888,25.587648,89.28,Aetna,Medicare Advantage,,,,,Included in per diem rate,
HIGH FLOW II TUBESET FOR PNEUMO SURE,,A4649,HCPCS,Facility,Both,,,,89.28,75.888,25.587648,89.28,Aetna,PPO,83.0304,93,,percent of total billed charges,,
HIGH FLOW II TUBESET FOR PNEUMO SURE,,A4649,HCPCS,Facility,Both,,,,89.28,75.888,25.587648,89.28,America's PPO,America's PPO,85.735584,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
HIGH FLOW II TUBESET FOR PNEUMO SURE,,A4649,HCPCS,Facility,Both,,,,89.28,75.888,25.587648,89.28,BlueCross BlueShield Minnesota, Federal Employee Program,87.85152,98.4,,percent of total billed charges,,
HIGH FLOW II TUBESET FOR PNEUMO SURE,,A4649,HCPCS,Facility,Both,,,,89.28,75.888,25.587648,89.28,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,89.28,100,,percent of total billed charges,,
HIGH FLOW II TUBESET FOR PNEUMO SURE,,A4649,HCPCS,Facility,Both,,,,89.28,75.888,25.587648,89.28,BlueCross BlueShield Minnesota,High Value Network Plan,80.352,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
HIGH FLOW II TUBESET FOR PNEUMO SURE,,A4649,HCPCS,Facility,Outpatient,,,,89.28,75.888,25.587648,89.28,BlueCross BlueShield Minnesota,Medicare Advantage,43.7472,49,,percent of total billed charges,,
HIGH FLOW II TUBESET FOR PNEUMO SURE,,A4649,HCPCS,Facility,Inpatient,,,,89.28,75.888,25.587648,89.28,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
HIGH FLOW II TUBESET FOR PNEUMO SURE,,A4649,HCPCS,Facility,Both,,,,89.28,75.888,25.587648,89.28,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,79.075296,88.57,,percent of total billed charges,,
HIGH FLOW II TUBESET FOR PNEUMO SURE,,A4649,HCPCS,Facility,Both,,,,89.28,75.888,25.587648,89.28,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,25.587648,28.66,,percent of total billed charges,,
HIGH FLOW II TUBESET FOR PNEUMO SURE,,A4649,HCPCS,Facility,Outpatient,,,,89.28,75.888,25.587648,89.28,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),43.7472,49,,percent of total billed charges,,
HIGH FLOW II TUBESET FOR PNEUMO SURE,,A4649,HCPCS,Facility,Inpatient,,,,89.28,75.888,25.587648,89.28,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
HIGH FLOW II TUBESET FOR PNEUMO SURE,,A4649,HCPCS,Facility,Both,,,,89.28,75.888,25.587648,89.28,CorVel,Worker's Compensation,89.28,100,,percent of total billed charges,,
HIGH FLOW II TUBESET FOR PNEUMO SURE,,A4649,HCPCS,Facility,Both,,,,89.28,75.888,25.587648,89.28,First Health Group Corporation,First Health Network,86.6016,97,,percent of total billed charges,,
HIGH FLOW II TUBESET FOR PNEUMO SURE,,A4649,HCPCS,Facility,Both,,,,89.28,75.888,25.587648,89.28,"Health Partners, Inc.",Commercial,84.45888,94.6,,percent of total billed charges,,
HIGH FLOW II TUBESET FOR PNEUMO SURE,,A4649,HCPCS,Facility,Outpatient,,,,89.28,75.888,25.587648,89.28,"Health Partners, Inc.",Medicare Advantage,43.7472,49,,percent of total billed charges,,
HIGH FLOW II TUBESET FOR PNEUMO SURE,,A4649,HCPCS,Facility,Inpatient,,,,89.28,75.888,25.587648,89.28,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
HIGH FLOW II TUBESET FOR PNEUMO SURE,,A4649,HCPCS,Facility,Both,,,,89.28,75.888,25.587648,89.28,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),53.568,60,,percent of total billed charges,,
HIGH FLOW II TUBESET FOR PNEUMO SURE,,A4649,HCPCS,Facility,Both,,,,89.28,75.888,25.587648,89.28,"Health Partners, Inc.",State of Minnesota Advantage Program,72.7632,81.5,,percent of total billed charges,,
HIGH FLOW II TUBESET FOR PNEUMO SURE,,A4649,HCPCS,Facility,Both,,,,89.28,75.888,25.587648,89.28,"Health Partners, Inc.",State Public Programs,44.64,50,,percent of total billed charges,,
HIGH FLOW II TUBESET FOR PNEUMO SURE,,A4649,HCPCS,Facility,Both,,,,89.28,75.888,25.587648,89.28,Humana Insurance Company,Commercial PPO,84.816,95,,percent of total billed charges,,
HIGH FLOW II TUBESET FOR PNEUMO SURE,,A4649,HCPCS,Facility,Outpatient,,,,89.28,75.888,25.587648,89.28,Humana Insurance Company,Medicare PPO,43.7472,49,,percent of total billed charges,,
HIGH FLOW II TUBESET FOR PNEUMO SURE,,A4649,HCPCS,Facility,Inpatient,,,,89.28,75.888,25.587648,89.28,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
HIGH FLOW II TUBESET FOR PNEUMO SURE,,A4649,HCPCS,Facility,Both,,,,89.28,75.888,25.587648,89.28,Medica,Individual & Family,88.47648,99.1,,percent of total billed charges,,
HIGH FLOW II TUBESET FOR PNEUMO SURE,,A4649,HCPCS,Facility,Outpatient,,,,89.28,75.888,25.587648,89.28,Medica,Medica Advantage Solution,44.46144,49.8,,percent of total billed charges,,
HIGH FLOW II TUBESET FOR PNEUMO SURE,,A4649,HCPCS,Facility,Inpatient,,,,89.28,75.888,25.587648,89.28,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
HIGH FLOW II TUBESET FOR PNEUMO SURE,,A4649,HCPCS,Facility,Outpatient,,,,89.28,75.888,25.587648,89.28,Medica,Medical Assistance,39.81888,44.6,,percent of total billed charges,,
HIGH FLOW II TUBESET FOR PNEUMO SURE,,A4649,HCPCS,Facility,Inpatient,,,,89.28,75.888,25.587648,89.28,Medica,Medical Assistance,,,,,Included in per diem rate,
HIGH FLOW II TUBESET FOR PNEUMO SURE,,A4649,HCPCS,Facility,Outpatient,,,,89.28,75.888,25.587648,89.28,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,44.46144,49.8,,percent of total billed charges,,
HIGH FLOW II TUBESET FOR PNEUMO SURE,,A4649,HCPCS,Facility,Inpatient,,,,89.28,75.888,25.587648,89.28,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
HIGH FLOW II TUBESET FOR PNEUMO SURE,,A4649,HCPCS,Facility,Both,,,,89.28,75.888,25.587648,89.28,"Multiplan, Inc.","Multiplan, Inc.",83.9232,94,,percent of total billed charges,,
HIGH FLOW II TUBESET FOR PNEUMO SURE,,A4649,HCPCS,Facility,Outpatient,,,,89.28,75.888,25.587648,89.28,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,80.44128,90.1,,percent of total billed charges,,
HIGH FLOW II TUBESET FOR PNEUMO SURE,,A4649,HCPCS,Facility,Inpatient,,,,89.28,75.888,25.587648,89.28,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
HIGH FLOW II TUBESET FOR PNEUMO SURE,,A4649,HCPCS,Facility,Both,,,,89.28,75.888,25.587648,89.28,"Preferred One Administrative Services, INC.",PPO,88.03008,98.6,,percent of total billed charges,,
HIGH FLOW II TUBESET FOR PNEUMO SURE,,A4649,HCPCS,Facility,Outpatient,,,,89.28,75.888,25.587648,89.28,PrimeWest Health,Minnesota Senior Health Options (MSHO),45.93456,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
HIGH FLOW II TUBESET FOR PNEUMO SURE,,A4649,HCPCS,Facility,Inpatient,,,,89.28,75.888,25.587648,89.28,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
HIGH FLOW II TUBESET FOR PNEUMO SURE,,A4649,HCPCS,Facility,Outpatient,,,,89.28,75.888,25.587648,89.28,PrimeWest Health,MinnesotaCare,45.854208,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
HIGH FLOW II TUBESET FOR PNEUMO SURE,,A4649,HCPCS,Facility,Inpatient,,,,89.28,75.888,25.587648,89.28,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
HIGH FLOW II TUBESET FOR PNEUMO SURE,,A4649,HCPCS,Facility,Both,,,,89.28,75.888,25.587648,89.28,Sanford Health Plan,Sanford Health Plan,82.1376,92,,percent of total billed charges,,
HIGH FLOW II TUBESET FOR PNEUMO SURE,,A4649,HCPCS,Facility,Outpatient,,,,89.28,75.888,25.587648,89.28,"UCare Health, Inc.",Individual & Family Plan,50.30928,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
HIGH FLOW II TUBESET FOR PNEUMO SURE,,A4649,HCPCS,Facility,Inpatient,,,,89.28,75.888,25.587648,89.28,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
HIGH FLOW II TUBESET FOR PNEUMO SURE,,A4649,HCPCS,Facility,Outpatient,,,,89.28,75.888,25.587648,89.28,"UCare Health, Inc.",Medical Assistance,45.059616,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
HIGH FLOW II TUBESET FOR PNEUMO SURE,,A4649,HCPCS,Facility,Inpatient,,,,89.28,75.888,25.587648,89.28,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
HIGH FLOW II TUBESET FOR PNEUMO SURE,,A4649,HCPCS,Facility,Outpatient,,,,89.28,75.888,25.587648,89.28,"UCare Health, Inc.",Medicare Advantage,45.059616,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
HIGH FLOW II TUBESET FOR PNEUMO SURE,,A4649,HCPCS,Facility,Inpatient,,,,89.28,75.888,25.587648,89.28,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
HIGH FLOW II TUBESET FOR PNEUMO SURE,,A4649,HCPCS,Facility,Outpatient,,,,89.28,75.888,25.587648,89.28,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),45.059616,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
HIGH FLOW II TUBESET FOR PNEUMO SURE,,A4649,HCPCS,Facility,Inpatient,,,,89.28,75.888,25.587648,89.28,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
HIGH FLOW II TUBESET FOR PNEUMO SURE,,A4649,HCPCS,Facility,Both,,,,89.28,75.888,25.587648,89.28,UnitedHealthcare,Individual & Family,83.9232,94,,percent of total billed charges,,
HIGH FLOW II TUBESET FOR PNEUMO SURE,,A4649,HCPCS,Facility,Outpatient,,,,89.28,75.888,25.587648,89.28,UnitedHealthcare,Medicare Advantage,43.7472,49,,percent of total billed charges,,
HIGH FLOW II TUBESET FOR PNEUMO SURE,,A4649,HCPCS,Facility,Inpatient,,,,89.28,75.888,25.587648,89.28,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
HIGH FLOW II TUBESET FOR PNEUMO SURE,,A4649,HCPCS,Facility,Outpatient,,,,89.28,75.888,25.587648,89.28,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,42.8544,48,,percent of total billed charges,,100% of DHS outpatient percentage
HIGH FLOW II TUBESET FOR PNEUMO SURE,,A4649,HCPCS,Facility,Inpatient,,,,89.28,75.888,25.587648,89.28,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
INNOMED KNEE POSITIONER DISPOSABLE PAD,,A4649,HCPCS,Facility,Both,,,,128.08,108.868,36.707728,128.08,Aetna,Commercial,117.8336,92,,percent of total billed charges,,
INNOMED KNEE POSITIONER DISPOSABLE PAD,,A4649,HCPCS,Facility,Outpatient,,,,128.08,108.868,36.707728,128.08,Aetna,Medicare Advantage,62.7592,49,,percent of total billed charges,,
INNOMED KNEE POSITIONER DISPOSABLE PAD,,A4649,HCPCS,Facility,Inpatient,,,,128.08,108.868,36.707728,128.08,Aetna,Medicare Advantage,,,,,Included in per diem rate,
INNOMED KNEE POSITIONER DISPOSABLE PAD,,A4649,HCPCS,Facility,Both,,,,128.08,108.868,36.707728,128.08,Aetna,PPO,119.1144,93,,percent of total billed charges,,
INNOMED KNEE POSITIONER DISPOSABLE PAD,,A4649,HCPCS,Facility,Both,,,,128.08,108.868,36.707728,128.08,America's PPO,America's PPO,122.995224,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
INNOMED KNEE POSITIONER DISPOSABLE PAD,,A4649,HCPCS,Facility,Both,,,,128.08,108.868,36.707728,128.08,BlueCross BlueShield Minnesota, Federal Employee Program,126.03072,98.4,,percent of total billed charges,,
INNOMED KNEE POSITIONER DISPOSABLE PAD,,A4649,HCPCS,Facility,Both,,,,128.08,108.868,36.707728,128.08,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,128.08,100,,percent of total billed charges,,
INNOMED KNEE POSITIONER DISPOSABLE PAD,,A4649,HCPCS,Facility,Both,,,,128.08,108.868,36.707728,128.08,BlueCross BlueShield Minnesota,High Value Network Plan,115.272,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
INNOMED KNEE POSITIONER DISPOSABLE PAD,,A4649,HCPCS,Facility,Outpatient,,,,128.08,108.868,36.707728,128.08,BlueCross BlueShield Minnesota,Medicare Advantage,62.7592,49,,percent of total billed charges,,
INNOMED KNEE POSITIONER DISPOSABLE PAD,,A4649,HCPCS,Facility,Inpatient,,,,128.08,108.868,36.707728,128.08,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
INNOMED KNEE POSITIONER DISPOSABLE PAD,,A4649,HCPCS,Facility,Both,,,,128.08,108.868,36.707728,128.08,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,113.440456,88.57,,percent of total billed charges,,
INNOMED KNEE POSITIONER DISPOSABLE PAD,,A4649,HCPCS,Facility,Both,,,,128.08,108.868,36.707728,128.08,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,36.707728,28.66,,percent of total billed charges,,
INNOMED KNEE POSITIONER DISPOSABLE PAD,,A4649,HCPCS,Facility,Outpatient,,,,128.08,108.868,36.707728,128.08,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),62.7592,49,,percent of total billed charges,,
INNOMED KNEE POSITIONER DISPOSABLE PAD,,A4649,HCPCS,Facility,Inpatient,,,,128.08,108.868,36.707728,128.08,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
INNOMED KNEE POSITIONER DISPOSABLE PAD,,A4649,HCPCS,Facility,Both,,,,128.08,108.868,36.707728,128.08,CorVel,Worker's Compensation,128.08,100,,percent of total billed charges,,
INNOMED KNEE POSITIONER DISPOSABLE PAD,,A4649,HCPCS,Facility,Both,,,,128.08,108.868,36.707728,128.08,First Health Group Corporation,First Health Network,124.2376,97,,percent of total billed charges,,
INNOMED KNEE POSITIONER DISPOSABLE PAD,,A4649,HCPCS,Facility,Both,,,,128.08,108.868,36.707728,128.08,"Health Partners, Inc.",Commercial,121.16368,94.6,,percent of total billed charges,,
INNOMED KNEE POSITIONER DISPOSABLE PAD,,A4649,HCPCS,Facility,Outpatient,,,,128.08,108.868,36.707728,128.08,"Health Partners, Inc.",Medicare Advantage,62.7592,49,,percent of total billed charges,,
INNOMED KNEE POSITIONER DISPOSABLE PAD,,A4649,HCPCS,Facility,Inpatient,,,,128.08,108.868,36.707728,128.08,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
INNOMED KNEE POSITIONER DISPOSABLE PAD,,A4649,HCPCS,Facility,Both,,,,128.08,108.868,36.707728,128.08,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),76.848,60,,percent of total billed charges,,
INNOMED KNEE POSITIONER DISPOSABLE PAD,,A4649,HCPCS,Facility,Both,,,,128.08,108.868,36.707728,128.08,"Health Partners, Inc.",State of Minnesota Advantage Program,104.3852,81.5,,percent of total billed charges,,
INNOMED KNEE POSITIONER DISPOSABLE PAD,,A4649,HCPCS,Facility,Both,,,,128.08,108.868,36.707728,128.08,"Health Partners, Inc.",State Public Programs,64.04,50,,percent of total billed charges,,
INNOMED KNEE POSITIONER DISPOSABLE PAD,,A4649,HCPCS,Facility,Both,,,,128.08,108.868,36.707728,128.08,Humana Insurance Company,Commercial PPO,121.676,95,,percent of total billed charges,,
INNOMED KNEE POSITIONER DISPOSABLE PAD,,A4649,HCPCS,Facility,Outpatient,,,,128.08,108.868,36.707728,128.08,Humana Insurance Company,Medicare PPO,62.7592,49,,percent of total billed charges,,
INNOMED KNEE POSITIONER DISPOSABLE PAD,,A4649,HCPCS,Facility,Inpatient,,,,128.08,108.868,36.707728,128.08,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
INNOMED KNEE POSITIONER DISPOSABLE PAD,,A4649,HCPCS,Facility,Both,,,,128.08,108.868,36.707728,128.08,Medica,Individual & Family,126.92728,99.1,,percent of total billed charges,,
INNOMED KNEE POSITIONER DISPOSABLE PAD,,A4649,HCPCS,Facility,Outpatient,,,,128.08,108.868,36.707728,128.08,Medica,Medica Advantage Solution,63.78384,49.8,,percent of total billed charges,,
INNOMED KNEE POSITIONER DISPOSABLE PAD,,A4649,HCPCS,Facility,Inpatient,,,,128.08,108.868,36.707728,128.08,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
INNOMED KNEE POSITIONER DISPOSABLE PAD,,A4649,HCPCS,Facility,Outpatient,,,,128.08,108.868,36.707728,128.08,Medica,Medical Assistance,57.12368,44.6,,percent of total billed charges,,
INNOMED KNEE POSITIONER DISPOSABLE PAD,,A4649,HCPCS,Facility,Inpatient,,,,128.08,108.868,36.707728,128.08,Medica,Medical Assistance,,,,,Included in per diem rate,
INNOMED KNEE POSITIONER DISPOSABLE PAD,,A4649,HCPCS,Facility,Outpatient,,,,128.08,108.868,36.707728,128.08,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,63.78384,49.8,,percent of total billed charges,,
INNOMED KNEE POSITIONER DISPOSABLE PAD,,A4649,HCPCS,Facility,Inpatient,,,,128.08,108.868,36.707728,128.08,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
INNOMED KNEE POSITIONER DISPOSABLE PAD,,A4649,HCPCS,Facility,Both,,,,128.08,108.868,36.707728,128.08,"Multiplan, Inc.","Multiplan, Inc.",120.3952,94,,percent of total billed charges,,
INNOMED KNEE POSITIONER DISPOSABLE PAD,,A4649,HCPCS,Facility,Outpatient,,,,128.08,108.868,36.707728,128.08,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,115.40008,90.1,,percent of total billed charges,,
INNOMED KNEE POSITIONER DISPOSABLE PAD,,A4649,HCPCS,Facility,Inpatient,,,,128.08,108.868,36.707728,128.08,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
INNOMED KNEE POSITIONER DISPOSABLE PAD,,A4649,HCPCS,Facility,Both,,,,128.08,108.868,36.707728,128.08,"Preferred One Administrative Services, INC.",PPO,126.28688,98.6,,percent of total billed charges,,
INNOMED KNEE POSITIONER DISPOSABLE PAD,,A4649,HCPCS,Facility,Outpatient,,,,128.08,108.868,36.707728,128.08,PrimeWest Health,Minnesota Senior Health Options (MSHO),65.89716,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
INNOMED KNEE POSITIONER DISPOSABLE PAD,,A4649,HCPCS,Facility,Inpatient,,,,128.08,108.868,36.707728,128.08,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
INNOMED KNEE POSITIONER DISPOSABLE PAD,,A4649,HCPCS,Facility,Outpatient,,,,128.08,108.868,36.707728,128.08,PrimeWest Health,MinnesotaCare,65.781888,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
INNOMED KNEE POSITIONER DISPOSABLE PAD,,A4649,HCPCS,Facility,Inpatient,,,,128.08,108.868,36.707728,128.08,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
INNOMED KNEE POSITIONER DISPOSABLE PAD,,A4649,HCPCS,Facility,Both,,,,128.08,108.868,36.707728,128.08,Sanford Health Plan,Sanford Health Plan,117.8336,92,,percent of total billed charges,,
INNOMED KNEE POSITIONER DISPOSABLE PAD,,A4649,HCPCS,Facility,Outpatient,,,,128.08,108.868,36.707728,128.08,"UCare Health, Inc.",Individual & Family Plan,72.17308,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
INNOMED KNEE POSITIONER DISPOSABLE PAD,,A4649,HCPCS,Facility,Inpatient,,,,128.08,108.868,36.707728,128.08,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
INNOMED KNEE POSITIONER DISPOSABLE PAD,,A4649,HCPCS,Facility,Outpatient,,,,128.08,108.868,36.707728,128.08,"UCare Health, Inc.",Medical Assistance,64.641976,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
INNOMED KNEE POSITIONER DISPOSABLE PAD,,A4649,HCPCS,Facility,Inpatient,,,,128.08,108.868,36.707728,128.08,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
INNOMED KNEE POSITIONER DISPOSABLE PAD,,A4649,HCPCS,Facility,Outpatient,,,,128.08,108.868,36.707728,128.08,"UCare Health, Inc.",Medicare Advantage,64.641976,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
INNOMED KNEE POSITIONER DISPOSABLE PAD,,A4649,HCPCS,Facility,Inpatient,,,,128.08,108.868,36.707728,128.08,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
INNOMED KNEE POSITIONER DISPOSABLE PAD,,A4649,HCPCS,Facility,Outpatient,,,,128.08,108.868,36.707728,128.08,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),64.641976,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
INNOMED KNEE POSITIONER DISPOSABLE PAD,,A4649,HCPCS,Facility,Inpatient,,,,128.08,108.868,36.707728,128.08,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
INNOMED KNEE POSITIONER DISPOSABLE PAD,,A4649,HCPCS,Facility,Both,,,,128.08,108.868,36.707728,128.08,UnitedHealthcare,Individual & Family,120.3952,94,,percent of total billed charges,,
INNOMED KNEE POSITIONER DISPOSABLE PAD,,A4649,HCPCS,Facility,Outpatient,,,,128.08,108.868,36.707728,128.08,UnitedHealthcare,Medicare Advantage,62.7592,49,,percent of total billed charges,,
INNOMED KNEE POSITIONER DISPOSABLE PAD,,A4649,HCPCS,Facility,Inpatient,,,,128.08,108.868,36.707728,128.08,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
INNOMED KNEE POSITIONER DISPOSABLE PAD,,A4649,HCPCS,Facility,Outpatient,,,,128.08,108.868,36.707728,128.08,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,61.4784,48,,percent of total billed charges,,100% of DHS outpatient percentage
INNOMED KNEE POSITIONER DISPOSABLE PAD,,A4649,HCPCS,Facility,Inpatient,,,,128.08,108.868,36.707728,128.08,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
IOBP CORE DECOMPRESSION AND DELIVERY KIT  ARTHREX ABS-2000-OT,,A4649,HCPCS,Facility,Both,,,,1644,1397.4,471.1704,1644,Aetna,Commercial,1512.48,92,,percent of total billed charges,,
IOBP CORE DECOMPRESSION AND DELIVERY KIT  ARTHREX ABS-2000-OT,,A4649,HCPCS,Facility,Outpatient,,,,1644,1397.4,471.1704,1644,Aetna,Medicare Advantage,805.56,49,,percent of total billed charges,,
IOBP CORE DECOMPRESSION AND DELIVERY KIT  ARTHREX ABS-2000-OT,,A4649,HCPCS,Facility,Inpatient,,,,1644,1397.4,471.1704,1644,Aetna,Medicare Advantage,,,,,Included in per diem rate,
IOBP CORE DECOMPRESSION AND DELIVERY KIT  ARTHREX ABS-2000-OT,,A4649,HCPCS,Facility,Both,,,,1644,1397.4,471.1704,1644,Aetna,PPO,1528.92,93,,percent of total billed charges,,
IOBP CORE DECOMPRESSION AND DELIVERY KIT  ARTHREX ABS-2000-OT,,A4649,HCPCS,Facility,Both,,,,1644,1397.4,471.1704,1644,America's PPO,America's PPO,1578.7332,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
IOBP CORE DECOMPRESSION AND DELIVERY KIT  ARTHREX ABS-2000-OT,,A4649,HCPCS,Facility,Both,,,,1644,1397.4,471.1704,1644,BlueCross BlueShield Minnesota, Federal Employee Program,1617.696,98.4,,percent of total billed charges,,
IOBP CORE DECOMPRESSION AND DELIVERY KIT  ARTHREX ABS-2000-OT,,A4649,HCPCS,Facility,Both,,,,1644,1397.4,471.1704,1644,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1644,100,,percent of total billed charges,,
IOBP CORE DECOMPRESSION AND DELIVERY KIT  ARTHREX ABS-2000-OT,,A4649,HCPCS,Facility,Both,,,,1644,1397.4,471.1704,1644,BlueCross BlueShield Minnesota,High Value Network Plan,1479.6,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
IOBP CORE DECOMPRESSION AND DELIVERY KIT  ARTHREX ABS-2000-OT,,A4649,HCPCS,Facility,Outpatient,,,,1644,1397.4,471.1704,1644,BlueCross BlueShield Minnesota,Medicare Advantage,805.56,49,,percent of total billed charges,,
IOBP CORE DECOMPRESSION AND DELIVERY KIT  ARTHREX ABS-2000-OT,,A4649,HCPCS,Facility,Inpatient,,,,1644,1397.4,471.1704,1644,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
IOBP CORE DECOMPRESSION AND DELIVERY KIT  ARTHREX ABS-2000-OT,,A4649,HCPCS,Facility,Both,,,,1644,1397.4,471.1704,1644,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1456.0908,88.57,,percent of total billed charges,,
IOBP CORE DECOMPRESSION AND DELIVERY KIT  ARTHREX ABS-2000-OT,,A4649,HCPCS,Facility,Both,,,,1644,1397.4,471.1704,1644,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,471.1704,28.66,,percent of total billed charges,,
IOBP CORE DECOMPRESSION AND DELIVERY KIT  ARTHREX ABS-2000-OT,,A4649,HCPCS,Facility,Outpatient,,,,1644,1397.4,471.1704,1644,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),805.56,49,,percent of total billed charges,,
IOBP CORE DECOMPRESSION AND DELIVERY KIT  ARTHREX ABS-2000-OT,,A4649,HCPCS,Facility,Inpatient,,,,1644,1397.4,471.1704,1644,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
IOBP CORE DECOMPRESSION AND DELIVERY KIT  ARTHREX ABS-2000-OT,,A4649,HCPCS,Facility,Both,,,,1644,1397.4,471.1704,1644,CorVel,Worker's Compensation,1644,100,,percent of total billed charges,,
IOBP CORE DECOMPRESSION AND DELIVERY KIT  ARTHREX ABS-2000-OT,,A4649,HCPCS,Facility,Both,,,,1644,1397.4,471.1704,1644,First Health Group Corporation,First Health Network,1594.68,97,,percent of total billed charges,,
IOBP CORE DECOMPRESSION AND DELIVERY KIT  ARTHREX ABS-2000-OT,,A4649,HCPCS,Facility,Both,,,,1644,1397.4,471.1704,1644,"Health Partners, Inc.",Commercial,1555.224,94.6,,percent of total billed charges,,
IOBP CORE DECOMPRESSION AND DELIVERY KIT  ARTHREX ABS-2000-OT,,A4649,HCPCS,Facility,Outpatient,,,,1644,1397.4,471.1704,1644,"Health Partners, Inc.",Medicare Advantage,805.56,49,,percent of total billed charges,,
IOBP CORE DECOMPRESSION AND DELIVERY KIT  ARTHREX ABS-2000-OT,,A4649,HCPCS,Facility,Inpatient,,,,1644,1397.4,471.1704,1644,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
IOBP CORE DECOMPRESSION AND DELIVERY KIT  ARTHREX ABS-2000-OT,,A4649,HCPCS,Facility,Both,,,,1644,1397.4,471.1704,1644,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),986.4,60,,percent of total billed charges,,
IOBP CORE DECOMPRESSION AND DELIVERY KIT  ARTHREX ABS-2000-OT,,A4649,HCPCS,Facility,Both,,,,1644,1397.4,471.1704,1644,"Health Partners, Inc.",State of Minnesota Advantage Program,1339.86,81.5,,percent of total billed charges,,
IOBP CORE DECOMPRESSION AND DELIVERY KIT  ARTHREX ABS-2000-OT,,A4649,HCPCS,Facility,Both,,,,1644,1397.4,471.1704,1644,"Health Partners, Inc.",State Public Programs,822,50,,percent of total billed charges,,
IOBP CORE DECOMPRESSION AND DELIVERY KIT  ARTHREX ABS-2000-OT,,A4649,HCPCS,Facility,Both,,,,1644,1397.4,471.1704,1644,Humana Insurance Company,Commercial PPO,1561.8,95,,percent of total billed charges,,
IOBP CORE DECOMPRESSION AND DELIVERY KIT  ARTHREX ABS-2000-OT,,A4649,HCPCS,Facility,Outpatient,,,,1644,1397.4,471.1704,1644,Humana Insurance Company,Medicare PPO,805.56,49,,percent of total billed charges,,
IOBP CORE DECOMPRESSION AND DELIVERY KIT  ARTHREX ABS-2000-OT,,A4649,HCPCS,Facility,Inpatient,,,,1644,1397.4,471.1704,1644,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
IOBP CORE DECOMPRESSION AND DELIVERY KIT  ARTHREX ABS-2000-OT,,A4649,HCPCS,Facility,Both,,,,1644,1397.4,471.1704,1644,Medica,Individual & Family,1629.204,99.1,,percent of total billed charges,,
IOBP CORE DECOMPRESSION AND DELIVERY KIT  ARTHREX ABS-2000-OT,,A4649,HCPCS,Facility,Outpatient,,,,1644,1397.4,471.1704,1644,Medica,Medica Advantage Solution,818.712,49.8,,percent of total billed charges,,
IOBP CORE DECOMPRESSION AND DELIVERY KIT  ARTHREX ABS-2000-OT,,A4649,HCPCS,Facility,Inpatient,,,,1644,1397.4,471.1704,1644,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
IOBP CORE DECOMPRESSION AND DELIVERY KIT  ARTHREX ABS-2000-OT,,A4649,HCPCS,Facility,Outpatient,,,,1644,1397.4,471.1704,1644,Medica,Medical Assistance,733.224,44.6,,percent of total billed charges,,
IOBP CORE DECOMPRESSION AND DELIVERY KIT  ARTHREX ABS-2000-OT,,A4649,HCPCS,Facility,Inpatient,,,,1644,1397.4,471.1704,1644,Medica,Medical Assistance,,,,,Included in per diem rate,
IOBP CORE DECOMPRESSION AND DELIVERY KIT  ARTHREX ABS-2000-OT,,A4649,HCPCS,Facility,Outpatient,,,,1644,1397.4,471.1704,1644,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,818.712,49.8,,percent of total billed charges,,
IOBP CORE DECOMPRESSION AND DELIVERY KIT  ARTHREX ABS-2000-OT,,A4649,HCPCS,Facility,Inpatient,,,,1644,1397.4,471.1704,1644,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
IOBP CORE DECOMPRESSION AND DELIVERY KIT  ARTHREX ABS-2000-OT,,A4649,HCPCS,Facility,Both,,,,1644,1397.4,471.1704,1644,"Multiplan, Inc.","Multiplan, Inc.",1545.36,94,,percent of total billed charges,,
IOBP CORE DECOMPRESSION AND DELIVERY KIT  ARTHREX ABS-2000-OT,,A4649,HCPCS,Facility,Outpatient,,,,1644,1397.4,471.1704,1644,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1481.244,90.1,,percent of total billed charges,,
IOBP CORE DECOMPRESSION AND DELIVERY KIT  ARTHREX ABS-2000-OT,,A4649,HCPCS,Facility,Inpatient,,,,1644,1397.4,471.1704,1644,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
IOBP CORE DECOMPRESSION AND DELIVERY KIT  ARTHREX ABS-2000-OT,,A4649,HCPCS,Facility,Both,,,,1644,1397.4,471.1704,1644,"Preferred One Administrative Services, INC.",PPO,1620.984,98.6,,percent of total billed charges,,
IOBP CORE DECOMPRESSION AND DELIVERY KIT  ARTHREX ABS-2000-OT,,A4649,HCPCS,Facility,Outpatient,,,,1644,1397.4,471.1704,1644,PrimeWest Health,Minnesota Senior Health Options (MSHO),845.838,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
IOBP CORE DECOMPRESSION AND DELIVERY KIT  ARTHREX ABS-2000-OT,,A4649,HCPCS,Facility,Inpatient,,,,1644,1397.4,471.1704,1644,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
IOBP CORE DECOMPRESSION AND DELIVERY KIT  ARTHREX ABS-2000-OT,,A4649,HCPCS,Facility,Outpatient,,,,1644,1397.4,471.1704,1644,PrimeWest Health,MinnesotaCare,844.3584,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
IOBP CORE DECOMPRESSION AND DELIVERY KIT  ARTHREX ABS-2000-OT,,A4649,HCPCS,Facility,Inpatient,,,,1644,1397.4,471.1704,1644,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
IOBP CORE DECOMPRESSION AND DELIVERY KIT  ARTHREX ABS-2000-OT,,A4649,HCPCS,Facility,Both,,,,1644,1397.4,471.1704,1644,Sanford Health Plan,Sanford Health Plan,1512.48,92,,percent of total billed charges,,
IOBP CORE DECOMPRESSION AND DELIVERY KIT  ARTHREX ABS-2000-OT,,A4649,HCPCS,Facility,Outpatient,,,,1644,1397.4,471.1704,1644,"UCare Health, Inc.",Individual & Family Plan,926.394,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
IOBP CORE DECOMPRESSION AND DELIVERY KIT  ARTHREX ABS-2000-OT,,A4649,HCPCS,Facility,Inpatient,,,,1644,1397.4,471.1704,1644,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
IOBP CORE DECOMPRESSION AND DELIVERY KIT  ARTHREX ABS-2000-OT,,A4649,HCPCS,Facility,Outpatient,,,,1644,1397.4,471.1704,1644,"UCare Health, Inc.",Medical Assistance,829.7268,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
IOBP CORE DECOMPRESSION AND DELIVERY KIT  ARTHREX ABS-2000-OT,,A4649,HCPCS,Facility,Inpatient,,,,1644,1397.4,471.1704,1644,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
IOBP CORE DECOMPRESSION AND DELIVERY KIT  ARTHREX ABS-2000-OT,,A4649,HCPCS,Facility,Outpatient,,,,1644,1397.4,471.1704,1644,"UCare Health, Inc.",Medicare Advantage,829.7268,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
IOBP CORE DECOMPRESSION AND DELIVERY KIT  ARTHREX ABS-2000-OT,,A4649,HCPCS,Facility,Inpatient,,,,1644,1397.4,471.1704,1644,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
IOBP CORE DECOMPRESSION AND DELIVERY KIT  ARTHREX ABS-2000-OT,,A4649,HCPCS,Facility,Outpatient,,,,1644,1397.4,471.1704,1644,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),829.7268,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
IOBP CORE DECOMPRESSION AND DELIVERY KIT  ARTHREX ABS-2000-OT,,A4649,HCPCS,Facility,Inpatient,,,,1644,1397.4,471.1704,1644,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
IOBP CORE DECOMPRESSION AND DELIVERY KIT  ARTHREX ABS-2000-OT,,A4649,HCPCS,Facility,Both,,,,1644,1397.4,471.1704,1644,UnitedHealthcare,Individual & Family,1545.36,94,,percent of total billed charges,,
IOBP CORE DECOMPRESSION AND DELIVERY KIT  ARTHREX ABS-2000-OT,,A4649,HCPCS,Facility,Outpatient,,,,1644,1397.4,471.1704,1644,UnitedHealthcare,Medicare Advantage,805.56,49,,percent of total billed charges,,
IOBP CORE DECOMPRESSION AND DELIVERY KIT  ARTHREX ABS-2000-OT,,A4649,HCPCS,Facility,Inpatient,,,,1644,1397.4,471.1704,1644,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
IOBP CORE DECOMPRESSION AND DELIVERY KIT  ARTHREX ABS-2000-OT,,A4649,HCPCS,Facility,Outpatient,,,,1644,1397.4,471.1704,1644,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,789.12,48,,percent of total billed charges,,100% of DHS outpatient percentage
IOBP CORE DECOMPRESSION AND DELIVERY KIT  ARTHREX ABS-2000-OT,,A4649,HCPCS,Facility,Inpatient,,,,1644,1397.4,471.1704,1644,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
JONES DRILL 3.2MM CANNULATED,,A4649,HCPCS,Facility,Both,,,,770,654.5,220.682,770,Aetna,Commercial,708.4,92,,percent of total billed charges,,
JONES DRILL 3.2MM CANNULATED,,A4649,HCPCS,Facility,Outpatient,,,,770,654.5,220.682,770,Aetna,Medicare Advantage,377.3,49,,percent of total billed charges,,
JONES DRILL 3.2MM CANNULATED,,A4649,HCPCS,Facility,Inpatient,,,,770,654.5,220.682,770,Aetna,Medicare Advantage,,,,,Included in per diem rate,
JONES DRILL 3.2MM CANNULATED,,A4649,HCPCS,Facility,Both,,,,770,654.5,220.682,770,Aetna,PPO,716.1,93,,percent of total billed charges,,
JONES DRILL 3.2MM CANNULATED,,A4649,HCPCS,Facility,Both,,,,770,654.5,220.682,770,America's PPO,America's PPO,739.431,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
JONES DRILL 3.2MM CANNULATED,,A4649,HCPCS,Facility,Both,,,,770,654.5,220.682,770,BlueCross BlueShield Minnesota, Federal Employee Program,757.68,98.4,,percent of total billed charges,,
JONES DRILL 3.2MM CANNULATED,,A4649,HCPCS,Facility,Both,,,,770,654.5,220.682,770,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,770,100,,percent of total billed charges,,
JONES DRILL 3.2MM CANNULATED,,A4649,HCPCS,Facility,Both,,,,770,654.5,220.682,770,BlueCross BlueShield Minnesota,High Value Network Plan,693,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
JONES DRILL 3.2MM CANNULATED,,A4649,HCPCS,Facility,Outpatient,,,,770,654.5,220.682,770,BlueCross BlueShield Minnesota,Medicare Advantage,377.3,49,,percent of total billed charges,,
JONES DRILL 3.2MM CANNULATED,,A4649,HCPCS,Facility,Inpatient,,,,770,654.5,220.682,770,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
JONES DRILL 3.2MM CANNULATED,,A4649,HCPCS,Facility,Both,,,,770,654.5,220.682,770,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,681.989,88.57,,percent of total billed charges,,
JONES DRILL 3.2MM CANNULATED,,A4649,HCPCS,Facility,Both,,,,770,654.5,220.682,770,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,220.682,28.66,,percent of total billed charges,,
JONES DRILL 3.2MM CANNULATED,,A4649,HCPCS,Facility,Outpatient,,,,770,654.5,220.682,770,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),377.3,49,,percent of total billed charges,,
JONES DRILL 3.2MM CANNULATED,,A4649,HCPCS,Facility,Inpatient,,,,770,654.5,220.682,770,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
JONES DRILL 3.2MM CANNULATED,,A4649,HCPCS,Facility,Both,,,,770,654.5,220.682,770,CorVel,Worker's Compensation,770,100,,percent of total billed charges,,
JONES DRILL 3.2MM CANNULATED,,A4649,HCPCS,Facility,Both,,,,770,654.5,220.682,770,First Health Group Corporation,First Health Network,746.9,97,,percent of total billed charges,,
JONES DRILL 3.2MM CANNULATED,,A4649,HCPCS,Facility,Both,,,,770,654.5,220.682,770,"Health Partners, Inc.",Commercial,728.42,94.6,,percent of total billed charges,,
JONES DRILL 3.2MM CANNULATED,,A4649,HCPCS,Facility,Outpatient,,,,770,654.5,220.682,770,"Health Partners, Inc.",Medicare Advantage,377.3,49,,percent of total billed charges,,
JONES DRILL 3.2MM CANNULATED,,A4649,HCPCS,Facility,Inpatient,,,,770,654.5,220.682,770,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
JONES DRILL 3.2MM CANNULATED,,A4649,HCPCS,Facility,Both,,,,770,654.5,220.682,770,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),462,60,,percent of total billed charges,,
JONES DRILL 3.2MM CANNULATED,,A4649,HCPCS,Facility,Both,,,,770,654.5,220.682,770,"Health Partners, Inc.",State of Minnesota Advantage Program,627.55,81.5,,percent of total billed charges,,
JONES DRILL 3.2MM CANNULATED,,A4649,HCPCS,Facility,Both,,,,770,654.5,220.682,770,"Health Partners, Inc.",State Public Programs,385,50,,percent of total billed charges,,
JONES DRILL 3.2MM CANNULATED,,A4649,HCPCS,Facility,Both,,,,770,654.5,220.682,770,Humana Insurance Company,Commercial PPO,731.5,95,,percent of total billed charges,,
JONES DRILL 3.2MM CANNULATED,,A4649,HCPCS,Facility,Outpatient,,,,770,654.5,220.682,770,Humana Insurance Company,Medicare PPO,377.3,49,,percent of total billed charges,,
JONES DRILL 3.2MM CANNULATED,,A4649,HCPCS,Facility,Inpatient,,,,770,654.5,220.682,770,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
JONES DRILL 3.2MM CANNULATED,,A4649,HCPCS,Facility,Both,,,,770,654.5,220.682,770,Medica,Individual & Family,763.07,99.1,,percent of total billed charges,,
JONES DRILL 3.2MM CANNULATED,,A4649,HCPCS,Facility,Outpatient,,,,770,654.5,220.682,770,Medica,Medica Advantage Solution,383.46,49.8,,percent of total billed charges,,
JONES DRILL 3.2MM CANNULATED,,A4649,HCPCS,Facility,Inpatient,,,,770,654.5,220.682,770,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
JONES DRILL 3.2MM CANNULATED,,A4649,HCPCS,Facility,Outpatient,,,,770,654.5,220.682,770,Medica,Medical Assistance,343.42,44.6,,percent of total billed charges,,
JONES DRILL 3.2MM CANNULATED,,A4649,HCPCS,Facility,Inpatient,,,,770,654.5,220.682,770,Medica,Medical Assistance,,,,,Included in per diem rate,
JONES DRILL 3.2MM CANNULATED,,A4649,HCPCS,Facility,Outpatient,,,,770,654.5,220.682,770,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,383.46,49.8,,percent of total billed charges,,
JONES DRILL 3.2MM CANNULATED,,A4649,HCPCS,Facility,Inpatient,,,,770,654.5,220.682,770,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
JONES DRILL 3.2MM CANNULATED,,A4649,HCPCS,Facility,Both,,,,770,654.5,220.682,770,"Multiplan, Inc.","Multiplan, Inc.",723.8,94,,percent of total billed charges,,
JONES DRILL 3.2MM CANNULATED,,A4649,HCPCS,Facility,Outpatient,,,,770,654.5,220.682,770,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,693.77,90.1,,percent of total billed charges,,
JONES DRILL 3.2MM CANNULATED,,A4649,HCPCS,Facility,Inpatient,,,,770,654.5,220.682,770,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
JONES DRILL 3.2MM CANNULATED,,A4649,HCPCS,Facility,Both,,,,770,654.5,220.682,770,"Preferred One Administrative Services, INC.",PPO,759.22,98.6,,percent of total billed charges,,
JONES DRILL 3.2MM CANNULATED,,A4649,HCPCS,Facility,Outpatient,,,,770,654.5,220.682,770,PrimeWest Health,Minnesota Senior Health Options (MSHO),396.165,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
JONES DRILL 3.2MM CANNULATED,,A4649,HCPCS,Facility,Inpatient,,,,770,654.5,220.682,770,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
JONES DRILL 3.2MM CANNULATED,,A4649,HCPCS,Facility,Outpatient,,,,770,654.5,220.682,770,PrimeWest Health,MinnesotaCare,395.472,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
JONES DRILL 3.2MM CANNULATED,,A4649,HCPCS,Facility,Inpatient,,,,770,654.5,220.682,770,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
JONES DRILL 3.2MM CANNULATED,,A4649,HCPCS,Facility,Both,,,,770,654.5,220.682,770,Sanford Health Plan,Sanford Health Plan,708.4,92,,percent of total billed charges,,
JONES DRILL 3.2MM CANNULATED,,A4649,HCPCS,Facility,Outpatient,,,,770,654.5,220.682,770,"UCare Health, Inc.",Individual & Family Plan,433.895,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
JONES DRILL 3.2MM CANNULATED,,A4649,HCPCS,Facility,Inpatient,,,,770,654.5,220.682,770,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
JONES DRILL 3.2MM CANNULATED,,A4649,HCPCS,Facility,Outpatient,,,,770,654.5,220.682,770,"UCare Health, Inc.",Medical Assistance,388.619,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
JONES DRILL 3.2MM CANNULATED,,A4649,HCPCS,Facility,Inpatient,,,,770,654.5,220.682,770,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
JONES DRILL 3.2MM CANNULATED,,A4649,HCPCS,Facility,Outpatient,,,,770,654.5,220.682,770,"UCare Health, Inc.",Medicare Advantage,388.619,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
JONES DRILL 3.2MM CANNULATED,,A4649,HCPCS,Facility,Inpatient,,,,770,654.5,220.682,770,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
JONES DRILL 3.2MM CANNULATED,,A4649,HCPCS,Facility,Outpatient,,,,770,654.5,220.682,770,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),388.619,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
JONES DRILL 3.2MM CANNULATED,,A4649,HCPCS,Facility,Inpatient,,,,770,654.5,220.682,770,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
JONES DRILL 3.2MM CANNULATED,,A4649,HCPCS,Facility,Both,,,,770,654.5,220.682,770,UnitedHealthcare,Individual & Family,723.8,94,,percent of total billed charges,,
JONES DRILL 3.2MM CANNULATED,,A4649,HCPCS,Facility,Outpatient,,,,770,654.5,220.682,770,UnitedHealthcare,Medicare Advantage,377.3,49,,percent of total billed charges,,
JONES DRILL 3.2MM CANNULATED,,A4649,HCPCS,Facility,Inpatient,,,,770,654.5,220.682,770,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
JONES DRILL 3.2MM CANNULATED,,A4649,HCPCS,Facility,Outpatient,,,,770,654.5,220.682,770,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,369.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
JONES DRILL 3.2MM CANNULATED,,A4649,HCPCS,Facility,Inpatient,,,,770,654.5,220.682,770,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
JP 10MM ROUND DRAIN,,A4649,HCPCS,Facility,Both,,,,29.15,24.7775,8.35439,29.15,Aetna,Commercial,26.818,92,,percent of total billed charges,,
JP 10MM ROUND DRAIN,,A4649,HCPCS,Facility,Outpatient,,,,29.15,24.7775,8.35439,29.15,Aetna,Medicare Advantage,14.2835,49,,percent of total billed charges,,
JP 10MM ROUND DRAIN,,A4649,HCPCS,Facility,Inpatient,,,,29.15,24.7775,8.35439,29.15,Aetna,Medicare Advantage,,,,,Included in per diem rate,
JP 10MM ROUND DRAIN,,A4649,HCPCS,Facility,Both,,,,29.15,24.7775,8.35439,29.15,Aetna,PPO,27.1095,93,,percent of total billed charges,,
JP 10MM ROUND DRAIN,,A4649,HCPCS,Facility,Both,,,,29.15,24.7775,8.35439,29.15,America's PPO,America's PPO,27.992745,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
JP 10MM ROUND DRAIN,,A4649,HCPCS,Facility,Both,,,,29.15,24.7775,8.35439,29.15,BlueCross BlueShield Minnesota, Federal Employee Program,28.6836,98.4,,percent of total billed charges,,
JP 10MM ROUND DRAIN,,A4649,HCPCS,Facility,Both,,,,29.15,24.7775,8.35439,29.15,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,29.15,100,,percent of total billed charges,,
JP 10MM ROUND DRAIN,,A4649,HCPCS,Facility,Both,,,,29.15,24.7775,8.35439,29.15,BlueCross BlueShield Minnesota,High Value Network Plan,26.235,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
JP 10MM ROUND DRAIN,,A4649,HCPCS,Facility,Outpatient,,,,29.15,24.7775,8.35439,29.15,BlueCross BlueShield Minnesota,Medicare Advantage,14.2835,49,,percent of total billed charges,,
JP 10MM ROUND DRAIN,,A4649,HCPCS,Facility,Inpatient,,,,29.15,24.7775,8.35439,29.15,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
JP 10MM ROUND DRAIN,,A4649,HCPCS,Facility,Both,,,,29.15,24.7775,8.35439,29.15,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,25.818155,88.57,,percent of total billed charges,,
JP 10MM ROUND DRAIN,,A4649,HCPCS,Facility,Both,,,,29.15,24.7775,8.35439,29.15,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,8.35439,28.66,,percent of total billed charges,,
JP 10MM ROUND DRAIN,,A4649,HCPCS,Facility,Outpatient,,,,29.15,24.7775,8.35439,29.15,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),14.2835,49,,percent of total billed charges,,
JP 10MM ROUND DRAIN,,A4649,HCPCS,Facility,Inpatient,,,,29.15,24.7775,8.35439,29.15,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
JP 10MM ROUND DRAIN,,A4649,HCPCS,Facility,Both,,,,29.15,24.7775,8.35439,29.15,CorVel,Worker's Compensation,29.15,100,,percent of total billed charges,,
JP 10MM ROUND DRAIN,,A4649,HCPCS,Facility,Both,,,,29.15,24.7775,8.35439,29.15,First Health Group Corporation,First Health Network,28.2755,97,,percent of total billed charges,,
JP 10MM ROUND DRAIN,,A4649,HCPCS,Facility,Both,,,,29.15,24.7775,8.35439,29.15,"Health Partners, Inc.",Commercial,27.5759,94.6,,percent of total billed charges,,
JP 10MM ROUND DRAIN,,A4649,HCPCS,Facility,Outpatient,,,,29.15,24.7775,8.35439,29.15,"Health Partners, Inc.",Medicare Advantage,14.2835,49,,percent of total billed charges,,
JP 10MM ROUND DRAIN,,A4649,HCPCS,Facility,Inpatient,,,,29.15,24.7775,8.35439,29.15,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
JP 10MM ROUND DRAIN,,A4649,HCPCS,Facility,Both,,,,29.15,24.7775,8.35439,29.15,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),17.49,60,,percent of total billed charges,,
JP 10MM ROUND DRAIN,,A4649,HCPCS,Facility,Both,,,,29.15,24.7775,8.35439,29.15,"Health Partners, Inc.",State of Minnesota Advantage Program,23.75725,81.5,,percent of total billed charges,,
JP 10MM ROUND DRAIN,,A4649,HCPCS,Facility,Both,,,,29.15,24.7775,8.35439,29.15,"Health Partners, Inc.",State Public Programs,14.575,50,,percent of total billed charges,,
JP 10MM ROUND DRAIN,,A4649,HCPCS,Facility,Both,,,,29.15,24.7775,8.35439,29.15,Humana Insurance Company,Commercial PPO,27.6925,95,,percent of total billed charges,,
JP 10MM ROUND DRAIN,,A4649,HCPCS,Facility,Outpatient,,,,29.15,24.7775,8.35439,29.15,Humana Insurance Company,Medicare PPO,14.2835,49,,percent of total billed charges,,
JP 10MM ROUND DRAIN,,A4649,HCPCS,Facility,Inpatient,,,,29.15,24.7775,8.35439,29.15,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
JP 10MM ROUND DRAIN,,A4649,HCPCS,Facility,Both,,,,29.15,24.7775,8.35439,29.15,Medica,Individual & Family,28.88765,99.1,,percent of total billed charges,,
JP 10MM ROUND DRAIN,,A4649,HCPCS,Facility,Outpatient,,,,29.15,24.7775,8.35439,29.15,Medica,Medica Advantage Solution,14.5167,49.8,,percent of total billed charges,,
JP 10MM ROUND DRAIN,,A4649,HCPCS,Facility,Inpatient,,,,29.15,24.7775,8.35439,29.15,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
JP 10MM ROUND DRAIN,,A4649,HCPCS,Facility,Outpatient,,,,29.15,24.7775,8.35439,29.15,Medica,Medical Assistance,13.0009,44.6,,percent of total billed charges,,
JP 10MM ROUND DRAIN,,A4649,HCPCS,Facility,Inpatient,,,,29.15,24.7775,8.35439,29.15,Medica,Medical Assistance,,,,,Included in per diem rate,
JP 10MM ROUND DRAIN,,A4649,HCPCS,Facility,Outpatient,,,,29.15,24.7775,8.35439,29.15,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,14.5167,49.8,,percent of total billed charges,,
JP 10MM ROUND DRAIN,,A4649,HCPCS,Facility,Inpatient,,,,29.15,24.7775,8.35439,29.15,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
JP 10MM ROUND DRAIN,,A4649,HCPCS,Facility,Both,,,,29.15,24.7775,8.35439,29.15,"Multiplan, Inc.","Multiplan, Inc.",27.401,94,,percent of total billed charges,,
JP 10MM ROUND DRAIN,,A4649,HCPCS,Facility,Outpatient,,,,29.15,24.7775,8.35439,29.15,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,26.26415,90.1,,percent of total billed charges,,
JP 10MM ROUND DRAIN,,A4649,HCPCS,Facility,Inpatient,,,,29.15,24.7775,8.35439,29.15,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
JP 10MM ROUND DRAIN,,A4649,HCPCS,Facility,Both,,,,29.15,24.7775,8.35439,29.15,"Preferred One Administrative Services, INC.",PPO,28.7419,98.6,,percent of total billed charges,,
JP 10MM ROUND DRAIN,,A4649,HCPCS,Facility,Outpatient,,,,29.15,24.7775,8.35439,29.15,PrimeWest Health,Minnesota Senior Health Options (MSHO),14.997675,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
JP 10MM ROUND DRAIN,,A4649,HCPCS,Facility,Inpatient,,,,29.15,24.7775,8.35439,29.15,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
JP 10MM ROUND DRAIN,,A4649,HCPCS,Facility,Outpatient,,,,29.15,24.7775,8.35439,29.15,PrimeWest Health,MinnesotaCare,14.97144,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
JP 10MM ROUND DRAIN,,A4649,HCPCS,Facility,Inpatient,,,,29.15,24.7775,8.35439,29.15,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
JP 10MM ROUND DRAIN,,A4649,HCPCS,Facility,Both,,,,29.15,24.7775,8.35439,29.15,Sanford Health Plan,Sanford Health Plan,26.818,92,,percent of total billed charges,,
JP 10MM ROUND DRAIN,,A4649,HCPCS,Facility,Outpatient,,,,29.15,24.7775,8.35439,29.15,"UCare Health, Inc.",Individual & Family Plan,16.426025,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
JP 10MM ROUND DRAIN,,A4649,HCPCS,Facility,Inpatient,,,,29.15,24.7775,8.35439,29.15,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
JP 10MM ROUND DRAIN,,A4649,HCPCS,Facility,Outpatient,,,,29.15,24.7775,8.35439,29.15,"UCare Health, Inc.",Medical Assistance,14.712005,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
JP 10MM ROUND DRAIN,,A4649,HCPCS,Facility,Inpatient,,,,29.15,24.7775,8.35439,29.15,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
JP 10MM ROUND DRAIN,,A4649,HCPCS,Facility,Outpatient,,,,29.15,24.7775,8.35439,29.15,"UCare Health, Inc.",Medicare Advantage,14.712005,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
JP 10MM ROUND DRAIN,,A4649,HCPCS,Facility,Inpatient,,,,29.15,24.7775,8.35439,29.15,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
JP 10MM ROUND DRAIN,,A4649,HCPCS,Facility,Outpatient,,,,29.15,24.7775,8.35439,29.15,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),14.712005,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
JP 10MM ROUND DRAIN,,A4649,HCPCS,Facility,Inpatient,,,,29.15,24.7775,8.35439,29.15,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
JP 10MM ROUND DRAIN,,A4649,HCPCS,Facility,Both,,,,29.15,24.7775,8.35439,29.15,UnitedHealthcare,Individual & Family,27.401,94,,percent of total billed charges,,
JP 10MM ROUND DRAIN,,A4649,HCPCS,Facility,Outpatient,,,,29.15,24.7775,8.35439,29.15,UnitedHealthcare,Medicare Advantage,14.2835,49,,percent of total billed charges,,
JP 10MM ROUND DRAIN,,A4649,HCPCS,Facility,Inpatient,,,,29.15,24.7775,8.35439,29.15,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
JP 10MM ROUND DRAIN,,A4649,HCPCS,Facility,Outpatient,,,,29.15,24.7775,8.35439,29.15,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,13.992,48,,percent of total billed charges,,100% of DHS outpatient percentage
JP 10MM ROUND DRAIN,,A4649,HCPCS,Facility,Inpatient,,,,29.15,24.7775,8.35439,29.15,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
JURGAN PIN BALL,,A4649,HCPCS,Facility,Both,,,,148,125.8,42.4168,148,Aetna,Commercial,136.16,92,,percent of total billed charges,,
JURGAN PIN BALL,,A4649,HCPCS,Facility,Outpatient,,,,148,125.8,42.4168,148,Aetna,Medicare Advantage,72.52,49,,percent of total billed charges,,
JURGAN PIN BALL,,A4649,HCPCS,Facility,Inpatient,,,,148,125.8,42.4168,148,Aetna,Medicare Advantage,,,,,Included in per diem rate,
JURGAN PIN BALL,,A4649,HCPCS,Facility,Both,,,,148,125.8,42.4168,148,Aetna,PPO,137.64,93,,percent of total billed charges,,
JURGAN PIN BALL,,A4649,HCPCS,Facility,Both,,,,148,125.8,42.4168,148,America's PPO,America's PPO,142.1244,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
JURGAN PIN BALL,,A4649,HCPCS,Facility,Both,,,,148,125.8,42.4168,148,BlueCross BlueShield Minnesota, Federal Employee Program,145.632,98.4,,percent of total billed charges,,
JURGAN PIN BALL,,A4649,HCPCS,Facility,Both,,,,148,125.8,42.4168,148,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,148,100,,percent of total billed charges,,
JURGAN PIN BALL,,A4649,HCPCS,Facility,Both,,,,148,125.8,42.4168,148,BlueCross BlueShield Minnesota,High Value Network Plan,133.2,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
JURGAN PIN BALL,,A4649,HCPCS,Facility,Outpatient,,,,148,125.8,42.4168,148,BlueCross BlueShield Minnesota,Medicare Advantage,72.52,49,,percent of total billed charges,,
JURGAN PIN BALL,,A4649,HCPCS,Facility,Inpatient,,,,148,125.8,42.4168,148,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
JURGAN PIN BALL,,A4649,HCPCS,Facility,Both,,,,148,125.8,42.4168,148,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,131.0836,88.57,,percent of total billed charges,,
JURGAN PIN BALL,,A4649,HCPCS,Facility,Both,,,,148,125.8,42.4168,148,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,42.4168,28.66,,percent of total billed charges,,
JURGAN PIN BALL,,A4649,HCPCS,Facility,Outpatient,,,,148,125.8,42.4168,148,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),72.52,49,,percent of total billed charges,,
JURGAN PIN BALL,,A4649,HCPCS,Facility,Inpatient,,,,148,125.8,42.4168,148,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
JURGAN PIN BALL,,A4649,HCPCS,Facility,Both,,,,148,125.8,42.4168,148,CorVel,Worker's Compensation,148,100,,percent of total billed charges,,
JURGAN PIN BALL,,A4649,HCPCS,Facility,Both,,,,148,125.8,42.4168,148,First Health Group Corporation,First Health Network,143.56,97,,percent of total billed charges,,
JURGAN PIN BALL,,A4649,HCPCS,Facility,Both,,,,148,125.8,42.4168,148,"Health Partners, Inc.",Commercial,140.008,94.6,,percent of total billed charges,,
JURGAN PIN BALL,,A4649,HCPCS,Facility,Outpatient,,,,148,125.8,42.4168,148,"Health Partners, Inc.",Medicare Advantage,72.52,49,,percent of total billed charges,,
JURGAN PIN BALL,,A4649,HCPCS,Facility,Inpatient,,,,148,125.8,42.4168,148,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
JURGAN PIN BALL,,A4649,HCPCS,Facility,Both,,,,148,125.8,42.4168,148,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),88.8,60,,percent of total billed charges,,
JURGAN PIN BALL,,A4649,HCPCS,Facility,Both,,,,148,125.8,42.4168,148,"Health Partners, Inc.",State of Minnesota Advantage Program,120.62,81.5,,percent of total billed charges,,
JURGAN PIN BALL,,A4649,HCPCS,Facility,Both,,,,148,125.8,42.4168,148,"Health Partners, Inc.",State Public Programs,74,50,,percent of total billed charges,,
JURGAN PIN BALL,,A4649,HCPCS,Facility,Both,,,,148,125.8,42.4168,148,Humana Insurance Company,Commercial PPO,140.6,95,,percent of total billed charges,,
JURGAN PIN BALL,,A4649,HCPCS,Facility,Outpatient,,,,148,125.8,42.4168,148,Humana Insurance Company,Medicare PPO,72.52,49,,percent of total billed charges,,
JURGAN PIN BALL,,A4649,HCPCS,Facility,Inpatient,,,,148,125.8,42.4168,148,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
JURGAN PIN BALL,,A4649,HCPCS,Facility,Both,,,,148,125.8,42.4168,148,Medica,Individual & Family,146.668,99.1,,percent of total billed charges,,
JURGAN PIN BALL,,A4649,HCPCS,Facility,Outpatient,,,,148,125.8,42.4168,148,Medica,Medica Advantage Solution,73.704,49.8,,percent of total billed charges,,
JURGAN PIN BALL,,A4649,HCPCS,Facility,Inpatient,,,,148,125.8,42.4168,148,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
JURGAN PIN BALL,,A4649,HCPCS,Facility,Outpatient,,,,148,125.8,42.4168,148,Medica,Medical Assistance,66.008,44.6,,percent of total billed charges,,
JURGAN PIN BALL,,A4649,HCPCS,Facility,Inpatient,,,,148,125.8,42.4168,148,Medica,Medical Assistance,,,,,Included in per diem rate,
JURGAN PIN BALL,,A4649,HCPCS,Facility,Outpatient,,,,148,125.8,42.4168,148,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,73.704,49.8,,percent of total billed charges,,
JURGAN PIN BALL,,A4649,HCPCS,Facility,Inpatient,,,,148,125.8,42.4168,148,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
JURGAN PIN BALL,,A4649,HCPCS,Facility,Both,,,,148,125.8,42.4168,148,"Multiplan, Inc.","Multiplan, Inc.",139.12,94,,percent of total billed charges,,
JURGAN PIN BALL,,A4649,HCPCS,Facility,Outpatient,,,,148,125.8,42.4168,148,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,133.348,90.1,,percent of total billed charges,,
JURGAN PIN BALL,,A4649,HCPCS,Facility,Inpatient,,,,148,125.8,42.4168,148,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
JURGAN PIN BALL,,A4649,HCPCS,Facility,Both,,,,148,125.8,42.4168,148,"Preferred One Administrative Services, INC.",PPO,145.928,98.6,,percent of total billed charges,,
JURGAN PIN BALL,,A4649,HCPCS,Facility,Outpatient,,,,148,125.8,42.4168,148,PrimeWest Health,Minnesota Senior Health Options (MSHO),76.146,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
JURGAN PIN BALL,,A4649,HCPCS,Facility,Inpatient,,,,148,125.8,42.4168,148,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
JURGAN PIN BALL,,A4649,HCPCS,Facility,Outpatient,,,,148,125.8,42.4168,148,PrimeWest Health,MinnesotaCare,76.0128,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
JURGAN PIN BALL,,A4649,HCPCS,Facility,Inpatient,,,,148,125.8,42.4168,148,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
JURGAN PIN BALL,,A4649,HCPCS,Facility,Both,,,,148,125.8,42.4168,148,Sanford Health Plan,Sanford Health Plan,136.16,92,,percent of total billed charges,,
JURGAN PIN BALL,,A4649,HCPCS,Facility,Outpatient,,,,148,125.8,42.4168,148,"UCare Health, Inc.",Individual & Family Plan,83.398,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
JURGAN PIN BALL,,A4649,HCPCS,Facility,Inpatient,,,,148,125.8,42.4168,148,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
JURGAN PIN BALL,,A4649,HCPCS,Facility,Outpatient,,,,148,125.8,42.4168,148,"UCare Health, Inc.",Medical Assistance,74.6956,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
JURGAN PIN BALL,,A4649,HCPCS,Facility,Inpatient,,,,148,125.8,42.4168,148,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
JURGAN PIN BALL,,A4649,HCPCS,Facility,Outpatient,,,,148,125.8,42.4168,148,"UCare Health, Inc.",Medicare Advantage,74.6956,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
JURGAN PIN BALL,,A4649,HCPCS,Facility,Inpatient,,,,148,125.8,42.4168,148,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
JURGAN PIN BALL,,A4649,HCPCS,Facility,Outpatient,,,,148,125.8,42.4168,148,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),74.6956,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
JURGAN PIN BALL,,A4649,HCPCS,Facility,Inpatient,,,,148,125.8,42.4168,148,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
JURGAN PIN BALL,,A4649,HCPCS,Facility,Both,,,,148,125.8,42.4168,148,UnitedHealthcare,Individual & Family,139.12,94,,percent of total billed charges,,
JURGAN PIN BALL,,A4649,HCPCS,Facility,Outpatient,,,,148,125.8,42.4168,148,UnitedHealthcare,Medicare Advantage,72.52,49,,percent of total billed charges,,
JURGAN PIN BALL,,A4649,HCPCS,Facility,Inpatient,,,,148,125.8,42.4168,148,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
JURGAN PIN BALL,,A4649,HCPCS,Facility,Outpatient,,,,148,125.8,42.4168,148,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,71.04,48,,percent of total billed charges,,100% of DHS outpatient percentage
JURGAN PIN BALL,,A4649,HCPCS,Facility,Inpatient,,,,148,125.8,42.4168,148,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
KIRSCHNER WIRES THREADED .062,,A4649,HCPCS,Facility,Both,,,,148,125.8,42.4168,148,Aetna,Commercial,136.16,92,,percent of total billed charges,,
KIRSCHNER WIRES THREADED .062,,A4649,HCPCS,Facility,Outpatient,,,,148,125.8,42.4168,148,Aetna,Medicare Advantage,72.52,49,,percent of total billed charges,,
KIRSCHNER WIRES THREADED .062,,A4649,HCPCS,Facility,Inpatient,,,,148,125.8,42.4168,148,Aetna,Medicare Advantage,,,,,Included in per diem rate,
KIRSCHNER WIRES THREADED .062,,A4649,HCPCS,Facility,Both,,,,148,125.8,42.4168,148,Aetna,PPO,137.64,93,,percent of total billed charges,,
KIRSCHNER WIRES THREADED .062,,A4649,HCPCS,Facility,Both,,,,148,125.8,42.4168,148,America's PPO,America's PPO,142.1244,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
KIRSCHNER WIRES THREADED .062,,A4649,HCPCS,Facility,Both,,,,148,125.8,42.4168,148,BlueCross BlueShield Minnesota, Federal Employee Program,145.632,98.4,,percent of total billed charges,,
KIRSCHNER WIRES THREADED .062,,A4649,HCPCS,Facility,Both,,,,148,125.8,42.4168,148,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,148,100,,percent of total billed charges,,
KIRSCHNER WIRES THREADED .062,,A4649,HCPCS,Facility,Both,,,,148,125.8,42.4168,148,BlueCross BlueShield Minnesota,High Value Network Plan,133.2,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
KIRSCHNER WIRES THREADED .062,,A4649,HCPCS,Facility,Outpatient,,,,148,125.8,42.4168,148,BlueCross BlueShield Minnesota,Medicare Advantage,72.52,49,,percent of total billed charges,,
KIRSCHNER WIRES THREADED .062,,A4649,HCPCS,Facility,Inpatient,,,,148,125.8,42.4168,148,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
KIRSCHNER WIRES THREADED .062,,A4649,HCPCS,Facility,Both,,,,148,125.8,42.4168,148,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,131.0836,88.57,,percent of total billed charges,,
KIRSCHNER WIRES THREADED .062,,A4649,HCPCS,Facility,Both,,,,148,125.8,42.4168,148,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,42.4168,28.66,,percent of total billed charges,,
KIRSCHNER WIRES THREADED .062,,A4649,HCPCS,Facility,Outpatient,,,,148,125.8,42.4168,148,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),72.52,49,,percent of total billed charges,,
KIRSCHNER WIRES THREADED .062,,A4649,HCPCS,Facility,Inpatient,,,,148,125.8,42.4168,148,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
KIRSCHNER WIRES THREADED .062,,A4649,HCPCS,Facility,Both,,,,148,125.8,42.4168,148,CorVel,Worker's Compensation,148,100,,percent of total billed charges,,
KIRSCHNER WIRES THREADED .062,,A4649,HCPCS,Facility,Both,,,,148,125.8,42.4168,148,First Health Group Corporation,First Health Network,143.56,97,,percent of total billed charges,,
KIRSCHNER WIRES THREADED .062,,A4649,HCPCS,Facility,Both,,,,148,125.8,42.4168,148,"Health Partners, Inc.",Commercial,140.008,94.6,,percent of total billed charges,,
KIRSCHNER WIRES THREADED .062,,A4649,HCPCS,Facility,Outpatient,,,,148,125.8,42.4168,148,"Health Partners, Inc.",Medicare Advantage,72.52,49,,percent of total billed charges,,
KIRSCHNER WIRES THREADED .062,,A4649,HCPCS,Facility,Inpatient,,,,148,125.8,42.4168,148,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
KIRSCHNER WIRES THREADED .062,,A4649,HCPCS,Facility,Both,,,,148,125.8,42.4168,148,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),88.8,60,,percent of total billed charges,,
KIRSCHNER WIRES THREADED .062,,A4649,HCPCS,Facility,Both,,,,148,125.8,42.4168,148,"Health Partners, Inc.",State of Minnesota Advantage Program,120.62,81.5,,percent of total billed charges,,
KIRSCHNER WIRES THREADED .062,,A4649,HCPCS,Facility,Both,,,,148,125.8,42.4168,148,"Health Partners, Inc.",State Public Programs,74,50,,percent of total billed charges,,
KIRSCHNER WIRES THREADED .062,,A4649,HCPCS,Facility,Both,,,,148,125.8,42.4168,148,Humana Insurance Company,Commercial PPO,140.6,95,,percent of total billed charges,,
KIRSCHNER WIRES THREADED .062,,A4649,HCPCS,Facility,Outpatient,,,,148,125.8,42.4168,148,Humana Insurance Company,Medicare PPO,72.52,49,,percent of total billed charges,,
KIRSCHNER WIRES THREADED .062,,A4649,HCPCS,Facility,Inpatient,,,,148,125.8,42.4168,148,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
KIRSCHNER WIRES THREADED .062,,A4649,HCPCS,Facility,Both,,,,148,125.8,42.4168,148,Medica,Individual & Family,146.668,99.1,,percent of total billed charges,,
KIRSCHNER WIRES THREADED .062,,A4649,HCPCS,Facility,Outpatient,,,,148,125.8,42.4168,148,Medica,Medica Advantage Solution,73.704,49.8,,percent of total billed charges,,
KIRSCHNER WIRES THREADED .062,,A4649,HCPCS,Facility,Inpatient,,,,148,125.8,42.4168,148,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
KIRSCHNER WIRES THREADED .062,,A4649,HCPCS,Facility,Outpatient,,,,148,125.8,42.4168,148,Medica,Medical Assistance,66.008,44.6,,percent of total billed charges,,
KIRSCHNER WIRES THREADED .062,,A4649,HCPCS,Facility,Inpatient,,,,148,125.8,42.4168,148,Medica,Medical Assistance,,,,,Included in per diem rate,
KIRSCHNER WIRES THREADED .062,,A4649,HCPCS,Facility,Outpatient,,,,148,125.8,42.4168,148,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,73.704,49.8,,percent of total billed charges,,
KIRSCHNER WIRES THREADED .062,,A4649,HCPCS,Facility,Inpatient,,,,148,125.8,42.4168,148,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
KIRSCHNER WIRES THREADED .062,,A4649,HCPCS,Facility,Both,,,,148,125.8,42.4168,148,"Multiplan, Inc.","Multiplan, Inc.",139.12,94,,percent of total billed charges,,
KIRSCHNER WIRES THREADED .062,,A4649,HCPCS,Facility,Outpatient,,,,148,125.8,42.4168,148,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,133.348,90.1,,percent of total billed charges,,
KIRSCHNER WIRES THREADED .062,,A4649,HCPCS,Facility,Inpatient,,,,148,125.8,42.4168,148,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
KIRSCHNER WIRES THREADED .062,,A4649,HCPCS,Facility,Both,,,,148,125.8,42.4168,148,"Preferred One Administrative Services, INC.",PPO,145.928,98.6,,percent of total billed charges,,
KIRSCHNER WIRES THREADED .062,,A4649,HCPCS,Facility,Outpatient,,,,148,125.8,42.4168,148,PrimeWest Health,Minnesota Senior Health Options (MSHO),76.146,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
KIRSCHNER WIRES THREADED .062,,A4649,HCPCS,Facility,Inpatient,,,,148,125.8,42.4168,148,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
KIRSCHNER WIRES THREADED .062,,A4649,HCPCS,Facility,Outpatient,,,,148,125.8,42.4168,148,PrimeWest Health,MinnesotaCare,76.0128,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
KIRSCHNER WIRES THREADED .062,,A4649,HCPCS,Facility,Inpatient,,,,148,125.8,42.4168,148,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
KIRSCHNER WIRES THREADED .062,,A4649,HCPCS,Facility,Both,,,,148,125.8,42.4168,148,Sanford Health Plan,Sanford Health Plan,136.16,92,,percent of total billed charges,,
KIRSCHNER WIRES THREADED .062,,A4649,HCPCS,Facility,Outpatient,,,,148,125.8,42.4168,148,"UCare Health, Inc.",Individual & Family Plan,83.398,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
KIRSCHNER WIRES THREADED .062,,A4649,HCPCS,Facility,Inpatient,,,,148,125.8,42.4168,148,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
KIRSCHNER WIRES THREADED .062,,A4649,HCPCS,Facility,Outpatient,,,,148,125.8,42.4168,148,"UCare Health, Inc.",Medical Assistance,74.6956,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
KIRSCHNER WIRES THREADED .062,,A4649,HCPCS,Facility,Inpatient,,,,148,125.8,42.4168,148,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
KIRSCHNER WIRES THREADED .062,,A4649,HCPCS,Facility,Outpatient,,,,148,125.8,42.4168,148,"UCare Health, Inc.",Medicare Advantage,74.6956,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
KIRSCHNER WIRES THREADED .062,,A4649,HCPCS,Facility,Inpatient,,,,148,125.8,42.4168,148,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
KIRSCHNER WIRES THREADED .062,,A4649,HCPCS,Facility,Outpatient,,,,148,125.8,42.4168,148,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),74.6956,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
KIRSCHNER WIRES THREADED .062,,A4649,HCPCS,Facility,Inpatient,,,,148,125.8,42.4168,148,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
KIRSCHNER WIRES THREADED .062,,A4649,HCPCS,Facility,Both,,,,148,125.8,42.4168,148,UnitedHealthcare,Individual & Family,139.12,94,,percent of total billed charges,,
KIRSCHNER WIRES THREADED .062,,A4649,HCPCS,Facility,Outpatient,,,,148,125.8,42.4168,148,UnitedHealthcare,Medicare Advantage,72.52,49,,percent of total billed charges,,
KIRSCHNER WIRES THREADED .062,,A4649,HCPCS,Facility,Inpatient,,,,148,125.8,42.4168,148,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
KIRSCHNER WIRES THREADED .062,,A4649,HCPCS,Facility,Outpatient,,,,148,125.8,42.4168,148,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,71.04,48,,percent of total billed charges,,100% of DHS outpatient percentage
KIRSCHNER WIRES THREADED .062,,A4649,HCPCS,Facility,Inpatient,,,,148,125.8,42.4168,148,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
KNEE WEDGE FOAM   925.AAKWM,,A4649,HCPCS,Facility,Both,,,,140,119,40.124,140,Aetna,Commercial,128.8,92,,percent of total billed charges,,
KNEE WEDGE FOAM   925.AAKWM,,A4649,HCPCS,Facility,Outpatient,,,,140,119,40.124,140,Aetna,Medicare Advantage,68.6,49,,percent of total billed charges,,
KNEE WEDGE FOAM   925.AAKWM,,A4649,HCPCS,Facility,Inpatient,,,,140,119,40.124,140,Aetna,Medicare Advantage,,,,,Included in per diem rate,
KNEE WEDGE FOAM   925.AAKWM,,A4649,HCPCS,Facility,Both,,,,140,119,40.124,140,Aetna,PPO,130.2,93,,percent of total billed charges,,
KNEE WEDGE FOAM   925.AAKWM,,A4649,HCPCS,Facility,Both,,,,140,119,40.124,140,America's PPO,America's PPO,134.442,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
KNEE WEDGE FOAM   925.AAKWM,,A4649,HCPCS,Facility,Both,,,,140,119,40.124,140,BlueCross BlueShield Minnesota, Federal Employee Program,137.76,98.4,,percent of total billed charges,,
KNEE WEDGE FOAM   925.AAKWM,,A4649,HCPCS,Facility,Both,,,,140,119,40.124,140,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,140,100,,percent of total billed charges,,
KNEE WEDGE FOAM   925.AAKWM,,A4649,HCPCS,Facility,Both,,,,140,119,40.124,140,BlueCross BlueShield Minnesota,High Value Network Plan,126,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
KNEE WEDGE FOAM   925.AAKWM,,A4649,HCPCS,Facility,Outpatient,,,,140,119,40.124,140,BlueCross BlueShield Minnesota,Medicare Advantage,68.6,49,,percent of total billed charges,,
KNEE WEDGE FOAM   925.AAKWM,,A4649,HCPCS,Facility,Inpatient,,,,140,119,40.124,140,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
KNEE WEDGE FOAM   925.AAKWM,,A4649,HCPCS,Facility,Both,,,,140,119,40.124,140,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,123.998,88.57,,percent of total billed charges,,
KNEE WEDGE FOAM   925.AAKWM,,A4649,HCPCS,Facility,Both,,,,140,119,40.124,140,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,40.124,28.66,,percent of total billed charges,,
KNEE WEDGE FOAM   925.AAKWM,,A4649,HCPCS,Facility,Outpatient,,,,140,119,40.124,140,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),68.6,49,,percent of total billed charges,,
KNEE WEDGE FOAM   925.AAKWM,,A4649,HCPCS,Facility,Inpatient,,,,140,119,40.124,140,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
KNEE WEDGE FOAM   925.AAKWM,,A4649,HCPCS,Facility,Both,,,,140,119,40.124,140,CorVel,Worker's Compensation,140,100,,percent of total billed charges,,
KNEE WEDGE FOAM   925.AAKWM,,A4649,HCPCS,Facility,Both,,,,140,119,40.124,140,First Health Group Corporation,First Health Network,135.8,97,,percent of total billed charges,,
KNEE WEDGE FOAM   925.AAKWM,,A4649,HCPCS,Facility,Both,,,,140,119,40.124,140,"Health Partners, Inc.",Commercial,132.44,94.6,,percent of total billed charges,,
KNEE WEDGE FOAM   925.AAKWM,,A4649,HCPCS,Facility,Outpatient,,,,140,119,40.124,140,"Health Partners, Inc.",Medicare Advantage,68.6,49,,percent of total billed charges,,
KNEE WEDGE FOAM   925.AAKWM,,A4649,HCPCS,Facility,Inpatient,,,,140,119,40.124,140,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
KNEE WEDGE FOAM   925.AAKWM,,A4649,HCPCS,Facility,Both,,,,140,119,40.124,140,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),84,60,,percent of total billed charges,,
KNEE WEDGE FOAM   925.AAKWM,,A4649,HCPCS,Facility,Both,,,,140,119,40.124,140,"Health Partners, Inc.",State of Minnesota Advantage Program,114.1,81.5,,percent of total billed charges,,
KNEE WEDGE FOAM   925.AAKWM,,A4649,HCPCS,Facility,Both,,,,140,119,40.124,140,"Health Partners, Inc.",State Public Programs,70,50,,percent of total billed charges,,
KNEE WEDGE FOAM   925.AAKWM,,A4649,HCPCS,Facility,Both,,,,140,119,40.124,140,Humana Insurance Company,Commercial PPO,133,95,,percent of total billed charges,,
KNEE WEDGE FOAM   925.AAKWM,,A4649,HCPCS,Facility,Outpatient,,,,140,119,40.124,140,Humana Insurance Company,Medicare PPO,68.6,49,,percent of total billed charges,,
KNEE WEDGE FOAM   925.AAKWM,,A4649,HCPCS,Facility,Inpatient,,,,140,119,40.124,140,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
KNEE WEDGE FOAM   925.AAKWM,,A4649,HCPCS,Facility,Both,,,,140,119,40.124,140,Medica,Individual & Family,138.74,99.1,,percent of total billed charges,,
KNEE WEDGE FOAM   925.AAKWM,,A4649,HCPCS,Facility,Outpatient,,,,140,119,40.124,140,Medica,Medica Advantage Solution,69.72,49.8,,percent of total billed charges,,
KNEE WEDGE FOAM   925.AAKWM,,A4649,HCPCS,Facility,Inpatient,,,,140,119,40.124,140,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
KNEE WEDGE FOAM   925.AAKWM,,A4649,HCPCS,Facility,Outpatient,,,,140,119,40.124,140,Medica,Medical Assistance,62.44,44.6,,percent of total billed charges,,
KNEE WEDGE FOAM   925.AAKWM,,A4649,HCPCS,Facility,Inpatient,,,,140,119,40.124,140,Medica,Medical Assistance,,,,,Included in per diem rate,
KNEE WEDGE FOAM   925.AAKWM,,A4649,HCPCS,Facility,Outpatient,,,,140,119,40.124,140,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,69.72,49.8,,percent of total billed charges,,
KNEE WEDGE FOAM   925.AAKWM,,A4649,HCPCS,Facility,Inpatient,,,,140,119,40.124,140,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
KNEE WEDGE FOAM   925.AAKWM,,A4649,HCPCS,Facility,Both,,,,140,119,40.124,140,"Multiplan, Inc.","Multiplan, Inc.",131.6,94,,percent of total billed charges,,
KNEE WEDGE FOAM   925.AAKWM,,A4649,HCPCS,Facility,Outpatient,,,,140,119,40.124,140,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,126.14,90.1,,percent of total billed charges,,
KNEE WEDGE FOAM   925.AAKWM,,A4649,HCPCS,Facility,Inpatient,,,,140,119,40.124,140,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
KNEE WEDGE FOAM   925.AAKWM,,A4649,HCPCS,Facility,Both,,,,140,119,40.124,140,"Preferred One Administrative Services, INC.",PPO,138.04,98.6,,percent of total billed charges,,
KNEE WEDGE FOAM   925.AAKWM,,A4649,HCPCS,Facility,Outpatient,,,,140,119,40.124,140,PrimeWest Health,Minnesota Senior Health Options (MSHO),72.03,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
KNEE WEDGE FOAM   925.AAKWM,,A4649,HCPCS,Facility,Inpatient,,,,140,119,40.124,140,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
KNEE WEDGE FOAM   925.AAKWM,,A4649,HCPCS,Facility,Outpatient,,,,140,119,40.124,140,PrimeWest Health,MinnesotaCare,71.904,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
KNEE WEDGE FOAM   925.AAKWM,,A4649,HCPCS,Facility,Inpatient,,,,140,119,40.124,140,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
KNEE WEDGE FOAM   925.AAKWM,,A4649,HCPCS,Facility,Both,,,,140,119,40.124,140,Sanford Health Plan,Sanford Health Plan,128.8,92,,percent of total billed charges,,
KNEE WEDGE FOAM   925.AAKWM,,A4649,HCPCS,Facility,Outpatient,,,,140,119,40.124,140,"UCare Health, Inc.",Individual & Family Plan,78.89,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
KNEE WEDGE FOAM   925.AAKWM,,A4649,HCPCS,Facility,Inpatient,,,,140,119,40.124,140,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
KNEE WEDGE FOAM   925.AAKWM,,A4649,HCPCS,Facility,Outpatient,,,,140,119,40.124,140,"UCare Health, Inc.",Medical Assistance,70.658,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
KNEE WEDGE FOAM   925.AAKWM,,A4649,HCPCS,Facility,Inpatient,,,,140,119,40.124,140,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
KNEE WEDGE FOAM   925.AAKWM,,A4649,HCPCS,Facility,Outpatient,,,,140,119,40.124,140,"UCare Health, Inc.",Medicare Advantage,70.658,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
KNEE WEDGE FOAM   925.AAKWM,,A4649,HCPCS,Facility,Inpatient,,,,140,119,40.124,140,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
KNEE WEDGE FOAM   925.AAKWM,,A4649,HCPCS,Facility,Outpatient,,,,140,119,40.124,140,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),70.658,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
KNEE WEDGE FOAM   925.AAKWM,,A4649,HCPCS,Facility,Inpatient,,,,140,119,40.124,140,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
KNEE WEDGE FOAM   925.AAKWM,,A4649,HCPCS,Facility,Both,,,,140,119,40.124,140,UnitedHealthcare,Individual & Family,131.6,94,,percent of total billed charges,,
KNEE WEDGE FOAM   925.AAKWM,,A4649,HCPCS,Facility,Outpatient,,,,140,119,40.124,140,UnitedHealthcare,Medicare Advantage,68.6,49,,percent of total billed charges,,
KNEE WEDGE FOAM   925.AAKWM,,A4649,HCPCS,Facility,Inpatient,,,,140,119,40.124,140,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
KNEE WEDGE FOAM   925.AAKWM,,A4649,HCPCS,Facility,Outpatient,,,,140,119,40.124,140,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,67.2,48,,percent of total billed charges,,100% of DHS outpatient percentage
KNEE WEDGE FOAM   925.AAKWM,,A4649,HCPCS,Facility,Inpatient,,,,140,119,40.124,140,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
KNOT PUSHER/SUTURE CUTTER,,A4649,HCPCS,Facility,Both,,,,525,446.25,150.465,525,Aetna,Commercial,483,92,,percent of total billed charges,,
KNOT PUSHER/SUTURE CUTTER,,A4649,HCPCS,Facility,Outpatient,,,,525,446.25,150.465,525,Aetna,Medicare Advantage,257.25,49,,percent of total billed charges,,
KNOT PUSHER/SUTURE CUTTER,,A4649,HCPCS,Facility,Inpatient,,,,525,446.25,150.465,525,Aetna,Medicare Advantage,,,,,Included in per diem rate,
KNOT PUSHER/SUTURE CUTTER,,A4649,HCPCS,Facility,Both,,,,525,446.25,150.465,525,Aetna,PPO,488.25,93,,percent of total billed charges,,
KNOT PUSHER/SUTURE CUTTER,,A4649,HCPCS,Facility,Both,,,,525,446.25,150.465,525,America's PPO,America's PPO,504.1575,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
KNOT PUSHER/SUTURE CUTTER,,A4649,HCPCS,Facility,Both,,,,525,446.25,150.465,525,BlueCross BlueShield Minnesota, Federal Employee Program,516.6,98.4,,percent of total billed charges,,
KNOT PUSHER/SUTURE CUTTER,,A4649,HCPCS,Facility,Both,,,,525,446.25,150.465,525,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,525,100,,percent of total billed charges,,
KNOT PUSHER/SUTURE CUTTER,,A4649,HCPCS,Facility,Both,,,,525,446.25,150.465,525,BlueCross BlueShield Minnesota,High Value Network Plan,472.5,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
KNOT PUSHER/SUTURE CUTTER,,A4649,HCPCS,Facility,Outpatient,,,,525,446.25,150.465,525,BlueCross BlueShield Minnesota,Medicare Advantage,257.25,49,,percent of total billed charges,,
KNOT PUSHER/SUTURE CUTTER,,A4649,HCPCS,Facility,Inpatient,,,,525,446.25,150.465,525,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
KNOT PUSHER/SUTURE CUTTER,,A4649,HCPCS,Facility,Both,,,,525,446.25,150.465,525,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,464.9925,88.57,,percent of total billed charges,,
KNOT PUSHER/SUTURE CUTTER,,A4649,HCPCS,Facility,Both,,,,525,446.25,150.465,525,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,150.465,28.66,,percent of total billed charges,,
KNOT PUSHER/SUTURE CUTTER,,A4649,HCPCS,Facility,Outpatient,,,,525,446.25,150.465,525,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),257.25,49,,percent of total billed charges,,
KNOT PUSHER/SUTURE CUTTER,,A4649,HCPCS,Facility,Inpatient,,,,525,446.25,150.465,525,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
KNOT PUSHER/SUTURE CUTTER,,A4649,HCPCS,Facility,Both,,,,525,446.25,150.465,525,CorVel,Worker's Compensation,525,100,,percent of total billed charges,,
KNOT PUSHER/SUTURE CUTTER,,A4649,HCPCS,Facility,Both,,,,525,446.25,150.465,525,First Health Group Corporation,First Health Network,509.25,97,,percent of total billed charges,,
KNOT PUSHER/SUTURE CUTTER,,A4649,HCPCS,Facility,Both,,,,525,446.25,150.465,525,"Health Partners, Inc.",Commercial,496.65,94.6,,percent of total billed charges,,
KNOT PUSHER/SUTURE CUTTER,,A4649,HCPCS,Facility,Outpatient,,,,525,446.25,150.465,525,"Health Partners, Inc.",Medicare Advantage,257.25,49,,percent of total billed charges,,
KNOT PUSHER/SUTURE CUTTER,,A4649,HCPCS,Facility,Inpatient,,,,525,446.25,150.465,525,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
KNOT PUSHER/SUTURE CUTTER,,A4649,HCPCS,Facility,Both,,,,525,446.25,150.465,525,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),315,60,,percent of total billed charges,,
KNOT PUSHER/SUTURE CUTTER,,A4649,HCPCS,Facility,Both,,,,525,446.25,150.465,525,"Health Partners, Inc.",State of Minnesota Advantage Program,427.875,81.5,,percent of total billed charges,,
KNOT PUSHER/SUTURE CUTTER,,A4649,HCPCS,Facility,Both,,,,525,446.25,150.465,525,"Health Partners, Inc.",State Public Programs,262.5,50,,percent of total billed charges,,
KNOT PUSHER/SUTURE CUTTER,,A4649,HCPCS,Facility,Both,,,,525,446.25,150.465,525,Humana Insurance Company,Commercial PPO,498.75,95,,percent of total billed charges,,
KNOT PUSHER/SUTURE CUTTER,,A4649,HCPCS,Facility,Outpatient,,,,525,446.25,150.465,525,Humana Insurance Company,Medicare PPO,257.25,49,,percent of total billed charges,,
KNOT PUSHER/SUTURE CUTTER,,A4649,HCPCS,Facility,Inpatient,,,,525,446.25,150.465,525,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
KNOT PUSHER/SUTURE CUTTER,,A4649,HCPCS,Facility,Both,,,,525,446.25,150.465,525,Medica,Individual & Family,520.275,99.1,,percent of total billed charges,,
KNOT PUSHER/SUTURE CUTTER,,A4649,HCPCS,Facility,Outpatient,,,,525,446.25,150.465,525,Medica,Medica Advantage Solution,261.45,49.8,,percent of total billed charges,,
KNOT PUSHER/SUTURE CUTTER,,A4649,HCPCS,Facility,Inpatient,,,,525,446.25,150.465,525,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
KNOT PUSHER/SUTURE CUTTER,,A4649,HCPCS,Facility,Outpatient,,,,525,446.25,150.465,525,Medica,Medical Assistance,234.15,44.6,,percent of total billed charges,,
KNOT PUSHER/SUTURE CUTTER,,A4649,HCPCS,Facility,Inpatient,,,,525,446.25,150.465,525,Medica,Medical Assistance,,,,,Included in per diem rate,
KNOT PUSHER/SUTURE CUTTER,,A4649,HCPCS,Facility,Outpatient,,,,525,446.25,150.465,525,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,261.45,49.8,,percent of total billed charges,,
KNOT PUSHER/SUTURE CUTTER,,A4649,HCPCS,Facility,Inpatient,,,,525,446.25,150.465,525,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
KNOT PUSHER/SUTURE CUTTER,,A4649,HCPCS,Facility,Both,,,,525,446.25,150.465,525,"Multiplan, Inc.","Multiplan, Inc.",493.5,94,,percent of total billed charges,,
KNOT PUSHER/SUTURE CUTTER,,A4649,HCPCS,Facility,Outpatient,,,,525,446.25,150.465,525,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,473.025,90.1,,percent of total billed charges,,
KNOT PUSHER/SUTURE CUTTER,,A4649,HCPCS,Facility,Inpatient,,,,525,446.25,150.465,525,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
KNOT PUSHER/SUTURE CUTTER,,A4649,HCPCS,Facility,Both,,,,525,446.25,150.465,525,"Preferred One Administrative Services, INC.",PPO,517.65,98.6,,percent of total billed charges,,
KNOT PUSHER/SUTURE CUTTER,,A4649,HCPCS,Facility,Outpatient,,,,525,446.25,150.465,525,PrimeWest Health,Minnesota Senior Health Options (MSHO),270.1125,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
KNOT PUSHER/SUTURE CUTTER,,A4649,HCPCS,Facility,Inpatient,,,,525,446.25,150.465,525,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
KNOT PUSHER/SUTURE CUTTER,,A4649,HCPCS,Facility,Outpatient,,,,525,446.25,150.465,525,PrimeWest Health,MinnesotaCare,269.64,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
KNOT PUSHER/SUTURE CUTTER,,A4649,HCPCS,Facility,Inpatient,,,,525,446.25,150.465,525,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
KNOT PUSHER/SUTURE CUTTER,,A4649,HCPCS,Facility,Both,,,,525,446.25,150.465,525,Sanford Health Plan,Sanford Health Plan,483,92,,percent of total billed charges,,
KNOT PUSHER/SUTURE CUTTER,,A4649,HCPCS,Facility,Outpatient,,,,525,446.25,150.465,525,"UCare Health, Inc.",Individual & Family Plan,295.8375,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
KNOT PUSHER/SUTURE CUTTER,,A4649,HCPCS,Facility,Inpatient,,,,525,446.25,150.465,525,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
KNOT PUSHER/SUTURE CUTTER,,A4649,HCPCS,Facility,Outpatient,,,,525,446.25,150.465,525,"UCare Health, Inc.",Medical Assistance,264.9675,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
KNOT PUSHER/SUTURE CUTTER,,A4649,HCPCS,Facility,Inpatient,,,,525,446.25,150.465,525,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
KNOT PUSHER/SUTURE CUTTER,,A4649,HCPCS,Facility,Outpatient,,,,525,446.25,150.465,525,"UCare Health, Inc.",Medicare Advantage,264.9675,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
KNOT PUSHER/SUTURE CUTTER,,A4649,HCPCS,Facility,Inpatient,,,,525,446.25,150.465,525,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
KNOT PUSHER/SUTURE CUTTER,,A4649,HCPCS,Facility,Outpatient,,,,525,446.25,150.465,525,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),264.9675,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
KNOT PUSHER/SUTURE CUTTER,,A4649,HCPCS,Facility,Inpatient,,,,525,446.25,150.465,525,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
KNOT PUSHER/SUTURE CUTTER,,A4649,HCPCS,Facility,Both,,,,525,446.25,150.465,525,UnitedHealthcare,Individual & Family,493.5,94,,percent of total billed charges,,
KNOT PUSHER/SUTURE CUTTER,,A4649,HCPCS,Facility,Outpatient,,,,525,446.25,150.465,525,UnitedHealthcare,Medicare Advantage,257.25,49,,percent of total billed charges,,
KNOT PUSHER/SUTURE CUTTER,,A4649,HCPCS,Facility,Inpatient,,,,525,446.25,150.465,525,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
KNOT PUSHER/SUTURE CUTTER,,A4649,HCPCS,Facility,Outpatient,,,,525,446.25,150.465,525,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,252,48,,percent of total billed charges,,100% of DHS outpatient percentage
KNOT PUSHER/SUTURE CUTTER,,A4649,HCPCS,Facility,Inpatient,,,,525,446.25,150.465,525,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
KNOTS TITANIUM LSI  030510,,A4649,HCPCS,Facility,Both,,,,315,267.75,90.279,315,Aetna,Commercial,289.8,92,,percent of total billed charges,,
KNOTS TITANIUM LSI  030510,,A4649,HCPCS,Facility,Outpatient,,,,315,267.75,90.279,315,Aetna,Medicare Advantage,154.35,49,,percent of total billed charges,,
KNOTS TITANIUM LSI  030510,,A4649,HCPCS,Facility,Inpatient,,,,315,267.75,90.279,315,Aetna,Medicare Advantage,,,,,Included in per diem rate,
KNOTS TITANIUM LSI  030510,,A4649,HCPCS,Facility,Both,,,,315,267.75,90.279,315,Aetna,PPO,292.95,93,,percent of total billed charges,,
KNOTS TITANIUM LSI  030510,,A4649,HCPCS,Facility,Both,,,,315,267.75,90.279,315,America's PPO,America's PPO,302.4945,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
KNOTS TITANIUM LSI  030510,,A4649,HCPCS,Facility,Both,,,,315,267.75,90.279,315,BlueCross BlueShield Minnesota, Federal Employee Program,309.96,98.4,,percent of total billed charges,,
KNOTS TITANIUM LSI  030510,,A4649,HCPCS,Facility,Both,,,,315,267.75,90.279,315,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,315,100,,percent of total billed charges,,
KNOTS TITANIUM LSI  030510,,A4649,HCPCS,Facility,Both,,,,315,267.75,90.279,315,BlueCross BlueShield Minnesota,High Value Network Plan,283.5,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
KNOTS TITANIUM LSI  030510,,A4649,HCPCS,Facility,Outpatient,,,,315,267.75,90.279,315,BlueCross BlueShield Minnesota,Medicare Advantage,154.35,49,,percent of total billed charges,,
KNOTS TITANIUM LSI  030510,,A4649,HCPCS,Facility,Inpatient,,,,315,267.75,90.279,315,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
KNOTS TITANIUM LSI  030510,,A4649,HCPCS,Facility,Both,,,,315,267.75,90.279,315,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,278.9955,88.57,,percent of total billed charges,,
KNOTS TITANIUM LSI  030510,,A4649,HCPCS,Facility,Both,,,,315,267.75,90.279,315,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,90.279,28.66,,percent of total billed charges,,
KNOTS TITANIUM LSI  030510,,A4649,HCPCS,Facility,Outpatient,,,,315,267.75,90.279,315,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),154.35,49,,percent of total billed charges,,
KNOTS TITANIUM LSI  030510,,A4649,HCPCS,Facility,Inpatient,,,,315,267.75,90.279,315,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
KNOTS TITANIUM LSI  030510,,A4649,HCPCS,Facility,Both,,,,315,267.75,90.279,315,CorVel,Worker's Compensation,315,100,,percent of total billed charges,,
KNOTS TITANIUM LSI  030510,,A4649,HCPCS,Facility,Both,,,,315,267.75,90.279,315,First Health Group Corporation,First Health Network,305.55,97,,percent of total billed charges,,
KNOTS TITANIUM LSI  030510,,A4649,HCPCS,Facility,Both,,,,315,267.75,90.279,315,"Health Partners, Inc.",Commercial,297.99,94.6,,percent of total billed charges,,
KNOTS TITANIUM LSI  030510,,A4649,HCPCS,Facility,Outpatient,,,,315,267.75,90.279,315,"Health Partners, Inc.",Medicare Advantage,154.35,49,,percent of total billed charges,,
KNOTS TITANIUM LSI  030510,,A4649,HCPCS,Facility,Inpatient,,,,315,267.75,90.279,315,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
KNOTS TITANIUM LSI  030510,,A4649,HCPCS,Facility,Both,,,,315,267.75,90.279,315,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),189,60,,percent of total billed charges,,
KNOTS TITANIUM LSI  030510,,A4649,HCPCS,Facility,Both,,,,315,267.75,90.279,315,"Health Partners, Inc.",State of Minnesota Advantage Program,256.725,81.5,,percent of total billed charges,,
KNOTS TITANIUM LSI  030510,,A4649,HCPCS,Facility,Both,,,,315,267.75,90.279,315,"Health Partners, Inc.",State Public Programs,157.5,50,,percent of total billed charges,,
KNOTS TITANIUM LSI  030510,,A4649,HCPCS,Facility,Both,,,,315,267.75,90.279,315,Humana Insurance Company,Commercial PPO,299.25,95,,percent of total billed charges,,
KNOTS TITANIUM LSI  030510,,A4649,HCPCS,Facility,Outpatient,,,,315,267.75,90.279,315,Humana Insurance Company,Medicare PPO,154.35,49,,percent of total billed charges,,
KNOTS TITANIUM LSI  030510,,A4649,HCPCS,Facility,Inpatient,,,,315,267.75,90.279,315,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
KNOTS TITANIUM LSI  030510,,A4649,HCPCS,Facility,Both,,,,315,267.75,90.279,315,Medica,Individual & Family,312.165,99.1,,percent of total billed charges,,
KNOTS TITANIUM LSI  030510,,A4649,HCPCS,Facility,Outpatient,,,,315,267.75,90.279,315,Medica,Medica Advantage Solution,156.87,49.8,,percent of total billed charges,,
KNOTS TITANIUM LSI  030510,,A4649,HCPCS,Facility,Inpatient,,,,315,267.75,90.279,315,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
KNOTS TITANIUM LSI  030510,,A4649,HCPCS,Facility,Outpatient,,,,315,267.75,90.279,315,Medica,Medical Assistance,140.49,44.6,,percent of total billed charges,,
KNOTS TITANIUM LSI  030510,,A4649,HCPCS,Facility,Inpatient,,,,315,267.75,90.279,315,Medica,Medical Assistance,,,,,Included in per diem rate,
KNOTS TITANIUM LSI  030510,,A4649,HCPCS,Facility,Outpatient,,,,315,267.75,90.279,315,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,156.87,49.8,,percent of total billed charges,,
KNOTS TITANIUM LSI  030510,,A4649,HCPCS,Facility,Inpatient,,,,315,267.75,90.279,315,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
KNOTS TITANIUM LSI  030510,,A4649,HCPCS,Facility,Both,,,,315,267.75,90.279,315,"Multiplan, Inc.","Multiplan, Inc.",296.1,94,,percent of total billed charges,,
KNOTS TITANIUM LSI  030510,,A4649,HCPCS,Facility,Outpatient,,,,315,267.75,90.279,315,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,283.815,90.1,,percent of total billed charges,,
KNOTS TITANIUM LSI  030510,,A4649,HCPCS,Facility,Inpatient,,,,315,267.75,90.279,315,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
KNOTS TITANIUM LSI  030510,,A4649,HCPCS,Facility,Both,,,,315,267.75,90.279,315,"Preferred One Administrative Services, INC.",PPO,310.59,98.6,,percent of total billed charges,,
KNOTS TITANIUM LSI  030510,,A4649,HCPCS,Facility,Outpatient,,,,315,267.75,90.279,315,PrimeWest Health,Minnesota Senior Health Options (MSHO),162.0675,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
KNOTS TITANIUM LSI  030510,,A4649,HCPCS,Facility,Inpatient,,,,315,267.75,90.279,315,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
KNOTS TITANIUM LSI  030510,,A4649,HCPCS,Facility,Outpatient,,,,315,267.75,90.279,315,PrimeWest Health,MinnesotaCare,161.784,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
KNOTS TITANIUM LSI  030510,,A4649,HCPCS,Facility,Inpatient,,,,315,267.75,90.279,315,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
KNOTS TITANIUM LSI  030510,,A4649,HCPCS,Facility,Both,,,,315,267.75,90.279,315,Sanford Health Plan,Sanford Health Plan,289.8,92,,percent of total billed charges,,
KNOTS TITANIUM LSI  030510,,A4649,HCPCS,Facility,Outpatient,,,,315,267.75,90.279,315,"UCare Health, Inc.",Individual & Family Plan,177.5025,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
KNOTS TITANIUM LSI  030510,,A4649,HCPCS,Facility,Inpatient,,,,315,267.75,90.279,315,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
KNOTS TITANIUM LSI  030510,,A4649,HCPCS,Facility,Outpatient,,,,315,267.75,90.279,315,"UCare Health, Inc.",Medical Assistance,158.9805,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
KNOTS TITANIUM LSI  030510,,A4649,HCPCS,Facility,Inpatient,,,,315,267.75,90.279,315,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
KNOTS TITANIUM LSI  030510,,A4649,HCPCS,Facility,Outpatient,,,,315,267.75,90.279,315,"UCare Health, Inc.",Medicare Advantage,158.9805,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
KNOTS TITANIUM LSI  030510,,A4649,HCPCS,Facility,Inpatient,,,,315,267.75,90.279,315,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
KNOTS TITANIUM LSI  030510,,A4649,HCPCS,Facility,Outpatient,,,,315,267.75,90.279,315,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),158.9805,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
KNOTS TITANIUM LSI  030510,,A4649,HCPCS,Facility,Inpatient,,,,315,267.75,90.279,315,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
KNOTS TITANIUM LSI  030510,,A4649,HCPCS,Facility,Both,,,,315,267.75,90.279,315,UnitedHealthcare,Individual & Family,296.1,94,,percent of total billed charges,,
KNOTS TITANIUM LSI  030510,,A4649,HCPCS,Facility,Outpatient,,,,315,267.75,90.279,315,UnitedHealthcare,Medicare Advantage,154.35,49,,percent of total billed charges,,
KNOTS TITANIUM LSI  030510,,A4649,HCPCS,Facility,Inpatient,,,,315,267.75,90.279,315,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
KNOTS TITANIUM LSI  030510,,A4649,HCPCS,Facility,Outpatient,,,,315,267.75,90.279,315,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,151.2,48,,percent of total billed charges,,100% of DHS outpatient percentage
KNOTS TITANIUM LSI  030510,,A4649,HCPCS,Facility,Inpatient,,,,315,267.75,90.279,315,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
LAPAROSCOPY PACK,,A4649,HCPCS,Facility,Both,,,,47.52,40.392,13.619232,47.52,Aetna,Commercial,43.7184,92,,percent of total billed charges,,
LAPAROSCOPY PACK,,A4649,HCPCS,Facility,Outpatient,,,,47.52,40.392,13.619232,47.52,Aetna,Medicare Advantage,23.2848,49,,percent of total billed charges,,
LAPAROSCOPY PACK,,A4649,HCPCS,Facility,Inpatient,,,,47.52,40.392,13.619232,47.52,Aetna,Medicare Advantage,,,,,Included in per diem rate,
LAPAROSCOPY PACK,,A4649,HCPCS,Facility,Both,,,,47.52,40.392,13.619232,47.52,Aetna,PPO,44.1936,93,,percent of total billed charges,,
LAPAROSCOPY PACK,,A4649,HCPCS,Facility,Both,,,,47.52,40.392,13.619232,47.52,America's PPO,America's PPO,45.633456,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
LAPAROSCOPY PACK,,A4649,HCPCS,Facility,Both,,,,47.52,40.392,13.619232,47.52,BlueCross BlueShield Minnesota, Federal Employee Program,46.75968,98.4,,percent of total billed charges,,
LAPAROSCOPY PACK,,A4649,HCPCS,Facility,Both,,,,47.52,40.392,13.619232,47.52,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,47.52,100,,percent of total billed charges,,
LAPAROSCOPY PACK,,A4649,HCPCS,Facility,Both,,,,47.52,40.392,13.619232,47.52,BlueCross BlueShield Minnesota,High Value Network Plan,42.768,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
LAPAROSCOPY PACK,,A4649,HCPCS,Facility,Outpatient,,,,47.52,40.392,13.619232,47.52,BlueCross BlueShield Minnesota,Medicare Advantage,23.2848,49,,percent of total billed charges,,
LAPAROSCOPY PACK,,A4649,HCPCS,Facility,Inpatient,,,,47.52,40.392,13.619232,47.52,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
LAPAROSCOPY PACK,,A4649,HCPCS,Facility,Both,,,,47.52,40.392,13.619232,47.52,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,42.088464,88.57,,percent of total billed charges,,
LAPAROSCOPY PACK,,A4649,HCPCS,Facility,Both,,,,47.52,40.392,13.619232,47.52,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,13.619232,28.66,,percent of total billed charges,,
LAPAROSCOPY PACK,,A4649,HCPCS,Facility,Outpatient,,,,47.52,40.392,13.619232,47.52,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),23.2848,49,,percent of total billed charges,,
LAPAROSCOPY PACK,,A4649,HCPCS,Facility,Inpatient,,,,47.52,40.392,13.619232,47.52,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
LAPAROSCOPY PACK,,A4649,HCPCS,Facility,Both,,,,47.52,40.392,13.619232,47.52,CorVel,Worker's Compensation,47.52,100,,percent of total billed charges,,
LAPAROSCOPY PACK,,A4649,HCPCS,Facility,Both,,,,47.52,40.392,13.619232,47.52,First Health Group Corporation,First Health Network,46.0944,97,,percent of total billed charges,,
LAPAROSCOPY PACK,,A4649,HCPCS,Facility,Both,,,,47.52,40.392,13.619232,47.52,"Health Partners, Inc.",Commercial,44.95392,94.6,,percent of total billed charges,,
LAPAROSCOPY PACK,,A4649,HCPCS,Facility,Outpatient,,,,47.52,40.392,13.619232,47.52,"Health Partners, Inc.",Medicare Advantage,23.2848,49,,percent of total billed charges,,
LAPAROSCOPY PACK,,A4649,HCPCS,Facility,Inpatient,,,,47.52,40.392,13.619232,47.52,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LAPAROSCOPY PACK,,A4649,HCPCS,Facility,Both,,,,47.52,40.392,13.619232,47.52,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),28.512,60,,percent of total billed charges,,
LAPAROSCOPY PACK,,A4649,HCPCS,Facility,Both,,,,47.52,40.392,13.619232,47.52,"Health Partners, Inc.",State of Minnesota Advantage Program,38.7288,81.5,,percent of total billed charges,,
LAPAROSCOPY PACK,,A4649,HCPCS,Facility,Both,,,,47.52,40.392,13.619232,47.52,"Health Partners, Inc.",State Public Programs,23.76,50,,percent of total billed charges,,
LAPAROSCOPY PACK,,A4649,HCPCS,Facility,Both,,,,47.52,40.392,13.619232,47.52,Humana Insurance Company,Commercial PPO,45.144,95,,percent of total billed charges,,
LAPAROSCOPY PACK,,A4649,HCPCS,Facility,Outpatient,,,,47.52,40.392,13.619232,47.52,Humana Insurance Company,Medicare PPO,23.2848,49,,percent of total billed charges,,
LAPAROSCOPY PACK,,A4649,HCPCS,Facility,Inpatient,,,,47.52,40.392,13.619232,47.52,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
LAPAROSCOPY PACK,,A4649,HCPCS,Facility,Both,,,,47.52,40.392,13.619232,47.52,Medica,Individual & Family,47.09232,99.1,,percent of total billed charges,,
LAPAROSCOPY PACK,,A4649,HCPCS,Facility,Outpatient,,,,47.52,40.392,13.619232,47.52,Medica,Medica Advantage Solution,23.66496,49.8,,percent of total billed charges,,
LAPAROSCOPY PACK,,A4649,HCPCS,Facility,Inpatient,,,,47.52,40.392,13.619232,47.52,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
LAPAROSCOPY PACK,,A4649,HCPCS,Facility,Outpatient,,,,47.52,40.392,13.619232,47.52,Medica,Medical Assistance,21.19392,44.6,,percent of total billed charges,,
LAPAROSCOPY PACK,,A4649,HCPCS,Facility,Inpatient,,,,47.52,40.392,13.619232,47.52,Medica,Medical Assistance,,,,,Included in per diem rate,
LAPAROSCOPY PACK,,A4649,HCPCS,Facility,Outpatient,,,,47.52,40.392,13.619232,47.52,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,23.66496,49.8,,percent of total billed charges,,
LAPAROSCOPY PACK,,A4649,HCPCS,Facility,Inpatient,,,,47.52,40.392,13.619232,47.52,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
LAPAROSCOPY PACK,,A4649,HCPCS,Facility,Both,,,,47.52,40.392,13.619232,47.52,"Multiplan, Inc.","Multiplan, Inc.",44.6688,94,,percent of total billed charges,,
LAPAROSCOPY PACK,,A4649,HCPCS,Facility,Outpatient,,,,47.52,40.392,13.619232,47.52,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,42.81552,90.1,,percent of total billed charges,,
LAPAROSCOPY PACK,,A4649,HCPCS,Facility,Inpatient,,,,47.52,40.392,13.619232,47.52,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
LAPAROSCOPY PACK,,A4649,HCPCS,Facility,Both,,,,47.52,40.392,13.619232,47.52,"Preferred One Administrative Services, INC.",PPO,46.85472,98.6,,percent of total billed charges,,
LAPAROSCOPY PACK,,A4649,HCPCS,Facility,Outpatient,,,,47.52,40.392,13.619232,47.52,PrimeWest Health,Minnesota Senior Health Options (MSHO),24.44904,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
LAPAROSCOPY PACK,,A4649,HCPCS,Facility,Inpatient,,,,47.52,40.392,13.619232,47.52,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LAPAROSCOPY PACK,,A4649,HCPCS,Facility,Outpatient,,,,47.52,40.392,13.619232,47.52,PrimeWest Health,MinnesotaCare,24.406272,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
LAPAROSCOPY PACK,,A4649,HCPCS,Facility,Inpatient,,,,47.52,40.392,13.619232,47.52,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
LAPAROSCOPY PACK,,A4649,HCPCS,Facility,Both,,,,47.52,40.392,13.619232,47.52,Sanford Health Plan,Sanford Health Plan,43.7184,92,,percent of total billed charges,,
LAPAROSCOPY PACK,,A4649,HCPCS,Facility,Outpatient,,,,47.52,40.392,13.619232,47.52,"UCare Health, Inc.",Individual & Family Plan,26.77752,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
LAPAROSCOPY PACK,,A4649,HCPCS,Facility,Inpatient,,,,47.52,40.392,13.619232,47.52,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
LAPAROSCOPY PACK,,A4649,HCPCS,Facility,Outpatient,,,,47.52,40.392,13.619232,47.52,"UCare Health, Inc.",Medical Assistance,23.983344,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LAPAROSCOPY PACK,,A4649,HCPCS,Facility,Inpatient,,,,47.52,40.392,13.619232,47.52,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
LAPAROSCOPY PACK,,A4649,HCPCS,Facility,Outpatient,,,,47.52,40.392,13.619232,47.52,"UCare Health, Inc.",Medicare Advantage,23.983344,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LAPAROSCOPY PACK,,A4649,HCPCS,Facility,Inpatient,,,,47.52,40.392,13.619232,47.52,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LAPAROSCOPY PACK,,A4649,HCPCS,Facility,Outpatient,,,,47.52,40.392,13.619232,47.52,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),23.983344,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LAPAROSCOPY PACK,,A4649,HCPCS,Facility,Inpatient,,,,47.52,40.392,13.619232,47.52,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LAPAROSCOPY PACK,,A4649,HCPCS,Facility,Both,,,,47.52,40.392,13.619232,47.52,UnitedHealthcare,Individual & Family,44.6688,94,,percent of total billed charges,,
LAPAROSCOPY PACK,,A4649,HCPCS,Facility,Outpatient,,,,47.52,40.392,13.619232,47.52,UnitedHealthcare,Medicare Advantage,23.2848,49,,percent of total billed charges,,
LAPAROSCOPY PACK,,A4649,HCPCS,Facility,Inpatient,,,,47.52,40.392,13.619232,47.52,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
LAPAROSCOPY PACK,,A4649,HCPCS,Facility,Outpatient,,,,47.52,40.392,13.619232,47.52,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,22.8096,48,,percent of total billed charges,,100% of DHS outpatient percentage
LAPAROSCOPY PACK,,A4649,HCPCS,Facility,Inpatient,,,,47.52,40.392,13.619232,47.52,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
LASER FIBER HOLMIUM (UROL) DISPOSABLE 940 MICRON COOK HLF-S940-HSMA / G25297,,A4649,HCPCS,Facility,Both,,,,1000,850,286.6,1000,Aetna,Commercial,920,92,,percent of total billed charges,,
LASER FIBER HOLMIUM (UROL) DISPOSABLE 940 MICRON COOK HLF-S940-HSMA / G25297,,A4649,HCPCS,Facility,Outpatient,,,,1000,850,286.6,1000,Aetna,Medicare Advantage,490,49,,percent of total billed charges,,
LASER FIBER HOLMIUM (UROL) DISPOSABLE 940 MICRON COOK HLF-S940-HSMA / G25297,,A4649,HCPCS,Facility,Inpatient,,,,1000,850,286.6,1000,Aetna,Medicare Advantage,,,,,Included in per diem rate,
LASER FIBER HOLMIUM (UROL) DISPOSABLE 940 MICRON COOK HLF-S940-HSMA / G25297,,A4649,HCPCS,Facility,Both,,,,1000,850,286.6,1000,Aetna,PPO,930,93,,percent of total billed charges,,
LASER FIBER HOLMIUM (UROL) DISPOSABLE 940 MICRON COOK HLF-S940-HSMA / G25297,,A4649,HCPCS,Facility,Both,,,,1000,850,286.6,1000,America's PPO,America's PPO,960.3,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
LASER FIBER HOLMIUM (UROL) DISPOSABLE 940 MICRON COOK HLF-S940-HSMA / G25297,,A4649,HCPCS,Facility,Both,,,,1000,850,286.6,1000,BlueCross BlueShield Minnesota, Federal Employee Program,984,98.4,,percent of total billed charges,,
LASER FIBER HOLMIUM (UROL) DISPOSABLE 940 MICRON COOK HLF-S940-HSMA / G25297,,A4649,HCPCS,Facility,Both,,,,1000,850,286.6,1000,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1000,100,,percent of total billed charges,,
LASER FIBER HOLMIUM (UROL) DISPOSABLE 940 MICRON COOK HLF-S940-HSMA / G25297,,A4649,HCPCS,Facility,Both,,,,1000,850,286.6,1000,BlueCross BlueShield Minnesota,High Value Network Plan,900,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
LASER FIBER HOLMIUM (UROL) DISPOSABLE 940 MICRON COOK HLF-S940-HSMA / G25297,,A4649,HCPCS,Facility,Outpatient,,,,1000,850,286.6,1000,BlueCross BlueShield Minnesota,Medicare Advantage,490,49,,percent of total billed charges,,
LASER FIBER HOLMIUM (UROL) DISPOSABLE 940 MICRON COOK HLF-S940-HSMA / G25297,,A4649,HCPCS,Facility,Inpatient,,,,1000,850,286.6,1000,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
LASER FIBER HOLMIUM (UROL) DISPOSABLE 940 MICRON COOK HLF-S940-HSMA / G25297,,A4649,HCPCS,Facility,Both,,,,1000,850,286.6,1000,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,885.7,88.57,,percent of total billed charges,,
LASER FIBER HOLMIUM (UROL) DISPOSABLE 940 MICRON COOK HLF-S940-HSMA / G25297,,A4649,HCPCS,Facility,Both,,,,1000,850,286.6,1000,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,286.6,28.66,,percent of total billed charges,,
LASER FIBER HOLMIUM (UROL) DISPOSABLE 940 MICRON COOK HLF-S940-HSMA / G25297,,A4649,HCPCS,Facility,Outpatient,,,,1000,850,286.6,1000,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),490,49,,percent of total billed charges,,
LASER FIBER HOLMIUM (UROL) DISPOSABLE 940 MICRON COOK HLF-S940-HSMA / G25297,,A4649,HCPCS,Facility,Inpatient,,,,1000,850,286.6,1000,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
LASER FIBER HOLMIUM (UROL) DISPOSABLE 940 MICRON COOK HLF-S940-HSMA / G25297,,A4649,HCPCS,Facility,Both,,,,1000,850,286.6,1000,CorVel,Worker's Compensation,1000,100,,percent of total billed charges,,
LASER FIBER HOLMIUM (UROL) DISPOSABLE 940 MICRON COOK HLF-S940-HSMA / G25297,,A4649,HCPCS,Facility,Both,,,,1000,850,286.6,1000,First Health Group Corporation,First Health Network,970,97,,percent of total billed charges,,
LASER FIBER HOLMIUM (UROL) DISPOSABLE 940 MICRON COOK HLF-S940-HSMA / G25297,,A4649,HCPCS,Facility,Both,,,,1000,850,286.6,1000,"Health Partners, Inc.",Commercial,946,94.6,,percent of total billed charges,,
LASER FIBER HOLMIUM (UROL) DISPOSABLE 940 MICRON COOK HLF-S940-HSMA / G25297,,A4649,HCPCS,Facility,Outpatient,,,,1000,850,286.6,1000,"Health Partners, Inc.",Medicare Advantage,490,49,,percent of total billed charges,,
LASER FIBER HOLMIUM (UROL) DISPOSABLE 940 MICRON COOK HLF-S940-HSMA / G25297,,A4649,HCPCS,Facility,Inpatient,,,,1000,850,286.6,1000,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LASER FIBER HOLMIUM (UROL) DISPOSABLE 940 MICRON COOK HLF-S940-HSMA / G25297,,A4649,HCPCS,Facility,Both,,,,1000,850,286.6,1000,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),600,60,,percent of total billed charges,,
LASER FIBER HOLMIUM (UROL) DISPOSABLE 940 MICRON COOK HLF-S940-HSMA / G25297,,A4649,HCPCS,Facility,Both,,,,1000,850,286.6,1000,"Health Partners, Inc.",State of Minnesota Advantage Program,815,81.5,,percent of total billed charges,,
LASER FIBER HOLMIUM (UROL) DISPOSABLE 940 MICRON COOK HLF-S940-HSMA / G25297,,A4649,HCPCS,Facility,Both,,,,1000,850,286.6,1000,"Health Partners, Inc.",State Public Programs,500,50,,percent of total billed charges,,
LASER FIBER HOLMIUM (UROL) DISPOSABLE 940 MICRON COOK HLF-S940-HSMA / G25297,,A4649,HCPCS,Facility,Both,,,,1000,850,286.6,1000,Humana Insurance Company,Commercial PPO,950,95,,percent of total billed charges,,
LASER FIBER HOLMIUM (UROL) DISPOSABLE 940 MICRON COOK HLF-S940-HSMA / G25297,,A4649,HCPCS,Facility,Outpatient,,,,1000,850,286.6,1000,Humana Insurance Company,Medicare PPO,490,49,,percent of total billed charges,,
LASER FIBER HOLMIUM (UROL) DISPOSABLE 940 MICRON COOK HLF-S940-HSMA / G25297,,A4649,HCPCS,Facility,Inpatient,,,,1000,850,286.6,1000,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
LASER FIBER HOLMIUM (UROL) DISPOSABLE 940 MICRON COOK HLF-S940-HSMA / G25297,,A4649,HCPCS,Facility,Both,,,,1000,850,286.6,1000,Medica,Individual & Family,991,99.1,,percent of total billed charges,,
LASER FIBER HOLMIUM (UROL) DISPOSABLE 940 MICRON COOK HLF-S940-HSMA / G25297,,A4649,HCPCS,Facility,Outpatient,,,,1000,850,286.6,1000,Medica,Medica Advantage Solution,498,49.8,,percent of total billed charges,,
LASER FIBER HOLMIUM (UROL) DISPOSABLE 940 MICRON COOK HLF-S940-HSMA / G25297,,A4649,HCPCS,Facility,Inpatient,,,,1000,850,286.6,1000,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
LASER FIBER HOLMIUM (UROL) DISPOSABLE 940 MICRON COOK HLF-S940-HSMA / G25297,,A4649,HCPCS,Facility,Outpatient,,,,1000,850,286.6,1000,Medica,Medical Assistance,446,44.6,,percent of total billed charges,,
LASER FIBER HOLMIUM (UROL) DISPOSABLE 940 MICRON COOK HLF-S940-HSMA / G25297,,A4649,HCPCS,Facility,Inpatient,,,,1000,850,286.6,1000,Medica,Medical Assistance,,,,,Included in per diem rate,
LASER FIBER HOLMIUM (UROL) DISPOSABLE 940 MICRON COOK HLF-S940-HSMA / G25297,,A4649,HCPCS,Facility,Outpatient,,,,1000,850,286.6,1000,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,498,49.8,,percent of total billed charges,,
LASER FIBER HOLMIUM (UROL) DISPOSABLE 940 MICRON COOK HLF-S940-HSMA / G25297,,A4649,HCPCS,Facility,Inpatient,,,,1000,850,286.6,1000,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
LASER FIBER HOLMIUM (UROL) DISPOSABLE 940 MICRON COOK HLF-S940-HSMA / G25297,,A4649,HCPCS,Facility,Both,,,,1000,850,286.6,1000,"Multiplan, Inc.","Multiplan, Inc.",940,94,,percent of total billed charges,,
LASER FIBER HOLMIUM (UROL) DISPOSABLE 940 MICRON COOK HLF-S940-HSMA / G25297,,A4649,HCPCS,Facility,Outpatient,,,,1000,850,286.6,1000,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,901,90.1,,percent of total billed charges,,
LASER FIBER HOLMIUM (UROL) DISPOSABLE 940 MICRON COOK HLF-S940-HSMA / G25297,,A4649,HCPCS,Facility,Inpatient,,,,1000,850,286.6,1000,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
LASER FIBER HOLMIUM (UROL) DISPOSABLE 940 MICRON COOK HLF-S940-HSMA / G25297,,A4649,HCPCS,Facility,Both,,,,1000,850,286.6,1000,"Preferred One Administrative Services, INC.",PPO,986,98.6,,percent of total billed charges,,
LASER FIBER HOLMIUM (UROL) DISPOSABLE 940 MICRON COOK HLF-S940-HSMA / G25297,,A4649,HCPCS,Facility,Outpatient,,,,1000,850,286.6,1000,PrimeWest Health,Minnesota Senior Health Options (MSHO),514.5,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
LASER FIBER HOLMIUM (UROL) DISPOSABLE 940 MICRON COOK HLF-S940-HSMA / G25297,,A4649,HCPCS,Facility,Inpatient,,,,1000,850,286.6,1000,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LASER FIBER HOLMIUM (UROL) DISPOSABLE 940 MICRON COOK HLF-S940-HSMA / G25297,,A4649,HCPCS,Facility,Outpatient,,,,1000,850,286.6,1000,PrimeWest Health,MinnesotaCare,513.6,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
LASER FIBER HOLMIUM (UROL) DISPOSABLE 940 MICRON COOK HLF-S940-HSMA / G25297,,A4649,HCPCS,Facility,Inpatient,,,,1000,850,286.6,1000,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
LASER FIBER HOLMIUM (UROL) DISPOSABLE 940 MICRON COOK HLF-S940-HSMA / G25297,,A4649,HCPCS,Facility,Both,,,,1000,850,286.6,1000,Sanford Health Plan,Sanford Health Plan,920,92,,percent of total billed charges,,
LASER FIBER HOLMIUM (UROL) DISPOSABLE 940 MICRON COOK HLF-S940-HSMA / G25297,,A4649,HCPCS,Facility,Outpatient,,,,1000,850,286.6,1000,"UCare Health, Inc.",Individual & Family Plan,563.5,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
LASER FIBER HOLMIUM (UROL) DISPOSABLE 940 MICRON COOK HLF-S940-HSMA / G25297,,A4649,HCPCS,Facility,Inpatient,,,,1000,850,286.6,1000,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
LASER FIBER HOLMIUM (UROL) DISPOSABLE 940 MICRON COOK HLF-S940-HSMA / G25297,,A4649,HCPCS,Facility,Outpatient,,,,1000,850,286.6,1000,"UCare Health, Inc.",Medical Assistance,504.7,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LASER FIBER HOLMIUM (UROL) DISPOSABLE 940 MICRON COOK HLF-S940-HSMA / G25297,,A4649,HCPCS,Facility,Inpatient,,,,1000,850,286.6,1000,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
LASER FIBER HOLMIUM (UROL) DISPOSABLE 940 MICRON COOK HLF-S940-HSMA / G25297,,A4649,HCPCS,Facility,Outpatient,,,,1000,850,286.6,1000,"UCare Health, Inc.",Medicare Advantage,504.7,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LASER FIBER HOLMIUM (UROL) DISPOSABLE 940 MICRON COOK HLF-S940-HSMA / G25297,,A4649,HCPCS,Facility,Inpatient,,,,1000,850,286.6,1000,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LASER FIBER HOLMIUM (UROL) DISPOSABLE 940 MICRON COOK HLF-S940-HSMA / G25297,,A4649,HCPCS,Facility,Outpatient,,,,1000,850,286.6,1000,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),504.7,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LASER FIBER HOLMIUM (UROL) DISPOSABLE 940 MICRON COOK HLF-S940-HSMA / G25297,,A4649,HCPCS,Facility,Inpatient,,,,1000,850,286.6,1000,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LASER FIBER HOLMIUM (UROL) DISPOSABLE 940 MICRON COOK HLF-S940-HSMA / G25297,,A4649,HCPCS,Facility,Both,,,,1000,850,286.6,1000,UnitedHealthcare,Individual & Family,940,94,,percent of total billed charges,,
LASER FIBER HOLMIUM (UROL) DISPOSABLE 940 MICRON COOK HLF-S940-HSMA / G25297,,A4649,HCPCS,Facility,Outpatient,,,,1000,850,286.6,1000,UnitedHealthcare,Medicare Advantage,490,49,,percent of total billed charges,,
LASER FIBER HOLMIUM (UROL) DISPOSABLE 940 MICRON COOK HLF-S940-HSMA / G25297,,A4649,HCPCS,Facility,Inpatient,,,,1000,850,286.6,1000,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
LASER FIBER HOLMIUM (UROL) DISPOSABLE 940 MICRON COOK HLF-S940-HSMA / G25297,,A4649,HCPCS,Facility,Outpatient,,,,1000,850,286.6,1000,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,480,48,,percent of total billed charges,,100% of DHS outpatient percentage
LASER FIBER HOLMIUM (UROL) DISPOSABLE 940 MICRON COOK HLF-S940-HSMA / G25297,,A4649,HCPCS,Facility,Inpatient,,,,1000,850,286.6,1000,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
LIGACLIP ENDO ROTATING MCA MEDIUM-LARGE  ETHICON ER320,,A4649,HCPCS,Facility,Both,,,,450,382.5,128.97,450,Aetna,Commercial,414,92,,percent of total billed charges,,
LIGACLIP ENDO ROTATING MCA MEDIUM-LARGE  ETHICON ER320,,A4649,HCPCS,Facility,Outpatient,,,,450,382.5,128.97,450,Aetna,Medicare Advantage,220.5,49,,percent of total billed charges,,
LIGACLIP ENDO ROTATING MCA MEDIUM-LARGE  ETHICON ER320,,A4649,HCPCS,Facility,Inpatient,,,,450,382.5,128.97,450,Aetna,Medicare Advantage,,,,,Included in per diem rate,
LIGACLIP ENDO ROTATING MCA MEDIUM-LARGE  ETHICON ER320,,A4649,HCPCS,Facility,Both,,,,450,382.5,128.97,450,Aetna,PPO,418.5,93,,percent of total billed charges,,
LIGACLIP ENDO ROTATING MCA MEDIUM-LARGE  ETHICON ER320,,A4649,HCPCS,Facility,Both,,,,450,382.5,128.97,450,America's PPO,America's PPO,432.135,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
LIGACLIP ENDO ROTATING MCA MEDIUM-LARGE  ETHICON ER320,,A4649,HCPCS,Facility,Both,,,,450,382.5,128.97,450,BlueCross BlueShield Minnesota, Federal Employee Program,442.8,98.4,,percent of total billed charges,,
LIGACLIP ENDO ROTATING MCA MEDIUM-LARGE  ETHICON ER320,,A4649,HCPCS,Facility,Both,,,,450,382.5,128.97,450,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,450,100,,percent of total billed charges,,
LIGACLIP ENDO ROTATING MCA MEDIUM-LARGE  ETHICON ER320,,A4649,HCPCS,Facility,Both,,,,450,382.5,128.97,450,BlueCross BlueShield Minnesota,High Value Network Plan,405,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
LIGACLIP ENDO ROTATING MCA MEDIUM-LARGE  ETHICON ER320,,A4649,HCPCS,Facility,Outpatient,,,,450,382.5,128.97,450,BlueCross BlueShield Minnesota,Medicare Advantage,220.5,49,,percent of total billed charges,,
LIGACLIP ENDO ROTATING MCA MEDIUM-LARGE  ETHICON ER320,,A4649,HCPCS,Facility,Inpatient,,,,450,382.5,128.97,450,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
LIGACLIP ENDO ROTATING MCA MEDIUM-LARGE  ETHICON ER320,,A4649,HCPCS,Facility,Both,,,,450,382.5,128.97,450,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,398.565,88.57,,percent of total billed charges,,
LIGACLIP ENDO ROTATING MCA MEDIUM-LARGE  ETHICON ER320,,A4649,HCPCS,Facility,Both,,,,450,382.5,128.97,450,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,128.97,28.66,,percent of total billed charges,,
LIGACLIP ENDO ROTATING MCA MEDIUM-LARGE  ETHICON ER320,,A4649,HCPCS,Facility,Outpatient,,,,450,382.5,128.97,450,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),220.5,49,,percent of total billed charges,,
LIGACLIP ENDO ROTATING MCA MEDIUM-LARGE  ETHICON ER320,,A4649,HCPCS,Facility,Inpatient,,,,450,382.5,128.97,450,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
LIGACLIP ENDO ROTATING MCA MEDIUM-LARGE  ETHICON ER320,,A4649,HCPCS,Facility,Both,,,,450,382.5,128.97,450,CorVel,Worker's Compensation,450,100,,percent of total billed charges,,
LIGACLIP ENDO ROTATING MCA MEDIUM-LARGE  ETHICON ER320,,A4649,HCPCS,Facility,Both,,,,450,382.5,128.97,450,First Health Group Corporation,First Health Network,436.5,97,,percent of total billed charges,,
LIGACLIP ENDO ROTATING MCA MEDIUM-LARGE  ETHICON ER320,,A4649,HCPCS,Facility,Both,,,,450,382.5,128.97,450,"Health Partners, Inc.",Commercial,425.7,94.6,,percent of total billed charges,,
LIGACLIP ENDO ROTATING MCA MEDIUM-LARGE  ETHICON ER320,,A4649,HCPCS,Facility,Outpatient,,,,450,382.5,128.97,450,"Health Partners, Inc.",Medicare Advantage,220.5,49,,percent of total billed charges,,
LIGACLIP ENDO ROTATING MCA MEDIUM-LARGE  ETHICON ER320,,A4649,HCPCS,Facility,Inpatient,,,,450,382.5,128.97,450,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LIGACLIP ENDO ROTATING MCA MEDIUM-LARGE  ETHICON ER320,,A4649,HCPCS,Facility,Both,,,,450,382.5,128.97,450,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),270,60,,percent of total billed charges,,
LIGACLIP ENDO ROTATING MCA MEDIUM-LARGE  ETHICON ER320,,A4649,HCPCS,Facility,Both,,,,450,382.5,128.97,450,"Health Partners, Inc.",State of Minnesota Advantage Program,366.75,81.5,,percent of total billed charges,,
LIGACLIP ENDO ROTATING MCA MEDIUM-LARGE  ETHICON ER320,,A4649,HCPCS,Facility,Both,,,,450,382.5,128.97,450,"Health Partners, Inc.",State Public Programs,225,50,,percent of total billed charges,,
LIGACLIP ENDO ROTATING MCA MEDIUM-LARGE  ETHICON ER320,,A4649,HCPCS,Facility,Both,,,,450,382.5,128.97,450,Humana Insurance Company,Commercial PPO,427.5,95,,percent of total billed charges,,
LIGACLIP ENDO ROTATING MCA MEDIUM-LARGE  ETHICON ER320,,A4649,HCPCS,Facility,Outpatient,,,,450,382.5,128.97,450,Humana Insurance Company,Medicare PPO,220.5,49,,percent of total billed charges,,
LIGACLIP ENDO ROTATING MCA MEDIUM-LARGE  ETHICON ER320,,A4649,HCPCS,Facility,Inpatient,,,,450,382.5,128.97,450,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
LIGACLIP ENDO ROTATING MCA MEDIUM-LARGE  ETHICON ER320,,A4649,HCPCS,Facility,Both,,,,450,382.5,128.97,450,Medica,Individual & Family,445.95,99.1,,percent of total billed charges,,
LIGACLIP ENDO ROTATING MCA MEDIUM-LARGE  ETHICON ER320,,A4649,HCPCS,Facility,Outpatient,,,,450,382.5,128.97,450,Medica,Medica Advantage Solution,224.1,49.8,,percent of total billed charges,,
LIGACLIP ENDO ROTATING MCA MEDIUM-LARGE  ETHICON ER320,,A4649,HCPCS,Facility,Inpatient,,,,450,382.5,128.97,450,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
LIGACLIP ENDO ROTATING MCA MEDIUM-LARGE  ETHICON ER320,,A4649,HCPCS,Facility,Outpatient,,,,450,382.5,128.97,450,Medica,Medical Assistance,200.7,44.6,,percent of total billed charges,,
LIGACLIP ENDO ROTATING MCA MEDIUM-LARGE  ETHICON ER320,,A4649,HCPCS,Facility,Inpatient,,,,450,382.5,128.97,450,Medica,Medical Assistance,,,,,Included in per diem rate,
LIGACLIP ENDO ROTATING MCA MEDIUM-LARGE  ETHICON ER320,,A4649,HCPCS,Facility,Outpatient,,,,450,382.5,128.97,450,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,224.1,49.8,,percent of total billed charges,,
LIGACLIP ENDO ROTATING MCA MEDIUM-LARGE  ETHICON ER320,,A4649,HCPCS,Facility,Inpatient,,,,450,382.5,128.97,450,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
LIGACLIP ENDO ROTATING MCA MEDIUM-LARGE  ETHICON ER320,,A4649,HCPCS,Facility,Both,,,,450,382.5,128.97,450,"Multiplan, Inc.","Multiplan, Inc.",423,94,,percent of total billed charges,,
LIGACLIP ENDO ROTATING MCA MEDIUM-LARGE  ETHICON ER320,,A4649,HCPCS,Facility,Outpatient,,,,450,382.5,128.97,450,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,405.45,90.1,,percent of total billed charges,,
LIGACLIP ENDO ROTATING MCA MEDIUM-LARGE  ETHICON ER320,,A4649,HCPCS,Facility,Inpatient,,,,450,382.5,128.97,450,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
LIGACLIP ENDO ROTATING MCA MEDIUM-LARGE  ETHICON ER320,,A4649,HCPCS,Facility,Both,,,,450,382.5,128.97,450,"Preferred One Administrative Services, INC.",PPO,443.7,98.6,,percent of total billed charges,,
LIGACLIP ENDO ROTATING MCA MEDIUM-LARGE  ETHICON ER320,,A4649,HCPCS,Facility,Outpatient,,,,450,382.5,128.97,450,PrimeWest Health,Minnesota Senior Health Options (MSHO),231.525,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
LIGACLIP ENDO ROTATING MCA MEDIUM-LARGE  ETHICON ER320,,A4649,HCPCS,Facility,Inpatient,,,,450,382.5,128.97,450,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LIGACLIP ENDO ROTATING MCA MEDIUM-LARGE  ETHICON ER320,,A4649,HCPCS,Facility,Outpatient,,,,450,382.5,128.97,450,PrimeWest Health,MinnesotaCare,231.12,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
LIGACLIP ENDO ROTATING MCA MEDIUM-LARGE  ETHICON ER320,,A4649,HCPCS,Facility,Inpatient,,,,450,382.5,128.97,450,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
LIGACLIP ENDO ROTATING MCA MEDIUM-LARGE  ETHICON ER320,,A4649,HCPCS,Facility,Both,,,,450,382.5,128.97,450,Sanford Health Plan,Sanford Health Plan,414,92,,percent of total billed charges,,
LIGACLIP ENDO ROTATING MCA MEDIUM-LARGE  ETHICON ER320,,A4649,HCPCS,Facility,Outpatient,,,,450,382.5,128.97,450,"UCare Health, Inc.",Individual & Family Plan,253.575,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
LIGACLIP ENDO ROTATING MCA MEDIUM-LARGE  ETHICON ER320,,A4649,HCPCS,Facility,Inpatient,,,,450,382.5,128.97,450,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
LIGACLIP ENDO ROTATING MCA MEDIUM-LARGE  ETHICON ER320,,A4649,HCPCS,Facility,Outpatient,,,,450,382.5,128.97,450,"UCare Health, Inc.",Medical Assistance,227.115,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LIGACLIP ENDO ROTATING MCA MEDIUM-LARGE  ETHICON ER320,,A4649,HCPCS,Facility,Inpatient,,,,450,382.5,128.97,450,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
LIGACLIP ENDO ROTATING MCA MEDIUM-LARGE  ETHICON ER320,,A4649,HCPCS,Facility,Outpatient,,,,450,382.5,128.97,450,"UCare Health, Inc.",Medicare Advantage,227.115,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LIGACLIP ENDO ROTATING MCA MEDIUM-LARGE  ETHICON ER320,,A4649,HCPCS,Facility,Inpatient,,,,450,382.5,128.97,450,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LIGACLIP ENDO ROTATING MCA MEDIUM-LARGE  ETHICON ER320,,A4649,HCPCS,Facility,Outpatient,,,,450,382.5,128.97,450,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),227.115,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LIGACLIP ENDO ROTATING MCA MEDIUM-LARGE  ETHICON ER320,,A4649,HCPCS,Facility,Inpatient,,,,450,382.5,128.97,450,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LIGACLIP ENDO ROTATING MCA MEDIUM-LARGE  ETHICON ER320,,A4649,HCPCS,Facility,Both,,,,450,382.5,128.97,450,UnitedHealthcare,Individual & Family,423,94,,percent of total billed charges,,
LIGACLIP ENDO ROTATING MCA MEDIUM-LARGE  ETHICON ER320,,A4649,HCPCS,Facility,Outpatient,,,,450,382.5,128.97,450,UnitedHealthcare,Medicare Advantage,220.5,49,,percent of total billed charges,,
LIGACLIP ENDO ROTATING MCA MEDIUM-LARGE  ETHICON ER320,,A4649,HCPCS,Facility,Inpatient,,,,450,382.5,128.97,450,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
LIGACLIP ENDO ROTATING MCA MEDIUM-LARGE  ETHICON ER320,,A4649,HCPCS,Facility,Outpatient,,,,450,382.5,128.97,450,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,216,48,,percent of total billed charges,,100% of DHS outpatient percentage
LIGACLIP ENDO ROTATING MCA MEDIUM-LARGE  ETHICON ER320,,A4649,HCPCS,Facility,Inpatient,,,,450,382.5,128.97,450,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
LITHOTOMY PACK,,A4649,HCPCS,Facility,Both,,,,25,21.25,7.165,25,Aetna,Commercial,23,92,,percent of total billed charges,,
LITHOTOMY PACK,,A4649,HCPCS,Facility,Outpatient,,,,25,21.25,7.165,25,Aetna,Medicare Advantage,12.25,49,,percent of total billed charges,,
LITHOTOMY PACK,,A4649,HCPCS,Facility,Inpatient,,,,25,21.25,7.165,25,Aetna,Medicare Advantage,,,,,Included in per diem rate,
LITHOTOMY PACK,,A4649,HCPCS,Facility,Both,,,,25,21.25,7.165,25,Aetna,PPO,23.25,93,,percent of total billed charges,,
LITHOTOMY PACK,,A4649,HCPCS,Facility,Both,,,,25,21.25,7.165,25,America's PPO,America's PPO,24.0075,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
LITHOTOMY PACK,,A4649,HCPCS,Facility,Both,,,,25,21.25,7.165,25,BlueCross BlueShield Minnesota, Federal Employee Program,24.6,98.4,,percent of total billed charges,,
LITHOTOMY PACK,,A4649,HCPCS,Facility,Both,,,,25,21.25,7.165,25,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,25,100,,percent of total billed charges,,
LITHOTOMY PACK,,A4649,HCPCS,Facility,Both,,,,25,21.25,7.165,25,BlueCross BlueShield Minnesota,High Value Network Plan,22.5,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
LITHOTOMY PACK,,A4649,HCPCS,Facility,Outpatient,,,,25,21.25,7.165,25,BlueCross BlueShield Minnesota,Medicare Advantage,12.25,49,,percent of total billed charges,,
LITHOTOMY PACK,,A4649,HCPCS,Facility,Inpatient,,,,25,21.25,7.165,25,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
LITHOTOMY PACK,,A4649,HCPCS,Facility,Both,,,,25,21.25,7.165,25,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,22.1425,88.57,,percent of total billed charges,,
LITHOTOMY PACK,,A4649,HCPCS,Facility,Both,,,,25,21.25,7.165,25,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,7.165,28.66,,percent of total billed charges,,
LITHOTOMY PACK,,A4649,HCPCS,Facility,Outpatient,,,,25,21.25,7.165,25,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),12.25,49,,percent of total billed charges,,
LITHOTOMY PACK,,A4649,HCPCS,Facility,Inpatient,,,,25,21.25,7.165,25,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
LITHOTOMY PACK,,A4649,HCPCS,Facility,Both,,,,25,21.25,7.165,25,CorVel,Worker's Compensation,25,100,,percent of total billed charges,,
LITHOTOMY PACK,,A4649,HCPCS,Facility,Both,,,,25,21.25,7.165,25,First Health Group Corporation,First Health Network,24.25,97,,percent of total billed charges,,
LITHOTOMY PACK,,A4649,HCPCS,Facility,Both,,,,25,21.25,7.165,25,"Health Partners, Inc.",Commercial,23.65,94.6,,percent of total billed charges,,
LITHOTOMY PACK,,A4649,HCPCS,Facility,Outpatient,,,,25,21.25,7.165,25,"Health Partners, Inc.",Medicare Advantage,12.25,49,,percent of total billed charges,,
LITHOTOMY PACK,,A4649,HCPCS,Facility,Inpatient,,,,25,21.25,7.165,25,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LITHOTOMY PACK,,A4649,HCPCS,Facility,Both,,,,25,21.25,7.165,25,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),15,60,,percent of total billed charges,,
LITHOTOMY PACK,,A4649,HCPCS,Facility,Both,,,,25,21.25,7.165,25,"Health Partners, Inc.",State of Minnesota Advantage Program,20.375,81.5,,percent of total billed charges,,
LITHOTOMY PACK,,A4649,HCPCS,Facility,Both,,,,25,21.25,7.165,25,"Health Partners, Inc.",State Public Programs,12.5,50,,percent of total billed charges,,
LITHOTOMY PACK,,A4649,HCPCS,Facility,Both,,,,25,21.25,7.165,25,Humana Insurance Company,Commercial PPO,23.75,95,,percent of total billed charges,,
LITHOTOMY PACK,,A4649,HCPCS,Facility,Outpatient,,,,25,21.25,7.165,25,Humana Insurance Company,Medicare PPO,12.25,49,,percent of total billed charges,,
LITHOTOMY PACK,,A4649,HCPCS,Facility,Inpatient,,,,25,21.25,7.165,25,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
LITHOTOMY PACK,,A4649,HCPCS,Facility,Both,,,,25,21.25,7.165,25,Medica,Individual & Family,24.775,99.1,,percent of total billed charges,,
LITHOTOMY PACK,,A4649,HCPCS,Facility,Outpatient,,,,25,21.25,7.165,25,Medica,Medica Advantage Solution,12.45,49.8,,percent of total billed charges,,
LITHOTOMY PACK,,A4649,HCPCS,Facility,Inpatient,,,,25,21.25,7.165,25,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
LITHOTOMY PACK,,A4649,HCPCS,Facility,Outpatient,,,,25,21.25,7.165,25,Medica,Medical Assistance,11.15,44.6,,percent of total billed charges,,
LITHOTOMY PACK,,A4649,HCPCS,Facility,Inpatient,,,,25,21.25,7.165,25,Medica,Medical Assistance,,,,,Included in per diem rate,
LITHOTOMY PACK,,A4649,HCPCS,Facility,Outpatient,,,,25,21.25,7.165,25,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,12.45,49.8,,percent of total billed charges,,
LITHOTOMY PACK,,A4649,HCPCS,Facility,Inpatient,,,,25,21.25,7.165,25,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
LITHOTOMY PACK,,A4649,HCPCS,Facility,Both,,,,25,21.25,7.165,25,"Multiplan, Inc.","Multiplan, Inc.",23.5,94,,percent of total billed charges,,
LITHOTOMY PACK,,A4649,HCPCS,Facility,Outpatient,,,,25,21.25,7.165,25,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,22.525,90.1,,percent of total billed charges,,
LITHOTOMY PACK,,A4649,HCPCS,Facility,Inpatient,,,,25,21.25,7.165,25,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
LITHOTOMY PACK,,A4649,HCPCS,Facility,Both,,,,25,21.25,7.165,25,"Preferred One Administrative Services, INC.",PPO,24.65,98.6,,percent of total billed charges,,
LITHOTOMY PACK,,A4649,HCPCS,Facility,Outpatient,,,,25,21.25,7.165,25,PrimeWest Health,Minnesota Senior Health Options (MSHO),12.8625,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
LITHOTOMY PACK,,A4649,HCPCS,Facility,Inpatient,,,,25,21.25,7.165,25,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LITHOTOMY PACK,,A4649,HCPCS,Facility,Outpatient,,,,25,21.25,7.165,25,PrimeWest Health,MinnesotaCare,12.84,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
LITHOTOMY PACK,,A4649,HCPCS,Facility,Inpatient,,,,25,21.25,7.165,25,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
LITHOTOMY PACK,,A4649,HCPCS,Facility,Both,,,,25,21.25,7.165,25,Sanford Health Plan,Sanford Health Plan,23,92,,percent of total billed charges,,
LITHOTOMY PACK,,A4649,HCPCS,Facility,Outpatient,,,,25,21.25,7.165,25,"UCare Health, Inc.",Individual & Family Plan,14.0875,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
LITHOTOMY PACK,,A4649,HCPCS,Facility,Inpatient,,,,25,21.25,7.165,25,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
LITHOTOMY PACK,,A4649,HCPCS,Facility,Outpatient,,,,25,21.25,7.165,25,"UCare Health, Inc.",Medical Assistance,12.6175,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LITHOTOMY PACK,,A4649,HCPCS,Facility,Inpatient,,,,25,21.25,7.165,25,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
LITHOTOMY PACK,,A4649,HCPCS,Facility,Outpatient,,,,25,21.25,7.165,25,"UCare Health, Inc.",Medicare Advantage,12.6175,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LITHOTOMY PACK,,A4649,HCPCS,Facility,Inpatient,,,,25,21.25,7.165,25,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LITHOTOMY PACK,,A4649,HCPCS,Facility,Outpatient,,,,25,21.25,7.165,25,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),12.6175,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LITHOTOMY PACK,,A4649,HCPCS,Facility,Inpatient,,,,25,21.25,7.165,25,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LITHOTOMY PACK,,A4649,HCPCS,Facility,Both,,,,25,21.25,7.165,25,UnitedHealthcare,Individual & Family,23.5,94,,percent of total billed charges,,
LITHOTOMY PACK,,A4649,HCPCS,Facility,Outpatient,,,,25,21.25,7.165,25,UnitedHealthcare,Medicare Advantage,12.25,49,,percent of total billed charges,,
LITHOTOMY PACK,,A4649,HCPCS,Facility,Inpatient,,,,25,21.25,7.165,25,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
LITHOTOMY PACK,,A4649,HCPCS,Facility,Outpatient,,,,25,21.25,7.165,25,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,12,48,,percent of total billed charges,,100% of DHS outpatient percentage
LITHOTOMY PACK,,A4649,HCPCS,Facility,Inpatient,,,,25,21.25,7.165,25,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
MALYUGIN RING 6.25MM MST,,A4649,HCPCS,Facility,Both,,,,465,395.25,133.269,465,Aetna,Commercial,427.8,92,,percent of total billed charges,,
MALYUGIN RING 6.25MM MST,,A4649,HCPCS,Facility,Outpatient,,,,465,395.25,133.269,465,Aetna,Medicare Advantage,227.85,49,,percent of total billed charges,,
MALYUGIN RING 6.25MM MST,,A4649,HCPCS,Facility,Inpatient,,,,465,395.25,133.269,465,Aetna,Medicare Advantage,,,,,Included in per diem rate,
MALYUGIN RING 6.25MM MST,,A4649,HCPCS,Facility,Both,,,,465,395.25,133.269,465,Aetna,PPO,432.45,93,,percent of total billed charges,,
MALYUGIN RING 6.25MM MST,,A4649,HCPCS,Facility,Both,,,,465,395.25,133.269,465,America's PPO,America's PPO,446.5395,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
MALYUGIN RING 6.25MM MST,,A4649,HCPCS,Facility,Both,,,,465,395.25,133.269,465,BlueCross BlueShield Minnesota, Federal Employee Program,457.56,98.4,,percent of total billed charges,,
MALYUGIN RING 6.25MM MST,,A4649,HCPCS,Facility,Both,,,,465,395.25,133.269,465,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,465,100,,percent of total billed charges,,
MALYUGIN RING 6.25MM MST,,A4649,HCPCS,Facility,Both,,,,465,395.25,133.269,465,BlueCross BlueShield Minnesota,High Value Network Plan,418.5,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
MALYUGIN RING 6.25MM MST,,A4649,HCPCS,Facility,Outpatient,,,,465,395.25,133.269,465,BlueCross BlueShield Minnesota,Medicare Advantage,227.85,49,,percent of total billed charges,,
MALYUGIN RING 6.25MM MST,,A4649,HCPCS,Facility,Inpatient,,,,465,395.25,133.269,465,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
MALYUGIN RING 6.25MM MST,,A4649,HCPCS,Facility,Both,,,,465,395.25,133.269,465,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,411.8505,88.57,,percent of total billed charges,,
MALYUGIN RING 6.25MM MST,,A4649,HCPCS,Facility,Both,,,,465,395.25,133.269,465,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,133.269,28.66,,percent of total billed charges,,
MALYUGIN RING 6.25MM MST,,A4649,HCPCS,Facility,Outpatient,,,,465,395.25,133.269,465,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),227.85,49,,percent of total billed charges,,
MALYUGIN RING 6.25MM MST,,A4649,HCPCS,Facility,Inpatient,,,,465,395.25,133.269,465,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
MALYUGIN RING 6.25MM MST,,A4649,HCPCS,Facility,Both,,,,465,395.25,133.269,465,CorVel,Worker's Compensation,465,100,,percent of total billed charges,,
MALYUGIN RING 6.25MM MST,,A4649,HCPCS,Facility,Both,,,,465,395.25,133.269,465,First Health Group Corporation,First Health Network,451.05,97,,percent of total billed charges,,
MALYUGIN RING 6.25MM MST,,A4649,HCPCS,Facility,Both,,,,465,395.25,133.269,465,"Health Partners, Inc.",Commercial,439.89,94.6,,percent of total billed charges,,
MALYUGIN RING 6.25MM MST,,A4649,HCPCS,Facility,Outpatient,,,,465,395.25,133.269,465,"Health Partners, Inc.",Medicare Advantage,227.85,49,,percent of total billed charges,,
MALYUGIN RING 6.25MM MST,,A4649,HCPCS,Facility,Inpatient,,,,465,395.25,133.269,465,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
MALYUGIN RING 6.25MM MST,,A4649,HCPCS,Facility,Both,,,,465,395.25,133.269,465,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),279,60,,percent of total billed charges,,
MALYUGIN RING 6.25MM MST,,A4649,HCPCS,Facility,Both,,,,465,395.25,133.269,465,"Health Partners, Inc.",State of Minnesota Advantage Program,378.975,81.5,,percent of total billed charges,,
MALYUGIN RING 6.25MM MST,,A4649,HCPCS,Facility,Both,,,,465,395.25,133.269,465,"Health Partners, Inc.",State Public Programs,232.5,50,,percent of total billed charges,,
MALYUGIN RING 6.25MM MST,,A4649,HCPCS,Facility,Both,,,,465,395.25,133.269,465,Humana Insurance Company,Commercial PPO,441.75,95,,percent of total billed charges,,
MALYUGIN RING 6.25MM MST,,A4649,HCPCS,Facility,Outpatient,,,,465,395.25,133.269,465,Humana Insurance Company,Medicare PPO,227.85,49,,percent of total billed charges,,
MALYUGIN RING 6.25MM MST,,A4649,HCPCS,Facility,Inpatient,,,,465,395.25,133.269,465,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
MALYUGIN RING 6.25MM MST,,A4649,HCPCS,Facility,Both,,,,465,395.25,133.269,465,Medica,Individual & Family,460.815,99.1,,percent of total billed charges,,
MALYUGIN RING 6.25MM MST,,A4649,HCPCS,Facility,Outpatient,,,,465,395.25,133.269,465,Medica,Medica Advantage Solution,231.57,49.8,,percent of total billed charges,,
MALYUGIN RING 6.25MM MST,,A4649,HCPCS,Facility,Inpatient,,,,465,395.25,133.269,465,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
MALYUGIN RING 6.25MM MST,,A4649,HCPCS,Facility,Outpatient,,,,465,395.25,133.269,465,Medica,Medical Assistance,207.39,44.6,,percent of total billed charges,,
MALYUGIN RING 6.25MM MST,,A4649,HCPCS,Facility,Inpatient,,,,465,395.25,133.269,465,Medica,Medical Assistance,,,,,Included in per diem rate,
MALYUGIN RING 6.25MM MST,,A4649,HCPCS,Facility,Outpatient,,,,465,395.25,133.269,465,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,231.57,49.8,,percent of total billed charges,,
MALYUGIN RING 6.25MM MST,,A4649,HCPCS,Facility,Inpatient,,,,465,395.25,133.269,465,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
MALYUGIN RING 6.25MM MST,,A4649,HCPCS,Facility,Both,,,,465,395.25,133.269,465,"Multiplan, Inc.","Multiplan, Inc.",437.1,94,,percent of total billed charges,,
MALYUGIN RING 6.25MM MST,,A4649,HCPCS,Facility,Outpatient,,,,465,395.25,133.269,465,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,418.965,90.1,,percent of total billed charges,,
MALYUGIN RING 6.25MM MST,,A4649,HCPCS,Facility,Inpatient,,,,465,395.25,133.269,465,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
MALYUGIN RING 6.25MM MST,,A4649,HCPCS,Facility,Both,,,,465,395.25,133.269,465,"Preferred One Administrative Services, INC.",PPO,458.49,98.6,,percent of total billed charges,,
MALYUGIN RING 6.25MM MST,,A4649,HCPCS,Facility,Outpatient,,,,465,395.25,133.269,465,PrimeWest Health,Minnesota Senior Health Options (MSHO),239.2425,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
MALYUGIN RING 6.25MM MST,,A4649,HCPCS,Facility,Inpatient,,,,465,395.25,133.269,465,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
MALYUGIN RING 6.25MM MST,,A4649,HCPCS,Facility,Outpatient,,,,465,395.25,133.269,465,PrimeWest Health,MinnesotaCare,238.824,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
MALYUGIN RING 6.25MM MST,,A4649,HCPCS,Facility,Inpatient,,,,465,395.25,133.269,465,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
MALYUGIN RING 6.25MM MST,,A4649,HCPCS,Facility,Both,,,,465,395.25,133.269,465,Sanford Health Plan,Sanford Health Plan,427.8,92,,percent of total billed charges,,
MALYUGIN RING 6.25MM MST,,A4649,HCPCS,Facility,Outpatient,,,,465,395.25,133.269,465,"UCare Health, Inc.",Individual & Family Plan,262.0275,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
MALYUGIN RING 6.25MM MST,,A4649,HCPCS,Facility,Inpatient,,,,465,395.25,133.269,465,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
MALYUGIN RING 6.25MM MST,,A4649,HCPCS,Facility,Outpatient,,,,465,395.25,133.269,465,"UCare Health, Inc.",Medical Assistance,234.6855,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MALYUGIN RING 6.25MM MST,,A4649,HCPCS,Facility,Inpatient,,,,465,395.25,133.269,465,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
MALYUGIN RING 6.25MM MST,,A4649,HCPCS,Facility,Outpatient,,,,465,395.25,133.269,465,"UCare Health, Inc.",Medicare Advantage,234.6855,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MALYUGIN RING 6.25MM MST,,A4649,HCPCS,Facility,Inpatient,,,,465,395.25,133.269,465,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
MALYUGIN RING 6.25MM MST,,A4649,HCPCS,Facility,Outpatient,,,,465,395.25,133.269,465,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),234.6855,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MALYUGIN RING 6.25MM MST,,A4649,HCPCS,Facility,Inpatient,,,,465,395.25,133.269,465,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
MALYUGIN RING 6.25MM MST,,A4649,HCPCS,Facility,Both,,,,465,395.25,133.269,465,UnitedHealthcare,Individual & Family,437.1,94,,percent of total billed charges,,
MALYUGIN RING 6.25MM MST,,A4649,HCPCS,Facility,Outpatient,,,,465,395.25,133.269,465,UnitedHealthcare,Medicare Advantage,227.85,49,,percent of total billed charges,,
MALYUGIN RING 6.25MM MST,,A4649,HCPCS,Facility,Inpatient,,,,465,395.25,133.269,465,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
MALYUGIN RING 6.25MM MST,,A4649,HCPCS,Facility,Outpatient,,,,465,395.25,133.269,465,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,223.2,48,,percent of total billed charges,,100% of DHS outpatient percentage
MALYUGIN RING 6.25MM MST,,A4649,HCPCS,Facility,Inpatient,,,,465,395.25,133.269,465,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
MALYUGIN RING CLASSIC SYSTEM 6.25 MM  MAL-0001,,A4649,HCPCS,Facility,Both,,,,465,395.25,133.269,465,Aetna,Commercial,427.8,92,,percent of total billed charges,,
MALYUGIN RING CLASSIC SYSTEM 6.25 MM  MAL-0001,,A4649,HCPCS,Facility,Outpatient,,,,465,395.25,133.269,465,Aetna,Medicare Advantage,227.85,49,,percent of total billed charges,,
MALYUGIN RING CLASSIC SYSTEM 6.25 MM  MAL-0001,,A4649,HCPCS,Facility,Inpatient,,,,465,395.25,133.269,465,Aetna,Medicare Advantage,,,,,Included in per diem rate,
MALYUGIN RING CLASSIC SYSTEM 6.25 MM  MAL-0001,,A4649,HCPCS,Facility,Both,,,,465,395.25,133.269,465,Aetna,PPO,432.45,93,,percent of total billed charges,,
MALYUGIN RING CLASSIC SYSTEM 6.25 MM  MAL-0001,,A4649,HCPCS,Facility,Both,,,,465,395.25,133.269,465,America's PPO,America's PPO,446.5395,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
MALYUGIN RING CLASSIC SYSTEM 6.25 MM  MAL-0001,,A4649,HCPCS,Facility,Both,,,,465,395.25,133.269,465,BlueCross BlueShield Minnesota, Federal Employee Program,457.56,98.4,,percent of total billed charges,,
MALYUGIN RING CLASSIC SYSTEM 6.25 MM  MAL-0001,,A4649,HCPCS,Facility,Both,,,,465,395.25,133.269,465,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,465,100,,percent of total billed charges,,
MALYUGIN RING CLASSIC SYSTEM 6.25 MM  MAL-0001,,A4649,HCPCS,Facility,Both,,,,465,395.25,133.269,465,BlueCross BlueShield Minnesota,High Value Network Plan,418.5,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
MALYUGIN RING CLASSIC SYSTEM 6.25 MM  MAL-0001,,A4649,HCPCS,Facility,Outpatient,,,,465,395.25,133.269,465,BlueCross BlueShield Minnesota,Medicare Advantage,227.85,49,,percent of total billed charges,,
MALYUGIN RING CLASSIC SYSTEM 6.25 MM  MAL-0001,,A4649,HCPCS,Facility,Inpatient,,,,465,395.25,133.269,465,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
MALYUGIN RING CLASSIC SYSTEM 6.25 MM  MAL-0001,,A4649,HCPCS,Facility,Both,,,,465,395.25,133.269,465,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,411.8505,88.57,,percent of total billed charges,,
MALYUGIN RING CLASSIC SYSTEM 6.25 MM  MAL-0001,,A4649,HCPCS,Facility,Both,,,,465,395.25,133.269,465,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,133.269,28.66,,percent of total billed charges,,
MALYUGIN RING CLASSIC SYSTEM 6.25 MM  MAL-0001,,A4649,HCPCS,Facility,Outpatient,,,,465,395.25,133.269,465,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),227.85,49,,percent of total billed charges,,
MALYUGIN RING CLASSIC SYSTEM 6.25 MM  MAL-0001,,A4649,HCPCS,Facility,Inpatient,,,,465,395.25,133.269,465,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
MALYUGIN RING CLASSIC SYSTEM 6.25 MM  MAL-0001,,A4649,HCPCS,Facility,Both,,,,465,395.25,133.269,465,CorVel,Worker's Compensation,465,100,,percent of total billed charges,,
MALYUGIN RING CLASSIC SYSTEM 6.25 MM  MAL-0001,,A4649,HCPCS,Facility,Both,,,,465,395.25,133.269,465,First Health Group Corporation,First Health Network,451.05,97,,percent of total billed charges,,
MALYUGIN RING CLASSIC SYSTEM 6.25 MM  MAL-0001,,A4649,HCPCS,Facility,Both,,,,465,395.25,133.269,465,"Health Partners, Inc.",Commercial,439.89,94.6,,percent of total billed charges,,
MALYUGIN RING CLASSIC SYSTEM 6.25 MM  MAL-0001,,A4649,HCPCS,Facility,Outpatient,,,,465,395.25,133.269,465,"Health Partners, Inc.",Medicare Advantage,227.85,49,,percent of total billed charges,,
MALYUGIN RING CLASSIC SYSTEM 6.25 MM  MAL-0001,,A4649,HCPCS,Facility,Inpatient,,,,465,395.25,133.269,465,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
MALYUGIN RING CLASSIC SYSTEM 6.25 MM  MAL-0001,,A4649,HCPCS,Facility,Both,,,,465,395.25,133.269,465,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),279,60,,percent of total billed charges,,
MALYUGIN RING CLASSIC SYSTEM 6.25 MM  MAL-0001,,A4649,HCPCS,Facility,Both,,,,465,395.25,133.269,465,"Health Partners, Inc.",State of Minnesota Advantage Program,378.975,81.5,,percent of total billed charges,,
MALYUGIN RING CLASSIC SYSTEM 6.25 MM  MAL-0001,,A4649,HCPCS,Facility,Both,,,,465,395.25,133.269,465,"Health Partners, Inc.",State Public Programs,232.5,50,,percent of total billed charges,,
MALYUGIN RING CLASSIC SYSTEM 6.25 MM  MAL-0001,,A4649,HCPCS,Facility,Both,,,,465,395.25,133.269,465,Humana Insurance Company,Commercial PPO,441.75,95,,percent of total billed charges,,
MALYUGIN RING CLASSIC SYSTEM 6.25 MM  MAL-0001,,A4649,HCPCS,Facility,Outpatient,,,,465,395.25,133.269,465,Humana Insurance Company,Medicare PPO,227.85,49,,percent of total billed charges,,
MALYUGIN RING CLASSIC SYSTEM 6.25 MM  MAL-0001,,A4649,HCPCS,Facility,Inpatient,,,,465,395.25,133.269,465,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
MALYUGIN RING CLASSIC SYSTEM 6.25 MM  MAL-0001,,A4649,HCPCS,Facility,Both,,,,465,395.25,133.269,465,Medica,Individual & Family,460.815,99.1,,percent of total billed charges,,
MALYUGIN RING CLASSIC SYSTEM 6.25 MM  MAL-0001,,A4649,HCPCS,Facility,Outpatient,,,,465,395.25,133.269,465,Medica,Medica Advantage Solution,231.57,49.8,,percent of total billed charges,,
MALYUGIN RING CLASSIC SYSTEM 6.25 MM  MAL-0001,,A4649,HCPCS,Facility,Inpatient,,,,465,395.25,133.269,465,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
MALYUGIN RING CLASSIC SYSTEM 6.25 MM  MAL-0001,,A4649,HCPCS,Facility,Outpatient,,,,465,395.25,133.269,465,Medica,Medical Assistance,207.39,44.6,,percent of total billed charges,,
MALYUGIN RING CLASSIC SYSTEM 6.25 MM  MAL-0001,,A4649,HCPCS,Facility,Inpatient,,,,465,395.25,133.269,465,Medica,Medical Assistance,,,,,Included in per diem rate,
MALYUGIN RING CLASSIC SYSTEM 6.25 MM  MAL-0001,,A4649,HCPCS,Facility,Outpatient,,,,465,395.25,133.269,465,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,231.57,49.8,,percent of total billed charges,,
MALYUGIN RING CLASSIC SYSTEM 6.25 MM  MAL-0001,,A4649,HCPCS,Facility,Inpatient,,,,465,395.25,133.269,465,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
MALYUGIN RING CLASSIC SYSTEM 6.25 MM  MAL-0001,,A4649,HCPCS,Facility,Both,,,,465,395.25,133.269,465,"Multiplan, Inc.","Multiplan, Inc.",437.1,94,,percent of total billed charges,,
MALYUGIN RING CLASSIC SYSTEM 6.25 MM  MAL-0001,,A4649,HCPCS,Facility,Outpatient,,,,465,395.25,133.269,465,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,418.965,90.1,,percent of total billed charges,,
MALYUGIN RING CLASSIC SYSTEM 6.25 MM  MAL-0001,,A4649,HCPCS,Facility,Inpatient,,,,465,395.25,133.269,465,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
MALYUGIN RING CLASSIC SYSTEM 6.25 MM  MAL-0001,,A4649,HCPCS,Facility,Both,,,,465,395.25,133.269,465,"Preferred One Administrative Services, INC.",PPO,458.49,98.6,,percent of total billed charges,,
MALYUGIN RING CLASSIC SYSTEM 6.25 MM  MAL-0001,,A4649,HCPCS,Facility,Outpatient,,,,465,395.25,133.269,465,PrimeWest Health,Minnesota Senior Health Options (MSHO),239.2425,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
MALYUGIN RING CLASSIC SYSTEM 6.25 MM  MAL-0001,,A4649,HCPCS,Facility,Inpatient,,,,465,395.25,133.269,465,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
MALYUGIN RING CLASSIC SYSTEM 6.25 MM  MAL-0001,,A4649,HCPCS,Facility,Outpatient,,,,465,395.25,133.269,465,PrimeWest Health,MinnesotaCare,238.824,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
MALYUGIN RING CLASSIC SYSTEM 6.25 MM  MAL-0001,,A4649,HCPCS,Facility,Inpatient,,,,465,395.25,133.269,465,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
MALYUGIN RING CLASSIC SYSTEM 6.25 MM  MAL-0001,,A4649,HCPCS,Facility,Both,,,,465,395.25,133.269,465,Sanford Health Plan,Sanford Health Plan,427.8,92,,percent of total billed charges,,
MALYUGIN RING CLASSIC SYSTEM 6.25 MM  MAL-0001,,A4649,HCPCS,Facility,Outpatient,,,,465,395.25,133.269,465,"UCare Health, Inc.",Individual & Family Plan,262.0275,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
MALYUGIN RING CLASSIC SYSTEM 6.25 MM  MAL-0001,,A4649,HCPCS,Facility,Inpatient,,,,465,395.25,133.269,465,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
MALYUGIN RING CLASSIC SYSTEM 6.25 MM  MAL-0001,,A4649,HCPCS,Facility,Outpatient,,,,465,395.25,133.269,465,"UCare Health, Inc.",Medical Assistance,234.6855,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MALYUGIN RING CLASSIC SYSTEM 6.25 MM  MAL-0001,,A4649,HCPCS,Facility,Inpatient,,,,465,395.25,133.269,465,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
MALYUGIN RING CLASSIC SYSTEM 6.25 MM  MAL-0001,,A4649,HCPCS,Facility,Outpatient,,,,465,395.25,133.269,465,"UCare Health, Inc.",Medicare Advantage,234.6855,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MALYUGIN RING CLASSIC SYSTEM 6.25 MM  MAL-0001,,A4649,HCPCS,Facility,Inpatient,,,,465,395.25,133.269,465,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
MALYUGIN RING CLASSIC SYSTEM 6.25 MM  MAL-0001,,A4649,HCPCS,Facility,Outpatient,,,,465,395.25,133.269,465,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),234.6855,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MALYUGIN RING CLASSIC SYSTEM 6.25 MM  MAL-0001,,A4649,HCPCS,Facility,Inpatient,,,,465,395.25,133.269,465,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
MALYUGIN RING CLASSIC SYSTEM 6.25 MM  MAL-0001,,A4649,HCPCS,Facility,Both,,,,465,395.25,133.269,465,UnitedHealthcare,Individual & Family,437.1,94,,percent of total billed charges,,
MALYUGIN RING CLASSIC SYSTEM 6.25 MM  MAL-0001,,A4649,HCPCS,Facility,Outpatient,,,,465,395.25,133.269,465,UnitedHealthcare,Medicare Advantage,227.85,49,,percent of total billed charges,,
MALYUGIN RING CLASSIC SYSTEM 6.25 MM  MAL-0001,,A4649,HCPCS,Facility,Inpatient,,,,465,395.25,133.269,465,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
MALYUGIN RING CLASSIC SYSTEM 6.25 MM  MAL-0001,,A4649,HCPCS,Facility,Outpatient,,,,465,395.25,133.269,465,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,223.2,48,,percent of total billed charges,,100% of DHS outpatient percentage
MALYUGIN RING CLASSIC SYSTEM 6.25 MM  MAL-0001,,A4649,HCPCS,Facility,Inpatient,,,,465,395.25,133.269,465,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
MIXER CEMENT W/ FEMORAL BREAKAWAY NOZZLE REVOLUTION  STRYKER 0606-563-000,,A4649,HCPCS,Facility,Both,,,,234.5,199.325,67.2077,234.5,Aetna,Commercial,215.74,92,,percent of total billed charges,,
MIXER CEMENT W/ FEMORAL BREAKAWAY NOZZLE REVOLUTION  STRYKER 0606-563-000,,A4649,HCPCS,Facility,Outpatient,,,,234.5,199.325,67.2077,234.5,Aetna,Medicare Advantage,114.905,49,,percent of total billed charges,,
MIXER CEMENT W/ FEMORAL BREAKAWAY NOZZLE REVOLUTION  STRYKER 0606-563-000,,A4649,HCPCS,Facility,Inpatient,,,,234.5,199.325,67.2077,234.5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
MIXER CEMENT W/ FEMORAL BREAKAWAY NOZZLE REVOLUTION  STRYKER 0606-563-000,,A4649,HCPCS,Facility,Both,,,,234.5,199.325,67.2077,234.5,Aetna,PPO,218.085,93,,percent of total billed charges,,
MIXER CEMENT W/ FEMORAL BREAKAWAY NOZZLE REVOLUTION  STRYKER 0606-563-000,,A4649,HCPCS,Facility,Both,,,,234.5,199.325,67.2077,234.5,America's PPO,America's PPO,225.19035,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
MIXER CEMENT W/ FEMORAL BREAKAWAY NOZZLE REVOLUTION  STRYKER 0606-563-000,,A4649,HCPCS,Facility,Both,,,,234.5,199.325,67.2077,234.5,BlueCross BlueShield Minnesota, Federal Employee Program,230.748,98.4,,percent of total billed charges,,
MIXER CEMENT W/ FEMORAL BREAKAWAY NOZZLE REVOLUTION  STRYKER 0606-563-000,,A4649,HCPCS,Facility,Both,,,,234.5,199.325,67.2077,234.5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,234.5,100,,percent of total billed charges,,
MIXER CEMENT W/ FEMORAL BREAKAWAY NOZZLE REVOLUTION  STRYKER 0606-563-000,,A4649,HCPCS,Facility,Both,,,,234.5,199.325,67.2077,234.5,BlueCross BlueShield Minnesota,High Value Network Plan,211.05,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
MIXER CEMENT W/ FEMORAL BREAKAWAY NOZZLE REVOLUTION  STRYKER 0606-563-000,,A4649,HCPCS,Facility,Outpatient,,,,234.5,199.325,67.2077,234.5,BlueCross BlueShield Minnesota,Medicare Advantage,114.905,49,,percent of total billed charges,,
MIXER CEMENT W/ FEMORAL BREAKAWAY NOZZLE REVOLUTION  STRYKER 0606-563-000,,A4649,HCPCS,Facility,Inpatient,,,,234.5,199.325,67.2077,234.5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
MIXER CEMENT W/ FEMORAL BREAKAWAY NOZZLE REVOLUTION  STRYKER 0606-563-000,,A4649,HCPCS,Facility,Both,,,,234.5,199.325,67.2077,234.5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,207.69665,88.57,,percent of total billed charges,,
MIXER CEMENT W/ FEMORAL BREAKAWAY NOZZLE REVOLUTION  STRYKER 0606-563-000,,A4649,HCPCS,Facility,Both,,,,234.5,199.325,67.2077,234.5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,67.2077,28.66,,percent of total billed charges,,
MIXER CEMENT W/ FEMORAL BREAKAWAY NOZZLE REVOLUTION  STRYKER 0606-563-000,,A4649,HCPCS,Facility,Outpatient,,,,234.5,199.325,67.2077,234.5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),114.905,49,,percent of total billed charges,,
MIXER CEMENT W/ FEMORAL BREAKAWAY NOZZLE REVOLUTION  STRYKER 0606-563-000,,A4649,HCPCS,Facility,Inpatient,,,,234.5,199.325,67.2077,234.5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
MIXER CEMENT W/ FEMORAL BREAKAWAY NOZZLE REVOLUTION  STRYKER 0606-563-000,,A4649,HCPCS,Facility,Both,,,,234.5,199.325,67.2077,234.5,CorVel,Worker's Compensation,234.5,100,,percent of total billed charges,,
MIXER CEMENT W/ FEMORAL BREAKAWAY NOZZLE REVOLUTION  STRYKER 0606-563-000,,A4649,HCPCS,Facility,Both,,,,234.5,199.325,67.2077,234.5,First Health Group Corporation,First Health Network,227.465,97,,percent of total billed charges,,
MIXER CEMENT W/ FEMORAL BREAKAWAY NOZZLE REVOLUTION  STRYKER 0606-563-000,,A4649,HCPCS,Facility,Both,,,,234.5,199.325,67.2077,234.5,"Health Partners, Inc.",Commercial,221.837,94.6,,percent of total billed charges,,
MIXER CEMENT W/ FEMORAL BREAKAWAY NOZZLE REVOLUTION  STRYKER 0606-563-000,,A4649,HCPCS,Facility,Outpatient,,,,234.5,199.325,67.2077,234.5,"Health Partners, Inc.",Medicare Advantage,114.905,49,,percent of total billed charges,,
MIXER CEMENT W/ FEMORAL BREAKAWAY NOZZLE REVOLUTION  STRYKER 0606-563-000,,A4649,HCPCS,Facility,Inpatient,,,,234.5,199.325,67.2077,234.5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
MIXER CEMENT W/ FEMORAL BREAKAWAY NOZZLE REVOLUTION  STRYKER 0606-563-000,,A4649,HCPCS,Facility,Both,,,,234.5,199.325,67.2077,234.5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),140.7,60,,percent of total billed charges,,
MIXER CEMENT W/ FEMORAL BREAKAWAY NOZZLE REVOLUTION  STRYKER 0606-563-000,,A4649,HCPCS,Facility,Both,,,,234.5,199.325,67.2077,234.5,"Health Partners, Inc.",State of Minnesota Advantage Program,191.1175,81.5,,percent of total billed charges,,
MIXER CEMENT W/ FEMORAL BREAKAWAY NOZZLE REVOLUTION  STRYKER 0606-563-000,,A4649,HCPCS,Facility,Both,,,,234.5,199.325,67.2077,234.5,"Health Partners, Inc.",State Public Programs,117.25,50,,percent of total billed charges,,
MIXER CEMENT W/ FEMORAL BREAKAWAY NOZZLE REVOLUTION  STRYKER 0606-563-000,,A4649,HCPCS,Facility,Both,,,,234.5,199.325,67.2077,234.5,Humana Insurance Company,Commercial PPO,222.775,95,,percent of total billed charges,,
MIXER CEMENT W/ FEMORAL BREAKAWAY NOZZLE REVOLUTION  STRYKER 0606-563-000,,A4649,HCPCS,Facility,Outpatient,,,,234.5,199.325,67.2077,234.5,Humana Insurance Company,Medicare PPO,114.905,49,,percent of total billed charges,,
MIXER CEMENT W/ FEMORAL BREAKAWAY NOZZLE REVOLUTION  STRYKER 0606-563-000,,A4649,HCPCS,Facility,Inpatient,,,,234.5,199.325,67.2077,234.5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
MIXER CEMENT W/ FEMORAL BREAKAWAY NOZZLE REVOLUTION  STRYKER 0606-563-000,,A4649,HCPCS,Facility,Both,,,,234.5,199.325,67.2077,234.5,Medica,Individual & Family,232.3895,99.1,,percent of total billed charges,,
MIXER CEMENT W/ FEMORAL BREAKAWAY NOZZLE REVOLUTION  STRYKER 0606-563-000,,A4649,HCPCS,Facility,Outpatient,,,,234.5,199.325,67.2077,234.5,Medica,Medica Advantage Solution,116.781,49.8,,percent of total billed charges,,
MIXER CEMENT W/ FEMORAL BREAKAWAY NOZZLE REVOLUTION  STRYKER 0606-563-000,,A4649,HCPCS,Facility,Inpatient,,,,234.5,199.325,67.2077,234.5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
MIXER CEMENT W/ FEMORAL BREAKAWAY NOZZLE REVOLUTION  STRYKER 0606-563-000,,A4649,HCPCS,Facility,Outpatient,,,,234.5,199.325,67.2077,234.5,Medica,Medical Assistance,104.587,44.6,,percent of total billed charges,,
MIXER CEMENT W/ FEMORAL BREAKAWAY NOZZLE REVOLUTION  STRYKER 0606-563-000,,A4649,HCPCS,Facility,Inpatient,,,,234.5,199.325,67.2077,234.5,Medica,Medical Assistance,,,,,Included in per diem rate,
MIXER CEMENT W/ FEMORAL BREAKAWAY NOZZLE REVOLUTION  STRYKER 0606-563-000,,A4649,HCPCS,Facility,Outpatient,,,,234.5,199.325,67.2077,234.5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,116.781,49.8,,percent of total billed charges,,
MIXER CEMENT W/ FEMORAL BREAKAWAY NOZZLE REVOLUTION  STRYKER 0606-563-000,,A4649,HCPCS,Facility,Inpatient,,,,234.5,199.325,67.2077,234.5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
MIXER CEMENT W/ FEMORAL BREAKAWAY NOZZLE REVOLUTION  STRYKER 0606-563-000,,A4649,HCPCS,Facility,Both,,,,234.5,199.325,67.2077,234.5,"Multiplan, Inc.","Multiplan, Inc.",220.43,94,,percent of total billed charges,,
MIXER CEMENT W/ FEMORAL BREAKAWAY NOZZLE REVOLUTION  STRYKER 0606-563-000,,A4649,HCPCS,Facility,Outpatient,,,,234.5,199.325,67.2077,234.5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,211.2845,90.1,,percent of total billed charges,,
MIXER CEMENT W/ FEMORAL BREAKAWAY NOZZLE REVOLUTION  STRYKER 0606-563-000,,A4649,HCPCS,Facility,Inpatient,,,,234.5,199.325,67.2077,234.5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
MIXER CEMENT W/ FEMORAL BREAKAWAY NOZZLE REVOLUTION  STRYKER 0606-563-000,,A4649,HCPCS,Facility,Both,,,,234.5,199.325,67.2077,234.5,"Preferred One Administrative Services, INC.",PPO,231.217,98.6,,percent of total billed charges,,
MIXER CEMENT W/ FEMORAL BREAKAWAY NOZZLE REVOLUTION  STRYKER 0606-563-000,,A4649,HCPCS,Facility,Outpatient,,,,234.5,199.325,67.2077,234.5,PrimeWest Health,Minnesota Senior Health Options (MSHO),120.65025,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
MIXER CEMENT W/ FEMORAL BREAKAWAY NOZZLE REVOLUTION  STRYKER 0606-563-000,,A4649,HCPCS,Facility,Inpatient,,,,234.5,199.325,67.2077,234.5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
MIXER CEMENT W/ FEMORAL BREAKAWAY NOZZLE REVOLUTION  STRYKER 0606-563-000,,A4649,HCPCS,Facility,Outpatient,,,,234.5,199.325,67.2077,234.5,PrimeWest Health,MinnesotaCare,120.4392,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
MIXER CEMENT W/ FEMORAL BREAKAWAY NOZZLE REVOLUTION  STRYKER 0606-563-000,,A4649,HCPCS,Facility,Inpatient,,,,234.5,199.325,67.2077,234.5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
MIXER CEMENT W/ FEMORAL BREAKAWAY NOZZLE REVOLUTION  STRYKER 0606-563-000,,A4649,HCPCS,Facility,Both,,,,234.5,199.325,67.2077,234.5,Sanford Health Plan,Sanford Health Plan,215.74,92,,percent of total billed charges,,
MIXER CEMENT W/ FEMORAL BREAKAWAY NOZZLE REVOLUTION  STRYKER 0606-563-000,,A4649,HCPCS,Facility,Outpatient,,,,234.5,199.325,67.2077,234.5,"UCare Health, Inc.",Individual & Family Plan,132.14075,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
MIXER CEMENT W/ FEMORAL BREAKAWAY NOZZLE REVOLUTION  STRYKER 0606-563-000,,A4649,HCPCS,Facility,Inpatient,,,,234.5,199.325,67.2077,234.5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
MIXER CEMENT W/ FEMORAL BREAKAWAY NOZZLE REVOLUTION  STRYKER 0606-563-000,,A4649,HCPCS,Facility,Outpatient,,,,234.5,199.325,67.2077,234.5,"UCare Health, Inc.",Medical Assistance,118.35215,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MIXER CEMENT W/ FEMORAL BREAKAWAY NOZZLE REVOLUTION  STRYKER 0606-563-000,,A4649,HCPCS,Facility,Inpatient,,,,234.5,199.325,67.2077,234.5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
MIXER CEMENT W/ FEMORAL BREAKAWAY NOZZLE REVOLUTION  STRYKER 0606-563-000,,A4649,HCPCS,Facility,Outpatient,,,,234.5,199.325,67.2077,234.5,"UCare Health, Inc.",Medicare Advantage,118.35215,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MIXER CEMENT W/ FEMORAL BREAKAWAY NOZZLE REVOLUTION  STRYKER 0606-563-000,,A4649,HCPCS,Facility,Inpatient,,,,234.5,199.325,67.2077,234.5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
MIXER CEMENT W/ FEMORAL BREAKAWAY NOZZLE REVOLUTION  STRYKER 0606-563-000,,A4649,HCPCS,Facility,Outpatient,,,,234.5,199.325,67.2077,234.5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),118.35215,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MIXER CEMENT W/ FEMORAL BREAKAWAY NOZZLE REVOLUTION  STRYKER 0606-563-000,,A4649,HCPCS,Facility,Inpatient,,,,234.5,199.325,67.2077,234.5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
MIXER CEMENT W/ FEMORAL BREAKAWAY NOZZLE REVOLUTION  STRYKER 0606-563-000,,A4649,HCPCS,Facility,Both,,,,234.5,199.325,67.2077,234.5,UnitedHealthcare,Individual & Family,220.43,94,,percent of total billed charges,,
MIXER CEMENT W/ FEMORAL BREAKAWAY NOZZLE REVOLUTION  STRYKER 0606-563-000,,A4649,HCPCS,Facility,Outpatient,,,,234.5,199.325,67.2077,234.5,UnitedHealthcare,Medicare Advantage,114.905,49,,percent of total billed charges,,
MIXER CEMENT W/ FEMORAL BREAKAWAY NOZZLE REVOLUTION  STRYKER 0606-563-000,,A4649,HCPCS,Facility,Inpatient,,,,234.5,199.325,67.2077,234.5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
MIXER CEMENT W/ FEMORAL BREAKAWAY NOZZLE REVOLUTION  STRYKER 0606-563-000,,A4649,HCPCS,Facility,Outpatient,,,,234.5,199.325,67.2077,234.5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,112.56,48,,percent of total billed charges,,100% of DHS outpatient percentage
MIXER CEMENT W/ FEMORAL BREAKAWAY NOZZLE REVOLUTION  STRYKER 0606-563-000,,A4649,HCPCS,Facility,Inpatient,,,,234.5,199.325,67.2077,234.5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
NEPTUNE MANIFOLD/FILTER 4-PORT  0702-020-000,,A4649,HCPCS,Facility,Both,,,,95.24,80.954,27.295784,95.24,Aetna,Commercial,87.6208,92,,percent of total billed charges,,
NEPTUNE MANIFOLD/FILTER 4-PORT  0702-020-000,,A4649,HCPCS,Facility,Outpatient,,,,95.24,80.954,27.295784,95.24,Aetna,Medicare Advantage,46.6676,49,,percent of total billed charges,,
NEPTUNE MANIFOLD/FILTER 4-PORT  0702-020-000,,A4649,HCPCS,Facility,Inpatient,,,,95.24,80.954,27.295784,95.24,Aetna,Medicare Advantage,,,,,Included in per diem rate,
NEPTUNE MANIFOLD/FILTER 4-PORT  0702-020-000,,A4649,HCPCS,Facility,Both,,,,95.24,80.954,27.295784,95.24,Aetna,PPO,88.5732,93,,percent of total billed charges,,
NEPTUNE MANIFOLD/FILTER 4-PORT  0702-020-000,,A4649,HCPCS,Facility,Both,,,,95.24,80.954,27.295784,95.24,America's PPO,America's PPO,91.458972,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
NEPTUNE MANIFOLD/FILTER 4-PORT  0702-020-000,,A4649,HCPCS,Facility,Both,,,,95.24,80.954,27.295784,95.24,BlueCross BlueShield Minnesota, Federal Employee Program,93.71616,98.4,,percent of total billed charges,,
NEPTUNE MANIFOLD/FILTER 4-PORT  0702-020-000,,A4649,HCPCS,Facility,Both,,,,95.24,80.954,27.295784,95.24,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,95.24,100,,percent of total billed charges,,
NEPTUNE MANIFOLD/FILTER 4-PORT  0702-020-000,,A4649,HCPCS,Facility,Both,,,,95.24,80.954,27.295784,95.24,BlueCross BlueShield Minnesota,High Value Network Plan,85.716,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
NEPTUNE MANIFOLD/FILTER 4-PORT  0702-020-000,,A4649,HCPCS,Facility,Outpatient,,,,95.24,80.954,27.295784,95.24,BlueCross BlueShield Minnesota,Medicare Advantage,46.6676,49,,percent of total billed charges,,
NEPTUNE MANIFOLD/FILTER 4-PORT  0702-020-000,,A4649,HCPCS,Facility,Inpatient,,,,95.24,80.954,27.295784,95.24,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
NEPTUNE MANIFOLD/FILTER 4-PORT  0702-020-000,,A4649,HCPCS,Facility,Both,,,,95.24,80.954,27.295784,95.24,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,84.354068,88.57,,percent of total billed charges,,
NEPTUNE MANIFOLD/FILTER 4-PORT  0702-020-000,,A4649,HCPCS,Facility,Both,,,,95.24,80.954,27.295784,95.24,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,27.295784,28.66,,percent of total billed charges,,
NEPTUNE MANIFOLD/FILTER 4-PORT  0702-020-000,,A4649,HCPCS,Facility,Outpatient,,,,95.24,80.954,27.295784,95.24,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),46.6676,49,,percent of total billed charges,,
NEPTUNE MANIFOLD/FILTER 4-PORT  0702-020-000,,A4649,HCPCS,Facility,Inpatient,,,,95.24,80.954,27.295784,95.24,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
NEPTUNE MANIFOLD/FILTER 4-PORT  0702-020-000,,A4649,HCPCS,Facility,Both,,,,95.24,80.954,27.295784,95.24,CorVel,Worker's Compensation,95.24,100,,percent of total billed charges,,
NEPTUNE MANIFOLD/FILTER 4-PORT  0702-020-000,,A4649,HCPCS,Facility,Both,,,,95.24,80.954,27.295784,95.24,First Health Group Corporation,First Health Network,92.3828,97,,percent of total billed charges,,
NEPTUNE MANIFOLD/FILTER 4-PORT  0702-020-000,,A4649,HCPCS,Facility,Both,,,,95.24,80.954,27.295784,95.24,"Health Partners, Inc.",Commercial,90.09704,94.6,,percent of total billed charges,,
NEPTUNE MANIFOLD/FILTER 4-PORT  0702-020-000,,A4649,HCPCS,Facility,Outpatient,,,,95.24,80.954,27.295784,95.24,"Health Partners, Inc.",Medicare Advantage,46.6676,49,,percent of total billed charges,,
NEPTUNE MANIFOLD/FILTER 4-PORT  0702-020-000,,A4649,HCPCS,Facility,Inpatient,,,,95.24,80.954,27.295784,95.24,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
NEPTUNE MANIFOLD/FILTER 4-PORT  0702-020-000,,A4649,HCPCS,Facility,Both,,,,95.24,80.954,27.295784,95.24,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),57.144,60,,percent of total billed charges,,
NEPTUNE MANIFOLD/FILTER 4-PORT  0702-020-000,,A4649,HCPCS,Facility,Both,,,,95.24,80.954,27.295784,95.24,"Health Partners, Inc.",State of Minnesota Advantage Program,77.6206,81.5,,percent of total billed charges,,
NEPTUNE MANIFOLD/FILTER 4-PORT  0702-020-000,,A4649,HCPCS,Facility,Both,,,,95.24,80.954,27.295784,95.24,"Health Partners, Inc.",State Public Programs,47.62,50,,percent of total billed charges,,
NEPTUNE MANIFOLD/FILTER 4-PORT  0702-020-000,,A4649,HCPCS,Facility,Both,,,,95.24,80.954,27.295784,95.24,Humana Insurance Company,Commercial PPO,90.478,95,,percent of total billed charges,,
NEPTUNE MANIFOLD/FILTER 4-PORT  0702-020-000,,A4649,HCPCS,Facility,Outpatient,,,,95.24,80.954,27.295784,95.24,Humana Insurance Company,Medicare PPO,46.6676,49,,percent of total billed charges,,
NEPTUNE MANIFOLD/FILTER 4-PORT  0702-020-000,,A4649,HCPCS,Facility,Inpatient,,,,95.24,80.954,27.295784,95.24,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
NEPTUNE MANIFOLD/FILTER 4-PORT  0702-020-000,,A4649,HCPCS,Facility,Both,,,,95.24,80.954,27.295784,95.24,Medica,Individual & Family,94.38284,99.1,,percent of total billed charges,,
NEPTUNE MANIFOLD/FILTER 4-PORT  0702-020-000,,A4649,HCPCS,Facility,Outpatient,,,,95.24,80.954,27.295784,95.24,Medica,Medica Advantage Solution,47.42952,49.8,,percent of total billed charges,,
NEPTUNE MANIFOLD/FILTER 4-PORT  0702-020-000,,A4649,HCPCS,Facility,Inpatient,,,,95.24,80.954,27.295784,95.24,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
NEPTUNE MANIFOLD/FILTER 4-PORT  0702-020-000,,A4649,HCPCS,Facility,Outpatient,,,,95.24,80.954,27.295784,95.24,Medica,Medical Assistance,42.47704,44.6,,percent of total billed charges,,
NEPTUNE MANIFOLD/FILTER 4-PORT  0702-020-000,,A4649,HCPCS,Facility,Inpatient,,,,95.24,80.954,27.295784,95.24,Medica,Medical Assistance,,,,,Included in per diem rate,
NEPTUNE MANIFOLD/FILTER 4-PORT  0702-020-000,,A4649,HCPCS,Facility,Outpatient,,,,95.24,80.954,27.295784,95.24,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,47.42952,49.8,,percent of total billed charges,,
NEPTUNE MANIFOLD/FILTER 4-PORT  0702-020-000,,A4649,HCPCS,Facility,Inpatient,,,,95.24,80.954,27.295784,95.24,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
NEPTUNE MANIFOLD/FILTER 4-PORT  0702-020-000,,A4649,HCPCS,Facility,Both,,,,95.24,80.954,27.295784,95.24,"Multiplan, Inc.","Multiplan, Inc.",89.5256,94,,percent of total billed charges,,
NEPTUNE MANIFOLD/FILTER 4-PORT  0702-020-000,,A4649,HCPCS,Facility,Outpatient,,,,95.24,80.954,27.295784,95.24,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,85.81124,90.1,,percent of total billed charges,,
NEPTUNE MANIFOLD/FILTER 4-PORT  0702-020-000,,A4649,HCPCS,Facility,Inpatient,,,,95.24,80.954,27.295784,95.24,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
NEPTUNE MANIFOLD/FILTER 4-PORT  0702-020-000,,A4649,HCPCS,Facility,Both,,,,95.24,80.954,27.295784,95.24,"Preferred One Administrative Services, INC.",PPO,93.90664,98.6,,percent of total billed charges,,
NEPTUNE MANIFOLD/FILTER 4-PORT  0702-020-000,,A4649,HCPCS,Facility,Outpatient,,,,95.24,80.954,27.295784,95.24,PrimeWest Health,Minnesota Senior Health Options (MSHO),49.00098,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
NEPTUNE MANIFOLD/FILTER 4-PORT  0702-020-000,,A4649,HCPCS,Facility,Inpatient,,,,95.24,80.954,27.295784,95.24,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
NEPTUNE MANIFOLD/FILTER 4-PORT  0702-020-000,,A4649,HCPCS,Facility,Outpatient,,,,95.24,80.954,27.295784,95.24,PrimeWest Health,MinnesotaCare,48.915264,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
NEPTUNE MANIFOLD/FILTER 4-PORT  0702-020-000,,A4649,HCPCS,Facility,Inpatient,,,,95.24,80.954,27.295784,95.24,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
NEPTUNE MANIFOLD/FILTER 4-PORT  0702-020-000,,A4649,HCPCS,Facility,Both,,,,95.24,80.954,27.295784,95.24,Sanford Health Plan,Sanford Health Plan,87.6208,92,,percent of total billed charges,,
NEPTUNE MANIFOLD/FILTER 4-PORT  0702-020-000,,A4649,HCPCS,Facility,Outpatient,,,,95.24,80.954,27.295784,95.24,"UCare Health, Inc.",Individual & Family Plan,53.66774,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
NEPTUNE MANIFOLD/FILTER 4-PORT  0702-020-000,,A4649,HCPCS,Facility,Inpatient,,,,95.24,80.954,27.295784,95.24,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
NEPTUNE MANIFOLD/FILTER 4-PORT  0702-020-000,,A4649,HCPCS,Facility,Outpatient,,,,95.24,80.954,27.295784,95.24,"UCare Health, Inc.",Medical Assistance,48.067628,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
NEPTUNE MANIFOLD/FILTER 4-PORT  0702-020-000,,A4649,HCPCS,Facility,Inpatient,,,,95.24,80.954,27.295784,95.24,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
NEPTUNE MANIFOLD/FILTER 4-PORT  0702-020-000,,A4649,HCPCS,Facility,Outpatient,,,,95.24,80.954,27.295784,95.24,"UCare Health, Inc.",Medicare Advantage,48.067628,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
NEPTUNE MANIFOLD/FILTER 4-PORT  0702-020-000,,A4649,HCPCS,Facility,Inpatient,,,,95.24,80.954,27.295784,95.24,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
NEPTUNE MANIFOLD/FILTER 4-PORT  0702-020-000,,A4649,HCPCS,Facility,Outpatient,,,,95.24,80.954,27.295784,95.24,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),48.067628,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
NEPTUNE MANIFOLD/FILTER 4-PORT  0702-020-000,,A4649,HCPCS,Facility,Inpatient,,,,95.24,80.954,27.295784,95.24,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
NEPTUNE MANIFOLD/FILTER 4-PORT  0702-020-000,,A4649,HCPCS,Facility,Both,,,,95.24,80.954,27.295784,95.24,UnitedHealthcare,Individual & Family,89.5256,94,,percent of total billed charges,,
NEPTUNE MANIFOLD/FILTER 4-PORT  0702-020-000,,A4649,HCPCS,Facility,Outpatient,,,,95.24,80.954,27.295784,95.24,UnitedHealthcare,Medicare Advantage,46.6676,49,,percent of total billed charges,,
NEPTUNE MANIFOLD/FILTER 4-PORT  0702-020-000,,A4649,HCPCS,Facility,Inpatient,,,,95.24,80.954,27.295784,95.24,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
NEPTUNE MANIFOLD/FILTER 4-PORT  0702-020-000,,A4649,HCPCS,Facility,Outpatient,,,,95.24,80.954,27.295784,95.24,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,45.7152,48,,percent of total billed charges,,100% of DHS outpatient percentage
NEPTUNE MANIFOLD/FILTER 4-PORT  0702-020-000,,A4649,HCPCS,Facility,Inpatient,,,,95.24,80.954,27.295784,95.24,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
OB PACK,,A4649,HCPCS,Facility,Both,,,,57.78,49.113,16.559748,57.78,Aetna,Commercial,53.1576,92,,percent of total billed charges,,
OB PACK,,A4649,HCPCS,Facility,Outpatient,,,,57.78,49.113,16.559748,57.78,Aetna,Medicare Advantage,28.3122,49,,percent of total billed charges,,
OB PACK,,A4649,HCPCS,Facility,Inpatient,,,,57.78,49.113,16.559748,57.78,Aetna,Medicare Advantage,,,,,Included in per diem rate,
OB PACK,,A4649,HCPCS,Facility,Both,,,,57.78,49.113,16.559748,57.78,Aetna,PPO,53.7354,93,,percent of total billed charges,,
OB PACK,,A4649,HCPCS,Facility,Both,,,,57.78,49.113,16.559748,57.78,America's PPO,America's PPO,55.486134,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
OB PACK,,A4649,HCPCS,Facility,Both,,,,57.78,49.113,16.559748,57.78,BlueCross BlueShield Minnesota, Federal Employee Program,56.85552,98.4,,percent of total billed charges,,
OB PACK,,A4649,HCPCS,Facility,Both,,,,57.78,49.113,16.559748,57.78,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,57.78,100,,percent of total billed charges,,
OB PACK,,A4649,HCPCS,Facility,Both,,,,57.78,49.113,16.559748,57.78,BlueCross BlueShield Minnesota,High Value Network Plan,52.002,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
OB PACK,,A4649,HCPCS,Facility,Outpatient,,,,57.78,49.113,16.559748,57.78,BlueCross BlueShield Minnesota,Medicare Advantage,28.3122,49,,percent of total billed charges,,
OB PACK,,A4649,HCPCS,Facility,Inpatient,,,,57.78,49.113,16.559748,57.78,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
OB PACK,,A4649,HCPCS,Facility,Both,,,,57.78,49.113,16.559748,57.78,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,51.175746,88.57,,percent of total billed charges,,
OB PACK,,A4649,HCPCS,Facility,Both,,,,57.78,49.113,16.559748,57.78,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,16.559748,28.66,,percent of total billed charges,,
OB PACK,,A4649,HCPCS,Facility,Outpatient,,,,57.78,49.113,16.559748,57.78,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),28.3122,49,,percent of total billed charges,,
OB PACK,,A4649,HCPCS,Facility,Inpatient,,,,57.78,49.113,16.559748,57.78,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
OB PACK,,A4649,HCPCS,Facility,Both,,,,57.78,49.113,16.559748,57.78,CorVel,Worker's Compensation,57.78,100,,percent of total billed charges,,
OB PACK,,A4649,HCPCS,Facility,Both,,,,57.78,49.113,16.559748,57.78,First Health Group Corporation,First Health Network,56.0466,97,,percent of total billed charges,,
OB PACK,,A4649,HCPCS,Facility,Both,,,,57.78,49.113,16.559748,57.78,"Health Partners, Inc.",Commercial,54.65988,94.6,,percent of total billed charges,,
OB PACK,,A4649,HCPCS,Facility,Outpatient,,,,57.78,49.113,16.559748,57.78,"Health Partners, Inc.",Medicare Advantage,28.3122,49,,percent of total billed charges,,
OB PACK,,A4649,HCPCS,Facility,Inpatient,,,,57.78,49.113,16.559748,57.78,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
OB PACK,,A4649,HCPCS,Facility,Both,,,,57.78,49.113,16.559748,57.78,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),34.668,60,,percent of total billed charges,,
OB PACK,,A4649,HCPCS,Facility,Both,,,,57.78,49.113,16.559748,57.78,"Health Partners, Inc.",State of Minnesota Advantage Program,47.0907,81.5,,percent of total billed charges,,
OB PACK,,A4649,HCPCS,Facility,Both,,,,57.78,49.113,16.559748,57.78,"Health Partners, Inc.",State Public Programs,28.89,50,,percent of total billed charges,,
OB PACK,,A4649,HCPCS,Facility,Both,,,,57.78,49.113,16.559748,57.78,Humana Insurance Company,Commercial PPO,54.891,95,,percent of total billed charges,,
OB PACK,,A4649,HCPCS,Facility,Outpatient,,,,57.78,49.113,16.559748,57.78,Humana Insurance Company,Medicare PPO,28.3122,49,,percent of total billed charges,,
OB PACK,,A4649,HCPCS,Facility,Inpatient,,,,57.78,49.113,16.559748,57.78,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
OB PACK,,A4649,HCPCS,Facility,Both,,,,57.78,49.113,16.559748,57.78,Medica,Individual & Family,57.25998,99.1,,percent of total billed charges,,
OB PACK,,A4649,HCPCS,Facility,Outpatient,,,,57.78,49.113,16.559748,57.78,Medica,Medica Advantage Solution,28.77444,49.8,,percent of total billed charges,,
OB PACK,,A4649,HCPCS,Facility,Inpatient,,,,57.78,49.113,16.559748,57.78,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
OB PACK,,A4649,HCPCS,Facility,Outpatient,,,,57.78,49.113,16.559748,57.78,Medica,Medical Assistance,25.76988,44.6,,percent of total billed charges,,
OB PACK,,A4649,HCPCS,Facility,Inpatient,,,,57.78,49.113,16.559748,57.78,Medica,Medical Assistance,,,,,Included in per diem rate,
OB PACK,,A4649,HCPCS,Facility,Outpatient,,,,57.78,49.113,16.559748,57.78,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,28.77444,49.8,,percent of total billed charges,,
OB PACK,,A4649,HCPCS,Facility,Inpatient,,,,57.78,49.113,16.559748,57.78,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
OB PACK,,A4649,HCPCS,Facility,Both,,,,57.78,49.113,16.559748,57.78,"Multiplan, Inc.","Multiplan, Inc.",54.3132,94,,percent of total billed charges,,
OB PACK,,A4649,HCPCS,Facility,Outpatient,,,,57.78,49.113,16.559748,57.78,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,52.05978,90.1,,percent of total billed charges,,
OB PACK,,A4649,HCPCS,Facility,Inpatient,,,,57.78,49.113,16.559748,57.78,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
OB PACK,,A4649,HCPCS,Facility,Both,,,,57.78,49.113,16.559748,57.78,"Preferred One Administrative Services, INC.",PPO,56.97108,98.6,,percent of total billed charges,,
OB PACK,,A4649,HCPCS,Facility,Outpatient,,,,57.78,49.113,16.559748,57.78,PrimeWest Health,Minnesota Senior Health Options (MSHO),29.72781,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
OB PACK,,A4649,HCPCS,Facility,Inpatient,,,,57.78,49.113,16.559748,57.78,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
OB PACK,,A4649,HCPCS,Facility,Outpatient,,,,57.78,49.113,16.559748,57.78,PrimeWest Health,MinnesotaCare,29.675808,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
OB PACK,,A4649,HCPCS,Facility,Inpatient,,,,57.78,49.113,16.559748,57.78,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
OB PACK,,A4649,HCPCS,Facility,Both,,,,57.78,49.113,16.559748,57.78,Sanford Health Plan,Sanford Health Plan,53.1576,92,,percent of total billed charges,,
OB PACK,,A4649,HCPCS,Facility,Outpatient,,,,57.78,49.113,16.559748,57.78,"UCare Health, Inc.",Individual & Family Plan,32.55903,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
OB PACK,,A4649,HCPCS,Facility,Inpatient,,,,57.78,49.113,16.559748,57.78,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
OB PACK,,A4649,HCPCS,Facility,Outpatient,,,,57.78,49.113,16.559748,57.78,"UCare Health, Inc.",Medical Assistance,29.161566,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
OB PACK,,A4649,HCPCS,Facility,Inpatient,,,,57.78,49.113,16.559748,57.78,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
OB PACK,,A4649,HCPCS,Facility,Outpatient,,,,57.78,49.113,16.559748,57.78,"UCare Health, Inc.",Medicare Advantage,29.161566,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
OB PACK,,A4649,HCPCS,Facility,Inpatient,,,,57.78,49.113,16.559748,57.78,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
OB PACK,,A4649,HCPCS,Facility,Outpatient,,,,57.78,49.113,16.559748,57.78,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),29.161566,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
OB PACK,,A4649,HCPCS,Facility,Inpatient,,,,57.78,49.113,16.559748,57.78,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
OB PACK,,A4649,HCPCS,Facility,Both,,,,57.78,49.113,16.559748,57.78,UnitedHealthcare,Individual & Family,54.3132,94,,percent of total billed charges,,
OB PACK,,A4649,HCPCS,Facility,Outpatient,,,,57.78,49.113,16.559748,57.78,UnitedHealthcare,Medicare Advantage,28.3122,49,,percent of total billed charges,,
OB PACK,,A4649,HCPCS,Facility,Inpatient,,,,57.78,49.113,16.559748,57.78,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
OB PACK,,A4649,HCPCS,Facility,Outpatient,,,,57.78,49.113,16.559748,57.78,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,27.7344,48,,percent of total billed charges,,100% of DHS outpatient percentage
OB PACK,,A4649,HCPCS,Facility,Inpatient,,,,57.78,49.113,16.559748,57.78,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
PACK EXTREMITY,,A4649,HCPCS,Facility,Both,,,,44.2,37.57,12.66772,44.2,Aetna,Commercial,40.664,92,,percent of total billed charges,,
PACK EXTREMITY,,A4649,HCPCS,Facility,Outpatient,,,,44.2,37.57,12.66772,44.2,Aetna,Medicare Advantage,21.658,49,,percent of total billed charges,,
PACK EXTREMITY,,A4649,HCPCS,Facility,Inpatient,,,,44.2,37.57,12.66772,44.2,Aetna,Medicare Advantage,,,,,Included in per diem rate,
PACK EXTREMITY,,A4649,HCPCS,Facility,Both,,,,44.2,37.57,12.66772,44.2,Aetna,PPO,41.106,93,,percent of total billed charges,,
PACK EXTREMITY,,A4649,HCPCS,Facility,Both,,,,44.2,37.57,12.66772,44.2,America's PPO,America's PPO,42.44526,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
PACK EXTREMITY,,A4649,HCPCS,Facility,Both,,,,44.2,37.57,12.66772,44.2,BlueCross BlueShield Minnesota, Federal Employee Program,43.4928,98.4,,percent of total billed charges,,
PACK EXTREMITY,,A4649,HCPCS,Facility,Both,,,,44.2,37.57,12.66772,44.2,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,44.2,100,,percent of total billed charges,,
PACK EXTREMITY,,A4649,HCPCS,Facility,Both,,,,44.2,37.57,12.66772,44.2,BlueCross BlueShield Minnesota,High Value Network Plan,39.78,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
PACK EXTREMITY,,A4649,HCPCS,Facility,Outpatient,,,,44.2,37.57,12.66772,44.2,BlueCross BlueShield Minnesota,Medicare Advantage,21.658,49,,percent of total billed charges,,
PACK EXTREMITY,,A4649,HCPCS,Facility,Inpatient,,,,44.2,37.57,12.66772,44.2,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
PACK EXTREMITY,,A4649,HCPCS,Facility,Both,,,,44.2,37.57,12.66772,44.2,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,39.14794,88.57,,percent of total billed charges,,
PACK EXTREMITY,,A4649,HCPCS,Facility,Both,,,,44.2,37.57,12.66772,44.2,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,12.66772,28.66,,percent of total billed charges,,
PACK EXTREMITY,,A4649,HCPCS,Facility,Outpatient,,,,44.2,37.57,12.66772,44.2,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),21.658,49,,percent of total billed charges,,
PACK EXTREMITY,,A4649,HCPCS,Facility,Inpatient,,,,44.2,37.57,12.66772,44.2,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
PACK EXTREMITY,,A4649,HCPCS,Facility,Both,,,,44.2,37.57,12.66772,44.2,CorVel,Worker's Compensation,44.2,100,,percent of total billed charges,,
PACK EXTREMITY,,A4649,HCPCS,Facility,Both,,,,44.2,37.57,12.66772,44.2,First Health Group Corporation,First Health Network,42.874,97,,percent of total billed charges,,
PACK EXTREMITY,,A4649,HCPCS,Facility,Both,,,,44.2,37.57,12.66772,44.2,"Health Partners, Inc.",Commercial,41.8132,94.6,,percent of total billed charges,,
PACK EXTREMITY,,A4649,HCPCS,Facility,Outpatient,,,,44.2,37.57,12.66772,44.2,"Health Partners, Inc.",Medicare Advantage,21.658,49,,percent of total billed charges,,
PACK EXTREMITY,,A4649,HCPCS,Facility,Inpatient,,,,44.2,37.57,12.66772,44.2,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PACK EXTREMITY,,A4649,HCPCS,Facility,Both,,,,44.2,37.57,12.66772,44.2,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),26.52,60,,percent of total billed charges,,
PACK EXTREMITY,,A4649,HCPCS,Facility,Both,,,,44.2,37.57,12.66772,44.2,"Health Partners, Inc.",State of Minnesota Advantage Program,36.023,81.5,,percent of total billed charges,,
PACK EXTREMITY,,A4649,HCPCS,Facility,Both,,,,44.2,37.57,12.66772,44.2,"Health Partners, Inc.",State Public Programs,22.1,50,,percent of total billed charges,,
PACK EXTREMITY,,A4649,HCPCS,Facility,Both,,,,44.2,37.57,12.66772,44.2,Humana Insurance Company,Commercial PPO,41.99,95,,percent of total billed charges,,
PACK EXTREMITY,,A4649,HCPCS,Facility,Outpatient,,,,44.2,37.57,12.66772,44.2,Humana Insurance Company,Medicare PPO,21.658,49,,percent of total billed charges,,
PACK EXTREMITY,,A4649,HCPCS,Facility,Inpatient,,,,44.2,37.57,12.66772,44.2,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
PACK EXTREMITY,,A4649,HCPCS,Facility,Both,,,,44.2,37.57,12.66772,44.2,Medica,Individual & Family,43.8022,99.1,,percent of total billed charges,,
PACK EXTREMITY,,A4649,HCPCS,Facility,Outpatient,,,,44.2,37.57,12.66772,44.2,Medica,Medica Advantage Solution,22.0116,49.8,,percent of total billed charges,,
PACK EXTREMITY,,A4649,HCPCS,Facility,Inpatient,,,,44.2,37.57,12.66772,44.2,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
PACK EXTREMITY,,A4649,HCPCS,Facility,Outpatient,,,,44.2,37.57,12.66772,44.2,Medica,Medical Assistance,19.7132,44.6,,percent of total billed charges,,
PACK EXTREMITY,,A4649,HCPCS,Facility,Inpatient,,,,44.2,37.57,12.66772,44.2,Medica,Medical Assistance,,,,,Included in per diem rate,
PACK EXTREMITY,,A4649,HCPCS,Facility,Outpatient,,,,44.2,37.57,12.66772,44.2,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,22.0116,49.8,,percent of total billed charges,,
PACK EXTREMITY,,A4649,HCPCS,Facility,Inpatient,,,,44.2,37.57,12.66772,44.2,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
PACK EXTREMITY,,A4649,HCPCS,Facility,Both,,,,44.2,37.57,12.66772,44.2,"Multiplan, Inc.","Multiplan, Inc.",41.548,94,,percent of total billed charges,,
PACK EXTREMITY,,A4649,HCPCS,Facility,Outpatient,,,,44.2,37.57,12.66772,44.2,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,39.8242,90.1,,percent of total billed charges,,
PACK EXTREMITY,,A4649,HCPCS,Facility,Inpatient,,,,44.2,37.57,12.66772,44.2,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
PACK EXTREMITY,,A4649,HCPCS,Facility,Both,,,,44.2,37.57,12.66772,44.2,"Preferred One Administrative Services, INC.",PPO,43.5812,98.6,,percent of total billed charges,,
PACK EXTREMITY,,A4649,HCPCS,Facility,Outpatient,,,,44.2,37.57,12.66772,44.2,PrimeWest Health,Minnesota Senior Health Options (MSHO),22.7409,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
PACK EXTREMITY,,A4649,HCPCS,Facility,Inpatient,,,,44.2,37.57,12.66772,44.2,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PACK EXTREMITY,,A4649,HCPCS,Facility,Outpatient,,,,44.2,37.57,12.66772,44.2,PrimeWest Health,MinnesotaCare,22.70112,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
PACK EXTREMITY,,A4649,HCPCS,Facility,Inpatient,,,,44.2,37.57,12.66772,44.2,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
PACK EXTREMITY,,A4649,HCPCS,Facility,Both,,,,44.2,37.57,12.66772,44.2,Sanford Health Plan,Sanford Health Plan,40.664,92,,percent of total billed charges,,
PACK EXTREMITY,,A4649,HCPCS,Facility,Outpatient,,,,44.2,37.57,12.66772,44.2,"UCare Health, Inc.",Individual & Family Plan,24.9067,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
PACK EXTREMITY,,A4649,HCPCS,Facility,Inpatient,,,,44.2,37.57,12.66772,44.2,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
PACK EXTREMITY,,A4649,HCPCS,Facility,Outpatient,,,,44.2,37.57,12.66772,44.2,"UCare Health, Inc.",Medical Assistance,22.30774,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PACK EXTREMITY,,A4649,HCPCS,Facility,Inpatient,,,,44.2,37.57,12.66772,44.2,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
PACK EXTREMITY,,A4649,HCPCS,Facility,Outpatient,,,,44.2,37.57,12.66772,44.2,"UCare Health, Inc.",Medicare Advantage,22.30774,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PACK EXTREMITY,,A4649,HCPCS,Facility,Inpatient,,,,44.2,37.57,12.66772,44.2,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PACK EXTREMITY,,A4649,HCPCS,Facility,Outpatient,,,,44.2,37.57,12.66772,44.2,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),22.30774,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PACK EXTREMITY,,A4649,HCPCS,Facility,Inpatient,,,,44.2,37.57,12.66772,44.2,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PACK EXTREMITY,,A4649,HCPCS,Facility,Both,,,,44.2,37.57,12.66772,44.2,UnitedHealthcare,Individual & Family,41.548,94,,percent of total billed charges,,
PACK EXTREMITY,,A4649,HCPCS,Facility,Outpatient,,,,44.2,37.57,12.66772,44.2,UnitedHealthcare,Medicare Advantage,21.658,49,,percent of total billed charges,,
PACK EXTREMITY,,A4649,HCPCS,Facility,Inpatient,,,,44.2,37.57,12.66772,44.2,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
PACK EXTREMITY,,A4649,HCPCS,Facility,Outpatient,,,,44.2,37.57,12.66772,44.2,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,21.216,48,,percent of total billed charges,,100% of DHS outpatient percentage
PACK EXTREMITY,,A4649,HCPCS,Facility,Inpatient,,,,44.2,37.57,12.66772,44.2,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
PACK GENERAL ENDO,,A4649,HCPCS,Facility,Both,,,,99.6,84.66,28.54536,99.6,Aetna,Commercial,91.632,92,,percent of total billed charges,,
PACK GENERAL ENDO,,A4649,HCPCS,Facility,Outpatient,,,,99.6,84.66,28.54536,99.6,Aetna,Medicare Advantage,48.804,49,,percent of total billed charges,,
PACK GENERAL ENDO,,A4649,HCPCS,Facility,Inpatient,,,,99.6,84.66,28.54536,99.6,Aetna,Medicare Advantage,,,,,Included in per diem rate,
PACK GENERAL ENDO,,A4649,HCPCS,Facility,Both,,,,99.6,84.66,28.54536,99.6,Aetna,PPO,92.628,93,,percent of total billed charges,,
PACK GENERAL ENDO,,A4649,HCPCS,Facility,Both,,,,99.6,84.66,28.54536,99.6,America's PPO,America's PPO,95.64588,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
PACK GENERAL ENDO,,A4649,HCPCS,Facility,Both,,,,99.6,84.66,28.54536,99.6,BlueCross BlueShield Minnesota, Federal Employee Program,98.0064,98.4,,percent of total billed charges,,
PACK GENERAL ENDO,,A4649,HCPCS,Facility,Both,,,,99.6,84.66,28.54536,99.6,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,99.6,100,,percent of total billed charges,,
PACK GENERAL ENDO,,A4649,HCPCS,Facility,Both,,,,99.6,84.66,28.54536,99.6,BlueCross BlueShield Minnesota,High Value Network Plan,89.64,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
PACK GENERAL ENDO,,A4649,HCPCS,Facility,Outpatient,,,,99.6,84.66,28.54536,99.6,BlueCross BlueShield Minnesota,Medicare Advantage,48.804,49,,percent of total billed charges,,
PACK GENERAL ENDO,,A4649,HCPCS,Facility,Inpatient,,,,99.6,84.66,28.54536,99.6,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
PACK GENERAL ENDO,,A4649,HCPCS,Facility,Both,,,,99.6,84.66,28.54536,99.6,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,88.21572,88.57,,percent of total billed charges,,
PACK GENERAL ENDO,,A4649,HCPCS,Facility,Both,,,,99.6,84.66,28.54536,99.6,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,28.54536,28.66,,percent of total billed charges,,
PACK GENERAL ENDO,,A4649,HCPCS,Facility,Outpatient,,,,99.6,84.66,28.54536,99.6,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),48.804,49,,percent of total billed charges,,
PACK GENERAL ENDO,,A4649,HCPCS,Facility,Inpatient,,,,99.6,84.66,28.54536,99.6,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
PACK GENERAL ENDO,,A4649,HCPCS,Facility,Both,,,,99.6,84.66,28.54536,99.6,CorVel,Worker's Compensation,99.6,100,,percent of total billed charges,,
PACK GENERAL ENDO,,A4649,HCPCS,Facility,Both,,,,99.6,84.66,28.54536,99.6,First Health Group Corporation,First Health Network,96.612,97,,percent of total billed charges,,
PACK GENERAL ENDO,,A4649,HCPCS,Facility,Both,,,,99.6,84.66,28.54536,99.6,"Health Partners, Inc.",Commercial,94.2216,94.6,,percent of total billed charges,,
PACK GENERAL ENDO,,A4649,HCPCS,Facility,Outpatient,,,,99.6,84.66,28.54536,99.6,"Health Partners, Inc.",Medicare Advantage,48.804,49,,percent of total billed charges,,
PACK GENERAL ENDO,,A4649,HCPCS,Facility,Inpatient,,,,99.6,84.66,28.54536,99.6,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PACK GENERAL ENDO,,A4649,HCPCS,Facility,Both,,,,99.6,84.66,28.54536,99.6,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),59.76,60,,percent of total billed charges,,
PACK GENERAL ENDO,,A4649,HCPCS,Facility,Both,,,,99.6,84.66,28.54536,99.6,"Health Partners, Inc.",State of Minnesota Advantage Program,81.174,81.5,,percent of total billed charges,,
PACK GENERAL ENDO,,A4649,HCPCS,Facility,Both,,,,99.6,84.66,28.54536,99.6,"Health Partners, Inc.",State Public Programs,49.8,50,,percent of total billed charges,,
PACK GENERAL ENDO,,A4649,HCPCS,Facility,Both,,,,99.6,84.66,28.54536,99.6,Humana Insurance Company,Commercial PPO,94.62,95,,percent of total billed charges,,
PACK GENERAL ENDO,,A4649,HCPCS,Facility,Outpatient,,,,99.6,84.66,28.54536,99.6,Humana Insurance Company,Medicare PPO,48.804,49,,percent of total billed charges,,
PACK GENERAL ENDO,,A4649,HCPCS,Facility,Inpatient,,,,99.6,84.66,28.54536,99.6,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
PACK GENERAL ENDO,,A4649,HCPCS,Facility,Both,,,,99.6,84.66,28.54536,99.6,Medica,Individual & Family,98.7036,99.1,,percent of total billed charges,,
PACK GENERAL ENDO,,A4649,HCPCS,Facility,Outpatient,,,,99.6,84.66,28.54536,99.6,Medica,Medica Advantage Solution,49.6008,49.8,,percent of total billed charges,,
PACK GENERAL ENDO,,A4649,HCPCS,Facility,Inpatient,,,,99.6,84.66,28.54536,99.6,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
PACK GENERAL ENDO,,A4649,HCPCS,Facility,Outpatient,,,,99.6,84.66,28.54536,99.6,Medica,Medical Assistance,44.4216,44.6,,percent of total billed charges,,
PACK GENERAL ENDO,,A4649,HCPCS,Facility,Inpatient,,,,99.6,84.66,28.54536,99.6,Medica,Medical Assistance,,,,,Included in per diem rate,
PACK GENERAL ENDO,,A4649,HCPCS,Facility,Outpatient,,,,99.6,84.66,28.54536,99.6,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,49.6008,49.8,,percent of total billed charges,,
PACK GENERAL ENDO,,A4649,HCPCS,Facility,Inpatient,,,,99.6,84.66,28.54536,99.6,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
PACK GENERAL ENDO,,A4649,HCPCS,Facility,Both,,,,99.6,84.66,28.54536,99.6,"Multiplan, Inc.","Multiplan, Inc.",93.624,94,,percent of total billed charges,,
PACK GENERAL ENDO,,A4649,HCPCS,Facility,Outpatient,,,,99.6,84.66,28.54536,99.6,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,89.7396,90.1,,percent of total billed charges,,
PACK GENERAL ENDO,,A4649,HCPCS,Facility,Inpatient,,,,99.6,84.66,28.54536,99.6,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
PACK GENERAL ENDO,,A4649,HCPCS,Facility,Both,,,,99.6,84.66,28.54536,99.6,"Preferred One Administrative Services, INC.",PPO,98.2056,98.6,,percent of total billed charges,,
PACK GENERAL ENDO,,A4649,HCPCS,Facility,Outpatient,,,,99.6,84.66,28.54536,99.6,PrimeWest Health,Minnesota Senior Health Options (MSHO),51.2442,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
PACK GENERAL ENDO,,A4649,HCPCS,Facility,Inpatient,,,,99.6,84.66,28.54536,99.6,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PACK GENERAL ENDO,,A4649,HCPCS,Facility,Outpatient,,,,99.6,84.66,28.54536,99.6,PrimeWest Health,MinnesotaCare,51.15456,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
PACK GENERAL ENDO,,A4649,HCPCS,Facility,Inpatient,,,,99.6,84.66,28.54536,99.6,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
PACK GENERAL ENDO,,A4649,HCPCS,Facility,Both,,,,99.6,84.66,28.54536,99.6,Sanford Health Plan,Sanford Health Plan,91.632,92,,percent of total billed charges,,
PACK GENERAL ENDO,,A4649,HCPCS,Facility,Outpatient,,,,99.6,84.66,28.54536,99.6,"UCare Health, Inc.",Individual & Family Plan,56.1246,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
PACK GENERAL ENDO,,A4649,HCPCS,Facility,Inpatient,,,,99.6,84.66,28.54536,99.6,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
PACK GENERAL ENDO,,A4649,HCPCS,Facility,Outpatient,,,,99.6,84.66,28.54536,99.6,"UCare Health, Inc.",Medical Assistance,50.26812,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PACK GENERAL ENDO,,A4649,HCPCS,Facility,Inpatient,,,,99.6,84.66,28.54536,99.6,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
PACK GENERAL ENDO,,A4649,HCPCS,Facility,Outpatient,,,,99.6,84.66,28.54536,99.6,"UCare Health, Inc.",Medicare Advantage,50.26812,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PACK GENERAL ENDO,,A4649,HCPCS,Facility,Inpatient,,,,99.6,84.66,28.54536,99.6,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PACK GENERAL ENDO,,A4649,HCPCS,Facility,Outpatient,,,,99.6,84.66,28.54536,99.6,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),50.26812,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PACK GENERAL ENDO,,A4649,HCPCS,Facility,Inpatient,,,,99.6,84.66,28.54536,99.6,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PACK GENERAL ENDO,,A4649,HCPCS,Facility,Both,,,,99.6,84.66,28.54536,99.6,UnitedHealthcare,Individual & Family,93.624,94,,percent of total billed charges,,
PACK GENERAL ENDO,,A4649,HCPCS,Facility,Outpatient,,,,99.6,84.66,28.54536,99.6,UnitedHealthcare,Medicare Advantage,48.804,49,,percent of total billed charges,,
PACK GENERAL ENDO,,A4649,HCPCS,Facility,Inpatient,,,,99.6,84.66,28.54536,99.6,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
PACK GENERAL ENDO,,A4649,HCPCS,Facility,Outpatient,,,,99.6,84.66,28.54536,99.6,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,47.808,48,,percent of total billed charges,,100% of DHS outpatient percentage
PACK GENERAL ENDO,,A4649,HCPCS,Facility,Inpatient,,,,99.6,84.66,28.54536,99.6,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
PACK TOTAL KNEE (SOPCNTKCMA),,A4649,HCPCS,Facility,Both,,,,304.5,258.825,87.2697,304.5,Aetna,Commercial,280.14,92,,percent of total billed charges,,
PACK TOTAL KNEE (SOPCNTKCMA),,A4649,HCPCS,Facility,Outpatient,,,,304.5,258.825,87.2697,304.5,Aetna,Medicare Advantage,149.205,49,,percent of total billed charges,,
PACK TOTAL KNEE (SOPCNTKCMA),,A4649,HCPCS,Facility,Inpatient,,,,304.5,258.825,87.2697,304.5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
PACK TOTAL KNEE (SOPCNTKCMA),,A4649,HCPCS,Facility,Both,,,,304.5,258.825,87.2697,304.5,Aetna,PPO,283.185,93,,percent of total billed charges,,
PACK TOTAL KNEE (SOPCNTKCMA),,A4649,HCPCS,Facility,Both,,,,304.5,258.825,87.2697,304.5,America's PPO,America's PPO,292.41135,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
PACK TOTAL KNEE (SOPCNTKCMA),,A4649,HCPCS,Facility,Both,,,,304.5,258.825,87.2697,304.5,BlueCross BlueShield Minnesota, Federal Employee Program,299.628,98.4,,percent of total billed charges,,
PACK TOTAL KNEE (SOPCNTKCMA),,A4649,HCPCS,Facility,Both,,,,304.5,258.825,87.2697,304.5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,304.5,100,,percent of total billed charges,,
PACK TOTAL KNEE (SOPCNTKCMA),,A4649,HCPCS,Facility,Both,,,,304.5,258.825,87.2697,304.5,BlueCross BlueShield Minnesota,High Value Network Plan,274.05,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
PACK TOTAL KNEE (SOPCNTKCMA),,A4649,HCPCS,Facility,Outpatient,,,,304.5,258.825,87.2697,304.5,BlueCross BlueShield Minnesota,Medicare Advantage,149.205,49,,percent of total billed charges,,
PACK TOTAL KNEE (SOPCNTKCMA),,A4649,HCPCS,Facility,Inpatient,,,,304.5,258.825,87.2697,304.5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
PACK TOTAL KNEE (SOPCNTKCMA),,A4649,HCPCS,Facility,Both,,,,304.5,258.825,87.2697,304.5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,269.69565,88.57,,percent of total billed charges,,
PACK TOTAL KNEE (SOPCNTKCMA),,A4649,HCPCS,Facility,Both,,,,304.5,258.825,87.2697,304.5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,87.2697,28.66,,percent of total billed charges,,
PACK TOTAL KNEE (SOPCNTKCMA),,A4649,HCPCS,Facility,Outpatient,,,,304.5,258.825,87.2697,304.5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),149.205,49,,percent of total billed charges,,
PACK TOTAL KNEE (SOPCNTKCMA),,A4649,HCPCS,Facility,Inpatient,,,,304.5,258.825,87.2697,304.5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
PACK TOTAL KNEE (SOPCNTKCMA),,A4649,HCPCS,Facility,Both,,,,304.5,258.825,87.2697,304.5,CorVel,Worker's Compensation,304.5,100,,percent of total billed charges,,
PACK TOTAL KNEE (SOPCNTKCMA),,A4649,HCPCS,Facility,Both,,,,304.5,258.825,87.2697,304.5,First Health Group Corporation,First Health Network,295.365,97,,percent of total billed charges,,
PACK TOTAL KNEE (SOPCNTKCMA),,A4649,HCPCS,Facility,Both,,,,304.5,258.825,87.2697,304.5,"Health Partners, Inc.",Commercial,288.057,94.6,,percent of total billed charges,,
PACK TOTAL KNEE (SOPCNTKCMA),,A4649,HCPCS,Facility,Outpatient,,,,304.5,258.825,87.2697,304.5,"Health Partners, Inc.",Medicare Advantage,149.205,49,,percent of total billed charges,,
PACK TOTAL KNEE (SOPCNTKCMA),,A4649,HCPCS,Facility,Inpatient,,,,304.5,258.825,87.2697,304.5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PACK TOTAL KNEE (SOPCNTKCMA),,A4649,HCPCS,Facility,Both,,,,304.5,258.825,87.2697,304.5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),182.7,60,,percent of total billed charges,,
PACK TOTAL KNEE (SOPCNTKCMA),,A4649,HCPCS,Facility,Both,,,,304.5,258.825,87.2697,304.5,"Health Partners, Inc.",State of Minnesota Advantage Program,248.1675,81.5,,percent of total billed charges,,
PACK TOTAL KNEE (SOPCNTKCMA),,A4649,HCPCS,Facility,Both,,,,304.5,258.825,87.2697,304.5,"Health Partners, Inc.",State Public Programs,152.25,50,,percent of total billed charges,,
PACK TOTAL KNEE (SOPCNTKCMA),,A4649,HCPCS,Facility,Both,,,,304.5,258.825,87.2697,304.5,Humana Insurance Company,Commercial PPO,289.275,95,,percent of total billed charges,,
PACK TOTAL KNEE (SOPCNTKCMA),,A4649,HCPCS,Facility,Outpatient,,,,304.5,258.825,87.2697,304.5,Humana Insurance Company,Medicare PPO,149.205,49,,percent of total billed charges,,
PACK TOTAL KNEE (SOPCNTKCMA),,A4649,HCPCS,Facility,Inpatient,,,,304.5,258.825,87.2697,304.5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
PACK TOTAL KNEE (SOPCNTKCMA),,A4649,HCPCS,Facility,Both,,,,304.5,258.825,87.2697,304.5,Medica,Individual & Family,301.7595,99.1,,percent of total billed charges,,
PACK TOTAL KNEE (SOPCNTKCMA),,A4649,HCPCS,Facility,Outpatient,,,,304.5,258.825,87.2697,304.5,Medica,Medica Advantage Solution,151.641,49.8,,percent of total billed charges,,
PACK TOTAL KNEE (SOPCNTKCMA),,A4649,HCPCS,Facility,Inpatient,,,,304.5,258.825,87.2697,304.5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
PACK TOTAL KNEE (SOPCNTKCMA),,A4649,HCPCS,Facility,Outpatient,,,,304.5,258.825,87.2697,304.5,Medica,Medical Assistance,135.807,44.6,,percent of total billed charges,,
PACK TOTAL KNEE (SOPCNTKCMA),,A4649,HCPCS,Facility,Inpatient,,,,304.5,258.825,87.2697,304.5,Medica,Medical Assistance,,,,,Included in per diem rate,
PACK TOTAL KNEE (SOPCNTKCMA),,A4649,HCPCS,Facility,Outpatient,,,,304.5,258.825,87.2697,304.5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,151.641,49.8,,percent of total billed charges,,
PACK TOTAL KNEE (SOPCNTKCMA),,A4649,HCPCS,Facility,Inpatient,,,,304.5,258.825,87.2697,304.5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
PACK TOTAL KNEE (SOPCNTKCMA),,A4649,HCPCS,Facility,Both,,,,304.5,258.825,87.2697,304.5,"Multiplan, Inc.","Multiplan, Inc.",286.23,94,,percent of total billed charges,,
PACK TOTAL KNEE (SOPCNTKCMA),,A4649,HCPCS,Facility,Outpatient,,,,304.5,258.825,87.2697,304.5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,274.3545,90.1,,percent of total billed charges,,
PACK TOTAL KNEE (SOPCNTKCMA),,A4649,HCPCS,Facility,Inpatient,,,,304.5,258.825,87.2697,304.5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
PACK TOTAL KNEE (SOPCNTKCMA),,A4649,HCPCS,Facility,Both,,,,304.5,258.825,87.2697,304.5,"Preferred One Administrative Services, INC.",PPO,300.237,98.6,,percent of total billed charges,,
PACK TOTAL KNEE (SOPCNTKCMA),,A4649,HCPCS,Facility,Outpatient,,,,304.5,258.825,87.2697,304.5,PrimeWest Health,Minnesota Senior Health Options (MSHO),156.66525,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
PACK TOTAL KNEE (SOPCNTKCMA),,A4649,HCPCS,Facility,Inpatient,,,,304.5,258.825,87.2697,304.5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PACK TOTAL KNEE (SOPCNTKCMA),,A4649,HCPCS,Facility,Outpatient,,,,304.5,258.825,87.2697,304.5,PrimeWest Health,MinnesotaCare,156.3912,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
PACK TOTAL KNEE (SOPCNTKCMA),,A4649,HCPCS,Facility,Inpatient,,,,304.5,258.825,87.2697,304.5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
PACK TOTAL KNEE (SOPCNTKCMA),,A4649,HCPCS,Facility,Both,,,,304.5,258.825,87.2697,304.5,Sanford Health Plan,Sanford Health Plan,280.14,92,,percent of total billed charges,,
PACK TOTAL KNEE (SOPCNTKCMA),,A4649,HCPCS,Facility,Outpatient,,,,304.5,258.825,87.2697,304.5,"UCare Health, Inc.",Individual & Family Plan,171.58575,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
PACK TOTAL KNEE (SOPCNTKCMA),,A4649,HCPCS,Facility,Inpatient,,,,304.5,258.825,87.2697,304.5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
PACK TOTAL KNEE (SOPCNTKCMA),,A4649,HCPCS,Facility,Outpatient,,,,304.5,258.825,87.2697,304.5,"UCare Health, Inc.",Medical Assistance,153.68115,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PACK TOTAL KNEE (SOPCNTKCMA),,A4649,HCPCS,Facility,Inpatient,,,,304.5,258.825,87.2697,304.5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
PACK TOTAL KNEE (SOPCNTKCMA),,A4649,HCPCS,Facility,Outpatient,,,,304.5,258.825,87.2697,304.5,"UCare Health, Inc.",Medicare Advantage,153.68115,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PACK TOTAL KNEE (SOPCNTKCMA),,A4649,HCPCS,Facility,Inpatient,,,,304.5,258.825,87.2697,304.5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PACK TOTAL KNEE (SOPCNTKCMA),,A4649,HCPCS,Facility,Outpatient,,,,304.5,258.825,87.2697,304.5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),153.68115,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PACK TOTAL KNEE (SOPCNTKCMA),,A4649,HCPCS,Facility,Inpatient,,,,304.5,258.825,87.2697,304.5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PACK TOTAL KNEE (SOPCNTKCMA),,A4649,HCPCS,Facility,Both,,,,304.5,258.825,87.2697,304.5,UnitedHealthcare,Individual & Family,286.23,94,,percent of total billed charges,,
PACK TOTAL KNEE (SOPCNTKCMA),,A4649,HCPCS,Facility,Outpatient,,,,304.5,258.825,87.2697,304.5,UnitedHealthcare,Medicare Advantage,149.205,49,,percent of total billed charges,,
PACK TOTAL KNEE (SOPCNTKCMA),,A4649,HCPCS,Facility,Inpatient,,,,304.5,258.825,87.2697,304.5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
PACK TOTAL KNEE (SOPCNTKCMA),,A4649,HCPCS,Facility,Outpatient,,,,304.5,258.825,87.2697,304.5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,146.16,48,,percent of total billed charges,,100% of DHS outpatient percentage
PACK TOTAL KNEE (SOPCNTKCMA),,A4649,HCPCS,Facility,Inpatient,,,,304.5,258.825,87.2697,304.5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
PENCIL PB NEPTUNE SMOKE EVAC  STRYKER 0703-046-000,,A4649,HCPCS,Facility,Both,,,,120,102,34.392,120,Aetna,Commercial,110.4,92,,percent of total billed charges,,
PENCIL PB NEPTUNE SMOKE EVAC  STRYKER 0703-046-000,,A4649,HCPCS,Facility,Outpatient,,,,120,102,34.392,120,Aetna,Medicare Advantage,58.8,49,,percent of total billed charges,,
PENCIL PB NEPTUNE SMOKE EVAC  STRYKER 0703-046-000,,A4649,HCPCS,Facility,Inpatient,,,,120,102,34.392,120,Aetna,Medicare Advantage,,,,,Included in per diem rate,
PENCIL PB NEPTUNE SMOKE EVAC  STRYKER 0703-046-000,,A4649,HCPCS,Facility,Both,,,,120,102,34.392,120,Aetna,PPO,111.6,93,,percent of total billed charges,,
PENCIL PB NEPTUNE SMOKE EVAC  STRYKER 0703-046-000,,A4649,HCPCS,Facility,Both,,,,120,102,34.392,120,America's PPO,America's PPO,115.236,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
PENCIL PB NEPTUNE SMOKE EVAC  STRYKER 0703-046-000,,A4649,HCPCS,Facility,Both,,,,120,102,34.392,120,BlueCross BlueShield Minnesota, Federal Employee Program,118.08,98.4,,percent of total billed charges,,
PENCIL PB NEPTUNE SMOKE EVAC  STRYKER 0703-046-000,,A4649,HCPCS,Facility,Both,,,,120,102,34.392,120,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,120,100,,percent of total billed charges,,
PENCIL PB NEPTUNE SMOKE EVAC  STRYKER 0703-046-000,,A4649,HCPCS,Facility,Both,,,,120,102,34.392,120,BlueCross BlueShield Minnesota,High Value Network Plan,108,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
PENCIL PB NEPTUNE SMOKE EVAC  STRYKER 0703-046-000,,A4649,HCPCS,Facility,Outpatient,,,,120,102,34.392,120,BlueCross BlueShield Minnesota,Medicare Advantage,58.8,49,,percent of total billed charges,,
PENCIL PB NEPTUNE SMOKE EVAC  STRYKER 0703-046-000,,A4649,HCPCS,Facility,Inpatient,,,,120,102,34.392,120,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
PENCIL PB NEPTUNE SMOKE EVAC  STRYKER 0703-046-000,,A4649,HCPCS,Facility,Both,,,,120,102,34.392,120,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,106.284,88.57,,percent of total billed charges,,
PENCIL PB NEPTUNE SMOKE EVAC  STRYKER 0703-046-000,,A4649,HCPCS,Facility,Both,,,,120,102,34.392,120,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,34.392,28.66,,percent of total billed charges,,
PENCIL PB NEPTUNE SMOKE EVAC  STRYKER 0703-046-000,,A4649,HCPCS,Facility,Outpatient,,,,120,102,34.392,120,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),58.8,49,,percent of total billed charges,,
PENCIL PB NEPTUNE SMOKE EVAC  STRYKER 0703-046-000,,A4649,HCPCS,Facility,Inpatient,,,,120,102,34.392,120,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
PENCIL PB NEPTUNE SMOKE EVAC  STRYKER 0703-046-000,,A4649,HCPCS,Facility,Both,,,,120,102,34.392,120,CorVel,Worker's Compensation,120,100,,percent of total billed charges,,
PENCIL PB NEPTUNE SMOKE EVAC  STRYKER 0703-046-000,,A4649,HCPCS,Facility,Both,,,,120,102,34.392,120,First Health Group Corporation,First Health Network,116.4,97,,percent of total billed charges,,
PENCIL PB NEPTUNE SMOKE EVAC  STRYKER 0703-046-000,,A4649,HCPCS,Facility,Both,,,,120,102,34.392,120,"Health Partners, Inc.",Commercial,113.52,94.6,,percent of total billed charges,,
PENCIL PB NEPTUNE SMOKE EVAC  STRYKER 0703-046-000,,A4649,HCPCS,Facility,Outpatient,,,,120,102,34.392,120,"Health Partners, Inc.",Medicare Advantage,58.8,49,,percent of total billed charges,,
PENCIL PB NEPTUNE SMOKE EVAC  STRYKER 0703-046-000,,A4649,HCPCS,Facility,Inpatient,,,,120,102,34.392,120,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PENCIL PB NEPTUNE SMOKE EVAC  STRYKER 0703-046-000,,A4649,HCPCS,Facility,Both,,,,120,102,34.392,120,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),72,60,,percent of total billed charges,,
PENCIL PB NEPTUNE SMOKE EVAC  STRYKER 0703-046-000,,A4649,HCPCS,Facility,Both,,,,120,102,34.392,120,"Health Partners, Inc.",State of Minnesota Advantage Program,97.8,81.5,,percent of total billed charges,,
PENCIL PB NEPTUNE SMOKE EVAC  STRYKER 0703-046-000,,A4649,HCPCS,Facility,Both,,,,120,102,34.392,120,"Health Partners, Inc.",State Public Programs,60,50,,percent of total billed charges,,
PENCIL PB NEPTUNE SMOKE EVAC  STRYKER 0703-046-000,,A4649,HCPCS,Facility,Both,,,,120,102,34.392,120,Humana Insurance Company,Commercial PPO,114,95,,percent of total billed charges,,
PENCIL PB NEPTUNE SMOKE EVAC  STRYKER 0703-046-000,,A4649,HCPCS,Facility,Outpatient,,,,120,102,34.392,120,Humana Insurance Company,Medicare PPO,58.8,49,,percent of total billed charges,,
PENCIL PB NEPTUNE SMOKE EVAC  STRYKER 0703-046-000,,A4649,HCPCS,Facility,Inpatient,,,,120,102,34.392,120,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
PENCIL PB NEPTUNE SMOKE EVAC  STRYKER 0703-046-000,,A4649,HCPCS,Facility,Both,,,,120,102,34.392,120,Medica,Individual & Family,118.92,99.1,,percent of total billed charges,,
PENCIL PB NEPTUNE SMOKE EVAC  STRYKER 0703-046-000,,A4649,HCPCS,Facility,Outpatient,,,,120,102,34.392,120,Medica,Medica Advantage Solution,59.76,49.8,,percent of total billed charges,,
PENCIL PB NEPTUNE SMOKE EVAC  STRYKER 0703-046-000,,A4649,HCPCS,Facility,Inpatient,,,,120,102,34.392,120,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
PENCIL PB NEPTUNE SMOKE EVAC  STRYKER 0703-046-000,,A4649,HCPCS,Facility,Outpatient,,,,120,102,34.392,120,Medica,Medical Assistance,53.52,44.6,,percent of total billed charges,,
PENCIL PB NEPTUNE SMOKE EVAC  STRYKER 0703-046-000,,A4649,HCPCS,Facility,Inpatient,,,,120,102,34.392,120,Medica,Medical Assistance,,,,,Included in per diem rate,
PENCIL PB NEPTUNE SMOKE EVAC  STRYKER 0703-046-000,,A4649,HCPCS,Facility,Outpatient,,,,120,102,34.392,120,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,59.76,49.8,,percent of total billed charges,,
PENCIL PB NEPTUNE SMOKE EVAC  STRYKER 0703-046-000,,A4649,HCPCS,Facility,Inpatient,,,,120,102,34.392,120,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
PENCIL PB NEPTUNE SMOKE EVAC  STRYKER 0703-046-000,,A4649,HCPCS,Facility,Both,,,,120,102,34.392,120,"Multiplan, Inc.","Multiplan, Inc.",112.8,94,,percent of total billed charges,,
PENCIL PB NEPTUNE SMOKE EVAC  STRYKER 0703-046-000,,A4649,HCPCS,Facility,Outpatient,,,,120,102,34.392,120,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,108.12,90.1,,percent of total billed charges,,
PENCIL PB NEPTUNE SMOKE EVAC  STRYKER 0703-046-000,,A4649,HCPCS,Facility,Inpatient,,,,120,102,34.392,120,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
PENCIL PB NEPTUNE SMOKE EVAC  STRYKER 0703-046-000,,A4649,HCPCS,Facility,Both,,,,120,102,34.392,120,"Preferred One Administrative Services, INC.",PPO,118.32,98.6,,percent of total billed charges,,
PENCIL PB NEPTUNE SMOKE EVAC  STRYKER 0703-046-000,,A4649,HCPCS,Facility,Outpatient,,,,120,102,34.392,120,PrimeWest Health,Minnesota Senior Health Options (MSHO),61.74,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
PENCIL PB NEPTUNE SMOKE EVAC  STRYKER 0703-046-000,,A4649,HCPCS,Facility,Inpatient,,,,120,102,34.392,120,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PENCIL PB NEPTUNE SMOKE EVAC  STRYKER 0703-046-000,,A4649,HCPCS,Facility,Outpatient,,,,120,102,34.392,120,PrimeWest Health,MinnesotaCare,61.632,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
PENCIL PB NEPTUNE SMOKE EVAC  STRYKER 0703-046-000,,A4649,HCPCS,Facility,Inpatient,,,,120,102,34.392,120,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
PENCIL PB NEPTUNE SMOKE EVAC  STRYKER 0703-046-000,,A4649,HCPCS,Facility,Both,,,,120,102,34.392,120,Sanford Health Plan,Sanford Health Plan,110.4,92,,percent of total billed charges,,
PENCIL PB NEPTUNE SMOKE EVAC  STRYKER 0703-046-000,,A4649,HCPCS,Facility,Outpatient,,,,120,102,34.392,120,"UCare Health, Inc.",Individual & Family Plan,67.62,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
PENCIL PB NEPTUNE SMOKE EVAC  STRYKER 0703-046-000,,A4649,HCPCS,Facility,Inpatient,,,,120,102,34.392,120,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
PENCIL PB NEPTUNE SMOKE EVAC  STRYKER 0703-046-000,,A4649,HCPCS,Facility,Outpatient,,,,120,102,34.392,120,"UCare Health, Inc.",Medical Assistance,60.564,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PENCIL PB NEPTUNE SMOKE EVAC  STRYKER 0703-046-000,,A4649,HCPCS,Facility,Inpatient,,,,120,102,34.392,120,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
PENCIL PB NEPTUNE SMOKE EVAC  STRYKER 0703-046-000,,A4649,HCPCS,Facility,Outpatient,,,,120,102,34.392,120,"UCare Health, Inc.",Medicare Advantage,60.564,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PENCIL PB NEPTUNE SMOKE EVAC  STRYKER 0703-046-000,,A4649,HCPCS,Facility,Inpatient,,,,120,102,34.392,120,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PENCIL PB NEPTUNE SMOKE EVAC  STRYKER 0703-046-000,,A4649,HCPCS,Facility,Outpatient,,,,120,102,34.392,120,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),60.564,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PENCIL PB NEPTUNE SMOKE EVAC  STRYKER 0703-046-000,,A4649,HCPCS,Facility,Inpatient,,,,120,102,34.392,120,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PENCIL PB NEPTUNE SMOKE EVAC  STRYKER 0703-046-000,,A4649,HCPCS,Facility,Both,,,,120,102,34.392,120,UnitedHealthcare,Individual & Family,112.8,94,,percent of total billed charges,,
PENCIL PB NEPTUNE SMOKE EVAC  STRYKER 0703-046-000,,A4649,HCPCS,Facility,Outpatient,,,,120,102,34.392,120,UnitedHealthcare,Medicare Advantage,58.8,49,,percent of total billed charges,,
PENCIL PB NEPTUNE SMOKE EVAC  STRYKER 0703-046-000,,A4649,HCPCS,Facility,Inpatient,,,,120,102,34.392,120,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
PENCIL PB NEPTUNE SMOKE EVAC  STRYKER 0703-046-000,,A4649,HCPCS,Facility,Outpatient,,,,120,102,34.392,120,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,57.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
PENCIL PB NEPTUNE SMOKE EVAC  STRYKER 0703-046-000,,A4649,HCPCS,Facility,Inpatient,,,,120,102,34.392,120,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
PIN GUIDE PSI PSN PREF PS,,A4649,HCPCS,Facility,Both,,,,1938,1647.3,555.4308,1938,Aetna,Commercial,1782.96,92,,percent of total billed charges,,
PIN GUIDE PSI PSN PREF PS,,A4649,HCPCS,Facility,Outpatient,,,,1938,1647.3,555.4308,1938,Aetna,Medicare Advantage,949.62,49,,percent of total billed charges,,
PIN GUIDE PSI PSN PREF PS,,A4649,HCPCS,Facility,Inpatient,,,,1938,1647.3,555.4308,1938,Aetna,Medicare Advantage,,,,,Included in per diem rate,
PIN GUIDE PSI PSN PREF PS,,A4649,HCPCS,Facility,Both,,,,1938,1647.3,555.4308,1938,Aetna,PPO,1802.34,93,,percent of total billed charges,,
PIN GUIDE PSI PSN PREF PS,,A4649,HCPCS,Facility,Both,,,,1938,1647.3,555.4308,1938,America's PPO,America's PPO,1861.0614,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
PIN GUIDE PSI PSN PREF PS,,A4649,HCPCS,Facility,Both,,,,1938,1647.3,555.4308,1938,BlueCross BlueShield Minnesota, Federal Employee Program,1906.992,98.4,,percent of total billed charges,,
PIN GUIDE PSI PSN PREF PS,,A4649,HCPCS,Facility,Both,,,,1938,1647.3,555.4308,1938,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1938,100,,percent of total billed charges,,
PIN GUIDE PSI PSN PREF PS,,A4649,HCPCS,Facility,Both,,,,1938,1647.3,555.4308,1938,BlueCross BlueShield Minnesota,High Value Network Plan,1744.2,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
PIN GUIDE PSI PSN PREF PS,,A4649,HCPCS,Facility,Outpatient,,,,1938,1647.3,555.4308,1938,BlueCross BlueShield Minnesota,Medicare Advantage,949.62,49,,percent of total billed charges,,
PIN GUIDE PSI PSN PREF PS,,A4649,HCPCS,Facility,Inpatient,,,,1938,1647.3,555.4308,1938,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
PIN GUIDE PSI PSN PREF PS,,A4649,HCPCS,Facility,Both,,,,1938,1647.3,555.4308,1938,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1716.4866,88.57,,percent of total billed charges,,
PIN GUIDE PSI PSN PREF PS,,A4649,HCPCS,Facility,Both,,,,1938,1647.3,555.4308,1938,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,555.4308,28.66,,percent of total billed charges,,
PIN GUIDE PSI PSN PREF PS,,A4649,HCPCS,Facility,Outpatient,,,,1938,1647.3,555.4308,1938,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),949.62,49,,percent of total billed charges,,
PIN GUIDE PSI PSN PREF PS,,A4649,HCPCS,Facility,Inpatient,,,,1938,1647.3,555.4308,1938,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
PIN GUIDE PSI PSN PREF PS,,A4649,HCPCS,Facility,Both,,,,1938,1647.3,555.4308,1938,CorVel,Worker's Compensation,1938,100,,percent of total billed charges,,
PIN GUIDE PSI PSN PREF PS,,A4649,HCPCS,Facility,Both,,,,1938,1647.3,555.4308,1938,First Health Group Corporation,First Health Network,1879.86,97,,percent of total billed charges,,
PIN GUIDE PSI PSN PREF PS,,A4649,HCPCS,Facility,Both,,,,1938,1647.3,555.4308,1938,"Health Partners, Inc.",Commercial,1833.348,94.6,,percent of total billed charges,,
PIN GUIDE PSI PSN PREF PS,,A4649,HCPCS,Facility,Outpatient,,,,1938,1647.3,555.4308,1938,"Health Partners, Inc.",Medicare Advantage,949.62,49,,percent of total billed charges,,
PIN GUIDE PSI PSN PREF PS,,A4649,HCPCS,Facility,Inpatient,,,,1938,1647.3,555.4308,1938,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PIN GUIDE PSI PSN PREF PS,,A4649,HCPCS,Facility,Both,,,,1938,1647.3,555.4308,1938,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1162.8,60,,percent of total billed charges,,
PIN GUIDE PSI PSN PREF PS,,A4649,HCPCS,Facility,Both,,,,1938,1647.3,555.4308,1938,"Health Partners, Inc.",State of Minnesota Advantage Program,1579.47,81.5,,percent of total billed charges,,
PIN GUIDE PSI PSN PREF PS,,A4649,HCPCS,Facility,Both,,,,1938,1647.3,555.4308,1938,"Health Partners, Inc.",State Public Programs,969,50,,percent of total billed charges,,
PIN GUIDE PSI PSN PREF PS,,A4649,HCPCS,Facility,Both,,,,1938,1647.3,555.4308,1938,Humana Insurance Company,Commercial PPO,1841.1,95,,percent of total billed charges,,
PIN GUIDE PSI PSN PREF PS,,A4649,HCPCS,Facility,Outpatient,,,,1938,1647.3,555.4308,1938,Humana Insurance Company,Medicare PPO,949.62,49,,percent of total billed charges,,
PIN GUIDE PSI PSN PREF PS,,A4649,HCPCS,Facility,Inpatient,,,,1938,1647.3,555.4308,1938,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
PIN GUIDE PSI PSN PREF PS,,A4649,HCPCS,Facility,Both,,,,1938,1647.3,555.4308,1938,Medica,Individual & Family,1920.558,99.1,,percent of total billed charges,,
PIN GUIDE PSI PSN PREF PS,,A4649,HCPCS,Facility,Outpatient,,,,1938,1647.3,555.4308,1938,Medica,Medica Advantage Solution,965.124,49.8,,percent of total billed charges,,
PIN GUIDE PSI PSN PREF PS,,A4649,HCPCS,Facility,Inpatient,,,,1938,1647.3,555.4308,1938,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
PIN GUIDE PSI PSN PREF PS,,A4649,HCPCS,Facility,Outpatient,,,,1938,1647.3,555.4308,1938,Medica,Medical Assistance,864.348,44.6,,percent of total billed charges,,
PIN GUIDE PSI PSN PREF PS,,A4649,HCPCS,Facility,Inpatient,,,,1938,1647.3,555.4308,1938,Medica,Medical Assistance,,,,,Included in per diem rate,
PIN GUIDE PSI PSN PREF PS,,A4649,HCPCS,Facility,Outpatient,,,,1938,1647.3,555.4308,1938,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,965.124,49.8,,percent of total billed charges,,
PIN GUIDE PSI PSN PREF PS,,A4649,HCPCS,Facility,Inpatient,,,,1938,1647.3,555.4308,1938,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
PIN GUIDE PSI PSN PREF PS,,A4649,HCPCS,Facility,Both,,,,1938,1647.3,555.4308,1938,"Multiplan, Inc.","Multiplan, Inc.",1821.72,94,,percent of total billed charges,,
PIN GUIDE PSI PSN PREF PS,,A4649,HCPCS,Facility,Outpatient,,,,1938,1647.3,555.4308,1938,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1746.138,90.1,,percent of total billed charges,,
PIN GUIDE PSI PSN PREF PS,,A4649,HCPCS,Facility,Inpatient,,,,1938,1647.3,555.4308,1938,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
PIN GUIDE PSI PSN PREF PS,,A4649,HCPCS,Facility,Both,,,,1938,1647.3,555.4308,1938,"Preferred One Administrative Services, INC.",PPO,1910.868,98.6,,percent of total billed charges,,
PIN GUIDE PSI PSN PREF PS,,A4649,HCPCS,Facility,Outpatient,,,,1938,1647.3,555.4308,1938,PrimeWest Health,Minnesota Senior Health Options (MSHO),997.101,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
PIN GUIDE PSI PSN PREF PS,,A4649,HCPCS,Facility,Inpatient,,,,1938,1647.3,555.4308,1938,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PIN GUIDE PSI PSN PREF PS,,A4649,HCPCS,Facility,Outpatient,,,,1938,1647.3,555.4308,1938,PrimeWest Health,MinnesotaCare,995.3568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
PIN GUIDE PSI PSN PREF PS,,A4649,HCPCS,Facility,Inpatient,,,,1938,1647.3,555.4308,1938,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
PIN GUIDE PSI PSN PREF PS,,A4649,HCPCS,Facility,Both,,,,1938,1647.3,555.4308,1938,Sanford Health Plan,Sanford Health Plan,1782.96,92,,percent of total billed charges,,
PIN GUIDE PSI PSN PREF PS,,A4649,HCPCS,Facility,Outpatient,,,,1938,1647.3,555.4308,1938,"UCare Health, Inc.",Individual & Family Plan,1092.063,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
PIN GUIDE PSI PSN PREF PS,,A4649,HCPCS,Facility,Inpatient,,,,1938,1647.3,555.4308,1938,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
PIN GUIDE PSI PSN PREF PS,,A4649,HCPCS,Facility,Outpatient,,,,1938,1647.3,555.4308,1938,"UCare Health, Inc.",Medical Assistance,978.1086,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PIN GUIDE PSI PSN PREF PS,,A4649,HCPCS,Facility,Inpatient,,,,1938,1647.3,555.4308,1938,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
PIN GUIDE PSI PSN PREF PS,,A4649,HCPCS,Facility,Outpatient,,,,1938,1647.3,555.4308,1938,"UCare Health, Inc.",Medicare Advantage,978.1086,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PIN GUIDE PSI PSN PREF PS,,A4649,HCPCS,Facility,Inpatient,,,,1938,1647.3,555.4308,1938,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PIN GUIDE PSI PSN PREF PS,,A4649,HCPCS,Facility,Outpatient,,,,1938,1647.3,555.4308,1938,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),978.1086,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PIN GUIDE PSI PSN PREF PS,,A4649,HCPCS,Facility,Inpatient,,,,1938,1647.3,555.4308,1938,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PIN GUIDE PSI PSN PREF PS,,A4649,HCPCS,Facility,Both,,,,1938,1647.3,555.4308,1938,UnitedHealthcare,Individual & Family,1821.72,94,,percent of total billed charges,,
PIN GUIDE PSI PSN PREF PS,,A4649,HCPCS,Facility,Outpatient,,,,1938,1647.3,555.4308,1938,UnitedHealthcare,Medicare Advantage,949.62,49,,percent of total billed charges,,
PIN GUIDE PSI PSN PREF PS,,A4649,HCPCS,Facility,Inpatient,,,,1938,1647.3,555.4308,1938,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
PIN GUIDE PSI PSN PREF PS,,A4649,HCPCS,Facility,Outpatient,,,,1938,1647.3,555.4308,1938,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,930.24,48,,percent of total billed charges,,100% of DHS outpatient percentage
PIN GUIDE PSI PSN PREF PS,,A4649,HCPCS,Facility,Inpatient,,,,1938,1647.3,555.4308,1938,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
PORTAL SKID AR-4505,,A4649,HCPCS,Facility,Both,,,,180,153,51.588,180,Aetna,Commercial,165.6,92,,percent of total billed charges,,
PORTAL SKID AR-4505,,A4649,HCPCS,Facility,Outpatient,,,,180,153,51.588,180,Aetna,Medicare Advantage,88.2,49,,percent of total billed charges,,
PORTAL SKID AR-4505,,A4649,HCPCS,Facility,Inpatient,,,,180,153,51.588,180,Aetna,Medicare Advantage,,,,,Included in per diem rate,
PORTAL SKID AR-4505,,A4649,HCPCS,Facility,Both,,,,180,153,51.588,180,Aetna,PPO,167.4,93,,percent of total billed charges,,
PORTAL SKID AR-4505,,A4649,HCPCS,Facility,Both,,,,180,153,51.588,180,America's PPO,America's PPO,172.854,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
PORTAL SKID AR-4505,,A4649,HCPCS,Facility,Both,,,,180,153,51.588,180,BlueCross BlueShield Minnesota, Federal Employee Program,177.12,98.4,,percent of total billed charges,,
PORTAL SKID AR-4505,,A4649,HCPCS,Facility,Both,,,,180,153,51.588,180,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,180,100,,percent of total billed charges,,
PORTAL SKID AR-4505,,A4649,HCPCS,Facility,Both,,,,180,153,51.588,180,BlueCross BlueShield Minnesota,High Value Network Plan,162,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
PORTAL SKID AR-4505,,A4649,HCPCS,Facility,Outpatient,,,,180,153,51.588,180,BlueCross BlueShield Minnesota,Medicare Advantage,88.2,49,,percent of total billed charges,,
PORTAL SKID AR-4505,,A4649,HCPCS,Facility,Inpatient,,,,180,153,51.588,180,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
PORTAL SKID AR-4505,,A4649,HCPCS,Facility,Both,,,,180,153,51.588,180,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,159.426,88.57,,percent of total billed charges,,
PORTAL SKID AR-4505,,A4649,HCPCS,Facility,Both,,,,180,153,51.588,180,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,51.588,28.66,,percent of total billed charges,,
PORTAL SKID AR-4505,,A4649,HCPCS,Facility,Outpatient,,,,180,153,51.588,180,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),88.2,49,,percent of total billed charges,,
PORTAL SKID AR-4505,,A4649,HCPCS,Facility,Inpatient,,,,180,153,51.588,180,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
PORTAL SKID AR-4505,,A4649,HCPCS,Facility,Both,,,,180,153,51.588,180,CorVel,Worker's Compensation,180,100,,percent of total billed charges,,
PORTAL SKID AR-4505,,A4649,HCPCS,Facility,Both,,,,180,153,51.588,180,First Health Group Corporation,First Health Network,174.6,97,,percent of total billed charges,,
PORTAL SKID AR-4505,,A4649,HCPCS,Facility,Both,,,,180,153,51.588,180,"Health Partners, Inc.",Commercial,170.28,94.6,,percent of total billed charges,,
PORTAL SKID AR-4505,,A4649,HCPCS,Facility,Outpatient,,,,180,153,51.588,180,"Health Partners, Inc.",Medicare Advantage,88.2,49,,percent of total billed charges,,
PORTAL SKID AR-4505,,A4649,HCPCS,Facility,Inpatient,,,,180,153,51.588,180,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PORTAL SKID AR-4505,,A4649,HCPCS,Facility,Both,,,,180,153,51.588,180,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),108,60,,percent of total billed charges,,
PORTAL SKID AR-4505,,A4649,HCPCS,Facility,Both,,,,180,153,51.588,180,"Health Partners, Inc.",State of Minnesota Advantage Program,146.7,81.5,,percent of total billed charges,,
PORTAL SKID AR-4505,,A4649,HCPCS,Facility,Both,,,,180,153,51.588,180,"Health Partners, Inc.",State Public Programs,90,50,,percent of total billed charges,,
PORTAL SKID AR-4505,,A4649,HCPCS,Facility,Both,,,,180,153,51.588,180,Humana Insurance Company,Commercial PPO,171,95,,percent of total billed charges,,
PORTAL SKID AR-4505,,A4649,HCPCS,Facility,Outpatient,,,,180,153,51.588,180,Humana Insurance Company,Medicare PPO,88.2,49,,percent of total billed charges,,
PORTAL SKID AR-4505,,A4649,HCPCS,Facility,Inpatient,,,,180,153,51.588,180,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
PORTAL SKID AR-4505,,A4649,HCPCS,Facility,Both,,,,180,153,51.588,180,Medica,Individual & Family,178.38,99.1,,percent of total billed charges,,
PORTAL SKID AR-4505,,A4649,HCPCS,Facility,Outpatient,,,,180,153,51.588,180,Medica,Medica Advantage Solution,89.64,49.8,,percent of total billed charges,,
PORTAL SKID AR-4505,,A4649,HCPCS,Facility,Inpatient,,,,180,153,51.588,180,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
PORTAL SKID AR-4505,,A4649,HCPCS,Facility,Outpatient,,,,180,153,51.588,180,Medica,Medical Assistance,80.28,44.6,,percent of total billed charges,,
PORTAL SKID AR-4505,,A4649,HCPCS,Facility,Inpatient,,,,180,153,51.588,180,Medica,Medical Assistance,,,,,Included in per diem rate,
PORTAL SKID AR-4505,,A4649,HCPCS,Facility,Outpatient,,,,180,153,51.588,180,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,89.64,49.8,,percent of total billed charges,,
PORTAL SKID AR-4505,,A4649,HCPCS,Facility,Inpatient,,,,180,153,51.588,180,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
PORTAL SKID AR-4505,,A4649,HCPCS,Facility,Both,,,,180,153,51.588,180,"Multiplan, Inc.","Multiplan, Inc.",169.2,94,,percent of total billed charges,,
PORTAL SKID AR-4505,,A4649,HCPCS,Facility,Outpatient,,,,180,153,51.588,180,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,162.18,90.1,,percent of total billed charges,,
PORTAL SKID AR-4505,,A4649,HCPCS,Facility,Inpatient,,,,180,153,51.588,180,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
PORTAL SKID AR-4505,,A4649,HCPCS,Facility,Both,,,,180,153,51.588,180,"Preferred One Administrative Services, INC.",PPO,177.48,98.6,,percent of total billed charges,,
PORTAL SKID AR-4505,,A4649,HCPCS,Facility,Outpatient,,,,180,153,51.588,180,PrimeWest Health,Minnesota Senior Health Options (MSHO),92.61,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
PORTAL SKID AR-4505,,A4649,HCPCS,Facility,Inpatient,,,,180,153,51.588,180,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PORTAL SKID AR-4505,,A4649,HCPCS,Facility,Outpatient,,,,180,153,51.588,180,PrimeWest Health,MinnesotaCare,92.448,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
PORTAL SKID AR-4505,,A4649,HCPCS,Facility,Inpatient,,,,180,153,51.588,180,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
PORTAL SKID AR-4505,,A4649,HCPCS,Facility,Both,,,,180,153,51.588,180,Sanford Health Plan,Sanford Health Plan,165.6,92,,percent of total billed charges,,
PORTAL SKID AR-4505,,A4649,HCPCS,Facility,Outpatient,,,,180,153,51.588,180,"UCare Health, Inc.",Individual & Family Plan,101.43,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
PORTAL SKID AR-4505,,A4649,HCPCS,Facility,Inpatient,,,,180,153,51.588,180,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
PORTAL SKID AR-4505,,A4649,HCPCS,Facility,Outpatient,,,,180,153,51.588,180,"UCare Health, Inc.",Medical Assistance,90.846,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PORTAL SKID AR-4505,,A4649,HCPCS,Facility,Inpatient,,,,180,153,51.588,180,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
PORTAL SKID AR-4505,,A4649,HCPCS,Facility,Outpatient,,,,180,153,51.588,180,"UCare Health, Inc.",Medicare Advantage,90.846,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PORTAL SKID AR-4505,,A4649,HCPCS,Facility,Inpatient,,,,180,153,51.588,180,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PORTAL SKID AR-4505,,A4649,HCPCS,Facility,Outpatient,,,,180,153,51.588,180,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),90.846,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PORTAL SKID AR-4505,,A4649,HCPCS,Facility,Inpatient,,,,180,153,51.588,180,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PORTAL SKID AR-4505,,A4649,HCPCS,Facility,Both,,,,180,153,51.588,180,UnitedHealthcare,Individual & Family,169.2,94,,percent of total billed charges,,
PORTAL SKID AR-4505,,A4649,HCPCS,Facility,Outpatient,,,,180,153,51.588,180,UnitedHealthcare,Medicare Advantage,88.2,49,,percent of total billed charges,,
PORTAL SKID AR-4505,,A4649,HCPCS,Facility,Inpatient,,,,180,153,51.588,180,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
PORTAL SKID AR-4505,,A4649,HCPCS,Facility,Outpatient,,,,180,153,51.588,180,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,86.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
PORTAL SKID AR-4505,,A4649,HCPCS,Facility,Inpatient,,,,180,153,51.588,180,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"PROBE COVER KIT, 6INX96IN",,A4649,HCPCS,Facility,Both,,,,30.15,25.6275,8.64099,30.15,Aetna,Commercial,27.738,92,,percent of total billed charges,,
"PROBE COVER KIT, 6INX96IN",,A4649,HCPCS,Facility,Outpatient,,,,30.15,25.6275,8.64099,30.15,Aetna,Medicare Advantage,14.7735,49,,percent of total billed charges,,
"PROBE COVER KIT, 6INX96IN",,A4649,HCPCS,Facility,Inpatient,,,,30.15,25.6275,8.64099,30.15,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"PROBE COVER KIT, 6INX96IN",,A4649,HCPCS,Facility,Both,,,,30.15,25.6275,8.64099,30.15,Aetna,PPO,28.0395,93,,percent of total billed charges,,
"PROBE COVER KIT, 6INX96IN",,A4649,HCPCS,Facility,Both,,,,30.15,25.6275,8.64099,30.15,America's PPO,America's PPO,28.953045,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"PROBE COVER KIT, 6INX96IN",,A4649,HCPCS,Facility,Both,,,,30.15,25.6275,8.64099,30.15,BlueCross BlueShield Minnesota, Federal Employee Program,29.6676,98.4,,percent of total billed charges,,
"PROBE COVER KIT, 6INX96IN",,A4649,HCPCS,Facility,Both,,,,30.15,25.6275,8.64099,30.15,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,30.15,100,,percent of total billed charges,,
"PROBE COVER KIT, 6INX96IN",,A4649,HCPCS,Facility,Both,,,,30.15,25.6275,8.64099,30.15,BlueCross BlueShield Minnesota,High Value Network Plan,27.135,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
"PROBE COVER KIT, 6INX96IN",,A4649,HCPCS,Facility,Outpatient,,,,30.15,25.6275,8.64099,30.15,BlueCross BlueShield Minnesota,Medicare Advantage,14.7735,49,,percent of total billed charges,,
"PROBE COVER KIT, 6INX96IN",,A4649,HCPCS,Facility,Inpatient,,,,30.15,25.6275,8.64099,30.15,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"PROBE COVER KIT, 6INX96IN",,A4649,HCPCS,Facility,Both,,,,30.15,25.6275,8.64099,30.15,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,26.703855,88.57,,percent of total billed charges,,
"PROBE COVER KIT, 6INX96IN",,A4649,HCPCS,Facility,Both,,,,30.15,25.6275,8.64099,30.15,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,8.64099,28.66,,percent of total billed charges,,
"PROBE COVER KIT, 6INX96IN",,A4649,HCPCS,Facility,Outpatient,,,,30.15,25.6275,8.64099,30.15,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),14.7735,49,,percent of total billed charges,,
"PROBE COVER KIT, 6INX96IN",,A4649,HCPCS,Facility,Inpatient,,,,30.15,25.6275,8.64099,30.15,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"PROBE COVER KIT, 6INX96IN",,A4649,HCPCS,Facility,Both,,,,30.15,25.6275,8.64099,30.15,CorVel,Worker's Compensation,30.15,100,,percent of total billed charges,,
"PROBE COVER KIT, 6INX96IN",,A4649,HCPCS,Facility,Both,,,,30.15,25.6275,8.64099,30.15,First Health Group Corporation,First Health Network,29.2455,97,,percent of total billed charges,,
"PROBE COVER KIT, 6INX96IN",,A4649,HCPCS,Facility,Both,,,,30.15,25.6275,8.64099,30.15,"Health Partners, Inc.",Commercial,28.5219,94.6,,percent of total billed charges,,
"PROBE COVER KIT, 6INX96IN",,A4649,HCPCS,Facility,Outpatient,,,,30.15,25.6275,8.64099,30.15,"Health Partners, Inc.",Medicare Advantage,14.7735,49,,percent of total billed charges,,
"PROBE COVER KIT, 6INX96IN",,A4649,HCPCS,Facility,Inpatient,,,,30.15,25.6275,8.64099,30.15,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"PROBE COVER KIT, 6INX96IN",,A4649,HCPCS,Facility,Both,,,,30.15,25.6275,8.64099,30.15,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),18.09,60,,percent of total billed charges,,
"PROBE COVER KIT, 6INX96IN",,A4649,HCPCS,Facility,Both,,,,30.15,25.6275,8.64099,30.15,"Health Partners, Inc.",State of Minnesota Advantage Program,24.57225,81.5,,percent of total billed charges,,
"PROBE COVER KIT, 6INX96IN",,A4649,HCPCS,Facility,Both,,,,30.15,25.6275,8.64099,30.15,"Health Partners, Inc.",State Public Programs,15.075,50,,percent of total billed charges,,
"PROBE COVER KIT, 6INX96IN",,A4649,HCPCS,Facility,Both,,,,30.15,25.6275,8.64099,30.15,Humana Insurance Company,Commercial PPO,28.6425,95,,percent of total billed charges,,
"PROBE COVER KIT, 6INX96IN",,A4649,HCPCS,Facility,Outpatient,,,,30.15,25.6275,8.64099,30.15,Humana Insurance Company,Medicare PPO,14.7735,49,,percent of total billed charges,,
"PROBE COVER KIT, 6INX96IN",,A4649,HCPCS,Facility,Inpatient,,,,30.15,25.6275,8.64099,30.15,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"PROBE COVER KIT, 6INX96IN",,A4649,HCPCS,Facility,Both,,,,30.15,25.6275,8.64099,30.15,Medica,Individual & Family,29.87865,99.1,,percent of total billed charges,,
"PROBE COVER KIT, 6INX96IN",,A4649,HCPCS,Facility,Outpatient,,,,30.15,25.6275,8.64099,30.15,Medica,Medica Advantage Solution,15.0147,49.8,,percent of total billed charges,,
"PROBE COVER KIT, 6INX96IN",,A4649,HCPCS,Facility,Inpatient,,,,30.15,25.6275,8.64099,30.15,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"PROBE COVER KIT, 6INX96IN",,A4649,HCPCS,Facility,Outpatient,,,,30.15,25.6275,8.64099,30.15,Medica,Medical Assistance,13.4469,44.6,,percent of total billed charges,,
"PROBE COVER KIT, 6INX96IN",,A4649,HCPCS,Facility,Inpatient,,,,30.15,25.6275,8.64099,30.15,Medica,Medical Assistance,,,,,Included in per diem rate,
"PROBE COVER KIT, 6INX96IN",,A4649,HCPCS,Facility,Outpatient,,,,30.15,25.6275,8.64099,30.15,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,15.0147,49.8,,percent of total billed charges,,
"PROBE COVER KIT, 6INX96IN",,A4649,HCPCS,Facility,Inpatient,,,,30.15,25.6275,8.64099,30.15,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"PROBE COVER KIT, 6INX96IN",,A4649,HCPCS,Facility,Both,,,,30.15,25.6275,8.64099,30.15,"Multiplan, Inc.","Multiplan, Inc.",28.341,94,,percent of total billed charges,,
"PROBE COVER KIT, 6INX96IN",,A4649,HCPCS,Facility,Outpatient,,,,30.15,25.6275,8.64099,30.15,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,27.16515,90.1,,percent of total billed charges,,
"PROBE COVER KIT, 6INX96IN",,A4649,HCPCS,Facility,Inpatient,,,,30.15,25.6275,8.64099,30.15,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"PROBE COVER KIT, 6INX96IN",,A4649,HCPCS,Facility,Both,,,,30.15,25.6275,8.64099,30.15,"Preferred One Administrative Services, INC.",PPO,29.7279,98.6,,percent of total billed charges,,
"PROBE COVER KIT, 6INX96IN",,A4649,HCPCS,Facility,Outpatient,,,,30.15,25.6275,8.64099,30.15,PrimeWest Health,Minnesota Senior Health Options (MSHO),15.512175,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"PROBE COVER KIT, 6INX96IN",,A4649,HCPCS,Facility,Inpatient,,,,30.15,25.6275,8.64099,30.15,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"PROBE COVER KIT, 6INX96IN",,A4649,HCPCS,Facility,Outpatient,,,,30.15,25.6275,8.64099,30.15,PrimeWest Health,MinnesotaCare,15.48504,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"PROBE COVER KIT, 6INX96IN",,A4649,HCPCS,Facility,Inpatient,,,,30.15,25.6275,8.64099,30.15,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"PROBE COVER KIT, 6INX96IN",,A4649,HCPCS,Facility,Both,,,,30.15,25.6275,8.64099,30.15,Sanford Health Plan,Sanford Health Plan,27.738,92,,percent of total billed charges,,
"PROBE COVER KIT, 6INX96IN",,A4649,HCPCS,Facility,Outpatient,,,,30.15,25.6275,8.64099,30.15,"UCare Health, Inc.",Individual & Family Plan,16.989525,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"PROBE COVER KIT, 6INX96IN",,A4649,HCPCS,Facility,Inpatient,,,,30.15,25.6275,8.64099,30.15,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"PROBE COVER KIT, 6INX96IN",,A4649,HCPCS,Facility,Outpatient,,,,30.15,25.6275,8.64099,30.15,"UCare Health, Inc.",Medical Assistance,15.216705,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"PROBE COVER KIT, 6INX96IN",,A4649,HCPCS,Facility,Inpatient,,,,30.15,25.6275,8.64099,30.15,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"PROBE COVER KIT, 6INX96IN",,A4649,HCPCS,Facility,Outpatient,,,,30.15,25.6275,8.64099,30.15,"UCare Health, Inc.",Medicare Advantage,15.216705,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"PROBE COVER KIT, 6INX96IN",,A4649,HCPCS,Facility,Inpatient,,,,30.15,25.6275,8.64099,30.15,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"PROBE COVER KIT, 6INX96IN",,A4649,HCPCS,Facility,Outpatient,,,,30.15,25.6275,8.64099,30.15,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),15.216705,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"PROBE COVER KIT, 6INX96IN",,A4649,HCPCS,Facility,Inpatient,,,,30.15,25.6275,8.64099,30.15,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"PROBE COVER KIT, 6INX96IN",,A4649,HCPCS,Facility,Both,,,,30.15,25.6275,8.64099,30.15,UnitedHealthcare,Individual & Family,28.341,94,,percent of total billed charges,,
"PROBE COVER KIT, 6INX96IN",,A4649,HCPCS,Facility,Outpatient,,,,30.15,25.6275,8.64099,30.15,UnitedHealthcare,Medicare Advantage,14.7735,49,,percent of total billed charges,,
"PROBE COVER KIT, 6INX96IN",,A4649,HCPCS,Facility,Inpatient,,,,30.15,25.6275,8.64099,30.15,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"PROBE COVER KIT, 6INX96IN",,A4649,HCPCS,Facility,Outpatient,,,,30.15,25.6275,8.64099,30.15,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,14.472,48,,percent of total billed charges,,100% of DHS outpatient percentage
"PROBE COVER KIT, 6INX96IN",,A4649,HCPCS,Facility,Inpatient,,,,30.15,25.6275,8.64099,30.15,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
PROTACK,,A4649,HCPCS,Facility,Both,,,,1163.14,988.669,333.355924,1163.14,Aetna,Commercial,1070.0888,92,,percent of total billed charges,,
PROTACK,,A4649,HCPCS,Facility,Outpatient,,,,1163.14,988.669,333.355924,1163.14,Aetna,Medicare Advantage,569.9386,49,,percent of total billed charges,,
PROTACK,,A4649,HCPCS,Facility,Inpatient,,,,1163.14,988.669,333.355924,1163.14,Aetna,Medicare Advantage,,,,,Included in per diem rate,
PROTACK,,A4649,HCPCS,Facility,Both,,,,1163.14,988.669,333.355924,1163.14,Aetna,PPO,1081.7202,93,,percent of total billed charges,,
PROTACK,,A4649,HCPCS,Facility,Both,,,,1163.14,988.669,333.355924,1163.14,America's PPO,America's PPO,1116.963342,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
PROTACK,,A4649,HCPCS,Facility,Both,,,,1163.14,988.669,333.355924,1163.14,BlueCross BlueShield Minnesota, Federal Employee Program,1144.52976,98.4,,percent of total billed charges,,
PROTACK,,A4649,HCPCS,Facility,Both,,,,1163.14,988.669,333.355924,1163.14,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1163.14,100,,percent of total billed charges,,
PROTACK,,A4649,HCPCS,Facility,Both,,,,1163.14,988.669,333.355924,1163.14,BlueCross BlueShield Minnesota,High Value Network Plan,1046.826,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
PROTACK,,A4649,HCPCS,Facility,Outpatient,,,,1163.14,988.669,333.355924,1163.14,BlueCross BlueShield Minnesota,Medicare Advantage,569.9386,49,,percent of total billed charges,,
PROTACK,,A4649,HCPCS,Facility,Inpatient,,,,1163.14,988.669,333.355924,1163.14,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
PROTACK,,A4649,HCPCS,Facility,Both,,,,1163.14,988.669,333.355924,1163.14,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1030.193098,88.57,,percent of total billed charges,,
PROTACK,,A4649,HCPCS,Facility,Both,,,,1163.14,988.669,333.355924,1163.14,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,333.355924,28.66,,percent of total billed charges,,
PROTACK,,A4649,HCPCS,Facility,Outpatient,,,,1163.14,988.669,333.355924,1163.14,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),569.9386,49,,percent of total billed charges,,
PROTACK,,A4649,HCPCS,Facility,Inpatient,,,,1163.14,988.669,333.355924,1163.14,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
PROTACK,,A4649,HCPCS,Facility,Both,,,,1163.14,988.669,333.355924,1163.14,CorVel,Worker's Compensation,1163.14,100,,percent of total billed charges,,
PROTACK,,A4649,HCPCS,Facility,Both,,,,1163.14,988.669,333.355924,1163.14,First Health Group Corporation,First Health Network,1128.2458,97,,percent of total billed charges,,
PROTACK,,A4649,HCPCS,Facility,Both,,,,1163.14,988.669,333.355924,1163.14,"Health Partners, Inc.",Commercial,1100.33044,94.6,,percent of total billed charges,,
PROTACK,,A4649,HCPCS,Facility,Outpatient,,,,1163.14,988.669,333.355924,1163.14,"Health Partners, Inc.",Medicare Advantage,569.9386,49,,percent of total billed charges,,
PROTACK,,A4649,HCPCS,Facility,Inpatient,,,,1163.14,988.669,333.355924,1163.14,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PROTACK,,A4649,HCPCS,Facility,Both,,,,1163.14,988.669,333.355924,1163.14,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),697.884,60,,percent of total billed charges,,
PROTACK,,A4649,HCPCS,Facility,Both,,,,1163.14,988.669,333.355924,1163.14,"Health Partners, Inc.",State of Minnesota Advantage Program,947.9591,81.5,,percent of total billed charges,,
PROTACK,,A4649,HCPCS,Facility,Both,,,,1163.14,988.669,333.355924,1163.14,"Health Partners, Inc.",State Public Programs,581.57,50,,percent of total billed charges,,
PROTACK,,A4649,HCPCS,Facility,Both,,,,1163.14,988.669,333.355924,1163.14,Humana Insurance Company,Commercial PPO,1104.983,95,,percent of total billed charges,,
PROTACK,,A4649,HCPCS,Facility,Outpatient,,,,1163.14,988.669,333.355924,1163.14,Humana Insurance Company,Medicare PPO,569.9386,49,,percent of total billed charges,,
PROTACK,,A4649,HCPCS,Facility,Inpatient,,,,1163.14,988.669,333.355924,1163.14,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
PROTACK,,A4649,HCPCS,Facility,Both,,,,1163.14,988.669,333.355924,1163.14,Medica,Individual & Family,1152.67174,99.1,,percent of total billed charges,,
PROTACK,,A4649,HCPCS,Facility,Outpatient,,,,1163.14,988.669,333.355924,1163.14,Medica,Medica Advantage Solution,579.24372,49.8,,percent of total billed charges,,
PROTACK,,A4649,HCPCS,Facility,Inpatient,,,,1163.14,988.669,333.355924,1163.14,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
PROTACK,,A4649,HCPCS,Facility,Outpatient,,,,1163.14,988.669,333.355924,1163.14,Medica,Medical Assistance,518.76044,44.6,,percent of total billed charges,,
PROTACK,,A4649,HCPCS,Facility,Inpatient,,,,1163.14,988.669,333.355924,1163.14,Medica,Medical Assistance,,,,,Included in per diem rate,
PROTACK,,A4649,HCPCS,Facility,Outpatient,,,,1163.14,988.669,333.355924,1163.14,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,579.24372,49.8,,percent of total billed charges,,
PROTACK,,A4649,HCPCS,Facility,Inpatient,,,,1163.14,988.669,333.355924,1163.14,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
PROTACK,,A4649,HCPCS,Facility,Both,,,,1163.14,988.669,333.355924,1163.14,"Multiplan, Inc.","Multiplan, Inc.",1093.3516,94,,percent of total billed charges,,
PROTACK,,A4649,HCPCS,Facility,Outpatient,,,,1163.14,988.669,333.355924,1163.14,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1047.98914,90.1,,percent of total billed charges,,
PROTACK,,A4649,HCPCS,Facility,Inpatient,,,,1163.14,988.669,333.355924,1163.14,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
PROTACK,,A4649,HCPCS,Facility,Both,,,,1163.14,988.669,333.355924,1163.14,"Preferred One Administrative Services, INC.",PPO,1146.85604,98.6,,percent of total billed charges,,
PROTACK,,A4649,HCPCS,Facility,Outpatient,,,,1163.14,988.669,333.355924,1163.14,PrimeWest Health,Minnesota Senior Health Options (MSHO),598.43553,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
PROTACK,,A4649,HCPCS,Facility,Inpatient,,,,1163.14,988.669,333.355924,1163.14,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PROTACK,,A4649,HCPCS,Facility,Outpatient,,,,1163.14,988.669,333.355924,1163.14,PrimeWest Health,MinnesotaCare,597.388704,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
PROTACK,,A4649,HCPCS,Facility,Inpatient,,,,1163.14,988.669,333.355924,1163.14,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
PROTACK,,A4649,HCPCS,Facility,Both,,,,1163.14,988.669,333.355924,1163.14,Sanford Health Plan,Sanford Health Plan,1070.0888,92,,percent of total billed charges,,
PROTACK,,A4649,HCPCS,Facility,Outpatient,,,,1163.14,988.669,333.355924,1163.14,"UCare Health, Inc.",Individual & Family Plan,655.42939,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
PROTACK,,A4649,HCPCS,Facility,Inpatient,,,,1163.14,988.669,333.355924,1163.14,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
PROTACK,,A4649,HCPCS,Facility,Outpatient,,,,1163.14,988.669,333.355924,1163.14,"UCare Health, Inc.",Medical Assistance,587.036758,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PROTACK,,A4649,HCPCS,Facility,Inpatient,,,,1163.14,988.669,333.355924,1163.14,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
PROTACK,,A4649,HCPCS,Facility,Outpatient,,,,1163.14,988.669,333.355924,1163.14,"UCare Health, Inc.",Medicare Advantage,587.036758,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PROTACK,,A4649,HCPCS,Facility,Inpatient,,,,1163.14,988.669,333.355924,1163.14,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PROTACK,,A4649,HCPCS,Facility,Outpatient,,,,1163.14,988.669,333.355924,1163.14,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),587.036758,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PROTACK,,A4649,HCPCS,Facility,Inpatient,,,,1163.14,988.669,333.355924,1163.14,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PROTACK,,A4649,HCPCS,Facility,Both,,,,1163.14,988.669,333.355924,1163.14,UnitedHealthcare,Individual & Family,1093.3516,94,,percent of total billed charges,,
PROTACK,,A4649,HCPCS,Facility,Outpatient,,,,1163.14,988.669,333.355924,1163.14,UnitedHealthcare,Medicare Advantage,569.9386,49,,percent of total billed charges,,
PROTACK,,A4649,HCPCS,Facility,Inpatient,,,,1163.14,988.669,333.355924,1163.14,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
PROTACK,,A4649,HCPCS,Facility,Outpatient,,,,1163.14,988.669,333.355924,1163.14,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,558.3072,48,,percent of total billed charges,,100% of DHS outpatient percentage
PROTACK,,A4649,HCPCS,Facility,Inpatient,,,,1163.14,988.669,333.355924,1163.14,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
PURE VIEW LAPAROSCOPIC PLUME FILTRATION DEVICE STRYKER  0620-030-100,,A4649,HCPCS,Facility,Both,,,,119.16,101.286,34.151256,119.16,Aetna,Commercial,109.6272,92,,percent of total billed charges,,
PURE VIEW LAPAROSCOPIC PLUME FILTRATION DEVICE STRYKER  0620-030-100,,A4649,HCPCS,Facility,Outpatient,,,,119.16,101.286,34.151256,119.16,Aetna,Medicare Advantage,58.3884,49,,percent of total billed charges,,
PURE VIEW LAPAROSCOPIC PLUME FILTRATION DEVICE STRYKER  0620-030-100,,A4649,HCPCS,Facility,Inpatient,,,,119.16,101.286,34.151256,119.16,Aetna,Medicare Advantage,,,,,Included in per diem rate,
PURE VIEW LAPAROSCOPIC PLUME FILTRATION DEVICE STRYKER  0620-030-100,,A4649,HCPCS,Facility,Both,,,,119.16,101.286,34.151256,119.16,Aetna,PPO,110.8188,93,,percent of total billed charges,,
PURE VIEW LAPAROSCOPIC PLUME FILTRATION DEVICE STRYKER  0620-030-100,,A4649,HCPCS,Facility,Both,,,,119.16,101.286,34.151256,119.16,America's PPO,America's PPO,114.429348,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
PURE VIEW LAPAROSCOPIC PLUME FILTRATION DEVICE STRYKER  0620-030-100,,A4649,HCPCS,Facility,Both,,,,119.16,101.286,34.151256,119.16,BlueCross BlueShield Minnesota, Federal Employee Program,117.25344,98.4,,percent of total billed charges,,
PURE VIEW LAPAROSCOPIC PLUME FILTRATION DEVICE STRYKER  0620-030-100,,A4649,HCPCS,Facility,Both,,,,119.16,101.286,34.151256,119.16,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,119.16,100,,percent of total billed charges,,
PURE VIEW LAPAROSCOPIC PLUME FILTRATION DEVICE STRYKER  0620-030-100,,A4649,HCPCS,Facility,Both,,,,119.16,101.286,34.151256,119.16,BlueCross BlueShield Minnesota,High Value Network Plan,107.244,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
PURE VIEW LAPAROSCOPIC PLUME FILTRATION DEVICE STRYKER  0620-030-100,,A4649,HCPCS,Facility,Outpatient,,,,119.16,101.286,34.151256,119.16,BlueCross BlueShield Minnesota,Medicare Advantage,58.3884,49,,percent of total billed charges,,
PURE VIEW LAPAROSCOPIC PLUME FILTRATION DEVICE STRYKER  0620-030-100,,A4649,HCPCS,Facility,Inpatient,,,,119.16,101.286,34.151256,119.16,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
PURE VIEW LAPAROSCOPIC PLUME FILTRATION DEVICE STRYKER  0620-030-100,,A4649,HCPCS,Facility,Both,,,,119.16,101.286,34.151256,119.16,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,105.540012,88.57,,percent of total billed charges,,
PURE VIEW LAPAROSCOPIC PLUME FILTRATION DEVICE STRYKER  0620-030-100,,A4649,HCPCS,Facility,Both,,,,119.16,101.286,34.151256,119.16,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,34.151256,28.66,,percent of total billed charges,,
PURE VIEW LAPAROSCOPIC PLUME FILTRATION DEVICE STRYKER  0620-030-100,,A4649,HCPCS,Facility,Outpatient,,,,119.16,101.286,34.151256,119.16,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),58.3884,49,,percent of total billed charges,,
PURE VIEW LAPAROSCOPIC PLUME FILTRATION DEVICE STRYKER  0620-030-100,,A4649,HCPCS,Facility,Inpatient,,,,119.16,101.286,34.151256,119.16,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
PURE VIEW LAPAROSCOPIC PLUME FILTRATION DEVICE STRYKER  0620-030-100,,A4649,HCPCS,Facility,Both,,,,119.16,101.286,34.151256,119.16,CorVel,Worker's Compensation,119.16,100,,percent of total billed charges,,
PURE VIEW LAPAROSCOPIC PLUME FILTRATION DEVICE STRYKER  0620-030-100,,A4649,HCPCS,Facility,Both,,,,119.16,101.286,34.151256,119.16,First Health Group Corporation,First Health Network,115.5852,97,,percent of total billed charges,,
PURE VIEW LAPAROSCOPIC PLUME FILTRATION DEVICE STRYKER  0620-030-100,,A4649,HCPCS,Facility,Both,,,,119.16,101.286,34.151256,119.16,"Health Partners, Inc.",Commercial,112.72536,94.6,,percent of total billed charges,,
PURE VIEW LAPAROSCOPIC PLUME FILTRATION DEVICE STRYKER  0620-030-100,,A4649,HCPCS,Facility,Outpatient,,,,119.16,101.286,34.151256,119.16,"Health Partners, Inc.",Medicare Advantage,58.3884,49,,percent of total billed charges,,
PURE VIEW LAPAROSCOPIC PLUME FILTRATION DEVICE STRYKER  0620-030-100,,A4649,HCPCS,Facility,Inpatient,,,,119.16,101.286,34.151256,119.16,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PURE VIEW LAPAROSCOPIC PLUME FILTRATION DEVICE STRYKER  0620-030-100,,A4649,HCPCS,Facility,Both,,,,119.16,101.286,34.151256,119.16,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),71.496,60,,percent of total billed charges,,
PURE VIEW LAPAROSCOPIC PLUME FILTRATION DEVICE STRYKER  0620-030-100,,A4649,HCPCS,Facility,Both,,,,119.16,101.286,34.151256,119.16,"Health Partners, Inc.",State of Minnesota Advantage Program,97.1154,81.5,,percent of total billed charges,,
PURE VIEW LAPAROSCOPIC PLUME FILTRATION DEVICE STRYKER  0620-030-100,,A4649,HCPCS,Facility,Both,,,,119.16,101.286,34.151256,119.16,"Health Partners, Inc.",State Public Programs,59.58,50,,percent of total billed charges,,
PURE VIEW LAPAROSCOPIC PLUME FILTRATION DEVICE STRYKER  0620-030-100,,A4649,HCPCS,Facility,Both,,,,119.16,101.286,34.151256,119.16,Humana Insurance Company,Commercial PPO,113.202,95,,percent of total billed charges,,
PURE VIEW LAPAROSCOPIC PLUME FILTRATION DEVICE STRYKER  0620-030-100,,A4649,HCPCS,Facility,Outpatient,,,,119.16,101.286,34.151256,119.16,Humana Insurance Company,Medicare PPO,58.3884,49,,percent of total billed charges,,
PURE VIEW LAPAROSCOPIC PLUME FILTRATION DEVICE STRYKER  0620-030-100,,A4649,HCPCS,Facility,Inpatient,,,,119.16,101.286,34.151256,119.16,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
PURE VIEW LAPAROSCOPIC PLUME FILTRATION DEVICE STRYKER  0620-030-100,,A4649,HCPCS,Facility,Both,,,,119.16,101.286,34.151256,119.16,Medica,Individual & Family,118.08756,99.1,,percent of total billed charges,,
PURE VIEW LAPAROSCOPIC PLUME FILTRATION DEVICE STRYKER  0620-030-100,,A4649,HCPCS,Facility,Outpatient,,,,119.16,101.286,34.151256,119.16,Medica,Medica Advantage Solution,59.34168,49.8,,percent of total billed charges,,
PURE VIEW LAPAROSCOPIC PLUME FILTRATION DEVICE STRYKER  0620-030-100,,A4649,HCPCS,Facility,Inpatient,,,,119.16,101.286,34.151256,119.16,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
PURE VIEW LAPAROSCOPIC PLUME FILTRATION DEVICE STRYKER  0620-030-100,,A4649,HCPCS,Facility,Outpatient,,,,119.16,101.286,34.151256,119.16,Medica,Medical Assistance,53.14536,44.6,,percent of total billed charges,,
PURE VIEW LAPAROSCOPIC PLUME FILTRATION DEVICE STRYKER  0620-030-100,,A4649,HCPCS,Facility,Inpatient,,,,119.16,101.286,34.151256,119.16,Medica,Medical Assistance,,,,,Included in per diem rate,
PURE VIEW LAPAROSCOPIC PLUME FILTRATION DEVICE STRYKER  0620-030-100,,A4649,HCPCS,Facility,Outpatient,,,,119.16,101.286,34.151256,119.16,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,59.34168,49.8,,percent of total billed charges,,
PURE VIEW LAPAROSCOPIC PLUME FILTRATION DEVICE STRYKER  0620-030-100,,A4649,HCPCS,Facility,Inpatient,,,,119.16,101.286,34.151256,119.16,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
PURE VIEW LAPAROSCOPIC PLUME FILTRATION DEVICE STRYKER  0620-030-100,,A4649,HCPCS,Facility,Both,,,,119.16,101.286,34.151256,119.16,"Multiplan, Inc.","Multiplan, Inc.",112.0104,94,,percent of total billed charges,,
PURE VIEW LAPAROSCOPIC PLUME FILTRATION DEVICE STRYKER  0620-030-100,,A4649,HCPCS,Facility,Outpatient,,,,119.16,101.286,34.151256,119.16,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,107.36316,90.1,,percent of total billed charges,,
PURE VIEW LAPAROSCOPIC PLUME FILTRATION DEVICE STRYKER  0620-030-100,,A4649,HCPCS,Facility,Inpatient,,,,119.16,101.286,34.151256,119.16,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
PURE VIEW LAPAROSCOPIC PLUME FILTRATION DEVICE STRYKER  0620-030-100,,A4649,HCPCS,Facility,Both,,,,119.16,101.286,34.151256,119.16,"Preferred One Administrative Services, INC.",PPO,117.49176,98.6,,percent of total billed charges,,
PURE VIEW LAPAROSCOPIC PLUME FILTRATION DEVICE STRYKER  0620-030-100,,A4649,HCPCS,Facility,Outpatient,,,,119.16,101.286,34.151256,119.16,PrimeWest Health,Minnesota Senior Health Options (MSHO),61.30782,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
PURE VIEW LAPAROSCOPIC PLUME FILTRATION DEVICE STRYKER  0620-030-100,,A4649,HCPCS,Facility,Inpatient,,,,119.16,101.286,34.151256,119.16,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PURE VIEW LAPAROSCOPIC PLUME FILTRATION DEVICE STRYKER  0620-030-100,,A4649,HCPCS,Facility,Outpatient,,,,119.16,101.286,34.151256,119.16,PrimeWest Health,MinnesotaCare,61.200576,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
PURE VIEW LAPAROSCOPIC PLUME FILTRATION DEVICE STRYKER  0620-030-100,,A4649,HCPCS,Facility,Inpatient,,,,119.16,101.286,34.151256,119.16,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
PURE VIEW LAPAROSCOPIC PLUME FILTRATION DEVICE STRYKER  0620-030-100,,A4649,HCPCS,Facility,Both,,,,119.16,101.286,34.151256,119.16,Sanford Health Plan,Sanford Health Plan,109.6272,92,,percent of total billed charges,,
PURE VIEW LAPAROSCOPIC PLUME FILTRATION DEVICE STRYKER  0620-030-100,,A4649,HCPCS,Facility,Outpatient,,,,119.16,101.286,34.151256,119.16,"UCare Health, Inc.",Individual & Family Plan,67.14666,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
PURE VIEW LAPAROSCOPIC PLUME FILTRATION DEVICE STRYKER  0620-030-100,,A4649,HCPCS,Facility,Inpatient,,,,119.16,101.286,34.151256,119.16,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
PURE VIEW LAPAROSCOPIC PLUME FILTRATION DEVICE STRYKER  0620-030-100,,A4649,HCPCS,Facility,Outpatient,,,,119.16,101.286,34.151256,119.16,"UCare Health, Inc.",Medical Assistance,60.140052,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PURE VIEW LAPAROSCOPIC PLUME FILTRATION DEVICE STRYKER  0620-030-100,,A4649,HCPCS,Facility,Inpatient,,,,119.16,101.286,34.151256,119.16,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
PURE VIEW LAPAROSCOPIC PLUME FILTRATION DEVICE STRYKER  0620-030-100,,A4649,HCPCS,Facility,Outpatient,,,,119.16,101.286,34.151256,119.16,"UCare Health, Inc.",Medicare Advantage,60.140052,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PURE VIEW LAPAROSCOPIC PLUME FILTRATION DEVICE STRYKER  0620-030-100,,A4649,HCPCS,Facility,Inpatient,,,,119.16,101.286,34.151256,119.16,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PURE VIEW LAPAROSCOPIC PLUME FILTRATION DEVICE STRYKER  0620-030-100,,A4649,HCPCS,Facility,Outpatient,,,,119.16,101.286,34.151256,119.16,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),60.140052,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PURE VIEW LAPAROSCOPIC PLUME FILTRATION DEVICE STRYKER  0620-030-100,,A4649,HCPCS,Facility,Inpatient,,,,119.16,101.286,34.151256,119.16,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PURE VIEW LAPAROSCOPIC PLUME FILTRATION DEVICE STRYKER  0620-030-100,,A4649,HCPCS,Facility,Both,,,,119.16,101.286,34.151256,119.16,UnitedHealthcare,Individual & Family,112.0104,94,,percent of total billed charges,,
PURE VIEW LAPAROSCOPIC PLUME FILTRATION DEVICE STRYKER  0620-030-100,,A4649,HCPCS,Facility,Outpatient,,,,119.16,101.286,34.151256,119.16,UnitedHealthcare,Medicare Advantage,58.3884,49,,percent of total billed charges,,
PURE VIEW LAPAROSCOPIC PLUME FILTRATION DEVICE STRYKER  0620-030-100,,A4649,HCPCS,Facility,Inpatient,,,,119.16,101.286,34.151256,119.16,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
PURE VIEW LAPAROSCOPIC PLUME FILTRATION DEVICE STRYKER  0620-030-100,,A4649,HCPCS,Facility,Outpatient,,,,119.16,101.286,34.151256,119.16,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,57.1968,48,,percent of total billed charges,,100% of DHS outpatient percentage
PURE VIEW LAPAROSCOPIC PLUME FILTRATION DEVICE STRYKER  0620-030-100,,A4649,HCPCS,Facility,Inpatient,,,,119.16,101.286,34.151256,119.16,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
RAULERSON SYRINGE 5CC - SPRING-WIRE GUIDE INTRODUCTION SYRINGE,,A4649,HCPCS,Facility,Both,,,,35.05,29.7925,10.04533,35.05,Aetna,Commercial,32.246,92,,percent of total billed charges,,
RAULERSON SYRINGE 5CC - SPRING-WIRE GUIDE INTRODUCTION SYRINGE,,A4649,HCPCS,Facility,Outpatient,,,,35.05,29.7925,10.04533,35.05,Aetna,Medicare Advantage,17.1745,49,,percent of total billed charges,,
RAULERSON SYRINGE 5CC - SPRING-WIRE GUIDE INTRODUCTION SYRINGE,,A4649,HCPCS,Facility,Inpatient,,,,35.05,29.7925,10.04533,35.05,Aetna,Medicare Advantage,,,,,Included in per diem rate,
RAULERSON SYRINGE 5CC - SPRING-WIRE GUIDE INTRODUCTION SYRINGE,,A4649,HCPCS,Facility,Both,,,,35.05,29.7925,10.04533,35.05,Aetna,PPO,32.5965,93,,percent of total billed charges,,
RAULERSON SYRINGE 5CC - SPRING-WIRE GUIDE INTRODUCTION SYRINGE,,A4649,HCPCS,Facility,Both,,,,35.05,29.7925,10.04533,35.05,America's PPO,America's PPO,33.658515,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
RAULERSON SYRINGE 5CC - SPRING-WIRE GUIDE INTRODUCTION SYRINGE,,A4649,HCPCS,Facility,Both,,,,35.05,29.7925,10.04533,35.05,BlueCross BlueShield Minnesota, Federal Employee Program,34.4892,98.4,,percent of total billed charges,,
RAULERSON SYRINGE 5CC - SPRING-WIRE GUIDE INTRODUCTION SYRINGE,,A4649,HCPCS,Facility,Both,,,,35.05,29.7925,10.04533,35.05,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,35.05,100,,percent of total billed charges,,
RAULERSON SYRINGE 5CC - SPRING-WIRE GUIDE INTRODUCTION SYRINGE,,A4649,HCPCS,Facility,Both,,,,35.05,29.7925,10.04533,35.05,BlueCross BlueShield Minnesota,High Value Network Plan,31.545,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
RAULERSON SYRINGE 5CC - SPRING-WIRE GUIDE INTRODUCTION SYRINGE,,A4649,HCPCS,Facility,Outpatient,,,,35.05,29.7925,10.04533,35.05,BlueCross BlueShield Minnesota,Medicare Advantage,17.1745,49,,percent of total billed charges,,
RAULERSON SYRINGE 5CC - SPRING-WIRE GUIDE INTRODUCTION SYRINGE,,A4649,HCPCS,Facility,Inpatient,,,,35.05,29.7925,10.04533,35.05,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
RAULERSON SYRINGE 5CC - SPRING-WIRE GUIDE INTRODUCTION SYRINGE,,A4649,HCPCS,Facility,Both,,,,35.05,29.7925,10.04533,35.05,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,31.043785,88.57,,percent of total billed charges,,
RAULERSON SYRINGE 5CC - SPRING-WIRE GUIDE INTRODUCTION SYRINGE,,A4649,HCPCS,Facility,Both,,,,35.05,29.7925,10.04533,35.05,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,10.04533,28.66,,percent of total billed charges,,
RAULERSON SYRINGE 5CC - SPRING-WIRE GUIDE INTRODUCTION SYRINGE,,A4649,HCPCS,Facility,Outpatient,,,,35.05,29.7925,10.04533,35.05,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),17.1745,49,,percent of total billed charges,,
RAULERSON SYRINGE 5CC - SPRING-WIRE GUIDE INTRODUCTION SYRINGE,,A4649,HCPCS,Facility,Inpatient,,,,35.05,29.7925,10.04533,35.05,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
RAULERSON SYRINGE 5CC - SPRING-WIRE GUIDE INTRODUCTION SYRINGE,,A4649,HCPCS,Facility,Both,,,,35.05,29.7925,10.04533,35.05,CorVel,Worker's Compensation,35.05,100,,percent of total billed charges,,
RAULERSON SYRINGE 5CC - SPRING-WIRE GUIDE INTRODUCTION SYRINGE,,A4649,HCPCS,Facility,Both,,,,35.05,29.7925,10.04533,35.05,First Health Group Corporation,First Health Network,33.9985,97,,percent of total billed charges,,
RAULERSON SYRINGE 5CC - SPRING-WIRE GUIDE INTRODUCTION SYRINGE,,A4649,HCPCS,Facility,Both,,,,35.05,29.7925,10.04533,35.05,"Health Partners, Inc.",Commercial,33.1573,94.6,,percent of total billed charges,,
RAULERSON SYRINGE 5CC - SPRING-WIRE GUIDE INTRODUCTION SYRINGE,,A4649,HCPCS,Facility,Outpatient,,,,35.05,29.7925,10.04533,35.05,"Health Partners, Inc.",Medicare Advantage,17.1745,49,,percent of total billed charges,,
RAULERSON SYRINGE 5CC - SPRING-WIRE GUIDE INTRODUCTION SYRINGE,,A4649,HCPCS,Facility,Inpatient,,,,35.05,29.7925,10.04533,35.05,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
RAULERSON SYRINGE 5CC - SPRING-WIRE GUIDE INTRODUCTION SYRINGE,,A4649,HCPCS,Facility,Both,,,,35.05,29.7925,10.04533,35.05,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),21.03,60,,percent of total billed charges,,
RAULERSON SYRINGE 5CC - SPRING-WIRE GUIDE INTRODUCTION SYRINGE,,A4649,HCPCS,Facility,Both,,,,35.05,29.7925,10.04533,35.05,"Health Partners, Inc.",State of Minnesota Advantage Program,28.56575,81.5,,percent of total billed charges,,
RAULERSON SYRINGE 5CC - SPRING-WIRE GUIDE INTRODUCTION SYRINGE,,A4649,HCPCS,Facility,Both,,,,35.05,29.7925,10.04533,35.05,"Health Partners, Inc.",State Public Programs,17.525,50,,percent of total billed charges,,
RAULERSON SYRINGE 5CC - SPRING-WIRE GUIDE INTRODUCTION SYRINGE,,A4649,HCPCS,Facility,Both,,,,35.05,29.7925,10.04533,35.05,Humana Insurance Company,Commercial PPO,33.2975,95,,percent of total billed charges,,
RAULERSON SYRINGE 5CC - SPRING-WIRE GUIDE INTRODUCTION SYRINGE,,A4649,HCPCS,Facility,Outpatient,,,,35.05,29.7925,10.04533,35.05,Humana Insurance Company,Medicare PPO,17.1745,49,,percent of total billed charges,,
RAULERSON SYRINGE 5CC - SPRING-WIRE GUIDE INTRODUCTION SYRINGE,,A4649,HCPCS,Facility,Inpatient,,,,35.05,29.7925,10.04533,35.05,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
RAULERSON SYRINGE 5CC - SPRING-WIRE GUIDE INTRODUCTION SYRINGE,,A4649,HCPCS,Facility,Both,,,,35.05,29.7925,10.04533,35.05,Medica,Individual & Family,34.73455,99.1,,percent of total billed charges,,
RAULERSON SYRINGE 5CC - SPRING-WIRE GUIDE INTRODUCTION SYRINGE,,A4649,HCPCS,Facility,Outpatient,,,,35.05,29.7925,10.04533,35.05,Medica,Medica Advantage Solution,17.4549,49.8,,percent of total billed charges,,
RAULERSON SYRINGE 5CC - SPRING-WIRE GUIDE INTRODUCTION SYRINGE,,A4649,HCPCS,Facility,Inpatient,,,,35.05,29.7925,10.04533,35.05,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
RAULERSON SYRINGE 5CC - SPRING-WIRE GUIDE INTRODUCTION SYRINGE,,A4649,HCPCS,Facility,Outpatient,,,,35.05,29.7925,10.04533,35.05,Medica,Medical Assistance,15.6323,44.6,,percent of total billed charges,,
RAULERSON SYRINGE 5CC - SPRING-WIRE GUIDE INTRODUCTION SYRINGE,,A4649,HCPCS,Facility,Inpatient,,,,35.05,29.7925,10.04533,35.05,Medica,Medical Assistance,,,,,Included in per diem rate,
RAULERSON SYRINGE 5CC - SPRING-WIRE GUIDE INTRODUCTION SYRINGE,,A4649,HCPCS,Facility,Outpatient,,,,35.05,29.7925,10.04533,35.05,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,17.4549,49.8,,percent of total billed charges,,
RAULERSON SYRINGE 5CC - SPRING-WIRE GUIDE INTRODUCTION SYRINGE,,A4649,HCPCS,Facility,Inpatient,,,,35.05,29.7925,10.04533,35.05,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
RAULERSON SYRINGE 5CC - SPRING-WIRE GUIDE INTRODUCTION SYRINGE,,A4649,HCPCS,Facility,Both,,,,35.05,29.7925,10.04533,35.05,"Multiplan, Inc.","Multiplan, Inc.",32.947,94,,percent of total billed charges,,
RAULERSON SYRINGE 5CC - SPRING-WIRE GUIDE INTRODUCTION SYRINGE,,A4649,HCPCS,Facility,Outpatient,,,,35.05,29.7925,10.04533,35.05,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,31.58005,90.1,,percent of total billed charges,,
RAULERSON SYRINGE 5CC - SPRING-WIRE GUIDE INTRODUCTION SYRINGE,,A4649,HCPCS,Facility,Inpatient,,,,35.05,29.7925,10.04533,35.05,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
RAULERSON SYRINGE 5CC - SPRING-WIRE GUIDE INTRODUCTION SYRINGE,,A4649,HCPCS,Facility,Both,,,,35.05,29.7925,10.04533,35.05,"Preferred One Administrative Services, INC.",PPO,34.5593,98.6,,percent of total billed charges,,
RAULERSON SYRINGE 5CC - SPRING-WIRE GUIDE INTRODUCTION SYRINGE,,A4649,HCPCS,Facility,Outpatient,,,,35.05,29.7925,10.04533,35.05,PrimeWest Health,Minnesota Senior Health Options (MSHO),18.033225,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
RAULERSON SYRINGE 5CC - SPRING-WIRE GUIDE INTRODUCTION SYRINGE,,A4649,HCPCS,Facility,Inpatient,,,,35.05,29.7925,10.04533,35.05,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
RAULERSON SYRINGE 5CC - SPRING-WIRE GUIDE INTRODUCTION SYRINGE,,A4649,HCPCS,Facility,Outpatient,,,,35.05,29.7925,10.04533,35.05,PrimeWest Health,MinnesotaCare,18.00168,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
RAULERSON SYRINGE 5CC - SPRING-WIRE GUIDE INTRODUCTION SYRINGE,,A4649,HCPCS,Facility,Inpatient,,,,35.05,29.7925,10.04533,35.05,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
RAULERSON SYRINGE 5CC - SPRING-WIRE GUIDE INTRODUCTION SYRINGE,,A4649,HCPCS,Facility,Both,,,,35.05,29.7925,10.04533,35.05,Sanford Health Plan,Sanford Health Plan,32.246,92,,percent of total billed charges,,
RAULERSON SYRINGE 5CC - SPRING-WIRE GUIDE INTRODUCTION SYRINGE,,A4649,HCPCS,Facility,Outpatient,,,,35.05,29.7925,10.04533,35.05,"UCare Health, Inc.",Individual & Family Plan,19.750675,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
RAULERSON SYRINGE 5CC - SPRING-WIRE GUIDE INTRODUCTION SYRINGE,,A4649,HCPCS,Facility,Inpatient,,,,35.05,29.7925,10.04533,35.05,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
RAULERSON SYRINGE 5CC - SPRING-WIRE GUIDE INTRODUCTION SYRINGE,,A4649,HCPCS,Facility,Outpatient,,,,35.05,29.7925,10.04533,35.05,"UCare Health, Inc.",Medical Assistance,17.689735,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
RAULERSON SYRINGE 5CC - SPRING-WIRE GUIDE INTRODUCTION SYRINGE,,A4649,HCPCS,Facility,Inpatient,,,,35.05,29.7925,10.04533,35.05,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
RAULERSON SYRINGE 5CC - SPRING-WIRE GUIDE INTRODUCTION SYRINGE,,A4649,HCPCS,Facility,Outpatient,,,,35.05,29.7925,10.04533,35.05,"UCare Health, Inc.",Medicare Advantage,17.689735,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
RAULERSON SYRINGE 5CC - SPRING-WIRE GUIDE INTRODUCTION SYRINGE,,A4649,HCPCS,Facility,Inpatient,,,,35.05,29.7925,10.04533,35.05,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
RAULERSON SYRINGE 5CC - SPRING-WIRE GUIDE INTRODUCTION SYRINGE,,A4649,HCPCS,Facility,Outpatient,,,,35.05,29.7925,10.04533,35.05,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),17.689735,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
RAULERSON SYRINGE 5CC - SPRING-WIRE GUIDE INTRODUCTION SYRINGE,,A4649,HCPCS,Facility,Inpatient,,,,35.05,29.7925,10.04533,35.05,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
RAULERSON SYRINGE 5CC - SPRING-WIRE GUIDE INTRODUCTION SYRINGE,,A4649,HCPCS,Facility,Both,,,,35.05,29.7925,10.04533,35.05,UnitedHealthcare,Individual & Family,32.947,94,,percent of total billed charges,,
RAULERSON SYRINGE 5CC - SPRING-WIRE GUIDE INTRODUCTION SYRINGE,,A4649,HCPCS,Facility,Outpatient,,,,35.05,29.7925,10.04533,35.05,UnitedHealthcare,Medicare Advantage,17.1745,49,,percent of total billed charges,,
RAULERSON SYRINGE 5CC - SPRING-WIRE GUIDE INTRODUCTION SYRINGE,,A4649,HCPCS,Facility,Inpatient,,,,35.05,29.7925,10.04533,35.05,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
RAULERSON SYRINGE 5CC - SPRING-WIRE GUIDE INTRODUCTION SYRINGE,,A4649,HCPCS,Facility,Outpatient,,,,35.05,29.7925,10.04533,35.05,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,16.824,48,,percent of total billed charges,,100% of DHS outpatient percentage
RAULERSON SYRINGE 5CC - SPRING-WIRE GUIDE INTRODUCTION SYRINGE,,A4649,HCPCS,Facility,Inpatient,,,,35.05,29.7925,10.04533,35.05,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
RETRACTOR LONE STAR STAYS  5MM 3311-8G,,A4649,HCPCS,Facility,Both,,,,232.155,197.33175,66.535623,232.155,Aetna,Commercial,213.5826,92,,percent of total billed charges,,
RETRACTOR LONE STAR STAYS  5MM 3311-8G,,A4649,HCPCS,Facility,Outpatient,,,,232.155,197.33175,66.535623,232.155,Aetna,Medicare Advantage,113.75595,49,,percent of total billed charges,,
RETRACTOR LONE STAR STAYS  5MM 3311-8G,,A4649,HCPCS,Facility,Inpatient,,,,232.155,197.33175,66.535623,232.155,Aetna,Medicare Advantage,,,,,Included in per diem rate,
RETRACTOR LONE STAR STAYS  5MM 3311-8G,,A4649,HCPCS,Facility,Both,,,,232.155,197.33175,66.535623,232.155,Aetna,PPO,215.90415,93,,percent of total billed charges,,
RETRACTOR LONE STAR STAYS  5MM 3311-8G,,A4649,HCPCS,Facility,Both,,,,232.155,197.33175,66.535623,232.155,America's PPO,America's PPO,222.9384465,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
RETRACTOR LONE STAR STAYS  5MM 3311-8G,,A4649,HCPCS,Facility,Both,,,,232.155,197.33175,66.535623,232.155,BlueCross BlueShield Minnesota, Federal Employee Program,228.44052,98.4,,percent of total billed charges,,
RETRACTOR LONE STAR STAYS  5MM 3311-8G,,A4649,HCPCS,Facility,Both,,,,232.155,197.33175,66.535623,232.155,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,232.155,100,,percent of total billed charges,,
RETRACTOR LONE STAR STAYS  5MM 3311-8G,,A4649,HCPCS,Facility,Both,,,,232.155,197.33175,66.535623,232.155,BlueCross BlueShield Minnesota,High Value Network Plan,208.9395,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
RETRACTOR LONE STAR STAYS  5MM 3311-8G,,A4649,HCPCS,Facility,Outpatient,,,,232.155,197.33175,66.535623,232.155,BlueCross BlueShield Minnesota,Medicare Advantage,113.75595,49,,percent of total billed charges,,
RETRACTOR LONE STAR STAYS  5MM 3311-8G,,A4649,HCPCS,Facility,Inpatient,,,,232.155,197.33175,66.535623,232.155,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
RETRACTOR LONE STAR STAYS  5MM 3311-8G,,A4649,HCPCS,Facility,Both,,,,232.155,197.33175,66.535623,232.155,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,205.6196835,88.57,,percent of total billed charges,,
RETRACTOR LONE STAR STAYS  5MM 3311-8G,,A4649,HCPCS,Facility,Both,,,,232.155,197.33175,66.535623,232.155,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,66.535623,28.66,,percent of total billed charges,,
RETRACTOR LONE STAR STAYS  5MM 3311-8G,,A4649,HCPCS,Facility,Outpatient,,,,232.155,197.33175,66.535623,232.155,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),113.75595,49,,percent of total billed charges,,
RETRACTOR LONE STAR STAYS  5MM 3311-8G,,A4649,HCPCS,Facility,Inpatient,,,,232.155,197.33175,66.535623,232.155,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
RETRACTOR LONE STAR STAYS  5MM 3311-8G,,A4649,HCPCS,Facility,Both,,,,232.155,197.33175,66.535623,232.155,CorVel,Worker's Compensation,232.155,100,,percent of total billed charges,,
RETRACTOR LONE STAR STAYS  5MM 3311-8G,,A4649,HCPCS,Facility,Both,,,,232.155,197.33175,66.535623,232.155,First Health Group Corporation,First Health Network,225.19035,97,,percent of total billed charges,,
RETRACTOR LONE STAR STAYS  5MM 3311-8G,,A4649,HCPCS,Facility,Both,,,,232.155,197.33175,66.535623,232.155,"Health Partners, Inc.",Commercial,219.61863,94.6,,percent of total billed charges,,
RETRACTOR LONE STAR STAYS  5MM 3311-8G,,A4649,HCPCS,Facility,Outpatient,,,,232.155,197.33175,66.535623,232.155,"Health Partners, Inc.",Medicare Advantage,113.75595,49,,percent of total billed charges,,
RETRACTOR LONE STAR STAYS  5MM 3311-8G,,A4649,HCPCS,Facility,Inpatient,,,,232.155,197.33175,66.535623,232.155,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
RETRACTOR LONE STAR STAYS  5MM 3311-8G,,A4649,HCPCS,Facility,Both,,,,232.155,197.33175,66.535623,232.155,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),139.293,60,,percent of total billed charges,,
RETRACTOR LONE STAR STAYS  5MM 3311-8G,,A4649,HCPCS,Facility,Both,,,,232.155,197.33175,66.535623,232.155,"Health Partners, Inc.",State of Minnesota Advantage Program,189.206325,81.5,,percent of total billed charges,,
RETRACTOR LONE STAR STAYS  5MM 3311-8G,,A4649,HCPCS,Facility,Both,,,,232.155,197.33175,66.535623,232.155,"Health Partners, Inc.",State Public Programs,116.0775,50,,percent of total billed charges,,
RETRACTOR LONE STAR STAYS  5MM 3311-8G,,A4649,HCPCS,Facility,Both,,,,232.155,197.33175,66.535623,232.155,Humana Insurance Company,Commercial PPO,220.54725,95,,percent of total billed charges,,
RETRACTOR LONE STAR STAYS  5MM 3311-8G,,A4649,HCPCS,Facility,Outpatient,,,,232.155,197.33175,66.535623,232.155,Humana Insurance Company,Medicare PPO,113.75595,49,,percent of total billed charges,,
RETRACTOR LONE STAR STAYS  5MM 3311-8G,,A4649,HCPCS,Facility,Inpatient,,,,232.155,197.33175,66.535623,232.155,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
RETRACTOR LONE STAR STAYS  5MM 3311-8G,,A4649,HCPCS,Facility,Both,,,,232.155,197.33175,66.535623,232.155,Medica,Individual & Family,230.065605,99.1,,percent of total billed charges,,
RETRACTOR LONE STAR STAYS  5MM 3311-8G,,A4649,HCPCS,Facility,Outpatient,,,,232.155,197.33175,66.535623,232.155,Medica,Medica Advantage Solution,115.61319,49.8,,percent of total billed charges,,
RETRACTOR LONE STAR STAYS  5MM 3311-8G,,A4649,HCPCS,Facility,Inpatient,,,,232.155,197.33175,66.535623,232.155,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
RETRACTOR LONE STAR STAYS  5MM 3311-8G,,A4649,HCPCS,Facility,Outpatient,,,,232.155,197.33175,66.535623,232.155,Medica,Medical Assistance,103.54113,44.6,,percent of total billed charges,,
RETRACTOR LONE STAR STAYS  5MM 3311-8G,,A4649,HCPCS,Facility,Inpatient,,,,232.155,197.33175,66.535623,232.155,Medica,Medical Assistance,,,,,Included in per diem rate,
RETRACTOR LONE STAR STAYS  5MM 3311-8G,,A4649,HCPCS,Facility,Outpatient,,,,232.155,197.33175,66.535623,232.155,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,115.61319,49.8,,percent of total billed charges,,
RETRACTOR LONE STAR STAYS  5MM 3311-8G,,A4649,HCPCS,Facility,Inpatient,,,,232.155,197.33175,66.535623,232.155,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
RETRACTOR LONE STAR STAYS  5MM 3311-8G,,A4649,HCPCS,Facility,Both,,,,232.155,197.33175,66.535623,232.155,"Multiplan, Inc.","Multiplan, Inc.",218.2257,94,,percent of total billed charges,,
RETRACTOR LONE STAR STAYS  5MM 3311-8G,,A4649,HCPCS,Facility,Outpatient,,,,232.155,197.33175,66.535623,232.155,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,209.171655,90.1,,percent of total billed charges,,
RETRACTOR LONE STAR STAYS  5MM 3311-8G,,A4649,HCPCS,Facility,Inpatient,,,,232.155,197.33175,66.535623,232.155,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
RETRACTOR LONE STAR STAYS  5MM 3311-8G,,A4649,HCPCS,Facility,Both,,,,232.155,197.33175,66.535623,232.155,"Preferred One Administrative Services, INC.",PPO,228.90483,98.6,,percent of total billed charges,,
RETRACTOR LONE STAR STAYS  5MM 3311-8G,,A4649,HCPCS,Facility,Outpatient,,,,232.155,197.33175,66.535623,232.155,PrimeWest Health,Minnesota Senior Health Options (MSHO),119.4437475,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
RETRACTOR LONE STAR STAYS  5MM 3311-8G,,A4649,HCPCS,Facility,Inpatient,,,,232.155,197.33175,66.535623,232.155,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
RETRACTOR LONE STAR STAYS  5MM 3311-8G,,A4649,HCPCS,Facility,Outpatient,,,,232.155,197.33175,66.535623,232.155,PrimeWest Health,MinnesotaCare,119.234808,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
RETRACTOR LONE STAR STAYS  5MM 3311-8G,,A4649,HCPCS,Facility,Inpatient,,,,232.155,197.33175,66.535623,232.155,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
RETRACTOR LONE STAR STAYS  5MM 3311-8G,,A4649,HCPCS,Facility,Both,,,,232.155,197.33175,66.535623,232.155,Sanford Health Plan,Sanford Health Plan,213.5826,92,,percent of total billed charges,,
RETRACTOR LONE STAR STAYS  5MM 3311-8G,,A4649,HCPCS,Facility,Outpatient,,,,232.155,197.33175,66.535623,232.155,"UCare Health, Inc.",Individual & Family Plan,130.8193425,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
RETRACTOR LONE STAR STAYS  5MM 3311-8G,,A4649,HCPCS,Facility,Inpatient,,,,232.155,197.33175,66.535623,232.155,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
RETRACTOR LONE STAR STAYS  5MM 3311-8G,,A4649,HCPCS,Facility,Outpatient,,,,232.155,197.33175,66.535623,232.155,"UCare Health, Inc.",Medical Assistance,117.1686285,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
RETRACTOR LONE STAR STAYS  5MM 3311-8G,,A4649,HCPCS,Facility,Inpatient,,,,232.155,197.33175,66.535623,232.155,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
RETRACTOR LONE STAR STAYS  5MM 3311-8G,,A4649,HCPCS,Facility,Outpatient,,,,232.155,197.33175,66.535623,232.155,"UCare Health, Inc.",Medicare Advantage,117.1686285,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
RETRACTOR LONE STAR STAYS  5MM 3311-8G,,A4649,HCPCS,Facility,Inpatient,,,,232.155,197.33175,66.535623,232.155,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
RETRACTOR LONE STAR STAYS  5MM 3311-8G,,A4649,HCPCS,Facility,Outpatient,,,,232.155,197.33175,66.535623,232.155,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),117.1686285,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
RETRACTOR LONE STAR STAYS  5MM 3311-8G,,A4649,HCPCS,Facility,Inpatient,,,,232.155,197.33175,66.535623,232.155,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
RETRACTOR LONE STAR STAYS  5MM 3311-8G,,A4649,HCPCS,Facility,Both,,,,232.155,197.33175,66.535623,232.155,UnitedHealthcare,Individual & Family,218.2257,94,,percent of total billed charges,,
RETRACTOR LONE STAR STAYS  5MM 3311-8G,,A4649,HCPCS,Facility,Outpatient,,,,232.155,197.33175,66.535623,232.155,UnitedHealthcare,Medicare Advantage,113.75595,49,,percent of total billed charges,,
RETRACTOR LONE STAR STAYS  5MM 3311-8G,,A4649,HCPCS,Facility,Inpatient,,,,232.155,197.33175,66.535623,232.155,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
RETRACTOR LONE STAR STAYS  5MM 3311-8G,,A4649,HCPCS,Facility,Outpatient,,,,232.155,197.33175,66.535623,232.155,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,111.4344,48,,percent of total billed charges,,100% of DHS outpatient percentage
RETRACTOR LONE STAR STAYS  5MM 3311-8G,,A4649,HCPCS,Facility,Inpatient,,,,232.155,197.33175,66.535623,232.155,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
RICHARDS T-TUBE 1.14MM,,A4649,HCPCS,Facility,Both,,,,83.6,71.06,23.95976,83.6,Aetna,Commercial,76.912,92,,percent of total billed charges,,
RICHARDS T-TUBE 1.14MM,,A4649,HCPCS,Facility,Outpatient,,,,83.6,71.06,23.95976,83.6,Aetna,Medicare Advantage,40.964,49,,percent of total billed charges,,
RICHARDS T-TUBE 1.14MM,,A4649,HCPCS,Facility,Inpatient,,,,83.6,71.06,23.95976,83.6,Aetna,Medicare Advantage,,,,,Included in per diem rate,
RICHARDS T-TUBE 1.14MM,,A4649,HCPCS,Facility,Both,,,,83.6,71.06,23.95976,83.6,Aetna,PPO,77.748,93,,percent of total billed charges,,
RICHARDS T-TUBE 1.14MM,,A4649,HCPCS,Facility,Both,,,,83.6,71.06,23.95976,83.6,America's PPO,America's PPO,80.28108,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
RICHARDS T-TUBE 1.14MM,,A4649,HCPCS,Facility,Both,,,,83.6,71.06,23.95976,83.6,BlueCross BlueShield Minnesota, Federal Employee Program,82.2624,98.4,,percent of total billed charges,,
RICHARDS T-TUBE 1.14MM,,A4649,HCPCS,Facility,Both,,,,83.6,71.06,23.95976,83.6,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,83.6,100,,percent of total billed charges,,
RICHARDS T-TUBE 1.14MM,,A4649,HCPCS,Facility,Both,,,,83.6,71.06,23.95976,83.6,BlueCross BlueShield Minnesota,High Value Network Plan,75.24,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
RICHARDS T-TUBE 1.14MM,,A4649,HCPCS,Facility,Outpatient,,,,83.6,71.06,23.95976,83.6,BlueCross BlueShield Minnesota,Medicare Advantage,40.964,49,,percent of total billed charges,,
RICHARDS T-TUBE 1.14MM,,A4649,HCPCS,Facility,Inpatient,,,,83.6,71.06,23.95976,83.6,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
RICHARDS T-TUBE 1.14MM,,A4649,HCPCS,Facility,Both,,,,83.6,71.06,23.95976,83.6,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,74.04452,88.57,,percent of total billed charges,,
RICHARDS T-TUBE 1.14MM,,A4649,HCPCS,Facility,Both,,,,83.6,71.06,23.95976,83.6,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,23.95976,28.66,,percent of total billed charges,,
RICHARDS T-TUBE 1.14MM,,A4649,HCPCS,Facility,Outpatient,,,,83.6,71.06,23.95976,83.6,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),40.964,49,,percent of total billed charges,,
RICHARDS T-TUBE 1.14MM,,A4649,HCPCS,Facility,Inpatient,,,,83.6,71.06,23.95976,83.6,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
RICHARDS T-TUBE 1.14MM,,A4649,HCPCS,Facility,Both,,,,83.6,71.06,23.95976,83.6,CorVel,Worker's Compensation,83.6,100,,percent of total billed charges,,
RICHARDS T-TUBE 1.14MM,,A4649,HCPCS,Facility,Both,,,,83.6,71.06,23.95976,83.6,First Health Group Corporation,First Health Network,81.092,97,,percent of total billed charges,,
RICHARDS T-TUBE 1.14MM,,A4649,HCPCS,Facility,Both,,,,83.6,71.06,23.95976,83.6,"Health Partners, Inc.",Commercial,79.0856,94.6,,percent of total billed charges,,
RICHARDS T-TUBE 1.14MM,,A4649,HCPCS,Facility,Outpatient,,,,83.6,71.06,23.95976,83.6,"Health Partners, Inc.",Medicare Advantage,40.964,49,,percent of total billed charges,,
RICHARDS T-TUBE 1.14MM,,A4649,HCPCS,Facility,Inpatient,,,,83.6,71.06,23.95976,83.6,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
RICHARDS T-TUBE 1.14MM,,A4649,HCPCS,Facility,Both,,,,83.6,71.06,23.95976,83.6,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),50.16,60,,percent of total billed charges,,
RICHARDS T-TUBE 1.14MM,,A4649,HCPCS,Facility,Both,,,,83.6,71.06,23.95976,83.6,"Health Partners, Inc.",State of Minnesota Advantage Program,68.134,81.5,,percent of total billed charges,,
RICHARDS T-TUBE 1.14MM,,A4649,HCPCS,Facility,Both,,,,83.6,71.06,23.95976,83.6,"Health Partners, Inc.",State Public Programs,41.8,50,,percent of total billed charges,,
RICHARDS T-TUBE 1.14MM,,A4649,HCPCS,Facility,Both,,,,83.6,71.06,23.95976,83.6,Humana Insurance Company,Commercial PPO,79.42,95,,percent of total billed charges,,
RICHARDS T-TUBE 1.14MM,,A4649,HCPCS,Facility,Outpatient,,,,83.6,71.06,23.95976,83.6,Humana Insurance Company,Medicare PPO,40.964,49,,percent of total billed charges,,
RICHARDS T-TUBE 1.14MM,,A4649,HCPCS,Facility,Inpatient,,,,83.6,71.06,23.95976,83.6,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
RICHARDS T-TUBE 1.14MM,,A4649,HCPCS,Facility,Both,,,,83.6,71.06,23.95976,83.6,Medica,Individual & Family,82.8476,99.1,,percent of total billed charges,,
RICHARDS T-TUBE 1.14MM,,A4649,HCPCS,Facility,Outpatient,,,,83.6,71.06,23.95976,83.6,Medica,Medica Advantage Solution,41.6328,49.8,,percent of total billed charges,,
RICHARDS T-TUBE 1.14MM,,A4649,HCPCS,Facility,Inpatient,,,,83.6,71.06,23.95976,83.6,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
RICHARDS T-TUBE 1.14MM,,A4649,HCPCS,Facility,Outpatient,,,,83.6,71.06,23.95976,83.6,Medica,Medical Assistance,37.2856,44.6,,percent of total billed charges,,
RICHARDS T-TUBE 1.14MM,,A4649,HCPCS,Facility,Inpatient,,,,83.6,71.06,23.95976,83.6,Medica,Medical Assistance,,,,,Included in per diem rate,
RICHARDS T-TUBE 1.14MM,,A4649,HCPCS,Facility,Outpatient,,,,83.6,71.06,23.95976,83.6,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,41.6328,49.8,,percent of total billed charges,,
RICHARDS T-TUBE 1.14MM,,A4649,HCPCS,Facility,Inpatient,,,,83.6,71.06,23.95976,83.6,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
RICHARDS T-TUBE 1.14MM,,A4649,HCPCS,Facility,Both,,,,83.6,71.06,23.95976,83.6,"Multiplan, Inc.","Multiplan, Inc.",78.584,94,,percent of total billed charges,,
RICHARDS T-TUBE 1.14MM,,A4649,HCPCS,Facility,Outpatient,,,,83.6,71.06,23.95976,83.6,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,75.3236,90.1,,percent of total billed charges,,
RICHARDS T-TUBE 1.14MM,,A4649,HCPCS,Facility,Inpatient,,,,83.6,71.06,23.95976,83.6,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
RICHARDS T-TUBE 1.14MM,,A4649,HCPCS,Facility,Both,,,,83.6,71.06,23.95976,83.6,"Preferred One Administrative Services, INC.",PPO,82.4296,98.6,,percent of total billed charges,,
RICHARDS T-TUBE 1.14MM,,A4649,HCPCS,Facility,Outpatient,,,,83.6,71.06,23.95976,83.6,PrimeWest Health,Minnesota Senior Health Options (MSHO),43.0122,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
RICHARDS T-TUBE 1.14MM,,A4649,HCPCS,Facility,Inpatient,,,,83.6,71.06,23.95976,83.6,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
RICHARDS T-TUBE 1.14MM,,A4649,HCPCS,Facility,Outpatient,,,,83.6,71.06,23.95976,83.6,PrimeWest Health,MinnesotaCare,42.93696,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
RICHARDS T-TUBE 1.14MM,,A4649,HCPCS,Facility,Inpatient,,,,83.6,71.06,23.95976,83.6,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
RICHARDS T-TUBE 1.14MM,,A4649,HCPCS,Facility,Both,,,,83.6,71.06,23.95976,83.6,Sanford Health Plan,Sanford Health Plan,76.912,92,,percent of total billed charges,,
RICHARDS T-TUBE 1.14MM,,A4649,HCPCS,Facility,Outpatient,,,,83.6,71.06,23.95976,83.6,"UCare Health, Inc.",Individual & Family Plan,47.1086,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
RICHARDS T-TUBE 1.14MM,,A4649,HCPCS,Facility,Inpatient,,,,83.6,71.06,23.95976,83.6,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
RICHARDS T-TUBE 1.14MM,,A4649,HCPCS,Facility,Outpatient,,,,83.6,71.06,23.95976,83.6,"UCare Health, Inc.",Medical Assistance,42.19292,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
RICHARDS T-TUBE 1.14MM,,A4649,HCPCS,Facility,Inpatient,,,,83.6,71.06,23.95976,83.6,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
RICHARDS T-TUBE 1.14MM,,A4649,HCPCS,Facility,Outpatient,,,,83.6,71.06,23.95976,83.6,"UCare Health, Inc.",Medicare Advantage,42.19292,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
RICHARDS T-TUBE 1.14MM,,A4649,HCPCS,Facility,Inpatient,,,,83.6,71.06,23.95976,83.6,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
RICHARDS T-TUBE 1.14MM,,A4649,HCPCS,Facility,Outpatient,,,,83.6,71.06,23.95976,83.6,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),42.19292,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
RICHARDS T-TUBE 1.14MM,,A4649,HCPCS,Facility,Inpatient,,,,83.6,71.06,23.95976,83.6,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
RICHARDS T-TUBE 1.14MM,,A4649,HCPCS,Facility,Both,,,,83.6,71.06,23.95976,83.6,UnitedHealthcare,Individual & Family,78.584,94,,percent of total billed charges,,
RICHARDS T-TUBE 1.14MM,,A4649,HCPCS,Facility,Outpatient,,,,83.6,71.06,23.95976,83.6,UnitedHealthcare,Medicare Advantage,40.964,49,,percent of total billed charges,,
RICHARDS T-TUBE 1.14MM,,A4649,HCPCS,Facility,Inpatient,,,,83.6,71.06,23.95976,83.6,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
RICHARDS T-TUBE 1.14MM,,A4649,HCPCS,Facility,Outpatient,,,,83.6,71.06,23.95976,83.6,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,40.128,48,,percent of total billed charges,,100% of DHS outpatient percentage
RICHARDS T-TUBE 1.14MM,,A4649,HCPCS,Facility,Inpatient,,,,83.6,71.06,23.95976,83.6,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
SKIN STAPLER,,A4649,HCPCS,Facility,Both,,,,25.5,21.675,7.3083,25.5,Aetna,Commercial,23.46,92,,percent of total billed charges,,
SKIN STAPLER,,A4649,HCPCS,Facility,Outpatient,,,,25.5,21.675,7.3083,25.5,Aetna,Medicare Advantage,12.495,49,,percent of total billed charges,,
SKIN STAPLER,,A4649,HCPCS,Facility,Inpatient,,,,25.5,21.675,7.3083,25.5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
SKIN STAPLER,,A4649,HCPCS,Facility,Both,,,,25.5,21.675,7.3083,25.5,Aetna,PPO,23.715,93,,percent of total billed charges,,
SKIN STAPLER,,A4649,HCPCS,Facility,Both,,,,25.5,21.675,7.3083,25.5,America's PPO,America's PPO,24.48765,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SKIN STAPLER,,A4649,HCPCS,Facility,Both,,,,25.5,21.675,7.3083,25.5,BlueCross BlueShield Minnesota, Federal Employee Program,25.092,98.4,,percent of total billed charges,,
SKIN STAPLER,,A4649,HCPCS,Facility,Both,,,,25.5,21.675,7.3083,25.5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,25.5,100,,percent of total billed charges,,
SKIN STAPLER,,A4649,HCPCS,Facility,Both,,,,25.5,21.675,7.3083,25.5,BlueCross BlueShield Minnesota,High Value Network Plan,22.95,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
SKIN STAPLER,,A4649,HCPCS,Facility,Outpatient,,,,25.5,21.675,7.3083,25.5,BlueCross BlueShield Minnesota,Medicare Advantage,12.495,49,,percent of total billed charges,,
SKIN STAPLER,,A4649,HCPCS,Facility,Inpatient,,,,25.5,21.675,7.3083,25.5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
SKIN STAPLER,,A4649,HCPCS,Facility,Both,,,,25.5,21.675,7.3083,25.5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,22.58535,88.57,,percent of total billed charges,,
SKIN STAPLER,,A4649,HCPCS,Facility,Both,,,,25.5,21.675,7.3083,25.5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,7.3083,28.66,,percent of total billed charges,,
SKIN STAPLER,,A4649,HCPCS,Facility,Outpatient,,,,25.5,21.675,7.3083,25.5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),12.495,49,,percent of total billed charges,,
SKIN STAPLER,,A4649,HCPCS,Facility,Inpatient,,,,25.5,21.675,7.3083,25.5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
SKIN STAPLER,,A4649,HCPCS,Facility,Both,,,,25.5,21.675,7.3083,25.5,CorVel,Worker's Compensation,25.5,100,,percent of total billed charges,,
SKIN STAPLER,,A4649,HCPCS,Facility,Both,,,,25.5,21.675,7.3083,25.5,First Health Group Corporation,First Health Network,24.735,97,,percent of total billed charges,,
SKIN STAPLER,,A4649,HCPCS,Facility,Both,,,,25.5,21.675,7.3083,25.5,"Health Partners, Inc.",Commercial,24.123,94.6,,percent of total billed charges,,
SKIN STAPLER,,A4649,HCPCS,Facility,Outpatient,,,,25.5,21.675,7.3083,25.5,"Health Partners, Inc.",Medicare Advantage,12.495,49,,percent of total billed charges,,
SKIN STAPLER,,A4649,HCPCS,Facility,Inpatient,,,,25.5,21.675,7.3083,25.5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SKIN STAPLER,,A4649,HCPCS,Facility,Both,,,,25.5,21.675,7.3083,25.5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),15.3,60,,percent of total billed charges,,
SKIN STAPLER,,A4649,HCPCS,Facility,Both,,,,25.5,21.675,7.3083,25.5,"Health Partners, Inc.",State of Minnesota Advantage Program,20.7825,81.5,,percent of total billed charges,,
SKIN STAPLER,,A4649,HCPCS,Facility,Both,,,,25.5,21.675,7.3083,25.5,"Health Partners, Inc.",State Public Programs,12.75,50,,percent of total billed charges,,
SKIN STAPLER,,A4649,HCPCS,Facility,Both,,,,25.5,21.675,7.3083,25.5,Humana Insurance Company,Commercial PPO,24.225,95,,percent of total billed charges,,
SKIN STAPLER,,A4649,HCPCS,Facility,Outpatient,,,,25.5,21.675,7.3083,25.5,Humana Insurance Company,Medicare PPO,12.495,49,,percent of total billed charges,,
SKIN STAPLER,,A4649,HCPCS,Facility,Inpatient,,,,25.5,21.675,7.3083,25.5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
SKIN STAPLER,,A4649,HCPCS,Facility,Both,,,,25.5,21.675,7.3083,25.5,Medica,Individual & Family,25.2705,99.1,,percent of total billed charges,,
SKIN STAPLER,,A4649,HCPCS,Facility,Outpatient,,,,25.5,21.675,7.3083,25.5,Medica,Medica Advantage Solution,12.699,49.8,,percent of total billed charges,,
SKIN STAPLER,,A4649,HCPCS,Facility,Inpatient,,,,25.5,21.675,7.3083,25.5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
SKIN STAPLER,,A4649,HCPCS,Facility,Outpatient,,,,25.5,21.675,7.3083,25.5,Medica,Medical Assistance,11.373,44.6,,percent of total billed charges,,
SKIN STAPLER,,A4649,HCPCS,Facility,Inpatient,,,,25.5,21.675,7.3083,25.5,Medica,Medical Assistance,,,,,Included in per diem rate,
SKIN STAPLER,,A4649,HCPCS,Facility,Outpatient,,,,25.5,21.675,7.3083,25.5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,12.699,49.8,,percent of total billed charges,,
SKIN STAPLER,,A4649,HCPCS,Facility,Inpatient,,,,25.5,21.675,7.3083,25.5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
SKIN STAPLER,,A4649,HCPCS,Facility,Both,,,,25.5,21.675,7.3083,25.5,"Multiplan, Inc.","Multiplan, Inc.",23.97,94,,percent of total billed charges,,
SKIN STAPLER,,A4649,HCPCS,Facility,Outpatient,,,,25.5,21.675,7.3083,25.5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,22.9755,90.1,,percent of total billed charges,,
SKIN STAPLER,,A4649,HCPCS,Facility,Inpatient,,,,25.5,21.675,7.3083,25.5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
SKIN STAPLER,,A4649,HCPCS,Facility,Both,,,,25.5,21.675,7.3083,25.5,"Preferred One Administrative Services, INC.",PPO,25.143,98.6,,percent of total billed charges,,
SKIN STAPLER,,A4649,HCPCS,Facility,Outpatient,,,,25.5,21.675,7.3083,25.5,PrimeWest Health,Minnesota Senior Health Options (MSHO),13.11975,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
SKIN STAPLER,,A4649,HCPCS,Facility,Inpatient,,,,25.5,21.675,7.3083,25.5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SKIN STAPLER,,A4649,HCPCS,Facility,Outpatient,,,,25.5,21.675,7.3083,25.5,PrimeWest Health,MinnesotaCare,13.0968,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
SKIN STAPLER,,A4649,HCPCS,Facility,Inpatient,,,,25.5,21.675,7.3083,25.5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
SKIN STAPLER,,A4649,HCPCS,Facility,Both,,,,25.5,21.675,7.3083,25.5,Sanford Health Plan,Sanford Health Plan,23.46,92,,percent of total billed charges,,
SKIN STAPLER,,A4649,HCPCS,Facility,Outpatient,,,,25.5,21.675,7.3083,25.5,"UCare Health, Inc.",Individual & Family Plan,14.36925,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
SKIN STAPLER,,A4649,HCPCS,Facility,Inpatient,,,,25.5,21.675,7.3083,25.5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
SKIN STAPLER,,A4649,HCPCS,Facility,Outpatient,,,,25.5,21.675,7.3083,25.5,"UCare Health, Inc.",Medical Assistance,12.86985,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SKIN STAPLER,,A4649,HCPCS,Facility,Inpatient,,,,25.5,21.675,7.3083,25.5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
SKIN STAPLER,,A4649,HCPCS,Facility,Outpatient,,,,25.5,21.675,7.3083,25.5,"UCare Health, Inc.",Medicare Advantage,12.86985,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SKIN STAPLER,,A4649,HCPCS,Facility,Inpatient,,,,25.5,21.675,7.3083,25.5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SKIN STAPLER,,A4649,HCPCS,Facility,Outpatient,,,,25.5,21.675,7.3083,25.5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),12.86985,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SKIN STAPLER,,A4649,HCPCS,Facility,Inpatient,,,,25.5,21.675,7.3083,25.5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SKIN STAPLER,,A4649,HCPCS,Facility,Both,,,,25.5,21.675,7.3083,25.5,UnitedHealthcare,Individual & Family,23.97,94,,percent of total billed charges,,
SKIN STAPLER,,A4649,HCPCS,Facility,Outpatient,,,,25.5,21.675,7.3083,25.5,UnitedHealthcare,Medicare Advantage,12.495,49,,percent of total billed charges,,
SKIN STAPLER,,A4649,HCPCS,Facility,Inpatient,,,,25.5,21.675,7.3083,25.5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
SKIN STAPLER,,A4649,HCPCS,Facility,Outpatient,,,,25.5,21.675,7.3083,25.5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,12.24,48,,percent of total billed charges,,100% of DHS outpatient percentage
SKIN STAPLER,,A4649,HCPCS,Facility,Inpatient,,,,25.5,21.675,7.3083,25.5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
SNARE ELECTROSURGICAL DISP SD-24OU-25,,A4649,HCPCS,Facility,Both,,,,97.52,82.892,27.949232,97.52,Aetna,Commercial,89.7184,92,,percent of total billed charges,,
SNARE ELECTROSURGICAL DISP SD-24OU-25,,A4649,HCPCS,Facility,Outpatient,,,,97.52,82.892,27.949232,97.52,Aetna,Medicare Advantage,47.7848,49,,percent of total billed charges,,
SNARE ELECTROSURGICAL DISP SD-24OU-25,,A4649,HCPCS,Facility,Inpatient,,,,97.52,82.892,27.949232,97.52,Aetna,Medicare Advantage,,,,,Included in per diem rate,
SNARE ELECTROSURGICAL DISP SD-24OU-25,,A4649,HCPCS,Facility,Both,,,,97.52,82.892,27.949232,97.52,Aetna,PPO,90.6936,93,,percent of total billed charges,,
SNARE ELECTROSURGICAL DISP SD-24OU-25,,A4649,HCPCS,Facility,Both,,,,97.52,82.892,27.949232,97.52,America's PPO,America's PPO,93.648456,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SNARE ELECTROSURGICAL DISP SD-24OU-25,,A4649,HCPCS,Facility,Both,,,,97.52,82.892,27.949232,97.52,BlueCross BlueShield Minnesota, Federal Employee Program,95.95968,98.4,,percent of total billed charges,,
SNARE ELECTROSURGICAL DISP SD-24OU-25,,A4649,HCPCS,Facility,Both,,,,97.52,82.892,27.949232,97.52,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,97.52,100,,percent of total billed charges,,
SNARE ELECTROSURGICAL DISP SD-24OU-25,,A4649,HCPCS,Facility,Both,,,,97.52,82.892,27.949232,97.52,BlueCross BlueShield Minnesota,High Value Network Plan,87.768,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
SNARE ELECTROSURGICAL DISP SD-24OU-25,,A4649,HCPCS,Facility,Outpatient,,,,97.52,82.892,27.949232,97.52,BlueCross BlueShield Minnesota,Medicare Advantage,47.7848,49,,percent of total billed charges,,
SNARE ELECTROSURGICAL DISP SD-24OU-25,,A4649,HCPCS,Facility,Inpatient,,,,97.52,82.892,27.949232,97.52,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
SNARE ELECTROSURGICAL DISP SD-24OU-25,,A4649,HCPCS,Facility,Both,,,,97.52,82.892,27.949232,97.52,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,86.373464,88.57,,percent of total billed charges,,
SNARE ELECTROSURGICAL DISP SD-24OU-25,,A4649,HCPCS,Facility,Both,,,,97.52,82.892,27.949232,97.52,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,27.949232,28.66,,percent of total billed charges,,
SNARE ELECTROSURGICAL DISP SD-24OU-25,,A4649,HCPCS,Facility,Outpatient,,,,97.52,82.892,27.949232,97.52,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),47.7848,49,,percent of total billed charges,,
SNARE ELECTROSURGICAL DISP SD-24OU-25,,A4649,HCPCS,Facility,Inpatient,,,,97.52,82.892,27.949232,97.52,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
SNARE ELECTROSURGICAL DISP SD-24OU-25,,A4649,HCPCS,Facility,Both,,,,97.52,82.892,27.949232,97.52,CorVel,Worker's Compensation,97.52,100,,percent of total billed charges,,
SNARE ELECTROSURGICAL DISP SD-24OU-25,,A4649,HCPCS,Facility,Both,,,,97.52,82.892,27.949232,97.52,First Health Group Corporation,First Health Network,94.5944,97,,percent of total billed charges,,
SNARE ELECTROSURGICAL DISP SD-24OU-25,,A4649,HCPCS,Facility,Both,,,,97.52,82.892,27.949232,97.52,"Health Partners, Inc.",Commercial,92.25392,94.6,,percent of total billed charges,,
SNARE ELECTROSURGICAL DISP SD-24OU-25,,A4649,HCPCS,Facility,Outpatient,,,,97.52,82.892,27.949232,97.52,"Health Partners, Inc.",Medicare Advantage,47.7848,49,,percent of total billed charges,,
SNARE ELECTROSURGICAL DISP SD-24OU-25,,A4649,HCPCS,Facility,Inpatient,,,,97.52,82.892,27.949232,97.52,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SNARE ELECTROSURGICAL DISP SD-24OU-25,,A4649,HCPCS,Facility,Both,,,,97.52,82.892,27.949232,97.52,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),58.512,60,,percent of total billed charges,,
SNARE ELECTROSURGICAL DISP SD-24OU-25,,A4649,HCPCS,Facility,Both,,,,97.52,82.892,27.949232,97.52,"Health Partners, Inc.",State of Minnesota Advantage Program,79.4788,81.5,,percent of total billed charges,,
SNARE ELECTROSURGICAL DISP SD-24OU-25,,A4649,HCPCS,Facility,Both,,,,97.52,82.892,27.949232,97.52,"Health Partners, Inc.",State Public Programs,48.76,50,,percent of total billed charges,,
SNARE ELECTROSURGICAL DISP SD-24OU-25,,A4649,HCPCS,Facility,Both,,,,97.52,82.892,27.949232,97.52,Humana Insurance Company,Commercial PPO,92.644,95,,percent of total billed charges,,
SNARE ELECTROSURGICAL DISP SD-24OU-25,,A4649,HCPCS,Facility,Outpatient,,,,97.52,82.892,27.949232,97.52,Humana Insurance Company,Medicare PPO,47.7848,49,,percent of total billed charges,,
SNARE ELECTROSURGICAL DISP SD-24OU-25,,A4649,HCPCS,Facility,Inpatient,,,,97.52,82.892,27.949232,97.52,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
SNARE ELECTROSURGICAL DISP SD-24OU-25,,A4649,HCPCS,Facility,Both,,,,97.52,82.892,27.949232,97.52,Medica,Individual & Family,96.64232,99.1,,percent of total billed charges,,
SNARE ELECTROSURGICAL DISP SD-24OU-25,,A4649,HCPCS,Facility,Outpatient,,,,97.52,82.892,27.949232,97.52,Medica,Medica Advantage Solution,48.56496,49.8,,percent of total billed charges,,
SNARE ELECTROSURGICAL DISP SD-24OU-25,,A4649,HCPCS,Facility,Inpatient,,,,97.52,82.892,27.949232,97.52,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
SNARE ELECTROSURGICAL DISP SD-24OU-25,,A4649,HCPCS,Facility,Outpatient,,,,97.52,82.892,27.949232,97.52,Medica,Medical Assistance,43.49392,44.6,,percent of total billed charges,,
SNARE ELECTROSURGICAL DISP SD-24OU-25,,A4649,HCPCS,Facility,Inpatient,,,,97.52,82.892,27.949232,97.52,Medica,Medical Assistance,,,,,Included in per diem rate,
SNARE ELECTROSURGICAL DISP SD-24OU-25,,A4649,HCPCS,Facility,Outpatient,,,,97.52,82.892,27.949232,97.52,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,48.56496,49.8,,percent of total billed charges,,
SNARE ELECTROSURGICAL DISP SD-24OU-25,,A4649,HCPCS,Facility,Inpatient,,,,97.52,82.892,27.949232,97.52,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
SNARE ELECTROSURGICAL DISP SD-24OU-25,,A4649,HCPCS,Facility,Both,,,,97.52,82.892,27.949232,97.52,"Multiplan, Inc.","Multiplan, Inc.",91.6688,94,,percent of total billed charges,,
SNARE ELECTROSURGICAL DISP SD-24OU-25,,A4649,HCPCS,Facility,Outpatient,,,,97.52,82.892,27.949232,97.52,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,87.86552,90.1,,percent of total billed charges,,
SNARE ELECTROSURGICAL DISP SD-24OU-25,,A4649,HCPCS,Facility,Inpatient,,,,97.52,82.892,27.949232,97.52,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
SNARE ELECTROSURGICAL DISP SD-24OU-25,,A4649,HCPCS,Facility,Both,,,,97.52,82.892,27.949232,97.52,"Preferred One Administrative Services, INC.",PPO,96.15472,98.6,,percent of total billed charges,,
SNARE ELECTROSURGICAL DISP SD-24OU-25,,A4649,HCPCS,Facility,Outpatient,,,,97.52,82.892,27.949232,97.52,PrimeWest Health,Minnesota Senior Health Options (MSHO),50.17404,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
SNARE ELECTROSURGICAL DISP SD-24OU-25,,A4649,HCPCS,Facility,Inpatient,,,,97.52,82.892,27.949232,97.52,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SNARE ELECTROSURGICAL DISP SD-24OU-25,,A4649,HCPCS,Facility,Outpatient,,,,97.52,82.892,27.949232,97.52,PrimeWest Health,MinnesotaCare,50.086272,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
SNARE ELECTROSURGICAL DISP SD-24OU-25,,A4649,HCPCS,Facility,Inpatient,,,,97.52,82.892,27.949232,97.52,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
SNARE ELECTROSURGICAL DISP SD-24OU-25,,A4649,HCPCS,Facility,Both,,,,97.52,82.892,27.949232,97.52,Sanford Health Plan,Sanford Health Plan,89.7184,92,,percent of total billed charges,,
SNARE ELECTROSURGICAL DISP SD-24OU-25,,A4649,HCPCS,Facility,Outpatient,,,,97.52,82.892,27.949232,97.52,"UCare Health, Inc.",Individual & Family Plan,54.95252,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
SNARE ELECTROSURGICAL DISP SD-24OU-25,,A4649,HCPCS,Facility,Inpatient,,,,97.52,82.892,27.949232,97.52,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
SNARE ELECTROSURGICAL DISP SD-24OU-25,,A4649,HCPCS,Facility,Outpatient,,,,97.52,82.892,27.949232,97.52,"UCare Health, Inc.",Medical Assistance,49.218344,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SNARE ELECTROSURGICAL DISP SD-24OU-25,,A4649,HCPCS,Facility,Inpatient,,,,97.52,82.892,27.949232,97.52,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
SNARE ELECTROSURGICAL DISP SD-24OU-25,,A4649,HCPCS,Facility,Outpatient,,,,97.52,82.892,27.949232,97.52,"UCare Health, Inc.",Medicare Advantage,49.218344,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SNARE ELECTROSURGICAL DISP SD-24OU-25,,A4649,HCPCS,Facility,Inpatient,,,,97.52,82.892,27.949232,97.52,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SNARE ELECTROSURGICAL DISP SD-24OU-25,,A4649,HCPCS,Facility,Outpatient,,,,97.52,82.892,27.949232,97.52,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),49.218344,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SNARE ELECTROSURGICAL DISP SD-24OU-25,,A4649,HCPCS,Facility,Inpatient,,,,97.52,82.892,27.949232,97.52,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SNARE ELECTROSURGICAL DISP SD-24OU-25,,A4649,HCPCS,Facility,Both,,,,97.52,82.892,27.949232,97.52,UnitedHealthcare,Individual & Family,91.6688,94,,percent of total billed charges,,
SNARE ELECTROSURGICAL DISP SD-24OU-25,,A4649,HCPCS,Facility,Outpatient,,,,97.52,82.892,27.949232,97.52,UnitedHealthcare,Medicare Advantage,47.7848,49,,percent of total billed charges,,
SNARE ELECTROSURGICAL DISP SD-24OU-25,,A4649,HCPCS,Facility,Inpatient,,,,97.52,82.892,27.949232,97.52,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
SNARE ELECTROSURGICAL DISP SD-24OU-25,,A4649,HCPCS,Facility,Outpatient,,,,97.52,82.892,27.949232,97.52,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,46.8096,48,,percent of total billed charges,,100% of DHS outpatient percentage
SNARE ELECTROSURGICAL DISP SD-24OU-25,,A4649,HCPCS,Facility,Inpatient,,,,97.52,82.892,27.949232,97.52,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
SPOT ENDOSCOPY MARKER  GIS-45,,A4649,HCPCS,Facility,Both,,,,118,100.3,33.8188,118,Aetna,Commercial,108.56,92,,percent of total billed charges,,
SPOT ENDOSCOPY MARKER  GIS-45,,A4649,HCPCS,Facility,Outpatient,,,,118,100.3,33.8188,118,Aetna,Medicare Advantage,57.82,49,,percent of total billed charges,,
SPOT ENDOSCOPY MARKER  GIS-45,,A4649,HCPCS,Facility,Inpatient,,,,118,100.3,33.8188,118,Aetna,Medicare Advantage,,,,,Included in per diem rate,
SPOT ENDOSCOPY MARKER  GIS-45,,A4649,HCPCS,Facility,Both,,,,118,100.3,33.8188,118,Aetna,PPO,109.74,93,,percent of total billed charges,,
SPOT ENDOSCOPY MARKER  GIS-45,,A4649,HCPCS,Facility,Both,,,,118,100.3,33.8188,118,America's PPO,America's PPO,113.3154,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SPOT ENDOSCOPY MARKER  GIS-45,,A4649,HCPCS,Facility,Both,,,,118,100.3,33.8188,118,BlueCross BlueShield Minnesota, Federal Employee Program,116.112,98.4,,percent of total billed charges,,
SPOT ENDOSCOPY MARKER  GIS-45,,A4649,HCPCS,Facility,Both,,,,118,100.3,33.8188,118,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,118,100,,percent of total billed charges,,
SPOT ENDOSCOPY MARKER  GIS-45,,A4649,HCPCS,Facility,Both,,,,118,100.3,33.8188,118,BlueCross BlueShield Minnesota,High Value Network Plan,106.2,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
SPOT ENDOSCOPY MARKER  GIS-45,,A4649,HCPCS,Facility,Outpatient,,,,118,100.3,33.8188,118,BlueCross BlueShield Minnesota,Medicare Advantage,57.82,49,,percent of total billed charges,,
SPOT ENDOSCOPY MARKER  GIS-45,,A4649,HCPCS,Facility,Inpatient,,,,118,100.3,33.8188,118,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
SPOT ENDOSCOPY MARKER  GIS-45,,A4649,HCPCS,Facility,Both,,,,118,100.3,33.8188,118,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,104.5126,88.57,,percent of total billed charges,,
SPOT ENDOSCOPY MARKER  GIS-45,,A4649,HCPCS,Facility,Both,,,,118,100.3,33.8188,118,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,33.8188,28.66,,percent of total billed charges,,
SPOT ENDOSCOPY MARKER  GIS-45,,A4649,HCPCS,Facility,Outpatient,,,,118,100.3,33.8188,118,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),57.82,49,,percent of total billed charges,,
SPOT ENDOSCOPY MARKER  GIS-45,,A4649,HCPCS,Facility,Inpatient,,,,118,100.3,33.8188,118,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
SPOT ENDOSCOPY MARKER  GIS-45,,A4649,HCPCS,Facility,Both,,,,118,100.3,33.8188,118,CorVel,Worker's Compensation,118,100,,percent of total billed charges,,
SPOT ENDOSCOPY MARKER  GIS-45,,A4649,HCPCS,Facility,Both,,,,118,100.3,33.8188,118,First Health Group Corporation,First Health Network,114.46,97,,percent of total billed charges,,
SPOT ENDOSCOPY MARKER  GIS-45,,A4649,HCPCS,Facility,Both,,,,118,100.3,33.8188,118,"Health Partners, Inc.",Commercial,111.628,94.6,,percent of total billed charges,,
SPOT ENDOSCOPY MARKER  GIS-45,,A4649,HCPCS,Facility,Outpatient,,,,118,100.3,33.8188,118,"Health Partners, Inc.",Medicare Advantage,57.82,49,,percent of total billed charges,,
SPOT ENDOSCOPY MARKER  GIS-45,,A4649,HCPCS,Facility,Inpatient,,,,118,100.3,33.8188,118,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SPOT ENDOSCOPY MARKER  GIS-45,,A4649,HCPCS,Facility,Both,,,,118,100.3,33.8188,118,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),70.8,60,,percent of total billed charges,,
SPOT ENDOSCOPY MARKER  GIS-45,,A4649,HCPCS,Facility,Both,,,,118,100.3,33.8188,118,"Health Partners, Inc.",State of Minnesota Advantage Program,96.17,81.5,,percent of total billed charges,,
SPOT ENDOSCOPY MARKER  GIS-45,,A4649,HCPCS,Facility,Both,,,,118,100.3,33.8188,118,"Health Partners, Inc.",State Public Programs,59,50,,percent of total billed charges,,
SPOT ENDOSCOPY MARKER  GIS-45,,A4649,HCPCS,Facility,Both,,,,118,100.3,33.8188,118,Humana Insurance Company,Commercial PPO,112.1,95,,percent of total billed charges,,
SPOT ENDOSCOPY MARKER  GIS-45,,A4649,HCPCS,Facility,Outpatient,,,,118,100.3,33.8188,118,Humana Insurance Company,Medicare PPO,57.82,49,,percent of total billed charges,,
SPOT ENDOSCOPY MARKER  GIS-45,,A4649,HCPCS,Facility,Inpatient,,,,118,100.3,33.8188,118,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
SPOT ENDOSCOPY MARKER  GIS-45,,A4649,HCPCS,Facility,Both,,,,118,100.3,33.8188,118,Medica,Individual & Family,116.938,99.1,,percent of total billed charges,,
SPOT ENDOSCOPY MARKER  GIS-45,,A4649,HCPCS,Facility,Outpatient,,,,118,100.3,33.8188,118,Medica,Medica Advantage Solution,58.764,49.8,,percent of total billed charges,,
SPOT ENDOSCOPY MARKER  GIS-45,,A4649,HCPCS,Facility,Inpatient,,,,118,100.3,33.8188,118,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
SPOT ENDOSCOPY MARKER  GIS-45,,A4649,HCPCS,Facility,Outpatient,,,,118,100.3,33.8188,118,Medica,Medical Assistance,52.628,44.6,,percent of total billed charges,,
SPOT ENDOSCOPY MARKER  GIS-45,,A4649,HCPCS,Facility,Inpatient,,,,118,100.3,33.8188,118,Medica,Medical Assistance,,,,,Included in per diem rate,
SPOT ENDOSCOPY MARKER  GIS-45,,A4649,HCPCS,Facility,Outpatient,,,,118,100.3,33.8188,118,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,58.764,49.8,,percent of total billed charges,,
SPOT ENDOSCOPY MARKER  GIS-45,,A4649,HCPCS,Facility,Inpatient,,,,118,100.3,33.8188,118,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
SPOT ENDOSCOPY MARKER  GIS-45,,A4649,HCPCS,Facility,Both,,,,118,100.3,33.8188,118,"Multiplan, Inc.","Multiplan, Inc.",110.92,94,,percent of total billed charges,,
SPOT ENDOSCOPY MARKER  GIS-45,,A4649,HCPCS,Facility,Outpatient,,,,118,100.3,33.8188,118,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,106.318,90.1,,percent of total billed charges,,
SPOT ENDOSCOPY MARKER  GIS-45,,A4649,HCPCS,Facility,Inpatient,,,,118,100.3,33.8188,118,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
SPOT ENDOSCOPY MARKER  GIS-45,,A4649,HCPCS,Facility,Both,,,,118,100.3,33.8188,118,"Preferred One Administrative Services, INC.",PPO,116.348,98.6,,percent of total billed charges,,
SPOT ENDOSCOPY MARKER  GIS-45,,A4649,HCPCS,Facility,Outpatient,,,,118,100.3,33.8188,118,PrimeWest Health,Minnesota Senior Health Options (MSHO),60.711,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
SPOT ENDOSCOPY MARKER  GIS-45,,A4649,HCPCS,Facility,Inpatient,,,,118,100.3,33.8188,118,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SPOT ENDOSCOPY MARKER  GIS-45,,A4649,HCPCS,Facility,Outpatient,,,,118,100.3,33.8188,118,PrimeWest Health,MinnesotaCare,60.6048,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
SPOT ENDOSCOPY MARKER  GIS-45,,A4649,HCPCS,Facility,Inpatient,,,,118,100.3,33.8188,118,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
SPOT ENDOSCOPY MARKER  GIS-45,,A4649,HCPCS,Facility,Both,,,,118,100.3,33.8188,118,Sanford Health Plan,Sanford Health Plan,108.56,92,,percent of total billed charges,,
SPOT ENDOSCOPY MARKER  GIS-45,,A4649,HCPCS,Facility,Outpatient,,,,118,100.3,33.8188,118,"UCare Health, Inc.",Individual & Family Plan,66.493,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
SPOT ENDOSCOPY MARKER  GIS-45,,A4649,HCPCS,Facility,Inpatient,,,,118,100.3,33.8188,118,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
SPOT ENDOSCOPY MARKER  GIS-45,,A4649,HCPCS,Facility,Outpatient,,,,118,100.3,33.8188,118,"UCare Health, Inc.",Medical Assistance,59.5546,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SPOT ENDOSCOPY MARKER  GIS-45,,A4649,HCPCS,Facility,Inpatient,,,,118,100.3,33.8188,118,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
SPOT ENDOSCOPY MARKER  GIS-45,,A4649,HCPCS,Facility,Outpatient,,,,118,100.3,33.8188,118,"UCare Health, Inc.",Medicare Advantage,59.5546,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SPOT ENDOSCOPY MARKER  GIS-45,,A4649,HCPCS,Facility,Inpatient,,,,118,100.3,33.8188,118,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SPOT ENDOSCOPY MARKER  GIS-45,,A4649,HCPCS,Facility,Outpatient,,,,118,100.3,33.8188,118,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),59.5546,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SPOT ENDOSCOPY MARKER  GIS-45,,A4649,HCPCS,Facility,Inpatient,,,,118,100.3,33.8188,118,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SPOT ENDOSCOPY MARKER  GIS-45,,A4649,HCPCS,Facility,Both,,,,118,100.3,33.8188,118,UnitedHealthcare,Individual & Family,110.92,94,,percent of total billed charges,,
SPOT ENDOSCOPY MARKER  GIS-45,,A4649,HCPCS,Facility,Outpatient,,,,118,100.3,33.8188,118,UnitedHealthcare,Medicare Advantage,57.82,49,,percent of total billed charges,,
SPOT ENDOSCOPY MARKER  GIS-45,,A4649,HCPCS,Facility,Inpatient,,,,118,100.3,33.8188,118,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
SPOT ENDOSCOPY MARKER  GIS-45,,A4649,HCPCS,Facility,Outpatient,,,,118,100.3,33.8188,118,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,56.64,48,,percent of total billed charges,,100% of DHS outpatient percentage
SPOT ENDOSCOPY MARKER  GIS-45,,A4649,HCPCS,Facility,Inpatient,,,,118,100.3,33.8188,118,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
STANDARD MINIRAIL FIXATOR,,A4649,HCPCS,Facility,Both,,,,2901.22,2466.037,831.489652,2901.22,Aetna,Commercial,2669.1224,92,,percent of total billed charges,,
STANDARD MINIRAIL FIXATOR,,A4649,HCPCS,Facility,Outpatient,,,,2901.22,2466.037,831.489652,2901.22,Aetna,Medicare Advantage,1421.5978,49,,percent of total billed charges,,
STANDARD MINIRAIL FIXATOR,,A4649,HCPCS,Facility,Inpatient,,,,2901.22,2466.037,831.489652,2901.22,Aetna,Medicare Advantage,,,,,Included in per diem rate,
STANDARD MINIRAIL FIXATOR,,A4649,HCPCS,Facility,Both,,,,2901.22,2466.037,831.489652,2901.22,Aetna,PPO,2698.1346,93,,percent of total billed charges,,
STANDARD MINIRAIL FIXATOR,,A4649,HCPCS,Facility,Both,,,,2901.22,2466.037,831.489652,2901.22,America's PPO,America's PPO,2786.041566,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
STANDARD MINIRAIL FIXATOR,,A4649,HCPCS,Facility,Both,,,,2901.22,2466.037,831.489652,2901.22,BlueCross BlueShield Minnesota, Federal Employee Program,2854.80048,98.4,,percent of total billed charges,,
STANDARD MINIRAIL FIXATOR,,A4649,HCPCS,Facility,Both,,,,2901.22,2466.037,831.489652,2901.22,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,2901.22,100,,percent of total billed charges,,
STANDARD MINIRAIL FIXATOR,,A4649,HCPCS,Facility,Both,,,,2901.22,2466.037,831.489652,2901.22,BlueCross BlueShield Minnesota,High Value Network Plan,2611.098,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
STANDARD MINIRAIL FIXATOR,,A4649,HCPCS,Facility,Outpatient,,,,2901.22,2466.037,831.489652,2901.22,BlueCross BlueShield Minnesota,Medicare Advantage,1421.5978,49,,percent of total billed charges,,
STANDARD MINIRAIL FIXATOR,,A4649,HCPCS,Facility,Inpatient,,,,2901.22,2466.037,831.489652,2901.22,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
STANDARD MINIRAIL FIXATOR,,A4649,HCPCS,Facility,Both,,,,2901.22,2466.037,831.489652,2901.22,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,2569.610554,88.57,,percent of total billed charges,,
STANDARD MINIRAIL FIXATOR,,A4649,HCPCS,Facility,Both,,,,2901.22,2466.037,831.489652,2901.22,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,831.489652,28.66,,percent of total billed charges,,
STANDARD MINIRAIL FIXATOR,,A4649,HCPCS,Facility,Outpatient,,,,2901.22,2466.037,831.489652,2901.22,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1421.5978,49,,percent of total billed charges,,
STANDARD MINIRAIL FIXATOR,,A4649,HCPCS,Facility,Inpatient,,,,2901.22,2466.037,831.489652,2901.22,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
STANDARD MINIRAIL FIXATOR,,A4649,HCPCS,Facility,Both,,,,2901.22,2466.037,831.489652,2901.22,CorVel,Worker's Compensation,2901.22,100,,percent of total billed charges,,
STANDARD MINIRAIL FIXATOR,,A4649,HCPCS,Facility,Both,,,,2901.22,2466.037,831.489652,2901.22,First Health Group Corporation,First Health Network,2814.1834,97,,percent of total billed charges,,
STANDARD MINIRAIL FIXATOR,,A4649,HCPCS,Facility,Both,,,,2901.22,2466.037,831.489652,2901.22,"Health Partners, Inc.",Commercial,2744.55412,94.6,,percent of total billed charges,,
STANDARD MINIRAIL FIXATOR,,A4649,HCPCS,Facility,Outpatient,,,,2901.22,2466.037,831.489652,2901.22,"Health Partners, Inc.",Medicare Advantage,1421.5978,49,,percent of total billed charges,,
STANDARD MINIRAIL FIXATOR,,A4649,HCPCS,Facility,Inpatient,,,,2901.22,2466.037,831.489652,2901.22,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
STANDARD MINIRAIL FIXATOR,,A4649,HCPCS,Facility,Both,,,,2901.22,2466.037,831.489652,2901.22,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1740.732,60,,percent of total billed charges,,
STANDARD MINIRAIL FIXATOR,,A4649,HCPCS,Facility,Both,,,,2901.22,2466.037,831.489652,2901.22,"Health Partners, Inc.",State of Minnesota Advantage Program,2364.4943,81.5,,percent of total billed charges,,
STANDARD MINIRAIL FIXATOR,,A4649,HCPCS,Facility,Both,,,,2901.22,2466.037,831.489652,2901.22,"Health Partners, Inc.",State Public Programs,1450.61,50,,percent of total billed charges,,
STANDARD MINIRAIL FIXATOR,,A4649,HCPCS,Facility,Both,,,,2901.22,2466.037,831.489652,2901.22,Humana Insurance Company,Commercial PPO,2756.159,95,,percent of total billed charges,,
STANDARD MINIRAIL FIXATOR,,A4649,HCPCS,Facility,Outpatient,,,,2901.22,2466.037,831.489652,2901.22,Humana Insurance Company,Medicare PPO,1421.5978,49,,percent of total billed charges,,
STANDARD MINIRAIL FIXATOR,,A4649,HCPCS,Facility,Inpatient,,,,2901.22,2466.037,831.489652,2901.22,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
STANDARD MINIRAIL FIXATOR,,A4649,HCPCS,Facility,Both,,,,2901.22,2466.037,831.489652,2901.22,Medica,Individual & Family,2875.10902,99.1,,percent of total billed charges,,
STANDARD MINIRAIL FIXATOR,,A4649,HCPCS,Facility,Outpatient,,,,2901.22,2466.037,831.489652,2901.22,Medica,Medica Advantage Solution,1444.80756,49.8,,percent of total billed charges,,
STANDARD MINIRAIL FIXATOR,,A4649,HCPCS,Facility,Inpatient,,,,2901.22,2466.037,831.489652,2901.22,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
STANDARD MINIRAIL FIXATOR,,A4649,HCPCS,Facility,Outpatient,,,,2901.22,2466.037,831.489652,2901.22,Medica,Medical Assistance,1293.94412,44.6,,percent of total billed charges,,
STANDARD MINIRAIL FIXATOR,,A4649,HCPCS,Facility,Inpatient,,,,2901.22,2466.037,831.489652,2901.22,Medica,Medical Assistance,,,,,Included in per diem rate,
STANDARD MINIRAIL FIXATOR,,A4649,HCPCS,Facility,Outpatient,,,,2901.22,2466.037,831.489652,2901.22,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1444.80756,49.8,,percent of total billed charges,,
STANDARD MINIRAIL FIXATOR,,A4649,HCPCS,Facility,Inpatient,,,,2901.22,2466.037,831.489652,2901.22,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
STANDARD MINIRAIL FIXATOR,,A4649,HCPCS,Facility,Both,,,,2901.22,2466.037,831.489652,2901.22,"Multiplan, Inc.","Multiplan, Inc.",2727.1468,94,,percent of total billed charges,,
STANDARD MINIRAIL FIXATOR,,A4649,HCPCS,Facility,Outpatient,,,,2901.22,2466.037,831.489652,2901.22,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,2613.99922,90.1,,percent of total billed charges,,
STANDARD MINIRAIL FIXATOR,,A4649,HCPCS,Facility,Inpatient,,,,2901.22,2466.037,831.489652,2901.22,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
STANDARD MINIRAIL FIXATOR,,A4649,HCPCS,Facility,Both,,,,2901.22,2466.037,831.489652,2901.22,"Preferred One Administrative Services, INC.",PPO,2860.60292,98.6,,percent of total billed charges,,
STANDARD MINIRAIL FIXATOR,,A4649,HCPCS,Facility,Outpatient,,,,2901.22,2466.037,831.489652,2901.22,PrimeWest Health,Minnesota Senior Health Options (MSHO),1492.67769,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
STANDARD MINIRAIL FIXATOR,,A4649,HCPCS,Facility,Inpatient,,,,2901.22,2466.037,831.489652,2901.22,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
STANDARD MINIRAIL FIXATOR,,A4649,HCPCS,Facility,Outpatient,,,,2901.22,2466.037,831.489652,2901.22,PrimeWest Health,MinnesotaCare,1490.066592,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
STANDARD MINIRAIL FIXATOR,,A4649,HCPCS,Facility,Inpatient,,,,2901.22,2466.037,831.489652,2901.22,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
STANDARD MINIRAIL FIXATOR,,A4649,HCPCS,Facility,Both,,,,2901.22,2466.037,831.489652,2901.22,Sanford Health Plan,Sanford Health Plan,2669.1224,92,,percent of total billed charges,,
STANDARD MINIRAIL FIXATOR,,A4649,HCPCS,Facility,Outpatient,,,,2901.22,2466.037,831.489652,2901.22,"UCare Health, Inc.",Individual & Family Plan,1634.83747,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
STANDARD MINIRAIL FIXATOR,,A4649,HCPCS,Facility,Inpatient,,,,2901.22,2466.037,831.489652,2901.22,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
STANDARD MINIRAIL FIXATOR,,A4649,HCPCS,Facility,Outpatient,,,,2901.22,2466.037,831.489652,2901.22,"UCare Health, Inc.",Medical Assistance,1464.245734,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
STANDARD MINIRAIL FIXATOR,,A4649,HCPCS,Facility,Inpatient,,,,2901.22,2466.037,831.489652,2901.22,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
STANDARD MINIRAIL FIXATOR,,A4649,HCPCS,Facility,Outpatient,,,,2901.22,2466.037,831.489652,2901.22,"UCare Health, Inc.",Medicare Advantage,1464.245734,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
STANDARD MINIRAIL FIXATOR,,A4649,HCPCS,Facility,Inpatient,,,,2901.22,2466.037,831.489652,2901.22,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
STANDARD MINIRAIL FIXATOR,,A4649,HCPCS,Facility,Outpatient,,,,2901.22,2466.037,831.489652,2901.22,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1464.245734,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
STANDARD MINIRAIL FIXATOR,,A4649,HCPCS,Facility,Inpatient,,,,2901.22,2466.037,831.489652,2901.22,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
STANDARD MINIRAIL FIXATOR,,A4649,HCPCS,Facility,Both,,,,2901.22,2466.037,831.489652,2901.22,UnitedHealthcare,Individual & Family,2727.1468,94,,percent of total billed charges,,
STANDARD MINIRAIL FIXATOR,,A4649,HCPCS,Facility,Outpatient,,,,2901.22,2466.037,831.489652,2901.22,UnitedHealthcare,Medicare Advantage,1421.5978,49,,percent of total billed charges,,
STANDARD MINIRAIL FIXATOR,,A4649,HCPCS,Facility,Inpatient,,,,2901.22,2466.037,831.489652,2901.22,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
STANDARD MINIRAIL FIXATOR,,A4649,HCPCS,Facility,Outpatient,,,,2901.22,2466.037,831.489652,2901.22,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1392.5856,48,,percent of total billed charges,,100% of DHS outpatient percentage
STANDARD MINIRAIL FIXATOR,,A4649,HCPCS,Facility,Inpatient,,,,2901.22,2466.037,831.489652,2901.22,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
STAPLE ENDO GIA STRAIGHT  30 2.5 030805L,,A4649,HCPCS,Facility,Both,,,,779.65,662.7025,223.44769,779.65,Aetna,Commercial,717.278,92,,percent of total billed charges,,
STAPLE ENDO GIA STRAIGHT  30 2.5 030805L,,A4649,HCPCS,Facility,Outpatient,,,,779.65,662.7025,223.44769,779.65,Aetna,Medicare Advantage,382.0285,49,,percent of total billed charges,,
STAPLE ENDO GIA STRAIGHT  30 2.5 030805L,,A4649,HCPCS,Facility,Inpatient,,,,779.65,662.7025,223.44769,779.65,Aetna,Medicare Advantage,,,,,Included in per diem rate,
STAPLE ENDO GIA STRAIGHT  30 2.5 030805L,,A4649,HCPCS,Facility,Both,,,,779.65,662.7025,223.44769,779.65,Aetna,PPO,725.0745,93,,percent of total billed charges,,
STAPLE ENDO GIA STRAIGHT  30 2.5 030805L,,A4649,HCPCS,Facility,Both,,,,779.65,662.7025,223.44769,779.65,America's PPO,America's PPO,748.697895,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
STAPLE ENDO GIA STRAIGHT  30 2.5 030805L,,A4649,HCPCS,Facility,Both,,,,779.65,662.7025,223.44769,779.65,BlueCross BlueShield Minnesota, Federal Employee Program,767.1756,98.4,,percent of total billed charges,,
STAPLE ENDO GIA STRAIGHT  30 2.5 030805L,,A4649,HCPCS,Facility,Both,,,,779.65,662.7025,223.44769,779.65,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,779.65,100,,percent of total billed charges,,
STAPLE ENDO GIA STRAIGHT  30 2.5 030805L,,A4649,HCPCS,Facility,Both,,,,779.65,662.7025,223.44769,779.65,BlueCross BlueShield Minnesota,High Value Network Plan,701.685,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
STAPLE ENDO GIA STRAIGHT  30 2.5 030805L,,A4649,HCPCS,Facility,Outpatient,,,,779.65,662.7025,223.44769,779.65,BlueCross BlueShield Minnesota,Medicare Advantage,382.0285,49,,percent of total billed charges,,
STAPLE ENDO GIA STRAIGHT  30 2.5 030805L,,A4649,HCPCS,Facility,Inpatient,,,,779.65,662.7025,223.44769,779.65,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
STAPLE ENDO GIA STRAIGHT  30 2.5 030805L,,A4649,HCPCS,Facility,Both,,,,779.65,662.7025,223.44769,779.65,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,690.536005,88.57,,percent of total billed charges,,
STAPLE ENDO GIA STRAIGHT  30 2.5 030805L,,A4649,HCPCS,Facility,Both,,,,779.65,662.7025,223.44769,779.65,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,223.44769,28.66,,percent of total billed charges,,
STAPLE ENDO GIA STRAIGHT  30 2.5 030805L,,A4649,HCPCS,Facility,Outpatient,,,,779.65,662.7025,223.44769,779.65,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),382.0285,49,,percent of total billed charges,,
STAPLE ENDO GIA STRAIGHT  30 2.5 030805L,,A4649,HCPCS,Facility,Inpatient,,,,779.65,662.7025,223.44769,779.65,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
STAPLE ENDO GIA STRAIGHT  30 2.5 030805L,,A4649,HCPCS,Facility,Both,,,,779.65,662.7025,223.44769,779.65,CorVel,Worker's Compensation,779.65,100,,percent of total billed charges,,
STAPLE ENDO GIA STRAIGHT  30 2.5 030805L,,A4649,HCPCS,Facility,Both,,,,779.65,662.7025,223.44769,779.65,First Health Group Corporation,First Health Network,756.2605,97,,percent of total billed charges,,
STAPLE ENDO GIA STRAIGHT  30 2.5 030805L,,A4649,HCPCS,Facility,Both,,,,779.65,662.7025,223.44769,779.65,"Health Partners, Inc.",Commercial,737.5489,94.6,,percent of total billed charges,,
STAPLE ENDO GIA STRAIGHT  30 2.5 030805L,,A4649,HCPCS,Facility,Outpatient,,,,779.65,662.7025,223.44769,779.65,"Health Partners, Inc.",Medicare Advantage,382.0285,49,,percent of total billed charges,,
STAPLE ENDO GIA STRAIGHT  30 2.5 030805L,,A4649,HCPCS,Facility,Inpatient,,,,779.65,662.7025,223.44769,779.65,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
STAPLE ENDO GIA STRAIGHT  30 2.5 030805L,,A4649,HCPCS,Facility,Both,,,,779.65,662.7025,223.44769,779.65,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),467.79,60,,percent of total billed charges,,
STAPLE ENDO GIA STRAIGHT  30 2.5 030805L,,A4649,HCPCS,Facility,Both,,,,779.65,662.7025,223.44769,779.65,"Health Partners, Inc.",State of Minnesota Advantage Program,635.41475,81.5,,percent of total billed charges,,
STAPLE ENDO GIA STRAIGHT  30 2.5 030805L,,A4649,HCPCS,Facility,Both,,,,779.65,662.7025,223.44769,779.65,"Health Partners, Inc.",State Public Programs,389.825,50,,percent of total billed charges,,
STAPLE ENDO GIA STRAIGHT  30 2.5 030805L,,A4649,HCPCS,Facility,Both,,,,779.65,662.7025,223.44769,779.65,Humana Insurance Company,Commercial PPO,740.6675,95,,percent of total billed charges,,
STAPLE ENDO GIA STRAIGHT  30 2.5 030805L,,A4649,HCPCS,Facility,Outpatient,,,,779.65,662.7025,223.44769,779.65,Humana Insurance Company,Medicare PPO,382.0285,49,,percent of total billed charges,,
STAPLE ENDO GIA STRAIGHT  30 2.5 030805L,,A4649,HCPCS,Facility,Inpatient,,,,779.65,662.7025,223.44769,779.65,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
STAPLE ENDO GIA STRAIGHT  30 2.5 030805L,,A4649,HCPCS,Facility,Both,,,,779.65,662.7025,223.44769,779.65,Medica,Individual & Family,772.63315,99.1,,percent of total billed charges,,
STAPLE ENDO GIA STRAIGHT  30 2.5 030805L,,A4649,HCPCS,Facility,Outpatient,,,,779.65,662.7025,223.44769,779.65,Medica,Medica Advantage Solution,388.2657,49.8,,percent of total billed charges,,
STAPLE ENDO GIA STRAIGHT  30 2.5 030805L,,A4649,HCPCS,Facility,Inpatient,,,,779.65,662.7025,223.44769,779.65,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
STAPLE ENDO GIA STRAIGHT  30 2.5 030805L,,A4649,HCPCS,Facility,Outpatient,,,,779.65,662.7025,223.44769,779.65,Medica,Medical Assistance,347.7239,44.6,,percent of total billed charges,,
STAPLE ENDO GIA STRAIGHT  30 2.5 030805L,,A4649,HCPCS,Facility,Inpatient,,,,779.65,662.7025,223.44769,779.65,Medica,Medical Assistance,,,,,Included in per diem rate,
STAPLE ENDO GIA STRAIGHT  30 2.5 030805L,,A4649,HCPCS,Facility,Outpatient,,,,779.65,662.7025,223.44769,779.65,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,388.2657,49.8,,percent of total billed charges,,
STAPLE ENDO GIA STRAIGHT  30 2.5 030805L,,A4649,HCPCS,Facility,Inpatient,,,,779.65,662.7025,223.44769,779.65,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
STAPLE ENDO GIA STRAIGHT  30 2.5 030805L,,A4649,HCPCS,Facility,Both,,,,779.65,662.7025,223.44769,779.65,"Multiplan, Inc.","Multiplan, Inc.",732.871,94,,percent of total billed charges,,
STAPLE ENDO GIA STRAIGHT  30 2.5 030805L,,A4649,HCPCS,Facility,Outpatient,,,,779.65,662.7025,223.44769,779.65,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,702.46465,90.1,,percent of total billed charges,,
STAPLE ENDO GIA STRAIGHT  30 2.5 030805L,,A4649,HCPCS,Facility,Inpatient,,,,779.65,662.7025,223.44769,779.65,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
STAPLE ENDO GIA STRAIGHT  30 2.5 030805L,,A4649,HCPCS,Facility,Both,,,,779.65,662.7025,223.44769,779.65,"Preferred One Administrative Services, INC.",PPO,768.7349,98.6,,percent of total billed charges,,
STAPLE ENDO GIA STRAIGHT  30 2.5 030805L,,A4649,HCPCS,Facility,Outpatient,,,,779.65,662.7025,223.44769,779.65,PrimeWest Health,Minnesota Senior Health Options (MSHO),401.129925,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
STAPLE ENDO GIA STRAIGHT  30 2.5 030805L,,A4649,HCPCS,Facility,Inpatient,,,,779.65,662.7025,223.44769,779.65,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
STAPLE ENDO GIA STRAIGHT  30 2.5 030805L,,A4649,HCPCS,Facility,Outpatient,,,,779.65,662.7025,223.44769,779.65,PrimeWest Health,MinnesotaCare,400.42824,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
STAPLE ENDO GIA STRAIGHT  30 2.5 030805L,,A4649,HCPCS,Facility,Inpatient,,,,779.65,662.7025,223.44769,779.65,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
STAPLE ENDO GIA STRAIGHT  30 2.5 030805L,,A4649,HCPCS,Facility,Both,,,,779.65,662.7025,223.44769,779.65,Sanford Health Plan,Sanford Health Plan,717.278,92,,percent of total billed charges,,
STAPLE ENDO GIA STRAIGHT  30 2.5 030805L,,A4649,HCPCS,Facility,Outpatient,,,,779.65,662.7025,223.44769,779.65,"UCare Health, Inc.",Individual & Family Plan,439.332775,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
STAPLE ENDO GIA STRAIGHT  30 2.5 030805L,,A4649,HCPCS,Facility,Inpatient,,,,779.65,662.7025,223.44769,779.65,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
STAPLE ENDO GIA STRAIGHT  30 2.5 030805L,,A4649,HCPCS,Facility,Outpatient,,,,779.65,662.7025,223.44769,779.65,"UCare Health, Inc.",Medical Assistance,393.489355,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
STAPLE ENDO GIA STRAIGHT  30 2.5 030805L,,A4649,HCPCS,Facility,Inpatient,,,,779.65,662.7025,223.44769,779.65,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
STAPLE ENDO GIA STRAIGHT  30 2.5 030805L,,A4649,HCPCS,Facility,Outpatient,,,,779.65,662.7025,223.44769,779.65,"UCare Health, Inc.",Medicare Advantage,393.489355,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
STAPLE ENDO GIA STRAIGHT  30 2.5 030805L,,A4649,HCPCS,Facility,Inpatient,,,,779.65,662.7025,223.44769,779.65,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
STAPLE ENDO GIA STRAIGHT  30 2.5 030805L,,A4649,HCPCS,Facility,Outpatient,,,,779.65,662.7025,223.44769,779.65,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),393.489355,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
STAPLE ENDO GIA STRAIGHT  30 2.5 030805L,,A4649,HCPCS,Facility,Inpatient,,,,779.65,662.7025,223.44769,779.65,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
STAPLE ENDO GIA STRAIGHT  30 2.5 030805L,,A4649,HCPCS,Facility,Both,,,,779.65,662.7025,223.44769,779.65,UnitedHealthcare,Individual & Family,732.871,94,,percent of total billed charges,,
STAPLE ENDO GIA STRAIGHT  30 2.5 030805L,,A4649,HCPCS,Facility,Outpatient,,,,779.65,662.7025,223.44769,779.65,UnitedHealthcare,Medicare Advantage,382.0285,49,,percent of total billed charges,,
STAPLE ENDO GIA STRAIGHT  30 2.5 030805L,,A4649,HCPCS,Facility,Inpatient,,,,779.65,662.7025,223.44769,779.65,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
STAPLE ENDO GIA STRAIGHT  30 2.5 030805L,,A4649,HCPCS,Facility,Outpatient,,,,779.65,662.7025,223.44769,779.65,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,374.232,48,,percent of total billed charges,,100% of DHS outpatient percentage
STAPLE ENDO GIA STRAIGHT  30 2.5 030805L,,A4649,HCPCS,Facility,Inpatient,,,,779.65,662.7025,223.44769,779.65,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
STAPLE LOAD (BLUE) GIA MULTIFIRE 80 MM 3.8  GIA8038L,,A4649,HCPCS,Facility,Both,,,,667.075,567.01375,191.183695,667.075,Aetna,Commercial,613.709,92,,percent of total billed charges,,
STAPLE LOAD (BLUE) GIA MULTIFIRE 80 MM 3.8  GIA8038L,,A4649,HCPCS,Facility,Outpatient,,,,667.075,567.01375,191.183695,667.075,Aetna,Medicare Advantage,326.86675,49,,percent of total billed charges,,
STAPLE LOAD (BLUE) GIA MULTIFIRE 80 MM 3.8  GIA8038L,,A4649,HCPCS,Facility,Inpatient,,,,667.075,567.01375,191.183695,667.075,Aetna,Medicare Advantage,,,,,Included in per diem rate,
STAPLE LOAD (BLUE) GIA MULTIFIRE 80 MM 3.8  GIA8038L,,A4649,HCPCS,Facility,Both,,,,667.075,567.01375,191.183695,667.075,Aetna,PPO,620.37975,93,,percent of total billed charges,,
STAPLE LOAD (BLUE) GIA MULTIFIRE 80 MM 3.8  GIA8038L,,A4649,HCPCS,Facility,Both,,,,667.075,567.01375,191.183695,667.075,America's PPO,America's PPO,640.5921225,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
STAPLE LOAD (BLUE) GIA MULTIFIRE 80 MM 3.8  GIA8038L,,A4649,HCPCS,Facility,Both,,,,667.075,567.01375,191.183695,667.075,BlueCross BlueShield Minnesota, Federal Employee Program,656.4018,98.4,,percent of total billed charges,,
STAPLE LOAD (BLUE) GIA MULTIFIRE 80 MM 3.8  GIA8038L,,A4649,HCPCS,Facility,Both,,,,667.075,567.01375,191.183695,667.075,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,667.075,100,,percent of total billed charges,,
STAPLE LOAD (BLUE) GIA MULTIFIRE 80 MM 3.8  GIA8038L,,A4649,HCPCS,Facility,Both,,,,667.075,567.01375,191.183695,667.075,BlueCross BlueShield Minnesota,High Value Network Plan,600.3675,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
STAPLE LOAD (BLUE) GIA MULTIFIRE 80 MM 3.8  GIA8038L,,A4649,HCPCS,Facility,Outpatient,,,,667.075,567.01375,191.183695,667.075,BlueCross BlueShield Minnesota,Medicare Advantage,326.86675,49,,percent of total billed charges,,
STAPLE LOAD (BLUE) GIA MULTIFIRE 80 MM 3.8  GIA8038L,,A4649,HCPCS,Facility,Inpatient,,,,667.075,567.01375,191.183695,667.075,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
STAPLE LOAD (BLUE) GIA MULTIFIRE 80 MM 3.8  GIA8038L,,A4649,HCPCS,Facility,Both,,,,667.075,567.01375,191.183695,667.075,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,590.8283275,88.57,,percent of total billed charges,,
STAPLE LOAD (BLUE) GIA MULTIFIRE 80 MM 3.8  GIA8038L,,A4649,HCPCS,Facility,Both,,,,667.075,567.01375,191.183695,667.075,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,191.183695,28.66,,percent of total billed charges,,
STAPLE LOAD (BLUE) GIA MULTIFIRE 80 MM 3.8  GIA8038L,,A4649,HCPCS,Facility,Outpatient,,,,667.075,567.01375,191.183695,667.075,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),326.86675,49,,percent of total billed charges,,
STAPLE LOAD (BLUE) GIA MULTIFIRE 80 MM 3.8  GIA8038L,,A4649,HCPCS,Facility,Inpatient,,,,667.075,567.01375,191.183695,667.075,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
STAPLE LOAD (BLUE) GIA MULTIFIRE 80 MM 3.8  GIA8038L,,A4649,HCPCS,Facility,Both,,,,667.075,567.01375,191.183695,667.075,CorVel,Worker's Compensation,667.075,100,,percent of total billed charges,,
STAPLE LOAD (BLUE) GIA MULTIFIRE 80 MM 3.8  GIA8038L,,A4649,HCPCS,Facility,Both,,,,667.075,567.01375,191.183695,667.075,First Health Group Corporation,First Health Network,647.06275,97,,percent of total billed charges,,
STAPLE LOAD (BLUE) GIA MULTIFIRE 80 MM 3.8  GIA8038L,,A4649,HCPCS,Facility,Both,,,,667.075,567.01375,191.183695,667.075,"Health Partners, Inc.",Commercial,631.05295,94.6,,percent of total billed charges,,
STAPLE LOAD (BLUE) GIA MULTIFIRE 80 MM 3.8  GIA8038L,,A4649,HCPCS,Facility,Outpatient,,,,667.075,567.01375,191.183695,667.075,"Health Partners, Inc.",Medicare Advantage,326.86675,49,,percent of total billed charges,,
STAPLE LOAD (BLUE) GIA MULTIFIRE 80 MM 3.8  GIA8038L,,A4649,HCPCS,Facility,Inpatient,,,,667.075,567.01375,191.183695,667.075,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
STAPLE LOAD (BLUE) GIA MULTIFIRE 80 MM 3.8  GIA8038L,,A4649,HCPCS,Facility,Both,,,,667.075,567.01375,191.183695,667.075,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),400.245,60,,percent of total billed charges,,
STAPLE LOAD (BLUE) GIA MULTIFIRE 80 MM 3.8  GIA8038L,,A4649,HCPCS,Facility,Both,,,,667.075,567.01375,191.183695,667.075,"Health Partners, Inc.",State of Minnesota Advantage Program,543.666125,81.5,,percent of total billed charges,,
STAPLE LOAD (BLUE) GIA MULTIFIRE 80 MM 3.8  GIA8038L,,A4649,HCPCS,Facility,Both,,,,667.075,567.01375,191.183695,667.075,"Health Partners, Inc.",State Public Programs,333.5375,50,,percent of total billed charges,,
STAPLE LOAD (BLUE) GIA MULTIFIRE 80 MM 3.8  GIA8038L,,A4649,HCPCS,Facility,Both,,,,667.075,567.01375,191.183695,667.075,Humana Insurance Company,Commercial PPO,633.72125,95,,percent of total billed charges,,
STAPLE LOAD (BLUE) GIA MULTIFIRE 80 MM 3.8  GIA8038L,,A4649,HCPCS,Facility,Outpatient,,,,667.075,567.01375,191.183695,667.075,Humana Insurance Company,Medicare PPO,326.86675,49,,percent of total billed charges,,
STAPLE LOAD (BLUE) GIA MULTIFIRE 80 MM 3.8  GIA8038L,,A4649,HCPCS,Facility,Inpatient,,,,667.075,567.01375,191.183695,667.075,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
STAPLE LOAD (BLUE) GIA MULTIFIRE 80 MM 3.8  GIA8038L,,A4649,HCPCS,Facility,Both,,,,667.075,567.01375,191.183695,667.075,Medica,Individual & Family,661.071325,99.1,,percent of total billed charges,,
STAPLE LOAD (BLUE) GIA MULTIFIRE 80 MM 3.8  GIA8038L,,A4649,HCPCS,Facility,Outpatient,,,,667.075,567.01375,191.183695,667.075,Medica,Medica Advantage Solution,332.20335,49.8,,percent of total billed charges,,
STAPLE LOAD (BLUE) GIA MULTIFIRE 80 MM 3.8  GIA8038L,,A4649,HCPCS,Facility,Inpatient,,,,667.075,567.01375,191.183695,667.075,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
STAPLE LOAD (BLUE) GIA MULTIFIRE 80 MM 3.8  GIA8038L,,A4649,HCPCS,Facility,Outpatient,,,,667.075,567.01375,191.183695,667.075,Medica,Medical Assistance,297.51545,44.6,,percent of total billed charges,,
STAPLE LOAD (BLUE) GIA MULTIFIRE 80 MM 3.8  GIA8038L,,A4649,HCPCS,Facility,Inpatient,,,,667.075,567.01375,191.183695,667.075,Medica,Medical Assistance,,,,,Included in per diem rate,
STAPLE LOAD (BLUE) GIA MULTIFIRE 80 MM 3.8  GIA8038L,,A4649,HCPCS,Facility,Outpatient,,,,667.075,567.01375,191.183695,667.075,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,332.20335,49.8,,percent of total billed charges,,
STAPLE LOAD (BLUE) GIA MULTIFIRE 80 MM 3.8  GIA8038L,,A4649,HCPCS,Facility,Inpatient,,,,667.075,567.01375,191.183695,667.075,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
STAPLE LOAD (BLUE) GIA MULTIFIRE 80 MM 3.8  GIA8038L,,A4649,HCPCS,Facility,Both,,,,667.075,567.01375,191.183695,667.075,"Multiplan, Inc.","Multiplan, Inc.",627.0505,94,,percent of total billed charges,,
STAPLE LOAD (BLUE) GIA MULTIFIRE 80 MM 3.8  GIA8038L,,A4649,HCPCS,Facility,Outpatient,,,,667.075,567.01375,191.183695,667.075,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,601.034575,90.1,,percent of total billed charges,,
STAPLE LOAD (BLUE) GIA MULTIFIRE 80 MM 3.8  GIA8038L,,A4649,HCPCS,Facility,Inpatient,,,,667.075,567.01375,191.183695,667.075,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
STAPLE LOAD (BLUE) GIA MULTIFIRE 80 MM 3.8  GIA8038L,,A4649,HCPCS,Facility,Both,,,,667.075,567.01375,191.183695,667.075,"Preferred One Administrative Services, INC.",PPO,657.73595,98.6,,percent of total billed charges,,
STAPLE LOAD (BLUE) GIA MULTIFIRE 80 MM 3.8  GIA8038L,,A4649,HCPCS,Facility,Outpatient,,,,667.075,567.01375,191.183695,667.075,PrimeWest Health,Minnesota Senior Health Options (MSHO),343.2100875,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
STAPLE LOAD (BLUE) GIA MULTIFIRE 80 MM 3.8  GIA8038L,,A4649,HCPCS,Facility,Inpatient,,,,667.075,567.01375,191.183695,667.075,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
STAPLE LOAD (BLUE) GIA MULTIFIRE 80 MM 3.8  GIA8038L,,A4649,HCPCS,Facility,Outpatient,,,,667.075,567.01375,191.183695,667.075,PrimeWest Health,MinnesotaCare,342.60972,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
STAPLE LOAD (BLUE) GIA MULTIFIRE 80 MM 3.8  GIA8038L,,A4649,HCPCS,Facility,Inpatient,,,,667.075,567.01375,191.183695,667.075,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
STAPLE LOAD (BLUE) GIA MULTIFIRE 80 MM 3.8  GIA8038L,,A4649,HCPCS,Facility,Both,,,,667.075,567.01375,191.183695,667.075,Sanford Health Plan,Sanford Health Plan,613.709,92,,percent of total billed charges,,
STAPLE LOAD (BLUE) GIA MULTIFIRE 80 MM 3.8  GIA8038L,,A4649,HCPCS,Facility,Outpatient,,,,667.075,567.01375,191.183695,667.075,"UCare Health, Inc.",Individual & Family Plan,375.8967625,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
STAPLE LOAD (BLUE) GIA MULTIFIRE 80 MM 3.8  GIA8038L,,A4649,HCPCS,Facility,Inpatient,,,,667.075,567.01375,191.183695,667.075,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
STAPLE LOAD (BLUE) GIA MULTIFIRE 80 MM 3.8  GIA8038L,,A4649,HCPCS,Facility,Outpatient,,,,667.075,567.01375,191.183695,667.075,"UCare Health, Inc.",Medical Assistance,336.6727525,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
STAPLE LOAD (BLUE) GIA MULTIFIRE 80 MM 3.8  GIA8038L,,A4649,HCPCS,Facility,Inpatient,,,,667.075,567.01375,191.183695,667.075,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
STAPLE LOAD (BLUE) GIA MULTIFIRE 80 MM 3.8  GIA8038L,,A4649,HCPCS,Facility,Outpatient,,,,667.075,567.01375,191.183695,667.075,"UCare Health, Inc.",Medicare Advantage,336.6727525,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
STAPLE LOAD (BLUE) GIA MULTIFIRE 80 MM 3.8  GIA8038L,,A4649,HCPCS,Facility,Inpatient,,,,667.075,567.01375,191.183695,667.075,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
STAPLE LOAD (BLUE) GIA MULTIFIRE 80 MM 3.8  GIA8038L,,A4649,HCPCS,Facility,Outpatient,,,,667.075,567.01375,191.183695,667.075,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),336.6727525,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
STAPLE LOAD (BLUE) GIA MULTIFIRE 80 MM 3.8  GIA8038L,,A4649,HCPCS,Facility,Inpatient,,,,667.075,567.01375,191.183695,667.075,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
STAPLE LOAD (BLUE) GIA MULTIFIRE 80 MM 3.8  GIA8038L,,A4649,HCPCS,Facility,Both,,,,667.075,567.01375,191.183695,667.075,UnitedHealthcare,Individual & Family,627.0505,94,,percent of total billed charges,,
STAPLE LOAD (BLUE) GIA MULTIFIRE 80 MM 3.8  GIA8038L,,A4649,HCPCS,Facility,Outpatient,,,,667.075,567.01375,191.183695,667.075,UnitedHealthcare,Medicare Advantage,326.86675,49,,percent of total billed charges,,
STAPLE LOAD (BLUE) GIA MULTIFIRE 80 MM 3.8  GIA8038L,,A4649,HCPCS,Facility,Inpatient,,,,667.075,567.01375,191.183695,667.075,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
STAPLE LOAD (BLUE) GIA MULTIFIRE 80 MM 3.8  GIA8038L,,A4649,HCPCS,Facility,Outpatient,,,,667.075,567.01375,191.183695,667.075,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,320.196,48,,percent of total billed charges,,100% of DHS outpatient percentage
STAPLE LOAD (BLUE) GIA MULTIFIRE 80 MM 3.8  GIA8038L,,A4649,HCPCS,Facility,Inpatient,,,,667.075,567.01375,191.183695,667.075,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
STAPLER DST 90MM 3.5   TA9035S,,A4649,HCPCS,Facility,Both,,,,864.8,735.08,247.85168,864.8,Aetna,Commercial,795.616,92,,percent of total billed charges,,
STAPLER DST 90MM 3.5   TA9035S,,A4649,HCPCS,Facility,Outpatient,,,,864.8,735.08,247.85168,864.8,Aetna,Medicare Advantage,423.752,49,,percent of total billed charges,,
STAPLER DST 90MM 3.5   TA9035S,,A4649,HCPCS,Facility,Inpatient,,,,864.8,735.08,247.85168,864.8,Aetna,Medicare Advantage,,,,,Included in per diem rate,
STAPLER DST 90MM 3.5   TA9035S,,A4649,HCPCS,Facility,Both,,,,864.8,735.08,247.85168,864.8,Aetna,PPO,804.264,93,,percent of total billed charges,,
STAPLER DST 90MM 3.5   TA9035S,,A4649,HCPCS,Facility,Both,,,,864.8,735.08,247.85168,864.8,America's PPO,America's PPO,830.46744,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
STAPLER DST 90MM 3.5   TA9035S,,A4649,HCPCS,Facility,Both,,,,864.8,735.08,247.85168,864.8,BlueCross BlueShield Minnesota, Federal Employee Program,850.9632,98.4,,percent of total billed charges,,
STAPLER DST 90MM 3.5   TA9035S,,A4649,HCPCS,Facility,Both,,,,864.8,735.08,247.85168,864.8,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,864.8,100,,percent of total billed charges,,
STAPLER DST 90MM 3.5   TA9035S,,A4649,HCPCS,Facility,Both,,,,864.8,735.08,247.85168,864.8,BlueCross BlueShield Minnesota,High Value Network Plan,778.32,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
STAPLER DST 90MM 3.5   TA9035S,,A4649,HCPCS,Facility,Outpatient,,,,864.8,735.08,247.85168,864.8,BlueCross BlueShield Minnesota,Medicare Advantage,423.752,49,,percent of total billed charges,,
STAPLER DST 90MM 3.5   TA9035S,,A4649,HCPCS,Facility,Inpatient,,,,864.8,735.08,247.85168,864.8,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
STAPLER DST 90MM 3.5   TA9035S,,A4649,HCPCS,Facility,Both,,,,864.8,735.08,247.85168,864.8,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,765.95336,88.57,,percent of total billed charges,,
STAPLER DST 90MM 3.5   TA9035S,,A4649,HCPCS,Facility,Both,,,,864.8,735.08,247.85168,864.8,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,247.85168,28.66,,percent of total billed charges,,
STAPLER DST 90MM 3.5   TA9035S,,A4649,HCPCS,Facility,Outpatient,,,,864.8,735.08,247.85168,864.8,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),423.752,49,,percent of total billed charges,,
STAPLER DST 90MM 3.5   TA9035S,,A4649,HCPCS,Facility,Inpatient,,,,864.8,735.08,247.85168,864.8,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
STAPLER DST 90MM 3.5   TA9035S,,A4649,HCPCS,Facility,Both,,,,864.8,735.08,247.85168,864.8,CorVel,Worker's Compensation,864.8,100,,percent of total billed charges,,
STAPLER DST 90MM 3.5   TA9035S,,A4649,HCPCS,Facility,Both,,,,864.8,735.08,247.85168,864.8,First Health Group Corporation,First Health Network,838.856,97,,percent of total billed charges,,
STAPLER DST 90MM 3.5   TA9035S,,A4649,HCPCS,Facility,Both,,,,864.8,735.08,247.85168,864.8,"Health Partners, Inc.",Commercial,818.1008,94.6,,percent of total billed charges,,
STAPLER DST 90MM 3.5   TA9035S,,A4649,HCPCS,Facility,Outpatient,,,,864.8,735.08,247.85168,864.8,"Health Partners, Inc.",Medicare Advantage,423.752,49,,percent of total billed charges,,
STAPLER DST 90MM 3.5   TA9035S,,A4649,HCPCS,Facility,Inpatient,,,,864.8,735.08,247.85168,864.8,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
STAPLER DST 90MM 3.5   TA9035S,,A4649,HCPCS,Facility,Both,,,,864.8,735.08,247.85168,864.8,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),518.88,60,,percent of total billed charges,,
STAPLER DST 90MM 3.5   TA9035S,,A4649,HCPCS,Facility,Both,,,,864.8,735.08,247.85168,864.8,"Health Partners, Inc.",State of Minnesota Advantage Program,704.812,81.5,,percent of total billed charges,,
STAPLER DST 90MM 3.5   TA9035S,,A4649,HCPCS,Facility,Both,,,,864.8,735.08,247.85168,864.8,"Health Partners, Inc.",State Public Programs,432.4,50,,percent of total billed charges,,
STAPLER DST 90MM 3.5   TA9035S,,A4649,HCPCS,Facility,Both,,,,864.8,735.08,247.85168,864.8,Humana Insurance Company,Commercial PPO,821.56,95,,percent of total billed charges,,
STAPLER DST 90MM 3.5   TA9035S,,A4649,HCPCS,Facility,Outpatient,,,,864.8,735.08,247.85168,864.8,Humana Insurance Company,Medicare PPO,423.752,49,,percent of total billed charges,,
STAPLER DST 90MM 3.5   TA9035S,,A4649,HCPCS,Facility,Inpatient,,,,864.8,735.08,247.85168,864.8,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
STAPLER DST 90MM 3.5   TA9035S,,A4649,HCPCS,Facility,Both,,,,864.8,735.08,247.85168,864.8,Medica,Individual & Family,857.0168,99.1,,percent of total billed charges,,
STAPLER DST 90MM 3.5   TA9035S,,A4649,HCPCS,Facility,Outpatient,,,,864.8,735.08,247.85168,864.8,Medica,Medica Advantage Solution,430.6704,49.8,,percent of total billed charges,,
STAPLER DST 90MM 3.5   TA9035S,,A4649,HCPCS,Facility,Inpatient,,,,864.8,735.08,247.85168,864.8,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
STAPLER DST 90MM 3.5   TA9035S,,A4649,HCPCS,Facility,Outpatient,,,,864.8,735.08,247.85168,864.8,Medica,Medical Assistance,385.7008,44.6,,percent of total billed charges,,
STAPLER DST 90MM 3.5   TA9035S,,A4649,HCPCS,Facility,Inpatient,,,,864.8,735.08,247.85168,864.8,Medica,Medical Assistance,,,,,Included in per diem rate,
STAPLER DST 90MM 3.5   TA9035S,,A4649,HCPCS,Facility,Outpatient,,,,864.8,735.08,247.85168,864.8,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,430.6704,49.8,,percent of total billed charges,,
STAPLER DST 90MM 3.5   TA9035S,,A4649,HCPCS,Facility,Inpatient,,,,864.8,735.08,247.85168,864.8,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
STAPLER DST 90MM 3.5   TA9035S,,A4649,HCPCS,Facility,Both,,,,864.8,735.08,247.85168,864.8,"Multiplan, Inc.","Multiplan, Inc.",812.912,94,,percent of total billed charges,,
STAPLER DST 90MM 3.5   TA9035S,,A4649,HCPCS,Facility,Outpatient,,,,864.8,735.08,247.85168,864.8,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,779.1848,90.1,,percent of total billed charges,,
STAPLER DST 90MM 3.5   TA9035S,,A4649,HCPCS,Facility,Inpatient,,,,864.8,735.08,247.85168,864.8,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
STAPLER DST 90MM 3.5   TA9035S,,A4649,HCPCS,Facility,Both,,,,864.8,735.08,247.85168,864.8,"Preferred One Administrative Services, INC.",PPO,852.6928,98.6,,percent of total billed charges,,
STAPLER DST 90MM 3.5   TA9035S,,A4649,HCPCS,Facility,Outpatient,,,,864.8,735.08,247.85168,864.8,PrimeWest Health,Minnesota Senior Health Options (MSHO),444.9396,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
STAPLER DST 90MM 3.5   TA9035S,,A4649,HCPCS,Facility,Inpatient,,,,864.8,735.08,247.85168,864.8,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
STAPLER DST 90MM 3.5   TA9035S,,A4649,HCPCS,Facility,Outpatient,,,,864.8,735.08,247.85168,864.8,PrimeWest Health,MinnesotaCare,444.16128,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
STAPLER DST 90MM 3.5   TA9035S,,A4649,HCPCS,Facility,Inpatient,,,,864.8,735.08,247.85168,864.8,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
STAPLER DST 90MM 3.5   TA9035S,,A4649,HCPCS,Facility,Both,,,,864.8,735.08,247.85168,864.8,Sanford Health Plan,Sanford Health Plan,795.616,92,,percent of total billed charges,,
STAPLER DST 90MM 3.5   TA9035S,,A4649,HCPCS,Facility,Outpatient,,,,864.8,735.08,247.85168,864.8,"UCare Health, Inc.",Individual & Family Plan,487.3148,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
STAPLER DST 90MM 3.5   TA9035S,,A4649,HCPCS,Facility,Inpatient,,,,864.8,735.08,247.85168,864.8,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
STAPLER DST 90MM 3.5   TA9035S,,A4649,HCPCS,Facility,Outpatient,,,,864.8,735.08,247.85168,864.8,"UCare Health, Inc.",Medical Assistance,436.46456,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
STAPLER DST 90MM 3.5   TA9035S,,A4649,HCPCS,Facility,Inpatient,,,,864.8,735.08,247.85168,864.8,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
STAPLER DST 90MM 3.5   TA9035S,,A4649,HCPCS,Facility,Outpatient,,,,864.8,735.08,247.85168,864.8,"UCare Health, Inc.",Medicare Advantage,436.46456,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
STAPLER DST 90MM 3.5   TA9035S,,A4649,HCPCS,Facility,Inpatient,,,,864.8,735.08,247.85168,864.8,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
STAPLER DST 90MM 3.5   TA9035S,,A4649,HCPCS,Facility,Outpatient,,,,864.8,735.08,247.85168,864.8,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),436.46456,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
STAPLER DST 90MM 3.5   TA9035S,,A4649,HCPCS,Facility,Inpatient,,,,864.8,735.08,247.85168,864.8,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
STAPLER DST 90MM 3.5   TA9035S,,A4649,HCPCS,Facility,Both,,,,864.8,735.08,247.85168,864.8,UnitedHealthcare,Individual & Family,812.912,94,,percent of total billed charges,,
STAPLER DST 90MM 3.5   TA9035S,,A4649,HCPCS,Facility,Outpatient,,,,864.8,735.08,247.85168,864.8,UnitedHealthcare,Medicare Advantage,423.752,49,,percent of total billed charges,,
STAPLER DST 90MM 3.5   TA9035S,,A4649,HCPCS,Facility,Inpatient,,,,864.8,735.08,247.85168,864.8,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
STAPLER DST 90MM 3.5   TA9035S,,A4649,HCPCS,Facility,Outpatient,,,,864.8,735.08,247.85168,864.8,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,415.104,48,,percent of total billed charges,,100% of DHS outpatient percentage
STAPLER DST 90MM 3.5   TA9035S,,A4649,HCPCS,Facility,Inpatient,,,,864.8,735.08,247.85168,864.8,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
STAPLER DST GIA 80MM 3.8  GIA8038S,,A4649,HCPCS,Facility,Both,,,,1028.16,873.936,294.670656,1028.16,Aetna,Commercial,945.9072,92,,percent of total billed charges,,
STAPLER DST GIA 80MM 3.8  GIA8038S,,A4649,HCPCS,Facility,Outpatient,,,,1028.16,873.936,294.670656,1028.16,Aetna,Medicare Advantage,503.7984,49,,percent of total billed charges,,
STAPLER DST GIA 80MM 3.8  GIA8038S,,A4649,HCPCS,Facility,Inpatient,,,,1028.16,873.936,294.670656,1028.16,Aetna,Medicare Advantage,,,,,Included in per diem rate,
STAPLER DST GIA 80MM 3.8  GIA8038S,,A4649,HCPCS,Facility,Both,,,,1028.16,873.936,294.670656,1028.16,Aetna,PPO,956.1888,93,,percent of total billed charges,,
STAPLER DST GIA 80MM 3.8  GIA8038S,,A4649,HCPCS,Facility,Both,,,,1028.16,873.936,294.670656,1028.16,America's PPO,America's PPO,987.342048,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
STAPLER DST GIA 80MM 3.8  GIA8038S,,A4649,HCPCS,Facility,Both,,,,1028.16,873.936,294.670656,1028.16,BlueCross BlueShield Minnesota, Federal Employee Program,1011.70944,98.4,,percent of total billed charges,,
STAPLER DST GIA 80MM 3.8  GIA8038S,,A4649,HCPCS,Facility,Both,,,,1028.16,873.936,294.670656,1028.16,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1028.16,100,,percent of total billed charges,,
STAPLER DST GIA 80MM 3.8  GIA8038S,,A4649,HCPCS,Facility,Both,,,,1028.16,873.936,294.670656,1028.16,BlueCross BlueShield Minnesota,High Value Network Plan,925.344,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
STAPLER DST GIA 80MM 3.8  GIA8038S,,A4649,HCPCS,Facility,Outpatient,,,,1028.16,873.936,294.670656,1028.16,BlueCross BlueShield Minnesota,Medicare Advantage,503.7984,49,,percent of total billed charges,,
STAPLER DST GIA 80MM 3.8  GIA8038S,,A4649,HCPCS,Facility,Inpatient,,,,1028.16,873.936,294.670656,1028.16,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
STAPLER DST GIA 80MM 3.8  GIA8038S,,A4649,HCPCS,Facility,Both,,,,1028.16,873.936,294.670656,1028.16,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,910.641312,88.57,,percent of total billed charges,,
STAPLER DST GIA 80MM 3.8  GIA8038S,,A4649,HCPCS,Facility,Both,,,,1028.16,873.936,294.670656,1028.16,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,294.670656,28.66,,percent of total billed charges,,
STAPLER DST GIA 80MM 3.8  GIA8038S,,A4649,HCPCS,Facility,Outpatient,,,,1028.16,873.936,294.670656,1028.16,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),503.7984,49,,percent of total billed charges,,
STAPLER DST GIA 80MM 3.8  GIA8038S,,A4649,HCPCS,Facility,Inpatient,,,,1028.16,873.936,294.670656,1028.16,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
STAPLER DST GIA 80MM 3.8  GIA8038S,,A4649,HCPCS,Facility,Both,,,,1028.16,873.936,294.670656,1028.16,CorVel,Worker's Compensation,1028.16,100,,percent of total billed charges,,
STAPLER DST GIA 80MM 3.8  GIA8038S,,A4649,HCPCS,Facility,Both,,,,1028.16,873.936,294.670656,1028.16,First Health Group Corporation,First Health Network,997.3152,97,,percent of total billed charges,,
STAPLER DST GIA 80MM 3.8  GIA8038S,,A4649,HCPCS,Facility,Both,,,,1028.16,873.936,294.670656,1028.16,"Health Partners, Inc.",Commercial,972.63936,94.6,,percent of total billed charges,,
STAPLER DST GIA 80MM 3.8  GIA8038S,,A4649,HCPCS,Facility,Outpatient,,,,1028.16,873.936,294.670656,1028.16,"Health Partners, Inc.",Medicare Advantage,503.7984,49,,percent of total billed charges,,
STAPLER DST GIA 80MM 3.8  GIA8038S,,A4649,HCPCS,Facility,Inpatient,,,,1028.16,873.936,294.670656,1028.16,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
STAPLER DST GIA 80MM 3.8  GIA8038S,,A4649,HCPCS,Facility,Both,,,,1028.16,873.936,294.670656,1028.16,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),616.896,60,,percent of total billed charges,,
STAPLER DST GIA 80MM 3.8  GIA8038S,,A4649,HCPCS,Facility,Both,,,,1028.16,873.936,294.670656,1028.16,"Health Partners, Inc.",State of Minnesota Advantage Program,837.9504,81.5,,percent of total billed charges,,
STAPLER DST GIA 80MM 3.8  GIA8038S,,A4649,HCPCS,Facility,Both,,,,1028.16,873.936,294.670656,1028.16,"Health Partners, Inc.",State Public Programs,514.08,50,,percent of total billed charges,,
STAPLER DST GIA 80MM 3.8  GIA8038S,,A4649,HCPCS,Facility,Both,,,,1028.16,873.936,294.670656,1028.16,Humana Insurance Company,Commercial PPO,976.752,95,,percent of total billed charges,,
STAPLER DST GIA 80MM 3.8  GIA8038S,,A4649,HCPCS,Facility,Outpatient,,,,1028.16,873.936,294.670656,1028.16,Humana Insurance Company,Medicare PPO,503.7984,49,,percent of total billed charges,,
STAPLER DST GIA 80MM 3.8  GIA8038S,,A4649,HCPCS,Facility,Inpatient,,,,1028.16,873.936,294.670656,1028.16,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
STAPLER DST GIA 80MM 3.8  GIA8038S,,A4649,HCPCS,Facility,Both,,,,1028.16,873.936,294.670656,1028.16,Medica,Individual & Family,1018.90656,99.1,,percent of total billed charges,,
STAPLER DST GIA 80MM 3.8  GIA8038S,,A4649,HCPCS,Facility,Outpatient,,,,1028.16,873.936,294.670656,1028.16,Medica,Medica Advantage Solution,512.02368,49.8,,percent of total billed charges,,
STAPLER DST GIA 80MM 3.8  GIA8038S,,A4649,HCPCS,Facility,Inpatient,,,,1028.16,873.936,294.670656,1028.16,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
STAPLER DST GIA 80MM 3.8  GIA8038S,,A4649,HCPCS,Facility,Outpatient,,,,1028.16,873.936,294.670656,1028.16,Medica,Medical Assistance,458.55936,44.6,,percent of total billed charges,,
STAPLER DST GIA 80MM 3.8  GIA8038S,,A4649,HCPCS,Facility,Inpatient,,,,1028.16,873.936,294.670656,1028.16,Medica,Medical Assistance,,,,,Included in per diem rate,
STAPLER DST GIA 80MM 3.8  GIA8038S,,A4649,HCPCS,Facility,Outpatient,,,,1028.16,873.936,294.670656,1028.16,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,512.02368,49.8,,percent of total billed charges,,
STAPLER DST GIA 80MM 3.8  GIA8038S,,A4649,HCPCS,Facility,Inpatient,,,,1028.16,873.936,294.670656,1028.16,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
STAPLER DST GIA 80MM 3.8  GIA8038S,,A4649,HCPCS,Facility,Both,,,,1028.16,873.936,294.670656,1028.16,"Multiplan, Inc.","Multiplan, Inc.",966.4704,94,,percent of total billed charges,,
STAPLER DST GIA 80MM 3.8  GIA8038S,,A4649,HCPCS,Facility,Outpatient,,,,1028.16,873.936,294.670656,1028.16,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,926.37216,90.1,,percent of total billed charges,,
STAPLER DST GIA 80MM 3.8  GIA8038S,,A4649,HCPCS,Facility,Inpatient,,,,1028.16,873.936,294.670656,1028.16,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
STAPLER DST GIA 80MM 3.8  GIA8038S,,A4649,HCPCS,Facility,Both,,,,1028.16,873.936,294.670656,1028.16,"Preferred One Administrative Services, INC.",PPO,1013.76576,98.6,,percent of total billed charges,,
STAPLER DST GIA 80MM 3.8  GIA8038S,,A4649,HCPCS,Facility,Outpatient,,,,1028.16,873.936,294.670656,1028.16,PrimeWest Health,Minnesota Senior Health Options (MSHO),528.98832,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
STAPLER DST GIA 80MM 3.8  GIA8038S,,A4649,HCPCS,Facility,Inpatient,,,,1028.16,873.936,294.670656,1028.16,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
STAPLER DST GIA 80MM 3.8  GIA8038S,,A4649,HCPCS,Facility,Outpatient,,,,1028.16,873.936,294.670656,1028.16,PrimeWest Health,MinnesotaCare,528.062976,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
STAPLER DST GIA 80MM 3.8  GIA8038S,,A4649,HCPCS,Facility,Inpatient,,,,1028.16,873.936,294.670656,1028.16,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
STAPLER DST GIA 80MM 3.8  GIA8038S,,A4649,HCPCS,Facility,Both,,,,1028.16,873.936,294.670656,1028.16,Sanford Health Plan,Sanford Health Plan,945.9072,92,,percent of total billed charges,,
STAPLER DST GIA 80MM 3.8  GIA8038S,,A4649,HCPCS,Facility,Outpatient,,,,1028.16,873.936,294.670656,1028.16,"UCare Health, Inc.",Individual & Family Plan,579.36816,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
STAPLER DST GIA 80MM 3.8  GIA8038S,,A4649,HCPCS,Facility,Inpatient,,,,1028.16,873.936,294.670656,1028.16,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
STAPLER DST GIA 80MM 3.8  GIA8038S,,A4649,HCPCS,Facility,Outpatient,,,,1028.16,873.936,294.670656,1028.16,"UCare Health, Inc.",Medical Assistance,518.912352,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
STAPLER DST GIA 80MM 3.8  GIA8038S,,A4649,HCPCS,Facility,Inpatient,,,,1028.16,873.936,294.670656,1028.16,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
STAPLER DST GIA 80MM 3.8  GIA8038S,,A4649,HCPCS,Facility,Outpatient,,,,1028.16,873.936,294.670656,1028.16,"UCare Health, Inc.",Medicare Advantage,518.912352,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
STAPLER DST GIA 80MM 3.8  GIA8038S,,A4649,HCPCS,Facility,Inpatient,,,,1028.16,873.936,294.670656,1028.16,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
STAPLER DST GIA 80MM 3.8  GIA8038S,,A4649,HCPCS,Facility,Outpatient,,,,1028.16,873.936,294.670656,1028.16,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),518.912352,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
STAPLER DST GIA 80MM 3.8  GIA8038S,,A4649,HCPCS,Facility,Inpatient,,,,1028.16,873.936,294.670656,1028.16,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
STAPLER DST GIA 80MM 3.8  GIA8038S,,A4649,HCPCS,Facility,Both,,,,1028.16,873.936,294.670656,1028.16,UnitedHealthcare,Individual & Family,966.4704,94,,percent of total billed charges,,
STAPLER DST GIA 80MM 3.8  GIA8038S,,A4649,HCPCS,Facility,Outpatient,,,,1028.16,873.936,294.670656,1028.16,UnitedHealthcare,Medicare Advantage,503.7984,49,,percent of total billed charges,,
STAPLER DST GIA 80MM 3.8  GIA8038S,,A4649,HCPCS,Facility,Inpatient,,,,1028.16,873.936,294.670656,1028.16,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
STAPLER DST GIA 80MM 3.8  GIA8038S,,A4649,HCPCS,Facility,Outpatient,,,,1028.16,873.936,294.670656,1028.16,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,493.5168,48,,percent of total billed charges,,100% of DHS outpatient percentage
STAPLER DST GIA 80MM 3.8  GIA8038S,,A4649,HCPCS,Facility,Inpatient,,,,1028.16,873.936,294.670656,1028.16,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
STAPLER ENDO GIA MULTIFIRE 30 3.5MM 030813,,A4649,HCPCS,Facility,Both,,,,1230.32,1045.772,352.609712,1230.32,Aetna,Commercial,1131.8944,92,,percent of total billed charges,,
STAPLER ENDO GIA MULTIFIRE 30 3.5MM 030813,,A4649,HCPCS,Facility,Outpatient,,,,1230.32,1045.772,352.609712,1230.32,Aetna,Medicare Advantage,602.8568,49,,percent of total billed charges,,
STAPLER ENDO GIA MULTIFIRE 30 3.5MM 030813,,A4649,HCPCS,Facility,Inpatient,,,,1230.32,1045.772,352.609712,1230.32,Aetna,Medicare Advantage,,,,,Included in per diem rate,
STAPLER ENDO GIA MULTIFIRE 30 3.5MM 030813,,A4649,HCPCS,Facility,Both,,,,1230.32,1045.772,352.609712,1230.32,Aetna,PPO,1144.1976,93,,percent of total billed charges,,
STAPLER ENDO GIA MULTIFIRE 30 3.5MM 030813,,A4649,HCPCS,Facility,Both,,,,1230.32,1045.772,352.609712,1230.32,America's PPO,America's PPO,1181.476296,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
STAPLER ENDO GIA MULTIFIRE 30 3.5MM 030813,,A4649,HCPCS,Facility,Both,,,,1230.32,1045.772,352.609712,1230.32,BlueCross BlueShield Minnesota, Federal Employee Program,1210.63488,98.4,,percent of total billed charges,,
STAPLER ENDO GIA MULTIFIRE 30 3.5MM 030813,,A4649,HCPCS,Facility,Both,,,,1230.32,1045.772,352.609712,1230.32,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1230.32,100,,percent of total billed charges,,
STAPLER ENDO GIA MULTIFIRE 30 3.5MM 030813,,A4649,HCPCS,Facility,Both,,,,1230.32,1045.772,352.609712,1230.32,BlueCross BlueShield Minnesota,High Value Network Plan,1107.288,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
STAPLER ENDO GIA MULTIFIRE 30 3.5MM 030813,,A4649,HCPCS,Facility,Outpatient,,,,1230.32,1045.772,352.609712,1230.32,BlueCross BlueShield Minnesota,Medicare Advantage,602.8568,49,,percent of total billed charges,,
STAPLER ENDO GIA MULTIFIRE 30 3.5MM 030813,,A4649,HCPCS,Facility,Inpatient,,,,1230.32,1045.772,352.609712,1230.32,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
STAPLER ENDO GIA MULTIFIRE 30 3.5MM 030813,,A4649,HCPCS,Facility,Both,,,,1230.32,1045.772,352.609712,1230.32,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1089.694424,88.57,,percent of total billed charges,,
STAPLER ENDO GIA MULTIFIRE 30 3.5MM 030813,,A4649,HCPCS,Facility,Both,,,,1230.32,1045.772,352.609712,1230.32,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,352.609712,28.66,,percent of total billed charges,,
STAPLER ENDO GIA MULTIFIRE 30 3.5MM 030813,,A4649,HCPCS,Facility,Outpatient,,,,1230.32,1045.772,352.609712,1230.32,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),602.8568,49,,percent of total billed charges,,
STAPLER ENDO GIA MULTIFIRE 30 3.5MM 030813,,A4649,HCPCS,Facility,Inpatient,,,,1230.32,1045.772,352.609712,1230.32,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
STAPLER ENDO GIA MULTIFIRE 30 3.5MM 030813,,A4649,HCPCS,Facility,Both,,,,1230.32,1045.772,352.609712,1230.32,CorVel,Worker's Compensation,1230.32,100,,percent of total billed charges,,
STAPLER ENDO GIA MULTIFIRE 30 3.5MM 030813,,A4649,HCPCS,Facility,Both,,,,1230.32,1045.772,352.609712,1230.32,First Health Group Corporation,First Health Network,1193.4104,97,,percent of total billed charges,,
STAPLER ENDO GIA MULTIFIRE 30 3.5MM 030813,,A4649,HCPCS,Facility,Both,,,,1230.32,1045.772,352.609712,1230.32,"Health Partners, Inc.",Commercial,1163.88272,94.6,,percent of total billed charges,,
STAPLER ENDO GIA MULTIFIRE 30 3.5MM 030813,,A4649,HCPCS,Facility,Outpatient,,,,1230.32,1045.772,352.609712,1230.32,"Health Partners, Inc.",Medicare Advantage,602.8568,49,,percent of total billed charges,,
STAPLER ENDO GIA MULTIFIRE 30 3.5MM 030813,,A4649,HCPCS,Facility,Inpatient,,,,1230.32,1045.772,352.609712,1230.32,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
STAPLER ENDO GIA MULTIFIRE 30 3.5MM 030813,,A4649,HCPCS,Facility,Both,,,,1230.32,1045.772,352.609712,1230.32,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),738.192,60,,percent of total billed charges,,
STAPLER ENDO GIA MULTIFIRE 30 3.5MM 030813,,A4649,HCPCS,Facility,Both,,,,1230.32,1045.772,352.609712,1230.32,"Health Partners, Inc.",State of Minnesota Advantage Program,1002.7108,81.5,,percent of total billed charges,,
STAPLER ENDO GIA MULTIFIRE 30 3.5MM 030813,,A4649,HCPCS,Facility,Both,,,,1230.32,1045.772,352.609712,1230.32,"Health Partners, Inc.",State Public Programs,615.16,50,,percent of total billed charges,,
STAPLER ENDO GIA MULTIFIRE 30 3.5MM 030813,,A4649,HCPCS,Facility,Both,,,,1230.32,1045.772,352.609712,1230.32,Humana Insurance Company,Commercial PPO,1168.804,95,,percent of total billed charges,,
STAPLER ENDO GIA MULTIFIRE 30 3.5MM 030813,,A4649,HCPCS,Facility,Outpatient,,,,1230.32,1045.772,352.609712,1230.32,Humana Insurance Company,Medicare PPO,602.8568,49,,percent of total billed charges,,
STAPLER ENDO GIA MULTIFIRE 30 3.5MM 030813,,A4649,HCPCS,Facility,Inpatient,,,,1230.32,1045.772,352.609712,1230.32,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
STAPLER ENDO GIA MULTIFIRE 30 3.5MM 030813,,A4649,HCPCS,Facility,Both,,,,1230.32,1045.772,352.609712,1230.32,Medica,Individual & Family,1219.24712,99.1,,percent of total billed charges,,
STAPLER ENDO GIA MULTIFIRE 30 3.5MM 030813,,A4649,HCPCS,Facility,Outpatient,,,,1230.32,1045.772,352.609712,1230.32,Medica,Medica Advantage Solution,612.69936,49.8,,percent of total billed charges,,
STAPLER ENDO GIA MULTIFIRE 30 3.5MM 030813,,A4649,HCPCS,Facility,Inpatient,,,,1230.32,1045.772,352.609712,1230.32,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
STAPLER ENDO GIA MULTIFIRE 30 3.5MM 030813,,A4649,HCPCS,Facility,Outpatient,,,,1230.32,1045.772,352.609712,1230.32,Medica,Medical Assistance,548.72272,44.6,,percent of total billed charges,,
STAPLER ENDO GIA MULTIFIRE 30 3.5MM 030813,,A4649,HCPCS,Facility,Inpatient,,,,1230.32,1045.772,352.609712,1230.32,Medica,Medical Assistance,,,,,Included in per diem rate,
STAPLER ENDO GIA MULTIFIRE 30 3.5MM 030813,,A4649,HCPCS,Facility,Outpatient,,,,1230.32,1045.772,352.609712,1230.32,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,612.69936,49.8,,percent of total billed charges,,
STAPLER ENDO GIA MULTIFIRE 30 3.5MM 030813,,A4649,HCPCS,Facility,Inpatient,,,,1230.32,1045.772,352.609712,1230.32,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
STAPLER ENDO GIA MULTIFIRE 30 3.5MM 030813,,A4649,HCPCS,Facility,Both,,,,1230.32,1045.772,352.609712,1230.32,"Multiplan, Inc.","Multiplan, Inc.",1156.5008,94,,percent of total billed charges,,
STAPLER ENDO GIA MULTIFIRE 30 3.5MM 030813,,A4649,HCPCS,Facility,Outpatient,,,,1230.32,1045.772,352.609712,1230.32,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1108.51832,90.1,,percent of total billed charges,,
STAPLER ENDO GIA MULTIFIRE 30 3.5MM 030813,,A4649,HCPCS,Facility,Inpatient,,,,1230.32,1045.772,352.609712,1230.32,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
STAPLER ENDO GIA MULTIFIRE 30 3.5MM 030813,,A4649,HCPCS,Facility,Both,,,,1230.32,1045.772,352.609712,1230.32,"Preferred One Administrative Services, INC.",PPO,1213.09552,98.6,,percent of total billed charges,,
STAPLER ENDO GIA MULTIFIRE 30 3.5MM 030813,,A4649,HCPCS,Facility,Outpatient,,,,1230.32,1045.772,352.609712,1230.32,PrimeWest Health,Minnesota Senior Health Options (MSHO),632.99964,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
STAPLER ENDO GIA MULTIFIRE 30 3.5MM 030813,,A4649,HCPCS,Facility,Inpatient,,,,1230.32,1045.772,352.609712,1230.32,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
STAPLER ENDO GIA MULTIFIRE 30 3.5MM 030813,,A4649,HCPCS,Facility,Outpatient,,,,1230.32,1045.772,352.609712,1230.32,PrimeWest Health,MinnesotaCare,631.892352,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
STAPLER ENDO GIA MULTIFIRE 30 3.5MM 030813,,A4649,HCPCS,Facility,Inpatient,,,,1230.32,1045.772,352.609712,1230.32,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
STAPLER ENDO GIA MULTIFIRE 30 3.5MM 030813,,A4649,HCPCS,Facility,Both,,,,1230.32,1045.772,352.609712,1230.32,Sanford Health Plan,Sanford Health Plan,1131.8944,92,,percent of total billed charges,,
STAPLER ENDO GIA MULTIFIRE 30 3.5MM 030813,,A4649,HCPCS,Facility,Outpatient,,,,1230.32,1045.772,352.609712,1230.32,"UCare Health, Inc.",Individual & Family Plan,693.28532,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
STAPLER ENDO GIA MULTIFIRE 30 3.5MM 030813,,A4649,HCPCS,Facility,Inpatient,,,,1230.32,1045.772,352.609712,1230.32,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
STAPLER ENDO GIA MULTIFIRE 30 3.5MM 030813,,A4649,HCPCS,Facility,Outpatient,,,,1230.32,1045.772,352.609712,1230.32,"UCare Health, Inc.",Medical Assistance,620.942504,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
STAPLER ENDO GIA MULTIFIRE 30 3.5MM 030813,,A4649,HCPCS,Facility,Inpatient,,,,1230.32,1045.772,352.609712,1230.32,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
STAPLER ENDO GIA MULTIFIRE 30 3.5MM 030813,,A4649,HCPCS,Facility,Outpatient,,,,1230.32,1045.772,352.609712,1230.32,"UCare Health, Inc.",Medicare Advantage,620.942504,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
STAPLER ENDO GIA MULTIFIRE 30 3.5MM 030813,,A4649,HCPCS,Facility,Inpatient,,,,1230.32,1045.772,352.609712,1230.32,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
STAPLER ENDO GIA MULTIFIRE 30 3.5MM 030813,,A4649,HCPCS,Facility,Outpatient,,,,1230.32,1045.772,352.609712,1230.32,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),620.942504,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
STAPLER ENDO GIA MULTIFIRE 30 3.5MM 030813,,A4649,HCPCS,Facility,Inpatient,,,,1230.32,1045.772,352.609712,1230.32,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
STAPLER ENDO GIA MULTIFIRE 30 3.5MM 030813,,A4649,HCPCS,Facility,Both,,,,1230.32,1045.772,352.609712,1230.32,UnitedHealthcare,Individual & Family,1156.5008,94,,percent of total billed charges,,
STAPLER ENDO GIA MULTIFIRE 30 3.5MM 030813,,A4649,HCPCS,Facility,Outpatient,,,,1230.32,1045.772,352.609712,1230.32,UnitedHealthcare,Medicare Advantage,602.8568,49,,percent of total billed charges,,
STAPLER ENDO GIA MULTIFIRE 30 3.5MM 030813,,A4649,HCPCS,Facility,Inpatient,,,,1230.32,1045.772,352.609712,1230.32,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
STAPLER ENDO GIA MULTIFIRE 30 3.5MM 030813,,A4649,HCPCS,Facility,Outpatient,,,,1230.32,1045.772,352.609712,1230.32,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,590.5536,48,,percent of total billed charges,,100% of DHS outpatient percentage
STAPLER ENDO GIA MULTIFIRE 30 3.5MM 030813,,A4649,HCPCS,Facility,Inpatient,,,,1230.32,1045.772,352.609712,1230.32,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
STAPLER ENDO GIA STRAIGHT 30 2.5 030811,,A4649,HCPCS,Facility,Both,,,,1230.32,1045.772,352.609712,1230.32,Aetna,Commercial,1131.8944,92,,percent of total billed charges,,
STAPLER ENDO GIA STRAIGHT 30 2.5 030811,,A4649,HCPCS,Facility,Outpatient,,,,1230.32,1045.772,352.609712,1230.32,Aetna,Medicare Advantage,602.8568,49,,percent of total billed charges,,
STAPLER ENDO GIA STRAIGHT 30 2.5 030811,,A4649,HCPCS,Facility,Inpatient,,,,1230.32,1045.772,352.609712,1230.32,Aetna,Medicare Advantage,,,,,Included in per diem rate,
STAPLER ENDO GIA STRAIGHT 30 2.5 030811,,A4649,HCPCS,Facility,Both,,,,1230.32,1045.772,352.609712,1230.32,Aetna,PPO,1144.1976,93,,percent of total billed charges,,
STAPLER ENDO GIA STRAIGHT 30 2.5 030811,,A4649,HCPCS,Facility,Both,,,,1230.32,1045.772,352.609712,1230.32,America's PPO,America's PPO,1181.476296,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
STAPLER ENDO GIA STRAIGHT 30 2.5 030811,,A4649,HCPCS,Facility,Both,,,,1230.32,1045.772,352.609712,1230.32,BlueCross BlueShield Minnesota, Federal Employee Program,1210.63488,98.4,,percent of total billed charges,,
STAPLER ENDO GIA STRAIGHT 30 2.5 030811,,A4649,HCPCS,Facility,Both,,,,1230.32,1045.772,352.609712,1230.32,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1230.32,100,,percent of total billed charges,,
STAPLER ENDO GIA STRAIGHT 30 2.5 030811,,A4649,HCPCS,Facility,Both,,,,1230.32,1045.772,352.609712,1230.32,BlueCross BlueShield Minnesota,High Value Network Plan,1107.288,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
STAPLER ENDO GIA STRAIGHT 30 2.5 030811,,A4649,HCPCS,Facility,Outpatient,,,,1230.32,1045.772,352.609712,1230.32,BlueCross BlueShield Minnesota,Medicare Advantage,602.8568,49,,percent of total billed charges,,
STAPLER ENDO GIA STRAIGHT 30 2.5 030811,,A4649,HCPCS,Facility,Inpatient,,,,1230.32,1045.772,352.609712,1230.32,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
STAPLER ENDO GIA STRAIGHT 30 2.5 030811,,A4649,HCPCS,Facility,Both,,,,1230.32,1045.772,352.609712,1230.32,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1089.694424,88.57,,percent of total billed charges,,
STAPLER ENDO GIA STRAIGHT 30 2.5 030811,,A4649,HCPCS,Facility,Both,,,,1230.32,1045.772,352.609712,1230.32,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,352.609712,28.66,,percent of total billed charges,,
STAPLER ENDO GIA STRAIGHT 30 2.5 030811,,A4649,HCPCS,Facility,Outpatient,,,,1230.32,1045.772,352.609712,1230.32,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),602.8568,49,,percent of total billed charges,,
STAPLER ENDO GIA STRAIGHT 30 2.5 030811,,A4649,HCPCS,Facility,Inpatient,,,,1230.32,1045.772,352.609712,1230.32,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
STAPLER ENDO GIA STRAIGHT 30 2.5 030811,,A4649,HCPCS,Facility,Both,,,,1230.32,1045.772,352.609712,1230.32,CorVel,Worker's Compensation,1230.32,100,,percent of total billed charges,,
STAPLER ENDO GIA STRAIGHT 30 2.5 030811,,A4649,HCPCS,Facility,Both,,,,1230.32,1045.772,352.609712,1230.32,First Health Group Corporation,First Health Network,1193.4104,97,,percent of total billed charges,,
STAPLER ENDO GIA STRAIGHT 30 2.5 030811,,A4649,HCPCS,Facility,Both,,,,1230.32,1045.772,352.609712,1230.32,"Health Partners, Inc.",Commercial,1163.88272,94.6,,percent of total billed charges,,
STAPLER ENDO GIA STRAIGHT 30 2.5 030811,,A4649,HCPCS,Facility,Outpatient,,,,1230.32,1045.772,352.609712,1230.32,"Health Partners, Inc.",Medicare Advantage,602.8568,49,,percent of total billed charges,,
STAPLER ENDO GIA STRAIGHT 30 2.5 030811,,A4649,HCPCS,Facility,Inpatient,,,,1230.32,1045.772,352.609712,1230.32,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
STAPLER ENDO GIA STRAIGHT 30 2.5 030811,,A4649,HCPCS,Facility,Both,,,,1230.32,1045.772,352.609712,1230.32,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),738.192,60,,percent of total billed charges,,
STAPLER ENDO GIA STRAIGHT 30 2.5 030811,,A4649,HCPCS,Facility,Both,,,,1230.32,1045.772,352.609712,1230.32,"Health Partners, Inc.",State of Minnesota Advantage Program,1002.7108,81.5,,percent of total billed charges,,
STAPLER ENDO GIA STRAIGHT 30 2.5 030811,,A4649,HCPCS,Facility,Both,,,,1230.32,1045.772,352.609712,1230.32,"Health Partners, Inc.",State Public Programs,615.16,50,,percent of total billed charges,,
STAPLER ENDO GIA STRAIGHT 30 2.5 030811,,A4649,HCPCS,Facility,Both,,,,1230.32,1045.772,352.609712,1230.32,Humana Insurance Company,Commercial PPO,1168.804,95,,percent of total billed charges,,
STAPLER ENDO GIA STRAIGHT 30 2.5 030811,,A4649,HCPCS,Facility,Outpatient,,,,1230.32,1045.772,352.609712,1230.32,Humana Insurance Company,Medicare PPO,602.8568,49,,percent of total billed charges,,
STAPLER ENDO GIA STRAIGHT 30 2.5 030811,,A4649,HCPCS,Facility,Inpatient,,,,1230.32,1045.772,352.609712,1230.32,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
STAPLER ENDO GIA STRAIGHT 30 2.5 030811,,A4649,HCPCS,Facility,Both,,,,1230.32,1045.772,352.609712,1230.32,Medica,Individual & Family,1219.24712,99.1,,percent of total billed charges,,
STAPLER ENDO GIA STRAIGHT 30 2.5 030811,,A4649,HCPCS,Facility,Outpatient,,,,1230.32,1045.772,352.609712,1230.32,Medica,Medica Advantage Solution,612.69936,49.8,,percent of total billed charges,,
STAPLER ENDO GIA STRAIGHT 30 2.5 030811,,A4649,HCPCS,Facility,Inpatient,,,,1230.32,1045.772,352.609712,1230.32,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
STAPLER ENDO GIA STRAIGHT 30 2.5 030811,,A4649,HCPCS,Facility,Outpatient,,,,1230.32,1045.772,352.609712,1230.32,Medica,Medical Assistance,548.72272,44.6,,percent of total billed charges,,
STAPLER ENDO GIA STRAIGHT 30 2.5 030811,,A4649,HCPCS,Facility,Inpatient,,,,1230.32,1045.772,352.609712,1230.32,Medica,Medical Assistance,,,,,Included in per diem rate,
STAPLER ENDO GIA STRAIGHT 30 2.5 030811,,A4649,HCPCS,Facility,Outpatient,,,,1230.32,1045.772,352.609712,1230.32,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,612.69936,49.8,,percent of total billed charges,,
STAPLER ENDO GIA STRAIGHT 30 2.5 030811,,A4649,HCPCS,Facility,Inpatient,,,,1230.32,1045.772,352.609712,1230.32,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
STAPLER ENDO GIA STRAIGHT 30 2.5 030811,,A4649,HCPCS,Facility,Both,,,,1230.32,1045.772,352.609712,1230.32,"Multiplan, Inc.","Multiplan, Inc.",1156.5008,94,,percent of total billed charges,,
STAPLER ENDO GIA STRAIGHT 30 2.5 030811,,A4649,HCPCS,Facility,Outpatient,,,,1230.32,1045.772,352.609712,1230.32,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1108.51832,90.1,,percent of total billed charges,,
STAPLER ENDO GIA STRAIGHT 30 2.5 030811,,A4649,HCPCS,Facility,Inpatient,,,,1230.32,1045.772,352.609712,1230.32,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
STAPLER ENDO GIA STRAIGHT 30 2.5 030811,,A4649,HCPCS,Facility,Both,,,,1230.32,1045.772,352.609712,1230.32,"Preferred One Administrative Services, INC.",PPO,1213.09552,98.6,,percent of total billed charges,,
STAPLER ENDO GIA STRAIGHT 30 2.5 030811,,A4649,HCPCS,Facility,Outpatient,,,,1230.32,1045.772,352.609712,1230.32,PrimeWest Health,Minnesota Senior Health Options (MSHO),632.99964,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
STAPLER ENDO GIA STRAIGHT 30 2.5 030811,,A4649,HCPCS,Facility,Inpatient,,,,1230.32,1045.772,352.609712,1230.32,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
STAPLER ENDO GIA STRAIGHT 30 2.5 030811,,A4649,HCPCS,Facility,Outpatient,,,,1230.32,1045.772,352.609712,1230.32,PrimeWest Health,MinnesotaCare,631.892352,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
STAPLER ENDO GIA STRAIGHT 30 2.5 030811,,A4649,HCPCS,Facility,Inpatient,,,,1230.32,1045.772,352.609712,1230.32,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
STAPLER ENDO GIA STRAIGHT 30 2.5 030811,,A4649,HCPCS,Facility,Both,,,,1230.32,1045.772,352.609712,1230.32,Sanford Health Plan,Sanford Health Plan,1131.8944,92,,percent of total billed charges,,
STAPLER ENDO GIA STRAIGHT 30 2.5 030811,,A4649,HCPCS,Facility,Outpatient,,,,1230.32,1045.772,352.609712,1230.32,"UCare Health, Inc.",Individual & Family Plan,693.28532,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
STAPLER ENDO GIA STRAIGHT 30 2.5 030811,,A4649,HCPCS,Facility,Inpatient,,,,1230.32,1045.772,352.609712,1230.32,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
STAPLER ENDO GIA STRAIGHT 30 2.5 030811,,A4649,HCPCS,Facility,Outpatient,,,,1230.32,1045.772,352.609712,1230.32,"UCare Health, Inc.",Medical Assistance,620.942504,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
STAPLER ENDO GIA STRAIGHT 30 2.5 030811,,A4649,HCPCS,Facility,Inpatient,,,,1230.32,1045.772,352.609712,1230.32,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
STAPLER ENDO GIA STRAIGHT 30 2.5 030811,,A4649,HCPCS,Facility,Outpatient,,,,1230.32,1045.772,352.609712,1230.32,"UCare Health, Inc.",Medicare Advantage,620.942504,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
STAPLER ENDO GIA STRAIGHT 30 2.5 030811,,A4649,HCPCS,Facility,Inpatient,,,,1230.32,1045.772,352.609712,1230.32,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
STAPLER ENDO GIA STRAIGHT 30 2.5 030811,,A4649,HCPCS,Facility,Outpatient,,,,1230.32,1045.772,352.609712,1230.32,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),620.942504,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
STAPLER ENDO GIA STRAIGHT 30 2.5 030811,,A4649,HCPCS,Facility,Inpatient,,,,1230.32,1045.772,352.609712,1230.32,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
STAPLER ENDO GIA STRAIGHT 30 2.5 030811,,A4649,HCPCS,Facility,Both,,,,1230.32,1045.772,352.609712,1230.32,UnitedHealthcare,Individual & Family,1156.5008,94,,percent of total billed charges,,
STAPLER ENDO GIA STRAIGHT 30 2.5 030811,,A4649,HCPCS,Facility,Outpatient,,,,1230.32,1045.772,352.609712,1230.32,UnitedHealthcare,Medicare Advantage,602.8568,49,,percent of total billed charges,,
STAPLER ENDO GIA STRAIGHT 30 2.5 030811,,A4649,HCPCS,Facility,Inpatient,,,,1230.32,1045.772,352.609712,1230.32,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
STAPLER ENDO GIA STRAIGHT 30 2.5 030811,,A4649,HCPCS,Facility,Outpatient,,,,1230.32,1045.772,352.609712,1230.32,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,590.5536,48,,percent of total billed charges,,100% of DHS outpatient percentage
STAPLER ENDO GIA STRAIGHT 30 2.5 030811,,A4649,HCPCS,Facility,Inpatient,,,,1230.32,1045.772,352.609712,1230.32,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
STAPLER HEMORROID CIRCULAR        PPH03,,A4649,HCPCS,Facility,Both,,,,1001.02,850.867,286.892332,1001.02,Aetna,Commercial,920.9384,92,,percent of total billed charges,,
STAPLER HEMORROID CIRCULAR        PPH03,,A4649,HCPCS,Facility,Outpatient,,,,1001.02,850.867,286.892332,1001.02,Aetna,Medicare Advantage,490.4998,49,,percent of total billed charges,,
STAPLER HEMORROID CIRCULAR        PPH03,,A4649,HCPCS,Facility,Inpatient,,,,1001.02,850.867,286.892332,1001.02,Aetna,Medicare Advantage,,,,,Included in per diem rate,
STAPLER HEMORROID CIRCULAR        PPH03,,A4649,HCPCS,Facility,Both,,,,1001.02,850.867,286.892332,1001.02,Aetna,PPO,930.9486,93,,percent of total billed charges,,
STAPLER HEMORROID CIRCULAR        PPH03,,A4649,HCPCS,Facility,Both,,,,1001.02,850.867,286.892332,1001.02,America's PPO,America's PPO,961.279506,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
STAPLER HEMORROID CIRCULAR        PPH03,,A4649,HCPCS,Facility,Both,,,,1001.02,850.867,286.892332,1001.02,BlueCross BlueShield Minnesota, Federal Employee Program,985.00368,98.4,,percent of total billed charges,,
STAPLER HEMORROID CIRCULAR        PPH03,,A4649,HCPCS,Facility,Both,,,,1001.02,850.867,286.892332,1001.02,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1001.02,100,,percent of total billed charges,,
STAPLER HEMORROID CIRCULAR        PPH03,,A4649,HCPCS,Facility,Both,,,,1001.02,850.867,286.892332,1001.02,BlueCross BlueShield Minnesota,High Value Network Plan,900.918,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
STAPLER HEMORROID CIRCULAR        PPH03,,A4649,HCPCS,Facility,Outpatient,,,,1001.02,850.867,286.892332,1001.02,BlueCross BlueShield Minnesota,Medicare Advantage,490.4998,49,,percent of total billed charges,,
STAPLER HEMORROID CIRCULAR        PPH03,,A4649,HCPCS,Facility,Inpatient,,,,1001.02,850.867,286.892332,1001.02,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
STAPLER HEMORROID CIRCULAR        PPH03,,A4649,HCPCS,Facility,Both,,,,1001.02,850.867,286.892332,1001.02,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,886.603414,88.57,,percent of total billed charges,,
STAPLER HEMORROID CIRCULAR        PPH03,,A4649,HCPCS,Facility,Both,,,,1001.02,850.867,286.892332,1001.02,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,286.892332,28.66,,percent of total billed charges,,
STAPLER HEMORROID CIRCULAR        PPH03,,A4649,HCPCS,Facility,Outpatient,,,,1001.02,850.867,286.892332,1001.02,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),490.4998,49,,percent of total billed charges,,
STAPLER HEMORROID CIRCULAR        PPH03,,A4649,HCPCS,Facility,Inpatient,,,,1001.02,850.867,286.892332,1001.02,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
STAPLER HEMORROID CIRCULAR        PPH03,,A4649,HCPCS,Facility,Both,,,,1001.02,850.867,286.892332,1001.02,CorVel,Worker's Compensation,1001.02,100,,percent of total billed charges,,
STAPLER HEMORROID CIRCULAR        PPH03,,A4649,HCPCS,Facility,Both,,,,1001.02,850.867,286.892332,1001.02,First Health Group Corporation,First Health Network,970.9894,97,,percent of total billed charges,,
STAPLER HEMORROID CIRCULAR        PPH03,,A4649,HCPCS,Facility,Both,,,,1001.02,850.867,286.892332,1001.02,"Health Partners, Inc.",Commercial,946.96492,94.6,,percent of total billed charges,,
STAPLER HEMORROID CIRCULAR        PPH03,,A4649,HCPCS,Facility,Outpatient,,,,1001.02,850.867,286.892332,1001.02,"Health Partners, Inc.",Medicare Advantage,490.4998,49,,percent of total billed charges,,
STAPLER HEMORROID CIRCULAR        PPH03,,A4649,HCPCS,Facility,Inpatient,,,,1001.02,850.867,286.892332,1001.02,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
STAPLER HEMORROID CIRCULAR        PPH03,,A4649,HCPCS,Facility,Both,,,,1001.02,850.867,286.892332,1001.02,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),600.612,60,,percent of total billed charges,,
STAPLER HEMORROID CIRCULAR        PPH03,,A4649,HCPCS,Facility,Both,,,,1001.02,850.867,286.892332,1001.02,"Health Partners, Inc.",State of Minnesota Advantage Program,815.8313,81.5,,percent of total billed charges,,
STAPLER HEMORROID CIRCULAR        PPH03,,A4649,HCPCS,Facility,Both,,,,1001.02,850.867,286.892332,1001.02,"Health Partners, Inc.",State Public Programs,500.51,50,,percent of total billed charges,,
STAPLER HEMORROID CIRCULAR        PPH03,,A4649,HCPCS,Facility,Both,,,,1001.02,850.867,286.892332,1001.02,Humana Insurance Company,Commercial PPO,950.969,95,,percent of total billed charges,,
STAPLER HEMORROID CIRCULAR        PPH03,,A4649,HCPCS,Facility,Outpatient,,,,1001.02,850.867,286.892332,1001.02,Humana Insurance Company,Medicare PPO,490.4998,49,,percent of total billed charges,,
STAPLER HEMORROID CIRCULAR        PPH03,,A4649,HCPCS,Facility,Inpatient,,,,1001.02,850.867,286.892332,1001.02,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
STAPLER HEMORROID CIRCULAR        PPH03,,A4649,HCPCS,Facility,Both,,,,1001.02,850.867,286.892332,1001.02,Medica,Individual & Family,992.01082,99.1,,percent of total billed charges,,
STAPLER HEMORROID CIRCULAR        PPH03,,A4649,HCPCS,Facility,Outpatient,,,,1001.02,850.867,286.892332,1001.02,Medica,Medica Advantage Solution,498.50796,49.8,,percent of total billed charges,,
STAPLER HEMORROID CIRCULAR        PPH03,,A4649,HCPCS,Facility,Inpatient,,,,1001.02,850.867,286.892332,1001.02,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
STAPLER HEMORROID CIRCULAR        PPH03,,A4649,HCPCS,Facility,Outpatient,,,,1001.02,850.867,286.892332,1001.02,Medica,Medical Assistance,446.45492,44.6,,percent of total billed charges,,
STAPLER HEMORROID CIRCULAR        PPH03,,A4649,HCPCS,Facility,Inpatient,,,,1001.02,850.867,286.892332,1001.02,Medica,Medical Assistance,,,,,Included in per diem rate,
STAPLER HEMORROID CIRCULAR        PPH03,,A4649,HCPCS,Facility,Outpatient,,,,1001.02,850.867,286.892332,1001.02,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,498.50796,49.8,,percent of total billed charges,,
STAPLER HEMORROID CIRCULAR        PPH03,,A4649,HCPCS,Facility,Inpatient,,,,1001.02,850.867,286.892332,1001.02,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
STAPLER HEMORROID CIRCULAR        PPH03,,A4649,HCPCS,Facility,Both,,,,1001.02,850.867,286.892332,1001.02,"Multiplan, Inc.","Multiplan, Inc.",940.9588,94,,percent of total billed charges,,
STAPLER HEMORROID CIRCULAR        PPH03,,A4649,HCPCS,Facility,Outpatient,,,,1001.02,850.867,286.892332,1001.02,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,901.91902,90.1,,percent of total billed charges,,
STAPLER HEMORROID CIRCULAR        PPH03,,A4649,HCPCS,Facility,Inpatient,,,,1001.02,850.867,286.892332,1001.02,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
STAPLER HEMORROID CIRCULAR        PPH03,,A4649,HCPCS,Facility,Both,,,,1001.02,850.867,286.892332,1001.02,"Preferred One Administrative Services, INC.",PPO,987.00572,98.6,,percent of total billed charges,,
STAPLER HEMORROID CIRCULAR        PPH03,,A4649,HCPCS,Facility,Outpatient,,,,1001.02,850.867,286.892332,1001.02,PrimeWest Health,Minnesota Senior Health Options (MSHO),515.02479,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
STAPLER HEMORROID CIRCULAR        PPH03,,A4649,HCPCS,Facility,Inpatient,,,,1001.02,850.867,286.892332,1001.02,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
STAPLER HEMORROID CIRCULAR        PPH03,,A4649,HCPCS,Facility,Outpatient,,,,1001.02,850.867,286.892332,1001.02,PrimeWest Health,MinnesotaCare,514.123872,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
STAPLER HEMORROID CIRCULAR        PPH03,,A4649,HCPCS,Facility,Inpatient,,,,1001.02,850.867,286.892332,1001.02,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
STAPLER HEMORROID CIRCULAR        PPH03,,A4649,HCPCS,Facility,Both,,,,1001.02,850.867,286.892332,1001.02,Sanford Health Plan,Sanford Health Plan,920.9384,92,,percent of total billed charges,,
STAPLER HEMORROID CIRCULAR        PPH03,,A4649,HCPCS,Facility,Outpatient,,,,1001.02,850.867,286.892332,1001.02,"UCare Health, Inc.",Individual & Family Plan,564.07477,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
STAPLER HEMORROID CIRCULAR        PPH03,,A4649,HCPCS,Facility,Inpatient,,,,1001.02,850.867,286.892332,1001.02,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
STAPLER HEMORROID CIRCULAR        PPH03,,A4649,HCPCS,Facility,Outpatient,,,,1001.02,850.867,286.892332,1001.02,"UCare Health, Inc.",Medical Assistance,505.214794,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
STAPLER HEMORROID CIRCULAR        PPH03,,A4649,HCPCS,Facility,Inpatient,,,,1001.02,850.867,286.892332,1001.02,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
STAPLER HEMORROID CIRCULAR        PPH03,,A4649,HCPCS,Facility,Outpatient,,,,1001.02,850.867,286.892332,1001.02,"UCare Health, Inc.",Medicare Advantage,505.214794,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
STAPLER HEMORROID CIRCULAR        PPH03,,A4649,HCPCS,Facility,Inpatient,,,,1001.02,850.867,286.892332,1001.02,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
STAPLER HEMORROID CIRCULAR        PPH03,,A4649,HCPCS,Facility,Outpatient,,,,1001.02,850.867,286.892332,1001.02,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),505.214794,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
STAPLER HEMORROID CIRCULAR        PPH03,,A4649,HCPCS,Facility,Inpatient,,,,1001.02,850.867,286.892332,1001.02,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
STAPLER HEMORROID CIRCULAR        PPH03,,A4649,HCPCS,Facility,Both,,,,1001.02,850.867,286.892332,1001.02,UnitedHealthcare,Individual & Family,940.9588,94,,percent of total billed charges,,
STAPLER HEMORROID CIRCULAR        PPH03,,A4649,HCPCS,Facility,Outpatient,,,,1001.02,850.867,286.892332,1001.02,UnitedHealthcare,Medicare Advantage,490.4998,49,,percent of total billed charges,,
STAPLER HEMORROID CIRCULAR        PPH03,,A4649,HCPCS,Facility,Inpatient,,,,1001.02,850.867,286.892332,1001.02,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
STAPLER HEMORROID CIRCULAR        PPH03,,A4649,HCPCS,Facility,Outpatient,,,,1001.02,850.867,286.892332,1001.02,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,480.4896,48,,percent of total billed charges,,100% of DHS outpatient percentage
STAPLER HEMORROID CIRCULAR        PPH03,,A4649,HCPCS,Facility,Inpatient,,,,1001.02,850.867,286.892332,1001.02,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
STAPLER PURSTRING INSTR 65 DISP  020242,,A4649,HCPCS,Facility,Both,,,,548.52,466.242,157.205832,548.52,Aetna,Commercial,504.6384,92,,percent of total billed charges,,
STAPLER PURSTRING INSTR 65 DISP  020242,,A4649,HCPCS,Facility,Outpatient,,,,548.52,466.242,157.205832,548.52,Aetna,Medicare Advantage,268.7748,49,,percent of total billed charges,,
STAPLER PURSTRING INSTR 65 DISP  020242,,A4649,HCPCS,Facility,Inpatient,,,,548.52,466.242,157.205832,548.52,Aetna,Medicare Advantage,,,,,Included in per diem rate,
STAPLER PURSTRING INSTR 65 DISP  020242,,A4649,HCPCS,Facility,Both,,,,548.52,466.242,157.205832,548.52,Aetna,PPO,510.1236,93,,percent of total billed charges,,
STAPLER PURSTRING INSTR 65 DISP  020242,,A4649,HCPCS,Facility,Both,,,,548.52,466.242,157.205832,548.52,America's PPO,America's PPO,526.743756,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
STAPLER PURSTRING INSTR 65 DISP  020242,,A4649,HCPCS,Facility,Both,,,,548.52,466.242,157.205832,548.52,BlueCross BlueShield Minnesota, Federal Employee Program,539.74368,98.4,,percent of total billed charges,,
STAPLER PURSTRING INSTR 65 DISP  020242,,A4649,HCPCS,Facility,Both,,,,548.52,466.242,157.205832,548.52,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,548.52,100,,percent of total billed charges,,
STAPLER PURSTRING INSTR 65 DISP  020242,,A4649,HCPCS,Facility,Both,,,,548.52,466.242,157.205832,548.52,BlueCross BlueShield Minnesota,High Value Network Plan,493.668,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
STAPLER PURSTRING INSTR 65 DISP  020242,,A4649,HCPCS,Facility,Outpatient,,,,548.52,466.242,157.205832,548.52,BlueCross BlueShield Minnesota,Medicare Advantage,268.7748,49,,percent of total billed charges,,
STAPLER PURSTRING INSTR 65 DISP  020242,,A4649,HCPCS,Facility,Inpatient,,,,548.52,466.242,157.205832,548.52,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
STAPLER PURSTRING INSTR 65 DISP  020242,,A4649,HCPCS,Facility,Both,,,,548.52,466.242,157.205832,548.52,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,485.824164,88.57,,percent of total billed charges,,
STAPLER PURSTRING INSTR 65 DISP  020242,,A4649,HCPCS,Facility,Both,,,,548.52,466.242,157.205832,548.52,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,157.205832,28.66,,percent of total billed charges,,
STAPLER PURSTRING INSTR 65 DISP  020242,,A4649,HCPCS,Facility,Outpatient,,,,548.52,466.242,157.205832,548.52,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),268.7748,49,,percent of total billed charges,,
STAPLER PURSTRING INSTR 65 DISP  020242,,A4649,HCPCS,Facility,Inpatient,,,,548.52,466.242,157.205832,548.52,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
STAPLER PURSTRING INSTR 65 DISP  020242,,A4649,HCPCS,Facility,Both,,,,548.52,466.242,157.205832,548.52,CorVel,Worker's Compensation,548.52,100,,percent of total billed charges,,
STAPLER PURSTRING INSTR 65 DISP  020242,,A4649,HCPCS,Facility,Both,,,,548.52,466.242,157.205832,548.52,First Health Group Corporation,First Health Network,532.0644,97,,percent of total billed charges,,
STAPLER PURSTRING INSTR 65 DISP  020242,,A4649,HCPCS,Facility,Both,,,,548.52,466.242,157.205832,548.52,"Health Partners, Inc.",Commercial,518.89992,94.6,,percent of total billed charges,,
STAPLER PURSTRING INSTR 65 DISP  020242,,A4649,HCPCS,Facility,Outpatient,,,,548.52,466.242,157.205832,548.52,"Health Partners, Inc.",Medicare Advantage,268.7748,49,,percent of total billed charges,,
STAPLER PURSTRING INSTR 65 DISP  020242,,A4649,HCPCS,Facility,Inpatient,,,,548.52,466.242,157.205832,548.52,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
STAPLER PURSTRING INSTR 65 DISP  020242,,A4649,HCPCS,Facility,Both,,,,548.52,466.242,157.205832,548.52,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),329.112,60,,percent of total billed charges,,
STAPLER PURSTRING INSTR 65 DISP  020242,,A4649,HCPCS,Facility,Both,,,,548.52,466.242,157.205832,548.52,"Health Partners, Inc.",State of Minnesota Advantage Program,447.0438,81.5,,percent of total billed charges,,
STAPLER PURSTRING INSTR 65 DISP  020242,,A4649,HCPCS,Facility,Both,,,,548.52,466.242,157.205832,548.52,"Health Partners, Inc.",State Public Programs,274.26,50,,percent of total billed charges,,
STAPLER PURSTRING INSTR 65 DISP  020242,,A4649,HCPCS,Facility,Both,,,,548.52,466.242,157.205832,548.52,Humana Insurance Company,Commercial PPO,521.094,95,,percent of total billed charges,,
STAPLER PURSTRING INSTR 65 DISP  020242,,A4649,HCPCS,Facility,Outpatient,,,,548.52,466.242,157.205832,548.52,Humana Insurance Company,Medicare PPO,268.7748,49,,percent of total billed charges,,
STAPLER PURSTRING INSTR 65 DISP  020242,,A4649,HCPCS,Facility,Inpatient,,,,548.52,466.242,157.205832,548.52,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
STAPLER PURSTRING INSTR 65 DISP  020242,,A4649,HCPCS,Facility,Both,,,,548.52,466.242,157.205832,548.52,Medica,Individual & Family,543.58332,99.1,,percent of total billed charges,,
STAPLER PURSTRING INSTR 65 DISP  020242,,A4649,HCPCS,Facility,Outpatient,,,,548.52,466.242,157.205832,548.52,Medica,Medica Advantage Solution,273.16296,49.8,,percent of total billed charges,,
STAPLER PURSTRING INSTR 65 DISP  020242,,A4649,HCPCS,Facility,Inpatient,,,,548.52,466.242,157.205832,548.52,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
STAPLER PURSTRING INSTR 65 DISP  020242,,A4649,HCPCS,Facility,Outpatient,,,,548.52,466.242,157.205832,548.52,Medica,Medical Assistance,244.63992,44.6,,percent of total billed charges,,
STAPLER PURSTRING INSTR 65 DISP  020242,,A4649,HCPCS,Facility,Inpatient,,,,548.52,466.242,157.205832,548.52,Medica,Medical Assistance,,,,,Included in per diem rate,
STAPLER PURSTRING INSTR 65 DISP  020242,,A4649,HCPCS,Facility,Outpatient,,,,548.52,466.242,157.205832,548.52,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,273.16296,49.8,,percent of total billed charges,,
STAPLER PURSTRING INSTR 65 DISP  020242,,A4649,HCPCS,Facility,Inpatient,,,,548.52,466.242,157.205832,548.52,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
STAPLER PURSTRING INSTR 65 DISP  020242,,A4649,HCPCS,Facility,Both,,,,548.52,466.242,157.205832,548.52,"Multiplan, Inc.","Multiplan, Inc.",515.6088,94,,percent of total billed charges,,
STAPLER PURSTRING INSTR 65 DISP  020242,,A4649,HCPCS,Facility,Outpatient,,,,548.52,466.242,157.205832,548.52,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,494.21652,90.1,,percent of total billed charges,,
STAPLER PURSTRING INSTR 65 DISP  020242,,A4649,HCPCS,Facility,Inpatient,,,,548.52,466.242,157.205832,548.52,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
STAPLER PURSTRING INSTR 65 DISP  020242,,A4649,HCPCS,Facility,Both,,,,548.52,466.242,157.205832,548.52,"Preferred One Administrative Services, INC.",PPO,540.84072,98.6,,percent of total billed charges,,
STAPLER PURSTRING INSTR 65 DISP  020242,,A4649,HCPCS,Facility,Outpatient,,,,548.52,466.242,157.205832,548.52,PrimeWest Health,Minnesota Senior Health Options (MSHO),282.21354,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
STAPLER PURSTRING INSTR 65 DISP  020242,,A4649,HCPCS,Facility,Inpatient,,,,548.52,466.242,157.205832,548.52,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
STAPLER PURSTRING INSTR 65 DISP  020242,,A4649,HCPCS,Facility,Outpatient,,,,548.52,466.242,157.205832,548.52,PrimeWest Health,MinnesotaCare,281.719872,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
STAPLER PURSTRING INSTR 65 DISP  020242,,A4649,HCPCS,Facility,Inpatient,,,,548.52,466.242,157.205832,548.52,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
STAPLER PURSTRING INSTR 65 DISP  020242,,A4649,HCPCS,Facility,Both,,,,548.52,466.242,157.205832,548.52,Sanford Health Plan,Sanford Health Plan,504.6384,92,,percent of total billed charges,,
STAPLER PURSTRING INSTR 65 DISP  020242,,A4649,HCPCS,Facility,Outpatient,,,,548.52,466.242,157.205832,548.52,"UCare Health, Inc.",Individual & Family Plan,309.09102,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
STAPLER PURSTRING INSTR 65 DISP  020242,,A4649,HCPCS,Facility,Inpatient,,,,548.52,466.242,157.205832,548.52,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
STAPLER PURSTRING INSTR 65 DISP  020242,,A4649,HCPCS,Facility,Outpatient,,,,548.52,466.242,157.205832,548.52,"UCare Health, Inc.",Medical Assistance,276.838044,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
STAPLER PURSTRING INSTR 65 DISP  020242,,A4649,HCPCS,Facility,Inpatient,,,,548.52,466.242,157.205832,548.52,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
STAPLER PURSTRING INSTR 65 DISP  020242,,A4649,HCPCS,Facility,Outpatient,,,,548.52,466.242,157.205832,548.52,"UCare Health, Inc.",Medicare Advantage,276.838044,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
STAPLER PURSTRING INSTR 65 DISP  020242,,A4649,HCPCS,Facility,Inpatient,,,,548.52,466.242,157.205832,548.52,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
STAPLER PURSTRING INSTR 65 DISP  020242,,A4649,HCPCS,Facility,Outpatient,,,,548.52,466.242,157.205832,548.52,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),276.838044,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
STAPLER PURSTRING INSTR 65 DISP  020242,,A4649,HCPCS,Facility,Inpatient,,,,548.52,466.242,157.205832,548.52,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
STAPLER PURSTRING INSTR 65 DISP  020242,,A4649,HCPCS,Facility,Both,,,,548.52,466.242,157.205832,548.52,UnitedHealthcare,Individual & Family,515.6088,94,,percent of total billed charges,,
STAPLER PURSTRING INSTR 65 DISP  020242,,A4649,HCPCS,Facility,Outpatient,,,,548.52,466.242,157.205832,548.52,UnitedHealthcare,Medicare Advantage,268.7748,49,,percent of total billed charges,,
STAPLER PURSTRING INSTR 65 DISP  020242,,A4649,HCPCS,Facility,Inpatient,,,,548.52,466.242,157.205832,548.52,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
STAPLER PURSTRING INSTR 65 DISP  020242,,A4649,HCPCS,Facility,Outpatient,,,,548.52,466.242,157.205832,548.52,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,263.2896,48,,percent of total billed charges,,100% of DHS outpatient percentage
STAPLER PURSTRING INSTR 65 DISP  020242,,A4649,HCPCS,Facility,Inpatient,,,,548.52,466.242,157.205832,548.52,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
STAPLER VERSATACK SHORT MULTFIRE 174021,,A4649,HCPCS,Facility,Both,,,,1050.8,893.18,301.15928,1050.8,Aetna,Commercial,966.736,92,,percent of total billed charges,,
STAPLER VERSATACK SHORT MULTFIRE 174021,,A4649,HCPCS,Facility,Outpatient,,,,1050.8,893.18,301.15928,1050.8,Aetna,Medicare Advantage,514.892,49,,percent of total billed charges,,
STAPLER VERSATACK SHORT MULTFIRE 174021,,A4649,HCPCS,Facility,Inpatient,,,,1050.8,893.18,301.15928,1050.8,Aetna,Medicare Advantage,,,,,Included in per diem rate,
STAPLER VERSATACK SHORT MULTFIRE 174021,,A4649,HCPCS,Facility,Both,,,,1050.8,893.18,301.15928,1050.8,Aetna,PPO,977.244,93,,percent of total billed charges,,
STAPLER VERSATACK SHORT MULTFIRE 174021,,A4649,HCPCS,Facility,Both,,,,1050.8,893.18,301.15928,1050.8,America's PPO,America's PPO,1009.08324,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
STAPLER VERSATACK SHORT MULTFIRE 174021,,A4649,HCPCS,Facility,Both,,,,1050.8,893.18,301.15928,1050.8,BlueCross BlueShield Minnesota, Federal Employee Program,1033.9872,98.4,,percent of total billed charges,,
STAPLER VERSATACK SHORT MULTFIRE 174021,,A4649,HCPCS,Facility,Both,,,,1050.8,893.18,301.15928,1050.8,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1050.8,100,,percent of total billed charges,,
STAPLER VERSATACK SHORT MULTFIRE 174021,,A4649,HCPCS,Facility,Both,,,,1050.8,893.18,301.15928,1050.8,BlueCross BlueShield Minnesota,High Value Network Plan,945.72,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
STAPLER VERSATACK SHORT MULTFIRE 174021,,A4649,HCPCS,Facility,Outpatient,,,,1050.8,893.18,301.15928,1050.8,BlueCross BlueShield Minnesota,Medicare Advantage,514.892,49,,percent of total billed charges,,
STAPLER VERSATACK SHORT MULTFIRE 174021,,A4649,HCPCS,Facility,Inpatient,,,,1050.8,893.18,301.15928,1050.8,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
STAPLER VERSATACK SHORT MULTFIRE 174021,,A4649,HCPCS,Facility,Both,,,,1050.8,893.18,301.15928,1050.8,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,930.69356,88.57,,percent of total billed charges,,
STAPLER VERSATACK SHORT MULTFIRE 174021,,A4649,HCPCS,Facility,Both,,,,1050.8,893.18,301.15928,1050.8,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,301.15928,28.66,,percent of total billed charges,,
STAPLER VERSATACK SHORT MULTFIRE 174021,,A4649,HCPCS,Facility,Outpatient,,,,1050.8,893.18,301.15928,1050.8,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),514.892,49,,percent of total billed charges,,
STAPLER VERSATACK SHORT MULTFIRE 174021,,A4649,HCPCS,Facility,Inpatient,,,,1050.8,893.18,301.15928,1050.8,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
STAPLER VERSATACK SHORT MULTFIRE 174021,,A4649,HCPCS,Facility,Both,,,,1050.8,893.18,301.15928,1050.8,CorVel,Worker's Compensation,1050.8,100,,percent of total billed charges,,
STAPLER VERSATACK SHORT MULTFIRE 174021,,A4649,HCPCS,Facility,Both,,,,1050.8,893.18,301.15928,1050.8,First Health Group Corporation,First Health Network,1019.276,97,,percent of total billed charges,,
STAPLER VERSATACK SHORT MULTFIRE 174021,,A4649,HCPCS,Facility,Both,,,,1050.8,893.18,301.15928,1050.8,"Health Partners, Inc.",Commercial,994.0568,94.6,,percent of total billed charges,,
STAPLER VERSATACK SHORT MULTFIRE 174021,,A4649,HCPCS,Facility,Outpatient,,,,1050.8,893.18,301.15928,1050.8,"Health Partners, Inc.",Medicare Advantage,514.892,49,,percent of total billed charges,,
STAPLER VERSATACK SHORT MULTFIRE 174021,,A4649,HCPCS,Facility,Inpatient,,,,1050.8,893.18,301.15928,1050.8,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
STAPLER VERSATACK SHORT MULTFIRE 174021,,A4649,HCPCS,Facility,Both,,,,1050.8,893.18,301.15928,1050.8,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),630.48,60,,percent of total billed charges,,
STAPLER VERSATACK SHORT MULTFIRE 174021,,A4649,HCPCS,Facility,Both,,,,1050.8,893.18,301.15928,1050.8,"Health Partners, Inc.",State of Minnesota Advantage Program,856.402,81.5,,percent of total billed charges,,
STAPLER VERSATACK SHORT MULTFIRE 174021,,A4649,HCPCS,Facility,Both,,,,1050.8,893.18,301.15928,1050.8,"Health Partners, Inc.",State Public Programs,525.4,50,,percent of total billed charges,,
STAPLER VERSATACK SHORT MULTFIRE 174021,,A4649,HCPCS,Facility,Both,,,,1050.8,893.18,301.15928,1050.8,Humana Insurance Company,Commercial PPO,998.26,95,,percent of total billed charges,,
STAPLER VERSATACK SHORT MULTFIRE 174021,,A4649,HCPCS,Facility,Outpatient,,,,1050.8,893.18,301.15928,1050.8,Humana Insurance Company,Medicare PPO,514.892,49,,percent of total billed charges,,
STAPLER VERSATACK SHORT MULTFIRE 174021,,A4649,HCPCS,Facility,Inpatient,,,,1050.8,893.18,301.15928,1050.8,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
STAPLER VERSATACK SHORT MULTFIRE 174021,,A4649,HCPCS,Facility,Both,,,,1050.8,893.18,301.15928,1050.8,Medica,Individual & Family,1041.3428,99.1,,percent of total billed charges,,
STAPLER VERSATACK SHORT MULTFIRE 174021,,A4649,HCPCS,Facility,Outpatient,,,,1050.8,893.18,301.15928,1050.8,Medica,Medica Advantage Solution,523.2984,49.8,,percent of total billed charges,,
STAPLER VERSATACK SHORT MULTFIRE 174021,,A4649,HCPCS,Facility,Inpatient,,,,1050.8,893.18,301.15928,1050.8,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
STAPLER VERSATACK SHORT MULTFIRE 174021,,A4649,HCPCS,Facility,Outpatient,,,,1050.8,893.18,301.15928,1050.8,Medica,Medical Assistance,468.6568,44.6,,percent of total billed charges,,
STAPLER VERSATACK SHORT MULTFIRE 174021,,A4649,HCPCS,Facility,Inpatient,,,,1050.8,893.18,301.15928,1050.8,Medica,Medical Assistance,,,,,Included in per diem rate,
STAPLER VERSATACK SHORT MULTFIRE 174021,,A4649,HCPCS,Facility,Outpatient,,,,1050.8,893.18,301.15928,1050.8,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,523.2984,49.8,,percent of total billed charges,,
STAPLER VERSATACK SHORT MULTFIRE 174021,,A4649,HCPCS,Facility,Inpatient,,,,1050.8,893.18,301.15928,1050.8,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
STAPLER VERSATACK SHORT MULTFIRE 174021,,A4649,HCPCS,Facility,Both,,,,1050.8,893.18,301.15928,1050.8,"Multiplan, Inc.","Multiplan, Inc.",987.752,94,,percent of total billed charges,,
STAPLER VERSATACK SHORT MULTFIRE 174021,,A4649,HCPCS,Facility,Outpatient,,,,1050.8,893.18,301.15928,1050.8,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,946.7708,90.1,,percent of total billed charges,,
STAPLER VERSATACK SHORT MULTFIRE 174021,,A4649,HCPCS,Facility,Inpatient,,,,1050.8,893.18,301.15928,1050.8,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
STAPLER VERSATACK SHORT MULTFIRE 174021,,A4649,HCPCS,Facility,Both,,,,1050.8,893.18,301.15928,1050.8,"Preferred One Administrative Services, INC.",PPO,1036.0888,98.6,,percent of total billed charges,,
STAPLER VERSATACK SHORT MULTFIRE 174021,,A4649,HCPCS,Facility,Outpatient,,,,1050.8,893.18,301.15928,1050.8,PrimeWest Health,Minnesota Senior Health Options (MSHO),540.6366,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
STAPLER VERSATACK SHORT MULTFIRE 174021,,A4649,HCPCS,Facility,Inpatient,,,,1050.8,893.18,301.15928,1050.8,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
STAPLER VERSATACK SHORT MULTFIRE 174021,,A4649,HCPCS,Facility,Outpatient,,,,1050.8,893.18,301.15928,1050.8,PrimeWest Health,MinnesotaCare,539.69088,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
STAPLER VERSATACK SHORT MULTFIRE 174021,,A4649,HCPCS,Facility,Inpatient,,,,1050.8,893.18,301.15928,1050.8,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
STAPLER VERSATACK SHORT MULTFIRE 174021,,A4649,HCPCS,Facility,Both,,,,1050.8,893.18,301.15928,1050.8,Sanford Health Plan,Sanford Health Plan,966.736,92,,percent of total billed charges,,
STAPLER VERSATACK SHORT MULTFIRE 174021,,A4649,HCPCS,Facility,Outpatient,,,,1050.8,893.18,301.15928,1050.8,"UCare Health, Inc.",Individual & Family Plan,592.1258,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
STAPLER VERSATACK SHORT MULTFIRE 174021,,A4649,HCPCS,Facility,Inpatient,,,,1050.8,893.18,301.15928,1050.8,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
STAPLER VERSATACK SHORT MULTFIRE 174021,,A4649,HCPCS,Facility,Outpatient,,,,1050.8,893.18,301.15928,1050.8,"UCare Health, Inc.",Medical Assistance,530.33876,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
STAPLER VERSATACK SHORT MULTFIRE 174021,,A4649,HCPCS,Facility,Inpatient,,,,1050.8,893.18,301.15928,1050.8,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
STAPLER VERSATACK SHORT MULTFIRE 174021,,A4649,HCPCS,Facility,Outpatient,,,,1050.8,893.18,301.15928,1050.8,"UCare Health, Inc.",Medicare Advantage,530.33876,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
STAPLER VERSATACK SHORT MULTFIRE 174021,,A4649,HCPCS,Facility,Inpatient,,,,1050.8,893.18,301.15928,1050.8,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
STAPLER VERSATACK SHORT MULTFIRE 174021,,A4649,HCPCS,Facility,Outpatient,,,,1050.8,893.18,301.15928,1050.8,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),530.33876,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
STAPLER VERSATACK SHORT MULTFIRE 174021,,A4649,HCPCS,Facility,Inpatient,,,,1050.8,893.18,301.15928,1050.8,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
STAPLER VERSATACK SHORT MULTFIRE 174021,,A4649,HCPCS,Facility,Both,,,,1050.8,893.18,301.15928,1050.8,UnitedHealthcare,Individual & Family,987.752,94,,percent of total billed charges,,
STAPLER VERSATACK SHORT MULTFIRE 174021,,A4649,HCPCS,Facility,Outpatient,,,,1050.8,893.18,301.15928,1050.8,UnitedHealthcare,Medicare Advantage,514.892,49,,percent of total billed charges,,
STAPLER VERSATACK SHORT MULTFIRE 174021,,A4649,HCPCS,Facility,Inpatient,,,,1050.8,893.18,301.15928,1050.8,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
STAPLER VERSATACK SHORT MULTFIRE 174021,,A4649,HCPCS,Facility,Outpatient,,,,1050.8,893.18,301.15928,1050.8,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,504.384,48,,percent of total billed charges,,100% of DHS outpatient percentage
STAPLER VERSATACK SHORT MULTFIRE 174021,,A4649,HCPCS,Facility,Inpatient,,,,1050.8,893.18,301.15928,1050.8,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
STRYKER AGGRESSIVE PLUS CUTTER 4.0MM,,A4649,HCPCS,Facility,Both,,,,194.25,165.1125,55.67205,194.25,Aetna,Commercial,178.71,92,,percent of total billed charges,,
STRYKER AGGRESSIVE PLUS CUTTER 4.0MM,,A4649,HCPCS,Facility,Outpatient,,,,194.25,165.1125,55.67205,194.25,Aetna,Medicare Advantage,95.1825,49,,percent of total billed charges,,
STRYKER AGGRESSIVE PLUS CUTTER 4.0MM,,A4649,HCPCS,Facility,Inpatient,,,,194.25,165.1125,55.67205,194.25,Aetna,Medicare Advantage,,,,,Included in per diem rate,
STRYKER AGGRESSIVE PLUS CUTTER 4.0MM,,A4649,HCPCS,Facility,Both,,,,194.25,165.1125,55.67205,194.25,Aetna,PPO,180.6525,93,,percent of total billed charges,,
STRYKER AGGRESSIVE PLUS CUTTER 4.0MM,,A4649,HCPCS,Facility,Both,,,,194.25,165.1125,55.67205,194.25,America's PPO,America's PPO,186.538275,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
STRYKER AGGRESSIVE PLUS CUTTER 4.0MM,,A4649,HCPCS,Facility,Both,,,,194.25,165.1125,55.67205,194.25,BlueCross BlueShield Minnesota, Federal Employee Program,191.142,98.4,,percent of total billed charges,,
STRYKER AGGRESSIVE PLUS CUTTER 4.0MM,,A4649,HCPCS,Facility,Both,,,,194.25,165.1125,55.67205,194.25,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,194.25,100,,percent of total billed charges,,
STRYKER AGGRESSIVE PLUS CUTTER 4.0MM,,A4649,HCPCS,Facility,Both,,,,194.25,165.1125,55.67205,194.25,BlueCross BlueShield Minnesota,High Value Network Plan,174.825,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
STRYKER AGGRESSIVE PLUS CUTTER 4.0MM,,A4649,HCPCS,Facility,Outpatient,,,,194.25,165.1125,55.67205,194.25,BlueCross BlueShield Minnesota,Medicare Advantage,95.1825,49,,percent of total billed charges,,
STRYKER AGGRESSIVE PLUS CUTTER 4.0MM,,A4649,HCPCS,Facility,Inpatient,,,,194.25,165.1125,55.67205,194.25,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
STRYKER AGGRESSIVE PLUS CUTTER 4.0MM,,A4649,HCPCS,Facility,Both,,,,194.25,165.1125,55.67205,194.25,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,172.047225,88.57,,percent of total billed charges,,
STRYKER AGGRESSIVE PLUS CUTTER 4.0MM,,A4649,HCPCS,Facility,Both,,,,194.25,165.1125,55.67205,194.25,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,55.67205,28.66,,percent of total billed charges,,
STRYKER AGGRESSIVE PLUS CUTTER 4.0MM,,A4649,HCPCS,Facility,Outpatient,,,,194.25,165.1125,55.67205,194.25,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),95.1825,49,,percent of total billed charges,,
STRYKER AGGRESSIVE PLUS CUTTER 4.0MM,,A4649,HCPCS,Facility,Inpatient,,,,194.25,165.1125,55.67205,194.25,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
STRYKER AGGRESSIVE PLUS CUTTER 4.0MM,,A4649,HCPCS,Facility,Both,,,,194.25,165.1125,55.67205,194.25,CorVel,Worker's Compensation,194.25,100,,percent of total billed charges,,
STRYKER AGGRESSIVE PLUS CUTTER 4.0MM,,A4649,HCPCS,Facility,Both,,,,194.25,165.1125,55.67205,194.25,First Health Group Corporation,First Health Network,188.4225,97,,percent of total billed charges,,
STRYKER AGGRESSIVE PLUS CUTTER 4.0MM,,A4649,HCPCS,Facility,Both,,,,194.25,165.1125,55.67205,194.25,"Health Partners, Inc.",Commercial,183.7605,94.6,,percent of total billed charges,,
STRYKER AGGRESSIVE PLUS CUTTER 4.0MM,,A4649,HCPCS,Facility,Outpatient,,,,194.25,165.1125,55.67205,194.25,"Health Partners, Inc.",Medicare Advantage,95.1825,49,,percent of total billed charges,,
STRYKER AGGRESSIVE PLUS CUTTER 4.0MM,,A4649,HCPCS,Facility,Inpatient,,,,194.25,165.1125,55.67205,194.25,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
STRYKER AGGRESSIVE PLUS CUTTER 4.0MM,,A4649,HCPCS,Facility,Both,,,,194.25,165.1125,55.67205,194.25,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),116.55,60,,percent of total billed charges,,
STRYKER AGGRESSIVE PLUS CUTTER 4.0MM,,A4649,HCPCS,Facility,Both,,,,194.25,165.1125,55.67205,194.25,"Health Partners, Inc.",State of Minnesota Advantage Program,158.31375,81.5,,percent of total billed charges,,
STRYKER AGGRESSIVE PLUS CUTTER 4.0MM,,A4649,HCPCS,Facility,Both,,,,194.25,165.1125,55.67205,194.25,"Health Partners, Inc.",State Public Programs,97.125,50,,percent of total billed charges,,
STRYKER AGGRESSIVE PLUS CUTTER 4.0MM,,A4649,HCPCS,Facility,Both,,,,194.25,165.1125,55.67205,194.25,Humana Insurance Company,Commercial PPO,184.5375,95,,percent of total billed charges,,
STRYKER AGGRESSIVE PLUS CUTTER 4.0MM,,A4649,HCPCS,Facility,Outpatient,,,,194.25,165.1125,55.67205,194.25,Humana Insurance Company,Medicare PPO,95.1825,49,,percent of total billed charges,,
STRYKER AGGRESSIVE PLUS CUTTER 4.0MM,,A4649,HCPCS,Facility,Inpatient,,,,194.25,165.1125,55.67205,194.25,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
STRYKER AGGRESSIVE PLUS CUTTER 4.0MM,,A4649,HCPCS,Facility,Both,,,,194.25,165.1125,55.67205,194.25,Medica,Individual & Family,192.50175,99.1,,percent of total billed charges,,
STRYKER AGGRESSIVE PLUS CUTTER 4.0MM,,A4649,HCPCS,Facility,Outpatient,,,,194.25,165.1125,55.67205,194.25,Medica,Medica Advantage Solution,96.7365,49.8,,percent of total billed charges,,
STRYKER AGGRESSIVE PLUS CUTTER 4.0MM,,A4649,HCPCS,Facility,Inpatient,,,,194.25,165.1125,55.67205,194.25,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
STRYKER AGGRESSIVE PLUS CUTTER 4.0MM,,A4649,HCPCS,Facility,Outpatient,,,,194.25,165.1125,55.67205,194.25,Medica,Medical Assistance,86.6355,44.6,,percent of total billed charges,,
STRYKER AGGRESSIVE PLUS CUTTER 4.0MM,,A4649,HCPCS,Facility,Inpatient,,,,194.25,165.1125,55.67205,194.25,Medica,Medical Assistance,,,,,Included in per diem rate,
STRYKER AGGRESSIVE PLUS CUTTER 4.0MM,,A4649,HCPCS,Facility,Outpatient,,,,194.25,165.1125,55.67205,194.25,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,96.7365,49.8,,percent of total billed charges,,
STRYKER AGGRESSIVE PLUS CUTTER 4.0MM,,A4649,HCPCS,Facility,Inpatient,,,,194.25,165.1125,55.67205,194.25,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
STRYKER AGGRESSIVE PLUS CUTTER 4.0MM,,A4649,HCPCS,Facility,Both,,,,194.25,165.1125,55.67205,194.25,"Multiplan, Inc.","Multiplan, Inc.",182.595,94,,percent of total billed charges,,
STRYKER AGGRESSIVE PLUS CUTTER 4.0MM,,A4649,HCPCS,Facility,Outpatient,,,,194.25,165.1125,55.67205,194.25,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,175.01925,90.1,,percent of total billed charges,,
STRYKER AGGRESSIVE PLUS CUTTER 4.0MM,,A4649,HCPCS,Facility,Inpatient,,,,194.25,165.1125,55.67205,194.25,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
STRYKER AGGRESSIVE PLUS CUTTER 4.0MM,,A4649,HCPCS,Facility,Both,,,,194.25,165.1125,55.67205,194.25,"Preferred One Administrative Services, INC.",PPO,191.5305,98.6,,percent of total billed charges,,
STRYKER AGGRESSIVE PLUS CUTTER 4.0MM,,A4649,HCPCS,Facility,Outpatient,,,,194.25,165.1125,55.67205,194.25,PrimeWest Health,Minnesota Senior Health Options (MSHO),99.941625,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
STRYKER AGGRESSIVE PLUS CUTTER 4.0MM,,A4649,HCPCS,Facility,Inpatient,,,,194.25,165.1125,55.67205,194.25,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
STRYKER AGGRESSIVE PLUS CUTTER 4.0MM,,A4649,HCPCS,Facility,Outpatient,,,,194.25,165.1125,55.67205,194.25,PrimeWest Health,MinnesotaCare,99.7668,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
STRYKER AGGRESSIVE PLUS CUTTER 4.0MM,,A4649,HCPCS,Facility,Inpatient,,,,194.25,165.1125,55.67205,194.25,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
STRYKER AGGRESSIVE PLUS CUTTER 4.0MM,,A4649,HCPCS,Facility,Both,,,,194.25,165.1125,55.67205,194.25,Sanford Health Plan,Sanford Health Plan,178.71,92,,percent of total billed charges,,
STRYKER AGGRESSIVE PLUS CUTTER 4.0MM,,A4649,HCPCS,Facility,Outpatient,,,,194.25,165.1125,55.67205,194.25,"UCare Health, Inc.",Individual & Family Plan,109.459875,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
STRYKER AGGRESSIVE PLUS CUTTER 4.0MM,,A4649,HCPCS,Facility,Inpatient,,,,194.25,165.1125,55.67205,194.25,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
STRYKER AGGRESSIVE PLUS CUTTER 4.0MM,,A4649,HCPCS,Facility,Outpatient,,,,194.25,165.1125,55.67205,194.25,"UCare Health, Inc.",Medical Assistance,98.037975,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
STRYKER AGGRESSIVE PLUS CUTTER 4.0MM,,A4649,HCPCS,Facility,Inpatient,,,,194.25,165.1125,55.67205,194.25,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
STRYKER AGGRESSIVE PLUS CUTTER 4.0MM,,A4649,HCPCS,Facility,Outpatient,,,,194.25,165.1125,55.67205,194.25,"UCare Health, Inc.",Medicare Advantage,98.037975,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
STRYKER AGGRESSIVE PLUS CUTTER 4.0MM,,A4649,HCPCS,Facility,Inpatient,,,,194.25,165.1125,55.67205,194.25,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
STRYKER AGGRESSIVE PLUS CUTTER 4.0MM,,A4649,HCPCS,Facility,Outpatient,,,,194.25,165.1125,55.67205,194.25,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),98.037975,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
STRYKER AGGRESSIVE PLUS CUTTER 4.0MM,,A4649,HCPCS,Facility,Inpatient,,,,194.25,165.1125,55.67205,194.25,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
STRYKER AGGRESSIVE PLUS CUTTER 4.0MM,,A4649,HCPCS,Facility,Both,,,,194.25,165.1125,55.67205,194.25,UnitedHealthcare,Individual & Family,182.595,94,,percent of total billed charges,,
STRYKER AGGRESSIVE PLUS CUTTER 4.0MM,,A4649,HCPCS,Facility,Outpatient,,,,194.25,165.1125,55.67205,194.25,UnitedHealthcare,Medicare Advantage,95.1825,49,,percent of total billed charges,,
STRYKER AGGRESSIVE PLUS CUTTER 4.0MM,,A4649,HCPCS,Facility,Inpatient,,,,194.25,165.1125,55.67205,194.25,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
STRYKER AGGRESSIVE PLUS CUTTER 4.0MM,,A4649,HCPCS,Facility,Outpatient,,,,194.25,165.1125,55.67205,194.25,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,93.24,48,,percent of total billed charges,,100% of DHS outpatient percentage
STRYKER AGGRESSIVE PLUS CUTTER 4.0MM,,A4649,HCPCS,Facility,Inpatient,,,,194.25,165.1125,55.67205,194.25,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
STRYKER RECIPROCATING BLADE 70.0X1.27.12.5MM,,A4649,HCPCS,Facility,Both,,,,183.4,155.89,52.56244,183.4,Aetna,Commercial,168.728,92,,percent of total billed charges,,
STRYKER RECIPROCATING BLADE 70.0X1.27.12.5MM,,A4649,HCPCS,Facility,Outpatient,,,,183.4,155.89,52.56244,183.4,Aetna,Medicare Advantage,89.866,49,,percent of total billed charges,,
STRYKER RECIPROCATING BLADE 70.0X1.27.12.5MM,,A4649,HCPCS,Facility,Inpatient,,,,183.4,155.89,52.56244,183.4,Aetna,Medicare Advantage,,,,,Included in per diem rate,
STRYKER RECIPROCATING BLADE 70.0X1.27.12.5MM,,A4649,HCPCS,Facility,Both,,,,183.4,155.89,52.56244,183.4,Aetna,PPO,170.562,93,,percent of total billed charges,,
STRYKER RECIPROCATING BLADE 70.0X1.27.12.5MM,,A4649,HCPCS,Facility,Both,,,,183.4,155.89,52.56244,183.4,America's PPO,America's PPO,176.11902,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
STRYKER RECIPROCATING BLADE 70.0X1.27.12.5MM,,A4649,HCPCS,Facility,Both,,,,183.4,155.89,52.56244,183.4,BlueCross BlueShield Minnesota, Federal Employee Program,180.4656,98.4,,percent of total billed charges,,
STRYKER RECIPROCATING BLADE 70.0X1.27.12.5MM,,A4649,HCPCS,Facility,Both,,,,183.4,155.89,52.56244,183.4,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,183.4,100,,percent of total billed charges,,
STRYKER RECIPROCATING BLADE 70.0X1.27.12.5MM,,A4649,HCPCS,Facility,Both,,,,183.4,155.89,52.56244,183.4,BlueCross BlueShield Minnesota,High Value Network Plan,165.06,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
STRYKER RECIPROCATING BLADE 70.0X1.27.12.5MM,,A4649,HCPCS,Facility,Outpatient,,,,183.4,155.89,52.56244,183.4,BlueCross BlueShield Minnesota,Medicare Advantage,89.866,49,,percent of total billed charges,,
STRYKER RECIPROCATING BLADE 70.0X1.27.12.5MM,,A4649,HCPCS,Facility,Inpatient,,,,183.4,155.89,52.56244,183.4,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
STRYKER RECIPROCATING BLADE 70.0X1.27.12.5MM,,A4649,HCPCS,Facility,Both,,,,183.4,155.89,52.56244,183.4,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,162.43738,88.57,,percent of total billed charges,,
STRYKER RECIPROCATING BLADE 70.0X1.27.12.5MM,,A4649,HCPCS,Facility,Both,,,,183.4,155.89,52.56244,183.4,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,52.56244,28.66,,percent of total billed charges,,
STRYKER RECIPROCATING BLADE 70.0X1.27.12.5MM,,A4649,HCPCS,Facility,Outpatient,,,,183.4,155.89,52.56244,183.4,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),89.866,49,,percent of total billed charges,,
STRYKER RECIPROCATING BLADE 70.0X1.27.12.5MM,,A4649,HCPCS,Facility,Inpatient,,,,183.4,155.89,52.56244,183.4,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
STRYKER RECIPROCATING BLADE 70.0X1.27.12.5MM,,A4649,HCPCS,Facility,Both,,,,183.4,155.89,52.56244,183.4,CorVel,Worker's Compensation,183.4,100,,percent of total billed charges,,
STRYKER RECIPROCATING BLADE 70.0X1.27.12.5MM,,A4649,HCPCS,Facility,Both,,,,183.4,155.89,52.56244,183.4,First Health Group Corporation,First Health Network,177.898,97,,percent of total billed charges,,
STRYKER RECIPROCATING BLADE 70.0X1.27.12.5MM,,A4649,HCPCS,Facility,Both,,,,183.4,155.89,52.56244,183.4,"Health Partners, Inc.",Commercial,173.4964,94.6,,percent of total billed charges,,
STRYKER RECIPROCATING BLADE 70.0X1.27.12.5MM,,A4649,HCPCS,Facility,Outpatient,,,,183.4,155.89,52.56244,183.4,"Health Partners, Inc.",Medicare Advantage,89.866,49,,percent of total billed charges,,
STRYKER RECIPROCATING BLADE 70.0X1.27.12.5MM,,A4649,HCPCS,Facility,Inpatient,,,,183.4,155.89,52.56244,183.4,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
STRYKER RECIPROCATING BLADE 70.0X1.27.12.5MM,,A4649,HCPCS,Facility,Both,,,,183.4,155.89,52.56244,183.4,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),110.04,60,,percent of total billed charges,,
STRYKER RECIPROCATING BLADE 70.0X1.27.12.5MM,,A4649,HCPCS,Facility,Both,,,,183.4,155.89,52.56244,183.4,"Health Partners, Inc.",State of Minnesota Advantage Program,149.471,81.5,,percent of total billed charges,,
STRYKER RECIPROCATING BLADE 70.0X1.27.12.5MM,,A4649,HCPCS,Facility,Both,,,,183.4,155.89,52.56244,183.4,"Health Partners, Inc.",State Public Programs,91.7,50,,percent of total billed charges,,
STRYKER RECIPROCATING BLADE 70.0X1.27.12.5MM,,A4649,HCPCS,Facility,Both,,,,183.4,155.89,52.56244,183.4,Humana Insurance Company,Commercial PPO,174.23,95,,percent of total billed charges,,
STRYKER RECIPROCATING BLADE 70.0X1.27.12.5MM,,A4649,HCPCS,Facility,Outpatient,,,,183.4,155.89,52.56244,183.4,Humana Insurance Company,Medicare PPO,89.866,49,,percent of total billed charges,,
STRYKER RECIPROCATING BLADE 70.0X1.27.12.5MM,,A4649,HCPCS,Facility,Inpatient,,,,183.4,155.89,52.56244,183.4,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
STRYKER RECIPROCATING BLADE 70.0X1.27.12.5MM,,A4649,HCPCS,Facility,Both,,,,183.4,155.89,52.56244,183.4,Medica,Individual & Family,181.7494,99.1,,percent of total billed charges,,
STRYKER RECIPROCATING BLADE 70.0X1.27.12.5MM,,A4649,HCPCS,Facility,Outpatient,,,,183.4,155.89,52.56244,183.4,Medica,Medica Advantage Solution,91.3332,49.8,,percent of total billed charges,,
STRYKER RECIPROCATING BLADE 70.0X1.27.12.5MM,,A4649,HCPCS,Facility,Inpatient,,,,183.4,155.89,52.56244,183.4,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
STRYKER RECIPROCATING BLADE 70.0X1.27.12.5MM,,A4649,HCPCS,Facility,Outpatient,,,,183.4,155.89,52.56244,183.4,Medica,Medical Assistance,81.7964,44.6,,percent of total billed charges,,
STRYKER RECIPROCATING BLADE 70.0X1.27.12.5MM,,A4649,HCPCS,Facility,Inpatient,,,,183.4,155.89,52.56244,183.4,Medica,Medical Assistance,,,,,Included in per diem rate,
STRYKER RECIPROCATING BLADE 70.0X1.27.12.5MM,,A4649,HCPCS,Facility,Outpatient,,,,183.4,155.89,52.56244,183.4,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,91.3332,49.8,,percent of total billed charges,,
STRYKER RECIPROCATING BLADE 70.0X1.27.12.5MM,,A4649,HCPCS,Facility,Inpatient,,,,183.4,155.89,52.56244,183.4,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
STRYKER RECIPROCATING BLADE 70.0X1.27.12.5MM,,A4649,HCPCS,Facility,Both,,,,183.4,155.89,52.56244,183.4,"Multiplan, Inc.","Multiplan, Inc.",172.396,94,,percent of total billed charges,,
STRYKER RECIPROCATING BLADE 70.0X1.27.12.5MM,,A4649,HCPCS,Facility,Outpatient,,,,183.4,155.89,52.56244,183.4,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,165.2434,90.1,,percent of total billed charges,,
STRYKER RECIPROCATING BLADE 70.0X1.27.12.5MM,,A4649,HCPCS,Facility,Inpatient,,,,183.4,155.89,52.56244,183.4,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
STRYKER RECIPROCATING BLADE 70.0X1.27.12.5MM,,A4649,HCPCS,Facility,Both,,,,183.4,155.89,52.56244,183.4,"Preferred One Administrative Services, INC.",PPO,180.8324,98.6,,percent of total billed charges,,
STRYKER RECIPROCATING BLADE 70.0X1.27.12.5MM,,A4649,HCPCS,Facility,Outpatient,,,,183.4,155.89,52.56244,183.4,PrimeWest Health,Minnesota Senior Health Options (MSHO),94.3593,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
STRYKER RECIPROCATING BLADE 70.0X1.27.12.5MM,,A4649,HCPCS,Facility,Inpatient,,,,183.4,155.89,52.56244,183.4,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
STRYKER RECIPROCATING BLADE 70.0X1.27.12.5MM,,A4649,HCPCS,Facility,Outpatient,,,,183.4,155.89,52.56244,183.4,PrimeWest Health,MinnesotaCare,94.19424,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
STRYKER RECIPROCATING BLADE 70.0X1.27.12.5MM,,A4649,HCPCS,Facility,Inpatient,,,,183.4,155.89,52.56244,183.4,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
STRYKER RECIPROCATING BLADE 70.0X1.27.12.5MM,,A4649,HCPCS,Facility,Both,,,,183.4,155.89,52.56244,183.4,Sanford Health Plan,Sanford Health Plan,168.728,92,,percent of total billed charges,,
STRYKER RECIPROCATING BLADE 70.0X1.27.12.5MM,,A4649,HCPCS,Facility,Outpatient,,,,183.4,155.89,52.56244,183.4,"UCare Health, Inc.",Individual & Family Plan,103.3459,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
STRYKER RECIPROCATING BLADE 70.0X1.27.12.5MM,,A4649,HCPCS,Facility,Inpatient,,,,183.4,155.89,52.56244,183.4,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
STRYKER RECIPROCATING BLADE 70.0X1.27.12.5MM,,A4649,HCPCS,Facility,Outpatient,,,,183.4,155.89,52.56244,183.4,"UCare Health, Inc.",Medical Assistance,92.56198,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
STRYKER RECIPROCATING BLADE 70.0X1.27.12.5MM,,A4649,HCPCS,Facility,Inpatient,,,,183.4,155.89,52.56244,183.4,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
STRYKER RECIPROCATING BLADE 70.0X1.27.12.5MM,,A4649,HCPCS,Facility,Outpatient,,,,183.4,155.89,52.56244,183.4,"UCare Health, Inc.",Medicare Advantage,92.56198,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
STRYKER RECIPROCATING BLADE 70.0X1.27.12.5MM,,A4649,HCPCS,Facility,Inpatient,,,,183.4,155.89,52.56244,183.4,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
STRYKER RECIPROCATING BLADE 70.0X1.27.12.5MM,,A4649,HCPCS,Facility,Outpatient,,,,183.4,155.89,52.56244,183.4,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),92.56198,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
STRYKER RECIPROCATING BLADE 70.0X1.27.12.5MM,,A4649,HCPCS,Facility,Inpatient,,,,183.4,155.89,52.56244,183.4,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
STRYKER RECIPROCATING BLADE 70.0X1.27.12.5MM,,A4649,HCPCS,Facility,Both,,,,183.4,155.89,52.56244,183.4,UnitedHealthcare,Individual & Family,172.396,94,,percent of total billed charges,,
STRYKER RECIPROCATING BLADE 70.0X1.27.12.5MM,,A4649,HCPCS,Facility,Outpatient,,,,183.4,155.89,52.56244,183.4,UnitedHealthcare,Medicare Advantage,89.866,49,,percent of total billed charges,,
STRYKER RECIPROCATING BLADE 70.0X1.27.12.5MM,,A4649,HCPCS,Facility,Inpatient,,,,183.4,155.89,52.56244,183.4,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
STRYKER RECIPROCATING BLADE 70.0X1.27.12.5MM,,A4649,HCPCS,Facility,Outpatient,,,,183.4,155.89,52.56244,183.4,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,88.032,48,,percent of total billed charges,,100% of DHS outpatient percentage
STRYKER RECIPROCATING BLADE 70.0X1.27.12.5MM,,A4649,HCPCS,Facility,Inpatient,,,,183.4,155.89,52.56244,183.4,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
STRYKER TOMCAT 4.0MM ANGLED CUTTER,,A4649,HCPCS,Facility,Both,,,,289.59,246.1515,82.996494,289.59,Aetna,Commercial,266.4228,92,,percent of total billed charges,,
STRYKER TOMCAT 4.0MM ANGLED CUTTER,,A4649,HCPCS,Facility,Outpatient,,,,289.59,246.1515,82.996494,289.59,Aetna,Medicare Advantage,141.8991,49,,percent of total billed charges,,
STRYKER TOMCAT 4.0MM ANGLED CUTTER,,A4649,HCPCS,Facility,Inpatient,,,,289.59,246.1515,82.996494,289.59,Aetna,Medicare Advantage,,,,,Included in per diem rate,
STRYKER TOMCAT 4.0MM ANGLED CUTTER,,A4649,HCPCS,Facility,Both,,,,289.59,246.1515,82.996494,289.59,Aetna,PPO,269.3187,93,,percent of total billed charges,,
STRYKER TOMCAT 4.0MM ANGLED CUTTER,,A4649,HCPCS,Facility,Both,,,,289.59,246.1515,82.996494,289.59,America's PPO,America's PPO,278.093277,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
STRYKER TOMCAT 4.0MM ANGLED CUTTER,,A4649,HCPCS,Facility,Both,,,,289.59,246.1515,82.996494,289.59,BlueCross BlueShield Minnesota, Federal Employee Program,284.95656,98.4,,percent of total billed charges,,
STRYKER TOMCAT 4.0MM ANGLED CUTTER,,A4649,HCPCS,Facility,Both,,,,289.59,246.1515,82.996494,289.59,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,289.59,100,,percent of total billed charges,,
STRYKER TOMCAT 4.0MM ANGLED CUTTER,,A4649,HCPCS,Facility,Both,,,,289.59,246.1515,82.996494,289.59,BlueCross BlueShield Minnesota,High Value Network Plan,260.631,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
STRYKER TOMCAT 4.0MM ANGLED CUTTER,,A4649,HCPCS,Facility,Outpatient,,,,289.59,246.1515,82.996494,289.59,BlueCross BlueShield Minnesota,Medicare Advantage,141.8991,49,,percent of total billed charges,,
STRYKER TOMCAT 4.0MM ANGLED CUTTER,,A4649,HCPCS,Facility,Inpatient,,,,289.59,246.1515,82.996494,289.59,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
STRYKER TOMCAT 4.0MM ANGLED CUTTER,,A4649,HCPCS,Facility,Both,,,,289.59,246.1515,82.996494,289.59,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,256.489863,88.57,,percent of total billed charges,,
STRYKER TOMCAT 4.0MM ANGLED CUTTER,,A4649,HCPCS,Facility,Both,,,,289.59,246.1515,82.996494,289.59,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,82.996494,28.66,,percent of total billed charges,,
STRYKER TOMCAT 4.0MM ANGLED CUTTER,,A4649,HCPCS,Facility,Outpatient,,,,289.59,246.1515,82.996494,289.59,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),141.8991,49,,percent of total billed charges,,
STRYKER TOMCAT 4.0MM ANGLED CUTTER,,A4649,HCPCS,Facility,Inpatient,,,,289.59,246.1515,82.996494,289.59,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
STRYKER TOMCAT 4.0MM ANGLED CUTTER,,A4649,HCPCS,Facility,Both,,,,289.59,246.1515,82.996494,289.59,CorVel,Worker's Compensation,289.59,100,,percent of total billed charges,,
STRYKER TOMCAT 4.0MM ANGLED CUTTER,,A4649,HCPCS,Facility,Both,,,,289.59,246.1515,82.996494,289.59,First Health Group Corporation,First Health Network,280.9023,97,,percent of total billed charges,,
STRYKER TOMCAT 4.0MM ANGLED CUTTER,,A4649,HCPCS,Facility,Both,,,,289.59,246.1515,82.996494,289.59,"Health Partners, Inc.",Commercial,273.95214,94.6,,percent of total billed charges,,
STRYKER TOMCAT 4.0MM ANGLED CUTTER,,A4649,HCPCS,Facility,Outpatient,,,,289.59,246.1515,82.996494,289.59,"Health Partners, Inc.",Medicare Advantage,141.8991,49,,percent of total billed charges,,
STRYKER TOMCAT 4.0MM ANGLED CUTTER,,A4649,HCPCS,Facility,Inpatient,,,,289.59,246.1515,82.996494,289.59,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
STRYKER TOMCAT 4.0MM ANGLED CUTTER,,A4649,HCPCS,Facility,Both,,,,289.59,246.1515,82.996494,289.59,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),173.754,60,,percent of total billed charges,,
STRYKER TOMCAT 4.0MM ANGLED CUTTER,,A4649,HCPCS,Facility,Both,,,,289.59,246.1515,82.996494,289.59,"Health Partners, Inc.",State of Minnesota Advantage Program,236.01585,81.5,,percent of total billed charges,,
STRYKER TOMCAT 4.0MM ANGLED CUTTER,,A4649,HCPCS,Facility,Both,,,,289.59,246.1515,82.996494,289.59,"Health Partners, Inc.",State Public Programs,144.795,50,,percent of total billed charges,,
STRYKER TOMCAT 4.0MM ANGLED CUTTER,,A4649,HCPCS,Facility,Both,,,,289.59,246.1515,82.996494,289.59,Humana Insurance Company,Commercial PPO,275.1105,95,,percent of total billed charges,,
STRYKER TOMCAT 4.0MM ANGLED CUTTER,,A4649,HCPCS,Facility,Outpatient,,,,289.59,246.1515,82.996494,289.59,Humana Insurance Company,Medicare PPO,141.8991,49,,percent of total billed charges,,
STRYKER TOMCAT 4.0MM ANGLED CUTTER,,A4649,HCPCS,Facility,Inpatient,,,,289.59,246.1515,82.996494,289.59,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
STRYKER TOMCAT 4.0MM ANGLED CUTTER,,A4649,HCPCS,Facility,Both,,,,289.59,246.1515,82.996494,289.59,Medica,Individual & Family,286.98369,99.1,,percent of total billed charges,,
STRYKER TOMCAT 4.0MM ANGLED CUTTER,,A4649,HCPCS,Facility,Outpatient,,,,289.59,246.1515,82.996494,289.59,Medica,Medica Advantage Solution,144.21582,49.8,,percent of total billed charges,,
STRYKER TOMCAT 4.0MM ANGLED CUTTER,,A4649,HCPCS,Facility,Inpatient,,,,289.59,246.1515,82.996494,289.59,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
STRYKER TOMCAT 4.0MM ANGLED CUTTER,,A4649,HCPCS,Facility,Outpatient,,,,289.59,246.1515,82.996494,289.59,Medica,Medical Assistance,129.15714,44.6,,percent of total billed charges,,
STRYKER TOMCAT 4.0MM ANGLED CUTTER,,A4649,HCPCS,Facility,Inpatient,,,,289.59,246.1515,82.996494,289.59,Medica,Medical Assistance,,,,,Included in per diem rate,
STRYKER TOMCAT 4.0MM ANGLED CUTTER,,A4649,HCPCS,Facility,Outpatient,,,,289.59,246.1515,82.996494,289.59,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,144.21582,49.8,,percent of total billed charges,,
STRYKER TOMCAT 4.0MM ANGLED CUTTER,,A4649,HCPCS,Facility,Inpatient,,,,289.59,246.1515,82.996494,289.59,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
STRYKER TOMCAT 4.0MM ANGLED CUTTER,,A4649,HCPCS,Facility,Both,,,,289.59,246.1515,82.996494,289.59,"Multiplan, Inc.","Multiplan, Inc.",272.2146,94,,percent of total billed charges,,
STRYKER TOMCAT 4.0MM ANGLED CUTTER,,A4649,HCPCS,Facility,Outpatient,,,,289.59,246.1515,82.996494,289.59,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,260.92059,90.1,,percent of total billed charges,,
STRYKER TOMCAT 4.0MM ANGLED CUTTER,,A4649,HCPCS,Facility,Inpatient,,,,289.59,246.1515,82.996494,289.59,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
STRYKER TOMCAT 4.0MM ANGLED CUTTER,,A4649,HCPCS,Facility,Both,,,,289.59,246.1515,82.996494,289.59,"Preferred One Administrative Services, INC.",PPO,285.53574,98.6,,percent of total billed charges,,
STRYKER TOMCAT 4.0MM ANGLED CUTTER,,A4649,HCPCS,Facility,Outpatient,,,,289.59,246.1515,82.996494,289.59,PrimeWest Health,Minnesota Senior Health Options (MSHO),148.994055,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
STRYKER TOMCAT 4.0MM ANGLED CUTTER,,A4649,HCPCS,Facility,Inpatient,,,,289.59,246.1515,82.996494,289.59,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
STRYKER TOMCAT 4.0MM ANGLED CUTTER,,A4649,HCPCS,Facility,Outpatient,,,,289.59,246.1515,82.996494,289.59,PrimeWest Health,MinnesotaCare,148.733424,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
STRYKER TOMCAT 4.0MM ANGLED CUTTER,,A4649,HCPCS,Facility,Inpatient,,,,289.59,246.1515,82.996494,289.59,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
STRYKER TOMCAT 4.0MM ANGLED CUTTER,,A4649,HCPCS,Facility,Both,,,,289.59,246.1515,82.996494,289.59,Sanford Health Plan,Sanford Health Plan,266.4228,92,,percent of total billed charges,,
STRYKER TOMCAT 4.0MM ANGLED CUTTER,,A4649,HCPCS,Facility,Outpatient,,,,289.59,246.1515,82.996494,289.59,"UCare Health, Inc.",Individual & Family Plan,163.183965,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
STRYKER TOMCAT 4.0MM ANGLED CUTTER,,A4649,HCPCS,Facility,Inpatient,,,,289.59,246.1515,82.996494,289.59,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
STRYKER TOMCAT 4.0MM ANGLED CUTTER,,A4649,HCPCS,Facility,Outpatient,,,,289.59,246.1515,82.996494,289.59,"UCare Health, Inc.",Medical Assistance,146.156073,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
STRYKER TOMCAT 4.0MM ANGLED CUTTER,,A4649,HCPCS,Facility,Inpatient,,,,289.59,246.1515,82.996494,289.59,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
STRYKER TOMCAT 4.0MM ANGLED CUTTER,,A4649,HCPCS,Facility,Outpatient,,,,289.59,246.1515,82.996494,289.59,"UCare Health, Inc.",Medicare Advantage,146.156073,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
STRYKER TOMCAT 4.0MM ANGLED CUTTER,,A4649,HCPCS,Facility,Inpatient,,,,289.59,246.1515,82.996494,289.59,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
STRYKER TOMCAT 4.0MM ANGLED CUTTER,,A4649,HCPCS,Facility,Outpatient,,,,289.59,246.1515,82.996494,289.59,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),146.156073,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
STRYKER TOMCAT 4.0MM ANGLED CUTTER,,A4649,HCPCS,Facility,Inpatient,,,,289.59,246.1515,82.996494,289.59,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
STRYKER TOMCAT 4.0MM ANGLED CUTTER,,A4649,HCPCS,Facility,Both,,,,289.59,246.1515,82.996494,289.59,UnitedHealthcare,Individual & Family,272.2146,94,,percent of total billed charges,,
STRYKER TOMCAT 4.0MM ANGLED CUTTER,,A4649,HCPCS,Facility,Outpatient,,,,289.59,246.1515,82.996494,289.59,UnitedHealthcare,Medicare Advantage,141.8991,49,,percent of total billed charges,,
STRYKER TOMCAT 4.0MM ANGLED CUTTER,,A4649,HCPCS,Facility,Inpatient,,,,289.59,246.1515,82.996494,289.59,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
STRYKER TOMCAT 4.0MM ANGLED CUTTER,,A4649,HCPCS,Facility,Outpatient,,,,289.59,246.1515,82.996494,289.59,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,139.0032,48,,percent of total billed charges,,100% of DHS outpatient percentage
STRYKER TOMCAT 4.0MM ANGLED CUTTER,,A4649,HCPCS,Facility,Inpatient,,,,289.59,246.1515,82.996494,289.59,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
SUCTION POLYP TRAP,,A4649,HCPCS,Facility,Both,,,,60.57,51.4845,17.359362,60.57,Aetna,Commercial,55.7244,92,,percent of total billed charges,,
SUCTION POLYP TRAP,,A4649,HCPCS,Facility,Outpatient,,,,60.57,51.4845,17.359362,60.57,Aetna,Medicare Advantage,29.6793,49,,percent of total billed charges,,
SUCTION POLYP TRAP,,A4649,HCPCS,Facility,Inpatient,,,,60.57,51.4845,17.359362,60.57,Aetna,Medicare Advantage,,,,,Included in per diem rate,
SUCTION POLYP TRAP,,A4649,HCPCS,Facility,Both,,,,60.57,51.4845,17.359362,60.57,Aetna,PPO,56.3301,93,,percent of total billed charges,,
SUCTION POLYP TRAP,,A4649,HCPCS,Facility,Both,,,,60.57,51.4845,17.359362,60.57,America's PPO,America's PPO,58.165371,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SUCTION POLYP TRAP,,A4649,HCPCS,Facility,Both,,,,60.57,51.4845,17.359362,60.57,BlueCross BlueShield Minnesota, Federal Employee Program,59.60088,98.4,,percent of total billed charges,,
SUCTION POLYP TRAP,,A4649,HCPCS,Facility,Both,,,,60.57,51.4845,17.359362,60.57,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,60.57,100,,percent of total billed charges,,
SUCTION POLYP TRAP,,A4649,HCPCS,Facility,Both,,,,60.57,51.4845,17.359362,60.57,BlueCross BlueShield Minnesota,High Value Network Plan,54.513,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
SUCTION POLYP TRAP,,A4649,HCPCS,Facility,Outpatient,,,,60.57,51.4845,17.359362,60.57,BlueCross BlueShield Minnesota,Medicare Advantage,29.6793,49,,percent of total billed charges,,
SUCTION POLYP TRAP,,A4649,HCPCS,Facility,Inpatient,,,,60.57,51.4845,17.359362,60.57,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
SUCTION POLYP TRAP,,A4649,HCPCS,Facility,Both,,,,60.57,51.4845,17.359362,60.57,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,53.646849,88.57,,percent of total billed charges,,
SUCTION POLYP TRAP,,A4649,HCPCS,Facility,Both,,,,60.57,51.4845,17.359362,60.57,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,17.359362,28.66,,percent of total billed charges,,
SUCTION POLYP TRAP,,A4649,HCPCS,Facility,Outpatient,,,,60.57,51.4845,17.359362,60.57,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),29.6793,49,,percent of total billed charges,,
SUCTION POLYP TRAP,,A4649,HCPCS,Facility,Inpatient,,,,60.57,51.4845,17.359362,60.57,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
SUCTION POLYP TRAP,,A4649,HCPCS,Facility,Both,,,,60.57,51.4845,17.359362,60.57,CorVel,Worker's Compensation,60.57,100,,percent of total billed charges,,
SUCTION POLYP TRAP,,A4649,HCPCS,Facility,Both,,,,60.57,51.4845,17.359362,60.57,First Health Group Corporation,First Health Network,58.7529,97,,percent of total billed charges,,
SUCTION POLYP TRAP,,A4649,HCPCS,Facility,Both,,,,60.57,51.4845,17.359362,60.57,"Health Partners, Inc.",Commercial,57.29922,94.6,,percent of total billed charges,,
SUCTION POLYP TRAP,,A4649,HCPCS,Facility,Outpatient,,,,60.57,51.4845,17.359362,60.57,"Health Partners, Inc.",Medicare Advantage,29.6793,49,,percent of total billed charges,,
SUCTION POLYP TRAP,,A4649,HCPCS,Facility,Inpatient,,,,60.57,51.4845,17.359362,60.57,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUCTION POLYP TRAP,,A4649,HCPCS,Facility,Both,,,,60.57,51.4845,17.359362,60.57,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),36.342,60,,percent of total billed charges,,
SUCTION POLYP TRAP,,A4649,HCPCS,Facility,Both,,,,60.57,51.4845,17.359362,60.57,"Health Partners, Inc.",State of Minnesota Advantage Program,49.36455,81.5,,percent of total billed charges,,
SUCTION POLYP TRAP,,A4649,HCPCS,Facility,Both,,,,60.57,51.4845,17.359362,60.57,"Health Partners, Inc.",State Public Programs,30.285,50,,percent of total billed charges,,
SUCTION POLYP TRAP,,A4649,HCPCS,Facility,Both,,,,60.57,51.4845,17.359362,60.57,Humana Insurance Company,Commercial PPO,57.5415,95,,percent of total billed charges,,
SUCTION POLYP TRAP,,A4649,HCPCS,Facility,Outpatient,,,,60.57,51.4845,17.359362,60.57,Humana Insurance Company,Medicare PPO,29.6793,49,,percent of total billed charges,,
SUCTION POLYP TRAP,,A4649,HCPCS,Facility,Inpatient,,,,60.57,51.4845,17.359362,60.57,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
SUCTION POLYP TRAP,,A4649,HCPCS,Facility,Both,,,,60.57,51.4845,17.359362,60.57,Medica,Individual & Family,60.02487,99.1,,percent of total billed charges,,
SUCTION POLYP TRAP,,A4649,HCPCS,Facility,Outpatient,,,,60.57,51.4845,17.359362,60.57,Medica,Medica Advantage Solution,30.16386,49.8,,percent of total billed charges,,
SUCTION POLYP TRAP,,A4649,HCPCS,Facility,Inpatient,,,,60.57,51.4845,17.359362,60.57,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
SUCTION POLYP TRAP,,A4649,HCPCS,Facility,Outpatient,,,,60.57,51.4845,17.359362,60.57,Medica,Medical Assistance,27.01422,44.6,,percent of total billed charges,,
SUCTION POLYP TRAP,,A4649,HCPCS,Facility,Inpatient,,,,60.57,51.4845,17.359362,60.57,Medica,Medical Assistance,,,,,Included in per diem rate,
SUCTION POLYP TRAP,,A4649,HCPCS,Facility,Outpatient,,,,60.57,51.4845,17.359362,60.57,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,30.16386,49.8,,percent of total billed charges,,
SUCTION POLYP TRAP,,A4649,HCPCS,Facility,Inpatient,,,,60.57,51.4845,17.359362,60.57,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
SUCTION POLYP TRAP,,A4649,HCPCS,Facility,Both,,,,60.57,51.4845,17.359362,60.57,"Multiplan, Inc.","Multiplan, Inc.",56.9358,94,,percent of total billed charges,,
SUCTION POLYP TRAP,,A4649,HCPCS,Facility,Outpatient,,,,60.57,51.4845,17.359362,60.57,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,54.57357,90.1,,percent of total billed charges,,
SUCTION POLYP TRAP,,A4649,HCPCS,Facility,Inpatient,,,,60.57,51.4845,17.359362,60.57,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
SUCTION POLYP TRAP,,A4649,HCPCS,Facility,Both,,,,60.57,51.4845,17.359362,60.57,"Preferred One Administrative Services, INC.",PPO,59.72202,98.6,,percent of total billed charges,,
SUCTION POLYP TRAP,,A4649,HCPCS,Facility,Outpatient,,,,60.57,51.4845,17.359362,60.57,PrimeWest Health,Minnesota Senior Health Options (MSHO),31.163265,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
SUCTION POLYP TRAP,,A4649,HCPCS,Facility,Inpatient,,,,60.57,51.4845,17.359362,60.57,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUCTION POLYP TRAP,,A4649,HCPCS,Facility,Outpatient,,,,60.57,51.4845,17.359362,60.57,PrimeWest Health,MinnesotaCare,31.108752,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
SUCTION POLYP TRAP,,A4649,HCPCS,Facility,Inpatient,,,,60.57,51.4845,17.359362,60.57,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
SUCTION POLYP TRAP,,A4649,HCPCS,Facility,Both,,,,60.57,51.4845,17.359362,60.57,Sanford Health Plan,Sanford Health Plan,55.7244,92,,percent of total billed charges,,
SUCTION POLYP TRAP,,A4649,HCPCS,Facility,Outpatient,,,,60.57,51.4845,17.359362,60.57,"UCare Health, Inc.",Individual & Family Plan,34.131195,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
SUCTION POLYP TRAP,,A4649,HCPCS,Facility,Inpatient,,,,60.57,51.4845,17.359362,60.57,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
SUCTION POLYP TRAP,,A4649,HCPCS,Facility,Outpatient,,,,60.57,51.4845,17.359362,60.57,"UCare Health, Inc.",Medical Assistance,30.569679,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUCTION POLYP TRAP,,A4649,HCPCS,Facility,Inpatient,,,,60.57,51.4845,17.359362,60.57,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
SUCTION POLYP TRAP,,A4649,HCPCS,Facility,Outpatient,,,,60.57,51.4845,17.359362,60.57,"UCare Health, Inc.",Medicare Advantage,30.569679,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUCTION POLYP TRAP,,A4649,HCPCS,Facility,Inpatient,,,,60.57,51.4845,17.359362,60.57,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUCTION POLYP TRAP,,A4649,HCPCS,Facility,Outpatient,,,,60.57,51.4845,17.359362,60.57,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),30.569679,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUCTION POLYP TRAP,,A4649,HCPCS,Facility,Inpatient,,,,60.57,51.4845,17.359362,60.57,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUCTION POLYP TRAP,,A4649,HCPCS,Facility,Both,,,,60.57,51.4845,17.359362,60.57,UnitedHealthcare,Individual & Family,56.9358,94,,percent of total billed charges,,
SUCTION POLYP TRAP,,A4649,HCPCS,Facility,Outpatient,,,,60.57,51.4845,17.359362,60.57,UnitedHealthcare,Medicare Advantage,29.6793,49,,percent of total billed charges,,
SUCTION POLYP TRAP,,A4649,HCPCS,Facility,Inpatient,,,,60.57,51.4845,17.359362,60.57,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
SUCTION POLYP TRAP,,A4649,HCPCS,Facility,Outpatient,,,,60.57,51.4845,17.359362,60.57,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,29.0736,48,,percent of total billed charges,,100% of DHS outpatient percentage
SUCTION POLYP TRAP,,A4649,HCPCS,Facility,Inpatient,,,,60.57,51.4845,17.359362,60.57,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Sup Ob Tray,,A4649,HCPCS,Facility,Both,,,,69,58.65,19.7754,69,Aetna,Commercial,63.48,92,,percent of total billed charges,,
Sup Ob Tray,,A4649,HCPCS,Facility,Outpatient,,,,69,58.65,19.7754,69,Aetna,Medicare Advantage,33.81,49,,percent of total billed charges,,
Sup Ob Tray,,A4649,HCPCS,Facility,Inpatient,,,,69,58.65,19.7754,69,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Sup Ob Tray,,A4649,HCPCS,Facility,Both,,,,69,58.65,19.7754,69,Aetna,PPO,64.17,93,,percent of total billed charges,,
Sup Ob Tray,,A4649,HCPCS,Facility,Both,,,,69,58.65,19.7754,69,America's PPO,America's PPO,66.2607,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Sup Ob Tray,,A4649,HCPCS,Facility,Both,,,,69,58.65,19.7754,69,BlueCross BlueShield Minnesota, Federal Employee Program,67.896,98.4,,percent of total billed charges,,
Sup Ob Tray,,A4649,HCPCS,Facility,Both,,,,69,58.65,19.7754,69,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,69,100,,percent of total billed charges,,
Sup Ob Tray,,A4649,HCPCS,Facility,Both,,,,69,58.65,19.7754,69,BlueCross BlueShield Minnesota,High Value Network Plan,62.1,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
Sup Ob Tray,,A4649,HCPCS,Facility,Outpatient,,,,69,58.65,19.7754,69,BlueCross BlueShield Minnesota,Medicare Advantage,33.81,49,,percent of total billed charges,,
Sup Ob Tray,,A4649,HCPCS,Facility,Inpatient,,,,69,58.65,19.7754,69,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Sup Ob Tray,,A4649,HCPCS,Facility,Both,,,,69,58.65,19.7754,69,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,61.1133,88.57,,percent of total billed charges,,
Sup Ob Tray,,A4649,HCPCS,Facility,Both,,,,69,58.65,19.7754,69,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,19.7754,28.66,,percent of total billed charges,,
Sup Ob Tray,,A4649,HCPCS,Facility,Outpatient,,,,69,58.65,19.7754,69,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),33.81,49,,percent of total billed charges,,
Sup Ob Tray,,A4649,HCPCS,Facility,Inpatient,,,,69,58.65,19.7754,69,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Sup Ob Tray,,A4649,HCPCS,Facility,Both,,,,69,58.65,19.7754,69,CorVel,Worker's Compensation,69,100,,percent of total billed charges,,
Sup Ob Tray,,A4649,HCPCS,Facility,Both,,,,69,58.65,19.7754,69,First Health Group Corporation,First Health Network,66.93,97,,percent of total billed charges,,
Sup Ob Tray,,A4649,HCPCS,Facility,Both,,,,69,58.65,19.7754,69,"Health Partners, Inc.",Commercial,65.274,94.6,,percent of total billed charges,,
Sup Ob Tray,,A4649,HCPCS,Facility,Outpatient,,,,69,58.65,19.7754,69,"Health Partners, Inc.",Medicare Advantage,33.81,49,,percent of total billed charges,,
Sup Ob Tray,,A4649,HCPCS,Facility,Inpatient,,,,69,58.65,19.7754,69,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Ob Tray,,A4649,HCPCS,Facility,Both,,,,69,58.65,19.7754,69,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),41.4,60,,percent of total billed charges,,
Sup Ob Tray,,A4649,HCPCS,Facility,Both,,,,69,58.65,19.7754,69,"Health Partners, Inc.",State of Minnesota Advantage Program,56.235,81.5,,percent of total billed charges,,
Sup Ob Tray,,A4649,HCPCS,Facility,Both,,,,69,58.65,19.7754,69,"Health Partners, Inc.",State Public Programs,34.5,50,,percent of total billed charges,,
Sup Ob Tray,,A4649,HCPCS,Facility,Both,,,,69,58.65,19.7754,69,Humana Insurance Company,Commercial PPO,65.55,95,,percent of total billed charges,,
Sup Ob Tray,,A4649,HCPCS,Facility,Outpatient,,,,69,58.65,19.7754,69,Humana Insurance Company,Medicare PPO,33.81,49,,percent of total billed charges,,
Sup Ob Tray,,A4649,HCPCS,Facility,Inpatient,,,,69,58.65,19.7754,69,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Sup Ob Tray,,A4649,HCPCS,Facility,Both,,,,69,58.65,19.7754,69,Medica,Individual & Family,68.379,99.1,,percent of total billed charges,,
Sup Ob Tray,,A4649,HCPCS,Facility,Outpatient,,,,69,58.65,19.7754,69,Medica,Medica Advantage Solution,34.362,49.8,,percent of total billed charges,,
Sup Ob Tray,,A4649,HCPCS,Facility,Inpatient,,,,69,58.65,19.7754,69,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Sup Ob Tray,,A4649,HCPCS,Facility,Outpatient,,,,69,58.65,19.7754,69,Medica,Medical Assistance,30.774,44.6,,percent of total billed charges,,
Sup Ob Tray,,A4649,HCPCS,Facility,Inpatient,,,,69,58.65,19.7754,69,Medica,Medical Assistance,,,,,Included in per diem rate,
Sup Ob Tray,,A4649,HCPCS,Facility,Outpatient,,,,69,58.65,19.7754,69,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,34.362,49.8,,percent of total billed charges,,
Sup Ob Tray,,A4649,HCPCS,Facility,Inpatient,,,,69,58.65,19.7754,69,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Sup Ob Tray,,A4649,HCPCS,Facility,Both,,,,69,58.65,19.7754,69,"Multiplan, Inc.","Multiplan, Inc.",64.86,94,,percent of total billed charges,,
Sup Ob Tray,,A4649,HCPCS,Facility,Outpatient,,,,69,58.65,19.7754,69,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,62.169,90.1,,percent of total billed charges,,
Sup Ob Tray,,A4649,HCPCS,Facility,Inpatient,,,,69,58.65,19.7754,69,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Sup Ob Tray,,A4649,HCPCS,Facility,Both,,,,69,58.65,19.7754,69,"Preferred One Administrative Services, INC.",PPO,68.034,98.6,,percent of total billed charges,,
Sup Ob Tray,,A4649,HCPCS,Facility,Outpatient,,,,69,58.65,19.7754,69,PrimeWest Health,Minnesota Senior Health Options (MSHO),35.5005,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Sup Ob Tray,,A4649,HCPCS,Facility,Inpatient,,,,69,58.65,19.7754,69,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Ob Tray,,A4649,HCPCS,Facility,Outpatient,,,,69,58.65,19.7754,69,PrimeWest Health,MinnesotaCare,35.4384,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Sup Ob Tray,,A4649,HCPCS,Facility,Inpatient,,,,69,58.65,19.7754,69,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Sup Ob Tray,,A4649,HCPCS,Facility,Both,,,,69,58.65,19.7754,69,Sanford Health Plan,Sanford Health Plan,63.48,92,,percent of total billed charges,,
Sup Ob Tray,,A4649,HCPCS,Facility,Outpatient,,,,69,58.65,19.7754,69,"UCare Health, Inc.",Individual & Family Plan,38.8815,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Sup Ob Tray,,A4649,HCPCS,Facility,Inpatient,,,,69,58.65,19.7754,69,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Sup Ob Tray,,A4649,HCPCS,Facility,Outpatient,,,,69,58.65,19.7754,69,"UCare Health, Inc.",Medical Assistance,34.8243,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Ob Tray,,A4649,HCPCS,Facility,Inpatient,,,,69,58.65,19.7754,69,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Sup Ob Tray,,A4649,HCPCS,Facility,Outpatient,,,,69,58.65,19.7754,69,"UCare Health, Inc.",Medicare Advantage,34.8243,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Ob Tray,,A4649,HCPCS,Facility,Inpatient,,,,69,58.65,19.7754,69,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Ob Tray,,A4649,HCPCS,Facility,Outpatient,,,,69,58.65,19.7754,69,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),34.8243,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Ob Tray,,A4649,HCPCS,Facility,Inpatient,,,,69,58.65,19.7754,69,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Ob Tray,,A4649,HCPCS,Facility,Both,,,,69,58.65,19.7754,69,UnitedHealthcare,Individual & Family,64.86,94,,percent of total billed charges,,
Sup Ob Tray,,A4649,HCPCS,Facility,Outpatient,,,,69,58.65,19.7754,69,UnitedHealthcare,Medicare Advantage,33.81,49,,percent of total billed charges,,
Sup Ob Tray,,A4649,HCPCS,Facility,Inpatient,,,,69,58.65,19.7754,69,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Sup Ob Tray,,A4649,HCPCS,Facility,Outpatient,,,,69,58.65,19.7754,69,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,33.12,48,,percent of total billed charges,,100% of DHS outpatient percentage
Sup Ob Tray,,A4649,HCPCS,Facility,Inpatient,,,,69,58.65,19.7754,69,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Sup Set Admin Irrigation Cysto,,A4649,HCPCS,Facility,Both,,,,19,16.15,5.4454,19,Aetna,Commercial,17.48,92,,percent of total billed charges,,
Sup Set Admin Irrigation Cysto,,A4649,HCPCS,Facility,Outpatient,,,,19,16.15,5.4454,19,Aetna,Medicare Advantage,9.31,49,,percent of total billed charges,,
Sup Set Admin Irrigation Cysto,,A4649,HCPCS,Facility,Inpatient,,,,19,16.15,5.4454,19,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Sup Set Admin Irrigation Cysto,,A4649,HCPCS,Facility,Both,,,,19,16.15,5.4454,19,Aetna,PPO,17.67,93,,percent of total billed charges,,
Sup Set Admin Irrigation Cysto,,A4649,HCPCS,Facility,Both,,,,19,16.15,5.4454,19,America's PPO,America's PPO,18.2457,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Sup Set Admin Irrigation Cysto,,A4649,HCPCS,Facility,Both,,,,19,16.15,5.4454,19,BlueCross BlueShield Minnesota, Federal Employee Program,18.696,98.4,,percent of total billed charges,,
Sup Set Admin Irrigation Cysto,,A4649,HCPCS,Facility,Both,,,,19,16.15,5.4454,19,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,19,100,,percent of total billed charges,,
Sup Set Admin Irrigation Cysto,,A4649,HCPCS,Facility,Both,,,,19,16.15,5.4454,19,BlueCross BlueShield Minnesota,High Value Network Plan,17.1,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
Sup Set Admin Irrigation Cysto,,A4649,HCPCS,Facility,Outpatient,,,,19,16.15,5.4454,19,BlueCross BlueShield Minnesota,Medicare Advantage,9.31,49,,percent of total billed charges,,
Sup Set Admin Irrigation Cysto,,A4649,HCPCS,Facility,Inpatient,,,,19,16.15,5.4454,19,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Sup Set Admin Irrigation Cysto,,A4649,HCPCS,Facility,Both,,,,19,16.15,5.4454,19,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,16.8283,88.57,,percent of total billed charges,,
Sup Set Admin Irrigation Cysto,,A4649,HCPCS,Facility,Both,,,,19,16.15,5.4454,19,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,5.4454,28.66,,percent of total billed charges,,
Sup Set Admin Irrigation Cysto,,A4649,HCPCS,Facility,Outpatient,,,,19,16.15,5.4454,19,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),9.31,49,,percent of total billed charges,,
Sup Set Admin Irrigation Cysto,,A4649,HCPCS,Facility,Inpatient,,,,19,16.15,5.4454,19,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Sup Set Admin Irrigation Cysto,,A4649,HCPCS,Facility,Both,,,,19,16.15,5.4454,19,CorVel,Worker's Compensation,19,100,,percent of total billed charges,,
Sup Set Admin Irrigation Cysto,,A4649,HCPCS,Facility,Both,,,,19,16.15,5.4454,19,First Health Group Corporation,First Health Network,18.43,97,,percent of total billed charges,,
Sup Set Admin Irrigation Cysto,,A4649,HCPCS,Facility,Both,,,,19,16.15,5.4454,19,"Health Partners, Inc.",Commercial,17.974,94.6,,percent of total billed charges,,
Sup Set Admin Irrigation Cysto,,A4649,HCPCS,Facility,Outpatient,,,,19,16.15,5.4454,19,"Health Partners, Inc.",Medicare Advantage,9.31,49,,percent of total billed charges,,
Sup Set Admin Irrigation Cysto,,A4649,HCPCS,Facility,Inpatient,,,,19,16.15,5.4454,19,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Set Admin Irrigation Cysto,,A4649,HCPCS,Facility,Both,,,,19,16.15,5.4454,19,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),11.4,60,,percent of total billed charges,,
Sup Set Admin Irrigation Cysto,,A4649,HCPCS,Facility,Both,,,,19,16.15,5.4454,19,"Health Partners, Inc.",State of Minnesota Advantage Program,15.485,81.5,,percent of total billed charges,,
Sup Set Admin Irrigation Cysto,,A4649,HCPCS,Facility,Both,,,,19,16.15,5.4454,19,"Health Partners, Inc.",State Public Programs,9.5,50,,percent of total billed charges,,
Sup Set Admin Irrigation Cysto,,A4649,HCPCS,Facility,Both,,,,19,16.15,5.4454,19,Humana Insurance Company,Commercial PPO,18.05,95,,percent of total billed charges,,
Sup Set Admin Irrigation Cysto,,A4649,HCPCS,Facility,Outpatient,,,,19,16.15,5.4454,19,Humana Insurance Company,Medicare PPO,9.31,49,,percent of total billed charges,,
Sup Set Admin Irrigation Cysto,,A4649,HCPCS,Facility,Inpatient,,,,19,16.15,5.4454,19,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Sup Set Admin Irrigation Cysto,,A4649,HCPCS,Facility,Both,,,,19,16.15,5.4454,19,Medica,Individual & Family,18.829,99.1,,percent of total billed charges,,
Sup Set Admin Irrigation Cysto,,A4649,HCPCS,Facility,Outpatient,,,,19,16.15,5.4454,19,Medica,Medica Advantage Solution,9.462,49.8,,percent of total billed charges,,
Sup Set Admin Irrigation Cysto,,A4649,HCPCS,Facility,Inpatient,,,,19,16.15,5.4454,19,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Sup Set Admin Irrigation Cysto,,A4649,HCPCS,Facility,Outpatient,,,,19,16.15,5.4454,19,Medica,Medical Assistance,8.474,44.6,,percent of total billed charges,,
Sup Set Admin Irrigation Cysto,,A4649,HCPCS,Facility,Inpatient,,,,19,16.15,5.4454,19,Medica,Medical Assistance,,,,,Included in per diem rate,
Sup Set Admin Irrigation Cysto,,A4649,HCPCS,Facility,Outpatient,,,,19,16.15,5.4454,19,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,9.462,49.8,,percent of total billed charges,,
Sup Set Admin Irrigation Cysto,,A4649,HCPCS,Facility,Inpatient,,,,19,16.15,5.4454,19,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Sup Set Admin Irrigation Cysto,,A4649,HCPCS,Facility,Both,,,,19,16.15,5.4454,19,"Multiplan, Inc.","Multiplan, Inc.",17.86,94,,percent of total billed charges,,
Sup Set Admin Irrigation Cysto,,A4649,HCPCS,Facility,Outpatient,,,,19,16.15,5.4454,19,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,17.119,90.1,,percent of total billed charges,,
Sup Set Admin Irrigation Cysto,,A4649,HCPCS,Facility,Inpatient,,,,19,16.15,5.4454,19,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Sup Set Admin Irrigation Cysto,,A4649,HCPCS,Facility,Both,,,,19,16.15,5.4454,19,"Preferred One Administrative Services, INC.",PPO,18.734,98.6,,percent of total billed charges,,
Sup Set Admin Irrigation Cysto,,A4649,HCPCS,Facility,Outpatient,,,,19,16.15,5.4454,19,PrimeWest Health,Minnesota Senior Health Options (MSHO),9.7755,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Sup Set Admin Irrigation Cysto,,A4649,HCPCS,Facility,Inpatient,,,,19,16.15,5.4454,19,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Set Admin Irrigation Cysto,,A4649,HCPCS,Facility,Outpatient,,,,19,16.15,5.4454,19,PrimeWest Health,MinnesotaCare,9.7584,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Sup Set Admin Irrigation Cysto,,A4649,HCPCS,Facility,Inpatient,,,,19,16.15,5.4454,19,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Sup Set Admin Irrigation Cysto,,A4649,HCPCS,Facility,Both,,,,19,16.15,5.4454,19,Sanford Health Plan,Sanford Health Plan,17.48,92,,percent of total billed charges,,
Sup Set Admin Irrigation Cysto,,A4649,HCPCS,Facility,Outpatient,,,,19,16.15,5.4454,19,"UCare Health, Inc.",Individual & Family Plan,10.7065,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Sup Set Admin Irrigation Cysto,,A4649,HCPCS,Facility,Inpatient,,,,19,16.15,5.4454,19,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Sup Set Admin Irrigation Cysto,,A4649,HCPCS,Facility,Outpatient,,,,19,16.15,5.4454,19,"UCare Health, Inc.",Medical Assistance,9.5893,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Set Admin Irrigation Cysto,,A4649,HCPCS,Facility,Inpatient,,,,19,16.15,5.4454,19,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Sup Set Admin Irrigation Cysto,,A4649,HCPCS,Facility,Outpatient,,,,19,16.15,5.4454,19,"UCare Health, Inc.",Medicare Advantage,9.5893,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Set Admin Irrigation Cysto,,A4649,HCPCS,Facility,Inpatient,,,,19,16.15,5.4454,19,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Set Admin Irrigation Cysto,,A4649,HCPCS,Facility,Outpatient,,,,19,16.15,5.4454,19,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),9.5893,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Set Admin Irrigation Cysto,,A4649,HCPCS,Facility,Inpatient,,,,19,16.15,5.4454,19,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Set Admin Irrigation Cysto,,A4649,HCPCS,Facility,Both,,,,19,16.15,5.4454,19,UnitedHealthcare,Individual & Family,17.86,94,,percent of total billed charges,,
Sup Set Admin Irrigation Cysto,,A4649,HCPCS,Facility,Outpatient,,,,19,16.15,5.4454,19,UnitedHealthcare,Medicare Advantage,9.31,49,,percent of total billed charges,,
Sup Set Admin Irrigation Cysto,,A4649,HCPCS,Facility,Inpatient,,,,19,16.15,5.4454,19,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Sup Set Admin Irrigation Cysto,,A4649,HCPCS,Facility,Outpatient,,,,19,16.15,5.4454,19,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,9.12,48,,percent of total billed charges,,100% of DHS outpatient percentage
Sup Set Admin Irrigation Cysto,,A4649,HCPCS,Facility,Inpatient,,,,19,16.15,5.4454,19,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Sup Stapler Skin 35W,,A4649,HCPCS,Facility,Both,,,,49,41.65,14.0434,49,Aetna,Commercial,45.08,92,,percent of total billed charges,,
Sup Stapler Skin 35W,,A4649,HCPCS,Facility,Outpatient,,,,49,41.65,14.0434,49,Aetna,Medicare Advantage,24.01,49,,percent of total billed charges,,
Sup Stapler Skin 35W,,A4649,HCPCS,Facility,Inpatient,,,,49,41.65,14.0434,49,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Sup Stapler Skin 35W,,A4649,HCPCS,Facility,Both,,,,49,41.65,14.0434,49,Aetna,PPO,45.57,93,,percent of total billed charges,,
Sup Stapler Skin 35W,,A4649,HCPCS,Facility,Both,,,,49,41.65,14.0434,49,America's PPO,America's PPO,47.0547,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Sup Stapler Skin 35W,,A4649,HCPCS,Facility,Both,,,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota, Federal Employee Program,48.216,98.4,,percent of total billed charges,,
Sup Stapler Skin 35W,,A4649,HCPCS,Facility,Both,,,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,49,100,,percent of total billed charges,,
Sup Stapler Skin 35W,,A4649,HCPCS,Facility,Both,,,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,High Value Network Plan,44.1,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
Sup Stapler Skin 35W,,A4649,HCPCS,Facility,Outpatient,,,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Medicare Advantage,24.01,49,,percent of total billed charges,,
Sup Stapler Skin 35W,,A4649,HCPCS,Facility,Inpatient,,,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Sup Stapler Skin 35W,,A4649,HCPCS,Facility,Both,,,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,43.3993,88.57,,percent of total billed charges,,
Sup Stapler Skin 35W,,A4649,HCPCS,Facility,Both,,,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,14.0434,28.66,,percent of total billed charges,,
Sup Stapler Skin 35W,,A4649,HCPCS,Facility,Outpatient,,,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),24.01,49,,percent of total billed charges,,
Sup Stapler Skin 35W,,A4649,HCPCS,Facility,Inpatient,,,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Sup Stapler Skin 35W,,A4649,HCPCS,Facility,Both,,,,49,41.65,14.0434,49,CorVel,Worker's Compensation,49,100,,percent of total billed charges,,
Sup Stapler Skin 35W,,A4649,HCPCS,Facility,Both,,,,49,41.65,14.0434,49,First Health Group Corporation,First Health Network,47.53,97,,percent of total billed charges,,
Sup Stapler Skin 35W,,A4649,HCPCS,Facility,Both,,,,49,41.65,14.0434,49,"Health Partners, Inc.",Commercial,46.354,94.6,,percent of total billed charges,,
Sup Stapler Skin 35W,,A4649,HCPCS,Facility,Outpatient,,,,49,41.65,14.0434,49,"Health Partners, Inc.",Medicare Advantage,24.01,49,,percent of total billed charges,,
Sup Stapler Skin 35W,,A4649,HCPCS,Facility,Inpatient,,,,49,41.65,14.0434,49,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Stapler Skin 35W,,A4649,HCPCS,Facility,Both,,,,49,41.65,14.0434,49,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),29.4,60,,percent of total billed charges,,
Sup Stapler Skin 35W,,A4649,HCPCS,Facility,Both,,,,49,41.65,14.0434,49,"Health Partners, Inc.",State of Minnesota Advantage Program,39.935,81.5,,percent of total billed charges,,
Sup Stapler Skin 35W,,A4649,HCPCS,Facility,Both,,,,49,41.65,14.0434,49,"Health Partners, Inc.",State Public Programs,24.5,50,,percent of total billed charges,,
Sup Stapler Skin 35W,,A4649,HCPCS,Facility,Both,,,,49,41.65,14.0434,49,Humana Insurance Company,Commercial PPO,46.55,95,,percent of total billed charges,,
Sup Stapler Skin 35W,,A4649,HCPCS,Facility,Outpatient,,,,49,41.65,14.0434,49,Humana Insurance Company,Medicare PPO,24.01,49,,percent of total billed charges,,
Sup Stapler Skin 35W,,A4649,HCPCS,Facility,Inpatient,,,,49,41.65,14.0434,49,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Sup Stapler Skin 35W,,A4649,HCPCS,Facility,Both,,,,49,41.65,14.0434,49,Medica,Individual & Family,48.559,99.1,,percent of total billed charges,,
Sup Stapler Skin 35W,,A4649,HCPCS,Facility,Outpatient,,,,49,41.65,14.0434,49,Medica,Medica Advantage Solution,24.402,49.8,,percent of total billed charges,,
Sup Stapler Skin 35W,,A4649,HCPCS,Facility,Inpatient,,,,49,41.65,14.0434,49,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Sup Stapler Skin 35W,,A4649,HCPCS,Facility,Outpatient,,,,49,41.65,14.0434,49,Medica,Medical Assistance,21.854,44.6,,percent of total billed charges,,
Sup Stapler Skin 35W,,A4649,HCPCS,Facility,Inpatient,,,,49,41.65,14.0434,49,Medica,Medical Assistance,,,,,Included in per diem rate,
Sup Stapler Skin 35W,,A4649,HCPCS,Facility,Outpatient,,,,49,41.65,14.0434,49,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,24.402,49.8,,percent of total billed charges,,
Sup Stapler Skin 35W,,A4649,HCPCS,Facility,Inpatient,,,,49,41.65,14.0434,49,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Sup Stapler Skin 35W,,A4649,HCPCS,Facility,Both,,,,49,41.65,14.0434,49,"Multiplan, Inc.","Multiplan, Inc.",46.06,94,,percent of total billed charges,,
Sup Stapler Skin 35W,,A4649,HCPCS,Facility,Outpatient,,,,49,41.65,14.0434,49,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,44.149,90.1,,percent of total billed charges,,
Sup Stapler Skin 35W,,A4649,HCPCS,Facility,Inpatient,,,,49,41.65,14.0434,49,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Sup Stapler Skin 35W,,A4649,HCPCS,Facility,Both,,,,49,41.65,14.0434,49,"Preferred One Administrative Services, INC.",PPO,48.314,98.6,,percent of total billed charges,,
Sup Stapler Skin 35W,,A4649,HCPCS,Facility,Outpatient,,,,49,41.65,14.0434,49,PrimeWest Health,Minnesota Senior Health Options (MSHO),25.2105,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Sup Stapler Skin 35W,,A4649,HCPCS,Facility,Inpatient,,,,49,41.65,14.0434,49,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Stapler Skin 35W,,A4649,HCPCS,Facility,Outpatient,,,,49,41.65,14.0434,49,PrimeWest Health,MinnesotaCare,25.1664,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Sup Stapler Skin 35W,,A4649,HCPCS,Facility,Inpatient,,,,49,41.65,14.0434,49,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Sup Stapler Skin 35W,,A4649,HCPCS,Facility,Both,,,,49,41.65,14.0434,49,Sanford Health Plan,Sanford Health Plan,45.08,92,,percent of total billed charges,,
Sup Stapler Skin 35W,,A4649,HCPCS,Facility,Outpatient,,,,49,41.65,14.0434,49,"UCare Health, Inc.",Individual & Family Plan,27.6115,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Sup Stapler Skin 35W,,A4649,HCPCS,Facility,Inpatient,,,,49,41.65,14.0434,49,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Sup Stapler Skin 35W,,A4649,HCPCS,Facility,Outpatient,,,,49,41.65,14.0434,49,"UCare Health, Inc.",Medical Assistance,24.7303,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Stapler Skin 35W,,A4649,HCPCS,Facility,Inpatient,,,,49,41.65,14.0434,49,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Sup Stapler Skin 35W,,A4649,HCPCS,Facility,Outpatient,,,,49,41.65,14.0434,49,"UCare Health, Inc.",Medicare Advantage,24.7303,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Stapler Skin 35W,,A4649,HCPCS,Facility,Inpatient,,,,49,41.65,14.0434,49,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Stapler Skin 35W,,A4649,HCPCS,Facility,Outpatient,,,,49,41.65,14.0434,49,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),24.7303,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Stapler Skin 35W,,A4649,HCPCS,Facility,Inpatient,,,,49,41.65,14.0434,49,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Stapler Skin 35W,,A4649,HCPCS,Facility,Both,,,,49,41.65,14.0434,49,UnitedHealthcare,Individual & Family,46.06,94,,percent of total billed charges,,
Sup Stapler Skin 35W,,A4649,HCPCS,Facility,Outpatient,,,,49,41.65,14.0434,49,UnitedHealthcare,Medicare Advantage,24.01,49,,percent of total billed charges,,
Sup Stapler Skin 35W,,A4649,HCPCS,Facility,Inpatient,,,,49,41.65,14.0434,49,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Sup Stapler Skin 35W,,A4649,HCPCS,Facility,Outpatient,,,,49,41.65,14.0434,49,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,23.52,48,,percent of total billed charges,,100% of DHS outpatient percentage
Sup Stapler Skin 35W,,A4649,HCPCS,Facility,Inpatient,,,,49,41.65,14.0434,49,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
SUTURE CAPROSYN 3/0 30 CV-23,,A4649,HCPCS,Facility,Both,,,,77.04,65.484,22.079664,77.04,Aetna,Commercial,70.8768,92,,percent of total billed charges,,
SUTURE CAPROSYN 3/0 30 CV-23,,A4649,HCPCS,Facility,Outpatient,,,,77.04,65.484,22.079664,77.04,Aetna,Medicare Advantage,37.7496,49,,percent of total billed charges,,
SUTURE CAPROSYN 3/0 30 CV-23,,A4649,HCPCS,Facility,Inpatient,,,,77.04,65.484,22.079664,77.04,Aetna,Medicare Advantage,,,,,Included in per diem rate,
SUTURE CAPROSYN 3/0 30 CV-23,,A4649,HCPCS,Facility,Both,,,,77.04,65.484,22.079664,77.04,Aetna,PPO,71.6472,93,,percent of total billed charges,,
SUTURE CAPROSYN 3/0 30 CV-23,,A4649,HCPCS,Facility,Both,,,,77.04,65.484,22.079664,77.04,America's PPO,America's PPO,73.981512,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SUTURE CAPROSYN 3/0 30 CV-23,,A4649,HCPCS,Facility,Both,,,,77.04,65.484,22.079664,77.04,BlueCross BlueShield Minnesota, Federal Employee Program,75.80736,98.4,,percent of total billed charges,,
SUTURE CAPROSYN 3/0 30 CV-23,,A4649,HCPCS,Facility,Both,,,,77.04,65.484,22.079664,77.04,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,77.04,100,,percent of total billed charges,,
SUTURE CAPROSYN 3/0 30 CV-23,,A4649,HCPCS,Facility,Both,,,,77.04,65.484,22.079664,77.04,BlueCross BlueShield Minnesota,High Value Network Plan,69.336,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
SUTURE CAPROSYN 3/0 30 CV-23,,A4649,HCPCS,Facility,Outpatient,,,,77.04,65.484,22.079664,77.04,BlueCross BlueShield Minnesota,Medicare Advantage,37.7496,49,,percent of total billed charges,,
SUTURE CAPROSYN 3/0 30 CV-23,,A4649,HCPCS,Facility,Inpatient,,,,77.04,65.484,22.079664,77.04,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
SUTURE CAPROSYN 3/0 30 CV-23,,A4649,HCPCS,Facility,Both,,,,77.04,65.484,22.079664,77.04,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,68.234328,88.57,,percent of total billed charges,,
SUTURE CAPROSYN 3/0 30 CV-23,,A4649,HCPCS,Facility,Both,,,,77.04,65.484,22.079664,77.04,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,22.079664,28.66,,percent of total billed charges,,
SUTURE CAPROSYN 3/0 30 CV-23,,A4649,HCPCS,Facility,Outpatient,,,,77.04,65.484,22.079664,77.04,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),37.7496,49,,percent of total billed charges,,
SUTURE CAPROSYN 3/0 30 CV-23,,A4649,HCPCS,Facility,Inpatient,,,,77.04,65.484,22.079664,77.04,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
SUTURE CAPROSYN 3/0 30 CV-23,,A4649,HCPCS,Facility,Both,,,,77.04,65.484,22.079664,77.04,CorVel,Worker's Compensation,77.04,100,,percent of total billed charges,,
SUTURE CAPROSYN 3/0 30 CV-23,,A4649,HCPCS,Facility,Both,,,,77.04,65.484,22.079664,77.04,First Health Group Corporation,First Health Network,74.7288,97,,percent of total billed charges,,
SUTURE CAPROSYN 3/0 30 CV-23,,A4649,HCPCS,Facility,Both,,,,77.04,65.484,22.079664,77.04,"Health Partners, Inc.",Commercial,72.87984,94.6,,percent of total billed charges,,
SUTURE CAPROSYN 3/0 30 CV-23,,A4649,HCPCS,Facility,Outpatient,,,,77.04,65.484,22.079664,77.04,"Health Partners, Inc.",Medicare Advantage,37.7496,49,,percent of total billed charges,,
SUTURE CAPROSYN 3/0 30 CV-23,,A4649,HCPCS,Facility,Inpatient,,,,77.04,65.484,22.079664,77.04,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE CAPROSYN 3/0 30 CV-23,,A4649,HCPCS,Facility,Both,,,,77.04,65.484,22.079664,77.04,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),46.224,60,,percent of total billed charges,,
SUTURE CAPROSYN 3/0 30 CV-23,,A4649,HCPCS,Facility,Both,,,,77.04,65.484,22.079664,77.04,"Health Partners, Inc.",State of Minnesota Advantage Program,62.7876,81.5,,percent of total billed charges,,
SUTURE CAPROSYN 3/0 30 CV-23,,A4649,HCPCS,Facility,Both,,,,77.04,65.484,22.079664,77.04,"Health Partners, Inc.",State Public Programs,38.52,50,,percent of total billed charges,,
SUTURE CAPROSYN 3/0 30 CV-23,,A4649,HCPCS,Facility,Both,,,,77.04,65.484,22.079664,77.04,Humana Insurance Company,Commercial PPO,73.188,95,,percent of total billed charges,,
SUTURE CAPROSYN 3/0 30 CV-23,,A4649,HCPCS,Facility,Outpatient,,,,77.04,65.484,22.079664,77.04,Humana Insurance Company,Medicare PPO,37.7496,49,,percent of total billed charges,,
SUTURE CAPROSYN 3/0 30 CV-23,,A4649,HCPCS,Facility,Inpatient,,,,77.04,65.484,22.079664,77.04,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
SUTURE CAPROSYN 3/0 30 CV-23,,A4649,HCPCS,Facility,Both,,,,77.04,65.484,22.079664,77.04,Medica,Individual & Family,76.34664,99.1,,percent of total billed charges,,
SUTURE CAPROSYN 3/0 30 CV-23,,A4649,HCPCS,Facility,Outpatient,,,,77.04,65.484,22.079664,77.04,Medica,Medica Advantage Solution,38.36592,49.8,,percent of total billed charges,,
SUTURE CAPROSYN 3/0 30 CV-23,,A4649,HCPCS,Facility,Inpatient,,,,77.04,65.484,22.079664,77.04,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
SUTURE CAPROSYN 3/0 30 CV-23,,A4649,HCPCS,Facility,Outpatient,,,,77.04,65.484,22.079664,77.04,Medica,Medical Assistance,34.35984,44.6,,percent of total billed charges,,
SUTURE CAPROSYN 3/0 30 CV-23,,A4649,HCPCS,Facility,Inpatient,,,,77.04,65.484,22.079664,77.04,Medica,Medical Assistance,,,,,Included in per diem rate,
SUTURE CAPROSYN 3/0 30 CV-23,,A4649,HCPCS,Facility,Outpatient,,,,77.04,65.484,22.079664,77.04,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,38.36592,49.8,,percent of total billed charges,,
SUTURE CAPROSYN 3/0 30 CV-23,,A4649,HCPCS,Facility,Inpatient,,,,77.04,65.484,22.079664,77.04,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
SUTURE CAPROSYN 3/0 30 CV-23,,A4649,HCPCS,Facility,Both,,,,77.04,65.484,22.079664,77.04,"Multiplan, Inc.","Multiplan, Inc.",72.4176,94,,percent of total billed charges,,
SUTURE CAPROSYN 3/0 30 CV-23,,A4649,HCPCS,Facility,Outpatient,,,,77.04,65.484,22.079664,77.04,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,69.41304,90.1,,percent of total billed charges,,
SUTURE CAPROSYN 3/0 30 CV-23,,A4649,HCPCS,Facility,Inpatient,,,,77.04,65.484,22.079664,77.04,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
SUTURE CAPROSYN 3/0 30 CV-23,,A4649,HCPCS,Facility,Both,,,,77.04,65.484,22.079664,77.04,"Preferred One Administrative Services, INC.",PPO,75.96144,98.6,,percent of total billed charges,,
SUTURE CAPROSYN 3/0 30 CV-23,,A4649,HCPCS,Facility,Outpatient,,,,77.04,65.484,22.079664,77.04,PrimeWest Health,Minnesota Senior Health Options (MSHO),39.63708,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
SUTURE CAPROSYN 3/0 30 CV-23,,A4649,HCPCS,Facility,Inpatient,,,,77.04,65.484,22.079664,77.04,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE CAPROSYN 3/0 30 CV-23,,A4649,HCPCS,Facility,Outpatient,,,,77.04,65.484,22.079664,77.04,PrimeWest Health,MinnesotaCare,39.567744,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
SUTURE CAPROSYN 3/0 30 CV-23,,A4649,HCPCS,Facility,Inpatient,,,,77.04,65.484,22.079664,77.04,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
SUTURE CAPROSYN 3/0 30 CV-23,,A4649,HCPCS,Facility,Both,,,,77.04,65.484,22.079664,77.04,Sanford Health Plan,Sanford Health Plan,70.8768,92,,percent of total billed charges,,
SUTURE CAPROSYN 3/0 30 CV-23,,A4649,HCPCS,Facility,Outpatient,,,,77.04,65.484,22.079664,77.04,"UCare Health, Inc.",Individual & Family Plan,43.41204,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
SUTURE CAPROSYN 3/0 30 CV-23,,A4649,HCPCS,Facility,Inpatient,,,,77.04,65.484,22.079664,77.04,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
SUTURE CAPROSYN 3/0 30 CV-23,,A4649,HCPCS,Facility,Outpatient,,,,77.04,65.484,22.079664,77.04,"UCare Health, Inc.",Medical Assistance,38.882088,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE CAPROSYN 3/0 30 CV-23,,A4649,HCPCS,Facility,Inpatient,,,,77.04,65.484,22.079664,77.04,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
SUTURE CAPROSYN 3/0 30 CV-23,,A4649,HCPCS,Facility,Outpatient,,,,77.04,65.484,22.079664,77.04,"UCare Health, Inc.",Medicare Advantage,38.882088,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE CAPROSYN 3/0 30 CV-23,,A4649,HCPCS,Facility,Inpatient,,,,77.04,65.484,22.079664,77.04,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE CAPROSYN 3/0 30 CV-23,,A4649,HCPCS,Facility,Outpatient,,,,77.04,65.484,22.079664,77.04,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),38.882088,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE CAPROSYN 3/0 30 CV-23,,A4649,HCPCS,Facility,Inpatient,,,,77.04,65.484,22.079664,77.04,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE CAPROSYN 3/0 30 CV-23,,A4649,HCPCS,Facility,Both,,,,77.04,65.484,22.079664,77.04,UnitedHealthcare,Individual & Family,72.4176,94,,percent of total billed charges,,
SUTURE CAPROSYN 3/0 30 CV-23,,A4649,HCPCS,Facility,Outpatient,,,,77.04,65.484,22.079664,77.04,UnitedHealthcare,Medicare Advantage,37.7496,49,,percent of total billed charges,,
SUTURE CAPROSYN 3/0 30 CV-23,,A4649,HCPCS,Facility,Inpatient,,,,77.04,65.484,22.079664,77.04,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
SUTURE CAPROSYN 3/0 30 CV-23,,A4649,HCPCS,Facility,Outpatient,,,,77.04,65.484,22.079664,77.04,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,36.9792,48,,percent of total billed charges,,100% of DHS outpatient percentage
SUTURE CAPROSYN 3/0 30 CV-23,,A4649,HCPCS,Facility,Inpatient,,,,77.04,65.484,22.079664,77.04,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
SUTURE CAPROSYN 3/0 30IN UNDYED GS-21,,A4649,HCPCS,Facility,Both,,,,61.785,52.51725,17.707581,61.785,Aetna,Commercial,56.8422,92,,percent of total billed charges,,
SUTURE CAPROSYN 3/0 30IN UNDYED GS-21,,A4649,HCPCS,Facility,Outpatient,,,,61.785,52.51725,17.707581,61.785,Aetna,Medicare Advantage,30.27465,49,,percent of total billed charges,,
SUTURE CAPROSYN 3/0 30IN UNDYED GS-21,,A4649,HCPCS,Facility,Inpatient,,,,61.785,52.51725,17.707581,61.785,Aetna,Medicare Advantage,,,,,Included in per diem rate,
SUTURE CAPROSYN 3/0 30IN UNDYED GS-21,,A4649,HCPCS,Facility,Both,,,,61.785,52.51725,17.707581,61.785,Aetna,PPO,57.46005,93,,percent of total billed charges,,
SUTURE CAPROSYN 3/0 30IN UNDYED GS-21,,A4649,HCPCS,Facility,Both,,,,61.785,52.51725,17.707581,61.785,America's PPO,America's PPO,59.3321355,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SUTURE CAPROSYN 3/0 30IN UNDYED GS-21,,A4649,HCPCS,Facility,Both,,,,61.785,52.51725,17.707581,61.785,BlueCross BlueShield Minnesota, Federal Employee Program,60.79644,98.4,,percent of total billed charges,,
SUTURE CAPROSYN 3/0 30IN UNDYED GS-21,,A4649,HCPCS,Facility,Both,,,,61.785,52.51725,17.707581,61.785,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,61.785,100,,percent of total billed charges,,
SUTURE CAPROSYN 3/0 30IN UNDYED GS-21,,A4649,HCPCS,Facility,Both,,,,61.785,52.51725,17.707581,61.785,BlueCross BlueShield Minnesota,High Value Network Plan,55.6065,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
SUTURE CAPROSYN 3/0 30IN UNDYED GS-21,,A4649,HCPCS,Facility,Outpatient,,,,61.785,52.51725,17.707581,61.785,BlueCross BlueShield Minnesota,Medicare Advantage,30.27465,49,,percent of total billed charges,,
SUTURE CAPROSYN 3/0 30IN UNDYED GS-21,,A4649,HCPCS,Facility,Inpatient,,,,61.785,52.51725,17.707581,61.785,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
SUTURE CAPROSYN 3/0 30IN UNDYED GS-21,,A4649,HCPCS,Facility,Both,,,,61.785,52.51725,17.707581,61.785,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,54.7229745,88.57,,percent of total billed charges,,
SUTURE CAPROSYN 3/0 30IN UNDYED GS-21,,A4649,HCPCS,Facility,Both,,,,61.785,52.51725,17.707581,61.785,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,17.707581,28.66,,percent of total billed charges,,
SUTURE CAPROSYN 3/0 30IN UNDYED GS-21,,A4649,HCPCS,Facility,Outpatient,,,,61.785,52.51725,17.707581,61.785,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),30.27465,49,,percent of total billed charges,,
SUTURE CAPROSYN 3/0 30IN UNDYED GS-21,,A4649,HCPCS,Facility,Inpatient,,,,61.785,52.51725,17.707581,61.785,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
SUTURE CAPROSYN 3/0 30IN UNDYED GS-21,,A4649,HCPCS,Facility,Both,,,,61.785,52.51725,17.707581,61.785,CorVel,Worker's Compensation,61.785,100,,percent of total billed charges,,
SUTURE CAPROSYN 3/0 30IN UNDYED GS-21,,A4649,HCPCS,Facility,Both,,,,61.785,52.51725,17.707581,61.785,First Health Group Corporation,First Health Network,59.93145,97,,percent of total billed charges,,
SUTURE CAPROSYN 3/0 30IN UNDYED GS-21,,A4649,HCPCS,Facility,Both,,,,61.785,52.51725,17.707581,61.785,"Health Partners, Inc.",Commercial,58.44861,94.6,,percent of total billed charges,,
SUTURE CAPROSYN 3/0 30IN UNDYED GS-21,,A4649,HCPCS,Facility,Outpatient,,,,61.785,52.51725,17.707581,61.785,"Health Partners, Inc.",Medicare Advantage,30.27465,49,,percent of total billed charges,,
SUTURE CAPROSYN 3/0 30IN UNDYED GS-21,,A4649,HCPCS,Facility,Inpatient,,,,61.785,52.51725,17.707581,61.785,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE CAPROSYN 3/0 30IN UNDYED GS-21,,A4649,HCPCS,Facility,Both,,,,61.785,52.51725,17.707581,61.785,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),37.071,60,,percent of total billed charges,,
SUTURE CAPROSYN 3/0 30IN UNDYED GS-21,,A4649,HCPCS,Facility,Both,,,,61.785,52.51725,17.707581,61.785,"Health Partners, Inc.",State of Minnesota Advantage Program,50.354775,81.5,,percent of total billed charges,,
SUTURE CAPROSYN 3/0 30IN UNDYED GS-21,,A4649,HCPCS,Facility,Both,,,,61.785,52.51725,17.707581,61.785,"Health Partners, Inc.",State Public Programs,30.8925,50,,percent of total billed charges,,
SUTURE CAPROSYN 3/0 30IN UNDYED GS-21,,A4649,HCPCS,Facility,Both,,,,61.785,52.51725,17.707581,61.785,Humana Insurance Company,Commercial PPO,58.69575,95,,percent of total billed charges,,
SUTURE CAPROSYN 3/0 30IN UNDYED GS-21,,A4649,HCPCS,Facility,Outpatient,,,,61.785,52.51725,17.707581,61.785,Humana Insurance Company,Medicare PPO,30.27465,49,,percent of total billed charges,,
SUTURE CAPROSYN 3/0 30IN UNDYED GS-21,,A4649,HCPCS,Facility,Inpatient,,,,61.785,52.51725,17.707581,61.785,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
SUTURE CAPROSYN 3/0 30IN UNDYED GS-21,,A4649,HCPCS,Facility,Both,,,,61.785,52.51725,17.707581,61.785,Medica,Individual & Family,61.228935,99.1,,percent of total billed charges,,
SUTURE CAPROSYN 3/0 30IN UNDYED GS-21,,A4649,HCPCS,Facility,Outpatient,,,,61.785,52.51725,17.707581,61.785,Medica,Medica Advantage Solution,30.76893,49.8,,percent of total billed charges,,
SUTURE CAPROSYN 3/0 30IN UNDYED GS-21,,A4649,HCPCS,Facility,Inpatient,,,,61.785,52.51725,17.707581,61.785,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
SUTURE CAPROSYN 3/0 30IN UNDYED GS-21,,A4649,HCPCS,Facility,Outpatient,,,,61.785,52.51725,17.707581,61.785,Medica,Medical Assistance,27.55611,44.6,,percent of total billed charges,,
SUTURE CAPROSYN 3/0 30IN UNDYED GS-21,,A4649,HCPCS,Facility,Inpatient,,,,61.785,52.51725,17.707581,61.785,Medica,Medical Assistance,,,,,Included in per diem rate,
SUTURE CAPROSYN 3/0 30IN UNDYED GS-21,,A4649,HCPCS,Facility,Outpatient,,,,61.785,52.51725,17.707581,61.785,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,30.76893,49.8,,percent of total billed charges,,
SUTURE CAPROSYN 3/0 30IN UNDYED GS-21,,A4649,HCPCS,Facility,Inpatient,,,,61.785,52.51725,17.707581,61.785,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
SUTURE CAPROSYN 3/0 30IN UNDYED GS-21,,A4649,HCPCS,Facility,Both,,,,61.785,52.51725,17.707581,61.785,"Multiplan, Inc.","Multiplan, Inc.",58.0779,94,,percent of total billed charges,,
SUTURE CAPROSYN 3/0 30IN UNDYED GS-21,,A4649,HCPCS,Facility,Outpatient,,,,61.785,52.51725,17.707581,61.785,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,55.668285,90.1,,percent of total billed charges,,
SUTURE CAPROSYN 3/0 30IN UNDYED GS-21,,A4649,HCPCS,Facility,Inpatient,,,,61.785,52.51725,17.707581,61.785,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
SUTURE CAPROSYN 3/0 30IN UNDYED GS-21,,A4649,HCPCS,Facility,Both,,,,61.785,52.51725,17.707581,61.785,"Preferred One Administrative Services, INC.",PPO,60.92001,98.6,,percent of total billed charges,,
SUTURE CAPROSYN 3/0 30IN UNDYED GS-21,,A4649,HCPCS,Facility,Outpatient,,,,61.785,52.51725,17.707581,61.785,PrimeWest Health,Minnesota Senior Health Options (MSHO),31.7883825,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
SUTURE CAPROSYN 3/0 30IN UNDYED GS-21,,A4649,HCPCS,Facility,Inpatient,,,,61.785,52.51725,17.707581,61.785,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE CAPROSYN 3/0 30IN UNDYED GS-21,,A4649,HCPCS,Facility,Outpatient,,,,61.785,52.51725,17.707581,61.785,PrimeWest Health,MinnesotaCare,31.732776,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
SUTURE CAPROSYN 3/0 30IN UNDYED GS-21,,A4649,HCPCS,Facility,Inpatient,,,,61.785,52.51725,17.707581,61.785,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
SUTURE CAPROSYN 3/0 30IN UNDYED GS-21,,A4649,HCPCS,Facility,Both,,,,61.785,52.51725,17.707581,61.785,Sanford Health Plan,Sanford Health Plan,56.8422,92,,percent of total billed charges,,
SUTURE CAPROSYN 3/0 30IN UNDYED GS-21,,A4649,HCPCS,Facility,Outpatient,,,,61.785,52.51725,17.707581,61.785,"UCare Health, Inc.",Individual & Family Plan,34.8158475,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
SUTURE CAPROSYN 3/0 30IN UNDYED GS-21,,A4649,HCPCS,Facility,Inpatient,,,,61.785,52.51725,17.707581,61.785,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
SUTURE CAPROSYN 3/0 30IN UNDYED GS-21,,A4649,HCPCS,Facility,Outpatient,,,,61.785,52.51725,17.707581,61.785,"UCare Health, Inc.",Medical Assistance,31.1828895,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE CAPROSYN 3/0 30IN UNDYED GS-21,,A4649,HCPCS,Facility,Inpatient,,,,61.785,52.51725,17.707581,61.785,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
SUTURE CAPROSYN 3/0 30IN UNDYED GS-21,,A4649,HCPCS,Facility,Outpatient,,,,61.785,52.51725,17.707581,61.785,"UCare Health, Inc.",Medicare Advantage,31.1828895,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE CAPROSYN 3/0 30IN UNDYED GS-21,,A4649,HCPCS,Facility,Inpatient,,,,61.785,52.51725,17.707581,61.785,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE CAPROSYN 3/0 30IN UNDYED GS-21,,A4649,HCPCS,Facility,Outpatient,,,,61.785,52.51725,17.707581,61.785,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),31.1828895,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE CAPROSYN 3/0 30IN UNDYED GS-21,,A4649,HCPCS,Facility,Inpatient,,,,61.785,52.51725,17.707581,61.785,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE CAPROSYN 3/0 30IN UNDYED GS-21,,A4649,HCPCS,Facility,Both,,,,61.785,52.51725,17.707581,61.785,UnitedHealthcare,Individual & Family,58.0779,94,,percent of total billed charges,,
SUTURE CAPROSYN 3/0 30IN UNDYED GS-21,,A4649,HCPCS,Facility,Outpatient,,,,61.785,52.51725,17.707581,61.785,UnitedHealthcare,Medicare Advantage,30.27465,49,,percent of total billed charges,,
SUTURE CAPROSYN 3/0 30IN UNDYED GS-21,,A4649,HCPCS,Facility,Inpatient,,,,61.785,52.51725,17.707581,61.785,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
SUTURE CAPROSYN 3/0 30IN UNDYED GS-21,,A4649,HCPCS,Facility,Outpatient,,,,61.785,52.51725,17.707581,61.785,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,29.6568,48,,percent of total billed charges,,100% of DHS outpatient percentage
SUTURE CAPROSYN 3/0 30IN UNDYED GS-21,,A4649,HCPCS,Facility,Inpatient,,,,61.785,52.51725,17.707581,61.785,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
SUTURE CAPROSYN 3-0,,A4649,HCPCS,Facility,Both,,,,61.785,52.51725,17.707581,61.785,Aetna,Commercial,56.8422,92,,percent of total billed charges,,
SUTURE CAPROSYN 3-0,,A4649,HCPCS,Facility,Outpatient,,,,61.785,52.51725,17.707581,61.785,Aetna,Medicare Advantage,30.27465,49,,percent of total billed charges,,
SUTURE CAPROSYN 3-0,,A4649,HCPCS,Facility,Inpatient,,,,61.785,52.51725,17.707581,61.785,Aetna,Medicare Advantage,,,,,Included in per diem rate,
SUTURE CAPROSYN 3-0,,A4649,HCPCS,Facility,Both,,,,61.785,52.51725,17.707581,61.785,Aetna,PPO,57.46005,93,,percent of total billed charges,,
SUTURE CAPROSYN 3-0,,A4649,HCPCS,Facility,Both,,,,61.785,52.51725,17.707581,61.785,America's PPO,America's PPO,59.3321355,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SUTURE CAPROSYN 3-0,,A4649,HCPCS,Facility,Both,,,,61.785,52.51725,17.707581,61.785,BlueCross BlueShield Minnesota, Federal Employee Program,60.79644,98.4,,percent of total billed charges,,
SUTURE CAPROSYN 3-0,,A4649,HCPCS,Facility,Both,,,,61.785,52.51725,17.707581,61.785,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,61.785,100,,percent of total billed charges,,
SUTURE CAPROSYN 3-0,,A4649,HCPCS,Facility,Both,,,,61.785,52.51725,17.707581,61.785,BlueCross BlueShield Minnesota,High Value Network Plan,55.6065,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
SUTURE CAPROSYN 3-0,,A4649,HCPCS,Facility,Outpatient,,,,61.785,52.51725,17.707581,61.785,BlueCross BlueShield Minnesota,Medicare Advantage,30.27465,49,,percent of total billed charges,,
SUTURE CAPROSYN 3-0,,A4649,HCPCS,Facility,Inpatient,,,,61.785,52.51725,17.707581,61.785,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
SUTURE CAPROSYN 3-0,,A4649,HCPCS,Facility,Both,,,,61.785,52.51725,17.707581,61.785,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,54.7229745,88.57,,percent of total billed charges,,
SUTURE CAPROSYN 3-0,,A4649,HCPCS,Facility,Both,,,,61.785,52.51725,17.707581,61.785,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,17.707581,28.66,,percent of total billed charges,,
SUTURE CAPROSYN 3-0,,A4649,HCPCS,Facility,Outpatient,,,,61.785,52.51725,17.707581,61.785,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),30.27465,49,,percent of total billed charges,,
SUTURE CAPROSYN 3-0,,A4649,HCPCS,Facility,Inpatient,,,,61.785,52.51725,17.707581,61.785,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
SUTURE CAPROSYN 3-0,,A4649,HCPCS,Facility,Both,,,,61.785,52.51725,17.707581,61.785,CorVel,Worker's Compensation,61.785,100,,percent of total billed charges,,
SUTURE CAPROSYN 3-0,,A4649,HCPCS,Facility,Both,,,,61.785,52.51725,17.707581,61.785,First Health Group Corporation,First Health Network,59.93145,97,,percent of total billed charges,,
SUTURE CAPROSYN 3-0,,A4649,HCPCS,Facility,Both,,,,61.785,52.51725,17.707581,61.785,"Health Partners, Inc.",Commercial,58.44861,94.6,,percent of total billed charges,,
SUTURE CAPROSYN 3-0,,A4649,HCPCS,Facility,Outpatient,,,,61.785,52.51725,17.707581,61.785,"Health Partners, Inc.",Medicare Advantage,30.27465,49,,percent of total billed charges,,
SUTURE CAPROSYN 3-0,,A4649,HCPCS,Facility,Inpatient,,,,61.785,52.51725,17.707581,61.785,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE CAPROSYN 3-0,,A4649,HCPCS,Facility,Both,,,,61.785,52.51725,17.707581,61.785,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),37.071,60,,percent of total billed charges,,
SUTURE CAPROSYN 3-0,,A4649,HCPCS,Facility,Both,,,,61.785,52.51725,17.707581,61.785,"Health Partners, Inc.",State of Minnesota Advantage Program,50.354775,81.5,,percent of total billed charges,,
SUTURE CAPROSYN 3-0,,A4649,HCPCS,Facility,Both,,,,61.785,52.51725,17.707581,61.785,"Health Partners, Inc.",State Public Programs,30.8925,50,,percent of total billed charges,,
SUTURE CAPROSYN 3-0,,A4649,HCPCS,Facility,Both,,,,61.785,52.51725,17.707581,61.785,Humana Insurance Company,Commercial PPO,58.69575,95,,percent of total billed charges,,
SUTURE CAPROSYN 3-0,,A4649,HCPCS,Facility,Outpatient,,,,61.785,52.51725,17.707581,61.785,Humana Insurance Company,Medicare PPO,30.27465,49,,percent of total billed charges,,
SUTURE CAPROSYN 3-0,,A4649,HCPCS,Facility,Inpatient,,,,61.785,52.51725,17.707581,61.785,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
SUTURE CAPROSYN 3-0,,A4649,HCPCS,Facility,Both,,,,61.785,52.51725,17.707581,61.785,Medica,Individual & Family,61.228935,99.1,,percent of total billed charges,,
SUTURE CAPROSYN 3-0,,A4649,HCPCS,Facility,Outpatient,,,,61.785,52.51725,17.707581,61.785,Medica,Medica Advantage Solution,30.76893,49.8,,percent of total billed charges,,
SUTURE CAPROSYN 3-0,,A4649,HCPCS,Facility,Inpatient,,,,61.785,52.51725,17.707581,61.785,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
SUTURE CAPROSYN 3-0,,A4649,HCPCS,Facility,Outpatient,,,,61.785,52.51725,17.707581,61.785,Medica,Medical Assistance,27.55611,44.6,,percent of total billed charges,,
SUTURE CAPROSYN 3-0,,A4649,HCPCS,Facility,Inpatient,,,,61.785,52.51725,17.707581,61.785,Medica,Medical Assistance,,,,,Included in per diem rate,
SUTURE CAPROSYN 3-0,,A4649,HCPCS,Facility,Outpatient,,,,61.785,52.51725,17.707581,61.785,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,30.76893,49.8,,percent of total billed charges,,
SUTURE CAPROSYN 3-0,,A4649,HCPCS,Facility,Inpatient,,,,61.785,52.51725,17.707581,61.785,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
SUTURE CAPROSYN 3-0,,A4649,HCPCS,Facility,Both,,,,61.785,52.51725,17.707581,61.785,"Multiplan, Inc.","Multiplan, Inc.",58.0779,94,,percent of total billed charges,,
SUTURE CAPROSYN 3-0,,A4649,HCPCS,Facility,Outpatient,,,,61.785,52.51725,17.707581,61.785,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,55.668285,90.1,,percent of total billed charges,,
SUTURE CAPROSYN 3-0,,A4649,HCPCS,Facility,Inpatient,,,,61.785,52.51725,17.707581,61.785,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
SUTURE CAPROSYN 3-0,,A4649,HCPCS,Facility,Both,,,,61.785,52.51725,17.707581,61.785,"Preferred One Administrative Services, INC.",PPO,60.92001,98.6,,percent of total billed charges,,
SUTURE CAPROSYN 3-0,,A4649,HCPCS,Facility,Outpatient,,,,61.785,52.51725,17.707581,61.785,PrimeWest Health,Minnesota Senior Health Options (MSHO),31.7883825,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
SUTURE CAPROSYN 3-0,,A4649,HCPCS,Facility,Inpatient,,,,61.785,52.51725,17.707581,61.785,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE CAPROSYN 3-0,,A4649,HCPCS,Facility,Outpatient,,,,61.785,52.51725,17.707581,61.785,PrimeWest Health,MinnesotaCare,31.732776,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
SUTURE CAPROSYN 3-0,,A4649,HCPCS,Facility,Inpatient,,,,61.785,52.51725,17.707581,61.785,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
SUTURE CAPROSYN 3-0,,A4649,HCPCS,Facility,Both,,,,61.785,52.51725,17.707581,61.785,Sanford Health Plan,Sanford Health Plan,56.8422,92,,percent of total billed charges,,
SUTURE CAPROSYN 3-0,,A4649,HCPCS,Facility,Outpatient,,,,61.785,52.51725,17.707581,61.785,"UCare Health, Inc.",Individual & Family Plan,34.8158475,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
SUTURE CAPROSYN 3-0,,A4649,HCPCS,Facility,Inpatient,,,,61.785,52.51725,17.707581,61.785,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
SUTURE CAPROSYN 3-0,,A4649,HCPCS,Facility,Outpatient,,,,61.785,52.51725,17.707581,61.785,"UCare Health, Inc.",Medical Assistance,31.1828895,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE CAPROSYN 3-0,,A4649,HCPCS,Facility,Inpatient,,,,61.785,52.51725,17.707581,61.785,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
SUTURE CAPROSYN 3-0,,A4649,HCPCS,Facility,Outpatient,,,,61.785,52.51725,17.707581,61.785,"UCare Health, Inc.",Medicare Advantage,31.1828895,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE CAPROSYN 3-0,,A4649,HCPCS,Facility,Inpatient,,,,61.785,52.51725,17.707581,61.785,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE CAPROSYN 3-0,,A4649,HCPCS,Facility,Outpatient,,,,61.785,52.51725,17.707581,61.785,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),31.1828895,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE CAPROSYN 3-0,,A4649,HCPCS,Facility,Inpatient,,,,61.785,52.51725,17.707581,61.785,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE CAPROSYN 3-0,,A4649,HCPCS,Facility,Both,,,,61.785,52.51725,17.707581,61.785,UnitedHealthcare,Individual & Family,58.0779,94,,percent of total billed charges,,
SUTURE CAPROSYN 3-0,,A4649,HCPCS,Facility,Outpatient,,,,61.785,52.51725,17.707581,61.785,UnitedHealthcare,Medicare Advantage,30.27465,49,,percent of total billed charges,,
SUTURE CAPROSYN 3-0,,A4649,HCPCS,Facility,Inpatient,,,,61.785,52.51725,17.707581,61.785,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
SUTURE CAPROSYN 3-0,,A4649,HCPCS,Facility,Outpatient,,,,61.785,52.51725,17.707581,61.785,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,29.6568,48,,percent of total billed charges,,100% of DHS outpatient percentage
SUTURE CAPROSYN 3-0,,A4649,HCPCS,Facility,Inpatient,,,,61.785,52.51725,17.707581,61.785,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
SUTURE CAPROSYN 4/0 30IN UNDYED V-20,,A4649,HCPCS,Facility,Both,,,,53.235,45.24975,15.257151,53.235,Aetna,Commercial,48.9762,92,,percent of total billed charges,,
SUTURE CAPROSYN 4/0 30IN UNDYED V-20,,A4649,HCPCS,Facility,Outpatient,,,,53.235,45.24975,15.257151,53.235,Aetna,Medicare Advantage,26.08515,49,,percent of total billed charges,,
SUTURE CAPROSYN 4/0 30IN UNDYED V-20,,A4649,HCPCS,Facility,Inpatient,,,,53.235,45.24975,15.257151,53.235,Aetna,Medicare Advantage,,,,,Included in per diem rate,
SUTURE CAPROSYN 4/0 30IN UNDYED V-20,,A4649,HCPCS,Facility,Both,,,,53.235,45.24975,15.257151,53.235,Aetna,PPO,49.50855,93,,percent of total billed charges,,
SUTURE CAPROSYN 4/0 30IN UNDYED V-20,,A4649,HCPCS,Facility,Both,,,,53.235,45.24975,15.257151,53.235,America's PPO,America's PPO,51.1215705,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SUTURE CAPROSYN 4/0 30IN UNDYED V-20,,A4649,HCPCS,Facility,Both,,,,53.235,45.24975,15.257151,53.235,BlueCross BlueShield Minnesota, Federal Employee Program,52.38324,98.4,,percent of total billed charges,,
SUTURE CAPROSYN 4/0 30IN UNDYED V-20,,A4649,HCPCS,Facility,Both,,,,53.235,45.24975,15.257151,53.235,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,53.235,100,,percent of total billed charges,,
SUTURE CAPROSYN 4/0 30IN UNDYED V-20,,A4649,HCPCS,Facility,Both,,,,53.235,45.24975,15.257151,53.235,BlueCross BlueShield Minnesota,High Value Network Plan,47.9115,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
SUTURE CAPROSYN 4/0 30IN UNDYED V-20,,A4649,HCPCS,Facility,Outpatient,,,,53.235,45.24975,15.257151,53.235,BlueCross BlueShield Minnesota,Medicare Advantage,26.08515,49,,percent of total billed charges,,
SUTURE CAPROSYN 4/0 30IN UNDYED V-20,,A4649,HCPCS,Facility,Inpatient,,,,53.235,45.24975,15.257151,53.235,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
SUTURE CAPROSYN 4/0 30IN UNDYED V-20,,A4649,HCPCS,Facility,Both,,,,53.235,45.24975,15.257151,53.235,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,47.1502395,88.57,,percent of total billed charges,,
SUTURE CAPROSYN 4/0 30IN UNDYED V-20,,A4649,HCPCS,Facility,Both,,,,53.235,45.24975,15.257151,53.235,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,15.257151,28.66,,percent of total billed charges,,
SUTURE CAPROSYN 4/0 30IN UNDYED V-20,,A4649,HCPCS,Facility,Outpatient,,,,53.235,45.24975,15.257151,53.235,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),26.08515,49,,percent of total billed charges,,
SUTURE CAPROSYN 4/0 30IN UNDYED V-20,,A4649,HCPCS,Facility,Inpatient,,,,53.235,45.24975,15.257151,53.235,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
SUTURE CAPROSYN 4/0 30IN UNDYED V-20,,A4649,HCPCS,Facility,Both,,,,53.235,45.24975,15.257151,53.235,CorVel,Worker's Compensation,53.235,100,,percent of total billed charges,,
SUTURE CAPROSYN 4/0 30IN UNDYED V-20,,A4649,HCPCS,Facility,Both,,,,53.235,45.24975,15.257151,53.235,First Health Group Corporation,First Health Network,51.63795,97,,percent of total billed charges,,
SUTURE CAPROSYN 4/0 30IN UNDYED V-20,,A4649,HCPCS,Facility,Both,,,,53.235,45.24975,15.257151,53.235,"Health Partners, Inc.",Commercial,50.36031,94.6,,percent of total billed charges,,
SUTURE CAPROSYN 4/0 30IN UNDYED V-20,,A4649,HCPCS,Facility,Outpatient,,,,53.235,45.24975,15.257151,53.235,"Health Partners, Inc.",Medicare Advantage,26.08515,49,,percent of total billed charges,,
SUTURE CAPROSYN 4/0 30IN UNDYED V-20,,A4649,HCPCS,Facility,Inpatient,,,,53.235,45.24975,15.257151,53.235,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE CAPROSYN 4/0 30IN UNDYED V-20,,A4649,HCPCS,Facility,Both,,,,53.235,45.24975,15.257151,53.235,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),31.941,60,,percent of total billed charges,,
SUTURE CAPROSYN 4/0 30IN UNDYED V-20,,A4649,HCPCS,Facility,Both,,,,53.235,45.24975,15.257151,53.235,"Health Partners, Inc.",State of Minnesota Advantage Program,43.386525,81.5,,percent of total billed charges,,
SUTURE CAPROSYN 4/0 30IN UNDYED V-20,,A4649,HCPCS,Facility,Both,,,,53.235,45.24975,15.257151,53.235,"Health Partners, Inc.",State Public Programs,26.6175,50,,percent of total billed charges,,
SUTURE CAPROSYN 4/0 30IN UNDYED V-20,,A4649,HCPCS,Facility,Both,,,,53.235,45.24975,15.257151,53.235,Humana Insurance Company,Commercial PPO,50.57325,95,,percent of total billed charges,,
SUTURE CAPROSYN 4/0 30IN UNDYED V-20,,A4649,HCPCS,Facility,Outpatient,,,,53.235,45.24975,15.257151,53.235,Humana Insurance Company,Medicare PPO,26.08515,49,,percent of total billed charges,,
SUTURE CAPROSYN 4/0 30IN UNDYED V-20,,A4649,HCPCS,Facility,Inpatient,,,,53.235,45.24975,15.257151,53.235,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
SUTURE CAPROSYN 4/0 30IN UNDYED V-20,,A4649,HCPCS,Facility,Both,,,,53.235,45.24975,15.257151,53.235,Medica,Individual & Family,52.755885,99.1,,percent of total billed charges,,
SUTURE CAPROSYN 4/0 30IN UNDYED V-20,,A4649,HCPCS,Facility,Outpatient,,,,53.235,45.24975,15.257151,53.235,Medica,Medica Advantage Solution,26.51103,49.8,,percent of total billed charges,,
SUTURE CAPROSYN 4/0 30IN UNDYED V-20,,A4649,HCPCS,Facility,Inpatient,,,,53.235,45.24975,15.257151,53.235,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
SUTURE CAPROSYN 4/0 30IN UNDYED V-20,,A4649,HCPCS,Facility,Outpatient,,,,53.235,45.24975,15.257151,53.235,Medica,Medical Assistance,23.74281,44.6,,percent of total billed charges,,
SUTURE CAPROSYN 4/0 30IN UNDYED V-20,,A4649,HCPCS,Facility,Inpatient,,,,53.235,45.24975,15.257151,53.235,Medica,Medical Assistance,,,,,Included in per diem rate,
SUTURE CAPROSYN 4/0 30IN UNDYED V-20,,A4649,HCPCS,Facility,Outpatient,,,,53.235,45.24975,15.257151,53.235,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,26.51103,49.8,,percent of total billed charges,,
SUTURE CAPROSYN 4/0 30IN UNDYED V-20,,A4649,HCPCS,Facility,Inpatient,,,,53.235,45.24975,15.257151,53.235,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
SUTURE CAPROSYN 4/0 30IN UNDYED V-20,,A4649,HCPCS,Facility,Both,,,,53.235,45.24975,15.257151,53.235,"Multiplan, Inc.","Multiplan, Inc.",50.0409,94,,percent of total billed charges,,
SUTURE CAPROSYN 4/0 30IN UNDYED V-20,,A4649,HCPCS,Facility,Outpatient,,,,53.235,45.24975,15.257151,53.235,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,47.964735,90.1,,percent of total billed charges,,
SUTURE CAPROSYN 4/0 30IN UNDYED V-20,,A4649,HCPCS,Facility,Inpatient,,,,53.235,45.24975,15.257151,53.235,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
SUTURE CAPROSYN 4/0 30IN UNDYED V-20,,A4649,HCPCS,Facility,Both,,,,53.235,45.24975,15.257151,53.235,"Preferred One Administrative Services, INC.",PPO,52.48971,98.6,,percent of total billed charges,,
SUTURE CAPROSYN 4/0 30IN UNDYED V-20,,A4649,HCPCS,Facility,Outpatient,,,,53.235,45.24975,15.257151,53.235,PrimeWest Health,Minnesota Senior Health Options (MSHO),27.3894075,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
SUTURE CAPROSYN 4/0 30IN UNDYED V-20,,A4649,HCPCS,Facility,Inpatient,,,,53.235,45.24975,15.257151,53.235,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE CAPROSYN 4/0 30IN UNDYED V-20,,A4649,HCPCS,Facility,Outpatient,,,,53.235,45.24975,15.257151,53.235,PrimeWest Health,MinnesotaCare,27.341496,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
SUTURE CAPROSYN 4/0 30IN UNDYED V-20,,A4649,HCPCS,Facility,Inpatient,,,,53.235,45.24975,15.257151,53.235,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
SUTURE CAPROSYN 4/0 30IN UNDYED V-20,,A4649,HCPCS,Facility,Both,,,,53.235,45.24975,15.257151,53.235,Sanford Health Plan,Sanford Health Plan,48.9762,92,,percent of total billed charges,,
SUTURE CAPROSYN 4/0 30IN UNDYED V-20,,A4649,HCPCS,Facility,Outpatient,,,,53.235,45.24975,15.257151,53.235,"UCare Health, Inc.",Individual & Family Plan,29.9979225,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
SUTURE CAPROSYN 4/0 30IN UNDYED V-20,,A4649,HCPCS,Facility,Inpatient,,,,53.235,45.24975,15.257151,53.235,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
SUTURE CAPROSYN 4/0 30IN UNDYED V-20,,A4649,HCPCS,Facility,Outpatient,,,,53.235,45.24975,15.257151,53.235,"UCare Health, Inc.",Medical Assistance,26.8677045,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE CAPROSYN 4/0 30IN UNDYED V-20,,A4649,HCPCS,Facility,Inpatient,,,,53.235,45.24975,15.257151,53.235,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
SUTURE CAPROSYN 4/0 30IN UNDYED V-20,,A4649,HCPCS,Facility,Outpatient,,,,53.235,45.24975,15.257151,53.235,"UCare Health, Inc.",Medicare Advantage,26.8677045,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE CAPROSYN 4/0 30IN UNDYED V-20,,A4649,HCPCS,Facility,Inpatient,,,,53.235,45.24975,15.257151,53.235,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE CAPROSYN 4/0 30IN UNDYED V-20,,A4649,HCPCS,Facility,Outpatient,,,,53.235,45.24975,15.257151,53.235,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),26.8677045,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE CAPROSYN 4/0 30IN UNDYED V-20,,A4649,HCPCS,Facility,Inpatient,,,,53.235,45.24975,15.257151,53.235,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE CAPROSYN 4/0 30IN UNDYED V-20,,A4649,HCPCS,Facility,Both,,,,53.235,45.24975,15.257151,53.235,UnitedHealthcare,Individual & Family,50.0409,94,,percent of total billed charges,,
SUTURE CAPROSYN 4/0 30IN UNDYED V-20,,A4649,HCPCS,Facility,Outpatient,,,,53.235,45.24975,15.257151,53.235,UnitedHealthcare,Medicare Advantage,26.08515,49,,percent of total billed charges,,
SUTURE CAPROSYN 4/0 30IN UNDYED V-20,,A4649,HCPCS,Facility,Inpatient,,,,53.235,45.24975,15.257151,53.235,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
SUTURE CAPROSYN 4/0 30IN UNDYED V-20,,A4649,HCPCS,Facility,Outpatient,,,,53.235,45.24975,15.257151,53.235,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,25.5528,48,,percent of total billed charges,,100% of DHS outpatient percentage
SUTURE CAPROSYN 4/0 30IN UNDYED V-20,,A4649,HCPCS,Facility,Inpatient,,,,53.235,45.24975,15.257151,53.235,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
SUTURE CAPROSYN 4-0 UC-203,,A4649,HCPCS,Facility,Both,,,,46,39.1,13.1836,46,Aetna,Commercial,42.32,92,,percent of total billed charges,,
SUTURE CAPROSYN 4-0 UC-203,,A4649,HCPCS,Facility,Outpatient,,,,46,39.1,13.1836,46,Aetna,Medicare Advantage,22.54,49,,percent of total billed charges,,
SUTURE CAPROSYN 4-0 UC-203,,A4649,HCPCS,Facility,Inpatient,,,,46,39.1,13.1836,46,Aetna,Medicare Advantage,,,,,Included in per diem rate,
SUTURE CAPROSYN 4-0 UC-203,,A4649,HCPCS,Facility,Both,,,,46,39.1,13.1836,46,Aetna,PPO,42.78,93,,percent of total billed charges,,
SUTURE CAPROSYN 4-0 UC-203,,A4649,HCPCS,Facility,Both,,,,46,39.1,13.1836,46,America's PPO,America's PPO,44.1738,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SUTURE CAPROSYN 4-0 UC-203,,A4649,HCPCS,Facility,Both,,,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota, Federal Employee Program,45.264,98.4,,percent of total billed charges,,
SUTURE CAPROSYN 4-0 UC-203,,A4649,HCPCS,Facility,Both,,,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,46,100,,percent of total billed charges,,
SUTURE CAPROSYN 4-0 UC-203,,A4649,HCPCS,Facility,Both,,,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,High Value Network Plan,41.4,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
SUTURE CAPROSYN 4-0 UC-203,,A4649,HCPCS,Facility,Outpatient,,,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Medicare Advantage,22.54,49,,percent of total billed charges,,
SUTURE CAPROSYN 4-0 UC-203,,A4649,HCPCS,Facility,Inpatient,,,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
SUTURE CAPROSYN 4-0 UC-203,,A4649,HCPCS,Facility,Both,,,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,40.7422,88.57,,percent of total billed charges,,
SUTURE CAPROSYN 4-0 UC-203,,A4649,HCPCS,Facility,Both,,,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,13.1836,28.66,,percent of total billed charges,,
SUTURE CAPROSYN 4-0 UC-203,,A4649,HCPCS,Facility,Outpatient,,,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),22.54,49,,percent of total billed charges,,
SUTURE CAPROSYN 4-0 UC-203,,A4649,HCPCS,Facility,Inpatient,,,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
SUTURE CAPROSYN 4-0 UC-203,,A4649,HCPCS,Facility,Both,,,,46,39.1,13.1836,46,CorVel,Worker's Compensation,46,100,,percent of total billed charges,,
SUTURE CAPROSYN 4-0 UC-203,,A4649,HCPCS,Facility,Both,,,,46,39.1,13.1836,46,First Health Group Corporation,First Health Network,44.62,97,,percent of total billed charges,,
SUTURE CAPROSYN 4-0 UC-203,,A4649,HCPCS,Facility,Both,,,,46,39.1,13.1836,46,"Health Partners, Inc.",Commercial,43.516,94.6,,percent of total billed charges,,
SUTURE CAPROSYN 4-0 UC-203,,A4649,HCPCS,Facility,Outpatient,,,,46,39.1,13.1836,46,"Health Partners, Inc.",Medicare Advantage,22.54,49,,percent of total billed charges,,
SUTURE CAPROSYN 4-0 UC-203,,A4649,HCPCS,Facility,Inpatient,,,,46,39.1,13.1836,46,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE CAPROSYN 4-0 UC-203,,A4649,HCPCS,Facility,Both,,,,46,39.1,13.1836,46,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),27.6,60,,percent of total billed charges,,
SUTURE CAPROSYN 4-0 UC-203,,A4649,HCPCS,Facility,Both,,,,46,39.1,13.1836,46,"Health Partners, Inc.",State of Minnesota Advantage Program,37.49,81.5,,percent of total billed charges,,
SUTURE CAPROSYN 4-0 UC-203,,A4649,HCPCS,Facility,Both,,,,46,39.1,13.1836,46,"Health Partners, Inc.",State Public Programs,23,50,,percent of total billed charges,,
SUTURE CAPROSYN 4-0 UC-203,,A4649,HCPCS,Facility,Both,,,,46,39.1,13.1836,46,Humana Insurance Company,Commercial PPO,43.7,95,,percent of total billed charges,,
SUTURE CAPROSYN 4-0 UC-203,,A4649,HCPCS,Facility,Outpatient,,,,46,39.1,13.1836,46,Humana Insurance Company,Medicare PPO,22.54,49,,percent of total billed charges,,
SUTURE CAPROSYN 4-0 UC-203,,A4649,HCPCS,Facility,Inpatient,,,,46,39.1,13.1836,46,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
SUTURE CAPROSYN 4-0 UC-203,,A4649,HCPCS,Facility,Both,,,,46,39.1,13.1836,46,Medica,Individual & Family,45.586,99.1,,percent of total billed charges,,
SUTURE CAPROSYN 4-0 UC-203,,A4649,HCPCS,Facility,Outpatient,,,,46,39.1,13.1836,46,Medica,Medica Advantage Solution,22.908,49.8,,percent of total billed charges,,
SUTURE CAPROSYN 4-0 UC-203,,A4649,HCPCS,Facility,Inpatient,,,,46,39.1,13.1836,46,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
SUTURE CAPROSYN 4-0 UC-203,,A4649,HCPCS,Facility,Outpatient,,,,46,39.1,13.1836,46,Medica,Medical Assistance,20.516,44.6,,percent of total billed charges,,
SUTURE CAPROSYN 4-0 UC-203,,A4649,HCPCS,Facility,Inpatient,,,,46,39.1,13.1836,46,Medica,Medical Assistance,,,,,Included in per diem rate,
SUTURE CAPROSYN 4-0 UC-203,,A4649,HCPCS,Facility,Outpatient,,,,46,39.1,13.1836,46,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,22.908,49.8,,percent of total billed charges,,
SUTURE CAPROSYN 4-0 UC-203,,A4649,HCPCS,Facility,Inpatient,,,,46,39.1,13.1836,46,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
SUTURE CAPROSYN 4-0 UC-203,,A4649,HCPCS,Facility,Both,,,,46,39.1,13.1836,46,"Multiplan, Inc.","Multiplan, Inc.",43.24,94,,percent of total billed charges,,
SUTURE CAPROSYN 4-0 UC-203,,A4649,HCPCS,Facility,Outpatient,,,,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,41.446,90.1,,percent of total billed charges,,
SUTURE CAPROSYN 4-0 UC-203,,A4649,HCPCS,Facility,Inpatient,,,,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
SUTURE CAPROSYN 4-0 UC-203,,A4649,HCPCS,Facility,Both,,,,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PPO,45.356,98.6,,percent of total billed charges,,
SUTURE CAPROSYN 4-0 UC-203,,A4649,HCPCS,Facility,Outpatient,,,,46,39.1,13.1836,46,PrimeWest Health,Minnesota Senior Health Options (MSHO),23.667,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
SUTURE CAPROSYN 4-0 UC-203,,A4649,HCPCS,Facility,Inpatient,,,,46,39.1,13.1836,46,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE CAPROSYN 4-0 UC-203,,A4649,HCPCS,Facility,Outpatient,,,,46,39.1,13.1836,46,PrimeWest Health,MinnesotaCare,23.6256,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
SUTURE CAPROSYN 4-0 UC-203,,A4649,HCPCS,Facility,Inpatient,,,,46,39.1,13.1836,46,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
SUTURE CAPROSYN 4-0 UC-203,,A4649,HCPCS,Facility,Both,,,,46,39.1,13.1836,46,Sanford Health Plan,Sanford Health Plan,42.32,92,,percent of total billed charges,,
SUTURE CAPROSYN 4-0 UC-203,,A4649,HCPCS,Facility,Outpatient,,,,46,39.1,13.1836,46,"UCare Health, Inc.",Individual & Family Plan,25.921,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
SUTURE CAPROSYN 4-0 UC-203,,A4649,HCPCS,Facility,Inpatient,,,,46,39.1,13.1836,46,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
SUTURE CAPROSYN 4-0 UC-203,,A4649,HCPCS,Facility,Outpatient,,,,46,39.1,13.1836,46,"UCare Health, Inc.",Medical Assistance,23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE CAPROSYN 4-0 UC-203,,A4649,HCPCS,Facility,Inpatient,,,,46,39.1,13.1836,46,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
SUTURE CAPROSYN 4-0 UC-203,,A4649,HCPCS,Facility,Outpatient,,,,46,39.1,13.1836,46,"UCare Health, Inc.",Medicare Advantage,23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE CAPROSYN 4-0 UC-203,,A4649,HCPCS,Facility,Inpatient,,,,46,39.1,13.1836,46,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE CAPROSYN 4-0 UC-203,,A4649,HCPCS,Facility,Outpatient,,,,46,39.1,13.1836,46,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE CAPROSYN 4-0 UC-203,,A4649,HCPCS,Facility,Inpatient,,,,46,39.1,13.1836,46,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE CAPROSYN 4-0 UC-203,,A4649,HCPCS,Facility,Both,,,,46,39.1,13.1836,46,UnitedHealthcare,Individual & Family,43.24,94,,percent of total billed charges,,
SUTURE CAPROSYN 4-0 UC-203,,A4649,HCPCS,Facility,Outpatient,,,,46,39.1,13.1836,46,UnitedHealthcare,Medicare Advantage,22.54,49,,percent of total billed charges,,
SUTURE CAPROSYN 4-0 UC-203,,A4649,HCPCS,Facility,Inpatient,,,,46,39.1,13.1836,46,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
SUTURE CAPROSYN 4-0 UC-203,,A4649,HCPCS,Facility,Outpatient,,,,46,39.1,13.1836,46,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,22.08,48,,percent of total billed charges,,100% of DHS outpatient percentage
SUTURE CAPROSYN 4-0 UC-203,,A4649,HCPCS,Facility,Inpatient,,,,46,39.1,13.1836,46,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
SUTURE CAPROSYN 5/0 UD 30IN CV-23,,A4649,HCPCS,Facility,Both,,,,17.4,14.79,4.98684,17.4,Aetna,Commercial,16.008,92,,percent of total billed charges,,
SUTURE CAPROSYN 5/0 UD 30IN CV-23,,A4649,HCPCS,Facility,Outpatient,,,,17.4,14.79,4.98684,17.4,Aetna,Medicare Advantage,8.526,49,,percent of total billed charges,,
SUTURE CAPROSYN 5/0 UD 30IN CV-23,,A4649,HCPCS,Facility,Inpatient,,,,17.4,14.79,4.98684,17.4,Aetna,Medicare Advantage,,,,,Included in per diem rate,
SUTURE CAPROSYN 5/0 UD 30IN CV-23,,A4649,HCPCS,Facility,Both,,,,17.4,14.79,4.98684,17.4,Aetna,PPO,16.182,93,,percent of total billed charges,,
SUTURE CAPROSYN 5/0 UD 30IN CV-23,,A4649,HCPCS,Facility,Both,,,,17.4,14.79,4.98684,17.4,America's PPO,America's PPO,16.70922,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SUTURE CAPROSYN 5/0 UD 30IN CV-23,,A4649,HCPCS,Facility,Both,,,,17.4,14.79,4.98684,17.4,BlueCross BlueShield Minnesota, Federal Employee Program,17.1216,98.4,,percent of total billed charges,,
SUTURE CAPROSYN 5/0 UD 30IN CV-23,,A4649,HCPCS,Facility,Both,,,,17.4,14.79,4.98684,17.4,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,17.4,100,,percent of total billed charges,,
SUTURE CAPROSYN 5/0 UD 30IN CV-23,,A4649,HCPCS,Facility,Both,,,,17.4,14.79,4.98684,17.4,BlueCross BlueShield Minnesota,High Value Network Plan,15.66,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
SUTURE CAPROSYN 5/0 UD 30IN CV-23,,A4649,HCPCS,Facility,Outpatient,,,,17.4,14.79,4.98684,17.4,BlueCross BlueShield Minnesota,Medicare Advantage,8.526,49,,percent of total billed charges,,
SUTURE CAPROSYN 5/0 UD 30IN CV-23,,A4649,HCPCS,Facility,Inpatient,,,,17.4,14.79,4.98684,17.4,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
SUTURE CAPROSYN 5/0 UD 30IN CV-23,,A4649,HCPCS,Facility,Both,,,,17.4,14.79,4.98684,17.4,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,15.41118,88.57,,percent of total billed charges,,
SUTURE CAPROSYN 5/0 UD 30IN CV-23,,A4649,HCPCS,Facility,Both,,,,17.4,14.79,4.98684,17.4,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,4.98684,28.66,,percent of total billed charges,,
SUTURE CAPROSYN 5/0 UD 30IN CV-23,,A4649,HCPCS,Facility,Outpatient,,,,17.4,14.79,4.98684,17.4,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),8.526,49,,percent of total billed charges,,
SUTURE CAPROSYN 5/0 UD 30IN CV-23,,A4649,HCPCS,Facility,Inpatient,,,,17.4,14.79,4.98684,17.4,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
SUTURE CAPROSYN 5/0 UD 30IN CV-23,,A4649,HCPCS,Facility,Both,,,,17.4,14.79,4.98684,17.4,CorVel,Worker's Compensation,17.4,100,,percent of total billed charges,,
SUTURE CAPROSYN 5/0 UD 30IN CV-23,,A4649,HCPCS,Facility,Both,,,,17.4,14.79,4.98684,17.4,First Health Group Corporation,First Health Network,16.878,97,,percent of total billed charges,,
SUTURE CAPROSYN 5/0 UD 30IN CV-23,,A4649,HCPCS,Facility,Both,,,,17.4,14.79,4.98684,17.4,"Health Partners, Inc.",Commercial,16.4604,94.6,,percent of total billed charges,,
SUTURE CAPROSYN 5/0 UD 30IN CV-23,,A4649,HCPCS,Facility,Outpatient,,,,17.4,14.79,4.98684,17.4,"Health Partners, Inc.",Medicare Advantage,8.526,49,,percent of total billed charges,,
SUTURE CAPROSYN 5/0 UD 30IN CV-23,,A4649,HCPCS,Facility,Inpatient,,,,17.4,14.79,4.98684,17.4,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE CAPROSYN 5/0 UD 30IN CV-23,,A4649,HCPCS,Facility,Both,,,,17.4,14.79,4.98684,17.4,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),10.44,60,,percent of total billed charges,,
SUTURE CAPROSYN 5/0 UD 30IN CV-23,,A4649,HCPCS,Facility,Both,,,,17.4,14.79,4.98684,17.4,"Health Partners, Inc.",State of Minnesota Advantage Program,14.181,81.5,,percent of total billed charges,,
SUTURE CAPROSYN 5/0 UD 30IN CV-23,,A4649,HCPCS,Facility,Both,,,,17.4,14.79,4.98684,17.4,"Health Partners, Inc.",State Public Programs,8.7,50,,percent of total billed charges,,
SUTURE CAPROSYN 5/0 UD 30IN CV-23,,A4649,HCPCS,Facility,Both,,,,17.4,14.79,4.98684,17.4,Humana Insurance Company,Commercial PPO,16.53,95,,percent of total billed charges,,
SUTURE CAPROSYN 5/0 UD 30IN CV-23,,A4649,HCPCS,Facility,Outpatient,,,,17.4,14.79,4.98684,17.4,Humana Insurance Company,Medicare PPO,8.526,49,,percent of total billed charges,,
SUTURE CAPROSYN 5/0 UD 30IN CV-23,,A4649,HCPCS,Facility,Inpatient,,,,17.4,14.79,4.98684,17.4,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
SUTURE CAPROSYN 5/0 UD 30IN CV-23,,A4649,HCPCS,Facility,Both,,,,17.4,14.79,4.98684,17.4,Medica,Individual & Family,17.2434,99.1,,percent of total billed charges,,
SUTURE CAPROSYN 5/0 UD 30IN CV-23,,A4649,HCPCS,Facility,Outpatient,,,,17.4,14.79,4.98684,17.4,Medica,Medica Advantage Solution,8.6652,49.8,,percent of total billed charges,,
SUTURE CAPROSYN 5/0 UD 30IN CV-23,,A4649,HCPCS,Facility,Inpatient,,,,17.4,14.79,4.98684,17.4,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
SUTURE CAPROSYN 5/0 UD 30IN CV-23,,A4649,HCPCS,Facility,Outpatient,,,,17.4,14.79,4.98684,17.4,Medica,Medical Assistance,7.7604,44.6,,percent of total billed charges,,
SUTURE CAPROSYN 5/0 UD 30IN CV-23,,A4649,HCPCS,Facility,Inpatient,,,,17.4,14.79,4.98684,17.4,Medica,Medical Assistance,,,,,Included in per diem rate,
SUTURE CAPROSYN 5/0 UD 30IN CV-23,,A4649,HCPCS,Facility,Outpatient,,,,17.4,14.79,4.98684,17.4,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,8.6652,49.8,,percent of total billed charges,,
SUTURE CAPROSYN 5/0 UD 30IN CV-23,,A4649,HCPCS,Facility,Inpatient,,,,17.4,14.79,4.98684,17.4,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
SUTURE CAPROSYN 5/0 UD 30IN CV-23,,A4649,HCPCS,Facility,Both,,,,17.4,14.79,4.98684,17.4,"Multiplan, Inc.","Multiplan, Inc.",16.356,94,,percent of total billed charges,,
SUTURE CAPROSYN 5/0 UD 30IN CV-23,,A4649,HCPCS,Facility,Outpatient,,,,17.4,14.79,4.98684,17.4,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,15.6774,90.1,,percent of total billed charges,,
SUTURE CAPROSYN 5/0 UD 30IN CV-23,,A4649,HCPCS,Facility,Inpatient,,,,17.4,14.79,4.98684,17.4,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
SUTURE CAPROSYN 5/0 UD 30IN CV-23,,A4649,HCPCS,Facility,Both,,,,17.4,14.79,4.98684,17.4,"Preferred One Administrative Services, INC.",PPO,17.1564,98.6,,percent of total billed charges,,
SUTURE CAPROSYN 5/0 UD 30IN CV-23,,A4649,HCPCS,Facility,Outpatient,,,,17.4,14.79,4.98684,17.4,PrimeWest Health,Minnesota Senior Health Options (MSHO),8.9523,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
SUTURE CAPROSYN 5/0 UD 30IN CV-23,,A4649,HCPCS,Facility,Inpatient,,,,17.4,14.79,4.98684,17.4,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE CAPROSYN 5/0 UD 30IN CV-23,,A4649,HCPCS,Facility,Outpatient,,,,17.4,14.79,4.98684,17.4,PrimeWest Health,MinnesotaCare,8.93664,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
SUTURE CAPROSYN 5/0 UD 30IN CV-23,,A4649,HCPCS,Facility,Inpatient,,,,17.4,14.79,4.98684,17.4,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
SUTURE CAPROSYN 5/0 UD 30IN CV-23,,A4649,HCPCS,Facility,Both,,,,17.4,14.79,4.98684,17.4,Sanford Health Plan,Sanford Health Plan,16.008,92,,percent of total billed charges,,
SUTURE CAPROSYN 5/0 UD 30IN CV-23,,A4649,HCPCS,Facility,Outpatient,,,,17.4,14.79,4.98684,17.4,"UCare Health, Inc.",Individual & Family Plan,9.8049,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
SUTURE CAPROSYN 5/0 UD 30IN CV-23,,A4649,HCPCS,Facility,Inpatient,,,,17.4,14.79,4.98684,17.4,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
SUTURE CAPROSYN 5/0 UD 30IN CV-23,,A4649,HCPCS,Facility,Outpatient,,,,17.4,14.79,4.98684,17.4,"UCare Health, Inc.",Medical Assistance,8.78178,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE CAPROSYN 5/0 UD 30IN CV-23,,A4649,HCPCS,Facility,Inpatient,,,,17.4,14.79,4.98684,17.4,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
SUTURE CAPROSYN 5/0 UD 30IN CV-23,,A4649,HCPCS,Facility,Outpatient,,,,17.4,14.79,4.98684,17.4,"UCare Health, Inc.",Medicare Advantage,8.78178,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE CAPROSYN 5/0 UD 30IN CV-23,,A4649,HCPCS,Facility,Inpatient,,,,17.4,14.79,4.98684,17.4,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE CAPROSYN 5/0 UD 30IN CV-23,,A4649,HCPCS,Facility,Outpatient,,,,17.4,14.79,4.98684,17.4,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),8.78178,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE CAPROSYN 5/0 UD 30IN CV-23,,A4649,HCPCS,Facility,Inpatient,,,,17.4,14.79,4.98684,17.4,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE CAPROSYN 5/0 UD 30IN CV-23,,A4649,HCPCS,Facility,Both,,,,17.4,14.79,4.98684,17.4,UnitedHealthcare,Individual & Family,16.356,94,,percent of total billed charges,,
SUTURE CAPROSYN 5/0 UD 30IN CV-23,,A4649,HCPCS,Facility,Outpatient,,,,17.4,14.79,4.98684,17.4,UnitedHealthcare,Medicare Advantage,8.526,49,,percent of total billed charges,,
SUTURE CAPROSYN 5/0 UD 30IN CV-23,,A4649,HCPCS,Facility,Inpatient,,,,17.4,14.79,4.98684,17.4,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
SUTURE CAPROSYN 5/0 UD 30IN CV-23,,A4649,HCPCS,Facility,Outpatient,,,,17.4,14.79,4.98684,17.4,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,8.352,48,,percent of total billed charges,,100% of DHS outpatient percentage
SUTURE CAPROSYN 5/0 UD 30IN CV-23,,A4649,HCPCS,Facility,Inpatient,,,,17.4,14.79,4.98684,17.4,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
SUTURE CAPROSYN 5-0,,A4649,HCPCS,Facility,Both,,,,17.4,14.79,4.98684,17.4,Aetna,Commercial,16.008,92,,percent of total billed charges,,
SUTURE CAPROSYN 5-0,,A4649,HCPCS,Facility,Outpatient,,,,17.4,14.79,4.98684,17.4,Aetna,Medicare Advantage,8.526,49,,percent of total billed charges,,
SUTURE CAPROSYN 5-0,,A4649,HCPCS,Facility,Inpatient,,,,17.4,14.79,4.98684,17.4,Aetna,Medicare Advantage,,,,,Included in per diem rate,
SUTURE CAPROSYN 5-0,,A4649,HCPCS,Facility,Both,,,,17.4,14.79,4.98684,17.4,Aetna,PPO,16.182,93,,percent of total billed charges,,
SUTURE CAPROSYN 5-0,,A4649,HCPCS,Facility,Both,,,,17.4,14.79,4.98684,17.4,America's PPO,America's PPO,16.70922,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SUTURE CAPROSYN 5-0,,A4649,HCPCS,Facility,Both,,,,17.4,14.79,4.98684,17.4,BlueCross BlueShield Minnesota, Federal Employee Program,17.1216,98.4,,percent of total billed charges,,
SUTURE CAPROSYN 5-0,,A4649,HCPCS,Facility,Both,,,,17.4,14.79,4.98684,17.4,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,17.4,100,,percent of total billed charges,,
SUTURE CAPROSYN 5-0,,A4649,HCPCS,Facility,Both,,,,17.4,14.79,4.98684,17.4,BlueCross BlueShield Minnesota,High Value Network Plan,15.66,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
SUTURE CAPROSYN 5-0,,A4649,HCPCS,Facility,Outpatient,,,,17.4,14.79,4.98684,17.4,BlueCross BlueShield Minnesota,Medicare Advantage,8.526,49,,percent of total billed charges,,
SUTURE CAPROSYN 5-0,,A4649,HCPCS,Facility,Inpatient,,,,17.4,14.79,4.98684,17.4,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
SUTURE CAPROSYN 5-0,,A4649,HCPCS,Facility,Both,,,,17.4,14.79,4.98684,17.4,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,15.41118,88.57,,percent of total billed charges,,
SUTURE CAPROSYN 5-0,,A4649,HCPCS,Facility,Both,,,,17.4,14.79,4.98684,17.4,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,4.98684,28.66,,percent of total billed charges,,
SUTURE CAPROSYN 5-0,,A4649,HCPCS,Facility,Outpatient,,,,17.4,14.79,4.98684,17.4,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),8.526,49,,percent of total billed charges,,
SUTURE CAPROSYN 5-0,,A4649,HCPCS,Facility,Inpatient,,,,17.4,14.79,4.98684,17.4,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
SUTURE CAPROSYN 5-0,,A4649,HCPCS,Facility,Both,,,,17.4,14.79,4.98684,17.4,CorVel,Worker's Compensation,17.4,100,,percent of total billed charges,,
SUTURE CAPROSYN 5-0,,A4649,HCPCS,Facility,Both,,,,17.4,14.79,4.98684,17.4,First Health Group Corporation,First Health Network,16.878,97,,percent of total billed charges,,
SUTURE CAPROSYN 5-0,,A4649,HCPCS,Facility,Both,,,,17.4,14.79,4.98684,17.4,"Health Partners, Inc.",Commercial,16.4604,94.6,,percent of total billed charges,,
SUTURE CAPROSYN 5-0,,A4649,HCPCS,Facility,Outpatient,,,,17.4,14.79,4.98684,17.4,"Health Partners, Inc.",Medicare Advantage,8.526,49,,percent of total billed charges,,
SUTURE CAPROSYN 5-0,,A4649,HCPCS,Facility,Inpatient,,,,17.4,14.79,4.98684,17.4,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE CAPROSYN 5-0,,A4649,HCPCS,Facility,Both,,,,17.4,14.79,4.98684,17.4,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),10.44,60,,percent of total billed charges,,
SUTURE CAPROSYN 5-0,,A4649,HCPCS,Facility,Both,,,,17.4,14.79,4.98684,17.4,"Health Partners, Inc.",State of Minnesota Advantage Program,14.181,81.5,,percent of total billed charges,,
SUTURE CAPROSYN 5-0,,A4649,HCPCS,Facility,Both,,,,17.4,14.79,4.98684,17.4,"Health Partners, Inc.",State Public Programs,8.7,50,,percent of total billed charges,,
SUTURE CAPROSYN 5-0,,A4649,HCPCS,Facility,Both,,,,17.4,14.79,4.98684,17.4,Humana Insurance Company,Commercial PPO,16.53,95,,percent of total billed charges,,
SUTURE CAPROSYN 5-0,,A4649,HCPCS,Facility,Outpatient,,,,17.4,14.79,4.98684,17.4,Humana Insurance Company,Medicare PPO,8.526,49,,percent of total billed charges,,
SUTURE CAPROSYN 5-0,,A4649,HCPCS,Facility,Inpatient,,,,17.4,14.79,4.98684,17.4,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
SUTURE CAPROSYN 5-0,,A4649,HCPCS,Facility,Both,,,,17.4,14.79,4.98684,17.4,Medica,Individual & Family,17.2434,99.1,,percent of total billed charges,,
SUTURE CAPROSYN 5-0,,A4649,HCPCS,Facility,Outpatient,,,,17.4,14.79,4.98684,17.4,Medica,Medica Advantage Solution,8.6652,49.8,,percent of total billed charges,,
SUTURE CAPROSYN 5-0,,A4649,HCPCS,Facility,Inpatient,,,,17.4,14.79,4.98684,17.4,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
SUTURE CAPROSYN 5-0,,A4649,HCPCS,Facility,Outpatient,,,,17.4,14.79,4.98684,17.4,Medica,Medical Assistance,7.7604,44.6,,percent of total billed charges,,
SUTURE CAPROSYN 5-0,,A4649,HCPCS,Facility,Inpatient,,,,17.4,14.79,4.98684,17.4,Medica,Medical Assistance,,,,,Included in per diem rate,
SUTURE CAPROSYN 5-0,,A4649,HCPCS,Facility,Outpatient,,,,17.4,14.79,4.98684,17.4,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,8.6652,49.8,,percent of total billed charges,,
SUTURE CAPROSYN 5-0,,A4649,HCPCS,Facility,Inpatient,,,,17.4,14.79,4.98684,17.4,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
SUTURE CAPROSYN 5-0,,A4649,HCPCS,Facility,Both,,,,17.4,14.79,4.98684,17.4,"Multiplan, Inc.","Multiplan, Inc.",16.356,94,,percent of total billed charges,,
SUTURE CAPROSYN 5-0,,A4649,HCPCS,Facility,Outpatient,,,,17.4,14.79,4.98684,17.4,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,15.6774,90.1,,percent of total billed charges,,
SUTURE CAPROSYN 5-0,,A4649,HCPCS,Facility,Inpatient,,,,17.4,14.79,4.98684,17.4,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
SUTURE CAPROSYN 5-0,,A4649,HCPCS,Facility,Both,,,,17.4,14.79,4.98684,17.4,"Preferred One Administrative Services, INC.",PPO,17.1564,98.6,,percent of total billed charges,,
SUTURE CAPROSYN 5-0,,A4649,HCPCS,Facility,Outpatient,,,,17.4,14.79,4.98684,17.4,PrimeWest Health,Minnesota Senior Health Options (MSHO),8.9523,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
SUTURE CAPROSYN 5-0,,A4649,HCPCS,Facility,Inpatient,,,,17.4,14.79,4.98684,17.4,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE CAPROSYN 5-0,,A4649,HCPCS,Facility,Outpatient,,,,17.4,14.79,4.98684,17.4,PrimeWest Health,MinnesotaCare,8.93664,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
SUTURE CAPROSYN 5-0,,A4649,HCPCS,Facility,Inpatient,,,,17.4,14.79,4.98684,17.4,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
SUTURE CAPROSYN 5-0,,A4649,HCPCS,Facility,Both,,,,17.4,14.79,4.98684,17.4,Sanford Health Plan,Sanford Health Plan,16.008,92,,percent of total billed charges,,
SUTURE CAPROSYN 5-0,,A4649,HCPCS,Facility,Outpatient,,,,17.4,14.79,4.98684,17.4,"UCare Health, Inc.",Individual & Family Plan,9.8049,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
SUTURE CAPROSYN 5-0,,A4649,HCPCS,Facility,Inpatient,,,,17.4,14.79,4.98684,17.4,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
SUTURE CAPROSYN 5-0,,A4649,HCPCS,Facility,Outpatient,,,,17.4,14.79,4.98684,17.4,"UCare Health, Inc.",Medical Assistance,8.78178,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE CAPROSYN 5-0,,A4649,HCPCS,Facility,Inpatient,,,,17.4,14.79,4.98684,17.4,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
SUTURE CAPROSYN 5-0,,A4649,HCPCS,Facility,Outpatient,,,,17.4,14.79,4.98684,17.4,"UCare Health, Inc.",Medicare Advantage,8.78178,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE CAPROSYN 5-0,,A4649,HCPCS,Facility,Inpatient,,,,17.4,14.79,4.98684,17.4,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE CAPROSYN 5-0,,A4649,HCPCS,Facility,Outpatient,,,,17.4,14.79,4.98684,17.4,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),8.78178,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE CAPROSYN 5-0,,A4649,HCPCS,Facility,Inpatient,,,,17.4,14.79,4.98684,17.4,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE CAPROSYN 5-0,,A4649,HCPCS,Facility,Both,,,,17.4,14.79,4.98684,17.4,UnitedHealthcare,Individual & Family,16.356,94,,percent of total billed charges,,
SUTURE CAPROSYN 5-0,,A4649,HCPCS,Facility,Outpatient,,,,17.4,14.79,4.98684,17.4,UnitedHealthcare,Medicare Advantage,8.526,49,,percent of total billed charges,,
SUTURE CAPROSYN 5-0,,A4649,HCPCS,Facility,Inpatient,,,,17.4,14.79,4.98684,17.4,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
SUTURE CAPROSYN 5-0,,A4649,HCPCS,Facility,Outpatient,,,,17.4,14.79,4.98684,17.4,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,8.352,48,,percent of total billed charges,,100% of DHS outpatient percentage
SUTURE CAPROSYN 5-0,,A4649,HCPCS,Facility,Inpatient,,,,17.4,14.79,4.98684,17.4,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
SUTURE CAPROSYN 5-0 SC-5689G,,A4649,HCPCS,Facility,Both,,,,63.72,54.162,18.262152,63.72,Aetna,Commercial,58.6224,92,,percent of total billed charges,,
SUTURE CAPROSYN 5-0 SC-5689G,,A4649,HCPCS,Facility,Outpatient,,,,63.72,54.162,18.262152,63.72,Aetna,Medicare Advantage,31.2228,49,,percent of total billed charges,,
SUTURE CAPROSYN 5-0 SC-5689G,,A4649,HCPCS,Facility,Inpatient,,,,63.72,54.162,18.262152,63.72,Aetna,Medicare Advantage,,,,,Included in per diem rate,
SUTURE CAPROSYN 5-0 SC-5689G,,A4649,HCPCS,Facility,Both,,,,63.72,54.162,18.262152,63.72,Aetna,PPO,59.2596,93,,percent of total billed charges,,
SUTURE CAPROSYN 5-0 SC-5689G,,A4649,HCPCS,Facility,Both,,,,63.72,54.162,18.262152,63.72,America's PPO,America's PPO,61.190316,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SUTURE CAPROSYN 5-0 SC-5689G,,A4649,HCPCS,Facility,Both,,,,63.72,54.162,18.262152,63.72,BlueCross BlueShield Minnesota, Federal Employee Program,62.70048,98.4,,percent of total billed charges,,
SUTURE CAPROSYN 5-0 SC-5689G,,A4649,HCPCS,Facility,Both,,,,63.72,54.162,18.262152,63.72,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,63.72,100,,percent of total billed charges,,
SUTURE CAPROSYN 5-0 SC-5689G,,A4649,HCPCS,Facility,Both,,,,63.72,54.162,18.262152,63.72,BlueCross BlueShield Minnesota,High Value Network Plan,57.348,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
SUTURE CAPROSYN 5-0 SC-5689G,,A4649,HCPCS,Facility,Outpatient,,,,63.72,54.162,18.262152,63.72,BlueCross BlueShield Minnesota,Medicare Advantage,31.2228,49,,percent of total billed charges,,
SUTURE CAPROSYN 5-0 SC-5689G,,A4649,HCPCS,Facility,Inpatient,,,,63.72,54.162,18.262152,63.72,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
SUTURE CAPROSYN 5-0 SC-5689G,,A4649,HCPCS,Facility,Both,,,,63.72,54.162,18.262152,63.72,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,56.436804,88.57,,percent of total billed charges,,
SUTURE CAPROSYN 5-0 SC-5689G,,A4649,HCPCS,Facility,Both,,,,63.72,54.162,18.262152,63.72,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,18.262152,28.66,,percent of total billed charges,,
SUTURE CAPROSYN 5-0 SC-5689G,,A4649,HCPCS,Facility,Outpatient,,,,63.72,54.162,18.262152,63.72,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),31.2228,49,,percent of total billed charges,,
SUTURE CAPROSYN 5-0 SC-5689G,,A4649,HCPCS,Facility,Inpatient,,,,63.72,54.162,18.262152,63.72,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
SUTURE CAPROSYN 5-0 SC-5689G,,A4649,HCPCS,Facility,Both,,,,63.72,54.162,18.262152,63.72,CorVel,Worker's Compensation,63.72,100,,percent of total billed charges,,
SUTURE CAPROSYN 5-0 SC-5689G,,A4649,HCPCS,Facility,Both,,,,63.72,54.162,18.262152,63.72,First Health Group Corporation,First Health Network,61.8084,97,,percent of total billed charges,,
SUTURE CAPROSYN 5-0 SC-5689G,,A4649,HCPCS,Facility,Both,,,,63.72,54.162,18.262152,63.72,"Health Partners, Inc.",Commercial,60.27912,94.6,,percent of total billed charges,,
SUTURE CAPROSYN 5-0 SC-5689G,,A4649,HCPCS,Facility,Outpatient,,,,63.72,54.162,18.262152,63.72,"Health Partners, Inc.",Medicare Advantage,31.2228,49,,percent of total billed charges,,
SUTURE CAPROSYN 5-0 SC-5689G,,A4649,HCPCS,Facility,Inpatient,,,,63.72,54.162,18.262152,63.72,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE CAPROSYN 5-0 SC-5689G,,A4649,HCPCS,Facility,Both,,,,63.72,54.162,18.262152,63.72,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),38.232,60,,percent of total billed charges,,
SUTURE CAPROSYN 5-0 SC-5689G,,A4649,HCPCS,Facility,Both,,,,63.72,54.162,18.262152,63.72,"Health Partners, Inc.",State of Minnesota Advantage Program,51.9318,81.5,,percent of total billed charges,,
SUTURE CAPROSYN 5-0 SC-5689G,,A4649,HCPCS,Facility,Both,,,,63.72,54.162,18.262152,63.72,"Health Partners, Inc.",State Public Programs,31.86,50,,percent of total billed charges,,
SUTURE CAPROSYN 5-0 SC-5689G,,A4649,HCPCS,Facility,Both,,,,63.72,54.162,18.262152,63.72,Humana Insurance Company,Commercial PPO,60.534,95,,percent of total billed charges,,
SUTURE CAPROSYN 5-0 SC-5689G,,A4649,HCPCS,Facility,Outpatient,,,,63.72,54.162,18.262152,63.72,Humana Insurance Company,Medicare PPO,31.2228,49,,percent of total billed charges,,
SUTURE CAPROSYN 5-0 SC-5689G,,A4649,HCPCS,Facility,Inpatient,,,,63.72,54.162,18.262152,63.72,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
SUTURE CAPROSYN 5-0 SC-5689G,,A4649,HCPCS,Facility,Both,,,,63.72,54.162,18.262152,63.72,Medica,Individual & Family,63.14652,99.1,,percent of total billed charges,,
SUTURE CAPROSYN 5-0 SC-5689G,,A4649,HCPCS,Facility,Outpatient,,,,63.72,54.162,18.262152,63.72,Medica,Medica Advantage Solution,31.73256,49.8,,percent of total billed charges,,
SUTURE CAPROSYN 5-0 SC-5689G,,A4649,HCPCS,Facility,Inpatient,,,,63.72,54.162,18.262152,63.72,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
SUTURE CAPROSYN 5-0 SC-5689G,,A4649,HCPCS,Facility,Outpatient,,,,63.72,54.162,18.262152,63.72,Medica,Medical Assistance,28.41912,44.6,,percent of total billed charges,,
SUTURE CAPROSYN 5-0 SC-5689G,,A4649,HCPCS,Facility,Inpatient,,,,63.72,54.162,18.262152,63.72,Medica,Medical Assistance,,,,,Included in per diem rate,
SUTURE CAPROSYN 5-0 SC-5689G,,A4649,HCPCS,Facility,Outpatient,,,,63.72,54.162,18.262152,63.72,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,31.73256,49.8,,percent of total billed charges,,
SUTURE CAPROSYN 5-0 SC-5689G,,A4649,HCPCS,Facility,Inpatient,,,,63.72,54.162,18.262152,63.72,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
SUTURE CAPROSYN 5-0 SC-5689G,,A4649,HCPCS,Facility,Both,,,,63.72,54.162,18.262152,63.72,"Multiplan, Inc.","Multiplan, Inc.",59.8968,94,,percent of total billed charges,,
SUTURE CAPROSYN 5-0 SC-5689G,,A4649,HCPCS,Facility,Outpatient,,,,63.72,54.162,18.262152,63.72,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,57.41172,90.1,,percent of total billed charges,,
SUTURE CAPROSYN 5-0 SC-5689G,,A4649,HCPCS,Facility,Inpatient,,,,63.72,54.162,18.262152,63.72,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
SUTURE CAPROSYN 5-0 SC-5689G,,A4649,HCPCS,Facility,Both,,,,63.72,54.162,18.262152,63.72,"Preferred One Administrative Services, INC.",PPO,62.82792,98.6,,percent of total billed charges,,
SUTURE CAPROSYN 5-0 SC-5689G,,A4649,HCPCS,Facility,Outpatient,,,,63.72,54.162,18.262152,63.72,PrimeWest Health,Minnesota Senior Health Options (MSHO),32.78394,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
SUTURE CAPROSYN 5-0 SC-5689G,,A4649,HCPCS,Facility,Inpatient,,,,63.72,54.162,18.262152,63.72,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE CAPROSYN 5-0 SC-5689G,,A4649,HCPCS,Facility,Outpatient,,,,63.72,54.162,18.262152,63.72,PrimeWest Health,MinnesotaCare,32.726592,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
SUTURE CAPROSYN 5-0 SC-5689G,,A4649,HCPCS,Facility,Inpatient,,,,63.72,54.162,18.262152,63.72,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
SUTURE CAPROSYN 5-0 SC-5689G,,A4649,HCPCS,Facility,Both,,,,63.72,54.162,18.262152,63.72,Sanford Health Plan,Sanford Health Plan,58.6224,92,,percent of total billed charges,,
SUTURE CAPROSYN 5-0 SC-5689G,,A4649,HCPCS,Facility,Outpatient,,,,63.72,54.162,18.262152,63.72,"UCare Health, Inc.",Individual & Family Plan,35.90622,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
SUTURE CAPROSYN 5-0 SC-5689G,,A4649,HCPCS,Facility,Inpatient,,,,63.72,54.162,18.262152,63.72,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
SUTURE CAPROSYN 5-0 SC-5689G,,A4649,HCPCS,Facility,Outpatient,,,,63.72,54.162,18.262152,63.72,"UCare Health, Inc.",Medical Assistance,32.159484,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE CAPROSYN 5-0 SC-5689G,,A4649,HCPCS,Facility,Inpatient,,,,63.72,54.162,18.262152,63.72,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
SUTURE CAPROSYN 5-0 SC-5689G,,A4649,HCPCS,Facility,Outpatient,,,,63.72,54.162,18.262152,63.72,"UCare Health, Inc.",Medicare Advantage,32.159484,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE CAPROSYN 5-0 SC-5689G,,A4649,HCPCS,Facility,Inpatient,,,,63.72,54.162,18.262152,63.72,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE CAPROSYN 5-0 SC-5689G,,A4649,HCPCS,Facility,Outpatient,,,,63.72,54.162,18.262152,63.72,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),32.159484,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE CAPROSYN 5-0 SC-5689G,,A4649,HCPCS,Facility,Inpatient,,,,63.72,54.162,18.262152,63.72,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE CAPROSYN 5-0 SC-5689G,,A4649,HCPCS,Facility,Both,,,,63.72,54.162,18.262152,63.72,UnitedHealthcare,Individual & Family,59.8968,94,,percent of total billed charges,,
SUTURE CAPROSYN 5-0 SC-5689G,,A4649,HCPCS,Facility,Outpatient,,,,63.72,54.162,18.262152,63.72,UnitedHealthcare,Medicare Advantage,31.2228,49,,percent of total billed charges,,
SUTURE CAPROSYN 5-0 SC-5689G,,A4649,HCPCS,Facility,Inpatient,,,,63.72,54.162,18.262152,63.72,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
SUTURE CAPROSYN 5-0 SC-5689G,,A4649,HCPCS,Facility,Outpatient,,,,63.72,54.162,18.262152,63.72,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,30.5856,48,,percent of total billed charges,,100% of DHS outpatient percentage
SUTURE CAPROSYN 5-0 SC-5689G,,A4649,HCPCS,Facility,Inpatient,,,,63.72,54.162,18.262152,63.72,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
SUTURE CHROMIC 3-0 1638H,,A4649,HCPCS,Facility,Both,,,,46.5,39.525,13.3269,46.5,Aetna,Commercial,42.78,92,,percent of total billed charges,,
SUTURE CHROMIC 3-0 1638H,,A4649,HCPCS,Facility,Outpatient,,,,46.5,39.525,13.3269,46.5,Aetna,Medicare Advantage,22.785,49,,percent of total billed charges,,
SUTURE CHROMIC 3-0 1638H,,A4649,HCPCS,Facility,Inpatient,,,,46.5,39.525,13.3269,46.5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
SUTURE CHROMIC 3-0 1638H,,A4649,HCPCS,Facility,Both,,,,46.5,39.525,13.3269,46.5,Aetna,PPO,43.245,93,,percent of total billed charges,,
SUTURE CHROMIC 3-0 1638H,,A4649,HCPCS,Facility,Both,,,,46.5,39.525,13.3269,46.5,America's PPO,America's PPO,44.65395,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SUTURE CHROMIC 3-0 1638H,,A4649,HCPCS,Facility,Both,,,,46.5,39.525,13.3269,46.5,BlueCross BlueShield Minnesota, Federal Employee Program,45.756,98.4,,percent of total billed charges,,
SUTURE CHROMIC 3-0 1638H,,A4649,HCPCS,Facility,Both,,,,46.5,39.525,13.3269,46.5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,46.5,100,,percent of total billed charges,,
SUTURE CHROMIC 3-0 1638H,,A4649,HCPCS,Facility,Both,,,,46.5,39.525,13.3269,46.5,BlueCross BlueShield Minnesota,High Value Network Plan,41.85,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
SUTURE CHROMIC 3-0 1638H,,A4649,HCPCS,Facility,Outpatient,,,,46.5,39.525,13.3269,46.5,BlueCross BlueShield Minnesota,Medicare Advantage,22.785,49,,percent of total billed charges,,
SUTURE CHROMIC 3-0 1638H,,A4649,HCPCS,Facility,Inpatient,,,,46.5,39.525,13.3269,46.5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
SUTURE CHROMIC 3-0 1638H,,A4649,HCPCS,Facility,Both,,,,46.5,39.525,13.3269,46.5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,41.18505,88.57,,percent of total billed charges,,
SUTURE CHROMIC 3-0 1638H,,A4649,HCPCS,Facility,Both,,,,46.5,39.525,13.3269,46.5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,13.3269,28.66,,percent of total billed charges,,
SUTURE CHROMIC 3-0 1638H,,A4649,HCPCS,Facility,Outpatient,,,,46.5,39.525,13.3269,46.5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),22.785,49,,percent of total billed charges,,
SUTURE CHROMIC 3-0 1638H,,A4649,HCPCS,Facility,Inpatient,,,,46.5,39.525,13.3269,46.5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
SUTURE CHROMIC 3-0 1638H,,A4649,HCPCS,Facility,Both,,,,46.5,39.525,13.3269,46.5,CorVel,Worker's Compensation,46.5,100,,percent of total billed charges,,
SUTURE CHROMIC 3-0 1638H,,A4649,HCPCS,Facility,Both,,,,46.5,39.525,13.3269,46.5,First Health Group Corporation,First Health Network,45.105,97,,percent of total billed charges,,
SUTURE CHROMIC 3-0 1638H,,A4649,HCPCS,Facility,Both,,,,46.5,39.525,13.3269,46.5,"Health Partners, Inc.",Commercial,43.989,94.6,,percent of total billed charges,,
SUTURE CHROMIC 3-0 1638H,,A4649,HCPCS,Facility,Outpatient,,,,46.5,39.525,13.3269,46.5,"Health Partners, Inc.",Medicare Advantage,22.785,49,,percent of total billed charges,,
SUTURE CHROMIC 3-0 1638H,,A4649,HCPCS,Facility,Inpatient,,,,46.5,39.525,13.3269,46.5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE CHROMIC 3-0 1638H,,A4649,HCPCS,Facility,Both,,,,46.5,39.525,13.3269,46.5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),27.9,60,,percent of total billed charges,,
SUTURE CHROMIC 3-0 1638H,,A4649,HCPCS,Facility,Both,,,,46.5,39.525,13.3269,46.5,"Health Partners, Inc.",State of Minnesota Advantage Program,37.8975,81.5,,percent of total billed charges,,
SUTURE CHROMIC 3-0 1638H,,A4649,HCPCS,Facility,Both,,,,46.5,39.525,13.3269,46.5,"Health Partners, Inc.",State Public Programs,23.25,50,,percent of total billed charges,,
SUTURE CHROMIC 3-0 1638H,,A4649,HCPCS,Facility,Both,,,,46.5,39.525,13.3269,46.5,Humana Insurance Company,Commercial PPO,44.175,95,,percent of total billed charges,,
SUTURE CHROMIC 3-0 1638H,,A4649,HCPCS,Facility,Outpatient,,,,46.5,39.525,13.3269,46.5,Humana Insurance Company,Medicare PPO,22.785,49,,percent of total billed charges,,
SUTURE CHROMIC 3-0 1638H,,A4649,HCPCS,Facility,Inpatient,,,,46.5,39.525,13.3269,46.5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
SUTURE CHROMIC 3-0 1638H,,A4649,HCPCS,Facility,Both,,,,46.5,39.525,13.3269,46.5,Medica,Individual & Family,46.0815,99.1,,percent of total billed charges,,
SUTURE CHROMIC 3-0 1638H,,A4649,HCPCS,Facility,Outpatient,,,,46.5,39.525,13.3269,46.5,Medica,Medica Advantage Solution,23.157,49.8,,percent of total billed charges,,
SUTURE CHROMIC 3-0 1638H,,A4649,HCPCS,Facility,Inpatient,,,,46.5,39.525,13.3269,46.5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
SUTURE CHROMIC 3-0 1638H,,A4649,HCPCS,Facility,Outpatient,,,,46.5,39.525,13.3269,46.5,Medica,Medical Assistance,20.739,44.6,,percent of total billed charges,,
SUTURE CHROMIC 3-0 1638H,,A4649,HCPCS,Facility,Inpatient,,,,46.5,39.525,13.3269,46.5,Medica,Medical Assistance,,,,,Included in per diem rate,
SUTURE CHROMIC 3-0 1638H,,A4649,HCPCS,Facility,Outpatient,,,,46.5,39.525,13.3269,46.5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,23.157,49.8,,percent of total billed charges,,
SUTURE CHROMIC 3-0 1638H,,A4649,HCPCS,Facility,Inpatient,,,,46.5,39.525,13.3269,46.5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
SUTURE CHROMIC 3-0 1638H,,A4649,HCPCS,Facility,Both,,,,46.5,39.525,13.3269,46.5,"Multiplan, Inc.","Multiplan, Inc.",43.71,94,,percent of total billed charges,,
SUTURE CHROMIC 3-0 1638H,,A4649,HCPCS,Facility,Outpatient,,,,46.5,39.525,13.3269,46.5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,41.8965,90.1,,percent of total billed charges,,
SUTURE CHROMIC 3-0 1638H,,A4649,HCPCS,Facility,Inpatient,,,,46.5,39.525,13.3269,46.5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
SUTURE CHROMIC 3-0 1638H,,A4649,HCPCS,Facility,Both,,,,46.5,39.525,13.3269,46.5,"Preferred One Administrative Services, INC.",PPO,45.849,98.6,,percent of total billed charges,,
SUTURE CHROMIC 3-0 1638H,,A4649,HCPCS,Facility,Outpatient,,,,46.5,39.525,13.3269,46.5,PrimeWest Health,Minnesota Senior Health Options (MSHO),23.92425,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
SUTURE CHROMIC 3-0 1638H,,A4649,HCPCS,Facility,Inpatient,,,,46.5,39.525,13.3269,46.5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE CHROMIC 3-0 1638H,,A4649,HCPCS,Facility,Outpatient,,,,46.5,39.525,13.3269,46.5,PrimeWest Health,MinnesotaCare,23.8824,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
SUTURE CHROMIC 3-0 1638H,,A4649,HCPCS,Facility,Inpatient,,,,46.5,39.525,13.3269,46.5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
SUTURE CHROMIC 3-0 1638H,,A4649,HCPCS,Facility,Both,,,,46.5,39.525,13.3269,46.5,Sanford Health Plan,Sanford Health Plan,42.78,92,,percent of total billed charges,,
SUTURE CHROMIC 3-0 1638H,,A4649,HCPCS,Facility,Outpatient,,,,46.5,39.525,13.3269,46.5,"UCare Health, Inc.",Individual & Family Plan,26.20275,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
SUTURE CHROMIC 3-0 1638H,,A4649,HCPCS,Facility,Inpatient,,,,46.5,39.525,13.3269,46.5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
SUTURE CHROMIC 3-0 1638H,,A4649,HCPCS,Facility,Outpatient,,,,46.5,39.525,13.3269,46.5,"UCare Health, Inc.",Medical Assistance,23.46855,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE CHROMIC 3-0 1638H,,A4649,HCPCS,Facility,Inpatient,,,,46.5,39.525,13.3269,46.5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
SUTURE CHROMIC 3-0 1638H,,A4649,HCPCS,Facility,Outpatient,,,,46.5,39.525,13.3269,46.5,"UCare Health, Inc.",Medicare Advantage,23.46855,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE CHROMIC 3-0 1638H,,A4649,HCPCS,Facility,Inpatient,,,,46.5,39.525,13.3269,46.5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE CHROMIC 3-0 1638H,,A4649,HCPCS,Facility,Outpatient,,,,46.5,39.525,13.3269,46.5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),23.46855,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE CHROMIC 3-0 1638H,,A4649,HCPCS,Facility,Inpatient,,,,46.5,39.525,13.3269,46.5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE CHROMIC 3-0 1638H,,A4649,HCPCS,Facility,Both,,,,46.5,39.525,13.3269,46.5,UnitedHealthcare,Individual & Family,43.71,94,,percent of total billed charges,,
SUTURE CHROMIC 3-0 1638H,,A4649,HCPCS,Facility,Outpatient,,,,46.5,39.525,13.3269,46.5,UnitedHealthcare,Medicare Advantage,22.785,49,,percent of total billed charges,,
SUTURE CHROMIC 3-0 1638H,,A4649,HCPCS,Facility,Inpatient,,,,46.5,39.525,13.3269,46.5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
SUTURE CHROMIC 3-0 1638H,,A4649,HCPCS,Facility,Outpatient,,,,46.5,39.525,13.3269,46.5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,22.32,48,,percent of total billed charges,,100% of DHS outpatient percentage
SUTURE CHROMIC 3-0 1638H,,A4649,HCPCS,Facility,Inpatient,,,,46.5,39.525,13.3269,46.5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
SUTURE CHROMIC 3-0 CT-1 CP-1,,A4649,HCPCS,Facility,Both,,,,14.7,12.495,4.21302,14.7,Aetna,Commercial,13.524,92,,percent of total billed charges,,
SUTURE CHROMIC 3-0 CT-1 CP-1,,A4649,HCPCS,Facility,Outpatient,,,,14.7,12.495,4.21302,14.7,Aetna,Medicare Advantage,7.203,49,,percent of total billed charges,,
SUTURE CHROMIC 3-0 CT-1 CP-1,,A4649,HCPCS,Facility,Inpatient,,,,14.7,12.495,4.21302,14.7,Aetna,Medicare Advantage,,,,,Included in per diem rate,
SUTURE CHROMIC 3-0 CT-1 CP-1,,A4649,HCPCS,Facility,Both,,,,14.7,12.495,4.21302,14.7,Aetna,PPO,13.671,93,,percent of total billed charges,,
SUTURE CHROMIC 3-0 CT-1 CP-1,,A4649,HCPCS,Facility,Both,,,,14.7,12.495,4.21302,14.7,America's PPO,America's PPO,14.11641,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SUTURE CHROMIC 3-0 CT-1 CP-1,,A4649,HCPCS,Facility,Both,,,,14.7,12.495,4.21302,14.7,BlueCross BlueShield Minnesota, Federal Employee Program,14.4648,98.4,,percent of total billed charges,,
SUTURE CHROMIC 3-0 CT-1 CP-1,,A4649,HCPCS,Facility,Both,,,,14.7,12.495,4.21302,14.7,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,14.7,100,,percent of total billed charges,,
SUTURE CHROMIC 3-0 CT-1 CP-1,,A4649,HCPCS,Facility,Both,,,,14.7,12.495,4.21302,14.7,BlueCross BlueShield Minnesota,High Value Network Plan,13.23,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
SUTURE CHROMIC 3-0 CT-1 CP-1,,A4649,HCPCS,Facility,Outpatient,,,,14.7,12.495,4.21302,14.7,BlueCross BlueShield Minnesota,Medicare Advantage,7.203,49,,percent of total billed charges,,
SUTURE CHROMIC 3-0 CT-1 CP-1,,A4649,HCPCS,Facility,Inpatient,,,,14.7,12.495,4.21302,14.7,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
SUTURE CHROMIC 3-0 CT-1 CP-1,,A4649,HCPCS,Facility,Both,,,,14.7,12.495,4.21302,14.7,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,13.01979,88.57,,percent of total billed charges,,
SUTURE CHROMIC 3-0 CT-1 CP-1,,A4649,HCPCS,Facility,Both,,,,14.7,12.495,4.21302,14.7,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,4.21302,28.66,,percent of total billed charges,,
SUTURE CHROMIC 3-0 CT-1 CP-1,,A4649,HCPCS,Facility,Outpatient,,,,14.7,12.495,4.21302,14.7,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),7.203,49,,percent of total billed charges,,
SUTURE CHROMIC 3-0 CT-1 CP-1,,A4649,HCPCS,Facility,Inpatient,,,,14.7,12.495,4.21302,14.7,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
SUTURE CHROMIC 3-0 CT-1 CP-1,,A4649,HCPCS,Facility,Both,,,,14.7,12.495,4.21302,14.7,CorVel,Worker's Compensation,14.7,100,,percent of total billed charges,,
SUTURE CHROMIC 3-0 CT-1 CP-1,,A4649,HCPCS,Facility,Both,,,,14.7,12.495,4.21302,14.7,First Health Group Corporation,First Health Network,14.259,97,,percent of total billed charges,,
SUTURE CHROMIC 3-0 CT-1 CP-1,,A4649,HCPCS,Facility,Both,,,,14.7,12.495,4.21302,14.7,"Health Partners, Inc.",Commercial,13.9062,94.6,,percent of total billed charges,,
SUTURE CHROMIC 3-0 CT-1 CP-1,,A4649,HCPCS,Facility,Outpatient,,,,14.7,12.495,4.21302,14.7,"Health Partners, Inc.",Medicare Advantage,7.203,49,,percent of total billed charges,,
SUTURE CHROMIC 3-0 CT-1 CP-1,,A4649,HCPCS,Facility,Inpatient,,,,14.7,12.495,4.21302,14.7,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE CHROMIC 3-0 CT-1 CP-1,,A4649,HCPCS,Facility,Both,,,,14.7,12.495,4.21302,14.7,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),8.82,60,,percent of total billed charges,,
SUTURE CHROMIC 3-0 CT-1 CP-1,,A4649,HCPCS,Facility,Both,,,,14.7,12.495,4.21302,14.7,"Health Partners, Inc.",State of Minnesota Advantage Program,11.9805,81.5,,percent of total billed charges,,
SUTURE CHROMIC 3-0 CT-1 CP-1,,A4649,HCPCS,Facility,Both,,,,14.7,12.495,4.21302,14.7,"Health Partners, Inc.",State Public Programs,7.35,50,,percent of total billed charges,,
SUTURE CHROMIC 3-0 CT-1 CP-1,,A4649,HCPCS,Facility,Both,,,,14.7,12.495,4.21302,14.7,Humana Insurance Company,Commercial PPO,13.965,95,,percent of total billed charges,,
SUTURE CHROMIC 3-0 CT-1 CP-1,,A4649,HCPCS,Facility,Outpatient,,,,14.7,12.495,4.21302,14.7,Humana Insurance Company,Medicare PPO,7.203,49,,percent of total billed charges,,
SUTURE CHROMIC 3-0 CT-1 CP-1,,A4649,HCPCS,Facility,Inpatient,,,,14.7,12.495,4.21302,14.7,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
SUTURE CHROMIC 3-0 CT-1 CP-1,,A4649,HCPCS,Facility,Both,,,,14.7,12.495,4.21302,14.7,Medica,Individual & Family,14.5677,99.1,,percent of total billed charges,,
SUTURE CHROMIC 3-0 CT-1 CP-1,,A4649,HCPCS,Facility,Outpatient,,,,14.7,12.495,4.21302,14.7,Medica,Medica Advantage Solution,7.3206,49.8,,percent of total billed charges,,
SUTURE CHROMIC 3-0 CT-1 CP-1,,A4649,HCPCS,Facility,Inpatient,,,,14.7,12.495,4.21302,14.7,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
SUTURE CHROMIC 3-0 CT-1 CP-1,,A4649,HCPCS,Facility,Outpatient,,,,14.7,12.495,4.21302,14.7,Medica,Medical Assistance,6.5562,44.6,,percent of total billed charges,,
SUTURE CHROMIC 3-0 CT-1 CP-1,,A4649,HCPCS,Facility,Inpatient,,,,14.7,12.495,4.21302,14.7,Medica,Medical Assistance,,,,,Included in per diem rate,
SUTURE CHROMIC 3-0 CT-1 CP-1,,A4649,HCPCS,Facility,Outpatient,,,,14.7,12.495,4.21302,14.7,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,7.3206,49.8,,percent of total billed charges,,
SUTURE CHROMIC 3-0 CT-1 CP-1,,A4649,HCPCS,Facility,Inpatient,,,,14.7,12.495,4.21302,14.7,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
SUTURE CHROMIC 3-0 CT-1 CP-1,,A4649,HCPCS,Facility,Both,,,,14.7,12.495,4.21302,14.7,"Multiplan, Inc.","Multiplan, Inc.",13.818,94,,percent of total billed charges,,
SUTURE CHROMIC 3-0 CT-1 CP-1,,A4649,HCPCS,Facility,Outpatient,,,,14.7,12.495,4.21302,14.7,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,13.2447,90.1,,percent of total billed charges,,
SUTURE CHROMIC 3-0 CT-1 CP-1,,A4649,HCPCS,Facility,Inpatient,,,,14.7,12.495,4.21302,14.7,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
SUTURE CHROMIC 3-0 CT-1 CP-1,,A4649,HCPCS,Facility,Both,,,,14.7,12.495,4.21302,14.7,"Preferred One Administrative Services, INC.",PPO,14.4942,98.6,,percent of total billed charges,,
SUTURE CHROMIC 3-0 CT-1 CP-1,,A4649,HCPCS,Facility,Outpatient,,,,14.7,12.495,4.21302,14.7,PrimeWest Health,Minnesota Senior Health Options (MSHO),7.56315,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
SUTURE CHROMIC 3-0 CT-1 CP-1,,A4649,HCPCS,Facility,Inpatient,,,,14.7,12.495,4.21302,14.7,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE CHROMIC 3-0 CT-1 CP-1,,A4649,HCPCS,Facility,Outpatient,,,,14.7,12.495,4.21302,14.7,PrimeWest Health,MinnesotaCare,7.54992,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
SUTURE CHROMIC 3-0 CT-1 CP-1,,A4649,HCPCS,Facility,Inpatient,,,,14.7,12.495,4.21302,14.7,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
SUTURE CHROMIC 3-0 CT-1 CP-1,,A4649,HCPCS,Facility,Both,,,,14.7,12.495,4.21302,14.7,Sanford Health Plan,Sanford Health Plan,13.524,92,,percent of total billed charges,,
SUTURE CHROMIC 3-0 CT-1 CP-1,,A4649,HCPCS,Facility,Outpatient,,,,14.7,12.495,4.21302,14.7,"UCare Health, Inc.",Individual & Family Plan,8.28345,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
SUTURE CHROMIC 3-0 CT-1 CP-1,,A4649,HCPCS,Facility,Inpatient,,,,14.7,12.495,4.21302,14.7,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
SUTURE CHROMIC 3-0 CT-1 CP-1,,A4649,HCPCS,Facility,Outpatient,,,,14.7,12.495,4.21302,14.7,"UCare Health, Inc.",Medical Assistance,7.41909,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE CHROMIC 3-0 CT-1 CP-1,,A4649,HCPCS,Facility,Inpatient,,,,14.7,12.495,4.21302,14.7,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
SUTURE CHROMIC 3-0 CT-1 CP-1,,A4649,HCPCS,Facility,Outpatient,,,,14.7,12.495,4.21302,14.7,"UCare Health, Inc.",Medicare Advantage,7.41909,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE CHROMIC 3-0 CT-1 CP-1,,A4649,HCPCS,Facility,Inpatient,,,,14.7,12.495,4.21302,14.7,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE CHROMIC 3-0 CT-1 CP-1,,A4649,HCPCS,Facility,Outpatient,,,,14.7,12.495,4.21302,14.7,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),7.41909,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE CHROMIC 3-0 CT-1 CP-1,,A4649,HCPCS,Facility,Inpatient,,,,14.7,12.495,4.21302,14.7,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE CHROMIC 3-0 CT-1 CP-1,,A4649,HCPCS,Facility,Both,,,,14.7,12.495,4.21302,14.7,UnitedHealthcare,Individual & Family,13.818,94,,percent of total billed charges,,
SUTURE CHROMIC 3-0 CT-1 CP-1,,A4649,HCPCS,Facility,Outpatient,,,,14.7,12.495,4.21302,14.7,UnitedHealthcare,Medicare Advantage,7.203,49,,percent of total billed charges,,
SUTURE CHROMIC 3-0 CT-1 CP-1,,A4649,HCPCS,Facility,Inpatient,,,,14.7,12.495,4.21302,14.7,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
SUTURE CHROMIC 3-0 CT-1 CP-1,,A4649,HCPCS,Facility,Outpatient,,,,14.7,12.495,4.21302,14.7,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,7.056,48,,percent of total billed charges,,100% of DHS outpatient percentage
SUTURE CHROMIC 3-0 CT-1 CP-1,,A4649,HCPCS,Facility,Inpatient,,,,14.7,12.495,4.21302,14.7,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
SUTURE ETHILON  4-0 P-3             699G,,A4649,HCPCS,Facility,Both,,,,49.5,42.075,14.1867,49.5,Aetna,Commercial,45.54,92,,percent of total billed charges,,
SUTURE ETHILON  4-0 P-3             699G,,A4649,HCPCS,Facility,Outpatient,,,,49.5,42.075,14.1867,49.5,Aetna,Medicare Advantage,24.255,49,,percent of total billed charges,,
SUTURE ETHILON  4-0 P-3             699G,,A4649,HCPCS,Facility,Inpatient,,,,49.5,42.075,14.1867,49.5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
SUTURE ETHILON  4-0 P-3             699G,,A4649,HCPCS,Facility,Both,,,,49.5,42.075,14.1867,49.5,Aetna,PPO,46.035,93,,percent of total billed charges,,
SUTURE ETHILON  4-0 P-3             699G,,A4649,HCPCS,Facility,Both,,,,49.5,42.075,14.1867,49.5,America's PPO,America's PPO,47.53485,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SUTURE ETHILON  4-0 P-3             699G,,A4649,HCPCS,Facility,Both,,,,49.5,42.075,14.1867,49.5,BlueCross BlueShield Minnesota, Federal Employee Program,48.708,98.4,,percent of total billed charges,,
SUTURE ETHILON  4-0 P-3             699G,,A4649,HCPCS,Facility,Both,,,,49.5,42.075,14.1867,49.5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,49.5,100,,percent of total billed charges,,
SUTURE ETHILON  4-0 P-3             699G,,A4649,HCPCS,Facility,Both,,,,49.5,42.075,14.1867,49.5,BlueCross BlueShield Minnesota,High Value Network Plan,44.55,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
SUTURE ETHILON  4-0 P-3             699G,,A4649,HCPCS,Facility,Outpatient,,,,49.5,42.075,14.1867,49.5,BlueCross BlueShield Minnesota,Medicare Advantage,24.255,49,,percent of total billed charges,,
SUTURE ETHILON  4-0 P-3             699G,,A4649,HCPCS,Facility,Inpatient,,,,49.5,42.075,14.1867,49.5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
SUTURE ETHILON  4-0 P-3             699G,,A4649,HCPCS,Facility,Both,,,,49.5,42.075,14.1867,49.5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,43.84215,88.57,,percent of total billed charges,,
SUTURE ETHILON  4-0 P-3             699G,,A4649,HCPCS,Facility,Both,,,,49.5,42.075,14.1867,49.5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,14.1867,28.66,,percent of total billed charges,,
SUTURE ETHILON  4-0 P-3             699G,,A4649,HCPCS,Facility,Outpatient,,,,49.5,42.075,14.1867,49.5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),24.255,49,,percent of total billed charges,,
SUTURE ETHILON  4-0 P-3             699G,,A4649,HCPCS,Facility,Inpatient,,,,49.5,42.075,14.1867,49.5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
SUTURE ETHILON  4-0 P-3             699G,,A4649,HCPCS,Facility,Both,,,,49.5,42.075,14.1867,49.5,CorVel,Worker's Compensation,49.5,100,,percent of total billed charges,,
SUTURE ETHILON  4-0 P-3             699G,,A4649,HCPCS,Facility,Both,,,,49.5,42.075,14.1867,49.5,First Health Group Corporation,First Health Network,48.015,97,,percent of total billed charges,,
SUTURE ETHILON  4-0 P-3             699G,,A4649,HCPCS,Facility,Both,,,,49.5,42.075,14.1867,49.5,"Health Partners, Inc.",Commercial,46.827,94.6,,percent of total billed charges,,
SUTURE ETHILON  4-0 P-3             699G,,A4649,HCPCS,Facility,Outpatient,,,,49.5,42.075,14.1867,49.5,"Health Partners, Inc.",Medicare Advantage,24.255,49,,percent of total billed charges,,
SUTURE ETHILON  4-0 P-3             699G,,A4649,HCPCS,Facility,Inpatient,,,,49.5,42.075,14.1867,49.5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE ETHILON  4-0 P-3             699G,,A4649,HCPCS,Facility,Both,,,,49.5,42.075,14.1867,49.5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),29.7,60,,percent of total billed charges,,
SUTURE ETHILON  4-0 P-3             699G,,A4649,HCPCS,Facility,Both,,,,49.5,42.075,14.1867,49.5,"Health Partners, Inc.",State of Minnesota Advantage Program,40.3425,81.5,,percent of total billed charges,,
SUTURE ETHILON  4-0 P-3             699G,,A4649,HCPCS,Facility,Both,,,,49.5,42.075,14.1867,49.5,"Health Partners, Inc.",State Public Programs,24.75,50,,percent of total billed charges,,
SUTURE ETHILON  4-0 P-3             699G,,A4649,HCPCS,Facility,Both,,,,49.5,42.075,14.1867,49.5,Humana Insurance Company,Commercial PPO,47.025,95,,percent of total billed charges,,
SUTURE ETHILON  4-0 P-3             699G,,A4649,HCPCS,Facility,Outpatient,,,,49.5,42.075,14.1867,49.5,Humana Insurance Company,Medicare PPO,24.255,49,,percent of total billed charges,,
SUTURE ETHILON  4-0 P-3             699G,,A4649,HCPCS,Facility,Inpatient,,,,49.5,42.075,14.1867,49.5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
SUTURE ETHILON  4-0 P-3             699G,,A4649,HCPCS,Facility,Both,,,,49.5,42.075,14.1867,49.5,Medica,Individual & Family,49.0545,99.1,,percent of total billed charges,,
SUTURE ETHILON  4-0 P-3             699G,,A4649,HCPCS,Facility,Outpatient,,,,49.5,42.075,14.1867,49.5,Medica,Medica Advantage Solution,24.651,49.8,,percent of total billed charges,,
SUTURE ETHILON  4-0 P-3             699G,,A4649,HCPCS,Facility,Inpatient,,,,49.5,42.075,14.1867,49.5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
SUTURE ETHILON  4-0 P-3             699G,,A4649,HCPCS,Facility,Outpatient,,,,49.5,42.075,14.1867,49.5,Medica,Medical Assistance,22.077,44.6,,percent of total billed charges,,
SUTURE ETHILON  4-0 P-3             699G,,A4649,HCPCS,Facility,Inpatient,,,,49.5,42.075,14.1867,49.5,Medica,Medical Assistance,,,,,Included in per diem rate,
SUTURE ETHILON  4-0 P-3             699G,,A4649,HCPCS,Facility,Outpatient,,,,49.5,42.075,14.1867,49.5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,24.651,49.8,,percent of total billed charges,,
SUTURE ETHILON  4-0 P-3             699G,,A4649,HCPCS,Facility,Inpatient,,,,49.5,42.075,14.1867,49.5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
SUTURE ETHILON  4-0 P-3             699G,,A4649,HCPCS,Facility,Both,,,,49.5,42.075,14.1867,49.5,"Multiplan, Inc.","Multiplan, Inc.",46.53,94,,percent of total billed charges,,
SUTURE ETHILON  4-0 P-3             699G,,A4649,HCPCS,Facility,Outpatient,,,,49.5,42.075,14.1867,49.5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,44.5995,90.1,,percent of total billed charges,,
SUTURE ETHILON  4-0 P-3             699G,,A4649,HCPCS,Facility,Inpatient,,,,49.5,42.075,14.1867,49.5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
SUTURE ETHILON  4-0 P-3             699G,,A4649,HCPCS,Facility,Both,,,,49.5,42.075,14.1867,49.5,"Preferred One Administrative Services, INC.",PPO,48.807,98.6,,percent of total billed charges,,
SUTURE ETHILON  4-0 P-3             699G,,A4649,HCPCS,Facility,Outpatient,,,,49.5,42.075,14.1867,49.5,PrimeWest Health,Minnesota Senior Health Options (MSHO),25.46775,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
SUTURE ETHILON  4-0 P-3             699G,,A4649,HCPCS,Facility,Inpatient,,,,49.5,42.075,14.1867,49.5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE ETHILON  4-0 P-3             699G,,A4649,HCPCS,Facility,Outpatient,,,,49.5,42.075,14.1867,49.5,PrimeWest Health,MinnesotaCare,25.4232,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
SUTURE ETHILON  4-0 P-3             699G,,A4649,HCPCS,Facility,Inpatient,,,,49.5,42.075,14.1867,49.5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
SUTURE ETHILON  4-0 P-3             699G,,A4649,HCPCS,Facility,Both,,,,49.5,42.075,14.1867,49.5,Sanford Health Plan,Sanford Health Plan,45.54,92,,percent of total billed charges,,
SUTURE ETHILON  4-0 P-3             699G,,A4649,HCPCS,Facility,Outpatient,,,,49.5,42.075,14.1867,49.5,"UCare Health, Inc.",Individual & Family Plan,27.89325,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
SUTURE ETHILON  4-0 P-3             699G,,A4649,HCPCS,Facility,Inpatient,,,,49.5,42.075,14.1867,49.5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
SUTURE ETHILON  4-0 P-3             699G,,A4649,HCPCS,Facility,Outpatient,,,,49.5,42.075,14.1867,49.5,"UCare Health, Inc.",Medical Assistance,24.98265,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE ETHILON  4-0 P-3             699G,,A4649,HCPCS,Facility,Inpatient,,,,49.5,42.075,14.1867,49.5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
SUTURE ETHILON  4-0 P-3             699G,,A4649,HCPCS,Facility,Outpatient,,,,49.5,42.075,14.1867,49.5,"UCare Health, Inc.",Medicare Advantage,24.98265,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE ETHILON  4-0 P-3             699G,,A4649,HCPCS,Facility,Inpatient,,,,49.5,42.075,14.1867,49.5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE ETHILON  4-0 P-3             699G,,A4649,HCPCS,Facility,Outpatient,,,,49.5,42.075,14.1867,49.5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),24.98265,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE ETHILON  4-0 P-3             699G,,A4649,HCPCS,Facility,Inpatient,,,,49.5,42.075,14.1867,49.5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE ETHILON  4-0 P-3             699G,,A4649,HCPCS,Facility,Both,,,,49.5,42.075,14.1867,49.5,UnitedHealthcare,Individual & Family,46.53,94,,percent of total billed charges,,
SUTURE ETHILON  4-0 P-3             699G,,A4649,HCPCS,Facility,Outpatient,,,,49.5,42.075,14.1867,49.5,UnitedHealthcare,Medicare Advantage,24.255,49,,percent of total billed charges,,
SUTURE ETHILON  4-0 P-3             699G,,A4649,HCPCS,Facility,Inpatient,,,,49.5,42.075,14.1867,49.5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
SUTURE ETHILON  4-0 P-3             699G,,A4649,HCPCS,Facility,Outpatient,,,,49.5,42.075,14.1867,49.5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,23.76,48,,percent of total billed charges,,100% of DHS outpatient percentage
SUTURE ETHILON  4-0 P-3             699G,,A4649,HCPCS,Facility,Inpatient,,,,49.5,42.075,14.1867,49.5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
SUTURE MAXON 0 6267-61,,A4649,HCPCS,Facility,Both,,,,15.25,12.9625,4.37065,15.25,Aetna,Commercial,14.03,92,,percent of total billed charges,,
SUTURE MAXON 0 6267-61,,A4649,HCPCS,Facility,Outpatient,,,,15.25,12.9625,4.37065,15.25,Aetna,Medicare Advantage,7.4725,49,,percent of total billed charges,,
SUTURE MAXON 0 6267-61,,A4649,HCPCS,Facility,Inpatient,,,,15.25,12.9625,4.37065,15.25,Aetna,Medicare Advantage,,,,,Included in per diem rate,
SUTURE MAXON 0 6267-61,,A4649,HCPCS,Facility,Both,,,,15.25,12.9625,4.37065,15.25,Aetna,PPO,14.1825,93,,percent of total billed charges,,
SUTURE MAXON 0 6267-61,,A4649,HCPCS,Facility,Both,,,,15.25,12.9625,4.37065,15.25,America's PPO,America's PPO,14.644575,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SUTURE MAXON 0 6267-61,,A4649,HCPCS,Facility,Both,,,,15.25,12.9625,4.37065,15.25,BlueCross BlueShield Minnesota, Federal Employee Program,15.006,98.4,,percent of total billed charges,,
SUTURE MAXON 0 6267-61,,A4649,HCPCS,Facility,Both,,,,15.25,12.9625,4.37065,15.25,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,15.25,100,,percent of total billed charges,,
SUTURE MAXON 0 6267-61,,A4649,HCPCS,Facility,Both,,,,15.25,12.9625,4.37065,15.25,BlueCross BlueShield Minnesota,High Value Network Plan,13.725,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
SUTURE MAXON 0 6267-61,,A4649,HCPCS,Facility,Outpatient,,,,15.25,12.9625,4.37065,15.25,BlueCross BlueShield Minnesota,Medicare Advantage,7.4725,49,,percent of total billed charges,,
SUTURE MAXON 0 6267-61,,A4649,HCPCS,Facility,Inpatient,,,,15.25,12.9625,4.37065,15.25,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
SUTURE MAXON 0 6267-61,,A4649,HCPCS,Facility,Both,,,,15.25,12.9625,4.37065,15.25,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,13.506925,88.57,,percent of total billed charges,,
SUTURE MAXON 0 6267-61,,A4649,HCPCS,Facility,Both,,,,15.25,12.9625,4.37065,15.25,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,4.37065,28.66,,percent of total billed charges,,
SUTURE MAXON 0 6267-61,,A4649,HCPCS,Facility,Outpatient,,,,15.25,12.9625,4.37065,15.25,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),7.4725,49,,percent of total billed charges,,
SUTURE MAXON 0 6267-61,,A4649,HCPCS,Facility,Inpatient,,,,15.25,12.9625,4.37065,15.25,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
SUTURE MAXON 0 6267-61,,A4649,HCPCS,Facility,Both,,,,15.25,12.9625,4.37065,15.25,CorVel,Worker's Compensation,15.25,100,,percent of total billed charges,,
SUTURE MAXON 0 6267-61,,A4649,HCPCS,Facility,Both,,,,15.25,12.9625,4.37065,15.25,First Health Group Corporation,First Health Network,14.7925,97,,percent of total billed charges,,
SUTURE MAXON 0 6267-61,,A4649,HCPCS,Facility,Both,,,,15.25,12.9625,4.37065,15.25,"Health Partners, Inc.",Commercial,14.4265,94.6,,percent of total billed charges,,
SUTURE MAXON 0 6267-61,,A4649,HCPCS,Facility,Outpatient,,,,15.25,12.9625,4.37065,15.25,"Health Partners, Inc.",Medicare Advantage,7.4725,49,,percent of total billed charges,,
SUTURE MAXON 0 6267-61,,A4649,HCPCS,Facility,Inpatient,,,,15.25,12.9625,4.37065,15.25,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE MAXON 0 6267-61,,A4649,HCPCS,Facility,Both,,,,15.25,12.9625,4.37065,15.25,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),9.15,60,,percent of total billed charges,,
SUTURE MAXON 0 6267-61,,A4649,HCPCS,Facility,Both,,,,15.25,12.9625,4.37065,15.25,"Health Partners, Inc.",State of Minnesota Advantage Program,12.42875,81.5,,percent of total billed charges,,
SUTURE MAXON 0 6267-61,,A4649,HCPCS,Facility,Both,,,,15.25,12.9625,4.37065,15.25,"Health Partners, Inc.",State Public Programs,7.625,50,,percent of total billed charges,,
SUTURE MAXON 0 6267-61,,A4649,HCPCS,Facility,Both,,,,15.25,12.9625,4.37065,15.25,Humana Insurance Company,Commercial PPO,14.4875,95,,percent of total billed charges,,
SUTURE MAXON 0 6267-61,,A4649,HCPCS,Facility,Outpatient,,,,15.25,12.9625,4.37065,15.25,Humana Insurance Company,Medicare PPO,7.4725,49,,percent of total billed charges,,
SUTURE MAXON 0 6267-61,,A4649,HCPCS,Facility,Inpatient,,,,15.25,12.9625,4.37065,15.25,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
SUTURE MAXON 0 6267-61,,A4649,HCPCS,Facility,Both,,,,15.25,12.9625,4.37065,15.25,Medica,Individual & Family,15.11275,99.1,,percent of total billed charges,,
SUTURE MAXON 0 6267-61,,A4649,HCPCS,Facility,Outpatient,,,,15.25,12.9625,4.37065,15.25,Medica,Medica Advantage Solution,7.5945,49.8,,percent of total billed charges,,
SUTURE MAXON 0 6267-61,,A4649,HCPCS,Facility,Inpatient,,,,15.25,12.9625,4.37065,15.25,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
SUTURE MAXON 0 6267-61,,A4649,HCPCS,Facility,Outpatient,,,,15.25,12.9625,4.37065,15.25,Medica,Medical Assistance,6.8015,44.6,,percent of total billed charges,,
SUTURE MAXON 0 6267-61,,A4649,HCPCS,Facility,Inpatient,,,,15.25,12.9625,4.37065,15.25,Medica,Medical Assistance,,,,,Included in per diem rate,
SUTURE MAXON 0 6267-61,,A4649,HCPCS,Facility,Outpatient,,,,15.25,12.9625,4.37065,15.25,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,7.5945,49.8,,percent of total billed charges,,
SUTURE MAXON 0 6267-61,,A4649,HCPCS,Facility,Inpatient,,,,15.25,12.9625,4.37065,15.25,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
SUTURE MAXON 0 6267-61,,A4649,HCPCS,Facility,Both,,,,15.25,12.9625,4.37065,15.25,"Multiplan, Inc.","Multiplan, Inc.",14.335,94,,percent of total billed charges,,
SUTURE MAXON 0 6267-61,,A4649,HCPCS,Facility,Outpatient,,,,15.25,12.9625,4.37065,15.25,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,13.74025,90.1,,percent of total billed charges,,
SUTURE MAXON 0 6267-61,,A4649,HCPCS,Facility,Inpatient,,,,15.25,12.9625,4.37065,15.25,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
SUTURE MAXON 0 6267-61,,A4649,HCPCS,Facility,Both,,,,15.25,12.9625,4.37065,15.25,"Preferred One Administrative Services, INC.",PPO,15.0365,98.6,,percent of total billed charges,,
SUTURE MAXON 0 6267-61,,A4649,HCPCS,Facility,Outpatient,,,,15.25,12.9625,4.37065,15.25,PrimeWest Health,Minnesota Senior Health Options (MSHO),7.846125,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
SUTURE MAXON 0 6267-61,,A4649,HCPCS,Facility,Inpatient,,,,15.25,12.9625,4.37065,15.25,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE MAXON 0 6267-61,,A4649,HCPCS,Facility,Outpatient,,,,15.25,12.9625,4.37065,15.25,PrimeWest Health,MinnesotaCare,7.8324,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
SUTURE MAXON 0 6267-61,,A4649,HCPCS,Facility,Inpatient,,,,15.25,12.9625,4.37065,15.25,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
SUTURE MAXON 0 6267-61,,A4649,HCPCS,Facility,Both,,,,15.25,12.9625,4.37065,15.25,Sanford Health Plan,Sanford Health Plan,14.03,92,,percent of total billed charges,,
SUTURE MAXON 0 6267-61,,A4649,HCPCS,Facility,Outpatient,,,,15.25,12.9625,4.37065,15.25,"UCare Health, Inc.",Individual & Family Plan,8.593375,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
SUTURE MAXON 0 6267-61,,A4649,HCPCS,Facility,Inpatient,,,,15.25,12.9625,4.37065,15.25,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
SUTURE MAXON 0 6267-61,,A4649,HCPCS,Facility,Outpatient,,,,15.25,12.9625,4.37065,15.25,"UCare Health, Inc.",Medical Assistance,7.696675,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE MAXON 0 6267-61,,A4649,HCPCS,Facility,Inpatient,,,,15.25,12.9625,4.37065,15.25,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
SUTURE MAXON 0 6267-61,,A4649,HCPCS,Facility,Outpatient,,,,15.25,12.9625,4.37065,15.25,"UCare Health, Inc.",Medicare Advantage,7.696675,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE MAXON 0 6267-61,,A4649,HCPCS,Facility,Inpatient,,,,15.25,12.9625,4.37065,15.25,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE MAXON 0 6267-61,,A4649,HCPCS,Facility,Outpatient,,,,15.25,12.9625,4.37065,15.25,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),7.696675,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE MAXON 0 6267-61,,A4649,HCPCS,Facility,Inpatient,,,,15.25,12.9625,4.37065,15.25,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE MAXON 0 6267-61,,A4649,HCPCS,Facility,Both,,,,15.25,12.9625,4.37065,15.25,UnitedHealthcare,Individual & Family,14.335,94,,percent of total billed charges,,
SUTURE MAXON 0 6267-61,,A4649,HCPCS,Facility,Outpatient,,,,15.25,12.9625,4.37065,15.25,UnitedHealthcare,Medicare Advantage,7.4725,49,,percent of total billed charges,,
SUTURE MAXON 0 6267-61,,A4649,HCPCS,Facility,Inpatient,,,,15.25,12.9625,4.37065,15.25,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
SUTURE MAXON 0 6267-61,,A4649,HCPCS,Facility,Outpatient,,,,15.25,12.9625,4.37065,15.25,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,7.32,48,,percent of total billed charges,,100% of DHS outpatient percentage
SUTURE MAXON 0 6267-61,,A4649,HCPCS,Facility,Inpatient,,,,15.25,12.9625,4.37065,15.25,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
SUTURE MAXON 0 6456-61,,A4649,HCPCS,Facility,Both,,,,16.2,13.77,4.64292,16.2,Aetna,Commercial,14.904,92,,percent of total billed charges,,
SUTURE MAXON 0 6456-61,,A4649,HCPCS,Facility,Outpatient,,,,16.2,13.77,4.64292,16.2,Aetna,Medicare Advantage,7.938,49,,percent of total billed charges,,
SUTURE MAXON 0 6456-61,,A4649,HCPCS,Facility,Inpatient,,,,16.2,13.77,4.64292,16.2,Aetna,Medicare Advantage,,,,,Included in per diem rate,
SUTURE MAXON 0 6456-61,,A4649,HCPCS,Facility,Both,,,,16.2,13.77,4.64292,16.2,Aetna,PPO,15.066,93,,percent of total billed charges,,
SUTURE MAXON 0 6456-61,,A4649,HCPCS,Facility,Both,,,,16.2,13.77,4.64292,16.2,America's PPO,America's PPO,15.55686,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SUTURE MAXON 0 6456-61,,A4649,HCPCS,Facility,Both,,,,16.2,13.77,4.64292,16.2,BlueCross BlueShield Minnesota, Federal Employee Program,15.9408,98.4,,percent of total billed charges,,
SUTURE MAXON 0 6456-61,,A4649,HCPCS,Facility,Both,,,,16.2,13.77,4.64292,16.2,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,16.2,100,,percent of total billed charges,,
SUTURE MAXON 0 6456-61,,A4649,HCPCS,Facility,Both,,,,16.2,13.77,4.64292,16.2,BlueCross BlueShield Minnesota,High Value Network Plan,14.58,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
SUTURE MAXON 0 6456-61,,A4649,HCPCS,Facility,Outpatient,,,,16.2,13.77,4.64292,16.2,BlueCross BlueShield Minnesota,Medicare Advantage,7.938,49,,percent of total billed charges,,
SUTURE MAXON 0 6456-61,,A4649,HCPCS,Facility,Inpatient,,,,16.2,13.77,4.64292,16.2,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
SUTURE MAXON 0 6456-61,,A4649,HCPCS,Facility,Both,,,,16.2,13.77,4.64292,16.2,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,14.34834,88.57,,percent of total billed charges,,
SUTURE MAXON 0 6456-61,,A4649,HCPCS,Facility,Both,,,,16.2,13.77,4.64292,16.2,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,4.64292,28.66,,percent of total billed charges,,
SUTURE MAXON 0 6456-61,,A4649,HCPCS,Facility,Outpatient,,,,16.2,13.77,4.64292,16.2,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),7.938,49,,percent of total billed charges,,
SUTURE MAXON 0 6456-61,,A4649,HCPCS,Facility,Inpatient,,,,16.2,13.77,4.64292,16.2,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
SUTURE MAXON 0 6456-61,,A4649,HCPCS,Facility,Both,,,,16.2,13.77,4.64292,16.2,CorVel,Worker's Compensation,16.2,100,,percent of total billed charges,,
SUTURE MAXON 0 6456-61,,A4649,HCPCS,Facility,Both,,,,16.2,13.77,4.64292,16.2,First Health Group Corporation,First Health Network,15.714,97,,percent of total billed charges,,
SUTURE MAXON 0 6456-61,,A4649,HCPCS,Facility,Both,,,,16.2,13.77,4.64292,16.2,"Health Partners, Inc.",Commercial,15.3252,94.6,,percent of total billed charges,,
SUTURE MAXON 0 6456-61,,A4649,HCPCS,Facility,Outpatient,,,,16.2,13.77,4.64292,16.2,"Health Partners, Inc.",Medicare Advantage,7.938,49,,percent of total billed charges,,
SUTURE MAXON 0 6456-61,,A4649,HCPCS,Facility,Inpatient,,,,16.2,13.77,4.64292,16.2,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE MAXON 0 6456-61,,A4649,HCPCS,Facility,Both,,,,16.2,13.77,4.64292,16.2,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),9.72,60,,percent of total billed charges,,
SUTURE MAXON 0 6456-61,,A4649,HCPCS,Facility,Both,,,,16.2,13.77,4.64292,16.2,"Health Partners, Inc.",State of Minnesota Advantage Program,13.203,81.5,,percent of total billed charges,,
SUTURE MAXON 0 6456-61,,A4649,HCPCS,Facility,Both,,,,16.2,13.77,4.64292,16.2,"Health Partners, Inc.",State Public Programs,8.1,50,,percent of total billed charges,,
SUTURE MAXON 0 6456-61,,A4649,HCPCS,Facility,Both,,,,16.2,13.77,4.64292,16.2,Humana Insurance Company,Commercial PPO,15.39,95,,percent of total billed charges,,
SUTURE MAXON 0 6456-61,,A4649,HCPCS,Facility,Outpatient,,,,16.2,13.77,4.64292,16.2,Humana Insurance Company,Medicare PPO,7.938,49,,percent of total billed charges,,
SUTURE MAXON 0 6456-61,,A4649,HCPCS,Facility,Inpatient,,,,16.2,13.77,4.64292,16.2,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
SUTURE MAXON 0 6456-61,,A4649,HCPCS,Facility,Both,,,,16.2,13.77,4.64292,16.2,Medica,Individual & Family,16.0542,99.1,,percent of total billed charges,,
SUTURE MAXON 0 6456-61,,A4649,HCPCS,Facility,Outpatient,,,,16.2,13.77,4.64292,16.2,Medica,Medica Advantage Solution,8.0676,49.8,,percent of total billed charges,,
SUTURE MAXON 0 6456-61,,A4649,HCPCS,Facility,Inpatient,,,,16.2,13.77,4.64292,16.2,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
SUTURE MAXON 0 6456-61,,A4649,HCPCS,Facility,Outpatient,,,,16.2,13.77,4.64292,16.2,Medica,Medical Assistance,7.2252,44.6,,percent of total billed charges,,
SUTURE MAXON 0 6456-61,,A4649,HCPCS,Facility,Inpatient,,,,16.2,13.77,4.64292,16.2,Medica,Medical Assistance,,,,,Included in per diem rate,
SUTURE MAXON 0 6456-61,,A4649,HCPCS,Facility,Outpatient,,,,16.2,13.77,4.64292,16.2,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,8.0676,49.8,,percent of total billed charges,,
SUTURE MAXON 0 6456-61,,A4649,HCPCS,Facility,Inpatient,,,,16.2,13.77,4.64292,16.2,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
SUTURE MAXON 0 6456-61,,A4649,HCPCS,Facility,Both,,,,16.2,13.77,4.64292,16.2,"Multiplan, Inc.","Multiplan, Inc.",15.228,94,,percent of total billed charges,,
SUTURE MAXON 0 6456-61,,A4649,HCPCS,Facility,Outpatient,,,,16.2,13.77,4.64292,16.2,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,14.5962,90.1,,percent of total billed charges,,
SUTURE MAXON 0 6456-61,,A4649,HCPCS,Facility,Inpatient,,,,16.2,13.77,4.64292,16.2,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
SUTURE MAXON 0 6456-61,,A4649,HCPCS,Facility,Both,,,,16.2,13.77,4.64292,16.2,"Preferred One Administrative Services, INC.",PPO,15.9732,98.6,,percent of total billed charges,,
SUTURE MAXON 0 6456-61,,A4649,HCPCS,Facility,Outpatient,,,,16.2,13.77,4.64292,16.2,PrimeWest Health,Minnesota Senior Health Options (MSHO),8.3349,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
SUTURE MAXON 0 6456-61,,A4649,HCPCS,Facility,Inpatient,,,,16.2,13.77,4.64292,16.2,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE MAXON 0 6456-61,,A4649,HCPCS,Facility,Outpatient,,,,16.2,13.77,4.64292,16.2,PrimeWest Health,MinnesotaCare,8.32032,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
SUTURE MAXON 0 6456-61,,A4649,HCPCS,Facility,Inpatient,,,,16.2,13.77,4.64292,16.2,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
SUTURE MAXON 0 6456-61,,A4649,HCPCS,Facility,Both,,,,16.2,13.77,4.64292,16.2,Sanford Health Plan,Sanford Health Plan,14.904,92,,percent of total billed charges,,
SUTURE MAXON 0 6456-61,,A4649,HCPCS,Facility,Outpatient,,,,16.2,13.77,4.64292,16.2,"UCare Health, Inc.",Individual & Family Plan,9.1287,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
SUTURE MAXON 0 6456-61,,A4649,HCPCS,Facility,Inpatient,,,,16.2,13.77,4.64292,16.2,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
SUTURE MAXON 0 6456-61,,A4649,HCPCS,Facility,Outpatient,,,,16.2,13.77,4.64292,16.2,"UCare Health, Inc.",Medical Assistance,8.17614,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE MAXON 0 6456-61,,A4649,HCPCS,Facility,Inpatient,,,,16.2,13.77,4.64292,16.2,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
SUTURE MAXON 0 6456-61,,A4649,HCPCS,Facility,Outpatient,,,,16.2,13.77,4.64292,16.2,"UCare Health, Inc.",Medicare Advantage,8.17614,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE MAXON 0 6456-61,,A4649,HCPCS,Facility,Inpatient,,,,16.2,13.77,4.64292,16.2,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE MAXON 0 6456-61,,A4649,HCPCS,Facility,Outpatient,,,,16.2,13.77,4.64292,16.2,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),8.17614,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE MAXON 0 6456-61,,A4649,HCPCS,Facility,Inpatient,,,,16.2,13.77,4.64292,16.2,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE MAXON 0 6456-61,,A4649,HCPCS,Facility,Both,,,,16.2,13.77,4.64292,16.2,UnitedHealthcare,Individual & Family,15.228,94,,percent of total billed charges,,
SUTURE MAXON 0 6456-61,,A4649,HCPCS,Facility,Outpatient,,,,16.2,13.77,4.64292,16.2,UnitedHealthcare,Medicare Advantage,7.938,49,,percent of total billed charges,,
SUTURE MAXON 0 6456-61,,A4649,HCPCS,Facility,Inpatient,,,,16.2,13.77,4.64292,16.2,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
SUTURE MAXON 0 6456-61,,A4649,HCPCS,Facility,Outpatient,,,,16.2,13.77,4.64292,16.2,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,7.776,48,,percent of total billed charges,,100% of DHS outpatient percentage
SUTURE MAXON 0 6456-61,,A4649,HCPCS,Facility,Inpatient,,,,16.2,13.77,4.64292,16.2,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
SUTURE MAXON 0 DETACH 6275-63,,A4649,HCPCS,Facility,Both,,,,62.37,53.0145,17.875242,62.37,Aetna,Commercial,57.3804,92,,percent of total billed charges,,
SUTURE MAXON 0 DETACH 6275-63,,A4649,HCPCS,Facility,Outpatient,,,,62.37,53.0145,17.875242,62.37,Aetna,Medicare Advantage,30.5613,49,,percent of total billed charges,,
SUTURE MAXON 0 DETACH 6275-63,,A4649,HCPCS,Facility,Inpatient,,,,62.37,53.0145,17.875242,62.37,Aetna,Medicare Advantage,,,,,Included in per diem rate,
SUTURE MAXON 0 DETACH 6275-63,,A4649,HCPCS,Facility,Both,,,,62.37,53.0145,17.875242,62.37,Aetna,PPO,58.0041,93,,percent of total billed charges,,
SUTURE MAXON 0 DETACH 6275-63,,A4649,HCPCS,Facility,Both,,,,62.37,53.0145,17.875242,62.37,America's PPO,America's PPO,59.893911,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SUTURE MAXON 0 DETACH 6275-63,,A4649,HCPCS,Facility,Both,,,,62.37,53.0145,17.875242,62.37,BlueCross BlueShield Minnesota, Federal Employee Program,61.37208,98.4,,percent of total billed charges,,
SUTURE MAXON 0 DETACH 6275-63,,A4649,HCPCS,Facility,Both,,,,62.37,53.0145,17.875242,62.37,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,62.37,100,,percent of total billed charges,,
SUTURE MAXON 0 DETACH 6275-63,,A4649,HCPCS,Facility,Both,,,,62.37,53.0145,17.875242,62.37,BlueCross BlueShield Minnesota,High Value Network Plan,56.133,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
SUTURE MAXON 0 DETACH 6275-63,,A4649,HCPCS,Facility,Outpatient,,,,62.37,53.0145,17.875242,62.37,BlueCross BlueShield Minnesota,Medicare Advantage,30.5613,49,,percent of total billed charges,,
SUTURE MAXON 0 DETACH 6275-63,,A4649,HCPCS,Facility,Inpatient,,,,62.37,53.0145,17.875242,62.37,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
SUTURE MAXON 0 DETACH 6275-63,,A4649,HCPCS,Facility,Both,,,,62.37,53.0145,17.875242,62.37,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,55.241109,88.57,,percent of total billed charges,,
SUTURE MAXON 0 DETACH 6275-63,,A4649,HCPCS,Facility,Both,,,,62.37,53.0145,17.875242,62.37,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,17.875242,28.66,,percent of total billed charges,,
SUTURE MAXON 0 DETACH 6275-63,,A4649,HCPCS,Facility,Outpatient,,,,62.37,53.0145,17.875242,62.37,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),30.5613,49,,percent of total billed charges,,
SUTURE MAXON 0 DETACH 6275-63,,A4649,HCPCS,Facility,Inpatient,,,,62.37,53.0145,17.875242,62.37,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
SUTURE MAXON 0 DETACH 6275-63,,A4649,HCPCS,Facility,Both,,,,62.37,53.0145,17.875242,62.37,CorVel,Worker's Compensation,62.37,100,,percent of total billed charges,,
SUTURE MAXON 0 DETACH 6275-63,,A4649,HCPCS,Facility,Both,,,,62.37,53.0145,17.875242,62.37,First Health Group Corporation,First Health Network,60.4989,97,,percent of total billed charges,,
SUTURE MAXON 0 DETACH 6275-63,,A4649,HCPCS,Facility,Both,,,,62.37,53.0145,17.875242,62.37,"Health Partners, Inc.",Commercial,59.00202,94.6,,percent of total billed charges,,
SUTURE MAXON 0 DETACH 6275-63,,A4649,HCPCS,Facility,Outpatient,,,,62.37,53.0145,17.875242,62.37,"Health Partners, Inc.",Medicare Advantage,30.5613,49,,percent of total billed charges,,
SUTURE MAXON 0 DETACH 6275-63,,A4649,HCPCS,Facility,Inpatient,,,,62.37,53.0145,17.875242,62.37,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE MAXON 0 DETACH 6275-63,,A4649,HCPCS,Facility,Both,,,,62.37,53.0145,17.875242,62.37,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),37.422,60,,percent of total billed charges,,
SUTURE MAXON 0 DETACH 6275-63,,A4649,HCPCS,Facility,Both,,,,62.37,53.0145,17.875242,62.37,"Health Partners, Inc.",State of Minnesota Advantage Program,50.83155,81.5,,percent of total billed charges,,
SUTURE MAXON 0 DETACH 6275-63,,A4649,HCPCS,Facility,Both,,,,62.37,53.0145,17.875242,62.37,"Health Partners, Inc.",State Public Programs,31.185,50,,percent of total billed charges,,
SUTURE MAXON 0 DETACH 6275-63,,A4649,HCPCS,Facility,Both,,,,62.37,53.0145,17.875242,62.37,Humana Insurance Company,Commercial PPO,59.2515,95,,percent of total billed charges,,
SUTURE MAXON 0 DETACH 6275-63,,A4649,HCPCS,Facility,Outpatient,,,,62.37,53.0145,17.875242,62.37,Humana Insurance Company,Medicare PPO,30.5613,49,,percent of total billed charges,,
SUTURE MAXON 0 DETACH 6275-63,,A4649,HCPCS,Facility,Inpatient,,,,62.37,53.0145,17.875242,62.37,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
SUTURE MAXON 0 DETACH 6275-63,,A4649,HCPCS,Facility,Both,,,,62.37,53.0145,17.875242,62.37,Medica,Individual & Family,61.80867,99.1,,percent of total billed charges,,
SUTURE MAXON 0 DETACH 6275-63,,A4649,HCPCS,Facility,Outpatient,,,,62.37,53.0145,17.875242,62.37,Medica,Medica Advantage Solution,31.06026,49.8,,percent of total billed charges,,
SUTURE MAXON 0 DETACH 6275-63,,A4649,HCPCS,Facility,Inpatient,,,,62.37,53.0145,17.875242,62.37,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
SUTURE MAXON 0 DETACH 6275-63,,A4649,HCPCS,Facility,Outpatient,,,,62.37,53.0145,17.875242,62.37,Medica,Medical Assistance,27.81702,44.6,,percent of total billed charges,,
SUTURE MAXON 0 DETACH 6275-63,,A4649,HCPCS,Facility,Inpatient,,,,62.37,53.0145,17.875242,62.37,Medica,Medical Assistance,,,,,Included in per diem rate,
SUTURE MAXON 0 DETACH 6275-63,,A4649,HCPCS,Facility,Outpatient,,,,62.37,53.0145,17.875242,62.37,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,31.06026,49.8,,percent of total billed charges,,
SUTURE MAXON 0 DETACH 6275-63,,A4649,HCPCS,Facility,Inpatient,,,,62.37,53.0145,17.875242,62.37,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
SUTURE MAXON 0 DETACH 6275-63,,A4649,HCPCS,Facility,Both,,,,62.37,53.0145,17.875242,62.37,"Multiplan, Inc.","Multiplan, Inc.",58.6278,94,,percent of total billed charges,,
SUTURE MAXON 0 DETACH 6275-63,,A4649,HCPCS,Facility,Outpatient,,,,62.37,53.0145,17.875242,62.37,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,56.19537,90.1,,percent of total billed charges,,
SUTURE MAXON 0 DETACH 6275-63,,A4649,HCPCS,Facility,Inpatient,,,,62.37,53.0145,17.875242,62.37,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
SUTURE MAXON 0 DETACH 6275-63,,A4649,HCPCS,Facility,Both,,,,62.37,53.0145,17.875242,62.37,"Preferred One Administrative Services, INC.",PPO,61.49682,98.6,,percent of total billed charges,,
SUTURE MAXON 0 DETACH 6275-63,,A4649,HCPCS,Facility,Outpatient,,,,62.37,53.0145,17.875242,62.37,PrimeWest Health,Minnesota Senior Health Options (MSHO),32.089365,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
SUTURE MAXON 0 DETACH 6275-63,,A4649,HCPCS,Facility,Inpatient,,,,62.37,53.0145,17.875242,62.37,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE MAXON 0 DETACH 6275-63,,A4649,HCPCS,Facility,Outpatient,,,,62.37,53.0145,17.875242,62.37,PrimeWest Health,MinnesotaCare,32.033232,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
SUTURE MAXON 0 DETACH 6275-63,,A4649,HCPCS,Facility,Inpatient,,,,62.37,53.0145,17.875242,62.37,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
SUTURE MAXON 0 DETACH 6275-63,,A4649,HCPCS,Facility,Both,,,,62.37,53.0145,17.875242,62.37,Sanford Health Plan,Sanford Health Plan,57.3804,92,,percent of total billed charges,,
SUTURE MAXON 0 DETACH 6275-63,,A4649,HCPCS,Facility,Outpatient,,,,62.37,53.0145,17.875242,62.37,"UCare Health, Inc.",Individual & Family Plan,35.145495,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
SUTURE MAXON 0 DETACH 6275-63,,A4649,HCPCS,Facility,Inpatient,,,,62.37,53.0145,17.875242,62.37,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
SUTURE MAXON 0 DETACH 6275-63,,A4649,HCPCS,Facility,Outpatient,,,,62.37,53.0145,17.875242,62.37,"UCare Health, Inc.",Medical Assistance,31.478139,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE MAXON 0 DETACH 6275-63,,A4649,HCPCS,Facility,Inpatient,,,,62.37,53.0145,17.875242,62.37,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
SUTURE MAXON 0 DETACH 6275-63,,A4649,HCPCS,Facility,Outpatient,,,,62.37,53.0145,17.875242,62.37,"UCare Health, Inc.",Medicare Advantage,31.478139,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE MAXON 0 DETACH 6275-63,,A4649,HCPCS,Facility,Inpatient,,,,62.37,53.0145,17.875242,62.37,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE MAXON 0 DETACH 6275-63,,A4649,HCPCS,Facility,Outpatient,,,,62.37,53.0145,17.875242,62.37,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),31.478139,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE MAXON 0 DETACH 6275-63,,A4649,HCPCS,Facility,Inpatient,,,,62.37,53.0145,17.875242,62.37,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE MAXON 0 DETACH 6275-63,,A4649,HCPCS,Facility,Both,,,,62.37,53.0145,17.875242,62.37,UnitedHealthcare,Individual & Family,58.6278,94,,percent of total billed charges,,
SUTURE MAXON 0 DETACH 6275-63,,A4649,HCPCS,Facility,Outpatient,,,,62.37,53.0145,17.875242,62.37,UnitedHealthcare,Medicare Advantage,30.5613,49,,percent of total billed charges,,
SUTURE MAXON 0 DETACH 6275-63,,A4649,HCPCS,Facility,Inpatient,,,,62.37,53.0145,17.875242,62.37,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
SUTURE MAXON 0 DETACH 6275-63,,A4649,HCPCS,Facility,Outpatient,,,,62.37,53.0145,17.875242,62.37,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,29.9376,48,,percent of total billed charges,,100% of DHS outpatient percentage
SUTURE MAXON 0 DETACH 6275-63,,A4649,HCPCS,Facility,Inpatient,,,,62.37,53.0145,17.875242,62.37,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
SUTURE MAXON 2-0 DETACH 6245-51,,A4649,HCPCS,Facility,Both,,,,13.55,11.5175,3.88343,13.55,Aetna,Commercial,12.466,92,,percent of total billed charges,,
SUTURE MAXON 2-0 DETACH 6245-51,,A4649,HCPCS,Facility,Outpatient,,,,13.55,11.5175,3.88343,13.55,Aetna,Medicare Advantage,6.6395,49,,percent of total billed charges,,
SUTURE MAXON 2-0 DETACH 6245-51,,A4649,HCPCS,Facility,Inpatient,,,,13.55,11.5175,3.88343,13.55,Aetna,Medicare Advantage,,,,,Included in per diem rate,
SUTURE MAXON 2-0 DETACH 6245-51,,A4649,HCPCS,Facility,Both,,,,13.55,11.5175,3.88343,13.55,Aetna,PPO,12.6015,93,,percent of total billed charges,,
SUTURE MAXON 2-0 DETACH 6245-51,,A4649,HCPCS,Facility,Both,,,,13.55,11.5175,3.88343,13.55,America's PPO,America's PPO,13.012065,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SUTURE MAXON 2-0 DETACH 6245-51,,A4649,HCPCS,Facility,Both,,,,13.55,11.5175,3.88343,13.55,BlueCross BlueShield Minnesota, Federal Employee Program,13.3332,98.4,,percent of total billed charges,,
SUTURE MAXON 2-0 DETACH 6245-51,,A4649,HCPCS,Facility,Both,,,,13.55,11.5175,3.88343,13.55,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,13.55,100,,percent of total billed charges,,
SUTURE MAXON 2-0 DETACH 6245-51,,A4649,HCPCS,Facility,Both,,,,13.55,11.5175,3.88343,13.55,BlueCross BlueShield Minnesota,High Value Network Plan,12.195,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
SUTURE MAXON 2-0 DETACH 6245-51,,A4649,HCPCS,Facility,Outpatient,,,,13.55,11.5175,3.88343,13.55,BlueCross BlueShield Minnesota,Medicare Advantage,6.6395,49,,percent of total billed charges,,
SUTURE MAXON 2-0 DETACH 6245-51,,A4649,HCPCS,Facility,Inpatient,,,,13.55,11.5175,3.88343,13.55,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
SUTURE MAXON 2-0 DETACH 6245-51,,A4649,HCPCS,Facility,Both,,,,13.55,11.5175,3.88343,13.55,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,12.001235,88.57,,percent of total billed charges,,
SUTURE MAXON 2-0 DETACH 6245-51,,A4649,HCPCS,Facility,Both,,,,13.55,11.5175,3.88343,13.55,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,3.88343,28.66,,percent of total billed charges,,
SUTURE MAXON 2-0 DETACH 6245-51,,A4649,HCPCS,Facility,Outpatient,,,,13.55,11.5175,3.88343,13.55,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),6.6395,49,,percent of total billed charges,,
SUTURE MAXON 2-0 DETACH 6245-51,,A4649,HCPCS,Facility,Inpatient,,,,13.55,11.5175,3.88343,13.55,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
SUTURE MAXON 2-0 DETACH 6245-51,,A4649,HCPCS,Facility,Both,,,,13.55,11.5175,3.88343,13.55,CorVel,Worker's Compensation,13.55,100,,percent of total billed charges,,
SUTURE MAXON 2-0 DETACH 6245-51,,A4649,HCPCS,Facility,Both,,,,13.55,11.5175,3.88343,13.55,First Health Group Corporation,First Health Network,13.1435,97,,percent of total billed charges,,
SUTURE MAXON 2-0 DETACH 6245-51,,A4649,HCPCS,Facility,Both,,,,13.55,11.5175,3.88343,13.55,"Health Partners, Inc.",Commercial,12.8183,94.6,,percent of total billed charges,,
SUTURE MAXON 2-0 DETACH 6245-51,,A4649,HCPCS,Facility,Outpatient,,,,13.55,11.5175,3.88343,13.55,"Health Partners, Inc.",Medicare Advantage,6.6395,49,,percent of total billed charges,,
SUTURE MAXON 2-0 DETACH 6245-51,,A4649,HCPCS,Facility,Inpatient,,,,13.55,11.5175,3.88343,13.55,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE MAXON 2-0 DETACH 6245-51,,A4649,HCPCS,Facility,Both,,,,13.55,11.5175,3.88343,13.55,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),8.13,60,,percent of total billed charges,,
SUTURE MAXON 2-0 DETACH 6245-51,,A4649,HCPCS,Facility,Both,,,,13.55,11.5175,3.88343,13.55,"Health Partners, Inc.",State of Minnesota Advantage Program,11.04325,81.5,,percent of total billed charges,,
SUTURE MAXON 2-0 DETACH 6245-51,,A4649,HCPCS,Facility,Both,,,,13.55,11.5175,3.88343,13.55,"Health Partners, Inc.",State Public Programs,6.775,50,,percent of total billed charges,,
SUTURE MAXON 2-0 DETACH 6245-51,,A4649,HCPCS,Facility,Both,,,,13.55,11.5175,3.88343,13.55,Humana Insurance Company,Commercial PPO,12.8725,95,,percent of total billed charges,,
SUTURE MAXON 2-0 DETACH 6245-51,,A4649,HCPCS,Facility,Outpatient,,,,13.55,11.5175,3.88343,13.55,Humana Insurance Company,Medicare PPO,6.6395,49,,percent of total billed charges,,
SUTURE MAXON 2-0 DETACH 6245-51,,A4649,HCPCS,Facility,Inpatient,,,,13.55,11.5175,3.88343,13.55,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
SUTURE MAXON 2-0 DETACH 6245-51,,A4649,HCPCS,Facility,Both,,,,13.55,11.5175,3.88343,13.55,Medica,Individual & Family,13.42805,99.1,,percent of total billed charges,,
SUTURE MAXON 2-0 DETACH 6245-51,,A4649,HCPCS,Facility,Outpatient,,,,13.55,11.5175,3.88343,13.55,Medica,Medica Advantage Solution,6.7479,49.8,,percent of total billed charges,,
SUTURE MAXON 2-0 DETACH 6245-51,,A4649,HCPCS,Facility,Inpatient,,,,13.55,11.5175,3.88343,13.55,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
SUTURE MAXON 2-0 DETACH 6245-51,,A4649,HCPCS,Facility,Outpatient,,,,13.55,11.5175,3.88343,13.55,Medica,Medical Assistance,6.0433,44.6,,percent of total billed charges,,
SUTURE MAXON 2-0 DETACH 6245-51,,A4649,HCPCS,Facility,Inpatient,,,,13.55,11.5175,3.88343,13.55,Medica,Medical Assistance,,,,,Included in per diem rate,
SUTURE MAXON 2-0 DETACH 6245-51,,A4649,HCPCS,Facility,Outpatient,,,,13.55,11.5175,3.88343,13.55,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,6.7479,49.8,,percent of total billed charges,,
SUTURE MAXON 2-0 DETACH 6245-51,,A4649,HCPCS,Facility,Inpatient,,,,13.55,11.5175,3.88343,13.55,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
SUTURE MAXON 2-0 DETACH 6245-51,,A4649,HCPCS,Facility,Both,,,,13.55,11.5175,3.88343,13.55,"Multiplan, Inc.","Multiplan, Inc.",12.737,94,,percent of total billed charges,,
SUTURE MAXON 2-0 DETACH 6245-51,,A4649,HCPCS,Facility,Outpatient,,,,13.55,11.5175,3.88343,13.55,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,12.20855,90.1,,percent of total billed charges,,
SUTURE MAXON 2-0 DETACH 6245-51,,A4649,HCPCS,Facility,Inpatient,,,,13.55,11.5175,3.88343,13.55,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
SUTURE MAXON 2-0 DETACH 6245-51,,A4649,HCPCS,Facility,Both,,,,13.55,11.5175,3.88343,13.55,"Preferred One Administrative Services, INC.",PPO,13.3603,98.6,,percent of total billed charges,,
SUTURE MAXON 2-0 DETACH 6245-51,,A4649,HCPCS,Facility,Outpatient,,,,13.55,11.5175,3.88343,13.55,PrimeWest Health,Minnesota Senior Health Options (MSHO),6.971475,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
SUTURE MAXON 2-0 DETACH 6245-51,,A4649,HCPCS,Facility,Inpatient,,,,13.55,11.5175,3.88343,13.55,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE MAXON 2-0 DETACH 6245-51,,A4649,HCPCS,Facility,Outpatient,,,,13.55,11.5175,3.88343,13.55,PrimeWest Health,MinnesotaCare,6.95928,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
SUTURE MAXON 2-0 DETACH 6245-51,,A4649,HCPCS,Facility,Inpatient,,,,13.55,11.5175,3.88343,13.55,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
SUTURE MAXON 2-0 DETACH 6245-51,,A4649,HCPCS,Facility,Both,,,,13.55,11.5175,3.88343,13.55,Sanford Health Plan,Sanford Health Plan,12.466,92,,percent of total billed charges,,
SUTURE MAXON 2-0 DETACH 6245-51,,A4649,HCPCS,Facility,Outpatient,,,,13.55,11.5175,3.88343,13.55,"UCare Health, Inc.",Individual & Family Plan,7.635425,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
SUTURE MAXON 2-0 DETACH 6245-51,,A4649,HCPCS,Facility,Inpatient,,,,13.55,11.5175,3.88343,13.55,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
SUTURE MAXON 2-0 DETACH 6245-51,,A4649,HCPCS,Facility,Outpatient,,,,13.55,11.5175,3.88343,13.55,"UCare Health, Inc.",Medical Assistance,6.838685,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE MAXON 2-0 DETACH 6245-51,,A4649,HCPCS,Facility,Inpatient,,,,13.55,11.5175,3.88343,13.55,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
SUTURE MAXON 2-0 DETACH 6245-51,,A4649,HCPCS,Facility,Outpatient,,,,13.55,11.5175,3.88343,13.55,"UCare Health, Inc.",Medicare Advantage,6.838685,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE MAXON 2-0 DETACH 6245-51,,A4649,HCPCS,Facility,Inpatient,,,,13.55,11.5175,3.88343,13.55,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE MAXON 2-0 DETACH 6245-51,,A4649,HCPCS,Facility,Outpatient,,,,13.55,11.5175,3.88343,13.55,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),6.838685,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE MAXON 2-0 DETACH 6245-51,,A4649,HCPCS,Facility,Inpatient,,,,13.55,11.5175,3.88343,13.55,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE MAXON 2-0 DETACH 6245-51,,A4649,HCPCS,Facility,Both,,,,13.55,11.5175,3.88343,13.55,UnitedHealthcare,Individual & Family,12.737,94,,percent of total billed charges,,
SUTURE MAXON 2-0 DETACH 6245-51,,A4649,HCPCS,Facility,Outpatient,,,,13.55,11.5175,3.88343,13.55,UnitedHealthcare,Medicare Advantage,6.6395,49,,percent of total billed charges,,
SUTURE MAXON 2-0 DETACH 6245-51,,A4649,HCPCS,Facility,Inpatient,,,,13.55,11.5175,3.88343,13.55,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
SUTURE MAXON 2-0 DETACH 6245-51,,A4649,HCPCS,Facility,Outpatient,,,,13.55,11.5175,3.88343,13.55,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,6.504,48,,percent of total billed charges,,100% of DHS outpatient percentage
SUTURE MAXON 2-0 DETACH 6245-51,,A4649,HCPCS,Facility,Inpatient,,,,13.55,11.5175,3.88343,13.55,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
SUTURE MAXON 2-0 DETACH 6247-53,,A4649,HCPCS,Facility,Both,,,,47.61,40.4685,13.645026,47.61,Aetna,Commercial,43.8012,92,,percent of total billed charges,,
SUTURE MAXON 2-0 DETACH 6247-53,,A4649,HCPCS,Facility,Outpatient,,,,47.61,40.4685,13.645026,47.61,Aetna,Medicare Advantage,23.3289,49,,percent of total billed charges,,
SUTURE MAXON 2-0 DETACH 6247-53,,A4649,HCPCS,Facility,Inpatient,,,,47.61,40.4685,13.645026,47.61,Aetna,Medicare Advantage,,,,,Included in per diem rate,
SUTURE MAXON 2-0 DETACH 6247-53,,A4649,HCPCS,Facility,Both,,,,47.61,40.4685,13.645026,47.61,Aetna,PPO,44.2773,93,,percent of total billed charges,,
SUTURE MAXON 2-0 DETACH 6247-53,,A4649,HCPCS,Facility,Both,,,,47.61,40.4685,13.645026,47.61,America's PPO,America's PPO,45.719883,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SUTURE MAXON 2-0 DETACH 6247-53,,A4649,HCPCS,Facility,Both,,,,47.61,40.4685,13.645026,47.61,BlueCross BlueShield Minnesota, Federal Employee Program,46.84824,98.4,,percent of total billed charges,,
SUTURE MAXON 2-0 DETACH 6247-53,,A4649,HCPCS,Facility,Both,,,,47.61,40.4685,13.645026,47.61,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,47.61,100,,percent of total billed charges,,
SUTURE MAXON 2-0 DETACH 6247-53,,A4649,HCPCS,Facility,Both,,,,47.61,40.4685,13.645026,47.61,BlueCross BlueShield Minnesota,High Value Network Plan,42.849,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
SUTURE MAXON 2-0 DETACH 6247-53,,A4649,HCPCS,Facility,Outpatient,,,,47.61,40.4685,13.645026,47.61,BlueCross BlueShield Minnesota,Medicare Advantage,23.3289,49,,percent of total billed charges,,
SUTURE MAXON 2-0 DETACH 6247-53,,A4649,HCPCS,Facility,Inpatient,,,,47.61,40.4685,13.645026,47.61,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
SUTURE MAXON 2-0 DETACH 6247-53,,A4649,HCPCS,Facility,Both,,,,47.61,40.4685,13.645026,47.61,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,42.168177,88.57,,percent of total billed charges,,
SUTURE MAXON 2-0 DETACH 6247-53,,A4649,HCPCS,Facility,Both,,,,47.61,40.4685,13.645026,47.61,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,13.645026,28.66,,percent of total billed charges,,
SUTURE MAXON 2-0 DETACH 6247-53,,A4649,HCPCS,Facility,Outpatient,,,,47.61,40.4685,13.645026,47.61,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),23.3289,49,,percent of total billed charges,,
SUTURE MAXON 2-0 DETACH 6247-53,,A4649,HCPCS,Facility,Inpatient,,,,47.61,40.4685,13.645026,47.61,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
SUTURE MAXON 2-0 DETACH 6247-53,,A4649,HCPCS,Facility,Both,,,,47.61,40.4685,13.645026,47.61,CorVel,Worker's Compensation,47.61,100,,percent of total billed charges,,
SUTURE MAXON 2-0 DETACH 6247-53,,A4649,HCPCS,Facility,Both,,,,47.61,40.4685,13.645026,47.61,First Health Group Corporation,First Health Network,46.1817,97,,percent of total billed charges,,
SUTURE MAXON 2-0 DETACH 6247-53,,A4649,HCPCS,Facility,Both,,,,47.61,40.4685,13.645026,47.61,"Health Partners, Inc.",Commercial,45.03906,94.6,,percent of total billed charges,,
SUTURE MAXON 2-0 DETACH 6247-53,,A4649,HCPCS,Facility,Outpatient,,,,47.61,40.4685,13.645026,47.61,"Health Partners, Inc.",Medicare Advantage,23.3289,49,,percent of total billed charges,,
SUTURE MAXON 2-0 DETACH 6247-53,,A4649,HCPCS,Facility,Inpatient,,,,47.61,40.4685,13.645026,47.61,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE MAXON 2-0 DETACH 6247-53,,A4649,HCPCS,Facility,Both,,,,47.61,40.4685,13.645026,47.61,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),28.566,60,,percent of total billed charges,,
SUTURE MAXON 2-0 DETACH 6247-53,,A4649,HCPCS,Facility,Both,,,,47.61,40.4685,13.645026,47.61,"Health Partners, Inc.",State of Minnesota Advantage Program,38.80215,81.5,,percent of total billed charges,,
SUTURE MAXON 2-0 DETACH 6247-53,,A4649,HCPCS,Facility,Both,,,,47.61,40.4685,13.645026,47.61,"Health Partners, Inc.",State Public Programs,23.805,50,,percent of total billed charges,,
SUTURE MAXON 2-0 DETACH 6247-53,,A4649,HCPCS,Facility,Both,,,,47.61,40.4685,13.645026,47.61,Humana Insurance Company,Commercial PPO,45.2295,95,,percent of total billed charges,,
SUTURE MAXON 2-0 DETACH 6247-53,,A4649,HCPCS,Facility,Outpatient,,,,47.61,40.4685,13.645026,47.61,Humana Insurance Company,Medicare PPO,23.3289,49,,percent of total billed charges,,
SUTURE MAXON 2-0 DETACH 6247-53,,A4649,HCPCS,Facility,Inpatient,,,,47.61,40.4685,13.645026,47.61,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
SUTURE MAXON 2-0 DETACH 6247-53,,A4649,HCPCS,Facility,Both,,,,47.61,40.4685,13.645026,47.61,Medica,Individual & Family,47.18151,99.1,,percent of total billed charges,,
SUTURE MAXON 2-0 DETACH 6247-53,,A4649,HCPCS,Facility,Outpatient,,,,47.61,40.4685,13.645026,47.61,Medica,Medica Advantage Solution,23.70978,49.8,,percent of total billed charges,,
SUTURE MAXON 2-0 DETACH 6247-53,,A4649,HCPCS,Facility,Inpatient,,,,47.61,40.4685,13.645026,47.61,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
SUTURE MAXON 2-0 DETACH 6247-53,,A4649,HCPCS,Facility,Outpatient,,,,47.61,40.4685,13.645026,47.61,Medica,Medical Assistance,21.23406,44.6,,percent of total billed charges,,
SUTURE MAXON 2-0 DETACH 6247-53,,A4649,HCPCS,Facility,Inpatient,,,,47.61,40.4685,13.645026,47.61,Medica,Medical Assistance,,,,,Included in per diem rate,
SUTURE MAXON 2-0 DETACH 6247-53,,A4649,HCPCS,Facility,Outpatient,,,,47.61,40.4685,13.645026,47.61,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,23.70978,49.8,,percent of total billed charges,,
SUTURE MAXON 2-0 DETACH 6247-53,,A4649,HCPCS,Facility,Inpatient,,,,47.61,40.4685,13.645026,47.61,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
SUTURE MAXON 2-0 DETACH 6247-53,,A4649,HCPCS,Facility,Both,,,,47.61,40.4685,13.645026,47.61,"Multiplan, Inc.","Multiplan, Inc.",44.7534,94,,percent of total billed charges,,
SUTURE MAXON 2-0 DETACH 6247-53,,A4649,HCPCS,Facility,Outpatient,,,,47.61,40.4685,13.645026,47.61,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,42.89661,90.1,,percent of total billed charges,,
SUTURE MAXON 2-0 DETACH 6247-53,,A4649,HCPCS,Facility,Inpatient,,,,47.61,40.4685,13.645026,47.61,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
SUTURE MAXON 2-0 DETACH 6247-53,,A4649,HCPCS,Facility,Both,,,,47.61,40.4685,13.645026,47.61,"Preferred One Administrative Services, INC.",PPO,46.94346,98.6,,percent of total billed charges,,
SUTURE MAXON 2-0 DETACH 6247-53,,A4649,HCPCS,Facility,Outpatient,,,,47.61,40.4685,13.645026,47.61,PrimeWest Health,Minnesota Senior Health Options (MSHO),24.495345,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
SUTURE MAXON 2-0 DETACH 6247-53,,A4649,HCPCS,Facility,Inpatient,,,,47.61,40.4685,13.645026,47.61,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE MAXON 2-0 DETACH 6247-53,,A4649,HCPCS,Facility,Outpatient,,,,47.61,40.4685,13.645026,47.61,PrimeWest Health,MinnesotaCare,24.452496,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
SUTURE MAXON 2-0 DETACH 6247-53,,A4649,HCPCS,Facility,Inpatient,,,,47.61,40.4685,13.645026,47.61,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
SUTURE MAXON 2-0 DETACH 6247-53,,A4649,HCPCS,Facility,Both,,,,47.61,40.4685,13.645026,47.61,Sanford Health Plan,Sanford Health Plan,43.8012,92,,percent of total billed charges,,
SUTURE MAXON 2-0 DETACH 6247-53,,A4649,HCPCS,Facility,Outpatient,,,,47.61,40.4685,13.645026,47.61,"UCare Health, Inc.",Individual & Family Plan,26.828235,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
SUTURE MAXON 2-0 DETACH 6247-53,,A4649,HCPCS,Facility,Inpatient,,,,47.61,40.4685,13.645026,47.61,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
SUTURE MAXON 2-0 DETACH 6247-53,,A4649,HCPCS,Facility,Outpatient,,,,47.61,40.4685,13.645026,47.61,"UCare Health, Inc.",Medical Assistance,24.028767,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE MAXON 2-0 DETACH 6247-53,,A4649,HCPCS,Facility,Inpatient,,,,47.61,40.4685,13.645026,47.61,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
SUTURE MAXON 2-0 DETACH 6247-53,,A4649,HCPCS,Facility,Outpatient,,,,47.61,40.4685,13.645026,47.61,"UCare Health, Inc.",Medicare Advantage,24.028767,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE MAXON 2-0 DETACH 6247-53,,A4649,HCPCS,Facility,Inpatient,,,,47.61,40.4685,13.645026,47.61,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE MAXON 2-0 DETACH 6247-53,,A4649,HCPCS,Facility,Outpatient,,,,47.61,40.4685,13.645026,47.61,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),24.028767,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE MAXON 2-0 DETACH 6247-53,,A4649,HCPCS,Facility,Inpatient,,,,47.61,40.4685,13.645026,47.61,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE MAXON 2-0 DETACH 6247-53,,A4649,HCPCS,Facility,Both,,,,47.61,40.4685,13.645026,47.61,UnitedHealthcare,Individual & Family,44.7534,94,,percent of total billed charges,,
SUTURE MAXON 2-0 DETACH 6247-53,,A4649,HCPCS,Facility,Outpatient,,,,47.61,40.4685,13.645026,47.61,UnitedHealthcare,Medicare Advantage,23.3289,49,,percent of total billed charges,,
SUTURE MAXON 2-0 DETACH 6247-53,,A4649,HCPCS,Facility,Inpatient,,,,47.61,40.4685,13.645026,47.61,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
SUTURE MAXON 2-0 DETACH 6247-53,,A4649,HCPCS,Facility,Outpatient,,,,47.61,40.4685,13.645026,47.61,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,22.8528,48,,percent of total billed charges,,100% of DHS outpatient percentage
SUTURE MAXON 2-0 DETACH 6247-53,,A4649,HCPCS,Facility,Inpatient,,,,47.61,40.4685,13.645026,47.61,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
SUTURE MAXON 3-0 6267-41,,A4649,HCPCS,Facility,Both,,,,45.55,38.7175,13.05463,45.55,Aetna,Commercial,41.906,92,,percent of total billed charges,,
SUTURE MAXON 3-0 6267-41,,A4649,HCPCS,Facility,Outpatient,,,,45.55,38.7175,13.05463,45.55,Aetna,Medicare Advantage,22.3195,49,,percent of total billed charges,,
SUTURE MAXON 3-0 6267-41,,A4649,HCPCS,Facility,Inpatient,,,,45.55,38.7175,13.05463,45.55,Aetna,Medicare Advantage,,,,,Included in per diem rate,
SUTURE MAXON 3-0 6267-41,,A4649,HCPCS,Facility,Both,,,,45.55,38.7175,13.05463,45.55,Aetna,PPO,42.3615,93,,percent of total billed charges,,
SUTURE MAXON 3-0 6267-41,,A4649,HCPCS,Facility,Both,,,,45.55,38.7175,13.05463,45.55,America's PPO,America's PPO,43.741665,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SUTURE MAXON 3-0 6267-41,,A4649,HCPCS,Facility,Both,,,,45.55,38.7175,13.05463,45.55,BlueCross BlueShield Minnesota, Federal Employee Program,44.8212,98.4,,percent of total billed charges,,
SUTURE MAXON 3-0 6267-41,,A4649,HCPCS,Facility,Both,,,,45.55,38.7175,13.05463,45.55,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,45.55,100,,percent of total billed charges,,
SUTURE MAXON 3-0 6267-41,,A4649,HCPCS,Facility,Both,,,,45.55,38.7175,13.05463,45.55,BlueCross BlueShield Minnesota,High Value Network Plan,40.995,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
SUTURE MAXON 3-0 6267-41,,A4649,HCPCS,Facility,Outpatient,,,,45.55,38.7175,13.05463,45.55,BlueCross BlueShield Minnesota,Medicare Advantage,22.3195,49,,percent of total billed charges,,
SUTURE MAXON 3-0 6267-41,,A4649,HCPCS,Facility,Inpatient,,,,45.55,38.7175,13.05463,45.55,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
SUTURE MAXON 3-0 6267-41,,A4649,HCPCS,Facility,Both,,,,45.55,38.7175,13.05463,45.55,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,40.343635,88.57,,percent of total billed charges,,
SUTURE MAXON 3-0 6267-41,,A4649,HCPCS,Facility,Both,,,,45.55,38.7175,13.05463,45.55,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,13.05463,28.66,,percent of total billed charges,,
SUTURE MAXON 3-0 6267-41,,A4649,HCPCS,Facility,Outpatient,,,,45.55,38.7175,13.05463,45.55,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),22.3195,49,,percent of total billed charges,,
SUTURE MAXON 3-0 6267-41,,A4649,HCPCS,Facility,Inpatient,,,,45.55,38.7175,13.05463,45.55,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
SUTURE MAXON 3-0 6267-41,,A4649,HCPCS,Facility,Both,,,,45.55,38.7175,13.05463,45.55,CorVel,Worker's Compensation,45.55,100,,percent of total billed charges,,
SUTURE MAXON 3-0 6267-41,,A4649,HCPCS,Facility,Both,,,,45.55,38.7175,13.05463,45.55,First Health Group Corporation,First Health Network,44.1835,97,,percent of total billed charges,,
SUTURE MAXON 3-0 6267-41,,A4649,HCPCS,Facility,Both,,,,45.55,38.7175,13.05463,45.55,"Health Partners, Inc.",Commercial,43.0903,94.6,,percent of total billed charges,,
SUTURE MAXON 3-0 6267-41,,A4649,HCPCS,Facility,Outpatient,,,,45.55,38.7175,13.05463,45.55,"Health Partners, Inc.",Medicare Advantage,22.3195,49,,percent of total billed charges,,
SUTURE MAXON 3-0 6267-41,,A4649,HCPCS,Facility,Inpatient,,,,45.55,38.7175,13.05463,45.55,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE MAXON 3-0 6267-41,,A4649,HCPCS,Facility,Both,,,,45.55,38.7175,13.05463,45.55,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),27.33,60,,percent of total billed charges,,
SUTURE MAXON 3-0 6267-41,,A4649,HCPCS,Facility,Both,,,,45.55,38.7175,13.05463,45.55,"Health Partners, Inc.",State of Minnesota Advantage Program,37.12325,81.5,,percent of total billed charges,,
SUTURE MAXON 3-0 6267-41,,A4649,HCPCS,Facility,Both,,,,45.55,38.7175,13.05463,45.55,"Health Partners, Inc.",State Public Programs,22.775,50,,percent of total billed charges,,
SUTURE MAXON 3-0 6267-41,,A4649,HCPCS,Facility,Both,,,,45.55,38.7175,13.05463,45.55,Humana Insurance Company,Commercial PPO,43.2725,95,,percent of total billed charges,,
SUTURE MAXON 3-0 6267-41,,A4649,HCPCS,Facility,Outpatient,,,,45.55,38.7175,13.05463,45.55,Humana Insurance Company,Medicare PPO,22.3195,49,,percent of total billed charges,,
SUTURE MAXON 3-0 6267-41,,A4649,HCPCS,Facility,Inpatient,,,,45.55,38.7175,13.05463,45.55,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
SUTURE MAXON 3-0 6267-41,,A4649,HCPCS,Facility,Both,,,,45.55,38.7175,13.05463,45.55,Medica,Individual & Family,45.14005,99.1,,percent of total billed charges,,
SUTURE MAXON 3-0 6267-41,,A4649,HCPCS,Facility,Outpatient,,,,45.55,38.7175,13.05463,45.55,Medica,Medica Advantage Solution,22.6839,49.8,,percent of total billed charges,,
SUTURE MAXON 3-0 6267-41,,A4649,HCPCS,Facility,Inpatient,,,,45.55,38.7175,13.05463,45.55,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
SUTURE MAXON 3-0 6267-41,,A4649,HCPCS,Facility,Outpatient,,,,45.55,38.7175,13.05463,45.55,Medica,Medical Assistance,20.3153,44.6,,percent of total billed charges,,
SUTURE MAXON 3-0 6267-41,,A4649,HCPCS,Facility,Inpatient,,,,45.55,38.7175,13.05463,45.55,Medica,Medical Assistance,,,,,Included in per diem rate,
SUTURE MAXON 3-0 6267-41,,A4649,HCPCS,Facility,Outpatient,,,,45.55,38.7175,13.05463,45.55,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,22.6839,49.8,,percent of total billed charges,,
SUTURE MAXON 3-0 6267-41,,A4649,HCPCS,Facility,Inpatient,,,,45.55,38.7175,13.05463,45.55,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
SUTURE MAXON 3-0 6267-41,,A4649,HCPCS,Facility,Both,,,,45.55,38.7175,13.05463,45.55,"Multiplan, Inc.","Multiplan, Inc.",42.817,94,,percent of total billed charges,,
SUTURE MAXON 3-0 6267-41,,A4649,HCPCS,Facility,Outpatient,,,,45.55,38.7175,13.05463,45.55,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,41.04055,90.1,,percent of total billed charges,,
SUTURE MAXON 3-0 6267-41,,A4649,HCPCS,Facility,Inpatient,,,,45.55,38.7175,13.05463,45.55,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
SUTURE MAXON 3-0 6267-41,,A4649,HCPCS,Facility,Both,,,,45.55,38.7175,13.05463,45.55,"Preferred One Administrative Services, INC.",PPO,44.9123,98.6,,percent of total billed charges,,
SUTURE MAXON 3-0 6267-41,,A4649,HCPCS,Facility,Outpatient,,,,45.55,38.7175,13.05463,45.55,PrimeWest Health,Minnesota Senior Health Options (MSHO),23.435475,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
SUTURE MAXON 3-0 6267-41,,A4649,HCPCS,Facility,Inpatient,,,,45.55,38.7175,13.05463,45.55,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE MAXON 3-0 6267-41,,A4649,HCPCS,Facility,Outpatient,,,,45.55,38.7175,13.05463,45.55,PrimeWest Health,MinnesotaCare,23.39448,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
SUTURE MAXON 3-0 6267-41,,A4649,HCPCS,Facility,Inpatient,,,,45.55,38.7175,13.05463,45.55,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
SUTURE MAXON 3-0 6267-41,,A4649,HCPCS,Facility,Both,,,,45.55,38.7175,13.05463,45.55,Sanford Health Plan,Sanford Health Plan,41.906,92,,percent of total billed charges,,
SUTURE MAXON 3-0 6267-41,,A4649,HCPCS,Facility,Outpatient,,,,45.55,38.7175,13.05463,45.55,"UCare Health, Inc.",Individual & Family Plan,25.667425,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
SUTURE MAXON 3-0 6267-41,,A4649,HCPCS,Facility,Inpatient,,,,45.55,38.7175,13.05463,45.55,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
SUTURE MAXON 3-0 6267-41,,A4649,HCPCS,Facility,Outpatient,,,,45.55,38.7175,13.05463,45.55,"UCare Health, Inc.",Medical Assistance,22.989085,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE MAXON 3-0 6267-41,,A4649,HCPCS,Facility,Inpatient,,,,45.55,38.7175,13.05463,45.55,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
SUTURE MAXON 3-0 6267-41,,A4649,HCPCS,Facility,Outpatient,,,,45.55,38.7175,13.05463,45.55,"UCare Health, Inc.",Medicare Advantage,22.989085,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE MAXON 3-0 6267-41,,A4649,HCPCS,Facility,Inpatient,,,,45.55,38.7175,13.05463,45.55,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE MAXON 3-0 6267-41,,A4649,HCPCS,Facility,Outpatient,,,,45.55,38.7175,13.05463,45.55,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),22.989085,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE MAXON 3-0 6267-41,,A4649,HCPCS,Facility,Inpatient,,,,45.55,38.7175,13.05463,45.55,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE MAXON 3-0 6267-41,,A4649,HCPCS,Facility,Both,,,,45.55,38.7175,13.05463,45.55,UnitedHealthcare,Individual & Family,42.817,94,,percent of total billed charges,,
SUTURE MAXON 3-0 6267-41,,A4649,HCPCS,Facility,Outpatient,,,,45.55,38.7175,13.05463,45.55,UnitedHealthcare,Medicare Advantage,22.3195,49,,percent of total billed charges,,
SUTURE MAXON 3-0 6267-41,,A4649,HCPCS,Facility,Inpatient,,,,45.55,38.7175,13.05463,45.55,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
SUTURE MAXON 3-0 6267-41,,A4649,HCPCS,Facility,Outpatient,,,,45.55,38.7175,13.05463,45.55,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,21.864,48,,percent of total billed charges,,100% of DHS outpatient percentage
SUTURE MAXON 3-0 6267-41,,A4649,HCPCS,Facility,Inpatient,,,,45.55,38.7175,13.05463,45.55,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
SUTURE MAXON GREEN 0 1X30IN T-12/GS-2,,A4649,HCPCS,Facility,Both,,,,41.25,35.0625,11.82225,41.25,Aetna,Commercial,37.95,92,,percent of total billed charges,,
SUTURE MAXON GREEN 0 1X30IN T-12/GS-2,,A4649,HCPCS,Facility,Outpatient,,,,41.25,35.0625,11.82225,41.25,Aetna,Medicare Advantage,20.2125,49,,percent of total billed charges,,
SUTURE MAXON GREEN 0 1X30IN T-12/GS-2,,A4649,HCPCS,Facility,Inpatient,,,,41.25,35.0625,11.82225,41.25,Aetna,Medicare Advantage,,,,,Included in per diem rate,
SUTURE MAXON GREEN 0 1X30IN T-12/GS-2,,A4649,HCPCS,Facility,Both,,,,41.25,35.0625,11.82225,41.25,Aetna,PPO,38.3625,93,,percent of total billed charges,,
SUTURE MAXON GREEN 0 1X30IN T-12/GS-2,,A4649,HCPCS,Facility,Both,,,,41.25,35.0625,11.82225,41.25,America's PPO,America's PPO,39.612375,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SUTURE MAXON GREEN 0 1X30IN T-12/GS-2,,A4649,HCPCS,Facility,Both,,,,41.25,35.0625,11.82225,41.25,BlueCross BlueShield Minnesota, Federal Employee Program,40.59,98.4,,percent of total billed charges,,
SUTURE MAXON GREEN 0 1X30IN T-12/GS-2,,A4649,HCPCS,Facility,Both,,,,41.25,35.0625,11.82225,41.25,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,41.25,100,,percent of total billed charges,,
SUTURE MAXON GREEN 0 1X30IN T-12/GS-2,,A4649,HCPCS,Facility,Both,,,,41.25,35.0625,11.82225,41.25,BlueCross BlueShield Minnesota,High Value Network Plan,37.125,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
SUTURE MAXON GREEN 0 1X30IN T-12/GS-2,,A4649,HCPCS,Facility,Outpatient,,,,41.25,35.0625,11.82225,41.25,BlueCross BlueShield Minnesota,Medicare Advantage,20.2125,49,,percent of total billed charges,,
SUTURE MAXON GREEN 0 1X30IN T-12/GS-2,,A4649,HCPCS,Facility,Inpatient,,,,41.25,35.0625,11.82225,41.25,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
SUTURE MAXON GREEN 0 1X30IN T-12/GS-2,,A4649,HCPCS,Facility,Both,,,,41.25,35.0625,11.82225,41.25,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,36.535125,88.57,,percent of total billed charges,,
SUTURE MAXON GREEN 0 1X30IN T-12/GS-2,,A4649,HCPCS,Facility,Both,,,,41.25,35.0625,11.82225,41.25,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,11.82225,28.66,,percent of total billed charges,,
SUTURE MAXON GREEN 0 1X30IN T-12/GS-2,,A4649,HCPCS,Facility,Outpatient,,,,41.25,35.0625,11.82225,41.25,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),20.2125,49,,percent of total billed charges,,
SUTURE MAXON GREEN 0 1X30IN T-12/GS-2,,A4649,HCPCS,Facility,Inpatient,,,,41.25,35.0625,11.82225,41.25,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
SUTURE MAXON GREEN 0 1X30IN T-12/GS-2,,A4649,HCPCS,Facility,Both,,,,41.25,35.0625,11.82225,41.25,CorVel,Worker's Compensation,41.25,100,,percent of total billed charges,,
SUTURE MAXON GREEN 0 1X30IN T-12/GS-2,,A4649,HCPCS,Facility,Both,,,,41.25,35.0625,11.82225,41.25,First Health Group Corporation,First Health Network,40.0125,97,,percent of total billed charges,,
SUTURE MAXON GREEN 0 1X30IN T-12/GS-2,,A4649,HCPCS,Facility,Both,,,,41.25,35.0625,11.82225,41.25,"Health Partners, Inc.",Commercial,39.0225,94.6,,percent of total billed charges,,
SUTURE MAXON GREEN 0 1X30IN T-12/GS-2,,A4649,HCPCS,Facility,Outpatient,,,,41.25,35.0625,11.82225,41.25,"Health Partners, Inc.",Medicare Advantage,20.2125,49,,percent of total billed charges,,
SUTURE MAXON GREEN 0 1X30IN T-12/GS-2,,A4649,HCPCS,Facility,Inpatient,,,,41.25,35.0625,11.82225,41.25,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE MAXON GREEN 0 1X30IN T-12/GS-2,,A4649,HCPCS,Facility,Both,,,,41.25,35.0625,11.82225,41.25,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),24.75,60,,percent of total billed charges,,
SUTURE MAXON GREEN 0 1X30IN T-12/GS-2,,A4649,HCPCS,Facility,Both,,,,41.25,35.0625,11.82225,41.25,"Health Partners, Inc.",State of Minnesota Advantage Program,33.61875,81.5,,percent of total billed charges,,
SUTURE MAXON GREEN 0 1X30IN T-12/GS-2,,A4649,HCPCS,Facility,Both,,,,41.25,35.0625,11.82225,41.25,"Health Partners, Inc.",State Public Programs,20.625,50,,percent of total billed charges,,
SUTURE MAXON GREEN 0 1X30IN T-12/GS-2,,A4649,HCPCS,Facility,Both,,,,41.25,35.0625,11.82225,41.25,Humana Insurance Company,Commercial PPO,39.1875,95,,percent of total billed charges,,
SUTURE MAXON GREEN 0 1X30IN T-12/GS-2,,A4649,HCPCS,Facility,Outpatient,,,,41.25,35.0625,11.82225,41.25,Humana Insurance Company,Medicare PPO,20.2125,49,,percent of total billed charges,,
SUTURE MAXON GREEN 0 1X30IN T-12/GS-2,,A4649,HCPCS,Facility,Inpatient,,,,41.25,35.0625,11.82225,41.25,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
SUTURE MAXON GREEN 0 1X30IN T-12/GS-2,,A4649,HCPCS,Facility,Both,,,,41.25,35.0625,11.82225,41.25,Medica,Individual & Family,40.87875,99.1,,percent of total billed charges,,
SUTURE MAXON GREEN 0 1X30IN T-12/GS-2,,A4649,HCPCS,Facility,Outpatient,,,,41.25,35.0625,11.82225,41.25,Medica,Medica Advantage Solution,20.5425,49.8,,percent of total billed charges,,
SUTURE MAXON GREEN 0 1X30IN T-12/GS-2,,A4649,HCPCS,Facility,Inpatient,,,,41.25,35.0625,11.82225,41.25,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
SUTURE MAXON GREEN 0 1X30IN T-12/GS-2,,A4649,HCPCS,Facility,Outpatient,,,,41.25,35.0625,11.82225,41.25,Medica,Medical Assistance,18.3975,44.6,,percent of total billed charges,,
SUTURE MAXON GREEN 0 1X30IN T-12/GS-2,,A4649,HCPCS,Facility,Inpatient,,,,41.25,35.0625,11.82225,41.25,Medica,Medical Assistance,,,,,Included in per diem rate,
SUTURE MAXON GREEN 0 1X30IN T-12/GS-2,,A4649,HCPCS,Facility,Outpatient,,,,41.25,35.0625,11.82225,41.25,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,20.5425,49.8,,percent of total billed charges,,
SUTURE MAXON GREEN 0 1X30IN T-12/GS-2,,A4649,HCPCS,Facility,Inpatient,,,,41.25,35.0625,11.82225,41.25,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
SUTURE MAXON GREEN 0 1X30IN T-12/GS-2,,A4649,HCPCS,Facility,Both,,,,41.25,35.0625,11.82225,41.25,"Multiplan, Inc.","Multiplan, Inc.",38.775,94,,percent of total billed charges,,
SUTURE MAXON GREEN 0 1X30IN T-12/GS-2,,A4649,HCPCS,Facility,Outpatient,,,,41.25,35.0625,11.82225,41.25,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,37.16625,90.1,,percent of total billed charges,,
SUTURE MAXON GREEN 0 1X30IN T-12/GS-2,,A4649,HCPCS,Facility,Inpatient,,,,41.25,35.0625,11.82225,41.25,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
SUTURE MAXON GREEN 0 1X30IN T-12/GS-2,,A4649,HCPCS,Facility,Both,,,,41.25,35.0625,11.82225,41.25,"Preferred One Administrative Services, INC.",PPO,40.6725,98.6,,percent of total billed charges,,
SUTURE MAXON GREEN 0 1X30IN T-12/GS-2,,A4649,HCPCS,Facility,Outpatient,,,,41.25,35.0625,11.82225,41.25,PrimeWest Health,Minnesota Senior Health Options (MSHO),21.223125,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
SUTURE MAXON GREEN 0 1X30IN T-12/GS-2,,A4649,HCPCS,Facility,Inpatient,,,,41.25,35.0625,11.82225,41.25,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE MAXON GREEN 0 1X30IN T-12/GS-2,,A4649,HCPCS,Facility,Outpatient,,,,41.25,35.0625,11.82225,41.25,PrimeWest Health,MinnesotaCare,21.186,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
SUTURE MAXON GREEN 0 1X30IN T-12/GS-2,,A4649,HCPCS,Facility,Inpatient,,,,41.25,35.0625,11.82225,41.25,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
SUTURE MAXON GREEN 0 1X30IN T-12/GS-2,,A4649,HCPCS,Facility,Both,,,,41.25,35.0625,11.82225,41.25,Sanford Health Plan,Sanford Health Plan,37.95,92,,percent of total billed charges,,
SUTURE MAXON GREEN 0 1X30IN T-12/GS-2,,A4649,HCPCS,Facility,Outpatient,,,,41.25,35.0625,11.82225,41.25,"UCare Health, Inc.",Individual & Family Plan,23.244375,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
SUTURE MAXON GREEN 0 1X30IN T-12/GS-2,,A4649,HCPCS,Facility,Inpatient,,,,41.25,35.0625,11.82225,41.25,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
SUTURE MAXON GREEN 0 1X30IN T-12/GS-2,,A4649,HCPCS,Facility,Outpatient,,,,41.25,35.0625,11.82225,41.25,"UCare Health, Inc.",Medical Assistance,20.818875,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE MAXON GREEN 0 1X30IN T-12/GS-2,,A4649,HCPCS,Facility,Inpatient,,,,41.25,35.0625,11.82225,41.25,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
SUTURE MAXON GREEN 0 1X30IN T-12/GS-2,,A4649,HCPCS,Facility,Outpatient,,,,41.25,35.0625,11.82225,41.25,"UCare Health, Inc.",Medicare Advantage,20.818875,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE MAXON GREEN 0 1X30IN T-12/GS-2,,A4649,HCPCS,Facility,Inpatient,,,,41.25,35.0625,11.82225,41.25,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE MAXON GREEN 0 1X30IN T-12/GS-2,,A4649,HCPCS,Facility,Outpatient,,,,41.25,35.0625,11.82225,41.25,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),20.818875,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE MAXON GREEN 0 1X30IN T-12/GS-2,,A4649,HCPCS,Facility,Inpatient,,,,41.25,35.0625,11.82225,41.25,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE MAXON GREEN 0 1X30IN T-12/GS-2,,A4649,HCPCS,Facility,Both,,,,41.25,35.0625,11.82225,41.25,UnitedHealthcare,Individual & Family,38.775,94,,percent of total billed charges,,
SUTURE MAXON GREEN 0 1X30IN T-12/GS-2,,A4649,HCPCS,Facility,Outpatient,,,,41.25,35.0625,11.82225,41.25,UnitedHealthcare,Medicare Advantage,20.2125,49,,percent of total billed charges,,
SUTURE MAXON GREEN 0 1X30IN T-12/GS-2,,A4649,HCPCS,Facility,Inpatient,,,,41.25,35.0625,11.82225,41.25,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
SUTURE MAXON GREEN 0 1X30IN T-12/GS-2,,A4649,HCPCS,Facility,Outpatient,,,,41.25,35.0625,11.82225,41.25,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,19.8,48,,percent of total billed charges,,100% of DHS outpatient percentage
SUTURE MAXON GREEN 0 1X30IN T-12/GS-2,,A4649,HCPCS,Facility,Inpatient,,,,41.25,35.0625,11.82225,41.25,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
SUTURE MAXON GREEN 2/0 1X30IN T-19GS-22,,A4649,HCPCS,Facility,Both,,,,45.4,38.59,13.01164,45.4,Aetna,Commercial,41.768,92,,percent of total billed charges,,
SUTURE MAXON GREEN 2/0 1X30IN T-19GS-22,,A4649,HCPCS,Facility,Outpatient,,,,45.4,38.59,13.01164,45.4,Aetna,Medicare Advantage,22.246,49,,percent of total billed charges,,
SUTURE MAXON GREEN 2/0 1X30IN T-19GS-22,,A4649,HCPCS,Facility,Inpatient,,,,45.4,38.59,13.01164,45.4,Aetna,Medicare Advantage,,,,,Included in per diem rate,
SUTURE MAXON GREEN 2/0 1X30IN T-19GS-22,,A4649,HCPCS,Facility,Both,,,,45.4,38.59,13.01164,45.4,Aetna,PPO,42.222,93,,percent of total billed charges,,
SUTURE MAXON GREEN 2/0 1X30IN T-19GS-22,,A4649,HCPCS,Facility,Both,,,,45.4,38.59,13.01164,45.4,America's PPO,America's PPO,43.59762,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SUTURE MAXON GREEN 2/0 1X30IN T-19GS-22,,A4649,HCPCS,Facility,Both,,,,45.4,38.59,13.01164,45.4,BlueCross BlueShield Minnesota, Federal Employee Program,44.6736,98.4,,percent of total billed charges,,
SUTURE MAXON GREEN 2/0 1X30IN T-19GS-22,,A4649,HCPCS,Facility,Both,,,,45.4,38.59,13.01164,45.4,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,45.4,100,,percent of total billed charges,,
SUTURE MAXON GREEN 2/0 1X30IN T-19GS-22,,A4649,HCPCS,Facility,Both,,,,45.4,38.59,13.01164,45.4,BlueCross BlueShield Minnesota,High Value Network Plan,40.86,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
SUTURE MAXON GREEN 2/0 1X30IN T-19GS-22,,A4649,HCPCS,Facility,Outpatient,,,,45.4,38.59,13.01164,45.4,BlueCross BlueShield Minnesota,Medicare Advantage,22.246,49,,percent of total billed charges,,
SUTURE MAXON GREEN 2/0 1X30IN T-19GS-22,,A4649,HCPCS,Facility,Inpatient,,,,45.4,38.59,13.01164,45.4,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
SUTURE MAXON GREEN 2/0 1X30IN T-19GS-22,,A4649,HCPCS,Facility,Both,,,,45.4,38.59,13.01164,45.4,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,40.21078,88.57,,percent of total billed charges,,
SUTURE MAXON GREEN 2/0 1X30IN T-19GS-22,,A4649,HCPCS,Facility,Both,,,,45.4,38.59,13.01164,45.4,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,13.01164,28.66,,percent of total billed charges,,
SUTURE MAXON GREEN 2/0 1X30IN T-19GS-22,,A4649,HCPCS,Facility,Outpatient,,,,45.4,38.59,13.01164,45.4,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),22.246,49,,percent of total billed charges,,
SUTURE MAXON GREEN 2/0 1X30IN T-19GS-22,,A4649,HCPCS,Facility,Inpatient,,,,45.4,38.59,13.01164,45.4,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
SUTURE MAXON GREEN 2/0 1X30IN T-19GS-22,,A4649,HCPCS,Facility,Both,,,,45.4,38.59,13.01164,45.4,CorVel,Worker's Compensation,45.4,100,,percent of total billed charges,,
SUTURE MAXON GREEN 2/0 1X30IN T-19GS-22,,A4649,HCPCS,Facility,Both,,,,45.4,38.59,13.01164,45.4,First Health Group Corporation,First Health Network,44.038,97,,percent of total billed charges,,
SUTURE MAXON GREEN 2/0 1X30IN T-19GS-22,,A4649,HCPCS,Facility,Both,,,,45.4,38.59,13.01164,45.4,"Health Partners, Inc.",Commercial,42.9484,94.6,,percent of total billed charges,,
SUTURE MAXON GREEN 2/0 1X30IN T-19GS-22,,A4649,HCPCS,Facility,Outpatient,,,,45.4,38.59,13.01164,45.4,"Health Partners, Inc.",Medicare Advantage,22.246,49,,percent of total billed charges,,
SUTURE MAXON GREEN 2/0 1X30IN T-19GS-22,,A4649,HCPCS,Facility,Inpatient,,,,45.4,38.59,13.01164,45.4,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE MAXON GREEN 2/0 1X30IN T-19GS-22,,A4649,HCPCS,Facility,Both,,,,45.4,38.59,13.01164,45.4,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),27.24,60,,percent of total billed charges,,
SUTURE MAXON GREEN 2/0 1X30IN T-19GS-22,,A4649,HCPCS,Facility,Both,,,,45.4,38.59,13.01164,45.4,"Health Partners, Inc.",State of Minnesota Advantage Program,37.001,81.5,,percent of total billed charges,,
SUTURE MAXON GREEN 2/0 1X30IN T-19GS-22,,A4649,HCPCS,Facility,Both,,,,45.4,38.59,13.01164,45.4,"Health Partners, Inc.",State Public Programs,22.7,50,,percent of total billed charges,,
SUTURE MAXON GREEN 2/0 1X30IN T-19GS-22,,A4649,HCPCS,Facility,Both,,,,45.4,38.59,13.01164,45.4,Humana Insurance Company,Commercial PPO,43.13,95,,percent of total billed charges,,
SUTURE MAXON GREEN 2/0 1X30IN T-19GS-22,,A4649,HCPCS,Facility,Outpatient,,,,45.4,38.59,13.01164,45.4,Humana Insurance Company,Medicare PPO,22.246,49,,percent of total billed charges,,
SUTURE MAXON GREEN 2/0 1X30IN T-19GS-22,,A4649,HCPCS,Facility,Inpatient,,,,45.4,38.59,13.01164,45.4,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
SUTURE MAXON GREEN 2/0 1X30IN T-19GS-22,,A4649,HCPCS,Facility,Both,,,,45.4,38.59,13.01164,45.4,Medica,Individual & Family,44.9914,99.1,,percent of total billed charges,,
SUTURE MAXON GREEN 2/0 1X30IN T-19GS-22,,A4649,HCPCS,Facility,Outpatient,,,,45.4,38.59,13.01164,45.4,Medica,Medica Advantage Solution,22.6092,49.8,,percent of total billed charges,,
SUTURE MAXON GREEN 2/0 1X30IN T-19GS-22,,A4649,HCPCS,Facility,Inpatient,,,,45.4,38.59,13.01164,45.4,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
SUTURE MAXON GREEN 2/0 1X30IN T-19GS-22,,A4649,HCPCS,Facility,Outpatient,,,,45.4,38.59,13.01164,45.4,Medica,Medical Assistance,20.2484,44.6,,percent of total billed charges,,
SUTURE MAXON GREEN 2/0 1X30IN T-19GS-22,,A4649,HCPCS,Facility,Inpatient,,,,45.4,38.59,13.01164,45.4,Medica,Medical Assistance,,,,,Included in per diem rate,
SUTURE MAXON GREEN 2/0 1X30IN T-19GS-22,,A4649,HCPCS,Facility,Outpatient,,,,45.4,38.59,13.01164,45.4,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,22.6092,49.8,,percent of total billed charges,,
SUTURE MAXON GREEN 2/0 1X30IN T-19GS-22,,A4649,HCPCS,Facility,Inpatient,,,,45.4,38.59,13.01164,45.4,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
SUTURE MAXON GREEN 2/0 1X30IN T-19GS-22,,A4649,HCPCS,Facility,Both,,,,45.4,38.59,13.01164,45.4,"Multiplan, Inc.","Multiplan, Inc.",42.676,94,,percent of total billed charges,,
SUTURE MAXON GREEN 2/0 1X30IN T-19GS-22,,A4649,HCPCS,Facility,Outpatient,,,,45.4,38.59,13.01164,45.4,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,40.9054,90.1,,percent of total billed charges,,
SUTURE MAXON GREEN 2/0 1X30IN T-19GS-22,,A4649,HCPCS,Facility,Inpatient,,,,45.4,38.59,13.01164,45.4,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
SUTURE MAXON GREEN 2/0 1X30IN T-19GS-22,,A4649,HCPCS,Facility,Both,,,,45.4,38.59,13.01164,45.4,"Preferred One Administrative Services, INC.",PPO,44.7644,98.6,,percent of total billed charges,,
SUTURE MAXON GREEN 2/0 1X30IN T-19GS-22,,A4649,HCPCS,Facility,Outpatient,,,,45.4,38.59,13.01164,45.4,PrimeWest Health,Minnesota Senior Health Options (MSHO),23.3583,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
SUTURE MAXON GREEN 2/0 1X30IN T-19GS-22,,A4649,HCPCS,Facility,Inpatient,,,,45.4,38.59,13.01164,45.4,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE MAXON GREEN 2/0 1X30IN T-19GS-22,,A4649,HCPCS,Facility,Outpatient,,,,45.4,38.59,13.01164,45.4,PrimeWest Health,MinnesotaCare,23.31744,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
SUTURE MAXON GREEN 2/0 1X30IN T-19GS-22,,A4649,HCPCS,Facility,Inpatient,,,,45.4,38.59,13.01164,45.4,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
SUTURE MAXON GREEN 2/0 1X30IN T-19GS-22,,A4649,HCPCS,Facility,Both,,,,45.4,38.59,13.01164,45.4,Sanford Health Plan,Sanford Health Plan,41.768,92,,percent of total billed charges,,
SUTURE MAXON GREEN 2/0 1X30IN T-19GS-22,,A4649,HCPCS,Facility,Outpatient,,,,45.4,38.59,13.01164,45.4,"UCare Health, Inc.",Individual & Family Plan,25.5829,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
SUTURE MAXON GREEN 2/0 1X30IN T-19GS-22,,A4649,HCPCS,Facility,Inpatient,,,,45.4,38.59,13.01164,45.4,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
SUTURE MAXON GREEN 2/0 1X30IN T-19GS-22,,A4649,HCPCS,Facility,Outpatient,,,,45.4,38.59,13.01164,45.4,"UCare Health, Inc.",Medical Assistance,22.91338,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE MAXON GREEN 2/0 1X30IN T-19GS-22,,A4649,HCPCS,Facility,Inpatient,,,,45.4,38.59,13.01164,45.4,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
SUTURE MAXON GREEN 2/0 1X30IN T-19GS-22,,A4649,HCPCS,Facility,Outpatient,,,,45.4,38.59,13.01164,45.4,"UCare Health, Inc.",Medicare Advantage,22.91338,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE MAXON GREEN 2/0 1X30IN T-19GS-22,,A4649,HCPCS,Facility,Inpatient,,,,45.4,38.59,13.01164,45.4,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE MAXON GREEN 2/0 1X30IN T-19GS-22,,A4649,HCPCS,Facility,Outpatient,,,,45.4,38.59,13.01164,45.4,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),22.91338,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE MAXON GREEN 2/0 1X30IN T-19GS-22,,A4649,HCPCS,Facility,Inpatient,,,,45.4,38.59,13.01164,45.4,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE MAXON GREEN 2/0 1X30IN T-19GS-22,,A4649,HCPCS,Facility,Both,,,,45.4,38.59,13.01164,45.4,UnitedHealthcare,Individual & Family,42.676,94,,percent of total billed charges,,
SUTURE MAXON GREEN 2/0 1X30IN T-19GS-22,,A4649,HCPCS,Facility,Outpatient,,,,45.4,38.59,13.01164,45.4,UnitedHealthcare,Medicare Advantage,22.246,49,,percent of total billed charges,,
SUTURE MAXON GREEN 2/0 1X30IN T-19GS-22,,A4649,HCPCS,Facility,Inpatient,,,,45.4,38.59,13.01164,45.4,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
SUTURE MAXON GREEN 2/0 1X30IN T-19GS-22,,A4649,HCPCS,Facility,Outpatient,,,,45.4,38.59,13.01164,45.4,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,21.792,48,,percent of total billed charges,,100% of DHS outpatient percentage
SUTURE MAXON GREEN 2/0 1X30IN T-19GS-22,,A4649,HCPCS,Facility,Inpatient,,,,45.4,38.59,13.01164,45.4,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
SUTURE MONOCRYL 5-0 PS-2 Y495G,,A4649,HCPCS,Facility,Both,,,,46,39.1,13.1836,46,Aetna,Commercial,42.32,92,,percent of total billed charges,,
SUTURE MONOCRYL 5-0 PS-2 Y495G,,A4649,HCPCS,Facility,Outpatient,,,,46,39.1,13.1836,46,Aetna,Medicare Advantage,22.54,49,,percent of total billed charges,,
SUTURE MONOCRYL 5-0 PS-2 Y495G,,A4649,HCPCS,Facility,Inpatient,,,,46,39.1,13.1836,46,Aetna,Medicare Advantage,,,,,Included in per diem rate,
SUTURE MONOCRYL 5-0 PS-2 Y495G,,A4649,HCPCS,Facility,Both,,,,46,39.1,13.1836,46,Aetna,PPO,42.78,93,,percent of total billed charges,,
SUTURE MONOCRYL 5-0 PS-2 Y495G,,A4649,HCPCS,Facility,Both,,,,46,39.1,13.1836,46,America's PPO,America's PPO,44.1738,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SUTURE MONOCRYL 5-0 PS-2 Y495G,,A4649,HCPCS,Facility,Both,,,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota, Federal Employee Program,45.264,98.4,,percent of total billed charges,,
SUTURE MONOCRYL 5-0 PS-2 Y495G,,A4649,HCPCS,Facility,Both,,,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,46,100,,percent of total billed charges,,
SUTURE MONOCRYL 5-0 PS-2 Y495G,,A4649,HCPCS,Facility,Both,,,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,High Value Network Plan,41.4,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
SUTURE MONOCRYL 5-0 PS-2 Y495G,,A4649,HCPCS,Facility,Outpatient,,,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Medicare Advantage,22.54,49,,percent of total billed charges,,
SUTURE MONOCRYL 5-0 PS-2 Y495G,,A4649,HCPCS,Facility,Inpatient,,,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
SUTURE MONOCRYL 5-0 PS-2 Y495G,,A4649,HCPCS,Facility,Both,,,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,40.7422,88.57,,percent of total billed charges,,
SUTURE MONOCRYL 5-0 PS-2 Y495G,,A4649,HCPCS,Facility,Both,,,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,13.1836,28.66,,percent of total billed charges,,
SUTURE MONOCRYL 5-0 PS-2 Y495G,,A4649,HCPCS,Facility,Outpatient,,,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),22.54,49,,percent of total billed charges,,
SUTURE MONOCRYL 5-0 PS-2 Y495G,,A4649,HCPCS,Facility,Inpatient,,,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
SUTURE MONOCRYL 5-0 PS-2 Y495G,,A4649,HCPCS,Facility,Both,,,,46,39.1,13.1836,46,CorVel,Worker's Compensation,46,100,,percent of total billed charges,,
SUTURE MONOCRYL 5-0 PS-2 Y495G,,A4649,HCPCS,Facility,Both,,,,46,39.1,13.1836,46,First Health Group Corporation,First Health Network,44.62,97,,percent of total billed charges,,
SUTURE MONOCRYL 5-0 PS-2 Y495G,,A4649,HCPCS,Facility,Both,,,,46,39.1,13.1836,46,"Health Partners, Inc.",Commercial,43.516,94.6,,percent of total billed charges,,
SUTURE MONOCRYL 5-0 PS-2 Y495G,,A4649,HCPCS,Facility,Outpatient,,,,46,39.1,13.1836,46,"Health Partners, Inc.",Medicare Advantage,22.54,49,,percent of total billed charges,,
SUTURE MONOCRYL 5-0 PS-2 Y495G,,A4649,HCPCS,Facility,Inpatient,,,,46,39.1,13.1836,46,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE MONOCRYL 5-0 PS-2 Y495G,,A4649,HCPCS,Facility,Both,,,,46,39.1,13.1836,46,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),27.6,60,,percent of total billed charges,,
SUTURE MONOCRYL 5-0 PS-2 Y495G,,A4649,HCPCS,Facility,Both,,,,46,39.1,13.1836,46,"Health Partners, Inc.",State of Minnesota Advantage Program,37.49,81.5,,percent of total billed charges,,
SUTURE MONOCRYL 5-0 PS-2 Y495G,,A4649,HCPCS,Facility,Both,,,,46,39.1,13.1836,46,"Health Partners, Inc.",State Public Programs,23,50,,percent of total billed charges,,
SUTURE MONOCRYL 5-0 PS-2 Y495G,,A4649,HCPCS,Facility,Both,,,,46,39.1,13.1836,46,Humana Insurance Company,Commercial PPO,43.7,95,,percent of total billed charges,,
SUTURE MONOCRYL 5-0 PS-2 Y495G,,A4649,HCPCS,Facility,Outpatient,,,,46,39.1,13.1836,46,Humana Insurance Company,Medicare PPO,22.54,49,,percent of total billed charges,,
SUTURE MONOCRYL 5-0 PS-2 Y495G,,A4649,HCPCS,Facility,Inpatient,,,,46,39.1,13.1836,46,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
SUTURE MONOCRYL 5-0 PS-2 Y495G,,A4649,HCPCS,Facility,Both,,,,46,39.1,13.1836,46,Medica,Individual & Family,45.586,99.1,,percent of total billed charges,,
SUTURE MONOCRYL 5-0 PS-2 Y495G,,A4649,HCPCS,Facility,Outpatient,,,,46,39.1,13.1836,46,Medica,Medica Advantage Solution,22.908,49.8,,percent of total billed charges,,
SUTURE MONOCRYL 5-0 PS-2 Y495G,,A4649,HCPCS,Facility,Inpatient,,,,46,39.1,13.1836,46,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
SUTURE MONOCRYL 5-0 PS-2 Y495G,,A4649,HCPCS,Facility,Outpatient,,,,46,39.1,13.1836,46,Medica,Medical Assistance,20.516,44.6,,percent of total billed charges,,
SUTURE MONOCRYL 5-0 PS-2 Y495G,,A4649,HCPCS,Facility,Inpatient,,,,46,39.1,13.1836,46,Medica,Medical Assistance,,,,,Included in per diem rate,
SUTURE MONOCRYL 5-0 PS-2 Y495G,,A4649,HCPCS,Facility,Outpatient,,,,46,39.1,13.1836,46,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,22.908,49.8,,percent of total billed charges,,
SUTURE MONOCRYL 5-0 PS-2 Y495G,,A4649,HCPCS,Facility,Inpatient,,,,46,39.1,13.1836,46,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
SUTURE MONOCRYL 5-0 PS-2 Y495G,,A4649,HCPCS,Facility,Both,,,,46,39.1,13.1836,46,"Multiplan, Inc.","Multiplan, Inc.",43.24,94,,percent of total billed charges,,
SUTURE MONOCRYL 5-0 PS-2 Y495G,,A4649,HCPCS,Facility,Outpatient,,,,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,41.446,90.1,,percent of total billed charges,,
SUTURE MONOCRYL 5-0 PS-2 Y495G,,A4649,HCPCS,Facility,Inpatient,,,,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
SUTURE MONOCRYL 5-0 PS-2 Y495G,,A4649,HCPCS,Facility,Both,,,,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PPO,45.356,98.6,,percent of total billed charges,,
SUTURE MONOCRYL 5-0 PS-2 Y495G,,A4649,HCPCS,Facility,Outpatient,,,,46,39.1,13.1836,46,PrimeWest Health,Minnesota Senior Health Options (MSHO),23.667,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
SUTURE MONOCRYL 5-0 PS-2 Y495G,,A4649,HCPCS,Facility,Inpatient,,,,46,39.1,13.1836,46,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE MONOCRYL 5-0 PS-2 Y495G,,A4649,HCPCS,Facility,Outpatient,,,,46,39.1,13.1836,46,PrimeWest Health,MinnesotaCare,23.6256,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
SUTURE MONOCRYL 5-0 PS-2 Y495G,,A4649,HCPCS,Facility,Inpatient,,,,46,39.1,13.1836,46,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
SUTURE MONOCRYL 5-0 PS-2 Y495G,,A4649,HCPCS,Facility,Both,,,,46,39.1,13.1836,46,Sanford Health Plan,Sanford Health Plan,42.32,92,,percent of total billed charges,,
SUTURE MONOCRYL 5-0 PS-2 Y495G,,A4649,HCPCS,Facility,Outpatient,,,,46,39.1,13.1836,46,"UCare Health, Inc.",Individual & Family Plan,25.921,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
SUTURE MONOCRYL 5-0 PS-2 Y495G,,A4649,HCPCS,Facility,Inpatient,,,,46,39.1,13.1836,46,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
SUTURE MONOCRYL 5-0 PS-2 Y495G,,A4649,HCPCS,Facility,Outpatient,,,,46,39.1,13.1836,46,"UCare Health, Inc.",Medical Assistance,23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE MONOCRYL 5-0 PS-2 Y495G,,A4649,HCPCS,Facility,Inpatient,,,,46,39.1,13.1836,46,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
SUTURE MONOCRYL 5-0 PS-2 Y495G,,A4649,HCPCS,Facility,Outpatient,,,,46,39.1,13.1836,46,"UCare Health, Inc.",Medicare Advantage,23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE MONOCRYL 5-0 PS-2 Y495G,,A4649,HCPCS,Facility,Inpatient,,,,46,39.1,13.1836,46,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE MONOCRYL 5-0 PS-2 Y495G,,A4649,HCPCS,Facility,Outpatient,,,,46,39.1,13.1836,46,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE MONOCRYL 5-0 PS-2 Y495G,,A4649,HCPCS,Facility,Inpatient,,,,46,39.1,13.1836,46,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE MONOCRYL 5-0 PS-2 Y495G,,A4649,HCPCS,Facility,Both,,,,46,39.1,13.1836,46,UnitedHealthcare,Individual & Family,43.24,94,,percent of total billed charges,,
SUTURE MONOCRYL 5-0 PS-2 Y495G,,A4649,HCPCS,Facility,Outpatient,,,,46,39.1,13.1836,46,UnitedHealthcare,Medicare Advantage,22.54,49,,percent of total billed charges,,
SUTURE MONOCRYL 5-0 PS-2 Y495G,,A4649,HCPCS,Facility,Inpatient,,,,46,39.1,13.1836,46,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
SUTURE MONOCRYL 5-0 PS-2 Y495G,,A4649,HCPCS,Facility,Outpatient,,,,46,39.1,13.1836,46,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,22.08,48,,percent of total billed charges,,100% of DHS outpatient percentage
SUTURE MONOCRYL 5-0 PS-2 Y495G,,A4649,HCPCS,Facility,Inpatient,,,,46,39.1,13.1836,46,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
SUTURE MONOSOF 3/0 36IN BLACK C-13,,A4649,HCPCS,Facility,Both,,,,27.75,23.5875,7.95315,27.75,Aetna,Commercial,25.53,92,,percent of total billed charges,,
SUTURE MONOSOF 3/0 36IN BLACK C-13,,A4649,HCPCS,Facility,Outpatient,,,,27.75,23.5875,7.95315,27.75,Aetna,Medicare Advantage,13.5975,49,,percent of total billed charges,,
SUTURE MONOSOF 3/0 36IN BLACK C-13,,A4649,HCPCS,Facility,Inpatient,,,,27.75,23.5875,7.95315,27.75,Aetna,Medicare Advantage,,,,,Included in per diem rate,
SUTURE MONOSOF 3/0 36IN BLACK C-13,,A4649,HCPCS,Facility,Both,,,,27.75,23.5875,7.95315,27.75,Aetna,PPO,25.8075,93,,percent of total billed charges,,
SUTURE MONOSOF 3/0 36IN BLACK C-13,,A4649,HCPCS,Facility,Both,,,,27.75,23.5875,7.95315,27.75,America's PPO,America's PPO,26.648325,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SUTURE MONOSOF 3/0 36IN BLACK C-13,,A4649,HCPCS,Facility,Both,,,,27.75,23.5875,7.95315,27.75,BlueCross BlueShield Minnesota, Federal Employee Program,27.306,98.4,,percent of total billed charges,,
SUTURE MONOSOF 3/0 36IN BLACK C-13,,A4649,HCPCS,Facility,Both,,,,27.75,23.5875,7.95315,27.75,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,27.75,100,,percent of total billed charges,,
SUTURE MONOSOF 3/0 36IN BLACK C-13,,A4649,HCPCS,Facility,Both,,,,27.75,23.5875,7.95315,27.75,BlueCross BlueShield Minnesota,High Value Network Plan,24.975,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
SUTURE MONOSOF 3/0 36IN BLACK C-13,,A4649,HCPCS,Facility,Outpatient,,,,27.75,23.5875,7.95315,27.75,BlueCross BlueShield Minnesota,Medicare Advantage,13.5975,49,,percent of total billed charges,,
SUTURE MONOSOF 3/0 36IN BLACK C-13,,A4649,HCPCS,Facility,Inpatient,,,,27.75,23.5875,7.95315,27.75,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
SUTURE MONOSOF 3/0 36IN BLACK C-13,,A4649,HCPCS,Facility,Both,,,,27.75,23.5875,7.95315,27.75,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,24.578175,88.57,,percent of total billed charges,,
SUTURE MONOSOF 3/0 36IN BLACK C-13,,A4649,HCPCS,Facility,Both,,,,27.75,23.5875,7.95315,27.75,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,7.95315,28.66,,percent of total billed charges,,
SUTURE MONOSOF 3/0 36IN BLACK C-13,,A4649,HCPCS,Facility,Outpatient,,,,27.75,23.5875,7.95315,27.75,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),13.5975,49,,percent of total billed charges,,
SUTURE MONOSOF 3/0 36IN BLACK C-13,,A4649,HCPCS,Facility,Inpatient,,,,27.75,23.5875,7.95315,27.75,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
SUTURE MONOSOF 3/0 36IN BLACK C-13,,A4649,HCPCS,Facility,Both,,,,27.75,23.5875,7.95315,27.75,CorVel,Worker's Compensation,27.75,100,,percent of total billed charges,,
SUTURE MONOSOF 3/0 36IN BLACK C-13,,A4649,HCPCS,Facility,Both,,,,27.75,23.5875,7.95315,27.75,First Health Group Corporation,First Health Network,26.9175,97,,percent of total billed charges,,
SUTURE MONOSOF 3/0 36IN BLACK C-13,,A4649,HCPCS,Facility,Both,,,,27.75,23.5875,7.95315,27.75,"Health Partners, Inc.",Commercial,26.2515,94.6,,percent of total billed charges,,
SUTURE MONOSOF 3/0 36IN BLACK C-13,,A4649,HCPCS,Facility,Outpatient,,,,27.75,23.5875,7.95315,27.75,"Health Partners, Inc.",Medicare Advantage,13.5975,49,,percent of total billed charges,,
SUTURE MONOSOF 3/0 36IN BLACK C-13,,A4649,HCPCS,Facility,Inpatient,,,,27.75,23.5875,7.95315,27.75,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE MONOSOF 3/0 36IN BLACK C-13,,A4649,HCPCS,Facility,Both,,,,27.75,23.5875,7.95315,27.75,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),16.65,60,,percent of total billed charges,,
SUTURE MONOSOF 3/0 36IN BLACK C-13,,A4649,HCPCS,Facility,Both,,,,27.75,23.5875,7.95315,27.75,"Health Partners, Inc.",State of Minnesota Advantage Program,22.61625,81.5,,percent of total billed charges,,
SUTURE MONOSOF 3/0 36IN BLACK C-13,,A4649,HCPCS,Facility,Both,,,,27.75,23.5875,7.95315,27.75,"Health Partners, Inc.",State Public Programs,13.875,50,,percent of total billed charges,,
SUTURE MONOSOF 3/0 36IN BLACK C-13,,A4649,HCPCS,Facility,Both,,,,27.75,23.5875,7.95315,27.75,Humana Insurance Company,Commercial PPO,26.3625,95,,percent of total billed charges,,
SUTURE MONOSOF 3/0 36IN BLACK C-13,,A4649,HCPCS,Facility,Outpatient,,,,27.75,23.5875,7.95315,27.75,Humana Insurance Company,Medicare PPO,13.5975,49,,percent of total billed charges,,
SUTURE MONOSOF 3/0 36IN BLACK C-13,,A4649,HCPCS,Facility,Inpatient,,,,27.75,23.5875,7.95315,27.75,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
SUTURE MONOSOF 3/0 36IN BLACK C-13,,A4649,HCPCS,Facility,Both,,,,27.75,23.5875,7.95315,27.75,Medica,Individual & Family,27.50025,99.1,,percent of total billed charges,,
SUTURE MONOSOF 3/0 36IN BLACK C-13,,A4649,HCPCS,Facility,Outpatient,,,,27.75,23.5875,7.95315,27.75,Medica,Medica Advantage Solution,13.8195,49.8,,percent of total billed charges,,
SUTURE MONOSOF 3/0 36IN BLACK C-13,,A4649,HCPCS,Facility,Inpatient,,,,27.75,23.5875,7.95315,27.75,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
SUTURE MONOSOF 3/0 36IN BLACK C-13,,A4649,HCPCS,Facility,Outpatient,,,,27.75,23.5875,7.95315,27.75,Medica,Medical Assistance,12.3765,44.6,,percent of total billed charges,,
SUTURE MONOSOF 3/0 36IN BLACK C-13,,A4649,HCPCS,Facility,Inpatient,,,,27.75,23.5875,7.95315,27.75,Medica,Medical Assistance,,,,,Included in per diem rate,
SUTURE MONOSOF 3/0 36IN BLACK C-13,,A4649,HCPCS,Facility,Outpatient,,,,27.75,23.5875,7.95315,27.75,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,13.8195,49.8,,percent of total billed charges,,
SUTURE MONOSOF 3/0 36IN BLACK C-13,,A4649,HCPCS,Facility,Inpatient,,,,27.75,23.5875,7.95315,27.75,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
SUTURE MONOSOF 3/0 36IN BLACK C-13,,A4649,HCPCS,Facility,Both,,,,27.75,23.5875,7.95315,27.75,"Multiplan, Inc.","Multiplan, Inc.",26.085,94,,percent of total billed charges,,
SUTURE MONOSOF 3/0 36IN BLACK C-13,,A4649,HCPCS,Facility,Outpatient,,,,27.75,23.5875,7.95315,27.75,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,25.00275,90.1,,percent of total billed charges,,
SUTURE MONOSOF 3/0 36IN BLACK C-13,,A4649,HCPCS,Facility,Inpatient,,,,27.75,23.5875,7.95315,27.75,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
SUTURE MONOSOF 3/0 36IN BLACK C-13,,A4649,HCPCS,Facility,Both,,,,27.75,23.5875,7.95315,27.75,"Preferred One Administrative Services, INC.",PPO,27.3615,98.6,,percent of total billed charges,,
SUTURE MONOSOF 3/0 36IN BLACK C-13,,A4649,HCPCS,Facility,Outpatient,,,,27.75,23.5875,7.95315,27.75,PrimeWest Health,Minnesota Senior Health Options (MSHO),14.277375,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
SUTURE MONOSOF 3/0 36IN BLACK C-13,,A4649,HCPCS,Facility,Inpatient,,,,27.75,23.5875,7.95315,27.75,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE MONOSOF 3/0 36IN BLACK C-13,,A4649,HCPCS,Facility,Outpatient,,,,27.75,23.5875,7.95315,27.75,PrimeWest Health,MinnesotaCare,14.2524,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
SUTURE MONOSOF 3/0 36IN BLACK C-13,,A4649,HCPCS,Facility,Inpatient,,,,27.75,23.5875,7.95315,27.75,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
SUTURE MONOSOF 3/0 36IN BLACK C-13,,A4649,HCPCS,Facility,Both,,,,27.75,23.5875,7.95315,27.75,Sanford Health Plan,Sanford Health Plan,25.53,92,,percent of total billed charges,,
SUTURE MONOSOF 3/0 36IN BLACK C-13,,A4649,HCPCS,Facility,Outpatient,,,,27.75,23.5875,7.95315,27.75,"UCare Health, Inc.",Individual & Family Plan,15.637125,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
SUTURE MONOSOF 3/0 36IN BLACK C-13,,A4649,HCPCS,Facility,Inpatient,,,,27.75,23.5875,7.95315,27.75,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
SUTURE MONOSOF 3/0 36IN BLACK C-13,,A4649,HCPCS,Facility,Outpatient,,,,27.75,23.5875,7.95315,27.75,"UCare Health, Inc.",Medical Assistance,14.005425,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE MONOSOF 3/0 36IN BLACK C-13,,A4649,HCPCS,Facility,Inpatient,,,,27.75,23.5875,7.95315,27.75,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
SUTURE MONOSOF 3/0 36IN BLACK C-13,,A4649,HCPCS,Facility,Outpatient,,,,27.75,23.5875,7.95315,27.75,"UCare Health, Inc.",Medicare Advantage,14.005425,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE MONOSOF 3/0 36IN BLACK C-13,,A4649,HCPCS,Facility,Inpatient,,,,27.75,23.5875,7.95315,27.75,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE MONOSOF 3/0 36IN BLACK C-13,,A4649,HCPCS,Facility,Outpatient,,,,27.75,23.5875,7.95315,27.75,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),14.005425,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE MONOSOF 3/0 36IN BLACK C-13,,A4649,HCPCS,Facility,Inpatient,,,,27.75,23.5875,7.95315,27.75,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE MONOSOF 3/0 36IN BLACK C-13,,A4649,HCPCS,Facility,Both,,,,27.75,23.5875,7.95315,27.75,UnitedHealthcare,Individual & Family,26.085,94,,percent of total billed charges,,
SUTURE MONOSOF 3/0 36IN BLACK C-13,,A4649,HCPCS,Facility,Outpatient,,,,27.75,23.5875,7.95315,27.75,UnitedHealthcare,Medicare Advantage,13.5975,49,,percent of total billed charges,,
SUTURE MONOSOF 3/0 36IN BLACK C-13,,A4649,HCPCS,Facility,Inpatient,,,,27.75,23.5875,7.95315,27.75,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
SUTURE MONOSOF 3/0 36IN BLACK C-13,,A4649,HCPCS,Facility,Outpatient,,,,27.75,23.5875,7.95315,27.75,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,13.32,48,,percent of total billed charges,,100% of DHS outpatient percentage
SUTURE MONOSOF 3/0 36IN BLACK C-13,,A4649,HCPCS,Facility,Inpatient,,,,27.75,23.5875,7.95315,27.75,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
SUTURE MONOSOF 3-0 SN-665,,A4649,HCPCS,Facility,Both,,,,27.75,23.5875,7.95315,27.75,Aetna,Commercial,25.53,92,,percent of total billed charges,,
SUTURE MONOSOF 3-0 SN-665,,A4649,HCPCS,Facility,Outpatient,,,,27.75,23.5875,7.95315,27.75,Aetna,Medicare Advantage,13.5975,49,,percent of total billed charges,,
SUTURE MONOSOF 3-0 SN-665,,A4649,HCPCS,Facility,Inpatient,,,,27.75,23.5875,7.95315,27.75,Aetna,Medicare Advantage,,,,,Included in per diem rate,
SUTURE MONOSOF 3-0 SN-665,,A4649,HCPCS,Facility,Both,,,,27.75,23.5875,7.95315,27.75,Aetna,PPO,25.8075,93,,percent of total billed charges,,
SUTURE MONOSOF 3-0 SN-665,,A4649,HCPCS,Facility,Both,,,,27.75,23.5875,7.95315,27.75,America's PPO,America's PPO,26.648325,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SUTURE MONOSOF 3-0 SN-665,,A4649,HCPCS,Facility,Both,,,,27.75,23.5875,7.95315,27.75,BlueCross BlueShield Minnesota, Federal Employee Program,27.306,98.4,,percent of total billed charges,,
SUTURE MONOSOF 3-0 SN-665,,A4649,HCPCS,Facility,Both,,,,27.75,23.5875,7.95315,27.75,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,27.75,100,,percent of total billed charges,,
SUTURE MONOSOF 3-0 SN-665,,A4649,HCPCS,Facility,Both,,,,27.75,23.5875,7.95315,27.75,BlueCross BlueShield Minnesota,High Value Network Plan,24.975,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
SUTURE MONOSOF 3-0 SN-665,,A4649,HCPCS,Facility,Outpatient,,,,27.75,23.5875,7.95315,27.75,BlueCross BlueShield Minnesota,Medicare Advantage,13.5975,49,,percent of total billed charges,,
SUTURE MONOSOF 3-0 SN-665,,A4649,HCPCS,Facility,Inpatient,,,,27.75,23.5875,7.95315,27.75,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
SUTURE MONOSOF 3-0 SN-665,,A4649,HCPCS,Facility,Both,,,,27.75,23.5875,7.95315,27.75,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,24.578175,88.57,,percent of total billed charges,,
SUTURE MONOSOF 3-0 SN-665,,A4649,HCPCS,Facility,Both,,,,27.75,23.5875,7.95315,27.75,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,7.95315,28.66,,percent of total billed charges,,
SUTURE MONOSOF 3-0 SN-665,,A4649,HCPCS,Facility,Outpatient,,,,27.75,23.5875,7.95315,27.75,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),13.5975,49,,percent of total billed charges,,
SUTURE MONOSOF 3-0 SN-665,,A4649,HCPCS,Facility,Inpatient,,,,27.75,23.5875,7.95315,27.75,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
SUTURE MONOSOF 3-0 SN-665,,A4649,HCPCS,Facility,Both,,,,27.75,23.5875,7.95315,27.75,CorVel,Worker's Compensation,27.75,100,,percent of total billed charges,,
SUTURE MONOSOF 3-0 SN-665,,A4649,HCPCS,Facility,Both,,,,27.75,23.5875,7.95315,27.75,First Health Group Corporation,First Health Network,26.9175,97,,percent of total billed charges,,
SUTURE MONOSOF 3-0 SN-665,,A4649,HCPCS,Facility,Both,,,,27.75,23.5875,7.95315,27.75,"Health Partners, Inc.",Commercial,26.2515,94.6,,percent of total billed charges,,
SUTURE MONOSOF 3-0 SN-665,,A4649,HCPCS,Facility,Outpatient,,,,27.75,23.5875,7.95315,27.75,"Health Partners, Inc.",Medicare Advantage,13.5975,49,,percent of total billed charges,,
SUTURE MONOSOF 3-0 SN-665,,A4649,HCPCS,Facility,Inpatient,,,,27.75,23.5875,7.95315,27.75,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE MONOSOF 3-0 SN-665,,A4649,HCPCS,Facility,Both,,,,27.75,23.5875,7.95315,27.75,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),16.65,60,,percent of total billed charges,,
SUTURE MONOSOF 3-0 SN-665,,A4649,HCPCS,Facility,Both,,,,27.75,23.5875,7.95315,27.75,"Health Partners, Inc.",State of Minnesota Advantage Program,22.61625,81.5,,percent of total billed charges,,
SUTURE MONOSOF 3-0 SN-665,,A4649,HCPCS,Facility,Both,,,,27.75,23.5875,7.95315,27.75,"Health Partners, Inc.",State Public Programs,13.875,50,,percent of total billed charges,,
SUTURE MONOSOF 3-0 SN-665,,A4649,HCPCS,Facility,Both,,,,27.75,23.5875,7.95315,27.75,Humana Insurance Company,Commercial PPO,26.3625,95,,percent of total billed charges,,
SUTURE MONOSOF 3-0 SN-665,,A4649,HCPCS,Facility,Outpatient,,,,27.75,23.5875,7.95315,27.75,Humana Insurance Company,Medicare PPO,13.5975,49,,percent of total billed charges,,
SUTURE MONOSOF 3-0 SN-665,,A4649,HCPCS,Facility,Inpatient,,,,27.75,23.5875,7.95315,27.75,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
SUTURE MONOSOF 3-0 SN-665,,A4649,HCPCS,Facility,Both,,,,27.75,23.5875,7.95315,27.75,Medica,Individual & Family,27.50025,99.1,,percent of total billed charges,,
SUTURE MONOSOF 3-0 SN-665,,A4649,HCPCS,Facility,Outpatient,,,,27.75,23.5875,7.95315,27.75,Medica,Medica Advantage Solution,13.8195,49.8,,percent of total billed charges,,
SUTURE MONOSOF 3-0 SN-665,,A4649,HCPCS,Facility,Inpatient,,,,27.75,23.5875,7.95315,27.75,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
SUTURE MONOSOF 3-0 SN-665,,A4649,HCPCS,Facility,Outpatient,,,,27.75,23.5875,7.95315,27.75,Medica,Medical Assistance,12.3765,44.6,,percent of total billed charges,,
SUTURE MONOSOF 3-0 SN-665,,A4649,HCPCS,Facility,Inpatient,,,,27.75,23.5875,7.95315,27.75,Medica,Medical Assistance,,,,,Included in per diem rate,
SUTURE MONOSOF 3-0 SN-665,,A4649,HCPCS,Facility,Outpatient,,,,27.75,23.5875,7.95315,27.75,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,13.8195,49.8,,percent of total billed charges,,
SUTURE MONOSOF 3-0 SN-665,,A4649,HCPCS,Facility,Inpatient,,,,27.75,23.5875,7.95315,27.75,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
SUTURE MONOSOF 3-0 SN-665,,A4649,HCPCS,Facility,Both,,,,27.75,23.5875,7.95315,27.75,"Multiplan, Inc.","Multiplan, Inc.",26.085,94,,percent of total billed charges,,
SUTURE MONOSOF 3-0 SN-665,,A4649,HCPCS,Facility,Outpatient,,,,27.75,23.5875,7.95315,27.75,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,25.00275,90.1,,percent of total billed charges,,
SUTURE MONOSOF 3-0 SN-665,,A4649,HCPCS,Facility,Inpatient,,,,27.75,23.5875,7.95315,27.75,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
SUTURE MONOSOF 3-0 SN-665,,A4649,HCPCS,Facility,Both,,,,27.75,23.5875,7.95315,27.75,"Preferred One Administrative Services, INC.",PPO,27.3615,98.6,,percent of total billed charges,,
SUTURE MONOSOF 3-0 SN-665,,A4649,HCPCS,Facility,Outpatient,,,,27.75,23.5875,7.95315,27.75,PrimeWest Health,Minnesota Senior Health Options (MSHO),14.277375,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
SUTURE MONOSOF 3-0 SN-665,,A4649,HCPCS,Facility,Inpatient,,,,27.75,23.5875,7.95315,27.75,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE MONOSOF 3-0 SN-665,,A4649,HCPCS,Facility,Outpatient,,,,27.75,23.5875,7.95315,27.75,PrimeWest Health,MinnesotaCare,14.2524,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
SUTURE MONOSOF 3-0 SN-665,,A4649,HCPCS,Facility,Inpatient,,,,27.75,23.5875,7.95315,27.75,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
SUTURE MONOSOF 3-0 SN-665,,A4649,HCPCS,Facility,Both,,,,27.75,23.5875,7.95315,27.75,Sanford Health Plan,Sanford Health Plan,25.53,92,,percent of total billed charges,,
SUTURE MONOSOF 3-0 SN-665,,A4649,HCPCS,Facility,Outpatient,,,,27.75,23.5875,7.95315,27.75,"UCare Health, Inc.",Individual & Family Plan,15.637125,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
SUTURE MONOSOF 3-0 SN-665,,A4649,HCPCS,Facility,Inpatient,,,,27.75,23.5875,7.95315,27.75,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
SUTURE MONOSOF 3-0 SN-665,,A4649,HCPCS,Facility,Outpatient,,,,27.75,23.5875,7.95315,27.75,"UCare Health, Inc.",Medical Assistance,14.005425,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE MONOSOF 3-0 SN-665,,A4649,HCPCS,Facility,Inpatient,,,,27.75,23.5875,7.95315,27.75,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
SUTURE MONOSOF 3-0 SN-665,,A4649,HCPCS,Facility,Outpatient,,,,27.75,23.5875,7.95315,27.75,"UCare Health, Inc.",Medicare Advantage,14.005425,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE MONOSOF 3-0 SN-665,,A4649,HCPCS,Facility,Inpatient,,,,27.75,23.5875,7.95315,27.75,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE MONOSOF 3-0 SN-665,,A4649,HCPCS,Facility,Outpatient,,,,27.75,23.5875,7.95315,27.75,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),14.005425,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE MONOSOF 3-0 SN-665,,A4649,HCPCS,Facility,Inpatient,,,,27.75,23.5875,7.95315,27.75,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE MONOSOF 3-0 SN-665,,A4649,HCPCS,Facility,Both,,,,27.75,23.5875,7.95315,27.75,UnitedHealthcare,Individual & Family,26.085,94,,percent of total billed charges,,
SUTURE MONOSOF 3-0 SN-665,,A4649,HCPCS,Facility,Outpatient,,,,27.75,23.5875,7.95315,27.75,UnitedHealthcare,Medicare Advantage,13.5975,49,,percent of total billed charges,,
SUTURE MONOSOF 3-0 SN-665,,A4649,HCPCS,Facility,Inpatient,,,,27.75,23.5875,7.95315,27.75,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
SUTURE MONOSOF 3-0 SN-665,,A4649,HCPCS,Facility,Outpatient,,,,27.75,23.5875,7.95315,27.75,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,13.32,48,,percent of total billed charges,,100% of DHS outpatient percentage
SUTURE MONOSOF 3-0 SN-665,,A4649,HCPCS,Facility,Inpatient,,,,27.75,23.5875,7.95315,27.75,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"SUTURE MONOSOF 4-0 18"" BLK P-13  SN5699G",,A4649,HCPCS,Facility,Both,,,,49.5,42.075,14.1867,49.5,Aetna,Commercial,45.54,92,,percent of total billed charges,,
"SUTURE MONOSOF 4-0 18"" BLK P-13  SN5699G",,A4649,HCPCS,Facility,Outpatient,,,,49.5,42.075,14.1867,49.5,Aetna,Medicare Advantage,24.255,49,,percent of total billed charges,,
"SUTURE MONOSOF 4-0 18"" BLK P-13  SN5699G",,A4649,HCPCS,Facility,Inpatient,,,,49.5,42.075,14.1867,49.5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"SUTURE MONOSOF 4-0 18"" BLK P-13  SN5699G",,A4649,HCPCS,Facility,Both,,,,49.5,42.075,14.1867,49.5,Aetna,PPO,46.035,93,,percent of total billed charges,,
"SUTURE MONOSOF 4-0 18"" BLK P-13  SN5699G",,A4649,HCPCS,Facility,Both,,,,49.5,42.075,14.1867,49.5,America's PPO,America's PPO,47.53485,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"SUTURE MONOSOF 4-0 18"" BLK P-13  SN5699G",,A4649,HCPCS,Facility,Both,,,,49.5,42.075,14.1867,49.5,BlueCross BlueShield Minnesota, Federal Employee Program,48.708,98.4,,percent of total billed charges,,
"SUTURE MONOSOF 4-0 18"" BLK P-13  SN5699G",,A4649,HCPCS,Facility,Both,,,,49.5,42.075,14.1867,49.5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,49.5,100,,percent of total billed charges,,
"SUTURE MONOSOF 4-0 18"" BLK P-13  SN5699G",,A4649,HCPCS,Facility,Both,,,,49.5,42.075,14.1867,49.5,BlueCross BlueShield Minnesota,High Value Network Plan,44.55,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
"SUTURE MONOSOF 4-0 18"" BLK P-13  SN5699G",,A4649,HCPCS,Facility,Outpatient,,,,49.5,42.075,14.1867,49.5,BlueCross BlueShield Minnesota,Medicare Advantage,24.255,49,,percent of total billed charges,,
"SUTURE MONOSOF 4-0 18"" BLK P-13  SN5699G",,A4649,HCPCS,Facility,Inpatient,,,,49.5,42.075,14.1867,49.5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"SUTURE MONOSOF 4-0 18"" BLK P-13  SN5699G",,A4649,HCPCS,Facility,Both,,,,49.5,42.075,14.1867,49.5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,43.84215,88.57,,percent of total billed charges,,
"SUTURE MONOSOF 4-0 18"" BLK P-13  SN5699G",,A4649,HCPCS,Facility,Both,,,,49.5,42.075,14.1867,49.5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,14.1867,28.66,,percent of total billed charges,,
"SUTURE MONOSOF 4-0 18"" BLK P-13  SN5699G",,A4649,HCPCS,Facility,Outpatient,,,,49.5,42.075,14.1867,49.5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),24.255,49,,percent of total billed charges,,
"SUTURE MONOSOF 4-0 18"" BLK P-13  SN5699G",,A4649,HCPCS,Facility,Inpatient,,,,49.5,42.075,14.1867,49.5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"SUTURE MONOSOF 4-0 18"" BLK P-13  SN5699G",,A4649,HCPCS,Facility,Both,,,,49.5,42.075,14.1867,49.5,CorVel,Worker's Compensation,49.5,100,,percent of total billed charges,,
"SUTURE MONOSOF 4-0 18"" BLK P-13  SN5699G",,A4649,HCPCS,Facility,Both,,,,49.5,42.075,14.1867,49.5,First Health Group Corporation,First Health Network,48.015,97,,percent of total billed charges,,
"SUTURE MONOSOF 4-0 18"" BLK P-13  SN5699G",,A4649,HCPCS,Facility,Both,,,,49.5,42.075,14.1867,49.5,"Health Partners, Inc.",Commercial,46.827,94.6,,percent of total billed charges,,
"SUTURE MONOSOF 4-0 18"" BLK P-13  SN5699G",,A4649,HCPCS,Facility,Outpatient,,,,49.5,42.075,14.1867,49.5,"Health Partners, Inc.",Medicare Advantage,24.255,49,,percent of total billed charges,,
"SUTURE MONOSOF 4-0 18"" BLK P-13  SN5699G",,A4649,HCPCS,Facility,Inpatient,,,,49.5,42.075,14.1867,49.5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"SUTURE MONOSOF 4-0 18"" BLK P-13  SN5699G",,A4649,HCPCS,Facility,Both,,,,49.5,42.075,14.1867,49.5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),29.7,60,,percent of total billed charges,,
"SUTURE MONOSOF 4-0 18"" BLK P-13  SN5699G",,A4649,HCPCS,Facility,Both,,,,49.5,42.075,14.1867,49.5,"Health Partners, Inc.",State of Minnesota Advantage Program,40.3425,81.5,,percent of total billed charges,,
"SUTURE MONOSOF 4-0 18"" BLK P-13  SN5699G",,A4649,HCPCS,Facility,Both,,,,49.5,42.075,14.1867,49.5,"Health Partners, Inc.",State Public Programs,24.75,50,,percent of total billed charges,,
"SUTURE MONOSOF 4-0 18"" BLK P-13  SN5699G",,A4649,HCPCS,Facility,Both,,,,49.5,42.075,14.1867,49.5,Humana Insurance Company,Commercial PPO,47.025,95,,percent of total billed charges,,
"SUTURE MONOSOF 4-0 18"" BLK P-13  SN5699G",,A4649,HCPCS,Facility,Outpatient,,,,49.5,42.075,14.1867,49.5,Humana Insurance Company,Medicare PPO,24.255,49,,percent of total billed charges,,
"SUTURE MONOSOF 4-0 18"" BLK P-13  SN5699G",,A4649,HCPCS,Facility,Inpatient,,,,49.5,42.075,14.1867,49.5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"SUTURE MONOSOF 4-0 18"" BLK P-13  SN5699G",,A4649,HCPCS,Facility,Both,,,,49.5,42.075,14.1867,49.5,Medica,Individual & Family,49.0545,99.1,,percent of total billed charges,,
"SUTURE MONOSOF 4-0 18"" BLK P-13  SN5699G",,A4649,HCPCS,Facility,Outpatient,,,,49.5,42.075,14.1867,49.5,Medica,Medica Advantage Solution,24.651,49.8,,percent of total billed charges,,
"SUTURE MONOSOF 4-0 18"" BLK P-13  SN5699G",,A4649,HCPCS,Facility,Inpatient,,,,49.5,42.075,14.1867,49.5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"SUTURE MONOSOF 4-0 18"" BLK P-13  SN5699G",,A4649,HCPCS,Facility,Outpatient,,,,49.5,42.075,14.1867,49.5,Medica,Medical Assistance,22.077,44.6,,percent of total billed charges,,
"SUTURE MONOSOF 4-0 18"" BLK P-13  SN5699G",,A4649,HCPCS,Facility,Inpatient,,,,49.5,42.075,14.1867,49.5,Medica,Medical Assistance,,,,,Included in per diem rate,
"SUTURE MONOSOF 4-0 18"" BLK P-13  SN5699G",,A4649,HCPCS,Facility,Outpatient,,,,49.5,42.075,14.1867,49.5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,24.651,49.8,,percent of total billed charges,,
"SUTURE MONOSOF 4-0 18"" BLK P-13  SN5699G",,A4649,HCPCS,Facility,Inpatient,,,,49.5,42.075,14.1867,49.5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"SUTURE MONOSOF 4-0 18"" BLK P-13  SN5699G",,A4649,HCPCS,Facility,Both,,,,49.5,42.075,14.1867,49.5,"Multiplan, Inc.","Multiplan, Inc.",46.53,94,,percent of total billed charges,,
"SUTURE MONOSOF 4-0 18"" BLK P-13  SN5699G",,A4649,HCPCS,Facility,Outpatient,,,,49.5,42.075,14.1867,49.5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,44.5995,90.1,,percent of total billed charges,,
"SUTURE MONOSOF 4-0 18"" BLK P-13  SN5699G",,A4649,HCPCS,Facility,Inpatient,,,,49.5,42.075,14.1867,49.5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"SUTURE MONOSOF 4-0 18"" BLK P-13  SN5699G",,A4649,HCPCS,Facility,Both,,,,49.5,42.075,14.1867,49.5,"Preferred One Administrative Services, INC.",PPO,48.807,98.6,,percent of total billed charges,,
"SUTURE MONOSOF 4-0 18"" BLK P-13  SN5699G",,A4649,HCPCS,Facility,Outpatient,,,,49.5,42.075,14.1867,49.5,PrimeWest Health,Minnesota Senior Health Options (MSHO),25.46775,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"SUTURE MONOSOF 4-0 18"" BLK P-13  SN5699G",,A4649,HCPCS,Facility,Inpatient,,,,49.5,42.075,14.1867,49.5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"SUTURE MONOSOF 4-0 18"" BLK P-13  SN5699G",,A4649,HCPCS,Facility,Outpatient,,,,49.5,42.075,14.1867,49.5,PrimeWest Health,MinnesotaCare,25.4232,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"SUTURE MONOSOF 4-0 18"" BLK P-13  SN5699G",,A4649,HCPCS,Facility,Inpatient,,,,49.5,42.075,14.1867,49.5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"SUTURE MONOSOF 4-0 18"" BLK P-13  SN5699G",,A4649,HCPCS,Facility,Both,,,,49.5,42.075,14.1867,49.5,Sanford Health Plan,Sanford Health Plan,45.54,92,,percent of total billed charges,,
"SUTURE MONOSOF 4-0 18"" BLK P-13  SN5699G",,A4649,HCPCS,Facility,Outpatient,,,,49.5,42.075,14.1867,49.5,"UCare Health, Inc.",Individual & Family Plan,27.89325,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"SUTURE MONOSOF 4-0 18"" BLK P-13  SN5699G",,A4649,HCPCS,Facility,Inpatient,,,,49.5,42.075,14.1867,49.5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"SUTURE MONOSOF 4-0 18"" BLK P-13  SN5699G",,A4649,HCPCS,Facility,Outpatient,,,,49.5,42.075,14.1867,49.5,"UCare Health, Inc.",Medical Assistance,24.98265,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"SUTURE MONOSOF 4-0 18"" BLK P-13  SN5699G",,A4649,HCPCS,Facility,Inpatient,,,,49.5,42.075,14.1867,49.5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"SUTURE MONOSOF 4-0 18"" BLK P-13  SN5699G",,A4649,HCPCS,Facility,Outpatient,,,,49.5,42.075,14.1867,49.5,"UCare Health, Inc.",Medicare Advantage,24.98265,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"SUTURE MONOSOF 4-0 18"" BLK P-13  SN5699G",,A4649,HCPCS,Facility,Inpatient,,,,49.5,42.075,14.1867,49.5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"SUTURE MONOSOF 4-0 18"" BLK P-13  SN5699G",,A4649,HCPCS,Facility,Outpatient,,,,49.5,42.075,14.1867,49.5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),24.98265,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"SUTURE MONOSOF 4-0 18"" BLK P-13  SN5699G",,A4649,HCPCS,Facility,Inpatient,,,,49.5,42.075,14.1867,49.5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"SUTURE MONOSOF 4-0 18"" BLK P-13  SN5699G",,A4649,HCPCS,Facility,Both,,,,49.5,42.075,14.1867,49.5,UnitedHealthcare,Individual & Family,46.53,94,,percent of total billed charges,,
"SUTURE MONOSOF 4-0 18"" BLK P-13  SN5699G",,A4649,HCPCS,Facility,Outpatient,,,,49.5,42.075,14.1867,49.5,UnitedHealthcare,Medicare Advantage,24.255,49,,percent of total billed charges,,
"SUTURE MONOSOF 4-0 18"" BLK P-13  SN5699G",,A4649,HCPCS,Facility,Inpatient,,,,49.5,42.075,14.1867,49.5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"SUTURE MONOSOF 4-0 18"" BLK P-13  SN5699G",,A4649,HCPCS,Facility,Outpatient,,,,49.5,42.075,14.1867,49.5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,23.76,48,,percent of total billed charges,,100% of DHS outpatient percentage
"SUTURE MONOSOF 4-0 18"" BLK P-13  SN5699G",,A4649,HCPCS,Facility,Inpatient,,,,49.5,42.075,14.1867,49.5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
SUTURE MONOSOF 4-0 SN-5699G,,A4649,HCPCS,Facility,Both,,,,49.5,42.075,14.1867,49.5,Aetna,Commercial,45.54,92,,percent of total billed charges,,
SUTURE MONOSOF 4-0 SN-5699G,,A4649,HCPCS,Facility,Outpatient,,,,49.5,42.075,14.1867,49.5,Aetna,Medicare Advantage,24.255,49,,percent of total billed charges,,
SUTURE MONOSOF 4-0 SN-5699G,,A4649,HCPCS,Facility,Inpatient,,,,49.5,42.075,14.1867,49.5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
SUTURE MONOSOF 4-0 SN-5699G,,A4649,HCPCS,Facility,Both,,,,49.5,42.075,14.1867,49.5,Aetna,PPO,46.035,93,,percent of total billed charges,,
SUTURE MONOSOF 4-0 SN-5699G,,A4649,HCPCS,Facility,Both,,,,49.5,42.075,14.1867,49.5,America's PPO,America's PPO,47.53485,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SUTURE MONOSOF 4-0 SN-5699G,,A4649,HCPCS,Facility,Both,,,,49.5,42.075,14.1867,49.5,BlueCross BlueShield Minnesota, Federal Employee Program,48.708,98.4,,percent of total billed charges,,
SUTURE MONOSOF 4-0 SN-5699G,,A4649,HCPCS,Facility,Both,,,,49.5,42.075,14.1867,49.5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,49.5,100,,percent of total billed charges,,
SUTURE MONOSOF 4-0 SN-5699G,,A4649,HCPCS,Facility,Both,,,,49.5,42.075,14.1867,49.5,BlueCross BlueShield Minnesota,High Value Network Plan,44.55,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
SUTURE MONOSOF 4-0 SN-5699G,,A4649,HCPCS,Facility,Outpatient,,,,49.5,42.075,14.1867,49.5,BlueCross BlueShield Minnesota,Medicare Advantage,24.255,49,,percent of total billed charges,,
SUTURE MONOSOF 4-0 SN-5699G,,A4649,HCPCS,Facility,Inpatient,,,,49.5,42.075,14.1867,49.5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
SUTURE MONOSOF 4-0 SN-5699G,,A4649,HCPCS,Facility,Both,,,,49.5,42.075,14.1867,49.5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,43.84215,88.57,,percent of total billed charges,,
SUTURE MONOSOF 4-0 SN-5699G,,A4649,HCPCS,Facility,Both,,,,49.5,42.075,14.1867,49.5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,14.1867,28.66,,percent of total billed charges,,
SUTURE MONOSOF 4-0 SN-5699G,,A4649,HCPCS,Facility,Outpatient,,,,49.5,42.075,14.1867,49.5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),24.255,49,,percent of total billed charges,,
SUTURE MONOSOF 4-0 SN-5699G,,A4649,HCPCS,Facility,Inpatient,,,,49.5,42.075,14.1867,49.5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
SUTURE MONOSOF 4-0 SN-5699G,,A4649,HCPCS,Facility,Both,,,,49.5,42.075,14.1867,49.5,CorVel,Worker's Compensation,49.5,100,,percent of total billed charges,,
SUTURE MONOSOF 4-0 SN-5699G,,A4649,HCPCS,Facility,Both,,,,49.5,42.075,14.1867,49.5,First Health Group Corporation,First Health Network,48.015,97,,percent of total billed charges,,
SUTURE MONOSOF 4-0 SN-5699G,,A4649,HCPCS,Facility,Both,,,,49.5,42.075,14.1867,49.5,"Health Partners, Inc.",Commercial,46.827,94.6,,percent of total billed charges,,
SUTURE MONOSOF 4-0 SN-5699G,,A4649,HCPCS,Facility,Outpatient,,,,49.5,42.075,14.1867,49.5,"Health Partners, Inc.",Medicare Advantage,24.255,49,,percent of total billed charges,,
SUTURE MONOSOF 4-0 SN-5699G,,A4649,HCPCS,Facility,Inpatient,,,,49.5,42.075,14.1867,49.5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE MONOSOF 4-0 SN-5699G,,A4649,HCPCS,Facility,Both,,,,49.5,42.075,14.1867,49.5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),29.7,60,,percent of total billed charges,,
SUTURE MONOSOF 4-0 SN-5699G,,A4649,HCPCS,Facility,Both,,,,49.5,42.075,14.1867,49.5,"Health Partners, Inc.",State of Minnesota Advantage Program,40.3425,81.5,,percent of total billed charges,,
SUTURE MONOSOF 4-0 SN-5699G,,A4649,HCPCS,Facility,Both,,,,49.5,42.075,14.1867,49.5,"Health Partners, Inc.",State Public Programs,24.75,50,,percent of total billed charges,,
SUTURE MONOSOF 4-0 SN-5699G,,A4649,HCPCS,Facility,Both,,,,49.5,42.075,14.1867,49.5,Humana Insurance Company,Commercial PPO,47.025,95,,percent of total billed charges,,
SUTURE MONOSOF 4-0 SN-5699G,,A4649,HCPCS,Facility,Outpatient,,,,49.5,42.075,14.1867,49.5,Humana Insurance Company,Medicare PPO,24.255,49,,percent of total billed charges,,
SUTURE MONOSOF 4-0 SN-5699G,,A4649,HCPCS,Facility,Inpatient,,,,49.5,42.075,14.1867,49.5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
SUTURE MONOSOF 4-0 SN-5699G,,A4649,HCPCS,Facility,Both,,,,49.5,42.075,14.1867,49.5,Medica,Individual & Family,49.0545,99.1,,percent of total billed charges,,
SUTURE MONOSOF 4-0 SN-5699G,,A4649,HCPCS,Facility,Outpatient,,,,49.5,42.075,14.1867,49.5,Medica,Medica Advantage Solution,24.651,49.8,,percent of total billed charges,,
SUTURE MONOSOF 4-0 SN-5699G,,A4649,HCPCS,Facility,Inpatient,,,,49.5,42.075,14.1867,49.5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
SUTURE MONOSOF 4-0 SN-5699G,,A4649,HCPCS,Facility,Outpatient,,,,49.5,42.075,14.1867,49.5,Medica,Medical Assistance,22.077,44.6,,percent of total billed charges,,
SUTURE MONOSOF 4-0 SN-5699G,,A4649,HCPCS,Facility,Inpatient,,,,49.5,42.075,14.1867,49.5,Medica,Medical Assistance,,,,,Included in per diem rate,
SUTURE MONOSOF 4-0 SN-5699G,,A4649,HCPCS,Facility,Outpatient,,,,49.5,42.075,14.1867,49.5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,24.651,49.8,,percent of total billed charges,,
SUTURE MONOSOF 4-0 SN-5699G,,A4649,HCPCS,Facility,Inpatient,,,,49.5,42.075,14.1867,49.5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
SUTURE MONOSOF 4-0 SN-5699G,,A4649,HCPCS,Facility,Both,,,,49.5,42.075,14.1867,49.5,"Multiplan, Inc.","Multiplan, Inc.",46.53,94,,percent of total billed charges,,
SUTURE MONOSOF 4-0 SN-5699G,,A4649,HCPCS,Facility,Outpatient,,,,49.5,42.075,14.1867,49.5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,44.5995,90.1,,percent of total billed charges,,
SUTURE MONOSOF 4-0 SN-5699G,,A4649,HCPCS,Facility,Inpatient,,,,49.5,42.075,14.1867,49.5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
SUTURE MONOSOF 4-0 SN-5699G,,A4649,HCPCS,Facility,Both,,,,49.5,42.075,14.1867,49.5,"Preferred One Administrative Services, INC.",PPO,48.807,98.6,,percent of total billed charges,,
SUTURE MONOSOF 4-0 SN-5699G,,A4649,HCPCS,Facility,Outpatient,,,,49.5,42.075,14.1867,49.5,PrimeWest Health,Minnesota Senior Health Options (MSHO),25.46775,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
SUTURE MONOSOF 4-0 SN-5699G,,A4649,HCPCS,Facility,Inpatient,,,,49.5,42.075,14.1867,49.5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE MONOSOF 4-0 SN-5699G,,A4649,HCPCS,Facility,Outpatient,,,,49.5,42.075,14.1867,49.5,PrimeWest Health,MinnesotaCare,25.4232,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
SUTURE MONOSOF 4-0 SN-5699G,,A4649,HCPCS,Facility,Inpatient,,,,49.5,42.075,14.1867,49.5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
SUTURE MONOSOF 4-0 SN-5699G,,A4649,HCPCS,Facility,Both,,,,49.5,42.075,14.1867,49.5,Sanford Health Plan,Sanford Health Plan,45.54,92,,percent of total billed charges,,
SUTURE MONOSOF 4-0 SN-5699G,,A4649,HCPCS,Facility,Outpatient,,,,49.5,42.075,14.1867,49.5,"UCare Health, Inc.",Individual & Family Plan,27.89325,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
SUTURE MONOSOF 4-0 SN-5699G,,A4649,HCPCS,Facility,Inpatient,,,,49.5,42.075,14.1867,49.5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
SUTURE MONOSOF 4-0 SN-5699G,,A4649,HCPCS,Facility,Outpatient,,,,49.5,42.075,14.1867,49.5,"UCare Health, Inc.",Medical Assistance,24.98265,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE MONOSOF 4-0 SN-5699G,,A4649,HCPCS,Facility,Inpatient,,,,49.5,42.075,14.1867,49.5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
SUTURE MONOSOF 4-0 SN-5699G,,A4649,HCPCS,Facility,Outpatient,,,,49.5,42.075,14.1867,49.5,"UCare Health, Inc.",Medicare Advantage,24.98265,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE MONOSOF 4-0 SN-5699G,,A4649,HCPCS,Facility,Inpatient,,,,49.5,42.075,14.1867,49.5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE MONOSOF 4-0 SN-5699G,,A4649,HCPCS,Facility,Outpatient,,,,49.5,42.075,14.1867,49.5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),24.98265,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE MONOSOF 4-0 SN-5699G,,A4649,HCPCS,Facility,Inpatient,,,,49.5,42.075,14.1867,49.5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE MONOSOF 4-0 SN-5699G,,A4649,HCPCS,Facility,Both,,,,49.5,42.075,14.1867,49.5,UnitedHealthcare,Individual & Family,46.53,94,,percent of total billed charges,,
SUTURE MONOSOF 4-0 SN-5699G,,A4649,HCPCS,Facility,Outpatient,,,,49.5,42.075,14.1867,49.5,UnitedHealthcare,Medicare Advantage,24.255,49,,percent of total billed charges,,
SUTURE MONOSOF 4-0 SN-5699G,,A4649,HCPCS,Facility,Inpatient,,,,49.5,42.075,14.1867,49.5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
SUTURE MONOSOF 4-0 SN-5699G,,A4649,HCPCS,Facility,Outpatient,,,,49.5,42.075,14.1867,49.5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,23.76,48,,percent of total billed charges,,100% of DHS outpatient percentage
SUTURE MONOSOF 4-0 SN-5699G,,A4649,HCPCS,Facility,Inpatient,,,,49.5,42.075,14.1867,49.5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
SUTURE MONOSOF 4-0 SN-662,,A4649,HCPCS,Facility,Both,,,,34.2,29.07,9.80172,34.2,Aetna,Commercial,31.464,92,,percent of total billed charges,,
SUTURE MONOSOF 4-0 SN-662,,A4649,HCPCS,Facility,Outpatient,,,,34.2,29.07,9.80172,34.2,Aetna,Medicare Advantage,16.758,49,,percent of total billed charges,,
SUTURE MONOSOF 4-0 SN-662,,A4649,HCPCS,Facility,Inpatient,,,,34.2,29.07,9.80172,34.2,Aetna,Medicare Advantage,,,,,Included in per diem rate,
SUTURE MONOSOF 4-0 SN-662,,A4649,HCPCS,Facility,Both,,,,34.2,29.07,9.80172,34.2,Aetna,PPO,31.806,93,,percent of total billed charges,,
SUTURE MONOSOF 4-0 SN-662,,A4649,HCPCS,Facility,Both,,,,34.2,29.07,9.80172,34.2,America's PPO,America's PPO,32.84226,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SUTURE MONOSOF 4-0 SN-662,,A4649,HCPCS,Facility,Both,,,,34.2,29.07,9.80172,34.2,BlueCross BlueShield Minnesota, Federal Employee Program,33.6528,98.4,,percent of total billed charges,,
SUTURE MONOSOF 4-0 SN-662,,A4649,HCPCS,Facility,Both,,,,34.2,29.07,9.80172,34.2,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,34.2,100,,percent of total billed charges,,
SUTURE MONOSOF 4-0 SN-662,,A4649,HCPCS,Facility,Both,,,,34.2,29.07,9.80172,34.2,BlueCross BlueShield Minnesota,High Value Network Plan,30.78,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
SUTURE MONOSOF 4-0 SN-662,,A4649,HCPCS,Facility,Outpatient,,,,34.2,29.07,9.80172,34.2,BlueCross BlueShield Minnesota,Medicare Advantage,16.758,49,,percent of total billed charges,,
SUTURE MONOSOF 4-0 SN-662,,A4649,HCPCS,Facility,Inpatient,,,,34.2,29.07,9.80172,34.2,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
SUTURE MONOSOF 4-0 SN-662,,A4649,HCPCS,Facility,Both,,,,34.2,29.07,9.80172,34.2,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,30.29094,88.57,,percent of total billed charges,,
SUTURE MONOSOF 4-0 SN-662,,A4649,HCPCS,Facility,Both,,,,34.2,29.07,9.80172,34.2,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,9.80172,28.66,,percent of total billed charges,,
SUTURE MONOSOF 4-0 SN-662,,A4649,HCPCS,Facility,Outpatient,,,,34.2,29.07,9.80172,34.2,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),16.758,49,,percent of total billed charges,,
SUTURE MONOSOF 4-0 SN-662,,A4649,HCPCS,Facility,Inpatient,,,,34.2,29.07,9.80172,34.2,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
SUTURE MONOSOF 4-0 SN-662,,A4649,HCPCS,Facility,Both,,,,34.2,29.07,9.80172,34.2,CorVel,Worker's Compensation,34.2,100,,percent of total billed charges,,
SUTURE MONOSOF 4-0 SN-662,,A4649,HCPCS,Facility,Both,,,,34.2,29.07,9.80172,34.2,First Health Group Corporation,First Health Network,33.174,97,,percent of total billed charges,,
SUTURE MONOSOF 4-0 SN-662,,A4649,HCPCS,Facility,Both,,,,34.2,29.07,9.80172,34.2,"Health Partners, Inc.",Commercial,32.3532,94.6,,percent of total billed charges,,
SUTURE MONOSOF 4-0 SN-662,,A4649,HCPCS,Facility,Outpatient,,,,34.2,29.07,9.80172,34.2,"Health Partners, Inc.",Medicare Advantage,16.758,49,,percent of total billed charges,,
SUTURE MONOSOF 4-0 SN-662,,A4649,HCPCS,Facility,Inpatient,,,,34.2,29.07,9.80172,34.2,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE MONOSOF 4-0 SN-662,,A4649,HCPCS,Facility,Both,,,,34.2,29.07,9.80172,34.2,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),20.52,60,,percent of total billed charges,,
SUTURE MONOSOF 4-0 SN-662,,A4649,HCPCS,Facility,Both,,,,34.2,29.07,9.80172,34.2,"Health Partners, Inc.",State of Minnesota Advantage Program,27.873,81.5,,percent of total billed charges,,
SUTURE MONOSOF 4-0 SN-662,,A4649,HCPCS,Facility,Both,,,,34.2,29.07,9.80172,34.2,"Health Partners, Inc.",State Public Programs,17.1,50,,percent of total billed charges,,
SUTURE MONOSOF 4-0 SN-662,,A4649,HCPCS,Facility,Both,,,,34.2,29.07,9.80172,34.2,Humana Insurance Company,Commercial PPO,32.49,95,,percent of total billed charges,,
SUTURE MONOSOF 4-0 SN-662,,A4649,HCPCS,Facility,Outpatient,,,,34.2,29.07,9.80172,34.2,Humana Insurance Company,Medicare PPO,16.758,49,,percent of total billed charges,,
SUTURE MONOSOF 4-0 SN-662,,A4649,HCPCS,Facility,Inpatient,,,,34.2,29.07,9.80172,34.2,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
SUTURE MONOSOF 4-0 SN-662,,A4649,HCPCS,Facility,Both,,,,34.2,29.07,9.80172,34.2,Medica,Individual & Family,33.8922,99.1,,percent of total billed charges,,
SUTURE MONOSOF 4-0 SN-662,,A4649,HCPCS,Facility,Outpatient,,,,34.2,29.07,9.80172,34.2,Medica,Medica Advantage Solution,17.0316,49.8,,percent of total billed charges,,
SUTURE MONOSOF 4-0 SN-662,,A4649,HCPCS,Facility,Inpatient,,,,34.2,29.07,9.80172,34.2,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
SUTURE MONOSOF 4-0 SN-662,,A4649,HCPCS,Facility,Outpatient,,,,34.2,29.07,9.80172,34.2,Medica,Medical Assistance,15.2532,44.6,,percent of total billed charges,,
SUTURE MONOSOF 4-0 SN-662,,A4649,HCPCS,Facility,Inpatient,,,,34.2,29.07,9.80172,34.2,Medica,Medical Assistance,,,,,Included in per diem rate,
SUTURE MONOSOF 4-0 SN-662,,A4649,HCPCS,Facility,Outpatient,,,,34.2,29.07,9.80172,34.2,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,17.0316,49.8,,percent of total billed charges,,
SUTURE MONOSOF 4-0 SN-662,,A4649,HCPCS,Facility,Inpatient,,,,34.2,29.07,9.80172,34.2,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
SUTURE MONOSOF 4-0 SN-662,,A4649,HCPCS,Facility,Both,,,,34.2,29.07,9.80172,34.2,"Multiplan, Inc.","Multiplan, Inc.",32.148,94,,percent of total billed charges,,
SUTURE MONOSOF 4-0 SN-662,,A4649,HCPCS,Facility,Outpatient,,,,34.2,29.07,9.80172,34.2,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,30.8142,90.1,,percent of total billed charges,,
SUTURE MONOSOF 4-0 SN-662,,A4649,HCPCS,Facility,Inpatient,,,,34.2,29.07,9.80172,34.2,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
SUTURE MONOSOF 4-0 SN-662,,A4649,HCPCS,Facility,Both,,,,34.2,29.07,9.80172,34.2,"Preferred One Administrative Services, INC.",PPO,33.7212,98.6,,percent of total billed charges,,
SUTURE MONOSOF 4-0 SN-662,,A4649,HCPCS,Facility,Outpatient,,,,34.2,29.07,9.80172,34.2,PrimeWest Health,Minnesota Senior Health Options (MSHO),17.5959,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
SUTURE MONOSOF 4-0 SN-662,,A4649,HCPCS,Facility,Inpatient,,,,34.2,29.07,9.80172,34.2,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE MONOSOF 4-0 SN-662,,A4649,HCPCS,Facility,Outpatient,,,,34.2,29.07,9.80172,34.2,PrimeWest Health,MinnesotaCare,17.56512,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
SUTURE MONOSOF 4-0 SN-662,,A4649,HCPCS,Facility,Inpatient,,,,34.2,29.07,9.80172,34.2,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
SUTURE MONOSOF 4-0 SN-662,,A4649,HCPCS,Facility,Both,,,,34.2,29.07,9.80172,34.2,Sanford Health Plan,Sanford Health Plan,31.464,92,,percent of total billed charges,,
SUTURE MONOSOF 4-0 SN-662,,A4649,HCPCS,Facility,Outpatient,,,,34.2,29.07,9.80172,34.2,"UCare Health, Inc.",Individual & Family Plan,19.2717,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
SUTURE MONOSOF 4-0 SN-662,,A4649,HCPCS,Facility,Inpatient,,,,34.2,29.07,9.80172,34.2,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
SUTURE MONOSOF 4-0 SN-662,,A4649,HCPCS,Facility,Outpatient,,,,34.2,29.07,9.80172,34.2,"UCare Health, Inc.",Medical Assistance,17.26074,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE MONOSOF 4-0 SN-662,,A4649,HCPCS,Facility,Inpatient,,,,34.2,29.07,9.80172,34.2,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
SUTURE MONOSOF 4-0 SN-662,,A4649,HCPCS,Facility,Outpatient,,,,34.2,29.07,9.80172,34.2,"UCare Health, Inc.",Medicare Advantage,17.26074,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE MONOSOF 4-0 SN-662,,A4649,HCPCS,Facility,Inpatient,,,,34.2,29.07,9.80172,34.2,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE MONOSOF 4-0 SN-662,,A4649,HCPCS,Facility,Outpatient,,,,34.2,29.07,9.80172,34.2,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),17.26074,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE MONOSOF 4-0 SN-662,,A4649,HCPCS,Facility,Inpatient,,,,34.2,29.07,9.80172,34.2,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE MONOSOF 4-0 SN-662,,A4649,HCPCS,Facility,Both,,,,34.2,29.07,9.80172,34.2,UnitedHealthcare,Individual & Family,32.148,94,,percent of total billed charges,,
SUTURE MONOSOF 4-0 SN-662,,A4649,HCPCS,Facility,Outpatient,,,,34.2,29.07,9.80172,34.2,UnitedHealthcare,Medicare Advantage,16.758,49,,percent of total billed charges,,
SUTURE MONOSOF 4-0 SN-662,,A4649,HCPCS,Facility,Inpatient,,,,34.2,29.07,9.80172,34.2,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
SUTURE MONOSOF 4-0 SN-662,,A4649,HCPCS,Facility,Outpatient,,,,34.2,29.07,9.80172,34.2,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,16.416,48,,percent of total billed charges,,100% of DHS outpatient percentage
SUTURE MONOSOF 4-0 SN-662,,A4649,HCPCS,Facility,Inpatient,,,,34.2,29.07,9.80172,34.2,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
SUTURE MONOSOF 5-0 BLK 18IN P-13  SN-5698G,,A4649,HCPCS,Facility,Both,,,,45.75,38.8875,13.11195,45.75,Aetna,Commercial,42.09,92,,percent of total billed charges,,
SUTURE MONOSOF 5-0 BLK 18IN P-13  SN-5698G,,A4649,HCPCS,Facility,Outpatient,,,,45.75,38.8875,13.11195,45.75,Aetna,Medicare Advantage,22.4175,49,,percent of total billed charges,,
SUTURE MONOSOF 5-0 BLK 18IN P-13  SN-5698G,,A4649,HCPCS,Facility,Inpatient,,,,45.75,38.8875,13.11195,45.75,Aetna,Medicare Advantage,,,,,Included in per diem rate,
SUTURE MONOSOF 5-0 BLK 18IN P-13  SN-5698G,,A4649,HCPCS,Facility,Both,,,,45.75,38.8875,13.11195,45.75,Aetna,PPO,42.5475,93,,percent of total billed charges,,
SUTURE MONOSOF 5-0 BLK 18IN P-13  SN-5698G,,A4649,HCPCS,Facility,Both,,,,45.75,38.8875,13.11195,45.75,America's PPO,America's PPO,43.933725,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SUTURE MONOSOF 5-0 BLK 18IN P-13  SN-5698G,,A4649,HCPCS,Facility,Both,,,,45.75,38.8875,13.11195,45.75,BlueCross BlueShield Minnesota, Federal Employee Program,45.018,98.4,,percent of total billed charges,,
SUTURE MONOSOF 5-0 BLK 18IN P-13  SN-5698G,,A4649,HCPCS,Facility,Both,,,,45.75,38.8875,13.11195,45.75,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,45.75,100,,percent of total billed charges,,
SUTURE MONOSOF 5-0 BLK 18IN P-13  SN-5698G,,A4649,HCPCS,Facility,Both,,,,45.75,38.8875,13.11195,45.75,BlueCross BlueShield Minnesota,High Value Network Plan,41.175,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
SUTURE MONOSOF 5-0 BLK 18IN P-13  SN-5698G,,A4649,HCPCS,Facility,Outpatient,,,,45.75,38.8875,13.11195,45.75,BlueCross BlueShield Minnesota,Medicare Advantage,22.4175,49,,percent of total billed charges,,
SUTURE MONOSOF 5-0 BLK 18IN P-13  SN-5698G,,A4649,HCPCS,Facility,Inpatient,,,,45.75,38.8875,13.11195,45.75,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
SUTURE MONOSOF 5-0 BLK 18IN P-13  SN-5698G,,A4649,HCPCS,Facility,Both,,,,45.75,38.8875,13.11195,45.75,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,40.520775,88.57,,percent of total billed charges,,
SUTURE MONOSOF 5-0 BLK 18IN P-13  SN-5698G,,A4649,HCPCS,Facility,Both,,,,45.75,38.8875,13.11195,45.75,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,13.11195,28.66,,percent of total billed charges,,
SUTURE MONOSOF 5-0 BLK 18IN P-13  SN-5698G,,A4649,HCPCS,Facility,Outpatient,,,,45.75,38.8875,13.11195,45.75,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),22.4175,49,,percent of total billed charges,,
SUTURE MONOSOF 5-0 BLK 18IN P-13  SN-5698G,,A4649,HCPCS,Facility,Inpatient,,,,45.75,38.8875,13.11195,45.75,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
SUTURE MONOSOF 5-0 BLK 18IN P-13  SN-5698G,,A4649,HCPCS,Facility,Both,,,,45.75,38.8875,13.11195,45.75,CorVel,Worker's Compensation,45.75,100,,percent of total billed charges,,
SUTURE MONOSOF 5-0 BLK 18IN P-13  SN-5698G,,A4649,HCPCS,Facility,Both,,,,45.75,38.8875,13.11195,45.75,First Health Group Corporation,First Health Network,44.3775,97,,percent of total billed charges,,
SUTURE MONOSOF 5-0 BLK 18IN P-13  SN-5698G,,A4649,HCPCS,Facility,Both,,,,45.75,38.8875,13.11195,45.75,"Health Partners, Inc.",Commercial,43.2795,94.6,,percent of total billed charges,,
SUTURE MONOSOF 5-0 BLK 18IN P-13  SN-5698G,,A4649,HCPCS,Facility,Outpatient,,,,45.75,38.8875,13.11195,45.75,"Health Partners, Inc.",Medicare Advantage,22.4175,49,,percent of total billed charges,,
SUTURE MONOSOF 5-0 BLK 18IN P-13  SN-5698G,,A4649,HCPCS,Facility,Inpatient,,,,45.75,38.8875,13.11195,45.75,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE MONOSOF 5-0 BLK 18IN P-13  SN-5698G,,A4649,HCPCS,Facility,Both,,,,45.75,38.8875,13.11195,45.75,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),27.45,60,,percent of total billed charges,,
SUTURE MONOSOF 5-0 BLK 18IN P-13  SN-5698G,,A4649,HCPCS,Facility,Both,,,,45.75,38.8875,13.11195,45.75,"Health Partners, Inc.",State of Minnesota Advantage Program,37.28625,81.5,,percent of total billed charges,,
SUTURE MONOSOF 5-0 BLK 18IN P-13  SN-5698G,,A4649,HCPCS,Facility,Both,,,,45.75,38.8875,13.11195,45.75,"Health Partners, Inc.",State Public Programs,22.875,50,,percent of total billed charges,,
SUTURE MONOSOF 5-0 BLK 18IN P-13  SN-5698G,,A4649,HCPCS,Facility,Both,,,,45.75,38.8875,13.11195,45.75,Humana Insurance Company,Commercial PPO,43.4625,95,,percent of total billed charges,,
SUTURE MONOSOF 5-0 BLK 18IN P-13  SN-5698G,,A4649,HCPCS,Facility,Outpatient,,,,45.75,38.8875,13.11195,45.75,Humana Insurance Company,Medicare PPO,22.4175,49,,percent of total billed charges,,
SUTURE MONOSOF 5-0 BLK 18IN P-13  SN-5698G,,A4649,HCPCS,Facility,Inpatient,,,,45.75,38.8875,13.11195,45.75,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
SUTURE MONOSOF 5-0 BLK 18IN P-13  SN-5698G,,A4649,HCPCS,Facility,Both,,,,45.75,38.8875,13.11195,45.75,Medica,Individual & Family,45.33825,99.1,,percent of total billed charges,,
SUTURE MONOSOF 5-0 BLK 18IN P-13  SN-5698G,,A4649,HCPCS,Facility,Outpatient,,,,45.75,38.8875,13.11195,45.75,Medica,Medica Advantage Solution,22.7835,49.8,,percent of total billed charges,,
SUTURE MONOSOF 5-0 BLK 18IN P-13  SN-5698G,,A4649,HCPCS,Facility,Inpatient,,,,45.75,38.8875,13.11195,45.75,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
SUTURE MONOSOF 5-0 BLK 18IN P-13  SN-5698G,,A4649,HCPCS,Facility,Outpatient,,,,45.75,38.8875,13.11195,45.75,Medica,Medical Assistance,20.4045,44.6,,percent of total billed charges,,
SUTURE MONOSOF 5-0 BLK 18IN P-13  SN-5698G,,A4649,HCPCS,Facility,Inpatient,,,,45.75,38.8875,13.11195,45.75,Medica,Medical Assistance,,,,,Included in per diem rate,
SUTURE MONOSOF 5-0 BLK 18IN P-13  SN-5698G,,A4649,HCPCS,Facility,Outpatient,,,,45.75,38.8875,13.11195,45.75,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,22.7835,49.8,,percent of total billed charges,,
SUTURE MONOSOF 5-0 BLK 18IN P-13  SN-5698G,,A4649,HCPCS,Facility,Inpatient,,,,45.75,38.8875,13.11195,45.75,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
SUTURE MONOSOF 5-0 BLK 18IN P-13  SN-5698G,,A4649,HCPCS,Facility,Both,,,,45.75,38.8875,13.11195,45.75,"Multiplan, Inc.","Multiplan, Inc.",43.005,94,,percent of total billed charges,,
SUTURE MONOSOF 5-0 BLK 18IN P-13  SN-5698G,,A4649,HCPCS,Facility,Outpatient,,,,45.75,38.8875,13.11195,45.75,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,41.22075,90.1,,percent of total billed charges,,
SUTURE MONOSOF 5-0 BLK 18IN P-13  SN-5698G,,A4649,HCPCS,Facility,Inpatient,,,,45.75,38.8875,13.11195,45.75,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
SUTURE MONOSOF 5-0 BLK 18IN P-13  SN-5698G,,A4649,HCPCS,Facility,Both,,,,45.75,38.8875,13.11195,45.75,"Preferred One Administrative Services, INC.",PPO,45.1095,98.6,,percent of total billed charges,,
SUTURE MONOSOF 5-0 BLK 18IN P-13  SN-5698G,,A4649,HCPCS,Facility,Outpatient,,,,45.75,38.8875,13.11195,45.75,PrimeWest Health,Minnesota Senior Health Options (MSHO),23.538375,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
SUTURE MONOSOF 5-0 BLK 18IN P-13  SN-5698G,,A4649,HCPCS,Facility,Inpatient,,,,45.75,38.8875,13.11195,45.75,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE MONOSOF 5-0 BLK 18IN P-13  SN-5698G,,A4649,HCPCS,Facility,Outpatient,,,,45.75,38.8875,13.11195,45.75,PrimeWest Health,MinnesotaCare,23.4972,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
SUTURE MONOSOF 5-0 BLK 18IN P-13  SN-5698G,,A4649,HCPCS,Facility,Inpatient,,,,45.75,38.8875,13.11195,45.75,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
SUTURE MONOSOF 5-0 BLK 18IN P-13  SN-5698G,,A4649,HCPCS,Facility,Both,,,,45.75,38.8875,13.11195,45.75,Sanford Health Plan,Sanford Health Plan,42.09,92,,percent of total billed charges,,
SUTURE MONOSOF 5-0 BLK 18IN P-13  SN-5698G,,A4649,HCPCS,Facility,Outpatient,,,,45.75,38.8875,13.11195,45.75,"UCare Health, Inc.",Individual & Family Plan,25.780125,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
SUTURE MONOSOF 5-0 BLK 18IN P-13  SN-5698G,,A4649,HCPCS,Facility,Inpatient,,,,45.75,38.8875,13.11195,45.75,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
SUTURE MONOSOF 5-0 BLK 18IN P-13  SN-5698G,,A4649,HCPCS,Facility,Outpatient,,,,45.75,38.8875,13.11195,45.75,"UCare Health, Inc.",Medical Assistance,23.090025,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE MONOSOF 5-0 BLK 18IN P-13  SN-5698G,,A4649,HCPCS,Facility,Inpatient,,,,45.75,38.8875,13.11195,45.75,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
SUTURE MONOSOF 5-0 BLK 18IN P-13  SN-5698G,,A4649,HCPCS,Facility,Outpatient,,,,45.75,38.8875,13.11195,45.75,"UCare Health, Inc.",Medicare Advantage,23.090025,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE MONOSOF 5-0 BLK 18IN P-13  SN-5698G,,A4649,HCPCS,Facility,Inpatient,,,,45.75,38.8875,13.11195,45.75,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE MONOSOF 5-0 BLK 18IN P-13  SN-5698G,,A4649,HCPCS,Facility,Outpatient,,,,45.75,38.8875,13.11195,45.75,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),23.090025,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE MONOSOF 5-0 BLK 18IN P-13  SN-5698G,,A4649,HCPCS,Facility,Inpatient,,,,45.75,38.8875,13.11195,45.75,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE MONOSOF 5-0 BLK 18IN P-13  SN-5698G,,A4649,HCPCS,Facility,Both,,,,45.75,38.8875,13.11195,45.75,UnitedHealthcare,Individual & Family,43.005,94,,percent of total billed charges,,
SUTURE MONOSOF 5-0 BLK 18IN P-13  SN-5698G,,A4649,HCPCS,Facility,Outpatient,,,,45.75,38.8875,13.11195,45.75,UnitedHealthcare,Medicare Advantage,22.4175,49,,percent of total billed charges,,
SUTURE MONOSOF 5-0 BLK 18IN P-13  SN-5698G,,A4649,HCPCS,Facility,Inpatient,,,,45.75,38.8875,13.11195,45.75,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
SUTURE MONOSOF 5-0 BLK 18IN P-13  SN-5698G,,A4649,HCPCS,Facility,Outpatient,,,,45.75,38.8875,13.11195,45.75,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,21.96,48,,percent of total billed charges,,100% of DHS outpatient percentage
SUTURE MONOSOF 5-0 BLK 18IN P-13  SN-5698G,,A4649,HCPCS,Facility,Inpatient,,,,45.75,38.8875,13.11195,45.75,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
SUTURE MONOSOF 6/0 BLACK 18IN P-13,,A4649,HCPCS,Facility,Both,,,,47.97,40.7745,13.748202,47.97,Aetna,Commercial,44.1324,92,,percent of total billed charges,,
SUTURE MONOSOF 6/0 BLACK 18IN P-13,,A4649,HCPCS,Facility,Outpatient,,,,47.97,40.7745,13.748202,47.97,Aetna,Medicare Advantage,23.5053,49,,percent of total billed charges,,
SUTURE MONOSOF 6/0 BLACK 18IN P-13,,A4649,HCPCS,Facility,Inpatient,,,,47.97,40.7745,13.748202,47.97,Aetna,Medicare Advantage,,,,,Included in per diem rate,
SUTURE MONOSOF 6/0 BLACK 18IN P-13,,A4649,HCPCS,Facility,Both,,,,47.97,40.7745,13.748202,47.97,Aetna,PPO,44.6121,93,,percent of total billed charges,,
SUTURE MONOSOF 6/0 BLACK 18IN P-13,,A4649,HCPCS,Facility,Both,,,,47.97,40.7745,13.748202,47.97,America's PPO,America's PPO,46.065591,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SUTURE MONOSOF 6/0 BLACK 18IN P-13,,A4649,HCPCS,Facility,Both,,,,47.97,40.7745,13.748202,47.97,BlueCross BlueShield Minnesota, Federal Employee Program,47.20248,98.4,,percent of total billed charges,,
SUTURE MONOSOF 6/0 BLACK 18IN P-13,,A4649,HCPCS,Facility,Both,,,,47.97,40.7745,13.748202,47.97,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,47.97,100,,percent of total billed charges,,
SUTURE MONOSOF 6/0 BLACK 18IN P-13,,A4649,HCPCS,Facility,Both,,,,47.97,40.7745,13.748202,47.97,BlueCross BlueShield Minnesota,High Value Network Plan,43.173,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
SUTURE MONOSOF 6/0 BLACK 18IN P-13,,A4649,HCPCS,Facility,Outpatient,,,,47.97,40.7745,13.748202,47.97,BlueCross BlueShield Minnesota,Medicare Advantage,23.5053,49,,percent of total billed charges,,
SUTURE MONOSOF 6/0 BLACK 18IN P-13,,A4649,HCPCS,Facility,Inpatient,,,,47.97,40.7745,13.748202,47.97,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
SUTURE MONOSOF 6/0 BLACK 18IN P-13,,A4649,HCPCS,Facility,Both,,,,47.97,40.7745,13.748202,47.97,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,42.487029,88.57,,percent of total billed charges,,
SUTURE MONOSOF 6/0 BLACK 18IN P-13,,A4649,HCPCS,Facility,Both,,,,47.97,40.7745,13.748202,47.97,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,13.748202,28.66,,percent of total billed charges,,
SUTURE MONOSOF 6/0 BLACK 18IN P-13,,A4649,HCPCS,Facility,Outpatient,,,,47.97,40.7745,13.748202,47.97,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),23.5053,49,,percent of total billed charges,,
SUTURE MONOSOF 6/0 BLACK 18IN P-13,,A4649,HCPCS,Facility,Inpatient,,,,47.97,40.7745,13.748202,47.97,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
SUTURE MONOSOF 6/0 BLACK 18IN P-13,,A4649,HCPCS,Facility,Both,,,,47.97,40.7745,13.748202,47.97,CorVel,Worker's Compensation,47.97,100,,percent of total billed charges,,
SUTURE MONOSOF 6/0 BLACK 18IN P-13,,A4649,HCPCS,Facility,Both,,,,47.97,40.7745,13.748202,47.97,First Health Group Corporation,First Health Network,46.5309,97,,percent of total billed charges,,
SUTURE MONOSOF 6/0 BLACK 18IN P-13,,A4649,HCPCS,Facility,Both,,,,47.97,40.7745,13.748202,47.97,"Health Partners, Inc.",Commercial,45.37962,94.6,,percent of total billed charges,,
SUTURE MONOSOF 6/0 BLACK 18IN P-13,,A4649,HCPCS,Facility,Outpatient,,,,47.97,40.7745,13.748202,47.97,"Health Partners, Inc.",Medicare Advantage,23.5053,49,,percent of total billed charges,,
SUTURE MONOSOF 6/0 BLACK 18IN P-13,,A4649,HCPCS,Facility,Inpatient,,,,47.97,40.7745,13.748202,47.97,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE MONOSOF 6/0 BLACK 18IN P-13,,A4649,HCPCS,Facility,Both,,,,47.97,40.7745,13.748202,47.97,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),28.782,60,,percent of total billed charges,,
SUTURE MONOSOF 6/0 BLACK 18IN P-13,,A4649,HCPCS,Facility,Both,,,,47.97,40.7745,13.748202,47.97,"Health Partners, Inc.",State of Minnesota Advantage Program,39.09555,81.5,,percent of total billed charges,,
SUTURE MONOSOF 6/0 BLACK 18IN P-13,,A4649,HCPCS,Facility,Both,,,,47.97,40.7745,13.748202,47.97,"Health Partners, Inc.",State Public Programs,23.985,50,,percent of total billed charges,,
SUTURE MONOSOF 6/0 BLACK 18IN P-13,,A4649,HCPCS,Facility,Both,,,,47.97,40.7745,13.748202,47.97,Humana Insurance Company,Commercial PPO,45.5715,95,,percent of total billed charges,,
SUTURE MONOSOF 6/0 BLACK 18IN P-13,,A4649,HCPCS,Facility,Outpatient,,,,47.97,40.7745,13.748202,47.97,Humana Insurance Company,Medicare PPO,23.5053,49,,percent of total billed charges,,
SUTURE MONOSOF 6/0 BLACK 18IN P-13,,A4649,HCPCS,Facility,Inpatient,,,,47.97,40.7745,13.748202,47.97,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
SUTURE MONOSOF 6/0 BLACK 18IN P-13,,A4649,HCPCS,Facility,Both,,,,47.97,40.7745,13.748202,47.97,Medica,Individual & Family,47.53827,99.1,,percent of total billed charges,,
SUTURE MONOSOF 6/0 BLACK 18IN P-13,,A4649,HCPCS,Facility,Outpatient,,,,47.97,40.7745,13.748202,47.97,Medica,Medica Advantage Solution,23.88906,49.8,,percent of total billed charges,,
SUTURE MONOSOF 6/0 BLACK 18IN P-13,,A4649,HCPCS,Facility,Inpatient,,,,47.97,40.7745,13.748202,47.97,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
SUTURE MONOSOF 6/0 BLACK 18IN P-13,,A4649,HCPCS,Facility,Outpatient,,,,47.97,40.7745,13.748202,47.97,Medica,Medical Assistance,21.39462,44.6,,percent of total billed charges,,
SUTURE MONOSOF 6/0 BLACK 18IN P-13,,A4649,HCPCS,Facility,Inpatient,,,,47.97,40.7745,13.748202,47.97,Medica,Medical Assistance,,,,,Included in per diem rate,
SUTURE MONOSOF 6/0 BLACK 18IN P-13,,A4649,HCPCS,Facility,Outpatient,,,,47.97,40.7745,13.748202,47.97,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,23.88906,49.8,,percent of total billed charges,,
SUTURE MONOSOF 6/0 BLACK 18IN P-13,,A4649,HCPCS,Facility,Inpatient,,,,47.97,40.7745,13.748202,47.97,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
SUTURE MONOSOF 6/0 BLACK 18IN P-13,,A4649,HCPCS,Facility,Both,,,,47.97,40.7745,13.748202,47.97,"Multiplan, Inc.","Multiplan, Inc.",45.0918,94,,percent of total billed charges,,
SUTURE MONOSOF 6/0 BLACK 18IN P-13,,A4649,HCPCS,Facility,Outpatient,,,,47.97,40.7745,13.748202,47.97,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,43.22097,90.1,,percent of total billed charges,,
SUTURE MONOSOF 6/0 BLACK 18IN P-13,,A4649,HCPCS,Facility,Inpatient,,,,47.97,40.7745,13.748202,47.97,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
SUTURE MONOSOF 6/0 BLACK 18IN P-13,,A4649,HCPCS,Facility,Both,,,,47.97,40.7745,13.748202,47.97,"Preferred One Administrative Services, INC.",PPO,47.29842,98.6,,percent of total billed charges,,
SUTURE MONOSOF 6/0 BLACK 18IN P-13,,A4649,HCPCS,Facility,Outpatient,,,,47.97,40.7745,13.748202,47.97,PrimeWest Health,Minnesota Senior Health Options (MSHO),24.680565,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
SUTURE MONOSOF 6/0 BLACK 18IN P-13,,A4649,HCPCS,Facility,Inpatient,,,,47.97,40.7745,13.748202,47.97,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE MONOSOF 6/0 BLACK 18IN P-13,,A4649,HCPCS,Facility,Outpatient,,,,47.97,40.7745,13.748202,47.97,PrimeWest Health,MinnesotaCare,24.637392,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
SUTURE MONOSOF 6/0 BLACK 18IN P-13,,A4649,HCPCS,Facility,Inpatient,,,,47.97,40.7745,13.748202,47.97,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
SUTURE MONOSOF 6/0 BLACK 18IN P-13,,A4649,HCPCS,Facility,Both,,,,47.97,40.7745,13.748202,47.97,Sanford Health Plan,Sanford Health Plan,44.1324,92,,percent of total billed charges,,
SUTURE MONOSOF 6/0 BLACK 18IN P-13,,A4649,HCPCS,Facility,Outpatient,,,,47.97,40.7745,13.748202,47.97,"UCare Health, Inc.",Individual & Family Plan,27.031095,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
SUTURE MONOSOF 6/0 BLACK 18IN P-13,,A4649,HCPCS,Facility,Inpatient,,,,47.97,40.7745,13.748202,47.97,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
SUTURE MONOSOF 6/0 BLACK 18IN P-13,,A4649,HCPCS,Facility,Outpatient,,,,47.97,40.7745,13.748202,47.97,"UCare Health, Inc.",Medical Assistance,24.210459,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE MONOSOF 6/0 BLACK 18IN P-13,,A4649,HCPCS,Facility,Inpatient,,,,47.97,40.7745,13.748202,47.97,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
SUTURE MONOSOF 6/0 BLACK 18IN P-13,,A4649,HCPCS,Facility,Outpatient,,,,47.97,40.7745,13.748202,47.97,"UCare Health, Inc.",Medicare Advantage,24.210459,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE MONOSOF 6/0 BLACK 18IN P-13,,A4649,HCPCS,Facility,Inpatient,,,,47.97,40.7745,13.748202,47.97,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE MONOSOF 6/0 BLACK 18IN P-13,,A4649,HCPCS,Facility,Outpatient,,,,47.97,40.7745,13.748202,47.97,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),24.210459,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE MONOSOF 6/0 BLACK 18IN P-13,,A4649,HCPCS,Facility,Inpatient,,,,47.97,40.7745,13.748202,47.97,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE MONOSOF 6/0 BLACK 18IN P-13,,A4649,HCPCS,Facility,Both,,,,47.97,40.7745,13.748202,47.97,UnitedHealthcare,Individual & Family,45.0918,94,,percent of total billed charges,,
SUTURE MONOSOF 6/0 BLACK 18IN P-13,,A4649,HCPCS,Facility,Outpatient,,,,47.97,40.7745,13.748202,47.97,UnitedHealthcare,Medicare Advantage,23.5053,49,,percent of total billed charges,,
SUTURE MONOSOF 6/0 BLACK 18IN P-13,,A4649,HCPCS,Facility,Inpatient,,,,47.97,40.7745,13.748202,47.97,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
SUTURE MONOSOF 6/0 BLACK 18IN P-13,,A4649,HCPCS,Facility,Outpatient,,,,47.97,40.7745,13.748202,47.97,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,23.0256,48,,percent of total billed charges,,100% of DHS outpatient percentage
SUTURE MONOSOF 6/0 BLACK 18IN P-13,,A4649,HCPCS,Facility,Inpatient,,,,47.97,40.7745,13.748202,47.97,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
SUTURE MONOSOF 6-0 SN-5696G,,A4649,HCPCS,Facility,Both,,,,17.8,15.13,5.10148,17.8,Aetna,Commercial,16.376,92,,percent of total billed charges,,
SUTURE MONOSOF 6-0 SN-5696G,,A4649,HCPCS,Facility,Outpatient,,,,17.8,15.13,5.10148,17.8,Aetna,Medicare Advantage,8.722,49,,percent of total billed charges,,
SUTURE MONOSOF 6-0 SN-5696G,,A4649,HCPCS,Facility,Inpatient,,,,17.8,15.13,5.10148,17.8,Aetna,Medicare Advantage,,,,,Included in per diem rate,
SUTURE MONOSOF 6-0 SN-5696G,,A4649,HCPCS,Facility,Both,,,,17.8,15.13,5.10148,17.8,Aetna,PPO,16.554,93,,percent of total billed charges,,
SUTURE MONOSOF 6-0 SN-5696G,,A4649,HCPCS,Facility,Both,,,,17.8,15.13,5.10148,17.8,America's PPO,America's PPO,17.09334,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SUTURE MONOSOF 6-0 SN-5696G,,A4649,HCPCS,Facility,Both,,,,17.8,15.13,5.10148,17.8,BlueCross BlueShield Minnesota, Federal Employee Program,17.5152,98.4,,percent of total billed charges,,
SUTURE MONOSOF 6-0 SN-5696G,,A4649,HCPCS,Facility,Both,,,,17.8,15.13,5.10148,17.8,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,17.8,100,,percent of total billed charges,,
SUTURE MONOSOF 6-0 SN-5696G,,A4649,HCPCS,Facility,Both,,,,17.8,15.13,5.10148,17.8,BlueCross BlueShield Minnesota,High Value Network Plan,16.02,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
SUTURE MONOSOF 6-0 SN-5696G,,A4649,HCPCS,Facility,Outpatient,,,,17.8,15.13,5.10148,17.8,BlueCross BlueShield Minnesota,Medicare Advantage,8.722,49,,percent of total billed charges,,
SUTURE MONOSOF 6-0 SN-5696G,,A4649,HCPCS,Facility,Inpatient,,,,17.8,15.13,5.10148,17.8,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
SUTURE MONOSOF 6-0 SN-5696G,,A4649,HCPCS,Facility,Both,,,,17.8,15.13,5.10148,17.8,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,15.76546,88.57,,percent of total billed charges,,
SUTURE MONOSOF 6-0 SN-5696G,,A4649,HCPCS,Facility,Both,,,,17.8,15.13,5.10148,17.8,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,5.10148,28.66,,percent of total billed charges,,
SUTURE MONOSOF 6-0 SN-5696G,,A4649,HCPCS,Facility,Outpatient,,,,17.8,15.13,5.10148,17.8,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),8.722,49,,percent of total billed charges,,
SUTURE MONOSOF 6-0 SN-5696G,,A4649,HCPCS,Facility,Inpatient,,,,17.8,15.13,5.10148,17.8,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
SUTURE MONOSOF 6-0 SN-5696G,,A4649,HCPCS,Facility,Both,,,,17.8,15.13,5.10148,17.8,CorVel,Worker's Compensation,17.8,100,,percent of total billed charges,,
SUTURE MONOSOF 6-0 SN-5696G,,A4649,HCPCS,Facility,Both,,,,17.8,15.13,5.10148,17.8,First Health Group Corporation,First Health Network,17.266,97,,percent of total billed charges,,
SUTURE MONOSOF 6-0 SN-5696G,,A4649,HCPCS,Facility,Both,,,,17.8,15.13,5.10148,17.8,"Health Partners, Inc.",Commercial,16.8388,94.6,,percent of total billed charges,,
SUTURE MONOSOF 6-0 SN-5696G,,A4649,HCPCS,Facility,Outpatient,,,,17.8,15.13,5.10148,17.8,"Health Partners, Inc.",Medicare Advantage,8.722,49,,percent of total billed charges,,
SUTURE MONOSOF 6-0 SN-5696G,,A4649,HCPCS,Facility,Inpatient,,,,17.8,15.13,5.10148,17.8,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE MONOSOF 6-0 SN-5696G,,A4649,HCPCS,Facility,Both,,,,17.8,15.13,5.10148,17.8,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),10.68,60,,percent of total billed charges,,
SUTURE MONOSOF 6-0 SN-5696G,,A4649,HCPCS,Facility,Both,,,,17.8,15.13,5.10148,17.8,"Health Partners, Inc.",State of Minnesota Advantage Program,14.507,81.5,,percent of total billed charges,,
SUTURE MONOSOF 6-0 SN-5696G,,A4649,HCPCS,Facility,Both,,,,17.8,15.13,5.10148,17.8,"Health Partners, Inc.",State Public Programs,8.9,50,,percent of total billed charges,,
SUTURE MONOSOF 6-0 SN-5696G,,A4649,HCPCS,Facility,Both,,,,17.8,15.13,5.10148,17.8,Humana Insurance Company,Commercial PPO,16.91,95,,percent of total billed charges,,
SUTURE MONOSOF 6-0 SN-5696G,,A4649,HCPCS,Facility,Outpatient,,,,17.8,15.13,5.10148,17.8,Humana Insurance Company,Medicare PPO,8.722,49,,percent of total billed charges,,
SUTURE MONOSOF 6-0 SN-5696G,,A4649,HCPCS,Facility,Inpatient,,,,17.8,15.13,5.10148,17.8,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
SUTURE MONOSOF 6-0 SN-5696G,,A4649,HCPCS,Facility,Both,,,,17.8,15.13,5.10148,17.8,Medica,Individual & Family,17.6398,99.1,,percent of total billed charges,,
SUTURE MONOSOF 6-0 SN-5696G,,A4649,HCPCS,Facility,Outpatient,,,,17.8,15.13,5.10148,17.8,Medica,Medica Advantage Solution,8.8644,49.8,,percent of total billed charges,,
SUTURE MONOSOF 6-0 SN-5696G,,A4649,HCPCS,Facility,Inpatient,,,,17.8,15.13,5.10148,17.8,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
SUTURE MONOSOF 6-0 SN-5696G,,A4649,HCPCS,Facility,Outpatient,,,,17.8,15.13,5.10148,17.8,Medica,Medical Assistance,7.9388,44.6,,percent of total billed charges,,
SUTURE MONOSOF 6-0 SN-5696G,,A4649,HCPCS,Facility,Inpatient,,,,17.8,15.13,5.10148,17.8,Medica,Medical Assistance,,,,,Included in per diem rate,
SUTURE MONOSOF 6-0 SN-5696G,,A4649,HCPCS,Facility,Outpatient,,,,17.8,15.13,5.10148,17.8,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,8.8644,49.8,,percent of total billed charges,,
SUTURE MONOSOF 6-0 SN-5696G,,A4649,HCPCS,Facility,Inpatient,,,,17.8,15.13,5.10148,17.8,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
SUTURE MONOSOF 6-0 SN-5696G,,A4649,HCPCS,Facility,Both,,,,17.8,15.13,5.10148,17.8,"Multiplan, Inc.","Multiplan, Inc.",16.732,94,,percent of total billed charges,,
SUTURE MONOSOF 6-0 SN-5696G,,A4649,HCPCS,Facility,Outpatient,,,,17.8,15.13,5.10148,17.8,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,16.0378,90.1,,percent of total billed charges,,
SUTURE MONOSOF 6-0 SN-5696G,,A4649,HCPCS,Facility,Inpatient,,,,17.8,15.13,5.10148,17.8,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
SUTURE MONOSOF 6-0 SN-5696G,,A4649,HCPCS,Facility,Both,,,,17.8,15.13,5.10148,17.8,"Preferred One Administrative Services, INC.",PPO,17.5508,98.6,,percent of total billed charges,,
SUTURE MONOSOF 6-0 SN-5696G,,A4649,HCPCS,Facility,Outpatient,,,,17.8,15.13,5.10148,17.8,PrimeWest Health,Minnesota Senior Health Options (MSHO),9.1581,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
SUTURE MONOSOF 6-0 SN-5696G,,A4649,HCPCS,Facility,Inpatient,,,,17.8,15.13,5.10148,17.8,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE MONOSOF 6-0 SN-5696G,,A4649,HCPCS,Facility,Outpatient,,,,17.8,15.13,5.10148,17.8,PrimeWest Health,MinnesotaCare,9.14208,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
SUTURE MONOSOF 6-0 SN-5696G,,A4649,HCPCS,Facility,Inpatient,,,,17.8,15.13,5.10148,17.8,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
SUTURE MONOSOF 6-0 SN-5696G,,A4649,HCPCS,Facility,Both,,,,17.8,15.13,5.10148,17.8,Sanford Health Plan,Sanford Health Plan,16.376,92,,percent of total billed charges,,
SUTURE MONOSOF 6-0 SN-5696G,,A4649,HCPCS,Facility,Outpatient,,,,17.8,15.13,5.10148,17.8,"UCare Health, Inc.",Individual & Family Plan,10.0303,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
SUTURE MONOSOF 6-0 SN-5696G,,A4649,HCPCS,Facility,Inpatient,,,,17.8,15.13,5.10148,17.8,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
SUTURE MONOSOF 6-0 SN-5696G,,A4649,HCPCS,Facility,Outpatient,,,,17.8,15.13,5.10148,17.8,"UCare Health, Inc.",Medical Assistance,8.98366,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE MONOSOF 6-0 SN-5696G,,A4649,HCPCS,Facility,Inpatient,,,,17.8,15.13,5.10148,17.8,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
SUTURE MONOSOF 6-0 SN-5696G,,A4649,HCPCS,Facility,Outpatient,,,,17.8,15.13,5.10148,17.8,"UCare Health, Inc.",Medicare Advantage,8.98366,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE MONOSOF 6-0 SN-5696G,,A4649,HCPCS,Facility,Inpatient,,,,17.8,15.13,5.10148,17.8,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE MONOSOF 6-0 SN-5696G,,A4649,HCPCS,Facility,Outpatient,,,,17.8,15.13,5.10148,17.8,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),8.98366,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE MONOSOF 6-0 SN-5696G,,A4649,HCPCS,Facility,Inpatient,,,,17.8,15.13,5.10148,17.8,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE MONOSOF 6-0 SN-5696G,,A4649,HCPCS,Facility,Both,,,,17.8,15.13,5.10148,17.8,UnitedHealthcare,Individual & Family,16.732,94,,percent of total billed charges,,
SUTURE MONOSOF 6-0 SN-5696G,,A4649,HCPCS,Facility,Outpatient,,,,17.8,15.13,5.10148,17.8,UnitedHealthcare,Medicare Advantage,8.722,49,,percent of total billed charges,,
SUTURE MONOSOF 6-0 SN-5696G,,A4649,HCPCS,Facility,Inpatient,,,,17.8,15.13,5.10148,17.8,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
SUTURE MONOSOF 6-0 SN-5696G,,A4649,HCPCS,Facility,Outpatient,,,,17.8,15.13,5.10148,17.8,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,8.544,48,,percent of total billed charges,,100% of DHS outpatient percentage
SUTURE MONOSOF 6-0 SN-5696G,,A4649,HCPCS,Facility,Inpatient,,,,17.8,15.13,5.10148,17.8,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
SUTURE NYLON 10-0 7756G,,A4649,HCPCS,Facility,Both,,,,67.5,57.375,19.3455,67.5,Aetna,Commercial,62.1,92,,percent of total billed charges,,
SUTURE NYLON 10-0 7756G,,A4649,HCPCS,Facility,Outpatient,,,,67.5,57.375,19.3455,67.5,Aetna,Medicare Advantage,33.075,49,,percent of total billed charges,,
SUTURE NYLON 10-0 7756G,,A4649,HCPCS,Facility,Inpatient,,,,67.5,57.375,19.3455,67.5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
SUTURE NYLON 10-0 7756G,,A4649,HCPCS,Facility,Both,,,,67.5,57.375,19.3455,67.5,Aetna,PPO,62.775,93,,percent of total billed charges,,
SUTURE NYLON 10-0 7756G,,A4649,HCPCS,Facility,Both,,,,67.5,57.375,19.3455,67.5,America's PPO,America's PPO,64.82025,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SUTURE NYLON 10-0 7756G,,A4649,HCPCS,Facility,Both,,,,67.5,57.375,19.3455,67.5,BlueCross BlueShield Minnesota, Federal Employee Program,66.42,98.4,,percent of total billed charges,,
SUTURE NYLON 10-0 7756G,,A4649,HCPCS,Facility,Both,,,,67.5,57.375,19.3455,67.5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,67.5,100,,percent of total billed charges,,
SUTURE NYLON 10-0 7756G,,A4649,HCPCS,Facility,Both,,,,67.5,57.375,19.3455,67.5,BlueCross BlueShield Minnesota,High Value Network Plan,60.75,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
SUTURE NYLON 10-0 7756G,,A4649,HCPCS,Facility,Outpatient,,,,67.5,57.375,19.3455,67.5,BlueCross BlueShield Minnesota,Medicare Advantage,33.075,49,,percent of total billed charges,,
SUTURE NYLON 10-0 7756G,,A4649,HCPCS,Facility,Inpatient,,,,67.5,57.375,19.3455,67.5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
SUTURE NYLON 10-0 7756G,,A4649,HCPCS,Facility,Both,,,,67.5,57.375,19.3455,67.5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,59.78475,88.57,,percent of total billed charges,,
SUTURE NYLON 10-0 7756G,,A4649,HCPCS,Facility,Both,,,,67.5,57.375,19.3455,67.5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,19.3455,28.66,,percent of total billed charges,,
SUTURE NYLON 10-0 7756G,,A4649,HCPCS,Facility,Outpatient,,,,67.5,57.375,19.3455,67.5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),33.075,49,,percent of total billed charges,,
SUTURE NYLON 10-0 7756G,,A4649,HCPCS,Facility,Inpatient,,,,67.5,57.375,19.3455,67.5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
SUTURE NYLON 10-0 7756G,,A4649,HCPCS,Facility,Both,,,,67.5,57.375,19.3455,67.5,CorVel,Worker's Compensation,67.5,100,,percent of total billed charges,,
SUTURE NYLON 10-0 7756G,,A4649,HCPCS,Facility,Both,,,,67.5,57.375,19.3455,67.5,First Health Group Corporation,First Health Network,65.475,97,,percent of total billed charges,,
SUTURE NYLON 10-0 7756G,,A4649,HCPCS,Facility,Both,,,,67.5,57.375,19.3455,67.5,"Health Partners, Inc.",Commercial,63.855,94.6,,percent of total billed charges,,
SUTURE NYLON 10-0 7756G,,A4649,HCPCS,Facility,Outpatient,,,,67.5,57.375,19.3455,67.5,"Health Partners, Inc.",Medicare Advantage,33.075,49,,percent of total billed charges,,
SUTURE NYLON 10-0 7756G,,A4649,HCPCS,Facility,Inpatient,,,,67.5,57.375,19.3455,67.5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE NYLON 10-0 7756G,,A4649,HCPCS,Facility,Both,,,,67.5,57.375,19.3455,67.5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),40.5,60,,percent of total billed charges,,
SUTURE NYLON 10-0 7756G,,A4649,HCPCS,Facility,Both,,,,67.5,57.375,19.3455,67.5,"Health Partners, Inc.",State of Minnesota Advantage Program,55.0125,81.5,,percent of total billed charges,,
SUTURE NYLON 10-0 7756G,,A4649,HCPCS,Facility,Both,,,,67.5,57.375,19.3455,67.5,"Health Partners, Inc.",State Public Programs,33.75,50,,percent of total billed charges,,
SUTURE NYLON 10-0 7756G,,A4649,HCPCS,Facility,Both,,,,67.5,57.375,19.3455,67.5,Humana Insurance Company,Commercial PPO,64.125,95,,percent of total billed charges,,
SUTURE NYLON 10-0 7756G,,A4649,HCPCS,Facility,Outpatient,,,,67.5,57.375,19.3455,67.5,Humana Insurance Company,Medicare PPO,33.075,49,,percent of total billed charges,,
SUTURE NYLON 10-0 7756G,,A4649,HCPCS,Facility,Inpatient,,,,67.5,57.375,19.3455,67.5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
SUTURE NYLON 10-0 7756G,,A4649,HCPCS,Facility,Both,,,,67.5,57.375,19.3455,67.5,Medica,Individual & Family,66.8925,99.1,,percent of total billed charges,,
SUTURE NYLON 10-0 7756G,,A4649,HCPCS,Facility,Outpatient,,,,67.5,57.375,19.3455,67.5,Medica,Medica Advantage Solution,33.615,49.8,,percent of total billed charges,,
SUTURE NYLON 10-0 7756G,,A4649,HCPCS,Facility,Inpatient,,,,67.5,57.375,19.3455,67.5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
SUTURE NYLON 10-0 7756G,,A4649,HCPCS,Facility,Outpatient,,,,67.5,57.375,19.3455,67.5,Medica,Medical Assistance,30.105,44.6,,percent of total billed charges,,
SUTURE NYLON 10-0 7756G,,A4649,HCPCS,Facility,Inpatient,,,,67.5,57.375,19.3455,67.5,Medica,Medical Assistance,,,,,Included in per diem rate,
SUTURE NYLON 10-0 7756G,,A4649,HCPCS,Facility,Outpatient,,,,67.5,57.375,19.3455,67.5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,33.615,49.8,,percent of total billed charges,,
SUTURE NYLON 10-0 7756G,,A4649,HCPCS,Facility,Inpatient,,,,67.5,57.375,19.3455,67.5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
SUTURE NYLON 10-0 7756G,,A4649,HCPCS,Facility,Both,,,,67.5,57.375,19.3455,67.5,"Multiplan, Inc.","Multiplan, Inc.",63.45,94,,percent of total billed charges,,
SUTURE NYLON 10-0 7756G,,A4649,HCPCS,Facility,Outpatient,,,,67.5,57.375,19.3455,67.5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,60.8175,90.1,,percent of total billed charges,,
SUTURE NYLON 10-0 7756G,,A4649,HCPCS,Facility,Inpatient,,,,67.5,57.375,19.3455,67.5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
SUTURE NYLON 10-0 7756G,,A4649,HCPCS,Facility,Both,,,,67.5,57.375,19.3455,67.5,"Preferred One Administrative Services, INC.",PPO,66.555,98.6,,percent of total billed charges,,
SUTURE NYLON 10-0 7756G,,A4649,HCPCS,Facility,Outpatient,,,,67.5,57.375,19.3455,67.5,PrimeWest Health,Minnesota Senior Health Options (MSHO),34.72875,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
SUTURE NYLON 10-0 7756G,,A4649,HCPCS,Facility,Inpatient,,,,67.5,57.375,19.3455,67.5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE NYLON 10-0 7756G,,A4649,HCPCS,Facility,Outpatient,,,,67.5,57.375,19.3455,67.5,PrimeWest Health,MinnesotaCare,34.668,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
SUTURE NYLON 10-0 7756G,,A4649,HCPCS,Facility,Inpatient,,,,67.5,57.375,19.3455,67.5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
SUTURE NYLON 10-0 7756G,,A4649,HCPCS,Facility,Both,,,,67.5,57.375,19.3455,67.5,Sanford Health Plan,Sanford Health Plan,62.1,92,,percent of total billed charges,,
SUTURE NYLON 10-0 7756G,,A4649,HCPCS,Facility,Outpatient,,,,67.5,57.375,19.3455,67.5,"UCare Health, Inc.",Individual & Family Plan,38.03625,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
SUTURE NYLON 10-0 7756G,,A4649,HCPCS,Facility,Inpatient,,,,67.5,57.375,19.3455,67.5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
SUTURE NYLON 10-0 7756G,,A4649,HCPCS,Facility,Outpatient,,,,67.5,57.375,19.3455,67.5,"UCare Health, Inc.",Medical Assistance,34.06725,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE NYLON 10-0 7756G,,A4649,HCPCS,Facility,Inpatient,,,,67.5,57.375,19.3455,67.5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
SUTURE NYLON 10-0 7756G,,A4649,HCPCS,Facility,Outpatient,,,,67.5,57.375,19.3455,67.5,"UCare Health, Inc.",Medicare Advantage,34.06725,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE NYLON 10-0 7756G,,A4649,HCPCS,Facility,Inpatient,,,,67.5,57.375,19.3455,67.5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE NYLON 10-0 7756G,,A4649,HCPCS,Facility,Outpatient,,,,67.5,57.375,19.3455,67.5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),34.06725,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE NYLON 10-0 7756G,,A4649,HCPCS,Facility,Inpatient,,,,67.5,57.375,19.3455,67.5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE NYLON 10-0 7756G,,A4649,HCPCS,Facility,Both,,,,67.5,57.375,19.3455,67.5,UnitedHealthcare,Individual & Family,63.45,94,,percent of total billed charges,,
SUTURE NYLON 10-0 7756G,,A4649,HCPCS,Facility,Outpatient,,,,67.5,57.375,19.3455,67.5,UnitedHealthcare,Medicare Advantage,33.075,49,,percent of total billed charges,,
SUTURE NYLON 10-0 7756G,,A4649,HCPCS,Facility,Inpatient,,,,67.5,57.375,19.3455,67.5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
SUTURE NYLON 10-0 7756G,,A4649,HCPCS,Facility,Outpatient,,,,67.5,57.375,19.3455,67.5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,32.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
SUTURE NYLON 10-0 7756G,,A4649,HCPCS,Facility,Inpatient,,,,67.5,57.375,19.3455,67.5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
SUTURE PLAIN 5-0 PC-1 FAST         1915G,,A4649,HCPCS,Facility,Both,,,,33.25,28.2625,9.52945,33.25,Aetna,Commercial,30.59,92,,percent of total billed charges,,
SUTURE PLAIN 5-0 PC-1 FAST         1915G,,A4649,HCPCS,Facility,Outpatient,,,,33.25,28.2625,9.52945,33.25,Aetna,Medicare Advantage,16.2925,49,,percent of total billed charges,,
SUTURE PLAIN 5-0 PC-1 FAST         1915G,,A4649,HCPCS,Facility,Inpatient,,,,33.25,28.2625,9.52945,33.25,Aetna,Medicare Advantage,,,,,Included in per diem rate,
SUTURE PLAIN 5-0 PC-1 FAST         1915G,,A4649,HCPCS,Facility,Both,,,,33.25,28.2625,9.52945,33.25,Aetna,PPO,30.9225,93,,percent of total billed charges,,
SUTURE PLAIN 5-0 PC-1 FAST         1915G,,A4649,HCPCS,Facility,Both,,,,33.25,28.2625,9.52945,33.25,America's PPO,America's PPO,31.929975,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SUTURE PLAIN 5-0 PC-1 FAST         1915G,,A4649,HCPCS,Facility,Both,,,,33.25,28.2625,9.52945,33.25,BlueCross BlueShield Minnesota, Federal Employee Program,32.718,98.4,,percent of total billed charges,,
SUTURE PLAIN 5-0 PC-1 FAST         1915G,,A4649,HCPCS,Facility,Both,,,,33.25,28.2625,9.52945,33.25,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,33.25,100,,percent of total billed charges,,
SUTURE PLAIN 5-0 PC-1 FAST         1915G,,A4649,HCPCS,Facility,Both,,,,33.25,28.2625,9.52945,33.25,BlueCross BlueShield Minnesota,High Value Network Plan,29.925,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
SUTURE PLAIN 5-0 PC-1 FAST         1915G,,A4649,HCPCS,Facility,Outpatient,,,,33.25,28.2625,9.52945,33.25,BlueCross BlueShield Minnesota,Medicare Advantage,16.2925,49,,percent of total billed charges,,
SUTURE PLAIN 5-0 PC-1 FAST         1915G,,A4649,HCPCS,Facility,Inpatient,,,,33.25,28.2625,9.52945,33.25,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
SUTURE PLAIN 5-0 PC-1 FAST         1915G,,A4649,HCPCS,Facility,Both,,,,33.25,28.2625,9.52945,33.25,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,29.449525,88.57,,percent of total billed charges,,
SUTURE PLAIN 5-0 PC-1 FAST         1915G,,A4649,HCPCS,Facility,Both,,,,33.25,28.2625,9.52945,33.25,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,9.52945,28.66,,percent of total billed charges,,
SUTURE PLAIN 5-0 PC-1 FAST         1915G,,A4649,HCPCS,Facility,Outpatient,,,,33.25,28.2625,9.52945,33.25,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),16.2925,49,,percent of total billed charges,,
SUTURE PLAIN 5-0 PC-1 FAST         1915G,,A4649,HCPCS,Facility,Inpatient,,,,33.25,28.2625,9.52945,33.25,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
SUTURE PLAIN 5-0 PC-1 FAST         1915G,,A4649,HCPCS,Facility,Both,,,,33.25,28.2625,9.52945,33.25,CorVel,Worker's Compensation,33.25,100,,percent of total billed charges,,
SUTURE PLAIN 5-0 PC-1 FAST         1915G,,A4649,HCPCS,Facility,Both,,,,33.25,28.2625,9.52945,33.25,First Health Group Corporation,First Health Network,32.2525,97,,percent of total billed charges,,
SUTURE PLAIN 5-0 PC-1 FAST         1915G,,A4649,HCPCS,Facility,Both,,,,33.25,28.2625,9.52945,33.25,"Health Partners, Inc.",Commercial,31.4545,94.6,,percent of total billed charges,,
SUTURE PLAIN 5-0 PC-1 FAST         1915G,,A4649,HCPCS,Facility,Outpatient,,,,33.25,28.2625,9.52945,33.25,"Health Partners, Inc.",Medicare Advantage,16.2925,49,,percent of total billed charges,,
SUTURE PLAIN 5-0 PC-1 FAST         1915G,,A4649,HCPCS,Facility,Inpatient,,,,33.25,28.2625,9.52945,33.25,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE PLAIN 5-0 PC-1 FAST         1915G,,A4649,HCPCS,Facility,Both,,,,33.25,28.2625,9.52945,33.25,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),19.95,60,,percent of total billed charges,,
SUTURE PLAIN 5-0 PC-1 FAST         1915G,,A4649,HCPCS,Facility,Both,,,,33.25,28.2625,9.52945,33.25,"Health Partners, Inc.",State of Minnesota Advantage Program,27.09875,81.5,,percent of total billed charges,,
SUTURE PLAIN 5-0 PC-1 FAST         1915G,,A4649,HCPCS,Facility,Both,,,,33.25,28.2625,9.52945,33.25,"Health Partners, Inc.",State Public Programs,16.625,50,,percent of total billed charges,,
SUTURE PLAIN 5-0 PC-1 FAST         1915G,,A4649,HCPCS,Facility,Both,,,,33.25,28.2625,9.52945,33.25,Humana Insurance Company,Commercial PPO,31.5875,95,,percent of total billed charges,,
SUTURE PLAIN 5-0 PC-1 FAST         1915G,,A4649,HCPCS,Facility,Outpatient,,,,33.25,28.2625,9.52945,33.25,Humana Insurance Company,Medicare PPO,16.2925,49,,percent of total billed charges,,
SUTURE PLAIN 5-0 PC-1 FAST         1915G,,A4649,HCPCS,Facility,Inpatient,,,,33.25,28.2625,9.52945,33.25,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
SUTURE PLAIN 5-0 PC-1 FAST         1915G,,A4649,HCPCS,Facility,Both,,,,33.25,28.2625,9.52945,33.25,Medica,Individual & Family,32.95075,99.1,,percent of total billed charges,,
SUTURE PLAIN 5-0 PC-1 FAST         1915G,,A4649,HCPCS,Facility,Outpatient,,,,33.25,28.2625,9.52945,33.25,Medica,Medica Advantage Solution,16.5585,49.8,,percent of total billed charges,,
SUTURE PLAIN 5-0 PC-1 FAST         1915G,,A4649,HCPCS,Facility,Inpatient,,,,33.25,28.2625,9.52945,33.25,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
SUTURE PLAIN 5-0 PC-1 FAST         1915G,,A4649,HCPCS,Facility,Outpatient,,,,33.25,28.2625,9.52945,33.25,Medica,Medical Assistance,14.8295,44.6,,percent of total billed charges,,
SUTURE PLAIN 5-0 PC-1 FAST         1915G,,A4649,HCPCS,Facility,Inpatient,,,,33.25,28.2625,9.52945,33.25,Medica,Medical Assistance,,,,,Included in per diem rate,
SUTURE PLAIN 5-0 PC-1 FAST         1915G,,A4649,HCPCS,Facility,Outpatient,,,,33.25,28.2625,9.52945,33.25,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,16.5585,49.8,,percent of total billed charges,,
SUTURE PLAIN 5-0 PC-1 FAST         1915G,,A4649,HCPCS,Facility,Inpatient,,,,33.25,28.2625,9.52945,33.25,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
SUTURE PLAIN 5-0 PC-1 FAST         1915G,,A4649,HCPCS,Facility,Both,,,,33.25,28.2625,9.52945,33.25,"Multiplan, Inc.","Multiplan, Inc.",31.255,94,,percent of total billed charges,,
SUTURE PLAIN 5-0 PC-1 FAST         1915G,,A4649,HCPCS,Facility,Outpatient,,,,33.25,28.2625,9.52945,33.25,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,29.95825,90.1,,percent of total billed charges,,
SUTURE PLAIN 5-0 PC-1 FAST         1915G,,A4649,HCPCS,Facility,Inpatient,,,,33.25,28.2625,9.52945,33.25,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
SUTURE PLAIN 5-0 PC-1 FAST         1915G,,A4649,HCPCS,Facility,Both,,,,33.25,28.2625,9.52945,33.25,"Preferred One Administrative Services, INC.",PPO,32.7845,98.6,,percent of total billed charges,,
SUTURE PLAIN 5-0 PC-1 FAST         1915G,,A4649,HCPCS,Facility,Outpatient,,,,33.25,28.2625,9.52945,33.25,PrimeWest Health,Minnesota Senior Health Options (MSHO),17.107125,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
SUTURE PLAIN 5-0 PC-1 FAST         1915G,,A4649,HCPCS,Facility,Inpatient,,,,33.25,28.2625,9.52945,33.25,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE PLAIN 5-0 PC-1 FAST         1915G,,A4649,HCPCS,Facility,Outpatient,,,,33.25,28.2625,9.52945,33.25,PrimeWest Health,MinnesotaCare,17.0772,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
SUTURE PLAIN 5-0 PC-1 FAST         1915G,,A4649,HCPCS,Facility,Inpatient,,,,33.25,28.2625,9.52945,33.25,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
SUTURE PLAIN 5-0 PC-1 FAST         1915G,,A4649,HCPCS,Facility,Both,,,,33.25,28.2625,9.52945,33.25,Sanford Health Plan,Sanford Health Plan,30.59,92,,percent of total billed charges,,
SUTURE PLAIN 5-0 PC-1 FAST         1915G,,A4649,HCPCS,Facility,Outpatient,,,,33.25,28.2625,9.52945,33.25,"UCare Health, Inc.",Individual & Family Plan,18.736375,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
SUTURE PLAIN 5-0 PC-1 FAST         1915G,,A4649,HCPCS,Facility,Inpatient,,,,33.25,28.2625,9.52945,33.25,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
SUTURE PLAIN 5-0 PC-1 FAST         1915G,,A4649,HCPCS,Facility,Outpatient,,,,33.25,28.2625,9.52945,33.25,"UCare Health, Inc.",Medical Assistance,16.781275,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE PLAIN 5-0 PC-1 FAST         1915G,,A4649,HCPCS,Facility,Inpatient,,,,33.25,28.2625,9.52945,33.25,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
SUTURE PLAIN 5-0 PC-1 FAST         1915G,,A4649,HCPCS,Facility,Outpatient,,,,33.25,28.2625,9.52945,33.25,"UCare Health, Inc.",Medicare Advantage,16.781275,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE PLAIN 5-0 PC-1 FAST         1915G,,A4649,HCPCS,Facility,Inpatient,,,,33.25,28.2625,9.52945,33.25,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE PLAIN 5-0 PC-1 FAST         1915G,,A4649,HCPCS,Facility,Outpatient,,,,33.25,28.2625,9.52945,33.25,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),16.781275,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE PLAIN 5-0 PC-1 FAST         1915G,,A4649,HCPCS,Facility,Inpatient,,,,33.25,28.2625,9.52945,33.25,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE PLAIN 5-0 PC-1 FAST         1915G,,A4649,HCPCS,Facility,Both,,,,33.25,28.2625,9.52945,33.25,UnitedHealthcare,Individual & Family,31.255,94,,percent of total billed charges,,
SUTURE PLAIN 5-0 PC-1 FAST         1915G,,A4649,HCPCS,Facility,Outpatient,,,,33.25,28.2625,9.52945,33.25,UnitedHealthcare,Medicare Advantage,16.2925,49,,percent of total billed charges,,
SUTURE PLAIN 5-0 PC-1 FAST         1915G,,A4649,HCPCS,Facility,Inpatient,,,,33.25,28.2625,9.52945,33.25,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
SUTURE PLAIN 5-0 PC-1 FAST         1915G,,A4649,HCPCS,Facility,Outpatient,,,,33.25,28.2625,9.52945,33.25,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,15.96,48,,percent of total billed charges,,100% of DHS outpatient percentage
SUTURE PLAIN 5-0 PC-1 FAST         1915G,,A4649,HCPCS,Facility,Inpatient,,,,33.25,28.2625,9.52945,33.25,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
SUTURE PLAIN 6-0 774G,,A4649,HCPCS,Facility,Both,,,,43.4,36.89,12.43844,43.4,Aetna,Commercial,39.928,92,,percent of total billed charges,,
SUTURE PLAIN 6-0 774G,,A4649,HCPCS,Facility,Outpatient,,,,43.4,36.89,12.43844,43.4,Aetna,Medicare Advantage,21.266,49,,percent of total billed charges,,
SUTURE PLAIN 6-0 774G,,A4649,HCPCS,Facility,Inpatient,,,,43.4,36.89,12.43844,43.4,Aetna,Medicare Advantage,,,,,Included in per diem rate,
SUTURE PLAIN 6-0 774G,,A4649,HCPCS,Facility,Both,,,,43.4,36.89,12.43844,43.4,Aetna,PPO,40.362,93,,percent of total billed charges,,
SUTURE PLAIN 6-0 774G,,A4649,HCPCS,Facility,Both,,,,43.4,36.89,12.43844,43.4,America's PPO,America's PPO,41.67702,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SUTURE PLAIN 6-0 774G,,A4649,HCPCS,Facility,Both,,,,43.4,36.89,12.43844,43.4,BlueCross BlueShield Minnesota, Federal Employee Program,42.7056,98.4,,percent of total billed charges,,
SUTURE PLAIN 6-0 774G,,A4649,HCPCS,Facility,Both,,,,43.4,36.89,12.43844,43.4,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,43.4,100,,percent of total billed charges,,
SUTURE PLAIN 6-0 774G,,A4649,HCPCS,Facility,Both,,,,43.4,36.89,12.43844,43.4,BlueCross BlueShield Minnesota,High Value Network Plan,39.06,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
SUTURE PLAIN 6-0 774G,,A4649,HCPCS,Facility,Outpatient,,,,43.4,36.89,12.43844,43.4,BlueCross BlueShield Minnesota,Medicare Advantage,21.266,49,,percent of total billed charges,,
SUTURE PLAIN 6-0 774G,,A4649,HCPCS,Facility,Inpatient,,,,43.4,36.89,12.43844,43.4,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
SUTURE PLAIN 6-0 774G,,A4649,HCPCS,Facility,Both,,,,43.4,36.89,12.43844,43.4,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,38.43938,88.57,,percent of total billed charges,,
SUTURE PLAIN 6-0 774G,,A4649,HCPCS,Facility,Both,,,,43.4,36.89,12.43844,43.4,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,12.43844,28.66,,percent of total billed charges,,
SUTURE PLAIN 6-0 774G,,A4649,HCPCS,Facility,Outpatient,,,,43.4,36.89,12.43844,43.4,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),21.266,49,,percent of total billed charges,,
SUTURE PLAIN 6-0 774G,,A4649,HCPCS,Facility,Inpatient,,,,43.4,36.89,12.43844,43.4,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
SUTURE PLAIN 6-0 774G,,A4649,HCPCS,Facility,Both,,,,43.4,36.89,12.43844,43.4,CorVel,Worker's Compensation,43.4,100,,percent of total billed charges,,
SUTURE PLAIN 6-0 774G,,A4649,HCPCS,Facility,Both,,,,43.4,36.89,12.43844,43.4,First Health Group Corporation,First Health Network,42.098,97,,percent of total billed charges,,
SUTURE PLAIN 6-0 774G,,A4649,HCPCS,Facility,Both,,,,43.4,36.89,12.43844,43.4,"Health Partners, Inc.",Commercial,41.0564,94.6,,percent of total billed charges,,
SUTURE PLAIN 6-0 774G,,A4649,HCPCS,Facility,Outpatient,,,,43.4,36.89,12.43844,43.4,"Health Partners, Inc.",Medicare Advantage,21.266,49,,percent of total billed charges,,
SUTURE PLAIN 6-0 774G,,A4649,HCPCS,Facility,Inpatient,,,,43.4,36.89,12.43844,43.4,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE PLAIN 6-0 774G,,A4649,HCPCS,Facility,Both,,,,43.4,36.89,12.43844,43.4,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),26.04,60,,percent of total billed charges,,
SUTURE PLAIN 6-0 774G,,A4649,HCPCS,Facility,Both,,,,43.4,36.89,12.43844,43.4,"Health Partners, Inc.",State of Minnesota Advantage Program,35.371,81.5,,percent of total billed charges,,
SUTURE PLAIN 6-0 774G,,A4649,HCPCS,Facility,Both,,,,43.4,36.89,12.43844,43.4,"Health Partners, Inc.",State Public Programs,21.7,50,,percent of total billed charges,,
SUTURE PLAIN 6-0 774G,,A4649,HCPCS,Facility,Both,,,,43.4,36.89,12.43844,43.4,Humana Insurance Company,Commercial PPO,41.23,95,,percent of total billed charges,,
SUTURE PLAIN 6-0 774G,,A4649,HCPCS,Facility,Outpatient,,,,43.4,36.89,12.43844,43.4,Humana Insurance Company,Medicare PPO,21.266,49,,percent of total billed charges,,
SUTURE PLAIN 6-0 774G,,A4649,HCPCS,Facility,Inpatient,,,,43.4,36.89,12.43844,43.4,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
SUTURE PLAIN 6-0 774G,,A4649,HCPCS,Facility,Both,,,,43.4,36.89,12.43844,43.4,Medica,Individual & Family,43.0094,99.1,,percent of total billed charges,,
SUTURE PLAIN 6-0 774G,,A4649,HCPCS,Facility,Outpatient,,,,43.4,36.89,12.43844,43.4,Medica,Medica Advantage Solution,21.6132,49.8,,percent of total billed charges,,
SUTURE PLAIN 6-0 774G,,A4649,HCPCS,Facility,Inpatient,,,,43.4,36.89,12.43844,43.4,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
SUTURE PLAIN 6-0 774G,,A4649,HCPCS,Facility,Outpatient,,,,43.4,36.89,12.43844,43.4,Medica,Medical Assistance,19.3564,44.6,,percent of total billed charges,,
SUTURE PLAIN 6-0 774G,,A4649,HCPCS,Facility,Inpatient,,,,43.4,36.89,12.43844,43.4,Medica,Medical Assistance,,,,,Included in per diem rate,
SUTURE PLAIN 6-0 774G,,A4649,HCPCS,Facility,Outpatient,,,,43.4,36.89,12.43844,43.4,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,21.6132,49.8,,percent of total billed charges,,
SUTURE PLAIN 6-0 774G,,A4649,HCPCS,Facility,Inpatient,,,,43.4,36.89,12.43844,43.4,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
SUTURE PLAIN 6-0 774G,,A4649,HCPCS,Facility,Both,,,,43.4,36.89,12.43844,43.4,"Multiplan, Inc.","Multiplan, Inc.",40.796,94,,percent of total billed charges,,
SUTURE PLAIN 6-0 774G,,A4649,HCPCS,Facility,Outpatient,,,,43.4,36.89,12.43844,43.4,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,39.1034,90.1,,percent of total billed charges,,
SUTURE PLAIN 6-0 774G,,A4649,HCPCS,Facility,Inpatient,,,,43.4,36.89,12.43844,43.4,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
SUTURE PLAIN 6-0 774G,,A4649,HCPCS,Facility,Both,,,,43.4,36.89,12.43844,43.4,"Preferred One Administrative Services, INC.",PPO,42.7924,98.6,,percent of total billed charges,,
SUTURE PLAIN 6-0 774G,,A4649,HCPCS,Facility,Outpatient,,,,43.4,36.89,12.43844,43.4,PrimeWest Health,Minnesota Senior Health Options (MSHO),22.3293,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
SUTURE PLAIN 6-0 774G,,A4649,HCPCS,Facility,Inpatient,,,,43.4,36.89,12.43844,43.4,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE PLAIN 6-0 774G,,A4649,HCPCS,Facility,Outpatient,,,,43.4,36.89,12.43844,43.4,PrimeWest Health,MinnesotaCare,22.29024,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
SUTURE PLAIN 6-0 774G,,A4649,HCPCS,Facility,Inpatient,,,,43.4,36.89,12.43844,43.4,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
SUTURE PLAIN 6-0 774G,,A4649,HCPCS,Facility,Both,,,,43.4,36.89,12.43844,43.4,Sanford Health Plan,Sanford Health Plan,39.928,92,,percent of total billed charges,,
SUTURE PLAIN 6-0 774G,,A4649,HCPCS,Facility,Outpatient,,,,43.4,36.89,12.43844,43.4,"UCare Health, Inc.",Individual & Family Plan,24.4559,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
SUTURE PLAIN 6-0 774G,,A4649,HCPCS,Facility,Inpatient,,,,43.4,36.89,12.43844,43.4,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
SUTURE PLAIN 6-0 774G,,A4649,HCPCS,Facility,Outpatient,,,,43.4,36.89,12.43844,43.4,"UCare Health, Inc.",Medical Assistance,21.90398,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE PLAIN 6-0 774G,,A4649,HCPCS,Facility,Inpatient,,,,43.4,36.89,12.43844,43.4,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
SUTURE PLAIN 6-0 774G,,A4649,HCPCS,Facility,Outpatient,,,,43.4,36.89,12.43844,43.4,"UCare Health, Inc.",Medicare Advantage,21.90398,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE PLAIN 6-0 774G,,A4649,HCPCS,Facility,Inpatient,,,,43.4,36.89,12.43844,43.4,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE PLAIN 6-0 774G,,A4649,HCPCS,Facility,Outpatient,,,,43.4,36.89,12.43844,43.4,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),21.90398,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE PLAIN 6-0 774G,,A4649,HCPCS,Facility,Inpatient,,,,43.4,36.89,12.43844,43.4,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE PLAIN 6-0 774G,,A4649,HCPCS,Facility,Both,,,,43.4,36.89,12.43844,43.4,UnitedHealthcare,Individual & Family,40.796,94,,percent of total billed charges,,
SUTURE PLAIN 6-0 774G,,A4649,HCPCS,Facility,Outpatient,,,,43.4,36.89,12.43844,43.4,UnitedHealthcare,Medicare Advantage,21.266,49,,percent of total billed charges,,
SUTURE PLAIN 6-0 774G,,A4649,HCPCS,Facility,Inpatient,,,,43.4,36.89,12.43844,43.4,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
SUTURE PLAIN 6-0 774G,,A4649,HCPCS,Facility,Outpatient,,,,43.4,36.89,12.43844,43.4,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,20.832,48,,percent of total billed charges,,100% of DHS outpatient percentage
SUTURE PLAIN 6-0 774G,,A4649,HCPCS,Facility,Inpatient,,,,43.4,36.89,12.43844,43.4,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"SUTURE POLSORB 4-0 60"" REEL/TIES UNDYED 125  LL101",,A4649,HCPCS,Facility,Both,,,,48.375,41.11875,13.864275,48.375,Aetna,Commercial,44.505,92,,percent of total billed charges,,
"SUTURE POLSORB 4-0 60"" REEL/TIES UNDYED 125  LL101",,A4649,HCPCS,Facility,Outpatient,,,,48.375,41.11875,13.864275,48.375,Aetna,Medicare Advantage,23.70375,49,,percent of total billed charges,,
"SUTURE POLSORB 4-0 60"" REEL/TIES UNDYED 125  LL101",,A4649,HCPCS,Facility,Inpatient,,,,48.375,41.11875,13.864275,48.375,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"SUTURE POLSORB 4-0 60"" REEL/TIES UNDYED 125  LL101",,A4649,HCPCS,Facility,Both,,,,48.375,41.11875,13.864275,48.375,Aetna,PPO,44.98875,93,,percent of total billed charges,,
"SUTURE POLSORB 4-0 60"" REEL/TIES UNDYED 125  LL101",,A4649,HCPCS,Facility,Both,,,,48.375,41.11875,13.864275,48.375,America's PPO,America's PPO,46.4545125,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"SUTURE POLSORB 4-0 60"" REEL/TIES UNDYED 125  LL101",,A4649,HCPCS,Facility,Both,,,,48.375,41.11875,13.864275,48.375,BlueCross BlueShield Minnesota, Federal Employee Program,47.601,98.4,,percent of total billed charges,,
"SUTURE POLSORB 4-0 60"" REEL/TIES UNDYED 125  LL101",,A4649,HCPCS,Facility,Both,,,,48.375,41.11875,13.864275,48.375,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,48.375,100,,percent of total billed charges,,
"SUTURE POLSORB 4-0 60"" REEL/TIES UNDYED 125  LL101",,A4649,HCPCS,Facility,Both,,,,48.375,41.11875,13.864275,48.375,BlueCross BlueShield Minnesota,High Value Network Plan,43.5375,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
"SUTURE POLSORB 4-0 60"" REEL/TIES UNDYED 125  LL101",,A4649,HCPCS,Facility,Outpatient,,,,48.375,41.11875,13.864275,48.375,BlueCross BlueShield Minnesota,Medicare Advantage,23.70375,49,,percent of total billed charges,,
"SUTURE POLSORB 4-0 60"" REEL/TIES UNDYED 125  LL101",,A4649,HCPCS,Facility,Inpatient,,,,48.375,41.11875,13.864275,48.375,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"SUTURE POLSORB 4-0 60"" REEL/TIES UNDYED 125  LL101",,A4649,HCPCS,Facility,Both,,,,48.375,41.11875,13.864275,48.375,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,42.8457375,88.57,,percent of total billed charges,,
"SUTURE POLSORB 4-0 60"" REEL/TIES UNDYED 125  LL101",,A4649,HCPCS,Facility,Both,,,,48.375,41.11875,13.864275,48.375,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,13.864275,28.66,,percent of total billed charges,,
"SUTURE POLSORB 4-0 60"" REEL/TIES UNDYED 125  LL101",,A4649,HCPCS,Facility,Outpatient,,,,48.375,41.11875,13.864275,48.375,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),23.70375,49,,percent of total billed charges,,
"SUTURE POLSORB 4-0 60"" REEL/TIES UNDYED 125  LL101",,A4649,HCPCS,Facility,Inpatient,,,,48.375,41.11875,13.864275,48.375,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"SUTURE POLSORB 4-0 60"" REEL/TIES UNDYED 125  LL101",,A4649,HCPCS,Facility,Both,,,,48.375,41.11875,13.864275,48.375,CorVel,Worker's Compensation,48.375,100,,percent of total billed charges,,
"SUTURE POLSORB 4-0 60"" REEL/TIES UNDYED 125  LL101",,A4649,HCPCS,Facility,Both,,,,48.375,41.11875,13.864275,48.375,First Health Group Corporation,First Health Network,46.92375,97,,percent of total billed charges,,
"SUTURE POLSORB 4-0 60"" REEL/TIES UNDYED 125  LL101",,A4649,HCPCS,Facility,Both,,,,48.375,41.11875,13.864275,48.375,"Health Partners, Inc.",Commercial,45.76275,94.6,,percent of total billed charges,,
"SUTURE POLSORB 4-0 60"" REEL/TIES UNDYED 125  LL101",,A4649,HCPCS,Facility,Outpatient,,,,48.375,41.11875,13.864275,48.375,"Health Partners, Inc.",Medicare Advantage,23.70375,49,,percent of total billed charges,,
"SUTURE POLSORB 4-0 60"" REEL/TIES UNDYED 125  LL101",,A4649,HCPCS,Facility,Inpatient,,,,48.375,41.11875,13.864275,48.375,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"SUTURE POLSORB 4-0 60"" REEL/TIES UNDYED 125  LL101",,A4649,HCPCS,Facility,Both,,,,48.375,41.11875,13.864275,48.375,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),29.025,60,,percent of total billed charges,,
"SUTURE POLSORB 4-0 60"" REEL/TIES UNDYED 125  LL101",,A4649,HCPCS,Facility,Both,,,,48.375,41.11875,13.864275,48.375,"Health Partners, Inc.",State of Minnesota Advantage Program,39.425625,81.5,,percent of total billed charges,,
"SUTURE POLSORB 4-0 60"" REEL/TIES UNDYED 125  LL101",,A4649,HCPCS,Facility,Both,,,,48.375,41.11875,13.864275,48.375,"Health Partners, Inc.",State Public Programs,24.1875,50,,percent of total billed charges,,
"SUTURE POLSORB 4-0 60"" REEL/TIES UNDYED 125  LL101",,A4649,HCPCS,Facility,Both,,,,48.375,41.11875,13.864275,48.375,Humana Insurance Company,Commercial PPO,45.95625,95,,percent of total billed charges,,
"SUTURE POLSORB 4-0 60"" REEL/TIES UNDYED 125  LL101",,A4649,HCPCS,Facility,Outpatient,,,,48.375,41.11875,13.864275,48.375,Humana Insurance Company,Medicare PPO,23.70375,49,,percent of total billed charges,,
"SUTURE POLSORB 4-0 60"" REEL/TIES UNDYED 125  LL101",,A4649,HCPCS,Facility,Inpatient,,,,48.375,41.11875,13.864275,48.375,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"SUTURE POLSORB 4-0 60"" REEL/TIES UNDYED 125  LL101",,A4649,HCPCS,Facility,Both,,,,48.375,41.11875,13.864275,48.375,Medica,Individual & Family,47.939625,99.1,,percent of total billed charges,,
"SUTURE POLSORB 4-0 60"" REEL/TIES UNDYED 125  LL101",,A4649,HCPCS,Facility,Outpatient,,,,48.375,41.11875,13.864275,48.375,Medica,Medica Advantage Solution,24.09075,49.8,,percent of total billed charges,,
"SUTURE POLSORB 4-0 60"" REEL/TIES UNDYED 125  LL101",,A4649,HCPCS,Facility,Inpatient,,,,48.375,41.11875,13.864275,48.375,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"SUTURE POLSORB 4-0 60"" REEL/TIES UNDYED 125  LL101",,A4649,HCPCS,Facility,Outpatient,,,,48.375,41.11875,13.864275,48.375,Medica,Medical Assistance,21.57525,44.6,,percent of total billed charges,,
"SUTURE POLSORB 4-0 60"" REEL/TIES UNDYED 125  LL101",,A4649,HCPCS,Facility,Inpatient,,,,48.375,41.11875,13.864275,48.375,Medica,Medical Assistance,,,,,Included in per diem rate,
"SUTURE POLSORB 4-0 60"" REEL/TIES UNDYED 125  LL101",,A4649,HCPCS,Facility,Outpatient,,,,48.375,41.11875,13.864275,48.375,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,24.09075,49.8,,percent of total billed charges,,
"SUTURE POLSORB 4-0 60"" REEL/TIES UNDYED 125  LL101",,A4649,HCPCS,Facility,Inpatient,,,,48.375,41.11875,13.864275,48.375,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"SUTURE POLSORB 4-0 60"" REEL/TIES UNDYED 125  LL101",,A4649,HCPCS,Facility,Both,,,,48.375,41.11875,13.864275,48.375,"Multiplan, Inc.","Multiplan, Inc.",45.4725,94,,percent of total billed charges,,
"SUTURE POLSORB 4-0 60"" REEL/TIES UNDYED 125  LL101",,A4649,HCPCS,Facility,Outpatient,,,,48.375,41.11875,13.864275,48.375,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,43.585875,90.1,,percent of total billed charges,,
"SUTURE POLSORB 4-0 60"" REEL/TIES UNDYED 125  LL101",,A4649,HCPCS,Facility,Inpatient,,,,48.375,41.11875,13.864275,48.375,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"SUTURE POLSORB 4-0 60"" REEL/TIES UNDYED 125  LL101",,A4649,HCPCS,Facility,Both,,,,48.375,41.11875,13.864275,48.375,"Preferred One Administrative Services, INC.",PPO,47.69775,98.6,,percent of total billed charges,,
"SUTURE POLSORB 4-0 60"" REEL/TIES UNDYED 125  LL101",,A4649,HCPCS,Facility,Outpatient,,,,48.375,41.11875,13.864275,48.375,PrimeWest Health,Minnesota Senior Health Options (MSHO),24.8889375,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"SUTURE POLSORB 4-0 60"" REEL/TIES UNDYED 125  LL101",,A4649,HCPCS,Facility,Inpatient,,,,48.375,41.11875,13.864275,48.375,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"SUTURE POLSORB 4-0 60"" REEL/TIES UNDYED 125  LL101",,A4649,HCPCS,Facility,Outpatient,,,,48.375,41.11875,13.864275,48.375,PrimeWest Health,MinnesotaCare,24.8454,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"SUTURE POLSORB 4-0 60"" REEL/TIES UNDYED 125  LL101",,A4649,HCPCS,Facility,Inpatient,,,,48.375,41.11875,13.864275,48.375,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"SUTURE POLSORB 4-0 60"" REEL/TIES UNDYED 125  LL101",,A4649,HCPCS,Facility,Both,,,,48.375,41.11875,13.864275,48.375,Sanford Health Plan,Sanford Health Plan,44.505,92,,percent of total billed charges,,
"SUTURE POLSORB 4-0 60"" REEL/TIES UNDYED 125  LL101",,A4649,HCPCS,Facility,Outpatient,,,,48.375,41.11875,13.864275,48.375,"UCare Health, Inc.",Individual & Family Plan,27.2593125,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"SUTURE POLSORB 4-0 60"" REEL/TIES UNDYED 125  LL101",,A4649,HCPCS,Facility,Inpatient,,,,48.375,41.11875,13.864275,48.375,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"SUTURE POLSORB 4-0 60"" REEL/TIES UNDYED 125  LL101",,A4649,HCPCS,Facility,Outpatient,,,,48.375,41.11875,13.864275,48.375,"UCare Health, Inc.",Medical Assistance,24.4148625,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"SUTURE POLSORB 4-0 60"" REEL/TIES UNDYED 125  LL101",,A4649,HCPCS,Facility,Inpatient,,,,48.375,41.11875,13.864275,48.375,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"SUTURE POLSORB 4-0 60"" REEL/TIES UNDYED 125  LL101",,A4649,HCPCS,Facility,Outpatient,,,,48.375,41.11875,13.864275,48.375,"UCare Health, Inc.",Medicare Advantage,24.4148625,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"SUTURE POLSORB 4-0 60"" REEL/TIES UNDYED 125  LL101",,A4649,HCPCS,Facility,Inpatient,,,,48.375,41.11875,13.864275,48.375,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"SUTURE POLSORB 4-0 60"" REEL/TIES UNDYED 125  LL101",,A4649,HCPCS,Facility,Outpatient,,,,48.375,41.11875,13.864275,48.375,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),24.4148625,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"SUTURE POLSORB 4-0 60"" REEL/TIES UNDYED 125  LL101",,A4649,HCPCS,Facility,Inpatient,,,,48.375,41.11875,13.864275,48.375,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"SUTURE POLSORB 4-0 60"" REEL/TIES UNDYED 125  LL101",,A4649,HCPCS,Facility,Both,,,,48.375,41.11875,13.864275,48.375,UnitedHealthcare,Individual & Family,45.4725,94,,percent of total billed charges,,
"SUTURE POLSORB 4-0 60"" REEL/TIES UNDYED 125  LL101",,A4649,HCPCS,Facility,Outpatient,,,,48.375,41.11875,13.864275,48.375,UnitedHealthcare,Medicare Advantage,23.70375,49,,percent of total billed charges,,
"SUTURE POLSORB 4-0 60"" REEL/TIES UNDYED 125  LL101",,A4649,HCPCS,Facility,Inpatient,,,,48.375,41.11875,13.864275,48.375,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"SUTURE POLSORB 4-0 60"" REEL/TIES UNDYED 125  LL101",,A4649,HCPCS,Facility,Outpatient,,,,48.375,41.11875,13.864275,48.375,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,23.22,48,,percent of total billed charges,,100% of DHS outpatient percentage
"SUTURE POLSORB 4-0 60"" REEL/TIES UNDYED 125  LL101",,A4649,HCPCS,Facility,Inpatient,,,,48.375,41.11875,13.864275,48.375,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"SUTURE POLYSORB 0 18"" UNDYED GS-21 D  CL14MG",,A4649,HCPCS,Facility,Both,,,,87.64,74.494,25.117624,87.64,Aetna,Commercial,80.6288,92,,percent of total billed charges,,
"SUTURE POLYSORB 0 18"" UNDYED GS-21 D  CL14MG",,A4649,HCPCS,Facility,Outpatient,,,,87.64,74.494,25.117624,87.64,Aetna,Medicare Advantage,42.9436,49,,percent of total billed charges,,
"SUTURE POLYSORB 0 18"" UNDYED GS-21 D  CL14MG",,A4649,HCPCS,Facility,Inpatient,,,,87.64,74.494,25.117624,87.64,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"SUTURE POLYSORB 0 18"" UNDYED GS-21 D  CL14MG",,A4649,HCPCS,Facility,Both,,,,87.64,74.494,25.117624,87.64,Aetna,PPO,81.5052,93,,percent of total billed charges,,
"SUTURE POLYSORB 0 18"" UNDYED GS-21 D  CL14MG",,A4649,HCPCS,Facility,Both,,,,87.64,74.494,25.117624,87.64,America's PPO,America's PPO,84.160692,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"SUTURE POLYSORB 0 18"" UNDYED GS-21 D  CL14MG",,A4649,HCPCS,Facility,Both,,,,87.64,74.494,25.117624,87.64,BlueCross BlueShield Minnesota, Federal Employee Program,86.23776,98.4,,percent of total billed charges,,
"SUTURE POLYSORB 0 18"" UNDYED GS-21 D  CL14MG",,A4649,HCPCS,Facility,Both,,,,87.64,74.494,25.117624,87.64,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,87.64,100,,percent of total billed charges,,
"SUTURE POLYSORB 0 18"" UNDYED GS-21 D  CL14MG",,A4649,HCPCS,Facility,Both,,,,87.64,74.494,25.117624,87.64,BlueCross BlueShield Minnesota,High Value Network Plan,78.876,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
"SUTURE POLYSORB 0 18"" UNDYED GS-21 D  CL14MG",,A4649,HCPCS,Facility,Outpatient,,,,87.64,74.494,25.117624,87.64,BlueCross BlueShield Minnesota,Medicare Advantage,42.9436,49,,percent of total billed charges,,
"SUTURE POLYSORB 0 18"" UNDYED GS-21 D  CL14MG",,A4649,HCPCS,Facility,Inpatient,,,,87.64,74.494,25.117624,87.64,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"SUTURE POLYSORB 0 18"" UNDYED GS-21 D  CL14MG",,A4649,HCPCS,Facility,Both,,,,87.64,74.494,25.117624,87.64,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,77.622748,88.57,,percent of total billed charges,,
"SUTURE POLYSORB 0 18"" UNDYED GS-21 D  CL14MG",,A4649,HCPCS,Facility,Both,,,,87.64,74.494,25.117624,87.64,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,25.117624,28.66,,percent of total billed charges,,
"SUTURE POLYSORB 0 18"" UNDYED GS-21 D  CL14MG",,A4649,HCPCS,Facility,Outpatient,,,,87.64,74.494,25.117624,87.64,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),42.9436,49,,percent of total billed charges,,
"SUTURE POLYSORB 0 18"" UNDYED GS-21 D  CL14MG",,A4649,HCPCS,Facility,Inpatient,,,,87.64,74.494,25.117624,87.64,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"SUTURE POLYSORB 0 18"" UNDYED GS-21 D  CL14MG",,A4649,HCPCS,Facility,Both,,,,87.64,74.494,25.117624,87.64,CorVel,Worker's Compensation,87.64,100,,percent of total billed charges,,
"SUTURE POLYSORB 0 18"" UNDYED GS-21 D  CL14MG",,A4649,HCPCS,Facility,Both,,,,87.64,74.494,25.117624,87.64,First Health Group Corporation,First Health Network,85.0108,97,,percent of total billed charges,,
"SUTURE POLYSORB 0 18"" UNDYED GS-21 D  CL14MG",,A4649,HCPCS,Facility,Both,,,,87.64,74.494,25.117624,87.64,"Health Partners, Inc.",Commercial,82.90744,94.6,,percent of total billed charges,,
"SUTURE POLYSORB 0 18"" UNDYED GS-21 D  CL14MG",,A4649,HCPCS,Facility,Outpatient,,,,87.64,74.494,25.117624,87.64,"Health Partners, Inc.",Medicare Advantage,42.9436,49,,percent of total billed charges,,
"SUTURE POLYSORB 0 18"" UNDYED GS-21 D  CL14MG",,A4649,HCPCS,Facility,Inpatient,,,,87.64,74.494,25.117624,87.64,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"SUTURE POLYSORB 0 18"" UNDYED GS-21 D  CL14MG",,A4649,HCPCS,Facility,Both,,,,87.64,74.494,25.117624,87.64,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),52.584,60,,percent of total billed charges,,
"SUTURE POLYSORB 0 18"" UNDYED GS-21 D  CL14MG",,A4649,HCPCS,Facility,Both,,,,87.64,74.494,25.117624,87.64,"Health Partners, Inc.",State of Minnesota Advantage Program,71.4266,81.5,,percent of total billed charges,,
"SUTURE POLYSORB 0 18"" UNDYED GS-21 D  CL14MG",,A4649,HCPCS,Facility,Both,,,,87.64,74.494,25.117624,87.64,"Health Partners, Inc.",State Public Programs,43.82,50,,percent of total billed charges,,
"SUTURE POLYSORB 0 18"" UNDYED GS-21 D  CL14MG",,A4649,HCPCS,Facility,Both,,,,87.64,74.494,25.117624,87.64,Humana Insurance Company,Commercial PPO,83.258,95,,percent of total billed charges,,
"SUTURE POLYSORB 0 18"" UNDYED GS-21 D  CL14MG",,A4649,HCPCS,Facility,Outpatient,,,,87.64,74.494,25.117624,87.64,Humana Insurance Company,Medicare PPO,42.9436,49,,percent of total billed charges,,
"SUTURE POLYSORB 0 18"" UNDYED GS-21 D  CL14MG",,A4649,HCPCS,Facility,Inpatient,,,,87.64,74.494,25.117624,87.64,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"SUTURE POLYSORB 0 18"" UNDYED GS-21 D  CL14MG",,A4649,HCPCS,Facility,Both,,,,87.64,74.494,25.117624,87.64,Medica,Individual & Family,86.85124,99.1,,percent of total billed charges,,
"SUTURE POLYSORB 0 18"" UNDYED GS-21 D  CL14MG",,A4649,HCPCS,Facility,Outpatient,,,,87.64,74.494,25.117624,87.64,Medica,Medica Advantage Solution,43.64472,49.8,,percent of total billed charges,,
"SUTURE POLYSORB 0 18"" UNDYED GS-21 D  CL14MG",,A4649,HCPCS,Facility,Inpatient,,,,87.64,74.494,25.117624,87.64,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"SUTURE POLYSORB 0 18"" UNDYED GS-21 D  CL14MG",,A4649,HCPCS,Facility,Outpatient,,,,87.64,74.494,25.117624,87.64,Medica,Medical Assistance,39.08744,44.6,,percent of total billed charges,,
"SUTURE POLYSORB 0 18"" UNDYED GS-21 D  CL14MG",,A4649,HCPCS,Facility,Inpatient,,,,87.64,74.494,25.117624,87.64,Medica,Medical Assistance,,,,,Included in per diem rate,
"SUTURE POLYSORB 0 18"" UNDYED GS-21 D  CL14MG",,A4649,HCPCS,Facility,Outpatient,,,,87.64,74.494,25.117624,87.64,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,43.64472,49.8,,percent of total billed charges,,
"SUTURE POLYSORB 0 18"" UNDYED GS-21 D  CL14MG",,A4649,HCPCS,Facility,Inpatient,,,,87.64,74.494,25.117624,87.64,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"SUTURE POLYSORB 0 18"" UNDYED GS-21 D  CL14MG",,A4649,HCPCS,Facility,Both,,,,87.64,74.494,25.117624,87.64,"Multiplan, Inc.","Multiplan, Inc.",82.3816,94,,percent of total billed charges,,
"SUTURE POLYSORB 0 18"" UNDYED GS-21 D  CL14MG",,A4649,HCPCS,Facility,Outpatient,,,,87.64,74.494,25.117624,87.64,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,78.96364,90.1,,percent of total billed charges,,
"SUTURE POLYSORB 0 18"" UNDYED GS-21 D  CL14MG",,A4649,HCPCS,Facility,Inpatient,,,,87.64,74.494,25.117624,87.64,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"SUTURE POLYSORB 0 18"" UNDYED GS-21 D  CL14MG",,A4649,HCPCS,Facility,Both,,,,87.64,74.494,25.117624,87.64,"Preferred One Administrative Services, INC.",PPO,86.41304,98.6,,percent of total billed charges,,
"SUTURE POLYSORB 0 18"" UNDYED GS-21 D  CL14MG",,A4649,HCPCS,Facility,Outpatient,,,,87.64,74.494,25.117624,87.64,PrimeWest Health,Minnesota Senior Health Options (MSHO),45.09078,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"SUTURE POLYSORB 0 18"" UNDYED GS-21 D  CL14MG",,A4649,HCPCS,Facility,Inpatient,,,,87.64,74.494,25.117624,87.64,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"SUTURE POLYSORB 0 18"" UNDYED GS-21 D  CL14MG",,A4649,HCPCS,Facility,Outpatient,,,,87.64,74.494,25.117624,87.64,PrimeWest Health,MinnesotaCare,45.011904,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"SUTURE POLYSORB 0 18"" UNDYED GS-21 D  CL14MG",,A4649,HCPCS,Facility,Inpatient,,,,87.64,74.494,25.117624,87.64,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"SUTURE POLYSORB 0 18"" UNDYED GS-21 D  CL14MG",,A4649,HCPCS,Facility,Both,,,,87.64,74.494,25.117624,87.64,Sanford Health Plan,Sanford Health Plan,80.6288,92,,percent of total billed charges,,
"SUTURE POLYSORB 0 18"" UNDYED GS-21 D  CL14MG",,A4649,HCPCS,Facility,Outpatient,,,,87.64,74.494,25.117624,87.64,"UCare Health, Inc.",Individual & Family Plan,49.38514,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"SUTURE POLYSORB 0 18"" UNDYED GS-21 D  CL14MG",,A4649,HCPCS,Facility,Inpatient,,,,87.64,74.494,25.117624,87.64,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"SUTURE POLYSORB 0 18"" UNDYED GS-21 D  CL14MG",,A4649,HCPCS,Facility,Outpatient,,,,87.64,74.494,25.117624,87.64,"UCare Health, Inc.",Medical Assistance,44.231908,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"SUTURE POLYSORB 0 18"" UNDYED GS-21 D  CL14MG",,A4649,HCPCS,Facility,Inpatient,,,,87.64,74.494,25.117624,87.64,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"SUTURE POLYSORB 0 18"" UNDYED GS-21 D  CL14MG",,A4649,HCPCS,Facility,Outpatient,,,,87.64,74.494,25.117624,87.64,"UCare Health, Inc.",Medicare Advantage,44.231908,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"SUTURE POLYSORB 0 18"" UNDYED GS-21 D  CL14MG",,A4649,HCPCS,Facility,Inpatient,,,,87.64,74.494,25.117624,87.64,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"SUTURE POLYSORB 0 18"" UNDYED GS-21 D  CL14MG",,A4649,HCPCS,Facility,Outpatient,,,,87.64,74.494,25.117624,87.64,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),44.231908,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"SUTURE POLYSORB 0 18"" UNDYED GS-21 D  CL14MG",,A4649,HCPCS,Facility,Inpatient,,,,87.64,74.494,25.117624,87.64,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"SUTURE POLYSORB 0 18"" UNDYED GS-21 D  CL14MG",,A4649,HCPCS,Facility,Both,,,,87.64,74.494,25.117624,87.64,UnitedHealthcare,Individual & Family,82.3816,94,,percent of total billed charges,,
"SUTURE POLYSORB 0 18"" UNDYED GS-21 D  CL14MG",,A4649,HCPCS,Facility,Outpatient,,,,87.64,74.494,25.117624,87.64,UnitedHealthcare,Medicare Advantage,42.9436,49,,percent of total billed charges,,
"SUTURE POLYSORB 0 18"" UNDYED GS-21 D  CL14MG",,A4649,HCPCS,Facility,Inpatient,,,,87.64,74.494,25.117624,87.64,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"SUTURE POLYSORB 0 18"" UNDYED GS-21 D  CL14MG",,A4649,HCPCS,Facility,Outpatient,,,,87.64,74.494,25.117624,87.64,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,42.0672,48,,percent of total billed charges,,100% of DHS outpatient percentage
"SUTURE POLYSORB 0 18"" UNDYED GS-21 D  CL14MG",,A4649,HCPCS,Facility,Inpatient,,,,87.64,74.494,25.117624,87.64,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
SUTURE POLYSORB 0 30 VIOLET GS-23,,A4649,HCPCS,Facility,Both,,,,28.65,24.3525,8.21109,28.65,Aetna,Commercial,26.358,92,,percent of total billed charges,,
SUTURE POLYSORB 0 30 VIOLET GS-23,,A4649,HCPCS,Facility,Outpatient,,,,28.65,24.3525,8.21109,28.65,Aetna,Medicare Advantage,14.0385,49,,percent of total billed charges,,
SUTURE POLYSORB 0 30 VIOLET GS-23,,A4649,HCPCS,Facility,Inpatient,,,,28.65,24.3525,8.21109,28.65,Aetna,Medicare Advantage,,,,,Included in per diem rate,
SUTURE POLYSORB 0 30 VIOLET GS-23,,A4649,HCPCS,Facility,Both,,,,28.65,24.3525,8.21109,28.65,Aetna,PPO,26.6445,93,,percent of total billed charges,,
SUTURE POLYSORB 0 30 VIOLET GS-23,,A4649,HCPCS,Facility,Both,,,,28.65,24.3525,8.21109,28.65,America's PPO,America's PPO,27.512595,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SUTURE POLYSORB 0 30 VIOLET GS-23,,A4649,HCPCS,Facility,Both,,,,28.65,24.3525,8.21109,28.65,BlueCross BlueShield Minnesota, Federal Employee Program,28.1916,98.4,,percent of total billed charges,,
SUTURE POLYSORB 0 30 VIOLET GS-23,,A4649,HCPCS,Facility,Both,,,,28.65,24.3525,8.21109,28.65,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,28.65,100,,percent of total billed charges,,
SUTURE POLYSORB 0 30 VIOLET GS-23,,A4649,HCPCS,Facility,Both,,,,28.65,24.3525,8.21109,28.65,BlueCross BlueShield Minnesota,High Value Network Plan,25.785,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
SUTURE POLYSORB 0 30 VIOLET GS-23,,A4649,HCPCS,Facility,Outpatient,,,,28.65,24.3525,8.21109,28.65,BlueCross BlueShield Minnesota,Medicare Advantage,14.0385,49,,percent of total billed charges,,
SUTURE POLYSORB 0 30 VIOLET GS-23,,A4649,HCPCS,Facility,Inpatient,,,,28.65,24.3525,8.21109,28.65,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
SUTURE POLYSORB 0 30 VIOLET GS-23,,A4649,HCPCS,Facility,Both,,,,28.65,24.3525,8.21109,28.65,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,25.375305,88.57,,percent of total billed charges,,
SUTURE POLYSORB 0 30 VIOLET GS-23,,A4649,HCPCS,Facility,Both,,,,28.65,24.3525,8.21109,28.65,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,8.21109,28.66,,percent of total billed charges,,
SUTURE POLYSORB 0 30 VIOLET GS-23,,A4649,HCPCS,Facility,Outpatient,,,,28.65,24.3525,8.21109,28.65,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),14.0385,49,,percent of total billed charges,,
SUTURE POLYSORB 0 30 VIOLET GS-23,,A4649,HCPCS,Facility,Inpatient,,,,28.65,24.3525,8.21109,28.65,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
SUTURE POLYSORB 0 30 VIOLET GS-23,,A4649,HCPCS,Facility,Both,,,,28.65,24.3525,8.21109,28.65,CorVel,Worker's Compensation,28.65,100,,percent of total billed charges,,
SUTURE POLYSORB 0 30 VIOLET GS-23,,A4649,HCPCS,Facility,Both,,,,28.65,24.3525,8.21109,28.65,First Health Group Corporation,First Health Network,27.7905,97,,percent of total billed charges,,
SUTURE POLYSORB 0 30 VIOLET GS-23,,A4649,HCPCS,Facility,Both,,,,28.65,24.3525,8.21109,28.65,"Health Partners, Inc.",Commercial,27.1029,94.6,,percent of total billed charges,,
SUTURE POLYSORB 0 30 VIOLET GS-23,,A4649,HCPCS,Facility,Outpatient,,,,28.65,24.3525,8.21109,28.65,"Health Partners, Inc.",Medicare Advantage,14.0385,49,,percent of total billed charges,,
SUTURE POLYSORB 0 30 VIOLET GS-23,,A4649,HCPCS,Facility,Inpatient,,,,28.65,24.3525,8.21109,28.65,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE POLYSORB 0 30 VIOLET GS-23,,A4649,HCPCS,Facility,Both,,,,28.65,24.3525,8.21109,28.65,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),17.19,60,,percent of total billed charges,,
SUTURE POLYSORB 0 30 VIOLET GS-23,,A4649,HCPCS,Facility,Both,,,,28.65,24.3525,8.21109,28.65,"Health Partners, Inc.",State of Minnesota Advantage Program,23.34975,81.5,,percent of total billed charges,,
SUTURE POLYSORB 0 30 VIOLET GS-23,,A4649,HCPCS,Facility,Both,,,,28.65,24.3525,8.21109,28.65,"Health Partners, Inc.",State Public Programs,14.325,50,,percent of total billed charges,,
SUTURE POLYSORB 0 30 VIOLET GS-23,,A4649,HCPCS,Facility,Both,,,,28.65,24.3525,8.21109,28.65,Humana Insurance Company,Commercial PPO,27.2175,95,,percent of total billed charges,,
SUTURE POLYSORB 0 30 VIOLET GS-23,,A4649,HCPCS,Facility,Outpatient,,,,28.65,24.3525,8.21109,28.65,Humana Insurance Company,Medicare PPO,14.0385,49,,percent of total billed charges,,
SUTURE POLYSORB 0 30 VIOLET GS-23,,A4649,HCPCS,Facility,Inpatient,,,,28.65,24.3525,8.21109,28.65,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
SUTURE POLYSORB 0 30 VIOLET GS-23,,A4649,HCPCS,Facility,Both,,,,28.65,24.3525,8.21109,28.65,Medica,Individual & Family,28.39215,99.1,,percent of total billed charges,,
SUTURE POLYSORB 0 30 VIOLET GS-23,,A4649,HCPCS,Facility,Outpatient,,,,28.65,24.3525,8.21109,28.65,Medica,Medica Advantage Solution,14.2677,49.8,,percent of total billed charges,,
SUTURE POLYSORB 0 30 VIOLET GS-23,,A4649,HCPCS,Facility,Inpatient,,,,28.65,24.3525,8.21109,28.65,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
SUTURE POLYSORB 0 30 VIOLET GS-23,,A4649,HCPCS,Facility,Outpatient,,,,28.65,24.3525,8.21109,28.65,Medica,Medical Assistance,12.7779,44.6,,percent of total billed charges,,
SUTURE POLYSORB 0 30 VIOLET GS-23,,A4649,HCPCS,Facility,Inpatient,,,,28.65,24.3525,8.21109,28.65,Medica,Medical Assistance,,,,,Included in per diem rate,
SUTURE POLYSORB 0 30 VIOLET GS-23,,A4649,HCPCS,Facility,Outpatient,,,,28.65,24.3525,8.21109,28.65,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,14.2677,49.8,,percent of total billed charges,,
SUTURE POLYSORB 0 30 VIOLET GS-23,,A4649,HCPCS,Facility,Inpatient,,,,28.65,24.3525,8.21109,28.65,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
SUTURE POLYSORB 0 30 VIOLET GS-23,,A4649,HCPCS,Facility,Both,,,,28.65,24.3525,8.21109,28.65,"Multiplan, Inc.","Multiplan, Inc.",26.931,94,,percent of total billed charges,,
SUTURE POLYSORB 0 30 VIOLET GS-23,,A4649,HCPCS,Facility,Outpatient,,,,28.65,24.3525,8.21109,28.65,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,25.81365,90.1,,percent of total billed charges,,
SUTURE POLYSORB 0 30 VIOLET GS-23,,A4649,HCPCS,Facility,Inpatient,,,,28.65,24.3525,8.21109,28.65,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
SUTURE POLYSORB 0 30 VIOLET GS-23,,A4649,HCPCS,Facility,Both,,,,28.65,24.3525,8.21109,28.65,"Preferred One Administrative Services, INC.",PPO,28.2489,98.6,,percent of total billed charges,,
SUTURE POLYSORB 0 30 VIOLET GS-23,,A4649,HCPCS,Facility,Outpatient,,,,28.65,24.3525,8.21109,28.65,PrimeWest Health,Minnesota Senior Health Options (MSHO),14.740425,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
SUTURE POLYSORB 0 30 VIOLET GS-23,,A4649,HCPCS,Facility,Inpatient,,,,28.65,24.3525,8.21109,28.65,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE POLYSORB 0 30 VIOLET GS-23,,A4649,HCPCS,Facility,Outpatient,,,,28.65,24.3525,8.21109,28.65,PrimeWest Health,MinnesotaCare,14.71464,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
SUTURE POLYSORB 0 30 VIOLET GS-23,,A4649,HCPCS,Facility,Inpatient,,,,28.65,24.3525,8.21109,28.65,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
SUTURE POLYSORB 0 30 VIOLET GS-23,,A4649,HCPCS,Facility,Both,,,,28.65,24.3525,8.21109,28.65,Sanford Health Plan,Sanford Health Plan,26.358,92,,percent of total billed charges,,
SUTURE POLYSORB 0 30 VIOLET GS-23,,A4649,HCPCS,Facility,Outpatient,,,,28.65,24.3525,8.21109,28.65,"UCare Health, Inc.",Individual & Family Plan,16.144275,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
SUTURE POLYSORB 0 30 VIOLET GS-23,,A4649,HCPCS,Facility,Inpatient,,,,28.65,24.3525,8.21109,28.65,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
SUTURE POLYSORB 0 30 VIOLET GS-23,,A4649,HCPCS,Facility,Outpatient,,,,28.65,24.3525,8.21109,28.65,"UCare Health, Inc.",Medical Assistance,14.459655,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE POLYSORB 0 30 VIOLET GS-23,,A4649,HCPCS,Facility,Inpatient,,,,28.65,24.3525,8.21109,28.65,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
SUTURE POLYSORB 0 30 VIOLET GS-23,,A4649,HCPCS,Facility,Outpatient,,,,28.65,24.3525,8.21109,28.65,"UCare Health, Inc.",Medicare Advantage,14.459655,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE POLYSORB 0 30 VIOLET GS-23,,A4649,HCPCS,Facility,Inpatient,,,,28.65,24.3525,8.21109,28.65,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE POLYSORB 0 30 VIOLET GS-23,,A4649,HCPCS,Facility,Outpatient,,,,28.65,24.3525,8.21109,28.65,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),14.459655,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE POLYSORB 0 30 VIOLET GS-23,,A4649,HCPCS,Facility,Inpatient,,,,28.65,24.3525,8.21109,28.65,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE POLYSORB 0 30 VIOLET GS-23,,A4649,HCPCS,Facility,Both,,,,28.65,24.3525,8.21109,28.65,UnitedHealthcare,Individual & Family,26.931,94,,percent of total billed charges,,
SUTURE POLYSORB 0 30 VIOLET GS-23,,A4649,HCPCS,Facility,Outpatient,,,,28.65,24.3525,8.21109,28.65,UnitedHealthcare,Medicare Advantage,14.0385,49,,percent of total billed charges,,
SUTURE POLYSORB 0 30 VIOLET GS-23,,A4649,HCPCS,Facility,Inpatient,,,,28.65,24.3525,8.21109,28.65,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
SUTURE POLYSORB 0 30 VIOLET GS-23,,A4649,HCPCS,Facility,Outpatient,,,,28.65,24.3525,8.21109,28.65,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,13.752,48,,percent of total billed charges,,100% of DHS outpatient percentage
SUTURE POLYSORB 0 30 VIOLET GS-23,,A4649,HCPCS,Facility,Inpatient,,,,28.65,24.3525,8.21109,28.65,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"SUTURE POLYSORB 0 30"" UNDYED GS-22 213T  CL831",,A4649,HCPCS,Facility,Both,,,,32.6,27.71,9.34316,32.6,Aetna,Commercial,29.992,92,,percent of total billed charges,,
"SUTURE POLYSORB 0 30"" UNDYED GS-22 213T  CL831",,A4649,HCPCS,Facility,Outpatient,,,,32.6,27.71,9.34316,32.6,Aetna,Medicare Advantage,15.974,49,,percent of total billed charges,,
"SUTURE POLYSORB 0 30"" UNDYED GS-22 213T  CL831",,A4649,HCPCS,Facility,Inpatient,,,,32.6,27.71,9.34316,32.6,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"SUTURE POLYSORB 0 30"" UNDYED GS-22 213T  CL831",,A4649,HCPCS,Facility,Both,,,,32.6,27.71,9.34316,32.6,Aetna,PPO,30.318,93,,percent of total billed charges,,
"SUTURE POLYSORB 0 30"" UNDYED GS-22 213T  CL831",,A4649,HCPCS,Facility,Both,,,,32.6,27.71,9.34316,32.6,America's PPO,America's PPO,31.30578,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"SUTURE POLYSORB 0 30"" UNDYED GS-22 213T  CL831",,A4649,HCPCS,Facility,Both,,,,32.6,27.71,9.34316,32.6,BlueCross BlueShield Minnesota, Federal Employee Program,32.0784,98.4,,percent of total billed charges,,
"SUTURE POLYSORB 0 30"" UNDYED GS-22 213T  CL831",,A4649,HCPCS,Facility,Both,,,,32.6,27.71,9.34316,32.6,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,32.6,100,,percent of total billed charges,,
"SUTURE POLYSORB 0 30"" UNDYED GS-22 213T  CL831",,A4649,HCPCS,Facility,Both,,,,32.6,27.71,9.34316,32.6,BlueCross BlueShield Minnesota,High Value Network Plan,29.34,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
"SUTURE POLYSORB 0 30"" UNDYED GS-22 213T  CL831",,A4649,HCPCS,Facility,Outpatient,,,,32.6,27.71,9.34316,32.6,BlueCross BlueShield Minnesota,Medicare Advantage,15.974,49,,percent of total billed charges,,
"SUTURE POLYSORB 0 30"" UNDYED GS-22 213T  CL831",,A4649,HCPCS,Facility,Inpatient,,,,32.6,27.71,9.34316,32.6,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"SUTURE POLYSORB 0 30"" UNDYED GS-22 213T  CL831",,A4649,HCPCS,Facility,Both,,,,32.6,27.71,9.34316,32.6,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,28.87382,88.57,,percent of total billed charges,,
"SUTURE POLYSORB 0 30"" UNDYED GS-22 213T  CL831",,A4649,HCPCS,Facility,Both,,,,32.6,27.71,9.34316,32.6,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,9.34316,28.66,,percent of total billed charges,,
"SUTURE POLYSORB 0 30"" UNDYED GS-22 213T  CL831",,A4649,HCPCS,Facility,Outpatient,,,,32.6,27.71,9.34316,32.6,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),15.974,49,,percent of total billed charges,,
"SUTURE POLYSORB 0 30"" UNDYED GS-22 213T  CL831",,A4649,HCPCS,Facility,Inpatient,,,,32.6,27.71,9.34316,32.6,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"SUTURE POLYSORB 0 30"" UNDYED GS-22 213T  CL831",,A4649,HCPCS,Facility,Both,,,,32.6,27.71,9.34316,32.6,CorVel,Worker's Compensation,32.6,100,,percent of total billed charges,,
"SUTURE POLYSORB 0 30"" UNDYED GS-22 213T  CL831",,A4649,HCPCS,Facility,Both,,,,32.6,27.71,9.34316,32.6,First Health Group Corporation,First Health Network,31.622,97,,percent of total billed charges,,
"SUTURE POLYSORB 0 30"" UNDYED GS-22 213T  CL831",,A4649,HCPCS,Facility,Both,,,,32.6,27.71,9.34316,32.6,"Health Partners, Inc.",Commercial,30.8396,94.6,,percent of total billed charges,,
"SUTURE POLYSORB 0 30"" UNDYED GS-22 213T  CL831",,A4649,HCPCS,Facility,Outpatient,,,,32.6,27.71,9.34316,32.6,"Health Partners, Inc.",Medicare Advantage,15.974,49,,percent of total billed charges,,
"SUTURE POLYSORB 0 30"" UNDYED GS-22 213T  CL831",,A4649,HCPCS,Facility,Inpatient,,,,32.6,27.71,9.34316,32.6,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"SUTURE POLYSORB 0 30"" UNDYED GS-22 213T  CL831",,A4649,HCPCS,Facility,Both,,,,32.6,27.71,9.34316,32.6,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),19.56,60,,percent of total billed charges,,
"SUTURE POLYSORB 0 30"" UNDYED GS-22 213T  CL831",,A4649,HCPCS,Facility,Both,,,,32.6,27.71,9.34316,32.6,"Health Partners, Inc.",State of Minnesota Advantage Program,26.569,81.5,,percent of total billed charges,,
"SUTURE POLYSORB 0 30"" UNDYED GS-22 213T  CL831",,A4649,HCPCS,Facility,Both,,,,32.6,27.71,9.34316,32.6,"Health Partners, Inc.",State Public Programs,16.3,50,,percent of total billed charges,,
"SUTURE POLYSORB 0 30"" UNDYED GS-22 213T  CL831",,A4649,HCPCS,Facility,Both,,,,32.6,27.71,9.34316,32.6,Humana Insurance Company,Commercial PPO,30.97,95,,percent of total billed charges,,
"SUTURE POLYSORB 0 30"" UNDYED GS-22 213T  CL831",,A4649,HCPCS,Facility,Outpatient,,,,32.6,27.71,9.34316,32.6,Humana Insurance Company,Medicare PPO,15.974,49,,percent of total billed charges,,
"SUTURE POLYSORB 0 30"" UNDYED GS-22 213T  CL831",,A4649,HCPCS,Facility,Inpatient,,,,32.6,27.71,9.34316,32.6,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"SUTURE POLYSORB 0 30"" UNDYED GS-22 213T  CL831",,A4649,HCPCS,Facility,Both,,,,32.6,27.71,9.34316,32.6,Medica,Individual & Family,32.3066,99.1,,percent of total billed charges,,
"SUTURE POLYSORB 0 30"" UNDYED GS-22 213T  CL831",,A4649,HCPCS,Facility,Outpatient,,,,32.6,27.71,9.34316,32.6,Medica,Medica Advantage Solution,16.2348,49.8,,percent of total billed charges,,
"SUTURE POLYSORB 0 30"" UNDYED GS-22 213T  CL831",,A4649,HCPCS,Facility,Inpatient,,,,32.6,27.71,9.34316,32.6,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"SUTURE POLYSORB 0 30"" UNDYED GS-22 213T  CL831",,A4649,HCPCS,Facility,Outpatient,,,,32.6,27.71,9.34316,32.6,Medica,Medical Assistance,14.5396,44.6,,percent of total billed charges,,
"SUTURE POLYSORB 0 30"" UNDYED GS-22 213T  CL831",,A4649,HCPCS,Facility,Inpatient,,,,32.6,27.71,9.34316,32.6,Medica,Medical Assistance,,,,,Included in per diem rate,
"SUTURE POLYSORB 0 30"" UNDYED GS-22 213T  CL831",,A4649,HCPCS,Facility,Outpatient,,,,32.6,27.71,9.34316,32.6,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,16.2348,49.8,,percent of total billed charges,,
"SUTURE POLYSORB 0 30"" UNDYED GS-22 213T  CL831",,A4649,HCPCS,Facility,Inpatient,,,,32.6,27.71,9.34316,32.6,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"SUTURE POLYSORB 0 30"" UNDYED GS-22 213T  CL831",,A4649,HCPCS,Facility,Both,,,,32.6,27.71,9.34316,32.6,"Multiplan, Inc.","Multiplan, Inc.",30.644,94,,percent of total billed charges,,
"SUTURE POLYSORB 0 30"" UNDYED GS-22 213T  CL831",,A4649,HCPCS,Facility,Outpatient,,,,32.6,27.71,9.34316,32.6,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,29.3726,90.1,,percent of total billed charges,,
"SUTURE POLYSORB 0 30"" UNDYED GS-22 213T  CL831",,A4649,HCPCS,Facility,Inpatient,,,,32.6,27.71,9.34316,32.6,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"SUTURE POLYSORB 0 30"" UNDYED GS-22 213T  CL831",,A4649,HCPCS,Facility,Both,,,,32.6,27.71,9.34316,32.6,"Preferred One Administrative Services, INC.",PPO,32.1436,98.6,,percent of total billed charges,,
"SUTURE POLYSORB 0 30"" UNDYED GS-22 213T  CL831",,A4649,HCPCS,Facility,Outpatient,,,,32.6,27.71,9.34316,32.6,PrimeWest Health,Minnesota Senior Health Options (MSHO),16.7727,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"SUTURE POLYSORB 0 30"" UNDYED GS-22 213T  CL831",,A4649,HCPCS,Facility,Inpatient,,,,32.6,27.71,9.34316,32.6,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"SUTURE POLYSORB 0 30"" UNDYED GS-22 213T  CL831",,A4649,HCPCS,Facility,Outpatient,,,,32.6,27.71,9.34316,32.6,PrimeWest Health,MinnesotaCare,16.74336,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"SUTURE POLYSORB 0 30"" UNDYED GS-22 213T  CL831",,A4649,HCPCS,Facility,Inpatient,,,,32.6,27.71,9.34316,32.6,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"SUTURE POLYSORB 0 30"" UNDYED GS-22 213T  CL831",,A4649,HCPCS,Facility,Both,,,,32.6,27.71,9.34316,32.6,Sanford Health Plan,Sanford Health Plan,29.992,92,,percent of total billed charges,,
"SUTURE POLYSORB 0 30"" UNDYED GS-22 213T  CL831",,A4649,HCPCS,Facility,Outpatient,,,,32.6,27.71,9.34316,32.6,"UCare Health, Inc.",Individual & Family Plan,18.3701,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"SUTURE POLYSORB 0 30"" UNDYED GS-22 213T  CL831",,A4649,HCPCS,Facility,Inpatient,,,,32.6,27.71,9.34316,32.6,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"SUTURE POLYSORB 0 30"" UNDYED GS-22 213T  CL831",,A4649,HCPCS,Facility,Outpatient,,,,32.6,27.71,9.34316,32.6,"UCare Health, Inc.",Medical Assistance,16.45322,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"SUTURE POLYSORB 0 30"" UNDYED GS-22 213T  CL831",,A4649,HCPCS,Facility,Inpatient,,,,32.6,27.71,9.34316,32.6,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"SUTURE POLYSORB 0 30"" UNDYED GS-22 213T  CL831",,A4649,HCPCS,Facility,Outpatient,,,,32.6,27.71,9.34316,32.6,"UCare Health, Inc.",Medicare Advantage,16.45322,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"SUTURE POLYSORB 0 30"" UNDYED GS-22 213T  CL831",,A4649,HCPCS,Facility,Inpatient,,,,32.6,27.71,9.34316,32.6,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"SUTURE POLYSORB 0 30"" UNDYED GS-22 213T  CL831",,A4649,HCPCS,Facility,Outpatient,,,,32.6,27.71,9.34316,32.6,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),16.45322,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"SUTURE POLYSORB 0 30"" UNDYED GS-22 213T  CL831",,A4649,HCPCS,Facility,Inpatient,,,,32.6,27.71,9.34316,32.6,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"SUTURE POLYSORB 0 30"" UNDYED GS-22 213T  CL831",,A4649,HCPCS,Facility,Both,,,,32.6,27.71,9.34316,32.6,UnitedHealthcare,Individual & Family,30.644,94,,percent of total billed charges,,
"SUTURE POLYSORB 0 30"" UNDYED GS-22 213T  CL831",,A4649,HCPCS,Facility,Outpatient,,,,32.6,27.71,9.34316,32.6,UnitedHealthcare,Medicare Advantage,15.974,49,,percent of total billed charges,,
"SUTURE POLYSORB 0 30"" UNDYED GS-22 213T  CL831",,A4649,HCPCS,Facility,Inpatient,,,,32.6,27.71,9.34316,32.6,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"SUTURE POLYSORB 0 30"" UNDYED GS-22 213T  CL831",,A4649,HCPCS,Facility,Outpatient,,,,32.6,27.71,9.34316,32.6,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,15.648,48,,percent of total billed charges,,100% of DHS outpatient percentage
"SUTURE POLYSORB 0 30"" UNDYED GS-22 213T  CL831",,A4649,HCPCS,Facility,Inpatient,,,,32.6,27.71,9.34316,32.6,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
SUTURE POLYSORB 0 CL-831,,A4649,HCPCS,Facility,Both,,,,2.25,1.9125,0.64485,2.25,Aetna,Commercial,2.07,92,,percent of total billed charges,,
SUTURE POLYSORB 0 CL-831,,A4649,HCPCS,Facility,Outpatient,,,,2.25,1.9125,0.64485,2.25,Aetna,Medicare Advantage,1.1025,49,,percent of total billed charges,,
SUTURE POLYSORB 0 CL-831,,A4649,HCPCS,Facility,Inpatient,,,,2.25,1.9125,0.64485,2.25,Aetna,Medicare Advantage,,,,,Included in per diem rate,
SUTURE POLYSORB 0 CL-831,,A4649,HCPCS,Facility,Both,,,,2.25,1.9125,0.64485,2.25,Aetna,PPO,2.0925,93,,percent of total billed charges,,
SUTURE POLYSORB 0 CL-831,,A4649,HCPCS,Facility,Both,,,,2.25,1.9125,0.64485,2.25,America's PPO,America's PPO,2.160675,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SUTURE POLYSORB 0 CL-831,,A4649,HCPCS,Facility,Both,,,,2.25,1.9125,0.64485,2.25,BlueCross BlueShield Minnesota, Federal Employee Program,2.214,98.4,,percent of total billed charges,,
SUTURE POLYSORB 0 CL-831,,A4649,HCPCS,Facility,Both,,,,2.25,1.9125,0.64485,2.25,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,2.25,100,,percent of total billed charges,,
SUTURE POLYSORB 0 CL-831,,A4649,HCPCS,Facility,Both,,,,2.25,1.9125,0.64485,2.25,BlueCross BlueShield Minnesota,High Value Network Plan,2.025,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
SUTURE POLYSORB 0 CL-831,,A4649,HCPCS,Facility,Outpatient,,,,2.25,1.9125,0.64485,2.25,BlueCross BlueShield Minnesota,Medicare Advantage,1.1025,49,,percent of total billed charges,,
SUTURE POLYSORB 0 CL-831,,A4649,HCPCS,Facility,Inpatient,,,,2.25,1.9125,0.64485,2.25,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
SUTURE POLYSORB 0 CL-831,,A4649,HCPCS,Facility,Both,,,,2.25,1.9125,0.64485,2.25,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1.992825,88.57,,percent of total billed charges,,
SUTURE POLYSORB 0 CL-831,,A4649,HCPCS,Facility,Both,,,,2.25,1.9125,0.64485,2.25,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,0.64485,28.66,,percent of total billed charges,,
SUTURE POLYSORB 0 CL-831,,A4649,HCPCS,Facility,Outpatient,,,,2.25,1.9125,0.64485,2.25,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1.1025,49,,percent of total billed charges,,
SUTURE POLYSORB 0 CL-831,,A4649,HCPCS,Facility,Inpatient,,,,2.25,1.9125,0.64485,2.25,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
SUTURE POLYSORB 0 CL-831,,A4649,HCPCS,Facility,Both,,,,2.25,1.9125,0.64485,2.25,CorVel,Worker's Compensation,2.25,100,,percent of total billed charges,,
SUTURE POLYSORB 0 CL-831,,A4649,HCPCS,Facility,Both,,,,2.25,1.9125,0.64485,2.25,First Health Group Corporation,First Health Network,2.1825,97,,percent of total billed charges,,
SUTURE POLYSORB 0 CL-831,,A4649,HCPCS,Facility,Both,,,,2.25,1.9125,0.64485,2.25,"Health Partners, Inc.",Commercial,2.1285,94.6,,percent of total billed charges,,
SUTURE POLYSORB 0 CL-831,,A4649,HCPCS,Facility,Outpatient,,,,2.25,1.9125,0.64485,2.25,"Health Partners, Inc.",Medicare Advantage,1.1025,49,,percent of total billed charges,,
SUTURE POLYSORB 0 CL-831,,A4649,HCPCS,Facility,Inpatient,,,,2.25,1.9125,0.64485,2.25,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE POLYSORB 0 CL-831,,A4649,HCPCS,Facility,Both,,,,2.25,1.9125,0.64485,2.25,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1.35,60,,percent of total billed charges,,
SUTURE POLYSORB 0 CL-831,,A4649,HCPCS,Facility,Both,,,,2.25,1.9125,0.64485,2.25,"Health Partners, Inc.",State of Minnesota Advantage Program,1.83375,81.5,,percent of total billed charges,,
SUTURE POLYSORB 0 CL-831,,A4649,HCPCS,Facility,Both,,,,2.25,1.9125,0.64485,2.25,"Health Partners, Inc.",State Public Programs,1.125,50,,percent of total billed charges,,
SUTURE POLYSORB 0 CL-831,,A4649,HCPCS,Facility,Both,,,,2.25,1.9125,0.64485,2.25,Humana Insurance Company,Commercial PPO,2.1375,95,,percent of total billed charges,,
SUTURE POLYSORB 0 CL-831,,A4649,HCPCS,Facility,Outpatient,,,,2.25,1.9125,0.64485,2.25,Humana Insurance Company,Medicare PPO,1.1025,49,,percent of total billed charges,,
SUTURE POLYSORB 0 CL-831,,A4649,HCPCS,Facility,Inpatient,,,,2.25,1.9125,0.64485,2.25,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
SUTURE POLYSORB 0 CL-831,,A4649,HCPCS,Facility,Both,,,,2.25,1.9125,0.64485,2.25,Medica,Individual & Family,2.22975,99.1,,percent of total billed charges,,
SUTURE POLYSORB 0 CL-831,,A4649,HCPCS,Facility,Outpatient,,,,2.25,1.9125,0.64485,2.25,Medica,Medica Advantage Solution,1.1205,49.8,,percent of total billed charges,,
SUTURE POLYSORB 0 CL-831,,A4649,HCPCS,Facility,Inpatient,,,,2.25,1.9125,0.64485,2.25,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
SUTURE POLYSORB 0 CL-831,,A4649,HCPCS,Facility,Outpatient,,,,2.25,1.9125,0.64485,2.25,Medica,Medical Assistance,1.0035,44.6,,percent of total billed charges,,
SUTURE POLYSORB 0 CL-831,,A4649,HCPCS,Facility,Inpatient,,,,2.25,1.9125,0.64485,2.25,Medica,Medical Assistance,,,,,Included in per diem rate,
SUTURE POLYSORB 0 CL-831,,A4649,HCPCS,Facility,Outpatient,,,,2.25,1.9125,0.64485,2.25,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1.1205,49.8,,percent of total billed charges,,
SUTURE POLYSORB 0 CL-831,,A4649,HCPCS,Facility,Inpatient,,,,2.25,1.9125,0.64485,2.25,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
SUTURE POLYSORB 0 CL-831,,A4649,HCPCS,Facility,Both,,,,2.25,1.9125,0.64485,2.25,"Multiplan, Inc.","Multiplan, Inc.",2.115,94,,percent of total billed charges,,
SUTURE POLYSORB 0 CL-831,,A4649,HCPCS,Facility,Outpatient,,,,2.25,1.9125,0.64485,2.25,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,2.02725,90.1,,percent of total billed charges,,
SUTURE POLYSORB 0 CL-831,,A4649,HCPCS,Facility,Inpatient,,,,2.25,1.9125,0.64485,2.25,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
SUTURE POLYSORB 0 CL-831,,A4649,HCPCS,Facility,Both,,,,2.25,1.9125,0.64485,2.25,"Preferred One Administrative Services, INC.",PPO,2.2185,98.6,,percent of total billed charges,,
SUTURE POLYSORB 0 CL-831,,A4649,HCPCS,Facility,Outpatient,,,,2.25,1.9125,0.64485,2.25,PrimeWest Health,Minnesota Senior Health Options (MSHO),1.157625,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
SUTURE POLYSORB 0 CL-831,,A4649,HCPCS,Facility,Inpatient,,,,2.25,1.9125,0.64485,2.25,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE POLYSORB 0 CL-831,,A4649,HCPCS,Facility,Outpatient,,,,2.25,1.9125,0.64485,2.25,PrimeWest Health,MinnesotaCare,1.1556,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
SUTURE POLYSORB 0 CL-831,,A4649,HCPCS,Facility,Inpatient,,,,2.25,1.9125,0.64485,2.25,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
SUTURE POLYSORB 0 CL-831,,A4649,HCPCS,Facility,Both,,,,2.25,1.9125,0.64485,2.25,Sanford Health Plan,Sanford Health Plan,2.07,92,,percent of total billed charges,,
SUTURE POLYSORB 0 CL-831,,A4649,HCPCS,Facility,Outpatient,,,,2.25,1.9125,0.64485,2.25,"UCare Health, Inc.",Individual & Family Plan,1.267875,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
SUTURE POLYSORB 0 CL-831,,A4649,HCPCS,Facility,Inpatient,,,,2.25,1.9125,0.64485,2.25,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
SUTURE POLYSORB 0 CL-831,,A4649,HCPCS,Facility,Outpatient,,,,2.25,1.9125,0.64485,2.25,"UCare Health, Inc.",Medical Assistance,1.135575,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE POLYSORB 0 CL-831,,A4649,HCPCS,Facility,Inpatient,,,,2.25,1.9125,0.64485,2.25,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
SUTURE POLYSORB 0 CL-831,,A4649,HCPCS,Facility,Outpatient,,,,2.25,1.9125,0.64485,2.25,"UCare Health, Inc.",Medicare Advantage,1.135575,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE POLYSORB 0 CL-831,,A4649,HCPCS,Facility,Inpatient,,,,2.25,1.9125,0.64485,2.25,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE POLYSORB 0 CL-831,,A4649,HCPCS,Facility,Outpatient,,,,2.25,1.9125,0.64485,2.25,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1.135575,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE POLYSORB 0 CL-831,,A4649,HCPCS,Facility,Inpatient,,,,2.25,1.9125,0.64485,2.25,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE POLYSORB 0 CL-831,,A4649,HCPCS,Facility,Both,,,,2.25,1.9125,0.64485,2.25,UnitedHealthcare,Individual & Family,2.115,94,,percent of total billed charges,,
SUTURE POLYSORB 0 CL-831,,A4649,HCPCS,Facility,Outpatient,,,,2.25,1.9125,0.64485,2.25,UnitedHealthcare,Medicare Advantage,1.1025,49,,percent of total billed charges,,
SUTURE POLYSORB 0 CL-831,,A4649,HCPCS,Facility,Inpatient,,,,2.25,1.9125,0.64485,2.25,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
SUTURE POLYSORB 0 CL-831,,A4649,HCPCS,Facility,Outpatient,,,,2.25,1.9125,0.64485,2.25,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1.08,48,,percent of total billed charges,,100% of DHS outpatient percentage
SUTURE POLYSORB 0 CL-831,,A4649,HCPCS,Facility,Inpatient,,,,2.25,1.9125,0.64485,2.25,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
SUTURE POLYSORB 0 CL-844,,A4649,HCPCS,Facility,Both,,,,2.18,1.853,0.624788,2.18,Aetna,Commercial,2.0056,92,,percent of total billed charges,,
SUTURE POLYSORB 0 CL-844,,A4649,HCPCS,Facility,Outpatient,,,,2.18,1.853,0.624788,2.18,Aetna,Medicare Advantage,1.0682,49,,percent of total billed charges,,
SUTURE POLYSORB 0 CL-844,,A4649,HCPCS,Facility,Inpatient,,,,2.18,1.853,0.624788,2.18,Aetna,Medicare Advantage,,,,,Included in per diem rate,
SUTURE POLYSORB 0 CL-844,,A4649,HCPCS,Facility,Both,,,,2.18,1.853,0.624788,2.18,Aetna,PPO,2.0274,93,,percent of total billed charges,,
SUTURE POLYSORB 0 CL-844,,A4649,HCPCS,Facility,Both,,,,2.18,1.853,0.624788,2.18,America's PPO,America's PPO,2.093454,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SUTURE POLYSORB 0 CL-844,,A4649,HCPCS,Facility,Both,,,,2.18,1.853,0.624788,2.18,BlueCross BlueShield Minnesota, Federal Employee Program,2.14512,98.4,,percent of total billed charges,,
SUTURE POLYSORB 0 CL-844,,A4649,HCPCS,Facility,Both,,,,2.18,1.853,0.624788,2.18,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,2.18,100,,percent of total billed charges,,
SUTURE POLYSORB 0 CL-844,,A4649,HCPCS,Facility,Both,,,,2.18,1.853,0.624788,2.18,BlueCross BlueShield Minnesota,High Value Network Plan,1.962,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
SUTURE POLYSORB 0 CL-844,,A4649,HCPCS,Facility,Outpatient,,,,2.18,1.853,0.624788,2.18,BlueCross BlueShield Minnesota,Medicare Advantage,1.0682,49,,percent of total billed charges,,
SUTURE POLYSORB 0 CL-844,,A4649,HCPCS,Facility,Inpatient,,,,2.18,1.853,0.624788,2.18,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
SUTURE POLYSORB 0 CL-844,,A4649,HCPCS,Facility,Both,,,,2.18,1.853,0.624788,2.18,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1.930826,88.57,,percent of total billed charges,,
SUTURE POLYSORB 0 CL-844,,A4649,HCPCS,Facility,Both,,,,2.18,1.853,0.624788,2.18,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,0.624788,28.66,,percent of total billed charges,,
SUTURE POLYSORB 0 CL-844,,A4649,HCPCS,Facility,Outpatient,,,,2.18,1.853,0.624788,2.18,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1.0682,49,,percent of total billed charges,,
SUTURE POLYSORB 0 CL-844,,A4649,HCPCS,Facility,Inpatient,,,,2.18,1.853,0.624788,2.18,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
SUTURE POLYSORB 0 CL-844,,A4649,HCPCS,Facility,Both,,,,2.18,1.853,0.624788,2.18,CorVel,Worker's Compensation,2.18,100,,percent of total billed charges,,
SUTURE POLYSORB 0 CL-844,,A4649,HCPCS,Facility,Both,,,,2.18,1.853,0.624788,2.18,First Health Group Corporation,First Health Network,2.1146,97,,percent of total billed charges,,
SUTURE POLYSORB 0 CL-844,,A4649,HCPCS,Facility,Both,,,,2.18,1.853,0.624788,2.18,"Health Partners, Inc.",Commercial,2.06228,94.6,,percent of total billed charges,,
SUTURE POLYSORB 0 CL-844,,A4649,HCPCS,Facility,Outpatient,,,,2.18,1.853,0.624788,2.18,"Health Partners, Inc.",Medicare Advantage,1.0682,49,,percent of total billed charges,,
SUTURE POLYSORB 0 CL-844,,A4649,HCPCS,Facility,Inpatient,,,,2.18,1.853,0.624788,2.18,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE POLYSORB 0 CL-844,,A4649,HCPCS,Facility,Both,,,,2.18,1.853,0.624788,2.18,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1.308,60,,percent of total billed charges,,
SUTURE POLYSORB 0 CL-844,,A4649,HCPCS,Facility,Both,,,,2.18,1.853,0.624788,2.18,"Health Partners, Inc.",State of Minnesota Advantage Program,1.7767,81.5,,percent of total billed charges,,
SUTURE POLYSORB 0 CL-844,,A4649,HCPCS,Facility,Both,,,,2.18,1.853,0.624788,2.18,"Health Partners, Inc.",State Public Programs,1.09,50,,percent of total billed charges,,
SUTURE POLYSORB 0 CL-844,,A4649,HCPCS,Facility,Both,,,,2.18,1.853,0.624788,2.18,Humana Insurance Company,Commercial PPO,2.071,95,,percent of total billed charges,,
SUTURE POLYSORB 0 CL-844,,A4649,HCPCS,Facility,Outpatient,,,,2.18,1.853,0.624788,2.18,Humana Insurance Company,Medicare PPO,1.0682,49,,percent of total billed charges,,
SUTURE POLYSORB 0 CL-844,,A4649,HCPCS,Facility,Inpatient,,,,2.18,1.853,0.624788,2.18,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
SUTURE POLYSORB 0 CL-844,,A4649,HCPCS,Facility,Both,,,,2.18,1.853,0.624788,2.18,Medica,Individual & Family,2.16038,99.1,,percent of total billed charges,,
SUTURE POLYSORB 0 CL-844,,A4649,HCPCS,Facility,Outpatient,,,,2.18,1.853,0.624788,2.18,Medica,Medica Advantage Solution,1.08564,49.8,,percent of total billed charges,,
SUTURE POLYSORB 0 CL-844,,A4649,HCPCS,Facility,Inpatient,,,,2.18,1.853,0.624788,2.18,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
SUTURE POLYSORB 0 CL-844,,A4649,HCPCS,Facility,Outpatient,,,,2.18,1.853,0.624788,2.18,Medica,Medical Assistance,0.97228,44.6,,percent of total billed charges,,
SUTURE POLYSORB 0 CL-844,,A4649,HCPCS,Facility,Inpatient,,,,2.18,1.853,0.624788,2.18,Medica,Medical Assistance,,,,,Included in per diem rate,
SUTURE POLYSORB 0 CL-844,,A4649,HCPCS,Facility,Outpatient,,,,2.18,1.853,0.624788,2.18,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1.08564,49.8,,percent of total billed charges,,
SUTURE POLYSORB 0 CL-844,,A4649,HCPCS,Facility,Inpatient,,,,2.18,1.853,0.624788,2.18,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
SUTURE POLYSORB 0 CL-844,,A4649,HCPCS,Facility,Both,,,,2.18,1.853,0.624788,2.18,"Multiplan, Inc.","Multiplan, Inc.",2.0492,94,,percent of total billed charges,,
SUTURE POLYSORB 0 CL-844,,A4649,HCPCS,Facility,Outpatient,,,,2.18,1.853,0.624788,2.18,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1.96418,90.1,,percent of total billed charges,,
SUTURE POLYSORB 0 CL-844,,A4649,HCPCS,Facility,Inpatient,,,,2.18,1.853,0.624788,2.18,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
SUTURE POLYSORB 0 CL-844,,A4649,HCPCS,Facility,Both,,,,2.18,1.853,0.624788,2.18,"Preferred One Administrative Services, INC.",PPO,2.14948,98.6,,percent of total billed charges,,
SUTURE POLYSORB 0 CL-844,,A4649,HCPCS,Facility,Outpatient,,,,2.18,1.853,0.624788,2.18,PrimeWest Health,Minnesota Senior Health Options (MSHO),1.12161,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
SUTURE POLYSORB 0 CL-844,,A4649,HCPCS,Facility,Inpatient,,,,2.18,1.853,0.624788,2.18,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE POLYSORB 0 CL-844,,A4649,HCPCS,Facility,Outpatient,,,,2.18,1.853,0.624788,2.18,PrimeWest Health,MinnesotaCare,1.119648,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
SUTURE POLYSORB 0 CL-844,,A4649,HCPCS,Facility,Inpatient,,,,2.18,1.853,0.624788,2.18,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
SUTURE POLYSORB 0 CL-844,,A4649,HCPCS,Facility,Both,,,,2.18,1.853,0.624788,2.18,Sanford Health Plan,Sanford Health Plan,2.0056,92,,percent of total billed charges,,
SUTURE POLYSORB 0 CL-844,,A4649,HCPCS,Facility,Outpatient,,,,2.18,1.853,0.624788,2.18,"UCare Health, Inc.",Individual & Family Plan,1.22843,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
SUTURE POLYSORB 0 CL-844,,A4649,HCPCS,Facility,Inpatient,,,,2.18,1.853,0.624788,2.18,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
SUTURE POLYSORB 0 CL-844,,A4649,HCPCS,Facility,Outpatient,,,,2.18,1.853,0.624788,2.18,"UCare Health, Inc.",Medical Assistance,1.100246,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE POLYSORB 0 CL-844,,A4649,HCPCS,Facility,Inpatient,,,,2.18,1.853,0.624788,2.18,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
SUTURE POLYSORB 0 CL-844,,A4649,HCPCS,Facility,Outpatient,,,,2.18,1.853,0.624788,2.18,"UCare Health, Inc.",Medicare Advantage,1.100246,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE POLYSORB 0 CL-844,,A4649,HCPCS,Facility,Inpatient,,,,2.18,1.853,0.624788,2.18,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE POLYSORB 0 CL-844,,A4649,HCPCS,Facility,Outpatient,,,,2.18,1.853,0.624788,2.18,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1.100246,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE POLYSORB 0 CL-844,,A4649,HCPCS,Facility,Inpatient,,,,2.18,1.853,0.624788,2.18,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE POLYSORB 0 CL-844,,A4649,HCPCS,Facility,Both,,,,2.18,1.853,0.624788,2.18,UnitedHealthcare,Individual & Family,2.0492,94,,percent of total billed charges,,
SUTURE POLYSORB 0 CL-844,,A4649,HCPCS,Facility,Outpatient,,,,2.18,1.853,0.624788,2.18,UnitedHealthcare,Medicare Advantage,1.0682,49,,percent of total billed charges,,
SUTURE POLYSORB 0 CL-844,,A4649,HCPCS,Facility,Inpatient,,,,2.18,1.853,0.624788,2.18,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
SUTURE POLYSORB 0 CL-844,,A4649,HCPCS,Facility,Outpatient,,,,2.18,1.853,0.624788,2.18,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1.0464,48,,percent of total billed charges,,100% of DHS outpatient percentage
SUTURE POLYSORB 0 CL-844,,A4649,HCPCS,Facility,Inpatient,,,,2.18,1.853,0.624788,2.18,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
SUTURE POLYSORB 0 CL-894,,A4649,HCPCS,Facility,Both,,,,28.65,24.3525,8.21109,28.65,Aetna,Commercial,26.358,92,,percent of total billed charges,,
SUTURE POLYSORB 0 CL-894,,A4649,HCPCS,Facility,Outpatient,,,,28.65,24.3525,8.21109,28.65,Aetna,Medicare Advantage,14.0385,49,,percent of total billed charges,,
SUTURE POLYSORB 0 CL-894,,A4649,HCPCS,Facility,Inpatient,,,,28.65,24.3525,8.21109,28.65,Aetna,Medicare Advantage,,,,,Included in per diem rate,
SUTURE POLYSORB 0 CL-894,,A4649,HCPCS,Facility,Both,,,,28.65,24.3525,8.21109,28.65,Aetna,PPO,26.6445,93,,percent of total billed charges,,
SUTURE POLYSORB 0 CL-894,,A4649,HCPCS,Facility,Both,,,,28.65,24.3525,8.21109,28.65,America's PPO,America's PPO,27.512595,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SUTURE POLYSORB 0 CL-894,,A4649,HCPCS,Facility,Both,,,,28.65,24.3525,8.21109,28.65,BlueCross BlueShield Minnesota, Federal Employee Program,28.1916,98.4,,percent of total billed charges,,
SUTURE POLYSORB 0 CL-894,,A4649,HCPCS,Facility,Both,,,,28.65,24.3525,8.21109,28.65,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,28.65,100,,percent of total billed charges,,
SUTURE POLYSORB 0 CL-894,,A4649,HCPCS,Facility,Both,,,,28.65,24.3525,8.21109,28.65,BlueCross BlueShield Minnesota,High Value Network Plan,25.785,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
SUTURE POLYSORB 0 CL-894,,A4649,HCPCS,Facility,Outpatient,,,,28.65,24.3525,8.21109,28.65,BlueCross BlueShield Minnesota,Medicare Advantage,14.0385,49,,percent of total billed charges,,
SUTURE POLYSORB 0 CL-894,,A4649,HCPCS,Facility,Inpatient,,,,28.65,24.3525,8.21109,28.65,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
SUTURE POLYSORB 0 CL-894,,A4649,HCPCS,Facility,Both,,,,28.65,24.3525,8.21109,28.65,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,25.375305,88.57,,percent of total billed charges,,
SUTURE POLYSORB 0 CL-894,,A4649,HCPCS,Facility,Both,,,,28.65,24.3525,8.21109,28.65,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,8.21109,28.66,,percent of total billed charges,,
SUTURE POLYSORB 0 CL-894,,A4649,HCPCS,Facility,Outpatient,,,,28.65,24.3525,8.21109,28.65,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),14.0385,49,,percent of total billed charges,,
SUTURE POLYSORB 0 CL-894,,A4649,HCPCS,Facility,Inpatient,,,,28.65,24.3525,8.21109,28.65,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
SUTURE POLYSORB 0 CL-894,,A4649,HCPCS,Facility,Both,,,,28.65,24.3525,8.21109,28.65,CorVel,Worker's Compensation,28.65,100,,percent of total billed charges,,
SUTURE POLYSORB 0 CL-894,,A4649,HCPCS,Facility,Both,,,,28.65,24.3525,8.21109,28.65,First Health Group Corporation,First Health Network,27.7905,97,,percent of total billed charges,,
SUTURE POLYSORB 0 CL-894,,A4649,HCPCS,Facility,Both,,,,28.65,24.3525,8.21109,28.65,"Health Partners, Inc.",Commercial,27.1029,94.6,,percent of total billed charges,,
SUTURE POLYSORB 0 CL-894,,A4649,HCPCS,Facility,Outpatient,,,,28.65,24.3525,8.21109,28.65,"Health Partners, Inc.",Medicare Advantage,14.0385,49,,percent of total billed charges,,
SUTURE POLYSORB 0 CL-894,,A4649,HCPCS,Facility,Inpatient,,,,28.65,24.3525,8.21109,28.65,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE POLYSORB 0 CL-894,,A4649,HCPCS,Facility,Both,,,,28.65,24.3525,8.21109,28.65,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),17.19,60,,percent of total billed charges,,
SUTURE POLYSORB 0 CL-894,,A4649,HCPCS,Facility,Both,,,,28.65,24.3525,8.21109,28.65,"Health Partners, Inc.",State of Minnesota Advantage Program,23.34975,81.5,,percent of total billed charges,,
SUTURE POLYSORB 0 CL-894,,A4649,HCPCS,Facility,Both,,,,28.65,24.3525,8.21109,28.65,"Health Partners, Inc.",State Public Programs,14.325,50,,percent of total billed charges,,
SUTURE POLYSORB 0 CL-894,,A4649,HCPCS,Facility,Both,,,,28.65,24.3525,8.21109,28.65,Humana Insurance Company,Commercial PPO,27.2175,95,,percent of total billed charges,,
SUTURE POLYSORB 0 CL-894,,A4649,HCPCS,Facility,Outpatient,,,,28.65,24.3525,8.21109,28.65,Humana Insurance Company,Medicare PPO,14.0385,49,,percent of total billed charges,,
SUTURE POLYSORB 0 CL-894,,A4649,HCPCS,Facility,Inpatient,,,,28.65,24.3525,8.21109,28.65,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
SUTURE POLYSORB 0 CL-894,,A4649,HCPCS,Facility,Both,,,,28.65,24.3525,8.21109,28.65,Medica,Individual & Family,28.39215,99.1,,percent of total billed charges,,
SUTURE POLYSORB 0 CL-894,,A4649,HCPCS,Facility,Outpatient,,,,28.65,24.3525,8.21109,28.65,Medica,Medica Advantage Solution,14.2677,49.8,,percent of total billed charges,,
SUTURE POLYSORB 0 CL-894,,A4649,HCPCS,Facility,Inpatient,,,,28.65,24.3525,8.21109,28.65,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
SUTURE POLYSORB 0 CL-894,,A4649,HCPCS,Facility,Outpatient,,,,28.65,24.3525,8.21109,28.65,Medica,Medical Assistance,12.7779,44.6,,percent of total billed charges,,
SUTURE POLYSORB 0 CL-894,,A4649,HCPCS,Facility,Inpatient,,,,28.65,24.3525,8.21109,28.65,Medica,Medical Assistance,,,,,Included in per diem rate,
SUTURE POLYSORB 0 CL-894,,A4649,HCPCS,Facility,Outpatient,,,,28.65,24.3525,8.21109,28.65,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,14.2677,49.8,,percent of total billed charges,,
SUTURE POLYSORB 0 CL-894,,A4649,HCPCS,Facility,Inpatient,,,,28.65,24.3525,8.21109,28.65,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
SUTURE POLYSORB 0 CL-894,,A4649,HCPCS,Facility,Both,,,,28.65,24.3525,8.21109,28.65,"Multiplan, Inc.","Multiplan, Inc.",26.931,94,,percent of total billed charges,,
SUTURE POLYSORB 0 CL-894,,A4649,HCPCS,Facility,Outpatient,,,,28.65,24.3525,8.21109,28.65,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,25.81365,90.1,,percent of total billed charges,,
SUTURE POLYSORB 0 CL-894,,A4649,HCPCS,Facility,Inpatient,,,,28.65,24.3525,8.21109,28.65,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
SUTURE POLYSORB 0 CL-894,,A4649,HCPCS,Facility,Both,,,,28.65,24.3525,8.21109,28.65,"Preferred One Administrative Services, INC.",PPO,28.2489,98.6,,percent of total billed charges,,
SUTURE POLYSORB 0 CL-894,,A4649,HCPCS,Facility,Outpatient,,,,28.65,24.3525,8.21109,28.65,PrimeWest Health,Minnesota Senior Health Options (MSHO),14.740425,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
SUTURE POLYSORB 0 CL-894,,A4649,HCPCS,Facility,Inpatient,,,,28.65,24.3525,8.21109,28.65,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE POLYSORB 0 CL-894,,A4649,HCPCS,Facility,Outpatient,,,,28.65,24.3525,8.21109,28.65,PrimeWest Health,MinnesotaCare,14.71464,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
SUTURE POLYSORB 0 CL-894,,A4649,HCPCS,Facility,Inpatient,,,,28.65,24.3525,8.21109,28.65,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
SUTURE POLYSORB 0 CL-894,,A4649,HCPCS,Facility,Both,,,,28.65,24.3525,8.21109,28.65,Sanford Health Plan,Sanford Health Plan,26.358,92,,percent of total billed charges,,
SUTURE POLYSORB 0 CL-894,,A4649,HCPCS,Facility,Outpatient,,,,28.65,24.3525,8.21109,28.65,"UCare Health, Inc.",Individual & Family Plan,16.144275,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
SUTURE POLYSORB 0 CL-894,,A4649,HCPCS,Facility,Inpatient,,,,28.65,24.3525,8.21109,28.65,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
SUTURE POLYSORB 0 CL-894,,A4649,HCPCS,Facility,Outpatient,,,,28.65,24.3525,8.21109,28.65,"UCare Health, Inc.",Medical Assistance,14.459655,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE POLYSORB 0 CL-894,,A4649,HCPCS,Facility,Inpatient,,,,28.65,24.3525,8.21109,28.65,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
SUTURE POLYSORB 0 CL-894,,A4649,HCPCS,Facility,Outpatient,,,,28.65,24.3525,8.21109,28.65,"UCare Health, Inc.",Medicare Advantage,14.459655,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE POLYSORB 0 CL-894,,A4649,HCPCS,Facility,Inpatient,,,,28.65,24.3525,8.21109,28.65,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE POLYSORB 0 CL-894,,A4649,HCPCS,Facility,Outpatient,,,,28.65,24.3525,8.21109,28.65,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),14.459655,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE POLYSORB 0 CL-894,,A4649,HCPCS,Facility,Inpatient,,,,28.65,24.3525,8.21109,28.65,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE POLYSORB 0 CL-894,,A4649,HCPCS,Facility,Both,,,,28.65,24.3525,8.21109,28.65,UnitedHealthcare,Individual & Family,26.931,94,,percent of total billed charges,,
SUTURE POLYSORB 0 CL-894,,A4649,HCPCS,Facility,Outpatient,,,,28.65,24.3525,8.21109,28.65,UnitedHealthcare,Medicare Advantage,14.0385,49,,percent of total billed charges,,
SUTURE POLYSORB 0 CL-894,,A4649,HCPCS,Facility,Inpatient,,,,28.65,24.3525,8.21109,28.65,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
SUTURE POLYSORB 0 CL-894,,A4649,HCPCS,Facility,Outpatient,,,,28.65,24.3525,8.21109,28.65,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,13.752,48,,percent of total billed charges,,100% of DHS outpatient percentage
SUTURE POLYSORB 0 CL-894,,A4649,HCPCS,Facility,Inpatient,,,,28.65,24.3525,8.21109,28.65,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
SUTURE POLYSORB 0 DETATCH CL-10-MG,,A4649,HCPCS,Facility,Both,,,,95.84,81.464,27.467744,95.84,Aetna,Commercial,88.1728,92,,percent of total billed charges,,
SUTURE POLYSORB 0 DETATCH CL-10-MG,,A4649,HCPCS,Facility,Both,,,,95.84,81.464,27.467744,95.84,Aetna,Commercial,88.1728,92,,percent of total billed charges,,
SUTURE POLYSORB 0 DETATCH CL-10-MG,,A4649,HCPCS,Facility,Outpatient,,,,95.84,81.464,27.467744,95.84,Aetna,Medicare Advantage,46.9616,49,,percent of total billed charges,,
SUTURE POLYSORB 0 DETATCH CL-10-MG,,A4649,HCPCS,Facility,Outpatient,,,,95.84,81.464,27.467744,95.84,Aetna,Medicare Advantage,46.9616,49,,percent of total billed charges,,
SUTURE POLYSORB 0 DETATCH CL-10-MG,,A4649,HCPCS,Facility,Inpatient,,,,95.84,81.464,27.467744,95.84,Aetna,Medicare Advantage,,,,,Included in per diem rate,
SUTURE POLYSORB 0 DETATCH CL-10-MG,,A4649,HCPCS,Facility,Inpatient,,,,95.84,81.464,27.467744,95.84,Aetna,Medicare Advantage,,,,,Included in per diem rate,
SUTURE POLYSORB 0 DETATCH CL-10-MG,,A4649,HCPCS,Facility,Both,,,,95.84,81.464,27.467744,95.84,Aetna,PPO,89.1312,93,,percent of total billed charges,,
SUTURE POLYSORB 0 DETATCH CL-10-MG,,A4649,HCPCS,Facility,Both,,,,95.84,81.464,27.467744,95.84,Aetna,PPO,89.1312,93,,percent of total billed charges,,
SUTURE POLYSORB 0 DETATCH CL-10-MG,,A4649,HCPCS,Facility,Both,,,,95.84,81.464,27.467744,95.84,America's PPO,America's PPO,92.035152,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SUTURE POLYSORB 0 DETATCH CL-10-MG,,A4649,HCPCS,Facility,Both,,,,95.84,81.464,27.467744,95.84,America's PPO,America's PPO,92.035152,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SUTURE POLYSORB 0 DETATCH CL-10-MG,,A4649,HCPCS,Facility,Both,,,,95.84,81.464,27.467744,95.84,BlueCross BlueShield Minnesota, Federal Employee Program,94.30656,98.4,,percent of total billed charges,,
SUTURE POLYSORB 0 DETATCH CL-10-MG,,A4649,HCPCS,Facility,Both,,,,95.84,81.464,27.467744,95.84,BlueCross BlueShield Minnesota, Federal Employee Program,94.30656,98.4,,percent of total billed charges,,
SUTURE POLYSORB 0 DETATCH CL-10-MG,,A4649,HCPCS,Facility,Both,,,,95.84,81.464,27.467744,95.84,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,95.84,100,,percent of total billed charges,,
SUTURE POLYSORB 0 DETATCH CL-10-MG,,A4649,HCPCS,Facility,Both,,,,95.84,81.464,27.467744,95.84,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,95.84,100,,percent of total billed charges,,
SUTURE POLYSORB 0 DETATCH CL-10-MG,,A4649,HCPCS,Facility,Both,,,,95.84,81.464,27.467744,95.84,BlueCross BlueShield Minnesota,High Value Network Plan,86.256,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
SUTURE POLYSORB 0 DETATCH CL-10-MG,,A4649,HCPCS,Facility,Both,,,,95.84,81.464,27.467744,95.84,BlueCross BlueShield Minnesota,High Value Network Plan,86.256,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
SUTURE POLYSORB 0 DETATCH CL-10-MG,,A4649,HCPCS,Facility,Outpatient,,,,95.84,81.464,27.467744,95.84,BlueCross BlueShield Minnesota,Medicare Advantage,46.9616,49,,percent of total billed charges,,
SUTURE POLYSORB 0 DETATCH CL-10-MG,,A4649,HCPCS,Facility,Outpatient,,,,95.84,81.464,27.467744,95.84,BlueCross BlueShield Minnesota,Medicare Advantage,46.9616,49,,percent of total billed charges,,
SUTURE POLYSORB 0 DETATCH CL-10-MG,,A4649,HCPCS,Facility,Inpatient,,,,95.84,81.464,27.467744,95.84,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
SUTURE POLYSORB 0 DETATCH CL-10-MG,,A4649,HCPCS,Facility,Inpatient,,,,95.84,81.464,27.467744,95.84,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
SUTURE POLYSORB 0 DETATCH CL-10-MG,,A4649,HCPCS,Facility,Both,,,,95.84,81.464,27.467744,95.84,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,84.885488,88.57,,percent of total billed charges,,
SUTURE POLYSORB 0 DETATCH CL-10-MG,,A4649,HCPCS,Facility,Both,,,,95.84,81.464,27.467744,95.84,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,84.885488,88.57,,percent of total billed charges,,
SUTURE POLYSORB 0 DETATCH CL-10-MG,,A4649,HCPCS,Facility,Both,,,,95.84,81.464,27.467744,95.84,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,27.467744,28.66,,percent of total billed charges,,
SUTURE POLYSORB 0 DETATCH CL-10-MG,,A4649,HCPCS,Facility,Both,,,,95.84,81.464,27.467744,95.84,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,27.467744,28.66,,percent of total billed charges,,
SUTURE POLYSORB 0 DETATCH CL-10-MG,,A4649,HCPCS,Facility,Outpatient,,,,95.84,81.464,27.467744,95.84,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),46.9616,49,,percent of total billed charges,,
SUTURE POLYSORB 0 DETATCH CL-10-MG,,A4649,HCPCS,Facility,Outpatient,,,,95.84,81.464,27.467744,95.84,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),46.9616,49,,percent of total billed charges,,
SUTURE POLYSORB 0 DETATCH CL-10-MG,,A4649,HCPCS,Facility,Inpatient,,,,95.84,81.464,27.467744,95.84,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
SUTURE POLYSORB 0 DETATCH CL-10-MG,,A4649,HCPCS,Facility,Inpatient,,,,95.84,81.464,27.467744,95.84,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
SUTURE POLYSORB 0 DETATCH CL-10-MG,,A4649,HCPCS,Facility,Both,,,,95.84,81.464,27.467744,95.84,CorVel,Worker's Compensation,95.84,100,,percent of total billed charges,,
SUTURE POLYSORB 0 DETATCH CL-10-MG,,A4649,HCPCS,Facility,Both,,,,95.84,81.464,27.467744,95.84,CorVel,Worker's Compensation,95.84,100,,percent of total billed charges,,
SUTURE POLYSORB 0 DETATCH CL-10-MG,,A4649,HCPCS,Facility,Both,,,,95.84,81.464,27.467744,95.84,First Health Group Corporation,First Health Network,92.9648,97,,percent of total billed charges,,
SUTURE POLYSORB 0 DETATCH CL-10-MG,,A4649,HCPCS,Facility,Both,,,,95.84,81.464,27.467744,95.84,First Health Group Corporation,First Health Network,92.9648,97,,percent of total billed charges,,
SUTURE POLYSORB 0 DETATCH CL-10-MG,,A4649,HCPCS,Facility,Both,,,,95.84,81.464,27.467744,95.84,"Health Partners, Inc.",Commercial,90.66464,94.6,,percent of total billed charges,,
SUTURE POLYSORB 0 DETATCH CL-10-MG,,A4649,HCPCS,Facility,Both,,,,95.84,81.464,27.467744,95.84,"Health Partners, Inc.",Commercial,90.66464,94.6,,percent of total billed charges,,
SUTURE POLYSORB 0 DETATCH CL-10-MG,,A4649,HCPCS,Facility,Outpatient,,,,95.84,81.464,27.467744,95.84,"Health Partners, Inc.",Medicare Advantage,46.9616,49,,percent of total billed charges,,
SUTURE POLYSORB 0 DETATCH CL-10-MG,,A4649,HCPCS,Facility,Outpatient,,,,95.84,81.464,27.467744,95.84,"Health Partners, Inc.",Medicare Advantage,46.9616,49,,percent of total billed charges,,
SUTURE POLYSORB 0 DETATCH CL-10-MG,,A4649,HCPCS,Facility,Inpatient,,,,95.84,81.464,27.467744,95.84,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE POLYSORB 0 DETATCH CL-10-MG,,A4649,HCPCS,Facility,Inpatient,,,,95.84,81.464,27.467744,95.84,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE POLYSORB 0 DETATCH CL-10-MG,,A4649,HCPCS,Facility,Both,,,,95.84,81.464,27.467744,95.84,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),57.504,60,,percent of total billed charges,,
SUTURE POLYSORB 0 DETATCH CL-10-MG,,A4649,HCPCS,Facility,Both,,,,95.84,81.464,27.467744,95.84,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),57.504,60,,percent of total billed charges,,
SUTURE POLYSORB 0 DETATCH CL-10-MG,,A4649,HCPCS,Facility,Both,,,,95.84,81.464,27.467744,95.84,"Health Partners, Inc.",State of Minnesota Advantage Program,78.1096,81.5,,percent of total billed charges,,
SUTURE POLYSORB 0 DETATCH CL-10-MG,,A4649,HCPCS,Facility,Both,,,,95.84,81.464,27.467744,95.84,"Health Partners, Inc.",State of Minnesota Advantage Program,78.1096,81.5,,percent of total billed charges,,
SUTURE POLYSORB 0 DETATCH CL-10-MG,,A4649,HCPCS,Facility,Both,,,,95.84,81.464,27.467744,95.84,"Health Partners, Inc.",State Public Programs,47.92,50,,percent of total billed charges,,
SUTURE POLYSORB 0 DETATCH CL-10-MG,,A4649,HCPCS,Facility,Both,,,,95.84,81.464,27.467744,95.84,"Health Partners, Inc.",State Public Programs,47.92,50,,percent of total billed charges,,
SUTURE POLYSORB 0 DETATCH CL-10-MG,,A4649,HCPCS,Facility,Both,,,,95.84,81.464,27.467744,95.84,Humana Insurance Company,Commercial PPO,91.048,95,,percent of total billed charges,,
SUTURE POLYSORB 0 DETATCH CL-10-MG,,A4649,HCPCS,Facility,Both,,,,95.84,81.464,27.467744,95.84,Humana Insurance Company,Commercial PPO,91.048,95,,percent of total billed charges,,
SUTURE POLYSORB 0 DETATCH CL-10-MG,,A4649,HCPCS,Facility,Outpatient,,,,95.84,81.464,27.467744,95.84,Humana Insurance Company,Medicare PPO,46.9616,49,,percent of total billed charges,,
SUTURE POLYSORB 0 DETATCH CL-10-MG,,A4649,HCPCS,Facility,Outpatient,,,,95.84,81.464,27.467744,95.84,Humana Insurance Company,Medicare PPO,46.9616,49,,percent of total billed charges,,
SUTURE POLYSORB 0 DETATCH CL-10-MG,,A4649,HCPCS,Facility,Inpatient,,,,95.84,81.464,27.467744,95.84,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
SUTURE POLYSORB 0 DETATCH CL-10-MG,,A4649,HCPCS,Facility,Inpatient,,,,95.84,81.464,27.467744,95.84,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
SUTURE POLYSORB 0 DETATCH CL-10-MG,,A4649,HCPCS,Facility,Both,,,,95.84,81.464,27.467744,95.84,Medica,Individual & Family,94.97744,99.1,,percent of total billed charges,,
SUTURE POLYSORB 0 DETATCH CL-10-MG,,A4649,HCPCS,Facility,Both,,,,95.84,81.464,27.467744,95.84,Medica,Individual & Family,94.97744,99.1,,percent of total billed charges,,
SUTURE POLYSORB 0 DETATCH CL-10-MG,,A4649,HCPCS,Facility,Outpatient,,,,95.84,81.464,27.467744,95.84,Medica,Medica Advantage Solution,47.72832,49.8,,percent of total billed charges,,
SUTURE POLYSORB 0 DETATCH CL-10-MG,,A4649,HCPCS,Facility,Outpatient,,,,95.84,81.464,27.467744,95.84,Medica,Medica Advantage Solution,47.72832,49.8,,percent of total billed charges,,
SUTURE POLYSORB 0 DETATCH CL-10-MG,,A4649,HCPCS,Facility,Inpatient,,,,95.84,81.464,27.467744,95.84,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
SUTURE POLYSORB 0 DETATCH CL-10-MG,,A4649,HCPCS,Facility,Inpatient,,,,95.84,81.464,27.467744,95.84,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
SUTURE POLYSORB 0 DETATCH CL-10-MG,,A4649,HCPCS,Facility,Outpatient,,,,95.84,81.464,27.467744,95.84,Medica,Medical Assistance,42.74464,44.6,,percent of total billed charges,,
SUTURE POLYSORB 0 DETATCH CL-10-MG,,A4649,HCPCS,Facility,Outpatient,,,,95.84,81.464,27.467744,95.84,Medica,Medical Assistance,42.74464,44.6,,percent of total billed charges,,
SUTURE POLYSORB 0 DETATCH CL-10-MG,,A4649,HCPCS,Facility,Inpatient,,,,95.84,81.464,27.467744,95.84,Medica,Medical Assistance,,,,,Included in per diem rate,
SUTURE POLYSORB 0 DETATCH CL-10-MG,,A4649,HCPCS,Facility,Inpatient,,,,95.84,81.464,27.467744,95.84,Medica,Medical Assistance,,,,,Included in per diem rate,
SUTURE POLYSORB 0 DETATCH CL-10-MG,,A4649,HCPCS,Facility,Outpatient,,,,95.84,81.464,27.467744,95.84,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,47.72832,49.8,,percent of total billed charges,,
SUTURE POLYSORB 0 DETATCH CL-10-MG,,A4649,HCPCS,Facility,Outpatient,,,,95.84,81.464,27.467744,95.84,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,47.72832,49.8,,percent of total billed charges,,
SUTURE POLYSORB 0 DETATCH CL-10-MG,,A4649,HCPCS,Facility,Inpatient,,,,95.84,81.464,27.467744,95.84,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
SUTURE POLYSORB 0 DETATCH CL-10-MG,,A4649,HCPCS,Facility,Inpatient,,,,95.84,81.464,27.467744,95.84,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
SUTURE POLYSORB 0 DETATCH CL-10-MG,,A4649,HCPCS,Facility,Both,,,,95.84,81.464,27.467744,95.84,"Multiplan, Inc.","Multiplan, Inc.",90.0896,94,,percent of total billed charges,,
SUTURE POLYSORB 0 DETATCH CL-10-MG,,A4649,HCPCS,Facility,Both,,,,95.84,81.464,27.467744,95.84,"Multiplan, Inc.","Multiplan, Inc.",90.0896,94,,percent of total billed charges,,
SUTURE POLYSORB 0 DETATCH CL-10-MG,,A4649,HCPCS,Facility,Outpatient,,,,95.84,81.464,27.467744,95.84,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,86.35184,90.1,,percent of total billed charges,,
SUTURE POLYSORB 0 DETATCH CL-10-MG,,A4649,HCPCS,Facility,Outpatient,,,,95.84,81.464,27.467744,95.84,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,86.35184,90.1,,percent of total billed charges,,
SUTURE POLYSORB 0 DETATCH CL-10-MG,,A4649,HCPCS,Facility,Inpatient,,,,95.84,81.464,27.467744,95.84,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
SUTURE POLYSORB 0 DETATCH CL-10-MG,,A4649,HCPCS,Facility,Inpatient,,,,95.84,81.464,27.467744,95.84,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
SUTURE POLYSORB 0 DETATCH CL-10-MG,,A4649,HCPCS,Facility,Both,,,,95.84,81.464,27.467744,95.84,"Preferred One Administrative Services, INC.",PPO,94.49824,98.6,,percent of total billed charges,,
SUTURE POLYSORB 0 DETATCH CL-10-MG,,A4649,HCPCS,Facility,Both,,,,95.84,81.464,27.467744,95.84,"Preferred One Administrative Services, INC.",PPO,94.49824,98.6,,percent of total billed charges,,
SUTURE POLYSORB 0 DETATCH CL-10-MG,,A4649,HCPCS,Facility,Outpatient,,,,95.84,81.464,27.467744,95.84,PrimeWest Health,Minnesota Senior Health Options (MSHO),49.30968,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
SUTURE POLYSORB 0 DETATCH CL-10-MG,,A4649,HCPCS,Facility,Outpatient,,,,95.84,81.464,27.467744,95.84,PrimeWest Health,Minnesota Senior Health Options (MSHO),49.30968,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
SUTURE POLYSORB 0 DETATCH CL-10-MG,,A4649,HCPCS,Facility,Inpatient,,,,95.84,81.464,27.467744,95.84,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE POLYSORB 0 DETATCH CL-10-MG,,A4649,HCPCS,Facility,Inpatient,,,,95.84,81.464,27.467744,95.84,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE POLYSORB 0 DETATCH CL-10-MG,,A4649,HCPCS,Facility,Outpatient,,,,95.84,81.464,27.467744,95.84,PrimeWest Health,MinnesotaCare,49.223424,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
SUTURE POLYSORB 0 DETATCH CL-10-MG,,A4649,HCPCS,Facility,Outpatient,,,,95.84,81.464,27.467744,95.84,PrimeWest Health,MinnesotaCare,49.223424,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
SUTURE POLYSORB 0 DETATCH CL-10-MG,,A4649,HCPCS,Facility,Inpatient,,,,95.84,81.464,27.467744,95.84,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
SUTURE POLYSORB 0 DETATCH CL-10-MG,,A4649,HCPCS,Facility,Inpatient,,,,95.84,81.464,27.467744,95.84,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
SUTURE POLYSORB 0 DETATCH CL-10-MG,,A4649,HCPCS,Facility,Both,,,,95.84,81.464,27.467744,95.84,Sanford Health Plan,Sanford Health Plan,88.1728,92,,percent of total billed charges,,
SUTURE POLYSORB 0 DETATCH CL-10-MG,,A4649,HCPCS,Facility,Both,,,,95.84,81.464,27.467744,95.84,Sanford Health Plan,Sanford Health Plan,88.1728,92,,percent of total billed charges,,
SUTURE POLYSORB 0 DETATCH CL-10-MG,,A4649,HCPCS,Facility,Outpatient,,,,95.84,81.464,27.467744,95.84,"UCare Health, Inc.",Individual & Family Plan,54.00584,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
SUTURE POLYSORB 0 DETATCH CL-10-MG,,A4649,HCPCS,Facility,Outpatient,,,,95.84,81.464,27.467744,95.84,"UCare Health, Inc.",Individual & Family Plan,54.00584,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
SUTURE POLYSORB 0 DETATCH CL-10-MG,,A4649,HCPCS,Facility,Inpatient,,,,95.84,81.464,27.467744,95.84,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
SUTURE POLYSORB 0 DETATCH CL-10-MG,,A4649,HCPCS,Facility,Inpatient,,,,95.84,81.464,27.467744,95.84,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
SUTURE POLYSORB 0 DETATCH CL-10-MG,,A4649,HCPCS,Facility,Outpatient,,,,95.84,81.464,27.467744,95.84,"UCare Health, Inc.",Medical Assistance,48.370448,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE POLYSORB 0 DETATCH CL-10-MG,,A4649,HCPCS,Facility,Outpatient,,,,95.84,81.464,27.467744,95.84,"UCare Health, Inc.",Medical Assistance,48.370448,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE POLYSORB 0 DETATCH CL-10-MG,,A4649,HCPCS,Facility,Inpatient,,,,95.84,81.464,27.467744,95.84,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
SUTURE POLYSORB 0 DETATCH CL-10-MG,,A4649,HCPCS,Facility,Inpatient,,,,95.84,81.464,27.467744,95.84,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
SUTURE POLYSORB 0 DETATCH CL-10-MG,,A4649,HCPCS,Facility,Outpatient,,,,95.84,81.464,27.467744,95.84,"UCare Health, Inc.",Medicare Advantage,48.370448,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE POLYSORB 0 DETATCH CL-10-MG,,A4649,HCPCS,Facility,Outpatient,,,,95.84,81.464,27.467744,95.84,"UCare Health, Inc.",Medicare Advantage,48.370448,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE POLYSORB 0 DETATCH CL-10-MG,,A4649,HCPCS,Facility,Inpatient,,,,95.84,81.464,27.467744,95.84,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE POLYSORB 0 DETATCH CL-10-MG,,A4649,HCPCS,Facility,Inpatient,,,,95.84,81.464,27.467744,95.84,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE POLYSORB 0 DETATCH CL-10-MG,,A4649,HCPCS,Facility,Outpatient,,,,95.84,81.464,27.467744,95.84,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),48.370448,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE POLYSORB 0 DETATCH CL-10-MG,,A4649,HCPCS,Facility,Outpatient,,,,95.84,81.464,27.467744,95.84,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),48.370448,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE POLYSORB 0 DETATCH CL-10-MG,,A4649,HCPCS,Facility,Inpatient,,,,95.84,81.464,27.467744,95.84,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE POLYSORB 0 DETATCH CL-10-MG,,A4649,HCPCS,Facility,Inpatient,,,,95.84,81.464,27.467744,95.84,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE POLYSORB 0 DETATCH CL-10-MG,,A4649,HCPCS,Facility,Both,,,,95.84,81.464,27.467744,95.84,UnitedHealthcare,Individual & Family,90.0896,94,,percent of total billed charges,,
SUTURE POLYSORB 0 DETATCH CL-10-MG,,A4649,HCPCS,Facility,Both,,,,95.84,81.464,27.467744,95.84,UnitedHealthcare,Individual & Family,90.0896,94,,percent of total billed charges,,
SUTURE POLYSORB 0 DETATCH CL-10-MG,,A4649,HCPCS,Facility,Outpatient,,,,95.84,81.464,27.467744,95.84,UnitedHealthcare,Medicare Advantage,46.9616,49,,percent of total billed charges,,
SUTURE POLYSORB 0 DETATCH CL-10-MG,,A4649,HCPCS,Facility,Outpatient,,,,95.84,81.464,27.467744,95.84,UnitedHealthcare,Medicare Advantage,46.9616,49,,percent of total billed charges,,
SUTURE POLYSORB 0 DETATCH CL-10-MG,,A4649,HCPCS,Facility,Inpatient,,,,95.84,81.464,27.467744,95.84,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
SUTURE POLYSORB 0 DETATCH CL-10-MG,,A4649,HCPCS,Facility,Inpatient,,,,95.84,81.464,27.467744,95.84,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
SUTURE POLYSORB 0 DETATCH CL-10-MG,,A4649,HCPCS,Facility,Outpatient,,,,95.84,81.464,27.467744,95.84,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,46.0032,48,,percent of total billed charges,,100% of DHS outpatient percentage
SUTURE POLYSORB 0 DETATCH CL-10-MG,,A4649,HCPCS,Facility,Outpatient,,,,95.84,81.464,27.467744,95.84,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,46.0032,48,,percent of total billed charges,,100% of DHS outpatient percentage
SUTURE POLYSORB 0 DETATCH CL-10-MG,,A4649,HCPCS,Facility,Inpatient,,,,95.84,81.464,27.467744,95.84,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
SUTURE POLYSORB 0 DETATCH CL-10-MG,,A4649,HCPCS,Facility,Inpatient,,,,95.84,81.464,27.467744,95.84,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
SUTURE POLYSORB 1 36 U/D GS-24,,A4649,HCPCS,Facility,Both,,,,40.75,34.6375,11.67895,40.75,Aetna,Commercial,37.49,92,,percent of total billed charges,,
SUTURE POLYSORB 1 36 U/D GS-24,,A4649,HCPCS,Facility,Outpatient,,,,40.75,34.6375,11.67895,40.75,Aetna,Medicare Advantage,19.9675,49,,percent of total billed charges,,
SUTURE POLYSORB 1 36 U/D GS-24,,A4649,HCPCS,Facility,Inpatient,,,,40.75,34.6375,11.67895,40.75,Aetna,Medicare Advantage,,,,,Included in per diem rate,
SUTURE POLYSORB 1 36 U/D GS-24,,A4649,HCPCS,Facility,Both,,,,40.75,34.6375,11.67895,40.75,Aetna,PPO,37.8975,93,,percent of total billed charges,,
SUTURE POLYSORB 1 36 U/D GS-24,,A4649,HCPCS,Facility,Both,,,,40.75,34.6375,11.67895,40.75,America's PPO,America's PPO,39.132225,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SUTURE POLYSORB 1 36 U/D GS-24,,A4649,HCPCS,Facility,Both,,,,40.75,34.6375,11.67895,40.75,BlueCross BlueShield Minnesota, Federal Employee Program,40.098,98.4,,percent of total billed charges,,
SUTURE POLYSORB 1 36 U/D GS-24,,A4649,HCPCS,Facility,Both,,,,40.75,34.6375,11.67895,40.75,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,40.75,100,,percent of total billed charges,,
SUTURE POLYSORB 1 36 U/D GS-24,,A4649,HCPCS,Facility,Both,,,,40.75,34.6375,11.67895,40.75,BlueCross BlueShield Minnesota,High Value Network Plan,36.675,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
SUTURE POLYSORB 1 36 U/D GS-24,,A4649,HCPCS,Facility,Outpatient,,,,40.75,34.6375,11.67895,40.75,BlueCross BlueShield Minnesota,Medicare Advantage,19.9675,49,,percent of total billed charges,,
SUTURE POLYSORB 1 36 U/D GS-24,,A4649,HCPCS,Facility,Inpatient,,,,40.75,34.6375,11.67895,40.75,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
SUTURE POLYSORB 1 36 U/D GS-24,,A4649,HCPCS,Facility,Both,,,,40.75,34.6375,11.67895,40.75,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,36.092275,88.57,,percent of total billed charges,,
SUTURE POLYSORB 1 36 U/D GS-24,,A4649,HCPCS,Facility,Both,,,,40.75,34.6375,11.67895,40.75,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,11.67895,28.66,,percent of total billed charges,,
SUTURE POLYSORB 1 36 U/D GS-24,,A4649,HCPCS,Facility,Outpatient,,,,40.75,34.6375,11.67895,40.75,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),19.9675,49,,percent of total billed charges,,
SUTURE POLYSORB 1 36 U/D GS-24,,A4649,HCPCS,Facility,Inpatient,,,,40.75,34.6375,11.67895,40.75,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
SUTURE POLYSORB 1 36 U/D GS-24,,A4649,HCPCS,Facility,Both,,,,40.75,34.6375,11.67895,40.75,CorVel,Worker's Compensation,40.75,100,,percent of total billed charges,,
SUTURE POLYSORB 1 36 U/D GS-24,,A4649,HCPCS,Facility,Both,,,,40.75,34.6375,11.67895,40.75,First Health Group Corporation,First Health Network,39.5275,97,,percent of total billed charges,,
SUTURE POLYSORB 1 36 U/D GS-24,,A4649,HCPCS,Facility,Both,,,,40.75,34.6375,11.67895,40.75,"Health Partners, Inc.",Commercial,38.5495,94.6,,percent of total billed charges,,
SUTURE POLYSORB 1 36 U/D GS-24,,A4649,HCPCS,Facility,Outpatient,,,,40.75,34.6375,11.67895,40.75,"Health Partners, Inc.",Medicare Advantage,19.9675,49,,percent of total billed charges,,
SUTURE POLYSORB 1 36 U/D GS-24,,A4649,HCPCS,Facility,Inpatient,,,,40.75,34.6375,11.67895,40.75,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE POLYSORB 1 36 U/D GS-24,,A4649,HCPCS,Facility,Both,,,,40.75,34.6375,11.67895,40.75,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),24.45,60,,percent of total billed charges,,
SUTURE POLYSORB 1 36 U/D GS-24,,A4649,HCPCS,Facility,Both,,,,40.75,34.6375,11.67895,40.75,"Health Partners, Inc.",State of Minnesota Advantage Program,33.21125,81.5,,percent of total billed charges,,
SUTURE POLYSORB 1 36 U/D GS-24,,A4649,HCPCS,Facility,Both,,,,40.75,34.6375,11.67895,40.75,"Health Partners, Inc.",State Public Programs,20.375,50,,percent of total billed charges,,
SUTURE POLYSORB 1 36 U/D GS-24,,A4649,HCPCS,Facility,Both,,,,40.75,34.6375,11.67895,40.75,Humana Insurance Company,Commercial PPO,38.7125,95,,percent of total billed charges,,
SUTURE POLYSORB 1 36 U/D GS-24,,A4649,HCPCS,Facility,Outpatient,,,,40.75,34.6375,11.67895,40.75,Humana Insurance Company,Medicare PPO,19.9675,49,,percent of total billed charges,,
SUTURE POLYSORB 1 36 U/D GS-24,,A4649,HCPCS,Facility,Inpatient,,,,40.75,34.6375,11.67895,40.75,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
SUTURE POLYSORB 1 36 U/D GS-24,,A4649,HCPCS,Facility,Both,,,,40.75,34.6375,11.67895,40.75,Medica,Individual & Family,40.38325,99.1,,percent of total billed charges,,
SUTURE POLYSORB 1 36 U/D GS-24,,A4649,HCPCS,Facility,Outpatient,,,,40.75,34.6375,11.67895,40.75,Medica,Medica Advantage Solution,20.2935,49.8,,percent of total billed charges,,
SUTURE POLYSORB 1 36 U/D GS-24,,A4649,HCPCS,Facility,Inpatient,,,,40.75,34.6375,11.67895,40.75,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
SUTURE POLYSORB 1 36 U/D GS-24,,A4649,HCPCS,Facility,Outpatient,,,,40.75,34.6375,11.67895,40.75,Medica,Medical Assistance,18.1745,44.6,,percent of total billed charges,,
SUTURE POLYSORB 1 36 U/D GS-24,,A4649,HCPCS,Facility,Inpatient,,,,40.75,34.6375,11.67895,40.75,Medica,Medical Assistance,,,,,Included in per diem rate,
SUTURE POLYSORB 1 36 U/D GS-24,,A4649,HCPCS,Facility,Outpatient,,,,40.75,34.6375,11.67895,40.75,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,20.2935,49.8,,percent of total billed charges,,
SUTURE POLYSORB 1 36 U/D GS-24,,A4649,HCPCS,Facility,Inpatient,,,,40.75,34.6375,11.67895,40.75,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
SUTURE POLYSORB 1 36 U/D GS-24,,A4649,HCPCS,Facility,Both,,,,40.75,34.6375,11.67895,40.75,"Multiplan, Inc.","Multiplan, Inc.",38.305,94,,percent of total billed charges,,
SUTURE POLYSORB 1 36 U/D GS-24,,A4649,HCPCS,Facility,Outpatient,,,,40.75,34.6375,11.67895,40.75,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,36.71575,90.1,,percent of total billed charges,,
SUTURE POLYSORB 1 36 U/D GS-24,,A4649,HCPCS,Facility,Inpatient,,,,40.75,34.6375,11.67895,40.75,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
SUTURE POLYSORB 1 36 U/D GS-24,,A4649,HCPCS,Facility,Both,,,,40.75,34.6375,11.67895,40.75,"Preferred One Administrative Services, INC.",PPO,40.1795,98.6,,percent of total billed charges,,
SUTURE POLYSORB 1 36 U/D GS-24,,A4649,HCPCS,Facility,Outpatient,,,,40.75,34.6375,11.67895,40.75,PrimeWest Health,Minnesota Senior Health Options (MSHO),20.965875,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
SUTURE POLYSORB 1 36 U/D GS-24,,A4649,HCPCS,Facility,Inpatient,,,,40.75,34.6375,11.67895,40.75,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE POLYSORB 1 36 U/D GS-24,,A4649,HCPCS,Facility,Outpatient,,,,40.75,34.6375,11.67895,40.75,PrimeWest Health,MinnesotaCare,20.9292,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
SUTURE POLYSORB 1 36 U/D GS-24,,A4649,HCPCS,Facility,Inpatient,,,,40.75,34.6375,11.67895,40.75,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
SUTURE POLYSORB 1 36 U/D GS-24,,A4649,HCPCS,Facility,Both,,,,40.75,34.6375,11.67895,40.75,Sanford Health Plan,Sanford Health Plan,37.49,92,,percent of total billed charges,,
SUTURE POLYSORB 1 36 U/D GS-24,,A4649,HCPCS,Facility,Outpatient,,,,40.75,34.6375,11.67895,40.75,"UCare Health, Inc.",Individual & Family Plan,22.962625,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
SUTURE POLYSORB 1 36 U/D GS-24,,A4649,HCPCS,Facility,Inpatient,,,,40.75,34.6375,11.67895,40.75,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
SUTURE POLYSORB 1 36 U/D GS-24,,A4649,HCPCS,Facility,Outpatient,,,,40.75,34.6375,11.67895,40.75,"UCare Health, Inc.",Medical Assistance,20.566525,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE POLYSORB 1 36 U/D GS-24,,A4649,HCPCS,Facility,Inpatient,,,,40.75,34.6375,11.67895,40.75,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
SUTURE POLYSORB 1 36 U/D GS-24,,A4649,HCPCS,Facility,Outpatient,,,,40.75,34.6375,11.67895,40.75,"UCare Health, Inc.",Medicare Advantage,20.566525,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE POLYSORB 1 36 U/D GS-24,,A4649,HCPCS,Facility,Inpatient,,,,40.75,34.6375,11.67895,40.75,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE POLYSORB 1 36 U/D GS-24,,A4649,HCPCS,Facility,Outpatient,,,,40.75,34.6375,11.67895,40.75,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),20.566525,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE POLYSORB 1 36 U/D GS-24,,A4649,HCPCS,Facility,Inpatient,,,,40.75,34.6375,11.67895,40.75,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE POLYSORB 1 36 U/D GS-24,,A4649,HCPCS,Facility,Both,,,,40.75,34.6375,11.67895,40.75,UnitedHealthcare,Individual & Family,38.305,94,,percent of total billed charges,,
SUTURE POLYSORB 1 36 U/D GS-24,,A4649,HCPCS,Facility,Outpatient,,,,40.75,34.6375,11.67895,40.75,UnitedHealthcare,Medicare Advantage,19.9675,49,,percent of total billed charges,,
SUTURE POLYSORB 1 36 U/D GS-24,,A4649,HCPCS,Facility,Inpatient,,,,40.75,34.6375,11.67895,40.75,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
SUTURE POLYSORB 1 36 U/D GS-24,,A4649,HCPCS,Facility,Outpatient,,,,40.75,34.6375,11.67895,40.75,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,19.56,48,,percent of total billed charges,,100% of DHS outpatient percentage
SUTURE POLYSORB 1 36 U/D GS-24,,A4649,HCPCS,Facility,Inpatient,,,,40.75,34.6375,11.67895,40.75,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
SUTURE POLYSORB 2 CL-825,,A4649,HCPCS,Facility,Both,,,,51.435,43.71975,14.741271,51.435,Aetna,Commercial,47.3202,92,,percent of total billed charges,,
SUTURE POLYSORB 2 CL-825,,A4649,HCPCS,Facility,Outpatient,,,,51.435,43.71975,14.741271,51.435,Aetna,Medicare Advantage,25.20315,49,,percent of total billed charges,,
SUTURE POLYSORB 2 CL-825,,A4649,HCPCS,Facility,Inpatient,,,,51.435,43.71975,14.741271,51.435,Aetna,Medicare Advantage,,,,,Included in per diem rate,
SUTURE POLYSORB 2 CL-825,,A4649,HCPCS,Facility,Both,,,,51.435,43.71975,14.741271,51.435,Aetna,PPO,47.83455,93,,percent of total billed charges,,
SUTURE POLYSORB 2 CL-825,,A4649,HCPCS,Facility,Both,,,,51.435,43.71975,14.741271,51.435,America's PPO,America's PPO,49.3930305,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SUTURE POLYSORB 2 CL-825,,A4649,HCPCS,Facility,Both,,,,51.435,43.71975,14.741271,51.435,BlueCross BlueShield Minnesota, Federal Employee Program,50.61204,98.4,,percent of total billed charges,,
SUTURE POLYSORB 2 CL-825,,A4649,HCPCS,Facility,Both,,,,51.435,43.71975,14.741271,51.435,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,51.435,100,,percent of total billed charges,,
SUTURE POLYSORB 2 CL-825,,A4649,HCPCS,Facility,Both,,,,51.435,43.71975,14.741271,51.435,BlueCross BlueShield Minnesota,High Value Network Plan,46.2915,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
SUTURE POLYSORB 2 CL-825,,A4649,HCPCS,Facility,Outpatient,,,,51.435,43.71975,14.741271,51.435,BlueCross BlueShield Minnesota,Medicare Advantage,25.20315,49,,percent of total billed charges,,
SUTURE POLYSORB 2 CL-825,,A4649,HCPCS,Facility,Inpatient,,,,51.435,43.71975,14.741271,51.435,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
SUTURE POLYSORB 2 CL-825,,A4649,HCPCS,Facility,Both,,,,51.435,43.71975,14.741271,51.435,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,45.5559795,88.57,,percent of total billed charges,,
SUTURE POLYSORB 2 CL-825,,A4649,HCPCS,Facility,Both,,,,51.435,43.71975,14.741271,51.435,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,14.741271,28.66,,percent of total billed charges,,
SUTURE POLYSORB 2 CL-825,,A4649,HCPCS,Facility,Outpatient,,,,51.435,43.71975,14.741271,51.435,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),25.20315,49,,percent of total billed charges,,
SUTURE POLYSORB 2 CL-825,,A4649,HCPCS,Facility,Inpatient,,,,51.435,43.71975,14.741271,51.435,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
SUTURE POLYSORB 2 CL-825,,A4649,HCPCS,Facility,Both,,,,51.435,43.71975,14.741271,51.435,CorVel,Worker's Compensation,51.435,100,,percent of total billed charges,,
SUTURE POLYSORB 2 CL-825,,A4649,HCPCS,Facility,Both,,,,51.435,43.71975,14.741271,51.435,First Health Group Corporation,First Health Network,49.89195,97,,percent of total billed charges,,
SUTURE POLYSORB 2 CL-825,,A4649,HCPCS,Facility,Both,,,,51.435,43.71975,14.741271,51.435,"Health Partners, Inc.",Commercial,48.65751,94.6,,percent of total billed charges,,
SUTURE POLYSORB 2 CL-825,,A4649,HCPCS,Facility,Outpatient,,,,51.435,43.71975,14.741271,51.435,"Health Partners, Inc.",Medicare Advantage,25.20315,49,,percent of total billed charges,,
SUTURE POLYSORB 2 CL-825,,A4649,HCPCS,Facility,Inpatient,,,,51.435,43.71975,14.741271,51.435,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE POLYSORB 2 CL-825,,A4649,HCPCS,Facility,Both,,,,51.435,43.71975,14.741271,51.435,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),30.861,60,,percent of total billed charges,,
SUTURE POLYSORB 2 CL-825,,A4649,HCPCS,Facility,Both,,,,51.435,43.71975,14.741271,51.435,"Health Partners, Inc.",State of Minnesota Advantage Program,41.919525,81.5,,percent of total billed charges,,
SUTURE POLYSORB 2 CL-825,,A4649,HCPCS,Facility,Both,,,,51.435,43.71975,14.741271,51.435,"Health Partners, Inc.",State Public Programs,25.7175,50,,percent of total billed charges,,
SUTURE POLYSORB 2 CL-825,,A4649,HCPCS,Facility,Both,,,,51.435,43.71975,14.741271,51.435,Humana Insurance Company,Commercial PPO,48.86325,95,,percent of total billed charges,,
SUTURE POLYSORB 2 CL-825,,A4649,HCPCS,Facility,Outpatient,,,,51.435,43.71975,14.741271,51.435,Humana Insurance Company,Medicare PPO,25.20315,49,,percent of total billed charges,,
SUTURE POLYSORB 2 CL-825,,A4649,HCPCS,Facility,Inpatient,,,,51.435,43.71975,14.741271,51.435,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
SUTURE POLYSORB 2 CL-825,,A4649,HCPCS,Facility,Both,,,,51.435,43.71975,14.741271,51.435,Medica,Individual & Family,50.972085,99.1,,percent of total billed charges,,
SUTURE POLYSORB 2 CL-825,,A4649,HCPCS,Facility,Outpatient,,,,51.435,43.71975,14.741271,51.435,Medica,Medica Advantage Solution,25.61463,49.8,,percent of total billed charges,,
SUTURE POLYSORB 2 CL-825,,A4649,HCPCS,Facility,Inpatient,,,,51.435,43.71975,14.741271,51.435,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
SUTURE POLYSORB 2 CL-825,,A4649,HCPCS,Facility,Outpatient,,,,51.435,43.71975,14.741271,51.435,Medica,Medical Assistance,22.94001,44.6,,percent of total billed charges,,
SUTURE POLYSORB 2 CL-825,,A4649,HCPCS,Facility,Inpatient,,,,51.435,43.71975,14.741271,51.435,Medica,Medical Assistance,,,,,Included in per diem rate,
SUTURE POLYSORB 2 CL-825,,A4649,HCPCS,Facility,Outpatient,,,,51.435,43.71975,14.741271,51.435,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,25.61463,49.8,,percent of total billed charges,,
SUTURE POLYSORB 2 CL-825,,A4649,HCPCS,Facility,Inpatient,,,,51.435,43.71975,14.741271,51.435,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
SUTURE POLYSORB 2 CL-825,,A4649,HCPCS,Facility,Both,,,,51.435,43.71975,14.741271,51.435,"Multiplan, Inc.","Multiplan, Inc.",48.3489,94,,percent of total billed charges,,
SUTURE POLYSORB 2 CL-825,,A4649,HCPCS,Facility,Outpatient,,,,51.435,43.71975,14.741271,51.435,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,46.342935,90.1,,percent of total billed charges,,
SUTURE POLYSORB 2 CL-825,,A4649,HCPCS,Facility,Inpatient,,,,51.435,43.71975,14.741271,51.435,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
SUTURE POLYSORB 2 CL-825,,A4649,HCPCS,Facility,Both,,,,51.435,43.71975,14.741271,51.435,"Preferred One Administrative Services, INC.",PPO,50.71491,98.6,,percent of total billed charges,,
SUTURE POLYSORB 2 CL-825,,A4649,HCPCS,Facility,Outpatient,,,,51.435,43.71975,14.741271,51.435,PrimeWest Health,Minnesota Senior Health Options (MSHO),26.4633075,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
SUTURE POLYSORB 2 CL-825,,A4649,HCPCS,Facility,Inpatient,,,,51.435,43.71975,14.741271,51.435,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE POLYSORB 2 CL-825,,A4649,HCPCS,Facility,Outpatient,,,,51.435,43.71975,14.741271,51.435,PrimeWest Health,MinnesotaCare,26.417016,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
SUTURE POLYSORB 2 CL-825,,A4649,HCPCS,Facility,Inpatient,,,,51.435,43.71975,14.741271,51.435,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
SUTURE POLYSORB 2 CL-825,,A4649,HCPCS,Facility,Both,,,,51.435,43.71975,14.741271,51.435,Sanford Health Plan,Sanford Health Plan,47.3202,92,,percent of total billed charges,,
SUTURE POLYSORB 2 CL-825,,A4649,HCPCS,Facility,Outpatient,,,,51.435,43.71975,14.741271,51.435,"UCare Health, Inc.",Individual & Family Plan,28.9836225,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
SUTURE POLYSORB 2 CL-825,,A4649,HCPCS,Facility,Inpatient,,,,51.435,43.71975,14.741271,51.435,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
SUTURE POLYSORB 2 CL-825,,A4649,HCPCS,Facility,Outpatient,,,,51.435,43.71975,14.741271,51.435,"UCare Health, Inc.",Medical Assistance,25.9592445,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE POLYSORB 2 CL-825,,A4649,HCPCS,Facility,Inpatient,,,,51.435,43.71975,14.741271,51.435,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
SUTURE POLYSORB 2 CL-825,,A4649,HCPCS,Facility,Outpatient,,,,51.435,43.71975,14.741271,51.435,"UCare Health, Inc.",Medicare Advantage,25.9592445,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE POLYSORB 2 CL-825,,A4649,HCPCS,Facility,Inpatient,,,,51.435,43.71975,14.741271,51.435,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE POLYSORB 2 CL-825,,A4649,HCPCS,Facility,Outpatient,,,,51.435,43.71975,14.741271,51.435,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),25.9592445,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE POLYSORB 2 CL-825,,A4649,HCPCS,Facility,Inpatient,,,,51.435,43.71975,14.741271,51.435,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE POLYSORB 2 CL-825,,A4649,HCPCS,Facility,Both,,,,51.435,43.71975,14.741271,51.435,UnitedHealthcare,Individual & Family,48.3489,94,,percent of total billed charges,,
SUTURE POLYSORB 2 CL-825,,A4649,HCPCS,Facility,Outpatient,,,,51.435,43.71975,14.741271,51.435,UnitedHealthcare,Medicare Advantage,25.20315,49,,percent of total billed charges,,
SUTURE POLYSORB 2 CL-825,,A4649,HCPCS,Facility,Inpatient,,,,51.435,43.71975,14.741271,51.435,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
SUTURE POLYSORB 2 CL-825,,A4649,HCPCS,Facility,Outpatient,,,,51.435,43.71975,14.741271,51.435,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,24.6888,48,,percent of total billed charges,,100% of DHS outpatient percentage
SUTURE POLYSORB 2 CL-825,,A4649,HCPCS,Facility,Inpatient,,,,51.435,43.71975,14.741271,51.435,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
SUTURE POLYSORB 2 CL-906,,A4649,HCPCS,Facility,Both,,,,16,13.6,4.5856,16,Aetna,Commercial,14.72,92,,percent of total billed charges,,
SUTURE POLYSORB 2 CL-906,,A4649,HCPCS,Facility,Outpatient,,,,16,13.6,4.5856,16,Aetna,Medicare Advantage,7.84,49,,percent of total billed charges,,
SUTURE POLYSORB 2 CL-906,,A4649,HCPCS,Facility,Inpatient,,,,16,13.6,4.5856,16,Aetna,Medicare Advantage,,,,,Included in per diem rate,
SUTURE POLYSORB 2 CL-906,,A4649,HCPCS,Facility,Both,,,,16,13.6,4.5856,16,Aetna,PPO,14.88,93,,percent of total billed charges,,
SUTURE POLYSORB 2 CL-906,,A4649,HCPCS,Facility,Both,,,,16,13.6,4.5856,16,America's PPO,America's PPO,15.3648,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SUTURE POLYSORB 2 CL-906,,A4649,HCPCS,Facility,Both,,,,16,13.6,4.5856,16,BlueCross BlueShield Minnesota, Federal Employee Program,15.744,98.4,,percent of total billed charges,,
SUTURE POLYSORB 2 CL-906,,A4649,HCPCS,Facility,Both,,,,16,13.6,4.5856,16,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,16,100,,percent of total billed charges,,
SUTURE POLYSORB 2 CL-906,,A4649,HCPCS,Facility,Both,,,,16,13.6,4.5856,16,BlueCross BlueShield Minnesota,High Value Network Plan,14.4,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
SUTURE POLYSORB 2 CL-906,,A4649,HCPCS,Facility,Outpatient,,,,16,13.6,4.5856,16,BlueCross BlueShield Minnesota,Medicare Advantage,7.84,49,,percent of total billed charges,,
SUTURE POLYSORB 2 CL-906,,A4649,HCPCS,Facility,Inpatient,,,,16,13.6,4.5856,16,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
SUTURE POLYSORB 2 CL-906,,A4649,HCPCS,Facility,Both,,,,16,13.6,4.5856,16,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,14.1712,88.57,,percent of total billed charges,,
SUTURE POLYSORB 2 CL-906,,A4649,HCPCS,Facility,Both,,,,16,13.6,4.5856,16,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,4.5856,28.66,,percent of total billed charges,,
SUTURE POLYSORB 2 CL-906,,A4649,HCPCS,Facility,Outpatient,,,,16,13.6,4.5856,16,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),7.84,49,,percent of total billed charges,,
SUTURE POLYSORB 2 CL-906,,A4649,HCPCS,Facility,Inpatient,,,,16,13.6,4.5856,16,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
SUTURE POLYSORB 2 CL-906,,A4649,HCPCS,Facility,Both,,,,16,13.6,4.5856,16,CorVel,Worker's Compensation,16,100,,percent of total billed charges,,
SUTURE POLYSORB 2 CL-906,,A4649,HCPCS,Facility,Both,,,,16,13.6,4.5856,16,First Health Group Corporation,First Health Network,15.52,97,,percent of total billed charges,,
SUTURE POLYSORB 2 CL-906,,A4649,HCPCS,Facility,Both,,,,16,13.6,4.5856,16,"Health Partners, Inc.",Commercial,15.136,94.6,,percent of total billed charges,,
SUTURE POLYSORB 2 CL-906,,A4649,HCPCS,Facility,Outpatient,,,,16,13.6,4.5856,16,"Health Partners, Inc.",Medicare Advantage,7.84,49,,percent of total billed charges,,
SUTURE POLYSORB 2 CL-906,,A4649,HCPCS,Facility,Inpatient,,,,16,13.6,4.5856,16,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE POLYSORB 2 CL-906,,A4649,HCPCS,Facility,Both,,,,16,13.6,4.5856,16,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),9.6,60,,percent of total billed charges,,
SUTURE POLYSORB 2 CL-906,,A4649,HCPCS,Facility,Both,,,,16,13.6,4.5856,16,"Health Partners, Inc.",State of Minnesota Advantage Program,13.04,81.5,,percent of total billed charges,,
SUTURE POLYSORB 2 CL-906,,A4649,HCPCS,Facility,Both,,,,16,13.6,4.5856,16,"Health Partners, Inc.",State Public Programs,8,50,,percent of total billed charges,,
SUTURE POLYSORB 2 CL-906,,A4649,HCPCS,Facility,Both,,,,16,13.6,4.5856,16,Humana Insurance Company,Commercial PPO,15.2,95,,percent of total billed charges,,
SUTURE POLYSORB 2 CL-906,,A4649,HCPCS,Facility,Outpatient,,,,16,13.6,4.5856,16,Humana Insurance Company,Medicare PPO,7.84,49,,percent of total billed charges,,
SUTURE POLYSORB 2 CL-906,,A4649,HCPCS,Facility,Inpatient,,,,16,13.6,4.5856,16,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
SUTURE POLYSORB 2 CL-906,,A4649,HCPCS,Facility,Both,,,,16,13.6,4.5856,16,Medica,Individual & Family,15.856,99.1,,percent of total billed charges,,
SUTURE POLYSORB 2 CL-906,,A4649,HCPCS,Facility,Outpatient,,,,16,13.6,4.5856,16,Medica,Medica Advantage Solution,7.968,49.8,,percent of total billed charges,,
SUTURE POLYSORB 2 CL-906,,A4649,HCPCS,Facility,Inpatient,,,,16,13.6,4.5856,16,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
SUTURE POLYSORB 2 CL-906,,A4649,HCPCS,Facility,Outpatient,,,,16,13.6,4.5856,16,Medica,Medical Assistance,7.136,44.6,,percent of total billed charges,,
SUTURE POLYSORB 2 CL-906,,A4649,HCPCS,Facility,Inpatient,,,,16,13.6,4.5856,16,Medica,Medical Assistance,,,,,Included in per diem rate,
SUTURE POLYSORB 2 CL-906,,A4649,HCPCS,Facility,Outpatient,,,,16,13.6,4.5856,16,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,7.968,49.8,,percent of total billed charges,,
SUTURE POLYSORB 2 CL-906,,A4649,HCPCS,Facility,Inpatient,,,,16,13.6,4.5856,16,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
SUTURE POLYSORB 2 CL-906,,A4649,HCPCS,Facility,Both,,,,16,13.6,4.5856,16,"Multiplan, Inc.","Multiplan, Inc.",15.04,94,,percent of total billed charges,,
SUTURE POLYSORB 2 CL-906,,A4649,HCPCS,Facility,Outpatient,,,,16,13.6,4.5856,16,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,14.416,90.1,,percent of total billed charges,,
SUTURE POLYSORB 2 CL-906,,A4649,HCPCS,Facility,Inpatient,,,,16,13.6,4.5856,16,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
SUTURE POLYSORB 2 CL-906,,A4649,HCPCS,Facility,Both,,,,16,13.6,4.5856,16,"Preferred One Administrative Services, INC.",PPO,15.776,98.6,,percent of total billed charges,,
SUTURE POLYSORB 2 CL-906,,A4649,HCPCS,Facility,Outpatient,,,,16,13.6,4.5856,16,PrimeWest Health,Minnesota Senior Health Options (MSHO),8.232,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
SUTURE POLYSORB 2 CL-906,,A4649,HCPCS,Facility,Inpatient,,,,16,13.6,4.5856,16,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE POLYSORB 2 CL-906,,A4649,HCPCS,Facility,Outpatient,,,,16,13.6,4.5856,16,PrimeWest Health,MinnesotaCare,8.2176,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
SUTURE POLYSORB 2 CL-906,,A4649,HCPCS,Facility,Inpatient,,,,16,13.6,4.5856,16,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
SUTURE POLYSORB 2 CL-906,,A4649,HCPCS,Facility,Both,,,,16,13.6,4.5856,16,Sanford Health Plan,Sanford Health Plan,14.72,92,,percent of total billed charges,,
SUTURE POLYSORB 2 CL-906,,A4649,HCPCS,Facility,Outpatient,,,,16,13.6,4.5856,16,"UCare Health, Inc.",Individual & Family Plan,9.016,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
SUTURE POLYSORB 2 CL-906,,A4649,HCPCS,Facility,Inpatient,,,,16,13.6,4.5856,16,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
SUTURE POLYSORB 2 CL-906,,A4649,HCPCS,Facility,Outpatient,,,,16,13.6,4.5856,16,"UCare Health, Inc.",Medical Assistance,8.0752,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE POLYSORB 2 CL-906,,A4649,HCPCS,Facility,Inpatient,,,,16,13.6,4.5856,16,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
SUTURE POLYSORB 2 CL-906,,A4649,HCPCS,Facility,Outpatient,,,,16,13.6,4.5856,16,"UCare Health, Inc.",Medicare Advantage,8.0752,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE POLYSORB 2 CL-906,,A4649,HCPCS,Facility,Inpatient,,,,16,13.6,4.5856,16,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE POLYSORB 2 CL-906,,A4649,HCPCS,Facility,Outpatient,,,,16,13.6,4.5856,16,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),8.0752,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE POLYSORB 2 CL-906,,A4649,HCPCS,Facility,Inpatient,,,,16,13.6,4.5856,16,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE POLYSORB 2 CL-906,,A4649,HCPCS,Facility,Both,,,,16,13.6,4.5856,16,UnitedHealthcare,Individual & Family,15.04,94,,percent of total billed charges,,
SUTURE POLYSORB 2 CL-906,,A4649,HCPCS,Facility,Outpatient,,,,16,13.6,4.5856,16,UnitedHealthcare,Medicare Advantage,7.84,49,,percent of total billed charges,,
SUTURE POLYSORB 2 CL-906,,A4649,HCPCS,Facility,Inpatient,,,,16,13.6,4.5856,16,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
SUTURE POLYSORB 2 CL-906,,A4649,HCPCS,Facility,Outpatient,,,,16,13.6,4.5856,16,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,7.68,48,,percent of total billed charges,,100% of DHS outpatient percentage
SUTURE POLYSORB 2 CL-906,,A4649,HCPCS,Facility,Inpatient,,,,16,13.6,4.5856,16,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
SUTURE POLYSORB 2/0 18IN VL V-20 DT,,A4649,HCPCS,Facility,Both,,,,86.12,73.202,24.681992,86.12,Aetna,Commercial,79.2304,92,,percent of total billed charges,,
SUTURE POLYSORB 2/0 18IN VL V-20 DT,,A4649,HCPCS,Facility,Outpatient,,,,86.12,73.202,24.681992,86.12,Aetna,Medicare Advantage,42.1988,49,,percent of total billed charges,,
SUTURE POLYSORB 2/0 18IN VL V-20 DT,,A4649,HCPCS,Facility,Inpatient,,,,86.12,73.202,24.681992,86.12,Aetna,Medicare Advantage,,,,,Included in per diem rate,
SUTURE POLYSORB 2/0 18IN VL V-20 DT,,A4649,HCPCS,Facility,Both,,,,86.12,73.202,24.681992,86.12,Aetna,PPO,80.0916,93,,percent of total billed charges,,
SUTURE POLYSORB 2/0 18IN VL V-20 DT,,A4649,HCPCS,Facility,Both,,,,86.12,73.202,24.681992,86.12,America's PPO,America's PPO,82.701036,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SUTURE POLYSORB 2/0 18IN VL V-20 DT,,A4649,HCPCS,Facility,Both,,,,86.12,73.202,24.681992,86.12,BlueCross BlueShield Minnesota, Federal Employee Program,84.74208,98.4,,percent of total billed charges,,
SUTURE POLYSORB 2/0 18IN VL V-20 DT,,A4649,HCPCS,Facility,Both,,,,86.12,73.202,24.681992,86.12,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,86.12,100,,percent of total billed charges,,
SUTURE POLYSORB 2/0 18IN VL V-20 DT,,A4649,HCPCS,Facility,Both,,,,86.12,73.202,24.681992,86.12,BlueCross BlueShield Minnesota,High Value Network Plan,77.508,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
SUTURE POLYSORB 2/0 18IN VL V-20 DT,,A4649,HCPCS,Facility,Outpatient,,,,86.12,73.202,24.681992,86.12,BlueCross BlueShield Minnesota,Medicare Advantage,42.1988,49,,percent of total billed charges,,
SUTURE POLYSORB 2/0 18IN VL V-20 DT,,A4649,HCPCS,Facility,Inpatient,,,,86.12,73.202,24.681992,86.12,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
SUTURE POLYSORB 2/0 18IN VL V-20 DT,,A4649,HCPCS,Facility,Both,,,,86.12,73.202,24.681992,86.12,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,76.276484,88.57,,percent of total billed charges,,
SUTURE POLYSORB 2/0 18IN VL V-20 DT,,A4649,HCPCS,Facility,Both,,,,86.12,73.202,24.681992,86.12,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,24.681992,28.66,,percent of total billed charges,,
SUTURE POLYSORB 2/0 18IN VL V-20 DT,,A4649,HCPCS,Facility,Outpatient,,,,86.12,73.202,24.681992,86.12,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),42.1988,49,,percent of total billed charges,,
SUTURE POLYSORB 2/0 18IN VL V-20 DT,,A4649,HCPCS,Facility,Inpatient,,,,86.12,73.202,24.681992,86.12,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
SUTURE POLYSORB 2/0 18IN VL V-20 DT,,A4649,HCPCS,Facility,Both,,,,86.12,73.202,24.681992,86.12,CorVel,Worker's Compensation,86.12,100,,percent of total billed charges,,
SUTURE POLYSORB 2/0 18IN VL V-20 DT,,A4649,HCPCS,Facility,Both,,,,86.12,73.202,24.681992,86.12,First Health Group Corporation,First Health Network,83.5364,97,,percent of total billed charges,,
SUTURE POLYSORB 2/0 18IN VL V-20 DT,,A4649,HCPCS,Facility,Both,,,,86.12,73.202,24.681992,86.12,"Health Partners, Inc.",Commercial,81.46952,94.6,,percent of total billed charges,,
SUTURE POLYSORB 2/0 18IN VL V-20 DT,,A4649,HCPCS,Facility,Outpatient,,,,86.12,73.202,24.681992,86.12,"Health Partners, Inc.",Medicare Advantage,42.1988,49,,percent of total billed charges,,
SUTURE POLYSORB 2/0 18IN VL V-20 DT,,A4649,HCPCS,Facility,Inpatient,,,,86.12,73.202,24.681992,86.12,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE POLYSORB 2/0 18IN VL V-20 DT,,A4649,HCPCS,Facility,Both,,,,86.12,73.202,24.681992,86.12,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),51.672,60,,percent of total billed charges,,
SUTURE POLYSORB 2/0 18IN VL V-20 DT,,A4649,HCPCS,Facility,Both,,,,86.12,73.202,24.681992,86.12,"Health Partners, Inc.",State of Minnesota Advantage Program,70.1878,81.5,,percent of total billed charges,,
SUTURE POLYSORB 2/0 18IN VL V-20 DT,,A4649,HCPCS,Facility,Both,,,,86.12,73.202,24.681992,86.12,"Health Partners, Inc.",State Public Programs,43.06,50,,percent of total billed charges,,
SUTURE POLYSORB 2/0 18IN VL V-20 DT,,A4649,HCPCS,Facility,Both,,,,86.12,73.202,24.681992,86.12,Humana Insurance Company,Commercial PPO,81.814,95,,percent of total billed charges,,
SUTURE POLYSORB 2/0 18IN VL V-20 DT,,A4649,HCPCS,Facility,Outpatient,,,,86.12,73.202,24.681992,86.12,Humana Insurance Company,Medicare PPO,42.1988,49,,percent of total billed charges,,
SUTURE POLYSORB 2/0 18IN VL V-20 DT,,A4649,HCPCS,Facility,Inpatient,,,,86.12,73.202,24.681992,86.12,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
SUTURE POLYSORB 2/0 18IN VL V-20 DT,,A4649,HCPCS,Facility,Both,,,,86.12,73.202,24.681992,86.12,Medica,Individual & Family,85.34492,99.1,,percent of total billed charges,,
SUTURE POLYSORB 2/0 18IN VL V-20 DT,,A4649,HCPCS,Facility,Outpatient,,,,86.12,73.202,24.681992,86.12,Medica,Medica Advantage Solution,42.88776,49.8,,percent of total billed charges,,
SUTURE POLYSORB 2/0 18IN VL V-20 DT,,A4649,HCPCS,Facility,Inpatient,,,,86.12,73.202,24.681992,86.12,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
SUTURE POLYSORB 2/0 18IN VL V-20 DT,,A4649,HCPCS,Facility,Outpatient,,,,86.12,73.202,24.681992,86.12,Medica,Medical Assistance,38.40952,44.6,,percent of total billed charges,,
SUTURE POLYSORB 2/0 18IN VL V-20 DT,,A4649,HCPCS,Facility,Inpatient,,,,86.12,73.202,24.681992,86.12,Medica,Medical Assistance,,,,,Included in per diem rate,
SUTURE POLYSORB 2/0 18IN VL V-20 DT,,A4649,HCPCS,Facility,Outpatient,,,,86.12,73.202,24.681992,86.12,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,42.88776,49.8,,percent of total billed charges,,
SUTURE POLYSORB 2/0 18IN VL V-20 DT,,A4649,HCPCS,Facility,Inpatient,,,,86.12,73.202,24.681992,86.12,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
SUTURE POLYSORB 2/0 18IN VL V-20 DT,,A4649,HCPCS,Facility,Both,,,,86.12,73.202,24.681992,86.12,"Multiplan, Inc.","Multiplan, Inc.",80.9528,94,,percent of total billed charges,,
SUTURE POLYSORB 2/0 18IN VL V-20 DT,,A4649,HCPCS,Facility,Outpatient,,,,86.12,73.202,24.681992,86.12,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,77.59412,90.1,,percent of total billed charges,,
SUTURE POLYSORB 2/0 18IN VL V-20 DT,,A4649,HCPCS,Facility,Inpatient,,,,86.12,73.202,24.681992,86.12,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
SUTURE POLYSORB 2/0 18IN VL V-20 DT,,A4649,HCPCS,Facility,Both,,,,86.12,73.202,24.681992,86.12,"Preferred One Administrative Services, INC.",PPO,84.91432,98.6,,percent of total billed charges,,
SUTURE POLYSORB 2/0 18IN VL V-20 DT,,A4649,HCPCS,Facility,Outpatient,,,,86.12,73.202,24.681992,86.12,PrimeWest Health,Minnesota Senior Health Options (MSHO),44.30874,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
SUTURE POLYSORB 2/0 18IN VL V-20 DT,,A4649,HCPCS,Facility,Inpatient,,,,86.12,73.202,24.681992,86.12,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE POLYSORB 2/0 18IN VL V-20 DT,,A4649,HCPCS,Facility,Outpatient,,,,86.12,73.202,24.681992,86.12,PrimeWest Health,MinnesotaCare,44.231232,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
SUTURE POLYSORB 2/0 18IN VL V-20 DT,,A4649,HCPCS,Facility,Inpatient,,,,86.12,73.202,24.681992,86.12,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
SUTURE POLYSORB 2/0 18IN VL V-20 DT,,A4649,HCPCS,Facility,Both,,,,86.12,73.202,24.681992,86.12,Sanford Health Plan,Sanford Health Plan,79.2304,92,,percent of total billed charges,,
SUTURE POLYSORB 2/0 18IN VL V-20 DT,,A4649,HCPCS,Facility,Outpatient,,,,86.12,73.202,24.681992,86.12,"UCare Health, Inc.",Individual & Family Plan,48.52862,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
SUTURE POLYSORB 2/0 18IN VL V-20 DT,,A4649,HCPCS,Facility,Inpatient,,,,86.12,73.202,24.681992,86.12,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
SUTURE POLYSORB 2/0 18IN VL V-20 DT,,A4649,HCPCS,Facility,Outpatient,,,,86.12,73.202,24.681992,86.12,"UCare Health, Inc.",Medical Assistance,43.464764,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE POLYSORB 2/0 18IN VL V-20 DT,,A4649,HCPCS,Facility,Inpatient,,,,86.12,73.202,24.681992,86.12,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
SUTURE POLYSORB 2/0 18IN VL V-20 DT,,A4649,HCPCS,Facility,Outpatient,,,,86.12,73.202,24.681992,86.12,"UCare Health, Inc.",Medicare Advantage,43.464764,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE POLYSORB 2/0 18IN VL V-20 DT,,A4649,HCPCS,Facility,Inpatient,,,,86.12,73.202,24.681992,86.12,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE POLYSORB 2/0 18IN VL V-20 DT,,A4649,HCPCS,Facility,Outpatient,,,,86.12,73.202,24.681992,86.12,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),43.464764,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE POLYSORB 2/0 18IN VL V-20 DT,,A4649,HCPCS,Facility,Inpatient,,,,86.12,73.202,24.681992,86.12,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE POLYSORB 2/0 18IN VL V-20 DT,,A4649,HCPCS,Facility,Both,,,,86.12,73.202,24.681992,86.12,UnitedHealthcare,Individual & Family,80.9528,94,,percent of total billed charges,,
SUTURE POLYSORB 2/0 18IN VL V-20 DT,,A4649,HCPCS,Facility,Outpatient,,,,86.12,73.202,24.681992,86.12,UnitedHealthcare,Medicare Advantage,42.1988,49,,percent of total billed charges,,
SUTURE POLYSORB 2/0 18IN VL V-20 DT,,A4649,HCPCS,Facility,Inpatient,,,,86.12,73.202,24.681992,86.12,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
SUTURE POLYSORB 2/0 18IN VL V-20 DT,,A4649,HCPCS,Facility,Outpatient,,,,86.12,73.202,24.681992,86.12,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,41.3376,48,,percent of total billed charges,,100% of DHS outpatient percentage
SUTURE POLYSORB 2/0 18IN VL V-20 DT,,A4649,HCPCS,Facility,Inpatient,,,,86.12,73.202,24.681992,86.12,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
SUTURE POLYSORB 2-0 3X18 UD HOS-11 DT,,A4649,HCPCS,Facility,Both,,,,140.68,119.578,40.318888,140.68,Aetna,Commercial,129.4256,92,,percent of total billed charges,,
SUTURE POLYSORB 2-0 3X18 UD HOS-11 DT,,A4649,HCPCS,Facility,Outpatient,,,,140.68,119.578,40.318888,140.68,Aetna,Medicare Advantage,68.9332,49,,percent of total billed charges,,
SUTURE POLYSORB 2-0 3X18 UD HOS-11 DT,,A4649,HCPCS,Facility,Inpatient,,,,140.68,119.578,40.318888,140.68,Aetna,Medicare Advantage,,,,,Included in per diem rate,
SUTURE POLYSORB 2-0 3X18 UD HOS-11 DT,,A4649,HCPCS,Facility,Both,,,,140.68,119.578,40.318888,140.68,Aetna,PPO,130.8324,93,,percent of total billed charges,,
SUTURE POLYSORB 2-0 3X18 UD HOS-11 DT,,A4649,HCPCS,Facility,Both,,,,140.68,119.578,40.318888,140.68,America's PPO,America's PPO,135.095004,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SUTURE POLYSORB 2-0 3X18 UD HOS-11 DT,,A4649,HCPCS,Facility,Both,,,,140.68,119.578,40.318888,140.68,BlueCross BlueShield Minnesota, Federal Employee Program,138.42912,98.4,,percent of total billed charges,,
SUTURE POLYSORB 2-0 3X18 UD HOS-11 DT,,A4649,HCPCS,Facility,Both,,,,140.68,119.578,40.318888,140.68,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,140.68,100,,percent of total billed charges,,
SUTURE POLYSORB 2-0 3X18 UD HOS-11 DT,,A4649,HCPCS,Facility,Both,,,,140.68,119.578,40.318888,140.68,BlueCross BlueShield Minnesota,High Value Network Plan,126.612,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
SUTURE POLYSORB 2-0 3X18 UD HOS-11 DT,,A4649,HCPCS,Facility,Outpatient,,,,140.68,119.578,40.318888,140.68,BlueCross BlueShield Minnesota,Medicare Advantage,68.9332,49,,percent of total billed charges,,
SUTURE POLYSORB 2-0 3X18 UD HOS-11 DT,,A4649,HCPCS,Facility,Inpatient,,,,140.68,119.578,40.318888,140.68,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
SUTURE POLYSORB 2-0 3X18 UD HOS-11 DT,,A4649,HCPCS,Facility,Both,,,,140.68,119.578,40.318888,140.68,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,124.600276,88.57,,percent of total billed charges,,
SUTURE POLYSORB 2-0 3X18 UD HOS-11 DT,,A4649,HCPCS,Facility,Both,,,,140.68,119.578,40.318888,140.68,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,40.318888,28.66,,percent of total billed charges,,
SUTURE POLYSORB 2-0 3X18 UD HOS-11 DT,,A4649,HCPCS,Facility,Outpatient,,,,140.68,119.578,40.318888,140.68,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),68.9332,49,,percent of total billed charges,,
SUTURE POLYSORB 2-0 3X18 UD HOS-11 DT,,A4649,HCPCS,Facility,Inpatient,,,,140.68,119.578,40.318888,140.68,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
SUTURE POLYSORB 2-0 3X18 UD HOS-11 DT,,A4649,HCPCS,Facility,Both,,,,140.68,119.578,40.318888,140.68,CorVel,Worker's Compensation,140.68,100,,percent of total billed charges,,
SUTURE POLYSORB 2-0 3X18 UD HOS-11 DT,,A4649,HCPCS,Facility,Both,,,,140.68,119.578,40.318888,140.68,First Health Group Corporation,First Health Network,136.4596,97,,percent of total billed charges,,
SUTURE POLYSORB 2-0 3X18 UD HOS-11 DT,,A4649,HCPCS,Facility,Both,,,,140.68,119.578,40.318888,140.68,"Health Partners, Inc.",Commercial,133.08328,94.6,,percent of total billed charges,,
SUTURE POLYSORB 2-0 3X18 UD HOS-11 DT,,A4649,HCPCS,Facility,Outpatient,,,,140.68,119.578,40.318888,140.68,"Health Partners, Inc.",Medicare Advantage,68.9332,49,,percent of total billed charges,,
SUTURE POLYSORB 2-0 3X18 UD HOS-11 DT,,A4649,HCPCS,Facility,Inpatient,,,,140.68,119.578,40.318888,140.68,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE POLYSORB 2-0 3X18 UD HOS-11 DT,,A4649,HCPCS,Facility,Both,,,,140.68,119.578,40.318888,140.68,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),84.408,60,,percent of total billed charges,,
SUTURE POLYSORB 2-0 3X18 UD HOS-11 DT,,A4649,HCPCS,Facility,Both,,,,140.68,119.578,40.318888,140.68,"Health Partners, Inc.",State of Minnesota Advantage Program,114.6542,81.5,,percent of total billed charges,,
SUTURE POLYSORB 2-0 3X18 UD HOS-11 DT,,A4649,HCPCS,Facility,Both,,,,140.68,119.578,40.318888,140.68,"Health Partners, Inc.",State Public Programs,70.34,50,,percent of total billed charges,,
SUTURE POLYSORB 2-0 3X18 UD HOS-11 DT,,A4649,HCPCS,Facility,Both,,,,140.68,119.578,40.318888,140.68,Humana Insurance Company,Commercial PPO,133.646,95,,percent of total billed charges,,
SUTURE POLYSORB 2-0 3X18 UD HOS-11 DT,,A4649,HCPCS,Facility,Outpatient,,,,140.68,119.578,40.318888,140.68,Humana Insurance Company,Medicare PPO,68.9332,49,,percent of total billed charges,,
SUTURE POLYSORB 2-0 3X18 UD HOS-11 DT,,A4649,HCPCS,Facility,Inpatient,,,,140.68,119.578,40.318888,140.68,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
SUTURE POLYSORB 2-0 3X18 UD HOS-11 DT,,A4649,HCPCS,Facility,Both,,,,140.68,119.578,40.318888,140.68,Medica,Individual & Family,139.41388,99.1,,percent of total billed charges,,
SUTURE POLYSORB 2-0 3X18 UD HOS-11 DT,,A4649,HCPCS,Facility,Outpatient,,,,140.68,119.578,40.318888,140.68,Medica,Medica Advantage Solution,70.05864,49.8,,percent of total billed charges,,
SUTURE POLYSORB 2-0 3X18 UD HOS-11 DT,,A4649,HCPCS,Facility,Inpatient,,,,140.68,119.578,40.318888,140.68,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
SUTURE POLYSORB 2-0 3X18 UD HOS-11 DT,,A4649,HCPCS,Facility,Outpatient,,,,140.68,119.578,40.318888,140.68,Medica,Medical Assistance,62.74328,44.6,,percent of total billed charges,,
SUTURE POLYSORB 2-0 3X18 UD HOS-11 DT,,A4649,HCPCS,Facility,Inpatient,,,,140.68,119.578,40.318888,140.68,Medica,Medical Assistance,,,,,Included in per diem rate,
SUTURE POLYSORB 2-0 3X18 UD HOS-11 DT,,A4649,HCPCS,Facility,Outpatient,,,,140.68,119.578,40.318888,140.68,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,70.05864,49.8,,percent of total billed charges,,
SUTURE POLYSORB 2-0 3X18 UD HOS-11 DT,,A4649,HCPCS,Facility,Inpatient,,,,140.68,119.578,40.318888,140.68,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
SUTURE POLYSORB 2-0 3X18 UD HOS-11 DT,,A4649,HCPCS,Facility,Both,,,,140.68,119.578,40.318888,140.68,"Multiplan, Inc.","Multiplan, Inc.",132.2392,94,,percent of total billed charges,,
SUTURE POLYSORB 2-0 3X18 UD HOS-11 DT,,A4649,HCPCS,Facility,Outpatient,,,,140.68,119.578,40.318888,140.68,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,126.75268,90.1,,percent of total billed charges,,
SUTURE POLYSORB 2-0 3X18 UD HOS-11 DT,,A4649,HCPCS,Facility,Inpatient,,,,140.68,119.578,40.318888,140.68,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
SUTURE POLYSORB 2-0 3X18 UD HOS-11 DT,,A4649,HCPCS,Facility,Both,,,,140.68,119.578,40.318888,140.68,"Preferred One Administrative Services, INC.",PPO,138.71048,98.6,,percent of total billed charges,,
SUTURE POLYSORB 2-0 3X18 UD HOS-11 DT,,A4649,HCPCS,Facility,Outpatient,,,,140.68,119.578,40.318888,140.68,PrimeWest Health,Minnesota Senior Health Options (MSHO),72.37986,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
SUTURE POLYSORB 2-0 3X18 UD HOS-11 DT,,A4649,HCPCS,Facility,Inpatient,,,,140.68,119.578,40.318888,140.68,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE POLYSORB 2-0 3X18 UD HOS-11 DT,,A4649,HCPCS,Facility,Outpatient,,,,140.68,119.578,40.318888,140.68,PrimeWest Health,MinnesotaCare,72.253248,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
SUTURE POLYSORB 2-0 3X18 UD HOS-11 DT,,A4649,HCPCS,Facility,Inpatient,,,,140.68,119.578,40.318888,140.68,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
SUTURE POLYSORB 2-0 3X18 UD HOS-11 DT,,A4649,HCPCS,Facility,Both,,,,140.68,119.578,40.318888,140.68,Sanford Health Plan,Sanford Health Plan,129.4256,92,,percent of total billed charges,,
SUTURE POLYSORB 2-0 3X18 UD HOS-11 DT,,A4649,HCPCS,Facility,Outpatient,,,,140.68,119.578,40.318888,140.68,"UCare Health, Inc.",Individual & Family Plan,79.27318,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
SUTURE POLYSORB 2-0 3X18 UD HOS-11 DT,,A4649,HCPCS,Facility,Inpatient,,,,140.68,119.578,40.318888,140.68,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
SUTURE POLYSORB 2-0 3X18 UD HOS-11 DT,,A4649,HCPCS,Facility,Outpatient,,,,140.68,119.578,40.318888,140.68,"UCare Health, Inc.",Medical Assistance,71.001196,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE POLYSORB 2-0 3X18 UD HOS-11 DT,,A4649,HCPCS,Facility,Inpatient,,,,140.68,119.578,40.318888,140.68,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
SUTURE POLYSORB 2-0 3X18 UD HOS-11 DT,,A4649,HCPCS,Facility,Outpatient,,,,140.68,119.578,40.318888,140.68,"UCare Health, Inc.",Medicare Advantage,71.001196,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE POLYSORB 2-0 3X18 UD HOS-11 DT,,A4649,HCPCS,Facility,Inpatient,,,,140.68,119.578,40.318888,140.68,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE POLYSORB 2-0 3X18 UD HOS-11 DT,,A4649,HCPCS,Facility,Outpatient,,,,140.68,119.578,40.318888,140.68,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),71.001196,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE POLYSORB 2-0 3X18 UD HOS-11 DT,,A4649,HCPCS,Facility,Inpatient,,,,140.68,119.578,40.318888,140.68,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE POLYSORB 2-0 3X18 UD HOS-11 DT,,A4649,HCPCS,Facility,Both,,,,140.68,119.578,40.318888,140.68,UnitedHealthcare,Individual & Family,132.2392,94,,percent of total billed charges,,
SUTURE POLYSORB 2-0 3X18 UD HOS-11 DT,,A4649,HCPCS,Facility,Outpatient,,,,140.68,119.578,40.318888,140.68,UnitedHealthcare,Medicare Advantage,68.9332,49,,percent of total billed charges,,
SUTURE POLYSORB 2-0 3X18 UD HOS-11 DT,,A4649,HCPCS,Facility,Inpatient,,,,140.68,119.578,40.318888,140.68,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
SUTURE POLYSORB 2-0 3X18 UD HOS-11 DT,,A4649,HCPCS,Facility,Outpatient,,,,140.68,119.578,40.318888,140.68,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,67.5264,48,,percent of total billed charges,,100% of DHS outpatient percentage
SUTURE POLYSORB 2-0 3X18 UD HOS-11 DT,,A4649,HCPCS,Facility,Inpatient,,,,140.68,119.578,40.318888,140.68,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
SUTURE POLYSORB 2-0 GL-123,,A4649,HCPCS,Facility,Both,,,,27.65,23.5025,7.92449,27.65,Aetna,Commercial,25.438,92,,percent of total billed charges,,
SUTURE POLYSORB 2-0 GL-123,,A4649,HCPCS,Facility,Outpatient,,,,27.65,23.5025,7.92449,27.65,Aetna,Medicare Advantage,13.5485,49,,percent of total billed charges,,
SUTURE POLYSORB 2-0 GL-123,,A4649,HCPCS,Facility,Inpatient,,,,27.65,23.5025,7.92449,27.65,Aetna,Medicare Advantage,,,,,Included in per diem rate,
SUTURE POLYSORB 2-0 GL-123,,A4649,HCPCS,Facility,Both,,,,27.65,23.5025,7.92449,27.65,Aetna,PPO,25.7145,93,,percent of total billed charges,,
SUTURE POLYSORB 2-0 GL-123,,A4649,HCPCS,Facility,Both,,,,27.65,23.5025,7.92449,27.65,America's PPO,America's PPO,26.552295,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SUTURE POLYSORB 2-0 GL-123,,A4649,HCPCS,Facility,Both,,,,27.65,23.5025,7.92449,27.65,BlueCross BlueShield Minnesota, Federal Employee Program,27.2076,98.4,,percent of total billed charges,,
SUTURE POLYSORB 2-0 GL-123,,A4649,HCPCS,Facility,Both,,,,27.65,23.5025,7.92449,27.65,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,27.65,100,,percent of total billed charges,,
SUTURE POLYSORB 2-0 GL-123,,A4649,HCPCS,Facility,Both,,,,27.65,23.5025,7.92449,27.65,BlueCross BlueShield Minnesota,High Value Network Plan,24.885,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
SUTURE POLYSORB 2-0 GL-123,,A4649,HCPCS,Facility,Outpatient,,,,27.65,23.5025,7.92449,27.65,BlueCross BlueShield Minnesota,Medicare Advantage,13.5485,49,,percent of total billed charges,,
SUTURE POLYSORB 2-0 GL-123,,A4649,HCPCS,Facility,Inpatient,,,,27.65,23.5025,7.92449,27.65,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
SUTURE POLYSORB 2-0 GL-123,,A4649,HCPCS,Facility,Both,,,,27.65,23.5025,7.92449,27.65,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,24.489605,88.57,,percent of total billed charges,,
SUTURE POLYSORB 2-0 GL-123,,A4649,HCPCS,Facility,Both,,,,27.65,23.5025,7.92449,27.65,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,7.92449,28.66,,percent of total billed charges,,
SUTURE POLYSORB 2-0 GL-123,,A4649,HCPCS,Facility,Outpatient,,,,27.65,23.5025,7.92449,27.65,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),13.5485,49,,percent of total billed charges,,
SUTURE POLYSORB 2-0 GL-123,,A4649,HCPCS,Facility,Inpatient,,,,27.65,23.5025,7.92449,27.65,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
SUTURE POLYSORB 2-0 GL-123,,A4649,HCPCS,Facility,Both,,,,27.65,23.5025,7.92449,27.65,CorVel,Worker's Compensation,27.65,100,,percent of total billed charges,,
SUTURE POLYSORB 2-0 GL-123,,A4649,HCPCS,Facility,Both,,,,27.65,23.5025,7.92449,27.65,First Health Group Corporation,First Health Network,26.8205,97,,percent of total billed charges,,
SUTURE POLYSORB 2-0 GL-123,,A4649,HCPCS,Facility,Both,,,,27.65,23.5025,7.92449,27.65,"Health Partners, Inc.",Commercial,26.1569,94.6,,percent of total billed charges,,
SUTURE POLYSORB 2-0 GL-123,,A4649,HCPCS,Facility,Outpatient,,,,27.65,23.5025,7.92449,27.65,"Health Partners, Inc.",Medicare Advantage,13.5485,49,,percent of total billed charges,,
SUTURE POLYSORB 2-0 GL-123,,A4649,HCPCS,Facility,Inpatient,,,,27.65,23.5025,7.92449,27.65,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE POLYSORB 2-0 GL-123,,A4649,HCPCS,Facility,Both,,,,27.65,23.5025,7.92449,27.65,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),16.59,60,,percent of total billed charges,,
SUTURE POLYSORB 2-0 GL-123,,A4649,HCPCS,Facility,Both,,,,27.65,23.5025,7.92449,27.65,"Health Partners, Inc.",State of Minnesota Advantage Program,22.53475,81.5,,percent of total billed charges,,
SUTURE POLYSORB 2-0 GL-123,,A4649,HCPCS,Facility,Both,,,,27.65,23.5025,7.92449,27.65,"Health Partners, Inc.",State Public Programs,13.825,50,,percent of total billed charges,,
SUTURE POLYSORB 2-0 GL-123,,A4649,HCPCS,Facility,Both,,,,27.65,23.5025,7.92449,27.65,Humana Insurance Company,Commercial PPO,26.2675,95,,percent of total billed charges,,
SUTURE POLYSORB 2-0 GL-123,,A4649,HCPCS,Facility,Outpatient,,,,27.65,23.5025,7.92449,27.65,Humana Insurance Company,Medicare PPO,13.5485,49,,percent of total billed charges,,
SUTURE POLYSORB 2-0 GL-123,,A4649,HCPCS,Facility,Inpatient,,,,27.65,23.5025,7.92449,27.65,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
SUTURE POLYSORB 2-0 GL-123,,A4649,HCPCS,Facility,Both,,,,27.65,23.5025,7.92449,27.65,Medica,Individual & Family,27.40115,99.1,,percent of total billed charges,,
SUTURE POLYSORB 2-0 GL-123,,A4649,HCPCS,Facility,Outpatient,,,,27.65,23.5025,7.92449,27.65,Medica,Medica Advantage Solution,13.7697,49.8,,percent of total billed charges,,
SUTURE POLYSORB 2-0 GL-123,,A4649,HCPCS,Facility,Inpatient,,,,27.65,23.5025,7.92449,27.65,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
SUTURE POLYSORB 2-0 GL-123,,A4649,HCPCS,Facility,Outpatient,,,,27.65,23.5025,7.92449,27.65,Medica,Medical Assistance,12.3319,44.6,,percent of total billed charges,,
SUTURE POLYSORB 2-0 GL-123,,A4649,HCPCS,Facility,Inpatient,,,,27.65,23.5025,7.92449,27.65,Medica,Medical Assistance,,,,,Included in per diem rate,
SUTURE POLYSORB 2-0 GL-123,,A4649,HCPCS,Facility,Outpatient,,,,27.65,23.5025,7.92449,27.65,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,13.7697,49.8,,percent of total billed charges,,
SUTURE POLYSORB 2-0 GL-123,,A4649,HCPCS,Facility,Inpatient,,,,27.65,23.5025,7.92449,27.65,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
SUTURE POLYSORB 2-0 GL-123,,A4649,HCPCS,Facility,Both,,,,27.65,23.5025,7.92449,27.65,"Multiplan, Inc.","Multiplan, Inc.",25.991,94,,percent of total billed charges,,
SUTURE POLYSORB 2-0 GL-123,,A4649,HCPCS,Facility,Outpatient,,,,27.65,23.5025,7.92449,27.65,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,24.91265,90.1,,percent of total billed charges,,
SUTURE POLYSORB 2-0 GL-123,,A4649,HCPCS,Facility,Inpatient,,,,27.65,23.5025,7.92449,27.65,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
SUTURE POLYSORB 2-0 GL-123,,A4649,HCPCS,Facility,Both,,,,27.65,23.5025,7.92449,27.65,"Preferred One Administrative Services, INC.",PPO,27.2629,98.6,,percent of total billed charges,,
SUTURE POLYSORB 2-0 GL-123,,A4649,HCPCS,Facility,Outpatient,,,,27.65,23.5025,7.92449,27.65,PrimeWest Health,Minnesota Senior Health Options (MSHO),14.225925,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
SUTURE POLYSORB 2-0 GL-123,,A4649,HCPCS,Facility,Inpatient,,,,27.65,23.5025,7.92449,27.65,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE POLYSORB 2-0 GL-123,,A4649,HCPCS,Facility,Outpatient,,,,27.65,23.5025,7.92449,27.65,PrimeWest Health,MinnesotaCare,14.20104,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
SUTURE POLYSORB 2-0 GL-123,,A4649,HCPCS,Facility,Inpatient,,,,27.65,23.5025,7.92449,27.65,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
SUTURE POLYSORB 2-0 GL-123,,A4649,HCPCS,Facility,Both,,,,27.65,23.5025,7.92449,27.65,Sanford Health Plan,Sanford Health Plan,25.438,92,,percent of total billed charges,,
SUTURE POLYSORB 2-0 GL-123,,A4649,HCPCS,Facility,Outpatient,,,,27.65,23.5025,7.92449,27.65,"UCare Health, Inc.",Individual & Family Plan,15.580775,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
SUTURE POLYSORB 2-0 GL-123,,A4649,HCPCS,Facility,Inpatient,,,,27.65,23.5025,7.92449,27.65,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
SUTURE POLYSORB 2-0 GL-123,,A4649,HCPCS,Facility,Outpatient,,,,27.65,23.5025,7.92449,27.65,"UCare Health, Inc.",Medical Assistance,13.954955,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE POLYSORB 2-0 GL-123,,A4649,HCPCS,Facility,Inpatient,,,,27.65,23.5025,7.92449,27.65,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
SUTURE POLYSORB 2-0 GL-123,,A4649,HCPCS,Facility,Outpatient,,,,27.65,23.5025,7.92449,27.65,"UCare Health, Inc.",Medicare Advantage,13.954955,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE POLYSORB 2-0 GL-123,,A4649,HCPCS,Facility,Inpatient,,,,27.65,23.5025,7.92449,27.65,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE POLYSORB 2-0 GL-123,,A4649,HCPCS,Facility,Outpatient,,,,27.65,23.5025,7.92449,27.65,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),13.954955,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE POLYSORB 2-0 GL-123,,A4649,HCPCS,Facility,Inpatient,,,,27.65,23.5025,7.92449,27.65,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE POLYSORB 2-0 GL-123,,A4649,HCPCS,Facility,Both,,,,27.65,23.5025,7.92449,27.65,UnitedHealthcare,Individual & Family,25.991,94,,percent of total billed charges,,
SUTURE POLYSORB 2-0 GL-123,,A4649,HCPCS,Facility,Outpatient,,,,27.65,23.5025,7.92449,27.65,UnitedHealthcare,Medicare Advantage,13.5485,49,,percent of total billed charges,,
SUTURE POLYSORB 2-0 GL-123,,A4649,HCPCS,Facility,Inpatient,,,,27.65,23.5025,7.92449,27.65,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
SUTURE POLYSORB 2-0 GL-123,,A4649,HCPCS,Facility,Outpatient,,,,27.65,23.5025,7.92449,27.65,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,13.272,48,,percent of total billed charges,,100% of DHS outpatient percentage
SUTURE POLYSORB 2-0 GL-123,,A4649,HCPCS,Facility,Inpatient,,,,27.65,23.5025,7.92449,27.65,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
SUTURE POLYSORB 2-0 UNDYED 30 GS-21,,A4649,HCPCS,Facility,Both,,,,33.8,28.73,9.68708,33.8,Aetna,Commercial,31.096,92,,percent of total billed charges,,
SUTURE POLYSORB 2-0 UNDYED 30 GS-21,,A4649,HCPCS,Facility,Outpatient,,,,33.8,28.73,9.68708,33.8,Aetna,Medicare Advantage,16.562,49,,percent of total billed charges,,
SUTURE POLYSORB 2-0 UNDYED 30 GS-21,,A4649,HCPCS,Facility,Inpatient,,,,33.8,28.73,9.68708,33.8,Aetna,Medicare Advantage,,,,,Included in per diem rate,
SUTURE POLYSORB 2-0 UNDYED 30 GS-21,,A4649,HCPCS,Facility,Both,,,,33.8,28.73,9.68708,33.8,Aetna,PPO,31.434,93,,percent of total billed charges,,
SUTURE POLYSORB 2-0 UNDYED 30 GS-21,,A4649,HCPCS,Facility,Both,,,,33.8,28.73,9.68708,33.8,America's PPO,America's PPO,32.45814,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SUTURE POLYSORB 2-0 UNDYED 30 GS-21,,A4649,HCPCS,Facility,Both,,,,33.8,28.73,9.68708,33.8,BlueCross BlueShield Minnesota, Federal Employee Program,33.2592,98.4,,percent of total billed charges,,
SUTURE POLYSORB 2-0 UNDYED 30 GS-21,,A4649,HCPCS,Facility,Both,,,,33.8,28.73,9.68708,33.8,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,33.8,100,,percent of total billed charges,,
SUTURE POLYSORB 2-0 UNDYED 30 GS-21,,A4649,HCPCS,Facility,Both,,,,33.8,28.73,9.68708,33.8,BlueCross BlueShield Minnesota,High Value Network Plan,30.42,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
SUTURE POLYSORB 2-0 UNDYED 30 GS-21,,A4649,HCPCS,Facility,Outpatient,,,,33.8,28.73,9.68708,33.8,BlueCross BlueShield Minnesota,Medicare Advantage,16.562,49,,percent of total billed charges,,
SUTURE POLYSORB 2-0 UNDYED 30 GS-21,,A4649,HCPCS,Facility,Inpatient,,,,33.8,28.73,9.68708,33.8,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
SUTURE POLYSORB 2-0 UNDYED 30 GS-21,,A4649,HCPCS,Facility,Both,,,,33.8,28.73,9.68708,33.8,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,29.93666,88.57,,percent of total billed charges,,
SUTURE POLYSORB 2-0 UNDYED 30 GS-21,,A4649,HCPCS,Facility,Both,,,,33.8,28.73,9.68708,33.8,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,9.68708,28.66,,percent of total billed charges,,
SUTURE POLYSORB 2-0 UNDYED 30 GS-21,,A4649,HCPCS,Facility,Outpatient,,,,33.8,28.73,9.68708,33.8,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),16.562,49,,percent of total billed charges,,
SUTURE POLYSORB 2-0 UNDYED 30 GS-21,,A4649,HCPCS,Facility,Inpatient,,,,33.8,28.73,9.68708,33.8,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
SUTURE POLYSORB 2-0 UNDYED 30 GS-21,,A4649,HCPCS,Facility,Both,,,,33.8,28.73,9.68708,33.8,CorVel,Worker's Compensation,33.8,100,,percent of total billed charges,,
SUTURE POLYSORB 2-0 UNDYED 30 GS-21,,A4649,HCPCS,Facility,Both,,,,33.8,28.73,9.68708,33.8,First Health Group Corporation,First Health Network,32.786,97,,percent of total billed charges,,
SUTURE POLYSORB 2-0 UNDYED 30 GS-21,,A4649,HCPCS,Facility,Both,,,,33.8,28.73,9.68708,33.8,"Health Partners, Inc.",Commercial,31.9748,94.6,,percent of total billed charges,,
SUTURE POLYSORB 2-0 UNDYED 30 GS-21,,A4649,HCPCS,Facility,Outpatient,,,,33.8,28.73,9.68708,33.8,"Health Partners, Inc.",Medicare Advantage,16.562,49,,percent of total billed charges,,
SUTURE POLYSORB 2-0 UNDYED 30 GS-21,,A4649,HCPCS,Facility,Inpatient,,,,33.8,28.73,9.68708,33.8,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE POLYSORB 2-0 UNDYED 30 GS-21,,A4649,HCPCS,Facility,Both,,,,33.8,28.73,9.68708,33.8,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),20.28,60,,percent of total billed charges,,
SUTURE POLYSORB 2-0 UNDYED 30 GS-21,,A4649,HCPCS,Facility,Both,,,,33.8,28.73,9.68708,33.8,"Health Partners, Inc.",State of Minnesota Advantage Program,27.547,81.5,,percent of total billed charges,,
SUTURE POLYSORB 2-0 UNDYED 30 GS-21,,A4649,HCPCS,Facility,Both,,,,33.8,28.73,9.68708,33.8,"Health Partners, Inc.",State Public Programs,16.9,50,,percent of total billed charges,,
SUTURE POLYSORB 2-0 UNDYED 30 GS-21,,A4649,HCPCS,Facility,Both,,,,33.8,28.73,9.68708,33.8,Humana Insurance Company,Commercial PPO,32.11,95,,percent of total billed charges,,
SUTURE POLYSORB 2-0 UNDYED 30 GS-21,,A4649,HCPCS,Facility,Outpatient,,,,33.8,28.73,9.68708,33.8,Humana Insurance Company,Medicare PPO,16.562,49,,percent of total billed charges,,
SUTURE POLYSORB 2-0 UNDYED 30 GS-21,,A4649,HCPCS,Facility,Inpatient,,,,33.8,28.73,9.68708,33.8,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
SUTURE POLYSORB 2-0 UNDYED 30 GS-21,,A4649,HCPCS,Facility,Both,,,,33.8,28.73,9.68708,33.8,Medica,Individual & Family,33.4958,99.1,,percent of total billed charges,,
SUTURE POLYSORB 2-0 UNDYED 30 GS-21,,A4649,HCPCS,Facility,Outpatient,,,,33.8,28.73,9.68708,33.8,Medica,Medica Advantage Solution,16.8324,49.8,,percent of total billed charges,,
SUTURE POLYSORB 2-0 UNDYED 30 GS-21,,A4649,HCPCS,Facility,Inpatient,,,,33.8,28.73,9.68708,33.8,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
SUTURE POLYSORB 2-0 UNDYED 30 GS-21,,A4649,HCPCS,Facility,Outpatient,,,,33.8,28.73,9.68708,33.8,Medica,Medical Assistance,15.0748,44.6,,percent of total billed charges,,
SUTURE POLYSORB 2-0 UNDYED 30 GS-21,,A4649,HCPCS,Facility,Inpatient,,,,33.8,28.73,9.68708,33.8,Medica,Medical Assistance,,,,,Included in per diem rate,
SUTURE POLYSORB 2-0 UNDYED 30 GS-21,,A4649,HCPCS,Facility,Outpatient,,,,33.8,28.73,9.68708,33.8,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,16.8324,49.8,,percent of total billed charges,,
SUTURE POLYSORB 2-0 UNDYED 30 GS-21,,A4649,HCPCS,Facility,Inpatient,,,,33.8,28.73,9.68708,33.8,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
SUTURE POLYSORB 2-0 UNDYED 30 GS-21,,A4649,HCPCS,Facility,Both,,,,33.8,28.73,9.68708,33.8,"Multiplan, Inc.","Multiplan, Inc.",31.772,94,,percent of total billed charges,,
SUTURE POLYSORB 2-0 UNDYED 30 GS-21,,A4649,HCPCS,Facility,Outpatient,,,,33.8,28.73,9.68708,33.8,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,30.4538,90.1,,percent of total billed charges,,
SUTURE POLYSORB 2-0 UNDYED 30 GS-21,,A4649,HCPCS,Facility,Inpatient,,,,33.8,28.73,9.68708,33.8,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
SUTURE POLYSORB 2-0 UNDYED 30 GS-21,,A4649,HCPCS,Facility,Both,,,,33.8,28.73,9.68708,33.8,"Preferred One Administrative Services, INC.",PPO,33.3268,98.6,,percent of total billed charges,,
SUTURE POLYSORB 2-0 UNDYED 30 GS-21,,A4649,HCPCS,Facility,Outpatient,,,,33.8,28.73,9.68708,33.8,PrimeWest Health,Minnesota Senior Health Options (MSHO),17.3901,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
SUTURE POLYSORB 2-0 UNDYED 30 GS-21,,A4649,HCPCS,Facility,Inpatient,,,,33.8,28.73,9.68708,33.8,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE POLYSORB 2-0 UNDYED 30 GS-21,,A4649,HCPCS,Facility,Outpatient,,,,33.8,28.73,9.68708,33.8,PrimeWest Health,MinnesotaCare,17.35968,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
SUTURE POLYSORB 2-0 UNDYED 30 GS-21,,A4649,HCPCS,Facility,Inpatient,,,,33.8,28.73,9.68708,33.8,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
SUTURE POLYSORB 2-0 UNDYED 30 GS-21,,A4649,HCPCS,Facility,Both,,,,33.8,28.73,9.68708,33.8,Sanford Health Plan,Sanford Health Plan,31.096,92,,percent of total billed charges,,
SUTURE POLYSORB 2-0 UNDYED 30 GS-21,,A4649,HCPCS,Facility,Outpatient,,,,33.8,28.73,9.68708,33.8,"UCare Health, Inc.",Individual & Family Plan,19.0463,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
SUTURE POLYSORB 2-0 UNDYED 30 GS-21,,A4649,HCPCS,Facility,Inpatient,,,,33.8,28.73,9.68708,33.8,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
SUTURE POLYSORB 2-0 UNDYED 30 GS-21,,A4649,HCPCS,Facility,Outpatient,,,,33.8,28.73,9.68708,33.8,"UCare Health, Inc.",Medical Assistance,17.05886,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE POLYSORB 2-0 UNDYED 30 GS-21,,A4649,HCPCS,Facility,Inpatient,,,,33.8,28.73,9.68708,33.8,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
SUTURE POLYSORB 2-0 UNDYED 30 GS-21,,A4649,HCPCS,Facility,Outpatient,,,,33.8,28.73,9.68708,33.8,"UCare Health, Inc.",Medicare Advantage,17.05886,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE POLYSORB 2-0 UNDYED 30 GS-21,,A4649,HCPCS,Facility,Inpatient,,,,33.8,28.73,9.68708,33.8,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE POLYSORB 2-0 UNDYED 30 GS-21,,A4649,HCPCS,Facility,Outpatient,,,,33.8,28.73,9.68708,33.8,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),17.05886,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE POLYSORB 2-0 UNDYED 30 GS-21,,A4649,HCPCS,Facility,Inpatient,,,,33.8,28.73,9.68708,33.8,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE POLYSORB 2-0 UNDYED 30 GS-21,,A4649,HCPCS,Facility,Both,,,,33.8,28.73,9.68708,33.8,UnitedHealthcare,Individual & Family,31.772,94,,percent of total billed charges,,
SUTURE POLYSORB 2-0 UNDYED 30 GS-21,,A4649,HCPCS,Facility,Outpatient,,,,33.8,28.73,9.68708,33.8,UnitedHealthcare,Medicare Advantage,16.562,49,,percent of total billed charges,,
SUTURE POLYSORB 2-0 UNDYED 30 GS-21,,A4649,HCPCS,Facility,Inpatient,,,,33.8,28.73,9.68708,33.8,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
SUTURE POLYSORB 2-0 UNDYED 30 GS-21,,A4649,HCPCS,Facility,Outpatient,,,,33.8,28.73,9.68708,33.8,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,16.224,48,,percent of total billed charges,,100% of DHS outpatient percentage
SUTURE POLYSORB 2-0 UNDYED 30 GS-21,,A4649,HCPCS,Facility,Inpatient,,,,33.8,28.73,9.68708,33.8,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"SUTURE POLYSORB 2-0 VIOLET 30"" V-20  GL123",,A4649,HCPCS,Facility,Both,,,,27.65,23.5025,7.92449,27.65,Aetna,Commercial,25.438,92,,percent of total billed charges,,
"SUTURE POLYSORB 2-0 VIOLET 30"" V-20  GL123",,A4649,HCPCS,Facility,Outpatient,,,,27.65,23.5025,7.92449,27.65,Aetna,Medicare Advantage,13.5485,49,,percent of total billed charges,,
"SUTURE POLYSORB 2-0 VIOLET 30"" V-20  GL123",,A4649,HCPCS,Facility,Inpatient,,,,27.65,23.5025,7.92449,27.65,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"SUTURE POLYSORB 2-0 VIOLET 30"" V-20  GL123",,A4649,HCPCS,Facility,Both,,,,27.65,23.5025,7.92449,27.65,Aetna,PPO,25.7145,93,,percent of total billed charges,,
"SUTURE POLYSORB 2-0 VIOLET 30"" V-20  GL123",,A4649,HCPCS,Facility,Both,,,,27.65,23.5025,7.92449,27.65,America's PPO,America's PPO,26.552295,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"SUTURE POLYSORB 2-0 VIOLET 30"" V-20  GL123",,A4649,HCPCS,Facility,Both,,,,27.65,23.5025,7.92449,27.65,BlueCross BlueShield Minnesota, Federal Employee Program,27.2076,98.4,,percent of total billed charges,,
"SUTURE POLYSORB 2-0 VIOLET 30"" V-20  GL123",,A4649,HCPCS,Facility,Both,,,,27.65,23.5025,7.92449,27.65,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,27.65,100,,percent of total billed charges,,
"SUTURE POLYSORB 2-0 VIOLET 30"" V-20  GL123",,A4649,HCPCS,Facility,Both,,,,27.65,23.5025,7.92449,27.65,BlueCross BlueShield Minnesota,High Value Network Plan,24.885,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
"SUTURE POLYSORB 2-0 VIOLET 30"" V-20  GL123",,A4649,HCPCS,Facility,Outpatient,,,,27.65,23.5025,7.92449,27.65,BlueCross BlueShield Minnesota,Medicare Advantage,13.5485,49,,percent of total billed charges,,
"SUTURE POLYSORB 2-0 VIOLET 30"" V-20  GL123",,A4649,HCPCS,Facility,Inpatient,,,,27.65,23.5025,7.92449,27.65,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"SUTURE POLYSORB 2-0 VIOLET 30"" V-20  GL123",,A4649,HCPCS,Facility,Both,,,,27.65,23.5025,7.92449,27.65,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,24.489605,88.57,,percent of total billed charges,,
"SUTURE POLYSORB 2-0 VIOLET 30"" V-20  GL123",,A4649,HCPCS,Facility,Both,,,,27.65,23.5025,7.92449,27.65,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,7.92449,28.66,,percent of total billed charges,,
"SUTURE POLYSORB 2-0 VIOLET 30"" V-20  GL123",,A4649,HCPCS,Facility,Outpatient,,,,27.65,23.5025,7.92449,27.65,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),13.5485,49,,percent of total billed charges,,
"SUTURE POLYSORB 2-0 VIOLET 30"" V-20  GL123",,A4649,HCPCS,Facility,Inpatient,,,,27.65,23.5025,7.92449,27.65,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"SUTURE POLYSORB 2-0 VIOLET 30"" V-20  GL123",,A4649,HCPCS,Facility,Both,,,,27.65,23.5025,7.92449,27.65,CorVel,Worker's Compensation,27.65,100,,percent of total billed charges,,
"SUTURE POLYSORB 2-0 VIOLET 30"" V-20  GL123",,A4649,HCPCS,Facility,Both,,,,27.65,23.5025,7.92449,27.65,First Health Group Corporation,First Health Network,26.8205,97,,percent of total billed charges,,
"SUTURE POLYSORB 2-0 VIOLET 30"" V-20  GL123",,A4649,HCPCS,Facility,Both,,,,27.65,23.5025,7.92449,27.65,"Health Partners, Inc.",Commercial,26.1569,94.6,,percent of total billed charges,,
"SUTURE POLYSORB 2-0 VIOLET 30"" V-20  GL123",,A4649,HCPCS,Facility,Outpatient,,,,27.65,23.5025,7.92449,27.65,"Health Partners, Inc.",Medicare Advantage,13.5485,49,,percent of total billed charges,,
"SUTURE POLYSORB 2-0 VIOLET 30"" V-20  GL123",,A4649,HCPCS,Facility,Inpatient,,,,27.65,23.5025,7.92449,27.65,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"SUTURE POLYSORB 2-0 VIOLET 30"" V-20  GL123",,A4649,HCPCS,Facility,Both,,,,27.65,23.5025,7.92449,27.65,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),16.59,60,,percent of total billed charges,,
"SUTURE POLYSORB 2-0 VIOLET 30"" V-20  GL123",,A4649,HCPCS,Facility,Both,,,,27.65,23.5025,7.92449,27.65,"Health Partners, Inc.",State of Minnesota Advantage Program,22.53475,81.5,,percent of total billed charges,,
"SUTURE POLYSORB 2-0 VIOLET 30"" V-20  GL123",,A4649,HCPCS,Facility,Both,,,,27.65,23.5025,7.92449,27.65,"Health Partners, Inc.",State Public Programs,13.825,50,,percent of total billed charges,,
"SUTURE POLYSORB 2-0 VIOLET 30"" V-20  GL123",,A4649,HCPCS,Facility,Both,,,,27.65,23.5025,7.92449,27.65,Humana Insurance Company,Commercial PPO,26.2675,95,,percent of total billed charges,,
"SUTURE POLYSORB 2-0 VIOLET 30"" V-20  GL123",,A4649,HCPCS,Facility,Outpatient,,,,27.65,23.5025,7.92449,27.65,Humana Insurance Company,Medicare PPO,13.5485,49,,percent of total billed charges,,
"SUTURE POLYSORB 2-0 VIOLET 30"" V-20  GL123",,A4649,HCPCS,Facility,Inpatient,,,,27.65,23.5025,7.92449,27.65,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"SUTURE POLYSORB 2-0 VIOLET 30"" V-20  GL123",,A4649,HCPCS,Facility,Both,,,,27.65,23.5025,7.92449,27.65,Medica,Individual & Family,27.40115,99.1,,percent of total billed charges,,
"SUTURE POLYSORB 2-0 VIOLET 30"" V-20  GL123",,A4649,HCPCS,Facility,Outpatient,,,,27.65,23.5025,7.92449,27.65,Medica,Medica Advantage Solution,13.7697,49.8,,percent of total billed charges,,
"SUTURE POLYSORB 2-0 VIOLET 30"" V-20  GL123",,A4649,HCPCS,Facility,Inpatient,,,,27.65,23.5025,7.92449,27.65,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"SUTURE POLYSORB 2-0 VIOLET 30"" V-20  GL123",,A4649,HCPCS,Facility,Outpatient,,,,27.65,23.5025,7.92449,27.65,Medica,Medical Assistance,12.3319,44.6,,percent of total billed charges,,
"SUTURE POLYSORB 2-0 VIOLET 30"" V-20  GL123",,A4649,HCPCS,Facility,Inpatient,,,,27.65,23.5025,7.92449,27.65,Medica,Medical Assistance,,,,,Included in per diem rate,
"SUTURE POLYSORB 2-0 VIOLET 30"" V-20  GL123",,A4649,HCPCS,Facility,Outpatient,,,,27.65,23.5025,7.92449,27.65,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,13.7697,49.8,,percent of total billed charges,,
"SUTURE POLYSORB 2-0 VIOLET 30"" V-20  GL123",,A4649,HCPCS,Facility,Inpatient,,,,27.65,23.5025,7.92449,27.65,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"SUTURE POLYSORB 2-0 VIOLET 30"" V-20  GL123",,A4649,HCPCS,Facility,Both,,,,27.65,23.5025,7.92449,27.65,"Multiplan, Inc.","Multiplan, Inc.",25.991,94,,percent of total billed charges,,
"SUTURE POLYSORB 2-0 VIOLET 30"" V-20  GL123",,A4649,HCPCS,Facility,Outpatient,,,,27.65,23.5025,7.92449,27.65,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,24.91265,90.1,,percent of total billed charges,,
"SUTURE POLYSORB 2-0 VIOLET 30"" V-20  GL123",,A4649,HCPCS,Facility,Inpatient,,,,27.65,23.5025,7.92449,27.65,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"SUTURE POLYSORB 2-0 VIOLET 30"" V-20  GL123",,A4649,HCPCS,Facility,Both,,,,27.65,23.5025,7.92449,27.65,"Preferred One Administrative Services, INC.",PPO,27.2629,98.6,,percent of total billed charges,,
"SUTURE POLYSORB 2-0 VIOLET 30"" V-20  GL123",,A4649,HCPCS,Facility,Outpatient,,,,27.65,23.5025,7.92449,27.65,PrimeWest Health,Minnesota Senior Health Options (MSHO),14.225925,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"SUTURE POLYSORB 2-0 VIOLET 30"" V-20  GL123",,A4649,HCPCS,Facility,Inpatient,,,,27.65,23.5025,7.92449,27.65,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"SUTURE POLYSORB 2-0 VIOLET 30"" V-20  GL123",,A4649,HCPCS,Facility,Outpatient,,,,27.65,23.5025,7.92449,27.65,PrimeWest Health,MinnesotaCare,14.20104,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"SUTURE POLYSORB 2-0 VIOLET 30"" V-20  GL123",,A4649,HCPCS,Facility,Inpatient,,,,27.65,23.5025,7.92449,27.65,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"SUTURE POLYSORB 2-0 VIOLET 30"" V-20  GL123",,A4649,HCPCS,Facility,Both,,,,27.65,23.5025,7.92449,27.65,Sanford Health Plan,Sanford Health Plan,25.438,92,,percent of total billed charges,,
"SUTURE POLYSORB 2-0 VIOLET 30"" V-20  GL123",,A4649,HCPCS,Facility,Outpatient,,,,27.65,23.5025,7.92449,27.65,"UCare Health, Inc.",Individual & Family Plan,15.580775,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"SUTURE POLYSORB 2-0 VIOLET 30"" V-20  GL123",,A4649,HCPCS,Facility,Inpatient,,,,27.65,23.5025,7.92449,27.65,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"SUTURE POLYSORB 2-0 VIOLET 30"" V-20  GL123",,A4649,HCPCS,Facility,Outpatient,,,,27.65,23.5025,7.92449,27.65,"UCare Health, Inc.",Medical Assistance,13.954955,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"SUTURE POLYSORB 2-0 VIOLET 30"" V-20  GL123",,A4649,HCPCS,Facility,Inpatient,,,,27.65,23.5025,7.92449,27.65,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"SUTURE POLYSORB 2-0 VIOLET 30"" V-20  GL123",,A4649,HCPCS,Facility,Outpatient,,,,27.65,23.5025,7.92449,27.65,"UCare Health, Inc.",Medicare Advantage,13.954955,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"SUTURE POLYSORB 2-0 VIOLET 30"" V-20  GL123",,A4649,HCPCS,Facility,Inpatient,,,,27.65,23.5025,7.92449,27.65,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"SUTURE POLYSORB 2-0 VIOLET 30"" V-20  GL123",,A4649,HCPCS,Facility,Outpatient,,,,27.65,23.5025,7.92449,27.65,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),13.954955,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"SUTURE POLYSORB 2-0 VIOLET 30"" V-20  GL123",,A4649,HCPCS,Facility,Inpatient,,,,27.65,23.5025,7.92449,27.65,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"SUTURE POLYSORB 2-0 VIOLET 30"" V-20  GL123",,A4649,HCPCS,Facility,Both,,,,27.65,23.5025,7.92449,27.65,UnitedHealthcare,Individual & Family,25.991,94,,percent of total billed charges,,
"SUTURE POLYSORB 2-0 VIOLET 30"" V-20  GL123",,A4649,HCPCS,Facility,Outpatient,,,,27.65,23.5025,7.92449,27.65,UnitedHealthcare,Medicare Advantage,13.5485,49,,percent of total billed charges,,
"SUTURE POLYSORB 2-0 VIOLET 30"" V-20  GL123",,A4649,HCPCS,Facility,Inpatient,,,,27.65,23.5025,7.92449,27.65,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"SUTURE POLYSORB 2-0 VIOLET 30"" V-20  GL123",,A4649,HCPCS,Facility,Outpatient,,,,27.65,23.5025,7.92449,27.65,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,13.272,48,,percent of total billed charges,,100% of DHS outpatient percentage
"SUTURE POLYSORB 2-0 VIOLET 30"" V-20  GL123",,A4649,HCPCS,Facility,Inpatient,,,,27.65,23.5025,7.92449,27.65,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
SUTURE POLYSORB 3/0 30IN VIOLET GU-46,,A4649,HCPCS,Facility,Both,,,,39.9,33.915,11.43534,39.9,Aetna,Commercial,36.708,92,,percent of total billed charges,,
SUTURE POLYSORB 3/0 30IN VIOLET GU-46,,A4649,HCPCS,Facility,Outpatient,,,,39.9,33.915,11.43534,39.9,Aetna,Medicare Advantage,19.551,49,,percent of total billed charges,,
SUTURE POLYSORB 3/0 30IN VIOLET GU-46,,A4649,HCPCS,Facility,Inpatient,,,,39.9,33.915,11.43534,39.9,Aetna,Medicare Advantage,,,,,Included in per diem rate,
SUTURE POLYSORB 3/0 30IN VIOLET GU-46,,A4649,HCPCS,Facility,Both,,,,39.9,33.915,11.43534,39.9,Aetna,PPO,37.107,93,,percent of total billed charges,,
SUTURE POLYSORB 3/0 30IN VIOLET GU-46,,A4649,HCPCS,Facility,Both,,,,39.9,33.915,11.43534,39.9,America's PPO,America's PPO,38.31597,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SUTURE POLYSORB 3/0 30IN VIOLET GU-46,,A4649,HCPCS,Facility,Both,,,,39.9,33.915,11.43534,39.9,BlueCross BlueShield Minnesota, Federal Employee Program,39.2616,98.4,,percent of total billed charges,,
SUTURE POLYSORB 3/0 30IN VIOLET GU-46,,A4649,HCPCS,Facility,Both,,,,39.9,33.915,11.43534,39.9,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,39.9,100,,percent of total billed charges,,
SUTURE POLYSORB 3/0 30IN VIOLET GU-46,,A4649,HCPCS,Facility,Both,,,,39.9,33.915,11.43534,39.9,BlueCross BlueShield Minnesota,High Value Network Plan,35.91,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
SUTURE POLYSORB 3/0 30IN VIOLET GU-46,,A4649,HCPCS,Facility,Outpatient,,,,39.9,33.915,11.43534,39.9,BlueCross BlueShield Minnesota,Medicare Advantage,19.551,49,,percent of total billed charges,,
SUTURE POLYSORB 3/0 30IN VIOLET GU-46,,A4649,HCPCS,Facility,Inpatient,,,,39.9,33.915,11.43534,39.9,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
SUTURE POLYSORB 3/0 30IN VIOLET GU-46,,A4649,HCPCS,Facility,Both,,,,39.9,33.915,11.43534,39.9,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,35.33943,88.57,,percent of total billed charges,,
SUTURE POLYSORB 3/0 30IN VIOLET GU-46,,A4649,HCPCS,Facility,Both,,,,39.9,33.915,11.43534,39.9,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,11.43534,28.66,,percent of total billed charges,,
SUTURE POLYSORB 3/0 30IN VIOLET GU-46,,A4649,HCPCS,Facility,Outpatient,,,,39.9,33.915,11.43534,39.9,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),19.551,49,,percent of total billed charges,,
SUTURE POLYSORB 3/0 30IN VIOLET GU-46,,A4649,HCPCS,Facility,Inpatient,,,,39.9,33.915,11.43534,39.9,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
SUTURE POLYSORB 3/0 30IN VIOLET GU-46,,A4649,HCPCS,Facility,Both,,,,39.9,33.915,11.43534,39.9,CorVel,Worker's Compensation,39.9,100,,percent of total billed charges,,
SUTURE POLYSORB 3/0 30IN VIOLET GU-46,,A4649,HCPCS,Facility,Both,,,,39.9,33.915,11.43534,39.9,First Health Group Corporation,First Health Network,38.703,97,,percent of total billed charges,,
SUTURE POLYSORB 3/0 30IN VIOLET GU-46,,A4649,HCPCS,Facility,Both,,,,39.9,33.915,11.43534,39.9,"Health Partners, Inc.",Commercial,37.7454,94.6,,percent of total billed charges,,
SUTURE POLYSORB 3/0 30IN VIOLET GU-46,,A4649,HCPCS,Facility,Outpatient,,,,39.9,33.915,11.43534,39.9,"Health Partners, Inc.",Medicare Advantage,19.551,49,,percent of total billed charges,,
SUTURE POLYSORB 3/0 30IN VIOLET GU-46,,A4649,HCPCS,Facility,Inpatient,,,,39.9,33.915,11.43534,39.9,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE POLYSORB 3/0 30IN VIOLET GU-46,,A4649,HCPCS,Facility,Both,,,,39.9,33.915,11.43534,39.9,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),23.94,60,,percent of total billed charges,,
SUTURE POLYSORB 3/0 30IN VIOLET GU-46,,A4649,HCPCS,Facility,Both,,,,39.9,33.915,11.43534,39.9,"Health Partners, Inc.",State of Minnesota Advantage Program,32.5185,81.5,,percent of total billed charges,,
SUTURE POLYSORB 3/0 30IN VIOLET GU-46,,A4649,HCPCS,Facility,Both,,,,39.9,33.915,11.43534,39.9,"Health Partners, Inc.",State Public Programs,19.95,50,,percent of total billed charges,,
SUTURE POLYSORB 3/0 30IN VIOLET GU-46,,A4649,HCPCS,Facility,Both,,,,39.9,33.915,11.43534,39.9,Humana Insurance Company,Commercial PPO,37.905,95,,percent of total billed charges,,
SUTURE POLYSORB 3/0 30IN VIOLET GU-46,,A4649,HCPCS,Facility,Outpatient,,,,39.9,33.915,11.43534,39.9,Humana Insurance Company,Medicare PPO,19.551,49,,percent of total billed charges,,
SUTURE POLYSORB 3/0 30IN VIOLET GU-46,,A4649,HCPCS,Facility,Inpatient,,,,39.9,33.915,11.43534,39.9,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
SUTURE POLYSORB 3/0 30IN VIOLET GU-46,,A4649,HCPCS,Facility,Both,,,,39.9,33.915,11.43534,39.9,Medica,Individual & Family,39.5409,99.1,,percent of total billed charges,,
SUTURE POLYSORB 3/0 30IN VIOLET GU-46,,A4649,HCPCS,Facility,Outpatient,,,,39.9,33.915,11.43534,39.9,Medica,Medica Advantage Solution,19.8702,49.8,,percent of total billed charges,,
SUTURE POLYSORB 3/0 30IN VIOLET GU-46,,A4649,HCPCS,Facility,Inpatient,,,,39.9,33.915,11.43534,39.9,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
SUTURE POLYSORB 3/0 30IN VIOLET GU-46,,A4649,HCPCS,Facility,Outpatient,,,,39.9,33.915,11.43534,39.9,Medica,Medical Assistance,17.7954,44.6,,percent of total billed charges,,
SUTURE POLYSORB 3/0 30IN VIOLET GU-46,,A4649,HCPCS,Facility,Inpatient,,,,39.9,33.915,11.43534,39.9,Medica,Medical Assistance,,,,,Included in per diem rate,
SUTURE POLYSORB 3/0 30IN VIOLET GU-46,,A4649,HCPCS,Facility,Outpatient,,,,39.9,33.915,11.43534,39.9,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,19.8702,49.8,,percent of total billed charges,,
SUTURE POLYSORB 3/0 30IN VIOLET GU-46,,A4649,HCPCS,Facility,Inpatient,,,,39.9,33.915,11.43534,39.9,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
SUTURE POLYSORB 3/0 30IN VIOLET GU-46,,A4649,HCPCS,Facility,Both,,,,39.9,33.915,11.43534,39.9,"Multiplan, Inc.","Multiplan, Inc.",37.506,94,,percent of total billed charges,,
SUTURE POLYSORB 3/0 30IN VIOLET GU-46,,A4649,HCPCS,Facility,Outpatient,,,,39.9,33.915,11.43534,39.9,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,35.9499,90.1,,percent of total billed charges,,
SUTURE POLYSORB 3/0 30IN VIOLET GU-46,,A4649,HCPCS,Facility,Inpatient,,,,39.9,33.915,11.43534,39.9,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
SUTURE POLYSORB 3/0 30IN VIOLET GU-46,,A4649,HCPCS,Facility,Both,,,,39.9,33.915,11.43534,39.9,"Preferred One Administrative Services, INC.",PPO,39.3414,98.6,,percent of total billed charges,,
SUTURE POLYSORB 3/0 30IN VIOLET GU-46,,A4649,HCPCS,Facility,Outpatient,,,,39.9,33.915,11.43534,39.9,PrimeWest Health,Minnesota Senior Health Options (MSHO),20.52855,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
SUTURE POLYSORB 3/0 30IN VIOLET GU-46,,A4649,HCPCS,Facility,Inpatient,,,,39.9,33.915,11.43534,39.9,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE POLYSORB 3/0 30IN VIOLET GU-46,,A4649,HCPCS,Facility,Outpatient,,,,39.9,33.915,11.43534,39.9,PrimeWest Health,MinnesotaCare,20.49264,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
SUTURE POLYSORB 3/0 30IN VIOLET GU-46,,A4649,HCPCS,Facility,Inpatient,,,,39.9,33.915,11.43534,39.9,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
SUTURE POLYSORB 3/0 30IN VIOLET GU-46,,A4649,HCPCS,Facility,Both,,,,39.9,33.915,11.43534,39.9,Sanford Health Plan,Sanford Health Plan,36.708,92,,percent of total billed charges,,
SUTURE POLYSORB 3/0 30IN VIOLET GU-46,,A4649,HCPCS,Facility,Outpatient,,,,39.9,33.915,11.43534,39.9,"UCare Health, Inc.",Individual & Family Plan,22.48365,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
SUTURE POLYSORB 3/0 30IN VIOLET GU-46,,A4649,HCPCS,Facility,Inpatient,,,,39.9,33.915,11.43534,39.9,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
SUTURE POLYSORB 3/0 30IN VIOLET GU-46,,A4649,HCPCS,Facility,Outpatient,,,,39.9,33.915,11.43534,39.9,"UCare Health, Inc.",Medical Assistance,20.13753,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE POLYSORB 3/0 30IN VIOLET GU-46,,A4649,HCPCS,Facility,Inpatient,,,,39.9,33.915,11.43534,39.9,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
SUTURE POLYSORB 3/0 30IN VIOLET GU-46,,A4649,HCPCS,Facility,Outpatient,,,,39.9,33.915,11.43534,39.9,"UCare Health, Inc.",Medicare Advantage,20.13753,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE POLYSORB 3/0 30IN VIOLET GU-46,,A4649,HCPCS,Facility,Inpatient,,,,39.9,33.915,11.43534,39.9,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE POLYSORB 3/0 30IN VIOLET GU-46,,A4649,HCPCS,Facility,Outpatient,,,,39.9,33.915,11.43534,39.9,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),20.13753,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE POLYSORB 3/0 30IN VIOLET GU-46,,A4649,HCPCS,Facility,Inpatient,,,,39.9,33.915,11.43534,39.9,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE POLYSORB 3/0 30IN VIOLET GU-46,,A4649,HCPCS,Facility,Both,,,,39.9,33.915,11.43534,39.9,UnitedHealthcare,Individual & Family,37.506,94,,percent of total billed charges,,
SUTURE POLYSORB 3/0 30IN VIOLET GU-46,,A4649,HCPCS,Facility,Outpatient,,,,39.9,33.915,11.43534,39.9,UnitedHealthcare,Medicare Advantage,19.551,49,,percent of total billed charges,,
SUTURE POLYSORB 3/0 30IN VIOLET GU-46,,A4649,HCPCS,Facility,Inpatient,,,,39.9,33.915,11.43534,39.9,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
SUTURE POLYSORB 3/0 30IN VIOLET GU-46,,A4649,HCPCS,Facility,Outpatient,,,,39.9,33.915,11.43534,39.9,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,19.152,48,,percent of total billed charges,,100% of DHS outpatient percentage
SUTURE POLYSORB 3/0 30IN VIOLET GU-46,,A4649,HCPCS,Facility,Inpatient,,,,39.9,33.915,11.43534,39.9,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
SUTURE POLYSORB 3-0 GL-322,,A4649,HCPCS,Facility,Both,,,,1.84,1.564,0.527344,1.84,Aetna,Commercial,1.6928,92,,percent of total billed charges,,
SUTURE POLYSORB 3-0 GL-322,,A4649,HCPCS,Facility,Outpatient,,,,1.84,1.564,0.527344,1.84,Aetna,Medicare Advantage,0.9016,49,,percent of total billed charges,,
SUTURE POLYSORB 3-0 GL-322,,A4649,HCPCS,Facility,Inpatient,,,,1.84,1.564,0.527344,1.84,Aetna,Medicare Advantage,,,,,Included in per diem rate,
SUTURE POLYSORB 3-0 GL-322,,A4649,HCPCS,Facility,Both,,,,1.84,1.564,0.527344,1.84,Aetna,PPO,1.7112,93,,percent of total billed charges,,
SUTURE POLYSORB 3-0 GL-322,,A4649,HCPCS,Facility,Both,,,,1.84,1.564,0.527344,1.84,America's PPO,America's PPO,1.766952,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SUTURE POLYSORB 3-0 GL-322,,A4649,HCPCS,Facility,Both,,,,1.84,1.564,0.527344,1.84,BlueCross BlueShield Minnesota, Federal Employee Program,1.81056,98.4,,percent of total billed charges,,
SUTURE POLYSORB 3-0 GL-322,,A4649,HCPCS,Facility,Both,,,,1.84,1.564,0.527344,1.84,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1.84,100,,percent of total billed charges,,
SUTURE POLYSORB 3-0 GL-322,,A4649,HCPCS,Facility,Both,,,,1.84,1.564,0.527344,1.84,BlueCross BlueShield Minnesota,High Value Network Plan,1.656,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
SUTURE POLYSORB 3-0 GL-322,,A4649,HCPCS,Facility,Outpatient,,,,1.84,1.564,0.527344,1.84,BlueCross BlueShield Minnesota,Medicare Advantage,0.9016,49,,percent of total billed charges,,
SUTURE POLYSORB 3-0 GL-322,,A4649,HCPCS,Facility,Inpatient,,,,1.84,1.564,0.527344,1.84,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
SUTURE POLYSORB 3-0 GL-322,,A4649,HCPCS,Facility,Both,,,,1.84,1.564,0.527344,1.84,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1.629688,88.57,,percent of total billed charges,,
SUTURE POLYSORB 3-0 GL-322,,A4649,HCPCS,Facility,Both,,,,1.84,1.564,0.527344,1.84,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,0.527344,28.66,,percent of total billed charges,,
SUTURE POLYSORB 3-0 GL-322,,A4649,HCPCS,Facility,Outpatient,,,,1.84,1.564,0.527344,1.84,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),0.9016,49,,percent of total billed charges,,
SUTURE POLYSORB 3-0 GL-322,,A4649,HCPCS,Facility,Inpatient,,,,1.84,1.564,0.527344,1.84,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
SUTURE POLYSORB 3-0 GL-322,,A4649,HCPCS,Facility,Both,,,,1.84,1.564,0.527344,1.84,CorVel,Worker's Compensation,1.84,100,,percent of total billed charges,,
SUTURE POLYSORB 3-0 GL-322,,A4649,HCPCS,Facility,Both,,,,1.84,1.564,0.527344,1.84,First Health Group Corporation,First Health Network,1.7848,97,,percent of total billed charges,,
SUTURE POLYSORB 3-0 GL-322,,A4649,HCPCS,Facility,Both,,,,1.84,1.564,0.527344,1.84,"Health Partners, Inc.",Commercial,1.74064,94.6,,percent of total billed charges,,
SUTURE POLYSORB 3-0 GL-322,,A4649,HCPCS,Facility,Outpatient,,,,1.84,1.564,0.527344,1.84,"Health Partners, Inc.",Medicare Advantage,0.9016,49,,percent of total billed charges,,
SUTURE POLYSORB 3-0 GL-322,,A4649,HCPCS,Facility,Inpatient,,,,1.84,1.564,0.527344,1.84,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE POLYSORB 3-0 GL-322,,A4649,HCPCS,Facility,Both,,,,1.84,1.564,0.527344,1.84,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1.104,60,,percent of total billed charges,,
SUTURE POLYSORB 3-0 GL-322,,A4649,HCPCS,Facility,Both,,,,1.84,1.564,0.527344,1.84,"Health Partners, Inc.",State of Minnesota Advantage Program,1.4996,81.5,,percent of total billed charges,,
SUTURE POLYSORB 3-0 GL-322,,A4649,HCPCS,Facility,Both,,,,1.84,1.564,0.527344,1.84,"Health Partners, Inc.",State Public Programs,0.92,50,,percent of total billed charges,,
SUTURE POLYSORB 3-0 GL-322,,A4649,HCPCS,Facility,Both,,,,1.84,1.564,0.527344,1.84,Humana Insurance Company,Commercial PPO,1.748,95,,percent of total billed charges,,
SUTURE POLYSORB 3-0 GL-322,,A4649,HCPCS,Facility,Outpatient,,,,1.84,1.564,0.527344,1.84,Humana Insurance Company,Medicare PPO,0.9016,49,,percent of total billed charges,,
SUTURE POLYSORB 3-0 GL-322,,A4649,HCPCS,Facility,Inpatient,,,,1.84,1.564,0.527344,1.84,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
SUTURE POLYSORB 3-0 GL-322,,A4649,HCPCS,Facility,Both,,,,1.84,1.564,0.527344,1.84,Medica,Individual & Family,1.82344,99.1,,percent of total billed charges,,
SUTURE POLYSORB 3-0 GL-322,,A4649,HCPCS,Facility,Outpatient,,,,1.84,1.564,0.527344,1.84,Medica,Medica Advantage Solution,0.91632,49.8,,percent of total billed charges,,
SUTURE POLYSORB 3-0 GL-322,,A4649,HCPCS,Facility,Inpatient,,,,1.84,1.564,0.527344,1.84,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
SUTURE POLYSORB 3-0 GL-322,,A4649,HCPCS,Facility,Outpatient,,,,1.84,1.564,0.527344,1.84,Medica,Medical Assistance,0.82064,44.6,,percent of total billed charges,,
SUTURE POLYSORB 3-0 GL-322,,A4649,HCPCS,Facility,Inpatient,,,,1.84,1.564,0.527344,1.84,Medica,Medical Assistance,,,,,Included in per diem rate,
SUTURE POLYSORB 3-0 GL-322,,A4649,HCPCS,Facility,Outpatient,,,,1.84,1.564,0.527344,1.84,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,0.91632,49.8,,percent of total billed charges,,
SUTURE POLYSORB 3-0 GL-322,,A4649,HCPCS,Facility,Inpatient,,,,1.84,1.564,0.527344,1.84,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
SUTURE POLYSORB 3-0 GL-322,,A4649,HCPCS,Facility,Both,,,,1.84,1.564,0.527344,1.84,"Multiplan, Inc.","Multiplan, Inc.",1.7296,94,,percent of total billed charges,,
SUTURE POLYSORB 3-0 GL-322,,A4649,HCPCS,Facility,Outpatient,,,,1.84,1.564,0.527344,1.84,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1.65784,90.1,,percent of total billed charges,,
SUTURE POLYSORB 3-0 GL-322,,A4649,HCPCS,Facility,Inpatient,,,,1.84,1.564,0.527344,1.84,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
SUTURE POLYSORB 3-0 GL-322,,A4649,HCPCS,Facility,Both,,,,1.84,1.564,0.527344,1.84,"Preferred One Administrative Services, INC.",PPO,1.81424,98.6,,percent of total billed charges,,
SUTURE POLYSORB 3-0 GL-322,,A4649,HCPCS,Facility,Outpatient,,,,1.84,1.564,0.527344,1.84,PrimeWest Health,Minnesota Senior Health Options (MSHO),0.94668,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
SUTURE POLYSORB 3-0 GL-322,,A4649,HCPCS,Facility,Inpatient,,,,1.84,1.564,0.527344,1.84,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE POLYSORB 3-0 GL-322,,A4649,HCPCS,Facility,Outpatient,,,,1.84,1.564,0.527344,1.84,PrimeWest Health,MinnesotaCare,0.945024,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
SUTURE POLYSORB 3-0 GL-322,,A4649,HCPCS,Facility,Inpatient,,,,1.84,1.564,0.527344,1.84,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
SUTURE POLYSORB 3-0 GL-322,,A4649,HCPCS,Facility,Both,,,,1.84,1.564,0.527344,1.84,Sanford Health Plan,Sanford Health Plan,1.6928,92,,percent of total billed charges,,
SUTURE POLYSORB 3-0 GL-322,,A4649,HCPCS,Facility,Outpatient,,,,1.84,1.564,0.527344,1.84,"UCare Health, Inc.",Individual & Family Plan,1.03684,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
SUTURE POLYSORB 3-0 GL-322,,A4649,HCPCS,Facility,Inpatient,,,,1.84,1.564,0.527344,1.84,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
SUTURE POLYSORB 3-0 GL-322,,A4649,HCPCS,Facility,Outpatient,,,,1.84,1.564,0.527344,1.84,"UCare Health, Inc.",Medical Assistance,0.928648,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE POLYSORB 3-0 GL-322,,A4649,HCPCS,Facility,Inpatient,,,,1.84,1.564,0.527344,1.84,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
SUTURE POLYSORB 3-0 GL-322,,A4649,HCPCS,Facility,Outpatient,,,,1.84,1.564,0.527344,1.84,"UCare Health, Inc.",Medicare Advantage,0.928648,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE POLYSORB 3-0 GL-322,,A4649,HCPCS,Facility,Inpatient,,,,1.84,1.564,0.527344,1.84,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE POLYSORB 3-0 GL-322,,A4649,HCPCS,Facility,Outpatient,,,,1.84,1.564,0.527344,1.84,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),0.928648,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE POLYSORB 3-0 GL-322,,A4649,HCPCS,Facility,Inpatient,,,,1.84,1.564,0.527344,1.84,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE POLYSORB 3-0 GL-322,,A4649,HCPCS,Facility,Both,,,,1.84,1.564,0.527344,1.84,UnitedHealthcare,Individual & Family,1.7296,94,,percent of total billed charges,,
SUTURE POLYSORB 3-0 GL-322,,A4649,HCPCS,Facility,Outpatient,,,,1.84,1.564,0.527344,1.84,UnitedHealthcare,Medicare Advantage,0.9016,49,,percent of total billed charges,,
SUTURE POLYSORB 3-0 GL-322,,A4649,HCPCS,Facility,Inpatient,,,,1.84,1.564,0.527344,1.84,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
SUTURE POLYSORB 3-0 GL-322,,A4649,HCPCS,Facility,Outpatient,,,,1.84,1.564,0.527344,1.84,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,0.8832,48,,percent of total billed charges,,100% of DHS outpatient percentage
SUTURE POLYSORB 3-0 GL-322,,A4649,HCPCS,Facility,Inpatient,,,,1.84,1.564,0.527344,1.84,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
SUTURE POLYSORB 4.0 GL-121,,A4649,HCPCS,Facility,Both,,,,27.55,23.4175,7.89583,27.55,Aetna,Commercial,25.346,92,,percent of total billed charges,,
SUTURE POLYSORB 4.0 GL-121,,A4649,HCPCS,Facility,Outpatient,,,,27.55,23.4175,7.89583,27.55,Aetna,Medicare Advantage,13.4995,49,,percent of total billed charges,,
SUTURE POLYSORB 4.0 GL-121,,A4649,HCPCS,Facility,Inpatient,,,,27.55,23.4175,7.89583,27.55,Aetna,Medicare Advantage,,,,,Included in per diem rate,
SUTURE POLYSORB 4.0 GL-121,,A4649,HCPCS,Facility,Both,,,,27.55,23.4175,7.89583,27.55,Aetna,PPO,25.6215,93,,percent of total billed charges,,
SUTURE POLYSORB 4.0 GL-121,,A4649,HCPCS,Facility,Both,,,,27.55,23.4175,7.89583,27.55,America's PPO,America's PPO,26.456265,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SUTURE POLYSORB 4.0 GL-121,,A4649,HCPCS,Facility,Both,,,,27.55,23.4175,7.89583,27.55,BlueCross BlueShield Minnesota, Federal Employee Program,27.1092,98.4,,percent of total billed charges,,
SUTURE POLYSORB 4.0 GL-121,,A4649,HCPCS,Facility,Both,,,,27.55,23.4175,7.89583,27.55,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,27.55,100,,percent of total billed charges,,
SUTURE POLYSORB 4.0 GL-121,,A4649,HCPCS,Facility,Both,,,,27.55,23.4175,7.89583,27.55,BlueCross BlueShield Minnesota,High Value Network Plan,24.795,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
SUTURE POLYSORB 4.0 GL-121,,A4649,HCPCS,Facility,Outpatient,,,,27.55,23.4175,7.89583,27.55,BlueCross BlueShield Minnesota,Medicare Advantage,13.4995,49,,percent of total billed charges,,
SUTURE POLYSORB 4.0 GL-121,,A4649,HCPCS,Facility,Inpatient,,,,27.55,23.4175,7.89583,27.55,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
SUTURE POLYSORB 4.0 GL-121,,A4649,HCPCS,Facility,Both,,,,27.55,23.4175,7.89583,27.55,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,24.401035,88.57,,percent of total billed charges,,
SUTURE POLYSORB 4.0 GL-121,,A4649,HCPCS,Facility,Both,,,,27.55,23.4175,7.89583,27.55,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,7.89583,28.66,,percent of total billed charges,,
SUTURE POLYSORB 4.0 GL-121,,A4649,HCPCS,Facility,Outpatient,,,,27.55,23.4175,7.89583,27.55,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),13.4995,49,,percent of total billed charges,,
SUTURE POLYSORB 4.0 GL-121,,A4649,HCPCS,Facility,Inpatient,,,,27.55,23.4175,7.89583,27.55,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
SUTURE POLYSORB 4.0 GL-121,,A4649,HCPCS,Facility,Both,,,,27.55,23.4175,7.89583,27.55,CorVel,Worker's Compensation,27.55,100,,percent of total billed charges,,
SUTURE POLYSORB 4.0 GL-121,,A4649,HCPCS,Facility,Both,,,,27.55,23.4175,7.89583,27.55,First Health Group Corporation,First Health Network,26.7235,97,,percent of total billed charges,,
SUTURE POLYSORB 4.0 GL-121,,A4649,HCPCS,Facility,Both,,,,27.55,23.4175,7.89583,27.55,"Health Partners, Inc.",Commercial,26.0623,94.6,,percent of total billed charges,,
SUTURE POLYSORB 4.0 GL-121,,A4649,HCPCS,Facility,Outpatient,,,,27.55,23.4175,7.89583,27.55,"Health Partners, Inc.",Medicare Advantage,13.4995,49,,percent of total billed charges,,
SUTURE POLYSORB 4.0 GL-121,,A4649,HCPCS,Facility,Inpatient,,,,27.55,23.4175,7.89583,27.55,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE POLYSORB 4.0 GL-121,,A4649,HCPCS,Facility,Both,,,,27.55,23.4175,7.89583,27.55,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),16.53,60,,percent of total billed charges,,
SUTURE POLYSORB 4.0 GL-121,,A4649,HCPCS,Facility,Both,,,,27.55,23.4175,7.89583,27.55,"Health Partners, Inc.",State of Minnesota Advantage Program,22.45325,81.5,,percent of total billed charges,,
SUTURE POLYSORB 4.0 GL-121,,A4649,HCPCS,Facility,Both,,,,27.55,23.4175,7.89583,27.55,"Health Partners, Inc.",State Public Programs,13.775,50,,percent of total billed charges,,
SUTURE POLYSORB 4.0 GL-121,,A4649,HCPCS,Facility,Both,,,,27.55,23.4175,7.89583,27.55,Humana Insurance Company,Commercial PPO,26.1725,95,,percent of total billed charges,,
SUTURE POLYSORB 4.0 GL-121,,A4649,HCPCS,Facility,Outpatient,,,,27.55,23.4175,7.89583,27.55,Humana Insurance Company,Medicare PPO,13.4995,49,,percent of total billed charges,,
SUTURE POLYSORB 4.0 GL-121,,A4649,HCPCS,Facility,Inpatient,,,,27.55,23.4175,7.89583,27.55,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
SUTURE POLYSORB 4.0 GL-121,,A4649,HCPCS,Facility,Both,,,,27.55,23.4175,7.89583,27.55,Medica,Individual & Family,27.30205,99.1,,percent of total billed charges,,
SUTURE POLYSORB 4.0 GL-121,,A4649,HCPCS,Facility,Outpatient,,,,27.55,23.4175,7.89583,27.55,Medica,Medica Advantage Solution,13.7199,49.8,,percent of total billed charges,,
SUTURE POLYSORB 4.0 GL-121,,A4649,HCPCS,Facility,Inpatient,,,,27.55,23.4175,7.89583,27.55,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
SUTURE POLYSORB 4.0 GL-121,,A4649,HCPCS,Facility,Outpatient,,,,27.55,23.4175,7.89583,27.55,Medica,Medical Assistance,12.2873,44.6,,percent of total billed charges,,
SUTURE POLYSORB 4.0 GL-121,,A4649,HCPCS,Facility,Inpatient,,,,27.55,23.4175,7.89583,27.55,Medica,Medical Assistance,,,,,Included in per diem rate,
SUTURE POLYSORB 4.0 GL-121,,A4649,HCPCS,Facility,Outpatient,,,,27.55,23.4175,7.89583,27.55,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,13.7199,49.8,,percent of total billed charges,,
SUTURE POLYSORB 4.0 GL-121,,A4649,HCPCS,Facility,Inpatient,,,,27.55,23.4175,7.89583,27.55,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
SUTURE POLYSORB 4.0 GL-121,,A4649,HCPCS,Facility,Both,,,,27.55,23.4175,7.89583,27.55,"Multiplan, Inc.","Multiplan, Inc.",25.897,94,,percent of total billed charges,,
SUTURE POLYSORB 4.0 GL-121,,A4649,HCPCS,Facility,Outpatient,,,,27.55,23.4175,7.89583,27.55,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,24.82255,90.1,,percent of total billed charges,,
SUTURE POLYSORB 4.0 GL-121,,A4649,HCPCS,Facility,Inpatient,,,,27.55,23.4175,7.89583,27.55,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
SUTURE POLYSORB 4.0 GL-121,,A4649,HCPCS,Facility,Both,,,,27.55,23.4175,7.89583,27.55,"Preferred One Administrative Services, INC.",PPO,27.1643,98.6,,percent of total billed charges,,
SUTURE POLYSORB 4.0 GL-121,,A4649,HCPCS,Facility,Outpatient,,,,27.55,23.4175,7.89583,27.55,PrimeWest Health,Minnesota Senior Health Options (MSHO),14.174475,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
SUTURE POLYSORB 4.0 GL-121,,A4649,HCPCS,Facility,Inpatient,,,,27.55,23.4175,7.89583,27.55,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE POLYSORB 4.0 GL-121,,A4649,HCPCS,Facility,Outpatient,,,,27.55,23.4175,7.89583,27.55,PrimeWest Health,MinnesotaCare,14.14968,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
SUTURE POLYSORB 4.0 GL-121,,A4649,HCPCS,Facility,Inpatient,,,,27.55,23.4175,7.89583,27.55,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
SUTURE POLYSORB 4.0 GL-121,,A4649,HCPCS,Facility,Both,,,,27.55,23.4175,7.89583,27.55,Sanford Health Plan,Sanford Health Plan,25.346,92,,percent of total billed charges,,
SUTURE POLYSORB 4.0 GL-121,,A4649,HCPCS,Facility,Outpatient,,,,27.55,23.4175,7.89583,27.55,"UCare Health, Inc.",Individual & Family Plan,15.524425,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
SUTURE POLYSORB 4.0 GL-121,,A4649,HCPCS,Facility,Inpatient,,,,27.55,23.4175,7.89583,27.55,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
SUTURE POLYSORB 4.0 GL-121,,A4649,HCPCS,Facility,Outpatient,,,,27.55,23.4175,7.89583,27.55,"UCare Health, Inc.",Medical Assistance,13.904485,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE POLYSORB 4.0 GL-121,,A4649,HCPCS,Facility,Inpatient,,,,27.55,23.4175,7.89583,27.55,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
SUTURE POLYSORB 4.0 GL-121,,A4649,HCPCS,Facility,Outpatient,,,,27.55,23.4175,7.89583,27.55,"UCare Health, Inc.",Medicare Advantage,13.904485,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE POLYSORB 4.0 GL-121,,A4649,HCPCS,Facility,Inpatient,,,,27.55,23.4175,7.89583,27.55,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE POLYSORB 4.0 GL-121,,A4649,HCPCS,Facility,Outpatient,,,,27.55,23.4175,7.89583,27.55,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),13.904485,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE POLYSORB 4.0 GL-121,,A4649,HCPCS,Facility,Inpatient,,,,27.55,23.4175,7.89583,27.55,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE POLYSORB 4.0 GL-121,,A4649,HCPCS,Facility,Both,,,,27.55,23.4175,7.89583,27.55,UnitedHealthcare,Individual & Family,25.897,94,,percent of total billed charges,,
SUTURE POLYSORB 4.0 GL-121,,A4649,HCPCS,Facility,Outpatient,,,,27.55,23.4175,7.89583,27.55,UnitedHealthcare,Medicare Advantage,13.4995,49,,percent of total billed charges,,
SUTURE POLYSORB 4.0 GL-121,,A4649,HCPCS,Facility,Inpatient,,,,27.55,23.4175,7.89583,27.55,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
SUTURE POLYSORB 4.0 GL-121,,A4649,HCPCS,Facility,Outpatient,,,,27.55,23.4175,7.89583,27.55,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,13.224,48,,percent of total billed charges,,100% of DHS outpatient percentage
SUTURE POLYSORB 4.0 GL-121,,A4649,HCPCS,Facility,Inpatient,,,,27.55,23.4175,7.89583,27.55,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
SUTURE POLYSORB 4-0 TIES LL-221,,A4649,HCPCS,Facility,Both,,,,16.25,13.8125,4.65725,16.25,Aetna,Commercial,14.95,92,,percent of total billed charges,,
SUTURE POLYSORB 4-0 TIES LL-221,,A4649,HCPCS,Facility,Both,,,,60.12,51.102,17.230392,60.12,Aetna,Commercial,55.3104,92,,percent of total billed charges,,
SUTURE POLYSORB 4-0 TIES LL-221,,A4649,HCPCS,Facility,Outpatient,,,,16.25,13.8125,4.65725,16.25,Aetna,Medicare Advantage,7.9625,49,,percent of total billed charges,,
SUTURE POLYSORB 4-0 TIES LL-221,,A4649,HCPCS,Facility,Outpatient,,,,60.12,51.102,17.230392,60.12,Aetna,Medicare Advantage,29.4588,49,,percent of total billed charges,,
SUTURE POLYSORB 4-0 TIES LL-221,,A4649,HCPCS,Facility,Inpatient,,,,16.25,13.8125,4.65725,16.25,Aetna,Medicare Advantage,,,,,Included in per diem rate,
SUTURE POLYSORB 4-0 TIES LL-221,,A4649,HCPCS,Facility,Inpatient,,,,60.12,51.102,17.230392,60.12,Aetna,Medicare Advantage,,,,,Included in per diem rate,
SUTURE POLYSORB 4-0 TIES LL-221,,A4649,HCPCS,Facility,Both,,,,16.25,13.8125,4.65725,16.25,Aetna,PPO,15.1125,93,,percent of total billed charges,,
SUTURE POLYSORB 4-0 TIES LL-221,,A4649,HCPCS,Facility,Both,,,,60.12,51.102,17.230392,60.12,Aetna,PPO,55.9116,93,,percent of total billed charges,,
SUTURE POLYSORB 4-0 TIES LL-221,,A4649,HCPCS,Facility,Both,,,,16.25,13.8125,4.65725,16.25,America's PPO,America's PPO,15.604875,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SUTURE POLYSORB 4-0 TIES LL-221,,A4649,HCPCS,Facility,Both,,,,60.12,51.102,17.230392,60.12,America's PPO,America's PPO,57.733236,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SUTURE POLYSORB 4-0 TIES LL-221,,A4649,HCPCS,Facility,Both,,,,16.25,13.8125,4.65725,16.25,BlueCross BlueShield Minnesota, Federal Employee Program,15.99,98.4,,percent of total billed charges,,
SUTURE POLYSORB 4-0 TIES LL-221,,A4649,HCPCS,Facility,Both,,,,60.12,51.102,17.230392,60.12,BlueCross BlueShield Minnesota, Federal Employee Program,59.15808,98.4,,percent of total billed charges,,
SUTURE POLYSORB 4-0 TIES LL-221,,A4649,HCPCS,Facility,Both,,,,16.25,13.8125,4.65725,16.25,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,16.25,100,,percent of total billed charges,,
SUTURE POLYSORB 4-0 TIES LL-221,,A4649,HCPCS,Facility,Both,,,,60.12,51.102,17.230392,60.12,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,60.12,100,,percent of total billed charges,,
SUTURE POLYSORB 4-0 TIES LL-221,,A4649,HCPCS,Facility,Both,,,,16.25,13.8125,4.65725,16.25,BlueCross BlueShield Minnesota,High Value Network Plan,14.625,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
SUTURE POLYSORB 4-0 TIES LL-221,,A4649,HCPCS,Facility,Both,,,,60.12,51.102,17.230392,60.12,BlueCross BlueShield Minnesota,High Value Network Plan,54.108,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
SUTURE POLYSORB 4-0 TIES LL-221,,A4649,HCPCS,Facility,Outpatient,,,,16.25,13.8125,4.65725,16.25,BlueCross BlueShield Minnesota,Medicare Advantage,7.9625,49,,percent of total billed charges,,
SUTURE POLYSORB 4-0 TIES LL-221,,A4649,HCPCS,Facility,Outpatient,,,,60.12,51.102,17.230392,60.12,BlueCross BlueShield Minnesota,Medicare Advantage,29.4588,49,,percent of total billed charges,,
SUTURE POLYSORB 4-0 TIES LL-221,,A4649,HCPCS,Facility,Inpatient,,,,16.25,13.8125,4.65725,16.25,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
SUTURE POLYSORB 4-0 TIES LL-221,,A4649,HCPCS,Facility,Inpatient,,,,60.12,51.102,17.230392,60.12,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
SUTURE POLYSORB 4-0 TIES LL-221,,A4649,HCPCS,Facility,Both,,,,16.25,13.8125,4.65725,16.25,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,14.392625,88.57,,percent of total billed charges,,
SUTURE POLYSORB 4-0 TIES LL-221,,A4649,HCPCS,Facility,Both,,,,60.12,51.102,17.230392,60.12,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,53.248284,88.57,,percent of total billed charges,,
SUTURE POLYSORB 4-0 TIES LL-221,,A4649,HCPCS,Facility,Both,,,,16.25,13.8125,4.65725,16.25,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,4.65725,28.66,,percent of total billed charges,,
SUTURE POLYSORB 4-0 TIES LL-221,,A4649,HCPCS,Facility,Both,,,,60.12,51.102,17.230392,60.12,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,17.230392,28.66,,percent of total billed charges,,
SUTURE POLYSORB 4-0 TIES LL-221,,A4649,HCPCS,Facility,Outpatient,,,,16.25,13.8125,4.65725,16.25,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),7.9625,49,,percent of total billed charges,,
SUTURE POLYSORB 4-0 TIES LL-221,,A4649,HCPCS,Facility,Outpatient,,,,60.12,51.102,17.230392,60.12,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),29.4588,49,,percent of total billed charges,,
SUTURE POLYSORB 4-0 TIES LL-221,,A4649,HCPCS,Facility,Inpatient,,,,16.25,13.8125,4.65725,16.25,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
SUTURE POLYSORB 4-0 TIES LL-221,,A4649,HCPCS,Facility,Inpatient,,,,60.12,51.102,17.230392,60.12,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
SUTURE POLYSORB 4-0 TIES LL-221,,A4649,HCPCS,Facility,Both,,,,16.25,13.8125,4.65725,16.25,CorVel,Worker's Compensation,16.25,100,,percent of total billed charges,,
SUTURE POLYSORB 4-0 TIES LL-221,,A4649,HCPCS,Facility,Both,,,,60.12,51.102,17.230392,60.12,CorVel,Worker's Compensation,60.12,100,,percent of total billed charges,,
SUTURE POLYSORB 4-0 TIES LL-221,,A4649,HCPCS,Facility,Both,,,,16.25,13.8125,4.65725,16.25,First Health Group Corporation,First Health Network,15.7625,97,,percent of total billed charges,,
SUTURE POLYSORB 4-0 TIES LL-221,,A4649,HCPCS,Facility,Both,,,,60.12,51.102,17.230392,60.12,First Health Group Corporation,First Health Network,58.3164,97,,percent of total billed charges,,
SUTURE POLYSORB 4-0 TIES LL-221,,A4649,HCPCS,Facility,Both,,,,16.25,13.8125,4.65725,16.25,"Health Partners, Inc.",Commercial,15.3725,94.6,,percent of total billed charges,,
SUTURE POLYSORB 4-0 TIES LL-221,,A4649,HCPCS,Facility,Both,,,,60.12,51.102,17.230392,60.12,"Health Partners, Inc.",Commercial,56.87352,94.6,,percent of total billed charges,,
SUTURE POLYSORB 4-0 TIES LL-221,,A4649,HCPCS,Facility,Outpatient,,,,16.25,13.8125,4.65725,16.25,"Health Partners, Inc.",Medicare Advantage,7.9625,49,,percent of total billed charges,,
SUTURE POLYSORB 4-0 TIES LL-221,,A4649,HCPCS,Facility,Outpatient,,,,60.12,51.102,17.230392,60.12,"Health Partners, Inc.",Medicare Advantage,29.4588,49,,percent of total billed charges,,
SUTURE POLYSORB 4-0 TIES LL-221,,A4649,HCPCS,Facility,Inpatient,,,,16.25,13.8125,4.65725,16.25,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE POLYSORB 4-0 TIES LL-221,,A4649,HCPCS,Facility,Inpatient,,,,60.12,51.102,17.230392,60.12,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE POLYSORB 4-0 TIES LL-221,,A4649,HCPCS,Facility,Both,,,,16.25,13.8125,4.65725,16.25,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),9.75,60,,percent of total billed charges,,
SUTURE POLYSORB 4-0 TIES LL-221,,A4649,HCPCS,Facility,Both,,,,60.12,51.102,17.230392,60.12,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),36.072,60,,percent of total billed charges,,
SUTURE POLYSORB 4-0 TIES LL-221,,A4649,HCPCS,Facility,Both,,,,16.25,13.8125,4.65725,16.25,"Health Partners, Inc.",State of Minnesota Advantage Program,13.24375,81.5,,percent of total billed charges,,
SUTURE POLYSORB 4-0 TIES LL-221,,A4649,HCPCS,Facility,Both,,,,60.12,51.102,17.230392,60.12,"Health Partners, Inc.",State of Minnesota Advantage Program,48.9978,81.5,,percent of total billed charges,,
SUTURE POLYSORB 4-0 TIES LL-221,,A4649,HCPCS,Facility,Both,,,,16.25,13.8125,4.65725,16.25,"Health Partners, Inc.",State Public Programs,8.125,50,,percent of total billed charges,,
SUTURE POLYSORB 4-0 TIES LL-221,,A4649,HCPCS,Facility,Both,,,,60.12,51.102,17.230392,60.12,"Health Partners, Inc.",State Public Programs,30.06,50,,percent of total billed charges,,
SUTURE POLYSORB 4-0 TIES LL-221,,A4649,HCPCS,Facility,Both,,,,16.25,13.8125,4.65725,16.25,Humana Insurance Company,Commercial PPO,15.4375,95,,percent of total billed charges,,
SUTURE POLYSORB 4-0 TIES LL-221,,A4649,HCPCS,Facility,Both,,,,60.12,51.102,17.230392,60.12,Humana Insurance Company,Commercial PPO,57.114,95,,percent of total billed charges,,
SUTURE POLYSORB 4-0 TIES LL-221,,A4649,HCPCS,Facility,Outpatient,,,,16.25,13.8125,4.65725,16.25,Humana Insurance Company,Medicare PPO,7.9625,49,,percent of total billed charges,,
SUTURE POLYSORB 4-0 TIES LL-221,,A4649,HCPCS,Facility,Outpatient,,,,60.12,51.102,17.230392,60.12,Humana Insurance Company,Medicare PPO,29.4588,49,,percent of total billed charges,,
SUTURE POLYSORB 4-0 TIES LL-221,,A4649,HCPCS,Facility,Inpatient,,,,16.25,13.8125,4.65725,16.25,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
SUTURE POLYSORB 4-0 TIES LL-221,,A4649,HCPCS,Facility,Inpatient,,,,60.12,51.102,17.230392,60.12,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
SUTURE POLYSORB 4-0 TIES LL-221,,A4649,HCPCS,Facility,Both,,,,16.25,13.8125,4.65725,16.25,Medica,Individual & Family,16.10375,99.1,,percent of total billed charges,,
SUTURE POLYSORB 4-0 TIES LL-221,,A4649,HCPCS,Facility,Both,,,,60.12,51.102,17.230392,60.12,Medica,Individual & Family,59.57892,99.1,,percent of total billed charges,,
SUTURE POLYSORB 4-0 TIES LL-221,,A4649,HCPCS,Facility,Outpatient,,,,16.25,13.8125,4.65725,16.25,Medica,Medica Advantage Solution,8.0925,49.8,,percent of total billed charges,,
SUTURE POLYSORB 4-0 TIES LL-221,,A4649,HCPCS,Facility,Outpatient,,,,60.12,51.102,17.230392,60.12,Medica,Medica Advantage Solution,29.93976,49.8,,percent of total billed charges,,
SUTURE POLYSORB 4-0 TIES LL-221,,A4649,HCPCS,Facility,Inpatient,,,,16.25,13.8125,4.65725,16.25,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
SUTURE POLYSORB 4-0 TIES LL-221,,A4649,HCPCS,Facility,Inpatient,,,,60.12,51.102,17.230392,60.12,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
SUTURE POLYSORB 4-0 TIES LL-221,,A4649,HCPCS,Facility,Outpatient,,,,16.25,13.8125,4.65725,16.25,Medica,Medical Assistance,7.2475,44.6,,percent of total billed charges,,
SUTURE POLYSORB 4-0 TIES LL-221,,A4649,HCPCS,Facility,Outpatient,,,,60.12,51.102,17.230392,60.12,Medica,Medical Assistance,26.81352,44.6,,percent of total billed charges,,
SUTURE POLYSORB 4-0 TIES LL-221,,A4649,HCPCS,Facility,Inpatient,,,,16.25,13.8125,4.65725,16.25,Medica,Medical Assistance,,,,,Included in per diem rate,
SUTURE POLYSORB 4-0 TIES LL-221,,A4649,HCPCS,Facility,Inpatient,,,,60.12,51.102,17.230392,60.12,Medica,Medical Assistance,,,,,Included in per diem rate,
SUTURE POLYSORB 4-0 TIES LL-221,,A4649,HCPCS,Facility,Outpatient,,,,16.25,13.8125,4.65725,16.25,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,8.0925,49.8,,percent of total billed charges,,
SUTURE POLYSORB 4-0 TIES LL-221,,A4649,HCPCS,Facility,Outpatient,,,,60.12,51.102,17.230392,60.12,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,29.93976,49.8,,percent of total billed charges,,
SUTURE POLYSORB 4-0 TIES LL-221,,A4649,HCPCS,Facility,Inpatient,,,,16.25,13.8125,4.65725,16.25,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
SUTURE POLYSORB 4-0 TIES LL-221,,A4649,HCPCS,Facility,Inpatient,,,,60.12,51.102,17.230392,60.12,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
SUTURE POLYSORB 4-0 TIES LL-221,,A4649,HCPCS,Facility,Both,,,,16.25,13.8125,4.65725,16.25,"Multiplan, Inc.","Multiplan, Inc.",15.275,94,,percent of total billed charges,,
SUTURE POLYSORB 4-0 TIES LL-221,,A4649,HCPCS,Facility,Both,,,,60.12,51.102,17.230392,60.12,"Multiplan, Inc.","Multiplan, Inc.",56.5128,94,,percent of total billed charges,,
SUTURE POLYSORB 4-0 TIES LL-221,,A4649,HCPCS,Facility,Outpatient,,,,16.25,13.8125,4.65725,16.25,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,14.64125,90.1,,percent of total billed charges,,
SUTURE POLYSORB 4-0 TIES LL-221,,A4649,HCPCS,Facility,Outpatient,,,,60.12,51.102,17.230392,60.12,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,54.16812,90.1,,percent of total billed charges,,
SUTURE POLYSORB 4-0 TIES LL-221,,A4649,HCPCS,Facility,Inpatient,,,,16.25,13.8125,4.65725,16.25,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
SUTURE POLYSORB 4-0 TIES LL-221,,A4649,HCPCS,Facility,Inpatient,,,,60.12,51.102,17.230392,60.12,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
SUTURE POLYSORB 4-0 TIES LL-221,,A4649,HCPCS,Facility,Both,,,,16.25,13.8125,4.65725,16.25,"Preferred One Administrative Services, INC.",PPO,16.0225,98.6,,percent of total billed charges,,
SUTURE POLYSORB 4-0 TIES LL-221,,A4649,HCPCS,Facility,Both,,,,60.12,51.102,17.230392,60.12,"Preferred One Administrative Services, INC.",PPO,59.27832,98.6,,percent of total billed charges,,
SUTURE POLYSORB 4-0 TIES LL-221,,A4649,HCPCS,Facility,Outpatient,,,,16.25,13.8125,4.65725,16.25,PrimeWest Health,Minnesota Senior Health Options (MSHO),8.360625,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
SUTURE POLYSORB 4-0 TIES LL-221,,A4649,HCPCS,Facility,Outpatient,,,,60.12,51.102,17.230392,60.12,PrimeWest Health,Minnesota Senior Health Options (MSHO),30.93174,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
SUTURE POLYSORB 4-0 TIES LL-221,,A4649,HCPCS,Facility,Inpatient,,,,16.25,13.8125,4.65725,16.25,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE POLYSORB 4-0 TIES LL-221,,A4649,HCPCS,Facility,Inpatient,,,,60.12,51.102,17.230392,60.12,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE POLYSORB 4-0 TIES LL-221,,A4649,HCPCS,Facility,Outpatient,,,,16.25,13.8125,4.65725,16.25,PrimeWest Health,MinnesotaCare,8.346,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
SUTURE POLYSORB 4-0 TIES LL-221,,A4649,HCPCS,Facility,Outpatient,,,,60.12,51.102,17.230392,60.12,PrimeWest Health,MinnesotaCare,30.877632,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
SUTURE POLYSORB 4-0 TIES LL-221,,A4649,HCPCS,Facility,Inpatient,,,,16.25,13.8125,4.65725,16.25,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
SUTURE POLYSORB 4-0 TIES LL-221,,A4649,HCPCS,Facility,Inpatient,,,,60.12,51.102,17.230392,60.12,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
SUTURE POLYSORB 4-0 TIES LL-221,,A4649,HCPCS,Facility,Both,,,,16.25,13.8125,4.65725,16.25,Sanford Health Plan,Sanford Health Plan,14.95,92,,percent of total billed charges,,
SUTURE POLYSORB 4-0 TIES LL-221,,A4649,HCPCS,Facility,Both,,,,60.12,51.102,17.230392,60.12,Sanford Health Plan,Sanford Health Plan,55.3104,92,,percent of total billed charges,,
SUTURE POLYSORB 4-0 TIES LL-221,,A4649,HCPCS,Facility,Outpatient,,,,16.25,13.8125,4.65725,16.25,"UCare Health, Inc.",Individual & Family Plan,9.156875,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
SUTURE POLYSORB 4-0 TIES LL-221,,A4649,HCPCS,Facility,Outpatient,,,,60.12,51.102,17.230392,60.12,"UCare Health, Inc.",Individual & Family Plan,33.87762,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
SUTURE POLYSORB 4-0 TIES LL-221,,A4649,HCPCS,Facility,Inpatient,,,,16.25,13.8125,4.65725,16.25,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
SUTURE POLYSORB 4-0 TIES LL-221,,A4649,HCPCS,Facility,Inpatient,,,,60.12,51.102,17.230392,60.12,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
SUTURE POLYSORB 4-0 TIES LL-221,,A4649,HCPCS,Facility,Outpatient,,,,16.25,13.8125,4.65725,16.25,"UCare Health, Inc.",Medical Assistance,8.201375,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE POLYSORB 4-0 TIES LL-221,,A4649,HCPCS,Facility,Outpatient,,,,60.12,51.102,17.230392,60.12,"UCare Health, Inc.",Medical Assistance,30.342564,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE POLYSORB 4-0 TIES LL-221,,A4649,HCPCS,Facility,Inpatient,,,,16.25,13.8125,4.65725,16.25,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
SUTURE POLYSORB 4-0 TIES LL-221,,A4649,HCPCS,Facility,Inpatient,,,,60.12,51.102,17.230392,60.12,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
SUTURE POLYSORB 4-0 TIES LL-221,,A4649,HCPCS,Facility,Outpatient,,,,16.25,13.8125,4.65725,16.25,"UCare Health, Inc.",Medicare Advantage,8.201375,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE POLYSORB 4-0 TIES LL-221,,A4649,HCPCS,Facility,Outpatient,,,,60.12,51.102,17.230392,60.12,"UCare Health, Inc.",Medicare Advantage,30.342564,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE POLYSORB 4-0 TIES LL-221,,A4649,HCPCS,Facility,Inpatient,,,,16.25,13.8125,4.65725,16.25,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE POLYSORB 4-0 TIES LL-221,,A4649,HCPCS,Facility,Inpatient,,,,60.12,51.102,17.230392,60.12,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE POLYSORB 4-0 TIES LL-221,,A4649,HCPCS,Facility,Outpatient,,,,16.25,13.8125,4.65725,16.25,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),8.201375,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE POLYSORB 4-0 TIES LL-221,,A4649,HCPCS,Facility,Outpatient,,,,60.12,51.102,17.230392,60.12,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),30.342564,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE POLYSORB 4-0 TIES LL-221,,A4649,HCPCS,Facility,Inpatient,,,,16.25,13.8125,4.65725,16.25,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE POLYSORB 4-0 TIES LL-221,,A4649,HCPCS,Facility,Inpatient,,,,60.12,51.102,17.230392,60.12,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE POLYSORB 4-0 TIES LL-221,,A4649,HCPCS,Facility,Both,,,,16.25,13.8125,4.65725,16.25,UnitedHealthcare,Individual & Family,15.275,94,,percent of total billed charges,,
SUTURE POLYSORB 4-0 TIES LL-221,,A4649,HCPCS,Facility,Both,,,,60.12,51.102,17.230392,60.12,UnitedHealthcare,Individual & Family,56.5128,94,,percent of total billed charges,,
SUTURE POLYSORB 4-0 TIES LL-221,,A4649,HCPCS,Facility,Outpatient,,,,16.25,13.8125,4.65725,16.25,UnitedHealthcare,Medicare Advantage,7.9625,49,,percent of total billed charges,,
SUTURE POLYSORB 4-0 TIES LL-221,,A4649,HCPCS,Facility,Outpatient,,,,60.12,51.102,17.230392,60.12,UnitedHealthcare,Medicare Advantage,29.4588,49,,percent of total billed charges,,
SUTURE POLYSORB 4-0 TIES LL-221,,A4649,HCPCS,Facility,Inpatient,,,,16.25,13.8125,4.65725,16.25,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
SUTURE POLYSORB 4-0 TIES LL-221,,A4649,HCPCS,Facility,Inpatient,,,,60.12,51.102,17.230392,60.12,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
SUTURE POLYSORB 4-0 TIES LL-221,,A4649,HCPCS,Facility,Outpatient,,,,16.25,13.8125,4.65725,16.25,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,7.8,48,,percent of total billed charges,,100% of DHS outpatient percentage
SUTURE POLYSORB 4-0 TIES LL-221,,A4649,HCPCS,Facility,Outpatient,,,,60.12,51.102,17.230392,60.12,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,28.8576,48,,percent of total billed charges,,100% of DHS outpatient percentage
SUTURE POLYSORB 4-0 TIES LL-221,,A4649,HCPCS,Facility,Inpatient,,,,16.25,13.8125,4.65725,16.25,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
SUTURE POLYSORB 4-0 TIES LL-221,,A4649,HCPCS,Facility,Inpatient,,,,60.12,51.102,17.230392,60.12,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
SUTURE POLYSORB 4-0 VIOLET 30IN V-20,,A4649,HCPCS,Facility,Both,,,,27.55,23.4175,7.89583,27.55,Aetna,Commercial,25.346,92,,percent of total billed charges,,
SUTURE POLYSORB 4-0 VIOLET 30IN V-20,,A4649,HCPCS,Facility,Outpatient,,,,27.55,23.4175,7.89583,27.55,Aetna,Medicare Advantage,13.4995,49,,percent of total billed charges,,
SUTURE POLYSORB 4-0 VIOLET 30IN V-20,,A4649,HCPCS,Facility,Inpatient,,,,27.55,23.4175,7.89583,27.55,Aetna,Medicare Advantage,,,,,Included in per diem rate,
SUTURE POLYSORB 4-0 VIOLET 30IN V-20,,A4649,HCPCS,Facility,Both,,,,27.55,23.4175,7.89583,27.55,Aetna,PPO,25.6215,93,,percent of total billed charges,,
SUTURE POLYSORB 4-0 VIOLET 30IN V-20,,A4649,HCPCS,Facility,Both,,,,27.55,23.4175,7.89583,27.55,America's PPO,America's PPO,26.456265,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SUTURE POLYSORB 4-0 VIOLET 30IN V-20,,A4649,HCPCS,Facility,Both,,,,27.55,23.4175,7.89583,27.55,BlueCross BlueShield Minnesota, Federal Employee Program,27.1092,98.4,,percent of total billed charges,,
SUTURE POLYSORB 4-0 VIOLET 30IN V-20,,A4649,HCPCS,Facility,Both,,,,27.55,23.4175,7.89583,27.55,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,27.55,100,,percent of total billed charges,,
SUTURE POLYSORB 4-0 VIOLET 30IN V-20,,A4649,HCPCS,Facility,Both,,,,27.55,23.4175,7.89583,27.55,BlueCross BlueShield Minnesota,High Value Network Plan,24.795,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
SUTURE POLYSORB 4-0 VIOLET 30IN V-20,,A4649,HCPCS,Facility,Outpatient,,,,27.55,23.4175,7.89583,27.55,BlueCross BlueShield Minnesota,Medicare Advantage,13.4995,49,,percent of total billed charges,,
SUTURE POLYSORB 4-0 VIOLET 30IN V-20,,A4649,HCPCS,Facility,Inpatient,,,,27.55,23.4175,7.89583,27.55,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
SUTURE POLYSORB 4-0 VIOLET 30IN V-20,,A4649,HCPCS,Facility,Both,,,,27.55,23.4175,7.89583,27.55,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,24.401035,88.57,,percent of total billed charges,,
SUTURE POLYSORB 4-0 VIOLET 30IN V-20,,A4649,HCPCS,Facility,Both,,,,27.55,23.4175,7.89583,27.55,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,7.89583,28.66,,percent of total billed charges,,
SUTURE POLYSORB 4-0 VIOLET 30IN V-20,,A4649,HCPCS,Facility,Outpatient,,,,27.55,23.4175,7.89583,27.55,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),13.4995,49,,percent of total billed charges,,
SUTURE POLYSORB 4-0 VIOLET 30IN V-20,,A4649,HCPCS,Facility,Inpatient,,,,27.55,23.4175,7.89583,27.55,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
SUTURE POLYSORB 4-0 VIOLET 30IN V-20,,A4649,HCPCS,Facility,Both,,,,27.55,23.4175,7.89583,27.55,CorVel,Worker's Compensation,27.55,100,,percent of total billed charges,,
SUTURE POLYSORB 4-0 VIOLET 30IN V-20,,A4649,HCPCS,Facility,Both,,,,27.55,23.4175,7.89583,27.55,First Health Group Corporation,First Health Network,26.7235,97,,percent of total billed charges,,
SUTURE POLYSORB 4-0 VIOLET 30IN V-20,,A4649,HCPCS,Facility,Both,,,,27.55,23.4175,7.89583,27.55,"Health Partners, Inc.",Commercial,26.0623,94.6,,percent of total billed charges,,
SUTURE POLYSORB 4-0 VIOLET 30IN V-20,,A4649,HCPCS,Facility,Outpatient,,,,27.55,23.4175,7.89583,27.55,"Health Partners, Inc.",Medicare Advantage,13.4995,49,,percent of total billed charges,,
SUTURE POLYSORB 4-0 VIOLET 30IN V-20,,A4649,HCPCS,Facility,Inpatient,,,,27.55,23.4175,7.89583,27.55,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE POLYSORB 4-0 VIOLET 30IN V-20,,A4649,HCPCS,Facility,Both,,,,27.55,23.4175,7.89583,27.55,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),16.53,60,,percent of total billed charges,,
SUTURE POLYSORB 4-0 VIOLET 30IN V-20,,A4649,HCPCS,Facility,Both,,,,27.55,23.4175,7.89583,27.55,"Health Partners, Inc.",State of Minnesota Advantage Program,22.45325,81.5,,percent of total billed charges,,
SUTURE POLYSORB 4-0 VIOLET 30IN V-20,,A4649,HCPCS,Facility,Both,,,,27.55,23.4175,7.89583,27.55,"Health Partners, Inc.",State Public Programs,13.775,50,,percent of total billed charges,,
SUTURE POLYSORB 4-0 VIOLET 30IN V-20,,A4649,HCPCS,Facility,Both,,,,27.55,23.4175,7.89583,27.55,Humana Insurance Company,Commercial PPO,26.1725,95,,percent of total billed charges,,
SUTURE POLYSORB 4-0 VIOLET 30IN V-20,,A4649,HCPCS,Facility,Outpatient,,,,27.55,23.4175,7.89583,27.55,Humana Insurance Company,Medicare PPO,13.4995,49,,percent of total billed charges,,
SUTURE POLYSORB 4-0 VIOLET 30IN V-20,,A4649,HCPCS,Facility,Inpatient,,,,27.55,23.4175,7.89583,27.55,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
SUTURE POLYSORB 4-0 VIOLET 30IN V-20,,A4649,HCPCS,Facility,Both,,,,27.55,23.4175,7.89583,27.55,Medica,Individual & Family,27.30205,99.1,,percent of total billed charges,,
SUTURE POLYSORB 4-0 VIOLET 30IN V-20,,A4649,HCPCS,Facility,Outpatient,,,,27.55,23.4175,7.89583,27.55,Medica,Medica Advantage Solution,13.7199,49.8,,percent of total billed charges,,
SUTURE POLYSORB 4-0 VIOLET 30IN V-20,,A4649,HCPCS,Facility,Inpatient,,,,27.55,23.4175,7.89583,27.55,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
SUTURE POLYSORB 4-0 VIOLET 30IN V-20,,A4649,HCPCS,Facility,Outpatient,,,,27.55,23.4175,7.89583,27.55,Medica,Medical Assistance,12.2873,44.6,,percent of total billed charges,,
SUTURE POLYSORB 4-0 VIOLET 30IN V-20,,A4649,HCPCS,Facility,Inpatient,,,,27.55,23.4175,7.89583,27.55,Medica,Medical Assistance,,,,,Included in per diem rate,
SUTURE POLYSORB 4-0 VIOLET 30IN V-20,,A4649,HCPCS,Facility,Outpatient,,,,27.55,23.4175,7.89583,27.55,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,13.7199,49.8,,percent of total billed charges,,
SUTURE POLYSORB 4-0 VIOLET 30IN V-20,,A4649,HCPCS,Facility,Inpatient,,,,27.55,23.4175,7.89583,27.55,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
SUTURE POLYSORB 4-0 VIOLET 30IN V-20,,A4649,HCPCS,Facility,Both,,,,27.55,23.4175,7.89583,27.55,"Multiplan, Inc.","Multiplan, Inc.",25.897,94,,percent of total billed charges,,
SUTURE POLYSORB 4-0 VIOLET 30IN V-20,,A4649,HCPCS,Facility,Outpatient,,,,27.55,23.4175,7.89583,27.55,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,24.82255,90.1,,percent of total billed charges,,
SUTURE POLYSORB 4-0 VIOLET 30IN V-20,,A4649,HCPCS,Facility,Inpatient,,,,27.55,23.4175,7.89583,27.55,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
SUTURE POLYSORB 4-0 VIOLET 30IN V-20,,A4649,HCPCS,Facility,Both,,,,27.55,23.4175,7.89583,27.55,"Preferred One Administrative Services, INC.",PPO,27.1643,98.6,,percent of total billed charges,,
SUTURE POLYSORB 4-0 VIOLET 30IN V-20,,A4649,HCPCS,Facility,Outpatient,,,,27.55,23.4175,7.89583,27.55,PrimeWest Health,Minnesota Senior Health Options (MSHO),14.174475,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
SUTURE POLYSORB 4-0 VIOLET 30IN V-20,,A4649,HCPCS,Facility,Inpatient,,,,27.55,23.4175,7.89583,27.55,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE POLYSORB 4-0 VIOLET 30IN V-20,,A4649,HCPCS,Facility,Outpatient,,,,27.55,23.4175,7.89583,27.55,PrimeWest Health,MinnesotaCare,14.14968,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
SUTURE POLYSORB 4-0 VIOLET 30IN V-20,,A4649,HCPCS,Facility,Inpatient,,,,27.55,23.4175,7.89583,27.55,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
SUTURE POLYSORB 4-0 VIOLET 30IN V-20,,A4649,HCPCS,Facility,Both,,,,27.55,23.4175,7.89583,27.55,Sanford Health Plan,Sanford Health Plan,25.346,92,,percent of total billed charges,,
SUTURE POLYSORB 4-0 VIOLET 30IN V-20,,A4649,HCPCS,Facility,Outpatient,,,,27.55,23.4175,7.89583,27.55,"UCare Health, Inc.",Individual & Family Plan,15.524425,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
SUTURE POLYSORB 4-0 VIOLET 30IN V-20,,A4649,HCPCS,Facility,Inpatient,,,,27.55,23.4175,7.89583,27.55,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
SUTURE POLYSORB 4-0 VIOLET 30IN V-20,,A4649,HCPCS,Facility,Outpatient,,,,27.55,23.4175,7.89583,27.55,"UCare Health, Inc.",Medical Assistance,13.904485,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE POLYSORB 4-0 VIOLET 30IN V-20,,A4649,HCPCS,Facility,Inpatient,,,,27.55,23.4175,7.89583,27.55,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
SUTURE POLYSORB 4-0 VIOLET 30IN V-20,,A4649,HCPCS,Facility,Outpatient,,,,27.55,23.4175,7.89583,27.55,"UCare Health, Inc.",Medicare Advantage,13.904485,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE POLYSORB 4-0 VIOLET 30IN V-20,,A4649,HCPCS,Facility,Inpatient,,,,27.55,23.4175,7.89583,27.55,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE POLYSORB 4-0 VIOLET 30IN V-20,,A4649,HCPCS,Facility,Outpatient,,,,27.55,23.4175,7.89583,27.55,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),13.904485,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE POLYSORB 4-0 VIOLET 30IN V-20,,A4649,HCPCS,Facility,Inpatient,,,,27.55,23.4175,7.89583,27.55,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE POLYSORB 4-0 VIOLET 30IN V-20,,A4649,HCPCS,Facility,Both,,,,27.55,23.4175,7.89583,27.55,UnitedHealthcare,Individual & Family,25.897,94,,percent of total billed charges,,
SUTURE POLYSORB 4-0 VIOLET 30IN V-20,,A4649,HCPCS,Facility,Outpatient,,,,27.55,23.4175,7.89583,27.55,UnitedHealthcare,Medicare Advantage,13.4995,49,,percent of total billed charges,,
SUTURE POLYSORB 4-0 VIOLET 30IN V-20,,A4649,HCPCS,Facility,Inpatient,,,,27.55,23.4175,7.89583,27.55,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
SUTURE POLYSORB 4-0 VIOLET 30IN V-20,,A4649,HCPCS,Facility,Outpatient,,,,27.55,23.4175,7.89583,27.55,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,13.224,48,,percent of total billed charges,,100% of DHS outpatient percentage
SUTURE POLYSORB 4-0 VIOLET 30IN V-20,,A4649,HCPCS,Facility,Inpatient,,,,27.55,23.4175,7.89583,27.55,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
SUTURE PROLENE  5-0 P-3   8698G,,A4649,HCPCS,Facility,Both,,,,24.9,21.165,7.13634,24.9,Aetna,Commercial,22.908,92,,percent of total billed charges,,
SUTURE PROLENE  5-0 P-3   8698G,,A4649,HCPCS,Facility,Outpatient,,,,24.9,21.165,7.13634,24.9,Aetna,Medicare Advantage,12.201,49,,percent of total billed charges,,
SUTURE PROLENE  5-0 P-3   8698G,,A4649,HCPCS,Facility,Inpatient,,,,24.9,21.165,7.13634,24.9,Aetna,Medicare Advantage,,,,,Included in per diem rate,
SUTURE PROLENE  5-0 P-3   8698G,,A4649,HCPCS,Facility,Both,,,,24.9,21.165,7.13634,24.9,Aetna,PPO,23.157,93,,percent of total billed charges,,
SUTURE PROLENE  5-0 P-3   8698G,,A4649,HCPCS,Facility,Both,,,,24.9,21.165,7.13634,24.9,America's PPO,America's PPO,23.91147,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SUTURE PROLENE  5-0 P-3   8698G,,A4649,HCPCS,Facility,Both,,,,24.9,21.165,7.13634,24.9,BlueCross BlueShield Minnesota, Federal Employee Program,24.5016,98.4,,percent of total billed charges,,
SUTURE PROLENE  5-0 P-3   8698G,,A4649,HCPCS,Facility,Both,,,,24.9,21.165,7.13634,24.9,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,24.9,100,,percent of total billed charges,,
SUTURE PROLENE  5-0 P-3   8698G,,A4649,HCPCS,Facility,Both,,,,24.9,21.165,7.13634,24.9,BlueCross BlueShield Minnesota,High Value Network Plan,22.41,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
SUTURE PROLENE  5-0 P-3   8698G,,A4649,HCPCS,Facility,Outpatient,,,,24.9,21.165,7.13634,24.9,BlueCross BlueShield Minnesota,Medicare Advantage,12.201,49,,percent of total billed charges,,
SUTURE PROLENE  5-0 P-3   8698G,,A4649,HCPCS,Facility,Inpatient,,,,24.9,21.165,7.13634,24.9,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
SUTURE PROLENE  5-0 P-3   8698G,,A4649,HCPCS,Facility,Both,,,,24.9,21.165,7.13634,24.9,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,22.05393,88.57,,percent of total billed charges,,
SUTURE PROLENE  5-0 P-3   8698G,,A4649,HCPCS,Facility,Both,,,,24.9,21.165,7.13634,24.9,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,7.13634,28.66,,percent of total billed charges,,
SUTURE PROLENE  5-0 P-3   8698G,,A4649,HCPCS,Facility,Outpatient,,,,24.9,21.165,7.13634,24.9,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),12.201,49,,percent of total billed charges,,
SUTURE PROLENE  5-0 P-3   8698G,,A4649,HCPCS,Facility,Inpatient,,,,24.9,21.165,7.13634,24.9,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
SUTURE PROLENE  5-0 P-3   8698G,,A4649,HCPCS,Facility,Both,,,,24.9,21.165,7.13634,24.9,CorVel,Worker's Compensation,24.9,100,,percent of total billed charges,,
SUTURE PROLENE  5-0 P-3   8698G,,A4649,HCPCS,Facility,Both,,,,24.9,21.165,7.13634,24.9,First Health Group Corporation,First Health Network,24.153,97,,percent of total billed charges,,
SUTURE PROLENE  5-0 P-3   8698G,,A4649,HCPCS,Facility,Both,,,,24.9,21.165,7.13634,24.9,"Health Partners, Inc.",Commercial,23.5554,94.6,,percent of total billed charges,,
SUTURE PROLENE  5-0 P-3   8698G,,A4649,HCPCS,Facility,Outpatient,,,,24.9,21.165,7.13634,24.9,"Health Partners, Inc.",Medicare Advantage,12.201,49,,percent of total billed charges,,
SUTURE PROLENE  5-0 P-3   8698G,,A4649,HCPCS,Facility,Inpatient,,,,24.9,21.165,7.13634,24.9,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE PROLENE  5-0 P-3   8698G,,A4649,HCPCS,Facility,Both,,,,24.9,21.165,7.13634,24.9,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),14.94,60,,percent of total billed charges,,
SUTURE PROLENE  5-0 P-3   8698G,,A4649,HCPCS,Facility,Both,,,,24.9,21.165,7.13634,24.9,"Health Partners, Inc.",State of Minnesota Advantage Program,20.2935,81.5,,percent of total billed charges,,
SUTURE PROLENE  5-0 P-3   8698G,,A4649,HCPCS,Facility,Both,,,,24.9,21.165,7.13634,24.9,"Health Partners, Inc.",State Public Programs,12.45,50,,percent of total billed charges,,
SUTURE PROLENE  5-0 P-3   8698G,,A4649,HCPCS,Facility,Both,,,,24.9,21.165,7.13634,24.9,Humana Insurance Company,Commercial PPO,23.655,95,,percent of total billed charges,,
SUTURE PROLENE  5-0 P-3   8698G,,A4649,HCPCS,Facility,Outpatient,,,,24.9,21.165,7.13634,24.9,Humana Insurance Company,Medicare PPO,12.201,49,,percent of total billed charges,,
SUTURE PROLENE  5-0 P-3   8698G,,A4649,HCPCS,Facility,Inpatient,,,,24.9,21.165,7.13634,24.9,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
SUTURE PROLENE  5-0 P-3   8698G,,A4649,HCPCS,Facility,Both,,,,24.9,21.165,7.13634,24.9,Medica,Individual & Family,24.6759,99.1,,percent of total billed charges,,
SUTURE PROLENE  5-0 P-3   8698G,,A4649,HCPCS,Facility,Outpatient,,,,24.9,21.165,7.13634,24.9,Medica,Medica Advantage Solution,12.4002,49.8,,percent of total billed charges,,
SUTURE PROLENE  5-0 P-3   8698G,,A4649,HCPCS,Facility,Inpatient,,,,24.9,21.165,7.13634,24.9,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
SUTURE PROLENE  5-0 P-3   8698G,,A4649,HCPCS,Facility,Outpatient,,,,24.9,21.165,7.13634,24.9,Medica,Medical Assistance,11.1054,44.6,,percent of total billed charges,,
SUTURE PROLENE  5-0 P-3   8698G,,A4649,HCPCS,Facility,Inpatient,,,,24.9,21.165,7.13634,24.9,Medica,Medical Assistance,,,,,Included in per diem rate,
SUTURE PROLENE  5-0 P-3   8698G,,A4649,HCPCS,Facility,Outpatient,,,,24.9,21.165,7.13634,24.9,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,12.4002,49.8,,percent of total billed charges,,
SUTURE PROLENE  5-0 P-3   8698G,,A4649,HCPCS,Facility,Inpatient,,,,24.9,21.165,7.13634,24.9,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
SUTURE PROLENE  5-0 P-3   8698G,,A4649,HCPCS,Facility,Both,,,,24.9,21.165,7.13634,24.9,"Multiplan, Inc.","Multiplan, Inc.",23.406,94,,percent of total billed charges,,
SUTURE PROLENE  5-0 P-3   8698G,,A4649,HCPCS,Facility,Outpatient,,,,24.9,21.165,7.13634,24.9,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,22.4349,90.1,,percent of total billed charges,,
SUTURE PROLENE  5-0 P-3   8698G,,A4649,HCPCS,Facility,Inpatient,,,,24.9,21.165,7.13634,24.9,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
SUTURE PROLENE  5-0 P-3   8698G,,A4649,HCPCS,Facility,Both,,,,24.9,21.165,7.13634,24.9,"Preferred One Administrative Services, INC.",PPO,24.5514,98.6,,percent of total billed charges,,
SUTURE PROLENE  5-0 P-3   8698G,,A4649,HCPCS,Facility,Outpatient,,,,24.9,21.165,7.13634,24.9,PrimeWest Health,Minnesota Senior Health Options (MSHO),12.81105,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
SUTURE PROLENE  5-0 P-3   8698G,,A4649,HCPCS,Facility,Inpatient,,,,24.9,21.165,7.13634,24.9,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE PROLENE  5-0 P-3   8698G,,A4649,HCPCS,Facility,Outpatient,,,,24.9,21.165,7.13634,24.9,PrimeWest Health,MinnesotaCare,12.78864,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
SUTURE PROLENE  5-0 P-3   8698G,,A4649,HCPCS,Facility,Inpatient,,,,24.9,21.165,7.13634,24.9,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
SUTURE PROLENE  5-0 P-3   8698G,,A4649,HCPCS,Facility,Both,,,,24.9,21.165,7.13634,24.9,Sanford Health Plan,Sanford Health Plan,22.908,92,,percent of total billed charges,,
SUTURE PROLENE  5-0 P-3   8698G,,A4649,HCPCS,Facility,Outpatient,,,,24.9,21.165,7.13634,24.9,"UCare Health, Inc.",Individual & Family Plan,14.03115,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
SUTURE PROLENE  5-0 P-3   8698G,,A4649,HCPCS,Facility,Inpatient,,,,24.9,21.165,7.13634,24.9,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
SUTURE PROLENE  5-0 P-3   8698G,,A4649,HCPCS,Facility,Outpatient,,,,24.9,21.165,7.13634,24.9,"UCare Health, Inc.",Medical Assistance,12.56703,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE PROLENE  5-0 P-3   8698G,,A4649,HCPCS,Facility,Inpatient,,,,24.9,21.165,7.13634,24.9,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
SUTURE PROLENE  5-0 P-3   8698G,,A4649,HCPCS,Facility,Outpatient,,,,24.9,21.165,7.13634,24.9,"UCare Health, Inc.",Medicare Advantage,12.56703,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE PROLENE  5-0 P-3   8698G,,A4649,HCPCS,Facility,Inpatient,,,,24.9,21.165,7.13634,24.9,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE PROLENE  5-0 P-3   8698G,,A4649,HCPCS,Facility,Outpatient,,,,24.9,21.165,7.13634,24.9,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),12.56703,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE PROLENE  5-0 P-3   8698G,,A4649,HCPCS,Facility,Inpatient,,,,24.9,21.165,7.13634,24.9,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE PROLENE  5-0 P-3   8698G,,A4649,HCPCS,Facility,Both,,,,24.9,21.165,7.13634,24.9,UnitedHealthcare,Individual & Family,23.406,94,,percent of total billed charges,,
SUTURE PROLENE  5-0 P-3   8698G,,A4649,HCPCS,Facility,Outpatient,,,,24.9,21.165,7.13634,24.9,UnitedHealthcare,Medicare Advantage,12.201,49,,percent of total billed charges,,
SUTURE PROLENE  5-0 P-3   8698G,,A4649,HCPCS,Facility,Inpatient,,,,24.9,21.165,7.13634,24.9,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
SUTURE PROLENE  5-0 P-3   8698G,,A4649,HCPCS,Facility,Outpatient,,,,24.9,21.165,7.13634,24.9,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,11.952,48,,percent of total billed charges,,100% of DHS outpatient percentage
SUTURE PROLENE  5-0 P-3   8698G,,A4649,HCPCS,Facility,Inpatient,,,,24.9,21.165,7.13634,24.9,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
SUTURE PROLENE  6-0 P-1     8606G,,A4649,HCPCS,Facility,Both,,,,31.7,26.945,9.08522,31.7,Aetna,Commercial,29.164,92,,percent of total billed charges,,
SUTURE PROLENE  6-0 P-1     8606G,,A4649,HCPCS,Facility,Outpatient,,,,31.7,26.945,9.08522,31.7,Aetna,Medicare Advantage,15.533,49,,percent of total billed charges,,
SUTURE PROLENE  6-0 P-1     8606G,,A4649,HCPCS,Facility,Inpatient,,,,31.7,26.945,9.08522,31.7,Aetna,Medicare Advantage,,,,,Included in per diem rate,
SUTURE PROLENE  6-0 P-1     8606G,,A4649,HCPCS,Facility,Both,,,,31.7,26.945,9.08522,31.7,Aetna,PPO,29.481,93,,percent of total billed charges,,
SUTURE PROLENE  6-0 P-1     8606G,,A4649,HCPCS,Facility,Both,,,,31.7,26.945,9.08522,31.7,America's PPO,America's PPO,30.44151,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SUTURE PROLENE  6-0 P-1     8606G,,A4649,HCPCS,Facility,Both,,,,31.7,26.945,9.08522,31.7,BlueCross BlueShield Minnesota, Federal Employee Program,31.1928,98.4,,percent of total billed charges,,
SUTURE PROLENE  6-0 P-1     8606G,,A4649,HCPCS,Facility,Both,,,,31.7,26.945,9.08522,31.7,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,31.7,100,,percent of total billed charges,,
SUTURE PROLENE  6-0 P-1     8606G,,A4649,HCPCS,Facility,Both,,,,31.7,26.945,9.08522,31.7,BlueCross BlueShield Minnesota,High Value Network Plan,28.53,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
SUTURE PROLENE  6-0 P-1     8606G,,A4649,HCPCS,Facility,Outpatient,,,,31.7,26.945,9.08522,31.7,BlueCross BlueShield Minnesota,Medicare Advantage,15.533,49,,percent of total billed charges,,
SUTURE PROLENE  6-0 P-1     8606G,,A4649,HCPCS,Facility,Inpatient,,,,31.7,26.945,9.08522,31.7,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
SUTURE PROLENE  6-0 P-1     8606G,,A4649,HCPCS,Facility,Both,,,,31.7,26.945,9.08522,31.7,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,28.07669,88.57,,percent of total billed charges,,
SUTURE PROLENE  6-0 P-1     8606G,,A4649,HCPCS,Facility,Both,,,,31.7,26.945,9.08522,31.7,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,9.08522,28.66,,percent of total billed charges,,
SUTURE PROLENE  6-0 P-1     8606G,,A4649,HCPCS,Facility,Outpatient,,,,31.7,26.945,9.08522,31.7,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),15.533,49,,percent of total billed charges,,
SUTURE PROLENE  6-0 P-1     8606G,,A4649,HCPCS,Facility,Inpatient,,,,31.7,26.945,9.08522,31.7,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
SUTURE PROLENE  6-0 P-1     8606G,,A4649,HCPCS,Facility,Both,,,,31.7,26.945,9.08522,31.7,CorVel,Worker's Compensation,31.7,100,,percent of total billed charges,,
SUTURE PROLENE  6-0 P-1     8606G,,A4649,HCPCS,Facility,Both,,,,31.7,26.945,9.08522,31.7,First Health Group Corporation,First Health Network,30.749,97,,percent of total billed charges,,
SUTURE PROLENE  6-0 P-1     8606G,,A4649,HCPCS,Facility,Both,,,,31.7,26.945,9.08522,31.7,"Health Partners, Inc.",Commercial,29.9882,94.6,,percent of total billed charges,,
SUTURE PROLENE  6-0 P-1     8606G,,A4649,HCPCS,Facility,Outpatient,,,,31.7,26.945,9.08522,31.7,"Health Partners, Inc.",Medicare Advantage,15.533,49,,percent of total billed charges,,
SUTURE PROLENE  6-0 P-1     8606G,,A4649,HCPCS,Facility,Inpatient,,,,31.7,26.945,9.08522,31.7,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE PROLENE  6-0 P-1     8606G,,A4649,HCPCS,Facility,Both,,,,31.7,26.945,9.08522,31.7,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),19.02,60,,percent of total billed charges,,
SUTURE PROLENE  6-0 P-1     8606G,,A4649,HCPCS,Facility,Both,,,,31.7,26.945,9.08522,31.7,"Health Partners, Inc.",State of Minnesota Advantage Program,25.8355,81.5,,percent of total billed charges,,
SUTURE PROLENE  6-0 P-1     8606G,,A4649,HCPCS,Facility,Both,,,,31.7,26.945,9.08522,31.7,"Health Partners, Inc.",State Public Programs,15.85,50,,percent of total billed charges,,
SUTURE PROLENE  6-0 P-1     8606G,,A4649,HCPCS,Facility,Both,,,,31.7,26.945,9.08522,31.7,Humana Insurance Company,Commercial PPO,30.115,95,,percent of total billed charges,,
SUTURE PROLENE  6-0 P-1     8606G,,A4649,HCPCS,Facility,Outpatient,,,,31.7,26.945,9.08522,31.7,Humana Insurance Company,Medicare PPO,15.533,49,,percent of total billed charges,,
SUTURE PROLENE  6-0 P-1     8606G,,A4649,HCPCS,Facility,Inpatient,,,,31.7,26.945,9.08522,31.7,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
SUTURE PROLENE  6-0 P-1     8606G,,A4649,HCPCS,Facility,Both,,,,31.7,26.945,9.08522,31.7,Medica,Individual & Family,31.4147,99.1,,percent of total billed charges,,
SUTURE PROLENE  6-0 P-1     8606G,,A4649,HCPCS,Facility,Outpatient,,,,31.7,26.945,9.08522,31.7,Medica,Medica Advantage Solution,15.7866,49.8,,percent of total billed charges,,
SUTURE PROLENE  6-0 P-1     8606G,,A4649,HCPCS,Facility,Inpatient,,,,31.7,26.945,9.08522,31.7,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
SUTURE PROLENE  6-0 P-1     8606G,,A4649,HCPCS,Facility,Outpatient,,,,31.7,26.945,9.08522,31.7,Medica,Medical Assistance,14.1382,44.6,,percent of total billed charges,,
SUTURE PROLENE  6-0 P-1     8606G,,A4649,HCPCS,Facility,Inpatient,,,,31.7,26.945,9.08522,31.7,Medica,Medical Assistance,,,,,Included in per diem rate,
SUTURE PROLENE  6-0 P-1     8606G,,A4649,HCPCS,Facility,Outpatient,,,,31.7,26.945,9.08522,31.7,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,15.7866,49.8,,percent of total billed charges,,
SUTURE PROLENE  6-0 P-1     8606G,,A4649,HCPCS,Facility,Inpatient,,,,31.7,26.945,9.08522,31.7,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
SUTURE PROLENE  6-0 P-1     8606G,,A4649,HCPCS,Facility,Both,,,,31.7,26.945,9.08522,31.7,"Multiplan, Inc.","Multiplan, Inc.",29.798,94,,percent of total billed charges,,
SUTURE PROLENE  6-0 P-1     8606G,,A4649,HCPCS,Facility,Outpatient,,,,31.7,26.945,9.08522,31.7,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,28.5617,90.1,,percent of total billed charges,,
SUTURE PROLENE  6-0 P-1     8606G,,A4649,HCPCS,Facility,Inpatient,,,,31.7,26.945,9.08522,31.7,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
SUTURE PROLENE  6-0 P-1     8606G,,A4649,HCPCS,Facility,Both,,,,31.7,26.945,9.08522,31.7,"Preferred One Administrative Services, INC.",PPO,31.2562,98.6,,percent of total billed charges,,
SUTURE PROLENE  6-0 P-1     8606G,,A4649,HCPCS,Facility,Outpatient,,,,31.7,26.945,9.08522,31.7,PrimeWest Health,Minnesota Senior Health Options (MSHO),16.30965,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
SUTURE PROLENE  6-0 P-1     8606G,,A4649,HCPCS,Facility,Inpatient,,,,31.7,26.945,9.08522,31.7,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE PROLENE  6-0 P-1     8606G,,A4649,HCPCS,Facility,Outpatient,,,,31.7,26.945,9.08522,31.7,PrimeWest Health,MinnesotaCare,16.28112,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
SUTURE PROLENE  6-0 P-1     8606G,,A4649,HCPCS,Facility,Inpatient,,,,31.7,26.945,9.08522,31.7,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
SUTURE PROLENE  6-0 P-1     8606G,,A4649,HCPCS,Facility,Both,,,,31.7,26.945,9.08522,31.7,Sanford Health Plan,Sanford Health Plan,29.164,92,,percent of total billed charges,,
SUTURE PROLENE  6-0 P-1     8606G,,A4649,HCPCS,Facility,Outpatient,,,,31.7,26.945,9.08522,31.7,"UCare Health, Inc.",Individual & Family Plan,17.86295,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
SUTURE PROLENE  6-0 P-1     8606G,,A4649,HCPCS,Facility,Inpatient,,,,31.7,26.945,9.08522,31.7,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
SUTURE PROLENE  6-0 P-1     8606G,,A4649,HCPCS,Facility,Outpatient,,,,31.7,26.945,9.08522,31.7,"UCare Health, Inc.",Medical Assistance,15.99899,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE PROLENE  6-0 P-1     8606G,,A4649,HCPCS,Facility,Inpatient,,,,31.7,26.945,9.08522,31.7,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
SUTURE PROLENE  6-0 P-1     8606G,,A4649,HCPCS,Facility,Outpatient,,,,31.7,26.945,9.08522,31.7,"UCare Health, Inc.",Medicare Advantage,15.99899,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE PROLENE  6-0 P-1     8606G,,A4649,HCPCS,Facility,Inpatient,,,,31.7,26.945,9.08522,31.7,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE PROLENE  6-0 P-1     8606G,,A4649,HCPCS,Facility,Outpatient,,,,31.7,26.945,9.08522,31.7,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),15.99899,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE PROLENE  6-0 P-1     8606G,,A4649,HCPCS,Facility,Inpatient,,,,31.7,26.945,9.08522,31.7,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE PROLENE  6-0 P-1     8606G,,A4649,HCPCS,Facility,Both,,,,31.7,26.945,9.08522,31.7,UnitedHealthcare,Individual & Family,29.798,94,,percent of total billed charges,,
SUTURE PROLENE  6-0 P-1     8606G,,A4649,HCPCS,Facility,Outpatient,,,,31.7,26.945,9.08522,31.7,UnitedHealthcare,Medicare Advantage,15.533,49,,percent of total billed charges,,
SUTURE PROLENE  6-0 P-1     8606G,,A4649,HCPCS,Facility,Inpatient,,,,31.7,26.945,9.08522,31.7,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
SUTURE PROLENE  6-0 P-1     8606G,,A4649,HCPCS,Facility,Outpatient,,,,31.7,26.945,9.08522,31.7,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,15.216,48,,percent of total billed charges,,100% of DHS outpatient percentage
SUTURE PROLENE  6-0 P-1     8606G,,A4649,HCPCS,Facility,Inpatient,,,,31.7,26.945,9.08522,31.7,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
SUTURE PROLENE 2-0 8411,,A4649,HCPCS,Facility,Both,,,,57.555,48.92175,16.495263,57.555,Aetna,Commercial,52.9506,92,,percent of total billed charges,,
SUTURE PROLENE 2-0 8411,,A4649,HCPCS,Facility,Outpatient,,,,57.555,48.92175,16.495263,57.555,Aetna,Medicare Advantage,28.20195,49,,percent of total billed charges,,
SUTURE PROLENE 2-0 8411,,A4649,HCPCS,Facility,Inpatient,,,,57.555,48.92175,16.495263,57.555,Aetna,Medicare Advantage,,,,,Included in per diem rate,
SUTURE PROLENE 2-0 8411,,A4649,HCPCS,Facility,Both,,,,57.555,48.92175,16.495263,57.555,Aetna,PPO,53.52615,93,,percent of total billed charges,,
SUTURE PROLENE 2-0 8411,,A4649,HCPCS,Facility,Both,,,,57.555,48.92175,16.495263,57.555,America's PPO,America's PPO,55.2700665,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SUTURE PROLENE 2-0 8411,,A4649,HCPCS,Facility,Both,,,,57.555,48.92175,16.495263,57.555,BlueCross BlueShield Minnesota, Federal Employee Program,56.63412,98.4,,percent of total billed charges,,
SUTURE PROLENE 2-0 8411,,A4649,HCPCS,Facility,Both,,,,57.555,48.92175,16.495263,57.555,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,57.555,100,,percent of total billed charges,,
SUTURE PROLENE 2-0 8411,,A4649,HCPCS,Facility,Both,,,,57.555,48.92175,16.495263,57.555,BlueCross BlueShield Minnesota,High Value Network Plan,51.7995,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
SUTURE PROLENE 2-0 8411,,A4649,HCPCS,Facility,Outpatient,,,,57.555,48.92175,16.495263,57.555,BlueCross BlueShield Minnesota,Medicare Advantage,28.20195,49,,percent of total billed charges,,
SUTURE PROLENE 2-0 8411,,A4649,HCPCS,Facility,Inpatient,,,,57.555,48.92175,16.495263,57.555,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
SUTURE PROLENE 2-0 8411,,A4649,HCPCS,Facility,Both,,,,57.555,48.92175,16.495263,57.555,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,50.9764635,88.57,,percent of total billed charges,,
SUTURE PROLENE 2-0 8411,,A4649,HCPCS,Facility,Both,,,,57.555,48.92175,16.495263,57.555,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,16.495263,28.66,,percent of total billed charges,,
SUTURE PROLENE 2-0 8411,,A4649,HCPCS,Facility,Outpatient,,,,57.555,48.92175,16.495263,57.555,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),28.20195,49,,percent of total billed charges,,
SUTURE PROLENE 2-0 8411,,A4649,HCPCS,Facility,Inpatient,,,,57.555,48.92175,16.495263,57.555,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
SUTURE PROLENE 2-0 8411,,A4649,HCPCS,Facility,Both,,,,57.555,48.92175,16.495263,57.555,CorVel,Worker's Compensation,57.555,100,,percent of total billed charges,,
SUTURE PROLENE 2-0 8411,,A4649,HCPCS,Facility,Both,,,,57.555,48.92175,16.495263,57.555,First Health Group Corporation,First Health Network,55.82835,97,,percent of total billed charges,,
SUTURE PROLENE 2-0 8411,,A4649,HCPCS,Facility,Both,,,,57.555,48.92175,16.495263,57.555,"Health Partners, Inc.",Commercial,54.44703,94.6,,percent of total billed charges,,
SUTURE PROLENE 2-0 8411,,A4649,HCPCS,Facility,Outpatient,,,,57.555,48.92175,16.495263,57.555,"Health Partners, Inc.",Medicare Advantage,28.20195,49,,percent of total billed charges,,
SUTURE PROLENE 2-0 8411,,A4649,HCPCS,Facility,Inpatient,,,,57.555,48.92175,16.495263,57.555,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE PROLENE 2-0 8411,,A4649,HCPCS,Facility,Both,,,,57.555,48.92175,16.495263,57.555,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),34.533,60,,percent of total billed charges,,
SUTURE PROLENE 2-0 8411,,A4649,HCPCS,Facility,Both,,,,57.555,48.92175,16.495263,57.555,"Health Partners, Inc.",State of Minnesota Advantage Program,46.907325,81.5,,percent of total billed charges,,
SUTURE PROLENE 2-0 8411,,A4649,HCPCS,Facility,Both,,,,57.555,48.92175,16.495263,57.555,"Health Partners, Inc.",State Public Programs,28.7775,50,,percent of total billed charges,,
SUTURE PROLENE 2-0 8411,,A4649,HCPCS,Facility,Both,,,,57.555,48.92175,16.495263,57.555,Humana Insurance Company,Commercial PPO,54.67725,95,,percent of total billed charges,,
SUTURE PROLENE 2-0 8411,,A4649,HCPCS,Facility,Outpatient,,,,57.555,48.92175,16.495263,57.555,Humana Insurance Company,Medicare PPO,28.20195,49,,percent of total billed charges,,
SUTURE PROLENE 2-0 8411,,A4649,HCPCS,Facility,Inpatient,,,,57.555,48.92175,16.495263,57.555,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
SUTURE PROLENE 2-0 8411,,A4649,HCPCS,Facility,Both,,,,57.555,48.92175,16.495263,57.555,Medica,Individual & Family,57.037005,99.1,,percent of total billed charges,,
SUTURE PROLENE 2-0 8411,,A4649,HCPCS,Facility,Outpatient,,,,57.555,48.92175,16.495263,57.555,Medica,Medica Advantage Solution,28.66239,49.8,,percent of total billed charges,,
SUTURE PROLENE 2-0 8411,,A4649,HCPCS,Facility,Inpatient,,,,57.555,48.92175,16.495263,57.555,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
SUTURE PROLENE 2-0 8411,,A4649,HCPCS,Facility,Outpatient,,,,57.555,48.92175,16.495263,57.555,Medica,Medical Assistance,25.66953,44.6,,percent of total billed charges,,
SUTURE PROLENE 2-0 8411,,A4649,HCPCS,Facility,Inpatient,,,,57.555,48.92175,16.495263,57.555,Medica,Medical Assistance,,,,,Included in per diem rate,
SUTURE PROLENE 2-0 8411,,A4649,HCPCS,Facility,Outpatient,,,,57.555,48.92175,16.495263,57.555,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,28.66239,49.8,,percent of total billed charges,,
SUTURE PROLENE 2-0 8411,,A4649,HCPCS,Facility,Inpatient,,,,57.555,48.92175,16.495263,57.555,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
SUTURE PROLENE 2-0 8411,,A4649,HCPCS,Facility,Both,,,,57.555,48.92175,16.495263,57.555,"Multiplan, Inc.","Multiplan, Inc.",54.1017,94,,percent of total billed charges,,
SUTURE PROLENE 2-0 8411,,A4649,HCPCS,Facility,Outpatient,,,,57.555,48.92175,16.495263,57.555,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,51.857055,90.1,,percent of total billed charges,,
SUTURE PROLENE 2-0 8411,,A4649,HCPCS,Facility,Inpatient,,,,57.555,48.92175,16.495263,57.555,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
SUTURE PROLENE 2-0 8411,,A4649,HCPCS,Facility,Both,,,,57.555,48.92175,16.495263,57.555,"Preferred One Administrative Services, INC.",PPO,56.74923,98.6,,percent of total billed charges,,
SUTURE PROLENE 2-0 8411,,A4649,HCPCS,Facility,Outpatient,,,,57.555,48.92175,16.495263,57.555,PrimeWest Health,Minnesota Senior Health Options (MSHO),29.6120475,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
SUTURE PROLENE 2-0 8411,,A4649,HCPCS,Facility,Inpatient,,,,57.555,48.92175,16.495263,57.555,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE PROLENE 2-0 8411,,A4649,HCPCS,Facility,Outpatient,,,,57.555,48.92175,16.495263,57.555,PrimeWest Health,MinnesotaCare,29.560248,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
SUTURE PROLENE 2-0 8411,,A4649,HCPCS,Facility,Inpatient,,,,57.555,48.92175,16.495263,57.555,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
SUTURE PROLENE 2-0 8411,,A4649,HCPCS,Facility,Both,,,,57.555,48.92175,16.495263,57.555,Sanford Health Plan,Sanford Health Plan,52.9506,92,,percent of total billed charges,,
SUTURE PROLENE 2-0 8411,,A4649,HCPCS,Facility,Outpatient,,,,57.555,48.92175,16.495263,57.555,"UCare Health, Inc.",Individual & Family Plan,32.4322425,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
SUTURE PROLENE 2-0 8411,,A4649,HCPCS,Facility,Inpatient,,,,57.555,48.92175,16.495263,57.555,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
SUTURE PROLENE 2-0 8411,,A4649,HCPCS,Facility,Outpatient,,,,57.555,48.92175,16.495263,57.555,"UCare Health, Inc.",Medical Assistance,29.0480085,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE PROLENE 2-0 8411,,A4649,HCPCS,Facility,Inpatient,,,,57.555,48.92175,16.495263,57.555,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
SUTURE PROLENE 2-0 8411,,A4649,HCPCS,Facility,Outpatient,,,,57.555,48.92175,16.495263,57.555,"UCare Health, Inc.",Medicare Advantage,29.0480085,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE PROLENE 2-0 8411,,A4649,HCPCS,Facility,Inpatient,,,,57.555,48.92175,16.495263,57.555,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE PROLENE 2-0 8411,,A4649,HCPCS,Facility,Outpatient,,,,57.555,48.92175,16.495263,57.555,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),29.0480085,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE PROLENE 2-0 8411,,A4649,HCPCS,Facility,Inpatient,,,,57.555,48.92175,16.495263,57.555,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE PROLENE 2-0 8411,,A4649,HCPCS,Facility,Both,,,,57.555,48.92175,16.495263,57.555,UnitedHealthcare,Individual & Family,54.1017,94,,percent of total billed charges,,
SUTURE PROLENE 2-0 8411,,A4649,HCPCS,Facility,Outpatient,,,,57.555,48.92175,16.495263,57.555,UnitedHealthcare,Medicare Advantage,28.20195,49,,percent of total billed charges,,
SUTURE PROLENE 2-0 8411,,A4649,HCPCS,Facility,Inpatient,,,,57.555,48.92175,16.495263,57.555,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
SUTURE PROLENE 2-0 8411,,A4649,HCPCS,Facility,Outpatient,,,,57.555,48.92175,16.495263,57.555,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,27.6264,48,,percent of total billed charges,,100% of DHS outpatient percentage
SUTURE PROLENE 2-0 8411,,A4649,HCPCS,Facility,Inpatient,,,,57.555,48.92175,16.495263,57.555,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
SUTURE PROLENE 4-0 8634G,,A4649,HCPCS,Facility,Both,,,,30.7,26.095,8.79862,30.7,Aetna,Commercial,28.244,92,,percent of total billed charges,,
SUTURE PROLENE 4-0 8634G,,A4649,HCPCS,Facility,Outpatient,,,,30.7,26.095,8.79862,30.7,Aetna,Medicare Advantage,15.043,49,,percent of total billed charges,,
SUTURE PROLENE 4-0 8634G,,A4649,HCPCS,Facility,Inpatient,,,,30.7,26.095,8.79862,30.7,Aetna,Medicare Advantage,,,,,Included in per diem rate,
SUTURE PROLENE 4-0 8634G,,A4649,HCPCS,Facility,Both,,,,30.7,26.095,8.79862,30.7,Aetna,PPO,28.551,93,,percent of total billed charges,,
SUTURE PROLENE 4-0 8634G,,A4649,HCPCS,Facility,Both,,,,30.7,26.095,8.79862,30.7,America's PPO,America's PPO,29.48121,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SUTURE PROLENE 4-0 8634G,,A4649,HCPCS,Facility,Both,,,,30.7,26.095,8.79862,30.7,BlueCross BlueShield Minnesota, Federal Employee Program,30.2088,98.4,,percent of total billed charges,,
SUTURE PROLENE 4-0 8634G,,A4649,HCPCS,Facility,Both,,,,30.7,26.095,8.79862,30.7,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,30.7,100,,percent of total billed charges,,
SUTURE PROLENE 4-0 8634G,,A4649,HCPCS,Facility,Both,,,,30.7,26.095,8.79862,30.7,BlueCross BlueShield Minnesota,High Value Network Plan,27.63,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
SUTURE PROLENE 4-0 8634G,,A4649,HCPCS,Facility,Outpatient,,,,30.7,26.095,8.79862,30.7,BlueCross BlueShield Minnesota,Medicare Advantage,15.043,49,,percent of total billed charges,,
SUTURE PROLENE 4-0 8634G,,A4649,HCPCS,Facility,Inpatient,,,,30.7,26.095,8.79862,30.7,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
SUTURE PROLENE 4-0 8634G,,A4649,HCPCS,Facility,Both,,,,30.7,26.095,8.79862,30.7,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,27.19099,88.57,,percent of total billed charges,,
SUTURE PROLENE 4-0 8634G,,A4649,HCPCS,Facility,Both,,,,30.7,26.095,8.79862,30.7,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,8.79862,28.66,,percent of total billed charges,,
SUTURE PROLENE 4-0 8634G,,A4649,HCPCS,Facility,Outpatient,,,,30.7,26.095,8.79862,30.7,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),15.043,49,,percent of total billed charges,,
SUTURE PROLENE 4-0 8634G,,A4649,HCPCS,Facility,Inpatient,,,,30.7,26.095,8.79862,30.7,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
SUTURE PROLENE 4-0 8634G,,A4649,HCPCS,Facility,Both,,,,30.7,26.095,8.79862,30.7,CorVel,Worker's Compensation,30.7,100,,percent of total billed charges,,
SUTURE PROLENE 4-0 8634G,,A4649,HCPCS,Facility,Both,,,,30.7,26.095,8.79862,30.7,First Health Group Corporation,First Health Network,29.779,97,,percent of total billed charges,,
SUTURE PROLENE 4-0 8634G,,A4649,HCPCS,Facility,Both,,,,30.7,26.095,8.79862,30.7,"Health Partners, Inc.",Commercial,29.0422,94.6,,percent of total billed charges,,
SUTURE PROLENE 4-0 8634G,,A4649,HCPCS,Facility,Outpatient,,,,30.7,26.095,8.79862,30.7,"Health Partners, Inc.",Medicare Advantage,15.043,49,,percent of total billed charges,,
SUTURE PROLENE 4-0 8634G,,A4649,HCPCS,Facility,Inpatient,,,,30.7,26.095,8.79862,30.7,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE PROLENE 4-0 8634G,,A4649,HCPCS,Facility,Both,,,,30.7,26.095,8.79862,30.7,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),18.42,60,,percent of total billed charges,,
SUTURE PROLENE 4-0 8634G,,A4649,HCPCS,Facility,Both,,,,30.7,26.095,8.79862,30.7,"Health Partners, Inc.",State of Minnesota Advantage Program,25.0205,81.5,,percent of total billed charges,,
SUTURE PROLENE 4-0 8634G,,A4649,HCPCS,Facility,Both,,,,30.7,26.095,8.79862,30.7,"Health Partners, Inc.",State Public Programs,15.35,50,,percent of total billed charges,,
SUTURE PROLENE 4-0 8634G,,A4649,HCPCS,Facility,Both,,,,30.7,26.095,8.79862,30.7,Humana Insurance Company,Commercial PPO,29.165,95,,percent of total billed charges,,
SUTURE PROLENE 4-0 8634G,,A4649,HCPCS,Facility,Outpatient,,,,30.7,26.095,8.79862,30.7,Humana Insurance Company,Medicare PPO,15.043,49,,percent of total billed charges,,
SUTURE PROLENE 4-0 8634G,,A4649,HCPCS,Facility,Inpatient,,,,30.7,26.095,8.79862,30.7,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
SUTURE PROLENE 4-0 8634G,,A4649,HCPCS,Facility,Both,,,,30.7,26.095,8.79862,30.7,Medica,Individual & Family,30.4237,99.1,,percent of total billed charges,,
SUTURE PROLENE 4-0 8634G,,A4649,HCPCS,Facility,Outpatient,,,,30.7,26.095,8.79862,30.7,Medica,Medica Advantage Solution,15.2886,49.8,,percent of total billed charges,,
SUTURE PROLENE 4-0 8634G,,A4649,HCPCS,Facility,Inpatient,,,,30.7,26.095,8.79862,30.7,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
SUTURE PROLENE 4-0 8634G,,A4649,HCPCS,Facility,Outpatient,,,,30.7,26.095,8.79862,30.7,Medica,Medical Assistance,13.6922,44.6,,percent of total billed charges,,
SUTURE PROLENE 4-0 8634G,,A4649,HCPCS,Facility,Inpatient,,,,30.7,26.095,8.79862,30.7,Medica,Medical Assistance,,,,,Included in per diem rate,
SUTURE PROLENE 4-0 8634G,,A4649,HCPCS,Facility,Outpatient,,,,30.7,26.095,8.79862,30.7,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,15.2886,49.8,,percent of total billed charges,,
SUTURE PROLENE 4-0 8634G,,A4649,HCPCS,Facility,Inpatient,,,,30.7,26.095,8.79862,30.7,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
SUTURE PROLENE 4-0 8634G,,A4649,HCPCS,Facility,Both,,,,30.7,26.095,8.79862,30.7,"Multiplan, Inc.","Multiplan, Inc.",28.858,94,,percent of total billed charges,,
SUTURE PROLENE 4-0 8634G,,A4649,HCPCS,Facility,Outpatient,,,,30.7,26.095,8.79862,30.7,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,27.6607,90.1,,percent of total billed charges,,
SUTURE PROLENE 4-0 8634G,,A4649,HCPCS,Facility,Inpatient,,,,30.7,26.095,8.79862,30.7,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
SUTURE PROLENE 4-0 8634G,,A4649,HCPCS,Facility,Both,,,,30.7,26.095,8.79862,30.7,"Preferred One Administrative Services, INC.",PPO,30.2702,98.6,,percent of total billed charges,,
SUTURE PROLENE 4-0 8634G,,A4649,HCPCS,Facility,Outpatient,,,,30.7,26.095,8.79862,30.7,PrimeWest Health,Minnesota Senior Health Options (MSHO),15.79515,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
SUTURE PROLENE 4-0 8634G,,A4649,HCPCS,Facility,Inpatient,,,,30.7,26.095,8.79862,30.7,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE PROLENE 4-0 8634G,,A4649,HCPCS,Facility,Outpatient,,,,30.7,26.095,8.79862,30.7,PrimeWest Health,MinnesotaCare,15.76752,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
SUTURE PROLENE 4-0 8634G,,A4649,HCPCS,Facility,Inpatient,,,,30.7,26.095,8.79862,30.7,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
SUTURE PROLENE 4-0 8634G,,A4649,HCPCS,Facility,Both,,,,30.7,26.095,8.79862,30.7,Sanford Health Plan,Sanford Health Plan,28.244,92,,percent of total billed charges,,
SUTURE PROLENE 4-0 8634G,,A4649,HCPCS,Facility,Outpatient,,,,30.7,26.095,8.79862,30.7,"UCare Health, Inc.",Individual & Family Plan,17.29945,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
SUTURE PROLENE 4-0 8634G,,A4649,HCPCS,Facility,Inpatient,,,,30.7,26.095,8.79862,30.7,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
SUTURE PROLENE 4-0 8634G,,A4649,HCPCS,Facility,Outpatient,,,,30.7,26.095,8.79862,30.7,"UCare Health, Inc.",Medical Assistance,15.49429,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE PROLENE 4-0 8634G,,A4649,HCPCS,Facility,Inpatient,,,,30.7,26.095,8.79862,30.7,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
SUTURE PROLENE 4-0 8634G,,A4649,HCPCS,Facility,Outpatient,,,,30.7,26.095,8.79862,30.7,"UCare Health, Inc.",Medicare Advantage,15.49429,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE PROLENE 4-0 8634G,,A4649,HCPCS,Facility,Inpatient,,,,30.7,26.095,8.79862,30.7,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE PROLENE 4-0 8634G,,A4649,HCPCS,Facility,Outpatient,,,,30.7,26.095,8.79862,30.7,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),15.49429,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE PROLENE 4-0 8634G,,A4649,HCPCS,Facility,Inpatient,,,,30.7,26.095,8.79862,30.7,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE PROLENE 4-0 8634G,,A4649,HCPCS,Facility,Both,,,,30.7,26.095,8.79862,30.7,UnitedHealthcare,Individual & Family,28.858,94,,percent of total billed charges,,
SUTURE PROLENE 4-0 8634G,,A4649,HCPCS,Facility,Outpatient,,,,30.7,26.095,8.79862,30.7,UnitedHealthcare,Medicare Advantage,15.043,49,,percent of total billed charges,,
SUTURE PROLENE 4-0 8634G,,A4649,HCPCS,Facility,Inpatient,,,,30.7,26.095,8.79862,30.7,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
SUTURE PROLENE 4-0 8634G,,A4649,HCPCS,Facility,Outpatient,,,,30.7,26.095,8.79862,30.7,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,14.736,48,,percent of total billed charges,,100% of DHS outpatient percentage
SUTURE PROLENE 4-0 8634G,,A4649,HCPCS,Facility,Inpatient,,,,30.7,26.095,8.79862,30.7,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
SUTURE Prolene 6-0,,A4649,HCPCS,Facility,Both,,,,31,26.35,8.8846,31,Aetna,Commercial,28.52,92,,percent of total billed charges,,
SUTURE Prolene 6-0,,A4649,HCPCS,Facility,Outpatient,,,,31,26.35,8.8846,31,Aetna,Medicare Advantage,15.19,49,,percent of total billed charges,,
SUTURE Prolene 6-0,,A4649,HCPCS,Facility,Inpatient,,,,31,26.35,8.8846,31,Aetna,Medicare Advantage,,,,,Included in per diem rate,
SUTURE Prolene 6-0,,A4649,HCPCS,Facility,Both,,,,31,26.35,8.8846,31,Aetna,PPO,28.83,93,,percent of total billed charges,,
SUTURE Prolene 6-0,,A4649,HCPCS,Facility,Both,,,,31,26.35,8.8846,31,America's PPO,America's PPO,29.7693,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SUTURE Prolene 6-0,,A4649,HCPCS,Facility,Both,,,,31,26.35,8.8846,31,BlueCross BlueShield Minnesota, Federal Employee Program,30.504,98.4,,percent of total billed charges,,
SUTURE Prolene 6-0,,A4649,HCPCS,Facility,Both,,,,31,26.35,8.8846,31,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,31,100,,percent of total billed charges,,
SUTURE Prolene 6-0,,A4649,HCPCS,Facility,Both,,,,31,26.35,8.8846,31,BlueCross BlueShield Minnesota,High Value Network Plan,27.9,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
SUTURE Prolene 6-0,,A4649,HCPCS,Facility,Outpatient,,,,31,26.35,8.8846,31,BlueCross BlueShield Minnesota,Medicare Advantage,15.19,49,,percent of total billed charges,,
SUTURE Prolene 6-0,,A4649,HCPCS,Facility,Inpatient,,,,31,26.35,8.8846,31,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
SUTURE Prolene 6-0,,A4649,HCPCS,Facility,Both,,,,31,26.35,8.8846,31,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,27.4567,88.57,,percent of total billed charges,,
SUTURE Prolene 6-0,,A4649,HCPCS,Facility,Both,,,,31,26.35,8.8846,31,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,8.8846,28.66,,percent of total billed charges,,
SUTURE Prolene 6-0,,A4649,HCPCS,Facility,Outpatient,,,,31,26.35,8.8846,31,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),15.19,49,,percent of total billed charges,,
SUTURE Prolene 6-0,,A4649,HCPCS,Facility,Inpatient,,,,31,26.35,8.8846,31,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
SUTURE Prolene 6-0,,A4649,HCPCS,Facility,Both,,,,31,26.35,8.8846,31,CorVel,Worker's Compensation,31,100,,percent of total billed charges,,
SUTURE Prolene 6-0,,A4649,HCPCS,Facility,Both,,,,31,26.35,8.8846,31,First Health Group Corporation,First Health Network,30.07,97,,percent of total billed charges,,
SUTURE Prolene 6-0,,A4649,HCPCS,Facility,Both,,,,31,26.35,8.8846,31,"Health Partners, Inc.",Commercial,29.326,94.6,,percent of total billed charges,,
SUTURE Prolene 6-0,,A4649,HCPCS,Facility,Outpatient,,,,31,26.35,8.8846,31,"Health Partners, Inc.",Medicare Advantage,15.19,49,,percent of total billed charges,,
SUTURE Prolene 6-0,,A4649,HCPCS,Facility,Inpatient,,,,31,26.35,8.8846,31,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE Prolene 6-0,,A4649,HCPCS,Facility,Both,,,,31,26.35,8.8846,31,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),18.6,60,,percent of total billed charges,,
SUTURE Prolene 6-0,,A4649,HCPCS,Facility,Both,,,,31,26.35,8.8846,31,"Health Partners, Inc.",State of Minnesota Advantage Program,25.265,81.5,,percent of total billed charges,,
SUTURE Prolene 6-0,,A4649,HCPCS,Facility,Both,,,,31,26.35,8.8846,31,"Health Partners, Inc.",State Public Programs,15.5,50,,percent of total billed charges,,
SUTURE Prolene 6-0,,A4649,HCPCS,Facility,Both,,,,31,26.35,8.8846,31,Humana Insurance Company,Commercial PPO,29.45,95,,percent of total billed charges,,
SUTURE Prolene 6-0,,A4649,HCPCS,Facility,Outpatient,,,,31,26.35,8.8846,31,Humana Insurance Company,Medicare PPO,15.19,49,,percent of total billed charges,,
SUTURE Prolene 6-0,,A4649,HCPCS,Facility,Inpatient,,,,31,26.35,8.8846,31,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
SUTURE Prolene 6-0,,A4649,HCPCS,Facility,Both,,,,31,26.35,8.8846,31,Medica,Individual & Family,30.721,99.1,,percent of total billed charges,,
SUTURE Prolene 6-0,,A4649,HCPCS,Facility,Outpatient,,,,31,26.35,8.8846,31,Medica,Medica Advantage Solution,15.438,49.8,,percent of total billed charges,,
SUTURE Prolene 6-0,,A4649,HCPCS,Facility,Inpatient,,,,31,26.35,8.8846,31,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
SUTURE Prolene 6-0,,A4649,HCPCS,Facility,Outpatient,,,,31,26.35,8.8846,31,Medica,Medical Assistance,13.826,44.6,,percent of total billed charges,,
SUTURE Prolene 6-0,,A4649,HCPCS,Facility,Inpatient,,,,31,26.35,8.8846,31,Medica,Medical Assistance,,,,,Included in per diem rate,
SUTURE Prolene 6-0,,A4649,HCPCS,Facility,Outpatient,,,,31,26.35,8.8846,31,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,15.438,49.8,,percent of total billed charges,,
SUTURE Prolene 6-0,,A4649,HCPCS,Facility,Inpatient,,,,31,26.35,8.8846,31,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
SUTURE Prolene 6-0,,A4649,HCPCS,Facility,Both,,,,31,26.35,8.8846,31,"Multiplan, Inc.","Multiplan, Inc.",29.14,94,,percent of total billed charges,,
SUTURE Prolene 6-0,,A4649,HCPCS,Facility,Outpatient,,,,31,26.35,8.8846,31,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,27.931,90.1,,percent of total billed charges,,
SUTURE Prolene 6-0,,A4649,HCPCS,Facility,Inpatient,,,,31,26.35,8.8846,31,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
SUTURE Prolene 6-0,,A4649,HCPCS,Facility,Both,,,,31,26.35,8.8846,31,"Preferred One Administrative Services, INC.",PPO,30.566,98.6,,percent of total billed charges,,
SUTURE Prolene 6-0,,A4649,HCPCS,Facility,Outpatient,,,,31,26.35,8.8846,31,PrimeWest Health,Minnesota Senior Health Options (MSHO),15.9495,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
SUTURE Prolene 6-0,,A4649,HCPCS,Facility,Inpatient,,,,31,26.35,8.8846,31,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE Prolene 6-0,,A4649,HCPCS,Facility,Outpatient,,,,31,26.35,8.8846,31,PrimeWest Health,MinnesotaCare,15.9216,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
SUTURE Prolene 6-0,,A4649,HCPCS,Facility,Inpatient,,,,31,26.35,8.8846,31,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
SUTURE Prolene 6-0,,A4649,HCPCS,Facility,Both,,,,31,26.35,8.8846,31,Sanford Health Plan,Sanford Health Plan,28.52,92,,percent of total billed charges,,
SUTURE Prolene 6-0,,A4649,HCPCS,Facility,Outpatient,,,,31,26.35,8.8846,31,"UCare Health, Inc.",Individual & Family Plan,17.4685,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
SUTURE Prolene 6-0,,A4649,HCPCS,Facility,Inpatient,,,,31,26.35,8.8846,31,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
SUTURE Prolene 6-0,,A4649,HCPCS,Facility,Outpatient,,,,31,26.35,8.8846,31,"UCare Health, Inc.",Medical Assistance,15.6457,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE Prolene 6-0,,A4649,HCPCS,Facility,Inpatient,,,,31,26.35,8.8846,31,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
SUTURE Prolene 6-0,,A4649,HCPCS,Facility,Outpatient,,,,31,26.35,8.8846,31,"UCare Health, Inc.",Medicare Advantage,15.6457,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE Prolene 6-0,,A4649,HCPCS,Facility,Inpatient,,,,31,26.35,8.8846,31,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE Prolene 6-0,,A4649,HCPCS,Facility,Outpatient,,,,31,26.35,8.8846,31,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),15.6457,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE Prolene 6-0,,A4649,HCPCS,Facility,Inpatient,,,,31,26.35,8.8846,31,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE Prolene 6-0,,A4649,HCPCS,Facility,Both,,,,31,26.35,8.8846,31,UnitedHealthcare,Individual & Family,29.14,94,,percent of total billed charges,,
SUTURE Prolene 6-0,,A4649,HCPCS,Facility,Outpatient,,,,31,26.35,8.8846,31,UnitedHealthcare,Medicare Advantage,15.19,49,,percent of total billed charges,,
SUTURE Prolene 6-0,,A4649,HCPCS,Facility,Inpatient,,,,31,26.35,8.8846,31,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
SUTURE Prolene 6-0,,A4649,HCPCS,Facility,Outpatient,,,,31,26.35,8.8846,31,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,14.88,48,,percent of total billed charges,,100% of DHS outpatient percentage
SUTURE Prolene 6-0,,A4649,HCPCS,Facility,Inpatient,,,,31,26.35,8.8846,31,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
SUTURE SILK 2-0 FS  685G,,A4649,HCPCS,Facility,Both,,,,34.75,29.5375,9.95935,34.75,Aetna,Commercial,31.97,92,,percent of total billed charges,,
SUTURE SILK 2-0 FS  685G,,A4649,HCPCS,Facility,Outpatient,,,,34.75,29.5375,9.95935,34.75,Aetna,Medicare Advantage,17.0275,49,,percent of total billed charges,,
SUTURE SILK 2-0 FS  685G,,A4649,HCPCS,Facility,Inpatient,,,,34.75,29.5375,9.95935,34.75,Aetna,Medicare Advantage,,,,,Included in per diem rate,
SUTURE SILK 2-0 FS  685G,,A4649,HCPCS,Facility,Both,,,,34.75,29.5375,9.95935,34.75,Aetna,PPO,32.3175,93,,percent of total billed charges,,
SUTURE SILK 2-0 FS  685G,,A4649,HCPCS,Facility,Both,,,,34.75,29.5375,9.95935,34.75,America's PPO,America's PPO,33.370425,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SUTURE SILK 2-0 FS  685G,,A4649,HCPCS,Facility,Both,,,,34.75,29.5375,9.95935,34.75,BlueCross BlueShield Minnesota, Federal Employee Program,34.194,98.4,,percent of total billed charges,,
SUTURE SILK 2-0 FS  685G,,A4649,HCPCS,Facility,Both,,,,34.75,29.5375,9.95935,34.75,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,34.75,100,,percent of total billed charges,,
SUTURE SILK 2-0 FS  685G,,A4649,HCPCS,Facility,Both,,,,34.75,29.5375,9.95935,34.75,BlueCross BlueShield Minnesota,High Value Network Plan,31.275,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
SUTURE SILK 2-0 FS  685G,,A4649,HCPCS,Facility,Outpatient,,,,34.75,29.5375,9.95935,34.75,BlueCross BlueShield Minnesota,Medicare Advantage,17.0275,49,,percent of total billed charges,,
SUTURE SILK 2-0 FS  685G,,A4649,HCPCS,Facility,Inpatient,,,,34.75,29.5375,9.95935,34.75,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
SUTURE SILK 2-0 FS  685G,,A4649,HCPCS,Facility,Both,,,,34.75,29.5375,9.95935,34.75,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,30.778075,88.57,,percent of total billed charges,,
SUTURE SILK 2-0 FS  685G,,A4649,HCPCS,Facility,Both,,,,34.75,29.5375,9.95935,34.75,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,9.95935,28.66,,percent of total billed charges,,
SUTURE SILK 2-0 FS  685G,,A4649,HCPCS,Facility,Outpatient,,,,34.75,29.5375,9.95935,34.75,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),17.0275,49,,percent of total billed charges,,
SUTURE SILK 2-0 FS  685G,,A4649,HCPCS,Facility,Inpatient,,,,34.75,29.5375,9.95935,34.75,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
SUTURE SILK 2-0 FS  685G,,A4649,HCPCS,Facility,Both,,,,34.75,29.5375,9.95935,34.75,CorVel,Worker's Compensation,34.75,100,,percent of total billed charges,,
SUTURE SILK 2-0 FS  685G,,A4649,HCPCS,Facility,Both,,,,34.75,29.5375,9.95935,34.75,First Health Group Corporation,First Health Network,33.7075,97,,percent of total billed charges,,
SUTURE SILK 2-0 FS  685G,,A4649,HCPCS,Facility,Both,,,,34.75,29.5375,9.95935,34.75,"Health Partners, Inc.",Commercial,32.8735,94.6,,percent of total billed charges,,
SUTURE SILK 2-0 FS  685G,,A4649,HCPCS,Facility,Outpatient,,,,34.75,29.5375,9.95935,34.75,"Health Partners, Inc.",Medicare Advantage,17.0275,49,,percent of total billed charges,,
SUTURE SILK 2-0 FS  685G,,A4649,HCPCS,Facility,Inpatient,,,,34.75,29.5375,9.95935,34.75,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE SILK 2-0 FS  685G,,A4649,HCPCS,Facility,Both,,,,34.75,29.5375,9.95935,34.75,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),20.85,60,,percent of total billed charges,,
SUTURE SILK 2-0 FS  685G,,A4649,HCPCS,Facility,Both,,,,34.75,29.5375,9.95935,34.75,"Health Partners, Inc.",State of Minnesota Advantage Program,28.32125,81.5,,percent of total billed charges,,
SUTURE SILK 2-0 FS  685G,,A4649,HCPCS,Facility,Both,,,,34.75,29.5375,9.95935,34.75,"Health Partners, Inc.",State Public Programs,17.375,50,,percent of total billed charges,,
SUTURE SILK 2-0 FS  685G,,A4649,HCPCS,Facility,Both,,,,34.75,29.5375,9.95935,34.75,Humana Insurance Company,Commercial PPO,33.0125,95,,percent of total billed charges,,
SUTURE SILK 2-0 FS  685G,,A4649,HCPCS,Facility,Outpatient,,,,34.75,29.5375,9.95935,34.75,Humana Insurance Company,Medicare PPO,17.0275,49,,percent of total billed charges,,
SUTURE SILK 2-0 FS  685G,,A4649,HCPCS,Facility,Inpatient,,,,34.75,29.5375,9.95935,34.75,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
SUTURE SILK 2-0 FS  685G,,A4649,HCPCS,Facility,Both,,,,34.75,29.5375,9.95935,34.75,Medica,Individual & Family,34.43725,99.1,,percent of total billed charges,,
SUTURE SILK 2-0 FS  685G,,A4649,HCPCS,Facility,Outpatient,,,,34.75,29.5375,9.95935,34.75,Medica,Medica Advantage Solution,17.3055,49.8,,percent of total billed charges,,
SUTURE SILK 2-0 FS  685G,,A4649,HCPCS,Facility,Inpatient,,,,34.75,29.5375,9.95935,34.75,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
SUTURE SILK 2-0 FS  685G,,A4649,HCPCS,Facility,Outpatient,,,,34.75,29.5375,9.95935,34.75,Medica,Medical Assistance,15.4985,44.6,,percent of total billed charges,,
SUTURE SILK 2-0 FS  685G,,A4649,HCPCS,Facility,Inpatient,,,,34.75,29.5375,9.95935,34.75,Medica,Medical Assistance,,,,,Included in per diem rate,
SUTURE SILK 2-0 FS  685G,,A4649,HCPCS,Facility,Outpatient,,,,34.75,29.5375,9.95935,34.75,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,17.3055,49.8,,percent of total billed charges,,
SUTURE SILK 2-0 FS  685G,,A4649,HCPCS,Facility,Inpatient,,,,34.75,29.5375,9.95935,34.75,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
SUTURE SILK 2-0 FS  685G,,A4649,HCPCS,Facility,Both,,,,34.75,29.5375,9.95935,34.75,"Multiplan, Inc.","Multiplan, Inc.",32.665,94,,percent of total billed charges,,
SUTURE SILK 2-0 FS  685G,,A4649,HCPCS,Facility,Outpatient,,,,34.75,29.5375,9.95935,34.75,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,31.30975,90.1,,percent of total billed charges,,
SUTURE SILK 2-0 FS  685G,,A4649,HCPCS,Facility,Inpatient,,,,34.75,29.5375,9.95935,34.75,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
SUTURE SILK 2-0 FS  685G,,A4649,HCPCS,Facility,Both,,,,34.75,29.5375,9.95935,34.75,"Preferred One Administrative Services, INC.",PPO,34.2635,98.6,,percent of total billed charges,,
SUTURE SILK 2-0 FS  685G,,A4649,HCPCS,Facility,Outpatient,,,,34.75,29.5375,9.95935,34.75,PrimeWest Health,Minnesota Senior Health Options (MSHO),17.878875,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
SUTURE SILK 2-0 FS  685G,,A4649,HCPCS,Facility,Inpatient,,,,34.75,29.5375,9.95935,34.75,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE SILK 2-0 FS  685G,,A4649,HCPCS,Facility,Outpatient,,,,34.75,29.5375,9.95935,34.75,PrimeWest Health,MinnesotaCare,17.8476,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
SUTURE SILK 2-0 FS  685G,,A4649,HCPCS,Facility,Inpatient,,,,34.75,29.5375,9.95935,34.75,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
SUTURE SILK 2-0 FS  685G,,A4649,HCPCS,Facility,Both,,,,34.75,29.5375,9.95935,34.75,Sanford Health Plan,Sanford Health Plan,31.97,92,,percent of total billed charges,,
SUTURE SILK 2-0 FS  685G,,A4649,HCPCS,Facility,Outpatient,,,,34.75,29.5375,9.95935,34.75,"UCare Health, Inc.",Individual & Family Plan,19.581625,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
SUTURE SILK 2-0 FS  685G,,A4649,HCPCS,Facility,Inpatient,,,,34.75,29.5375,9.95935,34.75,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
SUTURE SILK 2-0 FS  685G,,A4649,HCPCS,Facility,Outpatient,,,,34.75,29.5375,9.95935,34.75,"UCare Health, Inc.",Medical Assistance,17.538325,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE SILK 2-0 FS  685G,,A4649,HCPCS,Facility,Inpatient,,,,34.75,29.5375,9.95935,34.75,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
SUTURE SILK 2-0 FS  685G,,A4649,HCPCS,Facility,Outpatient,,,,34.75,29.5375,9.95935,34.75,"UCare Health, Inc.",Medicare Advantage,17.538325,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE SILK 2-0 FS  685G,,A4649,HCPCS,Facility,Inpatient,,,,34.75,29.5375,9.95935,34.75,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE SILK 2-0 FS  685G,,A4649,HCPCS,Facility,Outpatient,,,,34.75,29.5375,9.95935,34.75,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),17.538325,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE SILK 2-0 FS  685G,,A4649,HCPCS,Facility,Inpatient,,,,34.75,29.5375,9.95935,34.75,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE SILK 2-0 FS  685G,,A4649,HCPCS,Facility,Both,,,,34.75,29.5375,9.95935,34.75,UnitedHealthcare,Individual & Family,32.665,94,,percent of total billed charges,,
SUTURE SILK 2-0 FS  685G,,A4649,HCPCS,Facility,Outpatient,,,,34.75,29.5375,9.95935,34.75,UnitedHealthcare,Medicare Advantage,17.0275,49,,percent of total billed charges,,
SUTURE SILK 2-0 FS  685G,,A4649,HCPCS,Facility,Inpatient,,,,34.75,29.5375,9.95935,34.75,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
SUTURE SILK 2-0 FS  685G,,A4649,HCPCS,Facility,Outpatient,,,,34.75,29.5375,9.95935,34.75,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,16.68,48,,percent of total billed charges,,100% of DHS outpatient percentage
SUTURE SILK 2-0 FS  685G,,A4649,HCPCS,Facility,Inpatient,,,,34.75,29.5375,9.95935,34.75,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
SUTURE SOFSILK 2/0 BLACK 18IN C-23,,A4649,HCPCS,Facility,Both,,,,38.65,32.8525,11.07709,38.65,Aetna,Commercial,35.558,92,,percent of total billed charges,,
SUTURE SOFSILK 2/0 BLACK 18IN C-23,,A4649,HCPCS,Facility,Outpatient,,,,38.65,32.8525,11.07709,38.65,Aetna,Medicare Advantage,18.9385,49,,percent of total billed charges,,
SUTURE SOFSILK 2/0 BLACK 18IN C-23,,A4649,HCPCS,Facility,Inpatient,,,,38.65,32.8525,11.07709,38.65,Aetna,Medicare Advantage,,,,,Included in per diem rate,
SUTURE SOFSILK 2/0 BLACK 18IN C-23,,A4649,HCPCS,Facility,Both,,,,38.65,32.8525,11.07709,38.65,Aetna,PPO,35.9445,93,,percent of total billed charges,,
SUTURE SOFSILK 2/0 BLACK 18IN C-23,,A4649,HCPCS,Facility,Both,,,,38.65,32.8525,11.07709,38.65,America's PPO,America's PPO,37.115595,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SUTURE SOFSILK 2/0 BLACK 18IN C-23,,A4649,HCPCS,Facility,Both,,,,38.65,32.8525,11.07709,38.65,BlueCross BlueShield Minnesota, Federal Employee Program,38.0316,98.4,,percent of total billed charges,,
SUTURE SOFSILK 2/0 BLACK 18IN C-23,,A4649,HCPCS,Facility,Both,,,,38.65,32.8525,11.07709,38.65,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,38.65,100,,percent of total billed charges,,
SUTURE SOFSILK 2/0 BLACK 18IN C-23,,A4649,HCPCS,Facility,Both,,,,38.65,32.8525,11.07709,38.65,BlueCross BlueShield Minnesota,High Value Network Plan,34.785,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
SUTURE SOFSILK 2/0 BLACK 18IN C-23,,A4649,HCPCS,Facility,Outpatient,,,,38.65,32.8525,11.07709,38.65,BlueCross BlueShield Minnesota,Medicare Advantage,18.9385,49,,percent of total billed charges,,
SUTURE SOFSILK 2/0 BLACK 18IN C-23,,A4649,HCPCS,Facility,Inpatient,,,,38.65,32.8525,11.07709,38.65,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
SUTURE SOFSILK 2/0 BLACK 18IN C-23,,A4649,HCPCS,Facility,Both,,,,38.65,32.8525,11.07709,38.65,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,34.232305,88.57,,percent of total billed charges,,
SUTURE SOFSILK 2/0 BLACK 18IN C-23,,A4649,HCPCS,Facility,Both,,,,38.65,32.8525,11.07709,38.65,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,11.07709,28.66,,percent of total billed charges,,
SUTURE SOFSILK 2/0 BLACK 18IN C-23,,A4649,HCPCS,Facility,Outpatient,,,,38.65,32.8525,11.07709,38.65,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),18.9385,49,,percent of total billed charges,,
SUTURE SOFSILK 2/0 BLACK 18IN C-23,,A4649,HCPCS,Facility,Inpatient,,,,38.65,32.8525,11.07709,38.65,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
SUTURE SOFSILK 2/0 BLACK 18IN C-23,,A4649,HCPCS,Facility,Both,,,,38.65,32.8525,11.07709,38.65,CorVel,Worker's Compensation,38.65,100,,percent of total billed charges,,
SUTURE SOFSILK 2/0 BLACK 18IN C-23,,A4649,HCPCS,Facility,Both,,,,38.65,32.8525,11.07709,38.65,First Health Group Corporation,First Health Network,37.4905,97,,percent of total billed charges,,
SUTURE SOFSILK 2/0 BLACK 18IN C-23,,A4649,HCPCS,Facility,Both,,,,38.65,32.8525,11.07709,38.65,"Health Partners, Inc.",Commercial,36.5629,94.6,,percent of total billed charges,,
SUTURE SOFSILK 2/0 BLACK 18IN C-23,,A4649,HCPCS,Facility,Outpatient,,,,38.65,32.8525,11.07709,38.65,"Health Partners, Inc.",Medicare Advantage,18.9385,49,,percent of total billed charges,,
SUTURE SOFSILK 2/0 BLACK 18IN C-23,,A4649,HCPCS,Facility,Inpatient,,,,38.65,32.8525,11.07709,38.65,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE SOFSILK 2/0 BLACK 18IN C-23,,A4649,HCPCS,Facility,Both,,,,38.65,32.8525,11.07709,38.65,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),23.19,60,,percent of total billed charges,,
SUTURE SOFSILK 2/0 BLACK 18IN C-23,,A4649,HCPCS,Facility,Both,,,,38.65,32.8525,11.07709,38.65,"Health Partners, Inc.",State of Minnesota Advantage Program,31.49975,81.5,,percent of total billed charges,,
SUTURE SOFSILK 2/0 BLACK 18IN C-23,,A4649,HCPCS,Facility,Both,,,,38.65,32.8525,11.07709,38.65,"Health Partners, Inc.",State Public Programs,19.325,50,,percent of total billed charges,,
SUTURE SOFSILK 2/0 BLACK 18IN C-23,,A4649,HCPCS,Facility,Both,,,,38.65,32.8525,11.07709,38.65,Humana Insurance Company,Commercial PPO,36.7175,95,,percent of total billed charges,,
SUTURE SOFSILK 2/0 BLACK 18IN C-23,,A4649,HCPCS,Facility,Outpatient,,,,38.65,32.8525,11.07709,38.65,Humana Insurance Company,Medicare PPO,18.9385,49,,percent of total billed charges,,
SUTURE SOFSILK 2/0 BLACK 18IN C-23,,A4649,HCPCS,Facility,Inpatient,,,,38.65,32.8525,11.07709,38.65,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
SUTURE SOFSILK 2/0 BLACK 18IN C-23,,A4649,HCPCS,Facility,Both,,,,38.65,32.8525,11.07709,38.65,Medica,Individual & Family,38.30215,99.1,,percent of total billed charges,,
SUTURE SOFSILK 2/0 BLACK 18IN C-23,,A4649,HCPCS,Facility,Outpatient,,,,38.65,32.8525,11.07709,38.65,Medica,Medica Advantage Solution,19.2477,49.8,,percent of total billed charges,,
SUTURE SOFSILK 2/0 BLACK 18IN C-23,,A4649,HCPCS,Facility,Inpatient,,,,38.65,32.8525,11.07709,38.65,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
SUTURE SOFSILK 2/0 BLACK 18IN C-23,,A4649,HCPCS,Facility,Outpatient,,,,38.65,32.8525,11.07709,38.65,Medica,Medical Assistance,17.2379,44.6,,percent of total billed charges,,
SUTURE SOFSILK 2/0 BLACK 18IN C-23,,A4649,HCPCS,Facility,Inpatient,,,,38.65,32.8525,11.07709,38.65,Medica,Medical Assistance,,,,,Included in per diem rate,
SUTURE SOFSILK 2/0 BLACK 18IN C-23,,A4649,HCPCS,Facility,Outpatient,,,,38.65,32.8525,11.07709,38.65,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,19.2477,49.8,,percent of total billed charges,,
SUTURE SOFSILK 2/0 BLACK 18IN C-23,,A4649,HCPCS,Facility,Inpatient,,,,38.65,32.8525,11.07709,38.65,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
SUTURE SOFSILK 2/0 BLACK 18IN C-23,,A4649,HCPCS,Facility,Both,,,,38.65,32.8525,11.07709,38.65,"Multiplan, Inc.","Multiplan, Inc.",36.331,94,,percent of total billed charges,,
SUTURE SOFSILK 2/0 BLACK 18IN C-23,,A4649,HCPCS,Facility,Outpatient,,,,38.65,32.8525,11.07709,38.65,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,34.82365,90.1,,percent of total billed charges,,
SUTURE SOFSILK 2/0 BLACK 18IN C-23,,A4649,HCPCS,Facility,Inpatient,,,,38.65,32.8525,11.07709,38.65,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
SUTURE SOFSILK 2/0 BLACK 18IN C-23,,A4649,HCPCS,Facility,Both,,,,38.65,32.8525,11.07709,38.65,"Preferred One Administrative Services, INC.",PPO,38.1089,98.6,,percent of total billed charges,,
SUTURE SOFSILK 2/0 BLACK 18IN C-23,,A4649,HCPCS,Facility,Outpatient,,,,38.65,32.8525,11.07709,38.65,PrimeWest Health,Minnesota Senior Health Options (MSHO),19.885425,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
SUTURE SOFSILK 2/0 BLACK 18IN C-23,,A4649,HCPCS,Facility,Inpatient,,,,38.65,32.8525,11.07709,38.65,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE SOFSILK 2/0 BLACK 18IN C-23,,A4649,HCPCS,Facility,Outpatient,,,,38.65,32.8525,11.07709,38.65,PrimeWest Health,MinnesotaCare,19.85064,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
SUTURE SOFSILK 2/0 BLACK 18IN C-23,,A4649,HCPCS,Facility,Inpatient,,,,38.65,32.8525,11.07709,38.65,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
SUTURE SOFSILK 2/0 BLACK 18IN C-23,,A4649,HCPCS,Facility,Both,,,,38.65,32.8525,11.07709,38.65,Sanford Health Plan,Sanford Health Plan,35.558,92,,percent of total billed charges,,
SUTURE SOFSILK 2/0 BLACK 18IN C-23,,A4649,HCPCS,Facility,Outpatient,,,,38.65,32.8525,11.07709,38.65,"UCare Health, Inc.",Individual & Family Plan,21.779275,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
SUTURE SOFSILK 2/0 BLACK 18IN C-23,,A4649,HCPCS,Facility,Inpatient,,,,38.65,32.8525,11.07709,38.65,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
SUTURE SOFSILK 2/0 BLACK 18IN C-23,,A4649,HCPCS,Facility,Outpatient,,,,38.65,32.8525,11.07709,38.65,"UCare Health, Inc.",Medical Assistance,19.506655,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE SOFSILK 2/0 BLACK 18IN C-23,,A4649,HCPCS,Facility,Inpatient,,,,38.65,32.8525,11.07709,38.65,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
SUTURE SOFSILK 2/0 BLACK 18IN C-23,,A4649,HCPCS,Facility,Outpatient,,,,38.65,32.8525,11.07709,38.65,"UCare Health, Inc.",Medicare Advantage,19.506655,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE SOFSILK 2/0 BLACK 18IN C-23,,A4649,HCPCS,Facility,Inpatient,,,,38.65,32.8525,11.07709,38.65,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE SOFSILK 2/0 BLACK 18IN C-23,,A4649,HCPCS,Facility,Outpatient,,,,38.65,32.8525,11.07709,38.65,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),19.506655,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE SOFSILK 2/0 BLACK 18IN C-23,,A4649,HCPCS,Facility,Inpatient,,,,38.65,32.8525,11.07709,38.65,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE SOFSILK 2/0 BLACK 18IN C-23,,A4649,HCPCS,Facility,Both,,,,38.65,32.8525,11.07709,38.65,UnitedHealthcare,Individual & Family,36.331,94,,percent of total billed charges,,
SUTURE SOFSILK 2/0 BLACK 18IN C-23,,A4649,HCPCS,Facility,Outpatient,,,,38.65,32.8525,11.07709,38.65,UnitedHealthcare,Medicare Advantage,18.9385,49,,percent of total billed charges,,
SUTURE SOFSILK 2/0 BLACK 18IN C-23,,A4649,HCPCS,Facility,Inpatient,,,,38.65,32.8525,11.07709,38.65,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
SUTURE SOFSILK 2/0 BLACK 18IN C-23,,A4649,HCPCS,Facility,Outpatient,,,,38.65,32.8525,11.07709,38.65,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,18.552,48,,percent of total billed charges,,100% of DHS outpatient percentage
SUTURE SOFSILK 2/0 BLACK 18IN C-23,,A4649,HCPCS,Facility,Inpatient,,,,38.65,32.8525,11.07709,38.65,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
SUTURE SOFSILK 2-0 18IN BLK V-20 MULTI CR  GS-62M,,A4649,HCPCS,Facility,Both,,,,27.45,23.3325,7.86717,27.45,Aetna,Commercial,25.254,92,,percent of total billed charges,,
SUTURE SOFSILK 2-0 18IN BLK V-20 MULTI CR  GS-62M,,A4649,HCPCS,Facility,Outpatient,,,,27.45,23.3325,7.86717,27.45,Aetna,Medicare Advantage,13.4505,49,,percent of total billed charges,,
SUTURE SOFSILK 2-0 18IN BLK V-20 MULTI CR  GS-62M,,A4649,HCPCS,Facility,Inpatient,,,,27.45,23.3325,7.86717,27.45,Aetna,Medicare Advantage,,,,,Included in per diem rate,
SUTURE SOFSILK 2-0 18IN BLK V-20 MULTI CR  GS-62M,,A4649,HCPCS,Facility,Both,,,,27.45,23.3325,7.86717,27.45,Aetna,PPO,25.5285,93,,percent of total billed charges,,
SUTURE SOFSILK 2-0 18IN BLK V-20 MULTI CR  GS-62M,,A4649,HCPCS,Facility,Both,,,,27.45,23.3325,7.86717,27.45,America's PPO,America's PPO,26.360235,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SUTURE SOFSILK 2-0 18IN BLK V-20 MULTI CR  GS-62M,,A4649,HCPCS,Facility,Both,,,,27.45,23.3325,7.86717,27.45,BlueCross BlueShield Minnesota, Federal Employee Program,27.0108,98.4,,percent of total billed charges,,
SUTURE SOFSILK 2-0 18IN BLK V-20 MULTI CR  GS-62M,,A4649,HCPCS,Facility,Both,,,,27.45,23.3325,7.86717,27.45,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,27.45,100,,percent of total billed charges,,
SUTURE SOFSILK 2-0 18IN BLK V-20 MULTI CR  GS-62M,,A4649,HCPCS,Facility,Both,,,,27.45,23.3325,7.86717,27.45,BlueCross BlueShield Minnesota,High Value Network Plan,24.705,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
SUTURE SOFSILK 2-0 18IN BLK V-20 MULTI CR  GS-62M,,A4649,HCPCS,Facility,Outpatient,,,,27.45,23.3325,7.86717,27.45,BlueCross BlueShield Minnesota,Medicare Advantage,13.4505,49,,percent of total billed charges,,
SUTURE SOFSILK 2-0 18IN BLK V-20 MULTI CR  GS-62M,,A4649,HCPCS,Facility,Inpatient,,,,27.45,23.3325,7.86717,27.45,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
SUTURE SOFSILK 2-0 18IN BLK V-20 MULTI CR  GS-62M,,A4649,HCPCS,Facility,Both,,,,27.45,23.3325,7.86717,27.45,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,24.312465,88.57,,percent of total billed charges,,
SUTURE SOFSILK 2-0 18IN BLK V-20 MULTI CR  GS-62M,,A4649,HCPCS,Facility,Both,,,,27.45,23.3325,7.86717,27.45,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,7.86717,28.66,,percent of total billed charges,,
SUTURE SOFSILK 2-0 18IN BLK V-20 MULTI CR  GS-62M,,A4649,HCPCS,Facility,Outpatient,,,,27.45,23.3325,7.86717,27.45,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),13.4505,49,,percent of total billed charges,,
SUTURE SOFSILK 2-0 18IN BLK V-20 MULTI CR  GS-62M,,A4649,HCPCS,Facility,Inpatient,,,,27.45,23.3325,7.86717,27.45,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
SUTURE SOFSILK 2-0 18IN BLK V-20 MULTI CR  GS-62M,,A4649,HCPCS,Facility,Both,,,,27.45,23.3325,7.86717,27.45,CorVel,Worker's Compensation,27.45,100,,percent of total billed charges,,
SUTURE SOFSILK 2-0 18IN BLK V-20 MULTI CR  GS-62M,,A4649,HCPCS,Facility,Both,,,,27.45,23.3325,7.86717,27.45,First Health Group Corporation,First Health Network,26.6265,97,,percent of total billed charges,,
SUTURE SOFSILK 2-0 18IN BLK V-20 MULTI CR  GS-62M,,A4649,HCPCS,Facility,Both,,,,27.45,23.3325,7.86717,27.45,"Health Partners, Inc.",Commercial,25.9677,94.6,,percent of total billed charges,,
SUTURE SOFSILK 2-0 18IN BLK V-20 MULTI CR  GS-62M,,A4649,HCPCS,Facility,Outpatient,,,,27.45,23.3325,7.86717,27.45,"Health Partners, Inc.",Medicare Advantage,13.4505,49,,percent of total billed charges,,
SUTURE SOFSILK 2-0 18IN BLK V-20 MULTI CR  GS-62M,,A4649,HCPCS,Facility,Inpatient,,,,27.45,23.3325,7.86717,27.45,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE SOFSILK 2-0 18IN BLK V-20 MULTI CR  GS-62M,,A4649,HCPCS,Facility,Both,,,,27.45,23.3325,7.86717,27.45,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),16.47,60,,percent of total billed charges,,
SUTURE SOFSILK 2-0 18IN BLK V-20 MULTI CR  GS-62M,,A4649,HCPCS,Facility,Both,,,,27.45,23.3325,7.86717,27.45,"Health Partners, Inc.",State of Minnesota Advantage Program,22.37175,81.5,,percent of total billed charges,,
SUTURE SOFSILK 2-0 18IN BLK V-20 MULTI CR  GS-62M,,A4649,HCPCS,Facility,Both,,,,27.45,23.3325,7.86717,27.45,"Health Partners, Inc.",State Public Programs,13.725,50,,percent of total billed charges,,
SUTURE SOFSILK 2-0 18IN BLK V-20 MULTI CR  GS-62M,,A4649,HCPCS,Facility,Both,,,,27.45,23.3325,7.86717,27.45,Humana Insurance Company,Commercial PPO,26.0775,95,,percent of total billed charges,,
SUTURE SOFSILK 2-0 18IN BLK V-20 MULTI CR  GS-62M,,A4649,HCPCS,Facility,Outpatient,,,,27.45,23.3325,7.86717,27.45,Humana Insurance Company,Medicare PPO,13.4505,49,,percent of total billed charges,,
SUTURE SOFSILK 2-0 18IN BLK V-20 MULTI CR  GS-62M,,A4649,HCPCS,Facility,Inpatient,,,,27.45,23.3325,7.86717,27.45,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
SUTURE SOFSILK 2-0 18IN BLK V-20 MULTI CR  GS-62M,,A4649,HCPCS,Facility,Both,,,,27.45,23.3325,7.86717,27.45,Medica,Individual & Family,27.20295,99.1,,percent of total billed charges,,
SUTURE SOFSILK 2-0 18IN BLK V-20 MULTI CR  GS-62M,,A4649,HCPCS,Facility,Outpatient,,,,27.45,23.3325,7.86717,27.45,Medica,Medica Advantage Solution,13.6701,49.8,,percent of total billed charges,,
SUTURE SOFSILK 2-0 18IN BLK V-20 MULTI CR  GS-62M,,A4649,HCPCS,Facility,Inpatient,,,,27.45,23.3325,7.86717,27.45,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
SUTURE SOFSILK 2-0 18IN BLK V-20 MULTI CR  GS-62M,,A4649,HCPCS,Facility,Outpatient,,,,27.45,23.3325,7.86717,27.45,Medica,Medical Assistance,12.2427,44.6,,percent of total billed charges,,
SUTURE SOFSILK 2-0 18IN BLK V-20 MULTI CR  GS-62M,,A4649,HCPCS,Facility,Inpatient,,,,27.45,23.3325,7.86717,27.45,Medica,Medical Assistance,,,,,Included in per diem rate,
SUTURE SOFSILK 2-0 18IN BLK V-20 MULTI CR  GS-62M,,A4649,HCPCS,Facility,Outpatient,,,,27.45,23.3325,7.86717,27.45,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,13.6701,49.8,,percent of total billed charges,,
SUTURE SOFSILK 2-0 18IN BLK V-20 MULTI CR  GS-62M,,A4649,HCPCS,Facility,Inpatient,,,,27.45,23.3325,7.86717,27.45,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
SUTURE SOFSILK 2-0 18IN BLK V-20 MULTI CR  GS-62M,,A4649,HCPCS,Facility,Both,,,,27.45,23.3325,7.86717,27.45,"Multiplan, Inc.","Multiplan, Inc.",25.803,94,,percent of total billed charges,,
SUTURE SOFSILK 2-0 18IN BLK V-20 MULTI CR  GS-62M,,A4649,HCPCS,Facility,Outpatient,,,,27.45,23.3325,7.86717,27.45,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,24.73245,90.1,,percent of total billed charges,,
SUTURE SOFSILK 2-0 18IN BLK V-20 MULTI CR  GS-62M,,A4649,HCPCS,Facility,Inpatient,,,,27.45,23.3325,7.86717,27.45,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
SUTURE SOFSILK 2-0 18IN BLK V-20 MULTI CR  GS-62M,,A4649,HCPCS,Facility,Both,,,,27.45,23.3325,7.86717,27.45,"Preferred One Administrative Services, INC.",PPO,27.0657,98.6,,percent of total billed charges,,
SUTURE SOFSILK 2-0 18IN BLK V-20 MULTI CR  GS-62M,,A4649,HCPCS,Facility,Outpatient,,,,27.45,23.3325,7.86717,27.45,PrimeWest Health,Minnesota Senior Health Options (MSHO),14.123025,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
SUTURE SOFSILK 2-0 18IN BLK V-20 MULTI CR  GS-62M,,A4649,HCPCS,Facility,Inpatient,,,,27.45,23.3325,7.86717,27.45,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE SOFSILK 2-0 18IN BLK V-20 MULTI CR  GS-62M,,A4649,HCPCS,Facility,Outpatient,,,,27.45,23.3325,7.86717,27.45,PrimeWest Health,MinnesotaCare,14.09832,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
SUTURE SOFSILK 2-0 18IN BLK V-20 MULTI CR  GS-62M,,A4649,HCPCS,Facility,Inpatient,,,,27.45,23.3325,7.86717,27.45,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
SUTURE SOFSILK 2-0 18IN BLK V-20 MULTI CR  GS-62M,,A4649,HCPCS,Facility,Both,,,,27.45,23.3325,7.86717,27.45,Sanford Health Plan,Sanford Health Plan,25.254,92,,percent of total billed charges,,
SUTURE SOFSILK 2-0 18IN BLK V-20 MULTI CR  GS-62M,,A4649,HCPCS,Facility,Outpatient,,,,27.45,23.3325,7.86717,27.45,"UCare Health, Inc.",Individual & Family Plan,15.468075,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
SUTURE SOFSILK 2-0 18IN BLK V-20 MULTI CR  GS-62M,,A4649,HCPCS,Facility,Inpatient,,,,27.45,23.3325,7.86717,27.45,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
SUTURE SOFSILK 2-0 18IN BLK V-20 MULTI CR  GS-62M,,A4649,HCPCS,Facility,Outpatient,,,,27.45,23.3325,7.86717,27.45,"UCare Health, Inc.",Medical Assistance,13.854015,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE SOFSILK 2-0 18IN BLK V-20 MULTI CR  GS-62M,,A4649,HCPCS,Facility,Inpatient,,,,27.45,23.3325,7.86717,27.45,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
SUTURE SOFSILK 2-0 18IN BLK V-20 MULTI CR  GS-62M,,A4649,HCPCS,Facility,Outpatient,,,,27.45,23.3325,7.86717,27.45,"UCare Health, Inc.",Medicare Advantage,13.854015,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE SOFSILK 2-0 18IN BLK V-20 MULTI CR  GS-62M,,A4649,HCPCS,Facility,Inpatient,,,,27.45,23.3325,7.86717,27.45,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE SOFSILK 2-0 18IN BLK V-20 MULTI CR  GS-62M,,A4649,HCPCS,Facility,Outpatient,,,,27.45,23.3325,7.86717,27.45,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),13.854015,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE SOFSILK 2-0 18IN BLK V-20 MULTI CR  GS-62M,,A4649,HCPCS,Facility,Inpatient,,,,27.45,23.3325,7.86717,27.45,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE SOFSILK 2-0 18IN BLK V-20 MULTI CR  GS-62M,,A4649,HCPCS,Facility,Both,,,,27.45,23.3325,7.86717,27.45,UnitedHealthcare,Individual & Family,25.803,94,,percent of total billed charges,,
SUTURE SOFSILK 2-0 18IN BLK V-20 MULTI CR  GS-62M,,A4649,HCPCS,Facility,Outpatient,,,,27.45,23.3325,7.86717,27.45,UnitedHealthcare,Medicare Advantage,13.4505,49,,percent of total billed charges,,
SUTURE SOFSILK 2-0 18IN BLK V-20 MULTI CR  GS-62M,,A4649,HCPCS,Facility,Inpatient,,,,27.45,23.3325,7.86717,27.45,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
SUTURE SOFSILK 2-0 18IN BLK V-20 MULTI CR  GS-62M,,A4649,HCPCS,Facility,Outpatient,,,,27.45,23.3325,7.86717,27.45,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,13.176,48,,percent of total billed charges,,100% of DHS outpatient percentage
SUTURE SOFSILK 2-0 18IN BLK V-20 MULTI CR  GS-62M,,A4649,HCPCS,Facility,Inpatient,,,,27.45,23.3325,7.86717,27.45,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
SUTURE SOFSILK 2-0 DETACH GS-62-M,,A4649,HCPCS,Facility,Both,,,,27.45,23.3325,7.86717,27.45,Aetna,Commercial,25.254,92,,percent of total billed charges,,
SUTURE SOFSILK 2-0 DETACH GS-62-M,,A4649,HCPCS,Facility,Outpatient,,,,27.45,23.3325,7.86717,27.45,Aetna,Medicare Advantage,13.4505,49,,percent of total billed charges,,
SUTURE SOFSILK 2-0 DETACH GS-62-M,,A4649,HCPCS,Facility,Inpatient,,,,27.45,23.3325,7.86717,27.45,Aetna,Medicare Advantage,,,,,Included in per diem rate,
SUTURE SOFSILK 2-0 DETACH GS-62-M,,A4649,HCPCS,Facility,Both,,,,27.45,23.3325,7.86717,27.45,Aetna,PPO,25.5285,93,,percent of total billed charges,,
SUTURE SOFSILK 2-0 DETACH GS-62-M,,A4649,HCPCS,Facility,Both,,,,27.45,23.3325,7.86717,27.45,America's PPO,America's PPO,26.360235,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SUTURE SOFSILK 2-0 DETACH GS-62-M,,A4649,HCPCS,Facility,Both,,,,27.45,23.3325,7.86717,27.45,BlueCross BlueShield Minnesota, Federal Employee Program,27.0108,98.4,,percent of total billed charges,,
SUTURE SOFSILK 2-0 DETACH GS-62-M,,A4649,HCPCS,Facility,Both,,,,27.45,23.3325,7.86717,27.45,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,27.45,100,,percent of total billed charges,,
SUTURE SOFSILK 2-0 DETACH GS-62-M,,A4649,HCPCS,Facility,Both,,,,27.45,23.3325,7.86717,27.45,BlueCross BlueShield Minnesota,High Value Network Plan,24.705,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
SUTURE SOFSILK 2-0 DETACH GS-62-M,,A4649,HCPCS,Facility,Outpatient,,,,27.45,23.3325,7.86717,27.45,BlueCross BlueShield Minnesota,Medicare Advantage,13.4505,49,,percent of total billed charges,,
SUTURE SOFSILK 2-0 DETACH GS-62-M,,A4649,HCPCS,Facility,Inpatient,,,,27.45,23.3325,7.86717,27.45,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
SUTURE SOFSILK 2-0 DETACH GS-62-M,,A4649,HCPCS,Facility,Both,,,,27.45,23.3325,7.86717,27.45,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,24.312465,88.57,,percent of total billed charges,,
SUTURE SOFSILK 2-0 DETACH GS-62-M,,A4649,HCPCS,Facility,Both,,,,27.45,23.3325,7.86717,27.45,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,7.86717,28.66,,percent of total billed charges,,
SUTURE SOFSILK 2-0 DETACH GS-62-M,,A4649,HCPCS,Facility,Outpatient,,,,27.45,23.3325,7.86717,27.45,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),13.4505,49,,percent of total billed charges,,
SUTURE SOFSILK 2-0 DETACH GS-62-M,,A4649,HCPCS,Facility,Inpatient,,,,27.45,23.3325,7.86717,27.45,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
SUTURE SOFSILK 2-0 DETACH GS-62-M,,A4649,HCPCS,Facility,Both,,,,27.45,23.3325,7.86717,27.45,CorVel,Worker's Compensation,27.45,100,,percent of total billed charges,,
SUTURE SOFSILK 2-0 DETACH GS-62-M,,A4649,HCPCS,Facility,Both,,,,27.45,23.3325,7.86717,27.45,First Health Group Corporation,First Health Network,26.6265,97,,percent of total billed charges,,
SUTURE SOFSILK 2-0 DETACH GS-62-M,,A4649,HCPCS,Facility,Both,,,,27.45,23.3325,7.86717,27.45,"Health Partners, Inc.",Commercial,25.9677,94.6,,percent of total billed charges,,
SUTURE SOFSILK 2-0 DETACH GS-62-M,,A4649,HCPCS,Facility,Outpatient,,,,27.45,23.3325,7.86717,27.45,"Health Partners, Inc.",Medicare Advantage,13.4505,49,,percent of total billed charges,,
SUTURE SOFSILK 2-0 DETACH GS-62-M,,A4649,HCPCS,Facility,Inpatient,,,,27.45,23.3325,7.86717,27.45,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE SOFSILK 2-0 DETACH GS-62-M,,A4649,HCPCS,Facility,Both,,,,27.45,23.3325,7.86717,27.45,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),16.47,60,,percent of total billed charges,,
SUTURE SOFSILK 2-0 DETACH GS-62-M,,A4649,HCPCS,Facility,Both,,,,27.45,23.3325,7.86717,27.45,"Health Partners, Inc.",State of Minnesota Advantage Program,22.37175,81.5,,percent of total billed charges,,
SUTURE SOFSILK 2-0 DETACH GS-62-M,,A4649,HCPCS,Facility,Both,,,,27.45,23.3325,7.86717,27.45,"Health Partners, Inc.",State Public Programs,13.725,50,,percent of total billed charges,,
SUTURE SOFSILK 2-0 DETACH GS-62-M,,A4649,HCPCS,Facility,Both,,,,27.45,23.3325,7.86717,27.45,Humana Insurance Company,Commercial PPO,26.0775,95,,percent of total billed charges,,
SUTURE SOFSILK 2-0 DETACH GS-62-M,,A4649,HCPCS,Facility,Outpatient,,,,27.45,23.3325,7.86717,27.45,Humana Insurance Company,Medicare PPO,13.4505,49,,percent of total billed charges,,
SUTURE SOFSILK 2-0 DETACH GS-62-M,,A4649,HCPCS,Facility,Inpatient,,,,27.45,23.3325,7.86717,27.45,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
SUTURE SOFSILK 2-0 DETACH GS-62-M,,A4649,HCPCS,Facility,Both,,,,27.45,23.3325,7.86717,27.45,Medica,Individual & Family,27.20295,99.1,,percent of total billed charges,,
SUTURE SOFSILK 2-0 DETACH GS-62-M,,A4649,HCPCS,Facility,Outpatient,,,,27.45,23.3325,7.86717,27.45,Medica,Medica Advantage Solution,13.6701,49.8,,percent of total billed charges,,
SUTURE SOFSILK 2-0 DETACH GS-62-M,,A4649,HCPCS,Facility,Inpatient,,,,27.45,23.3325,7.86717,27.45,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
SUTURE SOFSILK 2-0 DETACH GS-62-M,,A4649,HCPCS,Facility,Outpatient,,,,27.45,23.3325,7.86717,27.45,Medica,Medical Assistance,12.2427,44.6,,percent of total billed charges,,
SUTURE SOFSILK 2-0 DETACH GS-62-M,,A4649,HCPCS,Facility,Inpatient,,,,27.45,23.3325,7.86717,27.45,Medica,Medical Assistance,,,,,Included in per diem rate,
SUTURE SOFSILK 2-0 DETACH GS-62-M,,A4649,HCPCS,Facility,Outpatient,,,,27.45,23.3325,7.86717,27.45,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,13.6701,49.8,,percent of total billed charges,,
SUTURE SOFSILK 2-0 DETACH GS-62-M,,A4649,HCPCS,Facility,Inpatient,,,,27.45,23.3325,7.86717,27.45,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
SUTURE SOFSILK 2-0 DETACH GS-62-M,,A4649,HCPCS,Facility,Both,,,,27.45,23.3325,7.86717,27.45,"Multiplan, Inc.","Multiplan, Inc.",25.803,94,,percent of total billed charges,,
SUTURE SOFSILK 2-0 DETACH GS-62-M,,A4649,HCPCS,Facility,Outpatient,,,,27.45,23.3325,7.86717,27.45,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,24.73245,90.1,,percent of total billed charges,,
SUTURE SOFSILK 2-0 DETACH GS-62-M,,A4649,HCPCS,Facility,Inpatient,,,,27.45,23.3325,7.86717,27.45,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
SUTURE SOFSILK 2-0 DETACH GS-62-M,,A4649,HCPCS,Facility,Both,,,,27.45,23.3325,7.86717,27.45,"Preferred One Administrative Services, INC.",PPO,27.0657,98.6,,percent of total billed charges,,
SUTURE SOFSILK 2-0 DETACH GS-62-M,,A4649,HCPCS,Facility,Outpatient,,,,27.45,23.3325,7.86717,27.45,PrimeWest Health,Minnesota Senior Health Options (MSHO),14.123025,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
SUTURE SOFSILK 2-0 DETACH GS-62-M,,A4649,HCPCS,Facility,Inpatient,,,,27.45,23.3325,7.86717,27.45,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE SOFSILK 2-0 DETACH GS-62-M,,A4649,HCPCS,Facility,Outpatient,,,,27.45,23.3325,7.86717,27.45,PrimeWest Health,MinnesotaCare,14.09832,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
SUTURE SOFSILK 2-0 DETACH GS-62-M,,A4649,HCPCS,Facility,Inpatient,,,,27.45,23.3325,7.86717,27.45,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
SUTURE SOFSILK 2-0 DETACH GS-62-M,,A4649,HCPCS,Facility,Both,,,,27.45,23.3325,7.86717,27.45,Sanford Health Plan,Sanford Health Plan,25.254,92,,percent of total billed charges,,
SUTURE SOFSILK 2-0 DETACH GS-62-M,,A4649,HCPCS,Facility,Outpatient,,,,27.45,23.3325,7.86717,27.45,"UCare Health, Inc.",Individual & Family Plan,15.468075,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
SUTURE SOFSILK 2-0 DETACH GS-62-M,,A4649,HCPCS,Facility,Inpatient,,,,27.45,23.3325,7.86717,27.45,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
SUTURE SOFSILK 2-0 DETACH GS-62-M,,A4649,HCPCS,Facility,Outpatient,,,,27.45,23.3325,7.86717,27.45,"UCare Health, Inc.",Medical Assistance,13.854015,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE SOFSILK 2-0 DETACH GS-62-M,,A4649,HCPCS,Facility,Inpatient,,,,27.45,23.3325,7.86717,27.45,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
SUTURE SOFSILK 2-0 DETACH GS-62-M,,A4649,HCPCS,Facility,Outpatient,,,,27.45,23.3325,7.86717,27.45,"UCare Health, Inc.",Medicare Advantage,13.854015,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE SOFSILK 2-0 DETACH GS-62-M,,A4649,HCPCS,Facility,Inpatient,,,,27.45,23.3325,7.86717,27.45,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE SOFSILK 2-0 DETACH GS-62-M,,A4649,HCPCS,Facility,Outpatient,,,,27.45,23.3325,7.86717,27.45,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),13.854015,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE SOFSILK 2-0 DETACH GS-62-M,,A4649,HCPCS,Facility,Inpatient,,,,27.45,23.3325,7.86717,27.45,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE SOFSILK 2-0 DETACH GS-62-M,,A4649,HCPCS,Facility,Both,,,,27.45,23.3325,7.86717,27.45,UnitedHealthcare,Individual & Family,25.803,94,,percent of total billed charges,,
SUTURE SOFSILK 2-0 DETACH GS-62-M,,A4649,HCPCS,Facility,Outpatient,,,,27.45,23.3325,7.86717,27.45,UnitedHealthcare,Medicare Advantage,13.4505,49,,percent of total billed charges,,
SUTURE SOFSILK 2-0 DETACH GS-62-M,,A4649,HCPCS,Facility,Inpatient,,,,27.45,23.3325,7.86717,27.45,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
SUTURE SOFSILK 2-0 DETACH GS-62-M,,A4649,HCPCS,Facility,Outpatient,,,,27.45,23.3325,7.86717,27.45,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,13.176,48,,percent of total billed charges,,100% of DHS outpatient percentage
SUTURE SOFSILK 2-0 DETACH GS-62-M,,A4649,HCPCS,Facility,Inpatient,,,,27.45,23.3325,7.86717,27.45,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
SUTURE SOFSILK 2-0 S-185,,A4649,HCPCS,Facility,Both,,,,1.58,1.343,0.452828,1.58,Aetna,Commercial,1.4536,92,,percent of total billed charges,,
SUTURE SOFSILK 2-0 S-185,,A4649,HCPCS,Facility,Outpatient,,,,1.58,1.343,0.452828,1.58,Aetna,Medicare Advantage,0.7742,49,,percent of total billed charges,,
SUTURE SOFSILK 2-0 S-185,,A4649,HCPCS,Facility,Inpatient,,,,1.58,1.343,0.452828,1.58,Aetna,Medicare Advantage,,,,,Included in per diem rate,
SUTURE SOFSILK 2-0 S-185,,A4649,HCPCS,Facility,Both,,,,1.58,1.343,0.452828,1.58,Aetna,PPO,1.4694,93,,percent of total billed charges,,
SUTURE SOFSILK 2-0 S-185,,A4649,HCPCS,Facility,Both,,,,1.58,1.343,0.452828,1.58,America's PPO,America's PPO,1.517274,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SUTURE SOFSILK 2-0 S-185,,A4649,HCPCS,Facility,Both,,,,1.58,1.343,0.452828,1.58,BlueCross BlueShield Minnesota, Federal Employee Program,1.55472,98.4,,percent of total billed charges,,
SUTURE SOFSILK 2-0 S-185,,A4649,HCPCS,Facility,Both,,,,1.58,1.343,0.452828,1.58,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1.58,100,,percent of total billed charges,,
SUTURE SOFSILK 2-0 S-185,,A4649,HCPCS,Facility,Both,,,,1.58,1.343,0.452828,1.58,BlueCross BlueShield Minnesota,High Value Network Plan,1.422,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
SUTURE SOFSILK 2-0 S-185,,A4649,HCPCS,Facility,Outpatient,,,,1.58,1.343,0.452828,1.58,BlueCross BlueShield Minnesota,Medicare Advantage,0.7742,49,,percent of total billed charges,,
SUTURE SOFSILK 2-0 S-185,,A4649,HCPCS,Facility,Inpatient,,,,1.58,1.343,0.452828,1.58,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
SUTURE SOFSILK 2-0 S-185,,A4649,HCPCS,Facility,Both,,,,1.58,1.343,0.452828,1.58,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1.399406,88.57,,percent of total billed charges,,
SUTURE SOFSILK 2-0 S-185,,A4649,HCPCS,Facility,Both,,,,1.58,1.343,0.452828,1.58,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,0.452828,28.66,,percent of total billed charges,,
SUTURE SOFSILK 2-0 S-185,,A4649,HCPCS,Facility,Outpatient,,,,1.58,1.343,0.452828,1.58,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),0.7742,49,,percent of total billed charges,,
SUTURE SOFSILK 2-0 S-185,,A4649,HCPCS,Facility,Inpatient,,,,1.58,1.343,0.452828,1.58,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
SUTURE SOFSILK 2-0 S-185,,A4649,HCPCS,Facility,Both,,,,1.58,1.343,0.452828,1.58,CorVel,Worker's Compensation,1.58,100,,percent of total billed charges,,
SUTURE SOFSILK 2-0 S-185,,A4649,HCPCS,Facility,Both,,,,1.58,1.343,0.452828,1.58,First Health Group Corporation,First Health Network,1.5326,97,,percent of total billed charges,,
SUTURE SOFSILK 2-0 S-185,,A4649,HCPCS,Facility,Both,,,,1.58,1.343,0.452828,1.58,"Health Partners, Inc.",Commercial,1.49468,94.6,,percent of total billed charges,,
SUTURE SOFSILK 2-0 S-185,,A4649,HCPCS,Facility,Outpatient,,,,1.58,1.343,0.452828,1.58,"Health Partners, Inc.",Medicare Advantage,0.7742,49,,percent of total billed charges,,
SUTURE SOFSILK 2-0 S-185,,A4649,HCPCS,Facility,Inpatient,,,,1.58,1.343,0.452828,1.58,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE SOFSILK 2-0 S-185,,A4649,HCPCS,Facility,Both,,,,1.58,1.343,0.452828,1.58,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),0.948,60,,percent of total billed charges,,
SUTURE SOFSILK 2-0 S-185,,A4649,HCPCS,Facility,Both,,,,1.58,1.343,0.452828,1.58,"Health Partners, Inc.",State of Minnesota Advantage Program,1.2877,81.5,,percent of total billed charges,,
SUTURE SOFSILK 2-0 S-185,,A4649,HCPCS,Facility,Both,,,,1.58,1.343,0.452828,1.58,"Health Partners, Inc.",State Public Programs,0.79,50,,percent of total billed charges,,
SUTURE SOFSILK 2-0 S-185,,A4649,HCPCS,Facility,Both,,,,1.58,1.343,0.452828,1.58,Humana Insurance Company,Commercial PPO,1.501,95,,percent of total billed charges,,
SUTURE SOFSILK 2-0 S-185,,A4649,HCPCS,Facility,Outpatient,,,,1.58,1.343,0.452828,1.58,Humana Insurance Company,Medicare PPO,0.7742,49,,percent of total billed charges,,
SUTURE SOFSILK 2-0 S-185,,A4649,HCPCS,Facility,Inpatient,,,,1.58,1.343,0.452828,1.58,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
SUTURE SOFSILK 2-0 S-185,,A4649,HCPCS,Facility,Both,,,,1.58,1.343,0.452828,1.58,Medica,Individual & Family,1.56578,99.1,,percent of total billed charges,,
SUTURE SOFSILK 2-0 S-185,,A4649,HCPCS,Facility,Outpatient,,,,1.58,1.343,0.452828,1.58,Medica,Medica Advantage Solution,0.78684,49.8,,percent of total billed charges,,
SUTURE SOFSILK 2-0 S-185,,A4649,HCPCS,Facility,Inpatient,,,,1.58,1.343,0.452828,1.58,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
SUTURE SOFSILK 2-0 S-185,,A4649,HCPCS,Facility,Outpatient,,,,1.58,1.343,0.452828,1.58,Medica,Medical Assistance,0.70468,44.6,,percent of total billed charges,,
SUTURE SOFSILK 2-0 S-185,,A4649,HCPCS,Facility,Inpatient,,,,1.58,1.343,0.452828,1.58,Medica,Medical Assistance,,,,,Included in per diem rate,
SUTURE SOFSILK 2-0 S-185,,A4649,HCPCS,Facility,Outpatient,,,,1.58,1.343,0.452828,1.58,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,0.78684,49.8,,percent of total billed charges,,
SUTURE SOFSILK 2-0 S-185,,A4649,HCPCS,Facility,Inpatient,,,,1.58,1.343,0.452828,1.58,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
SUTURE SOFSILK 2-0 S-185,,A4649,HCPCS,Facility,Both,,,,1.58,1.343,0.452828,1.58,"Multiplan, Inc.","Multiplan, Inc.",1.4852,94,,percent of total billed charges,,
SUTURE SOFSILK 2-0 S-185,,A4649,HCPCS,Facility,Outpatient,,,,1.58,1.343,0.452828,1.58,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1.42358,90.1,,percent of total billed charges,,
SUTURE SOFSILK 2-0 S-185,,A4649,HCPCS,Facility,Inpatient,,,,1.58,1.343,0.452828,1.58,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
SUTURE SOFSILK 2-0 S-185,,A4649,HCPCS,Facility,Both,,,,1.58,1.343,0.452828,1.58,"Preferred One Administrative Services, INC.",PPO,1.55788,98.6,,percent of total billed charges,,
SUTURE SOFSILK 2-0 S-185,,A4649,HCPCS,Facility,Outpatient,,,,1.58,1.343,0.452828,1.58,PrimeWest Health,Minnesota Senior Health Options (MSHO),0.81291,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
SUTURE SOFSILK 2-0 S-185,,A4649,HCPCS,Facility,Inpatient,,,,1.58,1.343,0.452828,1.58,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE SOFSILK 2-0 S-185,,A4649,HCPCS,Facility,Outpatient,,,,1.58,1.343,0.452828,1.58,PrimeWest Health,MinnesotaCare,0.811488,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
SUTURE SOFSILK 2-0 S-185,,A4649,HCPCS,Facility,Inpatient,,,,1.58,1.343,0.452828,1.58,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
SUTURE SOFSILK 2-0 S-185,,A4649,HCPCS,Facility,Both,,,,1.58,1.343,0.452828,1.58,Sanford Health Plan,Sanford Health Plan,1.4536,92,,percent of total billed charges,,
SUTURE SOFSILK 2-0 S-185,,A4649,HCPCS,Facility,Outpatient,,,,1.58,1.343,0.452828,1.58,"UCare Health, Inc.",Individual & Family Plan,0.89033,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
SUTURE SOFSILK 2-0 S-185,,A4649,HCPCS,Facility,Inpatient,,,,1.58,1.343,0.452828,1.58,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
SUTURE SOFSILK 2-0 S-185,,A4649,HCPCS,Facility,Outpatient,,,,1.58,1.343,0.452828,1.58,"UCare Health, Inc.",Medical Assistance,0.797426,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE SOFSILK 2-0 S-185,,A4649,HCPCS,Facility,Inpatient,,,,1.58,1.343,0.452828,1.58,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
SUTURE SOFSILK 2-0 S-185,,A4649,HCPCS,Facility,Outpatient,,,,1.58,1.343,0.452828,1.58,"UCare Health, Inc.",Medicare Advantage,0.797426,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE SOFSILK 2-0 S-185,,A4649,HCPCS,Facility,Inpatient,,,,1.58,1.343,0.452828,1.58,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE SOFSILK 2-0 S-185,,A4649,HCPCS,Facility,Outpatient,,,,1.58,1.343,0.452828,1.58,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),0.797426,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE SOFSILK 2-0 S-185,,A4649,HCPCS,Facility,Inpatient,,,,1.58,1.343,0.452828,1.58,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE SOFSILK 2-0 S-185,,A4649,HCPCS,Facility,Both,,,,1.58,1.343,0.452828,1.58,UnitedHealthcare,Individual & Family,1.4852,94,,percent of total billed charges,,
SUTURE SOFSILK 2-0 S-185,,A4649,HCPCS,Facility,Outpatient,,,,1.58,1.343,0.452828,1.58,UnitedHealthcare,Medicare Advantage,0.7742,49,,percent of total billed charges,,
SUTURE SOFSILK 2-0 S-185,,A4649,HCPCS,Facility,Inpatient,,,,1.58,1.343,0.452828,1.58,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
SUTURE SOFSILK 2-0 S-185,,A4649,HCPCS,Facility,Outpatient,,,,1.58,1.343,0.452828,1.58,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,0.7584,48,,percent of total billed charges,,100% of DHS outpatient percentage
SUTURE SOFSILK 2-0 S-185,,A4649,HCPCS,Facility,Inpatient,,,,1.58,1.343,0.452828,1.58,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"SUTURE SOFSILK 3-0 18"" BLK C-14 02R  SS684G",,A4649,HCPCS,Facility,Both,,,,26.25,22.3125,7.52325,26.25,Aetna,Commercial,24.15,92,,percent of total billed charges,,
"SUTURE SOFSILK 3-0 18"" BLK C-14 02R  SS684G",,A4649,HCPCS,Facility,Outpatient,,,,26.25,22.3125,7.52325,26.25,Aetna,Medicare Advantage,12.8625,49,,percent of total billed charges,,
"SUTURE SOFSILK 3-0 18"" BLK C-14 02R  SS684G",,A4649,HCPCS,Facility,Inpatient,,,,26.25,22.3125,7.52325,26.25,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"SUTURE SOFSILK 3-0 18"" BLK C-14 02R  SS684G",,A4649,HCPCS,Facility,Both,,,,26.25,22.3125,7.52325,26.25,Aetna,PPO,24.4125,93,,percent of total billed charges,,
"SUTURE SOFSILK 3-0 18"" BLK C-14 02R  SS684G",,A4649,HCPCS,Facility,Both,,,,26.25,22.3125,7.52325,26.25,America's PPO,America's PPO,25.207875,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"SUTURE SOFSILK 3-0 18"" BLK C-14 02R  SS684G",,A4649,HCPCS,Facility,Both,,,,26.25,22.3125,7.52325,26.25,BlueCross BlueShield Minnesota, Federal Employee Program,25.83,98.4,,percent of total billed charges,,
"SUTURE SOFSILK 3-0 18"" BLK C-14 02R  SS684G",,A4649,HCPCS,Facility,Both,,,,26.25,22.3125,7.52325,26.25,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,26.25,100,,percent of total billed charges,,
"SUTURE SOFSILK 3-0 18"" BLK C-14 02R  SS684G",,A4649,HCPCS,Facility,Both,,,,26.25,22.3125,7.52325,26.25,BlueCross BlueShield Minnesota,High Value Network Plan,23.625,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
"SUTURE SOFSILK 3-0 18"" BLK C-14 02R  SS684G",,A4649,HCPCS,Facility,Outpatient,,,,26.25,22.3125,7.52325,26.25,BlueCross BlueShield Minnesota,Medicare Advantage,12.8625,49,,percent of total billed charges,,
"SUTURE SOFSILK 3-0 18"" BLK C-14 02R  SS684G",,A4649,HCPCS,Facility,Inpatient,,,,26.25,22.3125,7.52325,26.25,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"SUTURE SOFSILK 3-0 18"" BLK C-14 02R  SS684G",,A4649,HCPCS,Facility,Both,,,,26.25,22.3125,7.52325,26.25,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,23.249625,88.57,,percent of total billed charges,,
"SUTURE SOFSILK 3-0 18"" BLK C-14 02R  SS684G",,A4649,HCPCS,Facility,Both,,,,26.25,22.3125,7.52325,26.25,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,7.52325,28.66,,percent of total billed charges,,
"SUTURE SOFSILK 3-0 18"" BLK C-14 02R  SS684G",,A4649,HCPCS,Facility,Outpatient,,,,26.25,22.3125,7.52325,26.25,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),12.8625,49,,percent of total billed charges,,
"SUTURE SOFSILK 3-0 18"" BLK C-14 02R  SS684G",,A4649,HCPCS,Facility,Inpatient,,,,26.25,22.3125,7.52325,26.25,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"SUTURE SOFSILK 3-0 18"" BLK C-14 02R  SS684G",,A4649,HCPCS,Facility,Both,,,,26.25,22.3125,7.52325,26.25,CorVel,Worker's Compensation,26.25,100,,percent of total billed charges,,
"SUTURE SOFSILK 3-0 18"" BLK C-14 02R  SS684G",,A4649,HCPCS,Facility,Both,,,,26.25,22.3125,7.52325,26.25,First Health Group Corporation,First Health Network,25.4625,97,,percent of total billed charges,,
"SUTURE SOFSILK 3-0 18"" BLK C-14 02R  SS684G",,A4649,HCPCS,Facility,Both,,,,26.25,22.3125,7.52325,26.25,"Health Partners, Inc.",Commercial,24.8325,94.6,,percent of total billed charges,,
"SUTURE SOFSILK 3-0 18"" BLK C-14 02R  SS684G",,A4649,HCPCS,Facility,Outpatient,,,,26.25,22.3125,7.52325,26.25,"Health Partners, Inc.",Medicare Advantage,12.8625,49,,percent of total billed charges,,
"SUTURE SOFSILK 3-0 18"" BLK C-14 02R  SS684G",,A4649,HCPCS,Facility,Inpatient,,,,26.25,22.3125,7.52325,26.25,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"SUTURE SOFSILK 3-0 18"" BLK C-14 02R  SS684G",,A4649,HCPCS,Facility,Both,,,,26.25,22.3125,7.52325,26.25,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),15.75,60,,percent of total billed charges,,
"SUTURE SOFSILK 3-0 18"" BLK C-14 02R  SS684G",,A4649,HCPCS,Facility,Both,,,,26.25,22.3125,7.52325,26.25,"Health Partners, Inc.",State of Minnesota Advantage Program,21.39375,81.5,,percent of total billed charges,,
"SUTURE SOFSILK 3-0 18"" BLK C-14 02R  SS684G",,A4649,HCPCS,Facility,Both,,,,26.25,22.3125,7.52325,26.25,"Health Partners, Inc.",State Public Programs,13.125,50,,percent of total billed charges,,
"SUTURE SOFSILK 3-0 18"" BLK C-14 02R  SS684G",,A4649,HCPCS,Facility,Both,,,,26.25,22.3125,7.52325,26.25,Humana Insurance Company,Commercial PPO,24.9375,95,,percent of total billed charges,,
"SUTURE SOFSILK 3-0 18"" BLK C-14 02R  SS684G",,A4649,HCPCS,Facility,Outpatient,,,,26.25,22.3125,7.52325,26.25,Humana Insurance Company,Medicare PPO,12.8625,49,,percent of total billed charges,,
"SUTURE SOFSILK 3-0 18"" BLK C-14 02R  SS684G",,A4649,HCPCS,Facility,Inpatient,,,,26.25,22.3125,7.52325,26.25,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"SUTURE SOFSILK 3-0 18"" BLK C-14 02R  SS684G",,A4649,HCPCS,Facility,Both,,,,26.25,22.3125,7.52325,26.25,Medica,Individual & Family,26.01375,99.1,,percent of total billed charges,,
"SUTURE SOFSILK 3-0 18"" BLK C-14 02R  SS684G",,A4649,HCPCS,Facility,Outpatient,,,,26.25,22.3125,7.52325,26.25,Medica,Medica Advantage Solution,13.0725,49.8,,percent of total billed charges,,
"SUTURE SOFSILK 3-0 18"" BLK C-14 02R  SS684G",,A4649,HCPCS,Facility,Inpatient,,,,26.25,22.3125,7.52325,26.25,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"SUTURE SOFSILK 3-0 18"" BLK C-14 02R  SS684G",,A4649,HCPCS,Facility,Outpatient,,,,26.25,22.3125,7.52325,26.25,Medica,Medical Assistance,11.7075,44.6,,percent of total billed charges,,
"SUTURE SOFSILK 3-0 18"" BLK C-14 02R  SS684G",,A4649,HCPCS,Facility,Inpatient,,,,26.25,22.3125,7.52325,26.25,Medica,Medical Assistance,,,,,Included in per diem rate,
"SUTURE SOFSILK 3-0 18"" BLK C-14 02R  SS684G",,A4649,HCPCS,Facility,Outpatient,,,,26.25,22.3125,7.52325,26.25,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,13.0725,49.8,,percent of total billed charges,,
"SUTURE SOFSILK 3-0 18"" BLK C-14 02R  SS684G",,A4649,HCPCS,Facility,Inpatient,,,,26.25,22.3125,7.52325,26.25,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"SUTURE SOFSILK 3-0 18"" BLK C-14 02R  SS684G",,A4649,HCPCS,Facility,Both,,,,26.25,22.3125,7.52325,26.25,"Multiplan, Inc.","Multiplan, Inc.",24.675,94,,percent of total billed charges,,
"SUTURE SOFSILK 3-0 18"" BLK C-14 02R  SS684G",,A4649,HCPCS,Facility,Outpatient,,,,26.25,22.3125,7.52325,26.25,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,23.65125,90.1,,percent of total billed charges,,
"SUTURE SOFSILK 3-0 18"" BLK C-14 02R  SS684G",,A4649,HCPCS,Facility,Inpatient,,,,26.25,22.3125,7.52325,26.25,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"SUTURE SOFSILK 3-0 18"" BLK C-14 02R  SS684G",,A4649,HCPCS,Facility,Both,,,,26.25,22.3125,7.52325,26.25,"Preferred One Administrative Services, INC.",PPO,25.8825,98.6,,percent of total billed charges,,
"SUTURE SOFSILK 3-0 18"" BLK C-14 02R  SS684G",,A4649,HCPCS,Facility,Outpatient,,,,26.25,22.3125,7.52325,26.25,PrimeWest Health,Minnesota Senior Health Options (MSHO),13.505625,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"SUTURE SOFSILK 3-0 18"" BLK C-14 02R  SS684G",,A4649,HCPCS,Facility,Inpatient,,,,26.25,22.3125,7.52325,26.25,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"SUTURE SOFSILK 3-0 18"" BLK C-14 02R  SS684G",,A4649,HCPCS,Facility,Outpatient,,,,26.25,22.3125,7.52325,26.25,PrimeWest Health,MinnesotaCare,13.482,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"SUTURE SOFSILK 3-0 18"" BLK C-14 02R  SS684G",,A4649,HCPCS,Facility,Inpatient,,,,26.25,22.3125,7.52325,26.25,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"SUTURE SOFSILK 3-0 18"" BLK C-14 02R  SS684G",,A4649,HCPCS,Facility,Both,,,,26.25,22.3125,7.52325,26.25,Sanford Health Plan,Sanford Health Plan,24.15,92,,percent of total billed charges,,
"SUTURE SOFSILK 3-0 18"" BLK C-14 02R  SS684G",,A4649,HCPCS,Facility,Outpatient,,,,26.25,22.3125,7.52325,26.25,"UCare Health, Inc.",Individual & Family Plan,14.791875,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"SUTURE SOFSILK 3-0 18"" BLK C-14 02R  SS684G",,A4649,HCPCS,Facility,Inpatient,,,,26.25,22.3125,7.52325,26.25,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"SUTURE SOFSILK 3-0 18"" BLK C-14 02R  SS684G",,A4649,HCPCS,Facility,Outpatient,,,,26.25,22.3125,7.52325,26.25,"UCare Health, Inc.",Medical Assistance,13.248375,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"SUTURE SOFSILK 3-0 18"" BLK C-14 02R  SS684G",,A4649,HCPCS,Facility,Inpatient,,,,26.25,22.3125,7.52325,26.25,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"SUTURE SOFSILK 3-0 18"" BLK C-14 02R  SS684G",,A4649,HCPCS,Facility,Outpatient,,,,26.25,22.3125,7.52325,26.25,"UCare Health, Inc.",Medicare Advantage,13.248375,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"SUTURE SOFSILK 3-0 18"" BLK C-14 02R  SS684G",,A4649,HCPCS,Facility,Inpatient,,,,26.25,22.3125,7.52325,26.25,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"SUTURE SOFSILK 3-0 18"" BLK C-14 02R  SS684G",,A4649,HCPCS,Facility,Outpatient,,,,26.25,22.3125,7.52325,26.25,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),13.248375,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"SUTURE SOFSILK 3-0 18"" BLK C-14 02R  SS684G",,A4649,HCPCS,Facility,Inpatient,,,,26.25,22.3125,7.52325,26.25,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"SUTURE SOFSILK 3-0 18"" BLK C-14 02R  SS684G",,A4649,HCPCS,Facility,Both,,,,26.25,22.3125,7.52325,26.25,UnitedHealthcare,Individual & Family,24.675,94,,percent of total billed charges,,
"SUTURE SOFSILK 3-0 18"" BLK C-14 02R  SS684G",,A4649,HCPCS,Facility,Outpatient,,,,26.25,22.3125,7.52325,26.25,UnitedHealthcare,Medicare Advantage,12.8625,49,,percent of total billed charges,,
"SUTURE SOFSILK 3-0 18"" BLK C-14 02R  SS684G",,A4649,HCPCS,Facility,Inpatient,,,,26.25,22.3125,7.52325,26.25,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"SUTURE SOFSILK 3-0 18"" BLK C-14 02R  SS684G",,A4649,HCPCS,Facility,Outpatient,,,,26.25,22.3125,7.52325,26.25,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,12.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
"SUTURE SOFSILK 3-0 18"" BLK C-14 02R  SS684G",,A4649,HCPCS,Facility,Inpatient,,,,26.25,22.3125,7.52325,26.25,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"SUTURE SOFSILK 3-0 18"" BLK CV-25 D  GS33M",,A4649,HCPCS,Facility,Both,,,,27.6,23.46,7.91016,27.6,Aetna,Commercial,25.392,92,,percent of total billed charges,,
"SUTURE SOFSILK 3-0 18"" BLK CV-25 D  GS33M",,A4649,HCPCS,Facility,Outpatient,,,,27.6,23.46,7.91016,27.6,Aetna,Medicare Advantage,13.524,49,,percent of total billed charges,,
"SUTURE SOFSILK 3-0 18"" BLK CV-25 D  GS33M",,A4649,HCPCS,Facility,Inpatient,,,,27.6,23.46,7.91016,27.6,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"SUTURE SOFSILK 3-0 18"" BLK CV-25 D  GS33M",,A4649,HCPCS,Facility,Both,,,,27.6,23.46,7.91016,27.6,Aetna,PPO,25.668,93,,percent of total billed charges,,
"SUTURE SOFSILK 3-0 18"" BLK CV-25 D  GS33M",,A4649,HCPCS,Facility,Both,,,,27.6,23.46,7.91016,27.6,America's PPO,America's PPO,26.50428,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"SUTURE SOFSILK 3-0 18"" BLK CV-25 D  GS33M",,A4649,HCPCS,Facility,Both,,,,27.6,23.46,7.91016,27.6,BlueCross BlueShield Minnesota, Federal Employee Program,27.1584,98.4,,percent of total billed charges,,
"SUTURE SOFSILK 3-0 18"" BLK CV-25 D  GS33M",,A4649,HCPCS,Facility,Both,,,,27.6,23.46,7.91016,27.6,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,27.6,100,,percent of total billed charges,,
"SUTURE SOFSILK 3-0 18"" BLK CV-25 D  GS33M",,A4649,HCPCS,Facility,Both,,,,27.6,23.46,7.91016,27.6,BlueCross BlueShield Minnesota,High Value Network Plan,24.84,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
"SUTURE SOFSILK 3-0 18"" BLK CV-25 D  GS33M",,A4649,HCPCS,Facility,Outpatient,,,,27.6,23.46,7.91016,27.6,BlueCross BlueShield Minnesota,Medicare Advantage,13.524,49,,percent of total billed charges,,
"SUTURE SOFSILK 3-0 18"" BLK CV-25 D  GS33M",,A4649,HCPCS,Facility,Inpatient,,,,27.6,23.46,7.91016,27.6,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"SUTURE SOFSILK 3-0 18"" BLK CV-25 D  GS33M",,A4649,HCPCS,Facility,Both,,,,27.6,23.46,7.91016,27.6,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,24.44532,88.57,,percent of total billed charges,,
"SUTURE SOFSILK 3-0 18"" BLK CV-25 D  GS33M",,A4649,HCPCS,Facility,Both,,,,27.6,23.46,7.91016,27.6,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,7.91016,28.66,,percent of total billed charges,,
"SUTURE SOFSILK 3-0 18"" BLK CV-25 D  GS33M",,A4649,HCPCS,Facility,Outpatient,,,,27.6,23.46,7.91016,27.6,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),13.524,49,,percent of total billed charges,,
"SUTURE SOFSILK 3-0 18"" BLK CV-25 D  GS33M",,A4649,HCPCS,Facility,Inpatient,,,,27.6,23.46,7.91016,27.6,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"SUTURE SOFSILK 3-0 18"" BLK CV-25 D  GS33M",,A4649,HCPCS,Facility,Both,,,,27.6,23.46,7.91016,27.6,CorVel,Worker's Compensation,27.6,100,,percent of total billed charges,,
"SUTURE SOFSILK 3-0 18"" BLK CV-25 D  GS33M",,A4649,HCPCS,Facility,Both,,,,27.6,23.46,7.91016,27.6,First Health Group Corporation,First Health Network,26.772,97,,percent of total billed charges,,
"SUTURE SOFSILK 3-0 18"" BLK CV-25 D  GS33M",,A4649,HCPCS,Facility,Both,,,,27.6,23.46,7.91016,27.6,"Health Partners, Inc.",Commercial,26.1096,94.6,,percent of total billed charges,,
"SUTURE SOFSILK 3-0 18"" BLK CV-25 D  GS33M",,A4649,HCPCS,Facility,Outpatient,,,,27.6,23.46,7.91016,27.6,"Health Partners, Inc.",Medicare Advantage,13.524,49,,percent of total billed charges,,
"SUTURE SOFSILK 3-0 18"" BLK CV-25 D  GS33M",,A4649,HCPCS,Facility,Inpatient,,,,27.6,23.46,7.91016,27.6,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"SUTURE SOFSILK 3-0 18"" BLK CV-25 D  GS33M",,A4649,HCPCS,Facility,Both,,,,27.6,23.46,7.91016,27.6,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),16.56,60,,percent of total billed charges,,
"SUTURE SOFSILK 3-0 18"" BLK CV-25 D  GS33M",,A4649,HCPCS,Facility,Both,,,,27.6,23.46,7.91016,27.6,"Health Partners, Inc.",State of Minnesota Advantage Program,22.494,81.5,,percent of total billed charges,,
"SUTURE SOFSILK 3-0 18"" BLK CV-25 D  GS33M",,A4649,HCPCS,Facility,Both,,,,27.6,23.46,7.91016,27.6,"Health Partners, Inc.",State Public Programs,13.8,50,,percent of total billed charges,,
"SUTURE SOFSILK 3-0 18"" BLK CV-25 D  GS33M",,A4649,HCPCS,Facility,Both,,,,27.6,23.46,7.91016,27.6,Humana Insurance Company,Commercial PPO,26.22,95,,percent of total billed charges,,
"SUTURE SOFSILK 3-0 18"" BLK CV-25 D  GS33M",,A4649,HCPCS,Facility,Outpatient,,,,27.6,23.46,7.91016,27.6,Humana Insurance Company,Medicare PPO,13.524,49,,percent of total billed charges,,
"SUTURE SOFSILK 3-0 18"" BLK CV-25 D  GS33M",,A4649,HCPCS,Facility,Inpatient,,,,27.6,23.46,7.91016,27.6,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"SUTURE SOFSILK 3-0 18"" BLK CV-25 D  GS33M",,A4649,HCPCS,Facility,Both,,,,27.6,23.46,7.91016,27.6,Medica,Individual & Family,27.3516,99.1,,percent of total billed charges,,
"SUTURE SOFSILK 3-0 18"" BLK CV-25 D  GS33M",,A4649,HCPCS,Facility,Outpatient,,,,27.6,23.46,7.91016,27.6,Medica,Medica Advantage Solution,13.7448,49.8,,percent of total billed charges,,
"SUTURE SOFSILK 3-0 18"" BLK CV-25 D  GS33M",,A4649,HCPCS,Facility,Inpatient,,,,27.6,23.46,7.91016,27.6,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"SUTURE SOFSILK 3-0 18"" BLK CV-25 D  GS33M",,A4649,HCPCS,Facility,Outpatient,,,,27.6,23.46,7.91016,27.6,Medica,Medical Assistance,12.3096,44.6,,percent of total billed charges,,
"SUTURE SOFSILK 3-0 18"" BLK CV-25 D  GS33M",,A4649,HCPCS,Facility,Inpatient,,,,27.6,23.46,7.91016,27.6,Medica,Medical Assistance,,,,,Included in per diem rate,
"SUTURE SOFSILK 3-0 18"" BLK CV-25 D  GS33M",,A4649,HCPCS,Facility,Outpatient,,,,27.6,23.46,7.91016,27.6,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,13.7448,49.8,,percent of total billed charges,,
"SUTURE SOFSILK 3-0 18"" BLK CV-25 D  GS33M",,A4649,HCPCS,Facility,Inpatient,,,,27.6,23.46,7.91016,27.6,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"SUTURE SOFSILK 3-0 18"" BLK CV-25 D  GS33M",,A4649,HCPCS,Facility,Both,,,,27.6,23.46,7.91016,27.6,"Multiplan, Inc.","Multiplan, Inc.",25.944,94,,percent of total billed charges,,
"SUTURE SOFSILK 3-0 18"" BLK CV-25 D  GS33M",,A4649,HCPCS,Facility,Outpatient,,,,27.6,23.46,7.91016,27.6,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,24.8676,90.1,,percent of total billed charges,,
"SUTURE SOFSILK 3-0 18"" BLK CV-25 D  GS33M",,A4649,HCPCS,Facility,Inpatient,,,,27.6,23.46,7.91016,27.6,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"SUTURE SOFSILK 3-0 18"" BLK CV-25 D  GS33M",,A4649,HCPCS,Facility,Both,,,,27.6,23.46,7.91016,27.6,"Preferred One Administrative Services, INC.",PPO,27.2136,98.6,,percent of total billed charges,,
"SUTURE SOFSILK 3-0 18"" BLK CV-25 D  GS33M",,A4649,HCPCS,Facility,Outpatient,,,,27.6,23.46,7.91016,27.6,PrimeWest Health,Minnesota Senior Health Options (MSHO),14.2002,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"SUTURE SOFSILK 3-0 18"" BLK CV-25 D  GS33M",,A4649,HCPCS,Facility,Inpatient,,,,27.6,23.46,7.91016,27.6,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"SUTURE SOFSILK 3-0 18"" BLK CV-25 D  GS33M",,A4649,HCPCS,Facility,Outpatient,,,,27.6,23.46,7.91016,27.6,PrimeWest Health,MinnesotaCare,14.17536,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"SUTURE SOFSILK 3-0 18"" BLK CV-25 D  GS33M",,A4649,HCPCS,Facility,Inpatient,,,,27.6,23.46,7.91016,27.6,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"SUTURE SOFSILK 3-0 18"" BLK CV-25 D  GS33M",,A4649,HCPCS,Facility,Both,,,,27.6,23.46,7.91016,27.6,Sanford Health Plan,Sanford Health Plan,25.392,92,,percent of total billed charges,,
"SUTURE SOFSILK 3-0 18"" BLK CV-25 D  GS33M",,A4649,HCPCS,Facility,Outpatient,,,,27.6,23.46,7.91016,27.6,"UCare Health, Inc.",Individual & Family Plan,15.5526,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"SUTURE SOFSILK 3-0 18"" BLK CV-25 D  GS33M",,A4649,HCPCS,Facility,Inpatient,,,,27.6,23.46,7.91016,27.6,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"SUTURE SOFSILK 3-0 18"" BLK CV-25 D  GS33M",,A4649,HCPCS,Facility,Outpatient,,,,27.6,23.46,7.91016,27.6,"UCare Health, Inc.",Medical Assistance,13.92972,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"SUTURE SOFSILK 3-0 18"" BLK CV-25 D  GS33M",,A4649,HCPCS,Facility,Inpatient,,,,27.6,23.46,7.91016,27.6,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"SUTURE SOFSILK 3-0 18"" BLK CV-25 D  GS33M",,A4649,HCPCS,Facility,Outpatient,,,,27.6,23.46,7.91016,27.6,"UCare Health, Inc.",Medicare Advantage,13.92972,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"SUTURE SOFSILK 3-0 18"" BLK CV-25 D  GS33M",,A4649,HCPCS,Facility,Inpatient,,,,27.6,23.46,7.91016,27.6,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"SUTURE SOFSILK 3-0 18"" BLK CV-25 D  GS33M",,A4649,HCPCS,Facility,Outpatient,,,,27.6,23.46,7.91016,27.6,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),13.92972,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"SUTURE SOFSILK 3-0 18"" BLK CV-25 D  GS33M",,A4649,HCPCS,Facility,Inpatient,,,,27.6,23.46,7.91016,27.6,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"SUTURE SOFSILK 3-0 18"" BLK CV-25 D  GS33M",,A4649,HCPCS,Facility,Both,,,,27.6,23.46,7.91016,27.6,UnitedHealthcare,Individual & Family,25.944,94,,percent of total billed charges,,
"SUTURE SOFSILK 3-0 18"" BLK CV-25 D  GS33M",,A4649,HCPCS,Facility,Outpatient,,,,27.6,23.46,7.91016,27.6,UnitedHealthcare,Medicare Advantage,13.524,49,,percent of total billed charges,,
"SUTURE SOFSILK 3-0 18"" BLK CV-25 D  GS33M",,A4649,HCPCS,Facility,Inpatient,,,,27.6,23.46,7.91016,27.6,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"SUTURE SOFSILK 3-0 18"" BLK CV-25 D  GS33M",,A4649,HCPCS,Facility,Outpatient,,,,27.6,23.46,7.91016,27.6,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,13.248,48,,percent of total billed charges,,100% of DHS outpatient percentage
"SUTURE SOFSILK 3-0 18"" BLK CV-25 D  GS33M",,A4649,HCPCS,Facility,Inpatient,,,,27.6,23.46,7.91016,27.6,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
SUTURE SOFSILK 3-0 DETACH GS-33-M,,A4649,HCPCS,Facility,Both,,,,27.6,23.46,7.91016,27.6,Aetna,Commercial,25.392,92,,percent of total billed charges,,
SUTURE SOFSILK 3-0 DETACH GS-33-M,,A4649,HCPCS,Facility,Outpatient,,,,27.6,23.46,7.91016,27.6,Aetna,Medicare Advantage,13.524,49,,percent of total billed charges,,
SUTURE SOFSILK 3-0 DETACH GS-33-M,,A4649,HCPCS,Facility,Inpatient,,,,27.6,23.46,7.91016,27.6,Aetna,Medicare Advantage,,,,,Included in per diem rate,
SUTURE SOFSILK 3-0 DETACH GS-33-M,,A4649,HCPCS,Facility,Both,,,,27.6,23.46,7.91016,27.6,Aetna,PPO,25.668,93,,percent of total billed charges,,
SUTURE SOFSILK 3-0 DETACH GS-33-M,,A4649,HCPCS,Facility,Both,,,,27.6,23.46,7.91016,27.6,America's PPO,America's PPO,26.50428,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SUTURE SOFSILK 3-0 DETACH GS-33-M,,A4649,HCPCS,Facility,Both,,,,27.6,23.46,7.91016,27.6,BlueCross BlueShield Minnesota, Federal Employee Program,27.1584,98.4,,percent of total billed charges,,
SUTURE SOFSILK 3-0 DETACH GS-33-M,,A4649,HCPCS,Facility,Both,,,,27.6,23.46,7.91016,27.6,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,27.6,100,,percent of total billed charges,,
SUTURE SOFSILK 3-0 DETACH GS-33-M,,A4649,HCPCS,Facility,Both,,,,27.6,23.46,7.91016,27.6,BlueCross BlueShield Minnesota,High Value Network Plan,24.84,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
SUTURE SOFSILK 3-0 DETACH GS-33-M,,A4649,HCPCS,Facility,Outpatient,,,,27.6,23.46,7.91016,27.6,BlueCross BlueShield Minnesota,Medicare Advantage,13.524,49,,percent of total billed charges,,
SUTURE SOFSILK 3-0 DETACH GS-33-M,,A4649,HCPCS,Facility,Inpatient,,,,27.6,23.46,7.91016,27.6,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
SUTURE SOFSILK 3-0 DETACH GS-33-M,,A4649,HCPCS,Facility,Both,,,,27.6,23.46,7.91016,27.6,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,24.44532,88.57,,percent of total billed charges,,
SUTURE SOFSILK 3-0 DETACH GS-33-M,,A4649,HCPCS,Facility,Both,,,,27.6,23.46,7.91016,27.6,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,7.91016,28.66,,percent of total billed charges,,
SUTURE SOFSILK 3-0 DETACH GS-33-M,,A4649,HCPCS,Facility,Outpatient,,,,27.6,23.46,7.91016,27.6,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),13.524,49,,percent of total billed charges,,
SUTURE SOFSILK 3-0 DETACH GS-33-M,,A4649,HCPCS,Facility,Inpatient,,,,27.6,23.46,7.91016,27.6,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
SUTURE SOFSILK 3-0 DETACH GS-33-M,,A4649,HCPCS,Facility,Both,,,,27.6,23.46,7.91016,27.6,CorVel,Worker's Compensation,27.6,100,,percent of total billed charges,,
SUTURE SOFSILK 3-0 DETACH GS-33-M,,A4649,HCPCS,Facility,Both,,,,27.6,23.46,7.91016,27.6,First Health Group Corporation,First Health Network,26.772,97,,percent of total billed charges,,
SUTURE SOFSILK 3-0 DETACH GS-33-M,,A4649,HCPCS,Facility,Both,,,,27.6,23.46,7.91016,27.6,"Health Partners, Inc.",Commercial,26.1096,94.6,,percent of total billed charges,,
SUTURE SOFSILK 3-0 DETACH GS-33-M,,A4649,HCPCS,Facility,Outpatient,,,,27.6,23.46,7.91016,27.6,"Health Partners, Inc.",Medicare Advantage,13.524,49,,percent of total billed charges,,
SUTURE SOFSILK 3-0 DETACH GS-33-M,,A4649,HCPCS,Facility,Inpatient,,,,27.6,23.46,7.91016,27.6,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE SOFSILK 3-0 DETACH GS-33-M,,A4649,HCPCS,Facility,Both,,,,27.6,23.46,7.91016,27.6,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),16.56,60,,percent of total billed charges,,
SUTURE SOFSILK 3-0 DETACH GS-33-M,,A4649,HCPCS,Facility,Both,,,,27.6,23.46,7.91016,27.6,"Health Partners, Inc.",State of Minnesota Advantage Program,22.494,81.5,,percent of total billed charges,,
SUTURE SOFSILK 3-0 DETACH GS-33-M,,A4649,HCPCS,Facility,Both,,,,27.6,23.46,7.91016,27.6,"Health Partners, Inc.",State Public Programs,13.8,50,,percent of total billed charges,,
SUTURE SOFSILK 3-0 DETACH GS-33-M,,A4649,HCPCS,Facility,Both,,,,27.6,23.46,7.91016,27.6,Humana Insurance Company,Commercial PPO,26.22,95,,percent of total billed charges,,
SUTURE SOFSILK 3-0 DETACH GS-33-M,,A4649,HCPCS,Facility,Outpatient,,,,27.6,23.46,7.91016,27.6,Humana Insurance Company,Medicare PPO,13.524,49,,percent of total billed charges,,
SUTURE SOFSILK 3-0 DETACH GS-33-M,,A4649,HCPCS,Facility,Inpatient,,,,27.6,23.46,7.91016,27.6,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
SUTURE SOFSILK 3-0 DETACH GS-33-M,,A4649,HCPCS,Facility,Both,,,,27.6,23.46,7.91016,27.6,Medica,Individual & Family,27.3516,99.1,,percent of total billed charges,,
SUTURE SOFSILK 3-0 DETACH GS-33-M,,A4649,HCPCS,Facility,Outpatient,,,,27.6,23.46,7.91016,27.6,Medica,Medica Advantage Solution,13.7448,49.8,,percent of total billed charges,,
SUTURE SOFSILK 3-0 DETACH GS-33-M,,A4649,HCPCS,Facility,Inpatient,,,,27.6,23.46,7.91016,27.6,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
SUTURE SOFSILK 3-0 DETACH GS-33-M,,A4649,HCPCS,Facility,Outpatient,,,,27.6,23.46,7.91016,27.6,Medica,Medical Assistance,12.3096,44.6,,percent of total billed charges,,
SUTURE SOFSILK 3-0 DETACH GS-33-M,,A4649,HCPCS,Facility,Inpatient,,,,27.6,23.46,7.91016,27.6,Medica,Medical Assistance,,,,,Included in per diem rate,
SUTURE SOFSILK 3-0 DETACH GS-33-M,,A4649,HCPCS,Facility,Outpatient,,,,27.6,23.46,7.91016,27.6,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,13.7448,49.8,,percent of total billed charges,,
SUTURE SOFSILK 3-0 DETACH GS-33-M,,A4649,HCPCS,Facility,Inpatient,,,,27.6,23.46,7.91016,27.6,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
SUTURE SOFSILK 3-0 DETACH GS-33-M,,A4649,HCPCS,Facility,Both,,,,27.6,23.46,7.91016,27.6,"Multiplan, Inc.","Multiplan, Inc.",25.944,94,,percent of total billed charges,,
SUTURE SOFSILK 3-0 DETACH GS-33-M,,A4649,HCPCS,Facility,Outpatient,,,,27.6,23.46,7.91016,27.6,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,24.8676,90.1,,percent of total billed charges,,
SUTURE SOFSILK 3-0 DETACH GS-33-M,,A4649,HCPCS,Facility,Inpatient,,,,27.6,23.46,7.91016,27.6,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
SUTURE SOFSILK 3-0 DETACH GS-33-M,,A4649,HCPCS,Facility,Both,,,,27.6,23.46,7.91016,27.6,"Preferred One Administrative Services, INC.",PPO,27.2136,98.6,,percent of total billed charges,,
SUTURE SOFSILK 3-0 DETACH GS-33-M,,A4649,HCPCS,Facility,Outpatient,,,,27.6,23.46,7.91016,27.6,PrimeWest Health,Minnesota Senior Health Options (MSHO),14.2002,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
SUTURE SOFSILK 3-0 DETACH GS-33-M,,A4649,HCPCS,Facility,Inpatient,,,,27.6,23.46,7.91016,27.6,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE SOFSILK 3-0 DETACH GS-33-M,,A4649,HCPCS,Facility,Outpatient,,,,27.6,23.46,7.91016,27.6,PrimeWest Health,MinnesotaCare,14.17536,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
SUTURE SOFSILK 3-0 DETACH GS-33-M,,A4649,HCPCS,Facility,Inpatient,,,,27.6,23.46,7.91016,27.6,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
SUTURE SOFSILK 3-0 DETACH GS-33-M,,A4649,HCPCS,Facility,Both,,,,27.6,23.46,7.91016,27.6,Sanford Health Plan,Sanford Health Plan,25.392,92,,percent of total billed charges,,
SUTURE SOFSILK 3-0 DETACH GS-33-M,,A4649,HCPCS,Facility,Outpatient,,,,27.6,23.46,7.91016,27.6,"UCare Health, Inc.",Individual & Family Plan,15.5526,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
SUTURE SOFSILK 3-0 DETACH GS-33-M,,A4649,HCPCS,Facility,Inpatient,,,,27.6,23.46,7.91016,27.6,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
SUTURE SOFSILK 3-0 DETACH GS-33-M,,A4649,HCPCS,Facility,Outpatient,,,,27.6,23.46,7.91016,27.6,"UCare Health, Inc.",Medical Assistance,13.92972,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE SOFSILK 3-0 DETACH GS-33-M,,A4649,HCPCS,Facility,Inpatient,,,,27.6,23.46,7.91016,27.6,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
SUTURE SOFSILK 3-0 DETACH GS-33-M,,A4649,HCPCS,Facility,Outpatient,,,,27.6,23.46,7.91016,27.6,"UCare Health, Inc.",Medicare Advantage,13.92972,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE SOFSILK 3-0 DETACH GS-33-M,,A4649,HCPCS,Facility,Inpatient,,,,27.6,23.46,7.91016,27.6,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE SOFSILK 3-0 DETACH GS-33-M,,A4649,HCPCS,Facility,Outpatient,,,,27.6,23.46,7.91016,27.6,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),13.92972,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE SOFSILK 3-0 DETACH GS-33-M,,A4649,HCPCS,Facility,Inpatient,,,,27.6,23.46,7.91016,27.6,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE SOFSILK 3-0 DETACH GS-33-M,,A4649,HCPCS,Facility,Both,,,,27.6,23.46,7.91016,27.6,UnitedHealthcare,Individual & Family,25.944,94,,percent of total billed charges,,
SUTURE SOFSILK 3-0 DETACH GS-33-M,,A4649,HCPCS,Facility,Outpatient,,,,27.6,23.46,7.91016,27.6,UnitedHealthcare,Medicare Advantage,13.524,49,,percent of total billed charges,,
SUTURE SOFSILK 3-0 DETACH GS-33-M,,A4649,HCPCS,Facility,Inpatient,,,,27.6,23.46,7.91016,27.6,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
SUTURE SOFSILK 3-0 DETACH GS-33-M,,A4649,HCPCS,Facility,Outpatient,,,,27.6,23.46,7.91016,27.6,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,13.248,48,,percent of total billed charges,,100% of DHS outpatient percentage
SUTURE SOFSILK 3-0 DETACH GS-33-M,,A4649,HCPCS,Facility,Inpatient,,,,27.6,23.46,7.91016,27.6,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
SUTURE SOFSILK 3-0 SS-684G,,A4649,HCPCS,Facility,Both,,,,26.25,22.3125,7.52325,26.25,Aetna,Commercial,24.15,92,,percent of total billed charges,,
SUTURE SOFSILK 3-0 SS-684G,,A4649,HCPCS,Facility,Outpatient,,,,26.25,22.3125,7.52325,26.25,Aetna,Medicare Advantage,12.8625,49,,percent of total billed charges,,
SUTURE SOFSILK 3-0 SS-684G,,A4649,HCPCS,Facility,Inpatient,,,,26.25,22.3125,7.52325,26.25,Aetna,Medicare Advantage,,,,,Included in per diem rate,
SUTURE SOFSILK 3-0 SS-684G,,A4649,HCPCS,Facility,Both,,,,26.25,22.3125,7.52325,26.25,Aetna,PPO,24.4125,93,,percent of total billed charges,,
SUTURE SOFSILK 3-0 SS-684G,,A4649,HCPCS,Facility,Both,,,,26.25,22.3125,7.52325,26.25,America's PPO,America's PPO,25.207875,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SUTURE SOFSILK 3-0 SS-684G,,A4649,HCPCS,Facility,Both,,,,26.25,22.3125,7.52325,26.25,BlueCross BlueShield Minnesota, Federal Employee Program,25.83,98.4,,percent of total billed charges,,
SUTURE SOFSILK 3-0 SS-684G,,A4649,HCPCS,Facility,Both,,,,26.25,22.3125,7.52325,26.25,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,26.25,100,,percent of total billed charges,,
SUTURE SOFSILK 3-0 SS-684G,,A4649,HCPCS,Facility,Both,,,,26.25,22.3125,7.52325,26.25,BlueCross BlueShield Minnesota,High Value Network Plan,23.625,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
SUTURE SOFSILK 3-0 SS-684G,,A4649,HCPCS,Facility,Outpatient,,,,26.25,22.3125,7.52325,26.25,BlueCross BlueShield Minnesota,Medicare Advantage,12.8625,49,,percent of total billed charges,,
SUTURE SOFSILK 3-0 SS-684G,,A4649,HCPCS,Facility,Inpatient,,,,26.25,22.3125,7.52325,26.25,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
SUTURE SOFSILK 3-0 SS-684G,,A4649,HCPCS,Facility,Both,,,,26.25,22.3125,7.52325,26.25,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,23.249625,88.57,,percent of total billed charges,,
SUTURE SOFSILK 3-0 SS-684G,,A4649,HCPCS,Facility,Both,,,,26.25,22.3125,7.52325,26.25,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,7.52325,28.66,,percent of total billed charges,,
SUTURE SOFSILK 3-0 SS-684G,,A4649,HCPCS,Facility,Outpatient,,,,26.25,22.3125,7.52325,26.25,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),12.8625,49,,percent of total billed charges,,
SUTURE SOFSILK 3-0 SS-684G,,A4649,HCPCS,Facility,Inpatient,,,,26.25,22.3125,7.52325,26.25,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
SUTURE SOFSILK 3-0 SS-684G,,A4649,HCPCS,Facility,Both,,,,26.25,22.3125,7.52325,26.25,CorVel,Worker's Compensation,26.25,100,,percent of total billed charges,,
SUTURE SOFSILK 3-0 SS-684G,,A4649,HCPCS,Facility,Both,,,,26.25,22.3125,7.52325,26.25,First Health Group Corporation,First Health Network,25.4625,97,,percent of total billed charges,,
SUTURE SOFSILK 3-0 SS-684G,,A4649,HCPCS,Facility,Both,,,,26.25,22.3125,7.52325,26.25,"Health Partners, Inc.",Commercial,24.8325,94.6,,percent of total billed charges,,
SUTURE SOFSILK 3-0 SS-684G,,A4649,HCPCS,Facility,Outpatient,,,,26.25,22.3125,7.52325,26.25,"Health Partners, Inc.",Medicare Advantage,12.8625,49,,percent of total billed charges,,
SUTURE SOFSILK 3-0 SS-684G,,A4649,HCPCS,Facility,Inpatient,,,,26.25,22.3125,7.52325,26.25,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE SOFSILK 3-0 SS-684G,,A4649,HCPCS,Facility,Both,,,,26.25,22.3125,7.52325,26.25,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),15.75,60,,percent of total billed charges,,
SUTURE SOFSILK 3-0 SS-684G,,A4649,HCPCS,Facility,Both,,,,26.25,22.3125,7.52325,26.25,"Health Partners, Inc.",State of Minnesota Advantage Program,21.39375,81.5,,percent of total billed charges,,
SUTURE SOFSILK 3-0 SS-684G,,A4649,HCPCS,Facility,Both,,,,26.25,22.3125,7.52325,26.25,"Health Partners, Inc.",State Public Programs,13.125,50,,percent of total billed charges,,
SUTURE SOFSILK 3-0 SS-684G,,A4649,HCPCS,Facility,Both,,,,26.25,22.3125,7.52325,26.25,Humana Insurance Company,Commercial PPO,24.9375,95,,percent of total billed charges,,
SUTURE SOFSILK 3-0 SS-684G,,A4649,HCPCS,Facility,Outpatient,,,,26.25,22.3125,7.52325,26.25,Humana Insurance Company,Medicare PPO,12.8625,49,,percent of total billed charges,,
SUTURE SOFSILK 3-0 SS-684G,,A4649,HCPCS,Facility,Inpatient,,,,26.25,22.3125,7.52325,26.25,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
SUTURE SOFSILK 3-0 SS-684G,,A4649,HCPCS,Facility,Both,,,,26.25,22.3125,7.52325,26.25,Medica,Individual & Family,26.01375,99.1,,percent of total billed charges,,
SUTURE SOFSILK 3-0 SS-684G,,A4649,HCPCS,Facility,Outpatient,,,,26.25,22.3125,7.52325,26.25,Medica,Medica Advantage Solution,13.0725,49.8,,percent of total billed charges,,
SUTURE SOFSILK 3-0 SS-684G,,A4649,HCPCS,Facility,Inpatient,,,,26.25,22.3125,7.52325,26.25,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
SUTURE SOFSILK 3-0 SS-684G,,A4649,HCPCS,Facility,Outpatient,,,,26.25,22.3125,7.52325,26.25,Medica,Medical Assistance,11.7075,44.6,,percent of total billed charges,,
SUTURE SOFSILK 3-0 SS-684G,,A4649,HCPCS,Facility,Inpatient,,,,26.25,22.3125,7.52325,26.25,Medica,Medical Assistance,,,,,Included in per diem rate,
SUTURE SOFSILK 3-0 SS-684G,,A4649,HCPCS,Facility,Outpatient,,,,26.25,22.3125,7.52325,26.25,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,13.0725,49.8,,percent of total billed charges,,
SUTURE SOFSILK 3-0 SS-684G,,A4649,HCPCS,Facility,Inpatient,,,,26.25,22.3125,7.52325,26.25,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
SUTURE SOFSILK 3-0 SS-684G,,A4649,HCPCS,Facility,Both,,,,26.25,22.3125,7.52325,26.25,"Multiplan, Inc.","Multiplan, Inc.",24.675,94,,percent of total billed charges,,
SUTURE SOFSILK 3-0 SS-684G,,A4649,HCPCS,Facility,Outpatient,,,,26.25,22.3125,7.52325,26.25,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,23.65125,90.1,,percent of total billed charges,,
SUTURE SOFSILK 3-0 SS-684G,,A4649,HCPCS,Facility,Inpatient,,,,26.25,22.3125,7.52325,26.25,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
SUTURE SOFSILK 3-0 SS-684G,,A4649,HCPCS,Facility,Both,,,,26.25,22.3125,7.52325,26.25,"Preferred One Administrative Services, INC.",PPO,25.8825,98.6,,percent of total billed charges,,
SUTURE SOFSILK 3-0 SS-684G,,A4649,HCPCS,Facility,Outpatient,,,,26.25,22.3125,7.52325,26.25,PrimeWest Health,Minnesota Senior Health Options (MSHO),13.505625,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
SUTURE SOFSILK 3-0 SS-684G,,A4649,HCPCS,Facility,Inpatient,,,,26.25,22.3125,7.52325,26.25,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE SOFSILK 3-0 SS-684G,,A4649,HCPCS,Facility,Outpatient,,,,26.25,22.3125,7.52325,26.25,PrimeWest Health,MinnesotaCare,13.482,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
SUTURE SOFSILK 3-0 SS-684G,,A4649,HCPCS,Facility,Inpatient,,,,26.25,22.3125,7.52325,26.25,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
SUTURE SOFSILK 3-0 SS-684G,,A4649,HCPCS,Facility,Both,,,,26.25,22.3125,7.52325,26.25,Sanford Health Plan,Sanford Health Plan,24.15,92,,percent of total billed charges,,
SUTURE SOFSILK 3-0 SS-684G,,A4649,HCPCS,Facility,Outpatient,,,,26.25,22.3125,7.52325,26.25,"UCare Health, Inc.",Individual & Family Plan,14.791875,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
SUTURE SOFSILK 3-0 SS-684G,,A4649,HCPCS,Facility,Inpatient,,,,26.25,22.3125,7.52325,26.25,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
SUTURE SOFSILK 3-0 SS-684G,,A4649,HCPCS,Facility,Outpatient,,,,26.25,22.3125,7.52325,26.25,"UCare Health, Inc.",Medical Assistance,13.248375,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE SOFSILK 3-0 SS-684G,,A4649,HCPCS,Facility,Inpatient,,,,26.25,22.3125,7.52325,26.25,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
SUTURE SOFSILK 3-0 SS-684G,,A4649,HCPCS,Facility,Outpatient,,,,26.25,22.3125,7.52325,26.25,"UCare Health, Inc.",Medicare Advantage,13.248375,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE SOFSILK 3-0 SS-684G,,A4649,HCPCS,Facility,Inpatient,,,,26.25,22.3125,7.52325,26.25,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE SOFSILK 3-0 SS-684G,,A4649,HCPCS,Facility,Outpatient,,,,26.25,22.3125,7.52325,26.25,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),13.248375,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE SOFSILK 3-0 SS-684G,,A4649,HCPCS,Facility,Inpatient,,,,26.25,22.3125,7.52325,26.25,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE SOFSILK 3-0 SS-684G,,A4649,HCPCS,Facility,Both,,,,26.25,22.3125,7.52325,26.25,UnitedHealthcare,Individual & Family,24.675,94,,percent of total billed charges,,
SUTURE SOFSILK 3-0 SS-684G,,A4649,HCPCS,Facility,Outpatient,,,,26.25,22.3125,7.52325,26.25,UnitedHealthcare,Medicare Advantage,12.8625,49,,percent of total billed charges,,
SUTURE SOFSILK 3-0 SS-684G,,A4649,HCPCS,Facility,Inpatient,,,,26.25,22.3125,7.52325,26.25,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
SUTURE SOFSILK 3-0 SS-684G,,A4649,HCPCS,Facility,Outpatient,,,,26.25,22.3125,7.52325,26.25,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,12.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
SUTURE SOFSILK 3-0 SS-684G,,A4649,HCPCS,Facility,Inpatient,,,,26.25,22.3125,7.52325,26.25,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
SUTURE SOFSILK 4-0 TIES,,A4649,HCPCS,Facility,Both,,,,1.82,1.547,0.521612,1.82,Aetna,Commercial,1.6744,92,,percent of total billed charges,,
SUTURE SOFSILK 4-0 TIES,,A4649,HCPCS,Facility,Outpatient,,,,1.82,1.547,0.521612,1.82,Aetna,Medicare Advantage,0.8918,49,,percent of total billed charges,,
SUTURE SOFSILK 4-0 TIES,,A4649,HCPCS,Facility,Inpatient,,,,1.82,1.547,0.521612,1.82,Aetna,Medicare Advantage,,,,,Included in per diem rate,
SUTURE SOFSILK 4-0 TIES,,A4649,HCPCS,Facility,Both,,,,1.82,1.547,0.521612,1.82,Aetna,PPO,1.6926,93,,percent of total billed charges,,
SUTURE SOFSILK 4-0 TIES,,A4649,HCPCS,Facility,Both,,,,1.82,1.547,0.521612,1.82,America's PPO,America's PPO,1.747746,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SUTURE SOFSILK 4-0 TIES,,A4649,HCPCS,Facility,Both,,,,1.82,1.547,0.521612,1.82,BlueCross BlueShield Minnesota, Federal Employee Program,1.79088,98.4,,percent of total billed charges,,
SUTURE SOFSILK 4-0 TIES,,A4649,HCPCS,Facility,Both,,,,1.82,1.547,0.521612,1.82,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1.82,100,,percent of total billed charges,,
SUTURE SOFSILK 4-0 TIES,,A4649,HCPCS,Facility,Both,,,,1.82,1.547,0.521612,1.82,BlueCross BlueShield Minnesota,High Value Network Plan,1.638,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
SUTURE SOFSILK 4-0 TIES,,A4649,HCPCS,Facility,Outpatient,,,,1.82,1.547,0.521612,1.82,BlueCross BlueShield Minnesota,Medicare Advantage,0.8918,49,,percent of total billed charges,,
SUTURE SOFSILK 4-0 TIES,,A4649,HCPCS,Facility,Inpatient,,,,1.82,1.547,0.521612,1.82,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
SUTURE SOFSILK 4-0 TIES,,A4649,HCPCS,Facility,Both,,,,1.82,1.547,0.521612,1.82,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1.611974,88.57,,percent of total billed charges,,
SUTURE SOFSILK 4-0 TIES,,A4649,HCPCS,Facility,Both,,,,1.82,1.547,0.521612,1.82,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,0.521612,28.66,,percent of total billed charges,,
SUTURE SOFSILK 4-0 TIES,,A4649,HCPCS,Facility,Outpatient,,,,1.82,1.547,0.521612,1.82,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),0.8918,49,,percent of total billed charges,,
SUTURE SOFSILK 4-0 TIES,,A4649,HCPCS,Facility,Inpatient,,,,1.82,1.547,0.521612,1.82,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
SUTURE SOFSILK 4-0 TIES,,A4649,HCPCS,Facility,Both,,,,1.82,1.547,0.521612,1.82,CorVel,Worker's Compensation,1.82,100,,percent of total billed charges,,
SUTURE SOFSILK 4-0 TIES,,A4649,HCPCS,Facility,Both,,,,1.82,1.547,0.521612,1.82,First Health Group Corporation,First Health Network,1.7654,97,,percent of total billed charges,,
SUTURE SOFSILK 4-0 TIES,,A4649,HCPCS,Facility,Both,,,,1.82,1.547,0.521612,1.82,"Health Partners, Inc.",Commercial,1.72172,94.6,,percent of total billed charges,,
SUTURE SOFSILK 4-0 TIES,,A4649,HCPCS,Facility,Outpatient,,,,1.82,1.547,0.521612,1.82,"Health Partners, Inc.",Medicare Advantage,0.8918,49,,percent of total billed charges,,
SUTURE SOFSILK 4-0 TIES,,A4649,HCPCS,Facility,Inpatient,,,,1.82,1.547,0.521612,1.82,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE SOFSILK 4-0 TIES,,A4649,HCPCS,Facility,Both,,,,1.82,1.547,0.521612,1.82,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1.092,60,,percent of total billed charges,,
SUTURE SOFSILK 4-0 TIES,,A4649,HCPCS,Facility,Both,,,,1.82,1.547,0.521612,1.82,"Health Partners, Inc.",State of Minnesota Advantage Program,1.4833,81.5,,percent of total billed charges,,
SUTURE SOFSILK 4-0 TIES,,A4649,HCPCS,Facility,Both,,,,1.82,1.547,0.521612,1.82,"Health Partners, Inc.",State Public Programs,0.91,50,,percent of total billed charges,,
SUTURE SOFSILK 4-0 TIES,,A4649,HCPCS,Facility,Both,,,,1.82,1.547,0.521612,1.82,Humana Insurance Company,Commercial PPO,1.729,95,,percent of total billed charges,,
SUTURE SOFSILK 4-0 TIES,,A4649,HCPCS,Facility,Outpatient,,,,1.82,1.547,0.521612,1.82,Humana Insurance Company,Medicare PPO,0.8918,49,,percent of total billed charges,,
SUTURE SOFSILK 4-0 TIES,,A4649,HCPCS,Facility,Inpatient,,,,1.82,1.547,0.521612,1.82,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
SUTURE SOFSILK 4-0 TIES,,A4649,HCPCS,Facility,Both,,,,1.82,1.547,0.521612,1.82,Medica,Individual & Family,1.80362,99.1,,percent of total billed charges,,
SUTURE SOFSILK 4-0 TIES,,A4649,HCPCS,Facility,Outpatient,,,,1.82,1.547,0.521612,1.82,Medica,Medica Advantage Solution,0.90636,49.8,,percent of total billed charges,,
SUTURE SOFSILK 4-0 TIES,,A4649,HCPCS,Facility,Inpatient,,,,1.82,1.547,0.521612,1.82,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
SUTURE SOFSILK 4-0 TIES,,A4649,HCPCS,Facility,Outpatient,,,,1.82,1.547,0.521612,1.82,Medica,Medical Assistance,0.81172,44.6,,percent of total billed charges,,
SUTURE SOFSILK 4-0 TIES,,A4649,HCPCS,Facility,Inpatient,,,,1.82,1.547,0.521612,1.82,Medica,Medical Assistance,,,,,Included in per diem rate,
SUTURE SOFSILK 4-0 TIES,,A4649,HCPCS,Facility,Outpatient,,,,1.82,1.547,0.521612,1.82,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,0.90636,49.8,,percent of total billed charges,,
SUTURE SOFSILK 4-0 TIES,,A4649,HCPCS,Facility,Inpatient,,,,1.82,1.547,0.521612,1.82,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
SUTURE SOFSILK 4-0 TIES,,A4649,HCPCS,Facility,Both,,,,1.82,1.547,0.521612,1.82,"Multiplan, Inc.","Multiplan, Inc.",1.7108,94,,percent of total billed charges,,
SUTURE SOFSILK 4-0 TIES,,A4649,HCPCS,Facility,Outpatient,,,,1.82,1.547,0.521612,1.82,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1.63982,90.1,,percent of total billed charges,,
SUTURE SOFSILK 4-0 TIES,,A4649,HCPCS,Facility,Inpatient,,,,1.82,1.547,0.521612,1.82,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
SUTURE SOFSILK 4-0 TIES,,A4649,HCPCS,Facility,Both,,,,1.82,1.547,0.521612,1.82,"Preferred One Administrative Services, INC.",PPO,1.79452,98.6,,percent of total billed charges,,
SUTURE SOFSILK 4-0 TIES,,A4649,HCPCS,Facility,Outpatient,,,,1.82,1.547,0.521612,1.82,PrimeWest Health,Minnesota Senior Health Options (MSHO),0.93639,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
SUTURE SOFSILK 4-0 TIES,,A4649,HCPCS,Facility,Inpatient,,,,1.82,1.547,0.521612,1.82,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE SOFSILK 4-0 TIES,,A4649,HCPCS,Facility,Outpatient,,,,1.82,1.547,0.521612,1.82,PrimeWest Health,MinnesotaCare,0.934752,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
SUTURE SOFSILK 4-0 TIES,,A4649,HCPCS,Facility,Inpatient,,,,1.82,1.547,0.521612,1.82,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
SUTURE SOFSILK 4-0 TIES,,A4649,HCPCS,Facility,Both,,,,1.82,1.547,0.521612,1.82,Sanford Health Plan,Sanford Health Plan,1.6744,92,,percent of total billed charges,,
SUTURE SOFSILK 4-0 TIES,,A4649,HCPCS,Facility,Outpatient,,,,1.82,1.547,0.521612,1.82,"UCare Health, Inc.",Individual & Family Plan,1.02557,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
SUTURE SOFSILK 4-0 TIES,,A4649,HCPCS,Facility,Inpatient,,,,1.82,1.547,0.521612,1.82,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
SUTURE SOFSILK 4-0 TIES,,A4649,HCPCS,Facility,Outpatient,,,,1.82,1.547,0.521612,1.82,"UCare Health, Inc.",Medical Assistance,0.918554,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE SOFSILK 4-0 TIES,,A4649,HCPCS,Facility,Inpatient,,,,1.82,1.547,0.521612,1.82,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
SUTURE SOFSILK 4-0 TIES,,A4649,HCPCS,Facility,Outpatient,,,,1.82,1.547,0.521612,1.82,"UCare Health, Inc.",Medicare Advantage,0.918554,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE SOFSILK 4-0 TIES,,A4649,HCPCS,Facility,Inpatient,,,,1.82,1.547,0.521612,1.82,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE SOFSILK 4-0 TIES,,A4649,HCPCS,Facility,Outpatient,,,,1.82,1.547,0.521612,1.82,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),0.918554,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE SOFSILK 4-0 TIES,,A4649,HCPCS,Facility,Inpatient,,,,1.82,1.547,0.521612,1.82,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE SOFSILK 4-0 TIES,,A4649,HCPCS,Facility,Both,,,,1.82,1.547,0.521612,1.82,UnitedHealthcare,Individual & Family,1.7108,94,,percent of total billed charges,,
SUTURE SOFSILK 4-0 TIES,,A4649,HCPCS,Facility,Outpatient,,,,1.82,1.547,0.521612,1.82,UnitedHealthcare,Medicare Advantage,0.8918,49,,percent of total billed charges,,
SUTURE SOFSILK 4-0 TIES,,A4649,HCPCS,Facility,Inpatient,,,,1.82,1.547,0.521612,1.82,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
SUTURE SOFSILK 4-0 TIES,,A4649,HCPCS,Facility,Outpatient,,,,1.82,1.547,0.521612,1.82,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,0.8736,48,,percent of total billed charges,,100% of DHS outpatient percentage
SUTURE SOFSILK 4-0 TIES,,A4649,HCPCS,Facility,Inpatient,,,,1.82,1.547,0.521612,1.82,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
SUTURE STRATAFIX 1 CT-1  SXPP1A404,,A4649,HCPCS,Facility,Both,,,,95.04,80.784,27.238464,95.04,Aetna,Commercial,87.4368,92,,percent of total billed charges,,
SUTURE STRATAFIX 1 CT-1  SXPP1A404,,A4649,HCPCS,Facility,Outpatient,,,,95.04,80.784,27.238464,95.04,Aetna,Medicare Advantage,46.5696,49,,percent of total billed charges,,
SUTURE STRATAFIX 1 CT-1  SXPP1A404,,A4649,HCPCS,Facility,Inpatient,,,,95.04,80.784,27.238464,95.04,Aetna,Medicare Advantage,,,,,Included in per diem rate,
SUTURE STRATAFIX 1 CT-1  SXPP1A404,,A4649,HCPCS,Facility,Both,,,,95.04,80.784,27.238464,95.04,Aetna,PPO,88.3872,93,,percent of total billed charges,,
SUTURE STRATAFIX 1 CT-1  SXPP1A404,,A4649,HCPCS,Facility,Both,,,,95.04,80.784,27.238464,95.04,America's PPO,America's PPO,91.266912,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SUTURE STRATAFIX 1 CT-1  SXPP1A404,,A4649,HCPCS,Facility,Both,,,,95.04,80.784,27.238464,95.04,BlueCross BlueShield Minnesota, Federal Employee Program,93.51936,98.4,,percent of total billed charges,,
SUTURE STRATAFIX 1 CT-1  SXPP1A404,,A4649,HCPCS,Facility,Both,,,,95.04,80.784,27.238464,95.04,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,95.04,100,,percent of total billed charges,,
SUTURE STRATAFIX 1 CT-1  SXPP1A404,,A4649,HCPCS,Facility,Both,,,,95.04,80.784,27.238464,95.04,BlueCross BlueShield Minnesota,High Value Network Plan,85.536,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
SUTURE STRATAFIX 1 CT-1  SXPP1A404,,A4649,HCPCS,Facility,Outpatient,,,,95.04,80.784,27.238464,95.04,BlueCross BlueShield Minnesota,Medicare Advantage,46.5696,49,,percent of total billed charges,,
SUTURE STRATAFIX 1 CT-1  SXPP1A404,,A4649,HCPCS,Facility,Inpatient,,,,95.04,80.784,27.238464,95.04,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
SUTURE STRATAFIX 1 CT-1  SXPP1A404,,A4649,HCPCS,Facility,Both,,,,95.04,80.784,27.238464,95.04,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,84.176928,88.57,,percent of total billed charges,,
SUTURE STRATAFIX 1 CT-1  SXPP1A404,,A4649,HCPCS,Facility,Both,,,,95.04,80.784,27.238464,95.04,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,27.238464,28.66,,percent of total billed charges,,
SUTURE STRATAFIX 1 CT-1  SXPP1A404,,A4649,HCPCS,Facility,Outpatient,,,,95.04,80.784,27.238464,95.04,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),46.5696,49,,percent of total billed charges,,
SUTURE STRATAFIX 1 CT-1  SXPP1A404,,A4649,HCPCS,Facility,Inpatient,,,,95.04,80.784,27.238464,95.04,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
SUTURE STRATAFIX 1 CT-1  SXPP1A404,,A4649,HCPCS,Facility,Both,,,,95.04,80.784,27.238464,95.04,CorVel,Worker's Compensation,95.04,100,,percent of total billed charges,,
SUTURE STRATAFIX 1 CT-1  SXPP1A404,,A4649,HCPCS,Facility,Both,,,,95.04,80.784,27.238464,95.04,First Health Group Corporation,First Health Network,92.1888,97,,percent of total billed charges,,
SUTURE STRATAFIX 1 CT-1  SXPP1A404,,A4649,HCPCS,Facility,Both,,,,95.04,80.784,27.238464,95.04,"Health Partners, Inc.",Commercial,89.90784,94.6,,percent of total billed charges,,
SUTURE STRATAFIX 1 CT-1  SXPP1A404,,A4649,HCPCS,Facility,Outpatient,,,,95.04,80.784,27.238464,95.04,"Health Partners, Inc.",Medicare Advantage,46.5696,49,,percent of total billed charges,,
SUTURE STRATAFIX 1 CT-1  SXPP1A404,,A4649,HCPCS,Facility,Inpatient,,,,95.04,80.784,27.238464,95.04,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE STRATAFIX 1 CT-1  SXPP1A404,,A4649,HCPCS,Facility,Both,,,,95.04,80.784,27.238464,95.04,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),57.024,60,,percent of total billed charges,,
SUTURE STRATAFIX 1 CT-1  SXPP1A404,,A4649,HCPCS,Facility,Both,,,,95.04,80.784,27.238464,95.04,"Health Partners, Inc.",State of Minnesota Advantage Program,77.4576,81.5,,percent of total billed charges,,
SUTURE STRATAFIX 1 CT-1  SXPP1A404,,A4649,HCPCS,Facility,Both,,,,95.04,80.784,27.238464,95.04,"Health Partners, Inc.",State Public Programs,47.52,50,,percent of total billed charges,,
SUTURE STRATAFIX 1 CT-1  SXPP1A404,,A4649,HCPCS,Facility,Both,,,,95.04,80.784,27.238464,95.04,Humana Insurance Company,Commercial PPO,90.288,95,,percent of total billed charges,,
SUTURE STRATAFIX 1 CT-1  SXPP1A404,,A4649,HCPCS,Facility,Outpatient,,,,95.04,80.784,27.238464,95.04,Humana Insurance Company,Medicare PPO,46.5696,49,,percent of total billed charges,,
SUTURE STRATAFIX 1 CT-1  SXPP1A404,,A4649,HCPCS,Facility,Inpatient,,,,95.04,80.784,27.238464,95.04,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
SUTURE STRATAFIX 1 CT-1  SXPP1A404,,A4649,HCPCS,Facility,Both,,,,95.04,80.784,27.238464,95.04,Medica,Individual & Family,94.18464,99.1,,percent of total billed charges,,
SUTURE STRATAFIX 1 CT-1  SXPP1A404,,A4649,HCPCS,Facility,Outpatient,,,,95.04,80.784,27.238464,95.04,Medica,Medica Advantage Solution,47.32992,49.8,,percent of total billed charges,,
SUTURE STRATAFIX 1 CT-1  SXPP1A404,,A4649,HCPCS,Facility,Inpatient,,,,95.04,80.784,27.238464,95.04,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
SUTURE STRATAFIX 1 CT-1  SXPP1A404,,A4649,HCPCS,Facility,Outpatient,,,,95.04,80.784,27.238464,95.04,Medica,Medical Assistance,42.38784,44.6,,percent of total billed charges,,
SUTURE STRATAFIX 1 CT-1  SXPP1A404,,A4649,HCPCS,Facility,Inpatient,,,,95.04,80.784,27.238464,95.04,Medica,Medical Assistance,,,,,Included in per diem rate,
SUTURE STRATAFIX 1 CT-1  SXPP1A404,,A4649,HCPCS,Facility,Outpatient,,,,95.04,80.784,27.238464,95.04,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,47.32992,49.8,,percent of total billed charges,,
SUTURE STRATAFIX 1 CT-1  SXPP1A404,,A4649,HCPCS,Facility,Inpatient,,,,95.04,80.784,27.238464,95.04,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
SUTURE STRATAFIX 1 CT-1  SXPP1A404,,A4649,HCPCS,Facility,Both,,,,95.04,80.784,27.238464,95.04,"Multiplan, Inc.","Multiplan, Inc.",89.3376,94,,percent of total billed charges,,
SUTURE STRATAFIX 1 CT-1  SXPP1A404,,A4649,HCPCS,Facility,Outpatient,,,,95.04,80.784,27.238464,95.04,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,85.63104,90.1,,percent of total billed charges,,
SUTURE STRATAFIX 1 CT-1  SXPP1A404,,A4649,HCPCS,Facility,Inpatient,,,,95.04,80.784,27.238464,95.04,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
SUTURE STRATAFIX 1 CT-1  SXPP1A404,,A4649,HCPCS,Facility,Both,,,,95.04,80.784,27.238464,95.04,"Preferred One Administrative Services, INC.",PPO,93.70944,98.6,,percent of total billed charges,,
SUTURE STRATAFIX 1 CT-1  SXPP1A404,,A4649,HCPCS,Facility,Outpatient,,,,95.04,80.784,27.238464,95.04,PrimeWest Health,Minnesota Senior Health Options (MSHO),48.89808,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
SUTURE STRATAFIX 1 CT-1  SXPP1A404,,A4649,HCPCS,Facility,Inpatient,,,,95.04,80.784,27.238464,95.04,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE STRATAFIX 1 CT-1  SXPP1A404,,A4649,HCPCS,Facility,Outpatient,,,,95.04,80.784,27.238464,95.04,PrimeWest Health,MinnesotaCare,48.812544,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
SUTURE STRATAFIX 1 CT-1  SXPP1A404,,A4649,HCPCS,Facility,Inpatient,,,,95.04,80.784,27.238464,95.04,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
SUTURE STRATAFIX 1 CT-1  SXPP1A404,,A4649,HCPCS,Facility,Both,,,,95.04,80.784,27.238464,95.04,Sanford Health Plan,Sanford Health Plan,87.4368,92,,percent of total billed charges,,
SUTURE STRATAFIX 1 CT-1  SXPP1A404,,A4649,HCPCS,Facility,Outpatient,,,,95.04,80.784,27.238464,95.04,"UCare Health, Inc.",Individual & Family Plan,53.55504,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
SUTURE STRATAFIX 1 CT-1  SXPP1A404,,A4649,HCPCS,Facility,Inpatient,,,,95.04,80.784,27.238464,95.04,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
SUTURE STRATAFIX 1 CT-1  SXPP1A404,,A4649,HCPCS,Facility,Outpatient,,,,95.04,80.784,27.238464,95.04,"UCare Health, Inc.",Medical Assistance,47.966688,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE STRATAFIX 1 CT-1  SXPP1A404,,A4649,HCPCS,Facility,Inpatient,,,,95.04,80.784,27.238464,95.04,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
SUTURE STRATAFIX 1 CT-1  SXPP1A404,,A4649,HCPCS,Facility,Outpatient,,,,95.04,80.784,27.238464,95.04,"UCare Health, Inc.",Medicare Advantage,47.966688,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE STRATAFIX 1 CT-1  SXPP1A404,,A4649,HCPCS,Facility,Inpatient,,,,95.04,80.784,27.238464,95.04,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE STRATAFIX 1 CT-1  SXPP1A404,,A4649,HCPCS,Facility,Outpatient,,,,95.04,80.784,27.238464,95.04,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),47.966688,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE STRATAFIX 1 CT-1  SXPP1A404,,A4649,HCPCS,Facility,Inpatient,,,,95.04,80.784,27.238464,95.04,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE STRATAFIX 1 CT-1  SXPP1A404,,A4649,HCPCS,Facility,Both,,,,95.04,80.784,27.238464,95.04,UnitedHealthcare,Individual & Family,89.3376,94,,percent of total billed charges,,
SUTURE STRATAFIX 1 CT-1  SXPP1A404,,A4649,HCPCS,Facility,Outpatient,,,,95.04,80.784,27.238464,95.04,UnitedHealthcare,Medicare Advantage,46.5696,49,,percent of total billed charges,,
SUTURE STRATAFIX 1 CT-1  SXPP1A404,,A4649,HCPCS,Facility,Inpatient,,,,95.04,80.784,27.238464,95.04,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
SUTURE STRATAFIX 1 CT-1  SXPP1A404,,A4649,HCPCS,Facility,Outpatient,,,,95.04,80.784,27.238464,95.04,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,45.6192,48,,percent of total billed charges,,100% of DHS outpatient percentage
SUTURE STRATAFIX 1 CT-1  SXPP1A404,,A4649,HCPCS,Facility,Inpatient,,,,95.04,80.784,27.238464,95.04,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
SUTURE STRATAFIX 2-0 PDS CT-1 18IN VLT  SXPP1A403,,A4649,HCPCS,Facility,Both,,,,87.48,74.358,25.071768,87.48,Aetna,Commercial,80.4816,92,,percent of total billed charges,,
SUTURE STRATAFIX 2-0 PDS CT-1 18IN VLT  SXPP1A403,,A4649,HCPCS,Facility,Outpatient,,,,87.48,74.358,25.071768,87.48,Aetna,Medicare Advantage,42.8652,49,,percent of total billed charges,,
SUTURE STRATAFIX 2-0 PDS CT-1 18IN VLT  SXPP1A403,,A4649,HCPCS,Facility,Inpatient,,,,87.48,74.358,25.071768,87.48,Aetna,Medicare Advantage,,,,,Included in per diem rate,
SUTURE STRATAFIX 2-0 PDS CT-1 18IN VLT  SXPP1A403,,A4649,HCPCS,Facility,Both,,,,87.48,74.358,25.071768,87.48,Aetna,PPO,81.3564,93,,percent of total billed charges,,
SUTURE STRATAFIX 2-0 PDS CT-1 18IN VLT  SXPP1A403,,A4649,HCPCS,Facility,Both,,,,87.48,74.358,25.071768,87.48,America's PPO,America's PPO,84.007044,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SUTURE STRATAFIX 2-0 PDS CT-1 18IN VLT  SXPP1A403,,A4649,HCPCS,Facility,Both,,,,87.48,74.358,25.071768,87.48,BlueCross BlueShield Minnesota, Federal Employee Program,86.08032,98.4,,percent of total billed charges,,
SUTURE STRATAFIX 2-0 PDS CT-1 18IN VLT  SXPP1A403,,A4649,HCPCS,Facility,Both,,,,87.48,74.358,25.071768,87.48,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,87.48,100,,percent of total billed charges,,
SUTURE STRATAFIX 2-0 PDS CT-1 18IN VLT  SXPP1A403,,A4649,HCPCS,Facility,Both,,,,87.48,74.358,25.071768,87.48,BlueCross BlueShield Minnesota,High Value Network Plan,78.732,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
SUTURE STRATAFIX 2-0 PDS CT-1 18IN VLT  SXPP1A403,,A4649,HCPCS,Facility,Outpatient,,,,87.48,74.358,25.071768,87.48,BlueCross BlueShield Minnesota,Medicare Advantage,42.8652,49,,percent of total billed charges,,
SUTURE STRATAFIX 2-0 PDS CT-1 18IN VLT  SXPP1A403,,A4649,HCPCS,Facility,Inpatient,,,,87.48,74.358,25.071768,87.48,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
SUTURE STRATAFIX 2-0 PDS CT-1 18IN VLT  SXPP1A403,,A4649,HCPCS,Facility,Both,,,,87.48,74.358,25.071768,87.48,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,77.481036,88.57,,percent of total billed charges,,
SUTURE STRATAFIX 2-0 PDS CT-1 18IN VLT  SXPP1A403,,A4649,HCPCS,Facility,Both,,,,87.48,74.358,25.071768,87.48,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,25.071768,28.66,,percent of total billed charges,,
SUTURE STRATAFIX 2-0 PDS CT-1 18IN VLT  SXPP1A403,,A4649,HCPCS,Facility,Outpatient,,,,87.48,74.358,25.071768,87.48,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),42.8652,49,,percent of total billed charges,,
SUTURE STRATAFIX 2-0 PDS CT-1 18IN VLT  SXPP1A403,,A4649,HCPCS,Facility,Inpatient,,,,87.48,74.358,25.071768,87.48,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
SUTURE STRATAFIX 2-0 PDS CT-1 18IN VLT  SXPP1A403,,A4649,HCPCS,Facility,Both,,,,87.48,74.358,25.071768,87.48,CorVel,Worker's Compensation,87.48,100,,percent of total billed charges,,
SUTURE STRATAFIX 2-0 PDS CT-1 18IN VLT  SXPP1A403,,A4649,HCPCS,Facility,Both,,,,87.48,74.358,25.071768,87.48,First Health Group Corporation,First Health Network,84.8556,97,,percent of total billed charges,,
SUTURE STRATAFIX 2-0 PDS CT-1 18IN VLT  SXPP1A403,,A4649,HCPCS,Facility,Both,,,,87.48,74.358,25.071768,87.48,"Health Partners, Inc.",Commercial,82.75608,94.6,,percent of total billed charges,,
SUTURE STRATAFIX 2-0 PDS CT-1 18IN VLT  SXPP1A403,,A4649,HCPCS,Facility,Outpatient,,,,87.48,74.358,25.071768,87.48,"Health Partners, Inc.",Medicare Advantage,42.8652,49,,percent of total billed charges,,
SUTURE STRATAFIX 2-0 PDS CT-1 18IN VLT  SXPP1A403,,A4649,HCPCS,Facility,Inpatient,,,,87.48,74.358,25.071768,87.48,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE STRATAFIX 2-0 PDS CT-1 18IN VLT  SXPP1A403,,A4649,HCPCS,Facility,Both,,,,87.48,74.358,25.071768,87.48,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),52.488,60,,percent of total billed charges,,
SUTURE STRATAFIX 2-0 PDS CT-1 18IN VLT  SXPP1A403,,A4649,HCPCS,Facility,Both,,,,87.48,74.358,25.071768,87.48,"Health Partners, Inc.",State of Minnesota Advantage Program,71.2962,81.5,,percent of total billed charges,,
SUTURE STRATAFIX 2-0 PDS CT-1 18IN VLT  SXPP1A403,,A4649,HCPCS,Facility,Both,,,,87.48,74.358,25.071768,87.48,"Health Partners, Inc.",State Public Programs,43.74,50,,percent of total billed charges,,
SUTURE STRATAFIX 2-0 PDS CT-1 18IN VLT  SXPP1A403,,A4649,HCPCS,Facility,Both,,,,87.48,74.358,25.071768,87.48,Humana Insurance Company,Commercial PPO,83.106,95,,percent of total billed charges,,
SUTURE STRATAFIX 2-0 PDS CT-1 18IN VLT  SXPP1A403,,A4649,HCPCS,Facility,Outpatient,,,,87.48,74.358,25.071768,87.48,Humana Insurance Company,Medicare PPO,42.8652,49,,percent of total billed charges,,
SUTURE STRATAFIX 2-0 PDS CT-1 18IN VLT  SXPP1A403,,A4649,HCPCS,Facility,Inpatient,,,,87.48,74.358,25.071768,87.48,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
SUTURE STRATAFIX 2-0 PDS CT-1 18IN VLT  SXPP1A403,,A4649,HCPCS,Facility,Both,,,,87.48,74.358,25.071768,87.48,Medica,Individual & Family,86.69268,99.1,,percent of total billed charges,,
SUTURE STRATAFIX 2-0 PDS CT-1 18IN VLT  SXPP1A403,,A4649,HCPCS,Facility,Outpatient,,,,87.48,74.358,25.071768,87.48,Medica,Medica Advantage Solution,43.56504,49.8,,percent of total billed charges,,
SUTURE STRATAFIX 2-0 PDS CT-1 18IN VLT  SXPP1A403,,A4649,HCPCS,Facility,Inpatient,,,,87.48,74.358,25.071768,87.48,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
SUTURE STRATAFIX 2-0 PDS CT-1 18IN VLT  SXPP1A403,,A4649,HCPCS,Facility,Outpatient,,,,87.48,74.358,25.071768,87.48,Medica,Medical Assistance,39.01608,44.6,,percent of total billed charges,,
SUTURE STRATAFIX 2-0 PDS CT-1 18IN VLT  SXPP1A403,,A4649,HCPCS,Facility,Inpatient,,,,87.48,74.358,25.071768,87.48,Medica,Medical Assistance,,,,,Included in per diem rate,
SUTURE STRATAFIX 2-0 PDS CT-1 18IN VLT  SXPP1A403,,A4649,HCPCS,Facility,Outpatient,,,,87.48,74.358,25.071768,87.48,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,43.56504,49.8,,percent of total billed charges,,
SUTURE STRATAFIX 2-0 PDS CT-1 18IN VLT  SXPP1A403,,A4649,HCPCS,Facility,Inpatient,,,,87.48,74.358,25.071768,87.48,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
SUTURE STRATAFIX 2-0 PDS CT-1 18IN VLT  SXPP1A403,,A4649,HCPCS,Facility,Both,,,,87.48,74.358,25.071768,87.48,"Multiplan, Inc.","Multiplan, Inc.",82.2312,94,,percent of total billed charges,,
SUTURE STRATAFIX 2-0 PDS CT-1 18IN VLT  SXPP1A403,,A4649,HCPCS,Facility,Outpatient,,,,87.48,74.358,25.071768,87.48,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,78.81948,90.1,,percent of total billed charges,,
SUTURE STRATAFIX 2-0 PDS CT-1 18IN VLT  SXPP1A403,,A4649,HCPCS,Facility,Inpatient,,,,87.48,74.358,25.071768,87.48,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
SUTURE STRATAFIX 2-0 PDS CT-1 18IN VLT  SXPP1A403,,A4649,HCPCS,Facility,Both,,,,87.48,74.358,25.071768,87.48,"Preferred One Administrative Services, INC.",PPO,86.25528,98.6,,percent of total billed charges,,
SUTURE STRATAFIX 2-0 PDS CT-1 18IN VLT  SXPP1A403,,A4649,HCPCS,Facility,Outpatient,,,,87.48,74.358,25.071768,87.48,PrimeWest Health,Minnesota Senior Health Options (MSHO),45.00846,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
SUTURE STRATAFIX 2-0 PDS CT-1 18IN VLT  SXPP1A403,,A4649,HCPCS,Facility,Inpatient,,,,87.48,74.358,25.071768,87.48,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE STRATAFIX 2-0 PDS CT-1 18IN VLT  SXPP1A403,,A4649,HCPCS,Facility,Outpatient,,,,87.48,74.358,25.071768,87.48,PrimeWest Health,MinnesotaCare,44.929728,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
SUTURE STRATAFIX 2-0 PDS CT-1 18IN VLT  SXPP1A403,,A4649,HCPCS,Facility,Inpatient,,,,87.48,74.358,25.071768,87.48,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
SUTURE STRATAFIX 2-0 PDS CT-1 18IN VLT  SXPP1A403,,A4649,HCPCS,Facility,Both,,,,87.48,74.358,25.071768,87.48,Sanford Health Plan,Sanford Health Plan,80.4816,92,,percent of total billed charges,,
SUTURE STRATAFIX 2-0 PDS CT-1 18IN VLT  SXPP1A403,,A4649,HCPCS,Facility,Outpatient,,,,87.48,74.358,25.071768,87.48,"UCare Health, Inc.",Individual & Family Plan,49.29498,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
SUTURE STRATAFIX 2-0 PDS CT-1 18IN VLT  SXPP1A403,,A4649,HCPCS,Facility,Inpatient,,,,87.48,74.358,25.071768,87.48,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
SUTURE STRATAFIX 2-0 PDS CT-1 18IN VLT  SXPP1A403,,A4649,HCPCS,Facility,Outpatient,,,,87.48,74.358,25.071768,87.48,"UCare Health, Inc.",Medical Assistance,44.151156,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE STRATAFIX 2-0 PDS CT-1 18IN VLT  SXPP1A403,,A4649,HCPCS,Facility,Inpatient,,,,87.48,74.358,25.071768,87.48,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
SUTURE STRATAFIX 2-0 PDS CT-1 18IN VLT  SXPP1A403,,A4649,HCPCS,Facility,Outpatient,,,,87.48,74.358,25.071768,87.48,"UCare Health, Inc.",Medicare Advantage,44.151156,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE STRATAFIX 2-0 PDS CT-1 18IN VLT  SXPP1A403,,A4649,HCPCS,Facility,Inpatient,,,,87.48,74.358,25.071768,87.48,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE STRATAFIX 2-0 PDS CT-1 18IN VLT  SXPP1A403,,A4649,HCPCS,Facility,Outpatient,,,,87.48,74.358,25.071768,87.48,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),44.151156,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE STRATAFIX 2-0 PDS CT-1 18IN VLT  SXPP1A403,,A4649,HCPCS,Facility,Inpatient,,,,87.48,74.358,25.071768,87.48,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE STRATAFIX 2-0 PDS CT-1 18IN VLT  SXPP1A403,,A4649,HCPCS,Facility,Both,,,,87.48,74.358,25.071768,87.48,UnitedHealthcare,Individual & Family,82.2312,94,,percent of total billed charges,,
SUTURE STRATAFIX 2-0 PDS CT-1 18IN VLT  SXPP1A403,,A4649,HCPCS,Facility,Outpatient,,,,87.48,74.358,25.071768,87.48,UnitedHealthcare,Medicare Advantage,42.8652,49,,percent of total billed charges,,
SUTURE STRATAFIX 2-0 PDS CT-1 18IN VLT  SXPP1A403,,A4649,HCPCS,Facility,Inpatient,,,,87.48,74.358,25.071768,87.48,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
SUTURE STRATAFIX 2-0 PDS CT-1 18IN VLT  SXPP1A403,,A4649,HCPCS,Facility,Outpatient,,,,87.48,74.358,25.071768,87.48,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,41.9904,48,,percent of total billed charges,,100% of DHS outpatient percentage
SUTURE STRATAFIX 2-0 PDS CT-1 18IN VLT  SXPP1A403,,A4649,HCPCS,Facility,Inpatient,,,,87.48,74.358,25.071768,87.48,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
SUTURE SURGIPRO II BL 3/0 18 P-14,,A4649,HCPCS,Facility,Both,,,,79.245,67.35825,22.711617,79.245,Aetna,Commercial,72.9054,92,,percent of total billed charges,,
SUTURE SURGIPRO II BL 3/0 18 P-14,,A4649,HCPCS,Facility,Outpatient,,,,79.245,67.35825,22.711617,79.245,Aetna,Medicare Advantage,38.83005,49,,percent of total billed charges,,
SUTURE SURGIPRO II BL 3/0 18 P-14,,A4649,HCPCS,Facility,Inpatient,,,,79.245,67.35825,22.711617,79.245,Aetna,Medicare Advantage,,,,,Included in per diem rate,
SUTURE SURGIPRO II BL 3/0 18 P-14,,A4649,HCPCS,Facility,Both,,,,79.245,67.35825,22.711617,79.245,Aetna,PPO,73.69785,93,,percent of total billed charges,,
SUTURE SURGIPRO II BL 3/0 18 P-14,,A4649,HCPCS,Facility,Both,,,,79.245,67.35825,22.711617,79.245,America's PPO,America's PPO,76.0989735,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SUTURE SURGIPRO II BL 3/0 18 P-14,,A4649,HCPCS,Facility,Both,,,,79.245,67.35825,22.711617,79.245,BlueCross BlueShield Minnesota, Federal Employee Program,77.97708,98.4,,percent of total billed charges,,
SUTURE SURGIPRO II BL 3/0 18 P-14,,A4649,HCPCS,Facility,Both,,,,79.245,67.35825,22.711617,79.245,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,79.245,100,,percent of total billed charges,,
SUTURE SURGIPRO II BL 3/0 18 P-14,,A4649,HCPCS,Facility,Both,,,,79.245,67.35825,22.711617,79.245,BlueCross BlueShield Minnesota,High Value Network Plan,71.3205,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
SUTURE SURGIPRO II BL 3/0 18 P-14,,A4649,HCPCS,Facility,Outpatient,,,,79.245,67.35825,22.711617,79.245,BlueCross BlueShield Minnesota,Medicare Advantage,38.83005,49,,percent of total billed charges,,
SUTURE SURGIPRO II BL 3/0 18 P-14,,A4649,HCPCS,Facility,Inpatient,,,,79.245,67.35825,22.711617,79.245,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
SUTURE SURGIPRO II BL 3/0 18 P-14,,A4649,HCPCS,Facility,Both,,,,79.245,67.35825,22.711617,79.245,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,70.1872965,88.57,,percent of total billed charges,,
SUTURE SURGIPRO II BL 3/0 18 P-14,,A4649,HCPCS,Facility,Both,,,,79.245,67.35825,22.711617,79.245,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,22.711617,28.66,,percent of total billed charges,,
SUTURE SURGIPRO II BL 3/0 18 P-14,,A4649,HCPCS,Facility,Outpatient,,,,79.245,67.35825,22.711617,79.245,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),38.83005,49,,percent of total billed charges,,
SUTURE SURGIPRO II BL 3/0 18 P-14,,A4649,HCPCS,Facility,Inpatient,,,,79.245,67.35825,22.711617,79.245,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
SUTURE SURGIPRO II BL 3/0 18 P-14,,A4649,HCPCS,Facility,Both,,,,79.245,67.35825,22.711617,79.245,CorVel,Worker's Compensation,79.245,100,,percent of total billed charges,,
SUTURE SURGIPRO II BL 3/0 18 P-14,,A4649,HCPCS,Facility,Both,,,,79.245,67.35825,22.711617,79.245,First Health Group Corporation,First Health Network,76.86765,97,,percent of total billed charges,,
SUTURE SURGIPRO II BL 3/0 18 P-14,,A4649,HCPCS,Facility,Both,,,,79.245,67.35825,22.711617,79.245,"Health Partners, Inc.",Commercial,74.96577,94.6,,percent of total billed charges,,
SUTURE SURGIPRO II BL 3/0 18 P-14,,A4649,HCPCS,Facility,Outpatient,,,,79.245,67.35825,22.711617,79.245,"Health Partners, Inc.",Medicare Advantage,38.83005,49,,percent of total billed charges,,
SUTURE SURGIPRO II BL 3/0 18 P-14,,A4649,HCPCS,Facility,Inpatient,,,,79.245,67.35825,22.711617,79.245,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE SURGIPRO II BL 3/0 18 P-14,,A4649,HCPCS,Facility,Both,,,,79.245,67.35825,22.711617,79.245,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),47.547,60,,percent of total billed charges,,
SUTURE SURGIPRO II BL 3/0 18 P-14,,A4649,HCPCS,Facility,Both,,,,79.245,67.35825,22.711617,79.245,"Health Partners, Inc.",State of Minnesota Advantage Program,64.584675,81.5,,percent of total billed charges,,
SUTURE SURGIPRO II BL 3/0 18 P-14,,A4649,HCPCS,Facility,Both,,,,79.245,67.35825,22.711617,79.245,"Health Partners, Inc.",State Public Programs,39.6225,50,,percent of total billed charges,,
SUTURE SURGIPRO II BL 3/0 18 P-14,,A4649,HCPCS,Facility,Both,,,,79.245,67.35825,22.711617,79.245,Humana Insurance Company,Commercial PPO,75.28275,95,,percent of total billed charges,,
SUTURE SURGIPRO II BL 3/0 18 P-14,,A4649,HCPCS,Facility,Outpatient,,,,79.245,67.35825,22.711617,79.245,Humana Insurance Company,Medicare PPO,38.83005,49,,percent of total billed charges,,
SUTURE SURGIPRO II BL 3/0 18 P-14,,A4649,HCPCS,Facility,Inpatient,,,,79.245,67.35825,22.711617,79.245,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
SUTURE SURGIPRO II BL 3/0 18 P-14,,A4649,HCPCS,Facility,Both,,,,79.245,67.35825,22.711617,79.245,Medica,Individual & Family,78.531795,99.1,,percent of total billed charges,,
SUTURE SURGIPRO II BL 3/0 18 P-14,,A4649,HCPCS,Facility,Outpatient,,,,79.245,67.35825,22.711617,79.245,Medica,Medica Advantage Solution,39.46401,49.8,,percent of total billed charges,,
SUTURE SURGIPRO II BL 3/0 18 P-14,,A4649,HCPCS,Facility,Inpatient,,,,79.245,67.35825,22.711617,79.245,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
SUTURE SURGIPRO II BL 3/0 18 P-14,,A4649,HCPCS,Facility,Outpatient,,,,79.245,67.35825,22.711617,79.245,Medica,Medical Assistance,35.34327,44.6,,percent of total billed charges,,
SUTURE SURGIPRO II BL 3/0 18 P-14,,A4649,HCPCS,Facility,Inpatient,,,,79.245,67.35825,22.711617,79.245,Medica,Medical Assistance,,,,,Included in per diem rate,
SUTURE SURGIPRO II BL 3/0 18 P-14,,A4649,HCPCS,Facility,Outpatient,,,,79.245,67.35825,22.711617,79.245,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,39.46401,49.8,,percent of total billed charges,,
SUTURE SURGIPRO II BL 3/0 18 P-14,,A4649,HCPCS,Facility,Inpatient,,,,79.245,67.35825,22.711617,79.245,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
SUTURE SURGIPRO II BL 3/0 18 P-14,,A4649,HCPCS,Facility,Both,,,,79.245,67.35825,22.711617,79.245,"Multiplan, Inc.","Multiplan, Inc.",74.4903,94,,percent of total billed charges,,
SUTURE SURGIPRO II BL 3/0 18 P-14,,A4649,HCPCS,Facility,Outpatient,,,,79.245,67.35825,22.711617,79.245,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,71.399745,90.1,,percent of total billed charges,,
SUTURE SURGIPRO II BL 3/0 18 P-14,,A4649,HCPCS,Facility,Inpatient,,,,79.245,67.35825,22.711617,79.245,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
SUTURE SURGIPRO II BL 3/0 18 P-14,,A4649,HCPCS,Facility,Both,,,,79.245,67.35825,22.711617,79.245,"Preferred One Administrative Services, INC.",PPO,78.13557,98.6,,percent of total billed charges,,
SUTURE SURGIPRO II BL 3/0 18 P-14,,A4649,HCPCS,Facility,Outpatient,,,,79.245,67.35825,22.711617,79.245,PrimeWest Health,Minnesota Senior Health Options (MSHO),40.7715525,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
SUTURE SURGIPRO II BL 3/0 18 P-14,,A4649,HCPCS,Facility,Inpatient,,,,79.245,67.35825,22.711617,79.245,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE SURGIPRO II BL 3/0 18 P-14,,A4649,HCPCS,Facility,Outpatient,,,,79.245,67.35825,22.711617,79.245,PrimeWest Health,MinnesotaCare,40.700232,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
SUTURE SURGIPRO II BL 3/0 18 P-14,,A4649,HCPCS,Facility,Inpatient,,,,79.245,67.35825,22.711617,79.245,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
SUTURE SURGIPRO II BL 3/0 18 P-14,,A4649,HCPCS,Facility,Both,,,,79.245,67.35825,22.711617,79.245,Sanford Health Plan,Sanford Health Plan,72.9054,92,,percent of total billed charges,,
SUTURE SURGIPRO II BL 3/0 18 P-14,,A4649,HCPCS,Facility,Outpatient,,,,79.245,67.35825,22.711617,79.245,"UCare Health, Inc.",Individual & Family Plan,44.6545575,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
SUTURE SURGIPRO II BL 3/0 18 P-14,,A4649,HCPCS,Facility,Inpatient,,,,79.245,67.35825,22.711617,79.245,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
SUTURE SURGIPRO II BL 3/0 18 P-14,,A4649,HCPCS,Facility,Outpatient,,,,79.245,67.35825,22.711617,79.245,"UCare Health, Inc.",Medical Assistance,39.9949515,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE SURGIPRO II BL 3/0 18 P-14,,A4649,HCPCS,Facility,Inpatient,,,,79.245,67.35825,22.711617,79.245,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
SUTURE SURGIPRO II BL 3/0 18 P-14,,A4649,HCPCS,Facility,Outpatient,,,,79.245,67.35825,22.711617,79.245,"UCare Health, Inc.",Medicare Advantage,39.9949515,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE SURGIPRO II BL 3/0 18 P-14,,A4649,HCPCS,Facility,Inpatient,,,,79.245,67.35825,22.711617,79.245,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE SURGIPRO II BL 3/0 18 P-14,,A4649,HCPCS,Facility,Outpatient,,,,79.245,67.35825,22.711617,79.245,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),39.9949515,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE SURGIPRO II BL 3/0 18 P-14,,A4649,HCPCS,Facility,Inpatient,,,,79.245,67.35825,22.711617,79.245,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE SURGIPRO II BL 3/0 18 P-14,,A4649,HCPCS,Facility,Both,,,,79.245,67.35825,22.711617,79.245,UnitedHealthcare,Individual & Family,74.4903,94,,percent of total billed charges,,
SUTURE SURGIPRO II BL 3/0 18 P-14,,A4649,HCPCS,Facility,Outpatient,,,,79.245,67.35825,22.711617,79.245,UnitedHealthcare,Medicare Advantage,38.83005,49,,percent of total billed charges,,
SUTURE SURGIPRO II BL 3/0 18 P-14,,A4649,HCPCS,Facility,Inpatient,,,,79.245,67.35825,22.711617,79.245,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
SUTURE SURGIPRO II BL 3/0 18 P-14,,A4649,HCPCS,Facility,Outpatient,,,,79.245,67.35825,22.711617,79.245,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,38.0376,48,,percent of total billed charges,,100% of DHS outpatient percentage
SUTURE SURGIPRO II BL 3/0 18 P-14,,A4649,HCPCS,Facility,Inpatient,,,,79.245,67.35825,22.711617,79.245,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
SUTURE SURGPRO 2/0 30 BLU GS-22 117P,,A4649,HCPCS,Facility,Both,,,,35.85,30.4725,10.27461,35.85,Aetna,Commercial,32.982,92,,percent of total billed charges,,
SUTURE SURGPRO 2/0 30 BLU GS-22 117P,,A4649,HCPCS,Facility,Outpatient,,,,35.85,30.4725,10.27461,35.85,Aetna,Medicare Advantage,17.5665,49,,percent of total billed charges,,
SUTURE SURGPRO 2/0 30 BLU GS-22 117P,,A4649,HCPCS,Facility,Inpatient,,,,35.85,30.4725,10.27461,35.85,Aetna,Medicare Advantage,,,,,Included in per diem rate,
SUTURE SURGPRO 2/0 30 BLU GS-22 117P,,A4649,HCPCS,Facility,Both,,,,35.85,30.4725,10.27461,35.85,Aetna,PPO,33.3405,93,,percent of total billed charges,,
SUTURE SURGPRO 2/0 30 BLU GS-22 117P,,A4649,HCPCS,Facility,Both,,,,35.85,30.4725,10.27461,35.85,America's PPO,America's PPO,34.426755,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SUTURE SURGPRO 2/0 30 BLU GS-22 117P,,A4649,HCPCS,Facility,Both,,,,35.85,30.4725,10.27461,35.85,BlueCross BlueShield Minnesota, Federal Employee Program,35.2764,98.4,,percent of total billed charges,,
SUTURE SURGPRO 2/0 30 BLU GS-22 117P,,A4649,HCPCS,Facility,Both,,,,35.85,30.4725,10.27461,35.85,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,35.85,100,,percent of total billed charges,,
SUTURE SURGPRO 2/0 30 BLU GS-22 117P,,A4649,HCPCS,Facility,Both,,,,35.85,30.4725,10.27461,35.85,BlueCross BlueShield Minnesota,High Value Network Plan,32.265,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
SUTURE SURGPRO 2/0 30 BLU GS-22 117P,,A4649,HCPCS,Facility,Outpatient,,,,35.85,30.4725,10.27461,35.85,BlueCross BlueShield Minnesota,Medicare Advantage,17.5665,49,,percent of total billed charges,,
SUTURE SURGPRO 2/0 30 BLU GS-22 117P,,A4649,HCPCS,Facility,Inpatient,,,,35.85,30.4725,10.27461,35.85,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
SUTURE SURGPRO 2/0 30 BLU GS-22 117P,,A4649,HCPCS,Facility,Both,,,,35.85,30.4725,10.27461,35.85,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,31.752345,88.57,,percent of total billed charges,,
SUTURE SURGPRO 2/0 30 BLU GS-22 117P,,A4649,HCPCS,Facility,Both,,,,35.85,30.4725,10.27461,35.85,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,10.27461,28.66,,percent of total billed charges,,
SUTURE SURGPRO 2/0 30 BLU GS-22 117P,,A4649,HCPCS,Facility,Outpatient,,,,35.85,30.4725,10.27461,35.85,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),17.5665,49,,percent of total billed charges,,
SUTURE SURGPRO 2/0 30 BLU GS-22 117P,,A4649,HCPCS,Facility,Inpatient,,,,35.85,30.4725,10.27461,35.85,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
SUTURE SURGPRO 2/0 30 BLU GS-22 117P,,A4649,HCPCS,Facility,Both,,,,35.85,30.4725,10.27461,35.85,CorVel,Worker's Compensation,35.85,100,,percent of total billed charges,,
SUTURE SURGPRO 2/0 30 BLU GS-22 117P,,A4649,HCPCS,Facility,Both,,,,35.85,30.4725,10.27461,35.85,First Health Group Corporation,First Health Network,34.7745,97,,percent of total billed charges,,
SUTURE SURGPRO 2/0 30 BLU GS-22 117P,,A4649,HCPCS,Facility,Both,,,,35.85,30.4725,10.27461,35.85,"Health Partners, Inc.",Commercial,33.9141,94.6,,percent of total billed charges,,
SUTURE SURGPRO 2/0 30 BLU GS-22 117P,,A4649,HCPCS,Facility,Outpatient,,,,35.85,30.4725,10.27461,35.85,"Health Partners, Inc.",Medicare Advantage,17.5665,49,,percent of total billed charges,,
SUTURE SURGPRO 2/0 30 BLU GS-22 117P,,A4649,HCPCS,Facility,Inpatient,,,,35.85,30.4725,10.27461,35.85,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE SURGPRO 2/0 30 BLU GS-22 117P,,A4649,HCPCS,Facility,Both,,,,35.85,30.4725,10.27461,35.85,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),21.51,60,,percent of total billed charges,,
SUTURE SURGPRO 2/0 30 BLU GS-22 117P,,A4649,HCPCS,Facility,Both,,,,35.85,30.4725,10.27461,35.85,"Health Partners, Inc.",State of Minnesota Advantage Program,29.21775,81.5,,percent of total billed charges,,
SUTURE SURGPRO 2/0 30 BLU GS-22 117P,,A4649,HCPCS,Facility,Both,,,,35.85,30.4725,10.27461,35.85,"Health Partners, Inc.",State Public Programs,17.925,50,,percent of total billed charges,,
SUTURE SURGPRO 2/0 30 BLU GS-22 117P,,A4649,HCPCS,Facility,Both,,,,35.85,30.4725,10.27461,35.85,Humana Insurance Company,Commercial PPO,34.0575,95,,percent of total billed charges,,
SUTURE SURGPRO 2/0 30 BLU GS-22 117P,,A4649,HCPCS,Facility,Outpatient,,,,35.85,30.4725,10.27461,35.85,Humana Insurance Company,Medicare PPO,17.5665,49,,percent of total billed charges,,
SUTURE SURGPRO 2/0 30 BLU GS-22 117P,,A4649,HCPCS,Facility,Inpatient,,,,35.85,30.4725,10.27461,35.85,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
SUTURE SURGPRO 2/0 30 BLU GS-22 117P,,A4649,HCPCS,Facility,Both,,,,35.85,30.4725,10.27461,35.85,Medica,Individual & Family,35.52735,99.1,,percent of total billed charges,,
SUTURE SURGPRO 2/0 30 BLU GS-22 117P,,A4649,HCPCS,Facility,Outpatient,,,,35.85,30.4725,10.27461,35.85,Medica,Medica Advantage Solution,17.8533,49.8,,percent of total billed charges,,
SUTURE SURGPRO 2/0 30 BLU GS-22 117P,,A4649,HCPCS,Facility,Inpatient,,,,35.85,30.4725,10.27461,35.85,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
SUTURE SURGPRO 2/0 30 BLU GS-22 117P,,A4649,HCPCS,Facility,Outpatient,,,,35.85,30.4725,10.27461,35.85,Medica,Medical Assistance,15.9891,44.6,,percent of total billed charges,,
SUTURE SURGPRO 2/0 30 BLU GS-22 117P,,A4649,HCPCS,Facility,Inpatient,,,,35.85,30.4725,10.27461,35.85,Medica,Medical Assistance,,,,,Included in per diem rate,
SUTURE SURGPRO 2/0 30 BLU GS-22 117P,,A4649,HCPCS,Facility,Outpatient,,,,35.85,30.4725,10.27461,35.85,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,17.8533,49.8,,percent of total billed charges,,
SUTURE SURGPRO 2/0 30 BLU GS-22 117P,,A4649,HCPCS,Facility,Inpatient,,,,35.85,30.4725,10.27461,35.85,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
SUTURE SURGPRO 2/0 30 BLU GS-22 117P,,A4649,HCPCS,Facility,Both,,,,35.85,30.4725,10.27461,35.85,"Multiplan, Inc.","Multiplan, Inc.",33.699,94,,percent of total billed charges,,
SUTURE SURGPRO 2/0 30 BLU GS-22 117P,,A4649,HCPCS,Facility,Outpatient,,,,35.85,30.4725,10.27461,35.85,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,32.30085,90.1,,percent of total billed charges,,
SUTURE SURGPRO 2/0 30 BLU GS-22 117P,,A4649,HCPCS,Facility,Inpatient,,,,35.85,30.4725,10.27461,35.85,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
SUTURE SURGPRO 2/0 30 BLU GS-22 117P,,A4649,HCPCS,Facility,Both,,,,35.85,30.4725,10.27461,35.85,"Preferred One Administrative Services, INC.",PPO,35.3481,98.6,,percent of total billed charges,,
SUTURE SURGPRO 2/0 30 BLU GS-22 117P,,A4649,HCPCS,Facility,Outpatient,,,,35.85,30.4725,10.27461,35.85,PrimeWest Health,Minnesota Senior Health Options (MSHO),18.444825,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
SUTURE SURGPRO 2/0 30 BLU GS-22 117P,,A4649,HCPCS,Facility,Inpatient,,,,35.85,30.4725,10.27461,35.85,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE SURGPRO 2/0 30 BLU GS-22 117P,,A4649,HCPCS,Facility,Outpatient,,,,35.85,30.4725,10.27461,35.85,PrimeWest Health,MinnesotaCare,18.41256,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
SUTURE SURGPRO 2/0 30 BLU GS-22 117P,,A4649,HCPCS,Facility,Inpatient,,,,35.85,30.4725,10.27461,35.85,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
SUTURE SURGPRO 2/0 30 BLU GS-22 117P,,A4649,HCPCS,Facility,Both,,,,35.85,30.4725,10.27461,35.85,Sanford Health Plan,Sanford Health Plan,32.982,92,,percent of total billed charges,,
SUTURE SURGPRO 2/0 30 BLU GS-22 117P,,A4649,HCPCS,Facility,Outpatient,,,,35.85,30.4725,10.27461,35.85,"UCare Health, Inc.",Individual & Family Plan,20.201475,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
SUTURE SURGPRO 2/0 30 BLU GS-22 117P,,A4649,HCPCS,Facility,Inpatient,,,,35.85,30.4725,10.27461,35.85,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
SUTURE SURGPRO 2/0 30 BLU GS-22 117P,,A4649,HCPCS,Facility,Outpatient,,,,35.85,30.4725,10.27461,35.85,"UCare Health, Inc.",Medical Assistance,18.093495,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE SURGPRO 2/0 30 BLU GS-22 117P,,A4649,HCPCS,Facility,Inpatient,,,,35.85,30.4725,10.27461,35.85,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
SUTURE SURGPRO 2/0 30 BLU GS-22 117P,,A4649,HCPCS,Facility,Outpatient,,,,35.85,30.4725,10.27461,35.85,"UCare Health, Inc.",Medicare Advantage,18.093495,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE SURGPRO 2/0 30 BLU GS-22 117P,,A4649,HCPCS,Facility,Inpatient,,,,35.85,30.4725,10.27461,35.85,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE SURGPRO 2/0 30 BLU GS-22 117P,,A4649,HCPCS,Facility,Outpatient,,,,35.85,30.4725,10.27461,35.85,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),18.093495,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE SURGPRO 2/0 30 BLU GS-22 117P,,A4649,HCPCS,Facility,Inpatient,,,,35.85,30.4725,10.27461,35.85,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE SURGPRO 2/0 30 BLU GS-22 117P,,A4649,HCPCS,Facility,Both,,,,35.85,30.4725,10.27461,35.85,UnitedHealthcare,Individual & Family,33.699,94,,percent of total billed charges,,
SUTURE SURGPRO 2/0 30 BLU GS-22 117P,,A4649,HCPCS,Facility,Outpatient,,,,35.85,30.4725,10.27461,35.85,UnitedHealthcare,Medicare Advantage,17.5665,49,,percent of total billed charges,,
SUTURE SURGPRO 2/0 30 BLU GS-22 117P,,A4649,HCPCS,Facility,Inpatient,,,,35.85,30.4725,10.27461,35.85,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
SUTURE SURGPRO 2/0 30 BLU GS-22 117P,,A4649,HCPCS,Facility,Outpatient,,,,35.85,30.4725,10.27461,35.85,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,17.208,48,,percent of total billed charges,,100% of DHS outpatient percentage
SUTURE SURGPRO 2/0 30 BLU GS-22 117P,,A4649,HCPCS,Facility,Inpatient,,,,35.85,30.4725,10.27461,35.85,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
SUTURE TICRON 0 3093-61,,A4649,HCPCS,Facility,Both,,,,34.2,29.07,9.80172,34.2,Aetna,Commercial,31.464,92,,percent of total billed charges,,
SUTURE TICRON 0 3093-61,,A4649,HCPCS,Facility,Outpatient,,,,34.2,29.07,9.80172,34.2,Aetna,Medicare Advantage,16.758,49,,percent of total billed charges,,
SUTURE TICRON 0 3093-61,,A4649,HCPCS,Facility,Inpatient,,,,34.2,29.07,9.80172,34.2,Aetna,Medicare Advantage,,,,,Included in per diem rate,
SUTURE TICRON 0 3093-61,,A4649,HCPCS,Facility,Both,,,,34.2,29.07,9.80172,34.2,Aetna,PPO,31.806,93,,percent of total billed charges,,
SUTURE TICRON 0 3093-61,,A4649,HCPCS,Facility,Both,,,,34.2,29.07,9.80172,34.2,America's PPO,America's PPO,32.84226,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SUTURE TICRON 0 3093-61,,A4649,HCPCS,Facility,Both,,,,34.2,29.07,9.80172,34.2,BlueCross BlueShield Minnesota, Federal Employee Program,33.6528,98.4,,percent of total billed charges,,
SUTURE TICRON 0 3093-61,,A4649,HCPCS,Facility,Both,,,,34.2,29.07,9.80172,34.2,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,34.2,100,,percent of total billed charges,,
SUTURE TICRON 0 3093-61,,A4649,HCPCS,Facility,Both,,,,34.2,29.07,9.80172,34.2,BlueCross BlueShield Minnesota,High Value Network Plan,30.78,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
SUTURE TICRON 0 3093-61,,A4649,HCPCS,Facility,Outpatient,,,,34.2,29.07,9.80172,34.2,BlueCross BlueShield Minnesota,Medicare Advantage,16.758,49,,percent of total billed charges,,
SUTURE TICRON 0 3093-61,,A4649,HCPCS,Facility,Inpatient,,,,34.2,29.07,9.80172,34.2,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
SUTURE TICRON 0 3093-61,,A4649,HCPCS,Facility,Both,,,,34.2,29.07,9.80172,34.2,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,30.29094,88.57,,percent of total billed charges,,
SUTURE TICRON 0 3093-61,,A4649,HCPCS,Facility,Both,,,,34.2,29.07,9.80172,34.2,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,9.80172,28.66,,percent of total billed charges,,
SUTURE TICRON 0 3093-61,,A4649,HCPCS,Facility,Outpatient,,,,34.2,29.07,9.80172,34.2,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),16.758,49,,percent of total billed charges,,
SUTURE TICRON 0 3093-61,,A4649,HCPCS,Facility,Inpatient,,,,34.2,29.07,9.80172,34.2,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
SUTURE TICRON 0 3093-61,,A4649,HCPCS,Facility,Both,,,,34.2,29.07,9.80172,34.2,CorVel,Worker's Compensation,34.2,100,,percent of total billed charges,,
SUTURE TICRON 0 3093-61,,A4649,HCPCS,Facility,Both,,,,34.2,29.07,9.80172,34.2,First Health Group Corporation,First Health Network,33.174,97,,percent of total billed charges,,
SUTURE TICRON 0 3093-61,,A4649,HCPCS,Facility,Both,,,,34.2,29.07,9.80172,34.2,"Health Partners, Inc.",Commercial,32.3532,94.6,,percent of total billed charges,,
SUTURE TICRON 0 3093-61,,A4649,HCPCS,Facility,Outpatient,,,,34.2,29.07,9.80172,34.2,"Health Partners, Inc.",Medicare Advantage,16.758,49,,percent of total billed charges,,
SUTURE TICRON 0 3093-61,,A4649,HCPCS,Facility,Inpatient,,,,34.2,29.07,9.80172,34.2,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE TICRON 0 3093-61,,A4649,HCPCS,Facility,Both,,,,34.2,29.07,9.80172,34.2,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),20.52,60,,percent of total billed charges,,
SUTURE TICRON 0 3093-61,,A4649,HCPCS,Facility,Both,,,,34.2,29.07,9.80172,34.2,"Health Partners, Inc.",State of Minnesota Advantage Program,27.873,81.5,,percent of total billed charges,,
SUTURE TICRON 0 3093-61,,A4649,HCPCS,Facility,Both,,,,34.2,29.07,9.80172,34.2,"Health Partners, Inc.",State Public Programs,17.1,50,,percent of total billed charges,,
SUTURE TICRON 0 3093-61,,A4649,HCPCS,Facility,Both,,,,34.2,29.07,9.80172,34.2,Humana Insurance Company,Commercial PPO,32.49,95,,percent of total billed charges,,
SUTURE TICRON 0 3093-61,,A4649,HCPCS,Facility,Outpatient,,,,34.2,29.07,9.80172,34.2,Humana Insurance Company,Medicare PPO,16.758,49,,percent of total billed charges,,
SUTURE TICRON 0 3093-61,,A4649,HCPCS,Facility,Inpatient,,,,34.2,29.07,9.80172,34.2,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
SUTURE TICRON 0 3093-61,,A4649,HCPCS,Facility,Both,,,,34.2,29.07,9.80172,34.2,Medica,Individual & Family,33.8922,99.1,,percent of total billed charges,,
SUTURE TICRON 0 3093-61,,A4649,HCPCS,Facility,Outpatient,,,,34.2,29.07,9.80172,34.2,Medica,Medica Advantage Solution,17.0316,49.8,,percent of total billed charges,,
SUTURE TICRON 0 3093-61,,A4649,HCPCS,Facility,Inpatient,,,,34.2,29.07,9.80172,34.2,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
SUTURE TICRON 0 3093-61,,A4649,HCPCS,Facility,Outpatient,,,,34.2,29.07,9.80172,34.2,Medica,Medical Assistance,15.2532,44.6,,percent of total billed charges,,
SUTURE TICRON 0 3093-61,,A4649,HCPCS,Facility,Inpatient,,,,34.2,29.07,9.80172,34.2,Medica,Medical Assistance,,,,,Included in per diem rate,
SUTURE TICRON 0 3093-61,,A4649,HCPCS,Facility,Outpatient,,,,34.2,29.07,9.80172,34.2,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,17.0316,49.8,,percent of total billed charges,,
SUTURE TICRON 0 3093-61,,A4649,HCPCS,Facility,Inpatient,,,,34.2,29.07,9.80172,34.2,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
SUTURE TICRON 0 3093-61,,A4649,HCPCS,Facility,Both,,,,34.2,29.07,9.80172,34.2,"Multiplan, Inc.","Multiplan, Inc.",32.148,94,,percent of total billed charges,,
SUTURE TICRON 0 3093-61,,A4649,HCPCS,Facility,Outpatient,,,,34.2,29.07,9.80172,34.2,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,30.8142,90.1,,percent of total billed charges,,
SUTURE TICRON 0 3093-61,,A4649,HCPCS,Facility,Inpatient,,,,34.2,29.07,9.80172,34.2,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
SUTURE TICRON 0 3093-61,,A4649,HCPCS,Facility,Both,,,,34.2,29.07,9.80172,34.2,"Preferred One Administrative Services, INC.",PPO,33.7212,98.6,,percent of total billed charges,,
SUTURE TICRON 0 3093-61,,A4649,HCPCS,Facility,Outpatient,,,,34.2,29.07,9.80172,34.2,PrimeWest Health,Minnesota Senior Health Options (MSHO),17.5959,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
SUTURE TICRON 0 3093-61,,A4649,HCPCS,Facility,Inpatient,,,,34.2,29.07,9.80172,34.2,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE TICRON 0 3093-61,,A4649,HCPCS,Facility,Outpatient,,,,34.2,29.07,9.80172,34.2,PrimeWest Health,MinnesotaCare,17.56512,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
SUTURE TICRON 0 3093-61,,A4649,HCPCS,Facility,Inpatient,,,,34.2,29.07,9.80172,34.2,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
SUTURE TICRON 0 3093-61,,A4649,HCPCS,Facility,Both,,,,34.2,29.07,9.80172,34.2,Sanford Health Plan,Sanford Health Plan,31.464,92,,percent of total billed charges,,
SUTURE TICRON 0 3093-61,,A4649,HCPCS,Facility,Outpatient,,,,34.2,29.07,9.80172,34.2,"UCare Health, Inc.",Individual & Family Plan,19.2717,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
SUTURE TICRON 0 3093-61,,A4649,HCPCS,Facility,Inpatient,,,,34.2,29.07,9.80172,34.2,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
SUTURE TICRON 0 3093-61,,A4649,HCPCS,Facility,Outpatient,,,,34.2,29.07,9.80172,34.2,"UCare Health, Inc.",Medical Assistance,17.26074,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE TICRON 0 3093-61,,A4649,HCPCS,Facility,Inpatient,,,,34.2,29.07,9.80172,34.2,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
SUTURE TICRON 0 3093-61,,A4649,HCPCS,Facility,Outpatient,,,,34.2,29.07,9.80172,34.2,"UCare Health, Inc.",Medicare Advantage,17.26074,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE TICRON 0 3093-61,,A4649,HCPCS,Facility,Inpatient,,,,34.2,29.07,9.80172,34.2,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE TICRON 0 3093-61,,A4649,HCPCS,Facility,Outpatient,,,,34.2,29.07,9.80172,34.2,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),17.26074,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE TICRON 0 3093-61,,A4649,HCPCS,Facility,Inpatient,,,,34.2,29.07,9.80172,34.2,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE TICRON 0 3093-61,,A4649,HCPCS,Facility,Both,,,,34.2,29.07,9.80172,34.2,UnitedHealthcare,Individual & Family,32.148,94,,percent of total billed charges,,
SUTURE TICRON 0 3093-61,,A4649,HCPCS,Facility,Outpatient,,,,34.2,29.07,9.80172,34.2,UnitedHealthcare,Medicare Advantage,16.758,49,,percent of total billed charges,,
SUTURE TICRON 0 3093-61,,A4649,HCPCS,Facility,Inpatient,,,,34.2,29.07,9.80172,34.2,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
SUTURE TICRON 0 3093-61,,A4649,HCPCS,Facility,Outpatient,,,,34.2,29.07,9.80172,34.2,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,16.416,48,,percent of total billed charges,,100% of DHS outpatient percentage
SUTURE TICRON 0 3093-61,,A4649,HCPCS,Facility,Inpatient,,,,34.2,29.07,9.80172,34.2,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
SUTURE TICRON 0 BLUE 30IN GS-22,,A4649,HCPCS,Facility,Both,,,,31.75,26.9875,9.09955,31.75,Aetna,Commercial,29.21,92,,percent of total billed charges,,
SUTURE TICRON 0 BLUE 30IN GS-22,,A4649,HCPCS,Facility,Outpatient,,,,31.75,26.9875,9.09955,31.75,Aetna,Medicare Advantage,15.5575,49,,percent of total billed charges,,
SUTURE TICRON 0 BLUE 30IN GS-22,,A4649,HCPCS,Facility,Inpatient,,,,31.75,26.9875,9.09955,31.75,Aetna,Medicare Advantage,,,,,Included in per diem rate,
SUTURE TICRON 0 BLUE 30IN GS-22,,A4649,HCPCS,Facility,Both,,,,31.75,26.9875,9.09955,31.75,Aetna,PPO,29.5275,93,,percent of total billed charges,,
SUTURE TICRON 0 BLUE 30IN GS-22,,A4649,HCPCS,Facility,Both,,,,31.75,26.9875,9.09955,31.75,America's PPO,America's PPO,30.489525,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SUTURE TICRON 0 BLUE 30IN GS-22,,A4649,HCPCS,Facility,Both,,,,31.75,26.9875,9.09955,31.75,BlueCross BlueShield Minnesota, Federal Employee Program,31.242,98.4,,percent of total billed charges,,
SUTURE TICRON 0 BLUE 30IN GS-22,,A4649,HCPCS,Facility,Both,,,,31.75,26.9875,9.09955,31.75,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,31.75,100,,percent of total billed charges,,
SUTURE TICRON 0 BLUE 30IN GS-22,,A4649,HCPCS,Facility,Both,,,,31.75,26.9875,9.09955,31.75,BlueCross BlueShield Minnesota,High Value Network Plan,28.575,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
SUTURE TICRON 0 BLUE 30IN GS-22,,A4649,HCPCS,Facility,Outpatient,,,,31.75,26.9875,9.09955,31.75,BlueCross BlueShield Minnesota,Medicare Advantage,15.5575,49,,percent of total billed charges,,
SUTURE TICRON 0 BLUE 30IN GS-22,,A4649,HCPCS,Facility,Inpatient,,,,31.75,26.9875,9.09955,31.75,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
SUTURE TICRON 0 BLUE 30IN GS-22,,A4649,HCPCS,Facility,Both,,,,31.75,26.9875,9.09955,31.75,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,28.120975,88.57,,percent of total billed charges,,
SUTURE TICRON 0 BLUE 30IN GS-22,,A4649,HCPCS,Facility,Both,,,,31.75,26.9875,9.09955,31.75,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,9.09955,28.66,,percent of total billed charges,,
SUTURE TICRON 0 BLUE 30IN GS-22,,A4649,HCPCS,Facility,Outpatient,,,,31.75,26.9875,9.09955,31.75,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),15.5575,49,,percent of total billed charges,,
SUTURE TICRON 0 BLUE 30IN GS-22,,A4649,HCPCS,Facility,Inpatient,,,,31.75,26.9875,9.09955,31.75,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
SUTURE TICRON 0 BLUE 30IN GS-22,,A4649,HCPCS,Facility,Both,,,,31.75,26.9875,9.09955,31.75,CorVel,Worker's Compensation,31.75,100,,percent of total billed charges,,
SUTURE TICRON 0 BLUE 30IN GS-22,,A4649,HCPCS,Facility,Both,,,,31.75,26.9875,9.09955,31.75,First Health Group Corporation,First Health Network,30.7975,97,,percent of total billed charges,,
SUTURE TICRON 0 BLUE 30IN GS-22,,A4649,HCPCS,Facility,Both,,,,31.75,26.9875,9.09955,31.75,"Health Partners, Inc.",Commercial,30.0355,94.6,,percent of total billed charges,,
SUTURE TICRON 0 BLUE 30IN GS-22,,A4649,HCPCS,Facility,Outpatient,,,,31.75,26.9875,9.09955,31.75,"Health Partners, Inc.",Medicare Advantage,15.5575,49,,percent of total billed charges,,
SUTURE TICRON 0 BLUE 30IN GS-22,,A4649,HCPCS,Facility,Inpatient,,,,31.75,26.9875,9.09955,31.75,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE TICRON 0 BLUE 30IN GS-22,,A4649,HCPCS,Facility,Both,,,,31.75,26.9875,9.09955,31.75,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),19.05,60,,percent of total billed charges,,
SUTURE TICRON 0 BLUE 30IN GS-22,,A4649,HCPCS,Facility,Both,,,,31.75,26.9875,9.09955,31.75,"Health Partners, Inc.",State of Minnesota Advantage Program,25.87625,81.5,,percent of total billed charges,,
SUTURE TICRON 0 BLUE 30IN GS-22,,A4649,HCPCS,Facility,Both,,,,31.75,26.9875,9.09955,31.75,"Health Partners, Inc.",State Public Programs,15.875,50,,percent of total billed charges,,
SUTURE TICRON 0 BLUE 30IN GS-22,,A4649,HCPCS,Facility,Both,,,,31.75,26.9875,9.09955,31.75,Humana Insurance Company,Commercial PPO,30.1625,95,,percent of total billed charges,,
SUTURE TICRON 0 BLUE 30IN GS-22,,A4649,HCPCS,Facility,Outpatient,,,,31.75,26.9875,9.09955,31.75,Humana Insurance Company,Medicare PPO,15.5575,49,,percent of total billed charges,,
SUTURE TICRON 0 BLUE 30IN GS-22,,A4649,HCPCS,Facility,Inpatient,,,,31.75,26.9875,9.09955,31.75,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
SUTURE TICRON 0 BLUE 30IN GS-22,,A4649,HCPCS,Facility,Both,,,,31.75,26.9875,9.09955,31.75,Medica,Individual & Family,31.46425,99.1,,percent of total billed charges,,
SUTURE TICRON 0 BLUE 30IN GS-22,,A4649,HCPCS,Facility,Outpatient,,,,31.75,26.9875,9.09955,31.75,Medica,Medica Advantage Solution,15.8115,49.8,,percent of total billed charges,,
SUTURE TICRON 0 BLUE 30IN GS-22,,A4649,HCPCS,Facility,Inpatient,,,,31.75,26.9875,9.09955,31.75,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
SUTURE TICRON 0 BLUE 30IN GS-22,,A4649,HCPCS,Facility,Outpatient,,,,31.75,26.9875,9.09955,31.75,Medica,Medical Assistance,14.1605,44.6,,percent of total billed charges,,
SUTURE TICRON 0 BLUE 30IN GS-22,,A4649,HCPCS,Facility,Inpatient,,,,31.75,26.9875,9.09955,31.75,Medica,Medical Assistance,,,,,Included in per diem rate,
SUTURE TICRON 0 BLUE 30IN GS-22,,A4649,HCPCS,Facility,Outpatient,,,,31.75,26.9875,9.09955,31.75,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,15.8115,49.8,,percent of total billed charges,,
SUTURE TICRON 0 BLUE 30IN GS-22,,A4649,HCPCS,Facility,Inpatient,,,,31.75,26.9875,9.09955,31.75,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
SUTURE TICRON 0 BLUE 30IN GS-22,,A4649,HCPCS,Facility,Both,,,,31.75,26.9875,9.09955,31.75,"Multiplan, Inc.","Multiplan, Inc.",29.845,94,,percent of total billed charges,,
SUTURE TICRON 0 BLUE 30IN GS-22,,A4649,HCPCS,Facility,Outpatient,,,,31.75,26.9875,9.09955,31.75,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,28.60675,90.1,,percent of total billed charges,,
SUTURE TICRON 0 BLUE 30IN GS-22,,A4649,HCPCS,Facility,Inpatient,,,,31.75,26.9875,9.09955,31.75,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
SUTURE TICRON 0 BLUE 30IN GS-22,,A4649,HCPCS,Facility,Both,,,,31.75,26.9875,9.09955,31.75,"Preferred One Administrative Services, INC.",PPO,31.3055,98.6,,percent of total billed charges,,
SUTURE TICRON 0 BLUE 30IN GS-22,,A4649,HCPCS,Facility,Outpatient,,,,31.75,26.9875,9.09955,31.75,PrimeWest Health,Minnesota Senior Health Options (MSHO),16.335375,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
SUTURE TICRON 0 BLUE 30IN GS-22,,A4649,HCPCS,Facility,Inpatient,,,,31.75,26.9875,9.09955,31.75,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE TICRON 0 BLUE 30IN GS-22,,A4649,HCPCS,Facility,Outpatient,,,,31.75,26.9875,9.09955,31.75,PrimeWest Health,MinnesotaCare,16.3068,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
SUTURE TICRON 0 BLUE 30IN GS-22,,A4649,HCPCS,Facility,Inpatient,,,,31.75,26.9875,9.09955,31.75,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
SUTURE TICRON 0 BLUE 30IN GS-22,,A4649,HCPCS,Facility,Both,,,,31.75,26.9875,9.09955,31.75,Sanford Health Plan,Sanford Health Plan,29.21,92,,percent of total billed charges,,
SUTURE TICRON 0 BLUE 30IN GS-22,,A4649,HCPCS,Facility,Outpatient,,,,31.75,26.9875,9.09955,31.75,"UCare Health, Inc.",Individual & Family Plan,17.891125,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
SUTURE TICRON 0 BLUE 30IN GS-22,,A4649,HCPCS,Facility,Inpatient,,,,31.75,26.9875,9.09955,31.75,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
SUTURE TICRON 0 BLUE 30IN GS-22,,A4649,HCPCS,Facility,Outpatient,,,,31.75,26.9875,9.09955,31.75,"UCare Health, Inc.",Medical Assistance,16.024225,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE TICRON 0 BLUE 30IN GS-22,,A4649,HCPCS,Facility,Inpatient,,,,31.75,26.9875,9.09955,31.75,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
SUTURE TICRON 0 BLUE 30IN GS-22,,A4649,HCPCS,Facility,Outpatient,,,,31.75,26.9875,9.09955,31.75,"UCare Health, Inc.",Medicare Advantage,16.024225,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE TICRON 0 BLUE 30IN GS-22,,A4649,HCPCS,Facility,Inpatient,,,,31.75,26.9875,9.09955,31.75,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE TICRON 0 BLUE 30IN GS-22,,A4649,HCPCS,Facility,Outpatient,,,,31.75,26.9875,9.09955,31.75,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),16.024225,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE TICRON 0 BLUE 30IN GS-22,,A4649,HCPCS,Facility,Inpatient,,,,31.75,26.9875,9.09955,31.75,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE TICRON 0 BLUE 30IN GS-22,,A4649,HCPCS,Facility,Both,,,,31.75,26.9875,9.09955,31.75,UnitedHealthcare,Individual & Family,29.845,94,,percent of total billed charges,,
SUTURE TICRON 0 BLUE 30IN GS-22,,A4649,HCPCS,Facility,Outpatient,,,,31.75,26.9875,9.09955,31.75,UnitedHealthcare,Medicare Advantage,15.5575,49,,percent of total billed charges,,
SUTURE TICRON 0 BLUE 30IN GS-22,,A4649,HCPCS,Facility,Inpatient,,,,31.75,26.9875,9.09955,31.75,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
SUTURE TICRON 0 BLUE 30IN GS-22,,A4649,HCPCS,Facility,Outpatient,,,,31.75,26.9875,9.09955,31.75,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,15.24,48,,percent of total billed charges,,100% of DHS outpatient percentage
SUTURE TICRON 0 BLUE 30IN GS-22,,A4649,HCPCS,Facility,Inpatient,,,,31.75,26.9875,9.09955,31.75,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
SUTURE TICRON 2/0 BLUE 30IN T-12/GS-2,,A4649,HCPCS,Facility,Both,,,,50.4,42.84,14.44464,50.4,Aetna,Commercial,46.368,92,,percent of total billed charges,,
SUTURE TICRON 2/0 BLUE 30IN T-12/GS-2,,A4649,HCPCS,Facility,Outpatient,,,,50.4,42.84,14.44464,50.4,Aetna,Medicare Advantage,24.696,49,,percent of total billed charges,,
SUTURE TICRON 2/0 BLUE 30IN T-12/GS-2,,A4649,HCPCS,Facility,Inpatient,,,,50.4,42.84,14.44464,50.4,Aetna,Medicare Advantage,,,,,Included in per diem rate,
SUTURE TICRON 2/0 BLUE 30IN T-12/GS-2,,A4649,HCPCS,Facility,Both,,,,50.4,42.84,14.44464,50.4,Aetna,PPO,46.872,93,,percent of total billed charges,,
SUTURE TICRON 2/0 BLUE 30IN T-12/GS-2,,A4649,HCPCS,Facility,Both,,,,50.4,42.84,14.44464,50.4,America's PPO,America's PPO,48.39912,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SUTURE TICRON 2/0 BLUE 30IN T-12/GS-2,,A4649,HCPCS,Facility,Both,,,,50.4,42.84,14.44464,50.4,BlueCross BlueShield Minnesota, Federal Employee Program,49.5936,98.4,,percent of total billed charges,,
SUTURE TICRON 2/0 BLUE 30IN T-12/GS-2,,A4649,HCPCS,Facility,Both,,,,50.4,42.84,14.44464,50.4,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,50.4,100,,percent of total billed charges,,
SUTURE TICRON 2/0 BLUE 30IN T-12/GS-2,,A4649,HCPCS,Facility,Both,,,,50.4,42.84,14.44464,50.4,BlueCross BlueShield Minnesota,High Value Network Plan,45.36,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
SUTURE TICRON 2/0 BLUE 30IN T-12/GS-2,,A4649,HCPCS,Facility,Outpatient,,,,50.4,42.84,14.44464,50.4,BlueCross BlueShield Minnesota,Medicare Advantage,24.696,49,,percent of total billed charges,,
SUTURE TICRON 2/0 BLUE 30IN T-12/GS-2,,A4649,HCPCS,Facility,Inpatient,,,,50.4,42.84,14.44464,50.4,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
SUTURE TICRON 2/0 BLUE 30IN T-12/GS-2,,A4649,HCPCS,Facility,Both,,,,50.4,42.84,14.44464,50.4,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,44.63928,88.57,,percent of total billed charges,,
SUTURE TICRON 2/0 BLUE 30IN T-12/GS-2,,A4649,HCPCS,Facility,Both,,,,50.4,42.84,14.44464,50.4,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,14.44464,28.66,,percent of total billed charges,,
SUTURE TICRON 2/0 BLUE 30IN T-12/GS-2,,A4649,HCPCS,Facility,Outpatient,,,,50.4,42.84,14.44464,50.4,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),24.696,49,,percent of total billed charges,,
SUTURE TICRON 2/0 BLUE 30IN T-12/GS-2,,A4649,HCPCS,Facility,Inpatient,,,,50.4,42.84,14.44464,50.4,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
SUTURE TICRON 2/0 BLUE 30IN T-12/GS-2,,A4649,HCPCS,Facility,Both,,,,50.4,42.84,14.44464,50.4,CorVel,Worker's Compensation,50.4,100,,percent of total billed charges,,
SUTURE TICRON 2/0 BLUE 30IN T-12/GS-2,,A4649,HCPCS,Facility,Both,,,,50.4,42.84,14.44464,50.4,First Health Group Corporation,First Health Network,48.888,97,,percent of total billed charges,,
SUTURE TICRON 2/0 BLUE 30IN T-12/GS-2,,A4649,HCPCS,Facility,Both,,,,50.4,42.84,14.44464,50.4,"Health Partners, Inc.",Commercial,47.6784,94.6,,percent of total billed charges,,
SUTURE TICRON 2/0 BLUE 30IN T-12/GS-2,,A4649,HCPCS,Facility,Outpatient,,,,50.4,42.84,14.44464,50.4,"Health Partners, Inc.",Medicare Advantage,24.696,49,,percent of total billed charges,,
SUTURE TICRON 2/0 BLUE 30IN T-12/GS-2,,A4649,HCPCS,Facility,Inpatient,,,,50.4,42.84,14.44464,50.4,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE TICRON 2/0 BLUE 30IN T-12/GS-2,,A4649,HCPCS,Facility,Both,,,,50.4,42.84,14.44464,50.4,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),30.24,60,,percent of total billed charges,,
SUTURE TICRON 2/0 BLUE 30IN T-12/GS-2,,A4649,HCPCS,Facility,Both,,,,50.4,42.84,14.44464,50.4,"Health Partners, Inc.",State of Minnesota Advantage Program,41.076,81.5,,percent of total billed charges,,
SUTURE TICRON 2/0 BLUE 30IN T-12/GS-2,,A4649,HCPCS,Facility,Both,,,,50.4,42.84,14.44464,50.4,"Health Partners, Inc.",State Public Programs,25.2,50,,percent of total billed charges,,
SUTURE TICRON 2/0 BLUE 30IN T-12/GS-2,,A4649,HCPCS,Facility,Both,,,,50.4,42.84,14.44464,50.4,Humana Insurance Company,Commercial PPO,47.88,95,,percent of total billed charges,,
SUTURE TICRON 2/0 BLUE 30IN T-12/GS-2,,A4649,HCPCS,Facility,Outpatient,,,,50.4,42.84,14.44464,50.4,Humana Insurance Company,Medicare PPO,24.696,49,,percent of total billed charges,,
SUTURE TICRON 2/0 BLUE 30IN T-12/GS-2,,A4649,HCPCS,Facility,Inpatient,,,,50.4,42.84,14.44464,50.4,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
SUTURE TICRON 2/0 BLUE 30IN T-12/GS-2,,A4649,HCPCS,Facility,Both,,,,50.4,42.84,14.44464,50.4,Medica,Individual & Family,49.9464,99.1,,percent of total billed charges,,
SUTURE TICRON 2/0 BLUE 30IN T-12/GS-2,,A4649,HCPCS,Facility,Outpatient,,,,50.4,42.84,14.44464,50.4,Medica,Medica Advantage Solution,25.0992,49.8,,percent of total billed charges,,
SUTURE TICRON 2/0 BLUE 30IN T-12/GS-2,,A4649,HCPCS,Facility,Inpatient,,,,50.4,42.84,14.44464,50.4,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
SUTURE TICRON 2/0 BLUE 30IN T-12/GS-2,,A4649,HCPCS,Facility,Outpatient,,,,50.4,42.84,14.44464,50.4,Medica,Medical Assistance,22.4784,44.6,,percent of total billed charges,,
SUTURE TICRON 2/0 BLUE 30IN T-12/GS-2,,A4649,HCPCS,Facility,Inpatient,,,,50.4,42.84,14.44464,50.4,Medica,Medical Assistance,,,,,Included in per diem rate,
SUTURE TICRON 2/0 BLUE 30IN T-12/GS-2,,A4649,HCPCS,Facility,Outpatient,,,,50.4,42.84,14.44464,50.4,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,25.0992,49.8,,percent of total billed charges,,
SUTURE TICRON 2/0 BLUE 30IN T-12/GS-2,,A4649,HCPCS,Facility,Inpatient,,,,50.4,42.84,14.44464,50.4,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
SUTURE TICRON 2/0 BLUE 30IN T-12/GS-2,,A4649,HCPCS,Facility,Both,,,,50.4,42.84,14.44464,50.4,"Multiplan, Inc.","Multiplan, Inc.",47.376,94,,percent of total billed charges,,
SUTURE TICRON 2/0 BLUE 30IN T-12/GS-2,,A4649,HCPCS,Facility,Outpatient,,,,50.4,42.84,14.44464,50.4,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,45.4104,90.1,,percent of total billed charges,,
SUTURE TICRON 2/0 BLUE 30IN T-12/GS-2,,A4649,HCPCS,Facility,Inpatient,,,,50.4,42.84,14.44464,50.4,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
SUTURE TICRON 2/0 BLUE 30IN T-12/GS-2,,A4649,HCPCS,Facility,Both,,,,50.4,42.84,14.44464,50.4,"Preferred One Administrative Services, INC.",PPO,49.6944,98.6,,percent of total billed charges,,
SUTURE TICRON 2/0 BLUE 30IN T-12/GS-2,,A4649,HCPCS,Facility,Outpatient,,,,50.4,42.84,14.44464,50.4,PrimeWest Health,Minnesota Senior Health Options (MSHO),25.9308,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
SUTURE TICRON 2/0 BLUE 30IN T-12/GS-2,,A4649,HCPCS,Facility,Inpatient,,,,50.4,42.84,14.44464,50.4,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE TICRON 2/0 BLUE 30IN T-12/GS-2,,A4649,HCPCS,Facility,Outpatient,,,,50.4,42.84,14.44464,50.4,PrimeWest Health,MinnesotaCare,25.88544,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
SUTURE TICRON 2/0 BLUE 30IN T-12/GS-2,,A4649,HCPCS,Facility,Inpatient,,,,50.4,42.84,14.44464,50.4,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
SUTURE TICRON 2/0 BLUE 30IN T-12/GS-2,,A4649,HCPCS,Facility,Both,,,,50.4,42.84,14.44464,50.4,Sanford Health Plan,Sanford Health Plan,46.368,92,,percent of total billed charges,,
SUTURE TICRON 2/0 BLUE 30IN T-12/GS-2,,A4649,HCPCS,Facility,Outpatient,,,,50.4,42.84,14.44464,50.4,"UCare Health, Inc.",Individual & Family Plan,28.4004,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
SUTURE TICRON 2/0 BLUE 30IN T-12/GS-2,,A4649,HCPCS,Facility,Inpatient,,,,50.4,42.84,14.44464,50.4,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
SUTURE TICRON 2/0 BLUE 30IN T-12/GS-2,,A4649,HCPCS,Facility,Outpatient,,,,50.4,42.84,14.44464,50.4,"UCare Health, Inc.",Medical Assistance,25.43688,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE TICRON 2/0 BLUE 30IN T-12/GS-2,,A4649,HCPCS,Facility,Inpatient,,,,50.4,42.84,14.44464,50.4,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
SUTURE TICRON 2/0 BLUE 30IN T-12/GS-2,,A4649,HCPCS,Facility,Outpatient,,,,50.4,42.84,14.44464,50.4,"UCare Health, Inc.",Medicare Advantage,25.43688,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE TICRON 2/0 BLUE 30IN T-12/GS-2,,A4649,HCPCS,Facility,Inpatient,,,,50.4,42.84,14.44464,50.4,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE TICRON 2/0 BLUE 30IN T-12/GS-2,,A4649,HCPCS,Facility,Outpatient,,,,50.4,42.84,14.44464,50.4,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),25.43688,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE TICRON 2/0 BLUE 30IN T-12/GS-2,,A4649,HCPCS,Facility,Inpatient,,,,50.4,42.84,14.44464,50.4,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE TICRON 2/0 BLUE 30IN T-12/GS-2,,A4649,HCPCS,Facility,Both,,,,50.4,42.84,14.44464,50.4,UnitedHealthcare,Individual & Family,47.376,94,,percent of total billed charges,,
SUTURE TICRON 2/0 BLUE 30IN T-12/GS-2,,A4649,HCPCS,Facility,Outpatient,,,,50.4,42.84,14.44464,50.4,UnitedHealthcare,Medicare Advantage,24.696,49,,percent of total billed charges,,
SUTURE TICRON 2/0 BLUE 30IN T-12/GS-2,,A4649,HCPCS,Facility,Inpatient,,,,50.4,42.84,14.44464,50.4,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
SUTURE TICRON 2/0 BLUE 30IN T-12/GS-2,,A4649,HCPCS,Facility,Outpatient,,,,50.4,42.84,14.44464,50.4,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,24.192,48,,percent of total billed charges,,100% of DHS outpatient percentage
SUTURE TICRON 2/0 BLUE 30IN T-12/GS-2,,A4649,HCPCS,Facility,Inpatient,,,,50.4,42.84,14.44464,50.4,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
SUTURE TICRON 2/0 BLUE 30IN T-19/GS-2,,A4649,HCPCS,Facility,Both,,,,34.25,29.1125,9.81605,34.25,Aetna,Commercial,31.51,92,,percent of total billed charges,,
SUTURE TICRON 2/0 BLUE 30IN T-19/GS-2,,A4649,HCPCS,Facility,Outpatient,,,,34.25,29.1125,9.81605,34.25,Aetna,Medicare Advantage,16.7825,49,,percent of total billed charges,,
SUTURE TICRON 2/0 BLUE 30IN T-19/GS-2,,A4649,HCPCS,Facility,Inpatient,,,,34.25,29.1125,9.81605,34.25,Aetna,Medicare Advantage,,,,,Included in per diem rate,
SUTURE TICRON 2/0 BLUE 30IN T-19/GS-2,,A4649,HCPCS,Facility,Both,,,,34.25,29.1125,9.81605,34.25,Aetna,PPO,31.8525,93,,percent of total billed charges,,
SUTURE TICRON 2/0 BLUE 30IN T-19/GS-2,,A4649,HCPCS,Facility,Both,,,,34.25,29.1125,9.81605,34.25,America's PPO,America's PPO,32.890275,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SUTURE TICRON 2/0 BLUE 30IN T-19/GS-2,,A4649,HCPCS,Facility,Both,,,,34.25,29.1125,9.81605,34.25,BlueCross BlueShield Minnesota, Federal Employee Program,33.702,98.4,,percent of total billed charges,,
SUTURE TICRON 2/0 BLUE 30IN T-19/GS-2,,A4649,HCPCS,Facility,Both,,,,34.25,29.1125,9.81605,34.25,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,34.25,100,,percent of total billed charges,,
SUTURE TICRON 2/0 BLUE 30IN T-19/GS-2,,A4649,HCPCS,Facility,Both,,,,34.25,29.1125,9.81605,34.25,BlueCross BlueShield Minnesota,High Value Network Plan,30.825,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
SUTURE TICRON 2/0 BLUE 30IN T-19/GS-2,,A4649,HCPCS,Facility,Outpatient,,,,34.25,29.1125,9.81605,34.25,BlueCross BlueShield Minnesota,Medicare Advantage,16.7825,49,,percent of total billed charges,,
SUTURE TICRON 2/0 BLUE 30IN T-19/GS-2,,A4649,HCPCS,Facility,Inpatient,,,,34.25,29.1125,9.81605,34.25,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
SUTURE TICRON 2/0 BLUE 30IN T-19/GS-2,,A4649,HCPCS,Facility,Both,,,,34.25,29.1125,9.81605,34.25,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,30.335225,88.57,,percent of total billed charges,,
SUTURE TICRON 2/0 BLUE 30IN T-19/GS-2,,A4649,HCPCS,Facility,Both,,,,34.25,29.1125,9.81605,34.25,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,9.81605,28.66,,percent of total billed charges,,
SUTURE TICRON 2/0 BLUE 30IN T-19/GS-2,,A4649,HCPCS,Facility,Outpatient,,,,34.25,29.1125,9.81605,34.25,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),16.7825,49,,percent of total billed charges,,
SUTURE TICRON 2/0 BLUE 30IN T-19/GS-2,,A4649,HCPCS,Facility,Inpatient,,,,34.25,29.1125,9.81605,34.25,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
SUTURE TICRON 2/0 BLUE 30IN T-19/GS-2,,A4649,HCPCS,Facility,Both,,,,34.25,29.1125,9.81605,34.25,CorVel,Worker's Compensation,34.25,100,,percent of total billed charges,,
SUTURE TICRON 2/0 BLUE 30IN T-19/GS-2,,A4649,HCPCS,Facility,Both,,,,34.25,29.1125,9.81605,34.25,First Health Group Corporation,First Health Network,33.2225,97,,percent of total billed charges,,
SUTURE TICRON 2/0 BLUE 30IN T-19/GS-2,,A4649,HCPCS,Facility,Both,,,,34.25,29.1125,9.81605,34.25,"Health Partners, Inc.",Commercial,32.4005,94.6,,percent of total billed charges,,
SUTURE TICRON 2/0 BLUE 30IN T-19/GS-2,,A4649,HCPCS,Facility,Outpatient,,,,34.25,29.1125,9.81605,34.25,"Health Partners, Inc.",Medicare Advantage,16.7825,49,,percent of total billed charges,,
SUTURE TICRON 2/0 BLUE 30IN T-19/GS-2,,A4649,HCPCS,Facility,Inpatient,,,,34.25,29.1125,9.81605,34.25,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE TICRON 2/0 BLUE 30IN T-19/GS-2,,A4649,HCPCS,Facility,Both,,,,34.25,29.1125,9.81605,34.25,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),20.55,60,,percent of total billed charges,,
SUTURE TICRON 2/0 BLUE 30IN T-19/GS-2,,A4649,HCPCS,Facility,Both,,,,34.25,29.1125,9.81605,34.25,"Health Partners, Inc.",State of Minnesota Advantage Program,27.91375,81.5,,percent of total billed charges,,
SUTURE TICRON 2/0 BLUE 30IN T-19/GS-2,,A4649,HCPCS,Facility,Both,,,,34.25,29.1125,9.81605,34.25,"Health Partners, Inc.",State Public Programs,17.125,50,,percent of total billed charges,,
SUTURE TICRON 2/0 BLUE 30IN T-19/GS-2,,A4649,HCPCS,Facility,Both,,,,34.25,29.1125,9.81605,34.25,Humana Insurance Company,Commercial PPO,32.5375,95,,percent of total billed charges,,
SUTURE TICRON 2/0 BLUE 30IN T-19/GS-2,,A4649,HCPCS,Facility,Outpatient,,,,34.25,29.1125,9.81605,34.25,Humana Insurance Company,Medicare PPO,16.7825,49,,percent of total billed charges,,
SUTURE TICRON 2/0 BLUE 30IN T-19/GS-2,,A4649,HCPCS,Facility,Inpatient,,,,34.25,29.1125,9.81605,34.25,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
SUTURE TICRON 2/0 BLUE 30IN T-19/GS-2,,A4649,HCPCS,Facility,Both,,,,34.25,29.1125,9.81605,34.25,Medica,Individual & Family,33.94175,99.1,,percent of total billed charges,,
SUTURE TICRON 2/0 BLUE 30IN T-19/GS-2,,A4649,HCPCS,Facility,Outpatient,,,,34.25,29.1125,9.81605,34.25,Medica,Medica Advantage Solution,17.0565,49.8,,percent of total billed charges,,
SUTURE TICRON 2/0 BLUE 30IN T-19/GS-2,,A4649,HCPCS,Facility,Inpatient,,,,34.25,29.1125,9.81605,34.25,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
SUTURE TICRON 2/0 BLUE 30IN T-19/GS-2,,A4649,HCPCS,Facility,Outpatient,,,,34.25,29.1125,9.81605,34.25,Medica,Medical Assistance,15.2755,44.6,,percent of total billed charges,,
SUTURE TICRON 2/0 BLUE 30IN T-19/GS-2,,A4649,HCPCS,Facility,Inpatient,,,,34.25,29.1125,9.81605,34.25,Medica,Medical Assistance,,,,,Included in per diem rate,
SUTURE TICRON 2/0 BLUE 30IN T-19/GS-2,,A4649,HCPCS,Facility,Outpatient,,,,34.25,29.1125,9.81605,34.25,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,17.0565,49.8,,percent of total billed charges,,
SUTURE TICRON 2/0 BLUE 30IN T-19/GS-2,,A4649,HCPCS,Facility,Inpatient,,,,34.25,29.1125,9.81605,34.25,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
SUTURE TICRON 2/0 BLUE 30IN T-19/GS-2,,A4649,HCPCS,Facility,Both,,,,34.25,29.1125,9.81605,34.25,"Multiplan, Inc.","Multiplan, Inc.",32.195,94,,percent of total billed charges,,
SUTURE TICRON 2/0 BLUE 30IN T-19/GS-2,,A4649,HCPCS,Facility,Outpatient,,,,34.25,29.1125,9.81605,34.25,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,30.85925,90.1,,percent of total billed charges,,
SUTURE TICRON 2/0 BLUE 30IN T-19/GS-2,,A4649,HCPCS,Facility,Inpatient,,,,34.25,29.1125,9.81605,34.25,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
SUTURE TICRON 2/0 BLUE 30IN T-19/GS-2,,A4649,HCPCS,Facility,Both,,,,34.25,29.1125,9.81605,34.25,"Preferred One Administrative Services, INC.",PPO,33.7705,98.6,,percent of total billed charges,,
SUTURE TICRON 2/0 BLUE 30IN T-19/GS-2,,A4649,HCPCS,Facility,Outpatient,,,,34.25,29.1125,9.81605,34.25,PrimeWest Health,Minnesota Senior Health Options (MSHO),17.621625,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
SUTURE TICRON 2/0 BLUE 30IN T-19/GS-2,,A4649,HCPCS,Facility,Inpatient,,,,34.25,29.1125,9.81605,34.25,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE TICRON 2/0 BLUE 30IN T-19/GS-2,,A4649,HCPCS,Facility,Outpatient,,,,34.25,29.1125,9.81605,34.25,PrimeWest Health,MinnesotaCare,17.5908,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
SUTURE TICRON 2/0 BLUE 30IN T-19/GS-2,,A4649,HCPCS,Facility,Inpatient,,,,34.25,29.1125,9.81605,34.25,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
SUTURE TICRON 2/0 BLUE 30IN T-19/GS-2,,A4649,HCPCS,Facility,Both,,,,34.25,29.1125,9.81605,34.25,Sanford Health Plan,Sanford Health Plan,31.51,92,,percent of total billed charges,,
SUTURE TICRON 2/0 BLUE 30IN T-19/GS-2,,A4649,HCPCS,Facility,Outpatient,,,,34.25,29.1125,9.81605,34.25,"UCare Health, Inc.",Individual & Family Plan,19.299875,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
SUTURE TICRON 2/0 BLUE 30IN T-19/GS-2,,A4649,HCPCS,Facility,Inpatient,,,,34.25,29.1125,9.81605,34.25,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
SUTURE TICRON 2/0 BLUE 30IN T-19/GS-2,,A4649,HCPCS,Facility,Outpatient,,,,34.25,29.1125,9.81605,34.25,"UCare Health, Inc.",Medical Assistance,17.285975,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE TICRON 2/0 BLUE 30IN T-19/GS-2,,A4649,HCPCS,Facility,Inpatient,,,,34.25,29.1125,9.81605,34.25,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
SUTURE TICRON 2/0 BLUE 30IN T-19/GS-2,,A4649,HCPCS,Facility,Outpatient,,,,34.25,29.1125,9.81605,34.25,"UCare Health, Inc.",Medicare Advantage,17.285975,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE TICRON 2/0 BLUE 30IN T-19/GS-2,,A4649,HCPCS,Facility,Inpatient,,,,34.25,29.1125,9.81605,34.25,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE TICRON 2/0 BLUE 30IN T-19/GS-2,,A4649,HCPCS,Facility,Outpatient,,,,34.25,29.1125,9.81605,34.25,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),17.285975,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE TICRON 2/0 BLUE 30IN T-19/GS-2,,A4649,HCPCS,Facility,Inpatient,,,,34.25,29.1125,9.81605,34.25,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE TICRON 2/0 BLUE 30IN T-19/GS-2,,A4649,HCPCS,Facility,Both,,,,34.25,29.1125,9.81605,34.25,UnitedHealthcare,Individual & Family,32.195,94,,percent of total billed charges,,
SUTURE TICRON 2/0 BLUE 30IN T-19/GS-2,,A4649,HCPCS,Facility,Outpatient,,,,34.25,29.1125,9.81605,34.25,UnitedHealthcare,Medicare Advantage,16.7825,49,,percent of total billed charges,,
SUTURE TICRON 2/0 BLUE 30IN T-19/GS-2,,A4649,HCPCS,Facility,Inpatient,,,,34.25,29.1125,9.81605,34.25,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
SUTURE TICRON 2/0 BLUE 30IN T-19/GS-2,,A4649,HCPCS,Facility,Outpatient,,,,34.25,29.1125,9.81605,34.25,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,16.44,48,,percent of total billed charges,,100% of DHS outpatient percentage
SUTURE TICRON 2/0 BLUE 30IN T-19/GS-2,,A4649,HCPCS,Facility,Inpatient,,,,34.25,29.1125,9.81605,34.25,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
SUTURE TICRON 2-0 3090-51,,A4649,HCPCS,Facility,Both,,,,2.16,1.836,0.619056,2.16,Aetna,Commercial,1.9872,92,,percent of total billed charges,,
SUTURE TICRON 2-0 3090-51,,A4649,HCPCS,Facility,Outpatient,,,,2.16,1.836,0.619056,2.16,Aetna,Medicare Advantage,1.0584,49,,percent of total billed charges,,
SUTURE TICRON 2-0 3090-51,,A4649,HCPCS,Facility,Inpatient,,,,2.16,1.836,0.619056,2.16,Aetna,Medicare Advantage,,,,,Included in per diem rate,
SUTURE TICRON 2-0 3090-51,,A4649,HCPCS,Facility,Both,,,,2.16,1.836,0.619056,2.16,Aetna,PPO,2.0088,93,,percent of total billed charges,,
SUTURE TICRON 2-0 3090-51,,A4649,HCPCS,Facility,Both,,,,2.16,1.836,0.619056,2.16,America's PPO,America's PPO,2.074248,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SUTURE TICRON 2-0 3090-51,,A4649,HCPCS,Facility,Both,,,,2.16,1.836,0.619056,2.16,BlueCross BlueShield Minnesota, Federal Employee Program,2.12544,98.4,,percent of total billed charges,,
SUTURE TICRON 2-0 3090-51,,A4649,HCPCS,Facility,Both,,,,2.16,1.836,0.619056,2.16,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,2.16,100,,percent of total billed charges,,
SUTURE TICRON 2-0 3090-51,,A4649,HCPCS,Facility,Both,,,,2.16,1.836,0.619056,2.16,BlueCross BlueShield Minnesota,High Value Network Plan,1.944,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
SUTURE TICRON 2-0 3090-51,,A4649,HCPCS,Facility,Outpatient,,,,2.16,1.836,0.619056,2.16,BlueCross BlueShield Minnesota,Medicare Advantage,1.0584,49,,percent of total billed charges,,
SUTURE TICRON 2-0 3090-51,,A4649,HCPCS,Facility,Inpatient,,,,2.16,1.836,0.619056,2.16,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
SUTURE TICRON 2-0 3090-51,,A4649,HCPCS,Facility,Both,,,,2.16,1.836,0.619056,2.16,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1.913112,88.57,,percent of total billed charges,,
SUTURE TICRON 2-0 3090-51,,A4649,HCPCS,Facility,Both,,,,2.16,1.836,0.619056,2.16,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,0.619056,28.66,,percent of total billed charges,,
SUTURE TICRON 2-0 3090-51,,A4649,HCPCS,Facility,Outpatient,,,,2.16,1.836,0.619056,2.16,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1.0584,49,,percent of total billed charges,,
SUTURE TICRON 2-0 3090-51,,A4649,HCPCS,Facility,Inpatient,,,,2.16,1.836,0.619056,2.16,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
SUTURE TICRON 2-0 3090-51,,A4649,HCPCS,Facility,Both,,,,2.16,1.836,0.619056,2.16,CorVel,Worker's Compensation,2.16,100,,percent of total billed charges,,
SUTURE TICRON 2-0 3090-51,,A4649,HCPCS,Facility,Both,,,,2.16,1.836,0.619056,2.16,First Health Group Corporation,First Health Network,2.0952,97,,percent of total billed charges,,
SUTURE TICRON 2-0 3090-51,,A4649,HCPCS,Facility,Both,,,,2.16,1.836,0.619056,2.16,"Health Partners, Inc.",Commercial,2.04336,94.6,,percent of total billed charges,,
SUTURE TICRON 2-0 3090-51,,A4649,HCPCS,Facility,Outpatient,,,,2.16,1.836,0.619056,2.16,"Health Partners, Inc.",Medicare Advantage,1.0584,49,,percent of total billed charges,,
SUTURE TICRON 2-0 3090-51,,A4649,HCPCS,Facility,Inpatient,,,,2.16,1.836,0.619056,2.16,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE TICRON 2-0 3090-51,,A4649,HCPCS,Facility,Both,,,,2.16,1.836,0.619056,2.16,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1.296,60,,percent of total billed charges,,
SUTURE TICRON 2-0 3090-51,,A4649,HCPCS,Facility,Both,,,,2.16,1.836,0.619056,2.16,"Health Partners, Inc.",State of Minnesota Advantage Program,1.7604,81.5,,percent of total billed charges,,
SUTURE TICRON 2-0 3090-51,,A4649,HCPCS,Facility,Both,,,,2.16,1.836,0.619056,2.16,"Health Partners, Inc.",State Public Programs,1.08,50,,percent of total billed charges,,
SUTURE TICRON 2-0 3090-51,,A4649,HCPCS,Facility,Both,,,,2.16,1.836,0.619056,2.16,Humana Insurance Company,Commercial PPO,2.052,95,,percent of total billed charges,,
SUTURE TICRON 2-0 3090-51,,A4649,HCPCS,Facility,Outpatient,,,,2.16,1.836,0.619056,2.16,Humana Insurance Company,Medicare PPO,1.0584,49,,percent of total billed charges,,
SUTURE TICRON 2-0 3090-51,,A4649,HCPCS,Facility,Inpatient,,,,2.16,1.836,0.619056,2.16,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
SUTURE TICRON 2-0 3090-51,,A4649,HCPCS,Facility,Both,,,,2.16,1.836,0.619056,2.16,Medica,Individual & Family,2.14056,99.1,,percent of total billed charges,,
SUTURE TICRON 2-0 3090-51,,A4649,HCPCS,Facility,Outpatient,,,,2.16,1.836,0.619056,2.16,Medica,Medica Advantage Solution,1.07568,49.8,,percent of total billed charges,,
SUTURE TICRON 2-0 3090-51,,A4649,HCPCS,Facility,Inpatient,,,,2.16,1.836,0.619056,2.16,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
SUTURE TICRON 2-0 3090-51,,A4649,HCPCS,Facility,Outpatient,,,,2.16,1.836,0.619056,2.16,Medica,Medical Assistance,0.96336,44.6,,percent of total billed charges,,
SUTURE TICRON 2-0 3090-51,,A4649,HCPCS,Facility,Inpatient,,,,2.16,1.836,0.619056,2.16,Medica,Medical Assistance,,,,,Included in per diem rate,
SUTURE TICRON 2-0 3090-51,,A4649,HCPCS,Facility,Outpatient,,,,2.16,1.836,0.619056,2.16,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1.07568,49.8,,percent of total billed charges,,
SUTURE TICRON 2-0 3090-51,,A4649,HCPCS,Facility,Inpatient,,,,2.16,1.836,0.619056,2.16,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
SUTURE TICRON 2-0 3090-51,,A4649,HCPCS,Facility,Both,,,,2.16,1.836,0.619056,2.16,"Multiplan, Inc.","Multiplan, Inc.",2.0304,94,,percent of total billed charges,,
SUTURE TICRON 2-0 3090-51,,A4649,HCPCS,Facility,Outpatient,,,,2.16,1.836,0.619056,2.16,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1.94616,90.1,,percent of total billed charges,,
SUTURE TICRON 2-0 3090-51,,A4649,HCPCS,Facility,Inpatient,,,,2.16,1.836,0.619056,2.16,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
SUTURE TICRON 2-0 3090-51,,A4649,HCPCS,Facility,Both,,,,2.16,1.836,0.619056,2.16,"Preferred One Administrative Services, INC.",PPO,2.12976,98.6,,percent of total billed charges,,
SUTURE TICRON 2-0 3090-51,,A4649,HCPCS,Facility,Outpatient,,,,2.16,1.836,0.619056,2.16,PrimeWest Health,Minnesota Senior Health Options (MSHO),1.11132,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
SUTURE TICRON 2-0 3090-51,,A4649,HCPCS,Facility,Inpatient,,,,2.16,1.836,0.619056,2.16,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE TICRON 2-0 3090-51,,A4649,HCPCS,Facility,Outpatient,,,,2.16,1.836,0.619056,2.16,PrimeWest Health,MinnesotaCare,1.109376,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
SUTURE TICRON 2-0 3090-51,,A4649,HCPCS,Facility,Inpatient,,,,2.16,1.836,0.619056,2.16,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
SUTURE TICRON 2-0 3090-51,,A4649,HCPCS,Facility,Both,,,,2.16,1.836,0.619056,2.16,Sanford Health Plan,Sanford Health Plan,1.9872,92,,percent of total billed charges,,
SUTURE TICRON 2-0 3090-51,,A4649,HCPCS,Facility,Outpatient,,,,2.16,1.836,0.619056,2.16,"UCare Health, Inc.",Individual & Family Plan,1.21716,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
SUTURE TICRON 2-0 3090-51,,A4649,HCPCS,Facility,Inpatient,,,,2.16,1.836,0.619056,2.16,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
SUTURE TICRON 2-0 3090-51,,A4649,HCPCS,Facility,Outpatient,,,,2.16,1.836,0.619056,2.16,"UCare Health, Inc.",Medical Assistance,1.090152,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE TICRON 2-0 3090-51,,A4649,HCPCS,Facility,Inpatient,,,,2.16,1.836,0.619056,2.16,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
SUTURE TICRON 2-0 3090-51,,A4649,HCPCS,Facility,Outpatient,,,,2.16,1.836,0.619056,2.16,"UCare Health, Inc.",Medicare Advantage,1.090152,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE TICRON 2-0 3090-51,,A4649,HCPCS,Facility,Inpatient,,,,2.16,1.836,0.619056,2.16,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE TICRON 2-0 3090-51,,A4649,HCPCS,Facility,Outpatient,,,,2.16,1.836,0.619056,2.16,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1.090152,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE TICRON 2-0 3090-51,,A4649,HCPCS,Facility,Inpatient,,,,2.16,1.836,0.619056,2.16,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE TICRON 2-0 3090-51,,A4649,HCPCS,Facility,Both,,,,2.16,1.836,0.619056,2.16,UnitedHealthcare,Individual & Family,2.0304,94,,percent of total billed charges,,
SUTURE TICRON 2-0 3090-51,,A4649,HCPCS,Facility,Outpatient,,,,2.16,1.836,0.619056,2.16,UnitedHealthcare,Medicare Advantage,1.0584,49,,percent of total billed charges,,
SUTURE TICRON 2-0 3090-51,,A4649,HCPCS,Facility,Inpatient,,,,2.16,1.836,0.619056,2.16,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
SUTURE TICRON 2-0 3090-51,,A4649,HCPCS,Facility,Outpatient,,,,2.16,1.836,0.619056,2.16,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1.0368,48,,percent of total billed charges,,100% of DHS outpatient percentage
SUTURE TICRON 2-0 3090-51,,A4649,HCPCS,Facility,Inpatient,,,,2.16,1.836,0.619056,2.16,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
SUTURE TICRON 3-0 3087-41,,A4649,HCPCS,Facility,Both,,,,23.3,19.805,6.67778,23.3,Aetna,Commercial,21.436,92,,percent of total billed charges,,
SUTURE TICRON 3-0 3087-41,,A4649,HCPCS,Facility,Outpatient,,,,23.3,19.805,6.67778,23.3,Aetna,Medicare Advantage,11.417,49,,percent of total billed charges,,
SUTURE TICRON 3-0 3087-41,,A4649,HCPCS,Facility,Inpatient,,,,23.3,19.805,6.67778,23.3,Aetna,Medicare Advantage,,,,,Included in per diem rate,
SUTURE TICRON 3-0 3087-41,,A4649,HCPCS,Facility,Both,,,,23.3,19.805,6.67778,23.3,Aetna,PPO,21.669,93,,percent of total billed charges,,
SUTURE TICRON 3-0 3087-41,,A4649,HCPCS,Facility,Both,,,,23.3,19.805,6.67778,23.3,America's PPO,America's PPO,22.37499,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SUTURE TICRON 3-0 3087-41,,A4649,HCPCS,Facility,Both,,,,23.3,19.805,6.67778,23.3,BlueCross BlueShield Minnesota, Federal Employee Program,22.9272,98.4,,percent of total billed charges,,
SUTURE TICRON 3-0 3087-41,,A4649,HCPCS,Facility,Both,,,,23.3,19.805,6.67778,23.3,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,23.3,100,,percent of total billed charges,,
SUTURE TICRON 3-0 3087-41,,A4649,HCPCS,Facility,Both,,,,23.3,19.805,6.67778,23.3,BlueCross BlueShield Minnesota,High Value Network Plan,20.97,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
SUTURE TICRON 3-0 3087-41,,A4649,HCPCS,Facility,Outpatient,,,,23.3,19.805,6.67778,23.3,BlueCross BlueShield Minnesota,Medicare Advantage,11.417,49,,percent of total billed charges,,
SUTURE TICRON 3-0 3087-41,,A4649,HCPCS,Facility,Inpatient,,,,23.3,19.805,6.67778,23.3,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
SUTURE TICRON 3-0 3087-41,,A4649,HCPCS,Facility,Both,,,,23.3,19.805,6.67778,23.3,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,20.63681,88.57,,percent of total billed charges,,
SUTURE TICRON 3-0 3087-41,,A4649,HCPCS,Facility,Both,,,,23.3,19.805,6.67778,23.3,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,6.67778,28.66,,percent of total billed charges,,
SUTURE TICRON 3-0 3087-41,,A4649,HCPCS,Facility,Outpatient,,,,23.3,19.805,6.67778,23.3,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),11.417,49,,percent of total billed charges,,
SUTURE TICRON 3-0 3087-41,,A4649,HCPCS,Facility,Inpatient,,,,23.3,19.805,6.67778,23.3,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
SUTURE TICRON 3-0 3087-41,,A4649,HCPCS,Facility,Both,,,,23.3,19.805,6.67778,23.3,CorVel,Worker's Compensation,23.3,100,,percent of total billed charges,,
SUTURE TICRON 3-0 3087-41,,A4649,HCPCS,Facility,Both,,,,23.3,19.805,6.67778,23.3,First Health Group Corporation,First Health Network,22.601,97,,percent of total billed charges,,
SUTURE TICRON 3-0 3087-41,,A4649,HCPCS,Facility,Both,,,,23.3,19.805,6.67778,23.3,"Health Partners, Inc.",Commercial,22.0418,94.6,,percent of total billed charges,,
SUTURE TICRON 3-0 3087-41,,A4649,HCPCS,Facility,Outpatient,,,,23.3,19.805,6.67778,23.3,"Health Partners, Inc.",Medicare Advantage,11.417,49,,percent of total billed charges,,
SUTURE TICRON 3-0 3087-41,,A4649,HCPCS,Facility,Inpatient,,,,23.3,19.805,6.67778,23.3,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE TICRON 3-0 3087-41,,A4649,HCPCS,Facility,Both,,,,23.3,19.805,6.67778,23.3,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),13.98,60,,percent of total billed charges,,
SUTURE TICRON 3-0 3087-41,,A4649,HCPCS,Facility,Both,,,,23.3,19.805,6.67778,23.3,"Health Partners, Inc.",State of Minnesota Advantage Program,18.9895,81.5,,percent of total billed charges,,
SUTURE TICRON 3-0 3087-41,,A4649,HCPCS,Facility,Both,,,,23.3,19.805,6.67778,23.3,"Health Partners, Inc.",State Public Programs,11.65,50,,percent of total billed charges,,
SUTURE TICRON 3-0 3087-41,,A4649,HCPCS,Facility,Both,,,,23.3,19.805,6.67778,23.3,Humana Insurance Company,Commercial PPO,22.135,95,,percent of total billed charges,,
SUTURE TICRON 3-0 3087-41,,A4649,HCPCS,Facility,Outpatient,,,,23.3,19.805,6.67778,23.3,Humana Insurance Company,Medicare PPO,11.417,49,,percent of total billed charges,,
SUTURE TICRON 3-0 3087-41,,A4649,HCPCS,Facility,Inpatient,,,,23.3,19.805,6.67778,23.3,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
SUTURE TICRON 3-0 3087-41,,A4649,HCPCS,Facility,Both,,,,23.3,19.805,6.67778,23.3,Medica,Individual & Family,23.0903,99.1,,percent of total billed charges,,
SUTURE TICRON 3-0 3087-41,,A4649,HCPCS,Facility,Outpatient,,,,23.3,19.805,6.67778,23.3,Medica,Medica Advantage Solution,11.6034,49.8,,percent of total billed charges,,
SUTURE TICRON 3-0 3087-41,,A4649,HCPCS,Facility,Inpatient,,,,23.3,19.805,6.67778,23.3,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
SUTURE TICRON 3-0 3087-41,,A4649,HCPCS,Facility,Outpatient,,,,23.3,19.805,6.67778,23.3,Medica,Medical Assistance,10.3918,44.6,,percent of total billed charges,,
SUTURE TICRON 3-0 3087-41,,A4649,HCPCS,Facility,Inpatient,,,,23.3,19.805,6.67778,23.3,Medica,Medical Assistance,,,,,Included in per diem rate,
SUTURE TICRON 3-0 3087-41,,A4649,HCPCS,Facility,Outpatient,,,,23.3,19.805,6.67778,23.3,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,11.6034,49.8,,percent of total billed charges,,
SUTURE TICRON 3-0 3087-41,,A4649,HCPCS,Facility,Inpatient,,,,23.3,19.805,6.67778,23.3,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
SUTURE TICRON 3-0 3087-41,,A4649,HCPCS,Facility,Both,,,,23.3,19.805,6.67778,23.3,"Multiplan, Inc.","Multiplan, Inc.",21.902,94,,percent of total billed charges,,
SUTURE TICRON 3-0 3087-41,,A4649,HCPCS,Facility,Outpatient,,,,23.3,19.805,6.67778,23.3,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,20.9933,90.1,,percent of total billed charges,,
SUTURE TICRON 3-0 3087-41,,A4649,HCPCS,Facility,Inpatient,,,,23.3,19.805,6.67778,23.3,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
SUTURE TICRON 3-0 3087-41,,A4649,HCPCS,Facility,Both,,,,23.3,19.805,6.67778,23.3,"Preferred One Administrative Services, INC.",PPO,22.9738,98.6,,percent of total billed charges,,
SUTURE TICRON 3-0 3087-41,,A4649,HCPCS,Facility,Outpatient,,,,23.3,19.805,6.67778,23.3,PrimeWest Health,Minnesota Senior Health Options (MSHO),11.98785,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
SUTURE TICRON 3-0 3087-41,,A4649,HCPCS,Facility,Inpatient,,,,23.3,19.805,6.67778,23.3,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE TICRON 3-0 3087-41,,A4649,HCPCS,Facility,Outpatient,,,,23.3,19.805,6.67778,23.3,PrimeWest Health,MinnesotaCare,11.96688,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
SUTURE TICRON 3-0 3087-41,,A4649,HCPCS,Facility,Inpatient,,,,23.3,19.805,6.67778,23.3,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
SUTURE TICRON 3-0 3087-41,,A4649,HCPCS,Facility,Both,,,,23.3,19.805,6.67778,23.3,Sanford Health Plan,Sanford Health Plan,21.436,92,,percent of total billed charges,,
SUTURE TICRON 3-0 3087-41,,A4649,HCPCS,Facility,Outpatient,,,,23.3,19.805,6.67778,23.3,"UCare Health, Inc.",Individual & Family Plan,13.12955,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
SUTURE TICRON 3-0 3087-41,,A4649,HCPCS,Facility,Inpatient,,,,23.3,19.805,6.67778,23.3,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
SUTURE TICRON 3-0 3087-41,,A4649,HCPCS,Facility,Outpatient,,,,23.3,19.805,6.67778,23.3,"UCare Health, Inc.",Medical Assistance,11.75951,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE TICRON 3-0 3087-41,,A4649,HCPCS,Facility,Inpatient,,,,23.3,19.805,6.67778,23.3,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
SUTURE TICRON 3-0 3087-41,,A4649,HCPCS,Facility,Outpatient,,,,23.3,19.805,6.67778,23.3,"UCare Health, Inc.",Medicare Advantage,11.75951,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE TICRON 3-0 3087-41,,A4649,HCPCS,Facility,Inpatient,,,,23.3,19.805,6.67778,23.3,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE TICRON 3-0 3087-41,,A4649,HCPCS,Facility,Outpatient,,,,23.3,19.805,6.67778,23.3,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),11.75951,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE TICRON 3-0 3087-41,,A4649,HCPCS,Facility,Inpatient,,,,23.3,19.805,6.67778,23.3,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE TICRON 3-0 3087-41,,A4649,HCPCS,Facility,Both,,,,23.3,19.805,6.67778,23.3,UnitedHealthcare,Individual & Family,21.902,94,,percent of total billed charges,,
SUTURE TICRON 3-0 3087-41,,A4649,HCPCS,Facility,Outpatient,,,,23.3,19.805,6.67778,23.3,UnitedHealthcare,Medicare Advantage,11.417,49,,percent of total billed charges,,
SUTURE TICRON 3-0 3087-41,,A4649,HCPCS,Facility,Inpatient,,,,23.3,19.805,6.67778,23.3,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
SUTURE TICRON 3-0 3087-41,,A4649,HCPCS,Facility,Outpatient,,,,23.3,19.805,6.67778,23.3,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,11.184,48,,percent of total billed charges,,100% of DHS outpatient percentage
SUTURE TICRON 3-0 3087-41,,A4649,HCPCS,Facility,Inpatient,,,,23.3,19.805,6.67778,23.3,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
SUTURE TICRON 3-0 P-22 18IN BLUE 3109-43,,A4649,HCPCS,Facility,Both,,,,82.52,70.142,23.650232,82.52,Aetna,Commercial,75.9184,92,,percent of total billed charges,,
SUTURE TICRON 3-0 P-22 18IN BLUE 3109-43,,A4649,HCPCS,Facility,Outpatient,,,,82.52,70.142,23.650232,82.52,Aetna,Medicare Advantage,40.4348,49,,percent of total billed charges,,
SUTURE TICRON 3-0 P-22 18IN BLUE 3109-43,,A4649,HCPCS,Facility,Inpatient,,,,82.52,70.142,23.650232,82.52,Aetna,Medicare Advantage,,,,,Included in per diem rate,
SUTURE TICRON 3-0 P-22 18IN BLUE 3109-43,,A4649,HCPCS,Facility,Both,,,,82.52,70.142,23.650232,82.52,Aetna,PPO,76.7436,93,,percent of total billed charges,,
SUTURE TICRON 3-0 P-22 18IN BLUE 3109-43,,A4649,HCPCS,Facility,Both,,,,82.52,70.142,23.650232,82.52,America's PPO,America's PPO,79.243956,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SUTURE TICRON 3-0 P-22 18IN BLUE 3109-43,,A4649,HCPCS,Facility,Both,,,,82.52,70.142,23.650232,82.52,BlueCross BlueShield Minnesota, Federal Employee Program,81.19968,98.4,,percent of total billed charges,,
SUTURE TICRON 3-0 P-22 18IN BLUE 3109-43,,A4649,HCPCS,Facility,Both,,,,82.52,70.142,23.650232,82.52,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,82.52,100,,percent of total billed charges,,
SUTURE TICRON 3-0 P-22 18IN BLUE 3109-43,,A4649,HCPCS,Facility,Both,,,,82.52,70.142,23.650232,82.52,BlueCross BlueShield Minnesota,High Value Network Plan,74.268,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
SUTURE TICRON 3-0 P-22 18IN BLUE 3109-43,,A4649,HCPCS,Facility,Outpatient,,,,82.52,70.142,23.650232,82.52,BlueCross BlueShield Minnesota,Medicare Advantage,40.4348,49,,percent of total billed charges,,
SUTURE TICRON 3-0 P-22 18IN BLUE 3109-43,,A4649,HCPCS,Facility,Inpatient,,,,82.52,70.142,23.650232,82.52,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
SUTURE TICRON 3-0 P-22 18IN BLUE 3109-43,,A4649,HCPCS,Facility,Both,,,,82.52,70.142,23.650232,82.52,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,73.087964,88.57,,percent of total billed charges,,
SUTURE TICRON 3-0 P-22 18IN BLUE 3109-43,,A4649,HCPCS,Facility,Both,,,,82.52,70.142,23.650232,82.52,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,23.650232,28.66,,percent of total billed charges,,
SUTURE TICRON 3-0 P-22 18IN BLUE 3109-43,,A4649,HCPCS,Facility,Outpatient,,,,82.52,70.142,23.650232,82.52,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),40.4348,49,,percent of total billed charges,,
SUTURE TICRON 3-0 P-22 18IN BLUE 3109-43,,A4649,HCPCS,Facility,Inpatient,,,,82.52,70.142,23.650232,82.52,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
SUTURE TICRON 3-0 P-22 18IN BLUE 3109-43,,A4649,HCPCS,Facility,Both,,,,82.52,70.142,23.650232,82.52,CorVel,Worker's Compensation,82.52,100,,percent of total billed charges,,
SUTURE TICRON 3-0 P-22 18IN BLUE 3109-43,,A4649,HCPCS,Facility,Both,,,,82.52,70.142,23.650232,82.52,First Health Group Corporation,First Health Network,80.0444,97,,percent of total billed charges,,
SUTURE TICRON 3-0 P-22 18IN BLUE 3109-43,,A4649,HCPCS,Facility,Both,,,,82.52,70.142,23.650232,82.52,"Health Partners, Inc.",Commercial,78.06392,94.6,,percent of total billed charges,,
SUTURE TICRON 3-0 P-22 18IN BLUE 3109-43,,A4649,HCPCS,Facility,Outpatient,,,,82.52,70.142,23.650232,82.52,"Health Partners, Inc.",Medicare Advantage,40.4348,49,,percent of total billed charges,,
SUTURE TICRON 3-0 P-22 18IN BLUE 3109-43,,A4649,HCPCS,Facility,Inpatient,,,,82.52,70.142,23.650232,82.52,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE TICRON 3-0 P-22 18IN BLUE 3109-43,,A4649,HCPCS,Facility,Both,,,,82.52,70.142,23.650232,82.52,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),49.512,60,,percent of total billed charges,,
SUTURE TICRON 3-0 P-22 18IN BLUE 3109-43,,A4649,HCPCS,Facility,Both,,,,82.52,70.142,23.650232,82.52,"Health Partners, Inc.",State of Minnesota Advantage Program,67.2538,81.5,,percent of total billed charges,,
SUTURE TICRON 3-0 P-22 18IN BLUE 3109-43,,A4649,HCPCS,Facility,Both,,,,82.52,70.142,23.650232,82.52,"Health Partners, Inc.",State Public Programs,41.26,50,,percent of total billed charges,,
SUTURE TICRON 3-0 P-22 18IN BLUE 3109-43,,A4649,HCPCS,Facility,Both,,,,82.52,70.142,23.650232,82.52,Humana Insurance Company,Commercial PPO,78.394,95,,percent of total billed charges,,
SUTURE TICRON 3-0 P-22 18IN BLUE 3109-43,,A4649,HCPCS,Facility,Outpatient,,,,82.52,70.142,23.650232,82.52,Humana Insurance Company,Medicare PPO,40.4348,49,,percent of total billed charges,,
SUTURE TICRON 3-0 P-22 18IN BLUE 3109-43,,A4649,HCPCS,Facility,Inpatient,,,,82.52,70.142,23.650232,82.52,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
SUTURE TICRON 3-0 P-22 18IN BLUE 3109-43,,A4649,HCPCS,Facility,Both,,,,82.52,70.142,23.650232,82.52,Medica,Individual & Family,81.77732,99.1,,percent of total billed charges,,
SUTURE TICRON 3-0 P-22 18IN BLUE 3109-43,,A4649,HCPCS,Facility,Outpatient,,,,82.52,70.142,23.650232,82.52,Medica,Medica Advantage Solution,41.09496,49.8,,percent of total billed charges,,
SUTURE TICRON 3-0 P-22 18IN BLUE 3109-43,,A4649,HCPCS,Facility,Inpatient,,,,82.52,70.142,23.650232,82.52,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
SUTURE TICRON 3-0 P-22 18IN BLUE 3109-43,,A4649,HCPCS,Facility,Outpatient,,,,82.52,70.142,23.650232,82.52,Medica,Medical Assistance,36.80392,44.6,,percent of total billed charges,,
SUTURE TICRON 3-0 P-22 18IN BLUE 3109-43,,A4649,HCPCS,Facility,Inpatient,,,,82.52,70.142,23.650232,82.52,Medica,Medical Assistance,,,,,Included in per diem rate,
SUTURE TICRON 3-0 P-22 18IN BLUE 3109-43,,A4649,HCPCS,Facility,Outpatient,,,,82.52,70.142,23.650232,82.52,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,41.09496,49.8,,percent of total billed charges,,
SUTURE TICRON 3-0 P-22 18IN BLUE 3109-43,,A4649,HCPCS,Facility,Inpatient,,,,82.52,70.142,23.650232,82.52,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
SUTURE TICRON 3-0 P-22 18IN BLUE 3109-43,,A4649,HCPCS,Facility,Both,,,,82.52,70.142,23.650232,82.52,"Multiplan, Inc.","Multiplan, Inc.",77.5688,94,,percent of total billed charges,,
SUTURE TICRON 3-0 P-22 18IN BLUE 3109-43,,A4649,HCPCS,Facility,Outpatient,,,,82.52,70.142,23.650232,82.52,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,74.35052,90.1,,percent of total billed charges,,
SUTURE TICRON 3-0 P-22 18IN BLUE 3109-43,,A4649,HCPCS,Facility,Inpatient,,,,82.52,70.142,23.650232,82.52,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
SUTURE TICRON 3-0 P-22 18IN BLUE 3109-43,,A4649,HCPCS,Facility,Both,,,,82.52,70.142,23.650232,82.52,"Preferred One Administrative Services, INC.",PPO,81.36472,98.6,,percent of total billed charges,,
SUTURE TICRON 3-0 P-22 18IN BLUE 3109-43,,A4649,HCPCS,Facility,Outpatient,,,,82.52,70.142,23.650232,82.52,PrimeWest Health,Minnesota Senior Health Options (MSHO),42.45654,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
SUTURE TICRON 3-0 P-22 18IN BLUE 3109-43,,A4649,HCPCS,Facility,Inpatient,,,,82.52,70.142,23.650232,82.52,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE TICRON 3-0 P-22 18IN BLUE 3109-43,,A4649,HCPCS,Facility,Outpatient,,,,82.52,70.142,23.650232,82.52,PrimeWest Health,MinnesotaCare,42.382272,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
SUTURE TICRON 3-0 P-22 18IN BLUE 3109-43,,A4649,HCPCS,Facility,Inpatient,,,,82.52,70.142,23.650232,82.52,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
SUTURE TICRON 3-0 P-22 18IN BLUE 3109-43,,A4649,HCPCS,Facility,Both,,,,82.52,70.142,23.650232,82.52,Sanford Health Plan,Sanford Health Plan,75.9184,92,,percent of total billed charges,,
SUTURE TICRON 3-0 P-22 18IN BLUE 3109-43,,A4649,HCPCS,Facility,Outpatient,,,,82.52,70.142,23.650232,82.52,"UCare Health, Inc.",Individual & Family Plan,46.50002,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
SUTURE TICRON 3-0 P-22 18IN BLUE 3109-43,,A4649,HCPCS,Facility,Inpatient,,,,82.52,70.142,23.650232,82.52,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
SUTURE TICRON 3-0 P-22 18IN BLUE 3109-43,,A4649,HCPCS,Facility,Outpatient,,,,82.52,70.142,23.650232,82.52,"UCare Health, Inc.",Medical Assistance,41.647844,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE TICRON 3-0 P-22 18IN BLUE 3109-43,,A4649,HCPCS,Facility,Inpatient,,,,82.52,70.142,23.650232,82.52,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
SUTURE TICRON 3-0 P-22 18IN BLUE 3109-43,,A4649,HCPCS,Facility,Outpatient,,,,82.52,70.142,23.650232,82.52,"UCare Health, Inc.",Medicare Advantage,41.647844,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE TICRON 3-0 P-22 18IN BLUE 3109-43,,A4649,HCPCS,Facility,Inpatient,,,,82.52,70.142,23.650232,82.52,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE TICRON 3-0 P-22 18IN BLUE 3109-43,,A4649,HCPCS,Facility,Outpatient,,,,82.52,70.142,23.650232,82.52,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),41.647844,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE TICRON 3-0 P-22 18IN BLUE 3109-43,,A4649,HCPCS,Facility,Inpatient,,,,82.52,70.142,23.650232,82.52,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE TICRON 3-0 P-22 18IN BLUE 3109-43,,A4649,HCPCS,Facility,Both,,,,82.52,70.142,23.650232,82.52,UnitedHealthcare,Individual & Family,77.5688,94,,percent of total billed charges,,
SUTURE TICRON 3-0 P-22 18IN BLUE 3109-43,,A4649,HCPCS,Facility,Outpatient,,,,82.52,70.142,23.650232,82.52,UnitedHealthcare,Medicare Advantage,40.4348,49,,percent of total billed charges,,
SUTURE TICRON 3-0 P-22 18IN BLUE 3109-43,,A4649,HCPCS,Facility,Inpatient,,,,82.52,70.142,23.650232,82.52,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
SUTURE TICRON 3-0 P-22 18IN BLUE 3109-43,,A4649,HCPCS,Facility,Outpatient,,,,82.52,70.142,23.650232,82.52,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,39.6096,48,,percent of total billed charges,,100% of DHS outpatient percentage
SUTURE TICRON 3-0 P-22 18IN BLUE 3109-43,,A4649,HCPCS,Facility,Inpatient,,,,82.52,70.142,23.650232,82.52,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
SUTURE VICRYL 3-0  CP-2  J868H,,A4649,HCPCS,Facility,Both,,,,74.43,63.2655,21.331638,74.43,Aetna,Commercial,68.4756,92,,percent of total billed charges,,
SUTURE VICRYL 3-0  CP-2  J868H,,A4649,HCPCS,Facility,Outpatient,,,,74.43,63.2655,21.331638,74.43,Aetna,Medicare Advantage,36.4707,49,,percent of total billed charges,,
SUTURE VICRYL 3-0  CP-2  J868H,,A4649,HCPCS,Facility,Inpatient,,,,74.43,63.2655,21.331638,74.43,Aetna,Medicare Advantage,,,,,Included in per diem rate,
SUTURE VICRYL 3-0  CP-2  J868H,,A4649,HCPCS,Facility,Both,,,,74.43,63.2655,21.331638,74.43,Aetna,PPO,69.2199,93,,percent of total billed charges,,
SUTURE VICRYL 3-0  CP-2  J868H,,A4649,HCPCS,Facility,Both,,,,74.43,63.2655,21.331638,74.43,America's PPO,America's PPO,71.475129,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SUTURE VICRYL 3-0  CP-2  J868H,,A4649,HCPCS,Facility,Both,,,,74.43,63.2655,21.331638,74.43,BlueCross BlueShield Minnesota, Federal Employee Program,73.23912,98.4,,percent of total billed charges,,
SUTURE VICRYL 3-0  CP-2  J868H,,A4649,HCPCS,Facility,Both,,,,74.43,63.2655,21.331638,74.43,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,74.43,100,,percent of total billed charges,,
SUTURE VICRYL 3-0  CP-2  J868H,,A4649,HCPCS,Facility,Both,,,,74.43,63.2655,21.331638,74.43,BlueCross BlueShield Minnesota,High Value Network Plan,66.987,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
SUTURE VICRYL 3-0  CP-2  J868H,,A4649,HCPCS,Facility,Outpatient,,,,74.43,63.2655,21.331638,74.43,BlueCross BlueShield Minnesota,Medicare Advantage,36.4707,49,,percent of total billed charges,,
SUTURE VICRYL 3-0  CP-2  J868H,,A4649,HCPCS,Facility,Inpatient,,,,74.43,63.2655,21.331638,74.43,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
SUTURE VICRYL 3-0  CP-2  J868H,,A4649,HCPCS,Facility,Both,,,,74.43,63.2655,21.331638,74.43,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,65.922651,88.57,,percent of total billed charges,,
SUTURE VICRYL 3-0  CP-2  J868H,,A4649,HCPCS,Facility,Both,,,,74.43,63.2655,21.331638,74.43,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,21.331638,28.66,,percent of total billed charges,,
SUTURE VICRYL 3-0  CP-2  J868H,,A4649,HCPCS,Facility,Outpatient,,,,74.43,63.2655,21.331638,74.43,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),36.4707,49,,percent of total billed charges,,
SUTURE VICRYL 3-0  CP-2  J868H,,A4649,HCPCS,Facility,Inpatient,,,,74.43,63.2655,21.331638,74.43,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
SUTURE VICRYL 3-0  CP-2  J868H,,A4649,HCPCS,Facility,Both,,,,74.43,63.2655,21.331638,74.43,CorVel,Worker's Compensation,74.43,100,,percent of total billed charges,,
SUTURE VICRYL 3-0  CP-2  J868H,,A4649,HCPCS,Facility,Both,,,,74.43,63.2655,21.331638,74.43,First Health Group Corporation,First Health Network,72.1971,97,,percent of total billed charges,,
SUTURE VICRYL 3-0  CP-2  J868H,,A4649,HCPCS,Facility,Both,,,,74.43,63.2655,21.331638,74.43,"Health Partners, Inc.",Commercial,70.41078,94.6,,percent of total billed charges,,
SUTURE VICRYL 3-0  CP-2  J868H,,A4649,HCPCS,Facility,Outpatient,,,,74.43,63.2655,21.331638,74.43,"Health Partners, Inc.",Medicare Advantage,36.4707,49,,percent of total billed charges,,
SUTURE VICRYL 3-0  CP-2  J868H,,A4649,HCPCS,Facility,Inpatient,,,,74.43,63.2655,21.331638,74.43,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE VICRYL 3-0  CP-2  J868H,,A4649,HCPCS,Facility,Both,,,,74.43,63.2655,21.331638,74.43,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),44.658,60,,percent of total billed charges,,
SUTURE VICRYL 3-0  CP-2  J868H,,A4649,HCPCS,Facility,Both,,,,74.43,63.2655,21.331638,74.43,"Health Partners, Inc.",State of Minnesota Advantage Program,60.66045,81.5,,percent of total billed charges,,
SUTURE VICRYL 3-0  CP-2  J868H,,A4649,HCPCS,Facility,Both,,,,74.43,63.2655,21.331638,74.43,"Health Partners, Inc.",State Public Programs,37.215,50,,percent of total billed charges,,
SUTURE VICRYL 3-0  CP-2  J868H,,A4649,HCPCS,Facility,Both,,,,74.43,63.2655,21.331638,74.43,Humana Insurance Company,Commercial PPO,70.7085,95,,percent of total billed charges,,
SUTURE VICRYL 3-0  CP-2  J868H,,A4649,HCPCS,Facility,Outpatient,,,,74.43,63.2655,21.331638,74.43,Humana Insurance Company,Medicare PPO,36.4707,49,,percent of total billed charges,,
SUTURE VICRYL 3-0  CP-2  J868H,,A4649,HCPCS,Facility,Inpatient,,,,74.43,63.2655,21.331638,74.43,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
SUTURE VICRYL 3-0  CP-2  J868H,,A4649,HCPCS,Facility,Both,,,,74.43,63.2655,21.331638,74.43,Medica,Individual & Family,73.76013,99.1,,percent of total billed charges,,
SUTURE VICRYL 3-0  CP-2  J868H,,A4649,HCPCS,Facility,Outpatient,,,,74.43,63.2655,21.331638,74.43,Medica,Medica Advantage Solution,37.06614,49.8,,percent of total billed charges,,
SUTURE VICRYL 3-0  CP-2  J868H,,A4649,HCPCS,Facility,Inpatient,,,,74.43,63.2655,21.331638,74.43,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
SUTURE VICRYL 3-0  CP-2  J868H,,A4649,HCPCS,Facility,Outpatient,,,,74.43,63.2655,21.331638,74.43,Medica,Medical Assistance,33.19578,44.6,,percent of total billed charges,,
SUTURE VICRYL 3-0  CP-2  J868H,,A4649,HCPCS,Facility,Inpatient,,,,74.43,63.2655,21.331638,74.43,Medica,Medical Assistance,,,,,Included in per diem rate,
SUTURE VICRYL 3-0  CP-2  J868H,,A4649,HCPCS,Facility,Outpatient,,,,74.43,63.2655,21.331638,74.43,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,37.06614,49.8,,percent of total billed charges,,
SUTURE VICRYL 3-0  CP-2  J868H,,A4649,HCPCS,Facility,Inpatient,,,,74.43,63.2655,21.331638,74.43,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
SUTURE VICRYL 3-0  CP-2  J868H,,A4649,HCPCS,Facility,Both,,,,74.43,63.2655,21.331638,74.43,"Multiplan, Inc.","Multiplan, Inc.",69.9642,94,,percent of total billed charges,,
SUTURE VICRYL 3-0  CP-2  J868H,,A4649,HCPCS,Facility,Outpatient,,,,74.43,63.2655,21.331638,74.43,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,67.06143,90.1,,percent of total billed charges,,
SUTURE VICRYL 3-0  CP-2  J868H,,A4649,HCPCS,Facility,Inpatient,,,,74.43,63.2655,21.331638,74.43,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
SUTURE VICRYL 3-0  CP-2  J868H,,A4649,HCPCS,Facility,Both,,,,74.43,63.2655,21.331638,74.43,"Preferred One Administrative Services, INC.",PPO,73.38798,98.6,,percent of total billed charges,,
SUTURE VICRYL 3-0  CP-2  J868H,,A4649,HCPCS,Facility,Outpatient,,,,74.43,63.2655,21.331638,74.43,PrimeWest Health,Minnesota Senior Health Options (MSHO),38.294235,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
SUTURE VICRYL 3-0  CP-2  J868H,,A4649,HCPCS,Facility,Inpatient,,,,74.43,63.2655,21.331638,74.43,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE VICRYL 3-0  CP-2  J868H,,A4649,HCPCS,Facility,Outpatient,,,,74.43,63.2655,21.331638,74.43,PrimeWest Health,MinnesotaCare,38.227248,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
SUTURE VICRYL 3-0  CP-2  J868H,,A4649,HCPCS,Facility,Inpatient,,,,74.43,63.2655,21.331638,74.43,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
SUTURE VICRYL 3-0  CP-2  J868H,,A4649,HCPCS,Facility,Both,,,,74.43,63.2655,21.331638,74.43,Sanford Health Plan,Sanford Health Plan,68.4756,92,,percent of total billed charges,,
SUTURE VICRYL 3-0  CP-2  J868H,,A4649,HCPCS,Facility,Outpatient,,,,74.43,63.2655,21.331638,74.43,"UCare Health, Inc.",Individual & Family Plan,41.941305,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
SUTURE VICRYL 3-0  CP-2  J868H,,A4649,HCPCS,Facility,Inpatient,,,,74.43,63.2655,21.331638,74.43,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
SUTURE VICRYL 3-0  CP-2  J868H,,A4649,HCPCS,Facility,Outpatient,,,,74.43,63.2655,21.331638,74.43,"UCare Health, Inc.",Medical Assistance,37.564821,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE VICRYL 3-0  CP-2  J868H,,A4649,HCPCS,Facility,Inpatient,,,,74.43,63.2655,21.331638,74.43,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
SUTURE VICRYL 3-0  CP-2  J868H,,A4649,HCPCS,Facility,Outpatient,,,,74.43,63.2655,21.331638,74.43,"UCare Health, Inc.",Medicare Advantage,37.564821,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE VICRYL 3-0  CP-2  J868H,,A4649,HCPCS,Facility,Inpatient,,,,74.43,63.2655,21.331638,74.43,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE VICRYL 3-0  CP-2  J868H,,A4649,HCPCS,Facility,Outpatient,,,,74.43,63.2655,21.331638,74.43,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),37.564821,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE VICRYL 3-0  CP-2  J868H,,A4649,HCPCS,Facility,Inpatient,,,,74.43,63.2655,21.331638,74.43,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE VICRYL 3-0  CP-2  J868H,,A4649,HCPCS,Facility,Both,,,,74.43,63.2655,21.331638,74.43,UnitedHealthcare,Individual & Family,69.9642,94,,percent of total billed charges,,
SUTURE VICRYL 3-0  CP-2  J868H,,A4649,HCPCS,Facility,Outpatient,,,,74.43,63.2655,21.331638,74.43,UnitedHealthcare,Medicare Advantage,36.4707,49,,percent of total billed charges,,
SUTURE VICRYL 3-0  CP-2  J868H,,A4649,HCPCS,Facility,Inpatient,,,,74.43,63.2655,21.331638,74.43,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
SUTURE VICRYL 3-0  CP-2  J868H,,A4649,HCPCS,Facility,Outpatient,,,,74.43,63.2655,21.331638,74.43,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,35.7264,48,,percent of total billed charges,,100% of DHS outpatient percentage
SUTURE VICRYL 3-0  CP-2  J868H,,A4649,HCPCS,Facility,Inpatient,,,,74.43,63.2655,21.331638,74.43,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
SUTURE VICRYL 3-0 CT-1 CP-1 J531H,,A4649,HCPCS,Facility,Both,,,,74.43,63.2655,21.331638,74.43,Aetna,Commercial,68.4756,92,,percent of total billed charges,,
SUTURE VICRYL 3-0 CT-1 CP-1 J531H,,A4649,HCPCS,Facility,Outpatient,,,,74.43,63.2655,21.331638,74.43,Aetna,Medicare Advantage,36.4707,49,,percent of total billed charges,,
SUTURE VICRYL 3-0 CT-1 CP-1 J531H,,A4649,HCPCS,Facility,Inpatient,,,,74.43,63.2655,21.331638,74.43,Aetna,Medicare Advantage,,,,,Included in per diem rate,
SUTURE VICRYL 3-0 CT-1 CP-1 J531H,,A4649,HCPCS,Facility,Both,,,,74.43,63.2655,21.331638,74.43,Aetna,PPO,69.2199,93,,percent of total billed charges,,
SUTURE VICRYL 3-0 CT-1 CP-1 J531H,,A4649,HCPCS,Facility,Both,,,,74.43,63.2655,21.331638,74.43,America's PPO,America's PPO,71.475129,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SUTURE VICRYL 3-0 CT-1 CP-1 J531H,,A4649,HCPCS,Facility,Both,,,,74.43,63.2655,21.331638,74.43,BlueCross BlueShield Minnesota, Federal Employee Program,73.23912,98.4,,percent of total billed charges,,
SUTURE VICRYL 3-0 CT-1 CP-1 J531H,,A4649,HCPCS,Facility,Both,,,,74.43,63.2655,21.331638,74.43,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,74.43,100,,percent of total billed charges,,
SUTURE VICRYL 3-0 CT-1 CP-1 J531H,,A4649,HCPCS,Facility,Both,,,,74.43,63.2655,21.331638,74.43,BlueCross BlueShield Minnesota,High Value Network Plan,66.987,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
SUTURE VICRYL 3-0 CT-1 CP-1 J531H,,A4649,HCPCS,Facility,Outpatient,,,,74.43,63.2655,21.331638,74.43,BlueCross BlueShield Minnesota,Medicare Advantage,36.4707,49,,percent of total billed charges,,
SUTURE VICRYL 3-0 CT-1 CP-1 J531H,,A4649,HCPCS,Facility,Inpatient,,,,74.43,63.2655,21.331638,74.43,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
SUTURE VICRYL 3-0 CT-1 CP-1 J531H,,A4649,HCPCS,Facility,Both,,,,74.43,63.2655,21.331638,74.43,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,65.922651,88.57,,percent of total billed charges,,
SUTURE VICRYL 3-0 CT-1 CP-1 J531H,,A4649,HCPCS,Facility,Both,,,,74.43,63.2655,21.331638,74.43,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,21.331638,28.66,,percent of total billed charges,,
SUTURE VICRYL 3-0 CT-1 CP-1 J531H,,A4649,HCPCS,Facility,Outpatient,,,,74.43,63.2655,21.331638,74.43,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),36.4707,49,,percent of total billed charges,,
SUTURE VICRYL 3-0 CT-1 CP-1 J531H,,A4649,HCPCS,Facility,Inpatient,,,,74.43,63.2655,21.331638,74.43,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
SUTURE VICRYL 3-0 CT-1 CP-1 J531H,,A4649,HCPCS,Facility,Both,,,,74.43,63.2655,21.331638,74.43,CorVel,Worker's Compensation,74.43,100,,percent of total billed charges,,
SUTURE VICRYL 3-0 CT-1 CP-1 J531H,,A4649,HCPCS,Facility,Both,,,,74.43,63.2655,21.331638,74.43,First Health Group Corporation,First Health Network,72.1971,97,,percent of total billed charges,,
SUTURE VICRYL 3-0 CT-1 CP-1 J531H,,A4649,HCPCS,Facility,Both,,,,74.43,63.2655,21.331638,74.43,"Health Partners, Inc.",Commercial,70.41078,94.6,,percent of total billed charges,,
SUTURE VICRYL 3-0 CT-1 CP-1 J531H,,A4649,HCPCS,Facility,Outpatient,,,,74.43,63.2655,21.331638,74.43,"Health Partners, Inc.",Medicare Advantage,36.4707,49,,percent of total billed charges,,
SUTURE VICRYL 3-0 CT-1 CP-1 J531H,,A4649,HCPCS,Facility,Inpatient,,,,74.43,63.2655,21.331638,74.43,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE VICRYL 3-0 CT-1 CP-1 J531H,,A4649,HCPCS,Facility,Both,,,,74.43,63.2655,21.331638,74.43,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),44.658,60,,percent of total billed charges,,
SUTURE VICRYL 3-0 CT-1 CP-1 J531H,,A4649,HCPCS,Facility,Both,,,,74.43,63.2655,21.331638,74.43,"Health Partners, Inc.",State of Minnesota Advantage Program,60.66045,81.5,,percent of total billed charges,,
SUTURE VICRYL 3-0 CT-1 CP-1 J531H,,A4649,HCPCS,Facility,Both,,,,74.43,63.2655,21.331638,74.43,"Health Partners, Inc.",State Public Programs,37.215,50,,percent of total billed charges,,
SUTURE VICRYL 3-0 CT-1 CP-1 J531H,,A4649,HCPCS,Facility,Both,,,,74.43,63.2655,21.331638,74.43,Humana Insurance Company,Commercial PPO,70.7085,95,,percent of total billed charges,,
SUTURE VICRYL 3-0 CT-1 CP-1 J531H,,A4649,HCPCS,Facility,Outpatient,,,,74.43,63.2655,21.331638,74.43,Humana Insurance Company,Medicare PPO,36.4707,49,,percent of total billed charges,,
SUTURE VICRYL 3-0 CT-1 CP-1 J531H,,A4649,HCPCS,Facility,Inpatient,,,,74.43,63.2655,21.331638,74.43,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
SUTURE VICRYL 3-0 CT-1 CP-1 J531H,,A4649,HCPCS,Facility,Both,,,,74.43,63.2655,21.331638,74.43,Medica,Individual & Family,73.76013,99.1,,percent of total billed charges,,
SUTURE VICRYL 3-0 CT-1 CP-1 J531H,,A4649,HCPCS,Facility,Outpatient,,,,74.43,63.2655,21.331638,74.43,Medica,Medica Advantage Solution,37.06614,49.8,,percent of total billed charges,,
SUTURE VICRYL 3-0 CT-1 CP-1 J531H,,A4649,HCPCS,Facility,Inpatient,,,,74.43,63.2655,21.331638,74.43,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
SUTURE VICRYL 3-0 CT-1 CP-1 J531H,,A4649,HCPCS,Facility,Outpatient,,,,74.43,63.2655,21.331638,74.43,Medica,Medical Assistance,33.19578,44.6,,percent of total billed charges,,
SUTURE VICRYL 3-0 CT-1 CP-1 J531H,,A4649,HCPCS,Facility,Inpatient,,,,74.43,63.2655,21.331638,74.43,Medica,Medical Assistance,,,,,Included in per diem rate,
SUTURE VICRYL 3-0 CT-1 CP-1 J531H,,A4649,HCPCS,Facility,Outpatient,,,,74.43,63.2655,21.331638,74.43,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,37.06614,49.8,,percent of total billed charges,,
SUTURE VICRYL 3-0 CT-1 CP-1 J531H,,A4649,HCPCS,Facility,Inpatient,,,,74.43,63.2655,21.331638,74.43,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
SUTURE VICRYL 3-0 CT-1 CP-1 J531H,,A4649,HCPCS,Facility,Both,,,,74.43,63.2655,21.331638,74.43,"Multiplan, Inc.","Multiplan, Inc.",69.9642,94,,percent of total billed charges,,
SUTURE VICRYL 3-0 CT-1 CP-1 J531H,,A4649,HCPCS,Facility,Outpatient,,,,74.43,63.2655,21.331638,74.43,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,67.06143,90.1,,percent of total billed charges,,
SUTURE VICRYL 3-0 CT-1 CP-1 J531H,,A4649,HCPCS,Facility,Inpatient,,,,74.43,63.2655,21.331638,74.43,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
SUTURE VICRYL 3-0 CT-1 CP-1 J531H,,A4649,HCPCS,Facility,Both,,,,74.43,63.2655,21.331638,74.43,"Preferred One Administrative Services, INC.",PPO,73.38798,98.6,,percent of total billed charges,,
SUTURE VICRYL 3-0 CT-1 CP-1 J531H,,A4649,HCPCS,Facility,Outpatient,,,,74.43,63.2655,21.331638,74.43,PrimeWest Health,Minnesota Senior Health Options (MSHO),38.294235,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
SUTURE VICRYL 3-0 CT-1 CP-1 J531H,,A4649,HCPCS,Facility,Inpatient,,,,74.43,63.2655,21.331638,74.43,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE VICRYL 3-0 CT-1 CP-1 J531H,,A4649,HCPCS,Facility,Outpatient,,,,74.43,63.2655,21.331638,74.43,PrimeWest Health,MinnesotaCare,38.227248,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
SUTURE VICRYL 3-0 CT-1 CP-1 J531H,,A4649,HCPCS,Facility,Inpatient,,,,74.43,63.2655,21.331638,74.43,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
SUTURE VICRYL 3-0 CT-1 CP-1 J531H,,A4649,HCPCS,Facility,Both,,,,74.43,63.2655,21.331638,74.43,Sanford Health Plan,Sanford Health Plan,68.4756,92,,percent of total billed charges,,
SUTURE VICRYL 3-0 CT-1 CP-1 J531H,,A4649,HCPCS,Facility,Outpatient,,,,74.43,63.2655,21.331638,74.43,"UCare Health, Inc.",Individual & Family Plan,41.941305,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
SUTURE VICRYL 3-0 CT-1 CP-1 J531H,,A4649,HCPCS,Facility,Inpatient,,,,74.43,63.2655,21.331638,74.43,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
SUTURE VICRYL 3-0 CT-1 CP-1 J531H,,A4649,HCPCS,Facility,Outpatient,,,,74.43,63.2655,21.331638,74.43,"UCare Health, Inc.",Medical Assistance,37.564821,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE VICRYL 3-0 CT-1 CP-1 J531H,,A4649,HCPCS,Facility,Inpatient,,,,74.43,63.2655,21.331638,74.43,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
SUTURE VICRYL 3-0 CT-1 CP-1 J531H,,A4649,HCPCS,Facility,Outpatient,,,,74.43,63.2655,21.331638,74.43,"UCare Health, Inc.",Medicare Advantage,37.564821,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE VICRYL 3-0 CT-1 CP-1 J531H,,A4649,HCPCS,Facility,Inpatient,,,,74.43,63.2655,21.331638,74.43,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE VICRYL 3-0 CT-1 CP-1 J531H,,A4649,HCPCS,Facility,Outpatient,,,,74.43,63.2655,21.331638,74.43,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),37.564821,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE VICRYL 3-0 CT-1 CP-1 J531H,,A4649,HCPCS,Facility,Inpatient,,,,74.43,63.2655,21.331638,74.43,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE VICRYL 3-0 CT-1 CP-1 J531H,,A4649,HCPCS,Facility,Both,,,,74.43,63.2655,21.331638,74.43,UnitedHealthcare,Individual & Family,69.9642,94,,percent of total billed charges,,
SUTURE VICRYL 3-0 CT-1 CP-1 J531H,,A4649,HCPCS,Facility,Outpatient,,,,74.43,63.2655,21.331638,74.43,UnitedHealthcare,Medicare Advantage,36.4707,49,,percent of total billed charges,,
SUTURE VICRYL 3-0 CT-1 CP-1 J531H,,A4649,HCPCS,Facility,Inpatient,,,,74.43,63.2655,21.331638,74.43,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
SUTURE VICRYL 3-0 CT-1 CP-1 J531H,,A4649,HCPCS,Facility,Outpatient,,,,74.43,63.2655,21.331638,74.43,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,35.7264,48,,percent of total billed charges,,100% of DHS outpatient percentage
SUTURE VICRYL 3-0 CT-1 CP-1 J531H,,A4649,HCPCS,Facility,Inpatient,,,,74.43,63.2655,21.331638,74.43,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
SUTURE VICRYL 3-0 RB-1 CR-8        J713D,,A4649,HCPCS,Facility,Both,,,,51.75,43.9875,14.83155,51.75,Aetna,Commercial,47.61,92,,percent of total billed charges,,
SUTURE VICRYL 3-0 RB-1 CR-8        J713D,,A4649,HCPCS,Facility,Outpatient,,,,51.75,43.9875,14.83155,51.75,Aetna,Medicare Advantage,25.3575,49,,percent of total billed charges,,
SUTURE VICRYL 3-0 RB-1 CR-8        J713D,,A4649,HCPCS,Facility,Inpatient,,,,51.75,43.9875,14.83155,51.75,Aetna,Medicare Advantage,,,,,Included in per diem rate,
SUTURE VICRYL 3-0 RB-1 CR-8        J713D,,A4649,HCPCS,Facility,Both,,,,51.75,43.9875,14.83155,51.75,Aetna,PPO,48.1275,93,,percent of total billed charges,,
SUTURE VICRYL 3-0 RB-1 CR-8        J713D,,A4649,HCPCS,Facility,Both,,,,51.75,43.9875,14.83155,51.75,America's PPO,America's PPO,49.695525,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SUTURE VICRYL 3-0 RB-1 CR-8        J713D,,A4649,HCPCS,Facility,Both,,,,51.75,43.9875,14.83155,51.75,BlueCross BlueShield Minnesota, Federal Employee Program,50.922,98.4,,percent of total billed charges,,
SUTURE VICRYL 3-0 RB-1 CR-8        J713D,,A4649,HCPCS,Facility,Both,,,,51.75,43.9875,14.83155,51.75,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,51.75,100,,percent of total billed charges,,
SUTURE VICRYL 3-0 RB-1 CR-8        J713D,,A4649,HCPCS,Facility,Both,,,,51.75,43.9875,14.83155,51.75,BlueCross BlueShield Minnesota,High Value Network Plan,46.575,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
SUTURE VICRYL 3-0 RB-1 CR-8        J713D,,A4649,HCPCS,Facility,Outpatient,,,,51.75,43.9875,14.83155,51.75,BlueCross BlueShield Minnesota,Medicare Advantage,25.3575,49,,percent of total billed charges,,
SUTURE VICRYL 3-0 RB-1 CR-8        J713D,,A4649,HCPCS,Facility,Inpatient,,,,51.75,43.9875,14.83155,51.75,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
SUTURE VICRYL 3-0 RB-1 CR-8        J713D,,A4649,HCPCS,Facility,Both,,,,51.75,43.9875,14.83155,51.75,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,45.834975,88.57,,percent of total billed charges,,
SUTURE VICRYL 3-0 RB-1 CR-8        J713D,,A4649,HCPCS,Facility,Both,,,,51.75,43.9875,14.83155,51.75,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,14.83155,28.66,,percent of total billed charges,,
SUTURE VICRYL 3-0 RB-1 CR-8        J713D,,A4649,HCPCS,Facility,Outpatient,,,,51.75,43.9875,14.83155,51.75,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),25.3575,49,,percent of total billed charges,,
SUTURE VICRYL 3-0 RB-1 CR-8        J713D,,A4649,HCPCS,Facility,Inpatient,,,,51.75,43.9875,14.83155,51.75,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
SUTURE VICRYL 3-0 RB-1 CR-8        J713D,,A4649,HCPCS,Facility,Both,,,,51.75,43.9875,14.83155,51.75,CorVel,Worker's Compensation,51.75,100,,percent of total billed charges,,
SUTURE VICRYL 3-0 RB-1 CR-8        J713D,,A4649,HCPCS,Facility,Both,,,,51.75,43.9875,14.83155,51.75,First Health Group Corporation,First Health Network,50.1975,97,,percent of total billed charges,,
SUTURE VICRYL 3-0 RB-1 CR-8        J713D,,A4649,HCPCS,Facility,Both,,,,51.75,43.9875,14.83155,51.75,"Health Partners, Inc.",Commercial,48.9555,94.6,,percent of total billed charges,,
SUTURE VICRYL 3-0 RB-1 CR-8        J713D,,A4649,HCPCS,Facility,Outpatient,,,,51.75,43.9875,14.83155,51.75,"Health Partners, Inc.",Medicare Advantage,25.3575,49,,percent of total billed charges,,
SUTURE VICRYL 3-0 RB-1 CR-8        J713D,,A4649,HCPCS,Facility,Inpatient,,,,51.75,43.9875,14.83155,51.75,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE VICRYL 3-0 RB-1 CR-8        J713D,,A4649,HCPCS,Facility,Both,,,,51.75,43.9875,14.83155,51.75,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),31.05,60,,percent of total billed charges,,
SUTURE VICRYL 3-0 RB-1 CR-8        J713D,,A4649,HCPCS,Facility,Both,,,,51.75,43.9875,14.83155,51.75,"Health Partners, Inc.",State of Minnesota Advantage Program,42.17625,81.5,,percent of total billed charges,,
SUTURE VICRYL 3-0 RB-1 CR-8        J713D,,A4649,HCPCS,Facility,Both,,,,51.75,43.9875,14.83155,51.75,"Health Partners, Inc.",State Public Programs,25.875,50,,percent of total billed charges,,
SUTURE VICRYL 3-0 RB-1 CR-8        J713D,,A4649,HCPCS,Facility,Both,,,,51.75,43.9875,14.83155,51.75,Humana Insurance Company,Commercial PPO,49.1625,95,,percent of total billed charges,,
SUTURE VICRYL 3-0 RB-1 CR-8        J713D,,A4649,HCPCS,Facility,Outpatient,,,,51.75,43.9875,14.83155,51.75,Humana Insurance Company,Medicare PPO,25.3575,49,,percent of total billed charges,,
SUTURE VICRYL 3-0 RB-1 CR-8        J713D,,A4649,HCPCS,Facility,Inpatient,,,,51.75,43.9875,14.83155,51.75,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
SUTURE VICRYL 3-0 RB-1 CR-8        J713D,,A4649,HCPCS,Facility,Both,,,,51.75,43.9875,14.83155,51.75,Medica,Individual & Family,51.28425,99.1,,percent of total billed charges,,
SUTURE VICRYL 3-0 RB-1 CR-8        J713D,,A4649,HCPCS,Facility,Outpatient,,,,51.75,43.9875,14.83155,51.75,Medica,Medica Advantage Solution,25.7715,49.8,,percent of total billed charges,,
SUTURE VICRYL 3-0 RB-1 CR-8        J713D,,A4649,HCPCS,Facility,Inpatient,,,,51.75,43.9875,14.83155,51.75,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
SUTURE VICRYL 3-0 RB-1 CR-8        J713D,,A4649,HCPCS,Facility,Outpatient,,,,51.75,43.9875,14.83155,51.75,Medica,Medical Assistance,23.0805,44.6,,percent of total billed charges,,
SUTURE VICRYL 3-0 RB-1 CR-8        J713D,,A4649,HCPCS,Facility,Inpatient,,,,51.75,43.9875,14.83155,51.75,Medica,Medical Assistance,,,,,Included in per diem rate,
SUTURE VICRYL 3-0 RB-1 CR-8        J713D,,A4649,HCPCS,Facility,Outpatient,,,,51.75,43.9875,14.83155,51.75,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,25.7715,49.8,,percent of total billed charges,,
SUTURE VICRYL 3-0 RB-1 CR-8        J713D,,A4649,HCPCS,Facility,Inpatient,,,,51.75,43.9875,14.83155,51.75,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
SUTURE VICRYL 3-0 RB-1 CR-8        J713D,,A4649,HCPCS,Facility,Both,,,,51.75,43.9875,14.83155,51.75,"Multiplan, Inc.","Multiplan, Inc.",48.645,94,,percent of total billed charges,,
SUTURE VICRYL 3-0 RB-1 CR-8        J713D,,A4649,HCPCS,Facility,Outpatient,,,,51.75,43.9875,14.83155,51.75,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,46.62675,90.1,,percent of total billed charges,,
SUTURE VICRYL 3-0 RB-1 CR-8        J713D,,A4649,HCPCS,Facility,Inpatient,,,,51.75,43.9875,14.83155,51.75,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
SUTURE VICRYL 3-0 RB-1 CR-8        J713D,,A4649,HCPCS,Facility,Both,,,,51.75,43.9875,14.83155,51.75,"Preferred One Administrative Services, INC.",PPO,51.0255,98.6,,percent of total billed charges,,
SUTURE VICRYL 3-0 RB-1 CR-8        J713D,,A4649,HCPCS,Facility,Outpatient,,,,51.75,43.9875,14.83155,51.75,PrimeWest Health,Minnesota Senior Health Options (MSHO),26.625375,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
SUTURE VICRYL 3-0 RB-1 CR-8        J713D,,A4649,HCPCS,Facility,Inpatient,,,,51.75,43.9875,14.83155,51.75,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE VICRYL 3-0 RB-1 CR-8        J713D,,A4649,HCPCS,Facility,Outpatient,,,,51.75,43.9875,14.83155,51.75,PrimeWest Health,MinnesotaCare,26.5788,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
SUTURE VICRYL 3-0 RB-1 CR-8        J713D,,A4649,HCPCS,Facility,Inpatient,,,,51.75,43.9875,14.83155,51.75,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
SUTURE VICRYL 3-0 RB-1 CR-8        J713D,,A4649,HCPCS,Facility,Both,,,,51.75,43.9875,14.83155,51.75,Sanford Health Plan,Sanford Health Plan,47.61,92,,percent of total billed charges,,
SUTURE VICRYL 3-0 RB-1 CR-8        J713D,,A4649,HCPCS,Facility,Outpatient,,,,51.75,43.9875,14.83155,51.75,"UCare Health, Inc.",Individual & Family Plan,29.161125,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
SUTURE VICRYL 3-0 RB-1 CR-8        J713D,,A4649,HCPCS,Facility,Inpatient,,,,51.75,43.9875,14.83155,51.75,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
SUTURE VICRYL 3-0 RB-1 CR-8        J713D,,A4649,HCPCS,Facility,Outpatient,,,,51.75,43.9875,14.83155,51.75,"UCare Health, Inc.",Medical Assistance,26.118225,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE VICRYL 3-0 RB-1 CR-8        J713D,,A4649,HCPCS,Facility,Inpatient,,,,51.75,43.9875,14.83155,51.75,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
SUTURE VICRYL 3-0 RB-1 CR-8        J713D,,A4649,HCPCS,Facility,Outpatient,,,,51.75,43.9875,14.83155,51.75,"UCare Health, Inc.",Medicare Advantage,26.118225,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE VICRYL 3-0 RB-1 CR-8        J713D,,A4649,HCPCS,Facility,Inpatient,,,,51.75,43.9875,14.83155,51.75,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE VICRYL 3-0 RB-1 CR-8        J713D,,A4649,HCPCS,Facility,Outpatient,,,,51.75,43.9875,14.83155,51.75,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),26.118225,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE VICRYL 3-0 RB-1 CR-8        J713D,,A4649,HCPCS,Facility,Inpatient,,,,51.75,43.9875,14.83155,51.75,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE VICRYL 3-0 RB-1 CR-8        J713D,,A4649,HCPCS,Facility,Both,,,,51.75,43.9875,14.83155,51.75,UnitedHealthcare,Individual & Family,48.645,94,,percent of total billed charges,,
SUTURE VICRYL 3-0 RB-1 CR-8        J713D,,A4649,HCPCS,Facility,Outpatient,,,,51.75,43.9875,14.83155,51.75,UnitedHealthcare,Medicare Advantage,25.3575,49,,percent of total billed charges,,
SUTURE VICRYL 3-0 RB-1 CR-8        J713D,,A4649,HCPCS,Facility,Inpatient,,,,51.75,43.9875,14.83155,51.75,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
SUTURE VICRYL 3-0 RB-1 CR-8        J713D,,A4649,HCPCS,Facility,Outpatient,,,,51.75,43.9875,14.83155,51.75,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,24.84,48,,percent of total billed charges,,100% of DHS outpatient percentage
SUTURE VICRYL 3-0 RB-1 CR-8        J713D,,A4649,HCPCS,Facility,Inpatient,,,,51.75,43.9875,14.83155,51.75,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
SUTURE VICRYL 5-0 PS-6,,A4649,HCPCS,Facility,Both,,,,87.36,74.256,25.037376,87.36,Aetna,Commercial,80.3712,92,,percent of total billed charges,,
SUTURE VICRYL 5-0 PS-6,,A4649,HCPCS,Facility,Outpatient,,,,87.36,74.256,25.037376,87.36,Aetna,Medicare Advantage,42.8064,49,,percent of total billed charges,,
SUTURE VICRYL 5-0 PS-6,,A4649,HCPCS,Facility,Inpatient,,,,87.36,74.256,25.037376,87.36,Aetna,Medicare Advantage,,,,,Included in per diem rate,
SUTURE VICRYL 5-0 PS-6,,A4649,HCPCS,Facility,Both,,,,87.36,74.256,25.037376,87.36,Aetna,PPO,81.2448,93,,percent of total billed charges,,
SUTURE VICRYL 5-0 PS-6,,A4649,HCPCS,Facility,Both,,,,87.36,74.256,25.037376,87.36,America's PPO,America's PPO,83.891808,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SUTURE VICRYL 5-0 PS-6,,A4649,HCPCS,Facility,Both,,,,87.36,74.256,25.037376,87.36,BlueCross BlueShield Minnesota, Federal Employee Program,85.96224,98.4,,percent of total billed charges,,
SUTURE VICRYL 5-0 PS-6,,A4649,HCPCS,Facility,Both,,,,87.36,74.256,25.037376,87.36,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,87.36,100,,percent of total billed charges,,
SUTURE VICRYL 5-0 PS-6,,A4649,HCPCS,Facility,Both,,,,87.36,74.256,25.037376,87.36,BlueCross BlueShield Minnesota,High Value Network Plan,78.624,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
SUTURE VICRYL 5-0 PS-6,,A4649,HCPCS,Facility,Outpatient,,,,87.36,74.256,25.037376,87.36,BlueCross BlueShield Minnesota,Medicare Advantage,42.8064,49,,percent of total billed charges,,
SUTURE VICRYL 5-0 PS-6,,A4649,HCPCS,Facility,Inpatient,,,,87.36,74.256,25.037376,87.36,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
SUTURE VICRYL 5-0 PS-6,,A4649,HCPCS,Facility,Both,,,,87.36,74.256,25.037376,87.36,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,77.374752,88.57,,percent of total billed charges,,
SUTURE VICRYL 5-0 PS-6,,A4649,HCPCS,Facility,Both,,,,87.36,74.256,25.037376,87.36,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,25.037376,28.66,,percent of total billed charges,,
SUTURE VICRYL 5-0 PS-6,,A4649,HCPCS,Facility,Outpatient,,,,87.36,74.256,25.037376,87.36,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),42.8064,49,,percent of total billed charges,,
SUTURE VICRYL 5-0 PS-6,,A4649,HCPCS,Facility,Inpatient,,,,87.36,74.256,25.037376,87.36,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
SUTURE VICRYL 5-0 PS-6,,A4649,HCPCS,Facility,Both,,,,87.36,74.256,25.037376,87.36,CorVel,Worker's Compensation,87.36,100,,percent of total billed charges,,
SUTURE VICRYL 5-0 PS-6,,A4649,HCPCS,Facility,Both,,,,87.36,74.256,25.037376,87.36,First Health Group Corporation,First Health Network,84.7392,97,,percent of total billed charges,,
SUTURE VICRYL 5-0 PS-6,,A4649,HCPCS,Facility,Both,,,,87.36,74.256,25.037376,87.36,"Health Partners, Inc.",Commercial,82.64256,94.6,,percent of total billed charges,,
SUTURE VICRYL 5-0 PS-6,,A4649,HCPCS,Facility,Outpatient,,,,87.36,74.256,25.037376,87.36,"Health Partners, Inc.",Medicare Advantage,42.8064,49,,percent of total billed charges,,
SUTURE VICRYL 5-0 PS-6,,A4649,HCPCS,Facility,Inpatient,,,,87.36,74.256,25.037376,87.36,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE VICRYL 5-0 PS-6,,A4649,HCPCS,Facility,Both,,,,87.36,74.256,25.037376,87.36,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),52.416,60,,percent of total billed charges,,
SUTURE VICRYL 5-0 PS-6,,A4649,HCPCS,Facility,Both,,,,87.36,74.256,25.037376,87.36,"Health Partners, Inc.",State of Minnesota Advantage Program,71.1984,81.5,,percent of total billed charges,,
SUTURE VICRYL 5-0 PS-6,,A4649,HCPCS,Facility,Both,,,,87.36,74.256,25.037376,87.36,"Health Partners, Inc.",State Public Programs,43.68,50,,percent of total billed charges,,
SUTURE VICRYL 5-0 PS-6,,A4649,HCPCS,Facility,Both,,,,87.36,74.256,25.037376,87.36,Humana Insurance Company,Commercial PPO,82.992,95,,percent of total billed charges,,
SUTURE VICRYL 5-0 PS-6,,A4649,HCPCS,Facility,Outpatient,,,,87.36,74.256,25.037376,87.36,Humana Insurance Company,Medicare PPO,42.8064,49,,percent of total billed charges,,
SUTURE VICRYL 5-0 PS-6,,A4649,HCPCS,Facility,Inpatient,,,,87.36,74.256,25.037376,87.36,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
SUTURE VICRYL 5-0 PS-6,,A4649,HCPCS,Facility,Both,,,,87.36,74.256,25.037376,87.36,Medica,Individual & Family,86.57376,99.1,,percent of total billed charges,,
SUTURE VICRYL 5-0 PS-6,,A4649,HCPCS,Facility,Outpatient,,,,87.36,74.256,25.037376,87.36,Medica,Medica Advantage Solution,43.50528,49.8,,percent of total billed charges,,
SUTURE VICRYL 5-0 PS-6,,A4649,HCPCS,Facility,Inpatient,,,,87.36,74.256,25.037376,87.36,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
SUTURE VICRYL 5-0 PS-6,,A4649,HCPCS,Facility,Outpatient,,,,87.36,74.256,25.037376,87.36,Medica,Medical Assistance,38.96256,44.6,,percent of total billed charges,,
SUTURE VICRYL 5-0 PS-6,,A4649,HCPCS,Facility,Inpatient,,,,87.36,74.256,25.037376,87.36,Medica,Medical Assistance,,,,,Included in per diem rate,
SUTURE VICRYL 5-0 PS-6,,A4649,HCPCS,Facility,Outpatient,,,,87.36,74.256,25.037376,87.36,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,43.50528,49.8,,percent of total billed charges,,
SUTURE VICRYL 5-0 PS-6,,A4649,HCPCS,Facility,Inpatient,,,,87.36,74.256,25.037376,87.36,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
SUTURE VICRYL 5-0 PS-6,,A4649,HCPCS,Facility,Both,,,,87.36,74.256,25.037376,87.36,"Multiplan, Inc.","Multiplan, Inc.",82.1184,94,,percent of total billed charges,,
SUTURE VICRYL 5-0 PS-6,,A4649,HCPCS,Facility,Outpatient,,,,87.36,74.256,25.037376,87.36,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,78.71136,90.1,,percent of total billed charges,,
SUTURE VICRYL 5-0 PS-6,,A4649,HCPCS,Facility,Inpatient,,,,87.36,74.256,25.037376,87.36,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
SUTURE VICRYL 5-0 PS-6,,A4649,HCPCS,Facility,Both,,,,87.36,74.256,25.037376,87.36,"Preferred One Administrative Services, INC.",PPO,86.13696,98.6,,percent of total billed charges,,
SUTURE VICRYL 5-0 PS-6,,A4649,HCPCS,Facility,Outpatient,,,,87.36,74.256,25.037376,87.36,PrimeWest Health,Minnesota Senior Health Options (MSHO),44.94672,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
SUTURE VICRYL 5-0 PS-6,,A4649,HCPCS,Facility,Inpatient,,,,87.36,74.256,25.037376,87.36,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE VICRYL 5-0 PS-6,,A4649,HCPCS,Facility,Outpatient,,,,87.36,74.256,25.037376,87.36,PrimeWest Health,MinnesotaCare,44.868096,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
SUTURE VICRYL 5-0 PS-6,,A4649,HCPCS,Facility,Inpatient,,,,87.36,74.256,25.037376,87.36,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
SUTURE VICRYL 5-0 PS-6,,A4649,HCPCS,Facility,Both,,,,87.36,74.256,25.037376,87.36,Sanford Health Plan,Sanford Health Plan,80.3712,92,,percent of total billed charges,,
SUTURE VICRYL 5-0 PS-6,,A4649,HCPCS,Facility,Outpatient,,,,87.36,74.256,25.037376,87.36,"UCare Health, Inc.",Individual & Family Plan,49.22736,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
SUTURE VICRYL 5-0 PS-6,,A4649,HCPCS,Facility,Inpatient,,,,87.36,74.256,25.037376,87.36,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
SUTURE VICRYL 5-0 PS-6,,A4649,HCPCS,Facility,Outpatient,,,,87.36,74.256,25.037376,87.36,"UCare Health, Inc.",Medical Assistance,44.090592,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE VICRYL 5-0 PS-6,,A4649,HCPCS,Facility,Inpatient,,,,87.36,74.256,25.037376,87.36,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
SUTURE VICRYL 5-0 PS-6,,A4649,HCPCS,Facility,Outpatient,,,,87.36,74.256,25.037376,87.36,"UCare Health, Inc.",Medicare Advantage,44.090592,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE VICRYL 5-0 PS-6,,A4649,HCPCS,Facility,Inpatient,,,,87.36,74.256,25.037376,87.36,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE VICRYL 5-0 PS-6,,A4649,HCPCS,Facility,Outpatient,,,,87.36,74.256,25.037376,87.36,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),44.090592,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE VICRYL 5-0 PS-6,,A4649,HCPCS,Facility,Inpatient,,,,87.36,74.256,25.037376,87.36,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE VICRYL 5-0 PS-6,,A4649,HCPCS,Facility,Both,,,,87.36,74.256,25.037376,87.36,UnitedHealthcare,Individual & Family,82.1184,94,,percent of total billed charges,,
SUTURE VICRYL 5-0 PS-6,,A4649,HCPCS,Facility,Outpatient,,,,87.36,74.256,25.037376,87.36,UnitedHealthcare,Medicare Advantage,42.8064,49,,percent of total billed charges,,
SUTURE VICRYL 5-0 PS-6,,A4649,HCPCS,Facility,Inpatient,,,,87.36,74.256,25.037376,87.36,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
SUTURE VICRYL 5-0 PS-6,,A4649,HCPCS,Facility,Outpatient,,,,87.36,74.256,25.037376,87.36,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,41.9328,48,,percent of total billed charges,,100% of DHS outpatient percentage
SUTURE VICRYL 5-0 PS-6,,A4649,HCPCS,Facility,Inpatient,,,,87.36,74.256,25.037376,87.36,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
SUTURE VICRYL 6-0 VIL S-29,,A4649,HCPCS,Facility,Both,,,,64.89,55.1565,18.597474,64.89,Aetna,Commercial,59.6988,92,,percent of total billed charges,,
SUTURE VICRYL 6-0 VIL S-29,,A4649,HCPCS,Facility,Outpatient,,,,64.89,55.1565,18.597474,64.89,Aetna,Medicare Advantage,31.7961,49,,percent of total billed charges,,
SUTURE VICRYL 6-0 VIL S-29,,A4649,HCPCS,Facility,Inpatient,,,,64.89,55.1565,18.597474,64.89,Aetna,Medicare Advantage,,,,,Included in per diem rate,
SUTURE VICRYL 6-0 VIL S-29,,A4649,HCPCS,Facility,Both,,,,64.89,55.1565,18.597474,64.89,Aetna,PPO,60.3477,93,,percent of total billed charges,,
SUTURE VICRYL 6-0 VIL S-29,,A4649,HCPCS,Facility,Both,,,,64.89,55.1565,18.597474,64.89,America's PPO,America's PPO,62.313867,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SUTURE VICRYL 6-0 VIL S-29,,A4649,HCPCS,Facility,Both,,,,64.89,55.1565,18.597474,64.89,BlueCross BlueShield Minnesota, Federal Employee Program,63.85176,98.4,,percent of total billed charges,,
SUTURE VICRYL 6-0 VIL S-29,,A4649,HCPCS,Facility,Both,,,,64.89,55.1565,18.597474,64.89,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,64.89,100,,percent of total billed charges,,
SUTURE VICRYL 6-0 VIL S-29,,A4649,HCPCS,Facility,Both,,,,64.89,55.1565,18.597474,64.89,BlueCross BlueShield Minnesota,High Value Network Plan,58.401,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
SUTURE VICRYL 6-0 VIL S-29,,A4649,HCPCS,Facility,Outpatient,,,,64.89,55.1565,18.597474,64.89,BlueCross BlueShield Minnesota,Medicare Advantage,31.7961,49,,percent of total billed charges,,
SUTURE VICRYL 6-0 VIL S-29,,A4649,HCPCS,Facility,Inpatient,,,,64.89,55.1565,18.597474,64.89,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
SUTURE VICRYL 6-0 VIL S-29,,A4649,HCPCS,Facility,Both,,,,64.89,55.1565,18.597474,64.89,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,57.473073,88.57,,percent of total billed charges,,
SUTURE VICRYL 6-0 VIL S-29,,A4649,HCPCS,Facility,Both,,,,64.89,55.1565,18.597474,64.89,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,18.597474,28.66,,percent of total billed charges,,
SUTURE VICRYL 6-0 VIL S-29,,A4649,HCPCS,Facility,Outpatient,,,,64.89,55.1565,18.597474,64.89,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),31.7961,49,,percent of total billed charges,,
SUTURE VICRYL 6-0 VIL S-29,,A4649,HCPCS,Facility,Inpatient,,,,64.89,55.1565,18.597474,64.89,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
SUTURE VICRYL 6-0 VIL S-29,,A4649,HCPCS,Facility,Both,,,,64.89,55.1565,18.597474,64.89,CorVel,Worker's Compensation,64.89,100,,percent of total billed charges,,
SUTURE VICRYL 6-0 VIL S-29,,A4649,HCPCS,Facility,Both,,,,64.89,55.1565,18.597474,64.89,First Health Group Corporation,First Health Network,62.9433,97,,percent of total billed charges,,
SUTURE VICRYL 6-0 VIL S-29,,A4649,HCPCS,Facility,Both,,,,64.89,55.1565,18.597474,64.89,"Health Partners, Inc.",Commercial,61.38594,94.6,,percent of total billed charges,,
SUTURE VICRYL 6-0 VIL S-29,,A4649,HCPCS,Facility,Outpatient,,,,64.89,55.1565,18.597474,64.89,"Health Partners, Inc.",Medicare Advantage,31.7961,49,,percent of total billed charges,,
SUTURE VICRYL 6-0 VIL S-29,,A4649,HCPCS,Facility,Inpatient,,,,64.89,55.1565,18.597474,64.89,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE VICRYL 6-0 VIL S-29,,A4649,HCPCS,Facility,Both,,,,64.89,55.1565,18.597474,64.89,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),38.934,60,,percent of total billed charges,,
SUTURE VICRYL 6-0 VIL S-29,,A4649,HCPCS,Facility,Both,,,,64.89,55.1565,18.597474,64.89,"Health Partners, Inc.",State of Minnesota Advantage Program,52.88535,81.5,,percent of total billed charges,,
SUTURE VICRYL 6-0 VIL S-29,,A4649,HCPCS,Facility,Both,,,,64.89,55.1565,18.597474,64.89,"Health Partners, Inc.",State Public Programs,32.445,50,,percent of total billed charges,,
SUTURE VICRYL 6-0 VIL S-29,,A4649,HCPCS,Facility,Both,,,,64.89,55.1565,18.597474,64.89,Humana Insurance Company,Commercial PPO,61.6455,95,,percent of total billed charges,,
SUTURE VICRYL 6-0 VIL S-29,,A4649,HCPCS,Facility,Outpatient,,,,64.89,55.1565,18.597474,64.89,Humana Insurance Company,Medicare PPO,31.7961,49,,percent of total billed charges,,
SUTURE VICRYL 6-0 VIL S-29,,A4649,HCPCS,Facility,Inpatient,,,,64.89,55.1565,18.597474,64.89,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
SUTURE VICRYL 6-0 VIL S-29,,A4649,HCPCS,Facility,Both,,,,64.89,55.1565,18.597474,64.89,Medica,Individual & Family,64.30599,99.1,,percent of total billed charges,,
SUTURE VICRYL 6-0 VIL S-29,,A4649,HCPCS,Facility,Outpatient,,,,64.89,55.1565,18.597474,64.89,Medica,Medica Advantage Solution,32.31522,49.8,,percent of total billed charges,,
SUTURE VICRYL 6-0 VIL S-29,,A4649,HCPCS,Facility,Inpatient,,,,64.89,55.1565,18.597474,64.89,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
SUTURE VICRYL 6-0 VIL S-29,,A4649,HCPCS,Facility,Outpatient,,,,64.89,55.1565,18.597474,64.89,Medica,Medical Assistance,28.94094,44.6,,percent of total billed charges,,
SUTURE VICRYL 6-0 VIL S-29,,A4649,HCPCS,Facility,Inpatient,,,,64.89,55.1565,18.597474,64.89,Medica,Medical Assistance,,,,,Included in per diem rate,
SUTURE VICRYL 6-0 VIL S-29,,A4649,HCPCS,Facility,Outpatient,,,,64.89,55.1565,18.597474,64.89,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,32.31522,49.8,,percent of total billed charges,,
SUTURE VICRYL 6-0 VIL S-29,,A4649,HCPCS,Facility,Inpatient,,,,64.89,55.1565,18.597474,64.89,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
SUTURE VICRYL 6-0 VIL S-29,,A4649,HCPCS,Facility,Both,,,,64.89,55.1565,18.597474,64.89,"Multiplan, Inc.","Multiplan, Inc.",60.9966,94,,percent of total billed charges,,
SUTURE VICRYL 6-0 VIL S-29,,A4649,HCPCS,Facility,Outpatient,,,,64.89,55.1565,18.597474,64.89,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,58.46589,90.1,,percent of total billed charges,,
SUTURE VICRYL 6-0 VIL S-29,,A4649,HCPCS,Facility,Inpatient,,,,64.89,55.1565,18.597474,64.89,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
SUTURE VICRYL 6-0 VIL S-29,,A4649,HCPCS,Facility,Both,,,,64.89,55.1565,18.597474,64.89,"Preferred One Administrative Services, INC.",PPO,63.98154,98.6,,percent of total billed charges,,
SUTURE VICRYL 6-0 VIL S-29,,A4649,HCPCS,Facility,Outpatient,,,,64.89,55.1565,18.597474,64.89,PrimeWest Health,Minnesota Senior Health Options (MSHO),33.385905,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
SUTURE VICRYL 6-0 VIL S-29,,A4649,HCPCS,Facility,Inpatient,,,,64.89,55.1565,18.597474,64.89,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE VICRYL 6-0 VIL S-29,,A4649,HCPCS,Facility,Outpatient,,,,64.89,55.1565,18.597474,64.89,PrimeWest Health,MinnesotaCare,33.327504,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
SUTURE VICRYL 6-0 VIL S-29,,A4649,HCPCS,Facility,Inpatient,,,,64.89,55.1565,18.597474,64.89,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
SUTURE VICRYL 6-0 VIL S-29,,A4649,HCPCS,Facility,Both,,,,64.89,55.1565,18.597474,64.89,Sanford Health Plan,Sanford Health Plan,59.6988,92,,percent of total billed charges,,
SUTURE VICRYL 6-0 VIL S-29,,A4649,HCPCS,Facility,Outpatient,,,,64.89,55.1565,18.597474,64.89,"UCare Health, Inc.",Individual & Family Plan,36.565515,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
SUTURE VICRYL 6-0 VIL S-29,,A4649,HCPCS,Facility,Inpatient,,,,64.89,55.1565,18.597474,64.89,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
SUTURE VICRYL 6-0 VIL S-29,,A4649,HCPCS,Facility,Outpatient,,,,64.89,55.1565,18.597474,64.89,"UCare Health, Inc.",Medical Assistance,32.749983,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE VICRYL 6-0 VIL S-29,,A4649,HCPCS,Facility,Inpatient,,,,64.89,55.1565,18.597474,64.89,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
SUTURE VICRYL 6-0 VIL S-29,,A4649,HCPCS,Facility,Outpatient,,,,64.89,55.1565,18.597474,64.89,"UCare Health, Inc.",Medicare Advantage,32.749983,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE VICRYL 6-0 VIL S-29,,A4649,HCPCS,Facility,Inpatient,,,,64.89,55.1565,18.597474,64.89,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE VICRYL 6-0 VIL S-29,,A4649,HCPCS,Facility,Outpatient,,,,64.89,55.1565,18.597474,64.89,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),32.749983,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE VICRYL 6-0 VIL S-29,,A4649,HCPCS,Facility,Inpatient,,,,64.89,55.1565,18.597474,64.89,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE VICRYL 6-0 VIL S-29,,A4649,HCPCS,Facility,Both,,,,64.89,55.1565,18.597474,64.89,UnitedHealthcare,Individual & Family,60.9966,94,,percent of total billed charges,,
SUTURE VICRYL 6-0 VIL S-29,,A4649,HCPCS,Facility,Outpatient,,,,64.89,55.1565,18.597474,64.89,UnitedHealthcare,Medicare Advantage,31.7961,49,,percent of total billed charges,,
SUTURE VICRYL 6-0 VIL S-29,,A4649,HCPCS,Facility,Inpatient,,,,64.89,55.1565,18.597474,64.89,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
SUTURE VICRYL 6-0 VIL S-29,,A4649,HCPCS,Facility,Outpatient,,,,64.89,55.1565,18.597474,64.89,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,31.1472,48,,percent of total billed charges,,100% of DHS outpatient percentage
SUTURE VICRYL 6-0 VIL S-29,,A4649,HCPCS,Facility,Inpatient,,,,64.89,55.1565,18.597474,64.89,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
SUTURE V-LOC 2-0 GS-21,,A4649,HCPCS,Facility,Both,,,,138.96,118.116,39.825936,138.96,Aetna,Commercial,127.8432,92,,percent of total billed charges,,
SUTURE V-LOC 2-0 GS-21,,A4649,HCPCS,Facility,Outpatient,,,,138.96,118.116,39.825936,138.96,Aetna,Medicare Advantage,68.0904,49,,percent of total billed charges,,
SUTURE V-LOC 2-0 GS-21,,A4649,HCPCS,Facility,Inpatient,,,,138.96,118.116,39.825936,138.96,Aetna,Medicare Advantage,,,,,Included in per diem rate,
SUTURE V-LOC 2-0 GS-21,,A4649,HCPCS,Facility,Both,,,,138.96,118.116,39.825936,138.96,Aetna,PPO,129.2328,93,,percent of total billed charges,,
SUTURE V-LOC 2-0 GS-21,,A4649,HCPCS,Facility,Both,,,,138.96,118.116,39.825936,138.96,America's PPO,America's PPO,133.443288,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SUTURE V-LOC 2-0 GS-21,,A4649,HCPCS,Facility,Both,,,,138.96,118.116,39.825936,138.96,BlueCross BlueShield Minnesota, Federal Employee Program,136.73664,98.4,,percent of total billed charges,,
SUTURE V-LOC 2-0 GS-21,,A4649,HCPCS,Facility,Both,,,,138.96,118.116,39.825936,138.96,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,138.96,100,,percent of total billed charges,,
SUTURE V-LOC 2-0 GS-21,,A4649,HCPCS,Facility,Both,,,,138.96,118.116,39.825936,138.96,BlueCross BlueShield Minnesota,High Value Network Plan,125.064,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
SUTURE V-LOC 2-0 GS-21,,A4649,HCPCS,Facility,Outpatient,,,,138.96,118.116,39.825936,138.96,BlueCross BlueShield Minnesota,Medicare Advantage,68.0904,49,,percent of total billed charges,,
SUTURE V-LOC 2-0 GS-21,,A4649,HCPCS,Facility,Inpatient,,,,138.96,118.116,39.825936,138.96,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
SUTURE V-LOC 2-0 GS-21,,A4649,HCPCS,Facility,Both,,,,138.96,118.116,39.825936,138.96,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,123.076872,88.57,,percent of total billed charges,,
SUTURE V-LOC 2-0 GS-21,,A4649,HCPCS,Facility,Both,,,,138.96,118.116,39.825936,138.96,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,39.825936,28.66,,percent of total billed charges,,
SUTURE V-LOC 2-0 GS-21,,A4649,HCPCS,Facility,Outpatient,,,,138.96,118.116,39.825936,138.96,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),68.0904,49,,percent of total billed charges,,
SUTURE V-LOC 2-0 GS-21,,A4649,HCPCS,Facility,Inpatient,,,,138.96,118.116,39.825936,138.96,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
SUTURE V-LOC 2-0 GS-21,,A4649,HCPCS,Facility,Both,,,,138.96,118.116,39.825936,138.96,CorVel,Worker's Compensation,138.96,100,,percent of total billed charges,,
SUTURE V-LOC 2-0 GS-21,,A4649,HCPCS,Facility,Both,,,,138.96,118.116,39.825936,138.96,First Health Group Corporation,First Health Network,134.7912,97,,percent of total billed charges,,
SUTURE V-LOC 2-0 GS-21,,A4649,HCPCS,Facility,Both,,,,138.96,118.116,39.825936,138.96,"Health Partners, Inc.",Commercial,131.45616,94.6,,percent of total billed charges,,
SUTURE V-LOC 2-0 GS-21,,A4649,HCPCS,Facility,Outpatient,,,,138.96,118.116,39.825936,138.96,"Health Partners, Inc.",Medicare Advantage,68.0904,49,,percent of total billed charges,,
SUTURE V-LOC 2-0 GS-21,,A4649,HCPCS,Facility,Inpatient,,,,138.96,118.116,39.825936,138.96,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE V-LOC 2-0 GS-21,,A4649,HCPCS,Facility,Both,,,,138.96,118.116,39.825936,138.96,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),83.376,60,,percent of total billed charges,,
SUTURE V-LOC 2-0 GS-21,,A4649,HCPCS,Facility,Both,,,,138.96,118.116,39.825936,138.96,"Health Partners, Inc.",State of Minnesota Advantage Program,113.2524,81.5,,percent of total billed charges,,
SUTURE V-LOC 2-0 GS-21,,A4649,HCPCS,Facility,Both,,,,138.96,118.116,39.825936,138.96,"Health Partners, Inc.",State Public Programs,69.48,50,,percent of total billed charges,,
SUTURE V-LOC 2-0 GS-21,,A4649,HCPCS,Facility,Both,,,,138.96,118.116,39.825936,138.96,Humana Insurance Company,Commercial PPO,132.012,95,,percent of total billed charges,,
SUTURE V-LOC 2-0 GS-21,,A4649,HCPCS,Facility,Outpatient,,,,138.96,118.116,39.825936,138.96,Humana Insurance Company,Medicare PPO,68.0904,49,,percent of total billed charges,,
SUTURE V-LOC 2-0 GS-21,,A4649,HCPCS,Facility,Inpatient,,,,138.96,118.116,39.825936,138.96,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
SUTURE V-LOC 2-0 GS-21,,A4649,HCPCS,Facility,Both,,,,138.96,118.116,39.825936,138.96,Medica,Individual & Family,137.70936,99.1,,percent of total billed charges,,
SUTURE V-LOC 2-0 GS-21,,A4649,HCPCS,Facility,Outpatient,,,,138.96,118.116,39.825936,138.96,Medica,Medica Advantage Solution,69.20208,49.8,,percent of total billed charges,,
SUTURE V-LOC 2-0 GS-21,,A4649,HCPCS,Facility,Inpatient,,,,138.96,118.116,39.825936,138.96,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
SUTURE V-LOC 2-0 GS-21,,A4649,HCPCS,Facility,Outpatient,,,,138.96,118.116,39.825936,138.96,Medica,Medical Assistance,61.97616,44.6,,percent of total billed charges,,
SUTURE V-LOC 2-0 GS-21,,A4649,HCPCS,Facility,Inpatient,,,,138.96,118.116,39.825936,138.96,Medica,Medical Assistance,,,,,Included in per diem rate,
SUTURE V-LOC 2-0 GS-21,,A4649,HCPCS,Facility,Outpatient,,,,138.96,118.116,39.825936,138.96,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,69.20208,49.8,,percent of total billed charges,,
SUTURE V-LOC 2-0 GS-21,,A4649,HCPCS,Facility,Inpatient,,,,138.96,118.116,39.825936,138.96,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
SUTURE V-LOC 2-0 GS-21,,A4649,HCPCS,Facility,Both,,,,138.96,118.116,39.825936,138.96,"Multiplan, Inc.","Multiplan, Inc.",130.6224,94,,percent of total billed charges,,
SUTURE V-LOC 2-0 GS-21,,A4649,HCPCS,Facility,Outpatient,,,,138.96,118.116,39.825936,138.96,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,125.20296,90.1,,percent of total billed charges,,
SUTURE V-LOC 2-0 GS-21,,A4649,HCPCS,Facility,Inpatient,,,,138.96,118.116,39.825936,138.96,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
SUTURE V-LOC 2-0 GS-21,,A4649,HCPCS,Facility,Both,,,,138.96,118.116,39.825936,138.96,"Preferred One Administrative Services, INC.",PPO,137.01456,98.6,,percent of total billed charges,,
SUTURE V-LOC 2-0 GS-21,,A4649,HCPCS,Facility,Outpatient,,,,138.96,118.116,39.825936,138.96,PrimeWest Health,Minnesota Senior Health Options (MSHO),71.49492,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
SUTURE V-LOC 2-0 GS-21,,A4649,HCPCS,Facility,Inpatient,,,,138.96,118.116,39.825936,138.96,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE V-LOC 2-0 GS-21,,A4649,HCPCS,Facility,Outpatient,,,,138.96,118.116,39.825936,138.96,PrimeWest Health,MinnesotaCare,71.369856,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
SUTURE V-LOC 2-0 GS-21,,A4649,HCPCS,Facility,Inpatient,,,,138.96,118.116,39.825936,138.96,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
SUTURE V-LOC 2-0 GS-21,,A4649,HCPCS,Facility,Both,,,,138.96,118.116,39.825936,138.96,Sanford Health Plan,Sanford Health Plan,127.8432,92,,percent of total billed charges,,
SUTURE V-LOC 2-0 GS-21,,A4649,HCPCS,Facility,Outpatient,,,,138.96,118.116,39.825936,138.96,"UCare Health, Inc.",Individual & Family Plan,78.30396,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
SUTURE V-LOC 2-0 GS-21,,A4649,HCPCS,Facility,Inpatient,,,,138.96,118.116,39.825936,138.96,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
SUTURE V-LOC 2-0 GS-21,,A4649,HCPCS,Facility,Outpatient,,,,138.96,118.116,39.825936,138.96,"UCare Health, Inc.",Medical Assistance,70.133112,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE V-LOC 2-0 GS-21,,A4649,HCPCS,Facility,Inpatient,,,,138.96,118.116,39.825936,138.96,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
SUTURE V-LOC 2-0 GS-21,,A4649,HCPCS,Facility,Outpatient,,,,138.96,118.116,39.825936,138.96,"UCare Health, Inc.",Medicare Advantage,70.133112,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE V-LOC 2-0 GS-21,,A4649,HCPCS,Facility,Inpatient,,,,138.96,118.116,39.825936,138.96,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE V-LOC 2-0 GS-21,,A4649,HCPCS,Facility,Outpatient,,,,138.96,118.116,39.825936,138.96,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),70.133112,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE V-LOC 2-0 GS-21,,A4649,HCPCS,Facility,Inpatient,,,,138.96,118.116,39.825936,138.96,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE V-LOC 2-0 GS-21,,A4649,HCPCS,Facility,Both,,,,138.96,118.116,39.825936,138.96,UnitedHealthcare,Individual & Family,130.6224,94,,percent of total billed charges,,
SUTURE V-LOC 2-0 GS-21,,A4649,HCPCS,Facility,Outpatient,,,,138.96,118.116,39.825936,138.96,UnitedHealthcare,Medicare Advantage,68.0904,49,,percent of total billed charges,,
SUTURE V-LOC 2-0 GS-21,,A4649,HCPCS,Facility,Inpatient,,,,138.96,118.116,39.825936,138.96,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
SUTURE V-LOC 2-0 GS-21,,A4649,HCPCS,Facility,Outpatient,,,,138.96,118.116,39.825936,138.96,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,66.7008,48,,percent of total billed charges,,100% of DHS outpatient percentage
SUTURE V-LOC 2-0 GS-21,,A4649,HCPCS,Facility,Inpatient,,,,138.96,118.116,39.825936,138.96,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
SYRINGE INFLATION SYS 60ML  BOSTON SCI 5060-05,,A4649,HCPCS,Facility,Both,,,,195.3,166.005,55.97298,195.3,Aetna,Commercial,179.676,92,,percent of total billed charges,,
SYRINGE INFLATION SYS 60ML  BOSTON SCI 5060-05,,A4649,HCPCS,Facility,Outpatient,,,,195.3,166.005,55.97298,195.3,Aetna,Medicare Advantage,95.697,49,,percent of total billed charges,,
SYRINGE INFLATION SYS 60ML  BOSTON SCI 5060-05,,A4649,HCPCS,Facility,Inpatient,,,,195.3,166.005,55.97298,195.3,Aetna,Medicare Advantage,,,,,Included in per diem rate,
SYRINGE INFLATION SYS 60ML  BOSTON SCI 5060-05,,A4649,HCPCS,Facility,Both,,,,195.3,166.005,55.97298,195.3,Aetna,PPO,181.629,93,,percent of total billed charges,,
SYRINGE INFLATION SYS 60ML  BOSTON SCI 5060-05,,A4649,HCPCS,Facility,Both,,,,195.3,166.005,55.97298,195.3,America's PPO,America's PPO,187.54659,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SYRINGE INFLATION SYS 60ML  BOSTON SCI 5060-05,,A4649,HCPCS,Facility,Both,,,,195.3,166.005,55.97298,195.3,BlueCross BlueShield Minnesota, Federal Employee Program,192.1752,98.4,,percent of total billed charges,,
SYRINGE INFLATION SYS 60ML  BOSTON SCI 5060-05,,A4649,HCPCS,Facility,Both,,,,195.3,166.005,55.97298,195.3,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,195.3,100,,percent of total billed charges,,
SYRINGE INFLATION SYS 60ML  BOSTON SCI 5060-05,,A4649,HCPCS,Facility,Both,,,,195.3,166.005,55.97298,195.3,BlueCross BlueShield Minnesota,High Value Network Plan,175.77,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
SYRINGE INFLATION SYS 60ML  BOSTON SCI 5060-05,,A4649,HCPCS,Facility,Outpatient,,,,195.3,166.005,55.97298,195.3,BlueCross BlueShield Minnesota,Medicare Advantage,95.697,49,,percent of total billed charges,,
SYRINGE INFLATION SYS 60ML  BOSTON SCI 5060-05,,A4649,HCPCS,Facility,Inpatient,,,,195.3,166.005,55.97298,195.3,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
SYRINGE INFLATION SYS 60ML  BOSTON SCI 5060-05,,A4649,HCPCS,Facility,Both,,,,195.3,166.005,55.97298,195.3,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,172.97721,88.57,,percent of total billed charges,,
SYRINGE INFLATION SYS 60ML  BOSTON SCI 5060-05,,A4649,HCPCS,Facility,Both,,,,195.3,166.005,55.97298,195.3,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,55.97298,28.66,,percent of total billed charges,,
SYRINGE INFLATION SYS 60ML  BOSTON SCI 5060-05,,A4649,HCPCS,Facility,Outpatient,,,,195.3,166.005,55.97298,195.3,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),95.697,49,,percent of total billed charges,,
SYRINGE INFLATION SYS 60ML  BOSTON SCI 5060-05,,A4649,HCPCS,Facility,Inpatient,,,,195.3,166.005,55.97298,195.3,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
SYRINGE INFLATION SYS 60ML  BOSTON SCI 5060-05,,A4649,HCPCS,Facility,Both,,,,195.3,166.005,55.97298,195.3,CorVel,Worker's Compensation,195.3,100,,percent of total billed charges,,
SYRINGE INFLATION SYS 60ML  BOSTON SCI 5060-05,,A4649,HCPCS,Facility,Both,,,,195.3,166.005,55.97298,195.3,First Health Group Corporation,First Health Network,189.441,97,,percent of total billed charges,,
SYRINGE INFLATION SYS 60ML  BOSTON SCI 5060-05,,A4649,HCPCS,Facility,Both,,,,195.3,166.005,55.97298,195.3,"Health Partners, Inc.",Commercial,184.7538,94.6,,percent of total billed charges,,
SYRINGE INFLATION SYS 60ML  BOSTON SCI 5060-05,,A4649,HCPCS,Facility,Outpatient,,,,195.3,166.005,55.97298,195.3,"Health Partners, Inc.",Medicare Advantage,95.697,49,,percent of total billed charges,,
SYRINGE INFLATION SYS 60ML  BOSTON SCI 5060-05,,A4649,HCPCS,Facility,Inpatient,,,,195.3,166.005,55.97298,195.3,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SYRINGE INFLATION SYS 60ML  BOSTON SCI 5060-05,,A4649,HCPCS,Facility,Both,,,,195.3,166.005,55.97298,195.3,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),117.18,60,,percent of total billed charges,,
SYRINGE INFLATION SYS 60ML  BOSTON SCI 5060-05,,A4649,HCPCS,Facility,Both,,,,195.3,166.005,55.97298,195.3,"Health Partners, Inc.",State of Minnesota Advantage Program,159.1695,81.5,,percent of total billed charges,,
SYRINGE INFLATION SYS 60ML  BOSTON SCI 5060-05,,A4649,HCPCS,Facility,Both,,,,195.3,166.005,55.97298,195.3,"Health Partners, Inc.",State Public Programs,97.65,50,,percent of total billed charges,,
SYRINGE INFLATION SYS 60ML  BOSTON SCI 5060-05,,A4649,HCPCS,Facility,Both,,,,195.3,166.005,55.97298,195.3,Humana Insurance Company,Commercial PPO,185.535,95,,percent of total billed charges,,
SYRINGE INFLATION SYS 60ML  BOSTON SCI 5060-05,,A4649,HCPCS,Facility,Outpatient,,,,195.3,166.005,55.97298,195.3,Humana Insurance Company,Medicare PPO,95.697,49,,percent of total billed charges,,
SYRINGE INFLATION SYS 60ML  BOSTON SCI 5060-05,,A4649,HCPCS,Facility,Inpatient,,,,195.3,166.005,55.97298,195.3,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
SYRINGE INFLATION SYS 60ML  BOSTON SCI 5060-05,,A4649,HCPCS,Facility,Both,,,,195.3,166.005,55.97298,195.3,Medica,Individual & Family,193.5423,99.1,,percent of total billed charges,,
SYRINGE INFLATION SYS 60ML  BOSTON SCI 5060-05,,A4649,HCPCS,Facility,Outpatient,,,,195.3,166.005,55.97298,195.3,Medica,Medica Advantage Solution,97.2594,49.8,,percent of total billed charges,,
SYRINGE INFLATION SYS 60ML  BOSTON SCI 5060-05,,A4649,HCPCS,Facility,Inpatient,,,,195.3,166.005,55.97298,195.3,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
SYRINGE INFLATION SYS 60ML  BOSTON SCI 5060-05,,A4649,HCPCS,Facility,Outpatient,,,,195.3,166.005,55.97298,195.3,Medica,Medical Assistance,87.1038,44.6,,percent of total billed charges,,
SYRINGE INFLATION SYS 60ML  BOSTON SCI 5060-05,,A4649,HCPCS,Facility,Inpatient,,,,195.3,166.005,55.97298,195.3,Medica,Medical Assistance,,,,,Included in per diem rate,
SYRINGE INFLATION SYS 60ML  BOSTON SCI 5060-05,,A4649,HCPCS,Facility,Outpatient,,,,195.3,166.005,55.97298,195.3,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,97.2594,49.8,,percent of total billed charges,,
SYRINGE INFLATION SYS 60ML  BOSTON SCI 5060-05,,A4649,HCPCS,Facility,Inpatient,,,,195.3,166.005,55.97298,195.3,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
SYRINGE INFLATION SYS 60ML  BOSTON SCI 5060-05,,A4649,HCPCS,Facility,Both,,,,195.3,166.005,55.97298,195.3,"Multiplan, Inc.","Multiplan, Inc.",183.582,94,,percent of total billed charges,,
SYRINGE INFLATION SYS 60ML  BOSTON SCI 5060-05,,A4649,HCPCS,Facility,Outpatient,,,,195.3,166.005,55.97298,195.3,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,175.9653,90.1,,percent of total billed charges,,
SYRINGE INFLATION SYS 60ML  BOSTON SCI 5060-05,,A4649,HCPCS,Facility,Inpatient,,,,195.3,166.005,55.97298,195.3,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
SYRINGE INFLATION SYS 60ML  BOSTON SCI 5060-05,,A4649,HCPCS,Facility,Both,,,,195.3,166.005,55.97298,195.3,"Preferred One Administrative Services, INC.",PPO,192.5658,98.6,,percent of total billed charges,,
SYRINGE INFLATION SYS 60ML  BOSTON SCI 5060-05,,A4649,HCPCS,Facility,Outpatient,,,,195.3,166.005,55.97298,195.3,PrimeWest Health,Minnesota Senior Health Options (MSHO),100.48185,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
SYRINGE INFLATION SYS 60ML  BOSTON SCI 5060-05,,A4649,HCPCS,Facility,Inpatient,,,,195.3,166.005,55.97298,195.3,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SYRINGE INFLATION SYS 60ML  BOSTON SCI 5060-05,,A4649,HCPCS,Facility,Outpatient,,,,195.3,166.005,55.97298,195.3,PrimeWest Health,MinnesotaCare,100.30608,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
SYRINGE INFLATION SYS 60ML  BOSTON SCI 5060-05,,A4649,HCPCS,Facility,Inpatient,,,,195.3,166.005,55.97298,195.3,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
SYRINGE INFLATION SYS 60ML  BOSTON SCI 5060-05,,A4649,HCPCS,Facility,Both,,,,195.3,166.005,55.97298,195.3,Sanford Health Plan,Sanford Health Plan,179.676,92,,percent of total billed charges,,
SYRINGE INFLATION SYS 60ML  BOSTON SCI 5060-05,,A4649,HCPCS,Facility,Outpatient,,,,195.3,166.005,55.97298,195.3,"UCare Health, Inc.",Individual & Family Plan,110.05155,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
SYRINGE INFLATION SYS 60ML  BOSTON SCI 5060-05,,A4649,HCPCS,Facility,Inpatient,,,,195.3,166.005,55.97298,195.3,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
SYRINGE INFLATION SYS 60ML  BOSTON SCI 5060-05,,A4649,HCPCS,Facility,Outpatient,,,,195.3,166.005,55.97298,195.3,"UCare Health, Inc.",Medical Assistance,98.56791,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SYRINGE INFLATION SYS 60ML  BOSTON SCI 5060-05,,A4649,HCPCS,Facility,Inpatient,,,,195.3,166.005,55.97298,195.3,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
SYRINGE INFLATION SYS 60ML  BOSTON SCI 5060-05,,A4649,HCPCS,Facility,Outpatient,,,,195.3,166.005,55.97298,195.3,"UCare Health, Inc.",Medicare Advantage,98.56791,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SYRINGE INFLATION SYS 60ML  BOSTON SCI 5060-05,,A4649,HCPCS,Facility,Inpatient,,,,195.3,166.005,55.97298,195.3,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SYRINGE INFLATION SYS 60ML  BOSTON SCI 5060-05,,A4649,HCPCS,Facility,Outpatient,,,,195.3,166.005,55.97298,195.3,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),98.56791,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SYRINGE INFLATION SYS 60ML  BOSTON SCI 5060-05,,A4649,HCPCS,Facility,Inpatient,,,,195.3,166.005,55.97298,195.3,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SYRINGE INFLATION SYS 60ML  BOSTON SCI 5060-05,,A4649,HCPCS,Facility,Both,,,,195.3,166.005,55.97298,195.3,UnitedHealthcare,Individual & Family,183.582,94,,percent of total billed charges,,
SYRINGE INFLATION SYS 60ML  BOSTON SCI 5060-05,,A4649,HCPCS,Facility,Outpatient,,,,195.3,166.005,55.97298,195.3,UnitedHealthcare,Medicare Advantage,95.697,49,,percent of total billed charges,,
SYRINGE INFLATION SYS 60ML  BOSTON SCI 5060-05,,A4649,HCPCS,Facility,Inpatient,,,,195.3,166.005,55.97298,195.3,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
SYRINGE INFLATION SYS 60ML  BOSTON SCI 5060-05,,A4649,HCPCS,Facility,Outpatient,,,,195.3,166.005,55.97298,195.3,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,93.744,48,,percent of total billed charges,,100% of DHS outpatient percentage
SYRINGE INFLATION SYS 60ML  BOSTON SCI 5060-05,,A4649,HCPCS,Facility,Inpatient,,,,195.3,166.005,55.97298,195.3,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
T WRENCH,,A4649,HCPCS,Facility,Both,,,,473.82,402.747,135.796812,473.82,Aetna,Commercial,435.9144,92,,percent of total billed charges,,
T WRENCH,,A4649,HCPCS,Facility,Outpatient,,,,473.82,402.747,135.796812,473.82,Aetna,Medicare Advantage,232.1718,49,,percent of total billed charges,,
T WRENCH,,A4649,HCPCS,Facility,Inpatient,,,,473.82,402.747,135.796812,473.82,Aetna,Medicare Advantage,,,,,Included in per diem rate,
T WRENCH,,A4649,HCPCS,Facility,Both,,,,473.82,402.747,135.796812,473.82,Aetna,PPO,440.6526,93,,percent of total billed charges,,
T WRENCH,,A4649,HCPCS,Facility,Both,,,,473.82,402.747,135.796812,473.82,America's PPO,America's PPO,455.009346,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
T WRENCH,,A4649,HCPCS,Facility,Both,,,,473.82,402.747,135.796812,473.82,BlueCross BlueShield Minnesota, Federal Employee Program,466.23888,98.4,,percent of total billed charges,,
T WRENCH,,A4649,HCPCS,Facility,Both,,,,473.82,402.747,135.796812,473.82,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,473.82,100,,percent of total billed charges,,
T WRENCH,,A4649,HCPCS,Facility,Both,,,,473.82,402.747,135.796812,473.82,BlueCross BlueShield Minnesota,High Value Network Plan,426.438,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
T WRENCH,,A4649,HCPCS,Facility,Outpatient,,,,473.82,402.747,135.796812,473.82,BlueCross BlueShield Minnesota,Medicare Advantage,232.1718,49,,percent of total billed charges,,
T WRENCH,,A4649,HCPCS,Facility,Inpatient,,,,473.82,402.747,135.796812,473.82,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
T WRENCH,,A4649,HCPCS,Facility,Both,,,,473.82,402.747,135.796812,473.82,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,419.662374,88.57,,percent of total billed charges,,
T WRENCH,,A4649,HCPCS,Facility,Both,,,,473.82,402.747,135.796812,473.82,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,135.796812,28.66,,percent of total billed charges,,
T WRENCH,,A4649,HCPCS,Facility,Outpatient,,,,473.82,402.747,135.796812,473.82,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),232.1718,49,,percent of total billed charges,,
T WRENCH,,A4649,HCPCS,Facility,Inpatient,,,,473.82,402.747,135.796812,473.82,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
T WRENCH,,A4649,HCPCS,Facility,Both,,,,473.82,402.747,135.796812,473.82,CorVel,Worker's Compensation,473.82,100,,percent of total billed charges,,
T WRENCH,,A4649,HCPCS,Facility,Both,,,,473.82,402.747,135.796812,473.82,First Health Group Corporation,First Health Network,459.6054,97,,percent of total billed charges,,
T WRENCH,,A4649,HCPCS,Facility,Both,,,,473.82,402.747,135.796812,473.82,"Health Partners, Inc.",Commercial,448.23372,94.6,,percent of total billed charges,,
T WRENCH,,A4649,HCPCS,Facility,Outpatient,,,,473.82,402.747,135.796812,473.82,"Health Partners, Inc.",Medicare Advantage,232.1718,49,,percent of total billed charges,,
T WRENCH,,A4649,HCPCS,Facility,Inpatient,,,,473.82,402.747,135.796812,473.82,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
T WRENCH,,A4649,HCPCS,Facility,Both,,,,473.82,402.747,135.796812,473.82,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),284.292,60,,percent of total billed charges,,
T WRENCH,,A4649,HCPCS,Facility,Both,,,,473.82,402.747,135.796812,473.82,"Health Partners, Inc.",State of Minnesota Advantage Program,386.1633,81.5,,percent of total billed charges,,
T WRENCH,,A4649,HCPCS,Facility,Both,,,,473.82,402.747,135.796812,473.82,"Health Partners, Inc.",State Public Programs,236.91,50,,percent of total billed charges,,
T WRENCH,,A4649,HCPCS,Facility,Both,,,,473.82,402.747,135.796812,473.82,Humana Insurance Company,Commercial PPO,450.129,95,,percent of total billed charges,,
T WRENCH,,A4649,HCPCS,Facility,Outpatient,,,,473.82,402.747,135.796812,473.82,Humana Insurance Company,Medicare PPO,232.1718,49,,percent of total billed charges,,
T WRENCH,,A4649,HCPCS,Facility,Inpatient,,,,473.82,402.747,135.796812,473.82,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
T WRENCH,,A4649,HCPCS,Facility,Both,,,,473.82,402.747,135.796812,473.82,Medica,Individual & Family,469.55562,99.1,,percent of total billed charges,,
T WRENCH,,A4649,HCPCS,Facility,Outpatient,,,,473.82,402.747,135.796812,473.82,Medica,Medica Advantage Solution,235.96236,49.8,,percent of total billed charges,,
T WRENCH,,A4649,HCPCS,Facility,Inpatient,,,,473.82,402.747,135.796812,473.82,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
T WRENCH,,A4649,HCPCS,Facility,Outpatient,,,,473.82,402.747,135.796812,473.82,Medica,Medical Assistance,211.32372,44.6,,percent of total billed charges,,
T WRENCH,,A4649,HCPCS,Facility,Inpatient,,,,473.82,402.747,135.796812,473.82,Medica,Medical Assistance,,,,,Included in per diem rate,
T WRENCH,,A4649,HCPCS,Facility,Outpatient,,,,473.82,402.747,135.796812,473.82,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,235.96236,49.8,,percent of total billed charges,,
T WRENCH,,A4649,HCPCS,Facility,Inpatient,,,,473.82,402.747,135.796812,473.82,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
T WRENCH,,A4649,HCPCS,Facility,Both,,,,473.82,402.747,135.796812,473.82,"Multiplan, Inc.","Multiplan, Inc.",445.3908,94,,percent of total billed charges,,
T WRENCH,,A4649,HCPCS,Facility,Outpatient,,,,473.82,402.747,135.796812,473.82,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,426.91182,90.1,,percent of total billed charges,,
T WRENCH,,A4649,HCPCS,Facility,Inpatient,,,,473.82,402.747,135.796812,473.82,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
T WRENCH,,A4649,HCPCS,Facility,Both,,,,473.82,402.747,135.796812,473.82,"Preferred One Administrative Services, INC.",PPO,467.18652,98.6,,percent of total billed charges,,
T WRENCH,,A4649,HCPCS,Facility,Outpatient,,,,473.82,402.747,135.796812,473.82,PrimeWest Health,Minnesota Senior Health Options (MSHO),243.78039,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
T WRENCH,,A4649,HCPCS,Facility,Inpatient,,,,473.82,402.747,135.796812,473.82,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
T WRENCH,,A4649,HCPCS,Facility,Outpatient,,,,473.82,402.747,135.796812,473.82,PrimeWest Health,MinnesotaCare,243.353952,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
T WRENCH,,A4649,HCPCS,Facility,Inpatient,,,,473.82,402.747,135.796812,473.82,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
T WRENCH,,A4649,HCPCS,Facility,Both,,,,473.82,402.747,135.796812,473.82,Sanford Health Plan,Sanford Health Plan,435.9144,92,,percent of total billed charges,,
T WRENCH,,A4649,HCPCS,Facility,Outpatient,,,,473.82,402.747,135.796812,473.82,"UCare Health, Inc.",Individual & Family Plan,266.99757,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
T WRENCH,,A4649,HCPCS,Facility,Inpatient,,,,473.82,402.747,135.796812,473.82,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
T WRENCH,,A4649,HCPCS,Facility,Outpatient,,,,473.82,402.747,135.796812,473.82,"UCare Health, Inc.",Medical Assistance,239.136954,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
T WRENCH,,A4649,HCPCS,Facility,Inpatient,,,,473.82,402.747,135.796812,473.82,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
T WRENCH,,A4649,HCPCS,Facility,Outpatient,,,,473.82,402.747,135.796812,473.82,"UCare Health, Inc.",Medicare Advantage,239.136954,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
T WRENCH,,A4649,HCPCS,Facility,Inpatient,,,,473.82,402.747,135.796812,473.82,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
T WRENCH,,A4649,HCPCS,Facility,Outpatient,,,,473.82,402.747,135.796812,473.82,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),239.136954,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
T WRENCH,,A4649,HCPCS,Facility,Inpatient,,,,473.82,402.747,135.796812,473.82,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
T WRENCH,,A4649,HCPCS,Facility,Both,,,,473.82,402.747,135.796812,473.82,UnitedHealthcare,Individual & Family,445.3908,94,,percent of total billed charges,,
T WRENCH,,A4649,HCPCS,Facility,Outpatient,,,,473.82,402.747,135.796812,473.82,UnitedHealthcare,Medicare Advantage,232.1718,49,,percent of total billed charges,,
T WRENCH,,A4649,HCPCS,Facility,Inpatient,,,,473.82,402.747,135.796812,473.82,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
T WRENCH,,A4649,HCPCS,Facility,Outpatient,,,,473.82,402.747,135.796812,473.82,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,227.4336,48,,percent of total billed charges,,100% of DHS outpatient percentage
T WRENCH,,A4649,HCPCS,Facility,Inpatient,,,,473.82,402.747,135.796812,473.82,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
T WRENCH MINIRAIL,,A4649,HCPCS,Facility,Both,,,,473.82,402.747,135.796812,473.82,Aetna,Commercial,435.9144,92,,percent of total billed charges,,
T WRENCH MINIRAIL,,A4649,HCPCS,Facility,Outpatient,,,,473.82,402.747,135.796812,473.82,Aetna,Medicare Advantage,232.1718,49,,percent of total billed charges,,
T WRENCH MINIRAIL,,A4649,HCPCS,Facility,Inpatient,,,,473.82,402.747,135.796812,473.82,Aetna,Medicare Advantage,,,,,Included in per diem rate,
T WRENCH MINIRAIL,,A4649,HCPCS,Facility,Both,,,,473.82,402.747,135.796812,473.82,Aetna,PPO,440.6526,93,,percent of total billed charges,,
T WRENCH MINIRAIL,,A4649,HCPCS,Facility,Both,,,,473.82,402.747,135.796812,473.82,America's PPO,America's PPO,455.009346,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
T WRENCH MINIRAIL,,A4649,HCPCS,Facility,Both,,,,473.82,402.747,135.796812,473.82,BlueCross BlueShield Minnesota, Federal Employee Program,466.23888,98.4,,percent of total billed charges,,
T WRENCH MINIRAIL,,A4649,HCPCS,Facility,Both,,,,473.82,402.747,135.796812,473.82,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,473.82,100,,percent of total billed charges,,
T WRENCH MINIRAIL,,A4649,HCPCS,Facility,Both,,,,473.82,402.747,135.796812,473.82,BlueCross BlueShield Minnesota,High Value Network Plan,426.438,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
T WRENCH MINIRAIL,,A4649,HCPCS,Facility,Outpatient,,,,473.82,402.747,135.796812,473.82,BlueCross BlueShield Minnesota,Medicare Advantage,232.1718,49,,percent of total billed charges,,
T WRENCH MINIRAIL,,A4649,HCPCS,Facility,Inpatient,,,,473.82,402.747,135.796812,473.82,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
T WRENCH MINIRAIL,,A4649,HCPCS,Facility,Both,,,,473.82,402.747,135.796812,473.82,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,419.662374,88.57,,percent of total billed charges,,
T WRENCH MINIRAIL,,A4649,HCPCS,Facility,Both,,,,473.82,402.747,135.796812,473.82,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,135.796812,28.66,,percent of total billed charges,,
T WRENCH MINIRAIL,,A4649,HCPCS,Facility,Outpatient,,,,473.82,402.747,135.796812,473.82,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),232.1718,49,,percent of total billed charges,,
T WRENCH MINIRAIL,,A4649,HCPCS,Facility,Inpatient,,,,473.82,402.747,135.796812,473.82,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
T WRENCH MINIRAIL,,A4649,HCPCS,Facility,Both,,,,473.82,402.747,135.796812,473.82,CorVel,Worker's Compensation,473.82,100,,percent of total billed charges,,
T WRENCH MINIRAIL,,A4649,HCPCS,Facility,Both,,,,473.82,402.747,135.796812,473.82,First Health Group Corporation,First Health Network,459.6054,97,,percent of total billed charges,,
T WRENCH MINIRAIL,,A4649,HCPCS,Facility,Both,,,,473.82,402.747,135.796812,473.82,"Health Partners, Inc.",Commercial,448.23372,94.6,,percent of total billed charges,,
T WRENCH MINIRAIL,,A4649,HCPCS,Facility,Outpatient,,,,473.82,402.747,135.796812,473.82,"Health Partners, Inc.",Medicare Advantage,232.1718,49,,percent of total billed charges,,
T WRENCH MINIRAIL,,A4649,HCPCS,Facility,Inpatient,,,,473.82,402.747,135.796812,473.82,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
T WRENCH MINIRAIL,,A4649,HCPCS,Facility,Both,,,,473.82,402.747,135.796812,473.82,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),284.292,60,,percent of total billed charges,,
T WRENCH MINIRAIL,,A4649,HCPCS,Facility,Both,,,,473.82,402.747,135.796812,473.82,"Health Partners, Inc.",State of Minnesota Advantage Program,386.1633,81.5,,percent of total billed charges,,
T WRENCH MINIRAIL,,A4649,HCPCS,Facility,Both,,,,473.82,402.747,135.796812,473.82,"Health Partners, Inc.",State Public Programs,236.91,50,,percent of total billed charges,,
T WRENCH MINIRAIL,,A4649,HCPCS,Facility,Both,,,,473.82,402.747,135.796812,473.82,Humana Insurance Company,Commercial PPO,450.129,95,,percent of total billed charges,,
T WRENCH MINIRAIL,,A4649,HCPCS,Facility,Outpatient,,,,473.82,402.747,135.796812,473.82,Humana Insurance Company,Medicare PPO,232.1718,49,,percent of total billed charges,,
T WRENCH MINIRAIL,,A4649,HCPCS,Facility,Inpatient,,,,473.82,402.747,135.796812,473.82,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
T WRENCH MINIRAIL,,A4649,HCPCS,Facility,Both,,,,473.82,402.747,135.796812,473.82,Medica,Individual & Family,469.55562,99.1,,percent of total billed charges,,
T WRENCH MINIRAIL,,A4649,HCPCS,Facility,Outpatient,,,,473.82,402.747,135.796812,473.82,Medica,Medica Advantage Solution,235.96236,49.8,,percent of total billed charges,,
T WRENCH MINIRAIL,,A4649,HCPCS,Facility,Inpatient,,,,473.82,402.747,135.796812,473.82,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
T WRENCH MINIRAIL,,A4649,HCPCS,Facility,Outpatient,,,,473.82,402.747,135.796812,473.82,Medica,Medical Assistance,211.32372,44.6,,percent of total billed charges,,
T WRENCH MINIRAIL,,A4649,HCPCS,Facility,Inpatient,,,,473.82,402.747,135.796812,473.82,Medica,Medical Assistance,,,,,Included in per diem rate,
T WRENCH MINIRAIL,,A4649,HCPCS,Facility,Outpatient,,,,473.82,402.747,135.796812,473.82,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,235.96236,49.8,,percent of total billed charges,,
T WRENCH MINIRAIL,,A4649,HCPCS,Facility,Inpatient,,,,473.82,402.747,135.796812,473.82,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
T WRENCH MINIRAIL,,A4649,HCPCS,Facility,Both,,,,473.82,402.747,135.796812,473.82,"Multiplan, Inc.","Multiplan, Inc.",445.3908,94,,percent of total billed charges,,
T WRENCH MINIRAIL,,A4649,HCPCS,Facility,Outpatient,,,,473.82,402.747,135.796812,473.82,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,426.91182,90.1,,percent of total billed charges,,
T WRENCH MINIRAIL,,A4649,HCPCS,Facility,Inpatient,,,,473.82,402.747,135.796812,473.82,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
T WRENCH MINIRAIL,,A4649,HCPCS,Facility,Both,,,,473.82,402.747,135.796812,473.82,"Preferred One Administrative Services, INC.",PPO,467.18652,98.6,,percent of total billed charges,,
T WRENCH MINIRAIL,,A4649,HCPCS,Facility,Outpatient,,,,473.82,402.747,135.796812,473.82,PrimeWest Health,Minnesota Senior Health Options (MSHO),243.78039,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
T WRENCH MINIRAIL,,A4649,HCPCS,Facility,Inpatient,,,,473.82,402.747,135.796812,473.82,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
T WRENCH MINIRAIL,,A4649,HCPCS,Facility,Outpatient,,,,473.82,402.747,135.796812,473.82,PrimeWest Health,MinnesotaCare,243.353952,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
T WRENCH MINIRAIL,,A4649,HCPCS,Facility,Inpatient,,,,473.82,402.747,135.796812,473.82,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
T WRENCH MINIRAIL,,A4649,HCPCS,Facility,Both,,,,473.82,402.747,135.796812,473.82,Sanford Health Plan,Sanford Health Plan,435.9144,92,,percent of total billed charges,,
T WRENCH MINIRAIL,,A4649,HCPCS,Facility,Outpatient,,,,473.82,402.747,135.796812,473.82,"UCare Health, Inc.",Individual & Family Plan,266.99757,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
T WRENCH MINIRAIL,,A4649,HCPCS,Facility,Inpatient,,,,473.82,402.747,135.796812,473.82,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
T WRENCH MINIRAIL,,A4649,HCPCS,Facility,Outpatient,,,,473.82,402.747,135.796812,473.82,"UCare Health, Inc.",Medical Assistance,239.136954,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
T WRENCH MINIRAIL,,A4649,HCPCS,Facility,Inpatient,,,,473.82,402.747,135.796812,473.82,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
T WRENCH MINIRAIL,,A4649,HCPCS,Facility,Outpatient,,,,473.82,402.747,135.796812,473.82,"UCare Health, Inc.",Medicare Advantage,239.136954,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
T WRENCH MINIRAIL,,A4649,HCPCS,Facility,Inpatient,,,,473.82,402.747,135.796812,473.82,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
T WRENCH MINIRAIL,,A4649,HCPCS,Facility,Outpatient,,,,473.82,402.747,135.796812,473.82,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),239.136954,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
T WRENCH MINIRAIL,,A4649,HCPCS,Facility,Inpatient,,,,473.82,402.747,135.796812,473.82,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
T WRENCH MINIRAIL,,A4649,HCPCS,Facility,Both,,,,473.82,402.747,135.796812,473.82,UnitedHealthcare,Individual & Family,445.3908,94,,percent of total billed charges,,
T WRENCH MINIRAIL,,A4649,HCPCS,Facility,Outpatient,,,,473.82,402.747,135.796812,473.82,UnitedHealthcare,Medicare Advantage,232.1718,49,,percent of total billed charges,,
T WRENCH MINIRAIL,,A4649,HCPCS,Facility,Inpatient,,,,473.82,402.747,135.796812,473.82,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
T WRENCH MINIRAIL,,A4649,HCPCS,Facility,Outpatient,,,,473.82,402.747,135.796812,473.82,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,227.4336,48,,percent of total billed charges,,100% of DHS outpatient percentage
T WRENCH MINIRAIL,,A4649,HCPCS,Facility,Inpatient,,,,473.82,402.747,135.796812,473.82,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
TACKER PROTACK 5MM INSTRUMENT     174006,,A4649,HCPCS,Facility,Both,,,,1381.02,1173.867,395.800332,1381.02,Aetna,Commercial,1270.5384,92,,percent of total billed charges,,
TACKER PROTACK 5MM INSTRUMENT     174006,,A4649,HCPCS,Facility,Outpatient,,,,1381.02,1173.867,395.800332,1381.02,Aetna,Medicare Advantage,676.6998,49,,percent of total billed charges,,
TACKER PROTACK 5MM INSTRUMENT     174006,,A4649,HCPCS,Facility,Inpatient,,,,1381.02,1173.867,395.800332,1381.02,Aetna,Medicare Advantage,,,,,Included in per diem rate,
TACKER PROTACK 5MM INSTRUMENT     174006,,A4649,HCPCS,Facility,Both,,,,1381.02,1173.867,395.800332,1381.02,Aetna,PPO,1284.3486,93,,percent of total billed charges,,
TACKER PROTACK 5MM INSTRUMENT     174006,,A4649,HCPCS,Facility,Both,,,,1381.02,1173.867,395.800332,1381.02,America's PPO,America's PPO,1326.193506,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
TACKER PROTACK 5MM INSTRUMENT     174006,,A4649,HCPCS,Facility,Both,,,,1381.02,1173.867,395.800332,1381.02,BlueCross BlueShield Minnesota, Federal Employee Program,1358.92368,98.4,,percent of total billed charges,,
TACKER PROTACK 5MM INSTRUMENT     174006,,A4649,HCPCS,Facility,Both,,,,1381.02,1173.867,395.800332,1381.02,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1381.02,100,,percent of total billed charges,,
TACKER PROTACK 5MM INSTRUMENT     174006,,A4649,HCPCS,Facility,Both,,,,1381.02,1173.867,395.800332,1381.02,BlueCross BlueShield Minnesota,High Value Network Plan,1242.918,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
TACKER PROTACK 5MM INSTRUMENT     174006,,A4649,HCPCS,Facility,Outpatient,,,,1381.02,1173.867,395.800332,1381.02,BlueCross BlueShield Minnesota,Medicare Advantage,676.6998,49,,percent of total billed charges,,
TACKER PROTACK 5MM INSTRUMENT     174006,,A4649,HCPCS,Facility,Inpatient,,,,1381.02,1173.867,395.800332,1381.02,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
TACKER PROTACK 5MM INSTRUMENT     174006,,A4649,HCPCS,Facility,Both,,,,1381.02,1173.867,395.800332,1381.02,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1223.169414,88.57,,percent of total billed charges,,
TACKER PROTACK 5MM INSTRUMENT     174006,,A4649,HCPCS,Facility,Both,,,,1381.02,1173.867,395.800332,1381.02,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,395.800332,28.66,,percent of total billed charges,,
TACKER PROTACK 5MM INSTRUMENT     174006,,A4649,HCPCS,Facility,Outpatient,,,,1381.02,1173.867,395.800332,1381.02,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),676.6998,49,,percent of total billed charges,,
TACKER PROTACK 5MM INSTRUMENT     174006,,A4649,HCPCS,Facility,Inpatient,,,,1381.02,1173.867,395.800332,1381.02,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
TACKER PROTACK 5MM INSTRUMENT     174006,,A4649,HCPCS,Facility,Both,,,,1381.02,1173.867,395.800332,1381.02,CorVel,Worker's Compensation,1381.02,100,,percent of total billed charges,,
TACKER PROTACK 5MM INSTRUMENT     174006,,A4649,HCPCS,Facility,Both,,,,1381.02,1173.867,395.800332,1381.02,First Health Group Corporation,First Health Network,1339.5894,97,,percent of total billed charges,,
TACKER PROTACK 5MM INSTRUMENT     174006,,A4649,HCPCS,Facility,Both,,,,1381.02,1173.867,395.800332,1381.02,"Health Partners, Inc.",Commercial,1306.44492,94.6,,percent of total billed charges,,
TACKER PROTACK 5MM INSTRUMENT     174006,,A4649,HCPCS,Facility,Outpatient,,,,1381.02,1173.867,395.800332,1381.02,"Health Partners, Inc.",Medicare Advantage,676.6998,49,,percent of total billed charges,,
TACKER PROTACK 5MM INSTRUMENT     174006,,A4649,HCPCS,Facility,Inpatient,,,,1381.02,1173.867,395.800332,1381.02,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
TACKER PROTACK 5MM INSTRUMENT     174006,,A4649,HCPCS,Facility,Both,,,,1381.02,1173.867,395.800332,1381.02,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),828.612,60,,percent of total billed charges,,
TACKER PROTACK 5MM INSTRUMENT     174006,,A4649,HCPCS,Facility,Both,,,,1381.02,1173.867,395.800332,1381.02,"Health Partners, Inc.",State of Minnesota Advantage Program,1125.5313,81.5,,percent of total billed charges,,
TACKER PROTACK 5MM INSTRUMENT     174006,,A4649,HCPCS,Facility,Both,,,,1381.02,1173.867,395.800332,1381.02,"Health Partners, Inc.",State Public Programs,690.51,50,,percent of total billed charges,,
TACKER PROTACK 5MM INSTRUMENT     174006,,A4649,HCPCS,Facility,Both,,,,1381.02,1173.867,395.800332,1381.02,Humana Insurance Company,Commercial PPO,1311.969,95,,percent of total billed charges,,
TACKER PROTACK 5MM INSTRUMENT     174006,,A4649,HCPCS,Facility,Outpatient,,,,1381.02,1173.867,395.800332,1381.02,Humana Insurance Company,Medicare PPO,676.6998,49,,percent of total billed charges,,
TACKER PROTACK 5MM INSTRUMENT     174006,,A4649,HCPCS,Facility,Inpatient,,,,1381.02,1173.867,395.800332,1381.02,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
TACKER PROTACK 5MM INSTRUMENT     174006,,A4649,HCPCS,Facility,Both,,,,1381.02,1173.867,395.800332,1381.02,Medica,Individual & Family,1368.59082,99.1,,percent of total billed charges,,
TACKER PROTACK 5MM INSTRUMENT     174006,,A4649,HCPCS,Facility,Outpatient,,,,1381.02,1173.867,395.800332,1381.02,Medica,Medica Advantage Solution,687.74796,49.8,,percent of total billed charges,,
TACKER PROTACK 5MM INSTRUMENT     174006,,A4649,HCPCS,Facility,Inpatient,,,,1381.02,1173.867,395.800332,1381.02,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
TACKER PROTACK 5MM INSTRUMENT     174006,,A4649,HCPCS,Facility,Outpatient,,,,1381.02,1173.867,395.800332,1381.02,Medica,Medical Assistance,615.93492,44.6,,percent of total billed charges,,
TACKER PROTACK 5MM INSTRUMENT     174006,,A4649,HCPCS,Facility,Inpatient,,,,1381.02,1173.867,395.800332,1381.02,Medica,Medical Assistance,,,,,Included in per diem rate,
TACKER PROTACK 5MM INSTRUMENT     174006,,A4649,HCPCS,Facility,Outpatient,,,,1381.02,1173.867,395.800332,1381.02,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,687.74796,49.8,,percent of total billed charges,,
TACKER PROTACK 5MM INSTRUMENT     174006,,A4649,HCPCS,Facility,Inpatient,,,,1381.02,1173.867,395.800332,1381.02,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
TACKER PROTACK 5MM INSTRUMENT     174006,,A4649,HCPCS,Facility,Both,,,,1381.02,1173.867,395.800332,1381.02,"Multiplan, Inc.","Multiplan, Inc.",1298.1588,94,,percent of total billed charges,,
TACKER PROTACK 5MM INSTRUMENT     174006,,A4649,HCPCS,Facility,Outpatient,,,,1381.02,1173.867,395.800332,1381.02,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1244.29902,90.1,,percent of total billed charges,,
TACKER PROTACK 5MM INSTRUMENT     174006,,A4649,HCPCS,Facility,Inpatient,,,,1381.02,1173.867,395.800332,1381.02,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
TACKER PROTACK 5MM INSTRUMENT     174006,,A4649,HCPCS,Facility,Both,,,,1381.02,1173.867,395.800332,1381.02,"Preferred One Administrative Services, INC.",PPO,1361.68572,98.6,,percent of total billed charges,,
TACKER PROTACK 5MM INSTRUMENT     174006,,A4649,HCPCS,Facility,Outpatient,,,,1381.02,1173.867,395.800332,1381.02,PrimeWest Health,Minnesota Senior Health Options (MSHO),710.53479,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
TACKER PROTACK 5MM INSTRUMENT     174006,,A4649,HCPCS,Facility,Inpatient,,,,1381.02,1173.867,395.800332,1381.02,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
TACKER PROTACK 5MM INSTRUMENT     174006,,A4649,HCPCS,Facility,Outpatient,,,,1381.02,1173.867,395.800332,1381.02,PrimeWest Health,MinnesotaCare,709.291872,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
TACKER PROTACK 5MM INSTRUMENT     174006,,A4649,HCPCS,Facility,Inpatient,,,,1381.02,1173.867,395.800332,1381.02,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
TACKER PROTACK 5MM INSTRUMENT     174006,,A4649,HCPCS,Facility,Both,,,,1381.02,1173.867,395.800332,1381.02,Sanford Health Plan,Sanford Health Plan,1270.5384,92,,percent of total billed charges,,
TACKER PROTACK 5MM INSTRUMENT     174006,,A4649,HCPCS,Facility,Outpatient,,,,1381.02,1173.867,395.800332,1381.02,"UCare Health, Inc.",Individual & Family Plan,778.20477,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
TACKER PROTACK 5MM INSTRUMENT     174006,,A4649,HCPCS,Facility,Inpatient,,,,1381.02,1173.867,395.800332,1381.02,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
TACKER PROTACK 5MM INSTRUMENT     174006,,A4649,HCPCS,Facility,Outpatient,,,,1381.02,1173.867,395.800332,1381.02,"UCare Health, Inc.",Medical Assistance,697.000794,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TACKER PROTACK 5MM INSTRUMENT     174006,,A4649,HCPCS,Facility,Inpatient,,,,1381.02,1173.867,395.800332,1381.02,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
TACKER PROTACK 5MM INSTRUMENT     174006,,A4649,HCPCS,Facility,Outpatient,,,,1381.02,1173.867,395.800332,1381.02,"UCare Health, Inc.",Medicare Advantage,697.000794,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TACKER PROTACK 5MM INSTRUMENT     174006,,A4649,HCPCS,Facility,Inpatient,,,,1381.02,1173.867,395.800332,1381.02,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
TACKER PROTACK 5MM INSTRUMENT     174006,,A4649,HCPCS,Facility,Outpatient,,,,1381.02,1173.867,395.800332,1381.02,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),697.000794,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TACKER PROTACK 5MM INSTRUMENT     174006,,A4649,HCPCS,Facility,Inpatient,,,,1381.02,1173.867,395.800332,1381.02,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
TACKER PROTACK 5MM INSTRUMENT     174006,,A4649,HCPCS,Facility,Both,,,,1381.02,1173.867,395.800332,1381.02,UnitedHealthcare,Individual & Family,1298.1588,94,,percent of total billed charges,,
TACKER PROTACK 5MM INSTRUMENT     174006,,A4649,HCPCS,Facility,Outpatient,,,,1381.02,1173.867,395.800332,1381.02,UnitedHealthcare,Medicare Advantage,676.6998,49,,percent of total billed charges,,
TACKER PROTACK 5MM INSTRUMENT     174006,,A4649,HCPCS,Facility,Inpatient,,,,1381.02,1173.867,395.800332,1381.02,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
TACKER PROTACK 5MM INSTRUMENT     174006,,A4649,HCPCS,Facility,Outpatient,,,,1381.02,1173.867,395.800332,1381.02,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,662.8896,48,,percent of total billed charges,,100% of DHS outpatient percentage
TACKER PROTACK 5MM INSTRUMENT     174006,,A4649,HCPCS,Facility,Inpatient,,,,1381.02,1173.867,395.800332,1381.02,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
TI-KNOT DEVICE LSI  030404,,A4649,HCPCS,Facility,Both,,,,609.375,517.96875,174.646875,609.375,Aetna,Commercial,560.625,92,,percent of total billed charges,,
TI-KNOT DEVICE LSI  030404,,A4649,HCPCS,Facility,Outpatient,,,,609.375,517.96875,174.646875,609.375,Aetna,Medicare Advantage,298.59375,49,,percent of total billed charges,,
TI-KNOT DEVICE LSI  030404,,A4649,HCPCS,Facility,Inpatient,,,,609.375,517.96875,174.646875,609.375,Aetna,Medicare Advantage,,,,,Included in per diem rate,
TI-KNOT DEVICE LSI  030404,,A4649,HCPCS,Facility,Both,,,,609.375,517.96875,174.646875,609.375,Aetna,PPO,566.71875,93,,percent of total billed charges,,
TI-KNOT DEVICE LSI  030404,,A4649,HCPCS,Facility,Both,,,,609.375,517.96875,174.646875,609.375,America's PPO,America's PPO,585.1828125,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
TI-KNOT DEVICE LSI  030404,,A4649,HCPCS,Facility,Both,,,,609.375,517.96875,174.646875,609.375,BlueCross BlueShield Minnesota, Federal Employee Program,599.625,98.4,,percent of total billed charges,,
TI-KNOT DEVICE LSI  030404,,A4649,HCPCS,Facility,Both,,,,609.375,517.96875,174.646875,609.375,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,609.375,100,,percent of total billed charges,,
TI-KNOT DEVICE LSI  030404,,A4649,HCPCS,Facility,Both,,,,609.375,517.96875,174.646875,609.375,BlueCross BlueShield Minnesota,High Value Network Plan,548.4375,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
TI-KNOT DEVICE LSI  030404,,A4649,HCPCS,Facility,Outpatient,,,,609.375,517.96875,174.646875,609.375,BlueCross BlueShield Minnesota,Medicare Advantage,298.59375,49,,percent of total billed charges,,
TI-KNOT DEVICE LSI  030404,,A4649,HCPCS,Facility,Inpatient,,,,609.375,517.96875,174.646875,609.375,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
TI-KNOT DEVICE LSI  030404,,A4649,HCPCS,Facility,Both,,,,609.375,517.96875,174.646875,609.375,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,539.7234375,88.57,,percent of total billed charges,,
TI-KNOT DEVICE LSI  030404,,A4649,HCPCS,Facility,Both,,,,609.375,517.96875,174.646875,609.375,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,174.646875,28.66,,percent of total billed charges,,
TI-KNOT DEVICE LSI  030404,,A4649,HCPCS,Facility,Outpatient,,,,609.375,517.96875,174.646875,609.375,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),298.59375,49,,percent of total billed charges,,
TI-KNOT DEVICE LSI  030404,,A4649,HCPCS,Facility,Inpatient,,,,609.375,517.96875,174.646875,609.375,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
TI-KNOT DEVICE LSI  030404,,A4649,HCPCS,Facility,Both,,,,609.375,517.96875,174.646875,609.375,CorVel,Worker's Compensation,609.375,100,,percent of total billed charges,,
TI-KNOT DEVICE LSI  030404,,A4649,HCPCS,Facility,Both,,,,609.375,517.96875,174.646875,609.375,First Health Group Corporation,First Health Network,591.09375,97,,percent of total billed charges,,
TI-KNOT DEVICE LSI  030404,,A4649,HCPCS,Facility,Both,,,,609.375,517.96875,174.646875,609.375,"Health Partners, Inc.",Commercial,576.46875,94.6,,percent of total billed charges,,
TI-KNOT DEVICE LSI  030404,,A4649,HCPCS,Facility,Outpatient,,,,609.375,517.96875,174.646875,609.375,"Health Partners, Inc.",Medicare Advantage,298.59375,49,,percent of total billed charges,,
TI-KNOT DEVICE LSI  030404,,A4649,HCPCS,Facility,Inpatient,,,,609.375,517.96875,174.646875,609.375,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
TI-KNOT DEVICE LSI  030404,,A4649,HCPCS,Facility,Both,,,,609.375,517.96875,174.646875,609.375,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),365.625,60,,percent of total billed charges,,
TI-KNOT DEVICE LSI  030404,,A4649,HCPCS,Facility,Both,,,,609.375,517.96875,174.646875,609.375,"Health Partners, Inc.",State of Minnesota Advantage Program,496.640625,81.5,,percent of total billed charges,,
TI-KNOT DEVICE LSI  030404,,A4649,HCPCS,Facility,Both,,,,609.375,517.96875,174.646875,609.375,"Health Partners, Inc.",State Public Programs,304.6875,50,,percent of total billed charges,,
TI-KNOT DEVICE LSI  030404,,A4649,HCPCS,Facility,Both,,,,609.375,517.96875,174.646875,609.375,Humana Insurance Company,Commercial PPO,578.90625,95,,percent of total billed charges,,
TI-KNOT DEVICE LSI  030404,,A4649,HCPCS,Facility,Outpatient,,,,609.375,517.96875,174.646875,609.375,Humana Insurance Company,Medicare PPO,298.59375,49,,percent of total billed charges,,
TI-KNOT DEVICE LSI  030404,,A4649,HCPCS,Facility,Inpatient,,,,609.375,517.96875,174.646875,609.375,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
TI-KNOT DEVICE LSI  030404,,A4649,HCPCS,Facility,Both,,,,609.375,517.96875,174.646875,609.375,Medica,Individual & Family,603.890625,99.1,,percent of total billed charges,,
TI-KNOT DEVICE LSI  030404,,A4649,HCPCS,Facility,Outpatient,,,,609.375,517.96875,174.646875,609.375,Medica,Medica Advantage Solution,303.46875,49.8,,percent of total billed charges,,
TI-KNOT DEVICE LSI  030404,,A4649,HCPCS,Facility,Inpatient,,,,609.375,517.96875,174.646875,609.375,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
TI-KNOT DEVICE LSI  030404,,A4649,HCPCS,Facility,Outpatient,,,,609.375,517.96875,174.646875,609.375,Medica,Medical Assistance,271.78125,44.6,,percent of total billed charges,,
TI-KNOT DEVICE LSI  030404,,A4649,HCPCS,Facility,Inpatient,,,,609.375,517.96875,174.646875,609.375,Medica,Medical Assistance,,,,,Included in per diem rate,
TI-KNOT DEVICE LSI  030404,,A4649,HCPCS,Facility,Outpatient,,,,609.375,517.96875,174.646875,609.375,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,303.46875,49.8,,percent of total billed charges,,
TI-KNOT DEVICE LSI  030404,,A4649,HCPCS,Facility,Inpatient,,,,609.375,517.96875,174.646875,609.375,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
TI-KNOT DEVICE LSI  030404,,A4649,HCPCS,Facility,Both,,,,609.375,517.96875,174.646875,609.375,"Multiplan, Inc.","Multiplan, Inc.",572.8125,94,,percent of total billed charges,,
TI-KNOT DEVICE LSI  030404,,A4649,HCPCS,Facility,Outpatient,,,,609.375,517.96875,174.646875,609.375,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,549.046875,90.1,,percent of total billed charges,,
TI-KNOT DEVICE LSI  030404,,A4649,HCPCS,Facility,Inpatient,,,,609.375,517.96875,174.646875,609.375,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
TI-KNOT DEVICE LSI  030404,,A4649,HCPCS,Facility,Both,,,,609.375,517.96875,174.646875,609.375,"Preferred One Administrative Services, INC.",PPO,600.84375,98.6,,percent of total billed charges,,
TI-KNOT DEVICE LSI  030404,,A4649,HCPCS,Facility,Outpatient,,,,609.375,517.96875,174.646875,609.375,PrimeWest Health,Minnesota Senior Health Options (MSHO),313.5234375,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
TI-KNOT DEVICE LSI  030404,,A4649,HCPCS,Facility,Inpatient,,,,609.375,517.96875,174.646875,609.375,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
TI-KNOT DEVICE LSI  030404,,A4649,HCPCS,Facility,Outpatient,,,,609.375,517.96875,174.646875,609.375,PrimeWest Health,MinnesotaCare,312.975,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
TI-KNOT DEVICE LSI  030404,,A4649,HCPCS,Facility,Inpatient,,,,609.375,517.96875,174.646875,609.375,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
TI-KNOT DEVICE LSI  030404,,A4649,HCPCS,Facility,Both,,,,609.375,517.96875,174.646875,609.375,Sanford Health Plan,Sanford Health Plan,560.625,92,,percent of total billed charges,,
TI-KNOT DEVICE LSI  030404,,A4649,HCPCS,Facility,Outpatient,,,,609.375,517.96875,174.646875,609.375,"UCare Health, Inc.",Individual & Family Plan,343.3828125,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
TI-KNOT DEVICE LSI  030404,,A4649,HCPCS,Facility,Inpatient,,,,609.375,517.96875,174.646875,609.375,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
TI-KNOT DEVICE LSI  030404,,A4649,HCPCS,Facility,Outpatient,,,,609.375,517.96875,174.646875,609.375,"UCare Health, Inc.",Medical Assistance,307.5515625,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TI-KNOT DEVICE LSI  030404,,A4649,HCPCS,Facility,Inpatient,,,,609.375,517.96875,174.646875,609.375,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
TI-KNOT DEVICE LSI  030404,,A4649,HCPCS,Facility,Outpatient,,,,609.375,517.96875,174.646875,609.375,"UCare Health, Inc.",Medicare Advantage,307.5515625,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TI-KNOT DEVICE LSI  030404,,A4649,HCPCS,Facility,Inpatient,,,,609.375,517.96875,174.646875,609.375,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
TI-KNOT DEVICE LSI  030404,,A4649,HCPCS,Facility,Outpatient,,,,609.375,517.96875,174.646875,609.375,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),307.5515625,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TI-KNOT DEVICE LSI  030404,,A4649,HCPCS,Facility,Inpatient,,,,609.375,517.96875,174.646875,609.375,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
TI-KNOT DEVICE LSI  030404,,A4649,HCPCS,Facility,Both,,,,609.375,517.96875,174.646875,609.375,UnitedHealthcare,Individual & Family,572.8125,94,,percent of total billed charges,,
TI-KNOT DEVICE LSI  030404,,A4649,HCPCS,Facility,Outpatient,,,,609.375,517.96875,174.646875,609.375,UnitedHealthcare,Medicare Advantage,298.59375,49,,percent of total billed charges,,
TI-KNOT DEVICE LSI  030404,,A4649,HCPCS,Facility,Inpatient,,,,609.375,517.96875,174.646875,609.375,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
TI-KNOT DEVICE LSI  030404,,A4649,HCPCS,Facility,Outpatient,,,,609.375,517.96875,174.646875,609.375,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,292.5,48,,percent of total billed charges,,100% of DHS outpatient percentage
TI-KNOT DEVICE LSI  030404,,A4649,HCPCS,Facility,Inpatient,,,,609.375,517.96875,174.646875,609.375,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
TITANIUM REUTER-BOBBIN VENT TUBE 1MM,,A4649,HCPCS,Facility,Both,,,,131,111.35,37.5446,131,Aetna,Commercial,120.52,92,,percent of total billed charges,,
TITANIUM REUTER-BOBBIN VENT TUBE 1MM,,A4649,HCPCS,Facility,Outpatient,,,,131,111.35,37.5446,131,Aetna,Medicare Advantage,64.19,49,,percent of total billed charges,,
TITANIUM REUTER-BOBBIN VENT TUBE 1MM,,A4649,HCPCS,Facility,Inpatient,,,,131,111.35,37.5446,131,Aetna,Medicare Advantage,,,,,Included in per diem rate,
TITANIUM REUTER-BOBBIN VENT TUBE 1MM,,A4649,HCPCS,Facility,Both,,,,131,111.35,37.5446,131,Aetna,PPO,121.83,93,,percent of total billed charges,,
TITANIUM REUTER-BOBBIN VENT TUBE 1MM,,A4649,HCPCS,Facility,Both,,,,131,111.35,37.5446,131,America's PPO,America's PPO,125.7993,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
TITANIUM REUTER-BOBBIN VENT TUBE 1MM,,A4649,HCPCS,Facility,Both,,,,131,111.35,37.5446,131,BlueCross BlueShield Minnesota, Federal Employee Program,128.904,98.4,,percent of total billed charges,,
TITANIUM REUTER-BOBBIN VENT TUBE 1MM,,A4649,HCPCS,Facility,Both,,,,131,111.35,37.5446,131,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,131,100,,percent of total billed charges,,
TITANIUM REUTER-BOBBIN VENT TUBE 1MM,,A4649,HCPCS,Facility,Both,,,,131,111.35,37.5446,131,BlueCross BlueShield Minnesota,High Value Network Plan,117.9,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
TITANIUM REUTER-BOBBIN VENT TUBE 1MM,,A4649,HCPCS,Facility,Outpatient,,,,131,111.35,37.5446,131,BlueCross BlueShield Minnesota,Medicare Advantage,64.19,49,,percent of total billed charges,,
TITANIUM REUTER-BOBBIN VENT TUBE 1MM,,A4649,HCPCS,Facility,Inpatient,,,,131,111.35,37.5446,131,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
TITANIUM REUTER-BOBBIN VENT TUBE 1MM,,A4649,HCPCS,Facility,Both,,,,131,111.35,37.5446,131,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,116.0267,88.57,,percent of total billed charges,,
TITANIUM REUTER-BOBBIN VENT TUBE 1MM,,A4649,HCPCS,Facility,Both,,,,131,111.35,37.5446,131,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,37.5446,28.66,,percent of total billed charges,,
TITANIUM REUTER-BOBBIN VENT TUBE 1MM,,A4649,HCPCS,Facility,Outpatient,,,,131,111.35,37.5446,131,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),64.19,49,,percent of total billed charges,,
TITANIUM REUTER-BOBBIN VENT TUBE 1MM,,A4649,HCPCS,Facility,Inpatient,,,,131,111.35,37.5446,131,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
TITANIUM REUTER-BOBBIN VENT TUBE 1MM,,A4649,HCPCS,Facility,Both,,,,131,111.35,37.5446,131,CorVel,Worker's Compensation,131,100,,percent of total billed charges,,
TITANIUM REUTER-BOBBIN VENT TUBE 1MM,,A4649,HCPCS,Facility,Both,,,,131,111.35,37.5446,131,First Health Group Corporation,First Health Network,127.07,97,,percent of total billed charges,,
TITANIUM REUTER-BOBBIN VENT TUBE 1MM,,A4649,HCPCS,Facility,Both,,,,131,111.35,37.5446,131,"Health Partners, Inc.",Commercial,123.926,94.6,,percent of total billed charges,,
TITANIUM REUTER-BOBBIN VENT TUBE 1MM,,A4649,HCPCS,Facility,Outpatient,,,,131,111.35,37.5446,131,"Health Partners, Inc.",Medicare Advantage,64.19,49,,percent of total billed charges,,
TITANIUM REUTER-BOBBIN VENT TUBE 1MM,,A4649,HCPCS,Facility,Inpatient,,,,131,111.35,37.5446,131,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
TITANIUM REUTER-BOBBIN VENT TUBE 1MM,,A4649,HCPCS,Facility,Both,,,,131,111.35,37.5446,131,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),78.6,60,,percent of total billed charges,,
TITANIUM REUTER-BOBBIN VENT TUBE 1MM,,A4649,HCPCS,Facility,Both,,,,131,111.35,37.5446,131,"Health Partners, Inc.",State of Minnesota Advantage Program,106.765,81.5,,percent of total billed charges,,
TITANIUM REUTER-BOBBIN VENT TUBE 1MM,,A4649,HCPCS,Facility,Both,,,,131,111.35,37.5446,131,"Health Partners, Inc.",State Public Programs,65.5,50,,percent of total billed charges,,
TITANIUM REUTER-BOBBIN VENT TUBE 1MM,,A4649,HCPCS,Facility,Both,,,,131,111.35,37.5446,131,Humana Insurance Company,Commercial PPO,124.45,95,,percent of total billed charges,,
TITANIUM REUTER-BOBBIN VENT TUBE 1MM,,A4649,HCPCS,Facility,Outpatient,,,,131,111.35,37.5446,131,Humana Insurance Company,Medicare PPO,64.19,49,,percent of total billed charges,,
TITANIUM REUTER-BOBBIN VENT TUBE 1MM,,A4649,HCPCS,Facility,Inpatient,,,,131,111.35,37.5446,131,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
TITANIUM REUTER-BOBBIN VENT TUBE 1MM,,A4649,HCPCS,Facility,Both,,,,131,111.35,37.5446,131,Medica,Individual & Family,129.821,99.1,,percent of total billed charges,,
TITANIUM REUTER-BOBBIN VENT TUBE 1MM,,A4649,HCPCS,Facility,Outpatient,,,,131,111.35,37.5446,131,Medica,Medica Advantage Solution,65.238,49.8,,percent of total billed charges,,
TITANIUM REUTER-BOBBIN VENT TUBE 1MM,,A4649,HCPCS,Facility,Inpatient,,,,131,111.35,37.5446,131,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
TITANIUM REUTER-BOBBIN VENT TUBE 1MM,,A4649,HCPCS,Facility,Outpatient,,,,131,111.35,37.5446,131,Medica,Medical Assistance,58.426,44.6,,percent of total billed charges,,
TITANIUM REUTER-BOBBIN VENT TUBE 1MM,,A4649,HCPCS,Facility,Inpatient,,,,131,111.35,37.5446,131,Medica,Medical Assistance,,,,,Included in per diem rate,
TITANIUM REUTER-BOBBIN VENT TUBE 1MM,,A4649,HCPCS,Facility,Outpatient,,,,131,111.35,37.5446,131,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,65.238,49.8,,percent of total billed charges,,
TITANIUM REUTER-BOBBIN VENT TUBE 1MM,,A4649,HCPCS,Facility,Inpatient,,,,131,111.35,37.5446,131,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
TITANIUM REUTER-BOBBIN VENT TUBE 1MM,,A4649,HCPCS,Facility,Both,,,,131,111.35,37.5446,131,"Multiplan, Inc.","Multiplan, Inc.",123.14,94,,percent of total billed charges,,
TITANIUM REUTER-BOBBIN VENT TUBE 1MM,,A4649,HCPCS,Facility,Outpatient,,,,131,111.35,37.5446,131,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,118.031,90.1,,percent of total billed charges,,
TITANIUM REUTER-BOBBIN VENT TUBE 1MM,,A4649,HCPCS,Facility,Inpatient,,,,131,111.35,37.5446,131,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
TITANIUM REUTER-BOBBIN VENT TUBE 1MM,,A4649,HCPCS,Facility,Both,,,,131,111.35,37.5446,131,"Preferred One Administrative Services, INC.",PPO,129.166,98.6,,percent of total billed charges,,
TITANIUM REUTER-BOBBIN VENT TUBE 1MM,,A4649,HCPCS,Facility,Outpatient,,,,131,111.35,37.5446,131,PrimeWest Health,Minnesota Senior Health Options (MSHO),67.3995,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
TITANIUM REUTER-BOBBIN VENT TUBE 1MM,,A4649,HCPCS,Facility,Inpatient,,,,131,111.35,37.5446,131,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
TITANIUM REUTER-BOBBIN VENT TUBE 1MM,,A4649,HCPCS,Facility,Outpatient,,,,131,111.35,37.5446,131,PrimeWest Health,MinnesotaCare,67.2816,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
TITANIUM REUTER-BOBBIN VENT TUBE 1MM,,A4649,HCPCS,Facility,Inpatient,,,,131,111.35,37.5446,131,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
TITANIUM REUTER-BOBBIN VENT TUBE 1MM,,A4649,HCPCS,Facility,Both,,,,131,111.35,37.5446,131,Sanford Health Plan,Sanford Health Plan,120.52,92,,percent of total billed charges,,
TITANIUM REUTER-BOBBIN VENT TUBE 1MM,,A4649,HCPCS,Facility,Outpatient,,,,131,111.35,37.5446,131,"UCare Health, Inc.",Individual & Family Plan,73.8185,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
TITANIUM REUTER-BOBBIN VENT TUBE 1MM,,A4649,HCPCS,Facility,Inpatient,,,,131,111.35,37.5446,131,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
TITANIUM REUTER-BOBBIN VENT TUBE 1MM,,A4649,HCPCS,Facility,Outpatient,,,,131,111.35,37.5446,131,"UCare Health, Inc.",Medical Assistance,66.1157,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TITANIUM REUTER-BOBBIN VENT TUBE 1MM,,A4649,HCPCS,Facility,Inpatient,,,,131,111.35,37.5446,131,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
TITANIUM REUTER-BOBBIN VENT TUBE 1MM,,A4649,HCPCS,Facility,Outpatient,,,,131,111.35,37.5446,131,"UCare Health, Inc.",Medicare Advantage,66.1157,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TITANIUM REUTER-BOBBIN VENT TUBE 1MM,,A4649,HCPCS,Facility,Inpatient,,,,131,111.35,37.5446,131,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
TITANIUM REUTER-BOBBIN VENT TUBE 1MM,,A4649,HCPCS,Facility,Outpatient,,,,131,111.35,37.5446,131,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),66.1157,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TITANIUM REUTER-BOBBIN VENT TUBE 1MM,,A4649,HCPCS,Facility,Inpatient,,,,131,111.35,37.5446,131,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
TITANIUM REUTER-BOBBIN VENT TUBE 1MM,,A4649,HCPCS,Facility,Both,,,,131,111.35,37.5446,131,UnitedHealthcare,Individual & Family,123.14,94,,percent of total billed charges,,
TITANIUM REUTER-BOBBIN VENT TUBE 1MM,,A4649,HCPCS,Facility,Outpatient,,,,131,111.35,37.5446,131,UnitedHealthcare,Medicare Advantage,64.19,49,,percent of total billed charges,,
TITANIUM REUTER-BOBBIN VENT TUBE 1MM,,A4649,HCPCS,Facility,Inpatient,,,,131,111.35,37.5446,131,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
TITANIUM REUTER-BOBBIN VENT TUBE 1MM,,A4649,HCPCS,Facility,Outpatient,,,,131,111.35,37.5446,131,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,62.88,48,,percent of total billed charges,,100% of DHS outpatient percentage
TITANIUM REUTER-BOBBIN VENT TUBE 1MM,,A4649,HCPCS,Facility,Inpatient,,,,131,111.35,37.5446,131,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Tourniquet Disp. Cuff 30""",,A4649,HCPCS,Facility,Both,,,,126.8,107.78,36.34088,126.8,Aetna,Commercial,116.656,92,,percent of total billed charges,,
"Tourniquet Disp. Cuff 30""",,A4649,HCPCS,Facility,Outpatient,,,,126.8,107.78,36.34088,126.8,Aetna,Medicare Advantage,62.132,49,,percent of total billed charges,,
"Tourniquet Disp. Cuff 30""",,A4649,HCPCS,Facility,Inpatient,,,,126.8,107.78,36.34088,126.8,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Tourniquet Disp. Cuff 30""",,A4649,HCPCS,Facility,Both,,,,126.8,107.78,36.34088,126.8,Aetna,PPO,117.924,93,,percent of total billed charges,,
"Tourniquet Disp. Cuff 30""",,A4649,HCPCS,Facility,Both,,,,126.8,107.78,36.34088,126.8,America's PPO,America's PPO,121.76604,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Tourniquet Disp. Cuff 30""",,A4649,HCPCS,Facility,Both,,,,126.8,107.78,36.34088,126.8,BlueCross BlueShield Minnesota, Federal Employee Program,124.7712,98.4,,percent of total billed charges,,
"Tourniquet Disp. Cuff 30""",,A4649,HCPCS,Facility,Both,,,,126.8,107.78,36.34088,126.8,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,126.8,100,,percent of total billed charges,,
"Tourniquet Disp. Cuff 30""",,A4649,HCPCS,Facility,Both,,,,126.8,107.78,36.34088,126.8,BlueCross BlueShield Minnesota,High Value Network Plan,114.12,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
"Tourniquet Disp. Cuff 30""",,A4649,HCPCS,Facility,Outpatient,,,,126.8,107.78,36.34088,126.8,BlueCross BlueShield Minnesota,Medicare Advantage,62.132,49,,percent of total billed charges,,
"Tourniquet Disp. Cuff 30""",,A4649,HCPCS,Facility,Inpatient,,,,126.8,107.78,36.34088,126.8,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Tourniquet Disp. Cuff 30""",,A4649,HCPCS,Facility,Both,,,,126.8,107.78,36.34088,126.8,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,112.30676,88.57,,percent of total billed charges,,
"Tourniquet Disp. Cuff 30""",,A4649,HCPCS,Facility,Both,,,,126.8,107.78,36.34088,126.8,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,36.34088,28.66,,percent of total billed charges,,
"Tourniquet Disp. Cuff 30""",,A4649,HCPCS,Facility,Outpatient,,,,126.8,107.78,36.34088,126.8,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),62.132,49,,percent of total billed charges,,
"Tourniquet Disp. Cuff 30""",,A4649,HCPCS,Facility,Inpatient,,,,126.8,107.78,36.34088,126.8,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Tourniquet Disp. Cuff 30""",,A4649,HCPCS,Facility,Both,,,,126.8,107.78,36.34088,126.8,CorVel,Worker's Compensation,126.8,100,,percent of total billed charges,,
"Tourniquet Disp. Cuff 30""",,A4649,HCPCS,Facility,Both,,,,126.8,107.78,36.34088,126.8,First Health Group Corporation,First Health Network,122.996,97,,percent of total billed charges,,
"Tourniquet Disp. Cuff 30""",,A4649,HCPCS,Facility,Both,,,,126.8,107.78,36.34088,126.8,"Health Partners, Inc.",Commercial,119.9528,94.6,,percent of total billed charges,,
"Tourniquet Disp. Cuff 30""",,A4649,HCPCS,Facility,Outpatient,,,,126.8,107.78,36.34088,126.8,"Health Partners, Inc.",Medicare Advantage,62.132,49,,percent of total billed charges,,
"Tourniquet Disp. Cuff 30""",,A4649,HCPCS,Facility,Inpatient,,,,126.8,107.78,36.34088,126.8,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Tourniquet Disp. Cuff 30""",,A4649,HCPCS,Facility,Both,,,,126.8,107.78,36.34088,126.8,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),76.08,60,,percent of total billed charges,,
"Tourniquet Disp. Cuff 30""",,A4649,HCPCS,Facility,Both,,,,126.8,107.78,36.34088,126.8,"Health Partners, Inc.",State of Minnesota Advantage Program,103.342,81.5,,percent of total billed charges,,
"Tourniquet Disp. Cuff 30""",,A4649,HCPCS,Facility,Both,,,,126.8,107.78,36.34088,126.8,"Health Partners, Inc.",State Public Programs,63.4,50,,percent of total billed charges,,
"Tourniquet Disp. Cuff 30""",,A4649,HCPCS,Facility,Both,,,,126.8,107.78,36.34088,126.8,Humana Insurance Company,Commercial PPO,120.46,95,,percent of total billed charges,,
"Tourniquet Disp. Cuff 30""",,A4649,HCPCS,Facility,Outpatient,,,,126.8,107.78,36.34088,126.8,Humana Insurance Company,Medicare PPO,62.132,49,,percent of total billed charges,,
"Tourniquet Disp. Cuff 30""",,A4649,HCPCS,Facility,Inpatient,,,,126.8,107.78,36.34088,126.8,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Tourniquet Disp. Cuff 30""",,A4649,HCPCS,Facility,Both,,,,126.8,107.78,36.34088,126.8,Medica,Individual & Family,125.6588,99.1,,percent of total billed charges,,
"Tourniquet Disp. Cuff 30""",,A4649,HCPCS,Facility,Outpatient,,,,126.8,107.78,36.34088,126.8,Medica,Medica Advantage Solution,63.1464,49.8,,percent of total billed charges,,
"Tourniquet Disp. Cuff 30""",,A4649,HCPCS,Facility,Inpatient,,,,126.8,107.78,36.34088,126.8,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Tourniquet Disp. Cuff 30""",,A4649,HCPCS,Facility,Outpatient,,,,126.8,107.78,36.34088,126.8,Medica,Medical Assistance,56.5528,44.6,,percent of total billed charges,,
"Tourniquet Disp. Cuff 30""",,A4649,HCPCS,Facility,Inpatient,,,,126.8,107.78,36.34088,126.8,Medica,Medical Assistance,,,,,Included in per diem rate,
"Tourniquet Disp. Cuff 30""",,A4649,HCPCS,Facility,Outpatient,,,,126.8,107.78,36.34088,126.8,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,63.1464,49.8,,percent of total billed charges,,
"Tourniquet Disp. Cuff 30""",,A4649,HCPCS,Facility,Inpatient,,,,126.8,107.78,36.34088,126.8,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Tourniquet Disp. Cuff 30""",,A4649,HCPCS,Facility,Both,,,,126.8,107.78,36.34088,126.8,"Multiplan, Inc.","Multiplan, Inc.",119.192,94,,percent of total billed charges,,
"Tourniquet Disp. Cuff 30""",,A4649,HCPCS,Facility,Outpatient,,,,126.8,107.78,36.34088,126.8,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,114.2468,90.1,,percent of total billed charges,,
"Tourniquet Disp. Cuff 30""",,A4649,HCPCS,Facility,Inpatient,,,,126.8,107.78,36.34088,126.8,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Tourniquet Disp. Cuff 30""",,A4649,HCPCS,Facility,Both,,,,126.8,107.78,36.34088,126.8,"Preferred One Administrative Services, INC.",PPO,125.0248,98.6,,percent of total billed charges,,
"Tourniquet Disp. Cuff 30""",,A4649,HCPCS,Facility,Outpatient,,,,126.8,107.78,36.34088,126.8,PrimeWest Health,Minnesota Senior Health Options (MSHO),65.2386,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Tourniquet Disp. Cuff 30""",,A4649,HCPCS,Facility,Inpatient,,,,126.8,107.78,36.34088,126.8,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Tourniquet Disp. Cuff 30""",,A4649,HCPCS,Facility,Outpatient,,,,126.8,107.78,36.34088,126.8,PrimeWest Health,MinnesotaCare,65.12448,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Tourniquet Disp. Cuff 30""",,A4649,HCPCS,Facility,Inpatient,,,,126.8,107.78,36.34088,126.8,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Tourniquet Disp. Cuff 30""",,A4649,HCPCS,Facility,Both,,,,126.8,107.78,36.34088,126.8,Sanford Health Plan,Sanford Health Plan,116.656,92,,percent of total billed charges,,
"Tourniquet Disp. Cuff 30""",,A4649,HCPCS,Facility,Outpatient,,,,126.8,107.78,36.34088,126.8,"UCare Health, Inc.",Individual & Family Plan,71.4518,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Tourniquet Disp. Cuff 30""",,A4649,HCPCS,Facility,Inpatient,,,,126.8,107.78,36.34088,126.8,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Tourniquet Disp. Cuff 30""",,A4649,HCPCS,Facility,Outpatient,,,,126.8,107.78,36.34088,126.8,"UCare Health, Inc.",Medical Assistance,63.99596,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Tourniquet Disp. Cuff 30""",,A4649,HCPCS,Facility,Inpatient,,,,126.8,107.78,36.34088,126.8,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Tourniquet Disp. Cuff 30""",,A4649,HCPCS,Facility,Outpatient,,,,126.8,107.78,36.34088,126.8,"UCare Health, Inc.",Medicare Advantage,63.99596,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Tourniquet Disp. Cuff 30""",,A4649,HCPCS,Facility,Inpatient,,,,126.8,107.78,36.34088,126.8,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Tourniquet Disp. Cuff 30""",,A4649,HCPCS,Facility,Outpatient,,,,126.8,107.78,36.34088,126.8,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),63.99596,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Tourniquet Disp. Cuff 30""",,A4649,HCPCS,Facility,Inpatient,,,,126.8,107.78,36.34088,126.8,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Tourniquet Disp. Cuff 30""",,A4649,HCPCS,Facility,Both,,,,126.8,107.78,36.34088,126.8,UnitedHealthcare,Individual & Family,119.192,94,,percent of total billed charges,,
"Tourniquet Disp. Cuff 30""",,A4649,HCPCS,Facility,Outpatient,,,,126.8,107.78,36.34088,126.8,UnitedHealthcare,Medicare Advantage,62.132,49,,percent of total billed charges,,
"Tourniquet Disp. Cuff 30""",,A4649,HCPCS,Facility,Inpatient,,,,126.8,107.78,36.34088,126.8,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Tourniquet Disp. Cuff 30""",,A4649,HCPCS,Facility,Outpatient,,,,126.8,107.78,36.34088,126.8,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,60.864,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Tourniquet Disp. Cuff 30""",,A4649,HCPCS,Facility,Inpatient,,,,126.8,107.78,36.34088,126.8,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"TOURNIQUET DISPOSABLE CUFF 24"" ZIMMER",,A4649,HCPCS,Facility,Both,,,,116.4,98.94,33.36024,116.4,Aetna,Commercial,107.088,92,,percent of total billed charges,,
"TOURNIQUET DISPOSABLE CUFF 24"" ZIMMER",,A4649,HCPCS,Facility,Outpatient,,,,116.4,98.94,33.36024,116.4,Aetna,Medicare Advantage,57.036,49,,percent of total billed charges,,
"TOURNIQUET DISPOSABLE CUFF 24"" ZIMMER",,A4649,HCPCS,Facility,Inpatient,,,,116.4,98.94,33.36024,116.4,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"TOURNIQUET DISPOSABLE CUFF 24"" ZIMMER",,A4649,HCPCS,Facility,Both,,,,116.4,98.94,33.36024,116.4,Aetna,PPO,108.252,93,,percent of total billed charges,,
"TOURNIQUET DISPOSABLE CUFF 24"" ZIMMER",,A4649,HCPCS,Facility,Both,,,,116.4,98.94,33.36024,116.4,America's PPO,America's PPO,111.77892,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"TOURNIQUET DISPOSABLE CUFF 24"" ZIMMER",,A4649,HCPCS,Facility,Both,,,,116.4,98.94,33.36024,116.4,BlueCross BlueShield Minnesota, Federal Employee Program,114.5376,98.4,,percent of total billed charges,,
"TOURNIQUET DISPOSABLE CUFF 24"" ZIMMER",,A4649,HCPCS,Facility,Both,,,,116.4,98.94,33.36024,116.4,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,116.4,100,,percent of total billed charges,,
"TOURNIQUET DISPOSABLE CUFF 24"" ZIMMER",,A4649,HCPCS,Facility,Both,,,,116.4,98.94,33.36024,116.4,BlueCross BlueShield Minnesota,High Value Network Plan,104.76,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
"TOURNIQUET DISPOSABLE CUFF 24"" ZIMMER",,A4649,HCPCS,Facility,Outpatient,,,,116.4,98.94,33.36024,116.4,BlueCross BlueShield Minnesota,Medicare Advantage,57.036,49,,percent of total billed charges,,
"TOURNIQUET DISPOSABLE CUFF 24"" ZIMMER",,A4649,HCPCS,Facility,Inpatient,,,,116.4,98.94,33.36024,116.4,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"TOURNIQUET DISPOSABLE CUFF 24"" ZIMMER",,A4649,HCPCS,Facility,Both,,,,116.4,98.94,33.36024,116.4,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,103.09548,88.57,,percent of total billed charges,,
"TOURNIQUET DISPOSABLE CUFF 24"" ZIMMER",,A4649,HCPCS,Facility,Both,,,,116.4,98.94,33.36024,116.4,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,33.36024,28.66,,percent of total billed charges,,
"TOURNIQUET DISPOSABLE CUFF 24"" ZIMMER",,A4649,HCPCS,Facility,Outpatient,,,,116.4,98.94,33.36024,116.4,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),57.036,49,,percent of total billed charges,,
"TOURNIQUET DISPOSABLE CUFF 24"" ZIMMER",,A4649,HCPCS,Facility,Inpatient,,,,116.4,98.94,33.36024,116.4,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"TOURNIQUET DISPOSABLE CUFF 24"" ZIMMER",,A4649,HCPCS,Facility,Both,,,,116.4,98.94,33.36024,116.4,CorVel,Worker's Compensation,116.4,100,,percent of total billed charges,,
"TOURNIQUET DISPOSABLE CUFF 24"" ZIMMER",,A4649,HCPCS,Facility,Both,,,,116.4,98.94,33.36024,116.4,First Health Group Corporation,First Health Network,112.908,97,,percent of total billed charges,,
"TOURNIQUET DISPOSABLE CUFF 24"" ZIMMER",,A4649,HCPCS,Facility,Both,,,,116.4,98.94,33.36024,116.4,"Health Partners, Inc.",Commercial,110.1144,94.6,,percent of total billed charges,,
"TOURNIQUET DISPOSABLE CUFF 24"" ZIMMER",,A4649,HCPCS,Facility,Outpatient,,,,116.4,98.94,33.36024,116.4,"Health Partners, Inc.",Medicare Advantage,57.036,49,,percent of total billed charges,,
"TOURNIQUET DISPOSABLE CUFF 24"" ZIMMER",,A4649,HCPCS,Facility,Inpatient,,,,116.4,98.94,33.36024,116.4,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"TOURNIQUET DISPOSABLE CUFF 24"" ZIMMER",,A4649,HCPCS,Facility,Both,,,,116.4,98.94,33.36024,116.4,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),69.84,60,,percent of total billed charges,,
"TOURNIQUET DISPOSABLE CUFF 24"" ZIMMER",,A4649,HCPCS,Facility,Both,,,,116.4,98.94,33.36024,116.4,"Health Partners, Inc.",State of Minnesota Advantage Program,94.866,81.5,,percent of total billed charges,,
"TOURNIQUET DISPOSABLE CUFF 24"" ZIMMER",,A4649,HCPCS,Facility,Both,,,,116.4,98.94,33.36024,116.4,"Health Partners, Inc.",State Public Programs,58.2,50,,percent of total billed charges,,
"TOURNIQUET DISPOSABLE CUFF 24"" ZIMMER",,A4649,HCPCS,Facility,Both,,,,116.4,98.94,33.36024,116.4,Humana Insurance Company,Commercial PPO,110.58,95,,percent of total billed charges,,
"TOURNIQUET DISPOSABLE CUFF 24"" ZIMMER",,A4649,HCPCS,Facility,Outpatient,,,,116.4,98.94,33.36024,116.4,Humana Insurance Company,Medicare PPO,57.036,49,,percent of total billed charges,,
"TOURNIQUET DISPOSABLE CUFF 24"" ZIMMER",,A4649,HCPCS,Facility,Inpatient,,,,116.4,98.94,33.36024,116.4,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"TOURNIQUET DISPOSABLE CUFF 24"" ZIMMER",,A4649,HCPCS,Facility,Both,,,,116.4,98.94,33.36024,116.4,Medica,Individual & Family,115.3524,99.1,,percent of total billed charges,,
"TOURNIQUET DISPOSABLE CUFF 24"" ZIMMER",,A4649,HCPCS,Facility,Outpatient,,,,116.4,98.94,33.36024,116.4,Medica,Medica Advantage Solution,57.9672,49.8,,percent of total billed charges,,
"TOURNIQUET DISPOSABLE CUFF 24"" ZIMMER",,A4649,HCPCS,Facility,Inpatient,,,,116.4,98.94,33.36024,116.4,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"TOURNIQUET DISPOSABLE CUFF 24"" ZIMMER",,A4649,HCPCS,Facility,Outpatient,,,,116.4,98.94,33.36024,116.4,Medica,Medical Assistance,51.9144,44.6,,percent of total billed charges,,
"TOURNIQUET DISPOSABLE CUFF 24"" ZIMMER",,A4649,HCPCS,Facility,Inpatient,,,,116.4,98.94,33.36024,116.4,Medica,Medical Assistance,,,,,Included in per diem rate,
"TOURNIQUET DISPOSABLE CUFF 24"" ZIMMER",,A4649,HCPCS,Facility,Outpatient,,,,116.4,98.94,33.36024,116.4,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,57.9672,49.8,,percent of total billed charges,,
"TOURNIQUET DISPOSABLE CUFF 24"" ZIMMER",,A4649,HCPCS,Facility,Inpatient,,,,116.4,98.94,33.36024,116.4,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"TOURNIQUET DISPOSABLE CUFF 24"" ZIMMER",,A4649,HCPCS,Facility,Both,,,,116.4,98.94,33.36024,116.4,"Multiplan, Inc.","Multiplan, Inc.",109.416,94,,percent of total billed charges,,
"TOURNIQUET DISPOSABLE CUFF 24"" ZIMMER",,A4649,HCPCS,Facility,Outpatient,,,,116.4,98.94,33.36024,116.4,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,104.8764,90.1,,percent of total billed charges,,
"TOURNIQUET DISPOSABLE CUFF 24"" ZIMMER",,A4649,HCPCS,Facility,Inpatient,,,,116.4,98.94,33.36024,116.4,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"TOURNIQUET DISPOSABLE CUFF 24"" ZIMMER",,A4649,HCPCS,Facility,Both,,,,116.4,98.94,33.36024,116.4,"Preferred One Administrative Services, INC.",PPO,114.7704,98.6,,percent of total billed charges,,
"TOURNIQUET DISPOSABLE CUFF 24"" ZIMMER",,A4649,HCPCS,Facility,Outpatient,,,,116.4,98.94,33.36024,116.4,PrimeWest Health,Minnesota Senior Health Options (MSHO),59.8878,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"TOURNIQUET DISPOSABLE CUFF 24"" ZIMMER",,A4649,HCPCS,Facility,Inpatient,,,,116.4,98.94,33.36024,116.4,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"TOURNIQUET DISPOSABLE CUFF 24"" ZIMMER",,A4649,HCPCS,Facility,Outpatient,,,,116.4,98.94,33.36024,116.4,PrimeWest Health,MinnesotaCare,59.78304,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"TOURNIQUET DISPOSABLE CUFF 24"" ZIMMER",,A4649,HCPCS,Facility,Inpatient,,,,116.4,98.94,33.36024,116.4,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"TOURNIQUET DISPOSABLE CUFF 24"" ZIMMER",,A4649,HCPCS,Facility,Both,,,,116.4,98.94,33.36024,116.4,Sanford Health Plan,Sanford Health Plan,107.088,92,,percent of total billed charges,,
"TOURNIQUET DISPOSABLE CUFF 24"" ZIMMER",,A4649,HCPCS,Facility,Outpatient,,,,116.4,98.94,33.36024,116.4,"UCare Health, Inc.",Individual & Family Plan,65.5914,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"TOURNIQUET DISPOSABLE CUFF 24"" ZIMMER",,A4649,HCPCS,Facility,Inpatient,,,,116.4,98.94,33.36024,116.4,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"TOURNIQUET DISPOSABLE CUFF 24"" ZIMMER",,A4649,HCPCS,Facility,Outpatient,,,,116.4,98.94,33.36024,116.4,"UCare Health, Inc.",Medical Assistance,58.74708,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"TOURNIQUET DISPOSABLE CUFF 24"" ZIMMER",,A4649,HCPCS,Facility,Inpatient,,,,116.4,98.94,33.36024,116.4,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"TOURNIQUET DISPOSABLE CUFF 24"" ZIMMER",,A4649,HCPCS,Facility,Outpatient,,,,116.4,98.94,33.36024,116.4,"UCare Health, Inc.",Medicare Advantage,58.74708,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"TOURNIQUET DISPOSABLE CUFF 24"" ZIMMER",,A4649,HCPCS,Facility,Inpatient,,,,116.4,98.94,33.36024,116.4,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"TOURNIQUET DISPOSABLE CUFF 24"" ZIMMER",,A4649,HCPCS,Facility,Outpatient,,,,116.4,98.94,33.36024,116.4,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),58.74708,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"TOURNIQUET DISPOSABLE CUFF 24"" ZIMMER",,A4649,HCPCS,Facility,Inpatient,,,,116.4,98.94,33.36024,116.4,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"TOURNIQUET DISPOSABLE CUFF 24"" ZIMMER",,A4649,HCPCS,Facility,Both,,,,116.4,98.94,33.36024,116.4,UnitedHealthcare,Individual & Family,109.416,94,,percent of total billed charges,,
"TOURNIQUET DISPOSABLE CUFF 24"" ZIMMER",,A4649,HCPCS,Facility,Outpatient,,,,116.4,98.94,33.36024,116.4,UnitedHealthcare,Medicare Advantage,57.036,49,,percent of total billed charges,,
"TOURNIQUET DISPOSABLE CUFF 24"" ZIMMER",,A4649,HCPCS,Facility,Inpatient,,,,116.4,98.94,33.36024,116.4,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"TOURNIQUET DISPOSABLE CUFF 24"" ZIMMER",,A4649,HCPCS,Facility,Outpatient,,,,116.4,98.94,33.36024,116.4,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,55.872,48,,percent of total billed charges,,100% of DHS outpatient percentage
"TOURNIQUET DISPOSABLE CUFF 24"" ZIMMER",,A4649,HCPCS,Facility,Inpatient,,,,116.4,98.94,33.36024,116.4,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"TOURNIQUET DISPOSABLE CUFF 34"" ZIMMER",,A4649,HCPCS,Facility,Both,,,,136.8,116.28,39.20688,136.8,Aetna,Commercial,125.856,92,,percent of total billed charges,,
"TOURNIQUET DISPOSABLE CUFF 34"" ZIMMER",,A4649,HCPCS,Facility,Outpatient,,,,136.8,116.28,39.20688,136.8,Aetna,Medicare Advantage,67.032,49,,percent of total billed charges,,
"TOURNIQUET DISPOSABLE CUFF 34"" ZIMMER",,A4649,HCPCS,Facility,Inpatient,,,,136.8,116.28,39.20688,136.8,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"TOURNIQUET DISPOSABLE CUFF 34"" ZIMMER",,A4649,HCPCS,Facility,Both,,,,136.8,116.28,39.20688,136.8,Aetna,PPO,127.224,93,,percent of total billed charges,,
"TOURNIQUET DISPOSABLE CUFF 34"" ZIMMER",,A4649,HCPCS,Facility,Both,,,,136.8,116.28,39.20688,136.8,America's PPO,America's PPO,131.36904,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"TOURNIQUET DISPOSABLE CUFF 34"" ZIMMER",,A4649,HCPCS,Facility,Both,,,,136.8,116.28,39.20688,136.8,BlueCross BlueShield Minnesota, Federal Employee Program,134.6112,98.4,,percent of total billed charges,,
"TOURNIQUET DISPOSABLE CUFF 34"" ZIMMER",,A4649,HCPCS,Facility,Both,,,,136.8,116.28,39.20688,136.8,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,136.8,100,,percent of total billed charges,,
"TOURNIQUET DISPOSABLE CUFF 34"" ZIMMER",,A4649,HCPCS,Facility,Both,,,,136.8,116.28,39.20688,136.8,BlueCross BlueShield Minnesota,High Value Network Plan,123.12,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
"TOURNIQUET DISPOSABLE CUFF 34"" ZIMMER",,A4649,HCPCS,Facility,Outpatient,,,,136.8,116.28,39.20688,136.8,BlueCross BlueShield Minnesota,Medicare Advantage,67.032,49,,percent of total billed charges,,
"TOURNIQUET DISPOSABLE CUFF 34"" ZIMMER",,A4649,HCPCS,Facility,Inpatient,,,,136.8,116.28,39.20688,136.8,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"TOURNIQUET DISPOSABLE CUFF 34"" ZIMMER",,A4649,HCPCS,Facility,Both,,,,136.8,116.28,39.20688,136.8,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,121.16376,88.57,,percent of total billed charges,,
"TOURNIQUET DISPOSABLE CUFF 34"" ZIMMER",,A4649,HCPCS,Facility,Both,,,,136.8,116.28,39.20688,136.8,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,39.20688,28.66,,percent of total billed charges,,
"TOURNIQUET DISPOSABLE CUFF 34"" ZIMMER",,A4649,HCPCS,Facility,Outpatient,,,,136.8,116.28,39.20688,136.8,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),67.032,49,,percent of total billed charges,,
"TOURNIQUET DISPOSABLE CUFF 34"" ZIMMER",,A4649,HCPCS,Facility,Inpatient,,,,136.8,116.28,39.20688,136.8,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"TOURNIQUET DISPOSABLE CUFF 34"" ZIMMER",,A4649,HCPCS,Facility,Both,,,,136.8,116.28,39.20688,136.8,CorVel,Worker's Compensation,136.8,100,,percent of total billed charges,,
"TOURNIQUET DISPOSABLE CUFF 34"" ZIMMER",,A4649,HCPCS,Facility,Both,,,,136.8,116.28,39.20688,136.8,First Health Group Corporation,First Health Network,132.696,97,,percent of total billed charges,,
"TOURNIQUET DISPOSABLE CUFF 34"" ZIMMER",,A4649,HCPCS,Facility,Both,,,,136.8,116.28,39.20688,136.8,"Health Partners, Inc.",Commercial,129.4128,94.6,,percent of total billed charges,,
"TOURNIQUET DISPOSABLE CUFF 34"" ZIMMER",,A4649,HCPCS,Facility,Outpatient,,,,136.8,116.28,39.20688,136.8,"Health Partners, Inc.",Medicare Advantage,67.032,49,,percent of total billed charges,,
"TOURNIQUET DISPOSABLE CUFF 34"" ZIMMER",,A4649,HCPCS,Facility,Inpatient,,,,136.8,116.28,39.20688,136.8,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"TOURNIQUET DISPOSABLE CUFF 34"" ZIMMER",,A4649,HCPCS,Facility,Both,,,,136.8,116.28,39.20688,136.8,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),82.08,60,,percent of total billed charges,,
"TOURNIQUET DISPOSABLE CUFF 34"" ZIMMER",,A4649,HCPCS,Facility,Both,,,,136.8,116.28,39.20688,136.8,"Health Partners, Inc.",State of Minnesota Advantage Program,111.492,81.5,,percent of total billed charges,,
"TOURNIQUET DISPOSABLE CUFF 34"" ZIMMER",,A4649,HCPCS,Facility,Both,,,,136.8,116.28,39.20688,136.8,"Health Partners, Inc.",State Public Programs,68.4,50,,percent of total billed charges,,
"TOURNIQUET DISPOSABLE CUFF 34"" ZIMMER",,A4649,HCPCS,Facility,Both,,,,136.8,116.28,39.20688,136.8,Humana Insurance Company,Commercial PPO,129.96,95,,percent of total billed charges,,
"TOURNIQUET DISPOSABLE CUFF 34"" ZIMMER",,A4649,HCPCS,Facility,Outpatient,,,,136.8,116.28,39.20688,136.8,Humana Insurance Company,Medicare PPO,67.032,49,,percent of total billed charges,,
"TOURNIQUET DISPOSABLE CUFF 34"" ZIMMER",,A4649,HCPCS,Facility,Inpatient,,,,136.8,116.28,39.20688,136.8,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"TOURNIQUET DISPOSABLE CUFF 34"" ZIMMER",,A4649,HCPCS,Facility,Both,,,,136.8,116.28,39.20688,136.8,Medica,Individual & Family,135.5688,99.1,,percent of total billed charges,,
"TOURNIQUET DISPOSABLE CUFF 34"" ZIMMER",,A4649,HCPCS,Facility,Outpatient,,,,136.8,116.28,39.20688,136.8,Medica,Medica Advantage Solution,68.1264,49.8,,percent of total billed charges,,
"TOURNIQUET DISPOSABLE CUFF 34"" ZIMMER",,A4649,HCPCS,Facility,Inpatient,,,,136.8,116.28,39.20688,136.8,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"TOURNIQUET DISPOSABLE CUFF 34"" ZIMMER",,A4649,HCPCS,Facility,Outpatient,,,,136.8,116.28,39.20688,136.8,Medica,Medical Assistance,61.0128,44.6,,percent of total billed charges,,
"TOURNIQUET DISPOSABLE CUFF 34"" ZIMMER",,A4649,HCPCS,Facility,Inpatient,,,,136.8,116.28,39.20688,136.8,Medica,Medical Assistance,,,,,Included in per diem rate,
"TOURNIQUET DISPOSABLE CUFF 34"" ZIMMER",,A4649,HCPCS,Facility,Outpatient,,,,136.8,116.28,39.20688,136.8,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,68.1264,49.8,,percent of total billed charges,,
"TOURNIQUET DISPOSABLE CUFF 34"" ZIMMER",,A4649,HCPCS,Facility,Inpatient,,,,136.8,116.28,39.20688,136.8,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"TOURNIQUET DISPOSABLE CUFF 34"" ZIMMER",,A4649,HCPCS,Facility,Both,,,,136.8,116.28,39.20688,136.8,"Multiplan, Inc.","Multiplan, Inc.",128.592,94,,percent of total billed charges,,
"TOURNIQUET DISPOSABLE CUFF 34"" ZIMMER",,A4649,HCPCS,Facility,Outpatient,,,,136.8,116.28,39.20688,136.8,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,123.2568,90.1,,percent of total billed charges,,
"TOURNIQUET DISPOSABLE CUFF 34"" ZIMMER",,A4649,HCPCS,Facility,Inpatient,,,,136.8,116.28,39.20688,136.8,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"TOURNIQUET DISPOSABLE CUFF 34"" ZIMMER",,A4649,HCPCS,Facility,Both,,,,136.8,116.28,39.20688,136.8,"Preferred One Administrative Services, INC.",PPO,134.8848,98.6,,percent of total billed charges,,
"TOURNIQUET DISPOSABLE CUFF 34"" ZIMMER",,A4649,HCPCS,Facility,Outpatient,,,,136.8,116.28,39.20688,136.8,PrimeWest Health,Minnesota Senior Health Options (MSHO),70.3836,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"TOURNIQUET DISPOSABLE CUFF 34"" ZIMMER",,A4649,HCPCS,Facility,Inpatient,,,,136.8,116.28,39.20688,136.8,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"TOURNIQUET DISPOSABLE CUFF 34"" ZIMMER",,A4649,HCPCS,Facility,Outpatient,,,,136.8,116.28,39.20688,136.8,PrimeWest Health,MinnesotaCare,70.26048,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"TOURNIQUET DISPOSABLE CUFF 34"" ZIMMER",,A4649,HCPCS,Facility,Inpatient,,,,136.8,116.28,39.20688,136.8,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"TOURNIQUET DISPOSABLE CUFF 34"" ZIMMER",,A4649,HCPCS,Facility,Both,,,,136.8,116.28,39.20688,136.8,Sanford Health Plan,Sanford Health Plan,125.856,92,,percent of total billed charges,,
"TOURNIQUET DISPOSABLE CUFF 34"" ZIMMER",,A4649,HCPCS,Facility,Outpatient,,,,136.8,116.28,39.20688,136.8,"UCare Health, Inc.",Individual & Family Plan,77.0868,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"TOURNIQUET DISPOSABLE CUFF 34"" ZIMMER",,A4649,HCPCS,Facility,Inpatient,,,,136.8,116.28,39.20688,136.8,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"TOURNIQUET DISPOSABLE CUFF 34"" ZIMMER",,A4649,HCPCS,Facility,Outpatient,,,,136.8,116.28,39.20688,136.8,"UCare Health, Inc.",Medical Assistance,69.04296,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"TOURNIQUET DISPOSABLE CUFF 34"" ZIMMER",,A4649,HCPCS,Facility,Inpatient,,,,136.8,116.28,39.20688,136.8,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"TOURNIQUET DISPOSABLE CUFF 34"" ZIMMER",,A4649,HCPCS,Facility,Outpatient,,,,136.8,116.28,39.20688,136.8,"UCare Health, Inc.",Medicare Advantage,69.04296,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"TOURNIQUET DISPOSABLE CUFF 34"" ZIMMER",,A4649,HCPCS,Facility,Inpatient,,,,136.8,116.28,39.20688,136.8,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"TOURNIQUET DISPOSABLE CUFF 34"" ZIMMER",,A4649,HCPCS,Facility,Outpatient,,,,136.8,116.28,39.20688,136.8,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),69.04296,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"TOURNIQUET DISPOSABLE CUFF 34"" ZIMMER",,A4649,HCPCS,Facility,Inpatient,,,,136.8,116.28,39.20688,136.8,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"TOURNIQUET DISPOSABLE CUFF 34"" ZIMMER",,A4649,HCPCS,Facility,Both,,,,136.8,116.28,39.20688,136.8,UnitedHealthcare,Individual & Family,128.592,94,,percent of total billed charges,,
"TOURNIQUET DISPOSABLE CUFF 34"" ZIMMER",,A4649,HCPCS,Facility,Outpatient,,,,136.8,116.28,39.20688,136.8,UnitedHealthcare,Medicare Advantage,67.032,49,,percent of total billed charges,,
"TOURNIQUET DISPOSABLE CUFF 34"" ZIMMER",,A4649,HCPCS,Facility,Inpatient,,,,136.8,116.28,39.20688,136.8,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"TOURNIQUET DISPOSABLE CUFF 34"" ZIMMER",,A4649,HCPCS,Facility,Outpatient,,,,136.8,116.28,39.20688,136.8,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,65.664,48,,percent of total billed charges,,100% of DHS outpatient percentage
"TOURNIQUET DISPOSABLE CUFF 34"" ZIMMER",,A4649,HCPCS,Facility,Inpatient,,,,136.8,116.28,39.20688,136.8,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
TROCAR VERSASTEP         12MM  VS101012P,,A4649,HCPCS,Facility,Both,,,,180,153,51.588,180,Aetna,Commercial,165.6,92,,percent of total billed charges,,
TROCAR VERSASTEP         12MM  VS101012P,,A4649,HCPCS,Facility,Outpatient,,,,180,153,51.588,180,Aetna,Medicare Advantage,88.2,49,,percent of total billed charges,,
TROCAR VERSASTEP         12MM  VS101012P,,A4649,HCPCS,Facility,Inpatient,,,,180,153,51.588,180,Aetna,Medicare Advantage,,,,,Included in per diem rate,
TROCAR VERSASTEP         12MM  VS101012P,,A4649,HCPCS,Facility,Both,,,,180,153,51.588,180,Aetna,PPO,167.4,93,,percent of total billed charges,,
TROCAR VERSASTEP         12MM  VS101012P,,A4649,HCPCS,Facility,Both,,,,180,153,51.588,180,America's PPO,America's PPO,172.854,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
TROCAR VERSASTEP         12MM  VS101012P,,A4649,HCPCS,Facility,Both,,,,180,153,51.588,180,BlueCross BlueShield Minnesota, Federal Employee Program,177.12,98.4,,percent of total billed charges,,
TROCAR VERSASTEP         12MM  VS101012P,,A4649,HCPCS,Facility,Both,,,,180,153,51.588,180,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,180,100,,percent of total billed charges,,
TROCAR VERSASTEP         12MM  VS101012P,,A4649,HCPCS,Facility,Both,,,,180,153,51.588,180,BlueCross BlueShield Minnesota,High Value Network Plan,162,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
TROCAR VERSASTEP         12MM  VS101012P,,A4649,HCPCS,Facility,Outpatient,,,,180,153,51.588,180,BlueCross BlueShield Minnesota,Medicare Advantage,88.2,49,,percent of total billed charges,,
TROCAR VERSASTEP         12MM  VS101012P,,A4649,HCPCS,Facility,Inpatient,,,,180,153,51.588,180,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
TROCAR VERSASTEP         12MM  VS101012P,,A4649,HCPCS,Facility,Both,,,,180,153,51.588,180,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,159.426,88.57,,percent of total billed charges,,
TROCAR VERSASTEP         12MM  VS101012P,,A4649,HCPCS,Facility,Both,,,,180,153,51.588,180,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,51.588,28.66,,percent of total billed charges,,
TROCAR VERSASTEP         12MM  VS101012P,,A4649,HCPCS,Facility,Outpatient,,,,180,153,51.588,180,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),88.2,49,,percent of total billed charges,,
TROCAR VERSASTEP         12MM  VS101012P,,A4649,HCPCS,Facility,Inpatient,,,,180,153,51.588,180,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
TROCAR VERSASTEP         12MM  VS101012P,,A4649,HCPCS,Facility,Both,,,,180,153,51.588,180,CorVel,Worker's Compensation,180,100,,percent of total billed charges,,
TROCAR VERSASTEP         12MM  VS101012P,,A4649,HCPCS,Facility,Both,,,,180,153,51.588,180,First Health Group Corporation,First Health Network,174.6,97,,percent of total billed charges,,
TROCAR VERSASTEP         12MM  VS101012P,,A4649,HCPCS,Facility,Both,,,,180,153,51.588,180,"Health Partners, Inc.",Commercial,170.28,94.6,,percent of total billed charges,,
TROCAR VERSASTEP         12MM  VS101012P,,A4649,HCPCS,Facility,Outpatient,,,,180,153,51.588,180,"Health Partners, Inc.",Medicare Advantage,88.2,49,,percent of total billed charges,,
TROCAR VERSASTEP         12MM  VS101012P,,A4649,HCPCS,Facility,Inpatient,,,,180,153,51.588,180,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
TROCAR VERSASTEP         12MM  VS101012P,,A4649,HCPCS,Facility,Both,,,,180,153,51.588,180,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),108,60,,percent of total billed charges,,
TROCAR VERSASTEP         12MM  VS101012P,,A4649,HCPCS,Facility,Both,,,,180,153,51.588,180,"Health Partners, Inc.",State of Minnesota Advantage Program,146.7,81.5,,percent of total billed charges,,
TROCAR VERSASTEP         12MM  VS101012P,,A4649,HCPCS,Facility,Both,,,,180,153,51.588,180,"Health Partners, Inc.",State Public Programs,90,50,,percent of total billed charges,,
TROCAR VERSASTEP         12MM  VS101012P,,A4649,HCPCS,Facility,Both,,,,180,153,51.588,180,Humana Insurance Company,Commercial PPO,171,95,,percent of total billed charges,,
TROCAR VERSASTEP         12MM  VS101012P,,A4649,HCPCS,Facility,Outpatient,,,,180,153,51.588,180,Humana Insurance Company,Medicare PPO,88.2,49,,percent of total billed charges,,
TROCAR VERSASTEP         12MM  VS101012P,,A4649,HCPCS,Facility,Inpatient,,,,180,153,51.588,180,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
TROCAR VERSASTEP         12MM  VS101012P,,A4649,HCPCS,Facility,Both,,,,180,153,51.588,180,Medica,Individual & Family,178.38,99.1,,percent of total billed charges,,
TROCAR VERSASTEP         12MM  VS101012P,,A4649,HCPCS,Facility,Outpatient,,,,180,153,51.588,180,Medica,Medica Advantage Solution,89.64,49.8,,percent of total billed charges,,
TROCAR VERSASTEP         12MM  VS101012P,,A4649,HCPCS,Facility,Inpatient,,,,180,153,51.588,180,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
TROCAR VERSASTEP         12MM  VS101012P,,A4649,HCPCS,Facility,Outpatient,,,,180,153,51.588,180,Medica,Medical Assistance,80.28,44.6,,percent of total billed charges,,
TROCAR VERSASTEP         12MM  VS101012P,,A4649,HCPCS,Facility,Inpatient,,,,180,153,51.588,180,Medica,Medical Assistance,,,,,Included in per diem rate,
TROCAR VERSASTEP         12MM  VS101012P,,A4649,HCPCS,Facility,Outpatient,,,,180,153,51.588,180,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,89.64,49.8,,percent of total billed charges,,
TROCAR VERSASTEP         12MM  VS101012P,,A4649,HCPCS,Facility,Inpatient,,,,180,153,51.588,180,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
TROCAR VERSASTEP         12MM  VS101012P,,A4649,HCPCS,Facility,Both,,,,180,153,51.588,180,"Multiplan, Inc.","Multiplan, Inc.",169.2,94,,percent of total billed charges,,
TROCAR VERSASTEP         12MM  VS101012P,,A4649,HCPCS,Facility,Outpatient,,,,180,153,51.588,180,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,162.18,90.1,,percent of total billed charges,,
TROCAR VERSASTEP         12MM  VS101012P,,A4649,HCPCS,Facility,Inpatient,,,,180,153,51.588,180,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
TROCAR VERSASTEP         12MM  VS101012P,,A4649,HCPCS,Facility,Both,,,,180,153,51.588,180,"Preferred One Administrative Services, INC.",PPO,177.48,98.6,,percent of total billed charges,,
TROCAR VERSASTEP         12MM  VS101012P,,A4649,HCPCS,Facility,Outpatient,,,,180,153,51.588,180,PrimeWest Health,Minnesota Senior Health Options (MSHO),92.61,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
TROCAR VERSASTEP         12MM  VS101012P,,A4649,HCPCS,Facility,Inpatient,,,,180,153,51.588,180,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
TROCAR VERSASTEP         12MM  VS101012P,,A4649,HCPCS,Facility,Outpatient,,,,180,153,51.588,180,PrimeWest Health,MinnesotaCare,92.448,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
TROCAR VERSASTEP         12MM  VS101012P,,A4649,HCPCS,Facility,Inpatient,,,,180,153,51.588,180,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
TROCAR VERSASTEP         12MM  VS101012P,,A4649,HCPCS,Facility,Both,,,,180,153,51.588,180,Sanford Health Plan,Sanford Health Plan,165.6,92,,percent of total billed charges,,
TROCAR VERSASTEP         12MM  VS101012P,,A4649,HCPCS,Facility,Outpatient,,,,180,153,51.588,180,"UCare Health, Inc.",Individual & Family Plan,101.43,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
TROCAR VERSASTEP         12MM  VS101012P,,A4649,HCPCS,Facility,Inpatient,,,,180,153,51.588,180,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
TROCAR VERSASTEP         12MM  VS101012P,,A4649,HCPCS,Facility,Outpatient,,,,180,153,51.588,180,"UCare Health, Inc.",Medical Assistance,90.846,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TROCAR VERSASTEP         12MM  VS101012P,,A4649,HCPCS,Facility,Inpatient,,,,180,153,51.588,180,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
TROCAR VERSASTEP         12MM  VS101012P,,A4649,HCPCS,Facility,Outpatient,,,,180,153,51.588,180,"UCare Health, Inc.",Medicare Advantage,90.846,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TROCAR VERSASTEP         12MM  VS101012P,,A4649,HCPCS,Facility,Inpatient,,,,180,153,51.588,180,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
TROCAR VERSASTEP         12MM  VS101012P,,A4649,HCPCS,Facility,Outpatient,,,,180,153,51.588,180,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),90.846,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TROCAR VERSASTEP         12MM  VS101012P,,A4649,HCPCS,Facility,Inpatient,,,,180,153,51.588,180,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
TROCAR VERSASTEP         12MM  VS101012P,,A4649,HCPCS,Facility,Both,,,,180,153,51.588,180,UnitedHealthcare,Individual & Family,169.2,94,,percent of total billed charges,,
TROCAR VERSASTEP         12MM  VS101012P,,A4649,HCPCS,Facility,Outpatient,,,,180,153,51.588,180,UnitedHealthcare,Medicare Advantage,88.2,49,,percent of total billed charges,,
TROCAR VERSASTEP         12MM  VS101012P,,A4649,HCPCS,Facility,Inpatient,,,,180,153,51.588,180,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
TROCAR VERSASTEP         12MM  VS101012P,,A4649,HCPCS,Facility,Outpatient,,,,180,153,51.588,180,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,86.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
TROCAR VERSASTEP         12MM  VS101012P,,A4649,HCPCS,Facility,Inpatient,,,,180,153,51.588,180,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
TUBE SET Pneumoclear Smoke Evacuation,,A4649,HCPCS,Facility,Both,,,,173.32,147.322,49.673512,173.32,Aetna,Commercial,159.4544,92,,percent of total billed charges,,
TUBE SET Pneumoclear Smoke Evacuation,,A4649,HCPCS,Facility,Outpatient,,,,173.32,147.322,49.673512,173.32,Aetna,Medicare Advantage,84.9268,49,,percent of total billed charges,,
TUBE SET Pneumoclear Smoke Evacuation,,A4649,HCPCS,Facility,Inpatient,,,,173.32,147.322,49.673512,173.32,Aetna,Medicare Advantage,,,,,Included in per diem rate,
TUBE SET Pneumoclear Smoke Evacuation,,A4649,HCPCS,Facility,Both,,,,173.32,147.322,49.673512,173.32,Aetna,PPO,161.1876,93,,percent of total billed charges,,
TUBE SET Pneumoclear Smoke Evacuation,,A4649,HCPCS,Facility,Both,,,,173.32,147.322,49.673512,173.32,America's PPO,America's PPO,166.439196,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
TUBE SET Pneumoclear Smoke Evacuation,,A4649,HCPCS,Facility,Both,,,,173.32,147.322,49.673512,173.32,BlueCross BlueShield Minnesota, Federal Employee Program,170.54688,98.4,,percent of total billed charges,,
TUBE SET Pneumoclear Smoke Evacuation,,A4649,HCPCS,Facility,Both,,,,173.32,147.322,49.673512,173.32,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,173.32,100,,percent of total billed charges,,
TUBE SET Pneumoclear Smoke Evacuation,,A4649,HCPCS,Facility,Both,,,,173.32,147.322,49.673512,173.32,BlueCross BlueShield Minnesota,High Value Network Plan,155.988,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
TUBE SET Pneumoclear Smoke Evacuation,,A4649,HCPCS,Facility,Outpatient,,,,173.32,147.322,49.673512,173.32,BlueCross BlueShield Minnesota,Medicare Advantage,84.9268,49,,percent of total billed charges,,
TUBE SET Pneumoclear Smoke Evacuation,,A4649,HCPCS,Facility,Inpatient,,,,173.32,147.322,49.673512,173.32,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
TUBE SET Pneumoclear Smoke Evacuation,,A4649,HCPCS,Facility,Both,,,,173.32,147.322,49.673512,173.32,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,153.509524,88.57,,percent of total billed charges,,
TUBE SET Pneumoclear Smoke Evacuation,,A4649,HCPCS,Facility,Both,,,,173.32,147.322,49.673512,173.32,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,49.673512,28.66,,percent of total billed charges,,
TUBE SET Pneumoclear Smoke Evacuation,,A4649,HCPCS,Facility,Outpatient,,,,173.32,147.322,49.673512,173.32,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),84.9268,49,,percent of total billed charges,,
TUBE SET Pneumoclear Smoke Evacuation,,A4649,HCPCS,Facility,Inpatient,,,,173.32,147.322,49.673512,173.32,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
TUBE SET Pneumoclear Smoke Evacuation,,A4649,HCPCS,Facility,Both,,,,173.32,147.322,49.673512,173.32,CorVel,Worker's Compensation,173.32,100,,percent of total billed charges,,
TUBE SET Pneumoclear Smoke Evacuation,,A4649,HCPCS,Facility,Both,,,,173.32,147.322,49.673512,173.32,First Health Group Corporation,First Health Network,168.1204,97,,percent of total billed charges,,
TUBE SET Pneumoclear Smoke Evacuation,,A4649,HCPCS,Facility,Both,,,,173.32,147.322,49.673512,173.32,"Health Partners, Inc.",Commercial,163.96072,94.6,,percent of total billed charges,,
TUBE SET Pneumoclear Smoke Evacuation,,A4649,HCPCS,Facility,Outpatient,,,,173.32,147.322,49.673512,173.32,"Health Partners, Inc.",Medicare Advantage,84.9268,49,,percent of total billed charges,,
TUBE SET Pneumoclear Smoke Evacuation,,A4649,HCPCS,Facility,Inpatient,,,,173.32,147.322,49.673512,173.32,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
TUBE SET Pneumoclear Smoke Evacuation,,A4649,HCPCS,Facility,Both,,,,173.32,147.322,49.673512,173.32,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),103.992,60,,percent of total billed charges,,
TUBE SET Pneumoclear Smoke Evacuation,,A4649,HCPCS,Facility,Both,,,,173.32,147.322,49.673512,173.32,"Health Partners, Inc.",State of Minnesota Advantage Program,141.2558,81.5,,percent of total billed charges,,
TUBE SET Pneumoclear Smoke Evacuation,,A4649,HCPCS,Facility,Both,,,,173.32,147.322,49.673512,173.32,"Health Partners, Inc.",State Public Programs,86.66,50,,percent of total billed charges,,
TUBE SET Pneumoclear Smoke Evacuation,,A4649,HCPCS,Facility,Both,,,,173.32,147.322,49.673512,173.32,Humana Insurance Company,Commercial PPO,164.654,95,,percent of total billed charges,,
TUBE SET Pneumoclear Smoke Evacuation,,A4649,HCPCS,Facility,Outpatient,,,,173.32,147.322,49.673512,173.32,Humana Insurance Company,Medicare PPO,84.9268,49,,percent of total billed charges,,
TUBE SET Pneumoclear Smoke Evacuation,,A4649,HCPCS,Facility,Inpatient,,,,173.32,147.322,49.673512,173.32,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
TUBE SET Pneumoclear Smoke Evacuation,,A4649,HCPCS,Facility,Both,,,,173.32,147.322,49.673512,173.32,Medica,Individual & Family,171.76012,99.1,,percent of total billed charges,,
TUBE SET Pneumoclear Smoke Evacuation,,A4649,HCPCS,Facility,Outpatient,,,,173.32,147.322,49.673512,173.32,Medica,Medica Advantage Solution,86.31336,49.8,,percent of total billed charges,,
TUBE SET Pneumoclear Smoke Evacuation,,A4649,HCPCS,Facility,Inpatient,,,,173.32,147.322,49.673512,173.32,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
TUBE SET Pneumoclear Smoke Evacuation,,A4649,HCPCS,Facility,Outpatient,,,,173.32,147.322,49.673512,173.32,Medica,Medical Assistance,77.30072,44.6,,percent of total billed charges,,
TUBE SET Pneumoclear Smoke Evacuation,,A4649,HCPCS,Facility,Inpatient,,,,173.32,147.322,49.673512,173.32,Medica,Medical Assistance,,,,,Included in per diem rate,
TUBE SET Pneumoclear Smoke Evacuation,,A4649,HCPCS,Facility,Outpatient,,,,173.32,147.322,49.673512,173.32,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,86.31336,49.8,,percent of total billed charges,,
TUBE SET Pneumoclear Smoke Evacuation,,A4649,HCPCS,Facility,Inpatient,,,,173.32,147.322,49.673512,173.32,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
TUBE SET Pneumoclear Smoke Evacuation,,A4649,HCPCS,Facility,Both,,,,173.32,147.322,49.673512,173.32,"Multiplan, Inc.","Multiplan, Inc.",162.9208,94,,percent of total billed charges,,
TUBE SET Pneumoclear Smoke Evacuation,,A4649,HCPCS,Facility,Outpatient,,,,173.32,147.322,49.673512,173.32,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,156.16132,90.1,,percent of total billed charges,,
TUBE SET Pneumoclear Smoke Evacuation,,A4649,HCPCS,Facility,Inpatient,,,,173.32,147.322,49.673512,173.32,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
TUBE SET Pneumoclear Smoke Evacuation,,A4649,HCPCS,Facility,Both,,,,173.32,147.322,49.673512,173.32,"Preferred One Administrative Services, INC.",PPO,170.89352,98.6,,percent of total billed charges,,
TUBE SET Pneumoclear Smoke Evacuation,,A4649,HCPCS,Facility,Outpatient,,,,173.32,147.322,49.673512,173.32,PrimeWest Health,Minnesota Senior Health Options (MSHO),89.17314,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
TUBE SET Pneumoclear Smoke Evacuation,,A4649,HCPCS,Facility,Inpatient,,,,173.32,147.322,49.673512,173.32,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
TUBE SET Pneumoclear Smoke Evacuation,,A4649,HCPCS,Facility,Outpatient,,,,173.32,147.322,49.673512,173.32,PrimeWest Health,MinnesotaCare,89.017152,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
TUBE SET Pneumoclear Smoke Evacuation,,A4649,HCPCS,Facility,Inpatient,,,,173.32,147.322,49.673512,173.32,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
TUBE SET Pneumoclear Smoke Evacuation,,A4649,HCPCS,Facility,Both,,,,173.32,147.322,49.673512,173.32,Sanford Health Plan,Sanford Health Plan,159.4544,92,,percent of total billed charges,,
TUBE SET Pneumoclear Smoke Evacuation,,A4649,HCPCS,Facility,Outpatient,,,,173.32,147.322,49.673512,173.32,"UCare Health, Inc.",Individual & Family Plan,97.66582,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
TUBE SET Pneumoclear Smoke Evacuation,,A4649,HCPCS,Facility,Inpatient,,,,173.32,147.322,49.673512,173.32,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
TUBE SET Pneumoclear Smoke Evacuation,,A4649,HCPCS,Facility,Outpatient,,,,173.32,147.322,49.673512,173.32,"UCare Health, Inc.",Medical Assistance,87.474604,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TUBE SET Pneumoclear Smoke Evacuation,,A4649,HCPCS,Facility,Inpatient,,,,173.32,147.322,49.673512,173.32,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
TUBE SET Pneumoclear Smoke Evacuation,,A4649,HCPCS,Facility,Outpatient,,,,173.32,147.322,49.673512,173.32,"UCare Health, Inc.",Medicare Advantage,87.474604,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TUBE SET Pneumoclear Smoke Evacuation,,A4649,HCPCS,Facility,Inpatient,,,,173.32,147.322,49.673512,173.32,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
TUBE SET Pneumoclear Smoke Evacuation,,A4649,HCPCS,Facility,Outpatient,,,,173.32,147.322,49.673512,173.32,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),87.474604,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TUBE SET Pneumoclear Smoke Evacuation,,A4649,HCPCS,Facility,Inpatient,,,,173.32,147.322,49.673512,173.32,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
TUBE SET Pneumoclear Smoke Evacuation,,A4649,HCPCS,Facility,Both,,,,173.32,147.322,49.673512,173.32,UnitedHealthcare,Individual & Family,162.9208,94,,percent of total billed charges,,
TUBE SET Pneumoclear Smoke Evacuation,,A4649,HCPCS,Facility,Outpatient,,,,173.32,147.322,49.673512,173.32,UnitedHealthcare,Medicare Advantage,84.9268,49,,percent of total billed charges,,
TUBE SET Pneumoclear Smoke Evacuation,,A4649,HCPCS,Facility,Inpatient,,,,173.32,147.322,49.673512,173.32,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
TUBE SET Pneumoclear Smoke Evacuation,,A4649,HCPCS,Facility,Outpatient,,,,173.32,147.322,49.673512,173.32,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,83.1936,48,,percent of total billed charges,,100% of DHS outpatient percentage
TUBE SET Pneumoclear Smoke Evacuation,,A4649,HCPCS,Facility,Inpatient,,,,173.32,147.322,49.673512,173.32,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
TUBE SHEEHY BUTTON 70145971,,A4649,HCPCS,Facility,Both,,,,83.32,70.822,23.879512,83.32,Aetna,Commercial,76.6544,92,,percent of total billed charges,,
TUBE SHEEHY BUTTON 70145971,,A4649,HCPCS,Facility,Outpatient,,,,83.32,70.822,23.879512,83.32,Aetna,Medicare Advantage,40.8268,49,,percent of total billed charges,,
TUBE SHEEHY BUTTON 70145971,,A4649,HCPCS,Facility,Inpatient,,,,83.32,70.822,23.879512,83.32,Aetna,Medicare Advantage,,,,,Included in per diem rate,
TUBE SHEEHY BUTTON 70145971,,A4649,HCPCS,Facility,Both,,,,83.32,70.822,23.879512,83.32,Aetna,PPO,77.4876,93,,percent of total billed charges,,
TUBE SHEEHY BUTTON 70145971,,A4649,HCPCS,Facility,Both,,,,83.32,70.822,23.879512,83.32,America's PPO,America's PPO,80.012196,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
TUBE SHEEHY BUTTON 70145971,,A4649,HCPCS,Facility,Both,,,,83.32,70.822,23.879512,83.32,BlueCross BlueShield Minnesota, Federal Employee Program,81.98688,98.4,,percent of total billed charges,,
TUBE SHEEHY BUTTON 70145971,,A4649,HCPCS,Facility,Both,,,,83.32,70.822,23.879512,83.32,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,83.32,100,,percent of total billed charges,,
TUBE SHEEHY BUTTON 70145971,,A4649,HCPCS,Facility,Both,,,,83.32,70.822,23.879512,83.32,BlueCross BlueShield Minnesota,High Value Network Plan,74.988,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
TUBE SHEEHY BUTTON 70145971,,A4649,HCPCS,Facility,Outpatient,,,,83.32,70.822,23.879512,83.32,BlueCross BlueShield Minnesota,Medicare Advantage,40.8268,49,,percent of total billed charges,,
TUBE SHEEHY BUTTON 70145971,,A4649,HCPCS,Facility,Inpatient,,,,83.32,70.822,23.879512,83.32,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
TUBE SHEEHY BUTTON 70145971,,A4649,HCPCS,Facility,Both,,,,83.32,70.822,23.879512,83.32,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,73.796524,88.57,,percent of total billed charges,,
TUBE SHEEHY BUTTON 70145971,,A4649,HCPCS,Facility,Both,,,,83.32,70.822,23.879512,83.32,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,23.879512,28.66,,percent of total billed charges,,
TUBE SHEEHY BUTTON 70145971,,A4649,HCPCS,Facility,Outpatient,,,,83.32,70.822,23.879512,83.32,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),40.8268,49,,percent of total billed charges,,
TUBE SHEEHY BUTTON 70145971,,A4649,HCPCS,Facility,Inpatient,,,,83.32,70.822,23.879512,83.32,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
TUBE SHEEHY BUTTON 70145971,,A4649,HCPCS,Facility,Both,,,,83.32,70.822,23.879512,83.32,CorVel,Worker's Compensation,83.32,100,,percent of total billed charges,,
TUBE SHEEHY BUTTON 70145971,,A4649,HCPCS,Facility,Both,,,,83.32,70.822,23.879512,83.32,First Health Group Corporation,First Health Network,80.8204,97,,percent of total billed charges,,
TUBE SHEEHY BUTTON 70145971,,A4649,HCPCS,Facility,Both,,,,83.32,70.822,23.879512,83.32,"Health Partners, Inc.",Commercial,78.82072,94.6,,percent of total billed charges,,
TUBE SHEEHY BUTTON 70145971,,A4649,HCPCS,Facility,Outpatient,,,,83.32,70.822,23.879512,83.32,"Health Partners, Inc.",Medicare Advantage,40.8268,49,,percent of total billed charges,,
TUBE SHEEHY BUTTON 70145971,,A4649,HCPCS,Facility,Inpatient,,,,83.32,70.822,23.879512,83.32,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
TUBE SHEEHY BUTTON 70145971,,A4649,HCPCS,Facility,Both,,,,83.32,70.822,23.879512,83.32,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),49.992,60,,percent of total billed charges,,
TUBE SHEEHY BUTTON 70145971,,A4649,HCPCS,Facility,Both,,,,83.32,70.822,23.879512,83.32,"Health Partners, Inc.",State of Minnesota Advantage Program,67.9058,81.5,,percent of total billed charges,,
TUBE SHEEHY BUTTON 70145971,,A4649,HCPCS,Facility,Both,,,,83.32,70.822,23.879512,83.32,"Health Partners, Inc.",State Public Programs,41.66,50,,percent of total billed charges,,
TUBE SHEEHY BUTTON 70145971,,A4649,HCPCS,Facility,Both,,,,83.32,70.822,23.879512,83.32,Humana Insurance Company,Commercial PPO,79.154,95,,percent of total billed charges,,
TUBE SHEEHY BUTTON 70145971,,A4649,HCPCS,Facility,Outpatient,,,,83.32,70.822,23.879512,83.32,Humana Insurance Company,Medicare PPO,40.8268,49,,percent of total billed charges,,
TUBE SHEEHY BUTTON 70145971,,A4649,HCPCS,Facility,Inpatient,,,,83.32,70.822,23.879512,83.32,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
TUBE SHEEHY BUTTON 70145971,,A4649,HCPCS,Facility,Both,,,,83.32,70.822,23.879512,83.32,Medica,Individual & Family,82.57012,99.1,,percent of total billed charges,,
TUBE SHEEHY BUTTON 70145971,,A4649,HCPCS,Facility,Outpatient,,,,83.32,70.822,23.879512,83.32,Medica,Medica Advantage Solution,41.49336,49.8,,percent of total billed charges,,
TUBE SHEEHY BUTTON 70145971,,A4649,HCPCS,Facility,Inpatient,,,,83.32,70.822,23.879512,83.32,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
TUBE SHEEHY BUTTON 70145971,,A4649,HCPCS,Facility,Outpatient,,,,83.32,70.822,23.879512,83.32,Medica,Medical Assistance,37.16072,44.6,,percent of total billed charges,,
TUBE SHEEHY BUTTON 70145971,,A4649,HCPCS,Facility,Inpatient,,,,83.32,70.822,23.879512,83.32,Medica,Medical Assistance,,,,,Included in per diem rate,
TUBE SHEEHY BUTTON 70145971,,A4649,HCPCS,Facility,Outpatient,,,,83.32,70.822,23.879512,83.32,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,41.49336,49.8,,percent of total billed charges,,
TUBE SHEEHY BUTTON 70145971,,A4649,HCPCS,Facility,Inpatient,,,,83.32,70.822,23.879512,83.32,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
TUBE SHEEHY BUTTON 70145971,,A4649,HCPCS,Facility,Both,,,,83.32,70.822,23.879512,83.32,"Multiplan, Inc.","Multiplan, Inc.",78.3208,94,,percent of total billed charges,,
TUBE SHEEHY BUTTON 70145971,,A4649,HCPCS,Facility,Outpatient,,,,83.32,70.822,23.879512,83.32,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,75.07132,90.1,,percent of total billed charges,,
TUBE SHEEHY BUTTON 70145971,,A4649,HCPCS,Facility,Inpatient,,,,83.32,70.822,23.879512,83.32,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
TUBE SHEEHY BUTTON 70145971,,A4649,HCPCS,Facility,Both,,,,83.32,70.822,23.879512,83.32,"Preferred One Administrative Services, INC.",PPO,82.15352,98.6,,percent of total billed charges,,
TUBE SHEEHY BUTTON 70145971,,A4649,HCPCS,Facility,Outpatient,,,,83.32,70.822,23.879512,83.32,PrimeWest Health,Minnesota Senior Health Options (MSHO),42.86814,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
TUBE SHEEHY BUTTON 70145971,,A4649,HCPCS,Facility,Inpatient,,,,83.32,70.822,23.879512,83.32,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
TUBE SHEEHY BUTTON 70145971,,A4649,HCPCS,Facility,Outpatient,,,,83.32,70.822,23.879512,83.32,PrimeWest Health,MinnesotaCare,42.793152,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
TUBE SHEEHY BUTTON 70145971,,A4649,HCPCS,Facility,Inpatient,,,,83.32,70.822,23.879512,83.32,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
TUBE SHEEHY BUTTON 70145971,,A4649,HCPCS,Facility,Both,,,,83.32,70.822,23.879512,83.32,Sanford Health Plan,Sanford Health Plan,76.6544,92,,percent of total billed charges,,
TUBE SHEEHY BUTTON 70145971,,A4649,HCPCS,Facility,Outpatient,,,,83.32,70.822,23.879512,83.32,"UCare Health, Inc.",Individual & Family Plan,46.95082,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
TUBE SHEEHY BUTTON 70145971,,A4649,HCPCS,Facility,Inpatient,,,,83.32,70.822,23.879512,83.32,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
TUBE SHEEHY BUTTON 70145971,,A4649,HCPCS,Facility,Outpatient,,,,83.32,70.822,23.879512,83.32,"UCare Health, Inc.",Medical Assistance,42.051604,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TUBE SHEEHY BUTTON 70145971,,A4649,HCPCS,Facility,Inpatient,,,,83.32,70.822,23.879512,83.32,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
TUBE SHEEHY BUTTON 70145971,,A4649,HCPCS,Facility,Outpatient,,,,83.32,70.822,23.879512,83.32,"UCare Health, Inc.",Medicare Advantage,42.051604,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TUBE SHEEHY BUTTON 70145971,,A4649,HCPCS,Facility,Inpatient,,,,83.32,70.822,23.879512,83.32,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
TUBE SHEEHY BUTTON 70145971,,A4649,HCPCS,Facility,Outpatient,,,,83.32,70.822,23.879512,83.32,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),42.051604,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TUBE SHEEHY BUTTON 70145971,,A4649,HCPCS,Facility,Inpatient,,,,83.32,70.822,23.879512,83.32,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
TUBE SHEEHY BUTTON 70145971,,A4649,HCPCS,Facility,Both,,,,83.32,70.822,23.879512,83.32,UnitedHealthcare,Individual & Family,78.3208,94,,percent of total billed charges,,
TUBE SHEEHY BUTTON 70145971,,A4649,HCPCS,Facility,Outpatient,,,,83.32,70.822,23.879512,83.32,UnitedHealthcare,Medicare Advantage,40.8268,49,,percent of total billed charges,,
TUBE SHEEHY BUTTON 70145971,,A4649,HCPCS,Facility,Inpatient,,,,83.32,70.822,23.879512,83.32,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
TUBE SHEEHY BUTTON 70145971,,A4649,HCPCS,Facility,Outpatient,,,,83.32,70.822,23.879512,83.32,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,39.9936,48,,percent of total billed charges,,100% of DHS outpatient percentage
TUBE SHEEHY BUTTON 70145971,,A4649,HCPCS,Facility,Inpatient,,,,83.32,70.822,23.879512,83.32,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"TUBE, VENTILATION SHEEHY COLLAR BUTTON, SILICONE",,A4649,HCPCS,Facility,Both,,,,53.775,45.70875,15.411915,53.775,Aetna,Commercial,49.473,92,,percent of total billed charges,,
"TUBE, VENTILATION SHEEHY COLLAR BUTTON, SILICONE",,A4649,HCPCS,Facility,Outpatient,,,,53.775,45.70875,15.411915,53.775,Aetna,Medicare Advantage,26.34975,49,,percent of total billed charges,,
"TUBE, VENTILATION SHEEHY COLLAR BUTTON, SILICONE",,A4649,HCPCS,Facility,Inpatient,,,,53.775,45.70875,15.411915,53.775,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"TUBE, VENTILATION SHEEHY COLLAR BUTTON, SILICONE",,A4649,HCPCS,Facility,Both,,,,53.775,45.70875,15.411915,53.775,Aetna,PPO,50.01075,93,,percent of total billed charges,,
"TUBE, VENTILATION SHEEHY COLLAR BUTTON, SILICONE",,A4649,HCPCS,Facility,Both,,,,53.775,45.70875,15.411915,53.775,America's PPO,America's PPO,51.6401325,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"TUBE, VENTILATION SHEEHY COLLAR BUTTON, SILICONE",,A4649,HCPCS,Facility,Both,,,,53.775,45.70875,15.411915,53.775,BlueCross BlueShield Minnesota, Federal Employee Program,52.9146,98.4,,percent of total billed charges,,
"TUBE, VENTILATION SHEEHY COLLAR BUTTON, SILICONE",,A4649,HCPCS,Facility,Both,,,,53.775,45.70875,15.411915,53.775,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,53.775,100,,percent of total billed charges,,
"TUBE, VENTILATION SHEEHY COLLAR BUTTON, SILICONE",,A4649,HCPCS,Facility,Both,,,,53.775,45.70875,15.411915,53.775,BlueCross BlueShield Minnesota,High Value Network Plan,48.3975,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
"TUBE, VENTILATION SHEEHY COLLAR BUTTON, SILICONE",,A4649,HCPCS,Facility,Outpatient,,,,53.775,45.70875,15.411915,53.775,BlueCross BlueShield Minnesota,Medicare Advantage,26.34975,49,,percent of total billed charges,,
"TUBE, VENTILATION SHEEHY COLLAR BUTTON, SILICONE",,A4649,HCPCS,Facility,Inpatient,,,,53.775,45.70875,15.411915,53.775,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"TUBE, VENTILATION SHEEHY COLLAR BUTTON, SILICONE",,A4649,HCPCS,Facility,Both,,,,53.775,45.70875,15.411915,53.775,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,47.6285175,88.57,,percent of total billed charges,,
"TUBE, VENTILATION SHEEHY COLLAR BUTTON, SILICONE",,A4649,HCPCS,Facility,Both,,,,53.775,45.70875,15.411915,53.775,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,15.411915,28.66,,percent of total billed charges,,
"TUBE, VENTILATION SHEEHY COLLAR BUTTON, SILICONE",,A4649,HCPCS,Facility,Outpatient,,,,53.775,45.70875,15.411915,53.775,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),26.34975,49,,percent of total billed charges,,
"TUBE, VENTILATION SHEEHY COLLAR BUTTON, SILICONE",,A4649,HCPCS,Facility,Inpatient,,,,53.775,45.70875,15.411915,53.775,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"TUBE, VENTILATION SHEEHY COLLAR BUTTON, SILICONE",,A4649,HCPCS,Facility,Both,,,,53.775,45.70875,15.411915,53.775,CorVel,Worker's Compensation,53.775,100,,percent of total billed charges,,
"TUBE, VENTILATION SHEEHY COLLAR BUTTON, SILICONE",,A4649,HCPCS,Facility,Both,,,,53.775,45.70875,15.411915,53.775,First Health Group Corporation,First Health Network,52.16175,97,,percent of total billed charges,,
"TUBE, VENTILATION SHEEHY COLLAR BUTTON, SILICONE",,A4649,HCPCS,Facility,Both,,,,53.775,45.70875,15.411915,53.775,"Health Partners, Inc.",Commercial,50.87115,94.6,,percent of total billed charges,,
"TUBE, VENTILATION SHEEHY COLLAR BUTTON, SILICONE",,A4649,HCPCS,Facility,Outpatient,,,,53.775,45.70875,15.411915,53.775,"Health Partners, Inc.",Medicare Advantage,26.34975,49,,percent of total billed charges,,
"TUBE, VENTILATION SHEEHY COLLAR BUTTON, SILICONE",,A4649,HCPCS,Facility,Inpatient,,,,53.775,45.70875,15.411915,53.775,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"TUBE, VENTILATION SHEEHY COLLAR BUTTON, SILICONE",,A4649,HCPCS,Facility,Both,,,,53.775,45.70875,15.411915,53.775,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),32.265,60,,percent of total billed charges,,
"TUBE, VENTILATION SHEEHY COLLAR BUTTON, SILICONE",,A4649,HCPCS,Facility,Both,,,,53.775,45.70875,15.411915,53.775,"Health Partners, Inc.",State of Minnesota Advantage Program,43.826625,81.5,,percent of total billed charges,,
"TUBE, VENTILATION SHEEHY COLLAR BUTTON, SILICONE",,A4649,HCPCS,Facility,Both,,,,53.775,45.70875,15.411915,53.775,"Health Partners, Inc.",State Public Programs,26.8875,50,,percent of total billed charges,,
"TUBE, VENTILATION SHEEHY COLLAR BUTTON, SILICONE",,A4649,HCPCS,Facility,Both,,,,53.775,45.70875,15.411915,53.775,Humana Insurance Company,Commercial PPO,51.08625,95,,percent of total billed charges,,
"TUBE, VENTILATION SHEEHY COLLAR BUTTON, SILICONE",,A4649,HCPCS,Facility,Outpatient,,,,53.775,45.70875,15.411915,53.775,Humana Insurance Company,Medicare PPO,26.34975,49,,percent of total billed charges,,
"TUBE, VENTILATION SHEEHY COLLAR BUTTON, SILICONE",,A4649,HCPCS,Facility,Inpatient,,,,53.775,45.70875,15.411915,53.775,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"TUBE, VENTILATION SHEEHY COLLAR BUTTON, SILICONE",,A4649,HCPCS,Facility,Both,,,,53.775,45.70875,15.411915,53.775,Medica,Individual & Family,53.291025,99.1,,percent of total billed charges,,
"TUBE, VENTILATION SHEEHY COLLAR BUTTON, SILICONE",,A4649,HCPCS,Facility,Outpatient,,,,53.775,45.70875,15.411915,53.775,Medica,Medica Advantage Solution,26.77995,49.8,,percent of total billed charges,,
"TUBE, VENTILATION SHEEHY COLLAR BUTTON, SILICONE",,A4649,HCPCS,Facility,Inpatient,,,,53.775,45.70875,15.411915,53.775,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"TUBE, VENTILATION SHEEHY COLLAR BUTTON, SILICONE",,A4649,HCPCS,Facility,Outpatient,,,,53.775,45.70875,15.411915,53.775,Medica,Medical Assistance,23.98365,44.6,,percent of total billed charges,,
"TUBE, VENTILATION SHEEHY COLLAR BUTTON, SILICONE",,A4649,HCPCS,Facility,Inpatient,,,,53.775,45.70875,15.411915,53.775,Medica,Medical Assistance,,,,,Included in per diem rate,
"TUBE, VENTILATION SHEEHY COLLAR BUTTON, SILICONE",,A4649,HCPCS,Facility,Outpatient,,,,53.775,45.70875,15.411915,53.775,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,26.77995,49.8,,percent of total billed charges,,
"TUBE, VENTILATION SHEEHY COLLAR BUTTON, SILICONE",,A4649,HCPCS,Facility,Inpatient,,,,53.775,45.70875,15.411915,53.775,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"TUBE, VENTILATION SHEEHY COLLAR BUTTON, SILICONE",,A4649,HCPCS,Facility,Both,,,,53.775,45.70875,15.411915,53.775,"Multiplan, Inc.","Multiplan, Inc.",50.5485,94,,percent of total billed charges,,
"TUBE, VENTILATION SHEEHY COLLAR BUTTON, SILICONE",,A4649,HCPCS,Facility,Outpatient,,,,53.775,45.70875,15.411915,53.775,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,48.451275,90.1,,percent of total billed charges,,
"TUBE, VENTILATION SHEEHY COLLAR BUTTON, SILICONE",,A4649,HCPCS,Facility,Inpatient,,,,53.775,45.70875,15.411915,53.775,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"TUBE, VENTILATION SHEEHY COLLAR BUTTON, SILICONE",,A4649,HCPCS,Facility,Both,,,,53.775,45.70875,15.411915,53.775,"Preferred One Administrative Services, INC.",PPO,53.02215,98.6,,percent of total billed charges,,
"TUBE, VENTILATION SHEEHY COLLAR BUTTON, SILICONE",,A4649,HCPCS,Facility,Outpatient,,,,53.775,45.70875,15.411915,53.775,PrimeWest Health,Minnesota Senior Health Options (MSHO),27.6672375,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"TUBE, VENTILATION SHEEHY COLLAR BUTTON, SILICONE",,A4649,HCPCS,Facility,Inpatient,,,,53.775,45.70875,15.411915,53.775,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"TUBE, VENTILATION SHEEHY COLLAR BUTTON, SILICONE",,A4649,HCPCS,Facility,Outpatient,,,,53.775,45.70875,15.411915,53.775,PrimeWest Health,MinnesotaCare,27.61884,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"TUBE, VENTILATION SHEEHY COLLAR BUTTON, SILICONE",,A4649,HCPCS,Facility,Inpatient,,,,53.775,45.70875,15.411915,53.775,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"TUBE, VENTILATION SHEEHY COLLAR BUTTON, SILICONE",,A4649,HCPCS,Facility,Both,,,,53.775,45.70875,15.411915,53.775,Sanford Health Plan,Sanford Health Plan,49.473,92,,percent of total billed charges,,
"TUBE, VENTILATION SHEEHY COLLAR BUTTON, SILICONE",,A4649,HCPCS,Facility,Outpatient,,,,53.775,45.70875,15.411915,53.775,"UCare Health, Inc.",Individual & Family Plan,30.3022125,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"TUBE, VENTILATION SHEEHY COLLAR BUTTON, SILICONE",,A4649,HCPCS,Facility,Inpatient,,,,53.775,45.70875,15.411915,53.775,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"TUBE, VENTILATION SHEEHY COLLAR BUTTON, SILICONE",,A4649,HCPCS,Facility,Outpatient,,,,53.775,45.70875,15.411915,53.775,"UCare Health, Inc.",Medical Assistance,27.1402425,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"TUBE, VENTILATION SHEEHY COLLAR BUTTON, SILICONE",,A4649,HCPCS,Facility,Inpatient,,,,53.775,45.70875,15.411915,53.775,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"TUBE, VENTILATION SHEEHY COLLAR BUTTON, SILICONE",,A4649,HCPCS,Facility,Outpatient,,,,53.775,45.70875,15.411915,53.775,"UCare Health, Inc.",Medicare Advantage,27.1402425,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"TUBE, VENTILATION SHEEHY COLLAR BUTTON, SILICONE",,A4649,HCPCS,Facility,Inpatient,,,,53.775,45.70875,15.411915,53.775,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"TUBE, VENTILATION SHEEHY COLLAR BUTTON, SILICONE",,A4649,HCPCS,Facility,Outpatient,,,,53.775,45.70875,15.411915,53.775,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),27.1402425,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"TUBE, VENTILATION SHEEHY COLLAR BUTTON, SILICONE",,A4649,HCPCS,Facility,Inpatient,,,,53.775,45.70875,15.411915,53.775,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"TUBE, VENTILATION SHEEHY COLLAR BUTTON, SILICONE",,A4649,HCPCS,Facility,Both,,,,53.775,45.70875,15.411915,53.775,UnitedHealthcare,Individual & Family,50.5485,94,,percent of total billed charges,,
"TUBE, VENTILATION SHEEHY COLLAR BUTTON, SILICONE",,A4649,HCPCS,Facility,Outpatient,,,,53.775,45.70875,15.411915,53.775,UnitedHealthcare,Medicare Advantage,26.34975,49,,percent of total billed charges,,
"TUBE, VENTILATION SHEEHY COLLAR BUTTON, SILICONE",,A4649,HCPCS,Facility,Inpatient,,,,53.775,45.70875,15.411915,53.775,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"TUBE, VENTILATION SHEEHY COLLAR BUTTON, SILICONE",,A4649,HCPCS,Facility,Outpatient,,,,53.775,45.70875,15.411915,53.775,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,25.812,48,,percent of total billed charges,,100% of DHS outpatient percentage
"TUBE, VENTILATION SHEEHY COLLAR BUTTON, SILICONE",,A4649,HCPCS,Facility,Inpatient,,,,53.775,45.70875,15.411915,53.775,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
TUBING DISP AUX WATER CHANNEL  MAJ-1651,,A4649,HCPCS,Facility,Both,,,,65.61,55.7685,18.803826,65.61,Aetna,Commercial,60.3612,92,,percent of total billed charges,,
TUBING DISP AUX WATER CHANNEL  MAJ-1651,,A4649,HCPCS,Facility,Outpatient,,,,65.61,55.7685,18.803826,65.61,Aetna,Medicare Advantage,32.1489,49,,percent of total billed charges,,
TUBING DISP AUX WATER CHANNEL  MAJ-1651,,A4649,HCPCS,Facility,Inpatient,,,,65.61,55.7685,18.803826,65.61,Aetna,Medicare Advantage,,,,,Included in per diem rate,
TUBING DISP AUX WATER CHANNEL  MAJ-1651,,A4649,HCPCS,Facility,Both,,,,65.61,55.7685,18.803826,65.61,Aetna,PPO,61.0173,93,,percent of total billed charges,,
TUBING DISP AUX WATER CHANNEL  MAJ-1651,,A4649,HCPCS,Facility,Both,,,,65.61,55.7685,18.803826,65.61,America's PPO,America's PPO,63.005283,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
TUBING DISP AUX WATER CHANNEL  MAJ-1651,,A4649,HCPCS,Facility,Both,,,,65.61,55.7685,18.803826,65.61,BlueCross BlueShield Minnesota, Federal Employee Program,64.56024,98.4,,percent of total billed charges,,
TUBING DISP AUX WATER CHANNEL  MAJ-1651,,A4649,HCPCS,Facility,Both,,,,65.61,55.7685,18.803826,65.61,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,65.61,100,,percent of total billed charges,,
TUBING DISP AUX WATER CHANNEL  MAJ-1651,,A4649,HCPCS,Facility,Both,,,,65.61,55.7685,18.803826,65.61,BlueCross BlueShield Minnesota,High Value Network Plan,59.049,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
TUBING DISP AUX WATER CHANNEL  MAJ-1651,,A4649,HCPCS,Facility,Outpatient,,,,65.61,55.7685,18.803826,65.61,BlueCross BlueShield Minnesota,Medicare Advantage,32.1489,49,,percent of total billed charges,,
TUBING DISP AUX WATER CHANNEL  MAJ-1651,,A4649,HCPCS,Facility,Inpatient,,,,65.61,55.7685,18.803826,65.61,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
TUBING DISP AUX WATER CHANNEL  MAJ-1651,,A4649,HCPCS,Facility,Both,,,,65.61,55.7685,18.803826,65.61,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,58.110777,88.57,,percent of total billed charges,,
TUBING DISP AUX WATER CHANNEL  MAJ-1651,,A4649,HCPCS,Facility,Both,,,,65.61,55.7685,18.803826,65.61,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,18.803826,28.66,,percent of total billed charges,,
TUBING DISP AUX WATER CHANNEL  MAJ-1651,,A4649,HCPCS,Facility,Outpatient,,,,65.61,55.7685,18.803826,65.61,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),32.1489,49,,percent of total billed charges,,
TUBING DISP AUX WATER CHANNEL  MAJ-1651,,A4649,HCPCS,Facility,Inpatient,,,,65.61,55.7685,18.803826,65.61,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
TUBING DISP AUX WATER CHANNEL  MAJ-1651,,A4649,HCPCS,Facility,Both,,,,65.61,55.7685,18.803826,65.61,CorVel,Worker's Compensation,65.61,100,,percent of total billed charges,,
TUBING DISP AUX WATER CHANNEL  MAJ-1651,,A4649,HCPCS,Facility,Both,,,,65.61,55.7685,18.803826,65.61,First Health Group Corporation,First Health Network,63.6417,97,,percent of total billed charges,,
TUBING DISP AUX WATER CHANNEL  MAJ-1651,,A4649,HCPCS,Facility,Both,,,,65.61,55.7685,18.803826,65.61,"Health Partners, Inc.",Commercial,62.06706,94.6,,percent of total billed charges,,
TUBING DISP AUX WATER CHANNEL  MAJ-1651,,A4649,HCPCS,Facility,Outpatient,,,,65.61,55.7685,18.803826,65.61,"Health Partners, Inc.",Medicare Advantage,32.1489,49,,percent of total billed charges,,
TUBING DISP AUX WATER CHANNEL  MAJ-1651,,A4649,HCPCS,Facility,Inpatient,,,,65.61,55.7685,18.803826,65.61,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
TUBING DISP AUX WATER CHANNEL  MAJ-1651,,A4649,HCPCS,Facility,Both,,,,65.61,55.7685,18.803826,65.61,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),39.366,60,,percent of total billed charges,,
TUBING DISP AUX WATER CHANNEL  MAJ-1651,,A4649,HCPCS,Facility,Both,,,,65.61,55.7685,18.803826,65.61,"Health Partners, Inc.",State of Minnesota Advantage Program,53.47215,81.5,,percent of total billed charges,,
TUBING DISP AUX WATER CHANNEL  MAJ-1651,,A4649,HCPCS,Facility,Both,,,,65.61,55.7685,18.803826,65.61,"Health Partners, Inc.",State Public Programs,32.805,50,,percent of total billed charges,,
TUBING DISP AUX WATER CHANNEL  MAJ-1651,,A4649,HCPCS,Facility,Both,,,,65.61,55.7685,18.803826,65.61,Humana Insurance Company,Commercial PPO,62.3295,95,,percent of total billed charges,,
TUBING DISP AUX WATER CHANNEL  MAJ-1651,,A4649,HCPCS,Facility,Outpatient,,,,65.61,55.7685,18.803826,65.61,Humana Insurance Company,Medicare PPO,32.1489,49,,percent of total billed charges,,
TUBING DISP AUX WATER CHANNEL  MAJ-1651,,A4649,HCPCS,Facility,Inpatient,,,,65.61,55.7685,18.803826,65.61,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
TUBING DISP AUX WATER CHANNEL  MAJ-1651,,A4649,HCPCS,Facility,Both,,,,65.61,55.7685,18.803826,65.61,Medica,Individual & Family,65.01951,99.1,,percent of total billed charges,,
TUBING DISP AUX WATER CHANNEL  MAJ-1651,,A4649,HCPCS,Facility,Outpatient,,,,65.61,55.7685,18.803826,65.61,Medica,Medica Advantage Solution,32.67378,49.8,,percent of total billed charges,,
TUBING DISP AUX WATER CHANNEL  MAJ-1651,,A4649,HCPCS,Facility,Inpatient,,,,65.61,55.7685,18.803826,65.61,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
TUBING DISP AUX WATER CHANNEL  MAJ-1651,,A4649,HCPCS,Facility,Outpatient,,,,65.61,55.7685,18.803826,65.61,Medica,Medical Assistance,29.26206,44.6,,percent of total billed charges,,
TUBING DISP AUX WATER CHANNEL  MAJ-1651,,A4649,HCPCS,Facility,Inpatient,,,,65.61,55.7685,18.803826,65.61,Medica,Medical Assistance,,,,,Included in per diem rate,
TUBING DISP AUX WATER CHANNEL  MAJ-1651,,A4649,HCPCS,Facility,Outpatient,,,,65.61,55.7685,18.803826,65.61,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,32.67378,49.8,,percent of total billed charges,,
TUBING DISP AUX WATER CHANNEL  MAJ-1651,,A4649,HCPCS,Facility,Inpatient,,,,65.61,55.7685,18.803826,65.61,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
TUBING DISP AUX WATER CHANNEL  MAJ-1651,,A4649,HCPCS,Facility,Both,,,,65.61,55.7685,18.803826,65.61,"Multiplan, Inc.","Multiplan, Inc.",61.6734,94,,percent of total billed charges,,
TUBING DISP AUX WATER CHANNEL  MAJ-1651,,A4649,HCPCS,Facility,Outpatient,,,,65.61,55.7685,18.803826,65.61,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,59.11461,90.1,,percent of total billed charges,,
TUBING DISP AUX WATER CHANNEL  MAJ-1651,,A4649,HCPCS,Facility,Inpatient,,,,65.61,55.7685,18.803826,65.61,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
TUBING DISP AUX WATER CHANNEL  MAJ-1651,,A4649,HCPCS,Facility,Both,,,,65.61,55.7685,18.803826,65.61,"Preferred One Administrative Services, INC.",PPO,64.69146,98.6,,percent of total billed charges,,
TUBING DISP AUX WATER CHANNEL  MAJ-1651,,A4649,HCPCS,Facility,Outpatient,,,,65.61,55.7685,18.803826,65.61,PrimeWest Health,Minnesota Senior Health Options (MSHO),33.756345,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
TUBING DISP AUX WATER CHANNEL  MAJ-1651,,A4649,HCPCS,Facility,Inpatient,,,,65.61,55.7685,18.803826,65.61,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
TUBING DISP AUX WATER CHANNEL  MAJ-1651,,A4649,HCPCS,Facility,Outpatient,,,,65.61,55.7685,18.803826,65.61,PrimeWest Health,MinnesotaCare,33.697296,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
TUBING DISP AUX WATER CHANNEL  MAJ-1651,,A4649,HCPCS,Facility,Inpatient,,,,65.61,55.7685,18.803826,65.61,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
TUBING DISP AUX WATER CHANNEL  MAJ-1651,,A4649,HCPCS,Facility,Both,,,,65.61,55.7685,18.803826,65.61,Sanford Health Plan,Sanford Health Plan,60.3612,92,,percent of total billed charges,,
TUBING DISP AUX WATER CHANNEL  MAJ-1651,,A4649,HCPCS,Facility,Outpatient,,,,65.61,55.7685,18.803826,65.61,"UCare Health, Inc.",Individual & Family Plan,36.971235,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
TUBING DISP AUX WATER CHANNEL  MAJ-1651,,A4649,HCPCS,Facility,Inpatient,,,,65.61,55.7685,18.803826,65.61,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
TUBING DISP AUX WATER CHANNEL  MAJ-1651,,A4649,HCPCS,Facility,Outpatient,,,,65.61,55.7685,18.803826,65.61,"UCare Health, Inc.",Medical Assistance,33.113367,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TUBING DISP AUX WATER CHANNEL  MAJ-1651,,A4649,HCPCS,Facility,Inpatient,,,,65.61,55.7685,18.803826,65.61,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
TUBING DISP AUX WATER CHANNEL  MAJ-1651,,A4649,HCPCS,Facility,Outpatient,,,,65.61,55.7685,18.803826,65.61,"UCare Health, Inc.",Medicare Advantage,33.113367,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TUBING DISP AUX WATER CHANNEL  MAJ-1651,,A4649,HCPCS,Facility,Inpatient,,,,65.61,55.7685,18.803826,65.61,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
TUBING DISP AUX WATER CHANNEL  MAJ-1651,,A4649,HCPCS,Facility,Outpatient,,,,65.61,55.7685,18.803826,65.61,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),33.113367,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TUBING DISP AUX WATER CHANNEL  MAJ-1651,,A4649,HCPCS,Facility,Inpatient,,,,65.61,55.7685,18.803826,65.61,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
TUBING DISP AUX WATER CHANNEL  MAJ-1651,,A4649,HCPCS,Facility,Both,,,,65.61,55.7685,18.803826,65.61,UnitedHealthcare,Individual & Family,61.6734,94,,percent of total billed charges,,
TUBING DISP AUX WATER CHANNEL  MAJ-1651,,A4649,HCPCS,Facility,Outpatient,,,,65.61,55.7685,18.803826,65.61,UnitedHealthcare,Medicare Advantage,32.1489,49,,percent of total billed charges,,
TUBING DISP AUX WATER CHANNEL  MAJ-1651,,A4649,HCPCS,Facility,Inpatient,,,,65.61,55.7685,18.803826,65.61,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
TUBING DISP AUX WATER CHANNEL  MAJ-1651,,A4649,HCPCS,Facility,Outpatient,,,,65.61,55.7685,18.803826,65.61,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,31.4928,48,,percent of total billed charges,,100% of DHS outpatient percentage
TUBING DISP AUX WATER CHANNEL  MAJ-1651,,A4649,HCPCS,Facility,Inpatient,,,,65.61,55.7685,18.803826,65.61,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
TURBINATOR WAND,,A4649,HCPCS,Facility,Both,,,,732.5,622.625,209.9345,732.5,Aetna,Commercial,673.9,92,,percent of total billed charges,,
TURBINATOR WAND,,A4649,HCPCS,Facility,Outpatient,,,,732.5,622.625,209.9345,732.5,Aetna,Medicare Advantage,358.925,49,,percent of total billed charges,,
TURBINATOR WAND,,A4649,HCPCS,Facility,Inpatient,,,,732.5,622.625,209.9345,732.5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
TURBINATOR WAND,,A4649,HCPCS,Facility,Both,,,,732.5,622.625,209.9345,732.5,Aetna,PPO,681.225,93,,percent of total billed charges,,
TURBINATOR WAND,,A4649,HCPCS,Facility,Both,,,,732.5,622.625,209.9345,732.5,America's PPO,America's PPO,703.41975,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
TURBINATOR WAND,,A4649,HCPCS,Facility,Both,,,,732.5,622.625,209.9345,732.5,BlueCross BlueShield Minnesota, Federal Employee Program,720.78,98.4,,percent of total billed charges,,
TURBINATOR WAND,,A4649,HCPCS,Facility,Both,,,,732.5,622.625,209.9345,732.5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,732.5,100,,percent of total billed charges,,
TURBINATOR WAND,,A4649,HCPCS,Facility,Both,,,,732.5,622.625,209.9345,732.5,BlueCross BlueShield Minnesota,High Value Network Plan,659.25,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
TURBINATOR WAND,,A4649,HCPCS,Facility,Outpatient,,,,732.5,622.625,209.9345,732.5,BlueCross BlueShield Minnesota,Medicare Advantage,358.925,49,,percent of total billed charges,,
TURBINATOR WAND,,A4649,HCPCS,Facility,Inpatient,,,,732.5,622.625,209.9345,732.5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
TURBINATOR WAND,,A4649,HCPCS,Facility,Both,,,,732.5,622.625,209.9345,732.5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,648.77525,88.57,,percent of total billed charges,,
TURBINATOR WAND,,A4649,HCPCS,Facility,Both,,,,732.5,622.625,209.9345,732.5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,209.9345,28.66,,percent of total billed charges,,
TURBINATOR WAND,,A4649,HCPCS,Facility,Outpatient,,,,732.5,622.625,209.9345,732.5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),358.925,49,,percent of total billed charges,,
TURBINATOR WAND,,A4649,HCPCS,Facility,Inpatient,,,,732.5,622.625,209.9345,732.5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
TURBINATOR WAND,,A4649,HCPCS,Facility,Both,,,,732.5,622.625,209.9345,732.5,CorVel,Worker's Compensation,732.5,100,,percent of total billed charges,,
TURBINATOR WAND,,A4649,HCPCS,Facility,Both,,,,732.5,622.625,209.9345,732.5,First Health Group Corporation,First Health Network,710.525,97,,percent of total billed charges,,
TURBINATOR WAND,,A4649,HCPCS,Facility,Both,,,,732.5,622.625,209.9345,732.5,"Health Partners, Inc.",Commercial,692.945,94.6,,percent of total billed charges,,
TURBINATOR WAND,,A4649,HCPCS,Facility,Outpatient,,,,732.5,622.625,209.9345,732.5,"Health Partners, Inc.",Medicare Advantage,358.925,49,,percent of total billed charges,,
TURBINATOR WAND,,A4649,HCPCS,Facility,Inpatient,,,,732.5,622.625,209.9345,732.5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
TURBINATOR WAND,,A4649,HCPCS,Facility,Both,,,,732.5,622.625,209.9345,732.5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),439.5,60,,percent of total billed charges,,
TURBINATOR WAND,,A4649,HCPCS,Facility,Both,,,,732.5,622.625,209.9345,732.5,"Health Partners, Inc.",State of Minnesota Advantage Program,596.9875,81.5,,percent of total billed charges,,
TURBINATOR WAND,,A4649,HCPCS,Facility,Both,,,,732.5,622.625,209.9345,732.5,"Health Partners, Inc.",State Public Programs,366.25,50,,percent of total billed charges,,
TURBINATOR WAND,,A4649,HCPCS,Facility,Both,,,,732.5,622.625,209.9345,732.5,Humana Insurance Company,Commercial PPO,695.875,95,,percent of total billed charges,,
TURBINATOR WAND,,A4649,HCPCS,Facility,Outpatient,,,,732.5,622.625,209.9345,732.5,Humana Insurance Company,Medicare PPO,358.925,49,,percent of total billed charges,,
TURBINATOR WAND,,A4649,HCPCS,Facility,Inpatient,,,,732.5,622.625,209.9345,732.5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
TURBINATOR WAND,,A4649,HCPCS,Facility,Both,,,,732.5,622.625,209.9345,732.5,Medica,Individual & Family,725.9075,99.1,,percent of total billed charges,,
TURBINATOR WAND,,A4649,HCPCS,Facility,Outpatient,,,,732.5,622.625,209.9345,732.5,Medica,Medica Advantage Solution,364.785,49.8,,percent of total billed charges,,
TURBINATOR WAND,,A4649,HCPCS,Facility,Inpatient,,,,732.5,622.625,209.9345,732.5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
TURBINATOR WAND,,A4649,HCPCS,Facility,Outpatient,,,,732.5,622.625,209.9345,732.5,Medica,Medical Assistance,326.695,44.6,,percent of total billed charges,,
TURBINATOR WAND,,A4649,HCPCS,Facility,Inpatient,,,,732.5,622.625,209.9345,732.5,Medica,Medical Assistance,,,,,Included in per diem rate,
TURBINATOR WAND,,A4649,HCPCS,Facility,Outpatient,,,,732.5,622.625,209.9345,732.5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,364.785,49.8,,percent of total billed charges,,
TURBINATOR WAND,,A4649,HCPCS,Facility,Inpatient,,,,732.5,622.625,209.9345,732.5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
TURBINATOR WAND,,A4649,HCPCS,Facility,Both,,,,732.5,622.625,209.9345,732.5,"Multiplan, Inc.","Multiplan, Inc.",688.55,94,,percent of total billed charges,,
TURBINATOR WAND,,A4649,HCPCS,Facility,Outpatient,,,,732.5,622.625,209.9345,732.5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,659.9825,90.1,,percent of total billed charges,,
TURBINATOR WAND,,A4649,HCPCS,Facility,Inpatient,,,,732.5,622.625,209.9345,732.5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
TURBINATOR WAND,,A4649,HCPCS,Facility,Both,,,,732.5,622.625,209.9345,732.5,"Preferred One Administrative Services, INC.",PPO,722.245,98.6,,percent of total billed charges,,
TURBINATOR WAND,,A4649,HCPCS,Facility,Outpatient,,,,732.5,622.625,209.9345,732.5,PrimeWest Health,Minnesota Senior Health Options (MSHO),376.87125,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
TURBINATOR WAND,,A4649,HCPCS,Facility,Inpatient,,,,732.5,622.625,209.9345,732.5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
TURBINATOR WAND,,A4649,HCPCS,Facility,Outpatient,,,,732.5,622.625,209.9345,732.5,PrimeWest Health,MinnesotaCare,376.212,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
TURBINATOR WAND,,A4649,HCPCS,Facility,Inpatient,,,,732.5,622.625,209.9345,732.5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
TURBINATOR WAND,,A4649,HCPCS,Facility,Both,,,,732.5,622.625,209.9345,732.5,Sanford Health Plan,Sanford Health Plan,673.9,92,,percent of total billed charges,,
TURBINATOR WAND,,A4649,HCPCS,Facility,Outpatient,,,,732.5,622.625,209.9345,732.5,"UCare Health, Inc.",Individual & Family Plan,412.76375,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
TURBINATOR WAND,,A4649,HCPCS,Facility,Inpatient,,,,732.5,622.625,209.9345,732.5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
TURBINATOR WAND,,A4649,HCPCS,Facility,Outpatient,,,,732.5,622.625,209.9345,732.5,"UCare Health, Inc.",Medical Assistance,369.69275,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TURBINATOR WAND,,A4649,HCPCS,Facility,Inpatient,,,,732.5,622.625,209.9345,732.5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
TURBINATOR WAND,,A4649,HCPCS,Facility,Outpatient,,,,732.5,622.625,209.9345,732.5,"UCare Health, Inc.",Medicare Advantage,369.69275,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TURBINATOR WAND,,A4649,HCPCS,Facility,Inpatient,,,,732.5,622.625,209.9345,732.5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
TURBINATOR WAND,,A4649,HCPCS,Facility,Outpatient,,,,732.5,622.625,209.9345,732.5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),369.69275,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TURBINATOR WAND,,A4649,HCPCS,Facility,Inpatient,,,,732.5,622.625,209.9345,732.5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
TURBINATOR WAND,,A4649,HCPCS,Facility,Both,,,,732.5,622.625,209.9345,732.5,UnitedHealthcare,Individual & Family,688.55,94,,percent of total billed charges,,
TURBINATOR WAND,,A4649,HCPCS,Facility,Outpatient,,,,732.5,622.625,209.9345,732.5,UnitedHealthcare,Medicare Advantage,358.925,49,,percent of total billed charges,,
TURBINATOR WAND,,A4649,HCPCS,Facility,Inpatient,,,,732.5,622.625,209.9345,732.5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
TURBINATOR WAND,,A4649,HCPCS,Facility,Outpatient,,,,732.5,622.625,209.9345,732.5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,351.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
TURBINATOR WAND,,A4649,HCPCS,Facility,Inpatient,,,,732.5,622.625,209.9345,732.5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
VNUS INFILTRATION TUBING SET,,A4649,HCPCS,Facility,Both,,,,57.555,48.92175,16.495263,57.555,Aetna,Commercial,52.9506,92,,percent of total billed charges,,
VNUS INFILTRATION TUBING SET,,A4649,HCPCS,Facility,Outpatient,,,,57.555,48.92175,16.495263,57.555,Aetna,Medicare Advantage,28.20195,49,,percent of total billed charges,,
VNUS INFILTRATION TUBING SET,,A4649,HCPCS,Facility,Inpatient,,,,57.555,48.92175,16.495263,57.555,Aetna,Medicare Advantage,,,,,Included in per diem rate,
VNUS INFILTRATION TUBING SET,,A4649,HCPCS,Facility,Both,,,,57.555,48.92175,16.495263,57.555,Aetna,PPO,53.52615,93,,percent of total billed charges,,
VNUS INFILTRATION TUBING SET,,A4649,HCPCS,Facility,Both,,,,57.555,48.92175,16.495263,57.555,America's PPO,America's PPO,55.2700665,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
VNUS INFILTRATION TUBING SET,,A4649,HCPCS,Facility,Both,,,,57.555,48.92175,16.495263,57.555,BlueCross BlueShield Minnesota, Federal Employee Program,56.63412,98.4,,percent of total billed charges,,
VNUS INFILTRATION TUBING SET,,A4649,HCPCS,Facility,Both,,,,57.555,48.92175,16.495263,57.555,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,57.555,100,,percent of total billed charges,,
VNUS INFILTRATION TUBING SET,,A4649,HCPCS,Facility,Both,,,,57.555,48.92175,16.495263,57.555,BlueCross BlueShield Minnesota,High Value Network Plan,51.7995,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
VNUS INFILTRATION TUBING SET,,A4649,HCPCS,Facility,Outpatient,,,,57.555,48.92175,16.495263,57.555,BlueCross BlueShield Minnesota,Medicare Advantage,28.20195,49,,percent of total billed charges,,
VNUS INFILTRATION TUBING SET,,A4649,HCPCS,Facility,Inpatient,,,,57.555,48.92175,16.495263,57.555,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
VNUS INFILTRATION TUBING SET,,A4649,HCPCS,Facility,Both,,,,57.555,48.92175,16.495263,57.555,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,50.9764635,88.57,,percent of total billed charges,,
VNUS INFILTRATION TUBING SET,,A4649,HCPCS,Facility,Both,,,,57.555,48.92175,16.495263,57.555,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,16.495263,28.66,,percent of total billed charges,,
VNUS INFILTRATION TUBING SET,,A4649,HCPCS,Facility,Outpatient,,,,57.555,48.92175,16.495263,57.555,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),28.20195,49,,percent of total billed charges,,
VNUS INFILTRATION TUBING SET,,A4649,HCPCS,Facility,Inpatient,,,,57.555,48.92175,16.495263,57.555,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
VNUS INFILTRATION TUBING SET,,A4649,HCPCS,Facility,Both,,,,57.555,48.92175,16.495263,57.555,CorVel,Worker's Compensation,57.555,100,,percent of total billed charges,,
VNUS INFILTRATION TUBING SET,,A4649,HCPCS,Facility,Both,,,,57.555,48.92175,16.495263,57.555,First Health Group Corporation,First Health Network,55.82835,97,,percent of total billed charges,,
VNUS INFILTRATION TUBING SET,,A4649,HCPCS,Facility,Both,,,,57.555,48.92175,16.495263,57.555,"Health Partners, Inc.",Commercial,54.44703,94.6,,percent of total billed charges,,
VNUS INFILTRATION TUBING SET,,A4649,HCPCS,Facility,Outpatient,,,,57.555,48.92175,16.495263,57.555,"Health Partners, Inc.",Medicare Advantage,28.20195,49,,percent of total billed charges,,
VNUS INFILTRATION TUBING SET,,A4649,HCPCS,Facility,Inpatient,,,,57.555,48.92175,16.495263,57.555,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
VNUS INFILTRATION TUBING SET,,A4649,HCPCS,Facility,Both,,,,57.555,48.92175,16.495263,57.555,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),34.533,60,,percent of total billed charges,,
VNUS INFILTRATION TUBING SET,,A4649,HCPCS,Facility,Both,,,,57.555,48.92175,16.495263,57.555,"Health Partners, Inc.",State of Minnesota Advantage Program,46.907325,81.5,,percent of total billed charges,,
VNUS INFILTRATION TUBING SET,,A4649,HCPCS,Facility,Both,,,,57.555,48.92175,16.495263,57.555,"Health Partners, Inc.",State Public Programs,28.7775,50,,percent of total billed charges,,
VNUS INFILTRATION TUBING SET,,A4649,HCPCS,Facility,Both,,,,57.555,48.92175,16.495263,57.555,Humana Insurance Company,Commercial PPO,54.67725,95,,percent of total billed charges,,
VNUS INFILTRATION TUBING SET,,A4649,HCPCS,Facility,Outpatient,,,,57.555,48.92175,16.495263,57.555,Humana Insurance Company,Medicare PPO,28.20195,49,,percent of total billed charges,,
VNUS INFILTRATION TUBING SET,,A4649,HCPCS,Facility,Inpatient,,,,57.555,48.92175,16.495263,57.555,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
VNUS INFILTRATION TUBING SET,,A4649,HCPCS,Facility,Both,,,,57.555,48.92175,16.495263,57.555,Medica,Individual & Family,57.037005,99.1,,percent of total billed charges,,
VNUS INFILTRATION TUBING SET,,A4649,HCPCS,Facility,Outpatient,,,,57.555,48.92175,16.495263,57.555,Medica,Medica Advantage Solution,28.66239,49.8,,percent of total billed charges,,
VNUS INFILTRATION TUBING SET,,A4649,HCPCS,Facility,Inpatient,,,,57.555,48.92175,16.495263,57.555,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
VNUS INFILTRATION TUBING SET,,A4649,HCPCS,Facility,Outpatient,,,,57.555,48.92175,16.495263,57.555,Medica,Medical Assistance,25.66953,44.6,,percent of total billed charges,,
VNUS INFILTRATION TUBING SET,,A4649,HCPCS,Facility,Inpatient,,,,57.555,48.92175,16.495263,57.555,Medica,Medical Assistance,,,,,Included in per diem rate,
VNUS INFILTRATION TUBING SET,,A4649,HCPCS,Facility,Outpatient,,,,57.555,48.92175,16.495263,57.555,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,28.66239,49.8,,percent of total billed charges,,
VNUS INFILTRATION TUBING SET,,A4649,HCPCS,Facility,Inpatient,,,,57.555,48.92175,16.495263,57.555,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
VNUS INFILTRATION TUBING SET,,A4649,HCPCS,Facility,Both,,,,57.555,48.92175,16.495263,57.555,"Multiplan, Inc.","Multiplan, Inc.",54.1017,94,,percent of total billed charges,,
VNUS INFILTRATION TUBING SET,,A4649,HCPCS,Facility,Outpatient,,,,57.555,48.92175,16.495263,57.555,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,51.857055,90.1,,percent of total billed charges,,
VNUS INFILTRATION TUBING SET,,A4649,HCPCS,Facility,Inpatient,,,,57.555,48.92175,16.495263,57.555,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
VNUS INFILTRATION TUBING SET,,A4649,HCPCS,Facility,Both,,,,57.555,48.92175,16.495263,57.555,"Preferred One Administrative Services, INC.",PPO,56.74923,98.6,,percent of total billed charges,,
VNUS INFILTRATION TUBING SET,,A4649,HCPCS,Facility,Outpatient,,,,57.555,48.92175,16.495263,57.555,PrimeWest Health,Minnesota Senior Health Options (MSHO),29.6120475,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
VNUS INFILTRATION TUBING SET,,A4649,HCPCS,Facility,Inpatient,,,,57.555,48.92175,16.495263,57.555,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
VNUS INFILTRATION TUBING SET,,A4649,HCPCS,Facility,Outpatient,,,,57.555,48.92175,16.495263,57.555,PrimeWest Health,MinnesotaCare,29.560248,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
VNUS INFILTRATION TUBING SET,,A4649,HCPCS,Facility,Inpatient,,,,57.555,48.92175,16.495263,57.555,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
VNUS INFILTRATION TUBING SET,,A4649,HCPCS,Facility,Both,,,,57.555,48.92175,16.495263,57.555,Sanford Health Plan,Sanford Health Plan,52.9506,92,,percent of total billed charges,,
VNUS INFILTRATION TUBING SET,,A4649,HCPCS,Facility,Outpatient,,,,57.555,48.92175,16.495263,57.555,"UCare Health, Inc.",Individual & Family Plan,32.4322425,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
VNUS INFILTRATION TUBING SET,,A4649,HCPCS,Facility,Inpatient,,,,57.555,48.92175,16.495263,57.555,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
VNUS INFILTRATION TUBING SET,,A4649,HCPCS,Facility,Outpatient,,,,57.555,48.92175,16.495263,57.555,"UCare Health, Inc.",Medical Assistance,29.0480085,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
VNUS INFILTRATION TUBING SET,,A4649,HCPCS,Facility,Inpatient,,,,57.555,48.92175,16.495263,57.555,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
VNUS INFILTRATION TUBING SET,,A4649,HCPCS,Facility,Outpatient,,,,57.555,48.92175,16.495263,57.555,"UCare Health, Inc.",Medicare Advantage,29.0480085,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
VNUS INFILTRATION TUBING SET,,A4649,HCPCS,Facility,Inpatient,,,,57.555,48.92175,16.495263,57.555,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
VNUS INFILTRATION TUBING SET,,A4649,HCPCS,Facility,Outpatient,,,,57.555,48.92175,16.495263,57.555,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),29.0480085,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
VNUS INFILTRATION TUBING SET,,A4649,HCPCS,Facility,Inpatient,,,,57.555,48.92175,16.495263,57.555,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
VNUS INFILTRATION TUBING SET,,A4649,HCPCS,Facility,Both,,,,57.555,48.92175,16.495263,57.555,UnitedHealthcare,Individual & Family,54.1017,94,,percent of total billed charges,,
VNUS INFILTRATION TUBING SET,,A4649,HCPCS,Facility,Outpatient,,,,57.555,48.92175,16.495263,57.555,UnitedHealthcare,Medicare Advantage,28.20195,49,,percent of total billed charges,,
VNUS INFILTRATION TUBING SET,,A4649,HCPCS,Facility,Inpatient,,,,57.555,48.92175,16.495263,57.555,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
VNUS INFILTRATION TUBING SET,,A4649,HCPCS,Facility,Outpatient,,,,57.555,48.92175,16.495263,57.555,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,27.6264,48,,percent of total billed charges,,100% of DHS outpatient percentage
VNUS INFILTRATION TUBING SET,,A4649,HCPCS,Facility,Inpatient,,,,57.555,48.92175,16.495263,57.555,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
WATER STERILE F/IRRIG 3000ML BAG,,A4649,HCPCS,Facility,Both,,,,50,42.5,14.33,50,Aetna,Commercial,46,92,,percent of total billed charges,,
WATER STERILE F/IRRIG 3000ML BAG,,A4649,HCPCS,Facility,Outpatient,,,,50,42.5,14.33,50,Aetna,Medicare Advantage,24.5,49,,percent of total billed charges,,
WATER STERILE F/IRRIG 3000ML BAG,,A4649,HCPCS,Facility,Inpatient,,,,50,42.5,14.33,50,Aetna,Medicare Advantage,,,,,Included in per diem rate,
WATER STERILE F/IRRIG 3000ML BAG,,A4649,HCPCS,Facility,Both,,,,50,42.5,14.33,50,Aetna,PPO,46.5,93,,percent of total billed charges,,
WATER STERILE F/IRRIG 3000ML BAG,,A4649,HCPCS,Facility,Both,,,,50,42.5,14.33,50,America's PPO,America's PPO,48.015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
WATER STERILE F/IRRIG 3000ML BAG,,A4649,HCPCS,Facility,Both,,,,50,42.5,14.33,50,BlueCross BlueShield Minnesota, Federal Employee Program,49.2,98.4,,percent of total billed charges,,
WATER STERILE F/IRRIG 3000ML BAG,,A4649,HCPCS,Facility,Both,,,,50,42.5,14.33,50,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,50,100,,percent of total billed charges,,
WATER STERILE F/IRRIG 3000ML BAG,,A4649,HCPCS,Facility,Both,,,,50,42.5,14.33,50,BlueCross BlueShield Minnesota,High Value Network Plan,45,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
WATER STERILE F/IRRIG 3000ML BAG,,A4649,HCPCS,Facility,Outpatient,,,,50,42.5,14.33,50,BlueCross BlueShield Minnesota,Medicare Advantage,24.5,49,,percent of total billed charges,,
WATER STERILE F/IRRIG 3000ML BAG,,A4649,HCPCS,Facility,Inpatient,,,,50,42.5,14.33,50,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
WATER STERILE F/IRRIG 3000ML BAG,,A4649,HCPCS,Facility,Both,,,,50,42.5,14.33,50,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,44.285,88.57,,percent of total billed charges,,
WATER STERILE F/IRRIG 3000ML BAG,,A4649,HCPCS,Facility,Both,,,,50,42.5,14.33,50,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,14.33,28.66,,percent of total billed charges,,
WATER STERILE F/IRRIG 3000ML BAG,,A4649,HCPCS,Facility,Outpatient,,,,50,42.5,14.33,50,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),24.5,49,,percent of total billed charges,,
WATER STERILE F/IRRIG 3000ML BAG,,A4649,HCPCS,Facility,Inpatient,,,,50,42.5,14.33,50,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
WATER STERILE F/IRRIG 3000ML BAG,,A4649,HCPCS,Facility,Both,,,,50,42.5,14.33,50,CorVel,Worker's Compensation,50,100,,percent of total billed charges,,
WATER STERILE F/IRRIG 3000ML BAG,,A4649,HCPCS,Facility,Both,,,,50,42.5,14.33,50,First Health Group Corporation,First Health Network,48.5,97,,percent of total billed charges,,
WATER STERILE F/IRRIG 3000ML BAG,,A4649,HCPCS,Facility,Both,,,,50,42.5,14.33,50,"Health Partners, Inc.",Commercial,47.3,94.6,,percent of total billed charges,,
WATER STERILE F/IRRIG 3000ML BAG,,A4649,HCPCS,Facility,Outpatient,,,,50,42.5,14.33,50,"Health Partners, Inc.",Medicare Advantage,24.5,49,,percent of total billed charges,,
WATER STERILE F/IRRIG 3000ML BAG,,A4649,HCPCS,Facility,Inpatient,,,,50,42.5,14.33,50,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
WATER STERILE F/IRRIG 3000ML BAG,,A4649,HCPCS,Facility,Both,,,,50,42.5,14.33,50,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),30,60,,percent of total billed charges,,
WATER STERILE F/IRRIG 3000ML BAG,,A4649,HCPCS,Facility,Both,,,,50,42.5,14.33,50,"Health Partners, Inc.",State of Minnesota Advantage Program,40.75,81.5,,percent of total billed charges,,
WATER STERILE F/IRRIG 3000ML BAG,,A4649,HCPCS,Facility,Both,,,,50,42.5,14.33,50,"Health Partners, Inc.",State Public Programs,25,50,,percent of total billed charges,,
WATER STERILE F/IRRIG 3000ML BAG,,A4649,HCPCS,Facility,Both,,,,50,42.5,14.33,50,Humana Insurance Company,Commercial PPO,47.5,95,,percent of total billed charges,,
WATER STERILE F/IRRIG 3000ML BAG,,A4649,HCPCS,Facility,Outpatient,,,,50,42.5,14.33,50,Humana Insurance Company,Medicare PPO,24.5,49,,percent of total billed charges,,
WATER STERILE F/IRRIG 3000ML BAG,,A4649,HCPCS,Facility,Inpatient,,,,50,42.5,14.33,50,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
WATER STERILE F/IRRIG 3000ML BAG,,A4649,HCPCS,Facility,Both,,,,50,42.5,14.33,50,Medica,Individual & Family,49.55,99.1,,percent of total billed charges,,
WATER STERILE F/IRRIG 3000ML BAG,,A4649,HCPCS,Facility,Outpatient,,,,50,42.5,14.33,50,Medica,Medica Advantage Solution,24.9,49.8,,percent of total billed charges,,
WATER STERILE F/IRRIG 3000ML BAG,,A4649,HCPCS,Facility,Inpatient,,,,50,42.5,14.33,50,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
WATER STERILE F/IRRIG 3000ML BAG,,A4649,HCPCS,Facility,Outpatient,,,,50,42.5,14.33,50,Medica,Medical Assistance,22.3,44.6,,percent of total billed charges,,
WATER STERILE F/IRRIG 3000ML BAG,,A4649,HCPCS,Facility,Inpatient,,,,50,42.5,14.33,50,Medica,Medical Assistance,,,,,Included in per diem rate,
WATER STERILE F/IRRIG 3000ML BAG,,A4649,HCPCS,Facility,Outpatient,,,,50,42.5,14.33,50,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,24.9,49.8,,percent of total billed charges,,
WATER STERILE F/IRRIG 3000ML BAG,,A4649,HCPCS,Facility,Inpatient,,,,50,42.5,14.33,50,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
WATER STERILE F/IRRIG 3000ML BAG,,A4649,HCPCS,Facility,Both,,,,50,42.5,14.33,50,"Multiplan, Inc.","Multiplan, Inc.",47,94,,percent of total billed charges,,
WATER STERILE F/IRRIG 3000ML BAG,,A4649,HCPCS,Facility,Outpatient,,,,50,42.5,14.33,50,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,45.05,90.1,,percent of total billed charges,,
WATER STERILE F/IRRIG 3000ML BAG,,A4649,HCPCS,Facility,Inpatient,,,,50,42.5,14.33,50,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
WATER STERILE F/IRRIG 3000ML BAG,,A4649,HCPCS,Facility,Both,,,,50,42.5,14.33,50,"Preferred One Administrative Services, INC.",PPO,49.3,98.6,,percent of total billed charges,,
WATER STERILE F/IRRIG 3000ML BAG,,A4649,HCPCS,Facility,Outpatient,,,,50,42.5,14.33,50,PrimeWest Health,Minnesota Senior Health Options (MSHO),25.725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
WATER STERILE F/IRRIG 3000ML BAG,,A4649,HCPCS,Facility,Inpatient,,,,50,42.5,14.33,50,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
WATER STERILE F/IRRIG 3000ML BAG,,A4649,HCPCS,Facility,Outpatient,,,,50,42.5,14.33,50,PrimeWest Health,MinnesotaCare,25.68,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
WATER STERILE F/IRRIG 3000ML BAG,,A4649,HCPCS,Facility,Inpatient,,,,50,42.5,14.33,50,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
WATER STERILE F/IRRIG 3000ML BAG,,A4649,HCPCS,Facility,Both,,,,50,42.5,14.33,50,Sanford Health Plan,Sanford Health Plan,46,92,,percent of total billed charges,,
WATER STERILE F/IRRIG 3000ML BAG,,A4649,HCPCS,Facility,Outpatient,,,,50,42.5,14.33,50,"UCare Health, Inc.",Individual & Family Plan,28.175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
WATER STERILE F/IRRIG 3000ML BAG,,A4649,HCPCS,Facility,Inpatient,,,,50,42.5,14.33,50,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
WATER STERILE F/IRRIG 3000ML BAG,,A4649,HCPCS,Facility,Outpatient,,,,50,42.5,14.33,50,"UCare Health, Inc.",Medical Assistance,25.235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
WATER STERILE F/IRRIG 3000ML BAG,,A4649,HCPCS,Facility,Inpatient,,,,50,42.5,14.33,50,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
WATER STERILE F/IRRIG 3000ML BAG,,A4649,HCPCS,Facility,Outpatient,,,,50,42.5,14.33,50,"UCare Health, Inc.",Medicare Advantage,25.235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
WATER STERILE F/IRRIG 3000ML BAG,,A4649,HCPCS,Facility,Inpatient,,,,50,42.5,14.33,50,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
WATER STERILE F/IRRIG 3000ML BAG,,A4649,HCPCS,Facility,Outpatient,,,,50,42.5,14.33,50,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),25.235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
WATER STERILE F/IRRIG 3000ML BAG,,A4649,HCPCS,Facility,Inpatient,,,,50,42.5,14.33,50,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
WATER STERILE F/IRRIG 3000ML BAG,,A4649,HCPCS,Facility,Both,,,,50,42.5,14.33,50,UnitedHealthcare,Individual & Family,47,94,,percent of total billed charges,,
WATER STERILE F/IRRIG 3000ML BAG,,A4649,HCPCS,Facility,Outpatient,,,,50,42.5,14.33,50,UnitedHealthcare,Medicare Advantage,24.5,49,,percent of total billed charges,,
WATER STERILE F/IRRIG 3000ML BAG,,A4649,HCPCS,Facility,Inpatient,,,,50,42.5,14.33,50,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
WATER STERILE F/IRRIG 3000ML BAG,,A4649,HCPCS,Facility,Outpatient,,,,50,42.5,14.33,50,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,24,48,,percent of total billed charges,,100% of DHS outpatient percentage
WATER STERILE F/IRRIG 3000ML BAG,,A4649,HCPCS,Facility,Inpatient,,,,50,42.5,14.33,50,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Sup Collagen Dressing, 4 X 4",,A6021,HCPCS,Facility,Both,,,,70.64,60.044,20.245424,70.64,Aetna,Commercial,64.9888,92,,percent of total billed charges,,
"Sup Collagen Dressing, 4 X 4",,A6021,HCPCS,Facility,Outpatient,,,,70.64,60.044,20.245424,70.64,Aetna,Medicare Advantage,34.6136,49,,percent of total billed charges,,
"Sup Collagen Dressing, 4 X 4",,A6021,HCPCS,Facility,Inpatient,,,,70.64,60.044,20.245424,70.64,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Sup Collagen Dressing, 4 X 4",,A6021,HCPCS,Facility,Both,,,,70.64,60.044,20.245424,70.64,Aetna,PPO,65.6952,93,,percent of total billed charges,,
"Sup Collagen Dressing, 4 X 4",,A6021,HCPCS,Facility,Both,,,,70.64,60.044,20.245424,70.64,America's PPO,America's PPO,67.835592,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Sup Collagen Dressing, 4 X 4",,A6021,HCPCS,Facility,Both,,,,70.64,60.044,20.245424,70.64,BlueCross BlueShield Minnesota, Federal Employee Program,69.50976,98.4,,percent of total billed charges,,
"Sup Collagen Dressing, 4 X 4",,A6021,HCPCS,Facility,Both,,,,70.64,60.044,20.245424,70.64,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,70.64,100,,percent of total billed charges,,
"Sup Collagen Dressing, 4 X 4",,A6021,HCPCS,Facility,Both,,,,70.64,60.044,20.245424,70.64,BlueCross BlueShield Minnesota,High Value Network Plan,63.576,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
"Sup Collagen Dressing, 4 X 4",,A6021,HCPCS,Facility,Outpatient,,,,70.64,60.044,20.245424,70.64,BlueCross BlueShield Minnesota,Medicare Advantage,34.6136,49,,percent of total billed charges,,
"Sup Collagen Dressing, 4 X 4",,A6021,HCPCS,Facility,Inpatient,,,,70.64,60.044,20.245424,70.64,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Sup Collagen Dressing, 4 X 4",,A6021,HCPCS,Facility,Both,,,,70.64,60.044,20.245424,70.64,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,62.565848,88.57,,percent of total billed charges,,
"Sup Collagen Dressing, 4 X 4",,A6021,HCPCS,Facility,Both,,,,70.64,60.044,20.245424,70.64,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,20.245424,28.66,,percent of total billed charges,,
"Sup Collagen Dressing, 4 X 4",,A6021,HCPCS,Facility,Outpatient,,,,70.64,60.044,20.245424,70.64,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),34.6136,49,,percent of total billed charges,,
"Sup Collagen Dressing, 4 X 4",,A6021,HCPCS,Facility,Inpatient,,,,70.64,60.044,20.245424,70.64,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Sup Collagen Dressing, 4 X 4",,A6021,HCPCS,Facility,Both,,,,70.64,60.044,20.245424,70.64,CorVel,Worker's Compensation,70.64,100,,percent of total billed charges,,
"Sup Collagen Dressing, 4 X 4",,A6021,HCPCS,Facility,Both,,,,70.64,60.044,20.245424,70.64,First Health Group Corporation,First Health Network,68.5208,97,,percent of total billed charges,,
"Sup Collagen Dressing, 4 X 4",,A6021,HCPCS,Facility,Both,,,,70.64,60.044,20.245424,70.64,"Health Partners, Inc.",Commercial,66.82544,94.6,,percent of total billed charges,,
"Sup Collagen Dressing, 4 X 4",,A6021,HCPCS,Facility,Outpatient,,,,70.64,60.044,20.245424,70.64,"Health Partners, Inc.",Medicare Advantage,34.6136,49,,percent of total billed charges,,
"Sup Collagen Dressing, 4 X 4",,A6021,HCPCS,Facility,Inpatient,,,,70.64,60.044,20.245424,70.64,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Sup Collagen Dressing, 4 X 4",,A6021,HCPCS,Facility,Both,,,,70.64,60.044,20.245424,70.64,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),42.384,60,,percent of total billed charges,,
"Sup Collagen Dressing, 4 X 4",,A6021,HCPCS,Facility,Both,,,,70.64,60.044,20.245424,70.64,"Health Partners, Inc.",State of Minnesota Advantage Program,57.5716,81.5,,percent of total billed charges,,
"Sup Collagen Dressing, 4 X 4",,A6021,HCPCS,Facility,Both,,,,70.64,60.044,20.245424,70.64,"Health Partners, Inc.",State Public Programs,35.32,50,,percent of total billed charges,,
"Sup Collagen Dressing, 4 X 4",,A6021,HCPCS,Facility,Both,,,,70.64,60.044,20.245424,70.64,Humana Insurance Company,Commercial PPO,67.108,95,,percent of total billed charges,,
"Sup Collagen Dressing, 4 X 4",,A6021,HCPCS,Facility,Outpatient,,,,70.64,60.044,20.245424,70.64,Humana Insurance Company,Medicare PPO,34.6136,49,,percent of total billed charges,,
"Sup Collagen Dressing, 4 X 4",,A6021,HCPCS,Facility,Inpatient,,,,70.64,60.044,20.245424,70.64,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Sup Collagen Dressing, 4 X 4",,A6021,HCPCS,Facility,Both,,,,70.64,60.044,20.245424,70.64,Medica,Individual & Family,70.00424,99.1,,percent of total billed charges,,
"Sup Collagen Dressing, 4 X 4",,A6021,HCPCS,Facility,Outpatient,,,,70.64,60.044,20.245424,70.64,Medica,Medica Advantage Solution,35.17872,49.8,,percent of total billed charges,,
"Sup Collagen Dressing, 4 X 4",,A6021,HCPCS,Facility,Inpatient,,,,70.64,60.044,20.245424,70.64,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Sup Collagen Dressing, 4 X 4",,A6021,HCPCS,Facility,Outpatient,,,,70.64,60.044,20.245424,70.64,Medica,Medical Assistance,31.50544,44.6,,percent of total billed charges,,
"Sup Collagen Dressing, 4 X 4",,A6021,HCPCS,Facility,Inpatient,,,,70.64,60.044,20.245424,70.64,Medica,Medical Assistance,,,,,Included in per diem rate,
"Sup Collagen Dressing, 4 X 4",,A6021,HCPCS,Facility,Outpatient,,,,70.64,60.044,20.245424,70.64,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,35.17872,49.8,,percent of total billed charges,,
"Sup Collagen Dressing, 4 X 4",,A6021,HCPCS,Facility,Inpatient,,,,70.64,60.044,20.245424,70.64,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Sup Collagen Dressing, 4 X 4",,A6021,HCPCS,Facility,Both,,,,70.64,60.044,20.245424,70.64,"Multiplan, Inc.","Multiplan, Inc.",66.4016,94,,percent of total billed charges,,
"Sup Collagen Dressing, 4 X 4",,A6021,HCPCS,Facility,Outpatient,,,,70.64,60.044,20.245424,70.64,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,63.64664,90.1,,percent of total billed charges,,
"Sup Collagen Dressing, 4 X 4",,A6021,HCPCS,Facility,Inpatient,,,,70.64,60.044,20.245424,70.64,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Sup Collagen Dressing, 4 X 4",,A6021,HCPCS,Facility,Both,,,,70.64,60.044,20.245424,70.64,"Preferred One Administrative Services, INC.",PPO,69.65104,98.6,,percent of total billed charges,,
"Sup Collagen Dressing, 4 X 4",,A6021,HCPCS,Facility,Outpatient,,,,70.64,60.044,20.245424,70.64,PrimeWest Health,Minnesota Senior Health Options (MSHO),36.34428,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Sup Collagen Dressing, 4 X 4",,A6021,HCPCS,Facility,Inpatient,,,,70.64,60.044,20.245424,70.64,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Sup Collagen Dressing, 4 X 4",,A6021,HCPCS,Facility,Outpatient,,,,70.64,60.044,20.245424,70.64,PrimeWest Health,MinnesotaCare,36.280704,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Sup Collagen Dressing, 4 X 4",,A6021,HCPCS,Facility,Inpatient,,,,70.64,60.044,20.245424,70.64,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Sup Collagen Dressing, 4 X 4",,A6021,HCPCS,Facility,Both,,,,70.64,60.044,20.245424,70.64,Sanford Health Plan,Sanford Health Plan,64.9888,92,,percent of total billed charges,,
"Sup Collagen Dressing, 4 X 4",,A6021,HCPCS,Facility,Outpatient,,,,70.64,60.044,20.245424,70.64,"UCare Health, Inc.",Individual & Family Plan,39.80564,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Sup Collagen Dressing, 4 X 4",,A6021,HCPCS,Facility,Inpatient,,,,70.64,60.044,20.245424,70.64,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Sup Collagen Dressing, 4 X 4",,A6021,HCPCS,Facility,Outpatient,,,,70.64,60.044,20.245424,70.64,"UCare Health, Inc.",Medical Assistance,35.652008,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Sup Collagen Dressing, 4 X 4",,A6021,HCPCS,Facility,Inpatient,,,,70.64,60.044,20.245424,70.64,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Sup Collagen Dressing, 4 X 4",,A6021,HCPCS,Facility,Outpatient,,,,70.64,60.044,20.245424,70.64,"UCare Health, Inc.",Medicare Advantage,35.652008,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Sup Collagen Dressing, 4 X 4",,A6021,HCPCS,Facility,Inpatient,,,,70.64,60.044,20.245424,70.64,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Sup Collagen Dressing, 4 X 4",,A6021,HCPCS,Facility,Outpatient,,,,70.64,60.044,20.245424,70.64,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),35.652008,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Sup Collagen Dressing, 4 X 4",,A6021,HCPCS,Facility,Inpatient,,,,70.64,60.044,20.245424,70.64,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Sup Collagen Dressing, 4 X 4",,A6021,HCPCS,Facility,Both,,,,70.64,60.044,20.245424,70.64,UnitedHealthcare,Individual & Family,66.4016,94,,percent of total billed charges,,
"Sup Collagen Dressing, 4 X 4",,A6021,HCPCS,Facility,Outpatient,,,,70.64,60.044,20.245424,70.64,UnitedHealthcare,Medicare Advantage,34.6136,49,,percent of total billed charges,,
"Sup Collagen Dressing, 4 X 4",,A6021,HCPCS,Facility,Inpatient,,,,70.64,60.044,20.245424,70.64,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Sup Collagen Dressing, 4 X 4",,A6021,HCPCS,Facility,Outpatient,,,,70.64,60.044,20.245424,70.64,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,33.9072,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Sup Collagen Dressing, 4 X 4",,A6021,HCPCS,Facility,Inpatient,,,,70.64,60.044,20.245424,70.64,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Sup Alginate Calcium/Cmc Dressing 4 X 4,,A6196,HCPCS,Facility,Both,,,,20.83,17.7055,5.969878,20.83,Aetna,Commercial,19.1636,92,,percent of total billed charges,,
Sup Alginate Calcium/Cmc Dressing 4 X 4,,A6196,HCPCS,Facility,Outpatient,,,,20.83,17.7055,5.969878,20.83,Aetna,Medicare Advantage,10.2067,49,,percent of total billed charges,,
Sup Alginate Calcium/Cmc Dressing 4 X 4,,A6196,HCPCS,Facility,Inpatient,,,,20.83,17.7055,5.969878,20.83,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Sup Alginate Calcium/Cmc Dressing 4 X 4,,A6196,HCPCS,Facility,Both,,,,20.83,17.7055,5.969878,20.83,Aetna,PPO,19.3719,93,,percent of total billed charges,,
Sup Alginate Calcium/Cmc Dressing 4 X 4,,A6196,HCPCS,Facility,Both,,,,20.83,17.7055,5.969878,20.83,America's PPO,America's PPO,20.003049,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Sup Alginate Calcium/Cmc Dressing 4 X 4,,A6196,HCPCS,Facility,Both,,,,20.83,17.7055,5.969878,20.83,BlueCross BlueShield Minnesota, Federal Employee Program,20.49672,98.4,,percent of total billed charges,,
Sup Alginate Calcium/Cmc Dressing 4 X 4,,A6196,HCPCS,Facility,Both,,,,20.83,17.7055,5.969878,20.83,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,20.83,100,,percent of total billed charges,,
Sup Alginate Calcium/Cmc Dressing 4 X 4,,A6196,HCPCS,Facility,Both,,,,20.83,17.7055,5.969878,20.83,BlueCross BlueShield Minnesota,High Value Network Plan,18.747,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
Sup Alginate Calcium/Cmc Dressing 4 X 4,,A6196,HCPCS,Facility,Outpatient,,,,20.83,17.7055,5.969878,20.83,BlueCross BlueShield Minnesota,Medicare Advantage,10.2067,49,,percent of total billed charges,,
Sup Alginate Calcium/Cmc Dressing 4 X 4,,A6196,HCPCS,Facility,Inpatient,,,,20.83,17.7055,5.969878,20.83,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Sup Alginate Calcium/Cmc Dressing 4 X 4,,A6196,HCPCS,Facility,Both,,,,20.83,17.7055,5.969878,20.83,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,18.449131,88.57,,percent of total billed charges,,
Sup Alginate Calcium/Cmc Dressing 4 X 4,,A6196,HCPCS,Facility,Both,,,,20.83,17.7055,5.969878,20.83,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,5.969878,28.66,,percent of total billed charges,,
Sup Alginate Calcium/Cmc Dressing 4 X 4,,A6196,HCPCS,Facility,Outpatient,,,,20.83,17.7055,5.969878,20.83,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),10.2067,49,,percent of total billed charges,,
Sup Alginate Calcium/Cmc Dressing 4 X 4,,A6196,HCPCS,Facility,Inpatient,,,,20.83,17.7055,5.969878,20.83,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Sup Alginate Calcium/Cmc Dressing 4 X 4,,A6196,HCPCS,Facility,Both,,,,20.83,17.7055,5.969878,20.83,CorVel,Worker's Compensation,20.83,100,,percent of total billed charges,,
Sup Alginate Calcium/Cmc Dressing 4 X 4,,A6196,HCPCS,Facility,Both,,,,20.83,17.7055,5.969878,20.83,First Health Group Corporation,First Health Network,20.2051,97,,percent of total billed charges,,
Sup Alginate Calcium/Cmc Dressing 4 X 4,,A6196,HCPCS,Facility,Both,,,,20.83,17.7055,5.969878,20.83,"Health Partners, Inc.",Commercial,19.70518,94.6,,percent of total billed charges,,
Sup Alginate Calcium/Cmc Dressing 4 X 4,,A6196,HCPCS,Facility,Outpatient,,,,20.83,17.7055,5.969878,20.83,"Health Partners, Inc.",Medicare Advantage,10.2067,49,,percent of total billed charges,,
Sup Alginate Calcium/Cmc Dressing 4 X 4,,A6196,HCPCS,Facility,Inpatient,,,,20.83,17.7055,5.969878,20.83,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Alginate Calcium/Cmc Dressing 4 X 4,,A6196,HCPCS,Facility,Both,,,,20.83,17.7055,5.969878,20.83,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),12.498,60,,percent of total billed charges,,
Sup Alginate Calcium/Cmc Dressing 4 X 4,,A6196,HCPCS,Facility,Both,,,,20.83,17.7055,5.969878,20.83,"Health Partners, Inc.",State of Minnesota Advantage Program,16.97645,81.5,,percent of total billed charges,,
Sup Alginate Calcium/Cmc Dressing 4 X 4,,A6196,HCPCS,Facility,Both,,,,20.83,17.7055,5.969878,20.83,"Health Partners, Inc.",State Public Programs,10.415,50,,percent of total billed charges,,
Sup Alginate Calcium/Cmc Dressing 4 X 4,,A6196,HCPCS,Facility,Both,,,,20.83,17.7055,5.969878,20.83,Humana Insurance Company,Commercial PPO,19.7885,95,,percent of total billed charges,,
Sup Alginate Calcium/Cmc Dressing 4 X 4,,A6196,HCPCS,Facility,Outpatient,,,,20.83,17.7055,5.969878,20.83,Humana Insurance Company,Medicare PPO,10.2067,49,,percent of total billed charges,,
Sup Alginate Calcium/Cmc Dressing 4 X 4,,A6196,HCPCS,Facility,Inpatient,,,,20.83,17.7055,5.969878,20.83,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Sup Alginate Calcium/Cmc Dressing 4 X 4,,A6196,HCPCS,Facility,Both,,,,20.83,17.7055,5.969878,20.83,Medica,Individual & Family,20.64253,99.1,,percent of total billed charges,,
Sup Alginate Calcium/Cmc Dressing 4 X 4,,A6196,HCPCS,Facility,Outpatient,,,,20.83,17.7055,5.969878,20.83,Medica,Medica Advantage Solution,10.37334,49.8,,percent of total billed charges,,
Sup Alginate Calcium/Cmc Dressing 4 X 4,,A6196,HCPCS,Facility,Inpatient,,,,20.83,17.7055,5.969878,20.83,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Sup Alginate Calcium/Cmc Dressing 4 X 4,,A6196,HCPCS,Facility,Outpatient,,,,20.83,17.7055,5.969878,20.83,Medica,Medical Assistance,9.29018,44.6,,percent of total billed charges,,
Sup Alginate Calcium/Cmc Dressing 4 X 4,,A6196,HCPCS,Facility,Inpatient,,,,20.83,17.7055,5.969878,20.83,Medica,Medical Assistance,,,,,Included in per diem rate,
Sup Alginate Calcium/Cmc Dressing 4 X 4,,A6196,HCPCS,Facility,Outpatient,,,,20.83,17.7055,5.969878,20.83,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,10.37334,49.8,,percent of total billed charges,,
Sup Alginate Calcium/Cmc Dressing 4 X 4,,A6196,HCPCS,Facility,Inpatient,,,,20.83,17.7055,5.969878,20.83,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Sup Alginate Calcium/Cmc Dressing 4 X 4,,A6196,HCPCS,Facility,Both,,,,20.83,17.7055,5.969878,20.83,"Multiplan, Inc.","Multiplan, Inc.",19.5802,94,,percent of total billed charges,,
Sup Alginate Calcium/Cmc Dressing 4 X 4,,A6196,HCPCS,Facility,Outpatient,,,,20.83,17.7055,5.969878,20.83,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,18.76783,90.1,,percent of total billed charges,,
Sup Alginate Calcium/Cmc Dressing 4 X 4,,A6196,HCPCS,Facility,Inpatient,,,,20.83,17.7055,5.969878,20.83,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Sup Alginate Calcium/Cmc Dressing 4 X 4,,A6196,HCPCS,Facility,Both,,,,20.83,17.7055,5.969878,20.83,"Preferred One Administrative Services, INC.",PPO,20.53838,98.6,,percent of total billed charges,,
Sup Alginate Calcium/Cmc Dressing 4 X 4,,A6196,HCPCS,Facility,Outpatient,,,,20.83,17.7055,5.969878,20.83,PrimeWest Health,Minnesota Senior Health Options (MSHO),10.717035,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Sup Alginate Calcium/Cmc Dressing 4 X 4,,A6196,HCPCS,Facility,Inpatient,,,,20.83,17.7055,5.969878,20.83,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Alginate Calcium/Cmc Dressing 4 X 4,,A6196,HCPCS,Facility,Outpatient,,,,20.83,17.7055,5.969878,20.83,PrimeWest Health,MinnesotaCare,10.698288,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Sup Alginate Calcium/Cmc Dressing 4 X 4,,A6196,HCPCS,Facility,Inpatient,,,,20.83,17.7055,5.969878,20.83,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Sup Alginate Calcium/Cmc Dressing 4 X 4,,A6196,HCPCS,Facility,Both,,,,20.83,17.7055,5.969878,20.83,Sanford Health Plan,Sanford Health Plan,19.1636,92,,percent of total billed charges,,
Sup Alginate Calcium/Cmc Dressing 4 X 4,,A6196,HCPCS,Facility,Outpatient,,,,20.83,17.7055,5.969878,20.83,"UCare Health, Inc.",Individual & Family Plan,11.737705,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Sup Alginate Calcium/Cmc Dressing 4 X 4,,A6196,HCPCS,Facility,Inpatient,,,,20.83,17.7055,5.969878,20.83,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Sup Alginate Calcium/Cmc Dressing 4 X 4,,A6196,HCPCS,Facility,Outpatient,,,,20.83,17.7055,5.969878,20.83,"UCare Health, Inc.",Medical Assistance,10.512901,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Alginate Calcium/Cmc Dressing 4 X 4,,A6196,HCPCS,Facility,Inpatient,,,,20.83,17.7055,5.969878,20.83,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Sup Alginate Calcium/Cmc Dressing 4 X 4,,A6196,HCPCS,Facility,Outpatient,,,,20.83,17.7055,5.969878,20.83,"UCare Health, Inc.",Medicare Advantage,10.512901,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Alginate Calcium/Cmc Dressing 4 X 4,,A6196,HCPCS,Facility,Inpatient,,,,20.83,17.7055,5.969878,20.83,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Alginate Calcium/Cmc Dressing 4 X 4,,A6196,HCPCS,Facility,Outpatient,,,,20.83,17.7055,5.969878,20.83,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),10.512901,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Alginate Calcium/Cmc Dressing 4 X 4,,A6196,HCPCS,Facility,Inpatient,,,,20.83,17.7055,5.969878,20.83,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Alginate Calcium/Cmc Dressing 4 X 4,,A6196,HCPCS,Facility,Both,,,,20.83,17.7055,5.969878,20.83,UnitedHealthcare,Individual & Family,19.5802,94,,percent of total billed charges,,
Sup Alginate Calcium/Cmc Dressing 4 X 4,,A6196,HCPCS,Facility,Outpatient,,,,20.83,17.7055,5.969878,20.83,UnitedHealthcare,Medicare Advantage,10.2067,49,,percent of total billed charges,,
Sup Alginate Calcium/Cmc Dressing 4 X 4,,A6196,HCPCS,Facility,Inpatient,,,,20.83,17.7055,5.969878,20.83,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Sup Alginate Calcium/Cmc Dressing 4 X 4,,A6196,HCPCS,Facility,Outpatient,,,,20.83,17.7055,5.969878,20.83,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,9.9984,48,,percent of total billed charges,,100% of DHS outpatient percentage
Sup Alginate Calcium/Cmc Dressing 4 X 4,,A6196,HCPCS,Facility,Inpatient,,,,20.83,17.7055,5.969878,20.83,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Sup Cl Alginate Or Other Fiber Gelling Dress, Pad Size <=16Sq In",,A6196,HCPCS,Facility,Both,,,,14.48,12.308,4.149968,14.48,Aetna,Commercial,13.3216,92,,percent of total billed charges,,
"Sup Cl Alginate Or Other Fiber Gelling Dress, Pad Size <=16Sq In",,A6196,HCPCS,Facility,Outpatient,,,,14.48,12.308,4.149968,14.48,Aetna,Medicare Advantage,7.0952,49,,percent of total billed charges,,
"Sup Cl Alginate Or Other Fiber Gelling Dress, Pad Size <=16Sq In",,A6196,HCPCS,Facility,Inpatient,,,,14.48,12.308,4.149968,14.48,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Sup Cl Alginate Or Other Fiber Gelling Dress, Pad Size <=16Sq In",,A6196,HCPCS,Facility,Both,,,,14.48,12.308,4.149968,14.48,Aetna,PPO,13.4664,93,,percent of total billed charges,,
"Sup Cl Alginate Or Other Fiber Gelling Dress, Pad Size <=16Sq In",,A6196,HCPCS,Facility,Both,,,,14.48,12.308,4.149968,14.48,America's PPO,America's PPO,13.905144,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Sup Cl Alginate Or Other Fiber Gelling Dress, Pad Size <=16Sq In",,A6196,HCPCS,Facility,Both,,,,14.48,12.308,4.149968,14.48,BlueCross BlueShield Minnesota, Federal Employee Program,14.24832,98.4,,percent of total billed charges,,
"Sup Cl Alginate Or Other Fiber Gelling Dress, Pad Size <=16Sq In",,A6196,HCPCS,Facility,Both,,,,14.48,12.308,4.149968,14.48,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,14.48,100,,percent of total billed charges,,
"Sup Cl Alginate Or Other Fiber Gelling Dress, Pad Size <=16Sq In",,A6196,HCPCS,Facility,Both,,,,14.48,12.308,4.149968,14.48,BlueCross BlueShield Minnesota,High Value Network Plan,13.032,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
"Sup Cl Alginate Or Other Fiber Gelling Dress, Pad Size <=16Sq In",,A6196,HCPCS,Facility,Outpatient,,,,14.48,12.308,4.149968,14.48,BlueCross BlueShield Minnesota,Medicare Advantage,7.0952,49,,percent of total billed charges,,
"Sup Cl Alginate Or Other Fiber Gelling Dress, Pad Size <=16Sq In",,A6196,HCPCS,Facility,Inpatient,,,,14.48,12.308,4.149968,14.48,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Sup Cl Alginate Or Other Fiber Gelling Dress, Pad Size <=16Sq In",,A6196,HCPCS,Facility,Both,,,,14.48,12.308,4.149968,14.48,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,12.824936,88.57,,percent of total billed charges,,
"Sup Cl Alginate Or Other Fiber Gelling Dress, Pad Size <=16Sq In",,A6196,HCPCS,Facility,Both,,,,14.48,12.308,4.149968,14.48,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,4.149968,28.66,,percent of total billed charges,,
"Sup Cl Alginate Or Other Fiber Gelling Dress, Pad Size <=16Sq In",,A6196,HCPCS,Facility,Outpatient,,,,14.48,12.308,4.149968,14.48,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),7.0952,49,,percent of total billed charges,,
"Sup Cl Alginate Or Other Fiber Gelling Dress, Pad Size <=16Sq In",,A6196,HCPCS,Facility,Inpatient,,,,14.48,12.308,4.149968,14.48,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Sup Cl Alginate Or Other Fiber Gelling Dress, Pad Size <=16Sq In",,A6196,HCPCS,Facility,Both,,,,14.48,12.308,4.149968,14.48,CorVel,Worker's Compensation,14.48,100,,percent of total billed charges,,
"Sup Cl Alginate Or Other Fiber Gelling Dress, Pad Size <=16Sq In",,A6196,HCPCS,Facility,Both,,,,14.48,12.308,4.149968,14.48,First Health Group Corporation,First Health Network,14.0456,97,,percent of total billed charges,,
"Sup Cl Alginate Or Other Fiber Gelling Dress, Pad Size <=16Sq In",,A6196,HCPCS,Facility,Both,,,,14.48,12.308,4.149968,14.48,"Health Partners, Inc.",Commercial,13.69808,94.6,,percent of total billed charges,,
"Sup Cl Alginate Or Other Fiber Gelling Dress, Pad Size <=16Sq In",,A6196,HCPCS,Facility,Outpatient,,,,14.48,12.308,4.149968,14.48,"Health Partners, Inc.",Medicare Advantage,7.0952,49,,percent of total billed charges,,
"Sup Cl Alginate Or Other Fiber Gelling Dress, Pad Size <=16Sq In",,A6196,HCPCS,Facility,Inpatient,,,,14.48,12.308,4.149968,14.48,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Sup Cl Alginate Or Other Fiber Gelling Dress, Pad Size <=16Sq In",,A6196,HCPCS,Facility,Both,,,,14.48,12.308,4.149968,14.48,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),8.688,60,,percent of total billed charges,,
"Sup Cl Alginate Or Other Fiber Gelling Dress, Pad Size <=16Sq In",,A6196,HCPCS,Facility,Both,,,,14.48,12.308,4.149968,14.48,"Health Partners, Inc.",State of Minnesota Advantage Program,11.8012,81.5,,percent of total billed charges,,
"Sup Cl Alginate Or Other Fiber Gelling Dress, Pad Size <=16Sq In",,A6196,HCPCS,Facility,Both,,,,14.48,12.308,4.149968,14.48,"Health Partners, Inc.",State Public Programs,7.24,50,,percent of total billed charges,,
"Sup Cl Alginate Or Other Fiber Gelling Dress, Pad Size <=16Sq In",,A6196,HCPCS,Facility,Both,,,,14.48,12.308,4.149968,14.48,Humana Insurance Company,Commercial PPO,13.756,95,,percent of total billed charges,,
"Sup Cl Alginate Or Other Fiber Gelling Dress, Pad Size <=16Sq In",,A6196,HCPCS,Facility,Outpatient,,,,14.48,12.308,4.149968,14.48,Humana Insurance Company,Medicare PPO,7.0952,49,,percent of total billed charges,,
"Sup Cl Alginate Or Other Fiber Gelling Dress, Pad Size <=16Sq In",,A6196,HCPCS,Facility,Inpatient,,,,14.48,12.308,4.149968,14.48,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Sup Cl Alginate Or Other Fiber Gelling Dress, Pad Size <=16Sq In",,A6196,HCPCS,Facility,Both,,,,14.48,12.308,4.149968,14.48,Medica,Individual & Family,14.34968,99.1,,percent of total billed charges,,
"Sup Cl Alginate Or Other Fiber Gelling Dress, Pad Size <=16Sq In",,A6196,HCPCS,Facility,Outpatient,,,,14.48,12.308,4.149968,14.48,Medica,Medica Advantage Solution,7.21104,49.8,,percent of total billed charges,,
"Sup Cl Alginate Or Other Fiber Gelling Dress, Pad Size <=16Sq In",,A6196,HCPCS,Facility,Inpatient,,,,14.48,12.308,4.149968,14.48,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Sup Cl Alginate Or Other Fiber Gelling Dress, Pad Size <=16Sq In",,A6196,HCPCS,Facility,Outpatient,,,,14.48,12.308,4.149968,14.48,Medica,Medical Assistance,6.45808,44.6,,percent of total billed charges,,
"Sup Cl Alginate Or Other Fiber Gelling Dress, Pad Size <=16Sq In",,A6196,HCPCS,Facility,Inpatient,,,,14.48,12.308,4.149968,14.48,Medica,Medical Assistance,,,,,Included in per diem rate,
"Sup Cl Alginate Or Other Fiber Gelling Dress, Pad Size <=16Sq In",,A6196,HCPCS,Facility,Outpatient,,,,14.48,12.308,4.149968,14.48,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,7.21104,49.8,,percent of total billed charges,,
"Sup Cl Alginate Or Other Fiber Gelling Dress, Pad Size <=16Sq In",,A6196,HCPCS,Facility,Inpatient,,,,14.48,12.308,4.149968,14.48,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Sup Cl Alginate Or Other Fiber Gelling Dress, Pad Size <=16Sq In",,A6196,HCPCS,Facility,Both,,,,14.48,12.308,4.149968,14.48,"Multiplan, Inc.","Multiplan, Inc.",13.6112,94,,percent of total billed charges,,
"Sup Cl Alginate Or Other Fiber Gelling Dress, Pad Size <=16Sq In",,A6196,HCPCS,Facility,Outpatient,,,,14.48,12.308,4.149968,14.48,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,13.04648,90.1,,percent of total billed charges,,
"Sup Cl Alginate Or Other Fiber Gelling Dress, Pad Size <=16Sq In",,A6196,HCPCS,Facility,Inpatient,,,,14.48,12.308,4.149968,14.48,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Sup Cl Alginate Or Other Fiber Gelling Dress, Pad Size <=16Sq In",,A6196,HCPCS,Facility,Both,,,,14.48,12.308,4.149968,14.48,"Preferred One Administrative Services, INC.",PPO,14.27728,98.6,,percent of total billed charges,,
"Sup Cl Alginate Or Other Fiber Gelling Dress, Pad Size <=16Sq In",,A6196,HCPCS,Facility,Outpatient,,,,14.48,12.308,4.149968,14.48,PrimeWest Health,Minnesota Senior Health Options (MSHO),7.44996,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Sup Cl Alginate Or Other Fiber Gelling Dress, Pad Size <=16Sq In",,A6196,HCPCS,Facility,Inpatient,,,,14.48,12.308,4.149968,14.48,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Sup Cl Alginate Or Other Fiber Gelling Dress, Pad Size <=16Sq In",,A6196,HCPCS,Facility,Outpatient,,,,14.48,12.308,4.149968,14.48,PrimeWest Health,MinnesotaCare,7.436928,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Sup Cl Alginate Or Other Fiber Gelling Dress, Pad Size <=16Sq In",,A6196,HCPCS,Facility,Inpatient,,,,14.48,12.308,4.149968,14.48,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Sup Cl Alginate Or Other Fiber Gelling Dress, Pad Size <=16Sq In",,A6196,HCPCS,Facility,Both,,,,14.48,12.308,4.149968,14.48,Sanford Health Plan,Sanford Health Plan,13.3216,92,,percent of total billed charges,,
"Sup Cl Alginate Or Other Fiber Gelling Dress, Pad Size <=16Sq In",,A6196,HCPCS,Facility,Outpatient,,,,14.48,12.308,4.149968,14.48,"UCare Health, Inc.",Individual & Family Plan,8.15948,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Sup Cl Alginate Or Other Fiber Gelling Dress, Pad Size <=16Sq In",,A6196,HCPCS,Facility,Inpatient,,,,14.48,12.308,4.149968,14.48,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Sup Cl Alginate Or Other Fiber Gelling Dress, Pad Size <=16Sq In",,A6196,HCPCS,Facility,Outpatient,,,,14.48,12.308,4.149968,14.48,"UCare Health, Inc.",Medical Assistance,7.308056,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Sup Cl Alginate Or Other Fiber Gelling Dress, Pad Size <=16Sq In",,A6196,HCPCS,Facility,Inpatient,,,,14.48,12.308,4.149968,14.48,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Sup Cl Alginate Or Other Fiber Gelling Dress, Pad Size <=16Sq In",,A6196,HCPCS,Facility,Outpatient,,,,14.48,12.308,4.149968,14.48,"UCare Health, Inc.",Medicare Advantage,7.308056,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Sup Cl Alginate Or Other Fiber Gelling Dress, Pad Size <=16Sq In",,A6196,HCPCS,Facility,Inpatient,,,,14.48,12.308,4.149968,14.48,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Sup Cl Alginate Or Other Fiber Gelling Dress, Pad Size <=16Sq In",,A6196,HCPCS,Facility,Outpatient,,,,14.48,12.308,4.149968,14.48,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),7.308056,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Sup Cl Alginate Or Other Fiber Gelling Dress, Pad Size <=16Sq In",,A6196,HCPCS,Facility,Inpatient,,,,14.48,12.308,4.149968,14.48,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Sup Cl Alginate Or Other Fiber Gelling Dress, Pad Size <=16Sq In",,A6196,HCPCS,Facility,Both,,,,14.48,12.308,4.149968,14.48,UnitedHealthcare,Individual & Family,13.6112,94,,percent of total billed charges,,
"Sup Cl Alginate Or Other Fiber Gelling Dress, Pad Size <=16Sq In",,A6196,HCPCS,Facility,Outpatient,,,,14.48,12.308,4.149968,14.48,UnitedHealthcare,Medicare Advantage,7.0952,49,,percent of total billed charges,,
"Sup Cl Alginate Or Other Fiber Gelling Dress, Pad Size <=16Sq In",,A6196,HCPCS,Facility,Inpatient,,,,14.48,12.308,4.149968,14.48,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Sup Cl Alginate Or Other Fiber Gelling Dress, Pad Size <=16Sq In",,A6196,HCPCS,Facility,Outpatient,,,,14.48,12.308,4.149968,14.48,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,6.9504,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Sup Cl Alginate Or Other Fiber Gelling Dress, Pad Size <=16Sq In",,A6196,HCPCS,Facility,Inpatient,,,,14.48,12.308,4.149968,14.48,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Sup Aquacel Ag Dressing 6X6,,A6197,HCPCS,Facility,Both,,,,75,63.75,21.495,75,Aetna,Commercial,69,92,,percent of total billed charges,,
Sup Aquacel Ag Dressing 6X6,,A6197,HCPCS,Facility,Outpatient,,,,75,63.75,21.495,75,Aetna,Medicare Advantage,36.75,49,,percent of total billed charges,,
Sup Aquacel Ag Dressing 6X6,,A6197,HCPCS,Facility,Inpatient,,,,75,63.75,21.495,75,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Sup Aquacel Ag Dressing 6X6,,A6197,HCPCS,Facility,Both,,,,75,63.75,21.495,75,Aetna,PPO,69.75,93,,percent of total billed charges,,
Sup Aquacel Ag Dressing 6X6,,A6197,HCPCS,Facility,Both,,,,75,63.75,21.495,75,America's PPO,America's PPO,72.0225,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Sup Aquacel Ag Dressing 6X6,,A6197,HCPCS,Facility,Both,,,,75,63.75,21.495,75,BlueCross BlueShield Minnesota, Federal Employee Program,73.8,98.4,,percent of total billed charges,,
Sup Aquacel Ag Dressing 6X6,,A6197,HCPCS,Facility,Both,,,,75,63.75,21.495,75,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,75,100,,percent of total billed charges,,
Sup Aquacel Ag Dressing 6X6,,A6197,HCPCS,Facility,Both,,,,75,63.75,21.495,75,BlueCross BlueShield Minnesota,High Value Network Plan,67.5,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
Sup Aquacel Ag Dressing 6X6,,A6197,HCPCS,Facility,Outpatient,,,,75,63.75,21.495,75,BlueCross BlueShield Minnesota,Medicare Advantage,36.75,49,,percent of total billed charges,,
Sup Aquacel Ag Dressing 6X6,,A6197,HCPCS,Facility,Inpatient,,,,75,63.75,21.495,75,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Sup Aquacel Ag Dressing 6X6,,A6197,HCPCS,Facility,Both,,,,75,63.75,21.495,75,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,66.4275,88.57,,percent of total billed charges,,
Sup Aquacel Ag Dressing 6X6,,A6197,HCPCS,Facility,Both,,,,75,63.75,21.495,75,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,21.495,28.66,,percent of total billed charges,,
Sup Aquacel Ag Dressing 6X6,,A6197,HCPCS,Facility,Outpatient,,,,75,63.75,21.495,75,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),36.75,49,,percent of total billed charges,,
Sup Aquacel Ag Dressing 6X6,,A6197,HCPCS,Facility,Inpatient,,,,75,63.75,21.495,75,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Sup Aquacel Ag Dressing 6X6,,A6197,HCPCS,Facility,Both,,,,75,63.75,21.495,75,CorVel,Worker's Compensation,75,100,,percent of total billed charges,,
Sup Aquacel Ag Dressing 6X6,,A6197,HCPCS,Facility,Both,,,,75,63.75,21.495,75,First Health Group Corporation,First Health Network,72.75,97,,percent of total billed charges,,
Sup Aquacel Ag Dressing 6X6,,A6197,HCPCS,Facility,Both,,,,75,63.75,21.495,75,"Health Partners, Inc.",Commercial,70.95,94.6,,percent of total billed charges,,
Sup Aquacel Ag Dressing 6X6,,A6197,HCPCS,Facility,Outpatient,,,,75,63.75,21.495,75,"Health Partners, Inc.",Medicare Advantage,36.75,49,,percent of total billed charges,,
Sup Aquacel Ag Dressing 6X6,,A6197,HCPCS,Facility,Inpatient,,,,75,63.75,21.495,75,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Aquacel Ag Dressing 6X6,,A6197,HCPCS,Facility,Both,,,,75,63.75,21.495,75,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),45,60,,percent of total billed charges,,
Sup Aquacel Ag Dressing 6X6,,A6197,HCPCS,Facility,Both,,,,75,63.75,21.495,75,"Health Partners, Inc.",State of Minnesota Advantage Program,61.125,81.5,,percent of total billed charges,,
Sup Aquacel Ag Dressing 6X6,,A6197,HCPCS,Facility,Both,,,,75,63.75,21.495,75,"Health Partners, Inc.",State Public Programs,37.5,50,,percent of total billed charges,,
Sup Aquacel Ag Dressing 6X6,,A6197,HCPCS,Facility,Both,,,,75,63.75,21.495,75,Humana Insurance Company,Commercial PPO,71.25,95,,percent of total billed charges,,
Sup Aquacel Ag Dressing 6X6,,A6197,HCPCS,Facility,Outpatient,,,,75,63.75,21.495,75,Humana Insurance Company,Medicare PPO,36.75,49,,percent of total billed charges,,
Sup Aquacel Ag Dressing 6X6,,A6197,HCPCS,Facility,Inpatient,,,,75,63.75,21.495,75,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Sup Aquacel Ag Dressing 6X6,,A6197,HCPCS,Facility,Both,,,,75,63.75,21.495,75,Medica,Individual & Family,74.325,99.1,,percent of total billed charges,,
Sup Aquacel Ag Dressing 6X6,,A6197,HCPCS,Facility,Outpatient,,,,75,63.75,21.495,75,Medica,Medica Advantage Solution,37.35,49.8,,percent of total billed charges,,
Sup Aquacel Ag Dressing 6X6,,A6197,HCPCS,Facility,Inpatient,,,,75,63.75,21.495,75,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Sup Aquacel Ag Dressing 6X6,,A6197,HCPCS,Facility,Outpatient,,,,75,63.75,21.495,75,Medica,Medical Assistance,33.45,44.6,,percent of total billed charges,,
Sup Aquacel Ag Dressing 6X6,,A6197,HCPCS,Facility,Inpatient,,,,75,63.75,21.495,75,Medica,Medical Assistance,,,,,Included in per diem rate,
Sup Aquacel Ag Dressing 6X6,,A6197,HCPCS,Facility,Outpatient,,,,75,63.75,21.495,75,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,37.35,49.8,,percent of total billed charges,,
Sup Aquacel Ag Dressing 6X6,,A6197,HCPCS,Facility,Inpatient,,,,75,63.75,21.495,75,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Sup Aquacel Ag Dressing 6X6,,A6197,HCPCS,Facility,Both,,,,75,63.75,21.495,75,"Multiplan, Inc.","Multiplan, Inc.",70.5,94,,percent of total billed charges,,
Sup Aquacel Ag Dressing 6X6,,A6197,HCPCS,Facility,Outpatient,,,,75,63.75,21.495,75,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,67.575,90.1,,percent of total billed charges,,
Sup Aquacel Ag Dressing 6X6,,A6197,HCPCS,Facility,Inpatient,,,,75,63.75,21.495,75,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Sup Aquacel Ag Dressing 6X6,,A6197,HCPCS,Facility,Both,,,,75,63.75,21.495,75,"Preferred One Administrative Services, INC.",PPO,73.95,98.6,,percent of total billed charges,,
Sup Aquacel Ag Dressing 6X6,,A6197,HCPCS,Facility,Outpatient,,,,75,63.75,21.495,75,PrimeWest Health,Minnesota Senior Health Options (MSHO),38.5875,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Sup Aquacel Ag Dressing 6X6,,A6197,HCPCS,Facility,Inpatient,,,,75,63.75,21.495,75,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Aquacel Ag Dressing 6X6,,A6197,HCPCS,Facility,Outpatient,,,,75,63.75,21.495,75,PrimeWest Health,MinnesotaCare,38.52,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Sup Aquacel Ag Dressing 6X6,,A6197,HCPCS,Facility,Inpatient,,,,75,63.75,21.495,75,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Sup Aquacel Ag Dressing 6X6,,A6197,HCPCS,Facility,Both,,,,75,63.75,21.495,75,Sanford Health Plan,Sanford Health Plan,69,92,,percent of total billed charges,,
Sup Aquacel Ag Dressing 6X6,,A6197,HCPCS,Facility,Outpatient,,,,75,63.75,21.495,75,"UCare Health, Inc.",Individual & Family Plan,42.2625,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Sup Aquacel Ag Dressing 6X6,,A6197,HCPCS,Facility,Inpatient,,,,75,63.75,21.495,75,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Sup Aquacel Ag Dressing 6X6,,A6197,HCPCS,Facility,Outpatient,,,,75,63.75,21.495,75,"UCare Health, Inc.",Medical Assistance,37.8525,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Aquacel Ag Dressing 6X6,,A6197,HCPCS,Facility,Inpatient,,,,75,63.75,21.495,75,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Sup Aquacel Ag Dressing 6X6,,A6197,HCPCS,Facility,Outpatient,,,,75,63.75,21.495,75,"UCare Health, Inc.",Medicare Advantage,37.8525,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Aquacel Ag Dressing 6X6,,A6197,HCPCS,Facility,Inpatient,,,,75,63.75,21.495,75,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Aquacel Ag Dressing 6X6,,A6197,HCPCS,Facility,Outpatient,,,,75,63.75,21.495,75,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),37.8525,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Aquacel Ag Dressing 6X6,,A6197,HCPCS,Facility,Inpatient,,,,75,63.75,21.495,75,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Aquacel Ag Dressing 6X6,,A6197,HCPCS,Facility,Both,,,,75,63.75,21.495,75,UnitedHealthcare,Individual & Family,70.5,94,,percent of total billed charges,,
Sup Aquacel Ag Dressing 6X6,,A6197,HCPCS,Facility,Outpatient,,,,75,63.75,21.495,75,UnitedHealthcare,Medicare Advantage,36.75,49,,percent of total billed charges,,
Sup Aquacel Ag Dressing 6X6,,A6197,HCPCS,Facility,Inpatient,,,,75,63.75,21.495,75,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Sup Aquacel Ag Dressing 6X6,,A6197,HCPCS,Facility,Outpatient,,,,75,63.75,21.495,75,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,36,48,,percent of total billed charges,,100% of DHS outpatient percentage
Sup Aquacel Ag Dressing 6X6,,A6197,HCPCS,Facility,Inpatient,,,,75,63.75,21.495,75,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Sup Cl Alginate Or Fiber Gelling Dress,Pad Size>16Sq In<48Sq In, Box",,A6197,HCPCS,Facility,Both,,,,52.02,44.217,14.908932,52.02,Aetna,Commercial,47.8584,92,,percent of total billed charges,,
"Sup Cl Alginate Or Fiber Gelling Dress,Pad Size>16Sq In<48Sq In, Box",,A6197,HCPCS,Facility,Outpatient,,,,52.02,44.217,14.908932,52.02,Aetna,Medicare Advantage,25.4898,49,,percent of total billed charges,,
"Sup Cl Alginate Or Fiber Gelling Dress,Pad Size>16Sq In<48Sq In, Box",,A6197,HCPCS,Facility,Inpatient,,,,52.02,44.217,14.908932,52.02,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Sup Cl Alginate Or Fiber Gelling Dress,Pad Size>16Sq In<48Sq In, Box",,A6197,HCPCS,Facility,Both,,,,52.02,44.217,14.908932,52.02,Aetna,PPO,48.3786,93,,percent of total billed charges,,
"Sup Cl Alginate Or Fiber Gelling Dress,Pad Size>16Sq In<48Sq In, Box",,A6197,HCPCS,Facility,Both,,,,52.02,44.217,14.908932,52.02,America's PPO,America's PPO,49.954806,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Sup Cl Alginate Or Fiber Gelling Dress,Pad Size>16Sq In<48Sq In, Box",,A6197,HCPCS,Facility,Both,,,,52.02,44.217,14.908932,52.02,BlueCross BlueShield Minnesota, Federal Employee Program,51.18768,98.4,,percent of total billed charges,,
"Sup Cl Alginate Or Fiber Gelling Dress,Pad Size>16Sq In<48Sq In, Box",,A6197,HCPCS,Facility,Both,,,,52.02,44.217,14.908932,52.02,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,52.02,100,,percent of total billed charges,,
"Sup Cl Alginate Or Fiber Gelling Dress,Pad Size>16Sq In<48Sq In, Box",,A6197,HCPCS,Facility,Both,,,,52.02,44.217,14.908932,52.02,BlueCross BlueShield Minnesota,High Value Network Plan,46.818,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
"Sup Cl Alginate Or Fiber Gelling Dress,Pad Size>16Sq In<48Sq In, Box",,A6197,HCPCS,Facility,Outpatient,,,,52.02,44.217,14.908932,52.02,BlueCross BlueShield Minnesota,Medicare Advantage,25.4898,49,,percent of total billed charges,,
"Sup Cl Alginate Or Fiber Gelling Dress,Pad Size>16Sq In<48Sq In, Box",,A6197,HCPCS,Facility,Inpatient,,,,52.02,44.217,14.908932,52.02,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Sup Cl Alginate Or Fiber Gelling Dress,Pad Size>16Sq In<48Sq In, Box",,A6197,HCPCS,Facility,Both,,,,52.02,44.217,14.908932,52.02,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,46.074114,88.57,,percent of total billed charges,,
"Sup Cl Alginate Or Fiber Gelling Dress,Pad Size>16Sq In<48Sq In, Box",,A6197,HCPCS,Facility,Both,,,,52.02,44.217,14.908932,52.02,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,14.908932,28.66,,percent of total billed charges,,
"Sup Cl Alginate Or Fiber Gelling Dress,Pad Size>16Sq In<48Sq In, Box",,A6197,HCPCS,Facility,Outpatient,,,,52.02,44.217,14.908932,52.02,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),25.4898,49,,percent of total billed charges,,
"Sup Cl Alginate Or Fiber Gelling Dress,Pad Size>16Sq In<48Sq In, Box",,A6197,HCPCS,Facility,Inpatient,,,,52.02,44.217,14.908932,52.02,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Sup Cl Alginate Or Fiber Gelling Dress,Pad Size>16Sq In<48Sq In, Box",,A6197,HCPCS,Facility,Both,,,,52.02,44.217,14.908932,52.02,CorVel,Worker's Compensation,52.02,100,,percent of total billed charges,,
"Sup Cl Alginate Or Fiber Gelling Dress,Pad Size>16Sq In<48Sq In, Box",,A6197,HCPCS,Facility,Both,,,,52.02,44.217,14.908932,52.02,First Health Group Corporation,First Health Network,50.4594,97,,percent of total billed charges,,
"Sup Cl Alginate Or Fiber Gelling Dress,Pad Size>16Sq In<48Sq In, Box",,A6197,HCPCS,Facility,Both,,,,52.02,44.217,14.908932,52.02,"Health Partners, Inc.",Commercial,49.21092,94.6,,percent of total billed charges,,
"Sup Cl Alginate Or Fiber Gelling Dress,Pad Size>16Sq In<48Sq In, Box",,A6197,HCPCS,Facility,Outpatient,,,,52.02,44.217,14.908932,52.02,"Health Partners, Inc.",Medicare Advantage,25.4898,49,,percent of total billed charges,,
"Sup Cl Alginate Or Fiber Gelling Dress,Pad Size>16Sq In<48Sq In, Box",,A6197,HCPCS,Facility,Inpatient,,,,52.02,44.217,14.908932,52.02,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Sup Cl Alginate Or Fiber Gelling Dress,Pad Size>16Sq In<48Sq In, Box",,A6197,HCPCS,Facility,Both,,,,52.02,44.217,14.908932,52.02,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),31.212,60,,percent of total billed charges,,
"Sup Cl Alginate Or Fiber Gelling Dress,Pad Size>16Sq In<48Sq In, Box",,A6197,HCPCS,Facility,Both,,,,52.02,44.217,14.908932,52.02,"Health Partners, Inc.",State of Minnesota Advantage Program,42.3963,81.5,,percent of total billed charges,,
"Sup Cl Alginate Or Fiber Gelling Dress,Pad Size>16Sq In<48Sq In, Box",,A6197,HCPCS,Facility,Both,,,,52.02,44.217,14.908932,52.02,"Health Partners, Inc.",State Public Programs,26.01,50,,percent of total billed charges,,
"Sup Cl Alginate Or Fiber Gelling Dress,Pad Size>16Sq In<48Sq In, Box",,A6197,HCPCS,Facility,Both,,,,52.02,44.217,14.908932,52.02,Humana Insurance Company,Commercial PPO,49.419,95,,percent of total billed charges,,
"Sup Cl Alginate Or Fiber Gelling Dress,Pad Size>16Sq In<48Sq In, Box",,A6197,HCPCS,Facility,Outpatient,,,,52.02,44.217,14.908932,52.02,Humana Insurance Company,Medicare PPO,25.4898,49,,percent of total billed charges,,
"Sup Cl Alginate Or Fiber Gelling Dress,Pad Size>16Sq In<48Sq In, Box",,A6197,HCPCS,Facility,Inpatient,,,,52.02,44.217,14.908932,52.02,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Sup Cl Alginate Or Fiber Gelling Dress,Pad Size>16Sq In<48Sq In, Box",,A6197,HCPCS,Facility,Both,,,,52.02,44.217,14.908932,52.02,Medica,Individual & Family,51.55182,99.1,,percent of total billed charges,,
"Sup Cl Alginate Or Fiber Gelling Dress,Pad Size>16Sq In<48Sq In, Box",,A6197,HCPCS,Facility,Outpatient,,,,52.02,44.217,14.908932,52.02,Medica,Medica Advantage Solution,25.90596,49.8,,percent of total billed charges,,
"Sup Cl Alginate Or Fiber Gelling Dress,Pad Size>16Sq In<48Sq In, Box",,A6197,HCPCS,Facility,Inpatient,,,,52.02,44.217,14.908932,52.02,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Sup Cl Alginate Or Fiber Gelling Dress,Pad Size>16Sq In<48Sq In, Box",,A6197,HCPCS,Facility,Outpatient,,,,52.02,44.217,14.908932,52.02,Medica,Medical Assistance,23.20092,44.6,,percent of total billed charges,,
"Sup Cl Alginate Or Fiber Gelling Dress,Pad Size>16Sq In<48Sq In, Box",,A6197,HCPCS,Facility,Inpatient,,,,52.02,44.217,14.908932,52.02,Medica,Medical Assistance,,,,,Included in per diem rate,
"Sup Cl Alginate Or Fiber Gelling Dress,Pad Size>16Sq In<48Sq In, Box",,A6197,HCPCS,Facility,Outpatient,,,,52.02,44.217,14.908932,52.02,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,25.90596,49.8,,percent of total billed charges,,
"Sup Cl Alginate Or Fiber Gelling Dress,Pad Size>16Sq In<48Sq In, Box",,A6197,HCPCS,Facility,Inpatient,,,,52.02,44.217,14.908932,52.02,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Sup Cl Alginate Or Fiber Gelling Dress,Pad Size>16Sq In<48Sq In, Box",,A6197,HCPCS,Facility,Both,,,,52.02,44.217,14.908932,52.02,"Multiplan, Inc.","Multiplan, Inc.",48.8988,94,,percent of total billed charges,,
"Sup Cl Alginate Or Fiber Gelling Dress,Pad Size>16Sq In<48Sq In, Box",,A6197,HCPCS,Facility,Outpatient,,,,52.02,44.217,14.908932,52.02,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,46.87002,90.1,,percent of total billed charges,,
"Sup Cl Alginate Or Fiber Gelling Dress,Pad Size>16Sq In<48Sq In, Box",,A6197,HCPCS,Facility,Inpatient,,,,52.02,44.217,14.908932,52.02,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Sup Cl Alginate Or Fiber Gelling Dress,Pad Size>16Sq In<48Sq In, Box",,A6197,HCPCS,Facility,Both,,,,52.02,44.217,14.908932,52.02,"Preferred One Administrative Services, INC.",PPO,51.29172,98.6,,percent of total billed charges,,
"Sup Cl Alginate Or Fiber Gelling Dress,Pad Size>16Sq In<48Sq In, Box",,A6197,HCPCS,Facility,Outpatient,,,,52.02,44.217,14.908932,52.02,PrimeWest Health,Minnesota Senior Health Options (MSHO),26.76429,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Sup Cl Alginate Or Fiber Gelling Dress,Pad Size>16Sq In<48Sq In, Box",,A6197,HCPCS,Facility,Inpatient,,,,52.02,44.217,14.908932,52.02,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Sup Cl Alginate Or Fiber Gelling Dress,Pad Size>16Sq In<48Sq In, Box",,A6197,HCPCS,Facility,Outpatient,,,,52.02,44.217,14.908932,52.02,PrimeWest Health,MinnesotaCare,26.717472,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Sup Cl Alginate Or Fiber Gelling Dress,Pad Size>16Sq In<48Sq In, Box",,A6197,HCPCS,Facility,Inpatient,,,,52.02,44.217,14.908932,52.02,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Sup Cl Alginate Or Fiber Gelling Dress,Pad Size>16Sq In<48Sq In, Box",,A6197,HCPCS,Facility,Both,,,,52.02,44.217,14.908932,52.02,Sanford Health Plan,Sanford Health Plan,47.8584,92,,percent of total billed charges,,
"Sup Cl Alginate Or Fiber Gelling Dress,Pad Size>16Sq In<48Sq In, Box",,A6197,HCPCS,Facility,Outpatient,,,,52.02,44.217,14.908932,52.02,"UCare Health, Inc.",Individual & Family Plan,29.31327,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Sup Cl Alginate Or Fiber Gelling Dress,Pad Size>16Sq In<48Sq In, Box",,A6197,HCPCS,Facility,Inpatient,,,,52.02,44.217,14.908932,52.02,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Sup Cl Alginate Or Fiber Gelling Dress,Pad Size>16Sq In<48Sq In, Box",,A6197,HCPCS,Facility,Outpatient,,,,52.02,44.217,14.908932,52.02,"UCare Health, Inc.",Medical Assistance,26.254494,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Sup Cl Alginate Or Fiber Gelling Dress,Pad Size>16Sq In<48Sq In, Box",,A6197,HCPCS,Facility,Inpatient,,,,52.02,44.217,14.908932,52.02,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Sup Cl Alginate Or Fiber Gelling Dress,Pad Size>16Sq In<48Sq In, Box",,A6197,HCPCS,Facility,Outpatient,,,,52.02,44.217,14.908932,52.02,"UCare Health, Inc.",Medicare Advantage,26.254494,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Sup Cl Alginate Or Fiber Gelling Dress,Pad Size>16Sq In<48Sq In, Box",,A6197,HCPCS,Facility,Inpatient,,,,52.02,44.217,14.908932,52.02,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Sup Cl Alginate Or Fiber Gelling Dress,Pad Size>16Sq In<48Sq In, Box",,A6197,HCPCS,Facility,Outpatient,,,,52.02,44.217,14.908932,52.02,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),26.254494,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Sup Cl Alginate Or Fiber Gelling Dress,Pad Size>16Sq In<48Sq In, Box",,A6197,HCPCS,Facility,Inpatient,,,,52.02,44.217,14.908932,52.02,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Sup Cl Alginate Or Fiber Gelling Dress,Pad Size>16Sq In<48Sq In, Box",,A6197,HCPCS,Facility,Both,,,,52.02,44.217,14.908932,52.02,UnitedHealthcare,Individual & Family,48.8988,94,,percent of total billed charges,,
"Sup Cl Alginate Or Fiber Gelling Dress,Pad Size>16Sq In<48Sq In, Box",,A6197,HCPCS,Facility,Outpatient,,,,52.02,44.217,14.908932,52.02,UnitedHealthcare,Medicare Advantage,25.4898,49,,percent of total billed charges,,
"Sup Cl Alginate Or Fiber Gelling Dress,Pad Size>16Sq In<48Sq In, Box",,A6197,HCPCS,Facility,Inpatient,,,,52.02,44.217,14.908932,52.02,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Sup Cl Alginate Or Fiber Gelling Dress,Pad Size>16Sq In<48Sq In, Box",,A6197,HCPCS,Facility,Outpatient,,,,52.02,44.217,14.908932,52.02,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,24.9696,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Sup Cl Alginate Or Fiber Gelling Dress,Pad Size>16Sq In<48Sq In, Box",,A6197,HCPCS,Facility,Inpatient,,,,52.02,44.217,14.908932,52.02,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
DRESSING AQUACELL AG ROPE,,A6199,HCPCS,Facility,Both,,,,48.195,40.96575,13.812687,48.195,Aetna,Commercial,44.3394,92,,percent of total billed charges,,
DRESSING AQUACELL AG ROPE,,A6199,HCPCS,Facility,Outpatient,,,,48.195,40.96575,13.812687,48.195,Aetna,Medicare Advantage,23.61555,49,,percent of total billed charges,,
DRESSING AQUACELL AG ROPE,,A6199,HCPCS,Facility,Inpatient,,,,48.195,40.96575,13.812687,48.195,Aetna,Medicare Advantage,,,,,Included in per diem rate,
DRESSING AQUACELL AG ROPE,,A6199,HCPCS,Facility,Both,,,,48.195,40.96575,13.812687,48.195,Aetna,PPO,44.82135,93,,percent of total billed charges,,
DRESSING AQUACELL AG ROPE,,A6199,HCPCS,Facility,Both,,,,48.195,40.96575,13.812687,48.195,America's PPO,America's PPO,46.2816585,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
DRESSING AQUACELL AG ROPE,,A6199,HCPCS,Facility,Both,,,,48.195,40.96575,13.812687,48.195,BlueCross BlueShield Minnesota, Federal Employee Program,47.42388,98.4,,percent of total billed charges,,
DRESSING AQUACELL AG ROPE,,A6199,HCPCS,Facility,Both,,,,48.195,40.96575,13.812687,48.195,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,48.195,100,,percent of total billed charges,,
DRESSING AQUACELL AG ROPE,,A6199,HCPCS,Facility,Both,,,,48.195,40.96575,13.812687,48.195,BlueCross BlueShield Minnesota,High Value Network Plan,43.3755,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
DRESSING AQUACELL AG ROPE,,A6199,HCPCS,Facility,Outpatient,,,,48.195,40.96575,13.812687,48.195,BlueCross BlueShield Minnesota,Medicare Advantage,23.61555,49,,percent of total billed charges,,
DRESSING AQUACELL AG ROPE,,A6199,HCPCS,Facility,Inpatient,,,,48.195,40.96575,13.812687,48.195,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
DRESSING AQUACELL AG ROPE,,A6199,HCPCS,Facility,Both,,,,48.195,40.96575,13.812687,48.195,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,42.6863115,88.57,,percent of total billed charges,,
DRESSING AQUACELL AG ROPE,,A6199,HCPCS,Facility,Both,,,,48.195,40.96575,13.812687,48.195,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,13.812687,28.66,,percent of total billed charges,,
DRESSING AQUACELL AG ROPE,,A6199,HCPCS,Facility,Outpatient,,,,48.195,40.96575,13.812687,48.195,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),23.61555,49,,percent of total billed charges,,
DRESSING AQUACELL AG ROPE,,A6199,HCPCS,Facility,Inpatient,,,,48.195,40.96575,13.812687,48.195,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
DRESSING AQUACELL AG ROPE,,A6199,HCPCS,Facility,Both,,,,48.195,40.96575,13.812687,48.195,CorVel,Worker's Compensation,48.195,100,,percent of total billed charges,,
DRESSING AQUACELL AG ROPE,,A6199,HCPCS,Facility,Both,,,,48.195,40.96575,13.812687,48.195,First Health Group Corporation,First Health Network,46.74915,97,,percent of total billed charges,,
DRESSING AQUACELL AG ROPE,,A6199,HCPCS,Facility,Both,,,,48.195,40.96575,13.812687,48.195,"Health Partners, Inc.",Commercial,45.59247,94.6,,percent of total billed charges,,
DRESSING AQUACELL AG ROPE,,A6199,HCPCS,Facility,Outpatient,,,,48.195,40.96575,13.812687,48.195,"Health Partners, Inc.",Medicare Advantage,23.61555,49,,percent of total billed charges,,
DRESSING AQUACELL AG ROPE,,A6199,HCPCS,Facility,Inpatient,,,,48.195,40.96575,13.812687,48.195,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DRESSING AQUACELL AG ROPE,,A6199,HCPCS,Facility,Both,,,,48.195,40.96575,13.812687,48.195,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),28.917,60,,percent of total billed charges,,
DRESSING AQUACELL AG ROPE,,A6199,HCPCS,Facility,Both,,,,48.195,40.96575,13.812687,48.195,"Health Partners, Inc.",State of Minnesota Advantage Program,39.278925,81.5,,percent of total billed charges,,
DRESSING AQUACELL AG ROPE,,A6199,HCPCS,Facility,Both,,,,48.195,40.96575,13.812687,48.195,"Health Partners, Inc.",State Public Programs,24.0975,50,,percent of total billed charges,,
DRESSING AQUACELL AG ROPE,,A6199,HCPCS,Facility,Both,,,,48.195,40.96575,13.812687,48.195,Humana Insurance Company,Commercial PPO,45.78525,95,,percent of total billed charges,,
DRESSING AQUACELL AG ROPE,,A6199,HCPCS,Facility,Outpatient,,,,48.195,40.96575,13.812687,48.195,Humana Insurance Company,Medicare PPO,23.61555,49,,percent of total billed charges,,
DRESSING AQUACELL AG ROPE,,A6199,HCPCS,Facility,Inpatient,,,,48.195,40.96575,13.812687,48.195,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
DRESSING AQUACELL AG ROPE,,A6199,HCPCS,Facility,Both,,,,48.195,40.96575,13.812687,48.195,Medica,Individual & Family,47.761245,99.1,,percent of total billed charges,,
DRESSING AQUACELL AG ROPE,,A6199,HCPCS,Facility,Outpatient,,,,48.195,40.96575,13.812687,48.195,Medica,Medica Advantage Solution,24.00111,49.8,,percent of total billed charges,,
DRESSING AQUACELL AG ROPE,,A6199,HCPCS,Facility,Inpatient,,,,48.195,40.96575,13.812687,48.195,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
DRESSING AQUACELL AG ROPE,,A6199,HCPCS,Facility,Outpatient,,,,48.195,40.96575,13.812687,48.195,Medica,Medical Assistance,21.49497,44.6,,percent of total billed charges,,
DRESSING AQUACELL AG ROPE,,A6199,HCPCS,Facility,Inpatient,,,,48.195,40.96575,13.812687,48.195,Medica,Medical Assistance,,,,,Included in per diem rate,
DRESSING AQUACELL AG ROPE,,A6199,HCPCS,Facility,Outpatient,,,,48.195,40.96575,13.812687,48.195,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,24.00111,49.8,,percent of total billed charges,,
DRESSING AQUACELL AG ROPE,,A6199,HCPCS,Facility,Inpatient,,,,48.195,40.96575,13.812687,48.195,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
DRESSING AQUACELL AG ROPE,,A6199,HCPCS,Facility,Both,,,,48.195,40.96575,13.812687,48.195,"Multiplan, Inc.","Multiplan, Inc.",45.3033,94,,percent of total billed charges,,
DRESSING AQUACELL AG ROPE,,A6199,HCPCS,Facility,Outpatient,,,,48.195,40.96575,13.812687,48.195,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,43.423695,90.1,,percent of total billed charges,,
DRESSING AQUACELL AG ROPE,,A6199,HCPCS,Facility,Inpatient,,,,48.195,40.96575,13.812687,48.195,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
DRESSING AQUACELL AG ROPE,,A6199,HCPCS,Facility,Both,,,,48.195,40.96575,13.812687,48.195,"Preferred One Administrative Services, INC.",PPO,47.52027,98.6,,percent of total billed charges,,
DRESSING AQUACELL AG ROPE,,A6199,HCPCS,Facility,Outpatient,,,,48.195,40.96575,13.812687,48.195,PrimeWest Health,Minnesota Senior Health Options (MSHO),24.7963275,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
DRESSING AQUACELL AG ROPE,,A6199,HCPCS,Facility,Inpatient,,,,48.195,40.96575,13.812687,48.195,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DRESSING AQUACELL AG ROPE,,A6199,HCPCS,Facility,Outpatient,,,,48.195,40.96575,13.812687,48.195,PrimeWest Health,MinnesotaCare,24.752952,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
DRESSING AQUACELL AG ROPE,,A6199,HCPCS,Facility,Inpatient,,,,48.195,40.96575,13.812687,48.195,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
DRESSING AQUACELL AG ROPE,,A6199,HCPCS,Facility,Both,,,,48.195,40.96575,13.812687,48.195,Sanford Health Plan,Sanford Health Plan,44.3394,92,,percent of total billed charges,,
DRESSING AQUACELL AG ROPE,,A6199,HCPCS,Facility,Outpatient,,,,48.195,40.96575,13.812687,48.195,"UCare Health, Inc.",Individual & Family Plan,27.1578825,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
DRESSING AQUACELL AG ROPE,,A6199,HCPCS,Facility,Inpatient,,,,48.195,40.96575,13.812687,48.195,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
DRESSING AQUACELL AG ROPE,,A6199,HCPCS,Facility,Outpatient,,,,48.195,40.96575,13.812687,48.195,"UCare Health, Inc.",Medical Assistance,24.3240165,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DRESSING AQUACELL AG ROPE,,A6199,HCPCS,Facility,Inpatient,,,,48.195,40.96575,13.812687,48.195,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
DRESSING AQUACELL AG ROPE,,A6199,HCPCS,Facility,Outpatient,,,,48.195,40.96575,13.812687,48.195,"UCare Health, Inc.",Medicare Advantage,24.3240165,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DRESSING AQUACELL AG ROPE,,A6199,HCPCS,Facility,Inpatient,,,,48.195,40.96575,13.812687,48.195,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DRESSING AQUACELL AG ROPE,,A6199,HCPCS,Facility,Outpatient,,,,48.195,40.96575,13.812687,48.195,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),24.3240165,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DRESSING AQUACELL AG ROPE,,A6199,HCPCS,Facility,Inpatient,,,,48.195,40.96575,13.812687,48.195,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DRESSING AQUACELL AG ROPE,,A6199,HCPCS,Facility,Both,,,,48.195,40.96575,13.812687,48.195,UnitedHealthcare,Individual & Family,45.3033,94,,percent of total billed charges,,
DRESSING AQUACELL AG ROPE,,A6199,HCPCS,Facility,Outpatient,,,,48.195,40.96575,13.812687,48.195,UnitedHealthcare,Medicare Advantage,23.61555,49,,percent of total billed charges,,
DRESSING AQUACELL AG ROPE,,A6199,HCPCS,Facility,Inpatient,,,,48.195,40.96575,13.812687,48.195,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
DRESSING AQUACELL AG ROPE,,A6199,HCPCS,Facility,Outpatient,,,,48.195,40.96575,13.812687,48.195,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,23.1336,48,,percent of total billed charges,,100% of DHS outpatient percentage
DRESSING AQUACELL AG ROPE,,A6199,HCPCS,Facility,Inpatient,,,,48.195,40.96575,13.812687,48.195,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Sup Alginate Calcium  2Gm Rope  18 In,,A6199,HCPCS,Facility,Both,,,,30.2,25.67,8.65532,30.2,Aetna,Commercial,27.784,92,,percent of total billed charges,,
Sup Alginate Calcium  2Gm Rope  18 In,,A6199,HCPCS,Facility,Outpatient,,,,30.2,25.67,8.65532,30.2,Aetna,Medicare Advantage,14.798,49,,percent of total billed charges,,
Sup Alginate Calcium  2Gm Rope  18 In,,A6199,HCPCS,Facility,Inpatient,,,,30.2,25.67,8.65532,30.2,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Sup Alginate Calcium  2Gm Rope  18 In,,A6199,HCPCS,Facility,Both,,,,30.2,25.67,8.65532,30.2,Aetna,PPO,28.086,93,,percent of total billed charges,,
Sup Alginate Calcium  2Gm Rope  18 In,,A6199,HCPCS,Facility,Both,,,,30.2,25.67,8.65532,30.2,America's PPO,America's PPO,29.00106,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Sup Alginate Calcium  2Gm Rope  18 In,,A6199,HCPCS,Facility,Both,,,,30.2,25.67,8.65532,30.2,BlueCross BlueShield Minnesota, Federal Employee Program,29.7168,98.4,,percent of total billed charges,,
Sup Alginate Calcium  2Gm Rope  18 In,,A6199,HCPCS,Facility,Both,,,,30.2,25.67,8.65532,30.2,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,30.2,100,,percent of total billed charges,,
Sup Alginate Calcium  2Gm Rope  18 In,,A6199,HCPCS,Facility,Both,,,,30.2,25.67,8.65532,30.2,BlueCross BlueShield Minnesota,High Value Network Plan,27.18,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
Sup Alginate Calcium  2Gm Rope  18 In,,A6199,HCPCS,Facility,Outpatient,,,,30.2,25.67,8.65532,30.2,BlueCross BlueShield Minnesota,Medicare Advantage,14.798,49,,percent of total billed charges,,
Sup Alginate Calcium  2Gm Rope  18 In,,A6199,HCPCS,Facility,Inpatient,,,,30.2,25.67,8.65532,30.2,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Sup Alginate Calcium  2Gm Rope  18 In,,A6199,HCPCS,Facility,Both,,,,30.2,25.67,8.65532,30.2,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,26.74814,88.57,,percent of total billed charges,,
Sup Alginate Calcium  2Gm Rope  18 In,,A6199,HCPCS,Facility,Both,,,,30.2,25.67,8.65532,30.2,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,8.65532,28.66,,percent of total billed charges,,
Sup Alginate Calcium  2Gm Rope  18 In,,A6199,HCPCS,Facility,Outpatient,,,,30.2,25.67,8.65532,30.2,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),14.798,49,,percent of total billed charges,,
Sup Alginate Calcium  2Gm Rope  18 In,,A6199,HCPCS,Facility,Inpatient,,,,30.2,25.67,8.65532,30.2,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Sup Alginate Calcium  2Gm Rope  18 In,,A6199,HCPCS,Facility,Both,,,,30.2,25.67,8.65532,30.2,CorVel,Worker's Compensation,30.2,100,,percent of total billed charges,,
Sup Alginate Calcium  2Gm Rope  18 In,,A6199,HCPCS,Facility,Both,,,,30.2,25.67,8.65532,30.2,First Health Group Corporation,First Health Network,29.294,97,,percent of total billed charges,,
Sup Alginate Calcium  2Gm Rope  18 In,,A6199,HCPCS,Facility,Both,,,,30.2,25.67,8.65532,30.2,"Health Partners, Inc.",Commercial,28.5692,94.6,,percent of total billed charges,,
Sup Alginate Calcium  2Gm Rope  18 In,,A6199,HCPCS,Facility,Outpatient,,,,30.2,25.67,8.65532,30.2,"Health Partners, Inc.",Medicare Advantage,14.798,49,,percent of total billed charges,,
Sup Alginate Calcium  2Gm Rope  18 In,,A6199,HCPCS,Facility,Inpatient,,,,30.2,25.67,8.65532,30.2,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Alginate Calcium  2Gm Rope  18 In,,A6199,HCPCS,Facility,Both,,,,30.2,25.67,8.65532,30.2,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),18.12,60,,percent of total billed charges,,
Sup Alginate Calcium  2Gm Rope  18 In,,A6199,HCPCS,Facility,Both,,,,30.2,25.67,8.65532,30.2,"Health Partners, Inc.",State of Minnesota Advantage Program,24.613,81.5,,percent of total billed charges,,
Sup Alginate Calcium  2Gm Rope  18 In,,A6199,HCPCS,Facility,Both,,,,30.2,25.67,8.65532,30.2,"Health Partners, Inc.",State Public Programs,15.1,50,,percent of total billed charges,,
Sup Alginate Calcium  2Gm Rope  18 In,,A6199,HCPCS,Facility,Both,,,,30.2,25.67,8.65532,30.2,Humana Insurance Company,Commercial PPO,28.69,95,,percent of total billed charges,,
Sup Alginate Calcium  2Gm Rope  18 In,,A6199,HCPCS,Facility,Outpatient,,,,30.2,25.67,8.65532,30.2,Humana Insurance Company,Medicare PPO,14.798,49,,percent of total billed charges,,
Sup Alginate Calcium  2Gm Rope  18 In,,A6199,HCPCS,Facility,Inpatient,,,,30.2,25.67,8.65532,30.2,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Sup Alginate Calcium  2Gm Rope  18 In,,A6199,HCPCS,Facility,Both,,,,30.2,25.67,8.65532,30.2,Medica,Individual & Family,29.9282,99.1,,percent of total billed charges,,
Sup Alginate Calcium  2Gm Rope  18 In,,A6199,HCPCS,Facility,Outpatient,,,,30.2,25.67,8.65532,30.2,Medica,Medica Advantage Solution,15.0396,49.8,,percent of total billed charges,,
Sup Alginate Calcium  2Gm Rope  18 In,,A6199,HCPCS,Facility,Inpatient,,,,30.2,25.67,8.65532,30.2,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Sup Alginate Calcium  2Gm Rope  18 In,,A6199,HCPCS,Facility,Outpatient,,,,30.2,25.67,8.65532,30.2,Medica,Medical Assistance,13.4692,44.6,,percent of total billed charges,,
Sup Alginate Calcium  2Gm Rope  18 In,,A6199,HCPCS,Facility,Inpatient,,,,30.2,25.67,8.65532,30.2,Medica,Medical Assistance,,,,,Included in per diem rate,
Sup Alginate Calcium  2Gm Rope  18 In,,A6199,HCPCS,Facility,Outpatient,,,,30.2,25.67,8.65532,30.2,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,15.0396,49.8,,percent of total billed charges,,
Sup Alginate Calcium  2Gm Rope  18 In,,A6199,HCPCS,Facility,Inpatient,,,,30.2,25.67,8.65532,30.2,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Sup Alginate Calcium  2Gm Rope  18 In,,A6199,HCPCS,Facility,Both,,,,30.2,25.67,8.65532,30.2,"Multiplan, Inc.","Multiplan, Inc.",28.388,94,,percent of total billed charges,,
Sup Alginate Calcium  2Gm Rope  18 In,,A6199,HCPCS,Facility,Outpatient,,,,30.2,25.67,8.65532,30.2,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,27.2102,90.1,,percent of total billed charges,,
Sup Alginate Calcium  2Gm Rope  18 In,,A6199,HCPCS,Facility,Inpatient,,,,30.2,25.67,8.65532,30.2,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Sup Alginate Calcium  2Gm Rope  18 In,,A6199,HCPCS,Facility,Both,,,,30.2,25.67,8.65532,30.2,"Preferred One Administrative Services, INC.",PPO,29.7772,98.6,,percent of total billed charges,,
Sup Alginate Calcium  2Gm Rope  18 In,,A6199,HCPCS,Facility,Outpatient,,,,30.2,25.67,8.65532,30.2,PrimeWest Health,Minnesota Senior Health Options (MSHO),15.5379,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Sup Alginate Calcium  2Gm Rope  18 In,,A6199,HCPCS,Facility,Inpatient,,,,30.2,25.67,8.65532,30.2,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Alginate Calcium  2Gm Rope  18 In,,A6199,HCPCS,Facility,Outpatient,,,,30.2,25.67,8.65532,30.2,PrimeWest Health,MinnesotaCare,15.51072,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Sup Alginate Calcium  2Gm Rope  18 In,,A6199,HCPCS,Facility,Inpatient,,,,30.2,25.67,8.65532,30.2,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Sup Alginate Calcium  2Gm Rope  18 In,,A6199,HCPCS,Facility,Both,,,,30.2,25.67,8.65532,30.2,Sanford Health Plan,Sanford Health Plan,27.784,92,,percent of total billed charges,,
Sup Alginate Calcium  2Gm Rope  18 In,,A6199,HCPCS,Facility,Outpatient,,,,30.2,25.67,8.65532,30.2,"UCare Health, Inc.",Individual & Family Plan,17.0177,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Sup Alginate Calcium  2Gm Rope  18 In,,A6199,HCPCS,Facility,Inpatient,,,,30.2,25.67,8.65532,30.2,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Sup Alginate Calcium  2Gm Rope  18 In,,A6199,HCPCS,Facility,Outpatient,,,,30.2,25.67,8.65532,30.2,"UCare Health, Inc.",Medical Assistance,15.24194,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Alginate Calcium  2Gm Rope  18 In,,A6199,HCPCS,Facility,Inpatient,,,,30.2,25.67,8.65532,30.2,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Sup Alginate Calcium  2Gm Rope  18 In,,A6199,HCPCS,Facility,Outpatient,,,,30.2,25.67,8.65532,30.2,"UCare Health, Inc.",Medicare Advantage,15.24194,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Alginate Calcium  2Gm Rope  18 In,,A6199,HCPCS,Facility,Inpatient,,,,30.2,25.67,8.65532,30.2,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Alginate Calcium  2Gm Rope  18 In,,A6199,HCPCS,Facility,Outpatient,,,,30.2,25.67,8.65532,30.2,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),15.24194,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Alginate Calcium  2Gm Rope  18 In,,A6199,HCPCS,Facility,Inpatient,,,,30.2,25.67,8.65532,30.2,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Alginate Calcium  2Gm Rope  18 In,,A6199,HCPCS,Facility,Both,,,,30.2,25.67,8.65532,30.2,UnitedHealthcare,Individual & Family,28.388,94,,percent of total billed charges,,
Sup Alginate Calcium  2Gm Rope  18 In,,A6199,HCPCS,Facility,Outpatient,,,,30.2,25.67,8.65532,30.2,UnitedHealthcare,Medicare Advantage,14.798,49,,percent of total billed charges,,
Sup Alginate Calcium  2Gm Rope  18 In,,A6199,HCPCS,Facility,Inpatient,,,,30.2,25.67,8.65532,30.2,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Sup Alginate Calcium  2Gm Rope  18 In,,A6199,HCPCS,Facility,Outpatient,,,,30.2,25.67,8.65532,30.2,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,14.496,48,,percent of total billed charges,,100% of DHS outpatient percentage
Sup Alginate Calcium  2Gm Rope  18 In,,A6199,HCPCS,Facility,Inpatient,,,,30.2,25.67,8.65532,30.2,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Sup Aquacel Ribbon Dressing,,A6199,HCPCS,Facility,Both,,,,50,42.5,14.33,50,Aetna,Commercial,46,92,,percent of total billed charges,,
Sup Aquacel Ribbon Dressing,,A6199,HCPCS,Facility,Outpatient,,,,50,42.5,14.33,50,Aetna,Medicare Advantage,24.5,49,,percent of total billed charges,,
Sup Aquacel Ribbon Dressing,,A6199,HCPCS,Facility,Inpatient,,,,50,42.5,14.33,50,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Sup Aquacel Ribbon Dressing,,A6199,HCPCS,Facility,Both,,,,50,42.5,14.33,50,Aetna,PPO,46.5,93,,percent of total billed charges,,
Sup Aquacel Ribbon Dressing,,A6199,HCPCS,Facility,Both,,,,50,42.5,14.33,50,America's PPO,America's PPO,48.015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Sup Aquacel Ribbon Dressing,,A6199,HCPCS,Facility,Both,,,,50,42.5,14.33,50,BlueCross BlueShield Minnesota, Federal Employee Program,49.2,98.4,,percent of total billed charges,,
Sup Aquacel Ribbon Dressing,,A6199,HCPCS,Facility,Both,,,,50,42.5,14.33,50,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,50,100,,percent of total billed charges,,
Sup Aquacel Ribbon Dressing,,A6199,HCPCS,Facility,Both,,,,50,42.5,14.33,50,BlueCross BlueShield Minnesota,High Value Network Plan,45,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
Sup Aquacel Ribbon Dressing,,A6199,HCPCS,Facility,Outpatient,,,,50,42.5,14.33,50,BlueCross BlueShield Minnesota,Medicare Advantage,24.5,49,,percent of total billed charges,,
Sup Aquacel Ribbon Dressing,,A6199,HCPCS,Facility,Inpatient,,,,50,42.5,14.33,50,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Sup Aquacel Ribbon Dressing,,A6199,HCPCS,Facility,Both,,,,50,42.5,14.33,50,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,44.285,88.57,,percent of total billed charges,,
Sup Aquacel Ribbon Dressing,,A6199,HCPCS,Facility,Both,,,,50,42.5,14.33,50,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,14.33,28.66,,percent of total billed charges,,
Sup Aquacel Ribbon Dressing,,A6199,HCPCS,Facility,Outpatient,,,,50,42.5,14.33,50,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),24.5,49,,percent of total billed charges,,
Sup Aquacel Ribbon Dressing,,A6199,HCPCS,Facility,Inpatient,,,,50,42.5,14.33,50,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Sup Aquacel Ribbon Dressing,,A6199,HCPCS,Facility,Both,,,,50,42.5,14.33,50,CorVel,Worker's Compensation,50,100,,percent of total billed charges,,
Sup Aquacel Ribbon Dressing,,A6199,HCPCS,Facility,Both,,,,50,42.5,14.33,50,First Health Group Corporation,First Health Network,48.5,97,,percent of total billed charges,,
Sup Aquacel Ribbon Dressing,,A6199,HCPCS,Facility,Both,,,,50,42.5,14.33,50,"Health Partners, Inc.",Commercial,47.3,94.6,,percent of total billed charges,,
Sup Aquacel Ribbon Dressing,,A6199,HCPCS,Facility,Outpatient,,,,50,42.5,14.33,50,"Health Partners, Inc.",Medicare Advantage,24.5,49,,percent of total billed charges,,
Sup Aquacel Ribbon Dressing,,A6199,HCPCS,Facility,Inpatient,,,,50,42.5,14.33,50,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Aquacel Ribbon Dressing,,A6199,HCPCS,Facility,Both,,,,50,42.5,14.33,50,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),30,60,,percent of total billed charges,,
Sup Aquacel Ribbon Dressing,,A6199,HCPCS,Facility,Both,,,,50,42.5,14.33,50,"Health Partners, Inc.",State of Minnesota Advantage Program,40.75,81.5,,percent of total billed charges,,
Sup Aquacel Ribbon Dressing,,A6199,HCPCS,Facility,Both,,,,50,42.5,14.33,50,"Health Partners, Inc.",State Public Programs,25,50,,percent of total billed charges,,
Sup Aquacel Ribbon Dressing,,A6199,HCPCS,Facility,Both,,,,50,42.5,14.33,50,Humana Insurance Company,Commercial PPO,47.5,95,,percent of total billed charges,,
Sup Aquacel Ribbon Dressing,,A6199,HCPCS,Facility,Outpatient,,,,50,42.5,14.33,50,Humana Insurance Company,Medicare PPO,24.5,49,,percent of total billed charges,,
Sup Aquacel Ribbon Dressing,,A6199,HCPCS,Facility,Inpatient,,,,50,42.5,14.33,50,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Sup Aquacel Ribbon Dressing,,A6199,HCPCS,Facility,Both,,,,50,42.5,14.33,50,Medica,Individual & Family,49.55,99.1,,percent of total billed charges,,
Sup Aquacel Ribbon Dressing,,A6199,HCPCS,Facility,Outpatient,,,,50,42.5,14.33,50,Medica,Medica Advantage Solution,24.9,49.8,,percent of total billed charges,,
Sup Aquacel Ribbon Dressing,,A6199,HCPCS,Facility,Inpatient,,,,50,42.5,14.33,50,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Sup Aquacel Ribbon Dressing,,A6199,HCPCS,Facility,Outpatient,,,,50,42.5,14.33,50,Medica,Medical Assistance,22.3,44.6,,percent of total billed charges,,
Sup Aquacel Ribbon Dressing,,A6199,HCPCS,Facility,Inpatient,,,,50,42.5,14.33,50,Medica,Medical Assistance,,,,,Included in per diem rate,
Sup Aquacel Ribbon Dressing,,A6199,HCPCS,Facility,Outpatient,,,,50,42.5,14.33,50,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,24.9,49.8,,percent of total billed charges,,
Sup Aquacel Ribbon Dressing,,A6199,HCPCS,Facility,Inpatient,,,,50,42.5,14.33,50,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Sup Aquacel Ribbon Dressing,,A6199,HCPCS,Facility,Both,,,,50,42.5,14.33,50,"Multiplan, Inc.","Multiplan, Inc.",47,94,,percent of total billed charges,,
Sup Aquacel Ribbon Dressing,,A6199,HCPCS,Facility,Outpatient,,,,50,42.5,14.33,50,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,45.05,90.1,,percent of total billed charges,,
Sup Aquacel Ribbon Dressing,,A6199,HCPCS,Facility,Inpatient,,,,50,42.5,14.33,50,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Sup Aquacel Ribbon Dressing,,A6199,HCPCS,Facility,Both,,,,50,42.5,14.33,50,"Preferred One Administrative Services, INC.",PPO,49.3,98.6,,percent of total billed charges,,
Sup Aquacel Ribbon Dressing,,A6199,HCPCS,Facility,Outpatient,,,,50,42.5,14.33,50,PrimeWest Health,Minnesota Senior Health Options (MSHO),25.725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Sup Aquacel Ribbon Dressing,,A6199,HCPCS,Facility,Inpatient,,,,50,42.5,14.33,50,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Aquacel Ribbon Dressing,,A6199,HCPCS,Facility,Outpatient,,,,50,42.5,14.33,50,PrimeWest Health,MinnesotaCare,25.68,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Sup Aquacel Ribbon Dressing,,A6199,HCPCS,Facility,Inpatient,,,,50,42.5,14.33,50,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Sup Aquacel Ribbon Dressing,,A6199,HCPCS,Facility,Both,,,,50,42.5,14.33,50,Sanford Health Plan,Sanford Health Plan,46,92,,percent of total billed charges,,
Sup Aquacel Ribbon Dressing,,A6199,HCPCS,Facility,Outpatient,,,,50,42.5,14.33,50,"UCare Health, Inc.",Individual & Family Plan,28.175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Sup Aquacel Ribbon Dressing,,A6199,HCPCS,Facility,Inpatient,,,,50,42.5,14.33,50,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Sup Aquacel Ribbon Dressing,,A6199,HCPCS,Facility,Outpatient,,,,50,42.5,14.33,50,"UCare Health, Inc.",Medical Assistance,25.235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Aquacel Ribbon Dressing,,A6199,HCPCS,Facility,Inpatient,,,,50,42.5,14.33,50,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Sup Aquacel Ribbon Dressing,,A6199,HCPCS,Facility,Outpatient,,,,50,42.5,14.33,50,"UCare Health, Inc.",Medicare Advantage,25.235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Aquacel Ribbon Dressing,,A6199,HCPCS,Facility,Inpatient,,,,50,42.5,14.33,50,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Aquacel Ribbon Dressing,,A6199,HCPCS,Facility,Outpatient,,,,50,42.5,14.33,50,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),25.235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Aquacel Ribbon Dressing,,A6199,HCPCS,Facility,Inpatient,,,,50,42.5,14.33,50,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Aquacel Ribbon Dressing,,A6199,HCPCS,Facility,Both,,,,50,42.5,14.33,50,UnitedHealthcare,Individual & Family,47,94,,percent of total billed charges,,
Sup Aquacel Ribbon Dressing,,A6199,HCPCS,Facility,Outpatient,,,,50,42.5,14.33,50,UnitedHealthcare,Medicare Advantage,24.5,49,,percent of total billed charges,,
Sup Aquacel Ribbon Dressing,,A6199,HCPCS,Facility,Inpatient,,,,50,42.5,14.33,50,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Sup Aquacel Ribbon Dressing,,A6199,HCPCS,Facility,Outpatient,,,,50,42.5,14.33,50,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,24,48,,percent of total billed charges,,100% of DHS outpatient percentage
Sup Aquacel Ribbon Dressing,,A6199,HCPCS,Facility,Inpatient,,,,50,42.5,14.33,50,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Sup Dressing Mepilex 6 X 8,,A6210,HCPCS,Facility,Both,,,,74.87,63.6395,21.457742,74.87,Aetna,Commercial,68.8804,92,,percent of total billed charges,,
Sup Dressing Mepilex 6 X 8,,A6210,HCPCS,Facility,Outpatient,,,,74.87,63.6395,21.457742,74.87,Aetna,Medicare Advantage,36.6863,49,,percent of total billed charges,,
Sup Dressing Mepilex 6 X 8,,A6210,HCPCS,Facility,Inpatient,,,,74.87,63.6395,21.457742,74.87,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Sup Dressing Mepilex 6 X 8,,A6210,HCPCS,Facility,Both,,,,74.87,63.6395,21.457742,74.87,Aetna,PPO,69.6291,93,,percent of total billed charges,,
Sup Dressing Mepilex 6 X 8,,A6210,HCPCS,Facility,Both,,,,74.87,63.6395,21.457742,74.87,America's PPO,America's PPO,71.897661,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Sup Dressing Mepilex 6 X 8,,A6210,HCPCS,Facility,Both,,,,74.87,63.6395,21.457742,74.87,BlueCross BlueShield Minnesota, Federal Employee Program,73.67208,98.4,,percent of total billed charges,,
Sup Dressing Mepilex 6 X 8,,A6210,HCPCS,Facility,Both,,,,74.87,63.6395,21.457742,74.87,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,74.87,100,,percent of total billed charges,,
Sup Dressing Mepilex 6 X 8,,A6210,HCPCS,Facility,Both,,,,74.87,63.6395,21.457742,74.87,BlueCross BlueShield Minnesota,High Value Network Plan,67.383,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
Sup Dressing Mepilex 6 X 8,,A6210,HCPCS,Facility,Outpatient,,,,74.87,63.6395,21.457742,74.87,BlueCross BlueShield Minnesota,Medicare Advantage,36.6863,49,,percent of total billed charges,,
Sup Dressing Mepilex 6 X 8,,A6210,HCPCS,Facility,Inpatient,,,,74.87,63.6395,21.457742,74.87,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Sup Dressing Mepilex 6 X 8,,A6210,HCPCS,Facility,Both,,,,74.87,63.6395,21.457742,74.87,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,66.312359,88.57,,percent of total billed charges,,
Sup Dressing Mepilex 6 X 8,,A6210,HCPCS,Facility,Both,,,,74.87,63.6395,21.457742,74.87,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,21.457742,28.66,,percent of total billed charges,,
Sup Dressing Mepilex 6 X 8,,A6210,HCPCS,Facility,Outpatient,,,,74.87,63.6395,21.457742,74.87,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),36.6863,49,,percent of total billed charges,,
Sup Dressing Mepilex 6 X 8,,A6210,HCPCS,Facility,Inpatient,,,,74.87,63.6395,21.457742,74.87,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Sup Dressing Mepilex 6 X 8,,A6210,HCPCS,Facility,Both,,,,74.87,63.6395,21.457742,74.87,CorVel,Worker's Compensation,74.87,100,,percent of total billed charges,,
Sup Dressing Mepilex 6 X 8,,A6210,HCPCS,Facility,Both,,,,74.87,63.6395,21.457742,74.87,First Health Group Corporation,First Health Network,72.6239,97,,percent of total billed charges,,
Sup Dressing Mepilex 6 X 8,,A6210,HCPCS,Facility,Both,,,,74.87,63.6395,21.457742,74.87,"Health Partners, Inc.",Commercial,70.82702,94.6,,percent of total billed charges,,
Sup Dressing Mepilex 6 X 8,,A6210,HCPCS,Facility,Outpatient,,,,74.87,63.6395,21.457742,74.87,"Health Partners, Inc.",Medicare Advantage,36.6863,49,,percent of total billed charges,,
Sup Dressing Mepilex 6 X 8,,A6210,HCPCS,Facility,Inpatient,,,,74.87,63.6395,21.457742,74.87,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Dressing Mepilex 6 X 8,,A6210,HCPCS,Facility,Both,,,,74.87,63.6395,21.457742,74.87,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),44.922,60,,percent of total billed charges,,
Sup Dressing Mepilex 6 X 8,,A6210,HCPCS,Facility,Both,,,,74.87,63.6395,21.457742,74.87,"Health Partners, Inc.",State of Minnesota Advantage Program,61.01905,81.5,,percent of total billed charges,,
Sup Dressing Mepilex 6 X 8,,A6210,HCPCS,Facility,Both,,,,74.87,63.6395,21.457742,74.87,"Health Partners, Inc.",State Public Programs,37.435,50,,percent of total billed charges,,
Sup Dressing Mepilex 6 X 8,,A6210,HCPCS,Facility,Both,,,,74.87,63.6395,21.457742,74.87,Humana Insurance Company,Commercial PPO,71.1265,95,,percent of total billed charges,,
Sup Dressing Mepilex 6 X 8,,A6210,HCPCS,Facility,Outpatient,,,,74.87,63.6395,21.457742,74.87,Humana Insurance Company,Medicare PPO,36.6863,49,,percent of total billed charges,,
Sup Dressing Mepilex 6 X 8,,A6210,HCPCS,Facility,Inpatient,,,,74.87,63.6395,21.457742,74.87,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Sup Dressing Mepilex 6 X 8,,A6210,HCPCS,Facility,Both,,,,74.87,63.6395,21.457742,74.87,Medica,Individual & Family,74.19617,99.1,,percent of total billed charges,,
Sup Dressing Mepilex 6 X 8,,A6210,HCPCS,Facility,Outpatient,,,,74.87,63.6395,21.457742,74.87,Medica,Medica Advantage Solution,37.28526,49.8,,percent of total billed charges,,
Sup Dressing Mepilex 6 X 8,,A6210,HCPCS,Facility,Inpatient,,,,74.87,63.6395,21.457742,74.87,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Sup Dressing Mepilex 6 X 8,,A6210,HCPCS,Facility,Outpatient,,,,74.87,63.6395,21.457742,74.87,Medica,Medical Assistance,33.39202,44.6,,percent of total billed charges,,
Sup Dressing Mepilex 6 X 8,,A6210,HCPCS,Facility,Inpatient,,,,74.87,63.6395,21.457742,74.87,Medica,Medical Assistance,,,,,Included in per diem rate,
Sup Dressing Mepilex 6 X 8,,A6210,HCPCS,Facility,Outpatient,,,,74.87,63.6395,21.457742,74.87,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,37.28526,49.8,,percent of total billed charges,,
Sup Dressing Mepilex 6 X 8,,A6210,HCPCS,Facility,Inpatient,,,,74.87,63.6395,21.457742,74.87,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Sup Dressing Mepilex 6 X 8,,A6210,HCPCS,Facility,Both,,,,74.87,63.6395,21.457742,74.87,"Multiplan, Inc.","Multiplan, Inc.",70.3778,94,,percent of total billed charges,,
Sup Dressing Mepilex 6 X 8,,A6210,HCPCS,Facility,Outpatient,,,,74.87,63.6395,21.457742,74.87,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,67.45787,90.1,,percent of total billed charges,,
Sup Dressing Mepilex 6 X 8,,A6210,HCPCS,Facility,Inpatient,,,,74.87,63.6395,21.457742,74.87,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Sup Dressing Mepilex 6 X 8,,A6210,HCPCS,Facility,Both,,,,74.87,63.6395,21.457742,74.87,"Preferred One Administrative Services, INC.",PPO,73.82182,98.6,,percent of total billed charges,,
Sup Dressing Mepilex 6 X 8,,A6210,HCPCS,Facility,Outpatient,,,,74.87,63.6395,21.457742,74.87,PrimeWest Health,Minnesota Senior Health Options (MSHO),38.520615,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Sup Dressing Mepilex 6 X 8,,A6210,HCPCS,Facility,Inpatient,,,,74.87,63.6395,21.457742,74.87,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Dressing Mepilex 6 X 8,,A6210,HCPCS,Facility,Outpatient,,,,74.87,63.6395,21.457742,74.87,PrimeWest Health,MinnesotaCare,38.453232,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Sup Dressing Mepilex 6 X 8,,A6210,HCPCS,Facility,Inpatient,,,,74.87,63.6395,21.457742,74.87,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Sup Dressing Mepilex 6 X 8,,A6210,HCPCS,Facility,Both,,,,74.87,63.6395,21.457742,74.87,Sanford Health Plan,Sanford Health Plan,68.8804,92,,percent of total billed charges,,
Sup Dressing Mepilex 6 X 8,,A6210,HCPCS,Facility,Outpatient,,,,74.87,63.6395,21.457742,74.87,"UCare Health, Inc.",Individual & Family Plan,42.189245,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Sup Dressing Mepilex 6 X 8,,A6210,HCPCS,Facility,Inpatient,,,,74.87,63.6395,21.457742,74.87,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Sup Dressing Mepilex 6 X 8,,A6210,HCPCS,Facility,Outpatient,,,,74.87,63.6395,21.457742,74.87,"UCare Health, Inc.",Medical Assistance,37.786889,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Dressing Mepilex 6 X 8,,A6210,HCPCS,Facility,Inpatient,,,,74.87,63.6395,21.457742,74.87,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Sup Dressing Mepilex 6 X 8,,A6210,HCPCS,Facility,Outpatient,,,,74.87,63.6395,21.457742,74.87,"UCare Health, Inc.",Medicare Advantage,37.786889,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Dressing Mepilex 6 X 8,,A6210,HCPCS,Facility,Inpatient,,,,74.87,63.6395,21.457742,74.87,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Dressing Mepilex 6 X 8,,A6210,HCPCS,Facility,Outpatient,,,,74.87,63.6395,21.457742,74.87,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),37.786889,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Dressing Mepilex 6 X 8,,A6210,HCPCS,Facility,Inpatient,,,,74.87,63.6395,21.457742,74.87,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Dressing Mepilex 6 X 8,,A6210,HCPCS,Facility,Both,,,,74.87,63.6395,21.457742,74.87,UnitedHealthcare,Individual & Family,70.3778,94,,percent of total billed charges,,
Sup Dressing Mepilex 6 X 8,,A6210,HCPCS,Facility,Outpatient,,,,74.87,63.6395,21.457742,74.87,UnitedHealthcare,Medicare Advantage,36.6863,49,,percent of total billed charges,,
Sup Dressing Mepilex 6 X 8,,A6210,HCPCS,Facility,Inpatient,,,,74.87,63.6395,21.457742,74.87,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Sup Dressing Mepilex 6 X 8,,A6210,HCPCS,Facility,Outpatient,,,,74.87,63.6395,21.457742,74.87,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,35.9376,48,,percent of total billed charges,,100% of DHS outpatient percentage
Sup Dressing Mepilex 6 X 8,,A6210,HCPCS,Facility,Inpatient,,,,74.87,63.6395,21.457742,74.87,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
DRESSING OPTIFOAM GENTLE 4 INCH X 12 INCH,,A6212,HCPCS,Facility,Both,,,,176.6,150.11,50.61356,176.6,Aetna,Commercial,162.472,92,,percent of total billed charges,,
DRESSING OPTIFOAM GENTLE 4 INCH X 12 INCH,,A6212,HCPCS,Facility,Outpatient,,,,176.6,150.11,50.61356,176.6,Aetna,Medicare Advantage,86.534,49,,percent of total billed charges,,
DRESSING OPTIFOAM GENTLE 4 INCH X 12 INCH,,A6212,HCPCS,Facility,Inpatient,,,,176.6,150.11,50.61356,176.6,Aetna,Medicare Advantage,,,,,Included in per diem rate,
DRESSING OPTIFOAM GENTLE 4 INCH X 12 INCH,,A6212,HCPCS,Facility,Both,,,,176.6,150.11,50.61356,176.6,Aetna,PPO,164.238,93,,percent of total billed charges,,
DRESSING OPTIFOAM GENTLE 4 INCH X 12 INCH,,A6212,HCPCS,Facility,Both,,,,176.6,150.11,50.61356,176.6,America's PPO,America's PPO,169.58898,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
DRESSING OPTIFOAM GENTLE 4 INCH X 12 INCH,,A6212,HCPCS,Facility,Both,,,,176.6,150.11,50.61356,176.6,BlueCross BlueShield Minnesota, Federal Employee Program,173.7744,98.4,,percent of total billed charges,,
DRESSING OPTIFOAM GENTLE 4 INCH X 12 INCH,,A6212,HCPCS,Facility,Both,,,,176.6,150.11,50.61356,176.6,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,176.6,100,,percent of total billed charges,,
DRESSING OPTIFOAM GENTLE 4 INCH X 12 INCH,,A6212,HCPCS,Facility,Both,,,,176.6,150.11,50.61356,176.6,BlueCross BlueShield Minnesota,High Value Network Plan,158.94,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
DRESSING OPTIFOAM GENTLE 4 INCH X 12 INCH,,A6212,HCPCS,Facility,Outpatient,,,,176.6,150.11,50.61356,176.6,BlueCross BlueShield Minnesota,Medicare Advantage,86.534,49,,percent of total billed charges,,
DRESSING OPTIFOAM GENTLE 4 INCH X 12 INCH,,A6212,HCPCS,Facility,Inpatient,,,,176.6,150.11,50.61356,176.6,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
DRESSING OPTIFOAM GENTLE 4 INCH X 12 INCH,,A6212,HCPCS,Facility,Both,,,,176.6,150.11,50.61356,176.6,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,156.41462,88.57,,percent of total billed charges,,
DRESSING OPTIFOAM GENTLE 4 INCH X 12 INCH,,A6212,HCPCS,Facility,Both,,,,176.6,150.11,50.61356,176.6,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,50.61356,28.66,,percent of total billed charges,,
DRESSING OPTIFOAM GENTLE 4 INCH X 12 INCH,,A6212,HCPCS,Facility,Outpatient,,,,176.6,150.11,50.61356,176.6,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),86.534,49,,percent of total billed charges,,
DRESSING OPTIFOAM GENTLE 4 INCH X 12 INCH,,A6212,HCPCS,Facility,Inpatient,,,,176.6,150.11,50.61356,176.6,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
DRESSING OPTIFOAM GENTLE 4 INCH X 12 INCH,,A6212,HCPCS,Facility,Both,,,,176.6,150.11,50.61356,176.6,CorVel,Worker's Compensation,176.6,100,,percent of total billed charges,,
DRESSING OPTIFOAM GENTLE 4 INCH X 12 INCH,,A6212,HCPCS,Facility,Both,,,,176.6,150.11,50.61356,176.6,First Health Group Corporation,First Health Network,171.302,97,,percent of total billed charges,,
DRESSING OPTIFOAM GENTLE 4 INCH X 12 INCH,,A6212,HCPCS,Facility,Both,,,,176.6,150.11,50.61356,176.6,"Health Partners, Inc.",Commercial,167.0636,94.6,,percent of total billed charges,,
DRESSING OPTIFOAM GENTLE 4 INCH X 12 INCH,,A6212,HCPCS,Facility,Outpatient,,,,176.6,150.11,50.61356,176.6,"Health Partners, Inc.",Medicare Advantage,86.534,49,,percent of total billed charges,,
DRESSING OPTIFOAM GENTLE 4 INCH X 12 INCH,,A6212,HCPCS,Facility,Inpatient,,,,176.6,150.11,50.61356,176.6,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DRESSING OPTIFOAM GENTLE 4 INCH X 12 INCH,,A6212,HCPCS,Facility,Both,,,,176.6,150.11,50.61356,176.6,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),105.96,60,,percent of total billed charges,,
DRESSING OPTIFOAM GENTLE 4 INCH X 12 INCH,,A6212,HCPCS,Facility,Both,,,,176.6,150.11,50.61356,176.6,"Health Partners, Inc.",State of Minnesota Advantage Program,143.929,81.5,,percent of total billed charges,,
DRESSING OPTIFOAM GENTLE 4 INCH X 12 INCH,,A6212,HCPCS,Facility,Both,,,,176.6,150.11,50.61356,176.6,"Health Partners, Inc.",State Public Programs,88.3,50,,percent of total billed charges,,
DRESSING OPTIFOAM GENTLE 4 INCH X 12 INCH,,A6212,HCPCS,Facility,Both,,,,176.6,150.11,50.61356,176.6,Humana Insurance Company,Commercial PPO,167.77,95,,percent of total billed charges,,
DRESSING OPTIFOAM GENTLE 4 INCH X 12 INCH,,A6212,HCPCS,Facility,Outpatient,,,,176.6,150.11,50.61356,176.6,Humana Insurance Company,Medicare PPO,86.534,49,,percent of total billed charges,,
DRESSING OPTIFOAM GENTLE 4 INCH X 12 INCH,,A6212,HCPCS,Facility,Inpatient,,,,176.6,150.11,50.61356,176.6,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
DRESSING OPTIFOAM GENTLE 4 INCH X 12 INCH,,A6212,HCPCS,Facility,Both,,,,176.6,150.11,50.61356,176.6,Medica,Individual & Family,175.0106,99.1,,percent of total billed charges,,
DRESSING OPTIFOAM GENTLE 4 INCH X 12 INCH,,A6212,HCPCS,Facility,Outpatient,,,,176.6,150.11,50.61356,176.6,Medica,Medica Advantage Solution,87.9468,49.8,,percent of total billed charges,,
DRESSING OPTIFOAM GENTLE 4 INCH X 12 INCH,,A6212,HCPCS,Facility,Inpatient,,,,176.6,150.11,50.61356,176.6,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
DRESSING OPTIFOAM GENTLE 4 INCH X 12 INCH,,A6212,HCPCS,Facility,Outpatient,,,,176.6,150.11,50.61356,176.6,Medica,Medical Assistance,78.7636,44.6,,percent of total billed charges,,
DRESSING OPTIFOAM GENTLE 4 INCH X 12 INCH,,A6212,HCPCS,Facility,Inpatient,,,,176.6,150.11,50.61356,176.6,Medica,Medical Assistance,,,,,Included in per diem rate,
DRESSING OPTIFOAM GENTLE 4 INCH X 12 INCH,,A6212,HCPCS,Facility,Outpatient,,,,176.6,150.11,50.61356,176.6,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,87.9468,49.8,,percent of total billed charges,,
DRESSING OPTIFOAM GENTLE 4 INCH X 12 INCH,,A6212,HCPCS,Facility,Inpatient,,,,176.6,150.11,50.61356,176.6,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
DRESSING OPTIFOAM GENTLE 4 INCH X 12 INCH,,A6212,HCPCS,Facility,Both,,,,176.6,150.11,50.61356,176.6,"Multiplan, Inc.","Multiplan, Inc.",166.004,94,,percent of total billed charges,,
DRESSING OPTIFOAM GENTLE 4 INCH X 12 INCH,,A6212,HCPCS,Facility,Outpatient,,,,176.6,150.11,50.61356,176.6,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,159.1166,90.1,,percent of total billed charges,,
DRESSING OPTIFOAM GENTLE 4 INCH X 12 INCH,,A6212,HCPCS,Facility,Inpatient,,,,176.6,150.11,50.61356,176.6,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
DRESSING OPTIFOAM GENTLE 4 INCH X 12 INCH,,A6212,HCPCS,Facility,Both,,,,176.6,150.11,50.61356,176.6,"Preferred One Administrative Services, INC.",PPO,174.1276,98.6,,percent of total billed charges,,
DRESSING OPTIFOAM GENTLE 4 INCH X 12 INCH,,A6212,HCPCS,Facility,Outpatient,,,,176.6,150.11,50.61356,176.6,PrimeWest Health,Minnesota Senior Health Options (MSHO),90.8607,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
DRESSING OPTIFOAM GENTLE 4 INCH X 12 INCH,,A6212,HCPCS,Facility,Inpatient,,,,176.6,150.11,50.61356,176.6,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DRESSING OPTIFOAM GENTLE 4 INCH X 12 INCH,,A6212,HCPCS,Facility,Outpatient,,,,176.6,150.11,50.61356,176.6,PrimeWest Health,MinnesotaCare,90.70176,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
DRESSING OPTIFOAM GENTLE 4 INCH X 12 INCH,,A6212,HCPCS,Facility,Inpatient,,,,176.6,150.11,50.61356,176.6,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
DRESSING OPTIFOAM GENTLE 4 INCH X 12 INCH,,A6212,HCPCS,Facility,Both,,,,176.6,150.11,50.61356,176.6,Sanford Health Plan,Sanford Health Plan,162.472,92,,percent of total billed charges,,
DRESSING OPTIFOAM GENTLE 4 INCH X 12 INCH,,A6212,HCPCS,Facility,Outpatient,,,,176.6,150.11,50.61356,176.6,"UCare Health, Inc.",Individual & Family Plan,99.5141,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
DRESSING OPTIFOAM GENTLE 4 INCH X 12 INCH,,A6212,HCPCS,Facility,Inpatient,,,,176.6,150.11,50.61356,176.6,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
DRESSING OPTIFOAM GENTLE 4 INCH X 12 INCH,,A6212,HCPCS,Facility,Outpatient,,,,176.6,150.11,50.61356,176.6,"UCare Health, Inc.",Medical Assistance,89.13002,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DRESSING OPTIFOAM GENTLE 4 INCH X 12 INCH,,A6212,HCPCS,Facility,Inpatient,,,,176.6,150.11,50.61356,176.6,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
DRESSING OPTIFOAM GENTLE 4 INCH X 12 INCH,,A6212,HCPCS,Facility,Outpatient,,,,176.6,150.11,50.61356,176.6,"UCare Health, Inc.",Medicare Advantage,89.13002,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DRESSING OPTIFOAM GENTLE 4 INCH X 12 INCH,,A6212,HCPCS,Facility,Inpatient,,,,176.6,150.11,50.61356,176.6,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DRESSING OPTIFOAM GENTLE 4 INCH X 12 INCH,,A6212,HCPCS,Facility,Outpatient,,,,176.6,150.11,50.61356,176.6,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),89.13002,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DRESSING OPTIFOAM GENTLE 4 INCH X 12 INCH,,A6212,HCPCS,Facility,Inpatient,,,,176.6,150.11,50.61356,176.6,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DRESSING OPTIFOAM GENTLE 4 INCH X 12 INCH,,A6212,HCPCS,Facility,Both,,,,176.6,150.11,50.61356,176.6,UnitedHealthcare,Individual & Family,166.004,94,,percent of total billed charges,,
DRESSING OPTIFOAM GENTLE 4 INCH X 12 INCH,,A6212,HCPCS,Facility,Outpatient,,,,176.6,150.11,50.61356,176.6,UnitedHealthcare,Medicare Advantage,86.534,49,,percent of total billed charges,,
DRESSING OPTIFOAM GENTLE 4 INCH X 12 INCH,,A6212,HCPCS,Facility,Inpatient,,,,176.6,150.11,50.61356,176.6,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
DRESSING OPTIFOAM GENTLE 4 INCH X 12 INCH,,A6212,HCPCS,Facility,Outpatient,,,,176.6,150.11,50.61356,176.6,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,84.768,48,,percent of total billed charges,,100% of DHS outpatient percentage
DRESSING OPTIFOAM GENTLE 4 INCH X 12 INCH,,A6212,HCPCS,Facility,Inpatient,,,,176.6,150.11,50.61356,176.6,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
DRESSING MEPILEX BORDER DRSG 4X4,,A6213,HCPCS,Facility,Both,,,,17.2,14.62,4.92952,17.2,Aetna,Commercial,15.824,92,,percent of total billed charges,,
DRESSING MEPILEX BORDER DRSG 4X4,,A6213,HCPCS,Facility,Outpatient,,,,17.2,14.62,4.92952,17.2,Aetna,Medicare Advantage,8.428,49,,percent of total billed charges,,
DRESSING MEPILEX BORDER DRSG 4X4,,A6213,HCPCS,Facility,Inpatient,,,,17.2,14.62,4.92952,17.2,Aetna,Medicare Advantage,,,,,Included in per diem rate,
DRESSING MEPILEX BORDER DRSG 4X4,,A6213,HCPCS,Facility,Both,,,,17.2,14.62,4.92952,17.2,Aetna,PPO,15.996,93,,percent of total billed charges,,
DRESSING MEPILEX BORDER DRSG 4X4,,A6213,HCPCS,Facility,Both,,,,17.2,14.62,4.92952,17.2,America's PPO,America's PPO,16.51716,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
DRESSING MEPILEX BORDER DRSG 4X4,,A6213,HCPCS,Facility,Both,,,,17.2,14.62,4.92952,17.2,BlueCross BlueShield Minnesota, Federal Employee Program,16.9248,98.4,,percent of total billed charges,,
DRESSING MEPILEX BORDER DRSG 4X4,,A6213,HCPCS,Facility,Both,,,,17.2,14.62,4.92952,17.2,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,17.2,100,,percent of total billed charges,,
DRESSING MEPILEX BORDER DRSG 4X4,,A6213,HCPCS,Facility,Both,,,,17.2,14.62,4.92952,17.2,BlueCross BlueShield Minnesota,High Value Network Plan,15.48,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
DRESSING MEPILEX BORDER DRSG 4X4,,A6213,HCPCS,Facility,Outpatient,,,,17.2,14.62,4.92952,17.2,BlueCross BlueShield Minnesota,Medicare Advantage,8.428,49,,percent of total billed charges,,
DRESSING MEPILEX BORDER DRSG 4X4,,A6213,HCPCS,Facility,Inpatient,,,,17.2,14.62,4.92952,17.2,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
DRESSING MEPILEX BORDER DRSG 4X4,,A6213,HCPCS,Facility,Both,,,,17.2,14.62,4.92952,17.2,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,15.23404,88.57,,percent of total billed charges,,
DRESSING MEPILEX BORDER DRSG 4X4,,A6213,HCPCS,Facility,Both,,,,17.2,14.62,4.92952,17.2,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,4.92952,28.66,,percent of total billed charges,,
DRESSING MEPILEX BORDER DRSG 4X4,,A6213,HCPCS,Facility,Outpatient,,,,17.2,14.62,4.92952,17.2,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),8.428,49,,percent of total billed charges,,
DRESSING MEPILEX BORDER DRSG 4X4,,A6213,HCPCS,Facility,Inpatient,,,,17.2,14.62,4.92952,17.2,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
DRESSING MEPILEX BORDER DRSG 4X4,,A6213,HCPCS,Facility,Both,,,,17.2,14.62,4.92952,17.2,CorVel,Worker's Compensation,17.2,100,,percent of total billed charges,,
DRESSING MEPILEX BORDER DRSG 4X4,,A6213,HCPCS,Facility,Both,,,,17.2,14.62,4.92952,17.2,First Health Group Corporation,First Health Network,16.684,97,,percent of total billed charges,,
DRESSING MEPILEX BORDER DRSG 4X4,,A6213,HCPCS,Facility,Both,,,,17.2,14.62,4.92952,17.2,"Health Partners, Inc.",Commercial,16.2712,94.6,,percent of total billed charges,,
DRESSING MEPILEX BORDER DRSG 4X4,,A6213,HCPCS,Facility,Outpatient,,,,17.2,14.62,4.92952,17.2,"Health Partners, Inc.",Medicare Advantage,8.428,49,,percent of total billed charges,,
DRESSING MEPILEX BORDER DRSG 4X4,,A6213,HCPCS,Facility,Inpatient,,,,17.2,14.62,4.92952,17.2,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DRESSING MEPILEX BORDER DRSG 4X4,,A6213,HCPCS,Facility,Both,,,,17.2,14.62,4.92952,17.2,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),10.32,60,,percent of total billed charges,,
DRESSING MEPILEX BORDER DRSG 4X4,,A6213,HCPCS,Facility,Both,,,,17.2,14.62,4.92952,17.2,"Health Partners, Inc.",State of Minnesota Advantage Program,14.018,81.5,,percent of total billed charges,,
DRESSING MEPILEX BORDER DRSG 4X4,,A6213,HCPCS,Facility,Both,,,,17.2,14.62,4.92952,17.2,"Health Partners, Inc.",State Public Programs,8.6,50,,percent of total billed charges,,
DRESSING MEPILEX BORDER DRSG 4X4,,A6213,HCPCS,Facility,Both,,,,17.2,14.62,4.92952,17.2,Humana Insurance Company,Commercial PPO,16.34,95,,percent of total billed charges,,
DRESSING MEPILEX BORDER DRSG 4X4,,A6213,HCPCS,Facility,Outpatient,,,,17.2,14.62,4.92952,17.2,Humana Insurance Company,Medicare PPO,8.428,49,,percent of total billed charges,,
DRESSING MEPILEX BORDER DRSG 4X4,,A6213,HCPCS,Facility,Inpatient,,,,17.2,14.62,4.92952,17.2,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
DRESSING MEPILEX BORDER DRSG 4X4,,A6213,HCPCS,Facility,Both,,,,17.2,14.62,4.92952,17.2,Medica,Individual & Family,17.0452,99.1,,percent of total billed charges,,
DRESSING MEPILEX BORDER DRSG 4X4,,A6213,HCPCS,Facility,Outpatient,,,,17.2,14.62,4.92952,17.2,Medica,Medica Advantage Solution,8.5656,49.8,,percent of total billed charges,,
DRESSING MEPILEX BORDER DRSG 4X4,,A6213,HCPCS,Facility,Inpatient,,,,17.2,14.62,4.92952,17.2,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
DRESSING MEPILEX BORDER DRSG 4X4,,A6213,HCPCS,Facility,Outpatient,,,,17.2,14.62,4.92952,17.2,Medica,Medical Assistance,7.6712,44.6,,percent of total billed charges,,
DRESSING MEPILEX BORDER DRSG 4X4,,A6213,HCPCS,Facility,Inpatient,,,,17.2,14.62,4.92952,17.2,Medica,Medical Assistance,,,,,Included in per diem rate,
DRESSING MEPILEX BORDER DRSG 4X4,,A6213,HCPCS,Facility,Outpatient,,,,17.2,14.62,4.92952,17.2,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,8.5656,49.8,,percent of total billed charges,,
DRESSING MEPILEX BORDER DRSG 4X4,,A6213,HCPCS,Facility,Inpatient,,,,17.2,14.62,4.92952,17.2,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
DRESSING MEPILEX BORDER DRSG 4X4,,A6213,HCPCS,Facility,Both,,,,17.2,14.62,4.92952,17.2,"Multiplan, Inc.","Multiplan, Inc.",16.168,94,,percent of total billed charges,,
DRESSING MEPILEX BORDER DRSG 4X4,,A6213,HCPCS,Facility,Outpatient,,,,17.2,14.62,4.92952,17.2,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,15.4972,90.1,,percent of total billed charges,,
DRESSING MEPILEX BORDER DRSG 4X4,,A6213,HCPCS,Facility,Inpatient,,,,17.2,14.62,4.92952,17.2,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
DRESSING MEPILEX BORDER DRSG 4X4,,A6213,HCPCS,Facility,Both,,,,17.2,14.62,4.92952,17.2,"Preferred One Administrative Services, INC.",PPO,16.9592,98.6,,percent of total billed charges,,
DRESSING MEPILEX BORDER DRSG 4X4,,A6213,HCPCS,Facility,Outpatient,,,,17.2,14.62,4.92952,17.2,PrimeWest Health,Minnesota Senior Health Options (MSHO),8.8494,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
DRESSING MEPILEX BORDER DRSG 4X4,,A6213,HCPCS,Facility,Inpatient,,,,17.2,14.62,4.92952,17.2,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DRESSING MEPILEX BORDER DRSG 4X4,,A6213,HCPCS,Facility,Outpatient,,,,17.2,14.62,4.92952,17.2,PrimeWest Health,MinnesotaCare,8.83392,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
DRESSING MEPILEX BORDER DRSG 4X4,,A6213,HCPCS,Facility,Inpatient,,,,17.2,14.62,4.92952,17.2,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
DRESSING MEPILEX BORDER DRSG 4X4,,A6213,HCPCS,Facility,Both,,,,17.2,14.62,4.92952,17.2,Sanford Health Plan,Sanford Health Plan,15.824,92,,percent of total billed charges,,
DRESSING MEPILEX BORDER DRSG 4X4,,A6213,HCPCS,Facility,Outpatient,,,,17.2,14.62,4.92952,17.2,"UCare Health, Inc.",Individual & Family Plan,9.6922,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
DRESSING MEPILEX BORDER DRSG 4X4,,A6213,HCPCS,Facility,Inpatient,,,,17.2,14.62,4.92952,17.2,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
DRESSING MEPILEX BORDER DRSG 4X4,,A6213,HCPCS,Facility,Outpatient,,,,17.2,14.62,4.92952,17.2,"UCare Health, Inc.",Medical Assistance,8.68084,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DRESSING MEPILEX BORDER DRSG 4X4,,A6213,HCPCS,Facility,Inpatient,,,,17.2,14.62,4.92952,17.2,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
DRESSING MEPILEX BORDER DRSG 4X4,,A6213,HCPCS,Facility,Outpatient,,,,17.2,14.62,4.92952,17.2,"UCare Health, Inc.",Medicare Advantage,8.68084,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DRESSING MEPILEX BORDER DRSG 4X4,,A6213,HCPCS,Facility,Inpatient,,,,17.2,14.62,4.92952,17.2,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DRESSING MEPILEX BORDER DRSG 4X4,,A6213,HCPCS,Facility,Outpatient,,,,17.2,14.62,4.92952,17.2,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),8.68084,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DRESSING MEPILEX BORDER DRSG 4X4,,A6213,HCPCS,Facility,Inpatient,,,,17.2,14.62,4.92952,17.2,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DRESSING MEPILEX BORDER DRSG 4X4,,A6213,HCPCS,Facility,Both,,,,17.2,14.62,4.92952,17.2,UnitedHealthcare,Individual & Family,16.168,94,,percent of total billed charges,,
DRESSING MEPILEX BORDER DRSG 4X4,,A6213,HCPCS,Facility,Outpatient,,,,17.2,14.62,4.92952,17.2,UnitedHealthcare,Medicare Advantage,8.428,49,,percent of total billed charges,,
DRESSING MEPILEX BORDER DRSG 4X4,,A6213,HCPCS,Facility,Inpatient,,,,17.2,14.62,4.92952,17.2,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
DRESSING MEPILEX BORDER DRSG 4X4,,A6213,HCPCS,Facility,Outpatient,,,,17.2,14.62,4.92952,17.2,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,8.256,48,,percent of total billed charges,,100% of DHS outpatient percentage
DRESSING MEPILEX BORDER DRSG 4X4,,A6213,HCPCS,Facility,Inpatient,,,,17.2,14.62,4.92952,17.2,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Sup Dressing Allevyn Sacro,,A6213,HCPCS,Facility,Both,,,,29,24.65,8.3114,29,Aetna,Commercial,26.68,92,,percent of total billed charges,,
Sup Dressing Allevyn Sacro,,A6213,HCPCS,Facility,Outpatient,,,,29,24.65,8.3114,29,Aetna,Medicare Advantage,14.21,49,,percent of total billed charges,,
Sup Dressing Allevyn Sacro,,A6213,HCPCS,Facility,Inpatient,,,,29,24.65,8.3114,29,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Sup Dressing Allevyn Sacro,,A6213,HCPCS,Facility,Both,,,,29,24.65,8.3114,29,Aetna,PPO,26.97,93,,percent of total billed charges,,
Sup Dressing Allevyn Sacro,,A6213,HCPCS,Facility,Both,,,,29,24.65,8.3114,29,America's PPO,America's PPO,27.8487,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Sup Dressing Allevyn Sacro,,A6213,HCPCS,Facility,Both,,,,29,24.65,8.3114,29,BlueCross BlueShield Minnesota, Federal Employee Program,28.536,98.4,,percent of total billed charges,,
Sup Dressing Allevyn Sacro,,A6213,HCPCS,Facility,Both,,,,29,24.65,8.3114,29,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,29,100,,percent of total billed charges,,
Sup Dressing Allevyn Sacro,,A6213,HCPCS,Facility,Both,,,,29,24.65,8.3114,29,BlueCross BlueShield Minnesota,High Value Network Plan,26.1,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
Sup Dressing Allevyn Sacro,,A6213,HCPCS,Facility,Outpatient,,,,29,24.65,8.3114,29,BlueCross BlueShield Minnesota,Medicare Advantage,14.21,49,,percent of total billed charges,,
Sup Dressing Allevyn Sacro,,A6213,HCPCS,Facility,Inpatient,,,,29,24.65,8.3114,29,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Sup Dressing Allevyn Sacro,,A6213,HCPCS,Facility,Both,,,,29,24.65,8.3114,29,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,25.6853,88.57,,percent of total billed charges,,
Sup Dressing Allevyn Sacro,,A6213,HCPCS,Facility,Both,,,,29,24.65,8.3114,29,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,8.3114,28.66,,percent of total billed charges,,
Sup Dressing Allevyn Sacro,,A6213,HCPCS,Facility,Outpatient,,,,29,24.65,8.3114,29,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),14.21,49,,percent of total billed charges,,
Sup Dressing Allevyn Sacro,,A6213,HCPCS,Facility,Inpatient,,,,29,24.65,8.3114,29,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Sup Dressing Allevyn Sacro,,A6213,HCPCS,Facility,Both,,,,29,24.65,8.3114,29,CorVel,Worker's Compensation,29,100,,percent of total billed charges,,
Sup Dressing Allevyn Sacro,,A6213,HCPCS,Facility,Both,,,,29,24.65,8.3114,29,First Health Group Corporation,First Health Network,28.13,97,,percent of total billed charges,,
Sup Dressing Allevyn Sacro,,A6213,HCPCS,Facility,Both,,,,29,24.65,8.3114,29,"Health Partners, Inc.",Commercial,27.434,94.6,,percent of total billed charges,,
Sup Dressing Allevyn Sacro,,A6213,HCPCS,Facility,Outpatient,,,,29,24.65,8.3114,29,"Health Partners, Inc.",Medicare Advantage,14.21,49,,percent of total billed charges,,
Sup Dressing Allevyn Sacro,,A6213,HCPCS,Facility,Inpatient,,,,29,24.65,8.3114,29,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Dressing Allevyn Sacro,,A6213,HCPCS,Facility,Both,,,,29,24.65,8.3114,29,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),17.4,60,,percent of total billed charges,,
Sup Dressing Allevyn Sacro,,A6213,HCPCS,Facility,Both,,,,29,24.65,8.3114,29,"Health Partners, Inc.",State of Minnesota Advantage Program,23.635,81.5,,percent of total billed charges,,
Sup Dressing Allevyn Sacro,,A6213,HCPCS,Facility,Both,,,,29,24.65,8.3114,29,"Health Partners, Inc.",State Public Programs,14.5,50,,percent of total billed charges,,
Sup Dressing Allevyn Sacro,,A6213,HCPCS,Facility,Both,,,,29,24.65,8.3114,29,Humana Insurance Company,Commercial PPO,27.55,95,,percent of total billed charges,,
Sup Dressing Allevyn Sacro,,A6213,HCPCS,Facility,Outpatient,,,,29,24.65,8.3114,29,Humana Insurance Company,Medicare PPO,14.21,49,,percent of total billed charges,,
Sup Dressing Allevyn Sacro,,A6213,HCPCS,Facility,Inpatient,,,,29,24.65,8.3114,29,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Sup Dressing Allevyn Sacro,,A6213,HCPCS,Facility,Both,,,,29,24.65,8.3114,29,Medica,Individual & Family,28.739,99.1,,percent of total billed charges,,
Sup Dressing Allevyn Sacro,,A6213,HCPCS,Facility,Outpatient,,,,29,24.65,8.3114,29,Medica,Medica Advantage Solution,14.442,49.8,,percent of total billed charges,,
Sup Dressing Allevyn Sacro,,A6213,HCPCS,Facility,Inpatient,,,,29,24.65,8.3114,29,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Sup Dressing Allevyn Sacro,,A6213,HCPCS,Facility,Outpatient,,,,29,24.65,8.3114,29,Medica,Medical Assistance,12.934,44.6,,percent of total billed charges,,
Sup Dressing Allevyn Sacro,,A6213,HCPCS,Facility,Inpatient,,,,29,24.65,8.3114,29,Medica,Medical Assistance,,,,,Included in per diem rate,
Sup Dressing Allevyn Sacro,,A6213,HCPCS,Facility,Outpatient,,,,29,24.65,8.3114,29,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,14.442,49.8,,percent of total billed charges,,
Sup Dressing Allevyn Sacro,,A6213,HCPCS,Facility,Inpatient,,,,29,24.65,8.3114,29,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Sup Dressing Allevyn Sacro,,A6213,HCPCS,Facility,Both,,,,29,24.65,8.3114,29,"Multiplan, Inc.","Multiplan, Inc.",27.26,94,,percent of total billed charges,,
Sup Dressing Allevyn Sacro,,A6213,HCPCS,Facility,Outpatient,,,,29,24.65,8.3114,29,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,26.129,90.1,,percent of total billed charges,,
Sup Dressing Allevyn Sacro,,A6213,HCPCS,Facility,Inpatient,,,,29,24.65,8.3114,29,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Sup Dressing Allevyn Sacro,,A6213,HCPCS,Facility,Both,,,,29,24.65,8.3114,29,"Preferred One Administrative Services, INC.",PPO,28.594,98.6,,percent of total billed charges,,
Sup Dressing Allevyn Sacro,,A6213,HCPCS,Facility,Outpatient,,,,29,24.65,8.3114,29,PrimeWest Health,Minnesota Senior Health Options (MSHO),14.9205,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Sup Dressing Allevyn Sacro,,A6213,HCPCS,Facility,Inpatient,,,,29,24.65,8.3114,29,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Dressing Allevyn Sacro,,A6213,HCPCS,Facility,Outpatient,,,,29,24.65,8.3114,29,PrimeWest Health,MinnesotaCare,14.8944,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Sup Dressing Allevyn Sacro,,A6213,HCPCS,Facility,Inpatient,,,,29,24.65,8.3114,29,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Sup Dressing Allevyn Sacro,,A6213,HCPCS,Facility,Both,,,,29,24.65,8.3114,29,Sanford Health Plan,Sanford Health Plan,26.68,92,,percent of total billed charges,,
Sup Dressing Allevyn Sacro,,A6213,HCPCS,Facility,Outpatient,,,,29,24.65,8.3114,29,"UCare Health, Inc.",Individual & Family Plan,16.3415,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Sup Dressing Allevyn Sacro,,A6213,HCPCS,Facility,Inpatient,,,,29,24.65,8.3114,29,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Sup Dressing Allevyn Sacro,,A6213,HCPCS,Facility,Outpatient,,,,29,24.65,8.3114,29,"UCare Health, Inc.",Medical Assistance,14.6363,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Dressing Allevyn Sacro,,A6213,HCPCS,Facility,Inpatient,,,,29,24.65,8.3114,29,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Sup Dressing Allevyn Sacro,,A6213,HCPCS,Facility,Outpatient,,,,29,24.65,8.3114,29,"UCare Health, Inc.",Medicare Advantage,14.6363,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Dressing Allevyn Sacro,,A6213,HCPCS,Facility,Inpatient,,,,29,24.65,8.3114,29,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Dressing Allevyn Sacro,,A6213,HCPCS,Facility,Outpatient,,,,29,24.65,8.3114,29,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),14.6363,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Dressing Allevyn Sacro,,A6213,HCPCS,Facility,Inpatient,,,,29,24.65,8.3114,29,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Dressing Allevyn Sacro,,A6213,HCPCS,Facility,Both,,,,29,24.65,8.3114,29,UnitedHealthcare,Individual & Family,27.26,94,,percent of total billed charges,,
Sup Dressing Allevyn Sacro,,A6213,HCPCS,Facility,Outpatient,,,,29,24.65,8.3114,29,UnitedHealthcare,Medicare Advantage,14.21,49,,percent of total billed charges,,
Sup Dressing Allevyn Sacro,,A6213,HCPCS,Facility,Inpatient,,,,29,24.65,8.3114,29,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Sup Dressing Allevyn Sacro,,A6213,HCPCS,Facility,Outpatient,,,,29,24.65,8.3114,29,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,13.92,48,,percent of total billed charges,,100% of DHS outpatient percentage
Sup Dressing Allevyn Sacro,,A6213,HCPCS,Facility,Inpatient,,,,29,24.65,8.3114,29,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Sup Foam Dressing Sterile W Adhesive Border 4 Inch X 10 Inches,,A6213,HCPCS,Facility,Both,,,,153,130.05,43.8498,153,Aetna,Commercial,140.76,92,,percent of total billed charges,,
Sup Foam Dressing Sterile W Adhesive Border 4 Inch X 10 Inches,,A6213,HCPCS,Facility,Outpatient,,,,153,130.05,43.8498,153,Aetna,Medicare Advantage,74.97,49,,percent of total billed charges,,
Sup Foam Dressing Sterile W Adhesive Border 4 Inch X 10 Inches,,A6213,HCPCS,Facility,Inpatient,,,,153,130.05,43.8498,153,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Sup Foam Dressing Sterile W Adhesive Border 4 Inch X 10 Inches,,A6213,HCPCS,Facility,Both,,,,153,130.05,43.8498,153,Aetna,PPO,142.29,93,,percent of total billed charges,,
Sup Foam Dressing Sterile W Adhesive Border 4 Inch X 10 Inches,,A6213,HCPCS,Facility,Both,,,,153,130.05,43.8498,153,America's PPO,America's PPO,146.9259,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Sup Foam Dressing Sterile W Adhesive Border 4 Inch X 10 Inches,,A6213,HCPCS,Facility,Both,,,,153,130.05,43.8498,153,BlueCross BlueShield Minnesota, Federal Employee Program,150.552,98.4,,percent of total billed charges,,
Sup Foam Dressing Sterile W Adhesive Border 4 Inch X 10 Inches,,A6213,HCPCS,Facility,Both,,,,153,130.05,43.8498,153,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,153,100,,percent of total billed charges,,
Sup Foam Dressing Sterile W Adhesive Border 4 Inch X 10 Inches,,A6213,HCPCS,Facility,Both,,,,153,130.05,43.8498,153,BlueCross BlueShield Minnesota,High Value Network Plan,137.7,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
Sup Foam Dressing Sterile W Adhesive Border 4 Inch X 10 Inches,,A6213,HCPCS,Facility,Outpatient,,,,153,130.05,43.8498,153,BlueCross BlueShield Minnesota,Medicare Advantage,74.97,49,,percent of total billed charges,,
Sup Foam Dressing Sterile W Adhesive Border 4 Inch X 10 Inches,,A6213,HCPCS,Facility,Inpatient,,,,153,130.05,43.8498,153,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Sup Foam Dressing Sterile W Adhesive Border 4 Inch X 10 Inches,,A6213,HCPCS,Facility,Both,,,,153,130.05,43.8498,153,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,135.5121,88.57,,percent of total billed charges,,
Sup Foam Dressing Sterile W Adhesive Border 4 Inch X 10 Inches,,A6213,HCPCS,Facility,Both,,,,153,130.05,43.8498,153,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,43.8498,28.66,,percent of total billed charges,,
Sup Foam Dressing Sterile W Adhesive Border 4 Inch X 10 Inches,,A6213,HCPCS,Facility,Outpatient,,,,153,130.05,43.8498,153,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),74.97,49,,percent of total billed charges,,
Sup Foam Dressing Sterile W Adhesive Border 4 Inch X 10 Inches,,A6213,HCPCS,Facility,Inpatient,,,,153,130.05,43.8498,153,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Sup Foam Dressing Sterile W Adhesive Border 4 Inch X 10 Inches,,A6213,HCPCS,Facility,Both,,,,153,130.05,43.8498,153,CorVel,Worker's Compensation,153,100,,percent of total billed charges,,
Sup Foam Dressing Sterile W Adhesive Border 4 Inch X 10 Inches,,A6213,HCPCS,Facility,Both,,,,153,130.05,43.8498,153,First Health Group Corporation,First Health Network,148.41,97,,percent of total billed charges,,
Sup Foam Dressing Sterile W Adhesive Border 4 Inch X 10 Inches,,A6213,HCPCS,Facility,Both,,,,153,130.05,43.8498,153,"Health Partners, Inc.",Commercial,144.738,94.6,,percent of total billed charges,,
Sup Foam Dressing Sterile W Adhesive Border 4 Inch X 10 Inches,,A6213,HCPCS,Facility,Outpatient,,,,153,130.05,43.8498,153,"Health Partners, Inc.",Medicare Advantage,74.97,49,,percent of total billed charges,,
Sup Foam Dressing Sterile W Adhesive Border 4 Inch X 10 Inches,,A6213,HCPCS,Facility,Inpatient,,,,153,130.05,43.8498,153,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Foam Dressing Sterile W Adhesive Border 4 Inch X 10 Inches,,A6213,HCPCS,Facility,Both,,,,153,130.05,43.8498,153,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),91.8,60,,percent of total billed charges,,
Sup Foam Dressing Sterile W Adhesive Border 4 Inch X 10 Inches,,A6213,HCPCS,Facility,Both,,,,153,130.05,43.8498,153,"Health Partners, Inc.",State of Minnesota Advantage Program,124.695,81.5,,percent of total billed charges,,
Sup Foam Dressing Sterile W Adhesive Border 4 Inch X 10 Inches,,A6213,HCPCS,Facility,Both,,,,153,130.05,43.8498,153,"Health Partners, Inc.",State Public Programs,76.5,50,,percent of total billed charges,,
Sup Foam Dressing Sterile W Adhesive Border 4 Inch X 10 Inches,,A6213,HCPCS,Facility,Both,,,,153,130.05,43.8498,153,Humana Insurance Company,Commercial PPO,145.35,95,,percent of total billed charges,,
Sup Foam Dressing Sterile W Adhesive Border 4 Inch X 10 Inches,,A6213,HCPCS,Facility,Outpatient,,,,153,130.05,43.8498,153,Humana Insurance Company,Medicare PPO,74.97,49,,percent of total billed charges,,
Sup Foam Dressing Sterile W Adhesive Border 4 Inch X 10 Inches,,A6213,HCPCS,Facility,Inpatient,,,,153,130.05,43.8498,153,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Sup Foam Dressing Sterile W Adhesive Border 4 Inch X 10 Inches,,A6213,HCPCS,Facility,Both,,,,153,130.05,43.8498,153,Medica,Individual & Family,151.623,99.1,,percent of total billed charges,,
Sup Foam Dressing Sterile W Adhesive Border 4 Inch X 10 Inches,,A6213,HCPCS,Facility,Outpatient,,,,153,130.05,43.8498,153,Medica,Medica Advantage Solution,76.194,49.8,,percent of total billed charges,,
Sup Foam Dressing Sterile W Adhesive Border 4 Inch X 10 Inches,,A6213,HCPCS,Facility,Inpatient,,,,153,130.05,43.8498,153,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Sup Foam Dressing Sterile W Adhesive Border 4 Inch X 10 Inches,,A6213,HCPCS,Facility,Outpatient,,,,153,130.05,43.8498,153,Medica,Medical Assistance,68.238,44.6,,percent of total billed charges,,
Sup Foam Dressing Sterile W Adhesive Border 4 Inch X 10 Inches,,A6213,HCPCS,Facility,Inpatient,,,,153,130.05,43.8498,153,Medica,Medical Assistance,,,,,Included in per diem rate,
Sup Foam Dressing Sterile W Adhesive Border 4 Inch X 10 Inches,,A6213,HCPCS,Facility,Outpatient,,,,153,130.05,43.8498,153,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,76.194,49.8,,percent of total billed charges,,
Sup Foam Dressing Sterile W Adhesive Border 4 Inch X 10 Inches,,A6213,HCPCS,Facility,Inpatient,,,,153,130.05,43.8498,153,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Sup Foam Dressing Sterile W Adhesive Border 4 Inch X 10 Inches,,A6213,HCPCS,Facility,Both,,,,153,130.05,43.8498,153,"Multiplan, Inc.","Multiplan, Inc.",143.82,94,,percent of total billed charges,,
Sup Foam Dressing Sterile W Adhesive Border 4 Inch X 10 Inches,,A6213,HCPCS,Facility,Outpatient,,,,153,130.05,43.8498,153,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,137.853,90.1,,percent of total billed charges,,
Sup Foam Dressing Sterile W Adhesive Border 4 Inch X 10 Inches,,A6213,HCPCS,Facility,Inpatient,,,,153,130.05,43.8498,153,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Sup Foam Dressing Sterile W Adhesive Border 4 Inch X 10 Inches,,A6213,HCPCS,Facility,Both,,,,153,130.05,43.8498,153,"Preferred One Administrative Services, INC.",PPO,150.858,98.6,,percent of total billed charges,,
Sup Foam Dressing Sterile W Adhesive Border 4 Inch X 10 Inches,,A6213,HCPCS,Facility,Outpatient,,,,153,130.05,43.8498,153,PrimeWest Health,Minnesota Senior Health Options (MSHO),78.7185,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Sup Foam Dressing Sterile W Adhesive Border 4 Inch X 10 Inches,,A6213,HCPCS,Facility,Inpatient,,,,153,130.05,43.8498,153,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Foam Dressing Sterile W Adhesive Border 4 Inch X 10 Inches,,A6213,HCPCS,Facility,Outpatient,,,,153,130.05,43.8498,153,PrimeWest Health,MinnesotaCare,78.5808,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Sup Foam Dressing Sterile W Adhesive Border 4 Inch X 10 Inches,,A6213,HCPCS,Facility,Inpatient,,,,153,130.05,43.8498,153,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Sup Foam Dressing Sterile W Adhesive Border 4 Inch X 10 Inches,,A6213,HCPCS,Facility,Both,,,,153,130.05,43.8498,153,Sanford Health Plan,Sanford Health Plan,140.76,92,,percent of total billed charges,,
Sup Foam Dressing Sterile W Adhesive Border 4 Inch X 10 Inches,,A6213,HCPCS,Facility,Outpatient,,,,153,130.05,43.8498,153,"UCare Health, Inc.",Individual & Family Plan,86.2155,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Sup Foam Dressing Sterile W Adhesive Border 4 Inch X 10 Inches,,A6213,HCPCS,Facility,Inpatient,,,,153,130.05,43.8498,153,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Sup Foam Dressing Sterile W Adhesive Border 4 Inch X 10 Inches,,A6213,HCPCS,Facility,Outpatient,,,,153,130.05,43.8498,153,"UCare Health, Inc.",Medical Assistance,77.2191,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Foam Dressing Sterile W Adhesive Border 4 Inch X 10 Inches,,A6213,HCPCS,Facility,Inpatient,,,,153,130.05,43.8498,153,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Sup Foam Dressing Sterile W Adhesive Border 4 Inch X 10 Inches,,A6213,HCPCS,Facility,Outpatient,,,,153,130.05,43.8498,153,"UCare Health, Inc.",Medicare Advantage,77.2191,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Foam Dressing Sterile W Adhesive Border 4 Inch X 10 Inches,,A6213,HCPCS,Facility,Inpatient,,,,153,130.05,43.8498,153,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Foam Dressing Sterile W Adhesive Border 4 Inch X 10 Inches,,A6213,HCPCS,Facility,Outpatient,,,,153,130.05,43.8498,153,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),77.2191,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Foam Dressing Sterile W Adhesive Border 4 Inch X 10 Inches,,A6213,HCPCS,Facility,Inpatient,,,,153,130.05,43.8498,153,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Foam Dressing Sterile W Adhesive Border 4 Inch X 10 Inches,,A6213,HCPCS,Facility,Both,,,,153,130.05,43.8498,153,UnitedHealthcare,Individual & Family,143.82,94,,percent of total billed charges,,
Sup Foam Dressing Sterile W Adhesive Border 4 Inch X 10 Inches,,A6213,HCPCS,Facility,Outpatient,,,,153,130.05,43.8498,153,UnitedHealthcare,Medicare Advantage,74.97,49,,percent of total billed charges,,
Sup Foam Dressing Sterile W Adhesive Border 4 Inch X 10 Inches,,A6213,HCPCS,Facility,Inpatient,,,,153,130.05,43.8498,153,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Sup Foam Dressing Sterile W Adhesive Border 4 Inch X 10 Inches,,A6213,HCPCS,Facility,Outpatient,,,,153,130.05,43.8498,153,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,73.44,48,,percent of total billed charges,,100% of DHS outpatient percentage
Sup Foam Dressing Sterile W Adhesive Border 4 Inch X 10 Inches,,A6213,HCPCS,Facility,Inpatient,,,,153,130.05,43.8498,153,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Sup Foam Dressing Sterile W Adhesive Border 4 Inch X 12 Inches,,A6213,HCPCS,Facility,Both,,,,184,156.4,52.7344,184,Aetna,Commercial,169.28,92,,percent of total billed charges,,
Sup Foam Dressing Sterile W Adhesive Border 4 Inch X 12 Inches,,A6213,HCPCS,Facility,Outpatient,,,,184,156.4,52.7344,184,Aetna,Medicare Advantage,90.16,49,,percent of total billed charges,,
Sup Foam Dressing Sterile W Adhesive Border 4 Inch X 12 Inches,,A6213,HCPCS,Facility,Inpatient,,,,184,156.4,52.7344,184,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Sup Foam Dressing Sterile W Adhesive Border 4 Inch X 12 Inches,,A6213,HCPCS,Facility,Both,,,,184,156.4,52.7344,184,Aetna,PPO,171.12,93,,percent of total billed charges,,
Sup Foam Dressing Sterile W Adhesive Border 4 Inch X 12 Inches,,A6213,HCPCS,Facility,Both,,,,184,156.4,52.7344,184,America's PPO,America's PPO,176.6952,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Sup Foam Dressing Sterile W Adhesive Border 4 Inch X 12 Inches,,A6213,HCPCS,Facility,Both,,,,184,156.4,52.7344,184,BlueCross BlueShield Minnesota, Federal Employee Program,181.056,98.4,,percent of total billed charges,,
Sup Foam Dressing Sterile W Adhesive Border 4 Inch X 12 Inches,,A6213,HCPCS,Facility,Both,,,,184,156.4,52.7344,184,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,184,100,,percent of total billed charges,,
Sup Foam Dressing Sterile W Adhesive Border 4 Inch X 12 Inches,,A6213,HCPCS,Facility,Both,,,,184,156.4,52.7344,184,BlueCross BlueShield Minnesota,High Value Network Plan,165.6,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
Sup Foam Dressing Sterile W Adhesive Border 4 Inch X 12 Inches,,A6213,HCPCS,Facility,Outpatient,,,,184,156.4,52.7344,184,BlueCross BlueShield Minnesota,Medicare Advantage,90.16,49,,percent of total billed charges,,
Sup Foam Dressing Sterile W Adhesive Border 4 Inch X 12 Inches,,A6213,HCPCS,Facility,Inpatient,,,,184,156.4,52.7344,184,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Sup Foam Dressing Sterile W Adhesive Border 4 Inch X 12 Inches,,A6213,HCPCS,Facility,Both,,,,184,156.4,52.7344,184,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,162.9688,88.57,,percent of total billed charges,,
Sup Foam Dressing Sterile W Adhesive Border 4 Inch X 12 Inches,,A6213,HCPCS,Facility,Both,,,,184,156.4,52.7344,184,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,52.7344,28.66,,percent of total billed charges,,
Sup Foam Dressing Sterile W Adhesive Border 4 Inch X 12 Inches,,A6213,HCPCS,Facility,Outpatient,,,,184,156.4,52.7344,184,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),90.16,49,,percent of total billed charges,,
Sup Foam Dressing Sterile W Adhesive Border 4 Inch X 12 Inches,,A6213,HCPCS,Facility,Inpatient,,,,184,156.4,52.7344,184,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Sup Foam Dressing Sterile W Adhesive Border 4 Inch X 12 Inches,,A6213,HCPCS,Facility,Both,,,,184,156.4,52.7344,184,CorVel,Worker's Compensation,184,100,,percent of total billed charges,,
Sup Foam Dressing Sterile W Adhesive Border 4 Inch X 12 Inches,,A6213,HCPCS,Facility,Both,,,,184,156.4,52.7344,184,First Health Group Corporation,First Health Network,178.48,97,,percent of total billed charges,,
Sup Foam Dressing Sterile W Adhesive Border 4 Inch X 12 Inches,,A6213,HCPCS,Facility,Both,,,,184,156.4,52.7344,184,"Health Partners, Inc.",Commercial,174.064,94.6,,percent of total billed charges,,
Sup Foam Dressing Sterile W Adhesive Border 4 Inch X 12 Inches,,A6213,HCPCS,Facility,Outpatient,,,,184,156.4,52.7344,184,"Health Partners, Inc.",Medicare Advantage,90.16,49,,percent of total billed charges,,
Sup Foam Dressing Sterile W Adhesive Border 4 Inch X 12 Inches,,A6213,HCPCS,Facility,Inpatient,,,,184,156.4,52.7344,184,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Foam Dressing Sterile W Adhesive Border 4 Inch X 12 Inches,,A6213,HCPCS,Facility,Both,,,,184,156.4,52.7344,184,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),110.4,60,,percent of total billed charges,,
Sup Foam Dressing Sterile W Adhesive Border 4 Inch X 12 Inches,,A6213,HCPCS,Facility,Both,,,,184,156.4,52.7344,184,"Health Partners, Inc.",State of Minnesota Advantage Program,149.96,81.5,,percent of total billed charges,,
Sup Foam Dressing Sterile W Adhesive Border 4 Inch X 12 Inches,,A6213,HCPCS,Facility,Both,,,,184,156.4,52.7344,184,"Health Partners, Inc.",State Public Programs,92,50,,percent of total billed charges,,
Sup Foam Dressing Sterile W Adhesive Border 4 Inch X 12 Inches,,A6213,HCPCS,Facility,Both,,,,184,156.4,52.7344,184,Humana Insurance Company,Commercial PPO,174.8,95,,percent of total billed charges,,
Sup Foam Dressing Sterile W Adhesive Border 4 Inch X 12 Inches,,A6213,HCPCS,Facility,Outpatient,,,,184,156.4,52.7344,184,Humana Insurance Company,Medicare PPO,90.16,49,,percent of total billed charges,,
Sup Foam Dressing Sterile W Adhesive Border 4 Inch X 12 Inches,,A6213,HCPCS,Facility,Inpatient,,,,184,156.4,52.7344,184,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Sup Foam Dressing Sterile W Adhesive Border 4 Inch X 12 Inches,,A6213,HCPCS,Facility,Both,,,,184,156.4,52.7344,184,Medica,Individual & Family,182.344,99.1,,percent of total billed charges,,
Sup Foam Dressing Sterile W Adhesive Border 4 Inch X 12 Inches,,A6213,HCPCS,Facility,Outpatient,,,,184,156.4,52.7344,184,Medica,Medica Advantage Solution,91.632,49.8,,percent of total billed charges,,
Sup Foam Dressing Sterile W Adhesive Border 4 Inch X 12 Inches,,A6213,HCPCS,Facility,Inpatient,,,,184,156.4,52.7344,184,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Sup Foam Dressing Sterile W Adhesive Border 4 Inch X 12 Inches,,A6213,HCPCS,Facility,Outpatient,,,,184,156.4,52.7344,184,Medica,Medical Assistance,82.064,44.6,,percent of total billed charges,,
Sup Foam Dressing Sterile W Adhesive Border 4 Inch X 12 Inches,,A6213,HCPCS,Facility,Inpatient,,,,184,156.4,52.7344,184,Medica,Medical Assistance,,,,,Included in per diem rate,
Sup Foam Dressing Sterile W Adhesive Border 4 Inch X 12 Inches,,A6213,HCPCS,Facility,Outpatient,,,,184,156.4,52.7344,184,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,91.632,49.8,,percent of total billed charges,,
Sup Foam Dressing Sterile W Adhesive Border 4 Inch X 12 Inches,,A6213,HCPCS,Facility,Inpatient,,,,184,156.4,52.7344,184,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Sup Foam Dressing Sterile W Adhesive Border 4 Inch X 12 Inches,,A6213,HCPCS,Facility,Both,,,,184,156.4,52.7344,184,"Multiplan, Inc.","Multiplan, Inc.",172.96,94,,percent of total billed charges,,
Sup Foam Dressing Sterile W Adhesive Border 4 Inch X 12 Inches,,A6213,HCPCS,Facility,Outpatient,,,,184,156.4,52.7344,184,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,165.784,90.1,,percent of total billed charges,,
Sup Foam Dressing Sterile W Adhesive Border 4 Inch X 12 Inches,,A6213,HCPCS,Facility,Inpatient,,,,184,156.4,52.7344,184,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Sup Foam Dressing Sterile W Adhesive Border 4 Inch X 12 Inches,,A6213,HCPCS,Facility,Both,,,,184,156.4,52.7344,184,"Preferred One Administrative Services, INC.",PPO,181.424,98.6,,percent of total billed charges,,
Sup Foam Dressing Sterile W Adhesive Border 4 Inch X 12 Inches,,A6213,HCPCS,Facility,Outpatient,,,,184,156.4,52.7344,184,PrimeWest Health,Minnesota Senior Health Options (MSHO),94.668,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Sup Foam Dressing Sterile W Adhesive Border 4 Inch X 12 Inches,,A6213,HCPCS,Facility,Inpatient,,,,184,156.4,52.7344,184,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Foam Dressing Sterile W Adhesive Border 4 Inch X 12 Inches,,A6213,HCPCS,Facility,Outpatient,,,,184,156.4,52.7344,184,PrimeWest Health,MinnesotaCare,94.5024,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Sup Foam Dressing Sterile W Adhesive Border 4 Inch X 12 Inches,,A6213,HCPCS,Facility,Inpatient,,,,184,156.4,52.7344,184,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Sup Foam Dressing Sterile W Adhesive Border 4 Inch X 12 Inches,,A6213,HCPCS,Facility,Both,,,,184,156.4,52.7344,184,Sanford Health Plan,Sanford Health Plan,169.28,92,,percent of total billed charges,,
Sup Foam Dressing Sterile W Adhesive Border 4 Inch X 12 Inches,,A6213,HCPCS,Facility,Outpatient,,,,184,156.4,52.7344,184,"UCare Health, Inc.",Individual & Family Plan,103.684,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Sup Foam Dressing Sterile W Adhesive Border 4 Inch X 12 Inches,,A6213,HCPCS,Facility,Inpatient,,,,184,156.4,52.7344,184,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Sup Foam Dressing Sterile W Adhesive Border 4 Inch X 12 Inches,,A6213,HCPCS,Facility,Outpatient,,,,184,156.4,52.7344,184,"UCare Health, Inc.",Medical Assistance,92.8648,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Foam Dressing Sterile W Adhesive Border 4 Inch X 12 Inches,,A6213,HCPCS,Facility,Inpatient,,,,184,156.4,52.7344,184,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Sup Foam Dressing Sterile W Adhesive Border 4 Inch X 12 Inches,,A6213,HCPCS,Facility,Outpatient,,,,184,156.4,52.7344,184,"UCare Health, Inc.",Medicare Advantage,92.8648,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Foam Dressing Sterile W Adhesive Border 4 Inch X 12 Inches,,A6213,HCPCS,Facility,Inpatient,,,,184,156.4,52.7344,184,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Foam Dressing Sterile W Adhesive Border 4 Inch X 12 Inches,,A6213,HCPCS,Facility,Outpatient,,,,184,156.4,52.7344,184,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),92.8648,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Foam Dressing Sterile W Adhesive Border 4 Inch X 12 Inches,,A6213,HCPCS,Facility,Inpatient,,,,184,156.4,52.7344,184,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Foam Dressing Sterile W Adhesive Border 4 Inch X 12 Inches,,A6213,HCPCS,Facility,Both,,,,184,156.4,52.7344,184,UnitedHealthcare,Individual & Family,172.96,94,,percent of total billed charges,,
Sup Foam Dressing Sterile W Adhesive Border 4 Inch X 12 Inches,,A6213,HCPCS,Facility,Outpatient,,,,184,156.4,52.7344,184,UnitedHealthcare,Medicare Advantage,90.16,49,,percent of total billed charges,,
Sup Foam Dressing Sterile W Adhesive Border 4 Inch X 12 Inches,,A6213,HCPCS,Facility,Inpatient,,,,184,156.4,52.7344,184,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Sup Foam Dressing Sterile W Adhesive Border 4 Inch X 12 Inches,,A6213,HCPCS,Facility,Outpatient,,,,184,156.4,52.7344,184,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,88.32,48,,percent of total billed charges,,100% of DHS outpatient percentage
Sup Foam Dressing Sterile W Adhesive Border 4 Inch X 12 Inches,,A6213,HCPCS,Facility,Inpatient,,,,184,156.4,52.7344,184,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Sup Foam Dressing Sterile W Adhesive Border 4 Inch X 8 Inches,,A6213,HCPCS,Facility,Both,,,,122,103.7,34.9652,122,Aetna,Commercial,112.24,92,,percent of total billed charges,,
Sup Foam Dressing Sterile W Adhesive Border 4 Inch X 8 Inches,,A6213,HCPCS,Facility,Outpatient,,,,122,103.7,34.9652,122,Aetna,Medicare Advantage,59.78,49,,percent of total billed charges,,
Sup Foam Dressing Sterile W Adhesive Border 4 Inch X 8 Inches,,A6213,HCPCS,Facility,Inpatient,,,,122,103.7,34.9652,122,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Sup Foam Dressing Sterile W Adhesive Border 4 Inch X 8 Inches,,A6213,HCPCS,Facility,Both,,,,122,103.7,34.9652,122,Aetna,PPO,113.46,93,,percent of total billed charges,,
Sup Foam Dressing Sterile W Adhesive Border 4 Inch X 8 Inches,,A6213,HCPCS,Facility,Both,,,,122,103.7,34.9652,122,America's PPO,America's PPO,117.1566,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Sup Foam Dressing Sterile W Adhesive Border 4 Inch X 8 Inches,,A6213,HCPCS,Facility,Both,,,,122,103.7,34.9652,122,BlueCross BlueShield Minnesota, Federal Employee Program,120.048,98.4,,percent of total billed charges,,
Sup Foam Dressing Sterile W Adhesive Border 4 Inch X 8 Inches,,A6213,HCPCS,Facility,Both,,,,122,103.7,34.9652,122,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,122,100,,percent of total billed charges,,
Sup Foam Dressing Sterile W Adhesive Border 4 Inch X 8 Inches,,A6213,HCPCS,Facility,Both,,,,122,103.7,34.9652,122,BlueCross BlueShield Minnesota,High Value Network Plan,109.8,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
Sup Foam Dressing Sterile W Adhesive Border 4 Inch X 8 Inches,,A6213,HCPCS,Facility,Outpatient,,,,122,103.7,34.9652,122,BlueCross BlueShield Minnesota,Medicare Advantage,59.78,49,,percent of total billed charges,,
Sup Foam Dressing Sterile W Adhesive Border 4 Inch X 8 Inches,,A6213,HCPCS,Facility,Inpatient,,,,122,103.7,34.9652,122,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Sup Foam Dressing Sterile W Adhesive Border 4 Inch X 8 Inches,,A6213,HCPCS,Facility,Both,,,,122,103.7,34.9652,122,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,108.0554,88.57,,percent of total billed charges,,
Sup Foam Dressing Sterile W Adhesive Border 4 Inch X 8 Inches,,A6213,HCPCS,Facility,Both,,,,122,103.7,34.9652,122,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,34.9652,28.66,,percent of total billed charges,,
Sup Foam Dressing Sterile W Adhesive Border 4 Inch X 8 Inches,,A6213,HCPCS,Facility,Outpatient,,,,122,103.7,34.9652,122,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),59.78,49,,percent of total billed charges,,
Sup Foam Dressing Sterile W Adhesive Border 4 Inch X 8 Inches,,A6213,HCPCS,Facility,Inpatient,,,,122,103.7,34.9652,122,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Sup Foam Dressing Sterile W Adhesive Border 4 Inch X 8 Inches,,A6213,HCPCS,Facility,Both,,,,122,103.7,34.9652,122,CorVel,Worker's Compensation,122,100,,percent of total billed charges,,
Sup Foam Dressing Sterile W Adhesive Border 4 Inch X 8 Inches,,A6213,HCPCS,Facility,Both,,,,122,103.7,34.9652,122,First Health Group Corporation,First Health Network,118.34,97,,percent of total billed charges,,
Sup Foam Dressing Sterile W Adhesive Border 4 Inch X 8 Inches,,A6213,HCPCS,Facility,Both,,,,122,103.7,34.9652,122,"Health Partners, Inc.",Commercial,115.412,94.6,,percent of total billed charges,,
Sup Foam Dressing Sterile W Adhesive Border 4 Inch X 8 Inches,,A6213,HCPCS,Facility,Outpatient,,,,122,103.7,34.9652,122,"Health Partners, Inc.",Medicare Advantage,59.78,49,,percent of total billed charges,,
Sup Foam Dressing Sterile W Adhesive Border 4 Inch X 8 Inches,,A6213,HCPCS,Facility,Inpatient,,,,122,103.7,34.9652,122,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Foam Dressing Sterile W Adhesive Border 4 Inch X 8 Inches,,A6213,HCPCS,Facility,Both,,,,122,103.7,34.9652,122,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),73.2,60,,percent of total billed charges,,
Sup Foam Dressing Sterile W Adhesive Border 4 Inch X 8 Inches,,A6213,HCPCS,Facility,Both,,,,122,103.7,34.9652,122,"Health Partners, Inc.",State of Minnesota Advantage Program,99.43,81.5,,percent of total billed charges,,
Sup Foam Dressing Sterile W Adhesive Border 4 Inch X 8 Inches,,A6213,HCPCS,Facility,Both,,,,122,103.7,34.9652,122,"Health Partners, Inc.",State Public Programs,61,50,,percent of total billed charges,,
Sup Foam Dressing Sterile W Adhesive Border 4 Inch X 8 Inches,,A6213,HCPCS,Facility,Both,,,,122,103.7,34.9652,122,Humana Insurance Company,Commercial PPO,115.9,95,,percent of total billed charges,,
Sup Foam Dressing Sterile W Adhesive Border 4 Inch X 8 Inches,,A6213,HCPCS,Facility,Outpatient,,,,122,103.7,34.9652,122,Humana Insurance Company,Medicare PPO,59.78,49,,percent of total billed charges,,
Sup Foam Dressing Sterile W Adhesive Border 4 Inch X 8 Inches,,A6213,HCPCS,Facility,Inpatient,,,,122,103.7,34.9652,122,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Sup Foam Dressing Sterile W Adhesive Border 4 Inch X 8 Inches,,A6213,HCPCS,Facility,Both,,,,122,103.7,34.9652,122,Medica,Individual & Family,120.902,99.1,,percent of total billed charges,,
Sup Foam Dressing Sterile W Adhesive Border 4 Inch X 8 Inches,,A6213,HCPCS,Facility,Outpatient,,,,122,103.7,34.9652,122,Medica,Medica Advantage Solution,60.756,49.8,,percent of total billed charges,,
Sup Foam Dressing Sterile W Adhesive Border 4 Inch X 8 Inches,,A6213,HCPCS,Facility,Inpatient,,,,122,103.7,34.9652,122,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Sup Foam Dressing Sterile W Adhesive Border 4 Inch X 8 Inches,,A6213,HCPCS,Facility,Outpatient,,,,122,103.7,34.9652,122,Medica,Medical Assistance,54.412,44.6,,percent of total billed charges,,
Sup Foam Dressing Sterile W Adhesive Border 4 Inch X 8 Inches,,A6213,HCPCS,Facility,Inpatient,,,,122,103.7,34.9652,122,Medica,Medical Assistance,,,,,Included in per diem rate,
Sup Foam Dressing Sterile W Adhesive Border 4 Inch X 8 Inches,,A6213,HCPCS,Facility,Outpatient,,,,122,103.7,34.9652,122,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,60.756,49.8,,percent of total billed charges,,
Sup Foam Dressing Sterile W Adhesive Border 4 Inch X 8 Inches,,A6213,HCPCS,Facility,Inpatient,,,,122,103.7,34.9652,122,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Sup Foam Dressing Sterile W Adhesive Border 4 Inch X 8 Inches,,A6213,HCPCS,Facility,Both,,,,122,103.7,34.9652,122,"Multiplan, Inc.","Multiplan, Inc.",114.68,94,,percent of total billed charges,,
Sup Foam Dressing Sterile W Adhesive Border 4 Inch X 8 Inches,,A6213,HCPCS,Facility,Outpatient,,,,122,103.7,34.9652,122,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,109.922,90.1,,percent of total billed charges,,
Sup Foam Dressing Sterile W Adhesive Border 4 Inch X 8 Inches,,A6213,HCPCS,Facility,Inpatient,,,,122,103.7,34.9652,122,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Sup Foam Dressing Sterile W Adhesive Border 4 Inch X 8 Inches,,A6213,HCPCS,Facility,Both,,,,122,103.7,34.9652,122,"Preferred One Administrative Services, INC.",PPO,120.292,98.6,,percent of total billed charges,,
Sup Foam Dressing Sterile W Adhesive Border 4 Inch X 8 Inches,,A6213,HCPCS,Facility,Outpatient,,,,122,103.7,34.9652,122,PrimeWest Health,Minnesota Senior Health Options (MSHO),62.769,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Sup Foam Dressing Sterile W Adhesive Border 4 Inch X 8 Inches,,A6213,HCPCS,Facility,Inpatient,,,,122,103.7,34.9652,122,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Foam Dressing Sterile W Adhesive Border 4 Inch X 8 Inches,,A6213,HCPCS,Facility,Outpatient,,,,122,103.7,34.9652,122,PrimeWest Health,MinnesotaCare,62.6592,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Sup Foam Dressing Sterile W Adhesive Border 4 Inch X 8 Inches,,A6213,HCPCS,Facility,Inpatient,,,,122,103.7,34.9652,122,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Sup Foam Dressing Sterile W Adhesive Border 4 Inch X 8 Inches,,A6213,HCPCS,Facility,Both,,,,122,103.7,34.9652,122,Sanford Health Plan,Sanford Health Plan,112.24,92,,percent of total billed charges,,
Sup Foam Dressing Sterile W Adhesive Border 4 Inch X 8 Inches,,A6213,HCPCS,Facility,Outpatient,,,,122,103.7,34.9652,122,"UCare Health, Inc.",Individual & Family Plan,68.747,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Sup Foam Dressing Sterile W Adhesive Border 4 Inch X 8 Inches,,A6213,HCPCS,Facility,Inpatient,,,,122,103.7,34.9652,122,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Sup Foam Dressing Sterile W Adhesive Border 4 Inch X 8 Inches,,A6213,HCPCS,Facility,Outpatient,,,,122,103.7,34.9652,122,"UCare Health, Inc.",Medical Assistance,61.5734,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Foam Dressing Sterile W Adhesive Border 4 Inch X 8 Inches,,A6213,HCPCS,Facility,Inpatient,,,,122,103.7,34.9652,122,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Sup Foam Dressing Sterile W Adhesive Border 4 Inch X 8 Inches,,A6213,HCPCS,Facility,Outpatient,,,,122,103.7,34.9652,122,"UCare Health, Inc.",Medicare Advantage,61.5734,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Foam Dressing Sterile W Adhesive Border 4 Inch X 8 Inches,,A6213,HCPCS,Facility,Inpatient,,,,122,103.7,34.9652,122,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Foam Dressing Sterile W Adhesive Border 4 Inch X 8 Inches,,A6213,HCPCS,Facility,Outpatient,,,,122,103.7,34.9652,122,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),61.5734,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Foam Dressing Sterile W Adhesive Border 4 Inch X 8 Inches,,A6213,HCPCS,Facility,Inpatient,,,,122,103.7,34.9652,122,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Foam Dressing Sterile W Adhesive Border 4 Inch X 8 Inches,,A6213,HCPCS,Facility,Both,,,,122,103.7,34.9652,122,UnitedHealthcare,Individual & Family,114.68,94,,percent of total billed charges,,
Sup Foam Dressing Sterile W Adhesive Border 4 Inch X 8 Inches,,A6213,HCPCS,Facility,Outpatient,,,,122,103.7,34.9652,122,UnitedHealthcare,Medicare Advantage,59.78,49,,percent of total billed charges,,
Sup Foam Dressing Sterile W Adhesive Border 4 Inch X 8 Inches,,A6213,HCPCS,Facility,Inpatient,,,,122,103.7,34.9652,122,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Sup Foam Dressing Sterile W Adhesive Border 4 Inch X 8 Inches,,A6213,HCPCS,Facility,Outpatient,,,,122,103.7,34.9652,122,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,58.56,48,,percent of total billed charges,,100% of DHS outpatient percentage
Sup Foam Dressing Sterile W Adhesive Border 4 Inch X 8 Inches,,A6213,HCPCS,Facility,Inpatient,,,,122,103.7,34.9652,122,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
DRESSING MEPILEX 3X3,,A6214,HCPCS,Facility,Both,,,,13,11.05,3.7258,13,Aetna,Commercial,11.96,92,,percent of total billed charges,,
DRESSING MEPILEX 3X3,,A6214,HCPCS,Facility,Outpatient,,,,13,11.05,3.7258,13,Aetna,Medicare Advantage,6.37,49,,percent of total billed charges,,
DRESSING MEPILEX 3X3,,A6214,HCPCS,Facility,Inpatient,,,,13,11.05,3.7258,13,Aetna,Medicare Advantage,,,,,Included in per diem rate,
DRESSING MEPILEX 3X3,,A6214,HCPCS,Facility,Both,,,,13,11.05,3.7258,13,Aetna,PPO,12.09,93,,percent of total billed charges,,
DRESSING MEPILEX 3X3,,A6214,HCPCS,Facility,Both,,,,13,11.05,3.7258,13,America's PPO,America's PPO,12.4839,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
DRESSING MEPILEX 3X3,,A6214,HCPCS,Facility,Both,,,,13,11.05,3.7258,13,BlueCross BlueShield Minnesota, Federal Employee Program,12.792,98.4,,percent of total billed charges,,
DRESSING MEPILEX 3X3,,A6214,HCPCS,Facility,Both,,,,13,11.05,3.7258,13,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,13,100,,percent of total billed charges,,
DRESSING MEPILEX 3X3,,A6214,HCPCS,Facility,Both,,,,13,11.05,3.7258,13,BlueCross BlueShield Minnesota,High Value Network Plan,11.7,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
DRESSING MEPILEX 3X3,,A6214,HCPCS,Facility,Outpatient,,,,13,11.05,3.7258,13,BlueCross BlueShield Minnesota,Medicare Advantage,6.37,49,,percent of total billed charges,,
DRESSING MEPILEX 3X3,,A6214,HCPCS,Facility,Inpatient,,,,13,11.05,3.7258,13,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
DRESSING MEPILEX 3X3,,A6214,HCPCS,Facility,Both,,,,13,11.05,3.7258,13,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,11.5141,88.57,,percent of total billed charges,,
DRESSING MEPILEX 3X3,,A6214,HCPCS,Facility,Both,,,,13,11.05,3.7258,13,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,3.7258,28.66,,percent of total billed charges,,
DRESSING MEPILEX 3X3,,A6214,HCPCS,Facility,Outpatient,,,,13,11.05,3.7258,13,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),6.37,49,,percent of total billed charges,,
DRESSING MEPILEX 3X3,,A6214,HCPCS,Facility,Inpatient,,,,13,11.05,3.7258,13,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
DRESSING MEPILEX 3X3,,A6214,HCPCS,Facility,Both,,,,13,11.05,3.7258,13,CorVel,Worker's Compensation,13,100,,percent of total billed charges,,
DRESSING MEPILEX 3X3,,A6214,HCPCS,Facility,Both,,,,13,11.05,3.7258,13,First Health Group Corporation,First Health Network,12.61,97,,percent of total billed charges,,
DRESSING MEPILEX 3X3,,A6214,HCPCS,Facility,Both,,,,13,11.05,3.7258,13,"Health Partners, Inc.",Commercial,12.298,94.6,,percent of total billed charges,,
DRESSING MEPILEX 3X3,,A6214,HCPCS,Facility,Outpatient,,,,13,11.05,3.7258,13,"Health Partners, Inc.",Medicare Advantage,6.37,49,,percent of total billed charges,,
DRESSING MEPILEX 3X3,,A6214,HCPCS,Facility,Inpatient,,,,13,11.05,3.7258,13,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DRESSING MEPILEX 3X3,,A6214,HCPCS,Facility,Both,,,,13,11.05,3.7258,13,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),7.8,60,,percent of total billed charges,,
DRESSING MEPILEX 3X3,,A6214,HCPCS,Facility,Both,,,,13,11.05,3.7258,13,"Health Partners, Inc.",State of Minnesota Advantage Program,10.595,81.5,,percent of total billed charges,,
DRESSING MEPILEX 3X3,,A6214,HCPCS,Facility,Both,,,,13,11.05,3.7258,13,"Health Partners, Inc.",State Public Programs,6.5,50,,percent of total billed charges,,
DRESSING MEPILEX 3X3,,A6214,HCPCS,Facility,Both,,,,13,11.05,3.7258,13,Humana Insurance Company,Commercial PPO,12.35,95,,percent of total billed charges,,
DRESSING MEPILEX 3X3,,A6214,HCPCS,Facility,Outpatient,,,,13,11.05,3.7258,13,Humana Insurance Company,Medicare PPO,6.37,49,,percent of total billed charges,,
DRESSING MEPILEX 3X3,,A6214,HCPCS,Facility,Inpatient,,,,13,11.05,3.7258,13,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
DRESSING MEPILEX 3X3,,A6214,HCPCS,Facility,Both,,,,13,11.05,3.7258,13,Medica,Individual & Family,12.883,99.1,,percent of total billed charges,,
DRESSING MEPILEX 3X3,,A6214,HCPCS,Facility,Outpatient,,,,13,11.05,3.7258,13,Medica,Medica Advantage Solution,6.474,49.8,,percent of total billed charges,,
DRESSING MEPILEX 3X3,,A6214,HCPCS,Facility,Inpatient,,,,13,11.05,3.7258,13,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
DRESSING MEPILEX 3X3,,A6214,HCPCS,Facility,Outpatient,,,,13,11.05,3.7258,13,Medica,Medical Assistance,5.798,44.6,,percent of total billed charges,,
DRESSING MEPILEX 3X3,,A6214,HCPCS,Facility,Inpatient,,,,13,11.05,3.7258,13,Medica,Medical Assistance,,,,,Included in per diem rate,
DRESSING MEPILEX 3X3,,A6214,HCPCS,Facility,Outpatient,,,,13,11.05,3.7258,13,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,6.474,49.8,,percent of total billed charges,,
DRESSING MEPILEX 3X3,,A6214,HCPCS,Facility,Inpatient,,,,13,11.05,3.7258,13,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
DRESSING MEPILEX 3X3,,A6214,HCPCS,Facility,Both,,,,13,11.05,3.7258,13,"Multiplan, Inc.","Multiplan, Inc.",12.22,94,,percent of total billed charges,,
DRESSING MEPILEX 3X3,,A6214,HCPCS,Facility,Outpatient,,,,13,11.05,3.7258,13,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,11.713,90.1,,percent of total billed charges,,
DRESSING MEPILEX 3X3,,A6214,HCPCS,Facility,Inpatient,,,,13,11.05,3.7258,13,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
DRESSING MEPILEX 3X3,,A6214,HCPCS,Facility,Both,,,,13,11.05,3.7258,13,"Preferred One Administrative Services, INC.",PPO,12.818,98.6,,percent of total billed charges,,
DRESSING MEPILEX 3X3,,A6214,HCPCS,Facility,Outpatient,,,,13,11.05,3.7258,13,PrimeWest Health,Minnesota Senior Health Options (MSHO),6.6885,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
DRESSING MEPILEX 3X3,,A6214,HCPCS,Facility,Inpatient,,,,13,11.05,3.7258,13,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DRESSING MEPILEX 3X3,,A6214,HCPCS,Facility,Outpatient,,,,13,11.05,3.7258,13,PrimeWest Health,MinnesotaCare,6.6768,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
DRESSING MEPILEX 3X3,,A6214,HCPCS,Facility,Inpatient,,,,13,11.05,3.7258,13,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
DRESSING MEPILEX 3X3,,A6214,HCPCS,Facility,Both,,,,13,11.05,3.7258,13,Sanford Health Plan,Sanford Health Plan,11.96,92,,percent of total billed charges,,
DRESSING MEPILEX 3X3,,A6214,HCPCS,Facility,Outpatient,,,,13,11.05,3.7258,13,"UCare Health, Inc.",Individual & Family Plan,7.3255,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
DRESSING MEPILEX 3X3,,A6214,HCPCS,Facility,Inpatient,,,,13,11.05,3.7258,13,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
DRESSING MEPILEX 3X3,,A6214,HCPCS,Facility,Outpatient,,,,13,11.05,3.7258,13,"UCare Health, Inc.",Medical Assistance,6.5611,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DRESSING MEPILEX 3X3,,A6214,HCPCS,Facility,Inpatient,,,,13,11.05,3.7258,13,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
DRESSING MEPILEX 3X3,,A6214,HCPCS,Facility,Outpatient,,,,13,11.05,3.7258,13,"UCare Health, Inc.",Medicare Advantage,6.5611,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DRESSING MEPILEX 3X3,,A6214,HCPCS,Facility,Inpatient,,,,13,11.05,3.7258,13,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DRESSING MEPILEX 3X3,,A6214,HCPCS,Facility,Outpatient,,,,13,11.05,3.7258,13,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),6.5611,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DRESSING MEPILEX 3X3,,A6214,HCPCS,Facility,Inpatient,,,,13,11.05,3.7258,13,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DRESSING MEPILEX 3X3,,A6214,HCPCS,Facility,Both,,,,13,11.05,3.7258,13,UnitedHealthcare,Individual & Family,12.22,94,,percent of total billed charges,,
DRESSING MEPILEX 3X3,,A6214,HCPCS,Facility,Outpatient,,,,13,11.05,3.7258,13,UnitedHealthcare,Medicare Advantage,6.37,49,,percent of total billed charges,,
DRESSING MEPILEX 3X3,,A6214,HCPCS,Facility,Inpatient,,,,13,11.05,3.7258,13,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
DRESSING MEPILEX 3X3,,A6214,HCPCS,Facility,Outpatient,,,,13,11.05,3.7258,13,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,6.24,48,,percent of total billed charges,,100% of DHS outpatient percentage
DRESSING MEPILEX 3X3,,A6214,HCPCS,Facility,Inpatient,,,,13,11.05,3.7258,13,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
DRESSING MEPILEX BORDER 4X10IN   295850,,A6214,HCPCS,Facility,Both,,,,31.45,26.7325,9.01357,31.45,Aetna,Commercial,28.934,92,,percent of total billed charges,,
DRESSING MEPILEX BORDER 4X10IN   295850,,A6214,HCPCS,Facility,Outpatient,,,,31.45,26.7325,9.01357,31.45,Aetna,Medicare Advantage,15.4105,49,,percent of total billed charges,,
DRESSING MEPILEX BORDER 4X10IN   295850,,A6214,HCPCS,Facility,Inpatient,,,,31.45,26.7325,9.01357,31.45,Aetna,Medicare Advantage,,,,,Included in per diem rate,
DRESSING MEPILEX BORDER 4X10IN   295850,,A6214,HCPCS,Facility,Both,,,,31.45,26.7325,9.01357,31.45,Aetna,PPO,29.2485,93,,percent of total billed charges,,
DRESSING MEPILEX BORDER 4X10IN   295850,,A6214,HCPCS,Facility,Both,,,,31.45,26.7325,9.01357,31.45,America's PPO,America's PPO,30.201435,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
DRESSING MEPILEX BORDER 4X10IN   295850,,A6214,HCPCS,Facility,Both,,,,31.45,26.7325,9.01357,31.45,BlueCross BlueShield Minnesota, Federal Employee Program,30.9468,98.4,,percent of total billed charges,,
DRESSING MEPILEX BORDER 4X10IN   295850,,A6214,HCPCS,Facility,Both,,,,31.45,26.7325,9.01357,31.45,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,31.45,100,,percent of total billed charges,,
DRESSING MEPILEX BORDER 4X10IN   295850,,A6214,HCPCS,Facility,Both,,,,31.45,26.7325,9.01357,31.45,BlueCross BlueShield Minnesota,High Value Network Plan,28.305,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
DRESSING MEPILEX BORDER 4X10IN   295850,,A6214,HCPCS,Facility,Outpatient,,,,31.45,26.7325,9.01357,31.45,BlueCross BlueShield Minnesota,Medicare Advantage,15.4105,49,,percent of total billed charges,,
DRESSING MEPILEX BORDER 4X10IN   295850,,A6214,HCPCS,Facility,Inpatient,,,,31.45,26.7325,9.01357,31.45,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
DRESSING MEPILEX BORDER 4X10IN   295850,,A6214,HCPCS,Facility,Both,,,,31.45,26.7325,9.01357,31.45,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,27.855265,88.57,,percent of total billed charges,,
DRESSING MEPILEX BORDER 4X10IN   295850,,A6214,HCPCS,Facility,Both,,,,31.45,26.7325,9.01357,31.45,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,9.01357,28.66,,percent of total billed charges,,
DRESSING MEPILEX BORDER 4X10IN   295850,,A6214,HCPCS,Facility,Outpatient,,,,31.45,26.7325,9.01357,31.45,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),15.4105,49,,percent of total billed charges,,
DRESSING MEPILEX BORDER 4X10IN   295850,,A6214,HCPCS,Facility,Inpatient,,,,31.45,26.7325,9.01357,31.45,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
DRESSING MEPILEX BORDER 4X10IN   295850,,A6214,HCPCS,Facility,Both,,,,31.45,26.7325,9.01357,31.45,CorVel,Worker's Compensation,31.45,100,,percent of total billed charges,,
DRESSING MEPILEX BORDER 4X10IN   295850,,A6214,HCPCS,Facility,Both,,,,31.45,26.7325,9.01357,31.45,First Health Group Corporation,First Health Network,30.5065,97,,percent of total billed charges,,
DRESSING MEPILEX BORDER 4X10IN   295850,,A6214,HCPCS,Facility,Both,,,,31.45,26.7325,9.01357,31.45,"Health Partners, Inc.",Commercial,29.7517,94.6,,percent of total billed charges,,
DRESSING MEPILEX BORDER 4X10IN   295850,,A6214,HCPCS,Facility,Outpatient,,,,31.45,26.7325,9.01357,31.45,"Health Partners, Inc.",Medicare Advantage,15.4105,49,,percent of total billed charges,,
DRESSING MEPILEX BORDER 4X10IN   295850,,A6214,HCPCS,Facility,Inpatient,,,,31.45,26.7325,9.01357,31.45,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DRESSING MEPILEX BORDER 4X10IN   295850,,A6214,HCPCS,Facility,Both,,,,31.45,26.7325,9.01357,31.45,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),18.87,60,,percent of total billed charges,,
DRESSING MEPILEX BORDER 4X10IN   295850,,A6214,HCPCS,Facility,Both,,,,31.45,26.7325,9.01357,31.45,"Health Partners, Inc.",State of Minnesota Advantage Program,25.63175,81.5,,percent of total billed charges,,
DRESSING MEPILEX BORDER 4X10IN   295850,,A6214,HCPCS,Facility,Both,,,,31.45,26.7325,9.01357,31.45,"Health Partners, Inc.",State Public Programs,15.725,50,,percent of total billed charges,,
DRESSING MEPILEX BORDER 4X10IN   295850,,A6214,HCPCS,Facility,Both,,,,31.45,26.7325,9.01357,31.45,Humana Insurance Company,Commercial PPO,29.8775,95,,percent of total billed charges,,
DRESSING MEPILEX BORDER 4X10IN   295850,,A6214,HCPCS,Facility,Outpatient,,,,31.45,26.7325,9.01357,31.45,Humana Insurance Company,Medicare PPO,15.4105,49,,percent of total billed charges,,
DRESSING MEPILEX BORDER 4X10IN   295850,,A6214,HCPCS,Facility,Inpatient,,,,31.45,26.7325,9.01357,31.45,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
DRESSING MEPILEX BORDER 4X10IN   295850,,A6214,HCPCS,Facility,Both,,,,31.45,26.7325,9.01357,31.45,Medica,Individual & Family,31.16695,99.1,,percent of total billed charges,,
DRESSING MEPILEX BORDER 4X10IN   295850,,A6214,HCPCS,Facility,Outpatient,,,,31.45,26.7325,9.01357,31.45,Medica,Medica Advantage Solution,15.6621,49.8,,percent of total billed charges,,
DRESSING MEPILEX BORDER 4X10IN   295850,,A6214,HCPCS,Facility,Inpatient,,,,31.45,26.7325,9.01357,31.45,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
DRESSING MEPILEX BORDER 4X10IN   295850,,A6214,HCPCS,Facility,Outpatient,,,,31.45,26.7325,9.01357,31.45,Medica,Medical Assistance,14.0267,44.6,,percent of total billed charges,,
DRESSING MEPILEX BORDER 4X10IN   295850,,A6214,HCPCS,Facility,Inpatient,,,,31.45,26.7325,9.01357,31.45,Medica,Medical Assistance,,,,,Included in per diem rate,
DRESSING MEPILEX BORDER 4X10IN   295850,,A6214,HCPCS,Facility,Outpatient,,,,31.45,26.7325,9.01357,31.45,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,15.6621,49.8,,percent of total billed charges,,
DRESSING MEPILEX BORDER 4X10IN   295850,,A6214,HCPCS,Facility,Inpatient,,,,31.45,26.7325,9.01357,31.45,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
DRESSING MEPILEX BORDER 4X10IN   295850,,A6214,HCPCS,Facility,Both,,,,31.45,26.7325,9.01357,31.45,"Multiplan, Inc.","Multiplan, Inc.",29.563,94,,percent of total billed charges,,
DRESSING MEPILEX BORDER 4X10IN   295850,,A6214,HCPCS,Facility,Outpatient,,,,31.45,26.7325,9.01357,31.45,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,28.33645,90.1,,percent of total billed charges,,
DRESSING MEPILEX BORDER 4X10IN   295850,,A6214,HCPCS,Facility,Inpatient,,,,31.45,26.7325,9.01357,31.45,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
DRESSING MEPILEX BORDER 4X10IN   295850,,A6214,HCPCS,Facility,Both,,,,31.45,26.7325,9.01357,31.45,"Preferred One Administrative Services, INC.",PPO,31.0097,98.6,,percent of total billed charges,,
DRESSING MEPILEX BORDER 4X10IN   295850,,A6214,HCPCS,Facility,Outpatient,,,,31.45,26.7325,9.01357,31.45,PrimeWest Health,Minnesota Senior Health Options (MSHO),16.181025,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
DRESSING MEPILEX BORDER 4X10IN   295850,,A6214,HCPCS,Facility,Inpatient,,,,31.45,26.7325,9.01357,31.45,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DRESSING MEPILEX BORDER 4X10IN   295850,,A6214,HCPCS,Facility,Outpatient,,,,31.45,26.7325,9.01357,31.45,PrimeWest Health,MinnesotaCare,16.15272,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
DRESSING MEPILEX BORDER 4X10IN   295850,,A6214,HCPCS,Facility,Inpatient,,,,31.45,26.7325,9.01357,31.45,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
DRESSING MEPILEX BORDER 4X10IN   295850,,A6214,HCPCS,Facility,Both,,,,31.45,26.7325,9.01357,31.45,Sanford Health Plan,Sanford Health Plan,28.934,92,,percent of total billed charges,,
DRESSING MEPILEX BORDER 4X10IN   295850,,A6214,HCPCS,Facility,Outpatient,,,,31.45,26.7325,9.01357,31.45,"UCare Health, Inc.",Individual & Family Plan,17.722075,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
DRESSING MEPILEX BORDER 4X10IN   295850,,A6214,HCPCS,Facility,Inpatient,,,,31.45,26.7325,9.01357,31.45,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
DRESSING MEPILEX BORDER 4X10IN   295850,,A6214,HCPCS,Facility,Outpatient,,,,31.45,26.7325,9.01357,31.45,"UCare Health, Inc.",Medical Assistance,15.872815,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DRESSING MEPILEX BORDER 4X10IN   295850,,A6214,HCPCS,Facility,Inpatient,,,,31.45,26.7325,9.01357,31.45,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
DRESSING MEPILEX BORDER 4X10IN   295850,,A6214,HCPCS,Facility,Outpatient,,,,31.45,26.7325,9.01357,31.45,"UCare Health, Inc.",Medicare Advantage,15.872815,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DRESSING MEPILEX BORDER 4X10IN   295850,,A6214,HCPCS,Facility,Inpatient,,,,31.45,26.7325,9.01357,31.45,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DRESSING MEPILEX BORDER 4X10IN   295850,,A6214,HCPCS,Facility,Outpatient,,,,31.45,26.7325,9.01357,31.45,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),15.872815,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DRESSING MEPILEX BORDER 4X10IN   295850,,A6214,HCPCS,Facility,Inpatient,,,,31.45,26.7325,9.01357,31.45,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DRESSING MEPILEX BORDER 4X10IN   295850,,A6214,HCPCS,Facility,Both,,,,31.45,26.7325,9.01357,31.45,UnitedHealthcare,Individual & Family,29.563,94,,percent of total billed charges,,
DRESSING MEPILEX BORDER 4X10IN   295850,,A6214,HCPCS,Facility,Outpatient,,,,31.45,26.7325,9.01357,31.45,UnitedHealthcare,Medicare Advantage,15.4105,49,,percent of total billed charges,,
DRESSING MEPILEX BORDER 4X10IN   295850,,A6214,HCPCS,Facility,Inpatient,,,,31.45,26.7325,9.01357,31.45,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
DRESSING MEPILEX BORDER 4X10IN   295850,,A6214,HCPCS,Facility,Outpatient,,,,31.45,26.7325,9.01357,31.45,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,15.096,48,,percent of total billed charges,,100% of DHS outpatient percentage
DRESSING MEPILEX BORDER 4X10IN   295850,,A6214,HCPCS,Facility,Inpatient,,,,31.45,26.7325,9.01357,31.45,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Sup Mepilex Ag 4X5,,A6214,HCPCS,Facility,Both,,,,59.21,50.3285,16.969586,59.21,Aetna,Commercial,54.4732,92,,percent of total billed charges,,
Sup Mepilex Ag 4X5,,A6214,HCPCS,Facility,Outpatient,,,,59.21,50.3285,16.969586,59.21,Aetna,Medicare Advantage,29.0129,49,,percent of total billed charges,,
Sup Mepilex Ag 4X5,,A6214,HCPCS,Facility,Inpatient,,,,59.21,50.3285,16.969586,59.21,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Sup Mepilex Ag 4X5,,A6214,HCPCS,Facility,Both,,,,59.21,50.3285,16.969586,59.21,Aetna,PPO,55.0653,93,,percent of total billed charges,,
Sup Mepilex Ag 4X5,,A6214,HCPCS,Facility,Both,,,,59.21,50.3285,16.969586,59.21,America's PPO,America's PPO,56.859363,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Sup Mepilex Ag 4X5,,A6214,HCPCS,Facility,Both,,,,59.21,50.3285,16.969586,59.21,BlueCross BlueShield Minnesota, Federal Employee Program,58.26264,98.4,,percent of total billed charges,,
Sup Mepilex Ag 4X5,,A6214,HCPCS,Facility,Both,,,,59.21,50.3285,16.969586,59.21,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,59.21,100,,percent of total billed charges,,
Sup Mepilex Ag 4X5,,A6214,HCPCS,Facility,Both,,,,59.21,50.3285,16.969586,59.21,BlueCross BlueShield Minnesota,High Value Network Plan,53.289,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
Sup Mepilex Ag 4X5,,A6214,HCPCS,Facility,Outpatient,,,,59.21,50.3285,16.969586,59.21,BlueCross BlueShield Minnesota,Medicare Advantage,29.0129,49,,percent of total billed charges,,
Sup Mepilex Ag 4X5,,A6214,HCPCS,Facility,Inpatient,,,,59.21,50.3285,16.969586,59.21,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Sup Mepilex Ag 4X5,,A6214,HCPCS,Facility,Both,,,,59.21,50.3285,16.969586,59.21,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,52.442297,88.57,,percent of total billed charges,,
Sup Mepilex Ag 4X5,,A6214,HCPCS,Facility,Both,,,,59.21,50.3285,16.969586,59.21,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,16.969586,28.66,,percent of total billed charges,,
Sup Mepilex Ag 4X5,,A6214,HCPCS,Facility,Outpatient,,,,59.21,50.3285,16.969586,59.21,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),29.0129,49,,percent of total billed charges,,
Sup Mepilex Ag 4X5,,A6214,HCPCS,Facility,Inpatient,,,,59.21,50.3285,16.969586,59.21,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Sup Mepilex Ag 4X5,,A6214,HCPCS,Facility,Both,,,,59.21,50.3285,16.969586,59.21,CorVel,Worker's Compensation,59.21,100,,percent of total billed charges,,
Sup Mepilex Ag 4X5,,A6214,HCPCS,Facility,Both,,,,59.21,50.3285,16.969586,59.21,First Health Group Corporation,First Health Network,57.4337,97,,percent of total billed charges,,
Sup Mepilex Ag 4X5,,A6214,HCPCS,Facility,Both,,,,59.21,50.3285,16.969586,59.21,"Health Partners, Inc.",Commercial,56.01266,94.6,,percent of total billed charges,,
Sup Mepilex Ag 4X5,,A6214,HCPCS,Facility,Outpatient,,,,59.21,50.3285,16.969586,59.21,"Health Partners, Inc.",Medicare Advantage,29.0129,49,,percent of total billed charges,,
Sup Mepilex Ag 4X5,,A6214,HCPCS,Facility,Inpatient,,,,59.21,50.3285,16.969586,59.21,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Mepilex Ag 4X5,,A6214,HCPCS,Facility,Both,,,,59.21,50.3285,16.969586,59.21,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),35.526,60,,percent of total billed charges,,
Sup Mepilex Ag 4X5,,A6214,HCPCS,Facility,Both,,,,59.21,50.3285,16.969586,59.21,"Health Partners, Inc.",State of Minnesota Advantage Program,48.25615,81.5,,percent of total billed charges,,
Sup Mepilex Ag 4X5,,A6214,HCPCS,Facility,Both,,,,59.21,50.3285,16.969586,59.21,"Health Partners, Inc.",State Public Programs,29.605,50,,percent of total billed charges,,
Sup Mepilex Ag 4X5,,A6214,HCPCS,Facility,Both,,,,59.21,50.3285,16.969586,59.21,Humana Insurance Company,Commercial PPO,56.2495,95,,percent of total billed charges,,
Sup Mepilex Ag 4X5,,A6214,HCPCS,Facility,Outpatient,,,,59.21,50.3285,16.969586,59.21,Humana Insurance Company,Medicare PPO,29.0129,49,,percent of total billed charges,,
Sup Mepilex Ag 4X5,,A6214,HCPCS,Facility,Inpatient,,,,59.21,50.3285,16.969586,59.21,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Sup Mepilex Ag 4X5,,A6214,HCPCS,Facility,Both,,,,59.21,50.3285,16.969586,59.21,Medica,Individual & Family,58.67711,99.1,,percent of total billed charges,,
Sup Mepilex Ag 4X5,,A6214,HCPCS,Facility,Outpatient,,,,59.21,50.3285,16.969586,59.21,Medica,Medica Advantage Solution,29.48658,49.8,,percent of total billed charges,,
Sup Mepilex Ag 4X5,,A6214,HCPCS,Facility,Inpatient,,,,59.21,50.3285,16.969586,59.21,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Sup Mepilex Ag 4X5,,A6214,HCPCS,Facility,Outpatient,,,,59.21,50.3285,16.969586,59.21,Medica,Medical Assistance,26.40766,44.6,,percent of total billed charges,,
Sup Mepilex Ag 4X5,,A6214,HCPCS,Facility,Inpatient,,,,59.21,50.3285,16.969586,59.21,Medica,Medical Assistance,,,,,Included in per diem rate,
Sup Mepilex Ag 4X5,,A6214,HCPCS,Facility,Outpatient,,,,59.21,50.3285,16.969586,59.21,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,29.48658,49.8,,percent of total billed charges,,
Sup Mepilex Ag 4X5,,A6214,HCPCS,Facility,Inpatient,,,,59.21,50.3285,16.969586,59.21,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Sup Mepilex Ag 4X5,,A6214,HCPCS,Facility,Both,,,,59.21,50.3285,16.969586,59.21,"Multiplan, Inc.","Multiplan, Inc.",55.6574,94,,percent of total billed charges,,
Sup Mepilex Ag 4X5,,A6214,HCPCS,Facility,Outpatient,,,,59.21,50.3285,16.969586,59.21,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,53.34821,90.1,,percent of total billed charges,,
Sup Mepilex Ag 4X5,,A6214,HCPCS,Facility,Inpatient,,,,59.21,50.3285,16.969586,59.21,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Sup Mepilex Ag 4X5,,A6214,HCPCS,Facility,Both,,,,59.21,50.3285,16.969586,59.21,"Preferred One Administrative Services, INC.",PPO,58.38106,98.6,,percent of total billed charges,,
Sup Mepilex Ag 4X5,,A6214,HCPCS,Facility,Outpatient,,,,59.21,50.3285,16.969586,59.21,PrimeWest Health,Minnesota Senior Health Options (MSHO),30.463545,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Sup Mepilex Ag 4X5,,A6214,HCPCS,Facility,Inpatient,,,,59.21,50.3285,16.969586,59.21,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Mepilex Ag 4X5,,A6214,HCPCS,Facility,Outpatient,,,,59.21,50.3285,16.969586,59.21,PrimeWest Health,MinnesotaCare,30.410256,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Sup Mepilex Ag 4X5,,A6214,HCPCS,Facility,Inpatient,,,,59.21,50.3285,16.969586,59.21,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Sup Mepilex Ag 4X5,,A6214,HCPCS,Facility,Both,,,,59.21,50.3285,16.969586,59.21,Sanford Health Plan,Sanford Health Plan,54.4732,92,,percent of total billed charges,,
Sup Mepilex Ag 4X5,,A6214,HCPCS,Facility,Outpatient,,,,59.21,50.3285,16.969586,59.21,"UCare Health, Inc.",Individual & Family Plan,33.364835,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Sup Mepilex Ag 4X5,,A6214,HCPCS,Facility,Inpatient,,,,59.21,50.3285,16.969586,59.21,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Sup Mepilex Ag 4X5,,A6214,HCPCS,Facility,Outpatient,,,,59.21,50.3285,16.969586,59.21,"UCare Health, Inc.",Medical Assistance,29.883287,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Mepilex Ag 4X5,,A6214,HCPCS,Facility,Inpatient,,,,59.21,50.3285,16.969586,59.21,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Sup Mepilex Ag 4X5,,A6214,HCPCS,Facility,Outpatient,,,,59.21,50.3285,16.969586,59.21,"UCare Health, Inc.",Medicare Advantage,29.883287,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Mepilex Ag 4X5,,A6214,HCPCS,Facility,Inpatient,,,,59.21,50.3285,16.969586,59.21,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Mepilex Ag 4X5,,A6214,HCPCS,Facility,Outpatient,,,,59.21,50.3285,16.969586,59.21,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),29.883287,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Mepilex Ag 4X5,,A6214,HCPCS,Facility,Inpatient,,,,59.21,50.3285,16.969586,59.21,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Mepilex Ag 4X5,,A6214,HCPCS,Facility,Both,,,,59.21,50.3285,16.969586,59.21,UnitedHealthcare,Individual & Family,55.6574,94,,percent of total billed charges,,
Sup Mepilex Ag 4X5,,A6214,HCPCS,Facility,Outpatient,,,,59.21,50.3285,16.969586,59.21,UnitedHealthcare,Medicare Advantage,29.0129,49,,percent of total billed charges,,
Sup Mepilex Ag 4X5,,A6214,HCPCS,Facility,Inpatient,,,,59.21,50.3285,16.969586,59.21,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Sup Mepilex Ag 4X5,,A6214,HCPCS,Facility,Outpatient,,,,59.21,50.3285,16.969586,59.21,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,28.4208,48,,percent of total billed charges,,100% of DHS outpatient percentage
Sup Mepilex Ag 4X5,,A6214,HCPCS,Facility,Inpatient,,,,59.21,50.3285,16.969586,59.21,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Sup Mepilex Border 6 X 6,,A6214,HCPCS,Facility,Both,,,,38,32.3,10.8908,38,Aetna,Commercial,34.96,92,,percent of total billed charges,,
Sup Mepilex Border 6 X 6,,A6214,HCPCS,Facility,Outpatient,,,,38,32.3,10.8908,38,Aetna,Medicare Advantage,18.62,49,,percent of total billed charges,,
Sup Mepilex Border 6 X 6,,A6214,HCPCS,Facility,Inpatient,,,,38,32.3,10.8908,38,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Sup Mepilex Border 6 X 6,,A6214,HCPCS,Facility,Both,,,,38,32.3,10.8908,38,Aetna,PPO,35.34,93,,percent of total billed charges,,
Sup Mepilex Border 6 X 6,,A6214,HCPCS,Facility,Both,,,,38,32.3,10.8908,38,America's PPO,America's PPO,36.4914,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Sup Mepilex Border 6 X 6,,A6214,HCPCS,Facility,Both,,,,38,32.3,10.8908,38,BlueCross BlueShield Minnesota, Federal Employee Program,37.392,98.4,,percent of total billed charges,,
Sup Mepilex Border 6 X 6,,A6214,HCPCS,Facility,Both,,,,38,32.3,10.8908,38,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,38,100,,percent of total billed charges,,
Sup Mepilex Border 6 X 6,,A6214,HCPCS,Facility,Both,,,,38,32.3,10.8908,38,BlueCross BlueShield Minnesota,High Value Network Plan,34.2,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
Sup Mepilex Border 6 X 6,,A6214,HCPCS,Facility,Outpatient,,,,38,32.3,10.8908,38,BlueCross BlueShield Minnesota,Medicare Advantage,18.62,49,,percent of total billed charges,,
Sup Mepilex Border 6 X 6,,A6214,HCPCS,Facility,Inpatient,,,,38,32.3,10.8908,38,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Sup Mepilex Border 6 X 6,,A6214,HCPCS,Facility,Both,,,,38,32.3,10.8908,38,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,33.6566,88.57,,percent of total billed charges,,
Sup Mepilex Border 6 X 6,,A6214,HCPCS,Facility,Both,,,,38,32.3,10.8908,38,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,10.8908,28.66,,percent of total billed charges,,
Sup Mepilex Border 6 X 6,,A6214,HCPCS,Facility,Outpatient,,,,38,32.3,10.8908,38,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),18.62,49,,percent of total billed charges,,
Sup Mepilex Border 6 X 6,,A6214,HCPCS,Facility,Inpatient,,,,38,32.3,10.8908,38,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Sup Mepilex Border 6 X 6,,A6214,HCPCS,Facility,Both,,,,38,32.3,10.8908,38,CorVel,Worker's Compensation,38,100,,percent of total billed charges,,
Sup Mepilex Border 6 X 6,,A6214,HCPCS,Facility,Both,,,,38,32.3,10.8908,38,First Health Group Corporation,First Health Network,36.86,97,,percent of total billed charges,,
Sup Mepilex Border 6 X 6,,A6214,HCPCS,Facility,Both,,,,38,32.3,10.8908,38,"Health Partners, Inc.",Commercial,35.948,94.6,,percent of total billed charges,,
Sup Mepilex Border 6 X 6,,A6214,HCPCS,Facility,Outpatient,,,,38,32.3,10.8908,38,"Health Partners, Inc.",Medicare Advantage,18.62,49,,percent of total billed charges,,
Sup Mepilex Border 6 X 6,,A6214,HCPCS,Facility,Inpatient,,,,38,32.3,10.8908,38,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Mepilex Border 6 X 6,,A6214,HCPCS,Facility,Both,,,,38,32.3,10.8908,38,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),22.8,60,,percent of total billed charges,,
Sup Mepilex Border 6 X 6,,A6214,HCPCS,Facility,Both,,,,38,32.3,10.8908,38,"Health Partners, Inc.",State of Minnesota Advantage Program,30.97,81.5,,percent of total billed charges,,
Sup Mepilex Border 6 X 6,,A6214,HCPCS,Facility,Both,,,,38,32.3,10.8908,38,"Health Partners, Inc.",State Public Programs,19,50,,percent of total billed charges,,
Sup Mepilex Border 6 X 6,,A6214,HCPCS,Facility,Both,,,,38,32.3,10.8908,38,Humana Insurance Company,Commercial PPO,36.1,95,,percent of total billed charges,,
Sup Mepilex Border 6 X 6,,A6214,HCPCS,Facility,Outpatient,,,,38,32.3,10.8908,38,Humana Insurance Company,Medicare PPO,18.62,49,,percent of total billed charges,,
Sup Mepilex Border 6 X 6,,A6214,HCPCS,Facility,Inpatient,,,,38,32.3,10.8908,38,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Sup Mepilex Border 6 X 6,,A6214,HCPCS,Facility,Both,,,,38,32.3,10.8908,38,Medica,Individual & Family,37.658,99.1,,percent of total billed charges,,
Sup Mepilex Border 6 X 6,,A6214,HCPCS,Facility,Outpatient,,,,38,32.3,10.8908,38,Medica,Medica Advantage Solution,18.924,49.8,,percent of total billed charges,,
Sup Mepilex Border 6 X 6,,A6214,HCPCS,Facility,Inpatient,,,,38,32.3,10.8908,38,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Sup Mepilex Border 6 X 6,,A6214,HCPCS,Facility,Outpatient,,,,38,32.3,10.8908,38,Medica,Medical Assistance,16.948,44.6,,percent of total billed charges,,
Sup Mepilex Border 6 X 6,,A6214,HCPCS,Facility,Inpatient,,,,38,32.3,10.8908,38,Medica,Medical Assistance,,,,,Included in per diem rate,
Sup Mepilex Border 6 X 6,,A6214,HCPCS,Facility,Outpatient,,,,38,32.3,10.8908,38,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,18.924,49.8,,percent of total billed charges,,
Sup Mepilex Border 6 X 6,,A6214,HCPCS,Facility,Inpatient,,,,38,32.3,10.8908,38,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Sup Mepilex Border 6 X 6,,A6214,HCPCS,Facility,Both,,,,38,32.3,10.8908,38,"Multiplan, Inc.","Multiplan, Inc.",35.72,94,,percent of total billed charges,,
Sup Mepilex Border 6 X 6,,A6214,HCPCS,Facility,Outpatient,,,,38,32.3,10.8908,38,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,34.238,90.1,,percent of total billed charges,,
Sup Mepilex Border 6 X 6,,A6214,HCPCS,Facility,Inpatient,,,,38,32.3,10.8908,38,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Sup Mepilex Border 6 X 6,,A6214,HCPCS,Facility,Both,,,,38,32.3,10.8908,38,"Preferred One Administrative Services, INC.",PPO,37.468,98.6,,percent of total billed charges,,
Sup Mepilex Border 6 X 6,,A6214,HCPCS,Facility,Outpatient,,,,38,32.3,10.8908,38,PrimeWest Health,Minnesota Senior Health Options (MSHO),19.551,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Sup Mepilex Border 6 X 6,,A6214,HCPCS,Facility,Inpatient,,,,38,32.3,10.8908,38,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Mepilex Border 6 X 6,,A6214,HCPCS,Facility,Outpatient,,,,38,32.3,10.8908,38,PrimeWest Health,MinnesotaCare,19.5168,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Sup Mepilex Border 6 X 6,,A6214,HCPCS,Facility,Inpatient,,,,38,32.3,10.8908,38,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Sup Mepilex Border 6 X 6,,A6214,HCPCS,Facility,Both,,,,38,32.3,10.8908,38,Sanford Health Plan,Sanford Health Plan,34.96,92,,percent of total billed charges,,
Sup Mepilex Border 6 X 6,,A6214,HCPCS,Facility,Outpatient,,,,38,32.3,10.8908,38,"UCare Health, Inc.",Individual & Family Plan,21.413,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Sup Mepilex Border 6 X 6,,A6214,HCPCS,Facility,Inpatient,,,,38,32.3,10.8908,38,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Sup Mepilex Border 6 X 6,,A6214,HCPCS,Facility,Outpatient,,,,38,32.3,10.8908,38,"UCare Health, Inc.",Medical Assistance,19.1786,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Mepilex Border 6 X 6,,A6214,HCPCS,Facility,Inpatient,,,,38,32.3,10.8908,38,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Sup Mepilex Border 6 X 6,,A6214,HCPCS,Facility,Outpatient,,,,38,32.3,10.8908,38,"UCare Health, Inc.",Medicare Advantage,19.1786,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Mepilex Border 6 X 6,,A6214,HCPCS,Facility,Inpatient,,,,38,32.3,10.8908,38,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Mepilex Border 6 X 6,,A6214,HCPCS,Facility,Outpatient,,,,38,32.3,10.8908,38,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),19.1786,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Mepilex Border 6 X 6,,A6214,HCPCS,Facility,Inpatient,,,,38,32.3,10.8908,38,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Mepilex Border 6 X 6,,A6214,HCPCS,Facility,Both,,,,38,32.3,10.8908,38,UnitedHealthcare,Individual & Family,35.72,94,,percent of total billed charges,,
Sup Mepilex Border 6 X 6,,A6214,HCPCS,Facility,Outpatient,,,,38,32.3,10.8908,38,UnitedHealthcare,Medicare Advantage,18.62,49,,percent of total billed charges,,
Sup Mepilex Border 6 X 6,,A6214,HCPCS,Facility,Inpatient,,,,38,32.3,10.8908,38,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Sup Mepilex Border 6 X 6,,A6214,HCPCS,Facility,Outpatient,,,,38,32.3,10.8908,38,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,18.24,48,,percent of total billed charges,,100% of DHS outpatient percentage
Sup Mepilex Border 6 X 6,,A6214,HCPCS,Facility,Inpatient,,,,38,32.3,10.8908,38,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Sup Cl Hydrocolloid Drsg,Sz 16Sq In Or Less,W/Any Adhes Border",,A6237,HCPCS,Facility,Both,,,,25,21.25,7.165,25,Aetna,Commercial,23,92,,percent of total billed charges,,
"Sup Cl Hydrocolloid Drsg,Sz 16Sq In Or Less,W/Any Adhes Border",,A6237,HCPCS,Facility,Outpatient,,,,25,21.25,7.165,25,Aetna,Medicare Advantage,12.25,49,,percent of total billed charges,,
"Sup Cl Hydrocolloid Drsg,Sz 16Sq In Or Less,W/Any Adhes Border",,A6237,HCPCS,Facility,Inpatient,,,,25,21.25,7.165,25,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Sup Cl Hydrocolloid Drsg,Sz 16Sq In Or Less,W/Any Adhes Border",,A6237,HCPCS,Facility,Both,,,,25,21.25,7.165,25,Aetna,PPO,23.25,93,,percent of total billed charges,,
"Sup Cl Hydrocolloid Drsg,Sz 16Sq In Or Less,W/Any Adhes Border",,A6237,HCPCS,Facility,Both,,,,25,21.25,7.165,25,America's PPO,America's PPO,24.0075,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Sup Cl Hydrocolloid Drsg,Sz 16Sq In Or Less,W/Any Adhes Border",,A6237,HCPCS,Facility,Both,,,,25,21.25,7.165,25,BlueCross BlueShield Minnesota, Federal Employee Program,24.6,98.4,,percent of total billed charges,,
"Sup Cl Hydrocolloid Drsg,Sz 16Sq In Or Less,W/Any Adhes Border",,A6237,HCPCS,Facility,Both,,,,25,21.25,7.165,25,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,25,100,,percent of total billed charges,,
"Sup Cl Hydrocolloid Drsg,Sz 16Sq In Or Less,W/Any Adhes Border",,A6237,HCPCS,Facility,Both,,,,25,21.25,7.165,25,BlueCross BlueShield Minnesota,High Value Network Plan,22.5,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
"Sup Cl Hydrocolloid Drsg,Sz 16Sq In Or Less,W/Any Adhes Border",,A6237,HCPCS,Facility,Outpatient,,,,25,21.25,7.165,25,BlueCross BlueShield Minnesota,Medicare Advantage,12.25,49,,percent of total billed charges,,
"Sup Cl Hydrocolloid Drsg,Sz 16Sq In Or Less,W/Any Adhes Border",,A6237,HCPCS,Facility,Inpatient,,,,25,21.25,7.165,25,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Sup Cl Hydrocolloid Drsg,Sz 16Sq In Or Less,W/Any Adhes Border",,A6237,HCPCS,Facility,Both,,,,25,21.25,7.165,25,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,22.1425,88.57,,percent of total billed charges,,
"Sup Cl Hydrocolloid Drsg,Sz 16Sq In Or Less,W/Any Adhes Border",,A6237,HCPCS,Facility,Both,,,,25,21.25,7.165,25,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,7.165,28.66,,percent of total billed charges,,
"Sup Cl Hydrocolloid Drsg,Sz 16Sq In Or Less,W/Any Adhes Border",,A6237,HCPCS,Facility,Outpatient,,,,25,21.25,7.165,25,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),12.25,49,,percent of total billed charges,,
"Sup Cl Hydrocolloid Drsg,Sz 16Sq In Or Less,W/Any Adhes Border",,A6237,HCPCS,Facility,Inpatient,,,,25,21.25,7.165,25,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Sup Cl Hydrocolloid Drsg,Sz 16Sq In Or Less,W/Any Adhes Border",,A6237,HCPCS,Facility,Both,,,,25,21.25,7.165,25,CorVel,Worker's Compensation,25,100,,percent of total billed charges,,
"Sup Cl Hydrocolloid Drsg,Sz 16Sq In Or Less,W/Any Adhes Border",,A6237,HCPCS,Facility,Both,,,,25,21.25,7.165,25,First Health Group Corporation,First Health Network,24.25,97,,percent of total billed charges,,
"Sup Cl Hydrocolloid Drsg,Sz 16Sq In Or Less,W/Any Adhes Border",,A6237,HCPCS,Facility,Both,,,,25,21.25,7.165,25,"Health Partners, Inc.",Commercial,23.65,94.6,,percent of total billed charges,,
"Sup Cl Hydrocolloid Drsg,Sz 16Sq In Or Less,W/Any Adhes Border",,A6237,HCPCS,Facility,Outpatient,,,,25,21.25,7.165,25,"Health Partners, Inc.",Medicare Advantage,12.25,49,,percent of total billed charges,,
"Sup Cl Hydrocolloid Drsg,Sz 16Sq In Or Less,W/Any Adhes Border",,A6237,HCPCS,Facility,Inpatient,,,,25,21.25,7.165,25,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Sup Cl Hydrocolloid Drsg,Sz 16Sq In Or Less,W/Any Adhes Border",,A6237,HCPCS,Facility,Both,,,,25,21.25,7.165,25,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),15,60,,percent of total billed charges,,
"Sup Cl Hydrocolloid Drsg,Sz 16Sq In Or Less,W/Any Adhes Border",,A6237,HCPCS,Facility,Both,,,,25,21.25,7.165,25,"Health Partners, Inc.",State of Minnesota Advantage Program,20.375,81.5,,percent of total billed charges,,
"Sup Cl Hydrocolloid Drsg,Sz 16Sq In Or Less,W/Any Adhes Border",,A6237,HCPCS,Facility,Both,,,,25,21.25,7.165,25,"Health Partners, Inc.",State Public Programs,12.5,50,,percent of total billed charges,,
"Sup Cl Hydrocolloid Drsg,Sz 16Sq In Or Less,W/Any Adhes Border",,A6237,HCPCS,Facility,Both,,,,25,21.25,7.165,25,Humana Insurance Company,Commercial PPO,23.75,95,,percent of total billed charges,,
"Sup Cl Hydrocolloid Drsg,Sz 16Sq In Or Less,W/Any Adhes Border",,A6237,HCPCS,Facility,Outpatient,,,,25,21.25,7.165,25,Humana Insurance Company,Medicare PPO,12.25,49,,percent of total billed charges,,
"Sup Cl Hydrocolloid Drsg,Sz 16Sq In Or Less,W/Any Adhes Border",,A6237,HCPCS,Facility,Inpatient,,,,25,21.25,7.165,25,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Sup Cl Hydrocolloid Drsg,Sz 16Sq In Or Less,W/Any Adhes Border",,A6237,HCPCS,Facility,Both,,,,25,21.25,7.165,25,Medica,Individual & Family,24.775,99.1,,percent of total billed charges,,
"Sup Cl Hydrocolloid Drsg,Sz 16Sq In Or Less,W/Any Adhes Border",,A6237,HCPCS,Facility,Outpatient,,,,25,21.25,7.165,25,Medica,Medica Advantage Solution,12.45,49.8,,percent of total billed charges,,
"Sup Cl Hydrocolloid Drsg,Sz 16Sq In Or Less,W/Any Adhes Border",,A6237,HCPCS,Facility,Inpatient,,,,25,21.25,7.165,25,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Sup Cl Hydrocolloid Drsg,Sz 16Sq In Or Less,W/Any Adhes Border",,A6237,HCPCS,Facility,Outpatient,,,,25,21.25,7.165,25,Medica,Medical Assistance,11.15,44.6,,percent of total billed charges,,
"Sup Cl Hydrocolloid Drsg,Sz 16Sq In Or Less,W/Any Adhes Border",,A6237,HCPCS,Facility,Inpatient,,,,25,21.25,7.165,25,Medica,Medical Assistance,,,,,Included in per diem rate,
"Sup Cl Hydrocolloid Drsg,Sz 16Sq In Or Less,W/Any Adhes Border",,A6237,HCPCS,Facility,Outpatient,,,,25,21.25,7.165,25,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,12.45,49.8,,percent of total billed charges,,
"Sup Cl Hydrocolloid Drsg,Sz 16Sq In Or Less,W/Any Adhes Border",,A6237,HCPCS,Facility,Inpatient,,,,25,21.25,7.165,25,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Sup Cl Hydrocolloid Drsg,Sz 16Sq In Or Less,W/Any Adhes Border",,A6237,HCPCS,Facility,Both,,,,25,21.25,7.165,25,"Multiplan, Inc.","Multiplan, Inc.",23.5,94,,percent of total billed charges,,
"Sup Cl Hydrocolloid Drsg,Sz 16Sq In Or Less,W/Any Adhes Border",,A6237,HCPCS,Facility,Outpatient,,,,25,21.25,7.165,25,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,22.525,90.1,,percent of total billed charges,,
"Sup Cl Hydrocolloid Drsg,Sz 16Sq In Or Less,W/Any Adhes Border",,A6237,HCPCS,Facility,Inpatient,,,,25,21.25,7.165,25,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Sup Cl Hydrocolloid Drsg,Sz 16Sq In Or Less,W/Any Adhes Border",,A6237,HCPCS,Facility,Both,,,,25,21.25,7.165,25,"Preferred One Administrative Services, INC.",PPO,24.65,98.6,,percent of total billed charges,,
"Sup Cl Hydrocolloid Drsg,Sz 16Sq In Or Less,W/Any Adhes Border",,A6237,HCPCS,Facility,Outpatient,,,,25,21.25,7.165,25,PrimeWest Health,Minnesota Senior Health Options (MSHO),12.8625,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Sup Cl Hydrocolloid Drsg,Sz 16Sq In Or Less,W/Any Adhes Border",,A6237,HCPCS,Facility,Inpatient,,,,25,21.25,7.165,25,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Sup Cl Hydrocolloid Drsg,Sz 16Sq In Or Less,W/Any Adhes Border",,A6237,HCPCS,Facility,Outpatient,,,,25,21.25,7.165,25,PrimeWest Health,MinnesotaCare,12.84,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Sup Cl Hydrocolloid Drsg,Sz 16Sq In Or Less,W/Any Adhes Border",,A6237,HCPCS,Facility,Inpatient,,,,25,21.25,7.165,25,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Sup Cl Hydrocolloid Drsg,Sz 16Sq In Or Less,W/Any Adhes Border",,A6237,HCPCS,Facility,Both,,,,25,21.25,7.165,25,Sanford Health Plan,Sanford Health Plan,23,92,,percent of total billed charges,,
"Sup Cl Hydrocolloid Drsg,Sz 16Sq In Or Less,W/Any Adhes Border",,A6237,HCPCS,Facility,Outpatient,,,,25,21.25,7.165,25,"UCare Health, Inc.",Individual & Family Plan,14.0875,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Sup Cl Hydrocolloid Drsg,Sz 16Sq In Or Less,W/Any Adhes Border",,A6237,HCPCS,Facility,Inpatient,,,,25,21.25,7.165,25,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Sup Cl Hydrocolloid Drsg,Sz 16Sq In Or Less,W/Any Adhes Border",,A6237,HCPCS,Facility,Outpatient,,,,25,21.25,7.165,25,"UCare Health, Inc.",Medical Assistance,12.6175,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Sup Cl Hydrocolloid Drsg,Sz 16Sq In Or Less,W/Any Adhes Border",,A6237,HCPCS,Facility,Inpatient,,,,25,21.25,7.165,25,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Sup Cl Hydrocolloid Drsg,Sz 16Sq In Or Less,W/Any Adhes Border",,A6237,HCPCS,Facility,Outpatient,,,,25,21.25,7.165,25,"UCare Health, Inc.",Medicare Advantage,12.6175,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Sup Cl Hydrocolloid Drsg,Sz 16Sq In Or Less,W/Any Adhes Border",,A6237,HCPCS,Facility,Inpatient,,,,25,21.25,7.165,25,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Sup Cl Hydrocolloid Drsg,Sz 16Sq In Or Less,W/Any Adhes Border",,A6237,HCPCS,Facility,Outpatient,,,,25,21.25,7.165,25,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),12.6175,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Sup Cl Hydrocolloid Drsg,Sz 16Sq In Or Less,W/Any Adhes Border",,A6237,HCPCS,Facility,Inpatient,,,,25,21.25,7.165,25,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Sup Cl Hydrocolloid Drsg,Sz 16Sq In Or Less,W/Any Adhes Border",,A6237,HCPCS,Facility,Both,,,,25,21.25,7.165,25,UnitedHealthcare,Individual & Family,23.5,94,,percent of total billed charges,,
"Sup Cl Hydrocolloid Drsg,Sz 16Sq In Or Less,W/Any Adhes Border",,A6237,HCPCS,Facility,Outpatient,,,,25,21.25,7.165,25,UnitedHealthcare,Medicare Advantage,12.25,49,,percent of total billed charges,,
"Sup Cl Hydrocolloid Drsg,Sz 16Sq In Or Less,W/Any Adhes Border",,A6237,HCPCS,Facility,Inpatient,,,,25,21.25,7.165,25,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Sup Cl Hydrocolloid Drsg,Sz 16Sq In Or Less,W/Any Adhes Border",,A6237,HCPCS,Facility,Outpatient,,,,25,21.25,7.165,25,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,12,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Sup Cl Hydrocolloid Drsg,Sz 16Sq In Or Less,W/Any Adhes Border",,A6237,HCPCS,Facility,Inpatient,,,,25,21.25,7.165,25,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Sup Hydrocolloid Wound Dressing,,A6237,HCPCS,Facility,Both,,,,11,9.35,3.1526,11,Aetna,Commercial,10.12,92,,percent of total billed charges,,
Sup Hydrocolloid Wound Dressing,,A6237,HCPCS,Facility,Outpatient,,,,11,9.35,3.1526,11,Aetna,Medicare Advantage,5.39,49,,percent of total billed charges,,
Sup Hydrocolloid Wound Dressing,,A6237,HCPCS,Facility,Inpatient,,,,11,9.35,3.1526,11,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Sup Hydrocolloid Wound Dressing,,A6237,HCPCS,Facility,Both,,,,11,9.35,3.1526,11,Aetna,PPO,10.23,93,,percent of total billed charges,,
Sup Hydrocolloid Wound Dressing,,A6237,HCPCS,Facility,Both,,,,11,9.35,3.1526,11,America's PPO,America's PPO,10.5633,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Sup Hydrocolloid Wound Dressing,,A6237,HCPCS,Facility,Both,,,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota, Federal Employee Program,10.824,98.4,,percent of total billed charges,,
Sup Hydrocolloid Wound Dressing,,A6237,HCPCS,Facility,Both,,,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,11,100,,percent of total billed charges,,
Sup Hydrocolloid Wound Dressing,,A6237,HCPCS,Facility,Both,,,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,High Value Network Plan,9.9,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
Sup Hydrocolloid Wound Dressing,,A6237,HCPCS,Facility,Outpatient,,,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,Medicare Advantage,5.39,49,,percent of total billed charges,,
Sup Hydrocolloid Wound Dressing,,A6237,HCPCS,Facility,Inpatient,,,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Sup Hydrocolloid Wound Dressing,,A6237,HCPCS,Facility,Both,,,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,9.7427,88.57,,percent of total billed charges,,
Sup Hydrocolloid Wound Dressing,,A6237,HCPCS,Facility,Both,,,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,3.1526,28.66,,percent of total billed charges,,
Sup Hydrocolloid Wound Dressing,,A6237,HCPCS,Facility,Outpatient,,,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),5.39,49,,percent of total billed charges,,
Sup Hydrocolloid Wound Dressing,,A6237,HCPCS,Facility,Inpatient,,,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Sup Hydrocolloid Wound Dressing,,A6237,HCPCS,Facility,Both,,,,11,9.35,3.1526,11,CorVel,Worker's Compensation,11,100,,percent of total billed charges,,
Sup Hydrocolloid Wound Dressing,,A6237,HCPCS,Facility,Both,,,,11,9.35,3.1526,11,First Health Group Corporation,First Health Network,10.67,97,,percent of total billed charges,,
Sup Hydrocolloid Wound Dressing,,A6237,HCPCS,Facility,Both,,,,11,9.35,3.1526,11,"Health Partners, Inc.",Commercial,10.406,94.6,,percent of total billed charges,,
Sup Hydrocolloid Wound Dressing,,A6237,HCPCS,Facility,Outpatient,,,,11,9.35,3.1526,11,"Health Partners, Inc.",Medicare Advantage,5.39,49,,percent of total billed charges,,
Sup Hydrocolloid Wound Dressing,,A6237,HCPCS,Facility,Inpatient,,,,11,9.35,3.1526,11,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Hydrocolloid Wound Dressing,,A6237,HCPCS,Facility,Both,,,,11,9.35,3.1526,11,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),6.6,60,,percent of total billed charges,,
Sup Hydrocolloid Wound Dressing,,A6237,HCPCS,Facility,Both,,,,11,9.35,3.1526,11,"Health Partners, Inc.",State of Minnesota Advantage Program,8.965,81.5,,percent of total billed charges,,
Sup Hydrocolloid Wound Dressing,,A6237,HCPCS,Facility,Both,,,,11,9.35,3.1526,11,"Health Partners, Inc.",State Public Programs,5.5,50,,percent of total billed charges,,
Sup Hydrocolloid Wound Dressing,,A6237,HCPCS,Facility,Both,,,,11,9.35,3.1526,11,Humana Insurance Company,Commercial PPO,10.45,95,,percent of total billed charges,,
Sup Hydrocolloid Wound Dressing,,A6237,HCPCS,Facility,Outpatient,,,,11,9.35,3.1526,11,Humana Insurance Company,Medicare PPO,5.39,49,,percent of total billed charges,,
Sup Hydrocolloid Wound Dressing,,A6237,HCPCS,Facility,Inpatient,,,,11,9.35,3.1526,11,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Sup Hydrocolloid Wound Dressing,,A6237,HCPCS,Facility,Both,,,,11,9.35,3.1526,11,Medica,Individual & Family,10.901,99.1,,percent of total billed charges,,
Sup Hydrocolloid Wound Dressing,,A6237,HCPCS,Facility,Outpatient,,,,11,9.35,3.1526,11,Medica,Medica Advantage Solution,5.478,49.8,,percent of total billed charges,,
Sup Hydrocolloid Wound Dressing,,A6237,HCPCS,Facility,Inpatient,,,,11,9.35,3.1526,11,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Sup Hydrocolloid Wound Dressing,,A6237,HCPCS,Facility,Outpatient,,,,11,9.35,3.1526,11,Medica,Medical Assistance,4.906,44.6,,percent of total billed charges,,
Sup Hydrocolloid Wound Dressing,,A6237,HCPCS,Facility,Inpatient,,,,11,9.35,3.1526,11,Medica,Medical Assistance,,,,,Included in per diem rate,
Sup Hydrocolloid Wound Dressing,,A6237,HCPCS,Facility,Outpatient,,,,11,9.35,3.1526,11,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,5.478,49.8,,percent of total billed charges,,
Sup Hydrocolloid Wound Dressing,,A6237,HCPCS,Facility,Inpatient,,,,11,9.35,3.1526,11,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Sup Hydrocolloid Wound Dressing,,A6237,HCPCS,Facility,Both,,,,11,9.35,3.1526,11,"Multiplan, Inc.","Multiplan, Inc.",10.34,94,,percent of total billed charges,,
Sup Hydrocolloid Wound Dressing,,A6237,HCPCS,Facility,Outpatient,,,,11,9.35,3.1526,11,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,9.911,90.1,,percent of total billed charges,,
Sup Hydrocolloid Wound Dressing,,A6237,HCPCS,Facility,Inpatient,,,,11,9.35,3.1526,11,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Sup Hydrocolloid Wound Dressing,,A6237,HCPCS,Facility,Both,,,,11,9.35,3.1526,11,"Preferred One Administrative Services, INC.",PPO,10.846,98.6,,percent of total billed charges,,
Sup Hydrocolloid Wound Dressing,,A6237,HCPCS,Facility,Outpatient,,,,11,9.35,3.1526,11,PrimeWest Health,Minnesota Senior Health Options (MSHO),5.6595,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Sup Hydrocolloid Wound Dressing,,A6237,HCPCS,Facility,Inpatient,,,,11,9.35,3.1526,11,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Hydrocolloid Wound Dressing,,A6237,HCPCS,Facility,Outpatient,,,,11,9.35,3.1526,11,PrimeWest Health,MinnesotaCare,5.6496,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Sup Hydrocolloid Wound Dressing,,A6237,HCPCS,Facility,Inpatient,,,,11,9.35,3.1526,11,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Sup Hydrocolloid Wound Dressing,,A6237,HCPCS,Facility,Both,,,,11,9.35,3.1526,11,Sanford Health Plan,Sanford Health Plan,10.12,92,,percent of total billed charges,,
Sup Hydrocolloid Wound Dressing,,A6237,HCPCS,Facility,Outpatient,,,,11,9.35,3.1526,11,"UCare Health, Inc.",Individual & Family Plan,6.1985,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Sup Hydrocolloid Wound Dressing,,A6237,HCPCS,Facility,Inpatient,,,,11,9.35,3.1526,11,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Sup Hydrocolloid Wound Dressing,,A6237,HCPCS,Facility,Outpatient,,,,11,9.35,3.1526,11,"UCare Health, Inc.",Medical Assistance,5.5517,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Hydrocolloid Wound Dressing,,A6237,HCPCS,Facility,Inpatient,,,,11,9.35,3.1526,11,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Sup Hydrocolloid Wound Dressing,,A6237,HCPCS,Facility,Outpatient,,,,11,9.35,3.1526,11,"UCare Health, Inc.",Medicare Advantage,5.5517,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Hydrocolloid Wound Dressing,,A6237,HCPCS,Facility,Inpatient,,,,11,9.35,3.1526,11,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Hydrocolloid Wound Dressing,,A6237,HCPCS,Facility,Outpatient,,,,11,9.35,3.1526,11,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),5.5517,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Hydrocolloid Wound Dressing,,A6237,HCPCS,Facility,Inpatient,,,,11,9.35,3.1526,11,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Hydrocolloid Wound Dressing,,A6237,HCPCS,Facility,Both,,,,11,9.35,3.1526,11,UnitedHealthcare,Individual & Family,10.34,94,,percent of total billed charges,,
Sup Hydrocolloid Wound Dressing,,A6237,HCPCS,Facility,Outpatient,,,,11,9.35,3.1526,11,UnitedHealthcare,Medicare Advantage,5.39,49,,percent of total billed charges,,
Sup Hydrocolloid Wound Dressing,,A6237,HCPCS,Facility,Inpatient,,,,11,9.35,3.1526,11,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Sup Hydrocolloid Wound Dressing,,A6237,HCPCS,Facility,Outpatient,,,,11,9.35,3.1526,11,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,5.28,48,,percent of total billed charges,,100% of DHS outpatient percentage
Sup Hydrocolloid Wound Dressing,,A6237,HCPCS,Facility,Inpatient,,,,11,9.35,3.1526,11,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Sup Cl Hydrogel Drsg, Wound Cover, Sterile, Pad Size 16 Sq. In Or Less, Wo Adhesive Border, Ea Drsg",,A6242,HCPCS,Facility,Both,,,,48.95,41.6075,14.02907,48.95,Aetna,Commercial,45.034,92,,percent of total billed charges,,
"Sup Cl Hydrogel Drsg, Wound Cover, Sterile, Pad Size 16 Sq. In Or Less, Wo Adhesive Border, Ea Drsg",,A6242,HCPCS,Facility,Outpatient,,,,48.95,41.6075,14.02907,48.95,Aetna,Medicare Advantage,23.9855,49,,percent of total billed charges,,
"Sup Cl Hydrogel Drsg, Wound Cover, Sterile, Pad Size 16 Sq. In Or Less, Wo Adhesive Border, Ea Drsg",,A6242,HCPCS,Facility,Inpatient,,,,48.95,41.6075,14.02907,48.95,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Sup Cl Hydrogel Drsg, Wound Cover, Sterile, Pad Size 16 Sq. In Or Less, Wo Adhesive Border, Ea Drsg",,A6242,HCPCS,Facility,Both,,,,48.95,41.6075,14.02907,48.95,Aetna,PPO,45.5235,93,,percent of total billed charges,,
"Sup Cl Hydrogel Drsg, Wound Cover, Sterile, Pad Size 16 Sq. In Or Less, Wo Adhesive Border, Ea Drsg",,A6242,HCPCS,Facility,Both,,,,48.95,41.6075,14.02907,48.95,America's PPO,America's PPO,47.006685,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Sup Cl Hydrogel Drsg, Wound Cover, Sterile, Pad Size 16 Sq. In Or Less, Wo Adhesive Border, Ea Drsg",,A6242,HCPCS,Facility,Both,,,,48.95,41.6075,14.02907,48.95,BlueCross BlueShield Minnesota, Federal Employee Program,48.1668,98.4,,percent of total billed charges,,
"Sup Cl Hydrogel Drsg, Wound Cover, Sterile, Pad Size 16 Sq. In Or Less, Wo Adhesive Border, Ea Drsg",,A6242,HCPCS,Facility,Both,,,,48.95,41.6075,14.02907,48.95,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,48.95,100,,percent of total billed charges,,
"Sup Cl Hydrogel Drsg, Wound Cover, Sterile, Pad Size 16 Sq. In Or Less, Wo Adhesive Border, Ea Drsg",,A6242,HCPCS,Facility,Both,,,,48.95,41.6075,14.02907,48.95,BlueCross BlueShield Minnesota,High Value Network Plan,44.055,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
"Sup Cl Hydrogel Drsg, Wound Cover, Sterile, Pad Size 16 Sq. In Or Less, Wo Adhesive Border, Ea Drsg",,A6242,HCPCS,Facility,Outpatient,,,,48.95,41.6075,14.02907,48.95,BlueCross BlueShield Minnesota,Medicare Advantage,23.9855,49,,percent of total billed charges,,
"Sup Cl Hydrogel Drsg, Wound Cover, Sterile, Pad Size 16 Sq. In Or Less, Wo Adhesive Border, Ea Drsg",,A6242,HCPCS,Facility,Inpatient,,,,48.95,41.6075,14.02907,48.95,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Sup Cl Hydrogel Drsg, Wound Cover, Sterile, Pad Size 16 Sq. In Or Less, Wo Adhesive Border, Ea Drsg",,A6242,HCPCS,Facility,Both,,,,48.95,41.6075,14.02907,48.95,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,43.355015,88.57,,percent of total billed charges,,
"Sup Cl Hydrogel Drsg, Wound Cover, Sterile, Pad Size 16 Sq. In Or Less, Wo Adhesive Border, Ea Drsg",,A6242,HCPCS,Facility,Both,,,,48.95,41.6075,14.02907,48.95,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,14.02907,28.66,,percent of total billed charges,,
"Sup Cl Hydrogel Drsg, Wound Cover, Sterile, Pad Size 16 Sq. In Or Less, Wo Adhesive Border, Ea Drsg",,A6242,HCPCS,Facility,Outpatient,,,,48.95,41.6075,14.02907,48.95,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),23.9855,49,,percent of total billed charges,,
"Sup Cl Hydrogel Drsg, Wound Cover, Sterile, Pad Size 16 Sq. In Or Less, Wo Adhesive Border, Ea Drsg",,A6242,HCPCS,Facility,Inpatient,,,,48.95,41.6075,14.02907,48.95,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Sup Cl Hydrogel Drsg, Wound Cover, Sterile, Pad Size 16 Sq. In Or Less, Wo Adhesive Border, Ea Drsg",,A6242,HCPCS,Facility,Both,,,,48.95,41.6075,14.02907,48.95,CorVel,Worker's Compensation,48.95,100,,percent of total billed charges,,
"Sup Cl Hydrogel Drsg, Wound Cover, Sterile, Pad Size 16 Sq. In Or Less, Wo Adhesive Border, Ea Drsg",,A6242,HCPCS,Facility,Both,,,,48.95,41.6075,14.02907,48.95,First Health Group Corporation,First Health Network,47.4815,97,,percent of total billed charges,,
"Sup Cl Hydrogel Drsg, Wound Cover, Sterile, Pad Size 16 Sq. In Or Less, Wo Adhesive Border, Ea Drsg",,A6242,HCPCS,Facility,Both,,,,48.95,41.6075,14.02907,48.95,"Health Partners, Inc.",Commercial,46.3067,94.6,,percent of total billed charges,,
"Sup Cl Hydrogel Drsg, Wound Cover, Sterile, Pad Size 16 Sq. In Or Less, Wo Adhesive Border, Ea Drsg",,A6242,HCPCS,Facility,Outpatient,,,,48.95,41.6075,14.02907,48.95,"Health Partners, Inc.",Medicare Advantage,23.9855,49,,percent of total billed charges,,
"Sup Cl Hydrogel Drsg, Wound Cover, Sterile, Pad Size 16 Sq. In Or Less, Wo Adhesive Border, Ea Drsg",,A6242,HCPCS,Facility,Inpatient,,,,48.95,41.6075,14.02907,48.95,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Sup Cl Hydrogel Drsg, Wound Cover, Sterile, Pad Size 16 Sq. In Or Less, Wo Adhesive Border, Ea Drsg",,A6242,HCPCS,Facility,Both,,,,48.95,41.6075,14.02907,48.95,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),29.37,60,,percent of total billed charges,,
"Sup Cl Hydrogel Drsg, Wound Cover, Sterile, Pad Size 16 Sq. In Or Less, Wo Adhesive Border, Ea Drsg",,A6242,HCPCS,Facility,Both,,,,48.95,41.6075,14.02907,48.95,"Health Partners, Inc.",State of Minnesota Advantage Program,39.89425,81.5,,percent of total billed charges,,
"Sup Cl Hydrogel Drsg, Wound Cover, Sterile, Pad Size 16 Sq. In Or Less, Wo Adhesive Border, Ea Drsg",,A6242,HCPCS,Facility,Both,,,,48.95,41.6075,14.02907,48.95,"Health Partners, Inc.",State Public Programs,24.475,50,,percent of total billed charges,,
"Sup Cl Hydrogel Drsg, Wound Cover, Sterile, Pad Size 16 Sq. In Or Less, Wo Adhesive Border, Ea Drsg",,A6242,HCPCS,Facility,Both,,,,48.95,41.6075,14.02907,48.95,Humana Insurance Company,Commercial PPO,46.5025,95,,percent of total billed charges,,
"Sup Cl Hydrogel Drsg, Wound Cover, Sterile, Pad Size 16 Sq. In Or Less, Wo Adhesive Border, Ea Drsg",,A6242,HCPCS,Facility,Outpatient,,,,48.95,41.6075,14.02907,48.95,Humana Insurance Company,Medicare PPO,23.9855,49,,percent of total billed charges,,
"Sup Cl Hydrogel Drsg, Wound Cover, Sterile, Pad Size 16 Sq. In Or Less, Wo Adhesive Border, Ea Drsg",,A6242,HCPCS,Facility,Inpatient,,,,48.95,41.6075,14.02907,48.95,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Sup Cl Hydrogel Drsg, Wound Cover, Sterile, Pad Size 16 Sq. In Or Less, Wo Adhesive Border, Ea Drsg",,A6242,HCPCS,Facility,Both,,,,48.95,41.6075,14.02907,48.95,Medica,Individual & Family,48.50945,99.1,,percent of total billed charges,,
"Sup Cl Hydrogel Drsg, Wound Cover, Sterile, Pad Size 16 Sq. In Or Less, Wo Adhesive Border, Ea Drsg",,A6242,HCPCS,Facility,Outpatient,,,,48.95,41.6075,14.02907,48.95,Medica,Medica Advantage Solution,24.3771,49.8,,percent of total billed charges,,
"Sup Cl Hydrogel Drsg, Wound Cover, Sterile, Pad Size 16 Sq. In Or Less, Wo Adhesive Border, Ea Drsg",,A6242,HCPCS,Facility,Inpatient,,,,48.95,41.6075,14.02907,48.95,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Sup Cl Hydrogel Drsg, Wound Cover, Sterile, Pad Size 16 Sq. In Or Less, Wo Adhesive Border, Ea Drsg",,A6242,HCPCS,Facility,Outpatient,,,,48.95,41.6075,14.02907,48.95,Medica,Medical Assistance,21.8317,44.6,,percent of total billed charges,,
"Sup Cl Hydrogel Drsg, Wound Cover, Sterile, Pad Size 16 Sq. In Or Less, Wo Adhesive Border, Ea Drsg",,A6242,HCPCS,Facility,Inpatient,,,,48.95,41.6075,14.02907,48.95,Medica,Medical Assistance,,,,,Included in per diem rate,
"Sup Cl Hydrogel Drsg, Wound Cover, Sterile, Pad Size 16 Sq. In Or Less, Wo Adhesive Border, Ea Drsg",,A6242,HCPCS,Facility,Outpatient,,,,48.95,41.6075,14.02907,48.95,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,24.3771,49.8,,percent of total billed charges,,
"Sup Cl Hydrogel Drsg, Wound Cover, Sterile, Pad Size 16 Sq. In Or Less, Wo Adhesive Border, Ea Drsg",,A6242,HCPCS,Facility,Inpatient,,,,48.95,41.6075,14.02907,48.95,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Sup Cl Hydrogel Drsg, Wound Cover, Sterile, Pad Size 16 Sq. In Or Less, Wo Adhesive Border, Ea Drsg",,A6242,HCPCS,Facility,Both,,,,48.95,41.6075,14.02907,48.95,"Multiplan, Inc.","Multiplan, Inc.",46.013,94,,percent of total billed charges,,
"Sup Cl Hydrogel Drsg, Wound Cover, Sterile, Pad Size 16 Sq. In Or Less, Wo Adhesive Border, Ea Drsg",,A6242,HCPCS,Facility,Outpatient,,,,48.95,41.6075,14.02907,48.95,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,44.10395,90.1,,percent of total billed charges,,
"Sup Cl Hydrogel Drsg, Wound Cover, Sterile, Pad Size 16 Sq. In Or Less, Wo Adhesive Border, Ea Drsg",,A6242,HCPCS,Facility,Inpatient,,,,48.95,41.6075,14.02907,48.95,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Sup Cl Hydrogel Drsg, Wound Cover, Sterile, Pad Size 16 Sq. In Or Less, Wo Adhesive Border, Ea Drsg",,A6242,HCPCS,Facility,Both,,,,48.95,41.6075,14.02907,48.95,"Preferred One Administrative Services, INC.",PPO,48.2647,98.6,,percent of total billed charges,,
"Sup Cl Hydrogel Drsg, Wound Cover, Sterile, Pad Size 16 Sq. In Or Less, Wo Adhesive Border, Ea Drsg",,A6242,HCPCS,Facility,Outpatient,,,,48.95,41.6075,14.02907,48.95,PrimeWest Health,Minnesota Senior Health Options (MSHO),25.184775,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Sup Cl Hydrogel Drsg, Wound Cover, Sterile, Pad Size 16 Sq. In Or Less, Wo Adhesive Border, Ea Drsg",,A6242,HCPCS,Facility,Inpatient,,,,48.95,41.6075,14.02907,48.95,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Sup Cl Hydrogel Drsg, Wound Cover, Sterile, Pad Size 16 Sq. In Or Less, Wo Adhesive Border, Ea Drsg",,A6242,HCPCS,Facility,Outpatient,,,,48.95,41.6075,14.02907,48.95,PrimeWest Health,MinnesotaCare,25.14072,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Sup Cl Hydrogel Drsg, Wound Cover, Sterile, Pad Size 16 Sq. In Or Less, Wo Adhesive Border, Ea Drsg",,A6242,HCPCS,Facility,Inpatient,,,,48.95,41.6075,14.02907,48.95,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Sup Cl Hydrogel Drsg, Wound Cover, Sterile, Pad Size 16 Sq. In Or Less, Wo Adhesive Border, Ea Drsg",,A6242,HCPCS,Facility,Both,,,,48.95,41.6075,14.02907,48.95,Sanford Health Plan,Sanford Health Plan,45.034,92,,percent of total billed charges,,
"Sup Cl Hydrogel Drsg, Wound Cover, Sterile, Pad Size 16 Sq. In Or Less, Wo Adhesive Border, Ea Drsg",,A6242,HCPCS,Facility,Outpatient,,,,48.95,41.6075,14.02907,48.95,"UCare Health, Inc.",Individual & Family Plan,27.583325,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Sup Cl Hydrogel Drsg, Wound Cover, Sterile, Pad Size 16 Sq. In Or Less, Wo Adhesive Border, Ea Drsg",,A6242,HCPCS,Facility,Inpatient,,,,48.95,41.6075,14.02907,48.95,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Sup Cl Hydrogel Drsg, Wound Cover, Sterile, Pad Size 16 Sq. In Or Less, Wo Adhesive Border, Ea Drsg",,A6242,HCPCS,Facility,Outpatient,,,,48.95,41.6075,14.02907,48.95,"UCare Health, Inc.",Medical Assistance,24.705065,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Sup Cl Hydrogel Drsg, Wound Cover, Sterile, Pad Size 16 Sq. In Or Less, Wo Adhesive Border, Ea Drsg",,A6242,HCPCS,Facility,Inpatient,,,,48.95,41.6075,14.02907,48.95,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Sup Cl Hydrogel Drsg, Wound Cover, Sterile, Pad Size 16 Sq. In Or Less, Wo Adhesive Border, Ea Drsg",,A6242,HCPCS,Facility,Outpatient,,,,48.95,41.6075,14.02907,48.95,"UCare Health, Inc.",Medicare Advantage,24.705065,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Sup Cl Hydrogel Drsg, Wound Cover, Sterile, Pad Size 16 Sq. In Or Less, Wo Adhesive Border, Ea Drsg",,A6242,HCPCS,Facility,Inpatient,,,,48.95,41.6075,14.02907,48.95,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Sup Cl Hydrogel Drsg, Wound Cover, Sterile, Pad Size 16 Sq. In Or Less, Wo Adhesive Border, Ea Drsg",,A6242,HCPCS,Facility,Outpatient,,,,48.95,41.6075,14.02907,48.95,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),24.705065,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Sup Cl Hydrogel Drsg, Wound Cover, Sterile, Pad Size 16 Sq. In Or Less, Wo Adhesive Border, Ea Drsg",,A6242,HCPCS,Facility,Inpatient,,,,48.95,41.6075,14.02907,48.95,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Sup Cl Hydrogel Drsg, Wound Cover, Sterile, Pad Size 16 Sq. In Or Less, Wo Adhesive Border, Ea Drsg",,A6242,HCPCS,Facility,Both,,,,48.95,41.6075,14.02907,48.95,UnitedHealthcare,Individual & Family,46.013,94,,percent of total billed charges,,
"Sup Cl Hydrogel Drsg, Wound Cover, Sterile, Pad Size 16 Sq. In Or Less, Wo Adhesive Border, Ea Drsg",,A6242,HCPCS,Facility,Outpatient,,,,48.95,41.6075,14.02907,48.95,UnitedHealthcare,Medicare Advantage,23.9855,49,,percent of total billed charges,,
"Sup Cl Hydrogel Drsg, Wound Cover, Sterile, Pad Size 16 Sq. In Or Less, Wo Adhesive Border, Ea Drsg",,A6242,HCPCS,Facility,Inpatient,,,,48.95,41.6075,14.02907,48.95,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Sup Cl Hydrogel Drsg, Wound Cover, Sterile, Pad Size 16 Sq. In Or Less, Wo Adhesive Border, Ea Drsg",,A6242,HCPCS,Facility,Outpatient,,,,48.95,41.6075,14.02907,48.95,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,23.496,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Sup Cl Hydrogel Drsg, Wound Cover, Sterile, Pad Size 16 Sq. In Or Less, Wo Adhesive Border, Ea Drsg",,A6242,HCPCS,Facility,Inpatient,,,,48.95,41.6075,14.02907,48.95,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Sup Antifungal Powder Or Cream,,A6250,HCPCS,Facility,Both,,,,22.39,19.0315,6.416974,22.39,Aetna,Commercial,20.5988,92,,percent of total billed charges,,
Sup Antifungal Powder Or Cream,,A6250,HCPCS,Facility,Outpatient,,,,22.39,19.0315,6.416974,22.39,Aetna,Medicare Advantage,10.9711,49,,percent of total billed charges,,
Sup Antifungal Powder Or Cream,,A6250,HCPCS,Facility,Inpatient,,,,22.39,19.0315,6.416974,22.39,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Sup Antifungal Powder Or Cream,,A6250,HCPCS,Facility,Both,,,,22.39,19.0315,6.416974,22.39,Aetna,PPO,20.8227,93,,percent of total billed charges,,
Sup Antifungal Powder Or Cream,,A6250,HCPCS,Facility,Both,,,,22.39,19.0315,6.416974,22.39,America's PPO,America's PPO,21.501117,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Sup Antifungal Powder Or Cream,,A6250,HCPCS,Facility,Both,,,,22.39,19.0315,6.416974,22.39,BlueCross BlueShield Minnesota, Federal Employee Program,22.03176,98.4,,percent of total billed charges,,
Sup Antifungal Powder Or Cream,,A6250,HCPCS,Facility,Both,,,,22.39,19.0315,6.416974,22.39,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,22.39,100,,percent of total billed charges,,
Sup Antifungal Powder Or Cream,,A6250,HCPCS,Facility,Both,,,,22.39,19.0315,6.416974,22.39,BlueCross BlueShield Minnesota,High Value Network Plan,20.151,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
Sup Antifungal Powder Or Cream,,A6250,HCPCS,Facility,Outpatient,,,,22.39,19.0315,6.416974,22.39,BlueCross BlueShield Minnesota,Medicare Advantage,10.9711,49,,percent of total billed charges,,
Sup Antifungal Powder Or Cream,,A6250,HCPCS,Facility,Inpatient,,,,22.39,19.0315,6.416974,22.39,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Sup Antifungal Powder Or Cream,,A6250,HCPCS,Facility,Both,,,,22.39,19.0315,6.416974,22.39,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,19.830823,88.57,,percent of total billed charges,,
Sup Antifungal Powder Or Cream,,A6250,HCPCS,Facility,Both,,,,22.39,19.0315,6.416974,22.39,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,6.416974,28.66,,percent of total billed charges,,
Sup Antifungal Powder Or Cream,,A6250,HCPCS,Facility,Outpatient,,,,22.39,19.0315,6.416974,22.39,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),10.9711,49,,percent of total billed charges,,
Sup Antifungal Powder Or Cream,,A6250,HCPCS,Facility,Inpatient,,,,22.39,19.0315,6.416974,22.39,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Sup Antifungal Powder Or Cream,,A6250,HCPCS,Facility,Both,,,,22.39,19.0315,6.416974,22.39,CorVel,Worker's Compensation,22.39,100,,percent of total billed charges,,
Sup Antifungal Powder Or Cream,,A6250,HCPCS,Facility,Both,,,,22.39,19.0315,6.416974,22.39,First Health Group Corporation,First Health Network,21.7183,97,,percent of total billed charges,,
Sup Antifungal Powder Or Cream,,A6250,HCPCS,Facility,Both,,,,22.39,19.0315,6.416974,22.39,"Health Partners, Inc.",Commercial,21.18094,94.6,,percent of total billed charges,,
Sup Antifungal Powder Or Cream,,A6250,HCPCS,Facility,Outpatient,,,,22.39,19.0315,6.416974,22.39,"Health Partners, Inc.",Medicare Advantage,10.9711,49,,percent of total billed charges,,
Sup Antifungal Powder Or Cream,,A6250,HCPCS,Facility,Inpatient,,,,22.39,19.0315,6.416974,22.39,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Antifungal Powder Or Cream,,A6250,HCPCS,Facility,Both,,,,22.39,19.0315,6.416974,22.39,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),13.434,60,,percent of total billed charges,,
Sup Antifungal Powder Or Cream,,A6250,HCPCS,Facility,Both,,,,22.39,19.0315,6.416974,22.39,"Health Partners, Inc.",State of Minnesota Advantage Program,18.24785,81.5,,percent of total billed charges,,
Sup Antifungal Powder Or Cream,,A6250,HCPCS,Facility,Both,,,,22.39,19.0315,6.416974,22.39,"Health Partners, Inc.",State Public Programs,11.195,50,,percent of total billed charges,,
Sup Antifungal Powder Or Cream,,A6250,HCPCS,Facility,Both,,,,22.39,19.0315,6.416974,22.39,Humana Insurance Company,Commercial PPO,21.2705,95,,percent of total billed charges,,
Sup Antifungal Powder Or Cream,,A6250,HCPCS,Facility,Outpatient,,,,22.39,19.0315,6.416974,22.39,Humana Insurance Company,Medicare PPO,10.9711,49,,percent of total billed charges,,
Sup Antifungal Powder Or Cream,,A6250,HCPCS,Facility,Inpatient,,,,22.39,19.0315,6.416974,22.39,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Sup Antifungal Powder Or Cream,,A6250,HCPCS,Facility,Both,,,,22.39,19.0315,6.416974,22.39,Medica,Individual & Family,22.18849,99.1,,percent of total billed charges,,
Sup Antifungal Powder Or Cream,,A6250,HCPCS,Facility,Outpatient,,,,22.39,19.0315,6.416974,22.39,Medica,Medica Advantage Solution,11.15022,49.8,,percent of total billed charges,,
Sup Antifungal Powder Or Cream,,A6250,HCPCS,Facility,Inpatient,,,,22.39,19.0315,6.416974,22.39,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Sup Antifungal Powder Or Cream,,A6250,HCPCS,Facility,Outpatient,,,,22.39,19.0315,6.416974,22.39,Medica,Medical Assistance,9.98594,44.6,,percent of total billed charges,,
Sup Antifungal Powder Or Cream,,A6250,HCPCS,Facility,Inpatient,,,,22.39,19.0315,6.416974,22.39,Medica,Medical Assistance,,,,,Included in per diem rate,
Sup Antifungal Powder Or Cream,,A6250,HCPCS,Facility,Outpatient,,,,22.39,19.0315,6.416974,22.39,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,11.15022,49.8,,percent of total billed charges,,
Sup Antifungal Powder Or Cream,,A6250,HCPCS,Facility,Inpatient,,,,22.39,19.0315,6.416974,22.39,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Sup Antifungal Powder Or Cream,,A6250,HCPCS,Facility,Both,,,,22.39,19.0315,6.416974,22.39,"Multiplan, Inc.","Multiplan, Inc.",21.0466,94,,percent of total billed charges,,
Sup Antifungal Powder Or Cream,,A6250,HCPCS,Facility,Outpatient,,,,22.39,19.0315,6.416974,22.39,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,20.17339,90.1,,percent of total billed charges,,
Sup Antifungal Powder Or Cream,,A6250,HCPCS,Facility,Inpatient,,,,22.39,19.0315,6.416974,22.39,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Sup Antifungal Powder Or Cream,,A6250,HCPCS,Facility,Both,,,,22.39,19.0315,6.416974,22.39,"Preferred One Administrative Services, INC.",PPO,22.07654,98.6,,percent of total billed charges,,
Sup Antifungal Powder Or Cream,,A6250,HCPCS,Facility,Outpatient,,,,22.39,19.0315,6.416974,22.39,PrimeWest Health,Minnesota Senior Health Options (MSHO),11.519655,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Sup Antifungal Powder Or Cream,,A6250,HCPCS,Facility,Inpatient,,,,22.39,19.0315,6.416974,22.39,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Antifungal Powder Or Cream,,A6250,HCPCS,Facility,Outpatient,,,,22.39,19.0315,6.416974,22.39,PrimeWest Health,MinnesotaCare,11.499504,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Sup Antifungal Powder Or Cream,,A6250,HCPCS,Facility,Inpatient,,,,22.39,19.0315,6.416974,22.39,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Sup Antifungal Powder Or Cream,,A6250,HCPCS,Facility,Both,,,,22.39,19.0315,6.416974,22.39,Sanford Health Plan,Sanford Health Plan,20.5988,92,,percent of total billed charges,,
Sup Antifungal Powder Or Cream,,A6250,HCPCS,Facility,Outpatient,,,,22.39,19.0315,6.416974,22.39,"UCare Health, Inc.",Individual & Family Plan,12.616765,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Sup Antifungal Powder Or Cream,,A6250,HCPCS,Facility,Inpatient,,,,22.39,19.0315,6.416974,22.39,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Sup Antifungal Powder Or Cream,,A6250,HCPCS,Facility,Outpatient,,,,22.39,19.0315,6.416974,22.39,"UCare Health, Inc.",Medical Assistance,11.300233,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Antifungal Powder Or Cream,,A6250,HCPCS,Facility,Inpatient,,,,22.39,19.0315,6.416974,22.39,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Sup Antifungal Powder Or Cream,,A6250,HCPCS,Facility,Outpatient,,,,22.39,19.0315,6.416974,22.39,"UCare Health, Inc.",Medicare Advantage,11.300233,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Antifungal Powder Or Cream,,A6250,HCPCS,Facility,Inpatient,,,,22.39,19.0315,6.416974,22.39,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Antifungal Powder Or Cream,,A6250,HCPCS,Facility,Outpatient,,,,22.39,19.0315,6.416974,22.39,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),11.300233,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Antifungal Powder Or Cream,,A6250,HCPCS,Facility,Inpatient,,,,22.39,19.0315,6.416974,22.39,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Antifungal Powder Or Cream,,A6250,HCPCS,Facility,Both,,,,22.39,19.0315,6.416974,22.39,UnitedHealthcare,Individual & Family,21.0466,94,,percent of total billed charges,,
Sup Antifungal Powder Or Cream,,A6250,HCPCS,Facility,Outpatient,,,,22.39,19.0315,6.416974,22.39,UnitedHealthcare,Medicare Advantage,10.9711,49,,percent of total billed charges,,
Sup Antifungal Powder Or Cream,,A6250,HCPCS,Facility,Inpatient,,,,22.39,19.0315,6.416974,22.39,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Sup Antifungal Powder Or Cream,,A6250,HCPCS,Facility,Outpatient,,,,22.39,19.0315,6.416974,22.39,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,10.7472,48,,percent of total billed charges,,100% of DHS outpatient percentage
Sup Antifungal Powder Or Cream,,A6250,HCPCS,Facility,Inpatient,,,,22.39,19.0315,6.416974,22.39,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Sup Liquid Skin Protectant .5 Gm Vial, 5 Pkg",,A6250,HCPCS,Facility,Both,,,,72.83,61.9055,20.873078,72.83,Aetna,Commercial,67.0036,92,,percent of total billed charges,,
"Sup Liquid Skin Protectant .5 Gm Vial, 5 Pkg",,A6250,HCPCS,Facility,Outpatient,,,,72.83,61.9055,20.873078,72.83,Aetna,Medicare Advantage,35.6867,49,,percent of total billed charges,,
"Sup Liquid Skin Protectant .5 Gm Vial, 5 Pkg",,A6250,HCPCS,Facility,Inpatient,,,,72.83,61.9055,20.873078,72.83,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Sup Liquid Skin Protectant .5 Gm Vial, 5 Pkg",,A6250,HCPCS,Facility,Both,,,,72.83,61.9055,20.873078,72.83,Aetna,PPO,67.7319,93,,percent of total billed charges,,
"Sup Liquid Skin Protectant .5 Gm Vial, 5 Pkg",,A6250,HCPCS,Facility,Both,,,,72.83,61.9055,20.873078,72.83,America's PPO,America's PPO,69.938649,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Sup Liquid Skin Protectant .5 Gm Vial, 5 Pkg",,A6250,HCPCS,Facility,Both,,,,72.83,61.9055,20.873078,72.83,BlueCross BlueShield Minnesota, Federal Employee Program,71.66472,98.4,,percent of total billed charges,,
"Sup Liquid Skin Protectant .5 Gm Vial, 5 Pkg",,A6250,HCPCS,Facility,Both,,,,72.83,61.9055,20.873078,72.83,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,72.83,100,,percent of total billed charges,,
"Sup Liquid Skin Protectant .5 Gm Vial, 5 Pkg",,A6250,HCPCS,Facility,Both,,,,72.83,61.9055,20.873078,72.83,BlueCross BlueShield Minnesota,High Value Network Plan,65.547,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
"Sup Liquid Skin Protectant .5 Gm Vial, 5 Pkg",,A6250,HCPCS,Facility,Outpatient,,,,72.83,61.9055,20.873078,72.83,BlueCross BlueShield Minnesota,Medicare Advantage,35.6867,49,,percent of total billed charges,,
"Sup Liquid Skin Protectant .5 Gm Vial, 5 Pkg",,A6250,HCPCS,Facility,Inpatient,,,,72.83,61.9055,20.873078,72.83,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Sup Liquid Skin Protectant .5 Gm Vial, 5 Pkg",,A6250,HCPCS,Facility,Both,,,,72.83,61.9055,20.873078,72.83,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,64.505531,88.57,,percent of total billed charges,,
"Sup Liquid Skin Protectant .5 Gm Vial, 5 Pkg",,A6250,HCPCS,Facility,Both,,,,72.83,61.9055,20.873078,72.83,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,20.873078,28.66,,percent of total billed charges,,
"Sup Liquid Skin Protectant .5 Gm Vial, 5 Pkg",,A6250,HCPCS,Facility,Outpatient,,,,72.83,61.9055,20.873078,72.83,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),35.6867,49,,percent of total billed charges,,
"Sup Liquid Skin Protectant .5 Gm Vial, 5 Pkg",,A6250,HCPCS,Facility,Inpatient,,,,72.83,61.9055,20.873078,72.83,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Sup Liquid Skin Protectant .5 Gm Vial, 5 Pkg",,A6250,HCPCS,Facility,Both,,,,72.83,61.9055,20.873078,72.83,CorVel,Worker's Compensation,72.83,100,,percent of total billed charges,,
"Sup Liquid Skin Protectant .5 Gm Vial, 5 Pkg",,A6250,HCPCS,Facility,Both,,,,72.83,61.9055,20.873078,72.83,First Health Group Corporation,First Health Network,70.6451,97,,percent of total billed charges,,
"Sup Liquid Skin Protectant .5 Gm Vial, 5 Pkg",,A6250,HCPCS,Facility,Both,,,,72.83,61.9055,20.873078,72.83,"Health Partners, Inc.",Commercial,68.89718,94.6,,percent of total billed charges,,
"Sup Liquid Skin Protectant .5 Gm Vial, 5 Pkg",,A6250,HCPCS,Facility,Outpatient,,,,72.83,61.9055,20.873078,72.83,"Health Partners, Inc.",Medicare Advantage,35.6867,49,,percent of total billed charges,,
"Sup Liquid Skin Protectant .5 Gm Vial, 5 Pkg",,A6250,HCPCS,Facility,Inpatient,,,,72.83,61.9055,20.873078,72.83,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Sup Liquid Skin Protectant .5 Gm Vial, 5 Pkg",,A6250,HCPCS,Facility,Both,,,,72.83,61.9055,20.873078,72.83,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),43.698,60,,percent of total billed charges,,
"Sup Liquid Skin Protectant .5 Gm Vial, 5 Pkg",,A6250,HCPCS,Facility,Both,,,,72.83,61.9055,20.873078,72.83,"Health Partners, Inc.",State of Minnesota Advantage Program,59.35645,81.5,,percent of total billed charges,,
"Sup Liquid Skin Protectant .5 Gm Vial, 5 Pkg",,A6250,HCPCS,Facility,Both,,,,72.83,61.9055,20.873078,72.83,"Health Partners, Inc.",State Public Programs,36.415,50,,percent of total billed charges,,
"Sup Liquid Skin Protectant .5 Gm Vial, 5 Pkg",,A6250,HCPCS,Facility,Both,,,,72.83,61.9055,20.873078,72.83,Humana Insurance Company,Commercial PPO,69.1885,95,,percent of total billed charges,,
"Sup Liquid Skin Protectant .5 Gm Vial, 5 Pkg",,A6250,HCPCS,Facility,Outpatient,,,,72.83,61.9055,20.873078,72.83,Humana Insurance Company,Medicare PPO,35.6867,49,,percent of total billed charges,,
"Sup Liquid Skin Protectant .5 Gm Vial, 5 Pkg",,A6250,HCPCS,Facility,Inpatient,,,,72.83,61.9055,20.873078,72.83,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Sup Liquid Skin Protectant .5 Gm Vial, 5 Pkg",,A6250,HCPCS,Facility,Both,,,,72.83,61.9055,20.873078,72.83,Medica,Individual & Family,72.17453,99.1,,percent of total billed charges,,
"Sup Liquid Skin Protectant .5 Gm Vial, 5 Pkg",,A6250,HCPCS,Facility,Outpatient,,,,72.83,61.9055,20.873078,72.83,Medica,Medica Advantage Solution,36.26934,49.8,,percent of total billed charges,,
"Sup Liquid Skin Protectant .5 Gm Vial, 5 Pkg",,A6250,HCPCS,Facility,Inpatient,,,,72.83,61.9055,20.873078,72.83,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Sup Liquid Skin Protectant .5 Gm Vial, 5 Pkg",,A6250,HCPCS,Facility,Outpatient,,,,72.83,61.9055,20.873078,72.83,Medica,Medical Assistance,32.48218,44.6,,percent of total billed charges,,
"Sup Liquid Skin Protectant .5 Gm Vial, 5 Pkg",,A6250,HCPCS,Facility,Inpatient,,,,72.83,61.9055,20.873078,72.83,Medica,Medical Assistance,,,,,Included in per diem rate,
"Sup Liquid Skin Protectant .5 Gm Vial, 5 Pkg",,A6250,HCPCS,Facility,Outpatient,,,,72.83,61.9055,20.873078,72.83,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,36.26934,49.8,,percent of total billed charges,,
"Sup Liquid Skin Protectant .5 Gm Vial, 5 Pkg",,A6250,HCPCS,Facility,Inpatient,,,,72.83,61.9055,20.873078,72.83,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Sup Liquid Skin Protectant .5 Gm Vial, 5 Pkg",,A6250,HCPCS,Facility,Both,,,,72.83,61.9055,20.873078,72.83,"Multiplan, Inc.","Multiplan, Inc.",68.4602,94,,percent of total billed charges,,
"Sup Liquid Skin Protectant .5 Gm Vial, 5 Pkg",,A6250,HCPCS,Facility,Outpatient,,,,72.83,61.9055,20.873078,72.83,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,65.61983,90.1,,percent of total billed charges,,
"Sup Liquid Skin Protectant .5 Gm Vial, 5 Pkg",,A6250,HCPCS,Facility,Inpatient,,,,72.83,61.9055,20.873078,72.83,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Sup Liquid Skin Protectant .5 Gm Vial, 5 Pkg",,A6250,HCPCS,Facility,Both,,,,72.83,61.9055,20.873078,72.83,"Preferred One Administrative Services, INC.",PPO,71.81038,98.6,,percent of total billed charges,,
"Sup Liquid Skin Protectant .5 Gm Vial, 5 Pkg",,A6250,HCPCS,Facility,Outpatient,,,,72.83,61.9055,20.873078,72.83,PrimeWest Health,Minnesota Senior Health Options (MSHO),37.471035,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Sup Liquid Skin Protectant .5 Gm Vial, 5 Pkg",,A6250,HCPCS,Facility,Inpatient,,,,72.83,61.9055,20.873078,72.83,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Sup Liquid Skin Protectant .5 Gm Vial, 5 Pkg",,A6250,HCPCS,Facility,Outpatient,,,,72.83,61.9055,20.873078,72.83,PrimeWest Health,MinnesotaCare,37.405488,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Sup Liquid Skin Protectant .5 Gm Vial, 5 Pkg",,A6250,HCPCS,Facility,Inpatient,,,,72.83,61.9055,20.873078,72.83,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Sup Liquid Skin Protectant .5 Gm Vial, 5 Pkg",,A6250,HCPCS,Facility,Both,,,,72.83,61.9055,20.873078,72.83,Sanford Health Plan,Sanford Health Plan,67.0036,92,,percent of total billed charges,,
"Sup Liquid Skin Protectant .5 Gm Vial, 5 Pkg",,A6250,HCPCS,Facility,Outpatient,,,,72.83,61.9055,20.873078,72.83,"UCare Health, Inc.",Individual & Family Plan,41.039705,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Sup Liquid Skin Protectant .5 Gm Vial, 5 Pkg",,A6250,HCPCS,Facility,Inpatient,,,,72.83,61.9055,20.873078,72.83,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Sup Liquid Skin Protectant .5 Gm Vial, 5 Pkg",,A6250,HCPCS,Facility,Outpatient,,,,72.83,61.9055,20.873078,72.83,"UCare Health, Inc.",Medical Assistance,36.757301,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Sup Liquid Skin Protectant .5 Gm Vial, 5 Pkg",,A6250,HCPCS,Facility,Inpatient,,,,72.83,61.9055,20.873078,72.83,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Sup Liquid Skin Protectant .5 Gm Vial, 5 Pkg",,A6250,HCPCS,Facility,Outpatient,,,,72.83,61.9055,20.873078,72.83,"UCare Health, Inc.",Medicare Advantage,36.757301,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Sup Liquid Skin Protectant .5 Gm Vial, 5 Pkg",,A6250,HCPCS,Facility,Inpatient,,,,72.83,61.9055,20.873078,72.83,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Sup Liquid Skin Protectant .5 Gm Vial, 5 Pkg",,A6250,HCPCS,Facility,Outpatient,,,,72.83,61.9055,20.873078,72.83,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),36.757301,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Sup Liquid Skin Protectant .5 Gm Vial, 5 Pkg",,A6250,HCPCS,Facility,Inpatient,,,,72.83,61.9055,20.873078,72.83,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Sup Liquid Skin Protectant .5 Gm Vial, 5 Pkg",,A6250,HCPCS,Facility,Both,,,,72.83,61.9055,20.873078,72.83,UnitedHealthcare,Individual & Family,68.4602,94,,percent of total billed charges,,
"Sup Liquid Skin Protectant .5 Gm Vial, 5 Pkg",,A6250,HCPCS,Facility,Outpatient,,,,72.83,61.9055,20.873078,72.83,UnitedHealthcare,Medicare Advantage,35.6867,49,,percent of total billed charges,,
"Sup Liquid Skin Protectant .5 Gm Vial, 5 Pkg",,A6250,HCPCS,Facility,Inpatient,,,,72.83,61.9055,20.873078,72.83,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Sup Liquid Skin Protectant .5 Gm Vial, 5 Pkg",,A6250,HCPCS,Facility,Outpatient,,,,72.83,61.9055,20.873078,72.83,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,34.9584,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Sup Liquid Skin Protectant .5 Gm Vial, 5 Pkg",,A6250,HCPCS,Facility,Inpatient,,,,72.83,61.9055,20.873078,72.83,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Sup Moisture Barrier Calazime Paste, All Size",,A6250,HCPCS,Facility,Both,,,,22.27,18.9295,6.382582,22.27,Aetna,Commercial,20.4884,92,,percent of total billed charges,,
"Sup Moisture Barrier Calazime Paste, All Size",,A6250,HCPCS,Facility,Outpatient,,,,22.27,18.9295,6.382582,22.27,Aetna,Medicare Advantage,10.9123,49,,percent of total billed charges,,
"Sup Moisture Barrier Calazime Paste, All Size",,A6250,HCPCS,Facility,Inpatient,,,,22.27,18.9295,6.382582,22.27,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Sup Moisture Barrier Calazime Paste, All Size",,A6250,HCPCS,Facility,Both,,,,22.27,18.9295,6.382582,22.27,Aetna,PPO,20.7111,93,,percent of total billed charges,,
"Sup Moisture Barrier Calazime Paste, All Size",,A6250,HCPCS,Facility,Both,,,,22.27,18.9295,6.382582,22.27,America's PPO,America's PPO,21.385881,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Sup Moisture Barrier Calazime Paste, All Size",,A6250,HCPCS,Facility,Both,,,,22.27,18.9295,6.382582,22.27,BlueCross BlueShield Minnesota, Federal Employee Program,21.91368,98.4,,percent of total billed charges,,
"Sup Moisture Barrier Calazime Paste, All Size",,A6250,HCPCS,Facility,Both,,,,22.27,18.9295,6.382582,22.27,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,22.27,100,,percent of total billed charges,,
"Sup Moisture Barrier Calazime Paste, All Size",,A6250,HCPCS,Facility,Both,,,,22.27,18.9295,6.382582,22.27,BlueCross BlueShield Minnesota,High Value Network Plan,20.043,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
"Sup Moisture Barrier Calazime Paste, All Size",,A6250,HCPCS,Facility,Outpatient,,,,22.27,18.9295,6.382582,22.27,BlueCross BlueShield Minnesota,Medicare Advantage,10.9123,49,,percent of total billed charges,,
"Sup Moisture Barrier Calazime Paste, All Size",,A6250,HCPCS,Facility,Inpatient,,,,22.27,18.9295,6.382582,22.27,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Sup Moisture Barrier Calazime Paste, All Size",,A6250,HCPCS,Facility,Both,,,,22.27,18.9295,6.382582,22.27,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,19.724539,88.57,,percent of total billed charges,,
"Sup Moisture Barrier Calazime Paste, All Size",,A6250,HCPCS,Facility,Both,,,,22.27,18.9295,6.382582,22.27,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,6.382582,28.66,,percent of total billed charges,,
"Sup Moisture Barrier Calazime Paste, All Size",,A6250,HCPCS,Facility,Outpatient,,,,22.27,18.9295,6.382582,22.27,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),10.9123,49,,percent of total billed charges,,
"Sup Moisture Barrier Calazime Paste, All Size",,A6250,HCPCS,Facility,Inpatient,,,,22.27,18.9295,6.382582,22.27,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Sup Moisture Barrier Calazime Paste, All Size",,A6250,HCPCS,Facility,Both,,,,22.27,18.9295,6.382582,22.27,CorVel,Worker's Compensation,22.27,100,,percent of total billed charges,,
"Sup Moisture Barrier Calazime Paste, All Size",,A6250,HCPCS,Facility,Both,,,,22.27,18.9295,6.382582,22.27,First Health Group Corporation,First Health Network,21.6019,97,,percent of total billed charges,,
"Sup Moisture Barrier Calazime Paste, All Size",,A6250,HCPCS,Facility,Both,,,,22.27,18.9295,6.382582,22.27,"Health Partners, Inc.",Commercial,21.06742,94.6,,percent of total billed charges,,
"Sup Moisture Barrier Calazime Paste, All Size",,A6250,HCPCS,Facility,Outpatient,,,,22.27,18.9295,6.382582,22.27,"Health Partners, Inc.",Medicare Advantage,10.9123,49,,percent of total billed charges,,
"Sup Moisture Barrier Calazime Paste, All Size",,A6250,HCPCS,Facility,Inpatient,,,,22.27,18.9295,6.382582,22.27,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Sup Moisture Barrier Calazime Paste, All Size",,A6250,HCPCS,Facility,Both,,,,22.27,18.9295,6.382582,22.27,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),13.362,60,,percent of total billed charges,,
"Sup Moisture Barrier Calazime Paste, All Size",,A6250,HCPCS,Facility,Both,,,,22.27,18.9295,6.382582,22.27,"Health Partners, Inc.",State of Minnesota Advantage Program,18.15005,81.5,,percent of total billed charges,,
"Sup Moisture Barrier Calazime Paste, All Size",,A6250,HCPCS,Facility,Both,,,,22.27,18.9295,6.382582,22.27,"Health Partners, Inc.",State Public Programs,11.135,50,,percent of total billed charges,,
"Sup Moisture Barrier Calazime Paste, All Size",,A6250,HCPCS,Facility,Both,,,,22.27,18.9295,6.382582,22.27,Humana Insurance Company,Commercial PPO,21.1565,95,,percent of total billed charges,,
"Sup Moisture Barrier Calazime Paste, All Size",,A6250,HCPCS,Facility,Outpatient,,,,22.27,18.9295,6.382582,22.27,Humana Insurance Company,Medicare PPO,10.9123,49,,percent of total billed charges,,
"Sup Moisture Barrier Calazime Paste, All Size",,A6250,HCPCS,Facility,Inpatient,,,,22.27,18.9295,6.382582,22.27,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Sup Moisture Barrier Calazime Paste, All Size",,A6250,HCPCS,Facility,Both,,,,22.27,18.9295,6.382582,22.27,Medica,Individual & Family,22.06957,99.1,,percent of total billed charges,,
"Sup Moisture Barrier Calazime Paste, All Size",,A6250,HCPCS,Facility,Outpatient,,,,22.27,18.9295,6.382582,22.27,Medica,Medica Advantage Solution,11.09046,49.8,,percent of total billed charges,,
"Sup Moisture Barrier Calazime Paste, All Size",,A6250,HCPCS,Facility,Inpatient,,,,22.27,18.9295,6.382582,22.27,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Sup Moisture Barrier Calazime Paste, All Size",,A6250,HCPCS,Facility,Outpatient,,,,22.27,18.9295,6.382582,22.27,Medica,Medical Assistance,9.93242,44.6,,percent of total billed charges,,
"Sup Moisture Barrier Calazime Paste, All Size",,A6250,HCPCS,Facility,Inpatient,,,,22.27,18.9295,6.382582,22.27,Medica,Medical Assistance,,,,,Included in per diem rate,
"Sup Moisture Barrier Calazime Paste, All Size",,A6250,HCPCS,Facility,Outpatient,,,,22.27,18.9295,6.382582,22.27,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,11.09046,49.8,,percent of total billed charges,,
"Sup Moisture Barrier Calazime Paste, All Size",,A6250,HCPCS,Facility,Inpatient,,,,22.27,18.9295,6.382582,22.27,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Sup Moisture Barrier Calazime Paste, All Size",,A6250,HCPCS,Facility,Both,,,,22.27,18.9295,6.382582,22.27,"Multiplan, Inc.","Multiplan, Inc.",20.9338,94,,percent of total billed charges,,
"Sup Moisture Barrier Calazime Paste, All Size",,A6250,HCPCS,Facility,Outpatient,,,,22.27,18.9295,6.382582,22.27,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,20.06527,90.1,,percent of total billed charges,,
"Sup Moisture Barrier Calazime Paste, All Size",,A6250,HCPCS,Facility,Inpatient,,,,22.27,18.9295,6.382582,22.27,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Sup Moisture Barrier Calazime Paste, All Size",,A6250,HCPCS,Facility,Both,,,,22.27,18.9295,6.382582,22.27,"Preferred One Administrative Services, INC.",PPO,21.95822,98.6,,percent of total billed charges,,
"Sup Moisture Barrier Calazime Paste, All Size",,A6250,HCPCS,Facility,Outpatient,,,,22.27,18.9295,6.382582,22.27,PrimeWest Health,Minnesota Senior Health Options (MSHO),11.457915,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Sup Moisture Barrier Calazime Paste, All Size",,A6250,HCPCS,Facility,Inpatient,,,,22.27,18.9295,6.382582,22.27,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Sup Moisture Barrier Calazime Paste, All Size",,A6250,HCPCS,Facility,Outpatient,,,,22.27,18.9295,6.382582,22.27,PrimeWest Health,MinnesotaCare,11.437872,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Sup Moisture Barrier Calazime Paste, All Size",,A6250,HCPCS,Facility,Inpatient,,,,22.27,18.9295,6.382582,22.27,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Sup Moisture Barrier Calazime Paste, All Size",,A6250,HCPCS,Facility,Both,,,,22.27,18.9295,6.382582,22.27,Sanford Health Plan,Sanford Health Plan,20.4884,92,,percent of total billed charges,,
"Sup Moisture Barrier Calazime Paste, All Size",,A6250,HCPCS,Facility,Outpatient,,,,22.27,18.9295,6.382582,22.27,"UCare Health, Inc.",Individual & Family Plan,12.549145,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Sup Moisture Barrier Calazime Paste, All Size",,A6250,HCPCS,Facility,Inpatient,,,,22.27,18.9295,6.382582,22.27,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Sup Moisture Barrier Calazime Paste, All Size",,A6250,HCPCS,Facility,Outpatient,,,,22.27,18.9295,6.382582,22.27,"UCare Health, Inc.",Medical Assistance,11.239669,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Sup Moisture Barrier Calazime Paste, All Size",,A6250,HCPCS,Facility,Inpatient,,,,22.27,18.9295,6.382582,22.27,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Sup Moisture Barrier Calazime Paste, All Size",,A6250,HCPCS,Facility,Outpatient,,,,22.27,18.9295,6.382582,22.27,"UCare Health, Inc.",Medicare Advantage,11.239669,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Sup Moisture Barrier Calazime Paste, All Size",,A6250,HCPCS,Facility,Inpatient,,,,22.27,18.9295,6.382582,22.27,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Sup Moisture Barrier Calazime Paste, All Size",,A6250,HCPCS,Facility,Outpatient,,,,22.27,18.9295,6.382582,22.27,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),11.239669,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Sup Moisture Barrier Calazime Paste, All Size",,A6250,HCPCS,Facility,Inpatient,,,,22.27,18.9295,6.382582,22.27,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Sup Moisture Barrier Calazime Paste, All Size",,A6250,HCPCS,Facility,Both,,,,22.27,18.9295,6.382582,22.27,UnitedHealthcare,Individual & Family,20.9338,94,,percent of total billed charges,,
"Sup Moisture Barrier Calazime Paste, All Size",,A6250,HCPCS,Facility,Outpatient,,,,22.27,18.9295,6.382582,22.27,UnitedHealthcare,Medicare Advantage,10.9123,49,,percent of total billed charges,,
"Sup Moisture Barrier Calazime Paste, All Size",,A6250,HCPCS,Facility,Inpatient,,,,22.27,18.9295,6.382582,22.27,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Sup Moisture Barrier Calazime Paste, All Size",,A6250,HCPCS,Facility,Outpatient,,,,22.27,18.9295,6.382582,22.27,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,10.6896,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Sup Moisture Barrier Calazime Paste, All Size",,A6250,HCPCS,Facility,Inpatient,,,,22.27,18.9295,6.382582,22.27,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Sup Skin Cream Dimethicone 5%,,A6250,HCPCS,Facility,Both,,,,55.28,46.988,15.843248,55.28,Aetna,Commercial,50.8576,92,,percent of total billed charges,,
Sup Skin Cream Dimethicone 5%,,A6250,HCPCS,Facility,Outpatient,,,,55.28,46.988,15.843248,55.28,Aetna,Medicare Advantage,27.0872,49,,percent of total billed charges,,
Sup Skin Cream Dimethicone 5%,,A6250,HCPCS,Facility,Inpatient,,,,55.28,46.988,15.843248,55.28,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Sup Skin Cream Dimethicone 5%,,A6250,HCPCS,Facility,Both,,,,55.28,46.988,15.843248,55.28,Aetna,PPO,51.4104,93,,percent of total billed charges,,
Sup Skin Cream Dimethicone 5%,,A6250,HCPCS,Facility,Both,,,,55.28,46.988,15.843248,55.28,America's PPO,America's PPO,53.085384,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Sup Skin Cream Dimethicone 5%,,A6250,HCPCS,Facility,Both,,,,55.28,46.988,15.843248,55.28,BlueCross BlueShield Minnesota, Federal Employee Program,54.39552,98.4,,percent of total billed charges,,
Sup Skin Cream Dimethicone 5%,,A6250,HCPCS,Facility,Both,,,,55.28,46.988,15.843248,55.28,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,55.28,100,,percent of total billed charges,,
Sup Skin Cream Dimethicone 5%,,A6250,HCPCS,Facility,Both,,,,55.28,46.988,15.843248,55.28,BlueCross BlueShield Minnesota,High Value Network Plan,49.752,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
Sup Skin Cream Dimethicone 5%,,A6250,HCPCS,Facility,Outpatient,,,,55.28,46.988,15.843248,55.28,BlueCross BlueShield Minnesota,Medicare Advantage,27.0872,49,,percent of total billed charges,,
Sup Skin Cream Dimethicone 5%,,A6250,HCPCS,Facility,Inpatient,,,,55.28,46.988,15.843248,55.28,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Sup Skin Cream Dimethicone 5%,,A6250,HCPCS,Facility,Both,,,,55.28,46.988,15.843248,55.28,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,48.961496,88.57,,percent of total billed charges,,
Sup Skin Cream Dimethicone 5%,,A6250,HCPCS,Facility,Both,,,,55.28,46.988,15.843248,55.28,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,15.843248,28.66,,percent of total billed charges,,
Sup Skin Cream Dimethicone 5%,,A6250,HCPCS,Facility,Outpatient,,,,55.28,46.988,15.843248,55.28,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),27.0872,49,,percent of total billed charges,,
Sup Skin Cream Dimethicone 5%,,A6250,HCPCS,Facility,Inpatient,,,,55.28,46.988,15.843248,55.28,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Sup Skin Cream Dimethicone 5%,,A6250,HCPCS,Facility,Both,,,,55.28,46.988,15.843248,55.28,CorVel,Worker's Compensation,55.28,100,,percent of total billed charges,,
Sup Skin Cream Dimethicone 5%,,A6250,HCPCS,Facility,Both,,,,55.28,46.988,15.843248,55.28,First Health Group Corporation,First Health Network,53.6216,97,,percent of total billed charges,,
Sup Skin Cream Dimethicone 5%,,A6250,HCPCS,Facility,Both,,,,55.28,46.988,15.843248,55.28,"Health Partners, Inc.",Commercial,52.29488,94.6,,percent of total billed charges,,
Sup Skin Cream Dimethicone 5%,,A6250,HCPCS,Facility,Outpatient,,,,55.28,46.988,15.843248,55.28,"Health Partners, Inc.",Medicare Advantage,27.0872,49,,percent of total billed charges,,
Sup Skin Cream Dimethicone 5%,,A6250,HCPCS,Facility,Inpatient,,,,55.28,46.988,15.843248,55.28,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Skin Cream Dimethicone 5%,,A6250,HCPCS,Facility,Both,,,,55.28,46.988,15.843248,55.28,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),33.168,60,,percent of total billed charges,,
Sup Skin Cream Dimethicone 5%,,A6250,HCPCS,Facility,Both,,,,55.28,46.988,15.843248,55.28,"Health Partners, Inc.",State of Minnesota Advantage Program,45.0532,81.5,,percent of total billed charges,,
Sup Skin Cream Dimethicone 5%,,A6250,HCPCS,Facility,Both,,,,55.28,46.988,15.843248,55.28,"Health Partners, Inc.",State Public Programs,27.64,50,,percent of total billed charges,,
Sup Skin Cream Dimethicone 5%,,A6250,HCPCS,Facility,Both,,,,55.28,46.988,15.843248,55.28,Humana Insurance Company,Commercial PPO,52.516,95,,percent of total billed charges,,
Sup Skin Cream Dimethicone 5%,,A6250,HCPCS,Facility,Outpatient,,,,55.28,46.988,15.843248,55.28,Humana Insurance Company,Medicare PPO,27.0872,49,,percent of total billed charges,,
Sup Skin Cream Dimethicone 5%,,A6250,HCPCS,Facility,Inpatient,,,,55.28,46.988,15.843248,55.28,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Sup Skin Cream Dimethicone 5%,,A6250,HCPCS,Facility,Both,,,,55.28,46.988,15.843248,55.28,Medica,Individual & Family,54.78248,99.1,,percent of total billed charges,,
Sup Skin Cream Dimethicone 5%,,A6250,HCPCS,Facility,Outpatient,,,,55.28,46.988,15.843248,55.28,Medica,Medica Advantage Solution,27.52944,49.8,,percent of total billed charges,,
Sup Skin Cream Dimethicone 5%,,A6250,HCPCS,Facility,Inpatient,,,,55.28,46.988,15.843248,55.28,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Sup Skin Cream Dimethicone 5%,,A6250,HCPCS,Facility,Outpatient,,,,55.28,46.988,15.843248,55.28,Medica,Medical Assistance,24.65488,44.6,,percent of total billed charges,,
Sup Skin Cream Dimethicone 5%,,A6250,HCPCS,Facility,Inpatient,,,,55.28,46.988,15.843248,55.28,Medica,Medical Assistance,,,,,Included in per diem rate,
Sup Skin Cream Dimethicone 5%,,A6250,HCPCS,Facility,Outpatient,,,,55.28,46.988,15.843248,55.28,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,27.52944,49.8,,percent of total billed charges,,
Sup Skin Cream Dimethicone 5%,,A6250,HCPCS,Facility,Inpatient,,,,55.28,46.988,15.843248,55.28,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Sup Skin Cream Dimethicone 5%,,A6250,HCPCS,Facility,Both,,,,55.28,46.988,15.843248,55.28,"Multiplan, Inc.","Multiplan, Inc.",51.9632,94,,percent of total billed charges,,
Sup Skin Cream Dimethicone 5%,,A6250,HCPCS,Facility,Outpatient,,,,55.28,46.988,15.843248,55.28,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,49.80728,90.1,,percent of total billed charges,,
Sup Skin Cream Dimethicone 5%,,A6250,HCPCS,Facility,Inpatient,,,,55.28,46.988,15.843248,55.28,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Sup Skin Cream Dimethicone 5%,,A6250,HCPCS,Facility,Both,,,,55.28,46.988,15.843248,55.28,"Preferred One Administrative Services, INC.",PPO,54.50608,98.6,,percent of total billed charges,,
Sup Skin Cream Dimethicone 5%,,A6250,HCPCS,Facility,Outpatient,,,,55.28,46.988,15.843248,55.28,PrimeWest Health,Minnesota Senior Health Options (MSHO),28.44156,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Sup Skin Cream Dimethicone 5%,,A6250,HCPCS,Facility,Inpatient,,,,55.28,46.988,15.843248,55.28,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Skin Cream Dimethicone 5%,,A6250,HCPCS,Facility,Outpatient,,,,55.28,46.988,15.843248,55.28,PrimeWest Health,MinnesotaCare,28.391808,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Sup Skin Cream Dimethicone 5%,,A6250,HCPCS,Facility,Inpatient,,,,55.28,46.988,15.843248,55.28,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Sup Skin Cream Dimethicone 5%,,A6250,HCPCS,Facility,Both,,,,55.28,46.988,15.843248,55.28,Sanford Health Plan,Sanford Health Plan,50.8576,92,,percent of total billed charges,,
Sup Skin Cream Dimethicone 5%,,A6250,HCPCS,Facility,Outpatient,,,,55.28,46.988,15.843248,55.28,"UCare Health, Inc.",Individual & Family Plan,31.15028,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Sup Skin Cream Dimethicone 5%,,A6250,HCPCS,Facility,Inpatient,,,,55.28,46.988,15.843248,55.28,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Sup Skin Cream Dimethicone 5%,,A6250,HCPCS,Facility,Outpatient,,,,55.28,46.988,15.843248,55.28,"UCare Health, Inc.",Medical Assistance,27.899816,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Skin Cream Dimethicone 5%,,A6250,HCPCS,Facility,Inpatient,,,,55.28,46.988,15.843248,55.28,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Sup Skin Cream Dimethicone 5%,,A6250,HCPCS,Facility,Outpatient,,,,55.28,46.988,15.843248,55.28,"UCare Health, Inc.",Medicare Advantage,27.899816,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Skin Cream Dimethicone 5%,,A6250,HCPCS,Facility,Inpatient,,,,55.28,46.988,15.843248,55.28,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Skin Cream Dimethicone 5%,,A6250,HCPCS,Facility,Outpatient,,,,55.28,46.988,15.843248,55.28,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),27.899816,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Skin Cream Dimethicone 5%,,A6250,HCPCS,Facility,Inpatient,,,,55.28,46.988,15.843248,55.28,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Skin Cream Dimethicone 5%,,A6250,HCPCS,Facility,Both,,,,55.28,46.988,15.843248,55.28,UnitedHealthcare,Individual & Family,51.9632,94,,percent of total billed charges,,
Sup Skin Cream Dimethicone 5%,,A6250,HCPCS,Facility,Outpatient,,,,55.28,46.988,15.843248,55.28,UnitedHealthcare,Medicare Advantage,27.0872,49,,percent of total billed charges,,
Sup Skin Cream Dimethicone 5%,,A6250,HCPCS,Facility,Inpatient,,,,55.28,46.988,15.843248,55.28,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Sup Skin Cream Dimethicone 5%,,A6250,HCPCS,Facility,Outpatient,,,,55.28,46.988,15.843248,55.28,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,26.5344,48,,percent of total billed charges,,100% of DHS outpatient percentage
Sup Skin Cream Dimethicone 5%,,A6250,HCPCS,Facility,Inpatient,,,,55.28,46.988,15.843248,55.28,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Sup Dressing Transparent,,A6257,HCPCS,Facility,Both,,,,28,23.8,8.0248,28,Aetna,Commercial,25.76,92,,percent of total billed charges,,
Sup Dressing Transparent,,A6257,HCPCS,Facility,Outpatient,,,,28,23.8,8.0248,28,Aetna,Medicare Advantage,13.72,49,,percent of total billed charges,,
Sup Dressing Transparent,,A6257,HCPCS,Facility,Inpatient,,,,28,23.8,8.0248,28,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Sup Dressing Transparent,,A6257,HCPCS,Facility,Both,,,,28,23.8,8.0248,28,Aetna,PPO,26.04,93,,percent of total billed charges,,
Sup Dressing Transparent,,A6257,HCPCS,Facility,Both,,,,28,23.8,8.0248,28,America's PPO,America's PPO,26.8884,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Sup Dressing Transparent,,A6257,HCPCS,Facility,Both,,,,28,23.8,8.0248,28,BlueCross BlueShield Minnesota, Federal Employee Program,27.552,98.4,,percent of total billed charges,,
Sup Dressing Transparent,,A6257,HCPCS,Facility,Both,,,,28,23.8,8.0248,28,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,28,100,,percent of total billed charges,,
Sup Dressing Transparent,,A6257,HCPCS,Facility,Both,,,,28,23.8,8.0248,28,BlueCross BlueShield Minnesota,High Value Network Plan,25.2,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
Sup Dressing Transparent,,A6257,HCPCS,Facility,Outpatient,,,,28,23.8,8.0248,28,BlueCross BlueShield Minnesota,Medicare Advantage,13.72,49,,percent of total billed charges,,
Sup Dressing Transparent,,A6257,HCPCS,Facility,Inpatient,,,,28,23.8,8.0248,28,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Sup Dressing Transparent,,A6257,HCPCS,Facility,Both,,,,28,23.8,8.0248,28,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,24.7996,88.57,,percent of total billed charges,,
Sup Dressing Transparent,,A6257,HCPCS,Facility,Both,,,,28,23.8,8.0248,28,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,8.0248,28.66,,percent of total billed charges,,
Sup Dressing Transparent,,A6257,HCPCS,Facility,Outpatient,,,,28,23.8,8.0248,28,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),13.72,49,,percent of total billed charges,,
Sup Dressing Transparent,,A6257,HCPCS,Facility,Inpatient,,,,28,23.8,8.0248,28,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Sup Dressing Transparent,,A6257,HCPCS,Facility,Both,,,,28,23.8,8.0248,28,CorVel,Worker's Compensation,28,100,,percent of total billed charges,,
Sup Dressing Transparent,,A6257,HCPCS,Facility,Both,,,,28,23.8,8.0248,28,First Health Group Corporation,First Health Network,27.16,97,,percent of total billed charges,,
Sup Dressing Transparent,,A6257,HCPCS,Facility,Both,,,,28,23.8,8.0248,28,"Health Partners, Inc.",Commercial,26.488,94.6,,percent of total billed charges,,
Sup Dressing Transparent,,A6257,HCPCS,Facility,Outpatient,,,,28,23.8,8.0248,28,"Health Partners, Inc.",Medicare Advantage,13.72,49,,percent of total billed charges,,
Sup Dressing Transparent,,A6257,HCPCS,Facility,Inpatient,,,,28,23.8,8.0248,28,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Dressing Transparent,,A6257,HCPCS,Facility,Both,,,,28,23.8,8.0248,28,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),16.8,60,,percent of total billed charges,,
Sup Dressing Transparent,,A6257,HCPCS,Facility,Both,,,,28,23.8,8.0248,28,"Health Partners, Inc.",State of Minnesota Advantage Program,22.82,81.5,,percent of total billed charges,,
Sup Dressing Transparent,,A6257,HCPCS,Facility,Both,,,,28,23.8,8.0248,28,"Health Partners, Inc.",State Public Programs,14,50,,percent of total billed charges,,
Sup Dressing Transparent,,A6257,HCPCS,Facility,Both,,,,28,23.8,8.0248,28,Humana Insurance Company,Commercial PPO,26.6,95,,percent of total billed charges,,
Sup Dressing Transparent,,A6257,HCPCS,Facility,Outpatient,,,,28,23.8,8.0248,28,Humana Insurance Company,Medicare PPO,13.72,49,,percent of total billed charges,,
Sup Dressing Transparent,,A6257,HCPCS,Facility,Inpatient,,,,28,23.8,8.0248,28,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Sup Dressing Transparent,,A6257,HCPCS,Facility,Both,,,,28,23.8,8.0248,28,Medica,Individual & Family,27.748,99.1,,percent of total billed charges,,
Sup Dressing Transparent,,A6257,HCPCS,Facility,Outpatient,,,,28,23.8,8.0248,28,Medica,Medica Advantage Solution,13.944,49.8,,percent of total billed charges,,
Sup Dressing Transparent,,A6257,HCPCS,Facility,Inpatient,,,,28,23.8,8.0248,28,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Sup Dressing Transparent,,A6257,HCPCS,Facility,Outpatient,,,,28,23.8,8.0248,28,Medica,Medical Assistance,12.488,44.6,,percent of total billed charges,,
Sup Dressing Transparent,,A6257,HCPCS,Facility,Inpatient,,,,28,23.8,8.0248,28,Medica,Medical Assistance,,,,,Included in per diem rate,
Sup Dressing Transparent,,A6257,HCPCS,Facility,Outpatient,,,,28,23.8,8.0248,28,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,13.944,49.8,,percent of total billed charges,,
Sup Dressing Transparent,,A6257,HCPCS,Facility,Inpatient,,,,28,23.8,8.0248,28,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Sup Dressing Transparent,,A6257,HCPCS,Facility,Both,,,,28,23.8,8.0248,28,"Multiplan, Inc.","Multiplan, Inc.",26.32,94,,percent of total billed charges,,
Sup Dressing Transparent,,A6257,HCPCS,Facility,Outpatient,,,,28,23.8,8.0248,28,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,25.228,90.1,,percent of total billed charges,,
Sup Dressing Transparent,,A6257,HCPCS,Facility,Inpatient,,,,28,23.8,8.0248,28,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Sup Dressing Transparent,,A6257,HCPCS,Facility,Both,,,,28,23.8,8.0248,28,"Preferred One Administrative Services, INC.",PPO,27.608,98.6,,percent of total billed charges,,
Sup Dressing Transparent,,A6257,HCPCS,Facility,Outpatient,,,,28,23.8,8.0248,28,PrimeWest Health,Minnesota Senior Health Options (MSHO),14.406,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Sup Dressing Transparent,,A6257,HCPCS,Facility,Inpatient,,,,28,23.8,8.0248,28,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Dressing Transparent,,A6257,HCPCS,Facility,Outpatient,,,,28,23.8,8.0248,28,PrimeWest Health,MinnesotaCare,14.3808,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Sup Dressing Transparent,,A6257,HCPCS,Facility,Inpatient,,,,28,23.8,8.0248,28,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Sup Dressing Transparent,,A6257,HCPCS,Facility,Both,,,,28,23.8,8.0248,28,Sanford Health Plan,Sanford Health Plan,25.76,92,,percent of total billed charges,,
Sup Dressing Transparent,,A6257,HCPCS,Facility,Outpatient,,,,28,23.8,8.0248,28,"UCare Health, Inc.",Individual & Family Plan,15.778,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Sup Dressing Transparent,,A6257,HCPCS,Facility,Inpatient,,,,28,23.8,8.0248,28,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Sup Dressing Transparent,,A6257,HCPCS,Facility,Outpatient,,,,28,23.8,8.0248,28,"UCare Health, Inc.",Medical Assistance,14.1316,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Dressing Transparent,,A6257,HCPCS,Facility,Inpatient,,,,28,23.8,8.0248,28,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Sup Dressing Transparent,,A6257,HCPCS,Facility,Outpatient,,,,28,23.8,8.0248,28,"UCare Health, Inc.",Medicare Advantage,14.1316,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Dressing Transparent,,A6257,HCPCS,Facility,Inpatient,,,,28,23.8,8.0248,28,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Dressing Transparent,,A6257,HCPCS,Facility,Outpatient,,,,28,23.8,8.0248,28,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),14.1316,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Dressing Transparent,,A6257,HCPCS,Facility,Inpatient,,,,28,23.8,8.0248,28,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Dressing Transparent,,A6257,HCPCS,Facility,Both,,,,28,23.8,8.0248,28,UnitedHealthcare,Individual & Family,26.32,94,,percent of total billed charges,,
Sup Dressing Transparent,,A6257,HCPCS,Facility,Outpatient,,,,28,23.8,8.0248,28,UnitedHealthcare,Medicare Advantage,13.72,49,,percent of total billed charges,,
Sup Dressing Transparent,,A6257,HCPCS,Facility,Inpatient,,,,28,23.8,8.0248,28,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Sup Dressing Transparent,,A6257,HCPCS,Facility,Outpatient,,,,28,23.8,8.0248,28,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,13.44,48,,percent of total billed charges,,100% of DHS outpatient percentage
Sup Dressing Transparent,,A6257,HCPCS,Facility,Inpatient,,,,28,23.8,8.0248,28,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Sup Sterile Gauze Dressing Mesh Tegaderm 4 X 5,,A6403,HCPCS,Facility,Both,,,,60.54,51.459,17.350764,60.54,Aetna,Commercial,55.6968,92,,percent of total billed charges,,
Sup Sterile Gauze Dressing Mesh Tegaderm 4 X 5,,A6403,HCPCS,Facility,Outpatient,,,,60.54,51.459,17.350764,60.54,Aetna,Medicare Advantage,29.6646,49,,percent of total billed charges,,
Sup Sterile Gauze Dressing Mesh Tegaderm 4 X 5,,A6403,HCPCS,Facility,Inpatient,,,,60.54,51.459,17.350764,60.54,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Sup Sterile Gauze Dressing Mesh Tegaderm 4 X 5,,A6403,HCPCS,Facility,Both,,,,60.54,51.459,17.350764,60.54,Aetna,PPO,56.3022,93,,percent of total billed charges,,
Sup Sterile Gauze Dressing Mesh Tegaderm 4 X 5,,A6403,HCPCS,Facility,Both,,,,60.54,51.459,17.350764,60.54,America's PPO,America's PPO,58.136562,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Sup Sterile Gauze Dressing Mesh Tegaderm 4 X 5,,A6403,HCPCS,Facility,Both,,,,60.54,51.459,17.350764,60.54,BlueCross BlueShield Minnesota, Federal Employee Program,59.57136,98.4,,percent of total billed charges,,
Sup Sterile Gauze Dressing Mesh Tegaderm 4 X 5,,A6403,HCPCS,Facility,Both,,,,60.54,51.459,17.350764,60.54,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,60.54,100,,percent of total billed charges,,
Sup Sterile Gauze Dressing Mesh Tegaderm 4 X 5,,A6403,HCPCS,Facility,Both,,,,60.54,51.459,17.350764,60.54,BlueCross BlueShield Minnesota,High Value Network Plan,54.486,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
Sup Sterile Gauze Dressing Mesh Tegaderm 4 X 5,,A6403,HCPCS,Facility,Outpatient,,,,60.54,51.459,17.350764,60.54,BlueCross BlueShield Minnesota,Medicare Advantage,29.6646,49,,percent of total billed charges,,
Sup Sterile Gauze Dressing Mesh Tegaderm 4 X 5,,A6403,HCPCS,Facility,Inpatient,,,,60.54,51.459,17.350764,60.54,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Sup Sterile Gauze Dressing Mesh Tegaderm 4 X 5,,A6403,HCPCS,Facility,Both,,,,60.54,51.459,17.350764,60.54,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,53.620278,88.57,,percent of total billed charges,,
Sup Sterile Gauze Dressing Mesh Tegaderm 4 X 5,,A6403,HCPCS,Facility,Both,,,,60.54,51.459,17.350764,60.54,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,17.350764,28.66,,percent of total billed charges,,
Sup Sterile Gauze Dressing Mesh Tegaderm 4 X 5,,A6403,HCPCS,Facility,Outpatient,,,,60.54,51.459,17.350764,60.54,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),29.6646,49,,percent of total billed charges,,
Sup Sterile Gauze Dressing Mesh Tegaderm 4 X 5,,A6403,HCPCS,Facility,Inpatient,,,,60.54,51.459,17.350764,60.54,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Sup Sterile Gauze Dressing Mesh Tegaderm 4 X 5,,A6403,HCPCS,Facility,Both,,,,60.54,51.459,17.350764,60.54,CorVel,Worker's Compensation,60.54,100,,percent of total billed charges,,
Sup Sterile Gauze Dressing Mesh Tegaderm 4 X 5,,A6403,HCPCS,Facility,Both,,,,60.54,51.459,17.350764,60.54,First Health Group Corporation,First Health Network,58.7238,97,,percent of total billed charges,,
Sup Sterile Gauze Dressing Mesh Tegaderm 4 X 5,,A6403,HCPCS,Facility,Both,,,,60.54,51.459,17.350764,60.54,"Health Partners, Inc.",Commercial,57.27084,94.6,,percent of total billed charges,,
Sup Sterile Gauze Dressing Mesh Tegaderm 4 X 5,,A6403,HCPCS,Facility,Outpatient,,,,60.54,51.459,17.350764,60.54,"Health Partners, Inc.",Medicare Advantage,29.6646,49,,percent of total billed charges,,
Sup Sterile Gauze Dressing Mesh Tegaderm 4 X 5,,A6403,HCPCS,Facility,Inpatient,,,,60.54,51.459,17.350764,60.54,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Sterile Gauze Dressing Mesh Tegaderm 4 X 5,,A6403,HCPCS,Facility,Both,,,,60.54,51.459,17.350764,60.54,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),36.324,60,,percent of total billed charges,,
Sup Sterile Gauze Dressing Mesh Tegaderm 4 X 5,,A6403,HCPCS,Facility,Both,,,,60.54,51.459,17.350764,60.54,"Health Partners, Inc.",State of Minnesota Advantage Program,49.3401,81.5,,percent of total billed charges,,
Sup Sterile Gauze Dressing Mesh Tegaderm 4 X 5,,A6403,HCPCS,Facility,Both,,,,60.54,51.459,17.350764,60.54,"Health Partners, Inc.",State Public Programs,30.27,50,,percent of total billed charges,,
Sup Sterile Gauze Dressing Mesh Tegaderm 4 X 5,,A6403,HCPCS,Facility,Both,,,,60.54,51.459,17.350764,60.54,Humana Insurance Company,Commercial PPO,57.513,95,,percent of total billed charges,,
Sup Sterile Gauze Dressing Mesh Tegaderm 4 X 5,,A6403,HCPCS,Facility,Outpatient,,,,60.54,51.459,17.350764,60.54,Humana Insurance Company,Medicare PPO,29.6646,49,,percent of total billed charges,,
Sup Sterile Gauze Dressing Mesh Tegaderm 4 X 5,,A6403,HCPCS,Facility,Inpatient,,,,60.54,51.459,17.350764,60.54,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Sup Sterile Gauze Dressing Mesh Tegaderm 4 X 5,,A6403,HCPCS,Facility,Both,,,,60.54,51.459,17.350764,60.54,Medica,Individual & Family,59.99514,99.1,,percent of total billed charges,,
Sup Sterile Gauze Dressing Mesh Tegaderm 4 X 5,,A6403,HCPCS,Facility,Outpatient,,,,60.54,51.459,17.350764,60.54,Medica,Medica Advantage Solution,30.14892,49.8,,percent of total billed charges,,
Sup Sterile Gauze Dressing Mesh Tegaderm 4 X 5,,A6403,HCPCS,Facility,Inpatient,,,,60.54,51.459,17.350764,60.54,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Sup Sterile Gauze Dressing Mesh Tegaderm 4 X 5,,A6403,HCPCS,Facility,Outpatient,,,,60.54,51.459,17.350764,60.54,Medica,Medical Assistance,27.00084,44.6,,percent of total billed charges,,
Sup Sterile Gauze Dressing Mesh Tegaderm 4 X 5,,A6403,HCPCS,Facility,Inpatient,,,,60.54,51.459,17.350764,60.54,Medica,Medical Assistance,,,,,Included in per diem rate,
Sup Sterile Gauze Dressing Mesh Tegaderm 4 X 5,,A6403,HCPCS,Facility,Outpatient,,,,60.54,51.459,17.350764,60.54,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,30.14892,49.8,,percent of total billed charges,,
Sup Sterile Gauze Dressing Mesh Tegaderm 4 X 5,,A6403,HCPCS,Facility,Inpatient,,,,60.54,51.459,17.350764,60.54,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Sup Sterile Gauze Dressing Mesh Tegaderm 4 X 5,,A6403,HCPCS,Facility,Both,,,,60.54,51.459,17.350764,60.54,"Multiplan, Inc.","Multiplan, Inc.",56.9076,94,,percent of total billed charges,,
Sup Sterile Gauze Dressing Mesh Tegaderm 4 X 5,,A6403,HCPCS,Facility,Outpatient,,,,60.54,51.459,17.350764,60.54,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,54.54654,90.1,,percent of total billed charges,,
Sup Sterile Gauze Dressing Mesh Tegaderm 4 X 5,,A6403,HCPCS,Facility,Inpatient,,,,60.54,51.459,17.350764,60.54,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Sup Sterile Gauze Dressing Mesh Tegaderm 4 X 5,,A6403,HCPCS,Facility,Both,,,,60.54,51.459,17.350764,60.54,"Preferred One Administrative Services, INC.",PPO,59.69244,98.6,,percent of total billed charges,,
Sup Sterile Gauze Dressing Mesh Tegaderm 4 X 5,,A6403,HCPCS,Facility,Outpatient,,,,60.54,51.459,17.350764,60.54,PrimeWest Health,Minnesota Senior Health Options (MSHO),31.14783,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Sup Sterile Gauze Dressing Mesh Tegaderm 4 X 5,,A6403,HCPCS,Facility,Inpatient,,,,60.54,51.459,17.350764,60.54,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Sterile Gauze Dressing Mesh Tegaderm 4 X 5,,A6403,HCPCS,Facility,Outpatient,,,,60.54,51.459,17.350764,60.54,PrimeWest Health,MinnesotaCare,31.093344,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Sup Sterile Gauze Dressing Mesh Tegaderm 4 X 5,,A6403,HCPCS,Facility,Inpatient,,,,60.54,51.459,17.350764,60.54,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Sup Sterile Gauze Dressing Mesh Tegaderm 4 X 5,,A6403,HCPCS,Facility,Both,,,,60.54,51.459,17.350764,60.54,Sanford Health Plan,Sanford Health Plan,55.6968,92,,percent of total billed charges,,
Sup Sterile Gauze Dressing Mesh Tegaderm 4 X 5,,A6403,HCPCS,Facility,Outpatient,,,,60.54,51.459,17.350764,60.54,"UCare Health, Inc.",Individual & Family Plan,34.11429,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Sup Sterile Gauze Dressing Mesh Tegaderm 4 X 5,,A6403,HCPCS,Facility,Inpatient,,,,60.54,51.459,17.350764,60.54,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Sup Sterile Gauze Dressing Mesh Tegaderm 4 X 5,,A6403,HCPCS,Facility,Outpatient,,,,60.54,51.459,17.350764,60.54,"UCare Health, Inc.",Medical Assistance,30.554538,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Sterile Gauze Dressing Mesh Tegaderm 4 X 5,,A6403,HCPCS,Facility,Inpatient,,,,60.54,51.459,17.350764,60.54,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Sup Sterile Gauze Dressing Mesh Tegaderm 4 X 5,,A6403,HCPCS,Facility,Outpatient,,,,60.54,51.459,17.350764,60.54,"UCare Health, Inc.",Medicare Advantage,30.554538,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Sterile Gauze Dressing Mesh Tegaderm 4 X 5,,A6403,HCPCS,Facility,Inpatient,,,,60.54,51.459,17.350764,60.54,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Sterile Gauze Dressing Mesh Tegaderm 4 X 5,,A6403,HCPCS,Facility,Outpatient,,,,60.54,51.459,17.350764,60.54,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),30.554538,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Sterile Gauze Dressing Mesh Tegaderm 4 X 5,,A6403,HCPCS,Facility,Inpatient,,,,60.54,51.459,17.350764,60.54,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Sterile Gauze Dressing Mesh Tegaderm 4 X 5,,A6403,HCPCS,Facility,Both,,,,60.54,51.459,17.350764,60.54,UnitedHealthcare,Individual & Family,56.9076,94,,percent of total billed charges,,
Sup Sterile Gauze Dressing Mesh Tegaderm 4 X 5,,A6403,HCPCS,Facility,Outpatient,,,,60.54,51.459,17.350764,60.54,UnitedHealthcare,Medicare Advantage,29.6646,49,,percent of total billed charges,,
Sup Sterile Gauze Dressing Mesh Tegaderm 4 X 5,,A6403,HCPCS,Facility,Inpatient,,,,60.54,51.459,17.350764,60.54,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Sup Sterile Gauze Dressing Mesh Tegaderm 4 X 5,,A6403,HCPCS,Facility,Outpatient,,,,60.54,51.459,17.350764,60.54,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,29.0592,48,,percent of total billed charges,,100% of DHS outpatient percentage
Sup Sterile Gauze Dressing Mesh Tegaderm 4 X 5,,A6403,HCPCS,Facility,Inpatient,,,,60.54,51.459,17.350764,60.54,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Sup Wrap Paste Calamine 3 In Unna Boot,,A6456,HCPCS,Facility,Both,,,,34.21,29.0785,9.804586,34.21,Aetna,Commercial,31.4732,92,,percent of total billed charges,,
Sup Wrap Paste Calamine 3 In Unna Boot,,A6456,HCPCS,Facility,Outpatient,,,,34.21,29.0785,9.804586,34.21,Aetna,Medicare Advantage,16.7629,49,,percent of total billed charges,,
Sup Wrap Paste Calamine 3 In Unna Boot,,A6456,HCPCS,Facility,Inpatient,,,,34.21,29.0785,9.804586,34.21,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Sup Wrap Paste Calamine 3 In Unna Boot,,A6456,HCPCS,Facility,Both,,,,34.21,29.0785,9.804586,34.21,Aetna,PPO,31.8153,93,,percent of total billed charges,,
Sup Wrap Paste Calamine 3 In Unna Boot,,A6456,HCPCS,Facility,Both,,,,34.21,29.0785,9.804586,34.21,America's PPO,America's PPO,32.851863,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Sup Wrap Paste Calamine 3 In Unna Boot,,A6456,HCPCS,Facility,Both,,,,34.21,29.0785,9.804586,34.21,BlueCross BlueShield Minnesota, Federal Employee Program,33.66264,98.4,,percent of total billed charges,,
Sup Wrap Paste Calamine 3 In Unna Boot,,A6456,HCPCS,Facility,Both,,,,34.21,29.0785,9.804586,34.21,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,34.21,100,,percent of total billed charges,,
Sup Wrap Paste Calamine 3 In Unna Boot,,A6456,HCPCS,Facility,Both,,,,34.21,29.0785,9.804586,34.21,BlueCross BlueShield Minnesota,High Value Network Plan,30.789,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
Sup Wrap Paste Calamine 3 In Unna Boot,,A6456,HCPCS,Facility,Outpatient,,,,34.21,29.0785,9.804586,34.21,BlueCross BlueShield Minnesota,Medicare Advantage,16.7629,49,,percent of total billed charges,,
Sup Wrap Paste Calamine 3 In Unna Boot,,A6456,HCPCS,Facility,Inpatient,,,,34.21,29.0785,9.804586,34.21,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Sup Wrap Paste Calamine 3 In Unna Boot,,A6456,HCPCS,Facility,Both,,,,34.21,29.0785,9.804586,34.21,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,30.299797,88.57,,percent of total billed charges,,
Sup Wrap Paste Calamine 3 In Unna Boot,,A6456,HCPCS,Facility,Both,,,,34.21,29.0785,9.804586,34.21,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,9.804586,28.66,,percent of total billed charges,,
Sup Wrap Paste Calamine 3 In Unna Boot,,A6456,HCPCS,Facility,Outpatient,,,,34.21,29.0785,9.804586,34.21,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),16.7629,49,,percent of total billed charges,,
Sup Wrap Paste Calamine 3 In Unna Boot,,A6456,HCPCS,Facility,Inpatient,,,,34.21,29.0785,9.804586,34.21,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Sup Wrap Paste Calamine 3 In Unna Boot,,A6456,HCPCS,Facility,Both,,,,34.21,29.0785,9.804586,34.21,CorVel,Worker's Compensation,34.21,100,,percent of total billed charges,,
Sup Wrap Paste Calamine 3 In Unna Boot,,A6456,HCPCS,Facility,Both,,,,34.21,29.0785,9.804586,34.21,First Health Group Corporation,First Health Network,33.1837,97,,percent of total billed charges,,
Sup Wrap Paste Calamine 3 In Unna Boot,,A6456,HCPCS,Facility,Both,,,,34.21,29.0785,9.804586,34.21,"Health Partners, Inc.",Commercial,32.36266,94.6,,percent of total billed charges,,
Sup Wrap Paste Calamine 3 In Unna Boot,,A6456,HCPCS,Facility,Outpatient,,,,34.21,29.0785,9.804586,34.21,"Health Partners, Inc.",Medicare Advantage,16.7629,49,,percent of total billed charges,,
Sup Wrap Paste Calamine 3 In Unna Boot,,A6456,HCPCS,Facility,Inpatient,,,,34.21,29.0785,9.804586,34.21,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Wrap Paste Calamine 3 In Unna Boot,,A6456,HCPCS,Facility,Both,,,,34.21,29.0785,9.804586,34.21,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),20.526,60,,percent of total billed charges,,
Sup Wrap Paste Calamine 3 In Unna Boot,,A6456,HCPCS,Facility,Both,,,,34.21,29.0785,9.804586,34.21,"Health Partners, Inc.",State of Minnesota Advantage Program,27.88115,81.5,,percent of total billed charges,,
Sup Wrap Paste Calamine 3 In Unna Boot,,A6456,HCPCS,Facility,Both,,,,34.21,29.0785,9.804586,34.21,"Health Partners, Inc.",State Public Programs,17.105,50,,percent of total billed charges,,
Sup Wrap Paste Calamine 3 In Unna Boot,,A6456,HCPCS,Facility,Both,,,,34.21,29.0785,9.804586,34.21,Humana Insurance Company,Commercial PPO,32.4995,95,,percent of total billed charges,,
Sup Wrap Paste Calamine 3 In Unna Boot,,A6456,HCPCS,Facility,Outpatient,,,,34.21,29.0785,9.804586,34.21,Humana Insurance Company,Medicare PPO,16.7629,49,,percent of total billed charges,,
Sup Wrap Paste Calamine 3 In Unna Boot,,A6456,HCPCS,Facility,Inpatient,,,,34.21,29.0785,9.804586,34.21,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Sup Wrap Paste Calamine 3 In Unna Boot,,A6456,HCPCS,Facility,Both,,,,34.21,29.0785,9.804586,34.21,Medica,Individual & Family,33.90211,99.1,,percent of total billed charges,,
Sup Wrap Paste Calamine 3 In Unna Boot,,A6456,HCPCS,Facility,Outpatient,,,,34.21,29.0785,9.804586,34.21,Medica,Medica Advantage Solution,17.03658,49.8,,percent of total billed charges,,
Sup Wrap Paste Calamine 3 In Unna Boot,,A6456,HCPCS,Facility,Inpatient,,,,34.21,29.0785,9.804586,34.21,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Sup Wrap Paste Calamine 3 In Unna Boot,,A6456,HCPCS,Facility,Outpatient,,,,34.21,29.0785,9.804586,34.21,Medica,Medical Assistance,15.25766,44.6,,percent of total billed charges,,
Sup Wrap Paste Calamine 3 In Unna Boot,,A6456,HCPCS,Facility,Inpatient,,,,34.21,29.0785,9.804586,34.21,Medica,Medical Assistance,,,,,Included in per diem rate,
Sup Wrap Paste Calamine 3 In Unna Boot,,A6456,HCPCS,Facility,Outpatient,,,,34.21,29.0785,9.804586,34.21,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,17.03658,49.8,,percent of total billed charges,,
Sup Wrap Paste Calamine 3 In Unna Boot,,A6456,HCPCS,Facility,Inpatient,,,,34.21,29.0785,9.804586,34.21,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Sup Wrap Paste Calamine 3 In Unna Boot,,A6456,HCPCS,Facility,Both,,,,34.21,29.0785,9.804586,34.21,"Multiplan, Inc.","Multiplan, Inc.",32.1574,94,,percent of total billed charges,,
Sup Wrap Paste Calamine 3 In Unna Boot,,A6456,HCPCS,Facility,Outpatient,,,,34.21,29.0785,9.804586,34.21,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,30.82321,90.1,,percent of total billed charges,,
Sup Wrap Paste Calamine 3 In Unna Boot,,A6456,HCPCS,Facility,Inpatient,,,,34.21,29.0785,9.804586,34.21,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Sup Wrap Paste Calamine 3 In Unna Boot,,A6456,HCPCS,Facility,Both,,,,34.21,29.0785,9.804586,34.21,"Preferred One Administrative Services, INC.",PPO,33.73106,98.6,,percent of total billed charges,,
Sup Wrap Paste Calamine 3 In Unna Boot,,A6456,HCPCS,Facility,Outpatient,,,,34.21,29.0785,9.804586,34.21,PrimeWest Health,Minnesota Senior Health Options (MSHO),17.601045,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Sup Wrap Paste Calamine 3 In Unna Boot,,A6456,HCPCS,Facility,Inpatient,,,,34.21,29.0785,9.804586,34.21,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Wrap Paste Calamine 3 In Unna Boot,,A6456,HCPCS,Facility,Outpatient,,,,34.21,29.0785,9.804586,34.21,PrimeWest Health,MinnesotaCare,17.570256,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Sup Wrap Paste Calamine 3 In Unna Boot,,A6456,HCPCS,Facility,Inpatient,,,,34.21,29.0785,9.804586,34.21,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Sup Wrap Paste Calamine 3 In Unna Boot,,A6456,HCPCS,Facility,Both,,,,34.21,29.0785,9.804586,34.21,Sanford Health Plan,Sanford Health Plan,31.4732,92,,percent of total billed charges,,
Sup Wrap Paste Calamine 3 In Unna Boot,,A6456,HCPCS,Facility,Outpatient,,,,34.21,29.0785,9.804586,34.21,"UCare Health, Inc.",Individual & Family Plan,19.277335,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Sup Wrap Paste Calamine 3 In Unna Boot,,A6456,HCPCS,Facility,Inpatient,,,,34.21,29.0785,9.804586,34.21,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Sup Wrap Paste Calamine 3 In Unna Boot,,A6456,HCPCS,Facility,Outpatient,,,,34.21,29.0785,9.804586,34.21,"UCare Health, Inc.",Medical Assistance,17.265787,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Wrap Paste Calamine 3 In Unna Boot,,A6456,HCPCS,Facility,Inpatient,,,,34.21,29.0785,9.804586,34.21,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Sup Wrap Paste Calamine 3 In Unna Boot,,A6456,HCPCS,Facility,Outpatient,,,,34.21,29.0785,9.804586,34.21,"UCare Health, Inc.",Medicare Advantage,17.265787,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Wrap Paste Calamine 3 In Unna Boot,,A6456,HCPCS,Facility,Inpatient,,,,34.21,29.0785,9.804586,34.21,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Wrap Paste Calamine 3 In Unna Boot,,A6456,HCPCS,Facility,Outpatient,,,,34.21,29.0785,9.804586,34.21,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),17.265787,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Wrap Paste Calamine 3 In Unna Boot,,A6456,HCPCS,Facility,Inpatient,,,,34.21,29.0785,9.804586,34.21,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Wrap Paste Calamine 3 In Unna Boot,,A6456,HCPCS,Facility,Both,,,,34.21,29.0785,9.804586,34.21,UnitedHealthcare,Individual & Family,32.1574,94,,percent of total billed charges,,
Sup Wrap Paste Calamine 3 In Unna Boot,,A6456,HCPCS,Facility,Outpatient,,,,34.21,29.0785,9.804586,34.21,UnitedHealthcare,Medicare Advantage,16.7629,49,,percent of total billed charges,,
Sup Wrap Paste Calamine 3 In Unna Boot,,A6456,HCPCS,Facility,Inpatient,,,,34.21,29.0785,9.804586,34.21,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Sup Wrap Paste Calamine 3 In Unna Boot,,A6456,HCPCS,Facility,Outpatient,,,,34.21,29.0785,9.804586,34.21,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,16.4208,48,,percent of total billed charges,,100% of DHS outpatient percentage
Sup Wrap Paste Calamine 3 In Unna Boot,,A6456,HCPCS,Facility,Inpatient,,,,34.21,29.0785,9.804586,34.21,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Sup Unna Boot Compression System, Zinc",,A6545,HCPCS,Facility,Both,,,,49.89,42.4065,14.298474,49.89,Aetna,Commercial,45.8988,92,,percent of total billed charges,,
"Sup Unna Boot Compression System, Zinc",,A6545,HCPCS,Facility,Outpatient,,,,49.89,42.4065,14.298474,49.89,Aetna,Medicare Advantage,24.4461,49,,percent of total billed charges,,
"Sup Unna Boot Compression System, Zinc",,A6545,HCPCS,Facility,Inpatient,,,,49.89,42.4065,14.298474,49.89,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Sup Unna Boot Compression System, Zinc",,A6545,HCPCS,Facility,Both,,,,49.89,42.4065,14.298474,49.89,Aetna,PPO,46.3977,93,,percent of total billed charges,,
"Sup Unna Boot Compression System, Zinc",,A6545,HCPCS,Facility,Both,,,,49.89,42.4065,14.298474,49.89,America's PPO,America's PPO,47.909367,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Sup Unna Boot Compression System, Zinc",,A6545,HCPCS,Facility,Both,,,,49.89,42.4065,14.298474,49.89,BlueCross BlueShield Minnesota, Federal Employee Program,49.09176,98.4,,percent of total billed charges,,
"Sup Unna Boot Compression System, Zinc",,A6545,HCPCS,Facility,Both,,,,49.89,42.4065,14.298474,49.89,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,49.89,100,,percent of total billed charges,,
"Sup Unna Boot Compression System, Zinc",,A6545,HCPCS,Facility,Both,,,,49.89,42.4065,14.298474,49.89,BlueCross BlueShield Minnesota,High Value Network Plan,44.901,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
"Sup Unna Boot Compression System, Zinc",,A6545,HCPCS,Facility,Outpatient,,,,49.89,42.4065,14.298474,49.89,BlueCross BlueShield Minnesota,Medicare Advantage,24.4461,49,,percent of total billed charges,,
"Sup Unna Boot Compression System, Zinc",,A6545,HCPCS,Facility,Inpatient,,,,49.89,42.4065,14.298474,49.89,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Sup Unna Boot Compression System, Zinc",,A6545,HCPCS,Facility,Both,,,,49.89,42.4065,14.298474,49.89,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,44.187573,88.57,,percent of total billed charges,,
"Sup Unna Boot Compression System, Zinc",,A6545,HCPCS,Facility,Both,,,,49.89,42.4065,14.298474,49.89,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,14.298474,28.66,,percent of total billed charges,,
"Sup Unna Boot Compression System, Zinc",,A6545,HCPCS,Facility,Outpatient,,,,49.89,42.4065,14.298474,49.89,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),24.4461,49,,percent of total billed charges,,
"Sup Unna Boot Compression System, Zinc",,A6545,HCPCS,Facility,Inpatient,,,,49.89,42.4065,14.298474,49.89,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Sup Unna Boot Compression System, Zinc",,A6545,HCPCS,Facility,Both,,,,49.89,42.4065,14.298474,49.89,CorVel,Worker's Compensation,49.89,100,,percent of total billed charges,,
"Sup Unna Boot Compression System, Zinc",,A6545,HCPCS,Facility,Both,,,,49.89,42.4065,14.298474,49.89,First Health Group Corporation,First Health Network,48.3933,97,,percent of total billed charges,,
"Sup Unna Boot Compression System, Zinc",,A6545,HCPCS,Facility,Both,,,,49.89,42.4065,14.298474,49.89,"Health Partners, Inc.",Commercial,47.19594,94.6,,percent of total billed charges,,
"Sup Unna Boot Compression System, Zinc",,A6545,HCPCS,Facility,Outpatient,,,,49.89,42.4065,14.298474,49.89,"Health Partners, Inc.",Medicare Advantage,24.4461,49,,percent of total billed charges,,
"Sup Unna Boot Compression System, Zinc",,A6545,HCPCS,Facility,Inpatient,,,,49.89,42.4065,14.298474,49.89,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Sup Unna Boot Compression System, Zinc",,A6545,HCPCS,Facility,Both,,,,49.89,42.4065,14.298474,49.89,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),29.934,60,,percent of total billed charges,,
"Sup Unna Boot Compression System, Zinc",,A6545,HCPCS,Facility,Both,,,,49.89,42.4065,14.298474,49.89,"Health Partners, Inc.",State of Minnesota Advantage Program,40.66035,81.5,,percent of total billed charges,,
"Sup Unna Boot Compression System, Zinc",,A6545,HCPCS,Facility,Both,,,,49.89,42.4065,14.298474,49.89,"Health Partners, Inc.",State Public Programs,24.945,50,,percent of total billed charges,,
"Sup Unna Boot Compression System, Zinc",,A6545,HCPCS,Facility,Both,,,,49.89,42.4065,14.298474,49.89,Humana Insurance Company,Commercial PPO,47.3955,95,,percent of total billed charges,,
"Sup Unna Boot Compression System, Zinc",,A6545,HCPCS,Facility,Outpatient,,,,49.89,42.4065,14.298474,49.89,Humana Insurance Company,Medicare PPO,24.4461,49,,percent of total billed charges,,
"Sup Unna Boot Compression System, Zinc",,A6545,HCPCS,Facility,Inpatient,,,,49.89,42.4065,14.298474,49.89,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Sup Unna Boot Compression System, Zinc",,A6545,HCPCS,Facility,Both,,,,49.89,42.4065,14.298474,49.89,Medica,Individual & Family,49.44099,99.1,,percent of total billed charges,,
"Sup Unna Boot Compression System, Zinc",,A6545,HCPCS,Facility,Outpatient,,,,49.89,42.4065,14.298474,49.89,Medica,Medica Advantage Solution,24.84522,49.8,,percent of total billed charges,,
"Sup Unna Boot Compression System, Zinc",,A6545,HCPCS,Facility,Inpatient,,,,49.89,42.4065,14.298474,49.89,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Sup Unna Boot Compression System, Zinc",,A6545,HCPCS,Facility,Outpatient,,,,49.89,42.4065,14.298474,49.89,Medica,Medical Assistance,22.25094,44.6,,percent of total billed charges,,
"Sup Unna Boot Compression System, Zinc",,A6545,HCPCS,Facility,Inpatient,,,,49.89,42.4065,14.298474,49.89,Medica,Medical Assistance,,,,,Included in per diem rate,
"Sup Unna Boot Compression System, Zinc",,A6545,HCPCS,Facility,Outpatient,,,,49.89,42.4065,14.298474,49.89,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,24.84522,49.8,,percent of total billed charges,,
"Sup Unna Boot Compression System, Zinc",,A6545,HCPCS,Facility,Inpatient,,,,49.89,42.4065,14.298474,49.89,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Sup Unna Boot Compression System, Zinc",,A6545,HCPCS,Facility,Both,,,,49.89,42.4065,14.298474,49.89,"Multiplan, Inc.","Multiplan, Inc.",46.8966,94,,percent of total billed charges,,
"Sup Unna Boot Compression System, Zinc",,A6545,HCPCS,Facility,Outpatient,,,,49.89,42.4065,14.298474,49.89,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,44.95089,90.1,,percent of total billed charges,,
"Sup Unna Boot Compression System, Zinc",,A6545,HCPCS,Facility,Inpatient,,,,49.89,42.4065,14.298474,49.89,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Sup Unna Boot Compression System, Zinc",,A6545,HCPCS,Facility,Both,,,,49.89,42.4065,14.298474,49.89,"Preferred One Administrative Services, INC.",PPO,49.19154,98.6,,percent of total billed charges,,
"Sup Unna Boot Compression System, Zinc",,A6545,HCPCS,Facility,Outpatient,,,,49.89,42.4065,14.298474,49.89,PrimeWest Health,Minnesota Senior Health Options (MSHO),25.668405,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Sup Unna Boot Compression System, Zinc",,A6545,HCPCS,Facility,Inpatient,,,,49.89,42.4065,14.298474,49.89,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Sup Unna Boot Compression System, Zinc",,A6545,HCPCS,Facility,Outpatient,,,,49.89,42.4065,14.298474,49.89,PrimeWest Health,MinnesotaCare,25.623504,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Sup Unna Boot Compression System, Zinc",,A6545,HCPCS,Facility,Inpatient,,,,49.89,42.4065,14.298474,49.89,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Sup Unna Boot Compression System, Zinc",,A6545,HCPCS,Facility,Both,,,,49.89,42.4065,14.298474,49.89,Sanford Health Plan,Sanford Health Plan,45.8988,92,,percent of total billed charges,,
"Sup Unna Boot Compression System, Zinc",,A6545,HCPCS,Facility,Outpatient,,,,49.89,42.4065,14.298474,49.89,"UCare Health, Inc.",Individual & Family Plan,28.113015,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Sup Unna Boot Compression System, Zinc",,A6545,HCPCS,Facility,Inpatient,,,,49.89,42.4065,14.298474,49.89,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Sup Unna Boot Compression System, Zinc",,A6545,HCPCS,Facility,Outpatient,,,,49.89,42.4065,14.298474,49.89,"UCare Health, Inc.",Medical Assistance,25.179483,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Sup Unna Boot Compression System, Zinc",,A6545,HCPCS,Facility,Inpatient,,,,49.89,42.4065,14.298474,49.89,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Sup Unna Boot Compression System, Zinc",,A6545,HCPCS,Facility,Outpatient,,,,49.89,42.4065,14.298474,49.89,"UCare Health, Inc.",Medicare Advantage,25.179483,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Sup Unna Boot Compression System, Zinc",,A6545,HCPCS,Facility,Inpatient,,,,49.89,42.4065,14.298474,49.89,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Sup Unna Boot Compression System, Zinc",,A6545,HCPCS,Facility,Outpatient,,,,49.89,42.4065,14.298474,49.89,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),25.179483,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Sup Unna Boot Compression System, Zinc",,A6545,HCPCS,Facility,Inpatient,,,,49.89,42.4065,14.298474,49.89,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Sup Unna Boot Compression System, Zinc",,A6545,HCPCS,Facility,Both,,,,49.89,42.4065,14.298474,49.89,UnitedHealthcare,Individual & Family,46.8966,94,,percent of total billed charges,,
"Sup Unna Boot Compression System, Zinc",,A6545,HCPCS,Facility,Outpatient,,,,49.89,42.4065,14.298474,49.89,UnitedHealthcare,Medicare Advantage,24.4461,49,,percent of total billed charges,,
"Sup Unna Boot Compression System, Zinc",,A6545,HCPCS,Facility,Inpatient,,,,49.89,42.4065,14.298474,49.89,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Sup Unna Boot Compression System, Zinc",,A6545,HCPCS,Facility,Outpatient,,,,49.89,42.4065,14.298474,49.89,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,23.9472,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Sup Unna Boot Compression System, Zinc",,A6545,HCPCS,Facility,Inpatient,,,,49.89,42.4065,14.298474,49.89,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
CLARIFIX II SYSTEM W/ DEVICE AND 2 CANISTERS  CFX-2000,,A7000,HCPCS,Facility,Both,,,,3196,2716.6,915.9736,3196,Aetna,Commercial,2940.32,92,,percent of total billed charges,,
CLARIFIX II SYSTEM W/ DEVICE AND 2 CANISTERS  CFX-2000,,A7000,HCPCS,Facility,Outpatient,,,,3196,2716.6,915.9736,3196,Aetna,Medicare Advantage,1566.04,49,,percent of total billed charges,,
CLARIFIX II SYSTEM W/ DEVICE AND 2 CANISTERS  CFX-2000,,A7000,HCPCS,Facility,Inpatient,,,,3196,2716.6,915.9736,3196,Aetna,Medicare Advantage,,,,,Included in per diem rate,
CLARIFIX II SYSTEM W/ DEVICE AND 2 CANISTERS  CFX-2000,,A7000,HCPCS,Facility,Both,,,,3196,2716.6,915.9736,3196,Aetna,PPO,2972.28,93,,percent of total billed charges,,
CLARIFIX II SYSTEM W/ DEVICE AND 2 CANISTERS  CFX-2000,,A7000,HCPCS,Facility,Both,,,,3196,2716.6,915.9736,3196,America's PPO,America's PPO,3069.1188,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
CLARIFIX II SYSTEM W/ DEVICE AND 2 CANISTERS  CFX-2000,,A7000,HCPCS,Facility,Both,,,,3196,2716.6,915.9736,3196,BlueCross BlueShield Minnesota, Federal Employee Program,3144.864,98.4,,percent of total billed charges,,
CLARIFIX II SYSTEM W/ DEVICE AND 2 CANISTERS  CFX-2000,,A7000,HCPCS,Facility,Both,,,,3196,2716.6,915.9736,3196,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,3196,100,,percent of total billed charges,,
CLARIFIX II SYSTEM W/ DEVICE AND 2 CANISTERS  CFX-2000,,A7000,HCPCS,Facility,Both,,,,3196,2716.6,915.9736,3196,BlueCross BlueShield Minnesota,High Value Network Plan,2876.4,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
CLARIFIX II SYSTEM W/ DEVICE AND 2 CANISTERS  CFX-2000,,A7000,HCPCS,Facility,Outpatient,,,,3196,2716.6,915.9736,3196,BlueCross BlueShield Minnesota,Medicare Advantage,1566.04,49,,percent of total billed charges,,
CLARIFIX II SYSTEM W/ DEVICE AND 2 CANISTERS  CFX-2000,,A7000,HCPCS,Facility,Inpatient,,,,3196,2716.6,915.9736,3196,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
CLARIFIX II SYSTEM W/ DEVICE AND 2 CANISTERS  CFX-2000,,A7000,HCPCS,Facility,Both,,,,3196,2716.6,915.9736,3196,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,2830.6972,88.57,,percent of total billed charges,,
CLARIFIX II SYSTEM W/ DEVICE AND 2 CANISTERS  CFX-2000,,A7000,HCPCS,Facility,Both,,,,3196,2716.6,915.9736,3196,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,915.9736,28.66,,percent of total billed charges,,
CLARIFIX II SYSTEM W/ DEVICE AND 2 CANISTERS  CFX-2000,,A7000,HCPCS,Facility,Outpatient,,,,3196,2716.6,915.9736,3196,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1566.04,49,,percent of total billed charges,,
CLARIFIX II SYSTEM W/ DEVICE AND 2 CANISTERS  CFX-2000,,A7000,HCPCS,Facility,Inpatient,,,,3196,2716.6,915.9736,3196,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
CLARIFIX II SYSTEM W/ DEVICE AND 2 CANISTERS  CFX-2000,,A7000,HCPCS,Facility,Both,,,,3196,2716.6,915.9736,3196,CorVel,Worker's Compensation,3196,100,,percent of total billed charges,,
CLARIFIX II SYSTEM W/ DEVICE AND 2 CANISTERS  CFX-2000,,A7000,HCPCS,Facility,Both,,,,3196,2716.6,915.9736,3196,First Health Group Corporation,First Health Network,3100.12,97,,percent of total billed charges,,
CLARIFIX II SYSTEM W/ DEVICE AND 2 CANISTERS  CFX-2000,,A7000,HCPCS,Facility,Both,,,,3196,2716.6,915.9736,3196,"Health Partners, Inc.",Commercial,3023.416,94.6,,percent of total billed charges,,
CLARIFIX II SYSTEM W/ DEVICE AND 2 CANISTERS  CFX-2000,,A7000,HCPCS,Facility,Outpatient,,,,3196,2716.6,915.9736,3196,"Health Partners, Inc.",Medicare Advantage,1566.04,49,,percent of total billed charges,,
CLARIFIX II SYSTEM W/ DEVICE AND 2 CANISTERS  CFX-2000,,A7000,HCPCS,Facility,Inpatient,,,,3196,2716.6,915.9736,3196,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CLARIFIX II SYSTEM W/ DEVICE AND 2 CANISTERS  CFX-2000,,A7000,HCPCS,Facility,Both,,,,3196,2716.6,915.9736,3196,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1917.6,60,,percent of total billed charges,,
CLARIFIX II SYSTEM W/ DEVICE AND 2 CANISTERS  CFX-2000,,A7000,HCPCS,Facility,Both,,,,3196,2716.6,915.9736,3196,"Health Partners, Inc.",State of Minnesota Advantage Program,2604.74,81.5,,percent of total billed charges,,
CLARIFIX II SYSTEM W/ DEVICE AND 2 CANISTERS  CFX-2000,,A7000,HCPCS,Facility,Both,,,,3196,2716.6,915.9736,3196,"Health Partners, Inc.",State Public Programs,1598,50,,percent of total billed charges,,
CLARIFIX II SYSTEM W/ DEVICE AND 2 CANISTERS  CFX-2000,,A7000,HCPCS,Facility,Both,,,,3196,2716.6,915.9736,3196,Humana Insurance Company,Commercial PPO,3036.2,95,,percent of total billed charges,,
CLARIFIX II SYSTEM W/ DEVICE AND 2 CANISTERS  CFX-2000,,A7000,HCPCS,Facility,Outpatient,,,,3196,2716.6,915.9736,3196,Humana Insurance Company,Medicare PPO,1566.04,49,,percent of total billed charges,,
CLARIFIX II SYSTEM W/ DEVICE AND 2 CANISTERS  CFX-2000,,A7000,HCPCS,Facility,Inpatient,,,,3196,2716.6,915.9736,3196,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
CLARIFIX II SYSTEM W/ DEVICE AND 2 CANISTERS  CFX-2000,,A7000,HCPCS,Facility,Both,,,,3196,2716.6,915.9736,3196,Medica,Individual & Family,3167.236,99.1,,percent of total billed charges,,
CLARIFIX II SYSTEM W/ DEVICE AND 2 CANISTERS  CFX-2000,,A7000,HCPCS,Facility,Outpatient,,,,3196,2716.6,915.9736,3196,Medica,Medica Advantage Solution,1591.608,49.8,,percent of total billed charges,,
CLARIFIX II SYSTEM W/ DEVICE AND 2 CANISTERS  CFX-2000,,A7000,HCPCS,Facility,Inpatient,,,,3196,2716.6,915.9736,3196,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
CLARIFIX II SYSTEM W/ DEVICE AND 2 CANISTERS  CFX-2000,,A7000,HCPCS,Facility,Outpatient,,,,3196,2716.6,915.9736,3196,Medica,Medical Assistance,1425.416,44.6,,percent of total billed charges,,
CLARIFIX II SYSTEM W/ DEVICE AND 2 CANISTERS  CFX-2000,,A7000,HCPCS,Facility,Inpatient,,,,3196,2716.6,915.9736,3196,Medica,Medical Assistance,,,,,Included in per diem rate,
CLARIFIX II SYSTEM W/ DEVICE AND 2 CANISTERS  CFX-2000,,A7000,HCPCS,Facility,Outpatient,,,,3196,2716.6,915.9736,3196,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1591.608,49.8,,percent of total billed charges,,
CLARIFIX II SYSTEM W/ DEVICE AND 2 CANISTERS  CFX-2000,,A7000,HCPCS,Facility,Inpatient,,,,3196,2716.6,915.9736,3196,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
CLARIFIX II SYSTEM W/ DEVICE AND 2 CANISTERS  CFX-2000,,A7000,HCPCS,Facility,Both,,,,3196,2716.6,915.9736,3196,"Multiplan, Inc.","Multiplan, Inc.",3004.24,94,,percent of total billed charges,,
CLARIFIX II SYSTEM W/ DEVICE AND 2 CANISTERS  CFX-2000,,A7000,HCPCS,Facility,Outpatient,,,,3196,2716.6,915.9736,3196,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,2879.596,90.1,,percent of total billed charges,,
CLARIFIX II SYSTEM W/ DEVICE AND 2 CANISTERS  CFX-2000,,A7000,HCPCS,Facility,Inpatient,,,,3196,2716.6,915.9736,3196,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
CLARIFIX II SYSTEM W/ DEVICE AND 2 CANISTERS  CFX-2000,,A7000,HCPCS,Facility,Both,,,,3196,2716.6,915.9736,3196,"Preferred One Administrative Services, INC.",PPO,3151.256,98.6,,percent of total billed charges,,
CLARIFIX II SYSTEM W/ DEVICE AND 2 CANISTERS  CFX-2000,,A7000,HCPCS,Facility,Outpatient,,,,3196,2716.6,915.9736,3196,PrimeWest Health,Minnesota Senior Health Options (MSHO),1644.342,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
CLARIFIX II SYSTEM W/ DEVICE AND 2 CANISTERS  CFX-2000,,A7000,HCPCS,Facility,Inpatient,,,,3196,2716.6,915.9736,3196,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CLARIFIX II SYSTEM W/ DEVICE AND 2 CANISTERS  CFX-2000,,A7000,HCPCS,Facility,Outpatient,,,,3196,2716.6,915.9736,3196,PrimeWest Health,MinnesotaCare,1641.4656,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
CLARIFIX II SYSTEM W/ DEVICE AND 2 CANISTERS  CFX-2000,,A7000,HCPCS,Facility,Inpatient,,,,3196,2716.6,915.9736,3196,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
CLARIFIX II SYSTEM W/ DEVICE AND 2 CANISTERS  CFX-2000,,A7000,HCPCS,Facility,Both,,,,3196,2716.6,915.9736,3196,Sanford Health Plan,Sanford Health Plan,2940.32,92,,percent of total billed charges,,
CLARIFIX II SYSTEM W/ DEVICE AND 2 CANISTERS  CFX-2000,,A7000,HCPCS,Facility,Outpatient,,,,3196,2716.6,915.9736,3196,"UCare Health, Inc.",Individual & Family Plan,1800.946,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
CLARIFIX II SYSTEM W/ DEVICE AND 2 CANISTERS  CFX-2000,,A7000,HCPCS,Facility,Inpatient,,,,3196,2716.6,915.9736,3196,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
CLARIFIX II SYSTEM W/ DEVICE AND 2 CANISTERS  CFX-2000,,A7000,HCPCS,Facility,Outpatient,,,,3196,2716.6,915.9736,3196,"UCare Health, Inc.",Medical Assistance,1613.0212,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CLARIFIX II SYSTEM W/ DEVICE AND 2 CANISTERS  CFX-2000,,A7000,HCPCS,Facility,Inpatient,,,,3196,2716.6,915.9736,3196,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
CLARIFIX II SYSTEM W/ DEVICE AND 2 CANISTERS  CFX-2000,,A7000,HCPCS,Facility,Outpatient,,,,3196,2716.6,915.9736,3196,"UCare Health, Inc.",Medicare Advantage,1613.0212,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CLARIFIX II SYSTEM W/ DEVICE AND 2 CANISTERS  CFX-2000,,A7000,HCPCS,Facility,Inpatient,,,,3196,2716.6,915.9736,3196,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CLARIFIX II SYSTEM W/ DEVICE AND 2 CANISTERS  CFX-2000,,A7000,HCPCS,Facility,Outpatient,,,,3196,2716.6,915.9736,3196,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1613.0212,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CLARIFIX II SYSTEM W/ DEVICE AND 2 CANISTERS  CFX-2000,,A7000,HCPCS,Facility,Inpatient,,,,3196,2716.6,915.9736,3196,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CLARIFIX II SYSTEM W/ DEVICE AND 2 CANISTERS  CFX-2000,,A7000,HCPCS,Facility,Both,,,,3196,2716.6,915.9736,3196,UnitedHealthcare,Individual & Family,3004.24,94,,percent of total billed charges,,
CLARIFIX II SYSTEM W/ DEVICE AND 2 CANISTERS  CFX-2000,,A7000,HCPCS,Facility,Outpatient,,,,3196,2716.6,915.9736,3196,UnitedHealthcare,Medicare Advantage,1566.04,49,,percent of total billed charges,,
CLARIFIX II SYSTEM W/ DEVICE AND 2 CANISTERS  CFX-2000,,A7000,HCPCS,Facility,Inpatient,,,,3196,2716.6,915.9736,3196,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
CLARIFIX II SYSTEM W/ DEVICE AND 2 CANISTERS  CFX-2000,,A7000,HCPCS,Facility,Outpatient,,,,3196,2716.6,915.9736,3196,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1534.08,48,,percent of total billed charges,,100% of DHS outpatient percentage
CLARIFIX II SYSTEM W/ DEVICE AND 2 CANISTERS  CFX-2000,,A7000,HCPCS,Facility,Inpatient,,,,3196,2716.6,915.9736,3196,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Sup Nebulizer Set,,A7003,HCPCS,Facility,Both,,,,89,75.65,25.5074,89,Aetna,Commercial,81.88,92,,percent of total billed charges,,
Sup Nebulizer Set,,A7003,HCPCS,Facility,Outpatient,,,,89,75.65,25.5074,89,Aetna,Medicare Advantage,43.61,49,,percent of total billed charges,,
Sup Nebulizer Set,,A7003,HCPCS,Facility,Inpatient,,,,89,75.65,25.5074,89,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Sup Nebulizer Set,,A7003,HCPCS,Facility,Both,,,,89,75.65,25.5074,89,Aetna,PPO,82.77,93,,percent of total billed charges,,
Sup Nebulizer Set,,A7003,HCPCS,Facility,Both,,,,89,75.65,25.5074,89,America's PPO,America's PPO,85.4667,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Sup Nebulizer Set,,A7003,HCPCS,Facility,Both,,,,89,75.65,25.5074,89,BlueCross BlueShield Minnesota, Federal Employee Program,87.576,98.4,,percent of total billed charges,,
Sup Nebulizer Set,,A7003,HCPCS,Facility,Both,,,,89,75.65,25.5074,89,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,89,100,,percent of total billed charges,,
Sup Nebulizer Set,,A7003,HCPCS,Facility,Both,,,,89,75.65,25.5074,89,BlueCross BlueShield Minnesota,High Value Network Plan,80.1,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
Sup Nebulizer Set,,A7003,HCPCS,Facility,Outpatient,,,,89,75.65,25.5074,89,BlueCross BlueShield Minnesota,Medicare Advantage,43.61,49,,percent of total billed charges,,
Sup Nebulizer Set,,A7003,HCPCS,Facility,Inpatient,,,,89,75.65,25.5074,89,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Sup Nebulizer Set,,A7003,HCPCS,Facility,Both,,,,89,75.65,25.5074,89,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,78.8273,88.57,,percent of total billed charges,,
Sup Nebulizer Set,,A7003,HCPCS,Facility,Both,,,,89,75.65,25.5074,89,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,25.5074,28.66,,percent of total billed charges,,
Sup Nebulizer Set,,A7003,HCPCS,Facility,Outpatient,,,,89,75.65,25.5074,89,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),43.61,49,,percent of total billed charges,,
Sup Nebulizer Set,,A7003,HCPCS,Facility,Inpatient,,,,89,75.65,25.5074,89,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Sup Nebulizer Set,,A7003,HCPCS,Facility,Both,,,,89,75.65,25.5074,89,CorVel,Worker's Compensation,89,100,,percent of total billed charges,,
Sup Nebulizer Set,,A7003,HCPCS,Facility,Both,,,,89,75.65,25.5074,89,First Health Group Corporation,First Health Network,86.33,97,,percent of total billed charges,,
Sup Nebulizer Set,,A7003,HCPCS,Facility,Both,,,,89,75.65,25.5074,89,"Health Partners, Inc.",Commercial,84.194,94.6,,percent of total billed charges,,
Sup Nebulizer Set,,A7003,HCPCS,Facility,Outpatient,,,,89,75.65,25.5074,89,"Health Partners, Inc.",Medicare Advantage,43.61,49,,percent of total billed charges,,
Sup Nebulizer Set,,A7003,HCPCS,Facility,Inpatient,,,,89,75.65,25.5074,89,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Nebulizer Set,,A7003,HCPCS,Facility,Both,,,,89,75.65,25.5074,89,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),53.4,60,,percent of total billed charges,,
Sup Nebulizer Set,,A7003,HCPCS,Facility,Both,,,,89,75.65,25.5074,89,"Health Partners, Inc.",State of Minnesota Advantage Program,72.535,81.5,,percent of total billed charges,,
Sup Nebulizer Set,,A7003,HCPCS,Facility,Both,,,,89,75.65,25.5074,89,"Health Partners, Inc.",State Public Programs,44.5,50,,percent of total billed charges,,
Sup Nebulizer Set,,A7003,HCPCS,Facility,Both,,,,89,75.65,25.5074,89,Humana Insurance Company,Commercial PPO,84.55,95,,percent of total billed charges,,
Sup Nebulizer Set,,A7003,HCPCS,Facility,Outpatient,,,,89,75.65,25.5074,89,Humana Insurance Company,Medicare PPO,43.61,49,,percent of total billed charges,,
Sup Nebulizer Set,,A7003,HCPCS,Facility,Inpatient,,,,89,75.65,25.5074,89,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Sup Nebulizer Set,,A7003,HCPCS,Facility,Both,,,,89,75.65,25.5074,89,Medica,Individual & Family,88.199,99.1,,percent of total billed charges,,
Sup Nebulizer Set,,A7003,HCPCS,Facility,Outpatient,,,,89,75.65,25.5074,89,Medica,Medica Advantage Solution,44.322,49.8,,percent of total billed charges,,
Sup Nebulizer Set,,A7003,HCPCS,Facility,Inpatient,,,,89,75.65,25.5074,89,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Sup Nebulizer Set,,A7003,HCPCS,Facility,Outpatient,,,,89,75.65,25.5074,89,Medica,Medical Assistance,39.694,44.6,,percent of total billed charges,,
Sup Nebulizer Set,,A7003,HCPCS,Facility,Inpatient,,,,89,75.65,25.5074,89,Medica,Medical Assistance,,,,,Included in per diem rate,
Sup Nebulizer Set,,A7003,HCPCS,Facility,Outpatient,,,,89,75.65,25.5074,89,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,44.322,49.8,,percent of total billed charges,,
Sup Nebulizer Set,,A7003,HCPCS,Facility,Inpatient,,,,89,75.65,25.5074,89,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Sup Nebulizer Set,,A7003,HCPCS,Facility,Both,,,,89,75.65,25.5074,89,"Multiplan, Inc.","Multiplan, Inc.",83.66,94,,percent of total billed charges,,
Sup Nebulizer Set,,A7003,HCPCS,Facility,Outpatient,,,,89,75.65,25.5074,89,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,80.189,90.1,,percent of total billed charges,,
Sup Nebulizer Set,,A7003,HCPCS,Facility,Inpatient,,,,89,75.65,25.5074,89,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Sup Nebulizer Set,,A7003,HCPCS,Facility,Both,,,,89,75.65,25.5074,89,"Preferred One Administrative Services, INC.",PPO,87.754,98.6,,percent of total billed charges,,
Sup Nebulizer Set,,A7003,HCPCS,Facility,Outpatient,,,,89,75.65,25.5074,89,PrimeWest Health,Minnesota Senior Health Options (MSHO),45.7905,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Sup Nebulizer Set,,A7003,HCPCS,Facility,Inpatient,,,,89,75.65,25.5074,89,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Nebulizer Set,,A7003,HCPCS,Facility,Outpatient,,,,89,75.65,25.5074,89,PrimeWest Health,MinnesotaCare,45.7104,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Sup Nebulizer Set,,A7003,HCPCS,Facility,Inpatient,,,,89,75.65,25.5074,89,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Sup Nebulizer Set,,A7003,HCPCS,Facility,Both,,,,89,75.65,25.5074,89,Sanford Health Plan,Sanford Health Plan,81.88,92,,percent of total billed charges,,
Sup Nebulizer Set,,A7003,HCPCS,Facility,Outpatient,,,,89,75.65,25.5074,89,"UCare Health, Inc.",Individual & Family Plan,50.1515,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Sup Nebulizer Set,,A7003,HCPCS,Facility,Inpatient,,,,89,75.65,25.5074,89,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Sup Nebulizer Set,,A7003,HCPCS,Facility,Outpatient,,,,89,75.65,25.5074,89,"UCare Health, Inc.",Medical Assistance,44.9183,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Nebulizer Set,,A7003,HCPCS,Facility,Inpatient,,,,89,75.65,25.5074,89,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Sup Nebulizer Set,,A7003,HCPCS,Facility,Outpatient,,,,89,75.65,25.5074,89,"UCare Health, Inc.",Medicare Advantage,44.9183,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Nebulizer Set,,A7003,HCPCS,Facility,Inpatient,,,,89,75.65,25.5074,89,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Nebulizer Set,,A7003,HCPCS,Facility,Outpatient,,,,89,75.65,25.5074,89,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),44.9183,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Nebulizer Set,,A7003,HCPCS,Facility,Inpatient,,,,89,75.65,25.5074,89,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Nebulizer Set,,A7003,HCPCS,Facility,Both,,,,89,75.65,25.5074,89,UnitedHealthcare,Individual & Family,83.66,94,,percent of total billed charges,,
Sup Nebulizer Set,,A7003,HCPCS,Facility,Outpatient,,,,89,75.65,25.5074,89,UnitedHealthcare,Medicare Advantage,43.61,49,,percent of total billed charges,,
Sup Nebulizer Set,,A7003,HCPCS,Facility,Inpatient,,,,89,75.65,25.5074,89,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Sup Nebulizer Set,,A7003,HCPCS,Facility,Outpatient,,,,89,75.65,25.5074,89,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,42.72,48,,percent of total billed charges,,100% of DHS outpatient percentage
Sup Nebulizer Set,,A7003,HCPCS,Facility,Inpatient,,,,89,75.65,25.5074,89,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Sup Mask Laryngeal,,A7034,HCPCS,Facility,Both,,,,30,25.5,8.598,30,Aetna,Commercial,27.6,92,,percent of total billed charges,,
Sup Mask Laryngeal,,A7034,HCPCS,Facility,Outpatient,,,,30,25.5,8.598,30,Aetna,Medicare Advantage,14.7,49,,percent of total billed charges,,
Sup Mask Laryngeal,,A7034,HCPCS,Facility,Inpatient,,,,30,25.5,8.598,30,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Sup Mask Laryngeal,,A7034,HCPCS,Facility,Both,,,,30,25.5,8.598,30,Aetna,PPO,27.9,93,,percent of total billed charges,,
Sup Mask Laryngeal,,A7034,HCPCS,Facility,Both,,,,30,25.5,8.598,30,America's PPO,America's PPO,28.809,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Sup Mask Laryngeal,,A7034,HCPCS,Facility,Both,,,,30,25.5,8.598,30,BlueCross BlueShield Minnesota, Federal Employee Program,29.52,98.4,,percent of total billed charges,,
Sup Mask Laryngeal,,A7034,HCPCS,Facility,Both,,,,30,25.5,8.598,30,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,30,100,,percent of total billed charges,,
Sup Mask Laryngeal,,A7034,HCPCS,Facility,Both,,,,30,25.5,8.598,30,BlueCross BlueShield Minnesota,High Value Network Plan,27,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
Sup Mask Laryngeal,,A7034,HCPCS,Facility,Outpatient,,,,30,25.5,8.598,30,BlueCross BlueShield Minnesota,Medicare Advantage,14.7,49,,percent of total billed charges,,
Sup Mask Laryngeal,,A7034,HCPCS,Facility,Inpatient,,,,30,25.5,8.598,30,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Sup Mask Laryngeal,,A7034,HCPCS,Facility,Both,,,,30,25.5,8.598,30,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,26.571,88.57,,percent of total billed charges,,
Sup Mask Laryngeal,,A7034,HCPCS,Facility,Both,,,,30,25.5,8.598,30,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,8.598,28.66,,percent of total billed charges,,
Sup Mask Laryngeal,,A7034,HCPCS,Facility,Outpatient,,,,30,25.5,8.598,30,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),14.7,49,,percent of total billed charges,,
Sup Mask Laryngeal,,A7034,HCPCS,Facility,Inpatient,,,,30,25.5,8.598,30,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Sup Mask Laryngeal,,A7034,HCPCS,Facility,Both,,,,30,25.5,8.598,30,CorVel,Worker's Compensation,30,100,,percent of total billed charges,,
Sup Mask Laryngeal,,A7034,HCPCS,Facility,Both,,,,30,25.5,8.598,30,First Health Group Corporation,First Health Network,29.1,97,,percent of total billed charges,,
Sup Mask Laryngeal,,A7034,HCPCS,Facility,Both,,,,30,25.5,8.598,30,"Health Partners, Inc.",Commercial,28.38,94.6,,percent of total billed charges,,
Sup Mask Laryngeal,,A7034,HCPCS,Facility,Outpatient,,,,30,25.5,8.598,30,"Health Partners, Inc.",Medicare Advantage,14.7,49,,percent of total billed charges,,
Sup Mask Laryngeal,,A7034,HCPCS,Facility,Inpatient,,,,30,25.5,8.598,30,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Mask Laryngeal,,A7034,HCPCS,Facility,Both,,,,30,25.5,8.598,30,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),18,60,,percent of total billed charges,,
Sup Mask Laryngeal,,A7034,HCPCS,Facility,Both,,,,30,25.5,8.598,30,"Health Partners, Inc.",State of Minnesota Advantage Program,24.45,81.5,,percent of total billed charges,,
Sup Mask Laryngeal,,A7034,HCPCS,Facility,Both,,,,30,25.5,8.598,30,"Health Partners, Inc.",State Public Programs,15,50,,percent of total billed charges,,
Sup Mask Laryngeal,,A7034,HCPCS,Facility,Both,,,,30,25.5,8.598,30,Humana Insurance Company,Commercial PPO,28.5,95,,percent of total billed charges,,
Sup Mask Laryngeal,,A7034,HCPCS,Facility,Outpatient,,,,30,25.5,8.598,30,Humana Insurance Company,Medicare PPO,14.7,49,,percent of total billed charges,,
Sup Mask Laryngeal,,A7034,HCPCS,Facility,Inpatient,,,,30,25.5,8.598,30,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Sup Mask Laryngeal,,A7034,HCPCS,Facility,Both,,,,30,25.5,8.598,30,Medica,Individual & Family,29.73,99.1,,percent of total billed charges,,
Sup Mask Laryngeal,,A7034,HCPCS,Facility,Outpatient,,,,30,25.5,8.598,30,Medica,Medica Advantage Solution,14.94,49.8,,percent of total billed charges,,
Sup Mask Laryngeal,,A7034,HCPCS,Facility,Inpatient,,,,30,25.5,8.598,30,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Sup Mask Laryngeal,,A7034,HCPCS,Facility,Outpatient,,,,30,25.5,8.598,30,Medica,Medical Assistance,13.38,44.6,,percent of total billed charges,,
Sup Mask Laryngeal,,A7034,HCPCS,Facility,Inpatient,,,,30,25.5,8.598,30,Medica,Medical Assistance,,,,,Included in per diem rate,
Sup Mask Laryngeal,,A7034,HCPCS,Facility,Outpatient,,,,30,25.5,8.598,30,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,14.94,49.8,,percent of total billed charges,,
Sup Mask Laryngeal,,A7034,HCPCS,Facility,Inpatient,,,,30,25.5,8.598,30,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Sup Mask Laryngeal,,A7034,HCPCS,Facility,Both,,,,30,25.5,8.598,30,"Multiplan, Inc.","Multiplan, Inc.",28.2,94,,percent of total billed charges,,
Sup Mask Laryngeal,,A7034,HCPCS,Facility,Outpatient,,,,30,25.5,8.598,30,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,27.03,90.1,,percent of total billed charges,,
Sup Mask Laryngeal,,A7034,HCPCS,Facility,Inpatient,,,,30,25.5,8.598,30,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Sup Mask Laryngeal,,A7034,HCPCS,Facility,Both,,,,30,25.5,8.598,30,"Preferred One Administrative Services, INC.",PPO,29.58,98.6,,percent of total billed charges,,
Sup Mask Laryngeal,,A7034,HCPCS,Facility,Outpatient,,,,30,25.5,8.598,30,PrimeWest Health,Minnesota Senior Health Options (MSHO),15.435,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Sup Mask Laryngeal,,A7034,HCPCS,Facility,Inpatient,,,,30,25.5,8.598,30,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Mask Laryngeal,,A7034,HCPCS,Facility,Outpatient,,,,30,25.5,8.598,30,PrimeWest Health,MinnesotaCare,15.408,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Sup Mask Laryngeal,,A7034,HCPCS,Facility,Inpatient,,,,30,25.5,8.598,30,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Sup Mask Laryngeal,,A7034,HCPCS,Facility,Both,,,,30,25.5,8.598,30,Sanford Health Plan,Sanford Health Plan,27.6,92,,percent of total billed charges,,
Sup Mask Laryngeal,,A7034,HCPCS,Facility,Outpatient,,,,30,25.5,8.598,30,"UCare Health, Inc.",Individual & Family Plan,16.905,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Sup Mask Laryngeal,,A7034,HCPCS,Facility,Inpatient,,,,30,25.5,8.598,30,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Sup Mask Laryngeal,,A7034,HCPCS,Facility,Outpatient,,,,30,25.5,8.598,30,"UCare Health, Inc.",Medical Assistance,15.141,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Mask Laryngeal,,A7034,HCPCS,Facility,Inpatient,,,,30,25.5,8.598,30,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Sup Mask Laryngeal,,A7034,HCPCS,Facility,Outpatient,,,,30,25.5,8.598,30,"UCare Health, Inc.",Medicare Advantage,15.141,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Mask Laryngeal,,A7034,HCPCS,Facility,Inpatient,,,,30,25.5,8.598,30,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Mask Laryngeal,,A7034,HCPCS,Facility,Outpatient,,,,30,25.5,8.598,30,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),15.141,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Mask Laryngeal,,A7034,HCPCS,Facility,Inpatient,,,,30,25.5,8.598,30,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Mask Laryngeal,,A7034,HCPCS,Facility,Both,,,,30,25.5,8.598,30,UnitedHealthcare,Individual & Family,28.2,94,,percent of total billed charges,,
Sup Mask Laryngeal,,A7034,HCPCS,Facility,Outpatient,,,,30,25.5,8.598,30,UnitedHealthcare,Medicare Advantage,14.7,49,,percent of total billed charges,,
Sup Mask Laryngeal,,A7034,HCPCS,Facility,Inpatient,,,,30,25.5,8.598,30,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Sup Mask Laryngeal,,A7034,HCPCS,Facility,Outpatient,,,,30,25.5,8.598,30,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,14.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
Sup Mask Laryngeal,,A7034,HCPCS,Facility,Inpatient,,,,30,25.5,8.598,30,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Sup Pleurovac Unit,,A7041,HCPCS,Facility,Both,,,,421,357.85,120.6586,421,Aetna,Commercial,387.32,92,,percent of total billed charges,,
Sup Pleurovac Unit,,A7041,HCPCS,Facility,Outpatient,,,,421,357.85,120.6586,421,Aetna,Medicare Advantage,206.29,49,,percent of total billed charges,,
Sup Pleurovac Unit,,A7041,HCPCS,Facility,Inpatient,,,,421,357.85,120.6586,421,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Sup Pleurovac Unit,,A7041,HCPCS,Facility,Both,,,,421,357.85,120.6586,421,Aetna,PPO,391.53,93,,percent of total billed charges,,
Sup Pleurovac Unit,,A7041,HCPCS,Facility,Both,,,,421,357.85,120.6586,421,America's PPO,America's PPO,404.2863,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Sup Pleurovac Unit,,A7041,HCPCS,Facility,Both,,,,421,357.85,120.6586,421,BlueCross BlueShield Minnesota, Federal Employee Program,414.264,98.4,,percent of total billed charges,,
Sup Pleurovac Unit,,A7041,HCPCS,Facility,Both,,,,421,357.85,120.6586,421,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,421,100,,percent of total billed charges,,
Sup Pleurovac Unit,,A7041,HCPCS,Facility,Both,,,,421,357.85,120.6586,421,BlueCross BlueShield Minnesota,High Value Network Plan,378.9,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
Sup Pleurovac Unit,,A7041,HCPCS,Facility,Outpatient,,,,421,357.85,120.6586,421,BlueCross BlueShield Minnesota,Medicare Advantage,206.29,49,,percent of total billed charges,,
Sup Pleurovac Unit,,A7041,HCPCS,Facility,Inpatient,,,,421,357.85,120.6586,421,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Sup Pleurovac Unit,,A7041,HCPCS,Facility,Both,,,,421,357.85,120.6586,421,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,372.8797,88.57,,percent of total billed charges,,
Sup Pleurovac Unit,,A7041,HCPCS,Facility,Both,,,,421,357.85,120.6586,421,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,120.6586,28.66,,percent of total billed charges,,
Sup Pleurovac Unit,,A7041,HCPCS,Facility,Outpatient,,,,421,357.85,120.6586,421,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),206.29,49,,percent of total billed charges,,
Sup Pleurovac Unit,,A7041,HCPCS,Facility,Inpatient,,,,421,357.85,120.6586,421,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Sup Pleurovac Unit,,A7041,HCPCS,Facility,Both,,,,421,357.85,120.6586,421,CorVel,Worker's Compensation,421,100,,percent of total billed charges,,
Sup Pleurovac Unit,,A7041,HCPCS,Facility,Both,,,,421,357.85,120.6586,421,First Health Group Corporation,First Health Network,408.37,97,,percent of total billed charges,,
Sup Pleurovac Unit,,A7041,HCPCS,Facility,Both,,,,421,357.85,120.6586,421,"Health Partners, Inc.",Commercial,398.266,94.6,,percent of total billed charges,,
Sup Pleurovac Unit,,A7041,HCPCS,Facility,Outpatient,,,,421,357.85,120.6586,421,"Health Partners, Inc.",Medicare Advantage,206.29,49,,percent of total billed charges,,
Sup Pleurovac Unit,,A7041,HCPCS,Facility,Inpatient,,,,421,357.85,120.6586,421,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Pleurovac Unit,,A7041,HCPCS,Facility,Both,,,,421,357.85,120.6586,421,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),252.6,60,,percent of total billed charges,,
Sup Pleurovac Unit,,A7041,HCPCS,Facility,Both,,,,421,357.85,120.6586,421,"Health Partners, Inc.",State of Minnesota Advantage Program,343.115,81.5,,percent of total billed charges,,
Sup Pleurovac Unit,,A7041,HCPCS,Facility,Both,,,,421,357.85,120.6586,421,"Health Partners, Inc.",State Public Programs,210.5,50,,percent of total billed charges,,
Sup Pleurovac Unit,,A7041,HCPCS,Facility,Both,,,,421,357.85,120.6586,421,Humana Insurance Company,Commercial PPO,399.95,95,,percent of total billed charges,,
Sup Pleurovac Unit,,A7041,HCPCS,Facility,Outpatient,,,,421,357.85,120.6586,421,Humana Insurance Company,Medicare PPO,206.29,49,,percent of total billed charges,,
Sup Pleurovac Unit,,A7041,HCPCS,Facility,Inpatient,,,,421,357.85,120.6586,421,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Sup Pleurovac Unit,,A7041,HCPCS,Facility,Both,,,,421,357.85,120.6586,421,Medica,Individual & Family,417.211,99.1,,percent of total billed charges,,
Sup Pleurovac Unit,,A7041,HCPCS,Facility,Outpatient,,,,421,357.85,120.6586,421,Medica,Medica Advantage Solution,209.658,49.8,,percent of total billed charges,,
Sup Pleurovac Unit,,A7041,HCPCS,Facility,Inpatient,,,,421,357.85,120.6586,421,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Sup Pleurovac Unit,,A7041,HCPCS,Facility,Outpatient,,,,421,357.85,120.6586,421,Medica,Medical Assistance,187.766,44.6,,percent of total billed charges,,
Sup Pleurovac Unit,,A7041,HCPCS,Facility,Inpatient,,,,421,357.85,120.6586,421,Medica,Medical Assistance,,,,,Included in per diem rate,
Sup Pleurovac Unit,,A7041,HCPCS,Facility,Outpatient,,,,421,357.85,120.6586,421,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,209.658,49.8,,percent of total billed charges,,
Sup Pleurovac Unit,,A7041,HCPCS,Facility,Inpatient,,,,421,357.85,120.6586,421,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Sup Pleurovac Unit,,A7041,HCPCS,Facility,Both,,,,421,357.85,120.6586,421,"Multiplan, Inc.","Multiplan, Inc.",395.74,94,,percent of total billed charges,,
Sup Pleurovac Unit,,A7041,HCPCS,Facility,Outpatient,,,,421,357.85,120.6586,421,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,379.321,90.1,,percent of total billed charges,,
Sup Pleurovac Unit,,A7041,HCPCS,Facility,Inpatient,,,,421,357.85,120.6586,421,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Sup Pleurovac Unit,,A7041,HCPCS,Facility,Both,,,,421,357.85,120.6586,421,"Preferred One Administrative Services, INC.",PPO,415.106,98.6,,percent of total billed charges,,
Sup Pleurovac Unit,,A7041,HCPCS,Facility,Outpatient,,,,421,357.85,120.6586,421,PrimeWest Health,Minnesota Senior Health Options (MSHO),216.6045,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Sup Pleurovac Unit,,A7041,HCPCS,Facility,Inpatient,,,,421,357.85,120.6586,421,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Pleurovac Unit,,A7041,HCPCS,Facility,Outpatient,,,,421,357.85,120.6586,421,PrimeWest Health,MinnesotaCare,216.2256,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Sup Pleurovac Unit,,A7041,HCPCS,Facility,Inpatient,,,,421,357.85,120.6586,421,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Sup Pleurovac Unit,,A7041,HCPCS,Facility,Both,,,,421,357.85,120.6586,421,Sanford Health Plan,Sanford Health Plan,387.32,92,,percent of total billed charges,,
Sup Pleurovac Unit,,A7041,HCPCS,Facility,Outpatient,,,,421,357.85,120.6586,421,"UCare Health, Inc.",Individual & Family Plan,237.2335,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Sup Pleurovac Unit,,A7041,HCPCS,Facility,Inpatient,,,,421,357.85,120.6586,421,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Sup Pleurovac Unit,,A7041,HCPCS,Facility,Outpatient,,,,421,357.85,120.6586,421,"UCare Health, Inc.",Medical Assistance,212.4787,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Pleurovac Unit,,A7041,HCPCS,Facility,Inpatient,,,,421,357.85,120.6586,421,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Sup Pleurovac Unit,,A7041,HCPCS,Facility,Outpatient,,,,421,357.85,120.6586,421,"UCare Health, Inc.",Medicare Advantage,212.4787,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Pleurovac Unit,,A7041,HCPCS,Facility,Inpatient,,,,421,357.85,120.6586,421,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Pleurovac Unit,,A7041,HCPCS,Facility,Outpatient,,,,421,357.85,120.6586,421,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),212.4787,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Pleurovac Unit,,A7041,HCPCS,Facility,Inpatient,,,,421,357.85,120.6586,421,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Pleurovac Unit,,A7041,HCPCS,Facility,Both,,,,421,357.85,120.6586,421,UnitedHealthcare,Individual & Family,395.74,94,,percent of total billed charges,,
Sup Pleurovac Unit,,A7041,HCPCS,Facility,Outpatient,,,,421,357.85,120.6586,421,UnitedHealthcare,Medicare Advantage,206.29,49,,percent of total billed charges,,
Sup Pleurovac Unit,,A7041,HCPCS,Facility,Inpatient,,,,421,357.85,120.6586,421,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Sup Pleurovac Unit,,A7041,HCPCS,Facility,Outpatient,,,,421,357.85,120.6586,421,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,202.08,48,,percent of total billed charges,,100% of DHS outpatient percentage
Sup Pleurovac Unit,,A7041,HCPCS,Facility,Inpatient,,,,421,357.85,120.6586,421,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
1000CC EVAC CONTAINER,,A7048,HCPCS,Facility,Both,,,,33,28.05,9.4578,33,Aetna,Commercial,30.36,92,,percent of total billed charges,,
1000CC EVAC CONTAINER,,A7048,HCPCS,Facility,Outpatient,,,,33,28.05,9.4578,33,Aetna,Medicare Advantage,16.17,49,,percent of total billed charges,,
1000CC EVAC CONTAINER,,A7048,HCPCS,Facility,Inpatient,,,,33,28.05,9.4578,33,Aetna,Medicare Advantage,,,,,Included in per diem rate,
1000CC EVAC CONTAINER,,A7048,HCPCS,Facility,Both,,,,33,28.05,9.4578,33,Aetna,PPO,30.69,93,,percent of total billed charges,,
1000CC EVAC CONTAINER,,A7048,HCPCS,Facility,Both,,,,33,28.05,9.4578,33,America's PPO,America's PPO,31.6899,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
1000CC EVAC CONTAINER,,A7048,HCPCS,Facility,Both,,,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota, Federal Employee Program,32.472,98.4,,percent of total billed charges,,
1000CC EVAC CONTAINER,,A7048,HCPCS,Facility,Both,,,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,33,100,,percent of total billed charges,,
1000CC EVAC CONTAINER,,A7048,HCPCS,Facility,Both,,,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota,High Value Network Plan,29.7,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
1000CC EVAC CONTAINER,,A7048,HCPCS,Facility,Outpatient,,,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota,Medicare Advantage,16.17,49,,percent of total billed charges,,
1000CC EVAC CONTAINER,,A7048,HCPCS,Facility,Inpatient,,,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
1000CC EVAC CONTAINER,,A7048,HCPCS,Facility,Both,,,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,29.2281,88.57,,percent of total billed charges,,
1000CC EVAC CONTAINER,,A7048,HCPCS,Facility,Both,,,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,9.4578,28.66,,percent of total billed charges,,
1000CC EVAC CONTAINER,,A7048,HCPCS,Facility,Outpatient,,,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),16.17,49,,percent of total billed charges,,
1000CC EVAC CONTAINER,,A7048,HCPCS,Facility,Inpatient,,,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
1000CC EVAC CONTAINER,,A7048,HCPCS,Facility,Both,,,,33,28.05,9.4578,33,CorVel,Worker's Compensation,33,100,,percent of total billed charges,,
1000CC EVAC CONTAINER,,A7048,HCPCS,Facility,Both,,,,33,28.05,9.4578,33,First Health Group Corporation,First Health Network,32.01,97,,percent of total billed charges,,
1000CC EVAC CONTAINER,,A7048,HCPCS,Facility,Both,,,,33,28.05,9.4578,33,"Health Partners, Inc.",Commercial,31.218,94.6,,percent of total billed charges,,
1000CC EVAC CONTAINER,,A7048,HCPCS,Facility,Outpatient,,,,33,28.05,9.4578,33,"Health Partners, Inc.",Medicare Advantage,16.17,49,,percent of total billed charges,,
1000CC EVAC CONTAINER,,A7048,HCPCS,Facility,Inpatient,,,,33,28.05,9.4578,33,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
1000CC EVAC CONTAINER,,A7048,HCPCS,Facility,Both,,,,33,28.05,9.4578,33,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),19.8,60,,percent of total billed charges,,
1000CC EVAC CONTAINER,,A7048,HCPCS,Facility,Both,,,,33,28.05,9.4578,33,"Health Partners, Inc.",State of Minnesota Advantage Program,26.895,81.5,,percent of total billed charges,,
1000CC EVAC CONTAINER,,A7048,HCPCS,Facility,Both,,,,33,28.05,9.4578,33,"Health Partners, Inc.",State Public Programs,16.5,50,,percent of total billed charges,,
1000CC EVAC CONTAINER,,A7048,HCPCS,Facility,Both,,,,33,28.05,9.4578,33,Humana Insurance Company,Commercial PPO,31.35,95,,percent of total billed charges,,
1000CC EVAC CONTAINER,,A7048,HCPCS,Facility,Outpatient,,,,33,28.05,9.4578,33,Humana Insurance Company,Medicare PPO,16.17,49,,percent of total billed charges,,
1000CC EVAC CONTAINER,,A7048,HCPCS,Facility,Inpatient,,,,33,28.05,9.4578,33,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
1000CC EVAC CONTAINER,,A7048,HCPCS,Facility,Both,,,,33,28.05,9.4578,33,Medica,Individual & Family,32.703,99.1,,percent of total billed charges,,
1000CC EVAC CONTAINER,,A7048,HCPCS,Facility,Outpatient,,,,33,28.05,9.4578,33,Medica,Medica Advantage Solution,16.434,49.8,,percent of total billed charges,,
1000CC EVAC CONTAINER,,A7048,HCPCS,Facility,Inpatient,,,,33,28.05,9.4578,33,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
1000CC EVAC CONTAINER,,A7048,HCPCS,Facility,Outpatient,,,,33,28.05,9.4578,33,Medica,Medical Assistance,14.718,44.6,,percent of total billed charges,,
1000CC EVAC CONTAINER,,A7048,HCPCS,Facility,Inpatient,,,,33,28.05,9.4578,33,Medica,Medical Assistance,,,,,Included in per diem rate,
1000CC EVAC CONTAINER,,A7048,HCPCS,Facility,Outpatient,,,,33,28.05,9.4578,33,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,16.434,49.8,,percent of total billed charges,,
1000CC EVAC CONTAINER,,A7048,HCPCS,Facility,Inpatient,,,,33,28.05,9.4578,33,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
1000CC EVAC CONTAINER,,A7048,HCPCS,Facility,Both,,,,33,28.05,9.4578,33,"Multiplan, Inc.","Multiplan, Inc.",31.02,94,,percent of total billed charges,,
1000CC EVAC CONTAINER,,A7048,HCPCS,Facility,Outpatient,,,,33,28.05,9.4578,33,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,29.733,90.1,,percent of total billed charges,,
1000CC EVAC CONTAINER,,A7048,HCPCS,Facility,Inpatient,,,,33,28.05,9.4578,33,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
1000CC EVAC CONTAINER,,A7048,HCPCS,Facility,Both,,,,33,28.05,9.4578,33,"Preferred One Administrative Services, INC.",PPO,32.538,98.6,,percent of total billed charges,,
1000CC EVAC CONTAINER,,A7048,HCPCS,Facility,Outpatient,,,,33,28.05,9.4578,33,PrimeWest Health,Minnesota Senior Health Options (MSHO),16.9785,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
1000CC EVAC CONTAINER,,A7048,HCPCS,Facility,Inpatient,,,,33,28.05,9.4578,33,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
1000CC EVAC CONTAINER,,A7048,HCPCS,Facility,Outpatient,,,,33,28.05,9.4578,33,PrimeWest Health,MinnesotaCare,16.9488,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
1000CC EVAC CONTAINER,,A7048,HCPCS,Facility,Inpatient,,,,33,28.05,9.4578,33,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
1000CC EVAC CONTAINER,,A7048,HCPCS,Facility,Both,,,,33,28.05,9.4578,33,Sanford Health Plan,Sanford Health Plan,30.36,92,,percent of total billed charges,,
1000CC EVAC CONTAINER,,A7048,HCPCS,Facility,Outpatient,,,,33,28.05,9.4578,33,"UCare Health, Inc.",Individual & Family Plan,18.5955,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
1000CC EVAC CONTAINER,,A7048,HCPCS,Facility,Inpatient,,,,33,28.05,9.4578,33,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
1000CC EVAC CONTAINER,,A7048,HCPCS,Facility,Outpatient,,,,33,28.05,9.4578,33,"UCare Health, Inc.",Medical Assistance,16.6551,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
1000CC EVAC CONTAINER,,A7048,HCPCS,Facility,Inpatient,,,,33,28.05,9.4578,33,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
1000CC EVAC CONTAINER,,A7048,HCPCS,Facility,Outpatient,,,,33,28.05,9.4578,33,"UCare Health, Inc.",Medicare Advantage,16.6551,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
1000CC EVAC CONTAINER,,A7048,HCPCS,Facility,Inpatient,,,,33,28.05,9.4578,33,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
1000CC EVAC CONTAINER,,A7048,HCPCS,Facility,Outpatient,,,,33,28.05,9.4578,33,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),16.6551,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
1000CC EVAC CONTAINER,,A7048,HCPCS,Facility,Inpatient,,,,33,28.05,9.4578,33,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
1000CC EVAC CONTAINER,,A7048,HCPCS,Facility,Both,,,,33,28.05,9.4578,33,UnitedHealthcare,Individual & Family,31.02,94,,percent of total billed charges,,
1000CC EVAC CONTAINER,,A7048,HCPCS,Facility,Outpatient,,,,33,28.05,9.4578,33,UnitedHealthcare,Medicare Advantage,16.17,49,,percent of total billed charges,,
1000CC EVAC CONTAINER,,A7048,HCPCS,Facility,Inpatient,,,,33,28.05,9.4578,33,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
1000CC EVAC CONTAINER,,A7048,HCPCS,Facility,Outpatient,,,,33,28.05,9.4578,33,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,15.84,48,,percent of total billed charges,,100% of DHS outpatient percentage
1000CC EVAC CONTAINER,,A7048,HCPCS,Facility,Inpatient,,,,33,28.05,9.4578,33,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
500CC EVAC CONTAINER,,A7048,HCPCS,Facility,Both,,,,17.3,14.705,4.95818,17.3,Aetna,Commercial,15.916,92,,percent of total billed charges,,
500CC EVAC CONTAINER,,A7048,HCPCS,Facility,Outpatient,,,,17.3,14.705,4.95818,17.3,Aetna,Medicare Advantage,8.477,49,,percent of total billed charges,,
500CC EVAC CONTAINER,,A7048,HCPCS,Facility,Inpatient,,,,17.3,14.705,4.95818,17.3,Aetna,Medicare Advantage,,,,,Included in per diem rate,
500CC EVAC CONTAINER,,A7048,HCPCS,Facility,Both,,,,17.3,14.705,4.95818,17.3,Aetna,PPO,16.089,93,,percent of total billed charges,,
500CC EVAC CONTAINER,,A7048,HCPCS,Facility,Both,,,,17.3,14.705,4.95818,17.3,America's PPO,America's PPO,16.61319,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
500CC EVAC CONTAINER,,A7048,HCPCS,Facility,Both,,,,17.3,14.705,4.95818,17.3,BlueCross BlueShield Minnesota, Federal Employee Program,17.0232,98.4,,percent of total billed charges,,
500CC EVAC CONTAINER,,A7048,HCPCS,Facility,Both,,,,17.3,14.705,4.95818,17.3,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,17.3,100,,percent of total billed charges,,
500CC EVAC CONTAINER,,A7048,HCPCS,Facility,Both,,,,17.3,14.705,4.95818,17.3,BlueCross BlueShield Minnesota,High Value Network Plan,15.57,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
500CC EVAC CONTAINER,,A7048,HCPCS,Facility,Outpatient,,,,17.3,14.705,4.95818,17.3,BlueCross BlueShield Minnesota,Medicare Advantage,8.477,49,,percent of total billed charges,,
500CC EVAC CONTAINER,,A7048,HCPCS,Facility,Inpatient,,,,17.3,14.705,4.95818,17.3,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
500CC EVAC CONTAINER,,A7048,HCPCS,Facility,Both,,,,17.3,14.705,4.95818,17.3,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,15.32261,88.57,,percent of total billed charges,,
500CC EVAC CONTAINER,,A7048,HCPCS,Facility,Both,,,,17.3,14.705,4.95818,17.3,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,4.95818,28.66,,percent of total billed charges,,
500CC EVAC CONTAINER,,A7048,HCPCS,Facility,Outpatient,,,,17.3,14.705,4.95818,17.3,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),8.477,49,,percent of total billed charges,,
500CC EVAC CONTAINER,,A7048,HCPCS,Facility,Inpatient,,,,17.3,14.705,4.95818,17.3,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
500CC EVAC CONTAINER,,A7048,HCPCS,Facility,Both,,,,17.3,14.705,4.95818,17.3,CorVel,Worker's Compensation,17.3,100,,percent of total billed charges,,
500CC EVAC CONTAINER,,A7048,HCPCS,Facility,Both,,,,17.3,14.705,4.95818,17.3,First Health Group Corporation,First Health Network,16.781,97,,percent of total billed charges,,
500CC EVAC CONTAINER,,A7048,HCPCS,Facility,Both,,,,17.3,14.705,4.95818,17.3,"Health Partners, Inc.",Commercial,16.3658,94.6,,percent of total billed charges,,
500CC EVAC CONTAINER,,A7048,HCPCS,Facility,Outpatient,,,,17.3,14.705,4.95818,17.3,"Health Partners, Inc.",Medicare Advantage,8.477,49,,percent of total billed charges,,
500CC EVAC CONTAINER,,A7048,HCPCS,Facility,Inpatient,,,,17.3,14.705,4.95818,17.3,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
500CC EVAC CONTAINER,,A7048,HCPCS,Facility,Both,,,,17.3,14.705,4.95818,17.3,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),10.38,60,,percent of total billed charges,,
500CC EVAC CONTAINER,,A7048,HCPCS,Facility,Both,,,,17.3,14.705,4.95818,17.3,"Health Partners, Inc.",State of Minnesota Advantage Program,14.0995,81.5,,percent of total billed charges,,
500CC EVAC CONTAINER,,A7048,HCPCS,Facility,Both,,,,17.3,14.705,4.95818,17.3,"Health Partners, Inc.",State Public Programs,8.65,50,,percent of total billed charges,,
500CC EVAC CONTAINER,,A7048,HCPCS,Facility,Both,,,,17.3,14.705,4.95818,17.3,Humana Insurance Company,Commercial PPO,16.435,95,,percent of total billed charges,,
500CC EVAC CONTAINER,,A7048,HCPCS,Facility,Outpatient,,,,17.3,14.705,4.95818,17.3,Humana Insurance Company,Medicare PPO,8.477,49,,percent of total billed charges,,
500CC EVAC CONTAINER,,A7048,HCPCS,Facility,Inpatient,,,,17.3,14.705,4.95818,17.3,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
500CC EVAC CONTAINER,,A7048,HCPCS,Facility,Both,,,,17.3,14.705,4.95818,17.3,Medica,Individual & Family,17.1443,99.1,,percent of total billed charges,,
500CC EVAC CONTAINER,,A7048,HCPCS,Facility,Outpatient,,,,17.3,14.705,4.95818,17.3,Medica,Medica Advantage Solution,8.6154,49.8,,percent of total billed charges,,
500CC EVAC CONTAINER,,A7048,HCPCS,Facility,Inpatient,,,,17.3,14.705,4.95818,17.3,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
500CC EVAC CONTAINER,,A7048,HCPCS,Facility,Outpatient,,,,17.3,14.705,4.95818,17.3,Medica,Medical Assistance,7.7158,44.6,,percent of total billed charges,,
500CC EVAC CONTAINER,,A7048,HCPCS,Facility,Inpatient,,,,17.3,14.705,4.95818,17.3,Medica,Medical Assistance,,,,,Included in per diem rate,
500CC EVAC CONTAINER,,A7048,HCPCS,Facility,Outpatient,,,,17.3,14.705,4.95818,17.3,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,8.6154,49.8,,percent of total billed charges,,
500CC EVAC CONTAINER,,A7048,HCPCS,Facility,Inpatient,,,,17.3,14.705,4.95818,17.3,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
500CC EVAC CONTAINER,,A7048,HCPCS,Facility,Both,,,,17.3,14.705,4.95818,17.3,"Multiplan, Inc.","Multiplan, Inc.",16.262,94,,percent of total billed charges,,
500CC EVAC CONTAINER,,A7048,HCPCS,Facility,Outpatient,,,,17.3,14.705,4.95818,17.3,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,15.5873,90.1,,percent of total billed charges,,
500CC EVAC CONTAINER,,A7048,HCPCS,Facility,Inpatient,,,,17.3,14.705,4.95818,17.3,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
500CC EVAC CONTAINER,,A7048,HCPCS,Facility,Both,,,,17.3,14.705,4.95818,17.3,"Preferred One Administrative Services, INC.",PPO,17.0578,98.6,,percent of total billed charges,,
500CC EVAC CONTAINER,,A7048,HCPCS,Facility,Outpatient,,,,17.3,14.705,4.95818,17.3,PrimeWest Health,Minnesota Senior Health Options (MSHO),8.90085,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
500CC EVAC CONTAINER,,A7048,HCPCS,Facility,Inpatient,,,,17.3,14.705,4.95818,17.3,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
500CC EVAC CONTAINER,,A7048,HCPCS,Facility,Outpatient,,,,17.3,14.705,4.95818,17.3,PrimeWest Health,MinnesotaCare,8.88528,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
500CC EVAC CONTAINER,,A7048,HCPCS,Facility,Inpatient,,,,17.3,14.705,4.95818,17.3,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
500CC EVAC CONTAINER,,A7048,HCPCS,Facility,Both,,,,17.3,14.705,4.95818,17.3,Sanford Health Plan,Sanford Health Plan,15.916,92,,percent of total billed charges,,
500CC EVAC CONTAINER,,A7048,HCPCS,Facility,Outpatient,,,,17.3,14.705,4.95818,17.3,"UCare Health, Inc.",Individual & Family Plan,9.74855,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
500CC EVAC CONTAINER,,A7048,HCPCS,Facility,Inpatient,,,,17.3,14.705,4.95818,17.3,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
500CC EVAC CONTAINER,,A7048,HCPCS,Facility,Outpatient,,,,17.3,14.705,4.95818,17.3,"UCare Health, Inc.",Medical Assistance,8.73131,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
500CC EVAC CONTAINER,,A7048,HCPCS,Facility,Inpatient,,,,17.3,14.705,4.95818,17.3,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
500CC EVAC CONTAINER,,A7048,HCPCS,Facility,Outpatient,,,,17.3,14.705,4.95818,17.3,"UCare Health, Inc.",Medicare Advantage,8.73131,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
500CC EVAC CONTAINER,,A7048,HCPCS,Facility,Inpatient,,,,17.3,14.705,4.95818,17.3,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
500CC EVAC CONTAINER,,A7048,HCPCS,Facility,Outpatient,,,,17.3,14.705,4.95818,17.3,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),8.73131,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
500CC EVAC CONTAINER,,A7048,HCPCS,Facility,Inpatient,,,,17.3,14.705,4.95818,17.3,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
500CC EVAC CONTAINER,,A7048,HCPCS,Facility,Both,,,,17.3,14.705,4.95818,17.3,UnitedHealthcare,Individual & Family,16.262,94,,percent of total billed charges,,
500CC EVAC CONTAINER,,A7048,HCPCS,Facility,Outpatient,,,,17.3,14.705,4.95818,17.3,UnitedHealthcare,Medicare Advantage,8.477,49,,percent of total billed charges,,
500CC EVAC CONTAINER,,A7048,HCPCS,Facility,Inpatient,,,,17.3,14.705,4.95818,17.3,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
500CC EVAC CONTAINER,,A7048,HCPCS,Facility,Outpatient,,,,17.3,14.705,4.95818,17.3,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,8.304,48,,percent of total billed charges,,100% of DHS outpatient percentage
500CC EVAC CONTAINER,,A7048,HCPCS,Facility,Inpatient,,,,17.3,14.705,4.95818,17.3,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
PLEUREVAC,,A7048,HCPCS,Facility,Both,,,,154.52,131.342,44.285432,154.52,Aetna,Commercial,142.1584,92,,percent of total billed charges,,
PLEUREVAC,,A7048,HCPCS,Facility,Outpatient,,,,154.52,131.342,44.285432,154.52,Aetna,Medicare Advantage,75.7148,49,,percent of total billed charges,,
PLEUREVAC,,A7048,HCPCS,Facility,Inpatient,,,,154.52,131.342,44.285432,154.52,Aetna,Medicare Advantage,,,,,Included in per diem rate,
PLEUREVAC,,A7048,HCPCS,Facility,Both,,,,154.52,131.342,44.285432,154.52,Aetna,PPO,143.7036,93,,percent of total billed charges,,
PLEUREVAC,,A7048,HCPCS,Facility,Both,,,,154.52,131.342,44.285432,154.52,America's PPO,America's PPO,148.385556,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
PLEUREVAC,,A7048,HCPCS,Facility,Both,,,,154.52,131.342,44.285432,154.52,BlueCross BlueShield Minnesota, Federal Employee Program,152.04768,98.4,,percent of total billed charges,,
PLEUREVAC,,A7048,HCPCS,Facility,Both,,,,154.52,131.342,44.285432,154.52,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,154.52,100,,percent of total billed charges,,
PLEUREVAC,,A7048,HCPCS,Facility,Both,,,,154.52,131.342,44.285432,154.52,BlueCross BlueShield Minnesota,High Value Network Plan,139.068,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
PLEUREVAC,,A7048,HCPCS,Facility,Outpatient,,,,154.52,131.342,44.285432,154.52,BlueCross BlueShield Minnesota,Medicare Advantage,75.7148,49,,percent of total billed charges,,
PLEUREVAC,,A7048,HCPCS,Facility,Inpatient,,,,154.52,131.342,44.285432,154.52,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
PLEUREVAC,,A7048,HCPCS,Facility,Both,,,,154.52,131.342,44.285432,154.52,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,136.858364,88.57,,percent of total billed charges,,
PLEUREVAC,,A7048,HCPCS,Facility,Both,,,,154.52,131.342,44.285432,154.52,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,44.285432,28.66,,percent of total billed charges,,
PLEUREVAC,,A7048,HCPCS,Facility,Outpatient,,,,154.52,131.342,44.285432,154.52,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),75.7148,49,,percent of total billed charges,,
PLEUREVAC,,A7048,HCPCS,Facility,Inpatient,,,,154.52,131.342,44.285432,154.52,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
PLEUREVAC,,A7048,HCPCS,Facility,Both,,,,154.52,131.342,44.285432,154.52,CorVel,Worker's Compensation,154.52,100,,percent of total billed charges,,
PLEUREVAC,,A7048,HCPCS,Facility,Both,,,,154.52,131.342,44.285432,154.52,First Health Group Corporation,First Health Network,149.8844,97,,percent of total billed charges,,
PLEUREVAC,,A7048,HCPCS,Facility,Both,,,,154.52,131.342,44.285432,154.52,"Health Partners, Inc.",Commercial,146.17592,94.6,,percent of total billed charges,,
PLEUREVAC,,A7048,HCPCS,Facility,Outpatient,,,,154.52,131.342,44.285432,154.52,"Health Partners, Inc.",Medicare Advantage,75.7148,49,,percent of total billed charges,,
PLEUREVAC,,A7048,HCPCS,Facility,Inpatient,,,,154.52,131.342,44.285432,154.52,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PLEUREVAC,,A7048,HCPCS,Facility,Both,,,,154.52,131.342,44.285432,154.52,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),92.712,60,,percent of total billed charges,,
PLEUREVAC,,A7048,HCPCS,Facility,Both,,,,154.52,131.342,44.285432,154.52,"Health Partners, Inc.",State of Minnesota Advantage Program,125.9338,81.5,,percent of total billed charges,,
PLEUREVAC,,A7048,HCPCS,Facility,Both,,,,154.52,131.342,44.285432,154.52,"Health Partners, Inc.",State Public Programs,77.26,50,,percent of total billed charges,,
PLEUREVAC,,A7048,HCPCS,Facility,Both,,,,154.52,131.342,44.285432,154.52,Humana Insurance Company,Commercial PPO,146.794,95,,percent of total billed charges,,
PLEUREVAC,,A7048,HCPCS,Facility,Outpatient,,,,154.52,131.342,44.285432,154.52,Humana Insurance Company,Medicare PPO,75.7148,49,,percent of total billed charges,,
PLEUREVAC,,A7048,HCPCS,Facility,Inpatient,,,,154.52,131.342,44.285432,154.52,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
PLEUREVAC,,A7048,HCPCS,Facility,Both,,,,154.52,131.342,44.285432,154.52,Medica,Individual & Family,153.12932,99.1,,percent of total billed charges,,
PLEUREVAC,,A7048,HCPCS,Facility,Outpatient,,,,154.52,131.342,44.285432,154.52,Medica,Medica Advantage Solution,76.95096,49.8,,percent of total billed charges,,
PLEUREVAC,,A7048,HCPCS,Facility,Inpatient,,,,154.52,131.342,44.285432,154.52,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
PLEUREVAC,,A7048,HCPCS,Facility,Outpatient,,,,154.52,131.342,44.285432,154.52,Medica,Medical Assistance,68.91592,44.6,,percent of total billed charges,,
PLEUREVAC,,A7048,HCPCS,Facility,Inpatient,,,,154.52,131.342,44.285432,154.52,Medica,Medical Assistance,,,,,Included in per diem rate,
PLEUREVAC,,A7048,HCPCS,Facility,Outpatient,,,,154.52,131.342,44.285432,154.52,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,76.95096,49.8,,percent of total billed charges,,
PLEUREVAC,,A7048,HCPCS,Facility,Inpatient,,,,154.52,131.342,44.285432,154.52,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
PLEUREVAC,,A7048,HCPCS,Facility,Both,,,,154.52,131.342,44.285432,154.52,"Multiplan, Inc.","Multiplan, Inc.",145.2488,94,,percent of total billed charges,,
PLEUREVAC,,A7048,HCPCS,Facility,Outpatient,,,,154.52,131.342,44.285432,154.52,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,139.22252,90.1,,percent of total billed charges,,
PLEUREVAC,,A7048,HCPCS,Facility,Inpatient,,,,154.52,131.342,44.285432,154.52,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
PLEUREVAC,,A7048,HCPCS,Facility,Both,,,,154.52,131.342,44.285432,154.52,"Preferred One Administrative Services, INC.",PPO,152.35672,98.6,,percent of total billed charges,,
PLEUREVAC,,A7048,HCPCS,Facility,Outpatient,,,,154.52,131.342,44.285432,154.52,PrimeWest Health,Minnesota Senior Health Options (MSHO),79.50054,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
PLEUREVAC,,A7048,HCPCS,Facility,Inpatient,,,,154.52,131.342,44.285432,154.52,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PLEUREVAC,,A7048,HCPCS,Facility,Outpatient,,,,154.52,131.342,44.285432,154.52,PrimeWest Health,MinnesotaCare,79.361472,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
PLEUREVAC,,A7048,HCPCS,Facility,Inpatient,,,,154.52,131.342,44.285432,154.52,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
PLEUREVAC,,A7048,HCPCS,Facility,Both,,,,154.52,131.342,44.285432,154.52,Sanford Health Plan,Sanford Health Plan,142.1584,92,,percent of total billed charges,,
PLEUREVAC,,A7048,HCPCS,Facility,Outpatient,,,,154.52,131.342,44.285432,154.52,"UCare Health, Inc.",Individual & Family Plan,87.07202,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
PLEUREVAC,,A7048,HCPCS,Facility,Inpatient,,,,154.52,131.342,44.285432,154.52,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
PLEUREVAC,,A7048,HCPCS,Facility,Outpatient,,,,154.52,131.342,44.285432,154.52,"UCare Health, Inc.",Medical Assistance,77.986244,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PLEUREVAC,,A7048,HCPCS,Facility,Inpatient,,,,154.52,131.342,44.285432,154.52,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
PLEUREVAC,,A7048,HCPCS,Facility,Outpatient,,,,154.52,131.342,44.285432,154.52,"UCare Health, Inc.",Medicare Advantage,77.986244,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PLEUREVAC,,A7048,HCPCS,Facility,Inpatient,,,,154.52,131.342,44.285432,154.52,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PLEUREVAC,,A7048,HCPCS,Facility,Outpatient,,,,154.52,131.342,44.285432,154.52,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),77.986244,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PLEUREVAC,,A7048,HCPCS,Facility,Inpatient,,,,154.52,131.342,44.285432,154.52,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PLEUREVAC,,A7048,HCPCS,Facility,Both,,,,154.52,131.342,44.285432,154.52,UnitedHealthcare,Individual & Family,145.2488,94,,percent of total billed charges,,
PLEUREVAC,,A7048,HCPCS,Facility,Outpatient,,,,154.52,131.342,44.285432,154.52,UnitedHealthcare,Medicare Advantage,75.7148,49,,percent of total billed charges,,
PLEUREVAC,,A7048,HCPCS,Facility,Inpatient,,,,154.52,131.342,44.285432,154.52,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
PLEUREVAC,,A7048,HCPCS,Facility,Outpatient,,,,154.52,131.342,44.285432,154.52,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,74.1696,48,,percent of total billed charges,,100% of DHS outpatient percentage
PLEUREVAC,,A7048,HCPCS,Facility,Inpatient,,,,154.52,131.342,44.285432,154.52,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Sup Pleurx Drainage Kit 1,000 Ml",,A7048,HCPCS,Facility,Both,,,,421,357.85,120.6586,421,Aetna,Commercial,387.32,92,,percent of total billed charges,,
"Sup Pleurx Drainage Kit 1,000 Ml",,A7048,HCPCS,Facility,Outpatient,,,,421,357.85,120.6586,421,Aetna,Medicare Advantage,206.29,49,,percent of total billed charges,,
"Sup Pleurx Drainage Kit 1,000 Ml",,A7048,HCPCS,Facility,Inpatient,,,,421,357.85,120.6586,421,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Sup Pleurx Drainage Kit 1,000 Ml",,A7048,HCPCS,Facility,Both,,,,421,357.85,120.6586,421,Aetna,PPO,391.53,93,,percent of total billed charges,,
"Sup Pleurx Drainage Kit 1,000 Ml",,A7048,HCPCS,Facility,Both,,,,421,357.85,120.6586,421,America's PPO,America's PPO,404.2863,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Sup Pleurx Drainage Kit 1,000 Ml",,A7048,HCPCS,Facility,Both,,,,421,357.85,120.6586,421,BlueCross BlueShield Minnesota, Federal Employee Program,414.264,98.4,,percent of total billed charges,,
"Sup Pleurx Drainage Kit 1,000 Ml",,A7048,HCPCS,Facility,Both,,,,421,357.85,120.6586,421,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,421,100,,percent of total billed charges,,
"Sup Pleurx Drainage Kit 1,000 Ml",,A7048,HCPCS,Facility,Both,,,,421,357.85,120.6586,421,BlueCross BlueShield Minnesota,High Value Network Plan,378.9,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
"Sup Pleurx Drainage Kit 1,000 Ml",,A7048,HCPCS,Facility,Outpatient,,,,421,357.85,120.6586,421,BlueCross BlueShield Minnesota,Medicare Advantage,206.29,49,,percent of total billed charges,,
"Sup Pleurx Drainage Kit 1,000 Ml",,A7048,HCPCS,Facility,Inpatient,,,,421,357.85,120.6586,421,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Sup Pleurx Drainage Kit 1,000 Ml",,A7048,HCPCS,Facility,Both,,,,421,357.85,120.6586,421,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,372.8797,88.57,,percent of total billed charges,,
"Sup Pleurx Drainage Kit 1,000 Ml",,A7048,HCPCS,Facility,Both,,,,421,357.85,120.6586,421,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,120.6586,28.66,,percent of total billed charges,,
"Sup Pleurx Drainage Kit 1,000 Ml",,A7048,HCPCS,Facility,Outpatient,,,,421,357.85,120.6586,421,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),206.29,49,,percent of total billed charges,,
"Sup Pleurx Drainage Kit 1,000 Ml",,A7048,HCPCS,Facility,Inpatient,,,,421,357.85,120.6586,421,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Sup Pleurx Drainage Kit 1,000 Ml",,A7048,HCPCS,Facility,Both,,,,421,357.85,120.6586,421,CorVel,Worker's Compensation,421,100,,percent of total billed charges,,
"Sup Pleurx Drainage Kit 1,000 Ml",,A7048,HCPCS,Facility,Both,,,,421,357.85,120.6586,421,First Health Group Corporation,First Health Network,408.37,97,,percent of total billed charges,,
"Sup Pleurx Drainage Kit 1,000 Ml",,A7048,HCPCS,Facility,Both,,,,421,357.85,120.6586,421,"Health Partners, Inc.",Commercial,398.266,94.6,,percent of total billed charges,,
"Sup Pleurx Drainage Kit 1,000 Ml",,A7048,HCPCS,Facility,Outpatient,,,,421,357.85,120.6586,421,"Health Partners, Inc.",Medicare Advantage,206.29,49,,percent of total billed charges,,
"Sup Pleurx Drainage Kit 1,000 Ml",,A7048,HCPCS,Facility,Inpatient,,,,421,357.85,120.6586,421,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Sup Pleurx Drainage Kit 1,000 Ml",,A7048,HCPCS,Facility,Both,,,,421,357.85,120.6586,421,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),252.6,60,,percent of total billed charges,,
"Sup Pleurx Drainage Kit 1,000 Ml",,A7048,HCPCS,Facility,Both,,,,421,357.85,120.6586,421,"Health Partners, Inc.",State of Minnesota Advantage Program,343.115,81.5,,percent of total billed charges,,
"Sup Pleurx Drainage Kit 1,000 Ml",,A7048,HCPCS,Facility,Both,,,,421,357.85,120.6586,421,"Health Partners, Inc.",State Public Programs,210.5,50,,percent of total billed charges,,
"Sup Pleurx Drainage Kit 1,000 Ml",,A7048,HCPCS,Facility,Both,,,,421,357.85,120.6586,421,Humana Insurance Company,Commercial PPO,399.95,95,,percent of total billed charges,,
"Sup Pleurx Drainage Kit 1,000 Ml",,A7048,HCPCS,Facility,Outpatient,,,,421,357.85,120.6586,421,Humana Insurance Company,Medicare PPO,206.29,49,,percent of total billed charges,,
"Sup Pleurx Drainage Kit 1,000 Ml",,A7048,HCPCS,Facility,Inpatient,,,,421,357.85,120.6586,421,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Sup Pleurx Drainage Kit 1,000 Ml",,A7048,HCPCS,Facility,Both,,,,421,357.85,120.6586,421,Medica,Individual & Family,417.211,99.1,,percent of total billed charges,,
"Sup Pleurx Drainage Kit 1,000 Ml",,A7048,HCPCS,Facility,Outpatient,,,,421,357.85,120.6586,421,Medica,Medica Advantage Solution,209.658,49.8,,percent of total billed charges,,
"Sup Pleurx Drainage Kit 1,000 Ml",,A7048,HCPCS,Facility,Inpatient,,,,421,357.85,120.6586,421,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Sup Pleurx Drainage Kit 1,000 Ml",,A7048,HCPCS,Facility,Outpatient,,,,421,357.85,120.6586,421,Medica,Medical Assistance,187.766,44.6,,percent of total billed charges,,
"Sup Pleurx Drainage Kit 1,000 Ml",,A7048,HCPCS,Facility,Inpatient,,,,421,357.85,120.6586,421,Medica,Medical Assistance,,,,,Included in per diem rate,
"Sup Pleurx Drainage Kit 1,000 Ml",,A7048,HCPCS,Facility,Outpatient,,,,421,357.85,120.6586,421,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,209.658,49.8,,percent of total billed charges,,
"Sup Pleurx Drainage Kit 1,000 Ml",,A7048,HCPCS,Facility,Inpatient,,,,421,357.85,120.6586,421,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Sup Pleurx Drainage Kit 1,000 Ml",,A7048,HCPCS,Facility,Both,,,,421,357.85,120.6586,421,"Multiplan, Inc.","Multiplan, Inc.",395.74,94,,percent of total billed charges,,
"Sup Pleurx Drainage Kit 1,000 Ml",,A7048,HCPCS,Facility,Outpatient,,,,421,357.85,120.6586,421,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,379.321,90.1,,percent of total billed charges,,
"Sup Pleurx Drainage Kit 1,000 Ml",,A7048,HCPCS,Facility,Inpatient,,,,421,357.85,120.6586,421,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Sup Pleurx Drainage Kit 1,000 Ml",,A7048,HCPCS,Facility,Both,,,,421,357.85,120.6586,421,"Preferred One Administrative Services, INC.",PPO,415.106,98.6,,percent of total billed charges,,
"Sup Pleurx Drainage Kit 1,000 Ml",,A7048,HCPCS,Facility,Outpatient,,,,421,357.85,120.6586,421,PrimeWest Health,Minnesota Senior Health Options (MSHO),216.6045,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Sup Pleurx Drainage Kit 1,000 Ml",,A7048,HCPCS,Facility,Inpatient,,,,421,357.85,120.6586,421,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Sup Pleurx Drainage Kit 1,000 Ml",,A7048,HCPCS,Facility,Outpatient,,,,421,357.85,120.6586,421,PrimeWest Health,MinnesotaCare,216.2256,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Sup Pleurx Drainage Kit 1,000 Ml",,A7048,HCPCS,Facility,Inpatient,,,,421,357.85,120.6586,421,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Sup Pleurx Drainage Kit 1,000 Ml",,A7048,HCPCS,Facility,Both,,,,421,357.85,120.6586,421,Sanford Health Plan,Sanford Health Plan,387.32,92,,percent of total billed charges,,
"Sup Pleurx Drainage Kit 1,000 Ml",,A7048,HCPCS,Facility,Outpatient,,,,421,357.85,120.6586,421,"UCare Health, Inc.",Individual & Family Plan,237.2335,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Sup Pleurx Drainage Kit 1,000 Ml",,A7048,HCPCS,Facility,Inpatient,,,,421,357.85,120.6586,421,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Sup Pleurx Drainage Kit 1,000 Ml",,A7048,HCPCS,Facility,Outpatient,,,,421,357.85,120.6586,421,"UCare Health, Inc.",Medical Assistance,212.4787,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Sup Pleurx Drainage Kit 1,000 Ml",,A7048,HCPCS,Facility,Inpatient,,,,421,357.85,120.6586,421,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Sup Pleurx Drainage Kit 1,000 Ml",,A7048,HCPCS,Facility,Outpatient,,,,421,357.85,120.6586,421,"UCare Health, Inc.",Medicare Advantage,212.4787,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Sup Pleurx Drainage Kit 1,000 Ml",,A7048,HCPCS,Facility,Inpatient,,,,421,357.85,120.6586,421,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Sup Pleurx Drainage Kit 1,000 Ml",,A7048,HCPCS,Facility,Outpatient,,,,421,357.85,120.6586,421,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),212.4787,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Sup Pleurx Drainage Kit 1,000 Ml",,A7048,HCPCS,Facility,Inpatient,,,,421,357.85,120.6586,421,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Sup Pleurx Drainage Kit 1,000 Ml",,A7048,HCPCS,Facility,Both,,,,421,357.85,120.6586,421,UnitedHealthcare,Individual & Family,395.74,94,,percent of total billed charges,,
"Sup Pleurx Drainage Kit 1,000 Ml",,A7048,HCPCS,Facility,Outpatient,,,,421,357.85,120.6586,421,UnitedHealthcare,Medicare Advantage,206.29,49,,percent of total billed charges,,
"Sup Pleurx Drainage Kit 1,000 Ml",,A7048,HCPCS,Facility,Inpatient,,,,421,357.85,120.6586,421,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Sup Pleurx Drainage Kit 1,000 Ml",,A7048,HCPCS,Facility,Outpatient,,,,421,357.85,120.6586,421,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,202.08,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Sup Pleurx Drainage Kit 1,000 Ml",,A7048,HCPCS,Facility,Inpatient,,,,421,357.85,120.6586,421,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
ARTHROSCOPY PUMP TUBE SET,,A9272,HCPCS,Facility,Both,,,,224.98,191.233,64.479268,224.98,Aetna,Commercial,206.9816,92,,percent of total billed charges,,
ARTHROSCOPY PUMP TUBE SET,,A9272,HCPCS,Facility,Outpatient,,,,224.98,191.233,64.479268,224.98,Aetna,Medicare Advantage,110.2402,49,,percent of total billed charges,,
ARTHROSCOPY PUMP TUBE SET,,A9272,HCPCS,Facility,Inpatient,,,,224.98,191.233,64.479268,224.98,Aetna,Medicare Advantage,,,,,Included in per diem rate,
ARTHROSCOPY PUMP TUBE SET,,A9272,HCPCS,Facility,Both,,,,224.98,191.233,64.479268,224.98,Aetna,PPO,209.2314,93,,percent of total billed charges,,
ARTHROSCOPY PUMP TUBE SET,,A9272,HCPCS,Facility,Both,,,,224.98,191.233,64.479268,224.98,America's PPO,America's PPO,216.048294,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
ARTHROSCOPY PUMP TUBE SET,,A9272,HCPCS,Facility,Both,,,,224.98,191.233,64.479268,224.98,BlueCross BlueShield Minnesota, Federal Employee Program,221.38032,98.4,,percent of total billed charges,,
ARTHROSCOPY PUMP TUBE SET,,A9272,HCPCS,Facility,Both,,,,224.98,191.233,64.479268,224.98,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,224.98,100,,percent of total billed charges,,
ARTHROSCOPY PUMP TUBE SET,,A9272,HCPCS,Facility,Both,,,,224.98,191.233,64.479268,224.98,BlueCross BlueShield Minnesota,High Value Network Plan,202.482,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
ARTHROSCOPY PUMP TUBE SET,,A9272,HCPCS,Facility,Outpatient,,,,224.98,191.233,64.479268,224.98,BlueCross BlueShield Minnesota,Medicare Advantage,110.2402,49,,percent of total billed charges,,
ARTHROSCOPY PUMP TUBE SET,,A9272,HCPCS,Facility,Inpatient,,,,224.98,191.233,64.479268,224.98,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
ARTHROSCOPY PUMP TUBE SET,,A9272,HCPCS,Facility,Both,,,,224.98,191.233,64.479268,224.98,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,199.264786,88.57,,percent of total billed charges,,
ARTHROSCOPY PUMP TUBE SET,,A9272,HCPCS,Facility,Both,,,,224.98,191.233,64.479268,224.98,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,64.479268,28.66,,percent of total billed charges,,
ARTHROSCOPY PUMP TUBE SET,,A9272,HCPCS,Facility,Outpatient,,,,224.98,191.233,64.479268,224.98,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),110.2402,49,,percent of total billed charges,,
ARTHROSCOPY PUMP TUBE SET,,A9272,HCPCS,Facility,Inpatient,,,,224.98,191.233,64.479268,224.98,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
ARTHROSCOPY PUMP TUBE SET,,A9272,HCPCS,Facility,Both,,,,224.98,191.233,64.479268,224.98,CorVel,Worker's Compensation,224.98,100,,percent of total billed charges,,
ARTHROSCOPY PUMP TUBE SET,,A9272,HCPCS,Facility,Both,,,,224.98,191.233,64.479268,224.98,First Health Group Corporation,First Health Network,218.2306,97,,percent of total billed charges,,
ARTHROSCOPY PUMP TUBE SET,,A9272,HCPCS,Facility,Both,,,,224.98,191.233,64.479268,224.98,"Health Partners, Inc.",Commercial,212.83108,94.6,,percent of total billed charges,,
ARTHROSCOPY PUMP TUBE SET,,A9272,HCPCS,Facility,Outpatient,,,,224.98,191.233,64.479268,224.98,"Health Partners, Inc.",Medicare Advantage,110.2402,49,,percent of total billed charges,,
ARTHROSCOPY PUMP TUBE SET,,A9272,HCPCS,Facility,Inpatient,,,,224.98,191.233,64.479268,224.98,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ARTHROSCOPY PUMP TUBE SET,,A9272,HCPCS,Facility,Both,,,,224.98,191.233,64.479268,224.98,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),134.988,60,,percent of total billed charges,,
ARTHROSCOPY PUMP TUBE SET,,A9272,HCPCS,Facility,Both,,,,224.98,191.233,64.479268,224.98,"Health Partners, Inc.",State of Minnesota Advantage Program,183.3587,81.5,,percent of total billed charges,,
ARTHROSCOPY PUMP TUBE SET,,A9272,HCPCS,Facility,Both,,,,224.98,191.233,64.479268,224.98,"Health Partners, Inc.",State Public Programs,112.49,50,,percent of total billed charges,,
ARTHROSCOPY PUMP TUBE SET,,A9272,HCPCS,Facility,Both,,,,224.98,191.233,64.479268,224.98,Humana Insurance Company,Commercial PPO,213.731,95,,percent of total billed charges,,
ARTHROSCOPY PUMP TUBE SET,,A9272,HCPCS,Facility,Outpatient,,,,224.98,191.233,64.479268,224.98,Humana Insurance Company,Medicare PPO,110.2402,49,,percent of total billed charges,,
ARTHROSCOPY PUMP TUBE SET,,A9272,HCPCS,Facility,Inpatient,,,,224.98,191.233,64.479268,224.98,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
ARTHROSCOPY PUMP TUBE SET,,A9272,HCPCS,Facility,Both,,,,224.98,191.233,64.479268,224.98,Medica,Individual & Family,222.95518,99.1,,percent of total billed charges,,
ARTHROSCOPY PUMP TUBE SET,,A9272,HCPCS,Facility,Outpatient,,,,224.98,191.233,64.479268,224.98,Medica,Medica Advantage Solution,112.04004,49.8,,percent of total billed charges,,
ARTHROSCOPY PUMP TUBE SET,,A9272,HCPCS,Facility,Inpatient,,,,224.98,191.233,64.479268,224.98,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
ARTHROSCOPY PUMP TUBE SET,,A9272,HCPCS,Facility,Outpatient,,,,224.98,191.233,64.479268,224.98,Medica,Medical Assistance,100.34108,44.6,,percent of total billed charges,,
ARTHROSCOPY PUMP TUBE SET,,A9272,HCPCS,Facility,Inpatient,,,,224.98,191.233,64.479268,224.98,Medica,Medical Assistance,,,,,Included in per diem rate,
ARTHROSCOPY PUMP TUBE SET,,A9272,HCPCS,Facility,Outpatient,,,,224.98,191.233,64.479268,224.98,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,112.04004,49.8,,percent of total billed charges,,
ARTHROSCOPY PUMP TUBE SET,,A9272,HCPCS,Facility,Inpatient,,,,224.98,191.233,64.479268,224.98,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
ARTHROSCOPY PUMP TUBE SET,,A9272,HCPCS,Facility,Both,,,,224.98,191.233,64.479268,224.98,"Multiplan, Inc.","Multiplan, Inc.",211.4812,94,,percent of total billed charges,,
ARTHROSCOPY PUMP TUBE SET,,A9272,HCPCS,Facility,Outpatient,,,,224.98,191.233,64.479268,224.98,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,202.70698,90.1,,percent of total billed charges,,
ARTHROSCOPY PUMP TUBE SET,,A9272,HCPCS,Facility,Inpatient,,,,224.98,191.233,64.479268,224.98,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
ARTHROSCOPY PUMP TUBE SET,,A9272,HCPCS,Facility,Both,,,,224.98,191.233,64.479268,224.98,"Preferred One Administrative Services, INC.",PPO,221.83028,98.6,,percent of total billed charges,,
ARTHROSCOPY PUMP TUBE SET,,A9272,HCPCS,Facility,Outpatient,,,,224.98,191.233,64.479268,224.98,PrimeWest Health,Minnesota Senior Health Options (MSHO),115.75221,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
ARTHROSCOPY PUMP TUBE SET,,A9272,HCPCS,Facility,Inpatient,,,,224.98,191.233,64.479268,224.98,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ARTHROSCOPY PUMP TUBE SET,,A9272,HCPCS,Facility,Outpatient,,,,224.98,191.233,64.479268,224.98,PrimeWest Health,MinnesotaCare,115.549728,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
ARTHROSCOPY PUMP TUBE SET,,A9272,HCPCS,Facility,Inpatient,,,,224.98,191.233,64.479268,224.98,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
ARTHROSCOPY PUMP TUBE SET,,A9272,HCPCS,Facility,Both,,,,224.98,191.233,64.479268,224.98,Sanford Health Plan,Sanford Health Plan,206.9816,92,,percent of total billed charges,,
ARTHROSCOPY PUMP TUBE SET,,A9272,HCPCS,Facility,Outpatient,,,,224.98,191.233,64.479268,224.98,"UCare Health, Inc.",Individual & Family Plan,126.77623,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
ARTHROSCOPY PUMP TUBE SET,,A9272,HCPCS,Facility,Inpatient,,,,224.98,191.233,64.479268,224.98,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
ARTHROSCOPY PUMP TUBE SET,,A9272,HCPCS,Facility,Outpatient,,,,224.98,191.233,64.479268,224.98,"UCare Health, Inc.",Medical Assistance,113.547406,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ARTHROSCOPY PUMP TUBE SET,,A9272,HCPCS,Facility,Inpatient,,,,224.98,191.233,64.479268,224.98,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
ARTHROSCOPY PUMP TUBE SET,,A9272,HCPCS,Facility,Outpatient,,,,224.98,191.233,64.479268,224.98,"UCare Health, Inc.",Medicare Advantage,113.547406,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ARTHROSCOPY PUMP TUBE SET,,A9272,HCPCS,Facility,Inpatient,,,,224.98,191.233,64.479268,224.98,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ARTHROSCOPY PUMP TUBE SET,,A9272,HCPCS,Facility,Outpatient,,,,224.98,191.233,64.479268,224.98,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),113.547406,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ARTHROSCOPY PUMP TUBE SET,,A9272,HCPCS,Facility,Inpatient,,,,224.98,191.233,64.479268,224.98,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ARTHROSCOPY PUMP TUBE SET,,A9272,HCPCS,Facility,Both,,,,224.98,191.233,64.479268,224.98,UnitedHealthcare,Individual & Family,211.4812,94,,percent of total billed charges,,
ARTHROSCOPY PUMP TUBE SET,,A9272,HCPCS,Facility,Outpatient,,,,224.98,191.233,64.479268,224.98,UnitedHealthcare,Medicare Advantage,110.2402,49,,percent of total billed charges,,
ARTHROSCOPY PUMP TUBE SET,,A9272,HCPCS,Facility,Inpatient,,,,224.98,191.233,64.479268,224.98,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
ARTHROSCOPY PUMP TUBE SET,,A9272,HCPCS,Facility,Outpatient,,,,224.98,191.233,64.479268,224.98,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,107.9904,48,,percent of total billed charges,,100% of DHS outpatient percentage
ARTHROSCOPY PUMP TUBE SET,,A9272,HCPCS,Facility,Inpatient,,,,224.98,191.233,64.479268,224.98,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
PULSAVAC PLUS WOUND DEBRIDEMENT SYSTEM,,A9272,HCPCS,Facility,Both,,,,156,132.6,44.7096,156,Aetna,Commercial,143.52,92,,percent of total billed charges,,
PULSAVAC PLUS WOUND DEBRIDEMENT SYSTEM,,A9272,HCPCS,Facility,Outpatient,,,,156,132.6,44.7096,156,Aetna,Medicare Advantage,76.44,49,,percent of total billed charges,,
PULSAVAC PLUS WOUND DEBRIDEMENT SYSTEM,,A9272,HCPCS,Facility,Inpatient,,,,156,132.6,44.7096,156,Aetna,Medicare Advantage,,,,,Included in per diem rate,
PULSAVAC PLUS WOUND DEBRIDEMENT SYSTEM,,A9272,HCPCS,Facility,Both,,,,156,132.6,44.7096,156,Aetna,PPO,145.08,93,,percent of total billed charges,,
PULSAVAC PLUS WOUND DEBRIDEMENT SYSTEM,,A9272,HCPCS,Facility,Both,,,,156,132.6,44.7096,156,America's PPO,America's PPO,149.8068,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
PULSAVAC PLUS WOUND DEBRIDEMENT SYSTEM,,A9272,HCPCS,Facility,Both,,,,156,132.6,44.7096,156,BlueCross BlueShield Minnesota, Federal Employee Program,153.504,98.4,,percent of total billed charges,,
PULSAVAC PLUS WOUND DEBRIDEMENT SYSTEM,,A9272,HCPCS,Facility,Both,,,,156,132.6,44.7096,156,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,156,100,,percent of total billed charges,,
PULSAVAC PLUS WOUND DEBRIDEMENT SYSTEM,,A9272,HCPCS,Facility,Both,,,,156,132.6,44.7096,156,BlueCross BlueShield Minnesota,High Value Network Plan,140.4,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
PULSAVAC PLUS WOUND DEBRIDEMENT SYSTEM,,A9272,HCPCS,Facility,Outpatient,,,,156,132.6,44.7096,156,BlueCross BlueShield Minnesota,Medicare Advantage,76.44,49,,percent of total billed charges,,
PULSAVAC PLUS WOUND DEBRIDEMENT SYSTEM,,A9272,HCPCS,Facility,Inpatient,,,,156,132.6,44.7096,156,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
PULSAVAC PLUS WOUND DEBRIDEMENT SYSTEM,,A9272,HCPCS,Facility,Both,,,,156,132.6,44.7096,156,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,138.1692,88.57,,percent of total billed charges,,
PULSAVAC PLUS WOUND DEBRIDEMENT SYSTEM,,A9272,HCPCS,Facility,Both,,,,156,132.6,44.7096,156,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,44.7096,28.66,,percent of total billed charges,,
PULSAVAC PLUS WOUND DEBRIDEMENT SYSTEM,,A9272,HCPCS,Facility,Outpatient,,,,156,132.6,44.7096,156,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),76.44,49,,percent of total billed charges,,
PULSAVAC PLUS WOUND DEBRIDEMENT SYSTEM,,A9272,HCPCS,Facility,Inpatient,,,,156,132.6,44.7096,156,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
PULSAVAC PLUS WOUND DEBRIDEMENT SYSTEM,,A9272,HCPCS,Facility,Both,,,,156,132.6,44.7096,156,CorVel,Worker's Compensation,156,100,,percent of total billed charges,,
PULSAVAC PLUS WOUND DEBRIDEMENT SYSTEM,,A9272,HCPCS,Facility,Both,,,,156,132.6,44.7096,156,First Health Group Corporation,First Health Network,151.32,97,,percent of total billed charges,,
PULSAVAC PLUS WOUND DEBRIDEMENT SYSTEM,,A9272,HCPCS,Facility,Both,,,,156,132.6,44.7096,156,"Health Partners, Inc.",Commercial,147.576,94.6,,percent of total billed charges,,
PULSAVAC PLUS WOUND DEBRIDEMENT SYSTEM,,A9272,HCPCS,Facility,Outpatient,,,,156,132.6,44.7096,156,"Health Partners, Inc.",Medicare Advantage,76.44,49,,percent of total billed charges,,
PULSAVAC PLUS WOUND DEBRIDEMENT SYSTEM,,A9272,HCPCS,Facility,Inpatient,,,,156,132.6,44.7096,156,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PULSAVAC PLUS WOUND DEBRIDEMENT SYSTEM,,A9272,HCPCS,Facility,Both,,,,156,132.6,44.7096,156,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),93.6,60,,percent of total billed charges,,
PULSAVAC PLUS WOUND DEBRIDEMENT SYSTEM,,A9272,HCPCS,Facility,Both,,,,156,132.6,44.7096,156,"Health Partners, Inc.",State of Minnesota Advantage Program,127.14,81.5,,percent of total billed charges,,
PULSAVAC PLUS WOUND DEBRIDEMENT SYSTEM,,A9272,HCPCS,Facility,Both,,,,156,132.6,44.7096,156,"Health Partners, Inc.",State Public Programs,78,50,,percent of total billed charges,,
PULSAVAC PLUS WOUND DEBRIDEMENT SYSTEM,,A9272,HCPCS,Facility,Both,,,,156,132.6,44.7096,156,Humana Insurance Company,Commercial PPO,148.2,95,,percent of total billed charges,,
PULSAVAC PLUS WOUND DEBRIDEMENT SYSTEM,,A9272,HCPCS,Facility,Outpatient,,,,156,132.6,44.7096,156,Humana Insurance Company,Medicare PPO,76.44,49,,percent of total billed charges,,
PULSAVAC PLUS WOUND DEBRIDEMENT SYSTEM,,A9272,HCPCS,Facility,Inpatient,,,,156,132.6,44.7096,156,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
PULSAVAC PLUS WOUND DEBRIDEMENT SYSTEM,,A9272,HCPCS,Facility,Both,,,,156,132.6,44.7096,156,Medica,Individual & Family,154.596,99.1,,percent of total billed charges,,
PULSAVAC PLUS WOUND DEBRIDEMENT SYSTEM,,A9272,HCPCS,Facility,Outpatient,,,,156,132.6,44.7096,156,Medica,Medica Advantage Solution,77.688,49.8,,percent of total billed charges,,
PULSAVAC PLUS WOUND DEBRIDEMENT SYSTEM,,A9272,HCPCS,Facility,Inpatient,,,,156,132.6,44.7096,156,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
PULSAVAC PLUS WOUND DEBRIDEMENT SYSTEM,,A9272,HCPCS,Facility,Outpatient,,,,156,132.6,44.7096,156,Medica,Medical Assistance,69.576,44.6,,percent of total billed charges,,
PULSAVAC PLUS WOUND DEBRIDEMENT SYSTEM,,A9272,HCPCS,Facility,Inpatient,,,,156,132.6,44.7096,156,Medica,Medical Assistance,,,,,Included in per diem rate,
PULSAVAC PLUS WOUND DEBRIDEMENT SYSTEM,,A9272,HCPCS,Facility,Outpatient,,,,156,132.6,44.7096,156,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,77.688,49.8,,percent of total billed charges,,
PULSAVAC PLUS WOUND DEBRIDEMENT SYSTEM,,A9272,HCPCS,Facility,Inpatient,,,,156,132.6,44.7096,156,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
PULSAVAC PLUS WOUND DEBRIDEMENT SYSTEM,,A9272,HCPCS,Facility,Both,,,,156,132.6,44.7096,156,"Multiplan, Inc.","Multiplan, Inc.",146.64,94,,percent of total billed charges,,
PULSAVAC PLUS WOUND DEBRIDEMENT SYSTEM,,A9272,HCPCS,Facility,Outpatient,,,,156,132.6,44.7096,156,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,140.556,90.1,,percent of total billed charges,,
PULSAVAC PLUS WOUND DEBRIDEMENT SYSTEM,,A9272,HCPCS,Facility,Inpatient,,,,156,132.6,44.7096,156,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
PULSAVAC PLUS WOUND DEBRIDEMENT SYSTEM,,A9272,HCPCS,Facility,Both,,,,156,132.6,44.7096,156,"Preferred One Administrative Services, INC.",PPO,153.816,98.6,,percent of total billed charges,,
PULSAVAC PLUS WOUND DEBRIDEMENT SYSTEM,,A9272,HCPCS,Facility,Outpatient,,,,156,132.6,44.7096,156,PrimeWest Health,Minnesota Senior Health Options (MSHO),80.262,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
PULSAVAC PLUS WOUND DEBRIDEMENT SYSTEM,,A9272,HCPCS,Facility,Inpatient,,,,156,132.6,44.7096,156,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PULSAVAC PLUS WOUND DEBRIDEMENT SYSTEM,,A9272,HCPCS,Facility,Outpatient,,,,156,132.6,44.7096,156,PrimeWest Health,MinnesotaCare,80.1216,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
PULSAVAC PLUS WOUND DEBRIDEMENT SYSTEM,,A9272,HCPCS,Facility,Inpatient,,,,156,132.6,44.7096,156,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
PULSAVAC PLUS WOUND DEBRIDEMENT SYSTEM,,A9272,HCPCS,Facility,Both,,,,156,132.6,44.7096,156,Sanford Health Plan,Sanford Health Plan,143.52,92,,percent of total billed charges,,
PULSAVAC PLUS WOUND DEBRIDEMENT SYSTEM,,A9272,HCPCS,Facility,Outpatient,,,,156,132.6,44.7096,156,"UCare Health, Inc.",Individual & Family Plan,87.906,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
PULSAVAC PLUS WOUND DEBRIDEMENT SYSTEM,,A9272,HCPCS,Facility,Inpatient,,,,156,132.6,44.7096,156,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
PULSAVAC PLUS WOUND DEBRIDEMENT SYSTEM,,A9272,HCPCS,Facility,Outpatient,,,,156,132.6,44.7096,156,"UCare Health, Inc.",Medical Assistance,78.7332,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PULSAVAC PLUS WOUND DEBRIDEMENT SYSTEM,,A9272,HCPCS,Facility,Inpatient,,,,156,132.6,44.7096,156,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
PULSAVAC PLUS WOUND DEBRIDEMENT SYSTEM,,A9272,HCPCS,Facility,Outpatient,,,,156,132.6,44.7096,156,"UCare Health, Inc.",Medicare Advantage,78.7332,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PULSAVAC PLUS WOUND DEBRIDEMENT SYSTEM,,A9272,HCPCS,Facility,Inpatient,,,,156,132.6,44.7096,156,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PULSAVAC PLUS WOUND DEBRIDEMENT SYSTEM,,A9272,HCPCS,Facility,Outpatient,,,,156,132.6,44.7096,156,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),78.7332,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PULSAVAC PLUS WOUND DEBRIDEMENT SYSTEM,,A9272,HCPCS,Facility,Inpatient,,,,156,132.6,44.7096,156,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PULSAVAC PLUS WOUND DEBRIDEMENT SYSTEM,,A9272,HCPCS,Facility,Both,,,,156,132.6,44.7096,156,UnitedHealthcare,Individual & Family,146.64,94,,percent of total billed charges,,
PULSAVAC PLUS WOUND DEBRIDEMENT SYSTEM,,A9272,HCPCS,Facility,Outpatient,,,,156,132.6,44.7096,156,UnitedHealthcare,Medicare Advantage,76.44,49,,percent of total billed charges,,
PULSAVAC PLUS WOUND DEBRIDEMENT SYSTEM,,A9272,HCPCS,Facility,Inpatient,,,,156,132.6,44.7096,156,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
PULSAVAC PLUS WOUND DEBRIDEMENT SYSTEM,,A9272,HCPCS,Facility,Outpatient,,,,156,132.6,44.7096,156,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,74.88,48,,percent of total billed charges,,100% of DHS outpatient percentage
PULSAVAC PLUS WOUND DEBRIDEMENT SYSTEM,,A9272,HCPCS,Facility,Inpatient,,,,156,132.6,44.7096,156,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
BAIR HUGGAR BLANKET,,A9273,HCPCS,Facility,Both,,,,33.15,28.1775,9.50079,33.15,Aetna,Commercial,30.498,92,,percent of total billed charges,,
BAIR HUGGAR BLANKET,,A9273,HCPCS,Facility,Outpatient,,,,33.15,28.1775,9.50079,33.15,Aetna,Medicare Advantage,16.2435,49,,percent of total billed charges,,
BAIR HUGGAR BLANKET,,A9273,HCPCS,Facility,Inpatient,,,,33.15,28.1775,9.50079,33.15,Aetna,Medicare Advantage,,,,,Included in per diem rate,
BAIR HUGGAR BLANKET,,A9273,HCPCS,Facility,Both,,,,33.15,28.1775,9.50079,33.15,Aetna,PPO,30.8295,93,,percent of total billed charges,,
BAIR HUGGAR BLANKET,,A9273,HCPCS,Facility,Both,,,,33.15,28.1775,9.50079,33.15,America's PPO,America's PPO,31.833945,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
BAIR HUGGAR BLANKET,,A9273,HCPCS,Facility,Both,,,,33.15,28.1775,9.50079,33.15,BlueCross BlueShield Minnesota, Federal Employee Program,32.6196,98.4,,percent of total billed charges,,
BAIR HUGGAR BLANKET,,A9273,HCPCS,Facility,Both,,,,33.15,28.1775,9.50079,33.15,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,33.15,100,,percent of total billed charges,,
BAIR HUGGAR BLANKET,,A9273,HCPCS,Facility,Both,,,,33.15,28.1775,9.50079,33.15,BlueCross BlueShield Minnesota,High Value Network Plan,29.835,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
BAIR HUGGAR BLANKET,,A9273,HCPCS,Facility,Outpatient,,,,33.15,28.1775,9.50079,33.15,BlueCross BlueShield Minnesota,Medicare Advantage,16.2435,49,,percent of total billed charges,,
BAIR HUGGAR BLANKET,,A9273,HCPCS,Facility,Inpatient,,,,33.15,28.1775,9.50079,33.15,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
BAIR HUGGAR BLANKET,,A9273,HCPCS,Facility,Both,,,,33.15,28.1775,9.50079,33.15,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,29.360955,88.57,,percent of total billed charges,,
BAIR HUGGAR BLANKET,,A9273,HCPCS,Facility,Both,,,,33.15,28.1775,9.50079,33.15,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,9.50079,28.66,,percent of total billed charges,,
BAIR HUGGAR BLANKET,,A9273,HCPCS,Facility,Outpatient,,,,33.15,28.1775,9.50079,33.15,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),16.2435,49,,percent of total billed charges,,
BAIR HUGGAR BLANKET,,A9273,HCPCS,Facility,Inpatient,,,,33.15,28.1775,9.50079,33.15,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
BAIR HUGGAR BLANKET,,A9273,HCPCS,Facility,Both,,,,33.15,28.1775,9.50079,33.15,CorVel,Worker's Compensation,33.15,100,,percent of total billed charges,,
BAIR HUGGAR BLANKET,,A9273,HCPCS,Facility,Both,,,,33.15,28.1775,9.50079,33.15,First Health Group Corporation,First Health Network,32.1555,97,,percent of total billed charges,,
BAIR HUGGAR BLANKET,,A9273,HCPCS,Facility,Both,,,,33.15,28.1775,9.50079,33.15,"Health Partners, Inc.",Commercial,31.3599,94.6,,percent of total billed charges,,
BAIR HUGGAR BLANKET,,A9273,HCPCS,Facility,Outpatient,,,,33.15,28.1775,9.50079,33.15,"Health Partners, Inc.",Medicare Advantage,16.2435,49,,percent of total billed charges,,
BAIR HUGGAR BLANKET,,A9273,HCPCS,Facility,Inpatient,,,,33.15,28.1775,9.50079,33.15,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
BAIR HUGGAR BLANKET,,A9273,HCPCS,Facility,Both,,,,33.15,28.1775,9.50079,33.15,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),19.89,60,,percent of total billed charges,,
BAIR HUGGAR BLANKET,,A9273,HCPCS,Facility,Both,,,,33.15,28.1775,9.50079,33.15,"Health Partners, Inc.",State of Minnesota Advantage Program,27.01725,81.5,,percent of total billed charges,,
BAIR HUGGAR BLANKET,,A9273,HCPCS,Facility,Both,,,,33.15,28.1775,9.50079,33.15,"Health Partners, Inc.",State Public Programs,16.575,50,,percent of total billed charges,,
BAIR HUGGAR BLANKET,,A9273,HCPCS,Facility,Both,,,,33.15,28.1775,9.50079,33.15,Humana Insurance Company,Commercial PPO,31.4925,95,,percent of total billed charges,,
BAIR HUGGAR BLANKET,,A9273,HCPCS,Facility,Outpatient,,,,33.15,28.1775,9.50079,33.15,Humana Insurance Company,Medicare PPO,16.2435,49,,percent of total billed charges,,
BAIR HUGGAR BLANKET,,A9273,HCPCS,Facility,Inpatient,,,,33.15,28.1775,9.50079,33.15,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
BAIR HUGGAR BLANKET,,A9273,HCPCS,Facility,Both,,,,33.15,28.1775,9.50079,33.15,Medica,Individual & Family,32.85165,99.1,,percent of total billed charges,,
BAIR HUGGAR BLANKET,,A9273,HCPCS,Facility,Outpatient,,,,33.15,28.1775,9.50079,33.15,Medica,Medica Advantage Solution,16.5087,49.8,,percent of total billed charges,,
BAIR HUGGAR BLANKET,,A9273,HCPCS,Facility,Inpatient,,,,33.15,28.1775,9.50079,33.15,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
BAIR HUGGAR BLANKET,,A9273,HCPCS,Facility,Outpatient,,,,33.15,28.1775,9.50079,33.15,Medica,Medical Assistance,14.7849,44.6,,percent of total billed charges,,
BAIR HUGGAR BLANKET,,A9273,HCPCS,Facility,Inpatient,,,,33.15,28.1775,9.50079,33.15,Medica,Medical Assistance,,,,,Included in per diem rate,
BAIR HUGGAR BLANKET,,A9273,HCPCS,Facility,Outpatient,,,,33.15,28.1775,9.50079,33.15,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,16.5087,49.8,,percent of total billed charges,,
BAIR HUGGAR BLANKET,,A9273,HCPCS,Facility,Inpatient,,,,33.15,28.1775,9.50079,33.15,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
BAIR HUGGAR BLANKET,,A9273,HCPCS,Facility,Both,,,,33.15,28.1775,9.50079,33.15,"Multiplan, Inc.","Multiplan, Inc.",31.161,94,,percent of total billed charges,,
BAIR HUGGAR BLANKET,,A9273,HCPCS,Facility,Outpatient,,,,33.15,28.1775,9.50079,33.15,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,29.86815,90.1,,percent of total billed charges,,
BAIR HUGGAR BLANKET,,A9273,HCPCS,Facility,Inpatient,,,,33.15,28.1775,9.50079,33.15,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
BAIR HUGGAR BLANKET,,A9273,HCPCS,Facility,Both,,,,33.15,28.1775,9.50079,33.15,"Preferred One Administrative Services, INC.",PPO,32.6859,98.6,,percent of total billed charges,,
BAIR HUGGAR BLANKET,,A9273,HCPCS,Facility,Outpatient,,,,33.15,28.1775,9.50079,33.15,PrimeWest Health,Minnesota Senior Health Options (MSHO),17.055675,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
BAIR HUGGAR BLANKET,,A9273,HCPCS,Facility,Inpatient,,,,33.15,28.1775,9.50079,33.15,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
BAIR HUGGAR BLANKET,,A9273,HCPCS,Facility,Outpatient,,,,33.15,28.1775,9.50079,33.15,PrimeWest Health,MinnesotaCare,17.02584,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
BAIR HUGGAR BLANKET,,A9273,HCPCS,Facility,Inpatient,,,,33.15,28.1775,9.50079,33.15,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
BAIR HUGGAR BLANKET,,A9273,HCPCS,Facility,Both,,,,33.15,28.1775,9.50079,33.15,Sanford Health Plan,Sanford Health Plan,30.498,92,,percent of total billed charges,,
BAIR HUGGAR BLANKET,,A9273,HCPCS,Facility,Outpatient,,,,33.15,28.1775,9.50079,33.15,"UCare Health, Inc.",Individual & Family Plan,18.680025,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
BAIR HUGGAR BLANKET,,A9273,HCPCS,Facility,Inpatient,,,,33.15,28.1775,9.50079,33.15,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
BAIR HUGGAR BLANKET,,A9273,HCPCS,Facility,Outpatient,,,,33.15,28.1775,9.50079,33.15,"UCare Health, Inc.",Medical Assistance,16.730805,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BAIR HUGGAR BLANKET,,A9273,HCPCS,Facility,Inpatient,,,,33.15,28.1775,9.50079,33.15,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
BAIR HUGGAR BLANKET,,A9273,HCPCS,Facility,Outpatient,,,,33.15,28.1775,9.50079,33.15,"UCare Health, Inc.",Medicare Advantage,16.730805,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BAIR HUGGAR BLANKET,,A9273,HCPCS,Facility,Inpatient,,,,33.15,28.1775,9.50079,33.15,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
BAIR HUGGAR BLANKET,,A9273,HCPCS,Facility,Outpatient,,,,33.15,28.1775,9.50079,33.15,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),16.730805,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BAIR HUGGAR BLANKET,,A9273,HCPCS,Facility,Inpatient,,,,33.15,28.1775,9.50079,33.15,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
BAIR HUGGAR BLANKET,,A9273,HCPCS,Facility,Both,,,,33.15,28.1775,9.50079,33.15,UnitedHealthcare,Individual & Family,31.161,94,,percent of total billed charges,,
BAIR HUGGAR BLANKET,,A9273,HCPCS,Facility,Outpatient,,,,33.15,28.1775,9.50079,33.15,UnitedHealthcare,Medicare Advantage,16.2435,49,,percent of total billed charges,,
BAIR HUGGAR BLANKET,,A9273,HCPCS,Facility,Inpatient,,,,33.15,28.1775,9.50079,33.15,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
BAIR HUGGAR BLANKET,,A9273,HCPCS,Facility,Outpatient,,,,33.15,28.1775,9.50079,33.15,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,15.912,48,,percent of total billed charges,,100% of DHS outpatient percentage
BAIR HUGGAR BLANKET,,A9273,HCPCS,Facility,Inpatient,,,,33.15,28.1775,9.50079,33.15,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Sup Warming Bair Paw Gown,,A9273,HCPCS,Facility,Both,,,,54,45.9,15.4764,54,Aetna,Commercial,49.68,92,,percent of total billed charges,,
Sup Warming Bair Paw Gown,,A9273,HCPCS,Facility,Outpatient,,,,54,45.9,15.4764,54,Aetna,Medicare Advantage,26.46,49,,percent of total billed charges,,
Sup Warming Bair Paw Gown,,A9273,HCPCS,Facility,Inpatient,,,,54,45.9,15.4764,54,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Sup Warming Bair Paw Gown,,A9273,HCPCS,Facility,Both,,,,54,45.9,15.4764,54,Aetna,PPO,50.22,93,,percent of total billed charges,,
Sup Warming Bair Paw Gown,,A9273,HCPCS,Facility,Both,,,,54,45.9,15.4764,54,America's PPO,America's PPO,51.8562,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Sup Warming Bair Paw Gown,,A9273,HCPCS,Facility,Both,,,,54,45.9,15.4764,54,BlueCross BlueShield Minnesota, Federal Employee Program,53.136,98.4,,percent of total billed charges,,
Sup Warming Bair Paw Gown,,A9273,HCPCS,Facility,Both,,,,54,45.9,15.4764,54,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,54,100,,percent of total billed charges,,
Sup Warming Bair Paw Gown,,A9273,HCPCS,Facility,Both,,,,54,45.9,15.4764,54,BlueCross BlueShield Minnesota,High Value Network Plan,48.6,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
Sup Warming Bair Paw Gown,,A9273,HCPCS,Facility,Outpatient,,,,54,45.9,15.4764,54,BlueCross BlueShield Minnesota,Medicare Advantage,26.46,49,,percent of total billed charges,,
Sup Warming Bair Paw Gown,,A9273,HCPCS,Facility,Inpatient,,,,54,45.9,15.4764,54,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Sup Warming Bair Paw Gown,,A9273,HCPCS,Facility,Both,,,,54,45.9,15.4764,54,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,47.8278,88.57,,percent of total billed charges,,
Sup Warming Bair Paw Gown,,A9273,HCPCS,Facility,Both,,,,54,45.9,15.4764,54,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,15.4764,28.66,,percent of total billed charges,,
Sup Warming Bair Paw Gown,,A9273,HCPCS,Facility,Outpatient,,,,54,45.9,15.4764,54,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),26.46,49,,percent of total billed charges,,
Sup Warming Bair Paw Gown,,A9273,HCPCS,Facility,Inpatient,,,,54,45.9,15.4764,54,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Sup Warming Bair Paw Gown,,A9273,HCPCS,Facility,Both,,,,54,45.9,15.4764,54,CorVel,Worker's Compensation,54,100,,percent of total billed charges,,
Sup Warming Bair Paw Gown,,A9273,HCPCS,Facility,Both,,,,54,45.9,15.4764,54,First Health Group Corporation,First Health Network,52.38,97,,percent of total billed charges,,
Sup Warming Bair Paw Gown,,A9273,HCPCS,Facility,Both,,,,54,45.9,15.4764,54,"Health Partners, Inc.",Commercial,51.084,94.6,,percent of total billed charges,,
Sup Warming Bair Paw Gown,,A9273,HCPCS,Facility,Outpatient,,,,54,45.9,15.4764,54,"Health Partners, Inc.",Medicare Advantage,26.46,49,,percent of total billed charges,,
Sup Warming Bair Paw Gown,,A9273,HCPCS,Facility,Inpatient,,,,54,45.9,15.4764,54,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Warming Bair Paw Gown,,A9273,HCPCS,Facility,Both,,,,54,45.9,15.4764,54,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),32.4,60,,percent of total billed charges,,
Sup Warming Bair Paw Gown,,A9273,HCPCS,Facility,Both,,,,54,45.9,15.4764,54,"Health Partners, Inc.",State of Minnesota Advantage Program,44.01,81.5,,percent of total billed charges,,
Sup Warming Bair Paw Gown,,A9273,HCPCS,Facility,Both,,,,54,45.9,15.4764,54,"Health Partners, Inc.",State Public Programs,27,50,,percent of total billed charges,,
Sup Warming Bair Paw Gown,,A9273,HCPCS,Facility,Both,,,,54,45.9,15.4764,54,Humana Insurance Company,Commercial PPO,51.3,95,,percent of total billed charges,,
Sup Warming Bair Paw Gown,,A9273,HCPCS,Facility,Outpatient,,,,54,45.9,15.4764,54,Humana Insurance Company,Medicare PPO,26.46,49,,percent of total billed charges,,
Sup Warming Bair Paw Gown,,A9273,HCPCS,Facility,Inpatient,,,,54,45.9,15.4764,54,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Sup Warming Bair Paw Gown,,A9273,HCPCS,Facility,Both,,,,54,45.9,15.4764,54,Medica,Individual & Family,53.514,99.1,,percent of total billed charges,,
Sup Warming Bair Paw Gown,,A9273,HCPCS,Facility,Outpatient,,,,54,45.9,15.4764,54,Medica,Medica Advantage Solution,26.892,49.8,,percent of total billed charges,,
Sup Warming Bair Paw Gown,,A9273,HCPCS,Facility,Inpatient,,,,54,45.9,15.4764,54,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Sup Warming Bair Paw Gown,,A9273,HCPCS,Facility,Outpatient,,,,54,45.9,15.4764,54,Medica,Medical Assistance,24.084,44.6,,percent of total billed charges,,
Sup Warming Bair Paw Gown,,A9273,HCPCS,Facility,Inpatient,,,,54,45.9,15.4764,54,Medica,Medical Assistance,,,,,Included in per diem rate,
Sup Warming Bair Paw Gown,,A9273,HCPCS,Facility,Outpatient,,,,54,45.9,15.4764,54,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,26.892,49.8,,percent of total billed charges,,
Sup Warming Bair Paw Gown,,A9273,HCPCS,Facility,Inpatient,,,,54,45.9,15.4764,54,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Sup Warming Bair Paw Gown,,A9273,HCPCS,Facility,Both,,,,54,45.9,15.4764,54,"Multiplan, Inc.","Multiplan, Inc.",50.76,94,,percent of total billed charges,,
Sup Warming Bair Paw Gown,,A9273,HCPCS,Facility,Outpatient,,,,54,45.9,15.4764,54,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,48.654,90.1,,percent of total billed charges,,
Sup Warming Bair Paw Gown,,A9273,HCPCS,Facility,Inpatient,,,,54,45.9,15.4764,54,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Sup Warming Bair Paw Gown,,A9273,HCPCS,Facility,Both,,,,54,45.9,15.4764,54,"Preferred One Administrative Services, INC.",PPO,53.244,98.6,,percent of total billed charges,,
Sup Warming Bair Paw Gown,,A9273,HCPCS,Facility,Outpatient,,,,54,45.9,15.4764,54,PrimeWest Health,Minnesota Senior Health Options (MSHO),27.783,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Sup Warming Bair Paw Gown,,A9273,HCPCS,Facility,Inpatient,,,,54,45.9,15.4764,54,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Warming Bair Paw Gown,,A9273,HCPCS,Facility,Outpatient,,,,54,45.9,15.4764,54,PrimeWest Health,MinnesotaCare,27.7344,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Sup Warming Bair Paw Gown,,A9273,HCPCS,Facility,Inpatient,,,,54,45.9,15.4764,54,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Sup Warming Bair Paw Gown,,A9273,HCPCS,Facility,Both,,,,54,45.9,15.4764,54,Sanford Health Plan,Sanford Health Plan,49.68,92,,percent of total billed charges,,
Sup Warming Bair Paw Gown,,A9273,HCPCS,Facility,Outpatient,,,,54,45.9,15.4764,54,"UCare Health, Inc.",Individual & Family Plan,30.429,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Sup Warming Bair Paw Gown,,A9273,HCPCS,Facility,Inpatient,,,,54,45.9,15.4764,54,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Sup Warming Bair Paw Gown,,A9273,HCPCS,Facility,Outpatient,,,,54,45.9,15.4764,54,"UCare Health, Inc.",Medical Assistance,27.2538,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Warming Bair Paw Gown,,A9273,HCPCS,Facility,Inpatient,,,,54,45.9,15.4764,54,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Sup Warming Bair Paw Gown,,A9273,HCPCS,Facility,Outpatient,,,,54,45.9,15.4764,54,"UCare Health, Inc.",Medicare Advantage,27.2538,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Warming Bair Paw Gown,,A9273,HCPCS,Facility,Inpatient,,,,54,45.9,15.4764,54,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Warming Bair Paw Gown,,A9273,HCPCS,Facility,Outpatient,,,,54,45.9,15.4764,54,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),27.2538,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Warming Bair Paw Gown,,A9273,HCPCS,Facility,Inpatient,,,,54,45.9,15.4764,54,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Warming Bair Paw Gown,,A9273,HCPCS,Facility,Both,,,,54,45.9,15.4764,54,UnitedHealthcare,Individual & Family,50.76,94,,percent of total billed charges,,
Sup Warming Bair Paw Gown,,A9273,HCPCS,Facility,Outpatient,,,,54,45.9,15.4764,54,UnitedHealthcare,Medicare Advantage,26.46,49,,percent of total billed charges,,
Sup Warming Bair Paw Gown,,A9273,HCPCS,Facility,Inpatient,,,,54,45.9,15.4764,54,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Sup Warming Bair Paw Gown,,A9273,HCPCS,Facility,Outpatient,,,,54,45.9,15.4764,54,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,25.92,48,,percent of total billed charges,,100% of DHS outpatient percentage
Sup Warming Bair Paw Gown,,A9273,HCPCS,Facility,Inpatient,,,,54,45.9,15.4764,54,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Sup Warming Blanket,,A9273,HCPCS,Facility,Both,,,,46,39.1,13.1836,46,Aetna,Commercial,42.32,92,,percent of total billed charges,,
Sup Warming Blanket,,A9273,HCPCS,Facility,Outpatient,,,,46,39.1,13.1836,46,Aetna,Medicare Advantage,22.54,49,,percent of total billed charges,,
Sup Warming Blanket,,A9273,HCPCS,Facility,Inpatient,,,,46,39.1,13.1836,46,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Sup Warming Blanket,,A9273,HCPCS,Facility,Both,,,,46,39.1,13.1836,46,Aetna,PPO,42.78,93,,percent of total billed charges,,
Sup Warming Blanket,,A9273,HCPCS,Facility,Both,,,,46,39.1,13.1836,46,America's PPO,America's PPO,44.1738,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Sup Warming Blanket,,A9273,HCPCS,Facility,Both,,,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota, Federal Employee Program,45.264,98.4,,percent of total billed charges,,
Sup Warming Blanket,,A9273,HCPCS,Facility,Both,,,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,46,100,,percent of total billed charges,,
Sup Warming Blanket,,A9273,HCPCS,Facility,Both,,,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,High Value Network Plan,41.4,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
Sup Warming Blanket,,A9273,HCPCS,Facility,Outpatient,,,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Medicare Advantage,22.54,49,,percent of total billed charges,,
Sup Warming Blanket,,A9273,HCPCS,Facility,Inpatient,,,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Sup Warming Blanket,,A9273,HCPCS,Facility,Both,,,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,40.7422,88.57,,percent of total billed charges,,
Sup Warming Blanket,,A9273,HCPCS,Facility,Both,,,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,13.1836,28.66,,percent of total billed charges,,
Sup Warming Blanket,,A9273,HCPCS,Facility,Outpatient,,,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),22.54,49,,percent of total billed charges,,
Sup Warming Blanket,,A9273,HCPCS,Facility,Inpatient,,,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Sup Warming Blanket,,A9273,HCPCS,Facility,Both,,,,46,39.1,13.1836,46,CorVel,Worker's Compensation,46,100,,percent of total billed charges,,
Sup Warming Blanket,,A9273,HCPCS,Facility,Both,,,,46,39.1,13.1836,46,First Health Group Corporation,First Health Network,44.62,97,,percent of total billed charges,,
Sup Warming Blanket,,A9273,HCPCS,Facility,Both,,,,46,39.1,13.1836,46,"Health Partners, Inc.",Commercial,43.516,94.6,,percent of total billed charges,,
Sup Warming Blanket,,A9273,HCPCS,Facility,Outpatient,,,,46,39.1,13.1836,46,"Health Partners, Inc.",Medicare Advantage,22.54,49,,percent of total billed charges,,
Sup Warming Blanket,,A9273,HCPCS,Facility,Inpatient,,,,46,39.1,13.1836,46,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Warming Blanket,,A9273,HCPCS,Facility,Both,,,,46,39.1,13.1836,46,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),27.6,60,,percent of total billed charges,,
Sup Warming Blanket,,A9273,HCPCS,Facility,Both,,,,46,39.1,13.1836,46,"Health Partners, Inc.",State of Minnesota Advantage Program,37.49,81.5,,percent of total billed charges,,
Sup Warming Blanket,,A9273,HCPCS,Facility,Both,,,,46,39.1,13.1836,46,"Health Partners, Inc.",State Public Programs,23,50,,percent of total billed charges,,
Sup Warming Blanket,,A9273,HCPCS,Facility,Both,,,,46,39.1,13.1836,46,Humana Insurance Company,Commercial PPO,43.7,95,,percent of total billed charges,,
Sup Warming Blanket,,A9273,HCPCS,Facility,Outpatient,,,,46,39.1,13.1836,46,Humana Insurance Company,Medicare PPO,22.54,49,,percent of total billed charges,,
Sup Warming Blanket,,A9273,HCPCS,Facility,Inpatient,,,,46,39.1,13.1836,46,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Sup Warming Blanket,,A9273,HCPCS,Facility,Both,,,,46,39.1,13.1836,46,Medica,Individual & Family,45.586,99.1,,percent of total billed charges,,
Sup Warming Blanket,,A9273,HCPCS,Facility,Outpatient,,,,46,39.1,13.1836,46,Medica,Medica Advantage Solution,22.908,49.8,,percent of total billed charges,,
Sup Warming Blanket,,A9273,HCPCS,Facility,Inpatient,,,,46,39.1,13.1836,46,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Sup Warming Blanket,,A9273,HCPCS,Facility,Outpatient,,,,46,39.1,13.1836,46,Medica,Medical Assistance,20.516,44.6,,percent of total billed charges,,
Sup Warming Blanket,,A9273,HCPCS,Facility,Inpatient,,,,46,39.1,13.1836,46,Medica,Medical Assistance,,,,,Included in per diem rate,
Sup Warming Blanket,,A9273,HCPCS,Facility,Outpatient,,,,46,39.1,13.1836,46,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,22.908,49.8,,percent of total billed charges,,
Sup Warming Blanket,,A9273,HCPCS,Facility,Inpatient,,,,46,39.1,13.1836,46,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Sup Warming Blanket,,A9273,HCPCS,Facility,Both,,,,46,39.1,13.1836,46,"Multiplan, Inc.","Multiplan, Inc.",43.24,94,,percent of total billed charges,,
Sup Warming Blanket,,A9273,HCPCS,Facility,Outpatient,,,,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,41.446,90.1,,percent of total billed charges,,
Sup Warming Blanket,,A9273,HCPCS,Facility,Inpatient,,,,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Sup Warming Blanket,,A9273,HCPCS,Facility,Both,,,,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PPO,45.356,98.6,,percent of total billed charges,,
Sup Warming Blanket,,A9273,HCPCS,Facility,Outpatient,,,,46,39.1,13.1836,46,PrimeWest Health,Minnesota Senior Health Options (MSHO),23.667,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Sup Warming Blanket,,A9273,HCPCS,Facility,Inpatient,,,,46,39.1,13.1836,46,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Warming Blanket,,A9273,HCPCS,Facility,Outpatient,,,,46,39.1,13.1836,46,PrimeWest Health,MinnesotaCare,23.6256,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Sup Warming Blanket,,A9273,HCPCS,Facility,Inpatient,,,,46,39.1,13.1836,46,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Sup Warming Blanket,,A9273,HCPCS,Facility,Both,,,,46,39.1,13.1836,46,Sanford Health Plan,Sanford Health Plan,42.32,92,,percent of total billed charges,,
Sup Warming Blanket,,A9273,HCPCS,Facility,Outpatient,,,,46,39.1,13.1836,46,"UCare Health, Inc.",Individual & Family Plan,25.921,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Sup Warming Blanket,,A9273,HCPCS,Facility,Inpatient,,,,46,39.1,13.1836,46,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Sup Warming Blanket,,A9273,HCPCS,Facility,Outpatient,,,,46,39.1,13.1836,46,"UCare Health, Inc.",Medical Assistance,23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Warming Blanket,,A9273,HCPCS,Facility,Inpatient,,,,46,39.1,13.1836,46,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Sup Warming Blanket,,A9273,HCPCS,Facility,Outpatient,,,,46,39.1,13.1836,46,"UCare Health, Inc.",Medicare Advantage,23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Warming Blanket,,A9273,HCPCS,Facility,Inpatient,,,,46,39.1,13.1836,46,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Warming Blanket,,A9273,HCPCS,Facility,Outpatient,,,,46,39.1,13.1836,46,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Warming Blanket,,A9273,HCPCS,Facility,Inpatient,,,,46,39.1,13.1836,46,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Warming Blanket,,A9273,HCPCS,Facility,Both,,,,46,39.1,13.1836,46,UnitedHealthcare,Individual & Family,43.24,94,,percent of total billed charges,,
Sup Warming Blanket,,A9273,HCPCS,Facility,Outpatient,,,,46,39.1,13.1836,46,UnitedHealthcare,Medicare Advantage,22.54,49,,percent of total billed charges,,
Sup Warming Blanket,,A9273,HCPCS,Facility,Inpatient,,,,46,39.1,13.1836,46,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Sup Warming Blanket,,A9273,HCPCS,Facility,Outpatient,,,,46,39.1,13.1836,46,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,22.08,48,,percent of total billed charges,,100% of DHS outpatient percentage
Sup Warming Blanket,,A9273,HCPCS,Facility,Inpatient,,,,46,39.1,13.1836,46,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
SUTURE GRASPER,,A9281,HCPCS,Facility,Both,,,,168.2,142.97,48.20612,168.2,Aetna,Commercial,154.744,92,,percent of total billed charges,,
SUTURE GRASPER,,A9281,HCPCS,Facility,Outpatient,,,,168.2,142.97,48.20612,168.2,Aetna,Medicare Advantage,82.418,49,,percent of total billed charges,,
SUTURE GRASPER,,A9281,HCPCS,Facility,Inpatient,,,,168.2,142.97,48.20612,168.2,Aetna,Medicare Advantage,,,,,Included in per diem rate,
SUTURE GRASPER,,A9281,HCPCS,Facility,Both,,,,168.2,142.97,48.20612,168.2,Aetna,PPO,156.426,93,,percent of total billed charges,,
SUTURE GRASPER,,A9281,HCPCS,Facility,Both,,,,168.2,142.97,48.20612,168.2,America's PPO,America's PPO,161.52246,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SUTURE GRASPER,,A9281,HCPCS,Facility,Both,,,,168.2,142.97,48.20612,168.2,BlueCross BlueShield Minnesota, Federal Employee Program,165.5088,98.4,,percent of total billed charges,,
SUTURE GRASPER,,A9281,HCPCS,Facility,Both,,,,168.2,142.97,48.20612,168.2,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,168.2,100,,percent of total billed charges,,
SUTURE GRASPER,,A9281,HCPCS,Facility,Both,,,,168.2,142.97,48.20612,168.2,BlueCross BlueShield Minnesota,High Value Network Plan,151.38,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
SUTURE GRASPER,,A9281,HCPCS,Facility,Outpatient,,,,168.2,142.97,48.20612,168.2,BlueCross BlueShield Minnesota,Medicare Advantage,82.418,49,,percent of total billed charges,,
SUTURE GRASPER,,A9281,HCPCS,Facility,Inpatient,,,,168.2,142.97,48.20612,168.2,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
SUTURE GRASPER,,A9281,HCPCS,Facility,Both,,,,168.2,142.97,48.20612,168.2,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,148.97474,88.57,,percent of total billed charges,,
SUTURE GRASPER,,A9281,HCPCS,Facility,Both,,,,168.2,142.97,48.20612,168.2,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,48.20612,28.66,,percent of total billed charges,,
SUTURE GRASPER,,A9281,HCPCS,Facility,Outpatient,,,,168.2,142.97,48.20612,168.2,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),82.418,49,,percent of total billed charges,,
SUTURE GRASPER,,A9281,HCPCS,Facility,Inpatient,,,,168.2,142.97,48.20612,168.2,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
SUTURE GRASPER,,A9281,HCPCS,Facility,Both,,,,168.2,142.97,48.20612,168.2,CorVel,Worker's Compensation,168.2,100,,percent of total billed charges,,
SUTURE GRASPER,,A9281,HCPCS,Facility,Both,,,,168.2,142.97,48.20612,168.2,First Health Group Corporation,First Health Network,163.154,97,,percent of total billed charges,,
SUTURE GRASPER,,A9281,HCPCS,Facility,Both,,,,168.2,142.97,48.20612,168.2,"Health Partners, Inc.",Commercial,159.1172,94.6,,percent of total billed charges,,
SUTURE GRASPER,,A9281,HCPCS,Facility,Outpatient,,,,168.2,142.97,48.20612,168.2,"Health Partners, Inc.",Medicare Advantage,82.418,49,,percent of total billed charges,,
SUTURE GRASPER,,A9281,HCPCS,Facility,Inpatient,,,,168.2,142.97,48.20612,168.2,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE GRASPER,,A9281,HCPCS,Facility,Both,,,,168.2,142.97,48.20612,168.2,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),100.92,60,,percent of total billed charges,,
SUTURE GRASPER,,A9281,HCPCS,Facility,Both,,,,168.2,142.97,48.20612,168.2,"Health Partners, Inc.",State of Minnesota Advantage Program,137.083,81.5,,percent of total billed charges,,
SUTURE GRASPER,,A9281,HCPCS,Facility,Both,,,,168.2,142.97,48.20612,168.2,"Health Partners, Inc.",State Public Programs,84.1,50,,percent of total billed charges,,
SUTURE GRASPER,,A9281,HCPCS,Facility,Both,,,,168.2,142.97,48.20612,168.2,Humana Insurance Company,Commercial PPO,159.79,95,,percent of total billed charges,,
SUTURE GRASPER,,A9281,HCPCS,Facility,Outpatient,,,,168.2,142.97,48.20612,168.2,Humana Insurance Company,Medicare PPO,82.418,49,,percent of total billed charges,,
SUTURE GRASPER,,A9281,HCPCS,Facility,Inpatient,,,,168.2,142.97,48.20612,168.2,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
SUTURE GRASPER,,A9281,HCPCS,Facility,Both,,,,168.2,142.97,48.20612,168.2,Medica,Individual & Family,166.6862,99.1,,percent of total billed charges,,
SUTURE GRASPER,,A9281,HCPCS,Facility,Outpatient,,,,168.2,142.97,48.20612,168.2,Medica,Medica Advantage Solution,83.7636,49.8,,percent of total billed charges,,
SUTURE GRASPER,,A9281,HCPCS,Facility,Inpatient,,,,168.2,142.97,48.20612,168.2,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
SUTURE GRASPER,,A9281,HCPCS,Facility,Outpatient,,,,168.2,142.97,48.20612,168.2,Medica,Medical Assistance,75.0172,44.6,,percent of total billed charges,,
SUTURE GRASPER,,A9281,HCPCS,Facility,Inpatient,,,,168.2,142.97,48.20612,168.2,Medica,Medical Assistance,,,,,Included in per diem rate,
SUTURE GRASPER,,A9281,HCPCS,Facility,Outpatient,,,,168.2,142.97,48.20612,168.2,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,83.7636,49.8,,percent of total billed charges,,
SUTURE GRASPER,,A9281,HCPCS,Facility,Inpatient,,,,168.2,142.97,48.20612,168.2,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
SUTURE GRASPER,,A9281,HCPCS,Facility,Both,,,,168.2,142.97,48.20612,168.2,"Multiplan, Inc.","Multiplan, Inc.",158.108,94,,percent of total billed charges,,
SUTURE GRASPER,,A9281,HCPCS,Facility,Outpatient,,,,168.2,142.97,48.20612,168.2,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,151.5482,90.1,,percent of total billed charges,,
SUTURE GRASPER,,A9281,HCPCS,Facility,Inpatient,,,,168.2,142.97,48.20612,168.2,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
SUTURE GRASPER,,A9281,HCPCS,Facility,Both,,,,168.2,142.97,48.20612,168.2,"Preferred One Administrative Services, INC.",PPO,165.8452,98.6,,percent of total billed charges,,
SUTURE GRASPER,,A9281,HCPCS,Facility,Outpatient,,,,168.2,142.97,48.20612,168.2,PrimeWest Health,Minnesota Senior Health Options (MSHO),86.5389,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
SUTURE GRASPER,,A9281,HCPCS,Facility,Inpatient,,,,168.2,142.97,48.20612,168.2,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE GRASPER,,A9281,HCPCS,Facility,Outpatient,,,,168.2,142.97,48.20612,168.2,PrimeWest Health,MinnesotaCare,86.38752,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
SUTURE GRASPER,,A9281,HCPCS,Facility,Inpatient,,,,168.2,142.97,48.20612,168.2,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
SUTURE GRASPER,,A9281,HCPCS,Facility,Both,,,,168.2,142.97,48.20612,168.2,Sanford Health Plan,Sanford Health Plan,154.744,92,,percent of total billed charges,,
SUTURE GRASPER,,A9281,HCPCS,Facility,Outpatient,,,,168.2,142.97,48.20612,168.2,"UCare Health, Inc.",Individual & Family Plan,94.7807,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
SUTURE GRASPER,,A9281,HCPCS,Facility,Inpatient,,,,168.2,142.97,48.20612,168.2,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
SUTURE GRASPER,,A9281,HCPCS,Facility,Outpatient,,,,168.2,142.97,48.20612,168.2,"UCare Health, Inc.",Medical Assistance,84.89054,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE GRASPER,,A9281,HCPCS,Facility,Inpatient,,,,168.2,142.97,48.20612,168.2,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
SUTURE GRASPER,,A9281,HCPCS,Facility,Outpatient,,,,168.2,142.97,48.20612,168.2,"UCare Health, Inc.",Medicare Advantage,84.89054,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE GRASPER,,A9281,HCPCS,Facility,Inpatient,,,,168.2,142.97,48.20612,168.2,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE GRASPER,,A9281,HCPCS,Facility,Outpatient,,,,168.2,142.97,48.20612,168.2,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),84.89054,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE GRASPER,,A9281,HCPCS,Facility,Inpatient,,,,168.2,142.97,48.20612,168.2,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE GRASPER,,A9281,HCPCS,Facility,Both,,,,168.2,142.97,48.20612,168.2,UnitedHealthcare,Individual & Family,158.108,94,,percent of total billed charges,,
SUTURE GRASPER,,A9281,HCPCS,Facility,Outpatient,,,,168.2,142.97,48.20612,168.2,UnitedHealthcare,Medicare Advantage,82.418,49,,percent of total billed charges,,
SUTURE GRASPER,,A9281,HCPCS,Facility,Inpatient,,,,168.2,142.97,48.20612,168.2,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
SUTURE GRASPER,,A9281,HCPCS,Facility,Outpatient,,,,168.2,142.97,48.20612,168.2,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,80.736,48,,percent of total billed charges,,100% of DHS outpatient percentage
SUTURE GRASPER,,A9281,HCPCS,Facility,Inpatient,,,,168.2,142.97,48.20612,168.2,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Sup Tc99M Sestamibi Per Dose,,A9500,HCPCS,Facility,Both,,,,427,362.95,122.3782,427,Aetna,Commercial,392.84,92,,percent of total billed charges,,
Sup Tc99M Sestamibi Per Dose,,A9500,HCPCS,Facility,Outpatient,,,,427,362.95,122.3782,427,Aetna,Medicare Advantage,209.23,49,,percent of total billed charges,,
Sup Tc99M Sestamibi Per Dose,,A9500,HCPCS,Facility,Inpatient,,,,427,362.95,122.3782,427,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Sup Tc99M Sestamibi Per Dose,,A9500,HCPCS,Facility,Both,,,,427,362.95,122.3782,427,Aetna,PPO,397.11,93,,percent of total billed charges,,
Sup Tc99M Sestamibi Per Dose,,A9500,HCPCS,Facility,Both,,,,427,362.95,122.3782,427,America's PPO,America's PPO,410.0481,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Sup Tc99M Sestamibi Per Dose,,A9500,HCPCS,Facility,Both,,,,427,362.95,122.3782,427,BlueCross BlueShield Minnesota, Federal Employee Program,420.168,98.4,,percent of total billed charges,,
Sup Tc99M Sestamibi Per Dose,,A9500,HCPCS,Facility,Both,,,,427,362.95,122.3782,427,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,427,100,,percent of total billed charges,,
Sup Tc99M Sestamibi Per Dose,,A9500,HCPCS,Facility,Both,,,,427,362.95,122.3782,427,BlueCross BlueShield Minnesota,High Value Network Plan,384.3,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
Sup Tc99M Sestamibi Per Dose,,A9500,HCPCS,Facility,Outpatient,,,,427,362.95,122.3782,427,BlueCross BlueShield Minnesota,Medicare Advantage,209.23,49,,percent of total billed charges,,
Sup Tc99M Sestamibi Per Dose,,A9500,HCPCS,Facility,Inpatient,,,,427,362.95,122.3782,427,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Sup Tc99M Sestamibi Per Dose,,A9500,HCPCS,Facility,Both,,,,427,362.95,122.3782,427,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,378.1939,88.57,,percent of total billed charges,,
Sup Tc99M Sestamibi Per Dose,,A9500,HCPCS,Facility,Both,,,,427,362.95,122.3782,427,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,122.3782,28.66,,percent of total billed charges,,
Sup Tc99M Sestamibi Per Dose,,A9500,HCPCS,Facility,Outpatient,,,,427,362.95,122.3782,427,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),209.23,49,,percent of total billed charges,,
Sup Tc99M Sestamibi Per Dose,,A9500,HCPCS,Facility,Inpatient,,,,427,362.95,122.3782,427,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Sup Tc99M Sestamibi Per Dose,,A9500,HCPCS,Facility,Both,,,,427,362.95,122.3782,427,CorVel,Worker's Compensation,427,100,,percent of total billed charges,,
Sup Tc99M Sestamibi Per Dose,,A9500,HCPCS,Facility,Both,,,,427,362.95,122.3782,427,First Health Group Corporation,First Health Network,414.19,97,,percent of total billed charges,,
Sup Tc99M Sestamibi Per Dose,,A9500,HCPCS,Facility,Both,,,,427,362.95,122.3782,427,"Health Partners, Inc.",Commercial,403.942,94.6,,percent of total billed charges,,
Sup Tc99M Sestamibi Per Dose,,A9500,HCPCS,Facility,Outpatient,,,,427,362.95,122.3782,427,"Health Partners, Inc.",Medicare Advantage,209.23,49,,percent of total billed charges,,
Sup Tc99M Sestamibi Per Dose,,A9500,HCPCS,Facility,Inpatient,,,,427,362.95,122.3782,427,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Tc99M Sestamibi Per Dose,,A9500,HCPCS,Facility,Both,,,,427,362.95,122.3782,427,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),256.2,60,,percent of total billed charges,,
Sup Tc99M Sestamibi Per Dose,,A9500,HCPCS,Facility,Both,,,,427,362.95,122.3782,427,"Health Partners, Inc.",State of Minnesota Advantage Program,348.005,81.5,,percent of total billed charges,,
Sup Tc99M Sestamibi Per Dose,,A9500,HCPCS,Facility,Both,,,,427,362.95,122.3782,427,"Health Partners, Inc.",State Public Programs,213.5,50,,percent of total billed charges,,
Sup Tc99M Sestamibi Per Dose,,A9500,HCPCS,Facility,Both,,,,427,362.95,122.3782,427,Humana Insurance Company,Commercial PPO,405.65,95,,percent of total billed charges,,
Sup Tc99M Sestamibi Per Dose,,A9500,HCPCS,Facility,Outpatient,,,,427,362.95,122.3782,427,Humana Insurance Company,Medicare PPO,209.23,49,,percent of total billed charges,,
Sup Tc99M Sestamibi Per Dose,,A9500,HCPCS,Facility,Inpatient,,,,427,362.95,122.3782,427,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Sup Tc99M Sestamibi Per Dose,,A9500,HCPCS,Facility,Both,,,,427,362.95,122.3782,427,Medica,Individual & Family,423.157,99.1,,percent of total billed charges,,
Sup Tc99M Sestamibi Per Dose,,A9500,HCPCS,Facility,Outpatient,,,,427,362.95,122.3782,427,Medica,Medica Advantage Solution,212.646,49.8,,percent of total billed charges,,
Sup Tc99M Sestamibi Per Dose,,A9500,HCPCS,Facility,Inpatient,,,,427,362.95,122.3782,427,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Sup Tc99M Sestamibi Per Dose,,A9500,HCPCS,Facility,Outpatient,,,,427,362.95,122.3782,427,Medica,Medical Assistance,190.442,44.6,,percent of total billed charges,,
Sup Tc99M Sestamibi Per Dose,,A9500,HCPCS,Facility,Inpatient,,,,427,362.95,122.3782,427,Medica,Medical Assistance,,,,,Included in per diem rate,
Sup Tc99M Sestamibi Per Dose,,A9500,HCPCS,Facility,Outpatient,,,,427,362.95,122.3782,427,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,212.646,49.8,,percent of total billed charges,,
Sup Tc99M Sestamibi Per Dose,,A9500,HCPCS,Facility,Inpatient,,,,427,362.95,122.3782,427,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Sup Tc99M Sestamibi Per Dose,,A9500,HCPCS,Facility,Both,,,,427,362.95,122.3782,427,"Multiplan, Inc.","Multiplan, Inc.",401.38,94,,percent of total billed charges,,
Sup Tc99M Sestamibi Per Dose,,A9500,HCPCS,Facility,Outpatient,,,,427,362.95,122.3782,427,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,384.727,90.1,,percent of total billed charges,,
Sup Tc99M Sestamibi Per Dose,,A9500,HCPCS,Facility,Inpatient,,,,427,362.95,122.3782,427,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Sup Tc99M Sestamibi Per Dose,,A9500,HCPCS,Facility,Both,,,,427,362.95,122.3782,427,"Preferred One Administrative Services, INC.",PPO,421.022,98.6,,percent of total billed charges,,
Sup Tc99M Sestamibi Per Dose,,A9500,HCPCS,Facility,Outpatient,,,,427,362.95,122.3782,427,PrimeWest Health,Minnesota Senior Health Options (MSHO),219.6915,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Sup Tc99M Sestamibi Per Dose,,A9500,HCPCS,Facility,Inpatient,,,,427,362.95,122.3782,427,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Tc99M Sestamibi Per Dose,,A9500,HCPCS,Facility,Outpatient,,,,427,362.95,122.3782,427,PrimeWest Health,MinnesotaCare,219.3072,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Sup Tc99M Sestamibi Per Dose,,A9500,HCPCS,Facility,Inpatient,,,,427,362.95,122.3782,427,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Sup Tc99M Sestamibi Per Dose,,A9500,HCPCS,Facility,Both,,,,427,362.95,122.3782,427,Sanford Health Plan,Sanford Health Plan,392.84,92,,percent of total billed charges,,
Sup Tc99M Sestamibi Per Dose,,A9500,HCPCS,Facility,Outpatient,,,,427,362.95,122.3782,427,"UCare Health, Inc.",Individual & Family Plan,240.6145,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Sup Tc99M Sestamibi Per Dose,,A9500,HCPCS,Facility,Inpatient,,,,427,362.95,122.3782,427,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Sup Tc99M Sestamibi Per Dose,,A9500,HCPCS,Facility,Outpatient,,,,427,362.95,122.3782,427,"UCare Health, Inc.",Medical Assistance,215.5069,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Tc99M Sestamibi Per Dose,,A9500,HCPCS,Facility,Inpatient,,,,427,362.95,122.3782,427,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Sup Tc99M Sestamibi Per Dose,,A9500,HCPCS,Facility,Outpatient,,,,427,362.95,122.3782,427,"UCare Health, Inc.",Medicare Advantage,215.5069,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Tc99M Sestamibi Per Dose,,A9500,HCPCS,Facility,Inpatient,,,,427,362.95,122.3782,427,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Tc99M Sestamibi Per Dose,,A9500,HCPCS,Facility,Outpatient,,,,427,362.95,122.3782,427,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),215.5069,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Tc99M Sestamibi Per Dose,,A9500,HCPCS,Facility,Inpatient,,,,427,362.95,122.3782,427,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Tc99M Sestamibi Per Dose,,A9500,HCPCS,Facility,Both,,,,427,362.95,122.3782,427,UnitedHealthcare,Individual & Family,401.38,94,,percent of total billed charges,,
Sup Tc99M Sestamibi Per Dose,,A9500,HCPCS,Facility,Outpatient,,,,427,362.95,122.3782,427,UnitedHealthcare,Medicare Advantage,209.23,49,,percent of total billed charges,,
Sup Tc99M Sestamibi Per Dose,,A9500,HCPCS,Facility,Inpatient,,,,427,362.95,122.3782,427,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Sup Tc99M Sestamibi Per Dose,,A9500,HCPCS,Facility,Outpatient,,,,427,362.95,122.3782,427,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,204.96,48,,percent of total billed charges,,100% of DHS outpatient percentage
Sup Tc99M Sestamibi Per Dose,,A9500,HCPCS,Facility,Inpatient,,,,427,362.95,122.3782,427,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Sup Tc99M Mdp Per Dose,,A9503,HCPCS,Facility,Both,,,,176,149.6,50.4416,176,Aetna,Commercial,161.92,92,,percent of total billed charges,,
Sup Tc99M Mdp Per Dose,,A9503,HCPCS,Facility,Outpatient,,,,176,149.6,50.4416,176,Aetna,Medicare Advantage,86.24,49,,percent of total billed charges,,
Sup Tc99M Mdp Per Dose,,A9503,HCPCS,Facility,Inpatient,,,,176,149.6,50.4416,176,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Sup Tc99M Mdp Per Dose,,A9503,HCPCS,Facility,Both,,,,176,149.6,50.4416,176,Aetna,PPO,163.68,93,,percent of total billed charges,,
Sup Tc99M Mdp Per Dose,,A9503,HCPCS,Facility,Both,,,,176,149.6,50.4416,176,America's PPO,America's PPO,169.0128,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Sup Tc99M Mdp Per Dose,,A9503,HCPCS,Facility,Both,,,,176,149.6,50.4416,176,BlueCross BlueShield Minnesota, Federal Employee Program,173.184,98.4,,percent of total billed charges,,
Sup Tc99M Mdp Per Dose,,A9503,HCPCS,Facility,Both,,,,176,149.6,50.4416,176,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,176,100,,percent of total billed charges,,
Sup Tc99M Mdp Per Dose,,A9503,HCPCS,Facility,Both,,,,176,149.6,50.4416,176,BlueCross BlueShield Minnesota,High Value Network Plan,158.4,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
Sup Tc99M Mdp Per Dose,,A9503,HCPCS,Facility,Outpatient,,,,176,149.6,50.4416,176,BlueCross BlueShield Minnesota,Medicare Advantage,86.24,49,,percent of total billed charges,,
Sup Tc99M Mdp Per Dose,,A9503,HCPCS,Facility,Inpatient,,,,176,149.6,50.4416,176,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Sup Tc99M Mdp Per Dose,,A9503,HCPCS,Facility,Both,,,,176,149.6,50.4416,176,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,155.8832,88.57,,percent of total billed charges,,
Sup Tc99M Mdp Per Dose,,A9503,HCPCS,Facility,Both,,,,176,149.6,50.4416,176,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,50.4416,28.66,,percent of total billed charges,,
Sup Tc99M Mdp Per Dose,,A9503,HCPCS,Facility,Outpatient,,,,176,149.6,50.4416,176,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),86.24,49,,percent of total billed charges,,
Sup Tc99M Mdp Per Dose,,A9503,HCPCS,Facility,Inpatient,,,,176,149.6,50.4416,176,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Sup Tc99M Mdp Per Dose,,A9503,HCPCS,Facility,Both,,,,176,149.6,50.4416,176,CorVel,Worker's Compensation,176,100,,percent of total billed charges,,
Sup Tc99M Mdp Per Dose,,A9503,HCPCS,Facility,Both,,,,176,149.6,50.4416,176,First Health Group Corporation,First Health Network,170.72,97,,percent of total billed charges,,
Sup Tc99M Mdp Per Dose,,A9503,HCPCS,Facility,Both,,,,176,149.6,50.4416,176,"Health Partners, Inc.",Commercial,166.496,94.6,,percent of total billed charges,,
Sup Tc99M Mdp Per Dose,,A9503,HCPCS,Facility,Outpatient,,,,176,149.6,50.4416,176,"Health Partners, Inc.",Medicare Advantage,86.24,49,,percent of total billed charges,,
Sup Tc99M Mdp Per Dose,,A9503,HCPCS,Facility,Inpatient,,,,176,149.6,50.4416,176,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Tc99M Mdp Per Dose,,A9503,HCPCS,Facility,Both,,,,176,149.6,50.4416,176,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),105.6,60,,percent of total billed charges,,
Sup Tc99M Mdp Per Dose,,A9503,HCPCS,Facility,Both,,,,176,149.6,50.4416,176,"Health Partners, Inc.",State of Minnesota Advantage Program,143.44,81.5,,percent of total billed charges,,
Sup Tc99M Mdp Per Dose,,A9503,HCPCS,Facility,Both,,,,176,149.6,50.4416,176,"Health Partners, Inc.",State Public Programs,88,50,,percent of total billed charges,,
Sup Tc99M Mdp Per Dose,,A9503,HCPCS,Facility,Both,,,,176,149.6,50.4416,176,Humana Insurance Company,Commercial PPO,167.2,95,,percent of total billed charges,,
Sup Tc99M Mdp Per Dose,,A9503,HCPCS,Facility,Outpatient,,,,176,149.6,50.4416,176,Humana Insurance Company,Medicare PPO,86.24,49,,percent of total billed charges,,
Sup Tc99M Mdp Per Dose,,A9503,HCPCS,Facility,Inpatient,,,,176,149.6,50.4416,176,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Sup Tc99M Mdp Per Dose,,A9503,HCPCS,Facility,Both,,,,176,149.6,50.4416,176,Medica,Individual & Family,174.416,99.1,,percent of total billed charges,,
Sup Tc99M Mdp Per Dose,,A9503,HCPCS,Facility,Outpatient,,,,176,149.6,50.4416,176,Medica,Medica Advantage Solution,87.648,49.8,,percent of total billed charges,,
Sup Tc99M Mdp Per Dose,,A9503,HCPCS,Facility,Inpatient,,,,176,149.6,50.4416,176,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Sup Tc99M Mdp Per Dose,,A9503,HCPCS,Facility,Outpatient,,,,176,149.6,50.4416,176,Medica,Medical Assistance,78.496,44.6,,percent of total billed charges,,
Sup Tc99M Mdp Per Dose,,A9503,HCPCS,Facility,Inpatient,,,,176,149.6,50.4416,176,Medica,Medical Assistance,,,,,Included in per diem rate,
Sup Tc99M Mdp Per Dose,,A9503,HCPCS,Facility,Outpatient,,,,176,149.6,50.4416,176,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,87.648,49.8,,percent of total billed charges,,
Sup Tc99M Mdp Per Dose,,A9503,HCPCS,Facility,Inpatient,,,,176,149.6,50.4416,176,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Sup Tc99M Mdp Per Dose,,A9503,HCPCS,Facility,Both,,,,176,149.6,50.4416,176,"Multiplan, Inc.","Multiplan, Inc.",165.44,94,,percent of total billed charges,,
Sup Tc99M Mdp Per Dose,,A9503,HCPCS,Facility,Outpatient,,,,176,149.6,50.4416,176,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,158.576,90.1,,percent of total billed charges,,
Sup Tc99M Mdp Per Dose,,A9503,HCPCS,Facility,Inpatient,,,,176,149.6,50.4416,176,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Sup Tc99M Mdp Per Dose,,A9503,HCPCS,Facility,Both,,,,176,149.6,50.4416,176,"Preferred One Administrative Services, INC.",PPO,173.536,98.6,,percent of total billed charges,,
Sup Tc99M Mdp Per Dose,,A9503,HCPCS,Facility,Outpatient,,,,176,149.6,50.4416,176,PrimeWest Health,Minnesota Senior Health Options (MSHO),90.552,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Sup Tc99M Mdp Per Dose,,A9503,HCPCS,Facility,Inpatient,,,,176,149.6,50.4416,176,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Tc99M Mdp Per Dose,,A9503,HCPCS,Facility,Outpatient,,,,176,149.6,50.4416,176,PrimeWest Health,MinnesotaCare,90.3936,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Sup Tc99M Mdp Per Dose,,A9503,HCPCS,Facility,Inpatient,,,,176,149.6,50.4416,176,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Sup Tc99M Mdp Per Dose,,A9503,HCPCS,Facility,Both,,,,176,149.6,50.4416,176,Sanford Health Plan,Sanford Health Plan,161.92,92,,percent of total billed charges,,
Sup Tc99M Mdp Per Dose,,A9503,HCPCS,Facility,Outpatient,,,,176,149.6,50.4416,176,"UCare Health, Inc.",Individual & Family Plan,99.176,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Sup Tc99M Mdp Per Dose,,A9503,HCPCS,Facility,Inpatient,,,,176,149.6,50.4416,176,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Sup Tc99M Mdp Per Dose,,A9503,HCPCS,Facility,Outpatient,,,,176,149.6,50.4416,176,"UCare Health, Inc.",Medical Assistance,88.8272,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Tc99M Mdp Per Dose,,A9503,HCPCS,Facility,Inpatient,,,,176,149.6,50.4416,176,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Sup Tc99M Mdp Per Dose,,A9503,HCPCS,Facility,Outpatient,,,,176,149.6,50.4416,176,"UCare Health, Inc.",Medicare Advantage,88.8272,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Tc99M Mdp Per Dose,,A9503,HCPCS,Facility,Inpatient,,,,176,149.6,50.4416,176,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Tc99M Mdp Per Dose,,A9503,HCPCS,Facility,Outpatient,,,,176,149.6,50.4416,176,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),88.8272,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Tc99M Mdp Per Dose,,A9503,HCPCS,Facility,Inpatient,,,,176,149.6,50.4416,176,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Tc99M Mdp Per Dose,,A9503,HCPCS,Facility,Both,,,,176,149.6,50.4416,176,UnitedHealthcare,Individual & Family,165.44,94,,percent of total billed charges,,
Sup Tc99M Mdp Per Dose,,A9503,HCPCS,Facility,Outpatient,,,,176,149.6,50.4416,176,UnitedHealthcare,Medicare Advantage,86.24,49,,percent of total billed charges,,
Sup Tc99M Mdp Per Dose,,A9503,HCPCS,Facility,Inpatient,,,,176,149.6,50.4416,176,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Sup Tc99M Mdp Per Dose,,A9503,HCPCS,Facility,Outpatient,,,,176,149.6,50.4416,176,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,84.48,48,,percent of total billed charges,,100% of DHS outpatient percentage
Sup Tc99M Mdp Per Dose,,A9503,HCPCS,Facility,Inpatient,,,,176,149.6,50.4416,176,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Sup Thallium Tl201 Per Mci,,A9505,HCPCS,Facility,Both,,,,322,273.7,92.2852,322,Aetna,Commercial,296.24,92,,percent of total billed charges,,
Sup Thallium Tl201 Per Mci,,A9505,HCPCS,Facility,Outpatient,,,,322,273.7,92.2852,322,Aetna,Medicare Advantage,157.78,49,,percent of total billed charges,,
Sup Thallium Tl201 Per Mci,,A9505,HCPCS,Facility,Inpatient,,,,322,273.7,92.2852,322,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Sup Thallium Tl201 Per Mci,,A9505,HCPCS,Facility,Both,,,,322,273.7,92.2852,322,Aetna,PPO,299.46,93,,percent of total billed charges,,
Sup Thallium Tl201 Per Mci,,A9505,HCPCS,Facility,Both,,,,322,273.7,92.2852,322,America's PPO,America's PPO,309.2166,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Sup Thallium Tl201 Per Mci,,A9505,HCPCS,Facility,Both,,,,322,273.7,92.2852,322,BlueCross BlueShield Minnesota, Federal Employee Program,316.848,98.4,,percent of total billed charges,,
Sup Thallium Tl201 Per Mci,,A9505,HCPCS,Facility,Both,,,,322,273.7,92.2852,322,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,322,100,,percent of total billed charges,,
Sup Thallium Tl201 Per Mci,,A9505,HCPCS,Facility,Both,,,,322,273.7,92.2852,322,BlueCross BlueShield Minnesota,High Value Network Plan,289.8,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
Sup Thallium Tl201 Per Mci,,A9505,HCPCS,Facility,Outpatient,,,,322,273.7,92.2852,322,BlueCross BlueShield Minnesota,Medicare Advantage,157.78,49,,percent of total billed charges,,
Sup Thallium Tl201 Per Mci,,A9505,HCPCS,Facility,Inpatient,,,,322,273.7,92.2852,322,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Sup Thallium Tl201 Per Mci,,A9505,HCPCS,Facility,Both,,,,322,273.7,92.2852,322,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,285.1954,88.57,,percent of total billed charges,,
Sup Thallium Tl201 Per Mci,,A9505,HCPCS,Facility,Both,,,,322,273.7,92.2852,322,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,92.2852,28.66,,percent of total billed charges,,
Sup Thallium Tl201 Per Mci,,A9505,HCPCS,Facility,Outpatient,,,,322,273.7,92.2852,322,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),157.78,49,,percent of total billed charges,,
Sup Thallium Tl201 Per Mci,,A9505,HCPCS,Facility,Inpatient,,,,322,273.7,92.2852,322,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Sup Thallium Tl201 Per Mci,,A9505,HCPCS,Facility,Both,,,,322,273.7,92.2852,322,CorVel,Worker's Compensation,322,100,,percent of total billed charges,,
Sup Thallium Tl201 Per Mci,,A9505,HCPCS,Facility,Both,,,,322,273.7,92.2852,322,First Health Group Corporation,First Health Network,312.34,97,,percent of total billed charges,,
Sup Thallium Tl201 Per Mci,,A9505,HCPCS,Facility,Both,,,,322,273.7,92.2852,322,"Health Partners, Inc.",Commercial,304.612,94.6,,percent of total billed charges,,
Sup Thallium Tl201 Per Mci,,A9505,HCPCS,Facility,Outpatient,,,,322,273.7,92.2852,322,"Health Partners, Inc.",Medicare Advantage,157.78,49,,percent of total billed charges,,
Sup Thallium Tl201 Per Mci,,A9505,HCPCS,Facility,Inpatient,,,,322,273.7,92.2852,322,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Thallium Tl201 Per Mci,,A9505,HCPCS,Facility,Both,,,,322,273.7,92.2852,322,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),193.2,60,,percent of total billed charges,,
Sup Thallium Tl201 Per Mci,,A9505,HCPCS,Facility,Both,,,,322,273.7,92.2852,322,"Health Partners, Inc.",State of Minnesota Advantage Program,262.43,81.5,,percent of total billed charges,,
Sup Thallium Tl201 Per Mci,,A9505,HCPCS,Facility,Both,,,,322,273.7,92.2852,322,"Health Partners, Inc.",State Public Programs,161,50,,percent of total billed charges,,
Sup Thallium Tl201 Per Mci,,A9505,HCPCS,Facility,Both,,,,322,273.7,92.2852,322,Humana Insurance Company,Commercial PPO,305.9,95,,percent of total billed charges,,
Sup Thallium Tl201 Per Mci,,A9505,HCPCS,Facility,Outpatient,,,,322,273.7,92.2852,322,Humana Insurance Company,Medicare PPO,157.78,49,,percent of total billed charges,,
Sup Thallium Tl201 Per Mci,,A9505,HCPCS,Facility,Inpatient,,,,322,273.7,92.2852,322,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Sup Thallium Tl201 Per Mci,,A9505,HCPCS,Facility,Both,,,,322,273.7,92.2852,322,Medica,Individual & Family,319.102,99.1,,percent of total billed charges,,
Sup Thallium Tl201 Per Mci,,A9505,HCPCS,Facility,Outpatient,,,,322,273.7,92.2852,322,Medica,Medica Advantage Solution,160.356,49.8,,percent of total billed charges,,
Sup Thallium Tl201 Per Mci,,A9505,HCPCS,Facility,Inpatient,,,,322,273.7,92.2852,322,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Sup Thallium Tl201 Per Mci,,A9505,HCPCS,Facility,Outpatient,,,,322,273.7,92.2852,322,Medica,Medical Assistance,143.612,44.6,,percent of total billed charges,,
Sup Thallium Tl201 Per Mci,,A9505,HCPCS,Facility,Inpatient,,,,322,273.7,92.2852,322,Medica,Medical Assistance,,,,,Included in per diem rate,
Sup Thallium Tl201 Per Mci,,A9505,HCPCS,Facility,Outpatient,,,,322,273.7,92.2852,322,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,160.356,49.8,,percent of total billed charges,,
Sup Thallium Tl201 Per Mci,,A9505,HCPCS,Facility,Inpatient,,,,322,273.7,92.2852,322,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Sup Thallium Tl201 Per Mci,,A9505,HCPCS,Facility,Both,,,,322,273.7,92.2852,322,"Multiplan, Inc.","Multiplan, Inc.",302.68,94,,percent of total billed charges,,
Sup Thallium Tl201 Per Mci,,A9505,HCPCS,Facility,Outpatient,,,,322,273.7,92.2852,322,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,290.122,90.1,,percent of total billed charges,,
Sup Thallium Tl201 Per Mci,,A9505,HCPCS,Facility,Inpatient,,,,322,273.7,92.2852,322,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Sup Thallium Tl201 Per Mci,,A9505,HCPCS,Facility,Both,,,,322,273.7,92.2852,322,"Preferred One Administrative Services, INC.",PPO,317.492,98.6,,percent of total billed charges,,
Sup Thallium Tl201 Per Mci,,A9505,HCPCS,Facility,Outpatient,,,,322,273.7,92.2852,322,PrimeWest Health,Minnesota Senior Health Options (MSHO),165.669,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Sup Thallium Tl201 Per Mci,,A9505,HCPCS,Facility,Inpatient,,,,322,273.7,92.2852,322,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Thallium Tl201 Per Mci,,A9505,HCPCS,Facility,Outpatient,,,,322,273.7,92.2852,322,PrimeWest Health,MinnesotaCare,165.3792,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Sup Thallium Tl201 Per Mci,,A9505,HCPCS,Facility,Inpatient,,,,322,273.7,92.2852,322,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Sup Thallium Tl201 Per Mci,,A9505,HCPCS,Facility,Both,,,,322,273.7,92.2852,322,Sanford Health Plan,Sanford Health Plan,296.24,92,,percent of total billed charges,,
Sup Thallium Tl201 Per Mci,,A9505,HCPCS,Facility,Outpatient,,,,322,273.7,92.2852,322,"UCare Health, Inc.",Individual & Family Plan,181.447,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Sup Thallium Tl201 Per Mci,,A9505,HCPCS,Facility,Inpatient,,,,322,273.7,92.2852,322,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Sup Thallium Tl201 Per Mci,,A9505,HCPCS,Facility,Outpatient,,,,322,273.7,92.2852,322,"UCare Health, Inc.",Medical Assistance,162.5134,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Thallium Tl201 Per Mci,,A9505,HCPCS,Facility,Inpatient,,,,322,273.7,92.2852,322,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Sup Thallium Tl201 Per Mci,,A9505,HCPCS,Facility,Outpatient,,,,322,273.7,92.2852,322,"UCare Health, Inc.",Medicare Advantage,162.5134,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Thallium Tl201 Per Mci,,A9505,HCPCS,Facility,Inpatient,,,,322,273.7,92.2852,322,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Thallium Tl201 Per Mci,,A9505,HCPCS,Facility,Outpatient,,,,322,273.7,92.2852,322,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),162.5134,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Thallium Tl201 Per Mci,,A9505,HCPCS,Facility,Inpatient,,,,322,273.7,92.2852,322,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Thallium Tl201 Per Mci,,A9505,HCPCS,Facility,Both,,,,322,273.7,92.2852,322,UnitedHealthcare,Individual & Family,302.68,94,,percent of total billed charges,,
Sup Thallium Tl201 Per Mci,,A9505,HCPCS,Facility,Outpatient,,,,322,273.7,92.2852,322,UnitedHealthcare,Medicare Advantage,157.78,49,,percent of total billed charges,,
Sup Thallium Tl201 Per Mci,,A9505,HCPCS,Facility,Inpatient,,,,322,273.7,92.2852,322,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Sup Thallium Tl201 Per Mci,,A9505,HCPCS,Facility,Outpatient,,,,322,273.7,92.2852,322,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,154.56,48,,percent of total billed charges,,100% of DHS outpatient percentage
Sup Thallium Tl201 Per Mci,,A9505,HCPCS,Facility,Inpatient,,,,322,273.7,92.2852,322,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Sup Tc99M Disofenin Per Dose,,A9510,HCPCS,Facility,Both,,,,179,152.15,51.3014,179,Aetna,Commercial,164.68,92,,percent of total billed charges,,
Sup Tc99M Disofenin Per Dose,,A9510,HCPCS,Facility,Outpatient,,,,179,152.15,51.3014,179,Aetna,Medicare Advantage,87.71,49,,percent of total billed charges,,
Sup Tc99M Disofenin Per Dose,,A9510,HCPCS,Facility,Inpatient,,,,179,152.15,51.3014,179,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Sup Tc99M Disofenin Per Dose,,A9510,HCPCS,Facility,Both,,,,179,152.15,51.3014,179,Aetna,PPO,166.47,93,,percent of total billed charges,,
Sup Tc99M Disofenin Per Dose,,A9510,HCPCS,Facility,Both,,,,179,152.15,51.3014,179,America's PPO,America's PPO,171.8937,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Sup Tc99M Disofenin Per Dose,,A9510,HCPCS,Facility,Both,,,,179,152.15,51.3014,179,BlueCross BlueShield Minnesota, Federal Employee Program,176.136,98.4,,percent of total billed charges,,
Sup Tc99M Disofenin Per Dose,,A9510,HCPCS,Facility,Both,,,,179,152.15,51.3014,179,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,179,100,,percent of total billed charges,,
Sup Tc99M Disofenin Per Dose,,A9510,HCPCS,Facility,Both,,,,179,152.15,51.3014,179,BlueCross BlueShield Minnesota,High Value Network Plan,161.1,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
Sup Tc99M Disofenin Per Dose,,A9510,HCPCS,Facility,Outpatient,,,,179,152.15,51.3014,179,BlueCross BlueShield Minnesota,Medicare Advantage,87.71,49,,percent of total billed charges,,
Sup Tc99M Disofenin Per Dose,,A9510,HCPCS,Facility,Inpatient,,,,179,152.15,51.3014,179,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Sup Tc99M Disofenin Per Dose,,A9510,HCPCS,Facility,Both,,,,179,152.15,51.3014,179,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,158.5403,88.57,,percent of total billed charges,,
Sup Tc99M Disofenin Per Dose,,A9510,HCPCS,Facility,Both,,,,179,152.15,51.3014,179,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,51.3014,28.66,,percent of total billed charges,,
Sup Tc99M Disofenin Per Dose,,A9510,HCPCS,Facility,Outpatient,,,,179,152.15,51.3014,179,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),87.71,49,,percent of total billed charges,,
Sup Tc99M Disofenin Per Dose,,A9510,HCPCS,Facility,Inpatient,,,,179,152.15,51.3014,179,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Sup Tc99M Disofenin Per Dose,,A9510,HCPCS,Facility,Both,,,,179,152.15,51.3014,179,CorVel,Worker's Compensation,179,100,,percent of total billed charges,,
Sup Tc99M Disofenin Per Dose,,A9510,HCPCS,Facility,Both,,,,179,152.15,51.3014,179,First Health Group Corporation,First Health Network,173.63,97,,percent of total billed charges,,
Sup Tc99M Disofenin Per Dose,,A9510,HCPCS,Facility,Both,,,,179,152.15,51.3014,179,"Health Partners, Inc.",Commercial,169.334,94.6,,percent of total billed charges,,
Sup Tc99M Disofenin Per Dose,,A9510,HCPCS,Facility,Outpatient,,,,179,152.15,51.3014,179,"Health Partners, Inc.",Medicare Advantage,87.71,49,,percent of total billed charges,,
Sup Tc99M Disofenin Per Dose,,A9510,HCPCS,Facility,Inpatient,,,,179,152.15,51.3014,179,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Tc99M Disofenin Per Dose,,A9510,HCPCS,Facility,Both,,,,179,152.15,51.3014,179,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),107.4,60,,percent of total billed charges,,
Sup Tc99M Disofenin Per Dose,,A9510,HCPCS,Facility,Both,,,,179,152.15,51.3014,179,"Health Partners, Inc.",State of Minnesota Advantage Program,145.885,81.5,,percent of total billed charges,,
Sup Tc99M Disofenin Per Dose,,A9510,HCPCS,Facility,Both,,,,179,152.15,51.3014,179,"Health Partners, Inc.",State Public Programs,89.5,50,,percent of total billed charges,,
Sup Tc99M Disofenin Per Dose,,A9510,HCPCS,Facility,Both,,,,179,152.15,51.3014,179,Humana Insurance Company,Commercial PPO,170.05,95,,percent of total billed charges,,
Sup Tc99M Disofenin Per Dose,,A9510,HCPCS,Facility,Outpatient,,,,179,152.15,51.3014,179,Humana Insurance Company,Medicare PPO,87.71,49,,percent of total billed charges,,
Sup Tc99M Disofenin Per Dose,,A9510,HCPCS,Facility,Inpatient,,,,179,152.15,51.3014,179,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Sup Tc99M Disofenin Per Dose,,A9510,HCPCS,Facility,Both,,,,179,152.15,51.3014,179,Medica,Individual & Family,177.389,99.1,,percent of total billed charges,,
Sup Tc99M Disofenin Per Dose,,A9510,HCPCS,Facility,Outpatient,,,,179,152.15,51.3014,179,Medica,Medica Advantage Solution,89.142,49.8,,percent of total billed charges,,
Sup Tc99M Disofenin Per Dose,,A9510,HCPCS,Facility,Inpatient,,,,179,152.15,51.3014,179,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Sup Tc99M Disofenin Per Dose,,A9510,HCPCS,Facility,Outpatient,,,,179,152.15,51.3014,179,Medica,Medical Assistance,79.834,44.6,,percent of total billed charges,,
Sup Tc99M Disofenin Per Dose,,A9510,HCPCS,Facility,Inpatient,,,,179,152.15,51.3014,179,Medica,Medical Assistance,,,,,Included in per diem rate,
Sup Tc99M Disofenin Per Dose,,A9510,HCPCS,Facility,Outpatient,,,,179,152.15,51.3014,179,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,89.142,49.8,,percent of total billed charges,,
Sup Tc99M Disofenin Per Dose,,A9510,HCPCS,Facility,Inpatient,,,,179,152.15,51.3014,179,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Sup Tc99M Disofenin Per Dose,,A9510,HCPCS,Facility,Both,,,,179,152.15,51.3014,179,"Multiplan, Inc.","Multiplan, Inc.",168.26,94,,percent of total billed charges,,
Sup Tc99M Disofenin Per Dose,,A9510,HCPCS,Facility,Outpatient,,,,179,152.15,51.3014,179,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,161.279,90.1,,percent of total billed charges,,
Sup Tc99M Disofenin Per Dose,,A9510,HCPCS,Facility,Inpatient,,,,179,152.15,51.3014,179,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Sup Tc99M Disofenin Per Dose,,A9510,HCPCS,Facility,Both,,,,179,152.15,51.3014,179,"Preferred One Administrative Services, INC.",PPO,176.494,98.6,,percent of total billed charges,,
Sup Tc99M Disofenin Per Dose,,A9510,HCPCS,Facility,Outpatient,,,,179,152.15,51.3014,179,PrimeWest Health,Minnesota Senior Health Options (MSHO),92.0955,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Sup Tc99M Disofenin Per Dose,,A9510,HCPCS,Facility,Inpatient,,,,179,152.15,51.3014,179,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Tc99M Disofenin Per Dose,,A9510,HCPCS,Facility,Outpatient,,,,179,152.15,51.3014,179,PrimeWest Health,MinnesotaCare,91.9344,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Sup Tc99M Disofenin Per Dose,,A9510,HCPCS,Facility,Inpatient,,,,179,152.15,51.3014,179,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Sup Tc99M Disofenin Per Dose,,A9510,HCPCS,Facility,Both,,,,179,152.15,51.3014,179,Sanford Health Plan,Sanford Health Plan,164.68,92,,percent of total billed charges,,
Sup Tc99M Disofenin Per Dose,,A9510,HCPCS,Facility,Outpatient,,,,179,152.15,51.3014,179,"UCare Health, Inc.",Individual & Family Plan,100.8665,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Sup Tc99M Disofenin Per Dose,,A9510,HCPCS,Facility,Inpatient,,,,179,152.15,51.3014,179,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Sup Tc99M Disofenin Per Dose,,A9510,HCPCS,Facility,Outpatient,,,,179,152.15,51.3014,179,"UCare Health, Inc.",Medical Assistance,90.3413,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Tc99M Disofenin Per Dose,,A9510,HCPCS,Facility,Inpatient,,,,179,152.15,51.3014,179,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Sup Tc99M Disofenin Per Dose,,A9510,HCPCS,Facility,Outpatient,,,,179,152.15,51.3014,179,"UCare Health, Inc.",Medicare Advantage,90.3413,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Tc99M Disofenin Per Dose,,A9510,HCPCS,Facility,Inpatient,,,,179,152.15,51.3014,179,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Tc99M Disofenin Per Dose,,A9510,HCPCS,Facility,Outpatient,,,,179,152.15,51.3014,179,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),90.3413,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Tc99M Disofenin Per Dose,,A9510,HCPCS,Facility,Inpatient,,,,179,152.15,51.3014,179,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Tc99M Disofenin Per Dose,,A9510,HCPCS,Facility,Both,,,,179,152.15,51.3014,179,UnitedHealthcare,Individual & Family,168.26,94,,percent of total billed charges,,
Sup Tc99M Disofenin Per Dose,,A9510,HCPCS,Facility,Outpatient,,,,179,152.15,51.3014,179,UnitedHealthcare,Medicare Advantage,87.71,49,,percent of total billed charges,,
Sup Tc99M Disofenin Per Dose,,A9510,HCPCS,Facility,Inpatient,,,,179,152.15,51.3014,179,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Sup Tc99M Disofenin Per Dose,,A9510,HCPCS,Facility,Outpatient,,,,179,152.15,51.3014,179,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,85.92,48,,percent of total billed charges,,100% of DHS outpatient percentage
Sup Tc99M Disofenin Per Dose,,A9510,HCPCS,Facility,Inpatient,,,,179,152.15,51.3014,179,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Sup Tc99M Sodium Pertechnate Per Mci,,A9512,HCPCS,Facility,Both,,,,9,7.65,2.5794,9,Aetna,Commercial,8.28,92,,percent of total billed charges,,
Sup Tc99M Sodium Pertechnate Per Mci,,A9512,HCPCS,Facility,Outpatient,,,,9,7.65,2.5794,9,Aetna,Medicare Advantage,4.41,49,,percent of total billed charges,,
Sup Tc99M Sodium Pertechnate Per Mci,,A9512,HCPCS,Facility,Inpatient,,,,9,7.65,2.5794,9,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Sup Tc99M Sodium Pertechnate Per Mci,,A9512,HCPCS,Facility,Both,,,,9,7.65,2.5794,9,Aetna,PPO,8.37,93,,percent of total billed charges,,
Sup Tc99M Sodium Pertechnate Per Mci,,A9512,HCPCS,Facility,Both,,,,9,7.65,2.5794,9,America's PPO,America's PPO,8.6427,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Sup Tc99M Sodium Pertechnate Per Mci,,A9512,HCPCS,Facility,Both,,,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota, Federal Employee Program,8.856,98.4,,percent of total billed charges,,
Sup Tc99M Sodium Pertechnate Per Mci,,A9512,HCPCS,Facility,Both,,,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,9,100,,percent of total billed charges,,
Sup Tc99M Sodium Pertechnate Per Mci,,A9512,HCPCS,Facility,Both,,,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota,High Value Network Plan,8.1,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
Sup Tc99M Sodium Pertechnate Per Mci,,A9512,HCPCS,Facility,Outpatient,,,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota,Medicare Advantage,4.41,49,,percent of total billed charges,,
Sup Tc99M Sodium Pertechnate Per Mci,,A9512,HCPCS,Facility,Inpatient,,,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Sup Tc99M Sodium Pertechnate Per Mci,,A9512,HCPCS,Facility,Both,,,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,7.9713,88.57,,percent of total billed charges,,
Sup Tc99M Sodium Pertechnate Per Mci,,A9512,HCPCS,Facility,Both,,,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,2.5794,28.66,,percent of total billed charges,,
Sup Tc99M Sodium Pertechnate Per Mci,,A9512,HCPCS,Facility,Outpatient,,,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),4.41,49,,percent of total billed charges,,
Sup Tc99M Sodium Pertechnate Per Mci,,A9512,HCPCS,Facility,Inpatient,,,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Sup Tc99M Sodium Pertechnate Per Mci,,A9512,HCPCS,Facility,Both,,,,9,7.65,2.5794,9,CorVel,Worker's Compensation,9,100,,percent of total billed charges,,
Sup Tc99M Sodium Pertechnate Per Mci,,A9512,HCPCS,Facility,Both,,,,9,7.65,2.5794,9,First Health Group Corporation,First Health Network,8.73,97,,percent of total billed charges,,
Sup Tc99M Sodium Pertechnate Per Mci,,A9512,HCPCS,Facility,Both,,,,9,7.65,2.5794,9,"Health Partners, Inc.",Commercial,8.514,94.6,,percent of total billed charges,,
Sup Tc99M Sodium Pertechnate Per Mci,,A9512,HCPCS,Facility,Outpatient,,,,9,7.65,2.5794,9,"Health Partners, Inc.",Medicare Advantage,4.41,49,,percent of total billed charges,,
Sup Tc99M Sodium Pertechnate Per Mci,,A9512,HCPCS,Facility,Inpatient,,,,9,7.65,2.5794,9,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Tc99M Sodium Pertechnate Per Mci,,A9512,HCPCS,Facility,Both,,,,9,7.65,2.5794,9,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),5.4,60,,percent of total billed charges,,
Sup Tc99M Sodium Pertechnate Per Mci,,A9512,HCPCS,Facility,Both,,,,9,7.65,2.5794,9,"Health Partners, Inc.",State of Minnesota Advantage Program,7.335,81.5,,percent of total billed charges,,
Sup Tc99M Sodium Pertechnate Per Mci,,A9512,HCPCS,Facility,Both,,,,9,7.65,2.5794,9,"Health Partners, Inc.",State Public Programs,4.5,50,,percent of total billed charges,,
Sup Tc99M Sodium Pertechnate Per Mci,,A9512,HCPCS,Facility,Both,,,,9,7.65,2.5794,9,Humana Insurance Company,Commercial PPO,8.55,95,,percent of total billed charges,,
Sup Tc99M Sodium Pertechnate Per Mci,,A9512,HCPCS,Facility,Outpatient,,,,9,7.65,2.5794,9,Humana Insurance Company,Medicare PPO,4.41,49,,percent of total billed charges,,
Sup Tc99M Sodium Pertechnate Per Mci,,A9512,HCPCS,Facility,Inpatient,,,,9,7.65,2.5794,9,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Sup Tc99M Sodium Pertechnate Per Mci,,A9512,HCPCS,Facility,Both,,,,9,7.65,2.5794,9,Medica,Individual & Family,8.919,99.1,,percent of total billed charges,,
Sup Tc99M Sodium Pertechnate Per Mci,,A9512,HCPCS,Facility,Outpatient,,,,9,7.65,2.5794,9,Medica,Medica Advantage Solution,4.482,49.8,,percent of total billed charges,,
Sup Tc99M Sodium Pertechnate Per Mci,,A9512,HCPCS,Facility,Inpatient,,,,9,7.65,2.5794,9,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Sup Tc99M Sodium Pertechnate Per Mci,,A9512,HCPCS,Facility,Outpatient,,,,9,7.65,2.5794,9,Medica,Medical Assistance,4.014,44.6,,percent of total billed charges,,
Sup Tc99M Sodium Pertechnate Per Mci,,A9512,HCPCS,Facility,Inpatient,,,,9,7.65,2.5794,9,Medica,Medical Assistance,,,,,Included in per diem rate,
Sup Tc99M Sodium Pertechnate Per Mci,,A9512,HCPCS,Facility,Outpatient,,,,9,7.65,2.5794,9,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,4.482,49.8,,percent of total billed charges,,
Sup Tc99M Sodium Pertechnate Per Mci,,A9512,HCPCS,Facility,Inpatient,,,,9,7.65,2.5794,9,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Sup Tc99M Sodium Pertechnate Per Mci,,A9512,HCPCS,Facility,Both,,,,9,7.65,2.5794,9,"Multiplan, Inc.","Multiplan, Inc.",8.46,94,,percent of total billed charges,,
Sup Tc99M Sodium Pertechnate Per Mci,,A9512,HCPCS,Facility,Outpatient,,,,9,7.65,2.5794,9,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,8.109,90.1,,percent of total billed charges,,
Sup Tc99M Sodium Pertechnate Per Mci,,A9512,HCPCS,Facility,Inpatient,,,,9,7.65,2.5794,9,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Sup Tc99M Sodium Pertechnate Per Mci,,A9512,HCPCS,Facility,Both,,,,9,7.65,2.5794,9,"Preferred One Administrative Services, INC.",PPO,8.874,98.6,,percent of total billed charges,,
Sup Tc99M Sodium Pertechnate Per Mci,,A9512,HCPCS,Facility,Outpatient,,,,9,7.65,2.5794,9,PrimeWest Health,Minnesota Senior Health Options (MSHO),4.6305,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Sup Tc99M Sodium Pertechnate Per Mci,,A9512,HCPCS,Facility,Inpatient,,,,9,7.65,2.5794,9,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Tc99M Sodium Pertechnate Per Mci,,A9512,HCPCS,Facility,Outpatient,,,,9,7.65,2.5794,9,PrimeWest Health,MinnesotaCare,4.6224,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Sup Tc99M Sodium Pertechnate Per Mci,,A9512,HCPCS,Facility,Inpatient,,,,9,7.65,2.5794,9,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Sup Tc99M Sodium Pertechnate Per Mci,,A9512,HCPCS,Facility,Both,,,,9,7.65,2.5794,9,Sanford Health Plan,Sanford Health Plan,8.28,92,,percent of total billed charges,,
Sup Tc99M Sodium Pertechnate Per Mci,,A9512,HCPCS,Facility,Outpatient,,,,9,7.65,2.5794,9,"UCare Health, Inc.",Individual & Family Plan,5.0715,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Sup Tc99M Sodium Pertechnate Per Mci,,A9512,HCPCS,Facility,Inpatient,,,,9,7.65,2.5794,9,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Sup Tc99M Sodium Pertechnate Per Mci,,A9512,HCPCS,Facility,Outpatient,,,,9,7.65,2.5794,9,"UCare Health, Inc.",Medical Assistance,4.5423,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Tc99M Sodium Pertechnate Per Mci,,A9512,HCPCS,Facility,Inpatient,,,,9,7.65,2.5794,9,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Sup Tc99M Sodium Pertechnate Per Mci,,A9512,HCPCS,Facility,Outpatient,,,,9,7.65,2.5794,9,"UCare Health, Inc.",Medicare Advantage,4.5423,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Tc99M Sodium Pertechnate Per Mci,,A9512,HCPCS,Facility,Inpatient,,,,9,7.65,2.5794,9,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Tc99M Sodium Pertechnate Per Mci,,A9512,HCPCS,Facility,Outpatient,,,,9,7.65,2.5794,9,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),4.5423,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Tc99M Sodium Pertechnate Per Mci,,A9512,HCPCS,Facility,Inpatient,,,,9,7.65,2.5794,9,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Tc99M Sodium Pertechnate Per Mci,,A9512,HCPCS,Facility,Both,,,,9,7.65,2.5794,9,UnitedHealthcare,Individual & Family,8.46,94,,percent of total billed charges,,
Sup Tc99M Sodium Pertechnate Per Mci,,A9512,HCPCS,Facility,Outpatient,,,,9,7.65,2.5794,9,UnitedHealthcare,Medicare Advantage,4.41,49,,percent of total billed charges,,
Sup Tc99M Sodium Pertechnate Per Mci,,A9512,HCPCS,Facility,Inpatient,,,,9,7.65,2.5794,9,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Sup Tc99M Sodium Pertechnate Per Mci,,A9512,HCPCS,Facility,Outpatient,,,,9,7.65,2.5794,9,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,4.32,48,,percent of total billed charges,,100% of DHS outpatient percentage
Sup Tc99M Sodium Pertechnate Per Mci,,A9512,HCPCS,Facility,Inpatient,,,,9,7.65,2.5794,9,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Sup I-123 Capsule Per 100 Uci,,A9516,HCPCS,Facility,Both,,,,184,156.4,52.7344,184,Aetna,Commercial,169.28,92,,percent of total billed charges,,
Sup I-123 Capsule Per 100 Uci,,A9516,HCPCS,Facility,Outpatient,,,,184,156.4,52.7344,184,Aetna,Medicare Advantage,90.16,49,,percent of total billed charges,,
Sup I-123 Capsule Per 100 Uci,,A9516,HCPCS,Facility,Inpatient,,,,184,156.4,52.7344,184,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Sup I-123 Capsule Per 100 Uci,,A9516,HCPCS,Facility,Both,,,,184,156.4,52.7344,184,Aetna,PPO,171.12,93,,percent of total billed charges,,
Sup I-123 Capsule Per 100 Uci,,A9516,HCPCS,Facility,Both,,,,184,156.4,52.7344,184,America's PPO,America's PPO,176.6952,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Sup I-123 Capsule Per 100 Uci,,A9516,HCPCS,Facility,Both,,,,184,156.4,52.7344,184,BlueCross BlueShield Minnesota, Federal Employee Program,181.056,98.4,,percent of total billed charges,,
Sup I-123 Capsule Per 100 Uci,,A9516,HCPCS,Facility,Both,,,,184,156.4,52.7344,184,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,184,100,,percent of total billed charges,,
Sup I-123 Capsule Per 100 Uci,,A9516,HCPCS,Facility,Both,,,,184,156.4,52.7344,184,BlueCross BlueShield Minnesota,High Value Network Plan,165.6,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
Sup I-123 Capsule Per 100 Uci,,A9516,HCPCS,Facility,Outpatient,,,,184,156.4,52.7344,184,BlueCross BlueShield Minnesota,Medicare Advantage,90.16,49,,percent of total billed charges,,
Sup I-123 Capsule Per 100 Uci,,A9516,HCPCS,Facility,Inpatient,,,,184,156.4,52.7344,184,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Sup I-123 Capsule Per 100 Uci,,A9516,HCPCS,Facility,Both,,,,184,156.4,52.7344,184,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,162.9688,88.57,,percent of total billed charges,,
Sup I-123 Capsule Per 100 Uci,,A9516,HCPCS,Facility,Both,,,,184,156.4,52.7344,184,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,52.7344,28.66,,percent of total billed charges,,
Sup I-123 Capsule Per 100 Uci,,A9516,HCPCS,Facility,Outpatient,,,,184,156.4,52.7344,184,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),90.16,49,,percent of total billed charges,,
Sup I-123 Capsule Per 100 Uci,,A9516,HCPCS,Facility,Inpatient,,,,184,156.4,52.7344,184,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Sup I-123 Capsule Per 100 Uci,,A9516,HCPCS,Facility,Both,,,,184,156.4,52.7344,184,CorVel,Worker's Compensation,184,100,,percent of total billed charges,,
Sup I-123 Capsule Per 100 Uci,,A9516,HCPCS,Facility,Both,,,,184,156.4,52.7344,184,First Health Group Corporation,First Health Network,178.48,97,,percent of total billed charges,,
Sup I-123 Capsule Per 100 Uci,,A9516,HCPCS,Facility,Both,,,,184,156.4,52.7344,184,"Health Partners, Inc.",Commercial,174.064,94.6,,percent of total billed charges,,
Sup I-123 Capsule Per 100 Uci,,A9516,HCPCS,Facility,Outpatient,,,,184,156.4,52.7344,184,"Health Partners, Inc.",Medicare Advantage,90.16,49,,percent of total billed charges,,
Sup I-123 Capsule Per 100 Uci,,A9516,HCPCS,Facility,Inpatient,,,,184,156.4,52.7344,184,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup I-123 Capsule Per 100 Uci,,A9516,HCPCS,Facility,Both,,,,184,156.4,52.7344,184,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),110.4,60,,percent of total billed charges,,
Sup I-123 Capsule Per 100 Uci,,A9516,HCPCS,Facility,Both,,,,184,156.4,52.7344,184,"Health Partners, Inc.",State of Minnesota Advantage Program,149.96,81.5,,percent of total billed charges,,
Sup I-123 Capsule Per 100 Uci,,A9516,HCPCS,Facility,Both,,,,184,156.4,52.7344,184,"Health Partners, Inc.",State Public Programs,92,50,,percent of total billed charges,,
Sup I-123 Capsule Per 100 Uci,,A9516,HCPCS,Facility,Both,,,,184,156.4,52.7344,184,Humana Insurance Company,Commercial PPO,174.8,95,,percent of total billed charges,,
Sup I-123 Capsule Per 100 Uci,,A9516,HCPCS,Facility,Outpatient,,,,184,156.4,52.7344,184,Humana Insurance Company,Medicare PPO,90.16,49,,percent of total billed charges,,
Sup I-123 Capsule Per 100 Uci,,A9516,HCPCS,Facility,Inpatient,,,,184,156.4,52.7344,184,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Sup I-123 Capsule Per 100 Uci,,A9516,HCPCS,Facility,Both,,,,184,156.4,52.7344,184,Medica,Individual & Family,182.344,99.1,,percent of total billed charges,,
Sup I-123 Capsule Per 100 Uci,,A9516,HCPCS,Facility,Outpatient,,,,184,156.4,52.7344,184,Medica,Medica Advantage Solution,91.632,49.8,,percent of total billed charges,,
Sup I-123 Capsule Per 100 Uci,,A9516,HCPCS,Facility,Inpatient,,,,184,156.4,52.7344,184,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Sup I-123 Capsule Per 100 Uci,,A9516,HCPCS,Facility,Outpatient,,,,184,156.4,52.7344,184,Medica,Medical Assistance,82.064,44.6,,percent of total billed charges,,
Sup I-123 Capsule Per 100 Uci,,A9516,HCPCS,Facility,Inpatient,,,,184,156.4,52.7344,184,Medica,Medical Assistance,,,,,Included in per diem rate,
Sup I-123 Capsule Per 100 Uci,,A9516,HCPCS,Facility,Outpatient,,,,184,156.4,52.7344,184,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,91.632,49.8,,percent of total billed charges,,
Sup I-123 Capsule Per 100 Uci,,A9516,HCPCS,Facility,Inpatient,,,,184,156.4,52.7344,184,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Sup I-123 Capsule Per 100 Uci,,A9516,HCPCS,Facility,Both,,,,184,156.4,52.7344,184,"Multiplan, Inc.","Multiplan, Inc.",172.96,94,,percent of total billed charges,,
Sup I-123 Capsule Per 100 Uci,,A9516,HCPCS,Facility,Outpatient,,,,184,156.4,52.7344,184,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,165.784,90.1,,percent of total billed charges,,
Sup I-123 Capsule Per 100 Uci,,A9516,HCPCS,Facility,Inpatient,,,,184,156.4,52.7344,184,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Sup I-123 Capsule Per 100 Uci,,A9516,HCPCS,Facility,Both,,,,184,156.4,52.7344,184,"Preferred One Administrative Services, INC.",PPO,181.424,98.6,,percent of total billed charges,,
Sup I-123 Capsule Per 100 Uci,,A9516,HCPCS,Facility,Outpatient,,,,184,156.4,52.7344,184,PrimeWest Health,Minnesota Senior Health Options (MSHO),94.668,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Sup I-123 Capsule Per 100 Uci,,A9516,HCPCS,Facility,Inpatient,,,,184,156.4,52.7344,184,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup I-123 Capsule Per 100 Uci,,A9516,HCPCS,Facility,Outpatient,,,,184,156.4,52.7344,184,PrimeWest Health,MinnesotaCare,94.5024,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Sup I-123 Capsule Per 100 Uci,,A9516,HCPCS,Facility,Inpatient,,,,184,156.4,52.7344,184,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Sup I-123 Capsule Per 100 Uci,,A9516,HCPCS,Facility,Both,,,,184,156.4,52.7344,184,Sanford Health Plan,Sanford Health Plan,169.28,92,,percent of total billed charges,,
Sup I-123 Capsule Per 100 Uci,,A9516,HCPCS,Facility,Outpatient,,,,184,156.4,52.7344,184,"UCare Health, Inc.",Individual & Family Plan,103.684,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Sup I-123 Capsule Per 100 Uci,,A9516,HCPCS,Facility,Inpatient,,,,184,156.4,52.7344,184,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Sup I-123 Capsule Per 100 Uci,,A9516,HCPCS,Facility,Outpatient,,,,184,156.4,52.7344,184,"UCare Health, Inc.",Medical Assistance,92.8648,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup I-123 Capsule Per 100 Uci,,A9516,HCPCS,Facility,Inpatient,,,,184,156.4,52.7344,184,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Sup I-123 Capsule Per 100 Uci,,A9516,HCPCS,Facility,Outpatient,,,,184,156.4,52.7344,184,"UCare Health, Inc.",Medicare Advantage,92.8648,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup I-123 Capsule Per 100 Uci,,A9516,HCPCS,Facility,Inpatient,,,,184,156.4,52.7344,184,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup I-123 Capsule Per 100 Uci,,A9516,HCPCS,Facility,Outpatient,,,,184,156.4,52.7344,184,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),92.8648,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup I-123 Capsule Per 100 Uci,,A9516,HCPCS,Facility,Inpatient,,,,184,156.4,52.7344,184,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup I-123 Capsule Per 100 Uci,,A9516,HCPCS,Facility,Both,,,,184,156.4,52.7344,184,UnitedHealthcare,Individual & Family,172.96,94,,percent of total billed charges,,
Sup I-123 Capsule Per 100 Uci,,A9516,HCPCS,Facility,Outpatient,,,,184,156.4,52.7344,184,UnitedHealthcare,Medicare Advantage,90.16,49,,percent of total billed charges,,
Sup I-123 Capsule Per 100 Uci,,A9516,HCPCS,Facility,Inpatient,,,,184,156.4,52.7344,184,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Sup I-123 Capsule Per 100 Uci,,A9516,HCPCS,Facility,Outpatient,,,,184,156.4,52.7344,184,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,88.32,48,,percent of total billed charges,,100% of DHS outpatient percentage
Sup I-123 Capsule Per 100 Uci,,A9516,HCPCS,Facility,Inpatient,,,,184,156.4,52.7344,184,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Sup Tc99M Choletec Per Dose,,A9537,HCPCS,Facility,Both,,,,228,193.8,65.3448,228,Aetna,Commercial,209.76,92,,percent of total billed charges,,
Sup Tc99M Choletec Per Dose,,A9537,HCPCS,Facility,Outpatient,,,,228,193.8,65.3448,228,Aetna,Medicare Advantage,111.72,49,,percent of total billed charges,,
Sup Tc99M Choletec Per Dose,,A9537,HCPCS,Facility,Inpatient,,,,228,193.8,65.3448,228,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Sup Tc99M Choletec Per Dose,,A9537,HCPCS,Facility,Both,,,,228,193.8,65.3448,228,Aetna,PPO,212.04,93,,percent of total billed charges,,
Sup Tc99M Choletec Per Dose,,A9537,HCPCS,Facility,Both,,,,228,193.8,65.3448,228,America's PPO,America's PPO,218.9484,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Sup Tc99M Choletec Per Dose,,A9537,HCPCS,Facility,Both,,,,228,193.8,65.3448,228,BlueCross BlueShield Minnesota, Federal Employee Program,224.352,98.4,,percent of total billed charges,,
Sup Tc99M Choletec Per Dose,,A9537,HCPCS,Facility,Both,,,,228,193.8,65.3448,228,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,228,100,,percent of total billed charges,,
Sup Tc99M Choletec Per Dose,,A9537,HCPCS,Facility,Both,,,,228,193.8,65.3448,228,BlueCross BlueShield Minnesota,High Value Network Plan,205.2,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
Sup Tc99M Choletec Per Dose,,A9537,HCPCS,Facility,Outpatient,,,,228,193.8,65.3448,228,BlueCross BlueShield Minnesota,Medicare Advantage,111.72,49,,percent of total billed charges,,
Sup Tc99M Choletec Per Dose,,A9537,HCPCS,Facility,Inpatient,,,,228,193.8,65.3448,228,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Sup Tc99M Choletec Per Dose,,A9537,HCPCS,Facility,Both,,,,228,193.8,65.3448,228,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,201.9396,88.57,,percent of total billed charges,,
Sup Tc99M Choletec Per Dose,,A9537,HCPCS,Facility,Both,,,,228,193.8,65.3448,228,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,65.3448,28.66,,percent of total billed charges,,
Sup Tc99M Choletec Per Dose,,A9537,HCPCS,Facility,Outpatient,,,,228,193.8,65.3448,228,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),111.72,49,,percent of total billed charges,,
Sup Tc99M Choletec Per Dose,,A9537,HCPCS,Facility,Inpatient,,,,228,193.8,65.3448,228,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Sup Tc99M Choletec Per Dose,,A9537,HCPCS,Facility,Both,,,,228,193.8,65.3448,228,CorVel,Worker's Compensation,228,100,,percent of total billed charges,,
Sup Tc99M Choletec Per Dose,,A9537,HCPCS,Facility,Both,,,,228,193.8,65.3448,228,First Health Group Corporation,First Health Network,221.16,97,,percent of total billed charges,,
Sup Tc99M Choletec Per Dose,,A9537,HCPCS,Facility,Both,,,,228,193.8,65.3448,228,"Health Partners, Inc.",Commercial,215.688,94.6,,percent of total billed charges,,
Sup Tc99M Choletec Per Dose,,A9537,HCPCS,Facility,Outpatient,,,,228,193.8,65.3448,228,"Health Partners, Inc.",Medicare Advantage,111.72,49,,percent of total billed charges,,
Sup Tc99M Choletec Per Dose,,A9537,HCPCS,Facility,Inpatient,,,,228,193.8,65.3448,228,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Tc99M Choletec Per Dose,,A9537,HCPCS,Facility,Both,,,,228,193.8,65.3448,228,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),136.8,60,,percent of total billed charges,,
Sup Tc99M Choletec Per Dose,,A9537,HCPCS,Facility,Both,,,,228,193.8,65.3448,228,"Health Partners, Inc.",State of Minnesota Advantage Program,185.82,81.5,,percent of total billed charges,,
Sup Tc99M Choletec Per Dose,,A9537,HCPCS,Facility,Both,,,,228,193.8,65.3448,228,"Health Partners, Inc.",State Public Programs,114,50,,percent of total billed charges,,
Sup Tc99M Choletec Per Dose,,A9537,HCPCS,Facility,Both,,,,228,193.8,65.3448,228,Humana Insurance Company,Commercial PPO,216.6,95,,percent of total billed charges,,
Sup Tc99M Choletec Per Dose,,A9537,HCPCS,Facility,Outpatient,,,,228,193.8,65.3448,228,Humana Insurance Company,Medicare PPO,111.72,49,,percent of total billed charges,,
Sup Tc99M Choletec Per Dose,,A9537,HCPCS,Facility,Inpatient,,,,228,193.8,65.3448,228,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Sup Tc99M Choletec Per Dose,,A9537,HCPCS,Facility,Both,,,,228,193.8,65.3448,228,Medica,Individual & Family,225.948,99.1,,percent of total billed charges,,
Sup Tc99M Choletec Per Dose,,A9537,HCPCS,Facility,Outpatient,,,,228,193.8,65.3448,228,Medica,Medica Advantage Solution,113.544,49.8,,percent of total billed charges,,
Sup Tc99M Choletec Per Dose,,A9537,HCPCS,Facility,Inpatient,,,,228,193.8,65.3448,228,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Sup Tc99M Choletec Per Dose,,A9537,HCPCS,Facility,Outpatient,,,,228,193.8,65.3448,228,Medica,Medical Assistance,101.688,44.6,,percent of total billed charges,,
Sup Tc99M Choletec Per Dose,,A9537,HCPCS,Facility,Inpatient,,,,228,193.8,65.3448,228,Medica,Medical Assistance,,,,,Included in per diem rate,
Sup Tc99M Choletec Per Dose,,A9537,HCPCS,Facility,Outpatient,,,,228,193.8,65.3448,228,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,113.544,49.8,,percent of total billed charges,,
Sup Tc99M Choletec Per Dose,,A9537,HCPCS,Facility,Inpatient,,,,228,193.8,65.3448,228,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Sup Tc99M Choletec Per Dose,,A9537,HCPCS,Facility,Both,,,,228,193.8,65.3448,228,"Multiplan, Inc.","Multiplan, Inc.",214.32,94,,percent of total billed charges,,
Sup Tc99M Choletec Per Dose,,A9537,HCPCS,Facility,Outpatient,,,,228,193.8,65.3448,228,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,205.428,90.1,,percent of total billed charges,,
Sup Tc99M Choletec Per Dose,,A9537,HCPCS,Facility,Inpatient,,,,228,193.8,65.3448,228,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Sup Tc99M Choletec Per Dose,,A9537,HCPCS,Facility,Both,,,,228,193.8,65.3448,228,"Preferred One Administrative Services, INC.",PPO,224.808,98.6,,percent of total billed charges,,
Sup Tc99M Choletec Per Dose,,A9537,HCPCS,Facility,Outpatient,,,,228,193.8,65.3448,228,PrimeWest Health,Minnesota Senior Health Options (MSHO),117.306,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Sup Tc99M Choletec Per Dose,,A9537,HCPCS,Facility,Inpatient,,,,228,193.8,65.3448,228,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Tc99M Choletec Per Dose,,A9537,HCPCS,Facility,Outpatient,,,,228,193.8,65.3448,228,PrimeWest Health,MinnesotaCare,117.1008,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Sup Tc99M Choletec Per Dose,,A9537,HCPCS,Facility,Inpatient,,,,228,193.8,65.3448,228,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Sup Tc99M Choletec Per Dose,,A9537,HCPCS,Facility,Both,,,,228,193.8,65.3448,228,Sanford Health Plan,Sanford Health Plan,209.76,92,,percent of total billed charges,,
Sup Tc99M Choletec Per Dose,,A9537,HCPCS,Facility,Outpatient,,,,228,193.8,65.3448,228,"UCare Health, Inc.",Individual & Family Plan,128.478,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Sup Tc99M Choletec Per Dose,,A9537,HCPCS,Facility,Inpatient,,,,228,193.8,65.3448,228,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Sup Tc99M Choletec Per Dose,,A9537,HCPCS,Facility,Outpatient,,,,228,193.8,65.3448,228,"UCare Health, Inc.",Medical Assistance,115.0716,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Tc99M Choletec Per Dose,,A9537,HCPCS,Facility,Inpatient,,,,228,193.8,65.3448,228,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Sup Tc99M Choletec Per Dose,,A9537,HCPCS,Facility,Outpatient,,,,228,193.8,65.3448,228,"UCare Health, Inc.",Medicare Advantage,115.0716,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Tc99M Choletec Per Dose,,A9537,HCPCS,Facility,Inpatient,,,,228,193.8,65.3448,228,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Tc99M Choletec Per Dose,,A9537,HCPCS,Facility,Outpatient,,,,228,193.8,65.3448,228,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),115.0716,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Tc99M Choletec Per Dose,,A9537,HCPCS,Facility,Inpatient,,,,228,193.8,65.3448,228,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Tc99M Choletec Per Dose,,A9537,HCPCS,Facility,Both,,,,228,193.8,65.3448,228,UnitedHealthcare,Individual & Family,214.32,94,,percent of total billed charges,,
Sup Tc99M Choletec Per Dose,,A9537,HCPCS,Facility,Outpatient,,,,228,193.8,65.3448,228,UnitedHealthcare,Medicare Advantage,111.72,49,,percent of total billed charges,,
Sup Tc99M Choletec Per Dose,,A9537,HCPCS,Facility,Inpatient,,,,228,193.8,65.3448,228,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Sup Tc99M Choletec Per Dose,,A9537,HCPCS,Facility,Outpatient,,,,228,193.8,65.3448,228,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,109.44,48,,percent of total billed charges,,100% of DHS outpatient percentage
Sup Tc99M Choletec Per Dose,,A9537,HCPCS,Facility,Inpatient,,,,228,193.8,65.3448,228,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Sup Tc99M Dtpa Diagnostic Per Dose,,A9539,HCPCS,Facility,Both,,,,122,103.7,34.9652,122,Aetna,Commercial,112.24,92,,percent of total billed charges,,
Sup Tc99M Dtpa Diagnostic Per Dose,,A9539,HCPCS,Facility,Outpatient,,,,122,103.7,34.9652,122,Aetna,Medicare Advantage,59.78,49,,percent of total billed charges,,
Sup Tc99M Dtpa Diagnostic Per Dose,,A9539,HCPCS,Facility,Inpatient,,,,122,103.7,34.9652,122,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Sup Tc99M Dtpa Diagnostic Per Dose,,A9539,HCPCS,Facility,Both,,,,122,103.7,34.9652,122,Aetna,PPO,113.46,93,,percent of total billed charges,,
Sup Tc99M Dtpa Diagnostic Per Dose,,A9539,HCPCS,Facility,Both,,,,122,103.7,34.9652,122,America's PPO,America's PPO,117.1566,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Sup Tc99M Dtpa Diagnostic Per Dose,,A9539,HCPCS,Facility,Both,,,,122,103.7,34.9652,122,BlueCross BlueShield Minnesota, Federal Employee Program,120.048,98.4,,percent of total billed charges,,
Sup Tc99M Dtpa Diagnostic Per Dose,,A9539,HCPCS,Facility,Both,,,,122,103.7,34.9652,122,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,122,100,,percent of total billed charges,,
Sup Tc99M Dtpa Diagnostic Per Dose,,A9539,HCPCS,Facility,Both,,,,122,103.7,34.9652,122,BlueCross BlueShield Minnesota,High Value Network Plan,109.8,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
Sup Tc99M Dtpa Diagnostic Per Dose,,A9539,HCPCS,Facility,Outpatient,,,,122,103.7,34.9652,122,BlueCross BlueShield Minnesota,Medicare Advantage,59.78,49,,percent of total billed charges,,
Sup Tc99M Dtpa Diagnostic Per Dose,,A9539,HCPCS,Facility,Inpatient,,,,122,103.7,34.9652,122,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Sup Tc99M Dtpa Diagnostic Per Dose,,A9539,HCPCS,Facility,Both,,,,122,103.7,34.9652,122,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,108.0554,88.57,,percent of total billed charges,,
Sup Tc99M Dtpa Diagnostic Per Dose,,A9539,HCPCS,Facility,Both,,,,122,103.7,34.9652,122,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,34.9652,28.66,,percent of total billed charges,,
Sup Tc99M Dtpa Diagnostic Per Dose,,A9539,HCPCS,Facility,Outpatient,,,,122,103.7,34.9652,122,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),59.78,49,,percent of total billed charges,,
Sup Tc99M Dtpa Diagnostic Per Dose,,A9539,HCPCS,Facility,Inpatient,,,,122,103.7,34.9652,122,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Sup Tc99M Dtpa Diagnostic Per Dose,,A9539,HCPCS,Facility,Both,,,,122,103.7,34.9652,122,CorVel,Worker's Compensation,122,100,,percent of total billed charges,,
Sup Tc99M Dtpa Diagnostic Per Dose,,A9539,HCPCS,Facility,Both,,,,122,103.7,34.9652,122,First Health Group Corporation,First Health Network,118.34,97,,percent of total billed charges,,
Sup Tc99M Dtpa Diagnostic Per Dose,,A9539,HCPCS,Facility,Both,,,,122,103.7,34.9652,122,"Health Partners, Inc.",Commercial,115.412,94.6,,percent of total billed charges,,
Sup Tc99M Dtpa Diagnostic Per Dose,,A9539,HCPCS,Facility,Outpatient,,,,122,103.7,34.9652,122,"Health Partners, Inc.",Medicare Advantage,59.78,49,,percent of total billed charges,,
Sup Tc99M Dtpa Diagnostic Per Dose,,A9539,HCPCS,Facility,Inpatient,,,,122,103.7,34.9652,122,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Tc99M Dtpa Diagnostic Per Dose,,A9539,HCPCS,Facility,Both,,,,122,103.7,34.9652,122,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),73.2,60,,percent of total billed charges,,
Sup Tc99M Dtpa Diagnostic Per Dose,,A9539,HCPCS,Facility,Both,,,,122,103.7,34.9652,122,"Health Partners, Inc.",State of Minnesota Advantage Program,99.43,81.5,,percent of total billed charges,,
Sup Tc99M Dtpa Diagnostic Per Dose,,A9539,HCPCS,Facility,Both,,,,122,103.7,34.9652,122,"Health Partners, Inc.",State Public Programs,61,50,,percent of total billed charges,,
Sup Tc99M Dtpa Diagnostic Per Dose,,A9539,HCPCS,Facility,Both,,,,122,103.7,34.9652,122,Humana Insurance Company,Commercial PPO,115.9,95,,percent of total billed charges,,
Sup Tc99M Dtpa Diagnostic Per Dose,,A9539,HCPCS,Facility,Outpatient,,,,122,103.7,34.9652,122,Humana Insurance Company,Medicare PPO,59.78,49,,percent of total billed charges,,
Sup Tc99M Dtpa Diagnostic Per Dose,,A9539,HCPCS,Facility,Inpatient,,,,122,103.7,34.9652,122,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Sup Tc99M Dtpa Diagnostic Per Dose,,A9539,HCPCS,Facility,Both,,,,122,103.7,34.9652,122,Medica,Individual & Family,120.902,99.1,,percent of total billed charges,,
Sup Tc99M Dtpa Diagnostic Per Dose,,A9539,HCPCS,Facility,Outpatient,,,,122,103.7,34.9652,122,Medica,Medica Advantage Solution,60.756,49.8,,percent of total billed charges,,
Sup Tc99M Dtpa Diagnostic Per Dose,,A9539,HCPCS,Facility,Inpatient,,,,122,103.7,34.9652,122,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Sup Tc99M Dtpa Diagnostic Per Dose,,A9539,HCPCS,Facility,Outpatient,,,,122,103.7,34.9652,122,Medica,Medical Assistance,54.412,44.6,,percent of total billed charges,,
Sup Tc99M Dtpa Diagnostic Per Dose,,A9539,HCPCS,Facility,Inpatient,,,,122,103.7,34.9652,122,Medica,Medical Assistance,,,,,Included in per diem rate,
Sup Tc99M Dtpa Diagnostic Per Dose,,A9539,HCPCS,Facility,Outpatient,,,,122,103.7,34.9652,122,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,60.756,49.8,,percent of total billed charges,,
Sup Tc99M Dtpa Diagnostic Per Dose,,A9539,HCPCS,Facility,Inpatient,,,,122,103.7,34.9652,122,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Sup Tc99M Dtpa Diagnostic Per Dose,,A9539,HCPCS,Facility,Both,,,,122,103.7,34.9652,122,"Multiplan, Inc.","Multiplan, Inc.",114.68,94,,percent of total billed charges,,
Sup Tc99M Dtpa Diagnostic Per Dose,,A9539,HCPCS,Facility,Outpatient,,,,122,103.7,34.9652,122,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,109.922,90.1,,percent of total billed charges,,
Sup Tc99M Dtpa Diagnostic Per Dose,,A9539,HCPCS,Facility,Inpatient,,,,122,103.7,34.9652,122,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Sup Tc99M Dtpa Diagnostic Per Dose,,A9539,HCPCS,Facility,Both,,,,122,103.7,34.9652,122,"Preferred One Administrative Services, INC.",PPO,120.292,98.6,,percent of total billed charges,,
Sup Tc99M Dtpa Diagnostic Per Dose,,A9539,HCPCS,Facility,Outpatient,,,,122,103.7,34.9652,122,PrimeWest Health,Minnesota Senior Health Options (MSHO),62.769,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Sup Tc99M Dtpa Diagnostic Per Dose,,A9539,HCPCS,Facility,Inpatient,,,,122,103.7,34.9652,122,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Tc99M Dtpa Diagnostic Per Dose,,A9539,HCPCS,Facility,Outpatient,,,,122,103.7,34.9652,122,PrimeWest Health,MinnesotaCare,62.6592,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Sup Tc99M Dtpa Diagnostic Per Dose,,A9539,HCPCS,Facility,Inpatient,,,,122,103.7,34.9652,122,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Sup Tc99M Dtpa Diagnostic Per Dose,,A9539,HCPCS,Facility,Both,,,,122,103.7,34.9652,122,Sanford Health Plan,Sanford Health Plan,112.24,92,,percent of total billed charges,,
Sup Tc99M Dtpa Diagnostic Per Dose,,A9539,HCPCS,Facility,Outpatient,,,,122,103.7,34.9652,122,"UCare Health, Inc.",Individual & Family Plan,68.747,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Sup Tc99M Dtpa Diagnostic Per Dose,,A9539,HCPCS,Facility,Inpatient,,,,122,103.7,34.9652,122,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Sup Tc99M Dtpa Diagnostic Per Dose,,A9539,HCPCS,Facility,Outpatient,,,,122,103.7,34.9652,122,"UCare Health, Inc.",Medical Assistance,61.5734,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Tc99M Dtpa Diagnostic Per Dose,,A9539,HCPCS,Facility,Inpatient,,,,122,103.7,34.9652,122,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Sup Tc99M Dtpa Diagnostic Per Dose,,A9539,HCPCS,Facility,Outpatient,,,,122,103.7,34.9652,122,"UCare Health, Inc.",Medicare Advantage,61.5734,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Tc99M Dtpa Diagnostic Per Dose,,A9539,HCPCS,Facility,Inpatient,,,,122,103.7,34.9652,122,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Tc99M Dtpa Diagnostic Per Dose,,A9539,HCPCS,Facility,Outpatient,,,,122,103.7,34.9652,122,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),61.5734,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Tc99M Dtpa Diagnostic Per Dose,,A9539,HCPCS,Facility,Inpatient,,,,122,103.7,34.9652,122,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Tc99M Dtpa Diagnostic Per Dose,,A9539,HCPCS,Facility,Both,,,,122,103.7,34.9652,122,UnitedHealthcare,Individual & Family,114.68,94,,percent of total billed charges,,
Sup Tc99M Dtpa Diagnostic Per Dose,,A9539,HCPCS,Facility,Outpatient,,,,122,103.7,34.9652,122,UnitedHealthcare,Medicare Advantage,59.78,49,,percent of total billed charges,,
Sup Tc99M Dtpa Diagnostic Per Dose,,A9539,HCPCS,Facility,Inpatient,,,,122,103.7,34.9652,122,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Sup Tc99M Dtpa Diagnostic Per Dose,,A9539,HCPCS,Facility,Outpatient,,,,122,103.7,34.9652,122,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,58.56,48,,percent of total billed charges,,100% of DHS outpatient percentage
Sup Tc99M Dtpa Diagnostic Per Dose,,A9539,HCPCS,Facility,Inpatient,,,,122,103.7,34.9652,122,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Sup Tc99M Maa Per Dose,,A9540,HCPCS,Facility,Both,,,,163,138.55,46.7158,163,Aetna,Commercial,149.96,92,,percent of total billed charges,,
Sup Tc99M Maa Per Dose,,A9540,HCPCS,Facility,Outpatient,,,,163,138.55,46.7158,163,Aetna,Medicare Advantage,79.87,49,,percent of total billed charges,,
Sup Tc99M Maa Per Dose,,A9540,HCPCS,Facility,Inpatient,,,,163,138.55,46.7158,163,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Sup Tc99M Maa Per Dose,,A9540,HCPCS,Facility,Both,,,,163,138.55,46.7158,163,Aetna,PPO,151.59,93,,percent of total billed charges,,
Sup Tc99M Maa Per Dose,,A9540,HCPCS,Facility,Both,,,,163,138.55,46.7158,163,America's PPO,America's PPO,156.5289,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Sup Tc99M Maa Per Dose,,A9540,HCPCS,Facility,Both,,,,163,138.55,46.7158,163,BlueCross BlueShield Minnesota, Federal Employee Program,160.392,98.4,,percent of total billed charges,,
Sup Tc99M Maa Per Dose,,A9540,HCPCS,Facility,Both,,,,163,138.55,46.7158,163,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,163,100,,percent of total billed charges,,
Sup Tc99M Maa Per Dose,,A9540,HCPCS,Facility,Both,,,,163,138.55,46.7158,163,BlueCross BlueShield Minnesota,High Value Network Plan,146.7,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
Sup Tc99M Maa Per Dose,,A9540,HCPCS,Facility,Outpatient,,,,163,138.55,46.7158,163,BlueCross BlueShield Minnesota,Medicare Advantage,79.87,49,,percent of total billed charges,,
Sup Tc99M Maa Per Dose,,A9540,HCPCS,Facility,Inpatient,,,,163,138.55,46.7158,163,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Sup Tc99M Maa Per Dose,,A9540,HCPCS,Facility,Both,,,,163,138.55,46.7158,163,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,144.3691,88.57,,percent of total billed charges,,
Sup Tc99M Maa Per Dose,,A9540,HCPCS,Facility,Both,,,,163,138.55,46.7158,163,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,46.7158,28.66,,percent of total billed charges,,
Sup Tc99M Maa Per Dose,,A9540,HCPCS,Facility,Outpatient,,,,163,138.55,46.7158,163,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),79.87,49,,percent of total billed charges,,
Sup Tc99M Maa Per Dose,,A9540,HCPCS,Facility,Inpatient,,,,163,138.55,46.7158,163,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Sup Tc99M Maa Per Dose,,A9540,HCPCS,Facility,Both,,,,163,138.55,46.7158,163,CorVel,Worker's Compensation,163,100,,percent of total billed charges,,
Sup Tc99M Maa Per Dose,,A9540,HCPCS,Facility,Both,,,,163,138.55,46.7158,163,First Health Group Corporation,First Health Network,158.11,97,,percent of total billed charges,,
Sup Tc99M Maa Per Dose,,A9540,HCPCS,Facility,Both,,,,163,138.55,46.7158,163,"Health Partners, Inc.",Commercial,154.198,94.6,,percent of total billed charges,,
Sup Tc99M Maa Per Dose,,A9540,HCPCS,Facility,Outpatient,,,,163,138.55,46.7158,163,"Health Partners, Inc.",Medicare Advantage,79.87,49,,percent of total billed charges,,
Sup Tc99M Maa Per Dose,,A9540,HCPCS,Facility,Inpatient,,,,163,138.55,46.7158,163,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Tc99M Maa Per Dose,,A9540,HCPCS,Facility,Both,,,,163,138.55,46.7158,163,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),97.8,60,,percent of total billed charges,,
Sup Tc99M Maa Per Dose,,A9540,HCPCS,Facility,Both,,,,163,138.55,46.7158,163,"Health Partners, Inc.",State of Minnesota Advantage Program,132.845,81.5,,percent of total billed charges,,
Sup Tc99M Maa Per Dose,,A9540,HCPCS,Facility,Both,,,,163,138.55,46.7158,163,"Health Partners, Inc.",State Public Programs,81.5,50,,percent of total billed charges,,
Sup Tc99M Maa Per Dose,,A9540,HCPCS,Facility,Both,,,,163,138.55,46.7158,163,Humana Insurance Company,Commercial PPO,154.85,95,,percent of total billed charges,,
Sup Tc99M Maa Per Dose,,A9540,HCPCS,Facility,Outpatient,,,,163,138.55,46.7158,163,Humana Insurance Company,Medicare PPO,79.87,49,,percent of total billed charges,,
Sup Tc99M Maa Per Dose,,A9540,HCPCS,Facility,Inpatient,,,,163,138.55,46.7158,163,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Sup Tc99M Maa Per Dose,,A9540,HCPCS,Facility,Both,,,,163,138.55,46.7158,163,Medica,Individual & Family,161.533,99.1,,percent of total billed charges,,
Sup Tc99M Maa Per Dose,,A9540,HCPCS,Facility,Outpatient,,,,163,138.55,46.7158,163,Medica,Medica Advantage Solution,81.174,49.8,,percent of total billed charges,,
Sup Tc99M Maa Per Dose,,A9540,HCPCS,Facility,Inpatient,,,,163,138.55,46.7158,163,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Sup Tc99M Maa Per Dose,,A9540,HCPCS,Facility,Outpatient,,,,163,138.55,46.7158,163,Medica,Medical Assistance,72.698,44.6,,percent of total billed charges,,
Sup Tc99M Maa Per Dose,,A9540,HCPCS,Facility,Inpatient,,,,163,138.55,46.7158,163,Medica,Medical Assistance,,,,,Included in per diem rate,
Sup Tc99M Maa Per Dose,,A9540,HCPCS,Facility,Outpatient,,,,163,138.55,46.7158,163,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,81.174,49.8,,percent of total billed charges,,
Sup Tc99M Maa Per Dose,,A9540,HCPCS,Facility,Inpatient,,,,163,138.55,46.7158,163,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Sup Tc99M Maa Per Dose,,A9540,HCPCS,Facility,Both,,,,163,138.55,46.7158,163,"Multiplan, Inc.","Multiplan, Inc.",153.22,94,,percent of total billed charges,,
Sup Tc99M Maa Per Dose,,A9540,HCPCS,Facility,Outpatient,,,,163,138.55,46.7158,163,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,146.863,90.1,,percent of total billed charges,,
Sup Tc99M Maa Per Dose,,A9540,HCPCS,Facility,Inpatient,,,,163,138.55,46.7158,163,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Sup Tc99M Maa Per Dose,,A9540,HCPCS,Facility,Both,,,,163,138.55,46.7158,163,"Preferred One Administrative Services, INC.",PPO,160.718,98.6,,percent of total billed charges,,
Sup Tc99M Maa Per Dose,,A9540,HCPCS,Facility,Outpatient,,,,163,138.55,46.7158,163,PrimeWest Health,Minnesota Senior Health Options (MSHO),83.8635,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Sup Tc99M Maa Per Dose,,A9540,HCPCS,Facility,Inpatient,,,,163,138.55,46.7158,163,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Tc99M Maa Per Dose,,A9540,HCPCS,Facility,Outpatient,,,,163,138.55,46.7158,163,PrimeWest Health,MinnesotaCare,83.7168,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Sup Tc99M Maa Per Dose,,A9540,HCPCS,Facility,Inpatient,,,,163,138.55,46.7158,163,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Sup Tc99M Maa Per Dose,,A9540,HCPCS,Facility,Both,,,,163,138.55,46.7158,163,Sanford Health Plan,Sanford Health Plan,149.96,92,,percent of total billed charges,,
Sup Tc99M Maa Per Dose,,A9540,HCPCS,Facility,Outpatient,,,,163,138.55,46.7158,163,"UCare Health, Inc.",Individual & Family Plan,91.8505,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Sup Tc99M Maa Per Dose,,A9540,HCPCS,Facility,Inpatient,,,,163,138.55,46.7158,163,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Sup Tc99M Maa Per Dose,,A9540,HCPCS,Facility,Outpatient,,,,163,138.55,46.7158,163,"UCare Health, Inc.",Medical Assistance,82.2661,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Tc99M Maa Per Dose,,A9540,HCPCS,Facility,Inpatient,,,,163,138.55,46.7158,163,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Sup Tc99M Maa Per Dose,,A9540,HCPCS,Facility,Outpatient,,,,163,138.55,46.7158,163,"UCare Health, Inc.",Medicare Advantage,82.2661,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Tc99M Maa Per Dose,,A9540,HCPCS,Facility,Inpatient,,,,163,138.55,46.7158,163,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Tc99M Maa Per Dose,,A9540,HCPCS,Facility,Outpatient,,,,163,138.55,46.7158,163,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),82.2661,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Tc99M Maa Per Dose,,A9540,HCPCS,Facility,Inpatient,,,,163,138.55,46.7158,163,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Tc99M Maa Per Dose,,A9540,HCPCS,Facility,Both,,,,163,138.55,46.7158,163,UnitedHealthcare,Individual & Family,153.22,94,,percent of total billed charges,,
Sup Tc99M Maa Per Dose,,A9540,HCPCS,Facility,Outpatient,,,,163,138.55,46.7158,163,UnitedHealthcare,Medicare Advantage,79.87,49,,percent of total billed charges,,
Sup Tc99M Maa Per Dose,,A9540,HCPCS,Facility,Inpatient,,,,163,138.55,46.7158,163,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Sup Tc99M Maa Per Dose,,A9540,HCPCS,Facility,Outpatient,,,,163,138.55,46.7158,163,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,78.24,48,,percent of total billed charges,,100% of DHS outpatient percentage
Sup Tc99M Maa Per Dose,,A9540,HCPCS,Facility,Inpatient,,,,163,138.55,46.7158,163,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Sup Tc99M Sulfur Colloid Per Dose,,A9541,HCPCS,Facility,Both,,,,184,156.4,52.7344,184,Aetna,Commercial,169.28,92,,percent of total billed charges,,
Sup Tc99M Sulfur Colloid Per Dose,,A9541,HCPCS,Facility,Outpatient,,,,184,156.4,52.7344,184,Aetna,Medicare Advantage,90.16,49,,percent of total billed charges,,
Sup Tc99M Sulfur Colloid Per Dose,,A9541,HCPCS,Facility,Inpatient,,,,184,156.4,52.7344,184,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Sup Tc99M Sulfur Colloid Per Dose,,A9541,HCPCS,Facility,Both,,,,184,156.4,52.7344,184,Aetna,PPO,171.12,93,,percent of total billed charges,,
Sup Tc99M Sulfur Colloid Per Dose,,A9541,HCPCS,Facility,Both,,,,184,156.4,52.7344,184,America's PPO,America's PPO,176.6952,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Sup Tc99M Sulfur Colloid Per Dose,,A9541,HCPCS,Facility,Both,,,,184,156.4,52.7344,184,BlueCross BlueShield Minnesota, Federal Employee Program,181.056,98.4,,percent of total billed charges,,
Sup Tc99M Sulfur Colloid Per Dose,,A9541,HCPCS,Facility,Both,,,,184,156.4,52.7344,184,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,184,100,,percent of total billed charges,,
Sup Tc99M Sulfur Colloid Per Dose,,A9541,HCPCS,Facility,Both,,,,184,156.4,52.7344,184,BlueCross BlueShield Minnesota,High Value Network Plan,165.6,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
Sup Tc99M Sulfur Colloid Per Dose,,A9541,HCPCS,Facility,Outpatient,,,,184,156.4,52.7344,184,BlueCross BlueShield Minnesota,Medicare Advantage,90.16,49,,percent of total billed charges,,
Sup Tc99M Sulfur Colloid Per Dose,,A9541,HCPCS,Facility,Inpatient,,,,184,156.4,52.7344,184,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Sup Tc99M Sulfur Colloid Per Dose,,A9541,HCPCS,Facility,Both,,,,184,156.4,52.7344,184,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,162.9688,88.57,,percent of total billed charges,,
Sup Tc99M Sulfur Colloid Per Dose,,A9541,HCPCS,Facility,Both,,,,184,156.4,52.7344,184,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,52.7344,28.66,,percent of total billed charges,,
Sup Tc99M Sulfur Colloid Per Dose,,A9541,HCPCS,Facility,Outpatient,,,,184,156.4,52.7344,184,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),90.16,49,,percent of total billed charges,,
Sup Tc99M Sulfur Colloid Per Dose,,A9541,HCPCS,Facility,Inpatient,,,,184,156.4,52.7344,184,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Sup Tc99M Sulfur Colloid Per Dose,,A9541,HCPCS,Facility,Both,,,,184,156.4,52.7344,184,CorVel,Worker's Compensation,184,100,,percent of total billed charges,,
Sup Tc99M Sulfur Colloid Per Dose,,A9541,HCPCS,Facility,Both,,,,184,156.4,52.7344,184,First Health Group Corporation,First Health Network,178.48,97,,percent of total billed charges,,
Sup Tc99M Sulfur Colloid Per Dose,,A9541,HCPCS,Facility,Both,,,,184,156.4,52.7344,184,"Health Partners, Inc.",Commercial,174.064,94.6,,percent of total billed charges,,
Sup Tc99M Sulfur Colloid Per Dose,,A9541,HCPCS,Facility,Outpatient,,,,184,156.4,52.7344,184,"Health Partners, Inc.",Medicare Advantage,90.16,49,,percent of total billed charges,,
Sup Tc99M Sulfur Colloid Per Dose,,A9541,HCPCS,Facility,Inpatient,,,,184,156.4,52.7344,184,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Tc99M Sulfur Colloid Per Dose,,A9541,HCPCS,Facility,Both,,,,184,156.4,52.7344,184,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),110.4,60,,percent of total billed charges,,
Sup Tc99M Sulfur Colloid Per Dose,,A9541,HCPCS,Facility,Both,,,,184,156.4,52.7344,184,"Health Partners, Inc.",State of Minnesota Advantage Program,149.96,81.5,,percent of total billed charges,,
Sup Tc99M Sulfur Colloid Per Dose,,A9541,HCPCS,Facility,Both,,,,184,156.4,52.7344,184,"Health Partners, Inc.",State Public Programs,92,50,,percent of total billed charges,,
Sup Tc99M Sulfur Colloid Per Dose,,A9541,HCPCS,Facility,Both,,,,184,156.4,52.7344,184,Humana Insurance Company,Commercial PPO,174.8,95,,percent of total billed charges,,
Sup Tc99M Sulfur Colloid Per Dose,,A9541,HCPCS,Facility,Outpatient,,,,184,156.4,52.7344,184,Humana Insurance Company,Medicare PPO,90.16,49,,percent of total billed charges,,
Sup Tc99M Sulfur Colloid Per Dose,,A9541,HCPCS,Facility,Inpatient,,,,184,156.4,52.7344,184,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Sup Tc99M Sulfur Colloid Per Dose,,A9541,HCPCS,Facility,Both,,,,184,156.4,52.7344,184,Medica,Individual & Family,182.344,99.1,,percent of total billed charges,,
Sup Tc99M Sulfur Colloid Per Dose,,A9541,HCPCS,Facility,Outpatient,,,,184,156.4,52.7344,184,Medica,Medica Advantage Solution,91.632,49.8,,percent of total billed charges,,
Sup Tc99M Sulfur Colloid Per Dose,,A9541,HCPCS,Facility,Inpatient,,,,184,156.4,52.7344,184,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Sup Tc99M Sulfur Colloid Per Dose,,A9541,HCPCS,Facility,Outpatient,,,,184,156.4,52.7344,184,Medica,Medical Assistance,82.064,44.6,,percent of total billed charges,,
Sup Tc99M Sulfur Colloid Per Dose,,A9541,HCPCS,Facility,Inpatient,,,,184,156.4,52.7344,184,Medica,Medical Assistance,,,,,Included in per diem rate,
Sup Tc99M Sulfur Colloid Per Dose,,A9541,HCPCS,Facility,Outpatient,,,,184,156.4,52.7344,184,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,91.632,49.8,,percent of total billed charges,,
Sup Tc99M Sulfur Colloid Per Dose,,A9541,HCPCS,Facility,Inpatient,,,,184,156.4,52.7344,184,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Sup Tc99M Sulfur Colloid Per Dose,,A9541,HCPCS,Facility,Both,,,,184,156.4,52.7344,184,"Multiplan, Inc.","Multiplan, Inc.",172.96,94,,percent of total billed charges,,
Sup Tc99M Sulfur Colloid Per Dose,,A9541,HCPCS,Facility,Outpatient,,,,184,156.4,52.7344,184,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,165.784,90.1,,percent of total billed charges,,
Sup Tc99M Sulfur Colloid Per Dose,,A9541,HCPCS,Facility,Inpatient,,,,184,156.4,52.7344,184,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Sup Tc99M Sulfur Colloid Per Dose,,A9541,HCPCS,Facility,Both,,,,184,156.4,52.7344,184,"Preferred One Administrative Services, INC.",PPO,181.424,98.6,,percent of total billed charges,,
Sup Tc99M Sulfur Colloid Per Dose,,A9541,HCPCS,Facility,Outpatient,,,,184,156.4,52.7344,184,PrimeWest Health,Minnesota Senior Health Options (MSHO),94.668,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Sup Tc99M Sulfur Colloid Per Dose,,A9541,HCPCS,Facility,Inpatient,,,,184,156.4,52.7344,184,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Tc99M Sulfur Colloid Per Dose,,A9541,HCPCS,Facility,Outpatient,,,,184,156.4,52.7344,184,PrimeWest Health,MinnesotaCare,94.5024,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Sup Tc99M Sulfur Colloid Per Dose,,A9541,HCPCS,Facility,Inpatient,,,,184,156.4,52.7344,184,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Sup Tc99M Sulfur Colloid Per Dose,,A9541,HCPCS,Facility,Both,,,,184,156.4,52.7344,184,Sanford Health Plan,Sanford Health Plan,169.28,92,,percent of total billed charges,,
Sup Tc99M Sulfur Colloid Per Dose,,A9541,HCPCS,Facility,Outpatient,,,,184,156.4,52.7344,184,"UCare Health, Inc.",Individual & Family Plan,103.684,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Sup Tc99M Sulfur Colloid Per Dose,,A9541,HCPCS,Facility,Inpatient,,,,184,156.4,52.7344,184,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Sup Tc99M Sulfur Colloid Per Dose,,A9541,HCPCS,Facility,Outpatient,,,,184,156.4,52.7344,184,"UCare Health, Inc.",Medical Assistance,92.8648,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Tc99M Sulfur Colloid Per Dose,,A9541,HCPCS,Facility,Inpatient,,,,184,156.4,52.7344,184,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Sup Tc99M Sulfur Colloid Per Dose,,A9541,HCPCS,Facility,Outpatient,,,,184,156.4,52.7344,184,"UCare Health, Inc.",Medicare Advantage,92.8648,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Tc99M Sulfur Colloid Per Dose,,A9541,HCPCS,Facility,Inpatient,,,,184,156.4,52.7344,184,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Tc99M Sulfur Colloid Per Dose,,A9541,HCPCS,Facility,Outpatient,,,,184,156.4,52.7344,184,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),92.8648,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Tc99M Sulfur Colloid Per Dose,,A9541,HCPCS,Facility,Inpatient,,,,184,156.4,52.7344,184,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Tc99M Sulfur Colloid Per Dose,,A9541,HCPCS,Facility,Both,,,,184,156.4,52.7344,184,UnitedHealthcare,Individual & Family,172.96,94,,percent of total billed charges,,
Sup Tc99M Sulfur Colloid Per Dose,,A9541,HCPCS,Facility,Outpatient,,,,184,156.4,52.7344,184,UnitedHealthcare,Medicare Advantage,90.16,49,,percent of total billed charges,,
Sup Tc99M Sulfur Colloid Per Dose,,A9541,HCPCS,Facility,Inpatient,,,,184,156.4,52.7344,184,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Sup Tc99M Sulfur Colloid Per Dose,,A9541,HCPCS,Facility,Outpatient,,,,184,156.4,52.7344,184,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,88.32,48,,percent of total billed charges,,100% of DHS outpatient percentage
Sup Tc99M Sulfur Colloid Per Dose,,A9541,HCPCS,Facility,Inpatient,,,,184,156.4,52.7344,184,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Sup Tc99M Hdp Per Dose,,A9561,HCPCS,Facility,Both,,,,107,90.95,30.6662,107,Aetna,Commercial,98.44,92,,percent of total billed charges,,
Sup Tc99M Hdp Per Dose,,A9561,HCPCS,Facility,Outpatient,,,,107,90.95,30.6662,107,Aetna,Medicare Advantage,52.43,49,,percent of total billed charges,,
Sup Tc99M Hdp Per Dose,,A9561,HCPCS,Facility,Inpatient,,,,107,90.95,30.6662,107,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Sup Tc99M Hdp Per Dose,,A9561,HCPCS,Facility,Both,,,,107,90.95,30.6662,107,Aetna,PPO,99.51,93,,percent of total billed charges,,
Sup Tc99M Hdp Per Dose,,A9561,HCPCS,Facility,Both,,,,107,90.95,30.6662,107,America's PPO,America's PPO,102.7521,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Sup Tc99M Hdp Per Dose,,A9561,HCPCS,Facility,Both,,,,107,90.95,30.6662,107,BlueCross BlueShield Minnesota, Federal Employee Program,105.288,98.4,,percent of total billed charges,,
Sup Tc99M Hdp Per Dose,,A9561,HCPCS,Facility,Both,,,,107,90.95,30.6662,107,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,107,100,,percent of total billed charges,,
Sup Tc99M Hdp Per Dose,,A9561,HCPCS,Facility,Both,,,,107,90.95,30.6662,107,BlueCross BlueShield Minnesota,High Value Network Plan,96.3,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
Sup Tc99M Hdp Per Dose,,A9561,HCPCS,Facility,Outpatient,,,,107,90.95,30.6662,107,BlueCross BlueShield Minnesota,Medicare Advantage,52.43,49,,percent of total billed charges,,
Sup Tc99M Hdp Per Dose,,A9561,HCPCS,Facility,Inpatient,,,,107,90.95,30.6662,107,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Sup Tc99M Hdp Per Dose,,A9561,HCPCS,Facility,Both,,,,107,90.95,30.6662,107,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,94.7699,88.57,,percent of total billed charges,,
Sup Tc99M Hdp Per Dose,,A9561,HCPCS,Facility,Both,,,,107,90.95,30.6662,107,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,30.6662,28.66,,percent of total billed charges,,
Sup Tc99M Hdp Per Dose,,A9561,HCPCS,Facility,Outpatient,,,,107,90.95,30.6662,107,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),52.43,49,,percent of total billed charges,,
Sup Tc99M Hdp Per Dose,,A9561,HCPCS,Facility,Inpatient,,,,107,90.95,30.6662,107,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Sup Tc99M Hdp Per Dose,,A9561,HCPCS,Facility,Both,,,,107,90.95,30.6662,107,CorVel,Worker's Compensation,107,100,,percent of total billed charges,,
Sup Tc99M Hdp Per Dose,,A9561,HCPCS,Facility,Both,,,,107,90.95,30.6662,107,First Health Group Corporation,First Health Network,103.79,97,,percent of total billed charges,,
Sup Tc99M Hdp Per Dose,,A9561,HCPCS,Facility,Both,,,,107,90.95,30.6662,107,"Health Partners, Inc.",Commercial,101.222,94.6,,percent of total billed charges,,
Sup Tc99M Hdp Per Dose,,A9561,HCPCS,Facility,Outpatient,,,,107,90.95,30.6662,107,"Health Partners, Inc.",Medicare Advantage,52.43,49,,percent of total billed charges,,
Sup Tc99M Hdp Per Dose,,A9561,HCPCS,Facility,Inpatient,,,,107,90.95,30.6662,107,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Tc99M Hdp Per Dose,,A9561,HCPCS,Facility,Both,,,,107,90.95,30.6662,107,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),64.2,60,,percent of total billed charges,,
Sup Tc99M Hdp Per Dose,,A9561,HCPCS,Facility,Both,,,,107,90.95,30.6662,107,"Health Partners, Inc.",State of Minnesota Advantage Program,87.205,81.5,,percent of total billed charges,,
Sup Tc99M Hdp Per Dose,,A9561,HCPCS,Facility,Both,,,,107,90.95,30.6662,107,"Health Partners, Inc.",State Public Programs,53.5,50,,percent of total billed charges,,
Sup Tc99M Hdp Per Dose,,A9561,HCPCS,Facility,Both,,,,107,90.95,30.6662,107,Humana Insurance Company,Commercial PPO,101.65,95,,percent of total billed charges,,
Sup Tc99M Hdp Per Dose,,A9561,HCPCS,Facility,Outpatient,,,,107,90.95,30.6662,107,Humana Insurance Company,Medicare PPO,52.43,49,,percent of total billed charges,,
Sup Tc99M Hdp Per Dose,,A9561,HCPCS,Facility,Inpatient,,,,107,90.95,30.6662,107,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Sup Tc99M Hdp Per Dose,,A9561,HCPCS,Facility,Both,,,,107,90.95,30.6662,107,Medica,Individual & Family,106.037,99.1,,percent of total billed charges,,
Sup Tc99M Hdp Per Dose,,A9561,HCPCS,Facility,Outpatient,,,,107,90.95,30.6662,107,Medica,Medica Advantage Solution,53.286,49.8,,percent of total billed charges,,
Sup Tc99M Hdp Per Dose,,A9561,HCPCS,Facility,Inpatient,,,,107,90.95,30.6662,107,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Sup Tc99M Hdp Per Dose,,A9561,HCPCS,Facility,Outpatient,,,,107,90.95,30.6662,107,Medica,Medical Assistance,47.722,44.6,,percent of total billed charges,,
Sup Tc99M Hdp Per Dose,,A9561,HCPCS,Facility,Inpatient,,,,107,90.95,30.6662,107,Medica,Medical Assistance,,,,,Included in per diem rate,
Sup Tc99M Hdp Per Dose,,A9561,HCPCS,Facility,Outpatient,,,,107,90.95,30.6662,107,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,53.286,49.8,,percent of total billed charges,,
Sup Tc99M Hdp Per Dose,,A9561,HCPCS,Facility,Inpatient,,,,107,90.95,30.6662,107,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Sup Tc99M Hdp Per Dose,,A9561,HCPCS,Facility,Both,,,,107,90.95,30.6662,107,"Multiplan, Inc.","Multiplan, Inc.",100.58,94,,percent of total billed charges,,
Sup Tc99M Hdp Per Dose,,A9561,HCPCS,Facility,Outpatient,,,,107,90.95,30.6662,107,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,96.407,90.1,,percent of total billed charges,,
Sup Tc99M Hdp Per Dose,,A9561,HCPCS,Facility,Inpatient,,,,107,90.95,30.6662,107,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Sup Tc99M Hdp Per Dose,,A9561,HCPCS,Facility,Both,,,,107,90.95,30.6662,107,"Preferred One Administrative Services, INC.",PPO,105.502,98.6,,percent of total billed charges,,
Sup Tc99M Hdp Per Dose,,A9561,HCPCS,Facility,Outpatient,,,,107,90.95,30.6662,107,PrimeWest Health,Minnesota Senior Health Options (MSHO),55.0515,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Sup Tc99M Hdp Per Dose,,A9561,HCPCS,Facility,Inpatient,,,,107,90.95,30.6662,107,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Tc99M Hdp Per Dose,,A9561,HCPCS,Facility,Outpatient,,,,107,90.95,30.6662,107,PrimeWest Health,MinnesotaCare,54.9552,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Sup Tc99M Hdp Per Dose,,A9561,HCPCS,Facility,Inpatient,,,,107,90.95,30.6662,107,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Sup Tc99M Hdp Per Dose,,A9561,HCPCS,Facility,Both,,,,107,90.95,30.6662,107,Sanford Health Plan,Sanford Health Plan,98.44,92,,percent of total billed charges,,
Sup Tc99M Hdp Per Dose,,A9561,HCPCS,Facility,Outpatient,,,,107,90.95,30.6662,107,"UCare Health, Inc.",Individual & Family Plan,60.2945,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Sup Tc99M Hdp Per Dose,,A9561,HCPCS,Facility,Inpatient,,,,107,90.95,30.6662,107,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Sup Tc99M Hdp Per Dose,,A9561,HCPCS,Facility,Outpatient,,,,107,90.95,30.6662,107,"UCare Health, Inc.",Medical Assistance,54.0029,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Tc99M Hdp Per Dose,,A9561,HCPCS,Facility,Inpatient,,,,107,90.95,30.6662,107,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Sup Tc99M Hdp Per Dose,,A9561,HCPCS,Facility,Outpatient,,,,107,90.95,30.6662,107,"UCare Health, Inc.",Medicare Advantage,54.0029,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Tc99M Hdp Per Dose,,A9561,HCPCS,Facility,Inpatient,,,,107,90.95,30.6662,107,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Tc99M Hdp Per Dose,,A9561,HCPCS,Facility,Outpatient,,,,107,90.95,30.6662,107,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),54.0029,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Tc99M Hdp Per Dose,,A9561,HCPCS,Facility,Inpatient,,,,107,90.95,30.6662,107,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Tc99M Hdp Per Dose,,A9561,HCPCS,Facility,Both,,,,107,90.95,30.6662,107,UnitedHealthcare,Individual & Family,100.58,94,,percent of total billed charges,,
Sup Tc99M Hdp Per Dose,,A9561,HCPCS,Facility,Outpatient,,,,107,90.95,30.6662,107,UnitedHealthcare,Medicare Advantage,52.43,49,,percent of total billed charges,,
Sup Tc99M Hdp Per Dose,,A9561,HCPCS,Facility,Inpatient,,,,107,90.95,30.6662,107,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Sup Tc99M Hdp Per Dose,,A9561,HCPCS,Facility,Outpatient,,,,107,90.95,30.6662,107,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,51.36,48,,percent of total billed charges,,100% of DHS outpatient percentage
Sup Tc99M Hdp Per Dose,,A9561,HCPCS,Facility,Inpatient,,,,107,90.95,30.6662,107,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Sup Tc99M Mag3 Per Dose,,A9562,HCPCS,Facility,Both,,,,658,559.3,188.5828,658,Aetna,Commercial,605.36,92,,percent of total billed charges,,
Sup Tc99M Mag3 Per Dose,,A9562,HCPCS,Facility,Outpatient,,,,658,559.3,188.5828,658,Aetna,Medicare Advantage,322.42,49,,percent of total billed charges,,
Sup Tc99M Mag3 Per Dose,,A9562,HCPCS,Facility,Inpatient,,,,658,559.3,188.5828,658,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Sup Tc99M Mag3 Per Dose,,A9562,HCPCS,Facility,Both,,,,658,559.3,188.5828,658,Aetna,PPO,611.94,93,,percent of total billed charges,,
Sup Tc99M Mag3 Per Dose,,A9562,HCPCS,Facility,Both,,,,658,559.3,188.5828,658,America's PPO,America's PPO,631.8774,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Sup Tc99M Mag3 Per Dose,,A9562,HCPCS,Facility,Both,,,,658,559.3,188.5828,658,BlueCross BlueShield Minnesota, Federal Employee Program,647.472,98.4,,percent of total billed charges,,
Sup Tc99M Mag3 Per Dose,,A9562,HCPCS,Facility,Both,,,,658,559.3,188.5828,658,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,658,100,,percent of total billed charges,,
Sup Tc99M Mag3 Per Dose,,A9562,HCPCS,Facility,Both,,,,658,559.3,188.5828,658,BlueCross BlueShield Minnesota,High Value Network Plan,592.2,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
Sup Tc99M Mag3 Per Dose,,A9562,HCPCS,Facility,Outpatient,,,,658,559.3,188.5828,658,BlueCross BlueShield Minnesota,Medicare Advantage,322.42,49,,percent of total billed charges,,
Sup Tc99M Mag3 Per Dose,,A9562,HCPCS,Facility,Inpatient,,,,658,559.3,188.5828,658,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Sup Tc99M Mag3 Per Dose,,A9562,HCPCS,Facility,Both,,,,658,559.3,188.5828,658,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,582.7906,88.57,,percent of total billed charges,,
Sup Tc99M Mag3 Per Dose,,A9562,HCPCS,Facility,Both,,,,658,559.3,188.5828,658,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,188.5828,28.66,,percent of total billed charges,,
Sup Tc99M Mag3 Per Dose,,A9562,HCPCS,Facility,Outpatient,,,,658,559.3,188.5828,658,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),322.42,49,,percent of total billed charges,,
Sup Tc99M Mag3 Per Dose,,A9562,HCPCS,Facility,Inpatient,,,,658,559.3,188.5828,658,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Sup Tc99M Mag3 Per Dose,,A9562,HCPCS,Facility,Both,,,,658,559.3,188.5828,658,CorVel,Worker's Compensation,658,100,,percent of total billed charges,,
Sup Tc99M Mag3 Per Dose,,A9562,HCPCS,Facility,Both,,,,658,559.3,188.5828,658,First Health Group Corporation,First Health Network,638.26,97,,percent of total billed charges,,
Sup Tc99M Mag3 Per Dose,,A9562,HCPCS,Facility,Both,,,,658,559.3,188.5828,658,"Health Partners, Inc.",Commercial,622.468,94.6,,percent of total billed charges,,
Sup Tc99M Mag3 Per Dose,,A9562,HCPCS,Facility,Outpatient,,,,658,559.3,188.5828,658,"Health Partners, Inc.",Medicare Advantage,322.42,49,,percent of total billed charges,,
Sup Tc99M Mag3 Per Dose,,A9562,HCPCS,Facility,Inpatient,,,,658,559.3,188.5828,658,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Tc99M Mag3 Per Dose,,A9562,HCPCS,Facility,Both,,,,658,559.3,188.5828,658,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),394.8,60,,percent of total billed charges,,
Sup Tc99M Mag3 Per Dose,,A9562,HCPCS,Facility,Both,,,,658,559.3,188.5828,658,"Health Partners, Inc.",State of Minnesota Advantage Program,536.27,81.5,,percent of total billed charges,,
Sup Tc99M Mag3 Per Dose,,A9562,HCPCS,Facility,Both,,,,658,559.3,188.5828,658,"Health Partners, Inc.",State Public Programs,329,50,,percent of total billed charges,,
Sup Tc99M Mag3 Per Dose,,A9562,HCPCS,Facility,Both,,,,658,559.3,188.5828,658,Humana Insurance Company,Commercial PPO,625.1,95,,percent of total billed charges,,
Sup Tc99M Mag3 Per Dose,,A9562,HCPCS,Facility,Outpatient,,,,658,559.3,188.5828,658,Humana Insurance Company,Medicare PPO,322.42,49,,percent of total billed charges,,
Sup Tc99M Mag3 Per Dose,,A9562,HCPCS,Facility,Inpatient,,,,658,559.3,188.5828,658,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Sup Tc99M Mag3 Per Dose,,A9562,HCPCS,Facility,Both,,,,658,559.3,188.5828,658,Medica,Individual & Family,652.078,99.1,,percent of total billed charges,,
Sup Tc99M Mag3 Per Dose,,A9562,HCPCS,Facility,Outpatient,,,,658,559.3,188.5828,658,Medica,Medica Advantage Solution,327.684,49.8,,percent of total billed charges,,
Sup Tc99M Mag3 Per Dose,,A9562,HCPCS,Facility,Inpatient,,,,658,559.3,188.5828,658,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Sup Tc99M Mag3 Per Dose,,A9562,HCPCS,Facility,Outpatient,,,,658,559.3,188.5828,658,Medica,Medical Assistance,293.468,44.6,,percent of total billed charges,,
Sup Tc99M Mag3 Per Dose,,A9562,HCPCS,Facility,Inpatient,,,,658,559.3,188.5828,658,Medica,Medical Assistance,,,,,Included in per diem rate,
Sup Tc99M Mag3 Per Dose,,A9562,HCPCS,Facility,Outpatient,,,,658,559.3,188.5828,658,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,327.684,49.8,,percent of total billed charges,,
Sup Tc99M Mag3 Per Dose,,A9562,HCPCS,Facility,Inpatient,,,,658,559.3,188.5828,658,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Sup Tc99M Mag3 Per Dose,,A9562,HCPCS,Facility,Both,,,,658,559.3,188.5828,658,"Multiplan, Inc.","Multiplan, Inc.",618.52,94,,percent of total billed charges,,
Sup Tc99M Mag3 Per Dose,,A9562,HCPCS,Facility,Outpatient,,,,658,559.3,188.5828,658,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,592.858,90.1,,percent of total billed charges,,
Sup Tc99M Mag3 Per Dose,,A9562,HCPCS,Facility,Inpatient,,,,658,559.3,188.5828,658,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Sup Tc99M Mag3 Per Dose,,A9562,HCPCS,Facility,Both,,,,658,559.3,188.5828,658,"Preferred One Administrative Services, INC.",PPO,648.788,98.6,,percent of total billed charges,,
Sup Tc99M Mag3 Per Dose,,A9562,HCPCS,Facility,Outpatient,,,,658,559.3,188.5828,658,PrimeWest Health,Minnesota Senior Health Options (MSHO),338.541,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Sup Tc99M Mag3 Per Dose,,A9562,HCPCS,Facility,Inpatient,,,,658,559.3,188.5828,658,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Tc99M Mag3 Per Dose,,A9562,HCPCS,Facility,Outpatient,,,,658,559.3,188.5828,658,PrimeWest Health,MinnesotaCare,337.9488,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Sup Tc99M Mag3 Per Dose,,A9562,HCPCS,Facility,Inpatient,,,,658,559.3,188.5828,658,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Sup Tc99M Mag3 Per Dose,,A9562,HCPCS,Facility,Both,,,,658,559.3,188.5828,658,Sanford Health Plan,Sanford Health Plan,605.36,92,,percent of total billed charges,,
Sup Tc99M Mag3 Per Dose,,A9562,HCPCS,Facility,Outpatient,,,,658,559.3,188.5828,658,"UCare Health, Inc.",Individual & Family Plan,370.783,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Sup Tc99M Mag3 Per Dose,,A9562,HCPCS,Facility,Inpatient,,,,658,559.3,188.5828,658,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Sup Tc99M Mag3 Per Dose,,A9562,HCPCS,Facility,Outpatient,,,,658,559.3,188.5828,658,"UCare Health, Inc.",Medical Assistance,332.0926,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Tc99M Mag3 Per Dose,,A9562,HCPCS,Facility,Inpatient,,,,658,559.3,188.5828,658,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Sup Tc99M Mag3 Per Dose,,A9562,HCPCS,Facility,Outpatient,,,,658,559.3,188.5828,658,"UCare Health, Inc.",Medicare Advantage,332.0926,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Tc99M Mag3 Per Dose,,A9562,HCPCS,Facility,Inpatient,,,,658,559.3,188.5828,658,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Tc99M Mag3 Per Dose,,A9562,HCPCS,Facility,Outpatient,,,,658,559.3,188.5828,658,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),332.0926,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Tc99M Mag3 Per Dose,,A9562,HCPCS,Facility,Inpatient,,,,658,559.3,188.5828,658,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Tc99M Mag3 Per Dose,,A9562,HCPCS,Facility,Both,,,,658,559.3,188.5828,658,UnitedHealthcare,Individual & Family,618.52,94,,percent of total billed charges,,
Sup Tc99M Mag3 Per Dose,,A9562,HCPCS,Facility,Outpatient,,,,658,559.3,188.5828,658,UnitedHealthcare,Medicare Advantage,322.42,49,,percent of total billed charges,,
Sup Tc99M Mag3 Per Dose,,A9562,HCPCS,Facility,Inpatient,,,,658,559.3,188.5828,658,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Sup Tc99M Mag3 Per Dose,,A9562,HCPCS,Facility,Outpatient,,,,658,559.3,188.5828,658,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,315.84,48,,percent of total billed charges,,100% of DHS outpatient percentage
Sup Tc99M Mag3 Per Dose,,A9562,HCPCS,Facility,Inpatient,,,,658,559.3,188.5828,658,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
GUAIFENESIN 100 MG/5 ML ORAL LIQD,,7844,LOCAL,Facility,Both,118,mL,,40,34,11.464,40,Aetna,Commercial,36.8,92,,percent of total billed charges,,
GUAIFENESIN 100 MG/5 ML ORAL LIQD,,7844,LOCAL,Facility,Outpatient,118,mL,,40,34,11.464,40,Aetna,Medicare Advantage,19.6,49,,percent of total billed charges,,
GUAIFENESIN 100 MG/5 ML ORAL LIQD,,7844,LOCAL,Facility,Inpatient,118,mL,,40,34,11.464,40,Aetna,Medicare Advantage,,,,,Included in per diem rate,
GUAIFENESIN 100 MG/5 ML ORAL LIQD,,7844,LOCAL,Facility,Both,118,mL,,40,34,11.464,40,Aetna,PPO,37.2,93,,percent of total billed charges,,
GUAIFENESIN 100 MG/5 ML ORAL LIQD,,7844,LOCAL,Facility,Both,118,mL,,40,34,11.464,40,America's PPO,America's PPO,38.412,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
GUAIFENESIN 100 MG/5 ML ORAL LIQD,,7844,LOCAL,Facility,Both,118,mL,,40,34,11.464,40,BlueCross BlueShield Minnesota, Federal Employee Program,39.36,98.4,,percent of total billed charges,,
GUAIFENESIN 100 MG/5 ML ORAL LIQD,,7844,LOCAL,Facility,Both,118,mL,,40,34,11.464,40,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,40,100,,percent of total billed charges,,
GUAIFENESIN 100 MG/5 ML ORAL LIQD,,7844,LOCAL,Facility,Both,118,mL,,40,34,11.464,40,BlueCross BlueShield Minnesota,High Value Network Plan,36,90,,percent of total billed charges,,
GUAIFENESIN 100 MG/5 ML ORAL LIQD,,7844,LOCAL,Facility,Outpatient,118,mL,,40,34,11.464,40,BlueCross BlueShield Minnesota,Medicare Advantage,19.6,49,,percent of total billed charges,,
GUAIFENESIN 100 MG/5 ML ORAL LIQD,,7844,LOCAL,Facility,Inpatient,118,mL,,40,34,11.464,40,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
GUAIFENESIN 100 MG/5 ML ORAL LIQD,,7844,LOCAL,Facility,Both,118,mL,,40,34,11.464,40,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,35.428,88.57,,percent of total billed charges,,
GUAIFENESIN 100 MG/5 ML ORAL LIQD,,7844,LOCAL,Facility,Both,118,mL,,40,34,11.464,40,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,11.464,28.66,,percent of total billed charges,,
GUAIFENESIN 100 MG/5 ML ORAL LIQD,,7844,LOCAL,Facility,Outpatient,118,mL,,40,34,11.464,40,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),19.6,49,,percent of total billed charges,,
GUAIFENESIN 100 MG/5 ML ORAL LIQD,,7844,LOCAL,Facility,Inpatient,118,mL,,40,34,11.464,40,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
GUAIFENESIN 100 MG/5 ML ORAL LIQD,,7844,LOCAL,Facility,Both,118,mL,,40,34,11.464,40,CorVel,Worker's Compensation,40,100,,percent of total billed charges,,
GUAIFENESIN 100 MG/5 ML ORAL LIQD,,7844,LOCAL,Facility,Both,118,mL,,40,34,11.464,40,First Health Group Corporation,First Health Network,38.8,97,,percent of total billed charges,,
GUAIFENESIN 100 MG/5 ML ORAL LIQD,,7844,LOCAL,Facility,Both,118,mL,,40,34,11.464,40,"Health Partners, Inc.",Commercial,37.84,94.6,,percent of total billed charges,,
GUAIFENESIN 100 MG/5 ML ORAL LIQD,,7844,LOCAL,Facility,Outpatient,118,mL,,40,34,11.464,40,"Health Partners, Inc.",Medicare Advantage,19.6,49,,percent of total billed charges,,
GUAIFENESIN 100 MG/5 ML ORAL LIQD,,7844,LOCAL,Facility,Inpatient,118,mL,,40,34,11.464,40,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
GUAIFENESIN 100 MG/5 ML ORAL LIQD,,7844,LOCAL,Facility,Both,118,mL,,40,34,11.464,40,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),24,60,,percent of total billed charges,,
GUAIFENESIN 100 MG/5 ML ORAL LIQD,,7844,LOCAL,Facility,Both,118,mL,,40,34,11.464,40,"Health Partners, Inc.",State of Minnesota Advantage Program,32.6,81.5,,percent of total billed charges,,
GUAIFENESIN 100 MG/5 ML ORAL LIQD,,7844,LOCAL,Facility,Both,118,mL,,40,34,11.464,40,"Health Partners, Inc.",State Public Programs,20,50,,percent of total billed charges,,
GUAIFENESIN 100 MG/5 ML ORAL LIQD,,7844,LOCAL,Facility,Both,118,mL,,40,34,11.464,40,Humana Insurance Company,Commercial PPO,38,95,,percent of total billed charges,,
GUAIFENESIN 100 MG/5 ML ORAL LIQD,,7844,LOCAL,Facility,Outpatient,118,mL,,40,34,11.464,40,Humana Insurance Company,Medicare PPO,19.6,49,,percent of total billed charges,,
GUAIFENESIN 100 MG/5 ML ORAL LIQD,,7844,LOCAL,Facility,Inpatient,118,mL,,40,34,11.464,40,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
GUAIFENESIN 100 MG/5 ML ORAL LIQD,,7844,LOCAL,Facility,Both,118,mL,,40,34,11.464,40,Medica,Individual & Family,39.64,99.1,,percent of total billed charges,,
GUAIFENESIN 100 MG/5 ML ORAL LIQD,,7844,LOCAL,Facility,Outpatient,118,mL,,40,34,11.464,40,Medica,Medica Advantage Solution,19.92,49.8,,percent of total billed charges,,
GUAIFENESIN 100 MG/5 ML ORAL LIQD,,7844,LOCAL,Facility,Inpatient,118,mL,,40,34,11.464,40,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
GUAIFENESIN 100 MG/5 ML ORAL LIQD,,7844,LOCAL,Facility,Outpatient,118,mL,,40,34,11.464,40,Medica,Medical Assistance,17.84,44.6,,percent of total billed charges,,
GUAIFENESIN 100 MG/5 ML ORAL LIQD,,7844,LOCAL,Facility,Inpatient,118,mL,,40,34,11.464,40,Medica,Medical Assistance,,,,,Included in per diem rate,
GUAIFENESIN 100 MG/5 ML ORAL LIQD,,7844,LOCAL,Facility,Outpatient,118,mL,,40,34,11.464,40,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,19.92,49.8,,percent of total billed charges,,
GUAIFENESIN 100 MG/5 ML ORAL LIQD,,7844,LOCAL,Facility,Inpatient,118,mL,,40,34,11.464,40,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
GUAIFENESIN 100 MG/5 ML ORAL LIQD,,7844,LOCAL,Facility,Both,118,mL,,40,34,11.464,40,"Multiplan, Inc.","Multiplan, Inc.",37.6,94,,percent of total billed charges,,
GUAIFENESIN 100 MG/5 ML ORAL LIQD,,7844,LOCAL,Facility,Outpatient,118,mL,,40,34,11.464,40,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,36.04,90.1,,percent of total billed charges,,
GUAIFENESIN 100 MG/5 ML ORAL LIQD,,7844,LOCAL,Facility,Inpatient,118,mL,,40,34,11.464,40,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
GUAIFENESIN 100 MG/5 ML ORAL LIQD,,7844,LOCAL,Facility,Both,118,mL,,40,34,11.464,40,"Preferred One Administrative Services, INC.",PPO,39.44,98.6,,percent of total billed charges,,
GUAIFENESIN 100 MG/5 ML ORAL LIQD,,7844,LOCAL,Facility,Outpatient,118,mL,,40,34,11.464,40,PrimeWest Health,Minnesota Senior Health Options (MSHO),20.58,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
GUAIFENESIN 100 MG/5 ML ORAL LIQD,,7844,LOCAL,Facility,Inpatient,118,mL,,40,34,11.464,40,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
GUAIFENESIN 100 MG/5 ML ORAL LIQD,,7844,LOCAL,Facility,Outpatient,118,mL,,40,34,11.464,40,PrimeWest Health,MinnesotaCare,20.544,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
GUAIFENESIN 100 MG/5 ML ORAL LIQD,,7844,LOCAL,Facility,Inpatient,118,mL,,40,34,11.464,40,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
GUAIFENESIN 100 MG/5 ML ORAL LIQD,,7844,LOCAL,Facility,Both,118,mL,,40,34,11.464,40,Sanford Health Plan,Sanford Health Plan,36.8,92,,percent of total billed charges,,
GUAIFENESIN 100 MG/5 ML ORAL LIQD,,7844,LOCAL,Facility,Outpatient,118,mL,,40,34,11.464,40,"UCare Health, Inc.",Individual & Family Plan,22.54,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
GUAIFENESIN 100 MG/5 ML ORAL LIQD,,7844,LOCAL,Facility,Inpatient,118,mL,,40,34,11.464,40,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
GUAIFENESIN 100 MG/5 ML ORAL LIQD,,7844,LOCAL,Facility,Outpatient,118,mL,,40,34,11.464,40,"UCare Health, Inc.",Medical Assistance,20.188,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
GUAIFENESIN 100 MG/5 ML ORAL LIQD,,7844,LOCAL,Facility,Inpatient,118,mL,,40,34,11.464,40,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
GUAIFENESIN 100 MG/5 ML ORAL LIQD,,7844,LOCAL,Facility,Outpatient,118,mL,,40,34,11.464,40,"UCare Health, Inc.",Medicare Advantage,20.188,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
GUAIFENESIN 100 MG/5 ML ORAL LIQD,,7844,LOCAL,Facility,Inpatient,118,mL,,40,34,11.464,40,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
GUAIFENESIN 100 MG/5 ML ORAL LIQD,,7844,LOCAL,Facility,Outpatient,118,mL,,40,34,11.464,40,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),20.188,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
GUAIFENESIN 100 MG/5 ML ORAL LIQD,,7844,LOCAL,Facility,Inpatient,118,mL,,40,34,11.464,40,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
GUAIFENESIN 100 MG/5 ML ORAL LIQD,,7844,LOCAL,Facility,Both,118,mL,,40,34,11.464,40,UnitedHealthcare,Individual & Family,37.6,94,,percent of total billed charges,,
GUAIFENESIN 100 MG/5 ML ORAL LIQD,,7844,LOCAL,Facility,Outpatient,118,mL,,40,34,11.464,40,UnitedHealthcare,Medicare Advantage,19.6,49,,percent of total billed charges,,
GUAIFENESIN 100 MG/5 ML ORAL LIQD,,7844,LOCAL,Facility,Inpatient,118,mL,,40,34,11.464,40,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
GUAIFENESIN 100 MG/5 ML ORAL LIQD,,7844,LOCAL,Facility,Outpatient,118,mL,,40,34,11.464,40,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,19.2,48,,percent of total billed charges,,100% of DHS outpatient percentage
GUAIFENESIN 100 MG/5 ML ORAL LIQD,,7844,LOCAL,Facility,Inpatient,118,mL,,40,34,11.464,40,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
PSEUDOEPHEDRINE HCL 15 MG/5 ML ORAL LIQD,,8899,LOCAL,Facility,Both,118,mL,,31,26.35,8.8846,31,Aetna,Commercial,28.52,92,,percent of total billed charges,,
PSEUDOEPHEDRINE HCL 15 MG/5 ML ORAL LIQD,,8899,LOCAL,Facility,Outpatient,118,mL,,31,26.35,8.8846,31,Aetna,Medicare Advantage,15.19,49,,percent of total billed charges,,
PSEUDOEPHEDRINE HCL 15 MG/5 ML ORAL LIQD,,8899,LOCAL,Facility,Inpatient,118,mL,,31,26.35,8.8846,31,Aetna,Medicare Advantage,,,,,Included in per diem rate,
PSEUDOEPHEDRINE HCL 15 MG/5 ML ORAL LIQD,,8899,LOCAL,Facility,Both,118,mL,,31,26.35,8.8846,31,Aetna,PPO,28.83,93,,percent of total billed charges,,
PSEUDOEPHEDRINE HCL 15 MG/5 ML ORAL LIQD,,8899,LOCAL,Facility,Both,118,mL,,31,26.35,8.8846,31,America's PPO,America's PPO,29.7693,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
PSEUDOEPHEDRINE HCL 15 MG/5 ML ORAL LIQD,,8899,LOCAL,Facility,Both,118,mL,,31,26.35,8.8846,31,BlueCross BlueShield Minnesota, Federal Employee Program,30.504,98.4,,percent of total billed charges,,
PSEUDOEPHEDRINE HCL 15 MG/5 ML ORAL LIQD,,8899,LOCAL,Facility,Both,118,mL,,31,26.35,8.8846,31,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,31,100,,percent of total billed charges,,
PSEUDOEPHEDRINE HCL 15 MG/5 ML ORAL LIQD,,8899,LOCAL,Facility,Both,118,mL,,31,26.35,8.8846,31,BlueCross BlueShield Minnesota,High Value Network Plan,27.9,90,,percent of total billed charges,,
PSEUDOEPHEDRINE HCL 15 MG/5 ML ORAL LIQD,,8899,LOCAL,Facility,Outpatient,118,mL,,31,26.35,8.8846,31,BlueCross BlueShield Minnesota,Medicare Advantage,15.19,49,,percent of total billed charges,,
PSEUDOEPHEDRINE HCL 15 MG/5 ML ORAL LIQD,,8899,LOCAL,Facility,Inpatient,118,mL,,31,26.35,8.8846,31,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
PSEUDOEPHEDRINE HCL 15 MG/5 ML ORAL LIQD,,8899,LOCAL,Facility,Both,118,mL,,31,26.35,8.8846,31,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,27.4567,88.57,,percent of total billed charges,,
PSEUDOEPHEDRINE HCL 15 MG/5 ML ORAL LIQD,,8899,LOCAL,Facility,Both,118,mL,,31,26.35,8.8846,31,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,8.8846,28.66,,percent of total billed charges,,
PSEUDOEPHEDRINE HCL 15 MG/5 ML ORAL LIQD,,8899,LOCAL,Facility,Outpatient,118,mL,,31,26.35,8.8846,31,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),15.19,49,,percent of total billed charges,,
PSEUDOEPHEDRINE HCL 15 MG/5 ML ORAL LIQD,,8899,LOCAL,Facility,Inpatient,118,mL,,31,26.35,8.8846,31,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
PSEUDOEPHEDRINE HCL 15 MG/5 ML ORAL LIQD,,8899,LOCAL,Facility,Both,118,mL,,31,26.35,8.8846,31,CorVel,Worker's Compensation,31,100,,percent of total billed charges,,
PSEUDOEPHEDRINE HCL 15 MG/5 ML ORAL LIQD,,8899,LOCAL,Facility,Both,118,mL,,31,26.35,8.8846,31,First Health Group Corporation,First Health Network,30.07,97,,percent of total billed charges,,
PSEUDOEPHEDRINE HCL 15 MG/5 ML ORAL LIQD,,8899,LOCAL,Facility,Both,118,mL,,31,26.35,8.8846,31,"Health Partners, Inc.",Commercial,29.326,94.6,,percent of total billed charges,,
PSEUDOEPHEDRINE HCL 15 MG/5 ML ORAL LIQD,,8899,LOCAL,Facility,Outpatient,118,mL,,31,26.35,8.8846,31,"Health Partners, Inc.",Medicare Advantage,15.19,49,,percent of total billed charges,,
PSEUDOEPHEDRINE HCL 15 MG/5 ML ORAL LIQD,,8899,LOCAL,Facility,Inpatient,118,mL,,31,26.35,8.8846,31,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PSEUDOEPHEDRINE HCL 15 MG/5 ML ORAL LIQD,,8899,LOCAL,Facility,Both,118,mL,,31,26.35,8.8846,31,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),18.6,60,,percent of total billed charges,,
PSEUDOEPHEDRINE HCL 15 MG/5 ML ORAL LIQD,,8899,LOCAL,Facility,Both,118,mL,,31,26.35,8.8846,31,"Health Partners, Inc.",State of Minnesota Advantage Program,25.265,81.5,,percent of total billed charges,,
PSEUDOEPHEDRINE HCL 15 MG/5 ML ORAL LIQD,,8899,LOCAL,Facility,Both,118,mL,,31,26.35,8.8846,31,"Health Partners, Inc.",State Public Programs,15.5,50,,percent of total billed charges,,
PSEUDOEPHEDRINE HCL 15 MG/5 ML ORAL LIQD,,8899,LOCAL,Facility,Both,118,mL,,31,26.35,8.8846,31,Humana Insurance Company,Commercial PPO,29.45,95,,percent of total billed charges,,
PSEUDOEPHEDRINE HCL 15 MG/5 ML ORAL LIQD,,8899,LOCAL,Facility,Outpatient,118,mL,,31,26.35,8.8846,31,Humana Insurance Company,Medicare PPO,15.19,49,,percent of total billed charges,,
PSEUDOEPHEDRINE HCL 15 MG/5 ML ORAL LIQD,,8899,LOCAL,Facility,Inpatient,118,mL,,31,26.35,8.8846,31,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
PSEUDOEPHEDRINE HCL 15 MG/5 ML ORAL LIQD,,8899,LOCAL,Facility,Both,118,mL,,31,26.35,8.8846,31,Medica,Individual & Family,30.721,99.1,,percent of total billed charges,,
PSEUDOEPHEDRINE HCL 15 MG/5 ML ORAL LIQD,,8899,LOCAL,Facility,Outpatient,118,mL,,31,26.35,8.8846,31,Medica,Medica Advantage Solution,15.438,49.8,,percent of total billed charges,,
PSEUDOEPHEDRINE HCL 15 MG/5 ML ORAL LIQD,,8899,LOCAL,Facility,Inpatient,118,mL,,31,26.35,8.8846,31,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
PSEUDOEPHEDRINE HCL 15 MG/5 ML ORAL LIQD,,8899,LOCAL,Facility,Outpatient,118,mL,,31,26.35,8.8846,31,Medica,Medical Assistance,13.826,44.6,,percent of total billed charges,,
PSEUDOEPHEDRINE HCL 15 MG/5 ML ORAL LIQD,,8899,LOCAL,Facility,Inpatient,118,mL,,31,26.35,8.8846,31,Medica,Medical Assistance,,,,,Included in per diem rate,
PSEUDOEPHEDRINE HCL 15 MG/5 ML ORAL LIQD,,8899,LOCAL,Facility,Outpatient,118,mL,,31,26.35,8.8846,31,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,15.438,49.8,,percent of total billed charges,,
PSEUDOEPHEDRINE HCL 15 MG/5 ML ORAL LIQD,,8899,LOCAL,Facility,Inpatient,118,mL,,31,26.35,8.8846,31,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
PSEUDOEPHEDRINE HCL 15 MG/5 ML ORAL LIQD,,8899,LOCAL,Facility,Both,118,mL,,31,26.35,8.8846,31,"Multiplan, Inc.","Multiplan, Inc.",29.14,94,,percent of total billed charges,,
PSEUDOEPHEDRINE HCL 15 MG/5 ML ORAL LIQD,,8899,LOCAL,Facility,Outpatient,118,mL,,31,26.35,8.8846,31,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,27.931,90.1,,percent of total billed charges,,
PSEUDOEPHEDRINE HCL 15 MG/5 ML ORAL LIQD,,8899,LOCAL,Facility,Inpatient,118,mL,,31,26.35,8.8846,31,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
PSEUDOEPHEDRINE HCL 15 MG/5 ML ORAL LIQD,,8899,LOCAL,Facility,Both,118,mL,,31,26.35,8.8846,31,"Preferred One Administrative Services, INC.",PPO,30.566,98.6,,percent of total billed charges,,
PSEUDOEPHEDRINE HCL 15 MG/5 ML ORAL LIQD,,8899,LOCAL,Facility,Outpatient,118,mL,,31,26.35,8.8846,31,PrimeWest Health,Minnesota Senior Health Options (MSHO),15.9495,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
PSEUDOEPHEDRINE HCL 15 MG/5 ML ORAL LIQD,,8899,LOCAL,Facility,Inpatient,118,mL,,31,26.35,8.8846,31,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PSEUDOEPHEDRINE HCL 15 MG/5 ML ORAL LIQD,,8899,LOCAL,Facility,Outpatient,118,mL,,31,26.35,8.8846,31,PrimeWest Health,MinnesotaCare,15.9216,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
PSEUDOEPHEDRINE HCL 15 MG/5 ML ORAL LIQD,,8899,LOCAL,Facility,Inpatient,118,mL,,31,26.35,8.8846,31,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
PSEUDOEPHEDRINE HCL 15 MG/5 ML ORAL LIQD,,8899,LOCAL,Facility,Both,118,mL,,31,26.35,8.8846,31,Sanford Health Plan,Sanford Health Plan,28.52,92,,percent of total billed charges,,
PSEUDOEPHEDRINE HCL 15 MG/5 ML ORAL LIQD,,8899,LOCAL,Facility,Outpatient,118,mL,,31,26.35,8.8846,31,"UCare Health, Inc.",Individual & Family Plan,17.4685,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
PSEUDOEPHEDRINE HCL 15 MG/5 ML ORAL LIQD,,8899,LOCAL,Facility,Inpatient,118,mL,,31,26.35,8.8846,31,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
PSEUDOEPHEDRINE HCL 15 MG/5 ML ORAL LIQD,,8899,LOCAL,Facility,Outpatient,118,mL,,31,26.35,8.8846,31,"UCare Health, Inc.",Medical Assistance,15.6457,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PSEUDOEPHEDRINE HCL 15 MG/5 ML ORAL LIQD,,8899,LOCAL,Facility,Inpatient,118,mL,,31,26.35,8.8846,31,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
PSEUDOEPHEDRINE HCL 15 MG/5 ML ORAL LIQD,,8899,LOCAL,Facility,Outpatient,118,mL,,31,26.35,8.8846,31,"UCare Health, Inc.",Medicare Advantage,15.6457,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PSEUDOEPHEDRINE HCL 15 MG/5 ML ORAL LIQD,,8899,LOCAL,Facility,Inpatient,118,mL,,31,26.35,8.8846,31,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PSEUDOEPHEDRINE HCL 15 MG/5 ML ORAL LIQD,,8899,LOCAL,Facility,Outpatient,118,mL,,31,26.35,8.8846,31,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),15.6457,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PSEUDOEPHEDRINE HCL 15 MG/5 ML ORAL LIQD,,8899,LOCAL,Facility,Inpatient,118,mL,,31,26.35,8.8846,31,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PSEUDOEPHEDRINE HCL 15 MG/5 ML ORAL LIQD,,8899,LOCAL,Facility,Both,118,mL,,31,26.35,8.8846,31,UnitedHealthcare,Individual & Family,29.14,94,,percent of total billed charges,,
PSEUDOEPHEDRINE HCL 15 MG/5 ML ORAL LIQD,,8899,LOCAL,Facility,Outpatient,118,mL,,31,26.35,8.8846,31,UnitedHealthcare,Medicare Advantage,15.19,49,,percent of total billed charges,,
PSEUDOEPHEDRINE HCL 15 MG/5 ML ORAL LIQD,,8899,LOCAL,Facility,Inpatient,118,mL,,31,26.35,8.8846,31,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
PSEUDOEPHEDRINE HCL 15 MG/5 ML ORAL LIQD,,8899,LOCAL,Facility,Outpatient,118,mL,,31,26.35,8.8846,31,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,14.88,48,,percent of total billed charges,,100% of DHS outpatient percentage
PSEUDOEPHEDRINE HCL 15 MG/5 ML ORAL LIQD,,8899,LOCAL,Facility,Inpatient,118,mL,,31,26.35,8.8846,31,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
BALANCED SALT SOLN NON-SURG 3 OPHT SOLN,,34941,LOCAL,Facility,Both,118,mL,,166,141.1,47.5756,166,Aetna,Commercial,152.72,92,,percent of total billed charges,,
BALANCED SALT SOLN NON-SURG 3 OPHT SOLN,,34941,LOCAL,Facility,Outpatient,118,mL,,166,141.1,47.5756,166,Aetna,Medicare Advantage,81.34,49,,percent of total billed charges,,
BALANCED SALT SOLN NON-SURG 3 OPHT SOLN,,34941,LOCAL,Facility,Inpatient,118,mL,,166,141.1,47.5756,166,Aetna,Medicare Advantage,,,,,Included in per diem rate,
BALANCED SALT SOLN NON-SURG 3 OPHT SOLN,,34941,LOCAL,Facility,Both,118,mL,,166,141.1,47.5756,166,Aetna,PPO,154.38,93,,percent of total billed charges,,
BALANCED SALT SOLN NON-SURG 3 OPHT SOLN,,34941,LOCAL,Facility,Both,118,mL,,166,141.1,47.5756,166,America's PPO,America's PPO,159.4098,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
BALANCED SALT SOLN NON-SURG 3 OPHT SOLN,,34941,LOCAL,Facility,Both,118,mL,,166,141.1,47.5756,166,BlueCross BlueShield Minnesota, Federal Employee Program,163.344,98.4,,percent of total billed charges,,
BALANCED SALT SOLN NON-SURG 3 OPHT SOLN,,34941,LOCAL,Facility,Both,118,mL,,166,141.1,47.5756,166,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,166,100,,percent of total billed charges,,
BALANCED SALT SOLN NON-SURG 3 OPHT SOLN,,34941,LOCAL,Facility,Both,118,mL,,166,141.1,47.5756,166,BlueCross BlueShield Minnesota,High Value Network Plan,149.4,90,,percent of total billed charges,,
BALANCED SALT SOLN NON-SURG 3 OPHT SOLN,,34941,LOCAL,Facility,Outpatient,118,mL,,166,141.1,47.5756,166,BlueCross BlueShield Minnesota,Medicare Advantage,81.34,49,,percent of total billed charges,,
BALANCED SALT SOLN NON-SURG 3 OPHT SOLN,,34941,LOCAL,Facility,Inpatient,118,mL,,166,141.1,47.5756,166,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
BALANCED SALT SOLN NON-SURG 3 OPHT SOLN,,34941,LOCAL,Facility,Both,118,mL,,166,141.1,47.5756,166,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,147.0262,88.57,,percent of total billed charges,,
BALANCED SALT SOLN NON-SURG 3 OPHT SOLN,,34941,LOCAL,Facility,Both,118,mL,,166,141.1,47.5756,166,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,47.5756,28.66,,percent of total billed charges,,
BALANCED SALT SOLN NON-SURG 3 OPHT SOLN,,34941,LOCAL,Facility,Outpatient,118,mL,,166,141.1,47.5756,166,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),81.34,49,,percent of total billed charges,,
BALANCED SALT SOLN NON-SURG 3 OPHT SOLN,,34941,LOCAL,Facility,Inpatient,118,mL,,166,141.1,47.5756,166,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
BALANCED SALT SOLN NON-SURG 3 OPHT SOLN,,34941,LOCAL,Facility,Both,118,mL,,166,141.1,47.5756,166,CorVel,Worker's Compensation,166,100,,percent of total billed charges,,
BALANCED SALT SOLN NON-SURG 3 OPHT SOLN,,34941,LOCAL,Facility,Both,118,mL,,166,141.1,47.5756,166,First Health Group Corporation,First Health Network,161.02,97,,percent of total billed charges,,
BALANCED SALT SOLN NON-SURG 3 OPHT SOLN,,34941,LOCAL,Facility,Both,118,mL,,166,141.1,47.5756,166,"Health Partners, Inc.",Commercial,157.036,94.6,,percent of total billed charges,,
BALANCED SALT SOLN NON-SURG 3 OPHT SOLN,,34941,LOCAL,Facility,Outpatient,118,mL,,166,141.1,47.5756,166,"Health Partners, Inc.",Medicare Advantage,81.34,49,,percent of total billed charges,,
BALANCED SALT SOLN NON-SURG 3 OPHT SOLN,,34941,LOCAL,Facility,Inpatient,118,mL,,166,141.1,47.5756,166,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
BALANCED SALT SOLN NON-SURG 3 OPHT SOLN,,34941,LOCAL,Facility,Both,118,mL,,166,141.1,47.5756,166,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),99.6,60,,percent of total billed charges,,
BALANCED SALT SOLN NON-SURG 3 OPHT SOLN,,34941,LOCAL,Facility,Both,118,mL,,166,141.1,47.5756,166,"Health Partners, Inc.",State of Minnesota Advantage Program,135.29,81.5,,percent of total billed charges,,
BALANCED SALT SOLN NON-SURG 3 OPHT SOLN,,34941,LOCAL,Facility,Both,118,mL,,166,141.1,47.5756,166,"Health Partners, Inc.",State Public Programs,83,50,,percent of total billed charges,,
BALANCED SALT SOLN NON-SURG 3 OPHT SOLN,,34941,LOCAL,Facility,Both,118,mL,,166,141.1,47.5756,166,Humana Insurance Company,Commercial PPO,157.7,95,,percent of total billed charges,,
BALANCED SALT SOLN NON-SURG 3 OPHT SOLN,,34941,LOCAL,Facility,Outpatient,118,mL,,166,141.1,47.5756,166,Humana Insurance Company,Medicare PPO,81.34,49,,percent of total billed charges,,
BALANCED SALT SOLN NON-SURG 3 OPHT SOLN,,34941,LOCAL,Facility,Inpatient,118,mL,,166,141.1,47.5756,166,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
BALANCED SALT SOLN NON-SURG 3 OPHT SOLN,,34941,LOCAL,Facility,Both,118,mL,,166,141.1,47.5756,166,Medica,Individual & Family,164.506,99.1,,percent of total billed charges,,
BALANCED SALT SOLN NON-SURG 3 OPHT SOLN,,34941,LOCAL,Facility,Outpatient,118,mL,,166,141.1,47.5756,166,Medica,Medica Advantage Solution,82.668,49.8,,percent of total billed charges,,
BALANCED SALT SOLN NON-SURG 3 OPHT SOLN,,34941,LOCAL,Facility,Inpatient,118,mL,,166,141.1,47.5756,166,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
BALANCED SALT SOLN NON-SURG 3 OPHT SOLN,,34941,LOCAL,Facility,Outpatient,118,mL,,166,141.1,47.5756,166,Medica,Medical Assistance,74.036,44.6,,percent of total billed charges,,
BALANCED SALT SOLN NON-SURG 3 OPHT SOLN,,34941,LOCAL,Facility,Inpatient,118,mL,,166,141.1,47.5756,166,Medica,Medical Assistance,,,,,Included in per diem rate,
BALANCED SALT SOLN NON-SURG 3 OPHT SOLN,,34941,LOCAL,Facility,Outpatient,118,mL,,166,141.1,47.5756,166,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,82.668,49.8,,percent of total billed charges,,
BALANCED SALT SOLN NON-SURG 3 OPHT SOLN,,34941,LOCAL,Facility,Inpatient,118,mL,,166,141.1,47.5756,166,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
BALANCED SALT SOLN NON-SURG 3 OPHT SOLN,,34941,LOCAL,Facility,Both,118,mL,,166,141.1,47.5756,166,"Multiplan, Inc.","Multiplan, Inc.",156.04,94,,percent of total billed charges,,
BALANCED SALT SOLN NON-SURG 3 OPHT SOLN,,34941,LOCAL,Facility,Outpatient,118,mL,,166,141.1,47.5756,166,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,149.566,90.1,,percent of total billed charges,,
BALANCED SALT SOLN NON-SURG 3 OPHT SOLN,,34941,LOCAL,Facility,Inpatient,118,mL,,166,141.1,47.5756,166,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
BALANCED SALT SOLN NON-SURG 3 OPHT SOLN,,34941,LOCAL,Facility,Both,118,mL,,166,141.1,47.5756,166,"Preferred One Administrative Services, INC.",PPO,163.676,98.6,,percent of total billed charges,,
BALANCED SALT SOLN NON-SURG 3 OPHT SOLN,,34941,LOCAL,Facility,Outpatient,118,mL,,166,141.1,47.5756,166,PrimeWest Health,Minnesota Senior Health Options (MSHO),85.407,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
BALANCED SALT SOLN NON-SURG 3 OPHT SOLN,,34941,LOCAL,Facility,Inpatient,118,mL,,166,141.1,47.5756,166,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
BALANCED SALT SOLN NON-SURG 3 OPHT SOLN,,34941,LOCAL,Facility,Outpatient,118,mL,,166,141.1,47.5756,166,PrimeWest Health,MinnesotaCare,85.2576,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
BALANCED SALT SOLN NON-SURG 3 OPHT SOLN,,34941,LOCAL,Facility,Inpatient,118,mL,,166,141.1,47.5756,166,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
BALANCED SALT SOLN NON-SURG 3 OPHT SOLN,,34941,LOCAL,Facility,Both,118,mL,,166,141.1,47.5756,166,Sanford Health Plan,Sanford Health Plan,152.72,92,,percent of total billed charges,,
BALANCED SALT SOLN NON-SURG 3 OPHT SOLN,,34941,LOCAL,Facility,Outpatient,118,mL,,166,141.1,47.5756,166,"UCare Health, Inc.",Individual & Family Plan,93.541,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
BALANCED SALT SOLN NON-SURG 3 OPHT SOLN,,34941,LOCAL,Facility,Inpatient,118,mL,,166,141.1,47.5756,166,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
BALANCED SALT SOLN NON-SURG 3 OPHT SOLN,,34941,LOCAL,Facility,Outpatient,118,mL,,166,141.1,47.5756,166,"UCare Health, Inc.",Medical Assistance,83.7802,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BALANCED SALT SOLN NON-SURG 3 OPHT SOLN,,34941,LOCAL,Facility,Inpatient,118,mL,,166,141.1,47.5756,166,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
BALANCED SALT SOLN NON-SURG 3 OPHT SOLN,,34941,LOCAL,Facility,Outpatient,118,mL,,166,141.1,47.5756,166,"UCare Health, Inc.",Medicare Advantage,83.7802,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BALANCED SALT SOLN NON-SURG 3 OPHT SOLN,,34941,LOCAL,Facility,Inpatient,118,mL,,166,141.1,47.5756,166,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
BALANCED SALT SOLN NON-SURG 3 OPHT SOLN,,34941,LOCAL,Facility,Outpatient,118,mL,,166,141.1,47.5756,166,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),83.7802,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BALANCED SALT SOLN NON-SURG 3 OPHT SOLN,,34941,LOCAL,Facility,Inpatient,118,mL,,166,141.1,47.5756,166,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
BALANCED SALT SOLN NON-SURG 3 OPHT SOLN,,34941,LOCAL,Facility,Both,118,mL,,166,141.1,47.5756,166,UnitedHealthcare,Individual & Family,156.04,94,,percent of total billed charges,,
BALANCED SALT SOLN NON-SURG 3 OPHT SOLN,,34941,LOCAL,Facility,Outpatient,118,mL,,166,141.1,47.5756,166,UnitedHealthcare,Medicare Advantage,81.34,49,,percent of total billed charges,,
BALANCED SALT SOLN NON-SURG 3 OPHT SOLN,,34941,LOCAL,Facility,Inpatient,118,mL,,166,141.1,47.5756,166,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
BALANCED SALT SOLN NON-SURG 3 OPHT SOLN,,34941,LOCAL,Facility,Outpatient,118,mL,,166,141.1,47.5756,166,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,79.68,48,,percent of total billed charges,,100% of DHS outpatient percentage
BALANCED SALT SOLN NON-SURG 3 OPHT SOLN,,34941,LOCAL,Facility,Inpatient,118,mL,,166,141.1,47.5756,166,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Sup Ambu Bag Infant,,A9999,HCPCS,Facility,Both,,,,59,50.15,16.9094,59,Aetna,Commercial,54.28,92,,percent of total billed charges,,
Sup Ambu Bag Infant,,A9999,HCPCS,Facility,Outpatient,,,,59,50.15,16.9094,59,Aetna,Medicare Advantage,28.91,49,,percent of total billed charges,,
Sup Ambu Bag Infant,,A9999,HCPCS,Facility,Inpatient,,,,59,50.15,16.9094,59,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Sup Ambu Bag Infant,,A9999,HCPCS,Facility,Both,,,,59,50.15,16.9094,59,Aetna,PPO,54.87,93,,percent of total billed charges,,
Sup Ambu Bag Infant,,A9999,HCPCS,Facility,Both,,,,59,50.15,16.9094,59,America's PPO,America's PPO,56.6577,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Sup Ambu Bag Infant,,A9999,HCPCS,Facility,Both,,,,59,50.15,16.9094,59,BlueCross BlueShield Minnesota, Federal Employee Program,58.056,98.4,,percent of total billed charges,,
Sup Ambu Bag Infant,,A9999,HCPCS,Facility,Both,,,,59,50.15,16.9094,59,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,59,100,,percent of total billed charges,,
Sup Ambu Bag Infant,,A9999,HCPCS,Facility,Both,,,,59,50.15,16.9094,59,BlueCross BlueShield Minnesota,High Value Network Plan,53.1,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
Sup Ambu Bag Infant,,A9999,HCPCS,Facility,Outpatient,,,,59,50.15,16.9094,59,BlueCross BlueShield Minnesota,Medicare Advantage,28.91,49,,percent of total billed charges,,
Sup Ambu Bag Infant,,A9999,HCPCS,Facility,Inpatient,,,,59,50.15,16.9094,59,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Sup Ambu Bag Infant,,A9999,HCPCS,Facility,Both,,,,59,50.15,16.9094,59,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,52.2563,88.57,,percent of total billed charges,,
Sup Ambu Bag Infant,,A9999,HCPCS,Facility,Both,,,,59,50.15,16.9094,59,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,16.9094,28.66,,percent of total billed charges,,
Sup Ambu Bag Infant,,A9999,HCPCS,Facility,Outpatient,,,,59,50.15,16.9094,59,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),28.91,49,,percent of total billed charges,,
Sup Ambu Bag Infant,,A9999,HCPCS,Facility,Inpatient,,,,59,50.15,16.9094,59,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Sup Ambu Bag Infant,,A9999,HCPCS,Facility,Both,,,,59,50.15,16.9094,59,CorVel,Worker's Compensation,59,100,,percent of total billed charges,,
Sup Ambu Bag Infant,,A9999,HCPCS,Facility,Both,,,,59,50.15,16.9094,59,First Health Group Corporation,First Health Network,57.23,97,,percent of total billed charges,,
Sup Ambu Bag Infant,,A9999,HCPCS,Facility,Both,,,,59,50.15,16.9094,59,"Health Partners, Inc.",Commercial,55.814,94.6,,percent of total billed charges,,
Sup Ambu Bag Infant,,A9999,HCPCS,Facility,Outpatient,,,,59,50.15,16.9094,59,"Health Partners, Inc.",Medicare Advantage,28.91,49,,percent of total billed charges,,
Sup Ambu Bag Infant,,A9999,HCPCS,Facility,Inpatient,,,,59,50.15,16.9094,59,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Ambu Bag Infant,,A9999,HCPCS,Facility,Both,,,,59,50.15,16.9094,59,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),35.4,60,,percent of total billed charges,,
Sup Ambu Bag Infant,,A9999,HCPCS,Facility,Both,,,,59,50.15,16.9094,59,"Health Partners, Inc.",State of Minnesota Advantage Program,48.085,81.5,,percent of total billed charges,,
Sup Ambu Bag Infant,,A9999,HCPCS,Facility,Both,,,,59,50.15,16.9094,59,"Health Partners, Inc.",State Public Programs,29.5,50,,percent of total billed charges,,
Sup Ambu Bag Infant,,A9999,HCPCS,Facility,Both,,,,59,50.15,16.9094,59,Humana Insurance Company,Commercial PPO,56.05,95,,percent of total billed charges,,
Sup Ambu Bag Infant,,A9999,HCPCS,Facility,Outpatient,,,,59,50.15,16.9094,59,Humana Insurance Company,Medicare PPO,28.91,49,,percent of total billed charges,,
Sup Ambu Bag Infant,,A9999,HCPCS,Facility,Inpatient,,,,59,50.15,16.9094,59,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Sup Ambu Bag Infant,,A9999,HCPCS,Facility,Both,,,,59,50.15,16.9094,59,Medica,Individual & Family,58.469,99.1,,percent of total billed charges,,
Sup Ambu Bag Infant,,A9999,HCPCS,Facility,Outpatient,,,,59,50.15,16.9094,59,Medica,Medica Advantage Solution,29.382,49.8,,percent of total billed charges,,
Sup Ambu Bag Infant,,A9999,HCPCS,Facility,Inpatient,,,,59,50.15,16.9094,59,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Sup Ambu Bag Infant,,A9999,HCPCS,Facility,Outpatient,,,,59,50.15,16.9094,59,Medica,Medical Assistance,26.314,44.6,,percent of total billed charges,,
Sup Ambu Bag Infant,,A9999,HCPCS,Facility,Inpatient,,,,59,50.15,16.9094,59,Medica,Medical Assistance,,,,,Included in per diem rate,
Sup Ambu Bag Infant,,A9999,HCPCS,Facility,Outpatient,,,,59,50.15,16.9094,59,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,29.382,49.8,,percent of total billed charges,,
Sup Ambu Bag Infant,,A9999,HCPCS,Facility,Inpatient,,,,59,50.15,16.9094,59,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Sup Ambu Bag Infant,,A9999,HCPCS,Facility,Both,,,,59,50.15,16.9094,59,"Multiplan, Inc.","Multiplan, Inc.",55.46,94,,percent of total billed charges,,
Sup Ambu Bag Infant,,A9999,HCPCS,Facility,Outpatient,,,,59,50.15,16.9094,59,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,53.159,90.1,,percent of total billed charges,,
Sup Ambu Bag Infant,,A9999,HCPCS,Facility,Inpatient,,,,59,50.15,16.9094,59,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Sup Ambu Bag Infant,,A9999,HCPCS,Facility,Both,,,,59,50.15,16.9094,59,"Preferred One Administrative Services, INC.",PPO,58.174,98.6,,percent of total billed charges,,
Sup Ambu Bag Infant,,A9999,HCPCS,Facility,Outpatient,,,,59,50.15,16.9094,59,PrimeWest Health,Minnesota Senior Health Options (MSHO),30.3555,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Sup Ambu Bag Infant,,A9999,HCPCS,Facility,Inpatient,,,,59,50.15,16.9094,59,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Ambu Bag Infant,,A9999,HCPCS,Facility,Outpatient,,,,59,50.15,16.9094,59,PrimeWest Health,MinnesotaCare,30.3024,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Sup Ambu Bag Infant,,A9999,HCPCS,Facility,Inpatient,,,,59,50.15,16.9094,59,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Sup Ambu Bag Infant,,A9999,HCPCS,Facility,Both,,,,59,50.15,16.9094,59,Sanford Health Plan,Sanford Health Plan,54.28,92,,percent of total billed charges,,
Sup Ambu Bag Infant,,A9999,HCPCS,Facility,Outpatient,,,,59,50.15,16.9094,59,"UCare Health, Inc.",Individual & Family Plan,33.2465,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Sup Ambu Bag Infant,,A9999,HCPCS,Facility,Inpatient,,,,59,50.15,16.9094,59,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Sup Ambu Bag Infant,,A9999,HCPCS,Facility,Outpatient,,,,59,50.15,16.9094,59,"UCare Health, Inc.",Medical Assistance,29.7773,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Ambu Bag Infant,,A9999,HCPCS,Facility,Inpatient,,,,59,50.15,16.9094,59,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Sup Ambu Bag Infant,,A9999,HCPCS,Facility,Outpatient,,,,59,50.15,16.9094,59,"UCare Health, Inc.",Medicare Advantage,29.7773,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Ambu Bag Infant,,A9999,HCPCS,Facility,Inpatient,,,,59,50.15,16.9094,59,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Ambu Bag Infant,,A9999,HCPCS,Facility,Outpatient,,,,59,50.15,16.9094,59,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),29.7773,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Ambu Bag Infant,,A9999,HCPCS,Facility,Inpatient,,,,59,50.15,16.9094,59,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Ambu Bag Infant,,A9999,HCPCS,Facility,Both,,,,59,50.15,16.9094,59,UnitedHealthcare,Individual & Family,55.46,94,,percent of total billed charges,,
Sup Ambu Bag Infant,,A9999,HCPCS,Facility,Outpatient,,,,59,50.15,16.9094,59,UnitedHealthcare,Medicare Advantage,28.91,49,,percent of total billed charges,,
Sup Ambu Bag Infant,,A9999,HCPCS,Facility,Inpatient,,,,59,50.15,16.9094,59,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Sup Ambu Bag Infant,,A9999,HCPCS,Facility,Outpatient,,,,59,50.15,16.9094,59,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,28.32,48,,percent of total billed charges,,100% of DHS outpatient percentage
Sup Ambu Bag Infant,,A9999,HCPCS,Facility,Inpatient,,,,59,50.15,16.9094,59,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Sup Brace Wrist,,A9999,HCPCS,Facility,Both,,,,38,32.3,10.8908,38,Aetna,Commercial,34.96,92,,percent of total billed charges,,
Sup Brace Wrist,,A9999,HCPCS,Facility,Outpatient,,,,38,32.3,10.8908,38,Aetna,Medicare Advantage,18.62,49,,percent of total billed charges,,
Sup Brace Wrist,,A9999,HCPCS,Facility,Inpatient,,,,38,32.3,10.8908,38,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Sup Brace Wrist,,A9999,HCPCS,Facility,Both,,,,38,32.3,10.8908,38,Aetna,PPO,35.34,93,,percent of total billed charges,,
Sup Brace Wrist,,A9999,HCPCS,Facility,Both,,,,38,32.3,10.8908,38,America's PPO,America's PPO,36.4914,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Sup Brace Wrist,,A9999,HCPCS,Facility,Both,,,,38,32.3,10.8908,38,BlueCross BlueShield Minnesota, Federal Employee Program,37.392,98.4,,percent of total billed charges,,
Sup Brace Wrist,,A9999,HCPCS,Facility,Both,,,,38,32.3,10.8908,38,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,38,100,,percent of total billed charges,,
Sup Brace Wrist,,A9999,HCPCS,Facility,Both,,,,38,32.3,10.8908,38,BlueCross BlueShield Minnesota,High Value Network Plan,34.2,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
Sup Brace Wrist,,A9999,HCPCS,Facility,Outpatient,,,,38,32.3,10.8908,38,BlueCross BlueShield Minnesota,Medicare Advantage,18.62,49,,percent of total billed charges,,
Sup Brace Wrist,,A9999,HCPCS,Facility,Inpatient,,,,38,32.3,10.8908,38,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Sup Brace Wrist,,A9999,HCPCS,Facility,Both,,,,38,32.3,10.8908,38,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,33.6566,88.57,,percent of total billed charges,,
Sup Brace Wrist,,A9999,HCPCS,Facility,Both,,,,38,32.3,10.8908,38,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,10.8908,28.66,,percent of total billed charges,,
Sup Brace Wrist,,A9999,HCPCS,Facility,Outpatient,,,,38,32.3,10.8908,38,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),18.62,49,,percent of total billed charges,,
Sup Brace Wrist,,A9999,HCPCS,Facility,Inpatient,,,,38,32.3,10.8908,38,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Sup Brace Wrist,,A9999,HCPCS,Facility,Both,,,,38,32.3,10.8908,38,CorVel,Worker's Compensation,38,100,,percent of total billed charges,,
Sup Brace Wrist,,A9999,HCPCS,Facility,Both,,,,38,32.3,10.8908,38,First Health Group Corporation,First Health Network,36.86,97,,percent of total billed charges,,
Sup Brace Wrist,,A9999,HCPCS,Facility,Both,,,,38,32.3,10.8908,38,"Health Partners, Inc.",Commercial,35.948,94.6,,percent of total billed charges,,
Sup Brace Wrist,,A9999,HCPCS,Facility,Outpatient,,,,38,32.3,10.8908,38,"Health Partners, Inc.",Medicare Advantage,18.62,49,,percent of total billed charges,,
Sup Brace Wrist,,A9999,HCPCS,Facility,Inpatient,,,,38,32.3,10.8908,38,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Brace Wrist,,A9999,HCPCS,Facility,Both,,,,38,32.3,10.8908,38,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),22.8,60,,percent of total billed charges,,
Sup Brace Wrist,,A9999,HCPCS,Facility,Both,,,,38,32.3,10.8908,38,"Health Partners, Inc.",State of Minnesota Advantage Program,30.97,81.5,,percent of total billed charges,,
Sup Brace Wrist,,A9999,HCPCS,Facility,Both,,,,38,32.3,10.8908,38,"Health Partners, Inc.",State Public Programs,19,50,,percent of total billed charges,,
Sup Brace Wrist,,A9999,HCPCS,Facility,Both,,,,38,32.3,10.8908,38,Humana Insurance Company,Commercial PPO,36.1,95,,percent of total billed charges,,
Sup Brace Wrist,,A9999,HCPCS,Facility,Outpatient,,,,38,32.3,10.8908,38,Humana Insurance Company,Medicare PPO,18.62,49,,percent of total billed charges,,
Sup Brace Wrist,,A9999,HCPCS,Facility,Inpatient,,,,38,32.3,10.8908,38,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Sup Brace Wrist,,A9999,HCPCS,Facility,Both,,,,38,32.3,10.8908,38,Medica,Individual & Family,37.658,99.1,,percent of total billed charges,,
Sup Brace Wrist,,A9999,HCPCS,Facility,Outpatient,,,,38,32.3,10.8908,38,Medica,Medica Advantage Solution,18.924,49.8,,percent of total billed charges,,
Sup Brace Wrist,,A9999,HCPCS,Facility,Inpatient,,,,38,32.3,10.8908,38,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Sup Brace Wrist,,A9999,HCPCS,Facility,Outpatient,,,,38,32.3,10.8908,38,Medica,Medical Assistance,16.948,44.6,,percent of total billed charges,,
Sup Brace Wrist,,A9999,HCPCS,Facility,Inpatient,,,,38,32.3,10.8908,38,Medica,Medical Assistance,,,,,Included in per diem rate,
Sup Brace Wrist,,A9999,HCPCS,Facility,Outpatient,,,,38,32.3,10.8908,38,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,18.924,49.8,,percent of total billed charges,,
Sup Brace Wrist,,A9999,HCPCS,Facility,Inpatient,,,,38,32.3,10.8908,38,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Sup Brace Wrist,,A9999,HCPCS,Facility,Both,,,,38,32.3,10.8908,38,"Multiplan, Inc.","Multiplan, Inc.",35.72,94,,percent of total billed charges,,
Sup Brace Wrist,,A9999,HCPCS,Facility,Outpatient,,,,38,32.3,10.8908,38,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,34.238,90.1,,percent of total billed charges,,
Sup Brace Wrist,,A9999,HCPCS,Facility,Inpatient,,,,38,32.3,10.8908,38,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Sup Brace Wrist,,A9999,HCPCS,Facility,Both,,,,38,32.3,10.8908,38,"Preferred One Administrative Services, INC.",PPO,37.468,98.6,,percent of total billed charges,,
Sup Brace Wrist,,A9999,HCPCS,Facility,Outpatient,,,,38,32.3,10.8908,38,PrimeWest Health,Minnesota Senior Health Options (MSHO),19.551,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Sup Brace Wrist,,A9999,HCPCS,Facility,Inpatient,,,,38,32.3,10.8908,38,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Brace Wrist,,A9999,HCPCS,Facility,Outpatient,,,,38,32.3,10.8908,38,PrimeWest Health,MinnesotaCare,19.5168,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Sup Brace Wrist,,A9999,HCPCS,Facility,Inpatient,,,,38,32.3,10.8908,38,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Sup Brace Wrist,,A9999,HCPCS,Facility,Both,,,,38,32.3,10.8908,38,Sanford Health Plan,Sanford Health Plan,34.96,92,,percent of total billed charges,,
Sup Brace Wrist,,A9999,HCPCS,Facility,Outpatient,,,,38,32.3,10.8908,38,"UCare Health, Inc.",Individual & Family Plan,21.413,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Sup Brace Wrist,,A9999,HCPCS,Facility,Inpatient,,,,38,32.3,10.8908,38,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Sup Brace Wrist,,A9999,HCPCS,Facility,Outpatient,,,,38,32.3,10.8908,38,"UCare Health, Inc.",Medical Assistance,19.1786,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Brace Wrist,,A9999,HCPCS,Facility,Inpatient,,,,38,32.3,10.8908,38,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Sup Brace Wrist,,A9999,HCPCS,Facility,Outpatient,,,,38,32.3,10.8908,38,"UCare Health, Inc.",Medicare Advantage,19.1786,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Brace Wrist,,A9999,HCPCS,Facility,Inpatient,,,,38,32.3,10.8908,38,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Brace Wrist,,A9999,HCPCS,Facility,Outpatient,,,,38,32.3,10.8908,38,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),19.1786,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Brace Wrist,,A9999,HCPCS,Facility,Inpatient,,,,38,32.3,10.8908,38,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Brace Wrist,,A9999,HCPCS,Facility,Both,,,,38,32.3,10.8908,38,UnitedHealthcare,Individual & Family,35.72,94,,percent of total billed charges,,
Sup Brace Wrist,,A9999,HCPCS,Facility,Outpatient,,,,38,32.3,10.8908,38,UnitedHealthcare,Medicare Advantage,18.62,49,,percent of total billed charges,,
Sup Brace Wrist,,A9999,HCPCS,Facility,Inpatient,,,,38,32.3,10.8908,38,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Sup Brace Wrist,,A9999,HCPCS,Facility,Outpatient,,,,38,32.3,10.8908,38,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,18.24,48,,percent of total billed charges,,100% of DHS outpatient percentage
Sup Brace Wrist,,A9999,HCPCS,Facility,Inpatient,,,,38,32.3,10.8908,38,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Sup Co2 Detector,,A9999,HCPCS,Facility,Both,,,,46,39.1,13.1836,46,Aetna,Commercial,42.32,92,,percent of total billed charges,,
Sup Co2 Detector,,A9999,HCPCS,Facility,Outpatient,,,,46,39.1,13.1836,46,Aetna,Medicare Advantage,22.54,49,,percent of total billed charges,,
Sup Co2 Detector,,A9999,HCPCS,Facility,Inpatient,,,,46,39.1,13.1836,46,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Sup Co2 Detector,,A9999,HCPCS,Facility,Both,,,,46,39.1,13.1836,46,Aetna,PPO,42.78,93,,percent of total billed charges,,
Sup Co2 Detector,,A9999,HCPCS,Facility,Both,,,,46,39.1,13.1836,46,America's PPO,America's PPO,44.1738,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Sup Co2 Detector,,A9999,HCPCS,Facility,Both,,,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota, Federal Employee Program,45.264,98.4,,percent of total billed charges,,
Sup Co2 Detector,,A9999,HCPCS,Facility,Both,,,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,46,100,,percent of total billed charges,,
Sup Co2 Detector,,A9999,HCPCS,Facility,Both,,,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,High Value Network Plan,41.4,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
Sup Co2 Detector,,A9999,HCPCS,Facility,Outpatient,,,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Medicare Advantage,22.54,49,,percent of total billed charges,,
Sup Co2 Detector,,A9999,HCPCS,Facility,Inpatient,,,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Sup Co2 Detector,,A9999,HCPCS,Facility,Both,,,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,40.7422,88.57,,percent of total billed charges,,
Sup Co2 Detector,,A9999,HCPCS,Facility,Both,,,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,13.1836,28.66,,percent of total billed charges,,
Sup Co2 Detector,,A9999,HCPCS,Facility,Outpatient,,,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),22.54,49,,percent of total billed charges,,
Sup Co2 Detector,,A9999,HCPCS,Facility,Inpatient,,,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Sup Co2 Detector,,A9999,HCPCS,Facility,Both,,,,46,39.1,13.1836,46,CorVel,Worker's Compensation,46,100,,percent of total billed charges,,
Sup Co2 Detector,,A9999,HCPCS,Facility,Both,,,,46,39.1,13.1836,46,First Health Group Corporation,First Health Network,44.62,97,,percent of total billed charges,,
Sup Co2 Detector,,A9999,HCPCS,Facility,Both,,,,46,39.1,13.1836,46,"Health Partners, Inc.",Commercial,43.516,94.6,,percent of total billed charges,,
Sup Co2 Detector,,A9999,HCPCS,Facility,Outpatient,,,,46,39.1,13.1836,46,"Health Partners, Inc.",Medicare Advantage,22.54,49,,percent of total billed charges,,
Sup Co2 Detector,,A9999,HCPCS,Facility,Inpatient,,,,46,39.1,13.1836,46,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Co2 Detector,,A9999,HCPCS,Facility,Both,,,,46,39.1,13.1836,46,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),27.6,60,,percent of total billed charges,,
Sup Co2 Detector,,A9999,HCPCS,Facility,Both,,,,46,39.1,13.1836,46,"Health Partners, Inc.",State of Minnesota Advantage Program,37.49,81.5,,percent of total billed charges,,
Sup Co2 Detector,,A9999,HCPCS,Facility,Both,,,,46,39.1,13.1836,46,"Health Partners, Inc.",State Public Programs,23,50,,percent of total billed charges,,
Sup Co2 Detector,,A9999,HCPCS,Facility,Both,,,,46,39.1,13.1836,46,Humana Insurance Company,Commercial PPO,43.7,95,,percent of total billed charges,,
Sup Co2 Detector,,A9999,HCPCS,Facility,Outpatient,,,,46,39.1,13.1836,46,Humana Insurance Company,Medicare PPO,22.54,49,,percent of total billed charges,,
Sup Co2 Detector,,A9999,HCPCS,Facility,Inpatient,,,,46,39.1,13.1836,46,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Sup Co2 Detector,,A9999,HCPCS,Facility,Both,,,,46,39.1,13.1836,46,Medica,Individual & Family,45.586,99.1,,percent of total billed charges,,
Sup Co2 Detector,,A9999,HCPCS,Facility,Outpatient,,,,46,39.1,13.1836,46,Medica,Medica Advantage Solution,22.908,49.8,,percent of total billed charges,,
Sup Co2 Detector,,A9999,HCPCS,Facility,Inpatient,,,,46,39.1,13.1836,46,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Sup Co2 Detector,,A9999,HCPCS,Facility,Outpatient,,,,46,39.1,13.1836,46,Medica,Medical Assistance,20.516,44.6,,percent of total billed charges,,
Sup Co2 Detector,,A9999,HCPCS,Facility,Inpatient,,,,46,39.1,13.1836,46,Medica,Medical Assistance,,,,,Included in per diem rate,
Sup Co2 Detector,,A9999,HCPCS,Facility,Outpatient,,,,46,39.1,13.1836,46,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,22.908,49.8,,percent of total billed charges,,
Sup Co2 Detector,,A9999,HCPCS,Facility,Inpatient,,,,46,39.1,13.1836,46,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Sup Co2 Detector,,A9999,HCPCS,Facility,Both,,,,46,39.1,13.1836,46,"Multiplan, Inc.","Multiplan, Inc.",43.24,94,,percent of total billed charges,,
Sup Co2 Detector,,A9999,HCPCS,Facility,Outpatient,,,,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,41.446,90.1,,percent of total billed charges,,
Sup Co2 Detector,,A9999,HCPCS,Facility,Inpatient,,,,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Sup Co2 Detector,,A9999,HCPCS,Facility,Both,,,,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PPO,45.356,98.6,,percent of total billed charges,,
Sup Co2 Detector,,A9999,HCPCS,Facility,Outpatient,,,,46,39.1,13.1836,46,PrimeWest Health,Minnesota Senior Health Options (MSHO),23.667,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Sup Co2 Detector,,A9999,HCPCS,Facility,Inpatient,,,,46,39.1,13.1836,46,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Co2 Detector,,A9999,HCPCS,Facility,Outpatient,,,,46,39.1,13.1836,46,PrimeWest Health,MinnesotaCare,23.6256,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Sup Co2 Detector,,A9999,HCPCS,Facility,Inpatient,,,,46,39.1,13.1836,46,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Sup Co2 Detector,,A9999,HCPCS,Facility,Both,,,,46,39.1,13.1836,46,Sanford Health Plan,Sanford Health Plan,42.32,92,,percent of total billed charges,,
Sup Co2 Detector,,A9999,HCPCS,Facility,Outpatient,,,,46,39.1,13.1836,46,"UCare Health, Inc.",Individual & Family Plan,25.921,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Sup Co2 Detector,,A9999,HCPCS,Facility,Inpatient,,,,46,39.1,13.1836,46,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Sup Co2 Detector,,A9999,HCPCS,Facility,Outpatient,,,,46,39.1,13.1836,46,"UCare Health, Inc.",Medical Assistance,23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Co2 Detector,,A9999,HCPCS,Facility,Inpatient,,,,46,39.1,13.1836,46,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Sup Co2 Detector,,A9999,HCPCS,Facility,Outpatient,,,,46,39.1,13.1836,46,"UCare Health, Inc.",Medicare Advantage,23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Co2 Detector,,A9999,HCPCS,Facility,Inpatient,,,,46,39.1,13.1836,46,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Co2 Detector,,A9999,HCPCS,Facility,Outpatient,,,,46,39.1,13.1836,46,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Co2 Detector,,A9999,HCPCS,Facility,Inpatient,,,,46,39.1,13.1836,46,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Co2 Detector,,A9999,HCPCS,Facility,Both,,,,46,39.1,13.1836,46,UnitedHealthcare,Individual & Family,43.24,94,,percent of total billed charges,,
Sup Co2 Detector,,A9999,HCPCS,Facility,Outpatient,,,,46,39.1,13.1836,46,UnitedHealthcare,Medicare Advantage,22.54,49,,percent of total billed charges,,
Sup Co2 Detector,,A9999,HCPCS,Facility,Inpatient,,,,46,39.1,13.1836,46,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Sup Co2 Detector,,A9999,HCPCS,Facility,Outpatient,,,,46,39.1,13.1836,46,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,22.08,48,,percent of total billed charges,,100% of DHS outpatient percentage
Sup Co2 Detector,,A9999,HCPCS,Facility,Inpatient,,,,46,39.1,13.1836,46,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Sup Combitube/King Airway,,A9999,HCPCS,Facility,Both,,,,227,192.95,65.0582,227,Aetna,Commercial,208.84,92,,percent of total billed charges,,
Sup Combitube/King Airway,,A9999,HCPCS,Facility,Outpatient,,,,227,192.95,65.0582,227,Aetna,Medicare Advantage,111.23,49,,percent of total billed charges,,
Sup Combitube/King Airway,,A9999,HCPCS,Facility,Inpatient,,,,227,192.95,65.0582,227,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Sup Combitube/King Airway,,A9999,HCPCS,Facility,Both,,,,227,192.95,65.0582,227,Aetna,PPO,211.11,93,,percent of total billed charges,,
Sup Combitube/King Airway,,A9999,HCPCS,Facility,Both,,,,227,192.95,65.0582,227,America's PPO,America's PPO,217.9881,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Sup Combitube/King Airway,,A9999,HCPCS,Facility,Both,,,,227,192.95,65.0582,227,BlueCross BlueShield Minnesota, Federal Employee Program,223.368,98.4,,percent of total billed charges,,
Sup Combitube/King Airway,,A9999,HCPCS,Facility,Both,,,,227,192.95,65.0582,227,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,227,100,,percent of total billed charges,,
Sup Combitube/King Airway,,A9999,HCPCS,Facility,Both,,,,227,192.95,65.0582,227,BlueCross BlueShield Minnesota,High Value Network Plan,204.3,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
Sup Combitube/King Airway,,A9999,HCPCS,Facility,Outpatient,,,,227,192.95,65.0582,227,BlueCross BlueShield Minnesota,Medicare Advantage,111.23,49,,percent of total billed charges,,
Sup Combitube/King Airway,,A9999,HCPCS,Facility,Inpatient,,,,227,192.95,65.0582,227,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Sup Combitube/King Airway,,A9999,HCPCS,Facility,Both,,,,227,192.95,65.0582,227,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,201.0539,88.57,,percent of total billed charges,,
Sup Combitube/King Airway,,A9999,HCPCS,Facility,Both,,,,227,192.95,65.0582,227,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,65.0582,28.66,,percent of total billed charges,,
Sup Combitube/King Airway,,A9999,HCPCS,Facility,Outpatient,,,,227,192.95,65.0582,227,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),111.23,49,,percent of total billed charges,,
Sup Combitube/King Airway,,A9999,HCPCS,Facility,Inpatient,,,,227,192.95,65.0582,227,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Sup Combitube/King Airway,,A9999,HCPCS,Facility,Both,,,,227,192.95,65.0582,227,CorVel,Worker's Compensation,227,100,,percent of total billed charges,,
Sup Combitube/King Airway,,A9999,HCPCS,Facility,Both,,,,227,192.95,65.0582,227,First Health Group Corporation,First Health Network,220.19,97,,percent of total billed charges,,
Sup Combitube/King Airway,,A9999,HCPCS,Facility,Both,,,,227,192.95,65.0582,227,"Health Partners, Inc.",Commercial,214.742,94.6,,percent of total billed charges,,
Sup Combitube/King Airway,,A9999,HCPCS,Facility,Outpatient,,,,227,192.95,65.0582,227,"Health Partners, Inc.",Medicare Advantage,111.23,49,,percent of total billed charges,,
Sup Combitube/King Airway,,A9999,HCPCS,Facility,Inpatient,,,,227,192.95,65.0582,227,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Combitube/King Airway,,A9999,HCPCS,Facility,Both,,,,227,192.95,65.0582,227,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),136.2,60,,percent of total billed charges,,
Sup Combitube/King Airway,,A9999,HCPCS,Facility,Both,,,,227,192.95,65.0582,227,"Health Partners, Inc.",State of Minnesota Advantage Program,185.005,81.5,,percent of total billed charges,,
Sup Combitube/King Airway,,A9999,HCPCS,Facility,Both,,,,227,192.95,65.0582,227,"Health Partners, Inc.",State Public Programs,113.5,50,,percent of total billed charges,,
Sup Combitube/King Airway,,A9999,HCPCS,Facility,Both,,,,227,192.95,65.0582,227,Humana Insurance Company,Commercial PPO,215.65,95,,percent of total billed charges,,
Sup Combitube/King Airway,,A9999,HCPCS,Facility,Outpatient,,,,227,192.95,65.0582,227,Humana Insurance Company,Medicare PPO,111.23,49,,percent of total billed charges,,
Sup Combitube/King Airway,,A9999,HCPCS,Facility,Inpatient,,,,227,192.95,65.0582,227,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Sup Combitube/King Airway,,A9999,HCPCS,Facility,Both,,,,227,192.95,65.0582,227,Medica,Individual & Family,224.957,99.1,,percent of total billed charges,,
Sup Combitube/King Airway,,A9999,HCPCS,Facility,Outpatient,,,,227,192.95,65.0582,227,Medica,Medica Advantage Solution,113.046,49.8,,percent of total billed charges,,
Sup Combitube/King Airway,,A9999,HCPCS,Facility,Inpatient,,,,227,192.95,65.0582,227,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Sup Combitube/King Airway,,A9999,HCPCS,Facility,Outpatient,,,,227,192.95,65.0582,227,Medica,Medical Assistance,101.242,44.6,,percent of total billed charges,,
Sup Combitube/King Airway,,A9999,HCPCS,Facility,Inpatient,,,,227,192.95,65.0582,227,Medica,Medical Assistance,,,,,Included in per diem rate,
Sup Combitube/King Airway,,A9999,HCPCS,Facility,Outpatient,,,,227,192.95,65.0582,227,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,113.046,49.8,,percent of total billed charges,,
Sup Combitube/King Airway,,A9999,HCPCS,Facility,Inpatient,,,,227,192.95,65.0582,227,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Sup Combitube/King Airway,,A9999,HCPCS,Facility,Both,,,,227,192.95,65.0582,227,"Multiplan, Inc.","Multiplan, Inc.",213.38,94,,percent of total billed charges,,
Sup Combitube/King Airway,,A9999,HCPCS,Facility,Outpatient,,,,227,192.95,65.0582,227,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,204.527,90.1,,percent of total billed charges,,
Sup Combitube/King Airway,,A9999,HCPCS,Facility,Inpatient,,,,227,192.95,65.0582,227,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Sup Combitube/King Airway,,A9999,HCPCS,Facility,Both,,,,227,192.95,65.0582,227,"Preferred One Administrative Services, INC.",PPO,223.822,98.6,,percent of total billed charges,,
Sup Combitube/King Airway,,A9999,HCPCS,Facility,Outpatient,,,,227,192.95,65.0582,227,PrimeWest Health,Minnesota Senior Health Options (MSHO),116.7915,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Sup Combitube/King Airway,,A9999,HCPCS,Facility,Inpatient,,,,227,192.95,65.0582,227,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Combitube/King Airway,,A9999,HCPCS,Facility,Outpatient,,,,227,192.95,65.0582,227,PrimeWest Health,MinnesotaCare,116.5872,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Sup Combitube/King Airway,,A9999,HCPCS,Facility,Inpatient,,,,227,192.95,65.0582,227,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Sup Combitube/King Airway,,A9999,HCPCS,Facility,Both,,,,227,192.95,65.0582,227,Sanford Health Plan,Sanford Health Plan,208.84,92,,percent of total billed charges,,
Sup Combitube/King Airway,,A9999,HCPCS,Facility,Outpatient,,,,227,192.95,65.0582,227,"UCare Health, Inc.",Individual & Family Plan,127.9145,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Sup Combitube/King Airway,,A9999,HCPCS,Facility,Inpatient,,,,227,192.95,65.0582,227,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Sup Combitube/King Airway,,A9999,HCPCS,Facility,Outpatient,,,,227,192.95,65.0582,227,"UCare Health, Inc.",Medical Assistance,114.5669,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Combitube/King Airway,,A9999,HCPCS,Facility,Inpatient,,,,227,192.95,65.0582,227,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Sup Combitube/King Airway,,A9999,HCPCS,Facility,Outpatient,,,,227,192.95,65.0582,227,"UCare Health, Inc.",Medicare Advantage,114.5669,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Combitube/King Airway,,A9999,HCPCS,Facility,Inpatient,,,,227,192.95,65.0582,227,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Combitube/King Airway,,A9999,HCPCS,Facility,Outpatient,,,,227,192.95,65.0582,227,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),114.5669,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Combitube/King Airway,,A9999,HCPCS,Facility,Inpatient,,,,227,192.95,65.0582,227,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Combitube/King Airway,,A9999,HCPCS,Facility,Both,,,,227,192.95,65.0582,227,UnitedHealthcare,Individual & Family,213.38,94,,percent of total billed charges,,
Sup Combitube/King Airway,,A9999,HCPCS,Facility,Outpatient,,,,227,192.95,65.0582,227,UnitedHealthcare,Medicare Advantage,111.23,49,,percent of total billed charges,,
Sup Combitube/King Airway,,A9999,HCPCS,Facility,Inpatient,,,,227,192.95,65.0582,227,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Sup Combitube/King Airway,,A9999,HCPCS,Facility,Outpatient,,,,227,192.95,65.0582,227,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,108.96,48,,percent of total billed charges,,100% of DHS outpatient percentage
Sup Combitube/King Airway,,A9999,HCPCS,Facility,Inpatient,,,,227,192.95,65.0582,227,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Sup Lumbar Puncture Tray,,A9999,HCPCS,Facility,Both,,,,47,39.95,13.4702,47,Aetna,Commercial,43.24,92,,percent of total billed charges,,
Sup Lumbar Puncture Tray,,A9999,HCPCS,Facility,Outpatient,,,,47,39.95,13.4702,47,Aetna,Medicare Advantage,23.03,49,,percent of total billed charges,,
Sup Lumbar Puncture Tray,,A9999,HCPCS,Facility,Inpatient,,,,47,39.95,13.4702,47,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Sup Lumbar Puncture Tray,,A9999,HCPCS,Facility,Both,,,,47,39.95,13.4702,47,Aetna,PPO,43.71,93,,percent of total billed charges,,
Sup Lumbar Puncture Tray,,A9999,HCPCS,Facility,Both,,,,47,39.95,13.4702,47,America's PPO,America's PPO,45.1341,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Sup Lumbar Puncture Tray,,A9999,HCPCS,Facility,Both,,,,47,39.95,13.4702,47,BlueCross BlueShield Minnesota, Federal Employee Program,46.248,98.4,,percent of total billed charges,,
Sup Lumbar Puncture Tray,,A9999,HCPCS,Facility,Both,,,,47,39.95,13.4702,47,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,47,100,,percent of total billed charges,,
Sup Lumbar Puncture Tray,,A9999,HCPCS,Facility,Both,,,,47,39.95,13.4702,47,BlueCross BlueShield Minnesota,High Value Network Plan,42.3,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
Sup Lumbar Puncture Tray,,A9999,HCPCS,Facility,Outpatient,,,,47,39.95,13.4702,47,BlueCross BlueShield Minnesota,Medicare Advantage,23.03,49,,percent of total billed charges,,
Sup Lumbar Puncture Tray,,A9999,HCPCS,Facility,Inpatient,,,,47,39.95,13.4702,47,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Sup Lumbar Puncture Tray,,A9999,HCPCS,Facility,Both,,,,47,39.95,13.4702,47,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,41.6279,88.57,,percent of total billed charges,,
Sup Lumbar Puncture Tray,,A9999,HCPCS,Facility,Both,,,,47,39.95,13.4702,47,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,13.4702,28.66,,percent of total billed charges,,
Sup Lumbar Puncture Tray,,A9999,HCPCS,Facility,Outpatient,,,,47,39.95,13.4702,47,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),23.03,49,,percent of total billed charges,,
Sup Lumbar Puncture Tray,,A9999,HCPCS,Facility,Inpatient,,,,47,39.95,13.4702,47,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Sup Lumbar Puncture Tray,,A9999,HCPCS,Facility,Both,,,,47,39.95,13.4702,47,CorVel,Worker's Compensation,47,100,,percent of total billed charges,,
Sup Lumbar Puncture Tray,,A9999,HCPCS,Facility,Both,,,,47,39.95,13.4702,47,First Health Group Corporation,First Health Network,45.59,97,,percent of total billed charges,,
Sup Lumbar Puncture Tray,,A9999,HCPCS,Facility,Both,,,,47,39.95,13.4702,47,"Health Partners, Inc.",Commercial,44.462,94.6,,percent of total billed charges,,
Sup Lumbar Puncture Tray,,A9999,HCPCS,Facility,Outpatient,,,,47,39.95,13.4702,47,"Health Partners, Inc.",Medicare Advantage,23.03,49,,percent of total billed charges,,
Sup Lumbar Puncture Tray,,A9999,HCPCS,Facility,Inpatient,,,,47,39.95,13.4702,47,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Lumbar Puncture Tray,,A9999,HCPCS,Facility,Both,,,,47,39.95,13.4702,47,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),28.2,60,,percent of total billed charges,,
Sup Lumbar Puncture Tray,,A9999,HCPCS,Facility,Both,,,,47,39.95,13.4702,47,"Health Partners, Inc.",State of Minnesota Advantage Program,38.305,81.5,,percent of total billed charges,,
Sup Lumbar Puncture Tray,,A9999,HCPCS,Facility,Both,,,,47,39.95,13.4702,47,"Health Partners, Inc.",State Public Programs,23.5,50,,percent of total billed charges,,
Sup Lumbar Puncture Tray,,A9999,HCPCS,Facility,Both,,,,47,39.95,13.4702,47,Humana Insurance Company,Commercial PPO,44.65,95,,percent of total billed charges,,
Sup Lumbar Puncture Tray,,A9999,HCPCS,Facility,Outpatient,,,,47,39.95,13.4702,47,Humana Insurance Company,Medicare PPO,23.03,49,,percent of total billed charges,,
Sup Lumbar Puncture Tray,,A9999,HCPCS,Facility,Inpatient,,,,47,39.95,13.4702,47,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Sup Lumbar Puncture Tray,,A9999,HCPCS,Facility,Both,,,,47,39.95,13.4702,47,Medica,Individual & Family,46.577,99.1,,percent of total billed charges,,
Sup Lumbar Puncture Tray,,A9999,HCPCS,Facility,Outpatient,,,,47,39.95,13.4702,47,Medica,Medica Advantage Solution,23.406,49.8,,percent of total billed charges,,
Sup Lumbar Puncture Tray,,A9999,HCPCS,Facility,Inpatient,,,,47,39.95,13.4702,47,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Sup Lumbar Puncture Tray,,A9999,HCPCS,Facility,Outpatient,,,,47,39.95,13.4702,47,Medica,Medical Assistance,20.962,44.6,,percent of total billed charges,,
Sup Lumbar Puncture Tray,,A9999,HCPCS,Facility,Inpatient,,,,47,39.95,13.4702,47,Medica,Medical Assistance,,,,,Included in per diem rate,
Sup Lumbar Puncture Tray,,A9999,HCPCS,Facility,Outpatient,,,,47,39.95,13.4702,47,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,23.406,49.8,,percent of total billed charges,,
Sup Lumbar Puncture Tray,,A9999,HCPCS,Facility,Inpatient,,,,47,39.95,13.4702,47,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Sup Lumbar Puncture Tray,,A9999,HCPCS,Facility,Both,,,,47,39.95,13.4702,47,"Multiplan, Inc.","Multiplan, Inc.",44.18,94,,percent of total billed charges,,
Sup Lumbar Puncture Tray,,A9999,HCPCS,Facility,Outpatient,,,,47,39.95,13.4702,47,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,42.347,90.1,,percent of total billed charges,,
Sup Lumbar Puncture Tray,,A9999,HCPCS,Facility,Inpatient,,,,47,39.95,13.4702,47,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Sup Lumbar Puncture Tray,,A9999,HCPCS,Facility,Both,,,,47,39.95,13.4702,47,"Preferred One Administrative Services, INC.",PPO,46.342,98.6,,percent of total billed charges,,
Sup Lumbar Puncture Tray,,A9999,HCPCS,Facility,Outpatient,,,,47,39.95,13.4702,47,PrimeWest Health,Minnesota Senior Health Options (MSHO),24.1815,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Sup Lumbar Puncture Tray,,A9999,HCPCS,Facility,Inpatient,,,,47,39.95,13.4702,47,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Lumbar Puncture Tray,,A9999,HCPCS,Facility,Outpatient,,,,47,39.95,13.4702,47,PrimeWest Health,MinnesotaCare,24.1392,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Sup Lumbar Puncture Tray,,A9999,HCPCS,Facility,Inpatient,,,,47,39.95,13.4702,47,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Sup Lumbar Puncture Tray,,A9999,HCPCS,Facility,Both,,,,47,39.95,13.4702,47,Sanford Health Plan,Sanford Health Plan,43.24,92,,percent of total billed charges,,
Sup Lumbar Puncture Tray,,A9999,HCPCS,Facility,Outpatient,,,,47,39.95,13.4702,47,"UCare Health, Inc.",Individual & Family Plan,26.4845,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Sup Lumbar Puncture Tray,,A9999,HCPCS,Facility,Inpatient,,,,47,39.95,13.4702,47,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Sup Lumbar Puncture Tray,,A9999,HCPCS,Facility,Outpatient,,,,47,39.95,13.4702,47,"UCare Health, Inc.",Medical Assistance,23.7209,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Lumbar Puncture Tray,,A9999,HCPCS,Facility,Inpatient,,,,47,39.95,13.4702,47,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Sup Lumbar Puncture Tray,,A9999,HCPCS,Facility,Outpatient,,,,47,39.95,13.4702,47,"UCare Health, Inc.",Medicare Advantage,23.7209,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Lumbar Puncture Tray,,A9999,HCPCS,Facility,Inpatient,,,,47,39.95,13.4702,47,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Lumbar Puncture Tray,,A9999,HCPCS,Facility,Outpatient,,,,47,39.95,13.4702,47,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),23.7209,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Lumbar Puncture Tray,,A9999,HCPCS,Facility,Inpatient,,,,47,39.95,13.4702,47,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Lumbar Puncture Tray,,A9999,HCPCS,Facility,Both,,,,47,39.95,13.4702,47,UnitedHealthcare,Individual & Family,44.18,94,,percent of total billed charges,,
Sup Lumbar Puncture Tray,,A9999,HCPCS,Facility,Outpatient,,,,47,39.95,13.4702,47,UnitedHealthcare,Medicare Advantage,23.03,49,,percent of total billed charges,,
Sup Lumbar Puncture Tray,,A9999,HCPCS,Facility,Inpatient,,,,47,39.95,13.4702,47,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Sup Lumbar Puncture Tray,,A9999,HCPCS,Facility,Outpatient,,,,47,39.95,13.4702,47,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,22.56,48,,percent of total billed charges,,100% of DHS outpatient percentage
Sup Lumbar Puncture Tray,,A9999,HCPCS,Facility,Inpatient,,,,47,39.95,13.4702,47,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Sup Peak Flow Meter,,A9999,HCPCS,Facility,Both,,,,49,41.65,14.0434,49,Aetna,Commercial,45.08,92,,percent of total billed charges,,
Sup Peak Flow Meter,,A9999,HCPCS,Facility,Outpatient,,,,49,41.65,14.0434,49,Aetna,Medicare Advantage,24.01,49,,percent of total billed charges,,
Sup Peak Flow Meter,,A9999,HCPCS,Facility,Inpatient,,,,49,41.65,14.0434,49,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Sup Peak Flow Meter,,A9999,HCPCS,Facility,Both,,,,49,41.65,14.0434,49,Aetna,PPO,45.57,93,,percent of total billed charges,,
Sup Peak Flow Meter,,A9999,HCPCS,Facility,Both,,,,49,41.65,14.0434,49,America's PPO,America's PPO,47.0547,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Sup Peak Flow Meter,,A9999,HCPCS,Facility,Both,,,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota, Federal Employee Program,48.216,98.4,,percent of total billed charges,,
Sup Peak Flow Meter,,A9999,HCPCS,Facility,Both,,,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,49,100,,percent of total billed charges,,
Sup Peak Flow Meter,,A9999,HCPCS,Facility,Both,,,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,High Value Network Plan,44.1,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
Sup Peak Flow Meter,,A9999,HCPCS,Facility,Outpatient,,,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Medicare Advantage,24.01,49,,percent of total billed charges,,
Sup Peak Flow Meter,,A9999,HCPCS,Facility,Inpatient,,,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Sup Peak Flow Meter,,A9999,HCPCS,Facility,Both,,,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,43.3993,88.57,,percent of total billed charges,,
Sup Peak Flow Meter,,A9999,HCPCS,Facility,Both,,,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,14.0434,28.66,,percent of total billed charges,,
Sup Peak Flow Meter,,A9999,HCPCS,Facility,Outpatient,,,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),24.01,49,,percent of total billed charges,,
Sup Peak Flow Meter,,A9999,HCPCS,Facility,Inpatient,,,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Sup Peak Flow Meter,,A9999,HCPCS,Facility,Both,,,,49,41.65,14.0434,49,CorVel,Worker's Compensation,49,100,,percent of total billed charges,,
Sup Peak Flow Meter,,A9999,HCPCS,Facility,Both,,,,49,41.65,14.0434,49,First Health Group Corporation,First Health Network,47.53,97,,percent of total billed charges,,
Sup Peak Flow Meter,,A9999,HCPCS,Facility,Both,,,,49,41.65,14.0434,49,"Health Partners, Inc.",Commercial,46.354,94.6,,percent of total billed charges,,
Sup Peak Flow Meter,,A9999,HCPCS,Facility,Outpatient,,,,49,41.65,14.0434,49,"Health Partners, Inc.",Medicare Advantage,24.01,49,,percent of total billed charges,,
Sup Peak Flow Meter,,A9999,HCPCS,Facility,Inpatient,,,,49,41.65,14.0434,49,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Peak Flow Meter,,A9999,HCPCS,Facility,Both,,,,49,41.65,14.0434,49,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),29.4,60,,percent of total billed charges,,
Sup Peak Flow Meter,,A9999,HCPCS,Facility,Both,,,,49,41.65,14.0434,49,"Health Partners, Inc.",State of Minnesota Advantage Program,39.935,81.5,,percent of total billed charges,,
Sup Peak Flow Meter,,A9999,HCPCS,Facility,Both,,,,49,41.65,14.0434,49,"Health Partners, Inc.",State Public Programs,24.5,50,,percent of total billed charges,,
Sup Peak Flow Meter,,A9999,HCPCS,Facility,Both,,,,49,41.65,14.0434,49,Humana Insurance Company,Commercial PPO,46.55,95,,percent of total billed charges,,
Sup Peak Flow Meter,,A9999,HCPCS,Facility,Outpatient,,,,49,41.65,14.0434,49,Humana Insurance Company,Medicare PPO,24.01,49,,percent of total billed charges,,
Sup Peak Flow Meter,,A9999,HCPCS,Facility,Inpatient,,,,49,41.65,14.0434,49,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Sup Peak Flow Meter,,A9999,HCPCS,Facility,Both,,,,49,41.65,14.0434,49,Medica,Individual & Family,48.559,99.1,,percent of total billed charges,,
Sup Peak Flow Meter,,A9999,HCPCS,Facility,Outpatient,,,,49,41.65,14.0434,49,Medica,Medica Advantage Solution,24.402,49.8,,percent of total billed charges,,
Sup Peak Flow Meter,,A9999,HCPCS,Facility,Inpatient,,,,49,41.65,14.0434,49,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Sup Peak Flow Meter,,A9999,HCPCS,Facility,Outpatient,,,,49,41.65,14.0434,49,Medica,Medical Assistance,21.854,44.6,,percent of total billed charges,,
Sup Peak Flow Meter,,A9999,HCPCS,Facility,Inpatient,,,,49,41.65,14.0434,49,Medica,Medical Assistance,,,,,Included in per diem rate,
Sup Peak Flow Meter,,A9999,HCPCS,Facility,Outpatient,,,,49,41.65,14.0434,49,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,24.402,49.8,,percent of total billed charges,,
Sup Peak Flow Meter,,A9999,HCPCS,Facility,Inpatient,,,,49,41.65,14.0434,49,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Sup Peak Flow Meter,,A9999,HCPCS,Facility,Both,,,,49,41.65,14.0434,49,"Multiplan, Inc.","Multiplan, Inc.",46.06,94,,percent of total billed charges,,
Sup Peak Flow Meter,,A9999,HCPCS,Facility,Outpatient,,,,49,41.65,14.0434,49,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,44.149,90.1,,percent of total billed charges,,
Sup Peak Flow Meter,,A9999,HCPCS,Facility,Inpatient,,,,49,41.65,14.0434,49,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Sup Peak Flow Meter,,A9999,HCPCS,Facility,Both,,,,49,41.65,14.0434,49,"Preferred One Administrative Services, INC.",PPO,48.314,98.6,,percent of total billed charges,,
Sup Peak Flow Meter,,A9999,HCPCS,Facility,Outpatient,,,,49,41.65,14.0434,49,PrimeWest Health,Minnesota Senior Health Options (MSHO),25.2105,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Sup Peak Flow Meter,,A9999,HCPCS,Facility,Inpatient,,,,49,41.65,14.0434,49,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Peak Flow Meter,,A9999,HCPCS,Facility,Outpatient,,,,49,41.65,14.0434,49,PrimeWest Health,MinnesotaCare,25.1664,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Sup Peak Flow Meter,,A9999,HCPCS,Facility,Inpatient,,,,49,41.65,14.0434,49,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Sup Peak Flow Meter,,A9999,HCPCS,Facility,Both,,,,49,41.65,14.0434,49,Sanford Health Plan,Sanford Health Plan,45.08,92,,percent of total billed charges,,
Sup Peak Flow Meter,,A9999,HCPCS,Facility,Outpatient,,,,49,41.65,14.0434,49,"UCare Health, Inc.",Individual & Family Plan,27.6115,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Sup Peak Flow Meter,,A9999,HCPCS,Facility,Inpatient,,,,49,41.65,14.0434,49,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Sup Peak Flow Meter,,A9999,HCPCS,Facility,Outpatient,,,,49,41.65,14.0434,49,"UCare Health, Inc.",Medical Assistance,24.7303,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Peak Flow Meter,,A9999,HCPCS,Facility,Inpatient,,,,49,41.65,14.0434,49,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Sup Peak Flow Meter,,A9999,HCPCS,Facility,Outpatient,,,,49,41.65,14.0434,49,"UCare Health, Inc.",Medicare Advantage,24.7303,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Peak Flow Meter,,A9999,HCPCS,Facility,Inpatient,,,,49,41.65,14.0434,49,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Peak Flow Meter,,A9999,HCPCS,Facility,Outpatient,,,,49,41.65,14.0434,49,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),24.7303,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Peak Flow Meter,,A9999,HCPCS,Facility,Inpatient,,,,49,41.65,14.0434,49,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Peak Flow Meter,,A9999,HCPCS,Facility,Both,,,,49,41.65,14.0434,49,UnitedHealthcare,Individual & Family,46.06,94,,percent of total billed charges,,
Sup Peak Flow Meter,,A9999,HCPCS,Facility,Outpatient,,,,49,41.65,14.0434,49,UnitedHealthcare,Medicare Advantage,24.01,49,,percent of total billed charges,,
Sup Peak Flow Meter,,A9999,HCPCS,Facility,Inpatient,,,,49,41.65,14.0434,49,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Sup Peak Flow Meter,,A9999,HCPCS,Facility,Outpatient,,,,49,41.65,14.0434,49,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,23.52,48,,percent of total billed charges,,100% of DHS outpatient percentage
Sup Peak Flow Meter,,A9999,HCPCS,Facility,Inpatient,,,,49,41.65,14.0434,49,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Sup Stat Lok Anchoring Device,,A9999,HCPCS,Facility,Both,,,,53,45.05,15.1898,53,Aetna,Commercial,48.76,92,,percent of total billed charges,,
Sup Stat Lok Anchoring Device,,A9999,HCPCS,Facility,Outpatient,,,,53,45.05,15.1898,53,Aetna,Medicare Advantage,25.97,49,,percent of total billed charges,,
Sup Stat Lok Anchoring Device,,A9999,HCPCS,Facility,Inpatient,,,,53,45.05,15.1898,53,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Sup Stat Lok Anchoring Device,,A9999,HCPCS,Facility,Both,,,,53,45.05,15.1898,53,Aetna,PPO,49.29,93,,percent of total billed charges,,
Sup Stat Lok Anchoring Device,,A9999,HCPCS,Facility,Both,,,,53,45.05,15.1898,53,America's PPO,America's PPO,50.8959,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Sup Stat Lok Anchoring Device,,A9999,HCPCS,Facility,Both,,,,53,45.05,15.1898,53,BlueCross BlueShield Minnesota, Federal Employee Program,52.152,98.4,,percent of total billed charges,,
Sup Stat Lok Anchoring Device,,A9999,HCPCS,Facility,Both,,,,53,45.05,15.1898,53,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,53,100,,percent of total billed charges,,
Sup Stat Lok Anchoring Device,,A9999,HCPCS,Facility,Both,,,,53,45.05,15.1898,53,BlueCross BlueShield Minnesota,High Value Network Plan,47.7,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
Sup Stat Lok Anchoring Device,,A9999,HCPCS,Facility,Outpatient,,,,53,45.05,15.1898,53,BlueCross BlueShield Minnesota,Medicare Advantage,25.97,49,,percent of total billed charges,,
Sup Stat Lok Anchoring Device,,A9999,HCPCS,Facility,Inpatient,,,,53,45.05,15.1898,53,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Sup Stat Lok Anchoring Device,,A9999,HCPCS,Facility,Both,,,,53,45.05,15.1898,53,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,46.9421,88.57,,percent of total billed charges,,
Sup Stat Lok Anchoring Device,,A9999,HCPCS,Facility,Both,,,,53,45.05,15.1898,53,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,15.1898,28.66,,percent of total billed charges,,
Sup Stat Lok Anchoring Device,,A9999,HCPCS,Facility,Outpatient,,,,53,45.05,15.1898,53,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),25.97,49,,percent of total billed charges,,
Sup Stat Lok Anchoring Device,,A9999,HCPCS,Facility,Inpatient,,,,53,45.05,15.1898,53,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Sup Stat Lok Anchoring Device,,A9999,HCPCS,Facility,Both,,,,53,45.05,15.1898,53,CorVel,Worker's Compensation,53,100,,percent of total billed charges,,
Sup Stat Lok Anchoring Device,,A9999,HCPCS,Facility,Both,,,,53,45.05,15.1898,53,First Health Group Corporation,First Health Network,51.41,97,,percent of total billed charges,,
Sup Stat Lok Anchoring Device,,A9999,HCPCS,Facility,Both,,,,53,45.05,15.1898,53,"Health Partners, Inc.",Commercial,50.138,94.6,,percent of total billed charges,,
Sup Stat Lok Anchoring Device,,A9999,HCPCS,Facility,Outpatient,,,,53,45.05,15.1898,53,"Health Partners, Inc.",Medicare Advantage,25.97,49,,percent of total billed charges,,
Sup Stat Lok Anchoring Device,,A9999,HCPCS,Facility,Inpatient,,,,53,45.05,15.1898,53,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Stat Lok Anchoring Device,,A9999,HCPCS,Facility,Both,,,,53,45.05,15.1898,53,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),31.8,60,,percent of total billed charges,,
Sup Stat Lok Anchoring Device,,A9999,HCPCS,Facility,Both,,,,53,45.05,15.1898,53,"Health Partners, Inc.",State of Minnesota Advantage Program,43.195,81.5,,percent of total billed charges,,
Sup Stat Lok Anchoring Device,,A9999,HCPCS,Facility,Both,,,,53,45.05,15.1898,53,"Health Partners, Inc.",State Public Programs,26.5,50,,percent of total billed charges,,
Sup Stat Lok Anchoring Device,,A9999,HCPCS,Facility,Both,,,,53,45.05,15.1898,53,Humana Insurance Company,Commercial PPO,50.35,95,,percent of total billed charges,,
Sup Stat Lok Anchoring Device,,A9999,HCPCS,Facility,Outpatient,,,,53,45.05,15.1898,53,Humana Insurance Company,Medicare PPO,25.97,49,,percent of total billed charges,,
Sup Stat Lok Anchoring Device,,A9999,HCPCS,Facility,Inpatient,,,,53,45.05,15.1898,53,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Sup Stat Lok Anchoring Device,,A9999,HCPCS,Facility,Both,,,,53,45.05,15.1898,53,Medica,Individual & Family,52.523,99.1,,percent of total billed charges,,
Sup Stat Lok Anchoring Device,,A9999,HCPCS,Facility,Outpatient,,,,53,45.05,15.1898,53,Medica,Medica Advantage Solution,26.394,49.8,,percent of total billed charges,,
Sup Stat Lok Anchoring Device,,A9999,HCPCS,Facility,Inpatient,,,,53,45.05,15.1898,53,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Sup Stat Lok Anchoring Device,,A9999,HCPCS,Facility,Outpatient,,,,53,45.05,15.1898,53,Medica,Medical Assistance,23.638,44.6,,percent of total billed charges,,
Sup Stat Lok Anchoring Device,,A9999,HCPCS,Facility,Inpatient,,,,53,45.05,15.1898,53,Medica,Medical Assistance,,,,,Included in per diem rate,
Sup Stat Lok Anchoring Device,,A9999,HCPCS,Facility,Outpatient,,,,53,45.05,15.1898,53,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,26.394,49.8,,percent of total billed charges,,
Sup Stat Lok Anchoring Device,,A9999,HCPCS,Facility,Inpatient,,,,53,45.05,15.1898,53,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Sup Stat Lok Anchoring Device,,A9999,HCPCS,Facility,Both,,,,53,45.05,15.1898,53,"Multiplan, Inc.","Multiplan, Inc.",49.82,94,,percent of total billed charges,,
Sup Stat Lok Anchoring Device,,A9999,HCPCS,Facility,Outpatient,,,,53,45.05,15.1898,53,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,47.753,90.1,,percent of total billed charges,,
Sup Stat Lok Anchoring Device,,A9999,HCPCS,Facility,Inpatient,,,,53,45.05,15.1898,53,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Sup Stat Lok Anchoring Device,,A9999,HCPCS,Facility,Both,,,,53,45.05,15.1898,53,"Preferred One Administrative Services, INC.",PPO,52.258,98.6,,percent of total billed charges,,
Sup Stat Lok Anchoring Device,,A9999,HCPCS,Facility,Outpatient,,,,53,45.05,15.1898,53,PrimeWest Health,Minnesota Senior Health Options (MSHO),27.2685,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Sup Stat Lok Anchoring Device,,A9999,HCPCS,Facility,Inpatient,,,,53,45.05,15.1898,53,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Stat Lok Anchoring Device,,A9999,HCPCS,Facility,Outpatient,,,,53,45.05,15.1898,53,PrimeWest Health,MinnesotaCare,27.2208,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Sup Stat Lok Anchoring Device,,A9999,HCPCS,Facility,Inpatient,,,,53,45.05,15.1898,53,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Sup Stat Lok Anchoring Device,,A9999,HCPCS,Facility,Both,,,,53,45.05,15.1898,53,Sanford Health Plan,Sanford Health Plan,48.76,92,,percent of total billed charges,,
Sup Stat Lok Anchoring Device,,A9999,HCPCS,Facility,Outpatient,,,,53,45.05,15.1898,53,"UCare Health, Inc.",Individual & Family Plan,29.8655,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Sup Stat Lok Anchoring Device,,A9999,HCPCS,Facility,Inpatient,,,,53,45.05,15.1898,53,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Sup Stat Lok Anchoring Device,,A9999,HCPCS,Facility,Outpatient,,,,53,45.05,15.1898,53,"UCare Health, Inc.",Medical Assistance,26.7491,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Stat Lok Anchoring Device,,A9999,HCPCS,Facility,Inpatient,,,,53,45.05,15.1898,53,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Sup Stat Lok Anchoring Device,,A9999,HCPCS,Facility,Outpatient,,,,53,45.05,15.1898,53,"UCare Health, Inc.",Medicare Advantage,26.7491,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Stat Lok Anchoring Device,,A9999,HCPCS,Facility,Inpatient,,,,53,45.05,15.1898,53,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Stat Lok Anchoring Device,,A9999,HCPCS,Facility,Outpatient,,,,53,45.05,15.1898,53,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),26.7491,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Stat Lok Anchoring Device,,A9999,HCPCS,Facility,Inpatient,,,,53,45.05,15.1898,53,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Stat Lok Anchoring Device,,A9999,HCPCS,Facility,Both,,,,53,45.05,15.1898,53,UnitedHealthcare,Individual & Family,49.82,94,,percent of total billed charges,,
Sup Stat Lok Anchoring Device,,A9999,HCPCS,Facility,Outpatient,,,,53,45.05,15.1898,53,UnitedHealthcare,Medicare Advantage,25.97,49,,percent of total billed charges,,
Sup Stat Lok Anchoring Device,,A9999,HCPCS,Facility,Inpatient,,,,53,45.05,15.1898,53,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Sup Stat Lok Anchoring Device,,A9999,HCPCS,Facility,Outpatient,,,,53,45.05,15.1898,53,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,25.44,48,,percent of total billed charges,,100% of DHS outpatient percentage
Sup Stat Lok Anchoring Device,,A9999,HCPCS,Facility,Inpatient,,,,53,45.05,15.1898,53,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Sup Suture Any Type,,A9999,HCPCS,Facility,Both,,,,36,30.6,10.3176,36,Aetna,Commercial,33.12,92,,percent of total billed charges,,
Sup Suture Any Type,,A9999,HCPCS,Facility,Outpatient,,,,36,30.6,10.3176,36,Aetna,Medicare Advantage,17.64,49,,percent of total billed charges,,
Sup Suture Any Type,,A9999,HCPCS,Facility,Inpatient,,,,36,30.6,10.3176,36,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Sup Suture Any Type,,A9999,HCPCS,Facility,Both,,,,36,30.6,10.3176,36,Aetna,PPO,33.48,93,,percent of total billed charges,,
Sup Suture Any Type,,A9999,HCPCS,Facility,Both,,,,36,30.6,10.3176,36,America's PPO,America's PPO,34.5708,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Sup Suture Any Type,,A9999,HCPCS,Facility,Both,,,,36,30.6,10.3176,36,BlueCross BlueShield Minnesota, Federal Employee Program,35.424,98.4,,percent of total billed charges,,
Sup Suture Any Type,,A9999,HCPCS,Facility,Both,,,,36,30.6,10.3176,36,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,36,100,,percent of total billed charges,,
Sup Suture Any Type,,A9999,HCPCS,Facility,Both,,,,36,30.6,10.3176,36,BlueCross BlueShield Minnesota,High Value Network Plan,32.4,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
Sup Suture Any Type,,A9999,HCPCS,Facility,Outpatient,,,,36,30.6,10.3176,36,BlueCross BlueShield Minnesota,Medicare Advantage,17.64,49,,percent of total billed charges,,
Sup Suture Any Type,,A9999,HCPCS,Facility,Inpatient,,,,36,30.6,10.3176,36,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Sup Suture Any Type,,A9999,HCPCS,Facility,Both,,,,36,30.6,10.3176,36,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,31.8852,88.57,,percent of total billed charges,,
Sup Suture Any Type,,A9999,HCPCS,Facility,Both,,,,36,30.6,10.3176,36,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,10.3176,28.66,,percent of total billed charges,,
Sup Suture Any Type,,A9999,HCPCS,Facility,Outpatient,,,,36,30.6,10.3176,36,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),17.64,49,,percent of total billed charges,,
Sup Suture Any Type,,A9999,HCPCS,Facility,Inpatient,,,,36,30.6,10.3176,36,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Sup Suture Any Type,,A9999,HCPCS,Facility,Both,,,,36,30.6,10.3176,36,CorVel,Worker's Compensation,36,100,,percent of total billed charges,,
Sup Suture Any Type,,A9999,HCPCS,Facility,Both,,,,36,30.6,10.3176,36,First Health Group Corporation,First Health Network,34.92,97,,percent of total billed charges,,
Sup Suture Any Type,,A9999,HCPCS,Facility,Both,,,,36,30.6,10.3176,36,"Health Partners, Inc.",Commercial,34.056,94.6,,percent of total billed charges,,
Sup Suture Any Type,,A9999,HCPCS,Facility,Outpatient,,,,36,30.6,10.3176,36,"Health Partners, Inc.",Medicare Advantage,17.64,49,,percent of total billed charges,,
Sup Suture Any Type,,A9999,HCPCS,Facility,Inpatient,,,,36,30.6,10.3176,36,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Suture Any Type,,A9999,HCPCS,Facility,Both,,,,36,30.6,10.3176,36,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),21.6,60,,percent of total billed charges,,
Sup Suture Any Type,,A9999,HCPCS,Facility,Both,,,,36,30.6,10.3176,36,"Health Partners, Inc.",State of Minnesota Advantage Program,29.34,81.5,,percent of total billed charges,,
Sup Suture Any Type,,A9999,HCPCS,Facility,Both,,,,36,30.6,10.3176,36,"Health Partners, Inc.",State Public Programs,18,50,,percent of total billed charges,,
Sup Suture Any Type,,A9999,HCPCS,Facility,Both,,,,36,30.6,10.3176,36,Humana Insurance Company,Commercial PPO,34.2,95,,percent of total billed charges,,
Sup Suture Any Type,,A9999,HCPCS,Facility,Outpatient,,,,36,30.6,10.3176,36,Humana Insurance Company,Medicare PPO,17.64,49,,percent of total billed charges,,
Sup Suture Any Type,,A9999,HCPCS,Facility,Inpatient,,,,36,30.6,10.3176,36,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Sup Suture Any Type,,A9999,HCPCS,Facility,Both,,,,36,30.6,10.3176,36,Medica,Individual & Family,35.676,99.1,,percent of total billed charges,,
Sup Suture Any Type,,A9999,HCPCS,Facility,Outpatient,,,,36,30.6,10.3176,36,Medica,Medica Advantage Solution,17.928,49.8,,percent of total billed charges,,
Sup Suture Any Type,,A9999,HCPCS,Facility,Inpatient,,,,36,30.6,10.3176,36,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Sup Suture Any Type,,A9999,HCPCS,Facility,Outpatient,,,,36,30.6,10.3176,36,Medica,Medical Assistance,16.056,44.6,,percent of total billed charges,,
Sup Suture Any Type,,A9999,HCPCS,Facility,Inpatient,,,,36,30.6,10.3176,36,Medica,Medical Assistance,,,,,Included in per diem rate,
Sup Suture Any Type,,A9999,HCPCS,Facility,Outpatient,,,,36,30.6,10.3176,36,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,17.928,49.8,,percent of total billed charges,,
Sup Suture Any Type,,A9999,HCPCS,Facility,Inpatient,,,,36,30.6,10.3176,36,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Sup Suture Any Type,,A9999,HCPCS,Facility,Both,,,,36,30.6,10.3176,36,"Multiplan, Inc.","Multiplan, Inc.",33.84,94,,percent of total billed charges,,
Sup Suture Any Type,,A9999,HCPCS,Facility,Outpatient,,,,36,30.6,10.3176,36,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,32.436,90.1,,percent of total billed charges,,
Sup Suture Any Type,,A9999,HCPCS,Facility,Inpatient,,,,36,30.6,10.3176,36,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Sup Suture Any Type,,A9999,HCPCS,Facility,Both,,,,36,30.6,10.3176,36,"Preferred One Administrative Services, INC.",PPO,35.496,98.6,,percent of total billed charges,,
Sup Suture Any Type,,A9999,HCPCS,Facility,Outpatient,,,,36,30.6,10.3176,36,PrimeWest Health,Minnesota Senior Health Options (MSHO),18.522,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Sup Suture Any Type,,A9999,HCPCS,Facility,Inpatient,,,,36,30.6,10.3176,36,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Suture Any Type,,A9999,HCPCS,Facility,Outpatient,,,,36,30.6,10.3176,36,PrimeWest Health,MinnesotaCare,18.4896,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Sup Suture Any Type,,A9999,HCPCS,Facility,Inpatient,,,,36,30.6,10.3176,36,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Sup Suture Any Type,,A9999,HCPCS,Facility,Both,,,,36,30.6,10.3176,36,Sanford Health Plan,Sanford Health Plan,33.12,92,,percent of total billed charges,,
Sup Suture Any Type,,A9999,HCPCS,Facility,Outpatient,,,,36,30.6,10.3176,36,"UCare Health, Inc.",Individual & Family Plan,20.286,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Sup Suture Any Type,,A9999,HCPCS,Facility,Inpatient,,,,36,30.6,10.3176,36,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Sup Suture Any Type,,A9999,HCPCS,Facility,Outpatient,,,,36,30.6,10.3176,36,"UCare Health, Inc.",Medical Assistance,18.1692,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Suture Any Type,,A9999,HCPCS,Facility,Inpatient,,,,36,30.6,10.3176,36,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Sup Suture Any Type,,A9999,HCPCS,Facility,Outpatient,,,,36,30.6,10.3176,36,"UCare Health, Inc.",Medicare Advantage,18.1692,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Suture Any Type,,A9999,HCPCS,Facility,Inpatient,,,,36,30.6,10.3176,36,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Suture Any Type,,A9999,HCPCS,Facility,Outpatient,,,,36,30.6,10.3176,36,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),18.1692,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Suture Any Type,,A9999,HCPCS,Facility,Inpatient,,,,36,30.6,10.3176,36,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Suture Any Type,,A9999,HCPCS,Facility,Both,,,,36,30.6,10.3176,36,UnitedHealthcare,Individual & Family,33.84,94,,percent of total billed charges,,
Sup Suture Any Type,,A9999,HCPCS,Facility,Outpatient,,,,36,30.6,10.3176,36,UnitedHealthcare,Medicare Advantage,17.64,49,,percent of total billed charges,,
Sup Suture Any Type,,A9999,HCPCS,Facility,Inpatient,,,,36,30.6,10.3176,36,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Sup Suture Any Type,,A9999,HCPCS,Facility,Outpatient,,,,36,30.6,10.3176,36,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,17.28,48,,percent of total billed charges,,100% of DHS outpatient percentage
Sup Suture Any Type,,A9999,HCPCS,Facility,Inpatient,,,,36,30.6,10.3176,36,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Sup Ted Thigh Med, Reg, Long",,A9999,HCPCS,Facility,Both,,,,36,30.6,10.3176,36,Aetna,Commercial,33.12,92,,percent of total billed charges,,
"Sup Ted Thigh Med, Reg, Long",,A9999,HCPCS,Facility,Outpatient,,,,36,30.6,10.3176,36,Aetna,Medicare Advantage,17.64,49,,percent of total billed charges,,
"Sup Ted Thigh Med, Reg, Long",,A9999,HCPCS,Facility,Inpatient,,,,36,30.6,10.3176,36,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Sup Ted Thigh Med, Reg, Long",,A9999,HCPCS,Facility,Both,,,,36,30.6,10.3176,36,Aetna,PPO,33.48,93,,percent of total billed charges,,
"Sup Ted Thigh Med, Reg, Long",,A9999,HCPCS,Facility,Both,,,,36,30.6,10.3176,36,America's PPO,America's PPO,34.5708,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Sup Ted Thigh Med, Reg, Long",,A9999,HCPCS,Facility,Both,,,,36,30.6,10.3176,36,BlueCross BlueShield Minnesota, Federal Employee Program,35.424,98.4,,percent of total billed charges,,
"Sup Ted Thigh Med, Reg, Long",,A9999,HCPCS,Facility,Both,,,,36,30.6,10.3176,36,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,36,100,,percent of total billed charges,,
"Sup Ted Thigh Med, Reg, Long",,A9999,HCPCS,Facility,Both,,,,36,30.6,10.3176,36,BlueCross BlueShield Minnesota,High Value Network Plan,32.4,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
"Sup Ted Thigh Med, Reg, Long",,A9999,HCPCS,Facility,Outpatient,,,,36,30.6,10.3176,36,BlueCross BlueShield Minnesota,Medicare Advantage,17.64,49,,percent of total billed charges,,
"Sup Ted Thigh Med, Reg, Long",,A9999,HCPCS,Facility,Inpatient,,,,36,30.6,10.3176,36,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Sup Ted Thigh Med, Reg, Long",,A9999,HCPCS,Facility,Both,,,,36,30.6,10.3176,36,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,31.8852,88.57,,percent of total billed charges,,
"Sup Ted Thigh Med, Reg, Long",,A9999,HCPCS,Facility,Both,,,,36,30.6,10.3176,36,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,10.3176,28.66,,percent of total billed charges,,
"Sup Ted Thigh Med, Reg, Long",,A9999,HCPCS,Facility,Outpatient,,,,36,30.6,10.3176,36,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),17.64,49,,percent of total billed charges,,
"Sup Ted Thigh Med, Reg, Long",,A9999,HCPCS,Facility,Inpatient,,,,36,30.6,10.3176,36,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Sup Ted Thigh Med, Reg, Long",,A9999,HCPCS,Facility,Both,,,,36,30.6,10.3176,36,CorVel,Worker's Compensation,36,100,,percent of total billed charges,,
"Sup Ted Thigh Med, Reg, Long",,A9999,HCPCS,Facility,Both,,,,36,30.6,10.3176,36,First Health Group Corporation,First Health Network,34.92,97,,percent of total billed charges,,
"Sup Ted Thigh Med, Reg, Long",,A9999,HCPCS,Facility,Both,,,,36,30.6,10.3176,36,"Health Partners, Inc.",Commercial,34.056,94.6,,percent of total billed charges,,
"Sup Ted Thigh Med, Reg, Long",,A9999,HCPCS,Facility,Outpatient,,,,36,30.6,10.3176,36,"Health Partners, Inc.",Medicare Advantage,17.64,49,,percent of total billed charges,,
"Sup Ted Thigh Med, Reg, Long",,A9999,HCPCS,Facility,Inpatient,,,,36,30.6,10.3176,36,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Sup Ted Thigh Med, Reg, Long",,A9999,HCPCS,Facility,Both,,,,36,30.6,10.3176,36,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),21.6,60,,percent of total billed charges,,
"Sup Ted Thigh Med, Reg, Long",,A9999,HCPCS,Facility,Both,,,,36,30.6,10.3176,36,"Health Partners, Inc.",State of Minnesota Advantage Program,29.34,81.5,,percent of total billed charges,,
"Sup Ted Thigh Med, Reg, Long",,A9999,HCPCS,Facility,Both,,,,36,30.6,10.3176,36,"Health Partners, Inc.",State Public Programs,18,50,,percent of total billed charges,,
"Sup Ted Thigh Med, Reg, Long",,A9999,HCPCS,Facility,Both,,,,36,30.6,10.3176,36,Humana Insurance Company,Commercial PPO,34.2,95,,percent of total billed charges,,
"Sup Ted Thigh Med, Reg, Long",,A9999,HCPCS,Facility,Outpatient,,,,36,30.6,10.3176,36,Humana Insurance Company,Medicare PPO,17.64,49,,percent of total billed charges,,
"Sup Ted Thigh Med, Reg, Long",,A9999,HCPCS,Facility,Inpatient,,,,36,30.6,10.3176,36,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Sup Ted Thigh Med, Reg, Long",,A9999,HCPCS,Facility,Both,,,,36,30.6,10.3176,36,Medica,Individual & Family,35.676,99.1,,percent of total billed charges,,
"Sup Ted Thigh Med, Reg, Long",,A9999,HCPCS,Facility,Outpatient,,,,36,30.6,10.3176,36,Medica,Medica Advantage Solution,17.928,49.8,,percent of total billed charges,,
"Sup Ted Thigh Med, Reg, Long",,A9999,HCPCS,Facility,Inpatient,,,,36,30.6,10.3176,36,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Sup Ted Thigh Med, Reg, Long",,A9999,HCPCS,Facility,Outpatient,,,,36,30.6,10.3176,36,Medica,Medical Assistance,16.056,44.6,,percent of total billed charges,,
"Sup Ted Thigh Med, Reg, Long",,A9999,HCPCS,Facility,Inpatient,,,,36,30.6,10.3176,36,Medica,Medical Assistance,,,,,Included in per diem rate,
"Sup Ted Thigh Med, Reg, Long",,A9999,HCPCS,Facility,Outpatient,,,,36,30.6,10.3176,36,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,17.928,49.8,,percent of total billed charges,,
"Sup Ted Thigh Med, Reg, Long",,A9999,HCPCS,Facility,Inpatient,,,,36,30.6,10.3176,36,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Sup Ted Thigh Med, Reg, Long",,A9999,HCPCS,Facility,Both,,,,36,30.6,10.3176,36,"Multiplan, Inc.","Multiplan, Inc.",33.84,94,,percent of total billed charges,,
"Sup Ted Thigh Med, Reg, Long",,A9999,HCPCS,Facility,Outpatient,,,,36,30.6,10.3176,36,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,32.436,90.1,,percent of total billed charges,,
"Sup Ted Thigh Med, Reg, Long",,A9999,HCPCS,Facility,Inpatient,,,,36,30.6,10.3176,36,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Sup Ted Thigh Med, Reg, Long",,A9999,HCPCS,Facility,Both,,,,36,30.6,10.3176,36,"Preferred One Administrative Services, INC.",PPO,35.496,98.6,,percent of total billed charges,,
"Sup Ted Thigh Med, Reg, Long",,A9999,HCPCS,Facility,Outpatient,,,,36,30.6,10.3176,36,PrimeWest Health,Minnesota Senior Health Options (MSHO),18.522,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Sup Ted Thigh Med, Reg, Long",,A9999,HCPCS,Facility,Inpatient,,,,36,30.6,10.3176,36,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Sup Ted Thigh Med, Reg, Long",,A9999,HCPCS,Facility,Outpatient,,,,36,30.6,10.3176,36,PrimeWest Health,MinnesotaCare,18.4896,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Sup Ted Thigh Med, Reg, Long",,A9999,HCPCS,Facility,Inpatient,,,,36,30.6,10.3176,36,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Sup Ted Thigh Med, Reg, Long",,A9999,HCPCS,Facility,Both,,,,36,30.6,10.3176,36,Sanford Health Plan,Sanford Health Plan,33.12,92,,percent of total billed charges,,
"Sup Ted Thigh Med, Reg, Long",,A9999,HCPCS,Facility,Outpatient,,,,36,30.6,10.3176,36,"UCare Health, Inc.",Individual & Family Plan,20.286,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Sup Ted Thigh Med, Reg, Long",,A9999,HCPCS,Facility,Inpatient,,,,36,30.6,10.3176,36,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Sup Ted Thigh Med, Reg, Long",,A9999,HCPCS,Facility,Outpatient,,,,36,30.6,10.3176,36,"UCare Health, Inc.",Medical Assistance,18.1692,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Sup Ted Thigh Med, Reg, Long",,A9999,HCPCS,Facility,Inpatient,,,,36,30.6,10.3176,36,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Sup Ted Thigh Med, Reg, Long",,A9999,HCPCS,Facility,Outpatient,,,,36,30.6,10.3176,36,"UCare Health, Inc.",Medicare Advantage,18.1692,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Sup Ted Thigh Med, Reg, Long",,A9999,HCPCS,Facility,Inpatient,,,,36,30.6,10.3176,36,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Sup Ted Thigh Med, Reg, Long",,A9999,HCPCS,Facility,Outpatient,,,,36,30.6,10.3176,36,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),18.1692,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Sup Ted Thigh Med, Reg, Long",,A9999,HCPCS,Facility,Inpatient,,,,36,30.6,10.3176,36,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Sup Ted Thigh Med, Reg, Long",,A9999,HCPCS,Facility,Both,,,,36,30.6,10.3176,36,UnitedHealthcare,Individual & Family,33.84,94,,percent of total billed charges,,
"Sup Ted Thigh Med, Reg, Long",,A9999,HCPCS,Facility,Outpatient,,,,36,30.6,10.3176,36,UnitedHealthcare,Medicare Advantage,17.64,49,,percent of total billed charges,,
"Sup Ted Thigh Med, Reg, Long",,A9999,HCPCS,Facility,Inpatient,,,,36,30.6,10.3176,36,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Sup Ted Thigh Med, Reg, Long",,A9999,HCPCS,Facility,Outpatient,,,,36,30.6,10.3176,36,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,17.28,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Sup Ted Thigh Med, Reg, Long",,A9999,HCPCS,Facility,Inpatient,,,,36,30.6,10.3176,36,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
2.7X14MM DARCO HEADED SCREW,,C1713,HCPCS,Facility,Both,,,,892.5,758.625,255.7905,892.5,Aetna,Commercial,821.1,92,,percent of total billed charges,,
2.7X14MM DARCO HEADED SCREW,,C1713,HCPCS,Facility,Outpatient,,,,892.5,758.625,255.7905,892.5,Aetna,Medicare Advantage,437.325,49,,percent of total billed charges,,
2.7X14MM DARCO HEADED SCREW,,C1713,HCPCS,Facility,Inpatient,,,,892.5,758.625,255.7905,892.5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
2.7X14MM DARCO HEADED SCREW,,C1713,HCPCS,Facility,Both,,,,892.5,758.625,255.7905,892.5,Aetna,PPO,830.025,93,,percent of total billed charges,,
2.7X14MM DARCO HEADED SCREW,,C1713,HCPCS,Facility,Both,,,,892.5,758.625,255.7905,892.5,America's PPO,America's PPO,857.06775,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
2.7X14MM DARCO HEADED SCREW,,C1713,HCPCS,Facility,Both,,,,892.5,758.625,255.7905,892.5,BlueCross BlueShield Minnesota, Federal Employee Program,878.22,98.4,,percent of total billed charges,,
2.7X14MM DARCO HEADED SCREW,,C1713,HCPCS,Facility,Both,,,,892.5,758.625,255.7905,892.5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,892.5,100,,percent of total billed charges,,
2.7X14MM DARCO HEADED SCREW,,C1713,HCPCS,Facility,Both,,,,892.5,758.625,255.7905,892.5,BlueCross BlueShield Minnesota,High Value Network Plan,803.25,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
2.7X14MM DARCO HEADED SCREW,,C1713,HCPCS,Facility,Outpatient,,,,892.5,758.625,255.7905,892.5,BlueCross BlueShield Minnesota,Medicare Advantage,437.325,49,,percent of total billed charges,,
2.7X14MM DARCO HEADED SCREW,,C1713,HCPCS,Facility,Inpatient,,,,892.5,758.625,255.7905,892.5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
2.7X14MM DARCO HEADED SCREW,,C1713,HCPCS,Facility,Both,,,,892.5,758.625,255.7905,892.5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,790.48725,88.57,,percent of total billed charges,,
2.7X14MM DARCO HEADED SCREW,,C1713,HCPCS,Facility,Both,,,,892.5,758.625,255.7905,892.5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,255.7905,28.66,,percent of total billed charges,,
2.7X14MM DARCO HEADED SCREW,,C1713,HCPCS,Facility,Outpatient,,,,892.5,758.625,255.7905,892.5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),437.325,49,,percent of total billed charges,,
2.7X14MM DARCO HEADED SCREW,,C1713,HCPCS,Facility,Inpatient,,,,892.5,758.625,255.7905,892.5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
2.7X14MM DARCO HEADED SCREW,,C1713,HCPCS,Facility,Both,,,,892.5,758.625,255.7905,892.5,CorVel,Worker's Compensation,892.5,100,,percent of total billed charges,,
2.7X14MM DARCO HEADED SCREW,,C1713,HCPCS,Facility,Both,,,,892.5,758.625,255.7905,892.5,First Health Group Corporation,First Health Network,865.725,97,,percent of total billed charges,,
2.7X14MM DARCO HEADED SCREW,,C1713,HCPCS,Facility,Both,,,,892.5,758.625,255.7905,892.5,"Health Partners, Inc.",Commercial,844.305,94.6,,percent of total billed charges,,
2.7X14MM DARCO HEADED SCREW,,C1713,HCPCS,Facility,Outpatient,,,,892.5,758.625,255.7905,892.5,"Health Partners, Inc.",Medicare Advantage,437.325,49,,percent of total billed charges,,
2.7X14MM DARCO HEADED SCREW,,C1713,HCPCS,Facility,Inpatient,,,,892.5,758.625,255.7905,892.5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
2.7X14MM DARCO HEADED SCREW,,C1713,HCPCS,Facility,Both,,,,892.5,758.625,255.7905,892.5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),535.5,60,,percent of total billed charges,,
2.7X14MM DARCO HEADED SCREW,,C1713,HCPCS,Facility,Both,,,,892.5,758.625,255.7905,892.5,"Health Partners, Inc.",State of Minnesota Advantage Program,727.3875,81.5,,percent of total billed charges,,
2.7X14MM DARCO HEADED SCREW,,C1713,HCPCS,Facility,Both,,,,892.5,758.625,255.7905,892.5,"Health Partners, Inc.",State Public Programs,446.25,50,,percent of total billed charges,,
2.7X14MM DARCO HEADED SCREW,,C1713,HCPCS,Facility,Both,,,,892.5,758.625,255.7905,892.5,Humana Insurance Company,Commercial PPO,847.875,95,,percent of total billed charges,,
2.7X14MM DARCO HEADED SCREW,,C1713,HCPCS,Facility,Outpatient,,,,892.5,758.625,255.7905,892.5,Humana Insurance Company,Medicare PPO,437.325,49,,percent of total billed charges,,
2.7X14MM DARCO HEADED SCREW,,C1713,HCPCS,Facility,Inpatient,,,,892.5,758.625,255.7905,892.5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
2.7X14MM DARCO HEADED SCREW,,C1713,HCPCS,Facility,Both,,,,892.5,758.625,255.7905,892.5,Medica,Individual & Family,884.4675,99.1,,percent of total billed charges,,
2.7X14MM DARCO HEADED SCREW,,C1713,HCPCS,Facility,Outpatient,,,,892.5,758.625,255.7905,892.5,Medica,Medica Advantage Solution,444.465,49.8,,percent of total billed charges,,
2.7X14MM DARCO HEADED SCREW,,C1713,HCPCS,Facility,Inpatient,,,,892.5,758.625,255.7905,892.5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
2.7X14MM DARCO HEADED SCREW,,C1713,HCPCS,Facility,Outpatient,,,,892.5,758.625,255.7905,892.5,Medica,Medical Assistance,398.055,44.6,,percent of total billed charges,,
2.7X14MM DARCO HEADED SCREW,,C1713,HCPCS,Facility,Inpatient,,,,892.5,758.625,255.7905,892.5,Medica,Medical Assistance,,,,,Included in per diem rate,
2.7X14MM DARCO HEADED SCREW,,C1713,HCPCS,Facility,Outpatient,,,,892.5,758.625,255.7905,892.5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,444.465,49.8,,percent of total billed charges,,
2.7X14MM DARCO HEADED SCREW,,C1713,HCPCS,Facility,Inpatient,,,,892.5,758.625,255.7905,892.5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
2.7X14MM DARCO HEADED SCREW,,C1713,HCPCS,Facility,Both,,,,892.5,758.625,255.7905,892.5,"Multiplan, Inc.","Multiplan, Inc.",838.95,94,,percent of total billed charges,,
2.7X14MM DARCO HEADED SCREW,,C1713,HCPCS,Facility,Outpatient,,,,892.5,758.625,255.7905,892.5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,804.1425,90.1,,percent of total billed charges,,
2.7X14MM DARCO HEADED SCREW,,C1713,HCPCS,Facility,Inpatient,,,,892.5,758.625,255.7905,892.5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
2.7X14MM DARCO HEADED SCREW,,C1713,HCPCS,Facility,Both,,,,892.5,758.625,255.7905,892.5,"Preferred One Administrative Services, INC.",PPO,880.005,98.6,,percent of total billed charges,,
2.7X14MM DARCO HEADED SCREW,,C1713,HCPCS,Facility,Outpatient,,,,892.5,758.625,255.7905,892.5,PrimeWest Health,Minnesota Senior Health Options (MSHO),459.19125,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
2.7X14MM DARCO HEADED SCREW,,C1713,HCPCS,Facility,Inpatient,,,,892.5,758.625,255.7905,892.5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
2.7X14MM DARCO HEADED SCREW,,C1713,HCPCS,Facility,Outpatient,,,,892.5,758.625,255.7905,892.5,PrimeWest Health,MinnesotaCare,458.388,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
2.7X14MM DARCO HEADED SCREW,,C1713,HCPCS,Facility,Inpatient,,,,892.5,758.625,255.7905,892.5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
2.7X14MM DARCO HEADED SCREW,,C1713,HCPCS,Facility,Both,,,,892.5,758.625,255.7905,892.5,Sanford Health Plan,Sanford Health Plan,821.1,92,,percent of total billed charges,,
2.7X14MM DARCO HEADED SCREW,,C1713,HCPCS,Facility,Outpatient,,,,892.5,758.625,255.7905,892.5,"UCare Health, Inc.",Individual & Family Plan,502.92375,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
2.7X14MM DARCO HEADED SCREW,,C1713,HCPCS,Facility,Inpatient,,,,892.5,758.625,255.7905,892.5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
2.7X14MM DARCO HEADED SCREW,,C1713,HCPCS,Facility,Outpatient,,,,892.5,758.625,255.7905,892.5,"UCare Health, Inc.",Medical Assistance,450.44475,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
2.7X14MM DARCO HEADED SCREW,,C1713,HCPCS,Facility,Inpatient,,,,892.5,758.625,255.7905,892.5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
2.7X14MM DARCO HEADED SCREW,,C1713,HCPCS,Facility,Outpatient,,,,892.5,758.625,255.7905,892.5,"UCare Health, Inc.",Medicare Advantage,450.44475,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
2.7X14MM DARCO HEADED SCREW,,C1713,HCPCS,Facility,Inpatient,,,,892.5,758.625,255.7905,892.5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
2.7X14MM DARCO HEADED SCREW,,C1713,HCPCS,Facility,Outpatient,,,,892.5,758.625,255.7905,892.5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),450.44475,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
2.7X14MM DARCO HEADED SCREW,,C1713,HCPCS,Facility,Inpatient,,,,892.5,758.625,255.7905,892.5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
2.7X14MM DARCO HEADED SCREW,,C1713,HCPCS,Facility,Both,,,,892.5,758.625,255.7905,892.5,UnitedHealthcare,Individual & Family,838.95,94,,percent of total billed charges,,
2.7X14MM DARCO HEADED SCREW,,C1713,HCPCS,Facility,Outpatient,,,,892.5,758.625,255.7905,892.5,UnitedHealthcare,Medicare Advantage,437.325,49,,percent of total billed charges,,
2.7X14MM DARCO HEADED SCREW,,C1713,HCPCS,Facility,Inpatient,,,,892.5,758.625,255.7905,892.5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
2.7X14MM DARCO HEADED SCREW,,C1713,HCPCS,Facility,Outpatient,,,,892.5,758.625,255.7905,892.5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,428.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
2.7X14MM DARCO HEADED SCREW,,C1713,HCPCS,Facility,Inpatient,,,,892.5,758.625,255.7905,892.5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
2.7X16MM HEADED SCREW SHORT,,C1713,HCPCS,Facility,Both,,,,892.5,758.625,255.7905,892.5,Aetna,Commercial,821.1,92,,percent of total billed charges,,
2.7X16MM HEADED SCREW SHORT,,C1713,HCPCS,Facility,Outpatient,,,,892.5,758.625,255.7905,892.5,Aetna,Medicare Advantage,437.325,49,,percent of total billed charges,,
2.7X16MM HEADED SCREW SHORT,,C1713,HCPCS,Facility,Inpatient,,,,892.5,758.625,255.7905,892.5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
2.7X16MM HEADED SCREW SHORT,,C1713,HCPCS,Facility,Both,,,,892.5,758.625,255.7905,892.5,Aetna,PPO,830.025,93,,percent of total billed charges,,
2.7X16MM HEADED SCREW SHORT,,C1713,HCPCS,Facility,Both,,,,892.5,758.625,255.7905,892.5,America's PPO,America's PPO,857.06775,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
2.7X16MM HEADED SCREW SHORT,,C1713,HCPCS,Facility,Both,,,,892.5,758.625,255.7905,892.5,BlueCross BlueShield Minnesota, Federal Employee Program,878.22,98.4,,percent of total billed charges,,
2.7X16MM HEADED SCREW SHORT,,C1713,HCPCS,Facility,Both,,,,892.5,758.625,255.7905,892.5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,892.5,100,,percent of total billed charges,,
2.7X16MM HEADED SCREW SHORT,,C1713,HCPCS,Facility,Both,,,,892.5,758.625,255.7905,892.5,BlueCross BlueShield Minnesota,High Value Network Plan,803.25,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
2.7X16MM HEADED SCREW SHORT,,C1713,HCPCS,Facility,Outpatient,,,,892.5,758.625,255.7905,892.5,BlueCross BlueShield Minnesota,Medicare Advantage,437.325,49,,percent of total billed charges,,
2.7X16MM HEADED SCREW SHORT,,C1713,HCPCS,Facility,Inpatient,,,,892.5,758.625,255.7905,892.5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
2.7X16MM HEADED SCREW SHORT,,C1713,HCPCS,Facility,Both,,,,892.5,758.625,255.7905,892.5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,790.48725,88.57,,percent of total billed charges,,
2.7X16MM HEADED SCREW SHORT,,C1713,HCPCS,Facility,Both,,,,892.5,758.625,255.7905,892.5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,255.7905,28.66,,percent of total billed charges,,
2.7X16MM HEADED SCREW SHORT,,C1713,HCPCS,Facility,Outpatient,,,,892.5,758.625,255.7905,892.5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),437.325,49,,percent of total billed charges,,
2.7X16MM HEADED SCREW SHORT,,C1713,HCPCS,Facility,Inpatient,,,,892.5,758.625,255.7905,892.5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
2.7X16MM HEADED SCREW SHORT,,C1713,HCPCS,Facility,Both,,,,892.5,758.625,255.7905,892.5,CorVel,Worker's Compensation,892.5,100,,percent of total billed charges,,
2.7X16MM HEADED SCREW SHORT,,C1713,HCPCS,Facility,Both,,,,892.5,758.625,255.7905,892.5,First Health Group Corporation,First Health Network,865.725,97,,percent of total billed charges,,
2.7X16MM HEADED SCREW SHORT,,C1713,HCPCS,Facility,Both,,,,892.5,758.625,255.7905,892.5,"Health Partners, Inc.",Commercial,844.305,94.6,,percent of total billed charges,,
2.7X16MM HEADED SCREW SHORT,,C1713,HCPCS,Facility,Outpatient,,,,892.5,758.625,255.7905,892.5,"Health Partners, Inc.",Medicare Advantage,437.325,49,,percent of total billed charges,,
2.7X16MM HEADED SCREW SHORT,,C1713,HCPCS,Facility,Inpatient,,,,892.5,758.625,255.7905,892.5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
2.7X16MM HEADED SCREW SHORT,,C1713,HCPCS,Facility,Both,,,,892.5,758.625,255.7905,892.5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),535.5,60,,percent of total billed charges,,
2.7X16MM HEADED SCREW SHORT,,C1713,HCPCS,Facility,Both,,,,892.5,758.625,255.7905,892.5,"Health Partners, Inc.",State of Minnesota Advantage Program,727.3875,81.5,,percent of total billed charges,,
2.7X16MM HEADED SCREW SHORT,,C1713,HCPCS,Facility,Both,,,,892.5,758.625,255.7905,892.5,"Health Partners, Inc.",State Public Programs,446.25,50,,percent of total billed charges,,
2.7X16MM HEADED SCREW SHORT,,C1713,HCPCS,Facility,Both,,,,892.5,758.625,255.7905,892.5,Humana Insurance Company,Commercial PPO,847.875,95,,percent of total billed charges,,
2.7X16MM HEADED SCREW SHORT,,C1713,HCPCS,Facility,Outpatient,,,,892.5,758.625,255.7905,892.5,Humana Insurance Company,Medicare PPO,437.325,49,,percent of total billed charges,,
2.7X16MM HEADED SCREW SHORT,,C1713,HCPCS,Facility,Inpatient,,,,892.5,758.625,255.7905,892.5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
2.7X16MM HEADED SCREW SHORT,,C1713,HCPCS,Facility,Both,,,,892.5,758.625,255.7905,892.5,Medica,Individual & Family,884.4675,99.1,,percent of total billed charges,,
2.7X16MM HEADED SCREW SHORT,,C1713,HCPCS,Facility,Outpatient,,,,892.5,758.625,255.7905,892.5,Medica,Medica Advantage Solution,444.465,49.8,,percent of total billed charges,,
2.7X16MM HEADED SCREW SHORT,,C1713,HCPCS,Facility,Inpatient,,,,892.5,758.625,255.7905,892.5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
2.7X16MM HEADED SCREW SHORT,,C1713,HCPCS,Facility,Outpatient,,,,892.5,758.625,255.7905,892.5,Medica,Medical Assistance,398.055,44.6,,percent of total billed charges,,
2.7X16MM HEADED SCREW SHORT,,C1713,HCPCS,Facility,Inpatient,,,,892.5,758.625,255.7905,892.5,Medica,Medical Assistance,,,,,Included in per diem rate,
2.7X16MM HEADED SCREW SHORT,,C1713,HCPCS,Facility,Outpatient,,,,892.5,758.625,255.7905,892.5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,444.465,49.8,,percent of total billed charges,,
2.7X16MM HEADED SCREW SHORT,,C1713,HCPCS,Facility,Inpatient,,,,892.5,758.625,255.7905,892.5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
2.7X16MM HEADED SCREW SHORT,,C1713,HCPCS,Facility,Both,,,,892.5,758.625,255.7905,892.5,"Multiplan, Inc.","Multiplan, Inc.",838.95,94,,percent of total billed charges,,
2.7X16MM HEADED SCREW SHORT,,C1713,HCPCS,Facility,Outpatient,,,,892.5,758.625,255.7905,892.5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,804.1425,90.1,,percent of total billed charges,,
2.7X16MM HEADED SCREW SHORT,,C1713,HCPCS,Facility,Inpatient,,,,892.5,758.625,255.7905,892.5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
2.7X16MM HEADED SCREW SHORT,,C1713,HCPCS,Facility,Both,,,,892.5,758.625,255.7905,892.5,"Preferred One Administrative Services, INC.",PPO,880.005,98.6,,percent of total billed charges,,
2.7X16MM HEADED SCREW SHORT,,C1713,HCPCS,Facility,Outpatient,,,,892.5,758.625,255.7905,892.5,PrimeWest Health,Minnesota Senior Health Options (MSHO),459.19125,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
2.7X16MM HEADED SCREW SHORT,,C1713,HCPCS,Facility,Inpatient,,,,892.5,758.625,255.7905,892.5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
2.7X16MM HEADED SCREW SHORT,,C1713,HCPCS,Facility,Outpatient,,,,892.5,758.625,255.7905,892.5,PrimeWest Health,MinnesotaCare,458.388,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
2.7X16MM HEADED SCREW SHORT,,C1713,HCPCS,Facility,Inpatient,,,,892.5,758.625,255.7905,892.5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
2.7X16MM HEADED SCREW SHORT,,C1713,HCPCS,Facility,Both,,,,892.5,758.625,255.7905,892.5,Sanford Health Plan,Sanford Health Plan,821.1,92,,percent of total billed charges,,
2.7X16MM HEADED SCREW SHORT,,C1713,HCPCS,Facility,Outpatient,,,,892.5,758.625,255.7905,892.5,"UCare Health, Inc.",Individual & Family Plan,502.92375,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
2.7X16MM HEADED SCREW SHORT,,C1713,HCPCS,Facility,Inpatient,,,,892.5,758.625,255.7905,892.5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
2.7X16MM HEADED SCREW SHORT,,C1713,HCPCS,Facility,Outpatient,,,,892.5,758.625,255.7905,892.5,"UCare Health, Inc.",Medical Assistance,450.44475,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
2.7X16MM HEADED SCREW SHORT,,C1713,HCPCS,Facility,Inpatient,,,,892.5,758.625,255.7905,892.5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
2.7X16MM HEADED SCREW SHORT,,C1713,HCPCS,Facility,Outpatient,,,,892.5,758.625,255.7905,892.5,"UCare Health, Inc.",Medicare Advantage,450.44475,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
2.7X16MM HEADED SCREW SHORT,,C1713,HCPCS,Facility,Inpatient,,,,892.5,758.625,255.7905,892.5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
2.7X16MM HEADED SCREW SHORT,,C1713,HCPCS,Facility,Outpatient,,,,892.5,758.625,255.7905,892.5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),450.44475,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
2.7X16MM HEADED SCREW SHORT,,C1713,HCPCS,Facility,Inpatient,,,,892.5,758.625,255.7905,892.5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
2.7X16MM HEADED SCREW SHORT,,C1713,HCPCS,Facility,Both,,,,892.5,758.625,255.7905,892.5,UnitedHealthcare,Individual & Family,838.95,94,,percent of total billed charges,,
2.7X16MM HEADED SCREW SHORT,,C1713,HCPCS,Facility,Outpatient,,,,892.5,758.625,255.7905,892.5,UnitedHealthcare,Medicare Advantage,437.325,49,,percent of total billed charges,,
2.7X16MM HEADED SCREW SHORT,,C1713,HCPCS,Facility,Inpatient,,,,892.5,758.625,255.7905,892.5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
2.7X16MM HEADED SCREW SHORT,,C1713,HCPCS,Facility,Outpatient,,,,892.5,758.625,255.7905,892.5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,428.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
2.7X16MM HEADED SCREW SHORT,,C1713,HCPCS,Facility,Inpatient,,,,892.5,758.625,255.7905,892.5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
2.7X18MM HEADED SCREW SHORT THREAD,,C1713,HCPCS,Facility,Both,,,,865,735.25,247.909,865,Aetna,Commercial,795.8,92,,percent of total billed charges,,
2.7X18MM HEADED SCREW SHORT THREAD,,C1713,HCPCS,Facility,Outpatient,,,,865,735.25,247.909,865,Aetna,Medicare Advantage,423.85,49,,percent of total billed charges,,
2.7X18MM HEADED SCREW SHORT THREAD,,C1713,HCPCS,Facility,Inpatient,,,,865,735.25,247.909,865,Aetna,Medicare Advantage,,,,,Included in per diem rate,
2.7X18MM HEADED SCREW SHORT THREAD,,C1713,HCPCS,Facility,Both,,,,865,735.25,247.909,865,Aetna,PPO,804.45,93,,percent of total billed charges,,
2.7X18MM HEADED SCREW SHORT THREAD,,C1713,HCPCS,Facility,Both,,,,865,735.25,247.909,865,America's PPO,America's PPO,830.6595,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
2.7X18MM HEADED SCREW SHORT THREAD,,C1713,HCPCS,Facility,Both,,,,865,735.25,247.909,865,BlueCross BlueShield Minnesota, Federal Employee Program,851.16,98.4,,percent of total billed charges,,
2.7X18MM HEADED SCREW SHORT THREAD,,C1713,HCPCS,Facility,Both,,,,865,735.25,247.909,865,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,865,100,,percent of total billed charges,,
2.7X18MM HEADED SCREW SHORT THREAD,,C1713,HCPCS,Facility,Both,,,,865,735.25,247.909,865,BlueCross BlueShield Minnesota,High Value Network Plan,778.5,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
2.7X18MM HEADED SCREW SHORT THREAD,,C1713,HCPCS,Facility,Outpatient,,,,865,735.25,247.909,865,BlueCross BlueShield Minnesota,Medicare Advantage,423.85,49,,percent of total billed charges,,
2.7X18MM HEADED SCREW SHORT THREAD,,C1713,HCPCS,Facility,Inpatient,,,,865,735.25,247.909,865,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
2.7X18MM HEADED SCREW SHORT THREAD,,C1713,HCPCS,Facility,Both,,,,865,735.25,247.909,865,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,766.1305,88.57,,percent of total billed charges,,
2.7X18MM HEADED SCREW SHORT THREAD,,C1713,HCPCS,Facility,Both,,,,865,735.25,247.909,865,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,247.909,28.66,,percent of total billed charges,,
2.7X18MM HEADED SCREW SHORT THREAD,,C1713,HCPCS,Facility,Outpatient,,,,865,735.25,247.909,865,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),423.85,49,,percent of total billed charges,,
2.7X18MM HEADED SCREW SHORT THREAD,,C1713,HCPCS,Facility,Inpatient,,,,865,735.25,247.909,865,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
2.7X18MM HEADED SCREW SHORT THREAD,,C1713,HCPCS,Facility,Both,,,,865,735.25,247.909,865,CorVel,Worker's Compensation,865,100,,percent of total billed charges,,
2.7X18MM HEADED SCREW SHORT THREAD,,C1713,HCPCS,Facility,Both,,,,865,735.25,247.909,865,First Health Group Corporation,First Health Network,839.05,97,,percent of total billed charges,,
2.7X18MM HEADED SCREW SHORT THREAD,,C1713,HCPCS,Facility,Both,,,,865,735.25,247.909,865,"Health Partners, Inc.",Commercial,818.29,94.6,,percent of total billed charges,,
2.7X18MM HEADED SCREW SHORT THREAD,,C1713,HCPCS,Facility,Outpatient,,,,865,735.25,247.909,865,"Health Partners, Inc.",Medicare Advantage,423.85,49,,percent of total billed charges,,
2.7X18MM HEADED SCREW SHORT THREAD,,C1713,HCPCS,Facility,Inpatient,,,,865,735.25,247.909,865,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
2.7X18MM HEADED SCREW SHORT THREAD,,C1713,HCPCS,Facility,Both,,,,865,735.25,247.909,865,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),519,60,,percent of total billed charges,,
2.7X18MM HEADED SCREW SHORT THREAD,,C1713,HCPCS,Facility,Both,,,,865,735.25,247.909,865,"Health Partners, Inc.",State of Minnesota Advantage Program,704.975,81.5,,percent of total billed charges,,
2.7X18MM HEADED SCREW SHORT THREAD,,C1713,HCPCS,Facility,Both,,,,865,735.25,247.909,865,"Health Partners, Inc.",State Public Programs,432.5,50,,percent of total billed charges,,
2.7X18MM HEADED SCREW SHORT THREAD,,C1713,HCPCS,Facility,Both,,,,865,735.25,247.909,865,Humana Insurance Company,Commercial PPO,821.75,95,,percent of total billed charges,,
2.7X18MM HEADED SCREW SHORT THREAD,,C1713,HCPCS,Facility,Outpatient,,,,865,735.25,247.909,865,Humana Insurance Company,Medicare PPO,423.85,49,,percent of total billed charges,,
2.7X18MM HEADED SCREW SHORT THREAD,,C1713,HCPCS,Facility,Inpatient,,,,865,735.25,247.909,865,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
2.7X18MM HEADED SCREW SHORT THREAD,,C1713,HCPCS,Facility,Both,,,,865,735.25,247.909,865,Medica,Individual & Family,857.215,99.1,,percent of total billed charges,,
2.7X18MM HEADED SCREW SHORT THREAD,,C1713,HCPCS,Facility,Outpatient,,,,865,735.25,247.909,865,Medica,Medica Advantage Solution,430.77,49.8,,percent of total billed charges,,
2.7X18MM HEADED SCREW SHORT THREAD,,C1713,HCPCS,Facility,Inpatient,,,,865,735.25,247.909,865,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
2.7X18MM HEADED SCREW SHORT THREAD,,C1713,HCPCS,Facility,Outpatient,,,,865,735.25,247.909,865,Medica,Medical Assistance,385.79,44.6,,percent of total billed charges,,
2.7X18MM HEADED SCREW SHORT THREAD,,C1713,HCPCS,Facility,Inpatient,,,,865,735.25,247.909,865,Medica,Medical Assistance,,,,,Included in per diem rate,
2.7X18MM HEADED SCREW SHORT THREAD,,C1713,HCPCS,Facility,Outpatient,,,,865,735.25,247.909,865,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,430.77,49.8,,percent of total billed charges,,
2.7X18MM HEADED SCREW SHORT THREAD,,C1713,HCPCS,Facility,Inpatient,,,,865,735.25,247.909,865,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
2.7X18MM HEADED SCREW SHORT THREAD,,C1713,HCPCS,Facility,Both,,,,865,735.25,247.909,865,"Multiplan, Inc.","Multiplan, Inc.",813.1,94,,percent of total billed charges,,
2.7X18MM HEADED SCREW SHORT THREAD,,C1713,HCPCS,Facility,Outpatient,,,,865,735.25,247.909,865,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,779.365,90.1,,percent of total billed charges,,
2.7X18MM HEADED SCREW SHORT THREAD,,C1713,HCPCS,Facility,Inpatient,,,,865,735.25,247.909,865,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
2.7X18MM HEADED SCREW SHORT THREAD,,C1713,HCPCS,Facility,Both,,,,865,735.25,247.909,865,"Preferred One Administrative Services, INC.",PPO,852.89,98.6,,percent of total billed charges,,
2.7X18MM HEADED SCREW SHORT THREAD,,C1713,HCPCS,Facility,Outpatient,,,,865,735.25,247.909,865,PrimeWest Health,Minnesota Senior Health Options (MSHO),445.0425,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
2.7X18MM HEADED SCREW SHORT THREAD,,C1713,HCPCS,Facility,Inpatient,,,,865,735.25,247.909,865,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
2.7X18MM HEADED SCREW SHORT THREAD,,C1713,HCPCS,Facility,Outpatient,,,,865,735.25,247.909,865,PrimeWest Health,MinnesotaCare,444.264,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
2.7X18MM HEADED SCREW SHORT THREAD,,C1713,HCPCS,Facility,Inpatient,,,,865,735.25,247.909,865,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
2.7X18MM HEADED SCREW SHORT THREAD,,C1713,HCPCS,Facility,Both,,,,865,735.25,247.909,865,Sanford Health Plan,Sanford Health Plan,795.8,92,,percent of total billed charges,,
2.7X18MM HEADED SCREW SHORT THREAD,,C1713,HCPCS,Facility,Outpatient,,,,865,735.25,247.909,865,"UCare Health, Inc.",Individual & Family Plan,487.4275,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
2.7X18MM HEADED SCREW SHORT THREAD,,C1713,HCPCS,Facility,Inpatient,,,,865,735.25,247.909,865,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
2.7X18MM HEADED SCREW SHORT THREAD,,C1713,HCPCS,Facility,Outpatient,,,,865,735.25,247.909,865,"UCare Health, Inc.",Medical Assistance,436.5655,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
2.7X18MM HEADED SCREW SHORT THREAD,,C1713,HCPCS,Facility,Inpatient,,,,865,735.25,247.909,865,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
2.7X18MM HEADED SCREW SHORT THREAD,,C1713,HCPCS,Facility,Outpatient,,,,865,735.25,247.909,865,"UCare Health, Inc.",Medicare Advantage,436.5655,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
2.7X18MM HEADED SCREW SHORT THREAD,,C1713,HCPCS,Facility,Inpatient,,,,865,735.25,247.909,865,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
2.7X18MM HEADED SCREW SHORT THREAD,,C1713,HCPCS,Facility,Outpatient,,,,865,735.25,247.909,865,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),436.5655,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
2.7X18MM HEADED SCREW SHORT THREAD,,C1713,HCPCS,Facility,Inpatient,,,,865,735.25,247.909,865,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
2.7X18MM HEADED SCREW SHORT THREAD,,C1713,HCPCS,Facility,Both,,,,865,735.25,247.909,865,UnitedHealthcare,Individual & Family,813.1,94,,percent of total billed charges,,
2.7X18MM HEADED SCREW SHORT THREAD,,C1713,HCPCS,Facility,Outpatient,,,,865,735.25,247.909,865,UnitedHealthcare,Medicare Advantage,423.85,49,,percent of total billed charges,,
2.7X18MM HEADED SCREW SHORT THREAD,,C1713,HCPCS,Facility,Inpatient,,,,865,735.25,247.909,865,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
2.7X18MM HEADED SCREW SHORT THREAD,,C1713,HCPCS,Facility,Outpatient,,,,865,735.25,247.909,865,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,415.2,48,,percent of total billed charges,,100% of DHS outpatient percentage
2.7X18MM HEADED SCREW SHORT THREAD,,C1713,HCPCS,Facility,Inpatient,,,,865,735.25,247.909,865,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
2.7X20MM DARCO HEADED SCREW,,C1713,HCPCS,Facility,Both,,,,892.5,758.625,255.7905,892.5,Aetna,Commercial,821.1,92,,percent of total billed charges,,
2.7X20MM DARCO HEADED SCREW,,C1713,HCPCS,Facility,Outpatient,,,,892.5,758.625,255.7905,892.5,Aetna,Medicare Advantage,437.325,49,,percent of total billed charges,,
2.7X20MM DARCO HEADED SCREW,,C1713,HCPCS,Facility,Inpatient,,,,892.5,758.625,255.7905,892.5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
2.7X20MM DARCO HEADED SCREW,,C1713,HCPCS,Facility,Both,,,,892.5,758.625,255.7905,892.5,Aetna,PPO,830.025,93,,percent of total billed charges,,
2.7X20MM DARCO HEADED SCREW,,C1713,HCPCS,Facility,Both,,,,892.5,758.625,255.7905,892.5,America's PPO,America's PPO,857.06775,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
2.7X20MM DARCO HEADED SCREW,,C1713,HCPCS,Facility,Both,,,,892.5,758.625,255.7905,892.5,BlueCross BlueShield Minnesota, Federal Employee Program,878.22,98.4,,percent of total billed charges,,
2.7X20MM DARCO HEADED SCREW,,C1713,HCPCS,Facility,Both,,,,892.5,758.625,255.7905,892.5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,892.5,100,,percent of total billed charges,,
2.7X20MM DARCO HEADED SCREW,,C1713,HCPCS,Facility,Both,,,,892.5,758.625,255.7905,892.5,BlueCross BlueShield Minnesota,High Value Network Plan,803.25,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
2.7X20MM DARCO HEADED SCREW,,C1713,HCPCS,Facility,Outpatient,,,,892.5,758.625,255.7905,892.5,BlueCross BlueShield Minnesota,Medicare Advantage,437.325,49,,percent of total billed charges,,
2.7X20MM DARCO HEADED SCREW,,C1713,HCPCS,Facility,Inpatient,,,,892.5,758.625,255.7905,892.5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
2.7X20MM DARCO HEADED SCREW,,C1713,HCPCS,Facility,Both,,,,892.5,758.625,255.7905,892.5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,790.48725,88.57,,percent of total billed charges,,
2.7X20MM DARCO HEADED SCREW,,C1713,HCPCS,Facility,Both,,,,892.5,758.625,255.7905,892.5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,255.7905,28.66,,percent of total billed charges,,
2.7X20MM DARCO HEADED SCREW,,C1713,HCPCS,Facility,Outpatient,,,,892.5,758.625,255.7905,892.5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),437.325,49,,percent of total billed charges,,
2.7X20MM DARCO HEADED SCREW,,C1713,HCPCS,Facility,Inpatient,,,,892.5,758.625,255.7905,892.5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
2.7X20MM DARCO HEADED SCREW,,C1713,HCPCS,Facility,Both,,,,892.5,758.625,255.7905,892.5,CorVel,Worker's Compensation,892.5,100,,percent of total billed charges,,
2.7X20MM DARCO HEADED SCREW,,C1713,HCPCS,Facility,Both,,,,892.5,758.625,255.7905,892.5,First Health Group Corporation,First Health Network,865.725,97,,percent of total billed charges,,
2.7X20MM DARCO HEADED SCREW,,C1713,HCPCS,Facility,Both,,,,892.5,758.625,255.7905,892.5,"Health Partners, Inc.",Commercial,844.305,94.6,,percent of total billed charges,,
2.7X20MM DARCO HEADED SCREW,,C1713,HCPCS,Facility,Outpatient,,,,892.5,758.625,255.7905,892.5,"Health Partners, Inc.",Medicare Advantage,437.325,49,,percent of total billed charges,,
2.7X20MM DARCO HEADED SCREW,,C1713,HCPCS,Facility,Inpatient,,,,892.5,758.625,255.7905,892.5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
2.7X20MM DARCO HEADED SCREW,,C1713,HCPCS,Facility,Both,,,,892.5,758.625,255.7905,892.5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),535.5,60,,percent of total billed charges,,
2.7X20MM DARCO HEADED SCREW,,C1713,HCPCS,Facility,Both,,,,892.5,758.625,255.7905,892.5,"Health Partners, Inc.",State of Minnesota Advantage Program,727.3875,81.5,,percent of total billed charges,,
2.7X20MM DARCO HEADED SCREW,,C1713,HCPCS,Facility,Both,,,,892.5,758.625,255.7905,892.5,"Health Partners, Inc.",State Public Programs,446.25,50,,percent of total billed charges,,
2.7X20MM DARCO HEADED SCREW,,C1713,HCPCS,Facility,Both,,,,892.5,758.625,255.7905,892.5,Humana Insurance Company,Commercial PPO,847.875,95,,percent of total billed charges,,
2.7X20MM DARCO HEADED SCREW,,C1713,HCPCS,Facility,Outpatient,,,,892.5,758.625,255.7905,892.5,Humana Insurance Company,Medicare PPO,437.325,49,,percent of total billed charges,,
2.7X20MM DARCO HEADED SCREW,,C1713,HCPCS,Facility,Inpatient,,,,892.5,758.625,255.7905,892.5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
2.7X20MM DARCO HEADED SCREW,,C1713,HCPCS,Facility,Both,,,,892.5,758.625,255.7905,892.5,Medica,Individual & Family,884.4675,99.1,,percent of total billed charges,,
2.7X20MM DARCO HEADED SCREW,,C1713,HCPCS,Facility,Outpatient,,,,892.5,758.625,255.7905,892.5,Medica,Medica Advantage Solution,444.465,49.8,,percent of total billed charges,,
2.7X20MM DARCO HEADED SCREW,,C1713,HCPCS,Facility,Inpatient,,,,892.5,758.625,255.7905,892.5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
2.7X20MM DARCO HEADED SCREW,,C1713,HCPCS,Facility,Outpatient,,,,892.5,758.625,255.7905,892.5,Medica,Medical Assistance,398.055,44.6,,percent of total billed charges,,
2.7X20MM DARCO HEADED SCREW,,C1713,HCPCS,Facility,Inpatient,,,,892.5,758.625,255.7905,892.5,Medica,Medical Assistance,,,,,Included in per diem rate,
2.7X20MM DARCO HEADED SCREW,,C1713,HCPCS,Facility,Outpatient,,,,892.5,758.625,255.7905,892.5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,444.465,49.8,,percent of total billed charges,,
2.7X20MM DARCO HEADED SCREW,,C1713,HCPCS,Facility,Inpatient,,,,892.5,758.625,255.7905,892.5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
2.7X20MM DARCO HEADED SCREW,,C1713,HCPCS,Facility,Both,,,,892.5,758.625,255.7905,892.5,"Multiplan, Inc.","Multiplan, Inc.",838.95,94,,percent of total billed charges,,
2.7X20MM DARCO HEADED SCREW,,C1713,HCPCS,Facility,Outpatient,,,,892.5,758.625,255.7905,892.5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,804.1425,90.1,,percent of total billed charges,,
2.7X20MM DARCO HEADED SCREW,,C1713,HCPCS,Facility,Inpatient,,,,892.5,758.625,255.7905,892.5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
2.7X20MM DARCO HEADED SCREW,,C1713,HCPCS,Facility,Both,,,,892.5,758.625,255.7905,892.5,"Preferred One Administrative Services, INC.",PPO,880.005,98.6,,percent of total billed charges,,
2.7X20MM DARCO HEADED SCREW,,C1713,HCPCS,Facility,Outpatient,,,,892.5,758.625,255.7905,892.5,PrimeWest Health,Minnesota Senior Health Options (MSHO),459.19125,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
2.7X20MM DARCO HEADED SCREW,,C1713,HCPCS,Facility,Inpatient,,,,892.5,758.625,255.7905,892.5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
2.7X20MM DARCO HEADED SCREW,,C1713,HCPCS,Facility,Outpatient,,,,892.5,758.625,255.7905,892.5,PrimeWest Health,MinnesotaCare,458.388,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
2.7X20MM DARCO HEADED SCREW,,C1713,HCPCS,Facility,Inpatient,,,,892.5,758.625,255.7905,892.5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
2.7X20MM DARCO HEADED SCREW,,C1713,HCPCS,Facility,Both,,,,892.5,758.625,255.7905,892.5,Sanford Health Plan,Sanford Health Plan,821.1,92,,percent of total billed charges,,
2.7X20MM DARCO HEADED SCREW,,C1713,HCPCS,Facility,Outpatient,,,,892.5,758.625,255.7905,892.5,"UCare Health, Inc.",Individual & Family Plan,502.92375,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
2.7X20MM DARCO HEADED SCREW,,C1713,HCPCS,Facility,Inpatient,,,,892.5,758.625,255.7905,892.5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
2.7X20MM DARCO HEADED SCREW,,C1713,HCPCS,Facility,Outpatient,,,,892.5,758.625,255.7905,892.5,"UCare Health, Inc.",Medical Assistance,450.44475,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
2.7X20MM DARCO HEADED SCREW,,C1713,HCPCS,Facility,Inpatient,,,,892.5,758.625,255.7905,892.5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
2.7X20MM DARCO HEADED SCREW,,C1713,HCPCS,Facility,Outpatient,,,,892.5,758.625,255.7905,892.5,"UCare Health, Inc.",Medicare Advantage,450.44475,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
2.7X20MM DARCO HEADED SCREW,,C1713,HCPCS,Facility,Inpatient,,,,892.5,758.625,255.7905,892.5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
2.7X20MM DARCO HEADED SCREW,,C1713,HCPCS,Facility,Outpatient,,,,892.5,758.625,255.7905,892.5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),450.44475,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
2.7X20MM DARCO HEADED SCREW,,C1713,HCPCS,Facility,Inpatient,,,,892.5,758.625,255.7905,892.5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
2.7X20MM DARCO HEADED SCREW,,C1713,HCPCS,Facility,Both,,,,892.5,758.625,255.7905,892.5,UnitedHealthcare,Individual & Family,838.95,94,,percent of total billed charges,,
2.7X20MM DARCO HEADED SCREW,,C1713,HCPCS,Facility,Outpatient,,,,892.5,758.625,255.7905,892.5,UnitedHealthcare,Medicare Advantage,437.325,49,,percent of total billed charges,,
2.7X20MM DARCO HEADED SCREW,,C1713,HCPCS,Facility,Inpatient,,,,892.5,758.625,255.7905,892.5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
2.7X20MM DARCO HEADED SCREW,,C1713,HCPCS,Facility,Outpatient,,,,892.5,758.625,255.7905,892.5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,428.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
2.7X20MM DARCO HEADED SCREW,,C1713,HCPCS,Facility,Inpatient,,,,892.5,758.625,255.7905,892.5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
2.7X22MM HEADED SCREW,,C1713,HCPCS,Facility,Both,,,,1177.5,1000.875,337.4715,1177.5,Aetna,Commercial,1083.3,92,,percent of total billed charges,,
2.7X22MM HEADED SCREW,,C1713,HCPCS,Facility,Outpatient,,,,1177.5,1000.875,337.4715,1177.5,Aetna,Medicare Advantage,576.975,49,,percent of total billed charges,,
2.7X22MM HEADED SCREW,,C1713,HCPCS,Facility,Inpatient,,,,1177.5,1000.875,337.4715,1177.5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
2.7X22MM HEADED SCREW,,C1713,HCPCS,Facility,Both,,,,1177.5,1000.875,337.4715,1177.5,Aetna,PPO,1095.075,93,,percent of total billed charges,,
2.7X22MM HEADED SCREW,,C1713,HCPCS,Facility,Both,,,,1177.5,1000.875,337.4715,1177.5,America's PPO,America's PPO,1130.75325,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
2.7X22MM HEADED SCREW,,C1713,HCPCS,Facility,Both,,,,1177.5,1000.875,337.4715,1177.5,BlueCross BlueShield Minnesota, Federal Employee Program,1158.66,98.4,,percent of total billed charges,,
2.7X22MM HEADED SCREW,,C1713,HCPCS,Facility,Both,,,,1177.5,1000.875,337.4715,1177.5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1177.5,100,,percent of total billed charges,,
2.7X22MM HEADED SCREW,,C1713,HCPCS,Facility,Both,,,,1177.5,1000.875,337.4715,1177.5,BlueCross BlueShield Minnesota,High Value Network Plan,1059.75,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
2.7X22MM HEADED SCREW,,C1713,HCPCS,Facility,Outpatient,,,,1177.5,1000.875,337.4715,1177.5,BlueCross BlueShield Minnesota,Medicare Advantage,576.975,49,,percent of total billed charges,,
2.7X22MM HEADED SCREW,,C1713,HCPCS,Facility,Inpatient,,,,1177.5,1000.875,337.4715,1177.5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
2.7X22MM HEADED SCREW,,C1713,HCPCS,Facility,Both,,,,1177.5,1000.875,337.4715,1177.5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1042.91175,88.57,,percent of total billed charges,,
2.7X22MM HEADED SCREW,,C1713,HCPCS,Facility,Both,,,,1177.5,1000.875,337.4715,1177.5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,337.4715,28.66,,percent of total billed charges,,
2.7X22MM HEADED SCREW,,C1713,HCPCS,Facility,Outpatient,,,,1177.5,1000.875,337.4715,1177.5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),576.975,49,,percent of total billed charges,,
2.7X22MM HEADED SCREW,,C1713,HCPCS,Facility,Inpatient,,,,1177.5,1000.875,337.4715,1177.5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
2.7X22MM HEADED SCREW,,C1713,HCPCS,Facility,Both,,,,1177.5,1000.875,337.4715,1177.5,CorVel,Worker's Compensation,1177.5,100,,percent of total billed charges,,
2.7X22MM HEADED SCREW,,C1713,HCPCS,Facility,Both,,,,1177.5,1000.875,337.4715,1177.5,First Health Group Corporation,First Health Network,1142.175,97,,percent of total billed charges,,
2.7X22MM HEADED SCREW,,C1713,HCPCS,Facility,Both,,,,1177.5,1000.875,337.4715,1177.5,"Health Partners, Inc.",Commercial,1113.915,94.6,,percent of total billed charges,,
2.7X22MM HEADED SCREW,,C1713,HCPCS,Facility,Outpatient,,,,1177.5,1000.875,337.4715,1177.5,"Health Partners, Inc.",Medicare Advantage,576.975,49,,percent of total billed charges,,
2.7X22MM HEADED SCREW,,C1713,HCPCS,Facility,Inpatient,,,,1177.5,1000.875,337.4715,1177.5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
2.7X22MM HEADED SCREW,,C1713,HCPCS,Facility,Both,,,,1177.5,1000.875,337.4715,1177.5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),706.5,60,,percent of total billed charges,,
2.7X22MM HEADED SCREW,,C1713,HCPCS,Facility,Both,,,,1177.5,1000.875,337.4715,1177.5,"Health Partners, Inc.",State of Minnesota Advantage Program,959.6625,81.5,,percent of total billed charges,,
2.7X22MM HEADED SCREW,,C1713,HCPCS,Facility,Both,,,,1177.5,1000.875,337.4715,1177.5,"Health Partners, Inc.",State Public Programs,588.75,50,,percent of total billed charges,,
2.7X22MM HEADED SCREW,,C1713,HCPCS,Facility,Both,,,,1177.5,1000.875,337.4715,1177.5,Humana Insurance Company,Commercial PPO,1118.625,95,,percent of total billed charges,,
2.7X22MM HEADED SCREW,,C1713,HCPCS,Facility,Outpatient,,,,1177.5,1000.875,337.4715,1177.5,Humana Insurance Company,Medicare PPO,576.975,49,,percent of total billed charges,,
2.7X22MM HEADED SCREW,,C1713,HCPCS,Facility,Inpatient,,,,1177.5,1000.875,337.4715,1177.5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
2.7X22MM HEADED SCREW,,C1713,HCPCS,Facility,Both,,,,1177.5,1000.875,337.4715,1177.5,Medica,Individual & Family,1166.9025,99.1,,percent of total billed charges,,
2.7X22MM HEADED SCREW,,C1713,HCPCS,Facility,Outpatient,,,,1177.5,1000.875,337.4715,1177.5,Medica,Medica Advantage Solution,586.395,49.8,,percent of total billed charges,,
2.7X22MM HEADED SCREW,,C1713,HCPCS,Facility,Inpatient,,,,1177.5,1000.875,337.4715,1177.5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
2.7X22MM HEADED SCREW,,C1713,HCPCS,Facility,Outpatient,,,,1177.5,1000.875,337.4715,1177.5,Medica,Medical Assistance,525.165,44.6,,percent of total billed charges,,
2.7X22MM HEADED SCREW,,C1713,HCPCS,Facility,Inpatient,,,,1177.5,1000.875,337.4715,1177.5,Medica,Medical Assistance,,,,,Included in per diem rate,
2.7X22MM HEADED SCREW,,C1713,HCPCS,Facility,Outpatient,,,,1177.5,1000.875,337.4715,1177.5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,586.395,49.8,,percent of total billed charges,,
2.7X22MM HEADED SCREW,,C1713,HCPCS,Facility,Inpatient,,,,1177.5,1000.875,337.4715,1177.5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
2.7X22MM HEADED SCREW,,C1713,HCPCS,Facility,Both,,,,1177.5,1000.875,337.4715,1177.5,"Multiplan, Inc.","Multiplan, Inc.",1106.85,94,,percent of total billed charges,,
2.7X22MM HEADED SCREW,,C1713,HCPCS,Facility,Outpatient,,,,1177.5,1000.875,337.4715,1177.5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1060.9275,90.1,,percent of total billed charges,,
2.7X22MM HEADED SCREW,,C1713,HCPCS,Facility,Inpatient,,,,1177.5,1000.875,337.4715,1177.5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
2.7X22MM HEADED SCREW,,C1713,HCPCS,Facility,Both,,,,1177.5,1000.875,337.4715,1177.5,"Preferred One Administrative Services, INC.",PPO,1161.015,98.6,,percent of total billed charges,,
2.7X22MM HEADED SCREW,,C1713,HCPCS,Facility,Outpatient,,,,1177.5,1000.875,337.4715,1177.5,PrimeWest Health,Minnesota Senior Health Options (MSHO),605.82375,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
2.7X22MM HEADED SCREW,,C1713,HCPCS,Facility,Inpatient,,,,1177.5,1000.875,337.4715,1177.5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
2.7X22MM HEADED SCREW,,C1713,HCPCS,Facility,Outpatient,,,,1177.5,1000.875,337.4715,1177.5,PrimeWest Health,MinnesotaCare,604.764,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
2.7X22MM HEADED SCREW,,C1713,HCPCS,Facility,Inpatient,,,,1177.5,1000.875,337.4715,1177.5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
2.7X22MM HEADED SCREW,,C1713,HCPCS,Facility,Both,,,,1177.5,1000.875,337.4715,1177.5,Sanford Health Plan,Sanford Health Plan,1083.3,92,,percent of total billed charges,,
2.7X22MM HEADED SCREW,,C1713,HCPCS,Facility,Outpatient,,,,1177.5,1000.875,337.4715,1177.5,"UCare Health, Inc.",Individual & Family Plan,663.52125,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
2.7X22MM HEADED SCREW,,C1713,HCPCS,Facility,Inpatient,,,,1177.5,1000.875,337.4715,1177.5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
2.7X22MM HEADED SCREW,,C1713,HCPCS,Facility,Outpatient,,,,1177.5,1000.875,337.4715,1177.5,"UCare Health, Inc.",Medical Assistance,594.28425,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
2.7X22MM HEADED SCREW,,C1713,HCPCS,Facility,Inpatient,,,,1177.5,1000.875,337.4715,1177.5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
2.7X22MM HEADED SCREW,,C1713,HCPCS,Facility,Outpatient,,,,1177.5,1000.875,337.4715,1177.5,"UCare Health, Inc.",Medicare Advantage,594.28425,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
2.7X22MM HEADED SCREW,,C1713,HCPCS,Facility,Inpatient,,,,1177.5,1000.875,337.4715,1177.5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
2.7X22MM HEADED SCREW,,C1713,HCPCS,Facility,Outpatient,,,,1177.5,1000.875,337.4715,1177.5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),594.28425,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
2.7X22MM HEADED SCREW,,C1713,HCPCS,Facility,Inpatient,,,,1177.5,1000.875,337.4715,1177.5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
2.7X22MM HEADED SCREW,,C1713,HCPCS,Facility,Both,,,,1177.5,1000.875,337.4715,1177.5,UnitedHealthcare,Individual & Family,1106.85,94,,percent of total billed charges,,
2.7X22MM HEADED SCREW,,C1713,HCPCS,Facility,Outpatient,,,,1177.5,1000.875,337.4715,1177.5,UnitedHealthcare,Medicare Advantage,576.975,49,,percent of total billed charges,,
2.7X22MM HEADED SCREW,,C1713,HCPCS,Facility,Inpatient,,,,1177.5,1000.875,337.4715,1177.5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
2.7X22MM HEADED SCREW,,C1713,HCPCS,Facility,Outpatient,,,,1177.5,1000.875,337.4715,1177.5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,565.2,48,,percent of total billed charges,,100% of DHS outpatient percentage
2.7X22MM HEADED SCREW,,C1713,HCPCS,Facility,Inpatient,,,,1177.5,1000.875,337.4715,1177.5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
3.2MM THREADED DRILL GUIDE312.445,,C1713,HCPCS,Facility,Both,,,,199.5,169.575,57.1767,199.5,Aetna,Commercial,183.54,92,,percent of total billed charges,,
3.2MM THREADED DRILL GUIDE312.445,,C1713,HCPCS,Facility,Outpatient,,,,199.5,169.575,57.1767,199.5,Aetna,Medicare Advantage,97.755,49,,percent of total billed charges,,
3.2MM THREADED DRILL GUIDE312.445,,C1713,HCPCS,Facility,Inpatient,,,,199.5,169.575,57.1767,199.5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
3.2MM THREADED DRILL GUIDE312.445,,C1713,HCPCS,Facility,Both,,,,199.5,169.575,57.1767,199.5,Aetna,PPO,185.535,93,,percent of total billed charges,,
3.2MM THREADED DRILL GUIDE312.445,,C1713,HCPCS,Facility,Both,,,,199.5,169.575,57.1767,199.5,America's PPO,America's PPO,191.57985,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
3.2MM THREADED DRILL GUIDE312.445,,C1713,HCPCS,Facility,Both,,,,199.5,169.575,57.1767,199.5,BlueCross BlueShield Minnesota, Federal Employee Program,196.308,98.4,,percent of total billed charges,,
3.2MM THREADED DRILL GUIDE312.445,,C1713,HCPCS,Facility,Both,,,,199.5,169.575,57.1767,199.5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,199.5,100,,percent of total billed charges,,
3.2MM THREADED DRILL GUIDE312.445,,C1713,HCPCS,Facility,Both,,,,199.5,169.575,57.1767,199.5,BlueCross BlueShield Minnesota,High Value Network Plan,179.55,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
3.2MM THREADED DRILL GUIDE312.445,,C1713,HCPCS,Facility,Outpatient,,,,199.5,169.575,57.1767,199.5,BlueCross BlueShield Minnesota,Medicare Advantage,97.755,49,,percent of total billed charges,,
3.2MM THREADED DRILL GUIDE312.445,,C1713,HCPCS,Facility,Inpatient,,,,199.5,169.575,57.1767,199.5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
3.2MM THREADED DRILL GUIDE312.445,,C1713,HCPCS,Facility,Both,,,,199.5,169.575,57.1767,199.5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,176.69715,88.57,,percent of total billed charges,,
3.2MM THREADED DRILL GUIDE312.445,,C1713,HCPCS,Facility,Both,,,,199.5,169.575,57.1767,199.5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,57.1767,28.66,,percent of total billed charges,,
3.2MM THREADED DRILL GUIDE312.445,,C1713,HCPCS,Facility,Outpatient,,,,199.5,169.575,57.1767,199.5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),97.755,49,,percent of total billed charges,,
3.2MM THREADED DRILL GUIDE312.445,,C1713,HCPCS,Facility,Inpatient,,,,199.5,169.575,57.1767,199.5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
3.2MM THREADED DRILL GUIDE312.445,,C1713,HCPCS,Facility,Both,,,,199.5,169.575,57.1767,199.5,CorVel,Worker's Compensation,199.5,100,,percent of total billed charges,,
3.2MM THREADED DRILL GUIDE312.445,,C1713,HCPCS,Facility,Both,,,,199.5,169.575,57.1767,199.5,First Health Group Corporation,First Health Network,193.515,97,,percent of total billed charges,,
3.2MM THREADED DRILL GUIDE312.445,,C1713,HCPCS,Facility,Both,,,,199.5,169.575,57.1767,199.5,"Health Partners, Inc.",Commercial,188.727,94.6,,percent of total billed charges,,
3.2MM THREADED DRILL GUIDE312.445,,C1713,HCPCS,Facility,Outpatient,,,,199.5,169.575,57.1767,199.5,"Health Partners, Inc.",Medicare Advantage,97.755,49,,percent of total billed charges,,
3.2MM THREADED DRILL GUIDE312.445,,C1713,HCPCS,Facility,Inpatient,,,,199.5,169.575,57.1767,199.5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
3.2MM THREADED DRILL GUIDE312.445,,C1713,HCPCS,Facility,Both,,,,199.5,169.575,57.1767,199.5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),119.7,60,,percent of total billed charges,,
3.2MM THREADED DRILL GUIDE312.445,,C1713,HCPCS,Facility,Both,,,,199.5,169.575,57.1767,199.5,"Health Partners, Inc.",State of Minnesota Advantage Program,162.5925,81.5,,percent of total billed charges,,
3.2MM THREADED DRILL GUIDE312.445,,C1713,HCPCS,Facility,Both,,,,199.5,169.575,57.1767,199.5,"Health Partners, Inc.",State Public Programs,99.75,50,,percent of total billed charges,,
3.2MM THREADED DRILL GUIDE312.445,,C1713,HCPCS,Facility,Both,,,,199.5,169.575,57.1767,199.5,Humana Insurance Company,Commercial PPO,189.525,95,,percent of total billed charges,,
3.2MM THREADED DRILL GUIDE312.445,,C1713,HCPCS,Facility,Outpatient,,,,199.5,169.575,57.1767,199.5,Humana Insurance Company,Medicare PPO,97.755,49,,percent of total billed charges,,
3.2MM THREADED DRILL GUIDE312.445,,C1713,HCPCS,Facility,Inpatient,,,,199.5,169.575,57.1767,199.5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
3.2MM THREADED DRILL GUIDE312.445,,C1713,HCPCS,Facility,Both,,,,199.5,169.575,57.1767,199.5,Medica,Individual & Family,197.7045,99.1,,percent of total billed charges,,
3.2MM THREADED DRILL GUIDE312.445,,C1713,HCPCS,Facility,Outpatient,,,,199.5,169.575,57.1767,199.5,Medica,Medica Advantage Solution,99.351,49.8,,percent of total billed charges,,
3.2MM THREADED DRILL GUIDE312.445,,C1713,HCPCS,Facility,Inpatient,,,,199.5,169.575,57.1767,199.5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
3.2MM THREADED DRILL GUIDE312.445,,C1713,HCPCS,Facility,Outpatient,,,,199.5,169.575,57.1767,199.5,Medica,Medical Assistance,88.977,44.6,,percent of total billed charges,,
3.2MM THREADED DRILL GUIDE312.445,,C1713,HCPCS,Facility,Inpatient,,,,199.5,169.575,57.1767,199.5,Medica,Medical Assistance,,,,,Included in per diem rate,
3.2MM THREADED DRILL GUIDE312.445,,C1713,HCPCS,Facility,Outpatient,,,,199.5,169.575,57.1767,199.5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,99.351,49.8,,percent of total billed charges,,
3.2MM THREADED DRILL GUIDE312.445,,C1713,HCPCS,Facility,Inpatient,,,,199.5,169.575,57.1767,199.5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
3.2MM THREADED DRILL GUIDE312.445,,C1713,HCPCS,Facility,Both,,,,199.5,169.575,57.1767,199.5,"Multiplan, Inc.","Multiplan, Inc.",187.53,94,,percent of total billed charges,,
3.2MM THREADED DRILL GUIDE312.445,,C1713,HCPCS,Facility,Outpatient,,,,199.5,169.575,57.1767,199.5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,179.7495,90.1,,percent of total billed charges,,
3.2MM THREADED DRILL GUIDE312.445,,C1713,HCPCS,Facility,Inpatient,,,,199.5,169.575,57.1767,199.5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
3.2MM THREADED DRILL GUIDE312.445,,C1713,HCPCS,Facility,Both,,,,199.5,169.575,57.1767,199.5,"Preferred One Administrative Services, INC.",PPO,196.707,98.6,,percent of total billed charges,,
3.2MM THREADED DRILL GUIDE312.445,,C1713,HCPCS,Facility,Outpatient,,,,199.5,169.575,57.1767,199.5,PrimeWest Health,Minnesota Senior Health Options (MSHO),102.64275,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
3.2MM THREADED DRILL GUIDE312.445,,C1713,HCPCS,Facility,Inpatient,,,,199.5,169.575,57.1767,199.5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
3.2MM THREADED DRILL GUIDE312.445,,C1713,HCPCS,Facility,Outpatient,,,,199.5,169.575,57.1767,199.5,PrimeWest Health,MinnesotaCare,102.4632,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
3.2MM THREADED DRILL GUIDE312.445,,C1713,HCPCS,Facility,Inpatient,,,,199.5,169.575,57.1767,199.5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
3.2MM THREADED DRILL GUIDE312.445,,C1713,HCPCS,Facility,Both,,,,199.5,169.575,57.1767,199.5,Sanford Health Plan,Sanford Health Plan,183.54,92,,percent of total billed charges,,
3.2MM THREADED DRILL GUIDE312.445,,C1713,HCPCS,Facility,Outpatient,,,,199.5,169.575,57.1767,199.5,"UCare Health, Inc.",Individual & Family Plan,112.41825,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
3.2MM THREADED DRILL GUIDE312.445,,C1713,HCPCS,Facility,Inpatient,,,,199.5,169.575,57.1767,199.5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
3.2MM THREADED DRILL GUIDE312.445,,C1713,HCPCS,Facility,Outpatient,,,,199.5,169.575,57.1767,199.5,"UCare Health, Inc.",Medical Assistance,100.68765,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
3.2MM THREADED DRILL GUIDE312.445,,C1713,HCPCS,Facility,Inpatient,,,,199.5,169.575,57.1767,199.5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
3.2MM THREADED DRILL GUIDE312.445,,C1713,HCPCS,Facility,Outpatient,,,,199.5,169.575,57.1767,199.5,"UCare Health, Inc.",Medicare Advantage,100.68765,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
3.2MM THREADED DRILL GUIDE312.445,,C1713,HCPCS,Facility,Inpatient,,,,199.5,169.575,57.1767,199.5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
3.2MM THREADED DRILL GUIDE312.445,,C1713,HCPCS,Facility,Outpatient,,,,199.5,169.575,57.1767,199.5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),100.68765,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
3.2MM THREADED DRILL GUIDE312.445,,C1713,HCPCS,Facility,Inpatient,,,,199.5,169.575,57.1767,199.5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
3.2MM THREADED DRILL GUIDE312.445,,C1713,HCPCS,Facility,Both,,,,199.5,169.575,57.1767,199.5,UnitedHealthcare,Individual & Family,187.53,94,,percent of total billed charges,,
3.2MM THREADED DRILL GUIDE312.445,,C1713,HCPCS,Facility,Outpatient,,,,199.5,169.575,57.1767,199.5,UnitedHealthcare,Medicare Advantage,97.755,49,,percent of total billed charges,,
3.2MM THREADED DRILL GUIDE312.445,,C1713,HCPCS,Facility,Inpatient,,,,199.5,169.575,57.1767,199.5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
3.2MM THREADED DRILL GUIDE312.445,,C1713,HCPCS,Facility,Outpatient,,,,199.5,169.575,57.1767,199.5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,95.76,48,,percent of total billed charges,,100% of DHS outpatient percentage
3.2MM THREADED DRILL GUIDE312.445,,C1713,HCPCS,Facility,Inpatient,,,,199.5,169.575,57.1767,199.5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
HAMMERTOE SOLID 2.4 X 13MM,,C1713,HCPCS,Facility,Both,,,,1870,1589.5,535.942,1870,Aetna,Commercial,1720.4,92,,percent of total billed charges,,
HAMMERTOE SOLID 2.4 X 13MM,,C1713,HCPCS,Facility,Outpatient,,,,1870,1589.5,535.942,1870,Aetna,Medicare Advantage,916.3,49,,percent of total billed charges,,
HAMMERTOE SOLID 2.4 X 13MM,,C1713,HCPCS,Facility,Inpatient,,,,1870,1589.5,535.942,1870,Aetna,Medicare Advantage,,,,,Included in per diem rate,
HAMMERTOE SOLID 2.4 X 13MM,,C1713,HCPCS,Facility,Both,,,,1870,1589.5,535.942,1870,Aetna,PPO,1739.1,93,,percent of total billed charges,,
HAMMERTOE SOLID 2.4 X 13MM,,C1713,HCPCS,Facility,Both,,,,1870,1589.5,535.942,1870,America's PPO,America's PPO,1795.761,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
HAMMERTOE SOLID 2.4 X 13MM,,C1713,HCPCS,Facility,Both,,,,1870,1589.5,535.942,1870,BlueCross BlueShield Minnesota, Federal Employee Program,1840.08,98.4,,percent of total billed charges,,
HAMMERTOE SOLID 2.4 X 13MM,,C1713,HCPCS,Facility,Both,,,,1870,1589.5,535.942,1870,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1870,100,,percent of total billed charges,,
HAMMERTOE SOLID 2.4 X 13MM,,C1713,HCPCS,Facility,Both,,,,1870,1589.5,535.942,1870,BlueCross BlueShield Minnesota,High Value Network Plan,1683,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
HAMMERTOE SOLID 2.4 X 13MM,,C1713,HCPCS,Facility,Outpatient,,,,1870,1589.5,535.942,1870,BlueCross BlueShield Minnesota,Medicare Advantage,916.3,49,,percent of total billed charges,,
HAMMERTOE SOLID 2.4 X 13MM,,C1713,HCPCS,Facility,Inpatient,,,,1870,1589.5,535.942,1870,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
HAMMERTOE SOLID 2.4 X 13MM,,C1713,HCPCS,Facility,Both,,,,1870,1589.5,535.942,1870,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1656.259,88.57,,percent of total billed charges,,
HAMMERTOE SOLID 2.4 X 13MM,,C1713,HCPCS,Facility,Both,,,,1870,1589.5,535.942,1870,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,535.942,28.66,,percent of total billed charges,,
HAMMERTOE SOLID 2.4 X 13MM,,C1713,HCPCS,Facility,Outpatient,,,,1870,1589.5,535.942,1870,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),916.3,49,,percent of total billed charges,,
HAMMERTOE SOLID 2.4 X 13MM,,C1713,HCPCS,Facility,Inpatient,,,,1870,1589.5,535.942,1870,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
HAMMERTOE SOLID 2.4 X 13MM,,C1713,HCPCS,Facility,Both,,,,1870,1589.5,535.942,1870,CorVel,Worker's Compensation,1870,100,,percent of total billed charges,,
HAMMERTOE SOLID 2.4 X 13MM,,C1713,HCPCS,Facility,Both,,,,1870,1589.5,535.942,1870,First Health Group Corporation,First Health Network,1813.9,97,,percent of total billed charges,,
HAMMERTOE SOLID 2.4 X 13MM,,C1713,HCPCS,Facility,Both,,,,1870,1589.5,535.942,1870,"Health Partners, Inc.",Commercial,1769.02,94.6,,percent of total billed charges,,
HAMMERTOE SOLID 2.4 X 13MM,,C1713,HCPCS,Facility,Outpatient,,,,1870,1589.5,535.942,1870,"Health Partners, Inc.",Medicare Advantage,916.3,49,,percent of total billed charges,,
HAMMERTOE SOLID 2.4 X 13MM,,C1713,HCPCS,Facility,Inpatient,,,,1870,1589.5,535.942,1870,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
HAMMERTOE SOLID 2.4 X 13MM,,C1713,HCPCS,Facility,Both,,,,1870,1589.5,535.942,1870,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1122,60,,percent of total billed charges,,
HAMMERTOE SOLID 2.4 X 13MM,,C1713,HCPCS,Facility,Both,,,,1870,1589.5,535.942,1870,"Health Partners, Inc.",State of Minnesota Advantage Program,1524.05,81.5,,percent of total billed charges,,
HAMMERTOE SOLID 2.4 X 13MM,,C1713,HCPCS,Facility,Both,,,,1870,1589.5,535.942,1870,"Health Partners, Inc.",State Public Programs,935,50,,percent of total billed charges,,
HAMMERTOE SOLID 2.4 X 13MM,,C1713,HCPCS,Facility,Both,,,,1870,1589.5,535.942,1870,Humana Insurance Company,Commercial PPO,1776.5,95,,percent of total billed charges,,
HAMMERTOE SOLID 2.4 X 13MM,,C1713,HCPCS,Facility,Outpatient,,,,1870,1589.5,535.942,1870,Humana Insurance Company,Medicare PPO,916.3,49,,percent of total billed charges,,
HAMMERTOE SOLID 2.4 X 13MM,,C1713,HCPCS,Facility,Inpatient,,,,1870,1589.5,535.942,1870,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
HAMMERTOE SOLID 2.4 X 13MM,,C1713,HCPCS,Facility,Both,,,,1870,1589.5,535.942,1870,Medica,Individual & Family,1853.17,99.1,,percent of total billed charges,,
HAMMERTOE SOLID 2.4 X 13MM,,C1713,HCPCS,Facility,Outpatient,,,,1870,1589.5,535.942,1870,Medica,Medica Advantage Solution,931.26,49.8,,percent of total billed charges,,
HAMMERTOE SOLID 2.4 X 13MM,,C1713,HCPCS,Facility,Inpatient,,,,1870,1589.5,535.942,1870,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
HAMMERTOE SOLID 2.4 X 13MM,,C1713,HCPCS,Facility,Outpatient,,,,1870,1589.5,535.942,1870,Medica,Medical Assistance,834.02,44.6,,percent of total billed charges,,
HAMMERTOE SOLID 2.4 X 13MM,,C1713,HCPCS,Facility,Inpatient,,,,1870,1589.5,535.942,1870,Medica,Medical Assistance,,,,,Included in per diem rate,
HAMMERTOE SOLID 2.4 X 13MM,,C1713,HCPCS,Facility,Outpatient,,,,1870,1589.5,535.942,1870,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,931.26,49.8,,percent of total billed charges,,
HAMMERTOE SOLID 2.4 X 13MM,,C1713,HCPCS,Facility,Inpatient,,,,1870,1589.5,535.942,1870,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
HAMMERTOE SOLID 2.4 X 13MM,,C1713,HCPCS,Facility,Both,,,,1870,1589.5,535.942,1870,"Multiplan, Inc.","Multiplan, Inc.",1757.8,94,,percent of total billed charges,,
HAMMERTOE SOLID 2.4 X 13MM,,C1713,HCPCS,Facility,Outpatient,,,,1870,1589.5,535.942,1870,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1684.87,90.1,,percent of total billed charges,,
HAMMERTOE SOLID 2.4 X 13MM,,C1713,HCPCS,Facility,Inpatient,,,,1870,1589.5,535.942,1870,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
HAMMERTOE SOLID 2.4 X 13MM,,C1713,HCPCS,Facility,Both,,,,1870,1589.5,535.942,1870,"Preferred One Administrative Services, INC.",PPO,1843.82,98.6,,percent of total billed charges,,
HAMMERTOE SOLID 2.4 X 13MM,,C1713,HCPCS,Facility,Outpatient,,,,1870,1589.5,535.942,1870,PrimeWest Health,Minnesota Senior Health Options (MSHO),962.115,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
HAMMERTOE SOLID 2.4 X 13MM,,C1713,HCPCS,Facility,Inpatient,,,,1870,1589.5,535.942,1870,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
HAMMERTOE SOLID 2.4 X 13MM,,C1713,HCPCS,Facility,Outpatient,,,,1870,1589.5,535.942,1870,PrimeWest Health,MinnesotaCare,960.432,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
HAMMERTOE SOLID 2.4 X 13MM,,C1713,HCPCS,Facility,Inpatient,,,,1870,1589.5,535.942,1870,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
HAMMERTOE SOLID 2.4 X 13MM,,C1713,HCPCS,Facility,Both,,,,1870,1589.5,535.942,1870,Sanford Health Plan,Sanford Health Plan,1720.4,92,,percent of total billed charges,,
HAMMERTOE SOLID 2.4 X 13MM,,C1713,HCPCS,Facility,Outpatient,,,,1870,1589.5,535.942,1870,"UCare Health, Inc.",Individual & Family Plan,1053.745,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
HAMMERTOE SOLID 2.4 X 13MM,,C1713,HCPCS,Facility,Inpatient,,,,1870,1589.5,535.942,1870,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
HAMMERTOE SOLID 2.4 X 13MM,,C1713,HCPCS,Facility,Outpatient,,,,1870,1589.5,535.942,1870,"UCare Health, Inc.",Medical Assistance,943.789,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
HAMMERTOE SOLID 2.4 X 13MM,,C1713,HCPCS,Facility,Inpatient,,,,1870,1589.5,535.942,1870,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
HAMMERTOE SOLID 2.4 X 13MM,,C1713,HCPCS,Facility,Outpatient,,,,1870,1589.5,535.942,1870,"UCare Health, Inc.",Medicare Advantage,943.789,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
HAMMERTOE SOLID 2.4 X 13MM,,C1713,HCPCS,Facility,Inpatient,,,,1870,1589.5,535.942,1870,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
HAMMERTOE SOLID 2.4 X 13MM,,C1713,HCPCS,Facility,Outpatient,,,,1870,1589.5,535.942,1870,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),943.789,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
HAMMERTOE SOLID 2.4 X 13MM,,C1713,HCPCS,Facility,Inpatient,,,,1870,1589.5,535.942,1870,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
HAMMERTOE SOLID 2.4 X 13MM,,C1713,HCPCS,Facility,Both,,,,1870,1589.5,535.942,1870,UnitedHealthcare,Individual & Family,1757.8,94,,percent of total billed charges,,
HAMMERTOE SOLID 2.4 X 13MM,,C1713,HCPCS,Facility,Outpatient,,,,1870,1589.5,535.942,1870,UnitedHealthcare,Medicare Advantage,916.3,49,,percent of total billed charges,,
HAMMERTOE SOLID 2.4 X 13MM,,C1713,HCPCS,Facility,Inpatient,,,,1870,1589.5,535.942,1870,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
HAMMERTOE SOLID 2.4 X 13MM,,C1713,HCPCS,Facility,Outpatient,,,,1870,1589.5,535.942,1870,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,897.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
HAMMERTOE SOLID 2.4 X 13MM,,C1713,HCPCS,Facility,Inpatient,,,,1870,1589.5,535.942,1870,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
HEADED SCREW 2.5MM X 16MM,,C1713,HCPCS,Facility,Both,,,,807.5,686.375,231.4295,807.5,Aetna,Commercial,742.9,92,,percent of total billed charges,,
HEADED SCREW 2.5MM X 16MM,,C1713,HCPCS,Facility,Outpatient,,,,807.5,686.375,231.4295,807.5,Aetna,Medicare Advantage,395.675,49,,percent of total billed charges,,
HEADED SCREW 2.5MM X 16MM,,C1713,HCPCS,Facility,Inpatient,,,,807.5,686.375,231.4295,807.5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
HEADED SCREW 2.5MM X 16MM,,C1713,HCPCS,Facility,Both,,,,807.5,686.375,231.4295,807.5,Aetna,PPO,750.975,93,,percent of total billed charges,,
HEADED SCREW 2.5MM X 16MM,,C1713,HCPCS,Facility,Both,,,,807.5,686.375,231.4295,807.5,America's PPO,America's PPO,775.44225,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
HEADED SCREW 2.5MM X 16MM,,C1713,HCPCS,Facility,Both,,,,807.5,686.375,231.4295,807.5,BlueCross BlueShield Minnesota, Federal Employee Program,794.58,98.4,,percent of total billed charges,,
HEADED SCREW 2.5MM X 16MM,,C1713,HCPCS,Facility,Both,,,,807.5,686.375,231.4295,807.5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,807.5,100,,percent of total billed charges,,
HEADED SCREW 2.5MM X 16MM,,C1713,HCPCS,Facility,Both,,,,807.5,686.375,231.4295,807.5,BlueCross BlueShield Minnesota,High Value Network Plan,726.75,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
HEADED SCREW 2.5MM X 16MM,,C1713,HCPCS,Facility,Outpatient,,,,807.5,686.375,231.4295,807.5,BlueCross BlueShield Minnesota,Medicare Advantage,395.675,49,,percent of total billed charges,,
HEADED SCREW 2.5MM X 16MM,,C1713,HCPCS,Facility,Inpatient,,,,807.5,686.375,231.4295,807.5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
HEADED SCREW 2.5MM X 16MM,,C1713,HCPCS,Facility,Both,,,,807.5,686.375,231.4295,807.5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,715.20275,88.57,,percent of total billed charges,,
HEADED SCREW 2.5MM X 16MM,,C1713,HCPCS,Facility,Both,,,,807.5,686.375,231.4295,807.5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,231.4295,28.66,,percent of total billed charges,,
HEADED SCREW 2.5MM X 16MM,,C1713,HCPCS,Facility,Outpatient,,,,807.5,686.375,231.4295,807.5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),395.675,49,,percent of total billed charges,,
HEADED SCREW 2.5MM X 16MM,,C1713,HCPCS,Facility,Inpatient,,,,807.5,686.375,231.4295,807.5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
HEADED SCREW 2.5MM X 16MM,,C1713,HCPCS,Facility,Both,,,,807.5,686.375,231.4295,807.5,CorVel,Worker's Compensation,807.5,100,,percent of total billed charges,,
HEADED SCREW 2.5MM X 16MM,,C1713,HCPCS,Facility,Both,,,,807.5,686.375,231.4295,807.5,First Health Group Corporation,First Health Network,783.275,97,,percent of total billed charges,,
HEADED SCREW 2.5MM X 16MM,,C1713,HCPCS,Facility,Both,,,,807.5,686.375,231.4295,807.5,"Health Partners, Inc.",Commercial,763.895,94.6,,percent of total billed charges,,
HEADED SCREW 2.5MM X 16MM,,C1713,HCPCS,Facility,Outpatient,,,,807.5,686.375,231.4295,807.5,"Health Partners, Inc.",Medicare Advantage,395.675,49,,percent of total billed charges,,
HEADED SCREW 2.5MM X 16MM,,C1713,HCPCS,Facility,Inpatient,,,,807.5,686.375,231.4295,807.5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
HEADED SCREW 2.5MM X 16MM,,C1713,HCPCS,Facility,Both,,,,807.5,686.375,231.4295,807.5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),484.5,60,,percent of total billed charges,,
HEADED SCREW 2.5MM X 16MM,,C1713,HCPCS,Facility,Both,,,,807.5,686.375,231.4295,807.5,"Health Partners, Inc.",State of Minnesota Advantage Program,658.1125,81.5,,percent of total billed charges,,
HEADED SCREW 2.5MM X 16MM,,C1713,HCPCS,Facility,Both,,,,807.5,686.375,231.4295,807.5,"Health Partners, Inc.",State Public Programs,403.75,50,,percent of total billed charges,,
HEADED SCREW 2.5MM X 16MM,,C1713,HCPCS,Facility,Both,,,,807.5,686.375,231.4295,807.5,Humana Insurance Company,Commercial PPO,767.125,95,,percent of total billed charges,,
HEADED SCREW 2.5MM X 16MM,,C1713,HCPCS,Facility,Outpatient,,,,807.5,686.375,231.4295,807.5,Humana Insurance Company,Medicare PPO,395.675,49,,percent of total billed charges,,
HEADED SCREW 2.5MM X 16MM,,C1713,HCPCS,Facility,Inpatient,,,,807.5,686.375,231.4295,807.5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
HEADED SCREW 2.5MM X 16MM,,C1713,HCPCS,Facility,Both,,,,807.5,686.375,231.4295,807.5,Medica,Individual & Family,800.2325,99.1,,percent of total billed charges,,
HEADED SCREW 2.5MM X 16MM,,C1713,HCPCS,Facility,Outpatient,,,,807.5,686.375,231.4295,807.5,Medica,Medica Advantage Solution,402.135,49.8,,percent of total billed charges,,
HEADED SCREW 2.5MM X 16MM,,C1713,HCPCS,Facility,Inpatient,,,,807.5,686.375,231.4295,807.5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
HEADED SCREW 2.5MM X 16MM,,C1713,HCPCS,Facility,Outpatient,,,,807.5,686.375,231.4295,807.5,Medica,Medical Assistance,360.145,44.6,,percent of total billed charges,,
HEADED SCREW 2.5MM X 16MM,,C1713,HCPCS,Facility,Inpatient,,,,807.5,686.375,231.4295,807.5,Medica,Medical Assistance,,,,,Included in per diem rate,
HEADED SCREW 2.5MM X 16MM,,C1713,HCPCS,Facility,Outpatient,,,,807.5,686.375,231.4295,807.5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,402.135,49.8,,percent of total billed charges,,
HEADED SCREW 2.5MM X 16MM,,C1713,HCPCS,Facility,Inpatient,,,,807.5,686.375,231.4295,807.5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
HEADED SCREW 2.5MM X 16MM,,C1713,HCPCS,Facility,Both,,,,807.5,686.375,231.4295,807.5,"Multiplan, Inc.","Multiplan, Inc.",759.05,94,,percent of total billed charges,,
HEADED SCREW 2.5MM X 16MM,,C1713,HCPCS,Facility,Outpatient,,,,807.5,686.375,231.4295,807.5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,727.5575,90.1,,percent of total billed charges,,
HEADED SCREW 2.5MM X 16MM,,C1713,HCPCS,Facility,Inpatient,,,,807.5,686.375,231.4295,807.5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
HEADED SCREW 2.5MM X 16MM,,C1713,HCPCS,Facility,Both,,,,807.5,686.375,231.4295,807.5,"Preferred One Administrative Services, INC.",PPO,796.195,98.6,,percent of total billed charges,,
HEADED SCREW 2.5MM X 16MM,,C1713,HCPCS,Facility,Outpatient,,,,807.5,686.375,231.4295,807.5,PrimeWest Health,Minnesota Senior Health Options (MSHO),415.45875,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
HEADED SCREW 2.5MM X 16MM,,C1713,HCPCS,Facility,Inpatient,,,,807.5,686.375,231.4295,807.5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
HEADED SCREW 2.5MM X 16MM,,C1713,HCPCS,Facility,Outpatient,,,,807.5,686.375,231.4295,807.5,PrimeWest Health,MinnesotaCare,414.732,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
HEADED SCREW 2.5MM X 16MM,,C1713,HCPCS,Facility,Inpatient,,,,807.5,686.375,231.4295,807.5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
HEADED SCREW 2.5MM X 16MM,,C1713,HCPCS,Facility,Both,,,,807.5,686.375,231.4295,807.5,Sanford Health Plan,Sanford Health Plan,742.9,92,,percent of total billed charges,,
HEADED SCREW 2.5MM X 16MM,,C1713,HCPCS,Facility,Outpatient,,,,807.5,686.375,231.4295,807.5,"UCare Health, Inc.",Individual & Family Plan,455.02625,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
HEADED SCREW 2.5MM X 16MM,,C1713,HCPCS,Facility,Inpatient,,,,807.5,686.375,231.4295,807.5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
HEADED SCREW 2.5MM X 16MM,,C1713,HCPCS,Facility,Outpatient,,,,807.5,686.375,231.4295,807.5,"UCare Health, Inc.",Medical Assistance,407.54525,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
HEADED SCREW 2.5MM X 16MM,,C1713,HCPCS,Facility,Inpatient,,,,807.5,686.375,231.4295,807.5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
HEADED SCREW 2.5MM X 16MM,,C1713,HCPCS,Facility,Outpatient,,,,807.5,686.375,231.4295,807.5,"UCare Health, Inc.",Medicare Advantage,407.54525,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
HEADED SCREW 2.5MM X 16MM,,C1713,HCPCS,Facility,Inpatient,,,,807.5,686.375,231.4295,807.5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
HEADED SCREW 2.5MM X 16MM,,C1713,HCPCS,Facility,Outpatient,,,,807.5,686.375,231.4295,807.5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),407.54525,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
HEADED SCREW 2.5MM X 16MM,,C1713,HCPCS,Facility,Inpatient,,,,807.5,686.375,231.4295,807.5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
HEADED SCREW 2.5MM X 16MM,,C1713,HCPCS,Facility,Both,,,,807.5,686.375,231.4295,807.5,UnitedHealthcare,Individual & Family,759.05,94,,percent of total billed charges,,
HEADED SCREW 2.5MM X 16MM,,C1713,HCPCS,Facility,Outpatient,,,,807.5,686.375,231.4295,807.5,UnitedHealthcare,Medicare Advantage,395.675,49,,percent of total billed charges,,
HEADED SCREW 2.5MM X 16MM,,C1713,HCPCS,Facility,Inpatient,,,,807.5,686.375,231.4295,807.5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
HEADED SCREW 2.5MM X 16MM,,C1713,HCPCS,Facility,Outpatient,,,,807.5,686.375,231.4295,807.5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,387.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
HEADED SCREW 2.5MM X 16MM,,C1713,HCPCS,Facility,Inpatient,,,,807.5,686.375,231.4295,807.5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
HEADED SCREW 3.0MM X 22MM,,C1713,HCPCS,Facility,Both,,,,877.5,745.875,251.4915,877.5,Aetna,Commercial,807.3,92,,percent of total billed charges,,
HEADED SCREW 3.0MM X 22MM,,C1713,HCPCS,Facility,Outpatient,,,,877.5,745.875,251.4915,877.5,Aetna,Medicare Advantage,429.975,49,,percent of total billed charges,,
HEADED SCREW 3.0MM X 22MM,,C1713,HCPCS,Facility,Inpatient,,,,877.5,745.875,251.4915,877.5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
HEADED SCREW 3.0MM X 22MM,,C1713,HCPCS,Facility,Both,,,,877.5,745.875,251.4915,877.5,Aetna,PPO,816.075,93,,percent of total billed charges,,
HEADED SCREW 3.0MM X 22MM,,C1713,HCPCS,Facility,Both,,,,877.5,745.875,251.4915,877.5,America's PPO,America's PPO,842.66325,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
HEADED SCREW 3.0MM X 22MM,,C1713,HCPCS,Facility,Both,,,,877.5,745.875,251.4915,877.5,BlueCross BlueShield Minnesota, Federal Employee Program,863.46,98.4,,percent of total billed charges,,
HEADED SCREW 3.0MM X 22MM,,C1713,HCPCS,Facility,Both,,,,877.5,745.875,251.4915,877.5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,877.5,100,,percent of total billed charges,,
HEADED SCREW 3.0MM X 22MM,,C1713,HCPCS,Facility,Both,,,,877.5,745.875,251.4915,877.5,BlueCross BlueShield Minnesota,High Value Network Plan,789.75,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
HEADED SCREW 3.0MM X 22MM,,C1713,HCPCS,Facility,Outpatient,,,,877.5,745.875,251.4915,877.5,BlueCross BlueShield Minnesota,Medicare Advantage,429.975,49,,percent of total billed charges,,
HEADED SCREW 3.0MM X 22MM,,C1713,HCPCS,Facility,Inpatient,,,,877.5,745.875,251.4915,877.5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
HEADED SCREW 3.0MM X 22MM,,C1713,HCPCS,Facility,Both,,,,877.5,745.875,251.4915,877.5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,777.20175,88.57,,percent of total billed charges,,
HEADED SCREW 3.0MM X 22MM,,C1713,HCPCS,Facility,Both,,,,877.5,745.875,251.4915,877.5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,251.4915,28.66,,percent of total billed charges,,
HEADED SCREW 3.0MM X 22MM,,C1713,HCPCS,Facility,Outpatient,,,,877.5,745.875,251.4915,877.5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),429.975,49,,percent of total billed charges,,
HEADED SCREW 3.0MM X 22MM,,C1713,HCPCS,Facility,Inpatient,,,,877.5,745.875,251.4915,877.5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
HEADED SCREW 3.0MM X 22MM,,C1713,HCPCS,Facility,Both,,,,877.5,745.875,251.4915,877.5,CorVel,Worker's Compensation,877.5,100,,percent of total billed charges,,
HEADED SCREW 3.0MM X 22MM,,C1713,HCPCS,Facility,Both,,,,877.5,745.875,251.4915,877.5,First Health Group Corporation,First Health Network,851.175,97,,percent of total billed charges,,
HEADED SCREW 3.0MM X 22MM,,C1713,HCPCS,Facility,Both,,,,877.5,745.875,251.4915,877.5,"Health Partners, Inc.",Commercial,830.115,94.6,,percent of total billed charges,,
HEADED SCREW 3.0MM X 22MM,,C1713,HCPCS,Facility,Outpatient,,,,877.5,745.875,251.4915,877.5,"Health Partners, Inc.",Medicare Advantage,429.975,49,,percent of total billed charges,,
HEADED SCREW 3.0MM X 22MM,,C1713,HCPCS,Facility,Inpatient,,,,877.5,745.875,251.4915,877.5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
HEADED SCREW 3.0MM X 22MM,,C1713,HCPCS,Facility,Both,,,,877.5,745.875,251.4915,877.5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),526.5,60,,percent of total billed charges,,
HEADED SCREW 3.0MM X 22MM,,C1713,HCPCS,Facility,Both,,,,877.5,745.875,251.4915,877.5,"Health Partners, Inc.",State of Minnesota Advantage Program,715.1625,81.5,,percent of total billed charges,,
HEADED SCREW 3.0MM X 22MM,,C1713,HCPCS,Facility,Both,,,,877.5,745.875,251.4915,877.5,"Health Partners, Inc.",State Public Programs,438.75,50,,percent of total billed charges,,
HEADED SCREW 3.0MM X 22MM,,C1713,HCPCS,Facility,Both,,,,877.5,745.875,251.4915,877.5,Humana Insurance Company,Commercial PPO,833.625,95,,percent of total billed charges,,
HEADED SCREW 3.0MM X 22MM,,C1713,HCPCS,Facility,Outpatient,,,,877.5,745.875,251.4915,877.5,Humana Insurance Company,Medicare PPO,429.975,49,,percent of total billed charges,,
HEADED SCREW 3.0MM X 22MM,,C1713,HCPCS,Facility,Inpatient,,,,877.5,745.875,251.4915,877.5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
HEADED SCREW 3.0MM X 22MM,,C1713,HCPCS,Facility,Both,,,,877.5,745.875,251.4915,877.5,Medica,Individual & Family,869.6025,99.1,,percent of total billed charges,,
HEADED SCREW 3.0MM X 22MM,,C1713,HCPCS,Facility,Outpatient,,,,877.5,745.875,251.4915,877.5,Medica,Medica Advantage Solution,436.995,49.8,,percent of total billed charges,,
HEADED SCREW 3.0MM X 22MM,,C1713,HCPCS,Facility,Inpatient,,,,877.5,745.875,251.4915,877.5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
HEADED SCREW 3.0MM X 22MM,,C1713,HCPCS,Facility,Outpatient,,,,877.5,745.875,251.4915,877.5,Medica,Medical Assistance,391.365,44.6,,percent of total billed charges,,
HEADED SCREW 3.0MM X 22MM,,C1713,HCPCS,Facility,Inpatient,,,,877.5,745.875,251.4915,877.5,Medica,Medical Assistance,,,,,Included in per diem rate,
HEADED SCREW 3.0MM X 22MM,,C1713,HCPCS,Facility,Outpatient,,,,877.5,745.875,251.4915,877.5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,436.995,49.8,,percent of total billed charges,,
HEADED SCREW 3.0MM X 22MM,,C1713,HCPCS,Facility,Inpatient,,,,877.5,745.875,251.4915,877.5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
HEADED SCREW 3.0MM X 22MM,,C1713,HCPCS,Facility,Both,,,,877.5,745.875,251.4915,877.5,"Multiplan, Inc.","Multiplan, Inc.",824.85,94,,percent of total billed charges,,
HEADED SCREW 3.0MM X 22MM,,C1713,HCPCS,Facility,Outpatient,,,,877.5,745.875,251.4915,877.5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,790.6275,90.1,,percent of total billed charges,,
HEADED SCREW 3.0MM X 22MM,,C1713,HCPCS,Facility,Inpatient,,,,877.5,745.875,251.4915,877.5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
HEADED SCREW 3.0MM X 22MM,,C1713,HCPCS,Facility,Both,,,,877.5,745.875,251.4915,877.5,"Preferred One Administrative Services, INC.",PPO,865.215,98.6,,percent of total billed charges,,
HEADED SCREW 3.0MM X 22MM,,C1713,HCPCS,Facility,Outpatient,,,,877.5,745.875,251.4915,877.5,PrimeWest Health,Minnesota Senior Health Options (MSHO),451.47375,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
HEADED SCREW 3.0MM X 22MM,,C1713,HCPCS,Facility,Inpatient,,,,877.5,745.875,251.4915,877.5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
HEADED SCREW 3.0MM X 22MM,,C1713,HCPCS,Facility,Outpatient,,,,877.5,745.875,251.4915,877.5,PrimeWest Health,MinnesotaCare,450.684,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
HEADED SCREW 3.0MM X 22MM,,C1713,HCPCS,Facility,Inpatient,,,,877.5,745.875,251.4915,877.5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
HEADED SCREW 3.0MM X 22MM,,C1713,HCPCS,Facility,Both,,,,877.5,745.875,251.4915,877.5,Sanford Health Plan,Sanford Health Plan,807.3,92,,percent of total billed charges,,
HEADED SCREW 3.0MM X 22MM,,C1713,HCPCS,Facility,Outpatient,,,,877.5,745.875,251.4915,877.5,"UCare Health, Inc.",Individual & Family Plan,494.47125,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
HEADED SCREW 3.0MM X 22MM,,C1713,HCPCS,Facility,Inpatient,,,,877.5,745.875,251.4915,877.5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
HEADED SCREW 3.0MM X 22MM,,C1713,HCPCS,Facility,Outpatient,,,,877.5,745.875,251.4915,877.5,"UCare Health, Inc.",Medical Assistance,442.87425,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
HEADED SCREW 3.0MM X 22MM,,C1713,HCPCS,Facility,Inpatient,,,,877.5,745.875,251.4915,877.5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
HEADED SCREW 3.0MM X 22MM,,C1713,HCPCS,Facility,Outpatient,,,,877.5,745.875,251.4915,877.5,"UCare Health, Inc.",Medicare Advantage,442.87425,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
HEADED SCREW 3.0MM X 22MM,,C1713,HCPCS,Facility,Inpatient,,,,877.5,745.875,251.4915,877.5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
HEADED SCREW 3.0MM X 22MM,,C1713,HCPCS,Facility,Outpatient,,,,877.5,745.875,251.4915,877.5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),442.87425,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
HEADED SCREW 3.0MM X 22MM,,C1713,HCPCS,Facility,Inpatient,,,,877.5,745.875,251.4915,877.5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
HEADED SCREW 3.0MM X 22MM,,C1713,HCPCS,Facility,Both,,,,877.5,745.875,251.4915,877.5,UnitedHealthcare,Individual & Family,824.85,94,,percent of total billed charges,,
HEADED SCREW 3.0MM X 22MM,,C1713,HCPCS,Facility,Outpatient,,,,877.5,745.875,251.4915,877.5,UnitedHealthcare,Medicare Advantage,429.975,49,,percent of total billed charges,,
HEADED SCREW 3.0MM X 22MM,,C1713,HCPCS,Facility,Inpatient,,,,877.5,745.875,251.4915,877.5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
HEADED SCREW 3.0MM X 22MM,,C1713,HCPCS,Facility,Outpatient,,,,877.5,745.875,251.4915,877.5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,421.2,48,,percent of total billed charges,,100% of DHS outpatient percentage
HEADED SCREW 3.0MM X 22MM,,C1713,HCPCS,Facility,Inpatient,,,,877.5,745.875,251.4915,877.5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
HEADLESS SCREW 3X30MM,,C1713,HCPCS,Facility,Both,,,,1082.5,920.125,310.2445,1082.5,Aetna,Commercial,995.9,92,,percent of total billed charges,,
HEADLESS SCREW 3X30MM,,C1713,HCPCS,Facility,Outpatient,,,,1082.5,920.125,310.2445,1082.5,Aetna,Medicare Advantage,530.425,49,,percent of total billed charges,,
HEADLESS SCREW 3X30MM,,C1713,HCPCS,Facility,Inpatient,,,,1082.5,920.125,310.2445,1082.5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
HEADLESS SCREW 3X30MM,,C1713,HCPCS,Facility,Both,,,,1082.5,920.125,310.2445,1082.5,Aetna,PPO,1006.725,93,,percent of total billed charges,,
HEADLESS SCREW 3X30MM,,C1713,HCPCS,Facility,Both,,,,1082.5,920.125,310.2445,1082.5,America's PPO,America's PPO,1039.52475,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
HEADLESS SCREW 3X30MM,,C1713,HCPCS,Facility,Both,,,,1082.5,920.125,310.2445,1082.5,BlueCross BlueShield Minnesota, Federal Employee Program,1065.18,98.4,,percent of total billed charges,,
HEADLESS SCREW 3X30MM,,C1713,HCPCS,Facility,Both,,,,1082.5,920.125,310.2445,1082.5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1082.5,100,,percent of total billed charges,,
HEADLESS SCREW 3X30MM,,C1713,HCPCS,Facility,Both,,,,1082.5,920.125,310.2445,1082.5,BlueCross BlueShield Minnesota,High Value Network Plan,974.25,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
HEADLESS SCREW 3X30MM,,C1713,HCPCS,Facility,Outpatient,,,,1082.5,920.125,310.2445,1082.5,BlueCross BlueShield Minnesota,Medicare Advantage,530.425,49,,percent of total billed charges,,
HEADLESS SCREW 3X30MM,,C1713,HCPCS,Facility,Inpatient,,,,1082.5,920.125,310.2445,1082.5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
HEADLESS SCREW 3X30MM,,C1713,HCPCS,Facility,Both,,,,1082.5,920.125,310.2445,1082.5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,958.77025,88.57,,percent of total billed charges,,
HEADLESS SCREW 3X30MM,,C1713,HCPCS,Facility,Both,,,,1082.5,920.125,310.2445,1082.5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,310.2445,28.66,,percent of total billed charges,,
HEADLESS SCREW 3X30MM,,C1713,HCPCS,Facility,Outpatient,,,,1082.5,920.125,310.2445,1082.5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),530.425,49,,percent of total billed charges,,
HEADLESS SCREW 3X30MM,,C1713,HCPCS,Facility,Inpatient,,,,1082.5,920.125,310.2445,1082.5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
HEADLESS SCREW 3X30MM,,C1713,HCPCS,Facility,Both,,,,1082.5,920.125,310.2445,1082.5,CorVel,Worker's Compensation,1082.5,100,,percent of total billed charges,,
HEADLESS SCREW 3X30MM,,C1713,HCPCS,Facility,Both,,,,1082.5,920.125,310.2445,1082.5,First Health Group Corporation,First Health Network,1050.025,97,,percent of total billed charges,,
HEADLESS SCREW 3X30MM,,C1713,HCPCS,Facility,Both,,,,1082.5,920.125,310.2445,1082.5,"Health Partners, Inc.",Commercial,1024.045,94.6,,percent of total billed charges,,
HEADLESS SCREW 3X30MM,,C1713,HCPCS,Facility,Outpatient,,,,1082.5,920.125,310.2445,1082.5,"Health Partners, Inc.",Medicare Advantage,530.425,49,,percent of total billed charges,,
HEADLESS SCREW 3X30MM,,C1713,HCPCS,Facility,Inpatient,,,,1082.5,920.125,310.2445,1082.5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
HEADLESS SCREW 3X30MM,,C1713,HCPCS,Facility,Both,,,,1082.5,920.125,310.2445,1082.5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),649.5,60,,percent of total billed charges,,
HEADLESS SCREW 3X30MM,,C1713,HCPCS,Facility,Both,,,,1082.5,920.125,310.2445,1082.5,"Health Partners, Inc.",State of Minnesota Advantage Program,882.2375,81.5,,percent of total billed charges,,
HEADLESS SCREW 3X30MM,,C1713,HCPCS,Facility,Both,,,,1082.5,920.125,310.2445,1082.5,"Health Partners, Inc.",State Public Programs,541.25,50,,percent of total billed charges,,
HEADLESS SCREW 3X30MM,,C1713,HCPCS,Facility,Both,,,,1082.5,920.125,310.2445,1082.5,Humana Insurance Company,Commercial PPO,1028.375,95,,percent of total billed charges,,
HEADLESS SCREW 3X30MM,,C1713,HCPCS,Facility,Outpatient,,,,1082.5,920.125,310.2445,1082.5,Humana Insurance Company,Medicare PPO,530.425,49,,percent of total billed charges,,
HEADLESS SCREW 3X30MM,,C1713,HCPCS,Facility,Inpatient,,,,1082.5,920.125,310.2445,1082.5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
HEADLESS SCREW 3X30MM,,C1713,HCPCS,Facility,Both,,,,1082.5,920.125,310.2445,1082.5,Medica,Individual & Family,1072.7575,99.1,,percent of total billed charges,,
HEADLESS SCREW 3X30MM,,C1713,HCPCS,Facility,Outpatient,,,,1082.5,920.125,310.2445,1082.5,Medica,Medica Advantage Solution,539.085,49.8,,percent of total billed charges,,
HEADLESS SCREW 3X30MM,,C1713,HCPCS,Facility,Inpatient,,,,1082.5,920.125,310.2445,1082.5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
HEADLESS SCREW 3X30MM,,C1713,HCPCS,Facility,Outpatient,,,,1082.5,920.125,310.2445,1082.5,Medica,Medical Assistance,482.795,44.6,,percent of total billed charges,,
HEADLESS SCREW 3X30MM,,C1713,HCPCS,Facility,Inpatient,,,,1082.5,920.125,310.2445,1082.5,Medica,Medical Assistance,,,,,Included in per diem rate,
HEADLESS SCREW 3X30MM,,C1713,HCPCS,Facility,Outpatient,,,,1082.5,920.125,310.2445,1082.5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,539.085,49.8,,percent of total billed charges,,
HEADLESS SCREW 3X30MM,,C1713,HCPCS,Facility,Inpatient,,,,1082.5,920.125,310.2445,1082.5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
HEADLESS SCREW 3X30MM,,C1713,HCPCS,Facility,Both,,,,1082.5,920.125,310.2445,1082.5,"Multiplan, Inc.","Multiplan, Inc.",1017.55,94,,percent of total billed charges,,
HEADLESS SCREW 3X30MM,,C1713,HCPCS,Facility,Outpatient,,,,1082.5,920.125,310.2445,1082.5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,975.3325,90.1,,percent of total billed charges,,
HEADLESS SCREW 3X30MM,,C1713,HCPCS,Facility,Inpatient,,,,1082.5,920.125,310.2445,1082.5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
HEADLESS SCREW 3X30MM,,C1713,HCPCS,Facility,Both,,,,1082.5,920.125,310.2445,1082.5,"Preferred One Administrative Services, INC.",PPO,1067.345,98.6,,percent of total billed charges,,
HEADLESS SCREW 3X30MM,,C1713,HCPCS,Facility,Outpatient,,,,1082.5,920.125,310.2445,1082.5,PrimeWest Health,Minnesota Senior Health Options (MSHO),556.94625,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
HEADLESS SCREW 3X30MM,,C1713,HCPCS,Facility,Inpatient,,,,1082.5,920.125,310.2445,1082.5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
HEADLESS SCREW 3X30MM,,C1713,HCPCS,Facility,Outpatient,,,,1082.5,920.125,310.2445,1082.5,PrimeWest Health,MinnesotaCare,555.972,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
HEADLESS SCREW 3X30MM,,C1713,HCPCS,Facility,Inpatient,,,,1082.5,920.125,310.2445,1082.5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
HEADLESS SCREW 3X30MM,,C1713,HCPCS,Facility,Both,,,,1082.5,920.125,310.2445,1082.5,Sanford Health Plan,Sanford Health Plan,995.9,92,,percent of total billed charges,,
HEADLESS SCREW 3X30MM,,C1713,HCPCS,Facility,Outpatient,,,,1082.5,920.125,310.2445,1082.5,"UCare Health, Inc.",Individual & Family Plan,609.98875,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
HEADLESS SCREW 3X30MM,,C1713,HCPCS,Facility,Inpatient,,,,1082.5,920.125,310.2445,1082.5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
HEADLESS SCREW 3X30MM,,C1713,HCPCS,Facility,Outpatient,,,,1082.5,920.125,310.2445,1082.5,"UCare Health, Inc.",Medical Assistance,546.33775,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
HEADLESS SCREW 3X30MM,,C1713,HCPCS,Facility,Inpatient,,,,1082.5,920.125,310.2445,1082.5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
HEADLESS SCREW 3X30MM,,C1713,HCPCS,Facility,Outpatient,,,,1082.5,920.125,310.2445,1082.5,"UCare Health, Inc.",Medicare Advantage,546.33775,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
HEADLESS SCREW 3X30MM,,C1713,HCPCS,Facility,Inpatient,,,,1082.5,920.125,310.2445,1082.5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
HEADLESS SCREW 3X30MM,,C1713,HCPCS,Facility,Outpatient,,,,1082.5,920.125,310.2445,1082.5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),546.33775,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
HEADLESS SCREW 3X30MM,,C1713,HCPCS,Facility,Inpatient,,,,1082.5,920.125,310.2445,1082.5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
HEADLESS SCREW 3X30MM,,C1713,HCPCS,Facility,Both,,,,1082.5,920.125,310.2445,1082.5,UnitedHealthcare,Individual & Family,1017.55,94,,percent of total billed charges,,
HEADLESS SCREW 3X30MM,,C1713,HCPCS,Facility,Outpatient,,,,1082.5,920.125,310.2445,1082.5,UnitedHealthcare,Medicare Advantage,530.425,49,,percent of total billed charges,,
HEADLESS SCREW 3X30MM,,C1713,HCPCS,Facility,Inpatient,,,,1082.5,920.125,310.2445,1082.5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
HEADLESS SCREW 3X30MM,,C1713,HCPCS,Facility,Outpatient,,,,1082.5,920.125,310.2445,1082.5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,519.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
HEADLESS SCREW 3X30MM,,C1713,HCPCS,Facility,Inpatient,,,,1082.5,920.125,310.2445,1082.5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
IMPLANT MEDIUM CANNULATED,,C1713,HCPCS,Facility,Both,,,,2000,1700,573.2,2000,Aetna,Commercial,1840,92,,percent of total billed charges,,
IMPLANT MEDIUM CANNULATED,,C1713,HCPCS,Facility,Outpatient,,,,2000,1700,573.2,2000,Aetna,Medicare Advantage,980,49,,percent of total billed charges,,
IMPLANT MEDIUM CANNULATED,,C1713,HCPCS,Facility,Inpatient,,,,2000,1700,573.2,2000,Aetna,Medicare Advantage,,,,,Included in per diem rate,
IMPLANT MEDIUM CANNULATED,,C1713,HCPCS,Facility,Both,,,,2000,1700,573.2,2000,Aetna,PPO,1860,93,,percent of total billed charges,,
IMPLANT MEDIUM CANNULATED,,C1713,HCPCS,Facility,Both,,,,2000,1700,573.2,2000,America's PPO,America's PPO,1920.6,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
IMPLANT MEDIUM CANNULATED,,C1713,HCPCS,Facility,Both,,,,2000,1700,573.2,2000,BlueCross BlueShield Minnesota, Federal Employee Program,1968,98.4,,percent of total billed charges,,
IMPLANT MEDIUM CANNULATED,,C1713,HCPCS,Facility,Both,,,,2000,1700,573.2,2000,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,2000,100,,percent of total billed charges,,
IMPLANT MEDIUM CANNULATED,,C1713,HCPCS,Facility,Both,,,,2000,1700,573.2,2000,BlueCross BlueShield Minnesota,High Value Network Plan,1800,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
IMPLANT MEDIUM CANNULATED,,C1713,HCPCS,Facility,Outpatient,,,,2000,1700,573.2,2000,BlueCross BlueShield Minnesota,Medicare Advantage,980,49,,percent of total billed charges,,
IMPLANT MEDIUM CANNULATED,,C1713,HCPCS,Facility,Inpatient,,,,2000,1700,573.2,2000,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
IMPLANT MEDIUM CANNULATED,,C1713,HCPCS,Facility,Both,,,,2000,1700,573.2,2000,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1771.4,88.57,,percent of total billed charges,,
IMPLANT MEDIUM CANNULATED,,C1713,HCPCS,Facility,Both,,,,2000,1700,573.2,2000,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,573.2,28.66,,percent of total billed charges,,
IMPLANT MEDIUM CANNULATED,,C1713,HCPCS,Facility,Outpatient,,,,2000,1700,573.2,2000,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),980,49,,percent of total billed charges,,
IMPLANT MEDIUM CANNULATED,,C1713,HCPCS,Facility,Inpatient,,,,2000,1700,573.2,2000,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
IMPLANT MEDIUM CANNULATED,,C1713,HCPCS,Facility,Both,,,,2000,1700,573.2,2000,CorVel,Worker's Compensation,2000,100,,percent of total billed charges,,
IMPLANT MEDIUM CANNULATED,,C1713,HCPCS,Facility,Both,,,,2000,1700,573.2,2000,First Health Group Corporation,First Health Network,1940,97,,percent of total billed charges,,
IMPLANT MEDIUM CANNULATED,,C1713,HCPCS,Facility,Both,,,,2000,1700,573.2,2000,"Health Partners, Inc.",Commercial,1892,94.6,,percent of total billed charges,,
IMPLANT MEDIUM CANNULATED,,C1713,HCPCS,Facility,Outpatient,,,,2000,1700,573.2,2000,"Health Partners, Inc.",Medicare Advantage,980,49,,percent of total billed charges,,
IMPLANT MEDIUM CANNULATED,,C1713,HCPCS,Facility,Inpatient,,,,2000,1700,573.2,2000,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
IMPLANT MEDIUM CANNULATED,,C1713,HCPCS,Facility,Both,,,,2000,1700,573.2,2000,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1200,60,,percent of total billed charges,,
IMPLANT MEDIUM CANNULATED,,C1713,HCPCS,Facility,Both,,,,2000,1700,573.2,2000,"Health Partners, Inc.",State of Minnesota Advantage Program,1630,81.5,,percent of total billed charges,,
IMPLANT MEDIUM CANNULATED,,C1713,HCPCS,Facility,Both,,,,2000,1700,573.2,2000,"Health Partners, Inc.",State Public Programs,1000,50,,percent of total billed charges,,
IMPLANT MEDIUM CANNULATED,,C1713,HCPCS,Facility,Both,,,,2000,1700,573.2,2000,Humana Insurance Company,Commercial PPO,1900,95,,percent of total billed charges,,
IMPLANT MEDIUM CANNULATED,,C1713,HCPCS,Facility,Outpatient,,,,2000,1700,573.2,2000,Humana Insurance Company,Medicare PPO,980,49,,percent of total billed charges,,
IMPLANT MEDIUM CANNULATED,,C1713,HCPCS,Facility,Inpatient,,,,2000,1700,573.2,2000,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
IMPLANT MEDIUM CANNULATED,,C1713,HCPCS,Facility,Both,,,,2000,1700,573.2,2000,Medica,Individual & Family,1982,99.1,,percent of total billed charges,,
IMPLANT MEDIUM CANNULATED,,C1713,HCPCS,Facility,Outpatient,,,,2000,1700,573.2,2000,Medica,Medica Advantage Solution,996,49.8,,percent of total billed charges,,
IMPLANT MEDIUM CANNULATED,,C1713,HCPCS,Facility,Inpatient,,,,2000,1700,573.2,2000,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
IMPLANT MEDIUM CANNULATED,,C1713,HCPCS,Facility,Outpatient,,,,2000,1700,573.2,2000,Medica,Medical Assistance,892,44.6,,percent of total billed charges,,
IMPLANT MEDIUM CANNULATED,,C1713,HCPCS,Facility,Inpatient,,,,2000,1700,573.2,2000,Medica,Medical Assistance,,,,,Included in per diem rate,
IMPLANT MEDIUM CANNULATED,,C1713,HCPCS,Facility,Outpatient,,,,2000,1700,573.2,2000,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,996,49.8,,percent of total billed charges,,
IMPLANT MEDIUM CANNULATED,,C1713,HCPCS,Facility,Inpatient,,,,2000,1700,573.2,2000,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
IMPLANT MEDIUM CANNULATED,,C1713,HCPCS,Facility,Both,,,,2000,1700,573.2,2000,"Multiplan, Inc.","Multiplan, Inc.",1880,94,,percent of total billed charges,,
IMPLANT MEDIUM CANNULATED,,C1713,HCPCS,Facility,Outpatient,,,,2000,1700,573.2,2000,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1802,90.1,,percent of total billed charges,,
IMPLANT MEDIUM CANNULATED,,C1713,HCPCS,Facility,Inpatient,,,,2000,1700,573.2,2000,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
IMPLANT MEDIUM CANNULATED,,C1713,HCPCS,Facility,Both,,,,2000,1700,573.2,2000,"Preferred One Administrative Services, INC.",PPO,1972,98.6,,percent of total billed charges,,
IMPLANT MEDIUM CANNULATED,,C1713,HCPCS,Facility,Outpatient,,,,2000,1700,573.2,2000,PrimeWest Health,Minnesota Senior Health Options (MSHO),1029,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
IMPLANT MEDIUM CANNULATED,,C1713,HCPCS,Facility,Inpatient,,,,2000,1700,573.2,2000,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
IMPLANT MEDIUM CANNULATED,,C1713,HCPCS,Facility,Outpatient,,,,2000,1700,573.2,2000,PrimeWest Health,MinnesotaCare,1027.2,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
IMPLANT MEDIUM CANNULATED,,C1713,HCPCS,Facility,Inpatient,,,,2000,1700,573.2,2000,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
IMPLANT MEDIUM CANNULATED,,C1713,HCPCS,Facility,Both,,,,2000,1700,573.2,2000,Sanford Health Plan,Sanford Health Plan,1840,92,,percent of total billed charges,,
IMPLANT MEDIUM CANNULATED,,C1713,HCPCS,Facility,Outpatient,,,,2000,1700,573.2,2000,"UCare Health, Inc.",Individual & Family Plan,1127,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
IMPLANT MEDIUM CANNULATED,,C1713,HCPCS,Facility,Inpatient,,,,2000,1700,573.2,2000,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
IMPLANT MEDIUM CANNULATED,,C1713,HCPCS,Facility,Outpatient,,,,2000,1700,573.2,2000,"UCare Health, Inc.",Medical Assistance,1009.4,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
IMPLANT MEDIUM CANNULATED,,C1713,HCPCS,Facility,Inpatient,,,,2000,1700,573.2,2000,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
IMPLANT MEDIUM CANNULATED,,C1713,HCPCS,Facility,Outpatient,,,,2000,1700,573.2,2000,"UCare Health, Inc.",Medicare Advantage,1009.4,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
IMPLANT MEDIUM CANNULATED,,C1713,HCPCS,Facility,Inpatient,,,,2000,1700,573.2,2000,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
IMPLANT MEDIUM CANNULATED,,C1713,HCPCS,Facility,Outpatient,,,,2000,1700,573.2,2000,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1009.4,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
IMPLANT MEDIUM CANNULATED,,C1713,HCPCS,Facility,Inpatient,,,,2000,1700,573.2,2000,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
IMPLANT MEDIUM CANNULATED,,C1713,HCPCS,Facility,Both,,,,2000,1700,573.2,2000,UnitedHealthcare,Individual & Family,1880,94,,percent of total billed charges,,
IMPLANT MEDIUM CANNULATED,,C1713,HCPCS,Facility,Outpatient,,,,2000,1700,573.2,2000,UnitedHealthcare,Medicare Advantage,980,49,,percent of total billed charges,,
IMPLANT MEDIUM CANNULATED,,C1713,HCPCS,Facility,Inpatient,,,,2000,1700,573.2,2000,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
IMPLANT MEDIUM CANNULATED,,C1713,HCPCS,Facility,Outpatient,,,,2000,1700,573.2,2000,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,960,48,,percent of total billed charges,,100% of DHS outpatient percentage
IMPLANT MEDIUM CANNULATED,,C1713,HCPCS,Facility,Inpatient,,,,2000,1700,573.2,2000,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
IMPLANT SMALL CANNULATED,,C1713,HCPCS,Facility,Both,,,,2000,1700,573.2,2000,Aetna,Commercial,1840,92,,percent of total billed charges,,
IMPLANT SMALL CANNULATED,,C1713,HCPCS,Facility,Outpatient,,,,2000,1700,573.2,2000,Aetna,Medicare Advantage,980,49,,percent of total billed charges,,
IMPLANT SMALL CANNULATED,,C1713,HCPCS,Facility,Inpatient,,,,2000,1700,573.2,2000,Aetna,Medicare Advantage,,,,,Included in per diem rate,
IMPLANT SMALL CANNULATED,,C1713,HCPCS,Facility,Both,,,,2000,1700,573.2,2000,Aetna,PPO,1860,93,,percent of total billed charges,,
IMPLANT SMALL CANNULATED,,C1713,HCPCS,Facility,Both,,,,2000,1700,573.2,2000,America's PPO,America's PPO,1920.6,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
IMPLANT SMALL CANNULATED,,C1713,HCPCS,Facility,Both,,,,2000,1700,573.2,2000,BlueCross BlueShield Minnesota, Federal Employee Program,1968,98.4,,percent of total billed charges,,
IMPLANT SMALL CANNULATED,,C1713,HCPCS,Facility,Both,,,,2000,1700,573.2,2000,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,2000,100,,percent of total billed charges,,
IMPLANT SMALL CANNULATED,,C1713,HCPCS,Facility,Both,,,,2000,1700,573.2,2000,BlueCross BlueShield Minnesota,High Value Network Plan,1800,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
IMPLANT SMALL CANNULATED,,C1713,HCPCS,Facility,Outpatient,,,,2000,1700,573.2,2000,BlueCross BlueShield Minnesota,Medicare Advantage,980,49,,percent of total billed charges,,
IMPLANT SMALL CANNULATED,,C1713,HCPCS,Facility,Inpatient,,,,2000,1700,573.2,2000,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
IMPLANT SMALL CANNULATED,,C1713,HCPCS,Facility,Both,,,,2000,1700,573.2,2000,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1771.4,88.57,,percent of total billed charges,,
IMPLANT SMALL CANNULATED,,C1713,HCPCS,Facility,Both,,,,2000,1700,573.2,2000,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,573.2,28.66,,percent of total billed charges,,
IMPLANT SMALL CANNULATED,,C1713,HCPCS,Facility,Outpatient,,,,2000,1700,573.2,2000,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),980,49,,percent of total billed charges,,
IMPLANT SMALL CANNULATED,,C1713,HCPCS,Facility,Inpatient,,,,2000,1700,573.2,2000,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
IMPLANT SMALL CANNULATED,,C1713,HCPCS,Facility,Both,,,,2000,1700,573.2,2000,CorVel,Worker's Compensation,2000,100,,percent of total billed charges,,
IMPLANT SMALL CANNULATED,,C1713,HCPCS,Facility,Both,,,,2000,1700,573.2,2000,First Health Group Corporation,First Health Network,1940,97,,percent of total billed charges,,
IMPLANT SMALL CANNULATED,,C1713,HCPCS,Facility,Both,,,,2000,1700,573.2,2000,"Health Partners, Inc.",Commercial,1892,94.6,,percent of total billed charges,,
IMPLANT SMALL CANNULATED,,C1713,HCPCS,Facility,Outpatient,,,,2000,1700,573.2,2000,"Health Partners, Inc.",Medicare Advantage,980,49,,percent of total billed charges,,
IMPLANT SMALL CANNULATED,,C1713,HCPCS,Facility,Inpatient,,,,2000,1700,573.2,2000,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
IMPLANT SMALL CANNULATED,,C1713,HCPCS,Facility,Both,,,,2000,1700,573.2,2000,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1200,60,,percent of total billed charges,,
IMPLANT SMALL CANNULATED,,C1713,HCPCS,Facility,Both,,,,2000,1700,573.2,2000,"Health Partners, Inc.",State of Minnesota Advantage Program,1630,81.5,,percent of total billed charges,,
IMPLANT SMALL CANNULATED,,C1713,HCPCS,Facility,Both,,,,2000,1700,573.2,2000,"Health Partners, Inc.",State Public Programs,1000,50,,percent of total billed charges,,
IMPLANT SMALL CANNULATED,,C1713,HCPCS,Facility,Both,,,,2000,1700,573.2,2000,Humana Insurance Company,Commercial PPO,1900,95,,percent of total billed charges,,
IMPLANT SMALL CANNULATED,,C1713,HCPCS,Facility,Outpatient,,,,2000,1700,573.2,2000,Humana Insurance Company,Medicare PPO,980,49,,percent of total billed charges,,
IMPLANT SMALL CANNULATED,,C1713,HCPCS,Facility,Inpatient,,,,2000,1700,573.2,2000,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
IMPLANT SMALL CANNULATED,,C1713,HCPCS,Facility,Both,,,,2000,1700,573.2,2000,Medica,Individual & Family,1982,99.1,,percent of total billed charges,,
IMPLANT SMALL CANNULATED,,C1713,HCPCS,Facility,Outpatient,,,,2000,1700,573.2,2000,Medica,Medica Advantage Solution,996,49.8,,percent of total billed charges,,
IMPLANT SMALL CANNULATED,,C1713,HCPCS,Facility,Inpatient,,,,2000,1700,573.2,2000,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
IMPLANT SMALL CANNULATED,,C1713,HCPCS,Facility,Outpatient,,,,2000,1700,573.2,2000,Medica,Medical Assistance,892,44.6,,percent of total billed charges,,
IMPLANT SMALL CANNULATED,,C1713,HCPCS,Facility,Inpatient,,,,2000,1700,573.2,2000,Medica,Medical Assistance,,,,,Included in per diem rate,
IMPLANT SMALL CANNULATED,,C1713,HCPCS,Facility,Outpatient,,,,2000,1700,573.2,2000,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,996,49.8,,percent of total billed charges,,
IMPLANT SMALL CANNULATED,,C1713,HCPCS,Facility,Inpatient,,,,2000,1700,573.2,2000,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
IMPLANT SMALL CANNULATED,,C1713,HCPCS,Facility,Both,,,,2000,1700,573.2,2000,"Multiplan, Inc.","Multiplan, Inc.",1880,94,,percent of total billed charges,,
IMPLANT SMALL CANNULATED,,C1713,HCPCS,Facility,Outpatient,,,,2000,1700,573.2,2000,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1802,90.1,,percent of total billed charges,,
IMPLANT SMALL CANNULATED,,C1713,HCPCS,Facility,Inpatient,,,,2000,1700,573.2,2000,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
IMPLANT SMALL CANNULATED,,C1713,HCPCS,Facility,Both,,,,2000,1700,573.2,2000,"Preferred One Administrative Services, INC.",PPO,1972,98.6,,percent of total billed charges,,
IMPLANT SMALL CANNULATED,,C1713,HCPCS,Facility,Outpatient,,,,2000,1700,573.2,2000,PrimeWest Health,Minnesota Senior Health Options (MSHO),1029,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
IMPLANT SMALL CANNULATED,,C1713,HCPCS,Facility,Inpatient,,,,2000,1700,573.2,2000,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
IMPLANT SMALL CANNULATED,,C1713,HCPCS,Facility,Outpatient,,,,2000,1700,573.2,2000,PrimeWest Health,MinnesotaCare,1027.2,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
IMPLANT SMALL CANNULATED,,C1713,HCPCS,Facility,Inpatient,,,,2000,1700,573.2,2000,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
IMPLANT SMALL CANNULATED,,C1713,HCPCS,Facility,Both,,,,2000,1700,573.2,2000,Sanford Health Plan,Sanford Health Plan,1840,92,,percent of total billed charges,,
IMPLANT SMALL CANNULATED,,C1713,HCPCS,Facility,Outpatient,,,,2000,1700,573.2,2000,"UCare Health, Inc.",Individual & Family Plan,1127,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
IMPLANT SMALL CANNULATED,,C1713,HCPCS,Facility,Inpatient,,,,2000,1700,573.2,2000,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
IMPLANT SMALL CANNULATED,,C1713,HCPCS,Facility,Outpatient,,,,2000,1700,573.2,2000,"UCare Health, Inc.",Medical Assistance,1009.4,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
IMPLANT SMALL CANNULATED,,C1713,HCPCS,Facility,Inpatient,,,,2000,1700,573.2,2000,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
IMPLANT SMALL CANNULATED,,C1713,HCPCS,Facility,Outpatient,,,,2000,1700,573.2,2000,"UCare Health, Inc.",Medicare Advantage,1009.4,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
IMPLANT SMALL CANNULATED,,C1713,HCPCS,Facility,Inpatient,,,,2000,1700,573.2,2000,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
IMPLANT SMALL CANNULATED,,C1713,HCPCS,Facility,Outpatient,,,,2000,1700,573.2,2000,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1009.4,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
IMPLANT SMALL CANNULATED,,C1713,HCPCS,Facility,Inpatient,,,,2000,1700,573.2,2000,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
IMPLANT SMALL CANNULATED,,C1713,HCPCS,Facility,Both,,,,2000,1700,573.2,2000,UnitedHealthcare,Individual & Family,1880,94,,percent of total billed charges,,
IMPLANT SMALL CANNULATED,,C1713,HCPCS,Facility,Outpatient,,,,2000,1700,573.2,2000,UnitedHealthcare,Medicare Advantage,980,49,,percent of total billed charges,,
IMPLANT SMALL CANNULATED,,C1713,HCPCS,Facility,Inpatient,,,,2000,1700,573.2,2000,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
IMPLANT SMALL CANNULATED,,C1713,HCPCS,Facility,Outpatient,,,,2000,1700,573.2,2000,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,960,48,,percent of total billed charges,,100% of DHS outpatient percentage
IMPLANT SMALL CANNULATED,,C1713,HCPCS,Facility,Inpatient,,,,2000,1700,573.2,2000,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
INTERNALBRACE LIGAMENT AUGMENT  ARTHREX  AR-1688-CP,,C1713,HCPCS,Facility,Both,,,,1827.5,1553.375,523.7615,1827.5,Aetna,Commercial,1681.3,92,,percent of total billed charges,,
INTERNALBRACE LIGAMENT AUGMENT  ARTHREX  AR-1688-CP,,C1713,HCPCS,Facility,Outpatient,,,,1827.5,1553.375,523.7615,1827.5,Aetna,Medicare Advantage,895.475,49,,percent of total billed charges,,
INTERNALBRACE LIGAMENT AUGMENT  ARTHREX  AR-1688-CP,,C1713,HCPCS,Facility,Inpatient,,,,1827.5,1553.375,523.7615,1827.5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
INTERNALBRACE LIGAMENT AUGMENT  ARTHREX  AR-1688-CP,,C1713,HCPCS,Facility,Both,,,,1827.5,1553.375,523.7615,1827.5,Aetna,PPO,1699.575,93,,percent of total billed charges,,
INTERNALBRACE LIGAMENT AUGMENT  ARTHREX  AR-1688-CP,,C1713,HCPCS,Facility,Both,,,,1827.5,1553.375,523.7615,1827.5,America's PPO,America's PPO,1754.94825,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
INTERNALBRACE LIGAMENT AUGMENT  ARTHREX  AR-1688-CP,,C1713,HCPCS,Facility,Both,,,,1827.5,1553.375,523.7615,1827.5,BlueCross BlueShield Minnesota, Federal Employee Program,1798.26,98.4,,percent of total billed charges,,
INTERNALBRACE LIGAMENT AUGMENT  ARTHREX  AR-1688-CP,,C1713,HCPCS,Facility,Both,,,,1827.5,1553.375,523.7615,1827.5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1827.5,100,,percent of total billed charges,,
INTERNALBRACE LIGAMENT AUGMENT  ARTHREX  AR-1688-CP,,C1713,HCPCS,Facility,Both,,,,1827.5,1553.375,523.7615,1827.5,BlueCross BlueShield Minnesota,High Value Network Plan,1644.75,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
INTERNALBRACE LIGAMENT AUGMENT  ARTHREX  AR-1688-CP,,C1713,HCPCS,Facility,Outpatient,,,,1827.5,1553.375,523.7615,1827.5,BlueCross BlueShield Minnesota,Medicare Advantage,895.475,49,,percent of total billed charges,,
INTERNALBRACE LIGAMENT AUGMENT  ARTHREX  AR-1688-CP,,C1713,HCPCS,Facility,Inpatient,,,,1827.5,1553.375,523.7615,1827.5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
INTERNALBRACE LIGAMENT AUGMENT  ARTHREX  AR-1688-CP,,C1713,HCPCS,Facility,Both,,,,1827.5,1553.375,523.7615,1827.5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1618.61675,88.57,,percent of total billed charges,,
INTERNALBRACE LIGAMENT AUGMENT  ARTHREX  AR-1688-CP,,C1713,HCPCS,Facility,Both,,,,1827.5,1553.375,523.7615,1827.5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,523.7615,28.66,,percent of total billed charges,,
INTERNALBRACE LIGAMENT AUGMENT  ARTHREX  AR-1688-CP,,C1713,HCPCS,Facility,Outpatient,,,,1827.5,1553.375,523.7615,1827.5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),895.475,49,,percent of total billed charges,,
INTERNALBRACE LIGAMENT AUGMENT  ARTHREX  AR-1688-CP,,C1713,HCPCS,Facility,Inpatient,,,,1827.5,1553.375,523.7615,1827.5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
INTERNALBRACE LIGAMENT AUGMENT  ARTHREX  AR-1688-CP,,C1713,HCPCS,Facility,Both,,,,1827.5,1553.375,523.7615,1827.5,CorVel,Worker's Compensation,1827.5,100,,percent of total billed charges,,
INTERNALBRACE LIGAMENT AUGMENT  ARTHREX  AR-1688-CP,,C1713,HCPCS,Facility,Both,,,,1827.5,1553.375,523.7615,1827.5,First Health Group Corporation,First Health Network,1772.675,97,,percent of total billed charges,,
INTERNALBRACE LIGAMENT AUGMENT  ARTHREX  AR-1688-CP,,C1713,HCPCS,Facility,Both,,,,1827.5,1553.375,523.7615,1827.5,"Health Partners, Inc.",Commercial,1728.815,94.6,,percent of total billed charges,,
INTERNALBRACE LIGAMENT AUGMENT  ARTHREX  AR-1688-CP,,C1713,HCPCS,Facility,Outpatient,,,,1827.5,1553.375,523.7615,1827.5,"Health Partners, Inc.",Medicare Advantage,895.475,49,,percent of total billed charges,,
INTERNALBRACE LIGAMENT AUGMENT  ARTHREX  AR-1688-CP,,C1713,HCPCS,Facility,Inpatient,,,,1827.5,1553.375,523.7615,1827.5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
INTERNALBRACE LIGAMENT AUGMENT  ARTHREX  AR-1688-CP,,C1713,HCPCS,Facility,Both,,,,1827.5,1553.375,523.7615,1827.5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1096.5,60,,percent of total billed charges,,
INTERNALBRACE LIGAMENT AUGMENT  ARTHREX  AR-1688-CP,,C1713,HCPCS,Facility,Both,,,,1827.5,1553.375,523.7615,1827.5,"Health Partners, Inc.",State of Minnesota Advantage Program,1489.4125,81.5,,percent of total billed charges,,
INTERNALBRACE LIGAMENT AUGMENT  ARTHREX  AR-1688-CP,,C1713,HCPCS,Facility,Both,,,,1827.5,1553.375,523.7615,1827.5,"Health Partners, Inc.",State Public Programs,913.75,50,,percent of total billed charges,,
INTERNALBRACE LIGAMENT AUGMENT  ARTHREX  AR-1688-CP,,C1713,HCPCS,Facility,Both,,,,1827.5,1553.375,523.7615,1827.5,Humana Insurance Company,Commercial PPO,1736.125,95,,percent of total billed charges,,
INTERNALBRACE LIGAMENT AUGMENT  ARTHREX  AR-1688-CP,,C1713,HCPCS,Facility,Outpatient,,,,1827.5,1553.375,523.7615,1827.5,Humana Insurance Company,Medicare PPO,895.475,49,,percent of total billed charges,,
INTERNALBRACE LIGAMENT AUGMENT  ARTHREX  AR-1688-CP,,C1713,HCPCS,Facility,Inpatient,,,,1827.5,1553.375,523.7615,1827.5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
INTERNALBRACE LIGAMENT AUGMENT  ARTHREX  AR-1688-CP,,C1713,HCPCS,Facility,Both,,,,1827.5,1553.375,523.7615,1827.5,Medica,Individual & Family,1811.0525,99.1,,percent of total billed charges,,
INTERNALBRACE LIGAMENT AUGMENT  ARTHREX  AR-1688-CP,,C1713,HCPCS,Facility,Outpatient,,,,1827.5,1553.375,523.7615,1827.5,Medica,Medica Advantage Solution,910.095,49.8,,percent of total billed charges,,
INTERNALBRACE LIGAMENT AUGMENT  ARTHREX  AR-1688-CP,,C1713,HCPCS,Facility,Inpatient,,,,1827.5,1553.375,523.7615,1827.5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
INTERNALBRACE LIGAMENT AUGMENT  ARTHREX  AR-1688-CP,,C1713,HCPCS,Facility,Outpatient,,,,1827.5,1553.375,523.7615,1827.5,Medica,Medical Assistance,815.065,44.6,,percent of total billed charges,,
INTERNALBRACE LIGAMENT AUGMENT  ARTHREX  AR-1688-CP,,C1713,HCPCS,Facility,Inpatient,,,,1827.5,1553.375,523.7615,1827.5,Medica,Medical Assistance,,,,,Included in per diem rate,
INTERNALBRACE LIGAMENT AUGMENT  ARTHREX  AR-1688-CP,,C1713,HCPCS,Facility,Outpatient,,,,1827.5,1553.375,523.7615,1827.5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,910.095,49.8,,percent of total billed charges,,
INTERNALBRACE LIGAMENT AUGMENT  ARTHREX  AR-1688-CP,,C1713,HCPCS,Facility,Inpatient,,,,1827.5,1553.375,523.7615,1827.5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
INTERNALBRACE LIGAMENT AUGMENT  ARTHREX  AR-1688-CP,,C1713,HCPCS,Facility,Both,,,,1827.5,1553.375,523.7615,1827.5,"Multiplan, Inc.","Multiplan, Inc.",1717.85,94,,percent of total billed charges,,
INTERNALBRACE LIGAMENT AUGMENT  ARTHREX  AR-1688-CP,,C1713,HCPCS,Facility,Outpatient,,,,1827.5,1553.375,523.7615,1827.5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1646.5775,90.1,,percent of total billed charges,,
INTERNALBRACE LIGAMENT AUGMENT  ARTHREX  AR-1688-CP,,C1713,HCPCS,Facility,Inpatient,,,,1827.5,1553.375,523.7615,1827.5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
INTERNALBRACE LIGAMENT AUGMENT  ARTHREX  AR-1688-CP,,C1713,HCPCS,Facility,Both,,,,1827.5,1553.375,523.7615,1827.5,"Preferred One Administrative Services, INC.",PPO,1801.915,98.6,,percent of total billed charges,,
INTERNALBRACE LIGAMENT AUGMENT  ARTHREX  AR-1688-CP,,C1713,HCPCS,Facility,Outpatient,,,,1827.5,1553.375,523.7615,1827.5,PrimeWest Health,Minnesota Senior Health Options (MSHO),940.24875,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
INTERNALBRACE LIGAMENT AUGMENT  ARTHREX  AR-1688-CP,,C1713,HCPCS,Facility,Inpatient,,,,1827.5,1553.375,523.7615,1827.5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
INTERNALBRACE LIGAMENT AUGMENT  ARTHREX  AR-1688-CP,,C1713,HCPCS,Facility,Outpatient,,,,1827.5,1553.375,523.7615,1827.5,PrimeWest Health,MinnesotaCare,938.604,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
INTERNALBRACE LIGAMENT AUGMENT  ARTHREX  AR-1688-CP,,C1713,HCPCS,Facility,Inpatient,,,,1827.5,1553.375,523.7615,1827.5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
INTERNALBRACE LIGAMENT AUGMENT  ARTHREX  AR-1688-CP,,C1713,HCPCS,Facility,Both,,,,1827.5,1553.375,523.7615,1827.5,Sanford Health Plan,Sanford Health Plan,1681.3,92,,percent of total billed charges,,
INTERNALBRACE LIGAMENT AUGMENT  ARTHREX  AR-1688-CP,,C1713,HCPCS,Facility,Outpatient,,,,1827.5,1553.375,523.7615,1827.5,"UCare Health, Inc.",Individual & Family Plan,1029.79625,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
INTERNALBRACE LIGAMENT AUGMENT  ARTHREX  AR-1688-CP,,C1713,HCPCS,Facility,Inpatient,,,,1827.5,1553.375,523.7615,1827.5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
INTERNALBRACE LIGAMENT AUGMENT  ARTHREX  AR-1688-CP,,C1713,HCPCS,Facility,Outpatient,,,,1827.5,1553.375,523.7615,1827.5,"UCare Health, Inc.",Medical Assistance,922.33925,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
INTERNALBRACE LIGAMENT AUGMENT  ARTHREX  AR-1688-CP,,C1713,HCPCS,Facility,Inpatient,,,,1827.5,1553.375,523.7615,1827.5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
INTERNALBRACE LIGAMENT AUGMENT  ARTHREX  AR-1688-CP,,C1713,HCPCS,Facility,Outpatient,,,,1827.5,1553.375,523.7615,1827.5,"UCare Health, Inc.",Medicare Advantage,922.33925,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
INTERNALBRACE LIGAMENT AUGMENT  ARTHREX  AR-1688-CP,,C1713,HCPCS,Facility,Inpatient,,,,1827.5,1553.375,523.7615,1827.5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
INTERNALBRACE LIGAMENT AUGMENT  ARTHREX  AR-1688-CP,,C1713,HCPCS,Facility,Outpatient,,,,1827.5,1553.375,523.7615,1827.5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),922.33925,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
INTERNALBRACE LIGAMENT AUGMENT  ARTHREX  AR-1688-CP,,C1713,HCPCS,Facility,Inpatient,,,,1827.5,1553.375,523.7615,1827.5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
INTERNALBRACE LIGAMENT AUGMENT  ARTHREX  AR-1688-CP,,C1713,HCPCS,Facility,Both,,,,1827.5,1553.375,523.7615,1827.5,UnitedHealthcare,Individual & Family,1717.85,94,,percent of total billed charges,,
INTERNALBRACE LIGAMENT AUGMENT  ARTHREX  AR-1688-CP,,C1713,HCPCS,Facility,Outpatient,,,,1827.5,1553.375,523.7615,1827.5,UnitedHealthcare,Medicare Advantage,895.475,49,,percent of total billed charges,,
INTERNALBRACE LIGAMENT AUGMENT  ARTHREX  AR-1688-CP,,C1713,HCPCS,Facility,Inpatient,,,,1827.5,1553.375,523.7615,1827.5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
INTERNALBRACE LIGAMENT AUGMENT  ARTHREX  AR-1688-CP,,C1713,HCPCS,Facility,Outpatient,,,,1827.5,1553.375,523.7615,1827.5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,877.2,48,,percent of total billed charges,,100% of DHS outpatient percentage
INTERNALBRACE LIGAMENT AUGMENT  ARTHREX  AR-1688-CP,,C1713,HCPCS,Facility,Inpatient,,,,1827.5,1553.375,523.7615,1827.5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
PIN 60/20 CORTICAL,,C1713,HCPCS,Facility,Both,,,,473.82,402.747,135.796812,473.82,Aetna,Commercial,435.9144,92,,percent of total billed charges,,
PIN 60/20 CORTICAL,,C1713,HCPCS,Facility,Outpatient,,,,473.82,402.747,135.796812,473.82,Aetna,Medicare Advantage,232.1718,49,,percent of total billed charges,,
PIN 60/20 CORTICAL,,C1713,HCPCS,Facility,Inpatient,,,,473.82,402.747,135.796812,473.82,Aetna,Medicare Advantage,,,,,Included in per diem rate,
PIN 60/20 CORTICAL,,C1713,HCPCS,Facility,Both,,,,473.82,402.747,135.796812,473.82,Aetna,PPO,440.6526,93,,percent of total billed charges,,
PIN 60/20 CORTICAL,,C1713,HCPCS,Facility,Both,,,,473.82,402.747,135.796812,473.82,America's PPO,America's PPO,455.009346,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
PIN 60/20 CORTICAL,,C1713,HCPCS,Facility,Both,,,,473.82,402.747,135.796812,473.82,BlueCross BlueShield Minnesota, Federal Employee Program,466.23888,98.4,,percent of total billed charges,,
PIN 60/20 CORTICAL,,C1713,HCPCS,Facility,Both,,,,473.82,402.747,135.796812,473.82,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,473.82,100,,percent of total billed charges,,
PIN 60/20 CORTICAL,,C1713,HCPCS,Facility,Both,,,,473.82,402.747,135.796812,473.82,BlueCross BlueShield Minnesota,High Value Network Plan,426.438,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
PIN 60/20 CORTICAL,,C1713,HCPCS,Facility,Outpatient,,,,473.82,402.747,135.796812,473.82,BlueCross BlueShield Minnesota,Medicare Advantage,232.1718,49,,percent of total billed charges,,
PIN 60/20 CORTICAL,,C1713,HCPCS,Facility,Inpatient,,,,473.82,402.747,135.796812,473.82,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
PIN 60/20 CORTICAL,,C1713,HCPCS,Facility,Both,,,,473.82,402.747,135.796812,473.82,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,419.662374,88.57,,percent of total billed charges,,
PIN 60/20 CORTICAL,,C1713,HCPCS,Facility,Both,,,,473.82,402.747,135.796812,473.82,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,135.796812,28.66,,percent of total billed charges,,
PIN 60/20 CORTICAL,,C1713,HCPCS,Facility,Outpatient,,,,473.82,402.747,135.796812,473.82,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),232.1718,49,,percent of total billed charges,,
PIN 60/20 CORTICAL,,C1713,HCPCS,Facility,Inpatient,,,,473.82,402.747,135.796812,473.82,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
PIN 60/20 CORTICAL,,C1713,HCPCS,Facility,Both,,,,473.82,402.747,135.796812,473.82,CorVel,Worker's Compensation,473.82,100,,percent of total billed charges,,
PIN 60/20 CORTICAL,,C1713,HCPCS,Facility,Both,,,,473.82,402.747,135.796812,473.82,First Health Group Corporation,First Health Network,459.6054,97,,percent of total billed charges,,
PIN 60/20 CORTICAL,,C1713,HCPCS,Facility,Both,,,,473.82,402.747,135.796812,473.82,"Health Partners, Inc.",Commercial,448.23372,94.6,,percent of total billed charges,,
PIN 60/20 CORTICAL,,C1713,HCPCS,Facility,Outpatient,,,,473.82,402.747,135.796812,473.82,"Health Partners, Inc.",Medicare Advantage,232.1718,49,,percent of total billed charges,,
PIN 60/20 CORTICAL,,C1713,HCPCS,Facility,Inpatient,,,,473.82,402.747,135.796812,473.82,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PIN 60/20 CORTICAL,,C1713,HCPCS,Facility,Both,,,,473.82,402.747,135.796812,473.82,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),284.292,60,,percent of total billed charges,,
PIN 60/20 CORTICAL,,C1713,HCPCS,Facility,Both,,,,473.82,402.747,135.796812,473.82,"Health Partners, Inc.",State of Minnesota Advantage Program,386.1633,81.5,,percent of total billed charges,,
PIN 60/20 CORTICAL,,C1713,HCPCS,Facility,Both,,,,473.82,402.747,135.796812,473.82,"Health Partners, Inc.",State Public Programs,236.91,50,,percent of total billed charges,,
PIN 60/20 CORTICAL,,C1713,HCPCS,Facility,Both,,,,473.82,402.747,135.796812,473.82,Humana Insurance Company,Commercial PPO,450.129,95,,percent of total billed charges,,
PIN 60/20 CORTICAL,,C1713,HCPCS,Facility,Outpatient,,,,473.82,402.747,135.796812,473.82,Humana Insurance Company,Medicare PPO,232.1718,49,,percent of total billed charges,,
PIN 60/20 CORTICAL,,C1713,HCPCS,Facility,Inpatient,,,,473.82,402.747,135.796812,473.82,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
PIN 60/20 CORTICAL,,C1713,HCPCS,Facility,Both,,,,473.82,402.747,135.796812,473.82,Medica,Individual & Family,469.55562,99.1,,percent of total billed charges,,
PIN 60/20 CORTICAL,,C1713,HCPCS,Facility,Outpatient,,,,473.82,402.747,135.796812,473.82,Medica,Medica Advantage Solution,235.96236,49.8,,percent of total billed charges,,
PIN 60/20 CORTICAL,,C1713,HCPCS,Facility,Inpatient,,,,473.82,402.747,135.796812,473.82,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
PIN 60/20 CORTICAL,,C1713,HCPCS,Facility,Outpatient,,,,473.82,402.747,135.796812,473.82,Medica,Medical Assistance,211.32372,44.6,,percent of total billed charges,,
PIN 60/20 CORTICAL,,C1713,HCPCS,Facility,Inpatient,,,,473.82,402.747,135.796812,473.82,Medica,Medical Assistance,,,,,Included in per diem rate,
PIN 60/20 CORTICAL,,C1713,HCPCS,Facility,Outpatient,,,,473.82,402.747,135.796812,473.82,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,235.96236,49.8,,percent of total billed charges,,
PIN 60/20 CORTICAL,,C1713,HCPCS,Facility,Inpatient,,,,473.82,402.747,135.796812,473.82,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
PIN 60/20 CORTICAL,,C1713,HCPCS,Facility,Both,,,,473.82,402.747,135.796812,473.82,"Multiplan, Inc.","Multiplan, Inc.",445.3908,94,,percent of total billed charges,,
PIN 60/20 CORTICAL,,C1713,HCPCS,Facility,Outpatient,,,,473.82,402.747,135.796812,473.82,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,426.91182,90.1,,percent of total billed charges,,
PIN 60/20 CORTICAL,,C1713,HCPCS,Facility,Inpatient,,,,473.82,402.747,135.796812,473.82,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
PIN 60/20 CORTICAL,,C1713,HCPCS,Facility,Both,,,,473.82,402.747,135.796812,473.82,"Preferred One Administrative Services, INC.",PPO,467.18652,98.6,,percent of total billed charges,,
PIN 60/20 CORTICAL,,C1713,HCPCS,Facility,Outpatient,,,,473.82,402.747,135.796812,473.82,PrimeWest Health,Minnesota Senior Health Options (MSHO),243.78039,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
PIN 60/20 CORTICAL,,C1713,HCPCS,Facility,Inpatient,,,,473.82,402.747,135.796812,473.82,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PIN 60/20 CORTICAL,,C1713,HCPCS,Facility,Outpatient,,,,473.82,402.747,135.796812,473.82,PrimeWest Health,MinnesotaCare,243.353952,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
PIN 60/20 CORTICAL,,C1713,HCPCS,Facility,Inpatient,,,,473.82,402.747,135.796812,473.82,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
PIN 60/20 CORTICAL,,C1713,HCPCS,Facility,Both,,,,473.82,402.747,135.796812,473.82,Sanford Health Plan,Sanford Health Plan,435.9144,92,,percent of total billed charges,,
PIN 60/20 CORTICAL,,C1713,HCPCS,Facility,Outpatient,,,,473.82,402.747,135.796812,473.82,"UCare Health, Inc.",Individual & Family Plan,266.99757,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
PIN 60/20 CORTICAL,,C1713,HCPCS,Facility,Inpatient,,,,473.82,402.747,135.796812,473.82,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
PIN 60/20 CORTICAL,,C1713,HCPCS,Facility,Outpatient,,,,473.82,402.747,135.796812,473.82,"UCare Health, Inc.",Medical Assistance,239.136954,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PIN 60/20 CORTICAL,,C1713,HCPCS,Facility,Inpatient,,,,473.82,402.747,135.796812,473.82,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
PIN 60/20 CORTICAL,,C1713,HCPCS,Facility,Outpatient,,,,473.82,402.747,135.796812,473.82,"UCare Health, Inc.",Medicare Advantage,239.136954,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PIN 60/20 CORTICAL,,C1713,HCPCS,Facility,Inpatient,,,,473.82,402.747,135.796812,473.82,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PIN 60/20 CORTICAL,,C1713,HCPCS,Facility,Outpatient,,,,473.82,402.747,135.796812,473.82,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),239.136954,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PIN 60/20 CORTICAL,,C1713,HCPCS,Facility,Inpatient,,,,473.82,402.747,135.796812,473.82,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PIN 60/20 CORTICAL,,C1713,HCPCS,Facility,Both,,,,473.82,402.747,135.796812,473.82,UnitedHealthcare,Individual & Family,445.3908,94,,percent of total billed charges,,
PIN 60/20 CORTICAL,,C1713,HCPCS,Facility,Outpatient,,,,473.82,402.747,135.796812,473.82,UnitedHealthcare,Medicare Advantage,232.1718,49,,percent of total billed charges,,
PIN 60/20 CORTICAL,,C1713,HCPCS,Facility,Inpatient,,,,473.82,402.747,135.796812,473.82,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
PIN 60/20 CORTICAL,,C1713,HCPCS,Facility,Outpatient,,,,473.82,402.747,135.796812,473.82,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,227.4336,48,,percent of total billed charges,,100% of DHS outpatient percentage
PIN 60/20 CORTICAL,,C1713,HCPCS,Facility,Inpatient,,,,473.82,402.747,135.796812,473.82,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
PIN TEMPORARY FIXATION 1.1MM  WRIGHT MED 58820006,,C1713,HCPCS,Facility,Both,,,,441,374.85,126.3906,441,Aetna,Commercial,405.72,92,,percent of total billed charges,,
PIN TEMPORARY FIXATION 1.1MM  WRIGHT MED 58820006,,C1713,HCPCS,Facility,Outpatient,,,,441,374.85,126.3906,441,Aetna,Medicare Advantage,216.09,49,,percent of total billed charges,,
PIN TEMPORARY FIXATION 1.1MM  WRIGHT MED 58820006,,C1713,HCPCS,Facility,Inpatient,,,,441,374.85,126.3906,441,Aetna,Medicare Advantage,,,,,Included in per diem rate,
PIN TEMPORARY FIXATION 1.1MM  WRIGHT MED 58820006,,C1713,HCPCS,Facility,Both,,,,441,374.85,126.3906,441,Aetna,PPO,410.13,93,,percent of total billed charges,,
PIN TEMPORARY FIXATION 1.1MM  WRIGHT MED 58820006,,C1713,HCPCS,Facility,Both,,,,441,374.85,126.3906,441,America's PPO,America's PPO,423.4923,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
PIN TEMPORARY FIXATION 1.1MM  WRIGHT MED 58820006,,C1713,HCPCS,Facility,Both,,,,441,374.85,126.3906,441,BlueCross BlueShield Minnesota, Federal Employee Program,433.944,98.4,,percent of total billed charges,,
PIN TEMPORARY FIXATION 1.1MM  WRIGHT MED 58820006,,C1713,HCPCS,Facility,Both,,,,441,374.85,126.3906,441,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,441,100,,percent of total billed charges,,
PIN TEMPORARY FIXATION 1.1MM  WRIGHT MED 58820006,,C1713,HCPCS,Facility,Both,,,,441,374.85,126.3906,441,BlueCross BlueShield Minnesota,High Value Network Plan,396.9,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
PIN TEMPORARY FIXATION 1.1MM  WRIGHT MED 58820006,,C1713,HCPCS,Facility,Outpatient,,,,441,374.85,126.3906,441,BlueCross BlueShield Minnesota,Medicare Advantage,216.09,49,,percent of total billed charges,,
PIN TEMPORARY FIXATION 1.1MM  WRIGHT MED 58820006,,C1713,HCPCS,Facility,Inpatient,,,,441,374.85,126.3906,441,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
PIN TEMPORARY FIXATION 1.1MM  WRIGHT MED 58820006,,C1713,HCPCS,Facility,Both,,,,441,374.85,126.3906,441,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,390.5937,88.57,,percent of total billed charges,,
PIN TEMPORARY FIXATION 1.1MM  WRIGHT MED 58820006,,C1713,HCPCS,Facility,Both,,,,441,374.85,126.3906,441,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,126.3906,28.66,,percent of total billed charges,,
PIN TEMPORARY FIXATION 1.1MM  WRIGHT MED 58820006,,C1713,HCPCS,Facility,Outpatient,,,,441,374.85,126.3906,441,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),216.09,49,,percent of total billed charges,,
PIN TEMPORARY FIXATION 1.1MM  WRIGHT MED 58820006,,C1713,HCPCS,Facility,Inpatient,,,,441,374.85,126.3906,441,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
PIN TEMPORARY FIXATION 1.1MM  WRIGHT MED 58820006,,C1713,HCPCS,Facility,Both,,,,441,374.85,126.3906,441,CorVel,Worker's Compensation,441,100,,percent of total billed charges,,
PIN TEMPORARY FIXATION 1.1MM  WRIGHT MED 58820006,,C1713,HCPCS,Facility,Both,,,,441,374.85,126.3906,441,First Health Group Corporation,First Health Network,427.77,97,,percent of total billed charges,,
PIN TEMPORARY FIXATION 1.1MM  WRIGHT MED 58820006,,C1713,HCPCS,Facility,Both,,,,441,374.85,126.3906,441,"Health Partners, Inc.",Commercial,417.186,94.6,,percent of total billed charges,,
PIN TEMPORARY FIXATION 1.1MM  WRIGHT MED 58820006,,C1713,HCPCS,Facility,Outpatient,,,,441,374.85,126.3906,441,"Health Partners, Inc.",Medicare Advantage,216.09,49,,percent of total billed charges,,
PIN TEMPORARY FIXATION 1.1MM  WRIGHT MED 58820006,,C1713,HCPCS,Facility,Inpatient,,,,441,374.85,126.3906,441,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PIN TEMPORARY FIXATION 1.1MM  WRIGHT MED 58820006,,C1713,HCPCS,Facility,Both,,,,441,374.85,126.3906,441,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),264.6,60,,percent of total billed charges,,
PIN TEMPORARY FIXATION 1.1MM  WRIGHT MED 58820006,,C1713,HCPCS,Facility,Both,,,,441,374.85,126.3906,441,"Health Partners, Inc.",State of Minnesota Advantage Program,359.415,81.5,,percent of total billed charges,,
PIN TEMPORARY FIXATION 1.1MM  WRIGHT MED 58820006,,C1713,HCPCS,Facility,Both,,,,441,374.85,126.3906,441,"Health Partners, Inc.",State Public Programs,220.5,50,,percent of total billed charges,,
PIN TEMPORARY FIXATION 1.1MM  WRIGHT MED 58820006,,C1713,HCPCS,Facility,Both,,,,441,374.85,126.3906,441,Humana Insurance Company,Commercial PPO,418.95,95,,percent of total billed charges,,
PIN TEMPORARY FIXATION 1.1MM  WRIGHT MED 58820006,,C1713,HCPCS,Facility,Outpatient,,,,441,374.85,126.3906,441,Humana Insurance Company,Medicare PPO,216.09,49,,percent of total billed charges,,
PIN TEMPORARY FIXATION 1.1MM  WRIGHT MED 58820006,,C1713,HCPCS,Facility,Inpatient,,,,441,374.85,126.3906,441,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
PIN TEMPORARY FIXATION 1.1MM  WRIGHT MED 58820006,,C1713,HCPCS,Facility,Both,,,,441,374.85,126.3906,441,Medica,Individual & Family,437.031,99.1,,percent of total billed charges,,
PIN TEMPORARY FIXATION 1.1MM  WRIGHT MED 58820006,,C1713,HCPCS,Facility,Outpatient,,,,441,374.85,126.3906,441,Medica,Medica Advantage Solution,219.618,49.8,,percent of total billed charges,,
PIN TEMPORARY FIXATION 1.1MM  WRIGHT MED 58820006,,C1713,HCPCS,Facility,Inpatient,,,,441,374.85,126.3906,441,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
PIN TEMPORARY FIXATION 1.1MM  WRIGHT MED 58820006,,C1713,HCPCS,Facility,Outpatient,,,,441,374.85,126.3906,441,Medica,Medical Assistance,196.686,44.6,,percent of total billed charges,,
PIN TEMPORARY FIXATION 1.1MM  WRIGHT MED 58820006,,C1713,HCPCS,Facility,Inpatient,,,,441,374.85,126.3906,441,Medica,Medical Assistance,,,,,Included in per diem rate,
PIN TEMPORARY FIXATION 1.1MM  WRIGHT MED 58820006,,C1713,HCPCS,Facility,Outpatient,,,,441,374.85,126.3906,441,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,219.618,49.8,,percent of total billed charges,,
PIN TEMPORARY FIXATION 1.1MM  WRIGHT MED 58820006,,C1713,HCPCS,Facility,Inpatient,,,,441,374.85,126.3906,441,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
PIN TEMPORARY FIXATION 1.1MM  WRIGHT MED 58820006,,C1713,HCPCS,Facility,Both,,,,441,374.85,126.3906,441,"Multiplan, Inc.","Multiplan, Inc.",414.54,94,,percent of total billed charges,,
PIN TEMPORARY FIXATION 1.1MM  WRIGHT MED 58820006,,C1713,HCPCS,Facility,Outpatient,,,,441,374.85,126.3906,441,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,397.341,90.1,,percent of total billed charges,,
PIN TEMPORARY FIXATION 1.1MM  WRIGHT MED 58820006,,C1713,HCPCS,Facility,Inpatient,,,,441,374.85,126.3906,441,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
PIN TEMPORARY FIXATION 1.1MM  WRIGHT MED 58820006,,C1713,HCPCS,Facility,Both,,,,441,374.85,126.3906,441,"Preferred One Administrative Services, INC.",PPO,434.826,98.6,,percent of total billed charges,,
PIN TEMPORARY FIXATION 1.1MM  WRIGHT MED 58820006,,C1713,HCPCS,Facility,Outpatient,,,,441,374.85,126.3906,441,PrimeWest Health,Minnesota Senior Health Options (MSHO),226.8945,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
PIN TEMPORARY FIXATION 1.1MM  WRIGHT MED 58820006,,C1713,HCPCS,Facility,Inpatient,,,,441,374.85,126.3906,441,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PIN TEMPORARY FIXATION 1.1MM  WRIGHT MED 58820006,,C1713,HCPCS,Facility,Outpatient,,,,441,374.85,126.3906,441,PrimeWest Health,MinnesotaCare,226.4976,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
PIN TEMPORARY FIXATION 1.1MM  WRIGHT MED 58820006,,C1713,HCPCS,Facility,Inpatient,,,,441,374.85,126.3906,441,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
PIN TEMPORARY FIXATION 1.1MM  WRIGHT MED 58820006,,C1713,HCPCS,Facility,Both,,,,441,374.85,126.3906,441,Sanford Health Plan,Sanford Health Plan,405.72,92,,percent of total billed charges,,
PIN TEMPORARY FIXATION 1.1MM  WRIGHT MED 58820006,,C1713,HCPCS,Facility,Outpatient,,,,441,374.85,126.3906,441,"UCare Health, Inc.",Individual & Family Plan,248.5035,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
PIN TEMPORARY FIXATION 1.1MM  WRIGHT MED 58820006,,C1713,HCPCS,Facility,Inpatient,,,,441,374.85,126.3906,441,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
PIN TEMPORARY FIXATION 1.1MM  WRIGHT MED 58820006,,C1713,HCPCS,Facility,Outpatient,,,,441,374.85,126.3906,441,"UCare Health, Inc.",Medical Assistance,222.5727,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PIN TEMPORARY FIXATION 1.1MM  WRIGHT MED 58820006,,C1713,HCPCS,Facility,Inpatient,,,,441,374.85,126.3906,441,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
PIN TEMPORARY FIXATION 1.1MM  WRIGHT MED 58820006,,C1713,HCPCS,Facility,Outpatient,,,,441,374.85,126.3906,441,"UCare Health, Inc.",Medicare Advantage,222.5727,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PIN TEMPORARY FIXATION 1.1MM  WRIGHT MED 58820006,,C1713,HCPCS,Facility,Inpatient,,,,441,374.85,126.3906,441,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PIN TEMPORARY FIXATION 1.1MM  WRIGHT MED 58820006,,C1713,HCPCS,Facility,Outpatient,,,,441,374.85,126.3906,441,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),222.5727,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PIN TEMPORARY FIXATION 1.1MM  WRIGHT MED 58820006,,C1713,HCPCS,Facility,Inpatient,,,,441,374.85,126.3906,441,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PIN TEMPORARY FIXATION 1.1MM  WRIGHT MED 58820006,,C1713,HCPCS,Facility,Both,,,,441,374.85,126.3906,441,UnitedHealthcare,Individual & Family,414.54,94,,percent of total billed charges,,
PIN TEMPORARY FIXATION 1.1MM  WRIGHT MED 58820006,,C1713,HCPCS,Facility,Outpatient,,,,441,374.85,126.3906,441,UnitedHealthcare,Medicare Advantage,216.09,49,,percent of total billed charges,,
PIN TEMPORARY FIXATION 1.1MM  WRIGHT MED 58820006,,C1713,HCPCS,Facility,Inpatient,,,,441,374.85,126.3906,441,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
PIN TEMPORARY FIXATION 1.1MM  WRIGHT MED 58820006,,C1713,HCPCS,Facility,Outpatient,,,,441,374.85,126.3906,441,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,211.68,48,,percent of total billed charges,,100% of DHS outpatient percentage
PIN TEMPORARY FIXATION 1.1MM  WRIGHT MED 58820006,,C1713,HCPCS,Facility,Inpatient,,,,441,374.85,126.3906,441,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
PIN THREADED 50/18 2.5  ORTHOFIX M310,,C1713,HCPCS,Facility,Both,,,,473.82,402.747,135.796812,473.82,Aetna,Commercial,435.9144,92,,percent of total billed charges,,
PIN THREADED 50/18 2.5  ORTHOFIX M310,,C1713,HCPCS,Facility,Outpatient,,,,473.82,402.747,135.796812,473.82,Aetna,Medicare Advantage,232.1718,49,,percent of total billed charges,,
PIN THREADED 50/18 2.5  ORTHOFIX M310,,C1713,HCPCS,Facility,Inpatient,,,,473.82,402.747,135.796812,473.82,Aetna,Medicare Advantage,,,,,Included in per diem rate,
PIN THREADED 50/18 2.5  ORTHOFIX M310,,C1713,HCPCS,Facility,Both,,,,473.82,402.747,135.796812,473.82,Aetna,PPO,440.6526,93,,percent of total billed charges,,
PIN THREADED 50/18 2.5  ORTHOFIX M310,,C1713,HCPCS,Facility,Both,,,,473.82,402.747,135.796812,473.82,America's PPO,America's PPO,455.009346,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
PIN THREADED 50/18 2.5  ORTHOFIX M310,,C1713,HCPCS,Facility,Both,,,,473.82,402.747,135.796812,473.82,BlueCross BlueShield Minnesota, Federal Employee Program,466.23888,98.4,,percent of total billed charges,,
PIN THREADED 50/18 2.5  ORTHOFIX M310,,C1713,HCPCS,Facility,Both,,,,473.82,402.747,135.796812,473.82,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,473.82,100,,percent of total billed charges,,
PIN THREADED 50/18 2.5  ORTHOFIX M310,,C1713,HCPCS,Facility,Both,,,,473.82,402.747,135.796812,473.82,BlueCross BlueShield Minnesota,High Value Network Plan,426.438,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
PIN THREADED 50/18 2.5  ORTHOFIX M310,,C1713,HCPCS,Facility,Outpatient,,,,473.82,402.747,135.796812,473.82,BlueCross BlueShield Minnesota,Medicare Advantage,232.1718,49,,percent of total billed charges,,
PIN THREADED 50/18 2.5  ORTHOFIX M310,,C1713,HCPCS,Facility,Inpatient,,,,473.82,402.747,135.796812,473.82,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
PIN THREADED 50/18 2.5  ORTHOFIX M310,,C1713,HCPCS,Facility,Both,,,,473.82,402.747,135.796812,473.82,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,419.662374,88.57,,percent of total billed charges,,
PIN THREADED 50/18 2.5  ORTHOFIX M310,,C1713,HCPCS,Facility,Both,,,,473.82,402.747,135.796812,473.82,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,135.796812,28.66,,percent of total billed charges,,
PIN THREADED 50/18 2.5  ORTHOFIX M310,,C1713,HCPCS,Facility,Outpatient,,,,473.82,402.747,135.796812,473.82,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),232.1718,49,,percent of total billed charges,,
PIN THREADED 50/18 2.5  ORTHOFIX M310,,C1713,HCPCS,Facility,Inpatient,,,,473.82,402.747,135.796812,473.82,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
PIN THREADED 50/18 2.5  ORTHOFIX M310,,C1713,HCPCS,Facility,Both,,,,473.82,402.747,135.796812,473.82,CorVel,Worker's Compensation,473.82,100,,percent of total billed charges,,
PIN THREADED 50/18 2.5  ORTHOFIX M310,,C1713,HCPCS,Facility,Both,,,,473.82,402.747,135.796812,473.82,First Health Group Corporation,First Health Network,459.6054,97,,percent of total billed charges,,
PIN THREADED 50/18 2.5  ORTHOFIX M310,,C1713,HCPCS,Facility,Both,,,,473.82,402.747,135.796812,473.82,"Health Partners, Inc.",Commercial,448.23372,94.6,,percent of total billed charges,,
PIN THREADED 50/18 2.5  ORTHOFIX M310,,C1713,HCPCS,Facility,Outpatient,,,,473.82,402.747,135.796812,473.82,"Health Partners, Inc.",Medicare Advantage,232.1718,49,,percent of total billed charges,,
PIN THREADED 50/18 2.5  ORTHOFIX M310,,C1713,HCPCS,Facility,Inpatient,,,,473.82,402.747,135.796812,473.82,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PIN THREADED 50/18 2.5  ORTHOFIX M310,,C1713,HCPCS,Facility,Both,,,,473.82,402.747,135.796812,473.82,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),284.292,60,,percent of total billed charges,,
PIN THREADED 50/18 2.5  ORTHOFIX M310,,C1713,HCPCS,Facility,Both,,,,473.82,402.747,135.796812,473.82,"Health Partners, Inc.",State of Minnesota Advantage Program,386.1633,81.5,,percent of total billed charges,,
PIN THREADED 50/18 2.5  ORTHOFIX M310,,C1713,HCPCS,Facility,Both,,,,473.82,402.747,135.796812,473.82,"Health Partners, Inc.",State Public Programs,236.91,50,,percent of total billed charges,,
PIN THREADED 50/18 2.5  ORTHOFIX M310,,C1713,HCPCS,Facility,Both,,,,473.82,402.747,135.796812,473.82,Humana Insurance Company,Commercial PPO,450.129,95,,percent of total billed charges,,
PIN THREADED 50/18 2.5  ORTHOFIX M310,,C1713,HCPCS,Facility,Outpatient,,,,473.82,402.747,135.796812,473.82,Humana Insurance Company,Medicare PPO,232.1718,49,,percent of total billed charges,,
PIN THREADED 50/18 2.5  ORTHOFIX M310,,C1713,HCPCS,Facility,Inpatient,,,,473.82,402.747,135.796812,473.82,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
PIN THREADED 50/18 2.5  ORTHOFIX M310,,C1713,HCPCS,Facility,Both,,,,473.82,402.747,135.796812,473.82,Medica,Individual & Family,469.55562,99.1,,percent of total billed charges,,
PIN THREADED 50/18 2.5  ORTHOFIX M310,,C1713,HCPCS,Facility,Outpatient,,,,473.82,402.747,135.796812,473.82,Medica,Medica Advantage Solution,235.96236,49.8,,percent of total billed charges,,
PIN THREADED 50/18 2.5  ORTHOFIX M310,,C1713,HCPCS,Facility,Inpatient,,,,473.82,402.747,135.796812,473.82,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
PIN THREADED 50/18 2.5  ORTHOFIX M310,,C1713,HCPCS,Facility,Outpatient,,,,473.82,402.747,135.796812,473.82,Medica,Medical Assistance,211.32372,44.6,,percent of total billed charges,,
PIN THREADED 50/18 2.5  ORTHOFIX M310,,C1713,HCPCS,Facility,Inpatient,,,,473.82,402.747,135.796812,473.82,Medica,Medical Assistance,,,,,Included in per diem rate,
PIN THREADED 50/18 2.5  ORTHOFIX M310,,C1713,HCPCS,Facility,Outpatient,,,,473.82,402.747,135.796812,473.82,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,235.96236,49.8,,percent of total billed charges,,
PIN THREADED 50/18 2.5  ORTHOFIX M310,,C1713,HCPCS,Facility,Inpatient,,,,473.82,402.747,135.796812,473.82,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
PIN THREADED 50/18 2.5  ORTHOFIX M310,,C1713,HCPCS,Facility,Both,,,,473.82,402.747,135.796812,473.82,"Multiplan, Inc.","Multiplan, Inc.",445.3908,94,,percent of total billed charges,,
PIN THREADED 50/18 2.5  ORTHOFIX M310,,C1713,HCPCS,Facility,Outpatient,,,,473.82,402.747,135.796812,473.82,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,426.91182,90.1,,percent of total billed charges,,
PIN THREADED 50/18 2.5  ORTHOFIX M310,,C1713,HCPCS,Facility,Inpatient,,,,473.82,402.747,135.796812,473.82,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
PIN THREADED 50/18 2.5  ORTHOFIX M310,,C1713,HCPCS,Facility,Both,,,,473.82,402.747,135.796812,473.82,"Preferred One Administrative Services, INC.",PPO,467.18652,98.6,,percent of total billed charges,,
PIN THREADED 50/18 2.5  ORTHOFIX M310,,C1713,HCPCS,Facility,Outpatient,,,,473.82,402.747,135.796812,473.82,PrimeWest Health,Minnesota Senior Health Options (MSHO),243.78039,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
PIN THREADED 50/18 2.5  ORTHOFIX M310,,C1713,HCPCS,Facility,Inpatient,,,,473.82,402.747,135.796812,473.82,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PIN THREADED 50/18 2.5  ORTHOFIX M310,,C1713,HCPCS,Facility,Outpatient,,,,473.82,402.747,135.796812,473.82,PrimeWest Health,MinnesotaCare,243.353952,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
PIN THREADED 50/18 2.5  ORTHOFIX M310,,C1713,HCPCS,Facility,Inpatient,,,,473.82,402.747,135.796812,473.82,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
PIN THREADED 50/18 2.5  ORTHOFIX M310,,C1713,HCPCS,Facility,Both,,,,473.82,402.747,135.796812,473.82,Sanford Health Plan,Sanford Health Plan,435.9144,92,,percent of total billed charges,,
PIN THREADED 50/18 2.5  ORTHOFIX M310,,C1713,HCPCS,Facility,Outpatient,,,,473.82,402.747,135.796812,473.82,"UCare Health, Inc.",Individual & Family Plan,266.99757,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
PIN THREADED 50/18 2.5  ORTHOFIX M310,,C1713,HCPCS,Facility,Inpatient,,,,473.82,402.747,135.796812,473.82,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
PIN THREADED 50/18 2.5  ORTHOFIX M310,,C1713,HCPCS,Facility,Outpatient,,,,473.82,402.747,135.796812,473.82,"UCare Health, Inc.",Medical Assistance,239.136954,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PIN THREADED 50/18 2.5  ORTHOFIX M310,,C1713,HCPCS,Facility,Inpatient,,,,473.82,402.747,135.796812,473.82,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
PIN THREADED 50/18 2.5  ORTHOFIX M310,,C1713,HCPCS,Facility,Outpatient,,,,473.82,402.747,135.796812,473.82,"UCare Health, Inc.",Medicare Advantage,239.136954,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PIN THREADED 50/18 2.5  ORTHOFIX M310,,C1713,HCPCS,Facility,Inpatient,,,,473.82,402.747,135.796812,473.82,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PIN THREADED 50/18 2.5  ORTHOFIX M310,,C1713,HCPCS,Facility,Outpatient,,,,473.82,402.747,135.796812,473.82,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),239.136954,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PIN THREADED 50/18 2.5  ORTHOFIX M310,,C1713,HCPCS,Facility,Inpatient,,,,473.82,402.747,135.796812,473.82,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PIN THREADED 50/18 2.5  ORTHOFIX M310,,C1713,HCPCS,Facility,Both,,,,473.82,402.747,135.796812,473.82,UnitedHealthcare,Individual & Family,445.3908,94,,percent of total billed charges,,
PIN THREADED 50/18 2.5  ORTHOFIX M310,,C1713,HCPCS,Facility,Outpatient,,,,473.82,402.747,135.796812,473.82,UnitedHealthcare,Medicare Advantage,232.1718,49,,percent of total billed charges,,
PIN THREADED 50/18 2.5  ORTHOFIX M310,,C1713,HCPCS,Facility,Inpatient,,,,473.82,402.747,135.796812,473.82,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
PIN THREADED 50/18 2.5  ORTHOFIX M310,,C1713,HCPCS,Facility,Outpatient,,,,473.82,402.747,135.796812,473.82,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,227.4336,48,,percent of total billed charges,,100% of DHS outpatient percentage
PIN THREADED 50/18 2.5  ORTHOFIX M310,,C1713,HCPCS,Facility,Inpatient,,,,473.82,402.747,135.796812,473.82,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
PLATE OPENING WEDGE 0MM  WRIGHT MED 58130000,,C1713,HCPCS,Facility,Both,,,,4872.2,4141.37,1396.37252,4872.2,Aetna,Commercial,4482.424,92,,percent of total billed charges,,
PLATE OPENING WEDGE 0MM  WRIGHT MED 58130000,,C1713,HCPCS,Facility,Outpatient,,,,4872.2,4141.37,1396.37252,4872.2,Aetna,Medicare Advantage,2387.378,49,,percent of total billed charges,,
PLATE OPENING WEDGE 0MM  WRIGHT MED 58130000,,C1713,HCPCS,Facility,Inpatient,,,,4872.2,4141.37,1396.37252,4872.2,Aetna,Medicare Advantage,,,,,Included in per diem rate,
PLATE OPENING WEDGE 0MM  WRIGHT MED 58130000,,C1713,HCPCS,Facility,Both,,,,4872.2,4141.37,1396.37252,4872.2,Aetna,PPO,4531.146,93,,percent of total billed charges,,
PLATE OPENING WEDGE 0MM  WRIGHT MED 58130000,,C1713,HCPCS,Facility,Both,,,,4872.2,4141.37,1396.37252,4872.2,America's PPO,America's PPO,4678.77366,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
PLATE OPENING WEDGE 0MM  WRIGHT MED 58130000,,C1713,HCPCS,Facility,Both,,,,4872.2,4141.37,1396.37252,4872.2,BlueCross BlueShield Minnesota, Federal Employee Program,4794.2448,98.4,,percent of total billed charges,,
PLATE OPENING WEDGE 0MM  WRIGHT MED 58130000,,C1713,HCPCS,Facility,Both,,,,4872.2,4141.37,1396.37252,4872.2,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,4872.2,100,,percent of total billed charges,,
PLATE OPENING WEDGE 0MM  WRIGHT MED 58130000,,C1713,HCPCS,Facility,Both,,,,4872.2,4141.37,1396.37252,4872.2,BlueCross BlueShield Minnesota,High Value Network Plan,4384.98,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
PLATE OPENING WEDGE 0MM  WRIGHT MED 58130000,,C1713,HCPCS,Facility,Outpatient,,,,4872.2,4141.37,1396.37252,4872.2,BlueCross BlueShield Minnesota,Medicare Advantage,2387.378,49,,percent of total billed charges,,
PLATE OPENING WEDGE 0MM  WRIGHT MED 58130000,,C1713,HCPCS,Facility,Inpatient,,,,4872.2,4141.37,1396.37252,4872.2,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
PLATE OPENING WEDGE 0MM  WRIGHT MED 58130000,,C1713,HCPCS,Facility,Both,,,,4872.2,4141.37,1396.37252,4872.2,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4315.30754,88.57,,percent of total billed charges,,
PLATE OPENING WEDGE 0MM  WRIGHT MED 58130000,,C1713,HCPCS,Facility,Both,,,,4872.2,4141.37,1396.37252,4872.2,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1396.37252,28.66,,percent of total billed charges,,
PLATE OPENING WEDGE 0MM  WRIGHT MED 58130000,,C1713,HCPCS,Facility,Outpatient,,,,4872.2,4141.37,1396.37252,4872.2,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2387.378,49,,percent of total billed charges,,
PLATE OPENING WEDGE 0MM  WRIGHT MED 58130000,,C1713,HCPCS,Facility,Inpatient,,,,4872.2,4141.37,1396.37252,4872.2,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
PLATE OPENING WEDGE 0MM  WRIGHT MED 58130000,,C1713,HCPCS,Facility,Both,,,,4872.2,4141.37,1396.37252,4872.2,CorVel,Worker's Compensation,4872.2,100,,percent of total billed charges,,
PLATE OPENING WEDGE 0MM  WRIGHT MED 58130000,,C1713,HCPCS,Facility,Both,,,,4872.2,4141.37,1396.37252,4872.2,First Health Group Corporation,First Health Network,4726.034,97,,percent of total billed charges,,
PLATE OPENING WEDGE 0MM  WRIGHT MED 58130000,,C1713,HCPCS,Facility,Both,,,,4872.2,4141.37,1396.37252,4872.2,"Health Partners, Inc.",Commercial,4609.1012,94.6,,percent of total billed charges,,
PLATE OPENING WEDGE 0MM  WRIGHT MED 58130000,,C1713,HCPCS,Facility,Outpatient,,,,4872.2,4141.37,1396.37252,4872.2,"Health Partners, Inc.",Medicare Advantage,2387.378,49,,percent of total billed charges,,
PLATE OPENING WEDGE 0MM  WRIGHT MED 58130000,,C1713,HCPCS,Facility,Inpatient,,,,4872.2,4141.37,1396.37252,4872.2,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PLATE OPENING WEDGE 0MM  WRIGHT MED 58130000,,C1713,HCPCS,Facility,Both,,,,4872.2,4141.37,1396.37252,4872.2,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),2923.32,60,,percent of total billed charges,,
PLATE OPENING WEDGE 0MM  WRIGHT MED 58130000,,C1713,HCPCS,Facility,Both,,,,4872.2,4141.37,1396.37252,4872.2,"Health Partners, Inc.",State of Minnesota Advantage Program,3970.843,81.5,,percent of total billed charges,,
PLATE OPENING WEDGE 0MM  WRIGHT MED 58130000,,C1713,HCPCS,Facility,Both,,,,4872.2,4141.37,1396.37252,4872.2,"Health Partners, Inc.",State Public Programs,2436.1,50,,percent of total billed charges,,
PLATE OPENING WEDGE 0MM  WRIGHT MED 58130000,,C1713,HCPCS,Facility,Both,,,,4872.2,4141.37,1396.37252,4872.2,Humana Insurance Company,Commercial PPO,4628.59,95,,percent of total billed charges,,
PLATE OPENING WEDGE 0MM  WRIGHT MED 58130000,,C1713,HCPCS,Facility,Outpatient,,,,4872.2,4141.37,1396.37252,4872.2,Humana Insurance Company,Medicare PPO,2387.378,49,,percent of total billed charges,,
PLATE OPENING WEDGE 0MM  WRIGHT MED 58130000,,C1713,HCPCS,Facility,Inpatient,,,,4872.2,4141.37,1396.37252,4872.2,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
PLATE OPENING WEDGE 0MM  WRIGHT MED 58130000,,C1713,HCPCS,Facility,Both,,,,4872.2,4141.37,1396.37252,4872.2,Medica,Individual & Family,4828.3502,99.1,,percent of total billed charges,,
PLATE OPENING WEDGE 0MM  WRIGHT MED 58130000,,C1713,HCPCS,Facility,Outpatient,,,,4872.2,4141.37,1396.37252,4872.2,Medica,Medica Advantage Solution,2426.3556,49.8,,percent of total billed charges,,
PLATE OPENING WEDGE 0MM  WRIGHT MED 58130000,,C1713,HCPCS,Facility,Inpatient,,,,4872.2,4141.37,1396.37252,4872.2,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
PLATE OPENING WEDGE 0MM  WRIGHT MED 58130000,,C1713,HCPCS,Facility,Outpatient,,,,4872.2,4141.37,1396.37252,4872.2,Medica,Medical Assistance,2173.0012,44.6,,percent of total billed charges,,
PLATE OPENING WEDGE 0MM  WRIGHT MED 58130000,,C1713,HCPCS,Facility,Inpatient,,,,4872.2,4141.37,1396.37252,4872.2,Medica,Medical Assistance,,,,,Included in per diem rate,
PLATE OPENING WEDGE 0MM  WRIGHT MED 58130000,,C1713,HCPCS,Facility,Outpatient,,,,4872.2,4141.37,1396.37252,4872.2,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2426.3556,49.8,,percent of total billed charges,,
PLATE OPENING WEDGE 0MM  WRIGHT MED 58130000,,C1713,HCPCS,Facility,Inpatient,,,,4872.2,4141.37,1396.37252,4872.2,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
PLATE OPENING WEDGE 0MM  WRIGHT MED 58130000,,C1713,HCPCS,Facility,Both,,,,4872.2,4141.37,1396.37252,4872.2,"Multiplan, Inc.","Multiplan, Inc.",4579.868,94,,percent of total billed charges,,
PLATE OPENING WEDGE 0MM  WRIGHT MED 58130000,,C1713,HCPCS,Facility,Outpatient,,,,4872.2,4141.37,1396.37252,4872.2,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4389.8522,90.1,,percent of total billed charges,,
PLATE OPENING WEDGE 0MM  WRIGHT MED 58130000,,C1713,HCPCS,Facility,Inpatient,,,,4872.2,4141.37,1396.37252,4872.2,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
PLATE OPENING WEDGE 0MM  WRIGHT MED 58130000,,C1713,HCPCS,Facility,Both,,,,4872.2,4141.37,1396.37252,4872.2,"Preferred One Administrative Services, INC.",PPO,4803.9892,98.6,,percent of total billed charges,,
PLATE OPENING WEDGE 0MM  WRIGHT MED 58130000,,C1713,HCPCS,Facility,Outpatient,,,,4872.2,4141.37,1396.37252,4872.2,PrimeWest Health,Minnesota Senior Health Options (MSHO),2506.7469,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
PLATE OPENING WEDGE 0MM  WRIGHT MED 58130000,,C1713,HCPCS,Facility,Inpatient,,,,4872.2,4141.37,1396.37252,4872.2,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PLATE OPENING WEDGE 0MM  WRIGHT MED 58130000,,C1713,HCPCS,Facility,Outpatient,,,,4872.2,4141.37,1396.37252,4872.2,PrimeWest Health,MinnesotaCare,2502.36192,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
PLATE OPENING WEDGE 0MM  WRIGHT MED 58130000,,C1713,HCPCS,Facility,Inpatient,,,,4872.2,4141.37,1396.37252,4872.2,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
PLATE OPENING WEDGE 0MM  WRIGHT MED 58130000,,C1713,HCPCS,Facility,Both,,,,4872.2,4141.37,1396.37252,4872.2,Sanford Health Plan,Sanford Health Plan,4482.424,92,,percent of total billed charges,,
PLATE OPENING WEDGE 0MM  WRIGHT MED 58130000,,C1713,HCPCS,Facility,Outpatient,,,,4872.2,4141.37,1396.37252,4872.2,"UCare Health, Inc.",Individual & Family Plan,2745.4847,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
PLATE OPENING WEDGE 0MM  WRIGHT MED 58130000,,C1713,HCPCS,Facility,Inpatient,,,,4872.2,4141.37,1396.37252,4872.2,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
PLATE OPENING WEDGE 0MM  WRIGHT MED 58130000,,C1713,HCPCS,Facility,Outpatient,,,,4872.2,4141.37,1396.37252,4872.2,"UCare Health, Inc.",Medical Assistance,2458.99934,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PLATE OPENING WEDGE 0MM  WRIGHT MED 58130000,,C1713,HCPCS,Facility,Inpatient,,,,4872.2,4141.37,1396.37252,4872.2,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
PLATE OPENING WEDGE 0MM  WRIGHT MED 58130000,,C1713,HCPCS,Facility,Outpatient,,,,4872.2,4141.37,1396.37252,4872.2,"UCare Health, Inc.",Medicare Advantage,2458.99934,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PLATE OPENING WEDGE 0MM  WRIGHT MED 58130000,,C1713,HCPCS,Facility,Inpatient,,,,4872.2,4141.37,1396.37252,4872.2,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PLATE OPENING WEDGE 0MM  WRIGHT MED 58130000,,C1713,HCPCS,Facility,Outpatient,,,,4872.2,4141.37,1396.37252,4872.2,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2458.99934,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PLATE OPENING WEDGE 0MM  WRIGHT MED 58130000,,C1713,HCPCS,Facility,Inpatient,,,,4872.2,4141.37,1396.37252,4872.2,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PLATE OPENING WEDGE 0MM  WRIGHT MED 58130000,,C1713,HCPCS,Facility,Both,,,,4872.2,4141.37,1396.37252,4872.2,UnitedHealthcare,Individual & Family,4579.868,94,,percent of total billed charges,,
PLATE OPENING WEDGE 0MM  WRIGHT MED 58130000,,C1713,HCPCS,Facility,Outpatient,,,,4872.2,4141.37,1396.37252,4872.2,UnitedHealthcare,Medicare Advantage,2387.378,49,,percent of total billed charges,,
PLATE OPENING WEDGE 0MM  WRIGHT MED 58130000,,C1713,HCPCS,Facility,Inpatient,,,,4872.2,4141.37,1396.37252,4872.2,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
PLATE OPENING WEDGE 0MM  WRIGHT MED 58130000,,C1713,HCPCS,Facility,Outpatient,,,,4872.2,4141.37,1396.37252,4872.2,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2338.656,48,,percent of total billed charges,,100% of DHS outpatient percentage
PLATE OPENING WEDGE 0MM  WRIGHT MED 58130000,,C1713,HCPCS,Facility,Inpatient,,,,4872.2,4141.37,1396.37252,4872.2,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
SCREW DARCO HEADED 2.7x34 SHORT,,C1713,HCPCS,Facility,Both,,,,1177.5,1000.875,337.4715,1177.5,Aetna,Commercial,1083.3,92,,percent of total billed charges,,
SCREW DARCO HEADED 2.7x34 SHORT,,C1713,HCPCS,Facility,Outpatient,,,,1177.5,1000.875,337.4715,1177.5,Aetna,Medicare Advantage,576.975,49,,percent of total billed charges,,
SCREW DARCO HEADED 2.7x34 SHORT,,C1713,HCPCS,Facility,Inpatient,,,,1177.5,1000.875,337.4715,1177.5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
SCREW DARCO HEADED 2.7x34 SHORT,,C1713,HCPCS,Facility,Both,,,,1177.5,1000.875,337.4715,1177.5,Aetna,PPO,1095.075,93,,percent of total billed charges,,
SCREW DARCO HEADED 2.7x34 SHORT,,C1713,HCPCS,Facility,Both,,,,1177.5,1000.875,337.4715,1177.5,America's PPO,America's PPO,1130.75325,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SCREW DARCO HEADED 2.7x34 SHORT,,C1713,HCPCS,Facility,Both,,,,1177.5,1000.875,337.4715,1177.5,BlueCross BlueShield Minnesota, Federal Employee Program,1158.66,98.4,,percent of total billed charges,,
SCREW DARCO HEADED 2.7x34 SHORT,,C1713,HCPCS,Facility,Both,,,,1177.5,1000.875,337.4715,1177.5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1177.5,100,,percent of total billed charges,,
SCREW DARCO HEADED 2.7x34 SHORT,,C1713,HCPCS,Facility,Both,,,,1177.5,1000.875,337.4715,1177.5,BlueCross BlueShield Minnesota,High Value Network Plan,1059.75,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
SCREW DARCO HEADED 2.7x34 SHORT,,C1713,HCPCS,Facility,Outpatient,,,,1177.5,1000.875,337.4715,1177.5,BlueCross BlueShield Minnesota,Medicare Advantage,576.975,49,,percent of total billed charges,,
SCREW DARCO HEADED 2.7x34 SHORT,,C1713,HCPCS,Facility,Inpatient,,,,1177.5,1000.875,337.4715,1177.5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
SCREW DARCO HEADED 2.7x34 SHORT,,C1713,HCPCS,Facility,Both,,,,1177.5,1000.875,337.4715,1177.5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1042.91175,88.57,,percent of total billed charges,,
SCREW DARCO HEADED 2.7x34 SHORT,,C1713,HCPCS,Facility,Both,,,,1177.5,1000.875,337.4715,1177.5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,337.4715,28.66,,percent of total billed charges,,
SCREW DARCO HEADED 2.7x34 SHORT,,C1713,HCPCS,Facility,Outpatient,,,,1177.5,1000.875,337.4715,1177.5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),576.975,49,,percent of total billed charges,,
SCREW DARCO HEADED 2.7x34 SHORT,,C1713,HCPCS,Facility,Inpatient,,,,1177.5,1000.875,337.4715,1177.5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
SCREW DARCO HEADED 2.7x34 SHORT,,C1713,HCPCS,Facility,Both,,,,1177.5,1000.875,337.4715,1177.5,CorVel,Worker's Compensation,1177.5,100,,percent of total billed charges,,
SCREW DARCO HEADED 2.7x34 SHORT,,C1713,HCPCS,Facility,Both,,,,1177.5,1000.875,337.4715,1177.5,First Health Group Corporation,First Health Network,1142.175,97,,percent of total billed charges,,
SCREW DARCO HEADED 2.7x34 SHORT,,C1713,HCPCS,Facility,Both,,,,1177.5,1000.875,337.4715,1177.5,"Health Partners, Inc.",Commercial,1113.915,94.6,,percent of total billed charges,,
SCREW DARCO HEADED 2.7x34 SHORT,,C1713,HCPCS,Facility,Outpatient,,,,1177.5,1000.875,337.4715,1177.5,"Health Partners, Inc.",Medicare Advantage,576.975,49,,percent of total billed charges,,
SCREW DARCO HEADED 2.7x34 SHORT,,C1713,HCPCS,Facility,Inpatient,,,,1177.5,1000.875,337.4715,1177.5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SCREW DARCO HEADED 2.7x34 SHORT,,C1713,HCPCS,Facility,Both,,,,1177.5,1000.875,337.4715,1177.5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),706.5,60,,percent of total billed charges,,
SCREW DARCO HEADED 2.7x34 SHORT,,C1713,HCPCS,Facility,Both,,,,1177.5,1000.875,337.4715,1177.5,"Health Partners, Inc.",State of Minnesota Advantage Program,959.6625,81.5,,percent of total billed charges,,
SCREW DARCO HEADED 2.7x34 SHORT,,C1713,HCPCS,Facility,Both,,,,1177.5,1000.875,337.4715,1177.5,"Health Partners, Inc.",State Public Programs,588.75,50,,percent of total billed charges,,
SCREW DARCO HEADED 2.7x34 SHORT,,C1713,HCPCS,Facility,Both,,,,1177.5,1000.875,337.4715,1177.5,Humana Insurance Company,Commercial PPO,1118.625,95,,percent of total billed charges,,
SCREW DARCO HEADED 2.7x34 SHORT,,C1713,HCPCS,Facility,Outpatient,,,,1177.5,1000.875,337.4715,1177.5,Humana Insurance Company,Medicare PPO,576.975,49,,percent of total billed charges,,
SCREW DARCO HEADED 2.7x34 SHORT,,C1713,HCPCS,Facility,Inpatient,,,,1177.5,1000.875,337.4715,1177.5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
SCREW DARCO HEADED 2.7x34 SHORT,,C1713,HCPCS,Facility,Both,,,,1177.5,1000.875,337.4715,1177.5,Medica,Individual & Family,1166.9025,99.1,,percent of total billed charges,,
SCREW DARCO HEADED 2.7x34 SHORT,,C1713,HCPCS,Facility,Outpatient,,,,1177.5,1000.875,337.4715,1177.5,Medica,Medica Advantage Solution,586.395,49.8,,percent of total billed charges,,
SCREW DARCO HEADED 2.7x34 SHORT,,C1713,HCPCS,Facility,Inpatient,,,,1177.5,1000.875,337.4715,1177.5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
SCREW DARCO HEADED 2.7x34 SHORT,,C1713,HCPCS,Facility,Outpatient,,,,1177.5,1000.875,337.4715,1177.5,Medica,Medical Assistance,525.165,44.6,,percent of total billed charges,,
SCREW DARCO HEADED 2.7x34 SHORT,,C1713,HCPCS,Facility,Inpatient,,,,1177.5,1000.875,337.4715,1177.5,Medica,Medical Assistance,,,,,Included in per diem rate,
SCREW DARCO HEADED 2.7x34 SHORT,,C1713,HCPCS,Facility,Outpatient,,,,1177.5,1000.875,337.4715,1177.5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,586.395,49.8,,percent of total billed charges,,
SCREW DARCO HEADED 2.7x34 SHORT,,C1713,HCPCS,Facility,Inpatient,,,,1177.5,1000.875,337.4715,1177.5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
SCREW DARCO HEADED 2.7x34 SHORT,,C1713,HCPCS,Facility,Both,,,,1177.5,1000.875,337.4715,1177.5,"Multiplan, Inc.","Multiplan, Inc.",1106.85,94,,percent of total billed charges,,
SCREW DARCO HEADED 2.7x34 SHORT,,C1713,HCPCS,Facility,Outpatient,,,,1177.5,1000.875,337.4715,1177.5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1060.9275,90.1,,percent of total billed charges,,
SCREW DARCO HEADED 2.7x34 SHORT,,C1713,HCPCS,Facility,Inpatient,,,,1177.5,1000.875,337.4715,1177.5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
SCREW DARCO HEADED 2.7x34 SHORT,,C1713,HCPCS,Facility,Both,,,,1177.5,1000.875,337.4715,1177.5,"Preferred One Administrative Services, INC.",PPO,1161.015,98.6,,percent of total billed charges,,
SCREW DARCO HEADED 2.7x34 SHORT,,C1713,HCPCS,Facility,Outpatient,,,,1177.5,1000.875,337.4715,1177.5,PrimeWest Health,Minnesota Senior Health Options (MSHO),605.82375,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
SCREW DARCO HEADED 2.7x34 SHORT,,C1713,HCPCS,Facility,Inpatient,,,,1177.5,1000.875,337.4715,1177.5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SCREW DARCO HEADED 2.7x34 SHORT,,C1713,HCPCS,Facility,Outpatient,,,,1177.5,1000.875,337.4715,1177.5,PrimeWest Health,MinnesotaCare,604.764,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
SCREW DARCO HEADED 2.7x34 SHORT,,C1713,HCPCS,Facility,Inpatient,,,,1177.5,1000.875,337.4715,1177.5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
SCREW DARCO HEADED 2.7x34 SHORT,,C1713,HCPCS,Facility,Both,,,,1177.5,1000.875,337.4715,1177.5,Sanford Health Plan,Sanford Health Plan,1083.3,92,,percent of total billed charges,,
SCREW DARCO HEADED 2.7x34 SHORT,,C1713,HCPCS,Facility,Outpatient,,,,1177.5,1000.875,337.4715,1177.5,"UCare Health, Inc.",Individual & Family Plan,663.52125,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
SCREW DARCO HEADED 2.7x34 SHORT,,C1713,HCPCS,Facility,Inpatient,,,,1177.5,1000.875,337.4715,1177.5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
SCREW DARCO HEADED 2.7x34 SHORT,,C1713,HCPCS,Facility,Outpatient,,,,1177.5,1000.875,337.4715,1177.5,"UCare Health, Inc.",Medical Assistance,594.28425,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SCREW DARCO HEADED 2.7x34 SHORT,,C1713,HCPCS,Facility,Inpatient,,,,1177.5,1000.875,337.4715,1177.5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
SCREW DARCO HEADED 2.7x34 SHORT,,C1713,HCPCS,Facility,Outpatient,,,,1177.5,1000.875,337.4715,1177.5,"UCare Health, Inc.",Medicare Advantage,594.28425,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SCREW DARCO HEADED 2.7x34 SHORT,,C1713,HCPCS,Facility,Inpatient,,,,1177.5,1000.875,337.4715,1177.5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SCREW DARCO HEADED 2.7x34 SHORT,,C1713,HCPCS,Facility,Outpatient,,,,1177.5,1000.875,337.4715,1177.5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),594.28425,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SCREW DARCO HEADED 2.7x34 SHORT,,C1713,HCPCS,Facility,Inpatient,,,,1177.5,1000.875,337.4715,1177.5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SCREW DARCO HEADED 2.7x34 SHORT,,C1713,HCPCS,Facility,Both,,,,1177.5,1000.875,337.4715,1177.5,UnitedHealthcare,Individual & Family,1106.85,94,,percent of total billed charges,,
SCREW DARCO HEADED 2.7x34 SHORT,,C1713,HCPCS,Facility,Outpatient,,,,1177.5,1000.875,337.4715,1177.5,UnitedHealthcare,Medicare Advantage,576.975,49,,percent of total billed charges,,
SCREW DARCO HEADED 2.7x34 SHORT,,C1713,HCPCS,Facility,Inpatient,,,,1177.5,1000.875,337.4715,1177.5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
SCREW DARCO HEADED 2.7x34 SHORT,,C1713,HCPCS,Facility,Outpatient,,,,1177.5,1000.875,337.4715,1177.5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,565.2,48,,percent of total billed charges,,100% of DHS outpatient percentage
SCREW DARCO HEADED 2.7x34 SHORT,,C1713,HCPCS,Facility,Inpatient,,,,1177.5,1000.875,337.4715,1177.5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
SCREW Darco headed 3.0x14,,C1713,HCPCS,Facility,Both,,,,835,709.75,239.311,835,Aetna,Commercial,768.2,92,,percent of total billed charges,,
SCREW Darco headed 3.0x14,,C1713,HCPCS,Facility,Outpatient,,,,835,709.75,239.311,835,Aetna,Medicare Advantage,409.15,49,,percent of total billed charges,,
SCREW Darco headed 3.0x14,,C1713,HCPCS,Facility,Inpatient,,,,835,709.75,239.311,835,Aetna,Medicare Advantage,,,,,Included in per diem rate,
SCREW Darco headed 3.0x14,,C1713,HCPCS,Facility,Both,,,,835,709.75,239.311,835,Aetna,PPO,776.55,93,,percent of total billed charges,,
SCREW Darco headed 3.0x14,,C1713,HCPCS,Facility,Both,,,,835,709.75,239.311,835,America's PPO,America's PPO,801.8505,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SCREW Darco headed 3.0x14,,C1713,HCPCS,Facility,Both,,,,835,709.75,239.311,835,BlueCross BlueShield Minnesota, Federal Employee Program,821.64,98.4,,percent of total billed charges,,
SCREW Darco headed 3.0x14,,C1713,HCPCS,Facility,Both,,,,835,709.75,239.311,835,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,835,100,,percent of total billed charges,,
SCREW Darco headed 3.0x14,,C1713,HCPCS,Facility,Both,,,,835,709.75,239.311,835,BlueCross BlueShield Minnesota,High Value Network Plan,751.5,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
SCREW Darco headed 3.0x14,,C1713,HCPCS,Facility,Outpatient,,,,835,709.75,239.311,835,BlueCross BlueShield Minnesota,Medicare Advantage,409.15,49,,percent of total billed charges,,
SCREW Darco headed 3.0x14,,C1713,HCPCS,Facility,Inpatient,,,,835,709.75,239.311,835,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
SCREW Darco headed 3.0x14,,C1713,HCPCS,Facility,Both,,,,835,709.75,239.311,835,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,739.5595,88.57,,percent of total billed charges,,
SCREW Darco headed 3.0x14,,C1713,HCPCS,Facility,Both,,,,835,709.75,239.311,835,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,239.311,28.66,,percent of total billed charges,,
SCREW Darco headed 3.0x14,,C1713,HCPCS,Facility,Outpatient,,,,835,709.75,239.311,835,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),409.15,49,,percent of total billed charges,,
SCREW Darco headed 3.0x14,,C1713,HCPCS,Facility,Inpatient,,,,835,709.75,239.311,835,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
SCREW Darco headed 3.0x14,,C1713,HCPCS,Facility,Both,,,,835,709.75,239.311,835,CorVel,Worker's Compensation,835,100,,percent of total billed charges,,
SCREW Darco headed 3.0x14,,C1713,HCPCS,Facility,Both,,,,835,709.75,239.311,835,First Health Group Corporation,First Health Network,809.95,97,,percent of total billed charges,,
SCREW Darco headed 3.0x14,,C1713,HCPCS,Facility,Both,,,,835,709.75,239.311,835,"Health Partners, Inc.",Commercial,789.91,94.6,,percent of total billed charges,,
SCREW Darco headed 3.0x14,,C1713,HCPCS,Facility,Outpatient,,,,835,709.75,239.311,835,"Health Partners, Inc.",Medicare Advantage,409.15,49,,percent of total billed charges,,
SCREW Darco headed 3.0x14,,C1713,HCPCS,Facility,Inpatient,,,,835,709.75,239.311,835,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SCREW Darco headed 3.0x14,,C1713,HCPCS,Facility,Both,,,,835,709.75,239.311,835,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),501,60,,percent of total billed charges,,
SCREW Darco headed 3.0x14,,C1713,HCPCS,Facility,Both,,,,835,709.75,239.311,835,"Health Partners, Inc.",State of Minnesota Advantage Program,680.525,81.5,,percent of total billed charges,,
SCREW Darco headed 3.0x14,,C1713,HCPCS,Facility,Both,,,,835,709.75,239.311,835,"Health Partners, Inc.",State Public Programs,417.5,50,,percent of total billed charges,,
SCREW Darco headed 3.0x14,,C1713,HCPCS,Facility,Both,,,,835,709.75,239.311,835,Humana Insurance Company,Commercial PPO,793.25,95,,percent of total billed charges,,
SCREW Darco headed 3.0x14,,C1713,HCPCS,Facility,Outpatient,,,,835,709.75,239.311,835,Humana Insurance Company,Medicare PPO,409.15,49,,percent of total billed charges,,
SCREW Darco headed 3.0x14,,C1713,HCPCS,Facility,Inpatient,,,,835,709.75,239.311,835,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
SCREW Darco headed 3.0x14,,C1713,HCPCS,Facility,Both,,,,835,709.75,239.311,835,Medica,Individual & Family,827.485,99.1,,percent of total billed charges,,
SCREW Darco headed 3.0x14,,C1713,HCPCS,Facility,Outpatient,,,,835,709.75,239.311,835,Medica,Medica Advantage Solution,415.83,49.8,,percent of total billed charges,,
SCREW Darco headed 3.0x14,,C1713,HCPCS,Facility,Inpatient,,,,835,709.75,239.311,835,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
SCREW Darco headed 3.0x14,,C1713,HCPCS,Facility,Outpatient,,,,835,709.75,239.311,835,Medica,Medical Assistance,372.41,44.6,,percent of total billed charges,,
SCREW Darco headed 3.0x14,,C1713,HCPCS,Facility,Inpatient,,,,835,709.75,239.311,835,Medica,Medical Assistance,,,,,Included in per diem rate,
SCREW Darco headed 3.0x14,,C1713,HCPCS,Facility,Outpatient,,,,835,709.75,239.311,835,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,415.83,49.8,,percent of total billed charges,,
SCREW Darco headed 3.0x14,,C1713,HCPCS,Facility,Inpatient,,,,835,709.75,239.311,835,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
SCREW Darco headed 3.0x14,,C1713,HCPCS,Facility,Both,,,,835,709.75,239.311,835,"Multiplan, Inc.","Multiplan, Inc.",784.9,94,,percent of total billed charges,,
SCREW Darco headed 3.0x14,,C1713,HCPCS,Facility,Outpatient,,,,835,709.75,239.311,835,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,752.335,90.1,,percent of total billed charges,,
SCREW Darco headed 3.0x14,,C1713,HCPCS,Facility,Inpatient,,,,835,709.75,239.311,835,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
SCREW Darco headed 3.0x14,,C1713,HCPCS,Facility,Both,,,,835,709.75,239.311,835,"Preferred One Administrative Services, INC.",PPO,823.31,98.6,,percent of total billed charges,,
SCREW Darco headed 3.0x14,,C1713,HCPCS,Facility,Outpatient,,,,835,709.75,239.311,835,PrimeWest Health,Minnesota Senior Health Options (MSHO),429.6075,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
SCREW Darco headed 3.0x14,,C1713,HCPCS,Facility,Inpatient,,,,835,709.75,239.311,835,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SCREW Darco headed 3.0x14,,C1713,HCPCS,Facility,Outpatient,,,,835,709.75,239.311,835,PrimeWest Health,MinnesotaCare,428.856,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
SCREW Darco headed 3.0x14,,C1713,HCPCS,Facility,Inpatient,,,,835,709.75,239.311,835,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
SCREW Darco headed 3.0x14,,C1713,HCPCS,Facility,Both,,,,835,709.75,239.311,835,Sanford Health Plan,Sanford Health Plan,768.2,92,,percent of total billed charges,,
SCREW Darco headed 3.0x14,,C1713,HCPCS,Facility,Outpatient,,,,835,709.75,239.311,835,"UCare Health, Inc.",Individual & Family Plan,470.5225,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
SCREW Darco headed 3.0x14,,C1713,HCPCS,Facility,Inpatient,,,,835,709.75,239.311,835,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
SCREW Darco headed 3.0x14,,C1713,HCPCS,Facility,Outpatient,,,,835,709.75,239.311,835,"UCare Health, Inc.",Medical Assistance,421.4245,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SCREW Darco headed 3.0x14,,C1713,HCPCS,Facility,Inpatient,,,,835,709.75,239.311,835,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
SCREW Darco headed 3.0x14,,C1713,HCPCS,Facility,Outpatient,,,,835,709.75,239.311,835,"UCare Health, Inc.",Medicare Advantage,421.4245,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SCREW Darco headed 3.0x14,,C1713,HCPCS,Facility,Inpatient,,,,835,709.75,239.311,835,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SCREW Darco headed 3.0x14,,C1713,HCPCS,Facility,Outpatient,,,,835,709.75,239.311,835,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),421.4245,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SCREW Darco headed 3.0x14,,C1713,HCPCS,Facility,Inpatient,,,,835,709.75,239.311,835,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SCREW Darco headed 3.0x14,,C1713,HCPCS,Facility,Both,,,,835,709.75,239.311,835,UnitedHealthcare,Individual & Family,784.9,94,,percent of total billed charges,,
SCREW Darco headed 3.0x14,,C1713,HCPCS,Facility,Outpatient,,,,835,709.75,239.311,835,UnitedHealthcare,Medicare Advantage,409.15,49,,percent of total billed charges,,
SCREW Darco headed 3.0x14,,C1713,HCPCS,Facility,Inpatient,,,,835,709.75,239.311,835,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
SCREW Darco headed 3.0x14,,C1713,HCPCS,Facility,Outpatient,,,,835,709.75,239.311,835,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,400.8,48,,percent of total billed charges,,100% of DHS outpatient percentage
SCREW Darco headed 3.0x14,,C1713,HCPCS,Facility,Inpatient,,,,835,709.75,239.311,835,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
SCREW HEADED 2.5MMX18MM,,C1713,HCPCS,Facility,Both,,,,807.5,686.375,231.4295,807.5,Aetna,Commercial,742.9,92,,percent of total billed charges,,
SCREW HEADED 2.5MMX18MM,,C1713,HCPCS,Facility,Outpatient,,,,807.5,686.375,231.4295,807.5,Aetna,Medicare Advantage,395.675,49,,percent of total billed charges,,
SCREW HEADED 2.5MMX18MM,,C1713,HCPCS,Facility,Inpatient,,,,807.5,686.375,231.4295,807.5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
SCREW HEADED 2.5MMX18MM,,C1713,HCPCS,Facility,Both,,,,807.5,686.375,231.4295,807.5,Aetna,PPO,750.975,93,,percent of total billed charges,,
SCREW HEADED 2.5MMX18MM,,C1713,HCPCS,Facility,Both,,,,807.5,686.375,231.4295,807.5,America's PPO,America's PPO,775.44225,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SCREW HEADED 2.5MMX18MM,,C1713,HCPCS,Facility,Both,,,,807.5,686.375,231.4295,807.5,BlueCross BlueShield Minnesota, Federal Employee Program,794.58,98.4,,percent of total billed charges,,
SCREW HEADED 2.5MMX18MM,,C1713,HCPCS,Facility,Both,,,,807.5,686.375,231.4295,807.5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,807.5,100,,percent of total billed charges,,
SCREW HEADED 2.5MMX18MM,,C1713,HCPCS,Facility,Both,,,,807.5,686.375,231.4295,807.5,BlueCross BlueShield Minnesota,High Value Network Plan,726.75,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
SCREW HEADED 2.5MMX18MM,,C1713,HCPCS,Facility,Outpatient,,,,807.5,686.375,231.4295,807.5,BlueCross BlueShield Minnesota,Medicare Advantage,395.675,49,,percent of total billed charges,,
SCREW HEADED 2.5MMX18MM,,C1713,HCPCS,Facility,Inpatient,,,,807.5,686.375,231.4295,807.5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
SCREW HEADED 2.5MMX18MM,,C1713,HCPCS,Facility,Both,,,,807.5,686.375,231.4295,807.5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,715.20275,88.57,,percent of total billed charges,,
SCREW HEADED 2.5MMX18MM,,C1713,HCPCS,Facility,Both,,,,807.5,686.375,231.4295,807.5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,231.4295,28.66,,percent of total billed charges,,
SCREW HEADED 2.5MMX18MM,,C1713,HCPCS,Facility,Outpatient,,,,807.5,686.375,231.4295,807.5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),395.675,49,,percent of total billed charges,,
SCREW HEADED 2.5MMX18MM,,C1713,HCPCS,Facility,Inpatient,,,,807.5,686.375,231.4295,807.5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
SCREW HEADED 2.5MMX18MM,,C1713,HCPCS,Facility,Both,,,,807.5,686.375,231.4295,807.5,CorVel,Worker's Compensation,807.5,100,,percent of total billed charges,,
SCREW HEADED 2.5MMX18MM,,C1713,HCPCS,Facility,Both,,,,807.5,686.375,231.4295,807.5,First Health Group Corporation,First Health Network,783.275,97,,percent of total billed charges,,
SCREW HEADED 2.5MMX18MM,,C1713,HCPCS,Facility,Both,,,,807.5,686.375,231.4295,807.5,"Health Partners, Inc.",Commercial,763.895,94.6,,percent of total billed charges,,
SCREW HEADED 2.5MMX18MM,,C1713,HCPCS,Facility,Outpatient,,,,807.5,686.375,231.4295,807.5,"Health Partners, Inc.",Medicare Advantage,395.675,49,,percent of total billed charges,,
SCREW HEADED 2.5MMX18MM,,C1713,HCPCS,Facility,Inpatient,,,,807.5,686.375,231.4295,807.5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SCREW HEADED 2.5MMX18MM,,C1713,HCPCS,Facility,Both,,,,807.5,686.375,231.4295,807.5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),484.5,60,,percent of total billed charges,,
SCREW HEADED 2.5MMX18MM,,C1713,HCPCS,Facility,Both,,,,807.5,686.375,231.4295,807.5,"Health Partners, Inc.",State of Minnesota Advantage Program,658.1125,81.5,,percent of total billed charges,,
SCREW HEADED 2.5MMX18MM,,C1713,HCPCS,Facility,Both,,,,807.5,686.375,231.4295,807.5,"Health Partners, Inc.",State Public Programs,403.75,50,,percent of total billed charges,,
SCREW HEADED 2.5MMX18MM,,C1713,HCPCS,Facility,Both,,,,807.5,686.375,231.4295,807.5,Humana Insurance Company,Commercial PPO,767.125,95,,percent of total billed charges,,
SCREW HEADED 2.5MMX18MM,,C1713,HCPCS,Facility,Outpatient,,,,807.5,686.375,231.4295,807.5,Humana Insurance Company,Medicare PPO,395.675,49,,percent of total billed charges,,
SCREW HEADED 2.5MMX18MM,,C1713,HCPCS,Facility,Inpatient,,,,807.5,686.375,231.4295,807.5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
SCREW HEADED 2.5MMX18MM,,C1713,HCPCS,Facility,Both,,,,807.5,686.375,231.4295,807.5,Medica,Individual & Family,800.2325,99.1,,percent of total billed charges,,
SCREW HEADED 2.5MMX18MM,,C1713,HCPCS,Facility,Outpatient,,,,807.5,686.375,231.4295,807.5,Medica,Medica Advantage Solution,402.135,49.8,,percent of total billed charges,,
SCREW HEADED 2.5MMX18MM,,C1713,HCPCS,Facility,Inpatient,,,,807.5,686.375,231.4295,807.5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
SCREW HEADED 2.5MMX18MM,,C1713,HCPCS,Facility,Outpatient,,,,807.5,686.375,231.4295,807.5,Medica,Medical Assistance,360.145,44.6,,percent of total billed charges,,
SCREW HEADED 2.5MMX18MM,,C1713,HCPCS,Facility,Inpatient,,,,807.5,686.375,231.4295,807.5,Medica,Medical Assistance,,,,,Included in per diem rate,
SCREW HEADED 2.5MMX18MM,,C1713,HCPCS,Facility,Outpatient,,,,807.5,686.375,231.4295,807.5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,402.135,49.8,,percent of total billed charges,,
SCREW HEADED 2.5MMX18MM,,C1713,HCPCS,Facility,Inpatient,,,,807.5,686.375,231.4295,807.5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
SCREW HEADED 2.5MMX18MM,,C1713,HCPCS,Facility,Both,,,,807.5,686.375,231.4295,807.5,"Multiplan, Inc.","Multiplan, Inc.",759.05,94,,percent of total billed charges,,
SCREW HEADED 2.5MMX18MM,,C1713,HCPCS,Facility,Outpatient,,,,807.5,686.375,231.4295,807.5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,727.5575,90.1,,percent of total billed charges,,
SCREW HEADED 2.5MMX18MM,,C1713,HCPCS,Facility,Inpatient,,,,807.5,686.375,231.4295,807.5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
SCREW HEADED 2.5MMX18MM,,C1713,HCPCS,Facility,Both,,,,807.5,686.375,231.4295,807.5,"Preferred One Administrative Services, INC.",PPO,796.195,98.6,,percent of total billed charges,,
SCREW HEADED 2.5MMX18MM,,C1713,HCPCS,Facility,Outpatient,,,,807.5,686.375,231.4295,807.5,PrimeWest Health,Minnesota Senior Health Options (MSHO),415.45875,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
SCREW HEADED 2.5MMX18MM,,C1713,HCPCS,Facility,Inpatient,,,,807.5,686.375,231.4295,807.5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SCREW HEADED 2.5MMX18MM,,C1713,HCPCS,Facility,Outpatient,,,,807.5,686.375,231.4295,807.5,PrimeWest Health,MinnesotaCare,414.732,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
SCREW HEADED 2.5MMX18MM,,C1713,HCPCS,Facility,Inpatient,,,,807.5,686.375,231.4295,807.5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
SCREW HEADED 2.5MMX18MM,,C1713,HCPCS,Facility,Both,,,,807.5,686.375,231.4295,807.5,Sanford Health Plan,Sanford Health Plan,742.9,92,,percent of total billed charges,,
SCREW HEADED 2.5MMX18MM,,C1713,HCPCS,Facility,Outpatient,,,,807.5,686.375,231.4295,807.5,"UCare Health, Inc.",Individual & Family Plan,455.02625,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
SCREW HEADED 2.5MMX18MM,,C1713,HCPCS,Facility,Inpatient,,,,807.5,686.375,231.4295,807.5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
SCREW HEADED 2.5MMX18MM,,C1713,HCPCS,Facility,Outpatient,,,,807.5,686.375,231.4295,807.5,"UCare Health, Inc.",Medical Assistance,407.54525,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SCREW HEADED 2.5MMX18MM,,C1713,HCPCS,Facility,Inpatient,,,,807.5,686.375,231.4295,807.5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
SCREW HEADED 2.5MMX18MM,,C1713,HCPCS,Facility,Outpatient,,,,807.5,686.375,231.4295,807.5,"UCare Health, Inc.",Medicare Advantage,407.54525,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SCREW HEADED 2.5MMX18MM,,C1713,HCPCS,Facility,Inpatient,,,,807.5,686.375,231.4295,807.5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SCREW HEADED 2.5MMX18MM,,C1713,HCPCS,Facility,Outpatient,,,,807.5,686.375,231.4295,807.5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),407.54525,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SCREW HEADED 2.5MMX18MM,,C1713,HCPCS,Facility,Inpatient,,,,807.5,686.375,231.4295,807.5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SCREW HEADED 2.5MMX18MM,,C1713,HCPCS,Facility,Both,,,,807.5,686.375,231.4295,807.5,UnitedHealthcare,Individual & Family,759.05,94,,percent of total billed charges,,
SCREW HEADED 2.5MMX18MM,,C1713,HCPCS,Facility,Outpatient,,,,807.5,686.375,231.4295,807.5,UnitedHealthcare,Medicare Advantage,395.675,49,,percent of total billed charges,,
SCREW HEADED 2.5MMX18MM,,C1713,HCPCS,Facility,Inpatient,,,,807.5,686.375,231.4295,807.5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
SCREW HEADED 2.5MMX18MM,,C1713,HCPCS,Facility,Outpatient,,,,807.5,686.375,231.4295,807.5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,387.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
SCREW HEADED 2.5MMX18MM,,C1713,HCPCS,Facility,Inpatient,,,,807.5,686.375,231.4295,807.5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
SCREW HEADED 3.0MMX18MM,,C1713,HCPCS,Facility,Both,,,,877.5,745.875,251.4915,877.5,Aetna,Commercial,807.3,92,,percent of total billed charges,,
SCREW HEADED 3.0MMX18MM,,C1713,HCPCS,Facility,Outpatient,,,,877.5,745.875,251.4915,877.5,Aetna,Medicare Advantage,429.975,49,,percent of total billed charges,,
SCREW HEADED 3.0MMX18MM,,C1713,HCPCS,Facility,Inpatient,,,,877.5,745.875,251.4915,877.5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
SCREW HEADED 3.0MMX18MM,,C1713,HCPCS,Facility,Both,,,,877.5,745.875,251.4915,877.5,Aetna,PPO,816.075,93,,percent of total billed charges,,
SCREW HEADED 3.0MMX18MM,,C1713,HCPCS,Facility,Both,,,,877.5,745.875,251.4915,877.5,America's PPO,America's PPO,842.66325,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SCREW HEADED 3.0MMX18MM,,C1713,HCPCS,Facility,Both,,,,877.5,745.875,251.4915,877.5,BlueCross BlueShield Minnesota, Federal Employee Program,863.46,98.4,,percent of total billed charges,,
SCREW HEADED 3.0MMX18MM,,C1713,HCPCS,Facility,Both,,,,877.5,745.875,251.4915,877.5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,877.5,100,,percent of total billed charges,,
SCREW HEADED 3.0MMX18MM,,C1713,HCPCS,Facility,Both,,,,877.5,745.875,251.4915,877.5,BlueCross BlueShield Minnesota,High Value Network Plan,789.75,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
SCREW HEADED 3.0MMX18MM,,C1713,HCPCS,Facility,Outpatient,,,,877.5,745.875,251.4915,877.5,BlueCross BlueShield Minnesota,Medicare Advantage,429.975,49,,percent of total billed charges,,
SCREW HEADED 3.0MMX18MM,,C1713,HCPCS,Facility,Inpatient,,,,877.5,745.875,251.4915,877.5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
SCREW HEADED 3.0MMX18MM,,C1713,HCPCS,Facility,Both,,,,877.5,745.875,251.4915,877.5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,777.20175,88.57,,percent of total billed charges,,
SCREW HEADED 3.0MMX18MM,,C1713,HCPCS,Facility,Both,,,,877.5,745.875,251.4915,877.5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,251.4915,28.66,,percent of total billed charges,,
SCREW HEADED 3.0MMX18MM,,C1713,HCPCS,Facility,Outpatient,,,,877.5,745.875,251.4915,877.5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),429.975,49,,percent of total billed charges,,
SCREW HEADED 3.0MMX18MM,,C1713,HCPCS,Facility,Inpatient,,,,877.5,745.875,251.4915,877.5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
SCREW HEADED 3.0MMX18MM,,C1713,HCPCS,Facility,Both,,,,877.5,745.875,251.4915,877.5,CorVel,Worker's Compensation,877.5,100,,percent of total billed charges,,
SCREW HEADED 3.0MMX18MM,,C1713,HCPCS,Facility,Both,,,,877.5,745.875,251.4915,877.5,First Health Group Corporation,First Health Network,851.175,97,,percent of total billed charges,,
SCREW HEADED 3.0MMX18MM,,C1713,HCPCS,Facility,Both,,,,877.5,745.875,251.4915,877.5,"Health Partners, Inc.",Commercial,830.115,94.6,,percent of total billed charges,,
SCREW HEADED 3.0MMX18MM,,C1713,HCPCS,Facility,Outpatient,,,,877.5,745.875,251.4915,877.5,"Health Partners, Inc.",Medicare Advantage,429.975,49,,percent of total billed charges,,
SCREW HEADED 3.0MMX18MM,,C1713,HCPCS,Facility,Inpatient,,,,877.5,745.875,251.4915,877.5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SCREW HEADED 3.0MMX18MM,,C1713,HCPCS,Facility,Both,,,,877.5,745.875,251.4915,877.5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),526.5,60,,percent of total billed charges,,
SCREW HEADED 3.0MMX18MM,,C1713,HCPCS,Facility,Both,,,,877.5,745.875,251.4915,877.5,"Health Partners, Inc.",State of Minnesota Advantage Program,715.1625,81.5,,percent of total billed charges,,
SCREW HEADED 3.0MMX18MM,,C1713,HCPCS,Facility,Both,,,,877.5,745.875,251.4915,877.5,"Health Partners, Inc.",State Public Programs,438.75,50,,percent of total billed charges,,
SCREW HEADED 3.0MMX18MM,,C1713,HCPCS,Facility,Both,,,,877.5,745.875,251.4915,877.5,Humana Insurance Company,Commercial PPO,833.625,95,,percent of total billed charges,,
SCREW HEADED 3.0MMX18MM,,C1713,HCPCS,Facility,Outpatient,,,,877.5,745.875,251.4915,877.5,Humana Insurance Company,Medicare PPO,429.975,49,,percent of total billed charges,,
SCREW HEADED 3.0MMX18MM,,C1713,HCPCS,Facility,Inpatient,,,,877.5,745.875,251.4915,877.5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
SCREW HEADED 3.0MMX18MM,,C1713,HCPCS,Facility,Both,,,,877.5,745.875,251.4915,877.5,Medica,Individual & Family,869.6025,99.1,,percent of total billed charges,,
SCREW HEADED 3.0MMX18MM,,C1713,HCPCS,Facility,Outpatient,,,,877.5,745.875,251.4915,877.5,Medica,Medica Advantage Solution,436.995,49.8,,percent of total billed charges,,
SCREW HEADED 3.0MMX18MM,,C1713,HCPCS,Facility,Inpatient,,,,877.5,745.875,251.4915,877.5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
SCREW HEADED 3.0MMX18MM,,C1713,HCPCS,Facility,Outpatient,,,,877.5,745.875,251.4915,877.5,Medica,Medical Assistance,391.365,44.6,,percent of total billed charges,,
SCREW HEADED 3.0MMX18MM,,C1713,HCPCS,Facility,Inpatient,,,,877.5,745.875,251.4915,877.5,Medica,Medical Assistance,,,,,Included in per diem rate,
SCREW HEADED 3.0MMX18MM,,C1713,HCPCS,Facility,Outpatient,,,,877.5,745.875,251.4915,877.5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,436.995,49.8,,percent of total billed charges,,
SCREW HEADED 3.0MMX18MM,,C1713,HCPCS,Facility,Inpatient,,,,877.5,745.875,251.4915,877.5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
SCREW HEADED 3.0MMX18MM,,C1713,HCPCS,Facility,Both,,,,877.5,745.875,251.4915,877.5,"Multiplan, Inc.","Multiplan, Inc.",824.85,94,,percent of total billed charges,,
SCREW HEADED 3.0MMX18MM,,C1713,HCPCS,Facility,Outpatient,,,,877.5,745.875,251.4915,877.5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,790.6275,90.1,,percent of total billed charges,,
SCREW HEADED 3.0MMX18MM,,C1713,HCPCS,Facility,Inpatient,,,,877.5,745.875,251.4915,877.5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
SCREW HEADED 3.0MMX18MM,,C1713,HCPCS,Facility,Both,,,,877.5,745.875,251.4915,877.5,"Preferred One Administrative Services, INC.",PPO,865.215,98.6,,percent of total billed charges,,
SCREW HEADED 3.0MMX18MM,,C1713,HCPCS,Facility,Outpatient,,,,877.5,745.875,251.4915,877.5,PrimeWest Health,Minnesota Senior Health Options (MSHO),451.47375,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
SCREW HEADED 3.0MMX18MM,,C1713,HCPCS,Facility,Inpatient,,,,877.5,745.875,251.4915,877.5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SCREW HEADED 3.0MMX18MM,,C1713,HCPCS,Facility,Outpatient,,,,877.5,745.875,251.4915,877.5,PrimeWest Health,MinnesotaCare,450.684,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
SCREW HEADED 3.0MMX18MM,,C1713,HCPCS,Facility,Inpatient,,,,877.5,745.875,251.4915,877.5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
SCREW HEADED 3.0MMX18MM,,C1713,HCPCS,Facility,Both,,,,877.5,745.875,251.4915,877.5,Sanford Health Plan,Sanford Health Plan,807.3,92,,percent of total billed charges,,
SCREW HEADED 3.0MMX18MM,,C1713,HCPCS,Facility,Outpatient,,,,877.5,745.875,251.4915,877.5,"UCare Health, Inc.",Individual & Family Plan,494.47125,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
SCREW HEADED 3.0MMX18MM,,C1713,HCPCS,Facility,Inpatient,,,,877.5,745.875,251.4915,877.5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
SCREW HEADED 3.0MMX18MM,,C1713,HCPCS,Facility,Outpatient,,,,877.5,745.875,251.4915,877.5,"UCare Health, Inc.",Medical Assistance,442.87425,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SCREW HEADED 3.0MMX18MM,,C1713,HCPCS,Facility,Inpatient,,,,877.5,745.875,251.4915,877.5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
SCREW HEADED 3.0MMX18MM,,C1713,HCPCS,Facility,Outpatient,,,,877.5,745.875,251.4915,877.5,"UCare Health, Inc.",Medicare Advantage,442.87425,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SCREW HEADED 3.0MMX18MM,,C1713,HCPCS,Facility,Inpatient,,,,877.5,745.875,251.4915,877.5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SCREW HEADED 3.0MMX18MM,,C1713,HCPCS,Facility,Outpatient,,,,877.5,745.875,251.4915,877.5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),442.87425,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SCREW HEADED 3.0MMX18MM,,C1713,HCPCS,Facility,Inpatient,,,,877.5,745.875,251.4915,877.5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SCREW HEADED 3.0MMX18MM,,C1713,HCPCS,Facility,Both,,,,877.5,745.875,251.4915,877.5,UnitedHealthcare,Individual & Family,824.85,94,,percent of total billed charges,,
SCREW HEADED 3.0MMX18MM,,C1713,HCPCS,Facility,Outpatient,,,,877.5,745.875,251.4915,877.5,UnitedHealthcare,Medicare Advantage,429.975,49,,percent of total billed charges,,
SCREW HEADED 3.0MMX18MM,,C1713,HCPCS,Facility,Inpatient,,,,877.5,745.875,251.4915,877.5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
SCREW HEADED 3.0MMX18MM,,C1713,HCPCS,Facility,Outpatient,,,,877.5,745.875,251.4915,877.5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,421.2,48,,percent of total billed charges,,100% of DHS outpatient percentage
SCREW HEADED 3.0MMX18MM,,C1713,HCPCS,Facility,Inpatient,,,,877.5,745.875,251.4915,877.5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
SCREW HEADED DARTFIRE 3X16MM,,C1713,HCPCS,Facility,Both,,,,877.5,745.875,251.4915,877.5,Aetna,Commercial,807.3,92,,percent of total billed charges,,
SCREW HEADED DARTFIRE 3X16MM,,C1713,HCPCS,Facility,Outpatient,,,,877.5,745.875,251.4915,877.5,Aetna,Medicare Advantage,429.975,49,,percent of total billed charges,,
SCREW HEADED DARTFIRE 3X16MM,,C1713,HCPCS,Facility,Inpatient,,,,877.5,745.875,251.4915,877.5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
SCREW HEADED DARTFIRE 3X16MM,,C1713,HCPCS,Facility,Both,,,,877.5,745.875,251.4915,877.5,Aetna,PPO,816.075,93,,percent of total billed charges,,
SCREW HEADED DARTFIRE 3X16MM,,C1713,HCPCS,Facility,Both,,,,877.5,745.875,251.4915,877.5,America's PPO,America's PPO,842.66325,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SCREW HEADED DARTFIRE 3X16MM,,C1713,HCPCS,Facility,Both,,,,877.5,745.875,251.4915,877.5,BlueCross BlueShield Minnesota, Federal Employee Program,863.46,98.4,,percent of total billed charges,,
SCREW HEADED DARTFIRE 3X16MM,,C1713,HCPCS,Facility,Both,,,,877.5,745.875,251.4915,877.5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,877.5,100,,percent of total billed charges,,
SCREW HEADED DARTFIRE 3X16MM,,C1713,HCPCS,Facility,Both,,,,877.5,745.875,251.4915,877.5,BlueCross BlueShield Minnesota,High Value Network Plan,789.75,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
SCREW HEADED DARTFIRE 3X16MM,,C1713,HCPCS,Facility,Outpatient,,,,877.5,745.875,251.4915,877.5,BlueCross BlueShield Minnesota,Medicare Advantage,429.975,49,,percent of total billed charges,,
SCREW HEADED DARTFIRE 3X16MM,,C1713,HCPCS,Facility,Inpatient,,,,877.5,745.875,251.4915,877.5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
SCREW HEADED DARTFIRE 3X16MM,,C1713,HCPCS,Facility,Both,,,,877.5,745.875,251.4915,877.5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,777.20175,88.57,,percent of total billed charges,,
SCREW HEADED DARTFIRE 3X16MM,,C1713,HCPCS,Facility,Both,,,,877.5,745.875,251.4915,877.5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,251.4915,28.66,,percent of total billed charges,,
SCREW HEADED DARTFIRE 3X16MM,,C1713,HCPCS,Facility,Outpatient,,,,877.5,745.875,251.4915,877.5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),429.975,49,,percent of total billed charges,,
SCREW HEADED DARTFIRE 3X16MM,,C1713,HCPCS,Facility,Inpatient,,,,877.5,745.875,251.4915,877.5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
SCREW HEADED DARTFIRE 3X16MM,,C1713,HCPCS,Facility,Both,,,,877.5,745.875,251.4915,877.5,CorVel,Worker's Compensation,877.5,100,,percent of total billed charges,,
SCREW HEADED DARTFIRE 3X16MM,,C1713,HCPCS,Facility,Both,,,,877.5,745.875,251.4915,877.5,First Health Group Corporation,First Health Network,851.175,97,,percent of total billed charges,,
SCREW HEADED DARTFIRE 3X16MM,,C1713,HCPCS,Facility,Both,,,,877.5,745.875,251.4915,877.5,"Health Partners, Inc.",Commercial,830.115,94.6,,percent of total billed charges,,
SCREW HEADED DARTFIRE 3X16MM,,C1713,HCPCS,Facility,Outpatient,,,,877.5,745.875,251.4915,877.5,"Health Partners, Inc.",Medicare Advantage,429.975,49,,percent of total billed charges,,
SCREW HEADED DARTFIRE 3X16MM,,C1713,HCPCS,Facility,Inpatient,,,,877.5,745.875,251.4915,877.5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SCREW HEADED DARTFIRE 3X16MM,,C1713,HCPCS,Facility,Both,,,,877.5,745.875,251.4915,877.5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),526.5,60,,percent of total billed charges,,
SCREW HEADED DARTFIRE 3X16MM,,C1713,HCPCS,Facility,Both,,,,877.5,745.875,251.4915,877.5,"Health Partners, Inc.",State of Minnesota Advantage Program,715.1625,81.5,,percent of total billed charges,,
SCREW HEADED DARTFIRE 3X16MM,,C1713,HCPCS,Facility,Both,,,,877.5,745.875,251.4915,877.5,"Health Partners, Inc.",State Public Programs,438.75,50,,percent of total billed charges,,
SCREW HEADED DARTFIRE 3X16MM,,C1713,HCPCS,Facility,Both,,,,877.5,745.875,251.4915,877.5,Humana Insurance Company,Commercial PPO,833.625,95,,percent of total billed charges,,
SCREW HEADED DARTFIRE 3X16MM,,C1713,HCPCS,Facility,Outpatient,,,,877.5,745.875,251.4915,877.5,Humana Insurance Company,Medicare PPO,429.975,49,,percent of total billed charges,,
SCREW HEADED DARTFIRE 3X16MM,,C1713,HCPCS,Facility,Inpatient,,,,877.5,745.875,251.4915,877.5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
SCREW HEADED DARTFIRE 3X16MM,,C1713,HCPCS,Facility,Both,,,,877.5,745.875,251.4915,877.5,Medica,Individual & Family,869.6025,99.1,,percent of total billed charges,,
SCREW HEADED DARTFIRE 3X16MM,,C1713,HCPCS,Facility,Outpatient,,,,877.5,745.875,251.4915,877.5,Medica,Medica Advantage Solution,436.995,49.8,,percent of total billed charges,,
SCREW HEADED DARTFIRE 3X16MM,,C1713,HCPCS,Facility,Inpatient,,,,877.5,745.875,251.4915,877.5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
SCREW HEADED DARTFIRE 3X16MM,,C1713,HCPCS,Facility,Outpatient,,,,877.5,745.875,251.4915,877.5,Medica,Medical Assistance,391.365,44.6,,percent of total billed charges,,
SCREW HEADED DARTFIRE 3X16MM,,C1713,HCPCS,Facility,Inpatient,,,,877.5,745.875,251.4915,877.5,Medica,Medical Assistance,,,,,Included in per diem rate,
SCREW HEADED DARTFIRE 3X16MM,,C1713,HCPCS,Facility,Outpatient,,,,877.5,745.875,251.4915,877.5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,436.995,49.8,,percent of total billed charges,,
SCREW HEADED DARTFIRE 3X16MM,,C1713,HCPCS,Facility,Inpatient,,,,877.5,745.875,251.4915,877.5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
SCREW HEADED DARTFIRE 3X16MM,,C1713,HCPCS,Facility,Both,,,,877.5,745.875,251.4915,877.5,"Multiplan, Inc.","Multiplan, Inc.",824.85,94,,percent of total billed charges,,
SCREW HEADED DARTFIRE 3X16MM,,C1713,HCPCS,Facility,Outpatient,,,,877.5,745.875,251.4915,877.5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,790.6275,90.1,,percent of total billed charges,,
SCREW HEADED DARTFIRE 3X16MM,,C1713,HCPCS,Facility,Inpatient,,,,877.5,745.875,251.4915,877.5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
SCREW HEADED DARTFIRE 3X16MM,,C1713,HCPCS,Facility,Both,,,,877.5,745.875,251.4915,877.5,"Preferred One Administrative Services, INC.",PPO,865.215,98.6,,percent of total billed charges,,
SCREW HEADED DARTFIRE 3X16MM,,C1713,HCPCS,Facility,Outpatient,,,,877.5,745.875,251.4915,877.5,PrimeWest Health,Minnesota Senior Health Options (MSHO),451.47375,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
SCREW HEADED DARTFIRE 3X16MM,,C1713,HCPCS,Facility,Inpatient,,,,877.5,745.875,251.4915,877.5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SCREW HEADED DARTFIRE 3X16MM,,C1713,HCPCS,Facility,Outpatient,,,,877.5,745.875,251.4915,877.5,PrimeWest Health,MinnesotaCare,450.684,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
SCREW HEADED DARTFIRE 3X16MM,,C1713,HCPCS,Facility,Inpatient,,,,877.5,745.875,251.4915,877.5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
SCREW HEADED DARTFIRE 3X16MM,,C1713,HCPCS,Facility,Both,,,,877.5,745.875,251.4915,877.5,Sanford Health Plan,Sanford Health Plan,807.3,92,,percent of total billed charges,,
SCREW HEADED DARTFIRE 3X16MM,,C1713,HCPCS,Facility,Outpatient,,,,877.5,745.875,251.4915,877.5,"UCare Health, Inc.",Individual & Family Plan,494.47125,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
SCREW HEADED DARTFIRE 3X16MM,,C1713,HCPCS,Facility,Inpatient,,,,877.5,745.875,251.4915,877.5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
SCREW HEADED DARTFIRE 3X16MM,,C1713,HCPCS,Facility,Outpatient,,,,877.5,745.875,251.4915,877.5,"UCare Health, Inc.",Medical Assistance,442.87425,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SCREW HEADED DARTFIRE 3X16MM,,C1713,HCPCS,Facility,Inpatient,,,,877.5,745.875,251.4915,877.5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
SCREW HEADED DARTFIRE 3X16MM,,C1713,HCPCS,Facility,Outpatient,,,,877.5,745.875,251.4915,877.5,"UCare Health, Inc.",Medicare Advantage,442.87425,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SCREW HEADED DARTFIRE 3X16MM,,C1713,HCPCS,Facility,Inpatient,,,,877.5,745.875,251.4915,877.5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SCREW HEADED DARTFIRE 3X16MM,,C1713,HCPCS,Facility,Outpatient,,,,877.5,745.875,251.4915,877.5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),442.87425,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SCREW HEADED DARTFIRE 3X16MM,,C1713,HCPCS,Facility,Inpatient,,,,877.5,745.875,251.4915,877.5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SCREW HEADED DARTFIRE 3X16MM,,C1713,HCPCS,Facility,Both,,,,877.5,745.875,251.4915,877.5,UnitedHealthcare,Individual & Family,824.85,94,,percent of total billed charges,,
SCREW HEADED DARTFIRE 3X16MM,,C1713,HCPCS,Facility,Outpatient,,,,877.5,745.875,251.4915,877.5,UnitedHealthcare,Medicare Advantage,429.975,49,,percent of total billed charges,,
SCREW HEADED DARTFIRE 3X16MM,,C1713,HCPCS,Facility,Inpatient,,,,877.5,745.875,251.4915,877.5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
SCREW HEADED DARTFIRE 3X16MM,,C1713,HCPCS,Facility,Outpatient,,,,877.5,745.875,251.4915,877.5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,421.2,48,,percent of total billed charges,,100% of DHS outpatient percentage
SCREW HEADED DARTFIRE 3X16MM,,C1713,HCPCS,Facility,Inpatient,,,,877.5,745.875,251.4915,877.5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
SCREW HEADLESS 3.0MM X 22MM,,C1713,HCPCS,Facility,Both,,,,1115,947.75,319.559,1115,Aetna,Commercial,1025.8,92,,percent of total billed charges,,
SCREW HEADLESS 3.0MM X 22MM,,C1713,HCPCS,Facility,Outpatient,,,,1115,947.75,319.559,1115,Aetna,Medicare Advantage,546.35,49,,percent of total billed charges,,
SCREW HEADLESS 3.0MM X 22MM,,C1713,HCPCS,Facility,Inpatient,,,,1115,947.75,319.559,1115,Aetna,Medicare Advantage,,,,,Included in per diem rate,
SCREW HEADLESS 3.0MM X 22MM,,C1713,HCPCS,Facility,Both,,,,1115,947.75,319.559,1115,Aetna,PPO,1036.95,93,,percent of total billed charges,,
SCREW HEADLESS 3.0MM X 22MM,,C1713,HCPCS,Facility,Both,,,,1115,947.75,319.559,1115,America's PPO,America's PPO,1070.7345,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SCREW HEADLESS 3.0MM X 22MM,,C1713,HCPCS,Facility,Both,,,,1115,947.75,319.559,1115,BlueCross BlueShield Minnesota, Federal Employee Program,1097.16,98.4,,percent of total billed charges,,
SCREW HEADLESS 3.0MM X 22MM,,C1713,HCPCS,Facility,Both,,,,1115,947.75,319.559,1115,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1115,100,,percent of total billed charges,,
SCREW HEADLESS 3.0MM X 22MM,,C1713,HCPCS,Facility,Both,,,,1115,947.75,319.559,1115,BlueCross BlueShield Minnesota,High Value Network Plan,1003.5,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
SCREW HEADLESS 3.0MM X 22MM,,C1713,HCPCS,Facility,Outpatient,,,,1115,947.75,319.559,1115,BlueCross BlueShield Minnesota,Medicare Advantage,546.35,49,,percent of total billed charges,,
SCREW HEADLESS 3.0MM X 22MM,,C1713,HCPCS,Facility,Inpatient,,,,1115,947.75,319.559,1115,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
SCREW HEADLESS 3.0MM X 22MM,,C1713,HCPCS,Facility,Both,,,,1115,947.75,319.559,1115,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,987.5555,88.57,,percent of total billed charges,,
SCREW HEADLESS 3.0MM X 22MM,,C1713,HCPCS,Facility,Both,,,,1115,947.75,319.559,1115,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,319.559,28.66,,percent of total billed charges,,
SCREW HEADLESS 3.0MM X 22MM,,C1713,HCPCS,Facility,Outpatient,,,,1115,947.75,319.559,1115,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),546.35,49,,percent of total billed charges,,
SCREW HEADLESS 3.0MM X 22MM,,C1713,HCPCS,Facility,Inpatient,,,,1115,947.75,319.559,1115,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
SCREW HEADLESS 3.0MM X 22MM,,C1713,HCPCS,Facility,Both,,,,1115,947.75,319.559,1115,CorVel,Worker's Compensation,1115,100,,percent of total billed charges,,
SCREW HEADLESS 3.0MM X 22MM,,C1713,HCPCS,Facility,Both,,,,1115,947.75,319.559,1115,First Health Group Corporation,First Health Network,1081.55,97,,percent of total billed charges,,
SCREW HEADLESS 3.0MM X 22MM,,C1713,HCPCS,Facility,Both,,,,1115,947.75,319.559,1115,"Health Partners, Inc.",Commercial,1054.79,94.6,,percent of total billed charges,,
SCREW HEADLESS 3.0MM X 22MM,,C1713,HCPCS,Facility,Outpatient,,,,1115,947.75,319.559,1115,"Health Partners, Inc.",Medicare Advantage,546.35,49,,percent of total billed charges,,
SCREW HEADLESS 3.0MM X 22MM,,C1713,HCPCS,Facility,Inpatient,,,,1115,947.75,319.559,1115,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SCREW HEADLESS 3.0MM X 22MM,,C1713,HCPCS,Facility,Both,,,,1115,947.75,319.559,1115,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),669,60,,percent of total billed charges,,
SCREW HEADLESS 3.0MM X 22MM,,C1713,HCPCS,Facility,Both,,,,1115,947.75,319.559,1115,"Health Partners, Inc.",State of Minnesota Advantage Program,908.725,81.5,,percent of total billed charges,,
SCREW HEADLESS 3.0MM X 22MM,,C1713,HCPCS,Facility,Both,,,,1115,947.75,319.559,1115,"Health Partners, Inc.",State Public Programs,557.5,50,,percent of total billed charges,,
SCREW HEADLESS 3.0MM X 22MM,,C1713,HCPCS,Facility,Both,,,,1115,947.75,319.559,1115,Humana Insurance Company,Commercial PPO,1059.25,95,,percent of total billed charges,,
SCREW HEADLESS 3.0MM X 22MM,,C1713,HCPCS,Facility,Outpatient,,,,1115,947.75,319.559,1115,Humana Insurance Company,Medicare PPO,546.35,49,,percent of total billed charges,,
SCREW HEADLESS 3.0MM X 22MM,,C1713,HCPCS,Facility,Inpatient,,,,1115,947.75,319.559,1115,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
SCREW HEADLESS 3.0MM X 22MM,,C1713,HCPCS,Facility,Both,,,,1115,947.75,319.559,1115,Medica,Individual & Family,1104.965,99.1,,percent of total billed charges,,
SCREW HEADLESS 3.0MM X 22MM,,C1713,HCPCS,Facility,Outpatient,,,,1115,947.75,319.559,1115,Medica,Medica Advantage Solution,555.27,49.8,,percent of total billed charges,,
SCREW HEADLESS 3.0MM X 22MM,,C1713,HCPCS,Facility,Inpatient,,,,1115,947.75,319.559,1115,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
SCREW HEADLESS 3.0MM X 22MM,,C1713,HCPCS,Facility,Outpatient,,,,1115,947.75,319.559,1115,Medica,Medical Assistance,497.29,44.6,,percent of total billed charges,,
SCREW HEADLESS 3.0MM X 22MM,,C1713,HCPCS,Facility,Inpatient,,,,1115,947.75,319.559,1115,Medica,Medical Assistance,,,,,Included in per diem rate,
SCREW HEADLESS 3.0MM X 22MM,,C1713,HCPCS,Facility,Outpatient,,,,1115,947.75,319.559,1115,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,555.27,49.8,,percent of total billed charges,,
SCREW HEADLESS 3.0MM X 22MM,,C1713,HCPCS,Facility,Inpatient,,,,1115,947.75,319.559,1115,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
SCREW HEADLESS 3.0MM X 22MM,,C1713,HCPCS,Facility,Both,,,,1115,947.75,319.559,1115,"Multiplan, Inc.","Multiplan, Inc.",1048.1,94,,percent of total billed charges,,
SCREW HEADLESS 3.0MM X 22MM,,C1713,HCPCS,Facility,Outpatient,,,,1115,947.75,319.559,1115,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1004.615,90.1,,percent of total billed charges,,
SCREW HEADLESS 3.0MM X 22MM,,C1713,HCPCS,Facility,Inpatient,,,,1115,947.75,319.559,1115,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
SCREW HEADLESS 3.0MM X 22MM,,C1713,HCPCS,Facility,Both,,,,1115,947.75,319.559,1115,"Preferred One Administrative Services, INC.",PPO,1099.39,98.6,,percent of total billed charges,,
SCREW HEADLESS 3.0MM X 22MM,,C1713,HCPCS,Facility,Outpatient,,,,1115,947.75,319.559,1115,PrimeWest Health,Minnesota Senior Health Options (MSHO),573.6675,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
SCREW HEADLESS 3.0MM X 22MM,,C1713,HCPCS,Facility,Inpatient,,,,1115,947.75,319.559,1115,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SCREW HEADLESS 3.0MM X 22MM,,C1713,HCPCS,Facility,Outpatient,,,,1115,947.75,319.559,1115,PrimeWest Health,MinnesotaCare,572.664,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
SCREW HEADLESS 3.0MM X 22MM,,C1713,HCPCS,Facility,Inpatient,,,,1115,947.75,319.559,1115,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
SCREW HEADLESS 3.0MM X 22MM,,C1713,HCPCS,Facility,Both,,,,1115,947.75,319.559,1115,Sanford Health Plan,Sanford Health Plan,1025.8,92,,percent of total billed charges,,
SCREW HEADLESS 3.0MM X 22MM,,C1713,HCPCS,Facility,Outpatient,,,,1115,947.75,319.559,1115,"UCare Health, Inc.",Individual & Family Plan,628.3025,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
SCREW HEADLESS 3.0MM X 22MM,,C1713,HCPCS,Facility,Inpatient,,,,1115,947.75,319.559,1115,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
SCREW HEADLESS 3.0MM X 22MM,,C1713,HCPCS,Facility,Outpatient,,,,1115,947.75,319.559,1115,"UCare Health, Inc.",Medical Assistance,562.7405,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SCREW HEADLESS 3.0MM X 22MM,,C1713,HCPCS,Facility,Inpatient,,,,1115,947.75,319.559,1115,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
SCREW HEADLESS 3.0MM X 22MM,,C1713,HCPCS,Facility,Outpatient,,,,1115,947.75,319.559,1115,"UCare Health, Inc.",Medicare Advantage,562.7405,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SCREW HEADLESS 3.0MM X 22MM,,C1713,HCPCS,Facility,Inpatient,,,,1115,947.75,319.559,1115,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SCREW HEADLESS 3.0MM X 22MM,,C1713,HCPCS,Facility,Outpatient,,,,1115,947.75,319.559,1115,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),562.7405,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SCREW HEADLESS 3.0MM X 22MM,,C1713,HCPCS,Facility,Inpatient,,,,1115,947.75,319.559,1115,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SCREW HEADLESS 3.0MM X 22MM,,C1713,HCPCS,Facility,Both,,,,1115,947.75,319.559,1115,UnitedHealthcare,Individual & Family,1048.1,94,,percent of total billed charges,,
SCREW HEADLESS 3.0MM X 22MM,,C1713,HCPCS,Facility,Outpatient,,,,1115,947.75,319.559,1115,UnitedHealthcare,Medicare Advantage,546.35,49,,percent of total billed charges,,
SCREW HEADLESS 3.0MM X 22MM,,C1713,HCPCS,Facility,Inpatient,,,,1115,947.75,319.559,1115,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
SCREW HEADLESS 3.0MM X 22MM,,C1713,HCPCS,Facility,Outpatient,,,,1115,947.75,319.559,1115,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,535.2,48,,percent of total billed charges,,100% of DHS outpatient percentage
SCREW HEADLESS 3.0MM X 22MM,,C1713,HCPCS,Facility,Inpatient,,,,1115,947.75,319.559,1115,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
SCREW HEADLESS 3.0X20MM,,C1713,HCPCS,Facility,Both,,,,1115,947.75,319.559,1115,Aetna,Commercial,1025.8,92,,percent of total billed charges,,
SCREW HEADLESS 3.0X20MM,,C1713,HCPCS,Facility,Outpatient,,,,1115,947.75,319.559,1115,Aetna,Medicare Advantage,546.35,49,,percent of total billed charges,,
SCREW HEADLESS 3.0X20MM,,C1713,HCPCS,Facility,Inpatient,,,,1115,947.75,319.559,1115,Aetna,Medicare Advantage,,,,,Included in per diem rate,
SCREW HEADLESS 3.0X20MM,,C1713,HCPCS,Facility,Both,,,,1115,947.75,319.559,1115,Aetna,PPO,1036.95,93,,percent of total billed charges,,
SCREW HEADLESS 3.0X20MM,,C1713,HCPCS,Facility,Both,,,,1115,947.75,319.559,1115,America's PPO,America's PPO,1070.7345,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SCREW HEADLESS 3.0X20MM,,C1713,HCPCS,Facility,Both,,,,1115,947.75,319.559,1115,BlueCross BlueShield Minnesota, Federal Employee Program,1097.16,98.4,,percent of total billed charges,,
SCREW HEADLESS 3.0X20MM,,C1713,HCPCS,Facility,Both,,,,1115,947.75,319.559,1115,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1115,100,,percent of total billed charges,,
SCREW HEADLESS 3.0X20MM,,C1713,HCPCS,Facility,Both,,,,1115,947.75,319.559,1115,BlueCross BlueShield Minnesota,High Value Network Plan,1003.5,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
SCREW HEADLESS 3.0X20MM,,C1713,HCPCS,Facility,Outpatient,,,,1115,947.75,319.559,1115,BlueCross BlueShield Minnesota,Medicare Advantage,546.35,49,,percent of total billed charges,,
SCREW HEADLESS 3.0X20MM,,C1713,HCPCS,Facility,Inpatient,,,,1115,947.75,319.559,1115,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
SCREW HEADLESS 3.0X20MM,,C1713,HCPCS,Facility,Both,,,,1115,947.75,319.559,1115,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,987.5555,88.57,,percent of total billed charges,,
SCREW HEADLESS 3.0X20MM,,C1713,HCPCS,Facility,Both,,,,1115,947.75,319.559,1115,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,319.559,28.66,,percent of total billed charges,,
SCREW HEADLESS 3.0X20MM,,C1713,HCPCS,Facility,Outpatient,,,,1115,947.75,319.559,1115,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),546.35,49,,percent of total billed charges,,
SCREW HEADLESS 3.0X20MM,,C1713,HCPCS,Facility,Inpatient,,,,1115,947.75,319.559,1115,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
SCREW HEADLESS 3.0X20MM,,C1713,HCPCS,Facility,Both,,,,1115,947.75,319.559,1115,CorVel,Worker's Compensation,1115,100,,percent of total billed charges,,
SCREW HEADLESS 3.0X20MM,,C1713,HCPCS,Facility,Both,,,,1115,947.75,319.559,1115,First Health Group Corporation,First Health Network,1081.55,97,,percent of total billed charges,,
SCREW HEADLESS 3.0X20MM,,C1713,HCPCS,Facility,Both,,,,1115,947.75,319.559,1115,"Health Partners, Inc.",Commercial,1054.79,94.6,,percent of total billed charges,,
SCREW HEADLESS 3.0X20MM,,C1713,HCPCS,Facility,Outpatient,,,,1115,947.75,319.559,1115,"Health Partners, Inc.",Medicare Advantage,546.35,49,,percent of total billed charges,,
SCREW HEADLESS 3.0X20MM,,C1713,HCPCS,Facility,Inpatient,,,,1115,947.75,319.559,1115,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SCREW HEADLESS 3.0X20MM,,C1713,HCPCS,Facility,Both,,,,1115,947.75,319.559,1115,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),669,60,,percent of total billed charges,,
SCREW HEADLESS 3.0X20MM,,C1713,HCPCS,Facility,Both,,,,1115,947.75,319.559,1115,"Health Partners, Inc.",State of Minnesota Advantage Program,908.725,81.5,,percent of total billed charges,,
SCREW HEADLESS 3.0X20MM,,C1713,HCPCS,Facility,Both,,,,1115,947.75,319.559,1115,"Health Partners, Inc.",State Public Programs,557.5,50,,percent of total billed charges,,
SCREW HEADLESS 3.0X20MM,,C1713,HCPCS,Facility,Both,,,,1115,947.75,319.559,1115,Humana Insurance Company,Commercial PPO,1059.25,95,,percent of total billed charges,,
SCREW HEADLESS 3.0X20MM,,C1713,HCPCS,Facility,Outpatient,,,,1115,947.75,319.559,1115,Humana Insurance Company,Medicare PPO,546.35,49,,percent of total billed charges,,
SCREW HEADLESS 3.0X20MM,,C1713,HCPCS,Facility,Inpatient,,,,1115,947.75,319.559,1115,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
SCREW HEADLESS 3.0X20MM,,C1713,HCPCS,Facility,Both,,,,1115,947.75,319.559,1115,Medica,Individual & Family,1104.965,99.1,,percent of total billed charges,,
SCREW HEADLESS 3.0X20MM,,C1713,HCPCS,Facility,Outpatient,,,,1115,947.75,319.559,1115,Medica,Medica Advantage Solution,555.27,49.8,,percent of total billed charges,,
SCREW HEADLESS 3.0X20MM,,C1713,HCPCS,Facility,Inpatient,,,,1115,947.75,319.559,1115,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
SCREW HEADLESS 3.0X20MM,,C1713,HCPCS,Facility,Outpatient,,,,1115,947.75,319.559,1115,Medica,Medical Assistance,497.29,44.6,,percent of total billed charges,,
SCREW HEADLESS 3.0X20MM,,C1713,HCPCS,Facility,Inpatient,,,,1115,947.75,319.559,1115,Medica,Medical Assistance,,,,,Included in per diem rate,
SCREW HEADLESS 3.0X20MM,,C1713,HCPCS,Facility,Outpatient,,,,1115,947.75,319.559,1115,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,555.27,49.8,,percent of total billed charges,,
SCREW HEADLESS 3.0X20MM,,C1713,HCPCS,Facility,Inpatient,,,,1115,947.75,319.559,1115,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
SCREW HEADLESS 3.0X20MM,,C1713,HCPCS,Facility,Both,,,,1115,947.75,319.559,1115,"Multiplan, Inc.","Multiplan, Inc.",1048.1,94,,percent of total billed charges,,
SCREW HEADLESS 3.0X20MM,,C1713,HCPCS,Facility,Outpatient,,,,1115,947.75,319.559,1115,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1004.615,90.1,,percent of total billed charges,,
SCREW HEADLESS 3.0X20MM,,C1713,HCPCS,Facility,Inpatient,,,,1115,947.75,319.559,1115,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
SCREW HEADLESS 3.0X20MM,,C1713,HCPCS,Facility,Both,,,,1115,947.75,319.559,1115,"Preferred One Administrative Services, INC.",PPO,1099.39,98.6,,percent of total billed charges,,
SCREW HEADLESS 3.0X20MM,,C1713,HCPCS,Facility,Outpatient,,,,1115,947.75,319.559,1115,PrimeWest Health,Minnesota Senior Health Options (MSHO),573.6675,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
SCREW HEADLESS 3.0X20MM,,C1713,HCPCS,Facility,Inpatient,,,,1115,947.75,319.559,1115,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SCREW HEADLESS 3.0X20MM,,C1713,HCPCS,Facility,Outpatient,,,,1115,947.75,319.559,1115,PrimeWest Health,MinnesotaCare,572.664,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
SCREW HEADLESS 3.0X20MM,,C1713,HCPCS,Facility,Inpatient,,,,1115,947.75,319.559,1115,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
SCREW HEADLESS 3.0X20MM,,C1713,HCPCS,Facility,Both,,,,1115,947.75,319.559,1115,Sanford Health Plan,Sanford Health Plan,1025.8,92,,percent of total billed charges,,
SCREW HEADLESS 3.0X20MM,,C1713,HCPCS,Facility,Outpatient,,,,1115,947.75,319.559,1115,"UCare Health, Inc.",Individual & Family Plan,628.3025,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
SCREW HEADLESS 3.0X20MM,,C1713,HCPCS,Facility,Inpatient,,,,1115,947.75,319.559,1115,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
SCREW HEADLESS 3.0X20MM,,C1713,HCPCS,Facility,Outpatient,,,,1115,947.75,319.559,1115,"UCare Health, Inc.",Medical Assistance,562.7405,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SCREW HEADLESS 3.0X20MM,,C1713,HCPCS,Facility,Inpatient,,,,1115,947.75,319.559,1115,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
SCREW HEADLESS 3.0X20MM,,C1713,HCPCS,Facility,Outpatient,,,,1115,947.75,319.559,1115,"UCare Health, Inc.",Medicare Advantage,562.7405,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SCREW HEADLESS 3.0X20MM,,C1713,HCPCS,Facility,Inpatient,,,,1115,947.75,319.559,1115,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SCREW HEADLESS 3.0X20MM,,C1713,HCPCS,Facility,Outpatient,,,,1115,947.75,319.559,1115,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),562.7405,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SCREW HEADLESS 3.0X20MM,,C1713,HCPCS,Facility,Inpatient,,,,1115,947.75,319.559,1115,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SCREW HEADLESS 3.0X20MM,,C1713,HCPCS,Facility,Both,,,,1115,947.75,319.559,1115,UnitedHealthcare,Individual & Family,1048.1,94,,percent of total billed charges,,
SCREW HEADLESS 3.0X20MM,,C1713,HCPCS,Facility,Outpatient,,,,1115,947.75,319.559,1115,UnitedHealthcare,Medicare Advantage,546.35,49,,percent of total billed charges,,
SCREW HEADLESS 3.0X20MM,,C1713,HCPCS,Facility,Inpatient,,,,1115,947.75,319.559,1115,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
SCREW HEADLESS 3.0X20MM,,C1713,HCPCS,Facility,Outpatient,,,,1115,947.75,319.559,1115,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,535.2,48,,percent of total billed charges,,100% of DHS outpatient percentage
SCREW HEADLESS 3.0X20MM,,C1713,HCPCS,Facility,Inpatient,,,,1115,947.75,319.559,1115,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
SCREW HEADLESS 3.0X28MM DART FIRE   WRIGHT MED D2N30028,,C1713,HCPCS,Facility,Both,,,,1082.5,920.125,310.2445,1082.5,Aetna,Commercial,995.9,92,,percent of total billed charges,,
SCREW HEADLESS 3.0X28MM DART FIRE   WRIGHT MED D2N30028,,C1713,HCPCS,Facility,Outpatient,,,,1082.5,920.125,310.2445,1082.5,Aetna,Medicare Advantage,530.425,49,,percent of total billed charges,,
SCREW HEADLESS 3.0X28MM DART FIRE   WRIGHT MED D2N30028,,C1713,HCPCS,Facility,Inpatient,,,,1082.5,920.125,310.2445,1082.5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
SCREW HEADLESS 3.0X28MM DART FIRE   WRIGHT MED D2N30028,,C1713,HCPCS,Facility,Both,,,,1082.5,920.125,310.2445,1082.5,Aetna,PPO,1006.725,93,,percent of total billed charges,,
SCREW HEADLESS 3.0X28MM DART FIRE   WRIGHT MED D2N30028,,C1713,HCPCS,Facility,Both,,,,1082.5,920.125,310.2445,1082.5,America's PPO,America's PPO,1039.52475,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SCREW HEADLESS 3.0X28MM DART FIRE   WRIGHT MED D2N30028,,C1713,HCPCS,Facility,Both,,,,1082.5,920.125,310.2445,1082.5,BlueCross BlueShield Minnesota, Federal Employee Program,1065.18,98.4,,percent of total billed charges,,
SCREW HEADLESS 3.0X28MM DART FIRE   WRIGHT MED D2N30028,,C1713,HCPCS,Facility,Both,,,,1082.5,920.125,310.2445,1082.5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1082.5,100,,percent of total billed charges,,
SCREW HEADLESS 3.0X28MM DART FIRE   WRIGHT MED D2N30028,,C1713,HCPCS,Facility,Both,,,,1082.5,920.125,310.2445,1082.5,BlueCross BlueShield Minnesota,High Value Network Plan,974.25,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
SCREW HEADLESS 3.0X28MM DART FIRE   WRIGHT MED D2N30028,,C1713,HCPCS,Facility,Outpatient,,,,1082.5,920.125,310.2445,1082.5,BlueCross BlueShield Minnesota,Medicare Advantage,530.425,49,,percent of total billed charges,,
SCREW HEADLESS 3.0X28MM DART FIRE   WRIGHT MED D2N30028,,C1713,HCPCS,Facility,Inpatient,,,,1082.5,920.125,310.2445,1082.5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
SCREW HEADLESS 3.0X28MM DART FIRE   WRIGHT MED D2N30028,,C1713,HCPCS,Facility,Both,,,,1082.5,920.125,310.2445,1082.5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,958.77025,88.57,,percent of total billed charges,,
SCREW HEADLESS 3.0X28MM DART FIRE   WRIGHT MED D2N30028,,C1713,HCPCS,Facility,Both,,,,1082.5,920.125,310.2445,1082.5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,310.2445,28.66,,percent of total billed charges,,
SCREW HEADLESS 3.0X28MM DART FIRE   WRIGHT MED D2N30028,,C1713,HCPCS,Facility,Outpatient,,,,1082.5,920.125,310.2445,1082.5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),530.425,49,,percent of total billed charges,,
SCREW HEADLESS 3.0X28MM DART FIRE   WRIGHT MED D2N30028,,C1713,HCPCS,Facility,Inpatient,,,,1082.5,920.125,310.2445,1082.5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
SCREW HEADLESS 3.0X28MM DART FIRE   WRIGHT MED D2N30028,,C1713,HCPCS,Facility,Both,,,,1082.5,920.125,310.2445,1082.5,CorVel,Worker's Compensation,1082.5,100,,percent of total billed charges,,
SCREW HEADLESS 3.0X28MM DART FIRE   WRIGHT MED D2N30028,,C1713,HCPCS,Facility,Both,,,,1082.5,920.125,310.2445,1082.5,First Health Group Corporation,First Health Network,1050.025,97,,percent of total billed charges,,
SCREW HEADLESS 3.0X28MM DART FIRE   WRIGHT MED D2N30028,,C1713,HCPCS,Facility,Both,,,,1082.5,920.125,310.2445,1082.5,"Health Partners, Inc.",Commercial,1024.045,94.6,,percent of total billed charges,,
SCREW HEADLESS 3.0X28MM DART FIRE   WRIGHT MED D2N30028,,C1713,HCPCS,Facility,Outpatient,,,,1082.5,920.125,310.2445,1082.5,"Health Partners, Inc.",Medicare Advantage,530.425,49,,percent of total billed charges,,
SCREW HEADLESS 3.0X28MM DART FIRE   WRIGHT MED D2N30028,,C1713,HCPCS,Facility,Inpatient,,,,1082.5,920.125,310.2445,1082.5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SCREW HEADLESS 3.0X28MM DART FIRE   WRIGHT MED D2N30028,,C1713,HCPCS,Facility,Both,,,,1082.5,920.125,310.2445,1082.5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),649.5,60,,percent of total billed charges,,
SCREW HEADLESS 3.0X28MM DART FIRE   WRIGHT MED D2N30028,,C1713,HCPCS,Facility,Both,,,,1082.5,920.125,310.2445,1082.5,"Health Partners, Inc.",State of Minnesota Advantage Program,882.2375,81.5,,percent of total billed charges,,
SCREW HEADLESS 3.0X28MM DART FIRE   WRIGHT MED D2N30028,,C1713,HCPCS,Facility,Both,,,,1082.5,920.125,310.2445,1082.5,"Health Partners, Inc.",State Public Programs,541.25,50,,percent of total billed charges,,
SCREW HEADLESS 3.0X28MM DART FIRE   WRIGHT MED D2N30028,,C1713,HCPCS,Facility,Both,,,,1082.5,920.125,310.2445,1082.5,Humana Insurance Company,Commercial PPO,1028.375,95,,percent of total billed charges,,
SCREW HEADLESS 3.0X28MM DART FIRE   WRIGHT MED D2N30028,,C1713,HCPCS,Facility,Outpatient,,,,1082.5,920.125,310.2445,1082.5,Humana Insurance Company,Medicare PPO,530.425,49,,percent of total billed charges,,
SCREW HEADLESS 3.0X28MM DART FIRE   WRIGHT MED D2N30028,,C1713,HCPCS,Facility,Inpatient,,,,1082.5,920.125,310.2445,1082.5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
SCREW HEADLESS 3.0X28MM DART FIRE   WRIGHT MED D2N30028,,C1713,HCPCS,Facility,Both,,,,1082.5,920.125,310.2445,1082.5,Medica,Individual & Family,1072.7575,99.1,,percent of total billed charges,,
SCREW HEADLESS 3.0X28MM DART FIRE   WRIGHT MED D2N30028,,C1713,HCPCS,Facility,Outpatient,,,,1082.5,920.125,310.2445,1082.5,Medica,Medica Advantage Solution,539.085,49.8,,percent of total billed charges,,
SCREW HEADLESS 3.0X28MM DART FIRE   WRIGHT MED D2N30028,,C1713,HCPCS,Facility,Inpatient,,,,1082.5,920.125,310.2445,1082.5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
SCREW HEADLESS 3.0X28MM DART FIRE   WRIGHT MED D2N30028,,C1713,HCPCS,Facility,Outpatient,,,,1082.5,920.125,310.2445,1082.5,Medica,Medical Assistance,482.795,44.6,,percent of total billed charges,,
SCREW HEADLESS 3.0X28MM DART FIRE   WRIGHT MED D2N30028,,C1713,HCPCS,Facility,Inpatient,,,,1082.5,920.125,310.2445,1082.5,Medica,Medical Assistance,,,,,Included in per diem rate,
SCREW HEADLESS 3.0X28MM DART FIRE   WRIGHT MED D2N30028,,C1713,HCPCS,Facility,Outpatient,,,,1082.5,920.125,310.2445,1082.5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,539.085,49.8,,percent of total billed charges,,
SCREW HEADLESS 3.0X28MM DART FIRE   WRIGHT MED D2N30028,,C1713,HCPCS,Facility,Inpatient,,,,1082.5,920.125,310.2445,1082.5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
SCREW HEADLESS 3.0X28MM DART FIRE   WRIGHT MED D2N30028,,C1713,HCPCS,Facility,Both,,,,1082.5,920.125,310.2445,1082.5,"Multiplan, Inc.","Multiplan, Inc.",1017.55,94,,percent of total billed charges,,
SCREW HEADLESS 3.0X28MM DART FIRE   WRIGHT MED D2N30028,,C1713,HCPCS,Facility,Outpatient,,,,1082.5,920.125,310.2445,1082.5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,975.3325,90.1,,percent of total billed charges,,
SCREW HEADLESS 3.0X28MM DART FIRE   WRIGHT MED D2N30028,,C1713,HCPCS,Facility,Inpatient,,,,1082.5,920.125,310.2445,1082.5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
SCREW HEADLESS 3.0X28MM DART FIRE   WRIGHT MED D2N30028,,C1713,HCPCS,Facility,Both,,,,1082.5,920.125,310.2445,1082.5,"Preferred One Administrative Services, INC.",PPO,1067.345,98.6,,percent of total billed charges,,
SCREW HEADLESS 3.0X28MM DART FIRE   WRIGHT MED D2N30028,,C1713,HCPCS,Facility,Outpatient,,,,1082.5,920.125,310.2445,1082.5,PrimeWest Health,Minnesota Senior Health Options (MSHO),556.94625,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
SCREW HEADLESS 3.0X28MM DART FIRE   WRIGHT MED D2N30028,,C1713,HCPCS,Facility,Inpatient,,,,1082.5,920.125,310.2445,1082.5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SCREW HEADLESS 3.0X28MM DART FIRE   WRIGHT MED D2N30028,,C1713,HCPCS,Facility,Outpatient,,,,1082.5,920.125,310.2445,1082.5,PrimeWest Health,MinnesotaCare,555.972,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
SCREW HEADLESS 3.0X28MM DART FIRE   WRIGHT MED D2N30028,,C1713,HCPCS,Facility,Inpatient,,,,1082.5,920.125,310.2445,1082.5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
SCREW HEADLESS 3.0X28MM DART FIRE   WRIGHT MED D2N30028,,C1713,HCPCS,Facility,Both,,,,1082.5,920.125,310.2445,1082.5,Sanford Health Plan,Sanford Health Plan,995.9,92,,percent of total billed charges,,
SCREW HEADLESS 3.0X28MM DART FIRE   WRIGHT MED D2N30028,,C1713,HCPCS,Facility,Outpatient,,,,1082.5,920.125,310.2445,1082.5,"UCare Health, Inc.",Individual & Family Plan,609.98875,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
SCREW HEADLESS 3.0X28MM DART FIRE   WRIGHT MED D2N30028,,C1713,HCPCS,Facility,Inpatient,,,,1082.5,920.125,310.2445,1082.5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
SCREW HEADLESS 3.0X28MM DART FIRE   WRIGHT MED D2N30028,,C1713,HCPCS,Facility,Outpatient,,,,1082.5,920.125,310.2445,1082.5,"UCare Health, Inc.",Medical Assistance,546.33775,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SCREW HEADLESS 3.0X28MM DART FIRE   WRIGHT MED D2N30028,,C1713,HCPCS,Facility,Inpatient,,,,1082.5,920.125,310.2445,1082.5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
SCREW HEADLESS 3.0X28MM DART FIRE   WRIGHT MED D2N30028,,C1713,HCPCS,Facility,Outpatient,,,,1082.5,920.125,310.2445,1082.5,"UCare Health, Inc.",Medicare Advantage,546.33775,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SCREW HEADLESS 3.0X28MM DART FIRE   WRIGHT MED D2N30028,,C1713,HCPCS,Facility,Inpatient,,,,1082.5,920.125,310.2445,1082.5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SCREW HEADLESS 3.0X28MM DART FIRE   WRIGHT MED D2N30028,,C1713,HCPCS,Facility,Outpatient,,,,1082.5,920.125,310.2445,1082.5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),546.33775,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SCREW HEADLESS 3.0X28MM DART FIRE   WRIGHT MED D2N30028,,C1713,HCPCS,Facility,Inpatient,,,,1082.5,920.125,310.2445,1082.5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SCREW HEADLESS 3.0X28MM DART FIRE   WRIGHT MED D2N30028,,C1713,HCPCS,Facility,Both,,,,1082.5,920.125,310.2445,1082.5,UnitedHealthcare,Individual & Family,1017.55,94,,percent of total billed charges,,
SCREW HEADLESS 3.0X28MM DART FIRE   WRIGHT MED D2N30028,,C1713,HCPCS,Facility,Outpatient,,,,1082.5,920.125,310.2445,1082.5,UnitedHealthcare,Medicare Advantage,530.425,49,,percent of total billed charges,,
SCREW HEADLESS 3.0X28MM DART FIRE   WRIGHT MED D2N30028,,C1713,HCPCS,Facility,Inpatient,,,,1082.5,920.125,310.2445,1082.5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
SCREW HEADLESS 3.0X28MM DART FIRE   WRIGHT MED D2N30028,,C1713,HCPCS,Facility,Outpatient,,,,1082.5,920.125,310.2445,1082.5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,519.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
SCREW HEADLESS 3.0X28MM DART FIRE   WRIGHT MED D2N30028,,C1713,HCPCS,Facility,Inpatient,,,,1082.5,920.125,310.2445,1082.5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
SCREW LOCKING 3.5X24 ORTHOLOC  WRIGHT MED 58803524,,C1713,HCPCS,Facility,Both,,,,1097.5,932.875,314.5435,1097.5,Aetna,Commercial,1009.7,92,,percent of total billed charges,,
SCREW LOCKING 3.5X24 ORTHOLOC  WRIGHT MED 58803524,,C1713,HCPCS,Facility,Outpatient,,,,1097.5,932.875,314.5435,1097.5,Aetna,Medicare Advantage,537.775,49,,percent of total billed charges,,
SCREW LOCKING 3.5X24 ORTHOLOC  WRIGHT MED 58803524,,C1713,HCPCS,Facility,Inpatient,,,,1097.5,932.875,314.5435,1097.5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
SCREW LOCKING 3.5X24 ORTHOLOC  WRIGHT MED 58803524,,C1713,HCPCS,Facility,Both,,,,1097.5,932.875,314.5435,1097.5,Aetna,PPO,1020.675,93,,percent of total billed charges,,
SCREW LOCKING 3.5X24 ORTHOLOC  WRIGHT MED 58803524,,C1713,HCPCS,Facility,Both,,,,1097.5,932.875,314.5435,1097.5,America's PPO,America's PPO,1053.92925,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SCREW LOCKING 3.5X24 ORTHOLOC  WRIGHT MED 58803524,,C1713,HCPCS,Facility,Both,,,,1097.5,932.875,314.5435,1097.5,BlueCross BlueShield Minnesota, Federal Employee Program,1079.94,98.4,,percent of total billed charges,,
SCREW LOCKING 3.5X24 ORTHOLOC  WRIGHT MED 58803524,,C1713,HCPCS,Facility,Both,,,,1097.5,932.875,314.5435,1097.5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1097.5,100,,percent of total billed charges,,
SCREW LOCKING 3.5X24 ORTHOLOC  WRIGHT MED 58803524,,C1713,HCPCS,Facility,Both,,,,1097.5,932.875,314.5435,1097.5,BlueCross BlueShield Minnesota,High Value Network Plan,987.75,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
SCREW LOCKING 3.5X24 ORTHOLOC  WRIGHT MED 58803524,,C1713,HCPCS,Facility,Outpatient,,,,1097.5,932.875,314.5435,1097.5,BlueCross BlueShield Minnesota,Medicare Advantage,537.775,49,,percent of total billed charges,,
SCREW LOCKING 3.5X24 ORTHOLOC  WRIGHT MED 58803524,,C1713,HCPCS,Facility,Inpatient,,,,1097.5,932.875,314.5435,1097.5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
SCREW LOCKING 3.5X24 ORTHOLOC  WRIGHT MED 58803524,,C1713,HCPCS,Facility,Both,,,,1097.5,932.875,314.5435,1097.5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,972.05575,88.57,,percent of total billed charges,,
SCREW LOCKING 3.5X24 ORTHOLOC  WRIGHT MED 58803524,,C1713,HCPCS,Facility,Both,,,,1097.5,932.875,314.5435,1097.5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,314.5435,28.66,,percent of total billed charges,,
SCREW LOCKING 3.5X24 ORTHOLOC  WRIGHT MED 58803524,,C1713,HCPCS,Facility,Outpatient,,,,1097.5,932.875,314.5435,1097.5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),537.775,49,,percent of total billed charges,,
SCREW LOCKING 3.5X24 ORTHOLOC  WRIGHT MED 58803524,,C1713,HCPCS,Facility,Inpatient,,,,1097.5,932.875,314.5435,1097.5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
SCREW LOCKING 3.5X24 ORTHOLOC  WRIGHT MED 58803524,,C1713,HCPCS,Facility,Both,,,,1097.5,932.875,314.5435,1097.5,CorVel,Worker's Compensation,1097.5,100,,percent of total billed charges,,
SCREW LOCKING 3.5X24 ORTHOLOC  WRIGHT MED 58803524,,C1713,HCPCS,Facility,Both,,,,1097.5,932.875,314.5435,1097.5,First Health Group Corporation,First Health Network,1064.575,97,,percent of total billed charges,,
SCREW LOCKING 3.5X24 ORTHOLOC  WRIGHT MED 58803524,,C1713,HCPCS,Facility,Both,,,,1097.5,932.875,314.5435,1097.5,"Health Partners, Inc.",Commercial,1038.235,94.6,,percent of total billed charges,,
SCREW LOCKING 3.5X24 ORTHOLOC  WRIGHT MED 58803524,,C1713,HCPCS,Facility,Outpatient,,,,1097.5,932.875,314.5435,1097.5,"Health Partners, Inc.",Medicare Advantage,537.775,49,,percent of total billed charges,,
SCREW LOCKING 3.5X24 ORTHOLOC  WRIGHT MED 58803524,,C1713,HCPCS,Facility,Inpatient,,,,1097.5,932.875,314.5435,1097.5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SCREW LOCKING 3.5X24 ORTHOLOC  WRIGHT MED 58803524,,C1713,HCPCS,Facility,Both,,,,1097.5,932.875,314.5435,1097.5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),658.5,60,,percent of total billed charges,,
SCREW LOCKING 3.5X24 ORTHOLOC  WRIGHT MED 58803524,,C1713,HCPCS,Facility,Both,,,,1097.5,932.875,314.5435,1097.5,"Health Partners, Inc.",State of Minnesota Advantage Program,894.4625,81.5,,percent of total billed charges,,
SCREW LOCKING 3.5X24 ORTHOLOC  WRIGHT MED 58803524,,C1713,HCPCS,Facility,Both,,,,1097.5,932.875,314.5435,1097.5,"Health Partners, Inc.",State Public Programs,548.75,50,,percent of total billed charges,,
SCREW LOCKING 3.5X24 ORTHOLOC  WRIGHT MED 58803524,,C1713,HCPCS,Facility,Both,,,,1097.5,932.875,314.5435,1097.5,Humana Insurance Company,Commercial PPO,1042.625,95,,percent of total billed charges,,
SCREW LOCKING 3.5X24 ORTHOLOC  WRIGHT MED 58803524,,C1713,HCPCS,Facility,Outpatient,,,,1097.5,932.875,314.5435,1097.5,Humana Insurance Company,Medicare PPO,537.775,49,,percent of total billed charges,,
SCREW LOCKING 3.5X24 ORTHOLOC  WRIGHT MED 58803524,,C1713,HCPCS,Facility,Inpatient,,,,1097.5,932.875,314.5435,1097.5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
SCREW LOCKING 3.5X24 ORTHOLOC  WRIGHT MED 58803524,,C1713,HCPCS,Facility,Both,,,,1097.5,932.875,314.5435,1097.5,Medica,Individual & Family,1087.6225,99.1,,percent of total billed charges,,
SCREW LOCKING 3.5X24 ORTHOLOC  WRIGHT MED 58803524,,C1713,HCPCS,Facility,Outpatient,,,,1097.5,932.875,314.5435,1097.5,Medica,Medica Advantage Solution,546.555,49.8,,percent of total billed charges,,
SCREW LOCKING 3.5X24 ORTHOLOC  WRIGHT MED 58803524,,C1713,HCPCS,Facility,Inpatient,,,,1097.5,932.875,314.5435,1097.5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
SCREW LOCKING 3.5X24 ORTHOLOC  WRIGHT MED 58803524,,C1713,HCPCS,Facility,Outpatient,,,,1097.5,932.875,314.5435,1097.5,Medica,Medical Assistance,489.485,44.6,,percent of total billed charges,,
SCREW LOCKING 3.5X24 ORTHOLOC  WRIGHT MED 58803524,,C1713,HCPCS,Facility,Inpatient,,,,1097.5,932.875,314.5435,1097.5,Medica,Medical Assistance,,,,,Included in per diem rate,
SCREW LOCKING 3.5X24 ORTHOLOC  WRIGHT MED 58803524,,C1713,HCPCS,Facility,Outpatient,,,,1097.5,932.875,314.5435,1097.5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,546.555,49.8,,percent of total billed charges,,
SCREW LOCKING 3.5X24 ORTHOLOC  WRIGHT MED 58803524,,C1713,HCPCS,Facility,Inpatient,,,,1097.5,932.875,314.5435,1097.5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
SCREW LOCKING 3.5X24 ORTHOLOC  WRIGHT MED 58803524,,C1713,HCPCS,Facility,Both,,,,1097.5,932.875,314.5435,1097.5,"Multiplan, Inc.","Multiplan, Inc.",1031.65,94,,percent of total billed charges,,
SCREW LOCKING 3.5X24 ORTHOLOC  WRIGHT MED 58803524,,C1713,HCPCS,Facility,Outpatient,,,,1097.5,932.875,314.5435,1097.5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,988.8475,90.1,,percent of total billed charges,,
SCREW LOCKING 3.5X24 ORTHOLOC  WRIGHT MED 58803524,,C1713,HCPCS,Facility,Inpatient,,,,1097.5,932.875,314.5435,1097.5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
SCREW LOCKING 3.5X24 ORTHOLOC  WRIGHT MED 58803524,,C1713,HCPCS,Facility,Both,,,,1097.5,932.875,314.5435,1097.5,"Preferred One Administrative Services, INC.",PPO,1082.135,98.6,,percent of total billed charges,,
SCREW LOCKING 3.5X24 ORTHOLOC  WRIGHT MED 58803524,,C1713,HCPCS,Facility,Outpatient,,,,1097.5,932.875,314.5435,1097.5,PrimeWest Health,Minnesota Senior Health Options (MSHO),564.66375,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
SCREW LOCKING 3.5X24 ORTHOLOC  WRIGHT MED 58803524,,C1713,HCPCS,Facility,Inpatient,,,,1097.5,932.875,314.5435,1097.5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SCREW LOCKING 3.5X24 ORTHOLOC  WRIGHT MED 58803524,,C1713,HCPCS,Facility,Outpatient,,,,1097.5,932.875,314.5435,1097.5,PrimeWest Health,MinnesotaCare,563.676,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
SCREW LOCKING 3.5X24 ORTHOLOC  WRIGHT MED 58803524,,C1713,HCPCS,Facility,Inpatient,,,,1097.5,932.875,314.5435,1097.5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
SCREW LOCKING 3.5X24 ORTHOLOC  WRIGHT MED 58803524,,C1713,HCPCS,Facility,Both,,,,1097.5,932.875,314.5435,1097.5,Sanford Health Plan,Sanford Health Plan,1009.7,92,,percent of total billed charges,,
SCREW LOCKING 3.5X24 ORTHOLOC  WRIGHT MED 58803524,,C1713,HCPCS,Facility,Outpatient,,,,1097.5,932.875,314.5435,1097.5,"UCare Health, Inc.",Individual & Family Plan,618.44125,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
SCREW LOCKING 3.5X24 ORTHOLOC  WRIGHT MED 58803524,,C1713,HCPCS,Facility,Inpatient,,,,1097.5,932.875,314.5435,1097.5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
SCREW LOCKING 3.5X24 ORTHOLOC  WRIGHT MED 58803524,,C1713,HCPCS,Facility,Outpatient,,,,1097.5,932.875,314.5435,1097.5,"UCare Health, Inc.",Medical Assistance,553.90825,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SCREW LOCKING 3.5X24 ORTHOLOC  WRIGHT MED 58803524,,C1713,HCPCS,Facility,Inpatient,,,,1097.5,932.875,314.5435,1097.5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
SCREW LOCKING 3.5X24 ORTHOLOC  WRIGHT MED 58803524,,C1713,HCPCS,Facility,Outpatient,,,,1097.5,932.875,314.5435,1097.5,"UCare Health, Inc.",Medicare Advantage,553.90825,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SCREW LOCKING 3.5X24 ORTHOLOC  WRIGHT MED 58803524,,C1713,HCPCS,Facility,Inpatient,,,,1097.5,932.875,314.5435,1097.5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SCREW LOCKING 3.5X24 ORTHOLOC  WRIGHT MED 58803524,,C1713,HCPCS,Facility,Outpatient,,,,1097.5,932.875,314.5435,1097.5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),553.90825,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SCREW LOCKING 3.5X24 ORTHOLOC  WRIGHT MED 58803524,,C1713,HCPCS,Facility,Inpatient,,,,1097.5,932.875,314.5435,1097.5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SCREW LOCKING 3.5X24 ORTHOLOC  WRIGHT MED 58803524,,C1713,HCPCS,Facility,Both,,,,1097.5,932.875,314.5435,1097.5,UnitedHealthcare,Individual & Family,1031.65,94,,percent of total billed charges,,
SCREW LOCKING 3.5X24 ORTHOLOC  WRIGHT MED 58803524,,C1713,HCPCS,Facility,Outpatient,,,,1097.5,932.875,314.5435,1097.5,UnitedHealthcare,Medicare Advantage,537.775,49,,percent of total billed charges,,
SCREW LOCKING 3.5X24 ORTHOLOC  WRIGHT MED 58803524,,C1713,HCPCS,Facility,Inpatient,,,,1097.5,932.875,314.5435,1097.5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
SCREW LOCKING 3.5X24 ORTHOLOC  WRIGHT MED 58803524,,C1713,HCPCS,Facility,Outpatient,,,,1097.5,932.875,314.5435,1097.5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,526.8,48,,percent of total billed charges,,100% of DHS outpatient percentage
SCREW LOCKING 3.5X24 ORTHOLOC  WRIGHT MED 58803524,,C1713,HCPCS,Facility,Inpatient,,,,1097.5,932.875,314.5435,1097.5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
SCREW LOCKING 3.5X26  WRIGHT MED 58803526,,C1713,HCPCS,Facility,Both,,,,1097.5,932.875,314.5435,1097.5,Aetna,Commercial,1009.7,92,,percent of total billed charges,,
SCREW LOCKING 3.5X26  WRIGHT MED 58803526,,C1713,HCPCS,Facility,Outpatient,,,,1097.5,932.875,314.5435,1097.5,Aetna,Medicare Advantage,537.775,49,,percent of total billed charges,,
SCREW LOCKING 3.5X26  WRIGHT MED 58803526,,C1713,HCPCS,Facility,Inpatient,,,,1097.5,932.875,314.5435,1097.5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
SCREW LOCKING 3.5X26  WRIGHT MED 58803526,,C1713,HCPCS,Facility,Both,,,,1097.5,932.875,314.5435,1097.5,Aetna,PPO,1020.675,93,,percent of total billed charges,,
SCREW LOCKING 3.5X26  WRIGHT MED 58803526,,C1713,HCPCS,Facility,Both,,,,1097.5,932.875,314.5435,1097.5,America's PPO,America's PPO,1053.92925,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SCREW LOCKING 3.5X26  WRIGHT MED 58803526,,C1713,HCPCS,Facility,Both,,,,1097.5,932.875,314.5435,1097.5,BlueCross BlueShield Minnesota, Federal Employee Program,1079.94,98.4,,percent of total billed charges,,
SCREW LOCKING 3.5X26  WRIGHT MED 58803526,,C1713,HCPCS,Facility,Both,,,,1097.5,932.875,314.5435,1097.5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1097.5,100,,percent of total billed charges,,
SCREW LOCKING 3.5X26  WRIGHT MED 58803526,,C1713,HCPCS,Facility,Both,,,,1097.5,932.875,314.5435,1097.5,BlueCross BlueShield Minnesota,High Value Network Plan,987.75,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
SCREW LOCKING 3.5X26  WRIGHT MED 58803526,,C1713,HCPCS,Facility,Outpatient,,,,1097.5,932.875,314.5435,1097.5,BlueCross BlueShield Minnesota,Medicare Advantage,537.775,49,,percent of total billed charges,,
SCREW LOCKING 3.5X26  WRIGHT MED 58803526,,C1713,HCPCS,Facility,Inpatient,,,,1097.5,932.875,314.5435,1097.5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
SCREW LOCKING 3.5X26  WRIGHT MED 58803526,,C1713,HCPCS,Facility,Both,,,,1097.5,932.875,314.5435,1097.5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,972.05575,88.57,,percent of total billed charges,,
SCREW LOCKING 3.5X26  WRIGHT MED 58803526,,C1713,HCPCS,Facility,Both,,,,1097.5,932.875,314.5435,1097.5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,314.5435,28.66,,percent of total billed charges,,
SCREW LOCKING 3.5X26  WRIGHT MED 58803526,,C1713,HCPCS,Facility,Outpatient,,,,1097.5,932.875,314.5435,1097.5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),537.775,49,,percent of total billed charges,,
SCREW LOCKING 3.5X26  WRIGHT MED 58803526,,C1713,HCPCS,Facility,Inpatient,,,,1097.5,932.875,314.5435,1097.5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
SCREW LOCKING 3.5X26  WRIGHT MED 58803526,,C1713,HCPCS,Facility,Both,,,,1097.5,932.875,314.5435,1097.5,CorVel,Worker's Compensation,1097.5,100,,percent of total billed charges,,
SCREW LOCKING 3.5X26  WRIGHT MED 58803526,,C1713,HCPCS,Facility,Both,,,,1097.5,932.875,314.5435,1097.5,First Health Group Corporation,First Health Network,1064.575,97,,percent of total billed charges,,
SCREW LOCKING 3.5X26  WRIGHT MED 58803526,,C1713,HCPCS,Facility,Both,,,,1097.5,932.875,314.5435,1097.5,"Health Partners, Inc.",Commercial,1038.235,94.6,,percent of total billed charges,,
SCREW LOCKING 3.5X26  WRIGHT MED 58803526,,C1713,HCPCS,Facility,Outpatient,,,,1097.5,932.875,314.5435,1097.5,"Health Partners, Inc.",Medicare Advantage,537.775,49,,percent of total billed charges,,
SCREW LOCKING 3.5X26  WRIGHT MED 58803526,,C1713,HCPCS,Facility,Inpatient,,,,1097.5,932.875,314.5435,1097.5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SCREW LOCKING 3.5X26  WRIGHT MED 58803526,,C1713,HCPCS,Facility,Both,,,,1097.5,932.875,314.5435,1097.5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),658.5,60,,percent of total billed charges,,
SCREW LOCKING 3.5X26  WRIGHT MED 58803526,,C1713,HCPCS,Facility,Both,,,,1097.5,932.875,314.5435,1097.5,"Health Partners, Inc.",State of Minnesota Advantage Program,894.4625,81.5,,percent of total billed charges,,
SCREW LOCKING 3.5X26  WRIGHT MED 58803526,,C1713,HCPCS,Facility,Both,,,,1097.5,932.875,314.5435,1097.5,"Health Partners, Inc.",State Public Programs,548.75,50,,percent of total billed charges,,
SCREW LOCKING 3.5X26  WRIGHT MED 58803526,,C1713,HCPCS,Facility,Both,,,,1097.5,932.875,314.5435,1097.5,Humana Insurance Company,Commercial PPO,1042.625,95,,percent of total billed charges,,
SCREW LOCKING 3.5X26  WRIGHT MED 58803526,,C1713,HCPCS,Facility,Outpatient,,,,1097.5,932.875,314.5435,1097.5,Humana Insurance Company,Medicare PPO,537.775,49,,percent of total billed charges,,
SCREW LOCKING 3.5X26  WRIGHT MED 58803526,,C1713,HCPCS,Facility,Inpatient,,,,1097.5,932.875,314.5435,1097.5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
SCREW LOCKING 3.5X26  WRIGHT MED 58803526,,C1713,HCPCS,Facility,Both,,,,1097.5,932.875,314.5435,1097.5,Medica,Individual & Family,1087.6225,99.1,,percent of total billed charges,,
SCREW LOCKING 3.5X26  WRIGHT MED 58803526,,C1713,HCPCS,Facility,Outpatient,,,,1097.5,932.875,314.5435,1097.5,Medica,Medica Advantage Solution,546.555,49.8,,percent of total billed charges,,
SCREW LOCKING 3.5X26  WRIGHT MED 58803526,,C1713,HCPCS,Facility,Inpatient,,,,1097.5,932.875,314.5435,1097.5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
SCREW LOCKING 3.5X26  WRIGHT MED 58803526,,C1713,HCPCS,Facility,Outpatient,,,,1097.5,932.875,314.5435,1097.5,Medica,Medical Assistance,489.485,44.6,,percent of total billed charges,,
SCREW LOCKING 3.5X26  WRIGHT MED 58803526,,C1713,HCPCS,Facility,Inpatient,,,,1097.5,932.875,314.5435,1097.5,Medica,Medical Assistance,,,,,Included in per diem rate,
SCREW LOCKING 3.5X26  WRIGHT MED 58803526,,C1713,HCPCS,Facility,Outpatient,,,,1097.5,932.875,314.5435,1097.5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,546.555,49.8,,percent of total billed charges,,
SCREW LOCKING 3.5X26  WRIGHT MED 58803526,,C1713,HCPCS,Facility,Inpatient,,,,1097.5,932.875,314.5435,1097.5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
SCREW LOCKING 3.5X26  WRIGHT MED 58803526,,C1713,HCPCS,Facility,Both,,,,1097.5,932.875,314.5435,1097.5,"Multiplan, Inc.","Multiplan, Inc.",1031.65,94,,percent of total billed charges,,
SCREW LOCKING 3.5X26  WRIGHT MED 58803526,,C1713,HCPCS,Facility,Outpatient,,,,1097.5,932.875,314.5435,1097.5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,988.8475,90.1,,percent of total billed charges,,
SCREW LOCKING 3.5X26  WRIGHT MED 58803526,,C1713,HCPCS,Facility,Inpatient,,,,1097.5,932.875,314.5435,1097.5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
SCREW LOCKING 3.5X26  WRIGHT MED 58803526,,C1713,HCPCS,Facility,Both,,,,1097.5,932.875,314.5435,1097.5,"Preferred One Administrative Services, INC.",PPO,1082.135,98.6,,percent of total billed charges,,
SCREW LOCKING 3.5X26  WRIGHT MED 58803526,,C1713,HCPCS,Facility,Outpatient,,,,1097.5,932.875,314.5435,1097.5,PrimeWest Health,Minnesota Senior Health Options (MSHO),564.66375,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
SCREW LOCKING 3.5X26  WRIGHT MED 58803526,,C1713,HCPCS,Facility,Inpatient,,,,1097.5,932.875,314.5435,1097.5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SCREW LOCKING 3.5X26  WRIGHT MED 58803526,,C1713,HCPCS,Facility,Outpatient,,,,1097.5,932.875,314.5435,1097.5,PrimeWest Health,MinnesotaCare,563.676,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
SCREW LOCKING 3.5X26  WRIGHT MED 58803526,,C1713,HCPCS,Facility,Inpatient,,,,1097.5,932.875,314.5435,1097.5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
SCREW LOCKING 3.5X26  WRIGHT MED 58803526,,C1713,HCPCS,Facility,Both,,,,1097.5,932.875,314.5435,1097.5,Sanford Health Plan,Sanford Health Plan,1009.7,92,,percent of total billed charges,,
SCREW LOCKING 3.5X26  WRIGHT MED 58803526,,C1713,HCPCS,Facility,Outpatient,,,,1097.5,932.875,314.5435,1097.5,"UCare Health, Inc.",Individual & Family Plan,618.44125,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
SCREW LOCKING 3.5X26  WRIGHT MED 58803526,,C1713,HCPCS,Facility,Inpatient,,,,1097.5,932.875,314.5435,1097.5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
SCREW LOCKING 3.5X26  WRIGHT MED 58803526,,C1713,HCPCS,Facility,Outpatient,,,,1097.5,932.875,314.5435,1097.5,"UCare Health, Inc.",Medical Assistance,553.90825,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SCREW LOCKING 3.5X26  WRIGHT MED 58803526,,C1713,HCPCS,Facility,Inpatient,,,,1097.5,932.875,314.5435,1097.5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
SCREW LOCKING 3.5X26  WRIGHT MED 58803526,,C1713,HCPCS,Facility,Outpatient,,,,1097.5,932.875,314.5435,1097.5,"UCare Health, Inc.",Medicare Advantage,553.90825,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SCREW LOCKING 3.5X26  WRIGHT MED 58803526,,C1713,HCPCS,Facility,Inpatient,,,,1097.5,932.875,314.5435,1097.5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SCREW LOCKING 3.5X26  WRIGHT MED 58803526,,C1713,HCPCS,Facility,Outpatient,,,,1097.5,932.875,314.5435,1097.5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),553.90825,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SCREW LOCKING 3.5X26  WRIGHT MED 58803526,,C1713,HCPCS,Facility,Inpatient,,,,1097.5,932.875,314.5435,1097.5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SCREW LOCKING 3.5X26  WRIGHT MED 58803526,,C1713,HCPCS,Facility,Both,,,,1097.5,932.875,314.5435,1097.5,UnitedHealthcare,Individual & Family,1031.65,94,,percent of total billed charges,,
SCREW LOCKING 3.5X26  WRIGHT MED 58803526,,C1713,HCPCS,Facility,Outpatient,,,,1097.5,932.875,314.5435,1097.5,UnitedHealthcare,Medicare Advantage,537.775,49,,percent of total billed charges,,
SCREW LOCKING 3.5X26  WRIGHT MED 58803526,,C1713,HCPCS,Facility,Inpatient,,,,1097.5,932.875,314.5435,1097.5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
SCREW LOCKING 3.5X26  WRIGHT MED 58803526,,C1713,HCPCS,Facility,Outpatient,,,,1097.5,932.875,314.5435,1097.5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,526.8,48,,percent of total billed charges,,100% of DHS outpatient percentage
SCREW LOCKING 3.5X26  WRIGHT MED 58803526,,C1713,HCPCS,Facility,Inpatient,,,,1097.5,932.875,314.5435,1097.5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
SCREW LOW-PRO CORT 3.5X30MM  WRIGHT MED 58813530,,C1713,HCPCS,Facility,Both,,,,560,476,160.496,560,Aetna,Commercial,515.2,92,,percent of total billed charges,,
SCREW LOW-PRO CORT 3.5X30MM  WRIGHT MED 58813530,,C1713,HCPCS,Facility,Outpatient,,,,560,476,160.496,560,Aetna,Medicare Advantage,274.4,49,,percent of total billed charges,,
SCREW LOW-PRO CORT 3.5X30MM  WRIGHT MED 58813530,,C1713,HCPCS,Facility,Inpatient,,,,560,476,160.496,560,Aetna,Medicare Advantage,,,,,Included in per diem rate,
SCREW LOW-PRO CORT 3.5X30MM  WRIGHT MED 58813530,,C1713,HCPCS,Facility,Both,,,,560,476,160.496,560,Aetna,PPO,520.8,93,,percent of total billed charges,,
SCREW LOW-PRO CORT 3.5X30MM  WRIGHT MED 58813530,,C1713,HCPCS,Facility,Both,,,,560,476,160.496,560,America's PPO,America's PPO,537.768,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SCREW LOW-PRO CORT 3.5X30MM  WRIGHT MED 58813530,,C1713,HCPCS,Facility,Both,,,,560,476,160.496,560,BlueCross BlueShield Minnesota, Federal Employee Program,551.04,98.4,,percent of total billed charges,,
SCREW LOW-PRO CORT 3.5X30MM  WRIGHT MED 58813530,,C1713,HCPCS,Facility,Both,,,,560,476,160.496,560,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,560,100,,percent of total billed charges,,
SCREW LOW-PRO CORT 3.5X30MM  WRIGHT MED 58813530,,C1713,HCPCS,Facility,Both,,,,560,476,160.496,560,BlueCross BlueShield Minnesota,High Value Network Plan,504,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
SCREW LOW-PRO CORT 3.5X30MM  WRIGHT MED 58813530,,C1713,HCPCS,Facility,Outpatient,,,,560,476,160.496,560,BlueCross BlueShield Minnesota,Medicare Advantage,274.4,49,,percent of total billed charges,,
SCREW LOW-PRO CORT 3.5X30MM  WRIGHT MED 58813530,,C1713,HCPCS,Facility,Inpatient,,,,560,476,160.496,560,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
SCREW LOW-PRO CORT 3.5X30MM  WRIGHT MED 58813530,,C1713,HCPCS,Facility,Both,,,,560,476,160.496,560,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,495.992,88.57,,percent of total billed charges,,
SCREW LOW-PRO CORT 3.5X30MM  WRIGHT MED 58813530,,C1713,HCPCS,Facility,Both,,,,560,476,160.496,560,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,160.496,28.66,,percent of total billed charges,,
SCREW LOW-PRO CORT 3.5X30MM  WRIGHT MED 58813530,,C1713,HCPCS,Facility,Outpatient,,,,560,476,160.496,560,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),274.4,49,,percent of total billed charges,,
SCREW LOW-PRO CORT 3.5X30MM  WRIGHT MED 58813530,,C1713,HCPCS,Facility,Inpatient,,,,560,476,160.496,560,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
SCREW LOW-PRO CORT 3.5X30MM  WRIGHT MED 58813530,,C1713,HCPCS,Facility,Both,,,,560,476,160.496,560,CorVel,Worker's Compensation,560,100,,percent of total billed charges,,
SCREW LOW-PRO CORT 3.5X30MM  WRIGHT MED 58813530,,C1713,HCPCS,Facility,Both,,,,560,476,160.496,560,First Health Group Corporation,First Health Network,543.2,97,,percent of total billed charges,,
SCREW LOW-PRO CORT 3.5X30MM  WRIGHT MED 58813530,,C1713,HCPCS,Facility,Both,,,,560,476,160.496,560,"Health Partners, Inc.",Commercial,529.76,94.6,,percent of total billed charges,,
SCREW LOW-PRO CORT 3.5X30MM  WRIGHT MED 58813530,,C1713,HCPCS,Facility,Outpatient,,,,560,476,160.496,560,"Health Partners, Inc.",Medicare Advantage,274.4,49,,percent of total billed charges,,
SCREW LOW-PRO CORT 3.5X30MM  WRIGHT MED 58813530,,C1713,HCPCS,Facility,Inpatient,,,,560,476,160.496,560,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SCREW LOW-PRO CORT 3.5X30MM  WRIGHT MED 58813530,,C1713,HCPCS,Facility,Both,,,,560,476,160.496,560,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),336,60,,percent of total billed charges,,
SCREW LOW-PRO CORT 3.5X30MM  WRIGHT MED 58813530,,C1713,HCPCS,Facility,Both,,,,560,476,160.496,560,"Health Partners, Inc.",State of Minnesota Advantage Program,456.4,81.5,,percent of total billed charges,,
SCREW LOW-PRO CORT 3.5X30MM  WRIGHT MED 58813530,,C1713,HCPCS,Facility,Both,,,,560,476,160.496,560,"Health Partners, Inc.",State Public Programs,280,50,,percent of total billed charges,,
SCREW LOW-PRO CORT 3.5X30MM  WRIGHT MED 58813530,,C1713,HCPCS,Facility,Both,,,,560,476,160.496,560,Humana Insurance Company,Commercial PPO,532,95,,percent of total billed charges,,
SCREW LOW-PRO CORT 3.5X30MM  WRIGHT MED 58813530,,C1713,HCPCS,Facility,Outpatient,,,,560,476,160.496,560,Humana Insurance Company,Medicare PPO,274.4,49,,percent of total billed charges,,
SCREW LOW-PRO CORT 3.5X30MM  WRIGHT MED 58813530,,C1713,HCPCS,Facility,Inpatient,,,,560,476,160.496,560,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
SCREW LOW-PRO CORT 3.5X30MM  WRIGHT MED 58813530,,C1713,HCPCS,Facility,Both,,,,560,476,160.496,560,Medica,Individual & Family,554.96,99.1,,percent of total billed charges,,
SCREW LOW-PRO CORT 3.5X30MM  WRIGHT MED 58813530,,C1713,HCPCS,Facility,Outpatient,,,,560,476,160.496,560,Medica,Medica Advantage Solution,278.88,49.8,,percent of total billed charges,,
SCREW LOW-PRO CORT 3.5X30MM  WRIGHT MED 58813530,,C1713,HCPCS,Facility,Inpatient,,,,560,476,160.496,560,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
SCREW LOW-PRO CORT 3.5X30MM  WRIGHT MED 58813530,,C1713,HCPCS,Facility,Outpatient,,,,560,476,160.496,560,Medica,Medical Assistance,249.76,44.6,,percent of total billed charges,,
SCREW LOW-PRO CORT 3.5X30MM  WRIGHT MED 58813530,,C1713,HCPCS,Facility,Inpatient,,,,560,476,160.496,560,Medica,Medical Assistance,,,,,Included in per diem rate,
SCREW LOW-PRO CORT 3.5X30MM  WRIGHT MED 58813530,,C1713,HCPCS,Facility,Outpatient,,,,560,476,160.496,560,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,278.88,49.8,,percent of total billed charges,,
SCREW LOW-PRO CORT 3.5X30MM  WRIGHT MED 58813530,,C1713,HCPCS,Facility,Inpatient,,,,560,476,160.496,560,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
SCREW LOW-PRO CORT 3.5X30MM  WRIGHT MED 58813530,,C1713,HCPCS,Facility,Both,,,,560,476,160.496,560,"Multiplan, Inc.","Multiplan, Inc.",526.4,94,,percent of total billed charges,,
SCREW LOW-PRO CORT 3.5X30MM  WRIGHT MED 58813530,,C1713,HCPCS,Facility,Outpatient,,,,560,476,160.496,560,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,504.56,90.1,,percent of total billed charges,,
SCREW LOW-PRO CORT 3.5X30MM  WRIGHT MED 58813530,,C1713,HCPCS,Facility,Inpatient,,,,560,476,160.496,560,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
SCREW LOW-PRO CORT 3.5X30MM  WRIGHT MED 58813530,,C1713,HCPCS,Facility,Both,,,,560,476,160.496,560,"Preferred One Administrative Services, INC.",PPO,552.16,98.6,,percent of total billed charges,,
SCREW LOW-PRO CORT 3.5X30MM  WRIGHT MED 58813530,,C1713,HCPCS,Facility,Outpatient,,,,560,476,160.496,560,PrimeWest Health,Minnesota Senior Health Options (MSHO),288.12,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
SCREW LOW-PRO CORT 3.5X30MM  WRIGHT MED 58813530,,C1713,HCPCS,Facility,Inpatient,,,,560,476,160.496,560,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SCREW LOW-PRO CORT 3.5X30MM  WRIGHT MED 58813530,,C1713,HCPCS,Facility,Outpatient,,,,560,476,160.496,560,PrimeWest Health,MinnesotaCare,287.616,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
SCREW LOW-PRO CORT 3.5X30MM  WRIGHT MED 58813530,,C1713,HCPCS,Facility,Inpatient,,,,560,476,160.496,560,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
SCREW LOW-PRO CORT 3.5X30MM  WRIGHT MED 58813530,,C1713,HCPCS,Facility,Both,,,,560,476,160.496,560,Sanford Health Plan,Sanford Health Plan,515.2,92,,percent of total billed charges,,
SCREW LOW-PRO CORT 3.5X30MM  WRIGHT MED 58813530,,C1713,HCPCS,Facility,Outpatient,,,,560,476,160.496,560,"UCare Health, Inc.",Individual & Family Plan,315.56,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
SCREW LOW-PRO CORT 3.5X30MM  WRIGHT MED 58813530,,C1713,HCPCS,Facility,Inpatient,,,,560,476,160.496,560,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
SCREW LOW-PRO CORT 3.5X30MM  WRIGHT MED 58813530,,C1713,HCPCS,Facility,Outpatient,,,,560,476,160.496,560,"UCare Health, Inc.",Medical Assistance,282.632,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SCREW LOW-PRO CORT 3.5X30MM  WRIGHT MED 58813530,,C1713,HCPCS,Facility,Inpatient,,,,560,476,160.496,560,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
SCREW LOW-PRO CORT 3.5X30MM  WRIGHT MED 58813530,,C1713,HCPCS,Facility,Outpatient,,,,560,476,160.496,560,"UCare Health, Inc.",Medicare Advantage,282.632,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SCREW LOW-PRO CORT 3.5X30MM  WRIGHT MED 58813530,,C1713,HCPCS,Facility,Inpatient,,,,560,476,160.496,560,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SCREW LOW-PRO CORT 3.5X30MM  WRIGHT MED 58813530,,C1713,HCPCS,Facility,Outpatient,,,,560,476,160.496,560,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),282.632,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SCREW LOW-PRO CORT 3.5X30MM  WRIGHT MED 58813530,,C1713,HCPCS,Facility,Inpatient,,,,560,476,160.496,560,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SCREW LOW-PRO CORT 3.5X30MM  WRIGHT MED 58813530,,C1713,HCPCS,Facility,Both,,,,560,476,160.496,560,UnitedHealthcare,Individual & Family,526.4,94,,percent of total billed charges,,
SCREW LOW-PRO CORT 3.5X30MM  WRIGHT MED 58813530,,C1713,HCPCS,Facility,Outpatient,,,,560,476,160.496,560,UnitedHealthcare,Medicare Advantage,274.4,49,,percent of total billed charges,,
SCREW LOW-PRO CORT 3.5X30MM  WRIGHT MED 58813530,,C1713,HCPCS,Facility,Inpatient,,,,560,476,160.496,560,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
SCREW LOW-PRO CORT 3.5X30MM  WRIGHT MED 58813530,,C1713,HCPCS,Facility,Outpatient,,,,560,476,160.496,560,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,268.8,48,,percent of total billed charges,,100% of DHS outpatient percentage
SCREW LOW-PRO CORT 3.5X30MM  WRIGHT MED 58813530,,C1713,HCPCS,Facility,Inpatient,,,,560,476,160.496,560,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
SCREW LOW-PRO CORTICAL 3.5X40MM  WRIGHT MED 58813540,,C1713,HCPCS,Facility,Both,,,,560,476,160.496,560,Aetna,Commercial,515.2,92,,percent of total billed charges,,
SCREW LOW-PRO CORTICAL 3.5X40MM  WRIGHT MED 58813540,,C1713,HCPCS,Facility,Outpatient,,,,560,476,160.496,560,Aetna,Medicare Advantage,274.4,49,,percent of total billed charges,,
SCREW LOW-PRO CORTICAL 3.5X40MM  WRIGHT MED 58813540,,C1713,HCPCS,Facility,Inpatient,,,,560,476,160.496,560,Aetna,Medicare Advantage,,,,,Included in per diem rate,
SCREW LOW-PRO CORTICAL 3.5X40MM  WRIGHT MED 58813540,,C1713,HCPCS,Facility,Both,,,,560,476,160.496,560,Aetna,PPO,520.8,93,,percent of total billed charges,,
SCREW LOW-PRO CORTICAL 3.5X40MM  WRIGHT MED 58813540,,C1713,HCPCS,Facility,Both,,,,560,476,160.496,560,America's PPO,America's PPO,537.768,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SCREW LOW-PRO CORTICAL 3.5X40MM  WRIGHT MED 58813540,,C1713,HCPCS,Facility,Both,,,,560,476,160.496,560,BlueCross BlueShield Minnesota, Federal Employee Program,551.04,98.4,,percent of total billed charges,,
SCREW LOW-PRO CORTICAL 3.5X40MM  WRIGHT MED 58813540,,C1713,HCPCS,Facility,Both,,,,560,476,160.496,560,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,560,100,,percent of total billed charges,,
SCREW LOW-PRO CORTICAL 3.5X40MM  WRIGHT MED 58813540,,C1713,HCPCS,Facility,Both,,,,560,476,160.496,560,BlueCross BlueShield Minnesota,High Value Network Plan,504,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
SCREW LOW-PRO CORTICAL 3.5X40MM  WRIGHT MED 58813540,,C1713,HCPCS,Facility,Outpatient,,,,560,476,160.496,560,BlueCross BlueShield Minnesota,Medicare Advantage,274.4,49,,percent of total billed charges,,
SCREW LOW-PRO CORTICAL 3.5X40MM  WRIGHT MED 58813540,,C1713,HCPCS,Facility,Inpatient,,,,560,476,160.496,560,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
SCREW LOW-PRO CORTICAL 3.5X40MM  WRIGHT MED 58813540,,C1713,HCPCS,Facility,Both,,,,560,476,160.496,560,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,495.992,88.57,,percent of total billed charges,,
SCREW LOW-PRO CORTICAL 3.5X40MM  WRIGHT MED 58813540,,C1713,HCPCS,Facility,Both,,,,560,476,160.496,560,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,160.496,28.66,,percent of total billed charges,,
SCREW LOW-PRO CORTICAL 3.5X40MM  WRIGHT MED 58813540,,C1713,HCPCS,Facility,Outpatient,,,,560,476,160.496,560,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),274.4,49,,percent of total billed charges,,
SCREW LOW-PRO CORTICAL 3.5X40MM  WRIGHT MED 58813540,,C1713,HCPCS,Facility,Inpatient,,,,560,476,160.496,560,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
SCREW LOW-PRO CORTICAL 3.5X40MM  WRIGHT MED 58813540,,C1713,HCPCS,Facility,Both,,,,560,476,160.496,560,CorVel,Worker's Compensation,560,100,,percent of total billed charges,,
SCREW LOW-PRO CORTICAL 3.5X40MM  WRIGHT MED 58813540,,C1713,HCPCS,Facility,Both,,,,560,476,160.496,560,First Health Group Corporation,First Health Network,543.2,97,,percent of total billed charges,,
SCREW LOW-PRO CORTICAL 3.5X40MM  WRIGHT MED 58813540,,C1713,HCPCS,Facility,Both,,,,560,476,160.496,560,"Health Partners, Inc.",Commercial,529.76,94.6,,percent of total billed charges,,
SCREW LOW-PRO CORTICAL 3.5X40MM  WRIGHT MED 58813540,,C1713,HCPCS,Facility,Outpatient,,,,560,476,160.496,560,"Health Partners, Inc.",Medicare Advantage,274.4,49,,percent of total billed charges,,
SCREW LOW-PRO CORTICAL 3.5X40MM  WRIGHT MED 58813540,,C1713,HCPCS,Facility,Inpatient,,,,560,476,160.496,560,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SCREW LOW-PRO CORTICAL 3.5X40MM  WRIGHT MED 58813540,,C1713,HCPCS,Facility,Both,,,,560,476,160.496,560,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),336,60,,percent of total billed charges,,
SCREW LOW-PRO CORTICAL 3.5X40MM  WRIGHT MED 58813540,,C1713,HCPCS,Facility,Both,,,,560,476,160.496,560,"Health Partners, Inc.",State of Minnesota Advantage Program,456.4,81.5,,percent of total billed charges,,
SCREW LOW-PRO CORTICAL 3.5X40MM  WRIGHT MED 58813540,,C1713,HCPCS,Facility,Both,,,,560,476,160.496,560,"Health Partners, Inc.",State Public Programs,280,50,,percent of total billed charges,,
SCREW LOW-PRO CORTICAL 3.5X40MM  WRIGHT MED 58813540,,C1713,HCPCS,Facility,Both,,,,560,476,160.496,560,Humana Insurance Company,Commercial PPO,532,95,,percent of total billed charges,,
SCREW LOW-PRO CORTICAL 3.5X40MM  WRIGHT MED 58813540,,C1713,HCPCS,Facility,Outpatient,,,,560,476,160.496,560,Humana Insurance Company,Medicare PPO,274.4,49,,percent of total billed charges,,
SCREW LOW-PRO CORTICAL 3.5X40MM  WRIGHT MED 58813540,,C1713,HCPCS,Facility,Inpatient,,,,560,476,160.496,560,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
SCREW LOW-PRO CORTICAL 3.5X40MM  WRIGHT MED 58813540,,C1713,HCPCS,Facility,Both,,,,560,476,160.496,560,Medica,Individual & Family,554.96,99.1,,percent of total billed charges,,
SCREW LOW-PRO CORTICAL 3.5X40MM  WRIGHT MED 58813540,,C1713,HCPCS,Facility,Outpatient,,,,560,476,160.496,560,Medica,Medica Advantage Solution,278.88,49.8,,percent of total billed charges,,
SCREW LOW-PRO CORTICAL 3.5X40MM  WRIGHT MED 58813540,,C1713,HCPCS,Facility,Inpatient,,,,560,476,160.496,560,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
SCREW LOW-PRO CORTICAL 3.5X40MM  WRIGHT MED 58813540,,C1713,HCPCS,Facility,Outpatient,,,,560,476,160.496,560,Medica,Medical Assistance,249.76,44.6,,percent of total billed charges,,
SCREW LOW-PRO CORTICAL 3.5X40MM  WRIGHT MED 58813540,,C1713,HCPCS,Facility,Inpatient,,,,560,476,160.496,560,Medica,Medical Assistance,,,,,Included in per diem rate,
SCREW LOW-PRO CORTICAL 3.5X40MM  WRIGHT MED 58813540,,C1713,HCPCS,Facility,Outpatient,,,,560,476,160.496,560,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,278.88,49.8,,percent of total billed charges,,
SCREW LOW-PRO CORTICAL 3.5X40MM  WRIGHT MED 58813540,,C1713,HCPCS,Facility,Inpatient,,,,560,476,160.496,560,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
SCREW LOW-PRO CORTICAL 3.5X40MM  WRIGHT MED 58813540,,C1713,HCPCS,Facility,Both,,,,560,476,160.496,560,"Multiplan, Inc.","Multiplan, Inc.",526.4,94,,percent of total billed charges,,
SCREW LOW-PRO CORTICAL 3.5X40MM  WRIGHT MED 58813540,,C1713,HCPCS,Facility,Outpatient,,,,560,476,160.496,560,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,504.56,90.1,,percent of total billed charges,,
SCREW LOW-PRO CORTICAL 3.5X40MM  WRIGHT MED 58813540,,C1713,HCPCS,Facility,Inpatient,,,,560,476,160.496,560,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
SCREW LOW-PRO CORTICAL 3.5X40MM  WRIGHT MED 58813540,,C1713,HCPCS,Facility,Both,,,,560,476,160.496,560,"Preferred One Administrative Services, INC.",PPO,552.16,98.6,,percent of total billed charges,,
SCREW LOW-PRO CORTICAL 3.5X40MM  WRIGHT MED 58813540,,C1713,HCPCS,Facility,Outpatient,,,,560,476,160.496,560,PrimeWest Health,Minnesota Senior Health Options (MSHO),288.12,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
SCREW LOW-PRO CORTICAL 3.5X40MM  WRIGHT MED 58813540,,C1713,HCPCS,Facility,Inpatient,,,,560,476,160.496,560,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SCREW LOW-PRO CORTICAL 3.5X40MM  WRIGHT MED 58813540,,C1713,HCPCS,Facility,Outpatient,,,,560,476,160.496,560,PrimeWest Health,MinnesotaCare,287.616,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
SCREW LOW-PRO CORTICAL 3.5X40MM  WRIGHT MED 58813540,,C1713,HCPCS,Facility,Inpatient,,,,560,476,160.496,560,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
SCREW LOW-PRO CORTICAL 3.5X40MM  WRIGHT MED 58813540,,C1713,HCPCS,Facility,Both,,,,560,476,160.496,560,Sanford Health Plan,Sanford Health Plan,515.2,92,,percent of total billed charges,,
SCREW LOW-PRO CORTICAL 3.5X40MM  WRIGHT MED 58813540,,C1713,HCPCS,Facility,Outpatient,,,,560,476,160.496,560,"UCare Health, Inc.",Individual & Family Plan,315.56,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
SCREW LOW-PRO CORTICAL 3.5X40MM  WRIGHT MED 58813540,,C1713,HCPCS,Facility,Inpatient,,,,560,476,160.496,560,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
SCREW LOW-PRO CORTICAL 3.5X40MM  WRIGHT MED 58813540,,C1713,HCPCS,Facility,Outpatient,,,,560,476,160.496,560,"UCare Health, Inc.",Medical Assistance,282.632,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SCREW LOW-PRO CORTICAL 3.5X40MM  WRIGHT MED 58813540,,C1713,HCPCS,Facility,Inpatient,,,,560,476,160.496,560,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
SCREW LOW-PRO CORTICAL 3.5X40MM  WRIGHT MED 58813540,,C1713,HCPCS,Facility,Outpatient,,,,560,476,160.496,560,"UCare Health, Inc.",Medicare Advantage,282.632,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SCREW LOW-PRO CORTICAL 3.5X40MM  WRIGHT MED 58813540,,C1713,HCPCS,Facility,Inpatient,,,,560,476,160.496,560,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SCREW LOW-PRO CORTICAL 3.5X40MM  WRIGHT MED 58813540,,C1713,HCPCS,Facility,Outpatient,,,,560,476,160.496,560,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),282.632,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SCREW LOW-PRO CORTICAL 3.5X40MM  WRIGHT MED 58813540,,C1713,HCPCS,Facility,Inpatient,,,,560,476,160.496,560,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SCREW LOW-PRO CORTICAL 3.5X40MM  WRIGHT MED 58813540,,C1713,HCPCS,Facility,Both,,,,560,476,160.496,560,UnitedHealthcare,Individual & Family,526.4,94,,percent of total billed charges,,
SCREW LOW-PRO CORTICAL 3.5X40MM  WRIGHT MED 58813540,,C1713,HCPCS,Facility,Outpatient,,,,560,476,160.496,560,UnitedHealthcare,Medicare Advantage,274.4,49,,percent of total billed charges,,
SCREW LOW-PRO CORTICAL 3.5X40MM  WRIGHT MED 58813540,,C1713,HCPCS,Facility,Inpatient,,,,560,476,160.496,560,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
SCREW LOW-PRO CORTICAL 3.5X40MM  WRIGHT MED 58813540,,C1713,HCPCS,Facility,Outpatient,,,,560,476,160.496,560,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,268.8,48,,percent of total billed charges,,100% of DHS outpatient percentage
SCREW LOW-PRO CORTICAL 3.5X40MM  WRIGHT MED 58813540,,C1713,HCPCS,Facility,Inpatient,,,,560,476,160.496,560,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
SCREW PROTOE C2 CANN 3.0 X 13MM,,C1713,HCPCS,Facility,Both,,,,1870,1589.5,535.942,1870,Aetna,Commercial,1720.4,92,,percent of total billed charges,,
SCREW PROTOE C2 CANN 3.0 X 13MM,,C1713,HCPCS,Facility,Outpatient,,,,1870,1589.5,535.942,1870,Aetna,Medicare Advantage,916.3,49,,percent of total billed charges,,
SCREW PROTOE C2 CANN 3.0 X 13MM,,C1713,HCPCS,Facility,Inpatient,,,,1870,1589.5,535.942,1870,Aetna,Medicare Advantage,,,,,Included in per diem rate,
SCREW PROTOE C2 CANN 3.0 X 13MM,,C1713,HCPCS,Facility,Both,,,,1870,1589.5,535.942,1870,Aetna,PPO,1739.1,93,,percent of total billed charges,,
SCREW PROTOE C2 CANN 3.0 X 13MM,,C1713,HCPCS,Facility,Both,,,,1870,1589.5,535.942,1870,America's PPO,America's PPO,1795.761,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SCREW PROTOE C2 CANN 3.0 X 13MM,,C1713,HCPCS,Facility,Both,,,,1870,1589.5,535.942,1870,BlueCross BlueShield Minnesota, Federal Employee Program,1840.08,98.4,,percent of total billed charges,,
SCREW PROTOE C2 CANN 3.0 X 13MM,,C1713,HCPCS,Facility,Both,,,,1870,1589.5,535.942,1870,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1870,100,,percent of total billed charges,,
SCREW PROTOE C2 CANN 3.0 X 13MM,,C1713,HCPCS,Facility,Both,,,,1870,1589.5,535.942,1870,BlueCross BlueShield Minnesota,High Value Network Plan,1683,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
SCREW PROTOE C2 CANN 3.0 X 13MM,,C1713,HCPCS,Facility,Outpatient,,,,1870,1589.5,535.942,1870,BlueCross BlueShield Minnesota,Medicare Advantage,916.3,49,,percent of total billed charges,,
SCREW PROTOE C2 CANN 3.0 X 13MM,,C1713,HCPCS,Facility,Inpatient,,,,1870,1589.5,535.942,1870,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
SCREW PROTOE C2 CANN 3.0 X 13MM,,C1713,HCPCS,Facility,Both,,,,1870,1589.5,535.942,1870,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1656.259,88.57,,percent of total billed charges,,
SCREW PROTOE C2 CANN 3.0 X 13MM,,C1713,HCPCS,Facility,Both,,,,1870,1589.5,535.942,1870,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,535.942,28.66,,percent of total billed charges,,
SCREW PROTOE C2 CANN 3.0 X 13MM,,C1713,HCPCS,Facility,Outpatient,,,,1870,1589.5,535.942,1870,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),916.3,49,,percent of total billed charges,,
SCREW PROTOE C2 CANN 3.0 X 13MM,,C1713,HCPCS,Facility,Inpatient,,,,1870,1589.5,535.942,1870,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
SCREW PROTOE C2 CANN 3.0 X 13MM,,C1713,HCPCS,Facility,Both,,,,1870,1589.5,535.942,1870,CorVel,Worker's Compensation,1870,100,,percent of total billed charges,,
SCREW PROTOE C2 CANN 3.0 X 13MM,,C1713,HCPCS,Facility,Both,,,,1870,1589.5,535.942,1870,First Health Group Corporation,First Health Network,1813.9,97,,percent of total billed charges,,
SCREW PROTOE C2 CANN 3.0 X 13MM,,C1713,HCPCS,Facility,Both,,,,1870,1589.5,535.942,1870,"Health Partners, Inc.",Commercial,1769.02,94.6,,percent of total billed charges,,
SCREW PROTOE C2 CANN 3.0 X 13MM,,C1713,HCPCS,Facility,Outpatient,,,,1870,1589.5,535.942,1870,"Health Partners, Inc.",Medicare Advantage,916.3,49,,percent of total billed charges,,
SCREW PROTOE C2 CANN 3.0 X 13MM,,C1713,HCPCS,Facility,Inpatient,,,,1870,1589.5,535.942,1870,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SCREW PROTOE C2 CANN 3.0 X 13MM,,C1713,HCPCS,Facility,Both,,,,1870,1589.5,535.942,1870,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1122,60,,percent of total billed charges,,
SCREW PROTOE C2 CANN 3.0 X 13MM,,C1713,HCPCS,Facility,Both,,,,1870,1589.5,535.942,1870,"Health Partners, Inc.",State of Minnesota Advantage Program,1524.05,81.5,,percent of total billed charges,,
SCREW PROTOE C2 CANN 3.0 X 13MM,,C1713,HCPCS,Facility,Both,,,,1870,1589.5,535.942,1870,"Health Partners, Inc.",State Public Programs,935,50,,percent of total billed charges,,
SCREW PROTOE C2 CANN 3.0 X 13MM,,C1713,HCPCS,Facility,Both,,,,1870,1589.5,535.942,1870,Humana Insurance Company,Commercial PPO,1776.5,95,,percent of total billed charges,,
SCREW PROTOE C2 CANN 3.0 X 13MM,,C1713,HCPCS,Facility,Outpatient,,,,1870,1589.5,535.942,1870,Humana Insurance Company,Medicare PPO,916.3,49,,percent of total billed charges,,
SCREW PROTOE C2 CANN 3.0 X 13MM,,C1713,HCPCS,Facility,Inpatient,,,,1870,1589.5,535.942,1870,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
SCREW PROTOE C2 CANN 3.0 X 13MM,,C1713,HCPCS,Facility,Both,,,,1870,1589.5,535.942,1870,Medica,Individual & Family,1853.17,99.1,,percent of total billed charges,,
SCREW PROTOE C2 CANN 3.0 X 13MM,,C1713,HCPCS,Facility,Outpatient,,,,1870,1589.5,535.942,1870,Medica,Medica Advantage Solution,931.26,49.8,,percent of total billed charges,,
SCREW PROTOE C2 CANN 3.0 X 13MM,,C1713,HCPCS,Facility,Inpatient,,,,1870,1589.5,535.942,1870,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
SCREW PROTOE C2 CANN 3.0 X 13MM,,C1713,HCPCS,Facility,Outpatient,,,,1870,1589.5,535.942,1870,Medica,Medical Assistance,834.02,44.6,,percent of total billed charges,,
SCREW PROTOE C2 CANN 3.0 X 13MM,,C1713,HCPCS,Facility,Inpatient,,,,1870,1589.5,535.942,1870,Medica,Medical Assistance,,,,,Included in per diem rate,
SCREW PROTOE C2 CANN 3.0 X 13MM,,C1713,HCPCS,Facility,Outpatient,,,,1870,1589.5,535.942,1870,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,931.26,49.8,,percent of total billed charges,,
SCREW PROTOE C2 CANN 3.0 X 13MM,,C1713,HCPCS,Facility,Inpatient,,,,1870,1589.5,535.942,1870,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
SCREW PROTOE C2 CANN 3.0 X 13MM,,C1713,HCPCS,Facility,Both,,,,1870,1589.5,535.942,1870,"Multiplan, Inc.","Multiplan, Inc.",1757.8,94,,percent of total billed charges,,
SCREW PROTOE C2 CANN 3.0 X 13MM,,C1713,HCPCS,Facility,Outpatient,,,,1870,1589.5,535.942,1870,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1684.87,90.1,,percent of total billed charges,,
SCREW PROTOE C2 CANN 3.0 X 13MM,,C1713,HCPCS,Facility,Inpatient,,,,1870,1589.5,535.942,1870,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
SCREW PROTOE C2 CANN 3.0 X 13MM,,C1713,HCPCS,Facility,Both,,,,1870,1589.5,535.942,1870,"Preferred One Administrative Services, INC.",PPO,1843.82,98.6,,percent of total billed charges,,
SCREW PROTOE C2 CANN 3.0 X 13MM,,C1713,HCPCS,Facility,Outpatient,,,,1870,1589.5,535.942,1870,PrimeWest Health,Minnesota Senior Health Options (MSHO),962.115,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
SCREW PROTOE C2 CANN 3.0 X 13MM,,C1713,HCPCS,Facility,Inpatient,,,,1870,1589.5,535.942,1870,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SCREW PROTOE C2 CANN 3.0 X 13MM,,C1713,HCPCS,Facility,Outpatient,,,,1870,1589.5,535.942,1870,PrimeWest Health,MinnesotaCare,960.432,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
SCREW PROTOE C2 CANN 3.0 X 13MM,,C1713,HCPCS,Facility,Inpatient,,,,1870,1589.5,535.942,1870,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
SCREW PROTOE C2 CANN 3.0 X 13MM,,C1713,HCPCS,Facility,Both,,,,1870,1589.5,535.942,1870,Sanford Health Plan,Sanford Health Plan,1720.4,92,,percent of total billed charges,,
SCREW PROTOE C2 CANN 3.0 X 13MM,,C1713,HCPCS,Facility,Outpatient,,,,1870,1589.5,535.942,1870,"UCare Health, Inc.",Individual & Family Plan,1053.745,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
SCREW PROTOE C2 CANN 3.0 X 13MM,,C1713,HCPCS,Facility,Inpatient,,,,1870,1589.5,535.942,1870,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
SCREW PROTOE C2 CANN 3.0 X 13MM,,C1713,HCPCS,Facility,Outpatient,,,,1870,1589.5,535.942,1870,"UCare Health, Inc.",Medical Assistance,943.789,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SCREW PROTOE C2 CANN 3.0 X 13MM,,C1713,HCPCS,Facility,Inpatient,,,,1870,1589.5,535.942,1870,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
SCREW PROTOE C2 CANN 3.0 X 13MM,,C1713,HCPCS,Facility,Outpatient,,,,1870,1589.5,535.942,1870,"UCare Health, Inc.",Medicare Advantage,943.789,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SCREW PROTOE C2 CANN 3.0 X 13MM,,C1713,HCPCS,Facility,Inpatient,,,,1870,1589.5,535.942,1870,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SCREW PROTOE C2 CANN 3.0 X 13MM,,C1713,HCPCS,Facility,Outpatient,,,,1870,1589.5,535.942,1870,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),943.789,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SCREW PROTOE C2 CANN 3.0 X 13MM,,C1713,HCPCS,Facility,Inpatient,,,,1870,1589.5,535.942,1870,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SCREW PROTOE C2 CANN 3.0 X 13MM,,C1713,HCPCS,Facility,Both,,,,1870,1589.5,535.942,1870,UnitedHealthcare,Individual & Family,1757.8,94,,percent of total billed charges,,
SCREW PROTOE C2 CANN 3.0 X 13MM,,C1713,HCPCS,Facility,Outpatient,,,,1870,1589.5,535.942,1870,UnitedHealthcare,Medicare Advantage,916.3,49,,percent of total billed charges,,
SCREW PROTOE C2 CANN 3.0 X 13MM,,C1713,HCPCS,Facility,Inpatient,,,,1870,1589.5,535.942,1870,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
SCREW PROTOE C2 CANN 3.0 X 13MM,,C1713,HCPCS,Facility,Outpatient,,,,1870,1589.5,535.942,1870,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,897.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
SCREW PROTOE C2 CANN 3.0 X 13MM,,C1713,HCPCS,Facility,Inpatient,,,,1870,1589.5,535.942,1870,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
SCREW UNICOMPARTMENTAL 48MM,,C1713,HCPCS,Facility,Both,,,,229.425,195.01125,65.753205,229.425,Aetna,Commercial,211.071,92,,percent of total billed charges,,
SCREW UNICOMPARTMENTAL 48MM,,C1713,HCPCS,Facility,Outpatient,,,,229.425,195.01125,65.753205,229.425,Aetna,Medicare Advantage,112.41825,49,,percent of total billed charges,,
SCREW UNICOMPARTMENTAL 48MM,,C1713,HCPCS,Facility,Inpatient,,,,229.425,195.01125,65.753205,229.425,Aetna,Medicare Advantage,,,,,Included in per diem rate,
SCREW UNICOMPARTMENTAL 48MM,,C1713,HCPCS,Facility,Both,,,,229.425,195.01125,65.753205,229.425,Aetna,PPO,213.36525,93,,percent of total billed charges,,
SCREW UNICOMPARTMENTAL 48MM,,C1713,HCPCS,Facility,Both,,,,229.425,195.01125,65.753205,229.425,America's PPO,America's PPO,220.3168275,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SCREW UNICOMPARTMENTAL 48MM,,C1713,HCPCS,Facility,Both,,,,229.425,195.01125,65.753205,229.425,BlueCross BlueShield Minnesota, Federal Employee Program,225.7542,98.4,,percent of total billed charges,,
SCREW UNICOMPARTMENTAL 48MM,,C1713,HCPCS,Facility,Both,,,,229.425,195.01125,65.753205,229.425,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,229.425,100,,percent of total billed charges,,
SCREW UNICOMPARTMENTAL 48MM,,C1713,HCPCS,Facility,Both,,,,229.425,195.01125,65.753205,229.425,BlueCross BlueShield Minnesota,High Value Network Plan,206.4825,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
SCREW UNICOMPARTMENTAL 48MM,,C1713,HCPCS,Facility,Outpatient,,,,229.425,195.01125,65.753205,229.425,BlueCross BlueShield Minnesota,Medicare Advantage,112.41825,49,,percent of total billed charges,,
SCREW UNICOMPARTMENTAL 48MM,,C1713,HCPCS,Facility,Inpatient,,,,229.425,195.01125,65.753205,229.425,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
SCREW UNICOMPARTMENTAL 48MM,,C1713,HCPCS,Facility,Both,,,,229.425,195.01125,65.753205,229.425,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,203.2017225,88.57,,percent of total billed charges,,
SCREW UNICOMPARTMENTAL 48MM,,C1713,HCPCS,Facility,Both,,,,229.425,195.01125,65.753205,229.425,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,65.753205,28.66,,percent of total billed charges,,
SCREW UNICOMPARTMENTAL 48MM,,C1713,HCPCS,Facility,Outpatient,,,,229.425,195.01125,65.753205,229.425,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),112.41825,49,,percent of total billed charges,,
SCREW UNICOMPARTMENTAL 48MM,,C1713,HCPCS,Facility,Inpatient,,,,229.425,195.01125,65.753205,229.425,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
SCREW UNICOMPARTMENTAL 48MM,,C1713,HCPCS,Facility,Both,,,,229.425,195.01125,65.753205,229.425,CorVel,Worker's Compensation,229.425,100,,percent of total billed charges,,
SCREW UNICOMPARTMENTAL 48MM,,C1713,HCPCS,Facility,Both,,,,229.425,195.01125,65.753205,229.425,First Health Group Corporation,First Health Network,222.54225,97,,percent of total billed charges,,
SCREW UNICOMPARTMENTAL 48MM,,C1713,HCPCS,Facility,Both,,,,229.425,195.01125,65.753205,229.425,"Health Partners, Inc.",Commercial,217.03605,94.6,,percent of total billed charges,,
SCREW UNICOMPARTMENTAL 48MM,,C1713,HCPCS,Facility,Outpatient,,,,229.425,195.01125,65.753205,229.425,"Health Partners, Inc.",Medicare Advantage,112.41825,49,,percent of total billed charges,,
SCREW UNICOMPARTMENTAL 48MM,,C1713,HCPCS,Facility,Inpatient,,,,229.425,195.01125,65.753205,229.425,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SCREW UNICOMPARTMENTAL 48MM,,C1713,HCPCS,Facility,Both,,,,229.425,195.01125,65.753205,229.425,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),137.655,60,,percent of total billed charges,,
SCREW UNICOMPARTMENTAL 48MM,,C1713,HCPCS,Facility,Both,,,,229.425,195.01125,65.753205,229.425,"Health Partners, Inc.",State of Minnesota Advantage Program,186.981375,81.5,,percent of total billed charges,,
SCREW UNICOMPARTMENTAL 48MM,,C1713,HCPCS,Facility,Both,,,,229.425,195.01125,65.753205,229.425,"Health Partners, Inc.",State Public Programs,114.7125,50,,percent of total billed charges,,
SCREW UNICOMPARTMENTAL 48MM,,C1713,HCPCS,Facility,Both,,,,229.425,195.01125,65.753205,229.425,Humana Insurance Company,Commercial PPO,217.95375,95,,percent of total billed charges,,
SCREW UNICOMPARTMENTAL 48MM,,C1713,HCPCS,Facility,Outpatient,,,,229.425,195.01125,65.753205,229.425,Humana Insurance Company,Medicare PPO,112.41825,49,,percent of total billed charges,,
SCREW UNICOMPARTMENTAL 48MM,,C1713,HCPCS,Facility,Inpatient,,,,229.425,195.01125,65.753205,229.425,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
SCREW UNICOMPARTMENTAL 48MM,,C1713,HCPCS,Facility,Both,,,,229.425,195.01125,65.753205,229.425,Medica,Individual & Family,227.360175,99.1,,percent of total billed charges,,
SCREW UNICOMPARTMENTAL 48MM,,C1713,HCPCS,Facility,Outpatient,,,,229.425,195.01125,65.753205,229.425,Medica,Medica Advantage Solution,114.25365,49.8,,percent of total billed charges,,
SCREW UNICOMPARTMENTAL 48MM,,C1713,HCPCS,Facility,Inpatient,,,,229.425,195.01125,65.753205,229.425,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
SCREW UNICOMPARTMENTAL 48MM,,C1713,HCPCS,Facility,Outpatient,,,,229.425,195.01125,65.753205,229.425,Medica,Medical Assistance,102.32355,44.6,,percent of total billed charges,,
SCREW UNICOMPARTMENTAL 48MM,,C1713,HCPCS,Facility,Inpatient,,,,229.425,195.01125,65.753205,229.425,Medica,Medical Assistance,,,,,Included in per diem rate,
SCREW UNICOMPARTMENTAL 48MM,,C1713,HCPCS,Facility,Outpatient,,,,229.425,195.01125,65.753205,229.425,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,114.25365,49.8,,percent of total billed charges,,
SCREW UNICOMPARTMENTAL 48MM,,C1713,HCPCS,Facility,Inpatient,,,,229.425,195.01125,65.753205,229.425,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
SCREW UNICOMPARTMENTAL 48MM,,C1713,HCPCS,Facility,Both,,,,229.425,195.01125,65.753205,229.425,"Multiplan, Inc.","Multiplan, Inc.",215.6595,94,,percent of total billed charges,,
SCREW UNICOMPARTMENTAL 48MM,,C1713,HCPCS,Facility,Outpatient,,,,229.425,195.01125,65.753205,229.425,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,206.711925,90.1,,percent of total billed charges,,
SCREW UNICOMPARTMENTAL 48MM,,C1713,HCPCS,Facility,Inpatient,,,,229.425,195.01125,65.753205,229.425,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
SCREW UNICOMPARTMENTAL 48MM,,C1713,HCPCS,Facility,Both,,,,229.425,195.01125,65.753205,229.425,"Preferred One Administrative Services, INC.",PPO,226.21305,98.6,,percent of total billed charges,,
SCREW UNICOMPARTMENTAL 48MM,,C1713,HCPCS,Facility,Outpatient,,,,229.425,195.01125,65.753205,229.425,PrimeWest Health,Minnesota Senior Health Options (MSHO),118.0391625,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
SCREW UNICOMPARTMENTAL 48MM,,C1713,HCPCS,Facility,Inpatient,,,,229.425,195.01125,65.753205,229.425,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SCREW UNICOMPARTMENTAL 48MM,,C1713,HCPCS,Facility,Outpatient,,,,229.425,195.01125,65.753205,229.425,PrimeWest Health,MinnesotaCare,117.83268,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
SCREW UNICOMPARTMENTAL 48MM,,C1713,HCPCS,Facility,Inpatient,,,,229.425,195.01125,65.753205,229.425,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
SCREW UNICOMPARTMENTAL 48MM,,C1713,HCPCS,Facility,Both,,,,229.425,195.01125,65.753205,229.425,Sanford Health Plan,Sanford Health Plan,211.071,92,,percent of total billed charges,,
SCREW UNICOMPARTMENTAL 48MM,,C1713,HCPCS,Facility,Outpatient,,,,229.425,195.01125,65.753205,229.425,"UCare Health, Inc.",Individual & Family Plan,129.2809875,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
SCREW UNICOMPARTMENTAL 48MM,,C1713,HCPCS,Facility,Inpatient,,,,229.425,195.01125,65.753205,229.425,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
SCREW UNICOMPARTMENTAL 48MM,,C1713,HCPCS,Facility,Outpatient,,,,229.425,195.01125,65.753205,229.425,"UCare Health, Inc.",Medical Assistance,115.7907975,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SCREW UNICOMPARTMENTAL 48MM,,C1713,HCPCS,Facility,Inpatient,,,,229.425,195.01125,65.753205,229.425,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
SCREW UNICOMPARTMENTAL 48MM,,C1713,HCPCS,Facility,Outpatient,,,,229.425,195.01125,65.753205,229.425,"UCare Health, Inc.",Medicare Advantage,115.7907975,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SCREW UNICOMPARTMENTAL 48MM,,C1713,HCPCS,Facility,Inpatient,,,,229.425,195.01125,65.753205,229.425,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SCREW UNICOMPARTMENTAL 48MM,,C1713,HCPCS,Facility,Outpatient,,,,229.425,195.01125,65.753205,229.425,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),115.7907975,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SCREW UNICOMPARTMENTAL 48MM,,C1713,HCPCS,Facility,Inpatient,,,,229.425,195.01125,65.753205,229.425,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SCREW UNICOMPARTMENTAL 48MM,,C1713,HCPCS,Facility,Both,,,,229.425,195.01125,65.753205,229.425,UnitedHealthcare,Individual & Family,215.6595,94,,percent of total billed charges,,
SCREW UNICOMPARTMENTAL 48MM,,C1713,HCPCS,Facility,Outpatient,,,,229.425,195.01125,65.753205,229.425,UnitedHealthcare,Medicare Advantage,112.41825,49,,percent of total billed charges,,
SCREW UNICOMPARTMENTAL 48MM,,C1713,HCPCS,Facility,Inpatient,,,,229.425,195.01125,65.753205,229.425,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
SCREW UNICOMPARTMENTAL 48MM,,C1713,HCPCS,Facility,Outpatient,,,,229.425,195.01125,65.753205,229.425,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,110.124,48,,percent of total billed charges,,100% of DHS outpatient percentage
SCREW UNICOMPARTMENTAL 48MM,,C1713,HCPCS,Facility,Inpatient,,,,229.425,195.01125,65.753205,229.425,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
TAP CANNULATED FOR 4.5MM,,C1713,HCPCS,Facility,Both,,,,770,654.5,220.682,770,Aetna,Commercial,708.4,92,,percent of total billed charges,,
TAP CANNULATED FOR 4.5MM,,C1713,HCPCS,Facility,Outpatient,,,,770,654.5,220.682,770,Aetna,Medicare Advantage,377.3,49,,percent of total billed charges,,
TAP CANNULATED FOR 4.5MM,,C1713,HCPCS,Facility,Inpatient,,,,770,654.5,220.682,770,Aetna,Medicare Advantage,,,,,Included in per diem rate,
TAP CANNULATED FOR 4.5MM,,C1713,HCPCS,Facility,Both,,,,770,654.5,220.682,770,Aetna,PPO,716.1,93,,percent of total billed charges,,
TAP CANNULATED FOR 4.5MM,,C1713,HCPCS,Facility,Both,,,,770,654.5,220.682,770,America's PPO,America's PPO,739.431,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
TAP CANNULATED FOR 4.5MM,,C1713,HCPCS,Facility,Both,,,,770,654.5,220.682,770,BlueCross BlueShield Minnesota, Federal Employee Program,757.68,98.4,,percent of total billed charges,,
TAP CANNULATED FOR 4.5MM,,C1713,HCPCS,Facility,Both,,,,770,654.5,220.682,770,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,770,100,,percent of total billed charges,,
TAP CANNULATED FOR 4.5MM,,C1713,HCPCS,Facility,Both,,,,770,654.5,220.682,770,BlueCross BlueShield Minnesota,High Value Network Plan,693,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
TAP CANNULATED FOR 4.5MM,,C1713,HCPCS,Facility,Outpatient,,,,770,654.5,220.682,770,BlueCross BlueShield Minnesota,Medicare Advantage,377.3,49,,percent of total billed charges,,
TAP CANNULATED FOR 4.5MM,,C1713,HCPCS,Facility,Inpatient,,,,770,654.5,220.682,770,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
TAP CANNULATED FOR 4.5MM,,C1713,HCPCS,Facility,Both,,,,770,654.5,220.682,770,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,681.989,88.57,,percent of total billed charges,,
TAP CANNULATED FOR 4.5MM,,C1713,HCPCS,Facility,Both,,,,770,654.5,220.682,770,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,220.682,28.66,,percent of total billed charges,,
TAP CANNULATED FOR 4.5MM,,C1713,HCPCS,Facility,Outpatient,,,,770,654.5,220.682,770,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),377.3,49,,percent of total billed charges,,
TAP CANNULATED FOR 4.5MM,,C1713,HCPCS,Facility,Inpatient,,,,770,654.5,220.682,770,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
TAP CANNULATED FOR 4.5MM,,C1713,HCPCS,Facility,Both,,,,770,654.5,220.682,770,CorVel,Worker's Compensation,770,100,,percent of total billed charges,,
TAP CANNULATED FOR 4.5MM,,C1713,HCPCS,Facility,Both,,,,770,654.5,220.682,770,First Health Group Corporation,First Health Network,746.9,97,,percent of total billed charges,,
TAP CANNULATED FOR 4.5MM,,C1713,HCPCS,Facility,Both,,,,770,654.5,220.682,770,"Health Partners, Inc.",Commercial,728.42,94.6,,percent of total billed charges,,
TAP CANNULATED FOR 4.5MM,,C1713,HCPCS,Facility,Outpatient,,,,770,654.5,220.682,770,"Health Partners, Inc.",Medicare Advantage,377.3,49,,percent of total billed charges,,
TAP CANNULATED FOR 4.5MM,,C1713,HCPCS,Facility,Inpatient,,,,770,654.5,220.682,770,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
TAP CANNULATED FOR 4.5MM,,C1713,HCPCS,Facility,Both,,,,770,654.5,220.682,770,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),462,60,,percent of total billed charges,,
TAP CANNULATED FOR 4.5MM,,C1713,HCPCS,Facility,Both,,,,770,654.5,220.682,770,"Health Partners, Inc.",State of Minnesota Advantage Program,627.55,81.5,,percent of total billed charges,,
TAP CANNULATED FOR 4.5MM,,C1713,HCPCS,Facility,Both,,,,770,654.5,220.682,770,"Health Partners, Inc.",State Public Programs,385,50,,percent of total billed charges,,
TAP CANNULATED FOR 4.5MM,,C1713,HCPCS,Facility,Both,,,,770,654.5,220.682,770,Humana Insurance Company,Commercial PPO,731.5,95,,percent of total billed charges,,
TAP CANNULATED FOR 4.5MM,,C1713,HCPCS,Facility,Outpatient,,,,770,654.5,220.682,770,Humana Insurance Company,Medicare PPO,377.3,49,,percent of total billed charges,,
TAP CANNULATED FOR 4.5MM,,C1713,HCPCS,Facility,Inpatient,,,,770,654.5,220.682,770,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
TAP CANNULATED FOR 4.5MM,,C1713,HCPCS,Facility,Both,,,,770,654.5,220.682,770,Medica,Individual & Family,763.07,99.1,,percent of total billed charges,,
TAP CANNULATED FOR 4.5MM,,C1713,HCPCS,Facility,Outpatient,,,,770,654.5,220.682,770,Medica,Medica Advantage Solution,383.46,49.8,,percent of total billed charges,,
TAP CANNULATED FOR 4.5MM,,C1713,HCPCS,Facility,Inpatient,,,,770,654.5,220.682,770,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
TAP CANNULATED FOR 4.5MM,,C1713,HCPCS,Facility,Outpatient,,,,770,654.5,220.682,770,Medica,Medical Assistance,343.42,44.6,,percent of total billed charges,,
TAP CANNULATED FOR 4.5MM,,C1713,HCPCS,Facility,Inpatient,,,,770,654.5,220.682,770,Medica,Medical Assistance,,,,,Included in per diem rate,
TAP CANNULATED FOR 4.5MM,,C1713,HCPCS,Facility,Outpatient,,,,770,654.5,220.682,770,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,383.46,49.8,,percent of total billed charges,,
TAP CANNULATED FOR 4.5MM,,C1713,HCPCS,Facility,Inpatient,,,,770,654.5,220.682,770,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
TAP CANNULATED FOR 4.5MM,,C1713,HCPCS,Facility,Both,,,,770,654.5,220.682,770,"Multiplan, Inc.","Multiplan, Inc.",723.8,94,,percent of total billed charges,,
TAP CANNULATED FOR 4.5MM,,C1713,HCPCS,Facility,Outpatient,,,,770,654.5,220.682,770,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,693.77,90.1,,percent of total billed charges,,
TAP CANNULATED FOR 4.5MM,,C1713,HCPCS,Facility,Inpatient,,,,770,654.5,220.682,770,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
TAP CANNULATED FOR 4.5MM,,C1713,HCPCS,Facility,Both,,,,770,654.5,220.682,770,"Preferred One Administrative Services, INC.",PPO,759.22,98.6,,percent of total billed charges,,
TAP CANNULATED FOR 4.5MM,,C1713,HCPCS,Facility,Outpatient,,,,770,654.5,220.682,770,PrimeWest Health,Minnesota Senior Health Options (MSHO),396.165,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
TAP CANNULATED FOR 4.5MM,,C1713,HCPCS,Facility,Inpatient,,,,770,654.5,220.682,770,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
TAP CANNULATED FOR 4.5MM,,C1713,HCPCS,Facility,Outpatient,,,,770,654.5,220.682,770,PrimeWest Health,MinnesotaCare,395.472,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
TAP CANNULATED FOR 4.5MM,,C1713,HCPCS,Facility,Inpatient,,,,770,654.5,220.682,770,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
TAP CANNULATED FOR 4.5MM,,C1713,HCPCS,Facility,Both,,,,770,654.5,220.682,770,Sanford Health Plan,Sanford Health Plan,708.4,92,,percent of total billed charges,,
TAP CANNULATED FOR 4.5MM,,C1713,HCPCS,Facility,Outpatient,,,,770,654.5,220.682,770,"UCare Health, Inc.",Individual & Family Plan,433.895,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
TAP CANNULATED FOR 4.5MM,,C1713,HCPCS,Facility,Inpatient,,,,770,654.5,220.682,770,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
TAP CANNULATED FOR 4.5MM,,C1713,HCPCS,Facility,Outpatient,,,,770,654.5,220.682,770,"UCare Health, Inc.",Medical Assistance,388.619,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TAP CANNULATED FOR 4.5MM,,C1713,HCPCS,Facility,Inpatient,,,,770,654.5,220.682,770,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
TAP CANNULATED FOR 4.5MM,,C1713,HCPCS,Facility,Outpatient,,,,770,654.5,220.682,770,"UCare Health, Inc.",Medicare Advantage,388.619,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TAP CANNULATED FOR 4.5MM,,C1713,HCPCS,Facility,Inpatient,,,,770,654.5,220.682,770,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
TAP CANNULATED FOR 4.5MM,,C1713,HCPCS,Facility,Outpatient,,,,770,654.5,220.682,770,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),388.619,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TAP CANNULATED FOR 4.5MM,,C1713,HCPCS,Facility,Inpatient,,,,770,654.5,220.682,770,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
TAP CANNULATED FOR 4.5MM,,C1713,HCPCS,Facility,Both,,,,770,654.5,220.682,770,UnitedHealthcare,Individual & Family,723.8,94,,percent of total billed charges,,
TAP CANNULATED FOR 4.5MM,,C1713,HCPCS,Facility,Outpatient,,,,770,654.5,220.682,770,UnitedHealthcare,Medicare Advantage,377.3,49,,percent of total billed charges,,
TAP CANNULATED FOR 4.5MM,,C1713,HCPCS,Facility,Inpatient,,,,770,654.5,220.682,770,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
TAP CANNULATED FOR 4.5MM,,C1713,HCPCS,Facility,Outpatient,,,,770,654.5,220.682,770,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,369.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
TAP CANNULATED FOR 4.5MM,,C1713,HCPCS,Facility,Inpatient,,,,770,654.5,220.682,770,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
TRIM IT PIN 1.5MM  AR-4151DS,,C1713,HCPCS,Facility,Both,,,,1050,892.5,300.93,1050,Aetna,Commercial,966,92,,percent of total billed charges,,
TRIM IT PIN 1.5MM  AR-4151DS,,C1713,HCPCS,Facility,Outpatient,,,,1050,892.5,300.93,1050,Aetna,Medicare Advantage,514.5,49,,percent of total billed charges,,
TRIM IT PIN 1.5MM  AR-4151DS,,C1713,HCPCS,Facility,Inpatient,,,,1050,892.5,300.93,1050,Aetna,Medicare Advantage,,,,,Included in per diem rate,
TRIM IT PIN 1.5MM  AR-4151DS,,C1713,HCPCS,Facility,Both,,,,1050,892.5,300.93,1050,Aetna,PPO,976.5,93,,percent of total billed charges,,
TRIM IT PIN 1.5MM  AR-4151DS,,C1713,HCPCS,Facility,Both,,,,1050,892.5,300.93,1050,America's PPO,America's PPO,1008.315,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
TRIM IT PIN 1.5MM  AR-4151DS,,C1713,HCPCS,Facility,Both,,,,1050,892.5,300.93,1050,BlueCross BlueShield Minnesota, Federal Employee Program,1033.2,98.4,,percent of total billed charges,,
TRIM IT PIN 1.5MM  AR-4151DS,,C1713,HCPCS,Facility,Both,,,,1050,892.5,300.93,1050,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1050,100,,percent of total billed charges,,
TRIM IT PIN 1.5MM  AR-4151DS,,C1713,HCPCS,Facility,Both,,,,1050,892.5,300.93,1050,BlueCross BlueShield Minnesota,High Value Network Plan,945,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
TRIM IT PIN 1.5MM  AR-4151DS,,C1713,HCPCS,Facility,Outpatient,,,,1050,892.5,300.93,1050,BlueCross BlueShield Minnesota,Medicare Advantage,514.5,49,,percent of total billed charges,,
TRIM IT PIN 1.5MM  AR-4151DS,,C1713,HCPCS,Facility,Inpatient,,,,1050,892.5,300.93,1050,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
TRIM IT PIN 1.5MM  AR-4151DS,,C1713,HCPCS,Facility,Both,,,,1050,892.5,300.93,1050,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,929.985,88.57,,percent of total billed charges,,
TRIM IT PIN 1.5MM  AR-4151DS,,C1713,HCPCS,Facility,Both,,,,1050,892.5,300.93,1050,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,300.93,28.66,,percent of total billed charges,,
TRIM IT PIN 1.5MM  AR-4151DS,,C1713,HCPCS,Facility,Outpatient,,,,1050,892.5,300.93,1050,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),514.5,49,,percent of total billed charges,,
TRIM IT PIN 1.5MM  AR-4151DS,,C1713,HCPCS,Facility,Inpatient,,,,1050,892.5,300.93,1050,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
TRIM IT PIN 1.5MM  AR-4151DS,,C1713,HCPCS,Facility,Both,,,,1050,892.5,300.93,1050,CorVel,Worker's Compensation,1050,100,,percent of total billed charges,,
TRIM IT PIN 1.5MM  AR-4151DS,,C1713,HCPCS,Facility,Both,,,,1050,892.5,300.93,1050,First Health Group Corporation,First Health Network,1018.5,97,,percent of total billed charges,,
TRIM IT PIN 1.5MM  AR-4151DS,,C1713,HCPCS,Facility,Both,,,,1050,892.5,300.93,1050,"Health Partners, Inc.",Commercial,993.3,94.6,,percent of total billed charges,,
TRIM IT PIN 1.5MM  AR-4151DS,,C1713,HCPCS,Facility,Outpatient,,,,1050,892.5,300.93,1050,"Health Partners, Inc.",Medicare Advantage,514.5,49,,percent of total billed charges,,
TRIM IT PIN 1.5MM  AR-4151DS,,C1713,HCPCS,Facility,Inpatient,,,,1050,892.5,300.93,1050,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
TRIM IT PIN 1.5MM  AR-4151DS,,C1713,HCPCS,Facility,Both,,,,1050,892.5,300.93,1050,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),630,60,,percent of total billed charges,,
TRIM IT PIN 1.5MM  AR-4151DS,,C1713,HCPCS,Facility,Both,,,,1050,892.5,300.93,1050,"Health Partners, Inc.",State of Minnesota Advantage Program,855.75,81.5,,percent of total billed charges,,
TRIM IT PIN 1.5MM  AR-4151DS,,C1713,HCPCS,Facility,Both,,,,1050,892.5,300.93,1050,"Health Partners, Inc.",State Public Programs,525,50,,percent of total billed charges,,
TRIM IT PIN 1.5MM  AR-4151DS,,C1713,HCPCS,Facility,Both,,,,1050,892.5,300.93,1050,Humana Insurance Company,Commercial PPO,997.5,95,,percent of total billed charges,,
TRIM IT PIN 1.5MM  AR-4151DS,,C1713,HCPCS,Facility,Outpatient,,,,1050,892.5,300.93,1050,Humana Insurance Company,Medicare PPO,514.5,49,,percent of total billed charges,,
TRIM IT PIN 1.5MM  AR-4151DS,,C1713,HCPCS,Facility,Inpatient,,,,1050,892.5,300.93,1050,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
TRIM IT PIN 1.5MM  AR-4151DS,,C1713,HCPCS,Facility,Both,,,,1050,892.5,300.93,1050,Medica,Individual & Family,1040.55,99.1,,percent of total billed charges,,
TRIM IT PIN 1.5MM  AR-4151DS,,C1713,HCPCS,Facility,Outpatient,,,,1050,892.5,300.93,1050,Medica,Medica Advantage Solution,522.9,49.8,,percent of total billed charges,,
TRIM IT PIN 1.5MM  AR-4151DS,,C1713,HCPCS,Facility,Inpatient,,,,1050,892.5,300.93,1050,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
TRIM IT PIN 1.5MM  AR-4151DS,,C1713,HCPCS,Facility,Outpatient,,,,1050,892.5,300.93,1050,Medica,Medical Assistance,468.3,44.6,,percent of total billed charges,,
TRIM IT PIN 1.5MM  AR-4151DS,,C1713,HCPCS,Facility,Inpatient,,,,1050,892.5,300.93,1050,Medica,Medical Assistance,,,,,Included in per diem rate,
TRIM IT PIN 1.5MM  AR-4151DS,,C1713,HCPCS,Facility,Outpatient,,,,1050,892.5,300.93,1050,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,522.9,49.8,,percent of total billed charges,,
TRIM IT PIN 1.5MM  AR-4151DS,,C1713,HCPCS,Facility,Inpatient,,,,1050,892.5,300.93,1050,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
TRIM IT PIN 1.5MM  AR-4151DS,,C1713,HCPCS,Facility,Both,,,,1050,892.5,300.93,1050,"Multiplan, Inc.","Multiplan, Inc.",987,94,,percent of total billed charges,,
TRIM IT PIN 1.5MM  AR-4151DS,,C1713,HCPCS,Facility,Outpatient,,,,1050,892.5,300.93,1050,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,946.05,90.1,,percent of total billed charges,,
TRIM IT PIN 1.5MM  AR-4151DS,,C1713,HCPCS,Facility,Inpatient,,,,1050,892.5,300.93,1050,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
TRIM IT PIN 1.5MM  AR-4151DS,,C1713,HCPCS,Facility,Both,,,,1050,892.5,300.93,1050,"Preferred One Administrative Services, INC.",PPO,1035.3,98.6,,percent of total billed charges,,
TRIM IT PIN 1.5MM  AR-4151DS,,C1713,HCPCS,Facility,Outpatient,,,,1050,892.5,300.93,1050,PrimeWest Health,Minnesota Senior Health Options (MSHO),540.225,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
TRIM IT PIN 1.5MM  AR-4151DS,,C1713,HCPCS,Facility,Inpatient,,,,1050,892.5,300.93,1050,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
TRIM IT PIN 1.5MM  AR-4151DS,,C1713,HCPCS,Facility,Outpatient,,,,1050,892.5,300.93,1050,PrimeWest Health,MinnesotaCare,539.28,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
TRIM IT PIN 1.5MM  AR-4151DS,,C1713,HCPCS,Facility,Inpatient,,,,1050,892.5,300.93,1050,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
TRIM IT PIN 1.5MM  AR-4151DS,,C1713,HCPCS,Facility,Both,,,,1050,892.5,300.93,1050,Sanford Health Plan,Sanford Health Plan,966,92,,percent of total billed charges,,
TRIM IT PIN 1.5MM  AR-4151DS,,C1713,HCPCS,Facility,Outpatient,,,,1050,892.5,300.93,1050,"UCare Health, Inc.",Individual & Family Plan,591.675,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
TRIM IT PIN 1.5MM  AR-4151DS,,C1713,HCPCS,Facility,Inpatient,,,,1050,892.5,300.93,1050,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
TRIM IT PIN 1.5MM  AR-4151DS,,C1713,HCPCS,Facility,Outpatient,,,,1050,892.5,300.93,1050,"UCare Health, Inc.",Medical Assistance,529.935,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TRIM IT PIN 1.5MM  AR-4151DS,,C1713,HCPCS,Facility,Inpatient,,,,1050,892.5,300.93,1050,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
TRIM IT PIN 1.5MM  AR-4151DS,,C1713,HCPCS,Facility,Outpatient,,,,1050,892.5,300.93,1050,"UCare Health, Inc.",Medicare Advantage,529.935,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TRIM IT PIN 1.5MM  AR-4151DS,,C1713,HCPCS,Facility,Inpatient,,,,1050,892.5,300.93,1050,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
TRIM IT PIN 1.5MM  AR-4151DS,,C1713,HCPCS,Facility,Outpatient,,,,1050,892.5,300.93,1050,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),529.935,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TRIM IT PIN 1.5MM  AR-4151DS,,C1713,HCPCS,Facility,Inpatient,,,,1050,892.5,300.93,1050,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
TRIM IT PIN 1.5MM  AR-4151DS,,C1713,HCPCS,Facility,Both,,,,1050,892.5,300.93,1050,UnitedHealthcare,Individual & Family,987,94,,percent of total billed charges,,
TRIM IT PIN 1.5MM  AR-4151DS,,C1713,HCPCS,Facility,Outpatient,,,,1050,892.5,300.93,1050,UnitedHealthcare,Medicare Advantage,514.5,49,,percent of total billed charges,,
TRIM IT PIN 1.5MM  AR-4151DS,,C1713,HCPCS,Facility,Inpatient,,,,1050,892.5,300.93,1050,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
TRIM IT PIN 1.5MM  AR-4151DS,,C1713,HCPCS,Facility,Outpatient,,,,1050,892.5,300.93,1050,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,504,48,,percent of total billed charges,,100% of DHS outpatient percentage
TRIM IT PIN 1.5MM  AR-4151DS,,C1713,HCPCS,Facility,Inpatient,,,,1050,892.5,300.93,1050,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
BALLOON WIRE CRE FIXED18MM-20MM,,C1726,HCPCS,Facility,Both,,,,835,709.75,239.311,835,Aetna,Commercial,768.2,92,,percent of total billed charges,,
BALLOON WIRE CRE FIXED18MM-20MM,,C1726,HCPCS,Facility,Outpatient,,,,835,709.75,239.311,835,Aetna,Medicare Advantage,409.15,49,,percent of total billed charges,,
BALLOON WIRE CRE FIXED18MM-20MM,,C1726,HCPCS,Facility,Inpatient,,,,835,709.75,239.311,835,Aetna,Medicare Advantage,,,,,Included in per diem rate,
BALLOON WIRE CRE FIXED18MM-20MM,,C1726,HCPCS,Facility,Both,,,,835,709.75,239.311,835,Aetna,PPO,776.55,93,,percent of total billed charges,,
BALLOON WIRE CRE FIXED18MM-20MM,,C1726,HCPCS,Facility,Both,,,,835,709.75,239.311,835,America's PPO,America's PPO,801.8505,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
BALLOON WIRE CRE FIXED18MM-20MM,,C1726,HCPCS,Facility,Both,,,,835,709.75,239.311,835,BlueCross BlueShield Minnesota, Federal Employee Program,821.64,98.4,,percent of total billed charges,,
BALLOON WIRE CRE FIXED18MM-20MM,,C1726,HCPCS,Facility,Both,,,,835,709.75,239.311,835,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,835,100,,percent of total billed charges,,
BALLOON WIRE CRE FIXED18MM-20MM,,C1726,HCPCS,Facility,Both,,,,835,709.75,239.311,835,BlueCross BlueShield Minnesota,High Value Network Plan,751.5,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
BALLOON WIRE CRE FIXED18MM-20MM,,C1726,HCPCS,Facility,Outpatient,,,,835,709.75,239.311,835,BlueCross BlueShield Minnesota,Medicare Advantage,409.15,49,,percent of total billed charges,,
BALLOON WIRE CRE FIXED18MM-20MM,,C1726,HCPCS,Facility,Inpatient,,,,835,709.75,239.311,835,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
BALLOON WIRE CRE FIXED18MM-20MM,,C1726,HCPCS,Facility,Both,,,,835,709.75,239.311,835,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,739.5595,88.57,,percent of total billed charges,,
BALLOON WIRE CRE FIXED18MM-20MM,,C1726,HCPCS,Facility,Both,,,,835,709.75,239.311,835,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,239.311,28.66,,percent of total billed charges,,
BALLOON WIRE CRE FIXED18MM-20MM,,C1726,HCPCS,Facility,Outpatient,,,,835,709.75,239.311,835,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),409.15,49,,percent of total billed charges,,
BALLOON WIRE CRE FIXED18MM-20MM,,C1726,HCPCS,Facility,Inpatient,,,,835,709.75,239.311,835,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
BALLOON WIRE CRE FIXED18MM-20MM,,C1726,HCPCS,Facility,Both,,,,835,709.75,239.311,835,CorVel,Worker's Compensation,835,100,,percent of total billed charges,,
BALLOON WIRE CRE FIXED18MM-20MM,,C1726,HCPCS,Facility,Both,,,,835,709.75,239.311,835,First Health Group Corporation,First Health Network,809.95,97,,percent of total billed charges,,
BALLOON WIRE CRE FIXED18MM-20MM,,C1726,HCPCS,Facility,Both,,,,835,709.75,239.311,835,"Health Partners, Inc.",Commercial,789.91,94.6,,percent of total billed charges,,
BALLOON WIRE CRE FIXED18MM-20MM,,C1726,HCPCS,Facility,Outpatient,,,,835,709.75,239.311,835,"Health Partners, Inc.",Medicare Advantage,409.15,49,,percent of total billed charges,,
BALLOON WIRE CRE FIXED18MM-20MM,,C1726,HCPCS,Facility,Inpatient,,,,835,709.75,239.311,835,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
BALLOON WIRE CRE FIXED18MM-20MM,,C1726,HCPCS,Facility,Both,,,,835,709.75,239.311,835,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),501,60,,percent of total billed charges,,
BALLOON WIRE CRE FIXED18MM-20MM,,C1726,HCPCS,Facility,Both,,,,835,709.75,239.311,835,"Health Partners, Inc.",State of Minnesota Advantage Program,680.525,81.5,,percent of total billed charges,,
BALLOON WIRE CRE FIXED18MM-20MM,,C1726,HCPCS,Facility,Both,,,,835,709.75,239.311,835,"Health Partners, Inc.",State Public Programs,417.5,50,,percent of total billed charges,,
BALLOON WIRE CRE FIXED18MM-20MM,,C1726,HCPCS,Facility,Both,,,,835,709.75,239.311,835,Humana Insurance Company,Commercial PPO,793.25,95,,percent of total billed charges,,
BALLOON WIRE CRE FIXED18MM-20MM,,C1726,HCPCS,Facility,Outpatient,,,,835,709.75,239.311,835,Humana Insurance Company,Medicare PPO,409.15,49,,percent of total billed charges,,
BALLOON WIRE CRE FIXED18MM-20MM,,C1726,HCPCS,Facility,Inpatient,,,,835,709.75,239.311,835,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
BALLOON WIRE CRE FIXED18MM-20MM,,C1726,HCPCS,Facility,Both,,,,835,709.75,239.311,835,Medica,Individual & Family,827.485,99.1,,percent of total billed charges,,
BALLOON WIRE CRE FIXED18MM-20MM,,C1726,HCPCS,Facility,Outpatient,,,,835,709.75,239.311,835,Medica,Medica Advantage Solution,415.83,49.8,,percent of total billed charges,,
BALLOON WIRE CRE FIXED18MM-20MM,,C1726,HCPCS,Facility,Inpatient,,,,835,709.75,239.311,835,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
BALLOON WIRE CRE FIXED18MM-20MM,,C1726,HCPCS,Facility,Outpatient,,,,835,709.75,239.311,835,Medica,Medical Assistance,372.41,44.6,,percent of total billed charges,,
BALLOON WIRE CRE FIXED18MM-20MM,,C1726,HCPCS,Facility,Inpatient,,,,835,709.75,239.311,835,Medica,Medical Assistance,,,,,Included in per diem rate,
BALLOON WIRE CRE FIXED18MM-20MM,,C1726,HCPCS,Facility,Outpatient,,,,835,709.75,239.311,835,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,415.83,49.8,,percent of total billed charges,,
BALLOON WIRE CRE FIXED18MM-20MM,,C1726,HCPCS,Facility,Inpatient,,,,835,709.75,239.311,835,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
BALLOON WIRE CRE FIXED18MM-20MM,,C1726,HCPCS,Facility,Both,,,,835,709.75,239.311,835,"Multiplan, Inc.","Multiplan, Inc.",784.9,94,,percent of total billed charges,,
BALLOON WIRE CRE FIXED18MM-20MM,,C1726,HCPCS,Facility,Outpatient,,,,835,709.75,239.311,835,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,752.335,90.1,,percent of total billed charges,,
BALLOON WIRE CRE FIXED18MM-20MM,,C1726,HCPCS,Facility,Inpatient,,,,835,709.75,239.311,835,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
BALLOON WIRE CRE FIXED18MM-20MM,,C1726,HCPCS,Facility,Both,,,,835,709.75,239.311,835,"Preferred One Administrative Services, INC.",PPO,823.31,98.6,,percent of total billed charges,,
BALLOON WIRE CRE FIXED18MM-20MM,,C1726,HCPCS,Facility,Outpatient,,,,835,709.75,239.311,835,PrimeWest Health,Minnesota Senior Health Options (MSHO),429.6075,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
BALLOON WIRE CRE FIXED18MM-20MM,,C1726,HCPCS,Facility,Inpatient,,,,835,709.75,239.311,835,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
BALLOON WIRE CRE FIXED18MM-20MM,,C1726,HCPCS,Facility,Outpatient,,,,835,709.75,239.311,835,PrimeWest Health,MinnesotaCare,428.856,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
BALLOON WIRE CRE FIXED18MM-20MM,,C1726,HCPCS,Facility,Inpatient,,,,835,709.75,239.311,835,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
BALLOON WIRE CRE FIXED18MM-20MM,,C1726,HCPCS,Facility,Both,,,,835,709.75,239.311,835,Sanford Health Plan,Sanford Health Plan,768.2,92,,percent of total billed charges,,
BALLOON WIRE CRE FIXED18MM-20MM,,C1726,HCPCS,Facility,Outpatient,,,,835,709.75,239.311,835,"UCare Health, Inc.",Individual & Family Plan,470.5225,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
BALLOON WIRE CRE FIXED18MM-20MM,,C1726,HCPCS,Facility,Inpatient,,,,835,709.75,239.311,835,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
BALLOON WIRE CRE FIXED18MM-20MM,,C1726,HCPCS,Facility,Outpatient,,,,835,709.75,239.311,835,"UCare Health, Inc.",Medical Assistance,421.4245,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BALLOON WIRE CRE FIXED18MM-20MM,,C1726,HCPCS,Facility,Inpatient,,,,835,709.75,239.311,835,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
BALLOON WIRE CRE FIXED18MM-20MM,,C1726,HCPCS,Facility,Outpatient,,,,835,709.75,239.311,835,"UCare Health, Inc.",Medicare Advantage,421.4245,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BALLOON WIRE CRE FIXED18MM-20MM,,C1726,HCPCS,Facility,Inpatient,,,,835,709.75,239.311,835,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
BALLOON WIRE CRE FIXED18MM-20MM,,C1726,HCPCS,Facility,Outpatient,,,,835,709.75,239.311,835,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),421.4245,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BALLOON WIRE CRE FIXED18MM-20MM,,C1726,HCPCS,Facility,Inpatient,,,,835,709.75,239.311,835,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
BALLOON WIRE CRE FIXED18MM-20MM,,C1726,HCPCS,Facility,Both,,,,835,709.75,239.311,835,UnitedHealthcare,Individual & Family,784.9,94,,percent of total billed charges,,
BALLOON WIRE CRE FIXED18MM-20MM,,C1726,HCPCS,Facility,Outpatient,,,,835,709.75,239.311,835,UnitedHealthcare,Medicare Advantage,409.15,49,,percent of total billed charges,,
BALLOON WIRE CRE FIXED18MM-20MM,,C1726,HCPCS,Facility,Inpatient,,,,835,709.75,239.311,835,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
BALLOON WIRE CRE FIXED18MM-20MM,,C1726,HCPCS,Facility,Outpatient,,,,835,709.75,239.311,835,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,400.8,48,,percent of total billed charges,,100% of DHS outpatient percentage
BALLOON WIRE CRE FIXED18MM-20MM,,C1726,HCPCS,Facility,Inpatient,,,,835,709.75,239.311,835,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
CATHETER BALLOON DILATION UROFORCE 18F 6MM X4 CM,,C1726,HCPCS,Facility,Both,,,,646.25,549.3125,185.21525,646.25,Aetna,Commercial,594.55,92,,percent of total billed charges,,
CATHETER BALLOON DILATION UROFORCE 18F 6MM X4 CM,,C1726,HCPCS,Facility,Outpatient,,,,646.25,549.3125,185.21525,646.25,Aetna,Medicare Advantage,316.6625,49,,percent of total billed charges,,
CATHETER BALLOON DILATION UROFORCE 18F 6MM X4 CM,,C1726,HCPCS,Facility,Inpatient,,,,646.25,549.3125,185.21525,646.25,Aetna,Medicare Advantage,,,,,Included in per diem rate,
CATHETER BALLOON DILATION UROFORCE 18F 6MM X4 CM,,C1726,HCPCS,Facility,Both,,,,646.25,549.3125,185.21525,646.25,Aetna,PPO,601.0125,93,,percent of total billed charges,,
CATHETER BALLOON DILATION UROFORCE 18F 6MM X4 CM,,C1726,HCPCS,Facility,Both,,,,646.25,549.3125,185.21525,646.25,America's PPO,America's PPO,620.593875,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
CATHETER BALLOON DILATION UROFORCE 18F 6MM X4 CM,,C1726,HCPCS,Facility,Both,,,,646.25,549.3125,185.21525,646.25,BlueCross BlueShield Minnesota, Federal Employee Program,635.91,98.4,,percent of total billed charges,,
CATHETER BALLOON DILATION UROFORCE 18F 6MM X4 CM,,C1726,HCPCS,Facility,Both,,,,646.25,549.3125,185.21525,646.25,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,646.25,100,,percent of total billed charges,,
CATHETER BALLOON DILATION UROFORCE 18F 6MM X4 CM,,C1726,HCPCS,Facility,Both,,,,646.25,549.3125,185.21525,646.25,BlueCross BlueShield Minnesota,High Value Network Plan,581.625,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
CATHETER BALLOON DILATION UROFORCE 18F 6MM X4 CM,,C1726,HCPCS,Facility,Outpatient,,,,646.25,549.3125,185.21525,646.25,BlueCross BlueShield Minnesota,Medicare Advantage,316.6625,49,,percent of total billed charges,,
CATHETER BALLOON DILATION UROFORCE 18F 6MM X4 CM,,C1726,HCPCS,Facility,Inpatient,,,,646.25,549.3125,185.21525,646.25,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
CATHETER BALLOON DILATION UROFORCE 18F 6MM X4 CM,,C1726,HCPCS,Facility,Both,,,,646.25,549.3125,185.21525,646.25,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,572.383625,88.57,,percent of total billed charges,,
CATHETER BALLOON DILATION UROFORCE 18F 6MM X4 CM,,C1726,HCPCS,Facility,Both,,,,646.25,549.3125,185.21525,646.25,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,185.21525,28.66,,percent of total billed charges,,
CATHETER BALLOON DILATION UROFORCE 18F 6MM X4 CM,,C1726,HCPCS,Facility,Outpatient,,,,646.25,549.3125,185.21525,646.25,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),316.6625,49,,percent of total billed charges,,
CATHETER BALLOON DILATION UROFORCE 18F 6MM X4 CM,,C1726,HCPCS,Facility,Inpatient,,,,646.25,549.3125,185.21525,646.25,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
CATHETER BALLOON DILATION UROFORCE 18F 6MM X4 CM,,C1726,HCPCS,Facility,Both,,,,646.25,549.3125,185.21525,646.25,CorVel,Worker's Compensation,646.25,100,,percent of total billed charges,,
CATHETER BALLOON DILATION UROFORCE 18F 6MM X4 CM,,C1726,HCPCS,Facility,Both,,,,646.25,549.3125,185.21525,646.25,First Health Group Corporation,First Health Network,626.8625,97,,percent of total billed charges,,
CATHETER BALLOON DILATION UROFORCE 18F 6MM X4 CM,,C1726,HCPCS,Facility,Both,,,,646.25,549.3125,185.21525,646.25,"Health Partners, Inc.",Commercial,611.3525,94.6,,percent of total billed charges,,
CATHETER BALLOON DILATION UROFORCE 18F 6MM X4 CM,,C1726,HCPCS,Facility,Outpatient,,,,646.25,549.3125,185.21525,646.25,"Health Partners, Inc.",Medicare Advantage,316.6625,49,,percent of total billed charges,,
CATHETER BALLOON DILATION UROFORCE 18F 6MM X4 CM,,C1726,HCPCS,Facility,Inpatient,,,,646.25,549.3125,185.21525,646.25,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CATHETER BALLOON DILATION UROFORCE 18F 6MM X4 CM,,C1726,HCPCS,Facility,Both,,,,646.25,549.3125,185.21525,646.25,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),387.75,60,,percent of total billed charges,,
CATHETER BALLOON DILATION UROFORCE 18F 6MM X4 CM,,C1726,HCPCS,Facility,Both,,,,646.25,549.3125,185.21525,646.25,"Health Partners, Inc.",State of Minnesota Advantage Program,526.69375,81.5,,percent of total billed charges,,
CATHETER BALLOON DILATION UROFORCE 18F 6MM X4 CM,,C1726,HCPCS,Facility,Both,,,,646.25,549.3125,185.21525,646.25,"Health Partners, Inc.",State Public Programs,323.125,50,,percent of total billed charges,,
CATHETER BALLOON DILATION UROFORCE 18F 6MM X4 CM,,C1726,HCPCS,Facility,Both,,,,646.25,549.3125,185.21525,646.25,Humana Insurance Company,Commercial PPO,613.9375,95,,percent of total billed charges,,
CATHETER BALLOON DILATION UROFORCE 18F 6MM X4 CM,,C1726,HCPCS,Facility,Outpatient,,,,646.25,549.3125,185.21525,646.25,Humana Insurance Company,Medicare PPO,316.6625,49,,percent of total billed charges,,
CATHETER BALLOON DILATION UROFORCE 18F 6MM X4 CM,,C1726,HCPCS,Facility,Inpatient,,,,646.25,549.3125,185.21525,646.25,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
CATHETER BALLOON DILATION UROFORCE 18F 6MM X4 CM,,C1726,HCPCS,Facility,Both,,,,646.25,549.3125,185.21525,646.25,Medica,Individual & Family,640.43375,99.1,,percent of total billed charges,,
CATHETER BALLOON DILATION UROFORCE 18F 6MM X4 CM,,C1726,HCPCS,Facility,Outpatient,,,,646.25,549.3125,185.21525,646.25,Medica,Medica Advantage Solution,321.8325,49.8,,percent of total billed charges,,
CATHETER BALLOON DILATION UROFORCE 18F 6MM X4 CM,,C1726,HCPCS,Facility,Inpatient,,,,646.25,549.3125,185.21525,646.25,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
CATHETER BALLOON DILATION UROFORCE 18F 6MM X4 CM,,C1726,HCPCS,Facility,Outpatient,,,,646.25,549.3125,185.21525,646.25,Medica,Medical Assistance,288.2275,44.6,,percent of total billed charges,,
CATHETER BALLOON DILATION UROFORCE 18F 6MM X4 CM,,C1726,HCPCS,Facility,Inpatient,,,,646.25,549.3125,185.21525,646.25,Medica,Medical Assistance,,,,,Included in per diem rate,
CATHETER BALLOON DILATION UROFORCE 18F 6MM X4 CM,,C1726,HCPCS,Facility,Outpatient,,,,646.25,549.3125,185.21525,646.25,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,321.8325,49.8,,percent of total billed charges,,
CATHETER BALLOON DILATION UROFORCE 18F 6MM X4 CM,,C1726,HCPCS,Facility,Inpatient,,,,646.25,549.3125,185.21525,646.25,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
CATHETER BALLOON DILATION UROFORCE 18F 6MM X4 CM,,C1726,HCPCS,Facility,Both,,,,646.25,549.3125,185.21525,646.25,"Multiplan, Inc.","Multiplan, Inc.",607.475,94,,percent of total billed charges,,
CATHETER BALLOON DILATION UROFORCE 18F 6MM X4 CM,,C1726,HCPCS,Facility,Outpatient,,,,646.25,549.3125,185.21525,646.25,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,582.27125,90.1,,percent of total billed charges,,
CATHETER BALLOON DILATION UROFORCE 18F 6MM X4 CM,,C1726,HCPCS,Facility,Inpatient,,,,646.25,549.3125,185.21525,646.25,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
CATHETER BALLOON DILATION UROFORCE 18F 6MM X4 CM,,C1726,HCPCS,Facility,Both,,,,646.25,549.3125,185.21525,646.25,"Preferred One Administrative Services, INC.",PPO,637.2025,98.6,,percent of total billed charges,,
CATHETER BALLOON DILATION UROFORCE 18F 6MM X4 CM,,C1726,HCPCS,Facility,Outpatient,,,,646.25,549.3125,185.21525,646.25,PrimeWest Health,Minnesota Senior Health Options (MSHO),332.495625,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
CATHETER BALLOON DILATION UROFORCE 18F 6MM X4 CM,,C1726,HCPCS,Facility,Inpatient,,,,646.25,549.3125,185.21525,646.25,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CATHETER BALLOON DILATION UROFORCE 18F 6MM X4 CM,,C1726,HCPCS,Facility,Outpatient,,,,646.25,549.3125,185.21525,646.25,PrimeWest Health,MinnesotaCare,331.914,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
CATHETER BALLOON DILATION UROFORCE 18F 6MM X4 CM,,C1726,HCPCS,Facility,Inpatient,,,,646.25,549.3125,185.21525,646.25,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
CATHETER BALLOON DILATION UROFORCE 18F 6MM X4 CM,,C1726,HCPCS,Facility,Both,,,,646.25,549.3125,185.21525,646.25,Sanford Health Plan,Sanford Health Plan,594.55,92,,percent of total billed charges,,
CATHETER BALLOON DILATION UROFORCE 18F 6MM X4 CM,,C1726,HCPCS,Facility,Outpatient,,,,646.25,549.3125,185.21525,646.25,"UCare Health, Inc.",Individual & Family Plan,364.161875,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
CATHETER BALLOON DILATION UROFORCE 18F 6MM X4 CM,,C1726,HCPCS,Facility,Inpatient,,,,646.25,549.3125,185.21525,646.25,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
CATHETER BALLOON DILATION UROFORCE 18F 6MM X4 CM,,C1726,HCPCS,Facility,Outpatient,,,,646.25,549.3125,185.21525,646.25,"UCare Health, Inc.",Medical Assistance,326.162375,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CATHETER BALLOON DILATION UROFORCE 18F 6MM X4 CM,,C1726,HCPCS,Facility,Inpatient,,,,646.25,549.3125,185.21525,646.25,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
CATHETER BALLOON DILATION UROFORCE 18F 6MM X4 CM,,C1726,HCPCS,Facility,Outpatient,,,,646.25,549.3125,185.21525,646.25,"UCare Health, Inc.",Medicare Advantage,326.162375,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CATHETER BALLOON DILATION UROFORCE 18F 6MM X4 CM,,C1726,HCPCS,Facility,Inpatient,,,,646.25,549.3125,185.21525,646.25,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CATHETER BALLOON DILATION UROFORCE 18F 6MM X4 CM,,C1726,HCPCS,Facility,Outpatient,,,,646.25,549.3125,185.21525,646.25,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),326.162375,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CATHETER BALLOON DILATION UROFORCE 18F 6MM X4 CM,,C1726,HCPCS,Facility,Inpatient,,,,646.25,549.3125,185.21525,646.25,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CATHETER BALLOON DILATION UROFORCE 18F 6MM X4 CM,,C1726,HCPCS,Facility,Both,,,,646.25,549.3125,185.21525,646.25,UnitedHealthcare,Individual & Family,607.475,94,,percent of total billed charges,,
CATHETER BALLOON DILATION UROFORCE 18F 6MM X4 CM,,C1726,HCPCS,Facility,Outpatient,,,,646.25,549.3125,185.21525,646.25,UnitedHealthcare,Medicare Advantage,316.6625,49,,percent of total billed charges,,
CATHETER BALLOON DILATION UROFORCE 18F 6MM X4 CM,,C1726,HCPCS,Facility,Inpatient,,,,646.25,549.3125,185.21525,646.25,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
CATHETER BALLOON DILATION UROFORCE 18F 6MM X4 CM,,C1726,HCPCS,Facility,Outpatient,,,,646.25,549.3125,185.21525,646.25,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,310.2,48,,percent of total billed charges,,100% of DHS outpatient percentage
CATHETER BALLOON DILATION UROFORCE 18F 6MM X4 CM,,C1726,HCPCS,Facility,Inpatient,,,,646.25,549.3125,185.21525,646.25,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
TROCAR STRUCTURAL HERNIA BALLOON 10MM  OMS-T10SB,,C1726,HCPCS,Facility,Both,,,,532.2,452.37,152.52852,532.2,Aetna,Commercial,489.624,92,,percent of total billed charges,,
TROCAR STRUCTURAL HERNIA BALLOON 10MM  OMS-T10SB,,C1726,HCPCS,Facility,Outpatient,,,,532.2,452.37,152.52852,532.2,Aetna,Medicare Advantage,260.778,49,,percent of total billed charges,,
TROCAR STRUCTURAL HERNIA BALLOON 10MM  OMS-T10SB,,C1726,HCPCS,Facility,Inpatient,,,,532.2,452.37,152.52852,532.2,Aetna,Medicare Advantage,,,,,Included in per diem rate,
TROCAR STRUCTURAL HERNIA BALLOON 10MM  OMS-T10SB,,C1726,HCPCS,Facility,Both,,,,532.2,452.37,152.52852,532.2,Aetna,PPO,494.946,93,,percent of total billed charges,,
TROCAR STRUCTURAL HERNIA BALLOON 10MM  OMS-T10SB,,C1726,HCPCS,Facility,Both,,,,532.2,452.37,152.52852,532.2,America's PPO,America's PPO,511.07166,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
TROCAR STRUCTURAL HERNIA BALLOON 10MM  OMS-T10SB,,C1726,HCPCS,Facility,Both,,,,532.2,452.37,152.52852,532.2,BlueCross BlueShield Minnesota, Federal Employee Program,523.6848,98.4,,percent of total billed charges,,
TROCAR STRUCTURAL HERNIA BALLOON 10MM  OMS-T10SB,,C1726,HCPCS,Facility,Both,,,,532.2,452.37,152.52852,532.2,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,532.2,100,,percent of total billed charges,,
TROCAR STRUCTURAL HERNIA BALLOON 10MM  OMS-T10SB,,C1726,HCPCS,Facility,Both,,,,532.2,452.37,152.52852,532.2,BlueCross BlueShield Minnesota,High Value Network Plan,478.98,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
TROCAR STRUCTURAL HERNIA BALLOON 10MM  OMS-T10SB,,C1726,HCPCS,Facility,Outpatient,,,,532.2,452.37,152.52852,532.2,BlueCross BlueShield Minnesota,Medicare Advantage,260.778,49,,percent of total billed charges,,
TROCAR STRUCTURAL HERNIA BALLOON 10MM  OMS-T10SB,,C1726,HCPCS,Facility,Inpatient,,,,532.2,452.37,152.52852,532.2,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
TROCAR STRUCTURAL HERNIA BALLOON 10MM  OMS-T10SB,,C1726,HCPCS,Facility,Both,,,,532.2,452.37,152.52852,532.2,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,471.36954,88.57,,percent of total billed charges,,
TROCAR STRUCTURAL HERNIA BALLOON 10MM  OMS-T10SB,,C1726,HCPCS,Facility,Both,,,,532.2,452.37,152.52852,532.2,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,152.52852,28.66,,percent of total billed charges,,
TROCAR STRUCTURAL HERNIA BALLOON 10MM  OMS-T10SB,,C1726,HCPCS,Facility,Outpatient,,,,532.2,452.37,152.52852,532.2,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),260.778,49,,percent of total billed charges,,
TROCAR STRUCTURAL HERNIA BALLOON 10MM  OMS-T10SB,,C1726,HCPCS,Facility,Inpatient,,,,532.2,452.37,152.52852,532.2,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
TROCAR STRUCTURAL HERNIA BALLOON 10MM  OMS-T10SB,,C1726,HCPCS,Facility,Both,,,,532.2,452.37,152.52852,532.2,CorVel,Worker's Compensation,532.2,100,,percent of total billed charges,,
TROCAR STRUCTURAL HERNIA BALLOON 10MM  OMS-T10SB,,C1726,HCPCS,Facility,Both,,,,532.2,452.37,152.52852,532.2,First Health Group Corporation,First Health Network,516.234,97,,percent of total billed charges,,
TROCAR STRUCTURAL HERNIA BALLOON 10MM  OMS-T10SB,,C1726,HCPCS,Facility,Both,,,,532.2,452.37,152.52852,532.2,"Health Partners, Inc.",Commercial,503.4612,94.6,,percent of total billed charges,,
TROCAR STRUCTURAL HERNIA BALLOON 10MM  OMS-T10SB,,C1726,HCPCS,Facility,Outpatient,,,,532.2,452.37,152.52852,532.2,"Health Partners, Inc.",Medicare Advantage,260.778,49,,percent of total billed charges,,
TROCAR STRUCTURAL HERNIA BALLOON 10MM  OMS-T10SB,,C1726,HCPCS,Facility,Inpatient,,,,532.2,452.37,152.52852,532.2,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
TROCAR STRUCTURAL HERNIA BALLOON 10MM  OMS-T10SB,,C1726,HCPCS,Facility,Both,,,,532.2,452.37,152.52852,532.2,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),319.32,60,,percent of total billed charges,,
TROCAR STRUCTURAL HERNIA BALLOON 10MM  OMS-T10SB,,C1726,HCPCS,Facility,Both,,,,532.2,452.37,152.52852,532.2,"Health Partners, Inc.",State of Minnesota Advantage Program,433.743,81.5,,percent of total billed charges,,
TROCAR STRUCTURAL HERNIA BALLOON 10MM  OMS-T10SB,,C1726,HCPCS,Facility,Both,,,,532.2,452.37,152.52852,532.2,"Health Partners, Inc.",State Public Programs,266.1,50,,percent of total billed charges,,
TROCAR STRUCTURAL HERNIA BALLOON 10MM  OMS-T10SB,,C1726,HCPCS,Facility,Both,,,,532.2,452.37,152.52852,532.2,Humana Insurance Company,Commercial PPO,505.59,95,,percent of total billed charges,,
TROCAR STRUCTURAL HERNIA BALLOON 10MM  OMS-T10SB,,C1726,HCPCS,Facility,Outpatient,,,,532.2,452.37,152.52852,532.2,Humana Insurance Company,Medicare PPO,260.778,49,,percent of total billed charges,,
TROCAR STRUCTURAL HERNIA BALLOON 10MM  OMS-T10SB,,C1726,HCPCS,Facility,Inpatient,,,,532.2,452.37,152.52852,532.2,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
TROCAR STRUCTURAL HERNIA BALLOON 10MM  OMS-T10SB,,C1726,HCPCS,Facility,Both,,,,532.2,452.37,152.52852,532.2,Medica,Individual & Family,527.4102,99.1,,percent of total billed charges,,
TROCAR STRUCTURAL HERNIA BALLOON 10MM  OMS-T10SB,,C1726,HCPCS,Facility,Outpatient,,,,532.2,452.37,152.52852,532.2,Medica,Medica Advantage Solution,265.0356,49.8,,percent of total billed charges,,
TROCAR STRUCTURAL HERNIA BALLOON 10MM  OMS-T10SB,,C1726,HCPCS,Facility,Inpatient,,,,532.2,452.37,152.52852,532.2,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
TROCAR STRUCTURAL HERNIA BALLOON 10MM  OMS-T10SB,,C1726,HCPCS,Facility,Outpatient,,,,532.2,452.37,152.52852,532.2,Medica,Medical Assistance,237.3612,44.6,,percent of total billed charges,,
TROCAR STRUCTURAL HERNIA BALLOON 10MM  OMS-T10SB,,C1726,HCPCS,Facility,Inpatient,,,,532.2,452.37,152.52852,532.2,Medica,Medical Assistance,,,,,Included in per diem rate,
TROCAR STRUCTURAL HERNIA BALLOON 10MM  OMS-T10SB,,C1726,HCPCS,Facility,Outpatient,,,,532.2,452.37,152.52852,532.2,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,265.0356,49.8,,percent of total billed charges,,
TROCAR STRUCTURAL HERNIA BALLOON 10MM  OMS-T10SB,,C1726,HCPCS,Facility,Inpatient,,,,532.2,452.37,152.52852,532.2,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
TROCAR STRUCTURAL HERNIA BALLOON 10MM  OMS-T10SB,,C1726,HCPCS,Facility,Both,,,,532.2,452.37,152.52852,532.2,"Multiplan, Inc.","Multiplan, Inc.",500.268,94,,percent of total billed charges,,
TROCAR STRUCTURAL HERNIA BALLOON 10MM  OMS-T10SB,,C1726,HCPCS,Facility,Outpatient,,,,532.2,452.37,152.52852,532.2,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,479.5122,90.1,,percent of total billed charges,,
TROCAR STRUCTURAL HERNIA BALLOON 10MM  OMS-T10SB,,C1726,HCPCS,Facility,Inpatient,,,,532.2,452.37,152.52852,532.2,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
TROCAR STRUCTURAL HERNIA BALLOON 10MM  OMS-T10SB,,C1726,HCPCS,Facility,Both,,,,532.2,452.37,152.52852,532.2,"Preferred One Administrative Services, INC.",PPO,524.7492,98.6,,percent of total billed charges,,
TROCAR STRUCTURAL HERNIA BALLOON 10MM  OMS-T10SB,,C1726,HCPCS,Facility,Outpatient,,,,532.2,452.37,152.52852,532.2,PrimeWest Health,Minnesota Senior Health Options (MSHO),273.8169,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
TROCAR STRUCTURAL HERNIA BALLOON 10MM  OMS-T10SB,,C1726,HCPCS,Facility,Inpatient,,,,532.2,452.37,152.52852,532.2,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
TROCAR STRUCTURAL HERNIA BALLOON 10MM  OMS-T10SB,,C1726,HCPCS,Facility,Outpatient,,,,532.2,452.37,152.52852,532.2,PrimeWest Health,MinnesotaCare,273.33792,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
TROCAR STRUCTURAL HERNIA BALLOON 10MM  OMS-T10SB,,C1726,HCPCS,Facility,Inpatient,,,,532.2,452.37,152.52852,532.2,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
TROCAR STRUCTURAL HERNIA BALLOON 10MM  OMS-T10SB,,C1726,HCPCS,Facility,Both,,,,532.2,452.37,152.52852,532.2,Sanford Health Plan,Sanford Health Plan,489.624,92,,percent of total billed charges,,
TROCAR STRUCTURAL HERNIA BALLOON 10MM  OMS-T10SB,,C1726,HCPCS,Facility,Outpatient,,,,532.2,452.37,152.52852,532.2,"UCare Health, Inc.",Individual & Family Plan,299.8947,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
TROCAR STRUCTURAL HERNIA BALLOON 10MM  OMS-T10SB,,C1726,HCPCS,Facility,Inpatient,,,,532.2,452.37,152.52852,532.2,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
TROCAR STRUCTURAL HERNIA BALLOON 10MM  OMS-T10SB,,C1726,HCPCS,Facility,Outpatient,,,,532.2,452.37,152.52852,532.2,"UCare Health, Inc.",Medical Assistance,268.60134,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TROCAR STRUCTURAL HERNIA BALLOON 10MM  OMS-T10SB,,C1726,HCPCS,Facility,Inpatient,,,,532.2,452.37,152.52852,532.2,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
TROCAR STRUCTURAL HERNIA BALLOON 10MM  OMS-T10SB,,C1726,HCPCS,Facility,Outpatient,,,,532.2,452.37,152.52852,532.2,"UCare Health, Inc.",Medicare Advantage,268.60134,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TROCAR STRUCTURAL HERNIA BALLOON 10MM  OMS-T10SB,,C1726,HCPCS,Facility,Inpatient,,,,532.2,452.37,152.52852,532.2,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
TROCAR STRUCTURAL HERNIA BALLOON 10MM  OMS-T10SB,,C1726,HCPCS,Facility,Outpatient,,,,532.2,452.37,152.52852,532.2,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),268.60134,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TROCAR STRUCTURAL HERNIA BALLOON 10MM  OMS-T10SB,,C1726,HCPCS,Facility,Inpatient,,,,532.2,452.37,152.52852,532.2,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
TROCAR STRUCTURAL HERNIA BALLOON 10MM  OMS-T10SB,,C1726,HCPCS,Facility,Both,,,,532.2,452.37,152.52852,532.2,UnitedHealthcare,Individual & Family,500.268,94,,percent of total billed charges,,
TROCAR STRUCTURAL HERNIA BALLOON 10MM  OMS-T10SB,,C1726,HCPCS,Facility,Outpatient,,,,532.2,452.37,152.52852,532.2,UnitedHealthcare,Medicare Advantage,260.778,49,,percent of total billed charges,,
TROCAR STRUCTURAL HERNIA BALLOON 10MM  OMS-T10SB,,C1726,HCPCS,Facility,Inpatient,,,,532.2,452.37,152.52852,532.2,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
TROCAR STRUCTURAL HERNIA BALLOON 10MM  OMS-T10SB,,C1726,HCPCS,Facility,Outpatient,,,,532.2,452.37,152.52852,532.2,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,255.456,48,,percent of total billed charges,,100% of DHS outpatient percentage
TROCAR STRUCTURAL HERNIA BALLOON 10MM  OMS-T10SB,,C1726,HCPCS,Facility,Inpatient,,,,532.2,452.37,152.52852,532.2,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
ENDOSCOPIC BALLOON BILATERAL DISSECTOR KIDNEY SHAPE  OMS-PDBS2,,C1727,HCPCS,Facility,Both,,,,1220.7,1037.595,349.85262,1220.7,Aetna,Commercial,1123.044,92,,percent of total billed charges,,
ENDOSCOPIC BALLOON BILATERAL DISSECTOR KIDNEY SHAPE  OMS-PDBS2,,C1727,HCPCS,Facility,Outpatient,,,,1220.7,1037.595,349.85262,1220.7,Aetna,Medicare Advantage,598.143,49,,percent of total billed charges,,
ENDOSCOPIC BALLOON BILATERAL DISSECTOR KIDNEY SHAPE  OMS-PDBS2,,C1727,HCPCS,Facility,Inpatient,,,,1220.7,1037.595,349.85262,1220.7,Aetna,Medicare Advantage,,,,,Included in per diem rate,
ENDOSCOPIC BALLOON BILATERAL DISSECTOR KIDNEY SHAPE  OMS-PDBS2,,C1727,HCPCS,Facility,Both,,,,1220.7,1037.595,349.85262,1220.7,Aetna,PPO,1135.251,93,,percent of total billed charges,,
ENDOSCOPIC BALLOON BILATERAL DISSECTOR KIDNEY SHAPE  OMS-PDBS2,,C1727,HCPCS,Facility,Both,,,,1220.7,1037.595,349.85262,1220.7,America's PPO,America's PPO,1172.23821,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
ENDOSCOPIC BALLOON BILATERAL DISSECTOR KIDNEY SHAPE  OMS-PDBS2,,C1727,HCPCS,Facility,Both,,,,1220.7,1037.595,349.85262,1220.7,BlueCross BlueShield Minnesota, Federal Employee Program,1201.1688,98.4,,percent of total billed charges,,
ENDOSCOPIC BALLOON BILATERAL DISSECTOR KIDNEY SHAPE  OMS-PDBS2,,C1727,HCPCS,Facility,Both,,,,1220.7,1037.595,349.85262,1220.7,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1220.7,100,,percent of total billed charges,,
ENDOSCOPIC BALLOON BILATERAL DISSECTOR KIDNEY SHAPE  OMS-PDBS2,,C1727,HCPCS,Facility,Both,,,,1220.7,1037.595,349.85262,1220.7,BlueCross BlueShield Minnesota,High Value Network Plan,1098.63,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
ENDOSCOPIC BALLOON BILATERAL DISSECTOR KIDNEY SHAPE  OMS-PDBS2,,C1727,HCPCS,Facility,Outpatient,,,,1220.7,1037.595,349.85262,1220.7,BlueCross BlueShield Minnesota,Medicare Advantage,598.143,49,,percent of total billed charges,,
ENDOSCOPIC BALLOON BILATERAL DISSECTOR KIDNEY SHAPE  OMS-PDBS2,,C1727,HCPCS,Facility,Inpatient,,,,1220.7,1037.595,349.85262,1220.7,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
ENDOSCOPIC BALLOON BILATERAL DISSECTOR KIDNEY SHAPE  OMS-PDBS2,,C1727,HCPCS,Facility,Both,,,,1220.7,1037.595,349.85262,1220.7,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1081.17399,88.57,,percent of total billed charges,,
ENDOSCOPIC BALLOON BILATERAL DISSECTOR KIDNEY SHAPE  OMS-PDBS2,,C1727,HCPCS,Facility,Both,,,,1220.7,1037.595,349.85262,1220.7,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,349.85262,28.66,,percent of total billed charges,,
ENDOSCOPIC BALLOON BILATERAL DISSECTOR KIDNEY SHAPE  OMS-PDBS2,,C1727,HCPCS,Facility,Outpatient,,,,1220.7,1037.595,349.85262,1220.7,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),598.143,49,,percent of total billed charges,,
ENDOSCOPIC BALLOON BILATERAL DISSECTOR KIDNEY SHAPE  OMS-PDBS2,,C1727,HCPCS,Facility,Inpatient,,,,1220.7,1037.595,349.85262,1220.7,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
ENDOSCOPIC BALLOON BILATERAL DISSECTOR KIDNEY SHAPE  OMS-PDBS2,,C1727,HCPCS,Facility,Both,,,,1220.7,1037.595,349.85262,1220.7,CorVel,Worker's Compensation,1220.7,100,,percent of total billed charges,,
ENDOSCOPIC BALLOON BILATERAL DISSECTOR KIDNEY SHAPE  OMS-PDBS2,,C1727,HCPCS,Facility,Both,,,,1220.7,1037.595,349.85262,1220.7,First Health Group Corporation,First Health Network,1184.079,97,,percent of total billed charges,,
ENDOSCOPIC BALLOON BILATERAL DISSECTOR KIDNEY SHAPE  OMS-PDBS2,,C1727,HCPCS,Facility,Both,,,,1220.7,1037.595,349.85262,1220.7,"Health Partners, Inc.",Commercial,1154.7822,94.6,,percent of total billed charges,,
ENDOSCOPIC BALLOON BILATERAL DISSECTOR KIDNEY SHAPE  OMS-PDBS2,,C1727,HCPCS,Facility,Outpatient,,,,1220.7,1037.595,349.85262,1220.7,"Health Partners, Inc.",Medicare Advantage,598.143,49,,percent of total billed charges,,
ENDOSCOPIC BALLOON BILATERAL DISSECTOR KIDNEY SHAPE  OMS-PDBS2,,C1727,HCPCS,Facility,Inpatient,,,,1220.7,1037.595,349.85262,1220.7,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ENDOSCOPIC BALLOON BILATERAL DISSECTOR KIDNEY SHAPE  OMS-PDBS2,,C1727,HCPCS,Facility,Both,,,,1220.7,1037.595,349.85262,1220.7,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),732.42,60,,percent of total billed charges,,
ENDOSCOPIC BALLOON BILATERAL DISSECTOR KIDNEY SHAPE  OMS-PDBS2,,C1727,HCPCS,Facility,Both,,,,1220.7,1037.595,349.85262,1220.7,"Health Partners, Inc.",State of Minnesota Advantage Program,994.8705,81.5,,percent of total billed charges,,
ENDOSCOPIC BALLOON BILATERAL DISSECTOR KIDNEY SHAPE  OMS-PDBS2,,C1727,HCPCS,Facility,Both,,,,1220.7,1037.595,349.85262,1220.7,"Health Partners, Inc.",State Public Programs,610.35,50,,percent of total billed charges,,
ENDOSCOPIC BALLOON BILATERAL DISSECTOR KIDNEY SHAPE  OMS-PDBS2,,C1727,HCPCS,Facility,Both,,,,1220.7,1037.595,349.85262,1220.7,Humana Insurance Company,Commercial PPO,1159.665,95,,percent of total billed charges,,
ENDOSCOPIC BALLOON BILATERAL DISSECTOR KIDNEY SHAPE  OMS-PDBS2,,C1727,HCPCS,Facility,Outpatient,,,,1220.7,1037.595,349.85262,1220.7,Humana Insurance Company,Medicare PPO,598.143,49,,percent of total billed charges,,
ENDOSCOPIC BALLOON BILATERAL DISSECTOR KIDNEY SHAPE  OMS-PDBS2,,C1727,HCPCS,Facility,Inpatient,,,,1220.7,1037.595,349.85262,1220.7,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
ENDOSCOPIC BALLOON BILATERAL DISSECTOR KIDNEY SHAPE  OMS-PDBS2,,C1727,HCPCS,Facility,Both,,,,1220.7,1037.595,349.85262,1220.7,Medica,Individual & Family,1209.7137,99.1,,percent of total billed charges,,
ENDOSCOPIC BALLOON BILATERAL DISSECTOR KIDNEY SHAPE  OMS-PDBS2,,C1727,HCPCS,Facility,Outpatient,,,,1220.7,1037.595,349.85262,1220.7,Medica,Medica Advantage Solution,607.9086,49.8,,percent of total billed charges,,
ENDOSCOPIC BALLOON BILATERAL DISSECTOR KIDNEY SHAPE  OMS-PDBS2,,C1727,HCPCS,Facility,Inpatient,,,,1220.7,1037.595,349.85262,1220.7,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
ENDOSCOPIC BALLOON BILATERAL DISSECTOR KIDNEY SHAPE  OMS-PDBS2,,C1727,HCPCS,Facility,Outpatient,,,,1220.7,1037.595,349.85262,1220.7,Medica,Medical Assistance,544.4322,44.6,,percent of total billed charges,,
ENDOSCOPIC BALLOON BILATERAL DISSECTOR KIDNEY SHAPE  OMS-PDBS2,,C1727,HCPCS,Facility,Inpatient,,,,1220.7,1037.595,349.85262,1220.7,Medica,Medical Assistance,,,,,Included in per diem rate,
ENDOSCOPIC BALLOON BILATERAL DISSECTOR KIDNEY SHAPE  OMS-PDBS2,,C1727,HCPCS,Facility,Outpatient,,,,1220.7,1037.595,349.85262,1220.7,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,607.9086,49.8,,percent of total billed charges,,
ENDOSCOPIC BALLOON BILATERAL DISSECTOR KIDNEY SHAPE  OMS-PDBS2,,C1727,HCPCS,Facility,Inpatient,,,,1220.7,1037.595,349.85262,1220.7,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
ENDOSCOPIC BALLOON BILATERAL DISSECTOR KIDNEY SHAPE  OMS-PDBS2,,C1727,HCPCS,Facility,Both,,,,1220.7,1037.595,349.85262,1220.7,"Multiplan, Inc.","Multiplan, Inc.",1147.458,94,,percent of total billed charges,,
ENDOSCOPIC BALLOON BILATERAL DISSECTOR KIDNEY SHAPE  OMS-PDBS2,,C1727,HCPCS,Facility,Outpatient,,,,1220.7,1037.595,349.85262,1220.7,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1099.8507,90.1,,percent of total billed charges,,
ENDOSCOPIC BALLOON BILATERAL DISSECTOR KIDNEY SHAPE  OMS-PDBS2,,C1727,HCPCS,Facility,Inpatient,,,,1220.7,1037.595,349.85262,1220.7,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
ENDOSCOPIC BALLOON BILATERAL DISSECTOR KIDNEY SHAPE  OMS-PDBS2,,C1727,HCPCS,Facility,Both,,,,1220.7,1037.595,349.85262,1220.7,"Preferred One Administrative Services, INC.",PPO,1203.6102,98.6,,percent of total billed charges,,
ENDOSCOPIC BALLOON BILATERAL DISSECTOR KIDNEY SHAPE  OMS-PDBS2,,C1727,HCPCS,Facility,Outpatient,,,,1220.7,1037.595,349.85262,1220.7,PrimeWest Health,Minnesota Senior Health Options (MSHO),628.05015,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
ENDOSCOPIC BALLOON BILATERAL DISSECTOR KIDNEY SHAPE  OMS-PDBS2,,C1727,HCPCS,Facility,Inpatient,,,,1220.7,1037.595,349.85262,1220.7,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ENDOSCOPIC BALLOON BILATERAL DISSECTOR KIDNEY SHAPE  OMS-PDBS2,,C1727,HCPCS,Facility,Outpatient,,,,1220.7,1037.595,349.85262,1220.7,PrimeWest Health,MinnesotaCare,626.95152,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
ENDOSCOPIC BALLOON BILATERAL DISSECTOR KIDNEY SHAPE  OMS-PDBS2,,C1727,HCPCS,Facility,Inpatient,,,,1220.7,1037.595,349.85262,1220.7,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
ENDOSCOPIC BALLOON BILATERAL DISSECTOR KIDNEY SHAPE  OMS-PDBS2,,C1727,HCPCS,Facility,Both,,,,1220.7,1037.595,349.85262,1220.7,Sanford Health Plan,Sanford Health Plan,1123.044,92,,percent of total billed charges,,
ENDOSCOPIC BALLOON BILATERAL DISSECTOR KIDNEY SHAPE  OMS-PDBS2,,C1727,HCPCS,Facility,Outpatient,,,,1220.7,1037.595,349.85262,1220.7,"UCare Health, Inc.",Individual & Family Plan,687.86445,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
ENDOSCOPIC BALLOON BILATERAL DISSECTOR KIDNEY SHAPE  OMS-PDBS2,,C1727,HCPCS,Facility,Inpatient,,,,1220.7,1037.595,349.85262,1220.7,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
ENDOSCOPIC BALLOON BILATERAL DISSECTOR KIDNEY SHAPE  OMS-PDBS2,,C1727,HCPCS,Facility,Outpatient,,,,1220.7,1037.595,349.85262,1220.7,"UCare Health, Inc.",Medical Assistance,616.08729,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ENDOSCOPIC BALLOON BILATERAL DISSECTOR KIDNEY SHAPE  OMS-PDBS2,,C1727,HCPCS,Facility,Inpatient,,,,1220.7,1037.595,349.85262,1220.7,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
ENDOSCOPIC BALLOON BILATERAL DISSECTOR KIDNEY SHAPE  OMS-PDBS2,,C1727,HCPCS,Facility,Outpatient,,,,1220.7,1037.595,349.85262,1220.7,"UCare Health, Inc.",Medicare Advantage,616.08729,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ENDOSCOPIC BALLOON BILATERAL DISSECTOR KIDNEY SHAPE  OMS-PDBS2,,C1727,HCPCS,Facility,Inpatient,,,,1220.7,1037.595,349.85262,1220.7,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ENDOSCOPIC BALLOON BILATERAL DISSECTOR KIDNEY SHAPE  OMS-PDBS2,,C1727,HCPCS,Facility,Outpatient,,,,1220.7,1037.595,349.85262,1220.7,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),616.08729,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ENDOSCOPIC BALLOON BILATERAL DISSECTOR KIDNEY SHAPE  OMS-PDBS2,,C1727,HCPCS,Facility,Inpatient,,,,1220.7,1037.595,349.85262,1220.7,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ENDOSCOPIC BALLOON BILATERAL DISSECTOR KIDNEY SHAPE  OMS-PDBS2,,C1727,HCPCS,Facility,Both,,,,1220.7,1037.595,349.85262,1220.7,UnitedHealthcare,Individual & Family,1147.458,94,,percent of total billed charges,,
ENDOSCOPIC BALLOON BILATERAL DISSECTOR KIDNEY SHAPE  OMS-PDBS2,,C1727,HCPCS,Facility,Outpatient,,,,1220.7,1037.595,349.85262,1220.7,UnitedHealthcare,Medicare Advantage,598.143,49,,percent of total billed charges,,
ENDOSCOPIC BALLOON BILATERAL DISSECTOR KIDNEY SHAPE  OMS-PDBS2,,C1727,HCPCS,Facility,Inpatient,,,,1220.7,1037.595,349.85262,1220.7,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
ENDOSCOPIC BALLOON BILATERAL DISSECTOR KIDNEY SHAPE  OMS-PDBS2,,C1727,HCPCS,Facility,Outpatient,,,,1220.7,1037.595,349.85262,1220.7,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,585.936,48,,percent of total billed charges,,100% of DHS outpatient percentage
ENDOSCOPIC BALLOON BILATERAL DISSECTOR KIDNEY SHAPE  OMS-PDBS2,,C1727,HCPCS,Facility,Inpatient,,,,1220.7,1037.595,349.85262,1220.7,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Sup Cath Thoracic,,C1729,HCPCS,Facility,Both,,,,51,43.35,14.6166,51,Aetna,Commercial,46.92,92,,percent of total billed charges,,
Sup Cath Thoracic,,C1729,HCPCS,Facility,Outpatient,,,,51,43.35,14.6166,51,Aetna,Medicare Advantage,24.99,49,,percent of total billed charges,,
Sup Cath Thoracic,,C1729,HCPCS,Facility,Inpatient,,,,51,43.35,14.6166,51,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Sup Cath Thoracic,,C1729,HCPCS,Facility,Both,,,,51,43.35,14.6166,51,Aetna,PPO,47.43,93,,percent of total billed charges,,
Sup Cath Thoracic,,C1729,HCPCS,Facility,Both,,,,51,43.35,14.6166,51,America's PPO,America's PPO,48.9753,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Sup Cath Thoracic,,C1729,HCPCS,Facility,Both,,,,51,43.35,14.6166,51,BlueCross BlueShield Minnesota, Federal Employee Program,50.184,98.4,,percent of total billed charges,,
Sup Cath Thoracic,,C1729,HCPCS,Facility,Both,,,,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,51,100,,percent of total billed charges,,
Sup Cath Thoracic,,C1729,HCPCS,Facility,Both,,,,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,High Value Network Plan,45.9,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
Sup Cath Thoracic,,C1729,HCPCS,Facility,Outpatient,,,,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,Medicare Advantage,24.99,49,,percent of total billed charges,,
Sup Cath Thoracic,,C1729,HCPCS,Facility,Inpatient,,,,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Sup Cath Thoracic,,C1729,HCPCS,Facility,Both,,,,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,45.1707,88.57,,percent of total billed charges,,
Sup Cath Thoracic,,C1729,HCPCS,Facility,Both,,,,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,14.6166,28.66,,percent of total billed charges,,
Sup Cath Thoracic,,C1729,HCPCS,Facility,Outpatient,,,,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),24.99,49,,percent of total billed charges,,
Sup Cath Thoracic,,C1729,HCPCS,Facility,Inpatient,,,,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Sup Cath Thoracic,,C1729,HCPCS,Facility,Both,,,,51,43.35,14.6166,51,CorVel,Worker's Compensation,51,100,,percent of total billed charges,,
Sup Cath Thoracic,,C1729,HCPCS,Facility,Both,,,,51,43.35,14.6166,51,First Health Group Corporation,First Health Network,49.47,97,,percent of total billed charges,,
Sup Cath Thoracic,,C1729,HCPCS,Facility,Both,,,,51,43.35,14.6166,51,"Health Partners, Inc.",Commercial,48.246,94.6,,percent of total billed charges,,
Sup Cath Thoracic,,C1729,HCPCS,Facility,Outpatient,,,,51,43.35,14.6166,51,"Health Partners, Inc.",Medicare Advantage,24.99,49,,percent of total billed charges,,
Sup Cath Thoracic,,C1729,HCPCS,Facility,Inpatient,,,,51,43.35,14.6166,51,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Cath Thoracic,,C1729,HCPCS,Facility,Both,,,,51,43.35,14.6166,51,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),30.6,60,,percent of total billed charges,,
Sup Cath Thoracic,,C1729,HCPCS,Facility,Both,,,,51,43.35,14.6166,51,"Health Partners, Inc.",State of Minnesota Advantage Program,41.565,81.5,,percent of total billed charges,,
Sup Cath Thoracic,,C1729,HCPCS,Facility,Both,,,,51,43.35,14.6166,51,"Health Partners, Inc.",State Public Programs,25.5,50,,percent of total billed charges,,
Sup Cath Thoracic,,C1729,HCPCS,Facility,Both,,,,51,43.35,14.6166,51,Humana Insurance Company,Commercial PPO,48.45,95,,percent of total billed charges,,
Sup Cath Thoracic,,C1729,HCPCS,Facility,Outpatient,,,,51,43.35,14.6166,51,Humana Insurance Company,Medicare PPO,24.99,49,,percent of total billed charges,,
Sup Cath Thoracic,,C1729,HCPCS,Facility,Inpatient,,,,51,43.35,14.6166,51,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Sup Cath Thoracic,,C1729,HCPCS,Facility,Both,,,,51,43.35,14.6166,51,Medica,Individual & Family,50.541,99.1,,percent of total billed charges,,
Sup Cath Thoracic,,C1729,HCPCS,Facility,Outpatient,,,,51,43.35,14.6166,51,Medica,Medica Advantage Solution,25.398,49.8,,percent of total billed charges,,
Sup Cath Thoracic,,C1729,HCPCS,Facility,Inpatient,,,,51,43.35,14.6166,51,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Sup Cath Thoracic,,C1729,HCPCS,Facility,Outpatient,,,,51,43.35,14.6166,51,Medica,Medical Assistance,22.746,44.6,,percent of total billed charges,,
Sup Cath Thoracic,,C1729,HCPCS,Facility,Inpatient,,,,51,43.35,14.6166,51,Medica,Medical Assistance,,,,,Included in per diem rate,
Sup Cath Thoracic,,C1729,HCPCS,Facility,Outpatient,,,,51,43.35,14.6166,51,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,25.398,49.8,,percent of total billed charges,,
Sup Cath Thoracic,,C1729,HCPCS,Facility,Inpatient,,,,51,43.35,14.6166,51,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Sup Cath Thoracic,,C1729,HCPCS,Facility,Both,,,,51,43.35,14.6166,51,"Multiplan, Inc.","Multiplan, Inc.",47.94,94,,percent of total billed charges,,
Sup Cath Thoracic,,C1729,HCPCS,Facility,Outpatient,,,,51,43.35,14.6166,51,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,45.951,90.1,,percent of total billed charges,,
Sup Cath Thoracic,,C1729,HCPCS,Facility,Inpatient,,,,51,43.35,14.6166,51,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Sup Cath Thoracic,,C1729,HCPCS,Facility,Both,,,,51,43.35,14.6166,51,"Preferred One Administrative Services, INC.",PPO,50.286,98.6,,percent of total billed charges,,
Sup Cath Thoracic,,C1729,HCPCS,Facility,Outpatient,,,,51,43.35,14.6166,51,PrimeWest Health,Minnesota Senior Health Options (MSHO),26.2395,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Sup Cath Thoracic,,C1729,HCPCS,Facility,Inpatient,,,,51,43.35,14.6166,51,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Cath Thoracic,,C1729,HCPCS,Facility,Outpatient,,,,51,43.35,14.6166,51,PrimeWest Health,MinnesotaCare,26.1936,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Sup Cath Thoracic,,C1729,HCPCS,Facility,Inpatient,,,,51,43.35,14.6166,51,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Sup Cath Thoracic,,C1729,HCPCS,Facility,Both,,,,51,43.35,14.6166,51,Sanford Health Plan,Sanford Health Plan,46.92,92,,percent of total billed charges,,
Sup Cath Thoracic,,C1729,HCPCS,Facility,Outpatient,,,,51,43.35,14.6166,51,"UCare Health, Inc.",Individual & Family Plan,28.7385,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Sup Cath Thoracic,,C1729,HCPCS,Facility,Inpatient,,,,51,43.35,14.6166,51,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Sup Cath Thoracic,,C1729,HCPCS,Facility,Outpatient,,,,51,43.35,14.6166,51,"UCare Health, Inc.",Medical Assistance,25.7397,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Cath Thoracic,,C1729,HCPCS,Facility,Inpatient,,,,51,43.35,14.6166,51,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Sup Cath Thoracic,,C1729,HCPCS,Facility,Outpatient,,,,51,43.35,14.6166,51,"UCare Health, Inc.",Medicare Advantage,25.7397,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Cath Thoracic,,C1729,HCPCS,Facility,Inpatient,,,,51,43.35,14.6166,51,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Cath Thoracic,,C1729,HCPCS,Facility,Outpatient,,,,51,43.35,14.6166,51,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),25.7397,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Cath Thoracic,,C1729,HCPCS,Facility,Inpatient,,,,51,43.35,14.6166,51,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Cath Thoracic,,C1729,HCPCS,Facility,Both,,,,51,43.35,14.6166,51,UnitedHealthcare,Individual & Family,47.94,94,,percent of total billed charges,,
Sup Cath Thoracic,,C1729,HCPCS,Facility,Outpatient,,,,51,43.35,14.6166,51,UnitedHealthcare,Medicare Advantage,24.99,49,,percent of total billed charges,,
Sup Cath Thoracic,,C1729,HCPCS,Facility,Inpatient,,,,51,43.35,14.6166,51,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Sup Cath Thoracic,,C1729,HCPCS,Facility,Outpatient,,,,51,43.35,14.6166,51,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,24.48,48,,percent of total billed charges,,100% of DHS outpatient percentage
Sup Cath Thoracic,,C1729,HCPCS,Facility,Inpatient,,,,51,43.35,14.6166,51,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
RADIOFREQUENCY ABLATION CATHETER 7X60CM  CF7-3-60,,C1733,HCPCS,Facility,Both,,,,1863.22,1583.737,533.998852,1863.22,Aetna,Commercial,1714.1624,92,,percent of total billed charges,,
RADIOFREQUENCY ABLATION CATHETER 7X60CM  CF7-3-60,,C1733,HCPCS,Facility,Outpatient,,,,1863.22,1583.737,533.998852,1863.22,Aetna,Medicare Advantage,912.9778,49,,percent of total billed charges,,
RADIOFREQUENCY ABLATION CATHETER 7X60CM  CF7-3-60,,C1733,HCPCS,Facility,Inpatient,,,,1863.22,1583.737,533.998852,1863.22,Aetna,Medicare Advantage,,,,,Included in per diem rate,
RADIOFREQUENCY ABLATION CATHETER 7X60CM  CF7-3-60,,C1733,HCPCS,Facility,Both,,,,1863.22,1583.737,533.998852,1863.22,Aetna,PPO,1732.7946,93,,percent of total billed charges,,
RADIOFREQUENCY ABLATION CATHETER 7X60CM  CF7-3-60,,C1733,HCPCS,Facility,Both,,,,1863.22,1583.737,533.998852,1863.22,America's PPO,America's PPO,1789.250166,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
RADIOFREQUENCY ABLATION CATHETER 7X60CM  CF7-3-60,,C1733,HCPCS,Facility,Both,,,,1863.22,1583.737,533.998852,1863.22,BlueCross BlueShield Minnesota, Federal Employee Program,1833.40848,98.4,,percent of total billed charges,,
RADIOFREQUENCY ABLATION CATHETER 7X60CM  CF7-3-60,,C1733,HCPCS,Facility,Both,,,,1863.22,1583.737,533.998852,1863.22,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1863.22,100,,percent of total billed charges,,
RADIOFREQUENCY ABLATION CATHETER 7X60CM  CF7-3-60,,C1733,HCPCS,Facility,Both,,,,1863.22,1583.737,533.998852,1863.22,BlueCross BlueShield Minnesota,High Value Network Plan,1676.898,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
RADIOFREQUENCY ABLATION CATHETER 7X60CM  CF7-3-60,,C1733,HCPCS,Facility,Outpatient,,,,1863.22,1583.737,533.998852,1863.22,BlueCross BlueShield Minnesota,Medicare Advantage,912.9778,49,,percent of total billed charges,,
RADIOFREQUENCY ABLATION CATHETER 7X60CM  CF7-3-60,,C1733,HCPCS,Facility,Inpatient,,,,1863.22,1583.737,533.998852,1863.22,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
RADIOFREQUENCY ABLATION CATHETER 7X60CM  CF7-3-60,,C1733,HCPCS,Facility,Both,,,,1863.22,1583.737,533.998852,1863.22,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1650.253954,88.57,,percent of total billed charges,,
RADIOFREQUENCY ABLATION CATHETER 7X60CM  CF7-3-60,,C1733,HCPCS,Facility,Both,,,,1863.22,1583.737,533.998852,1863.22,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,533.998852,28.66,,percent of total billed charges,,
RADIOFREQUENCY ABLATION CATHETER 7X60CM  CF7-3-60,,C1733,HCPCS,Facility,Outpatient,,,,1863.22,1583.737,533.998852,1863.22,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),912.9778,49,,percent of total billed charges,,
RADIOFREQUENCY ABLATION CATHETER 7X60CM  CF7-3-60,,C1733,HCPCS,Facility,Inpatient,,,,1863.22,1583.737,533.998852,1863.22,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
RADIOFREQUENCY ABLATION CATHETER 7X60CM  CF7-3-60,,C1733,HCPCS,Facility,Both,,,,1863.22,1583.737,533.998852,1863.22,CorVel,Worker's Compensation,1863.22,100,,percent of total billed charges,,
RADIOFREQUENCY ABLATION CATHETER 7X60CM  CF7-3-60,,C1733,HCPCS,Facility,Both,,,,1863.22,1583.737,533.998852,1863.22,First Health Group Corporation,First Health Network,1807.3234,97,,percent of total billed charges,,
RADIOFREQUENCY ABLATION CATHETER 7X60CM  CF7-3-60,,C1733,HCPCS,Facility,Both,,,,1863.22,1583.737,533.998852,1863.22,"Health Partners, Inc.",Commercial,1762.60612,94.6,,percent of total billed charges,,
RADIOFREQUENCY ABLATION CATHETER 7X60CM  CF7-3-60,,C1733,HCPCS,Facility,Outpatient,,,,1863.22,1583.737,533.998852,1863.22,"Health Partners, Inc.",Medicare Advantage,912.9778,49,,percent of total billed charges,,
RADIOFREQUENCY ABLATION CATHETER 7X60CM  CF7-3-60,,C1733,HCPCS,Facility,Inpatient,,,,1863.22,1583.737,533.998852,1863.22,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
RADIOFREQUENCY ABLATION CATHETER 7X60CM  CF7-3-60,,C1733,HCPCS,Facility,Both,,,,1863.22,1583.737,533.998852,1863.22,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1117.932,60,,percent of total billed charges,,
RADIOFREQUENCY ABLATION CATHETER 7X60CM  CF7-3-60,,C1733,HCPCS,Facility,Both,,,,1863.22,1583.737,533.998852,1863.22,"Health Partners, Inc.",State of Minnesota Advantage Program,1518.5243,81.5,,percent of total billed charges,,
RADIOFREQUENCY ABLATION CATHETER 7X60CM  CF7-3-60,,C1733,HCPCS,Facility,Both,,,,1863.22,1583.737,533.998852,1863.22,"Health Partners, Inc.",State Public Programs,931.61,50,,percent of total billed charges,,
RADIOFREQUENCY ABLATION CATHETER 7X60CM  CF7-3-60,,C1733,HCPCS,Facility,Both,,,,1863.22,1583.737,533.998852,1863.22,Humana Insurance Company,Commercial PPO,1770.059,95,,percent of total billed charges,,
RADIOFREQUENCY ABLATION CATHETER 7X60CM  CF7-3-60,,C1733,HCPCS,Facility,Outpatient,,,,1863.22,1583.737,533.998852,1863.22,Humana Insurance Company,Medicare PPO,912.9778,49,,percent of total billed charges,,
RADIOFREQUENCY ABLATION CATHETER 7X60CM  CF7-3-60,,C1733,HCPCS,Facility,Inpatient,,,,1863.22,1583.737,533.998852,1863.22,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
RADIOFREQUENCY ABLATION CATHETER 7X60CM  CF7-3-60,,C1733,HCPCS,Facility,Both,,,,1863.22,1583.737,533.998852,1863.22,Medica,Individual & Family,1846.45102,99.1,,percent of total billed charges,,
RADIOFREQUENCY ABLATION CATHETER 7X60CM  CF7-3-60,,C1733,HCPCS,Facility,Outpatient,,,,1863.22,1583.737,533.998852,1863.22,Medica,Medica Advantage Solution,927.88356,49.8,,percent of total billed charges,,
RADIOFREQUENCY ABLATION CATHETER 7X60CM  CF7-3-60,,C1733,HCPCS,Facility,Inpatient,,,,1863.22,1583.737,533.998852,1863.22,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
RADIOFREQUENCY ABLATION CATHETER 7X60CM  CF7-3-60,,C1733,HCPCS,Facility,Outpatient,,,,1863.22,1583.737,533.998852,1863.22,Medica,Medical Assistance,830.99612,44.6,,percent of total billed charges,,
RADIOFREQUENCY ABLATION CATHETER 7X60CM  CF7-3-60,,C1733,HCPCS,Facility,Inpatient,,,,1863.22,1583.737,533.998852,1863.22,Medica,Medical Assistance,,,,,Included in per diem rate,
RADIOFREQUENCY ABLATION CATHETER 7X60CM  CF7-3-60,,C1733,HCPCS,Facility,Outpatient,,,,1863.22,1583.737,533.998852,1863.22,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,927.88356,49.8,,percent of total billed charges,,
RADIOFREQUENCY ABLATION CATHETER 7X60CM  CF7-3-60,,C1733,HCPCS,Facility,Inpatient,,,,1863.22,1583.737,533.998852,1863.22,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
RADIOFREQUENCY ABLATION CATHETER 7X60CM  CF7-3-60,,C1733,HCPCS,Facility,Both,,,,1863.22,1583.737,533.998852,1863.22,"Multiplan, Inc.","Multiplan, Inc.",1751.4268,94,,percent of total billed charges,,
RADIOFREQUENCY ABLATION CATHETER 7X60CM  CF7-3-60,,C1733,HCPCS,Facility,Outpatient,,,,1863.22,1583.737,533.998852,1863.22,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1678.76122,90.1,,percent of total billed charges,,
RADIOFREQUENCY ABLATION CATHETER 7X60CM  CF7-3-60,,C1733,HCPCS,Facility,Inpatient,,,,1863.22,1583.737,533.998852,1863.22,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
RADIOFREQUENCY ABLATION CATHETER 7X60CM  CF7-3-60,,C1733,HCPCS,Facility,Both,,,,1863.22,1583.737,533.998852,1863.22,"Preferred One Administrative Services, INC.",PPO,1837.13492,98.6,,percent of total billed charges,,
RADIOFREQUENCY ABLATION CATHETER 7X60CM  CF7-3-60,,C1733,HCPCS,Facility,Outpatient,,,,1863.22,1583.737,533.998852,1863.22,PrimeWest Health,Minnesota Senior Health Options (MSHO),958.62669,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
RADIOFREQUENCY ABLATION CATHETER 7X60CM  CF7-3-60,,C1733,HCPCS,Facility,Inpatient,,,,1863.22,1583.737,533.998852,1863.22,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
RADIOFREQUENCY ABLATION CATHETER 7X60CM  CF7-3-60,,C1733,HCPCS,Facility,Outpatient,,,,1863.22,1583.737,533.998852,1863.22,PrimeWest Health,MinnesotaCare,956.949792,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
RADIOFREQUENCY ABLATION CATHETER 7X60CM  CF7-3-60,,C1733,HCPCS,Facility,Inpatient,,,,1863.22,1583.737,533.998852,1863.22,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
RADIOFREQUENCY ABLATION CATHETER 7X60CM  CF7-3-60,,C1733,HCPCS,Facility,Both,,,,1863.22,1583.737,533.998852,1863.22,Sanford Health Plan,Sanford Health Plan,1714.1624,92,,percent of total billed charges,,
RADIOFREQUENCY ABLATION CATHETER 7X60CM  CF7-3-60,,C1733,HCPCS,Facility,Outpatient,,,,1863.22,1583.737,533.998852,1863.22,"UCare Health, Inc.",Individual & Family Plan,1049.92447,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
RADIOFREQUENCY ABLATION CATHETER 7X60CM  CF7-3-60,,C1733,HCPCS,Facility,Inpatient,,,,1863.22,1583.737,533.998852,1863.22,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
RADIOFREQUENCY ABLATION CATHETER 7X60CM  CF7-3-60,,C1733,HCPCS,Facility,Outpatient,,,,1863.22,1583.737,533.998852,1863.22,"UCare Health, Inc.",Medical Assistance,940.367134,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
RADIOFREQUENCY ABLATION CATHETER 7X60CM  CF7-3-60,,C1733,HCPCS,Facility,Inpatient,,,,1863.22,1583.737,533.998852,1863.22,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
RADIOFREQUENCY ABLATION CATHETER 7X60CM  CF7-3-60,,C1733,HCPCS,Facility,Outpatient,,,,1863.22,1583.737,533.998852,1863.22,"UCare Health, Inc.",Medicare Advantage,940.367134,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
RADIOFREQUENCY ABLATION CATHETER 7X60CM  CF7-3-60,,C1733,HCPCS,Facility,Inpatient,,,,1863.22,1583.737,533.998852,1863.22,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
RADIOFREQUENCY ABLATION CATHETER 7X60CM  CF7-3-60,,C1733,HCPCS,Facility,Outpatient,,,,1863.22,1583.737,533.998852,1863.22,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),940.367134,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
RADIOFREQUENCY ABLATION CATHETER 7X60CM  CF7-3-60,,C1733,HCPCS,Facility,Inpatient,,,,1863.22,1583.737,533.998852,1863.22,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
RADIOFREQUENCY ABLATION CATHETER 7X60CM  CF7-3-60,,C1733,HCPCS,Facility,Both,,,,1863.22,1583.737,533.998852,1863.22,UnitedHealthcare,Individual & Family,1751.4268,94,,percent of total billed charges,,
RADIOFREQUENCY ABLATION CATHETER 7X60CM  CF7-3-60,,C1733,HCPCS,Facility,Outpatient,,,,1863.22,1583.737,533.998852,1863.22,UnitedHealthcare,Medicare Advantage,912.9778,49,,percent of total billed charges,,
RADIOFREQUENCY ABLATION CATHETER 7X60CM  CF7-3-60,,C1733,HCPCS,Facility,Inpatient,,,,1863.22,1583.737,533.998852,1863.22,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
RADIOFREQUENCY ABLATION CATHETER 7X60CM  CF7-3-60,,C1733,HCPCS,Facility,Outpatient,,,,1863.22,1583.737,533.998852,1863.22,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,894.3456,48,,percent of total billed charges,,100% of DHS outpatient percentage
RADIOFREQUENCY ABLATION CATHETER 7X60CM  CF7-3-60,,C1733,HCPCS,Facility,Inpatient,,,,1863.22,1583.737,533.998852,1863.22,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
RADIOFREQUENCY ABLATON CATHETER 7FR X 100CM  CF7-7-100,,C1733,HCPCS,Facility,Both,,,,1785,1517.25,511.581,1785,Aetna,Commercial,1642.2,92,,percent of total billed charges,,
RADIOFREQUENCY ABLATON CATHETER 7FR X 100CM  CF7-7-100,,C1733,HCPCS,Facility,Outpatient,,,,1785,1517.25,511.581,1785,Aetna,Medicare Advantage,874.65,49,,percent of total billed charges,,
RADIOFREQUENCY ABLATON CATHETER 7FR X 100CM  CF7-7-100,,C1733,HCPCS,Facility,Inpatient,,,,1785,1517.25,511.581,1785,Aetna,Medicare Advantage,,,,,Included in per diem rate,
RADIOFREQUENCY ABLATON CATHETER 7FR X 100CM  CF7-7-100,,C1733,HCPCS,Facility,Both,,,,1785,1517.25,511.581,1785,Aetna,PPO,1660.05,93,,percent of total billed charges,,
RADIOFREQUENCY ABLATON CATHETER 7FR X 100CM  CF7-7-100,,C1733,HCPCS,Facility,Both,,,,1785,1517.25,511.581,1785,America's PPO,America's PPO,1714.1355,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
RADIOFREQUENCY ABLATON CATHETER 7FR X 100CM  CF7-7-100,,C1733,HCPCS,Facility,Both,,,,1785,1517.25,511.581,1785,BlueCross BlueShield Minnesota, Federal Employee Program,1756.44,98.4,,percent of total billed charges,,
RADIOFREQUENCY ABLATON CATHETER 7FR X 100CM  CF7-7-100,,C1733,HCPCS,Facility,Both,,,,1785,1517.25,511.581,1785,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1785,100,,percent of total billed charges,,
RADIOFREQUENCY ABLATON CATHETER 7FR X 100CM  CF7-7-100,,C1733,HCPCS,Facility,Both,,,,1785,1517.25,511.581,1785,BlueCross BlueShield Minnesota,High Value Network Plan,1606.5,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
RADIOFREQUENCY ABLATON CATHETER 7FR X 100CM  CF7-7-100,,C1733,HCPCS,Facility,Outpatient,,,,1785,1517.25,511.581,1785,BlueCross BlueShield Minnesota,Medicare Advantage,874.65,49,,percent of total billed charges,,
RADIOFREQUENCY ABLATON CATHETER 7FR X 100CM  CF7-7-100,,C1733,HCPCS,Facility,Inpatient,,,,1785,1517.25,511.581,1785,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
RADIOFREQUENCY ABLATON CATHETER 7FR X 100CM  CF7-7-100,,C1733,HCPCS,Facility,Both,,,,1785,1517.25,511.581,1785,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1580.9745,88.57,,percent of total billed charges,,
RADIOFREQUENCY ABLATON CATHETER 7FR X 100CM  CF7-7-100,,C1733,HCPCS,Facility,Both,,,,1785,1517.25,511.581,1785,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,511.581,28.66,,percent of total billed charges,,
RADIOFREQUENCY ABLATON CATHETER 7FR X 100CM  CF7-7-100,,C1733,HCPCS,Facility,Outpatient,,,,1785,1517.25,511.581,1785,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),874.65,49,,percent of total billed charges,,
RADIOFREQUENCY ABLATON CATHETER 7FR X 100CM  CF7-7-100,,C1733,HCPCS,Facility,Inpatient,,,,1785,1517.25,511.581,1785,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
RADIOFREQUENCY ABLATON CATHETER 7FR X 100CM  CF7-7-100,,C1733,HCPCS,Facility,Both,,,,1785,1517.25,511.581,1785,CorVel,Worker's Compensation,1785,100,,percent of total billed charges,,
RADIOFREQUENCY ABLATON CATHETER 7FR X 100CM  CF7-7-100,,C1733,HCPCS,Facility,Both,,,,1785,1517.25,511.581,1785,First Health Group Corporation,First Health Network,1731.45,97,,percent of total billed charges,,
RADIOFREQUENCY ABLATON CATHETER 7FR X 100CM  CF7-7-100,,C1733,HCPCS,Facility,Both,,,,1785,1517.25,511.581,1785,"Health Partners, Inc.",Commercial,1688.61,94.6,,percent of total billed charges,,
RADIOFREQUENCY ABLATON CATHETER 7FR X 100CM  CF7-7-100,,C1733,HCPCS,Facility,Outpatient,,,,1785,1517.25,511.581,1785,"Health Partners, Inc.",Medicare Advantage,874.65,49,,percent of total billed charges,,
RADIOFREQUENCY ABLATON CATHETER 7FR X 100CM  CF7-7-100,,C1733,HCPCS,Facility,Inpatient,,,,1785,1517.25,511.581,1785,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
RADIOFREQUENCY ABLATON CATHETER 7FR X 100CM  CF7-7-100,,C1733,HCPCS,Facility,Both,,,,1785,1517.25,511.581,1785,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1071,60,,percent of total billed charges,,
RADIOFREQUENCY ABLATON CATHETER 7FR X 100CM  CF7-7-100,,C1733,HCPCS,Facility,Both,,,,1785,1517.25,511.581,1785,"Health Partners, Inc.",State of Minnesota Advantage Program,1454.775,81.5,,percent of total billed charges,,
RADIOFREQUENCY ABLATON CATHETER 7FR X 100CM  CF7-7-100,,C1733,HCPCS,Facility,Both,,,,1785,1517.25,511.581,1785,"Health Partners, Inc.",State Public Programs,892.5,50,,percent of total billed charges,,
RADIOFREQUENCY ABLATON CATHETER 7FR X 100CM  CF7-7-100,,C1733,HCPCS,Facility,Both,,,,1785,1517.25,511.581,1785,Humana Insurance Company,Commercial PPO,1695.75,95,,percent of total billed charges,,
RADIOFREQUENCY ABLATON CATHETER 7FR X 100CM  CF7-7-100,,C1733,HCPCS,Facility,Outpatient,,,,1785,1517.25,511.581,1785,Humana Insurance Company,Medicare PPO,874.65,49,,percent of total billed charges,,
RADIOFREQUENCY ABLATON CATHETER 7FR X 100CM  CF7-7-100,,C1733,HCPCS,Facility,Inpatient,,,,1785,1517.25,511.581,1785,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
RADIOFREQUENCY ABLATON CATHETER 7FR X 100CM  CF7-7-100,,C1733,HCPCS,Facility,Both,,,,1785,1517.25,511.581,1785,Medica,Individual & Family,1768.935,99.1,,percent of total billed charges,,
RADIOFREQUENCY ABLATON CATHETER 7FR X 100CM  CF7-7-100,,C1733,HCPCS,Facility,Outpatient,,,,1785,1517.25,511.581,1785,Medica,Medica Advantage Solution,888.93,49.8,,percent of total billed charges,,
RADIOFREQUENCY ABLATON CATHETER 7FR X 100CM  CF7-7-100,,C1733,HCPCS,Facility,Inpatient,,,,1785,1517.25,511.581,1785,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
RADIOFREQUENCY ABLATON CATHETER 7FR X 100CM  CF7-7-100,,C1733,HCPCS,Facility,Outpatient,,,,1785,1517.25,511.581,1785,Medica,Medical Assistance,796.11,44.6,,percent of total billed charges,,
RADIOFREQUENCY ABLATON CATHETER 7FR X 100CM  CF7-7-100,,C1733,HCPCS,Facility,Inpatient,,,,1785,1517.25,511.581,1785,Medica,Medical Assistance,,,,,Included in per diem rate,
RADIOFREQUENCY ABLATON CATHETER 7FR X 100CM  CF7-7-100,,C1733,HCPCS,Facility,Outpatient,,,,1785,1517.25,511.581,1785,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,888.93,49.8,,percent of total billed charges,,
RADIOFREQUENCY ABLATON CATHETER 7FR X 100CM  CF7-7-100,,C1733,HCPCS,Facility,Inpatient,,,,1785,1517.25,511.581,1785,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
RADIOFREQUENCY ABLATON CATHETER 7FR X 100CM  CF7-7-100,,C1733,HCPCS,Facility,Both,,,,1785,1517.25,511.581,1785,"Multiplan, Inc.","Multiplan, Inc.",1677.9,94,,percent of total billed charges,,
RADIOFREQUENCY ABLATON CATHETER 7FR X 100CM  CF7-7-100,,C1733,HCPCS,Facility,Outpatient,,,,1785,1517.25,511.581,1785,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1608.285,90.1,,percent of total billed charges,,
RADIOFREQUENCY ABLATON CATHETER 7FR X 100CM  CF7-7-100,,C1733,HCPCS,Facility,Inpatient,,,,1785,1517.25,511.581,1785,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
RADIOFREQUENCY ABLATON CATHETER 7FR X 100CM  CF7-7-100,,C1733,HCPCS,Facility,Both,,,,1785,1517.25,511.581,1785,"Preferred One Administrative Services, INC.",PPO,1760.01,98.6,,percent of total billed charges,,
RADIOFREQUENCY ABLATON CATHETER 7FR X 100CM  CF7-7-100,,C1733,HCPCS,Facility,Outpatient,,,,1785,1517.25,511.581,1785,PrimeWest Health,Minnesota Senior Health Options (MSHO),918.3825,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
RADIOFREQUENCY ABLATON CATHETER 7FR X 100CM  CF7-7-100,,C1733,HCPCS,Facility,Inpatient,,,,1785,1517.25,511.581,1785,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
RADIOFREQUENCY ABLATON CATHETER 7FR X 100CM  CF7-7-100,,C1733,HCPCS,Facility,Outpatient,,,,1785,1517.25,511.581,1785,PrimeWest Health,MinnesotaCare,916.776,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
RADIOFREQUENCY ABLATON CATHETER 7FR X 100CM  CF7-7-100,,C1733,HCPCS,Facility,Inpatient,,,,1785,1517.25,511.581,1785,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
RADIOFREQUENCY ABLATON CATHETER 7FR X 100CM  CF7-7-100,,C1733,HCPCS,Facility,Both,,,,1785,1517.25,511.581,1785,Sanford Health Plan,Sanford Health Plan,1642.2,92,,percent of total billed charges,,
RADIOFREQUENCY ABLATON CATHETER 7FR X 100CM  CF7-7-100,,C1733,HCPCS,Facility,Outpatient,,,,1785,1517.25,511.581,1785,"UCare Health, Inc.",Individual & Family Plan,1005.8475,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
RADIOFREQUENCY ABLATON CATHETER 7FR X 100CM  CF7-7-100,,C1733,HCPCS,Facility,Inpatient,,,,1785,1517.25,511.581,1785,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
RADIOFREQUENCY ABLATON CATHETER 7FR X 100CM  CF7-7-100,,C1733,HCPCS,Facility,Outpatient,,,,1785,1517.25,511.581,1785,"UCare Health, Inc.",Medical Assistance,900.8895,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
RADIOFREQUENCY ABLATON CATHETER 7FR X 100CM  CF7-7-100,,C1733,HCPCS,Facility,Inpatient,,,,1785,1517.25,511.581,1785,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
RADIOFREQUENCY ABLATON CATHETER 7FR X 100CM  CF7-7-100,,C1733,HCPCS,Facility,Outpatient,,,,1785,1517.25,511.581,1785,"UCare Health, Inc.",Medicare Advantage,900.8895,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
RADIOFREQUENCY ABLATON CATHETER 7FR X 100CM  CF7-7-100,,C1733,HCPCS,Facility,Inpatient,,,,1785,1517.25,511.581,1785,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
RADIOFREQUENCY ABLATON CATHETER 7FR X 100CM  CF7-7-100,,C1733,HCPCS,Facility,Outpatient,,,,1785,1517.25,511.581,1785,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),900.8895,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
RADIOFREQUENCY ABLATON CATHETER 7FR X 100CM  CF7-7-100,,C1733,HCPCS,Facility,Inpatient,,,,1785,1517.25,511.581,1785,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
RADIOFREQUENCY ABLATON CATHETER 7FR X 100CM  CF7-7-100,,C1733,HCPCS,Facility,Both,,,,1785,1517.25,511.581,1785,UnitedHealthcare,Individual & Family,1677.9,94,,percent of total billed charges,,
RADIOFREQUENCY ABLATON CATHETER 7FR X 100CM  CF7-7-100,,C1733,HCPCS,Facility,Outpatient,,,,1785,1517.25,511.581,1785,UnitedHealthcare,Medicare Advantage,874.65,49,,percent of total billed charges,,
RADIOFREQUENCY ABLATON CATHETER 7FR X 100CM  CF7-7-100,,C1733,HCPCS,Facility,Inpatient,,,,1785,1517.25,511.581,1785,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
RADIOFREQUENCY ABLATON CATHETER 7FR X 100CM  CF7-7-100,,C1733,HCPCS,Facility,Outpatient,,,,1785,1517.25,511.581,1785,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,856.8,48,,percent of total billed charges,,100% of DHS outpatient percentage
RADIOFREQUENCY ABLATON CATHETER 7FR X 100CM  CF7-7-100,,C1733,HCPCS,Facility,Inpatient,,,,1785,1517.25,511.581,1785,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
MINI IGNITE POWER MIX 4CC,,C1734,HCPCS,Facility,Both,,,,4318,3670.3,1237.5388,4318,Aetna,Commercial,3972.56,92,,percent of total billed charges,,
MINI IGNITE POWER MIX 4CC,,C1734,HCPCS,Facility,Outpatient,,,,4318,3670.3,1237.5388,4318,Aetna,Medicare Advantage,2115.82,49,,percent of total billed charges,,
MINI IGNITE POWER MIX 4CC,,C1734,HCPCS,Facility,Inpatient,,,,4318,3670.3,1237.5388,4318,Aetna,Medicare Advantage,,,,,Included in per diem rate,
MINI IGNITE POWER MIX 4CC,,C1734,HCPCS,Facility,Both,,,,4318,3670.3,1237.5388,4318,Aetna,PPO,4015.74,93,,percent of total billed charges,,
MINI IGNITE POWER MIX 4CC,,C1734,HCPCS,Facility,Both,,,,4318,3670.3,1237.5388,4318,America's PPO,America's PPO,4146.5754,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
MINI IGNITE POWER MIX 4CC,,C1734,HCPCS,Facility,Both,,,,4318,3670.3,1237.5388,4318,BlueCross BlueShield Minnesota, Federal Employee Program,4248.912,98.4,,percent of total billed charges,,
MINI IGNITE POWER MIX 4CC,,C1734,HCPCS,Facility,Both,,,,4318,3670.3,1237.5388,4318,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,4318,100,,percent of total billed charges,,
MINI IGNITE POWER MIX 4CC,,C1734,HCPCS,Facility,Both,,,,4318,3670.3,1237.5388,4318,BlueCross BlueShield Minnesota,High Value Network Plan,3886.2,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
MINI IGNITE POWER MIX 4CC,,C1734,HCPCS,Facility,Outpatient,,,,4318,3670.3,1237.5388,4318,BlueCross BlueShield Minnesota,Medicare Advantage,2115.82,49,,percent of total billed charges,,
MINI IGNITE POWER MIX 4CC,,C1734,HCPCS,Facility,Inpatient,,,,4318,3670.3,1237.5388,4318,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
MINI IGNITE POWER MIX 4CC,,C1734,HCPCS,Facility,Both,,,,4318,3670.3,1237.5388,4318,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,3824.4526,88.57,,percent of total billed charges,,
MINI IGNITE POWER MIX 4CC,,C1734,HCPCS,Facility,Both,,,,4318,3670.3,1237.5388,4318,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1237.5388,28.66,,percent of total billed charges,,
MINI IGNITE POWER MIX 4CC,,C1734,HCPCS,Facility,Outpatient,,,,4318,3670.3,1237.5388,4318,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2115.82,49,,percent of total billed charges,,
MINI IGNITE POWER MIX 4CC,,C1734,HCPCS,Facility,Inpatient,,,,4318,3670.3,1237.5388,4318,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
MINI IGNITE POWER MIX 4CC,,C1734,HCPCS,Facility,Both,,,,4318,3670.3,1237.5388,4318,CorVel,Worker's Compensation,4318,100,,percent of total billed charges,,
MINI IGNITE POWER MIX 4CC,,C1734,HCPCS,Facility,Both,,,,4318,3670.3,1237.5388,4318,First Health Group Corporation,First Health Network,4188.46,97,,percent of total billed charges,,
MINI IGNITE POWER MIX 4CC,,C1734,HCPCS,Facility,Both,,,,4318,3670.3,1237.5388,4318,"Health Partners, Inc.",Commercial,4084.828,94.6,,percent of total billed charges,,
MINI IGNITE POWER MIX 4CC,,C1734,HCPCS,Facility,Outpatient,,,,4318,3670.3,1237.5388,4318,"Health Partners, Inc.",Medicare Advantage,2115.82,49,,percent of total billed charges,,
MINI IGNITE POWER MIX 4CC,,C1734,HCPCS,Facility,Inpatient,,,,4318,3670.3,1237.5388,4318,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
MINI IGNITE POWER MIX 4CC,,C1734,HCPCS,Facility,Both,,,,4318,3670.3,1237.5388,4318,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),2590.8,60,,percent of total billed charges,,
MINI IGNITE POWER MIX 4CC,,C1734,HCPCS,Facility,Both,,,,4318,3670.3,1237.5388,4318,"Health Partners, Inc.",State of Minnesota Advantage Program,3519.17,81.5,,percent of total billed charges,,
MINI IGNITE POWER MIX 4CC,,C1734,HCPCS,Facility,Both,,,,4318,3670.3,1237.5388,4318,"Health Partners, Inc.",State Public Programs,2159,50,,percent of total billed charges,,
MINI IGNITE POWER MIX 4CC,,C1734,HCPCS,Facility,Both,,,,4318,3670.3,1237.5388,4318,Humana Insurance Company,Commercial PPO,4102.1,95,,percent of total billed charges,,
MINI IGNITE POWER MIX 4CC,,C1734,HCPCS,Facility,Outpatient,,,,4318,3670.3,1237.5388,4318,Humana Insurance Company,Medicare PPO,2115.82,49,,percent of total billed charges,,
MINI IGNITE POWER MIX 4CC,,C1734,HCPCS,Facility,Inpatient,,,,4318,3670.3,1237.5388,4318,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
MINI IGNITE POWER MIX 4CC,,C1734,HCPCS,Facility,Both,,,,4318,3670.3,1237.5388,4318,Medica,Individual & Family,4279.138,99.1,,percent of total billed charges,,
MINI IGNITE POWER MIX 4CC,,C1734,HCPCS,Facility,Outpatient,,,,4318,3670.3,1237.5388,4318,Medica,Medica Advantage Solution,2150.364,49.8,,percent of total billed charges,,
MINI IGNITE POWER MIX 4CC,,C1734,HCPCS,Facility,Inpatient,,,,4318,3670.3,1237.5388,4318,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
MINI IGNITE POWER MIX 4CC,,C1734,HCPCS,Facility,Outpatient,,,,4318,3670.3,1237.5388,4318,Medica,Medical Assistance,1925.828,44.6,,percent of total billed charges,,
MINI IGNITE POWER MIX 4CC,,C1734,HCPCS,Facility,Inpatient,,,,4318,3670.3,1237.5388,4318,Medica,Medical Assistance,,,,,Included in per diem rate,
MINI IGNITE POWER MIX 4CC,,C1734,HCPCS,Facility,Outpatient,,,,4318,3670.3,1237.5388,4318,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2150.364,49.8,,percent of total billed charges,,
MINI IGNITE POWER MIX 4CC,,C1734,HCPCS,Facility,Inpatient,,,,4318,3670.3,1237.5388,4318,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
MINI IGNITE POWER MIX 4CC,,C1734,HCPCS,Facility,Both,,,,4318,3670.3,1237.5388,4318,"Multiplan, Inc.","Multiplan, Inc.",4058.92,94,,percent of total billed charges,,
MINI IGNITE POWER MIX 4CC,,C1734,HCPCS,Facility,Outpatient,,,,4318,3670.3,1237.5388,4318,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,3890.518,90.1,,percent of total billed charges,,
MINI IGNITE POWER MIX 4CC,,C1734,HCPCS,Facility,Inpatient,,,,4318,3670.3,1237.5388,4318,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
MINI IGNITE POWER MIX 4CC,,C1734,HCPCS,Facility,Both,,,,4318,3670.3,1237.5388,4318,"Preferred One Administrative Services, INC.",PPO,4257.548,98.6,,percent of total billed charges,,
MINI IGNITE POWER MIX 4CC,,C1734,HCPCS,Facility,Outpatient,,,,4318,3670.3,1237.5388,4318,PrimeWest Health,Minnesota Senior Health Options (MSHO),2221.611,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
MINI IGNITE POWER MIX 4CC,,C1734,HCPCS,Facility,Inpatient,,,,4318,3670.3,1237.5388,4318,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
MINI IGNITE POWER MIX 4CC,,C1734,HCPCS,Facility,Outpatient,,,,4318,3670.3,1237.5388,4318,PrimeWest Health,MinnesotaCare,2217.7248,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
MINI IGNITE POWER MIX 4CC,,C1734,HCPCS,Facility,Inpatient,,,,4318,3670.3,1237.5388,4318,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
MINI IGNITE POWER MIX 4CC,,C1734,HCPCS,Facility,Both,,,,4318,3670.3,1237.5388,4318,Sanford Health Plan,Sanford Health Plan,3972.56,92,,percent of total billed charges,,
MINI IGNITE POWER MIX 4CC,,C1734,HCPCS,Facility,Outpatient,,,,4318,3670.3,1237.5388,4318,"UCare Health, Inc.",Individual & Family Plan,2433.193,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
MINI IGNITE POWER MIX 4CC,,C1734,HCPCS,Facility,Inpatient,,,,4318,3670.3,1237.5388,4318,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
MINI IGNITE POWER MIX 4CC,,C1734,HCPCS,Facility,Outpatient,,,,4318,3670.3,1237.5388,4318,"UCare Health, Inc.",Medical Assistance,2179.2946,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MINI IGNITE POWER MIX 4CC,,C1734,HCPCS,Facility,Inpatient,,,,4318,3670.3,1237.5388,4318,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
MINI IGNITE POWER MIX 4CC,,C1734,HCPCS,Facility,Outpatient,,,,4318,3670.3,1237.5388,4318,"UCare Health, Inc.",Medicare Advantage,2179.2946,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MINI IGNITE POWER MIX 4CC,,C1734,HCPCS,Facility,Inpatient,,,,4318,3670.3,1237.5388,4318,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
MINI IGNITE POWER MIX 4CC,,C1734,HCPCS,Facility,Outpatient,,,,4318,3670.3,1237.5388,4318,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2179.2946,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MINI IGNITE POWER MIX 4CC,,C1734,HCPCS,Facility,Inpatient,,,,4318,3670.3,1237.5388,4318,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
MINI IGNITE POWER MIX 4CC,,C1734,HCPCS,Facility,Both,,,,4318,3670.3,1237.5388,4318,UnitedHealthcare,Individual & Family,4058.92,94,,percent of total billed charges,,
MINI IGNITE POWER MIX 4CC,,C1734,HCPCS,Facility,Outpatient,,,,4318,3670.3,1237.5388,4318,UnitedHealthcare,Medicare Advantage,2115.82,49,,percent of total billed charges,,
MINI IGNITE POWER MIX 4CC,,C1734,HCPCS,Facility,Inpatient,,,,4318,3670.3,1237.5388,4318,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
MINI IGNITE POWER MIX 4CC,,C1734,HCPCS,Facility,Outpatient,,,,4318,3670.3,1237.5388,4318,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2072.64,48,,percent of total billed charges,,100% of DHS outpatient percentage
MINI IGNITE POWER MIX 4CC,,C1734,HCPCS,Facility,Inpatient,,,,4318,3670.3,1237.5388,4318,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
MINIRAIL LONG  ORTHOFIX M102,,C1734,HCPCS,Facility,Both,,,,5069.026,4308.6721,1452.782852,5069.026,Aetna,Commercial,4663.50392,92,,percent of total billed charges,,
MINIRAIL LONG  ORTHOFIX M102,,C1734,HCPCS,Facility,Outpatient,,,,5069.026,4308.6721,1452.782852,5069.026,Aetna,Medicare Advantage,2483.82274,49,,percent of total billed charges,,
MINIRAIL LONG  ORTHOFIX M102,,C1734,HCPCS,Facility,Inpatient,,,,5069.026,4308.6721,1452.782852,5069.026,Aetna,Medicare Advantage,,,,,Included in per diem rate,
MINIRAIL LONG  ORTHOFIX M102,,C1734,HCPCS,Facility,Both,,,,5069.026,4308.6721,1452.782852,5069.026,Aetna,PPO,4714.19418,93,,percent of total billed charges,,
MINIRAIL LONG  ORTHOFIX M102,,C1734,HCPCS,Facility,Both,,,,5069.026,4308.6721,1452.782852,5069.026,America's PPO,America's PPO,4867.785668,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
MINIRAIL LONG  ORTHOFIX M102,,C1734,HCPCS,Facility,Both,,,,5069.026,4308.6721,1452.782852,5069.026,BlueCross BlueShield Minnesota, Federal Employee Program,4987.921584,98.4,,percent of total billed charges,,
MINIRAIL LONG  ORTHOFIX M102,,C1734,HCPCS,Facility,Both,,,,5069.026,4308.6721,1452.782852,5069.026,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5069.026,100,,percent of total billed charges,,
MINIRAIL LONG  ORTHOFIX M102,,C1734,HCPCS,Facility,Both,,,,5069.026,4308.6721,1452.782852,5069.026,BlueCross BlueShield Minnesota,High Value Network Plan,4562.1234,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
MINIRAIL LONG  ORTHOFIX M102,,C1734,HCPCS,Facility,Outpatient,,,,5069.026,4308.6721,1452.782852,5069.026,BlueCross BlueShield Minnesota,Medicare Advantage,2483.82274,49,,percent of total billed charges,,
MINIRAIL LONG  ORTHOFIX M102,,C1734,HCPCS,Facility,Inpatient,,,,5069.026,4308.6721,1452.782852,5069.026,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
MINIRAIL LONG  ORTHOFIX M102,,C1734,HCPCS,Facility,Both,,,,5069.026,4308.6721,1452.782852,5069.026,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4489.636328,88.57,,percent of total billed charges,,
MINIRAIL LONG  ORTHOFIX M102,,C1734,HCPCS,Facility,Both,,,,5069.026,4308.6721,1452.782852,5069.026,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1452.782852,28.66,,percent of total billed charges,,
MINIRAIL LONG  ORTHOFIX M102,,C1734,HCPCS,Facility,Outpatient,,,,5069.026,4308.6721,1452.782852,5069.026,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2483.82274,49,,percent of total billed charges,,
MINIRAIL LONG  ORTHOFIX M102,,C1734,HCPCS,Facility,Inpatient,,,,5069.026,4308.6721,1452.782852,5069.026,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
MINIRAIL LONG  ORTHOFIX M102,,C1734,HCPCS,Facility,Both,,,,5069.026,4308.6721,1452.782852,5069.026,CorVel,Worker's Compensation,5069.026,100,,percent of total billed charges,,
MINIRAIL LONG  ORTHOFIX M102,,C1734,HCPCS,Facility,Both,,,,5069.026,4308.6721,1452.782852,5069.026,First Health Group Corporation,First Health Network,4916.95522,97,,percent of total billed charges,,
MINIRAIL LONG  ORTHOFIX M102,,C1734,HCPCS,Facility,Both,,,,5069.026,4308.6721,1452.782852,5069.026,"Health Partners, Inc.",Commercial,4795.298596,94.6,,percent of total billed charges,,
MINIRAIL LONG  ORTHOFIX M102,,C1734,HCPCS,Facility,Outpatient,,,,5069.026,4308.6721,1452.782852,5069.026,"Health Partners, Inc.",Medicare Advantage,2483.82274,49,,percent of total billed charges,,
MINIRAIL LONG  ORTHOFIX M102,,C1734,HCPCS,Facility,Inpatient,,,,5069.026,4308.6721,1452.782852,5069.026,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
MINIRAIL LONG  ORTHOFIX M102,,C1734,HCPCS,Facility,Both,,,,5069.026,4308.6721,1452.782852,5069.026,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3041.4156,60,,percent of total billed charges,,
MINIRAIL LONG  ORTHOFIX M102,,C1734,HCPCS,Facility,Both,,,,5069.026,4308.6721,1452.782852,5069.026,"Health Partners, Inc.",State of Minnesota Advantage Program,4131.25619,81.5,,percent of total billed charges,,
MINIRAIL LONG  ORTHOFIX M102,,C1734,HCPCS,Facility,Both,,,,5069.026,4308.6721,1452.782852,5069.026,"Health Partners, Inc.",State Public Programs,2534.513,50,,percent of total billed charges,,
MINIRAIL LONG  ORTHOFIX M102,,C1734,HCPCS,Facility,Both,,,,5069.026,4308.6721,1452.782852,5069.026,Humana Insurance Company,Commercial PPO,4815.5747,95,,percent of total billed charges,,
MINIRAIL LONG  ORTHOFIX M102,,C1734,HCPCS,Facility,Outpatient,,,,5069.026,4308.6721,1452.782852,5069.026,Humana Insurance Company,Medicare PPO,2483.82274,49,,percent of total billed charges,,
MINIRAIL LONG  ORTHOFIX M102,,C1734,HCPCS,Facility,Inpatient,,,,5069.026,4308.6721,1452.782852,5069.026,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
MINIRAIL LONG  ORTHOFIX M102,,C1734,HCPCS,Facility,Both,,,,5069.026,4308.6721,1452.782852,5069.026,Medica,Individual & Family,5023.404766,99.1,,percent of total billed charges,,
MINIRAIL LONG  ORTHOFIX M102,,C1734,HCPCS,Facility,Outpatient,,,,5069.026,4308.6721,1452.782852,5069.026,Medica,Medica Advantage Solution,2524.374948,49.8,,percent of total billed charges,,
MINIRAIL LONG  ORTHOFIX M102,,C1734,HCPCS,Facility,Inpatient,,,,5069.026,4308.6721,1452.782852,5069.026,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
MINIRAIL LONG  ORTHOFIX M102,,C1734,HCPCS,Facility,Outpatient,,,,5069.026,4308.6721,1452.782852,5069.026,Medica,Medical Assistance,2260.785596,44.6,,percent of total billed charges,,
MINIRAIL LONG  ORTHOFIX M102,,C1734,HCPCS,Facility,Inpatient,,,,5069.026,4308.6721,1452.782852,5069.026,Medica,Medical Assistance,,,,,Included in per diem rate,
MINIRAIL LONG  ORTHOFIX M102,,C1734,HCPCS,Facility,Outpatient,,,,5069.026,4308.6721,1452.782852,5069.026,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2524.374948,49.8,,percent of total billed charges,,
MINIRAIL LONG  ORTHOFIX M102,,C1734,HCPCS,Facility,Inpatient,,,,5069.026,4308.6721,1452.782852,5069.026,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
MINIRAIL LONG  ORTHOFIX M102,,C1734,HCPCS,Facility,Both,,,,5069.026,4308.6721,1452.782852,5069.026,"Multiplan, Inc.","Multiplan, Inc.",4764.88444,94,,percent of total billed charges,,
MINIRAIL LONG  ORTHOFIX M102,,C1734,HCPCS,Facility,Outpatient,,,,5069.026,4308.6721,1452.782852,5069.026,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4567.192426,90.1,,percent of total billed charges,,
MINIRAIL LONG  ORTHOFIX M102,,C1734,HCPCS,Facility,Inpatient,,,,5069.026,4308.6721,1452.782852,5069.026,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
MINIRAIL LONG  ORTHOFIX M102,,C1734,HCPCS,Facility,Both,,,,5069.026,4308.6721,1452.782852,5069.026,"Preferred One Administrative Services, INC.",PPO,4998.059636,98.6,,percent of total billed charges,,
MINIRAIL LONG  ORTHOFIX M102,,C1734,HCPCS,Facility,Outpatient,,,,5069.026,4308.6721,1452.782852,5069.026,PrimeWest Health,Minnesota Senior Health Options (MSHO),2608.013877,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
MINIRAIL LONG  ORTHOFIX M102,,C1734,HCPCS,Facility,Inpatient,,,,5069.026,4308.6721,1452.782852,5069.026,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
MINIRAIL LONG  ORTHOFIX M102,,C1734,HCPCS,Facility,Outpatient,,,,5069.026,4308.6721,1452.782852,5069.026,PrimeWest Health,MinnesotaCare,2603.451754,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
MINIRAIL LONG  ORTHOFIX M102,,C1734,HCPCS,Facility,Inpatient,,,,5069.026,4308.6721,1452.782852,5069.026,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
MINIRAIL LONG  ORTHOFIX M102,,C1734,HCPCS,Facility,Both,,,,5069.026,4308.6721,1452.782852,5069.026,Sanford Health Plan,Sanford Health Plan,4663.50392,92,,percent of total billed charges,,
MINIRAIL LONG  ORTHOFIX M102,,C1734,HCPCS,Facility,Outpatient,,,,5069.026,4308.6721,1452.782852,5069.026,"UCare Health, Inc.",Individual & Family Plan,2856.396151,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
MINIRAIL LONG  ORTHOFIX M102,,C1734,HCPCS,Facility,Inpatient,,,,5069.026,4308.6721,1452.782852,5069.026,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
MINIRAIL LONG  ORTHOFIX M102,,C1734,HCPCS,Facility,Outpatient,,,,5069.026,4308.6721,1452.782852,5069.026,"UCare Health, Inc.",Medical Assistance,2558.337422,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MINIRAIL LONG  ORTHOFIX M102,,C1734,HCPCS,Facility,Inpatient,,,,5069.026,4308.6721,1452.782852,5069.026,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
MINIRAIL LONG  ORTHOFIX M102,,C1734,HCPCS,Facility,Outpatient,,,,5069.026,4308.6721,1452.782852,5069.026,"UCare Health, Inc.",Medicare Advantage,2558.337422,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MINIRAIL LONG  ORTHOFIX M102,,C1734,HCPCS,Facility,Inpatient,,,,5069.026,4308.6721,1452.782852,5069.026,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
MINIRAIL LONG  ORTHOFIX M102,,C1734,HCPCS,Facility,Outpatient,,,,5069.026,4308.6721,1452.782852,5069.026,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2558.337422,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MINIRAIL LONG  ORTHOFIX M102,,C1734,HCPCS,Facility,Inpatient,,,,5069.026,4308.6721,1452.782852,5069.026,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
MINIRAIL LONG  ORTHOFIX M102,,C1734,HCPCS,Facility,Both,,,,5069.026,4308.6721,1452.782852,5069.026,UnitedHealthcare,Individual & Family,4764.88444,94,,percent of total billed charges,,
MINIRAIL LONG  ORTHOFIX M102,,C1734,HCPCS,Facility,Outpatient,,,,5069.026,4308.6721,1452.782852,5069.026,UnitedHealthcare,Medicare Advantage,2483.82274,49,,percent of total billed charges,,
MINIRAIL LONG  ORTHOFIX M102,,C1734,HCPCS,Facility,Inpatient,,,,5069.026,4308.6721,1452.782852,5069.026,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
MINIRAIL LONG  ORTHOFIX M102,,C1734,HCPCS,Facility,Outpatient,,,,5069.026,4308.6721,1452.782852,5069.026,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2433.13248,48,,percent of total billed charges,,100% of DHS outpatient percentage
MINIRAIL LONG  ORTHOFIX M102,,C1734,HCPCS,Facility,Inpatient,,,,5069.026,4308.6721,1452.782852,5069.026,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
QUICKSET INJECTABLE MACROPOROUS CALCIUM PHOSPHATE 8CC  ARTHREX ABS-3008,,C1734,HCPCS,Facility,Both,,,,4845,4118.25,1388.577,4845,Aetna,Commercial,4457.4,92,,percent of total billed charges,,
QUICKSET INJECTABLE MACROPOROUS CALCIUM PHOSPHATE 8CC  ARTHREX ABS-3008,,C1734,HCPCS,Facility,Outpatient,,,,4845,4118.25,1388.577,4845,Aetna,Medicare Advantage,2374.05,49,,percent of total billed charges,,
QUICKSET INJECTABLE MACROPOROUS CALCIUM PHOSPHATE 8CC  ARTHREX ABS-3008,,C1734,HCPCS,Facility,Inpatient,,,,4845,4118.25,1388.577,4845,Aetna,Medicare Advantage,,,,,Included in per diem rate,
QUICKSET INJECTABLE MACROPOROUS CALCIUM PHOSPHATE 8CC  ARTHREX ABS-3008,,C1734,HCPCS,Facility,Both,,,,4845,4118.25,1388.577,4845,Aetna,PPO,4505.85,93,,percent of total billed charges,,
QUICKSET INJECTABLE MACROPOROUS CALCIUM PHOSPHATE 8CC  ARTHREX ABS-3008,,C1734,HCPCS,Facility,Both,,,,4845,4118.25,1388.577,4845,America's PPO,America's PPO,4652.6535,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
QUICKSET INJECTABLE MACROPOROUS CALCIUM PHOSPHATE 8CC  ARTHREX ABS-3008,,C1734,HCPCS,Facility,Both,,,,4845,4118.25,1388.577,4845,BlueCross BlueShield Minnesota, Federal Employee Program,4767.48,98.4,,percent of total billed charges,,
QUICKSET INJECTABLE MACROPOROUS CALCIUM PHOSPHATE 8CC  ARTHREX ABS-3008,,C1734,HCPCS,Facility,Both,,,,4845,4118.25,1388.577,4845,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,4845,100,,percent of total billed charges,,
QUICKSET INJECTABLE MACROPOROUS CALCIUM PHOSPHATE 8CC  ARTHREX ABS-3008,,C1734,HCPCS,Facility,Both,,,,4845,4118.25,1388.577,4845,BlueCross BlueShield Minnesota,High Value Network Plan,4360.5,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
QUICKSET INJECTABLE MACROPOROUS CALCIUM PHOSPHATE 8CC  ARTHREX ABS-3008,,C1734,HCPCS,Facility,Outpatient,,,,4845,4118.25,1388.577,4845,BlueCross BlueShield Minnesota,Medicare Advantage,2374.05,49,,percent of total billed charges,,
QUICKSET INJECTABLE MACROPOROUS CALCIUM PHOSPHATE 8CC  ARTHREX ABS-3008,,C1734,HCPCS,Facility,Inpatient,,,,4845,4118.25,1388.577,4845,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
QUICKSET INJECTABLE MACROPOROUS CALCIUM PHOSPHATE 8CC  ARTHREX ABS-3008,,C1734,HCPCS,Facility,Both,,,,4845,4118.25,1388.577,4845,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4291.2165,88.57,,percent of total billed charges,,
QUICKSET INJECTABLE MACROPOROUS CALCIUM PHOSPHATE 8CC  ARTHREX ABS-3008,,C1734,HCPCS,Facility,Both,,,,4845,4118.25,1388.577,4845,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1388.577,28.66,,percent of total billed charges,,
QUICKSET INJECTABLE MACROPOROUS CALCIUM PHOSPHATE 8CC  ARTHREX ABS-3008,,C1734,HCPCS,Facility,Outpatient,,,,4845,4118.25,1388.577,4845,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2374.05,49,,percent of total billed charges,,
QUICKSET INJECTABLE MACROPOROUS CALCIUM PHOSPHATE 8CC  ARTHREX ABS-3008,,C1734,HCPCS,Facility,Inpatient,,,,4845,4118.25,1388.577,4845,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
QUICKSET INJECTABLE MACROPOROUS CALCIUM PHOSPHATE 8CC  ARTHREX ABS-3008,,C1734,HCPCS,Facility,Both,,,,4845,4118.25,1388.577,4845,CorVel,Worker's Compensation,4845,100,,percent of total billed charges,,
QUICKSET INJECTABLE MACROPOROUS CALCIUM PHOSPHATE 8CC  ARTHREX ABS-3008,,C1734,HCPCS,Facility,Both,,,,4845,4118.25,1388.577,4845,First Health Group Corporation,First Health Network,4699.65,97,,percent of total billed charges,,
QUICKSET INJECTABLE MACROPOROUS CALCIUM PHOSPHATE 8CC  ARTHREX ABS-3008,,C1734,HCPCS,Facility,Both,,,,4845,4118.25,1388.577,4845,"Health Partners, Inc.",Commercial,4583.37,94.6,,percent of total billed charges,,
QUICKSET INJECTABLE MACROPOROUS CALCIUM PHOSPHATE 8CC  ARTHREX ABS-3008,,C1734,HCPCS,Facility,Outpatient,,,,4845,4118.25,1388.577,4845,"Health Partners, Inc.",Medicare Advantage,2374.05,49,,percent of total billed charges,,
QUICKSET INJECTABLE MACROPOROUS CALCIUM PHOSPHATE 8CC  ARTHREX ABS-3008,,C1734,HCPCS,Facility,Inpatient,,,,4845,4118.25,1388.577,4845,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
QUICKSET INJECTABLE MACROPOROUS CALCIUM PHOSPHATE 8CC  ARTHREX ABS-3008,,C1734,HCPCS,Facility,Both,,,,4845,4118.25,1388.577,4845,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),2907,60,,percent of total billed charges,,
QUICKSET INJECTABLE MACROPOROUS CALCIUM PHOSPHATE 8CC  ARTHREX ABS-3008,,C1734,HCPCS,Facility,Both,,,,4845,4118.25,1388.577,4845,"Health Partners, Inc.",State of Minnesota Advantage Program,3948.675,81.5,,percent of total billed charges,,
QUICKSET INJECTABLE MACROPOROUS CALCIUM PHOSPHATE 8CC  ARTHREX ABS-3008,,C1734,HCPCS,Facility,Both,,,,4845,4118.25,1388.577,4845,"Health Partners, Inc.",State Public Programs,2422.5,50,,percent of total billed charges,,
QUICKSET INJECTABLE MACROPOROUS CALCIUM PHOSPHATE 8CC  ARTHREX ABS-3008,,C1734,HCPCS,Facility,Both,,,,4845,4118.25,1388.577,4845,Humana Insurance Company,Commercial PPO,4602.75,95,,percent of total billed charges,,
QUICKSET INJECTABLE MACROPOROUS CALCIUM PHOSPHATE 8CC  ARTHREX ABS-3008,,C1734,HCPCS,Facility,Outpatient,,,,4845,4118.25,1388.577,4845,Humana Insurance Company,Medicare PPO,2374.05,49,,percent of total billed charges,,
QUICKSET INJECTABLE MACROPOROUS CALCIUM PHOSPHATE 8CC  ARTHREX ABS-3008,,C1734,HCPCS,Facility,Inpatient,,,,4845,4118.25,1388.577,4845,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
QUICKSET INJECTABLE MACROPOROUS CALCIUM PHOSPHATE 8CC  ARTHREX ABS-3008,,C1734,HCPCS,Facility,Both,,,,4845,4118.25,1388.577,4845,Medica,Individual & Family,4801.395,99.1,,percent of total billed charges,,
QUICKSET INJECTABLE MACROPOROUS CALCIUM PHOSPHATE 8CC  ARTHREX ABS-3008,,C1734,HCPCS,Facility,Outpatient,,,,4845,4118.25,1388.577,4845,Medica,Medica Advantage Solution,2412.81,49.8,,percent of total billed charges,,
QUICKSET INJECTABLE MACROPOROUS CALCIUM PHOSPHATE 8CC  ARTHREX ABS-3008,,C1734,HCPCS,Facility,Inpatient,,,,4845,4118.25,1388.577,4845,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
QUICKSET INJECTABLE MACROPOROUS CALCIUM PHOSPHATE 8CC  ARTHREX ABS-3008,,C1734,HCPCS,Facility,Outpatient,,,,4845,4118.25,1388.577,4845,Medica,Medical Assistance,2160.87,44.6,,percent of total billed charges,,
QUICKSET INJECTABLE MACROPOROUS CALCIUM PHOSPHATE 8CC  ARTHREX ABS-3008,,C1734,HCPCS,Facility,Inpatient,,,,4845,4118.25,1388.577,4845,Medica,Medical Assistance,,,,,Included in per diem rate,
QUICKSET INJECTABLE MACROPOROUS CALCIUM PHOSPHATE 8CC  ARTHREX ABS-3008,,C1734,HCPCS,Facility,Outpatient,,,,4845,4118.25,1388.577,4845,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2412.81,49.8,,percent of total billed charges,,
QUICKSET INJECTABLE MACROPOROUS CALCIUM PHOSPHATE 8CC  ARTHREX ABS-3008,,C1734,HCPCS,Facility,Inpatient,,,,4845,4118.25,1388.577,4845,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
QUICKSET INJECTABLE MACROPOROUS CALCIUM PHOSPHATE 8CC  ARTHREX ABS-3008,,C1734,HCPCS,Facility,Both,,,,4845,4118.25,1388.577,4845,"Multiplan, Inc.","Multiplan, Inc.",4554.3,94,,percent of total billed charges,,
QUICKSET INJECTABLE MACROPOROUS CALCIUM PHOSPHATE 8CC  ARTHREX ABS-3008,,C1734,HCPCS,Facility,Outpatient,,,,4845,4118.25,1388.577,4845,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4365.345,90.1,,percent of total billed charges,,
QUICKSET INJECTABLE MACROPOROUS CALCIUM PHOSPHATE 8CC  ARTHREX ABS-3008,,C1734,HCPCS,Facility,Inpatient,,,,4845,4118.25,1388.577,4845,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
QUICKSET INJECTABLE MACROPOROUS CALCIUM PHOSPHATE 8CC  ARTHREX ABS-3008,,C1734,HCPCS,Facility,Both,,,,4845,4118.25,1388.577,4845,"Preferred One Administrative Services, INC.",PPO,4777.17,98.6,,percent of total billed charges,,
QUICKSET INJECTABLE MACROPOROUS CALCIUM PHOSPHATE 8CC  ARTHREX ABS-3008,,C1734,HCPCS,Facility,Outpatient,,,,4845,4118.25,1388.577,4845,PrimeWest Health,Minnesota Senior Health Options (MSHO),2492.7525,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
QUICKSET INJECTABLE MACROPOROUS CALCIUM PHOSPHATE 8CC  ARTHREX ABS-3008,,C1734,HCPCS,Facility,Inpatient,,,,4845,4118.25,1388.577,4845,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
QUICKSET INJECTABLE MACROPOROUS CALCIUM PHOSPHATE 8CC  ARTHREX ABS-3008,,C1734,HCPCS,Facility,Outpatient,,,,4845,4118.25,1388.577,4845,PrimeWest Health,MinnesotaCare,2488.392,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
QUICKSET INJECTABLE MACROPOROUS CALCIUM PHOSPHATE 8CC  ARTHREX ABS-3008,,C1734,HCPCS,Facility,Inpatient,,,,4845,4118.25,1388.577,4845,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
QUICKSET INJECTABLE MACROPOROUS CALCIUM PHOSPHATE 8CC  ARTHREX ABS-3008,,C1734,HCPCS,Facility,Both,,,,4845,4118.25,1388.577,4845,Sanford Health Plan,Sanford Health Plan,4457.4,92,,percent of total billed charges,,
QUICKSET INJECTABLE MACROPOROUS CALCIUM PHOSPHATE 8CC  ARTHREX ABS-3008,,C1734,HCPCS,Facility,Outpatient,,,,4845,4118.25,1388.577,4845,"UCare Health, Inc.",Individual & Family Plan,2730.1575,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
QUICKSET INJECTABLE MACROPOROUS CALCIUM PHOSPHATE 8CC  ARTHREX ABS-3008,,C1734,HCPCS,Facility,Inpatient,,,,4845,4118.25,1388.577,4845,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
QUICKSET INJECTABLE MACROPOROUS CALCIUM PHOSPHATE 8CC  ARTHREX ABS-3008,,C1734,HCPCS,Facility,Outpatient,,,,4845,4118.25,1388.577,4845,"UCare Health, Inc.",Medical Assistance,2445.2715,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
QUICKSET INJECTABLE MACROPOROUS CALCIUM PHOSPHATE 8CC  ARTHREX ABS-3008,,C1734,HCPCS,Facility,Inpatient,,,,4845,4118.25,1388.577,4845,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
QUICKSET INJECTABLE MACROPOROUS CALCIUM PHOSPHATE 8CC  ARTHREX ABS-3008,,C1734,HCPCS,Facility,Outpatient,,,,4845,4118.25,1388.577,4845,"UCare Health, Inc.",Medicare Advantage,2445.2715,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
QUICKSET INJECTABLE MACROPOROUS CALCIUM PHOSPHATE 8CC  ARTHREX ABS-3008,,C1734,HCPCS,Facility,Inpatient,,,,4845,4118.25,1388.577,4845,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
QUICKSET INJECTABLE MACROPOROUS CALCIUM PHOSPHATE 8CC  ARTHREX ABS-3008,,C1734,HCPCS,Facility,Outpatient,,,,4845,4118.25,1388.577,4845,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2445.2715,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
QUICKSET INJECTABLE MACROPOROUS CALCIUM PHOSPHATE 8CC  ARTHREX ABS-3008,,C1734,HCPCS,Facility,Inpatient,,,,4845,4118.25,1388.577,4845,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
QUICKSET INJECTABLE MACROPOROUS CALCIUM PHOSPHATE 8CC  ARTHREX ABS-3008,,C1734,HCPCS,Facility,Both,,,,4845,4118.25,1388.577,4845,UnitedHealthcare,Individual & Family,4554.3,94,,percent of total billed charges,,
QUICKSET INJECTABLE MACROPOROUS CALCIUM PHOSPHATE 8CC  ARTHREX ABS-3008,,C1734,HCPCS,Facility,Outpatient,,,,4845,4118.25,1388.577,4845,UnitedHealthcare,Medicare Advantage,2374.05,49,,percent of total billed charges,,
QUICKSET INJECTABLE MACROPOROUS CALCIUM PHOSPHATE 8CC  ARTHREX ABS-3008,,C1734,HCPCS,Facility,Inpatient,,,,4845,4118.25,1388.577,4845,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
QUICKSET INJECTABLE MACROPOROUS CALCIUM PHOSPHATE 8CC  ARTHREX ABS-3008,,C1734,HCPCS,Facility,Outpatient,,,,4845,4118.25,1388.577,4845,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2325.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
QUICKSET INJECTABLE MACROPOROUS CALCIUM PHOSPHATE 8CC  ARTHREX ABS-3008,,C1734,HCPCS,Facility,Inpatient,,,,4845,4118.25,1388.577,4845,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
CATHETER FOLEY LATEX 22FR 30ML 3WAY  0167L22,,C1758,HCPCS,Facility,Both,,,,46.3,39.355,13.26958,46.3,Aetna,Commercial,42.596,92,,percent of total billed charges,,
CATHETER FOLEY LATEX 22FR 30ML 3WAY  0167L22,,C1758,HCPCS,Facility,Outpatient,,,,46.3,39.355,13.26958,46.3,Aetna,Medicare Advantage,22.687,49,,percent of total billed charges,,
CATHETER FOLEY LATEX 22FR 30ML 3WAY  0167L22,,C1758,HCPCS,Facility,Inpatient,,,,46.3,39.355,13.26958,46.3,Aetna,Medicare Advantage,,,,,Included in per diem rate,
CATHETER FOLEY LATEX 22FR 30ML 3WAY  0167L22,,C1758,HCPCS,Facility,Both,,,,46.3,39.355,13.26958,46.3,Aetna,PPO,43.059,93,,percent of total billed charges,,
CATHETER FOLEY LATEX 22FR 30ML 3WAY  0167L22,,C1758,HCPCS,Facility,Both,,,,46.3,39.355,13.26958,46.3,America's PPO,America's PPO,44.46189,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
CATHETER FOLEY LATEX 22FR 30ML 3WAY  0167L22,,C1758,HCPCS,Facility,Both,,,,46.3,39.355,13.26958,46.3,BlueCross BlueShield Minnesota, Federal Employee Program,45.5592,98.4,,percent of total billed charges,,
CATHETER FOLEY LATEX 22FR 30ML 3WAY  0167L22,,C1758,HCPCS,Facility,Both,,,,46.3,39.355,13.26958,46.3,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,46.3,100,,percent of total billed charges,,
CATHETER FOLEY LATEX 22FR 30ML 3WAY  0167L22,,C1758,HCPCS,Facility,Both,,,,46.3,39.355,13.26958,46.3,BlueCross BlueShield Minnesota,High Value Network Plan,41.67,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
CATHETER FOLEY LATEX 22FR 30ML 3WAY  0167L22,,C1758,HCPCS,Facility,Outpatient,,,,46.3,39.355,13.26958,46.3,BlueCross BlueShield Minnesota,Medicare Advantage,22.687,49,,percent of total billed charges,,
CATHETER FOLEY LATEX 22FR 30ML 3WAY  0167L22,,C1758,HCPCS,Facility,Inpatient,,,,46.3,39.355,13.26958,46.3,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
CATHETER FOLEY LATEX 22FR 30ML 3WAY  0167L22,,C1758,HCPCS,Facility,Both,,,,46.3,39.355,13.26958,46.3,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,41.00791,88.57,,percent of total billed charges,,
CATHETER FOLEY LATEX 22FR 30ML 3WAY  0167L22,,C1758,HCPCS,Facility,Both,,,,46.3,39.355,13.26958,46.3,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,13.26958,28.66,,percent of total billed charges,,
CATHETER FOLEY LATEX 22FR 30ML 3WAY  0167L22,,C1758,HCPCS,Facility,Outpatient,,,,46.3,39.355,13.26958,46.3,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),22.687,49,,percent of total billed charges,,
CATHETER FOLEY LATEX 22FR 30ML 3WAY  0167L22,,C1758,HCPCS,Facility,Inpatient,,,,46.3,39.355,13.26958,46.3,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
CATHETER FOLEY LATEX 22FR 30ML 3WAY  0167L22,,C1758,HCPCS,Facility,Both,,,,46.3,39.355,13.26958,46.3,CorVel,Worker's Compensation,46.3,100,,percent of total billed charges,,
CATHETER FOLEY LATEX 22FR 30ML 3WAY  0167L22,,C1758,HCPCS,Facility,Both,,,,46.3,39.355,13.26958,46.3,First Health Group Corporation,First Health Network,44.911,97,,percent of total billed charges,,
CATHETER FOLEY LATEX 22FR 30ML 3WAY  0167L22,,C1758,HCPCS,Facility,Both,,,,46.3,39.355,13.26958,46.3,"Health Partners, Inc.",Commercial,43.7998,94.6,,percent of total billed charges,,
CATHETER FOLEY LATEX 22FR 30ML 3WAY  0167L22,,C1758,HCPCS,Facility,Outpatient,,,,46.3,39.355,13.26958,46.3,"Health Partners, Inc.",Medicare Advantage,22.687,49,,percent of total billed charges,,
CATHETER FOLEY LATEX 22FR 30ML 3WAY  0167L22,,C1758,HCPCS,Facility,Inpatient,,,,46.3,39.355,13.26958,46.3,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CATHETER FOLEY LATEX 22FR 30ML 3WAY  0167L22,,C1758,HCPCS,Facility,Both,,,,46.3,39.355,13.26958,46.3,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),27.78,60,,percent of total billed charges,,
CATHETER FOLEY LATEX 22FR 30ML 3WAY  0167L22,,C1758,HCPCS,Facility,Both,,,,46.3,39.355,13.26958,46.3,"Health Partners, Inc.",State of Minnesota Advantage Program,37.7345,81.5,,percent of total billed charges,,
CATHETER FOLEY LATEX 22FR 30ML 3WAY  0167L22,,C1758,HCPCS,Facility,Both,,,,46.3,39.355,13.26958,46.3,"Health Partners, Inc.",State Public Programs,23.15,50,,percent of total billed charges,,
CATHETER FOLEY LATEX 22FR 30ML 3WAY  0167L22,,C1758,HCPCS,Facility,Both,,,,46.3,39.355,13.26958,46.3,Humana Insurance Company,Commercial PPO,43.985,95,,percent of total billed charges,,
CATHETER FOLEY LATEX 22FR 30ML 3WAY  0167L22,,C1758,HCPCS,Facility,Outpatient,,,,46.3,39.355,13.26958,46.3,Humana Insurance Company,Medicare PPO,22.687,49,,percent of total billed charges,,
CATHETER FOLEY LATEX 22FR 30ML 3WAY  0167L22,,C1758,HCPCS,Facility,Inpatient,,,,46.3,39.355,13.26958,46.3,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
CATHETER FOLEY LATEX 22FR 30ML 3WAY  0167L22,,C1758,HCPCS,Facility,Both,,,,46.3,39.355,13.26958,46.3,Medica,Individual & Family,45.8833,99.1,,percent of total billed charges,,
CATHETER FOLEY LATEX 22FR 30ML 3WAY  0167L22,,C1758,HCPCS,Facility,Outpatient,,,,46.3,39.355,13.26958,46.3,Medica,Medica Advantage Solution,23.0574,49.8,,percent of total billed charges,,
CATHETER FOLEY LATEX 22FR 30ML 3WAY  0167L22,,C1758,HCPCS,Facility,Inpatient,,,,46.3,39.355,13.26958,46.3,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
CATHETER FOLEY LATEX 22FR 30ML 3WAY  0167L22,,C1758,HCPCS,Facility,Outpatient,,,,46.3,39.355,13.26958,46.3,Medica,Medical Assistance,20.6498,44.6,,percent of total billed charges,,
CATHETER FOLEY LATEX 22FR 30ML 3WAY  0167L22,,C1758,HCPCS,Facility,Inpatient,,,,46.3,39.355,13.26958,46.3,Medica,Medical Assistance,,,,,Included in per diem rate,
CATHETER FOLEY LATEX 22FR 30ML 3WAY  0167L22,,C1758,HCPCS,Facility,Outpatient,,,,46.3,39.355,13.26958,46.3,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,23.0574,49.8,,percent of total billed charges,,
CATHETER FOLEY LATEX 22FR 30ML 3WAY  0167L22,,C1758,HCPCS,Facility,Inpatient,,,,46.3,39.355,13.26958,46.3,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
CATHETER FOLEY LATEX 22FR 30ML 3WAY  0167L22,,C1758,HCPCS,Facility,Both,,,,46.3,39.355,13.26958,46.3,"Multiplan, Inc.","Multiplan, Inc.",43.522,94,,percent of total billed charges,,
CATHETER FOLEY LATEX 22FR 30ML 3WAY  0167L22,,C1758,HCPCS,Facility,Outpatient,,,,46.3,39.355,13.26958,46.3,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,41.7163,90.1,,percent of total billed charges,,
CATHETER FOLEY LATEX 22FR 30ML 3WAY  0167L22,,C1758,HCPCS,Facility,Inpatient,,,,46.3,39.355,13.26958,46.3,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
CATHETER FOLEY LATEX 22FR 30ML 3WAY  0167L22,,C1758,HCPCS,Facility,Both,,,,46.3,39.355,13.26958,46.3,"Preferred One Administrative Services, INC.",PPO,45.6518,98.6,,percent of total billed charges,,
CATHETER FOLEY LATEX 22FR 30ML 3WAY  0167L22,,C1758,HCPCS,Facility,Outpatient,,,,46.3,39.355,13.26958,46.3,PrimeWest Health,Minnesota Senior Health Options (MSHO),23.82135,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
CATHETER FOLEY LATEX 22FR 30ML 3WAY  0167L22,,C1758,HCPCS,Facility,Inpatient,,,,46.3,39.355,13.26958,46.3,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CATHETER FOLEY LATEX 22FR 30ML 3WAY  0167L22,,C1758,HCPCS,Facility,Outpatient,,,,46.3,39.355,13.26958,46.3,PrimeWest Health,MinnesotaCare,23.77968,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
CATHETER FOLEY LATEX 22FR 30ML 3WAY  0167L22,,C1758,HCPCS,Facility,Inpatient,,,,46.3,39.355,13.26958,46.3,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
CATHETER FOLEY LATEX 22FR 30ML 3WAY  0167L22,,C1758,HCPCS,Facility,Both,,,,46.3,39.355,13.26958,46.3,Sanford Health Plan,Sanford Health Plan,42.596,92,,percent of total billed charges,,
CATHETER FOLEY LATEX 22FR 30ML 3WAY  0167L22,,C1758,HCPCS,Facility,Outpatient,,,,46.3,39.355,13.26958,46.3,"UCare Health, Inc.",Individual & Family Plan,26.09005,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
CATHETER FOLEY LATEX 22FR 30ML 3WAY  0167L22,,C1758,HCPCS,Facility,Inpatient,,,,46.3,39.355,13.26958,46.3,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
CATHETER FOLEY LATEX 22FR 30ML 3WAY  0167L22,,C1758,HCPCS,Facility,Outpatient,,,,46.3,39.355,13.26958,46.3,"UCare Health, Inc.",Medical Assistance,23.36761,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CATHETER FOLEY LATEX 22FR 30ML 3WAY  0167L22,,C1758,HCPCS,Facility,Inpatient,,,,46.3,39.355,13.26958,46.3,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
CATHETER FOLEY LATEX 22FR 30ML 3WAY  0167L22,,C1758,HCPCS,Facility,Outpatient,,,,46.3,39.355,13.26958,46.3,"UCare Health, Inc.",Medicare Advantage,23.36761,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CATHETER FOLEY LATEX 22FR 30ML 3WAY  0167L22,,C1758,HCPCS,Facility,Inpatient,,,,46.3,39.355,13.26958,46.3,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CATHETER FOLEY LATEX 22FR 30ML 3WAY  0167L22,,C1758,HCPCS,Facility,Outpatient,,,,46.3,39.355,13.26958,46.3,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),23.36761,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CATHETER FOLEY LATEX 22FR 30ML 3WAY  0167L22,,C1758,HCPCS,Facility,Inpatient,,,,46.3,39.355,13.26958,46.3,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CATHETER FOLEY LATEX 22FR 30ML 3WAY  0167L22,,C1758,HCPCS,Facility,Both,,,,46.3,39.355,13.26958,46.3,UnitedHealthcare,Individual & Family,43.522,94,,percent of total billed charges,,
CATHETER FOLEY LATEX 22FR 30ML 3WAY  0167L22,,C1758,HCPCS,Facility,Outpatient,,,,46.3,39.355,13.26958,46.3,UnitedHealthcare,Medicare Advantage,22.687,49,,percent of total billed charges,,
CATHETER FOLEY LATEX 22FR 30ML 3WAY  0167L22,,C1758,HCPCS,Facility,Inpatient,,,,46.3,39.355,13.26958,46.3,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
CATHETER FOLEY LATEX 22FR 30ML 3WAY  0167L22,,C1758,HCPCS,Facility,Outpatient,,,,46.3,39.355,13.26958,46.3,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,22.224,48,,percent of total billed charges,,100% of DHS outpatient percentage
CATHETER FOLEY LATEX 22FR 30ML 3WAY  0167L22,,C1758,HCPCS,Facility,Inpatient,,,,46.3,39.355,13.26958,46.3,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
CATHETER TIGERTAIL FLEXIBLE TIP 6 FR X 70 CM,,C1758,HCPCS,Facility,Both,,,,57.6,48.96,16.50816,57.6,Aetna,Commercial,52.992,92,,percent of total billed charges,,
CATHETER TIGERTAIL FLEXIBLE TIP 6 FR X 70 CM,,C1758,HCPCS,Facility,Outpatient,,,,57.6,48.96,16.50816,57.6,Aetna,Medicare Advantage,28.224,49,,percent of total billed charges,,
CATHETER TIGERTAIL FLEXIBLE TIP 6 FR X 70 CM,,C1758,HCPCS,Facility,Inpatient,,,,57.6,48.96,16.50816,57.6,Aetna,Medicare Advantage,,,,,Included in per diem rate,
CATHETER TIGERTAIL FLEXIBLE TIP 6 FR X 70 CM,,C1758,HCPCS,Facility,Both,,,,57.6,48.96,16.50816,57.6,Aetna,PPO,53.568,93,,percent of total billed charges,,
CATHETER TIGERTAIL FLEXIBLE TIP 6 FR X 70 CM,,C1758,HCPCS,Facility,Both,,,,57.6,48.96,16.50816,57.6,America's PPO,America's PPO,55.31328,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
CATHETER TIGERTAIL FLEXIBLE TIP 6 FR X 70 CM,,C1758,HCPCS,Facility,Both,,,,57.6,48.96,16.50816,57.6,BlueCross BlueShield Minnesota, Federal Employee Program,56.6784,98.4,,percent of total billed charges,,
CATHETER TIGERTAIL FLEXIBLE TIP 6 FR X 70 CM,,C1758,HCPCS,Facility,Both,,,,57.6,48.96,16.50816,57.6,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,57.6,100,,percent of total billed charges,,
CATHETER TIGERTAIL FLEXIBLE TIP 6 FR X 70 CM,,C1758,HCPCS,Facility,Both,,,,57.6,48.96,16.50816,57.6,BlueCross BlueShield Minnesota,High Value Network Plan,51.84,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
CATHETER TIGERTAIL FLEXIBLE TIP 6 FR X 70 CM,,C1758,HCPCS,Facility,Outpatient,,,,57.6,48.96,16.50816,57.6,BlueCross BlueShield Minnesota,Medicare Advantage,28.224,49,,percent of total billed charges,,
CATHETER TIGERTAIL FLEXIBLE TIP 6 FR X 70 CM,,C1758,HCPCS,Facility,Inpatient,,,,57.6,48.96,16.50816,57.6,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
CATHETER TIGERTAIL FLEXIBLE TIP 6 FR X 70 CM,,C1758,HCPCS,Facility,Both,,,,57.6,48.96,16.50816,57.6,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,51.01632,88.57,,percent of total billed charges,,
CATHETER TIGERTAIL FLEXIBLE TIP 6 FR X 70 CM,,C1758,HCPCS,Facility,Both,,,,57.6,48.96,16.50816,57.6,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,16.50816,28.66,,percent of total billed charges,,
CATHETER TIGERTAIL FLEXIBLE TIP 6 FR X 70 CM,,C1758,HCPCS,Facility,Outpatient,,,,57.6,48.96,16.50816,57.6,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),28.224,49,,percent of total billed charges,,
CATHETER TIGERTAIL FLEXIBLE TIP 6 FR X 70 CM,,C1758,HCPCS,Facility,Inpatient,,,,57.6,48.96,16.50816,57.6,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
CATHETER TIGERTAIL FLEXIBLE TIP 6 FR X 70 CM,,C1758,HCPCS,Facility,Both,,,,57.6,48.96,16.50816,57.6,CorVel,Worker's Compensation,57.6,100,,percent of total billed charges,,
CATHETER TIGERTAIL FLEXIBLE TIP 6 FR X 70 CM,,C1758,HCPCS,Facility,Both,,,,57.6,48.96,16.50816,57.6,First Health Group Corporation,First Health Network,55.872,97,,percent of total billed charges,,
CATHETER TIGERTAIL FLEXIBLE TIP 6 FR X 70 CM,,C1758,HCPCS,Facility,Both,,,,57.6,48.96,16.50816,57.6,"Health Partners, Inc.",Commercial,54.4896,94.6,,percent of total billed charges,,
CATHETER TIGERTAIL FLEXIBLE TIP 6 FR X 70 CM,,C1758,HCPCS,Facility,Outpatient,,,,57.6,48.96,16.50816,57.6,"Health Partners, Inc.",Medicare Advantage,28.224,49,,percent of total billed charges,,
CATHETER TIGERTAIL FLEXIBLE TIP 6 FR X 70 CM,,C1758,HCPCS,Facility,Inpatient,,,,57.6,48.96,16.50816,57.6,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CATHETER TIGERTAIL FLEXIBLE TIP 6 FR X 70 CM,,C1758,HCPCS,Facility,Both,,,,57.6,48.96,16.50816,57.6,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),34.56,60,,percent of total billed charges,,
CATHETER TIGERTAIL FLEXIBLE TIP 6 FR X 70 CM,,C1758,HCPCS,Facility,Both,,,,57.6,48.96,16.50816,57.6,"Health Partners, Inc.",State of Minnesota Advantage Program,46.944,81.5,,percent of total billed charges,,
CATHETER TIGERTAIL FLEXIBLE TIP 6 FR X 70 CM,,C1758,HCPCS,Facility,Both,,,,57.6,48.96,16.50816,57.6,"Health Partners, Inc.",State Public Programs,28.8,50,,percent of total billed charges,,
CATHETER TIGERTAIL FLEXIBLE TIP 6 FR X 70 CM,,C1758,HCPCS,Facility,Both,,,,57.6,48.96,16.50816,57.6,Humana Insurance Company,Commercial PPO,54.72,95,,percent of total billed charges,,
CATHETER TIGERTAIL FLEXIBLE TIP 6 FR X 70 CM,,C1758,HCPCS,Facility,Outpatient,,,,57.6,48.96,16.50816,57.6,Humana Insurance Company,Medicare PPO,28.224,49,,percent of total billed charges,,
CATHETER TIGERTAIL FLEXIBLE TIP 6 FR X 70 CM,,C1758,HCPCS,Facility,Inpatient,,,,57.6,48.96,16.50816,57.6,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
CATHETER TIGERTAIL FLEXIBLE TIP 6 FR X 70 CM,,C1758,HCPCS,Facility,Both,,,,57.6,48.96,16.50816,57.6,Medica,Individual & Family,57.0816,99.1,,percent of total billed charges,,
CATHETER TIGERTAIL FLEXIBLE TIP 6 FR X 70 CM,,C1758,HCPCS,Facility,Outpatient,,,,57.6,48.96,16.50816,57.6,Medica,Medica Advantage Solution,28.6848,49.8,,percent of total billed charges,,
CATHETER TIGERTAIL FLEXIBLE TIP 6 FR X 70 CM,,C1758,HCPCS,Facility,Inpatient,,,,57.6,48.96,16.50816,57.6,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
CATHETER TIGERTAIL FLEXIBLE TIP 6 FR X 70 CM,,C1758,HCPCS,Facility,Outpatient,,,,57.6,48.96,16.50816,57.6,Medica,Medical Assistance,25.6896,44.6,,percent of total billed charges,,
CATHETER TIGERTAIL FLEXIBLE TIP 6 FR X 70 CM,,C1758,HCPCS,Facility,Inpatient,,,,57.6,48.96,16.50816,57.6,Medica,Medical Assistance,,,,,Included in per diem rate,
CATHETER TIGERTAIL FLEXIBLE TIP 6 FR X 70 CM,,C1758,HCPCS,Facility,Outpatient,,,,57.6,48.96,16.50816,57.6,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,28.6848,49.8,,percent of total billed charges,,
CATHETER TIGERTAIL FLEXIBLE TIP 6 FR X 70 CM,,C1758,HCPCS,Facility,Inpatient,,,,57.6,48.96,16.50816,57.6,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
CATHETER TIGERTAIL FLEXIBLE TIP 6 FR X 70 CM,,C1758,HCPCS,Facility,Both,,,,57.6,48.96,16.50816,57.6,"Multiplan, Inc.","Multiplan, Inc.",54.144,94,,percent of total billed charges,,
CATHETER TIGERTAIL FLEXIBLE TIP 6 FR X 70 CM,,C1758,HCPCS,Facility,Outpatient,,,,57.6,48.96,16.50816,57.6,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,51.8976,90.1,,percent of total billed charges,,
CATHETER TIGERTAIL FLEXIBLE TIP 6 FR X 70 CM,,C1758,HCPCS,Facility,Inpatient,,,,57.6,48.96,16.50816,57.6,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
CATHETER TIGERTAIL FLEXIBLE TIP 6 FR X 70 CM,,C1758,HCPCS,Facility,Both,,,,57.6,48.96,16.50816,57.6,"Preferred One Administrative Services, INC.",PPO,56.7936,98.6,,percent of total billed charges,,
CATHETER TIGERTAIL FLEXIBLE TIP 6 FR X 70 CM,,C1758,HCPCS,Facility,Outpatient,,,,57.6,48.96,16.50816,57.6,PrimeWest Health,Minnesota Senior Health Options (MSHO),29.6352,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
CATHETER TIGERTAIL FLEXIBLE TIP 6 FR X 70 CM,,C1758,HCPCS,Facility,Inpatient,,,,57.6,48.96,16.50816,57.6,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CATHETER TIGERTAIL FLEXIBLE TIP 6 FR X 70 CM,,C1758,HCPCS,Facility,Outpatient,,,,57.6,48.96,16.50816,57.6,PrimeWest Health,MinnesotaCare,29.58336,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
CATHETER TIGERTAIL FLEXIBLE TIP 6 FR X 70 CM,,C1758,HCPCS,Facility,Inpatient,,,,57.6,48.96,16.50816,57.6,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
CATHETER TIGERTAIL FLEXIBLE TIP 6 FR X 70 CM,,C1758,HCPCS,Facility,Both,,,,57.6,48.96,16.50816,57.6,Sanford Health Plan,Sanford Health Plan,52.992,92,,percent of total billed charges,,
CATHETER TIGERTAIL FLEXIBLE TIP 6 FR X 70 CM,,C1758,HCPCS,Facility,Outpatient,,,,57.6,48.96,16.50816,57.6,"UCare Health, Inc.",Individual & Family Plan,32.4576,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
CATHETER TIGERTAIL FLEXIBLE TIP 6 FR X 70 CM,,C1758,HCPCS,Facility,Inpatient,,,,57.6,48.96,16.50816,57.6,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
CATHETER TIGERTAIL FLEXIBLE TIP 6 FR X 70 CM,,C1758,HCPCS,Facility,Outpatient,,,,57.6,48.96,16.50816,57.6,"UCare Health, Inc.",Medical Assistance,29.07072,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CATHETER TIGERTAIL FLEXIBLE TIP 6 FR X 70 CM,,C1758,HCPCS,Facility,Inpatient,,,,57.6,48.96,16.50816,57.6,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
CATHETER TIGERTAIL FLEXIBLE TIP 6 FR X 70 CM,,C1758,HCPCS,Facility,Outpatient,,,,57.6,48.96,16.50816,57.6,"UCare Health, Inc.",Medicare Advantage,29.07072,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CATHETER TIGERTAIL FLEXIBLE TIP 6 FR X 70 CM,,C1758,HCPCS,Facility,Inpatient,,,,57.6,48.96,16.50816,57.6,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CATHETER TIGERTAIL FLEXIBLE TIP 6 FR X 70 CM,,C1758,HCPCS,Facility,Outpatient,,,,57.6,48.96,16.50816,57.6,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),29.07072,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CATHETER TIGERTAIL FLEXIBLE TIP 6 FR X 70 CM,,C1758,HCPCS,Facility,Inpatient,,,,57.6,48.96,16.50816,57.6,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CATHETER TIGERTAIL FLEXIBLE TIP 6 FR X 70 CM,,C1758,HCPCS,Facility,Both,,,,57.6,48.96,16.50816,57.6,UnitedHealthcare,Individual & Family,54.144,94,,percent of total billed charges,,
CATHETER TIGERTAIL FLEXIBLE TIP 6 FR X 70 CM,,C1758,HCPCS,Facility,Outpatient,,,,57.6,48.96,16.50816,57.6,UnitedHealthcare,Medicare Advantage,28.224,49,,percent of total billed charges,,
CATHETER TIGERTAIL FLEXIBLE TIP 6 FR X 70 CM,,C1758,HCPCS,Facility,Inpatient,,,,57.6,48.96,16.50816,57.6,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
CATHETER TIGERTAIL FLEXIBLE TIP 6 FR X 70 CM,,C1758,HCPCS,Facility,Outpatient,,,,57.6,48.96,16.50816,57.6,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,27.648,48,,percent of total billed charges,,100% of DHS outpatient percentage
CATHETER TIGERTAIL FLEXIBLE TIP 6 FR X 70 CM,,C1758,HCPCS,Facility,Inpatient,,,,57.6,48.96,16.50816,57.6,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
.062 K-WIRE,,C1769,HCPCS,Facility,Both,,,,148,125.8,42.4168,148,Aetna,Commercial,136.16,92,,percent of total billed charges,,
.062 K-WIRE,,C1769,HCPCS,Facility,Outpatient,,,,148,125.8,42.4168,148,Aetna,Medicare Advantage,72.52,49,,percent of total billed charges,,
.062 K-WIRE,,C1769,HCPCS,Facility,Inpatient,,,,148,125.8,42.4168,148,Aetna,Medicare Advantage,,,,,Included in per diem rate,
.062 K-WIRE,,C1769,HCPCS,Facility,Both,,,,148,125.8,42.4168,148,Aetna,PPO,137.64,93,,percent of total billed charges,,
.062 K-WIRE,,C1769,HCPCS,Facility,Both,,,,148,125.8,42.4168,148,America's PPO,America's PPO,142.1244,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
.062 K-WIRE,,C1769,HCPCS,Facility,Both,,,,148,125.8,42.4168,148,BlueCross BlueShield Minnesota, Federal Employee Program,145.632,98.4,,percent of total billed charges,,
.062 K-WIRE,,C1769,HCPCS,Facility,Both,,,,148,125.8,42.4168,148,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,148,100,,percent of total billed charges,,
.062 K-WIRE,,C1769,HCPCS,Facility,Both,,,,148,125.8,42.4168,148,BlueCross BlueShield Minnesota,High Value Network Plan,133.2,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
.062 K-WIRE,,C1769,HCPCS,Facility,Outpatient,,,,148,125.8,42.4168,148,BlueCross BlueShield Minnesota,Medicare Advantage,72.52,49,,percent of total billed charges,,
.062 K-WIRE,,C1769,HCPCS,Facility,Inpatient,,,,148,125.8,42.4168,148,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
.062 K-WIRE,,C1769,HCPCS,Facility,Both,,,,148,125.8,42.4168,148,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,131.0836,88.57,,percent of total billed charges,,
.062 K-WIRE,,C1769,HCPCS,Facility,Both,,,,148,125.8,42.4168,148,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,42.4168,28.66,,percent of total billed charges,,
.062 K-WIRE,,C1769,HCPCS,Facility,Outpatient,,,,148,125.8,42.4168,148,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),72.52,49,,percent of total billed charges,,
.062 K-WIRE,,C1769,HCPCS,Facility,Inpatient,,,,148,125.8,42.4168,148,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
.062 K-WIRE,,C1769,HCPCS,Facility,Both,,,,148,125.8,42.4168,148,CorVel,Worker's Compensation,148,100,,percent of total billed charges,,
.062 K-WIRE,,C1769,HCPCS,Facility,Both,,,,148,125.8,42.4168,148,First Health Group Corporation,First Health Network,143.56,97,,percent of total billed charges,,
.062 K-WIRE,,C1769,HCPCS,Facility,Both,,,,148,125.8,42.4168,148,"Health Partners, Inc.",Commercial,140.008,94.6,,percent of total billed charges,,
.062 K-WIRE,,C1769,HCPCS,Facility,Outpatient,,,,148,125.8,42.4168,148,"Health Partners, Inc.",Medicare Advantage,72.52,49,,percent of total billed charges,,
.062 K-WIRE,,C1769,HCPCS,Facility,Inpatient,,,,148,125.8,42.4168,148,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
.062 K-WIRE,,C1769,HCPCS,Facility,Both,,,,148,125.8,42.4168,148,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),88.8,60,,percent of total billed charges,,
.062 K-WIRE,,C1769,HCPCS,Facility,Both,,,,148,125.8,42.4168,148,"Health Partners, Inc.",State of Minnesota Advantage Program,120.62,81.5,,percent of total billed charges,,
.062 K-WIRE,,C1769,HCPCS,Facility,Both,,,,148,125.8,42.4168,148,"Health Partners, Inc.",State Public Programs,74,50,,percent of total billed charges,,
.062 K-WIRE,,C1769,HCPCS,Facility,Both,,,,148,125.8,42.4168,148,Humana Insurance Company,Commercial PPO,140.6,95,,percent of total billed charges,,
.062 K-WIRE,,C1769,HCPCS,Facility,Outpatient,,,,148,125.8,42.4168,148,Humana Insurance Company,Medicare PPO,72.52,49,,percent of total billed charges,,
.062 K-WIRE,,C1769,HCPCS,Facility,Inpatient,,,,148,125.8,42.4168,148,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
.062 K-WIRE,,C1769,HCPCS,Facility,Both,,,,148,125.8,42.4168,148,Medica,Individual & Family,146.668,99.1,,percent of total billed charges,,
.062 K-WIRE,,C1769,HCPCS,Facility,Outpatient,,,,148,125.8,42.4168,148,Medica,Medica Advantage Solution,73.704,49.8,,percent of total billed charges,,
.062 K-WIRE,,C1769,HCPCS,Facility,Inpatient,,,,148,125.8,42.4168,148,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
.062 K-WIRE,,C1769,HCPCS,Facility,Outpatient,,,,148,125.8,42.4168,148,Medica,Medical Assistance,66.008,44.6,,percent of total billed charges,,
.062 K-WIRE,,C1769,HCPCS,Facility,Inpatient,,,,148,125.8,42.4168,148,Medica,Medical Assistance,,,,,Included in per diem rate,
.062 K-WIRE,,C1769,HCPCS,Facility,Outpatient,,,,148,125.8,42.4168,148,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,73.704,49.8,,percent of total billed charges,,
.062 K-WIRE,,C1769,HCPCS,Facility,Inpatient,,,,148,125.8,42.4168,148,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
.062 K-WIRE,,C1769,HCPCS,Facility,Both,,,,148,125.8,42.4168,148,"Multiplan, Inc.","Multiplan, Inc.",139.12,94,,percent of total billed charges,,
.062 K-WIRE,,C1769,HCPCS,Facility,Outpatient,,,,148,125.8,42.4168,148,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,133.348,90.1,,percent of total billed charges,,
.062 K-WIRE,,C1769,HCPCS,Facility,Inpatient,,,,148,125.8,42.4168,148,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
.062 K-WIRE,,C1769,HCPCS,Facility,Both,,,,148,125.8,42.4168,148,"Preferred One Administrative Services, INC.",PPO,145.928,98.6,,percent of total billed charges,,
.062 K-WIRE,,C1769,HCPCS,Facility,Outpatient,,,,148,125.8,42.4168,148,PrimeWest Health,Minnesota Senior Health Options (MSHO),76.146,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
.062 K-WIRE,,C1769,HCPCS,Facility,Inpatient,,,,148,125.8,42.4168,148,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
.062 K-WIRE,,C1769,HCPCS,Facility,Outpatient,,,,148,125.8,42.4168,148,PrimeWest Health,MinnesotaCare,76.0128,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
.062 K-WIRE,,C1769,HCPCS,Facility,Inpatient,,,,148,125.8,42.4168,148,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
.062 K-WIRE,,C1769,HCPCS,Facility,Both,,,,148,125.8,42.4168,148,Sanford Health Plan,Sanford Health Plan,136.16,92,,percent of total billed charges,,
.062 K-WIRE,,C1769,HCPCS,Facility,Outpatient,,,,148,125.8,42.4168,148,"UCare Health, Inc.",Individual & Family Plan,83.398,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
.062 K-WIRE,,C1769,HCPCS,Facility,Inpatient,,,,148,125.8,42.4168,148,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
.062 K-WIRE,,C1769,HCPCS,Facility,Outpatient,,,,148,125.8,42.4168,148,"UCare Health, Inc.",Medical Assistance,74.6956,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
.062 K-WIRE,,C1769,HCPCS,Facility,Inpatient,,,,148,125.8,42.4168,148,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
.062 K-WIRE,,C1769,HCPCS,Facility,Outpatient,,,,148,125.8,42.4168,148,"UCare Health, Inc.",Medicare Advantage,74.6956,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
.062 K-WIRE,,C1769,HCPCS,Facility,Inpatient,,,,148,125.8,42.4168,148,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
.062 K-WIRE,,C1769,HCPCS,Facility,Outpatient,,,,148,125.8,42.4168,148,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),74.6956,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
.062 K-WIRE,,C1769,HCPCS,Facility,Inpatient,,,,148,125.8,42.4168,148,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
.062 K-WIRE,,C1769,HCPCS,Facility,Both,,,,148,125.8,42.4168,148,UnitedHealthcare,Individual & Family,139.12,94,,percent of total billed charges,,
.062 K-WIRE,,C1769,HCPCS,Facility,Outpatient,,,,148,125.8,42.4168,148,UnitedHealthcare,Medicare Advantage,72.52,49,,percent of total billed charges,,
.062 K-WIRE,,C1769,HCPCS,Facility,Inpatient,,,,148,125.8,42.4168,148,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
.062 K-WIRE,,C1769,HCPCS,Facility,Outpatient,,,,148,125.8,42.4168,148,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,71.04,48,,percent of total billed charges,,100% of DHS outpatient percentage
.062 K-WIRE,,C1769,HCPCS,Facility,Inpatient,,,,148,125.8,42.4168,148,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
1.8 FR.4 WIRE NITINOL NO TIP B,,C1769,HCPCS,Facility,Both,,,,519.4,441.49,148.86004,519.4,Aetna,Commercial,477.848,92,,percent of total billed charges,,
1.8 FR.4 WIRE NITINOL NO TIP B,,C1769,HCPCS,Facility,Outpatient,,,,519.4,441.49,148.86004,519.4,Aetna,Medicare Advantage,254.506,49,,percent of total billed charges,,
1.8 FR.4 WIRE NITINOL NO TIP B,,C1769,HCPCS,Facility,Inpatient,,,,519.4,441.49,148.86004,519.4,Aetna,Medicare Advantage,,,,,Included in per diem rate,
1.8 FR.4 WIRE NITINOL NO TIP B,,C1769,HCPCS,Facility,Both,,,,519.4,441.49,148.86004,519.4,Aetna,PPO,483.042,93,,percent of total billed charges,,
1.8 FR.4 WIRE NITINOL NO TIP B,,C1769,HCPCS,Facility,Both,,,,519.4,441.49,148.86004,519.4,America's PPO,America's PPO,498.77982,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
1.8 FR.4 WIRE NITINOL NO TIP B,,C1769,HCPCS,Facility,Both,,,,519.4,441.49,148.86004,519.4,BlueCross BlueShield Minnesota, Federal Employee Program,511.0896,98.4,,percent of total billed charges,,
1.8 FR.4 WIRE NITINOL NO TIP B,,C1769,HCPCS,Facility,Both,,,,519.4,441.49,148.86004,519.4,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,519.4,100,,percent of total billed charges,,
1.8 FR.4 WIRE NITINOL NO TIP B,,C1769,HCPCS,Facility,Both,,,,519.4,441.49,148.86004,519.4,BlueCross BlueShield Minnesota,High Value Network Plan,467.46,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
1.8 FR.4 WIRE NITINOL NO TIP B,,C1769,HCPCS,Facility,Outpatient,,,,519.4,441.49,148.86004,519.4,BlueCross BlueShield Minnesota,Medicare Advantage,254.506,49,,percent of total billed charges,,
1.8 FR.4 WIRE NITINOL NO TIP B,,C1769,HCPCS,Facility,Inpatient,,,,519.4,441.49,148.86004,519.4,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
1.8 FR.4 WIRE NITINOL NO TIP B,,C1769,HCPCS,Facility,Both,,,,519.4,441.49,148.86004,519.4,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,460.03258,88.57,,percent of total billed charges,,
1.8 FR.4 WIRE NITINOL NO TIP B,,C1769,HCPCS,Facility,Both,,,,519.4,441.49,148.86004,519.4,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,148.86004,28.66,,percent of total billed charges,,
1.8 FR.4 WIRE NITINOL NO TIP B,,C1769,HCPCS,Facility,Outpatient,,,,519.4,441.49,148.86004,519.4,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),254.506,49,,percent of total billed charges,,
1.8 FR.4 WIRE NITINOL NO TIP B,,C1769,HCPCS,Facility,Inpatient,,,,519.4,441.49,148.86004,519.4,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
1.8 FR.4 WIRE NITINOL NO TIP B,,C1769,HCPCS,Facility,Both,,,,519.4,441.49,148.86004,519.4,CorVel,Worker's Compensation,519.4,100,,percent of total billed charges,,
1.8 FR.4 WIRE NITINOL NO TIP B,,C1769,HCPCS,Facility,Both,,,,519.4,441.49,148.86004,519.4,First Health Group Corporation,First Health Network,503.818,97,,percent of total billed charges,,
1.8 FR.4 WIRE NITINOL NO TIP B,,C1769,HCPCS,Facility,Both,,,,519.4,441.49,148.86004,519.4,"Health Partners, Inc.",Commercial,491.3524,94.6,,percent of total billed charges,,
1.8 FR.4 WIRE NITINOL NO TIP B,,C1769,HCPCS,Facility,Outpatient,,,,519.4,441.49,148.86004,519.4,"Health Partners, Inc.",Medicare Advantage,254.506,49,,percent of total billed charges,,
1.8 FR.4 WIRE NITINOL NO TIP B,,C1769,HCPCS,Facility,Inpatient,,,,519.4,441.49,148.86004,519.4,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
1.8 FR.4 WIRE NITINOL NO TIP B,,C1769,HCPCS,Facility,Both,,,,519.4,441.49,148.86004,519.4,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),311.64,60,,percent of total billed charges,,
1.8 FR.4 WIRE NITINOL NO TIP B,,C1769,HCPCS,Facility,Both,,,,519.4,441.49,148.86004,519.4,"Health Partners, Inc.",State of Minnesota Advantage Program,423.311,81.5,,percent of total billed charges,,
1.8 FR.4 WIRE NITINOL NO TIP B,,C1769,HCPCS,Facility,Both,,,,519.4,441.49,148.86004,519.4,"Health Partners, Inc.",State Public Programs,259.7,50,,percent of total billed charges,,
1.8 FR.4 WIRE NITINOL NO TIP B,,C1769,HCPCS,Facility,Both,,,,519.4,441.49,148.86004,519.4,Humana Insurance Company,Commercial PPO,493.43,95,,percent of total billed charges,,
1.8 FR.4 WIRE NITINOL NO TIP B,,C1769,HCPCS,Facility,Outpatient,,,,519.4,441.49,148.86004,519.4,Humana Insurance Company,Medicare PPO,254.506,49,,percent of total billed charges,,
1.8 FR.4 WIRE NITINOL NO TIP B,,C1769,HCPCS,Facility,Inpatient,,,,519.4,441.49,148.86004,519.4,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
1.8 FR.4 WIRE NITINOL NO TIP B,,C1769,HCPCS,Facility,Both,,,,519.4,441.49,148.86004,519.4,Medica,Individual & Family,514.7254,99.1,,percent of total billed charges,,
1.8 FR.4 WIRE NITINOL NO TIP B,,C1769,HCPCS,Facility,Outpatient,,,,519.4,441.49,148.86004,519.4,Medica,Medica Advantage Solution,258.6612,49.8,,percent of total billed charges,,
1.8 FR.4 WIRE NITINOL NO TIP B,,C1769,HCPCS,Facility,Inpatient,,,,519.4,441.49,148.86004,519.4,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
1.8 FR.4 WIRE NITINOL NO TIP B,,C1769,HCPCS,Facility,Outpatient,,,,519.4,441.49,148.86004,519.4,Medica,Medical Assistance,231.6524,44.6,,percent of total billed charges,,
1.8 FR.4 WIRE NITINOL NO TIP B,,C1769,HCPCS,Facility,Inpatient,,,,519.4,441.49,148.86004,519.4,Medica,Medical Assistance,,,,,Included in per diem rate,
1.8 FR.4 WIRE NITINOL NO TIP B,,C1769,HCPCS,Facility,Outpatient,,,,519.4,441.49,148.86004,519.4,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,258.6612,49.8,,percent of total billed charges,,
1.8 FR.4 WIRE NITINOL NO TIP B,,C1769,HCPCS,Facility,Inpatient,,,,519.4,441.49,148.86004,519.4,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
1.8 FR.4 WIRE NITINOL NO TIP B,,C1769,HCPCS,Facility,Both,,,,519.4,441.49,148.86004,519.4,"Multiplan, Inc.","Multiplan, Inc.",488.236,94,,percent of total billed charges,,
1.8 FR.4 WIRE NITINOL NO TIP B,,C1769,HCPCS,Facility,Outpatient,,,,519.4,441.49,148.86004,519.4,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,467.9794,90.1,,percent of total billed charges,,
1.8 FR.4 WIRE NITINOL NO TIP B,,C1769,HCPCS,Facility,Inpatient,,,,519.4,441.49,148.86004,519.4,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
1.8 FR.4 WIRE NITINOL NO TIP B,,C1769,HCPCS,Facility,Both,,,,519.4,441.49,148.86004,519.4,"Preferred One Administrative Services, INC.",PPO,512.1284,98.6,,percent of total billed charges,,
1.8 FR.4 WIRE NITINOL NO TIP B,,C1769,HCPCS,Facility,Outpatient,,,,519.4,441.49,148.86004,519.4,PrimeWest Health,Minnesota Senior Health Options (MSHO),267.2313,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
1.8 FR.4 WIRE NITINOL NO TIP B,,C1769,HCPCS,Facility,Inpatient,,,,519.4,441.49,148.86004,519.4,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
1.8 FR.4 WIRE NITINOL NO TIP B,,C1769,HCPCS,Facility,Outpatient,,,,519.4,441.49,148.86004,519.4,PrimeWest Health,MinnesotaCare,266.76384,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
1.8 FR.4 WIRE NITINOL NO TIP B,,C1769,HCPCS,Facility,Inpatient,,,,519.4,441.49,148.86004,519.4,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
1.8 FR.4 WIRE NITINOL NO TIP B,,C1769,HCPCS,Facility,Both,,,,519.4,441.49,148.86004,519.4,Sanford Health Plan,Sanford Health Plan,477.848,92,,percent of total billed charges,,
1.8 FR.4 WIRE NITINOL NO TIP B,,C1769,HCPCS,Facility,Outpatient,,,,519.4,441.49,148.86004,519.4,"UCare Health, Inc.",Individual & Family Plan,292.6819,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
1.8 FR.4 WIRE NITINOL NO TIP B,,C1769,HCPCS,Facility,Inpatient,,,,519.4,441.49,148.86004,519.4,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
1.8 FR.4 WIRE NITINOL NO TIP B,,C1769,HCPCS,Facility,Outpatient,,,,519.4,441.49,148.86004,519.4,"UCare Health, Inc.",Medical Assistance,262.14118,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
1.8 FR.4 WIRE NITINOL NO TIP B,,C1769,HCPCS,Facility,Inpatient,,,,519.4,441.49,148.86004,519.4,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
1.8 FR.4 WIRE NITINOL NO TIP B,,C1769,HCPCS,Facility,Outpatient,,,,519.4,441.49,148.86004,519.4,"UCare Health, Inc.",Medicare Advantage,262.14118,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
1.8 FR.4 WIRE NITINOL NO TIP B,,C1769,HCPCS,Facility,Inpatient,,,,519.4,441.49,148.86004,519.4,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
1.8 FR.4 WIRE NITINOL NO TIP B,,C1769,HCPCS,Facility,Outpatient,,,,519.4,441.49,148.86004,519.4,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),262.14118,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
1.8 FR.4 WIRE NITINOL NO TIP B,,C1769,HCPCS,Facility,Inpatient,,,,519.4,441.49,148.86004,519.4,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
1.8 FR.4 WIRE NITINOL NO TIP B,,C1769,HCPCS,Facility,Both,,,,519.4,441.49,148.86004,519.4,UnitedHealthcare,Individual & Family,488.236,94,,percent of total billed charges,,
1.8 FR.4 WIRE NITINOL NO TIP B,,C1769,HCPCS,Facility,Outpatient,,,,519.4,441.49,148.86004,519.4,UnitedHealthcare,Medicare Advantage,254.506,49,,percent of total billed charges,,
1.8 FR.4 WIRE NITINOL NO TIP B,,C1769,HCPCS,Facility,Inpatient,,,,519.4,441.49,148.86004,519.4,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
1.8 FR.4 WIRE NITINOL NO TIP B,,C1769,HCPCS,Facility,Outpatient,,,,519.4,441.49,148.86004,519.4,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,249.312,48,,percent of total billed charges,,100% of DHS outpatient percentage
1.8 FR.4 WIRE NITINOL NO TIP B,,C1769,HCPCS,Facility,Inpatient,,,,519.4,441.49,148.86004,519.4,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
GUIDEWIRE UROL HIWIRE NITINOL .035/150CM COOK HW-035150 / G30476,,C1769,HCPCS,Facility,Both,,,,195.3,166.005,55.97298,195.3,Aetna,Commercial,179.676,92,,percent of total billed charges,,
GUIDEWIRE UROL HIWIRE NITINOL .035/150CM COOK HW-035150 / G30476,,C1769,HCPCS,Facility,Outpatient,,,,195.3,166.005,55.97298,195.3,Aetna,Medicare Advantage,95.697,49,,percent of total billed charges,,
GUIDEWIRE UROL HIWIRE NITINOL .035/150CM COOK HW-035150 / G30476,,C1769,HCPCS,Facility,Inpatient,,,,195.3,166.005,55.97298,195.3,Aetna,Medicare Advantage,,,,,Included in per diem rate,
GUIDEWIRE UROL HIWIRE NITINOL .035/150CM COOK HW-035150 / G30476,,C1769,HCPCS,Facility,Both,,,,195.3,166.005,55.97298,195.3,Aetna,PPO,181.629,93,,percent of total billed charges,,
GUIDEWIRE UROL HIWIRE NITINOL .035/150CM COOK HW-035150 / G30476,,C1769,HCPCS,Facility,Both,,,,195.3,166.005,55.97298,195.3,America's PPO,America's PPO,187.54659,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
GUIDEWIRE UROL HIWIRE NITINOL .035/150CM COOK HW-035150 / G30476,,C1769,HCPCS,Facility,Both,,,,195.3,166.005,55.97298,195.3,BlueCross BlueShield Minnesota, Federal Employee Program,192.1752,98.4,,percent of total billed charges,,
GUIDEWIRE UROL HIWIRE NITINOL .035/150CM COOK HW-035150 / G30476,,C1769,HCPCS,Facility,Both,,,,195.3,166.005,55.97298,195.3,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,195.3,100,,percent of total billed charges,,
GUIDEWIRE UROL HIWIRE NITINOL .035/150CM COOK HW-035150 / G30476,,C1769,HCPCS,Facility,Both,,,,195.3,166.005,55.97298,195.3,BlueCross BlueShield Minnesota,High Value Network Plan,175.77,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
GUIDEWIRE UROL HIWIRE NITINOL .035/150CM COOK HW-035150 / G30476,,C1769,HCPCS,Facility,Outpatient,,,,195.3,166.005,55.97298,195.3,BlueCross BlueShield Minnesota,Medicare Advantage,95.697,49,,percent of total billed charges,,
GUIDEWIRE UROL HIWIRE NITINOL .035/150CM COOK HW-035150 / G30476,,C1769,HCPCS,Facility,Inpatient,,,,195.3,166.005,55.97298,195.3,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
GUIDEWIRE UROL HIWIRE NITINOL .035/150CM COOK HW-035150 / G30476,,C1769,HCPCS,Facility,Both,,,,195.3,166.005,55.97298,195.3,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,172.97721,88.57,,percent of total billed charges,,
GUIDEWIRE UROL HIWIRE NITINOL .035/150CM COOK HW-035150 / G30476,,C1769,HCPCS,Facility,Both,,,,195.3,166.005,55.97298,195.3,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,55.97298,28.66,,percent of total billed charges,,
GUIDEWIRE UROL HIWIRE NITINOL .035/150CM COOK HW-035150 / G30476,,C1769,HCPCS,Facility,Outpatient,,,,195.3,166.005,55.97298,195.3,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),95.697,49,,percent of total billed charges,,
GUIDEWIRE UROL HIWIRE NITINOL .035/150CM COOK HW-035150 / G30476,,C1769,HCPCS,Facility,Inpatient,,,,195.3,166.005,55.97298,195.3,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
GUIDEWIRE UROL HIWIRE NITINOL .035/150CM COOK HW-035150 / G30476,,C1769,HCPCS,Facility,Both,,,,195.3,166.005,55.97298,195.3,CorVel,Worker's Compensation,195.3,100,,percent of total billed charges,,
GUIDEWIRE UROL HIWIRE NITINOL .035/150CM COOK HW-035150 / G30476,,C1769,HCPCS,Facility,Both,,,,195.3,166.005,55.97298,195.3,First Health Group Corporation,First Health Network,189.441,97,,percent of total billed charges,,
GUIDEWIRE UROL HIWIRE NITINOL .035/150CM COOK HW-035150 / G30476,,C1769,HCPCS,Facility,Both,,,,195.3,166.005,55.97298,195.3,"Health Partners, Inc.",Commercial,184.7538,94.6,,percent of total billed charges,,
GUIDEWIRE UROL HIWIRE NITINOL .035/150CM COOK HW-035150 / G30476,,C1769,HCPCS,Facility,Outpatient,,,,195.3,166.005,55.97298,195.3,"Health Partners, Inc.",Medicare Advantage,95.697,49,,percent of total billed charges,,
GUIDEWIRE UROL HIWIRE NITINOL .035/150CM COOK HW-035150 / G30476,,C1769,HCPCS,Facility,Inpatient,,,,195.3,166.005,55.97298,195.3,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
GUIDEWIRE UROL HIWIRE NITINOL .035/150CM COOK HW-035150 / G30476,,C1769,HCPCS,Facility,Both,,,,195.3,166.005,55.97298,195.3,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),117.18,60,,percent of total billed charges,,
GUIDEWIRE UROL HIWIRE NITINOL .035/150CM COOK HW-035150 / G30476,,C1769,HCPCS,Facility,Both,,,,195.3,166.005,55.97298,195.3,"Health Partners, Inc.",State of Minnesota Advantage Program,159.1695,81.5,,percent of total billed charges,,
GUIDEWIRE UROL HIWIRE NITINOL .035/150CM COOK HW-035150 / G30476,,C1769,HCPCS,Facility,Both,,,,195.3,166.005,55.97298,195.3,"Health Partners, Inc.",State Public Programs,97.65,50,,percent of total billed charges,,
GUIDEWIRE UROL HIWIRE NITINOL .035/150CM COOK HW-035150 / G30476,,C1769,HCPCS,Facility,Both,,,,195.3,166.005,55.97298,195.3,Humana Insurance Company,Commercial PPO,185.535,95,,percent of total billed charges,,
GUIDEWIRE UROL HIWIRE NITINOL .035/150CM COOK HW-035150 / G30476,,C1769,HCPCS,Facility,Outpatient,,,,195.3,166.005,55.97298,195.3,Humana Insurance Company,Medicare PPO,95.697,49,,percent of total billed charges,,
GUIDEWIRE UROL HIWIRE NITINOL .035/150CM COOK HW-035150 / G30476,,C1769,HCPCS,Facility,Inpatient,,,,195.3,166.005,55.97298,195.3,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
GUIDEWIRE UROL HIWIRE NITINOL .035/150CM COOK HW-035150 / G30476,,C1769,HCPCS,Facility,Both,,,,195.3,166.005,55.97298,195.3,Medica,Individual & Family,193.5423,99.1,,percent of total billed charges,,
GUIDEWIRE UROL HIWIRE NITINOL .035/150CM COOK HW-035150 / G30476,,C1769,HCPCS,Facility,Outpatient,,,,195.3,166.005,55.97298,195.3,Medica,Medica Advantage Solution,97.2594,49.8,,percent of total billed charges,,
GUIDEWIRE UROL HIWIRE NITINOL .035/150CM COOK HW-035150 / G30476,,C1769,HCPCS,Facility,Inpatient,,,,195.3,166.005,55.97298,195.3,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
GUIDEWIRE UROL HIWIRE NITINOL .035/150CM COOK HW-035150 / G30476,,C1769,HCPCS,Facility,Outpatient,,,,195.3,166.005,55.97298,195.3,Medica,Medical Assistance,87.1038,44.6,,percent of total billed charges,,
GUIDEWIRE UROL HIWIRE NITINOL .035/150CM COOK HW-035150 / G30476,,C1769,HCPCS,Facility,Inpatient,,,,195.3,166.005,55.97298,195.3,Medica,Medical Assistance,,,,,Included in per diem rate,
GUIDEWIRE UROL HIWIRE NITINOL .035/150CM COOK HW-035150 / G30476,,C1769,HCPCS,Facility,Outpatient,,,,195.3,166.005,55.97298,195.3,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,97.2594,49.8,,percent of total billed charges,,
GUIDEWIRE UROL HIWIRE NITINOL .035/150CM COOK HW-035150 / G30476,,C1769,HCPCS,Facility,Inpatient,,,,195.3,166.005,55.97298,195.3,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
GUIDEWIRE UROL HIWIRE NITINOL .035/150CM COOK HW-035150 / G30476,,C1769,HCPCS,Facility,Both,,,,195.3,166.005,55.97298,195.3,"Multiplan, Inc.","Multiplan, Inc.",183.582,94,,percent of total billed charges,,
GUIDEWIRE UROL HIWIRE NITINOL .035/150CM COOK HW-035150 / G30476,,C1769,HCPCS,Facility,Outpatient,,,,195.3,166.005,55.97298,195.3,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,175.9653,90.1,,percent of total billed charges,,
GUIDEWIRE UROL HIWIRE NITINOL .035/150CM COOK HW-035150 / G30476,,C1769,HCPCS,Facility,Inpatient,,,,195.3,166.005,55.97298,195.3,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
GUIDEWIRE UROL HIWIRE NITINOL .035/150CM COOK HW-035150 / G30476,,C1769,HCPCS,Facility,Both,,,,195.3,166.005,55.97298,195.3,"Preferred One Administrative Services, INC.",PPO,192.5658,98.6,,percent of total billed charges,,
GUIDEWIRE UROL HIWIRE NITINOL .035/150CM COOK HW-035150 / G30476,,C1769,HCPCS,Facility,Outpatient,,,,195.3,166.005,55.97298,195.3,PrimeWest Health,Minnesota Senior Health Options (MSHO),100.48185,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
GUIDEWIRE UROL HIWIRE NITINOL .035/150CM COOK HW-035150 / G30476,,C1769,HCPCS,Facility,Inpatient,,,,195.3,166.005,55.97298,195.3,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
GUIDEWIRE UROL HIWIRE NITINOL .035/150CM COOK HW-035150 / G30476,,C1769,HCPCS,Facility,Outpatient,,,,195.3,166.005,55.97298,195.3,PrimeWest Health,MinnesotaCare,100.30608,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
GUIDEWIRE UROL HIWIRE NITINOL .035/150CM COOK HW-035150 / G30476,,C1769,HCPCS,Facility,Inpatient,,,,195.3,166.005,55.97298,195.3,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
GUIDEWIRE UROL HIWIRE NITINOL .035/150CM COOK HW-035150 / G30476,,C1769,HCPCS,Facility,Both,,,,195.3,166.005,55.97298,195.3,Sanford Health Plan,Sanford Health Plan,179.676,92,,percent of total billed charges,,
GUIDEWIRE UROL HIWIRE NITINOL .035/150CM COOK HW-035150 / G30476,,C1769,HCPCS,Facility,Outpatient,,,,195.3,166.005,55.97298,195.3,"UCare Health, Inc.",Individual & Family Plan,110.05155,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
GUIDEWIRE UROL HIWIRE NITINOL .035/150CM COOK HW-035150 / G30476,,C1769,HCPCS,Facility,Inpatient,,,,195.3,166.005,55.97298,195.3,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
GUIDEWIRE UROL HIWIRE NITINOL .035/150CM COOK HW-035150 / G30476,,C1769,HCPCS,Facility,Outpatient,,,,195.3,166.005,55.97298,195.3,"UCare Health, Inc.",Medical Assistance,98.56791,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
GUIDEWIRE UROL HIWIRE NITINOL .035/150CM COOK HW-035150 / G30476,,C1769,HCPCS,Facility,Inpatient,,,,195.3,166.005,55.97298,195.3,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
GUIDEWIRE UROL HIWIRE NITINOL .035/150CM COOK HW-035150 / G30476,,C1769,HCPCS,Facility,Outpatient,,,,195.3,166.005,55.97298,195.3,"UCare Health, Inc.",Medicare Advantage,98.56791,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
GUIDEWIRE UROL HIWIRE NITINOL .035/150CM COOK HW-035150 / G30476,,C1769,HCPCS,Facility,Inpatient,,,,195.3,166.005,55.97298,195.3,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
GUIDEWIRE UROL HIWIRE NITINOL .035/150CM COOK HW-035150 / G30476,,C1769,HCPCS,Facility,Outpatient,,,,195.3,166.005,55.97298,195.3,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),98.56791,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
GUIDEWIRE UROL HIWIRE NITINOL .035/150CM COOK HW-035150 / G30476,,C1769,HCPCS,Facility,Inpatient,,,,195.3,166.005,55.97298,195.3,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
GUIDEWIRE UROL HIWIRE NITINOL .035/150CM COOK HW-035150 / G30476,,C1769,HCPCS,Facility,Both,,,,195.3,166.005,55.97298,195.3,UnitedHealthcare,Individual & Family,183.582,94,,percent of total billed charges,,
GUIDEWIRE UROL HIWIRE NITINOL .035/150CM COOK HW-035150 / G30476,,C1769,HCPCS,Facility,Outpatient,,,,195.3,166.005,55.97298,195.3,UnitedHealthcare,Medicare Advantage,95.697,49,,percent of total billed charges,,
GUIDEWIRE UROL HIWIRE NITINOL .035/150CM COOK HW-035150 / G30476,,C1769,HCPCS,Facility,Inpatient,,,,195.3,166.005,55.97298,195.3,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
GUIDEWIRE UROL HIWIRE NITINOL .035/150CM COOK HW-035150 / G30476,,C1769,HCPCS,Facility,Outpatient,,,,195.3,166.005,55.97298,195.3,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,93.744,48,,percent of total billed charges,,100% of DHS outpatient percentage
GUIDEWIRE UROL HIWIRE NITINOL .035/150CM COOK HW-035150 / G30476,,C1769,HCPCS,Facility,Inpatient,,,,195.3,166.005,55.97298,195.3,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"GUIDEWIRE UROL ULTRATRACK HYBRID OLYMPUS .035 X 150CM REGULAR BODY, STRAIGHT TIP GWH3505R",,C1769,HCPCS,Facility,Both,,,,90,76.5,25.794,90,Aetna,Commercial,82.8,92,,percent of total billed charges,,
"GUIDEWIRE UROL ULTRATRACK HYBRID OLYMPUS .035 X 150CM REGULAR BODY, STRAIGHT TIP GWH3505R",,C1769,HCPCS,Facility,Outpatient,,,,90,76.5,25.794,90,Aetna,Medicare Advantage,44.1,49,,percent of total billed charges,,
"GUIDEWIRE UROL ULTRATRACK HYBRID OLYMPUS .035 X 150CM REGULAR BODY, STRAIGHT TIP GWH3505R",,C1769,HCPCS,Facility,Inpatient,,,,90,76.5,25.794,90,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"GUIDEWIRE UROL ULTRATRACK HYBRID OLYMPUS .035 X 150CM REGULAR BODY, STRAIGHT TIP GWH3505R",,C1769,HCPCS,Facility,Both,,,,90,76.5,25.794,90,Aetna,PPO,83.7,93,,percent of total billed charges,,
"GUIDEWIRE UROL ULTRATRACK HYBRID OLYMPUS .035 X 150CM REGULAR BODY, STRAIGHT TIP GWH3505R",,C1769,HCPCS,Facility,Both,,,,90,76.5,25.794,90,America's PPO,America's PPO,86.427,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"GUIDEWIRE UROL ULTRATRACK HYBRID OLYMPUS .035 X 150CM REGULAR BODY, STRAIGHT TIP GWH3505R",,C1769,HCPCS,Facility,Both,,,,90,76.5,25.794,90,BlueCross BlueShield Minnesota, Federal Employee Program,88.56,98.4,,percent of total billed charges,,
"GUIDEWIRE UROL ULTRATRACK HYBRID OLYMPUS .035 X 150CM REGULAR BODY, STRAIGHT TIP GWH3505R",,C1769,HCPCS,Facility,Both,,,,90,76.5,25.794,90,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,90,100,,percent of total billed charges,,
"GUIDEWIRE UROL ULTRATRACK HYBRID OLYMPUS .035 X 150CM REGULAR BODY, STRAIGHT TIP GWH3505R",,C1769,HCPCS,Facility,Both,,,,90,76.5,25.794,90,BlueCross BlueShield Minnesota,High Value Network Plan,81,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
"GUIDEWIRE UROL ULTRATRACK HYBRID OLYMPUS .035 X 150CM REGULAR BODY, STRAIGHT TIP GWH3505R",,C1769,HCPCS,Facility,Outpatient,,,,90,76.5,25.794,90,BlueCross BlueShield Minnesota,Medicare Advantage,44.1,49,,percent of total billed charges,,
"GUIDEWIRE UROL ULTRATRACK HYBRID OLYMPUS .035 X 150CM REGULAR BODY, STRAIGHT TIP GWH3505R",,C1769,HCPCS,Facility,Inpatient,,,,90,76.5,25.794,90,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"GUIDEWIRE UROL ULTRATRACK HYBRID OLYMPUS .035 X 150CM REGULAR BODY, STRAIGHT TIP GWH3505R",,C1769,HCPCS,Facility,Both,,,,90,76.5,25.794,90,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,79.713,88.57,,percent of total billed charges,,
"GUIDEWIRE UROL ULTRATRACK HYBRID OLYMPUS .035 X 150CM REGULAR BODY, STRAIGHT TIP GWH3505R",,C1769,HCPCS,Facility,Both,,,,90,76.5,25.794,90,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,25.794,28.66,,percent of total billed charges,,
"GUIDEWIRE UROL ULTRATRACK HYBRID OLYMPUS .035 X 150CM REGULAR BODY, STRAIGHT TIP GWH3505R",,C1769,HCPCS,Facility,Outpatient,,,,90,76.5,25.794,90,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),44.1,49,,percent of total billed charges,,
"GUIDEWIRE UROL ULTRATRACK HYBRID OLYMPUS .035 X 150CM REGULAR BODY, STRAIGHT TIP GWH3505R",,C1769,HCPCS,Facility,Inpatient,,,,90,76.5,25.794,90,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"GUIDEWIRE UROL ULTRATRACK HYBRID OLYMPUS .035 X 150CM REGULAR BODY, STRAIGHT TIP GWH3505R",,C1769,HCPCS,Facility,Both,,,,90,76.5,25.794,90,CorVel,Worker's Compensation,90,100,,percent of total billed charges,,
"GUIDEWIRE UROL ULTRATRACK HYBRID OLYMPUS .035 X 150CM REGULAR BODY, STRAIGHT TIP GWH3505R",,C1769,HCPCS,Facility,Both,,,,90,76.5,25.794,90,First Health Group Corporation,First Health Network,87.3,97,,percent of total billed charges,,
"GUIDEWIRE UROL ULTRATRACK HYBRID OLYMPUS .035 X 150CM REGULAR BODY, STRAIGHT TIP GWH3505R",,C1769,HCPCS,Facility,Both,,,,90,76.5,25.794,90,"Health Partners, Inc.",Commercial,85.14,94.6,,percent of total billed charges,,
"GUIDEWIRE UROL ULTRATRACK HYBRID OLYMPUS .035 X 150CM REGULAR BODY, STRAIGHT TIP GWH3505R",,C1769,HCPCS,Facility,Outpatient,,,,90,76.5,25.794,90,"Health Partners, Inc.",Medicare Advantage,44.1,49,,percent of total billed charges,,
"GUIDEWIRE UROL ULTRATRACK HYBRID OLYMPUS .035 X 150CM REGULAR BODY, STRAIGHT TIP GWH3505R",,C1769,HCPCS,Facility,Inpatient,,,,90,76.5,25.794,90,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"GUIDEWIRE UROL ULTRATRACK HYBRID OLYMPUS .035 X 150CM REGULAR BODY, STRAIGHT TIP GWH3505R",,C1769,HCPCS,Facility,Both,,,,90,76.5,25.794,90,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),54,60,,percent of total billed charges,,
"GUIDEWIRE UROL ULTRATRACK HYBRID OLYMPUS .035 X 150CM REGULAR BODY, STRAIGHT TIP GWH3505R",,C1769,HCPCS,Facility,Both,,,,90,76.5,25.794,90,"Health Partners, Inc.",State of Minnesota Advantage Program,73.35,81.5,,percent of total billed charges,,
"GUIDEWIRE UROL ULTRATRACK HYBRID OLYMPUS .035 X 150CM REGULAR BODY, STRAIGHT TIP GWH3505R",,C1769,HCPCS,Facility,Both,,,,90,76.5,25.794,90,"Health Partners, Inc.",State Public Programs,45,50,,percent of total billed charges,,
"GUIDEWIRE UROL ULTRATRACK HYBRID OLYMPUS .035 X 150CM REGULAR BODY, STRAIGHT TIP GWH3505R",,C1769,HCPCS,Facility,Both,,,,90,76.5,25.794,90,Humana Insurance Company,Commercial PPO,85.5,95,,percent of total billed charges,,
"GUIDEWIRE UROL ULTRATRACK HYBRID OLYMPUS .035 X 150CM REGULAR BODY, STRAIGHT TIP GWH3505R",,C1769,HCPCS,Facility,Outpatient,,,,90,76.5,25.794,90,Humana Insurance Company,Medicare PPO,44.1,49,,percent of total billed charges,,
"GUIDEWIRE UROL ULTRATRACK HYBRID OLYMPUS .035 X 150CM REGULAR BODY, STRAIGHT TIP GWH3505R",,C1769,HCPCS,Facility,Inpatient,,,,90,76.5,25.794,90,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"GUIDEWIRE UROL ULTRATRACK HYBRID OLYMPUS .035 X 150CM REGULAR BODY, STRAIGHT TIP GWH3505R",,C1769,HCPCS,Facility,Both,,,,90,76.5,25.794,90,Medica,Individual & Family,89.19,99.1,,percent of total billed charges,,
"GUIDEWIRE UROL ULTRATRACK HYBRID OLYMPUS .035 X 150CM REGULAR BODY, STRAIGHT TIP GWH3505R",,C1769,HCPCS,Facility,Outpatient,,,,90,76.5,25.794,90,Medica,Medica Advantage Solution,44.82,49.8,,percent of total billed charges,,
"GUIDEWIRE UROL ULTRATRACK HYBRID OLYMPUS .035 X 150CM REGULAR BODY, STRAIGHT TIP GWH3505R",,C1769,HCPCS,Facility,Inpatient,,,,90,76.5,25.794,90,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"GUIDEWIRE UROL ULTRATRACK HYBRID OLYMPUS .035 X 150CM REGULAR BODY, STRAIGHT TIP GWH3505R",,C1769,HCPCS,Facility,Outpatient,,,,90,76.5,25.794,90,Medica,Medical Assistance,40.14,44.6,,percent of total billed charges,,
"GUIDEWIRE UROL ULTRATRACK HYBRID OLYMPUS .035 X 150CM REGULAR BODY, STRAIGHT TIP GWH3505R",,C1769,HCPCS,Facility,Inpatient,,,,90,76.5,25.794,90,Medica,Medical Assistance,,,,,Included in per diem rate,
"GUIDEWIRE UROL ULTRATRACK HYBRID OLYMPUS .035 X 150CM REGULAR BODY, STRAIGHT TIP GWH3505R",,C1769,HCPCS,Facility,Outpatient,,,,90,76.5,25.794,90,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,44.82,49.8,,percent of total billed charges,,
"GUIDEWIRE UROL ULTRATRACK HYBRID OLYMPUS .035 X 150CM REGULAR BODY, STRAIGHT TIP GWH3505R",,C1769,HCPCS,Facility,Inpatient,,,,90,76.5,25.794,90,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"GUIDEWIRE UROL ULTRATRACK HYBRID OLYMPUS .035 X 150CM REGULAR BODY, STRAIGHT TIP GWH3505R",,C1769,HCPCS,Facility,Both,,,,90,76.5,25.794,90,"Multiplan, Inc.","Multiplan, Inc.",84.6,94,,percent of total billed charges,,
"GUIDEWIRE UROL ULTRATRACK HYBRID OLYMPUS .035 X 150CM REGULAR BODY, STRAIGHT TIP GWH3505R",,C1769,HCPCS,Facility,Outpatient,,,,90,76.5,25.794,90,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,81.09,90.1,,percent of total billed charges,,
"GUIDEWIRE UROL ULTRATRACK HYBRID OLYMPUS .035 X 150CM REGULAR BODY, STRAIGHT TIP GWH3505R",,C1769,HCPCS,Facility,Inpatient,,,,90,76.5,25.794,90,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"GUIDEWIRE UROL ULTRATRACK HYBRID OLYMPUS .035 X 150CM REGULAR BODY, STRAIGHT TIP GWH3505R",,C1769,HCPCS,Facility,Both,,,,90,76.5,25.794,90,"Preferred One Administrative Services, INC.",PPO,88.74,98.6,,percent of total billed charges,,
"GUIDEWIRE UROL ULTRATRACK HYBRID OLYMPUS .035 X 150CM REGULAR BODY, STRAIGHT TIP GWH3505R",,C1769,HCPCS,Facility,Outpatient,,,,90,76.5,25.794,90,PrimeWest Health,Minnesota Senior Health Options (MSHO),46.305,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"GUIDEWIRE UROL ULTRATRACK HYBRID OLYMPUS .035 X 150CM REGULAR BODY, STRAIGHT TIP GWH3505R",,C1769,HCPCS,Facility,Inpatient,,,,90,76.5,25.794,90,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"GUIDEWIRE UROL ULTRATRACK HYBRID OLYMPUS .035 X 150CM REGULAR BODY, STRAIGHT TIP GWH3505R",,C1769,HCPCS,Facility,Outpatient,,,,90,76.5,25.794,90,PrimeWest Health,MinnesotaCare,46.224,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"GUIDEWIRE UROL ULTRATRACK HYBRID OLYMPUS .035 X 150CM REGULAR BODY, STRAIGHT TIP GWH3505R",,C1769,HCPCS,Facility,Inpatient,,,,90,76.5,25.794,90,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"GUIDEWIRE UROL ULTRATRACK HYBRID OLYMPUS .035 X 150CM REGULAR BODY, STRAIGHT TIP GWH3505R",,C1769,HCPCS,Facility,Both,,,,90,76.5,25.794,90,Sanford Health Plan,Sanford Health Plan,82.8,92,,percent of total billed charges,,
"GUIDEWIRE UROL ULTRATRACK HYBRID OLYMPUS .035 X 150CM REGULAR BODY, STRAIGHT TIP GWH3505R",,C1769,HCPCS,Facility,Outpatient,,,,90,76.5,25.794,90,"UCare Health, Inc.",Individual & Family Plan,50.715,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"GUIDEWIRE UROL ULTRATRACK HYBRID OLYMPUS .035 X 150CM REGULAR BODY, STRAIGHT TIP GWH3505R",,C1769,HCPCS,Facility,Inpatient,,,,90,76.5,25.794,90,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"GUIDEWIRE UROL ULTRATRACK HYBRID OLYMPUS .035 X 150CM REGULAR BODY, STRAIGHT TIP GWH3505R",,C1769,HCPCS,Facility,Outpatient,,,,90,76.5,25.794,90,"UCare Health, Inc.",Medical Assistance,45.423,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"GUIDEWIRE UROL ULTRATRACK HYBRID OLYMPUS .035 X 150CM REGULAR BODY, STRAIGHT TIP GWH3505R",,C1769,HCPCS,Facility,Inpatient,,,,90,76.5,25.794,90,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"GUIDEWIRE UROL ULTRATRACK HYBRID OLYMPUS .035 X 150CM REGULAR BODY, STRAIGHT TIP GWH3505R",,C1769,HCPCS,Facility,Outpatient,,,,90,76.5,25.794,90,"UCare Health, Inc.",Medicare Advantage,45.423,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"GUIDEWIRE UROL ULTRATRACK HYBRID OLYMPUS .035 X 150CM REGULAR BODY, STRAIGHT TIP GWH3505R",,C1769,HCPCS,Facility,Inpatient,,,,90,76.5,25.794,90,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"GUIDEWIRE UROL ULTRATRACK HYBRID OLYMPUS .035 X 150CM REGULAR BODY, STRAIGHT TIP GWH3505R",,C1769,HCPCS,Facility,Outpatient,,,,90,76.5,25.794,90,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),45.423,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"GUIDEWIRE UROL ULTRATRACK HYBRID OLYMPUS .035 X 150CM REGULAR BODY, STRAIGHT TIP GWH3505R",,C1769,HCPCS,Facility,Inpatient,,,,90,76.5,25.794,90,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"GUIDEWIRE UROL ULTRATRACK HYBRID OLYMPUS .035 X 150CM REGULAR BODY, STRAIGHT TIP GWH3505R",,C1769,HCPCS,Facility,Both,,,,90,76.5,25.794,90,UnitedHealthcare,Individual & Family,84.6,94,,percent of total billed charges,,
"GUIDEWIRE UROL ULTRATRACK HYBRID OLYMPUS .035 X 150CM REGULAR BODY, STRAIGHT TIP GWH3505R",,C1769,HCPCS,Facility,Outpatient,,,,90,76.5,25.794,90,UnitedHealthcare,Medicare Advantage,44.1,49,,percent of total billed charges,,
"GUIDEWIRE UROL ULTRATRACK HYBRID OLYMPUS .035 X 150CM REGULAR BODY, STRAIGHT TIP GWH3505R",,C1769,HCPCS,Facility,Inpatient,,,,90,76.5,25.794,90,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"GUIDEWIRE UROL ULTRATRACK HYBRID OLYMPUS .035 X 150CM REGULAR BODY, STRAIGHT TIP GWH3505R",,C1769,HCPCS,Facility,Outpatient,,,,90,76.5,25.794,90,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,43.2,48,,percent of total billed charges,,100% of DHS outpatient percentage
"GUIDEWIRE UROL ULTRATRACK HYBRID OLYMPUS .035 X 150CM REGULAR BODY, STRAIGHT TIP GWH3505R",,C1769,HCPCS,Facility,Inpatient,,,,90,76.5,25.794,90,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
K WIRE 1.2 X 150MM  WRIGHT MED 707091202,,C1769,HCPCS,Facility,Both,,,,164,139.4,47.0024,164,Aetna,Commercial,150.88,92,,percent of total billed charges,,
K WIRE 1.2 X 150MM  WRIGHT MED 707091202,,C1769,HCPCS,Facility,Outpatient,,,,164,139.4,47.0024,164,Aetna,Medicare Advantage,80.36,49,,percent of total billed charges,,
K WIRE 1.2 X 150MM  WRIGHT MED 707091202,,C1769,HCPCS,Facility,Inpatient,,,,164,139.4,47.0024,164,Aetna,Medicare Advantage,,,,,Included in per diem rate,
K WIRE 1.2 X 150MM  WRIGHT MED 707091202,,C1769,HCPCS,Facility,Both,,,,164,139.4,47.0024,164,Aetna,PPO,152.52,93,,percent of total billed charges,,
K WIRE 1.2 X 150MM  WRIGHT MED 707091202,,C1769,HCPCS,Facility,Both,,,,164,139.4,47.0024,164,America's PPO,America's PPO,157.4892,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
K WIRE 1.2 X 150MM  WRIGHT MED 707091202,,C1769,HCPCS,Facility,Both,,,,164,139.4,47.0024,164,BlueCross BlueShield Minnesota, Federal Employee Program,161.376,98.4,,percent of total billed charges,,
K WIRE 1.2 X 150MM  WRIGHT MED 707091202,,C1769,HCPCS,Facility,Both,,,,164,139.4,47.0024,164,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,164,100,,percent of total billed charges,,
K WIRE 1.2 X 150MM  WRIGHT MED 707091202,,C1769,HCPCS,Facility,Both,,,,164,139.4,47.0024,164,BlueCross BlueShield Minnesota,High Value Network Plan,147.6,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
K WIRE 1.2 X 150MM  WRIGHT MED 707091202,,C1769,HCPCS,Facility,Outpatient,,,,164,139.4,47.0024,164,BlueCross BlueShield Minnesota,Medicare Advantage,80.36,49,,percent of total billed charges,,
K WIRE 1.2 X 150MM  WRIGHT MED 707091202,,C1769,HCPCS,Facility,Inpatient,,,,164,139.4,47.0024,164,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
K WIRE 1.2 X 150MM  WRIGHT MED 707091202,,C1769,HCPCS,Facility,Both,,,,164,139.4,47.0024,164,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,145.2548,88.57,,percent of total billed charges,,
K WIRE 1.2 X 150MM  WRIGHT MED 707091202,,C1769,HCPCS,Facility,Both,,,,164,139.4,47.0024,164,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,47.0024,28.66,,percent of total billed charges,,
K WIRE 1.2 X 150MM  WRIGHT MED 707091202,,C1769,HCPCS,Facility,Outpatient,,,,164,139.4,47.0024,164,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),80.36,49,,percent of total billed charges,,
K WIRE 1.2 X 150MM  WRIGHT MED 707091202,,C1769,HCPCS,Facility,Inpatient,,,,164,139.4,47.0024,164,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
K WIRE 1.2 X 150MM  WRIGHT MED 707091202,,C1769,HCPCS,Facility,Both,,,,164,139.4,47.0024,164,CorVel,Worker's Compensation,164,100,,percent of total billed charges,,
K WIRE 1.2 X 150MM  WRIGHT MED 707091202,,C1769,HCPCS,Facility,Both,,,,164,139.4,47.0024,164,First Health Group Corporation,First Health Network,159.08,97,,percent of total billed charges,,
K WIRE 1.2 X 150MM  WRIGHT MED 707091202,,C1769,HCPCS,Facility,Both,,,,164,139.4,47.0024,164,"Health Partners, Inc.",Commercial,155.144,94.6,,percent of total billed charges,,
K WIRE 1.2 X 150MM  WRIGHT MED 707091202,,C1769,HCPCS,Facility,Outpatient,,,,164,139.4,47.0024,164,"Health Partners, Inc.",Medicare Advantage,80.36,49,,percent of total billed charges,,
K WIRE 1.2 X 150MM  WRIGHT MED 707091202,,C1769,HCPCS,Facility,Inpatient,,,,164,139.4,47.0024,164,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
K WIRE 1.2 X 150MM  WRIGHT MED 707091202,,C1769,HCPCS,Facility,Both,,,,164,139.4,47.0024,164,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),98.4,60,,percent of total billed charges,,
K WIRE 1.2 X 150MM  WRIGHT MED 707091202,,C1769,HCPCS,Facility,Both,,,,164,139.4,47.0024,164,"Health Partners, Inc.",State of Minnesota Advantage Program,133.66,81.5,,percent of total billed charges,,
K WIRE 1.2 X 150MM  WRIGHT MED 707091202,,C1769,HCPCS,Facility,Both,,,,164,139.4,47.0024,164,"Health Partners, Inc.",State Public Programs,82,50,,percent of total billed charges,,
K WIRE 1.2 X 150MM  WRIGHT MED 707091202,,C1769,HCPCS,Facility,Both,,,,164,139.4,47.0024,164,Humana Insurance Company,Commercial PPO,155.8,95,,percent of total billed charges,,
K WIRE 1.2 X 150MM  WRIGHT MED 707091202,,C1769,HCPCS,Facility,Outpatient,,,,164,139.4,47.0024,164,Humana Insurance Company,Medicare PPO,80.36,49,,percent of total billed charges,,
K WIRE 1.2 X 150MM  WRIGHT MED 707091202,,C1769,HCPCS,Facility,Inpatient,,,,164,139.4,47.0024,164,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
K WIRE 1.2 X 150MM  WRIGHT MED 707091202,,C1769,HCPCS,Facility,Both,,,,164,139.4,47.0024,164,Medica,Individual & Family,162.524,99.1,,percent of total billed charges,,
K WIRE 1.2 X 150MM  WRIGHT MED 707091202,,C1769,HCPCS,Facility,Outpatient,,,,164,139.4,47.0024,164,Medica,Medica Advantage Solution,81.672,49.8,,percent of total billed charges,,
K WIRE 1.2 X 150MM  WRIGHT MED 707091202,,C1769,HCPCS,Facility,Inpatient,,,,164,139.4,47.0024,164,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
K WIRE 1.2 X 150MM  WRIGHT MED 707091202,,C1769,HCPCS,Facility,Outpatient,,,,164,139.4,47.0024,164,Medica,Medical Assistance,73.144,44.6,,percent of total billed charges,,
K WIRE 1.2 X 150MM  WRIGHT MED 707091202,,C1769,HCPCS,Facility,Inpatient,,,,164,139.4,47.0024,164,Medica,Medical Assistance,,,,,Included in per diem rate,
K WIRE 1.2 X 150MM  WRIGHT MED 707091202,,C1769,HCPCS,Facility,Outpatient,,,,164,139.4,47.0024,164,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,81.672,49.8,,percent of total billed charges,,
K WIRE 1.2 X 150MM  WRIGHT MED 707091202,,C1769,HCPCS,Facility,Inpatient,,,,164,139.4,47.0024,164,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
K WIRE 1.2 X 150MM  WRIGHT MED 707091202,,C1769,HCPCS,Facility,Both,,,,164,139.4,47.0024,164,"Multiplan, Inc.","Multiplan, Inc.",154.16,94,,percent of total billed charges,,
K WIRE 1.2 X 150MM  WRIGHT MED 707091202,,C1769,HCPCS,Facility,Outpatient,,,,164,139.4,47.0024,164,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,147.764,90.1,,percent of total billed charges,,
K WIRE 1.2 X 150MM  WRIGHT MED 707091202,,C1769,HCPCS,Facility,Inpatient,,,,164,139.4,47.0024,164,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
K WIRE 1.2 X 150MM  WRIGHT MED 707091202,,C1769,HCPCS,Facility,Both,,,,164,139.4,47.0024,164,"Preferred One Administrative Services, INC.",PPO,161.704,98.6,,percent of total billed charges,,
K WIRE 1.2 X 150MM  WRIGHT MED 707091202,,C1769,HCPCS,Facility,Outpatient,,,,164,139.4,47.0024,164,PrimeWest Health,Minnesota Senior Health Options (MSHO),84.378,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
K WIRE 1.2 X 150MM  WRIGHT MED 707091202,,C1769,HCPCS,Facility,Inpatient,,,,164,139.4,47.0024,164,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
K WIRE 1.2 X 150MM  WRIGHT MED 707091202,,C1769,HCPCS,Facility,Outpatient,,,,164,139.4,47.0024,164,PrimeWest Health,MinnesotaCare,84.2304,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
K WIRE 1.2 X 150MM  WRIGHT MED 707091202,,C1769,HCPCS,Facility,Inpatient,,,,164,139.4,47.0024,164,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
K WIRE 1.2 X 150MM  WRIGHT MED 707091202,,C1769,HCPCS,Facility,Both,,,,164,139.4,47.0024,164,Sanford Health Plan,Sanford Health Plan,150.88,92,,percent of total billed charges,,
K WIRE 1.2 X 150MM  WRIGHT MED 707091202,,C1769,HCPCS,Facility,Outpatient,,,,164,139.4,47.0024,164,"UCare Health, Inc.",Individual & Family Plan,92.414,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
K WIRE 1.2 X 150MM  WRIGHT MED 707091202,,C1769,HCPCS,Facility,Inpatient,,,,164,139.4,47.0024,164,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
K WIRE 1.2 X 150MM  WRIGHT MED 707091202,,C1769,HCPCS,Facility,Outpatient,,,,164,139.4,47.0024,164,"UCare Health, Inc.",Medical Assistance,82.7708,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
K WIRE 1.2 X 150MM  WRIGHT MED 707091202,,C1769,HCPCS,Facility,Inpatient,,,,164,139.4,47.0024,164,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
K WIRE 1.2 X 150MM  WRIGHT MED 707091202,,C1769,HCPCS,Facility,Outpatient,,,,164,139.4,47.0024,164,"UCare Health, Inc.",Medicare Advantage,82.7708,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
K WIRE 1.2 X 150MM  WRIGHT MED 707091202,,C1769,HCPCS,Facility,Inpatient,,,,164,139.4,47.0024,164,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
K WIRE 1.2 X 150MM  WRIGHT MED 707091202,,C1769,HCPCS,Facility,Outpatient,,,,164,139.4,47.0024,164,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),82.7708,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
K WIRE 1.2 X 150MM  WRIGHT MED 707091202,,C1769,HCPCS,Facility,Inpatient,,,,164,139.4,47.0024,164,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
K WIRE 1.2 X 150MM  WRIGHT MED 707091202,,C1769,HCPCS,Facility,Both,,,,164,139.4,47.0024,164,UnitedHealthcare,Individual & Family,154.16,94,,percent of total billed charges,,
K WIRE 1.2 X 150MM  WRIGHT MED 707091202,,C1769,HCPCS,Facility,Outpatient,,,,164,139.4,47.0024,164,UnitedHealthcare,Medicare Advantage,80.36,49,,percent of total billed charges,,
K WIRE 1.2 X 150MM  WRIGHT MED 707091202,,C1769,HCPCS,Facility,Inpatient,,,,164,139.4,47.0024,164,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
K WIRE 1.2 X 150MM  WRIGHT MED 707091202,,C1769,HCPCS,Facility,Outpatient,,,,164,139.4,47.0024,164,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,78.72,48,,percent of total billed charges,,100% of DHS outpatient percentage
K WIRE 1.2 X 150MM  WRIGHT MED 707091202,,C1769,HCPCS,Facility,Inpatient,,,,164,139.4,47.0024,164,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
K WIRE 1.4X150 BLUNT TROCAR ORTHOLOC 3D  WRIGHT MED DSDS1014,,C1769,HCPCS,Facility,Both,,,,200,170,57.32,200,Aetna,Commercial,184,92,,percent of total billed charges,,
K WIRE 1.4X150 BLUNT TROCAR ORTHOLOC 3D  WRIGHT MED DSDS1014,,C1769,HCPCS,Facility,Outpatient,,,,200,170,57.32,200,Aetna,Medicare Advantage,98,49,,percent of total billed charges,,
K WIRE 1.4X150 BLUNT TROCAR ORTHOLOC 3D  WRIGHT MED DSDS1014,,C1769,HCPCS,Facility,Inpatient,,,,200,170,57.32,200,Aetna,Medicare Advantage,,,,,Included in per diem rate,
K WIRE 1.4X150 BLUNT TROCAR ORTHOLOC 3D  WRIGHT MED DSDS1014,,C1769,HCPCS,Facility,Both,,,,200,170,57.32,200,Aetna,PPO,186,93,,percent of total billed charges,,
K WIRE 1.4X150 BLUNT TROCAR ORTHOLOC 3D  WRIGHT MED DSDS1014,,C1769,HCPCS,Facility,Both,,,,200,170,57.32,200,America's PPO,America's PPO,192.06,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
K WIRE 1.4X150 BLUNT TROCAR ORTHOLOC 3D  WRIGHT MED DSDS1014,,C1769,HCPCS,Facility,Both,,,,200,170,57.32,200,BlueCross BlueShield Minnesota, Federal Employee Program,196.8,98.4,,percent of total billed charges,,
K WIRE 1.4X150 BLUNT TROCAR ORTHOLOC 3D  WRIGHT MED DSDS1014,,C1769,HCPCS,Facility,Both,,,,200,170,57.32,200,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,200,100,,percent of total billed charges,,
K WIRE 1.4X150 BLUNT TROCAR ORTHOLOC 3D  WRIGHT MED DSDS1014,,C1769,HCPCS,Facility,Both,,,,200,170,57.32,200,BlueCross BlueShield Minnesota,High Value Network Plan,180,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
K WIRE 1.4X150 BLUNT TROCAR ORTHOLOC 3D  WRIGHT MED DSDS1014,,C1769,HCPCS,Facility,Outpatient,,,,200,170,57.32,200,BlueCross BlueShield Minnesota,Medicare Advantage,98,49,,percent of total billed charges,,
K WIRE 1.4X150 BLUNT TROCAR ORTHOLOC 3D  WRIGHT MED DSDS1014,,C1769,HCPCS,Facility,Inpatient,,,,200,170,57.32,200,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
K WIRE 1.4X150 BLUNT TROCAR ORTHOLOC 3D  WRIGHT MED DSDS1014,,C1769,HCPCS,Facility,Both,,,,200,170,57.32,200,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,177.14,88.57,,percent of total billed charges,,
K WIRE 1.4X150 BLUNT TROCAR ORTHOLOC 3D  WRIGHT MED DSDS1014,,C1769,HCPCS,Facility,Both,,,,200,170,57.32,200,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,57.32,28.66,,percent of total billed charges,,
K WIRE 1.4X150 BLUNT TROCAR ORTHOLOC 3D  WRIGHT MED DSDS1014,,C1769,HCPCS,Facility,Outpatient,,,,200,170,57.32,200,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),98,49,,percent of total billed charges,,
K WIRE 1.4X150 BLUNT TROCAR ORTHOLOC 3D  WRIGHT MED DSDS1014,,C1769,HCPCS,Facility,Inpatient,,,,200,170,57.32,200,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
K WIRE 1.4X150 BLUNT TROCAR ORTHOLOC 3D  WRIGHT MED DSDS1014,,C1769,HCPCS,Facility,Both,,,,200,170,57.32,200,CorVel,Worker's Compensation,200,100,,percent of total billed charges,,
K WIRE 1.4X150 BLUNT TROCAR ORTHOLOC 3D  WRIGHT MED DSDS1014,,C1769,HCPCS,Facility,Both,,,,200,170,57.32,200,First Health Group Corporation,First Health Network,194,97,,percent of total billed charges,,
K WIRE 1.4X150 BLUNT TROCAR ORTHOLOC 3D  WRIGHT MED DSDS1014,,C1769,HCPCS,Facility,Both,,,,200,170,57.32,200,"Health Partners, Inc.",Commercial,189.2,94.6,,percent of total billed charges,,
K WIRE 1.4X150 BLUNT TROCAR ORTHOLOC 3D  WRIGHT MED DSDS1014,,C1769,HCPCS,Facility,Outpatient,,,,200,170,57.32,200,"Health Partners, Inc.",Medicare Advantage,98,49,,percent of total billed charges,,
K WIRE 1.4X150 BLUNT TROCAR ORTHOLOC 3D  WRIGHT MED DSDS1014,,C1769,HCPCS,Facility,Inpatient,,,,200,170,57.32,200,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
K WIRE 1.4X150 BLUNT TROCAR ORTHOLOC 3D  WRIGHT MED DSDS1014,,C1769,HCPCS,Facility,Both,,,,200,170,57.32,200,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),120,60,,percent of total billed charges,,
K WIRE 1.4X150 BLUNT TROCAR ORTHOLOC 3D  WRIGHT MED DSDS1014,,C1769,HCPCS,Facility,Both,,,,200,170,57.32,200,"Health Partners, Inc.",State of Minnesota Advantage Program,163,81.5,,percent of total billed charges,,
K WIRE 1.4X150 BLUNT TROCAR ORTHOLOC 3D  WRIGHT MED DSDS1014,,C1769,HCPCS,Facility,Both,,,,200,170,57.32,200,"Health Partners, Inc.",State Public Programs,100,50,,percent of total billed charges,,
K WIRE 1.4X150 BLUNT TROCAR ORTHOLOC 3D  WRIGHT MED DSDS1014,,C1769,HCPCS,Facility,Both,,,,200,170,57.32,200,Humana Insurance Company,Commercial PPO,190,95,,percent of total billed charges,,
K WIRE 1.4X150 BLUNT TROCAR ORTHOLOC 3D  WRIGHT MED DSDS1014,,C1769,HCPCS,Facility,Outpatient,,,,200,170,57.32,200,Humana Insurance Company,Medicare PPO,98,49,,percent of total billed charges,,
K WIRE 1.4X150 BLUNT TROCAR ORTHOLOC 3D  WRIGHT MED DSDS1014,,C1769,HCPCS,Facility,Inpatient,,,,200,170,57.32,200,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
K WIRE 1.4X150 BLUNT TROCAR ORTHOLOC 3D  WRIGHT MED DSDS1014,,C1769,HCPCS,Facility,Both,,,,200,170,57.32,200,Medica,Individual & Family,198.2,99.1,,percent of total billed charges,,
K WIRE 1.4X150 BLUNT TROCAR ORTHOLOC 3D  WRIGHT MED DSDS1014,,C1769,HCPCS,Facility,Outpatient,,,,200,170,57.32,200,Medica,Medica Advantage Solution,99.6,49.8,,percent of total billed charges,,
K WIRE 1.4X150 BLUNT TROCAR ORTHOLOC 3D  WRIGHT MED DSDS1014,,C1769,HCPCS,Facility,Inpatient,,,,200,170,57.32,200,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
K WIRE 1.4X150 BLUNT TROCAR ORTHOLOC 3D  WRIGHT MED DSDS1014,,C1769,HCPCS,Facility,Outpatient,,,,200,170,57.32,200,Medica,Medical Assistance,89.2,44.6,,percent of total billed charges,,
K WIRE 1.4X150 BLUNT TROCAR ORTHOLOC 3D  WRIGHT MED DSDS1014,,C1769,HCPCS,Facility,Inpatient,,,,200,170,57.32,200,Medica,Medical Assistance,,,,,Included in per diem rate,
K WIRE 1.4X150 BLUNT TROCAR ORTHOLOC 3D  WRIGHT MED DSDS1014,,C1769,HCPCS,Facility,Outpatient,,,,200,170,57.32,200,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,99.6,49.8,,percent of total billed charges,,
K WIRE 1.4X150 BLUNT TROCAR ORTHOLOC 3D  WRIGHT MED DSDS1014,,C1769,HCPCS,Facility,Inpatient,,,,200,170,57.32,200,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
K WIRE 1.4X150 BLUNT TROCAR ORTHOLOC 3D  WRIGHT MED DSDS1014,,C1769,HCPCS,Facility,Both,,,,200,170,57.32,200,"Multiplan, Inc.","Multiplan, Inc.",188,94,,percent of total billed charges,,
K WIRE 1.4X150 BLUNT TROCAR ORTHOLOC 3D  WRIGHT MED DSDS1014,,C1769,HCPCS,Facility,Outpatient,,,,200,170,57.32,200,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,180.2,90.1,,percent of total billed charges,,
K WIRE 1.4X150 BLUNT TROCAR ORTHOLOC 3D  WRIGHT MED DSDS1014,,C1769,HCPCS,Facility,Inpatient,,,,200,170,57.32,200,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
K WIRE 1.4X150 BLUNT TROCAR ORTHOLOC 3D  WRIGHT MED DSDS1014,,C1769,HCPCS,Facility,Both,,,,200,170,57.32,200,"Preferred One Administrative Services, INC.",PPO,197.2,98.6,,percent of total billed charges,,
K WIRE 1.4X150 BLUNT TROCAR ORTHOLOC 3D  WRIGHT MED DSDS1014,,C1769,HCPCS,Facility,Outpatient,,,,200,170,57.32,200,PrimeWest Health,Minnesota Senior Health Options (MSHO),102.9,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
K WIRE 1.4X150 BLUNT TROCAR ORTHOLOC 3D  WRIGHT MED DSDS1014,,C1769,HCPCS,Facility,Inpatient,,,,200,170,57.32,200,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
K WIRE 1.4X150 BLUNT TROCAR ORTHOLOC 3D  WRIGHT MED DSDS1014,,C1769,HCPCS,Facility,Outpatient,,,,200,170,57.32,200,PrimeWest Health,MinnesotaCare,102.72,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
K WIRE 1.4X150 BLUNT TROCAR ORTHOLOC 3D  WRIGHT MED DSDS1014,,C1769,HCPCS,Facility,Inpatient,,,,200,170,57.32,200,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
K WIRE 1.4X150 BLUNT TROCAR ORTHOLOC 3D  WRIGHT MED DSDS1014,,C1769,HCPCS,Facility,Both,,,,200,170,57.32,200,Sanford Health Plan,Sanford Health Plan,184,92,,percent of total billed charges,,
K WIRE 1.4X150 BLUNT TROCAR ORTHOLOC 3D  WRIGHT MED DSDS1014,,C1769,HCPCS,Facility,Outpatient,,,,200,170,57.32,200,"UCare Health, Inc.",Individual & Family Plan,112.7,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
K WIRE 1.4X150 BLUNT TROCAR ORTHOLOC 3D  WRIGHT MED DSDS1014,,C1769,HCPCS,Facility,Inpatient,,,,200,170,57.32,200,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
K WIRE 1.4X150 BLUNT TROCAR ORTHOLOC 3D  WRIGHT MED DSDS1014,,C1769,HCPCS,Facility,Outpatient,,,,200,170,57.32,200,"UCare Health, Inc.",Medical Assistance,100.94,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
K WIRE 1.4X150 BLUNT TROCAR ORTHOLOC 3D  WRIGHT MED DSDS1014,,C1769,HCPCS,Facility,Inpatient,,,,200,170,57.32,200,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
K WIRE 1.4X150 BLUNT TROCAR ORTHOLOC 3D  WRIGHT MED DSDS1014,,C1769,HCPCS,Facility,Outpatient,,,,200,170,57.32,200,"UCare Health, Inc.",Medicare Advantage,100.94,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
K WIRE 1.4X150 BLUNT TROCAR ORTHOLOC 3D  WRIGHT MED DSDS1014,,C1769,HCPCS,Facility,Inpatient,,,,200,170,57.32,200,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
K WIRE 1.4X150 BLUNT TROCAR ORTHOLOC 3D  WRIGHT MED DSDS1014,,C1769,HCPCS,Facility,Outpatient,,,,200,170,57.32,200,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),100.94,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
K WIRE 1.4X150 BLUNT TROCAR ORTHOLOC 3D  WRIGHT MED DSDS1014,,C1769,HCPCS,Facility,Inpatient,,,,200,170,57.32,200,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
K WIRE 1.4X150 BLUNT TROCAR ORTHOLOC 3D  WRIGHT MED DSDS1014,,C1769,HCPCS,Facility,Both,,,,200,170,57.32,200,UnitedHealthcare,Individual & Family,188,94,,percent of total billed charges,,
K WIRE 1.4X150 BLUNT TROCAR ORTHOLOC 3D  WRIGHT MED DSDS1014,,C1769,HCPCS,Facility,Outpatient,,,,200,170,57.32,200,UnitedHealthcare,Medicare Advantage,98,49,,percent of total billed charges,,
K WIRE 1.4X150 BLUNT TROCAR ORTHOLOC 3D  WRIGHT MED DSDS1014,,C1769,HCPCS,Facility,Inpatient,,,,200,170,57.32,200,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
K WIRE 1.4X150 BLUNT TROCAR ORTHOLOC 3D  WRIGHT MED DSDS1014,,C1769,HCPCS,Facility,Outpatient,,,,200,170,57.32,200,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,96,48,,percent of total billed charges,,100% of DHS outpatient percentage
K WIRE 1.4X150 BLUNT TROCAR ORTHOLOC 3D  WRIGHT MED DSDS1014,,C1769,HCPCS,Facility,Inpatient,,,,200,170,57.32,200,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
K-WIRE .062 X 6 IN,,C1769,HCPCS,Facility,Both,,,,148,125.8,42.4168,148,Aetna,Commercial,136.16,92,,percent of total billed charges,,
K-WIRE .062 X 6 IN,,C1769,HCPCS,Facility,Outpatient,,,,148,125.8,42.4168,148,Aetna,Medicare Advantage,72.52,49,,percent of total billed charges,,
K-WIRE .062 X 6 IN,,C1769,HCPCS,Facility,Inpatient,,,,148,125.8,42.4168,148,Aetna,Medicare Advantage,,,,,Included in per diem rate,
K-WIRE .062 X 6 IN,,C1769,HCPCS,Facility,Both,,,,148,125.8,42.4168,148,Aetna,PPO,137.64,93,,percent of total billed charges,,
K-WIRE .062 X 6 IN,,C1769,HCPCS,Facility,Both,,,,148,125.8,42.4168,148,America's PPO,America's PPO,142.1244,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
K-WIRE .062 X 6 IN,,C1769,HCPCS,Facility,Both,,,,148,125.8,42.4168,148,BlueCross BlueShield Minnesota, Federal Employee Program,145.632,98.4,,percent of total billed charges,,
K-WIRE .062 X 6 IN,,C1769,HCPCS,Facility,Both,,,,148,125.8,42.4168,148,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,148,100,,percent of total billed charges,,
K-WIRE .062 X 6 IN,,C1769,HCPCS,Facility,Both,,,,148,125.8,42.4168,148,BlueCross BlueShield Minnesota,High Value Network Plan,133.2,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
K-WIRE .062 X 6 IN,,C1769,HCPCS,Facility,Outpatient,,,,148,125.8,42.4168,148,BlueCross BlueShield Minnesota,Medicare Advantage,72.52,49,,percent of total billed charges,,
K-WIRE .062 X 6 IN,,C1769,HCPCS,Facility,Inpatient,,,,148,125.8,42.4168,148,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
K-WIRE .062 X 6 IN,,C1769,HCPCS,Facility,Both,,,,148,125.8,42.4168,148,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,131.0836,88.57,,percent of total billed charges,,
K-WIRE .062 X 6 IN,,C1769,HCPCS,Facility,Both,,,,148,125.8,42.4168,148,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,42.4168,28.66,,percent of total billed charges,,
K-WIRE .062 X 6 IN,,C1769,HCPCS,Facility,Outpatient,,,,148,125.8,42.4168,148,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),72.52,49,,percent of total billed charges,,
K-WIRE .062 X 6 IN,,C1769,HCPCS,Facility,Inpatient,,,,148,125.8,42.4168,148,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
K-WIRE .062 X 6 IN,,C1769,HCPCS,Facility,Both,,,,148,125.8,42.4168,148,CorVel,Worker's Compensation,148,100,,percent of total billed charges,,
K-WIRE .062 X 6 IN,,C1769,HCPCS,Facility,Both,,,,148,125.8,42.4168,148,First Health Group Corporation,First Health Network,143.56,97,,percent of total billed charges,,
K-WIRE .062 X 6 IN,,C1769,HCPCS,Facility,Both,,,,148,125.8,42.4168,148,"Health Partners, Inc.",Commercial,140.008,94.6,,percent of total billed charges,,
K-WIRE .062 X 6 IN,,C1769,HCPCS,Facility,Outpatient,,,,148,125.8,42.4168,148,"Health Partners, Inc.",Medicare Advantage,72.52,49,,percent of total billed charges,,
K-WIRE .062 X 6 IN,,C1769,HCPCS,Facility,Inpatient,,,,148,125.8,42.4168,148,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
K-WIRE .062 X 6 IN,,C1769,HCPCS,Facility,Both,,,,148,125.8,42.4168,148,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),88.8,60,,percent of total billed charges,,
K-WIRE .062 X 6 IN,,C1769,HCPCS,Facility,Both,,,,148,125.8,42.4168,148,"Health Partners, Inc.",State of Minnesota Advantage Program,120.62,81.5,,percent of total billed charges,,
K-WIRE .062 X 6 IN,,C1769,HCPCS,Facility,Both,,,,148,125.8,42.4168,148,"Health Partners, Inc.",State Public Programs,74,50,,percent of total billed charges,,
K-WIRE .062 X 6 IN,,C1769,HCPCS,Facility,Both,,,,148,125.8,42.4168,148,Humana Insurance Company,Commercial PPO,140.6,95,,percent of total billed charges,,
K-WIRE .062 X 6 IN,,C1769,HCPCS,Facility,Outpatient,,,,148,125.8,42.4168,148,Humana Insurance Company,Medicare PPO,72.52,49,,percent of total billed charges,,
K-WIRE .062 X 6 IN,,C1769,HCPCS,Facility,Inpatient,,,,148,125.8,42.4168,148,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
K-WIRE .062 X 6 IN,,C1769,HCPCS,Facility,Both,,,,148,125.8,42.4168,148,Medica,Individual & Family,146.668,99.1,,percent of total billed charges,,
K-WIRE .062 X 6 IN,,C1769,HCPCS,Facility,Outpatient,,,,148,125.8,42.4168,148,Medica,Medica Advantage Solution,73.704,49.8,,percent of total billed charges,,
K-WIRE .062 X 6 IN,,C1769,HCPCS,Facility,Inpatient,,,,148,125.8,42.4168,148,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
K-WIRE .062 X 6 IN,,C1769,HCPCS,Facility,Outpatient,,,,148,125.8,42.4168,148,Medica,Medical Assistance,66.008,44.6,,percent of total billed charges,,
K-WIRE .062 X 6 IN,,C1769,HCPCS,Facility,Inpatient,,,,148,125.8,42.4168,148,Medica,Medical Assistance,,,,,Included in per diem rate,
K-WIRE .062 X 6 IN,,C1769,HCPCS,Facility,Outpatient,,,,148,125.8,42.4168,148,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,73.704,49.8,,percent of total billed charges,,
K-WIRE .062 X 6 IN,,C1769,HCPCS,Facility,Inpatient,,,,148,125.8,42.4168,148,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
K-WIRE .062 X 6 IN,,C1769,HCPCS,Facility,Both,,,,148,125.8,42.4168,148,"Multiplan, Inc.","Multiplan, Inc.",139.12,94,,percent of total billed charges,,
K-WIRE .062 X 6 IN,,C1769,HCPCS,Facility,Outpatient,,,,148,125.8,42.4168,148,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,133.348,90.1,,percent of total billed charges,,
K-WIRE .062 X 6 IN,,C1769,HCPCS,Facility,Inpatient,,,,148,125.8,42.4168,148,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
K-WIRE .062 X 6 IN,,C1769,HCPCS,Facility,Both,,,,148,125.8,42.4168,148,"Preferred One Administrative Services, INC.",PPO,145.928,98.6,,percent of total billed charges,,
K-WIRE .062 X 6 IN,,C1769,HCPCS,Facility,Outpatient,,,,148,125.8,42.4168,148,PrimeWest Health,Minnesota Senior Health Options (MSHO),76.146,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
K-WIRE .062 X 6 IN,,C1769,HCPCS,Facility,Inpatient,,,,148,125.8,42.4168,148,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
K-WIRE .062 X 6 IN,,C1769,HCPCS,Facility,Outpatient,,,,148,125.8,42.4168,148,PrimeWest Health,MinnesotaCare,76.0128,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
K-WIRE .062 X 6 IN,,C1769,HCPCS,Facility,Inpatient,,,,148,125.8,42.4168,148,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
K-WIRE .062 X 6 IN,,C1769,HCPCS,Facility,Both,,,,148,125.8,42.4168,148,Sanford Health Plan,Sanford Health Plan,136.16,92,,percent of total billed charges,,
K-WIRE .062 X 6 IN,,C1769,HCPCS,Facility,Outpatient,,,,148,125.8,42.4168,148,"UCare Health, Inc.",Individual & Family Plan,83.398,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
K-WIRE .062 X 6 IN,,C1769,HCPCS,Facility,Inpatient,,,,148,125.8,42.4168,148,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
K-WIRE .062 X 6 IN,,C1769,HCPCS,Facility,Outpatient,,,,148,125.8,42.4168,148,"UCare Health, Inc.",Medical Assistance,74.6956,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
K-WIRE .062 X 6 IN,,C1769,HCPCS,Facility,Inpatient,,,,148,125.8,42.4168,148,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
K-WIRE .062 X 6 IN,,C1769,HCPCS,Facility,Outpatient,,,,148,125.8,42.4168,148,"UCare Health, Inc.",Medicare Advantage,74.6956,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
K-WIRE .062 X 6 IN,,C1769,HCPCS,Facility,Inpatient,,,,148,125.8,42.4168,148,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
K-WIRE .062 X 6 IN,,C1769,HCPCS,Facility,Outpatient,,,,148,125.8,42.4168,148,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),74.6956,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
K-WIRE .062 X 6 IN,,C1769,HCPCS,Facility,Inpatient,,,,148,125.8,42.4168,148,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
K-WIRE .062 X 6 IN,,C1769,HCPCS,Facility,Both,,,,148,125.8,42.4168,148,UnitedHealthcare,Individual & Family,139.12,94,,percent of total billed charges,,
K-WIRE .062 X 6 IN,,C1769,HCPCS,Facility,Outpatient,,,,148,125.8,42.4168,148,UnitedHealthcare,Medicare Advantage,72.52,49,,percent of total billed charges,,
K-WIRE .062 X 6 IN,,C1769,HCPCS,Facility,Inpatient,,,,148,125.8,42.4168,148,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
K-WIRE .062 X 6 IN,,C1769,HCPCS,Facility,Outpatient,,,,148,125.8,42.4168,148,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,71.04,48,,percent of total billed charges,,100% of DHS outpatient percentage
K-WIRE .062 X 6 IN,,C1769,HCPCS,Facility,Inpatient,,,,148,125.8,42.4168,148,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
K-WIRE 0.9MM X 102MM,,C1769,HCPCS,Facility,Both,,,,200,170,57.32,200,Aetna,Commercial,184,92,,percent of total billed charges,,
K-WIRE 0.9MM X 102MM,,C1769,HCPCS,Facility,Outpatient,,,,200,170,57.32,200,Aetna,Medicare Advantage,98,49,,percent of total billed charges,,
K-WIRE 0.9MM X 102MM,,C1769,HCPCS,Facility,Inpatient,,,,200,170,57.32,200,Aetna,Medicare Advantage,,,,,Included in per diem rate,
K-WIRE 0.9MM X 102MM,,C1769,HCPCS,Facility,Both,,,,200,170,57.32,200,Aetna,PPO,186,93,,percent of total billed charges,,
K-WIRE 0.9MM X 102MM,,C1769,HCPCS,Facility,Both,,,,200,170,57.32,200,America's PPO,America's PPO,192.06,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
K-WIRE 0.9MM X 102MM,,C1769,HCPCS,Facility,Both,,,,200,170,57.32,200,BlueCross BlueShield Minnesota, Federal Employee Program,196.8,98.4,,percent of total billed charges,,
K-WIRE 0.9MM X 102MM,,C1769,HCPCS,Facility,Both,,,,200,170,57.32,200,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,200,100,,percent of total billed charges,,
K-WIRE 0.9MM X 102MM,,C1769,HCPCS,Facility,Both,,,,200,170,57.32,200,BlueCross BlueShield Minnesota,High Value Network Plan,180,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
K-WIRE 0.9MM X 102MM,,C1769,HCPCS,Facility,Outpatient,,,,200,170,57.32,200,BlueCross BlueShield Minnesota,Medicare Advantage,98,49,,percent of total billed charges,,
K-WIRE 0.9MM X 102MM,,C1769,HCPCS,Facility,Inpatient,,,,200,170,57.32,200,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
K-WIRE 0.9MM X 102MM,,C1769,HCPCS,Facility,Both,,,,200,170,57.32,200,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,177.14,88.57,,percent of total billed charges,,
K-WIRE 0.9MM X 102MM,,C1769,HCPCS,Facility,Both,,,,200,170,57.32,200,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,57.32,28.66,,percent of total billed charges,,
K-WIRE 0.9MM X 102MM,,C1769,HCPCS,Facility,Outpatient,,,,200,170,57.32,200,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),98,49,,percent of total billed charges,,
K-WIRE 0.9MM X 102MM,,C1769,HCPCS,Facility,Inpatient,,,,200,170,57.32,200,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
K-WIRE 0.9MM X 102MM,,C1769,HCPCS,Facility,Both,,,,200,170,57.32,200,CorVel,Worker's Compensation,200,100,,percent of total billed charges,,
K-WIRE 0.9MM X 102MM,,C1769,HCPCS,Facility,Both,,,,200,170,57.32,200,First Health Group Corporation,First Health Network,194,97,,percent of total billed charges,,
K-WIRE 0.9MM X 102MM,,C1769,HCPCS,Facility,Both,,,,200,170,57.32,200,"Health Partners, Inc.",Commercial,189.2,94.6,,percent of total billed charges,,
K-WIRE 0.9MM X 102MM,,C1769,HCPCS,Facility,Outpatient,,,,200,170,57.32,200,"Health Partners, Inc.",Medicare Advantage,98,49,,percent of total billed charges,,
K-WIRE 0.9MM X 102MM,,C1769,HCPCS,Facility,Inpatient,,,,200,170,57.32,200,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
K-WIRE 0.9MM X 102MM,,C1769,HCPCS,Facility,Both,,,,200,170,57.32,200,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),120,60,,percent of total billed charges,,
K-WIRE 0.9MM X 102MM,,C1769,HCPCS,Facility,Both,,,,200,170,57.32,200,"Health Partners, Inc.",State of Minnesota Advantage Program,163,81.5,,percent of total billed charges,,
K-WIRE 0.9MM X 102MM,,C1769,HCPCS,Facility,Both,,,,200,170,57.32,200,"Health Partners, Inc.",State Public Programs,100,50,,percent of total billed charges,,
K-WIRE 0.9MM X 102MM,,C1769,HCPCS,Facility,Both,,,,200,170,57.32,200,Humana Insurance Company,Commercial PPO,190,95,,percent of total billed charges,,
K-WIRE 0.9MM X 102MM,,C1769,HCPCS,Facility,Outpatient,,,,200,170,57.32,200,Humana Insurance Company,Medicare PPO,98,49,,percent of total billed charges,,
K-WIRE 0.9MM X 102MM,,C1769,HCPCS,Facility,Inpatient,,,,200,170,57.32,200,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
K-WIRE 0.9MM X 102MM,,C1769,HCPCS,Facility,Both,,,,200,170,57.32,200,Medica,Individual & Family,198.2,99.1,,percent of total billed charges,,
K-WIRE 0.9MM X 102MM,,C1769,HCPCS,Facility,Outpatient,,,,200,170,57.32,200,Medica,Medica Advantage Solution,99.6,49.8,,percent of total billed charges,,
K-WIRE 0.9MM X 102MM,,C1769,HCPCS,Facility,Inpatient,,,,200,170,57.32,200,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
K-WIRE 0.9MM X 102MM,,C1769,HCPCS,Facility,Outpatient,,,,200,170,57.32,200,Medica,Medical Assistance,89.2,44.6,,percent of total billed charges,,
K-WIRE 0.9MM X 102MM,,C1769,HCPCS,Facility,Inpatient,,,,200,170,57.32,200,Medica,Medical Assistance,,,,,Included in per diem rate,
K-WIRE 0.9MM X 102MM,,C1769,HCPCS,Facility,Outpatient,,,,200,170,57.32,200,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,99.6,49.8,,percent of total billed charges,,
K-WIRE 0.9MM X 102MM,,C1769,HCPCS,Facility,Inpatient,,,,200,170,57.32,200,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
K-WIRE 0.9MM X 102MM,,C1769,HCPCS,Facility,Both,,,,200,170,57.32,200,"Multiplan, Inc.","Multiplan, Inc.",188,94,,percent of total billed charges,,
K-WIRE 0.9MM X 102MM,,C1769,HCPCS,Facility,Outpatient,,,,200,170,57.32,200,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,180.2,90.1,,percent of total billed charges,,
K-WIRE 0.9MM X 102MM,,C1769,HCPCS,Facility,Inpatient,,,,200,170,57.32,200,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
K-WIRE 0.9MM X 102MM,,C1769,HCPCS,Facility,Both,,,,200,170,57.32,200,"Preferred One Administrative Services, INC.",PPO,197.2,98.6,,percent of total billed charges,,
K-WIRE 0.9MM X 102MM,,C1769,HCPCS,Facility,Outpatient,,,,200,170,57.32,200,PrimeWest Health,Minnesota Senior Health Options (MSHO),102.9,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
K-WIRE 0.9MM X 102MM,,C1769,HCPCS,Facility,Inpatient,,,,200,170,57.32,200,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
K-WIRE 0.9MM X 102MM,,C1769,HCPCS,Facility,Outpatient,,,,200,170,57.32,200,PrimeWest Health,MinnesotaCare,102.72,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
K-WIRE 0.9MM X 102MM,,C1769,HCPCS,Facility,Inpatient,,,,200,170,57.32,200,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
K-WIRE 0.9MM X 102MM,,C1769,HCPCS,Facility,Both,,,,200,170,57.32,200,Sanford Health Plan,Sanford Health Plan,184,92,,percent of total billed charges,,
K-WIRE 0.9MM X 102MM,,C1769,HCPCS,Facility,Outpatient,,,,200,170,57.32,200,"UCare Health, Inc.",Individual & Family Plan,112.7,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
K-WIRE 0.9MM X 102MM,,C1769,HCPCS,Facility,Inpatient,,,,200,170,57.32,200,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
K-WIRE 0.9MM X 102MM,,C1769,HCPCS,Facility,Outpatient,,,,200,170,57.32,200,"UCare Health, Inc.",Medical Assistance,100.94,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
K-WIRE 0.9MM X 102MM,,C1769,HCPCS,Facility,Inpatient,,,,200,170,57.32,200,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
K-WIRE 0.9MM X 102MM,,C1769,HCPCS,Facility,Outpatient,,,,200,170,57.32,200,"UCare Health, Inc.",Medicare Advantage,100.94,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
K-WIRE 0.9MM X 102MM,,C1769,HCPCS,Facility,Inpatient,,,,200,170,57.32,200,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
K-WIRE 0.9MM X 102MM,,C1769,HCPCS,Facility,Outpatient,,,,200,170,57.32,200,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),100.94,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
K-WIRE 0.9MM X 102MM,,C1769,HCPCS,Facility,Inpatient,,,,200,170,57.32,200,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
K-WIRE 0.9MM X 102MM,,C1769,HCPCS,Facility,Both,,,,200,170,57.32,200,UnitedHealthcare,Individual & Family,188,94,,percent of total billed charges,,
K-WIRE 0.9MM X 102MM,,C1769,HCPCS,Facility,Outpatient,,,,200,170,57.32,200,UnitedHealthcare,Medicare Advantage,98,49,,percent of total billed charges,,
K-WIRE 0.9MM X 102MM,,C1769,HCPCS,Facility,Inpatient,,,,200,170,57.32,200,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
K-WIRE 0.9MM X 102MM,,C1769,HCPCS,Facility,Outpatient,,,,200,170,57.32,200,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,96,48,,percent of total billed charges,,100% of DHS outpatient percentage
K-WIRE 0.9MM X 102MM,,C1769,HCPCS,Facility,Inpatient,,,,200,170,57.32,200,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
K-WIRE 1.1 X 150MM  WRIGHT MED 45750001,,C1769,HCPCS,Facility,Both,,,,180,153,51.588,180,Aetna,Commercial,165.6,92,,percent of total billed charges,,
K-WIRE 1.1 X 150MM  WRIGHT MED 45750001,,C1769,HCPCS,Facility,Outpatient,,,,180,153,51.588,180,Aetna,Medicare Advantage,88.2,49,,percent of total billed charges,,
K-WIRE 1.1 X 150MM  WRIGHT MED 45750001,,C1769,HCPCS,Facility,Inpatient,,,,180,153,51.588,180,Aetna,Medicare Advantage,,,,,Included in per diem rate,
K-WIRE 1.1 X 150MM  WRIGHT MED 45750001,,C1769,HCPCS,Facility,Both,,,,180,153,51.588,180,Aetna,PPO,167.4,93,,percent of total billed charges,,
K-WIRE 1.1 X 150MM  WRIGHT MED 45750001,,C1769,HCPCS,Facility,Both,,,,180,153,51.588,180,America's PPO,America's PPO,172.854,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
K-WIRE 1.1 X 150MM  WRIGHT MED 45750001,,C1769,HCPCS,Facility,Both,,,,180,153,51.588,180,BlueCross BlueShield Minnesota, Federal Employee Program,177.12,98.4,,percent of total billed charges,,
K-WIRE 1.1 X 150MM  WRIGHT MED 45750001,,C1769,HCPCS,Facility,Both,,,,180,153,51.588,180,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,180,100,,percent of total billed charges,,
K-WIRE 1.1 X 150MM  WRIGHT MED 45750001,,C1769,HCPCS,Facility,Both,,,,180,153,51.588,180,BlueCross BlueShield Minnesota,High Value Network Plan,162,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
K-WIRE 1.1 X 150MM  WRIGHT MED 45750001,,C1769,HCPCS,Facility,Outpatient,,,,180,153,51.588,180,BlueCross BlueShield Minnesota,Medicare Advantage,88.2,49,,percent of total billed charges,,
K-WIRE 1.1 X 150MM  WRIGHT MED 45750001,,C1769,HCPCS,Facility,Inpatient,,,,180,153,51.588,180,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
K-WIRE 1.1 X 150MM  WRIGHT MED 45750001,,C1769,HCPCS,Facility,Both,,,,180,153,51.588,180,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,159.426,88.57,,percent of total billed charges,,
K-WIRE 1.1 X 150MM  WRIGHT MED 45750001,,C1769,HCPCS,Facility,Both,,,,180,153,51.588,180,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,51.588,28.66,,percent of total billed charges,,
K-WIRE 1.1 X 150MM  WRIGHT MED 45750001,,C1769,HCPCS,Facility,Outpatient,,,,180,153,51.588,180,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),88.2,49,,percent of total billed charges,,
K-WIRE 1.1 X 150MM  WRIGHT MED 45750001,,C1769,HCPCS,Facility,Inpatient,,,,180,153,51.588,180,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
K-WIRE 1.1 X 150MM  WRIGHT MED 45750001,,C1769,HCPCS,Facility,Both,,,,180,153,51.588,180,CorVel,Worker's Compensation,180,100,,percent of total billed charges,,
K-WIRE 1.1 X 150MM  WRIGHT MED 45750001,,C1769,HCPCS,Facility,Both,,,,180,153,51.588,180,First Health Group Corporation,First Health Network,174.6,97,,percent of total billed charges,,
K-WIRE 1.1 X 150MM  WRIGHT MED 45750001,,C1769,HCPCS,Facility,Both,,,,180,153,51.588,180,"Health Partners, Inc.",Commercial,170.28,94.6,,percent of total billed charges,,
K-WIRE 1.1 X 150MM  WRIGHT MED 45750001,,C1769,HCPCS,Facility,Outpatient,,,,180,153,51.588,180,"Health Partners, Inc.",Medicare Advantage,88.2,49,,percent of total billed charges,,
K-WIRE 1.1 X 150MM  WRIGHT MED 45750001,,C1769,HCPCS,Facility,Inpatient,,,,180,153,51.588,180,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
K-WIRE 1.1 X 150MM  WRIGHT MED 45750001,,C1769,HCPCS,Facility,Both,,,,180,153,51.588,180,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),108,60,,percent of total billed charges,,
K-WIRE 1.1 X 150MM  WRIGHT MED 45750001,,C1769,HCPCS,Facility,Both,,,,180,153,51.588,180,"Health Partners, Inc.",State of Minnesota Advantage Program,146.7,81.5,,percent of total billed charges,,
K-WIRE 1.1 X 150MM  WRIGHT MED 45750001,,C1769,HCPCS,Facility,Both,,,,180,153,51.588,180,"Health Partners, Inc.",State Public Programs,90,50,,percent of total billed charges,,
K-WIRE 1.1 X 150MM  WRIGHT MED 45750001,,C1769,HCPCS,Facility,Both,,,,180,153,51.588,180,Humana Insurance Company,Commercial PPO,171,95,,percent of total billed charges,,
K-WIRE 1.1 X 150MM  WRIGHT MED 45750001,,C1769,HCPCS,Facility,Outpatient,,,,180,153,51.588,180,Humana Insurance Company,Medicare PPO,88.2,49,,percent of total billed charges,,
K-WIRE 1.1 X 150MM  WRIGHT MED 45750001,,C1769,HCPCS,Facility,Inpatient,,,,180,153,51.588,180,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
K-WIRE 1.1 X 150MM  WRIGHT MED 45750001,,C1769,HCPCS,Facility,Both,,,,180,153,51.588,180,Medica,Individual & Family,178.38,99.1,,percent of total billed charges,,
K-WIRE 1.1 X 150MM  WRIGHT MED 45750001,,C1769,HCPCS,Facility,Outpatient,,,,180,153,51.588,180,Medica,Medica Advantage Solution,89.64,49.8,,percent of total billed charges,,
K-WIRE 1.1 X 150MM  WRIGHT MED 45750001,,C1769,HCPCS,Facility,Inpatient,,,,180,153,51.588,180,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
K-WIRE 1.1 X 150MM  WRIGHT MED 45750001,,C1769,HCPCS,Facility,Outpatient,,,,180,153,51.588,180,Medica,Medical Assistance,80.28,44.6,,percent of total billed charges,,
K-WIRE 1.1 X 150MM  WRIGHT MED 45750001,,C1769,HCPCS,Facility,Inpatient,,,,180,153,51.588,180,Medica,Medical Assistance,,,,,Included in per diem rate,
K-WIRE 1.1 X 150MM  WRIGHT MED 45750001,,C1769,HCPCS,Facility,Outpatient,,,,180,153,51.588,180,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,89.64,49.8,,percent of total billed charges,,
K-WIRE 1.1 X 150MM  WRIGHT MED 45750001,,C1769,HCPCS,Facility,Inpatient,,,,180,153,51.588,180,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
K-WIRE 1.1 X 150MM  WRIGHT MED 45750001,,C1769,HCPCS,Facility,Both,,,,180,153,51.588,180,"Multiplan, Inc.","Multiplan, Inc.",169.2,94,,percent of total billed charges,,
K-WIRE 1.1 X 150MM  WRIGHT MED 45750001,,C1769,HCPCS,Facility,Outpatient,,,,180,153,51.588,180,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,162.18,90.1,,percent of total billed charges,,
K-WIRE 1.1 X 150MM  WRIGHT MED 45750001,,C1769,HCPCS,Facility,Inpatient,,,,180,153,51.588,180,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
K-WIRE 1.1 X 150MM  WRIGHT MED 45750001,,C1769,HCPCS,Facility,Both,,,,180,153,51.588,180,"Preferred One Administrative Services, INC.",PPO,177.48,98.6,,percent of total billed charges,,
K-WIRE 1.1 X 150MM  WRIGHT MED 45750001,,C1769,HCPCS,Facility,Outpatient,,,,180,153,51.588,180,PrimeWest Health,Minnesota Senior Health Options (MSHO),92.61,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
K-WIRE 1.1 X 150MM  WRIGHT MED 45750001,,C1769,HCPCS,Facility,Inpatient,,,,180,153,51.588,180,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
K-WIRE 1.1 X 150MM  WRIGHT MED 45750001,,C1769,HCPCS,Facility,Outpatient,,,,180,153,51.588,180,PrimeWest Health,MinnesotaCare,92.448,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
K-WIRE 1.1 X 150MM  WRIGHT MED 45750001,,C1769,HCPCS,Facility,Inpatient,,,,180,153,51.588,180,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
K-WIRE 1.1 X 150MM  WRIGHT MED 45750001,,C1769,HCPCS,Facility,Both,,,,180,153,51.588,180,Sanford Health Plan,Sanford Health Plan,165.6,92,,percent of total billed charges,,
K-WIRE 1.1 X 150MM  WRIGHT MED 45750001,,C1769,HCPCS,Facility,Outpatient,,,,180,153,51.588,180,"UCare Health, Inc.",Individual & Family Plan,101.43,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
K-WIRE 1.1 X 150MM  WRIGHT MED 45750001,,C1769,HCPCS,Facility,Inpatient,,,,180,153,51.588,180,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
K-WIRE 1.1 X 150MM  WRIGHT MED 45750001,,C1769,HCPCS,Facility,Outpatient,,,,180,153,51.588,180,"UCare Health, Inc.",Medical Assistance,90.846,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
K-WIRE 1.1 X 150MM  WRIGHT MED 45750001,,C1769,HCPCS,Facility,Inpatient,,,,180,153,51.588,180,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
K-WIRE 1.1 X 150MM  WRIGHT MED 45750001,,C1769,HCPCS,Facility,Outpatient,,,,180,153,51.588,180,"UCare Health, Inc.",Medicare Advantage,90.846,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
K-WIRE 1.1 X 150MM  WRIGHT MED 45750001,,C1769,HCPCS,Facility,Inpatient,,,,180,153,51.588,180,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
K-WIRE 1.1 X 150MM  WRIGHT MED 45750001,,C1769,HCPCS,Facility,Outpatient,,,,180,153,51.588,180,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),90.846,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
K-WIRE 1.1 X 150MM  WRIGHT MED 45750001,,C1769,HCPCS,Facility,Inpatient,,,,180,153,51.588,180,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
K-WIRE 1.1 X 150MM  WRIGHT MED 45750001,,C1769,HCPCS,Facility,Both,,,,180,153,51.588,180,UnitedHealthcare,Individual & Family,169.2,94,,percent of total billed charges,,
K-WIRE 1.1 X 150MM  WRIGHT MED 45750001,,C1769,HCPCS,Facility,Outpatient,,,,180,153,51.588,180,UnitedHealthcare,Medicare Advantage,88.2,49,,percent of total billed charges,,
K-WIRE 1.1 X 150MM  WRIGHT MED 45750001,,C1769,HCPCS,Facility,Inpatient,,,,180,153,51.588,180,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
K-WIRE 1.1 X 150MM  WRIGHT MED 45750001,,C1769,HCPCS,Facility,Outpatient,,,,180,153,51.588,180,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,86.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
K-WIRE 1.1 X 150MM  WRIGHT MED 45750001,,C1769,HCPCS,Facility,Inpatient,,,,180,153,51.588,180,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
K-WIRE 1.6 MM,,C1769,HCPCS,Facility,Both,,,,54,45.9,15.4764,54,Aetna,Commercial,49.68,92,,percent of total billed charges,,
K-WIRE 1.6 MM,,C1769,HCPCS,Facility,Outpatient,,,,54,45.9,15.4764,54,Aetna,Medicare Advantage,26.46,49,,percent of total billed charges,,
K-WIRE 1.6 MM,,C1769,HCPCS,Facility,Inpatient,,,,54,45.9,15.4764,54,Aetna,Medicare Advantage,,,,,Included in per diem rate,
K-WIRE 1.6 MM,,C1769,HCPCS,Facility,Both,,,,54,45.9,15.4764,54,Aetna,PPO,50.22,93,,percent of total billed charges,,
K-WIRE 1.6 MM,,C1769,HCPCS,Facility,Both,,,,54,45.9,15.4764,54,America's PPO,America's PPO,51.8562,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
K-WIRE 1.6 MM,,C1769,HCPCS,Facility,Both,,,,54,45.9,15.4764,54,BlueCross BlueShield Minnesota, Federal Employee Program,53.136,98.4,,percent of total billed charges,,
K-WIRE 1.6 MM,,C1769,HCPCS,Facility,Both,,,,54,45.9,15.4764,54,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,54,100,,percent of total billed charges,,
K-WIRE 1.6 MM,,C1769,HCPCS,Facility,Both,,,,54,45.9,15.4764,54,BlueCross BlueShield Minnesota,High Value Network Plan,48.6,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
K-WIRE 1.6 MM,,C1769,HCPCS,Facility,Outpatient,,,,54,45.9,15.4764,54,BlueCross BlueShield Minnesota,Medicare Advantage,26.46,49,,percent of total billed charges,,
K-WIRE 1.6 MM,,C1769,HCPCS,Facility,Inpatient,,,,54,45.9,15.4764,54,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
K-WIRE 1.6 MM,,C1769,HCPCS,Facility,Both,,,,54,45.9,15.4764,54,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,47.8278,88.57,,percent of total billed charges,,
K-WIRE 1.6 MM,,C1769,HCPCS,Facility,Both,,,,54,45.9,15.4764,54,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,15.4764,28.66,,percent of total billed charges,,
K-WIRE 1.6 MM,,C1769,HCPCS,Facility,Outpatient,,,,54,45.9,15.4764,54,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),26.46,49,,percent of total billed charges,,
K-WIRE 1.6 MM,,C1769,HCPCS,Facility,Inpatient,,,,54,45.9,15.4764,54,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
K-WIRE 1.6 MM,,C1769,HCPCS,Facility,Both,,,,54,45.9,15.4764,54,CorVel,Worker's Compensation,54,100,,percent of total billed charges,,
K-WIRE 1.6 MM,,C1769,HCPCS,Facility,Both,,,,54,45.9,15.4764,54,First Health Group Corporation,First Health Network,52.38,97,,percent of total billed charges,,
K-WIRE 1.6 MM,,C1769,HCPCS,Facility,Both,,,,54,45.9,15.4764,54,"Health Partners, Inc.",Commercial,51.084,94.6,,percent of total billed charges,,
K-WIRE 1.6 MM,,C1769,HCPCS,Facility,Outpatient,,,,54,45.9,15.4764,54,"Health Partners, Inc.",Medicare Advantage,26.46,49,,percent of total billed charges,,
K-WIRE 1.6 MM,,C1769,HCPCS,Facility,Inpatient,,,,54,45.9,15.4764,54,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
K-WIRE 1.6 MM,,C1769,HCPCS,Facility,Both,,,,54,45.9,15.4764,54,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),32.4,60,,percent of total billed charges,,
K-WIRE 1.6 MM,,C1769,HCPCS,Facility,Both,,,,54,45.9,15.4764,54,"Health Partners, Inc.",State of Minnesota Advantage Program,44.01,81.5,,percent of total billed charges,,
K-WIRE 1.6 MM,,C1769,HCPCS,Facility,Both,,,,54,45.9,15.4764,54,"Health Partners, Inc.",State Public Programs,27,50,,percent of total billed charges,,
K-WIRE 1.6 MM,,C1769,HCPCS,Facility,Both,,,,54,45.9,15.4764,54,Humana Insurance Company,Commercial PPO,51.3,95,,percent of total billed charges,,
K-WIRE 1.6 MM,,C1769,HCPCS,Facility,Outpatient,,,,54,45.9,15.4764,54,Humana Insurance Company,Medicare PPO,26.46,49,,percent of total billed charges,,
K-WIRE 1.6 MM,,C1769,HCPCS,Facility,Inpatient,,,,54,45.9,15.4764,54,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
K-WIRE 1.6 MM,,C1769,HCPCS,Facility,Both,,,,54,45.9,15.4764,54,Medica,Individual & Family,53.514,99.1,,percent of total billed charges,,
K-WIRE 1.6 MM,,C1769,HCPCS,Facility,Outpatient,,,,54,45.9,15.4764,54,Medica,Medica Advantage Solution,26.892,49.8,,percent of total billed charges,,
K-WIRE 1.6 MM,,C1769,HCPCS,Facility,Inpatient,,,,54,45.9,15.4764,54,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
K-WIRE 1.6 MM,,C1769,HCPCS,Facility,Outpatient,,,,54,45.9,15.4764,54,Medica,Medical Assistance,24.084,44.6,,percent of total billed charges,,
K-WIRE 1.6 MM,,C1769,HCPCS,Facility,Inpatient,,,,54,45.9,15.4764,54,Medica,Medical Assistance,,,,,Included in per diem rate,
K-WIRE 1.6 MM,,C1769,HCPCS,Facility,Outpatient,,,,54,45.9,15.4764,54,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,26.892,49.8,,percent of total billed charges,,
K-WIRE 1.6 MM,,C1769,HCPCS,Facility,Inpatient,,,,54,45.9,15.4764,54,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
K-WIRE 1.6 MM,,C1769,HCPCS,Facility,Both,,,,54,45.9,15.4764,54,"Multiplan, Inc.","Multiplan, Inc.",50.76,94,,percent of total billed charges,,
K-WIRE 1.6 MM,,C1769,HCPCS,Facility,Outpatient,,,,54,45.9,15.4764,54,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,48.654,90.1,,percent of total billed charges,,
K-WIRE 1.6 MM,,C1769,HCPCS,Facility,Inpatient,,,,54,45.9,15.4764,54,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
K-WIRE 1.6 MM,,C1769,HCPCS,Facility,Both,,,,54,45.9,15.4764,54,"Preferred One Administrative Services, INC.",PPO,53.244,98.6,,percent of total billed charges,,
K-WIRE 1.6 MM,,C1769,HCPCS,Facility,Outpatient,,,,54,45.9,15.4764,54,PrimeWest Health,Minnesota Senior Health Options (MSHO),27.783,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
K-WIRE 1.6 MM,,C1769,HCPCS,Facility,Inpatient,,,,54,45.9,15.4764,54,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
K-WIRE 1.6 MM,,C1769,HCPCS,Facility,Outpatient,,,,54,45.9,15.4764,54,PrimeWest Health,MinnesotaCare,27.7344,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
K-WIRE 1.6 MM,,C1769,HCPCS,Facility,Inpatient,,,,54,45.9,15.4764,54,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
K-WIRE 1.6 MM,,C1769,HCPCS,Facility,Both,,,,54,45.9,15.4764,54,Sanford Health Plan,Sanford Health Plan,49.68,92,,percent of total billed charges,,
K-WIRE 1.6 MM,,C1769,HCPCS,Facility,Outpatient,,,,54,45.9,15.4764,54,"UCare Health, Inc.",Individual & Family Plan,30.429,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
K-WIRE 1.6 MM,,C1769,HCPCS,Facility,Inpatient,,,,54,45.9,15.4764,54,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
K-WIRE 1.6 MM,,C1769,HCPCS,Facility,Outpatient,,,,54,45.9,15.4764,54,"UCare Health, Inc.",Medical Assistance,27.2538,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
K-WIRE 1.6 MM,,C1769,HCPCS,Facility,Inpatient,,,,54,45.9,15.4764,54,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
K-WIRE 1.6 MM,,C1769,HCPCS,Facility,Outpatient,,,,54,45.9,15.4764,54,"UCare Health, Inc.",Medicare Advantage,27.2538,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
K-WIRE 1.6 MM,,C1769,HCPCS,Facility,Inpatient,,,,54,45.9,15.4764,54,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
K-WIRE 1.6 MM,,C1769,HCPCS,Facility,Outpatient,,,,54,45.9,15.4764,54,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),27.2538,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
K-WIRE 1.6 MM,,C1769,HCPCS,Facility,Inpatient,,,,54,45.9,15.4764,54,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
K-WIRE 1.6 MM,,C1769,HCPCS,Facility,Both,,,,54,45.9,15.4764,54,UnitedHealthcare,Individual & Family,50.76,94,,percent of total billed charges,,
K-WIRE 1.6 MM,,C1769,HCPCS,Facility,Outpatient,,,,54,45.9,15.4764,54,UnitedHealthcare,Medicare Advantage,26.46,49,,percent of total billed charges,,
K-WIRE 1.6 MM,,C1769,HCPCS,Facility,Inpatient,,,,54,45.9,15.4764,54,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
K-WIRE 1.6 MM,,C1769,HCPCS,Facility,Outpatient,,,,54,45.9,15.4764,54,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,25.92,48,,percent of total billed charges,,100% of DHS outpatient percentage
K-WIRE 1.6 MM,,C1769,HCPCS,Facility,Inpatient,,,,54,45.9,15.4764,54,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
K-WIRE 228MM JONES  WRIGHT MED 56010228,,C1769,HCPCS,Facility,Both,,,,172,146.2,49.2952,172,Aetna,Commercial,158.24,92,,percent of total billed charges,,
K-WIRE 228MM JONES  WRIGHT MED 56010228,,C1769,HCPCS,Facility,Outpatient,,,,172,146.2,49.2952,172,Aetna,Medicare Advantage,84.28,49,,percent of total billed charges,,
K-WIRE 228MM JONES  WRIGHT MED 56010228,,C1769,HCPCS,Facility,Inpatient,,,,172,146.2,49.2952,172,Aetna,Medicare Advantage,,,,,Included in per diem rate,
K-WIRE 228MM JONES  WRIGHT MED 56010228,,C1769,HCPCS,Facility,Both,,,,172,146.2,49.2952,172,Aetna,PPO,159.96,93,,percent of total billed charges,,
K-WIRE 228MM JONES  WRIGHT MED 56010228,,C1769,HCPCS,Facility,Both,,,,172,146.2,49.2952,172,America's PPO,America's PPO,165.1716,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
K-WIRE 228MM JONES  WRIGHT MED 56010228,,C1769,HCPCS,Facility,Both,,,,172,146.2,49.2952,172,BlueCross BlueShield Minnesota, Federal Employee Program,169.248,98.4,,percent of total billed charges,,
K-WIRE 228MM JONES  WRIGHT MED 56010228,,C1769,HCPCS,Facility,Both,,,,172,146.2,49.2952,172,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,172,100,,percent of total billed charges,,
K-WIRE 228MM JONES  WRIGHT MED 56010228,,C1769,HCPCS,Facility,Both,,,,172,146.2,49.2952,172,BlueCross BlueShield Minnesota,High Value Network Plan,154.8,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
K-WIRE 228MM JONES  WRIGHT MED 56010228,,C1769,HCPCS,Facility,Outpatient,,,,172,146.2,49.2952,172,BlueCross BlueShield Minnesota,Medicare Advantage,84.28,49,,percent of total billed charges,,
K-WIRE 228MM JONES  WRIGHT MED 56010228,,C1769,HCPCS,Facility,Inpatient,,,,172,146.2,49.2952,172,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
K-WIRE 228MM JONES  WRIGHT MED 56010228,,C1769,HCPCS,Facility,Both,,,,172,146.2,49.2952,172,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,152.3404,88.57,,percent of total billed charges,,
K-WIRE 228MM JONES  WRIGHT MED 56010228,,C1769,HCPCS,Facility,Both,,,,172,146.2,49.2952,172,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,49.2952,28.66,,percent of total billed charges,,
K-WIRE 228MM JONES  WRIGHT MED 56010228,,C1769,HCPCS,Facility,Outpatient,,,,172,146.2,49.2952,172,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),84.28,49,,percent of total billed charges,,
K-WIRE 228MM JONES  WRIGHT MED 56010228,,C1769,HCPCS,Facility,Inpatient,,,,172,146.2,49.2952,172,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
K-WIRE 228MM JONES  WRIGHT MED 56010228,,C1769,HCPCS,Facility,Both,,,,172,146.2,49.2952,172,CorVel,Worker's Compensation,172,100,,percent of total billed charges,,
K-WIRE 228MM JONES  WRIGHT MED 56010228,,C1769,HCPCS,Facility,Both,,,,172,146.2,49.2952,172,First Health Group Corporation,First Health Network,166.84,97,,percent of total billed charges,,
K-WIRE 228MM JONES  WRIGHT MED 56010228,,C1769,HCPCS,Facility,Both,,,,172,146.2,49.2952,172,"Health Partners, Inc.",Commercial,162.712,94.6,,percent of total billed charges,,
K-WIRE 228MM JONES  WRIGHT MED 56010228,,C1769,HCPCS,Facility,Outpatient,,,,172,146.2,49.2952,172,"Health Partners, Inc.",Medicare Advantage,84.28,49,,percent of total billed charges,,
K-WIRE 228MM JONES  WRIGHT MED 56010228,,C1769,HCPCS,Facility,Inpatient,,,,172,146.2,49.2952,172,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
K-WIRE 228MM JONES  WRIGHT MED 56010228,,C1769,HCPCS,Facility,Both,,,,172,146.2,49.2952,172,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),103.2,60,,percent of total billed charges,,
K-WIRE 228MM JONES  WRIGHT MED 56010228,,C1769,HCPCS,Facility,Both,,,,172,146.2,49.2952,172,"Health Partners, Inc.",State of Minnesota Advantage Program,140.18,81.5,,percent of total billed charges,,
K-WIRE 228MM JONES  WRIGHT MED 56010228,,C1769,HCPCS,Facility,Both,,,,172,146.2,49.2952,172,"Health Partners, Inc.",State Public Programs,86,50,,percent of total billed charges,,
K-WIRE 228MM JONES  WRIGHT MED 56010228,,C1769,HCPCS,Facility,Both,,,,172,146.2,49.2952,172,Humana Insurance Company,Commercial PPO,163.4,95,,percent of total billed charges,,
K-WIRE 228MM JONES  WRIGHT MED 56010228,,C1769,HCPCS,Facility,Outpatient,,,,172,146.2,49.2952,172,Humana Insurance Company,Medicare PPO,84.28,49,,percent of total billed charges,,
K-WIRE 228MM JONES  WRIGHT MED 56010228,,C1769,HCPCS,Facility,Inpatient,,,,172,146.2,49.2952,172,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
K-WIRE 228MM JONES  WRIGHT MED 56010228,,C1769,HCPCS,Facility,Both,,,,172,146.2,49.2952,172,Medica,Individual & Family,170.452,99.1,,percent of total billed charges,,
K-WIRE 228MM JONES  WRIGHT MED 56010228,,C1769,HCPCS,Facility,Outpatient,,,,172,146.2,49.2952,172,Medica,Medica Advantage Solution,85.656,49.8,,percent of total billed charges,,
K-WIRE 228MM JONES  WRIGHT MED 56010228,,C1769,HCPCS,Facility,Inpatient,,,,172,146.2,49.2952,172,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
K-WIRE 228MM JONES  WRIGHT MED 56010228,,C1769,HCPCS,Facility,Outpatient,,,,172,146.2,49.2952,172,Medica,Medical Assistance,76.712,44.6,,percent of total billed charges,,
K-WIRE 228MM JONES  WRIGHT MED 56010228,,C1769,HCPCS,Facility,Inpatient,,,,172,146.2,49.2952,172,Medica,Medical Assistance,,,,,Included in per diem rate,
K-WIRE 228MM JONES  WRIGHT MED 56010228,,C1769,HCPCS,Facility,Outpatient,,,,172,146.2,49.2952,172,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,85.656,49.8,,percent of total billed charges,,
K-WIRE 228MM JONES  WRIGHT MED 56010228,,C1769,HCPCS,Facility,Inpatient,,,,172,146.2,49.2952,172,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
K-WIRE 228MM JONES  WRIGHT MED 56010228,,C1769,HCPCS,Facility,Both,,,,172,146.2,49.2952,172,"Multiplan, Inc.","Multiplan, Inc.",161.68,94,,percent of total billed charges,,
K-WIRE 228MM JONES  WRIGHT MED 56010228,,C1769,HCPCS,Facility,Outpatient,,,,172,146.2,49.2952,172,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,154.972,90.1,,percent of total billed charges,,
K-WIRE 228MM JONES  WRIGHT MED 56010228,,C1769,HCPCS,Facility,Inpatient,,,,172,146.2,49.2952,172,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
K-WIRE 228MM JONES  WRIGHT MED 56010228,,C1769,HCPCS,Facility,Both,,,,172,146.2,49.2952,172,"Preferred One Administrative Services, INC.",PPO,169.592,98.6,,percent of total billed charges,,
K-WIRE 228MM JONES  WRIGHT MED 56010228,,C1769,HCPCS,Facility,Outpatient,,,,172,146.2,49.2952,172,PrimeWest Health,Minnesota Senior Health Options (MSHO),88.494,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
K-WIRE 228MM JONES  WRIGHT MED 56010228,,C1769,HCPCS,Facility,Inpatient,,,,172,146.2,49.2952,172,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
K-WIRE 228MM JONES  WRIGHT MED 56010228,,C1769,HCPCS,Facility,Outpatient,,,,172,146.2,49.2952,172,PrimeWest Health,MinnesotaCare,88.3392,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
K-WIRE 228MM JONES  WRIGHT MED 56010228,,C1769,HCPCS,Facility,Inpatient,,,,172,146.2,49.2952,172,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
K-WIRE 228MM JONES  WRIGHT MED 56010228,,C1769,HCPCS,Facility,Both,,,,172,146.2,49.2952,172,Sanford Health Plan,Sanford Health Plan,158.24,92,,percent of total billed charges,,
K-WIRE 228MM JONES  WRIGHT MED 56010228,,C1769,HCPCS,Facility,Outpatient,,,,172,146.2,49.2952,172,"UCare Health, Inc.",Individual & Family Plan,96.922,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
K-WIRE 228MM JONES  WRIGHT MED 56010228,,C1769,HCPCS,Facility,Inpatient,,,,172,146.2,49.2952,172,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
K-WIRE 228MM JONES  WRIGHT MED 56010228,,C1769,HCPCS,Facility,Outpatient,,,,172,146.2,49.2952,172,"UCare Health, Inc.",Medical Assistance,86.8084,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
K-WIRE 228MM JONES  WRIGHT MED 56010228,,C1769,HCPCS,Facility,Inpatient,,,,172,146.2,49.2952,172,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
K-WIRE 228MM JONES  WRIGHT MED 56010228,,C1769,HCPCS,Facility,Outpatient,,,,172,146.2,49.2952,172,"UCare Health, Inc.",Medicare Advantage,86.8084,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
K-WIRE 228MM JONES  WRIGHT MED 56010228,,C1769,HCPCS,Facility,Inpatient,,,,172,146.2,49.2952,172,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
K-WIRE 228MM JONES  WRIGHT MED 56010228,,C1769,HCPCS,Facility,Outpatient,,,,172,146.2,49.2952,172,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),86.8084,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
K-WIRE 228MM JONES  WRIGHT MED 56010228,,C1769,HCPCS,Facility,Inpatient,,,,172,146.2,49.2952,172,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
K-WIRE 228MM JONES  WRIGHT MED 56010228,,C1769,HCPCS,Facility,Both,,,,172,146.2,49.2952,172,UnitedHealthcare,Individual & Family,161.68,94,,percent of total billed charges,,
K-WIRE 228MM JONES  WRIGHT MED 56010228,,C1769,HCPCS,Facility,Outpatient,,,,172,146.2,49.2952,172,UnitedHealthcare,Medicare Advantage,84.28,49,,percent of total billed charges,,
K-WIRE 228MM JONES  WRIGHT MED 56010228,,C1769,HCPCS,Facility,Inpatient,,,,172,146.2,49.2952,172,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
K-WIRE 228MM JONES  WRIGHT MED 56010228,,C1769,HCPCS,Facility,Outpatient,,,,172,146.2,49.2952,172,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,82.56,48,,percent of total billed charges,,100% of DHS outpatient percentage
K-WIRE 228MM JONES  WRIGHT MED 56010228,,C1769,HCPCS,Facility,Inpatient,,,,172,146.2,49.2952,172,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
PTFE GUIDEWIRE,,C1769,HCPCS,Facility,Both,,,,144,122.4,41.2704,144,Aetna,Commercial,132.48,92,,percent of total billed charges,,
PTFE GUIDEWIRE,,C1769,HCPCS,Facility,Outpatient,,,,144,122.4,41.2704,144,Aetna,Medicare Advantage,70.56,49,,percent of total billed charges,,
PTFE GUIDEWIRE,,C1769,HCPCS,Facility,Inpatient,,,,144,122.4,41.2704,144,Aetna,Medicare Advantage,,,,,Included in per diem rate,
PTFE GUIDEWIRE,,C1769,HCPCS,Facility,Both,,,,144,122.4,41.2704,144,Aetna,PPO,133.92,93,,percent of total billed charges,,
PTFE GUIDEWIRE,,C1769,HCPCS,Facility,Both,,,,144,122.4,41.2704,144,America's PPO,America's PPO,138.2832,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
PTFE GUIDEWIRE,,C1769,HCPCS,Facility,Both,,,,144,122.4,41.2704,144,BlueCross BlueShield Minnesota, Federal Employee Program,141.696,98.4,,percent of total billed charges,,
PTFE GUIDEWIRE,,C1769,HCPCS,Facility,Both,,,,144,122.4,41.2704,144,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,144,100,,percent of total billed charges,,
PTFE GUIDEWIRE,,C1769,HCPCS,Facility,Both,,,,144,122.4,41.2704,144,BlueCross BlueShield Minnesota,High Value Network Plan,129.6,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
PTFE GUIDEWIRE,,C1769,HCPCS,Facility,Outpatient,,,,144,122.4,41.2704,144,BlueCross BlueShield Minnesota,Medicare Advantage,70.56,49,,percent of total billed charges,,
PTFE GUIDEWIRE,,C1769,HCPCS,Facility,Inpatient,,,,144,122.4,41.2704,144,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
PTFE GUIDEWIRE,,C1769,HCPCS,Facility,Both,,,,144,122.4,41.2704,144,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,127.5408,88.57,,percent of total billed charges,,
PTFE GUIDEWIRE,,C1769,HCPCS,Facility,Both,,,,144,122.4,41.2704,144,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,41.2704,28.66,,percent of total billed charges,,
PTFE GUIDEWIRE,,C1769,HCPCS,Facility,Outpatient,,,,144,122.4,41.2704,144,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),70.56,49,,percent of total billed charges,,
PTFE GUIDEWIRE,,C1769,HCPCS,Facility,Inpatient,,,,144,122.4,41.2704,144,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
PTFE GUIDEWIRE,,C1769,HCPCS,Facility,Both,,,,144,122.4,41.2704,144,CorVel,Worker's Compensation,144,100,,percent of total billed charges,,
PTFE GUIDEWIRE,,C1769,HCPCS,Facility,Both,,,,144,122.4,41.2704,144,First Health Group Corporation,First Health Network,139.68,97,,percent of total billed charges,,
PTFE GUIDEWIRE,,C1769,HCPCS,Facility,Both,,,,144,122.4,41.2704,144,"Health Partners, Inc.",Commercial,136.224,94.6,,percent of total billed charges,,
PTFE GUIDEWIRE,,C1769,HCPCS,Facility,Outpatient,,,,144,122.4,41.2704,144,"Health Partners, Inc.",Medicare Advantage,70.56,49,,percent of total billed charges,,
PTFE GUIDEWIRE,,C1769,HCPCS,Facility,Inpatient,,,,144,122.4,41.2704,144,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PTFE GUIDEWIRE,,C1769,HCPCS,Facility,Both,,,,144,122.4,41.2704,144,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),86.4,60,,percent of total billed charges,,
PTFE GUIDEWIRE,,C1769,HCPCS,Facility,Both,,,,144,122.4,41.2704,144,"Health Partners, Inc.",State of Minnesota Advantage Program,117.36,81.5,,percent of total billed charges,,
PTFE GUIDEWIRE,,C1769,HCPCS,Facility,Both,,,,144,122.4,41.2704,144,"Health Partners, Inc.",State Public Programs,72,50,,percent of total billed charges,,
PTFE GUIDEWIRE,,C1769,HCPCS,Facility,Both,,,,144,122.4,41.2704,144,Humana Insurance Company,Commercial PPO,136.8,95,,percent of total billed charges,,
PTFE GUIDEWIRE,,C1769,HCPCS,Facility,Outpatient,,,,144,122.4,41.2704,144,Humana Insurance Company,Medicare PPO,70.56,49,,percent of total billed charges,,
PTFE GUIDEWIRE,,C1769,HCPCS,Facility,Inpatient,,,,144,122.4,41.2704,144,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
PTFE GUIDEWIRE,,C1769,HCPCS,Facility,Both,,,,144,122.4,41.2704,144,Medica,Individual & Family,142.704,99.1,,percent of total billed charges,,
PTFE GUIDEWIRE,,C1769,HCPCS,Facility,Outpatient,,,,144,122.4,41.2704,144,Medica,Medica Advantage Solution,71.712,49.8,,percent of total billed charges,,
PTFE GUIDEWIRE,,C1769,HCPCS,Facility,Inpatient,,,,144,122.4,41.2704,144,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
PTFE GUIDEWIRE,,C1769,HCPCS,Facility,Outpatient,,,,144,122.4,41.2704,144,Medica,Medical Assistance,64.224,44.6,,percent of total billed charges,,
PTFE GUIDEWIRE,,C1769,HCPCS,Facility,Inpatient,,,,144,122.4,41.2704,144,Medica,Medical Assistance,,,,,Included in per diem rate,
PTFE GUIDEWIRE,,C1769,HCPCS,Facility,Outpatient,,,,144,122.4,41.2704,144,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,71.712,49.8,,percent of total billed charges,,
PTFE GUIDEWIRE,,C1769,HCPCS,Facility,Inpatient,,,,144,122.4,41.2704,144,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
PTFE GUIDEWIRE,,C1769,HCPCS,Facility,Both,,,,144,122.4,41.2704,144,"Multiplan, Inc.","Multiplan, Inc.",135.36,94,,percent of total billed charges,,
PTFE GUIDEWIRE,,C1769,HCPCS,Facility,Outpatient,,,,144,122.4,41.2704,144,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,129.744,90.1,,percent of total billed charges,,
PTFE GUIDEWIRE,,C1769,HCPCS,Facility,Inpatient,,,,144,122.4,41.2704,144,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
PTFE GUIDEWIRE,,C1769,HCPCS,Facility,Both,,,,144,122.4,41.2704,144,"Preferred One Administrative Services, INC.",PPO,141.984,98.6,,percent of total billed charges,,
PTFE GUIDEWIRE,,C1769,HCPCS,Facility,Outpatient,,,,144,122.4,41.2704,144,PrimeWest Health,Minnesota Senior Health Options (MSHO),74.088,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
PTFE GUIDEWIRE,,C1769,HCPCS,Facility,Inpatient,,,,144,122.4,41.2704,144,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PTFE GUIDEWIRE,,C1769,HCPCS,Facility,Outpatient,,,,144,122.4,41.2704,144,PrimeWest Health,MinnesotaCare,73.9584,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
PTFE GUIDEWIRE,,C1769,HCPCS,Facility,Inpatient,,,,144,122.4,41.2704,144,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
PTFE GUIDEWIRE,,C1769,HCPCS,Facility,Both,,,,144,122.4,41.2704,144,Sanford Health Plan,Sanford Health Plan,132.48,92,,percent of total billed charges,,
PTFE GUIDEWIRE,,C1769,HCPCS,Facility,Outpatient,,,,144,122.4,41.2704,144,"UCare Health, Inc.",Individual & Family Plan,81.144,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
PTFE GUIDEWIRE,,C1769,HCPCS,Facility,Inpatient,,,,144,122.4,41.2704,144,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
PTFE GUIDEWIRE,,C1769,HCPCS,Facility,Outpatient,,,,144,122.4,41.2704,144,"UCare Health, Inc.",Medical Assistance,72.6768,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PTFE GUIDEWIRE,,C1769,HCPCS,Facility,Inpatient,,,,144,122.4,41.2704,144,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
PTFE GUIDEWIRE,,C1769,HCPCS,Facility,Outpatient,,,,144,122.4,41.2704,144,"UCare Health, Inc.",Medicare Advantage,72.6768,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PTFE GUIDEWIRE,,C1769,HCPCS,Facility,Inpatient,,,,144,122.4,41.2704,144,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PTFE GUIDEWIRE,,C1769,HCPCS,Facility,Outpatient,,,,144,122.4,41.2704,144,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),72.6768,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PTFE GUIDEWIRE,,C1769,HCPCS,Facility,Inpatient,,,,144,122.4,41.2704,144,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PTFE GUIDEWIRE,,C1769,HCPCS,Facility,Both,,,,144,122.4,41.2704,144,UnitedHealthcare,Individual & Family,135.36,94,,percent of total billed charges,,
PTFE GUIDEWIRE,,C1769,HCPCS,Facility,Outpatient,,,,144,122.4,41.2704,144,UnitedHealthcare,Medicare Advantage,70.56,49,,percent of total billed charges,,
PTFE GUIDEWIRE,,C1769,HCPCS,Facility,Inpatient,,,,144,122.4,41.2704,144,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
PTFE GUIDEWIRE,,C1769,HCPCS,Facility,Outpatient,,,,144,122.4,41.2704,144,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,69.12,48,,percent of total billed charges,,100% of DHS outpatient percentage
PTFE GUIDEWIRE,,C1769,HCPCS,Facility,Inpatient,,,,144,122.4,41.2704,144,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
SPECIMEN RETRIEVAL DEVICE ENDOCATCH GOLD 10MM 173050G,,C1773,HCPCS,Facility,Both,,,,178.5,151.725,51.1581,178.5,Aetna,Commercial,164.22,92,,percent of total billed charges,,
SPECIMEN RETRIEVAL DEVICE ENDOCATCH GOLD 10MM 173050G,,C1773,HCPCS,Facility,Outpatient,,,,178.5,151.725,51.1581,178.5,Aetna,Medicare Advantage,87.465,49,,percent of total billed charges,,
SPECIMEN RETRIEVAL DEVICE ENDOCATCH GOLD 10MM 173050G,,C1773,HCPCS,Facility,Inpatient,,,,178.5,151.725,51.1581,178.5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
SPECIMEN RETRIEVAL DEVICE ENDOCATCH GOLD 10MM 173050G,,C1773,HCPCS,Facility,Both,,,,178.5,151.725,51.1581,178.5,Aetna,PPO,166.005,93,,percent of total billed charges,,
SPECIMEN RETRIEVAL DEVICE ENDOCATCH GOLD 10MM 173050G,,C1773,HCPCS,Facility,Both,,,,178.5,151.725,51.1581,178.5,America's PPO,America's PPO,171.41355,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SPECIMEN RETRIEVAL DEVICE ENDOCATCH GOLD 10MM 173050G,,C1773,HCPCS,Facility,Both,,,,178.5,151.725,51.1581,178.5,BlueCross BlueShield Minnesota, Federal Employee Program,175.644,98.4,,percent of total billed charges,,
SPECIMEN RETRIEVAL DEVICE ENDOCATCH GOLD 10MM 173050G,,C1773,HCPCS,Facility,Both,,,,178.5,151.725,51.1581,178.5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,178.5,100,,percent of total billed charges,,
SPECIMEN RETRIEVAL DEVICE ENDOCATCH GOLD 10MM 173050G,,C1773,HCPCS,Facility,Both,,,,178.5,151.725,51.1581,178.5,BlueCross BlueShield Minnesota,High Value Network Plan,160.65,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
SPECIMEN RETRIEVAL DEVICE ENDOCATCH GOLD 10MM 173050G,,C1773,HCPCS,Facility,Outpatient,,,,178.5,151.725,51.1581,178.5,BlueCross BlueShield Minnesota,Medicare Advantage,87.465,49,,percent of total billed charges,,
SPECIMEN RETRIEVAL DEVICE ENDOCATCH GOLD 10MM 173050G,,C1773,HCPCS,Facility,Inpatient,,,,178.5,151.725,51.1581,178.5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
SPECIMEN RETRIEVAL DEVICE ENDOCATCH GOLD 10MM 173050G,,C1773,HCPCS,Facility,Both,,,,178.5,151.725,51.1581,178.5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,158.09745,88.57,,percent of total billed charges,,
SPECIMEN RETRIEVAL DEVICE ENDOCATCH GOLD 10MM 173050G,,C1773,HCPCS,Facility,Both,,,,178.5,151.725,51.1581,178.5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,51.1581,28.66,,percent of total billed charges,,
SPECIMEN RETRIEVAL DEVICE ENDOCATCH GOLD 10MM 173050G,,C1773,HCPCS,Facility,Outpatient,,,,178.5,151.725,51.1581,178.5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),87.465,49,,percent of total billed charges,,
SPECIMEN RETRIEVAL DEVICE ENDOCATCH GOLD 10MM 173050G,,C1773,HCPCS,Facility,Inpatient,,,,178.5,151.725,51.1581,178.5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
SPECIMEN RETRIEVAL DEVICE ENDOCATCH GOLD 10MM 173050G,,C1773,HCPCS,Facility,Both,,,,178.5,151.725,51.1581,178.5,CorVel,Worker's Compensation,178.5,100,,percent of total billed charges,,
SPECIMEN RETRIEVAL DEVICE ENDOCATCH GOLD 10MM 173050G,,C1773,HCPCS,Facility,Both,,,,178.5,151.725,51.1581,178.5,First Health Group Corporation,First Health Network,173.145,97,,percent of total billed charges,,
SPECIMEN RETRIEVAL DEVICE ENDOCATCH GOLD 10MM 173050G,,C1773,HCPCS,Facility,Both,,,,178.5,151.725,51.1581,178.5,"Health Partners, Inc.",Commercial,168.861,94.6,,percent of total billed charges,,
SPECIMEN RETRIEVAL DEVICE ENDOCATCH GOLD 10MM 173050G,,C1773,HCPCS,Facility,Outpatient,,,,178.5,151.725,51.1581,178.5,"Health Partners, Inc.",Medicare Advantage,87.465,49,,percent of total billed charges,,
SPECIMEN RETRIEVAL DEVICE ENDOCATCH GOLD 10MM 173050G,,C1773,HCPCS,Facility,Inpatient,,,,178.5,151.725,51.1581,178.5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SPECIMEN RETRIEVAL DEVICE ENDOCATCH GOLD 10MM 173050G,,C1773,HCPCS,Facility,Both,,,,178.5,151.725,51.1581,178.5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),107.1,60,,percent of total billed charges,,
SPECIMEN RETRIEVAL DEVICE ENDOCATCH GOLD 10MM 173050G,,C1773,HCPCS,Facility,Both,,,,178.5,151.725,51.1581,178.5,"Health Partners, Inc.",State of Minnesota Advantage Program,145.4775,81.5,,percent of total billed charges,,
SPECIMEN RETRIEVAL DEVICE ENDOCATCH GOLD 10MM 173050G,,C1773,HCPCS,Facility,Both,,,,178.5,151.725,51.1581,178.5,"Health Partners, Inc.",State Public Programs,89.25,50,,percent of total billed charges,,
SPECIMEN RETRIEVAL DEVICE ENDOCATCH GOLD 10MM 173050G,,C1773,HCPCS,Facility,Both,,,,178.5,151.725,51.1581,178.5,Humana Insurance Company,Commercial PPO,169.575,95,,percent of total billed charges,,
SPECIMEN RETRIEVAL DEVICE ENDOCATCH GOLD 10MM 173050G,,C1773,HCPCS,Facility,Outpatient,,,,178.5,151.725,51.1581,178.5,Humana Insurance Company,Medicare PPO,87.465,49,,percent of total billed charges,,
SPECIMEN RETRIEVAL DEVICE ENDOCATCH GOLD 10MM 173050G,,C1773,HCPCS,Facility,Inpatient,,,,178.5,151.725,51.1581,178.5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
SPECIMEN RETRIEVAL DEVICE ENDOCATCH GOLD 10MM 173050G,,C1773,HCPCS,Facility,Both,,,,178.5,151.725,51.1581,178.5,Medica,Individual & Family,176.8935,99.1,,percent of total billed charges,,
SPECIMEN RETRIEVAL DEVICE ENDOCATCH GOLD 10MM 173050G,,C1773,HCPCS,Facility,Outpatient,,,,178.5,151.725,51.1581,178.5,Medica,Medica Advantage Solution,88.893,49.8,,percent of total billed charges,,
SPECIMEN RETRIEVAL DEVICE ENDOCATCH GOLD 10MM 173050G,,C1773,HCPCS,Facility,Inpatient,,,,178.5,151.725,51.1581,178.5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
SPECIMEN RETRIEVAL DEVICE ENDOCATCH GOLD 10MM 173050G,,C1773,HCPCS,Facility,Outpatient,,,,178.5,151.725,51.1581,178.5,Medica,Medical Assistance,79.611,44.6,,percent of total billed charges,,
SPECIMEN RETRIEVAL DEVICE ENDOCATCH GOLD 10MM 173050G,,C1773,HCPCS,Facility,Inpatient,,,,178.5,151.725,51.1581,178.5,Medica,Medical Assistance,,,,,Included in per diem rate,
SPECIMEN RETRIEVAL DEVICE ENDOCATCH GOLD 10MM 173050G,,C1773,HCPCS,Facility,Outpatient,,,,178.5,151.725,51.1581,178.5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,88.893,49.8,,percent of total billed charges,,
SPECIMEN RETRIEVAL DEVICE ENDOCATCH GOLD 10MM 173050G,,C1773,HCPCS,Facility,Inpatient,,,,178.5,151.725,51.1581,178.5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
SPECIMEN RETRIEVAL DEVICE ENDOCATCH GOLD 10MM 173050G,,C1773,HCPCS,Facility,Both,,,,178.5,151.725,51.1581,178.5,"Multiplan, Inc.","Multiplan, Inc.",167.79,94,,percent of total billed charges,,
SPECIMEN RETRIEVAL DEVICE ENDOCATCH GOLD 10MM 173050G,,C1773,HCPCS,Facility,Outpatient,,,,178.5,151.725,51.1581,178.5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,160.8285,90.1,,percent of total billed charges,,
SPECIMEN RETRIEVAL DEVICE ENDOCATCH GOLD 10MM 173050G,,C1773,HCPCS,Facility,Inpatient,,,,178.5,151.725,51.1581,178.5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
SPECIMEN RETRIEVAL DEVICE ENDOCATCH GOLD 10MM 173050G,,C1773,HCPCS,Facility,Both,,,,178.5,151.725,51.1581,178.5,"Preferred One Administrative Services, INC.",PPO,176.001,98.6,,percent of total billed charges,,
SPECIMEN RETRIEVAL DEVICE ENDOCATCH GOLD 10MM 173050G,,C1773,HCPCS,Facility,Outpatient,,,,178.5,151.725,51.1581,178.5,PrimeWest Health,Minnesota Senior Health Options (MSHO),91.83825,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
SPECIMEN RETRIEVAL DEVICE ENDOCATCH GOLD 10MM 173050G,,C1773,HCPCS,Facility,Inpatient,,,,178.5,151.725,51.1581,178.5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SPECIMEN RETRIEVAL DEVICE ENDOCATCH GOLD 10MM 173050G,,C1773,HCPCS,Facility,Outpatient,,,,178.5,151.725,51.1581,178.5,PrimeWest Health,MinnesotaCare,91.6776,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
SPECIMEN RETRIEVAL DEVICE ENDOCATCH GOLD 10MM 173050G,,C1773,HCPCS,Facility,Inpatient,,,,178.5,151.725,51.1581,178.5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
SPECIMEN RETRIEVAL DEVICE ENDOCATCH GOLD 10MM 173050G,,C1773,HCPCS,Facility,Both,,,,178.5,151.725,51.1581,178.5,Sanford Health Plan,Sanford Health Plan,164.22,92,,percent of total billed charges,,
SPECIMEN RETRIEVAL DEVICE ENDOCATCH GOLD 10MM 173050G,,C1773,HCPCS,Facility,Outpatient,,,,178.5,151.725,51.1581,178.5,"UCare Health, Inc.",Individual & Family Plan,100.58475,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
SPECIMEN RETRIEVAL DEVICE ENDOCATCH GOLD 10MM 173050G,,C1773,HCPCS,Facility,Inpatient,,,,178.5,151.725,51.1581,178.5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
SPECIMEN RETRIEVAL DEVICE ENDOCATCH GOLD 10MM 173050G,,C1773,HCPCS,Facility,Outpatient,,,,178.5,151.725,51.1581,178.5,"UCare Health, Inc.",Medical Assistance,90.08895,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SPECIMEN RETRIEVAL DEVICE ENDOCATCH GOLD 10MM 173050G,,C1773,HCPCS,Facility,Inpatient,,,,178.5,151.725,51.1581,178.5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
SPECIMEN RETRIEVAL DEVICE ENDOCATCH GOLD 10MM 173050G,,C1773,HCPCS,Facility,Outpatient,,,,178.5,151.725,51.1581,178.5,"UCare Health, Inc.",Medicare Advantage,90.08895,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SPECIMEN RETRIEVAL DEVICE ENDOCATCH GOLD 10MM 173050G,,C1773,HCPCS,Facility,Inpatient,,,,178.5,151.725,51.1581,178.5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SPECIMEN RETRIEVAL DEVICE ENDOCATCH GOLD 10MM 173050G,,C1773,HCPCS,Facility,Outpatient,,,,178.5,151.725,51.1581,178.5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),90.08895,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SPECIMEN RETRIEVAL DEVICE ENDOCATCH GOLD 10MM 173050G,,C1773,HCPCS,Facility,Inpatient,,,,178.5,151.725,51.1581,178.5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SPECIMEN RETRIEVAL DEVICE ENDOCATCH GOLD 10MM 173050G,,C1773,HCPCS,Facility,Both,,,,178.5,151.725,51.1581,178.5,UnitedHealthcare,Individual & Family,167.79,94,,percent of total billed charges,,
SPECIMEN RETRIEVAL DEVICE ENDOCATCH GOLD 10MM 173050G,,C1773,HCPCS,Facility,Outpatient,,,,178.5,151.725,51.1581,178.5,UnitedHealthcare,Medicare Advantage,87.465,49,,percent of total billed charges,,
SPECIMEN RETRIEVAL DEVICE ENDOCATCH GOLD 10MM 173050G,,C1773,HCPCS,Facility,Inpatient,,,,178.5,151.725,51.1581,178.5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
SPECIMEN RETRIEVAL DEVICE ENDOCATCH GOLD 10MM 173050G,,C1773,HCPCS,Facility,Outpatient,,,,178.5,151.725,51.1581,178.5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,85.68,48,,percent of total billed charges,,100% of DHS outpatient percentage
SPECIMEN RETRIEVAL DEVICE ENDOCATCH GOLD 10MM 173050G,,C1773,HCPCS,Facility,Inpatient,,,,178.5,151.725,51.1581,178.5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
ALL POLY PAT VE 32MM DIAMATER,,C1776,HCPCS,Facility,Both,,,,1995,1695.75,571.767,1995,Aetna,Commercial,1835.4,92,,percent of total billed charges,,
ALL POLY PAT VE 32MM DIAMATER,,C1776,HCPCS,Facility,Outpatient,,,,1995,1695.75,571.767,1995,Aetna,Medicare Advantage,977.55,49,,percent of total billed charges,,
ALL POLY PAT VE 32MM DIAMATER,,C1776,HCPCS,Facility,Inpatient,,,,1995,1695.75,571.767,1995,Aetna,Medicare Advantage,,,,,Included in per diem rate,
ALL POLY PAT VE 32MM DIAMATER,,C1776,HCPCS,Facility,Both,,,,1995,1695.75,571.767,1995,Aetna,PPO,1855.35,93,,percent of total billed charges,,
ALL POLY PAT VE 32MM DIAMATER,,C1776,HCPCS,Facility,Both,,,,1995,1695.75,571.767,1995,America's PPO,America's PPO,1915.7985,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
ALL POLY PAT VE 32MM DIAMATER,,C1776,HCPCS,Facility,Both,,,,1995,1695.75,571.767,1995,BlueCross BlueShield Minnesota, Federal Employee Program,1963.08,98.4,,percent of total billed charges,,
ALL POLY PAT VE 32MM DIAMATER,,C1776,HCPCS,Facility,Both,,,,1995,1695.75,571.767,1995,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1995,100,,percent of total billed charges,,
ALL POLY PAT VE 32MM DIAMATER,,C1776,HCPCS,Facility,Both,,,,1995,1695.75,571.767,1995,BlueCross BlueShield Minnesota,High Value Network Plan,1795.5,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
ALL POLY PAT VE 32MM DIAMATER,,C1776,HCPCS,Facility,Outpatient,,,,1995,1695.75,571.767,1995,BlueCross BlueShield Minnesota,Medicare Advantage,977.55,49,,percent of total billed charges,,
ALL POLY PAT VE 32MM DIAMATER,,C1776,HCPCS,Facility,Inpatient,,,,1995,1695.75,571.767,1995,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
ALL POLY PAT VE 32MM DIAMATER,,C1776,HCPCS,Facility,Both,,,,1995,1695.75,571.767,1995,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1766.9715,88.57,,percent of total billed charges,,
ALL POLY PAT VE 32MM DIAMATER,,C1776,HCPCS,Facility,Both,,,,1995,1695.75,571.767,1995,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,571.767,28.66,,percent of total billed charges,,
ALL POLY PAT VE 32MM DIAMATER,,C1776,HCPCS,Facility,Outpatient,,,,1995,1695.75,571.767,1995,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),977.55,49,,percent of total billed charges,,
ALL POLY PAT VE 32MM DIAMATER,,C1776,HCPCS,Facility,Inpatient,,,,1995,1695.75,571.767,1995,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
ALL POLY PAT VE 32MM DIAMATER,,C1776,HCPCS,Facility,Both,,,,1995,1695.75,571.767,1995,CorVel,Worker's Compensation,1995,100,,percent of total billed charges,,
ALL POLY PAT VE 32MM DIAMATER,,C1776,HCPCS,Facility,Both,,,,1995,1695.75,571.767,1995,First Health Group Corporation,First Health Network,1935.15,97,,percent of total billed charges,,
ALL POLY PAT VE 32MM DIAMATER,,C1776,HCPCS,Facility,Both,,,,1995,1695.75,571.767,1995,"Health Partners, Inc.",Commercial,1887.27,94.6,,percent of total billed charges,,
ALL POLY PAT VE 32MM DIAMATER,,C1776,HCPCS,Facility,Outpatient,,,,1995,1695.75,571.767,1995,"Health Partners, Inc.",Medicare Advantage,977.55,49,,percent of total billed charges,,
ALL POLY PAT VE 32MM DIAMATER,,C1776,HCPCS,Facility,Inpatient,,,,1995,1695.75,571.767,1995,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ALL POLY PAT VE 32MM DIAMATER,,C1776,HCPCS,Facility,Both,,,,1995,1695.75,571.767,1995,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1197,60,,percent of total billed charges,,
ALL POLY PAT VE 32MM DIAMATER,,C1776,HCPCS,Facility,Both,,,,1995,1695.75,571.767,1995,"Health Partners, Inc.",State of Minnesota Advantage Program,1625.925,81.5,,percent of total billed charges,,
ALL POLY PAT VE 32MM DIAMATER,,C1776,HCPCS,Facility,Both,,,,1995,1695.75,571.767,1995,"Health Partners, Inc.",State Public Programs,997.5,50,,percent of total billed charges,,
ALL POLY PAT VE 32MM DIAMATER,,C1776,HCPCS,Facility,Both,,,,1995,1695.75,571.767,1995,Humana Insurance Company,Commercial PPO,1895.25,95,,percent of total billed charges,,
ALL POLY PAT VE 32MM DIAMATER,,C1776,HCPCS,Facility,Outpatient,,,,1995,1695.75,571.767,1995,Humana Insurance Company,Medicare PPO,977.55,49,,percent of total billed charges,,
ALL POLY PAT VE 32MM DIAMATER,,C1776,HCPCS,Facility,Inpatient,,,,1995,1695.75,571.767,1995,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
ALL POLY PAT VE 32MM DIAMATER,,C1776,HCPCS,Facility,Both,,,,1995,1695.75,571.767,1995,Medica,Individual & Family,1977.045,99.1,,percent of total billed charges,,
ALL POLY PAT VE 32MM DIAMATER,,C1776,HCPCS,Facility,Outpatient,,,,1995,1695.75,571.767,1995,Medica,Medica Advantage Solution,993.51,49.8,,percent of total billed charges,,
ALL POLY PAT VE 32MM DIAMATER,,C1776,HCPCS,Facility,Inpatient,,,,1995,1695.75,571.767,1995,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
ALL POLY PAT VE 32MM DIAMATER,,C1776,HCPCS,Facility,Outpatient,,,,1995,1695.75,571.767,1995,Medica,Medical Assistance,889.77,44.6,,percent of total billed charges,,
ALL POLY PAT VE 32MM DIAMATER,,C1776,HCPCS,Facility,Inpatient,,,,1995,1695.75,571.767,1995,Medica,Medical Assistance,,,,,Included in per diem rate,
ALL POLY PAT VE 32MM DIAMATER,,C1776,HCPCS,Facility,Outpatient,,,,1995,1695.75,571.767,1995,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,993.51,49.8,,percent of total billed charges,,
ALL POLY PAT VE 32MM DIAMATER,,C1776,HCPCS,Facility,Inpatient,,,,1995,1695.75,571.767,1995,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
ALL POLY PAT VE 32MM DIAMATER,,C1776,HCPCS,Facility,Both,,,,1995,1695.75,571.767,1995,"Multiplan, Inc.","Multiplan, Inc.",1875.3,94,,percent of total billed charges,,
ALL POLY PAT VE 32MM DIAMATER,,C1776,HCPCS,Facility,Outpatient,,,,1995,1695.75,571.767,1995,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1797.495,90.1,,percent of total billed charges,,
ALL POLY PAT VE 32MM DIAMATER,,C1776,HCPCS,Facility,Inpatient,,,,1995,1695.75,571.767,1995,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
ALL POLY PAT VE 32MM DIAMATER,,C1776,HCPCS,Facility,Both,,,,1995,1695.75,571.767,1995,"Preferred One Administrative Services, INC.",PPO,1967.07,98.6,,percent of total billed charges,,
ALL POLY PAT VE 32MM DIAMATER,,C1776,HCPCS,Facility,Outpatient,,,,1995,1695.75,571.767,1995,PrimeWest Health,Minnesota Senior Health Options (MSHO),1026.4275,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
ALL POLY PAT VE 32MM DIAMATER,,C1776,HCPCS,Facility,Inpatient,,,,1995,1695.75,571.767,1995,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ALL POLY PAT VE 32MM DIAMATER,,C1776,HCPCS,Facility,Outpatient,,,,1995,1695.75,571.767,1995,PrimeWest Health,MinnesotaCare,1024.632,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
ALL POLY PAT VE 32MM DIAMATER,,C1776,HCPCS,Facility,Inpatient,,,,1995,1695.75,571.767,1995,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
ALL POLY PAT VE 32MM DIAMATER,,C1776,HCPCS,Facility,Both,,,,1995,1695.75,571.767,1995,Sanford Health Plan,Sanford Health Plan,1835.4,92,,percent of total billed charges,,
ALL POLY PAT VE 32MM DIAMATER,,C1776,HCPCS,Facility,Outpatient,,,,1995,1695.75,571.767,1995,"UCare Health, Inc.",Individual & Family Plan,1124.1825,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
ALL POLY PAT VE 32MM DIAMATER,,C1776,HCPCS,Facility,Inpatient,,,,1995,1695.75,571.767,1995,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
ALL POLY PAT VE 32MM DIAMATER,,C1776,HCPCS,Facility,Outpatient,,,,1995,1695.75,571.767,1995,"UCare Health, Inc.",Medical Assistance,1006.8765,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ALL POLY PAT VE 32MM DIAMATER,,C1776,HCPCS,Facility,Inpatient,,,,1995,1695.75,571.767,1995,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
ALL POLY PAT VE 32MM DIAMATER,,C1776,HCPCS,Facility,Outpatient,,,,1995,1695.75,571.767,1995,"UCare Health, Inc.",Medicare Advantage,1006.8765,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ALL POLY PAT VE 32MM DIAMATER,,C1776,HCPCS,Facility,Inpatient,,,,1995,1695.75,571.767,1995,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ALL POLY PAT VE 32MM DIAMATER,,C1776,HCPCS,Facility,Outpatient,,,,1995,1695.75,571.767,1995,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1006.8765,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ALL POLY PAT VE 32MM DIAMATER,,C1776,HCPCS,Facility,Inpatient,,,,1995,1695.75,571.767,1995,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ALL POLY PAT VE 32MM DIAMATER,,C1776,HCPCS,Facility,Both,,,,1995,1695.75,571.767,1995,UnitedHealthcare,Individual & Family,1875.3,94,,percent of total billed charges,,
ALL POLY PAT VE 32MM DIAMATER,,C1776,HCPCS,Facility,Outpatient,,,,1995,1695.75,571.767,1995,UnitedHealthcare,Medicare Advantage,977.55,49,,percent of total billed charges,,
ALL POLY PAT VE 32MM DIAMATER,,C1776,HCPCS,Facility,Inpatient,,,,1995,1695.75,571.767,1995,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
ALL POLY PAT VE 32MM DIAMATER,,C1776,HCPCS,Facility,Outpatient,,,,1995,1695.75,571.767,1995,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,957.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
ALL POLY PAT VE 32MM DIAMATER,,C1776,HCPCS,Facility,Inpatient,,,,1995,1695.75,571.767,1995,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
ALL POLY PAT VE 41 MM DIA,,C1776,HCPCS,Facility,Both,,,,1995,1695.75,571.767,1995,Aetna,Commercial,1835.4,92,,percent of total billed charges,,
ALL POLY PAT VE 41 MM DIA,,C1776,HCPCS,Facility,Outpatient,,,,1995,1695.75,571.767,1995,Aetna,Medicare Advantage,977.55,49,,percent of total billed charges,,
ALL POLY PAT VE 41 MM DIA,,C1776,HCPCS,Facility,Inpatient,,,,1995,1695.75,571.767,1995,Aetna,Medicare Advantage,,,,,Included in per diem rate,
ALL POLY PAT VE 41 MM DIA,,C1776,HCPCS,Facility,Both,,,,1995,1695.75,571.767,1995,Aetna,PPO,1855.35,93,,percent of total billed charges,,
ALL POLY PAT VE 41 MM DIA,,C1776,HCPCS,Facility,Both,,,,1995,1695.75,571.767,1995,America's PPO,America's PPO,1915.7985,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
ALL POLY PAT VE 41 MM DIA,,C1776,HCPCS,Facility,Both,,,,1995,1695.75,571.767,1995,BlueCross BlueShield Minnesota, Federal Employee Program,1963.08,98.4,,percent of total billed charges,,
ALL POLY PAT VE 41 MM DIA,,C1776,HCPCS,Facility,Both,,,,1995,1695.75,571.767,1995,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1995,100,,percent of total billed charges,,
ALL POLY PAT VE 41 MM DIA,,C1776,HCPCS,Facility,Both,,,,1995,1695.75,571.767,1995,BlueCross BlueShield Minnesota,High Value Network Plan,1795.5,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
ALL POLY PAT VE 41 MM DIA,,C1776,HCPCS,Facility,Outpatient,,,,1995,1695.75,571.767,1995,BlueCross BlueShield Minnesota,Medicare Advantage,977.55,49,,percent of total billed charges,,
ALL POLY PAT VE 41 MM DIA,,C1776,HCPCS,Facility,Inpatient,,,,1995,1695.75,571.767,1995,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
ALL POLY PAT VE 41 MM DIA,,C1776,HCPCS,Facility,Both,,,,1995,1695.75,571.767,1995,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1766.9715,88.57,,percent of total billed charges,,
ALL POLY PAT VE 41 MM DIA,,C1776,HCPCS,Facility,Both,,,,1995,1695.75,571.767,1995,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,571.767,28.66,,percent of total billed charges,,
ALL POLY PAT VE 41 MM DIA,,C1776,HCPCS,Facility,Outpatient,,,,1995,1695.75,571.767,1995,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),977.55,49,,percent of total billed charges,,
ALL POLY PAT VE 41 MM DIA,,C1776,HCPCS,Facility,Inpatient,,,,1995,1695.75,571.767,1995,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
ALL POLY PAT VE 41 MM DIA,,C1776,HCPCS,Facility,Both,,,,1995,1695.75,571.767,1995,CorVel,Worker's Compensation,1995,100,,percent of total billed charges,,
ALL POLY PAT VE 41 MM DIA,,C1776,HCPCS,Facility,Both,,,,1995,1695.75,571.767,1995,First Health Group Corporation,First Health Network,1935.15,97,,percent of total billed charges,,
ALL POLY PAT VE 41 MM DIA,,C1776,HCPCS,Facility,Both,,,,1995,1695.75,571.767,1995,"Health Partners, Inc.",Commercial,1887.27,94.6,,percent of total billed charges,,
ALL POLY PAT VE 41 MM DIA,,C1776,HCPCS,Facility,Outpatient,,,,1995,1695.75,571.767,1995,"Health Partners, Inc.",Medicare Advantage,977.55,49,,percent of total billed charges,,
ALL POLY PAT VE 41 MM DIA,,C1776,HCPCS,Facility,Inpatient,,,,1995,1695.75,571.767,1995,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ALL POLY PAT VE 41 MM DIA,,C1776,HCPCS,Facility,Both,,,,1995,1695.75,571.767,1995,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1197,60,,percent of total billed charges,,
ALL POLY PAT VE 41 MM DIA,,C1776,HCPCS,Facility,Both,,,,1995,1695.75,571.767,1995,"Health Partners, Inc.",State of Minnesota Advantage Program,1625.925,81.5,,percent of total billed charges,,
ALL POLY PAT VE 41 MM DIA,,C1776,HCPCS,Facility,Both,,,,1995,1695.75,571.767,1995,"Health Partners, Inc.",State Public Programs,997.5,50,,percent of total billed charges,,
ALL POLY PAT VE 41 MM DIA,,C1776,HCPCS,Facility,Both,,,,1995,1695.75,571.767,1995,Humana Insurance Company,Commercial PPO,1895.25,95,,percent of total billed charges,,
ALL POLY PAT VE 41 MM DIA,,C1776,HCPCS,Facility,Outpatient,,,,1995,1695.75,571.767,1995,Humana Insurance Company,Medicare PPO,977.55,49,,percent of total billed charges,,
ALL POLY PAT VE 41 MM DIA,,C1776,HCPCS,Facility,Inpatient,,,,1995,1695.75,571.767,1995,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
ALL POLY PAT VE 41 MM DIA,,C1776,HCPCS,Facility,Both,,,,1995,1695.75,571.767,1995,Medica,Individual & Family,1977.045,99.1,,percent of total billed charges,,
ALL POLY PAT VE 41 MM DIA,,C1776,HCPCS,Facility,Outpatient,,,,1995,1695.75,571.767,1995,Medica,Medica Advantage Solution,993.51,49.8,,percent of total billed charges,,
ALL POLY PAT VE 41 MM DIA,,C1776,HCPCS,Facility,Inpatient,,,,1995,1695.75,571.767,1995,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
ALL POLY PAT VE 41 MM DIA,,C1776,HCPCS,Facility,Outpatient,,,,1995,1695.75,571.767,1995,Medica,Medical Assistance,889.77,44.6,,percent of total billed charges,,
ALL POLY PAT VE 41 MM DIA,,C1776,HCPCS,Facility,Inpatient,,,,1995,1695.75,571.767,1995,Medica,Medical Assistance,,,,,Included in per diem rate,
ALL POLY PAT VE 41 MM DIA,,C1776,HCPCS,Facility,Outpatient,,,,1995,1695.75,571.767,1995,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,993.51,49.8,,percent of total billed charges,,
ALL POLY PAT VE 41 MM DIA,,C1776,HCPCS,Facility,Inpatient,,,,1995,1695.75,571.767,1995,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
ALL POLY PAT VE 41 MM DIA,,C1776,HCPCS,Facility,Both,,,,1995,1695.75,571.767,1995,"Multiplan, Inc.","Multiplan, Inc.",1875.3,94,,percent of total billed charges,,
ALL POLY PAT VE 41 MM DIA,,C1776,HCPCS,Facility,Outpatient,,,,1995,1695.75,571.767,1995,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1797.495,90.1,,percent of total billed charges,,
ALL POLY PAT VE 41 MM DIA,,C1776,HCPCS,Facility,Inpatient,,,,1995,1695.75,571.767,1995,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
ALL POLY PAT VE 41 MM DIA,,C1776,HCPCS,Facility,Both,,,,1995,1695.75,571.767,1995,"Preferred One Administrative Services, INC.",PPO,1967.07,98.6,,percent of total billed charges,,
ALL POLY PAT VE 41 MM DIA,,C1776,HCPCS,Facility,Outpatient,,,,1995,1695.75,571.767,1995,PrimeWest Health,Minnesota Senior Health Options (MSHO),1026.4275,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
ALL POLY PAT VE 41 MM DIA,,C1776,HCPCS,Facility,Inpatient,,,,1995,1695.75,571.767,1995,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ALL POLY PAT VE 41 MM DIA,,C1776,HCPCS,Facility,Outpatient,,,,1995,1695.75,571.767,1995,PrimeWest Health,MinnesotaCare,1024.632,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
ALL POLY PAT VE 41 MM DIA,,C1776,HCPCS,Facility,Inpatient,,,,1995,1695.75,571.767,1995,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
ALL POLY PAT VE 41 MM DIA,,C1776,HCPCS,Facility,Both,,,,1995,1695.75,571.767,1995,Sanford Health Plan,Sanford Health Plan,1835.4,92,,percent of total billed charges,,
ALL POLY PAT VE 41 MM DIA,,C1776,HCPCS,Facility,Outpatient,,,,1995,1695.75,571.767,1995,"UCare Health, Inc.",Individual & Family Plan,1124.1825,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
ALL POLY PAT VE 41 MM DIA,,C1776,HCPCS,Facility,Inpatient,,,,1995,1695.75,571.767,1995,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
ALL POLY PAT VE 41 MM DIA,,C1776,HCPCS,Facility,Outpatient,,,,1995,1695.75,571.767,1995,"UCare Health, Inc.",Medical Assistance,1006.8765,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ALL POLY PAT VE 41 MM DIA,,C1776,HCPCS,Facility,Inpatient,,,,1995,1695.75,571.767,1995,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
ALL POLY PAT VE 41 MM DIA,,C1776,HCPCS,Facility,Outpatient,,,,1995,1695.75,571.767,1995,"UCare Health, Inc.",Medicare Advantage,1006.8765,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ALL POLY PAT VE 41 MM DIA,,C1776,HCPCS,Facility,Inpatient,,,,1995,1695.75,571.767,1995,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ALL POLY PAT VE 41 MM DIA,,C1776,HCPCS,Facility,Outpatient,,,,1995,1695.75,571.767,1995,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1006.8765,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ALL POLY PAT VE 41 MM DIA,,C1776,HCPCS,Facility,Inpatient,,,,1995,1695.75,571.767,1995,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ALL POLY PAT VE 41 MM DIA,,C1776,HCPCS,Facility,Both,,,,1995,1695.75,571.767,1995,UnitedHealthcare,Individual & Family,1875.3,94,,percent of total billed charges,,
ALL POLY PAT VE 41 MM DIA,,C1776,HCPCS,Facility,Outpatient,,,,1995,1695.75,571.767,1995,UnitedHealthcare,Medicare Advantage,977.55,49,,percent of total billed charges,,
ALL POLY PAT VE 41 MM DIA,,C1776,HCPCS,Facility,Inpatient,,,,1995,1695.75,571.767,1995,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
ALL POLY PAT VE 41 MM DIA,,C1776,HCPCS,Facility,Outpatient,,,,1995,1695.75,571.767,1995,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,957.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
ALL POLY PAT VE 41 MM DIA,,C1776,HCPCS,Facility,Inpatient,,,,1995,1695.75,571.767,1995,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
MINIRAIL TEMP KIT,,C1776,HCPCS,Facility,Both,,,,818.85,696.0225,234.68241,818.85,Aetna,Commercial,753.342,92,,percent of total billed charges,,
MINIRAIL TEMP KIT,,C1776,HCPCS,Facility,Outpatient,,,,818.85,696.0225,234.68241,818.85,Aetna,Medicare Advantage,401.2365,49,,percent of total billed charges,,
MINIRAIL TEMP KIT,,C1776,HCPCS,Facility,Inpatient,,,,818.85,696.0225,234.68241,818.85,Aetna,Medicare Advantage,,,,,Included in per diem rate,
MINIRAIL TEMP KIT,,C1776,HCPCS,Facility,Both,,,,818.85,696.0225,234.68241,818.85,Aetna,PPO,761.5305,93,,percent of total billed charges,,
MINIRAIL TEMP KIT,,C1776,HCPCS,Facility,Both,,,,818.85,696.0225,234.68241,818.85,America's PPO,America's PPO,786.341655,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
MINIRAIL TEMP KIT,,C1776,HCPCS,Facility,Both,,,,818.85,696.0225,234.68241,818.85,BlueCross BlueShield Minnesota, Federal Employee Program,805.7484,98.4,,percent of total billed charges,,
MINIRAIL TEMP KIT,,C1776,HCPCS,Facility,Both,,,,818.85,696.0225,234.68241,818.85,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,818.85,100,,percent of total billed charges,,
MINIRAIL TEMP KIT,,C1776,HCPCS,Facility,Both,,,,818.85,696.0225,234.68241,818.85,BlueCross BlueShield Minnesota,High Value Network Plan,736.965,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
MINIRAIL TEMP KIT,,C1776,HCPCS,Facility,Outpatient,,,,818.85,696.0225,234.68241,818.85,BlueCross BlueShield Minnesota,Medicare Advantage,401.2365,49,,percent of total billed charges,,
MINIRAIL TEMP KIT,,C1776,HCPCS,Facility,Inpatient,,,,818.85,696.0225,234.68241,818.85,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
MINIRAIL TEMP KIT,,C1776,HCPCS,Facility,Both,,,,818.85,696.0225,234.68241,818.85,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,725.255445,88.57,,percent of total billed charges,,
MINIRAIL TEMP KIT,,C1776,HCPCS,Facility,Both,,,,818.85,696.0225,234.68241,818.85,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,234.68241,28.66,,percent of total billed charges,,
MINIRAIL TEMP KIT,,C1776,HCPCS,Facility,Outpatient,,,,818.85,696.0225,234.68241,818.85,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),401.2365,49,,percent of total billed charges,,
MINIRAIL TEMP KIT,,C1776,HCPCS,Facility,Inpatient,,,,818.85,696.0225,234.68241,818.85,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
MINIRAIL TEMP KIT,,C1776,HCPCS,Facility,Both,,,,818.85,696.0225,234.68241,818.85,CorVel,Worker's Compensation,818.85,100,,percent of total billed charges,,
MINIRAIL TEMP KIT,,C1776,HCPCS,Facility,Both,,,,818.85,696.0225,234.68241,818.85,First Health Group Corporation,First Health Network,794.2845,97,,percent of total billed charges,,
MINIRAIL TEMP KIT,,C1776,HCPCS,Facility,Both,,,,818.85,696.0225,234.68241,818.85,"Health Partners, Inc.",Commercial,774.6321,94.6,,percent of total billed charges,,
MINIRAIL TEMP KIT,,C1776,HCPCS,Facility,Outpatient,,,,818.85,696.0225,234.68241,818.85,"Health Partners, Inc.",Medicare Advantage,401.2365,49,,percent of total billed charges,,
MINIRAIL TEMP KIT,,C1776,HCPCS,Facility,Inpatient,,,,818.85,696.0225,234.68241,818.85,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
MINIRAIL TEMP KIT,,C1776,HCPCS,Facility,Both,,,,818.85,696.0225,234.68241,818.85,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),491.31,60,,percent of total billed charges,,
MINIRAIL TEMP KIT,,C1776,HCPCS,Facility,Both,,,,818.85,696.0225,234.68241,818.85,"Health Partners, Inc.",State of Minnesota Advantage Program,667.36275,81.5,,percent of total billed charges,,
MINIRAIL TEMP KIT,,C1776,HCPCS,Facility,Both,,,,818.85,696.0225,234.68241,818.85,"Health Partners, Inc.",State Public Programs,409.425,50,,percent of total billed charges,,
MINIRAIL TEMP KIT,,C1776,HCPCS,Facility,Both,,,,818.85,696.0225,234.68241,818.85,Humana Insurance Company,Commercial PPO,777.9075,95,,percent of total billed charges,,
MINIRAIL TEMP KIT,,C1776,HCPCS,Facility,Outpatient,,,,818.85,696.0225,234.68241,818.85,Humana Insurance Company,Medicare PPO,401.2365,49,,percent of total billed charges,,
MINIRAIL TEMP KIT,,C1776,HCPCS,Facility,Inpatient,,,,818.85,696.0225,234.68241,818.85,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
MINIRAIL TEMP KIT,,C1776,HCPCS,Facility,Both,,,,818.85,696.0225,234.68241,818.85,Medica,Individual & Family,811.48035,99.1,,percent of total billed charges,,
MINIRAIL TEMP KIT,,C1776,HCPCS,Facility,Outpatient,,,,818.85,696.0225,234.68241,818.85,Medica,Medica Advantage Solution,407.7873,49.8,,percent of total billed charges,,
MINIRAIL TEMP KIT,,C1776,HCPCS,Facility,Inpatient,,,,818.85,696.0225,234.68241,818.85,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
MINIRAIL TEMP KIT,,C1776,HCPCS,Facility,Outpatient,,,,818.85,696.0225,234.68241,818.85,Medica,Medical Assistance,365.2071,44.6,,percent of total billed charges,,
MINIRAIL TEMP KIT,,C1776,HCPCS,Facility,Inpatient,,,,818.85,696.0225,234.68241,818.85,Medica,Medical Assistance,,,,,Included in per diem rate,
MINIRAIL TEMP KIT,,C1776,HCPCS,Facility,Outpatient,,,,818.85,696.0225,234.68241,818.85,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,407.7873,49.8,,percent of total billed charges,,
MINIRAIL TEMP KIT,,C1776,HCPCS,Facility,Inpatient,,,,818.85,696.0225,234.68241,818.85,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
MINIRAIL TEMP KIT,,C1776,HCPCS,Facility,Both,,,,818.85,696.0225,234.68241,818.85,"Multiplan, Inc.","Multiplan, Inc.",769.719,94,,percent of total billed charges,,
MINIRAIL TEMP KIT,,C1776,HCPCS,Facility,Outpatient,,,,818.85,696.0225,234.68241,818.85,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,737.78385,90.1,,percent of total billed charges,,
MINIRAIL TEMP KIT,,C1776,HCPCS,Facility,Inpatient,,,,818.85,696.0225,234.68241,818.85,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
MINIRAIL TEMP KIT,,C1776,HCPCS,Facility,Both,,,,818.85,696.0225,234.68241,818.85,"Preferred One Administrative Services, INC.",PPO,807.3861,98.6,,percent of total billed charges,,
MINIRAIL TEMP KIT,,C1776,HCPCS,Facility,Outpatient,,,,818.85,696.0225,234.68241,818.85,PrimeWest Health,Minnesota Senior Health Options (MSHO),421.298325,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
MINIRAIL TEMP KIT,,C1776,HCPCS,Facility,Inpatient,,,,818.85,696.0225,234.68241,818.85,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
MINIRAIL TEMP KIT,,C1776,HCPCS,Facility,Outpatient,,,,818.85,696.0225,234.68241,818.85,PrimeWest Health,MinnesotaCare,420.56136,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
MINIRAIL TEMP KIT,,C1776,HCPCS,Facility,Inpatient,,,,818.85,696.0225,234.68241,818.85,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
MINIRAIL TEMP KIT,,C1776,HCPCS,Facility,Both,,,,818.85,696.0225,234.68241,818.85,Sanford Health Plan,Sanford Health Plan,753.342,92,,percent of total billed charges,,
MINIRAIL TEMP KIT,,C1776,HCPCS,Facility,Outpatient,,,,818.85,696.0225,234.68241,818.85,"UCare Health, Inc.",Individual & Family Plan,461.421975,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
MINIRAIL TEMP KIT,,C1776,HCPCS,Facility,Inpatient,,,,818.85,696.0225,234.68241,818.85,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
MINIRAIL TEMP KIT,,C1776,HCPCS,Facility,Outpatient,,,,818.85,696.0225,234.68241,818.85,"UCare Health, Inc.",Medical Assistance,413.273595,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MINIRAIL TEMP KIT,,C1776,HCPCS,Facility,Inpatient,,,,818.85,696.0225,234.68241,818.85,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
MINIRAIL TEMP KIT,,C1776,HCPCS,Facility,Outpatient,,,,818.85,696.0225,234.68241,818.85,"UCare Health, Inc.",Medicare Advantage,413.273595,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MINIRAIL TEMP KIT,,C1776,HCPCS,Facility,Inpatient,,,,818.85,696.0225,234.68241,818.85,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
MINIRAIL TEMP KIT,,C1776,HCPCS,Facility,Outpatient,,,,818.85,696.0225,234.68241,818.85,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),413.273595,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MINIRAIL TEMP KIT,,C1776,HCPCS,Facility,Inpatient,,,,818.85,696.0225,234.68241,818.85,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
MINIRAIL TEMP KIT,,C1776,HCPCS,Facility,Both,,,,818.85,696.0225,234.68241,818.85,UnitedHealthcare,Individual & Family,769.719,94,,percent of total billed charges,,
MINIRAIL TEMP KIT,,C1776,HCPCS,Facility,Outpatient,,,,818.85,696.0225,234.68241,818.85,UnitedHealthcare,Medicare Advantage,401.2365,49,,percent of total billed charges,,
MINIRAIL TEMP KIT,,C1776,HCPCS,Facility,Inpatient,,,,818.85,696.0225,234.68241,818.85,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
MINIRAIL TEMP KIT,,C1776,HCPCS,Facility,Outpatient,,,,818.85,696.0225,234.68241,818.85,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,393.048,48,,percent of total billed charges,,100% of DHS outpatient percentage
MINIRAIL TEMP KIT,,C1776,HCPCS,Facility,Inpatient,,,,818.85,696.0225,234.68241,818.85,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
PSN ASF CPS 12mm VE R 10-11 EF,,C1776,HCPCS,Facility,Both,,,,4481.625,3809.38125,1284.433725,4481.625,Aetna,Commercial,4123.095,92,,percent of total billed charges,,
PSN ASF CPS 12mm VE R 10-11 EF,,C1776,HCPCS,Facility,Outpatient,,,,4481.625,3809.38125,1284.433725,4481.625,Aetna,Medicare Advantage,2195.99625,49,,percent of total billed charges,,
PSN ASF CPS 12mm VE R 10-11 EF,,C1776,HCPCS,Facility,Inpatient,,,,4481.625,3809.38125,1284.433725,4481.625,Aetna,Medicare Advantage,,,,,Included in per diem rate,
PSN ASF CPS 12mm VE R 10-11 EF,,C1776,HCPCS,Facility,Both,,,,4481.625,3809.38125,1284.433725,4481.625,Aetna,PPO,4167.91125,93,,percent of total billed charges,,
PSN ASF CPS 12mm VE R 10-11 EF,,C1776,HCPCS,Facility,Both,,,,4481.625,3809.38125,1284.433725,4481.625,America's PPO,America's PPO,4303.704488,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
PSN ASF CPS 12mm VE R 10-11 EF,,C1776,HCPCS,Facility,Both,,,,4481.625,3809.38125,1284.433725,4481.625,BlueCross BlueShield Minnesota, Federal Employee Program,4409.919,98.4,,percent of total billed charges,,
PSN ASF CPS 12mm VE R 10-11 EF,,C1776,HCPCS,Facility,Both,,,,4481.625,3809.38125,1284.433725,4481.625,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,4481.625,100,,percent of total billed charges,,
PSN ASF CPS 12mm VE R 10-11 EF,,C1776,HCPCS,Facility,Both,,,,4481.625,3809.38125,1284.433725,4481.625,BlueCross BlueShield Minnesota,High Value Network Plan,4033.4625,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
PSN ASF CPS 12mm VE R 10-11 EF,,C1776,HCPCS,Facility,Outpatient,,,,4481.625,3809.38125,1284.433725,4481.625,BlueCross BlueShield Minnesota,Medicare Advantage,2195.99625,49,,percent of total billed charges,,
PSN ASF CPS 12mm VE R 10-11 EF,,C1776,HCPCS,Facility,Inpatient,,,,4481.625,3809.38125,1284.433725,4481.625,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
PSN ASF CPS 12mm VE R 10-11 EF,,C1776,HCPCS,Facility,Both,,,,4481.625,3809.38125,1284.433725,4481.625,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,3969.375263,88.57,,percent of total billed charges,,
PSN ASF CPS 12mm VE R 10-11 EF,,C1776,HCPCS,Facility,Both,,,,4481.625,3809.38125,1284.433725,4481.625,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1284.433725,28.66,,percent of total billed charges,,
PSN ASF CPS 12mm VE R 10-11 EF,,C1776,HCPCS,Facility,Outpatient,,,,4481.625,3809.38125,1284.433725,4481.625,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2195.99625,49,,percent of total billed charges,,
PSN ASF CPS 12mm VE R 10-11 EF,,C1776,HCPCS,Facility,Inpatient,,,,4481.625,3809.38125,1284.433725,4481.625,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
PSN ASF CPS 12mm VE R 10-11 EF,,C1776,HCPCS,Facility,Both,,,,4481.625,3809.38125,1284.433725,4481.625,CorVel,Worker's Compensation,4481.625,100,,percent of total billed charges,,
PSN ASF CPS 12mm VE R 10-11 EF,,C1776,HCPCS,Facility,Both,,,,4481.625,3809.38125,1284.433725,4481.625,First Health Group Corporation,First Health Network,4347.17625,97,,percent of total billed charges,,
PSN ASF CPS 12mm VE R 10-11 EF,,C1776,HCPCS,Facility,Both,,,,4481.625,3809.38125,1284.433725,4481.625,"Health Partners, Inc.",Commercial,4239.61725,94.6,,percent of total billed charges,,
PSN ASF CPS 12mm VE R 10-11 EF,,C1776,HCPCS,Facility,Outpatient,,,,4481.625,3809.38125,1284.433725,4481.625,"Health Partners, Inc.",Medicare Advantage,2195.99625,49,,percent of total billed charges,,
PSN ASF CPS 12mm VE R 10-11 EF,,C1776,HCPCS,Facility,Inpatient,,,,4481.625,3809.38125,1284.433725,4481.625,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PSN ASF CPS 12mm VE R 10-11 EF,,C1776,HCPCS,Facility,Both,,,,4481.625,3809.38125,1284.433725,4481.625,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),2688.975,60,,percent of total billed charges,,
PSN ASF CPS 12mm VE R 10-11 EF,,C1776,HCPCS,Facility,Both,,,,4481.625,3809.38125,1284.433725,4481.625,"Health Partners, Inc.",State of Minnesota Advantage Program,3652.524375,81.5,,percent of total billed charges,,
PSN ASF CPS 12mm VE R 10-11 EF,,C1776,HCPCS,Facility,Both,,,,4481.625,3809.38125,1284.433725,4481.625,"Health Partners, Inc.",State Public Programs,2240.8125,50,,percent of total billed charges,,
PSN ASF CPS 12mm VE R 10-11 EF,,C1776,HCPCS,Facility,Both,,,,4481.625,3809.38125,1284.433725,4481.625,Humana Insurance Company,Commercial PPO,4257.54375,95,,percent of total billed charges,,
PSN ASF CPS 12mm VE R 10-11 EF,,C1776,HCPCS,Facility,Outpatient,,,,4481.625,3809.38125,1284.433725,4481.625,Humana Insurance Company,Medicare PPO,2195.99625,49,,percent of total billed charges,,
PSN ASF CPS 12mm VE R 10-11 EF,,C1776,HCPCS,Facility,Inpatient,,,,4481.625,3809.38125,1284.433725,4481.625,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
PSN ASF CPS 12mm VE R 10-11 EF,,C1776,HCPCS,Facility,Both,,,,4481.625,3809.38125,1284.433725,4481.625,Medica,Individual & Family,4441.290375,99.1,,percent of total billed charges,,
PSN ASF CPS 12mm VE R 10-11 EF,,C1776,HCPCS,Facility,Outpatient,,,,4481.625,3809.38125,1284.433725,4481.625,Medica,Medica Advantage Solution,2231.84925,49.8,,percent of total billed charges,,
PSN ASF CPS 12mm VE R 10-11 EF,,C1776,HCPCS,Facility,Inpatient,,,,4481.625,3809.38125,1284.433725,4481.625,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
PSN ASF CPS 12mm VE R 10-11 EF,,C1776,HCPCS,Facility,Outpatient,,,,4481.625,3809.38125,1284.433725,4481.625,Medica,Medical Assistance,1998.80475,44.6,,percent of total billed charges,,
PSN ASF CPS 12mm VE R 10-11 EF,,C1776,HCPCS,Facility,Inpatient,,,,4481.625,3809.38125,1284.433725,4481.625,Medica,Medical Assistance,,,,,Included in per diem rate,
PSN ASF CPS 12mm VE R 10-11 EF,,C1776,HCPCS,Facility,Outpatient,,,,4481.625,3809.38125,1284.433725,4481.625,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2231.84925,49.8,,percent of total billed charges,,
PSN ASF CPS 12mm VE R 10-11 EF,,C1776,HCPCS,Facility,Inpatient,,,,4481.625,3809.38125,1284.433725,4481.625,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
PSN ASF CPS 12mm VE R 10-11 EF,,C1776,HCPCS,Facility,Both,,,,4481.625,3809.38125,1284.433725,4481.625,"Multiplan, Inc.","Multiplan, Inc.",4212.7275,94,,percent of total billed charges,,
PSN ASF CPS 12mm VE R 10-11 EF,,C1776,HCPCS,Facility,Outpatient,,,,4481.625,3809.38125,1284.433725,4481.625,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4037.944125,90.1,,percent of total billed charges,,
PSN ASF CPS 12mm VE R 10-11 EF,,C1776,HCPCS,Facility,Inpatient,,,,4481.625,3809.38125,1284.433725,4481.625,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
PSN ASF CPS 12mm VE R 10-11 EF,,C1776,HCPCS,Facility,Both,,,,4481.625,3809.38125,1284.433725,4481.625,"Preferred One Administrative Services, INC.",PPO,4418.88225,98.6,,percent of total billed charges,,
PSN ASF CPS 12mm VE R 10-11 EF,,C1776,HCPCS,Facility,Outpatient,,,,4481.625,3809.38125,1284.433725,4481.625,PrimeWest Health,Minnesota Senior Health Options (MSHO),2305.796063,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
PSN ASF CPS 12mm VE R 10-11 EF,,C1776,HCPCS,Facility,Inpatient,,,,4481.625,3809.38125,1284.433725,4481.625,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PSN ASF CPS 12mm VE R 10-11 EF,,C1776,HCPCS,Facility,Outpatient,,,,4481.625,3809.38125,1284.433725,4481.625,PrimeWest Health,MinnesotaCare,2301.7626,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
PSN ASF CPS 12mm VE R 10-11 EF,,C1776,HCPCS,Facility,Inpatient,,,,4481.625,3809.38125,1284.433725,4481.625,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
PSN ASF CPS 12mm VE R 10-11 EF,,C1776,HCPCS,Facility,Both,,,,4481.625,3809.38125,1284.433725,4481.625,Sanford Health Plan,Sanford Health Plan,4123.095,92,,percent of total billed charges,,
PSN ASF CPS 12mm VE R 10-11 EF,,C1776,HCPCS,Facility,Outpatient,,,,4481.625,3809.38125,1284.433725,4481.625,"UCare Health, Inc.",Individual & Family Plan,2525.395688,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
PSN ASF CPS 12mm VE R 10-11 EF,,C1776,HCPCS,Facility,Inpatient,,,,4481.625,3809.38125,1284.433725,4481.625,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
PSN ASF CPS 12mm VE R 10-11 EF,,C1776,HCPCS,Facility,Outpatient,,,,4481.625,3809.38125,1284.433725,4481.625,"UCare Health, Inc.",Medical Assistance,2261.876138,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PSN ASF CPS 12mm VE R 10-11 EF,,C1776,HCPCS,Facility,Inpatient,,,,4481.625,3809.38125,1284.433725,4481.625,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
PSN ASF CPS 12mm VE R 10-11 EF,,C1776,HCPCS,Facility,Outpatient,,,,4481.625,3809.38125,1284.433725,4481.625,"UCare Health, Inc.",Medicare Advantage,2261.876138,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PSN ASF CPS 12mm VE R 10-11 EF,,C1776,HCPCS,Facility,Inpatient,,,,4481.625,3809.38125,1284.433725,4481.625,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PSN ASF CPS 12mm VE R 10-11 EF,,C1776,HCPCS,Facility,Outpatient,,,,4481.625,3809.38125,1284.433725,4481.625,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2261.876138,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PSN ASF CPS 12mm VE R 10-11 EF,,C1776,HCPCS,Facility,Inpatient,,,,4481.625,3809.38125,1284.433725,4481.625,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PSN ASF CPS 12mm VE R 10-11 EF,,C1776,HCPCS,Facility,Both,,,,4481.625,3809.38125,1284.433725,4481.625,UnitedHealthcare,Individual & Family,4212.7275,94,,percent of total billed charges,,
PSN ASF CPS 12mm VE R 10-11 EF,,C1776,HCPCS,Facility,Outpatient,,,,4481.625,3809.38125,1284.433725,4481.625,UnitedHealthcare,Medicare Advantage,2195.99625,49,,percent of total billed charges,,
PSN ASF CPS 12mm VE R 10-11 EF,,C1776,HCPCS,Facility,Inpatient,,,,4481.625,3809.38125,1284.433725,4481.625,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
PSN ASF CPS 12mm VE R 10-11 EF,,C1776,HCPCS,Facility,Outpatient,,,,4481.625,3809.38125,1284.433725,4481.625,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2151.18,48,,percent of total billed charges,,100% of DHS outpatient percentage
PSN ASF CPS 12mm VE R 10-11 EF,,C1776,HCPCS,Facility,Inpatient,,,,4481.625,3809.38125,1284.433725,4481.625,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
PSN ASF CPS 12MM VE R 6-9EF,,C1776,HCPCS,Facility,Both,,,,4481.625,3809.38125,1284.433725,4481.625,Aetna,Commercial,4123.095,92,,percent of total billed charges,,
PSN ASF CPS 12MM VE R 6-9EF,,C1776,HCPCS,Facility,Outpatient,,,,4481.625,3809.38125,1284.433725,4481.625,Aetna,Medicare Advantage,2195.99625,49,,percent of total billed charges,,
PSN ASF CPS 12MM VE R 6-9EF,,C1776,HCPCS,Facility,Inpatient,,,,4481.625,3809.38125,1284.433725,4481.625,Aetna,Medicare Advantage,,,,,Included in per diem rate,
PSN ASF CPS 12MM VE R 6-9EF,,C1776,HCPCS,Facility,Both,,,,4481.625,3809.38125,1284.433725,4481.625,Aetna,PPO,4167.91125,93,,percent of total billed charges,,
PSN ASF CPS 12MM VE R 6-9EF,,C1776,HCPCS,Facility,Both,,,,4481.625,3809.38125,1284.433725,4481.625,America's PPO,America's PPO,4303.704488,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
PSN ASF CPS 12MM VE R 6-9EF,,C1776,HCPCS,Facility,Both,,,,4481.625,3809.38125,1284.433725,4481.625,BlueCross BlueShield Minnesota, Federal Employee Program,4409.919,98.4,,percent of total billed charges,,
PSN ASF CPS 12MM VE R 6-9EF,,C1776,HCPCS,Facility,Both,,,,4481.625,3809.38125,1284.433725,4481.625,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,4481.625,100,,percent of total billed charges,,
PSN ASF CPS 12MM VE R 6-9EF,,C1776,HCPCS,Facility,Both,,,,4481.625,3809.38125,1284.433725,4481.625,BlueCross BlueShield Minnesota,High Value Network Plan,4033.4625,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
PSN ASF CPS 12MM VE R 6-9EF,,C1776,HCPCS,Facility,Outpatient,,,,4481.625,3809.38125,1284.433725,4481.625,BlueCross BlueShield Minnesota,Medicare Advantage,2195.99625,49,,percent of total billed charges,,
PSN ASF CPS 12MM VE R 6-9EF,,C1776,HCPCS,Facility,Inpatient,,,,4481.625,3809.38125,1284.433725,4481.625,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
PSN ASF CPS 12MM VE R 6-9EF,,C1776,HCPCS,Facility,Both,,,,4481.625,3809.38125,1284.433725,4481.625,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,3969.375263,88.57,,percent of total billed charges,,
PSN ASF CPS 12MM VE R 6-9EF,,C1776,HCPCS,Facility,Both,,,,4481.625,3809.38125,1284.433725,4481.625,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1284.433725,28.66,,percent of total billed charges,,
PSN ASF CPS 12MM VE R 6-9EF,,C1776,HCPCS,Facility,Outpatient,,,,4481.625,3809.38125,1284.433725,4481.625,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2195.99625,49,,percent of total billed charges,,
PSN ASF CPS 12MM VE R 6-9EF,,C1776,HCPCS,Facility,Inpatient,,,,4481.625,3809.38125,1284.433725,4481.625,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
PSN ASF CPS 12MM VE R 6-9EF,,C1776,HCPCS,Facility,Both,,,,4481.625,3809.38125,1284.433725,4481.625,CorVel,Worker's Compensation,4481.625,100,,percent of total billed charges,,
PSN ASF CPS 12MM VE R 6-9EF,,C1776,HCPCS,Facility,Both,,,,4481.625,3809.38125,1284.433725,4481.625,First Health Group Corporation,First Health Network,4347.17625,97,,percent of total billed charges,,
PSN ASF CPS 12MM VE R 6-9EF,,C1776,HCPCS,Facility,Both,,,,4481.625,3809.38125,1284.433725,4481.625,"Health Partners, Inc.",Commercial,4239.61725,94.6,,percent of total billed charges,,
PSN ASF CPS 12MM VE R 6-9EF,,C1776,HCPCS,Facility,Outpatient,,,,4481.625,3809.38125,1284.433725,4481.625,"Health Partners, Inc.",Medicare Advantage,2195.99625,49,,percent of total billed charges,,
PSN ASF CPS 12MM VE R 6-9EF,,C1776,HCPCS,Facility,Inpatient,,,,4481.625,3809.38125,1284.433725,4481.625,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PSN ASF CPS 12MM VE R 6-9EF,,C1776,HCPCS,Facility,Both,,,,4481.625,3809.38125,1284.433725,4481.625,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),2688.975,60,,percent of total billed charges,,
PSN ASF CPS 12MM VE R 6-9EF,,C1776,HCPCS,Facility,Both,,,,4481.625,3809.38125,1284.433725,4481.625,"Health Partners, Inc.",State of Minnesota Advantage Program,3652.524375,81.5,,percent of total billed charges,,
PSN ASF CPS 12MM VE R 6-9EF,,C1776,HCPCS,Facility,Both,,,,4481.625,3809.38125,1284.433725,4481.625,"Health Partners, Inc.",State Public Programs,2240.8125,50,,percent of total billed charges,,
PSN ASF CPS 12MM VE R 6-9EF,,C1776,HCPCS,Facility,Both,,,,4481.625,3809.38125,1284.433725,4481.625,Humana Insurance Company,Commercial PPO,4257.54375,95,,percent of total billed charges,,
PSN ASF CPS 12MM VE R 6-9EF,,C1776,HCPCS,Facility,Outpatient,,,,4481.625,3809.38125,1284.433725,4481.625,Humana Insurance Company,Medicare PPO,2195.99625,49,,percent of total billed charges,,
PSN ASF CPS 12MM VE R 6-9EF,,C1776,HCPCS,Facility,Inpatient,,,,4481.625,3809.38125,1284.433725,4481.625,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
PSN ASF CPS 12MM VE R 6-9EF,,C1776,HCPCS,Facility,Both,,,,4481.625,3809.38125,1284.433725,4481.625,Medica,Individual & Family,4441.290375,99.1,,percent of total billed charges,,
PSN ASF CPS 12MM VE R 6-9EF,,C1776,HCPCS,Facility,Outpatient,,,,4481.625,3809.38125,1284.433725,4481.625,Medica,Medica Advantage Solution,2231.84925,49.8,,percent of total billed charges,,
PSN ASF CPS 12MM VE R 6-9EF,,C1776,HCPCS,Facility,Inpatient,,,,4481.625,3809.38125,1284.433725,4481.625,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
PSN ASF CPS 12MM VE R 6-9EF,,C1776,HCPCS,Facility,Outpatient,,,,4481.625,3809.38125,1284.433725,4481.625,Medica,Medical Assistance,1998.80475,44.6,,percent of total billed charges,,
PSN ASF CPS 12MM VE R 6-9EF,,C1776,HCPCS,Facility,Inpatient,,,,4481.625,3809.38125,1284.433725,4481.625,Medica,Medical Assistance,,,,,Included in per diem rate,
PSN ASF CPS 12MM VE R 6-9EF,,C1776,HCPCS,Facility,Outpatient,,,,4481.625,3809.38125,1284.433725,4481.625,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2231.84925,49.8,,percent of total billed charges,,
PSN ASF CPS 12MM VE R 6-9EF,,C1776,HCPCS,Facility,Inpatient,,,,4481.625,3809.38125,1284.433725,4481.625,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
PSN ASF CPS 12MM VE R 6-9EF,,C1776,HCPCS,Facility,Both,,,,4481.625,3809.38125,1284.433725,4481.625,"Multiplan, Inc.","Multiplan, Inc.",4212.7275,94,,percent of total billed charges,,
PSN ASF CPS 12MM VE R 6-9EF,,C1776,HCPCS,Facility,Outpatient,,,,4481.625,3809.38125,1284.433725,4481.625,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4037.944125,90.1,,percent of total billed charges,,
PSN ASF CPS 12MM VE R 6-9EF,,C1776,HCPCS,Facility,Inpatient,,,,4481.625,3809.38125,1284.433725,4481.625,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
PSN ASF CPS 12MM VE R 6-9EF,,C1776,HCPCS,Facility,Both,,,,4481.625,3809.38125,1284.433725,4481.625,"Preferred One Administrative Services, INC.",PPO,4418.88225,98.6,,percent of total billed charges,,
PSN ASF CPS 12MM VE R 6-9EF,,C1776,HCPCS,Facility,Outpatient,,,,4481.625,3809.38125,1284.433725,4481.625,PrimeWest Health,Minnesota Senior Health Options (MSHO),2305.796063,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
PSN ASF CPS 12MM VE R 6-9EF,,C1776,HCPCS,Facility,Inpatient,,,,4481.625,3809.38125,1284.433725,4481.625,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PSN ASF CPS 12MM VE R 6-9EF,,C1776,HCPCS,Facility,Outpatient,,,,4481.625,3809.38125,1284.433725,4481.625,PrimeWest Health,MinnesotaCare,2301.7626,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
PSN ASF CPS 12MM VE R 6-9EF,,C1776,HCPCS,Facility,Inpatient,,,,4481.625,3809.38125,1284.433725,4481.625,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
PSN ASF CPS 12MM VE R 6-9EF,,C1776,HCPCS,Facility,Both,,,,4481.625,3809.38125,1284.433725,4481.625,Sanford Health Plan,Sanford Health Plan,4123.095,92,,percent of total billed charges,,
PSN ASF CPS 12MM VE R 6-9EF,,C1776,HCPCS,Facility,Outpatient,,,,4481.625,3809.38125,1284.433725,4481.625,"UCare Health, Inc.",Individual & Family Plan,2525.395688,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
PSN ASF CPS 12MM VE R 6-9EF,,C1776,HCPCS,Facility,Inpatient,,,,4481.625,3809.38125,1284.433725,4481.625,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
PSN ASF CPS 12MM VE R 6-9EF,,C1776,HCPCS,Facility,Outpatient,,,,4481.625,3809.38125,1284.433725,4481.625,"UCare Health, Inc.",Medical Assistance,2261.876138,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PSN ASF CPS 12MM VE R 6-9EF,,C1776,HCPCS,Facility,Inpatient,,,,4481.625,3809.38125,1284.433725,4481.625,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
PSN ASF CPS 12MM VE R 6-9EF,,C1776,HCPCS,Facility,Outpatient,,,,4481.625,3809.38125,1284.433725,4481.625,"UCare Health, Inc.",Medicare Advantage,2261.876138,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PSN ASF CPS 12MM VE R 6-9EF,,C1776,HCPCS,Facility,Inpatient,,,,4481.625,3809.38125,1284.433725,4481.625,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PSN ASF CPS 12MM VE R 6-9EF,,C1776,HCPCS,Facility,Outpatient,,,,4481.625,3809.38125,1284.433725,4481.625,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2261.876138,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PSN ASF CPS 12MM VE R 6-9EF,,C1776,HCPCS,Facility,Inpatient,,,,4481.625,3809.38125,1284.433725,4481.625,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PSN ASF CPS 12MM VE R 6-9EF,,C1776,HCPCS,Facility,Both,,,,4481.625,3809.38125,1284.433725,4481.625,UnitedHealthcare,Individual & Family,4212.7275,94,,percent of total billed charges,,
PSN ASF CPS 12MM VE R 6-9EF,,C1776,HCPCS,Facility,Outpatient,,,,4481.625,3809.38125,1284.433725,4481.625,UnitedHealthcare,Medicare Advantage,2195.99625,49,,percent of total billed charges,,
PSN ASF CPS 12MM VE R 6-9EF,,C1776,HCPCS,Facility,Inpatient,,,,4481.625,3809.38125,1284.433725,4481.625,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
PSN ASF CPS 12MM VE R 6-9EF,,C1776,HCPCS,Facility,Outpatient,,,,4481.625,3809.38125,1284.433725,4481.625,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2151.18,48,,percent of total billed charges,,100% of DHS outpatient percentage
PSN ASF CPS 12MM VE R 6-9EF,,C1776,HCPCS,Facility,Inpatient,,,,4481.625,3809.38125,1284.433725,4481.625,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
PSN ASF PS 11M VE L 6-9EF,,C1776,HCPCS,Facility,Both,,,,2826.25,2402.3125,810.00325,2826.25,Aetna,Commercial,2600.15,92,,percent of total billed charges,,
PSN ASF PS 11M VE L 6-9EF,,C1776,HCPCS,Facility,Outpatient,,,,2826.25,2402.3125,810.00325,2826.25,Aetna,Medicare Advantage,1384.8625,49,,percent of total billed charges,,
PSN ASF PS 11M VE L 6-9EF,,C1776,HCPCS,Facility,Inpatient,,,,2826.25,2402.3125,810.00325,2826.25,Aetna,Medicare Advantage,,,,,Included in per diem rate,
PSN ASF PS 11M VE L 6-9EF,,C1776,HCPCS,Facility,Both,,,,2826.25,2402.3125,810.00325,2826.25,Aetna,PPO,2628.4125,93,,percent of total billed charges,,
PSN ASF PS 11M VE L 6-9EF,,C1776,HCPCS,Facility,Both,,,,2826.25,2402.3125,810.00325,2826.25,America's PPO,America's PPO,2714.047875,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
PSN ASF PS 11M VE L 6-9EF,,C1776,HCPCS,Facility,Both,,,,2826.25,2402.3125,810.00325,2826.25,BlueCross BlueShield Minnesota, Federal Employee Program,2781.03,98.4,,percent of total billed charges,,
PSN ASF PS 11M VE L 6-9EF,,C1776,HCPCS,Facility,Both,,,,2826.25,2402.3125,810.00325,2826.25,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,2826.25,100,,percent of total billed charges,,
PSN ASF PS 11M VE L 6-9EF,,C1776,HCPCS,Facility,Both,,,,2826.25,2402.3125,810.00325,2826.25,BlueCross BlueShield Minnesota,High Value Network Plan,2543.625,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
PSN ASF PS 11M VE L 6-9EF,,C1776,HCPCS,Facility,Outpatient,,,,2826.25,2402.3125,810.00325,2826.25,BlueCross BlueShield Minnesota,Medicare Advantage,1384.8625,49,,percent of total billed charges,,
PSN ASF PS 11M VE L 6-9EF,,C1776,HCPCS,Facility,Inpatient,,,,2826.25,2402.3125,810.00325,2826.25,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
PSN ASF PS 11M VE L 6-9EF,,C1776,HCPCS,Facility,Both,,,,2826.25,2402.3125,810.00325,2826.25,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,2503.209625,88.57,,percent of total billed charges,,
PSN ASF PS 11M VE L 6-9EF,,C1776,HCPCS,Facility,Both,,,,2826.25,2402.3125,810.00325,2826.25,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,810.00325,28.66,,percent of total billed charges,,
PSN ASF PS 11M VE L 6-9EF,,C1776,HCPCS,Facility,Outpatient,,,,2826.25,2402.3125,810.00325,2826.25,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1384.8625,49,,percent of total billed charges,,
PSN ASF PS 11M VE L 6-9EF,,C1776,HCPCS,Facility,Inpatient,,,,2826.25,2402.3125,810.00325,2826.25,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
PSN ASF PS 11M VE L 6-9EF,,C1776,HCPCS,Facility,Both,,,,2826.25,2402.3125,810.00325,2826.25,CorVel,Worker's Compensation,2826.25,100,,percent of total billed charges,,
PSN ASF PS 11M VE L 6-9EF,,C1776,HCPCS,Facility,Both,,,,2826.25,2402.3125,810.00325,2826.25,First Health Group Corporation,First Health Network,2741.4625,97,,percent of total billed charges,,
PSN ASF PS 11M VE L 6-9EF,,C1776,HCPCS,Facility,Both,,,,2826.25,2402.3125,810.00325,2826.25,"Health Partners, Inc.",Commercial,2673.6325,94.6,,percent of total billed charges,,
PSN ASF PS 11M VE L 6-9EF,,C1776,HCPCS,Facility,Outpatient,,,,2826.25,2402.3125,810.00325,2826.25,"Health Partners, Inc.",Medicare Advantage,1384.8625,49,,percent of total billed charges,,
PSN ASF PS 11M VE L 6-9EF,,C1776,HCPCS,Facility,Inpatient,,,,2826.25,2402.3125,810.00325,2826.25,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PSN ASF PS 11M VE L 6-9EF,,C1776,HCPCS,Facility,Both,,,,2826.25,2402.3125,810.00325,2826.25,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1695.75,60,,percent of total billed charges,,
PSN ASF PS 11M VE L 6-9EF,,C1776,HCPCS,Facility,Both,,,,2826.25,2402.3125,810.00325,2826.25,"Health Partners, Inc.",State of Minnesota Advantage Program,2303.39375,81.5,,percent of total billed charges,,
PSN ASF PS 11M VE L 6-9EF,,C1776,HCPCS,Facility,Both,,,,2826.25,2402.3125,810.00325,2826.25,"Health Partners, Inc.",State Public Programs,1413.125,50,,percent of total billed charges,,
PSN ASF PS 11M VE L 6-9EF,,C1776,HCPCS,Facility,Both,,,,2826.25,2402.3125,810.00325,2826.25,Humana Insurance Company,Commercial PPO,2684.9375,95,,percent of total billed charges,,
PSN ASF PS 11M VE L 6-9EF,,C1776,HCPCS,Facility,Outpatient,,,,2826.25,2402.3125,810.00325,2826.25,Humana Insurance Company,Medicare PPO,1384.8625,49,,percent of total billed charges,,
PSN ASF PS 11M VE L 6-9EF,,C1776,HCPCS,Facility,Inpatient,,,,2826.25,2402.3125,810.00325,2826.25,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
PSN ASF PS 11M VE L 6-9EF,,C1776,HCPCS,Facility,Both,,,,2826.25,2402.3125,810.00325,2826.25,Medica,Individual & Family,2800.81375,99.1,,percent of total billed charges,,
PSN ASF PS 11M VE L 6-9EF,,C1776,HCPCS,Facility,Outpatient,,,,2826.25,2402.3125,810.00325,2826.25,Medica,Medica Advantage Solution,1407.4725,49.8,,percent of total billed charges,,
PSN ASF PS 11M VE L 6-9EF,,C1776,HCPCS,Facility,Inpatient,,,,2826.25,2402.3125,810.00325,2826.25,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
PSN ASF PS 11M VE L 6-9EF,,C1776,HCPCS,Facility,Outpatient,,,,2826.25,2402.3125,810.00325,2826.25,Medica,Medical Assistance,1260.5075,44.6,,percent of total billed charges,,
PSN ASF PS 11M VE L 6-9EF,,C1776,HCPCS,Facility,Inpatient,,,,2826.25,2402.3125,810.00325,2826.25,Medica,Medical Assistance,,,,,Included in per diem rate,
PSN ASF PS 11M VE L 6-9EF,,C1776,HCPCS,Facility,Outpatient,,,,2826.25,2402.3125,810.00325,2826.25,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1407.4725,49.8,,percent of total billed charges,,
PSN ASF PS 11M VE L 6-9EF,,C1776,HCPCS,Facility,Inpatient,,,,2826.25,2402.3125,810.00325,2826.25,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
PSN ASF PS 11M VE L 6-9EF,,C1776,HCPCS,Facility,Both,,,,2826.25,2402.3125,810.00325,2826.25,"Multiplan, Inc.","Multiplan, Inc.",2656.675,94,,percent of total billed charges,,
PSN ASF PS 11M VE L 6-9EF,,C1776,HCPCS,Facility,Outpatient,,,,2826.25,2402.3125,810.00325,2826.25,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,2546.45125,90.1,,percent of total billed charges,,
PSN ASF PS 11M VE L 6-9EF,,C1776,HCPCS,Facility,Inpatient,,,,2826.25,2402.3125,810.00325,2826.25,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
PSN ASF PS 11M VE L 6-9EF,,C1776,HCPCS,Facility,Both,,,,2826.25,2402.3125,810.00325,2826.25,"Preferred One Administrative Services, INC.",PPO,2786.6825,98.6,,percent of total billed charges,,
PSN ASF PS 11M VE L 6-9EF,,C1776,HCPCS,Facility,Outpatient,,,,2826.25,2402.3125,810.00325,2826.25,PrimeWest Health,Minnesota Senior Health Options (MSHO),1454.105625,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
PSN ASF PS 11M VE L 6-9EF,,C1776,HCPCS,Facility,Inpatient,,,,2826.25,2402.3125,810.00325,2826.25,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PSN ASF PS 11M VE L 6-9EF,,C1776,HCPCS,Facility,Outpatient,,,,2826.25,2402.3125,810.00325,2826.25,PrimeWest Health,MinnesotaCare,1451.562,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
PSN ASF PS 11M VE L 6-9EF,,C1776,HCPCS,Facility,Inpatient,,,,2826.25,2402.3125,810.00325,2826.25,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
PSN ASF PS 11M VE L 6-9EF,,C1776,HCPCS,Facility,Both,,,,2826.25,2402.3125,810.00325,2826.25,Sanford Health Plan,Sanford Health Plan,2600.15,92,,percent of total billed charges,,
PSN ASF PS 11M VE L 6-9EF,,C1776,HCPCS,Facility,Outpatient,,,,2826.25,2402.3125,810.00325,2826.25,"UCare Health, Inc.",Individual & Family Plan,1592.591875,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
PSN ASF PS 11M VE L 6-9EF,,C1776,HCPCS,Facility,Inpatient,,,,2826.25,2402.3125,810.00325,2826.25,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
PSN ASF PS 11M VE L 6-9EF,,C1776,HCPCS,Facility,Outpatient,,,,2826.25,2402.3125,810.00325,2826.25,"UCare Health, Inc.",Medical Assistance,1426.408375,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PSN ASF PS 11M VE L 6-9EF,,C1776,HCPCS,Facility,Inpatient,,,,2826.25,2402.3125,810.00325,2826.25,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
PSN ASF PS 11M VE L 6-9EF,,C1776,HCPCS,Facility,Outpatient,,,,2826.25,2402.3125,810.00325,2826.25,"UCare Health, Inc.",Medicare Advantage,1426.408375,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PSN ASF PS 11M VE L 6-9EF,,C1776,HCPCS,Facility,Inpatient,,,,2826.25,2402.3125,810.00325,2826.25,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PSN ASF PS 11M VE L 6-9EF,,C1776,HCPCS,Facility,Outpatient,,,,2826.25,2402.3125,810.00325,2826.25,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1426.408375,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PSN ASF PS 11M VE L 6-9EF,,C1776,HCPCS,Facility,Inpatient,,,,2826.25,2402.3125,810.00325,2826.25,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PSN ASF PS 11M VE L 6-9EF,,C1776,HCPCS,Facility,Both,,,,2826.25,2402.3125,810.00325,2826.25,UnitedHealthcare,Individual & Family,2656.675,94,,percent of total billed charges,,
PSN ASF PS 11M VE L 6-9EF,,C1776,HCPCS,Facility,Outpatient,,,,2826.25,2402.3125,810.00325,2826.25,UnitedHealthcare,Medicare Advantage,1384.8625,49,,percent of total billed charges,,
PSN ASF PS 11M VE L 6-9EF,,C1776,HCPCS,Facility,Inpatient,,,,2826.25,2402.3125,810.00325,2826.25,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
PSN ASF PS 11M VE L 6-9EF,,C1776,HCPCS,Facility,Outpatient,,,,2826.25,2402.3125,810.00325,2826.25,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1356.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
PSN ASF PS 11M VE L 6-9EF,,C1776,HCPCS,Facility,Inpatient,,,,2826.25,2402.3125,810.00325,2826.25,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
PSN ASF PS 11MM VE L 10-12GH,,C1776,HCPCS,Facility,Both,,,,2826.25,2402.3125,810.00325,2826.25,Aetna,Commercial,2600.15,92,,percent of total billed charges,,
PSN ASF PS 11MM VE L 10-12GH,,C1776,HCPCS,Facility,Outpatient,,,,2826.25,2402.3125,810.00325,2826.25,Aetna,Medicare Advantage,1384.8625,49,,percent of total billed charges,,
PSN ASF PS 11MM VE L 10-12GH,,C1776,HCPCS,Facility,Inpatient,,,,2826.25,2402.3125,810.00325,2826.25,Aetna,Medicare Advantage,,,,,Included in per diem rate,
PSN ASF PS 11MM VE L 10-12GH,,C1776,HCPCS,Facility,Both,,,,2826.25,2402.3125,810.00325,2826.25,Aetna,PPO,2628.4125,93,,percent of total billed charges,,
PSN ASF PS 11MM VE L 10-12GH,,C1776,HCPCS,Facility,Both,,,,2826.25,2402.3125,810.00325,2826.25,America's PPO,America's PPO,2714.047875,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
PSN ASF PS 11MM VE L 10-12GH,,C1776,HCPCS,Facility,Both,,,,2826.25,2402.3125,810.00325,2826.25,BlueCross BlueShield Minnesota, Federal Employee Program,2781.03,98.4,,percent of total billed charges,,
PSN ASF PS 11MM VE L 10-12GH,,C1776,HCPCS,Facility,Both,,,,2826.25,2402.3125,810.00325,2826.25,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,2826.25,100,,percent of total billed charges,,
PSN ASF PS 11MM VE L 10-12GH,,C1776,HCPCS,Facility,Both,,,,2826.25,2402.3125,810.00325,2826.25,BlueCross BlueShield Minnesota,High Value Network Plan,2543.625,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
PSN ASF PS 11MM VE L 10-12GH,,C1776,HCPCS,Facility,Outpatient,,,,2826.25,2402.3125,810.00325,2826.25,BlueCross BlueShield Minnesota,Medicare Advantage,1384.8625,49,,percent of total billed charges,,
PSN ASF PS 11MM VE L 10-12GH,,C1776,HCPCS,Facility,Inpatient,,,,2826.25,2402.3125,810.00325,2826.25,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
PSN ASF PS 11MM VE L 10-12GH,,C1776,HCPCS,Facility,Both,,,,2826.25,2402.3125,810.00325,2826.25,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,2503.209625,88.57,,percent of total billed charges,,
PSN ASF PS 11MM VE L 10-12GH,,C1776,HCPCS,Facility,Both,,,,2826.25,2402.3125,810.00325,2826.25,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,810.00325,28.66,,percent of total billed charges,,
PSN ASF PS 11MM VE L 10-12GH,,C1776,HCPCS,Facility,Outpatient,,,,2826.25,2402.3125,810.00325,2826.25,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1384.8625,49,,percent of total billed charges,,
PSN ASF PS 11MM VE L 10-12GH,,C1776,HCPCS,Facility,Inpatient,,,,2826.25,2402.3125,810.00325,2826.25,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
PSN ASF PS 11MM VE L 10-12GH,,C1776,HCPCS,Facility,Both,,,,2826.25,2402.3125,810.00325,2826.25,CorVel,Worker's Compensation,2826.25,100,,percent of total billed charges,,
PSN ASF PS 11MM VE L 10-12GH,,C1776,HCPCS,Facility,Both,,,,2826.25,2402.3125,810.00325,2826.25,First Health Group Corporation,First Health Network,2741.4625,97,,percent of total billed charges,,
PSN ASF PS 11MM VE L 10-12GH,,C1776,HCPCS,Facility,Both,,,,2826.25,2402.3125,810.00325,2826.25,"Health Partners, Inc.",Commercial,2673.6325,94.6,,percent of total billed charges,,
PSN ASF PS 11MM VE L 10-12GH,,C1776,HCPCS,Facility,Outpatient,,,,2826.25,2402.3125,810.00325,2826.25,"Health Partners, Inc.",Medicare Advantage,1384.8625,49,,percent of total billed charges,,
PSN ASF PS 11MM VE L 10-12GH,,C1776,HCPCS,Facility,Inpatient,,,,2826.25,2402.3125,810.00325,2826.25,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PSN ASF PS 11MM VE L 10-12GH,,C1776,HCPCS,Facility,Both,,,,2826.25,2402.3125,810.00325,2826.25,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1695.75,60,,percent of total billed charges,,
PSN ASF PS 11MM VE L 10-12GH,,C1776,HCPCS,Facility,Both,,,,2826.25,2402.3125,810.00325,2826.25,"Health Partners, Inc.",State of Minnesota Advantage Program,2303.39375,81.5,,percent of total billed charges,,
PSN ASF PS 11MM VE L 10-12GH,,C1776,HCPCS,Facility,Both,,,,2826.25,2402.3125,810.00325,2826.25,"Health Partners, Inc.",State Public Programs,1413.125,50,,percent of total billed charges,,
PSN ASF PS 11MM VE L 10-12GH,,C1776,HCPCS,Facility,Both,,,,2826.25,2402.3125,810.00325,2826.25,Humana Insurance Company,Commercial PPO,2684.9375,95,,percent of total billed charges,,
PSN ASF PS 11MM VE L 10-12GH,,C1776,HCPCS,Facility,Outpatient,,,,2826.25,2402.3125,810.00325,2826.25,Humana Insurance Company,Medicare PPO,1384.8625,49,,percent of total billed charges,,
PSN ASF PS 11MM VE L 10-12GH,,C1776,HCPCS,Facility,Inpatient,,,,2826.25,2402.3125,810.00325,2826.25,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
PSN ASF PS 11MM VE L 10-12GH,,C1776,HCPCS,Facility,Both,,,,2826.25,2402.3125,810.00325,2826.25,Medica,Individual & Family,2800.81375,99.1,,percent of total billed charges,,
PSN ASF PS 11MM VE L 10-12GH,,C1776,HCPCS,Facility,Outpatient,,,,2826.25,2402.3125,810.00325,2826.25,Medica,Medica Advantage Solution,1407.4725,49.8,,percent of total billed charges,,
PSN ASF PS 11MM VE L 10-12GH,,C1776,HCPCS,Facility,Inpatient,,,,2826.25,2402.3125,810.00325,2826.25,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
PSN ASF PS 11MM VE L 10-12GH,,C1776,HCPCS,Facility,Outpatient,,,,2826.25,2402.3125,810.00325,2826.25,Medica,Medical Assistance,1260.5075,44.6,,percent of total billed charges,,
PSN ASF PS 11MM VE L 10-12GH,,C1776,HCPCS,Facility,Inpatient,,,,2826.25,2402.3125,810.00325,2826.25,Medica,Medical Assistance,,,,,Included in per diem rate,
PSN ASF PS 11MM VE L 10-12GH,,C1776,HCPCS,Facility,Outpatient,,,,2826.25,2402.3125,810.00325,2826.25,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1407.4725,49.8,,percent of total billed charges,,
PSN ASF PS 11MM VE L 10-12GH,,C1776,HCPCS,Facility,Inpatient,,,,2826.25,2402.3125,810.00325,2826.25,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
PSN ASF PS 11MM VE L 10-12GH,,C1776,HCPCS,Facility,Both,,,,2826.25,2402.3125,810.00325,2826.25,"Multiplan, Inc.","Multiplan, Inc.",2656.675,94,,percent of total billed charges,,
PSN ASF PS 11MM VE L 10-12GH,,C1776,HCPCS,Facility,Outpatient,,,,2826.25,2402.3125,810.00325,2826.25,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,2546.45125,90.1,,percent of total billed charges,,
PSN ASF PS 11MM VE L 10-12GH,,C1776,HCPCS,Facility,Inpatient,,,,2826.25,2402.3125,810.00325,2826.25,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
PSN ASF PS 11MM VE L 10-12GH,,C1776,HCPCS,Facility,Both,,,,2826.25,2402.3125,810.00325,2826.25,"Preferred One Administrative Services, INC.",PPO,2786.6825,98.6,,percent of total billed charges,,
PSN ASF PS 11MM VE L 10-12GH,,C1776,HCPCS,Facility,Outpatient,,,,2826.25,2402.3125,810.00325,2826.25,PrimeWest Health,Minnesota Senior Health Options (MSHO),1454.105625,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
PSN ASF PS 11MM VE L 10-12GH,,C1776,HCPCS,Facility,Inpatient,,,,2826.25,2402.3125,810.00325,2826.25,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PSN ASF PS 11MM VE L 10-12GH,,C1776,HCPCS,Facility,Outpatient,,,,2826.25,2402.3125,810.00325,2826.25,PrimeWest Health,MinnesotaCare,1451.562,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
PSN ASF PS 11MM VE L 10-12GH,,C1776,HCPCS,Facility,Inpatient,,,,2826.25,2402.3125,810.00325,2826.25,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
PSN ASF PS 11MM VE L 10-12GH,,C1776,HCPCS,Facility,Both,,,,2826.25,2402.3125,810.00325,2826.25,Sanford Health Plan,Sanford Health Plan,2600.15,92,,percent of total billed charges,,
PSN ASF PS 11MM VE L 10-12GH,,C1776,HCPCS,Facility,Outpatient,,,,2826.25,2402.3125,810.00325,2826.25,"UCare Health, Inc.",Individual & Family Plan,1592.591875,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
PSN ASF PS 11MM VE L 10-12GH,,C1776,HCPCS,Facility,Inpatient,,,,2826.25,2402.3125,810.00325,2826.25,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
PSN ASF PS 11MM VE L 10-12GH,,C1776,HCPCS,Facility,Outpatient,,,,2826.25,2402.3125,810.00325,2826.25,"UCare Health, Inc.",Medical Assistance,1426.408375,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PSN ASF PS 11MM VE L 10-12GH,,C1776,HCPCS,Facility,Inpatient,,,,2826.25,2402.3125,810.00325,2826.25,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
PSN ASF PS 11MM VE L 10-12GH,,C1776,HCPCS,Facility,Outpatient,,,,2826.25,2402.3125,810.00325,2826.25,"UCare Health, Inc.",Medicare Advantage,1426.408375,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PSN ASF PS 11MM VE L 10-12GH,,C1776,HCPCS,Facility,Inpatient,,,,2826.25,2402.3125,810.00325,2826.25,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PSN ASF PS 11MM VE L 10-12GH,,C1776,HCPCS,Facility,Outpatient,,,,2826.25,2402.3125,810.00325,2826.25,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1426.408375,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PSN ASF PS 11MM VE L 10-12GH,,C1776,HCPCS,Facility,Inpatient,,,,2826.25,2402.3125,810.00325,2826.25,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PSN ASF PS 11MM VE L 10-12GH,,C1776,HCPCS,Facility,Both,,,,2826.25,2402.3125,810.00325,2826.25,UnitedHealthcare,Individual & Family,2656.675,94,,percent of total billed charges,,
PSN ASF PS 11MM VE L 10-12GH,,C1776,HCPCS,Facility,Outpatient,,,,2826.25,2402.3125,810.00325,2826.25,UnitedHealthcare,Medicare Advantage,1384.8625,49,,percent of total billed charges,,
PSN ASF PS 11MM VE L 10-12GH,,C1776,HCPCS,Facility,Inpatient,,,,2826.25,2402.3125,810.00325,2826.25,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
PSN ASF PS 11MM VE L 10-12GH,,C1776,HCPCS,Facility,Outpatient,,,,2826.25,2402.3125,810.00325,2826.25,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1356.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
PSN ASF PS 11MM VE L 10-12GH,,C1776,HCPCS,Facility,Inpatient,,,,2826.25,2402.3125,810.00325,2826.25,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
PSN ASF PS 11MM VE R 10-11 EF,,C1776,HCPCS,Facility,Both,,,,2826.25,2402.3125,810.00325,2826.25,Aetna,Commercial,2600.15,92,,percent of total billed charges,,
PSN ASF PS 11MM VE R 10-11 EF,,C1776,HCPCS,Facility,Outpatient,,,,2826.25,2402.3125,810.00325,2826.25,Aetna,Medicare Advantage,1384.8625,49,,percent of total billed charges,,
PSN ASF PS 11MM VE R 10-11 EF,,C1776,HCPCS,Facility,Inpatient,,,,2826.25,2402.3125,810.00325,2826.25,Aetna,Medicare Advantage,,,,,Included in per diem rate,
PSN ASF PS 11MM VE R 10-11 EF,,C1776,HCPCS,Facility,Both,,,,2826.25,2402.3125,810.00325,2826.25,Aetna,PPO,2628.4125,93,,percent of total billed charges,,
PSN ASF PS 11MM VE R 10-11 EF,,C1776,HCPCS,Facility,Both,,,,2826.25,2402.3125,810.00325,2826.25,America's PPO,America's PPO,2714.047875,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
PSN ASF PS 11MM VE R 10-11 EF,,C1776,HCPCS,Facility,Both,,,,2826.25,2402.3125,810.00325,2826.25,BlueCross BlueShield Minnesota, Federal Employee Program,2781.03,98.4,,percent of total billed charges,,
PSN ASF PS 11MM VE R 10-11 EF,,C1776,HCPCS,Facility,Both,,,,2826.25,2402.3125,810.00325,2826.25,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,2826.25,100,,percent of total billed charges,,
PSN ASF PS 11MM VE R 10-11 EF,,C1776,HCPCS,Facility,Both,,,,2826.25,2402.3125,810.00325,2826.25,BlueCross BlueShield Minnesota,High Value Network Plan,2543.625,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
PSN ASF PS 11MM VE R 10-11 EF,,C1776,HCPCS,Facility,Outpatient,,,,2826.25,2402.3125,810.00325,2826.25,BlueCross BlueShield Minnesota,Medicare Advantage,1384.8625,49,,percent of total billed charges,,
PSN ASF PS 11MM VE R 10-11 EF,,C1776,HCPCS,Facility,Inpatient,,,,2826.25,2402.3125,810.00325,2826.25,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
PSN ASF PS 11MM VE R 10-11 EF,,C1776,HCPCS,Facility,Both,,,,2826.25,2402.3125,810.00325,2826.25,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,2503.209625,88.57,,percent of total billed charges,,
PSN ASF PS 11MM VE R 10-11 EF,,C1776,HCPCS,Facility,Both,,,,2826.25,2402.3125,810.00325,2826.25,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,810.00325,28.66,,percent of total billed charges,,
PSN ASF PS 11MM VE R 10-11 EF,,C1776,HCPCS,Facility,Outpatient,,,,2826.25,2402.3125,810.00325,2826.25,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1384.8625,49,,percent of total billed charges,,
PSN ASF PS 11MM VE R 10-11 EF,,C1776,HCPCS,Facility,Inpatient,,,,2826.25,2402.3125,810.00325,2826.25,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
PSN ASF PS 11MM VE R 10-11 EF,,C1776,HCPCS,Facility,Both,,,,2826.25,2402.3125,810.00325,2826.25,CorVel,Worker's Compensation,2826.25,100,,percent of total billed charges,,
PSN ASF PS 11MM VE R 10-11 EF,,C1776,HCPCS,Facility,Both,,,,2826.25,2402.3125,810.00325,2826.25,First Health Group Corporation,First Health Network,2741.4625,97,,percent of total billed charges,,
PSN ASF PS 11MM VE R 10-11 EF,,C1776,HCPCS,Facility,Both,,,,2826.25,2402.3125,810.00325,2826.25,"Health Partners, Inc.",Commercial,2673.6325,94.6,,percent of total billed charges,,
PSN ASF PS 11MM VE R 10-11 EF,,C1776,HCPCS,Facility,Outpatient,,,,2826.25,2402.3125,810.00325,2826.25,"Health Partners, Inc.",Medicare Advantage,1384.8625,49,,percent of total billed charges,,
PSN ASF PS 11MM VE R 10-11 EF,,C1776,HCPCS,Facility,Inpatient,,,,2826.25,2402.3125,810.00325,2826.25,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PSN ASF PS 11MM VE R 10-11 EF,,C1776,HCPCS,Facility,Both,,,,2826.25,2402.3125,810.00325,2826.25,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1695.75,60,,percent of total billed charges,,
PSN ASF PS 11MM VE R 10-11 EF,,C1776,HCPCS,Facility,Both,,,,2826.25,2402.3125,810.00325,2826.25,"Health Partners, Inc.",State of Minnesota Advantage Program,2303.39375,81.5,,percent of total billed charges,,
PSN ASF PS 11MM VE R 10-11 EF,,C1776,HCPCS,Facility,Both,,,,2826.25,2402.3125,810.00325,2826.25,"Health Partners, Inc.",State Public Programs,1413.125,50,,percent of total billed charges,,
PSN ASF PS 11MM VE R 10-11 EF,,C1776,HCPCS,Facility,Both,,,,2826.25,2402.3125,810.00325,2826.25,Humana Insurance Company,Commercial PPO,2684.9375,95,,percent of total billed charges,,
PSN ASF PS 11MM VE R 10-11 EF,,C1776,HCPCS,Facility,Outpatient,,,,2826.25,2402.3125,810.00325,2826.25,Humana Insurance Company,Medicare PPO,1384.8625,49,,percent of total billed charges,,
PSN ASF PS 11MM VE R 10-11 EF,,C1776,HCPCS,Facility,Inpatient,,,,2826.25,2402.3125,810.00325,2826.25,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
PSN ASF PS 11MM VE R 10-11 EF,,C1776,HCPCS,Facility,Both,,,,2826.25,2402.3125,810.00325,2826.25,Medica,Individual & Family,2800.81375,99.1,,percent of total billed charges,,
PSN ASF PS 11MM VE R 10-11 EF,,C1776,HCPCS,Facility,Outpatient,,,,2826.25,2402.3125,810.00325,2826.25,Medica,Medica Advantage Solution,1407.4725,49.8,,percent of total billed charges,,
PSN ASF PS 11MM VE R 10-11 EF,,C1776,HCPCS,Facility,Inpatient,,,,2826.25,2402.3125,810.00325,2826.25,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
PSN ASF PS 11MM VE R 10-11 EF,,C1776,HCPCS,Facility,Outpatient,,,,2826.25,2402.3125,810.00325,2826.25,Medica,Medical Assistance,1260.5075,44.6,,percent of total billed charges,,
PSN ASF PS 11MM VE R 10-11 EF,,C1776,HCPCS,Facility,Inpatient,,,,2826.25,2402.3125,810.00325,2826.25,Medica,Medical Assistance,,,,,Included in per diem rate,
PSN ASF PS 11MM VE R 10-11 EF,,C1776,HCPCS,Facility,Outpatient,,,,2826.25,2402.3125,810.00325,2826.25,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1407.4725,49.8,,percent of total billed charges,,
PSN ASF PS 11MM VE R 10-11 EF,,C1776,HCPCS,Facility,Inpatient,,,,2826.25,2402.3125,810.00325,2826.25,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
PSN ASF PS 11MM VE R 10-11 EF,,C1776,HCPCS,Facility,Both,,,,2826.25,2402.3125,810.00325,2826.25,"Multiplan, Inc.","Multiplan, Inc.",2656.675,94,,percent of total billed charges,,
PSN ASF PS 11MM VE R 10-11 EF,,C1776,HCPCS,Facility,Outpatient,,,,2826.25,2402.3125,810.00325,2826.25,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,2546.45125,90.1,,percent of total billed charges,,
PSN ASF PS 11MM VE R 10-11 EF,,C1776,HCPCS,Facility,Inpatient,,,,2826.25,2402.3125,810.00325,2826.25,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
PSN ASF PS 11MM VE R 10-11 EF,,C1776,HCPCS,Facility,Both,,,,2826.25,2402.3125,810.00325,2826.25,"Preferred One Administrative Services, INC.",PPO,2786.6825,98.6,,percent of total billed charges,,
PSN ASF PS 11MM VE R 10-11 EF,,C1776,HCPCS,Facility,Outpatient,,,,2826.25,2402.3125,810.00325,2826.25,PrimeWest Health,Minnesota Senior Health Options (MSHO),1454.105625,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
PSN ASF PS 11MM VE R 10-11 EF,,C1776,HCPCS,Facility,Inpatient,,,,2826.25,2402.3125,810.00325,2826.25,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PSN ASF PS 11MM VE R 10-11 EF,,C1776,HCPCS,Facility,Outpatient,,,,2826.25,2402.3125,810.00325,2826.25,PrimeWest Health,MinnesotaCare,1451.562,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
PSN ASF PS 11MM VE R 10-11 EF,,C1776,HCPCS,Facility,Inpatient,,,,2826.25,2402.3125,810.00325,2826.25,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
PSN ASF PS 11MM VE R 10-11 EF,,C1776,HCPCS,Facility,Both,,,,2826.25,2402.3125,810.00325,2826.25,Sanford Health Plan,Sanford Health Plan,2600.15,92,,percent of total billed charges,,
PSN ASF PS 11MM VE R 10-11 EF,,C1776,HCPCS,Facility,Outpatient,,,,2826.25,2402.3125,810.00325,2826.25,"UCare Health, Inc.",Individual & Family Plan,1592.591875,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
PSN ASF PS 11MM VE R 10-11 EF,,C1776,HCPCS,Facility,Inpatient,,,,2826.25,2402.3125,810.00325,2826.25,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
PSN ASF PS 11MM VE R 10-11 EF,,C1776,HCPCS,Facility,Outpatient,,,,2826.25,2402.3125,810.00325,2826.25,"UCare Health, Inc.",Medical Assistance,1426.408375,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PSN ASF PS 11MM VE R 10-11 EF,,C1776,HCPCS,Facility,Inpatient,,,,2826.25,2402.3125,810.00325,2826.25,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
PSN ASF PS 11MM VE R 10-11 EF,,C1776,HCPCS,Facility,Outpatient,,,,2826.25,2402.3125,810.00325,2826.25,"UCare Health, Inc.",Medicare Advantage,1426.408375,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PSN ASF PS 11MM VE R 10-11 EF,,C1776,HCPCS,Facility,Inpatient,,,,2826.25,2402.3125,810.00325,2826.25,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PSN ASF PS 11MM VE R 10-11 EF,,C1776,HCPCS,Facility,Outpatient,,,,2826.25,2402.3125,810.00325,2826.25,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1426.408375,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PSN ASF PS 11MM VE R 10-11 EF,,C1776,HCPCS,Facility,Inpatient,,,,2826.25,2402.3125,810.00325,2826.25,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PSN ASF PS 11MM VE R 10-11 EF,,C1776,HCPCS,Facility,Both,,,,2826.25,2402.3125,810.00325,2826.25,UnitedHealthcare,Individual & Family,2656.675,94,,percent of total billed charges,,
PSN ASF PS 11MM VE R 10-11 EF,,C1776,HCPCS,Facility,Outpatient,,,,2826.25,2402.3125,810.00325,2826.25,UnitedHealthcare,Medicare Advantage,1384.8625,49,,percent of total billed charges,,
PSN ASF PS 11MM VE R 10-11 EF,,C1776,HCPCS,Facility,Inpatient,,,,2826.25,2402.3125,810.00325,2826.25,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
PSN ASF PS 11MM VE R 10-11 EF,,C1776,HCPCS,Facility,Outpatient,,,,2826.25,2402.3125,810.00325,2826.25,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1356.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
PSN ASF PS 11MM VE R 10-11 EF,,C1776,HCPCS,Facility,Inpatient,,,,2826.25,2402.3125,810.00325,2826.25,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
PSN ASF PS 12MM VE L 6-9 EF,,C1776,HCPCS,Facility,Both,,,,2826.25,2402.3125,810.00325,2826.25,Aetna,Commercial,2600.15,92,,percent of total billed charges,,
PSN ASF PS 12MM VE L 6-9 EF,,C1776,HCPCS,Facility,Outpatient,,,,2826.25,2402.3125,810.00325,2826.25,Aetna,Medicare Advantage,1384.8625,49,,percent of total billed charges,,
PSN ASF PS 12MM VE L 6-9 EF,,C1776,HCPCS,Facility,Inpatient,,,,2826.25,2402.3125,810.00325,2826.25,Aetna,Medicare Advantage,,,,,Included in per diem rate,
PSN ASF PS 12MM VE L 6-9 EF,,C1776,HCPCS,Facility,Both,,,,2826.25,2402.3125,810.00325,2826.25,Aetna,PPO,2628.4125,93,,percent of total billed charges,,
PSN ASF PS 12MM VE L 6-9 EF,,C1776,HCPCS,Facility,Both,,,,2826.25,2402.3125,810.00325,2826.25,America's PPO,America's PPO,2714.047875,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
PSN ASF PS 12MM VE L 6-9 EF,,C1776,HCPCS,Facility,Both,,,,2826.25,2402.3125,810.00325,2826.25,BlueCross BlueShield Minnesota, Federal Employee Program,2781.03,98.4,,percent of total billed charges,,
PSN ASF PS 12MM VE L 6-9 EF,,C1776,HCPCS,Facility,Both,,,,2826.25,2402.3125,810.00325,2826.25,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,2826.25,100,,percent of total billed charges,,
PSN ASF PS 12MM VE L 6-9 EF,,C1776,HCPCS,Facility,Both,,,,2826.25,2402.3125,810.00325,2826.25,BlueCross BlueShield Minnesota,High Value Network Plan,2543.625,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
PSN ASF PS 12MM VE L 6-9 EF,,C1776,HCPCS,Facility,Outpatient,,,,2826.25,2402.3125,810.00325,2826.25,BlueCross BlueShield Minnesota,Medicare Advantage,1384.8625,49,,percent of total billed charges,,
PSN ASF PS 12MM VE L 6-9 EF,,C1776,HCPCS,Facility,Inpatient,,,,2826.25,2402.3125,810.00325,2826.25,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
PSN ASF PS 12MM VE L 6-9 EF,,C1776,HCPCS,Facility,Both,,,,2826.25,2402.3125,810.00325,2826.25,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,2503.209625,88.57,,percent of total billed charges,,
PSN ASF PS 12MM VE L 6-9 EF,,C1776,HCPCS,Facility,Both,,,,2826.25,2402.3125,810.00325,2826.25,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,810.00325,28.66,,percent of total billed charges,,
PSN ASF PS 12MM VE L 6-9 EF,,C1776,HCPCS,Facility,Outpatient,,,,2826.25,2402.3125,810.00325,2826.25,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1384.8625,49,,percent of total billed charges,,
PSN ASF PS 12MM VE L 6-9 EF,,C1776,HCPCS,Facility,Inpatient,,,,2826.25,2402.3125,810.00325,2826.25,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
PSN ASF PS 12MM VE L 6-9 EF,,C1776,HCPCS,Facility,Both,,,,2826.25,2402.3125,810.00325,2826.25,CorVel,Worker's Compensation,2826.25,100,,percent of total billed charges,,
PSN ASF PS 12MM VE L 6-9 EF,,C1776,HCPCS,Facility,Both,,,,2826.25,2402.3125,810.00325,2826.25,First Health Group Corporation,First Health Network,2741.4625,97,,percent of total billed charges,,
PSN ASF PS 12MM VE L 6-9 EF,,C1776,HCPCS,Facility,Both,,,,2826.25,2402.3125,810.00325,2826.25,"Health Partners, Inc.",Commercial,2673.6325,94.6,,percent of total billed charges,,
PSN ASF PS 12MM VE L 6-9 EF,,C1776,HCPCS,Facility,Outpatient,,,,2826.25,2402.3125,810.00325,2826.25,"Health Partners, Inc.",Medicare Advantage,1384.8625,49,,percent of total billed charges,,
PSN ASF PS 12MM VE L 6-9 EF,,C1776,HCPCS,Facility,Inpatient,,,,2826.25,2402.3125,810.00325,2826.25,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PSN ASF PS 12MM VE L 6-9 EF,,C1776,HCPCS,Facility,Both,,,,2826.25,2402.3125,810.00325,2826.25,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1695.75,60,,percent of total billed charges,,
PSN ASF PS 12MM VE L 6-9 EF,,C1776,HCPCS,Facility,Both,,,,2826.25,2402.3125,810.00325,2826.25,"Health Partners, Inc.",State of Minnesota Advantage Program,2303.39375,81.5,,percent of total billed charges,,
PSN ASF PS 12MM VE L 6-9 EF,,C1776,HCPCS,Facility,Both,,,,2826.25,2402.3125,810.00325,2826.25,"Health Partners, Inc.",State Public Programs,1413.125,50,,percent of total billed charges,,
PSN ASF PS 12MM VE L 6-9 EF,,C1776,HCPCS,Facility,Both,,,,2826.25,2402.3125,810.00325,2826.25,Humana Insurance Company,Commercial PPO,2684.9375,95,,percent of total billed charges,,
PSN ASF PS 12MM VE L 6-9 EF,,C1776,HCPCS,Facility,Outpatient,,,,2826.25,2402.3125,810.00325,2826.25,Humana Insurance Company,Medicare PPO,1384.8625,49,,percent of total billed charges,,
PSN ASF PS 12MM VE L 6-9 EF,,C1776,HCPCS,Facility,Inpatient,,,,2826.25,2402.3125,810.00325,2826.25,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
PSN ASF PS 12MM VE L 6-9 EF,,C1776,HCPCS,Facility,Both,,,,2826.25,2402.3125,810.00325,2826.25,Medica,Individual & Family,2800.81375,99.1,,percent of total billed charges,,
PSN ASF PS 12MM VE L 6-9 EF,,C1776,HCPCS,Facility,Outpatient,,,,2826.25,2402.3125,810.00325,2826.25,Medica,Medica Advantage Solution,1407.4725,49.8,,percent of total billed charges,,
PSN ASF PS 12MM VE L 6-9 EF,,C1776,HCPCS,Facility,Inpatient,,,,2826.25,2402.3125,810.00325,2826.25,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
PSN ASF PS 12MM VE L 6-9 EF,,C1776,HCPCS,Facility,Outpatient,,,,2826.25,2402.3125,810.00325,2826.25,Medica,Medical Assistance,1260.5075,44.6,,percent of total billed charges,,
PSN ASF PS 12MM VE L 6-9 EF,,C1776,HCPCS,Facility,Inpatient,,,,2826.25,2402.3125,810.00325,2826.25,Medica,Medical Assistance,,,,,Included in per diem rate,
PSN ASF PS 12MM VE L 6-9 EF,,C1776,HCPCS,Facility,Outpatient,,,,2826.25,2402.3125,810.00325,2826.25,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1407.4725,49.8,,percent of total billed charges,,
PSN ASF PS 12MM VE L 6-9 EF,,C1776,HCPCS,Facility,Inpatient,,,,2826.25,2402.3125,810.00325,2826.25,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
PSN ASF PS 12MM VE L 6-9 EF,,C1776,HCPCS,Facility,Both,,,,2826.25,2402.3125,810.00325,2826.25,"Multiplan, Inc.","Multiplan, Inc.",2656.675,94,,percent of total billed charges,,
PSN ASF PS 12MM VE L 6-9 EF,,C1776,HCPCS,Facility,Outpatient,,,,2826.25,2402.3125,810.00325,2826.25,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,2546.45125,90.1,,percent of total billed charges,,
PSN ASF PS 12MM VE L 6-9 EF,,C1776,HCPCS,Facility,Inpatient,,,,2826.25,2402.3125,810.00325,2826.25,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
PSN ASF PS 12MM VE L 6-9 EF,,C1776,HCPCS,Facility,Both,,,,2826.25,2402.3125,810.00325,2826.25,"Preferred One Administrative Services, INC.",PPO,2786.6825,98.6,,percent of total billed charges,,
PSN ASF PS 12MM VE L 6-9 EF,,C1776,HCPCS,Facility,Outpatient,,,,2826.25,2402.3125,810.00325,2826.25,PrimeWest Health,Minnesota Senior Health Options (MSHO),1454.105625,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
PSN ASF PS 12MM VE L 6-9 EF,,C1776,HCPCS,Facility,Inpatient,,,,2826.25,2402.3125,810.00325,2826.25,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PSN ASF PS 12MM VE L 6-9 EF,,C1776,HCPCS,Facility,Outpatient,,,,2826.25,2402.3125,810.00325,2826.25,PrimeWest Health,MinnesotaCare,1451.562,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
PSN ASF PS 12MM VE L 6-9 EF,,C1776,HCPCS,Facility,Inpatient,,,,2826.25,2402.3125,810.00325,2826.25,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
PSN ASF PS 12MM VE L 6-9 EF,,C1776,HCPCS,Facility,Both,,,,2826.25,2402.3125,810.00325,2826.25,Sanford Health Plan,Sanford Health Plan,2600.15,92,,percent of total billed charges,,
PSN ASF PS 12MM VE L 6-9 EF,,C1776,HCPCS,Facility,Outpatient,,,,2826.25,2402.3125,810.00325,2826.25,"UCare Health, Inc.",Individual & Family Plan,1592.591875,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
PSN ASF PS 12MM VE L 6-9 EF,,C1776,HCPCS,Facility,Inpatient,,,,2826.25,2402.3125,810.00325,2826.25,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
PSN ASF PS 12MM VE L 6-9 EF,,C1776,HCPCS,Facility,Outpatient,,,,2826.25,2402.3125,810.00325,2826.25,"UCare Health, Inc.",Medical Assistance,1426.408375,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PSN ASF PS 12MM VE L 6-9 EF,,C1776,HCPCS,Facility,Inpatient,,,,2826.25,2402.3125,810.00325,2826.25,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
PSN ASF PS 12MM VE L 6-9 EF,,C1776,HCPCS,Facility,Outpatient,,,,2826.25,2402.3125,810.00325,2826.25,"UCare Health, Inc.",Medicare Advantage,1426.408375,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PSN ASF PS 12MM VE L 6-9 EF,,C1776,HCPCS,Facility,Inpatient,,,,2826.25,2402.3125,810.00325,2826.25,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PSN ASF PS 12MM VE L 6-9 EF,,C1776,HCPCS,Facility,Outpatient,,,,2826.25,2402.3125,810.00325,2826.25,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1426.408375,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PSN ASF PS 12MM VE L 6-9 EF,,C1776,HCPCS,Facility,Inpatient,,,,2826.25,2402.3125,810.00325,2826.25,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PSN ASF PS 12MM VE L 6-9 EF,,C1776,HCPCS,Facility,Both,,,,2826.25,2402.3125,810.00325,2826.25,UnitedHealthcare,Individual & Family,2656.675,94,,percent of total billed charges,,
PSN ASF PS 12MM VE L 6-9 EF,,C1776,HCPCS,Facility,Outpatient,,,,2826.25,2402.3125,810.00325,2826.25,UnitedHealthcare,Medicare Advantage,1384.8625,49,,percent of total billed charges,,
PSN ASF PS 12MM VE L 6-9 EF,,C1776,HCPCS,Facility,Inpatient,,,,2826.25,2402.3125,810.00325,2826.25,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
PSN ASF PS 12MM VE L 6-9 EF,,C1776,HCPCS,Facility,Outpatient,,,,2826.25,2402.3125,810.00325,2826.25,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1356.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
PSN ASF PS 12MM VE L 6-9 EF,,C1776,HCPCS,Facility,Inpatient,,,,2826.25,2402.3125,810.00325,2826.25,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
PSN FEM PS CMT CCR NRW SZ7 L,,C1776,HCPCS,Facility,Both,,,,6298.5,5353.725,1805.1501,6298.5,Aetna,Commercial,5794.62,92,,percent of total billed charges,,
PSN FEM PS CMT CCR NRW SZ7 L,,C1776,HCPCS,Facility,Outpatient,,,,6298.5,5353.725,1805.1501,6298.5,Aetna,Medicare Advantage,3086.265,49,,percent of total billed charges,,
PSN FEM PS CMT CCR NRW SZ7 L,,C1776,HCPCS,Facility,Inpatient,,,,6298.5,5353.725,1805.1501,6298.5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
PSN FEM PS CMT CCR NRW SZ7 L,,C1776,HCPCS,Facility,Both,,,,6298.5,5353.725,1805.1501,6298.5,Aetna,PPO,5857.605,93,,percent of total billed charges,,
PSN FEM PS CMT CCR NRW SZ7 L,,C1776,HCPCS,Facility,Both,,,,6298.5,5353.725,1805.1501,6298.5,America's PPO,America's PPO,6048.44955,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
PSN FEM PS CMT CCR NRW SZ7 L,,C1776,HCPCS,Facility,Both,,,,6298.5,5353.725,1805.1501,6298.5,BlueCross BlueShield Minnesota, Federal Employee Program,6197.724,98.4,,percent of total billed charges,,
PSN FEM PS CMT CCR NRW SZ7 L,,C1776,HCPCS,Facility,Both,,,,6298.5,5353.725,1805.1501,6298.5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,6298.5,100,,percent of total billed charges,,
PSN FEM PS CMT CCR NRW SZ7 L,,C1776,HCPCS,Facility,Both,,,,6298.5,5353.725,1805.1501,6298.5,BlueCross BlueShield Minnesota,High Value Network Plan,5668.65,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
PSN FEM PS CMT CCR NRW SZ7 L,,C1776,HCPCS,Facility,Outpatient,,,,6298.5,5353.725,1805.1501,6298.5,BlueCross BlueShield Minnesota,Medicare Advantage,3086.265,49,,percent of total billed charges,,
PSN FEM PS CMT CCR NRW SZ7 L,,C1776,HCPCS,Facility,Inpatient,,,,6298.5,5353.725,1805.1501,6298.5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
PSN FEM PS CMT CCR NRW SZ7 L,,C1776,HCPCS,Facility,Both,,,,6298.5,5353.725,1805.1501,6298.5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,5578.58145,88.57,,percent of total billed charges,,
PSN FEM PS CMT CCR NRW SZ7 L,,C1776,HCPCS,Facility,Both,,,,6298.5,5353.725,1805.1501,6298.5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1805.1501,28.66,,percent of total billed charges,,
PSN FEM PS CMT CCR NRW SZ7 L,,C1776,HCPCS,Facility,Outpatient,,,,6298.5,5353.725,1805.1501,6298.5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),3086.265,49,,percent of total billed charges,,
PSN FEM PS CMT CCR NRW SZ7 L,,C1776,HCPCS,Facility,Inpatient,,,,6298.5,5353.725,1805.1501,6298.5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
PSN FEM PS CMT CCR NRW SZ7 L,,C1776,HCPCS,Facility,Both,,,,6298.5,5353.725,1805.1501,6298.5,CorVel,Worker's Compensation,6298.5,100,,percent of total billed charges,,
PSN FEM PS CMT CCR NRW SZ7 L,,C1776,HCPCS,Facility,Both,,,,6298.5,5353.725,1805.1501,6298.5,First Health Group Corporation,First Health Network,6109.545,97,,percent of total billed charges,,
PSN FEM PS CMT CCR NRW SZ7 L,,C1776,HCPCS,Facility,Both,,,,6298.5,5353.725,1805.1501,6298.5,"Health Partners, Inc.",Commercial,5958.381,94.6,,percent of total billed charges,,
PSN FEM PS CMT CCR NRW SZ7 L,,C1776,HCPCS,Facility,Outpatient,,,,6298.5,5353.725,1805.1501,6298.5,"Health Partners, Inc.",Medicare Advantage,3086.265,49,,percent of total billed charges,,
PSN FEM PS CMT CCR NRW SZ7 L,,C1776,HCPCS,Facility,Inpatient,,,,6298.5,5353.725,1805.1501,6298.5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PSN FEM PS CMT CCR NRW SZ7 L,,C1776,HCPCS,Facility,Both,,,,6298.5,5353.725,1805.1501,6298.5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3779.1,60,,percent of total billed charges,,
PSN FEM PS CMT CCR NRW SZ7 L,,C1776,HCPCS,Facility,Both,,,,6298.5,5353.725,1805.1501,6298.5,"Health Partners, Inc.",State of Minnesota Advantage Program,5133.2775,81.5,,percent of total billed charges,,
PSN FEM PS CMT CCR NRW SZ7 L,,C1776,HCPCS,Facility,Both,,,,6298.5,5353.725,1805.1501,6298.5,"Health Partners, Inc.",State Public Programs,3149.25,50,,percent of total billed charges,,
PSN FEM PS CMT CCR NRW SZ7 L,,C1776,HCPCS,Facility,Both,,,,6298.5,5353.725,1805.1501,6298.5,Humana Insurance Company,Commercial PPO,5983.575,95,,percent of total billed charges,,
PSN FEM PS CMT CCR NRW SZ7 L,,C1776,HCPCS,Facility,Outpatient,,,,6298.5,5353.725,1805.1501,6298.5,Humana Insurance Company,Medicare PPO,3086.265,49,,percent of total billed charges,,
PSN FEM PS CMT CCR NRW SZ7 L,,C1776,HCPCS,Facility,Inpatient,,,,6298.5,5353.725,1805.1501,6298.5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
PSN FEM PS CMT CCR NRW SZ7 L,,C1776,HCPCS,Facility,Both,,,,6298.5,5353.725,1805.1501,6298.5,Medica,Individual & Family,6241.8135,99.1,,percent of total billed charges,,
PSN FEM PS CMT CCR NRW SZ7 L,,C1776,HCPCS,Facility,Outpatient,,,,6298.5,5353.725,1805.1501,6298.5,Medica,Medica Advantage Solution,3136.653,49.8,,percent of total billed charges,,
PSN FEM PS CMT CCR NRW SZ7 L,,C1776,HCPCS,Facility,Inpatient,,,,6298.5,5353.725,1805.1501,6298.5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
PSN FEM PS CMT CCR NRW SZ7 L,,C1776,HCPCS,Facility,Outpatient,,,,6298.5,5353.725,1805.1501,6298.5,Medica,Medical Assistance,2809.131,44.6,,percent of total billed charges,,
PSN FEM PS CMT CCR NRW SZ7 L,,C1776,HCPCS,Facility,Inpatient,,,,6298.5,5353.725,1805.1501,6298.5,Medica,Medical Assistance,,,,,Included in per diem rate,
PSN FEM PS CMT CCR NRW SZ7 L,,C1776,HCPCS,Facility,Outpatient,,,,6298.5,5353.725,1805.1501,6298.5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,3136.653,49.8,,percent of total billed charges,,
PSN FEM PS CMT CCR NRW SZ7 L,,C1776,HCPCS,Facility,Inpatient,,,,6298.5,5353.725,1805.1501,6298.5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
PSN FEM PS CMT CCR NRW SZ7 L,,C1776,HCPCS,Facility,Both,,,,6298.5,5353.725,1805.1501,6298.5,"Multiplan, Inc.","Multiplan, Inc.",5920.59,94,,percent of total billed charges,,
PSN FEM PS CMT CCR NRW SZ7 L,,C1776,HCPCS,Facility,Outpatient,,,,6298.5,5353.725,1805.1501,6298.5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,5674.9485,90.1,,percent of total billed charges,,
PSN FEM PS CMT CCR NRW SZ7 L,,C1776,HCPCS,Facility,Inpatient,,,,6298.5,5353.725,1805.1501,6298.5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
PSN FEM PS CMT CCR NRW SZ7 L,,C1776,HCPCS,Facility,Both,,,,6298.5,5353.725,1805.1501,6298.5,"Preferred One Administrative Services, INC.",PPO,6210.321,98.6,,percent of total billed charges,,
PSN FEM PS CMT CCR NRW SZ7 L,,C1776,HCPCS,Facility,Outpatient,,,,6298.5,5353.725,1805.1501,6298.5,PrimeWest Health,Minnesota Senior Health Options (MSHO),3240.57825,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
PSN FEM PS CMT CCR NRW SZ7 L,,C1776,HCPCS,Facility,Inpatient,,,,6298.5,5353.725,1805.1501,6298.5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PSN FEM PS CMT CCR NRW SZ7 L,,C1776,HCPCS,Facility,Outpatient,,,,6298.5,5353.725,1805.1501,6298.5,PrimeWest Health,MinnesotaCare,3234.9096,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
PSN FEM PS CMT CCR NRW SZ7 L,,C1776,HCPCS,Facility,Inpatient,,,,6298.5,5353.725,1805.1501,6298.5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
PSN FEM PS CMT CCR NRW SZ7 L,,C1776,HCPCS,Facility,Both,,,,6298.5,5353.725,1805.1501,6298.5,Sanford Health Plan,Sanford Health Plan,5794.62,92,,percent of total billed charges,,
PSN FEM PS CMT CCR NRW SZ7 L,,C1776,HCPCS,Facility,Outpatient,,,,6298.5,5353.725,1805.1501,6298.5,"UCare Health, Inc.",Individual & Family Plan,3549.20475,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
PSN FEM PS CMT CCR NRW SZ7 L,,C1776,HCPCS,Facility,Inpatient,,,,6298.5,5353.725,1805.1501,6298.5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
PSN FEM PS CMT CCR NRW SZ7 L,,C1776,HCPCS,Facility,Outpatient,,,,6298.5,5353.725,1805.1501,6298.5,"UCare Health, Inc.",Medical Assistance,3178.85295,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PSN FEM PS CMT CCR NRW SZ7 L,,C1776,HCPCS,Facility,Inpatient,,,,6298.5,5353.725,1805.1501,6298.5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
PSN FEM PS CMT CCR NRW SZ7 L,,C1776,HCPCS,Facility,Outpatient,,,,6298.5,5353.725,1805.1501,6298.5,"UCare Health, Inc.",Medicare Advantage,3178.85295,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PSN FEM PS CMT CCR NRW SZ7 L,,C1776,HCPCS,Facility,Inpatient,,,,6298.5,5353.725,1805.1501,6298.5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PSN FEM PS CMT CCR NRW SZ7 L,,C1776,HCPCS,Facility,Outpatient,,,,6298.5,5353.725,1805.1501,6298.5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),3178.85295,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PSN FEM PS CMT CCR NRW SZ7 L,,C1776,HCPCS,Facility,Inpatient,,,,6298.5,5353.725,1805.1501,6298.5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PSN FEM PS CMT CCR NRW SZ7 L,,C1776,HCPCS,Facility,Both,,,,6298.5,5353.725,1805.1501,6298.5,UnitedHealthcare,Individual & Family,5920.59,94,,percent of total billed charges,,
PSN FEM PS CMT CCR NRW SZ7 L,,C1776,HCPCS,Facility,Outpatient,,,,6298.5,5353.725,1805.1501,6298.5,UnitedHealthcare,Medicare Advantage,3086.265,49,,percent of total billed charges,,
PSN FEM PS CMT CCR NRW SZ7 L,,C1776,HCPCS,Facility,Inpatient,,,,6298.5,5353.725,1805.1501,6298.5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
PSN FEM PS CMT CCR NRW SZ7 L,,C1776,HCPCS,Facility,Outpatient,,,,6298.5,5353.725,1805.1501,6298.5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,3023.28,48,,percent of total billed charges,,100% of DHS outpatient percentage
PSN FEM PS CMT CCR NRW SZ7 L,,C1776,HCPCS,Facility,Inpatient,,,,6298.5,5353.725,1805.1501,6298.5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
PSN FEM PS CMT CCR NRW SZ8 R,,C1776,HCPCS,Facility,Both,,,,6298.5,5353.725,1805.1501,6298.5,Aetna,Commercial,5794.62,92,,percent of total billed charges,,
PSN FEM PS CMT CCR NRW SZ8 R,,C1776,HCPCS,Facility,Outpatient,,,,6298.5,5353.725,1805.1501,6298.5,Aetna,Medicare Advantage,3086.265,49,,percent of total billed charges,,
PSN FEM PS CMT CCR NRW SZ8 R,,C1776,HCPCS,Facility,Inpatient,,,,6298.5,5353.725,1805.1501,6298.5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
PSN FEM PS CMT CCR NRW SZ8 R,,C1776,HCPCS,Facility,Both,,,,6298.5,5353.725,1805.1501,6298.5,Aetna,PPO,5857.605,93,,percent of total billed charges,,
PSN FEM PS CMT CCR NRW SZ8 R,,C1776,HCPCS,Facility,Both,,,,6298.5,5353.725,1805.1501,6298.5,America's PPO,America's PPO,6048.44955,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
PSN FEM PS CMT CCR NRW SZ8 R,,C1776,HCPCS,Facility,Both,,,,6298.5,5353.725,1805.1501,6298.5,BlueCross BlueShield Minnesota, Federal Employee Program,6197.724,98.4,,percent of total billed charges,,
PSN FEM PS CMT CCR NRW SZ8 R,,C1776,HCPCS,Facility,Both,,,,6298.5,5353.725,1805.1501,6298.5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,6298.5,100,,percent of total billed charges,,
PSN FEM PS CMT CCR NRW SZ8 R,,C1776,HCPCS,Facility,Both,,,,6298.5,5353.725,1805.1501,6298.5,BlueCross BlueShield Minnesota,High Value Network Plan,5668.65,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
PSN FEM PS CMT CCR NRW SZ8 R,,C1776,HCPCS,Facility,Outpatient,,,,6298.5,5353.725,1805.1501,6298.5,BlueCross BlueShield Minnesota,Medicare Advantage,3086.265,49,,percent of total billed charges,,
PSN FEM PS CMT CCR NRW SZ8 R,,C1776,HCPCS,Facility,Inpatient,,,,6298.5,5353.725,1805.1501,6298.5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
PSN FEM PS CMT CCR NRW SZ8 R,,C1776,HCPCS,Facility,Both,,,,6298.5,5353.725,1805.1501,6298.5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,5578.58145,88.57,,percent of total billed charges,,
PSN FEM PS CMT CCR NRW SZ8 R,,C1776,HCPCS,Facility,Both,,,,6298.5,5353.725,1805.1501,6298.5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1805.1501,28.66,,percent of total billed charges,,
PSN FEM PS CMT CCR NRW SZ8 R,,C1776,HCPCS,Facility,Outpatient,,,,6298.5,5353.725,1805.1501,6298.5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),3086.265,49,,percent of total billed charges,,
PSN FEM PS CMT CCR NRW SZ8 R,,C1776,HCPCS,Facility,Inpatient,,,,6298.5,5353.725,1805.1501,6298.5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
PSN FEM PS CMT CCR NRW SZ8 R,,C1776,HCPCS,Facility,Both,,,,6298.5,5353.725,1805.1501,6298.5,CorVel,Worker's Compensation,6298.5,100,,percent of total billed charges,,
PSN FEM PS CMT CCR NRW SZ8 R,,C1776,HCPCS,Facility,Both,,,,6298.5,5353.725,1805.1501,6298.5,First Health Group Corporation,First Health Network,6109.545,97,,percent of total billed charges,,
PSN FEM PS CMT CCR NRW SZ8 R,,C1776,HCPCS,Facility,Both,,,,6298.5,5353.725,1805.1501,6298.5,"Health Partners, Inc.",Commercial,5958.381,94.6,,percent of total billed charges,,
PSN FEM PS CMT CCR NRW SZ8 R,,C1776,HCPCS,Facility,Outpatient,,,,6298.5,5353.725,1805.1501,6298.5,"Health Partners, Inc.",Medicare Advantage,3086.265,49,,percent of total billed charges,,
PSN FEM PS CMT CCR NRW SZ8 R,,C1776,HCPCS,Facility,Inpatient,,,,6298.5,5353.725,1805.1501,6298.5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PSN FEM PS CMT CCR NRW SZ8 R,,C1776,HCPCS,Facility,Both,,,,6298.5,5353.725,1805.1501,6298.5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3779.1,60,,percent of total billed charges,,
PSN FEM PS CMT CCR NRW SZ8 R,,C1776,HCPCS,Facility,Both,,,,6298.5,5353.725,1805.1501,6298.5,"Health Partners, Inc.",State of Minnesota Advantage Program,5133.2775,81.5,,percent of total billed charges,,
PSN FEM PS CMT CCR NRW SZ8 R,,C1776,HCPCS,Facility,Both,,,,6298.5,5353.725,1805.1501,6298.5,"Health Partners, Inc.",State Public Programs,3149.25,50,,percent of total billed charges,,
PSN FEM PS CMT CCR NRW SZ8 R,,C1776,HCPCS,Facility,Both,,,,6298.5,5353.725,1805.1501,6298.5,Humana Insurance Company,Commercial PPO,5983.575,95,,percent of total billed charges,,
PSN FEM PS CMT CCR NRW SZ8 R,,C1776,HCPCS,Facility,Outpatient,,,,6298.5,5353.725,1805.1501,6298.5,Humana Insurance Company,Medicare PPO,3086.265,49,,percent of total billed charges,,
PSN FEM PS CMT CCR NRW SZ8 R,,C1776,HCPCS,Facility,Inpatient,,,,6298.5,5353.725,1805.1501,6298.5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
PSN FEM PS CMT CCR NRW SZ8 R,,C1776,HCPCS,Facility,Both,,,,6298.5,5353.725,1805.1501,6298.5,Medica,Individual & Family,6241.8135,99.1,,percent of total billed charges,,
PSN FEM PS CMT CCR NRW SZ8 R,,C1776,HCPCS,Facility,Outpatient,,,,6298.5,5353.725,1805.1501,6298.5,Medica,Medica Advantage Solution,3136.653,49.8,,percent of total billed charges,,
PSN FEM PS CMT CCR NRW SZ8 R,,C1776,HCPCS,Facility,Inpatient,,,,6298.5,5353.725,1805.1501,6298.5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
PSN FEM PS CMT CCR NRW SZ8 R,,C1776,HCPCS,Facility,Outpatient,,,,6298.5,5353.725,1805.1501,6298.5,Medica,Medical Assistance,2809.131,44.6,,percent of total billed charges,,
PSN FEM PS CMT CCR NRW SZ8 R,,C1776,HCPCS,Facility,Inpatient,,,,6298.5,5353.725,1805.1501,6298.5,Medica,Medical Assistance,,,,,Included in per diem rate,
PSN FEM PS CMT CCR NRW SZ8 R,,C1776,HCPCS,Facility,Outpatient,,,,6298.5,5353.725,1805.1501,6298.5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,3136.653,49.8,,percent of total billed charges,,
PSN FEM PS CMT CCR NRW SZ8 R,,C1776,HCPCS,Facility,Inpatient,,,,6298.5,5353.725,1805.1501,6298.5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
PSN FEM PS CMT CCR NRW SZ8 R,,C1776,HCPCS,Facility,Both,,,,6298.5,5353.725,1805.1501,6298.5,"Multiplan, Inc.","Multiplan, Inc.",5920.59,94,,percent of total billed charges,,
PSN FEM PS CMT CCR NRW SZ8 R,,C1776,HCPCS,Facility,Outpatient,,,,6298.5,5353.725,1805.1501,6298.5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,5674.9485,90.1,,percent of total billed charges,,
PSN FEM PS CMT CCR NRW SZ8 R,,C1776,HCPCS,Facility,Inpatient,,,,6298.5,5353.725,1805.1501,6298.5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
PSN FEM PS CMT CCR NRW SZ8 R,,C1776,HCPCS,Facility,Both,,,,6298.5,5353.725,1805.1501,6298.5,"Preferred One Administrative Services, INC.",PPO,6210.321,98.6,,percent of total billed charges,,
PSN FEM PS CMT CCR NRW SZ8 R,,C1776,HCPCS,Facility,Outpatient,,,,6298.5,5353.725,1805.1501,6298.5,PrimeWest Health,Minnesota Senior Health Options (MSHO),3240.57825,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
PSN FEM PS CMT CCR NRW SZ8 R,,C1776,HCPCS,Facility,Inpatient,,,,6298.5,5353.725,1805.1501,6298.5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PSN FEM PS CMT CCR NRW SZ8 R,,C1776,HCPCS,Facility,Outpatient,,,,6298.5,5353.725,1805.1501,6298.5,PrimeWest Health,MinnesotaCare,3234.9096,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
PSN FEM PS CMT CCR NRW SZ8 R,,C1776,HCPCS,Facility,Inpatient,,,,6298.5,5353.725,1805.1501,6298.5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
PSN FEM PS CMT CCR NRW SZ8 R,,C1776,HCPCS,Facility,Both,,,,6298.5,5353.725,1805.1501,6298.5,Sanford Health Plan,Sanford Health Plan,5794.62,92,,percent of total billed charges,,
PSN FEM PS CMT CCR NRW SZ8 R,,C1776,HCPCS,Facility,Outpatient,,,,6298.5,5353.725,1805.1501,6298.5,"UCare Health, Inc.",Individual & Family Plan,3549.20475,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
PSN FEM PS CMT CCR NRW SZ8 R,,C1776,HCPCS,Facility,Inpatient,,,,6298.5,5353.725,1805.1501,6298.5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
PSN FEM PS CMT CCR NRW SZ8 R,,C1776,HCPCS,Facility,Outpatient,,,,6298.5,5353.725,1805.1501,6298.5,"UCare Health, Inc.",Medical Assistance,3178.85295,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PSN FEM PS CMT CCR NRW SZ8 R,,C1776,HCPCS,Facility,Inpatient,,,,6298.5,5353.725,1805.1501,6298.5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
PSN FEM PS CMT CCR NRW SZ8 R,,C1776,HCPCS,Facility,Outpatient,,,,6298.5,5353.725,1805.1501,6298.5,"UCare Health, Inc.",Medicare Advantage,3178.85295,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PSN FEM PS CMT CCR NRW SZ8 R,,C1776,HCPCS,Facility,Inpatient,,,,6298.5,5353.725,1805.1501,6298.5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PSN FEM PS CMT CCR NRW SZ8 R,,C1776,HCPCS,Facility,Outpatient,,,,6298.5,5353.725,1805.1501,6298.5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),3178.85295,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PSN FEM PS CMT CCR NRW SZ8 R,,C1776,HCPCS,Facility,Inpatient,,,,6298.5,5353.725,1805.1501,6298.5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PSN FEM PS CMT CCR NRW SZ8 R,,C1776,HCPCS,Facility,Both,,,,6298.5,5353.725,1805.1501,6298.5,UnitedHealthcare,Individual & Family,5920.59,94,,percent of total billed charges,,
PSN FEM PS CMT CCR NRW SZ8 R,,C1776,HCPCS,Facility,Outpatient,,,,6298.5,5353.725,1805.1501,6298.5,UnitedHealthcare,Medicare Advantage,3086.265,49,,percent of total billed charges,,
PSN FEM PS CMT CCR NRW SZ8 R,,C1776,HCPCS,Facility,Inpatient,,,,6298.5,5353.725,1805.1501,6298.5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
PSN FEM PS CMT CCR NRW SZ8 R,,C1776,HCPCS,Facility,Outpatient,,,,6298.5,5353.725,1805.1501,6298.5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,3023.28,48,,percent of total billed charges,,100% of DHS outpatient percentage
PSN FEM PS CMT CCR NRW SZ8 R,,C1776,HCPCS,Facility,Inpatient,,,,6298.5,5353.725,1805.1501,6298.5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
PSN FEM PS CMT TIV STD SZ 10R,,C1776,HCPCS,Facility,Both,,,,6460,5491,1851.436,6460,Aetna,Commercial,5943.2,92,,percent of total billed charges,,
PSN FEM PS CMT TIV STD SZ 10R,,C1776,HCPCS,Facility,Outpatient,,,,6460,5491,1851.436,6460,Aetna,Medicare Advantage,3165.4,49,,percent of total billed charges,,
PSN FEM PS CMT TIV STD SZ 10R,,C1776,HCPCS,Facility,Inpatient,,,,6460,5491,1851.436,6460,Aetna,Medicare Advantage,,,,,Included in per diem rate,
PSN FEM PS CMT TIV STD SZ 10R,,C1776,HCPCS,Facility,Both,,,,6460,5491,1851.436,6460,Aetna,PPO,6007.8,93,,percent of total billed charges,,
PSN FEM PS CMT TIV STD SZ 10R,,C1776,HCPCS,Facility,Both,,,,6460,5491,1851.436,6460,America's PPO,America's PPO,6203.538,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
PSN FEM PS CMT TIV STD SZ 10R,,C1776,HCPCS,Facility,Both,,,,6460,5491,1851.436,6460,BlueCross BlueShield Minnesota, Federal Employee Program,6356.64,98.4,,percent of total billed charges,,
PSN FEM PS CMT TIV STD SZ 10R,,C1776,HCPCS,Facility,Both,,,,6460,5491,1851.436,6460,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,6460,100,,percent of total billed charges,,
PSN FEM PS CMT TIV STD SZ 10R,,C1776,HCPCS,Facility,Both,,,,6460,5491,1851.436,6460,BlueCross BlueShield Minnesota,High Value Network Plan,5814,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
PSN FEM PS CMT TIV STD SZ 10R,,C1776,HCPCS,Facility,Outpatient,,,,6460,5491,1851.436,6460,BlueCross BlueShield Minnesota,Medicare Advantage,3165.4,49,,percent of total billed charges,,
PSN FEM PS CMT TIV STD SZ 10R,,C1776,HCPCS,Facility,Inpatient,,,,6460,5491,1851.436,6460,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
PSN FEM PS CMT TIV STD SZ 10R,,C1776,HCPCS,Facility,Both,,,,6460,5491,1851.436,6460,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,5721.622,88.57,,percent of total billed charges,,
PSN FEM PS CMT TIV STD SZ 10R,,C1776,HCPCS,Facility,Both,,,,6460,5491,1851.436,6460,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1851.436,28.66,,percent of total billed charges,,
PSN FEM PS CMT TIV STD SZ 10R,,C1776,HCPCS,Facility,Outpatient,,,,6460,5491,1851.436,6460,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),3165.4,49,,percent of total billed charges,,
PSN FEM PS CMT TIV STD SZ 10R,,C1776,HCPCS,Facility,Inpatient,,,,6460,5491,1851.436,6460,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
PSN FEM PS CMT TIV STD SZ 10R,,C1776,HCPCS,Facility,Both,,,,6460,5491,1851.436,6460,CorVel,Worker's Compensation,6460,100,,percent of total billed charges,,
PSN FEM PS CMT TIV STD SZ 10R,,C1776,HCPCS,Facility,Both,,,,6460,5491,1851.436,6460,First Health Group Corporation,First Health Network,6266.2,97,,percent of total billed charges,,
PSN FEM PS CMT TIV STD SZ 10R,,C1776,HCPCS,Facility,Both,,,,6460,5491,1851.436,6460,"Health Partners, Inc.",Commercial,6111.16,94.6,,percent of total billed charges,,
PSN FEM PS CMT TIV STD SZ 10R,,C1776,HCPCS,Facility,Outpatient,,,,6460,5491,1851.436,6460,"Health Partners, Inc.",Medicare Advantage,3165.4,49,,percent of total billed charges,,
PSN FEM PS CMT TIV STD SZ 10R,,C1776,HCPCS,Facility,Inpatient,,,,6460,5491,1851.436,6460,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PSN FEM PS CMT TIV STD SZ 10R,,C1776,HCPCS,Facility,Both,,,,6460,5491,1851.436,6460,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3876,60,,percent of total billed charges,,
PSN FEM PS CMT TIV STD SZ 10R,,C1776,HCPCS,Facility,Both,,,,6460,5491,1851.436,6460,"Health Partners, Inc.",State of Minnesota Advantage Program,5264.9,81.5,,percent of total billed charges,,
PSN FEM PS CMT TIV STD SZ 10R,,C1776,HCPCS,Facility,Both,,,,6460,5491,1851.436,6460,"Health Partners, Inc.",State Public Programs,3230,50,,percent of total billed charges,,
PSN FEM PS CMT TIV STD SZ 10R,,C1776,HCPCS,Facility,Both,,,,6460,5491,1851.436,6460,Humana Insurance Company,Commercial PPO,6137,95,,percent of total billed charges,,
PSN FEM PS CMT TIV STD SZ 10R,,C1776,HCPCS,Facility,Outpatient,,,,6460,5491,1851.436,6460,Humana Insurance Company,Medicare PPO,3165.4,49,,percent of total billed charges,,
PSN FEM PS CMT TIV STD SZ 10R,,C1776,HCPCS,Facility,Inpatient,,,,6460,5491,1851.436,6460,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
PSN FEM PS CMT TIV STD SZ 10R,,C1776,HCPCS,Facility,Both,,,,6460,5491,1851.436,6460,Medica,Individual & Family,6401.86,99.1,,percent of total billed charges,,
PSN FEM PS CMT TIV STD SZ 10R,,C1776,HCPCS,Facility,Outpatient,,,,6460,5491,1851.436,6460,Medica,Medica Advantage Solution,3217.08,49.8,,percent of total billed charges,,
PSN FEM PS CMT TIV STD SZ 10R,,C1776,HCPCS,Facility,Inpatient,,,,6460,5491,1851.436,6460,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
PSN FEM PS CMT TIV STD SZ 10R,,C1776,HCPCS,Facility,Outpatient,,,,6460,5491,1851.436,6460,Medica,Medical Assistance,2881.16,44.6,,percent of total billed charges,,
PSN FEM PS CMT TIV STD SZ 10R,,C1776,HCPCS,Facility,Inpatient,,,,6460,5491,1851.436,6460,Medica,Medical Assistance,,,,,Included in per diem rate,
PSN FEM PS CMT TIV STD SZ 10R,,C1776,HCPCS,Facility,Outpatient,,,,6460,5491,1851.436,6460,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,3217.08,49.8,,percent of total billed charges,,
PSN FEM PS CMT TIV STD SZ 10R,,C1776,HCPCS,Facility,Inpatient,,,,6460,5491,1851.436,6460,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
PSN FEM PS CMT TIV STD SZ 10R,,C1776,HCPCS,Facility,Both,,,,6460,5491,1851.436,6460,"Multiplan, Inc.","Multiplan, Inc.",6072.4,94,,percent of total billed charges,,
PSN FEM PS CMT TIV STD SZ 10R,,C1776,HCPCS,Facility,Outpatient,,,,6460,5491,1851.436,6460,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,5820.46,90.1,,percent of total billed charges,,
PSN FEM PS CMT TIV STD SZ 10R,,C1776,HCPCS,Facility,Inpatient,,,,6460,5491,1851.436,6460,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
PSN FEM PS CMT TIV STD SZ 10R,,C1776,HCPCS,Facility,Both,,,,6460,5491,1851.436,6460,"Preferred One Administrative Services, INC.",PPO,6369.56,98.6,,percent of total billed charges,,
PSN FEM PS CMT TIV STD SZ 10R,,C1776,HCPCS,Facility,Outpatient,,,,6460,5491,1851.436,6460,PrimeWest Health,Minnesota Senior Health Options (MSHO),3323.67,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
PSN FEM PS CMT TIV STD SZ 10R,,C1776,HCPCS,Facility,Inpatient,,,,6460,5491,1851.436,6460,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PSN FEM PS CMT TIV STD SZ 10R,,C1776,HCPCS,Facility,Outpatient,,,,6460,5491,1851.436,6460,PrimeWest Health,MinnesotaCare,3317.856,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
PSN FEM PS CMT TIV STD SZ 10R,,C1776,HCPCS,Facility,Inpatient,,,,6460,5491,1851.436,6460,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
PSN FEM PS CMT TIV STD SZ 10R,,C1776,HCPCS,Facility,Both,,,,6460,5491,1851.436,6460,Sanford Health Plan,Sanford Health Plan,5943.2,92,,percent of total billed charges,,
PSN FEM PS CMT TIV STD SZ 10R,,C1776,HCPCS,Facility,Outpatient,,,,6460,5491,1851.436,6460,"UCare Health, Inc.",Individual & Family Plan,3640.21,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
PSN FEM PS CMT TIV STD SZ 10R,,C1776,HCPCS,Facility,Inpatient,,,,6460,5491,1851.436,6460,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
PSN FEM PS CMT TIV STD SZ 10R,,C1776,HCPCS,Facility,Outpatient,,,,6460,5491,1851.436,6460,"UCare Health, Inc.",Medical Assistance,3260.362,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PSN FEM PS CMT TIV STD SZ 10R,,C1776,HCPCS,Facility,Inpatient,,,,6460,5491,1851.436,6460,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
PSN FEM PS CMT TIV STD SZ 10R,,C1776,HCPCS,Facility,Outpatient,,,,6460,5491,1851.436,6460,"UCare Health, Inc.",Medicare Advantage,3260.362,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PSN FEM PS CMT TIV STD SZ 10R,,C1776,HCPCS,Facility,Inpatient,,,,6460,5491,1851.436,6460,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PSN FEM PS CMT TIV STD SZ 10R,,C1776,HCPCS,Facility,Outpatient,,,,6460,5491,1851.436,6460,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),3260.362,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PSN FEM PS CMT TIV STD SZ 10R,,C1776,HCPCS,Facility,Inpatient,,,,6460,5491,1851.436,6460,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PSN FEM PS CMT TIV STD SZ 10R,,C1776,HCPCS,Facility,Both,,,,6460,5491,1851.436,6460,UnitedHealthcare,Individual & Family,6072.4,94,,percent of total billed charges,,
PSN FEM PS CMT TIV STD SZ 10R,,C1776,HCPCS,Facility,Outpatient,,,,6460,5491,1851.436,6460,UnitedHealthcare,Medicare Advantage,3165.4,49,,percent of total billed charges,,
PSN FEM PS CMT TIV STD SZ 10R,,C1776,HCPCS,Facility,Inpatient,,,,6460,5491,1851.436,6460,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
PSN FEM PS CMT TIV STD SZ 10R,,C1776,HCPCS,Facility,Outpatient,,,,6460,5491,1851.436,6460,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,3100.8,48,,percent of total billed charges,,100% of DHS outpatient percentage
PSN FEM PS CMT TIV STD SZ 10R,,C1776,HCPCS,Facility,Inpatient,,,,6460,5491,1851.436,6460,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
PSN FEM PS POR CCR STD SZ10 R,,C1776,HCPCS,Facility,Both,,,,7913.5,6726.475,2268.0091,7913.5,Aetna,Commercial,7280.42,92,,percent of total billed charges,,
PSN FEM PS POR CCR STD SZ10 R,,C1776,HCPCS,Facility,Outpatient,,,,7913.5,6726.475,2268.0091,7913.5,Aetna,Medicare Advantage,3877.615,49,,percent of total billed charges,,
PSN FEM PS POR CCR STD SZ10 R,,C1776,HCPCS,Facility,Inpatient,,,,7913.5,6726.475,2268.0091,7913.5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
PSN FEM PS POR CCR STD SZ10 R,,C1776,HCPCS,Facility,Both,,,,7913.5,6726.475,2268.0091,7913.5,Aetna,PPO,7359.555,93,,percent of total billed charges,,
PSN FEM PS POR CCR STD SZ10 R,,C1776,HCPCS,Facility,Both,,,,7913.5,6726.475,2268.0091,7913.5,America's PPO,America's PPO,7599.33405,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
PSN FEM PS POR CCR STD SZ10 R,,C1776,HCPCS,Facility,Both,,,,7913.5,6726.475,2268.0091,7913.5,BlueCross BlueShield Minnesota, Federal Employee Program,7786.884,98.4,,percent of total billed charges,,
PSN FEM PS POR CCR STD SZ10 R,,C1776,HCPCS,Facility,Both,,,,7913.5,6726.475,2268.0091,7913.5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,7913.5,100,,percent of total billed charges,,
PSN FEM PS POR CCR STD SZ10 R,,C1776,HCPCS,Facility,Both,,,,7913.5,6726.475,2268.0091,7913.5,BlueCross BlueShield Minnesota,High Value Network Plan,7122.15,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
PSN FEM PS POR CCR STD SZ10 R,,C1776,HCPCS,Facility,Outpatient,,,,7913.5,6726.475,2268.0091,7913.5,BlueCross BlueShield Minnesota,Medicare Advantage,3877.615,49,,percent of total billed charges,,
PSN FEM PS POR CCR STD SZ10 R,,C1776,HCPCS,Facility,Inpatient,,,,7913.5,6726.475,2268.0091,7913.5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
PSN FEM PS POR CCR STD SZ10 R,,C1776,HCPCS,Facility,Both,,,,7913.5,6726.475,2268.0091,7913.5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,7008.98695,88.57,,percent of total billed charges,,
PSN FEM PS POR CCR STD SZ10 R,,C1776,HCPCS,Facility,Both,,,,7913.5,6726.475,2268.0091,7913.5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,2268.0091,28.66,,percent of total billed charges,,
PSN FEM PS POR CCR STD SZ10 R,,C1776,HCPCS,Facility,Outpatient,,,,7913.5,6726.475,2268.0091,7913.5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),3877.615,49,,percent of total billed charges,,
PSN FEM PS POR CCR STD SZ10 R,,C1776,HCPCS,Facility,Inpatient,,,,7913.5,6726.475,2268.0091,7913.5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
PSN FEM PS POR CCR STD SZ10 R,,C1776,HCPCS,Facility,Both,,,,7913.5,6726.475,2268.0091,7913.5,CorVel,Worker's Compensation,7913.5,100,,percent of total billed charges,,
PSN FEM PS POR CCR STD SZ10 R,,C1776,HCPCS,Facility,Both,,,,7913.5,6726.475,2268.0091,7913.5,First Health Group Corporation,First Health Network,7676.095,97,,percent of total billed charges,,
PSN FEM PS POR CCR STD SZ10 R,,C1776,HCPCS,Facility,Both,,,,7913.5,6726.475,2268.0091,7913.5,"Health Partners, Inc.",Commercial,7486.171,94.6,,percent of total billed charges,,
PSN FEM PS POR CCR STD SZ10 R,,C1776,HCPCS,Facility,Outpatient,,,,7913.5,6726.475,2268.0091,7913.5,"Health Partners, Inc.",Medicare Advantage,3877.615,49,,percent of total billed charges,,
PSN FEM PS POR CCR STD SZ10 R,,C1776,HCPCS,Facility,Inpatient,,,,7913.5,6726.475,2268.0091,7913.5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PSN FEM PS POR CCR STD SZ10 R,,C1776,HCPCS,Facility,Both,,,,7913.5,6726.475,2268.0091,7913.5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),4748.1,60,,percent of total billed charges,,
PSN FEM PS POR CCR STD SZ10 R,,C1776,HCPCS,Facility,Both,,,,7913.5,6726.475,2268.0091,7913.5,"Health Partners, Inc.",State of Minnesota Advantage Program,6449.5025,81.5,,percent of total billed charges,,
PSN FEM PS POR CCR STD SZ10 R,,C1776,HCPCS,Facility,Both,,,,7913.5,6726.475,2268.0091,7913.5,"Health Partners, Inc.",State Public Programs,3956.75,50,,percent of total billed charges,,
PSN FEM PS POR CCR STD SZ10 R,,C1776,HCPCS,Facility,Both,,,,7913.5,6726.475,2268.0091,7913.5,Humana Insurance Company,Commercial PPO,7517.825,95,,percent of total billed charges,,
PSN FEM PS POR CCR STD SZ10 R,,C1776,HCPCS,Facility,Outpatient,,,,7913.5,6726.475,2268.0091,7913.5,Humana Insurance Company,Medicare PPO,3877.615,49,,percent of total billed charges,,
PSN FEM PS POR CCR STD SZ10 R,,C1776,HCPCS,Facility,Inpatient,,,,7913.5,6726.475,2268.0091,7913.5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
PSN FEM PS POR CCR STD SZ10 R,,C1776,HCPCS,Facility,Both,,,,7913.5,6726.475,2268.0091,7913.5,Medica,Individual & Family,7842.2785,99.1,,percent of total billed charges,,
PSN FEM PS POR CCR STD SZ10 R,,C1776,HCPCS,Facility,Outpatient,,,,7913.5,6726.475,2268.0091,7913.5,Medica,Medica Advantage Solution,3940.923,49.8,,percent of total billed charges,,
PSN FEM PS POR CCR STD SZ10 R,,C1776,HCPCS,Facility,Inpatient,,,,7913.5,6726.475,2268.0091,7913.5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
PSN FEM PS POR CCR STD SZ10 R,,C1776,HCPCS,Facility,Outpatient,,,,7913.5,6726.475,2268.0091,7913.5,Medica,Medical Assistance,3529.421,44.6,,percent of total billed charges,,
PSN FEM PS POR CCR STD SZ10 R,,C1776,HCPCS,Facility,Inpatient,,,,7913.5,6726.475,2268.0091,7913.5,Medica,Medical Assistance,,,,,Included in per diem rate,
PSN FEM PS POR CCR STD SZ10 R,,C1776,HCPCS,Facility,Outpatient,,,,7913.5,6726.475,2268.0091,7913.5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,3940.923,49.8,,percent of total billed charges,,
PSN FEM PS POR CCR STD SZ10 R,,C1776,HCPCS,Facility,Inpatient,,,,7913.5,6726.475,2268.0091,7913.5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
PSN FEM PS POR CCR STD SZ10 R,,C1776,HCPCS,Facility,Both,,,,7913.5,6726.475,2268.0091,7913.5,"Multiplan, Inc.","Multiplan, Inc.",7438.69,94,,percent of total billed charges,,
PSN FEM PS POR CCR STD SZ10 R,,C1776,HCPCS,Facility,Outpatient,,,,7913.5,6726.475,2268.0091,7913.5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,7130.0635,90.1,,percent of total billed charges,,
PSN FEM PS POR CCR STD SZ10 R,,C1776,HCPCS,Facility,Inpatient,,,,7913.5,6726.475,2268.0091,7913.5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
PSN FEM PS POR CCR STD SZ10 R,,C1776,HCPCS,Facility,Both,,,,7913.5,6726.475,2268.0091,7913.5,"Preferred One Administrative Services, INC.",PPO,7802.711,98.6,,percent of total billed charges,,
PSN FEM PS POR CCR STD SZ10 R,,C1776,HCPCS,Facility,Outpatient,,,,7913.5,6726.475,2268.0091,7913.5,PrimeWest Health,Minnesota Senior Health Options (MSHO),4071.49575,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
PSN FEM PS POR CCR STD SZ10 R,,C1776,HCPCS,Facility,Inpatient,,,,7913.5,6726.475,2268.0091,7913.5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PSN FEM PS POR CCR STD SZ10 R,,C1776,HCPCS,Facility,Outpatient,,,,7913.5,6726.475,2268.0091,7913.5,PrimeWest Health,MinnesotaCare,4064.3736,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
PSN FEM PS POR CCR STD SZ10 R,,C1776,HCPCS,Facility,Inpatient,,,,7913.5,6726.475,2268.0091,7913.5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
PSN FEM PS POR CCR STD SZ10 R,,C1776,HCPCS,Facility,Both,,,,7913.5,6726.475,2268.0091,7913.5,Sanford Health Plan,Sanford Health Plan,7280.42,92,,percent of total billed charges,,
PSN FEM PS POR CCR STD SZ10 R,,C1776,HCPCS,Facility,Outpatient,,,,7913.5,6726.475,2268.0091,7913.5,"UCare Health, Inc.",Individual & Family Plan,4459.25725,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
PSN FEM PS POR CCR STD SZ10 R,,C1776,HCPCS,Facility,Inpatient,,,,7913.5,6726.475,2268.0091,7913.5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
PSN FEM PS POR CCR STD SZ10 R,,C1776,HCPCS,Facility,Outpatient,,,,7913.5,6726.475,2268.0091,7913.5,"UCare Health, Inc.",Medical Assistance,3993.94345,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PSN FEM PS POR CCR STD SZ10 R,,C1776,HCPCS,Facility,Inpatient,,,,7913.5,6726.475,2268.0091,7913.5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
PSN FEM PS POR CCR STD SZ10 R,,C1776,HCPCS,Facility,Outpatient,,,,7913.5,6726.475,2268.0091,7913.5,"UCare Health, Inc.",Medicare Advantage,3993.94345,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PSN FEM PS POR CCR STD SZ10 R,,C1776,HCPCS,Facility,Inpatient,,,,7913.5,6726.475,2268.0091,7913.5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PSN FEM PS POR CCR STD SZ10 R,,C1776,HCPCS,Facility,Outpatient,,,,7913.5,6726.475,2268.0091,7913.5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),3993.94345,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PSN FEM PS POR CCR STD SZ10 R,,C1776,HCPCS,Facility,Inpatient,,,,7913.5,6726.475,2268.0091,7913.5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PSN FEM PS POR CCR STD SZ10 R,,C1776,HCPCS,Facility,Both,,,,7913.5,6726.475,2268.0091,7913.5,UnitedHealthcare,Individual & Family,7438.69,94,,percent of total billed charges,,
PSN FEM PS POR CCR STD SZ10 R,,C1776,HCPCS,Facility,Outpatient,,,,7913.5,6726.475,2268.0091,7913.5,UnitedHealthcare,Medicare Advantage,3877.615,49,,percent of total billed charges,,
PSN FEM PS POR CCR STD SZ10 R,,C1776,HCPCS,Facility,Inpatient,,,,7913.5,6726.475,2268.0091,7913.5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
PSN FEM PS POR CCR STD SZ10 R,,C1776,HCPCS,Facility,Outpatient,,,,7913.5,6726.475,2268.0091,7913.5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,3798.48,48,,percent of total billed charges,,100% of DHS outpatient percentage
PSN FEM PS POR CCR STD SZ10 R,,C1776,HCPCS,Facility,Inpatient,,,,7913.5,6726.475,2268.0091,7913.5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
PSN FEM PS POR CCR STD SZ11,,C1776,HCPCS,Facility,Both,,,,7913.5,6726.475,2268.0091,7913.5,Aetna,Commercial,7280.42,92,,percent of total billed charges,,
PSN FEM PS POR CCR STD SZ11,,C1776,HCPCS,Facility,Outpatient,,,,7913.5,6726.475,2268.0091,7913.5,Aetna,Medicare Advantage,3877.615,49,,percent of total billed charges,,
PSN FEM PS POR CCR STD SZ11,,C1776,HCPCS,Facility,Inpatient,,,,7913.5,6726.475,2268.0091,7913.5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
PSN FEM PS POR CCR STD SZ11,,C1776,HCPCS,Facility,Both,,,,7913.5,6726.475,2268.0091,7913.5,Aetna,PPO,7359.555,93,,percent of total billed charges,,
PSN FEM PS POR CCR STD SZ11,,C1776,HCPCS,Facility,Both,,,,7913.5,6726.475,2268.0091,7913.5,America's PPO,America's PPO,7599.33405,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
PSN FEM PS POR CCR STD SZ11,,C1776,HCPCS,Facility,Both,,,,7913.5,6726.475,2268.0091,7913.5,BlueCross BlueShield Minnesota, Federal Employee Program,7786.884,98.4,,percent of total billed charges,,
PSN FEM PS POR CCR STD SZ11,,C1776,HCPCS,Facility,Both,,,,7913.5,6726.475,2268.0091,7913.5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,7913.5,100,,percent of total billed charges,,
PSN FEM PS POR CCR STD SZ11,,C1776,HCPCS,Facility,Both,,,,7913.5,6726.475,2268.0091,7913.5,BlueCross BlueShield Minnesota,High Value Network Plan,7122.15,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
PSN FEM PS POR CCR STD SZ11,,C1776,HCPCS,Facility,Outpatient,,,,7913.5,6726.475,2268.0091,7913.5,BlueCross BlueShield Minnesota,Medicare Advantage,3877.615,49,,percent of total billed charges,,
PSN FEM PS POR CCR STD SZ11,,C1776,HCPCS,Facility,Inpatient,,,,7913.5,6726.475,2268.0091,7913.5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
PSN FEM PS POR CCR STD SZ11,,C1776,HCPCS,Facility,Both,,,,7913.5,6726.475,2268.0091,7913.5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,7008.98695,88.57,,percent of total billed charges,,
PSN FEM PS POR CCR STD SZ11,,C1776,HCPCS,Facility,Both,,,,7913.5,6726.475,2268.0091,7913.5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,2268.0091,28.66,,percent of total billed charges,,
PSN FEM PS POR CCR STD SZ11,,C1776,HCPCS,Facility,Outpatient,,,,7913.5,6726.475,2268.0091,7913.5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),3877.615,49,,percent of total billed charges,,
PSN FEM PS POR CCR STD SZ11,,C1776,HCPCS,Facility,Inpatient,,,,7913.5,6726.475,2268.0091,7913.5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
PSN FEM PS POR CCR STD SZ11,,C1776,HCPCS,Facility,Both,,,,7913.5,6726.475,2268.0091,7913.5,CorVel,Worker's Compensation,7913.5,100,,percent of total billed charges,,
PSN FEM PS POR CCR STD SZ11,,C1776,HCPCS,Facility,Both,,,,7913.5,6726.475,2268.0091,7913.5,First Health Group Corporation,First Health Network,7676.095,97,,percent of total billed charges,,
PSN FEM PS POR CCR STD SZ11,,C1776,HCPCS,Facility,Both,,,,7913.5,6726.475,2268.0091,7913.5,"Health Partners, Inc.",Commercial,7486.171,94.6,,percent of total billed charges,,
PSN FEM PS POR CCR STD SZ11,,C1776,HCPCS,Facility,Outpatient,,,,7913.5,6726.475,2268.0091,7913.5,"Health Partners, Inc.",Medicare Advantage,3877.615,49,,percent of total billed charges,,
PSN FEM PS POR CCR STD SZ11,,C1776,HCPCS,Facility,Inpatient,,,,7913.5,6726.475,2268.0091,7913.5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PSN FEM PS POR CCR STD SZ11,,C1776,HCPCS,Facility,Both,,,,7913.5,6726.475,2268.0091,7913.5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),4748.1,60,,percent of total billed charges,,
PSN FEM PS POR CCR STD SZ11,,C1776,HCPCS,Facility,Both,,,,7913.5,6726.475,2268.0091,7913.5,"Health Partners, Inc.",State of Minnesota Advantage Program,6449.5025,81.5,,percent of total billed charges,,
PSN FEM PS POR CCR STD SZ11,,C1776,HCPCS,Facility,Both,,,,7913.5,6726.475,2268.0091,7913.5,"Health Partners, Inc.",State Public Programs,3956.75,50,,percent of total billed charges,,
PSN FEM PS POR CCR STD SZ11,,C1776,HCPCS,Facility,Both,,,,7913.5,6726.475,2268.0091,7913.5,Humana Insurance Company,Commercial PPO,7517.825,95,,percent of total billed charges,,
PSN FEM PS POR CCR STD SZ11,,C1776,HCPCS,Facility,Outpatient,,,,7913.5,6726.475,2268.0091,7913.5,Humana Insurance Company,Medicare PPO,3877.615,49,,percent of total billed charges,,
PSN FEM PS POR CCR STD SZ11,,C1776,HCPCS,Facility,Inpatient,,,,7913.5,6726.475,2268.0091,7913.5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
PSN FEM PS POR CCR STD SZ11,,C1776,HCPCS,Facility,Both,,,,7913.5,6726.475,2268.0091,7913.5,Medica,Individual & Family,7842.2785,99.1,,percent of total billed charges,,
PSN FEM PS POR CCR STD SZ11,,C1776,HCPCS,Facility,Outpatient,,,,7913.5,6726.475,2268.0091,7913.5,Medica,Medica Advantage Solution,3940.923,49.8,,percent of total billed charges,,
PSN FEM PS POR CCR STD SZ11,,C1776,HCPCS,Facility,Inpatient,,,,7913.5,6726.475,2268.0091,7913.5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
PSN FEM PS POR CCR STD SZ11,,C1776,HCPCS,Facility,Outpatient,,,,7913.5,6726.475,2268.0091,7913.5,Medica,Medical Assistance,3529.421,44.6,,percent of total billed charges,,
PSN FEM PS POR CCR STD SZ11,,C1776,HCPCS,Facility,Inpatient,,,,7913.5,6726.475,2268.0091,7913.5,Medica,Medical Assistance,,,,,Included in per diem rate,
PSN FEM PS POR CCR STD SZ11,,C1776,HCPCS,Facility,Outpatient,,,,7913.5,6726.475,2268.0091,7913.5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,3940.923,49.8,,percent of total billed charges,,
PSN FEM PS POR CCR STD SZ11,,C1776,HCPCS,Facility,Inpatient,,,,7913.5,6726.475,2268.0091,7913.5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
PSN FEM PS POR CCR STD SZ11,,C1776,HCPCS,Facility,Both,,,,7913.5,6726.475,2268.0091,7913.5,"Multiplan, Inc.","Multiplan, Inc.",7438.69,94,,percent of total billed charges,,
PSN FEM PS POR CCR STD SZ11,,C1776,HCPCS,Facility,Outpatient,,,,7913.5,6726.475,2268.0091,7913.5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,7130.0635,90.1,,percent of total billed charges,,
PSN FEM PS POR CCR STD SZ11,,C1776,HCPCS,Facility,Inpatient,,,,7913.5,6726.475,2268.0091,7913.5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
PSN FEM PS POR CCR STD SZ11,,C1776,HCPCS,Facility,Both,,,,7913.5,6726.475,2268.0091,7913.5,"Preferred One Administrative Services, INC.",PPO,7802.711,98.6,,percent of total billed charges,,
PSN FEM PS POR CCR STD SZ11,,C1776,HCPCS,Facility,Outpatient,,,,7913.5,6726.475,2268.0091,7913.5,PrimeWest Health,Minnesota Senior Health Options (MSHO),4071.49575,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
PSN FEM PS POR CCR STD SZ11,,C1776,HCPCS,Facility,Inpatient,,,,7913.5,6726.475,2268.0091,7913.5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PSN FEM PS POR CCR STD SZ11,,C1776,HCPCS,Facility,Outpatient,,,,7913.5,6726.475,2268.0091,7913.5,PrimeWest Health,MinnesotaCare,4064.3736,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
PSN FEM PS POR CCR STD SZ11,,C1776,HCPCS,Facility,Inpatient,,,,7913.5,6726.475,2268.0091,7913.5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
PSN FEM PS POR CCR STD SZ11,,C1776,HCPCS,Facility,Both,,,,7913.5,6726.475,2268.0091,7913.5,Sanford Health Plan,Sanford Health Plan,7280.42,92,,percent of total billed charges,,
PSN FEM PS POR CCR STD SZ11,,C1776,HCPCS,Facility,Outpatient,,,,7913.5,6726.475,2268.0091,7913.5,"UCare Health, Inc.",Individual & Family Plan,4459.25725,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
PSN FEM PS POR CCR STD SZ11,,C1776,HCPCS,Facility,Inpatient,,,,7913.5,6726.475,2268.0091,7913.5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
PSN FEM PS POR CCR STD SZ11,,C1776,HCPCS,Facility,Outpatient,,,,7913.5,6726.475,2268.0091,7913.5,"UCare Health, Inc.",Medical Assistance,3993.94345,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PSN FEM PS POR CCR STD SZ11,,C1776,HCPCS,Facility,Inpatient,,,,7913.5,6726.475,2268.0091,7913.5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
PSN FEM PS POR CCR STD SZ11,,C1776,HCPCS,Facility,Outpatient,,,,7913.5,6726.475,2268.0091,7913.5,"UCare Health, Inc.",Medicare Advantage,3993.94345,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PSN FEM PS POR CCR STD SZ11,,C1776,HCPCS,Facility,Inpatient,,,,7913.5,6726.475,2268.0091,7913.5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PSN FEM PS POR CCR STD SZ11,,C1776,HCPCS,Facility,Outpatient,,,,7913.5,6726.475,2268.0091,7913.5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),3993.94345,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PSN FEM PS POR CCR STD SZ11,,C1776,HCPCS,Facility,Inpatient,,,,7913.5,6726.475,2268.0091,7913.5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PSN FEM PS POR CCR STD SZ11,,C1776,HCPCS,Facility,Both,,,,7913.5,6726.475,2268.0091,7913.5,UnitedHealthcare,Individual & Family,7438.69,94,,percent of total billed charges,,
PSN FEM PS POR CCR STD SZ11,,C1776,HCPCS,Facility,Outpatient,,,,7913.5,6726.475,2268.0091,7913.5,UnitedHealthcare,Medicare Advantage,3877.615,49,,percent of total billed charges,,
PSN FEM PS POR CCR STD SZ11,,C1776,HCPCS,Facility,Inpatient,,,,7913.5,6726.475,2268.0091,7913.5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
PSN FEM PS POR CCR STD SZ11,,C1776,HCPCS,Facility,Outpatient,,,,7913.5,6726.475,2268.0091,7913.5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,3798.48,48,,percent of total billed charges,,100% of DHS outpatient percentage
PSN FEM PS POR CCR STD SZ11,,C1776,HCPCS,Facility,Inpatient,,,,7913.5,6726.475,2268.0091,7913.5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
PSN FEM PS POR CCR STD SZ9 L,,C1776,HCPCS,Facility,Both,,,,7913.5,6726.475,2268.0091,7913.5,Aetna,Commercial,7280.42,92,,percent of total billed charges,,
PSN FEM PS POR CCR STD SZ9 L,,C1776,HCPCS,Facility,Outpatient,,,,7913.5,6726.475,2268.0091,7913.5,Aetna,Medicare Advantage,3877.615,49,,percent of total billed charges,,
PSN FEM PS POR CCR STD SZ9 L,,C1776,HCPCS,Facility,Inpatient,,,,7913.5,6726.475,2268.0091,7913.5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
PSN FEM PS POR CCR STD SZ9 L,,C1776,HCPCS,Facility,Both,,,,7913.5,6726.475,2268.0091,7913.5,Aetna,PPO,7359.555,93,,percent of total billed charges,,
PSN FEM PS POR CCR STD SZ9 L,,C1776,HCPCS,Facility,Both,,,,7913.5,6726.475,2268.0091,7913.5,America's PPO,America's PPO,7599.33405,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
PSN FEM PS POR CCR STD SZ9 L,,C1776,HCPCS,Facility,Both,,,,7913.5,6726.475,2268.0091,7913.5,BlueCross BlueShield Minnesota, Federal Employee Program,7786.884,98.4,,percent of total billed charges,,
PSN FEM PS POR CCR STD SZ9 L,,C1776,HCPCS,Facility,Both,,,,7913.5,6726.475,2268.0091,7913.5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,7913.5,100,,percent of total billed charges,,
PSN FEM PS POR CCR STD SZ9 L,,C1776,HCPCS,Facility,Both,,,,7913.5,6726.475,2268.0091,7913.5,BlueCross BlueShield Minnesota,High Value Network Plan,7122.15,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
PSN FEM PS POR CCR STD SZ9 L,,C1776,HCPCS,Facility,Outpatient,,,,7913.5,6726.475,2268.0091,7913.5,BlueCross BlueShield Minnesota,Medicare Advantage,3877.615,49,,percent of total billed charges,,
PSN FEM PS POR CCR STD SZ9 L,,C1776,HCPCS,Facility,Inpatient,,,,7913.5,6726.475,2268.0091,7913.5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
PSN FEM PS POR CCR STD SZ9 L,,C1776,HCPCS,Facility,Both,,,,7913.5,6726.475,2268.0091,7913.5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,7008.98695,88.57,,percent of total billed charges,,
PSN FEM PS POR CCR STD SZ9 L,,C1776,HCPCS,Facility,Both,,,,7913.5,6726.475,2268.0091,7913.5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,2268.0091,28.66,,percent of total billed charges,,
PSN FEM PS POR CCR STD SZ9 L,,C1776,HCPCS,Facility,Outpatient,,,,7913.5,6726.475,2268.0091,7913.5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),3877.615,49,,percent of total billed charges,,
PSN FEM PS POR CCR STD SZ9 L,,C1776,HCPCS,Facility,Inpatient,,,,7913.5,6726.475,2268.0091,7913.5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
PSN FEM PS POR CCR STD SZ9 L,,C1776,HCPCS,Facility,Both,,,,7913.5,6726.475,2268.0091,7913.5,CorVel,Worker's Compensation,7913.5,100,,percent of total billed charges,,
PSN FEM PS POR CCR STD SZ9 L,,C1776,HCPCS,Facility,Both,,,,7913.5,6726.475,2268.0091,7913.5,First Health Group Corporation,First Health Network,7676.095,97,,percent of total billed charges,,
PSN FEM PS POR CCR STD SZ9 L,,C1776,HCPCS,Facility,Both,,,,7913.5,6726.475,2268.0091,7913.5,"Health Partners, Inc.",Commercial,7486.171,94.6,,percent of total billed charges,,
PSN FEM PS POR CCR STD SZ9 L,,C1776,HCPCS,Facility,Outpatient,,,,7913.5,6726.475,2268.0091,7913.5,"Health Partners, Inc.",Medicare Advantage,3877.615,49,,percent of total billed charges,,
PSN FEM PS POR CCR STD SZ9 L,,C1776,HCPCS,Facility,Inpatient,,,,7913.5,6726.475,2268.0091,7913.5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PSN FEM PS POR CCR STD SZ9 L,,C1776,HCPCS,Facility,Both,,,,7913.5,6726.475,2268.0091,7913.5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),4748.1,60,,percent of total billed charges,,
PSN FEM PS POR CCR STD SZ9 L,,C1776,HCPCS,Facility,Both,,,,7913.5,6726.475,2268.0091,7913.5,"Health Partners, Inc.",State of Minnesota Advantage Program,6449.5025,81.5,,percent of total billed charges,,
PSN FEM PS POR CCR STD SZ9 L,,C1776,HCPCS,Facility,Both,,,,7913.5,6726.475,2268.0091,7913.5,"Health Partners, Inc.",State Public Programs,3956.75,50,,percent of total billed charges,,
PSN FEM PS POR CCR STD SZ9 L,,C1776,HCPCS,Facility,Both,,,,7913.5,6726.475,2268.0091,7913.5,Humana Insurance Company,Commercial PPO,7517.825,95,,percent of total billed charges,,
PSN FEM PS POR CCR STD SZ9 L,,C1776,HCPCS,Facility,Outpatient,,,,7913.5,6726.475,2268.0091,7913.5,Humana Insurance Company,Medicare PPO,3877.615,49,,percent of total billed charges,,
PSN FEM PS POR CCR STD SZ9 L,,C1776,HCPCS,Facility,Inpatient,,,,7913.5,6726.475,2268.0091,7913.5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
PSN FEM PS POR CCR STD SZ9 L,,C1776,HCPCS,Facility,Both,,,,7913.5,6726.475,2268.0091,7913.5,Medica,Individual & Family,7842.2785,99.1,,percent of total billed charges,,
PSN FEM PS POR CCR STD SZ9 L,,C1776,HCPCS,Facility,Outpatient,,,,7913.5,6726.475,2268.0091,7913.5,Medica,Medica Advantage Solution,3940.923,49.8,,percent of total billed charges,,
PSN FEM PS POR CCR STD SZ9 L,,C1776,HCPCS,Facility,Inpatient,,,,7913.5,6726.475,2268.0091,7913.5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
PSN FEM PS POR CCR STD SZ9 L,,C1776,HCPCS,Facility,Outpatient,,,,7913.5,6726.475,2268.0091,7913.5,Medica,Medical Assistance,3529.421,44.6,,percent of total billed charges,,
PSN FEM PS POR CCR STD SZ9 L,,C1776,HCPCS,Facility,Inpatient,,,,7913.5,6726.475,2268.0091,7913.5,Medica,Medical Assistance,,,,,Included in per diem rate,
PSN FEM PS POR CCR STD SZ9 L,,C1776,HCPCS,Facility,Outpatient,,,,7913.5,6726.475,2268.0091,7913.5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,3940.923,49.8,,percent of total billed charges,,
PSN FEM PS POR CCR STD SZ9 L,,C1776,HCPCS,Facility,Inpatient,,,,7913.5,6726.475,2268.0091,7913.5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
PSN FEM PS POR CCR STD SZ9 L,,C1776,HCPCS,Facility,Both,,,,7913.5,6726.475,2268.0091,7913.5,"Multiplan, Inc.","Multiplan, Inc.",7438.69,94,,percent of total billed charges,,
PSN FEM PS POR CCR STD SZ9 L,,C1776,HCPCS,Facility,Outpatient,,,,7913.5,6726.475,2268.0091,7913.5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,7130.0635,90.1,,percent of total billed charges,,
PSN FEM PS POR CCR STD SZ9 L,,C1776,HCPCS,Facility,Inpatient,,,,7913.5,6726.475,2268.0091,7913.5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
PSN FEM PS POR CCR STD SZ9 L,,C1776,HCPCS,Facility,Both,,,,7913.5,6726.475,2268.0091,7913.5,"Preferred One Administrative Services, INC.",PPO,7802.711,98.6,,percent of total billed charges,,
PSN FEM PS POR CCR STD SZ9 L,,C1776,HCPCS,Facility,Outpatient,,,,7913.5,6726.475,2268.0091,7913.5,PrimeWest Health,Minnesota Senior Health Options (MSHO),4071.49575,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
PSN FEM PS POR CCR STD SZ9 L,,C1776,HCPCS,Facility,Inpatient,,,,7913.5,6726.475,2268.0091,7913.5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PSN FEM PS POR CCR STD SZ9 L,,C1776,HCPCS,Facility,Outpatient,,,,7913.5,6726.475,2268.0091,7913.5,PrimeWest Health,MinnesotaCare,4064.3736,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
PSN FEM PS POR CCR STD SZ9 L,,C1776,HCPCS,Facility,Inpatient,,,,7913.5,6726.475,2268.0091,7913.5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
PSN FEM PS POR CCR STD SZ9 L,,C1776,HCPCS,Facility,Both,,,,7913.5,6726.475,2268.0091,7913.5,Sanford Health Plan,Sanford Health Plan,7280.42,92,,percent of total billed charges,,
PSN FEM PS POR CCR STD SZ9 L,,C1776,HCPCS,Facility,Outpatient,,,,7913.5,6726.475,2268.0091,7913.5,"UCare Health, Inc.",Individual & Family Plan,4459.25725,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
PSN FEM PS POR CCR STD SZ9 L,,C1776,HCPCS,Facility,Inpatient,,,,7913.5,6726.475,2268.0091,7913.5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
PSN FEM PS POR CCR STD SZ9 L,,C1776,HCPCS,Facility,Outpatient,,,,7913.5,6726.475,2268.0091,7913.5,"UCare Health, Inc.",Medical Assistance,3993.94345,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PSN FEM PS POR CCR STD SZ9 L,,C1776,HCPCS,Facility,Inpatient,,,,7913.5,6726.475,2268.0091,7913.5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
PSN FEM PS POR CCR STD SZ9 L,,C1776,HCPCS,Facility,Outpatient,,,,7913.5,6726.475,2268.0091,7913.5,"UCare Health, Inc.",Medicare Advantage,3993.94345,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PSN FEM PS POR CCR STD SZ9 L,,C1776,HCPCS,Facility,Inpatient,,,,7913.5,6726.475,2268.0091,7913.5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PSN FEM PS POR CCR STD SZ9 L,,C1776,HCPCS,Facility,Outpatient,,,,7913.5,6726.475,2268.0091,7913.5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),3993.94345,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PSN FEM PS POR CCR STD SZ9 L,,C1776,HCPCS,Facility,Inpatient,,,,7913.5,6726.475,2268.0091,7913.5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PSN FEM PS POR CCR STD SZ9 L,,C1776,HCPCS,Facility,Both,,,,7913.5,6726.475,2268.0091,7913.5,UnitedHealthcare,Individual & Family,7438.69,94,,percent of total billed charges,,
PSN FEM PS POR CCR STD SZ9 L,,C1776,HCPCS,Facility,Outpatient,,,,7913.5,6726.475,2268.0091,7913.5,UnitedHealthcare,Medicare Advantage,3877.615,49,,percent of total billed charges,,
PSN FEM PS POR CCR STD SZ9 L,,C1776,HCPCS,Facility,Inpatient,,,,7913.5,6726.475,2268.0091,7913.5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
PSN FEM PS POR CCR STD SZ9 L,,C1776,HCPCS,Facility,Outpatient,,,,7913.5,6726.475,2268.0091,7913.5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,3798.48,48,,percent of total billed charges,,100% of DHS outpatient percentage
PSN FEM PS POR CCR STD SZ9 L,,C1776,HCPCS,Facility,Inpatient,,,,7913.5,6726.475,2268.0091,7913.5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
PSN TIB STM 5 DEG SZ E L,,C1776,HCPCS,Facility,Both,,,,2745.5,2333.675,786.8603,2745.5,Aetna,Commercial,2525.86,92,,percent of total billed charges,,
PSN TIB STM 5 DEG SZ E L,,C1776,HCPCS,Facility,Outpatient,,,,2745.5,2333.675,786.8603,2745.5,Aetna,Medicare Advantage,1345.295,49,,percent of total billed charges,,
PSN TIB STM 5 DEG SZ E L,,C1776,HCPCS,Facility,Inpatient,,,,2745.5,2333.675,786.8603,2745.5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
PSN TIB STM 5 DEG SZ E L,,C1776,HCPCS,Facility,Both,,,,2745.5,2333.675,786.8603,2745.5,Aetna,PPO,2553.315,93,,percent of total billed charges,,
PSN TIB STM 5 DEG SZ E L,,C1776,HCPCS,Facility,Both,,,,2745.5,2333.675,786.8603,2745.5,America's PPO,America's PPO,2636.50365,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
PSN TIB STM 5 DEG SZ E L,,C1776,HCPCS,Facility,Both,,,,2745.5,2333.675,786.8603,2745.5,BlueCross BlueShield Minnesota, Federal Employee Program,2701.572,98.4,,percent of total billed charges,,
PSN TIB STM 5 DEG SZ E L,,C1776,HCPCS,Facility,Both,,,,2745.5,2333.675,786.8603,2745.5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,2745.5,100,,percent of total billed charges,,
PSN TIB STM 5 DEG SZ E L,,C1776,HCPCS,Facility,Both,,,,2745.5,2333.675,786.8603,2745.5,BlueCross BlueShield Minnesota,High Value Network Plan,2470.95,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
PSN TIB STM 5 DEG SZ E L,,C1776,HCPCS,Facility,Outpatient,,,,2745.5,2333.675,786.8603,2745.5,BlueCross BlueShield Minnesota,Medicare Advantage,1345.295,49,,percent of total billed charges,,
PSN TIB STM 5 DEG SZ E L,,C1776,HCPCS,Facility,Inpatient,,,,2745.5,2333.675,786.8603,2745.5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
PSN TIB STM 5 DEG SZ E L,,C1776,HCPCS,Facility,Both,,,,2745.5,2333.675,786.8603,2745.5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,2431.68935,88.57,,percent of total billed charges,,
PSN TIB STM 5 DEG SZ E L,,C1776,HCPCS,Facility,Both,,,,2745.5,2333.675,786.8603,2745.5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,786.8603,28.66,,percent of total billed charges,,
PSN TIB STM 5 DEG SZ E L,,C1776,HCPCS,Facility,Outpatient,,,,2745.5,2333.675,786.8603,2745.5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1345.295,49,,percent of total billed charges,,
PSN TIB STM 5 DEG SZ E L,,C1776,HCPCS,Facility,Inpatient,,,,2745.5,2333.675,786.8603,2745.5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
PSN TIB STM 5 DEG SZ E L,,C1776,HCPCS,Facility,Both,,,,2745.5,2333.675,786.8603,2745.5,CorVel,Worker's Compensation,2745.5,100,,percent of total billed charges,,
PSN TIB STM 5 DEG SZ E L,,C1776,HCPCS,Facility,Both,,,,2745.5,2333.675,786.8603,2745.5,First Health Group Corporation,First Health Network,2663.135,97,,percent of total billed charges,,
PSN TIB STM 5 DEG SZ E L,,C1776,HCPCS,Facility,Both,,,,2745.5,2333.675,786.8603,2745.5,"Health Partners, Inc.",Commercial,2597.243,94.6,,percent of total billed charges,,
PSN TIB STM 5 DEG SZ E L,,C1776,HCPCS,Facility,Outpatient,,,,2745.5,2333.675,786.8603,2745.5,"Health Partners, Inc.",Medicare Advantage,1345.295,49,,percent of total billed charges,,
PSN TIB STM 5 DEG SZ E L,,C1776,HCPCS,Facility,Inpatient,,,,2745.5,2333.675,786.8603,2745.5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PSN TIB STM 5 DEG SZ E L,,C1776,HCPCS,Facility,Both,,,,2745.5,2333.675,786.8603,2745.5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1647.3,60,,percent of total billed charges,,
PSN TIB STM 5 DEG SZ E L,,C1776,HCPCS,Facility,Both,,,,2745.5,2333.675,786.8603,2745.5,"Health Partners, Inc.",State of Minnesota Advantage Program,2237.5825,81.5,,percent of total billed charges,,
PSN TIB STM 5 DEG SZ E L,,C1776,HCPCS,Facility,Both,,,,2745.5,2333.675,786.8603,2745.5,"Health Partners, Inc.",State Public Programs,1372.75,50,,percent of total billed charges,,
PSN TIB STM 5 DEG SZ E L,,C1776,HCPCS,Facility,Both,,,,2745.5,2333.675,786.8603,2745.5,Humana Insurance Company,Commercial PPO,2608.225,95,,percent of total billed charges,,
PSN TIB STM 5 DEG SZ E L,,C1776,HCPCS,Facility,Outpatient,,,,2745.5,2333.675,786.8603,2745.5,Humana Insurance Company,Medicare PPO,1345.295,49,,percent of total billed charges,,
PSN TIB STM 5 DEG SZ E L,,C1776,HCPCS,Facility,Inpatient,,,,2745.5,2333.675,786.8603,2745.5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
PSN TIB STM 5 DEG SZ E L,,C1776,HCPCS,Facility,Both,,,,2745.5,2333.675,786.8603,2745.5,Medica,Individual & Family,2720.7905,99.1,,percent of total billed charges,,
PSN TIB STM 5 DEG SZ E L,,C1776,HCPCS,Facility,Outpatient,,,,2745.5,2333.675,786.8603,2745.5,Medica,Medica Advantage Solution,1367.259,49.8,,percent of total billed charges,,
PSN TIB STM 5 DEG SZ E L,,C1776,HCPCS,Facility,Inpatient,,,,2745.5,2333.675,786.8603,2745.5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
PSN TIB STM 5 DEG SZ E L,,C1776,HCPCS,Facility,Outpatient,,,,2745.5,2333.675,786.8603,2745.5,Medica,Medical Assistance,1224.493,44.6,,percent of total billed charges,,
PSN TIB STM 5 DEG SZ E L,,C1776,HCPCS,Facility,Inpatient,,,,2745.5,2333.675,786.8603,2745.5,Medica,Medical Assistance,,,,,Included in per diem rate,
PSN TIB STM 5 DEG SZ E L,,C1776,HCPCS,Facility,Outpatient,,,,2745.5,2333.675,786.8603,2745.5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1367.259,49.8,,percent of total billed charges,,
PSN TIB STM 5 DEG SZ E L,,C1776,HCPCS,Facility,Inpatient,,,,2745.5,2333.675,786.8603,2745.5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
PSN TIB STM 5 DEG SZ E L,,C1776,HCPCS,Facility,Both,,,,2745.5,2333.675,786.8603,2745.5,"Multiplan, Inc.","Multiplan, Inc.",2580.77,94,,percent of total billed charges,,
PSN TIB STM 5 DEG SZ E L,,C1776,HCPCS,Facility,Outpatient,,,,2745.5,2333.675,786.8603,2745.5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,2473.6955,90.1,,percent of total billed charges,,
PSN TIB STM 5 DEG SZ E L,,C1776,HCPCS,Facility,Inpatient,,,,2745.5,2333.675,786.8603,2745.5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
PSN TIB STM 5 DEG SZ E L,,C1776,HCPCS,Facility,Both,,,,2745.5,2333.675,786.8603,2745.5,"Preferred One Administrative Services, INC.",PPO,2707.063,98.6,,percent of total billed charges,,
PSN TIB STM 5 DEG SZ E L,,C1776,HCPCS,Facility,Outpatient,,,,2745.5,2333.675,786.8603,2745.5,PrimeWest Health,Minnesota Senior Health Options (MSHO),1412.55975,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
PSN TIB STM 5 DEG SZ E L,,C1776,HCPCS,Facility,Inpatient,,,,2745.5,2333.675,786.8603,2745.5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PSN TIB STM 5 DEG SZ E L,,C1776,HCPCS,Facility,Outpatient,,,,2745.5,2333.675,786.8603,2745.5,PrimeWest Health,MinnesotaCare,1410.0888,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
PSN TIB STM 5 DEG SZ E L,,C1776,HCPCS,Facility,Inpatient,,,,2745.5,2333.675,786.8603,2745.5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
PSN TIB STM 5 DEG SZ E L,,C1776,HCPCS,Facility,Both,,,,2745.5,2333.675,786.8603,2745.5,Sanford Health Plan,Sanford Health Plan,2525.86,92,,percent of total billed charges,,
PSN TIB STM 5 DEG SZ E L,,C1776,HCPCS,Facility,Outpatient,,,,2745.5,2333.675,786.8603,2745.5,"UCare Health, Inc.",Individual & Family Plan,1547.08925,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
PSN TIB STM 5 DEG SZ E L,,C1776,HCPCS,Facility,Inpatient,,,,2745.5,2333.675,786.8603,2745.5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
PSN TIB STM 5 DEG SZ E L,,C1776,HCPCS,Facility,Outpatient,,,,2745.5,2333.675,786.8603,2745.5,"UCare Health, Inc.",Medical Assistance,1385.65385,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PSN TIB STM 5 DEG SZ E L,,C1776,HCPCS,Facility,Inpatient,,,,2745.5,2333.675,786.8603,2745.5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
PSN TIB STM 5 DEG SZ E L,,C1776,HCPCS,Facility,Outpatient,,,,2745.5,2333.675,786.8603,2745.5,"UCare Health, Inc.",Medicare Advantage,1385.65385,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PSN TIB STM 5 DEG SZ E L,,C1776,HCPCS,Facility,Inpatient,,,,2745.5,2333.675,786.8603,2745.5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PSN TIB STM 5 DEG SZ E L,,C1776,HCPCS,Facility,Outpatient,,,,2745.5,2333.675,786.8603,2745.5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1385.65385,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PSN TIB STM 5 DEG SZ E L,,C1776,HCPCS,Facility,Inpatient,,,,2745.5,2333.675,786.8603,2745.5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PSN TIB STM 5 DEG SZ E L,,C1776,HCPCS,Facility,Both,,,,2745.5,2333.675,786.8603,2745.5,UnitedHealthcare,Individual & Family,2580.77,94,,percent of total billed charges,,
PSN TIB STM 5 DEG SZ E L,,C1776,HCPCS,Facility,Outpatient,,,,2745.5,2333.675,786.8603,2745.5,UnitedHealthcare,Medicare Advantage,1345.295,49,,percent of total billed charges,,
PSN TIB STM 5 DEG SZ E L,,C1776,HCPCS,Facility,Inpatient,,,,2745.5,2333.675,786.8603,2745.5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
PSN TIB STM 5 DEG SZ E L,,C1776,HCPCS,Facility,Outpatient,,,,2745.5,2333.675,786.8603,2745.5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1317.84,48,,percent of total billed charges,,100% of DHS outpatient percentage
PSN TIB STM 5 DEG SZ E L,,C1776,HCPCS,Facility,Inpatient,,,,2745.5,2333.675,786.8603,2745.5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
PSN TIB STM 5 DEG SZ E R,,C1776,HCPCS,Facility,Both,,,,2745.5,2333.675,786.8603,2745.5,Aetna,Commercial,2525.86,92,,percent of total billed charges,,
PSN TIB STM 5 DEG SZ E R,,C1776,HCPCS,Facility,Outpatient,,,,2745.5,2333.675,786.8603,2745.5,Aetna,Medicare Advantage,1345.295,49,,percent of total billed charges,,
PSN TIB STM 5 DEG SZ E R,,C1776,HCPCS,Facility,Inpatient,,,,2745.5,2333.675,786.8603,2745.5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
PSN TIB STM 5 DEG SZ E R,,C1776,HCPCS,Facility,Both,,,,2745.5,2333.675,786.8603,2745.5,Aetna,PPO,2553.315,93,,percent of total billed charges,,
PSN TIB STM 5 DEG SZ E R,,C1776,HCPCS,Facility,Both,,,,2745.5,2333.675,786.8603,2745.5,America's PPO,America's PPO,2636.50365,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
PSN TIB STM 5 DEG SZ E R,,C1776,HCPCS,Facility,Both,,,,2745.5,2333.675,786.8603,2745.5,BlueCross BlueShield Minnesota, Federal Employee Program,2701.572,98.4,,percent of total billed charges,,
PSN TIB STM 5 DEG SZ E R,,C1776,HCPCS,Facility,Both,,,,2745.5,2333.675,786.8603,2745.5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,2745.5,100,,percent of total billed charges,,
PSN TIB STM 5 DEG SZ E R,,C1776,HCPCS,Facility,Both,,,,2745.5,2333.675,786.8603,2745.5,BlueCross BlueShield Minnesota,High Value Network Plan,2470.95,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
PSN TIB STM 5 DEG SZ E R,,C1776,HCPCS,Facility,Outpatient,,,,2745.5,2333.675,786.8603,2745.5,BlueCross BlueShield Minnesota,Medicare Advantage,1345.295,49,,percent of total billed charges,,
PSN TIB STM 5 DEG SZ E R,,C1776,HCPCS,Facility,Inpatient,,,,2745.5,2333.675,786.8603,2745.5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
PSN TIB STM 5 DEG SZ E R,,C1776,HCPCS,Facility,Both,,,,2745.5,2333.675,786.8603,2745.5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,2431.68935,88.57,,percent of total billed charges,,
PSN TIB STM 5 DEG SZ E R,,C1776,HCPCS,Facility,Both,,,,2745.5,2333.675,786.8603,2745.5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,786.8603,28.66,,percent of total billed charges,,
PSN TIB STM 5 DEG SZ E R,,C1776,HCPCS,Facility,Outpatient,,,,2745.5,2333.675,786.8603,2745.5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1345.295,49,,percent of total billed charges,,
PSN TIB STM 5 DEG SZ E R,,C1776,HCPCS,Facility,Inpatient,,,,2745.5,2333.675,786.8603,2745.5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
PSN TIB STM 5 DEG SZ E R,,C1776,HCPCS,Facility,Both,,,,2745.5,2333.675,786.8603,2745.5,CorVel,Worker's Compensation,2745.5,100,,percent of total billed charges,,
PSN TIB STM 5 DEG SZ E R,,C1776,HCPCS,Facility,Both,,,,2745.5,2333.675,786.8603,2745.5,First Health Group Corporation,First Health Network,2663.135,97,,percent of total billed charges,,
PSN TIB STM 5 DEG SZ E R,,C1776,HCPCS,Facility,Both,,,,2745.5,2333.675,786.8603,2745.5,"Health Partners, Inc.",Commercial,2597.243,94.6,,percent of total billed charges,,
PSN TIB STM 5 DEG SZ E R,,C1776,HCPCS,Facility,Outpatient,,,,2745.5,2333.675,786.8603,2745.5,"Health Partners, Inc.",Medicare Advantage,1345.295,49,,percent of total billed charges,,
PSN TIB STM 5 DEG SZ E R,,C1776,HCPCS,Facility,Inpatient,,,,2745.5,2333.675,786.8603,2745.5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PSN TIB STM 5 DEG SZ E R,,C1776,HCPCS,Facility,Both,,,,2745.5,2333.675,786.8603,2745.5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1647.3,60,,percent of total billed charges,,
PSN TIB STM 5 DEG SZ E R,,C1776,HCPCS,Facility,Both,,,,2745.5,2333.675,786.8603,2745.5,"Health Partners, Inc.",State of Minnesota Advantage Program,2237.5825,81.5,,percent of total billed charges,,
PSN TIB STM 5 DEG SZ E R,,C1776,HCPCS,Facility,Both,,,,2745.5,2333.675,786.8603,2745.5,"Health Partners, Inc.",State Public Programs,1372.75,50,,percent of total billed charges,,
PSN TIB STM 5 DEG SZ E R,,C1776,HCPCS,Facility,Both,,,,2745.5,2333.675,786.8603,2745.5,Humana Insurance Company,Commercial PPO,2608.225,95,,percent of total billed charges,,
PSN TIB STM 5 DEG SZ E R,,C1776,HCPCS,Facility,Outpatient,,,,2745.5,2333.675,786.8603,2745.5,Humana Insurance Company,Medicare PPO,1345.295,49,,percent of total billed charges,,
PSN TIB STM 5 DEG SZ E R,,C1776,HCPCS,Facility,Inpatient,,,,2745.5,2333.675,786.8603,2745.5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
PSN TIB STM 5 DEG SZ E R,,C1776,HCPCS,Facility,Both,,,,2745.5,2333.675,786.8603,2745.5,Medica,Individual & Family,2720.7905,99.1,,percent of total billed charges,,
PSN TIB STM 5 DEG SZ E R,,C1776,HCPCS,Facility,Outpatient,,,,2745.5,2333.675,786.8603,2745.5,Medica,Medica Advantage Solution,1367.259,49.8,,percent of total billed charges,,
PSN TIB STM 5 DEG SZ E R,,C1776,HCPCS,Facility,Inpatient,,,,2745.5,2333.675,786.8603,2745.5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
PSN TIB STM 5 DEG SZ E R,,C1776,HCPCS,Facility,Outpatient,,,,2745.5,2333.675,786.8603,2745.5,Medica,Medical Assistance,1224.493,44.6,,percent of total billed charges,,
PSN TIB STM 5 DEG SZ E R,,C1776,HCPCS,Facility,Inpatient,,,,2745.5,2333.675,786.8603,2745.5,Medica,Medical Assistance,,,,,Included in per diem rate,
PSN TIB STM 5 DEG SZ E R,,C1776,HCPCS,Facility,Outpatient,,,,2745.5,2333.675,786.8603,2745.5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1367.259,49.8,,percent of total billed charges,,
PSN TIB STM 5 DEG SZ E R,,C1776,HCPCS,Facility,Inpatient,,,,2745.5,2333.675,786.8603,2745.5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
PSN TIB STM 5 DEG SZ E R,,C1776,HCPCS,Facility,Both,,,,2745.5,2333.675,786.8603,2745.5,"Multiplan, Inc.","Multiplan, Inc.",2580.77,94,,percent of total billed charges,,
PSN TIB STM 5 DEG SZ E R,,C1776,HCPCS,Facility,Outpatient,,,,2745.5,2333.675,786.8603,2745.5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,2473.6955,90.1,,percent of total billed charges,,
PSN TIB STM 5 DEG SZ E R,,C1776,HCPCS,Facility,Inpatient,,,,2745.5,2333.675,786.8603,2745.5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
PSN TIB STM 5 DEG SZ E R,,C1776,HCPCS,Facility,Both,,,,2745.5,2333.675,786.8603,2745.5,"Preferred One Administrative Services, INC.",PPO,2707.063,98.6,,percent of total billed charges,,
PSN TIB STM 5 DEG SZ E R,,C1776,HCPCS,Facility,Outpatient,,,,2745.5,2333.675,786.8603,2745.5,PrimeWest Health,Minnesota Senior Health Options (MSHO),1412.55975,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
PSN TIB STM 5 DEG SZ E R,,C1776,HCPCS,Facility,Inpatient,,,,2745.5,2333.675,786.8603,2745.5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PSN TIB STM 5 DEG SZ E R,,C1776,HCPCS,Facility,Outpatient,,,,2745.5,2333.675,786.8603,2745.5,PrimeWest Health,MinnesotaCare,1410.0888,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
PSN TIB STM 5 DEG SZ E R,,C1776,HCPCS,Facility,Inpatient,,,,2745.5,2333.675,786.8603,2745.5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
PSN TIB STM 5 DEG SZ E R,,C1776,HCPCS,Facility,Both,,,,2745.5,2333.675,786.8603,2745.5,Sanford Health Plan,Sanford Health Plan,2525.86,92,,percent of total billed charges,,
PSN TIB STM 5 DEG SZ E R,,C1776,HCPCS,Facility,Outpatient,,,,2745.5,2333.675,786.8603,2745.5,"UCare Health, Inc.",Individual & Family Plan,1547.08925,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
PSN TIB STM 5 DEG SZ E R,,C1776,HCPCS,Facility,Inpatient,,,,2745.5,2333.675,786.8603,2745.5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
PSN TIB STM 5 DEG SZ E R,,C1776,HCPCS,Facility,Outpatient,,,,2745.5,2333.675,786.8603,2745.5,"UCare Health, Inc.",Medical Assistance,1385.65385,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PSN TIB STM 5 DEG SZ E R,,C1776,HCPCS,Facility,Inpatient,,,,2745.5,2333.675,786.8603,2745.5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
PSN TIB STM 5 DEG SZ E R,,C1776,HCPCS,Facility,Outpatient,,,,2745.5,2333.675,786.8603,2745.5,"UCare Health, Inc.",Medicare Advantage,1385.65385,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PSN TIB STM 5 DEG SZ E R,,C1776,HCPCS,Facility,Inpatient,,,,2745.5,2333.675,786.8603,2745.5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PSN TIB STM 5 DEG SZ E R,,C1776,HCPCS,Facility,Outpatient,,,,2745.5,2333.675,786.8603,2745.5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1385.65385,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PSN TIB STM 5 DEG SZ E R,,C1776,HCPCS,Facility,Inpatient,,,,2745.5,2333.675,786.8603,2745.5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PSN TIB STM 5 DEG SZ E R,,C1776,HCPCS,Facility,Both,,,,2745.5,2333.675,786.8603,2745.5,UnitedHealthcare,Individual & Family,2580.77,94,,percent of total billed charges,,
PSN TIB STM 5 DEG SZ E R,,C1776,HCPCS,Facility,Outpatient,,,,2745.5,2333.675,786.8603,2745.5,UnitedHealthcare,Medicare Advantage,1345.295,49,,percent of total billed charges,,
PSN TIB STM 5 DEG SZ E R,,C1776,HCPCS,Facility,Inpatient,,,,2745.5,2333.675,786.8603,2745.5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
PSN TIB STM 5 DEG SZ E R,,C1776,HCPCS,Facility,Outpatient,,,,2745.5,2333.675,786.8603,2745.5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1317.84,48,,percent of total billed charges,,100% of DHS outpatient percentage
PSN TIB STM 5 DEG SZ E R,,C1776,HCPCS,Facility,Inpatient,,,,2745.5,2333.675,786.8603,2745.5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
PSN TIB STM 5 DEG SZ F L,,C1776,HCPCS,Facility,Both,,,,2745.5,2333.675,786.8603,2745.5,Aetna,Commercial,2525.86,92,,percent of total billed charges,,
PSN TIB STM 5 DEG SZ F L,,C1776,HCPCS,Facility,Outpatient,,,,2745.5,2333.675,786.8603,2745.5,Aetna,Medicare Advantage,1345.295,49,,percent of total billed charges,,
PSN TIB STM 5 DEG SZ F L,,C1776,HCPCS,Facility,Inpatient,,,,2745.5,2333.675,786.8603,2745.5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
PSN TIB STM 5 DEG SZ F L,,C1776,HCPCS,Facility,Both,,,,2745.5,2333.675,786.8603,2745.5,Aetna,PPO,2553.315,93,,percent of total billed charges,,
PSN TIB STM 5 DEG SZ F L,,C1776,HCPCS,Facility,Both,,,,2745.5,2333.675,786.8603,2745.5,America's PPO,America's PPO,2636.50365,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
PSN TIB STM 5 DEG SZ F L,,C1776,HCPCS,Facility,Both,,,,2745.5,2333.675,786.8603,2745.5,BlueCross BlueShield Minnesota, Federal Employee Program,2701.572,98.4,,percent of total billed charges,,
PSN TIB STM 5 DEG SZ F L,,C1776,HCPCS,Facility,Both,,,,2745.5,2333.675,786.8603,2745.5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,2745.5,100,,percent of total billed charges,,
PSN TIB STM 5 DEG SZ F L,,C1776,HCPCS,Facility,Both,,,,2745.5,2333.675,786.8603,2745.5,BlueCross BlueShield Minnesota,High Value Network Plan,2470.95,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
PSN TIB STM 5 DEG SZ F L,,C1776,HCPCS,Facility,Outpatient,,,,2745.5,2333.675,786.8603,2745.5,BlueCross BlueShield Minnesota,Medicare Advantage,1345.295,49,,percent of total billed charges,,
PSN TIB STM 5 DEG SZ F L,,C1776,HCPCS,Facility,Inpatient,,,,2745.5,2333.675,786.8603,2745.5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
PSN TIB STM 5 DEG SZ F L,,C1776,HCPCS,Facility,Both,,,,2745.5,2333.675,786.8603,2745.5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,2431.68935,88.57,,percent of total billed charges,,
PSN TIB STM 5 DEG SZ F L,,C1776,HCPCS,Facility,Both,,,,2745.5,2333.675,786.8603,2745.5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,786.8603,28.66,,percent of total billed charges,,
PSN TIB STM 5 DEG SZ F L,,C1776,HCPCS,Facility,Outpatient,,,,2745.5,2333.675,786.8603,2745.5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1345.295,49,,percent of total billed charges,,
PSN TIB STM 5 DEG SZ F L,,C1776,HCPCS,Facility,Inpatient,,,,2745.5,2333.675,786.8603,2745.5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
PSN TIB STM 5 DEG SZ F L,,C1776,HCPCS,Facility,Both,,,,2745.5,2333.675,786.8603,2745.5,CorVel,Worker's Compensation,2745.5,100,,percent of total billed charges,,
PSN TIB STM 5 DEG SZ F L,,C1776,HCPCS,Facility,Both,,,,2745.5,2333.675,786.8603,2745.5,First Health Group Corporation,First Health Network,2663.135,97,,percent of total billed charges,,
PSN TIB STM 5 DEG SZ F L,,C1776,HCPCS,Facility,Both,,,,2745.5,2333.675,786.8603,2745.5,"Health Partners, Inc.",Commercial,2597.243,94.6,,percent of total billed charges,,
PSN TIB STM 5 DEG SZ F L,,C1776,HCPCS,Facility,Outpatient,,,,2745.5,2333.675,786.8603,2745.5,"Health Partners, Inc.",Medicare Advantage,1345.295,49,,percent of total billed charges,,
PSN TIB STM 5 DEG SZ F L,,C1776,HCPCS,Facility,Inpatient,,,,2745.5,2333.675,786.8603,2745.5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PSN TIB STM 5 DEG SZ F L,,C1776,HCPCS,Facility,Both,,,,2745.5,2333.675,786.8603,2745.5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1647.3,60,,percent of total billed charges,,
PSN TIB STM 5 DEG SZ F L,,C1776,HCPCS,Facility,Both,,,,2745.5,2333.675,786.8603,2745.5,"Health Partners, Inc.",State of Minnesota Advantage Program,2237.5825,81.5,,percent of total billed charges,,
PSN TIB STM 5 DEG SZ F L,,C1776,HCPCS,Facility,Both,,,,2745.5,2333.675,786.8603,2745.5,"Health Partners, Inc.",State Public Programs,1372.75,50,,percent of total billed charges,,
PSN TIB STM 5 DEG SZ F L,,C1776,HCPCS,Facility,Both,,,,2745.5,2333.675,786.8603,2745.5,Humana Insurance Company,Commercial PPO,2608.225,95,,percent of total billed charges,,
PSN TIB STM 5 DEG SZ F L,,C1776,HCPCS,Facility,Outpatient,,,,2745.5,2333.675,786.8603,2745.5,Humana Insurance Company,Medicare PPO,1345.295,49,,percent of total billed charges,,
PSN TIB STM 5 DEG SZ F L,,C1776,HCPCS,Facility,Inpatient,,,,2745.5,2333.675,786.8603,2745.5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
PSN TIB STM 5 DEG SZ F L,,C1776,HCPCS,Facility,Both,,,,2745.5,2333.675,786.8603,2745.5,Medica,Individual & Family,2720.7905,99.1,,percent of total billed charges,,
PSN TIB STM 5 DEG SZ F L,,C1776,HCPCS,Facility,Outpatient,,,,2745.5,2333.675,786.8603,2745.5,Medica,Medica Advantage Solution,1367.259,49.8,,percent of total billed charges,,
PSN TIB STM 5 DEG SZ F L,,C1776,HCPCS,Facility,Inpatient,,,,2745.5,2333.675,786.8603,2745.5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
PSN TIB STM 5 DEG SZ F L,,C1776,HCPCS,Facility,Outpatient,,,,2745.5,2333.675,786.8603,2745.5,Medica,Medical Assistance,1224.493,44.6,,percent of total billed charges,,
PSN TIB STM 5 DEG SZ F L,,C1776,HCPCS,Facility,Inpatient,,,,2745.5,2333.675,786.8603,2745.5,Medica,Medical Assistance,,,,,Included in per diem rate,
PSN TIB STM 5 DEG SZ F L,,C1776,HCPCS,Facility,Outpatient,,,,2745.5,2333.675,786.8603,2745.5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1367.259,49.8,,percent of total billed charges,,
PSN TIB STM 5 DEG SZ F L,,C1776,HCPCS,Facility,Inpatient,,,,2745.5,2333.675,786.8603,2745.5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
PSN TIB STM 5 DEG SZ F L,,C1776,HCPCS,Facility,Both,,,,2745.5,2333.675,786.8603,2745.5,"Multiplan, Inc.","Multiplan, Inc.",2580.77,94,,percent of total billed charges,,
PSN TIB STM 5 DEG SZ F L,,C1776,HCPCS,Facility,Outpatient,,,,2745.5,2333.675,786.8603,2745.5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,2473.6955,90.1,,percent of total billed charges,,
PSN TIB STM 5 DEG SZ F L,,C1776,HCPCS,Facility,Inpatient,,,,2745.5,2333.675,786.8603,2745.5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
PSN TIB STM 5 DEG SZ F L,,C1776,HCPCS,Facility,Both,,,,2745.5,2333.675,786.8603,2745.5,"Preferred One Administrative Services, INC.",PPO,2707.063,98.6,,percent of total billed charges,,
PSN TIB STM 5 DEG SZ F L,,C1776,HCPCS,Facility,Outpatient,,,,2745.5,2333.675,786.8603,2745.5,PrimeWest Health,Minnesota Senior Health Options (MSHO),1412.55975,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
PSN TIB STM 5 DEG SZ F L,,C1776,HCPCS,Facility,Inpatient,,,,2745.5,2333.675,786.8603,2745.5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PSN TIB STM 5 DEG SZ F L,,C1776,HCPCS,Facility,Outpatient,,,,2745.5,2333.675,786.8603,2745.5,PrimeWest Health,MinnesotaCare,1410.0888,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
PSN TIB STM 5 DEG SZ F L,,C1776,HCPCS,Facility,Inpatient,,,,2745.5,2333.675,786.8603,2745.5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
PSN TIB STM 5 DEG SZ F L,,C1776,HCPCS,Facility,Both,,,,2745.5,2333.675,786.8603,2745.5,Sanford Health Plan,Sanford Health Plan,2525.86,92,,percent of total billed charges,,
PSN TIB STM 5 DEG SZ F L,,C1776,HCPCS,Facility,Outpatient,,,,2745.5,2333.675,786.8603,2745.5,"UCare Health, Inc.",Individual & Family Plan,1547.08925,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
PSN TIB STM 5 DEG SZ F L,,C1776,HCPCS,Facility,Inpatient,,,,2745.5,2333.675,786.8603,2745.5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
PSN TIB STM 5 DEG SZ F L,,C1776,HCPCS,Facility,Outpatient,,,,2745.5,2333.675,786.8603,2745.5,"UCare Health, Inc.",Medical Assistance,1385.65385,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PSN TIB STM 5 DEG SZ F L,,C1776,HCPCS,Facility,Inpatient,,,,2745.5,2333.675,786.8603,2745.5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
PSN TIB STM 5 DEG SZ F L,,C1776,HCPCS,Facility,Outpatient,,,,2745.5,2333.675,786.8603,2745.5,"UCare Health, Inc.",Medicare Advantage,1385.65385,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PSN TIB STM 5 DEG SZ F L,,C1776,HCPCS,Facility,Inpatient,,,,2745.5,2333.675,786.8603,2745.5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PSN TIB STM 5 DEG SZ F L,,C1776,HCPCS,Facility,Outpatient,,,,2745.5,2333.675,786.8603,2745.5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1385.65385,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PSN TIB STM 5 DEG SZ F L,,C1776,HCPCS,Facility,Inpatient,,,,2745.5,2333.675,786.8603,2745.5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PSN TIB STM 5 DEG SZ F L,,C1776,HCPCS,Facility,Both,,,,2745.5,2333.675,786.8603,2745.5,UnitedHealthcare,Individual & Family,2580.77,94,,percent of total billed charges,,
PSN TIB STM 5 DEG SZ F L,,C1776,HCPCS,Facility,Outpatient,,,,2745.5,2333.675,786.8603,2745.5,UnitedHealthcare,Medicare Advantage,1345.295,49,,percent of total billed charges,,
PSN TIB STM 5 DEG SZ F L,,C1776,HCPCS,Facility,Inpatient,,,,2745.5,2333.675,786.8603,2745.5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
PSN TIB STM 5 DEG SZ F L,,C1776,HCPCS,Facility,Outpatient,,,,2745.5,2333.675,786.8603,2745.5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1317.84,48,,percent of total billed charges,,100% of DHS outpatient percentage
PSN TIB STM 5 DEG SZ F L,,C1776,HCPCS,Facility,Inpatient,,,,2745.5,2333.675,786.8603,2745.5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
PSN TIB STM 5 DEG SZ H L,,C1776,HCPCS,Facility,Both,,,,2745.5,2333.675,786.8603,2745.5,Aetna,Commercial,2525.86,92,,percent of total billed charges,,
PSN TIB STM 5 DEG SZ H L,,C1776,HCPCS,Facility,Outpatient,,,,2745.5,2333.675,786.8603,2745.5,Aetna,Medicare Advantage,1345.295,49,,percent of total billed charges,,
PSN TIB STM 5 DEG SZ H L,,C1776,HCPCS,Facility,Inpatient,,,,2745.5,2333.675,786.8603,2745.5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
PSN TIB STM 5 DEG SZ H L,,C1776,HCPCS,Facility,Both,,,,2745.5,2333.675,786.8603,2745.5,Aetna,PPO,2553.315,93,,percent of total billed charges,,
PSN TIB STM 5 DEG SZ H L,,C1776,HCPCS,Facility,Both,,,,2745.5,2333.675,786.8603,2745.5,America's PPO,America's PPO,2636.50365,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
PSN TIB STM 5 DEG SZ H L,,C1776,HCPCS,Facility,Both,,,,2745.5,2333.675,786.8603,2745.5,BlueCross BlueShield Minnesota, Federal Employee Program,2701.572,98.4,,percent of total billed charges,,
PSN TIB STM 5 DEG SZ H L,,C1776,HCPCS,Facility,Both,,,,2745.5,2333.675,786.8603,2745.5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,2745.5,100,,percent of total billed charges,,
PSN TIB STM 5 DEG SZ H L,,C1776,HCPCS,Facility,Both,,,,2745.5,2333.675,786.8603,2745.5,BlueCross BlueShield Minnesota,High Value Network Plan,2470.95,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
PSN TIB STM 5 DEG SZ H L,,C1776,HCPCS,Facility,Outpatient,,,,2745.5,2333.675,786.8603,2745.5,BlueCross BlueShield Minnesota,Medicare Advantage,1345.295,49,,percent of total billed charges,,
PSN TIB STM 5 DEG SZ H L,,C1776,HCPCS,Facility,Inpatient,,,,2745.5,2333.675,786.8603,2745.5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
PSN TIB STM 5 DEG SZ H L,,C1776,HCPCS,Facility,Both,,,,2745.5,2333.675,786.8603,2745.5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,2431.68935,88.57,,percent of total billed charges,,
PSN TIB STM 5 DEG SZ H L,,C1776,HCPCS,Facility,Both,,,,2745.5,2333.675,786.8603,2745.5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,786.8603,28.66,,percent of total billed charges,,
PSN TIB STM 5 DEG SZ H L,,C1776,HCPCS,Facility,Outpatient,,,,2745.5,2333.675,786.8603,2745.5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1345.295,49,,percent of total billed charges,,
PSN TIB STM 5 DEG SZ H L,,C1776,HCPCS,Facility,Inpatient,,,,2745.5,2333.675,786.8603,2745.5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
PSN TIB STM 5 DEG SZ H L,,C1776,HCPCS,Facility,Both,,,,2745.5,2333.675,786.8603,2745.5,CorVel,Worker's Compensation,2745.5,100,,percent of total billed charges,,
PSN TIB STM 5 DEG SZ H L,,C1776,HCPCS,Facility,Both,,,,2745.5,2333.675,786.8603,2745.5,First Health Group Corporation,First Health Network,2663.135,97,,percent of total billed charges,,
PSN TIB STM 5 DEG SZ H L,,C1776,HCPCS,Facility,Both,,,,2745.5,2333.675,786.8603,2745.5,"Health Partners, Inc.",Commercial,2597.243,94.6,,percent of total billed charges,,
PSN TIB STM 5 DEG SZ H L,,C1776,HCPCS,Facility,Outpatient,,,,2745.5,2333.675,786.8603,2745.5,"Health Partners, Inc.",Medicare Advantage,1345.295,49,,percent of total billed charges,,
PSN TIB STM 5 DEG SZ H L,,C1776,HCPCS,Facility,Inpatient,,,,2745.5,2333.675,786.8603,2745.5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PSN TIB STM 5 DEG SZ H L,,C1776,HCPCS,Facility,Both,,,,2745.5,2333.675,786.8603,2745.5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1647.3,60,,percent of total billed charges,,
PSN TIB STM 5 DEG SZ H L,,C1776,HCPCS,Facility,Both,,,,2745.5,2333.675,786.8603,2745.5,"Health Partners, Inc.",State of Minnesota Advantage Program,2237.5825,81.5,,percent of total billed charges,,
PSN TIB STM 5 DEG SZ H L,,C1776,HCPCS,Facility,Both,,,,2745.5,2333.675,786.8603,2745.5,"Health Partners, Inc.",State Public Programs,1372.75,50,,percent of total billed charges,,
PSN TIB STM 5 DEG SZ H L,,C1776,HCPCS,Facility,Both,,,,2745.5,2333.675,786.8603,2745.5,Humana Insurance Company,Commercial PPO,2608.225,95,,percent of total billed charges,,
PSN TIB STM 5 DEG SZ H L,,C1776,HCPCS,Facility,Outpatient,,,,2745.5,2333.675,786.8603,2745.5,Humana Insurance Company,Medicare PPO,1345.295,49,,percent of total billed charges,,
PSN TIB STM 5 DEG SZ H L,,C1776,HCPCS,Facility,Inpatient,,,,2745.5,2333.675,786.8603,2745.5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
PSN TIB STM 5 DEG SZ H L,,C1776,HCPCS,Facility,Both,,,,2745.5,2333.675,786.8603,2745.5,Medica,Individual & Family,2720.7905,99.1,,percent of total billed charges,,
PSN TIB STM 5 DEG SZ H L,,C1776,HCPCS,Facility,Outpatient,,,,2745.5,2333.675,786.8603,2745.5,Medica,Medica Advantage Solution,1367.259,49.8,,percent of total billed charges,,
PSN TIB STM 5 DEG SZ H L,,C1776,HCPCS,Facility,Inpatient,,,,2745.5,2333.675,786.8603,2745.5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
PSN TIB STM 5 DEG SZ H L,,C1776,HCPCS,Facility,Outpatient,,,,2745.5,2333.675,786.8603,2745.5,Medica,Medical Assistance,1224.493,44.6,,percent of total billed charges,,
PSN TIB STM 5 DEG SZ H L,,C1776,HCPCS,Facility,Inpatient,,,,2745.5,2333.675,786.8603,2745.5,Medica,Medical Assistance,,,,,Included in per diem rate,
PSN TIB STM 5 DEG SZ H L,,C1776,HCPCS,Facility,Outpatient,,,,2745.5,2333.675,786.8603,2745.5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1367.259,49.8,,percent of total billed charges,,
PSN TIB STM 5 DEG SZ H L,,C1776,HCPCS,Facility,Inpatient,,,,2745.5,2333.675,786.8603,2745.5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
PSN TIB STM 5 DEG SZ H L,,C1776,HCPCS,Facility,Both,,,,2745.5,2333.675,786.8603,2745.5,"Multiplan, Inc.","Multiplan, Inc.",2580.77,94,,percent of total billed charges,,
PSN TIB STM 5 DEG SZ H L,,C1776,HCPCS,Facility,Outpatient,,,,2745.5,2333.675,786.8603,2745.5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,2473.6955,90.1,,percent of total billed charges,,
PSN TIB STM 5 DEG SZ H L,,C1776,HCPCS,Facility,Inpatient,,,,2745.5,2333.675,786.8603,2745.5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
PSN TIB STM 5 DEG SZ H L,,C1776,HCPCS,Facility,Both,,,,2745.5,2333.675,786.8603,2745.5,"Preferred One Administrative Services, INC.",PPO,2707.063,98.6,,percent of total billed charges,,
PSN TIB STM 5 DEG SZ H L,,C1776,HCPCS,Facility,Outpatient,,,,2745.5,2333.675,786.8603,2745.5,PrimeWest Health,Minnesota Senior Health Options (MSHO),1412.55975,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
PSN TIB STM 5 DEG SZ H L,,C1776,HCPCS,Facility,Inpatient,,,,2745.5,2333.675,786.8603,2745.5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PSN TIB STM 5 DEG SZ H L,,C1776,HCPCS,Facility,Outpatient,,,,2745.5,2333.675,786.8603,2745.5,PrimeWest Health,MinnesotaCare,1410.0888,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
PSN TIB STM 5 DEG SZ H L,,C1776,HCPCS,Facility,Inpatient,,,,2745.5,2333.675,786.8603,2745.5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
PSN TIB STM 5 DEG SZ H L,,C1776,HCPCS,Facility,Both,,,,2745.5,2333.675,786.8603,2745.5,Sanford Health Plan,Sanford Health Plan,2525.86,92,,percent of total billed charges,,
PSN TIB STM 5 DEG SZ H L,,C1776,HCPCS,Facility,Outpatient,,,,2745.5,2333.675,786.8603,2745.5,"UCare Health, Inc.",Individual & Family Plan,1547.08925,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
PSN TIB STM 5 DEG SZ H L,,C1776,HCPCS,Facility,Inpatient,,,,2745.5,2333.675,786.8603,2745.5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
PSN TIB STM 5 DEG SZ H L,,C1776,HCPCS,Facility,Outpatient,,,,2745.5,2333.675,786.8603,2745.5,"UCare Health, Inc.",Medical Assistance,1385.65385,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PSN TIB STM 5 DEG SZ H L,,C1776,HCPCS,Facility,Inpatient,,,,2745.5,2333.675,786.8603,2745.5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
PSN TIB STM 5 DEG SZ H L,,C1776,HCPCS,Facility,Outpatient,,,,2745.5,2333.675,786.8603,2745.5,"UCare Health, Inc.",Medicare Advantage,1385.65385,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PSN TIB STM 5 DEG SZ H L,,C1776,HCPCS,Facility,Inpatient,,,,2745.5,2333.675,786.8603,2745.5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PSN TIB STM 5 DEG SZ H L,,C1776,HCPCS,Facility,Outpatient,,,,2745.5,2333.675,786.8603,2745.5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1385.65385,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PSN TIB STM 5 DEG SZ H L,,C1776,HCPCS,Facility,Inpatient,,,,2745.5,2333.675,786.8603,2745.5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PSN TIB STM 5 DEG SZ H L,,C1776,HCPCS,Facility,Both,,,,2745.5,2333.675,786.8603,2745.5,UnitedHealthcare,Individual & Family,2580.77,94,,percent of total billed charges,,
PSN TIB STM 5 DEG SZ H L,,C1776,HCPCS,Facility,Outpatient,,,,2745.5,2333.675,786.8603,2745.5,UnitedHealthcare,Medicare Advantage,1345.295,49,,percent of total billed charges,,
PSN TIB STM 5 DEG SZ H L,,C1776,HCPCS,Facility,Inpatient,,,,2745.5,2333.675,786.8603,2745.5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
PSN TIB STM 5 DEG SZ H L,,C1776,HCPCS,Facility,Outpatient,,,,2745.5,2333.675,786.8603,2745.5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1317.84,48,,percent of total billed charges,,100% of DHS outpatient percentage
PSN TIB STM 5 DEG SZ H L,,C1776,HCPCS,Facility,Inpatient,,,,2745.5,2333.675,786.8603,2745.5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
STEM EXTEN TAPERED CEMENTED 14MM +30MM PERSONA  ZIMMER 42-5570-001-14,,C1776,HCPCS,Facility,Both,,,,3570,3034.5,1023.162,3570,Aetna,Commercial,3284.4,92,,percent of total billed charges,,
STEM EXTEN TAPERED CEMENTED 14MM +30MM PERSONA  ZIMMER 42-5570-001-14,,C1776,HCPCS,Facility,Outpatient,,,,3570,3034.5,1023.162,3570,Aetna,Medicare Advantage,1749.3,49,,percent of total billed charges,,
STEM EXTEN TAPERED CEMENTED 14MM +30MM PERSONA  ZIMMER 42-5570-001-14,,C1776,HCPCS,Facility,Inpatient,,,,3570,3034.5,1023.162,3570,Aetna,Medicare Advantage,,,,,Included in per diem rate,
STEM EXTEN TAPERED CEMENTED 14MM +30MM PERSONA  ZIMMER 42-5570-001-14,,C1776,HCPCS,Facility,Both,,,,3570,3034.5,1023.162,3570,Aetna,PPO,3320.1,93,,percent of total billed charges,,
STEM EXTEN TAPERED CEMENTED 14MM +30MM PERSONA  ZIMMER 42-5570-001-14,,C1776,HCPCS,Facility,Both,,,,3570,3034.5,1023.162,3570,America's PPO,America's PPO,3428.271,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
STEM EXTEN TAPERED CEMENTED 14MM +30MM PERSONA  ZIMMER 42-5570-001-14,,C1776,HCPCS,Facility,Both,,,,3570,3034.5,1023.162,3570,BlueCross BlueShield Minnesota, Federal Employee Program,3512.88,98.4,,percent of total billed charges,,
STEM EXTEN TAPERED CEMENTED 14MM +30MM PERSONA  ZIMMER 42-5570-001-14,,C1776,HCPCS,Facility,Both,,,,3570,3034.5,1023.162,3570,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,3570,100,,percent of total billed charges,,
STEM EXTEN TAPERED CEMENTED 14MM +30MM PERSONA  ZIMMER 42-5570-001-14,,C1776,HCPCS,Facility,Both,,,,3570,3034.5,1023.162,3570,BlueCross BlueShield Minnesota,High Value Network Plan,3213,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
STEM EXTEN TAPERED CEMENTED 14MM +30MM PERSONA  ZIMMER 42-5570-001-14,,C1776,HCPCS,Facility,Outpatient,,,,3570,3034.5,1023.162,3570,BlueCross BlueShield Minnesota,Medicare Advantage,1749.3,49,,percent of total billed charges,,
STEM EXTEN TAPERED CEMENTED 14MM +30MM PERSONA  ZIMMER 42-5570-001-14,,C1776,HCPCS,Facility,Inpatient,,,,3570,3034.5,1023.162,3570,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
STEM EXTEN TAPERED CEMENTED 14MM +30MM PERSONA  ZIMMER 42-5570-001-14,,C1776,HCPCS,Facility,Both,,,,3570,3034.5,1023.162,3570,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,3161.949,88.57,,percent of total billed charges,,
STEM EXTEN TAPERED CEMENTED 14MM +30MM PERSONA  ZIMMER 42-5570-001-14,,C1776,HCPCS,Facility,Both,,,,3570,3034.5,1023.162,3570,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1023.162,28.66,,percent of total billed charges,,
STEM EXTEN TAPERED CEMENTED 14MM +30MM PERSONA  ZIMMER 42-5570-001-14,,C1776,HCPCS,Facility,Outpatient,,,,3570,3034.5,1023.162,3570,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1749.3,49,,percent of total billed charges,,
STEM EXTEN TAPERED CEMENTED 14MM +30MM PERSONA  ZIMMER 42-5570-001-14,,C1776,HCPCS,Facility,Inpatient,,,,3570,3034.5,1023.162,3570,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
STEM EXTEN TAPERED CEMENTED 14MM +30MM PERSONA  ZIMMER 42-5570-001-14,,C1776,HCPCS,Facility,Both,,,,3570,3034.5,1023.162,3570,CorVel,Worker's Compensation,3570,100,,percent of total billed charges,,
STEM EXTEN TAPERED CEMENTED 14MM +30MM PERSONA  ZIMMER 42-5570-001-14,,C1776,HCPCS,Facility,Both,,,,3570,3034.5,1023.162,3570,First Health Group Corporation,First Health Network,3462.9,97,,percent of total billed charges,,
STEM EXTEN TAPERED CEMENTED 14MM +30MM PERSONA  ZIMMER 42-5570-001-14,,C1776,HCPCS,Facility,Both,,,,3570,3034.5,1023.162,3570,"Health Partners, Inc.",Commercial,3377.22,94.6,,percent of total billed charges,,
STEM EXTEN TAPERED CEMENTED 14MM +30MM PERSONA  ZIMMER 42-5570-001-14,,C1776,HCPCS,Facility,Outpatient,,,,3570,3034.5,1023.162,3570,"Health Partners, Inc.",Medicare Advantage,1749.3,49,,percent of total billed charges,,
STEM EXTEN TAPERED CEMENTED 14MM +30MM PERSONA  ZIMMER 42-5570-001-14,,C1776,HCPCS,Facility,Inpatient,,,,3570,3034.5,1023.162,3570,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
STEM EXTEN TAPERED CEMENTED 14MM +30MM PERSONA  ZIMMER 42-5570-001-14,,C1776,HCPCS,Facility,Both,,,,3570,3034.5,1023.162,3570,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),2142,60,,percent of total billed charges,,
STEM EXTEN TAPERED CEMENTED 14MM +30MM PERSONA  ZIMMER 42-5570-001-14,,C1776,HCPCS,Facility,Both,,,,3570,3034.5,1023.162,3570,"Health Partners, Inc.",State of Minnesota Advantage Program,2909.55,81.5,,percent of total billed charges,,
STEM EXTEN TAPERED CEMENTED 14MM +30MM PERSONA  ZIMMER 42-5570-001-14,,C1776,HCPCS,Facility,Both,,,,3570,3034.5,1023.162,3570,"Health Partners, Inc.",State Public Programs,1785,50,,percent of total billed charges,,
STEM EXTEN TAPERED CEMENTED 14MM +30MM PERSONA  ZIMMER 42-5570-001-14,,C1776,HCPCS,Facility,Both,,,,3570,3034.5,1023.162,3570,Humana Insurance Company,Commercial PPO,3391.5,95,,percent of total billed charges,,
STEM EXTEN TAPERED CEMENTED 14MM +30MM PERSONA  ZIMMER 42-5570-001-14,,C1776,HCPCS,Facility,Outpatient,,,,3570,3034.5,1023.162,3570,Humana Insurance Company,Medicare PPO,1749.3,49,,percent of total billed charges,,
STEM EXTEN TAPERED CEMENTED 14MM +30MM PERSONA  ZIMMER 42-5570-001-14,,C1776,HCPCS,Facility,Inpatient,,,,3570,3034.5,1023.162,3570,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
STEM EXTEN TAPERED CEMENTED 14MM +30MM PERSONA  ZIMMER 42-5570-001-14,,C1776,HCPCS,Facility,Both,,,,3570,3034.5,1023.162,3570,Medica,Individual & Family,3537.87,99.1,,percent of total billed charges,,
STEM EXTEN TAPERED CEMENTED 14MM +30MM PERSONA  ZIMMER 42-5570-001-14,,C1776,HCPCS,Facility,Outpatient,,,,3570,3034.5,1023.162,3570,Medica,Medica Advantage Solution,1777.86,49.8,,percent of total billed charges,,
STEM EXTEN TAPERED CEMENTED 14MM +30MM PERSONA  ZIMMER 42-5570-001-14,,C1776,HCPCS,Facility,Inpatient,,,,3570,3034.5,1023.162,3570,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
STEM EXTEN TAPERED CEMENTED 14MM +30MM PERSONA  ZIMMER 42-5570-001-14,,C1776,HCPCS,Facility,Outpatient,,,,3570,3034.5,1023.162,3570,Medica,Medical Assistance,1592.22,44.6,,percent of total billed charges,,
STEM EXTEN TAPERED CEMENTED 14MM +30MM PERSONA  ZIMMER 42-5570-001-14,,C1776,HCPCS,Facility,Inpatient,,,,3570,3034.5,1023.162,3570,Medica,Medical Assistance,,,,,Included in per diem rate,
STEM EXTEN TAPERED CEMENTED 14MM +30MM PERSONA  ZIMMER 42-5570-001-14,,C1776,HCPCS,Facility,Outpatient,,,,3570,3034.5,1023.162,3570,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1777.86,49.8,,percent of total billed charges,,
STEM EXTEN TAPERED CEMENTED 14MM +30MM PERSONA  ZIMMER 42-5570-001-14,,C1776,HCPCS,Facility,Inpatient,,,,3570,3034.5,1023.162,3570,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
STEM EXTEN TAPERED CEMENTED 14MM +30MM PERSONA  ZIMMER 42-5570-001-14,,C1776,HCPCS,Facility,Both,,,,3570,3034.5,1023.162,3570,"Multiplan, Inc.","Multiplan, Inc.",3355.8,94,,percent of total billed charges,,
STEM EXTEN TAPERED CEMENTED 14MM +30MM PERSONA  ZIMMER 42-5570-001-14,,C1776,HCPCS,Facility,Outpatient,,,,3570,3034.5,1023.162,3570,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,3216.57,90.1,,percent of total billed charges,,
STEM EXTEN TAPERED CEMENTED 14MM +30MM PERSONA  ZIMMER 42-5570-001-14,,C1776,HCPCS,Facility,Inpatient,,,,3570,3034.5,1023.162,3570,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
STEM EXTEN TAPERED CEMENTED 14MM +30MM PERSONA  ZIMMER 42-5570-001-14,,C1776,HCPCS,Facility,Both,,,,3570,3034.5,1023.162,3570,"Preferred One Administrative Services, INC.",PPO,3520.02,98.6,,percent of total billed charges,,
STEM EXTEN TAPERED CEMENTED 14MM +30MM PERSONA  ZIMMER 42-5570-001-14,,C1776,HCPCS,Facility,Outpatient,,,,3570,3034.5,1023.162,3570,PrimeWest Health,Minnesota Senior Health Options (MSHO),1836.765,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
STEM EXTEN TAPERED CEMENTED 14MM +30MM PERSONA  ZIMMER 42-5570-001-14,,C1776,HCPCS,Facility,Inpatient,,,,3570,3034.5,1023.162,3570,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
STEM EXTEN TAPERED CEMENTED 14MM +30MM PERSONA  ZIMMER 42-5570-001-14,,C1776,HCPCS,Facility,Outpatient,,,,3570,3034.5,1023.162,3570,PrimeWest Health,MinnesotaCare,1833.552,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
STEM EXTEN TAPERED CEMENTED 14MM +30MM PERSONA  ZIMMER 42-5570-001-14,,C1776,HCPCS,Facility,Inpatient,,,,3570,3034.5,1023.162,3570,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
STEM EXTEN TAPERED CEMENTED 14MM +30MM PERSONA  ZIMMER 42-5570-001-14,,C1776,HCPCS,Facility,Both,,,,3570,3034.5,1023.162,3570,Sanford Health Plan,Sanford Health Plan,3284.4,92,,percent of total billed charges,,
STEM EXTEN TAPERED CEMENTED 14MM +30MM PERSONA  ZIMMER 42-5570-001-14,,C1776,HCPCS,Facility,Outpatient,,,,3570,3034.5,1023.162,3570,"UCare Health, Inc.",Individual & Family Plan,2011.695,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
STEM EXTEN TAPERED CEMENTED 14MM +30MM PERSONA  ZIMMER 42-5570-001-14,,C1776,HCPCS,Facility,Inpatient,,,,3570,3034.5,1023.162,3570,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
STEM EXTEN TAPERED CEMENTED 14MM +30MM PERSONA  ZIMMER 42-5570-001-14,,C1776,HCPCS,Facility,Outpatient,,,,3570,3034.5,1023.162,3570,"UCare Health, Inc.",Medical Assistance,1801.779,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
STEM EXTEN TAPERED CEMENTED 14MM +30MM PERSONA  ZIMMER 42-5570-001-14,,C1776,HCPCS,Facility,Inpatient,,,,3570,3034.5,1023.162,3570,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
STEM EXTEN TAPERED CEMENTED 14MM +30MM PERSONA  ZIMMER 42-5570-001-14,,C1776,HCPCS,Facility,Outpatient,,,,3570,3034.5,1023.162,3570,"UCare Health, Inc.",Medicare Advantage,1801.779,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
STEM EXTEN TAPERED CEMENTED 14MM +30MM PERSONA  ZIMMER 42-5570-001-14,,C1776,HCPCS,Facility,Inpatient,,,,3570,3034.5,1023.162,3570,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
STEM EXTEN TAPERED CEMENTED 14MM +30MM PERSONA  ZIMMER 42-5570-001-14,,C1776,HCPCS,Facility,Outpatient,,,,3570,3034.5,1023.162,3570,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1801.779,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
STEM EXTEN TAPERED CEMENTED 14MM +30MM PERSONA  ZIMMER 42-5570-001-14,,C1776,HCPCS,Facility,Inpatient,,,,3570,3034.5,1023.162,3570,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
STEM EXTEN TAPERED CEMENTED 14MM +30MM PERSONA  ZIMMER 42-5570-001-14,,C1776,HCPCS,Facility,Both,,,,3570,3034.5,1023.162,3570,UnitedHealthcare,Individual & Family,3355.8,94,,percent of total billed charges,,
STEM EXTEN TAPERED CEMENTED 14MM +30MM PERSONA  ZIMMER 42-5570-001-14,,C1776,HCPCS,Facility,Outpatient,,,,3570,3034.5,1023.162,3570,UnitedHealthcare,Medicare Advantage,1749.3,49,,percent of total billed charges,,
STEM EXTEN TAPERED CEMENTED 14MM +30MM PERSONA  ZIMMER 42-5570-001-14,,C1776,HCPCS,Facility,Inpatient,,,,3570,3034.5,1023.162,3570,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
STEM EXTEN TAPERED CEMENTED 14MM +30MM PERSONA  ZIMMER 42-5570-001-14,,C1776,HCPCS,Facility,Outpatient,,,,3570,3034.5,1023.162,3570,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1713.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
STEM EXTEN TAPERED CEMENTED 14MM +30MM PERSONA  ZIMMER 42-5570-001-14,,C1776,HCPCS,Facility,Inpatient,,,,3570,3034.5,1023.162,3570,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"ZIMMER, PERSONA, CEMENTED PATELLA, 35 MM, 9 MM HEIGHT",,C1776,HCPCS,Facility,Both,,,,1995,1695.75,571.767,1995,Aetna,Commercial,1835.4,92,,percent of total billed charges,,
"ZIMMER, PERSONA, CEMENTED PATELLA, 35 MM, 9 MM HEIGHT",,C1776,HCPCS,Facility,Outpatient,,,,1995,1695.75,571.767,1995,Aetna,Medicare Advantage,977.55,49,,percent of total billed charges,,
"ZIMMER, PERSONA, CEMENTED PATELLA, 35 MM, 9 MM HEIGHT",,C1776,HCPCS,Facility,Inpatient,,,,1995,1695.75,571.767,1995,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"ZIMMER, PERSONA, CEMENTED PATELLA, 35 MM, 9 MM HEIGHT",,C1776,HCPCS,Facility,Both,,,,1995,1695.75,571.767,1995,Aetna,PPO,1855.35,93,,percent of total billed charges,,
"ZIMMER, PERSONA, CEMENTED PATELLA, 35 MM, 9 MM HEIGHT",,C1776,HCPCS,Facility,Both,,,,1995,1695.75,571.767,1995,America's PPO,America's PPO,1915.7985,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"ZIMMER, PERSONA, CEMENTED PATELLA, 35 MM, 9 MM HEIGHT",,C1776,HCPCS,Facility,Both,,,,1995,1695.75,571.767,1995,BlueCross BlueShield Minnesota, Federal Employee Program,1963.08,98.4,,percent of total billed charges,,
"ZIMMER, PERSONA, CEMENTED PATELLA, 35 MM, 9 MM HEIGHT",,C1776,HCPCS,Facility,Both,,,,1995,1695.75,571.767,1995,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1995,100,,percent of total billed charges,,
"ZIMMER, PERSONA, CEMENTED PATELLA, 35 MM, 9 MM HEIGHT",,C1776,HCPCS,Facility,Both,,,,1995,1695.75,571.767,1995,BlueCross BlueShield Minnesota,High Value Network Plan,1795.5,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
"ZIMMER, PERSONA, CEMENTED PATELLA, 35 MM, 9 MM HEIGHT",,C1776,HCPCS,Facility,Outpatient,,,,1995,1695.75,571.767,1995,BlueCross BlueShield Minnesota,Medicare Advantage,977.55,49,,percent of total billed charges,,
"ZIMMER, PERSONA, CEMENTED PATELLA, 35 MM, 9 MM HEIGHT",,C1776,HCPCS,Facility,Inpatient,,,,1995,1695.75,571.767,1995,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"ZIMMER, PERSONA, CEMENTED PATELLA, 35 MM, 9 MM HEIGHT",,C1776,HCPCS,Facility,Both,,,,1995,1695.75,571.767,1995,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1766.9715,88.57,,percent of total billed charges,,
"ZIMMER, PERSONA, CEMENTED PATELLA, 35 MM, 9 MM HEIGHT",,C1776,HCPCS,Facility,Both,,,,1995,1695.75,571.767,1995,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,571.767,28.66,,percent of total billed charges,,
"ZIMMER, PERSONA, CEMENTED PATELLA, 35 MM, 9 MM HEIGHT",,C1776,HCPCS,Facility,Outpatient,,,,1995,1695.75,571.767,1995,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),977.55,49,,percent of total billed charges,,
"ZIMMER, PERSONA, CEMENTED PATELLA, 35 MM, 9 MM HEIGHT",,C1776,HCPCS,Facility,Inpatient,,,,1995,1695.75,571.767,1995,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"ZIMMER, PERSONA, CEMENTED PATELLA, 35 MM, 9 MM HEIGHT",,C1776,HCPCS,Facility,Both,,,,1995,1695.75,571.767,1995,CorVel,Worker's Compensation,1995,100,,percent of total billed charges,,
"ZIMMER, PERSONA, CEMENTED PATELLA, 35 MM, 9 MM HEIGHT",,C1776,HCPCS,Facility,Both,,,,1995,1695.75,571.767,1995,First Health Group Corporation,First Health Network,1935.15,97,,percent of total billed charges,,
"ZIMMER, PERSONA, CEMENTED PATELLA, 35 MM, 9 MM HEIGHT",,C1776,HCPCS,Facility,Both,,,,1995,1695.75,571.767,1995,"Health Partners, Inc.",Commercial,1887.27,94.6,,percent of total billed charges,,
"ZIMMER, PERSONA, CEMENTED PATELLA, 35 MM, 9 MM HEIGHT",,C1776,HCPCS,Facility,Outpatient,,,,1995,1695.75,571.767,1995,"Health Partners, Inc.",Medicare Advantage,977.55,49,,percent of total billed charges,,
"ZIMMER, PERSONA, CEMENTED PATELLA, 35 MM, 9 MM HEIGHT",,C1776,HCPCS,Facility,Inpatient,,,,1995,1695.75,571.767,1995,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"ZIMMER, PERSONA, CEMENTED PATELLA, 35 MM, 9 MM HEIGHT",,C1776,HCPCS,Facility,Both,,,,1995,1695.75,571.767,1995,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1197,60,,percent of total billed charges,,
"ZIMMER, PERSONA, CEMENTED PATELLA, 35 MM, 9 MM HEIGHT",,C1776,HCPCS,Facility,Both,,,,1995,1695.75,571.767,1995,"Health Partners, Inc.",State of Minnesota Advantage Program,1625.925,81.5,,percent of total billed charges,,
"ZIMMER, PERSONA, CEMENTED PATELLA, 35 MM, 9 MM HEIGHT",,C1776,HCPCS,Facility,Both,,,,1995,1695.75,571.767,1995,"Health Partners, Inc.",State Public Programs,997.5,50,,percent of total billed charges,,
"ZIMMER, PERSONA, CEMENTED PATELLA, 35 MM, 9 MM HEIGHT",,C1776,HCPCS,Facility,Both,,,,1995,1695.75,571.767,1995,Humana Insurance Company,Commercial PPO,1895.25,95,,percent of total billed charges,,
"ZIMMER, PERSONA, CEMENTED PATELLA, 35 MM, 9 MM HEIGHT",,C1776,HCPCS,Facility,Outpatient,,,,1995,1695.75,571.767,1995,Humana Insurance Company,Medicare PPO,977.55,49,,percent of total billed charges,,
"ZIMMER, PERSONA, CEMENTED PATELLA, 35 MM, 9 MM HEIGHT",,C1776,HCPCS,Facility,Inpatient,,,,1995,1695.75,571.767,1995,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"ZIMMER, PERSONA, CEMENTED PATELLA, 35 MM, 9 MM HEIGHT",,C1776,HCPCS,Facility,Both,,,,1995,1695.75,571.767,1995,Medica,Individual & Family,1977.045,99.1,,percent of total billed charges,,
"ZIMMER, PERSONA, CEMENTED PATELLA, 35 MM, 9 MM HEIGHT",,C1776,HCPCS,Facility,Outpatient,,,,1995,1695.75,571.767,1995,Medica,Medica Advantage Solution,993.51,49.8,,percent of total billed charges,,
"ZIMMER, PERSONA, CEMENTED PATELLA, 35 MM, 9 MM HEIGHT",,C1776,HCPCS,Facility,Inpatient,,,,1995,1695.75,571.767,1995,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"ZIMMER, PERSONA, CEMENTED PATELLA, 35 MM, 9 MM HEIGHT",,C1776,HCPCS,Facility,Outpatient,,,,1995,1695.75,571.767,1995,Medica,Medical Assistance,889.77,44.6,,percent of total billed charges,,
"ZIMMER, PERSONA, CEMENTED PATELLA, 35 MM, 9 MM HEIGHT",,C1776,HCPCS,Facility,Inpatient,,,,1995,1695.75,571.767,1995,Medica,Medical Assistance,,,,,Included in per diem rate,
"ZIMMER, PERSONA, CEMENTED PATELLA, 35 MM, 9 MM HEIGHT",,C1776,HCPCS,Facility,Outpatient,,,,1995,1695.75,571.767,1995,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,993.51,49.8,,percent of total billed charges,,
"ZIMMER, PERSONA, CEMENTED PATELLA, 35 MM, 9 MM HEIGHT",,C1776,HCPCS,Facility,Inpatient,,,,1995,1695.75,571.767,1995,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"ZIMMER, PERSONA, CEMENTED PATELLA, 35 MM, 9 MM HEIGHT",,C1776,HCPCS,Facility,Both,,,,1995,1695.75,571.767,1995,"Multiplan, Inc.","Multiplan, Inc.",1875.3,94,,percent of total billed charges,,
"ZIMMER, PERSONA, CEMENTED PATELLA, 35 MM, 9 MM HEIGHT",,C1776,HCPCS,Facility,Outpatient,,,,1995,1695.75,571.767,1995,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1797.495,90.1,,percent of total billed charges,,
"ZIMMER, PERSONA, CEMENTED PATELLA, 35 MM, 9 MM HEIGHT",,C1776,HCPCS,Facility,Inpatient,,,,1995,1695.75,571.767,1995,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"ZIMMER, PERSONA, CEMENTED PATELLA, 35 MM, 9 MM HEIGHT",,C1776,HCPCS,Facility,Both,,,,1995,1695.75,571.767,1995,"Preferred One Administrative Services, INC.",PPO,1967.07,98.6,,percent of total billed charges,,
"ZIMMER, PERSONA, CEMENTED PATELLA, 35 MM, 9 MM HEIGHT",,C1776,HCPCS,Facility,Outpatient,,,,1995,1695.75,571.767,1995,PrimeWest Health,Minnesota Senior Health Options (MSHO),1026.4275,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"ZIMMER, PERSONA, CEMENTED PATELLA, 35 MM, 9 MM HEIGHT",,C1776,HCPCS,Facility,Inpatient,,,,1995,1695.75,571.767,1995,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"ZIMMER, PERSONA, CEMENTED PATELLA, 35 MM, 9 MM HEIGHT",,C1776,HCPCS,Facility,Outpatient,,,,1995,1695.75,571.767,1995,PrimeWest Health,MinnesotaCare,1024.632,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"ZIMMER, PERSONA, CEMENTED PATELLA, 35 MM, 9 MM HEIGHT",,C1776,HCPCS,Facility,Inpatient,,,,1995,1695.75,571.767,1995,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"ZIMMER, PERSONA, CEMENTED PATELLA, 35 MM, 9 MM HEIGHT",,C1776,HCPCS,Facility,Both,,,,1995,1695.75,571.767,1995,Sanford Health Plan,Sanford Health Plan,1835.4,92,,percent of total billed charges,,
"ZIMMER, PERSONA, CEMENTED PATELLA, 35 MM, 9 MM HEIGHT",,C1776,HCPCS,Facility,Outpatient,,,,1995,1695.75,571.767,1995,"UCare Health, Inc.",Individual & Family Plan,1124.1825,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"ZIMMER, PERSONA, CEMENTED PATELLA, 35 MM, 9 MM HEIGHT",,C1776,HCPCS,Facility,Inpatient,,,,1995,1695.75,571.767,1995,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"ZIMMER, PERSONA, CEMENTED PATELLA, 35 MM, 9 MM HEIGHT",,C1776,HCPCS,Facility,Outpatient,,,,1995,1695.75,571.767,1995,"UCare Health, Inc.",Medical Assistance,1006.8765,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"ZIMMER, PERSONA, CEMENTED PATELLA, 35 MM, 9 MM HEIGHT",,C1776,HCPCS,Facility,Inpatient,,,,1995,1695.75,571.767,1995,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"ZIMMER, PERSONA, CEMENTED PATELLA, 35 MM, 9 MM HEIGHT",,C1776,HCPCS,Facility,Outpatient,,,,1995,1695.75,571.767,1995,"UCare Health, Inc.",Medicare Advantage,1006.8765,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"ZIMMER, PERSONA, CEMENTED PATELLA, 35 MM, 9 MM HEIGHT",,C1776,HCPCS,Facility,Inpatient,,,,1995,1695.75,571.767,1995,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"ZIMMER, PERSONA, CEMENTED PATELLA, 35 MM, 9 MM HEIGHT",,C1776,HCPCS,Facility,Outpatient,,,,1995,1695.75,571.767,1995,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1006.8765,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"ZIMMER, PERSONA, CEMENTED PATELLA, 35 MM, 9 MM HEIGHT",,C1776,HCPCS,Facility,Inpatient,,,,1995,1695.75,571.767,1995,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"ZIMMER, PERSONA, CEMENTED PATELLA, 35 MM, 9 MM HEIGHT",,C1776,HCPCS,Facility,Both,,,,1995,1695.75,571.767,1995,UnitedHealthcare,Individual & Family,1875.3,94,,percent of total billed charges,,
"ZIMMER, PERSONA, CEMENTED PATELLA, 35 MM, 9 MM HEIGHT",,C1776,HCPCS,Facility,Outpatient,,,,1995,1695.75,571.767,1995,UnitedHealthcare,Medicare Advantage,977.55,49,,percent of total billed charges,,
"ZIMMER, PERSONA, CEMENTED PATELLA, 35 MM, 9 MM HEIGHT",,C1776,HCPCS,Facility,Inpatient,,,,1995,1695.75,571.767,1995,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"ZIMMER, PERSONA, CEMENTED PATELLA, 35 MM, 9 MM HEIGHT",,C1776,HCPCS,Facility,Outpatient,,,,1995,1695.75,571.767,1995,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,957.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
"ZIMMER, PERSONA, CEMENTED PATELLA, 35 MM, 9 MM HEIGHT",,C1776,HCPCS,Facility,Inpatient,,,,1995,1695.75,571.767,1995,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
IOL Tecnis,,C1780,HCPCS,Facility,Both,,,,227.5,193.375,65.2015,227.5,Aetna,Commercial,209.3,92,,percent of total billed charges,,
IOL Tecnis,,C1780,HCPCS,Facility,Outpatient,,,,227.5,193.375,65.2015,227.5,Aetna,Medicare Advantage,111.475,49,,percent of total billed charges,,
IOL Tecnis,,C1780,HCPCS,Facility,Inpatient,,,,227.5,193.375,65.2015,227.5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
IOL Tecnis,,C1780,HCPCS,Facility,Both,,,,227.5,193.375,65.2015,227.5,Aetna,PPO,211.575,93,,percent of total billed charges,,
IOL Tecnis,,C1780,HCPCS,Facility,Both,,,,227.5,193.375,65.2015,227.5,America's PPO,America's PPO,218.46825,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
IOL Tecnis,,C1780,HCPCS,Facility,Both,,,,227.5,193.375,65.2015,227.5,BlueCross BlueShield Minnesota, Federal Employee Program,223.86,98.4,,percent of total billed charges,,
IOL Tecnis,,C1780,HCPCS,Facility,Both,,,,227.5,193.375,65.2015,227.5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,227.5,100,,percent of total billed charges,,
IOL Tecnis,,C1780,HCPCS,Facility,Both,,,,227.5,193.375,65.2015,227.5,BlueCross BlueShield Minnesota,High Value Network Plan,204.75,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
IOL Tecnis,,C1780,HCPCS,Facility,Outpatient,,,,227.5,193.375,65.2015,227.5,BlueCross BlueShield Minnesota,Medicare Advantage,111.475,49,,percent of total billed charges,,
IOL Tecnis,,C1780,HCPCS,Facility,Inpatient,,,,227.5,193.375,65.2015,227.5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
IOL Tecnis,,C1780,HCPCS,Facility,Both,,,,227.5,193.375,65.2015,227.5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,201.49675,88.57,,percent of total billed charges,,
IOL Tecnis,,C1780,HCPCS,Facility,Both,,,,227.5,193.375,65.2015,227.5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,65.2015,28.66,,percent of total billed charges,,
IOL Tecnis,,C1780,HCPCS,Facility,Outpatient,,,,227.5,193.375,65.2015,227.5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),111.475,49,,percent of total billed charges,,
IOL Tecnis,,C1780,HCPCS,Facility,Inpatient,,,,227.5,193.375,65.2015,227.5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
IOL Tecnis,,C1780,HCPCS,Facility,Both,,,,227.5,193.375,65.2015,227.5,CorVel,Worker's Compensation,227.5,100,,percent of total billed charges,,
IOL Tecnis,,C1780,HCPCS,Facility,Both,,,,227.5,193.375,65.2015,227.5,First Health Group Corporation,First Health Network,220.675,97,,percent of total billed charges,,
IOL Tecnis,,C1780,HCPCS,Facility,Both,,,,227.5,193.375,65.2015,227.5,"Health Partners, Inc.",Commercial,215.215,94.6,,percent of total billed charges,,
IOL Tecnis,,C1780,HCPCS,Facility,Outpatient,,,,227.5,193.375,65.2015,227.5,"Health Partners, Inc.",Medicare Advantage,111.475,49,,percent of total billed charges,,
IOL Tecnis,,C1780,HCPCS,Facility,Inpatient,,,,227.5,193.375,65.2015,227.5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
IOL Tecnis,,C1780,HCPCS,Facility,Both,,,,227.5,193.375,65.2015,227.5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),136.5,60,,percent of total billed charges,,
IOL Tecnis,,C1780,HCPCS,Facility,Both,,,,227.5,193.375,65.2015,227.5,"Health Partners, Inc.",State of Minnesota Advantage Program,185.4125,81.5,,percent of total billed charges,,
IOL Tecnis,,C1780,HCPCS,Facility,Both,,,,227.5,193.375,65.2015,227.5,"Health Partners, Inc.",State Public Programs,113.75,50,,percent of total billed charges,,
IOL Tecnis,,C1780,HCPCS,Facility,Both,,,,227.5,193.375,65.2015,227.5,Humana Insurance Company,Commercial PPO,216.125,95,,percent of total billed charges,,
IOL Tecnis,,C1780,HCPCS,Facility,Outpatient,,,,227.5,193.375,65.2015,227.5,Humana Insurance Company,Medicare PPO,111.475,49,,percent of total billed charges,,
IOL Tecnis,,C1780,HCPCS,Facility,Inpatient,,,,227.5,193.375,65.2015,227.5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
IOL Tecnis,,C1780,HCPCS,Facility,Both,,,,227.5,193.375,65.2015,227.5,Medica,Individual & Family,225.4525,99.1,,percent of total billed charges,,
IOL Tecnis,,C1780,HCPCS,Facility,Outpatient,,,,227.5,193.375,65.2015,227.5,Medica,Medica Advantage Solution,113.295,49.8,,percent of total billed charges,,
IOL Tecnis,,C1780,HCPCS,Facility,Inpatient,,,,227.5,193.375,65.2015,227.5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
IOL Tecnis,,C1780,HCPCS,Facility,Outpatient,,,,227.5,193.375,65.2015,227.5,Medica,Medical Assistance,101.465,44.6,,percent of total billed charges,,
IOL Tecnis,,C1780,HCPCS,Facility,Inpatient,,,,227.5,193.375,65.2015,227.5,Medica,Medical Assistance,,,,,Included in per diem rate,
IOL Tecnis,,C1780,HCPCS,Facility,Outpatient,,,,227.5,193.375,65.2015,227.5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,113.295,49.8,,percent of total billed charges,,
IOL Tecnis,,C1780,HCPCS,Facility,Inpatient,,,,227.5,193.375,65.2015,227.5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
IOL Tecnis,,C1780,HCPCS,Facility,Both,,,,227.5,193.375,65.2015,227.5,"Multiplan, Inc.","Multiplan, Inc.",213.85,94,,percent of total billed charges,,
IOL Tecnis,,C1780,HCPCS,Facility,Outpatient,,,,227.5,193.375,65.2015,227.5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,204.9775,90.1,,percent of total billed charges,,
IOL Tecnis,,C1780,HCPCS,Facility,Inpatient,,,,227.5,193.375,65.2015,227.5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
IOL Tecnis,,C1780,HCPCS,Facility,Both,,,,227.5,193.375,65.2015,227.5,"Preferred One Administrative Services, INC.",PPO,224.315,98.6,,percent of total billed charges,,
IOL Tecnis,,C1780,HCPCS,Facility,Outpatient,,,,227.5,193.375,65.2015,227.5,PrimeWest Health,Minnesota Senior Health Options (MSHO),117.04875,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
IOL Tecnis,,C1780,HCPCS,Facility,Inpatient,,,,227.5,193.375,65.2015,227.5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
IOL Tecnis,,C1780,HCPCS,Facility,Outpatient,,,,227.5,193.375,65.2015,227.5,PrimeWest Health,MinnesotaCare,116.844,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
IOL Tecnis,,C1780,HCPCS,Facility,Inpatient,,,,227.5,193.375,65.2015,227.5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
IOL Tecnis,,C1780,HCPCS,Facility,Both,,,,227.5,193.375,65.2015,227.5,Sanford Health Plan,Sanford Health Plan,209.3,92,,percent of total billed charges,,
IOL Tecnis,,C1780,HCPCS,Facility,Outpatient,,,,227.5,193.375,65.2015,227.5,"UCare Health, Inc.",Individual & Family Plan,128.19625,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
IOL Tecnis,,C1780,HCPCS,Facility,Inpatient,,,,227.5,193.375,65.2015,227.5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
IOL Tecnis,,C1780,HCPCS,Facility,Outpatient,,,,227.5,193.375,65.2015,227.5,"UCare Health, Inc.",Medical Assistance,114.81925,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
IOL Tecnis,,C1780,HCPCS,Facility,Inpatient,,,,227.5,193.375,65.2015,227.5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
IOL Tecnis,,C1780,HCPCS,Facility,Outpatient,,,,227.5,193.375,65.2015,227.5,"UCare Health, Inc.",Medicare Advantage,114.81925,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
IOL Tecnis,,C1780,HCPCS,Facility,Inpatient,,,,227.5,193.375,65.2015,227.5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
IOL Tecnis,,C1780,HCPCS,Facility,Outpatient,,,,227.5,193.375,65.2015,227.5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),114.81925,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
IOL Tecnis,,C1780,HCPCS,Facility,Inpatient,,,,227.5,193.375,65.2015,227.5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
IOL Tecnis,,C1780,HCPCS,Facility,Both,,,,227.5,193.375,65.2015,227.5,UnitedHealthcare,Individual & Family,213.85,94,,percent of total billed charges,,
IOL Tecnis,,C1780,HCPCS,Facility,Outpatient,,,,227.5,193.375,65.2015,227.5,UnitedHealthcare,Medicare Advantage,111.475,49,,percent of total billed charges,,
IOL Tecnis,,C1780,HCPCS,Facility,Inpatient,,,,227.5,193.375,65.2015,227.5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
IOL Tecnis,,C1780,HCPCS,Facility,Outpatient,,,,227.5,193.375,65.2015,227.5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,109.2,48,,percent of total billed charges,,100% of DHS outpatient percentage
IOL Tecnis,,C1780,HCPCS,Facility,Inpatient,,,,227.5,193.375,65.2015,227.5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
LENS IOL A M O ABBOT  ZCB00 STANDARD,,C1780,HCPCS,Facility,Both,,,,200,170,57.32,200,Aetna,Commercial,184,92,,percent of total billed charges,,
LENS IOL A M O ABBOT  ZCB00 STANDARD,,C1780,HCPCS,Facility,Outpatient,,,,200,170,57.32,200,Aetna,Medicare Advantage,98,49,,percent of total billed charges,,
LENS IOL A M O ABBOT  ZCB00 STANDARD,,C1780,HCPCS,Facility,Inpatient,,,,200,170,57.32,200,Aetna,Medicare Advantage,,,,,Included in per diem rate,
LENS IOL A M O ABBOT  ZCB00 STANDARD,,C1780,HCPCS,Facility,Both,,,,200,170,57.32,200,Aetna,PPO,186,93,,percent of total billed charges,,
LENS IOL A M O ABBOT  ZCB00 STANDARD,,C1780,HCPCS,Facility,Both,,,,200,170,57.32,200,America's PPO,America's PPO,192.06,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
LENS IOL A M O ABBOT  ZCB00 STANDARD,,C1780,HCPCS,Facility,Both,,,,200,170,57.32,200,BlueCross BlueShield Minnesota, Federal Employee Program,196.8,98.4,,percent of total billed charges,,
LENS IOL A M O ABBOT  ZCB00 STANDARD,,C1780,HCPCS,Facility,Both,,,,200,170,57.32,200,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,200,100,,percent of total billed charges,,
LENS IOL A M O ABBOT  ZCB00 STANDARD,,C1780,HCPCS,Facility,Both,,,,200,170,57.32,200,BlueCross BlueShield Minnesota,High Value Network Plan,180,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
LENS IOL A M O ABBOT  ZCB00 STANDARD,,C1780,HCPCS,Facility,Outpatient,,,,200,170,57.32,200,BlueCross BlueShield Minnesota,Medicare Advantage,98,49,,percent of total billed charges,,
LENS IOL A M O ABBOT  ZCB00 STANDARD,,C1780,HCPCS,Facility,Inpatient,,,,200,170,57.32,200,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
LENS IOL A M O ABBOT  ZCB00 STANDARD,,C1780,HCPCS,Facility,Both,,,,200,170,57.32,200,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,177.14,88.57,,percent of total billed charges,,
LENS IOL A M O ABBOT  ZCB00 STANDARD,,C1780,HCPCS,Facility,Both,,,,200,170,57.32,200,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,57.32,28.66,,percent of total billed charges,,
LENS IOL A M O ABBOT  ZCB00 STANDARD,,C1780,HCPCS,Facility,Outpatient,,,,200,170,57.32,200,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),98,49,,percent of total billed charges,,
LENS IOL A M O ABBOT  ZCB00 STANDARD,,C1780,HCPCS,Facility,Inpatient,,,,200,170,57.32,200,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
LENS IOL A M O ABBOT  ZCB00 STANDARD,,C1780,HCPCS,Facility,Both,,,,200,170,57.32,200,CorVel,Worker's Compensation,200,100,,percent of total billed charges,,
LENS IOL A M O ABBOT  ZCB00 STANDARD,,C1780,HCPCS,Facility,Both,,,,200,170,57.32,200,First Health Group Corporation,First Health Network,194,97,,percent of total billed charges,,
LENS IOL A M O ABBOT  ZCB00 STANDARD,,C1780,HCPCS,Facility,Both,,,,200,170,57.32,200,"Health Partners, Inc.",Commercial,189.2,94.6,,percent of total billed charges,,
LENS IOL A M O ABBOT  ZCB00 STANDARD,,C1780,HCPCS,Facility,Outpatient,,,,200,170,57.32,200,"Health Partners, Inc.",Medicare Advantage,98,49,,percent of total billed charges,,
LENS IOL A M O ABBOT  ZCB00 STANDARD,,C1780,HCPCS,Facility,Inpatient,,,,200,170,57.32,200,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LENS IOL A M O ABBOT  ZCB00 STANDARD,,C1780,HCPCS,Facility,Both,,,,200,170,57.32,200,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),120,60,,percent of total billed charges,,
LENS IOL A M O ABBOT  ZCB00 STANDARD,,C1780,HCPCS,Facility,Both,,,,200,170,57.32,200,"Health Partners, Inc.",State of Minnesota Advantage Program,163,81.5,,percent of total billed charges,,
LENS IOL A M O ABBOT  ZCB00 STANDARD,,C1780,HCPCS,Facility,Both,,,,200,170,57.32,200,"Health Partners, Inc.",State Public Programs,100,50,,percent of total billed charges,,
LENS IOL A M O ABBOT  ZCB00 STANDARD,,C1780,HCPCS,Facility,Both,,,,200,170,57.32,200,Humana Insurance Company,Commercial PPO,190,95,,percent of total billed charges,,
LENS IOL A M O ABBOT  ZCB00 STANDARD,,C1780,HCPCS,Facility,Outpatient,,,,200,170,57.32,200,Humana Insurance Company,Medicare PPO,98,49,,percent of total billed charges,,
LENS IOL A M O ABBOT  ZCB00 STANDARD,,C1780,HCPCS,Facility,Inpatient,,,,200,170,57.32,200,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
LENS IOL A M O ABBOT  ZCB00 STANDARD,,C1780,HCPCS,Facility,Both,,,,200,170,57.32,200,Medica,Individual & Family,198.2,99.1,,percent of total billed charges,,
LENS IOL A M O ABBOT  ZCB00 STANDARD,,C1780,HCPCS,Facility,Outpatient,,,,200,170,57.32,200,Medica,Medica Advantage Solution,99.6,49.8,,percent of total billed charges,,
LENS IOL A M O ABBOT  ZCB00 STANDARD,,C1780,HCPCS,Facility,Inpatient,,,,200,170,57.32,200,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
LENS IOL A M O ABBOT  ZCB00 STANDARD,,C1780,HCPCS,Facility,Outpatient,,,,200,170,57.32,200,Medica,Medical Assistance,89.2,44.6,,percent of total billed charges,,
LENS IOL A M O ABBOT  ZCB00 STANDARD,,C1780,HCPCS,Facility,Inpatient,,,,200,170,57.32,200,Medica,Medical Assistance,,,,,Included in per diem rate,
LENS IOL A M O ABBOT  ZCB00 STANDARD,,C1780,HCPCS,Facility,Outpatient,,,,200,170,57.32,200,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,99.6,49.8,,percent of total billed charges,,
LENS IOL A M O ABBOT  ZCB00 STANDARD,,C1780,HCPCS,Facility,Inpatient,,,,200,170,57.32,200,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
LENS IOL A M O ABBOT  ZCB00 STANDARD,,C1780,HCPCS,Facility,Both,,,,200,170,57.32,200,"Multiplan, Inc.","Multiplan, Inc.",188,94,,percent of total billed charges,,
LENS IOL A M O ABBOT  ZCB00 STANDARD,,C1780,HCPCS,Facility,Outpatient,,,,200,170,57.32,200,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,180.2,90.1,,percent of total billed charges,,
LENS IOL A M O ABBOT  ZCB00 STANDARD,,C1780,HCPCS,Facility,Inpatient,,,,200,170,57.32,200,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
LENS IOL A M O ABBOT  ZCB00 STANDARD,,C1780,HCPCS,Facility,Both,,,,200,170,57.32,200,"Preferred One Administrative Services, INC.",PPO,197.2,98.6,,percent of total billed charges,,
LENS IOL A M O ABBOT  ZCB00 STANDARD,,C1780,HCPCS,Facility,Outpatient,,,,200,170,57.32,200,PrimeWest Health,Minnesota Senior Health Options (MSHO),102.9,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
LENS IOL A M O ABBOT  ZCB00 STANDARD,,C1780,HCPCS,Facility,Inpatient,,,,200,170,57.32,200,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LENS IOL A M O ABBOT  ZCB00 STANDARD,,C1780,HCPCS,Facility,Outpatient,,,,200,170,57.32,200,PrimeWest Health,MinnesotaCare,102.72,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
LENS IOL A M O ABBOT  ZCB00 STANDARD,,C1780,HCPCS,Facility,Inpatient,,,,200,170,57.32,200,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
LENS IOL A M O ABBOT  ZCB00 STANDARD,,C1780,HCPCS,Facility,Both,,,,200,170,57.32,200,Sanford Health Plan,Sanford Health Plan,184,92,,percent of total billed charges,,
LENS IOL A M O ABBOT  ZCB00 STANDARD,,C1780,HCPCS,Facility,Outpatient,,,,200,170,57.32,200,"UCare Health, Inc.",Individual & Family Plan,112.7,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
LENS IOL A M O ABBOT  ZCB00 STANDARD,,C1780,HCPCS,Facility,Inpatient,,,,200,170,57.32,200,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
LENS IOL A M O ABBOT  ZCB00 STANDARD,,C1780,HCPCS,Facility,Outpatient,,,,200,170,57.32,200,"UCare Health, Inc.",Medical Assistance,100.94,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LENS IOL A M O ABBOT  ZCB00 STANDARD,,C1780,HCPCS,Facility,Inpatient,,,,200,170,57.32,200,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
LENS IOL A M O ABBOT  ZCB00 STANDARD,,C1780,HCPCS,Facility,Outpatient,,,,200,170,57.32,200,"UCare Health, Inc.",Medicare Advantage,100.94,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LENS IOL A M O ABBOT  ZCB00 STANDARD,,C1780,HCPCS,Facility,Inpatient,,,,200,170,57.32,200,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LENS IOL A M O ABBOT  ZCB00 STANDARD,,C1780,HCPCS,Facility,Outpatient,,,,200,170,57.32,200,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),100.94,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LENS IOL A M O ABBOT  ZCB00 STANDARD,,C1780,HCPCS,Facility,Inpatient,,,,200,170,57.32,200,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LENS IOL A M O ABBOT  ZCB00 STANDARD,,C1780,HCPCS,Facility,Both,,,,200,170,57.32,200,UnitedHealthcare,Individual & Family,188,94,,percent of total billed charges,,
LENS IOL A M O ABBOT  ZCB00 STANDARD,,C1780,HCPCS,Facility,Outpatient,,,,200,170,57.32,200,UnitedHealthcare,Medicare Advantage,98,49,,percent of total billed charges,,
LENS IOL A M O ABBOT  ZCB00 STANDARD,,C1780,HCPCS,Facility,Inpatient,,,,200,170,57.32,200,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
LENS IOL A M O ABBOT  ZCB00 STANDARD,,C1780,HCPCS,Facility,Outpatient,,,,200,170,57.32,200,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,96,48,,percent of total billed charges,,100% of DHS outpatient percentage
LENS IOL A M O ABBOT  ZCB00 STANDARD,,C1780,HCPCS,Facility,Inpatient,,,,200,170,57.32,200,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
COMPOSITE MESH PCO8VP,,C1781,HCPCS,Facility,Both,,,,1138.6,967.81,326.32276,1138.6,Aetna,Commercial,1047.512,92,,percent of total billed charges,,
COMPOSITE MESH PCO8VP,,C1781,HCPCS,Facility,Outpatient,,,,1138.6,967.81,326.32276,1138.6,Aetna,Medicare Advantage,557.914,49,,percent of total billed charges,,
COMPOSITE MESH PCO8VP,,C1781,HCPCS,Facility,Inpatient,,,,1138.6,967.81,326.32276,1138.6,Aetna,Medicare Advantage,,,,,Included in per diem rate,
COMPOSITE MESH PCO8VP,,C1781,HCPCS,Facility,Both,,,,1138.6,967.81,326.32276,1138.6,Aetna,PPO,1058.898,93,,percent of total billed charges,,
COMPOSITE MESH PCO8VP,,C1781,HCPCS,Facility,Both,,,,1138.6,967.81,326.32276,1138.6,America's PPO,America's PPO,1093.39758,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
COMPOSITE MESH PCO8VP,,C1781,HCPCS,Facility,Both,,,,1138.6,967.81,326.32276,1138.6,BlueCross BlueShield Minnesota, Federal Employee Program,1120.3824,98.4,,percent of total billed charges,,
COMPOSITE MESH PCO8VP,,C1781,HCPCS,Facility,Both,,,,1138.6,967.81,326.32276,1138.6,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1138.6,100,,percent of total billed charges,,
COMPOSITE MESH PCO8VP,,C1781,HCPCS,Facility,Both,,,,1138.6,967.81,326.32276,1138.6,BlueCross BlueShield Minnesota,High Value Network Plan,1024.74,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
COMPOSITE MESH PCO8VP,,C1781,HCPCS,Facility,Outpatient,,,,1138.6,967.81,326.32276,1138.6,BlueCross BlueShield Minnesota,Medicare Advantage,557.914,49,,percent of total billed charges,,
COMPOSITE MESH PCO8VP,,C1781,HCPCS,Facility,Inpatient,,,,1138.6,967.81,326.32276,1138.6,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
COMPOSITE MESH PCO8VP,,C1781,HCPCS,Facility,Both,,,,1138.6,967.81,326.32276,1138.6,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1008.45802,88.57,,percent of total billed charges,,
COMPOSITE MESH PCO8VP,,C1781,HCPCS,Facility,Both,,,,1138.6,967.81,326.32276,1138.6,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,326.32276,28.66,,percent of total billed charges,,
COMPOSITE MESH PCO8VP,,C1781,HCPCS,Facility,Outpatient,,,,1138.6,967.81,326.32276,1138.6,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),557.914,49,,percent of total billed charges,,
COMPOSITE MESH PCO8VP,,C1781,HCPCS,Facility,Inpatient,,,,1138.6,967.81,326.32276,1138.6,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
COMPOSITE MESH PCO8VP,,C1781,HCPCS,Facility,Both,,,,1138.6,967.81,326.32276,1138.6,CorVel,Worker's Compensation,1138.6,100,,percent of total billed charges,,
COMPOSITE MESH PCO8VP,,C1781,HCPCS,Facility,Both,,,,1138.6,967.81,326.32276,1138.6,First Health Group Corporation,First Health Network,1104.442,97,,percent of total billed charges,,
COMPOSITE MESH PCO8VP,,C1781,HCPCS,Facility,Both,,,,1138.6,967.81,326.32276,1138.6,"Health Partners, Inc.",Commercial,1077.1156,94.6,,percent of total billed charges,,
COMPOSITE MESH PCO8VP,,C1781,HCPCS,Facility,Outpatient,,,,1138.6,967.81,326.32276,1138.6,"Health Partners, Inc.",Medicare Advantage,557.914,49,,percent of total billed charges,,
COMPOSITE MESH PCO8VP,,C1781,HCPCS,Facility,Inpatient,,,,1138.6,967.81,326.32276,1138.6,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
COMPOSITE MESH PCO8VP,,C1781,HCPCS,Facility,Both,,,,1138.6,967.81,326.32276,1138.6,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),683.16,60,,percent of total billed charges,,
COMPOSITE MESH PCO8VP,,C1781,HCPCS,Facility,Both,,,,1138.6,967.81,326.32276,1138.6,"Health Partners, Inc.",State of Minnesota Advantage Program,927.959,81.5,,percent of total billed charges,,
COMPOSITE MESH PCO8VP,,C1781,HCPCS,Facility,Both,,,,1138.6,967.81,326.32276,1138.6,"Health Partners, Inc.",State Public Programs,569.3,50,,percent of total billed charges,,
COMPOSITE MESH PCO8VP,,C1781,HCPCS,Facility,Both,,,,1138.6,967.81,326.32276,1138.6,Humana Insurance Company,Commercial PPO,1081.67,95,,percent of total billed charges,,
COMPOSITE MESH PCO8VP,,C1781,HCPCS,Facility,Outpatient,,,,1138.6,967.81,326.32276,1138.6,Humana Insurance Company,Medicare PPO,557.914,49,,percent of total billed charges,,
COMPOSITE MESH PCO8VP,,C1781,HCPCS,Facility,Inpatient,,,,1138.6,967.81,326.32276,1138.6,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
COMPOSITE MESH PCO8VP,,C1781,HCPCS,Facility,Both,,,,1138.6,967.81,326.32276,1138.6,Medica,Individual & Family,1128.3526,99.1,,percent of total billed charges,,
COMPOSITE MESH PCO8VP,,C1781,HCPCS,Facility,Outpatient,,,,1138.6,967.81,326.32276,1138.6,Medica,Medica Advantage Solution,567.0228,49.8,,percent of total billed charges,,
COMPOSITE MESH PCO8VP,,C1781,HCPCS,Facility,Inpatient,,,,1138.6,967.81,326.32276,1138.6,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
COMPOSITE MESH PCO8VP,,C1781,HCPCS,Facility,Outpatient,,,,1138.6,967.81,326.32276,1138.6,Medica,Medical Assistance,507.8156,44.6,,percent of total billed charges,,
COMPOSITE MESH PCO8VP,,C1781,HCPCS,Facility,Inpatient,,,,1138.6,967.81,326.32276,1138.6,Medica,Medical Assistance,,,,,Included in per diem rate,
COMPOSITE MESH PCO8VP,,C1781,HCPCS,Facility,Outpatient,,,,1138.6,967.81,326.32276,1138.6,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,567.0228,49.8,,percent of total billed charges,,
COMPOSITE MESH PCO8VP,,C1781,HCPCS,Facility,Inpatient,,,,1138.6,967.81,326.32276,1138.6,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
COMPOSITE MESH PCO8VP,,C1781,HCPCS,Facility,Both,,,,1138.6,967.81,326.32276,1138.6,"Multiplan, Inc.","Multiplan, Inc.",1070.284,94,,percent of total billed charges,,
COMPOSITE MESH PCO8VP,,C1781,HCPCS,Facility,Outpatient,,,,1138.6,967.81,326.32276,1138.6,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1025.8786,90.1,,percent of total billed charges,,
COMPOSITE MESH PCO8VP,,C1781,HCPCS,Facility,Inpatient,,,,1138.6,967.81,326.32276,1138.6,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
COMPOSITE MESH PCO8VP,,C1781,HCPCS,Facility,Both,,,,1138.6,967.81,326.32276,1138.6,"Preferred One Administrative Services, INC.",PPO,1122.6596,98.6,,percent of total billed charges,,
COMPOSITE MESH PCO8VP,,C1781,HCPCS,Facility,Outpatient,,,,1138.6,967.81,326.32276,1138.6,PrimeWest Health,Minnesota Senior Health Options (MSHO),585.8097,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
COMPOSITE MESH PCO8VP,,C1781,HCPCS,Facility,Inpatient,,,,1138.6,967.81,326.32276,1138.6,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
COMPOSITE MESH PCO8VP,,C1781,HCPCS,Facility,Outpatient,,,,1138.6,967.81,326.32276,1138.6,PrimeWest Health,MinnesotaCare,584.78496,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
COMPOSITE MESH PCO8VP,,C1781,HCPCS,Facility,Inpatient,,,,1138.6,967.81,326.32276,1138.6,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
COMPOSITE MESH PCO8VP,,C1781,HCPCS,Facility,Both,,,,1138.6,967.81,326.32276,1138.6,Sanford Health Plan,Sanford Health Plan,1047.512,92,,percent of total billed charges,,
COMPOSITE MESH PCO8VP,,C1781,HCPCS,Facility,Outpatient,,,,1138.6,967.81,326.32276,1138.6,"UCare Health, Inc.",Individual & Family Plan,641.6011,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
COMPOSITE MESH PCO8VP,,C1781,HCPCS,Facility,Inpatient,,,,1138.6,967.81,326.32276,1138.6,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
COMPOSITE MESH PCO8VP,,C1781,HCPCS,Facility,Outpatient,,,,1138.6,967.81,326.32276,1138.6,"UCare Health, Inc.",Medical Assistance,574.65142,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
COMPOSITE MESH PCO8VP,,C1781,HCPCS,Facility,Inpatient,,,,1138.6,967.81,326.32276,1138.6,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
COMPOSITE MESH PCO8VP,,C1781,HCPCS,Facility,Outpatient,,,,1138.6,967.81,326.32276,1138.6,"UCare Health, Inc.",Medicare Advantage,574.65142,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
COMPOSITE MESH PCO8VP,,C1781,HCPCS,Facility,Inpatient,,,,1138.6,967.81,326.32276,1138.6,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
COMPOSITE MESH PCO8VP,,C1781,HCPCS,Facility,Outpatient,,,,1138.6,967.81,326.32276,1138.6,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),574.65142,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
COMPOSITE MESH PCO8VP,,C1781,HCPCS,Facility,Inpatient,,,,1138.6,967.81,326.32276,1138.6,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
COMPOSITE MESH PCO8VP,,C1781,HCPCS,Facility,Both,,,,1138.6,967.81,326.32276,1138.6,UnitedHealthcare,Individual & Family,1070.284,94,,percent of total billed charges,,
COMPOSITE MESH PCO8VP,,C1781,HCPCS,Facility,Outpatient,,,,1138.6,967.81,326.32276,1138.6,UnitedHealthcare,Medicare Advantage,557.914,49,,percent of total billed charges,,
COMPOSITE MESH PCO8VP,,C1781,HCPCS,Facility,Inpatient,,,,1138.6,967.81,326.32276,1138.6,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
COMPOSITE MESH PCO8VP,,C1781,HCPCS,Facility,Outpatient,,,,1138.6,967.81,326.32276,1138.6,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,546.528,48,,percent of total billed charges,,100% of DHS outpatient percentage
COMPOSITE MESH PCO8VP,,C1781,HCPCS,Facility,Inpatient,,,,1138.6,967.81,326.32276,1138.6,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
CQUR FX MESH 6.4 CM X 14CM ATRIUM,,C1781,HCPCS,Facility,Both,,,,338.43,287.6655,96.994038,338.43,Aetna,Commercial,311.3556,92,,percent of total billed charges,,
CQUR FX MESH 6.4 CM X 14CM ATRIUM,,C1781,HCPCS,Facility,Outpatient,,,,338.43,287.6655,96.994038,338.43,Aetna,Medicare Advantage,165.8307,49,,percent of total billed charges,,
CQUR FX MESH 6.4 CM X 14CM ATRIUM,,C1781,HCPCS,Facility,Inpatient,,,,338.43,287.6655,96.994038,338.43,Aetna,Medicare Advantage,,,,,Included in per diem rate,
CQUR FX MESH 6.4 CM X 14CM ATRIUM,,C1781,HCPCS,Facility,Both,,,,338.43,287.6655,96.994038,338.43,Aetna,PPO,314.7399,93,,percent of total billed charges,,
CQUR FX MESH 6.4 CM X 14CM ATRIUM,,C1781,HCPCS,Facility,Both,,,,338.43,287.6655,96.994038,338.43,America's PPO,America's PPO,324.994329,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
CQUR FX MESH 6.4 CM X 14CM ATRIUM,,C1781,HCPCS,Facility,Both,,,,338.43,287.6655,96.994038,338.43,BlueCross BlueShield Minnesota, Federal Employee Program,333.01512,98.4,,percent of total billed charges,,
CQUR FX MESH 6.4 CM X 14CM ATRIUM,,C1781,HCPCS,Facility,Both,,,,338.43,287.6655,96.994038,338.43,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,338.43,100,,percent of total billed charges,,
CQUR FX MESH 6.4 CM X 14CM ATRIUM,,C1781,HCPCS,Facility,Both,,,,338.43,287.6655,96.994038,338.43,BlueCross BlueShield Minnesota,High Value Network Plan,304.587,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
CQUR FX MESH 6.4 CM X 14CM ATRIUM,,C1781,HCPCS,Facility,Outpatient,,,,338.43,287.6655,96.994038,338.43,BlueCross BlueShield Minnesota,Medicare Advantage,165.8307,49,,percent of total billed charges,,
CQUR FX MESH 6.4 CM X 14CM ATRIUM,,C1781,HCPCS,Facility,Inpatient,,,,338.43,287.6655,96.994038,338.43,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
CQUR FX MESH 6.4 CM X 14CM ATRIUM,,C1781,HCPCS,Facility,Both,,,,338.43,287.6655,96.994038,338.43,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,299.747451,88.57,,percent of total billed charges,,
CQUR FX MESH 6.4 CM X 14CM ATRIUM,,C1781,HCPCS,Facility,Both,,,,338.43,287.6655,96.994038,338.43,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,96.994038,28.66,,percent of total billed charges,,
CQUR FX MESH 6.4 CM X 14CM ATRIUM,,C1781,HCPCS,Facility,Outpatient,,,,338.43,287.6655,96.994038,338.43,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),165.8307,49,,percent of total billed charges,,
CQUR FX MESH 6.4 CM X 14CM ATRIUM,,C1781,HCPCS,Facility,Inpatient,,,,338.43,287.6655,96.994038,338.43,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
CQUR FX MESH 6.4 CM X 14CM ATRIUM,,C1781,HCPCS,Facility,Both,,,,338.43,287.6655,96.994038,338.43,CorVel,Worker's Compensation,338.43,100,,percent of total billed charges,,
CQUR FX MESH 6.4 CM X 14CM ATRIUM,,C1781,HCPCS,Facility,Both,,,,338.43,287.6655,96.994038,338.43,First Health Group Corporation,First Health Network,328.2771,97,,percent of total billed charges,,
CQUR FX MESH 6.4 CM X 14CM ATRIUM,,C1781,HCPCS,Facility,Both,,,,338.43,287.6655,96.994038,338.43,"Health Partners, Inc.",Commercial,320.15478,94.6,,percent of total billed charges,,
CQUR FX MESH 6.4 CM X 14CM ATRIUM,,C1781,HCPCS,Facility,Outpatient,,,,338.43,287.6655,96.994038,338.43,"Health Partners, Inc.",Medicare Advantage,165.8307,49,,percent of total billed charges,,
CQUR FX MESH 6.4 CM X 14CM ATRIUM,,C1781,HCPCS,Facility,Inpatient,,,,338.43,287.6655,96.994038,338.43,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CQUR FX MESH 6.4 CM X 14CM ATRIUM,,C1781,HCPCS,Facility,Both,,,,338.43,287.6655,96.994038,338.43,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),203.058,60,,percent of total billed charges,,
CQUR FX MESH 6.4 CM X 14CM ATRIUM,,C1781,HCPCS,Facility,Both,,,,338.43,287.6655,96.994038,338.43,"Health Partners, Inc.",State of Minnesota Advantage Program,275.82045,81.5,,percent of total billed charges,,
CQUR FX MESH 6.4 CM X 14CM ATRIUM,,C1781,HCPCS,Facility,Both,,,,338.43,287.6655,96.994038,338.43,"Health Partners, Inc.",State Public Programs,169.215,50,,percent of total billed charges,,
CQUR FX MESH 6.4 CM X 14CM ATRIUM,,C1781,HCPCS,Facility,Both,,,,338.43,287.6655,96.994038,338.43,Humana Insurance Company,Commercial PPO,321.5085,95,,percent of total billed charges,,
CQUR FX MESH 6.4 CM X 14CM ATRIUM,,C1781,HCPCS,Facility,Outpatient,,,,338.43,287.6655,96.994038,338.43,Humana Insurance Company,Medicare PPO,165.8307,49,,percent of total billed charges,,
CQUR FX MESH 6.4 CM X 14CM ATRIUM,,C1781,HCPCS,Facility,Inpatient,,,,338.43,287.6655,96.994038,338.43,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
CQUR FX MESH 6.4 CM X 14CM ATRIUM,,C1781,HCPCS,Facility,Both,,,,338.43,287.6655,96.994038,338.43,Medica,Individual & Family,335.38413,99.1,,percent of total billed charges,,
CQUR FX MESH 6.4 CM X 14CM ATRIUM,,C1781,HCPCS,Facility,Outpatient,,,,338.43,287.6655,96.994038,338.43,Medica,Medica Advantage Solution,168.53814,49.8,,percent of total billed charges,,
CQUR FX MESH 6.4 CM X 14CM ATRIUM,,C1781,HCPCS,Facility,Inpatient,,,,338.43,287.6655,96.994038,338.43,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
CQUR FX MESH 6.4 CM X 14CM ATRIUM,,C1781,HCPCS,Facility,Outpatient,,,,338.43,287.6655,96.994038,338.43,Medica,Medical Assistance,150.93978,44.6,,percent of total billed charges,,
CQUR FX MESH 6.4 CM X 14CM ATRIUM,,C1781,HCPCS,Facility,Inpatient,,,,338.43,287.6655,96.994038,338.43,Medica,Medical Assistance,,,,,Included in per diem rate,
CQUR FX MESH 6.4 CM X 14CM ATRIUM,,C1781,HCPCS,Facility,Outpatient,,,,338.43,287.6655,96.994038,338.43,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,168.53814,49.8,,percent of total billed charges,,
CQUR FX MESH 6.4 CM X 14CM ATRIUM,,C1781,HCPCS,Facility,Inpatient,,,,338.43,287.6655,96.994038,338.43,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
CQUR FX MESH 6.4 CM X 14CM ATRIUM,,C1781,HCPCS,Facility,Both,,,,338.43,287.6655,96.994038,338.43,"Multiplan, Inc.","Multiplan, Inc.",318.1242,94,,percent of total billed charges,,
CQUR FX MESH 6.4 CM X 14CM ATRIUM,,C1781,HCPCS,Facility,Outpatient,,,,338.43,287.6655,96.994038,338.43,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,304.92543,90.1,,percent of total billed charges,,
CQUR FX MESH 6.4 CM X 14CM ATRIUM,,C1781,HCPCS,Facility,Inpatient,,,,338.43,287.6655,96.994038,338.43,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
CQUR FX MESH 6.4 CM X 14CM ATRIUM,,C1781,HCPCS,Facility,Both,,,,338.43,287.6655,96.994038,338.43,"Preferred One Administrative Services, INC.",PPO,333.69198,98.6,,percent of total billed charges,,
CQUR FX MESH 6.4 CM X 14CM ATRIUM,,C1781,HCPCS,Facility,Outpatient,,,,338.43,287.6655,96.994038,338.43,PrimeWest Health,Minnesota Senior Health Options (MSHO),174.122235,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
CQUR FX MESH 6.4 CM X 14CM ATRIUM,,C1781,HCPCS,Facility,Inpatient,,,,338.43,287.6655,96.994038,338.43,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CQUR FX MESH 6.4 CM X 14CM ATRIUM,,C1781,HCPCS,Facility,Outpatient,,,,338.43,287.6655,96.994038,338.43,PrimeWest Health,MinnesotaCare,173.817648,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
CQUR FX MESH 6.4 CM X 14CM ATRIUM,,C1781,HCPCS,Facility,Inpatient,,,,338.43,287.6655,96.994038,338.43,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
CQUR FX MESH 6.4 CM X 14CM ATRIUM,,C1781,HCPCS,Facility,Both,,,,338.43,287.6655,96.994038,338.43,Sanford Health Plan,Sanford Health Plan,311.3556,92,,percent of total billed charges,,
CQUR FX MESH 6.4 CM X 14CM ATRIUM,,C1781,HCPCS,Facility,Outpatient,,,,338.43,287.6655,96.994038,338.43,"UCare Health, Inc.",Individual & Family Plan,190.705305,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
CQUR FX MESH 6.4 CM X 14CM ATRIUM,,C1781,HCPCS,Facility,Inpatient,,,,338.43,287.6655,96.994038,338.43,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
CQUR FX MESH 6.4 CM X 14CM ATRIUM,,C1781,HCPCS,Facility,Outpatient,,,,338.43,287.6655,96.994038,338.43,"UCare Health, Inc.",Medical Assistance,170.805621,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CQUR FX MESH 6.4 CM X 14CM ATRIUM,,C1781,HCPCS,Facility,Inpatient,,,,338.43,287.6655,96.994038,338.43,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
CQUR FX MESH 6.4 CM X 14CM ATRIUM,,C1781,HCPCS,Facility,Outpatient,,,,338.43,287.6655,96.994038,338.43,"UCare Health, Inc.",Medicare Advantage,170.805621,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CQUR FX MESH 6.4 CM X 14CM ATRIUM,,C1781,HCPCS,Facility,Inpatient,,,,338.43,287.6655,96.994038,338.43,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CQUR FX MESH 6.4 CM X 14CM ATRIUM,,C1781,HCPCS,Facility,Outpatient,,,,338.43,287.6655,96.994038,338.43,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),170.805621,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CQUR FX MESH 6.4 CM X 14CM ATRIUM,,C1781,HCPCS,Facility,Inpatient,,,,338.43,287.6655,96.994038,338.43,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CQUR FX MESH 6.4 CM X 14CM ATRIUM,,C1781,HCPCS,Facility,Both,,,,338.43,287.6655,96.994038,338.43,UnitedHealthcare,Individual & Family,318.1242,94,,percent of total billed charges,,
CQUR FX MESH 6.4 CM X 14CM ATRIUM,,C1781,HCPCS,Facility,Outpatient,,,,338.43,287.6655,96.994038,338.43,UnitedHealthcare,Medicare Advantage,165.8307,49,,percent of total billed charges,,
CQUR FX MESH 6.4 CM X 14CM ATRIUM,,C1781,HCPCS,Facility,Inpatient,,,,338.43,287.6655,96.994038,338.43,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
CQUR FX MESH 6.4 CM X 14CM ATRIUM,,C1781,HCPCS,Facility,Outpatient,,,,338.43,287.6655,96.994038,338.43,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,162.4464,48,,percent of total billed charges,,100% of DHS outpatient percentage
CQUR FX MESH 6.4 CM X 14CM ATRIUM,,C1781,HCPCS,Facility,Inpatient,,,,338.43,287.6655,96.994038,338.43,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
C-QUR MOSAIC MESH 15CM X 15CM,,C1781,HCPCS,Facility,Both,,,,1170.86,995.231,335.568476,1170.86,Aetna,Commercial,1077.1912,92,,percent of total billed charges,,
C-QUR MOSAIC MESH 15CM X 15CM,,C1781,HCPCS,Facility,Outpatient,,,,1170.86,995.231,335.568476,1170.86,Aetna,Medicare Advantage,573.7214,49,,percent of total billed charges,,
C-QUR MOSAIC MESH 15CM X 15CM,,C1781,HCPCS,Facility,Inpatient,,,,1170.86,995.231,335.568476,1170.86,Aetna,Medicare Advantage,,,,,Included in per diem rate,
C-QUR MOSAIC MESH 15CM X 15CM,,C1781,HCPCS,Facility,Both,,,,1170.86,995.231,335.568476,1170.86,Aetna,PPO,1088.8998,93,,percent of total billed charges,,
C-QUR MOSAIC MESH 15CM X 15CM,,C1781,HCPCS,Facility,Both,,,,1170.86,995.231,335.568476,1170.86,America's PPO,America's PPO,1124.376858,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
C-QUR MOSAIC MESH 15CM X 15CM,,C1781,HCPCS,Facility,Both,,,,1170.86,995.231,335.568476,1170.86,BlueCross BlueShield Minnesota, Federal Employee Program,1152.12624,98.4,,percent of total billed charges,,
C-QUR MOSAIC MESH 15CM X 15CM,,C1781,HCPCS,Facility,Both,,,,1170.86,995.231,335.568476,1170.86,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1170.86,100,,percent of total billed charges,,
C-QUR MOSAIC MESH 15CM X 15CM,,C1781,HCPCS,Facility,Both,,,,1170.86,995.231,335.568476,1170.86,BlueCross BlueShield Minnesota,High Value Network Plan,1053.774,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
C-QUR MOSAIC MESH 15CM X 15CM,,C1781,HCPCS,Facility,Outpatient,,,,1170.86,995.231,335.568476,1170.86,BlueCross BlueShield Minnesota,Medicare Advantage,573.7214,49,,percent of total billed charges,,
C-QUR MOSAIC MESH 15CM X 15CM,,C1781,HCPCS,Facility,Inpatient,,,,1170.86,995.231,335.568476,1170.86,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
C-QUR MOSAIC MESH 15CM X 15CM,,C1781,HCPCS,Facility,Both,,,,1170.86,995.231,335.568476,1170.86,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1037.030702,88.57,,percent of total billed charges,,
C-QUR MOSAIC MESH 15CM X 15CM,,C1781,HCPCS,Facility,Both,,,,1170.86,995.231,335.568476,1170.86,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,335.568476,28.66,,percent of total billed charges,,
C-QUR MOSAIC MESH 15CM X 15CM,,C1781,HCPCS,Facility,Outpatient,,,,1170.86,995.231,335.568476,1170.86,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),573.7214,49,,percent of total billed charges,,
C-QUR MOSAIC MESH 15CM X 15CM,,C1781,HCPCS,Facility,Inpatient,,,,1170.86,995.231,335.568476,1170.86,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
C-QUR MOSAIC MESH 15CM X 15CM,,C1781,HCPCS,Facility,Both,,,,1170.86,995.231,335.568476,1170.86,CorVel,Worker's Compensation,1170.86,100,,percent of total billed charges,,
C-QUR MOSAIC MESH 15CM X 15CM,,C1781,HCPCS,Facility,Both,,,,1170.86,995.231,335.568476,1170.86,First Health Group Corporation,First Health Network,1135.7342,97,,percent of total billed charges,,
C-QUR MOSAIC MESH 15CM X 15CM,,C1781,HCPCS,Facility,Both,,,,1170.86,995.231,335.568476,1170.86,"Health Partners, Inc.",Commercial,1107.63356,94.6,,percent of total billed charges,,
C-QUR MOSAIC MESH 15CM X 15CM,,C1781,HCPCS,Facility,Outpatient,,,,1170.86,995.231,335.568476,1170.86,"Health Partners, Inc.",Medicare Advantage,573.7214,49,,percent of total billed charges,,
C-QUR MOSAIC MESH 15CM X 15CM,,C1781,HCPCS,Facility,Inpatient,,,,1170.86,995.231,335.568476,1170.86,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
C-QUR MOSAIC MESH 15CM X 15CM,,C1781,HCPCS,Facility,Both,,,,1170.86,995.231,335.568476,1170.86,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),702.516,60,,percent of total billed charges,,
C-QUR MOSAIC MESH 15CM X 15CM,,C1781,HCPCS,Facility,Both,,,,1170.86,995.231,335.568476,1170.86,"Health Partners, Inc.",State of Minnesota Advantage Program,954.2509,81.5,,percent of total billed charges,,
C-QUR MOSAIC MESH 15CM X 15CM,,C1781,HCPCS,Facility,Both,,,,1170.86,995.231,335.568476,1170.86,"Health Partners, Inc.",State Public Programs,585.43,50,,percent of total billed charges,,
C-QUR MOSAIC MESH 15CM X 15CM,,C1781,HCPCS,Facility,Both,,,,1170.86,995.231,335.568476,1170.86,Humana Insurance Company,Commercial PPO,1112.317,95,,percent of total billed charges,,
C-QUR MOSAIC MESH 15CM X 15CM,,C1781,HCPCS,Facility,Outpatient,,,,1170.86,995.231,335.568476,1170.86,Humana Insurance Company,Medicare PPO,573.7214,49,,percent of total billed charges,,
C-QUR MOSAIC MESH 15CM X 15CM,,C1781,HCPCS,Facility,Inpatient,,,,1170.86,995.231,335.568476,1170.86,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
C-QUR MOSAIC MESH 15CM X 15CM,,C1781,HCPCS,Facility,Both,,,,1170.86,995.231,335.568476,1170.86,Medica,Individual & Family,1160.32226,99.1,,percent of total billed charges,,
C-QUR MOSAIC MESH 15CM X 15CM,,C1781,HCPCS,Facility,Outpatient,,,,1170.86,995.231,335.568476,1170.86,Medica,Medica Advantage Solution,583.08828,49.8,,percent of total billed charges,,
C-QUR MOSAIC MESH 15CM X 15CM,,C1781,HCPCS,Facility,Inpatient,,,,1170.86,995.231,335.568476,1170.86,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
C-QUR MOSAIC MESH 15CM X 15CM,,C1781,HCPCS,Facility,Outpatient,,,,1170.86,995.231,335.568476,1170.86,Medica,Medical Assistance,522.20356,44.6,,percent of total billed charges,,
C-QUR MOSAIC MESH 15CM X 15CM,,C1781,HCPCS,Facility,Inpatient,,,,1170.86,995.231,335.568476,1170.86,Medica,Medical Assistance,,,,,Included in per diem rate,
C-QUR MOSAIC MESH 15CM X 15CM,,C1781,HCPCS,Facility,Outpatient,,,,1170.86,995.231,335.568476,1170.86,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,583.08828,49.8,,percent of total billed charges,,
C-QUR MOSAIC MESH 15CM X 15CM,,C1781,HCPCS,Facility,Inpatient,,,,1170.86,995.231,335.568476,1170.86,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
C-QUR MOSAIC MESH 15CM X 15CM,,C1781,HCPCS,Facility,Both,,,,1170.86,995.231,335.568476,1170.86,"Multiplan, Inc.","Multiplan, Inc.",1100.6084,94,,percent of total billed charges,,
C-QUR MOSAIC MESH 15CM X 15CM,,C1781,HCPCS,Facility,Outpatient,,,,1170.86,995.231,335.568476,1170.86,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1054.94486,90.1,,percent of total billed charges,,
C-QUR MOSAIC MESH 15CM X 15CM,,C1781,HCPCS,Facility,Inpatient,,,,1170.86,995.231,335.568476,1170.86,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
C-QUR MOSAIC MESH 15CM X 15CM,,C1781,HCPCS,Facility,Both,,,,1170.86,995.231,335.568476,1170.86,"Preferred One Administrative Services, INC.",PPO,1154.46796,98.6,,percent of total billed charges,,
C-QUR MOSAIC MESH 15CM X 15CM,,C1781,HCPCS,Facility,Outpatient,,,,1170.86,995.231,335.568476,1170.86,PrimeWest Health,Minnesota Senior Health Options (MSHO),602.40747,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
C-QUR MOSAIC MESH 15CM X 15CM,,C1781,HCPCS,Facility,Inpatient,,,,1170.86,995.231,335.568476,1170.86,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
C-QUR MOSAIC MESH 15CM X 15CM,,C1781,HCPCS,Facility,Outpatient,,,,1170.86,995.231,335.568476,1170.86,PrimeWest Health,MinnesotaCare,601.353696,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
C-QUR MOSAIC MESH 15CM X 15CM,,C1781,HCPCS,Facility,Inpatient,,,,1170.86,995.231,335.568476,1170.86,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
C-QUR MOSAIC MESH 15CM X 15CM,,C1781,HCPCS,Facility,Both,,,,1170.86,995.231,335.568476,1170.86,Sanford Health Plan,Sanford Health Plan,1077.1912,92,,percent of total billed charges,,
C-QUR MOSAIC MESH 15CM X 15CM,,C1781,HCPCS,Facility,Outpatient,,,,1170.86,995.231,335.568476,1170.86,"UCare Health, Inc.",Individual & Family Plan,659.77961,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
C-QUR MOSAIC MESH 15CM X 15CM,,C1781,HCPCS,Facility,Inpatient,,,,1170.86,995.231,335.568476,1170.86,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
C-QUR MOSAIC MESH 15CM X 15CM,,C1781,HCPCS,Facility,Outpatient,,,,1170.86,995.231,335.568476,1170.86,"UCare Health, Inc.",Medical Assistance,590.933042,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
C-QUR MOSAIC MESH 15CM X 15CM,,C1781,HCPCS,Facility,Inpatient,,,,1170.86,995.231,335.568476,1170.86,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
C-QUR MOSAIC MESH 15CM X 15CM,,C1781,HCPCS,Facility,Outpatient,,,,1170.86,995.231,335.568476,1170.86,"UCare Health, Inc.",Medicare Advantage,590.933042,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
C-QUR MOSAIC MESH 15CM X 15CM,,C1781,HCPCS,Facility,Inpatient,,,,1170.86,995.231,335.568476,1170.86,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
C-QUR MOSAIC MESH 15CM X 15CM,,C1781,HCPCS,Facility,Outpatient,,,,1170.86,995.231,335.568476,1170.86,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),590.933042,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
C-QUR MOSAIC MESH 15CM X 15CM,,C1781,HCPCS,Facility,Inpatient,,,,1170.86,995.231,335.568476,1170.86,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
C-QUR MOSAIC MESH 15CM X 15CM,,C1781,HCPCS,Facility,Both,,,,1170.86,995.231,335.568476,1170.86,UnitedHealthcare,Individual & Family,1100.6084,94,,percent of total billed charges,,
C-QUR MOSAIC MESH 15CM X 15CM,,C1781,HCPCS,Facility,Outpatient,,,,1170.86,995.231,335.568476,1170.86,UnitedHealthcare,Medicare Advantage,573.7214,49,,percent of total billed charges,,
C-QUR MOSAIC MESH 15CM X 15CM,,C1781,HCPCS,Facility,Inpatient,,,,1170.86,995.231,335.568476,1170.86,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
C-QUR MOSAIC MESH 15CM X 15CM,,C1781,HCPCS,Facility,Outpatient,,,,1170.86,995.231,335.568476,1170.86,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,562.0128,48,,percent of total billed charges,,100% of DHS outpatient percentage
C-QUR MOSAIC MESH 15CM X 15CM,,C1781,HCPCS,Facility,Inpatient,,,,1170.86,995.231,335.568476,1170.86,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
C-QUR MOSAIC MESH 8 IN X 10 IN,,C1781,HCPCS,Facility,Both,,,,1330,1130.5,381.178,1330,Aetna,Commercial,1223.6,92,,percent of total billed charges,,
C-QUR MOSAIC MESH 8 IN X 10 IN,,C1781,HCPCS,Facility,Outpatient,,,,1330,1130.5,381.178,1330,Aetna,Medicare Advantage,651.7,49,,percent of total billed charges,,
C-QUR MOSAIC MESH 8 IN X 10 IN,,C1781,HCPCS,Facility,Inpatient,,,,1330,1130.5,381.178,1330,Aetna,Medicare Advantage,,,,,Included in per diem rate,
C-QUR MOSAIC MESH 8 IN X 10 IN,,C1781,HCPCS,Facility,Both,,,,1330,1130.5,381.178,1330,Aetna,PPO,1236.9,93,,percent of total billed charges,,
C-QUR MOSAIC MESH 8 IN X 10 IN,,C1781,HCPCS,Facility,Both,,,,1330,1130.5,381.178,1330,America's PPO,America's PPO,1277.199,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
C-QUR MOSAIC MESH 8 IN X 10 IN,,C1781,HCPCS,Facility,Both,,,,1330,1130.5,381.178,1330,BlueCross BlueShield Minnesota, Federal Employee Program,1308.72,98.4,,percent of total billed charges,,
C-QUR MOSAIC MESH 8 IN X 10 IN,,C1781,HCPCS,Facility,Both,,,,1330,1130.5,381.178,1330,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1330,100,,percent of total billed charges,,
C-QUR MOSAIC MESH 8 IN X 10 IN,,C1781,HCPCS,Facility,Both,,,,1330,1130.5,381.178,1330,BlueCross BlueShield Minnesota,High Value Network Plan,1197,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
C-QUR MOSAIC MESH 8 IN X 10 IN,,C1781,HCPCS,Facility,Outpatient,,,,1330,1130.5,381.178,1330,BlueCross BlueShield Minnesota,Medicare Advantage,651.7,49,,percent of total billed charges,,
C-QUR MOSAIC MESH 8 IN X 10 IN,,C1781,HCPCS,Facility,Inpatient,,,,1330,1130.5,381.178,1330,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
C-QUR MOSAIC MESH 8 IN X 10 IN,,C1781,HCPCS,Facility,Both,,,,1330,1130.5,381.178,1330,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1177.981,88.57,,percent of total billed charges,,
C-QUR MOSAIC MESH 8 IN X 10 IN,,C1781,HCPCS,Facility,Both,,,,1330,1130.5,381.178,1330,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,381.178,28.66,,percent of total billed charges,,
C-QUR MOSAIC MESH 8 IN X 10 IN,,C1781,HCPCS,Facility,Outpatient,,,,1330,1130.5,381.178,1330,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),651.7,49,,percent of total billed charges,,
C-QUR MOSAIC MESH 8 IN X 10 IN,,C1781,HCPCS,Facility,Inpatient,,,,1330,1130.5,381.178,1330,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
C-QUR MOSAIC MESH 8 IN X 10 IN,,C1781,HCPCS,Facility,Both,,,,1330,1130.5,381.178,1330,CorVel,Worker's Compensation,1330,100,,percent of total billed charges,,
C-QUR MOSAIC MESH 8 IN X 10 IN,,C1781,HCPCS,Facility,Both,,,,1330,1130.5,381.178,1330,First Health Group Corporation,First Health Network,1290.1,97,,percent of total billed charges,,
C-QUR MOSAIC MESH 8 IN X 10 IN,,C1781,HCPCS,Facility,Both,,,,1330,1130.5,381.178,1330,"Health Partners, Inc.",Commercial,1258.18,94.6,,percent of total billed charges,,
C-QUR MOSAIC MESH 8 IN X 10 IN,,C1781,HCPCS,Facility,Outpatient,,,,1330,1130.5,381.178,1330,"Health Partners, Inc.",Medicare Advantage,651.7,49,,percent of total billed charges,,
C-QUR MOSAIC MESH 8 IN X 10 IN,,C1781,HCPCS,Facility,Inpatient,,,,1330,1130.5,381.178,1330,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
C-QUR MOSAIC MESH 8 IN X 10 IN,,C1781,HCPCS,Facility,Both,,,,1330,1130.5,381.178,1330,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),798,60,,percent of total billed charges,,
C-QUR MOSAIC MESH 8 IN X 10 IN,,C1781,HCPCS,Facility,Both,,,,1330,1130.5,381.178,1330,"Health Partners, Inc.",State of Minnesota Advantage Program,1083.95,81.5,,percent of total billed charges,,
C-QUR MOSAIC MESH 8 IN X 10 IN,,C1781,HCPCS,Facility,Both,,,,1330,1130.5,381.178,1330,"Health Partners, Inc.",State Public Programs,665,50,,percent of total billed charges,,
C-QUR MOSAIC MESH 8 IN X 10 IN,,C1781,HCPCS,Facility,Both,,,,1330,1130.5,381.178,1330,Humana Insurance Company,Commercial PPO,1263.5,95,,percent of total billed charges,,
C-QUR MOSAIC MESH 8 IN X 10 IN,,C1781,HCPCS,Facility,Outpatient,,,,1330,1130.5,381.178,1330,Humana Insurance Company,Medicare PPO,651.7,49,,percent of total billed charges,,
C-QUR MOSAIC MESH 8 IN X 10 IN,,C1781,HCPCS,Facility,Inpatient,,,,1330,1130.5,381.178,1330,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
C-QUR MOSAIC MESH 8 IN X 10 IN,,C1781,HCPCS,Facility,Both,,,,1330,1130.5,381.178,1330,Medica,Individual & Family,1318.03,99.1,,percent of total billed charges,,
C-QUR MOSAIC MESH 8 IN X 10 IN,,C1781,HCPCS,Facility,Outpatient,,,,1330,1130.5,381.178,1330,Medica,Medica Advantage Solution,662.34,49.8,,percent of total billed charges,,
C-QUR MOSAIC MESH 8 IN X 10 IN,,C1781,HCPCS,Facility,Inpatient,,,,1330,1130.5,381.178,1330,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
C-QUR MOSAIC MESH 8 IN X 10 IN,,C1781,HCPCS,Facility,Outpatient,,,,1330,1130.5,381.178,1330,Medica,Medical Assistance,593.18,44.6,,percent of total billed charges,,
C-QUR MOSAIC MESH 8 IN X 10 IN,,C1781,HCPCS,Facility,Inpatient,,,,1330,1130.5,381.178,1330,Medica,Medical Assistance,,,,,Included in per diem rate,
C-QUR MOSAIC MESH 8 IN X 10 IN,,C1781,HCPCS,Facility,Outpatient,,,,1330,1130.5,381.178,1330,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,662.34,49.8,,percent of total billed charges,,
C-QUR MOSAIC MESH 8 IN X 10 IN,,C1781,HCPCS,Facility,Inpatient,,,,1330,1130.5,381.178,1330,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
C-QUR MOSAIC MESH 8 IN X 10 IN,,C1781,HCPCS,Facility,Both,,,,1330,1130.5,381.178,1330,"Multiplan, Inc.","Multiplan, Inc.",1250.2,94,,percent of total billed charges,,
C-QUR MOSAIC MESH 8 IN X 10 IN,,C1781,HCPCS,Facility,Outpatient,,,,1330,1130.5,381.178,1330,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1198.33,90.1,,percent of total billed charges,,
C-QUR MOSAIC MESH 8 IN X 10 IN,,C1781,HCPCS,Facility,Inpatient,,,,1330,1130.5,381.178,1330,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
C-QUR MOSAIC MESH 8 IN X 10 IN,,C1781,HCPCS,Facility,Both,,,,1330,1130.5,381.178,1330,"Preferred One Administrative Services, INC.",PPO,1311.38,98.6,,percent of total billed charges,,
C-QUR MOSAIC MESH 8 IN X 10 IN,,C1781,HCPCS,Facility,Outpatient,,,,1330,1130.5,381.178,1330,PrimeWest Health,Minnesota Senior Health Options (MSHO),684.285,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
C-QUR MOSAIC MESH 8 IN X 10 IN,,C1781,HCPCS,Facility,Inpatient,,,,1330,1130.5,381.178,1330,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
C-QUR MOSAIC MESH 8 IN X 10 IN,,C1781,HCPCS,Facility,Outpatient,,,,1330,1130.5,381.178,1330,PrimeWest Health,MinnesotaCare,683.088,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
C-QUR MOSAIC MESH 8 IN X 10 IN,,C1781,HCPCS,Facility,Inpatient,,,,1330,1130.5,381.178,1330,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
C-QUR MOSAIC MESH 8 IN X 10 IN,,C1781,HCPCS,Facility,Both,,,,1330,1130.5,381.178,1330,Sanford Health Plan,Sanford Health Plan,1223.6,92,,percent of total billed charges,,
C-QUR MOSAIC MESH 8 IN X 10 IN,,C1781,HCPCS,Facility,Outpatient,,,,1330,1130.5,381.178,1330,"UCare Health, Inc.",Individual & Family Plan,749.455,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
C-QUR MOSAIC MESH 8 IN X 10 IN,,C1781,HCPCS,Facility,Inpatient,,,,1330,1130.5,381.178,1330,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
C-QUR MOSAIC MESH 8 IN X 10 IN,,C1781,HCPCS,Facility,Outpatient,,,,1330,1130.5,381.178,1330,"UCare Health, Inc.",Medical Assistance,671.251,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
C-QUR MOSAIC MESH 8 IN X 10 IN,,C1781,HCPCS,Facility,Inpatient,,,,1330,1130.5,381.178,1330,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
C-QUR MOSAIC MESH 8 IN X 10 IN,,C1781,HCPCS,Facility,Outpatient,,,,1330,1130.5,381.178,1330,"UCare Health, Inc.",Medicare Advantage,671.251,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
C-QUR MOSAIC MESH 8 IN X 10 IN,,C1781,HCPCS,Facility,Inpatient,,,,1330,1130.5,381.178,1330,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
C-QUR MOSAIC MESH 8 IN X 10 IN,,C1781,HCPCS,Facility,Outpatient,,,,1330,1130.5,381.178,1330,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),671.251,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
C-QUR MOSAIC MESH 8 IN X 10 IN,,C1781,HCPCS,Facility,Inpatient,,,,1330,1130.5,381.178,1330,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
C-QUR MOSAIC MESH 8 IN X 10 IN,,C1781,HCPCS,Facility,Both,,,,1330,1130.5,381.178,1330,UnitedHealthcare,Individual & Family,1250.2,94,,percent of total billed charges,,
C-QUR MOSAIC MESH 8 IN X 10 IN,,C1781,HCPCS,Facility,Outpatient,,,,1330,1130.5,381.178,1330,UnitedHealthcare,Medicare Advantage,651.7,49,,percent of total billed charges,,
C-QUR MOSAIC MESH 8 IN X 10 IN,,C1781,HCPCS,Facility,Inpatient,,,,1330,1130.5,381.178,1330,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
C-QUR MOSAIC MESH 8 IN X 10 IN,,C1781,HCPCS,Facility,Outpatient,,,,1330,1130.5,381.178,1330,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,638.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
C-QUR MOSAIC MESH 8 IN X 10 IN,,C1781,HCPCS,Facility,Inpatient,,,,1330,1130.5,381.178,1330,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
MENISCAL CINCH  ARTHREX AR-4501,,C1781,HCPCS,Facility,Both,,,,987.5,839.375,283.0175,987.5,Aetna,Commercial,908.5,92,,percent of total billed charges,,
MENISCAL CINCH  ARTHREX AR-4501,,C1781,HCPCS,Facility,Outpatient,,,,987.5,839.375,283.0175,987.5,Aetna,Medicare Advantage,483.875,49,,percent of total billed charges,,
MENISCAL CINCH  ARTHREX AR-4501,,C1781,HCPCS,Facility,Inpatient,,,,987.5,839.375,283.0175,987.5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
MENISCAL CINCH  ARTHREX AR-4501,,C1781,HCPCS,Facility,Both,,,,987.5,839.375,283.0175,987.5,Aetna,PPO,918.375,93,,percent of total billed charges,,
MENISCAL CINCH  ARTHREX AR-4501,,C1781,HCPCS,Facility,Both,,,,987.5,839.375,283.0175,987.5,America's PPO,America's PPO,948.29625,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
MENISCAL CINCH  ARTHREX AR-4501,,C1781,HCPCS,Facility,Both,,,,987.5,839.375,283.0175,987.5,BlueCross BlueShield Minnesota, Federal Employee Program,971.7,98.4,,percent of total billed charges,,
MENISCAL CINCH  ARTHREX AR-4501,,C1781,HCPCS,Facility,Both,,,,987.5,839.375,283.0175,987.5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,987.5,100,,percent of total billed charges,,
MENISCAL CINCH  ARTHREX AR-4501,,C1781,HCPCS,Facility,Both,,,,987.5,839.375,283.0175,987.5,BlueCross BlueShield Minnesota,High Value Network Plan,888.75,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
MENISCAL CINCH  ARTHREX AR-4501,,C1781,HCPCS,Facility,Outpatient,,,,987.5,839.375,283.0175,987.5,BlueCross BlueShield Minnesota,Medicare Advantage,483.875,49,,percent of total billed charges,,
MENISCAL CINCH  ARTHREX AR-4501,,C1781,HCPCS,Facility,Inpatient,,,,987.5,839.375,283.0175,987.5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
MENISCAL CINCH  ARTHREX AR-4501,,C1781,HCPCS,Facility,Both,,,,987.5,839.375,283.0175,987.5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,874.62875,88.57,,percent of total billed charges,,
MENISCAL CINCH  ARTHREX AR-4501,,C1781,HCPCS,Facility,Both,,,,987.5,839.375,283.0175,987.5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,283.0175,28.66,,percent of total billed charges,,
MENISCAL CINCH  ARTHREX AR-4501,,C1781,HCPCS,Facility,Outpatient,,,,987.5,839.375,283.0175,987.5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),483.875,49,,percent of total billed charges,,
MENISCAL CINCH  ARTHREX AR-4501,,C1781,HCPCS,Facility,Inpatient,,,,987.5,839.375,283.0175,987.5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
MENISCAL CINCH  ARTHREX AR-4501,,C1781,HCPCS,Facility,Both,,,,987.5,839.375,283.0175,987.5,CorVel,Worker's Compensation,987.5,100,,percent of total billed charges,,
MENISCAL CINCH  ARTHREX AR-4501,,C1781,HCPCS,Facility,Both,,,,987.5,839.375,283.0175,987.5,First Health Group Corporation,First Health Network,957.875,97,,percent of total billed charges,,
MENISCAL CINCH  ARTHREX AR-4501,,C1781,HCPCS,Facility,Both,,,,987.5,839.375,283.0175,987.5,"Health Partners, Inc.",Commercial,934.175,94.6,,percent of total billed charges,,
MENISCAL CINCH  ARTHREX AR-4501,,C1781,HCPCS,Facility,Outpatient,,,,987.5,839.375,283.0175,987.5,"Health Partners, Inc.",Medicare Advantage,483.875,49,,percent of total billed charges,,
MENISCAL CINCH  ARTHREX AR-4501,,C1781,HCPCS,Facility,Inpatient,,,,987.5,839.375,283.0175,987.5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
MENISCAL CINCH  ARTHREX AR-4501,,C1781,HCPCS,Facility,Both,,,,987.5,839.375,283.0175,987.5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),592.5,60,,percent of total billed charges,,
MENISCAL CINCH  ARTHREX AR-4501,,C1781,HCPCS,Facility,Both,,,,987.5,839.375,283.0175,987.5,"Health Partners, Inc.",State of Minnesota Advantage Program,804.8125,81.5,,percent of total billed charges,,
MENISCAL CINCH  ARTHREX AR-4501,,C1781,HCPCS,Facility,Both,,,,987.5,839.375,283.0175,987.5,"Health Partners, Inc.",State Public Programs,493.75,50,,percent of total billed charges,,
MENISCAL CINCH  ARTHREX AR-4501,,C1781,HCPCS,Facility,Both,,,,987.5,839.375,283.0175,987.5,Humana Insurance Company,Commercial PPO,938.125,95,,percent of total billed charges,,
MENISCAL CINCH  ARTHREX AR-4501,,C1781,HCPCS,Facility,Outpatient,,,,987.5,839.375,283.0175,987.5,Humana Insurance Company,Medicare PPO,483.875,49,,percent of total billed charges,,
MENISCAL CINCH  ARTHREX AR-4501,,C1781,HCPCS,Facility,Inpatient,,,,987.5,839.375,283.0175,987.5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
MENISCAL CINCH  ARTHREX AR-4501,,C1781,HCPCS,Facility,Both,,,,987.5,839.375,283.0175,987.5,Medica,Individual & Family,978.6125,99.1,,percent of total billed charges,,
MENISCAL CINCH  ARTHREX AR-4501,,C1781,HCPCS,Facility,Outpatient,,,,987.5,839.375,283.0175,987.5,Medica,Medica Advantage Solution,491.775,49.8,,percent of total billed charges,,
MENISCAL CINCH  ARTHREX AR-4501,,C1781,HCPCS,Facility,Inpatient,,,,987.5,839.375,283.0175,987.5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
MENISCAL CINCH  ARTHREX AR-4501,,C1781,HCPCS,Facility,Outpatient,,,,987.5,839.375,283.0175,987.5,Medica,Medical Assistance,440.425,44.6,,percent of total billed charges,,
MENISCAL CINCH  ARTHREX AR-4501,,C1781,HCPCS,Facility,Inpatient,,,,987.5,839.375,283.0175,987.5,Medica,Medical Assistance,,,,,Included in per diem rate,
MENISCAL CINCH  ARTHREX AR-4501,,C1781,HCPCS,Facility,Outpatient,,,,987.5,839.375,283.0175,987.5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,491.775,49.8,,percent of total billed charges,,
MENISCAL CINCH  ARTHREX AR-4501,,C1781,HCPCS,Facility,Inpatient,,,,987.5,839.375,283.0175,987.5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
MENISCAL CINCH  ARTHREX AR-4501,,C1781,HCPCS,Facility,Both,,,,987.5,839.375,283.0175,987.5,"Multiplan, Inc.","Multiplan, Inc.",928.25,94,,percent of total billed charges,,
MENISCAL CINCH  ARTHREX AR-4501,,C1781,HCPCS,Facility,Outpatient,,,,987.5,839.375,283.0175,987.5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,889.7375,90.1,,percent of total billed charges,,
MENISCAL CINCH  ARTHREX AR-4501,,C1781,HCPCS,Facility,Inpatient,,,,987.5,839.375,283.0175,987.5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
MENISCAL CINCH  ARTHREX AR-4501,,C1781,HCPCS,Facility,Both,,,,987.5,839.375,283.0175,987.5,"Preferred One Administrative Services, INC.",PPO,973.675,98.6,,percent of total billed charges,,
MENISCAL CINCH  ARTHREX AR-4501,,C1781,HCPCS,Facility,Outpatient,,,,987.5,839.375,283.0175,987.5,PrimeWest Health,Minnesota Senior Health Options (MSHO),508.06875,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
MENISCAL CINCH  ARTHREX AR-4501,,C1781,HCPCS,Facility,Inpatient,,,,987.5,839.375,283.0175,987.5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
MENISCAL CINCH  ARTHREX AR-4501,,C1781,HCPCS,Facility,Outpatient,,,,987.5,839.375,283.0175,987.5,PrimeWest Health,MinnesotaCare,507.18,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
MENISCAL CINCH  ARTHREX AR-4501,,C1781,HCPCS,Facility,Inpatient,,,,987.5,839.375,283.0175,987.5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
MENISCAL CINCH  ARTHREX AR-4501,,C1781,HCPCS,Facility,Both,,,,987.5,839.375,283.0175,987.5,Sanford Health Plan,Sanford Health Plan,908.5,92,,percent of total billed charges,,
MENISCAL CINCH  ARTHREX AR-4501,,C1781,HCPCS,Facility,Outpatient,,,,987.5,839.375,283.0175,987.5,"UCare Health, Inc.",Individual & Family Plan,556.45625,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
MENISCAL CINCH  ARTHREX AR-4501,,C1781,HCPCS,Facility,Inpatient,,,,987.5,839.375,283.0175,987.5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
MENISCAL CINCH  ARTHREX AR-4501,,C1781,HCPCS,Facility,Outpatient,,,,987.5,839.375,283.0175,987.5,"UCare Health, Inc.",Medical Assistance,498.39125,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MENISCAL CINCH  ARTHREX AR-4501,,C1781,HCPCS,Facility,Inpatient,,,,987.5,839.375,283.0175,987.5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
MENISCAL CINCH  ARTHREX AR-4501,,C1781,HCPCS,Facility,Outpatient,,,,987.5,839.375,283.0175,987.5,"UCare Health, Inc.",Medicare Advantage,498.39125,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MENISCAL CINCH  ARTHREX AR-4501,,C1781,HCPCS,Facility,Inpatient,,,,987.5,839.375,283.0175,987.5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
MENISCAL CINCH  ARTHREX AR-4501,,C1781,HCPCS,Facility,Outpatient,,,,987.5,839.375,283.0175,987.5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),498.39125,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MENISCAL CINCH  ARTHREX AR-4501,,C1781,HCPCS,Facility,Inpatient,,,,987.5,839.375,283.0175,987.5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
MENISCAL CINCH  ARTHREX AR-4501,,C1781,HCPCS,Facility,Both,,,,987.5,839.375,283.0175,987.5,UnitedHealthcare,Individual & Family,928.25,94,,percent of total billed charges,,
MENISCAL CINCH  ARTHREX AR-4501,,C1781,HCPCS,Facility,Outpatient,,,,987.5,839.375,283.0175,987.5,UnitedHealthcare,Medicare Advantage,483.875,49,,percent of total billed charges,,
MENISCAL CINCH  ARTHREX AR-4501,,C1781,HCPCS,Facility,Inpatient,,,,987.5,839.375,283.0175,987.5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
MENISCAL CINCH  ARTHREX AR-4501,,C1781,HCPCS,Facility,Outpatient,,,,987.5,839.375,283.0175,987.5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,474,48,,percent of total billed charges,,100% of DHS outpatient percentage
MENISCAL CINCH  ARTHREX AR-4501,,C1781,HCPCS,Facility,Inpatient,,,,987.5,839.375,283.0175,987.5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
MESH C QUR V-PATCH 6.4 X 6.4CM ATRIUM MED     31201,,C1781,HCPCS,Facility,Both,,,,787.5,669.375,225.6975,787.5,Aetna,Commercial,724.5,92,,percent of total billed charges,,
MESH C QUR V-PATCH 6.4 X 6.4CM ATRIUM MED     31201,,C1781,HCPCS,Facility,Outpatient,,,,787.5,669.375,225.6975,787.5,Aetna,Medicare Advantage,385.875,49,,percent of total billed charges,,
MESH C QUR V-PATCH 6.4 X 6.4CM ATRIUM MED     31201,,C1781,HCPCS,Facility,Inpatient,,,,787.5,669.375,225.6975,787.5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
MESH C QUR V-PATCH 6.4 X 6.4CM ATRIUM MED     31201,,C1781,HCPCS,Facility,Both,,,,787.5,669.375,225.6975,787.5,Aetna,PPO,732.375,93,,percent of total billed charges,,
MESH C QUR V-PATCH 6.4 X 6.4CM ATRIUM MED     31201,,C1781,HCPCS,Facility,Both,,,,787.5,669.375,225.6975,787.5,America's PPO,America's PPO,756.23625,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
MESH C QUR V-PATCH 6.4 X 6.4CM ATRIUM MED     31201,,C1781,HCPCS,Facility,Both,,,,787.5,669.375,225.6975,787.5,BlueCross BlueShield Minnesota, Federal Employee Program,774.9,98.4,,percent of total billed charges,,
MESH C QUR V-PATCH 6.4 X 6.4CM ATRIUM MED     31201,,C1781,HCPCS,Facility,Both,,,,787.5,669.375,225.6975,787.5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,787.5,100,,percent of total billed charges,,
MESH C QUR V-PATCH 6.4 X 6.4CM ATRIUM MED     31201,,C1781,HCPCS,Facility,Both,,,,787.5,669.375,225.6975,787.5,BlueCross BlueShield Minnesota,High Value Network Plan,708.75,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
MESH C QUR V-PATCH 6.4 X 6.4CM ATRIUM MED     31201,,C1781,HCPCS,Facility,Outpatient,,,,787.5,669.375,225.6975,787.5,BlueCross BlueShield Minnesota,Medicare Advantage,385.875,49,,percent of total billed charges,,
MESH C QUR V-PATCH 6.4 X 6.4CM ATRIUM MED     31201,,C1781,HCPCS,Facility,Inpatient,,,,787.5,669.375,225.6975,787.5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
MESH C QUR V-PATCH 6.4 X 6.4CM ATRIUM MED     31201,,C1781,HCPCS,Facility,Both,,,,787.5,669.375,225.6975,787.5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,697.48875,88.57,,percent of total billed charges,,
MESH C QUR V-PATCH 6.4 X 6.4CM ATRIUM MED     31201,,C1781,HCPCS,Facility,Both,,,,787.5,669.375,225.6975,787.5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,225.6975,28.66,,percent of total billed charges,,
MESH C QUR V-PATCH 6.4 X 6.4CM ATRIUM MED     31201,,C1781,HCPCS,Facility,Outpatient,,,,787.5,669.375,225.6975,787.5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),385.875,49,,percent of total billed charges,,
MESH C QUR V-PATCH 6.4 X 6.4CM ATRIUM MED     31201,,C1781,HCPCS,Facility,Inpatient,,,,787.5,669.375,225.6975,787.5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
MESH C QUR V-PATCH 6.4 X 6.4CM ATRIUM MED     31201,,C1781,HCPCS,Facility,Both,,,,787.5,669.375,225.6975,787.5,CorVel,Worker's Compensation,787.5,100,,percent of total billed charges,,
MESH C QUR V-PATCH 6.4 X 6.4CM ATRIUM MED     31201,,C1781,HCPCS,Facility,Both,,,,787.5,669.375,225.6975,787.5,First Health Group Corporation,First Health Network,763.875,97,,percent of total billed charges,,
MESH C QUR V-PATCH 6.4 X 6.4CM ATRIUM MED     31201,,C1781,HCPCS,Facility,Both,,,,787.5,669.375,225.6975,787.5,"Health Partners, Inc.",Commercial,744.975,94.6,,percent of total billed charges,,
MESH C QUR V-PATCH 6.4 X 6.4CM ATRIUM MED     31201,,C1781,HCPCS,Facility,Outpatient,,,,787.5,669.375,225.6975,787.5,"Health Partners, Inc.",Medicare Advantage,385.875,49,,percent of total billed charges,,
MESH C QUR V-PATCH 6.4 X 6.4CM ATRIUM MED     31201,,C1781,HCPCS,Facility,Inpatient,,,,787.5,669.375,225.6975,787.5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
MESH C QUR V-PATCH 6.4 X 6.4CM ATRIUM MED     31201,,C1781,HCPCS,Facility,Both,,,,787.5,669.375,225.6975,787.5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),472.5,60,,percent of total billed charges,,
MESH C QUR V-PATCH 6.4 X 6.4CM ATRIUM MED     31201,,C1781,HCPCS,Facility,Both,,,,787.5,669.375,225.6975,787.5,"Health Partners, Inc.",State of Minnesota Advantage Program,641.8125,81.5,,percent of total billed charges,,
MESH C QUR V-PATCH 6.4 X 6.4CM ATRIUM MED     31201,,C1781,HCPCS,Facility,Both,,,,787.5,669.375,225.6975,787.5,"Health Partners, Inc.",State Public Programs,393.75,50,,percent of total billed charges,,
MESH C QUR V-PATCH 6.4 X 6.4CM ATRIUM MED     31201,,C1781,HCPCS,Facility,Both,,,,787.5,669.375,225.6975,787.5,Humana Insurance Company,Commercial PPO,748.125,95,,percent of total billed charges,,
MESH C QUR V-PATCH 6.4 X 6.4CM ATRIUM MED     31201,,C1781,HCPCS,Facility,Outpatient,,,,787.5,669.375,225.6975,787.5,Humana Insurance Company,Medicare PPO,385.875,49,,percent of total billed charges,,
MESH C QUR V-PATCH 6.4 X 6.4CM ATRIUM MED     31201,,C1781,HCPCS,Facility,Inpatient,,,,787.5,669.375,225.6975,787.5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
MESH C QUR V-PATCH 6.4 X 6.4CM ATRIUM MED     31201,,C1781,HCPCS,Facility,Both,,,,787.5,669.375,225.6975,787.5,Medica,Individual & Family,780.4125,99.1,,percent of total billed charges,,
MESH C QUR V-PATCH 6.4 X 6.4CM ATRIUM MED     31201,,C1781,HCPCS,Facility,Outpatient,,,,787.5,669.375,225.6975,787.5,Medica,Medica Advantage Solution,392.175,49.8,,percent of total billed charges,,
MESH C QUR V-PATCH 6.4 X 6.4CM ATRIUM MED     31201,,C1781,HCPCS,Facility,Inpatient,,,,787.5,669.375,225.6975,787.5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
MESH C QUR V-PATCH 6.4 X 6.4CM ATRIUM MED     31201,,C1781,HCPCS,Facility,Outpatient,,,,787.5,669.375,225.6975,787.5,Medica,Medical Assistance,351.225,44.6,,percent of total billed charges,,
MESH C QUR V-PATCH 6.4 X 6.4CM ATRIUM MED     31201,,C1781,HCPCS,Facility,Inpatient,,,,787.5,669.375,225.6975,787.5,Medica,Medical Assistance,,,,,Included in per diem rate,
MESH C QUR V-PATCH 6.4 X 6.4CM ATRIUM MED     31201,,C1781,HCPCS,Facility,Outpatient,,,,787.5,669.375,225.6975,787.5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,392.175,49.8,,percent of total billed charges,,
MESH C QUR V-PATCH 6.4 X 6.4CM ATRIUM MED     31201,,C1781,HCPCS,Facility,Inpatient,,,,787.5,669.375,225.6975,787.5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
MESH C QUR V-PATCH 6.4 X 6.4CM ATRIUM MED     31201,,C1781,HCPCS,Facility,Both,,,,787.5,669.375,225.6975,787.5,"Multiplan, Inc.","Multiplan, Inc.",740.25,94,,percent of total billed charges,,
MESH C QUR V-PATCH 6.4 X 6.4CM ATRIUM MED     31201,,C1781,HCPCS,Facility,Outpatient,,,,787.5,669.375,225.6975,787.5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,709.5375,90.1,,percent of total billed charges,,
MESH C QUR V-PATCH 6.4 X 6.4CM ATRIUM MED     31201,,C1781,HCPCS,Facility,Inpatient,,,,787.5,669.375,225.6975,787.5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
MESH C QUR V-PATCH 6.4 X 6.4CM ATRIUM MED     31201,,C1781,HCPCS,Facility,Both,,,,787.5,669.375,225.6975,787.5,"Preferred One Administrative Services, INC.",PPO,776.475,98.6,,percent of total billed charges,,
MESH C QUR V-PATCH 6.4 X 6.4CM ATRIUM MED     31201,,C1781,HCPCS,Facility,Outpatient,,,,787.5,669.375,225.6975,787.5,PrimeWest Health,Minnesota Senior Health Options (MSHO),405.16875,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
MESH C QUR V-PATCH 6.4 X 6.4CM ATRIUM MED     31201,,C1781,HCPCS,Facility,Inpatient,,,,787.5,669.375,225.6975,787.5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
MESH C QUR V-PATCH 6.4 X 6.4CM ATRIUM MED     31201,,C1781,HCPCS,Facility,Outpatient,,,,787.5,669.375,225.6975,787.5,PrimeWest Health,MinnesotaCare,404.46,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
MESH C QUR V-PATCH 6.4 X 6.4CM ATRIUM MED     31201,,C1781,HCPCS,Facility,Inpatient,,,,787.5,669.375,225.6975,787.5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
MESH C QUR V-PATCH 6.4 X 6.4CM ATRIUM MED     31201,,C1781,HCPCS,Facility,Both,,,,787.5,669.375,225.6975,787.5,Sanford Health Plan,Sanford Health Plan,724.5,92,,percent of total billed charges,,
MESH C QUR V-PATCH 6.4 X 6.4CM ATRIUM MED     31201,,C1781,HCPCS,Facility,Outpatient,,,,787.5,669.375,225.6975,787.5,"UCare Health, Inc.",Individual & Family Plan,443.75625,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
MESH C QUR V-PATCH 6.4 X 6.4CM ATRIUM MED     31201,,C1781,HCPCS,Facility,Inpatient,,,,787.5,669.375,225.6975,787.5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
MESH C QUR V-PATCH 6.4 X 6.4CM ATRIUM MED     31201,,C1781,HCPCS,Facility,Outpatient,,,,787.5,669.375,225.6975,787.5,"UCare Health, Inc.",Medical Assistance,397.45125,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MESH C QUR V-PATCH 6.4 X 6.4CM ATRIUM MED     31201,,C1781,HCPCS,Facility,Inpatient,,,,787.5,669.375,225.6975,787.5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
MESH C QUR V-PATCH 6.4 X 6.4CM ATRIUM MED     31201,,C1781,HCPCS,Facility,Outpatient,,,,787.5,669.375,225.6975,787.5,"UCare Health, Inc.",Medicare Advantage,397.45125,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MESH C QUR V-PATCH 6.4 X 6.4CM ATRIUM MED     31201,,C1781,HCPCS,Facility,Inpatient,,,,787.5,669.375,225.6975,787.5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
MESH C QUR V-PATCH 6.4 X 6.4CM ATRIUM MED     31201,,C1781,HCPCS,Facility,Outpatient,,,,787.5,669.375,225.6975,787.5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),397.45125,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MESH C QUR V-PATCH 6.4 X 6.4CM ATRIUM MED     31201,,C1781,HCPCS,Facility,Inpatient,,,,787.5,669.375,225.6975,787.5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
MESH C QUR V-PATCH 6.4 X 6.4CM ATRIUM MED     31201,,C1781,HCPCS,Facility,Both,,,,787.5,669.375,225.6975,787.5,UnitedHealthcare,Individual & Family,740.25,94,,percent of total billed charges,,
MESH C QUR V-PATCH 6.4 X 6.4CM ATRIUM MED     31201,,C1781,HCPCS,Facility,Outpatient,,,,787.5,669.375,225.6975,787.5,UnitedHealthcare,Medicare Advantage,385.875,49,,percent of total billed charges,,
MESH C QUR V-PATCH 6.4 X 6.4CM ATRIUM MED     31201,,C1781,HCPCS,Facility,Inpatient,,,,787.5,669.375,225.6975,787.5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
MESH C QUR V-PATCH 6.4 X 6.4CM ATRIUM MED     31201,,C1781,HCPCS,Facility,Outpatient,,,,787.5,669.375,225.6975,787.5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,378,48,,percent of total billed charges,,100% of DHS outpatient percentage
MESH C QUR V-PATCH 6.4 X 6.4CM ATRIUM MED     31201,,C1781,HCPCS,Facility,Inpatient,,,,787.5,669.375,225.6975,787.5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
MESH C-QUR V-PATCH ATRIUM MEDICAL 8.0 X 8.0CM    31202,,C1781,HCPCS,Facility,Both,,,,875,743.75,250.775,875,Aetna,Commercial,805,92,,percent of total billed charges,,
MESH C-QUR V-PATCH ATRIUM MEDICAL 8.0 X 8.0CM    31202,,C1781,HCPCS,Facility,Outpatient,,,,875,743.75,250.775,875,Aetna,Medicare Advantage,428.75,49,,percent of total billed charges,,
MESH C-QUR V-PATCH ATRIUM MEDICAL 8.0 X 8.0CM    31202,,C1781,HCPCS,Facility,Inpatient,,,,875,743.75,250.775,875,Aetna,Medicare Advantage,,,,,Included in per diem rate,
MESH C-QUR V-PATCH ATRIUM MEDICAL 8.0 X 8.0CM    31202,,C1781,HCPCS,Facility,Both,,,,875,743.75,250.775,875,Aetna,PPO,813.75,93,,percent of total billed charges,,
MESH C-QUR V-PATCH ATRIUM MEDICAL 8.0 X 8.0CM    31202,,C1781,HCPCS,Facility,Both,,,,875,743.75,250.775,875,America's PPO,America's PPO,840.2625,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
MESH C-QUR V-PATCH ATRIUM MEDICAL 8.0 X 8.0CM    31202,,C1781,HCPCS,Facility,Both,,,,875,743.75,250.775,875,BlueCross BlueShield Minnesota, Federal Employee Program,861,98.4,,percent of total billed charges,,
MESH C-QUR V-PATCH ATRIUM MEDICAL 8.0 X 8.0CM    31202,,C1781,HCPCS,Facility,Both,,,,875,743.75,250.775,875,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,875,100,,percent of total billed charges,,
MESH C-QUR V-PATCH ATRIUM MEDICAL 8.0 X 8.0CM    31202,,C1781,HCPCS,Facility,Both,,,,875,743.75,250.775,875,BlueCross BlueShield Minnesota,High Value Network Plan,787.5,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
MESH C-QUR V-PATCH ATRIUM MEDICAL 8.0 X 8.0CM    31202,,C1781,HCPCS,Facility,Outpatient,,,,875,743.75,250.775,875,BlueCross BlueShield Minnesota,Medicare Advantage,428.75,49,,percent of total billed charges,,
MESH C-QUR V-PATCH ATRIUM MEDICAL 8.0 X 8.0CM    31202,,C1781,HCPCS,Facility,Inpatient,,,,875,743.75,250.775,875,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
MESH C-QUR V-PATCH ATRIUM MEDICAL 8.0 X 8.0CM    31202,,C1781,HCPCS,Facility,Both,,,,875,743.75,250.775,875,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,774.9875,88.57,,percent of total billed charges,,
MESH C-QUR V-PATCH ATRIUM MEDICAL 8.0 X 8.0CM    31202,,C1781,HCPCS,Facility,Both,,,,875,743.75,250.775,875,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,250.775,28.66,,percent of total billed charges,,
MESH C-QUR V-PATCH ATRIUM MEDICAL 8.0 X 8.0CM    31202,,C1781,HCPCS,Facility,Outpatient,,,,875,743.75,250.775,875,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),428.75,49,,percent of total billed charges,,
MESH C-QUR V-PATCH ATRIUM MEDICAL 8.0 X 8.0CM    31202,,C1781,HCPCS,Facility,Inpatient,,,,875,743.75,250.775,875,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
MESH C-QUR V-PATCH ATRIUM MEDICAL 8.0 X 8.0CM    31202,,C1781,HCPCS,Facility,Both,,,,875,743.75,250.775,875,CorVel,Worker's Compensation,875,100,,percent of total billed charges,,
MESH C-QUR V-PATCH ATRIUM MEDICAL 8.0 X 8.0CM    31202,,C1781,HCPCS,Facility,Both,,,,875,743.75,250.775,875,First Health Group Corporation,First Health Network,848.75,97,,percent of total billed charges,,
MESH C-QUR V-PATCH ATRIUM MEDICAL 8.0 X 8.0CM    31202,,C1781,HCPCS,Facility,Both,,,,875,743.75,250.775,875,"Health Partners, Inc.",Commercial,827.75,94.6,,percent of total billed charges,,
MESH C-QUR V-PATCH ATRIUM MEDICAL 8.0 X 8.0CM    31202,,C1781,HCPCS,Facility,Outpatient,,,,875,743.75,250.775,875,"Health Partners, Inc.",Medicare Advantage,428.75,49,,percent of total billed charges,,
MESH C-QUR V-PATCH ATRIUM MEDICAL 8.0 X 8.0CM    31202,,C1781,HCPCS,Facility,Inpatient,,,,875,743.75,250.775,875,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
MESH C-QUR V-PATCH ATRIUM MEDICAL 8.0 X 8.0CM    31202,,C1781,HCPCS,Facility,Both,,,,875,743.75,250.775,875,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),525,60,,percent of total billed charges,,
MESH C-QUR V-PATCH ATRIUM MEDICAL 8.0 X 8.0CM    31202,,C1781,HCPCS,Facility,Both,,,,875,743.75,250.775,875,"Health Partners, Inc.",State of Minnesota Advantage Program,713.125,81.5,,percent of total billed charges,,
MESH C-QUR V-PATCH ATRIUM MEDICAL 8.0 X 8.0CM    31202,,C1781,HCPCS,Facility,Both,,,,875,743.75,250.775,875,"Health Partners, Inc.",State Public Programs,437.5,50,,percent of total billed charges,,
MESH C-QUR V-PATCH ATRIUM MEDICAL 8.0 X 8.0CM    31202,,C1781,HCPCS,Facility,Both,,,,875,743.75,250.775,875,Humana Insurance Company,Commercial PPO,831.25,95,,percent of total billed charges,,
MESH C-QUR V-PATCH ATRIUM MEDICAL 8.0 X 8.0CM    31202,,C1781,HCPCS,Facility,Outpatient,,,,875,743.75,250.775,875,Humana Insurance Company,Medicare PPO,428.75,49,,percent of total billed charges,,
MESH C-QUR V-PATCH ATRIUM MEDICAL 8.0 X 8.0CM    31202,,C1781,HCPCS,Facility,Inpatient,,,,875,743.75,250.775,875,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
MESH C-QUR V-PATCH ATRIUM MEDICAL 8.0 X 8.0CM    31202,,C1781,HCPCS,Facility,Both,,,,875,743.75,250.775,875,Medica,Individual & Family,867.125,99.1,,percent of total billed charges,,
MESH C-QUR V-PATCH ATRIUM MEDICAL 8.0 X 8.0CM    31202,,C1781,HCPCS,Facility,Outpatient,,,,875,743.75,250.775,875,Medica,Medica Advantage Solution,435.75,49.8,,percent of total billed charges,,
MESH C-QUR V-PATCH ATRIUM MEDICAL 8.0 X 8.0CM    31202,,C1781,HCPCS,Facility,Inpatient,,,,875,743.75,250.775,875,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
MESH C-QUR V-PATCH ATRIUM MEDICAL 8.0 X 8.0CM    31202,,C1781,HCPCS,Facility,Outpatient,,,,875,743.75,250.775,875,Medica,Medical Assistance,390.25,44.6,,percent of total billed charges,,
MESH C-QUR V-PATCH ATRIUM MEDICAL 8.0 X 8.0CM    31202,,C1781,HCPCS,Facility,Inpatient,,,,875,743.75,250.775,875,Medica,Medical Assistance,,,,,Included in per diem rate,
MESH C-QUR V-PATCH ATRIUM MEDICAL 8.0 X 8.0CM    31202,,C1781,HCPCS,Facility,Outpatient,,,,875,743.75,250.775,875,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,435.75,49.8,,percent of total billed charges,,
MESH C-QUR V-PATCH ATRIUM MEDICAL 8.0 X 8.0CM    31202,,C1781,HCPCS,Facility,Inpatient,,,,875,743.75,250.775,875,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
MESH C-QUR V-PATCH ATRIUM MEDICAL 8.0 X 8.0CM    31202,,C1781,HCPCS,Facility,Both,,,,875,743.75,250.775,875,"Multiplan, Inc.","Multiplan, Inc.",822.5,94,,percent of total billed charges,,
MESH C-QUR V-PATCH ATRIUM MEDICAL 8.0 X 8.0CM    31202,,C1781,HCPCS,Facility,Outpatient,,,,875,743.75,250.775,875,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,788.375,90.1,,percent of total billed charges,,
MESH C-QUR V-PATCH ATRIUM MEDICAL 8.0 X 8.0CM    31202,,C1781,HCPCS,Facility,Inpatient,,,,875,743.75,250.775,875,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
MESH C-QUR V-PATCH ATRIUM MEDICAL 8.0 X 8.0CM    31202,,C1781,HCPCS,Facility,Both,,,,875,743.75,250.775,875,"Preferred One Administrative Services, INC.",PPO,862.75,98.6,,percent of total billed charges,,
MESH C-QUR V-PATCH ATRIUM MEDICAL 8.0 X 8.0CM    31202,,C1781,HCPCS,Facility,Outpatient,,,,875,743.75,250.775,875,PrimeWest Health,Minnesota Senior Health Options (MSHO),450.1875,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
MESH C-QUR V-PATCH ATRIUM MEDICAL 8.0 X 8.0CM    31202,,C1781,HCPCS,Facility,Inpatient,,,,875,743.75,250.775,875,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
MESH C-QUR V-PATCH ATRIUM MEDICAL 8.0 X 8.0CM    31202,,C1781,HCPCS,Facility,Outpatient,,,,875,743.75,250.775,875,PrimeWest Health,MinnesotaCare,449.4,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
MESH C-QUR V-PATCH ATRIUM MEDICAL 8.0 X 8.0CM    31202,,C1781,HCPCS,Facility,Inpatient,,,,875,743.75,250.775,875,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
MESH C-QUR V-PATCH ATRIUM MEDICAL 8.0 X 8.0CM    31202,,C1781,HCPCS,Facility,Both,,,,875,743.75,250.775,875,Sanford Health Plan,Sanford Health Plan,805,92,,percent of total billed charges,,
MESH C-QUR V-PATCH ATRIUM MEDICAL 8.0 X 8.0CM    31202,,C1781,HCPCS,Facility,Outpatient,,,,875,743.75,250.775,875,"UCare Health, Inc.",Individual & Family Plan,493.0625,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
MESH C-QUR V-PATCH ATRIUM MEDICAL 8.0 X 8.0CM    31202,,C1781,HCPCS,Facility,Inpatient,,,,875,743.75,250.775,875,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
MESH C-QUR V-PATCH ATRIUM MEDICAL 8.0 X 8.0CM    31202,,C1781,HCPCS,Facility,Outpatient,,,,875,743.75,250.775,875,"UCare Health, Inc.",Medical Assistance,441.6125,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MESH C-QUR V-PATCH ATRIUM MEDICAL 8.0 X 8.0CM    31202,,C1781,HCPCS,Facility,Inpatient,,,,875,743.75,250.775,875,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
MESH C-QUR V-PATCH ATRIUM MEDICAL 8.0 X 8.0CM    31202,,C1781,HCPCS,Facility,Outpatient,,,,875,743.75,250.775,875,"UCare Health, Inc.",Medicare Advantage,441.6125,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MESH C-QUR V-PATCH ATRIUM MEDICAL 8.0 X 8.0CM    31202,,C1781,HCPCS,Facility,Inpatient,,,,875,743.75,250.775,875,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
MESH C-QUR V-PATCH ATRIUM MEDICAL 8.0 X 8.0CM    31202,,C1781,HCPCS,Facility,Outpatient,,,,875,743.75,250.775,875,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),441.6125,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MESH C-QUR V-PATCH ATRIUM MEDICAL 8.0 X 8.0CM    31202,,C1781,HCPCS,Facility,Inpatient,,,,875,743.75,250.775,875,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
MESH C-QUR V-PATCH ATRIUM MEDICAL 8.0 X 8.0CM    31202,,C1781,HCPCS,Facility,Both,,,,875,743.75,250.775,875,UnitedHealthcare,Individual & Family,822.5,94,,percent of total billed charges,,
MESH C-QUR V-PATCH ATRIUM MEDICAL 8.0 X 8.0CM    31202,,C1781,HCPCS,Facility,Outpatient,,,,875,743.75,250.775,875,UnitedHealthcare,Medicare Advantage,428.75,49,,percent of total billed charges,,
MESH C-QUR V-PATCH ATRIUM MEDICAL 8.0 X 8.0CM    31202,,C1781,HCPCS,Facility,Inpatient,,,,875,743.75,250.775,875,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
MESH C-QUR V-PATCH ATRIUM MEDICAL 8.0 X 8.0CM    31202,,C1781,HCPCS,Facility,Outpatient,,,,875,743.75,250.775,875,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,420,48,,percent of total billed charges,,100% of DHS outpatient percentage
MESH C-QUR V-PATCH ATRIUM MEDICAL 8.0 X 8.0CM    31202,,C1781,HCPCS,Facility,Inpatient,,,,875,743.75,250.775,875,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
MESH DEVICE LARGE ULTRAPRO  UHSL6,,C1781,HCPCS,Facility,Both,,,,836.875,711.34375,239.848375,836.875,Aetna,Commercial,769.925,92,,percent of total billed charges,,
MESH DEVICE LARGE ULTRAPRO  UHSL6,,C1781,HCPCS,Facility,Outpatient,,,,836.875,711.34375,239.848375,836.875,Aetna,Medicare Advantage,410.06875,49,,percent of total billed charges,,
MESH DEVICE LARGE ULTRAPRO  UHSL6,,C1781,HCPCS,Facility,Inpatient,,,,836.875,711.34375,239.848375,836.875,Aetna,Medicare Advantage,,,,,Included in per diem rate,
MESH DEVICE LARGE ULTRAPRO  UHSL6,,C1781,HCPCS,Facility,Both,,,,836.875,711.34375,239.848375,836.875,Aetna,PPO,778.29375,93,,percent of total billed charges,,
MESH DEVICE LARGE ULTRAPRO  UHSL6,,C1781,HCPCS,Facility,Both,,,,836.875,711.34375,239.848375,836.875,America's PPO,America's PPO,803.6510625,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
MESH DEVICE LARGE ULTRAPRO  UHSL6,,C1781,HCPCS,Facility,Both,,,,836.875,711.34375,239.848375,836.875,BlueCross BlueShield Minnesota, Federal Employee Program,823.485,98.4,,percent of total billed charges,,
MESH DEVICE LARGE ULTRAPRO  UHSL6,,C1781,HCPCS,Facility,Both,,,,836.875,711.34375,239.848375,836.875,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,836.875,100,,percent of total billed charges,,
MESH DEVICE LARGE ULTRAPRO  UHSL6,,C1781,HCPCS,Facility,Both,,,,836.875,711.34375,239.848375,836.875,BlueCross BlueShield Minnesota,High Value Network Plan,753.1875,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
MESH DEVICE LARGE ULTRAPRO  UHSL6,,C1781,HCPCS,Facility,Outpatient,,,,836.875,711.34375,239.848375,836.875,BlueCross BlueShield Minnesota,Medicare Advantage,410.06875,49,,percent of total billed charges,,
MESH DEVICE LARGE ULTRAPRO  UHSL6,,C1781,HCPCS,Facility,Inpatient,,,,836.875,711.34375,239.848375,836.875,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
MESH DEVICE LARGE ULTRAPRO  UHSL6,,C1781,HCPCS,Facility,Both,,,,836.875,711.34375,239.848375,836.875,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,741.2201875,88.57,,percent of total billed charges,,
MESH DEVICE LARGE ULTRAPRO  UHSL6,,C1781,HCPCS,Facility,Both,,,,836.875,711.34375,239.848375,836.875,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,239.848375,28.66,,percent of total billed charges,,
MESH DEVICE LARGE ULTRAPRO  UHSL6,,C1781,HCPCS,Facility,Outpatient,,,,836.875,711.34375,239.848375,836.875,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),410.06875,49,,percent of total billed charges,,
MESH DEVICE LARGE ULTRAPRO  UHSL6,,C1781,HCPCS,Facility,Inpatient,,,,836.875,711.34375,239.848375,836.875,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
MESH DEVICE LARGE ULTRAPRO  UHSL6,,C1781,HCPCS,Facility,Both,,,,836.875,711.34375,239.848375,836.875,CorVel,Worker's Compensation,836.875,100,,percent of total billed charges,,
MESH DEVICE LARGE ULTRAPRO  UHSL6,,C1781,HCPCS,Facility,Both,,,,836.875,711.34375,239.848375,836.875,First Health Group Corporation,First Health Network,811.76875,97,,percent of total billed charges,,
MESH DEVICE LARGE ULTRAPRO  UHSL6,,C1781,HCPCS,Facility,Both,,,,836.875,711.34375,239.848375,836.875,"Health Partners, Inc.",Commercial,791.68375,94.6,,percent of total billed charges,,
MESH DEVICE LARGE ULTRAPRO  UHSL6,,C1781,HCPCS,Facility,Outpatient,,,,836.875,711.34375,239.848375,836.875,"Health Partners, Inc.",Medicare Advantage,410.06875,49,,percent of total billed charges,,
MESH DEVICE LARGE ULTRAPRO  UHSL6,,C1781,HCPCS,Facility,Inpatient,,,,836.875,711.34375,239.848375,836.875,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
MESH DEVICE LARGE ULTRAPRO  UHSL6,,C1781,HCPCS,Facility,Both,,,,836.875,711.34375,239.848375,836.875,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),502.125,60,,percent of total billed charges,,
MESH DEVICE LARGE ULTRAPRO  UHSL6,,C1781,HCPCS,Facility,Both,,,,836.875,711.34375,239.848375,836.875,"Health Partners, Inc.",State of Minnesota Advantage Program,682.053125,81.5,,percent of total billed charges,,
MESH DEVICE LARGE ULTRAPRO  UHSL6,,C1781,HCPCS,Facility,Both,,,,836.875,711.34375,239.848375,836.875,"Health Partners, Inc.",State Public Programs,418.4375,50,,percent of total billed charges,,
MESH DEVICE LARGE ULTRAPRO  UHSL6,,C1781,HCPCS,Facility,Both,,,,836.875,711.34375,239.848375,836.875,Humana Insurance Company,Commercial PPO,795.03125,95,,percent of total billed charges,,
MESH DEVICE LARGE ULTRAPRO  UHSL6,,C1781,HCPCS,Facility,Outpatient,,,,836.875,711.34375,239.848375,836.875,Humana Insurance Company,Medicare PPO,410.06875,49,,percent of total billed charges,,
MESH DEVICE LARGE ULTRAPRO  UHSL6,,C1781,HCPCS,Facility,Inpatient,,,,836.875,711.34375,239.848375,836.875,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
MESH DEVICE LARGE ULTRAPRO  UHSL6,,C1781,HCPCS,Facility,Both,,,,836.875,711.34375,239.848375,836.875,Medica,Individual & Family,829.343125,99.1,,percent of total billed charges,,
MESH DEVICE LARGE ULTRAPRO  UHSL6,,C1781,HCPCS,Facility,Outpatient,,,,836.875,711.34375,239.848375,836.875,Medica,Medica Advantage Solution,416.76375,49.8,,percent of total billed charges,,
MESH DEVICE LARGE ULTRAPRO  UHSL6,,C1781,HCPCS,Facility,Inpatient,,,,836.875,711.34375,239.848375,836.875,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
MESH DEVICE LARGE ULTRAPRO  UHSL6,,C1781,HCPCS,Facility,Outpatient,,,,836.875,711.34375,239.848375,836.875,Medica,Medical Assistance,373.24625,44.6,,percent of total billed charges,,
MESH DEVICE LARGE ULTRAPRO  UHSL6,,C1781,HCPCS,Facility,Inpatient,,,,836.875,711.34375,239.848375,836.875,Medica,Medical Assistance,,,,,Included in per diem rate,
MESH DEVICE LARGE ULTRAPRO  UHSL6,,C1781,HCPCS,Facility,Outpatient,,,,836.875,711.34375,239.848375,836.875,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,416.76375,49.8,,percent of total billed charges,,
MESH DEVICE LARGE ULTRAPRO  UHSL6,,C1781,HCPCS,Facility,Inpatient,,,,836.875,711.34375,239.848375,836.875,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
MESH DEVICE LARGE ULTRAPRO  UHSL6,,C1781,HCPCS,Facility,Both,,,,836.875,711.34375,239.848375,836.875,"Multiplan, Inc.","Multiplan, Inc.",786.6625,94,,percent of total billed charges,,
MESH DEVICE LARGE ULTRAPRO  UHSL6,,C1781,HCPCS,Facility,Outpatient,,,,836.875,711.34375,239.848375,836.875,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,754.024375,90.1,,percent of total billed charges,,
MESH DEVICE LARGE ULTRAPRO  UHSL6,,C1781,HCPCS,Facility,Inpatient,,,,836.875,711.34375,239.848375,836.875,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
MESH DEVICE LARGE ULTRAPRO  UHSL6,,C1781,HCPCS,Facility,Both,,,,836.875,711.34375,239.848375,836.875,"Preferred One Administrative Services, INC.",PPO,825.15875,98.6,,percent of total billed charges,,
MESH DEVICE LARGE ULTRAPRO  UHSL6,,C1781,HCPCS,Facility,Outpatient,,,,836.875,711.34375,239.848375,836.875,PrimeWest Health,Minnesota Senior Health Options (MSHO),430.5721875,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
MESH DEVICE LARGE ULTRAPRO  UHSL6,,C1781,HCPCS,Facility,Inpatient,,,,836.875,711.34375,239.848375,836.875,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
MESH DEVICE LARGE ULTRAPRO  UHSL6,,C1781,HCPCS,Facility,Outpatient,,,,836.875,711.34375,239.848375,836.875,PrimeWest Health,MinnesotaCare,429.819,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
MESH DEVICE LARGE ULTRAPRO  UHSL6,,C1781,HCPCS,Facility,Inpatient,,,,836.875,711.34375,239.848375,836.875,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
MESH DEVICE LARGE ULTRAPRO  UHSL6,,C1781,HCPCS,Facility,Both,,,,836.875,711.34375,239.848375,836.875,Sanford Health Plan,Sanford Health Plan,769.925,92,,percent of total billed charges,,
MESH DEVICE LARGE ULTRAPRO  UHSL6,,C1781,HCPCS,Facility,Outpatient,,,,836.875,711.34375,239.848375,836.875,"UCare Health, Inc.",Individual & Family Plan,471.5790625,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
MESH DEVICE LARGE ULTRAPRO  UHSL6,,C1781,HCPCS,Facility,Inpatient,,,,836.875,711.34375,239.848375,836.875,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
MESH DEVICE LARGE ULTRAPRO  UHSL6,,C1781,HCPCS,Facility,Outpatient,,,,836.875,711.34375,239.848375,836.875,"UCare Health, Inc.",Medical Assistance,422.3708125,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MESH DEVICE LARGE ULTRAPRO  UHSL6,,C1781,HCPCS,Facility,Inpatient,,,,836.875,711.34375,239.848375,836.875,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
MESH DEVICE LARGE ULTRAPRO  UHSL6,,C1781,HCPCS,Facility,Outpatient,,,,836.875,711.34375,239.848375,836.875,"UCare Health, Inc.",Medicare Advantage,422.3708125,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MESH DEVICE LARGE ULTRAPRO  UHSL6,,C1781,HCPCS,Facility,Inpatient,,,,836.875,711.34375,239.848375,836.875,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
MESH DEVICE LARGE ULTRAPRO  UHSL6,,C1781,HCPCS,Facility,Outpatient,,,,836.875,711.34375,239.848375,836.875,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),422.3708125,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MESH DEVICE LARGE ULTRAPRO  UHSL6,,C1781,HCPCS,Facility,Inpatient,,,,836.875,711.34375,239.848375,836.875,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
MESH DEVICE LARGE ULTRAPRO  UHSL6,,C1781,HCPCS,Facility,Both,,,,836.875,711.34375,239.848375,836.875,UnitedHealthcare,Individual & Family,786.6625,94,,percent of total billed charges,,
MESH DEVICE LARGE ULTRAPRO  UHSL6,,C1781,HCPCS,Facility,Outpatient,,,,836.875,711.34375,239.848375,836.875,UnitedHealthcare,Medicare Advantage,410.06875,49,,percent of total billed charges,,
MESH DEVICE LARGE ULTRAPRO  UHSL6,,C1781,HCPCS,Facility,Inpatient,,,,836.875,711.34375,239.848375,836.875,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
MESH DEVICE LARGE ULTRAPRO  UHSL6,,C1781,HCPCS,Facility,Outpatient,,,,836.875,711.34375,239.848375,836.875,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,401.7,48,,percent of total billed charges,,100% of DHS outpatient percentage
MESH DEVICE LARGE ULTRAPRO  UHSL6,,C1781,HCPCS,Facility,Inpatient,,,,836.875,711.34375,239.848375,836.875,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Mesh Hernia Plug and Patch,,C1781,HCPCS,Facility,Both,,,,1408,1196.8,403.5328,1408,Aetna,Commercial,1295.36,92,,percent of total billed charges,,
Mesh Hernia Plug and Patch,,C1781,HCPCS,Facility,Outpatient,,,,1408,1196.8,403.5328,1408,Aetna,Medicare Advantage,689.92,49,,percent of total billed charges,,
Mesh Hernia Plug and Patch,,C1781,HCPCS,Facility,Inpatient,,,,1408,1196.8,403.5328,1408,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Mesh Hernia Plug and Patch,,C1781,HCPCS,Facility,Both,,,,1408,1196.8,403.5328,1408,Aetna,PPO,1309.44,93,,percent of total billed charges,,
Mesh Hernia Plug and Patch,,C1781,HCPCS,Facility,Both,,,,1408,1196.8,403.5328,1408,America's PPO,America's PPO,1352.1024,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Mesh Hernia Plug and Patch,,C1781,HCPCS,Facility,Both,,,,1408,1196.8,403.5328,1408,BlueCross BlueShield Minnesota, Federal Employee Program,1385.472,98.4,,percent of total billed charges,,
Mesh Hernia Plug and Patch,,C1781,HCPCS,Facility,Both,,,,1408,1196.8,403.5328,1408,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1408,100,,percent of total billed charges,,
Mesh Hernia Plug and Patch,,C1781,HCPCS,Facility,Both,,,,1408,1196.8,403.5328,1408,BlueCross BlueShield Minnesota,High Value Network Plan,1267.2,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
Mesh Hernia Plug and Patch,,C1781,HCPCS,Facility,Outpatient,,,,1408,1196.8,403.5328,1408,BlueCross BlueShield Minnesota,Medicare Advantage,689.92,49,,percent of total billed charges,,
Mesh Hernia Plug and Patch,,C1781,HCPCS,Facility,Inpatient,,,,1408,1196.8,403.5328,1408,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Mesh Hernia Plug and Patch,,C1781,HCPCS,Facility,Both,,,,1408,1196.8,403.5328,1408,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1247.0656,88.57,,percent of total billed charges,,
Mesh Hernia Plug and Patch,,C1781,HCPCS,Facility,Both,,,,1408,1196.8,403.5328,1408,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,403.5328,28.66,,percent of total billed charges,,
Mesh Hernia Plug and Patch,,C1781,HCPCS,Facility,Outpatient,,,,1408,1196.8,403.5328,1408,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),689.92,49,,percent of total billed charges,,
Mesh Hernia Plug and Patch,,C1781,HCPCS,Facility,Inpatient,,,,1408,1196.8,403.5328,1408,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Mesh Hernia Plug and Patch,,C1781,HCPCS,Facility,Both,,,,1408,1196.8,403.5328,1408,CorVel,Worker's Compensation,1408,100,,percent of total billed charges,,
Mesh Hernia Plug and Patch,,C1781,HCPCS,Facility,Both,,,,1408,1196.8,403.5328,1408,First Health Group Corporation,First Health Network,1365.76,97,,percent of total billed charges,,
Mesh Hernia Plug and Patch,,C1781,HCPCS,Facility,Both,,,,1408,1196.8,403.5328,1408,"Health Partners, Inc.",Commercial,1331.968,94.6,,percent of total billed charges,,
Mesh Hernia Plug and Patch,,C1781,HCPCS,Facility,Outpatient,,,,1408,1196.8,403.5328,1408,"Health Partners, Inc.",Medicare Advantage,689.92,49,,percent of total billed charges,,
Mesh Hernia Plug and Patch,,C1781,HCPCS,Facility,Inpatient,,,,1408,1196.8,403.5328,1408,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mesh Hernia Plug and Patch,,C1781,HCPCS,Facility,Both,,,,1408,1196.8,403.5328,1408,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),844.8,60,,percent of total billed charges,,
Mesh Hernia Plug and Patch,,C1781,HCPCS,Facility,Both,,,,1408,1196.8,403.5328,1408,"Health Partners, Inc.",State of Minnesota Advantage Program,1147.52,81.5,,percent of total billed charges,,
Mesh Hernia Plug and Patch,,C1781,HCPCS,Facility,Both,,,,1408,1196.8,403.5328,1408,"Health Partners, Inc.",State Public Programs,704,50,,percent of total billed charges,,
Mesh Hernia Plug and Patch,,C1781,HCPCS,Facility,Both,,,,1408,1196.8,403.5328,1408,Humana Insurance Company,Commercial PPO,1337.6,95,,percent of total billed charges,,
Mesh Hernia Plug and Patch,,C1781,HCPCS,Facility,Outpatient,,,,1408,1196.8,403.5328,1408,Humana Insurance Company,Medicare PPO,689.92,49,,percent of total billed charges,,
Mesh Hernia Plug and Patch,,C1781,HCPCS,Facility,Inpatient,,,,1408,1196.8,403.5328,1408,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Mesh Hernia Plug and Patch,,C1781,HCPCS,Facility,Both,,,,1408,1196.8,403.5328,1408,Medica,Individual & Family,1395.328,99.1,,percent of total billed charges,,
Mesh Hernia Plug and Patch,,C1781,HCPCS,Facility,Outpatient,,,,1408,1196.8,403.5328,1408,Medica,Medica Advantage Solution,701.184,49.8,,percent of total billed charges,,
Mesh Hernia Plug and Patch,,C1781,HCPCS,Facility,Inpatient,,,,1408,1196.8,403.5328,1408,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Mesh Hernia Plug and Patch,,C1781,HCPCS,Facility,Outpatient,,,,1408,1196.8,403.5328,1408,Medica,Medical Assistance,627.968,44.6,,percent of total billed charges,,
Mesh Hernia Plug and Patch,,C1781,HCPCS,Facility,Inpatient,,,,1408,1196.8,403.5328,1408,Medica,Medical Assistance,,,,,Included in per diem rate,
Mesh Hernia Plug and Patch,,C1781,HCPCS,Facility,Outpatient,,,,1408,1196.8,403.5328,1408,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,701.184,49.8,,percent of total billed charges,,
Mesh Hernia Plug and Patch,,C1781,HCPCS,Facility,Inpatient,,,,1408,1196.8,403.5328,1408,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Mesh Hernia Plug and Patch,,C1781,HCPCS,Facility,Both,,,,1408,1196.8,403.5328,1408,"Multiplan, Inc.","Multiplan, Inc.",1323.52,94,,percent of total billed charges,,
Mesh Hernia Plug and Patch,,C1781,HCPCS,Facility,Outpatient,,,,1408,1196.8,403.5328,1408,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1268.608,90.1,,percent of total billed charges,,
Mesh Hernia Plug and Patch,,C1781,HCPCS,Facility,Inpatient,,,,1408,1196.8,403.5328,1408,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Mesh Hernia Plug and Patch,,C1781,HCPCS,Facility,Both,,,,1408,1196.8,403.5328,1408,"Preferred One Administrative Services, INC.",PPO,1388.288,98.6,,percent of total billed charges,,
Mesh Hernia Plug and Patch,,C1781,HCPCS,Facility,Outpatient,,,,1408,1196.8,403.5328,1408,PrimeWest Health,Minnesota Senior Health Options (MSHO),724.416,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Mesh Hernia Plug and Patch,,C1781,HCPCS,Facility,Inpatient,,,,1408,1196.8,403.5328,1408,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mesh Hernia Plug and Patch,,C1781,HCPCS,Facility,Outpatient,,,,1408,1196.8,403.5328,1408,PrimeWest Health,MinnesotaCare,723.1488,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Mesh Hernia Plug and Patch,,C1781,HCPCS,Facility,Inpatient,,,,1408,1196.8,403.5328,1408,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Mesh Hernia Plug and Patch,,C1781,HCPCS,Facility,Both,,,,1408,1196.8,403.5328,1408,Sanford Health Plan,Sanford Health Plan,1295.36,92,,percent of total billed charges,,
Mesh Hernia Plug and Patch,,C1781,HCPCS,Facility,Outpatient,,,,1408,1196.8,403.5328,1408,"UCare Health, Inc.",Individual & Family Plan,793.408,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Mesh Hernia Plug and Patch,,C1781,HCPCS,Facility,Inpatient,,,,1408,1196.8,403.5328,1408,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Mesh Hernia Plug and Patch,,C1781,HCPCS,Facility,Outpatient,,,,1408,1196.8,403.5328,1408,"UCare Health, Inc.",Medical Assistance,710.6176,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mesh Hernia Plug and Patch,,C1781,HCPCS,Facility,Inpatient,,,,1408,1196.8,403.5328,1408,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Mesh Hernia Plug and Patch,,C1781,HCPCS,Facility,Outpatient,,,,1408,1196.8,403.5328,1408,"UCare Health, Inc.",Medicare Advantage,710.6176,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mesh Hernia Plug and Patch,,C1781,HCPCS,Facility,Inpatient,,,,1408,1196.8,403.5328,1408,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mesh Hernia Plug and Patch,,C1781,HCPCS,Facility,Outpatient,,,,1408,1196.8,403.5328,1408,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),710.6176,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mesh Hernia Plug and Patch,,C1781,HCPCS,Facility,Inpatient,,,,1408,1196.8,403.5328,1408,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mesh Hernia Plug and Patch,,C1781,HCPCS,Facility,Both,,,,1408,1196.8,403.5328,1408,UnitedHealthcare,Individual & Family,1323.52,94,,percent of total billed charges,,
Mesh Hernia Plug and Patch,,C1781,HCPCS,Facility,Outpatient,,,,1408,1196.8,403.5328,1408,UnitedHealthcare,Medicare Advantage,689.92,49,,percent of total billed charges,,
Mesh Hernia Plug and Patch,,C1781,HCPCS,Facility,Inpatient,,,,1408,1196.8,403.5328,1408,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Mesh Hernia Plug and Patch,,C1781,HCPCS,Facility,Outpatient,,,,1408,1196.8,403.5328,1408,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,675.84,48,,percent of total billed charges,,100% of DHS outpatient percentage
Mesh Hernia Plug and Patch,,C1781,HCPCS,Facility,Inpatient,,,,1408,1196.8,403.5328,1408,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
MESH Parietene Macroporous 15 cm x 15 cm,,C1781,HCPCS,Facility,Both,,,,334.32,284.172,95.816112,334.32,Aetna,Commercial,307.5744,92,,percent of total billed charges,,
MESH Parietene Macroporous 15 cm x 15 cm,,C1781,HCPCS,Facility,Outpatient,,,,334.32,284.172,95.816112,334.32,Aetna,Medicare Advantage,163.8168,49,,percent of total billed charges,,
MESH Parietene Macroporous 15 cm x 15 cm,,C1781,HCPCS,Facility,Inpatient,,,,334.32,284.172,95.816112,334.32,Aetna,Medicare Advantage,,,,,Included in per diem rate,
MESH Parietene Macroporous 15 cm x 15 cm,,C1781,HCPCS,Facility,Both,,,,334.32,284.172,95.816112,334.32,Aetna,PPO,310.9176,93,,percent of total billed charges,,
MESH Parietene Macroporous 15 cm x 15 cm,,C1781,HCPCS,Facility,Both,,,,334.32,284.172,95.816112,334.32,America's PPO,America's PPO,321.047496,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
MESH Parietene Macroporous 15 cm x 15 cm,,C1781,HCPCS,Facility,Both,,,,334.32,284.172,95.816112,334.32,BlueCross BlueShield Minnesota, Federal Employee Program,328.97088,98.4,,percent of total billed charges,,
MESH Parietene Macroporous 15 cm x 15 cm,,C1781,HCPCS,Facility,Both,,,,334.32,284.172,95.816112,334.32,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,334.32,100,,percent of total billed charges,,
MESH Parietene Macroporous 15 cm x 15 cm,,C1781,HCPCS,Facility,Both,,,,334.32,284.172,95.816112,334.32,BlueCross BlueShield Minnesota,High Value Network Plan,300.888,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
MESH Parietene Macroporous 15 cm x 15 cm,,C1781,HCPCS,Facility,Outpatient,,,,334.32,284.172,95.816112,334.32,BlueCross BlueShield Minnesota,Medicare Advantage,163.8168,49,,percent of total billed charges,,
MESH Parietene Macroporous 15 cm x 15 cm,,C1781,HCPCS,Facility,Inpatient,,,,334.32,284.172,95.816112,334.32,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
MESH Parietene Macroporous 15 cm x 15 cm,,C1781,HCPCS,Facility,Both,,,,334.32,284.172,95.816112,334.32,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,296.107224,88.57,,percent of total billed charges,,
MESH Parietene Macroporous 15 cm x 15 cm,,C1781,HCPCS,Facility,Both,,,,334.32,284.172,95.816112,334.32,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,95.816112,28.66,,percent of total billed charges,,
MESH Parietene Macroporous 15 cm x 15 cm,,C1781,HCPCS,Facility,Outpatient,,,,334.32,284.172,95.816112,334.32,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),163.8168,49,,percent of total billed charges,,
MESH Parietene Macroporous 15 cm x 15 cm,,C1781,HCPCS,Facility,Inpatient,,,,334.32,284.172,95.816112,334.32,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
MESH Parietene Macroporous 15 cm x 15 cm,,C1781,HCPCS,Facility,Both,,,,334.32,284.172,95.816112,334.32,CorVel,Worker's Compensation,334.32,100,,percent of total billed charges,,
MESH Parietene Macroporous 15 cm x 15 cm,,C1781,HCPCS,Facility,Both,,,,334.32,284.172,95.816112,334.32,First Health Group Corporation,First Health Network,324.2904,97,,percent of total billed charges,,
MESH Parietene Macroporous 15 cm x 15 cm,,C1781,HCPCS,Facility,Both,,,,334.32,284.172,95.816112,334.32,"Health Partners, Inc.",Commercial,316.26672,94.6,,percent of total billed charges,,
MESH Parietene Macroporous 15 cm x 15 cm,,C1781,HCPCS,Facility,Outpatient,,,,334.32,284.172,95.816112,334.32,"Health Partners, Inc.",Medicare Advantage,163.8168,49,,percent of total billed charges,,
MESH Parietene Macroporous 15 cm x 15 cm,,C1781,HCPCS,Facility,Inpatient,,,,334.32,284.172,95.816112,334.32,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
MESH Parietene Macroporous 15 cm x 15 cm,,C1781,HCPCS,Facility,Both,,,,334.32,284.172,95.816112,334.32,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),200.592,60,,percent of total billed charges,,
MESH Parietene Macroporous 15 cm x 15 cm,,C1781,HCPCS,Facility,Both,,,,334.32,284.172,95.816112,334.32,"Health Partners, Inc.",State of Minnesota Advantage Program,272.4708,81.5,,percent of total billed charges,,
MESH Parietene Macroporous 15 cm x 15 cm,,C1781,HCPCS,Facility,Both,,,,334.32,284.172,95.816112,334.32,"Health Partners, Inc.",State Public Programs,167.16,50,,percent of total billed charges,,
MESH Parietene Macroporous 15 cm x 15 cm,,C1781,HCPCS,Facility,Both,,,,334.32,284.172,95.816112,334.32,Humana Insurance Company,Commercial PPO,317.604,95,,percent of total billed charges,,
MESH Parietene Macroporous 15 cm x 15 cm,,C1781,HCPCS,Facility,Outpatient,,,,334.32,284.172,95.816112,334.32,Humana Insurance Company,Medicare PPO,163.8168,49,,percent of total billed charges,,
MESH Parietene Macroporous 15 cm x 15 cm,,C1781,HCPCS,Facility,Inpatient,,,,334.32,284.172,95.816112,334.32,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
MESH Parietene Macroporous 15 cm x 15 cm,,C1781,HCPCS,Facility,Both,,,,334.32,284.172,95.816112,334.32,Medica,Individual & Family,331.31112,99.1,,percent of total billed charges,,
MESH Parietene Macroporous 15 cm x 15 cm,,C1781,HCPCS,Facility,Outpatient,,,,334.32,284.172,95.816112,334.32,Medica,Medica Advantage Solution,166.49136,49.8,,percent of total billed charges,,
MESH Parietene Macroporous 15 cm x 15 cm,,C1781,HCPCS,Facility,Inpatient,,,,334.32,284.172,95.816112,334.32,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
MESH Parietene Macroporous 15 cm x 15 cm,,C1781,HCPCS,Facility,Outpatient,,,,334.32,284.172,95.816112,334.32,Medica,Medical Assistance,149.10672,44.6,,percent of total billed charges,,
MESH Parietene Macroporous 15 cm x 15 cm,,C1781,HCPCS,Facility,Inpatient,,,,334.32,284.172,95.816112,334.32,Medica,Medical Assistance,,,,,Included in per diem rate,
MESH Parietene Macroporous 15 cm x 15 cm,,C1781,HCPCS,Facility,Outpatient,,,,334.32,284.172,95.816112,334.32,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,166.49136,49.8,,percent of total billed charges,,
MESH Parietene Macroporous 15 cm x 15 cm,,C1781,HCPCS,Facility,Inpatient,,,,334.32,284.172,95.816112,334.32,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
MESH Parietene Macroporous 15 cm x 15 cm,,C1781,HCPCS,Facility,Both,,,,334.32,284.172,95.816112,334.32,"Multiplan, Inc.","Multiplan, Inc.",314.2608,94,,percent of total billed charges,,
MESH Parietene Macroporous 15 cm x 15 cm,,C1781,HCPCS,Facility,Outpatient,,,,334.32,284.172,95.816112,334.32,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,301.22232,90.1,,percent of total billed charges,,
MESH Parietene Macroporous 15 cm x 15 cm,,C1781,HCPCS,Facility,Inpatient,,,,334.32,284.172,95.816112,334.32,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
MESH Parietene Macroporous 15 cm x 15 cm,,C1781,HCPCS,Facility,Both,,,,334.32,284.172,95.816112,334.32,"Preferred One Administrative Services, INC.",PPO,329.63952,98.6,,percent of total billed charges,,
MESH Parietene Macroporous 15 cm x 15 cm,,C1781,HCPCS,Facility,Outpatient,,,,334.32,284.172,95.816112,334.32,PrimeWest Health,Minnesota Senior Health Options (MSHO),172.00764,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
MESH Parietene Macroporous 15 cm x 15 cm,,C1781,HCPCS,Facility,Inpatient,,,,334.32,284.172,95.816112,334.32,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
MESH Parietene Macroporous 15 cm x 15 cm,,C1781,HCPCS,Facility,Outpatient,,,,334.32,284.172,95.816112,334.32,PrimeWest Health,MinnesotaCare,171.706752,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
MESH Parietene Macroporous 15 cm x 15 cm,,C1781,HCPCS,Facility,Inpatient,,,,334.32,284.172,95.816112,334.32,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
MESH Parietene Macroporous 15 cm x 15 cm,,C1781,HCPCS,Facility,Both,,,,334.32,284.172,95.816112,334.32,Sanford Health Plan,Sanford Health Plan,307.5744,92,,percent of total billed charges,,
MESH Parietene Macroporous 15 cm x 15 cm,,C1781,HCPCS,Facility,Outpatient,,,,334.32,284.172,95.816112,334.32,"UCare Health, Inc.",Individual & Family Plan,188.38932,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
MESH Parietene Macroporous 15 cm x 15 cm,,C1781,HCPCS,Facility,Inpatient,,,,334.32,284.172,95.816112,334.32,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
MESH Parietene Macroporous 15 cm x 15 cm,,C1781,HCPCS,Facility,Outpatient,,,,334.32,284.172,95.816112,334.32,"UCare Health, Inc.",Medical Assistance,168.731304,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MESH Parietene Macroporous 15 cm x 15 cm,,C1781,HCPCS,Facility,Inpatient,,,,334.32,284.172,95.816112,334.32,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
MESH Parietene Macroporous 15 cm x 15 cm,,C1781,HCPCS,Facility,Outpatient,,,,334.32,284.172,95.816112,334.32,"UCare Health, Inc.",Medicare Advantage,168.731304,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MESH Parietene Macroporous 15 cm x 15 cm,,C1781,HCPCS,Facility,Inpatient,,,,334.32,284.172,95.816112,334.32,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
MESH Parietene Macroporous 15 cm x 15 cm,,C1781,HCPCS,Facility,Outpatient,,,,334.32,284.172,95.816112,334.32,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),168.731304,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MESH Parietene Macroporous 15 cm x 15 cm,,C1781,HCPCS,Facility,Inpatient,,,,334.32,284.172,95.816112,334.32,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
MESH Parietene Macroporous 15 cm x 15 cm,,C1781,HCPCS,Facility,Both,,,,334.32,284.172,95.816112,334.32,UnitedHealthcare,Individual & Family,314.2608,94,,percent of total billed charges,,
MESH Parietene Macroporous 15 cm x 15 cm,,C1781,HCPCS,Facility,Outpatient,,,,334.32,284.172,95.816112,334.32,UnitedHealthcare,Medicare Advantage,163.8168,49,,percent of total billed charges,,
MESH Parietene Macroporous 15 cm x 15 cm,,C1781,HCPCS,Facility,Inpatient,,,,334.32,284.172,95.816112,334.32,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
MESH Parietene Macroporous 15 cm x 15 cm,,C1781,HCPCS,Facility,Outpatient,,,,334.32,284.172,95.816112,334.32,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,160.4736,48,,percent of total billed charges,,100% of DHS outpatient percentage
MESH Parietene Macroporous 15 cm x 15 cm,,C1781,HCPCS,Facility,Inpatient,,,,334.32,284.172,95.816112,334.32,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
MESH PROLENE 3X6 MESH,,C1781,HCPCS,Facility,Both,,,,346.62,294.627,99.341292,346.62,Aetna,Commercial,318.8904,92,,percent of total billed charges,,
MESH PROLENE 3X6 MESH,,C1781,HCPCS,Facility,Outpatient,,,,346.62,294.627,99.341292,346.62,Aetna,Medicare Advantage,169.8438,49,,percent of total billed charges,,
MESH PROLENE 3X6 MESH,,C1781,HCPCS,Facility,Inpatient,,,,346.62,294.627,99.341292,346.62,Aetna,Medicare Advantage,,,,,Included in per diem rate,
MESH PROLENE 3X6 MESH,,C1781,HCPCS,Facility,Both,,,,346.62,294.627,99.341292,346.62,Aetna,PPO,322.3566,93,,percent of total billed charges,,
MESH PROLENE 3X6 MESH,,C1781,HCPCS,Facility,Both,,,,346.62,294.627,99.341292,346.62,America's PPO,America's PPO,332.859186,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
MESH PROLENE 3X6 MESH,,C1781,HCPCS,Facility,Both,,,,346.62,294.627,99.341292,346.62,BlueCross BlueShield Minnesota, Federal Employee Program,341.07408,98.4,,percent of total billed charges,,
MESH PROLENE 3X6 MESH,,C1781,HCPCS,Facility,Both,,,,346.62,294.627,99.341292,346.62,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,346.62,100,,percent of total billed charges,,
MESH PROLENE 3X6 MESH,,C1781,HCPCS,Facility,Both,,,,346.62,294.627,99.341292,346.62,BlueCross BlueShield Minnesota,High Value Network Plan,311.958,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
MESH PROLENE 3X6 MESH,,C1781,HCPCS,Facility,Outpatient,,,,346.62,294.627,99.341292,346.62,BlueCross BlueShield Minnesota,Medicare Advantage,169.8438,49,,percent of total billed charges,,
MESH PROLENE 3X6 MESH,,C1781,HCPCS,Facility,Inpatient,,,,346.62,294.627,99.341292,346.62,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
MESH PROLENE 3X6 MESH,,C1781,HCPCS,Facility,Both,,,,346.62,294.627,99.341292,346.62,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,307.001334,88.57,,percent of total billed charges,,
MESH PROLENE 3X6 MESH,,C1781,HCPCS,Facility,Both,,,,346.62,294.627,99.341292,346.62,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,99.341292,28.66,,percent of total billed charges,,
MESH PROLENE 3X6 MESH,,C1781,HCPCS,Facility,Outpatient,,,,346.62,294.627,99.341292,346.62,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),169.8438,49,,percent of total billed charges,,
MESH PROLENE 3X6 MESH,,C1781,HCPCS,Facility,Inpatient,,,,346.62,294.627,99.341292,346.62,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
MESH PROLENE 3X6 MESH,,C1781,HCPCS,Facility,Both,,,,346.62,294.627,99.341292,346.62,CorVel,Worker's Compensation,346.62,100,,percent of total billed charges,,
MESH PROLENE 3X6 MESH,,C1781,HCPCS,Facility,Both,,,,346.62,294.627,99.341292,346.62,First Health Group Corporation,First Health Network,336.2214,97,,percent of total billed charges,,
MESH PROLENE 3X6 MESH,,C1781,HCPCS,Facility,Both,,,,346.62,294.627,99.341292,346.62,"Health Partners, Inc.",Commercial,327.90252,94.6,,percent of total billed charges,,
MESH PROLENE 3X6 MESH,,C1781,HCPCS,Facility,Outpatient,,,,346.62,294.627,99.341292,346.62,"Health Partners, Inc.",Medicare Advantage,169.8438,49,,percent of total billed charges,,
MESH PROLENE 3X6 MESH,,C1781,HCPCS,Facility,Inpatient,,,,346.62,294.627,99.341292,346.62,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
MESH PROLENE 3X6 MESH,,C1781,HCPCS,Facility,Both,,,,346.62,294.627,99.341292,346.62,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),207.972,60,,percent of total billed charges,,
MESH PROLENE 3X6 MESH,,C1781,HCPCS,Facility,Both,,,,346.62,294.627,99.341292,346.62,"Health Partners, Inc.",State of Minnesota Advantage Program,282.4953,81.5,,percent of total billed charges,,
MESH PROLENE 3X6 MESH,,C1781,HCPCS,Facility,Both,,,,346.62,294.627,99.341292,346.62,"Health Partners, Inc.",State Public Programs,173.31,50,,percent of total billed charges,,
MESH PROLENE 3X6 MESH,,C1781,HCPCS,Facility,Both,,,,346.62,294.627,99.341292,346.62,Humana Insurance Company,Commercial PPO,329.289,95,,percent of total billed charges,,
MESH PROLENE 3X6 MESH,,C1781,HCPCS,Facility,Outpatient,,,,346.62,294.627,99.341292,346.62,Humana Insurance Company,Medicare PPO,169.8438,49,,percent of total billed charges,,
MESH PROLENE 3X6 MESH,,C1781,HCPCS,Facility,Inpatient,,,,346.62,294.627,99.341292,346.62,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
MESH PROLENE 3X6 MESH,,C1781,HCPCS,Facility,Both,,,,346.62,294.627,99.341292,346.62,Medica,Individual & Family,343.50042,99.1,,percent of total billed charges,,
MESH PROLENE 3X6 MESH,,C1781,HCPCS,Facility,Outpatient,,,,346.62,294.627,99.341292,346.62,Medica,Medica Advantage Solution,172.61676,49.8,,percent of total billed charges,,
MESH PROLENE 3X6 MESH,,C1781,HCPCS,Facility,Inpatient,,,,346.62,294.627,99.341292,346.62,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
MESH PROLENE 3X6 MESH,,C1781,HCPCS,Facility,Outpatient,,,,346.62,294.627,99.341292,346.62,Medica,Medical Assistance,154.59252,44.6,,percent of total billed charges,,
MESH PROLENE 3X6 MESH,,C1781,HCPCS,Facility,Inpatient,,,,346.62,294.627,99.341292,346.62,Medica,Medical Assistance,,,,,Included in per diem rate,
MESH PROLENE 3X6 MESH,,C1781,HCPCS,Facility,Outpatient,,,,346.62,294.627,99.341292,346.62,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,172.61676,49.8,,percent of total billed charges,,
MESH PROLENE 3X6 MESH,,C1781,HCPCS,Facility,Inpatient,,,,346.62,294.627,99.341292,346.62,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
MESH PROLENE 3X6 MESH,,C1781,HCPCS,Facility,Both,,,,346.62,294.627,99.341292,346.62,"Multiplan, Inc.","Multiplan, Inc.",325.8228,94,,percent of total billed charges,,
MESH PROLENE 3X6 MESH,,C1781,HCPCS,Facility,Outpatient,,,,346.62,294.627,99.341292,346.62,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,312.30462,90.1,,percent of total billed charges,,
MESH PROLENE 3X6 MESH,,C1781,HCPCS,Facility,Inpatient,,,,346.62,294.627,99.341292,346.62,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
MESH PROLENE 3X6 MESH,,C1781,HCPCS,Facility,Both,,,,346.62,294.627,99.341292,346.62,"Preferred One Administrative Services, INC.",PPO,341.76732,98.6,,percent of total billed charges,,
MESH PROLENE 3X6 MESH,,C1781,HCPCS,Facility,Outpatient,,,,346.62,294.627,99.341292,346.62,PrimeWest Health,Minnesota Senior Health Options (MSHO),178.33599,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
MESH PROLENE 3X6 MESH,,C1781,HCPCS,Facility,Inpatient,,,,346.62,294.627,99.341292,346.62,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
MESH PROLENE 3X6 MESH,,C1781,HCPCS,Facility,Outpatient,,,,346.62,294.627,99.341292,346.62,PrimeWest Health,MinnesotaCare,178.024032,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
MESH PROLENE 3X6 MESH,,C1781,HCPCS,Facility,Inpatient,,,,346.62,294.627,99.341292,346.62,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
MESH PROLENE 3X6 MESH,,C1781,HCPCS,Facility,Both,,,,346.62,294.627,99.341292,346.62,Sanford Health Plan,Sanford Health Plan,318.8904,92,,percent of total billed charges,,
MESH PROLENE 3X6 MESH,,C1781,HCPCS,Facility,Outpatient,,,,346.62,294.627,99.341292,346.62,"UCare Health, Inc.",Individual & Family Plan,195.32037,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
MESH PROLENE 3X6 MESH,,C1781,HCPCS,Facility,Inpatient,,,,346.62,294.627,99.341292,346.62,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
MESH PROLENE 3X6 MESH,,C1781,HCPCS,Facility,Outpatient,,,,346.62,294.627,99.341292,346.62,"UCare Health, Inc.",Medical Assistance,174.939114,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MESH PROLENE 3X6 MESH,,C1781,HCPCS,Facility,Inpatient,,,,346.62,294.627,99.341292,346.62,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
MESH PROLENE 3X6 MESH,,C1781,HCPCS,Facility,Outpatient,,,,346.62,294.627,99.341292,346.62,"UCare Health, Inc.",Medicare Advantage,174.939114,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MESH PROLENE 3X6 MESH,,C1781,HCPCS,Facility,Inpatient,,,,346.62,294.627,99.341292,346.62,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
MESH PROLENE 3X6 MESH,,C1781,HCPCS,Facility,Outpatient,,,,346.62,294.627,99.341292,346.62,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),174.939114,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MESH PROLENE 3X6 MESH,,C1781,HCPCS,Facility,Inpatient,,,,346.62,294.627,99.341292,346.62,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
MESH PROLENE 3X6 MESH,,C1781,HCPCS,Facility,Both,,,,346.62,294.627,99.341292,346.62,UnitedHealthcare,Individual & Family,325.8228,94,,percent of total billed charges,,
MESH PROLENE 3X6 MESH,,C1781,HCPCS,Facility,Outpatient,,,,346.62,294.627,99.341292,346.62,UnitedHealthcare,Medicare Advantage,169.8438,49,,percent of total billed charges,,
MESH PROLENE 3X6 MESH,,C1781,HCPCS,Facility,Inpatient,,,,346.62,294.627,99.341292,346.62,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
MESH PROLENE 3X6 MESH,,C1781,HCPCS,Facility,Outpatient,,,,346.62,294.627,99.341292,346.62,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,166.3776,48,,percent of total billed charges,,100% of DHS outpatient percentage
MESH PROLENE 3X6 MESH,,C1781,HCPCS,Facility,Inpatient,,,,346.62,294.627,99.341292,346.62,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
MESH PROLENE 6X6 HERNIA,,C1781,HCPCS,Facility,Both,,,,400.23,340.1955,114.705918,400.23,Aetna,Commercial,368.2116,92,,percent of total billed charges,,
MESH PROLENE 6X6 HERNIA,,C1781,HCPCS,Facility,Outpatient,,,,400.23,340.1955,114.705918,400.23,Aetna,Medicare Advantage,196.1127,49,,percent of total billed charges,,
MESH PROLENE 6X6 HERNIA,,C1781,HCPCS,Facility,Inpatient,,,,400.23,340.1955,114.705918,400.23,Aetna,Medicare Advantage,,,,,Included in per diem rate,
MESH PROLENE 6X6 HERNIA,,C1781,HCPCS,Facility,Both,,,,400.23,340.1955,114.705918,400.23,Aetna,PPO,372.2139,93,,percent of total billed charges,,
MESH PROLENE 6X6 HERNIA,,C1781,HCPCS,Facility,Both,,,,400.23,340.1955,114.705918,400.23,America's PPO,America's PPO,384.340869,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
MESH PROLENE 6X6 HERNIA,,C1781,HCPCS,Facility,Both,,,,400.23,340.1955,114.705918,400.23,BlueCross BlueShield Minnesota, Federal Employee Program,393.82632,98.4,,percent of total billed charges,,
MESH PROLENE 6X6 HERNIA,,C1781,HCPCS,Facility,Both,,,,400.23,340.1955,114.705918,400.23,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,400.23,100,,percent of total billed charges,,
MESH PROLENE 6X6 HERNIA,,C1781,HCPCS,Facility,Both,,,,400.23,340.1955,114.705918,400.23,BlueCross BlueShield Minnesota,High Value Network Plan,360.207,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
MESH PROLENE 6X6 HERNIA,,C1781,HCPCS,Facility,Outpatient,,,,400.23,340.1955,114.705918,400.23,BlueCross BlueShield Minnesota,Medicare Advantage,196.1127,49,,percent of total billed charges,,
MESH PROLENE 6X6 HERNIA,,C1781,HCPCS,Facility,Inpatient,,,,400.23,340.1955,114.705918,400.23,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
MESH PROLENE 6X6 HERNIA,,C1781,HCPCS,Facility,Both,,,,400.23,340.1955,114.705918,400.23,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,354.483711,88.57,,percent of total billed charges,,
MESH PROLENE 6X6 HERNIA,,C1781,HCPCS,Facility,Both,,,,400.23,340.1955,114.705918,400.23,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,114.705918,28.66,,percent of total billed charges,,
MESH PROLENE 6X6 HERNIA,,C1781,HCPCS,Facility,Outpatient,,,,400.23,340.1955,114.705918,400.23,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),196.1127,49,,percent of total billed charges,,
MESH PROLENE 6X6 HERNIA,,C1781,HCPCS,Facility,Inpatient,,,,400.23,340.1955,114.705918,400.23,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
MESH PROLENE 6X6 HERNIA,,C1781,HCPCS,Facility,Both,,,,400.23,340.1955,114.705918,400.23,CorVel,Worker's Compensation,400.23,100,,percent of total billed charges,,
MESH PROLENE 6X6 HERNIA,,C1781,HCPCS,Facility,Both,,,,400.23,340.1955,114.705918,400.23,First Health Group Corporation,First Health Network,388.2231,97,,percent of total billed charges,,
MESH PROLENE 6X6 HERNIA,,C1781,HCPCS,Facility,Both,,,,400.23,340.1955,114.705918,400.23,"Health Partners, Inc.",Commercial,378.61758,94.6,,percent of total billed charges,,
MESH PROLENE 6X6 HERNIA,,C1781,HCPCS,Facility,Outpatient,,,,400.23,340.1955,114.705918,400.23,"Health Partners, Inc.",Medicare Advantage,196.1127,49,,percent of total billed charges,,
MESH PROLENE 6X6 HERNIA,,C1781,HCPCS,Facility,Inpatient,,,,400.23,340.1955,114.705918,400.23,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
MESH PROLENE 6X6 HERNIA,,C1781,HCPCS,Facility,Both,,,,400.23,340.1955,114.705918,400.23,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),240.138,60,,percent of total billed charges,,
MESH PROLENE 6X6 HERNIA,,C1781,HCPCS,Facility,Both,,,,400.23,340.1955,114.705918,400.23,"Health Partners, Inc.",State of Minnesota Advantage Program,326.18745,81.5,,percent of total billed charges,,
MESH PROLENE 6X6 HERNIA,,C1781,HCPCS,Facility,Both,,,,400.23,340.1955,114.705918,400.23,"Health Partners, Inc.",State Public Programs,200.115,50,,percent of total billed charges,,
MESH PROLENE 6X6 HERNIA,,C1781,HCPCS,Facility,Both,,,,400.23,340.1955,114.705918,400.23,Humana Insurance Company,Commercial PPO,380.2185,95,,percent of total billed charges,,
MESH PROLENE 6X6 HERNIA,,C1781,HCPCS,Facility,Outpatient,,,,400.23,340.1955,114.705918,400.23,Humana Insurance Company,Medicare PPO,196.1127,49,,percent of total billed charges,,
MESH PROLENE 6X6 HERNIA,,C1781,HCPCS,Facility,Inpatient,,,,400.23,340.1955,114.705918,400.23,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
MESH PROLENE 6X6 HERNIA,,C1781,HCPCS,Facility,Both,,,,400.23,340.1955,114.705918,400.23,Medica,Individual & Family,396.62793,99.1,,percent of total billed charges,,
MESH PROLENE 6X6 HERNIA,,C1781,HCPCS,Facility,Outpatient,,,,400.23,340.1955,114.705918,400.23,Medica,Medica Advantage Solution,199.31454,49.8,,percent of total billed charges,,
MESH PROLENE 6X6 HERNIA,,C1781,HCPCS,Facility,Inpatient,,,,400.23,340.1955,114.705918,400.23,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
MESH PROLENE 6X6 HERNIA,,C1781,HCPCS,Facility,Outpatient,,,,400.23,340.1955,114.705918,400.23,Medica,Medical Assistance,178.50258,44.6,,percent of total billed charges,,
MESH PROLENE 6X6 HERNIA,,C1781,HCPCS,Facility,Inpatient,,,,400.23,340.1955,114.705918,400.23,Medica,Medical Assistance,,,,,Included in per diem rate,
MESH PROLENE 6X6 HERNIA,,C1781,HCPCS,Facility,Outpatient,,,,400.23,340.1955,114.705918,400.23,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,199.31454,49.8,,percent of total billed charges,,
MESH PROLENE 6X6 HERNIA,,C1781,HCPCS,Facility,Inpatient,,,,400.23,340.1955,114.705918,400.23,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
MESH PROLENE 6X6 HERNIA,,C1781,HCPCS,Facility,Both,,,,400.23,340.1955,114.705918,400.23,"Multiplan, Inc.","Multiplan, Inc.",376.2162,94,,percent of total billed charges,,
MESH PROLENE 6X6 HERNIA,,C1781,HCPCS,Facility,Outpatient,,,,400.23,340.1955,114.705918,400.23,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,360.60723,90.1,,percent of total billed charges,,
MESH PROLENE 6X6 HERNIA,,C1781,HCPCS,Facility,Inpatient,,,,400.23,340.1955,114.705918,400.23,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
MESH PROLENE 6X6 HERNIA,,C1781,HCPCS,Facility,Both,,,,400.23,340.1955,114.705918,400.23,"Preferred One Administrative Services, INC.",PPO,394.62678,98.6,,percent of total billed charges,,
MESH PROLENE 6X6 HERNIA,,C1781,HCPCS,Facility,Outpatient,,,,400.23,340.1955,114.705918,400.23,PrimeWest Health,Minnesota Senior Health Options (MSHO),205.918335,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
MESH PROLENE 6X6 HERNIA,,C1781,HCPCS,Facility,Inpatient,,,,400.23,340.1955,114.705918,400.23,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
MESH PROLENE 6X6 HERNIA,,C1781,HCPCS,Facility,Outpatient,,,,400.23,340.1955,114.705918,400.23,PrimeWest Health,MinnesotaCare,205.558128,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
MESH PROLENE 6X6 HERNIA,,C1781,HCPCS,Facility,Inpatient,,,,400.23,340.1955,114.705918,400.23,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
MESH PROLENE 6X6 HERNIA,,C1781,HCPCS,Facility,Both,,,,400.23,340.1955,114.705918,400.23,Sanford Health Plan,Sanford Health Plan,368.2116,92,,percent of total billed charges,,
MESH PROLENE 6X6 HERNIA,,C1781,HCPCS,Facility,Outpatient,,,,400.23,340.1955,114.705918,400.23,"UCare Health, Inc.",Individual & Family Plan,225.529605,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
MESH PROLENE 6X6 HERNIA,,C1781,HCPCS,Facility,Inpatient,,,,400.23,340.1955,114.705918,400.23,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
MESH PROLENE 6X6 HERNIA,,C1781,HCPCS,Facility,Outpatient,,,,400.23,340.1955,114.705918,400.23,"UCare Health, Inc.",Medical Assistance,201.996081,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MESH PROLENE 6X6 HERNIA,,C1781,HCPCS,Facility,Inpatient,,,,400.23,340.1955,114.705918,400.23,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
MESH PROLENE 6X6 HERNIA,,C1781,HCPCS,Facility,Outpatient,,,,400.23,340.1955,114.705918,400.23,"UCare Health, Inc.",Medicare Advantage,201.996081,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MESH PROLENE 6X6 HERNIA,,C1781,HCPCS,Facility,Inpatient,,,,400.23,340.1955,114.705918,400.23,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
MESH PROLENE 6X6 HERNIA,,C1781,HCPCS,Facility,Outpatient,,,,400.23,340.1955,114.705918,400.23,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),201.996081,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MESH PROLENE 6X6 HERNIA,,C1781,HCPCS,Facility,Inpatient,,,,400.23,340.1955,114.705918,400.23,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
MESH PROLENE 6X6 HERNIA,,C1781,HCPCS,Facility,Both,,,,400.23,340.1955,114.705918,400.23,UnitedHealthcare,Individual & Family,376.2162,94,,percent of total billed charges,,
MESH PROLENE 6X6 HERNIA,,C1781,HCPCS,Facility,Outpatient,,,,400.23,340.1955,114.705918,400.23,UnitedHealthcare,Medicare Advantage,196.1127,49,,percent of total billed charges,,
MESH PROLENE 6X6 HERNIA,,C1781,HCPCS,Facility,Inpatient,,,,400.23,340.1955,114.705918,400.23,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
MESH PROLENE 6X6 HERNIA,,C1781,HCPCS,Facility,Outpatient,,,,400.23,340.1955,114.705918,400.23,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,192.1104,48,,percent of total billed charges,,100% of DHS outpatient percentage
MESH PROLENE 6X6 HERNIA,,C1781,HCPCS,Facility,Inpatient,,,,400.23,340.1955,114.705918,400.23,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
MESH PROLITE ATRIUM 6 X 6,,C1781,HCPCS,Facility,Both,,,,148,125.8,42.4168,148,Aetna,Commercial,136.16,92,,percent of total billed charges,,
MESH PROLITE ATRIUM 6 X 6,,C1781,HCPCS,Facility,Outpatient,,,,148,125.8,42.4168,148,Aetna,Medicare Advantage,72.52,49,,percent of total billed charges,,
MESH PROLITE ATRIUM 6 X 6,,C1781,HCPCS,Facility,Inpatient,,,,148,125.8,42.4168,148,Aetna,Medicare Advantage,,,,,Included in per diem rate,
MESH PROLITE ATRIUM 6 X 6,,C1781,HCPCS,Facility,Both,,,,148,125.8,42.4168,148,Aetna,PPO,137.64,93,,percent of total billed charges,,
MESH PROLITE ATRIUM 6 X 6,,C1781,HCPCS,Facility,Both,,,,148,125.8,42.4168,148,America's PPO,America's PPO,142.1244,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
MESH PROLITE ATRIUM 6 X 6,,C1781,HCPCS,Facility,Both,,,,148,125.8,42.4168,148,BlueCross BlueShield Minnesota, Federal Employee Program,145.632,98.4,,percent of total billed charges,,
MESH PROLITE ATRIUM 6 X 6,,C1781,HCPCS,Facility,Both,,,,148,125.8,42.4168,148,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,148,100,,percent of total billed charges,,
MESH PROLITE ATRIUM 6 X 6,,C1781,HCPCS,Facility,Both,,,,148,125.8,42.4168,148,BlueCross BlueShield Minnesota,High Value Network Plan,133.2,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
MESH PROLITE ATRIUM 6 X 6,,C1781,HCPCS,Facility,Outpatient,,,,148,125.8,42.4168,148,BlueCross BlueShield Minnesota,Medicare Advantage,72.52,49,,percent of total billed charges,,
MESH PROLITE ATRIUM 6 X 6,,C1781,HCPCS,Facility,Inpatient,,,,148,125.8,42.4168,148,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
MESH PROLITE ATRIUM 6 X 6,,C1781,HCPCS,Facility,Both,,,,148,125.8,42.4168,148,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,131.0836,88.57,,percent of total billed charges,,
MESH PROLITE ATRIUM 6 X 6,,C1781,HCPCS,Facility,Both,,,,148,125.8,42.4168,148,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,42.4168,28.66,,percent of total billed charges,,
MESH PROLITE ATRIUM 6 X 6,,C1781,HCPCS,Facility,Outpatient,,,,148,125.8,42.4168,148,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),72.52,49,,percent of total billed charges,,
MESH PROLITE ATRIUM 6 X 6,,C1781,HCPCS,Facility,Inpatient,,,,148,125.8,42.4168,148,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
MESH PROLITE ATRIUM 6 X 6,,C1781,HCPCS,Facility,Both,,,,148,125.8,42.4168,148,CorVel,Worker's Compensation,148,100,,percent of total billed charges,,
MESH PROLITE ATRIUM 6 X 6,,C1781,HCPCS,Facility,Both,,,,148,125.8,42.4168,148,First Health Group Corporation,First Health Network,143.56,97,,percent of total billed charges,,
MESH PROLITE ATRIUM 6 X 6,,C1781,HCPCS,Facility,Both,,,,148,125.8,42.4168,148,"Health Partners, Inc.",Commercial,140.008,94.6,,percent of total billed charges,,
MESH PROLITE ATRIUM 6 X 6,,C1781,HCPCS,Facility,Outpatient,,,,148,125.8,42.4168,148,"Health Partners, Inc.",Medicare Advantage,72.52,49,,percent of total billed charges,,
MESH PROLITE ATRIUM 6 X 6,,C1781,HCPCS,Facility,Inpatient,,,,148,125.8,42.4168,148,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
MESH PROLITE ATRIUM 6 X 6,,C1781,HCPCS,Facility,Both,,,,148,125.8,42.4168,148,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),88.8,60,,percent of total billed charges,,
MESH PROLITE ATRIUM 6 X 6,,C1781,HCPCS,Facility,Both,,,,148,125.8,42.4168,148,"Health Partners, Inc.",State of Minnesota Advantage Program,120.62,81.5,,percent of total billed charges,,
MESH PROLITE ATRIUM 6 X 6,,C1781,HCPCS,Facility,Both,,,,148,125.8,42.4168,148,"Health Partners, Inc.",State Public Programs,74,50,,percent of total billed charges,,
MESH PROLITE ATRIUM 6 X 6,,C1781,HCPCS,Facility,Both,,,,148,125.8,42.4168,148,Humana Insurance Company,Commercial PPO,140.6,95,,percent of total billed charges,,
MESH PROLITE ATRIUM 6 X 6,,C1781,HCPCS,Facility,Outpatient,,,,148,125.8,42.4168,148,Humana Insurance Company,Medicare PPO,72.52,49,,percent of total billed charges,,
MESH PROLITE ATRIUM 6 X 6,,C1781,HCPCS,Facility,Inpatient,,,,148,125.8,42.4168,148,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
MESH PROLITE ATRIUM 6 X 6,,C1781,HCPCS,Facility,Both,,,,148,125.8,42.4168,148,Medica,Individual & Family,146.668,99.1,,percent of total billed charges,,
MESH PROLITE ATRIUM 6 X 6,,C1781,HCPCS,Facility,Outpatient,,,,148,125.8,42.4168,148,Medica,Medica Advantage Solution,73.704,49.8,,percent of total billed charges,,
MESH PROLITE ATRIUM 6 X 6,,C1781,HCPCS,Facility,Inpatient,,,,148,125.8,42.4168,148,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
MESH PROLITE ATRIUM 6 X 6,,C1781,HCPCS,Facility,Outpatient,,,,148,125.8,42.4168,148,Medica,Medical Assistance,66.008,44.6,,percent of total billed charges,,
MESH PROLITE ATRIUM 6 X 6,,C1781,HCPCS,Facility,Inpatient,,,,148,125.8,42.4168,148,Medica,Medical Assistance,,,,,Included in per diem rate,
MESH PROLITE ATRIUM 6 X 6,,C1781,HCPCS,Facility,Outpatient,,,,148,125.8,42.4168,148,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,73.704,49.8,,percent of total billed charges,,
MESH PROLITE ATRIUM 6 X 6,,C1781,HCPCS,Facility,Inpatient,,,,148,125.8,42.4168,148,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
MESH PROLITE ATRIUM 6 X 6,,C1781,HCPCS,Facility,Both,,,,148,125.8,42.4168,148,"Multiplan, Inc.","Multiplan, Inc.",139.12,94,,percent of total billed charges,,
MESH PROLITE ATRIUM 6 X 6,,C1781,HCPCS,Facility,Outpatient,,,,148,125.8,42.4168,148,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,133.348,90.1,,percent of total billed charges,,
MESH PROLITE ATRIUM 6 X 6,,C1781,HCPCS,Facility,Inpatient,,,,148,125.8,42.4168,148,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
MESH PROLITE ATRIUM 6 X 6,,C1781,HCPCS,Facility,Both,,,,148,125.8,42.4168,148,"Preferred One Administrative Services, INC.",PPO,145.928,98.6,,percent of total billed charges,,
MESH PROLITE ATRIUM 6 X 6,,C1781,HCPCS,Facility,Outpatient,,,,148,125.8,42.4168,148,PrimeWest Health,Minnesota Senior Health Options (MSHO),76.146,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
MESH PROLITE ATRIUM 6 X 6,,C1781,HCPCS,Facility,Inpatient,,,,148,125.8,42.4168,148,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
MESH PROLITE ATRIUM 6 X 6,,C1781,HCPCS,Facility,Outpatient,,,,148,125.8,42.4168,148,PrimeWest Health,MinnesotaCare,76.0128,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
MESH PROLITE ATRIUM 6 X 6,,C1781,HCPCS,Facility,Inpatient,,,,148,125.8,42.4168,148,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
MESH PROLITE ATRIUM 6 X 6,,C1781,HCPCS,Facility,Both,,,,148,125.8,42.4168,148,Sanford Health Plan,Sanford Health Plan,136.16,92,,percent of total billed charges,,
MESH PROLITE ATRIUM 6 X 6,,C1781,HCPCS,Facility,Outpatient,,,,148,125.8,42.4168,148,"UCare Health, Inc.",Individual & Family Plan,83.398,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
MESH PROLITE ATRIUM 6 X 6,,C1781,HCPCS,Facility,Inpatient,,,,148,125.8,42.4168,148,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
MESH PROLITE ATRIUM 6 X 6,,C1781,HCPCS,Facility,Outpatient,,,,148,125.8,42.4168,148,"UCare Health, Inc.",Medical Assistance,74.6956,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MESH PROLITE ATRIUM 6 X 6,,C1781,HCPCS,Facility,Inpatient,,,,148,125.8,42.4168,148,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
MESH PROLITE ATRIUM 6 X 6,,C1781,HCPCS,Facility,Outpatient,,,,148,125.8,42.4168,148,"UCare Health, Inc.",Medicare Advantage,74.6956,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MESH PROLITE ATRIUM 6 X 6,,C1781,HCPCS,Facility,Inpatient,,,,148,125.8,42.4168,148,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
MESH PROLITE ATRIUM 6 X 6,,C1781,HCPCS,Facility,Outpatient,,,,148,125.8,42.4168,148,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),74.6956,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MESH PROLITE ATRIUM 6 X 6,,C1781,HCPCS,Facility,Inpatient,,,,148,125.8,42.4168,148,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
MESH PROLITE ATRIUM 6 X 6,,C1781,HCPCS,Facility,Both,,,,148,125.8,42.4168,148,UnitedHealthcare,Individual & Family,139.12,94,,percent of total billed charges,,
MESH PROLITE ATRIUM 6 X 6,,C1781,HCPCS,Facility,Outpatient,,,,148,125.8,42.4168,148,UnitedHealthcare,Medicare Advantage,72.52,49,,percent of total billed charges,,
MESH PROLITE ATRIUM 6 X 6,,C1781,HCPCS,Facility,Inpatient,,,,148,125.8,42.4168,148,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
MESH PROLITE ATRIUM 6 X 6,,C1781,HCPCS,Facility,Outpatient,,,,148,125.8,42.4168,148,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,71.04,48,,percent of total billed charges,,100% of DHS outpatient percentage
MESH PROLITE ATRIUM 6 X 6,,C1781,HCPCS,Facility,Inpatient,,,,148,125.8,42.4168,148,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
MESH SOFT LARGE 3X6 INCH BARD   0117009,,C1781,HCPCS,Facility,Both,,,,187.425,159.31125,53.716005,187.425,Aetna,Commercial,172.431,92,,percent of total billed charges,,
MESH SOFT LARGE 3X6 INCH BARD   0117009,,C1781,HCPCS,Facility,Outpatient,,,,187.425,159.31125,53.716005,187.425,Aetna,Medicare Advantage,91.83825,49,,percent of total billed charges,,
MESH SOFT LARGE 3X6 INCH BARD   0117009,,C1781,HCPCS,Facility,Inpatient,,,,187.425,159.31125,53.716005,187.425,Aetna,Medicare Advantage,,,,,Included in per diem rate,
MESH SOFT LARGE 3X6 INCH BARD   0117009,,C1781,HCPCS,Facility,Both,,,,187.425,159.31125,53.716005,187.425,Aetna,PPO,174.30525,93,,percent of total billed charges,,
MESH SOFT LARGE 3X6 INCH BARD   0117009,,C1781,HCPCS,Facility,Both,,,,187.425,159.31125,53.716005,187.425,America's PPO,America's PPO,179.9842275,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
MESH SOFT LARGE 3X6 INCH BARD   0117009,,C1781,HCPCS,Facility,Both,,,,187.425,159.31125,53.716005,187.425,BlueCross BlueShield Minnesota, Federal Employee Program,184.4262,98.4,,percent of total billed charges,,
MESH SOFT LARGE 3X6 INCH BARD   0117009,,C1781,HCPCS,Facility,Both,,,,187.425,159.31125,53.716005,187.425,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,187.425,100,,percent of total billed charges,,
MESH SOFT LARGE 3X6 INCH BARD   0117009,,C1781,HCPCS,Facility,Both,,,,187.425,159.31125,53.716005,187.425,BlueCross BlueShield Minnesota,High Value Network Plan,168.6825,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
MESH SOFT LARGE 3X6 INCH BARD   0117009,,C1781,HCPCS,Facility,Outpatient,,,,187.425,159.31125,53.716005,187.425,BlueCross BlueShield Minnesota,Medicare Advantage,91.83825,49,,percent of total billed charges,,
MESH SOFT LARGE 3X6 INCH BARD   0117009,,C1781,HCPCS,Facility,Inpatient,,,,187.425,159.31125,53.716005,187.425,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
MESH SOFT LARGE 3X6 INCH BARD   0117009,,C1781,HCPCS,Facility,Both,,,,187.425,159.31125,53.716005,187.425,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,166.0023225,88.57,,percent of total billed charges,,
MESH SOFT LARGE 3X6 INCH BARD   0117009,,C1781,HCPCS,Facility,Both,,,,187.425,159.31125,53.716005,187.425,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,53.716005,28.66,,percent of total billed charges,,
MESH SOFT LARGE 3X6 INCH BARD   0117009,,C1781,HCPCS,Facility,Outpatient,,,,187.425,159.31125,53.716005,187.425,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),91.83825,49,,percent of total billed charges,,
MESH SOFT LARGE 3X6 INCH BARD   0117009,,C1781,HCPCS,Facility,Inpatient,,,,187.425,159.31125,53.716005,187.425,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
MESH SOFT LARGE 3X6 INCH BARD   0117009,,C1781,HCPCS,Facility,Both,,,,187.425,159.31125,53.716005,187.425,CorVel,Worker's Compensation,187.425,100,,percent of total billed charges,,
MESH SOFT LARGE 3X6 INCH BARD   0117009,,C1781,HCPCS,Facility,Both,,,,187.425,159.31125,53.716005,187.425,First Health Group Corporation,First Health Network,181.80225,97,,percent of total billed charges,,
MESH SOFT LARGE 3X6 INCH BARD   0117009,,C1781,HCPCS,Facility,Both,,,,187.425,159.31125,53.716005,187.425,"Health Partners, Inc.",Commercial,177.30405,94.6,,percent of total billed charges,,
MESH SOFT LARGE 3X6 INCH BARD   0117009,,C1781,HCPCS,Facility,Outpatient,,,,187.425,159.31125,53.716005,187.425,"Health Partners, Inc.",Medicare Advantage,91.83825,49,,percent of total billed charges,,
MESH SOFT LARGE 3X6 INCH BARD   0117009,,C1781,HCPCS,Facility,Inpatient,,,,187.425,159.31125,53.716005,187.425,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
MESH SOFT LARGE 3X6 INCH BARD   0117009,,C1781,HCPCS,Facility,Both,,,,187.425,159.31125,53.716005,187.425,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),112.455,60,,percent of total billed charges,,
MESH SOFT LARGE 3X6 INCH BARD   0117009,,C1781,HCPCS,Facility,Both,,,,187.425,159.31125,53.716005,187.425,"Health Partners, Inc.",State of Minnesota Advantage Program,152.751375,81.5,,percent of total billed charges,,
MESH SOFT LARGE 3X6 INCH BARD   0117009,,C1781,HCPCS,Facility,Both,,,,187.425,159.31125,53.716005,187.425,"Health Partners, Inc.",State Public Programs,93.7125,50,,percent of total billed charges,,
MESH SOFT LARGE 3X6 INCH BARD   0117009,,C1781,HCPCS,Facility,Both,,,,187.425,159.31125,53.716005,187.425,Humana Insurance Company,Commercial PPO,178.05375,95,,percent of total billed charges,,
MESH SOFT LARGE 3X6 INCH BARD   0117009,,C1781,HCPCS,Facility,Outpatient,,,,187.425,159.31125,53.716005,187.425,Humana Insurance Company,Medicare PPO,91.83825,49,,percent of total billed charges,,
MESH SOFT LARGE 3X6 INCH BARD   0117009,,C1781,HCPCS,Facility,Inpatient,,,,187.425,159.31125,53.716005,187.425,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
MESH SOFT LARGE 3X6 INCH BARD   0117009,,C1781,HCPCS,Facility,Both,,,,187.425,159.31125,53.716005,187.425,Medica,Individual & Family,185.738175,99.1,,percent of total billed charges,,
MESH SOFT LARGE 3X6 INCH BARD   0117009,,C1781,HCPCS,Facility,Outpatient,,,,187.425,159.31125,53.716005,187.425,Medica,Medica Advantage Solution,93.33765,49.8,,percent of total billed charges,,
MESH SOFT LARGE 3X6 INCH BARD   0117009,,C1781,HCPCS,Facility,Inpatient,,,,187.425,159.31125,53.716005,187.425,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
MESH SOFT LARGE 3X6 INCH BARD   0117009,,C1781,HCPCS,Facility,Outpatient,,,,187.425,159.31125,53.716005,187.425,Medica,Medical Assistance,83.59155,44.6,,percent of total billed charges,,
MESH SOFT LARGE 3X6 INCH BARD   0117009,,C1781,HCPCS,Facility,Inpatient,,,,187.425,159.31125,53.716005,187.425,Medica,Medical Assistance,,,,,Included in per diem rate,
MESH SOFT LARGE 3X6 INCH BARD   0117009,,C1781,HCPCS,Facility,Outpatient,,,,187.425,159.31125,53.716005,187.425,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,93.33765,49.8,,percent of total billed charges,,
MESH SOFT LARGE 3X6 INCH BARD   0117009,,C1781,HCPCS,Facility,Inpatient,,,,187.425,159.31125,53.716005,187.425,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
MESH SOFT LARGE 3X6 INCH BARD   0117009,,C1781,HCPCS,Facility,Both,,,,187.425,159.31125,53.716005,187.425,"Multiplan, Inc.","Multiplan, Inc.",176.1795,94,,percent of total billed charges,,
MESH SOFT LARGE 3X6 INCH BARD   0117009,,C1781,HCPCS,Facility,Outpatient,,,,187.425,159.31125,53.716005,187.425,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,168.869925,90.1,,percent of total billed charges,,
MESH SOFT LARGE 3X6 INCH BARD   0117009,,C1781,HCPCS,Facility,Inpatient,,,,187.425,159.31125,53.716005,187.425,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
MESH SOFT LARGE 3X6 INCH BARD   0117009,,C1781,HCPCS,Facility,Both,,,,187.425,159.31125,53.716005,187.425,"Preferred One Administrative Services, INC.",PPO,184.80105,98.6,,percent of total billed charges,,
MESH SOFT LARGE 3X6 INCH BARD   0117009,,C1781,HCPCS,Facility,Outpatient,,,,187.425,159.31125,53.716005,187.425,PrimeWest Health,Minnesota Senior Health Options (MSHO),96.4301625,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
MESH SOFT LARGE 3X6 INCH BARD   0117009,,C1781,HCPCS,Facility,Inpatient,,,,187.425,159.31125,53.716005,187.425,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
MESH SOFT LARGE 3X6 INCH BARD   0117009,,C1781,HCPCS,Facility,Outpatient,,,,187.425,159.31125,53.716005,187.425,PrimeWest Health,MinnesotaCare,96.26148,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
MESH SOFT LARGE 3X6 INCH BARD   0117009,,C1781,HCPCS,Facility,Inpatient,,,,187.425,159.31125,53.716005,187.425,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
MESH SOFT LARGE 3X6 INCH BARD   0117009,,C1781,HCPCS,Facility,Both,,,,187.425,159.31125,53.716005,187.425,Sanford Health Plan,Sanford Health Plan,172.431,92,,percent of total billed charges,,
MESH SOFT LARGE 3X6 INCH BARD   0117009,,C1781,HCPCS,Facility,Outpatient,,,,187.425,159.31125,53.716005,187.425,"UCare Health, Inc.",Individual & Family Plan,105.6139875,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
MESH SOFT LARGE 3X6 INCH BARD   0117009,,C1781,HCPCS,Facility,Inpatient,,,,187.425,159.31125,53.716005,187.425,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
MESH SOFT LARGE 3X6 INCH BARD   0117009,,C1781,HCPCS,Facility,Outpatient,,,,187.425,159.31125,53.716005,187.425,"UCare Health, Inc.",Medical Assistance,94.5933975,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MESH SOFT LARGE 3X6 INCH BARD   0117009,,C1781,HCPCS,Facility,Inpatient,,,,187.425,159.31125,53.716005,187.425,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
MESH SOFT LARGE 3X6 INCH BARD   0117009,,C1781,HCPCS,Facility,Outpatient,,,,187.425,159.31125,53.716005,187.425,"UCare Health, Inc.",Medicare Advantage,94.5933975,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MESH SOFT LARGE 3X6 INCH BARD   0117009,,C1781,HCPCS,Facility,Inpatient,,,,187.425,159.31125,53.716005,187.425,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
MESH SOFT LARGE 3X6 INCH BARD   0117009,,C1781,HCPCS,Facility,Outpatient,,,,187.425,159.31125,53.716005,187.425,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),94.5933975,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MESH SOFT LARGE 3X6 INCH BARD   0117009,,C1781,HCPCS,Facility,Inpatient,,,,187.425,159.31125,53.716005,187.425,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
MESH SOFT LARGE 3X6 INCH BARD   0117009,,C1781,HCPCS,Facility,Both,,,,187.425,159.31125,53.716005,187.425,UnitedHealthcare,Individual & Family,176.1795,94,,percent of total billed charges,,
MESH SOFT LARGE 3X6 INCH BARD   0117009,,C1781,HCPCS,Facility,Outpatient,,,,187.425,159.31125,53.716005,187.425,UnitedHealthcare,Medicare Advantage,91.83825,49,,percent of total billed charges,,
MESH SOFT LARGE 3X6 INCH BARD   0117009,,C1781,HCPCS,Facility,Inpatient,,,,187.425,159.31125,53.716005,187.425,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
MESH SOFT LARGE 3X6 INCH BARD   0117009,,C1781,HCPCS,Facility,Outpatient,,,,187.425,159.31125,53.716005,187.425,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,89.964,48,,percent of total billed charges,,100% of DHS outpatient percentage
MESH SOFT LARGE 3X6 INCH BARD   0117009,,C1781,HCPCS,Facility,Inpatient,,,,187.425,159.31125,53.716005,187.425,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
MESH SURGICAL PLUG X-LG BARD     0112780,,C1781,HCPCS,Facility,Both,,,,877.5,745.875,251.4915,877.5,Aetna,Commercial,807.3,92,,percent of total billed charges,,
MESH SURGICAL PLUG X-LG BARD     0112780,,C1781,HCPCS,Facility,Outpatient,,,,877.5,745.875,251.4915,877.5,Aetna,Medicare Advantage,429.975,49,,percent of total billed charges,,
MESH SURGICAL PLUG X-LG BARD     0112780,,C1781,HCPCS,Facility,Inpatient,,,,877.5,745.875,251.4915,877.5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
MESH SURGICAL PLUG X-LG BARD     0112780,,C1781,HCPCS,Facility,Both,,,,877.5,745.875,251.4915,877.5,Aetna,PPO,816.075,93,,percent of total billed charges,,
MESH SURGICAL PLUG X-LG BARD     0112780,,C1781,HCPCS,Facility,Both,,,,877.5,745.875,251.4915,877.5,America's PPO,America's PPO,842.66325,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
MESH SURGICAL PLUG X-LG BARD     0112780,,C1781,HCPCS,Facility,Both,,,,877.5,745.875,251.4915,877.5,BlueCross BlueShield Minnesota, Federal Employee Program,863.46,98.4,,percent of total billed charges,,
MESH SURGICAL PLUG X-LG BARD     0112780,,C1781,HCPCS,Facility,Both,,,,877.5,745.875,251.4915,877.5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,877.5,100,,percent of total billed charges,,
MESH SURGICAL PLUG X-LG BARD     0112780,,C1781,HCPCS,Facility,Both,,,,877.5,745.875,251.4915,877.5,BlueCross BlueShield Minnesota,High Value Network Plan,789.75,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
MESH SURGICAL PLUG X-LG BARD     0112780,,C1781,HCPCS,Facility,Outpatient,,,,877.5,745.875,251.4915,877.5,BlueCross BlueShield Minnesota,Medicare Advantage,429.975,49,,percent of total billed charges,,
MESH SURGICAL PLUG X-LG BARD     0112780,,C1781,HCPCS,Facility,Inpatient,,,,877.5,745.875,251.4915,877.5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
MESH SURGICAL PLUG X-LG BARD     0112780,,C1781,HCPCS,Facility,Both,,,,877.5,745.875,251.4915,877.5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,777.20175,88.57,,percent of total billed charges,,
MESH SURGICAL PLUG X-LG BARD     0112780,,C1781,HCPCS,Facility,Both,,,,877.5,745.875,251.4915,877.5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,251.4915,28.66,,percent of total billed charges,,
MESH SURGICAL PLUG X-LG BARD     0112780,,C1781,HCPCS,Facility,Outpatient,,,,877.5,745.875,251.4915,877.5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),429.975,49,,percent of total billed charges,,
MESH SURGICAL PLUG X-LG BARD     0112780,,C1781,HCPCS,Facility,Inpatient,,,,877.5,745.875,251.4915,877.5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
MESH SURGICAL PLUG X-LG BARD     0112780,,C1781,HCPCS,Facility,Both,,,,877.5,745.875,251.4915,877.5,CorVel,Worker's Compensation,877.5,100,,percent of total billed charges,,
MESH SURGICAL PLUG X-LG BARD     0112780,,C1781,HCPCS,Facility,Both,,,,877.5,745.875,251.4915,877.5,First Health Group Corporation,First Health Network,851.175,97,,percent of total billed charges,,
MESH SURGICAL PLUG X-LG BARD     0112780,,C1781,HCPCS,Facility,Both,,,,877.5,745.875,251.4915,877.5,"Health Partners, Inc.",Commercial,830.115,94.6,,percent of total billed charges,,
MESH SURGICAL PLUG X-LG BARD     0112780,,C1781,HCPCS,Facility,Outpatient,,,,877.5,745.875,251.4915,877.5,"Health Partners, Inc.",Medicare Advantage,429.975,49,,percent of total billed charges,,
MESH SURGICAL PLUG X-LG BARD     0112780,,C1781,HCPCS,Facility,Inpatient,,,,877.5,745.875,251.4915,877.5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
MESH SURGICAL PLUG X-LG BARD     0112780,,C1781,HCPCS,Facility,Both,,,,877.5,745.875,251.4915,877.5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),526.5,60,,percent of total billed charges,,
MESH SURGICAL PLUG X-LG BARD     0112780,,C1781,HCPCS,Facility,Both,,,,877.5,745.875,251.4915,877.5,"Health Partners, Inc.",State of Minnesota Advantage Program,715.1625,81.5,,percent of total billed charges,,
MESH SURGICAL PLUG X-LG BARD     0112780,,C1781,HCPCS,Facility,Both,,,,877.5,745.875,251.4915,877.5,"Health Partners, Inc.",State Public Programs,438.75,50,,percent of total billed charges,,
MESH SURGICAL PLUG X-LG BARD     0112780,,C1781,HCPCS,Facility,Both,,,,877.5,745.875,251.4915,877.5,Humana Insurance Company,Commercial PPO,833.625,95,,percent of total billed charges,,
MESH SURGICAL PLUG X-LG BARD     0112780,,C1781,HCPCS,Facility,Outpatient,,,,877.5,745.875,251.4915,877.5,Humana Insurance Company,Medicare PPO,429.975,49,,percent of total billed charges,,
MESH SURGICAL PLUG X-LG BARD     0112780,,C1781,HCPCS,Facility,Inpatient,,,,877.5,745.875,251.4915,877.5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
MESH SURGICAL PLUG X-LG BARD     0112780,,C1781,HCPCS,Facility,Both,,,,877.5,745.875,251.4915,877.5,Medica,Individual & Family,869.6025,99.1,,percent of total billed charges,,
MESH SURGICAL PLUG X-LG BARD     0112780,,C1781,HCPCS,Facility,Outpatient,,,,877.5,745.875,251.4915,877.5,Medica,Medica Advantage Solution,436.995,49.8,,percent of total billed charges,,
MESH SURGICAL PLUG X-LG BARD     0112780,,C1781,HCPCS,Facility,Inpatient,,,,877.5,745.875,251.4915,877.5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
MESH SURGICAL PLUG X-LG BARD     0112780,,C1781,HCPCS,Facility,Outpatient,,,,877.5,745.875,251.4915,877.5,Medica,Medical Assistance,391.365,44.6,,percent of total billed charges,,
MESH SURGICAL PLUG X-LG BARD     0112780,,C1781,HCPCS,Facility,Inpatient,,,,877.5,745.875,251.4915,877.5,Medica,Medical Assistance,,,,,Included in per diem rate,
MESH SURGICAL PLUG X-LG BARD     0112780,,C1781,HCPCS,Facility,Outpatient,,,,877.5,745.875,251.4915,877.5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,436.995,49.8,,percent of total billed charges,,
MESH SURGICAL PLUG X-LG BARD     0112780,,C1781,HCPCS,Facility,Inpatient,,,,877.5,745.875,251.4915,877.5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
MESH SURGICAL PLUG X-LG BARD     0112780,,C1781,HCPCS,Facility,Both,,,,877.5,745.875,251.4915,877.5,"Multiplan, Inc.","Multiplan, Inc.",824.85,94,,percent of total billed charges,,
MESH SURGICAL PLUG X-LG BARD     0112780,,C1781,HCPCS,Facility,Outpatient,,,,877.5,745.875,251.4915,877.5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,790.6275,90.1,,percent of total billed charges,,
MESH SURGICAL PLUG X-LG BARD     0112780,,C1781,HCPCS,Facility,Inpatient,,,,877.5,745.875,251.4915,877.5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
MESH SURGICAL PLUG X-LG BARD     0112780,,C1781,HCPCS,Facility,Both,,,,877.5,745.875,251.4915,877.5,"Preferred One Administrative Services, INC.",PPO,865.215,98.6,,percent of total billed charges,,
MESH SURGICAL PLUG X-LG BARD     0112780,,C1781,HCPCS,Facility,Outpatient,,,,877.5,745.875,251.4915,877.5,PrimeWest Health,Minnesota Senior Health Options (MSHO),451.47375,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
MESH SURGICAL PLUG X-LG BARD     0112780,,C1781,HCPCS,Facility,Inpatient,,,,877.5,745.875,251.4915,877.5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
MESH SURGICAL PLUG X-LG BARD     0112780,,C1781,HCPCS,Facility,Outpatient,,,,877.5,745.875,251.4915,877.5,PrimeWest Health,MinnesotaCare,450.684,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
MESH SURGICAL PLUG X-LG BARD     0112780,,C1781,HCPCS,Facility,Inpatient,,,,877.5,745.875,251.4915,877.5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
MESH SURGICAL PLUG X-LG BARD     0112780,,C1781,HCPCS,Facility,Both,,,,877.5,745.875,251.4915,877.5,Sanford Health Plan,Sanford Health Plan,807.3,92,,percent of total billed charges,,
MESH SURGICAL PLUG X-LG BARD     0112780,,C1781,HCPCS,Facility,Outpatient,,,,877.5,745.875,251.4915,877.5,"UCare Health, Inc.",Individual & Family Plan,494.47125,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
MESH SURGICAL PLUG X-LG BARD     0112780,,C1781,HCPCS,Facility,Inpatient,,,,877.5,745.875,251.4915,877.5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
MESH SURGICAL PLUG X-LG BARD     0112780,,C1781,HCPCS,Facility,Outpatient,,,,877.5,745.875,251.4915,877.5,"UCare Health, Inc.",Medical Assistance,442.87425,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MESH SURGICAL PLUG X-LG BARD     0112780,,C1781,HCPCS,Facility,Inpatient,,,,877.5,745.875,251.4915,877.5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
MESH SURGICAL PLUG X-LG BARD     0112780,,C1781,HCPCS,Facility,Outpatient,,,,877.5,745.875,251.4915,877.5,"UCare Health, Inc.",Medicare Advantage,442.87425,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MESH SURGICAL PLUG X-LG BARD     0112780,,C1781,HCPCS,Facility,Inpatient,,,,877.5,745.875,251.4915,877.5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
MESH SURGICAL PLUG X-LG BARD     0112780,,C1781,HCPCS,Facility,Outpatient,,,,877.5,745.875,251.4915,877.5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),442.87425,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MESH SURGICAL PLUG X-LG BARD     0112780,,C1781,HCPCS,Facility,Inpatient,,,,877.5,745.875,251.4915,877.5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
MESH SURGICAL PLUG X-LG BARD     0112780,,C1781,HCPCS,Facility,Both,,,,877.5,745.875,251.4915,877.5,UnitedHealthcare,Individual & Family,824.85,94,,percent of total billed charges,,
MESH SURGICAL PLUG X-LG BARD     0112780,,C1781,HCPCS,Facility,Outpatient,,,,877.5,745.875,251.4915,877.5,UnitedHealthcare,Medicare Advantage,429.975,49,,percent of total billed charges,,
MESH SURGICAL PLUG X-LG BARD     0112780,,C1781,HCPCS,Facility,Inpatient,,,,877.5,745.875,251.4915,877.5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
MESH SURGICAL PLUG X-LG BARD     0112780,,C1781,HCPCS,Facility,Outpatient,,,,877.5,745.875,251.4915,877.5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,421.2,48,,percent of total billed charges,,100% of DHS outpatient percentage
MESH SURGICAL PLUG X-LG BARD     0112780,,C1781,HCPCS,Facility,Inpatient,,,,877.5,745.875,251.4915,877.5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
PARIETENE DS COMPOSITE MESH 15CM ROUND,,C1781,HCPCS,Facility,Both,,,,1245.24,1058.454,356.885784,1245.24,Aetna,Commercial,1145.6208,92,,percent of total billed charges,,
PARIETENE DS COMPOSITE MESH 15CM ROUND,,C1781,HCPCS,Facility,Outpatient,,,,1245.24,1058.454,356.885784,1245.24,Aetna,Medicare Advantage,610.1676,49,,percent of total billed charges,,
PARIETENE DS COMPOSITE MESH 15CM ROUND,,C1781,HCPCS,Facility,Inpatient,,,,1245.24,1058.454,356.885784,1245.24,Aetna,Medicare Advantage,,,,,Included in per diem rate,
PARIETENE DS COMPOSITE MESH 15CM ROUND,,C1781,HCPCS,Facility,Both,,,,1245.24,1058.454,356.885784,1245.24,Aetna,PPO,1158.0732,93,,percent of total billed charges,,
PARIETENE DS COMPOSITE MESH 15CM ROUND,,C1781,HCPCS,Facility,Both,,,,1245.24,1058.454,356.885784,1245.24,America's PPO,America's PPO,1195.803972,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
PARIETENE DS COMPOSITE MESH 15CM ROUND,,C1781,HCPCS,Facility,Both,,,,1245.24,1058.454,356.885784,1245.24,BlueCross BlueShield Minnesota, Federal Employee Program,1225.31616,98.4,,percent of total billed charges,,
PARIETENE DS COMPOSITE MESH 15CM ROUND,,C1781,HCPCS,Facility,Both,,,,1245.24,1058.454,356.885784,1245.24,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1245.24,100,,percent of total billed charges,,
PARIETENE DS COMPOSITE MESH 15CM ROUND,,C1781,HCPCS,Facility,Both,,,,1245.24,1058.454,356.885784,1245.24,BlueCross BlueShield Minnesota,High Value Network Plan,1120.716,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
PARIETENE DS COMPOSITE MESH 15CM ROUND,,C1781,HCPCS,Facility,Outpatient,,,,1245.24,1058.454,356.885784,1245.24,BlueCross BlueShield Minnesota,Medicare Advantage,610.1676,49,,percent of total billed charges,,
PARIETENE DS COMPOSITE MESH 15CM ROUND,,C1781,HCPCS,Facility,Inpatient,,,,1245.24,1058.454,356.885784,1245.24,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
PARIETENE DS COMPOSITE MESH 15CM ROUND,,C1781,HCPCS,Facility,Both,,,,1245.24,1058.454,356.885784,1245.24,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1102.909068,88.57,,percent of total billed charges,,
PARIETENE DS COMPOSITE MESH 15CM ROUND,,C1781,HCPCS,Facility,Both,,,,1245.24,1058.454,356.885784,1245.24,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,356.885784,28.66,,percent of total billed charges,,
PARIETENE DS COMPOSITE MESH 15CM ROUND,,C1781,HCPCS,Facility,Outpatient,,,,1245.24,1058.454,356.885784,1245.24,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),610.1676,49,,percent of total billed charges,,
PARIETENE DS COMPOSITE MESH 15CM ROUND,,C1781,HCPCS,Facility,Inpatient,,,,1245.24,1058.454,356.885784,1245.24,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
PARIETENE DS COMPOSITE MESH 15CM ROUND,,C1781,HCPCS,Facility,Both,,,,1245.24,1058.454,356.885784,1245.24,CorVel,Worker's Compensation,1245.24,100,,percent of total billed charges,,
PARIETENE DS COMPOSITE MESH 15CM ROUND,,C1781,HCPCS,Facility,Both,,,,1245.24,1058.454,356.885784,1245.24,First Health Group Corporation,First Health Network,1207.8828,97,,percent of total billed charges,,
PARIETENE DS COMPOSITE MESH 15CM ROUND,,C1781,HCPCS,Facility,Both,,,,1245.24,1058.454,356.885784,1245.24,"Health Partners, Inc.",Commercial,1177.99704,94.6,,percent of total billed charges,,
PARIETENE DS COMPOSITE MESH 15CM ROUND,,C1781,HCPCS,Facility,Outpatient,,,,1245.24,1058.454,356.885784,1245.24,"Health Partners, Inc.",Medicare Advantage,610.1676,49,,percent of total billed charges,,
PARIETENE DS COMPOSITE MESH 15CM ROUND,,C1781,HCPCS,Facility,Inpatient,,,,1245.24,1058.454,356.885784,1245.24,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PARIETENE DS COMPOSITE MESH 15CM ROUND,,C1781,HCPCS,Facility,Both,,,,1245.24,1058.454,356.885784,1245.24,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),747.144,60,,percent of total billed charges,,
PARIETENE DS COMPOSITE MESH 15CM ROUND,,C1781,HCPCS,Facility,Both,,,,1245.24,1058.454,356.885784,1245.24,"Health Partners, Inc.",State of Minnesota Advantage Program,1014.8706,81.5,,percent of total billed charges,,
PARIETENE DS COMPOSITE MESH 15CM ROUND,,C1781,HCPCS,Facility,Both,,,,1245.24,1058.454,356.885784,1245.24,"Health Partners, Inc.",State Public Programs,622.62,50,,percent of total billed charges,,
PARIETENE DS COMPOSITE MESH 15CM ROUND,,C1781,HCPCS,Facility,Both,,,,1245.24,1058.454,356.885784,1245.24,Humana Insurance Company,Commercial PPO,1182.978,95,,percent of total billed charges,,
PARIETENE DS COMPOSITE MESH 15CM ROUND,,C1781,HCPCS,Facility,Outpatient,,,,1245.24,1058.454,356.885784,1245.24,Humana Insurance Company,Medicare PPO,610.1676,49,,percent of total billed charges,,
PARIETENE DS COMPOSITE MESH 15CM ROUND,,C1781,HCPCS,Facility,Inpatient,,,,1245.24,1058.454,356.885784,1245.24,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
PARIETENE DS COMPOSITE MESH 15CM ROUND,,C1781,HCPCS,Facility,Both,,,,1245.24,1058.454,356.885784,1245.24,Medica,Individual & Family,1234.03284,99.1,,percent of total billed charges,,
PARIETENE DS COMPOSITE MESH 15CM ROUND,,C1781,HCPCS,Facility,Outpatient,,,,1245.24,1058.454,356.885784,1245.24,Medica,Medica Advantage Solution,620.12952,49.8,,percent of total billed charges,,
PARIETENE DS COMPOSITE MESH 15CM ROUND,,C1781,HCPCS,Facility,Inpatient,,,,1245.24,1058.454,356.885784,1245.24,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
PARIETENE DS COMPOSITE MESH 15CM ROUND,,C1781,HCPCS,Facility,Outpatient,,,,1245.24,1058.454,356.885784,1245.24,Medica,Medical Assistance,555.37704,44.6,,percent of total billed charges,,
PARIETENE DS COMPOSITE MESH 15CM ROUND,,C1781,HCPCS,Facility,Inpatient,,,,1245.24,1058.454,356.885784,1245.24,Medica,Medical Assistance,,,,,Included in per diem rate,
PARIETENE DS COMPOSITE MESH 15CM ROUND,,C1781,HCPCS,Facility,Outpatient,,,,1245.24,1058.454,356.885784,1245.24,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,620.12952,49.8,,percent of total billed charges,,
PARIETENE DS COMPOSITE MESH 15CM ROUND,,C1781,HCPCS,Facility,Inpatient,,,,1245.24,1058.454,356.885784,1245.24,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
PARIETENE DS COMPOSITE MESH 15CM ROUND,,C1781,HCPCS,Facility,Both,,,,1245.24,1058.454,356.885784,1245.24,"Multiplan, Inc.","Multiplan, Inc.",1170.5256,94,,percent of total billed charges,,
PARIETENE DS COMPOSITE MESH 15CM ROUND,,C1781,HCPCS,Facility,Outpatient,,,,1245.24,1058.454,356.885784,1245.24,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1121.96124,90.1,,percent of total billed charges,,
PARIETENE DS COMPOSITE MESH 15CM ROUND,,C1781,HCPCS,Facility,Inpatient,,,,1245.24,1058.454,356.885784,1245.24,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
PARIETENE DS COMPOSITE MESH 15CM ROUND,,C1781,HCPCS,Facility,Both,,,,1245.24,1058.454,356.885784,1245.24,"Preferred One Administrative Services, INC.",PPO,1227.80664,98.6,,percent of total billed charges,,
PARIETENE DS COMPOSITE MESH 15CM ROUND,,C1781,HCPCS,Facility,Outpatient,,,,1245.24,1058.454,356.885784,1245.24,PrimeWest Health,Minnesota Senior Health Options (MSHO),640.67598,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
PARIETENE DS COMPOSITE MESH 15CM ROUND,,C1781,HCPCS,Facility,Inpatient,,,,1245.24,1058.454,356.885784,1245.24,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PARIETENE DS COMPOSITE MESH 15CM ROUND,,C1781,HCPCS,Facility,Outpatient,,,,1245.24,1058.454,356.885784,1245.24,PrimeWest Health,MinnesotaCare,639.555264,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
PARIETENE DS COMPOSITE MESH 15CM ROUND,,C1781,HCPCS,Facility,Inpatient,,,,1245.24,1058.454,356.885784,1245.24,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
PARIETENE DS COMPOSITE MESH 15CM ROUND,,C1781,HCPCS,Facility,Both,,,,1245.24,1058.454,356.885784,1245.24,Sanford Health Plan,Sanford Health Plan,1145.6208,92,,percent of total billed charges,,
PARIETENE DS COMPOSITE MESH 15CM ROUND,,C1781,HCPCS,Facility,Outpatient,,,,1245.24,1058.454,356.885784,1245.24,"UCare Health, Inc.",Individual & Family Plan,701.69274,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
PARIETENE DS COMPOSITE MESH 15CM ROUND,,C1781,HCPCS,Facility,Inpatient,,,,1245.24,1058.454,356.885784,1245.24,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
PARIETENE DS COMPOSITE MESH 15CM ROUND,,C1781,HCPCS,Facility,Outpatient,,,,1245.24,1058.454,356.885784,1245.24,"UCare Health, Inc.",Medical Assistance,628.472628,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PARIETENE DS COMPOSITE MESH 15CM ROUND,,C1781,HCPCS,Facility,Inpatient,,,,1245.24,1058.454,356.885784,1245.24,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
PARIETENE DS COMPOSITE MESH 15CM ROUND,,C1781,HCPCS,Facility,Outpatient,,,,1245.24,1058.454,356.885784,1245.24,"UCare Health, Inc.",Medicare Advantage,628.472628,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PARIETENE DS COMPOSITE MESH 15CM ROUND,,C1781,HCPCS,Facility,Inpatient,,,,1245.24,1058.454,356.885784,1245.24,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PARIETENE DS COMPOSITE MESH 15CM ROUND,,C1781,HCPCS,Facility,Outpatient,,,,1245.24,1058.454,356.885784,1245.24,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),628.472628,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PARIETENE DS COMPOSITE MESH 15CM ROUND,,C1781,HCPCS,Facility,Inpatient,,,,1245.24,1058.454,356.885784,1245.24,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PARIETENE DS COMPOSITE MESH 15CM ROUND,,C1781,HCPCS,Facility,Both,,,,1245.24,1058.454,356.885784,1245.24,UnitedHealthcare,Individual & Family,1170.5256,94,,percent of total billed charges,,
PARIETENE DS COMPOSITE MESH 15CM ROUND,,C1781,HCPCS,Facility,Outpatient,,,,1245.24,1058.454,356.885784,1245.24,UnitedHealthcare,Medicare Advantage,610.1676,49,,percent of total billed charges,,
PARIETENE DS COMPOSITE MESH 15CM ROUND,,C1781,HCPCS,Facility,Inpatient,,,,1245.24,1058.454,356.885784,1245.24,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
PARIETENE DS COMPOSITE MESH 15CM ROUND,,C1781,HCPCS,Facility,Outpatient,,,,1245.24,1058.454,356.885784,1245.24,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,597.7152,48,,percent of total billed charges,,100% of DHS outpatient percentage
PARIETENE DS COMPOSITE MESH 15CM ROUND,,C1781,HCPCS,Facility,Inpatient,,,,1245.24,1058.454,356.885784,1245.24,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
PARIETEX MESH 15CM OPT COMPOSITE,,C1781,HCPCS,Facility,Both,,,,2118.931,1801.09135,607.2856246,2118.931,Aetna,Commercial,1949.41652,92,,percent of total billed charges,,
PARIETEX MESH 15CM OPT COMPOSITE,,C1781,HCPCS,Facility,Outpatient,,,,2118.931,1801.09135,607.2856246,2118.931,Aetna,Medicare Advantage,1038.27619,49,,percent of total billed charges,,
PARIETEX MESH 15CM OPT COMPOSITE,,C1781,HCPCS,Facility,Inpatient,,,,2118.931,1801.09135,607.2856246,2118.931,Aetna,Medicare Advantage,,,,,Included in per diem rate,
PARIETEX MESH 15CM OPT COMPOSITE,,C1781,HCPCS,Facility,Both,,,,2118.931,1801.09135,607.2856246,2118.931,Aetna,PPO,1970.60583,93,,percent of total billed charges,,
PARIETEX MESH 15CM OPT COMPOSITE,,C1781,HCPCS,Facility,Both,,,,2118.931,1801.09135,607.2856246,2118.931,America's PPO,America's PPO,2034.809439,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
PARIETEX MESH 15CM OPT COMPOSITE,,C1781,HCPCS,Facility,Both,,,,2118.931,1801.09135,607.2856246,2118.931,BlueCross BlueShield Minnesota, Federal Employee Program,2085.028104,98.4,,percent of total billed charges,,
PARIETEX MESH 15CM OPT COMPOSITE,,C1781,HCPCS,Facility,Both,,,,2118.931,1801.09135,607.2856246,2118.931,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,2118.931,100,,percent of total billed charges,,
PARIETEX MESH 15CM OPT COMPOSITE,,C1781,HCPCS,Facility,Both,,,,2118.931,1801.09135,607.2856246,2118.931,BlueCross BlueShield Minnesota,High Value Network Plan,1907.0379,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
PARIETEX MESH 15CM OPT COMPOSITE,,C1781,HCPCS,Facility,Outpatient,,,,2118.931,1801.09135,607.2856246,2118.931,BlueCross BlueShield Minnesota,Medicare Advantage,1038.27619,49,,percent of total billed charges,,
PARIETEX MESH 15CM OPT COMPOSITE,,C1781,HCPCS,Facility,Inpatient,,,,2118.931,1801.09135,607.2856246,2118.931,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
PARIETEX MESH 15CM OPT COMPOSITE,,C1781,HCPCS,Facility,Both,,,,2118.931,1801.09135,607.2856246,2118.931,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1876.737187,88.57,,percent of total billed charges,,
PARIETEX MESH 15CM OPT COMPOSITE,,C1781,HCPCS,Facility,Both,,,,2118.931,1801.09135,607.2856246,2118.931,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,607.2856246,28.66,,percent of total billed charges,,
PARIETEX MESH 15CM OPT COMPOSITE,,C1781,HCPCS,Facility,Outpatient,,,,2118.931,1801.09135,607.2856246,2118.931,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1038.27619,49,,percent of total billed charges,,
PARIETEX MESH 15CM OPT COMPOSITE,,C1781,HCPCS,Facility,Inpatient,,,,2118.931,1801.09135,607.2856246,2118.931,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
PARIETEX MESH 15CM OPT COMPOSITE,,C1781,HCPCS,Facility,Both,,,,2118.931,1801.09135,607.2856246,2118.931,CorVel,Worker's Compensation,2118.931,100,,percent of total billed charges,,
PARIETEX MESH 15CM OPT COMPOSITE,,C1781,HCPCS,Facility,Both,,,,2118.931,1801.09135,607.2856246,2118.931,First Health Group Corporation,First Health Network,2055.36307,97,,percent of total billed charges,,
PARIETEX MESH 15CM OPT COMPOSITE,,C1781,HCPCS,Facility,Both,,,,2118.931,1801.09135,607.2856246,2118.931,"Health Partners, Inc.",Commercial,2004.508726,94.6,,percent of total billed charges,,
PARIETEX MESH 15CM OPT COMPOSITE,,C1781,HCPCS,Facility,Outpatient,,,,2118.931,1801.09135,607.2856246,2118.931,"Health Partners, Inc.",Medicare Advantage,1038.27619,49,,percent of total billed charges,,
PARIETEX MESH 15CM OPT COMPOSITE,,C1781,HCPCS,Facility,Inpatient,,,,2118.931,1801.09135,607.2856246,2118.931,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PARIETEX MESH 15CM OPT COMPOSITE,,C1781,HCPCS,Facility,Both,,,,2118.931,1801.09135,607.2856246,2118.931,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1271.3586,60,,percent of total billed charges,,
PARIETEX MESH 15CM OPT COMPOSITE,,C1781,HCPCS,Facility,Both,,,,2118.931,1801.09135,607.2856246,2118.931,"Health Partners, Inc.",State of Minnesota Advantage Program,1726.928765,81.5,,percent of total billed charges,,
PARIETEX MESH 15CM OPT COMPOSITE,,C1781,HCPCS,Facility,Both,,,,2118.931,1801.09135,607.2856246,2118.931,"Health Partners, Inc.",State Public Programs,1059.4655,50,,percent of total billed charges,,
PARIETEX MESH 15CM OPT COMPOSITE,,C1781,HCPCS,Facility,Both,,,,2118.931,1801.09135,607.2856246,2118.931,Humana Insurance Company,Commercial PPO,2012.98445,95,,percent of total billed charges,,
PARIETEX MESH 15CM OPT COMPOSITE,,C1781,HCPCS,Facility,Outpatient,,,,2118.931,1801.09135,607.2856246,2118.931,Humana Insurance Company,Medicare PPO,1038.27619,49,,percent of total billed charges,,
PARIETEX MESH 15CM OPT COMPOSITE,,C1781,HCPCS,Facility,Inpatient,,,,2118.931,1801.09135,607.2856246,2118.931,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
PARIETEX MESH 15CM OPT COMPOSITE,,C1781,HCPCS,Facility,Both,,,,2118.931,1801.09135,607.2856246,2118.931,Medica,Individual & Family,2099.860621,99.1,,percent of total billed charges,,
PARIETEX MESH 15CM OPT COMPOSITE,,C1781,HCPCS,Facility,Outpatient,,,,2118.931,1801.09135,607.2856246,2118.931,Medica,Medica Advantage Solution,1055.227638,49.8,,percent of total billed charges,,
PARIETEX MESH 15CM OPT COMPOSITE,,C1781,HCPCS,Facility,Inpatient,,,,2118.931,1801.09135,607.2856246,2118.931,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
PARIETEX MESH 15CM OPT COMPOSITE,,C1781,HCPCS,Facility,Outpatient,,,,2118.931,1801.09135,607.2856246,2118.931,Medica,Medical Assistance,945.043226,44.6,,percent of total billed charges,,
PARIETEX MESH 15CM OPT COMPOSITE,,C1781,HCPCS,Facility,Inpatient,,,,2118.931,1801.09135,607.2856246,2118.931,Medica,Medical Assistance,,,,,Included in per diem rate,
PARIETEX MESH 15CM OPT COMPOSITE,,C1781,HCPCS,Facility,Outpatient,,,,2118.931,1801.09135,607.2856246,2118.931,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1055.227638,49.8,,percent of total billed charges,,
PARIETEX MESH 15CM OPT COMPOSITE,,C1781,HCPCS,Facility,Inpatient,,,,2118.931,1801.09135,607.2856246,2118.931,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
PARIETEX MESH 15CM OPT COMPOSITE,,C1781,HCPCS,Facility,Both,,,,2118.931,1801.09135,607.2856246,2118.931,"Multiplan, Inc.","Multiplan, Inc.",1991.79514,94,,percent of total billed charges,,
PARIETEX MESH 15CM OPT COMPOSITE,,C1781,HCPCS,Facility,Outpatient,,,,2118.931,1801.09135,607.2856246,2118.931,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1909.156831,90.1,,percent of total billed charges,,
PARIETEX MESH 15CM OPT COMPOSITE,,C1781,HCPCS,Facility,Inpatient,,,,2118.931,1801.09135,607.2856246,2118.931,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
PARIETEX MESH 15CM OPT COMPOSITE,,C1781,HCPCS,Facility,Both,,,,2118.931,1801.09135,607.2856246,2118.931,"Preferred One Administrative Services, INC.",PPO,2089.265966,98.6,,percent of total billed charges,,
PARIETEX MESH 15CM OPT COMPOSITE,,C1781,HCPCS,Facility,Outpatient,,,,2118.931,1801.09135,607.2856246,2118.931,PrimeWest Health,Minnesota Senior Health Options (MSHO),1090.19,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
PARIETEX MESH 15CM OPT COMPOSITE,,C1781,HCPCS,Facility,Inpatient,,,,2118.931,1801.09135,607.2856246,2118.931,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PARIETEX MESH 15CM OPT COMPOSITE,,C1781,HCPCS,Facility,Outpatient,,,,2118.931,1801.09135,607.2856246,2118.931,PrimeWest Health,MinnesotaCare,1088.282962,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
PARIETEX MESH 15CM OPT COMPOSITE,,C1781,HCPCS,Facility,Inpatient,,,,2118.931,1801.09135,607.2856246,2118.931,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
PARIETEX MESH 15CM OPT COMPOSITE,,C1781,HCPCS,Facility,Both,,,,2118.931,1801.09135,607.2856246,2118.931,Sanford Health Plan,Sanford Health Plan,1949.41652,92,,percent of total billed charges,,
PARIETEX MESH 15CM OPT COMPOSITE,,C1781,HCPCS,Facility,Outpatient,,,,2118.931,1801.09135,607.2856246,2118.931,"UCare Health, Inc.",Individual & Family Plan,1194.017619,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
PARIETEX MESH 15CM OPT COMPOSITE,,C1781,HCPCS,Facility,Inpatient,,,,2118.931,1801.09135,607.2856246,2118.931,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
PARIETEX MESH 15CM OPT COMPOSITE,,C1781,HCPCS,Facility,Outpatient,,,,2118.931,1801.09135,607.2856246,2118.931,"UCare Health, Inc.",Medical Assistance,1069.424476,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PARIETEX MESH 15CM OPT COMPOSITE,,C1781,HCPCS,Facility,Inpatient,,,,2118.931,1801.09135,607.2856246,2118.931,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
PARIETEX MESH 15CM OPT COMPOSITE,,C1781,HCPCS,Facility,Outpatient,,,,2118.931,1801.09135,607.2856246,2118.931,"UCare Health, Inc.",Medicare Advantage,1069.424476,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PARIETEX MESH 15CM OPT COMPOSITE,,C1781,HCPCS,Facility,Inpatient,,,,2118.931,1801.09135,607.2856246,2118.931,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PARIETEX MESH 15CM OPT COMPOSITE,,C1781,HCPCS,Facility,Outpatient,,,,2118.931,1801.09135,607.2856246,2118.931,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1069.424476,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PARIETEX MESH 15CM OPT COMPOSITE,,C1781,HCPCS,Facility,Inpatient,,,,2118.931,1801.09135,607.2856246,2118.931,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PARIETEX MESH 15CM OPT COMPOSITE,,C1781,HCPCS,Facility,Both,,,,2118.931,1801.09135,607.2856246,2118.931,UnitedHealthcare,Individual & Family,1991.79514,94,,percent of total billed charges,,
PARIETEX MESH 15CM OPT COMPOSITE,,C1781,HCPCS,Facility,Outpatient,,,,2118.931,1801.09135,607.2856246,2118.931,UnitedHealthcare,Medicare Advantage,1038.27619,49,,percent of total billed charges,,
PARIETEX MESH 15CM OPT COMPOSITE,,C1781,HCPCS,Facility,Inpatient,,,,2118.931,1801.09135,607.2856246,2118.931,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
PARIETEX MESH 15CM OPT COMPOSITE,,C1781,HCPCS,Facility,Outpatient,,,,2118.931,1801.09135,607.2856246,2118.931,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1017.08688,48,,percent of total billed charges,,100% of DHS outpatient percentage
PARIETEX MESH 15CM OPT COMPOSITE,,C1781,HCPCS,Facility,Inpatient,,,,2118.931,1801.09135,607.2856246,2118.931,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
PARIETEX VENTRAL PATCH 4C,,C1781,HCPCS,Facility,Both,,,,924.65,785.9525,265.00469,924.65,Aetna,Commercial,850.678,92,,percent of total billed charges,,
PARIETEX VENTRAL PATCH 4C,,C1781,HCPCS,Facility,Outpatient,,,,924.65,785.9525,265.00469,924.65,Aetna,Medicare Advantage,453.0785,49,,percent of total billed charges,,
PARIETEX VENTRAL PATCH 4C,,C1781,HCPCS,Facility,Inpatient,,,,924.65,785.9525,265.00469,924.65,Aetna,Medicare Advantage,,,,,Included in per diem rate,
PARIETEX VENTRAL PATCH 4C,,C1781,HCPCS,Facility,Both,,,,924.65,785.9525,265.00469,924.65,Aetna,PPO,859.9245,93,,percent of total billed charges,,
PARIETEX VENTRAL PATCH 4C,,C1781,HCPCS,Facility,Both,,,,924.65,785.9525,265.00469,924.65,America's PPO,America's PPO,887.941395,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
PARIETEX VENTRAL PATCH 4C,,C1781,HCPCS,Facility,Both,,,,924.65,785.9525,265.00469,924.65,BlueCross BlueShield Minnesota, Federal Employee Program,909.8556,98.4,,percent of total billed charges,,
PARIETEX VENTRAL PATCH 4C,,C1781,HCPCS,Facility,Both,,,,924.65,785.9525,265.00469,924.65,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,924.65,100,,percent of total billed charges,,
PARIETEX VENTRAL PATCH 4C,,C1781,HCPCS,Facility,Both,,,,924.65,785.9525,265.00469,924.65,BlueCross BlueShield Minnesota,High Value Network Plan,832.185,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
PARIETEX VENTRAL PATCH 4C,,C1781,HCPCS,Facility,Outpatient,,,,924.65,785.9525,265.00469,924.65,BlueCross BlueShield Minnesota,Medicare Advantage,453.0785,49,,percent of total billed charges,,
PARIETEX VENTRAL PATCH 4C,,C1781,HCPCS,Facility,Inpatient,,,,924.65,785.9525,265.00469,924.65,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
PARIETEX VENTRAL PATCH 4C,,C1781,HCPCS,Facility,Both,,,,924.65,785.9525,265.00469,924.65,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,818.962505,88.57,,percent of total billed charges,,
PARIETEX VENTRAL PATCH 4C,,C1781,HCPCS,Facility,Both,,,,924.65,785.9525,265.00469,924.65,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,265.00469,28.66,,percent of total billed charges,,
PARIETEX VENTRAL PATCH 4C,,C1781,HCPCS,Facility,Outpatient,,,,924.65,785.9525,265.00469,924.65,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),453.0785,49,,percent of total billed charges,,
PARIETEX VENTRAL PATCH 4C,,C1781,HCPCS,Facility,Inpatient,,,,924.65,785.9525,265.00469,924.65,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
PARIETEX VENTRAL PATCH 4C,,C1781,HCPCS,Facility,Both,,,,924.65,785.9525,265.00469,924.65,CorVel,Worker's Compensation,924.65,100,,percent of total billed charges,,
PARIETEX VENTRAL PATCH 4C,,C1781,HCPCS,Facility,Both,,,,924.65,785.9525,265.00469,924.65,First Health Group Corporation,First Health Network,896.9105,97,,percent of total billed charges,,
PARIETEX VENTRAL PATCH 4C,,C1781,HCPCS,Facility,Both,,,,924.65,785.9525,265.00469,924.65,"Health Partners, Inc.",Commercial,874.7189,94.6,,percent of total billed charges,,
PARIETEX VENTRAL PATCH 4C,,C1781,HCPCS,Facility,Outpatient,,,,924.65,785.9525,265.00469,924.65,"Health Partners, Inc.",Medicare Advantage,453.0785,49,,percent of total billed charges,,
PARIETEX VENTRAL PATCH 4C,,C1781,HCPCS,Facility,Inpatient,,,,924.65,785.9525,265.00469,924.65,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PARIETEX VENTRAL PATCH 4C,,C1781,HCPCS,Facility,Both,,,,924.65,785.9525,265.00469,924.65,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),554.79,60,,percent of total billed charges,,
PARIETEX VENTRAL PATCH 4C,,C1781,HCPCS,Facility,Both,,,,924.65,785.9525,265.00469,924.65,"Health Partners, Inc.",State of Minnesota Advantage Program,753.58975,81.5,,percent of total billed charges,,
PARIETEX VENTRAL PATCH 4C,,C1781,HCPCS,Facility,Both,,,,924.65,785.9525,265.00469,924.65,"Health Partners, Inc.",State Public Programs,462.325,50,,percent of total billed charges,,
PARIETEX VENTRAL PATCH 4C,,C1781,HCPCS,Facility,Both,,,,924.65,785.9525,265.00469,924.65,Humana Insurance Company,Commercial PPO,878.4175,95,,percent of total billed charges,,
PARIETEX VENTRAL PATCH 4C,,C1781,HCPCS,Facility,Outpatient,,,,924.65,785.9525,265.00469,924.65,Humana Insurance Company,Medicare PPO,453.0785,49,,percent of total billed charges,,
PARIETEX VENTRAL PATCH 4C,,C1781,HCPCS,Facility,Inpatient,,,,924.65,785.9525,265.00469,924.65,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
PARIETEX VENTRAL PATCH 4C,,C1781,HCPCS,Facility,Both,,,,924.65,785.9525,265.00469,924.65,Medica,Individual & Family,916.32815,99.1,,percent of total billed charges,,
PARIETEX VENTRAL PATCH 4C,,C1781,HCPCS,Facility,Outpatient,,,,924.65,785.9525,265.00469,924.65,Medica,Medica Advantage Solution,460.4757,49.8,,percent of total billed charges,,
PARIETEX VENTRAL PATCH 4C,,C1781,HCPCS,Facility,Inpatient,,,,924.65,785.9525,265.00469,924.65,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
PARIETEX VENTRAL PATCH 4C,,C1781,HCPCS,Facility,Outpatient,,,,924.65,785.9525,265.00469,924.65,Medica,Medical Assistance,412.3939,44.6,,percent of total billed charges,,
PARIETEX VENTRAL PATCH 4C,,C1781,HCPCS,Facility,Inpatient,,,,924.65,785.9525,265.00469,924.65,Medica,Medical Assistance,,,,,Included in per diem rate,
PARIETEX VENTRAL PATCH 4C,,C1781,HCPCS,Facility,Outpatient,,,,924.65,785.9525,265.00469,924.65,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,460.4757,49.8,,percent of total billed charges,,
PARIETEX VENTRAL PATCH 4C,,C1781,HCPCS,Facility,Inpatient,,,,924.65,785.9525,265.00469,924.65,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
PARIETEX VENTRAL PATCH 4C,,C1781,HCPCS,Facility,Both,,,,924.65,785.9525,265.00469,924.65,"Multiplan, Inc.","Multiplan, Inc.",869.171,94,,percent of total billed charges,,
PARIETEX VENTRAL PATCH 4C,,C1781,HCPCS,Facility,Outpatient,,,,924.65,785.9525,265.00469,924.65,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,833.10965,90.1,,percent of total billed charges,,
PARIETEX VENTRAL PATCH 4C,,C1781,HCPCS,Facility,Inpatient,,,,924.65,785.9525,265.00469,924.65,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
PARIETEX VENTRAL PATCH 4C,,C1781,HCPCS,Facility,Both,,,,924.65,785.9525,265.00469,924.65,"Preferred One Administrative Services, INC.",PPO,911.7049,98.6,,percent of total billed charges,,
PARIETEX VENTRAL PATCH 4C,,C1781,HCPCS,Facility,Outpatient,,,,924.65,785.9525,265.00469,924.65,PrimeWest Health,Minnesota Senior Health Options (MSHO),475.732425,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
PARIETEX VENTRAL PATCH 4C,,C1781,HCPCS,Facility,Inpatient,,,,924.65,785.9525,265.00469,924.65,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PARIETEX VENTRAL PATCH 4C,,C1781,HCPCS,Facility,Outpatient,,,,924.65,785.9525,265.00469,924.65,PrimeWest Health,MinnesotaCare,474.90024,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
PARIETEX VENTRAL PATCH 4C,,C1781,HCPCS,Facility,Inpatient,,,,924.65,785.9525,265.00469,924.65,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
PARIETEX VENTRAL PATCH 4C,,C1781,HCPCS,Facility,Both,,,,924.65,785.9525,265.00469,924.65,Sanford Health Plan,Sanford Health Plan,850.678,92,,percent of total billed charges,,
PARIETEX VENTRAL PATCH 4C,,C1781,HCPCS,Facility,Outpatient,,,,924.65,785.9525,265.00469,924.65,"UCare Health, Inc.",Individual & Family Plan,521.040275,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
PARIETEX VENTRAL PATCH 4C,,C1781,HCPCS,Facility,Inpatient,,,,924.65,785.9525,265.00469,924.65,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
PARIETEX VENTRAL PATCH 4C,,C1781,HCPCS,Facility,Outpatient,,,,924.65,785.9525,265.00469,924.65,"UCare Health, Inc.",Medical Assistance,466.670855,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PARIETEX VENTRAL PATCH 4C,,C1781,HCPCS,Facility,Inpatient,,,,924.65,785.9525,265.00469,924.65,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
PARIETEX VENTRAL PATCH 4C,,C1781,HCPCS,Facility,Outpatient,,,,924.65,785.9525,265.00469,924.65,"UCare Health, Inc.",Medicare Advantage,466.670855,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PARIETEX VENTRAL PATCH 4C,,C1781,HCPCS,Facility,Inpatient,,,,924.65,785.9525,265.00469,924.65,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PARIETEX VENTRAL PATCH 4C,,C1781,HCPCS,Facility,Outpatient,,,,924.65,785.9525,265.00469,924.65,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),466.670855,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PARIETEX VENTRAL PATCH 4C,,C1781,HCPCS,Facility,Inpatient,,,,924.65,785.9525,265.00469,924.65,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PARIETEX VENTRAL PATCH 4C,,C1781,HCPCS,Facility,Both,,,,924.65,785.9525,265.00469,924.65,UnitedHealthcare,Individual & Family,869.171,94,,percent of total billed charges,,
PARIETEX VENTRAL PATCH 4C,,C1781,HCPCS,Facility,Outpatient,,,,924.65,785.9525,265.00469,924.65,UnitedHealthcare,Medicare Advantage,453.0785,49,,percent of total billed charges,,
PARIETEX VENTRAL PATCH 4C,,C1781,HCPCS,Facility,Inpatient,,,,924.65,785.9525,265.00469,924.65,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
PARIETEX VENTRAL PATCH 4C,,C1781,HCPCS,Facility,Outpatient,,,,924.65,785.9525,265.00469,924.65,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,443.832,48,,percent of total billed charges,,100% of DHS outpatient percentage
PARIETEX VENTRAL PATCH 4C,,C1781,HCPCS,Facility,Inpatient,,,,924.65,785.9525,265.00469,924.65,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
PARIETEX VENTRAL PATCH 6C,,C1781,HCPCS,Facility,Both,,,,1932.72,1642.812,553.917552,1932.72,Aetna,Commercial,1778.1024,92,,percent of total billed charges,,
PARIETEX VENTRAL PATCH 6C,,C1781,HCPCS,Facility,Outpatient,,,,1932.72,1642.812,553.917552,1932.72,Aetna,Medicare Advantage,947.0328,49,,percent of total billed charges,,
PARIETEX VENTRAL PATCH 6C,,C1781,HCPCS,Facility,Inpatient,,,,1932.72,1642.812,553.917552,1932.72,Aetna,Medicare Advantage,,,,,Included in per diem rate,
PARIETEX VENTRAL PATCH 6C,,C1781,HCPCS,Facility,Both,,,,1932.72,1642.812,553.917552,1932.72,Aetna,PPO,1797.4296,93,,percent of total billed charges,,
PARIETEX VENTRAL PATCH 6C,,C1781,HCPCS,Facility,Both,,,,1932.72,1642.812,553.917552,1932.72,America's PPO,America's PPO,1855.991016,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
PARIETEX VENTRAL PATCH 6C,,C1781,HCPCS,Facility,Both,,,,1932.72,1642.812,553.917552,1932.72,BlueCross BlueShield Minnesota, Federal Employee Program,1901.79648,98.4,,percent of total billed charges,,
PARIETEX VENTRAL PATCH 6C,,C1781,HCPCS,Facility,Both,,,,1932.72,1642.812,553.917552,1932.72,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1932.72,100,,percent of total billed charges,,
PARIETEX VENTRAL PATCH 6C,,C1781,HCPCS,Facility,Both,,,,1932.72,1642.812,553.917552,1932.72,BlueCross BlueShield Minnesota,High Value Network Plan,1739.448,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
PARIETEX VENTRAL PATCH 6C,,C1781,HCPCS,Facility,Outpatient,,,,1932.72,1642.812,553.917552,1932.72,BlueCross BlueShield Minnesota,Medicare Advantage,947.0328,49,,percent of total billed charges,,
PARIETEX VENTRAL PATCH 6C,,C1781,HCPCS,Facility,Inpatient,,,,1932.72,1642.812,553.917552,1932.72,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
PARIETEX VENTRAL PATCH 6C,,C1781,HCPCS,Facility,Both,,,,1932.72,1642.812,553.917552,1932.72,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1711.810104,88.57,,percent of total billed charges,,
PARIETEX VENTRAL PATCH 6C,,C1781,HCPCS,Facility,Both,,,,1932.72,1642.812,553.917552,1932.72,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,553.917552,28.66,,percent of total billed charges,,
PARIETEX VENTRAL PATCH 6C,,C1781,HCPCS,Facility,Outpatient,,,,1932.72,1642.812,553.917552,1932.72,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),947.0328,49,,percent of total billed charges,,
PARIETEX VENTRAL PATCH 6C,,C1781,HCPCS,Facility,Inpatient,,,,1932.72,1642.812,553.917552,1932.72,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
PARIETEX VENTRAL PATCH 6C,,C1781,HCPCS,Facility,Both,,,,1932.72,1642.812,553.917552,1932.72,CorVel,Worker's Compensation,1932.72,100,,percent of total billed charges,,
PARIETEX VENTRAL PATCH 6C,,C1781,HCPCS,Facility,Both,,,,1932.72,1642.812,553.917552,1932.72,First Health Group Corporation,First Health Network,1874.7384,97,,percent of total billed charges,,
PARIETEX VENTRAL PATCH 6C,,C1781,HCPCS,Facility,Both,,,,1932.72,1642.812,553.917552,1932.72,"Health Partners, Inc.",Commercial,1828.35312,94.6,,percent of total billed charges,,
PARIETEX VENTRAL PATCH 6C,,C1781,HCPCS,Facility,Outpatient,,,,1932.72,1642.812,553.917552,1932.72,"Health Partners, Inc.",Medicare Advantage,947.0328,49,,percent of total billed charges,,
PARIETEX VENTRAL PATCH 6C,,C1781,HCPCS,Facility,Inpatient,,,,1932.72,1642.812,553.917552,1932.72,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PARIETEX VENTRAL PATCH 6C,,C1781,HCPCS,Facility,Both,,,,1932.72,1642.812,553.917552,1932.72,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1159.632,60,,percent of total billed charges,,
PARIETEX VENTRAL PATCH 6C,,C1781,HCPCS,Facility,Both,,,,1932.72,1642.812,553.917552,1932.72,"Health Partners, Inc.",State of Minnesota Advantage Program,1575.1668,81.5,,percent of total billed charges,,
PARIETEX VENTRAL PATCH 6C,,C1781,HCPCS,Facility,Both,,,,1932.72,1642.812,553.917552,1932.72,"Health Partners, Inc.",State Public Programs,966.36,50,,percent of total billed charges,,
PARIETEX VENTRAL PATCH 6C,,C1781,HCPCS,Facility,Both,,,,1932.72,1642.812,553.917552,1932.72,Humana Insurance Company,Commercial PPO,1836.084,95,,percent of total billed charges,,
PARIETEX VENTRAL PATCH 6C,,C1781,HCPCS,Facility,Outpatient,,,,1932.72,1642.812,553.917552,1932.72,Humana Insurance Company,Medicare PPO,947.0328,49,,percent of total billed charges,,
PARIETEX VENTRAL PATCH 6C,,C1781,HCPCS,Facility,Inpatient,,,,1932.72,1642.812,553.917552,1932.72,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
PARIETEX VENTRAL PATCH 6C,,C1781,HCPCS,Facility,Both,,,,1932.72,1642.812,553.917552,1932.72,Medica,Individual & Family,1915.32552,99.1,,percent of total billed charges,,
PARIETEX VENTRAL PATCH 6C,,C1781,HCPCS,Facility,Outpatient,,,,1932.72,1642.812,553.917552,1932.72,Medica,Medica Advantage Solution,962.49456,49.8,,percent of total billed charges,,
PARIETEX VENTRAL PATCH 6C,,C1781,HCPCS,Facility,Inpatient,,,,1932.72,1642.812,553.917552,1932.72,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
PARIETEX VENTRAL PATCH 6C,,C1781,HCPCS,Facility,Outpatient,,,,1932.72,1642.812,553.917552,1932.72,Medica,Medical Assistance,861.99312,44.6,,percent of total billed charges,,
PARIETEX VENTRAL PATCH 6C,,C1781,HCPCS,Facility,Inpatient,,,,1932.72,1642.812,553.917552,1932.72,Medica,Medical Assistance,,,,,Included in per diem rate,
PARIETEX VENTRAL PATCH 6C,,C1781,HCPCS,Facility,Outpatient,,,,1932.72,1642.812,553.917552,1932.72,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,962.49456,49.8,,percent of total billed charges,,
PARIETEX VENTRAL PATCH 6C,,C1781,HCPCS,Facility,Inpatient,,,,1932.72,1642.812,553.917552,1932.72,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
PARIETEX VENTRAL PATCH 6C,,C1781,HCPCS,Facility,Both,,,,1932.72,1642.812,553.917552,1932.72,"Multiplan, Inc.","Multiplan, Inc.",1816.7568,94,,percent of total billed charges,,
PARIETEX VENTRAL PATCH 6C,,C1781,HCPCS,Facility,Outpatient,,,,1932.72,1642.812,553.917552,1932.72,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1741.38072,90.1,,percent of total billed charges,,
PARIETEX VENTRAL PATCH 6C,,C1781,HCPCS,Facility,Inpatient,,,,1932.72,1642.812,553.917552,1932.72,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
PARIETEX VENTRAL PATCH 6C,,C1781,HCPCS,Facility,Both,,,,1932.72,1642.812,553.917552,1932.72,"Preferred One Administrative Services, INC.",PPO,1905.66192,98.6,,percent of total billed charges,,
PARIETEX VENTRAL PATCH 6C,,C1781,HCPCS,Facility,Outpatient,,,,1932.72,1642.812,553.917552,1932.72,PrimeWest Health,Minnesota Senior Health Options (MSHO),994.38444,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
PARIETEX VENTRAL PATCH 6C,,C1781,HCPCS,Facility,Inpatient,,,,1932.72,1642.812,553.917552,1932.72,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PARIETEX VENTRAL PATCH 6C,,C1781,HCPCS,Facility,Outpatient,,,,1932.72,1642.812,553.917552,1932.72,PrimeWest Health,MinnesotaCare,992.644992,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
PARIETEX VENTRAL PATCH 6C,,C1781,HCPCS,Facility,Inpatient,,,,1932.72,1642.812,553.917552,1932.72,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
PARIETEX VENTRAL PATCH 6C,,C1781,HCPCS,Facility,Both,,,,1932.72,1642.812,553.917552,1932.72,Sanford Health Plan,Sanford Health Plan,1778.1024,92,,percent of total billed charges,,
PARIETEX VENTRAL PATCH 6C,,C1781,HCPCS,Facility,Outpatient,,,,1932.72,1642.812,553.917552,1932.72,"UCare Health, Inc.",Individual & Family Plan,1089.08772,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
PARIETEX VENTRAL PATCH 6C,,C1781,HCPCS,Facility,Inpatient,,,,1932.72,1642.812,553.917552,1932.72,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
PARIETEX VENTRAL PATCH 6C,,C1781,HCPCS,Facility,Outpatient,,,,1932.72,1642.812,553.917552,1932.72,"UCare Health, Inc.",Medical Assistance,975.443784,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PARIETEX VENTRAL PATCH 6C,,C1781,HCPCS,Facility,Inpatient,,,,1932.72,1642.812,553.917552,1932.72,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
PARIETEX VENTRAL PATCH 6C,,C1781,HCPCS,Facility,Outpatient,,,,1932.72,1642.812,553.917552,1932.72,"UCare Health, Inc.",Medicare Advantage,975.443784,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PARIETEX VENTRAL PATCH 6C,,C1781,HCPCS,Facility,Inpatient,,,,1932.72,1642.812,553.917552,1932.72,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PARIETEX VENTRAL PATCH 6C,,C1781,HCPCS,Facility,Outpatient,,,,1932.72,1642.812,553.917552,1932.72,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),975.443784,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PARIETEX VENTRAL PATCH 6C,,C1781,HCPCS,Facility,Inpatient,,,,1932.72,1642.812,553.917552,1932.72,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PARIETEX VENTRAL PATCH 6C,,C1781,HCPCS,Facility,Both,,,,1932.72,1642.812,553.917552,1932.72,UnitedHealthcare,Individual & Family,1816.7568,94,,percent of total billed charges,,
PARIETEX VENTRAL PATCH 6C,,C1781,HCPCS,Facility,Outpatient,,,,1932.72,1642.812,553.917552,1932.72,UnitedHealthcare,Medicare Advantage,947.0328,49,,percent of total billed charges,,
PARIETEX VENTRAL PATCH 6C,,C1781,HCPCS,Facility,Inpatient,,,,1932.72,1642.812,553.917552,1932.72,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
PARIETEX VENTRAL PATCH 6C,,C1781,HCPCS,Facility,Outpatient,,,,1932.72,1642.812,553.917552,1932.72,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,927.7056,48,,percent of total billed charges,,100% of DHS outpatient percentage
PARIETEX VENTRAL PATCH 6C,,C1781,HCPCS,Facility,Inpatient,,,,1932.72,1642.812,553.917552,1932.72,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
PROLOOP MESH LG AT30922,,C1781,HCPCS,Facility,Both,,,,454.44,386.274,130.242504,454.44,Aetna,Commercial,418.0848,92,,percent of total billed charges,,
PROLOOP MESH LG AT30922,,C1781,HCPCS,Facility,Outpatient,,,,454.44,386.274,130.242504,454.44,Aetna,Medicare Advantage,222.6756,49,,percent of total billed charges,,
PROLOOP MESH LG AT30922,,C1781,HCPCS,Facility,Inpatient,,,,454.44,386.274,130.242504,454.44,Aetna,Medicare Advantage,,,,,Included in per diem rate,
PROLOOP MESH LG AT30922,,C1781,HCPCS,Facility,Both,,,,454.44,386.274,130.242504,454.44,Aetna,PPO,422.6292,93,,percent of total billed charges,,
PROLOOP MESH LG AT30922,,C1781,HCPCS,Facility,Both,,,,454.44,386.274,130.242504,454.44,America's PPO,America's PPO,436.398732,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
PROLOOP MESH LG AT30922,,C1781,HCPCS,Facility,Both,,,,454.44,386.274,130.242504,454.44,BlueCross BlueShield Minnesota, Federal Employee Program,447.16896,98.4,,percent of total billed charges,,
PROLOOP MESH LG AT30922,,C1781,HCPCS,Facility,Both,,,,454.44,386.274,130.242504,454.44,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,454.44,100,,percent of total billed charges,,
PROLOOP MESH LG AT30922,,C1781,HCPCS,Facility,Both,,,,454.44,386.274,130.242504,454.44,BlueCross BlueShield Minnesota,High Value Network Plan,408.996,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
PROLOOP MESH LG AT30922,,C1781,HCPCS,Facility,Outpatient,,,,454.44,386.274,130.242504,454.44,BlueCross BlueShield Minnesota,Medicare Advantage,222.6756,49,,percent of total billed charges,,
PROLOOP MESH LG AT30922,,C1781,HCPCS,Facility,Inpatient,,,,454.44,386.274,130.242504,454.44,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
PROLOOP MESH LG AT30922,,C1781,HCPCS,Facility,Both,,,,454.44,386.274,130.242504,454.44,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,402.497508,88.57,,percent of total billed charges,,
PROLOOP MESH LG AT30922,,C1781,HCPCS,Facility,Both,,,,454.44,386.274,130.242504,454.44,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,130.242504,28.66,,percent of total billed charges,,
PROLOOP MESH LG AT30922,,C1781,HCPCS,Facility,Outpatient,,,,454.44,386.274,130.242504,454.44,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),222.6756,49,,percent of total billed charges,,
PROLOOP MESH LG AT30922,,C1781,HCPCS,Facility,Inpatient,,,,454.44,386.274,130.242504,454.44,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
PROLOOP MESH LG AT30922,,C1781,HCPCS,Facility,Both,,,,454.44,386.274,130.242504,454.44,CorVel,Worker's Compensation,454.44,100,,percent of total billed charges,,
PROLOOP MESH LG AT30922,,C1781,HCPCS,Facility,Both,,,,454.44,386.274,130.242504,454.44,First Health Group Corporation,First Health Network,440.8068,97,,percent of total billed charges,,
PROLOOP MESH LG AT30922,,C1781,HCPCS,Facility,Both,,,,454.44,386.274,130.242504,454.44,"Health Partners, Inc.",Commercial,429.90024,94.6,,percent of total billed charges,,
PROLOOP MESH LG AT30922,,C1781,HCPCS,Facility,Outpatient,,,,454.44,386.274,130.242504,454.44,"Health Partners, Inc.",Medicare Advantage,222.6756,49,,percent of total billed charges,,
PROLOOP MESH LG AT30922,,C1781,HCPCS,Facility,Inpatient,,,,454.44,386.274,130.242504,454.44,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PROLOOP MESH LG AT30922,,C1781,HCPCS,Facility,Both,,,,454.44,386.274,130.242504,454.44,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),272.664,60,,percent of total billed charges,,
PROLOOP MESH LG AT30922,,C1781,HCPCS,Facility,Both,,,,454.44,386.274,130.242504,454.44,"Health Partners, Inc.",State of Minnesota Advantage Program,370.3686,81.5,,percent of total billed charges,,
PROLOOP MESH LG AT30922,,C1781,HCPCS,Facility,Both,,,,454.44,386.274,130.242504,454.44,"Health Partners, Inc.",State Public Programs,227.22,50,,percent of total billed charges,,
PROLOOP MESH LG AT30922,,C1781,HCPCS,Facility,Both,,,,454.44,386.274,130.242504,454.44,Humana Insurance Company,Commercial PPO,431.718,95,,percent of total billed charges,,
PROLOOP MESH LG AT30922,,C1781,HCPCS,Facility,Outpatient,,,,454.44,386.274,130.242504,454.44,Humana Insurance Company,Medicare PPO,222.6756,49,,percent of total billed charges,,
PROLOOP MESH LG AT30922,,C1781,HCPCS,Facility,Inpatient,,,,454.44,386.274,130.242504,454.44,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
PROLOOP MESH LG AT30922,,C1781,HCPCS,Facility,Both,,,,454.44,386.274,130.242504,454.44,Medica,Individual & Family,450.35004,99.1,,percent of total billed charges,,
PROLOOP MESH LG AT30922,,C1781,HCPCS,Facility,Outpatient,,,,454.44,386.274,130.242504,454.44,Medica,Medica Advantage Solution,226.31112,49.8,,percent of total billed charges,,
PROLOOP MESH LG AT30922,,C1781,HCPCS,Facility,Inpatient,,,,454.44,386.274,130.242504,454.44,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
PROLOOP MESH LG AT30922,,C1781,HCPCS,Facility,Outpatient,,,,454.44,386.274,130.242504,454.44,Medica,Medical Assistance,202.68024,44.6,,percent of total billed charges,,
PROLOOP MESH LG AT30922,,C1781,HCPCS,Facility,Inpatient,,,,454.44,386.274,130.242504,454.44,Medica,Medical Assistance,,,,,Included in per diem rate,
PROLOOP MESH LG AT30922,,C1781,HCPCS,Facility,Outpatient,,,,454.44,386.274,130.242504,454.44,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,226.31112,49.8,,percent of total billed charges,,
PROLOOP MESH LG AT30922,,C1781,HCPCS,Facility,Inpatient,,,,454.44,386.274,130.242504,454.44,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
PROLOOP MESH LG AT30922,,C1781,HCPCS,Facility,Both,,,,454.44,386.274,130.242504,454.44,"Multiplan, Inc.","Multiplan, Inc.",427.1736,94,,percent of total billed charges,,
PROLOOP MESH LG AT30922,,C1781,HCPCS,Facility,Outpatient,,,,454.44,386.274,130.242504,454.44,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,409.45044,90.1,,percent of total billed charges,,
PROLOOP MESH LG AT30922,,C1781,HCPCS,Facility,Inpatient,,,,454.44,386.274,130.242504,454.44,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
PROLOOP MESH LG AT30922,,C1781,HCPCS,Facility,Both,,,,454.44,386.274,130.242504,454.44,"Preferred One Administrative Services, INC.",PPO,448.07784,98.6,,percent of total billed charges,,
PROLOOP MESH LG AT30922,,C1781,HCPCS,Facility,Outpatient,,,,454.44,386.274,130.242504,454.44,PrimeWest Health,Minnesota Senior Health Options (MSHO),233.80938,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
PROLOOP MESH LG AT30922,,C1781,HCPCS,Facility,Inpatient,,,,454.44,386.274,130.242504,454.44,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PROLOOP MESH LG AT30922,,C1781,HCPCS,Facility,Outpatient,,,,454.44,386.274,130.242504,454.44,PrimeWest Health,MinnesotaCare,233.400384,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
PROLOOP MESH LG AT30922,,C1781,HCPCS,Facility,Inpatient,,,,454.44,386.274,130.242504,454.44,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
PROLOOP MESH LG AT30922,,C1781,HCPCS,Facility,Both,,,,454.44,386.274,130.242504,454.44,Sanford Health Plan,Sanford Health Plan,418.0848,92,,percent of total billed charges,,
PROLOOP MESH LG AT30922,,C1781,HCPCS,Facility,Outpatient,,,,454.44,386.274,130.242504,454.44,"UCare Health, Inc.",Individual & Family Plan,256.07694,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
PROLOOP MESH LG AT30922,,C1781,HCPCS,Facility,Inpatient,,,,454.44,386.274,130.242504,454.44,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
PROLOOP MESH LG AT30922,,C1781,HCPCS,Facility,Outpatient,,,,454.44,386.274,130.242504,454.44,"UCare Health, Inc.",Medical Assistance,229.355868,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PROLOOP MESH LG AT30922,,C1781,HCPCS,Facility,Inpatient,,,,454.44,386.274,130.242504,454.44,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
PROLOOP MESH LG AT30922,,C1781,HCPCS,Facility,Outpatient,,,,454.44,386.274,130.242504,454.44,"UCare Health, Inc.",Medicare Advantage,229.355868,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PROLOOP MESH LG AT30922,,C1781,HCPCS,Facility,Inpatient,,,,454.44,386.274,130.242504,454.44,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PROLOOP MESH LG AT30922,,C1781,HCPCS,Facility,Outpatient,,,,454.44,386.274,130.242504,454.44,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),229.355868,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PROLOOP MESH LG AT30922,,C1781,HCPCS,Facility,Inpatient,,,,454.44,386.274,130.242504,454.44,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PROLOOP MESH LG AT30922,,C1781,HCPCS,Facility,Both,,,,454.44,386.274,130.242504,454.44,UnitedHealthcare,Individual & Family,427.1736,94,,percent of total billed charges,,
PROLOOP MESH LG AT30922,,C1781,HCPCS,Facility,Outpatient,,,,454.44,386.274,130.242504,454.44,UnitedHealthcare,Medicare Advantage,222.6756,49,,percent of total billed charges,,
PROLOOP MESH LG AT30922,,C1781,HCPCS,Facility,Inpatient,,,,454.44,386.274,130.242504,454.44,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
PROLOOP MESH LG AT30922,,C1781,HCPCS,Facility,Outpatient,,,,454.44,386.274,130.242504,454.44,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,218.1312,48,,percent of total billed charges,,100% of DHS outpatient percentage
PROLOOP MESH LG AT30922,,C1781,HCPCS,Facility,Inpatient,,,,454.44,386.274,130.242504,454.44,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
PROLOOP MESH MED AT30909,,C1781,HCPCS,Facility,Both,,,,315,267.75,90.279,315,Aetna,Commercial,289.8,92,,percent of total billed charges,,
PROLOOP MESH MED AT30909,,C1781,HCPCS,Facility,Outpatient,,,,315,267.75,90.279,315,Aetna,Medicare Advantage,154.35,49,,percent of total billed charges,,
PROLOOP MESH MED AT30909,,C1781,HCPCS,Facility,Inpatient,,,,315,267.75,90.279,315,Aetna,Medicare Advantage,,,,,Included in per diem rate,
PROLOOP MESH MED AT30909,,C1781,HCPCS,Facility,Both,,,,315,267.75,90.279,315,Aetna,PPO,292.95,93,,percent of total billed charges,,
PROLOOP MESH MED AT30909,,C1781,HCPCS,Facility,Both,,,,315,267.75,90.279,315,America's PPO,America's PPO,302.4945,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
PROLOOP MESH MED AT30909,,C1781,HCPCS,Facility,Both,,,,315,267.75,90.279,315,BlueCross BlueShield Minnesota, Federal Employee Program,309.96,98.4,,percent of total billed charges,,
PROLOOP MESH MED AT30909,,C1781,HCPCS,Facility,Both,,,,315,267.75,90.279,315,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,315,100,,percent of total billed charges,,
PROLOOP MESH MED AT30909,,C1781,HCPCS,Facility,Both,,,,315,267.75,90.279,315,BlueCross BlueShield Minnesota,High Value Network Plan,283.5,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
PROLOOP MESH MED AT30909,,C1781,HCPCS,Facility,Outpatient,,,,315,267.75,90.279,315,BlueCross BlueShield Minnesota,Medicare Advantage,154.35,49,,percent of total billed charges,,
PROLOOP MESH MED AT30909,,C1781,HCPCS,Facility,Inpatient,,,,315,267.75,90.279,315,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
PROLOOP MESH MED AT30909,,C1781,HCPCS,Facility,Both,,,,315,267.75,90.279,315,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,278.9955,88.57,,percent of total billed charges,,
PROLOOP MESH MED AT30909,,C1781,HCPCS,Facility,Both,,,,315,267.75,90.279,315,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,90.279,28.66,,percent of total billed charges,,
PROLOOP MESH MED AT30909,,C1781,HCPCS,Facility,Outpatient,,,,315,267.75,90.279,315,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),154.35,49,,percent of total billed charges,,
PROLOOP MESH MED AT30909,,C1781,HCPCS,Facility,Inpatient,,,,315,267.75,90.279,315,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
PROLOOP MESH MED AT30909,,C1781,HCPCS,Facility,Both,,,,315,267.75,90.279,315,CorVel,Worker's Compensation,315,100,,percent of total billed charges,,
PROLOOP MESH MED AT30909,,C1781,HCPCS,Facility,Both,,,,315,267.75,90.279,315,First Health Group Corporation,First Health Network,305.55,97,,percent of total billed charges,,
PROLOOP MESH MED AT30909,,C1781,HCPCS,Facility,Both,,,,315,267.75,90.279,315,"Health Partners, Inc.",Commercial,297.99,94.6,,percent of total billed charges,,
PROLOOP MESH MED AT30909,,C1781,HCPCS,Facility,Outpatient,,,,315,267.75,90.279,315,"Health Partners, Inc.",Medicare Advantage,154.35,49,,percent of total billed charges,,
PROLOOP MESH MED AT30909,,C1781,HCPCS,Facility,Inpatient,,,,315,267.75,90.279,315,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PROLOOP MESH MED AT30909,,C1781,HCPCS,Facility,Both,,,,315,267.75,90.279,315,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),189,60,,percent of total billed charges,,
PROLOOP MESH MED AT30909,,C1781,HCPCS,Facility,Both,,,,315,267.75,90.279,315,"Health Partners, Inc.",State of Minnesota Advantage Program,256.725,81.5,,percent of total billed charges,,
PROLOOP MESH MED AT30909,,C1781,HCPCS,Facility,Both,,,,315,267.75,90.279,315,"Health Partners, Inc.",State Public Programs,157.5,50,,percent of total billed charges,,
PROLOOP MESH MED AT30909,,C1781,HCPCS,Facility,Both,,,,315,267.75,90.279,315,Humana Insurance Company,Commercial PPO,299.25,95,,percent of total billed charges,,
PROLOOP MESH MED AT30909,,C1781,HCPCS,Facility,Outpatient,,,,315,267.75,90.279,315,Humana Insurance Company,Medicare PPO,154.35,49,,percent of total billed charges,,
PROLOOP MESH MED AT30909,,C1781,HCPCS,Facility,Inpatient,,,,315,267.75,90.279,315,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
PROLOOP MESH MED AT30909,,C1781,HCPCS,Facility,Both,,,,315,267.75,90.279,315,Medica,Individual & Family,312.165,99.1,,percent of total billed charges,,
PROLOOP MESH MED AT30909,,C1781,HCPCS,Facility,Outpatient,,,,315,267.75,90.279,315,Medica,Medica Advantage Solution,156.87,49.8,,percent of total billed charges,,
PROLOOP MESH MED AT30909,,C1781,HCPCS,Facility,Inpatient,,,,315,267.75,90.279,315,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
PROLOOP MESH MED AT30909,,C1781,HCPCS,Facility,Outpatient,,,,315,267.75,90.279,315,Medica,Medical Assistance,140.49,44.6,,percent of total billed charges,,
PROLOOP MESH MED AT30909,,C1781,HCPCS,Facility,Inpatient,,,,315,267.75,90.279,315,Medica,Medical Assistance,,,,,Included in per diem rate,
PROLOOP MESH MED AT30909,,C1781,HCPCS,Facility,Outpatient,,,,315,267.75,90.279,315,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,156.87,49.8,,percent of total billed charges,,
PROLOOP MESH MED AT30909,,C1781,HCPCS,Facility,Inpatient,,,,315,267.75,90.279,315,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
PROLOOP MESH MED AT30909,,C1781,HCPCS,Facility,Both,,,,315,267.75,90.279,315,"Multiplan, Inc.","Multiplan, Inc.",296.1,94,,percent of total billed charges,,
PROLOOP MESH MED AT30909,,C1781,HCPCS,Facility,Outpatient,,,,315,267.75,90.279,315,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,283.815,90.1,,percent of total billed charges,,
PROLOOP MESH MED AT30909,,C1781,HCPCS,Facility,Inpatient,,,,315,267.75,90.279,315,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
PROLOOP MESH MED AT30909,,C1781,HCPCS,Facility,Both,,,,315,267.75,90.279,315,"Preferred One Administrative Services, INC.",PPO,310.59,98.6,,percent of total billed charges,,
PROLOOP MESH MED AT30909,,C1781,HCPCS,Facility,Outpatient,,,,315,267.75,90.279,315,PrimeWest Health,Minnesota Senior Health Options (MSHO),162.0675,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
PROLOOP MESH MED AT30909,,C1781,HCPCS,Facility,Inpatient,,,,315,267.75,90.279,315,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PROLOOP MESH MED AT30909,,C1781,HCPCS,Facility,Outpatient,,,,315,267.75,90.279,315,PrimeWest Health,MinnesotaCare,161.784,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
PROLOOP MESH MED AT30909,,C1781,HCPCS,Facility,Inpatient,,,,315,267.75,90.279,315,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
PROLOOP MESH MED AT30909,,C1781,HCPCS,Facility,Both,,,,315,267.75,90.279,315,Sanford Health Plan,Sanford Health Plan,289.8,92,,percent of total billed charges,,
PROLOOP MESH MED AT30909,,C1781,HCPCS,Facility,Outpatient,,,,315,267.75,90.279,315,"UCare Health, Inc.",Individual & Family Plan,177.5025,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
PROLOOP MESH MED AT30909,,C1781,HCPCS,Facility,Inpatient,,,,315,267.75,90.279,315,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
PROLOOP MESH MED AT30909,,C1781,HCPCS,Facility,Outpatient,,,,315,267.75,90.279,315,"UCare Health, Inc.",Medical Assistance,158.9805,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PROLOOP MESH MED AT30909,,C1781,HCPCS,Facility,Inpatient,,,,315,267.75,90.279,315,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
PROLOOP MESH MED AT30909,,C1781,HCPCS,Facility,Outpatient,,,,315,267.75,90.279,315,"UCare Health, Inc.",Medicare Advantage,158.9805,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PROLOOP MESH MED AT30909,,C1781,HCPCS,Facility,Inpatient,,,,315,267.75,90.279,315,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PROLOOP MESH MED AT30909,,C1781,HCPCS,Facility,Outpatient,,,,315,267.75,90.279,315,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),158.9805,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PROLOOP MESH MED AT30909,,C1781,HCPCS,Facility,Inpatient,,,,315,267.75,90.279,315,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PROLOOP MESH MED AT30909,,C1781,HCPCS,Facility,Both,,,,315,267.75,90.279,315,UnitedHealthcare,Individual & Family,296.1,94,,percent of total billed charges,,
PROLOOP MESH MED AT30909,,C1781,HCPCS,Facility,Outpatient,,,,315,267.75,90.279,315,UnitedHealthcare,Medicare Advantage,154.35,49,,percent of total billed charges,,
PROLOOP MESH MED AT30909,,C1781,HCPCS,Facility,Inpatient,,,,315,267.75,90.279,315,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
PROLOOP MESH MED AT30909,,C1781,HCPCS,Facility,Outpatient,,,,315,267.75,90.279,315,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,151.2,48,,percent of total billed charges,,100% of DHS outpatient percentage
PROLOOP MESH MED AT30909,,C1781,HCPCS,Facility,Inpatient,,,,315,267.75,90.279,315,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
PROLOOP MESH SM 30908,,C1781,HCPCS,Facility,Both,,,,506.13,430.2105,145.056858,506.13,Aetna,Commercial,465.6396,92,,percent of total billed charges,,
PROLOOP MESH SM 30908,,C1781,HCPCS,Facility,Outpatient,,,,506.13,430.2105,145.056858,506.13,Aetna,Medicare Advantage,248.0037,49,,percent of total billed charges,,
PROLOOP MESH SM 30908,,C1781,HCPCS,Facility,Inpatient,,,,506.13,430.2105,145.056858,506.13,Aetna,Medicare Advantage,,,,,Included in per diem rate,
PROLOOP MESH SM 30908,,C1781,HCPCS,Facility,Both,,,,506.13,430.2105,145.056858,506.13,Aetna,PPO,470.7009,93,,percent of total billed charges,,
PROLOOP MESH SM 30908,,C1781,HCPCS,Facility,Both,,,,506.13,430.2105,145.056858,506.13,America's PPO,America's PPO,486.036639,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
PROLOOP MESH SM 30908,,C1781,HCPCS,Facility,Both,,,,506.13,430.2105,145.056858,506.13,BlueCross BlueShield Minnesota, Federal Employee Program,498.03192,98.4,,percent of total billed charges,,
PROLOOP MESH SM 30908,,C1781,HCPCS,Facility,Both,,,,506.13,430.2105,145.056858,506.13,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,506.13,100,,percent of total billed charges,,
PROLOOP MESH SM 30908,,C1781,HCPCS,Facility,Both,,,,506.13,430.2105,145.056858,506.13,BlueCross BlueShield Minnesota,High Value Network Plan,455.517,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
PROLOOP MESH SM 30908,,C1781,HCPCS,Facility,Outpatient,,,,506.13,430.2105,145.056858,506.13,BlueCross BlueShield Minnesota,Medicare Advantage,248.0037,49,,percent of total billed charges,,
PROLOOP MESH SM 30908,,C1781,HCPCS,Facility,Inpatient,,,,506.13,430.2105,145.056858,506.13,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
PROLOOP MESH SM 30908,,C1781,HCPCS,Facility,Both,,,,506.13,430.2105,145.056858,506.13,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,448.279341,88.57,,percent of total billed charges,,
PROLOOP MESH SM 30908,,C1781,HCPCS,Facility,Both,,,,506.13,430.2105,145.056858,506.13,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,145.056858,28.66,,percent of total billed charges,,
PROLOOP MESH SM 30908,,C1781,HCPCS,Facility,Outpatient,,,,506.13,430.2105,145.056858,506.13,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),248.0037,49,,percent of total billed charges,,
PROLOOP MESH SM 30908,,C1781,HCPCS,Facility,Inpatient,,,,506.13,430.2105,145.056858,506.13,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
PROLOOP MESH SM 30908,,C1781,HCPCS,Facility,Both,,,,506.13,430.2105,145.056858,506.13,CorVel,Worker's Compensation,506.13,100,,percent of total billed charges,,
PROLOOP MESH SM 30908,,C1781,HCPCS,Facility,Both,,,,506.13,430.2105,145.056858,506.13,First Health Group Corporation,First Health Network,490.9461,97,,percent of total billed charges,,
PROLOOP MESH SM 30908,,C1781,HCPCS,Facility,Both,,,,506.13,430.2105,145.056858,506.13,"Health Partners, Inc.",Commercial,478.79898,94.6,,percent of total billed charges,,
PROLOOP MESH SM 30908,,C1781,HCPCS,Facility,Outpatient,,,,506.13,430.2105,145.056858,506.13,"Health Partners, Inc.",Medicare Advantage,248.0037,49,,percent of total billed charges,,
PROLOOP MESH SM 30908,,C1781,HCPCS,Facility,Inpatient,,,,506.13,430.2105,145.056858,506.13,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PROLOOP MESH SM 30908,,C1781,HCPCS,Facility,Both,,,,506.13,430.2105,145.056858,506.13,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),303.678,60,,percent of total billed charges,,
PROLOOP MESH SM 30908,,C1781,HCPCS,Facility,Both,,,,506.13,430.2105,145.056858,506.13,"Health Partners, Inc.",State of Minnesota Advantage Program,412.49595,81.5,,percent of total billed charges,,
PROLOOP MESH SM 30908,,C1781,HCPCS,Facility,Both,,,,506.13,430.2105,145.056858,506.13,"Health Partners, Inc.",State Public Programs,253.065,50,,percent of total billed charges,,
PROLOOP MESH SM 30908,,C1781,HCPCS,Facility,Both,,,,506.13,430.2105,145.056858,506.13,Humana Insurance Company,Commercial PPO,480.8235,95,,percent of total billed charges,,
PROLOOP MESH SM 30908,,C1781,HCPCS,Facility,Outpatient,,,,506.13,430.2105,145.056858,506.13,Humana Insurance Company,Medicare PPO,248.0037,49,,percent of total billed charges,,
PROLOOP MESH SM 30908,,C1781,HCPCS,Facility,Inpatient,,,,506.13,430.2105,145.056858,506.13,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
PROLOOP MESH SM 30908,,C1781,HCPCS,Facility,Both,,,,506.13,430.2105,145.056858,506.13,Medica,Individual & Family,501.57483,99.1,,percent of total billed charges,,
PROLOOP MESH SM 30908,,C1781,HCPCS,Facility,Outpatient,,,,506.13,430.2105,145.056858,506.13,Medica,Medica Advantage Solution,252.05274,49.8,,percent of total billed charges,,
PROLOOP MESH SM 30908,,C1781,HCPCS,Facility,Inpatient,,,,506.13,430.2105,145.056858,506.13,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
PROLOOP MESH SM 30908,,C1781,HCPCS,Facility,Outpatient,,,,506.13,430.2105,145.056858,506.13,Medica,Medical Assistance,225.73398,44.6,,percent of total billed charges,,
PROLOOP MESH SM 30908,,C1781,HCPCS,Facility,Inpatient,,,,506.13,430.2105,145.056858,506.13,Medica,Medical Assistance,,,,,Included in per diem rate,
PROLOOP MESH SM 30908,,C1781,HCPCS,Facility,Outpatient,,,,506.13,430.2105,145.056858,506.13,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,252.05274,49.8,,percent of total billed charges,,
PROLOOP MESH SM 30908,,C1781,HCPCS,Facility,Inpatient,,,,506.13,430.2105,145.056858,506.13,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
PROLOOP MESH SM 30908,,C1781,HCPCS,Facility,Both,,,,506.13,430.2105,145.056858,506.13,"Multiplan, Inc.","Multiplan, Inc.",475.7622,94,,percent of total billed charges,,
PROLOOP MESH SM 30908,,C1781,HCPCS,Facility,Outpatient,,,,506.13,430.2105,145.056858,506.13,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,456.02313,90.1,,percent of total billed charges,,
PROLOOP MESH SM 30908,,C1781,HCPCS,Facility,Inpatient,,,,506.13,430.2105,145.056858,506.13,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
PROLOOP MESH SM 30908,,C1781,HCPCS,Facility,Both,,,,506.13,430.2105,145.056858,506.13,"Preferred One Administrative Services, INC.",PPO,499.04418,98.6,,percent of total billed charges,,
PROLOOP MESH SM 30908,,C1781,HCPCS,Facility,Outpatient,,,,506.13,430.2105,145.056858,506.13,PrimeWest Health,Minnesota Senior Health Options (MSHO),260.403885,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
PROLOOP MESH SM 30908,,C1781,HCPCS,Facility,Inpatient,,,,506.13,430.2105,145.056858,506.13,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PROLOOP MESH SM 30908,,C1781,HCPCS,Facility,Outpatient,,,,506.13,430.2105,145.056858,506.13,PrimeWest Health,MinnesotaCare,259.948368,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
PROLOOP MESH SM 30908,,C1781,HCPCS,Facility,Inpatient,,,,506.13,430.2105,145.056858,506.13,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
PROLOOP MESH SM 30908,,C1781,HCPCS,Facility,Both,,,,506.13,430.2105,145.056858,506.13,Sanford Health Plan,Sanford Health Plan,465.6396,92,,percent of total billed charges,,
PROLOOP MESH SM 30908,,C1781,HCPCS,Facility,Outpatient,,,,506.13,430.2105,145.056858,506.13,"UCare Health, Inc.",Individual & Family Plan,285.204255,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
PROLOOP MESH SM 30908,,C1781,HCPCS,Facility,Inpatient,,,,506.13,430.2105,145.056858,506.13,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
PROLOOP MESH SM 30908,,C1781,HCPCS,Facility,Outpatient,,,,506.13,430.2105,145.056858,506.13,"UCare Health, Inc.",Medical Assistance,255.443811,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PROLOOP MESH SM 30908,,C1781,HCPCS,Facility,Inpatient,,,,506.13,430.2105,145.056858,506.13,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
PROLOOP MESH SM 30908,,C1781,HCPCS,Facility,Outpatient,,,,506.13,430.2105,145.056858,506.13,"UCare Health, Inc.",Medicare Advantage,255.443811,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PROLOOP MESH SM 30908,,C1781,HCPCS,Facility,Inpatient,,,,506.13,430.2105,145.056858,506.13,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PROLOOP MESH SM 30908,,C1781,HCPCS,Facility,Outpatient,,,,506.13,430.2105,145.056858,506.13,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),255.443811,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PROLOOP MESH SM 30908,,C1781,HCPCS,Facility,Inpatient,,,,506.13,430.2105,145.056858,506.13,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PROLOOP MESH SM 30908,,C1781,HCPCS,Facility,Both,,,,506.13,430.2105,145.056858,506.13,UnitedHealthcare,Individual & Family,475.7622,94,,percent of total billed charges,,
PROLOOP MESH SM 30908,,C1781,HCPCS,Facility,Outpatient,,,,506.13,430.2105,145.056858,506.13,UnitedHealthcare,Medicare Advantage,248.0037,49,,percent of total billed charges,,
PROLOOP MESH SM 30908,,C1781,HCPCS,Facility,Inpatient,,,,506.13,430.2105,145.056858,506.13,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
PROLOOP MESH SM 30908,,C1781,HCPCS,Facility,Outpatient,,,,506.13,430.2105,145.056858,506.13,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,242.9424,48,,percent of total billed charges,,100% of DHS outpatient percentage
PROLOOP MESH SM 30908,,C1781,HCPCS,Facility,Inpatient,,,,506.13,430.2105,145.056858,506.13,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
PROLOOP MESH XL,,C1781,HCPCS,Facility,Both,,,,552.12,469.302,158.237592,552.12,Aetna,Commercial,507.9504,92,,percent of total billed charges,,
PROLOOP MESH XL,,C1781,HCPCS,Facility,Outpatient,,,,552.12,469.302,158.237592,552.12,Aetna,Medicare Advantage,270.5388,49,,percent of total billed charges,,
PROLOOP MESH XL,,C1781,HCPCS,Facility,Inpatient,,,,552.12,469.302,158.237592,552.12,Aetna,Medicare Advantage,,,,,Included in per diem rate,
PROLOOP MESH XL,,C1781,HCPCS,Facility,Both,,,,552.12,469.302,158.237592,552.12,Aetna,PPO,513.4716,93,,percent of total billed charges,,
PROLOOP MESH XL,,C1781,HCPCS,Facility,Both,,,,552.12,469.302,158.237592,552.12,America's PPO,America's PPO,530.200836,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
PROLOOP MESH XL,,C1781,HCPCS,Facility,Both,,,,552.12,469.302,158.237592,552.12,BlueCross BlueShield Minnesota, Federal Employee Program,543.28608,98.4,,percent of total billed charges,,
PROLOOP MESH XL,,C1781,HCPCS,Facility,Both,,,,552.12,469.302,158.237592,552.12,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,552.12,100,,percent of total billed charges,,
PROLOOP MESH XL,,C1781,HCPCS,Facility,Both,,,,552.12,469.302,158.237592,552.12,BlueCross BlueShield Minnesota,High Value Network Plan,496.908,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
PROLOOP MESH XL,,C1781,HCPCS,Facility,Outpatient,,,,552.12,469.302,158.237592,552.12,BlueCross BlueShield Minnesota,Medicare Advantage,270.5388,49,,percent of total billed charges,,
PROLOOP MESH XL,,C1781,HCPCS,Facility,Inpatient,,,,552.12,469.302,158.237592,552.12,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
PROLOOP MESH XL,,C1781,HCPCS,Facility,Both,,,,552.12,469.302,158.237592,552.12,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,489.012684,88.57,,percent of total billed charges,,
PROLOOP MESH XL,,C1781,HCPCS,Facility,Both,,,,552.12,469.302,158.237592,552.12,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,158.237592,28.66,,percent of total billed charges,,
PROLOOP MESH XL,,C1781,HCPCS,Facility,Outpatient,,,,552.12,469.302,158.237592,552.12,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),270.5388,49,,percent of total billed charges,,
PROLOOP MESH XL,,C1781,HCPCS,Facility,Inpatient,,,,552.12,469.302,158.237592,552.12,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
PROLOOP MESH XL,,C1781,HCPCS,Facility,Both,,,,552.12,469.302,158.237592,552.12,CorVel,Worker's Compensation,552.12,100,,percent of total billed charges,,
PROLOOP MESH XL,,C1781,HCPCS,Facility,Both,,,,552.12,469.302,158.237592,552.12,First Health Group Corporation,First Health Network,535.5564,97,,percent of total billed charges,,
PROLOOP MESH XL,,C1781,HCPCS,Facility,Both,,,,552.12,469.302,158.237592,552.12,"Health Partners, Inc.",Commercial,522.30552,94.6,,percent of total billed charges,,
PROLOOP MESH XL,,C1781,HCPCS,Facility,Outpatient,,,,552.12,469.302,158.237592,552.12,"Health Partners, Inc.",Medicare Advantage,270.5388,49,,percent of total billed charges,,
PROLOOP MESH XL,,C1781,HCPCS,Facility,Inpatient,,,,552.12,469.302,158.237592,552.12,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PROLOOP MESH XL,,C1781,HCPCS,Facility,Both,,,,552.12,469.302,158.237592,552.12,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),331.272,60,,percent of total billed charges,,
PROLOOP MESH XL,,C1781,HCPCS,Facility,Both,,,,552.12,469.302,158.237592,552.12,"Health Partners, Inc.",State of Minnesota Advantage Program,449.9778,81.5,,percent of total billed charges,,
PROLOOP MESH XL,,C1781,HCPCS,Facility,Both,,,,552.12,469.302,158.237592,552.12,"Health Partners, Inc.",State Public Programs,276.06,50,,percent of total billed charges,,
PROLOOP MESH XL,,C1781,HCPCS,Facility,Both,,,,552.12,469.302,158.237592,552.12,Humana Insurance Company,Commercial PPO,524.514,95,,percent of total billed charges,,
PROLOOP MESH XL,,C1781,HCPCS,Facility,Outpatient,,,,552.12,469.302,158.237592,552.12,Humana Insurance Company,Medicare PPO,270.5388,49,,percent of total billed charges,,
PROLOOP MESH XL,,C1781,HCPCS,Facility,Inpatient,,,,552.12,469.302,158.237592,552.12,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
PROLOOP MESH XL,,C1781,HCPCS,Facility,Both,,,,552.12,469.302,158.237592,552.12,Medica,Individual & Family,547.15092,99.1,,percent of total billed charges,,
PROLOOP MESH XL,,C1781,HCPCS,Facility,Outpatient,,,,552.12,469.302,158.237592,552.12,Medica,Medica Advantage Solution,274.95576,49.8,,percent of total billed charges,,
PROLOOP MESH XL,,C1781,HCPCS,Facility,Inpatient,,,,552.12,469.302,158.237592,552.12,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
PROLOOP MESH XL,,C1781,HCPCS,Facility,Outpatient,,,,552.12,469.302,158.237592,552.12,Medica,Medical Assistance,246.24552,44.6,,percent of total billed charges,,
PROLOOP MESH XL,,C1781,HCPCS,Facility,Inpatient,,,,552.12,469.302,158.237592,552.12,Medica,Medical Assistance,,,,,Included in per diem rate,
PROLOOP MESH XL,,C1781,HCPCS,Facility,Outpatient,,,,552.12,469.302,158.237592,552.12,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,274.95576,49.8,,percent of total billed charges,,
PROLOOP MESH XL,,C1781,HCPCS,Facility,Inpatient,,,,552.12,469.302,158.237592,552.12,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
PROLOOP MESH XL,,C1781,HCPCS,Facility,Both,,,,552.12,469.302,158.237592,552.12,"Multiplan, Inc.","Multiplan, Inc.",518.9928,94,,percent of total billed charges,,
PROLOOP MESH XL,,C1781,HCPCS,Facility,Outpatient,,,,552.12,469.302,158.237592,552.12,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,497.46012,90.1,,percent of total billed charges,,
PROLOOP MESH XL,,C1781,HCPCS,Facility,Inpatient,,,,552.12,469.302,158.237592,552.12,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
PROLOOP MESH XL,,C1781,HCPCS,Facility,Both,,,,552.12,469.302,158.237592,552.12,"Preferred One Administrative Services, INC.",PPO,544.39032,98.6,,percent of total billed charges,,
PROLOOP MESH XL,,C1781,HCPCS,Facility,Outpatient,,,,552.12,469.302,158.237592,552.12,PrimeWest Health,Minnesota Senior Health Options (MSHO),284.06574,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
PROLOOP MESH XL,,C1781,HCPCS,Facility,Inpatient,,,,552.12,469.302,158.237592,552.12,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PROLOOP MESH XL,,C1781,HCPCS,Facility,Outpatient,,,,552.12,469.302,158.237592,552.12,PrimeWest Health,MinnesotaCare,283.568832,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
PROLOOP MESH XL,,C1781,HCPCS,Facility,Inpatient,,,,552.12,469.302,158.237592,552.12,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
PROLOOP MESH XL,,C1781,HCPCS,Facility,Both,,,,552.12,469.302,158.237592,552.12,Sanford Health Plan,Sanford Health Plan,507.9504,92,,percent of total billed charges,,
PROLOOP MESH XL,,C1781,HCPCS,Facility,Outpatient,,,,552.12,469.302,158.237592,552.12,"UCare Health, Inc.",Individual & Family Plan,311.11962,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
PROLOOP MESH XL,,C1781,HCPCS,Facility,Inpatient,,,,552.12,469.302,158.237592,552.12,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
PROLOOP MESH XL,,C1781,HCPCS,Facility,Outpatient,,,,552.12,469.302,158.237592,552.12,"UCare Health, Inc.",Medical Assistance,278.654964,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PROLOOP MESH XL,,C1781,HCPCS,Facility,Inpatient,,,,552.12,469.302,158.237592,552.12,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
PROLOOP MESH XL,,C1781,HCPCS,Facility,Outpatient,,,,552.12,469.302,158.237592,552.12,"UCare Health, Inc.",Medicare Advantage,278.654964,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PROLOOP MESH XL,,C1781,HCPCS,Facility,Inpatient,,,,552.12,469.302,158.237592,552.12,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PROLOOP MESH XL,,C1781,HCPCS,Facility,Outpatient,,,,552.12,469.302,158.237592,552.12,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),278.654964,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PROLOOP MESH XL,,C1781,HCPCS,Facility,Inpatient,,,,552.12,469.302,158.237592,552.12,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PROLOOP MESH XL,,C1781,HCPCS,Facility,Both,,,,552.12,469.302,158.237592,552.12,UnitedHealthcare,Individual & Family,518.9928,94,,percent of total billed charges,,
PROLOOP MESH XL,,C1781,HCPCS,Facility,Outpatient,,,,552.12,469.302,158.237592,552.12,UnitedHealthcare,Medicare Advantage,270.5388,49,,percent of total billed charges,,
PROLOOP MESH XL,,C1781,HCPCS,Facility,Inpatient,,,,552.12,469.302,158.237592,552.12,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
PROLOOP MESH XL,,C1781,HCPCS,Facility,Outpatient,,,,552.12,469.302,158.237592,552.12,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,265.0176,48,,percent of total billed charges,,100% of DHS outpatient percentage
PROLOOP MESH XL,,C1781,HCPCS,Facility,Inpatient,,,,552.12,469.302,158.237592,552.12,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
ISTENT GLAUKOS,,C1783,HCPCS,Facility,Both,,,,4530.5,3850.925,1298.4413,4530.5,Aetna,Commercial,4168.06,92,,percent of total billed charges,,
ISTENT GLAUKOS,,C1783,HCPCS,Facility,Outpatient,,,,4530.5,3850.925,1298.4413,4530.5,Aetna,Medicare Advantage,2219.945,49,,percent of total billed charges,,
ISTENT GLAUKOS,,C1783,HCPCS,Facility,Inpatient,,,,4530.5,3850.925,1298.4413,4530.5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
ISTENT GLAUKOS,,C1783,HCPCS,Facility,Both,,,,4530.5,3850.925,1298.4413,4530.5,Aetna,PPO,4213.365,93,,percent of total billed charges,,
ISTENT GLAUKOS,,C1783,HCPCS,Facility,Both,,,,4530.5,3850.925,1298.4413,4530.5,America's PPO,America's PPO,4350.63915,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
ISTENT GLAUKOS,,C1783,HCPCS,Facility,Both,,,,4530.5,3850.925,1298.4413,4530.5,BlueCross BlueShield Minnesota, Federal Employee Program,4458.012,98.4,,percent of total billed charges,,
ISTENT GLAUKOS,,C1783,HCPCS,Facility,Both,,,,4530.5,3850.925,1298.4413,4530.5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,4530.5,100,,percent of total billed charges,,
ISTENT GLAUKOS,,C1783,HCPCS,Facility,Both,,,,4530.5,3850.925,1298.4413,4530.5,BlueCross BlueShield Minnesota,High Value Network Plan,4077.45,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
ISTENT GLAUKOS,,C1783,HCPCS,Facility,Outpatient,,,,4530.5,3850.925,1298.4413,4530.5,BlueCross BlueShield Minnesota,Medicare Advantage,2219.945,49,,percent of total billed charges,,
ISTENT GLAUKOS,,C1783,HCPCS,Facility,Inpatient,,,,4530.5,3850.925,1298.4413,4530.5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
ISTENT GLAUKOS,,C1783,HCPCS,Facility,Both,,,,4530.5,3850.925,1298.4413,4530.5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4012.66385,88.57,,percent of total billed charges,,
ISTENT GLAUKOS,,C1783,HCPCS,Facility,Both,,,,4530.5,3850.925,1298.4413,4530.5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1298.4413,28.66,,percent of total billed charges,,
ISTENT GLAUKOS,,C1783,HCPCS,Facility,Outpatient,,,,4530.5,3850.925,1298.4413,4530.5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2219.945,49,,percent of total billed charges,,
ISTENT GLAUKOS,,C1783,HCPCS,Facility,Inpatient,,,,4530.5,3850.925,1298.4413,4530.5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
ISTENT GLAUKOS,,C1783,HCPCS,Facility,Both,,,,4530.5,3850.925,1298.4413,4530.5,CorVel,Worker's Compensation,4530.5,100,,percent of total billed charges,,
ISTENT GLAUKOS,,C1783,HCPCS,Facility,Both,,,,4530.5,3850.925,1298.4413,4530.5,First Health Group Corporation,First Health Network,4394.585,97,,percent of total billed charges,,
ISTENT GLAUKOS,,C1783,HCPCS,Facility,Both,,,,4530.5,3850.925,1298.4413,4530.5,"Health Partners, Inc.",Commercial,4285.853,94.6,,percent of total billed charges,,
ISTENT GLAUKOS,,C1783,HCPCS,Facility,Outpatient,,,,4530.5,3850.925,1298.4413,4530.5,"Health Partners, Inc.",Medicare Advantage,2219.945,49,,percent of total billed charges,,
ISTENT GLAUKOS,,C1783,HCPCS,Facility,Inpatient,,,,4530.5,3850.925,1298.4413,4530.5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ISTENT GLAUKOS,,C1783,HCPCS,Facility,Both,,,,4530.5,3850.925,1298.4413,4530.5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),2718.3,60,,percent of total billed charges,,
ISTENT GLAUKOS,,C1783,HCPCS,Facility,Both,,,,4530.5,3850.925,1298.4413,4530.5,"Health Partners, Inc.",State of Minnesota Advantage Program,3692.3575,81.5,,percent of total billed charges,,
ISTENT GLAUKOS,,C1783,HCPCS,Facility,Both,,,,4530.5,3850.925,1298.4413,4530.5,"Health Partners, Inc.",State Public Programs,2265.25,50,,percent of total billed charges,,
ISTENT GLAUKOS,,C1783,HCPCS,Facility,Both,,,,4530.5,3850.925,1298.4413,4530.5,Humana Insurance Company,Commercial PPO,4303.975,95,,percent of total billed charges,,
ISTENT GLAUKOS,,C1783,HCPCS,Facility,Outpatient,,,,4530.5,3850.925,1298.4413,4530.5,Humana Insurance Company,Medicare PPO,2219.945,49,,percent of total billed charges,,
ISTENT GLAUKOS,,C1783,HCPCS,Facility,Inpatient,,,,4530.5,3850.925,1298.4413,4530.5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
ISTENT GLAUKOS,,C1783,HCPCS,Facility,Both,,,,4530.5,3850.925,1298.4413,4530.5,Medica,Individual & Family,4489.7255,99.1,,percent of total billed charges,,
ISTENT GLAUKOS,,C1783,HCPCS,Facility,Outpatient,,,,4530.5,3850.925,1298.4413,4530.5,Medica,Medica Advantage Solution,2256.189,49.8,,percent of total billed charges,,
ISTENT GLAUKOS,,C1783,HCPCS,Facility,Inpatient,,,,4530.5,3850.925,1298.4413,4530.5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
ISTENT GLAUKOS,,C1783,HCPCS,Facility,Outpatient,,,,4530.5,3850.925,1298.4413,4530.5,Medica,Medical Assistance,2020.603,44.6,,percent of total billed charges,,
ISTENT GLAUKOS,,C1783,HCPCS,Facility,Inpatient,,,,4530.5,3850.925,1298.4413,4530.5,Medica,Medical Assistance,,,,,Included in per diem rate,
ISTENT GLAUKOS,,C1783,HCPCS,Facility,Outpatient,,,,4530.5,3850.925,1298.4413,4530.5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2256.189,49.8,,percent of total billed charges,,
ISTENT GLAUKOS,,C1783,HCPCS,Facility,Inpatient,,,,4530.5,3850.925,1298.4413,4530.5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
ISTENT GLAUKOS,,C1783,HCPCS,Facility,Both,,,,4530.5,3850.925,1298.4413,4530.5,"Multiplan, Inc.","Multiplan, Inc.",4258.67,94,,percent of total billed charges,,
ISTENT GLAUKOS,,C1783,HCPCS,Facility,Outpatient,,,,4530.5,3850.925,1298.4413,4530.5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4081.9805,90.1,,percent of total billed charges,,
ISTENT GLAUKOS,,C1783,HCPCS,Facility,Inpatient,,,,4530.5,3850.925,1298.4413,4530.5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
ISTENT GLAUKOS,,C1783,HCPCS,Facility,Both,,,,4530.5,3850.925,1298.4413,4530.5,"Preferred One Administrative Services, INC.",PPO,4467.073,98.6,,percent of total billed charges,,
ISTENT GLAUKOS,,C1783,HCPCS,Facility,Outpatient,,,,4530.5,3850.925,1298.4413,4530.5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2330.94225,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
ISTENT GLAUKOS,,C1783,HCPCS,Facility,Inpatient,,,,4530.5,3850.925,1298.4413,4530.5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ISTENT GLAUKOS,,C1783,HCPCS,Facility,Outpatient,,,,4530.5,3850.925,1298.4413,4530.5,PrimeWest Health,MinnesotaCare,2326.8648,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
ISTENT GLAUKOS,,C1783,HCPCS,Facility,Inpatient,,,,4530.5,3850.925,1298.4413,4530.5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
ISTENT GLAUKOS,,C1783,HCPCS,Facility,Both,,,,4530.5,3850.925,1298.4413,4530.5,Sanford Health Plan,Sanford Health Plan,4168.06,92,,percent of total billed charges,,
ISTENT GLAUKOS,,C1783,HCPCS,Facility,Outpatient,,,,4530.5,3850.925,1298.4413,4530.5,"UCare Health, Inc.",Individual & Family Plan,2552.93675,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
ISTENT GLAUKOS,,C1783,HCPCS,Facility,Inpatient,,,,4530.5,3850.925,1298.4413,4530.5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
ISTENT GLAUKOS,,C1783,HCPCS,Facility,Outpatient,,,,4530.5,3850.925,1298.4413,4530.5,"UCare Health, Inc.",Medical Assistance,2286.54335,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ISTENT GLAUKOS,,C1783,HCPCS,Facility,Inpatient,,,,4530.5,3850.925,1298.4413,4530.5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
ISTENT GLAUKOS,,C1783,HCPCS,Facility,Outpatient,,,,4530.5,3850.925,1298.4413,4530.5,"UCare Health, Inc.",Medicare Advantage,2286.54335,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ISTENT GLAUKOS,,C1783,HCPCS,Facility,Inpatient,,,,4530.5,3850.925,1298.4413,4530.5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ISTENT GLAUKOS,,C1783,HCPCS,Facility,Outpatient,,,,4530.5,3850.925,1298.4413,4530.5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2286.54335,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ISTENT GLAUKOS,,C1783,HCPCS,Facility,Inpatient,,,,4530.5,3850.925,1298.4413,4530.5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ISTENT GLAUKOS,,C1783,HCPCS,Facility,Both,,,,4530.5,3850.925,1298.4413,4530.5,UnitedHealthcare,Individual & Family,4258.67,94,,percent of total billed charges,,
ISTENT GLAUKOS,,C1783,HCPCS,Facility,Outpatient,,,,4530.5,3850.925,1298.4413,4530.5,UnitedHealthcare,Medicare Advantage,2219.945,49,,percent of total billed charges,,
ISTENT GLAUKOS,,C1783,HCPCS,Facility,Inpatient,,,,4530.5,3850.925,1298.4413,4530.5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
ISTENT GLAUKOS,,C1783,HCPCS,Facility,Outpatient,,,,4530.5,3850.925,1298.4413,4530.5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2174.64,48,,percent of total billed charges,,100% of DHS outpatient percentage
ISTENT GLAUKOS,,C1783,HCPCS,Facility,Inpatient,,,,4530.5,3850.925,1298.4413,4530.5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
POWER PORT IMPLANTABLE PORT BARD    1808000,,C1788,HCPCS,Facility,Both,,,,2225.3,1891.505,637.77098,2225.3,Aetna,Commercial,2047.276,92,,percent of total billed charges,,
POWER PORT IMPLANTABLE PORT BARD    1808000,,C1788,HCPCS,Facility,Outpatient,,,,2225.3,1891.505,637.77098,2225.3,Aetna,Medicare Advantage,1090.397,49,,percent of total billed charges,,
POWER PORT IMPLANTABLE PORT BARD    1808000,,C1788,HCPCS,Facility,Inpatient,,,,2225.3,1891.505,637.77098,2225.3,Aetna,Medicare Advantage,,,,,Included in per diem rate,
POWER PORT IMPLANTABLE PORT BARD    1808000,,C1788,HCPCS,Facility,Both,,,,2225.3,1891.505,637.77098,2225.3,Aetna,PPO,2069.529,93,,percent of total billed charges,,
POWER PORT IMPLANTABLE PORT BARD    1808000,,C1788,HCPCS,Facility,Both,,,,2225.3,1891.505,637.77098,2225.3,America's PPO,America's PPO,2136.95559,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
POWER PORT IMPLANTABLE PORT BARD    1808000,,C1788,HCPCS,Facility,Both,,,,2225.3,1891.505,637.77098,2225.3,BlueCross BlueShield Minnesota, Federal Employee Program,2189.6952,98.4,,percent of total billed charges,,
POWER PORT IMPLANTABLE PORT BARD    1808000,,C1788,HCPCS,Facility,Both,,,,2225.3,1891.505,637.77098,2225.3,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,2225.3,100,,percent of total billed charges,,
POWER PORT IMPLANTABLE PORT BARD    1808000,,C1788,HCPCS,Facility,Both,,,,2225.3,1891.505,637.77098,2225.3,BlueCross BlueShield Minnesota,High Value Network Plan,2002.77,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
POWER PORT IMPLANTABLE PORT BARD    1808000,,C1788,HCPCS,Facility,Outpatient,,,,2225.3,1891.505,637.77098,2225.3,BlueCross BlueShield Minnesota,Medicare Advantage,1090.397,49,,percent of total billed charges,,
POWER PORT IMPLANTABLE PORT BARD    1808000,,C1788,HCPCS,Facility,Inpatient,,,,2225.3,1891.505,637.77098,2225.3,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
POWER PORT IMPLANTABLE PORT BARD    1808000,,C1788,HCPCS,Facility,Both,,,,2225.3,1891.505,637.77098,2225.3,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1970.94821,88.57,,percent of total billed charges,,
POWER PORT IMPLANTABLE PORT BARD    1808000,,C1788,HCPCS,Facility,Both,,,,2225.3,1891.505,637.77098,2225.3,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,637.77098,28.66,,percent of total billed charges,,
POWER PORT IMPLANTABLE PORT BARD    1808000,,C1788,HCPCS,Facility,Outpatient,,,,2225.3,1891.505,637.77098,2225.3,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1090.397,49,,percent of total billed charges,,
POWER PORT IMPLANTABLE PORT BARD    1808000,,C1788,HCPCS,Facility,Inpatient,,,,2225.3,1891.505,637.77098,2225.3,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
POWER PORT IMPLANTABLE PORT BARD    1808000,,C1788,HCPCS,Facility,Both,,,,2225.3,1891.505,637.77098,2225.3,CorVel,Worker's Compensation,2225.3,100,,percent of total billed charges,,
POWER PORT IMPLANTABLE PORT BARD    1808000,,C1788,HCPCS,Facility,Both,,,,2225.3,1891.505,637.77098,2225.3,First Health Group Corporation,First Health Network,2158.541,97,,percent of total billed charges,,
POWER PORT IMPLANTABLE PORT BARD    1808000,,C1788,HCPCS,Facility,Both,,,,2225.3,1891.505,637.77098,2225.3,"Health Partners, Inc.",Commercial,2105.1338,94.6,,percent of total billed charges,,
POWER PORT IMPLANTABLE PORT BARD    1808000,,C1788,HCPCS,Facility,Outpatient,,,,2225.3,1891.505,637.77098,2225.3,"Health Partners, Inc.",Medicare Advantage,1090.397,49,,percent of total billed charges,,
POWER PORT IMPLANTABLE PORT BARD    1808000,,C1788,HCPCS,Facility,Inpatient,,,,2225.3,1891.505,637.77098,2225.3,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
POWER PORT IMPLANTABLE PORT BARD    1808000,,C1788,HCPCS,Facility,Both,,,,2225.3,1891.505,637.77098,2225.3,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1335.18,60,,percent of total billed charges,,
POWER PORT IMPLANTABLE PORT BARD    1808000,,C1788,HCPCS,Facility,Both,,,,2225.3,1891.505,637.77098,2225.3,"Health Partners, Inc.",State of Minnesota Advantage Program,1813.6195,81.5,,percent of total billed charges,,
POWER PORT IMPLANTABLE PORT BARD    1808000,,C1788,HCPCS,Facility,Both,,,,2225.3,1891.505,637.77098,2225.3,"Health Partners, Inc.",State Public Programs,1112.65,50,,percent of total billed charges,,
POWER PORT IMPLANTABLE PORT BARD    1808000,,C1788,HCPCS,Facility,Both,,,,2225.3,1891.505,637.77098,2225.3,Humana Insurance Company,Commercial PPO,2114.035,95,,percent of total billed charges,,
POWER PORT IMPLANTABLE PORT BARD    1808000,,C1788,HCPCS,Facility,Outpatient,,,,2225.3,1891.505,637.77098,2225.3,Humana Insurance Company,Medicare PPO,1090.397,49,,percent of total billed charges,,
POWER PORT IMPLANTABLE PORT BARD    1808000,,C1788,HCPCS,Facility,Inpatient,,,,2225.3,1891.505,637.77098,2225.3,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
POWER PORT IMPLANTABLE PORT BARD    1808000,,C1788,HCPCS,Facility,Both,,,,2225.3,1891.505,637.77098,2225.3,Medica,Individual & Family,2205.2723,99.1,,percent of total billed charges,,
POWER PORT IMPLANTABLE PORT BARD    1808000,,C1788,HCPCS,Facility,Outpatient,,,,2225.3,1891.505,637.77098,2225.3,Medica,Medica Advantage Solution,1108.1994,49.8,,percent of total billed charges,,
POWER PORT IMPLANTABLE PORT BARD    1808000,,C1788,HCPCS,Facility,Inpatient,,,,2225.3,1891.505,637.77098,2225.3,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
POWER PORT IMPLANTABLE PORT BARD    1808000,,C1788,HCPCS,Facility,Outpatient,,,,2225.3,1891.505,637.77098,2225.3,Medica,Medical Assistance,992.4838,44.6,,percent of total billed charges,,
POWER PORT IMPLANTABLE PORT BARD    1808000,,C1788,HCPCS,Facility,Inpatient,,,,2225.3,1891.505,637.77098,2225.3,Medica,Medical Assistance,,,,,Included in per diem rate,
POWER PORT IMPLANTABLE PORT BARD    1808000,,C1788,HCPCS,Facility,Outpatient,,,,2225.3,1891.505,637.77098,2225.3,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1108.1994,49.8,,percent of total billed charges,,
POWER PORT IMPLANTABLE PORT BARD    1808000,,C1788,HCPCS,Facility,Inpatient,,,,2225.3,1891.505,637.77098,2225.3,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
POWER PORT IMPLANTABLE PORT BARD    1808000,,C1788,HCPCS,Facility,Both,,,,2225.3,1891.505,637.77098,2225.3,"Multiplan, Inc.","Multiplan, Inc.",2091.782,94,,percent of total billed charges,,
POWER PORT IMPLANTABLE PORT BARD    1808000,,C1788,HCPCS,Facility,Outpatient,,,,2225.3,1891.505,637.77098,2225.3,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,2004.9953,90.1,,percent of total billed charges,,
POWER PORT IMPLANTABLE PORT BARD    1808000,,C1788,HCPCS,Facility,Inpatient,,,,2225.3,1891.505,637.77098,2225.3,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
POWER PORT IMPLANTABLE PORT BARD    1808000,,C1788,HCPCS,Facility,Both,,,,2225.3,1891.505,637.77098,2225.3,"Preferred One Administrative Services, INC.",PPO,2194.1458,98.6,,percent of total billed charges,,
POWER PORT IMPLANTABLE PORT BARD    1808000,,C1788,HCPCS,Facility,Outpatient,,,,2225.3,1891.505,637.77098,2225.3,PrimeWest Health,Minnesota Senior Health Options (MSHO),1144.91685,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
POWER PORT IMPLANTABLE PORT BARD    1808000,,C1788,HCPCS,Facility,Inpatient,,,,2225.3,1891.505,637.77098,2225.3,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
POWER PORT IMPLANTABLE PORT BARD    1808000,,C1788,HCPCS,Facility,Outpatient,,,,2225.3,1891.505,637.77098,2225.3,PrimeWest Health,MinnesotaCare,1142.91408,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
POWER PORT IMPLANTABLE PORT BARD    1808000,,C1788,HCPCS,Facility,Inpatient,,,,2225.3,1891.505,637.77098,2225.3,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
POWER PORT IMPLANTABLE PORT BARD    1808000,,C1788,HCPCS,Facility,Both,,,,2225.3,1891.505,637.77098,2225.3,Sanford Health Plan,Sanford Health Plan,2047.276,92,,percent of total billed charges,,
POWER PORT IMPLANTABLE PORT BARD    1808000,,C1788,HCPCS,Facility,Outpatient,,,,2225.3,1891.505,637.77098,2225.3,"UCare Health, Inc.",Individual & Family Plan,1253.95655,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
POWER PORT IMPLANTABLE PORT BARD    1808000,,C1788,HCPCS,Facility,Inpatient,,,,2225.3,1891.505,637.77098,2225.3,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
POWER PORT IMPLANTABLE PORT BARD    1808000,,C1788,HCPCS,Facility,Outpatient,,,,2225.3,1891.505,637.77098,2225.3,"UCare Health, Inc.",Medical Assistance,1123.10891,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
POWER PORT IMPLANTABLE PORT BARD    1808000,,C1788,HCPCS,Facility,Inpatient,,,,2225.3,1891.505,637.77098,2225.3,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
POWER PORT IMPLANTABLE PORT BARD    1808000,,C1788,HCPCS,Facility,Outpatient,,,,2225.3,1891.505,637.77098,2225.3,"UCare Health, Inc.",Medicare Advantage,1123.10891,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
POWER PORT IMPLANTABLE PORT BARD    1808000,,C1788,HCPCS,Facility,Inpatient,,,,2225.3,1891.505,637.77098,2225.3,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
POWER PORT IMPLANTABLE PORT BARD    1808000,,C1788,HCPCS,Facility,Outpatient,,,,2225.3,1891.505,637.77098,2225.3,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1123.10891,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
POWER PORT IMPLANTABLE PORT BARD    1808000,,C1788,HCPCS,Facility,Inpatient,,,,2225.3,1891.505,637.77098,2225.3,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
POWER PORT IMPLANTABLE PORT BARD    1808000,,C1788,HCPCS,Facility,Both,,,,2225.3,1891.505,637.77098,2225.3,UnitedHealthcare,Individual & Family,2091.782,94,,percent of total billed charges,,
POWER PORT IMPLANTABLE PORT BARD    1808000,,C1788,HCPCS,Facility,Outpatient,,,,2225.3,1891.505,637.77098,2225.3,UnitedHealthcare,Medicare Advantage,1090.397,49,,percent of total billed charges,,
POWER PORT IMPLANTABLE PORT BARD    1808000,,C1788,HCPCS,Facility,Inpatient,,,,2225.3,1891.505,637.77098,2225.3,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
POWER PORT IMPLANTABLE PORT BARD    1808000,,C1788,HCPCS,Facility,Outpatient,,,,2225.3,1891.505,637.77098,2225.3,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1068.144,48,,percent of total billed charges,,100% of DHS outpatient percentage
POWER PORT IMPLANTABLE PORT BARD    1808000,,C1788,HCPCS,Facility,Inpatient,,,,2225.3,1891.505,637.77098,2225.3,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
WECK VISTA PORT 5-8MM X 100MM,,C1788,HCPCS,Facility,Both,,,,175,148.75,50.155,175,Aetna,Commercial,161,92,,percent of total billed charges,,
WECK VISTA PORT 5-8MM X 100MM,,C1788,HCPCS,Facility,Outpatient,,,,175,148.75,50.155,175,Aetna,Medicare Advantage,85.75,49,,percent of total billed charges,,
WECK VISTA PORT 5-8MM X 100MM,,C1788,HCPCS,Facility,Inpatient,,,,175,148.75,50.155,175,Aetna,Medicare Advantage,,,,,Included in per diem rate,
WECK VISTA PORT 5-8MM X 100MM,,C1788,HCPCS,Facility,Both,,,,175,148.75,50.155,175,Aetna,PPO,162.75,93,,percent of total billed charges,,
WECK VISTA PORT 5-8MM X 100MM,,C1788,HCPCS,Facility,Both,,,,175,148.75,50.155,175,America's PPO,America's PPO,168.0525,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
WECK VISTA PORT 5-8MM X 100MM,,C1788,HCPCS,Facility,Both,,,,175,148.75,50.155,175,BlueCross BlueShield Minnesota, Federal Employee Program,172.2,98.4,,percent of total billed charges,,
WECK VISTA PORT 5-8MM X 100MM,,C1788,HCPCS,Facility,Both,,,,175,148.75,50.155,175,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,175,100,,percent of total billed charges,,
WECK VISTA PORT 5-8MM X 100MM,,C1788,HCPCS,Facility,Both,,,,175,148.75,50.155,175,BlueCross BlueShield Minnesota,High Value Network Plan,157.5,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
WECK VISTA PORT 5-8MM X 100MM,,C1788,HCPCS,Facility,Outpatient,,,,175,148.75,50.155,175,BlueCross BlueShield Minnesota,Medicare Advantage,85.75,49,,percent of total billed charges,,
WECK VISTA PORT 5-8MM X 100MM,,C1788,HCPCS,Facility,Inpatient,,,,175,148.75,50.155,175,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
WECK VISTA PORT 5-8MM X 100MM,,C1788,HCPCS,Facility,Both,,,,175,148.75,50.155,175,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,154.9975,88.57,,percent of total billed charges,,
WECK VISTA PORT 5-8MM X 100MM,,C1788,HCPCS,Facility,Both,,,,175,148.75,50.155,175,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,50.155,28.66,,percent of total billed charges,,
WECK VISTA PORT 5-8MM X 100MM,,C1788,HCPCS,Facility,Outpatient,,,,175,148.75,50.155,175,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),85.75,49,,percent of total billed charges,,
WECK VISTA PORT 5-8MM X 100MM,,C1788,HCPCS,Facility,Inpatient,,,,175,148.75,50.155,175,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
WECK VISTA PORT 5-8MM X 100MM,,C1788,HCPCS,Facility,Both,,,,175,148.75,50.155,175,CorVel,Worker's Compensation,175,100,,percent of total billed charges,,
WECK VISTA PORT 5-8MM X 100MM,,C1788,HCPCS,Facility,Both,,,,175,148.75,50.155,175,First Health Group Corporation,First Health Network,169.75,97,,percent of total billed charges,,
WECK VISTA PORT 5-8MM X 100MM,,C1788,HCPCS,Facility,Both,,,,175,148.75,50.155,175,"Health Partners, Inc.",Commercial,165.55,94.6,,percent of total billed charges,,
WECK VISTA PORT 5-8MM X 100MM,,C1788,HCPCS,Facility,Outpatient,,,,175,148.75,50.155,175,"Health Partners, Inc.",Medicare Advantage,85.75,49,,percent of total billed charges,,
WECK VISTA PORT 5-8MM X 100MM,,C1788,HCPCS,Facility,Inpatient,,,,175,148.75,50.155,175,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
WECK VISTA PORT 5-8MM X 100MM,,C1788,HCPCS,Facility,Both,,,,175,148.75,50.155,175,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),105,60,,percent of total billed charges,,
WECK VISTA PORT 5-8MM X 100MM,,C1788,HCPCS,Facility,Both,,,,175,148.75,50.155,175,"Health Partners, Inc.",State of Minnesota Advantage Program,142.625,81.5,,percent of total billed charges,,
WECK VISTA PORT 5-8MM X 100MM,,C1788,HCPCS,Facility,Both,,,,175,148.75,50.155,175,"Health Partners, Inc.",State Public Programs,87.5,50,,percent of total billed charges,,
WECK VISTA PORT 5-8MM X 100MM,,C1788,HCPCS,Facility,Both,,,,175,148.75,50.155,175,Humana Insurance Company,Commercial PPO,166.25,95,,percent of total billed charges,,
WECK VISTA PORT 5-8MM X 100MM,,C1788,HCPCS,Facility,Outpatient,,,,175,148.75,50.155,175,Humana Insurance Company,Medicare PPO,85.75,49,,percent of total billed charges,,
WECK VISTA PORT 5-8MM X 100MM,,C1788,HCPCS,Facility,Inpatient,,,,175,148.75,50.155,175,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
WECK VISTA PORT 5-8MM X 100MM,,C1788,HCPCS,Facility,Both,,,,175,148.75,50.155,175,Medica,Individual & Family,173.425,99.1,,percent of total billed charges,,
WECK VISTA PORT 5-8MM X 100MM,,C1788,HCPCS,Facility,Outpatient,,,,175,148.75,50.155,175,Medica,Medica Advantage Solution,87.15,49.8,,percent of total billed charges,,
WECK VISTA PORT 5-8MM X 100MM,,C1788,HCPCS,Facility,Inpatient,,,,175,148.75,50.155,175,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
WECK VISTA PORT 5-8MM X 100MM,,C1788,HCPCS,Facility,Outpatient,,,,175,148.75,50.155,175,Medica,Medical Assistance,78.05,44.6,,percent of total billed charges,,
WECK VISTA PORT 5-8MM X 100MM,,C1788,HCPCS,Facility,Inpatient,,,,175,148.75,50.155,175,Medica,Medical Assistance,,,,,Included in per diem rate,
WECK VISTA PORT 5-8MM X 100MM,,C1788,HCPCS,Facility,Outpatient,,,,175,148.75,50.155,175,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,87.15,49.8,,percent of total billed charges,,
WECK VISTA PORT 5-8MM X 100MM,,C1788,HCPCS,Facility,Inpatient,,,,175,148.75,50.155,175,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
WECK VISTA PORT 5-8MM X 100MM,,C1788,HCPCS,Facility,Both,,,,175,148.75,50.155,175,"Multiplan, Inc.","Multiplan, Inc.",164.5,94,,percent of total billed charges,,
WECK VISTA PORT 5-8MM X 100MM,,C1788,HCPCS,Facility,Outpatient,,,,175,148.75,50.155,175,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,157.675,90.1,,percent of total billed charges,,
WECK VISTA PORT 5-8MM X 100MM,,C1788,HCPCS,Facility,Inpatient,,,,175,148.75,50.155,175,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
WECK VISTA PORT 5-8MM X 100MM,,C1788,HCPCS,Facility,Both,,,,175,148.75,50.155,175,"Preferred One Administrative Services, INC.",PPO,172.55,98.6,,percent of total billed charges,,
WECK VISTA PORT 5-8MM X 100MM,,C1788,HCPCS,Facility,Outpatient,,,,175,148.75,50.155,175,PrimeWest Health,Minnesota Senior Health Options (MSHO),90.0375,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
WECK VISTA PORT 5-8MM X 100MM,,C1788,HCPCS,Facility,Inpatient,,,,175,148.75,50.155,175,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
WECK VISTA PORT 5-8MM X 100MM,,C1788,HCPCS,Facility,Outpatient,,,,175,148.75,50.155,175,PrimeWest Health,MinnesotaCare,89.88,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
WECK VISTA PORT 5-8MM X 100MM,,C1788,HCPCS,Facility,Inpatient,,,,175,148.75,50.155,175,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
WECK VISTA PORT 5-8MM X 100MM,,C1788,HCPCS,Facility,Both,,,,175,148.75,50.155,175,Sanford Health Plan,Sanford Health Plan,161,92,,percent of total billed charges,,
WECK VISTA PORT 5-8MM X 100MM,,C1788,HCPCS,Facility,Outpatient,,,,175,148.75,50.155,175,"UCare Health, Inc.",Individual & Family Plan,98.6125,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
WECK VISTA PORT 5-8MM X 100MM,,C1788,HCPCS,Facility,Inpatient,,,,175,148.75,50.155,175,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
WECK VISTA PORT 5-8MM X 100MM,,C1788,HCPCS,Facility,Outpatient,,,,175,148.75,50.155,175,"UCare Health, Inc.",Medical Assistance,88.3225,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
WECK VISTA PORT 5-8MM X 100MM,,C1788,HCPCS,Facility,Inpatient,,,,175,148.75,50.155,175,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
WECK VISTA PORT 5-8MM X 100MM,,C1788,HCPCS,Facility,Outpatient,,,,175,148.75,50.155,175,"UCare Health, Inc.",Medicare Advantage,88.3225,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
WECK VISTA PORT 5-8MM X 100MM,,C1788,HCPCS,Facility,Inpatient,,,,175,148.75,50.155,175,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
WECK VISTA PORT 5-8MM X 100MM,,C1788,HCPCS,Facility,Outpatient,,,,175,148.75,50.155,175,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),88.3225,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
WECK VISTA PORT 5-8MM X 100MM,,C1788,HCPCS,Facility,Inpatient,,,,175,148.75,50.155,175,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
WECK VISTA PORT 5-8MM X 100MM,,C1788,HCPCS,Facility,Both,,,,175,148.75,50.155,175,UnitedHealthcare,Individual & Family,164.5,94,,percent of total billed charges,,
WECK VISTA PORT 5-8MM X 100MM,,C1788,HCPCS,Facility,Outpatient,,,,175,148.75,50.155,175,UnitedHealthcare,Medicare Advantage,85.75,49,,percent of total billed charges,,
WECK VISTA PORT 5-8MM X 100MM,,C1788,HCPCS,Facility,Inpatient,,,,175,148.75,50.155,175,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
WECK VISTA PORT 5-8MM X 100MM,,C1788,HCPCS,Facility,Outpatient,,,,175,148.75,50.155,175,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,84,48,,percent of total billed charges,,100% of DHS outpatient percentage
WECK VISTA PORT 5-8MM X 100MM,,C1788,HCPCS,Facility,Inpatient,,,,175,148.75,50.155,175,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
BONE MARROW BIOPSY TRAY,,C1830,HCPCS,Facility,Both,,,,107.6,91.46,30.83816,107.6,Aetna,Commercial,98.992,92,,percent of total billed charges,,
BONE MARROW BIOPSY TRAY,,C1830,HCPCS,Facility,Outpatient,,,,107.6,91.46,30.83816,107.6,Aetna,Medicare Advantage,52.724,49,,percent of total billed charges,,
BONE MARROW BIOPSY TRAY,,C1830,HCPCS,Facility,Inpatient,,,,107.6,91.46,30.83816,107.6,Aetna,Medicare Advantage,,,,,Included in per diem rate,
BONE MARROW BIOPSY TRAY,,C1830,HCPCS,Facility,Both,,,,107.6,91.46,30.83816,107.6,Aetna,PPO,100.068,93,,percent of total billed charges,,
BONE MARROW BIOPSY TRAY,,C1830,HCPCS,Facility,Both,,,,107.6,91.46,30.83816,107.6,America's PPO,America's PPO,103.32828,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
BONE MARROW BIOPSY TRAY,,C1830,HCPCS,Facility,Both,,,,107.6,91.46,30.83816,107.6,BlueCross BlueShield Minnesota, Federal Employee Program,105.8784,98.4,,percent of total billed charges,,
BONE MARROW BIOPSY TRAY,,C1830,HCPCS,Facility,Both,,,,107.6,91.46,30.83816,107.6,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,107.6,100,,percent of total billed charges,,
BONE MARROW BIOPSY TRAY,,C1830,HCPCS,Facility,Both,,,,107.6,91.46,30.83816,107.6,BlueCross BlueShield Minnesota,High Value Network Plan,96.84,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
BONE MARROW BIOPSY TRAY,,C1830,HCPCS,Facility,Outpatient,,,,107.6,91.46,30.83816,107.6,BlueCross BlueShield Minnesota,Medicare Advantage,52.724,49,,percent of total billed charges,,
BONE MARROW BIOPSY TRAY,,C1830,HCPCS,Facility,Inpatient,,,,107.6,91.46,30.83816,107.6,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
BONE MARROW BIOPSY TRAY,,C1830,HCPCS,Facility,Both,,,,107.6,91.46,30.83816,107.6,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,95.30132,88.57,,percent of total billed charges,,
BONE MARROW BIOPSY TRAY,,C1830,HCPCS,Facility,Both,,,,107.6,91.46,30.83816,107.6,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,30.83816,28.66,,percent of total billed charges,,
BONE MARROW BIOPSY TRAY,,C1830,HCPCS,Facility,Outpatient,,,,107.6,91.46,30.83816,107.6,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),52.724,49,,percent of total billed charges,,
BONE MARROW BIOPSY TRAY,,C1830,HCPCS,Facility,Inpatient,,,,107.6,91.46,30.83816,107.6,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
BONE MARROW BIOPSY TRAY,,C1830,HCPCS,Facility,Both,,,,107.6,91.46,30.83816,107.6,CorVel,Worker's Compensation,107.6,100,,percent of total billed charges,,
BONE MARROW BIOPSY TRAY,,C1830,HCPCS,Facility,Both,,,,107.6,91.46,30.83816,107.6,First Health Group Corporation,First Health Network,104.372,97,,percent of total billed charges,,
BONE MARROW BIOPSY TRAY,,C1830,HCPCS,Facility,Both,,,,107.6,91.46,30.83816,107.6,"Health Partners, Inc.",Commercial,101.7896,94.6,,percent of total billed charges,,
BONE MARROW BIOPSY TRAY,,C1830,HCPCS,Facility,Outpatient,,,,107.6,91.46,30.83816,107.6,"Health Partners, Inc.",Medicare Advantage,52.724,49,,percent of total billed charges,,
BONE MARROW BIOPSY TRAY,,C1830,HCPCS,Facility,Inpatient,,,,107.6,91.46,30.83816,107.6,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
BONE MARROW BIOPSY TRAY,,C1830,HCPCS,Facility,Both,,,,107.6,91.46,30.83816,107.6,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),64.56,60,,percent of total billed charges,,
BONE MARROW BIOPSY TRAY,,C1830,HCPCS,Facility,Both,,,,107.6,91.46,30.83816,107.6,"Health Partners, Inc.",State of Minnesota Advantage Program,87.694,81.5,,percent of total billed charges,,
BONE MARROW BIOPSY TRAY,,C1830,HCPCS,Facility,Both,,,,107.6,91.46,30.83816,107.6,"Health Partners, Inc.",State Public Programs,53.8,50,,percent of total billed charges,,
BONE MARROW BIOPSY TRAY,,C1830,HCPCS,Facility,Both,,,,107.6,91.46,30.83816,107.6,Humana Insurance Company,Commercial PPO,102.22,95,,percent of total billed charges,,
BONE MARROW BIOPSY TRAY,,C1830,HCPCS,Facility,Outpatient,,,,107.6,91.46,30.83816,107.6,Humana Insurance Company,Medicare PPO,52.724,49,,percent of total billed charges,,
BONE MARROW BIOPSY TRAY,,C1830,HCPCS,Facility,Inpatient,,,,107.6,91.46,30.83816,107.6,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
BONE MARROW BIOPSY TRAY,,C1830,HCPCS,Facility,Both,,,,107.6,91.46,30.83816,107.6,Medica,Individual & Family,106.6316,99.1,,percent of total billed charges,,
BONE MARROW BIOPSY TRAY,,C1830,HCPCS,Facility,Outpatient,,,,107.6,91.46,30.83816,107.6,Medica,Medica Advantage Solution,53.5848,49.8,,percent of total billed charges,,
BONE MARROW BIOPSY TRAY,,C1830,HCPCS,Facility,Inpatient,,,,107.6,91.46,30.83816,107.6,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
BONE MARROW BIOPSY TRAY,,C1830,HCPCS,Facility,Outpatient,,,,107.6,91.46,30.83816,107.6,Medica,Medical Assistance,47.9896,44.6,,percent of total billed charges,,
BONE MARROW BIOPSY TRAY,,C1830,HCPCS,Facility,Inpatient,,,,107.6,91.46,30.83816,107.6,Medica,Medical Assistance,,,,,Included in per diem rate,
BONE MARROW BIOPSY TRAY,,C1830,HCPCS,Facility,Outpatient,,,,107.6,91.46,30.83816,107.6,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,53.5848,49.8,,percent of total billed charges,,
BONE MARROW BIOPSY TRAY,,C1830,HCPCS,Facility,Inpatient,,,,107.6,91.46,30.83816,107.6,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
BONE MARROW BIOPSY TRAY,,C1830,HCPCS,Facility,Both,,,,107.6,91.46,30.83816,107.6,"Multiplan, Inc.","Multiplan, Inc.",101.144,94,,percent of total billed charges,,
BONE MARROW BIOPSY TRAY,,C1830,HCPCS,Facility,Outpatient,,,,107.6,91.46,30.83816,107.6,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,96.9476,90.1,,percent of total billed charges,,
BONE MARROW BIOPSY TRAY,,C1830,HCPCS,Facility,Inpatient,,,,107.6,91.46,30.83816,107.6,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
BONE MARROW BIOPSY TRAY,,C1830,HCPCS,Facility,Both,,,,107.6,91.46,30.83816,107.6,"Preferred One Administrative Services, INC.",PPO,106.0936,98.6,,percent of total billed charges,,
BONE MARROW BIOPSY TRAY,,C1830,HCPCS,Facility,Outpatient,,,,107.6,91.46,30.83816,107.6,PrimeWest Health,Minnesota Senior Health Options (MSHO),55.3602,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
BONE MARROW BIOPSY TRAY,,C1830,HCPCS,Facility,Inpatient,,,,107.6,91.46,30.83816,107.6,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
BONE MARROW BIOPSY TRAY,,C1830,HCPCS,Facility,Outpatient,,,,107.6,91.46,30.83816,107.6,PrimeWest Health,MinnesotaCare,55.26336,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
BONE MARROW BIOPSY TRAY,,C1830,HCPCS,Facility,Inpatient,,,,107.6,91.46,30.83816,107.6,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
BONE MARROW BIOPSY TRAY,,C1830,HCPCS,Facility,Both,,,,107.6,91.46,30.83816,107.6,Sanford Health Plan,Sanford Health Plan,98.992,92,,percent of total billed charges,,
BONE MARROW BIOPSY TRAY,,C1830,HCPCS,Facility,Outpatient,,,,107.6,91.46,30.83816,107.6,"UCare Health, Inc.",Individual & Family Plan,60.6326,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
BONE MARROW BIOPSY TRAY,,C1830,HCPCS,Facility,Inpatient,,,,107.6,91.46,30.83816,107.6,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
BONE MARROW BIOPSY TRAY,,C1830,HCPCS,Facility,Outpatient,,,,107.6,91.46,30.83816,107.6,"UCare Health, Inc.",Medical Assistance,54.30572,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BONE MARROW BIOPSY TRAY,,C1830,HCPCS,Facility,Inpatient,,,,107.6,91.46,30.83816,107.6,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
BONE MARROW BIOPSY TRAY,,C1830,HCPCS,Facility,Outpatient,,,,107.6,91.46,30.83816,107.6,"UCare Health, Inc.",Medicare Advantage,54.30572,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BONE MARROW BIOPSY TRAY,,C1830,HCPCS,Facility,Inpatient,,,,107.6,91.46,30.83816,107.6,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
BONE MARROW BIOPSY TRAY,,C1830,HCPCS,Facility,Outpatient,,,,107.6,91.46,30.83816,107.6,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),54.30572,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BONE MARROW BIOPSY TRAY,,C1830,HCPCS,Facility,Inpatient,,,,107.6,91.46,30.83816,107.6,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
BONE MARROW BIOPSY TRAY,,C1830,HCPCS,Facility,Both,,,,107.6,91.46,30.83816,107.6,UnitedHealthcare,Individual & Family,101.144,94,,percent of total billed charges,,
BONE MARROW BIOPSY TRAY,,C1830,HCPCS,Facility,Outpatient,,,,107.6,91.46,30.83816,107.6,UnitedHealthcare,Medicare Advantage,52.724,49,,percent of total billed charges,,
BONE MARROW BIOPSY TRAY,,C1830,HCPCS,Facility,Inpatient,,,,107.6,91.46,30.83816,107.6,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
BONE MARROW BIOPSY TRAY,,C1830,HCPCS,Facility,Outpatient,,,,107.6,91.46,30.83816,107.6,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,51.648,48,,percent of total billed charges,,100% of DHS outpatient percentage
BONE MARROW BIOPSY TRAY,,C1830,HCPCS,Facility,Inpatient,,,,107.6,91.46,30.83816,107.6,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Sup Bone Marrow Tray-Dis,,C1830,HCPCS,Facility,Both,,,,93,79.05,26.6538,93,Aetna,Commercial,85.56,92,,percent of total billed charges,,
Sup Bone Marrow Tray-Dis,,C1830,HCPCS,Facility,Outpatient,,,,93,79.05,26.6538,93,Aetna,Medicare Advantage,45.57,49,,percent of total billed charges,,
Sup Bone Marrow Tray-Dis,,C1830,HCPCS,Facility,Inpatient,,,,93,79.05,26.6538,93,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Sup Bone Marrow Tray-Dis,,C1830,HCPCS,Facility,Both,,,,93,79.05,26.6538,93,Aetna,PPO,86.49,93,,percent of total billed charges,,
Sup Bone Marrow Tray-Dis,,C1830,HCPCS,Facility,Both,,,,93,79.05,26.6538,93,America's PPO,America's PPO,89.3079,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Sup Bone Marrow Tray-Dis,,C1830,HCPCS,Facility,Both,,,,93,79.05,26.6538,93,BlueCross BlueShield Minnesota, Federal Employee Program,91.512,98.4,,percent of total billed charges,,
Sup Bone Marrow Tray-Dis,,C1830,HCPCS,Facility,Both,,,,93,79.05,26.6538,93,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,93,100,,percent of total billed charges,,
Sup Bone Marrow Tray-Dis,,C1830,HCPCS,Facility,Both,,,,93,79.05,26.6538,93,BlueCross BlueShield Minnesota,High Value Network Plan,83.7,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
Sup Bone Marrow Tray-Dis,,C1830,HCPCS,Facility,Outpatient,,,,93,79.05,26.6538,93,BlueCross BlueShield Minnesota,Medicare Advantage,45.57,49,,percent of total billed charges,,
Sup Bone Marrow Tray-Dis,,C1830,HCPCS,Facility,Inpatient,,,,93,79.05,26.6538,93,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Sup Bone Marrow Tray-Dis,,C1830,HCPCS,Facility,Both,,,,93,79.05,26.6538,93,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,82.3701,88.57,,percent of total billed charges,,
Sup Bone Marrow Tray-Dis,,C1830,HCPCS,Facility,Both,,,,93,79.05,26.6538,93,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,26.6538,28.66,,percent of total billed charges,,
Sup Bone Marrow Tray-Dis,,C1830,HCPCS,Facility,Outpatient,,,,93,79.05,26.6538,93,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),45.57,49,,percent of total billed charges,,
Sup Bone Marrow Tray-Dis,,C1830,HCPCS,Facility,Inpatient,,,,93,79.05,26.6538,93,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Sup Bone Marrow Tray-Dis,,C1830,HCPCS,Facility,Both,,,,93,79.05,26.6538,93,CorVel,Worker's Compensation,93,100,,percent of total billed charges,,
Sup Bone Marrow Tray-Dis,,C1830,HCPCS,Facility,Both,,,,93,79.05,26.6538,93,First Health Group Corporation,First Health Network,90.21,97,,percent of total billed charges,,
Sup Bone Marrow Tray-Dis,,C1830,HCPCS,Facility,Both,,,,93,79.05,26.6538,93,"Health Partners, Inc.",Commercial,87.978,94.6,,percent of total billed charges,,
Sup Bone Marrow Tray-Dis,,C1830,HCPCS,Facility,Outpatient,,,,93,79.05,26.6538,93,"Health Partners, Inc.",Medicare Advantage,45.57,49,,percent of total billed charges,,
Sup Bone Marrow Tray-Dis,,C1830,HCPCS,Facility,Inpatient,,,,93,79.05,26.6538,93,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Bone Marrow Tray-Dis,,C1830,HCPCS,Facility,Both,,,,93,79.05,26.6538,93,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),55.8,60,,percent of total billed charges,,
Sup Bone Marrow Tray-Dis,,C1830,HCPCS,Facility,Both,,,,93,79.05,26.6538,93,"Health Partners, Inc.",State of Minnesota Advantage Program,75.795,81.5,,percent of total billed charges,,
Sup Bone Marrow Tray-Dis,,C1830,HCPCS,Facility,Both,,,,93,79.05,26.6538,93,"Health Partners, Inc.",State Public Programs,46.5,50,,percent of total billed charges,,
Sup Bone Marrow Tray-Dis,,C1830,HCPCS,Facility,Both,,,,93,79.05,26.6538,93,Humana Insurance Company,Commercial PPO,88.35,95,,percent of total billed charges,,
Sup Bone Marrow Tray-Dis,,C1830,HCPCS,Facility,Outpatient,,,,93,79.05,26.6538,93,Humana Insurance Company,Medicare PPO,45.57,49,,percent of total billed charges,,
Sup Bone Marrow Tray-Dis,,C1830,HCPCS,Facility,Inpatient,,,,93,79.05,26.6538,93,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Sup Bone Marrow Tray-Dis,,C1830,HCPCS,Facility,Both,,,,93,79.05,26.6538,93,Medica,Individual & Family,92.163,99.1,,percent of total billed charges,,
Sup Bone Marrow Tray-Dis,,C1830,HCPCS,Facility,Outpatient,,,,93,79.05,26.6538,93,Medica,Medica Advantage Solution,46.314,49.8,,percent of total billed charges,,
Sup Bone Marrow Tray-Dis,,C1830,HCPCS,Facility,Inpatient,,,,93,79.05,26.6538,93,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Sup Bone Marrow Tray-Dis,,C1830,HCPCS,Facility,Outpatient,,,,93,79.05,26.6538,93,Medica,Medical Assistance,41.478,44.6,,percent of total billed charges,,
Sup Bone Marrow Tray-Dis,,C1830,HCPCS,Facility,Inpatient,,,,93,79.05,26.6538,93,Medica,Medical Assistance,,,,,Included in per diem rate,
Sup Bone Marrow Tray-Dis,,C1830,HCPCS,Facility,Outpatient,,,,93,79.05,26.6538,93,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,46.314,49.8,,percent of total billed charges,,
Sup Bone Marrow Tray-Dis,,C1830,HCPCS,Facility,Inpatient,,,,93,79.05,26.6538,93,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Sup Bone Marrow Tray-Dis,,C1830,HCPCS,Facility,Both,,,,93,79.05,26.6538,93,"Multiplan, Inc.","Multiplan, Inc.",87.42,94,,percent of total billed charges,,
Sup Bone Marrow Tray-Dis,,C1830,HCPCS,Facility,Outpatient,,,,93,79.05,26.6538,93,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,83.793,90.1,,percent of total billed charges,,
Sup Bone Marrow Tray-Dis,,C1830,HCPCS,Facility,Inpatient,,,,93,79.05,26.6538,93,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Sup Bone Marrow Tray-Dis,,C1830,HCPCS,Facility,Both,,,,93,79.05,26.6538,93,"Preferred One Administrative Services, INC.",PPO,91.698,98.6,,percent of total billed charges,,
Sup Bone Marrow Tray-Dis,,C1830,HCPCS,Facility,Outpatient,,,,93,79.05,26.6538,93,PrimeWest Health,Minnesota Senior Health Options (MSHO),47.8485,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Sup Bone Marrow Tray-Dis,,C1830,HCPCS,Facility,Inpatient,,,,93,79.05,26.6538,93,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Bone Marrow Tray-Dis,,C1830,HCPCS,Facility,Outpatient,,,,93,79.05,26.6538,93,PrimeWest Health,MinnesotaCare,47.7648,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Sup Bone Marrow Tray-Dis,,C1830,HCPCS,Facility,Inpatient,,,,93,79.05,26.6538,93,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Sup Bone Marrow Tray-Dis,,C1830,HCPCS,Facility,Both,,,,93,79.05,26.6538,93,Sanford Health Plan,Sanford Health Plan,85.56,92,,percent of total billed charges,,
Sup Bone Marrow Tray-Dis,,C1830,HCPCS,Facility,Outpatient,,,,93,79.05,26.6538,93,"UCare Health, Inc.",Individual & Family Plan,52.4055,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Sup Bone Marrow Tray-Dis,,C1830,HCPCS,Facility,Inpatient,,,,93,79.05,26.6538,93,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Sup Bone Marrow Tray-Dis,,C1830,HCPCS,Facility,Outpatient,,,,93,79.05,26.6538,93,"UCare Health, Inc.",Medical Assistance,46.9371,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Bone Marrow Tray-Dis,,C1830,HCPCS,Facility,Inpatient,,,,93,79.05,26.6538,93,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Sup Bone Marrow Tray-Dis,,C1830,HCPCS,Facility,Outpatient,,,,93,79.05,26.6538,93,"UCare Health, Inc.",Medicare Advantage,46.9371,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Bone Marrow Tray-Dis,,C1830,HCPCS,Facility,Inpatient,,,,93,79.05,26.6538,93,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Bone Marrow Tray-Dis,,C1830,HCPCS,Facility,Outpatient,,,,93,79.05,26.6538,93,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),46.9371,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Bone Marrow Tray-Dis,,C1830,HCPCS,Facility,Inpatient,,,,93,79.05,26.6538,93,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Bone Marrow Tray-Dis,,C1830,HCPCS,Facility,Both,,,,93,79.05,26.6538,93,UnitedHealthcare,Individual & Family,87.42,94,,percent of total billed charges,,
Sup Bone Marrow Tray-Dis,,C1830,HCPCS,Facility,Outpatient,,,,93,79.05,26.6538,93,UnitedHealthcare,Medicare Advantage,45.57,49,,percent of total billed charges,,
Sup Bone Marrow Tray-Dis,,C1830,HCPCS,Facility,Inpatient,,,,93,79.05,26.6538,93,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Sup Bone Marrow Tray-Dis,,C1830,HCPCS,Facility,Outpatient,,,,93,79.05,26.6538,93,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,44.64,48,,percent of total billed charges,,100% of DHS outpatient percentage
Sup Bone Marrow Tray-Dis,,C1830,HCPCS,Facility,Inpatient,,,,93,79.05,26.6538,93,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
STENT URETERAL 6 X 26,,C1876,HCPCS,Facility,Both,,,,477,405.45,136.7082,477,Aetna,Commercial,438.84,92,,percent of total billed charges,,
STENT URETERAL 6 X 26,,C1876,HCPCS,Facility,Outpatient,,,,477,405.45,136.7082,477,Aetna,Medicare Advantage,233.73,49,,percent of total billed charges,,
STENT URETERAL 6 X 26,,C1876,HCPCS,Facility,Inpatient,,,,477,405.45,136.7082,477,Aetna,Medicare Advantage,,,,,Included in per diem rate,
STENT URETERAL 6 X 26,,C1876,HCPCS,Facility,Both,,,,477,405.45,136.7082,477,Aetna,PPO,443.61,93,,percent of total billed charges,,
STENT URETERAL 6 X 26,,C1876,HCPCS,Facility,Both,,,,477,405.45,136.7082,477,America's PPO,America's PPO,458.0631,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
STENT URETERAL 6 X 26,,C1876,HCPCS,Facility,Both,,,,477,405.45,136.7082,477,BlueCross BlueShield Minnesota, Federal Employee Program,469.368,98.4,,percent of total billed charges,,
STENT URETERAL 6 X 26,,C1876,HCPCS,Facility,Both,,,,477,405.45,136.7082,477,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,477,100,,percent of total billed charges,,
STENT URETERAL 6 X 26,,C1876,HCPCS,Facility,Both,,,,477,405.45,136.7082,477,BlueCross BlueShield Minnesota,High Value Network Plan,429.3,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
STENT URETERAL 6 X 26,,C1876,HCPCS,Facility,Outpatient,,,,477,405.45,136.7082,477,BlueCross BlueShield Minnesota,Medicare Advantage,233.73,49,,percent of total billed charges,,
STENT URETERAL 6 X 26,,C1876,HCPCS,Facility,Inpatient,,,,477,405.45,136.7082,477,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
STENT URETERAL 6 X 26,,C1876,HCPCS,Facility,Both,,,,477,405.45,136.7082,477,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,422.4789,88.57,,percent of total billed charges,,
STENT URETERAL 6 X 26,,C1876,HCPCS,Facility,Both,,,,477,405.45,136.7082,477,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,136.7082,28.66,,percent of total billed charges,,
STENT URETERAL 6 X 26,,C1876,HCPCS,Facility,Outpatient,,,,477,405.45,136.7082,477,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),233.73,49,,percent of total billed charges,,
STENT URETERAL 6 X 26,,C1876,HCPCS,Facility,Inpatient,,,,477,405.45,136.7082,477,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
STENT URETERAL 6 X 26,,C1876,HCPCS,Facility,Both,,,,477,405.45,136.7082,477,CorVel,Worker's Compensation,477,100,,percent of total billed charges,,
STENT URETERAL 6 X 26,,C1876,HCPCS,Facility,Both,,,,477,405.45,136.7082,477,First Health Group Corporation,First Health Network,462.69,97,,percent of total billed charges,,
STENT URETERAL 6 X 26,,C1876,HCPCS,Facility,Both,,,,477,405.45,136.7082,477,"Health Partners, Inc.",Commercial,451.242,94.6,,percent of total billed charges,,
STENT URETERAL 6 X 26,,C1876,HCPCS,Facility,Outpatient,,,,477,405.45,136.7082,477,"Health Partners, Inc.",Medicare Advantage,233.73,49,,percent of total billed charges,,
STENT URETERAL 6 X 26,,C1876,HCPCS,Facility,Inpatient,,,,477,405.45,136.7082,477,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
STENT URETERAL 6 X 26,,C1876,HCPCS,Facility,Both,,,,477,405.45,136.7082,477,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),286.2,60,,percent of total billed charges,,
STENT URETERAL 6 X 26,,C1876,HCPCS,Facility,Both,,,,477,405.45,136.7082,477,"Health Partners, Inc.",State of Minnesota Advantage Program,388.755,81.5,,percent of total billed charges,,
STENT URETERAL 6 X 26,,C1876,HCPCS,Facility,Both,,,,477,405.45,136.7082,477,"Health Partners, Inc.",State Public Programs,238.5,50,,percent of total billed charges,,
STENT URETERAL 6 X 26,,C1876,HCPCS,Facility,Both,,,,477,405.45,136.7082,477,Humana Insurance Company,Commercial PPO,453.15,95,,percent of total billed charges,,
STENT URETERAL 6 X 26,,C1876,HCPCS,Facility,Outpatient,,,,477,405.45,136.7082,477,Humana Insurance Company,Medicare PPO,233.73,49,,percent of total billed charges,,
STENT URETERAL 6 X 26,,C1876,HCPCS,Facility,Inpatient,,,,477,405.45,136.7082,477,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
STENT URETERAL 6 X 26,,C1876,HCPCS,Facility,Both,,,,477,405.45,136.7082,477,Medica,Individual & Family,472.707,99.1,,percent of total billed charges,,
STENT URETERAL 6 X 26,,C1876,HCPCS,Facility,Outpatient,,,,477,405.45,136.7082,477,Medica,Medica Advantage Solution,237.546,49.8,,percent of total billed charges,,
STENT URETERAL 6 X 26,,C1876,HCPCS,Facility,Inpatient,,,,477,405.45,136.7082,477,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
STENT URETERAL 6 X 26,,C1876,HCPCS,Facility,Outpatient,,,,477,405.45,136.7082,477,Medica,Medical Assistance,212.742,44.6,,percent of total billed charges,,
STENT URETERAL 6 X 26,,C1876,HCPCS,Facility,Inpatient,,,,477,405.45,136.7082,477,Medica,Medical Assistance,,,,,Included in per diem rate,
STENT URETERAL 6 X 26,,C1876,HCPCS,Facility,Outpatient,,,,477,405.45,136.7082,477,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,237.546,49.8,,percent of total billed charges,,
STENT URETERAL 6 X 26,,C1876,HCPCS,Facility,Inpatient,,,,477,405.45,136.7082,477,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
STENT URETERAL 6 X 26,,C1876,HCPCS,Facility,Both,,,,477,405.45,136.7082,477,"Multiplan, Inc.","Multiplan, Inc.",448.38,94,,percent of total billed charges,,
STENT URETERAL 6 X 26,,C1876,HCPCS,Facility,Outpatient,,,,477,405.45,136.7082,477,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,429.777,90.1,,percent of total billed charges,,
STENT URETERAL 6 X 26,,C1876,HCPCS,Facility,Inpatient,,,,477,405.45,136.7082,477,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
STENT URETERAL 6 X 26,,C1876,HCPCS,Facility,Both,,,,477,405.45,136.7082,477,"Preferred One Administrative Services, INC.",PPO,470.322,98.6,,percent of total billed charges,,
STENT URETERAL 6 X 26,,C1876,HCPCS,Facility,Outpatient,,,,477,405.45,136.7082,477,PrimeWest Health,Minnesota Senior Health Options (MSHO),245.4165,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
STENT URETERAL 6 X 26,,C1876,HCPCS,Facility,Inpatient,,,,477,405.45,136.7082,477,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
STENT URETERAL 6 X 26,,C1876,HCPCS,Facility,Outpatient,,,,477,405.45,136.7082,477,PrimeWest Health,MinnesotaCare,244.9872,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
STENT URETERAL 6 X 26,,C1876,HCPCS,Facility,Inpatient,,,,477,405.45,136.7082,477,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
STENT URETERAL 6 X 26,,C1876,HCPCS,Facility,Both,,,,477,405.45,136.7082,477,Sanford Health Plan,Sanford Health Plan,438.84,92,,percent of total billed charges,,
STENT URETERAL 6 X 26,,C1876,HCPCS,Facility,Outpatient,,,,477,405.45,136.7082,477,"UCare Health, Inc.",Individual & Family Plan,268.7895,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
STENT URETERAL 6 X 26,,C1876,HCPCS,Facility,Inpatient,,,,477,405.45,136.7082,477,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
STENT URETERAL 6 X 26,,C1876,HCPCS,Facility,Outpatient,,,,477,405.45,136.7082,477,"UCare Health, Inc.",Medical Assistance,240.7419,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
STENT URETERAL 6 X 26,,C1876,HCPCS,Facility,Inpatient,,,,477,405.45,136.7082,477,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
STENT URETERAL 6 X 26,,C1876,HCPCS,Facility,Outpatient,,,,477,405.45,136.7082,477,"UCare Health, Inc.",Medicare Advantage,240.7419,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
STENT URETERAL 6 X 26,,C1876,HCPCS,Facility,Inpatient,,,,477,405.45,136.7082,477,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
STENT URETERAL 6 X 26,,C1876,HCPCS,Facility,Outpatient,,,,477,405.45,136.7082,477,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),240.7419,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
STENT URETERAL 6 X 26,,C1876,HCPCS,Facility,Inpatient,,,,477,405.45,136.7082,477,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
STENT URETERAL 6 X 26,,C1876,HCPCS,Facility,Both,,,,477,405.45,136.7082,477,UnitedHealthcare,Individual & Family,448.38,94,,percent of total billed charges,,
STENT URETERAL 6 X 26,,C1876,HCPCS,Facility,Outpatient,,,,477,405.45,136.7082,477,UnitedHealthcare,Medicare Advantage,233.73,49,,percent of total billed charges,,
STENT URETERAL 6 X 26,,C1876,HCPCS,Facility,Inpatient,,,,477,405.45,136.7082,477,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
STENT URETERAL 6 X 26,,C1876,HCPCS,Facility,Outpatient,,,,477,405.45,136.7082,477,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,228.96,48,,percent of total billed charges,,100% of DHS outpatient percentage
STENT URETERAL 6 X 26,,C1876,HCPCS,Facility,Inpatient,,,,477,405.45,136.7082,477,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
STENT URETHRAL DOUBLE J 6X28,,C1876,HCPCS,Facility,Both,,,,515,437.75,147.599,515,Aetna,Commercial,473.8,92,,percent of total billed charges,,
STENT URETHRAL DOUBLE J 6X28,,C1876,HCPCS,Facility,Outpatient,,,,515,437.75,147.599,515,Aetna,Medicare Advantage,252.35,49,,percent of total billed charges,,
STENT URETHRAL DOUBLE J 6X28,,C1876,HCPCS,Facility,Inpatient,,,,515,437.75,147.599,515,Aetna,Medicare Advantage,,,,,Included in per diem rate,
STENT URETHRAL DOUBLE J 6X28,,C1876,HCPCS,Facility,Both,,,,515,437.75,147.599,515,Aetna,PPO,478.95,93,,percent of total billed charges,,
STENT URETHRAL DOUBLE J 6X28,,C1876,HCPCS,Facility,Both,,,,515,437.75,147.599,515,America's PPO,America's PPO,494.5545,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
STENT URETHRAL DOUBLE J 6X28,,C1876,HCPCS,Facility,Both,,,,515,437.75,147.599,515,BlueCross BlueShield Minnesota, Federal Employee Program,506.76,98.4,,percent of total billed charges,,
STENT URETHRAL DOUBLE J 6X28,,C1876,HCPCS,Facility,Both,,,,515,437.75,147.599,515,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,515,100,,percent of total billed charges,,
STENT URETHRAL DOUBLE J 6X28,,C1876,HCPCS,Facility,Both,,,,515,437.75,147.599,515,BlueCross BlueShield Minnesota,High Value Network Plan,463.5,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
STENT URETHRAL DOUBLE J 6X28,,C1876,HCPCS,Facility,Outpatient,,,,515,437.75,147.599,515,BlueCross BlueShield Minnesota,Medicare Advantage,252.35,49,,percent of total billed charges,,
STENT URETHRAL DOUBLE J 6X28,,C1876,HCPCS,Facility,Inpatient,,,,515,437.75,147.599,515,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
STENT URETHRAL DOUBLE J 6X28,,C1876,HCPCS,Facility,Both,,,,515,437.75,147.599,515,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,456.1355,88.57,,percent of total billed charges,,
STENT URETHRAL DOUBLE J 6X28,,C1876,HCPCS,Facility,Both,,,,515,437.75,147.599,515,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,147.599,28.66,,percent of total billed charges,,
STENT URETHRAL DOUBLE J 6X28,,C1876,HCPCS,Facility,Outpatient,,,,515,437.75,147.599,515,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),252.35,49,,percent of total billed charges,,
STENT URETHRAL DOUBLE J 6X28,,C1876,HCPCS,Facility,Inpatient,,,,515,437.75,147.599,515,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
STENT URETHRAL DOUBLE J 6X28,,C1876,HCPCS,Facility,Both,,,,515,437.75,147.599,515,CorVel,Worker's Compensation,515,100,,percent of total billed charges,,
STENT URETHRAL DOUBLE J 6X28,,C1876,HCPCS,Facility,Both,,,,515,437.75,147.599,515,First Health Group Corporation,First Health Network,499.55,97,,percent of total billed charges,,
STENT URETHRAL DOUBLE J 6X28,,C1876,HCPCS,Facility,Both,,,,515,437.75,147.599,515,"Health Partners, Inc.",Commercial,487.19,94.6,,percent of total billed charges,,
STENT URETHRAL DOUBLE J 6X28,,C1876,HCPCS,Facility,Outpatient,,,,515,437.75,147.599,515,"Health Partners, Inc.",Medicare Advantage,252.35,49,,percent of total billed charges,,
STENT URETHRAL DOUBLE J 6X28,,C1876,HCPCS,Facility,Inpatient,,,,515,437.75,147.599,515,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
STENT URETHRAL DOUBLE J 6X28,,C1876,HCPCS,Facility,Both,,,,515,437.75,147.599,515,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),309,60,,percent of total billed charges,,
STENT URETHRAL DOUBLE J 6X28,,C1876,HCPCS,Facility,Both,,,,515,437.75,147.599,515,"Health Partners, Inc.",State of Minnesota Advantage Program,419.725,81.5,,percent of total billed charges,,
STENT URETHRAL DOUBLE J 6X28,,C1876,HCPCS,Facility,Both,,,,515,437.75,147.599,515,"Health Partners, Inc.",State Public Programs,257.5,50,,percent of total billed charges,,
STENT URETHRAL DOUBLE J 6X28,,C1876,HCPCS,Facility,Both,,,,515,437.75,147.599,515,Humana Insurance Company,Commercial PPO,489.25,95,,percent of total billed charges,,
STENT URETHRAL DOUBLE J 6X28,,C1876,HCPCS,Facility,Outpatient,,,,515,437.75,147.599,515,Humana Insurance Company,Medicare PPO,252.35,49,,percent of total billed charges,,
STENT URETHRAL DOUBLE J 6X28,,C1876,HCPCS,Facility,Inpatient,,,,515,437.75,147.599,515,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
STENT URETHRAL DOUBLE J 6X28,,C1876,HCPCS,Facility,Both,,,,515,437.75,147.599,515,Medica,Individual & Family,510.365,99.1,,percent of total billed charges,,
STENT URETHRAL DOUBLE J 6X28,,C1876,HCPCS,Facility,Outpatient,,,,515,437.75,147.599,515,Medica,Medica Advantage Solution,256.47,49.8,,percent of total billed charges,,
STENT URETHRAL DOUBLE J 6X28,,C1876,HCPCS,Facility,Inpatient,,,,515,437.75,147.599,515,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
STENT URETHRAL DOUBLE J 6X28,,C1876,HCPCS,Facility,Outpatient,,,,515,437.75,147.599,515,Medica,Medical Assistance,229.69,44.6,,percent of total billed charges,,
STENT URETHRAL DOUBLE J 6X28,,C1876,HCPCS,Facility,Inpatient,,,,515,437.75,147.599,515,Medica,Medical Assistance,,,,,Included in per diem rate,
STENT URETHRAL DOUBLE J 6X28,,C1876,HCPCS,Facility,Outpatient,,,,515,437.75,147.599,515,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,256.47,49.8,,percent of total billed charges,,
STENT URETHRAL DOUBLE J 6X28,,C1876,HCPCS,Facility,Inpatient,,,,515,437.75,147.599,515,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
STENT URETHRAL DOUBLE J 6X28,,C1876,HCPCS,Facility,Both,,,,515,437.75,147.599,515,"Multiplan, Inc.","Multiplan, Inc.",484.1,94,,percent of total billed charges,,
STENT URETHRAL DOUBLE J 6X28,,C1876,HCPCS,Facility,Outpatient,,,,515,437.75,147.599,515,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,464.015,90.1,,percent of total billed charges,,
STENT URETHRAL DOUBLE J 6X28,,C1876,HCPCS,Facility,Inpatient,,,,515,437.75,147.599,515,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
STENT URETHRAL DOUBLE J 6X28,,C1876,HCPCS,Facility,Both,,,,515,437.75,147.599,515,"Preferred One Administrative Services, INC.",PPO,507.79,98.6,,percent of total billed charges,,
STENT URETHRAL DOUBLE J 6X28,,C1876,HCPCS,Facility,Outpatient,,,,515,437.75,147.599,515,PrimeWest Health,Minnesota Senior Health Options (MSHO),264.9675,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
STENT URETHRAL DOUBLE J 6X28,,C1876,HCPCS,Facility,Inpatient,,,,515,437.75,147.599,515,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
STENT URETHRAL DOUBLE J 6X28,,C1876,HCPCS,Facility,Outpatient,,,,515,437.75,147.599,515,PrimeWest Health,MinnesotaCare,264.504,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
STENT URETHRAL DOUBLE J 6X28,,C1876,HCPCS,Facility,Inpatient,,,,515,437.75,147.599,515,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
STENT URETHRAL DOUBLE J 6X28,,C1876,HCPCS,Facility,Both,,,,515,437.75,147.599,515,Sanford Health Plan,Sanford Health Plan,473.8,92,,percent of total billed charges,,
STENT URETHRAL DOUBLE J 6X28,,C1876,HCPCS,Facility,Outpatient,,,,515,437.75,147.599,515,"UCare Health, Inc.",Individual & Family Plan,290.2025,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
STENT URETHRAL DOUBLE J 6X28,,C1876,HCPCS,Facility,Inpatient,,,,515,437.75,147.599,515,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
STENT URETHRAL DOUBLE J 6X28,,C1876,HCPCS,Facility,Outpatient,,,,515,437.75,147.599,515,"UCare Health, Inc.",Medical Assistance,259.9205,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
STENT URETHRAL DOUBLE J 6X28,,C1876,HCPCS,Facility,Inpatient,,,,515,437.75,147.599,515,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
STENT URETHRAL DOUBLE J 6X28,,C1876,HCPCS,Facility,Outpatient,,,,515,437.75,147.599,515,"UCare Health, Inc.",Medicare Advantage,259.9205,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
STENT URETHRAL DOUBLE J 6X28,,C1876,HCPCS,Facility,Inpatient,,,,515,437.75,147.599,515,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
STENT URETHRAL DOUBLE J 6X28,,C1876,HCPCS,Facility,Outpatient,,,,515,437.75,147.599,515,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),259.9205,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
STENT URETHRAL DOUBLE J 6X28,,C1876,HCPCS,Facility,Inpatient,,,,515,437.75,147.599,515,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
STENT URETHRAL DOUBLE J 6X28,,C1876,HCPCS,Facility,Both,,,,515,437.75,147.599,515,UnitedHealthcare,Individual & Family,484.1,94,,percent of total billed charges,,
STENT URETHRAL DOUBLE J 6X28,,C1876,HCPCS,Facility,Outpatient,,,,515,437.75,147.599,515,UnitedHealthcare,Medicare Advantage,252.35,49,,percent of total billed charges,,
STENT URETHRAL DOUBLE J 6X28,,C1876,HCPCS,Facility,Inpatient,,,,515,437.75,147.599,515,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
STENT URETHRAL DOUBLE J 6X28,,C1876,HCPCS,Facility,Outpatient,,,,515,437.75,147.599,515,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,247.2,48,,percent of total billed charges,,100% of DHS outpatient percentage
STENT URETHRAL DOUBLE J 6X28,,C1876,HCPCS,Facility,Inpatient,,,,515,437.75,147.599,515,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
CATHETER ABLATION RFS  6 FR        RFS2-6-12,,C1886,HCPCS,Facility,Both,,,,1323,1124.55,379.1718,1323,Aetna,Commercial,1217.16,92,,percent of total billed charges,,
CATHETER ABLATION RFS  6 FR        RFS2-6-12,,C1886,HCPCS,Facility,Outpatient,,,,1323,1124.55,379.1718,1323,Aetna,Medicare Advantage,648.27,49,,percent of total billed charges,,
CATHETER ABLATION RFS  6 FR        RFS2-6-12,,C1886,HCPCS,Facility,Inpatient,,,,1323,1124.55,379.1718,1323,Aetna,Medicare Advantage,,,,,Included in per diem rate,
CATHETER ABLATION RFS  6 FR        RFS2-6-12,,C1886,HCPCS,Facility,Both,,,,1323,1124.55,379.1718,1323,Aetna,PPO,1230.39,93,,percent of total billed charges,,
CATHETER ABLATION RFS  6 FR        RFS2-6-12,,C1886,HCPCS,Facility,Both,,,,1323,1124.55,379.1718,1323,America's PPO,America's PPO,1270.4769,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
CATHETER ABLATION RFS  6 FR        RFS2-6-12,,C1886,HCPCS,Facility,Both,,,,1323,1124.55,379.1718,1323,BlueCross BlueShield Minnesota, Federal Employee Program,1301.832,98.4,,percent of total billed charges,,
CATHETER ABLATION RFS  6 FR        RFS2-6-12,,C1886,HCPCS,Facility,Both,,,,1323,1124.55,379.1718,1323,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1323,100,,percent of total billed charges,,
CATHETER ABLATION RFS  6 FR        RFS2-6-12,,C1886,HCPCS,Facility,Both,,,,1323,1124.55,379.1718,1323,BlueCross BlueShield Minnesota,High Value Network Plan,1190.7,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
CATHETER ABLATION RFS  6 FR        RFS2-6-12,,C1886,HCPCS,Facility,Outpatient,,,,1323,1124.55,379.1718,1323,BlueCross BlueShield Minnesota,Medicare Advantage,648.27,49,,percent of total billed charges,,
CATHETER ABLATION RFS  6 FR        RFS2-6-12,,C1886,HCPCS,Facility,Inpatient,,,,1323,1124.55,379.1718,1323,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
CATHETER ABLATION RFS  6 FR        RFS2-6-12,,C1886,HCPCS,Facility,Both,,,,1323,1124.55,379.1718,1323,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1171.7811,88.57,,percent of total billed charges,,
CATHETER ABLATION RFS  6 FR        RFS2-6-12,,C1886,HCPCS,Facility,Both,,,,1323,1124.55,379.1718,1323,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,379.1718,28.66,,percent of total billed charges,,
CATHETER ABLATION RFS  6 FR        RFS2-6-12,,C1886,HCPCS,Facility,Outpatient,,,,1323,1124.55,379.1718,1323,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),648.27,49,,percent of total billed charges,,
CATHETER ABLATION RFS  6 FR        RFS2-6-12,,C1886,HCPCS,Facility,Inpatient,,,,1323,1124.55,379.1718,1323,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
CATHETER ABLATION RFS  6 FR        RFS2-6-12,,C1886,HCPCS,Facility,Both,,,,1323,1124.55,379.1718,1323,CorVel,Worker's Compensation,1323,100,,percent of total billed charges,,
CATHETER ABLATION RFS  6 FR        RFS2-6-12,,C1886,HCPCS,Facility,Both,,,,1323,1124.55,379.1718,1323,First Health Group Corporation,First Health Network,1283.31,97,,percent of total billed charges,,
CATHETER ABLATION RFS  6 FR        RFS2-6-12,,C1886,HCPCS,Facility,Both,,,,1323,1124.55,379.1718,1323,"Health Partners, Inc.",Commercial,1251.558,94.6,,percent of total billed charges,,
CATHETER ABLATION RFS  6 FR        RFS2-6-12,,C1886,HCPCS,Facility,Outpatient,,,,1323,1124.55,379.1718,1323,"Health Partners, Inc.",Medicare Advantage,648.27,49,,percent of total billed charges,,
CATHETER ABLATION RFS  6 FR        RFS2-6-12,,C1886,HCPCS,Facility,Inpatient,,,,1323,1124.55,379.1718,1323,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CATHETER ABLATION RFS  6 FR        RFS2-6-12,,C1886,HCPCS,Facility,Both,,,,1323,1124.55,379.1718,1323,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),793.8,60,,percent of total billed charges,,
CATHETER ABLATION RFS  6 FR        RFS2-6-12,,C1886,HCPCS,Facility,Both,,,,1323,1124.55,379.1718,1323,"Health Partners, Inc.",State of Minnesota Advantage Program,1078.245,81.5,,percent of total billed charges,,
CATHETER ABLATION RFS  6 FR        RFS2-6-12,,C1886,HCPCS,Facility,Both,,,,1323,1124.55,379.1718,1323,"Health Partners, Inc.",State Public Programs,661.5,50,,percent of total billed charges,,
CATHETER ABLATION RFS  6 FR        RFS2-6-12,,C1886,HCPCS,Facility,Both,,,,1323,1124.55,379.1718,1323,Humana Insurance Company,Commercial PPO,1256.85,95,,percent of total billed charges,,
CATHETER ABLATION RFS  6 FR        RFS2-6-12,,C1886,HCPCS,Facility,Outpatient,,,,1323,1124.55,379.1718,1323,Humana Insurance Company,Medicare PPO,648.27,49,,percent of total billed charges,,
CATHETER ABLATION RFS  6 FR        RFS2-6-12,,C1886,HCPCS,Facility,Inpatient,,,,1323,1124.55,379.1718,1323,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
CATHETER ABLATION RFS  6 FR        RFS2-6-12,,C1886,HCPCS,Facility,Both,,,,1323,1124.55,379.1718,1323,Medica,Individual & Family,1311.093,99.1,,percent of total billed charges,,
CATHETER ABLATION RFS  6 FR        RFS2-6-12,,C1886,HCPCS,Facility,Outpatient,,,,1323,1124.55,379.1718,1323,Medica,Medica Advantage Solution,658.854,49.8,,percent of total billed charges,,
CATHETER ABLATION RFS  6 FR        RFS2-6-12,,C1886,HCPCS,Facility,Inpatient,,,,1323,1124.55,379.1718,1323,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
CATHETER ABLATION RFS  6 FR        RFS2-6-12,,C1886,HCPCS,Facility,Outpatient,,,,1323,1124.55,379.1718,1323,Medica,Medical Assistance,590.058,44.6,,percent of total billed charges,,
CATHETER ABLATION RFS  6 FR        RFS2-6-12,,C1886,HCPCS,Facility,Inpatient,,,,1323,1124.55,379.1718,1323,Medica,Medical Assistance,,,,,Included in per diem rate,
CATHETER ABLATION RFS  6 FR        RFS2-6-12,,C1886,HCPCS,Facility,Outpatient,,,,1323,1124.55,379.1718,1323,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,658.854,49.8,,percent of total billed charges,,
CATHETER ABLATION RFS  6 FR        RFS2-6-12,,C1886,HCPCS,Facility,Inpatient,,,,1323,1124.55,379.1718,1323,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
CATHETER ABLATION RFS  6 FR        RFS2-6-12,,C1886,HCPCS,Facility,Both,,,,1323,1124.55,379.1718,1323,"Multiplan, Inc.","Multiplan, Inc.",1243.62,94,,percent of total billed charges,,
CATHETER ABLATION RFS  6 FR        RFS2-6-12,,C1886,HCPCS,Facility,Outpatient,,,,1323,1124.55,379.1718,1323,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1192.023,90.1,,percent of total billed charges,,
CATHETER ABLATION RFS  6 FR        RFS2-6-12,,C1886,HCPCS,Facility,Inpatient,,,,1323,1124.55,379.1718,1323,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
CATHETER ABLATION RFS  6 FR        RFS2-6-12,,C1886,HCPCS,Facility,Both,,,,1323,1124.55,379.1718,1323,"Preferred One Administrative Services, INC.",PPO,1304.478,98.6,,percent of total billed charges,,
CATHETER ABLATION RFS  6 FR        RFS2-6-12,,C1886,HCPCS,Facility,Outpatient,,,,1323,1124.55,379.1718,1323,PrimeWest Health,Minnesota Senior Health Options (MSHO),680.6835,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
CATHETER ABLATION RFS  6 FR        RFS2-6-12,,C1886,HCPCS,Facility,Inpatient,,,,1323,1124.55,379.1718,1323,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CATHETER ABLATION RFS  6 FR        RFS2-6-12,,C1886,HCPCS,Facility,Outpatient,,,,1323,1124.55,379.1718,1323,PrimeWest Health,MinnesotaCare,679.4928,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
CATHETER ABLATION RFS  6 FR        RFS2-6-12,,C1886,HCPCS,Facility,Inpatient,,,,1323,1124.55,379.1718,1323,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
CATHETER ABLATION RFS  6 FR        RFS2-6-12,,C1886,HCPCS,Facility,Both,,,,1323,1124.55,379.1718,1323,Sanford Health Plan,Sanford Health Plan,1217.16,92,,percent of total billed charges,,
CATHETER ABLATION RFS  6 FR        RFS2-6-12,,C1886,HCPCS,Facility,Outpatient,,,,1323,1124.55,379.1718,1323,"UCare Health, Inc.",Individual & Family Plan,745.5105,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
CATHETER ABLATION RFS  6 FR        RFS2-6-12,,C1886,HCPCS,Facility,Inpatient,,,,1323,1124.55,379.1718,1323,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
CATHETER ABLATION RFS  6 FR        RFS2-6-12,,C1886,HCPCS,Facility,Outpatient,,,,1323,1124.55,379.1718,1323,"UCare Health, Inc.",Medical Assistance,667.7181,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CATHETER ABLATION RFS  6 FR        RFS2-6-12,,C1886,HCPCS,Facility,Inpatient,,,,1323,1124.55,379.1718,1323,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
CATHETER ABLATION RFS  6 FR        RFS2-6-12,,C1886,HCPCS,Facility,Outpatient,,,,1323,1124.55,379.1718,1323,"UCare Health, Inc.",Medicare Advantage,667.7181,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CATHETER ABLATION RFS  6 FR        RFS2-6-12,,C1886,HCPCS,Facility,Inpatient,,,,1323,1124.55,379.1718,1323,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CATHETER ABLATION RFS  6 FR        RFS2-6-12,,C1886,HCPCS,Facility,Outpatient,,,,1323,1124.55,379.1718,1323,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),667.7181,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CATHETER ABLATION RFS  6 FR        RFS2-6-12,,C1886,HCPCS,Facility,Inpatient,,,,1323,1124.55,379.1718,1323,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CATHETER ABLATION RFS  6 FR        RFS2-6-12,,C1886,HCPCS,Facility,Both,,,,1323,1124.55,379.1718,1323,UnitedHealthcare,Individual & Family,1243.62,94,,percent of total billed charges,,
CATHETER ABLATION RFS  6 FR        RFS2-6-12,,C1886,HCPCS,Facility,Outpatient,,,,1323,1124.55,379.1718,1323,UnitedHealthcare,Medicare Advantage,648.27,49,,percent of total billed charges,,
CATHETER ABLATION RFS  6 FR        RFS2-6-12,,C1886,HCPCS,Facility,Inpatient,,,,1323,1124.55,379.1718,1323,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
CATHETER ABLATION RFS  6 FR        RFS2-6-12,,C1886,HCPCS,Facility,Outpatient,,,,1323,1124.55,379.1718,1323,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,635.04,48,,percent of total billed charges,,100% of DHS outpatient percentage
CATHETER ABLATION RFS  6 FR        RFS2-6-12,,C1886,HCPCS,Facility,Inpatient,,,,1323,1124.55,379.1718,1323,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
DRAIN JP 7MM FLAT,,C1889,HCPCS,Facility,Both,,,,28.3,24.055,8.11078,28.3,Aetna,Commercial,26.036,92,,percent of total billed charges,,
DRAIN JP 7MM FLAT,,C1889,HCPCS,Facility,Outpatient,,,,28.3,24.055,8.11078,28.3,Aetna,Medicare Advantage,13.867,49,,percent of total billed charges,,
DRAIN JP 7MM FLAT,,C1889,HCPCS,Facility,Inpatient,,,,28.3,24.055,8.11078,28.3,Aetna,Medicare Advantage,,,,,Included in per diem rate,
DRAIN JP 7MM FLAT,,C1889,HCPCS,Facility,Both,,,,28.3,24.055,8.11078,28.3,Aetna,PPO,26.319,93,,percent of total billed charges,,
DRAIN JP 7MM FLAT,,C1889,HCPCS,Facility,Both,,,,28.3,24.055,8.11078,28.3,America's PPO,America's PPO,27.17649,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
DRAIN JP 7MM FLAT,,C1889,HCPCS,Facility,Both,,,,28.3,24.055,8.11078,28.3,BlueCross BlueShield Minnesota, Federal Employee Program,27.8472,98.4,,percent of total billed charges,,
DRAIN JP 7MM FLAT,,C1889,HCPCS,Facility,Both,,,,28.3,24.055,8.11078,28.3,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,28.3,100,,percent of total billed charges,,
DRAIN JP 7MM FLAT,,C1889,HCPCS,Facility,Both,,,,28.3,24.055,8.11078,28.3,BlueCross BlueShield Minnesota,High Value Network Plan,25.47,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
DRAIN JP 7MM FLAT,,C1889,HCPCS,Facility,Outpatient,,,,28.3,24.055,8.11078,28.3,BlueCross BlueShield Minnesota,Medicare Advantage,13.867,49,,percent of total billed charges,,
DRAIN JP 7MM FLAT,,C1889,HCPCS,Facility,Inpatient,,,,28.3,24.055,8.11078,28.3,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
DRAIN JP 7MM FLAT,,C1889,HCPCS,Facility,Both,,,,28.3,24.055,8.11078,28.3,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,25.06531,88.57,,percent of total billed charges,,
DRAIN JP 7MM FLAT,,C1889,HCPCS,Facility,Both,,,,28.3,24.055,8.11078,28.3,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,8.11078,28.66,,percent of total billed charges,,
DRAIN JP 7MM FLAT,,C1889,HCPCS,Facility,Outpatient,,,,28.3,24.055,8.11078,28.3,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),13.867,49,,percent of total billed charges,,
DRAIN JP 7MM FLAT,,C1889,HCPCS,Facility,Inpatient,,,,28.3,24.055,8.11078,28.3,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
DRAIN JP 7MM FLAT,,C1889,HCPCS,Facility,Both,,,,28.3,24.055,8.11078,28.3,CorVel,Worker's Compensation,28.3,100,,percent of total billed charges,,
DRAIN JP 7MM FLAT,,C1889,HCPCS,Facility,Both,,,,28.3,24.055,8.11078,28.3,First Health Group Corporation,First Health Network,27.451,97,,percent of total billed charges,,
DRAIN JP 7MM FLAT,,C1889,HCPCS,Facility,Both,,,,28.3,24.055,8.11078,28.3,"Health Partners, Inc.",Commercial,26.7718,94.6,,percent of total billed charges,,
DRAIN JP 7MM FLAT,,C1889,HCPCS,Facility,Outpatient,,,,28.3,24.055,8.11078,28.3,"Health Partners, Inc.",Medicare Advantage,13.867,49,,percent of total billed charges,,
DRAIN JP 7MM FLAT,,C1889,HCPCS,Facility,Inpatient,,,,28.3,24.055,8.11078,28.3,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DRAIN JP 7MM FLAT,,C1889,HCPCS,Facility,Both,,,,28.3,24.055,8.11078,28.3,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),16.98,60,,percent of total billed charges,,
DRAIN JP 7MM FLAT,,C1889,HCPCS,Facility,Both,,,,28.3,24.055,8.11078,28.3,"Health Partners, Inc.",State of Minnesota Advantage Program,23.0645,81.5,,percent of total billed charges,,
DRAIN JP 7MM FLAT,,C1889,HCPCS,Facility,Both,,,,28.3,24.055,8.11078,28.3,"Health Partners, Inc.",State Public Programs,14.15,50,,percent of total billed charges,,
DRAIN JP 7MM FLAT,,C1889,HCPCS,Facility,Both,,,,28.3,24.055,8.11078,28.3,Humana Insurance Company,Commercial PPO,26.885,95,,percent of total billed charges,,
DRAIN JP 7MM FLAT,,C1889,HCPCS,Facility,Outpatient,,,,28.3,24.055,8.11078,28.3,Humana Insurance Company,Medicare PPO,13.867,49,,percent of total billed charges,,
DRAIN JP 7MM FLAT,,C1889,HCPCS,Facility,Inpatient,,,,28.3,24.055,8.11078,28.3,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
DRAIN JP 7MM FLAT,,C1889,HCPCS,Facility,Both,,,,28.3,24.055,8.11078,28.3,Medica,Individual & Family,28.0453,99.1,,percent of total billed charges,,
DRAIN JP 7MM FLAT,,C1889,HCPCS,Facility,Outpatient,,,,28.3,24.055,8.11078,28.3,Medica,Medica Advantage Solution,14.0934,49.8,,percent of total billed charges,,
DRAIN JP 7MM FLAT,,C1889,HCPCS,Facility,Inpatient,,,,28.3,24.055,8.11078,28.3,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
DRAIN JP 7MM FLAT,,C1889,HCPCS,Facility,Outpatient,,,,28.3,24.055,8.11078,28.3,Medica,Medical Assistance,12.6218,44.6,,percent of total billed charges,,
DRAIN JP 7MM FLAT,,C1889,HCPCS,Facility,Inpatient,,,,28.3,24.055,8.11078,28.3,Medica,Medical Assistance,,,,,Included in per diem rate,
DRAIN JP 7MM FLAT,,C1889,HCPCS,Facility,Outpatient,,,,28.3,24.055,8.11078,28.3,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,14.0934,49.8,,percent of total billed charges,,
DRAIN JP 7MM FLAT,,C1889,HCPCS,Facility,Inpatient,,,,28.3,24.055,8.11078,28.3,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
DRAIN JP 7MM FLAT,,C1889,HCPCS,Facility,Both,,,,28.3,24.055,8.11078,28.3,"Multiplan, Inc.","Multiplan, Inc.",26.602,94,,percent of total billed charges,,
DRAIN JP 7MM FLAT,,C1889,HCPCS,Facility,Outpatient,,,,28.3,24.055,8.11078,28.3,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,25.4983,90.1,,percent of total billed charges,,
DRAIN JP 7MM FLAT,,C1889,HCPCS,Facility,Inpatient,,,,28.3,24.055,8.11078,28.3,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
DRAIN JP 7MM FLAT,,C1889,HCPCS,Facility,Both,,,,28.3,24.055,8.11078,28.3,"Preferred One Administrative Services, INC.",PPO,27.9038,98.6,,percent of total billed charges,,
DRAIN JP 7MM FLAT,,C1889,HCPCS,Facility,Outpatient,,,,28.3,24.055,8.11078,28.3,PrimeWest Health,Minnesota Senior Health Options (MSHO),14.56035,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
DRAIN JP 7MM FLAT,,C1889,HCPCS,Facility,Inpatient,,,,28.3,24.055,8.11078,28.3,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DRAIN JP 7MM FLAT,,C1889,HCPCS,Facility,Outpatient,,,,28.3,24.055,8.11078,28.3,PrimeWest Health,MinnesotaCare,14.53488,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
DRAIN JP 7MM FLAT,,C1889,HCPCS,Facility,Inpatient,,,,28.3,24.055,8.11078,28.3,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
DRAIN JP 7MM FLAT,,C1889,HCPCS,Facility,Both,,,,28.3,24.055,8.11078,28.3,Sanford Health Plan,Sanford Health Plan,26.036,92,,percent of total billed charges,,
DRAIN JP 7MM FLAT,,C1889,HCPCS,Facility,Outpatient,,,,28.3,24.055,8.11078,28.3,"UCare Health, Inc.",Individual & Family Plan,15.94705,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
DRAIN JP 7MM FLAT,,C1889,HCPCS,Facility,Inpatient,,,,28.3,24.055,8.11078,28.3,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
DRAIN JP 7MM FLAT,,C1889,HCPCS,Facility,Outpatient,,,,28.3,24.055,8.11078,28.3,"UCare Health, Inc.",Medical Assistance,14.28301,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DRAIN JP 7MM FLAT,,C1889,HCPCS,Facility,Inpatient,,,,28.3,24.055,8.11078,28.3,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
DRAIN JP 7MM FLAT,,C1889,HCPCS,Facility,Outpatient,,,,28.3,24.055,8.11078,28.3,"UCare Health, Inc.",Medicare Advantage,14.28301,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DRAIN JP 7MM FLAT,,C1889,HCPCS,Facility,Inpatient,,,,28.3,24.055,8.11078,28.3,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DRAIN JP 7MM FLAT,,C1889,HCPCS,Facility,Outpatient,,,,28.3,24.055,8.11078,28.3,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),14.28301,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DRAIN JP 7MM FLAT,,C1889,HCPCS,Facility,Inpatient,,,,28.3,24.055,8.11078,28.3,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DRAIN JP 7MM FLAT,,C1889,HCPCS,Facility,Both,,,,28.3,24.055,8.11078,28.3,UnitedHealthcare,Individual & Family,26.602,94,,percent of total billed charges,,
DRAIN JP 7MM FLAT,,C1889,HCPCS,Facility,Outpatient,,,,28.3,24.055,8.11078,28.3,UnitedHealthcare,Medicare Advantage,13.867,49,,percent of total billed charges,,
DRAIN JP 7MM FLAT,,C1889,HCPCS,Facility,Inpatient,,,,28.3,24.055,8.11078,28.3,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
DRAIN JP 7MM FLAT,,C1889,HCPCS,Facility,Outpatient,,,,28.3,24.055,8.11078,28.3,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,13.584,48,,percent of total billed charges,,100% of DHS outpatient percentage
DRAIN JP 7MM FLAT,,C1889,HCPCS,Facility,Inpatient,,,,28.3,24.055,8.11078,28.3,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
DRAIN JP FLAT 10MM,,C1889,HCPCS,Facility,Both,,,,28.2,23.97,8.08212,28.2,Aetna,Commercial,25.944,92,,percent of total billed charges,,
DRAIN JP FLAT 10MM,,C1889,HCPCS,Facility,Outpatient,,,,28.2,23.97,8.08212,28.2,Aetna,Medicare Advantage,13.818,49,,percent of total billed charges,,
DRAIN JP FLAT 10MM,,C1889,HCPCS,Facility,Inpatient,,,,28.2,23.97,8.08212,28.2,Aetna,Medicare Advantage,,,,,Included in per diem rate,
DRAIN JP FLAT 10MM,,C1889,HCPCS,Facility,Both,,,,28.2,23.97,8.08212,28.2,Aetna,PPO,26.226,93,,percent of total billed charges,,
DRAIN JP FLAT 10MM,,C1889,HCPCS,Facility,Both,,,,28.2,23.97,8.08212,28.2,America's PPO,America's PPO,27.08046,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
DRAIN JP FLAT 10MM,,C1889,HCPCS,Facility,Both,,,,28.2,23.97,8.08212,28.2,BlueCross BlueShield Minnesota, Federal Employee Program,27.7488,98.4,,percent of total billed charges,,
DRAIN JP FLAT 10MM,,C1889,HCPCS,Facility,Both,,,,28.2,23.97,8.08212,28.2,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,28.2,100,,percent of total billed charges,,
DRAIN JP FLAT 10MM,,C1889,HCPCS,Facility,Both,,,,28.2,23.97,8.08212,28.2,BlueCross BlueShield Minnesota,High Value Network Plan,25.38,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
DRAIN JP FLAT 10MM,,C1889,HCPCS,Facility,Outpatient,,,,28.2,23.97,8.08212,28.2,BlueCross BlueShield Minnesota,Medicare Advantage,13.818,49,,percent of total billed charges,,
DRAIN JP FLAT 10MM,,C1889,HCPCS,Facility,Inpatient,,,,28.2,23.97,8.08212,28.2,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
DRAIN JP FLAT 10MM,,C1889,HCPCS,Facility,Both,,,,28.2,23.97,8.08212,28.2,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,24.97674,88.57,,percent of total billed charges,,
DRAIN JP FLAT 10MM,,C1889,HCPCS,Facility,Both,,,,28.2,23.97,8.08212,28.2,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,8.08212,28.66,,percent of total billed charges,,
DRAIN JP FLAT 10MM,,C1889,HCPCS,Facility,Outpatient,,,,28.2,23.97,8.08212,28.2,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),13.818,49,,percent of total billed charges,,
DRAIN JP FLAT 10MM,,C1889,HCPCS,Facility,Inpatient,,,,28.2,23.97,8.08212,28.2,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
DRAIN JP FLAT 10MM,,C1889,HCPCS,Facility,Both,,,,28.2,23.97,8.08212,28.2,CorVel,Worker's Compensation,28.2,100,,percent of total billed charges,,
DRAIN JP FLAT 10MM,,C1889,HCPCS,Facility,Both,,,,28.2,23.97,8.08212,28.2,First Health Group Corporation,First Health Network,27.354,97,,percent of total billed charges,,
DRAIN JP FLAT 10MM,,C1889,HCPCS,Facility,Both,,,,28.2,23.97,8.08212,28.2,"Health Partners, Inc.",Commercial,26.6772,94.6,,percent of total billed charges,,
DRAIN JP FLAT 10MM,,C1889,HCPCS,Facility,Outpatient,,,,28.2,23.97,8.08212,28.2,"Health Partners, Inc.",Medicare Advantage,13.818,49,,percent of total billed charges,,
DRAIN JP FLAT 10MM,,C1889,HCPCS,Facility,Inpatient,,,,28.2,23.97,8.08212,28.2,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DRAIN JP FLAT 10MM,,C1889,HCPCS,Facility,Both,,,,28.2,23.97,8.08212,28.2,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),16.92,60,,percent of total billed charges,,
DRAIN JP FLAT 10MM,,C1889,HCPCS,Facility,Both,,,,28.2,23.97,8.08212,28.2,"Health Partners, Inc.",State of Minnesota Advantage Program,22.983,81.5,,percent of total billed charges,,
DRAIN JP FLAT 10MM,,C1889,HCPCS,Facility,Both,,,,28.2,23.97,8.08212,28.2,"Health Partners, Inc.",State Public Programs,14.1,50,,percent of total billed charges,,
DRAIN JP FLAT 10MM,,C1889,HCPCS,Facility,Both,,,,28.2,23.97,8.08212,28.2,Humana Insurance Company,Commercial PPO,26.79,95,,percent of total billed charges,,
DRAIN JP FLAT 10MM,,C1889,HCPCS,Facility,Outpatient,,,,28.2,23.97,8.08212,28.2,Humana Insurance Company,Medicare PPO,13.818,49,,percent of total billed charges,,
DRAIN JP FLAT 10MM,,C1889,HCPCS,Facility,Inpatient,,,,28.2,23.97,8.08212,28.2,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
DRAIN JP FLAT 10MM,,C1889,HCPCS,Facility,Both,,,,28.2,23.97,8.08212,28.2,Medica,Individual & Family,27.9462,99.1,,percent of total billed charges,,
DRAIN JP FLAT 10MM,,C1889,HCPCS,Facility,Outpatient,,,,28.2,23.97,8.08212,28.2,Medica,Medica Advantage Solution,14.0436,49.8,,percent of total billed charges,,
DRAIN JP FLAT 10MM,,C1889,HCPCS,Facility,Inpatient,,,,28.2,23.97,8.08212,28.2,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
DRAIN JP FLAT 10MM,,C1889,HCPCS,Facility,Outpatient,,,,28.2,23.97,8.08212,28.2,Medica,Medical Assistance,12.5772,44.6,,percent of total billed charges,,
DRAIN JP FLAT 10MM,,C1889,HCPCS,Facility,Inpatient,,,,28.2,23.97,8.08212,28.2,Medica,Medical Assistance,,,,,Included in per diem rate,
DRAIN JP FLAT 10MM,,C1889,HCPCS,Facility,Outpatient,,,,28.2,23.97,8.08212,28.2,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,14.0436,49.8,,percent of total billed charges,,
DRAIN JP FLAT 10MM,,C1889,HCPCS,Facility,Inpatient,,,,28.2,23.97,8.08212,28.2,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
DRAIN JP FLAT 10MM,,C1889,HCPCS,Facility,Both,,,,28.2,23.97,8.08212,28.2,"Multiplan, Inc.","Multiplan, Inc.",26.508,94,,percent of total billed charges,,
DRAIN JP FLAT 10MM,,C1889,HCPCS,Facility,Outpatient,,,,28.2,23.97,8.08212,28.2,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,25.4082,90.1,,percent of total billed charges,,
DRAIN JP FLAT 10MM,,C1889,HCPCS,Facility,Inpatient,,,,28.2,23.97,8.08212,28.2,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
DRAIN JP FLAT 10MM,,C1889,HCPCS,Facility,Both,,,,28.2,23.97,8.08212,28.2,"Preferred One Administrative Services, INC.",PPO,27.8052,98.6,,percent of total billed charges,,
DRAIN JP FLAT 10MM,,C1889,HCPCS,Facility,Outpatient,,,,28.2,23.97,8.08212,28.2,PrimeWest Health,Minnesota Senior Health Options (MSHO),14.5089,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
DRAIN JP FLAT 10MM,,C1889,HCPCS,Facility,Inpatient,,,,28.2,23.97,8.08212,28.2,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DRAIN JP FLAT 10MM,,C1889,HCPCS,Facility,Outpatient,,,,28.2,23.97,8.08212,28.2,PrimeWest Health,MinnesotaCare,14.48352,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
DRAIN JP FLAT 10MM,,C1889,HCPCS,Facility,Inpatient,,,,28.2,23.97,8.08212,28.2,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
DRAIN JP FLAT 10MM,,C1889,HCPCS,Facility,Both,,,,28.2,23.97,8.08212,28.2,Sanford Health Plan,Sanford Health Plan,25.944,92,,percent of total billed charges,,
DRAIN JP FLAT 10MM,,C1889,HCPCS,Facility,Outpatient,,,,28.2,23.97,8.08212,28.2,"UCare Health, Inc.",Individual & Family Plan,15.8907,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
DRAIN JP FLAT 10MM,,C1889,HCPCS,Facility,Inpatient,,,,28.2,23.97,8.08212,28.2,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
DRAIN JP FLAT 10MM,,C1889,HCPCS,Facility,Outpatient,,,,28.2,23.97,8.08212,28.2,"UCare Health, Inc.",Medical Assistance,14.23254,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DRAIN JP FLAT 10MM,,C1889,HCPCS,Facility,Inpatient,,,,28.2,23.97,8.08212,28.2,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
DRAIN JP FLAT 10MM,,C1889,HCPCS,Facility,Outpatient,,,,28.2,23.97,8.08212,28.2,"UCare Health, Inc.",Medicare Advantage,14.23254,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DRAIN JP FLAT 10MM,,C1889,HCPCS,Facility,Inpatient,,,,28.2,23.97,8.08212,28.2,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DRAIN JP FLAT 10MM,,C1889,HCPCS,Facility,Outpatient,,,,28.2,23.97,8.08212,28.2,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),14.23254,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DRAIN JP FLAT 10MM,,C1889,HCPCS,Facility,Inpatient,,,,28.2,23.97,8.08212,28.2,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DRAIN JP FLAT 10MM,,C1889,HCPCS,Facility,Both,,,,28.2,23.97,8.08212,28.2,UnitedHealthcare,Individual & Family,26.508,94,,percent of total billed charges,,
DRAIN JP FLAT 10MM,,C1889,HCPCS,Facility,Outpatient,,,,28.2,23.97,8.08212,28.2,UnitedHealthcare,Medicare Advantage,13.818,49,,percent of total billed charges,,
DRAIN JP FLAT 10MM,,C1889,HCPCS,Facility,Inpatient,,,,28.2,23.97,8.08212,28.2,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
DRAIN JP FLAT 10MM,,C1889,HCPCS,Facility,Outpatient,,,,28.2,23.97,8.08212,28.2,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,13.536,48,,percent of total billed charges,,100% of DHS outpatient percentage
DRAIN JP FLAT 10MM,,C1889,HCPCS,Facility,Inpatient,,,,28.2,23.97,8.08212,28.2,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
DRAIN JP ROUND 7FR,,C1889,HCPCS,Facility,Both,,,,29,24.65,8.3114,29,Aetna,Commercial,26.68,92,,percent of total billed charges,,
DRAIN JP ROUND 7FR,,C1889,HCPCS,Facility,Outpatient,,,,29,24.65,8.3114,29,Aetna,Medicare Advantage,14.21,49,,percent of total billed charges,,
DRAIN JP ROUND 7FR,,C1889,HCPCS,Facility,Inpatient,,,,29,24.65,8.3114,29,Aetna,Medicare Advantage,,,,,Included in per diem rate,
DRAIN JP ROUND 7FR,,C1889,HCPCS,Facility,Both,,,,29,24.65,8.3114,29,Aetna,PPO,26.97,93,,percent of total billed charges,,
DRAIN JP ROUND 7FR,,C1889,HCPCS,Facility,Both,,,,29,24.65,8.3114,29,America's PPO,America's PPO,27.8487,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
DRAIN JP ROUND 7FR,,C1889,HCPCS,Facility,Both,,,,29,24.65,8.3114,29,BlueCross BlueShield Minnesota, Federal Employee Program,28.536,98.4,,percent of total billed charges,,
DRAIN JP ROUND 7FR,,C1889,HCPCS,Facility,Both,,,,29,24.65,8.3114,29,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,29,100,,percent of total billed charges,,
DRAIN JP ROUND 7FR,,C1889,HCPCS,Facility,Both,,,,29,24.65,8.3114,29,BlueCross BlueShield Minnesota,High Value Network Plan,26.1,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
DRAIN JP ROUND 7FR,,C1889,HCPCS,Facility,Outpatient,,,,29,24.65,8.3114,29,BlueCross BlueShield Minnesota,Medicare Advantage,14.21,49,,percent of total billed charges,,
DRAIN JP ROUND 7FR,,C1889,HCPCS,Facility,Inpatient,,,,29,24.65,8.3114,29,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
DRAIN JP ROUND 7FR,,C1889,HCPCS,Facility,Both,,,,29,24.65,8.3114,29,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,25.6853,88.57,,percent of total billed charges,,
DRAIN JP ROUND 7FR,,C1889,HCPCS,Facility,Both,,,,29,24.65,8.3114,29,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,8.3114,28.66,,percent of total billed charges,,
DRAIN JP ROUND 7FR,,C1889,HCPCS,Facility,Outpatient,,,,29,24.65,8.3114,29,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),14.21,49,,percent of total billed charges,,
DRAIN JP ROUND 7FR,,C1889,HCPCS,Facility,Inpatient,,,,29,24.65,8.3114,29,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
DRAIN JP ROUND 7FR,,C1889,HCPCS,Facility,Both,,,,29,24.65,8.3114,29,CorVel,Worker's Compensation,29,100,,percent of total billed charges,,
DRAIN JP ROUND 7FR,,C1889,HCPCS,Facility,Both,,,,29,24.65,8.3114,29,First Health Group Corporation,First Health Network,28.13,97,,percent of total billed charges,,
DRAIN JP ROUND 7FR,,C1889,HCPCS,Facility,Both,,,,29,24.65,8.3114,29,"Health Partners, Inc.",Commercial,27.434,94.6,,percent of total billed charges,,
DRAIN JP ROUND 7FR,,C1889,HCPCS,Facility,Outpatient,,,,29,24.65,8.3114,29,"Health Partners, Inc.",Medicare Advantage,14.21,49,,percent of total billed charges,,
DRAIN JP ROUND 7FR,,C1889,HCPCS,Facility,Inpatient,,,,29,24.65,8.3114,29,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DRAIN JP ROUND 7FR,,C1889,HCPCS,Facility,Both,,,,29,24.65,8.3114,29,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),17.4,60,,percent of total billed charges,,
DRAIN JP ROUND 7FR,,C1889,HCPCS,Facility,Both,,,,29,24.65,8.3114,29,"Health Partners, Inc.",State of Minnesota Advantage Program,23.635,81.5,,percent of total billed charges,,
DRAIN JP ROUND 7FR,,C1889,HCPCS,Facility,Both,,,,29,24.65,8.3114,29,"Health Partners, Inc.",State Public Programs,14.5,50,,percent of total billed charges,,
DRAIN JP ROUND 7FR,,C1889,HCPCS,Facility,Both,,,,29,24.65,8.3114,29,Humana Insurance Company,Commercial PPO,27.55,95,,percent of total billed charges,,
DRAIN JP ROUND 7FR,,C1889,HCPCS,Facility,Outpatient,,,,29,24.65,8.3114,29,Humana Insurance Company,Medicare PPO,14.21,49,,percent of total billed charges,,
DRAIN JP ROUND 7FR,,C1889,HCPCS,Facility,Inpatient,,,,29,24.65,8.3114,29,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
DRAIN JP ROUND 7FR,,C1889,HCPCS,Facility,Both,,,,29,24.65,8.3114,29,Medica,Individual & Family,28.739,99.1,,percent of total billed charges,,
DRAIN JP ROUND 7FR,,C1889,HCPCS,Facility,Outpatient,,,,29,24.65,8.3114,29,Medica,Medica Advantage Solution,14.442,49.8,,percent of total billed charges,,
DRAIN JP ROUND 7FR,,C1889,HCPCS,Facility,Inpatient,,,,29,24.65,8.3114,29,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
DRAIN JP ROUND 7FR,,C1889,HCPCS,Facility,Outpatient,,,,29,24.65,8.3114,29,Medica,Medical Assistance,12.934,44.6,,percent of total billed charges,,
DRAIN JP ROUND 7FR,,C1889,HCPCS,Facility,Inpatient,,,,29,24.65,8.3114,29,Medica,Medical Assistance,,,,,Included in per diem rate,
DRAIN JP ROUND 7FR,,C1889,HCPCS,Facility,Outpatient,,,,29,24.65,8.3114,29,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,14.442,49.8,,percent of total billed charges,,
DRAIN JP ROUND 7FR,,C1889,HCPCS,Facility,Inpatient,,,,29,24.65,8.3114,29,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
DRAIN JP ROUND 7FR,,C1889,HCPCS,Facility,Both,,,,29,24.65,8.3114,29,"Multiplan, Inc.","Multiplan, Inc.",27.26,94,,percent of total billed charges,,
DRAIN JP ROUND 7FR,,C1889,HCPCS,Facility,Outpatient,,,,29,24.65,8.3114,29,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,26.129,90.1,,percent of total billed charges,,
DRAIN JP ROUND 7FR,,C1889,HCPCS,Facility,Inpatient,,,,29,24.65,8.3114,29,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
DRAIN JP ROUND 7FR,,C1889,HCPCS,Facility,Both,,,,29,24.65,8.3114,29,"Preferred One Administrative Services, INC.",PPO,28.594,98.6,,percent of total billed charges,,
DRAIN JP ROUND 7FR,,C1889,HCPCS,Facility,Outpatient,,,,29,24.65,8.3114,29,PrimeWest Health,Minnesota Senior Health Options (MSHO),14.9205,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
DRAIN JP ROUND 7FR,,C1889,HCPCS,Facility,Inpatient,,,,29,24.65,8.3114,29,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DRAIN JP ROUND 7FR,,C1889,HCPCS,Facility,Outpatient,,,,29,24.65,8.3114,29,PrimeWest Health,MinnesotaCare,14.8944,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
DRAIN JP ROUND 7FR,,C1889,HCPCS,Facility,Inpatient,,,,29,24.65,8.3114,29,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
DRAIN JP ROUND 7FR,,C1889,HCPCS,Facility,Both,,,,29,24.65,8.3114,29,Sanford Health Plan,Sanford Health Plan,26.68,92,,percent of total billed charges,,
DRAIN JP ROUND 7FR,,C1889,HCPCS,Facility,Outpatient,,,,29,24.65,8.3114,29,"UCare Health, Inc.",Individual & Family Plan,16.3415,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
DRAIN JP ROUND 7FR,,C1889,HCPCS,Facility,Inpatient,,,,29,24.65,8.3114,29,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
DRAIN JP ROUND 7FR,,C1889,HCPCS,Facility,Outpatient,,,,29,24.65,8.3114,29,"UCare Health, Inc.",Medical Assistance,14.6363,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DRAIN JP ROUND 7FR,,C1889,HCPCS,Facility,Inpatient,,,,29,24.65,8.3114,29,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
DRAIN JP ROUND 7FR,,C1889,HCPCS,Facility,Outpatient,,,,29,24.65,8.3114,29,"UCare Health, Inc.",Medicare Advantage,14.6363,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DRAIN JP ROUND 7FR,,C1889,HCPCS,Facility,Inpatient,,,,29,24.65,8.3114,29,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DRAIN JP ROUND 7FR,,C1889,HCPCS,Facility,Outpatient,,,,29,24.65,8.3114,29,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),14.6363,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DRAIN JP ROUND 7FR,,C1889,HCPCS,Facility,Inpatient,,,,29,24.65,8.3114,29,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DRAIN JP ROUND 7FR,,C1889,HCPCS,Facility,Both,,,,29,24.65,8.3114,29,UnitedHealthcare,Individual & Family,27.26,94,,percent of total billed charges,,
DRAIN JP ROUND 7FR,,C1889,HCPCS,Facility,Outpatient,,,,29,24.65,8.3114,29,UnitedHealthcare,Medicare Advantage,14.21,49,,percent of total billed charges,,
DRAIN JP ROUND 7FR,,C1889,HCPCS,Facility,Inpatient,,,,29,24.65,8.3114,29,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
DRAIN JP ROUND 7FR,,C1889,HCPCS,Facility,Outpatient,,,,29,24.65,8.3114,29,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,13.92,48,,percent of total billed charges,,100% of DHS outpatient percentage
DRAIN JP ROUND 7FR,,C1889,HCPCS,Facility,Inpatient,,,,29,24.65,8.3114,29,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
VNUS INTRODUCER SHEATH  MIS-7F11,,C1892,HCPCS,Facility,Both,,,,122,103.7,34.9652,122,Aetna,Commercial,112.24,92,,percent of total billed charges,,
VNUS INTRODUCER SHEATH  MIS-7F11,,C1892,HCPCS,Facility,Outpatient,,,,122,103.7,34.9652,122,Aetna,Medicare Advantage,59.78,49,,percent of total billed charges,,
VNUS INTRODUCER SHEATH  MIS-7F11,,C1892,HCPCS,Facility,Inpatient,,,,122,103.7,34.9652,122,Aetna,Medicare Advantage,,,,,Included in per diem rate,
VNUS INTRODUCER SHEATH  MIS-7F11,,C1892,HCPCS,Facility,Both,,,,122,103.7,34.9652,122,Aetna,PPO,113.46,93,,percent of total billed charges,,
VNUS INTRODUCER SHEATH  MIS-7F11,,C1892,HCPCS,Facility,Both,,,,122,103.7,34.9652,122,America's PPO,America's PPO,117.1566,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
VNUS INTRODUCER SHEATH  MIS-7F11,,C1892,HCPCS,Facility,Both,,,,122,103.7,34.9652,122,BlueCross BlueShield Minnesota, Federal Employee Program,120.048,98.4,,percent of total billed charges,,
VNUS INTRODUCER SHEATH  MIS-7F11,,C1892,HCPCS,Facility,Both,,,,122,103.7,34.9652,122,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,122,100,,percent of total billed charges,,
VNUS INTRODUCER SHEATH  MIS-7F11,,C1892,HCPCS,Facility,Both,,,,122,103.7,34.9652,122,BlueCross BlueShield Minnesota,High Value Network Plan,109.8,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
VNUS INTRODUCER SHEATH  MIS-7F11,,C1892,HCPCS,Facility,Outpatient,,,,122,103.7,34.9652,122,BlueCross BlueShield Minnesota,Medicare Advantage,59.78,49,,percent of total billed charges,,
VNUS INTRODUCER SHEATH  MIS-7F11,,C1892,HCPCS,Facility,Inpatient,,,,122,103.7,34.9652,122,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
VNUS INTRODUCER SHEATH  MIS-7F11,,C1892,HCPCS,Facility,Both,,,,122,103.7,34.9652,122,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,108.0554,88.57,,percent of total billed charges,,
VNUS INTRODUCER SHEATH  MIS-7F11,,C1892,HCPCS,Facility,Both,,,,122,103.7,34.9652,122,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,34.9652,28.66,,percent of total billed charges,,
VNUS INTRODUCER SHEATH  MIS-7F11,,C1892,HCPCS,Facility,Outpatient,,,,122,103.7,34.9652,122,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),59.78,49,,percent of total billed charges,,
VNUS INTRODUCER SHEATH  MIS-7F11,,C1892,HCPCS,Facility,Inpatient,,,,122,103.7,34.9652,122,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
VNUS INTRODUCER SHEATH  MIS-7F11,,C1892,HCPCS,Facility,Both,,,,122,103.7,34.9652,122,CorVel,Worker's Compensation,122,100,,percent of total billed charges,,
VNUS INTRODUCER SHEATH  MIS-7F11,,C1892,HCPCS,Facility,Both,,,,122,103.7,34.9652,122,First Health Group Corporation,First Health Network,118.34,97,,percent of total billed charges,,
VNUS INTRODUCER SHEATH  MIS-7F11,,C1892,HCPCS,Facility,Both,,,,122,103.7,34.9652,122,"Health Partners, Inc.",Commercial,115.412,94.6,,percent of total billed charges,,
VNUS INTRODUCER SHEATH  MIS-7F11,,C1892,HCPCS,Facility,Outpatient,,,,122,103.7,34.9652,122,"Health Partners, Inc.",Medicare Advantage,59.78,49,,percent of total billed charges,,
VNUS INTRODUCER SHEATH  MIS-7F11,,C1892,HCPCS,Facility,Inpatient,,,,122,103.7,34.9652,122,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
VNUS INTRODUCER SHEATH  MIS-7F11,,C1892,HCPCS,Facility,Both,,,,122,103.7,34.9652,122,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),73.2,60,,percent of total billed charges,,
VNUS INTRODUCER SHEATH  MIS-7F11,,C1892,HCPCS,Facility,Both,,,,122,103.7,34.9652,122,"Health Partners, Inc.",State of Minnesota Advantage Program,99.43,81.5,,percent of total billed charges,,
VNUS INTRODUCER SHEATH  MIS-7F11,,C1892,HCPCS,Facility,Both,,,,122,103.7,34.9652,122,"Health Partners, Inc.",State Public Programs,61,50,,percent of total billed charges,,
VNUS INTRODUCER SHEATH  MIS-7F11,,C1892,HCPCS,Facility,Both,,,,122,103.7,34.9652,122,Humana Insurance Company,Commercial PPO,115.9,95,,percent of total billed charges,,
VNUS INTRODUCER SHEATH  MIS-7F11,,C1892,HCPCS,Facility,Outpatient,,,,122,103.7,34.9652,122,Humana Insurance Company,Medicare PPO,59.78,49,,percent of total billed charges,,
VNUS INTRODUCER SHEATH  MIS-7F11,,C1892,HCPCS,Facility,Inpatient,,,,122,103.7,34.9652,122,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
VNUS INTRODUCER SHEATH  MIS-7F11,,C1892,HCPCS,Facility,Both,,,,122,103.7,34.9652,122,Medica,Individual & Family,120.902,99.1,,percent of total billed charges,,
VNUS INTRODUCER SHEATH  MIS-7F11,,C1892,HCPCS,Facility,Outpatient,,,,122,103.7,34.9652,122,Medica,Medica Advantage Solution,60.756,49.8,,percent of total billed charges,,
VNUS INTRODUCER SHEATH  MIS-7F11,,C1892,HCPCS,Facility,Inpatient,,,,122,103.7,34.9652,122,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
VNUS INTRODUCER SHEATH  MIS-7F11,,C1892,HCPCS,Facility,Outpatient,,,,122,103.7,34.9652,122,Medica,Medical Assistance,54.412,44.6,,percent of total billed charges,,
VNUS INTRODUCER SHEATH  MIS-7F11,,C1892,HCPCS,Facility,Inpatient,,,,122,103.7,34.9652,122,Medica,Medical Assistance,,,,,Included in per diem rate,
VNUS INTRODUCER SHEATH  MIS-7F11,,C1892,HCPCS,Facility,Outpatient,,,,122,103.7,34.9652,122,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,60.756,49.8,,percent of total billed charges,,
VNUS INTRODUCER SHEATH  MIS-7F11,,C1892,HCPCS,Facility,Inpatient,,,,122,103.7,34.9652,122,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
VNUS INTRODUCER SHEATH  MIS-7F11,,C1892,HCPCS,Facility,Both,,,,122,103.7,34.9652,122,"Multiplan, Inc.","Multiplan, Inc.",114.68,94,,percent of total billed charges,,
VNUS INTRODUCER SHEATH  MIS-7F11,,C1892,HCPCS,Facility,Outpatient,,,,122,103.7,34.9652,122,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,109.922,90.1,,percent of total billed charges,,
VNUS INTRODUCER SHEATH  MIS-7F11,,C1892,HCPCS,Facility,Inpatient,,,,122,103.7,34.9652,122,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
VNUS INTRODUCER SHEATH  MIS-7F11,,C1892,HCPCS,Facility,Both,,,,122,103.7,34.9652,122,"Preferred One Administrative Services, INC.",PPO,120.292,98.6,,percent of total billed charges,,
VNUS INTRODUCER SHEATH  MIS-7F11,,C1892,HCPCS,Facility,Outpatient,,,,122,103.7,34.9652,122,PrimeWest Health,Minnesota Senior Health Options (MSHO),62.769,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
VNUS INTRODUCER SHEATH  MIS-7F11,,C1892,HCPCS,Facility,Inpatient,,,,122,103.7,34.9652,122,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
VNUS INTRODUCER SHEATH  MIS-7F11,,C1892,HCPCS,Facility,Outpatient,,,,122,103.7,34.9652,122,PrimeWest Health,MinnesotaCare,62.6592,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
VNUS INTRODUCER SHEATH  MIS-7F11,,C1892,HCPCS,Facility,Inpatient,,,,122,103.7,34.9652,122,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
VNUS INTRODUCER SHEATH  MIS-7F11,,C1892,HCPCS,Facility,Both,,,,122,103.7,34.9652,122,Sanford Health Plan,Sanford Health Plan,112.24,92,,percent of total billed charges,,
VNUS INTRODUCER SHEATH  MIS-7F11,,C1892,HCPCS,Facility,Outpatient,,,,122,103.7,34.9652,122,"UCare Health, Inc.",Individual & Family Plan,68.747,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
VNUS INTRODUCER SHEATH  MIS-7F11,,C1892,HCPCS,Facility,Inpatient,,,,122,103.7,34.9652,122,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
VNUS INTRODUCER SHEATH  MIS-7F11,,C1892,HCPCS,Facility,Outpatient,,,,122,103.7,34.9652,122,"UCare Health, Inc.",Medical Assistance,61.5734,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
VNUS INTRODUCER SHEATH  MIS-7F11,,C1892,HCPCS,Facility,Inpatient,,,,122,103.7,34.9652,122,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
VNUS INTRODUCER SHEATH  MIS-7F11,,C1892,HCPCS,Facility,Outpatient,,,,122,103.7,34.9652,122,"UCare Health, Inc.",Medicare Advantage,61.5734,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
VNUS INTRODUCER SHEATH  MIS-7F11,,C1892,HCPCS,Facility,Inpatient,,,,122,103.7,34.9652,122,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
VNUS INTRODUCER SHEATH  MIS-7F11,,C1892,HCPCS,Facility,Outpatient,,,,122,103.7,34.9652,122,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),61.5734,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
VNUS INTRODUCER SHEATH  MIS-7F11,,C1892,HCPCS,Facility,Inpatient,,,,122,103.7,34.9652,122,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
VNUS INTRODUCER SHEATH  MIS-7F11,,C1892,HCPCS,Facility,Both,,,,122,103.7,34.9652,122,UnitedHealthcare,Individual & Family,114.68,94,,percent of total billed charges,,
VNUS INTRODUCER SHEATH  MIS-7F11,,C1892,HCPCS,Facility,Outpatient,,,,122,103.7,34.9652,122,UnitedHealthcare,Medicare Advantage,59.78,49,,percent of total billed charges,,
VNUS INTRODUCER SHEATH  MIS-7F11,,C1892,HCPCS,Facility,Inpatient,,,,122,103.7,34.9652,122,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
VNUS INTRODUCER SHEATH  MIS-7F11,,C1892,HCPCS,Facility,Outpatient,,,,122,103.7,34.9652,122,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,58.56,48,,percent of total billed charges,,100% of DHS outpatient percentage
VNUS INTRODUCER SHEATH  MIS-7F11,,C1892,HCPCS,Facility,Inpatient,,,,122,103.7,34.9652,122,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
VNUS PROCEDURE PACK CFP,,C1892,HCPCS,Facility,Both,,,,313.25,266.2625,89.77745,313.25,Aetna,Commercial,288.19,92,,percent of total billed charges,,
VNUS PROCEDURE PACK CFP,,C1892,HCPCS,Facility,Outpatient,,,,313.25,266.2625,89.77745,313.25,Aetna,Medicare Advantage,153.4925,49,,percent of total billed charges,,
VNUS PROCEDURE PACK CFP,,C1892,HCPCS,Facility,Inpatient,,,,313.25,266.2625,89.77745,313.25,Aetna,Medicare Advantage,,,,,Included in per diem rate,
VNUS PROCEDURE PACK CFP,,C1892,HCPCS,Facility,Both,,,,313.25,266.2625,89.77745,313.25,Aetna,PPO,291.3225,93,,percent of total billed charges,,
VNUS PROCEDURE PACK CFP,,C1892,HCPCS,Facility,Both,,,,313.25,266.2625,89.77745,313.25,America's PPO,America's PPO,300.813975,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
VNUS PROCEDURE PACK CFP,,C1892,HCPCS,Facility,Both,,,,313.25,266.2625,89.77745,313.25,BlueCross BlueShield Minnesota, Federal Employee Program,308.238,98.4,,percent of total billed charges,,
VNUS PROCEDURE PACK CFP,,C1892,HCPCS,Facility,Both,,,,313.25,266.2625,89.77745,313.25,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,313.25,100,,percent of total billed charges,,
VNUS PROCEDURE PACK CFP,,C1892,HCPCS,Facility,Both,,,,313.25,266.2625,89.77745,313.25,BlueCross BlueShield Minnesota,High Value Network Plan,281.925,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
VNUS PROCEDURE PACK CFP,,C1892,HCPCS,Facility,Outpatient,,,,313.25,266.2625,89.77745,313.25,BlueCross BlueShield Minnesota,Medicare Advantage,153.4925,49,,percent of total billed charges,,
VNUS PROCEDURE PACK CFP,,C1892,HCPCS,Facility,Inpatient,,,,313.25,266.2625,89.77745,313.25,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
VNUS PROCEDURE PACK CFP,,C1892,HCPCS,Facility,Both,,,,313.25,266.2625,89.77745,313.25,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,277.445525,88.57,,percent of total billed charges,,
VNUS PROCEDURE PACK CFP,,C1892,HCPCS,Facility,Both,,,,313.25,266.2625,89.77745,313.25,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,89.77745,28.66,,percent of total billed charges,,
VNUS PROCEDURE PACK CFP,,C1892,HCPCS,Facility,Outpatient,,,,313.25,266.2625,89.77745,313.25,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),153.4925,49,,percent of total billed charges,,
VNUS PROCEDURE PACK CFP,,C1892,HCPCS,Facility,Inpatient,,,,313.25,266.2625,89.77745,313.25,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
VNUS PROCEDURE PACK CFP,,C1892,HCPCS,Facility,Both,,,,313.25,266.2625,89.77745,313.25,CorVel,Worker's Compensation,313.25,100,,percent of total billed charges,,
VNUS PROCEDURE PACK CFP,,C1892,HCPCS,Facility,Both,,,,313.25,266.2625,89.77745,313.25,First Health Group Corporation,First Health Network,303.8525,97,,percent of total billed charges,,
VNUS PROCEDURE PACK CFP,,C1892,HCPCS,Facility,Both,,,,313.25,266.2625,89.77745,313.25,"Health Partners, Inc.",Commercial,296.3345,94.6,,percent of total billed charges,,
VNUS PROCEDURE PACK CFP,,C1892,HCPCS,Facility,Outpatient,,,,313.25,266.2625,89.77745,313.25,"Health Partners, Inc.",Medicare Advantage,153.4925,49,,percent of total billed charges,,
VNUS PROCEDURE PACK CFP,,C1892,HCPCS,Facility,Inpatient,,,,313.25,266.2625,89.77745,313.25,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
VNUS PROCEDURE PACK CFP,,C1892,HCPCS,Facility,Both,,,,313.25,266.2625,89.77745,313.25,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),187.95,60,,percent of total billed charges,,
VNUS PROCEDURE PACK CFP,,C1892,HCPCS,Facility,Both,,,,313.25,266.2625,89.77745,313.25,"Health Partners, Inc.",State of Minnesota Advantage Program,255.29875,81.5,,percent of total billed charges,,
VNUS PROCEDURE PACK CFP,,C1892,HCPCS,Facility,Both,,,,313.25,266.2625,89.77745,313.25,"Health Partners, Inc.",State Public Programs,156.625,50,,percent of total billed charges,,
VNUS PROCEDURE PACK CFP,,C1892,HCPCS,Facility,Both,,,,313.25,266.2625,89.77745,313.25,Humana Insurance Company,Commercial PPO,297.5875,95,,percent of total billed charges,,
VNUS PROCEDURE PACK CFP,,C1892,HCPCS,Facility,Outpatient,,,,313.25,266.2625,89.77745,313.25,Humana Insurance Company,Medicare PPO,153.4925,49,,percent of total billed charges,,
VNUS PROCEDURE PACK CFP,,C1892,HCPCS,Facility,Inpatient,,,,313.25,266.2625,89.77745,313.25,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
VNUS PROCEDURE PACK CFP,,C1892,HCPCS,Facility,Both,,,,313.25,266.2625,89.77745,313.25,Medica,Individual & Family,310.43075,99.1,,percent of total billed charges,,
VNUS PROCEDURE PACK CFP,,C1892,HCPCS,Facility,Outpatient,,,,313.25,266.2625,89.77745,313.25,Medica,Medica Advantage Solution,155.9985,49.8,,percent of total billed charges,,
VNUS PROCEDURE PACK CFP,,C1892,HCPCS,Facility,Inpatient,,,,313.25,266.2625,89.77745,313.25,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
VNUS PROCEDURE PACK CFP,,C1892,HCPCS,Facility,Outpatient,,,,313.25,266.2625,89.77745,313.25,Medica,Medical Assistance,139.7095,44.6,,percent of total billed charges,,
VNUS PROCEDURE PACK CFP,,C1892,HCPCS,Facility,Inpatient,,,,313.25,266.2625,89.77745,313.25,Medica,Medical Assistance,,,,,Included in per diem rate,
VNUS PROCEDURE PACK CFP,,C1892,HCPCS,Facility,Outpatient,,,,313.25,266.2625,89.77745,313.25,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,155.9985,49.8,,percent of total billed charges,,
VNUS PROCEDURE PACK CFP,,C1892,HCPCS,Facility,Inpatient,,,,313.25,266.2625,89.77745,313.25,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
VNUS PROCEDURE PACK CFP,,C1892,HCPCS,Facility,Both,,,,313.25,266.2625,89.77745,313.25,"Multiplan, Inc.","Multiplan, Inc.",294.455,94,,percent of total billed charges,,
VNUS PROCEDURE PACK CFP,,C1892,HCPCS,Facility,Outpatient,,,,313.25,266.2625,89.77745,313.25,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,282.23825,90.1,,percent of total billed charges,,
VNUS PROCEDURE PACK CFP,,C1892,HCPCS,Facility,Inpatient,,,,313.25,266.2625,89.77745,313.25,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
VNUS PROCEDURE PACK CFP,,C1892,HCPCS,Facility,Both,,,,313.25,266.2625,89.77745,313.25,"Preferred One Administrative Services, INC.",PPO,308.8645,98.6,,percent of total billed charges,,
VNUS PROCEDURE PACK CFP,,C1892,HCPCS,Facility,Outpatient,,,,313.25,266.2625,89.77745,313.25,PrimeWest Health,Minnesota Senior Health Options (MSHO),161.167125,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
VNUS PROCEDURE PACK CFP,,C1892,HCPCS,Facility,Inpatient,,,,313.25,266.2625,89.77745,313.25,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
VNUS PROCEDURE PACK CFP,,C1892,HCPCS,Facility,Outpatient,,,,313.25,266.2625,89.77745,313.25,PrimeWest Health,MinnesotaCare,160.8852,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
VNUS PROCEDURE PACK CFP,,C1892,HCPCS,Facility,Inpatient,,,,313.25,266.2625,89.77745,313.25,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
VNUS PROCEDURE PACK CFP,,C1892,HCPCS,Facility,Both,,,,313.25,266.2625,89.77745,313.25,Sanford Health Plan,Sanford Health Plan,288.19,92,,percent of total billed charges,,
VNUS PROCEDURE PACK CFP,,C1892,HCPCS,Facility,Outpatient,,,,313.25,266.2625,89.77745,313.25,"UCare Health, Inc.",Individual & Family Plan,176.516375,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
VNUS PROCEDURE PACK CFP,,C1892,HCPCS,Facility,Inpatient,,,,313.25,266.2625,89.77745,313.25,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
VNUS PROCEDURE PACK CFP,,C1892,HCPCS,Facility,Outpatient,,,,313.25,266.2625,89.77745,313.25,"UCare Health, Inc.",Medical Assistance,158.097275,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
VNUS PROCEDURE PACK CFP,,C1892,HCPCS,Facility,Inpatient,,,,313.25,266.2625,89.77745,313.25,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
VNUS PROCEDURE PACK CFP,,C1892,HCPCS,Facility,Outpatient,,,,313.25,266.2625,89.77745,313.25,"UCare Health, Inc.",Medicare Advantage,158.097275,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
VNUS PROCEDURE PACK CFP,,C1892,HCPCS,Facility,Inpatient,,,,313.25,266.2625,89.77745,313.25,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
VNUS PROCEDURE PACK CFP,,C1892,HCPCS,Facility,Outpatient,,,,313.25,266.2625,89.77745,313.25,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),158.097275,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
VNUS PROCEDURE PACK CFP,,C1892,HCPCS,Facility,Inpatient,,,,313.25,266.2625,89.77745,313.25,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
VNUS PROCEDURE PACK CFP,,C1892,HCPCS,Facility,Both,,,,313.25,266.2625,89.77745,313.25,UnitedHealthcare,Individual & Family,294.455,94,,percent of total billed charges,,
VNUS PROCEDURE PACK CFP,,C1892,HCPCS,Facility,Outpatient,,,,313.25,266.2625,89.77745,313.25,UnitedHealthcare,Medicare Advantage,153.4925,49,,percent of total billed charges,,
VNUS PROCEDURE PACK CFP,,C1892,HCPCS,Facility,Inpatient,,,,313.25,266.2625,89.77745,313.25,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
VNUS PROCEDURE PACK CFP,,C1892,HCPCS,Facility,Outpatient,,,,313.25,266.2625,89.77745,313.25,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,150.36,48,,percent of total billed charges,,100% of DHS outpatient percentage
VNUS PROCEDURE PACK CFP,,C1892,HCPCS,Facility,Inpatient,,,,313.25,266.2625,89.77745,313.25,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
50-S SERFAS ENERGY SUCTION PROBE,,C2618,HCPCS,Facility,Both,,,,585.51,497.6835,167.807166,585.51,Aetna,Commercial,538.6692,92,,percent of total billed charges,,
50-S SERFAS ENERGY SUCTION PROBE,,C2618,HCPCS,Facility,Outpatient,,,,585.51,497.6835,167.807166,585.51,Aetna,Medicare Advantage,286.8999,49,,percent of total billed charges,,
50-S SERFAS ENERGY SUCTION PROBE,,C2618,HCPCS,Facility,Inpatient,,,,585.51,497.6835,167.807166,585.51,Aetna,Medicare Advantage,,,,,Included in per diem rate,
50-S SERFAS ENERGY SUCTION PROBE,,C2618,HCPCS,Facility,Both,,,,585.51,497.6835,167.807166,585.51,Aetna,PPO,544.5243,93,,percent of total billed charges,,
50-S SERFAS ENERGY SUCTION PROBE,,C2618,HCPCS,Facility,Both,,,,585.51,497.6835,167.807166,585.51,America's PPO,America's PPO,562.265253,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
50-S SERFAS ENERGY SUCTION PROBE,,C2618,HCPCS,Facility,Both,,,,585.51,497.6835,167.807166,585.51,BlueCross BlueShield Minnesota, Federal Employee Program,576.14184,98.4,,percent of total billed charges,,
50-S SERFAS ENERGY SUCTION PROBE,,C2618,HCPCS,Facility,Both,,,,585.51,497.6835,167.807166,585.51,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,585.51,100,,percent of total billed charges,,
50-S SERFAS ENERGY SUCTION PROBE,,C2618,HCPCS,Facility,Both,,,,585.51,497.6835,167.807166,585.51,BlueCross BlueShield Minnesota,High Value Network Plan,526.959,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
50-S SERFAS ENERGY SUCTION PROBE,,C2618,HCPCS,Facility,Outpatient,,,,585.51,497.6835,167.807166,585.51,BlueCross BlueShield Minnesota,Medicare Advantage,286.8999,49,,percent of total billed charges,,
50-S SERFAS ENERGY SUCTION PROBE,,C2618,HCPCS,Facility,Inpatient,,,,585.51,497.6835,167.807166,585.51,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
50-S SERFAS ENERGY SUCTION PROBE,,C2618,HCPCS,Facility,Both,,,,585.51,497.6835,167.807166,585.51,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,518.586207,88.57,,percent of total billed charges,,
50-S SERFAS ENERGY SUCTION PROBE,,C2618,HCPCS,Facility,Both,,,,585.51,497.6835,167.807166,585.51,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,167.807166,28.66,,percent of total billed charges,,
50-S SERFAS ENERGY SUCTION PROBE,,C2618,HCPCS,Facility,Outpatient,,,,585.51,497.6835,167.807166,585.51,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),286.8999,49,,percent of total billed charges,,
50-S SERFAS ENERGY SUCTION PROBE,,C2618,HCPCS,Facility,Inpatient,,,,585.51,497.6835,167.807166,585.51,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
50-S SERFAS ENERGY SUCTION PROBE,,C2618,HCPCS,Facility,Both,,,,585.51,497.6835,167.807166,585.51,CorVel,Worker's Compensation,585.51,100,,percent of total billed charges,,
50-S SERFAS ENERGY SUCTION PROBE,,C2618,HCPCS,Facility,Both,,,,585.51,497.6835,167.807166,585.51,First Health Group Corporation,First Health Network,567.9447,97,,percent of total billed charges,,
50-S SERFAS ENERGY SUCTION PROBE,,C2618,HCPCS,Facility,Both,,,,585.51,497.6835,167.807166,585.51,"Health Partners, Inc.",Commercial,553.89246,94.6,,percent of total billed charges,,
50-S SERFAS ENERGY SUCTION PROBE,,C2618,HCPCS,Facility,Outpatient,,,,585.51,497.6835,167.807166,585.51,"Health Partners, Inc.",Medicare Advantage,286.8999,49,,percent of total billed charges,,
50-S SERFAS ENERGY SUCTION PROBE,,C2618,HCPCS,Facility,Inpatient,,,,585.51,497.6835,167.807166,585.51,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
50-S SERFAS ENERGY SUCTION PROBE,,C2618,HCPCS,Facility,Both,,,,585.51,497.6835,167.807166,585.51,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),351.306,60,,percent of total billed charges,,
50-S SERFAS ENERGY SUCTION PROBE,,C2618,HCPCS,Facility,Both,,,,585.51,497.6835,167.807166,585.51,"Health Partners, Inc.",State of Minnesota Advantage Program,477.19065,81.5,,percent of total billed charges,,
50-S SERFAS ENERGY SUCTION PROBE,,C2618,HCPCS,Facility,Both,,,,585.51,497.6835,167.807166,585.51,"Health Partners, Inc.",State Public Programs,292.755,50,,percent of total billed charges,,
50-S SERFAS ENERGY SUCTION PROBE,,C2618,HCPCS,Facility,Both,,,,585.51,497.6835,167.807166,585.51,Humana Insurance Company,Commercial PPO,556.2345,95,,percent of total billed charges,,
50-S SERFAS ENERGY SUCTION PROBE,,C2618,HCPCS,Facility,Outpatient,,,,585.51,497.6835,167.807166,585.51,Humana Insurance Company,Medicare PPO,286.8999,49,,percent of total billed charges,,
50-S SERFAS ENERGY SUCTION PROBE,,C2618,HCPCS,Facility,Inpatient,,,,585.51,497.6835,167.807166,585.51,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
50-S SERFAS ENERGY SUCTION PROBE,,C2618,HCPCS,Facility,Both,,,,585.51,497.6835,167.807166,585.51,Medica,Individual & Family,580.24041,99.1,,percent of total billed charges,,
50-S SERFAS ENERGY SUCTION PROBE,,C2618,HCPCS,Facility,Outpatient,,,,585.51,497.6835,167.807166,585.51,Medica,Medica Advantage Solution,291.58398,49.8,,percent of total billed charges,,
50-S SERFAS ENERGY SUCTION PROBE,,C2618,HCPCS,Facility,Inpatient,,,,585.51,497.6835,167.807166,585.51,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
50-S SERFAS ENERGY SUCTION PROBE,,C2618,HCPCS,Facility,Outpatient,,,,585.51,497.6835,167.807166,585.51,Medica,Medical Assistance,261.13746,44.6,,percent of total billed charges,,
50-S SERFAS ENERGY SUCTION PROBE,,C2618,HCPCS,Facility,Inpatient,,,,585.51,497.6835,167.807166,585.51,Medica,Medical Assistance,,,,,Included in per diem rate,
50-S SERFAS ENERGY SUCTION PROBE,,C2618,HCPCS,Facility,Outpatient,,,,585.51,497.6835,167.807166,585.51,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,291.58398,49.8,,percent of total billed charges,,
50-S SERFAS ENERGY SUCTION PROBE,,C2618,HCPCS,Facility,Inpatient,,,,585.51,497.6835,167.807166,585.51,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
50-S SERFAS ENERGY SUCTION PROBE,,C2618,HCPCS,Facility,Both,,,,585.51,497.6835,167.807166,585.51,"Multiplan, Inc.","Multiplan, Inc.",550.3794,94,,percent of total billed charges,,
50-S SERFAS ENERGY SUCTION PROBE,,C2618,HCPCS,Facility,Outpatient,,,,585.51,497.6835,167.807166,585.51,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,527.54451,90.1,,percent of total billed charges,,
50-S SERFAS ENERGY SUCTION PROBE,,C2618,HCPCS,Facility,Inpatient,,,,585.51,497.6835,167.807166,585.51,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
50-S SERFAS ENERGY SUCTION PROBE,,C2618,HCPCS,Facility,Both,,,,585.51,497.6835,167.807166,585.51,"Preferred One Administrative Services, INC.",PPO,577.31286,98.6,,percent of total billed charges,,
50-S SERFAS ENERGY SUCTION PROBE,,C2618,HCPCS,Facility,Outpatient,,,,585.51,497.6835,167.807166,585.51,PrimeWest Health,Minnesota Senior Health Options (MSHO),301.244895,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
50-S SERFAS ENERGY SUCTION PROBE,,C2618,HCPCS,Facility,Inpatient,,,,585.51,497.6835,167.807166,585.51,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
50-S SERFAS ENERGY SUCTION PROBE,,C2618,HCPCS,Facility,Outpatient,,,,585.51,497.6835,167.807166,585.51,PrimeWest Health,MinnesotaCare,300.717936,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
50-S SERFAS ENERGY SUCTION PROBE,,C2618,HCPCS,Facility,Inpatient,,,,585.51,497.6835,167.807166,585.51,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
50-S SERFAS ENERGY SUCTION PROBE,,C2618,HCPCS,Facility,Both,,,,585.51,497.6835,167.807166,585.51,Sanford Health Plan,Sanford Health Plan,538.6692,92,,percent of total billed charges,,
50-S SERFAS ENERGY SUCTION PROBE,,C2618,HCPCS,Facility,Outpatient,,,,585.51,497.6835,167.807166,585.51,"UCare Health, Inc.",Individual & Family Plan,329.934885,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
50-S SERFAS ENERGY SUCTION PROBE,,C2618,HCPCS,Facility,Inpatient,,,,585.51,497.6835,167.807166,585.51,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
50-S SERFAS ENERGY SUCTION PROBE,,C2618,HCPCS,Facility,Outpatient,,,,585.51,497.6835,167.807166,585.51,"UCare Health, Inc.",Medical Assistance,295.506897,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
50-S SERFAS ENERGY SUCTION PROBE,,C2618,HCPCS,Facility,Inpatient,,,,585.51,497.6835,167.807166,585.51,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
50-S SERFAS ENERGY SUCTION PROBE,,C2618,HCPCS,Facility,Outpatient,,,,585.51,497.6835,167.807166,585.51,"UCare Health, Inc.",Medicare Advantage,295.506897,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
50-S SERFAS ENERGY SUCTION PROBE,,C2618,HCPCS,Facility,Inpatient,,,,585.51,497.6835,167.807166,585.51,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
50-S SERFAS ENERGY SUCTION PROBE,,C2618,HCPCS,Facility,Outpatient,,,,585.51,497.6835,167.807166,585.51,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),295.506897,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
50-S SERFAS ENERGY SUCTION PROBE,,C2618,HCPCS,Facility,Inpatient,,,,585.51,497.6835,167.807166,585.51,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
50-S SERFAS ENERGY SUCTION PROBE,,C2618,HCPCS,Facility,Both,,,,585.51,497.6835,167.807166,585.51,UnitedHealthcare,Individual & Family,550.3794,94,,percent of total billed charges,,
50-S SERFAS ENERGY SUCTION PROBE,,C2618,HCPCS,Facility,Outpatient,,,,585.51,497.6835,167.807166,585.51,UnitedHealthcare,Medicare Advantage,286.8999,49,,percent of total billed charges,,
50-S SERFAS ENERGY SUCTION PROBE,,C2618,HCPCS,Facility,Inpatient,,,,585.51,497.6835,167.807166,585.51,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
50-S SERFAS ENERGY SUCTION PROBE,,C2618,HCPCS,Facility,Outpatient,,,,585.51,497.6835,167.807166,585.51,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,281.0448,48,,percent of total billed charges,,100% of DHS outpatient percentage
50-S SERFAS ENERGY SUCTION PROBE,,C2618,HCPCS,Facility,Inpatient,,,,585.51,497.6835,167.807166,585.51,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
BIOCOAG HEMOSTASIS PROBE,,C2618,HCPCS,Facility,Both,,,,850,722.5,243.61,850,Aetna,Commercial,782,92,,percent of total billed charges,,
BIOCOAG HEMOSTASIS PROBE,,C2618,HCPCS,Facility,Outpatient,,,,850,722.5,243.61,850,Aetna,Medicare Advantage,416.5,49,,percent of total billed charges,,
BIOCOAG HEMOSTASIS PROBE,,C2618,HCPCS,Facility,Inpatient,,,,850,722.5,243.61,850,Aetna,Medicare Advantage,,,,,Included in per diem rate,
BIOCOAG HEMOSTASIS PROBE,,C2618,HCPCS,Facility,Both,,,,850,722.5,243.61,850,Aetna,PPO,790.5,93,,percent of total billed charges,,
BIOCOAG HEMOSTASIS PROBE,,C2618,HCPCS,Facility,Both,,,,850,722.5,243.61,850,America's PPO,America's PPO,816.255,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
BIOCOAG HEMOSTASIS PROBE,,C2618,HCPCS,Facility,Both,,,,850,722.5,243.61,850,BlueCross BlueShield Minnesota, Federal Employee Program,836.4,98.4,,percent of total billed charges,,
BIOCOAG HEMOSTASIS PROBE,,C2618,HCPCS,Facility,Both,,,,850,722.5,243.61,850,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,850,100,,percent of total billed charges,,
BIOCOAG HEMOSTASIS PROBE,,C2618,HCPCS,Facility,Both,,,,850,722.5,243.61,850,BlueCross BlueShield Minnesota,High Value Network Plan,765,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
BIOCOAG HEMOSTASIS PROBE,,C2618,HCPCS,Facility,Outpatient,,,,850,722.5,243.61,850,BlueCross BlueShield Minnesota,Medicare Advantage,416.5,49,,percent of total billed charges,,
BIOCOAG HEMOSTASIS PROBE,,C2618,HCPCS,Facility,Inpatient,,,,850,722.5,243.61,850,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
BIOCOAG HEMOSTASIS PROBE,,C2618,HCPCS,Facility,Both,,,,850,722.5,243.61,850,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,752.845,88.57,,percent of total billed charges,,
BIOCOAG HEMOSTASIS PROBE,,C2618,HCPCS,Facility,Both,,,,850,722.5,243.61,850,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,243.61,28.66,,percent of total billed charges,,
BIOCOAG HEMOSTASIS PROBE,,C2618,HCPCS,Facility,Outpatient,,,,850,722.5,243.61,850,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),416.5,49,,percent of total billed charges,,
BIOCOAG HEMOSTASIS PROBE,,C2618,HCPCS,Facility,Inpatient,,,,850,722.5,243.61,850,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
BIOCOAG HEMOSTASIS PROBE,,C2618,HCPCS,Facility,Both,,,,850,722.5,243.61,850,CorVel,Worker's Compensation,850,100,,percent of total billed charges,,
BIOCOAG HEMOSTASIS PROBE,,C2618,HCPCS,Facility,Both,,,,850,722.5,243.61,850,First Health Group Corporation,First Health Network,824.5,97,,percent of total billed charges,,
BIOCOAG HEMOSTASIS PROBE,,C2618,HCPCS,Facility,Both,,,,850,722.5,243.61,850,"Health Partners, Inc.",Commercial,804.1,94.6,,percent of total billed charges,,
BIOCOAG HEMOSTASIS PROBE,,C2618,HCPCS,Facility,Outpatient,,,,850,722.5,243.61,850,"Health Partners, Inc.",Medicare Advantage,416.5,49,,percent of total billed charges,,
BIOCOAG HEMOSTASIS PROBE,,C2618,HCPCS,Facility,Inpatient,,,,850,722.5,243.61,850,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
BIOCOAG HEMOSTASIS PROBE,,C2618,HCPCS,Facility,Both,,,,850,722.5,243.61,850,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),510,60,,percent of total billed charges,,
BIOCOAG HEMOSTASIS PROBE,,C2618,HCPCS,Facility,Both,,,,850,722.5,243.61,850,"Health Partners, Inc.",State of Minnesota Advantage Program,692.75,81.5,,percent of total billed charges,,
BIOCOAG HEMOSTASIS PROBE,,C2618,HCPCS,Facility,Both,,,,850,722.5,243.61,850,"Health Partners, Inc.",State Public Programs,425,50,,percent of total billed charges,,
BIOCOAG HEMOSTASIS PROBE,,C2618,HCPCS,Facility,Both,,,,850,722.5,243.61,850,Humana Insurance Company,Commercial PPO,807.5,95,,percent of total billed charges,,
BIOCOAG HEMOSTASIS PROBE,,C2618,HCPCS,Facility,Outpatient,,,,850,722.5,243.61,850,Humana Insurance Company,Medicare PPO,416.5,49,,percent of total billed charges,,
BIOCOAG HEMOSTASIS PROBE,,C2618,HCPCS,Facility,Inpatient,,,,850,722.5,243.61,850,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
BIOCOAG HEMOSTASIS PROBE,,C2618,HCPCS,Facility,Both,,,,850,722.5,243.61,850,Medica,Individual & Family,842.35,99.1,,percent of total billed charges,,
BIOCOAG HEMOSTASIS PROBE,,C2618,HCPCS,Facility,Outpatient,,,,850,722.5,243.61,850,Medica,Medica Advantage Solution,423.3,49.8,,percent of total billed charges,,
BIOCOAG HEMOSTASIS PROBE,,C2618,HCPCS,Facility,Inpatient,,,,850,722.5,243.61,850,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
BIOCOAG HEMOSTASIS PROBE,,C2618,HCPCS,Facility,Outpatient,,,,850,722.5,243.61,850,Medica,Medical Assistance,379.1,44.6,,percent of total billed charges,,
BIOCOAG HEMOSTASIS PROBE,,C2618,HCPCS,Facility,Inpatient,,,,850,722.5,243.61,850,Medica,Medical Assistance,,,,,Included in per diem rate,
BIOCOAG HEMOSTASIS PROBE,,C2618,HCPCS,Facility,Outpatient,,,,850,722.5,243.61,850,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,423.3,49.8,,percent of total billed charges,,
BIOCOAG HEMOSTASIS PROBE,,C2618,HCPCS,Facility,Inpatient,,,,850,722.5,243.61,850,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
BIOCOAG HEMOSTASIS PROBE,,C2618,HCPCS,Facility,Both,,,,850,722.5,243.61,850,"Multiplan, Inc.","Multiplan, Inc.",799,94,,percent of total billed charges,,
BIOCOAG HEMOSTASIS PROBE,,C2618,HCPCS,Facility,Outpatient,,,,850,722.5,243.61,850,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,765.85,90.1,,percent of total billed charges,,
BIOCOAG HEMOSTASIS PROBE,,C2618,HCPCS,Facility,Inpatient,,,,850,722.5,243.61,850,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
BIOCOAG HEMOSTASIS PROBE,,C2618,HCPCS,Facility,Both,,,,850,722.5,243.61,850,"Preferred One Administrative Services, INC.",PPO,838.1,98.6,,percent of total billed charges,,
BIOCOAG HEMOSTASIS PROBE,,C2618,HCPCS,Facility,Outpatient,,,,850,722.5,243.61,850,PrimeWest Health,Minnesota Senior Health Options (MSHO),437.325,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
BIOCOAG HEMOSTASIS PROBE,,C2618,HCPCS,Facility,Inpatient,,,,850,722.5,243.61,850,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
BIOCOAG HEMOSTASIS PROBE,,C2618,HCPCS,Facility,Outpatient,,,,850,722.5,243.61,850,PrimeWest Health,MinnesotaCare,436.56,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
BIOCOAG HEMOSTASIS PROBE,,C2618,HCPCS,Facility,Inpatient,,,,850,722.5,243.61,850,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
BIOCOAG HEMOSTASIS PROBE,,C2618,HCPCS,Facility,Both,,,,850,722.5,243.61,850,Sanford Health Plan,Sanford Health Plan,782,92,,percent of total billed charges,,
BIOCOAG HEMOSTASIS PROBE,,C2618,HCPCS,Facility,Outpatient,,,,850,722.5,243.61,850,"UCare Health, Inc.",Individual & Family Plan,478.975,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
BIOCOAG HEMOSTASIS PROBE,,C2618,HCPCS,Facility,Inpatient,,,,850,722.5,243.61,850,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
BIOCOAG HEMOSTASIS PROBE,,C2618,HCPCS,Facility,Outpatient,,,,850,722.5,243.61,850,"UCare Health, Inc.",Medical Assistance,428.995,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BIOCOAG HEMOSTASIS PROBE,,C2618,HCPCS,Facility,Inpatient,,,,850,722.5,243.61,850,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
BIOCOAG HEMOSTASIS PROBE,,C2618,HCPCS,Facility,Outpatient,,,,850,722.5,243.61,850,"UCare Health, Inc.",Medicare Advantage,428.995,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BIOCOAG HEMOSTASIS PROBE,,C2618,HCPCS,Facility,Inpatient,,,,850,722.5,243.61,850,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
BIOCOAG HEMOSTASIS PROBE,,C2618,HCPCS,Facility,Outpatient,,,,850,722.5,243.61,850,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),428.995,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BIOCOAG HEMOSTASIS PROBE,,C2618,HCPCS,Facility,Inpatient,,,,850,722.5,243.61,850,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
BIOCOAG HEMOSTASIS PROBE,,C2618,HCPCS,Facility,Both,,,,850,722.5,243.61,850,UnitedHealthcare,Individual & Family,799,94,,percent of total billed charges,,
BIOCOAG HEMOSTASIS PROBE,,C2618,HCPCS,Facility,Outpatient,,,,850,722.5,243.61,850,UnitedHealthcare,Medicare Advantage,416.5,49,,percent of total billed charges,,
BIOCOAG HEMOSTASIS PROBE,,C2618,HCPCS,Facility,Inpatient,,,,850,722.5,243.61,850,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
BIOCOAG HEMOSTASIS PROBE,,C2618,HCPCS,Facility,Outpatient,,,,850,722.5,243.61,850,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,408,48,,percent of total billed charges,,100% of DHS outpatient percentage
BIOCOAG HEMOSTASIS PROBE,,C2618,HCPCS,Facility,Inpatient,,,,850,722.5,243.61,850,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Mra Abdomen Wo W Contrast,,C8902,HCPCS,Facility,Outpatient,,,,3254,2765.9,747,3078.284,Aetna,Medicare Advantage,1594.46,49,,percent of total billed charges,,
Mra Abdomen Wo W Contrast,,C8902,HCPCS,Facility,Inpatient,,,,3254,2765.9,747,3078.284,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Mra Abdomen Wo W Contrast,,C8902,HCPCS,Facility,Outpatient,,,,3254,2765.9,747,3078.284,BlueCross BlueShield Minnesota,Medicare Advantage,1594.46,49,,percent of total billed charges,,
Mra Abdomen Wo W Contrast,,C8902,HCPCS,Facility,Inpatient,,,,3254,2765.9,747,3078.284,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Mra Abdomen Wo W Contrast,,C8902,HCPCS,Facility,Both,,,,3254,2765.9,747,3078.284,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,932.5964,28.66,,percent of total billed charges,,
Mra Abdomen Wo W Contrast,,C8902,HCPCS,Facility,Outpatient,,,,3254,2765.9,747,3078.284,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1594.46,49,,percent of total billed charges,,
Mra Abdomen Wo W Contrast,,C8902,HCPCS,Facility,Inpatient,,,,3254,2765.9,747,3078.284,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Mra Abdomen Wo W Contrast,,C8902,HCPCS,Facility,Both,,,,3254,2765.9,747,3078.284,"Health Partners, Inc.",Commercial,3078.284,94.6,,percent of total billed charges,,
Mra Abdomen Wo W Contrast,,C8902,HCPCS,Facility,Outpatient,,,,3254,2765.9,747,3078.284,"Health Partners, Inc.",Medicare Advantage,1594.46,49,,percent of total billed charges,,
Mra Abdomen Wo W Contrast,,C8902,HCPCS,Facility,Inpatient,,,,3254,2765.9,747,3078.284,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mra Abdomen Wo W Contrast,,C8902,HCPCS,Facility,Both,,,,3254,2765.9,747,3078.284,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1952.4,60,,percent of total billed charges,,
Mra Abdomen Wo W Contrast,,C8902,HCPCS,Facility,Both,,,,3254,2765.9,747,3078.284,"Health Partners, Inc.",State of Minnesota Advantage Program,2652.01,81.5,,percent of total billed charges,,
Mra Abdomen Wo W Contrast,,C8902,HCPCS,Facility,Both,,,,3254,2765.9,747,3078.284,"Health Partners, Inc.",State Public Programs,1627,50,,percent of total billed charges,,
Mra Abdomen Wo W Contrast,,C8902,HCPCS,Facility,Outpatient,,,,3254,2765.9,747,3078.284,Humana Insurance Company,Medicare PPO,1594.46,49,,percent of total billed charges,,
Mra Abdomen Wo W Contrast,,C8902,HCPCS,Facility,Inpatient,,,,3254,2765.9,747,3078.284,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Mra Abdomen Wo W Contrast,,C8902,HCPCS,Facility,Outpatient,,,,3254,2765.9,747,3078.284,Medica,Medica Advantage Solution,1620.492,49.8,,percent of total billed charges,,
Mra Abdomen Wo W Contrast,,C8902,HCPCS,Facility,Inpatient,,,,3254,2765.9,747,3078.284,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Mra Abdomen Wo W Contrast,,C8902,HCPCS,Facility,Outpatient,,,,3254,2765.9,747,3078.284,Medica,Medical Assistance,747,,,Other,Per vist,Pays in addition to all Outpatient Service Categories
Mra Abdomen Wo W Contrast,,C8902,HCPCS,Facility,Inpatient,,,,3254,2765.9,747,3078.284,Medica,Medical Assistance,,,,,Included in per diem rate,
Mra Abdomen Wo W Contrast,,C8902,HCPCS,Facility,Outpatient,,,,3254,2765.9,747,3078.284,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1620.492,49.8,,percent of total billed charges,,
Mra Abdomen Wo W Contrast,,C8902,HCPCS,Facility,Inpatient,,,,3254,2765.9,747,3078.284,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Mra Abdomen Wo W Contrast,,C8902,HCPCS,Facility,Outpatient,,,,3254,2765.9,747,3078.284,PrimeWest Health,Minnesota Senior Health Options (MSHO),1674.183,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Mra Abdomen Wo W Contrast,,C8902,HCPCS,Facility,Inpatient,,,,3254,2765.9,747,3078.284,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mra Abdomen Wo W Contrast,,C8902,HCPCS,Facility,Outpatient,,,,3254,2765.9,747,3078.284,PrimeWest Health,MinnesotaCare,1671.2544,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Mra Abdomen Wo W Contrast,,C8902,HCPCS,Facility,Inpatient,,,,3254,2765.9,747,3078.284,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Mra Abdomen Wo W Contrast,,C8902,HCPCS,Facility,Outpatient,,,,3254,2765.9,747,3078.284,"UCare Health, Inc.",Individual & Family Plan,1833.629,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Mra Abdomen Wo W Contrast,,C8902,HCPCS,Facility,Inpatient,,,,3254,2765.9,747,3078.284,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Mra Abdomen Wo W Contrast,,C8902,HCPCS,Facility,Outpatient,,,,3254,2765.9,747,3078.284,"UCare Health, Inc.",Medical Assistance,1642.2938,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mra Abdomen Wo W Contrast,,C8902,HCPCS,Facility,Inpatient,,,,3254,2765.9,747,3078.284,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Mra Abdomen Wo W Contrast,,C8902,HCPCS,Facility,Outpatient,,,,3254,2765.9,747,3078.284,"UCare Health, Inc.",Medicare Advantage,1642.2938,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mra Abdomen Wo W Contrast,,C8902,HCPCS,Facility,Inpatient,,,,3254,2765.9,747,3078.284,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mra Abdomen Wo W Contrast,,C8902,HCPCS,Facility,Outpatient,,,,3254,2765.9,747,3078.284,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1642.2938,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mra Abdomen Wo W Contrast,,C8902,HCPCS,Facility,Inpatient,,,,3254,2765.9,747,3078.284,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mra Abdomen Wo W Contrast,,C8902,HCPCS,Facility,Outpatient,,,,3254,2765.9,747,3078.284,UnitedHealthcare,Medicare Advantage,1594.46,49,,percent of total billed charges,,
Mra Abdomen Wo W Contrast,,C8902,HCPCS,Facility,Inpatient,,,,3254,2765.9,747,3078.284,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Mra Abdomen Wo W Contrast,,C8902,HCPCS,Facility,Outpatient,,,,3254,2765.9,747,3078.284,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1561.92,48,,percent of total billed charges,,100% of DHS outpatient percentage
Mra Abdomen Wo W Contrast,,C8902,HCPCS,Facility,Inpatient,,,,3254,2765.9,747,3078.284,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Mra Chest Wo W Contrast,,C8911,HCPCS,Facility,Outpatient,,,,2856,2427.6,747,2570.4,Aetna,Medicare Advantage,1399.44,49,,percent of total billed charges,,
Mra Chest Wo W Contrast,,C8911,HCPCS,Facility,Inpatient,,,,2856,2427.6,747,2570.4,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Mra Chest Wo W Contrast,,C8911,HCPCS,Facility,Outpatient,,,,2856,2427.6,747,2570.4,BlueCross BlueShield Minnesota,Medicare Advantage,1399.44,49,,percent of total billed charges,,
Mra Chest Wo W Contrast,,C8911,HCPCS,Facility,Inpatient,,,,2856,2427.6,747,2570.4,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Mra Chest Wo W Contrast,,C8911,HCPCS,Facility,Both,,,,2856,2427.6,747,2570.4,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,818.5296,28.66,,percent of total billed charges,,
Mra Chest Wo W Contrast,,C8911,HCPCS,Facility,Outpatient,,,,2856,2427.6,747,2570.4,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1399.44,49,,percent of total billed charges,,
Mra Chest Wo W Contrast,,C8911,HCPCS,Facility,Inpatient,,,,2856,2427.6,747,2570.4,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Mra Chest Wo W Contrast,,C8911,HCPCS,Facility,Outpatient,,,,2856,2427.6,747,2570.4,"Health Partners, Inc.",Medicare Advantage,1399.44,49,,percent of total billed charges,,
Mra Chest Wo W Contrast,,C8911,HCPCS,Facility,Inpatient,,,,2856,2427.6,747,2570.4,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mra Chest Wo W Contrast,,C8911,HCPCS,Facility,Both,,,,2856,2427.6,747,2570.4,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1713.6,60,,percent of total billed charges,,
Mra Chest Wo W Contrast,,C8911,HCPCS,Facility,Both,,,,2856,2427.6,747,2570.4,"Health Partners, Inc.",State Public Programs,1428,50,,percent of total billed charges,,
Mra Chest Wo W Contrast,,C8911,HCPCS,Facility,Outpatient,,,,2856,2427.6,747,2570.4,Humana Insurance Company,Medicare PPO,1399.44,49,,percent of total billed charges,,
Mra Chest Wo W Contrast,,C8911,HCPCS,Facility,Inpatient,,,,2856,2427.6,747,2570.4,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Mra Chest Wo W Contrast,,C8911,HCPCS,Facility,Outpatient,,,,2856,2427.6,747,2570.4,Medica,Medica Advantage Solution,1422.288,49.8,,percent of total billed charges,,
Mra Chest Wo W Contrast,,C8911,HCPCS,Facility,Inpatient,,,,2856,2427.6,747,2570.4,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Mra Chest Wo W Contrast,,C8911,HCPCS,Facility,Outpatient,,,,2856,2427.6,747,2570.4,Medica,Medical Assistance,747,,,Other,Per vist,Pays in addition to all Outpatient Service Categories
Mra Chest Wo W Contrast,,C8911,HCPCS,Facility,Inpatient,,,,2856,2427.6,747,2570.4,Medica,Medical Assistance,,,,,Included in per diem rate,
Mra Chest Wo W Contrast,,C8911,HCPCS,Facility,Outpatient,,,,2856,2427.6,747,2570.4,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1422.288,49.8,,percent of total billed charges,,
Mra Chest Wo W Contrast,,C8911,HCPCS,Facility,Inpatient,,,,2856,2427.6,747,2570.4,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Mra Chest Wo W Contrast,,C8911,HCPCS,Facility,Outpatient,,,,2856,2427.6,747,2570.4,PrimeWest Health,Minnesota Senior Health Options (MSHO),1469.412,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Mra Chest Wo W Contrast,,C8911,HCPCS,Facility,Inpatient,,,,2856,2427.6,747,2570.4,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mra Chest Wo W Contrast,,C8911,HCPCS,Facility,Outpatient,,,,2856,2427.6,747,2570.4,PrimeWest Health,MinnesotaCare,1466.8416,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Mra Chest Wo W Contrast,,C8911,HCPCS,Facility,Inpatient,,,,2856,2427.6,747,2570.4,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Mra Chest Wo W Contrast,,C8911,HCPCS,Facility,Outpatient,,,,2856,2427.6,747,2570.4,"UCare Health, Inc.",Medical Assistance,1441.4232,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mra Chest Wo W Contrast,,C8911,HCPCS,Facility,Inpatient,,,,2856,2427.6,747,2570.4,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Mra Chest Wo W Contrast,,C8911,HCPCS,Facility,Outpatient,,,,2856,2427.6,747,2570.4,"UCare Health, Inc.",Medicare Advantage,1441.4232,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mra Chest Wo W Contrast,,C8911,HCPCS,Facility,Inpatient,,,,2856,2427.6,747,2570.4,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mra Chest Wo W Contrast,,C8911,HCPCS,Facility,Outpatient,,,,2856,2427.6,747,2570.4,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1441.4232,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mra Chest Wo W Contrast,,C8911,HCPCS,Facility,Inpatient,,,,2856,2427.6,747,2570.4,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mra Chest Wo W Contrast,,C8911,HCPCS,Facility,Outpatient,,,,2856,2427.6,747,2570.4,UnitedHealthcare,Medicare Advantage,1399.44,49,,percent of total billed charges,,
Mra Chest Wo W Contrast,,C8911,HCPCS,Facility,Inpatient,,,,2856,2427.6,747,2570.4,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Mra Chest Wo W Contrast,,C8911,HCPCS,Facility,Outpatient,,,,2856,2427.6,747,2570.4,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1370.88,48,,percent of total billed charges,,100% of DHS outpatient percentage
Mra Chest Wo W Contrast,,C8911,HCPCS,Facility,Inpatient,,,,2856,2427.6,747,2570.4,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Mra Lower Extremity Wo/W Contrast,,C8914,HCPCS,Facility,Outpatient,,,,2346,1994.1,672.3636,2111.4,Aetna,Medicare Advantage,1149.54,49,,percent of total billed charges,,
Mra Lower Extremity Wo/W Contrast,,C8914,HCPCS,Facility,Inpatient,,,,2346,1994.1,672.3636,2111.4,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Mra Lower Extremity Wo/W Contrast,,C8914,HCPCS,Facility,Outpatient,,,,2346,1994.1,672.3636,2111.4,BlueCross BlueShield Minnesota,Medicare Advantage,1149.54,49,,percent of total billed charges,,
Mra Lower Extremity Wo/W Contrast,,C8914,HCPCS,Facility,Inpatient,,,,2346,1994.1,672.3636,2111.4,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Mra Lower Extremity Wo/W Contrast,,C8914,HCPCS,Facility,Both,,,,2346,1994.1,672.3636,2111.4,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,672.3636,28.66,,percent of total billed charges,,
Mra Lower Extremity Wo/W Contrast,,C8914,HCPCS,Facility,Outpatient,,,,2346,1994.1,672.3636,2111.4,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1149.54,49,,percent of total billed charges,,
Mra Lower Extremity Wo/W Contrast,,C8914,HCPCS,Facility,Inpatient,,,,2346,1994.1,672.3636,2111.4,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Mra Lower Extremity Wo/W Contrast,,C8914,HCPCS,Facility,Outpatient,,,,2346,1994.1,672.3636,2111.4,"Health Partners, Inc.",Medicare Advantage,1149.54,49,,percent of total billed charges,,
Mra Lower Extremity Wo/W Contrast,,C8914,HCPCS,Facility,Inpatient,,,,2346,1994.1,672.3636,2111.4,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mra Lower Extremity Wo/W Contrast,,C8914,HCPCS,Facility,Both,,,,2346,1994.1,672.3636,2111.4,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1407.6,60,,percent of total billed charges,,
Mra Lower Extremity Wo/W Contrast,,C8914,HCPCS,Facility,Both,,,,2346,1994.1,672.3636,2111.4,"Health Partners, Inc.",State Public Programs,1173,50,,percent of total billed charges,,
Mra Lower Extremity Wo/W Contrast,,C8914,HCPCS,Facility,Outpatient,,,,2346,1994.1,672.3636,2111.4,Humana Insurance Company,Medicare PPO,1149.54,49,,percent of total billed charges,,
Mra Lower Extremity Wo/W Contrast,,C8914,HCPCS,Facility,Inpatient,,,,2346,1994.1,672.3636,2111.4,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Mra Lower Extremity Wo/W Contrast,,C8914,HCPCS,Facility,Outpatient,,,,2346,1994.1,672.3636,2111.4,Medica,Medica Advantage Solution,1168.308,49.8,,percent of total billed charges,,
Mra Lower Extremity Wo/W Contrast,,C8914,HCPCS,Facility,Inpatient,,,,2346,1994.1,672.3636,2111.4,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Mra Lower Extremity Wo/W Contrast,,C8914,HCPCS,Facility,Outpatient,,,,2346,1994.1,672.3636,2111.4,Medica,Medical Assistance,747,,,Other ,per vist,Pays in addition to all Outpatient Service Categories
Mra Lower Extremity Wo/W Contrast,,C8914,HCPCS,Facility,Inpatient,,,,2346,1994.1,672.3636,2111.4,Medica,Medical Assistance,,,,,Included in per diem rate,
Mra Lower Extremity Wo/W Contrast,,C8914,HCPCS,Facility,Outpatient,,,,2346,1994.1,672.3636,2111.4,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1168.308,49.8,,percent of total billed charges,,
Mra Lower Extremity Wo/W Contrast,,C8914,HCPCS,Facility,Inpatient,,,,2346,1994.1,672.3636,2111.4,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Mra Lower Extremity Wo/W Contrast,,C8914,HCPCS,Facility,Outpatient,,,,2346,1994.1,672.3636,2111.4,PrimeWest Health,Minnesota Senior Health Options (MSHO),1207.017,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Mra Lower Extremity Wo/W Contrast,,C8914,HCPCS,Facility,Inpatient,,,,2346,1994.1,672.3636,2111.4,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mra Lower Extremity Wo/W Contrast,,C8914,HCPCS,Facility,Outpatient,,,,2346,1994.1,672.3636,2111.4,PrimeWest Health,MinnesotaCare,1204.9056,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Mra Lower Extremity Wo/W Contrast,,C8914,HCPCS,Facility,Inpatient,,,,2346,1994.1,672.3636,2111.4,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Mra Lower Extremity Wo/W Contrast,,C8914,HCPCS,Facility,Outpatient,,,,2346,1994.1,672.3636,2111.4,"UCare Health, Inc.",Medical Assistance,1184.0262,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mra Lower Extremity Wo/W Contrast,,C8914,HCPCS,Facility,Inpatient,,,,2346,1994.1,672.3636,2111.4,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Mra Lower Extremity Wo/W Contrast,,C8914,HCPCS,Facility,Outpatient,,,,2346,1994.1,672.3636,2111.4,"UCare Health, Inc.",Medicare Advantage,1184.0262,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mra Lower Extremity Wo/W Contrast,,C8914,HCPCS,Facility,Inpatient,,,,2346,1994.1,672.3636,2111.4,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mra Lower Extremity Wo/W Contrast,,C8914,HCPCS,Facility,Outpatient,,,,2346,1994.1,672.3636,2111.4,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1184.0262,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mra Lower Extremity Wo/W Contrast,,C8914,HCPCS,Facility,Inpatient,,,,2346,1994.1,672.3636,2111.4,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mra Lower Extremity Wo/W Contrast,,C8914,HCPCS,Facility,Outpatient,,,,2346,1994.1,672.3636,2111.4,UnitedHealthcare,Medicare Advantage,1149.54,49,,percent of total billed charges,,
Mra Lower Extremity Wo/W Contrast,,C8914,HCPCS,Facility,Inpatient,,,,2346,1994.1,672.3636,2111.4,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Mra Lower Extremity Wo/W Contrast,,C8914,HCPCS,Facility,Outpatient,,,,2346,1994.1,672.3636,2111.4,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1126.08,48,,percent of total billed charges,,100% of DHS outpatient percentage
Mra Lower Extremity Wo/W Contrast,,C8914,HCPCS,Facility,Inpatient,,,,2346,1994.1,672.3636,2111.4,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
KETOCONAZOLE 2 % TOP SHAM,,2015,LOCAL,Facility,Both,120,mL,,120,102,34.392,120,Aetna,Commercial,110.4,92,,percent of total billed charges,,
KETOCONAZOLE 2 % TOP SHAM,,2015,LOCAL,Facility,Outpatient,120,mL,,120,102,34.392,120,Aetna,Medicare Advantage,58.8,49,,percent of total billed charges,,
KETOCONAZOLE 2 % TOP SHAM,,2015,LOCAL,Facility,Inpatient,120,mL,,120,102,34.392,120,Aetna,Medicare Advantage,,,,,Included in per diem rate,
KETOCONAZOLE 2 % TOP SHAM,,2015,LOCAL,Facility,Both,120,mL,,120,102,34.392,120,Aetna,PPO,111.6,93,,percent of total billed charges,,
KETOCONAZOLE 2 % TOP SHAM,,2015,LOCAL,Facility,Both,120,mL,,120,102,34.392,120,America's PPO,America's PPO,115.236,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
KETOCONAZOLE 2 % TOP SHAM,,2015,LOCAL,Facility,Both,120,mL,,120,102,34.392,120,BlueCross BlueShield Minnesota, Federal Employee Program,118.08,98.4,,percent of total billed charges,,
KETOCONAZOLE 2 % TOP SHAM,,2015,LOCAL,Facility,Both,120,mL,,120,102,34.392,120,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,120,100,,percent of total billed charges,,
KETOCONAZOLE 2 % TOP SHAM,,2015,LOCAL,Facility,Both,120,mL,,120,102,34.392,120,BlueCross BlueShield Minnesota,High Value Network Plan,108,90,,percent of total billed charges,,
KETOCONAZOLE 2 % TOP SHAM,,2015,LOCAL,Facility,Outpatient,120,mL,,120,102,34.392,120,BlueCross BlueShield Minnesota,Medicare Advantage,58.8,49,,percent of total billed charges,,
KETOCONAZOLE 2 % TOP SHAM,,2015,LOCAL,Facility,Inpatient,120,mL,,120,102,34.392,120,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
KETOCONAZOLE 2 % TOP SHAM,,2015,LOCAL,Facility,Both,120,mL,,120,102,34.392,120,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,106.284,88.57,,percent of total billed charges,,
KETOCONAZOLE 2 % TOP SHAM,,2015,LOCAL,Facility,Both,120,mL,,120,102,34.392,120,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,34.392,28.66,,percent of total billed charges,,
KETOCONAZOLE 2 % TOP SHAM,,2015,LOCAL,Facility,Outpatient,120,mL,,120,102,34.392,120,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),58.8,49,,percent of total billed charges,,
KETOCONAZOLE 2 % TOP SHAM,,2015,LOCAL,Facility,Inpatient,120,mL,,120,102,34.392,120,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
KETOCONAZOLE 2 % TOP SHAM,,2015,LOCAL,Facility,Both,120,mL,,120,102,34.392,120,CorVel,Worker's Compensation,120,100,,percent of total billed charges,,
KETOCONAZOLE 2 % TOP SHAM,,2015,LOCAL,Facility,Both,120,mL,,120,102,34.392,120,First Health Group Corporation,First Health Network,116.4,97,,percent of total billed charges,,
KETOCONAZOLE 2 % TOP SHAM,,2015,LOCAL,Facility,Both,120,mL,,120,102,34.392,120,"Health Partners, Inc.",Commercial,113.52,94.6,,percent of total billed charges,,
KETOCONAZOLE 2 % TOP SHAM,,2015,LOCAL,Facility,Outpatient,120,mL,,120,102,34.392,120,"Health Partners, Inc.",Medicare Advantage,58.8,49,,percent of total billed charges,,
KETOCONAZOLE 2 % TOP SHAM,,2015,LOCAL,Facility,Inpatient,120,mL,,120,102,34.392,120,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
KETOCONAZOLE 2 % TOP SHAM,,2015,LOCAL,Facility,Both,120,mL,,120,102,34.392,120,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),72,60,,percent of total billed charges,,
KETOCONAZOLE 2 % TOP SHAM,,2015,LOCAL,Facility,Both,120,mL,,120,102,34.392,120,"Health Partners, Inc.",State of Minnesota Advantage Program,97.8,81.5,,percent of total billed charges,,
KETOCONAZOLE 2 % TOP SHAM,,2015,LOCAL,Facility,Both,120,mL,,120,102,34.392,120,"Health Partners, Inc.",State Public Programs,60,50,,percent of total billed charges,,
KETOCONAZOLE 2 % TOP SHAM,,2015,LOCAL,Facility,Both,120,mL,,120,102,34.392,120,Humana Insurance Company,Commercial PPO,114,95,,percent of total billed charges,,
KETOCONAZOLE 2 % TOP SHAM,,2015,LOCAL,Facility,Outpatient,120,mL,,120,102,34.392,120,Humana Insurance Company,Medicare PPO,58.8,49,,percent of total billed charges,,
KETOCONAZOLE 2 % TOP SHAM,,2015,LOCAL,Facility,Inpatient,120,mL,,120,102,34.392,120,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
KETOCONAZOLE 2 % TOP SHAM,,2015,LOCAL,Facility,Both,120,mL,,120,102,34.392,120,Medica,Individual & Family,118.92,99.1,,percent of total billed charges,,
KETOCONAZOLE 2 % TOP SHAM,,2015,LOCAL,Facility,Outpatient,120,mL,,120,102,34.392,120,Medica,Medica Advantage Solution,59.76,49.8,,percent of total billed charges,,
KETOCONAZOLE 2 % TOP SHAM,,2015,LOCAL,Facility,Inpatient,120,mL,,120,102,34.392,120,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
KETOCONAZOLE 2 % TOP SHAM,,2015,LOCAL,Facility,Outpatient,120,mL,,120,102,34.392,120,Medica,Medical Assistance,53.52,44.6,,percent of total billed charges,,
KETOCONAZOLE 2 % TOP SHAM,,2015,LOCAL,Facility,Inpatient,120,mL,,120,102,34.392,120,Medica,Medical Assistance,,,,,Included in per diem rate,
KETOCONAZOLE 2 % TOP SHAM,,2015,LOCAL,Facility,Outpatient,120,mL,,120,102,34.392,120,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,59.76,49.8,,percent of total billed charges,,
KETOCONAZOLE 2 % TOP SHAM,,2015,LOCAL,Facility,Inpatient,120,mL,,120,102,34.392,120,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
KETOCONAZOLE 2 % TOP SHAM,,2015,LOCAL,Facility,Both,120,mL,,120,102,34.392,120,"Multiplan, Inc.","Multiplan, Inc.",112.8,94,,percent of total billed charges,,
KETOCONAZOLE 2 % TOP SHAM,,2015,LOCAL,Facility,Outpatient,120,mL,,120,102,34.392,120,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,108.12,90.1,,percent of total billed charges,,
KETOCONAZOLE 2 % TOP SHAM,,2015,LOCAL,Facility,Inpatient,120,mL,,120,102,34.392,120,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
KETOCONAZOLE 2 % TOP SHAM,,2015,LOCAL,Facility,Both,120,mL,,120,102,34.392,120,"Preferred One Administrative Services, INC.",PPO,118.32,98.6,,percent of total billed charges,,
KETOCONAZOLE 2 % TOP SHAM,,2015,LOCAL,Facility,Outpatient,120,mL,,120,102,34.392,120,PrimeWest Health,Minnesota Senior Health Options (MSHO),61.74,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
KETOCONAZOLE 2 % TOP SHAM,,2015,LOCAL,Facility,Inpatient,120,mL,,120,102,34.392,120,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
KETOCONAZOLE 2 % TOP SHAM,,2015,LOCAL,Facility,Outpatient,120,mL,,120,102,34.392,120,PrimeWest Health,MinnesotaCare,61.632,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
KETOCONAZOLE 2 % TOP SHAM,,2015,LOCAL,Facility,Inpatient,120,mL,,120,102,34.392,120,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
KETOCONAZOLE 2 % TOP SHAM,,2015,LOCAL,Facility,Both,120,mL,,120,102,34.392,120,Sanford Health Plan,Sanford Health Plan,110.4,92,,percent of total billed charges,,
KETOCONAZOLE 2 % TOP SHAM,,2015,LOCAL,Facility,Outpatient,120,mL,,120,102,34.392,120,"UCare Health, Inc.",Individual & Family Plan,67.62,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
KETOCONAZOLE 2 % TOP SHAM,,2015,LOCAL,Facility,Inpatient,120,mL,,120,102,34.392,120,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
KETOCONAZOLE 2 % TOP SHAM,,2015,LOCAL,Facility,Outpatient,120,mL,,120,102,34.392,120,"UCare Health, Inc.",Medical Assistance,60.564,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
KETOCONAZOLE 2 % TOP SHAM,,2015,LOCAL,Facility,Inpatient,120,mL,,120,102,34.392,120,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
KETOCONAZOLE 2 % TOP SHAM,,2015,LOCAL,Facility,Outpatient,120,mL,,120,102,34.392,120,"UCare Health, Inc.",Medicare Advantage,60.564,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
KETOCONAZOLE 2 % TOP SHAM,,2015,LOCAL,Facility,Inpatient,120,mL,,120,102,34.392,120,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
KETOCONAZOLE 2 % TOP SHAM,,2015,LOCAL,Facility,Outpatient,120,mL,,120,102,34.392,120,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),60.564,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
KETOCONAZOLE 2 % TOP SHAM,,2015,LOCAL,Facility,Inpatient,120,mL,,120,102,34.392,120,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
KETOCONAZOLE 2 % TOP SHAM,,2015,LOCAL,Facility,Both,120,mL,,120,102,34.392,120,UnitedHealthcare,Individual & Family,112.8,94,,percent of total billed charges,,
KETOCONAZOLE 2 % TOP SHAM,,2015,LOCAL,Facility,Outpatient,120,mL,,120,102,34.392,120,UnitedHealthcare,Medicare Advantage,58.8,49,,percent of total billed charges,,
KETOCONAZOLE 2 % TOP SHAM,,2015,LOCAL,Facility,Inpatient,120,mL,,120,102,34.392,120,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
KETOCONAZOLE 2 % TOP SHAM,,2015,LOCAL,Facility,Outpatient,120,mL,,120,102,34.392,120,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,57.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
KETOCONAZOLE 2 % TOP SHAM,,2015,LOCAL,Facility,Inpatient,120,mL,,120,102,34.392,120,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
FUROSEMIDE 10 MG/ML ORAL SOLN,,2836,LOCAL,Facility,Both,120,mL,,85,72.25,24.361,85,Aetna,Commercial,78.2,92,,percent of total billed charges,,
FUROSEMIDE 10 MG/ML ORAL SOLN,,2836,LOCAL,Facility,Outpatient,120,mL,,85,72.25,24.361,85,Aetna,Medicare Advantage,41.65,49,,percent of total billed charges,,
FUROSEMIDE 10 MG/ML ORAL SOLN,,2836,LOCAL,Facility,Inpatient,120,mL,,85,72.25,24.361,85,Aetna,Medicare Advantage,,,,,Included in per diem rate,
FUROSEMIDE 10 MG/ML ORAL SOLN,,2836,LOCAL,Facility,Both,120,mL,,85,72.25,24.361,85,Aetna,PPO,79.05,93,,percent of total billed charges,,
FUROSEMIDE 10 MG/ML ORAL SOLN,,2836,LOCAL,Facility,Both,120,mL,,85,72.25,24.361,85,America's PPO,America's PPO,81.6255,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
FUROSEMIDE 10 MG/ML ORAL SOLN,,2836,LOCAL,Facility,Both,120,mL,,85,72.25,24.361,85,BlueCross BlueShield Minnesota, Federal Employee Program,83.64,98.4,,percent of total billed charges,,
FUROSEMIDE 10 MG/ML ORAL SOLN,,2836,LOCAL,Facility,Both,120,mL,,85,72.25,24.361,85,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,85,100,,percent of total billed charges,,
FUROSEMIDE 10 MG/ML ORAL SOLN,,2836,LOCAL,Facility,Both,120,mL,,85,72.25,24.361,85,BlueCross BlueShield Minnesota,High Value Network Plan,76.5,90,,percent of total billed charges,,
FUROSEMIDE 10 MG/ML ORAL SOLN,,2836,LOCAL,Facility,Outpatient,120,mL,,85,72.25,24.361,85,BlueCross BlueShield Minnesota,Medicare Advantage,41.65,49,,percent of total billed charges,,
FUROSEMIDE 10 MG/ML ORAL SOLN,,2836,LOCAL,Facility,Inpatient,120,mL,,85,72.25,24.361,85,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
FUROSEMIDE 10 MG/ML ORAL SOLN,,2836,LOCAL,Facility,Both,120,mL,,85,72.25,24.361,85,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,75.2845,88.57,,percent of total billed charges,,
FUROSEMIDE 10 MG/ML ORAL SOLN,,2836,LOCAL,Facility,Both,120,mL,,85,72.25,24.361,85,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,24.361,28.66,,percent of total billed charges,,
FUROSEMIDE 10 MG/ML ORAL SOLN,,2836,LOCAL,Facility,Outpatient,120,mL,,85,72.25,24.361,85,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),41.65,49,,percent of total billed charges,,
FUROSEMIDE 10 MG/ML ORAL SOLN,,2836,LOCAL,Facility,Inpatient,120,mL,,85,72.25,24.361,85,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
FUROSEMIDE 10 MG/ML ORAL SOLN,,2836,LOCAL,Facility,Both,120,mL,,85,72.25,24.361,85,CorVel,Worker's Compensation,85,100,,percent of total billed charges,,
FUROSEMIDE 10 MG/ML ORAL SOLN,,2836,LOCAL,Facility,Both,120,mL,,85,72.25,24.361,85,First Health Group Corporation,First Health Network,82.45,97,,percent of total billed charges,,
FUROSEMIDE 10 MG/ML ORAL SOLN,,2836,LOCAL,Facility,Both,120,mL,,85,72.25,24.361,85,"Health Partners, Inc.",Commercial,80.41,94.6,,percent of total billed charges,,
FUROSEMIDE 10 MG/ML ORAL SOLN,,2836,LOCAL,Facility,Outpatient,120,mL,,85,72.25,24.361,85,"Health Partners, Inc.",Medicare Advantage,41.65,49,,percent of total billed charges,,
FUROSEMIDE 10 MG/ML ORAL SOLN,,2836,LOCAL,Facility,Inpatient,120,mL,,85,72.25,24.361,85,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
FUROSEMIDE 10 MG/ML ORAL SOLN,,2836,LOCAL,Facility,Both,120,mL,,85,72.25,24.361,85,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),51,60,,percent of total billed charges,,
FUROSEMIDE 10 MG/ML ORAL SOLN,,2836,LOCAL,Facility,Both,120,mL,,85,72.25,24.361,85,"Health Partners, Inc.",State of Minnesota Advantage Program,69.275,81.5,,percent of total billed charges,,
FUROSEMIDE 10 MG/ML ORAL SOLN,,2836,LOCAL,Facility,Both,120,mL,,85,72.25,24.361,85,"Health Partners, Inc.",State Public Programs,42.5,50,,percent of total billed charges,,
FUROSEMIDE 10 MG/ML ORAL SOLN,,2836,LOCAL,Facility,Both,120,mL,,85,72.25,24.361,85,Humana Insurance Company,Commercial PPO,80.75,95,,percent of total billed charges,,
FUROSEMIDE 10 MG/ML ORAL SOLN,,2836,LOCAL,Facility,Outpatient,120,mL,,85,72.25,24.361,85,Humana Insurance Company,Medicare PPO,41.65,49,,percent of total billed charges,,
FUROSEMIDE 10 MG/ML ORAL SOLN,,2836,LOCAL,Facility,Inpatient,120,mL,,85,72.25,24.361,85,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
FUROSEMIDE 10 MG/ML ORAL SOLN,,2836,LOCAL,Facility,Both,120,mL,,85,72.25,24.361,85,Medica,Individual & Family,84.235,99.1,,percent of total billed charges,,
FUROSEMIDE 10 MG/ML ORAL SOLN,,2836,LOCAL,Facility,Outpatient,120,mL,,85,72.25,24.361,85,Medica,Medica Advantage Solution,42.33,49.8,,percent of total billed charges,,
FUROSEMIDE 10 MG/ML ORAL SOLN,,2836,LOCAL,Facility,Inpatient,120,mL,,85,72.25,24.361,85,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
FUROSEMIDE 10 MG/ML ORAL SOLN,,2836,LOCAL,Facility,Outpatient,120,mL,,85,72.25,24.361,85,Medica,Medical Assistance,37.91,44.6,,percent of total billed charges,,
FUROSEMIDE 10 MG/ML ORAL SOLN,,2836,LOCAL,Facility,Inpatient,120,mL,,85,72.25,24.361,85,Medica,Medical Assistance,,,,,Included in per diem rate,
FUROSEMIDE 10 MG/ML ORAL SOLN,,2836,LOCAL,Facility,Outpatient,120,mL,,85,72.25,24.361,85,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,42.33,49.8,,percent of total billed charges,,
FUROSEMIDE 10 MG/ML ORAL SOLN,,2836,LOCAL,Facility,Inpatient,120,mL,,85,72.25,24.361,85,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
FUROSEMIDE 10 MG/ML ORAL SOLN,,2836,LOCAL,Facility,Both,120,mL,,85,72.25,24.361,85,"Multiplan, Inc.","Multiplan, Inc.",79.9,94,,percent of total billed charges,,
FUROSEMIDE 10 MG/ML ORAL SOLN,,2836,LOCAL,Facility,Outpatient,120,mL,,85,72.25,24.361,85,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,76.585,90.1,,percent of total billed charges,,
FUROSEMIDE 10 MG/ML ORAL SOLN,,2836,LOCAL,Facility,Inpatient,120,mL,,85,72.25,24.361,85,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
FUROSEMIDE 10 MG/ML ORAL SOLN,,2836,LOCAL,Facility,Both,120,mL,,85,72.25,24.361,85,"Preferred One Administrative Services, INC.",PPO,83.81,98.6,,percent of total billed charges,,
FUROSEMIDE 10 MG/ML ORAL SOLN,,2836,LOCAL,Facility,Outpatient,120,mL,,85,72.25,24.361,85,PrimeWest Health,Minnesota Senior Health Options (MSHO),43.7325,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
FUROSEMIDE 10 MG/ML ORAL SOLN,,2836,LOCAL,Facility,Inpatient,120,mL,,85,72.25,24.361,85,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
FUROSEMIDE 10 MG/ML ORAL SOLN,,2836,LOCAL,Facility,Outpatient,120,mL,,85,72.25,24.361,85,PrimeWest Health,MinnesotaCare,43.656,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
FUROSEMIDE 10 MG/ML ORAL SOLN,,2836,LOCAL,Facility,Inpatient,120,mL,,85,72.25,24.361,85,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
FUROSEMIDE 10 MG/ML ORAL SOLN,,2836,LOCAL,Facility,Both,120,mL,,85,72.25,24.361,85,Sanford Health Plan,Sanford Health Plan,78.2,92,,percent of total billed charges,,
FUROSEMIDE 10 MG/ML ORAL SOLN,,2836,LOCAL,Facility,Outpatient,120,mL,,85,72.25,24.361,85,"UCare Health, Inc.",Individual & Family Plan,47.8975,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
FUROSEMIDE 10 MG/ML ORAL SOLN,,2836,LOCAL,Facility,Inpatient,120,mL,,85,72.25,24.361,85,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
FUROSEMIDE 10 MG/ML ORAL SOLN,,2836,LOCAL,Facility,Outpatient,120,mL,,85,72.25,24.361,85,"UCare Health, Inc.",Medical Assistance,42.8995,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FUROSEMIDE 10 MG/ML ORAL SOLN,,2836,LOCAL,Facility,Inpatient,120,mL,,85,72.25,24.361,85,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
FUROSEMIDE 10 MG/ML ORAL SOLN,,2836,LOCAL,Facility,Outpatient,120,mL,,85,72.25,24.361,85,"UCare Health, Inc.",Medicare Advantage,42.8995,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FUROSEMIDE 10 MG/ML ORAL SOLN,,2836,LOCAL,Facility,Inpatient,120,mL,,85,72.25,24.361,85,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
FUROSEMIDE 10 MG/ML ORAL SOLN,,2836,LOCAL,Facility,Outpatient,120,mL,,85,72.25,24.361,85,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),42.8995,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FUROSEMIDE 10 MG/ML ORAL SOLN,,2836,LOCAL,Facility,Inpatient,120,mL,,85,72.25,24.361,85,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
FUROSEMIDE 10 MG/ML ORAL SOLN,,2836,LOCAL,Facility,Both,120,mL,,85,72.25,24.361,85,UnitedHealthcare,Individual & Family,79.9,94,,percent of total billed charges,,
FUROSEMIDE 10 MG/ML ORAL SOLN,,2836,LOCAL,Facility,Outpatient,120,mL,,85,72.25,24.361,85,UnitedHealthcare,Medicare Advantage,41.65,49,,percent of total billed charges,,
FUROSEMIDE 10 MG/ML ORAL SOLN,,2836,LOCAL,Facility,Inpatient,120,mL,,85,72.25,24.361,85,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
FUROSEMIDE 10 MG/ML ORAL SOLN,,2836,LOCAL,Facility,Outpatient,120,mL,,85,72.25,24.361,85,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,40.8,48,,percent of total billed charges,,100% of DHS outpatient percentage
FUROSEMIDE 10 MG/ML ORAL SOLN,,2836,LOCAL,Facility,Inpatient,120,mL,,85,72.25,24.361,85,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Hospital Outpatient Clinic Visit Specimen Collection For Covid-19,,C9803,HCPCS,Facility,Outpatient,,,,41,34.85,11.7506,41,Aetna,Commercial,37.72,92,,percent of total billed charges,,
Hospital Outpatient Clinic Visit Specimen Collection For Covid-19,,C9803,HCPCS,Facility,Outpatient,,,,41,34.85,11.7506,41,Aetna,Medicare Advantage,20.09,49,,percent of total billed charges,,
Hospital Outpatient Clinic Visit Specimen Collection For Covid-19,,C9803,HCPCS,Facility,Outpatient,,,,41,34.85,11.7506,41,Aetna,PPO,38.13,93,,percent of total billed charges,,
Hospital Outpatient Clinic Visit Specimen Collection For Covid-19,,C9803,HCPCS,Facility,Outpatient,,,,41,34.85,11.7506,41,America's PPO,America's PPO,39.3723,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Hospital Outpatient Clinic Visit Specimen Collection For Covid-19,,C9803,HCPCS,Facility,Outpatient,,,,41,34.85,11.7506,41,BlueCross BlueShield Minnesota, Federal Employee Program,40.344,98.4,,percent of total billed charges,,
Hospital Outpatient Clinic Visit Specimen Collection For Covid-19,,C9803,HCPCS,Facility,Outpatient,,,,41,34.85,11.7506,41,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,41,100,,percent of total billed charges,,
Hospital Outpatient Clinic Visit Specimen Collection For Covid-19,,C9803,HCPCS,Facility,Outpatient,,,,41,34.85,11.7506,41,BlueCross BlueShield Minnesota,High Value Network Plan,36.9,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
Hospital Outpatient Clinic Visit Specimen Collection For Covid-19,,C9803,HCPCS,Facility,Outpatient,,,,41,34.85,11.7506,41,BlueCross BlueShield Minnesota,Medicare Advantage,20.09,49,,percent of total billed charges,,
Hospital Outpatient Clinic Visit Specimen Collection For Covid-19,,C9803,HCPCS,Facility,Outpatient,,,,41,34.85,11.7506,41,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,11.7506,28.66,,percent of total billed charges,,
Hospital Outpatient Clinic Visit Specimen Collection For Covid-19,,C9803,HCPCS,Facility,Outpatient,,,,41,34.85,11.7506,41,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),20.09,49,,percent of total billed charges,,
Hospital Outpatient Clinic Visit Specimen Collection For Covid-19,,C9803,HCPCS,Facility,Outpatient,,,,41,34.85,11.7506,41,CorVel,Worker's Compensation,41,100,,percent of total billed charges,,
Hospital Outpatient Clinic Visit Specimen Collection For Covid-19,,C9803,HCPCS,Facility,Outpatient,,,,41,34.85,11.7506,41,First Health Group Corporation,First Health Network,39.77,97,,percent of total billed charges,,
Hospital Outpatient Clinic Visit Specimen Collection For Covid-19,,C9803,HCPCS,Facility,Outpatient,,,,41,34.85,11.7506,41,"Health Partners, Inc.",Commercial,38.786,94.6,,percent of total billed charges,,
Hospital Outpatient Clinic Visit Specimen Collection For Covid-19,,C9803,HCPCS,Facility,Outpatient,,,,41,34.85,11.7506,41,"Health Partners, Inc.",Medicare Advantage,20.09,49,,percent of total billed charges,,
Hospital Outpatient Clinic Visit Specimen Collection For Covid-19,,C9803,HCPCS,Facility,Outpatient,,,,41,34.85,11.7506,41,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),24.6,60,,percent of total billed charges,,
Hospital Outpatient Clinic Visit Specimen Collection For Covid-19,,C9803,HCPCS,Facility,Outpatient,,,,41,34.85,11.7506,41,"Health Partners, Inc.",State of Minnesota Advantage Program,33.415,81.5,,percent of total billed charges,,
Hospital Outpatient Clinic Visit Specimen Collection For Covid-19,,C9803,HCPCS,Facility,Outpatient,,,,41,34.85,11.7506,41,"Health Partners, Inc.",State Public Programs,20.5,50,,percent of total billed charges,,
Hospital Outpatient Clinic Visit Specimen Collection For Covid-19,,C9803,HCPCS,Facility,Outpatient,,,,41,34.85,11.7506,41,Humana Insurance Company,Commercial PPO,38.95,95,,percent of total billed charges,,
Hospital Outpatient Clinic Visit Specimen Collection For Covid-19,,C9803,HCPCS,Facility,Outpatient,,,,41,34.85,11.7506,41,Humana Insurance Company,Medicare PPO,20.09,49,,percent of total billed charges,,
Hospital Outpatient Clinic Visit Specimen Collection For Covid-19,,C9803,HCPCS,Facility,Outpatient,,,,41,34.85,11.7506,41,Medica,Individual & Family,40.631,99.1,,percent of total billed charges,,
Hospital Outpatient Clinic Visit Specimen Collection For Covid-19,,C9803,HCPCS,Facility,Outpatient,,,,41,34.85,11.7506,41,Medica,Medica Advantage Solution,20.418,49.8,,percent of total billed charges,,
Hospital Outpatient Clinic Visit Specimen Collection For Covid-19,,C9803,HCPCS,Facility,Outpatient,,,,41,34.85,11.7506,41,Medica,Medical Assistance,18.286,44.6,,percent of total billed charges,,
Hospital Outpatient Clinic Visit Specimen Collection For Covid-19,,C9803,HCPCS,Facility,Outpatient,,,,41,34.85,11.7506,41,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,20.418,49.8,,percent of total billed charges,,
Hospital Outpatient Clinic Visit Specimen Collection For Covid-19,,C9803,HCPCS,Facility,Outpatient,,,,41,34.85,11.7506,41,"Multiplan, Inc.","Multiplan, Inc.",38.54,94,,percent of total billed charges,,
Hospital Outpatient Clinic Visit Specimen Collection For Covid-19,,C9803,HCPCS,Facility,Outpatient,,,,41,34.85,11.7506,41,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,35.424,86.4,,percent of total billed charges,,
Hospital Outpatient Clinic Visit Specimen Collection For Covid-19,,C9803,HCPCS,Facility,Outpatient,,,,41,34.85,11.7506,41,"Preferred One Administrative Services, INC.",PPO,40.426,98.6,,percent of total billed charges,,
Hospital Outpatient Clinic Visit Specimen Collection For Covid-19,,C9803,HCPCS,Facility,Outpatient,,,,41,34.85,11.7506,41,PrimeWest Health,Minnesota Senior Health Options (MSHO),21.0945,51.45,,percent of total billed charges,,
Hospital Outpatient Clinic Visit Specimen Collection For Covid-19,,C9803,HCPCS,Facility,Outpatient,,,,41,34.85,11.7506,41,PrimeWest Health,MinnesotaCare,21.0576,51.36,,percent of total billed charges,,
Hospital Outpatient Clinic Visit Specimen Collection For Covid-19,,C9803,HCPCS,Facility,Outpatient,,,,41,34.85,11.7506,41,Sanford Health Plan,Sanford Health Plan,37.72,92,,percent of total billed charges,,
Hospital Outpatient Clinic Visit Specimen Collection For Covid-19,,C9803,HCPCS,Facility,Outpatient,,,,41,34.85,11.7506,41,"UCare Health, Inc.",Individual & Family Plan,23.1035,56.35,,percent of total billed charges,,
Hospital Outpatient Clinic Visit Specimen Collection For Covid-19,,C9803,HCPCS,Facility,Outpatient,,,,41,34.85,11.7506,41,"UCare Health, Inc.",Medical Assistance,20.6927,50.47,,percent of total billed charges,,
Hospital Outpatient Clinic Visit Specimen Collection For Covid-19,,C9803,HCPCS,Facility,Outpatient,,,,41,34.85,11.7506,41,"UCare Health, Inc.",Medicare Advantage,20.6927,50.47,,percent of total billed charges,,
Hospital Outpatient Clinic Visit Specimen Collection For Covid-19,,C9803,HCPCS,Facility,Outpatient,,,,41,34.85,11.7506,41,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),20.6927,50.47,,percent of total billed charges,,
Hospital Outpatient Clinic Visit Specimen Collection For Covid-19,,C9803,HCPCS,Facility,Outpatient,,,,41,34.85,11.7506,41,UnitedHealthcare,Individual & Family,38.54,94,,percent of total billed charges,,
Hospital Outpatient Clinic Visit Specimen Collection For Covid-19,,C9803,HCPCS,Facility,Outpatient,,,,41,34.85,11.7506,41,UnitedHealthcare,Medicare Advantage,20.09,49,,percent of total billed charges,,
Hospital Outpatient Clinic Visit Specimen Collection For Covid-19,,C9803,HCPCS,Facility,Outpatient,,,,41,34.85,11.7506,41,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,19.68,48,,percent of total billed charges,,100% of DHS outpatient percentage
Sup Crutches,,E0114,HCPCS,Facility,Both,,,,61,51.85,17.4826,61,Aetna,Commercial,56.12,92,,percent of total billed charges,,
Sup Crutches,,E0114,HCPCS,Facility,Outpatient,,,,61,51.85,17.4826,61,Aetna,Medicare Advantage,29.89,49,,percent of total billed charges,,
Sup Crutches,,E0114,HCPCS,Facility,Inpatient,,,,61,51.85,17.4826,61,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Sup Crutches,,E0114,HCPCS,Facility,Both,,,,61,51.85,17.4826,61,Aetna,PPO,56.73,93,,percent of total billed charges,,
Sup Crutches,,E0114,HCPCS,Facility,Both,,,,61,51.85,17.4826,61,America's PPO,America's PPO,58.5783,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Sup Crutches,,E0114,HCPCS,Facility,Both,,,,61,51.85,17.4826,61,BlueCross BlueShield Minnesota, Federal Employee Program,60.024,98.4,,percent of total billed charges,,
Sup Crutches,,E0114,HCPCS,Facility,Both,,,,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,61,100,,percent of total billed charges,,
Sup Crutches,,E0114,HCPCS,Facility,Both,,,,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,High Value Network Plan,54.9,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
Sup Crutches,,E0114,HCPCS,Facility,Outpatient,,,,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,Medicare Advantage,29.89,49,,percent of total billed charges,,
Sup Crutches,,E0114,HCPCS,Facility,Inpatient,,,,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Sup Crutches,,E0114,HCPCS,Facility,Both,,,,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,54.0277,88.57,,percent of total billed charges,,
Sup Crutches,,E0114,HCPCS,Facility,Both,,,,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,17.4826,28.66,,percent of total billed charges,,
Sup Crutches,,E0114,HCPCS,Facility,Outpatient,,,,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),29.89,49,,percent of total billed charges,,
Sup Crutches,,E0114,HCPCS,Facility,Inpatient,,,,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Sup Crutches,,E0114,HCPCS,Facility,Both,,,,61,51.85,17.4826,61,CorVel,Worker's Compensation,61,100,,percent of total billed charges,,
Sup Crutches,,E0114,HCPCS,Facility,Both,,,,61,51.85,17.4826,61,First Health Group Corporation,First Health Network,59.17,97,,percent of total billed charges,,
Sup Crutches,,E0114,HCPCS,Facility,Both,,,,61,51.85,17.4826,61,"Health Partners, Inc.",Commercial,57.706,94.6,,percent of total billed charges,,
Sup Crutches,,E0114,HCPCS,Facility,Outpatient,,,,61,51.85,17.4826,61,"Health Partners, Inc.",Medicare Advantage,29.89,49,,percent of total billed charges,,
Sup Crutches,,E0114,HCPCS,Facility,Inpatient,,,,61,51.85,17.4826,61,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Crutches,,E0114,HCPCS,Facility,Both,,,,61,51.85,17.4826,61,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),36.6,60,,percent of total billed charges,,
Sup Crutches,,E0114,HCPCS,Facility,Both,,,,61,51.85,17.4826,61,"Health Partners, Inc.",State of Minnesota Advantage Program,49.715,81.5,,percent of total billed charges,,
Sup Crutches,,E0114,HCPCS,Facility,Both,,,,61,51.85,17.4826,61,"Health Partners, Inc.",State Public Programs,30.5,50,,percent of total billed charges,,
Sup Crutches,,E0114,HCPCS,Facility,Both,,,,61,51.85,17.4826,61,Humana Insurance Company,Commercial PPO,57.95,95,,percent of total billed charges,,
Sup Crutches,,E0114,HCPCS,Facility,Outpatient,,,,61,51.85,17.4826,61,Humana Insurance Company,Medicare PPO,29.89,49,,percent of total billed charges,,
Sup Crutches,,E0114,HCPCS,Facility,Inpatient,,,,61,51.85,17.4826,61,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Sup Crutches,,E0114,HCPCS,Facility,Both,,,,61,51.85,17.4826,61,Medica,Individual & Family,60.451,99.1,,percent of total billed charges,,
Sup Crutches,,E0114,HCPCS,Facility,Outpatient,,,,61,51.85,17.4826,61,Medica,Medica Advantage Solution,30.378,49.8,,percent of total billed charges,,
Sup Crutches,,E0114,HCPCS,Facility,Inpatient,,,,61,51.85,17.4826,61,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Sup Crutches,,E0114,HCPCS,Facility,Outpatient,,,,61,51.85,17.4826,61,Medica,Medical Assistance,27.206,44.6,,percent of total billed charges,,
Sup Crutches,,E0114,HCPCS,Facility,Inpatient,,,,61,51.85,17.4826,61,Medica,Medical Assistance,,,,,Included in per diem rate,
Sup Crutches,,E0114,HCPCS,Facility,Outpatient,,,,61,51.85,17.4826,61,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,30.378,49.8,,percent of total billed charges,,
Sup Crutches,,E0114,HCPCS,Facility,Inpatient,,,,61,51.85,17.4826,61,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Sup Crutches,,E0114,HCPCS,Facility,Both,,,,61,51.85,17.4826,61,"Multiplan, Inc.","Multiplan, Inc.",57.34,94,,percent of total billed charges,,
Sup Crutches,,E0114,HCPCS,Facility,Outpatient,,,,61,51.85,17.4826,61,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,54.961,90.1,,percent of total billed charges,,
Sup Crutches,,E0114,HCPCS,Facility,Inpatient,,,,61,51.85,17.4826,61,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Sup Crutches,,E0114,HCPCS,Facility,Both,,,,61,51.85,17.4826,61,"Preferred One Administrative Services, INC.",PPO,60.146,98.6,,percent of total billed charges,,
Sup Crutches,,E0114,HCPCS,Facility,Outpatient,,,,61,51.85,17.4826,61,PrimeWest Health,Minnesota Senior Health Options (MSHO),31.3845,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Sup Crutches,,E0114,HCPCS,Facility,Inpatient,,,,61,51.85,17.4826,61,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Crutches,,E0114,HCPCS,Facility,Outpatient,,,,61,51.85,17.4826,61,PrimeWest Health,MinnesotaCare,31.3296,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Sup Crutches,,E0114,HCPCS,Facility,Inpatient,,,,61,51.85,17.4826,61,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Sup Crutches,,E0114,HCPCS,Facility,Both,,,,61,51.85,17.4826,61,Sanford Health Plan,Sanford Health Plan,56.12,92,,percent of total billed charges,,
Sup Crutches,,E0114,HCPCS,Facility,Outpatient,,,,61,51.85,17.4826,61,"UCare Health, Inc.",Individual & Family Plan,34.3735,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Sup Crutches,,E0114,HCPCS,Facility,Inpatient,,,,61,51.85,17.4826,61,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Sup Crutches,,E0114,HCPCS,Facility,Outpatient,,,,61,51.85,17.4826,61,"UCare Health, Inc.",Medical Assistance,30.7867,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Crutches,,E0114,HCPCS,Facility,Inpatient,,,,61,51.85,17.4826,61,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Sup Crutches,,E0114,HCPCS,Facility,Outpatient,,,,61,51.85,17.4826,61,"UCare Health, Inc.",Medicare Advantage,30.7867,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Crutches,,E0114,HCPCS,Facility,Inpatient,,,,61,51.85,17.4826,61,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Crutches,,E0114,HCPCS,Facility,Outpatient,,,,61,51.85,17.4826,61,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),30.7867,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Crutches,,E0114,HCPCS,Facility,Inpatient,,,,61,51.85,17.4826,61,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Crutches,,E0114,HCPCS,Facility,Both,,,,61,51.85,17.4826,61,UnitedHealthcare,Individual & Family,57.34,94,,percent of total billed charges,,
Sup Crutches,,E0114,HCPCS,Facility,Outpatient,,,,61,51.85,17.4826,61,UnitedHealthcare,Medicare Advantage,29.89,49,,percent of total billed charges,,
Sup Crutches,,E0114,HCPCS,Facility,Inpatient,,,,61,51.85,17.4826,61,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Sup Crutches,,E0114,HCPCS,Facility,Outpatient,,,,61,51.85,17.4826,61,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,29.28,48,,percent of total billed charges,,100% of DHS outpatient percentage
Sup Crutches,,E0114,HCPCS,Facility,Inpatient,,,,61,51.85,17.4826,61,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Sup Foam Mattress Pad,,E0199,HCPCS,Facility,Both,,,,86,73.1,24.6476,86,Aetna,Commercial,79.12,92,,percent of total billed charges,,
Sup Foam Mattress Pad,,E0199,HCPCS,Facility,Outpatient,,,,86,73.1,24.6476,86,Aetna,Medicare Advantage,42.14,49,,percent of total billed charges,,
Sup Foam Mattress Pad,,E0199,HCPCS,Facility,Inpatient,,,,86,73.1,24.6476,86,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Sup Foam Mattress Pad,,E0199,HCPCS,Facility,Both,,,,86,73.1,24.6476,86,Aetna,PPO,79.98,93,,percent of total billed charges,,
Sup Foam Mattress Pad,,E0199,HCPCS,Facility,Both,,,,86,73.1,24.6476,86,America's PPO,America's PPO,82.5858,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Sup Foam Mattress Pad,,E0199,HCPCS,Facility,Both,,,,86,73.1,24.6476,86,BlueCross BlueShield Minnesota, Federal Employee Program,84.624,98.4,,percent of total billed charges,,
Sup Foam Mattress Pad,,E0199,HCPCS,Facility,Both,,,,86,73.1,24.6476,86,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,86,100,,percent of total billed charges,,
Sup Foam Mattress Pad,,E0199,HCPCS,Facility,Both,,,,86,73.1,24.6476,86,BlueCross BlueShield Minnesota,High Value Network Plan,77.4,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
Sup Foam Mattress Pad,,E0199,HCPCS,Facility,Outpatient,,,,86,73.1,24.6476,86,BlueCross BlueShield Minnesota,Medicare Advantage,42.14,49,,percent of total billed charges,,
Sup Foam Mattress Pad,,E0199,HCPCS,Facility,Inpatient,,,,86,73.1,24.6476,86,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Sup Foam Mattress Pad,,E0199,HCPCS,Facility,Both,,,,86,73.1,24.6476,86,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,76.1702,88.57,,percent of total billed charges,,
Sup Foam Mattress Pad,,E0199,HCPCS,Facility,Both,,,,86,73.1,24.6476,86,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,24.6476,28.66,,percent of total billed charges,,
Sup Foam Mattress Pad,,E0199,HCPCS,Facility,Outpatient,,,,86,73.1,24.6476,86,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),42.14,49,,percent of total billed charges,,
Sup Foam Mattress Pad,,E0199,HCPCS,Facility,Inpatient,,,,86,73.1,24.6476,86,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Sup Foam Mattress Pad,,E0199,HCPCS,Facility,Both,,,,86,73.1,24.6476,86,CorVel,Worker's Compensation,86,100,,percent of total billed charges,,
Sup Foam Mattress Pad,,E0199,HCPCS,Facility,Both,,,,86,73.1,24.6476,86,First Health Group Corporation,First Health Network,83.42,97,,percent of total billed charges,,
Sup Foam Mattress Pad,,E0199,HCPCS,Facility,Both,,,,86,73.1,24.6476,86,"Health Partners, Inc.",Commercial,81.356,94.6,,percent of total billed charges,,
Sup Foam Mattress Pad,,E0199,HCPCS,Facility,Outpatient,,,,86,73.1,24.6476,86,"Health Partners, Inc.",Medicare Advantage,42.14,49,,percent of total billed charges,,
Sup Foam Mattress Pad,,E0199,HCPCS,Facility,Inpatient,,,,86,73.1,24.6476,86,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Foam Mattress Pad,,E0199,HCPCS,Facility,Both,,,,86,73.1,24.6476,86,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),51.6,60,,percent of total billed charges,,
Sup Foam Mattress Pad,,E0199,HCPCS,Facility,Both,,,,86,73.1,24.6476,86,"Health Partners, Inc.",State of Minnesota Advantage Program,70.09,81.5,,percent of total billed charges,,
Sup Foam Mattress Pad,,E0199,HCPCS,Facility,Both,,,,86,73.1,24.6476,86,"Health Partners, Inc.",State Public Programs,43,50,,percent of total billed charges,,
Sup Foam Mattress Pad,,E0199,HCPCS,Facility,Both,,,,86,73.1,24.6476,86,Humana Insurance Company,Commercial PPO,81.7,95,,percent of total billed charges,,
Sup Foam Mattress Pad,,E0199,HCPCS,Facility,Outpatient,,,,86,73.1,24.6476,86,Humana Insurance Company,Medicare PPO,42.14,49,,percent of total billed charges,,
Sup Foam Mattress Pad,,E0199,HCPCS,Facility,Inpatient,,,,86,73.1,24.6476,86,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Sup Foam Mattress Pad,,E0199,HCPCS,Facility,Both,,,,86,73.1,24.6476,86,Medica,Individual & Family,85.226,99.1,,percent of total billed charges,,
Sup Foam Mattress Pad,,E0199,HCPCS,Facility,Outpatient,,,,86,73.1,24.6476,86,Medica,Medica Advantage Solution,42.828,49.8,,percent of total billed charges,,
Sup Foam Mattress Pad,,E0199,HCPCS,Facility,Inpatient,,,,86,73.1,24.6476,86,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Sup Foam Mattress Pad,,E0199,HCPCS,Facility,Outpatient,,,,86,73.1,24.6476,86,Medica,Medical Assistance,38.356,44.6,,percent of total billed charges,,
Sup Foam Mattress Pad,,E0199,HCPCS,Facility,Inpatient,,,,86,73.1,24.6476,86,Medica,Medical Assistance,,,,,Included in per diem rate,
Sup Foam Mattress Pad,,E0199,HCPCS,Facility,Outpatient,,,,86,73.1,24.6476,86,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,42.828,49.8,,percent of total billed charges,,
Sup Foam Mattress Pad,,E0199,HCPCS,Facility,Inpatient,,,,86,73.1,24.6476,86,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Sup Foam Mattress Pad,,E0199,HCPCS,Facility,Both,,,,86,73.1,24.6476,86,"Multiplan, Inc.","Multiplan, Inc.",80.84,94,,percent of total billed charges,,
Sup Foam Mattress Pad,,E0199,HCPCS,Facility,Outpatient,,,,86,73.1,24.6476,86,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,77.486,90.1,,percent of total billed charges,,
Sup Foam Mattress Pad,,E0199,HCPCS,Facility,Inpatient,,,,86,73.1,24.6476,86,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Sup Foam Mattress Pad,,E0199,HCPCS,Facility,Both,,,,86,73.1,24.6476,86,"Preferred One Administrative Services, INC.",PPO,84.796,98.6,,percent of total billed charges,,
Sup Foam Mattress Pad,,E0199,HCPCS,Facility,Outpatient,,,,86,73.1,24.6476,86,PrimeWest Health,Minnesota Senior Health Options (MSHO),44.247,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Sup Foam Mattress Pad,,E0199,HCPCS,Facility,Inpatient,,,,86,73.1,24.6476,86,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Foam Mattress Pad,,E0199,HCPCS,Facility,Outpatient,,,,86,73.1,24.6476,86,PrimeWest Health,MinnesotaCare,44.1696,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Sup Foam Mattress Pad,,E0199,HCPCS,Facility,Inpatient,,,,86,73.1,24.6476,86,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Sup Foam Mattress Pad,,E0199,HCPCS,Facility,Both,,,,86,73.1,24.6476,86,Sanford Health Plan,Sanford Health Plan,79.12,92,,percent of total billed charges,,
Sup Foam Mattress Pad,,E0199,HCPCS,Facility,Outpatient,,,,86,73.1,24.6476,86,"UCare Health, Inc.",Individual & Family Plan,48.461,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Sup Foam Mattress Pad,,E0199,HCPCS,Facility,Inpatient,,,,86,73.1,24.6476,86,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Sup Foam Mattress Pad,,E0199,HCPCS,Facility,Outpatient,,,,86,73.1,24.6476,86,"UCare Health, Inc.",Medical Assistance,43.4042,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Foam Mattress Pad,,E0199,HCPCS,Facility,Inpatient,,,,86,73.1,24.6476,86,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Sup Foam Mattress Pad,,E0199,HCPCS,Facility,Outpatient,,,,86,73.1,24.6476,86,"UCare Health, Inc.",Medicare Advantage,43.4042,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Foam Mattress Pad,,E0199,HCPCS,Facility,Inpatient,,,,86,73.1,24.6476,86,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Foam Mattress Pad,,E0199,HCPCS,Facility,Outpatient,,,,86,73.1,24.6476,86,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),43.4042,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Foam Mattress Pad,,E0199,HCPCS,Facility,Inpatient,,,,86,73.1,24.6476,86,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Foam Mattress Pad,,E0199,HCPCS,Facility,Both,,,,86,73.1,24.6476,86,UnitedHealthcare,Individual & Family,80.84,94,,percent of total billed charges,,
Sup Foam Mattress Pad,,E0199,HCPCS,Facility,Outpatient,,,,86,73.1,24.6476,86,UnitedHealthcare,Medicare Advantage,42.14,49,,percent of total billed charges,,
Sup Foam Mattress Pad,,E0199,HCPCS,Facility,Inpatient,,,,86,73.1,24.6476,86,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Sup Foam Mattress Pad,,E0199,HCPCS,Facility,Outpatient,,,,86,73.1,24.6476,86,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,41.28,48,,percent of total billed charges,,100% of DHS outpatient percentage
Sup Foam Mattress Pad,,E0199,HCPCS,Facility,Inpatient,,,,86,73.1,24.6476,86,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Sup Duo Therm Pad,,E0217,HCPCS,Facility,Both,,,,27,22.95,7.7382,27,Aetna,Commercial,24.84,92,,percent of total billed charges,,
Sup Duo Therm Pad,,E0217,HCPCS,Facility,Outpatient,,,,27,22.95,7.7382,27,Aetna,Medicare Advantage,13.23,49,,percent of total billed charges,,
Sup Duo Therm Pad,,E0217,HCPCS,Facility,Inpatient,,,,27,22.95,7.7382,27,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Sup Duo Therm Pad,,E0217,HCPCS,Facility,Both,,,,27,22.95,7.7382,27,Aetna,PPO,25.11,93,,percent of total billed charges,,
Sup Duo Therm Pad,,E0217,HCPCS,Facility,Both,,,,27,22.95,7.7382,27,America's PPO,America's PPO,25.9281,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Sup Duo Therm Pad,,E0217,HCPCS,Facility,Both,,,,27,22.95,7.7382,27,BlueCross BlueShield Minnesota, Federal Employee Program,26.568,98.4,,percent of total billed charges,,
Sup Duo Therm Pad,,E0217,HCPCS,Facility,Both,,,,27,22.95,7.7382,27,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,27,100,,percent of total billed charges,,
Sup Duo Therm Pad,,E0217,HCPCS,Facility,Both,,,,27,22.95,7.7382,27,BlueCross BlueShield Minnesota,High Value Network Plan,24.3,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
Sup Duo Therm Pad,,E0217,HCPCS,Facility,Outpatient,,,,27,22.95,7.7382,27,BlueCross BlueShield Minnesota,Medicare Advantage,13.23,49,,percent of total billed charges,,
Sup Duo Therm Pad,,E0217,HCPCS,Facility,Inpatient,,,,27,22.95,7.7382,27,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Sup Duo Therm Pad,,E0217,HCPCS,Facility,Both,,,,27,22.95,7.7382,27,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,23.9139,88.57,,percent of total billed charges,,
Sup Duo Therm Pad,,E0217,HCPCS,Facility,Both,,,,27,22.95,7.7382,27,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,7.7382,28.66,,percent of total billed charges,,
Sup Duo Therm Pad,,E0217,HCPCS,Facility,Outpatient,,,,27,22.95,7.7382,27,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),13.23,49,,percent of total billed charges,,
Sup Duo Therm Pad,,E0217,HCPCS,Facility,Inpatient,,,,27,22.95,7.7382,27,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Sup Duo Therm Pad,,E0217,HCPCS,Facility,Both,,,,27,22.95,7.7382,27,CorVel,Worker's Compensation,27,100,,percent of total billed charges,,
Sup Duo Therm Pad,,E0217,HCPCS,Facility,Both,,,,27,22.95,7.7382,27,First Health Group Corporation,First Health Network,26.19,97,,percent of total billed charges,,
Sup Duo Therm Pad,,E0217,HCPCS,Facility,Both,,,,27,22.95,7.7382,27,"Health Partners, Inc.",Commercial,25.542,94.6,,percent of total billed charges,,
Sup Duo Therm Pad,,E0217,HCPCS,Facility,Outpatient,,,,27,22.95,7.7382,27,"Health Partners, Inc.",Medicare Advantage,13.23,49,,percent of total billed charges,,
Sup Duo Therm Pad,,E0217,HCPCS,Facility,Inpatient,,,,27,22.95,7.7382,27,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Duo Therm Pad,,E0217,HCPCS,Facility,Both,,,,27,22.95,7.7382,27,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),16.2,60,,percent of total billed charges,,
Sup Duo Therm Pad,,E0217,HCPCS,Facility,Both,,,,27,22.95,7.7382,27,"Health Partners, Inc.",State of Minnesota Advantage Program,22.005,81.5,,percent of total billed charges,,
Sup Duo Therm Pad,,E0217,HCPCS,Facility,Both,,,,27,22.95,7.7382,27,"Health Partners, Inc.",State Public Programs,13.5,50,,percent of total billed charges,,
Sup Duo Therm Pad,,E0217,HCPCS,Facility,Both,,,,27,22.95,7.7382,27,Humana Insurance Company,Commercial PPO,25.65,95,,percent of total billed charges,,
Sup Duo Therm Pad,,E0217,HCPCS,Facility,Outpatient,,,,27,22.95,7.7382,27,Humana Insurance Company,Medicare PPO,13.23,49,,percent of total billed charges,,
Sup Duo Therm Pad,,E0217,HCPCS,Facility,Inpatient,,,,27,22.95,7.7382,27,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Sup Duo Therm Pad,,E0217,HCPCS,Facility,Both,,,,27,22.95,7.7382,27,Medica,Individual & Family,26.757,99.1,,percent of total billed charges,,
Sup Duo Therm Pad,,E0217,HCPCS,Facility,Outpatient,,,,27,22.95,7.7382,27,Medica,Medica Advantage Solution,13.446,49.8,,percent of total billed charges,,
Sup Duo Therm Pad,,E0217,HCPCS,Facility,Inpatient,,,,27,22.95,7.7382,27,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Sup Duo Therm Pad,,E0217,HCPCS,Facility,Outpatient,,,,27,22.95,7.7382,27,Medica,Medical Assistance,12.042,44.6,,percent of total billed charges,,
Sup Duo Therm Pad,,E0217,HCPCS,Facility,Inpatient,,,,27,22.95,7.7382,27,Medica,Medical Assistance,,,,,Included in per diem rate,
Sup Duo Therm Pad,,E0217,HCPCS,Facility,Outpatient,,,,27,22.95,7.7382,27,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,13.446,49.8,,percent of total billed charges,,
Sup Duo Therm Pad,,E0217,HCPCS,Facility,Inpatient,,,,27,22.95,7.7382,27,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Sup Duo Therm Pad,,E0217,HCPCS,Facility,Both,,,,27,22.95,7.7382,27,"Multiplan, Inc.","Multiplan, Inc.",25.38,94,,percent of total billed charges,,
Sup Duo Therm Pad,,E0217,HCPCS,Facility,Outpatient,,,,27,22.95,7.7382,27,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,24.327,90.1,,percent of total billed charges,,
Sup Duo Therm Pad,,E0217,HCPCS,Facility,Inpatient,,,,27,22.95,7.7382,27,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Sup Duo Therm Pad,,E0217,HCPCS,Facility,Both,,,,27,22.95,7.7382,27,"Preferred One Administrative Services, INC.",PPO,26.622,98.6,,percent of total billed charges,,
Sup Duo Therm Pad,,E0217,HCPCS,Facility,Outpatient,,,,27,22.95,7.7382,27,PrimeWest Health,Minnesota Senior Health Options (MSHO),13.8915,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Sup Duo Therm Pad,,E0217,HCPCS,Facility,Inpatient,,,,27,22.95,7.7382,27,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Duo Therm Pad,,E0217,HCPCS,Facility,Outpatient,,,,27,22.95,7.7382,27,PrimeWest Health,MinnesotaCare,13.8672,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Sup Duo Therm Pad,,E0217,HCPCS,Facility,Inpatient,,,,27,22.95,7.7382,27,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Sup Duo Therm Pad,,E0217,HCPCS,Facility,Both,,,,27,22.95,7.7382,27,Sanford Health Plan,Sanford Health Plan,24.84,92,,percent of total billed charges,,
Sup Duo Therm Pad,,E0217,HCPCS,Facility,Outpatient,,,,27,22.95,7.7382,27,"UCare Health, Inc.",Individual & Family Plan,15.2145,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Sup Duo Therm Pad,,E0217,HCPCS,Facility,Inpatient,,,,27,22.95,7.7382,27,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Sup Duo Therm Pad,,E0217,HCPCS,Facility,Outpatient,,,,27,22.95,7.7382,27,"UCare Health, Inc.",Medical Assistance,13.6269,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Duo Therm Pad,,E0217,HCPCS,Facility,Inpatient,,,,27,22.95,7.7382,27,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Sup Duo Therm Pad,,E0217,HCPCS,Facility,Outpatient,,,,27,22.95,7.7382,27,"UCare Health, Inc.",Medicare Advantage,13.6269,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Duo Therm Pad,,E0217,HCPCS,Facility,Inpatient,,,,27,22.95,7.7382,27,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Duo Therm Pad,,E0217,HCPCS,Facility,Outpatient,,,,27,22.95,7.7382,27,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),13.6269,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Duo Therm Pad,,E0217,HCPCS,Facility,Inpatient,,,,27,22.95,7.7382,27,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Duo Therm Pad,,E0217,HCPCS,Facility,Both,,,,27,22.95,7.7382,27,UnitedHealthcare,Individual & Family,25.38,94,,percent of total billed charges,,
Sup Duo Therm Pad,,E0217,HCPCS,Facility,Outpatient,,,,27,22.95,7.7382,27,UnitedHealthcare,Medicare Advantage,13.23,49,,percent of total billed charges,,
Sup Duo Therm Pad,,E0217,HCPCS,Facility,Inpatient,,,,27,22.95,7.7382,27,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Sup Duo Therm Pad,,E0217,HCPCS,Facility,Outpatient,,,,27,22.95,7.7382,27,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,12.96,48,,percent of total billed charges,,100% of DHS outpatient percentage
Sup Duo Therm Pad,,E0217,HCPCS,Facility,Inpatient,,,,27,22.95,7.7382,27,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Sup Foam Mattress Pad,,E0272,HCPCS,Facility,Both,,,,86,73.1,24.6476,86,Aetna,Commercial,79.12,92,,percent of total billed charges,,
Sup Foam Mattress Pad,,E0272,HCPCS,Facility,Outpatient,,,,86,73.1,24.6476,86,Aetna,Medicare Advantage,42.14,49,,percent of total billed charges,,
Sup Foam Mattress Pad,,E0272,HCPCS,Facility,Inpatient,,,,86,73.1,24.6476,86,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Sup Foam Mattress Pad,,E0272,HCPCS,Facility,Both,,,,86,73.1,24.6476,86,Aetna,PPO,79.98,93,,percent of total billed charges,,
Sup Foam Mattress Pad,,E0272,HCPCS,Facility,Both,,,,86,73.1,24.6476,86,America's PPO,America's PPO,82.5858,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Sup Foam Mattress Pad,,E0272,HCPCS,Facility,Both,,,,86,73.1,24.6476,86,BlueCross BlueShield Minnesota, Federal Employee Program,84.624,98.4,,percent of total billed charges,,
Sup Foam Mattress Pad,,E0272,HCPCS,Facility,Both,,,,86,73.1,24.6476,86,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,86,100,,percent of total billed charges,,
Sup Foam Mattress Pad,,E0272,HCPCS,Facility,Both,,,,86,73.1,24.6476,86,BlueCross BlueShield Minnesota,High Value Network Plan,77.4,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
Sup Foam Mattress Pad,,E0272,HCPCS,Facility,Outpatient,,,,86,73.1,24.6476,86,BlueCross BlueShield Minnesota,Medicare Advantage,42.14,49,,percent of total billed charges,,
Sup Foam Mattress Pad,,E0272,HCPCS,Facility,Inpatient,,,,86,73.1,24.6476,86,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Sup Foam Mattress Pad,,E0272,HCPCS,Facility,Both,,,,86,73.1,24.6476,86,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,76.1702,88.57,,percent of total billed charges,,
Sup Foam Mattress Pad,,E0272,HCPCS,Facility,Both,,,,86,73.1,24.6476,86,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,24.6476,28.66,,percent of total billed charges,,
Sup Foam Mattress Pad,,E0272,HCPCS,Facility,Outpatient,,,,86,73.1,24.6476,86,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),42.14,49,,percent of total billed charges,,
Sup Foam Mattress Pad,,E0272,HCPCS,Facility,Inpatient,,,,86,73.1,24.6476,86,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Sup Foam Mattress Pad,,E0272,HCPCS,Facility,Both,,,,86,73.1,24.6476,86,CorVel,Worker's Compensation,86,100,,percent of total billed charges,,
Sup Foam Mattress Pad,,E0272,HCPCS,Facility,Both,,,,86,73.1,24.6476,86,First Health Group Corporation,First Health Network,83.42,97,,percent of total billed charges,,
Sup Foam Mattress Pad,,E0272,HCPCS,Facility,Both,,,,86,73.1,24.6476,86,"Health Partners, Inc.",Commercial,81.356,94.6,,percent of total billed charges,,
Sup Foam Mattress Pad,,E0272,HCPCS,Facility,Outpatient,,,,86,73.1,24.6476,86,"Health Partners, Inc.",Medicare Advantage,42.14,49,,percent of total billed charges,,
Sup Foam Mattress Pad,,E0272,HCPCS,Facility,Inpatient,,,,86,73.1,24.6476,86,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Foam Mattress Pad,,E0272,HCPCS,Facility,Both,,,,86,73.1,24.6476,86,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),51.6,60,,percent of total billed charges,,
Sup Foam Mattress Pad,,E0272,HCPCS,Facility,Both,,,,86,73.1,24.6476,86,"Health Partners, Inc.",State of Minnesota Advantage Program,70.09,81.5,,percent of total billed charges,,
Sup Foam Mattress Pad,,E0272,HCPCS,Facility,Both,,,,86,73.1,24.6476,86,"Health Partners, Inc.",State Public Programs,43,50,,percent of total billed charges,,
Sup Foam Mattress Pad,,E0272,HCPCS,Facility,Both,,,,86,73.1,24.6476,86,Humana Insurance Company,Commercial PPO,81.7,95,,percent of total billed charges,,
Sup Foam Mattress Pad,,E0272,HCPCS,Facility,Outpatient,,,,86,73.1,24.6476,86,Humana Insurance Company,Medicare PPO,42.14,49,,percent of total billed charges,,
Sup Foam Mattress Pad,,E0272,HCPCS,Facility,Inpatient,,,,86,73.1,24.6476,86,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Sup Foam Mattress Pad,,E0272,HCPCS,Facility,Both,,,,86,73.1,24.6476,86,Medica,Individual & Family,85.226,99.1,,percent of total billed charges,,
Sup Foam Mattress Pad,,E0272,HCPCS,Facility,Outpatient,,,,86,73.1,24.6476,86,Medica,Medica Advantage Solution,42.828,49.8,,percent of total billed charges,,
Sup Foam Mattress Pad,,E0272,HCPCS,Facility,Inpatient,,,,86,73.1,24.6476,86,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Sup Foam Mattress Pad,,E0272,HCPCS,Facility,Outpatient,,,,86,73.1,24.6476,86,Medica,Medical Assistance,38.356,44.6,,percent of total billed charges,,
Sup Foam Mattress Pad,,E0272,HCPCS,Facility,Inpatient,,,,86,73.1,24.6476,86,Medica,Medical Assistance,,,,,Included in per diem rate,
Sup Foam Mattress Pad,,E0272,HCPCS,Facility,Outpatient,,,,86,73.1,24.6476,86,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,42.828,49.8,,percent of total billed charges,,
Sup Foam Mattress Pad,,E0272,HCPCS,Facility,Inpatient,,,,86,73.1,24.6476,86,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Sup Foam Mattress Pad,,E0272,HCPCS,Facility,Both,,,,86,73.1,24.6476,86,"Multiplan, Inc.","Multiplan, Inc.",80.84,94,,percent of total billed charges,,
Sup Foam Mattress Pad,,E0272,HCPCS,Facility,Outpatient,,,,86,73.1,24.6476,86,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,77.486,90.1,,percent of total billed charges,,
Sup Foam Mattress Pad,,E0272,HCPCS,Facility,Inpatient,,,,86,73.1,24.6476,86,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Sup Foam Mattress Pad,,E0272,HCPCS,Facility,Both,,,,86,73.1,24.6476,86,"Preferred One Administrative Services, INC.",PPO,84.796,98.6,,percent of total billed charges,,
Sup Foam Mattress Pad,,E0272,HCPCS,Facility,Outpatient,,,,86,73.1,24.6476,86,PrimeWest Health,Minnesota Senior Health Options (MSHO),44.247,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Sup Foam Mattress Pad,,E0272,HCPCS,Facility,Inpatient,,,,86,73.1,24.6476,86,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Foam Mattress Pad,,E0272,HCPCS,Facility,Outpatient,,,,86,73.1,24.6476,86,PrimeWest Health,MinnesotaCare,44.1696,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Sup Foam Mattress Pad,,E0272,HCPCS,Facility,Inpatient,,,,86,73.1,24.6476,86,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Sup Foam Mattress Pad,,E0272,HCPCS,Facility,Both,,,,86,73.1,24.6476,86,Sanford Health Plan,Sanford Health Plan,79.12,92,,percent of total billed charges,,
Sup Foam Mattress Pad,,E0272,HCPCS,Facility,Outpatient,,,,86,73.1,24.6476,86,"UCare Health, Inc.",Individual & Family Plan,48.461,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Sup Foam Mattress Pad,,E0272,HCPCS,Facility,Inpatient,,,,86,73.1,24.6476,86,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Sup Foam Mattress Pad,,E0272,HCPCS,Facility,Outpatient,,,,86,73.1,24.6476,86,"UCare Health, Inc.",Medical Assistance,43.4042,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Foam Mattress Pad,,E0272,HCPCS,Facility,Inpatient,,,,86,73.1,24.6476,86,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Sup Foam Mattress Pad,,E0272,HCPCS,Facility,Outpatient,,,,86,73.1,24.6476,86,"UCare Health, Inc.",Medicare Advantage,43.4042,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Foam Mattress Pad,,E0272,HCPCS,Facility,Inpatient,,,,86,73.1,24.6476,86,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Foam Mattress Pad,,E0272,HCPCS,Facility,Outpatient,,,,86,73.1,24.6476,86,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),43.4042,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Foam Mattress Pad,,E0272,HCPCS,Facility,Inpatient,,,,86,73.1,24.6476,86,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Foam Mattress Pad,,E0272,HCPCS,Facility,Both,,,,86,73.1,24.6476,86,UnitedHealthcare,Individual & Family,80.84,94,,percent of total billed charges,,
Sup Foam Mattress Pad,,E0272,HCPCS,Facility,Outpatient,,,,86,73.1,24.6476,86,UnitedHealthcare,Medicare Advantage,42.14,49,,percent of total billed charges,,
Sup Foam Mattress Pad,,E0272,HCPCS,Facility,Inpatient,,,,86,73.1,24.6476,86,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Sup Foam Mattress Pad,,E0272,HCPCS,Facility,Outpatient,,,,86,73.1,24.6476,86,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,41.28,48,,percent of total billed charges,,100% of DHS outpatient percentage
Sup Foam Mattress Pad,,E0272,HCPCS,Facility,Inpatient,,,,86,73.1,24.6476,86,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Sup Endotracheal Tube,,E0485,HCPCS,Facility,Both,,,,71,60.35,20.3486,71,Aetna,Commercial,65.32,92,,percent of total billed charges,,
Sup Endotracheal Tube,,E0485,HCPCS,Facility,Outpatient,,,,71,60.35,20.3486,71,Aetna,Medicare Advantage,34.79,49,,percent of total billed charges,,
Sup Endotracheal Tube,,E0485,HCPCS,Facility,Inpatient,,,,71,60.35,20.3486,71,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Sup Endotracheal Tube,,E0485,HCPCS,Facility,Both,,,,71,60.35,20.3486,71,Aetna,PPO,66.03,93,,percent of total billed charges,,
Sup Endotracheal Tube,,E0485,HCPCS,Facility,Both,,,,71,60.35,20.3486,71,America's PPO,America's PPO,68.1813,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Sup Endotracheal Tube,,E0485,HCPCS,Facility,Both,,,,71,60.35,20.3486,71,BlueCross BlueShield Minnesota, Federal Employee Program,69.864,98.4,,percent of total billed charges,,
Sup Endotracheal Tube,,E0485,HCPCS,Facility,Both,,,,71,60.35,20.3486,71,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,71,100,,percent of total billed charges,,
Sup Endotracheal Tube,,E0485,HCPCS,Facility,Both,,,,71,60.35,20.3486,71,BlueCross BlueShield Minnesota,High Value Network Plan,63.9,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
Sup Endotracheal Tube,,E0485,HCPCS,Facility,Outpatient,,,,71,60.35,20.3486,71,BlueCross BlueShield Minnesota,Medicare Advantage,34.79,49,,percent of total billed charges,,
Sup Endotracheal Tube,,E0485,HCPCS,Facility,Inpatient,,,,71,60.35,20.3486,71,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Sup Endotracheal Tube,,E0485,HCPCS,Facility,Both,,,,71,60.35,20.3486,71,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,62.8847,88.57,,percent of total billed charges,,
Sup Endotracheal Tube,,E0485,HCPCS,Facility,Both,,,,71,60.35,20.3486,71,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,20.3486,28.66,,percent of total billed charges,,
Sup Endotracheal Tube,,E0485,HCPCS,Facility,Outpatient,,,,71,60.35,20.3486,71,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),34.79,49,,percent of total billed charges,,
Sup Endotracheal Tube,,E0485,HCPCS,Facility,Inpatient,,,,71,60.35,20.3486,71,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Sup Endotracheal Tube,,E0485,HCPCS,Facility,Both,,,,71,60.35,20.3486,71,CorVel,Worker's Compensation,71,100,,percent of total billed charges,,
Sup Endotracheal Tube,,E0485,HCPCS,Facility,Both,,,,71,60.35,20.3486,71,First Health Group Corporation,First Health Network,68.87,97,,percent of total billed charges,,
Sup Endotracheal Tube,,E0485,HCPCS,Facility,Both,,,,71,60.35,20.3486,71,"Health Partners, Inc.",Commercial,67.166,94.6,,percent of total billed charges,,
Sup Endotracheal Tube,,E0485,HCPCS,Facility,Outpatient,,,,71,60.35,20.3486,71,"Health Partners, Inc.",Medicare Advantage,34.79,49,,percent of total billed charges,,
Sup Endotracheal Tube,,E0485,HCPCS,Facility,Inpatient,,,,71,60.35,20.3486,71,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Endotracheal Tube,,E0485,HCPCS,Facility,Both,,,,71,60.35,20.3486,71,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),42.6,60,,percent of total billed charges,,
Sup Endotracheal Tube,,E0485,HCPCS,Facility,Both,,,,71,60.35,20.3486,71,"Health Partners, Inc.",State of Minnesota Advantage Program,57.865,81.5,,percent of total billed charges,,
Sup Endotracheal Tube,,E0485,HCPCS,Facility,Both,,,,71,60.35,20.3486,71,"Health Partners, Inc.",State Public Programs,35.5,50,,percent of total billed charges,,
Sup Endotracheal Tube,,E0485,HCPCS,Facility,Both,,,,71,60.35,20.3486,71,Humana Insurance Company,Commercial PPO,67.45,95,,percent of total billed charges,,
Sup Endotracheal Tube,,E0485,HCPCS,Facility,Outpatient,,,,71,60.35,20.3486,71,Humana Insurance Company,Medicare PPO,34.79,49,,percent of total billed charges,,
Sup Endotracheal Tube,,E0485,HCPCS,Facility,Inpatient,,,,71,60.35,20.3486,71,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Sup Endotracheal Tube,,E0485,HCPCS,Facility,Both,,,,71,60.35,20.3486,71,Medica,Individual & Family,70.361,99.1,,percent of total billed charges,,
Sup Endotracheal Tube,,E0485,HCPCS,Facility,Outpatient,,,,71,60.35,20.3486,71,Medica,Medica Advantage Solution,35.358,49.8,,percent of total billed charges,,
Sup Endotracheal Tube,,E0485,HCPCS,Facility,Inpatient,,,,71,60.35,20.3486,71,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Sup Endotracheal Tube,,E0485,HCPCS,Facility,Outpatient,,,,71,60.35,20.3486,71,Medica,Medical Assistance,31.666,44.6,,percent of total billed charges,,
Sup Endotracheal Tube,,E0485,HCPCS,Facility,Inpatient,,,,71,60.35,20.3486,71,Medica,Medical Assistance,,,,,Included in per diem rate,
Sup Endotracheal Tube,,E0485,HCPCS,Facility,Outpatient,,,,71,60.35,20.3486,71,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,35.358,49.8,,percent of total billed charges,,
Sup Endotracheal Tube,,E0485,HCPCS,Facility,Inpatient,,,,71,60.35,20.3486,71,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Sup Endotracheal Tube,,E0485,HCPCS,Facility,Both,,,,71,60.35,20.3486,71,"Multiplan, Inc.","Multiplan, Inc.",66.74,94,,percent of total billed charges,,
Sup Endotracheal Tube,,E0485,HCPCS,Facility,Outpatient,,,,71,60.35,20.3486,71,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,63.971,90.1,,percent of total billed charges,,
Sup Endotracheal Tube,,E0485,HCPCS,Facility,Inpatient,,,,71,60.35,20.3486,71,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Sup Endotracheal Tube,,E0485,HCPCS,Facility,Both,,,,71,60.35,20.3486,71,"Preferred One Administrative Services, INC.",PPO,70.006,98.6,,percent of total billed charges,,
Sup Endotracheal Tube,,E0485,HCPCS,Facility,Outpatient,,,,71,60.35,20.3486,71,PrimeWest Health,Minnesota Senior Health Options (MSHO),36.5295,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Sup Endotracheal Tube,,E0485,HCPCS,Facility,Inpatient,,,,71,60.35,20.3486,71,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Endotracheal Tube,,E0485,HCPCS,Facility,Outpatient,,,,71,60.35,20.3486,71,PrimeWest Health,MinnesotaCare,36.4656,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Sup Endotracheal Tube,,E0485,HCPCS,Facility,Inpatient,,,,71,60.35,20.3486,71,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Sup Endotracheal Tube,,E0485,HCPCS,Facility,Both,,,,71,60.35,20.3486,71,Sanford Health Plan,Sanford Health Plan,65.32,92,,percent of total billed charges,,
Sup Endotracheal Tube,,E0485,HCPCS,Facility,Outpatient,,,,71,60.35,20.3486,71,"UCare Health, Inc.",Individual & Family Plan,40.0085,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Sup Endotracheal Tube,,E0485,HCPCS,Facility,Inpatient,,,,71,60.35,20.3486,71,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Sup Endotracheal Tube,,E0485,HCPCS,Facility,Outpatient,,,,71,60.35,20.3486,71,"UCare Health, Inc.",Medical Assistance,35.8337,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Endotracheal Tube,,E0485,HCPCS,Facility,Inpatient,,,,71,60.35,20.3486,71,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Sup Endotracheal Tube,,E0485,HCPCS,Facility,Outpatient,,,,71,60.35,20.3486,71,"UCare Health, Inc.",Medicare Advantage,35.8337,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Endotracheal Tube,,E0485,HCPCS,Facility,Inpatient,,,,71,60.35,20.3486,71,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Endotracheal Tube,,E0485,HCPCS,Facility,Outpatient,,,,71,60.35,20.3486,71,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),35.8337,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Endotracheal Tube,,E0485,HCPCS,Facility,Inpatient,,,,71,60.35,20.3486,71,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Endotracheal Tube,,E0485,HCPCS,Facility,Both,,,,71,60.35,20.3486,71,UnitedHealthcare,Individual & Family,66.74,94,,percent of total billed charges,,
Sup Endotracheal Tube,,E0485,HCPCS,Facility,Outpatient,,,,71,60.35,20.3486,71,UnitedHealthcare,Medicare Advantage,34.79,49,,percent of total billed charges,,
Sup Endotracheal Tube,,E0485,HCPCS,Facility,Inpatient,,,,71,60.35,20.3486,71,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Sup Endotracheal Tube,,E0485,HCPCS,Facility,Outpatient,,,,71,60.35,20.3486,71,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,34.08,48,,percent of total billed charges,,100% of DHS outpatient percentage
Sup Endotracheal Tube,,E0485,HCPCS,Facility,Inpatient,,,,71,60.35,20.3486,71,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Sup Oral Airway, All Sizes",,E0486,HCPCS,Facility,Both,,,,87,73.95,24.9342,87,Aetna,Commercial,80.04,92,,percent of total billed charges,,
"Sup Oral Airway, All Sizes",,E0486,HCPCS,Facility,Outpatient,,,,87,73.95,24.9342,87,Aetna,Medicare Advantage,42.63,49,,percent of total billed charges,,
"Sup Oral Airway, All Sizes",,E0486,HCPCS,Facility,Inpatient,,,,87,73.95,24.9342,87,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Sup Oral Airway, All Sizes",,E0486,HCPCS,Facility,Both,,,,87,73.95,24.9342,87,Aetna,PPO,80.91,93,,percent of total billed charges,,
"Sup Oral Airway, All Sizes",,E0486,HCPCS,Facility,Both,,,,87,73.95,24.9342,87,America's PPO,America's PPO,83.5461,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Sup Oral Airway, All Sizes",,E0486,HCPCS,Facility,Both,,,,87,73.95,24.9342,87,BlueCross BlueShield Minnesota, Federal Employee Program,85.608,98.4,,percent of total billed charges,,
"Sup Oral Airway, All Sizes",,E0486,HCPCS,Facility,Both,,,,87,73.95,24.9342,87,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,87,100,,percent of total billed charges,,
"Sup Oral Airway, All Sizes",,E0486,HCPCS,Facility,Both,,,,87,73.95,24.9342,87,BlueCross BlueShield Minnesota,High Value Network Plan,78.3,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
"Sup Oral Airway, All Sizes",,E0486,HCPCS,Facility,Outpatient,,,,87,73.95,24.9342,87,BlueCross BlueShield Minnesota,Medicare Advantage,42.63,49,,percent of total billed charges,,
"Sup Oral Airway, All Sizes",,E0486,HCPCS,Facility,Inpatient,,,,87,73.95,24.9342,87,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Sup Oral Airway, All Sizes",,E0486,HCPCS,Facility,Both,,,,87,73.95,24.9342,87,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,77.0559,88.57,,percent of total billed charges,,
"Sup Oral Airway, All Sizes",,E0486,HCPCS,Facility,Both,,,,87,73.95,24.9342,87,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,24.9342,28.66,,percent of total billed charges,,
"Sup Oral Airway, All Sizes",,E0486,HCPCS,Facility,Outpatient,,,,87,73.95,24.9342,87,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),42.63,49,,percent of total billed charges,,
"Sup Oral Airway, All Sizes",,E0486,HCPCS,Facility,Inpatient,,,,87,73.95,24.9342,87,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Sup Oral Airway, All Sizes",,E0486,HCPCS,Facility,Both,,,,87,73.95,24.9342,87,CorVel,Worker's Compensation,87,100,,percent of total billed charges,,
"Sup Oral Airway, All Sizes",,E0486,HCPCS,Facility,Both,,,,87,73.95,24.9342,87,First Health Group Corporation,First Health Network,84.39,97,,percent of total billed charges,,
"Sup Oral Airway, All Sizes",,E0486,HCPCS,Facility,Both,,,,87,73.95,24.9342,87,"Health Partners, Inc.",Commercial,82.302,94.6,,percent of total billed charges,,
"Sup Oral Airway, All Sizes",,E0486,HCPCS,Facility,Outpatient,,,,87,73.95,24.9342,87,"Health Partners, Inc.",Medicare Advantage,42.63,49,,percent of total billed charges,,
"Sup Oral Airway, All Sizes",,E0486,HCPCS,Facility,Inpatient,,,,87,73.95,24.9342,87,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Sup Oral Airway, All Sizes",,E0486,HCPCS,Facility,Both,,,,87,73.95,24.9342,87,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),52.2,60,,percent of total billed charges,,
"Sup Oral Airway, All Sizes",,E0486,HCPCS,Facility,Both,,,,87,73.95,24.9342,87,"Health Partners, Inc.",State of Minnesota Advantage Program,70.905,81.5,,percent of total billed charges,,
"Sup Oral Airway, All Sizes",,E0486,HCPCS,Facility,Both,,,,87,73.95,24.9342,87,"Health Partners, Inc.",State Public Programs,43.5,50,,percent of total billed charges,,
"Sup Oral Airway, All Sizes",,E0486,HCPCS,Facility,Both,,,,87,73.95,24.9342,87,Humana Insurance Company,Commercial PPO,82.65,95,,percent of total billed charges,,
"Sup Oral Airway, All Sizes",,E0486,HCPCS,Facility,Outpatient,,,,87,73.95,24.9342,87,Humana Insurance Company,Medicare PPO,42.63,49,,percent of total billed charges,,
"Sup Oral Airway, All Sizes",,E0486,HCPCS,Facility,Inpatient,,,,87,73.95,24.9342,87,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Sup Oral Airway, All Sizes",,E0486,HCPCS,Facility,Both,,,,87,73.95,24.9342,87,Medica,Individual & Family,86.217,99.1,,percent of total billed charges,,
"Sup Oral Airway, All Sizes",,E0486,HCPCS,Facility,Outpatient,,,,87,73.95,24.9342,87,Medica,Medica Advantage Solution,43.326,49.8,,percent of total billed charges,,
"Sup Oral Airway, All Sizes",,E0486,HCPCS,Facility,Inpatient,,,,87,73.95,24.9342,87,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Sup Oral Airway, All Sizes",,E0486,HCPCS,Facility,Outpatient,,,,87,73.95,24.9342,87,Medica,Medical Assistance,38.802,44.6,,percent of total billed charges,,
"Sup Oral Airway, All Sizes",,E0486,HCPCS,Facility,Inpatient,,,,87,73.95,24.9342,87,Medica,Medical Assistance,,,,,Included in per diem rate,
"Sup Oral Airway, All Sizes",,E0486,HCPCS,Facility,Outpatient,,,,87,73.95,24.9342,87,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,43.326,49.8,,percent of total billed charges,,
"Sup Oral Airway, All Sizes",,E0486,HCPCS,Facility,Inpatient,,,,87,73.95,24.9342,87,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Sup Oral Airway, All Sizes",,E0486,HCPCS,Facility,Both,,,,87,73.95,24.9342,87,"Multiplan, Inc.","Multiplan, Inc.",81.78,94,,percent of total billed charges,,
"Sup Oral Airway, All Sizes",,E0486,HCPCS,Facility,Outpatient,,,,87,73.95,24.9342,87,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,78.387,90.1,,percent of total billed charges,,
"Sup Oral Airway, All Sizes",,E0486,HCPCS,Facility,Inpatient,,,,87,73.95,24.9342,87,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Sup Oral Airway, All Sizes",,E0486,HCPCS,Facility,Both,,,,87,73.95,24.9342,87,"Preferred One Administrative Services, INC.",PPO,85.782,98.6,,percent of total billed charges,,
"Sup Oral Airway, All Sizes",,E0486,HCPCS,Facility,Outpatient,,,,87,73.95,24.9342,87,PrimeWest Health,Minnesota Senior Health Options (MSHO),44.7615,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Sup Oral Airway, All Sizes",,E0486,HCPCS,Facility,Inpatient,,,,87,73.95,24.9342,87,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Sup Oral Airway, All Sizes",,E0486,HCPCS,Facility,Outpatient,,,,87,73.95,24.9342,87,PrimeWest Health,MinnesotaCare,44.6832,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Sup Oral Airway, All Sizes",,E0486,HCPCS,Facility,Inpatient,,,,87,73.95,24.9342,87,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Sup Oral Airway, All Sizes",,E0486,HCPCS,Facility,Both,,,,87,73.95,24.9342,87,Sanford Health Plan,Sanford Health Plan,80.04,92,,percent of total billed charges,,
"Sup Oral Airway, All Sizes",,E0486,HCPCS,Facility,Outpatient,,,,87,73.95,24.9342,87,"UCare Health, Inc.",Individual & Family Plan,49.0245,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Sup Oral Airway, All Sizes",,E0486,HCPCS,Facility,Inpatient,,,,87,73.95,24.9342,87,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Sup Oral Airway, All Sizes",,E0486,HCPCS,Facility,Outpatient,,,,87,73.95,24.9342,87,"UCare Health, Inc.",Medical Assistance,43.9089,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Sup Oral Airway, All Sizes",,E0486,HCPCS,Facility,Inpatient,,,,87,73.95,24.9342,87,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Sup Oral Airway, All Sizes",,E0486,HCPCS,Facility,Outpatient,,,,87,73.95,24.9342,87,"UCare Health, Inc.",Medicare Advantage,43.9089,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Sup Oral Airway, All Sizes",,E0486,HCPCS,Facility,Inpatient,,,,87,73.95,24.9342,87,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Sup Oral Airway, All Sizes",,E0486,HCPCS,Facility,Outpatient,,,,87,73.95,24.9342,87,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),43.9089,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Sup Oral Airway, All Sizes",,E0486,HCPCS,Facility,Inpatient,,,,87,73.95,24.9342,87,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Sup Oral Airway, All Sizes",,E0486,HCPCS,Facility,Both,,,,87,73.95,24.9342,87,UnitedHealthcare,Individual & Family,81.78,94,,percent of total billed charges,,
"Sup Oral Airway, All Sizes",,E0486,HCPCS,Facility,Outpatient,,,,87,73.95,24.9342,87,UnitedHealthcare,Medicare Advantage,42.63,49,,percent of total billed charges,,
"Sup Oral Airway, All Sizes",,E0486,HCPCS,Facility,Inpatient,,,,87,73.95,24.9342,87,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Sup Oral Airway, All Sizes",,E0486,HCPCS,Facility,Outpatient,,,,87,73.95,24.9342,87,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,41.76,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Sup Oral Airway, All Sizes",,E0486,HCPCS,Facility,Inpatient,,,,87,73.95,24.9342,87,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
SLEEVE COMP HUNTLEIGH STANDARD TO 17 IN     DVT10,,E0676,HCPCS,Facility,Both,,,,193.28,164.288,55.394048,193.28,Aetna,Commercial,177.8176,92,,percent of total billed charges,,
SLEEVE COMP HUNTLEIGH STANDARD TO 17 IN     DVT10,,E0676,HCPCS,Facility,Outpatient,,,,193.28,164.288,55.394048,193.28,Aetna,Medicare Advantage,94.7072,49,,percent of total billed charges,,
SLEEVE COMP HUNTLEIGH STANDARD TO 17 IN     DVT10,,E0676,HCPCS,Facility,Inpatient,,,,193.28,164.288,55.394048,193.28,Aetna,Medicare Advantage,,,,,Included in per diem rate,
SLEEVE COMP HUNTLEIGH STANDARD TO 17 IN     DVT10,,E0676,HCPCS,Facility,Both,,,,193.28,164.288,55.394048,193.28,Aetna,PPO,179.7504,93,,percent of total billed charges,,
SLEEVE COMP HUNTLEIGH STANDARD TO 17 IN     DVT10,,E0676,HCPCS,Facility,Both,,,,193.28,164.288,55.394048,193.28,America's PPO,America's PPO,185.606784,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SLEEVE COMP HUNTLEIGH STANDARD TO 17 IN     DVT10,,E0676,HCPCS,Facility,Both,,,,193.28,164.288,55.394048,193.28,BlueCross BlueShield Minnesota, Federal Employee Program,190.18752,98.4,,percent of total billed charges,,
SLEEVE COMP HUNTLEIGH STANDARD TO 17 IN     DVT10,,E0676,HCPCS,Facility,Both,,,,193.28,164.288,55.394048,193.28,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,193.28,100,,percent of total billed charges,,
SLEEVE COMP HUNTLEIGH STANDARD TO 17 IN     DVT10,,E0676,HCPCS,Facility,Both,,,,193.28,164.288,55.394048,193.28,BlueCross BlueShield Minnesota,High Value Network Plan,173.952,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
SLEEVE COMP HUNTLEIGH STANDARD TO 17 IN     DVT10,,E0676,HCPCS,Facility,Outpatient,,,,193.28,164.288,55.394048,193.28,BlueCross BlueShield Minnesota,Medicare Advantage,94.7072,49,,percent of total billed charges,,
SLEEVE COMP HUNTLEIGH STANDARD TO 17 IN     DVT10,,E0676,HCPCS,Facility,Inpatient,,,,193.28,164.288,55.394048,193.28,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
SLEEVE COMP HUNTLEIGH STANDARD TO 17 IN     DVT10,,E0676,HCPCS,Facility,Both,,,,193.28,164.288,55.394048,193.28,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,171.188096,88.57,,percent of total billed charges,,
SLEEVE COMP HUNTLEIGH STANDARD TO 17 IN     DVT10,,E0676,HCPCS,Facility,Both,,,,193.28,164.288,55.394048,193.28,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,55.394048,28.66,,percent of total billed charges,,
SLEEVE COMP HUNTLEIGH STANDARD TO 17 IN     DVT10,,E0676,HCPCS,Facility,Outpatient,,,,193.28,164.288,55.394048,193.28,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),94.7072,49,,percent of total billed charges,,
SLEEVE COMP HUNTLEIGH STANDARD TO 17 IN     DVT10,,E0676,HCPCS,Facility,Inpatient,,,,193.28,164.288,55.394048,193.28,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
SLEEVE COMP HUNTLEIGH STANDARD TO 17 IN     DVT10,,E0676,HCPCS,Facility,Both,,,,193.28,164.288,55.394048,193.28,CorVel,Worker's Compensation,193.28,100,,percent of total billed charges,,
SLEEVE COMP HUNTLEIGH STANDARD TO 17 IN     DVT10,,E0676,HCPCS,Facility,Both,,,,193.28,164.288,55.394048,193.28,First Health Group Corporation,First Health Network,187.4816,97,,percent of total billed charges,,
SLEEVE COMP HUNTLEIGH STANDARD TO 17 IN     DVT10,,E0676,HCPCS,Facility,Both,,,,193.28,164.288,55.394048,193.28,"Health Partners, Inc.",Commercial,182.84288,94.6,,percent of total billed charges,,
SLEEVE COMP HUNTLEIGH STANDARD TO 17 IN     DVT10,,E0676,HCPCS,Facility,Outpatient,,,,193.28,164.288,55.394048,193.28,"Health Partners, Inc.",Medicare Advantage,94.7072,49,,percent of total billed charges,,
SLEEVE COMP HUNTLEIGH STANDARD TO 17 IN     DVT10,,E0676,HCPCS,Facility,Inpatient,,,,193.28,164.288,55.394048,193.28,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SLEEVE COMP HUNTLEIGH STANDARD TO 17 IN     DVT10,,E0676,HCPCS,Facility,Both,,,,193.28,164.288,55.394048,193.28,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),115.968,60,,percent of total billed charges,,
SLEEVE COMP HUNTLEIGH STANDARD TO 17 IN     DVT10,,E0676,HCPCS,Facility,Both,,,,193.28,164.288,55.394048,193.28,"Health Partners, Inc.",State of Minnesota Advantage Program,157.5232,81.5,,percent of total billed charges,,
SLEEVE COMP HUNTLEIGH STANDARD TO 17 IN     DVT10,,E0676,HCPCS,Facility,Both,,,,193.28,164.288,55.394048,193.28,"Health Partners, Inc.",State Public Programs,96.64,50,,percent of total billed charges,,
SLEEVE COMP HUNTLEIGH STANDARD TO 17 IN     DVT10,,E0676,HCPCS,Facility,Both,,,,193.28,164.288,55.394048,193.28,Humana Insurance Company,Commercial PPO,183.616,95,,percent of total billed charges,,
SLEEVE COMP HUNTLEIGH STANDARD TO 17 IN     DVT10,,E0676,HCPCS,Facility,Outpatient,,,,193.28,164.288,55.394048,193.28,Humana Insurance Company,Medicare PPO,94.7072,49,,percent of total billed charges,,
SLEEVE COMP HUNTLEIGH STANDARD TO 17 IN     DVT10,,E0676,HCPCS,Facility,Inpatient,,,,193.28,164.288,55.394048,193.28,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
SLEEVE COMP HUNTLEIGH STANDARD TO 17 IN     DVT10,,E0676,HCPCS,Facility,Both,,,,193.28,164.288,55.394048,193.28,Medica,Individual & Family,191.54048,99.1,,percent of total billed charges,,
SLEEVE COMP HUNTLEIGH STANDARD TO 17 IN     DVT10,,E0676,HCPCS,Facility,Outpatient,,,,193.28,164.288,55.394048,193.28,Medica,Medica Advantage Solution,96.25344,49.8,,percent of total billed charges,,
SLEEVE COMP HUNTLEIGH STANDARD TO 17 IN     DVT10,,E0676,HCPCS,Facility,Inpatient,,,,193.28,164.288,55.394048,193.28,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
SLEEVE COMP HUNTLEIGH STANDARD TO 17 IN     DVT10,,E0676,HCPCS,Facility,Outpatient,,,,193.28,164.288,55.394048,193.28,Medica,Medical Assistance,86.20288,44.6,,percent of total billed charges,,
SLEEVE COMP HUNTLEIGH STANDARD TO 17 IN     DVT10,,E0676,HCPCS,Facility,Inpatient,,,,193.28,164.288,55.394048,193.28,Medica,Medical Assistance,,,,,Included in per diem rate,
SLEEVE COMP HUNTLEIGH STANDARD TO 17 IN     DVT10,,E0676,HCPCS,Facility,Outpatient,,,,193.28,164.288,55.394048,193.28,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,96.25344,49.8,,percent of total billed charges,,
SLEEVE COMP HUNTLEIGH STANDARD TO 17 IN     DVT10,,E0676,HCPCS,Facility,Inpatient,,,,193.28,164.288,55.394048,193.28,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
SLEEVE COMP HUNTLEIGH STANDARD TO 17 IN     DVT10,,E0676,HCPCS,Facility,Both,,,,193.28,164.288,55.394048,193.28,"Multiplan, Inc.","Multiplan, Inc.",181.6832,94,,percent of total billed charges,,
SLEEVE COMP HUNTLEIGH STANDARD TO 17 IN     DVT10,,E0676,HCPCS,Facility,Outpatient,,,,193.28,164.288,55.394048,193.28,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,174.14528,90.1,,percent of total billed charges,,
SLEEVE COMP HUNTLEIGH STANDARD TO 17 IN     DVT10,,E0676,HCPCS,Facility,Inpatient,,,,193.28,164.288,55.394048,193.28,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
SLEEVE COMP HUNTLEIGH STANDARD TO 17 IN     DVT10,,E0676,HCPCS,Facility,Both,,,,193.28,164.288,55.394048,193.28,"Preferred One Administrative Services, INC.",PPO,190.57408,98.6,,percent of total billed charges,,
SLEEVE COMP HUNTLEIGH STANDARD TO 17 IN     DVT10,,E0676,HCPCS,Facility,Outpatient,,,,193.28,164.288,55.394048,193.28,PrimeWest Health,Minnesota Senior Health Options (MSHO),99.44256,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
SLEEVE COMP HUNTLEIGH STANDARD TO 17 IN     DVT10,,E0676,HCPCS,Facility,Inpatient,,,,193.28,164.288,55.394048,193.28,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SLEEVE COMP HUNTLEIGH STANDARD TO 17 IN     DVT10,,E0676,HCPCS,Facility,Outpatient,,,,193.28,164.288,55.394048,193.28,PrimeWest Health,MinnesotaCare,99.268608,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
SLEEVE COMP HUNTLEIGH STANDARD TO 17 IN     DVT10,,E0676,HCPCS,Facility,Inpatient,,,,193.28,164.288,55.394048,193.28,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
SLEEVE COMP HUNTLEIGH STANDARD TO 17 IN     DVT10,,E0676,HCPCS,Facility,Both,,,,193.28,164.288,55.394048,193.28,Sanford Health Plan,Sanford Health Plan,177.8176,92,,percent of total billed charges,,
SLEEVE COMP HUNTLEIGH STANDARD TO 17 IN     DVT10,,E0676,HCPCS,Facility,Outpatient,,,,193.28,164.288,55.394048,193.28,"UCare Health, Inc.",Individual & Family Plan,108.91328,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
SLEEVE COMP HUNTLEIGH STANDARD TO 17 IN     DVT10,,E0676,HCPCS,Facility,Inpatient,,,,193.28,164.288,55.394048,193.28,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
SLEEVE COMP HUNTLEIGH STANDARD TO 17 IN     DVT10,,E0676,HCPCS,Facility,Outpatient,,,,193.28,164.288,55.394048,193.28,"UCare Health, Inc.",Medical Assistance,97.548416,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SLEEVE COMP HUNTLEIGH STANDARD TO 17 IN     DVT10,,E0676,HCPCS,Facility,Inpatient,,,,193.28,164.288,55.394048,193.28,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
SLEEVE COMP HUNTLEIGH STANDARD TO 17 IN     DVT10,,E0676,HCPCS,Facility,Outpatient,,,,193.28,164.288,55.394048,193.28,"UCare Health, Inc.",Medicare Advantage,97.548416,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SLEEVE COMP HUNTLEIGH STANDARD TO 17 IN     DVT10,,E0676,HCPCS,Facility,Inpatient,,,,193.28,164.288,55.394048,193.28,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SLEEVE COMP HUNTLEIGH STANDARD TO 17 IN     DVT10,,E0676,HCPCS,Facility,Outpatient,,,,193.28,164.288,55.394048,193.28,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),97.548416,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SLEEVE COMP HUNTLEIGH STANDARD TO 17 IN     DVT10,,E0676,HCPCS,Facility,Inpatient,,,,193.28,164.288,55.394048,193.28,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SLEEVE COMP HUNTLEIGH STANDARD TO 17 IN     DVT10,,E0676,HCPCS,Facility,Both,,,,193.28,164.288,55.394048,193.28,UnitedHealthcare,Individual & Family,181.6832,94,,percent of total billed charges,,
SLEEVE COMP HUNTLEIGH STANDARD TO 17 IN     DVT10,,E0676,HCPCS,Facility,Outpatient,,,,193.28,164.288,55.394048,193.28,UnitedHealthcare,Medicare Advantage,94.7072,49,,percent of total billed charges,,
SLEEVE COMP HUNTLEIGH STANDARD TO 17 IN     DVT10,,E0676,HCPCS,Facility,Inpatient,,,,193.28,164.288,55.394048,193.28,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
SLEEVE COMP HUNTLEIGH STANDARD TO 17 IN     DVT10,,E0676,HCPCS,Facility,Outpatient,,,,193.28,164.288,55.394048,193.28,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,92.7744,48,,percent of total billed charges,,100% of DHS outpatient percentage
SLEEVE COMP HUNTLEIGH STANDARD TO 17 IN     DVT10,,E0676,HCPCS,Facility,Inpatient,,,,193.28,164.288,55.394048,193.28,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Sup Pressure Stocking,,E0676,HCPCS,Facility,Both,,,,163,138.55,46.7158,163,Aetna,Commercial,149.96,92,,percent of total billed charges,,
Sup Pressure Stocking,,E0676,HCPCS,Facility,Outpatient,,,,163,138.55,46.7158,163,Aetna,Medicare Advantage,79.87,49,,percent of total billed charges,,
Sup Pressure Stocking,,E0676,HCPCS,Facility,Inpatient,,,,163,138.55,46.7158,163,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Sup Pressure Stocking,,E0676,HCPCS,Facility,Both,,,,163,138.55,46.7158,163,Aetna,PPO,151.59,93,,percent of total billed charges,,
Sup Pressure Stocking,,E0676,HCPCS,Facility,Both,,,,163,138.55,46.7158,163,America's PPO,America's PPO,156.5289,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Sup Pressure Stocking,,E0676,HCPCS,Facility,Both,,,,163,138.55,46.7158,163,BlueCross BlueShield Minnesota, Federal Employee Program,160.392,98.4,,percent of total billed charges,,
Sup Pressure Stocking,,E0676,HCPCS,Facility,Both,,,,163,138.55,46.7158,163,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,163,100,,percent of total billed charges,,
Sup Pressure Stocking,,E0676,HCPCS,Facility,Both,,,,163,138.55,46.7158,163,BlueCross BlueShield Minnesota,High Value Network Plan,146.7,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
Sup Pressure Stocking,,E0676,HCPCS,Facility,Outpatient,,,,163,138.55,46.7158,163,BlueCross BlueShield Minnesota,Medicare Advantage,79.87,49,,percent of total billed charges,,
Sup Pressure Stocking,,E0676,HCPCS,Facility,Inpatient,,,,163,138.55,46.7158,163,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Sup Pressure Stocking,,E0676,HCPCS,Facility,Both,,,,163,138.55,46.7158,163,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,144.3691,88.57,,percent of total billed charges,,
Sup Pressure Stocking,,E0676,HCPCS,Facility,Both,,,,163,138.55,46.7158,163,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,46.7158,28.66,,percent of total billed charges,,
Sup Pressure Stocking,,E0676,HCPCS,Facility,Outpatient,,,,163,138.55,46.7158,163,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),79.87,49,,percent of total billed charges,,
Sup Pressure Stocking,,E0676,HCPCS,Facility,Inpatient,,,,163,138.55,46.7158,163,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Sup Pressure Stocking,,E0676,HCPCS,Facility,Both,,,,163,138.55,46.7158,163,CorVel,Worker's Compensation,163,100,,percent of total billed charges,,
Sup Pressure Stocking,,E0676,HCPCS,Facility,Both,,,,163,138.55,46.7158,163,First Health Group Corporation,First Health Network,158.11,97,,percent of total billed charges,,
Sup Pressure Stocking,,E0676,HCPCS,Facility,Both,,,,163,138.55,46.7158,163,"Health Partners, Inc.",Commercial,154.198,94.6,,percent of total billed charges,,
Sup Pressure Stocking,,E0676,HCPCS,Facility,Outpatient,,,,163,138.55,46.7158,163,"Health Partners, Inc.",Medicare Advantage,79.87,49,,percent of total billed charges,,
Sup Pressure Stocking,,E0676,HCPCS,Facility,Inpatient,,,,163,138.55,46.7158,163,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Pressure Stocking,,E0676,HCPCS,Facility,Both,,,,163,138.55,46.7158,163,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),97.8,60,,percent of total billed charges,,
Sup Pressure Stocking,,E0676,HCPCS,Facility,Both,,,,163,138.55,46.7158,163,"Health Partners, Inc.",State of Minnesota Advantage Program,132.845,81.5,,percent of total billed charges,,
Sup Pressure Stocking,,E0676,HCPCS,Facility,Both,,,,163,138.55,46.7158,163,"Health Partners, Inc.",State Public Programs,81.5,50,,percent of total billed charges,,
Sup Pressure Stocking,,E0676,HCPCS,Facility,Both,,,,163,138.55,46.7158,163,Humana Insurance Company,Commercial PPO,154.85,95,,percent of total billed charges,,
Sup Pressure Stocking,,E0676,HCPCS,Facility,Outpatient,,,,163,138.55,46.7158,163,Humana Insurance Company,Medicare PPO,79.87,49,,percent of total billed charges,,
Sup Pressure Stocking,,E0676,HCPCS,Facility,Inpatient,,,,163,138.55,46.7158,163,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Sup Pressure Stocking,,E0676,HCPCS,Facility,Both,,,,163,138.55,46.7158,163,Medica,Individual & Family,161.533,99.1,,percent of total billed charges,,
Sup Pressure Stocking,,E0676,HCPCS,Facility,Outpatient,,,,163,138.55,46.7158,163,Medica,Medica Advantage Solution,81.174,49.8,,percent of total billed charges,,
Sup Pressure Stocking,,E0676,HCPCS,Facility,Inpatient,,,,163,138.55,46.7158,163,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Sup Pressure Stocking,,E0676,HCPCS,Facility,Outpatient,,,,163,138.55,46.7158,163,Medica,Medical Assistance,72.698,44.6,,percent of total billed charges,,
Sup Pressure Stocking,,E0676,HCPCS,Facility,Inpatient,,,,163,138.55,46.7158,163,Medica,Medical Assistance,,,,,Included in per diem rate,
Sup Pressure Stocking,,E0676,HCPCS,Facility,Outpatient,,,,163,138.55,46.7158,163,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,81.174,49.8,,percent of total billed charges,,
Sup Pressure Stocking,,E0676,HCPCS,Facility,Inpatient,,,,163,138.55,46.7158,163,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Sup Pressure Stocking,,E0676,HCPCS,Facility,Both,,,,163,138.55,46.7158,163,"Multiplan, Inc.","Multiplan, Inc.",153.22,94,,percent of total billed charges,,
Sup Pressure Stocking,,E0676,HCPCS,Facility,Outpatient,,,,163,138.55,46.7158,163,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,146.863,90.1,,percent of total billed charges,,
Sup Pressure Stocking,,E0676,HCPCS,Facility,Inpatient,,,,163,138.55,46.7158,163,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Sup Pressure Stocking,,E0676,HCPCS,Facility,Both,,,,163,138.55,46.7158,163,"Preferred One Administrative Services, INC.",PPO,160.718,98.6,,percent of total billed charges,,
Sup Pressure Stocking,,E0676,HCPCS,Facility,Outpatient,,,,163,138.55,46.7158,163,PrimeWest Health,Minnesota Senior Health Options (MSHO),83.8635,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Sup Pressure Stocking,,E0676,HCPCS,Facility,Inpatient,,,,163,138.55,46.7158,163,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Pressure Stocking,,E0676,HCPCS,Facility,Outpatient,,,,163,138.55,46.7158,163,PrimeWest Health,MinnesotaCare,83.7168,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Sup Pressure Stocking,,E0676,HCPCS,Facility,Inpatient,,,,163,138.55,46.7158,163,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Sup Pressure Stocking,,E0676,HCPCS,Facility,Both,,,,163,138.55,46.7158,163,Sanford Health Plan,Sanford Health Plan,149.96,92,,percent of total billed charges,,
Sup Pressure Stocking,,E0676,HCPCS,Facility,Outpatient,,,,163,138.55,46.7158,163,"UCare Health, Inc.",Individual & Family Plan,91.8505,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Sup Pressure Stocking,,E0676,HCPCS,Facility,Inpatient,,,,163,138.55,46.7158,163,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Sup Pressure Stocking,,E0676,HCPCS,Facility,Outpatient,,,,163,138.55,46.7158,163,"UCare Health, Inc.",Medical Assistance,82.2661,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Pressure Stocking,,E0676,HCPCS,Facility,Inpatient,,,,163,138.55,46.7158,163,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Sup Pressure Stocking,,E0676,HCPCS,Facility,Outpatient,,,,163,138.55,46.7158,163,"UCare Health, Inc.",Medicare Advantage,82.2661,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Pressure Stocking,,E0676,HCPCS,Facility,Inpatient,,,,163,138.55,46.7158,163,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Pressure Stocking,,E0676,HCPCS,Facility,Outpatient,,,,163,138.55,46.7158,163,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),82.2661,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Pressure Stocking,,E0676,HCPCS,Facility,Inpatient,,,,163,138.55,46.7158,163,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Pressure Stocking,,E0676,HCPCS,Facility,Both,,,,163,138.55,46.7158,163,UnitedHealthcare,Individual & Family,153.22,94,,percent of total billed charges,,
Sup Pressure Stocking,,E0676,HCPCS,Facility,Outpatient,,,,163,138.55,46.7158,163,UnitedHealthcare,Medicare Advantage,79.87,49,,percent of total billed charges,,
Sup Pressure Stocking,,E0676,HCPCS,Facility,Inpatient,,,,163,138.55,46.7158,163,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Sup Pressure Stocking,,E0676,HCPCS,Facility,Outpatient,,,,163,138.55,46.7158,163,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,78.24,48,,percent of total billed charges,,100% of DHS outpatient percentage
Sup Pressure Stocking,,E0676,HCPCS,Facility,Inpatient,,,,163,138.55,46.7158,163,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
DRESSING POLAR CARE COMBO CUBE,,E1399,HCPCS,Facility,Both,,,,637.325,541.72625,182.657345,637.325,Aetna,Commercial,586.339,92,,percent of total billed charges,,
DRESSING POLAR CARE COMBO CUBE,,E1399,HCPCS,Facility,Outpatient,,,,637.325,541.72625,182.657345,637.325,Aetna,Medicare Advantage,312.28925,49,,percent of total billed charges,,
DRESSING POLAR CARE COMBO CUBE,,E1399,HCPCS,Facility,Inpatient,,,,637.325,541.72625,182.657345,637.325,Aetna,Medicare Advantage,,,,,Included in per diem rate,
DRESSING POLAR CARE COMBO CUBE,,E1399,HCPCS,Facility,Both,,,,637.325,541.72625,182.657345,637.325,Aetna,PPO,592.71225,93,,percent of total billed charges,,
DRESSING POLAR CARE COMBO CUBE,,E1399,HCPCS,Facility,Both,,,,637.325,541.72625,182.657345,637.325,America's PPO,America's PPO,612.0231975,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
DRESSING POLAR CARE COMBO CUBE,,E1399,HCPCS,Facility,Both,,,,637.325,541.72625,182.657345,637.325,BlueCross BlueShield Minnesota, Federal Employee Program,627.1278,98.4,,percent of total billed charges,,
DRESSING POLAR CARE COMBO CUBE,,E1399,HCPCS,Facility,Both,,,,637.325,541.72625,182.657345,637.325,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,637.325,100,,percent of total billed charges,,
DRESSING POLAR CARE COMBO CUBE,,E1399,HCPCS,Facility,Both,,,,637.325,541.72625,182.657345,637.325,BlueCross BlueShield Minnesota,High Value Network Plan,573.5925,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
DRESSING POLAR CARE COMBO CUBE,,E1399,HCPCS,Facility,Outpatient,,,,637.325,541.72625,182.657345,637.325,BlueCross BlueShield Minnesota,Medicare Advantage,312.28925,49,,percent of total billed charges,,
DRESSING POLAR CARE COMBO CUBE,,E1399,HCPCS,Facility,Inpatient,,,,637.325,541.72625,182.657345,637.325,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
DRESSING POLAR CARE COMBO CUBE,,E1399,HCPCS,Facility,Both,,,,637.325,541.72625,182.657345,637.325,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,564.4787525,88.57,,percent of total billed charges,,
DRESSING POLAR CARE COMBO CUBE,,E1399,HCPCS,Facility,Both,,,,637.325,541.72625,182.657345,637.325,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,182.657345,28.66,,percent of total billed charges,,
DRESSING POLAR CARE COMBO CUBE,,E1399,HCPCS,Facility,Outpatient,,,,637.325,541.72625,182.657345,637.325,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),312.28925,49,,percent of total billed charges,,
DRESSING POLAR CARE COMBO CUBE,,E1399,HCPCS,Facility,Inpatient,,,,637.325,541.72625,182.657345,637.325,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
DRESSING POLAR CARE COMBO CUBE,,E1399,HCPCS,Facility,Both,,,,637.325,541.72625,182.657345,637.325,CorVel,Worker's Compensation,637.325,100,,percent of total billed charges,,
DRESSING POLAR CARE COMBO CUBE,,E1399,HCPCS,Facility,Both,,,,637.325,541.72625,182.657345,637.325,First Health Group Corporation,First Health Network,618.20525,97,,percent of total billed charges,,
DRESSING POLAR CARE COMBO CUBE,,E1399,HCPCS,Facility,Both,,,,637.325,541.72625,182.657345,637.325,"Health Partners, Inc.",Commercial,602.90945,94.6,,percent of total billed charges,,
DRESSING POLAR CARE COMBO CUBE,,E1399,HCPCS,Facility,Outpatient,,,,637.325,541.72625,182.657345,637.325,"Health Partners, Inc.",Medicare Advantage,312.28925,49,,percent of total billed charges,,
DRESSING POLAR CARE COMBO CUBE,,E1399,HCPCS,Facility,Inpatient,,,,637.325,541.72625,182.657345,637.325,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DRESSING POLAR CARE COMBO CUBE,,E1399,HCPCS,Facility,Both,,,,637.325,541.72625,182.657345,637.325,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),382.395,60,,percent of total billed charges,,
DRESSING POLAR CARE COMBO CUBE,,E1399,HCPCS,Facility,Both,,,,637.325,541.72625,182.657345,637.325,"Health Partners, Inc.",State of Minnesota Advantage Program,519.419875,81.5,,percent of total billed charges,,
DRESSING POLAR CARE COMBO CUBE,,E1399,HCPCS,Facility,Both,,,,637.325,541.72625,182.657345,637.325,"Health Partners, Inc.",State Public Programs,318.6625,50,,percent of total billed charges,,
DRESSING POLAR CARE COMBO CUBE,,E1399,HCPCS,Facility,Both,,,,637.325,541.72625,182.657345,637.325,Humana Insurance Company,Commercial PPO,605.45875,95,,percent of total billed charges,,
DRESSING POLAR CARE COMBO CUBE,,E1399,HCPCS,Facility,Outpatient,,,,637.325,541.72625,182.657345,637.325,Humana Insurance Company,Medicare PPO,312.28925,49,,percent of total billed charges,,
DRESSING POLAR CARE COMBO CUBE,,E1399,HCPCS,Facility,Inpatient,,,,637.325,541.72625,182.657345,637.325,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
DRESSING POLAR CARE COMBO CUBE,,E1399,HCPCS,Facility,Both,,,,637.325,541.72625,182.657345,637.325,Medica,Individual & Family,631.589075,99.1,,percent of total billed charges,,
DRESSING POLAR CARE COMBO CUBE,,E1399,HCPCS,Facility,Outpatient,,,,637.325,541.72625,182.657345,637.325,Medica,Medica Advantage Solution,317.38785,49.8,,percent of total billed charges,,
DRESSING POLAR CARE COMBO CUBE,,E1399,HCPCS,Facility,Inpatient,,,,637.325,541.72625,182.657345,637.325,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
DRESSING POLAR CARE COMBO CUBE,,E1399,HCPCS,Facility,Outpatient,,,,637.325,541.72625,182.657345,637.325,Medica,Medical Assistance,284.24695,44.6,,percent of total billed charges,,
DRESSING POLAR CARE COMBO CUBE,,E1399,HCPCS,Facility,Inpatient,,,,637.325,541.72625,182.657345,637.325,Medica,Medical Assistance,,,,,Included in per diem rate,
DRESSING POLAR CARE COMBO CUBE,,E1399,HCPCS,Facility,Outpatient,,,,637.325,541.72625,182.657345,637.325,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,317.38785,49.8,,percent of total billed charges,,
DRESSING POLAR CARE COMBO CUBE,,E1399,HCPCS,Facility,Inpatient,,,,637.325,541.72625,182.657345,637.325,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
DRESSING POLAR CARE COMBO CUBE,,E1399,HCPCS,Facility,Both,,,,637.325,541.72625,182.657345,637.325,"Multiplan, Inc.","Multiplan, Inc.",599.0855,94,,percent of total billed charges,,
DRESSING POLAR CARE COMBO CUBE,,E1399,HCPCS,Facility,Outpatient,,,,637.325,541.72625,182.657345,637.325,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,574.229825,90.1,,percent of total billed charges,,
DRESSING POLAR CARE COMBO CUBE,,E1399,HCPCS,Facility,Inpatient,,,,637.325,541.72625,182.657345,637.325,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
DRESSING POLAR CARE COMBO CUBE,,E1399,HCPCS,Facility,Both,,,,637.325,541.72625,182.657345,637.325,"Preferred One Administrative Services, INC.",PPO,628.40245,98.6,,percent of total billed charges,,
DRESSING POLAR CARE COMBO CUBE,,E1399,HCPCS,Facility,Outpatient,,,,637.325,541.72625,182.657345,637.325,PrimeWest Health,Minnesota Senior Health Options (MSHO),327.9037125,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
DRESSING POLAR CARE COMBO CUBE,,E1399,HCPCS,Facility,Inpatient,,,,637.325,541.72625,182.657345,637.325,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DRESSING POLAR CARE COMBO CUBE,,E1399,HCPCS,Facility,Outpatient,,,,637.325,541.72625,182.657345,637.325,PrimeWest Health,MinnesotaCare,327.33012,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
DRESSING POLAR CARE COMBO CUBE,,E1399,HCPCS,Facility,Inpatient,,,,637.325,541.72625,182.657345,637.325,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
DRESSING POLAR CARE COMBO CUBE,,E1399,HCPCS,Facility,Both,,,,637.325,541.72625,182.657345,637.325,Sanford Health Plan,Sanford Health Plan,586.339,92,,percent of total billed charges,,
DRESSING POLAR CARE COMBO CUBE,,E1399,HCPCS,Facility,Outpatient,,,,637.325,541.72625,182.657345,637.325,"UCare Health, Inc.",Individual & Family Plan,359.1326375,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
DRESSING POLAR CARE COMBO CUBE,,E1399,HCPCS,Facility,Inpatient,,,,637.325,541.72625,182.657345,637.325,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
DRESSING POLAR CARE COMBO CUBE,,E1399,HCPCS,Facility,Outpatient,,,,637.325,541.72625,182.657345,637.325,"UCare Health, Inc.",Medical Assistance,321.6579275,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DRESSING POLAR CARE COMBO CUBE,,E1399,HCPCS,Facility,Inpatient,,,,637.325,541.72625,182.657345,637.325,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
DRESSING POLAR CARE COMBO CUBE,,E1399,HCPCS,Facility,Outpatient,,,,637.325,541.72625,182.657345,637.325,"UCare Health, Inc.",Medicare Advantage,321.6579275,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DRESSING POLAR CARE COMBO CUBE,,E1399,HCPCS,Facility,Inpatient,,,,637.325,541.72625,182.657345,637.325,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DRESSING POLAR CARE COMBO CUBE,,E1399,HCPCS,Facility,Outpatient,,,,637.325,541.72625,182.657345,637.325,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),321.6579275,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DRESSING POLAR CARE COMBO CUBE,,E1399,HCPCS,Facility,Inpatient,,,,637.325,541.72625,182.657345,637.325,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DRESSING POLAR CARE COMBO CUBE,,E1399,HCPCS,Facility,Both,,,,637.325,541.72625,182.657345,637.325,UnitedHealthcare,Individual & Family,599.0855,94,,percent of total billed charges,,
DRESSING POLAR CARE COMBO CUBE,,E1399,HCPCS,Facility,Outpatient,,,,637.325,541.72625,182.657345,637.325,UnitedHealthcare,Medicare Advantage,312.28925,49,,percent of total billed charges,,
DRESSING POLAR CARE COMBO CUBE,,E1399,HCPCS,Facility,Inpatient,,,,637.325,541.72625,182.657345,637.325,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
DRESSING POLAR CARE COMBO CUBE,,E1399,HCPCS,Facility,Outpatient,,,,637.325,541.72625,182.657345,637.325,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,305.916,48,,percent of total billed charges,,100% of DHS outpatient percentage
DRESSING POLAR CARE COMBO CUBE,,E1399,HCPCS,Facility,Inpatient,,,,637.325,541.72625,182.657345,637.325,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Administration Influenza Vaccine,,G0008,HCPCS,Facility,Outpatient,,,,25,21.25,12.25,22.5,Aetna,Medicare Advantage,12.25,49,,percent of total billed charges,,
Administration Influenza Vaccine,,G0008,HCPCS,Facility,Inpatient,,,,25,21.25,12.25,22.5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Administration Influenza Vaccine,,G0008,HCPCS,Facility,Outpatient,,,,25,21.25,12.25,22.5,BlueCross BlueShield Minnesota,Medicare Advantage,12.25,49,,percent of total billed charges,,
Administration Influenza Vaccine,,G0008,HCPCS,Facility,Inpatient,,,,25,21.25,12.25,22.5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Administration Influenza Vaccine,,G0008,HCPCS,Facility,Outpatient,,,,25,21.25,12.25,22.5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),12.25,49,,percent of total billed charges,,
Administration Influenza Vaccine,,G0008,HCPCS,Facility,Inpatient,,,,25,21.25,12.25,22.5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Administration Influenza Vaccine,,G0008,HCPCS,Facility,Outpatient,,,,25,21.25,12.25,22.5,"Health Partners, Inc.",Medicare Advantage,12.25,49,,percent of total billed charges,,
Administration Influenza Vaccine,,G0008,HCPCS,Facility,Inpatient,,,,25,21.25,12.25,22.5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Administration Influenza Vaccine,,G0008,HCPCS,Facility,Both,,,,25,21.25,12.25,22.5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),15,60,,percent of total billed charges,,
Administration Influenza Vaccine,,G0008,HCPCS,Facility,Outpatient,,,,25,21.25,12.25,22.5,Humana Insurance Company,Medicare PPO,12.25,49,,percent of total billed charges,,
Administration Influenza Vaccine,,G0008,HCPCS,Facility,Inpatient,,,,25,21.25,12.25,22.5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Administration Influenza Vaccine,,G0008,HCPCS,Facility,Outpatient,,,,25,21.25,12.25,22.5,Medica,Medica Advantage Solution,12.45,49.8,,percent of total billed charges,,
Administration Influenza Vaccine,,G0008,HCPCS,Facility,Inpatient,,,,25,21.25,12.25,22.5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Administration Influenza Vaccine,,G0008,HCPCS,Facility,Outpatient,,,,25,21.25,12.25,22.5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,12.45,49.8,,percent of total billed charges,,
Administration Influenza Vaccine,,G0008,HCPCS,Facility,Inpatient,,,,25,21.25,12.25,22.5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Administration Influenza Vaccine,,G0008,HCPCS,Facility,Outpatient,,,,25,21.25,12.25,22.5,PrimeWest Health,Minnesota Senior Health Options (MSHO),12.8625,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Administration Influenza Vaccine,,G0008,HCPCS,Facility,Inpatient,,,,25,21.25,12.25,22.5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Administration Influenza Vaccine,,G0008,HCPCS,Facility,Outpatient,,,,25,21.25,12.25,22.5,"UCare Health, Inc.",Medicare Advantage,12.6175,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Administration Influenza Vaccine,,G0008,HCPCS,Facility,Inpatient,,,,25,21.25,12.25,22.5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Administration Influenza Vaccine,,G0008,HCPCS,Facility,Outpatient,,,,25,21.25,12.25,22.5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),12.6175,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Administration Influenza Vaccine,,G0008,HCPCS,Facility,Inpatient,,,,25,21.25,12.25,22.5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Administration Influenza Vaccine,,G0008,HCPCS,Facility,Outpatient,,,,25,21.25,12.25,22.5,UnitedHealthcare,Medicare Advantage,12.25,49,,percent of total billed charges,,
Administration Influenza Vaccine,,G0008,HCPCS,Facility,Inpatient,,,,25,21.25,12.25,22.5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Administration Pneumococcal Vaccine,,G0009,HCPCS,Facility,Outpatient,,,,25,21.25,12.25,22.5,Aetna,Medicare Advantage,12.25,49,,percent of total billed charges,,
Administration Pneumococcal Vaccine,,G0009,HCPCS,Facility,Inpatient,,,,25,21.25,12.25,22.5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Administration Pneumococcal Vaccine,,G0009,HCPCS,Facility,Outpatient,,,,25,21.25,12.25,22.5,BlueCross BlueShield Minnesota,Medicare Advantage,12.25,49,,percent of total billed charges,,
Administration Pneumococcal Vaccine,,G0009,HCPCS,Facility,Inpatient,,,,25,21.25,12.25,22.5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Administration Pneumococcal Vaccine,,G0009,HCPCS,Facility,Outpatient,,,,25,21.25,12.25,22.5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),12.25,49,,percent of total billed charges,,
Administration Pneumococcal Vaccine,,G0009,HCPCS,Facility,Inpatient,,,,25,21.25,12.25,22.5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Administration Pneumococcal Vaccine,,G0009,HCPCS,Facility,Outpatient,,,,25,21.25,12.25,22.5,"Health Partners, Inc.",Medicare Advantage,12.25,49,,percent of total billed charges,,
Administration Pneumococcal Vaccine,,G0009,HCPCS,Facility,Inpatient,,,,25,21.25,12.25,22.5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Administration Pneumococcal Vaccine,,G0009,HCPCS,Facility,Both,,,,25,21.25,12.25,22.5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),15,60,,percent of total billed charges,,
Administration Pneumococcal Vaccine,,G0009,HCPCS,Facility,Outpatient,,,,25,21.25,12.25,22.5,Humana Insurance Company,Medicare PPO,12.25,49,,percent of total billed charges,,
Administration Pneumococcal Vaccine,,G0009,HCPCS,Facility,Inpatient,,,,25,21.25,12.25,22.5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Administration Pneumococcal Vaccine,,G0009,HCPCS,Facility,Outpatient,,,,25,21.25,12.25,22.5,Medica,Medica Advantage Solution,12.45,49.8,,percent of total billed charges,,
Administration Pneumococcal Vaccine,,G0009,HCPCS,Facility,Inpatient,,,,25,21.25,12.25,22.5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Administration Pneumococcal Vaccine,,G0009,HCPCS,Facility,Outpatient,,,,25,21.25,12.25,22.5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,12.45,49.8,,percent of total billed charges,,
Administration Pneumococcal Vaccine,,G0009,HCPCS,Facility,Inpatient,,,,25,21.25,12.25,22.5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Administration Pneumococcal Vaccine,,G0009,HCPCS,Facility,Outpatient,,,,25,21.25,12.25,22.5,PrimeWest Health,Minnesota Senior Health Options (MSHO),12.8625,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Administration Pneumococcal Vaccine,,G0009,HCPCS,Facility,Inpatient,,,,25,21.25,12.25,22.5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Administration Pneumococcal Vaccine,,G0009,HCPCS,Facility,Outpatient,,,,25,21.25,12.25,22.5,"UCare Health, Inc.",Medicare Advantage,12.6175,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Administration Pneumococcal Vaccine,,G0009,HCPCS,Facility,Inpatient,,,,25,21.25,12.25,22.5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Administration Pneumococcal Vaccine,,G0009,HCPCS,Facility,Outpatient,,,,25,21.25,12.25,22.5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),12.6175,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Administration Pneumococcal Vaccine,,G0009,HCPCS,Facility,Inpatient,,,,25,21.25,12.25,22.5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Administration Pneumococcal Vaccine,,G0009,HCPCS,Facility,Outpatient,,,,25,21.25,12.25,22.5,UnitedHealthcare,Medicare Advantage,12.25,49,,percent of total billed charges,,
Administration Pneumococcal Vaccine,,G0009,HCPCS,Facility,Inpatient,,,,25,21.25,12.25,22.5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Psa, Screening",,G0103,HCPCS,Facility,Outpatient,,,,146,124.1,71.54,131.4,Aetna,Medicare Advantage,71.54,49,,percent of total billed charges,,
"Psa, Screening",,G0103,HCPCS,Facility,Inpatient,,,,146,124.1,71.54,131.4,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Psa, Screening",,G0103,HCPCS,Facility,Outpatient,,,,146,124.1,71.54,131.4,BlueCross BlueShield Minnesota,Medicare Advantage,71.54,49,,percent of total billed charges,,
"Psa, Screening",,G0103,HCPCS,Facility,Inpatient,,,,146,124.1,71.54,131.4,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Psa, Screening",,G0103,HCPCS,Facility,Outpatient,,,,146,124.1,71.54,131.4,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),71.54,49,,percent of total billed charges,,
"Psa, Screening",,G0103,HCPCS,Facility,Inpatient,,,,146,124.1,71.54,131.4,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Psa, Screening",,G0103,HCPCS,Facility,Outpatient,,,,146,124.1,71.54,131.4,"Health Partners, Inc.",Medicare Advantage,71.54,49,,percent of total billed charges,,
"Psa, Screening",,G0103,HCPCS,Facility,Inpatient,,,,146,124.1,71.54,131.4,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Psa, Screening",,G0103,HCPCS,Facility,Both,,,,146,124.1,71.54,131.4,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),87.6,60,,percent of total billed charges,,
"Psa, Screening",,G0103,HCPCS,Facility,Outpatient,,,,146,124.1,71.54,131.4,Humana Insurance Company,Medicare PPO,71.54,49,,percent of total billed charges,,
"Psa, Screening",,G0103,HCPCS,Facility,Inpatient,,,,146,124.1,71.54,131.4,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Psa, Screening",,G0103,HCPCS,Facility,Outpatient,,,,146,124.1,71.54,131.4,Medica,Medica Advantage Solution,72.708,49.8,,percent of total billed charges,,
"Psa, Screening",,G0103,HCPCS,Facility,Inpatient,,,,146,124.1,71.54,131.4,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Psa, Screening",,G0103,HCPCS,Facility,Outpatient,,,,146,124.1,71.54,131.4,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,72.708,49.8,,percent of total billed charges,,
"Psa, Screening",,G0103,HCPCS,Facility,Inpatient,,,,146,124.1,71.54,131.4,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Psa, Screening",,G0103,HCPCS,Facility,Outpatient,,,,146,124.1,71.54,131.4,PrimeWest Health,Minnesota Senior Health Options (MSHO),75.117,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Psa, Screening",,G0103,HCPCS,Facility,Inpatient,,,,146,124.1,71.54,131.4,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Psa, Screening",,G0103,HCPCS,Facility,Outpatient,,,,146,124.1,71.54,131.4,"UCare Health, Inc.",Medicare Advantage,73.6862,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Psa, Screening",,G0103,HCPCS,Facility,Inpatient,,,,146,124.1,71.54,131.4,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Psa, Screening",,G0103,HCPCS,Facility,Outpatient,,,,146,124.1,71.54,131.4,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),73.6862,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Psa, Screening",,G0103,HCPCS,Facility,Inpatient,,,,146,124.1,71.54,131.4,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Psa, Screening",,G0103,HCPCS,Facility,Outpatient,,,,146,124.1,71.54,131.4,UnitedHealthcare,Medicare Advantage,71.54,49,,percent of total billed charges,,
"Psa, Screening",,G0103,HCPCS,Facility,Inpatient,,,,146,124.1,71.54,131.4,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Colorectal Cancer Screening; Flexible Sigmoidoscopy (Pro Cah),,G0104,HCPCS,Professional,Both,,,,1309,1112.65,34.46,1309,Aetna,Commercial,1112.65,85,,percent of total billed charges,,
Colorectal Cancer Screening; Flexible Sigmoidoscopy (Pro Cah),,G0104,HCPCS,Professional,Both,,,,1309,1112.65,34.46,1309,Aetna,Medicare Advantage,54.35,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Colorectal Cancer Screening; Flexible Sigmoidoscopy (Pro Cah),,G0104,HCPCS,Professional,Both,,,,1309,1112.65,34.46,1309,Aetna,PPO,1217.37,93,,percent of total billed charges,,
Colorectal Cancer Screening; Flexible Sigmoidoscopy (Pro Cah),,G0104,HCPCS,Professional,Both,,,,1309,1112.65,34.46,1309,America's PPO,America's PPO,1118.4096,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Colorectal Cancer Screening; Flexible Sigmoidoscopy (Pro Cah),,G0104,HCPCS,Professional,Both,,,,1309,1112.65,34.46,1309,BlueCross BlueShield Minnesota, Federal Employee Program,96.28,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Colorectal Cancer Screening; Flexible Sigmoidoscopy (Pro Cah),,G0104,HCPCS,Professional,Both,,,,1309,1112.65,34.46,1309,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,97.82048,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Colorectal Cancer Screening; Flexible Sigmoidoscopy (Pro Cah),,G0104,HCPCS,Professional,Both,,,,1309,1112.65,34.46,1309,BlueCross BlueShield Minnesota,Medicare Advantage,61.9275,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Colorectal Cancer Screening; Flexible Sigmoidoscopy (Pro Cah),,G0104,HCPCS,Professional,Both,,,,1309,1112.65,34.46,1309,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,97.82048,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Colorectal Cancer Screening; Flexible Sigmoidoscopy (Pro Cah),,G0104,HCPCS,Professional,Both,,,,1309,1112.65,34.46,1309,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,39.78656,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Colorectal Cancer Screening; Flexible Sigmoidoscopy (Pro Cah),,G0104,HCPCS,Professional,Both,,,,1309,1112.65,34.46,1309,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),61.9275,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Colorectal Cancer Screening; Flexible Sigmoidoscopy (Pro Cah),,G0104,HCPCS,Professional,Both,,,,1309,1112.65,34.46,1309,CorVel,Worker's Compensation,105.980826,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Colorectal Cancer Screening; Flexible Sigmoidoscopy (Pro Cah),,G0104,HCPCS,Professional,Both,,,,1309,1112.65,34.46,1309,First Health Group Corporation,First Health Network,1269.73,97,,percent of total billed charges,,
Colorectal Cancer Screening; Flexible Sigmoidoscopy (Pro Cah),,G0104,HCPCS,Professional,Both,,,,1309,1112.65,34.46,1309,"Health Partners, Inc.",Commercial,60.2,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Colorectal Cancer Screening; Flexible Sigmoidoscopy (Pro Cah),,G0104,HCPCS,Professional,Both,,,,1309,1112.65,34.46,1309,"Health Partners, Inc.",Medicare Advantage,61.9275,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Colorectal Cancer Screening; Flexible Sigmoidoscopy (Pro Cah),,G0104,HCPCS,Professional,Both,,,,1309,1112.65,34.46,1309,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),53.88,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Colorectal Cancer Screening; Flexible Sigmoidoscopy (Pro Cah),,G0104,HCPCS,Professional,Both,,,,1309,1112.65,34.46,1309,"Health Partners, Inc.",State of Minnesota Advantage Program,51.8623,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Colorectal Cancer Screening; Flexible Sigmoidoscopy (Pro Cah),,G0104,HCPCS,Professional,Both,,,,1309,1112.65,34.46,1309,"Health Partners, Inc.",State Public Programs,34.46,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Colorectal Cancer Screening; Flexible Sigmoidoscopy (Pro Cah),,G0104,HCPCS,Professional,Both,,,,1309,1112.65,34.46,1309,Humana Insurance Company,Commercial PPO,53.85,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Colorectal Cancer Screening; Flexible Sigmoidoscopy (Pro Cah),,G0104,HCPCS,Professional,Both,,,,1309,1112.65,34.46,1309,Humana Insurance Company,Medicare PPO,1309,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Colorectal Cancer Screening; Flexible Sigmoidoscopy (Pro Cah),,G0104,HCPCS,Professional,Both,,,,1309,1112.65,34.46,1309,Medica,Individual & Family,1110.032,84.8,,percent of total billed charges,,
Colorectal Cancer Screening; Flexible Sigmoidoscopy (Pro Cah),,G0104,HCPCS,Professional,Both,,,,1309,1112.65,34.46,1309,Medica,Medica Advantage Solution,651.882,49.8,,percent of total billed charges,,
Colorectal Cancer Screening; Flexible Sigmoidoscopy (Pro Cah),,G0104,HCPCS,Professional,Both,,,,1309,1112.65,34.46,1309,Medica,Medical Assistance,39.79,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Colorectal Cancer Screening; Flexible Sigmoidoscopy (Pro Cah),,G0104,HCPCS,Professional,Both,,,,1309,1112.65,34.46,1309,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,53.85,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Colorectal Cancer Screening; Flexible Sigmoidoscopy (Pro Cah),,G0104,HCPCS,Professional,Both,,,,1309,1112.65,34.46,1309,"Multiplan, Inc.","Multiplan, Inc.",1230.46,94,,percent of total billed charges,,
Colorectal Cancer Screening; Flexible Sigmoidoscopy (Pro Cah),,G0104,HCPCS,Professional,Both,,,,1309,1112.65,34.46,1309,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1179.409,90.1,,percent of total billed charges,,
Colorectal Cancer Screening; Flexible Sigmoidoscopy (Pro Cah),,G0104,HCPCS,Professional,Both,,,,1309,1112.65,34.46,1309,"Preferred One Administrative Services, INC.",PPO,1290.674,98.6,,percent of total billed charges,,
Colorectal Cancer Screening; Flexible Sigmoidoscopy (Pro Cah),,G0104,HCPCS,Professional,Both,,,,1309,1112.65,34.46,1309,PrimeWest Health,Minnesota Senior Health Options (MSHO),61.9275,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Colorectal Cancer Screening; Flexible Sigmoidoscopy (Pro Cah),,G0104,HCPCS,Professional,Both,,,,1309,1112.65,34.46,1309,PrimeWest Health,MinnesotaCare,42.5716192,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Colorectal Cancer Screening; Flexible Sigmoidoscopy (Pro Cah),,G0104,HCPCS,Professional,Both,,,,1309,1112.65,34.46,1309,Sanford Health Plan,Sanford Health Plan,1151.92,88,,percent of total billed charges,,
Colorectal Cancer Screening; Flexible Sigmoidoscopy (Pro Cah),,G0104,HCPCS,Professional,Both,,,,1309,1112.65,34.46,1309,"UCare Health, Inc.",Individual & Family Plan,87.53856,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Colorectal Cancer Screening; Flexible Sigmoidoscopy (Pro Cah),,G0104,HCPCS,Professional,Both,,,,1309,1112.65,34.46,1309,"UCare Health, Inc.",Medical Assistance,43.765216,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Colorectal Cancer Screening; Flexible Sigmoidoscopy (Pro Cah),,G0104,HCPCS,Professional,Both,,,,1309,1112.65,34.46,1309,"UCare Health, Inc.",Medicare Advantage,61.9275,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Colorectal Cancer Screening; Flexible Sigmoidoscopy (Pro Cah),,G0104,HCPCS,Professional,Both,,,,1309,1112.65,34.46,1309,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),49.542,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Colorectal Cancer Screening; Flexible Sigmoidoscopy (Pro Cah),,G0104,HCPCS,Professional,Both,,,,1309,1112.65,34.46,1309,UnitedHealthcare,Individual & Family,1309,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Colorectal Cancer Screening; Flexible Sigmoidoscopy (Pro Cah),,G0104,HCPCS,Professional,Both,,,,1309,1112.65,34.46,1309,UnitedHealthcare,Medicare Advantage,61.9275,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Colorectal Cancer Screening; Flexible Sigmoidoscopy (Pro Cah),,G0104,HCPCS,Professional,Both,,,,1309,1112.65,34.46,1309,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,39.78656,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Colorectal Cancer Screening;Colonoscopy On Individual At High Risk (Pro Cah),,G0105,HCPCS,Professional,Both,,,,816,693.6,112.56,816,Aetna,Commercial,693.6,85,,percent of total billed charges,,
Colorectal Cancer Screening;Colonoscopy On Individual At High Risk (Pro Cah),,G0105,HCPCS,Professional,Both,,,,816,693.6,112.56,816,Aetna,Medicare Advantage,179.95,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Colorectal Cancer Screening;Colonoscopy On Individual At High Risk (Pro Cah),,G0105,HCPCS,Professional,Both,,,,816,693.6,112.56,816,Aetna,PPO,758.88,93,,percent of total billed charges,,
Colorectal Cancer Screening;Colonoscopy On Individual At High Risk (Pro Cah),,G0105,HCPCS,Professional,Both,,,,816,693.6,112.56,816,America's PPO,America's PPO,697.1904,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Colorectal Cancer Screening;Colonoscopy On Individual At High Risk (Pro Cah),,G0105,HCPCS,Professional,Both,,,,816,693.6,112.56,816,BlueCross BlueShield Minnesota, Federal Employee Program,316.26,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Colorectal Cancer Screening;Colonoscopy On Individual At High Risk (Pro Cah),,G0105,HCPCS,Professional,Both,,,,816,693.6,112.56,816,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,321.32016,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Colorectal Cancer Screening;Colonoscopy On Individual At High Risk (Pro Cah),,G0105,HCPCS,Professional,Both,,,,816,693.6,112.56,816,BlueCross BlueShield Minnesota,Medicare Advantage,201.48,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Colorectal Cancer Screening;Colonoscopy On Individual At High Risk (Pro Cah),,G0105,HCPCS,Professional,Both,,,,816,693.6,112.56,816,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,321.32016,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Colorectal Cancer Screening;Colonoscopy On Individual At High Risk (Pro Cah),,G0105,HCPCS,Professional,Both,,,,816,693.6,112.56,816,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,129.95656,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Colorectal Cancer Screening;Colonoscopy On Individual At High Risk (Pro Cah),,G0105,HCPCS,Professional,Both,,,,816,693.6,112.56,816,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),201.48,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Colorectal Cancer Screening;Colonoscopy On Individual At High Risk (Pro Cah),,G0105,HCPCS,Professional,Both,,,,816,693.6,112.56,816,CorVel,Worker's Compensation,346.8537894,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Colorectal Cancer Screening;Colonoscopy On Individual At High Risk (Pro Cah),,G0105,HCPCS,Professional,Both,,,,816,693.6,112.56,816,First Health Group Corporation,First Health Network,791.52,97,,percent of total billed charges,,
Colorectal Cancer Screening;Colonoscopy On Individual At High Risk (Pro Cah),,G0105,HCPCS,Professional,Both,,,,816,693.6,112.56,816,"Health Partners, Inc.",Commercial,196.6,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Colorectal Cancer Screening;Colonoscopy On Individual At High Risk (Pro Cah),,G0105,HCPCS,Professional,Both,,,,816,693.6,112.56,816,"Health Partners, Inc.",Medicare Advantage,201.48,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Colorectal Cancer Screening;Colonoscopy On Individual At High Risk (Pro Cah),,G0105,HCPCS,Professional,Both,,,,816,693.6,112.56,816,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),175.2,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Colorectal Cancer Screening;Colonoscopy On Individual At High Risk (Pro Cah),,G0105,HCPCS,Professional,Both,,,,816,693.6,112.56,816,"Health Partners, Inc.",State of Minnesota Advantage Program,169.3709,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Colorectal Cancer Screening;Colonoscopy On Individual At High Risk (Pro Cah),,G0105,HCPCS,Professional,Both,,,,816,693.6,112.56,816,"Health Partners, Inc.",State Public Programs,112.56,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Colorectal Cancer Screening;Colonoscopy On Individual At High Risk (Pro Cah),,G0105,HCPCS,Professional,Both,,,,816,693.6,112.56,816,Humana Insurance Company,Commercial PPO,175.2,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Colorectal Cancer Screening;Colonoscopy On Individual At High Risk (Pro Cah),,G0105,HCPCS,Professional,Both,,,,816,693.6,112.56,816,Humana Insurance Company,Medicare PPO,816,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Colorectal Cancer Screening;Colonoscopy On Individual At High Risk (Pro Cah),,G0105,HCPCS,Professional,Both,,,,816,693.6,112.56,816,Medica,Individual & Family,691.968,84.8,,percent of total billed charges,,
Colorectal Cancer Screening;Colonoscopy On Individual At High Risk (Pro Cah),,G0105,HCPCS,Professional,Both,,,,816,693.6,112.56,816,Medica,Medica Advantage Solution,406.368,49.8,,percent of total billed charges,,
Colorectal Cancer Screening;Colonoscopy On Individual At High Risk (Pro Cah),,G0105,HCPCS,Professional,Both,,,,816,693.6,112.56,816,Medica,Medical Assistance,129.96,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Colorectal Cancer Screening;Colonoscopy On Individual At High Risk (Pro Cah),,G0105,HCPCS,Professional,Both,,,,816,693.6,112.56,816,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,175.2,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Colorectal Cancer Screening;Colonoscopy On Individual At High Risk (Pro Cah),,G0105,HCPCS,Professional,Both,,,,816,693.6,112.56,816,"Multiplan, Inc.","Multiplan, Inc.",767.04,94,,percent of total billed charges,,
Colorectal Cancer Screening;Colonoscopy On Individual At High Risk (Pro Cah),,G0105,HCPCS,Professional,Both,,,,816,693.6,112.56,816,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,735.216,90.1,,percent of total billed charges,,
Colorectal Cancer Screening;Colonoscopy On Individual At High Risk (Pro Cah),,G0105,HCPCS,Professional,Both,,,,816,693.6,112.56,816,"Preferred One Administrative Services, INC.",PPO,804.576,98.6,,percent of total billed charges,,
Colorectal Cancer Screening;Colonoscopy On Individual At High Risk (Pro Cah),,G0105,HCPCS,Professional,Both,,,,816,693.6,112.56,816,PrimeWest Health,Minnesota Senior Health Options (MSHO),201.48,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Colorectal Cancer Screening;Colonoscopy On Individual At High Risk (Pro Cah),,G0105,HCPCS,Professional,Both,,,,816,693.6,112.56,816,PrimeWest Health,MinnesotaCare,139.0535192,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Colorectal Cancer Screening;Colonoscopy On Individual At High Risk (Pro Cah),,G0105,HCPCS,Professional,Both,,,,816,693.6,112.56,816,Sanford Health Plan,Sanford Health Plan,718.08,88,,percent of total billed charges,,
Colorectal Cancer Screening;Colonoscopy On Individual At High Risk (Pro Cah),,G0105,HCPCS,Professional,Both,,,,816,693.6,112.56,816,"UCare Health, Inc.",Individual & Family Plan,284.80512,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Colorectal Cancer Screening;Colonoscopy On Individual At High Risk (Pro Cah),,G0105,HCPCS,Professional,Both,,,,816,693.6,112.56,816,"UCare Health, Inc.",Medical Assistance,142.952216,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Colorectal Cancer Screening;Colonoscopy On Individual At High Risk (Pro Cah),,G0105,HCPCS,Professional,Both,,,,816,693.6,112.56,816,"UCare Health, Inc.",Medicare Advantage,201.48,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Colorectal Cancer Screening;Colonoscopy On Individual At High Risk (Pro Cah),,G0105,HCPCS,Professional,Both,,,,816,693.6,112.56,816,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),161.184,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Colorectal Cancer Screening;Colonoscopy On Individual At High Risk (Pro Cah),,G0105,HCPCS,Professional,Both,,,,816,693.6,112.56,816,UnitedHealthcare,Individual & Family,816,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Colorectal Cancer Screening;Colonoscopy On Individual At High Risk (Pro Cah),,G0105,HCPCS,Professional,Both,,,,816,693.6,112.56,816,UnitedHealthcare,Medicare Advantage,201.48,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Colorectal Cancer Screening;Colonoscopy On Individual At High Risk (Pro Cah),,G0105,HCPCS,Professional,Both,,,,816,693.6,112.56,816,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,129.95656,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Dsmt Rd Comprehensive Individual,,G0108,HCPCS,Facility,Both,,,,58,49.3,16.6228,58,Aetna,Commercial,53.36,92,,percent of total billed charges,,
Dsmt Rd Comprehensive Individual,,G0108,HCPCS,Facility,Outpatient,,,,58,49.3,16.6228,58,Aetna,Medicare Advantage,28.42,49,,percent of total billed charges,,
Dsmt Rd Comprehensive Individual,,G0108,HCPCS,Facility,Inpatient,,,,58,49.3,16.6228,58,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Dsmt Rd Comprehensive Individual,,G0108,HCPCS,Facility,Both,,,,58,49.3,16.6228,58,Aetna,PPO,53.94,93,,percent of total billed charges,,
Dsmt Rd Comprehensive Individual,,G0108,HCPCS,Facility,Both,,,,58,49.3,16.6228,58,America's PPO,America's PPO,55.6974,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Dsmt Rd Comprehensive Individual,,G0108,HCPCS,Facility,Both,,,,58,49.3,16.6228,58,BlueCross BlueShield Minnesota, Federal Employee Program,57.072,98.4,,percent of total billed charges,,
Dsmt Rd Comprehensive Individual,,G0108,HCPCS,Facility,Both,,,,58,49.3,16.6228,58,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,58,100,,percent of total billed charges,,
Dsmt Rd Comprehensive Individual,,G0108,HCPCS,Facility,Both,,,,58,49.3,16.6228,58,BlueCross BlueShield Minnesota,High Value Network Plan,52.2,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
Dsmt Rd Comprehensive Individual,,G0108,HCPCS,Facility,Outpatient,,,,58,49.3,16.6228,58,BlueCross BlueShield Minnesota,Medicare Advantage,28.42,49,,percent of total billed charges,,
Dsmt Rd Comprehensive Individual,,G0108,HCPCS,Facility,Inpatient,,,,58,49.3,16.6228,58,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Dsmt Rd Comprehensive Individual,,G0108,HCPCS,Facility,Both,,,,58,49.3,16.6228,58,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,51.3706,88.57,,percent of total billed charges,,
Dsmt Rd Comprehensive Individual,,G0108,HCPCS,Facility,Both,,,,58,49.3,16.6228,58,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,16.6228,28.66,,percent of total billed charges,,
Dsmt Rd Comprehensive Individual,,G0108,HCPCS,Facility,Outpatient,,,,58,49.3,16.6228,58,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),28.42,49,,percent of total billed charges,,
Dsmt Rd Comprehensive Individual,,G0108,HCPCS,Facility,Inpatient,,,,58,49.3,16.6228,58,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Dsmt Rd Comprehensive Individual,,G0108,HCPCS,Facility,Both,,,,58,49.3,16.6228,58,CorVel,Worker's Compensation,58,100,,percent of total billed charges,,
Dsmt Rd Comprehensive Individual,,G0108,HCPCS,Facility,Both,,,,58,49.3,16.6228,58,First Health Group Corporation,First Health Network,56.26,97,,percent of total billed charges,,
Dsmt Rd Comprehensive Individual,,G0108,HCPCS,Facility,Both,,,,58,49.3,16.6228,58,"Health Partners, Inc.",Commercial,54.868,94.6,,percent of total billed charges,,
Dsmt Rd Comprehensive Individual,,G0108,HCPCS,Facility,Outpatient,,,,58,49.3,16.6228,58,"Health Partners, Inc.",Medicare Advantage,28.42,49,,percent of total billed charges,,
Dsmt Rd Comprehensive Individual,,G0108,HCPCS,Facility,Inpatient,,,,58,49.3,16.6228,58,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Dsmt Rd Comprehensive Individual,,G0108,HCPCS,Facility,Both,,,,58,49.3,16.6228,58,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),34.8,60,,percent of total billed charges,,
Dsmt Rd Comprehensive Individual,,G0108,HCPCS,Facility,Both,,,,58,49.3,16.6228,58,"Health Partners, Inc.",State of Minnesota Advantage Program,47.27,81.5,,percent of total billed charges,,
Dsmt Rd Comprehensive Individual,,G0108,HCPCS,Facility,Both,,,,58,49.3,16.6228,58,"Health Partners, Inc.",State Public Programs,29,50,,percent of total billed charges,,
Dsmt Rd Comprehensive Individual,,G0108,HCPCS,Facility,Both,,,,58,49.3,16.6228,58,Humana Insurance Company,Commercial PPO,55.1,95,,percent of total billed charges,,
Dsmt Rd Comprehensive Individual,,G0108,HCPCS,Facility,Outpatient,,,,58,49.3,16.6228,58,Humana Insurance Company,Medicare PPO,28.42,49,,percent of total billed charges,,
Dsmt Rd Comprehensive Individual,,G0108,HCPCS,Facility,Inpatient,,,,58,49.3,16.6228,58,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Dsmt Rd Comprehensive Individual,,G0108,HCPCS,Facility,Both,,,,58,49.3,16.6228,58,Medica,Individual & Family,57.478,99.1,,percent of total billed charges,,
Dsmt Rd Comprehensive Individual,,G0108,HCPCS,Facility,Outpatient,,,,58,49.3,16.6228,58,Medica,Medica Advantage Solution,28.884,49.8,,percent of total billed charges,,
Dsmt Rd Comprehensive Individual,,G0108,HCPCS,Facility,Inpatient,,,,58,49.3,16.6228,58,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Dsmt Rd Comprehensive Individual,,G0108,HCPCS,Facility,Outpatient,,,,58,49.3,16.6228,58,Medica,Medical Assistance,25.868,44.6,,percent of total billed charges,,
Dsmt Rd Comprehensive Individual,,G0108,HCPCS,Facility,Inpatient,,,,58,49.3,16.6228,58,Medica,Medical Assistance,,,,,Included in per diem rate,
Dsmt Rd Comprehensive Individual,,G0108,HCPCS,Facility,Outpatient,,,,58,49.3,16.6228,58,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,28.884,49.8,,percent of total billed charges,,
Dsmt Rd Comprehensive Individual,,G0108,HCPCS,Facility,Inpatient,,,,58,49.3,16.6228,58,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Dsmt Rd Comprehensive Individual,,G0108,HCPCS,Facility,Both,,,,58,49.3,16.6228,58,"Multiplan, Inc.","Multiplan, Inc.",54.52,94,,percent of total billed charges,,
Dsmt Rd Comprehensive Individual,,G0108,HCPCS,Facility,Outpatient,,,,58,49.3,16.6228,58,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,52.258,90.1,,percent of total billed charges,,
Dsmt Rd Comprehensive Individual,,G0108,HCPCS,Facility,Inpatient,,,,58,49.3,16.6228,58,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Dsmt Rd Comprehensive Individual,,G0108,HCPCS,Facility,Both,,,,58,49.3,16.6228,58,"Preferred One Administrative Services, INC.",PPO,57.188,98.6,,percent of total billed charges,,
Dsmt Rd Comprehensive Individual,,G0108,HCPCS,Facility,Outpatient,,,,58,49.3,16.6228,58,PrimeWest Health,Minnesota Senior Health Options (MSHO),29.841,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Dsmt Rd Comprehensive Individual,,G0108,HCPCS,Facility,Inpatient,,,,58,49.3,16.6228,58,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Dsmt Rd Comprehensive Individual,,G0108,HCPCS,Facility,Outpatient,,,,58,49.3,16.6228,58,PrimeWest Health,MinnesotaCare,29.7888,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Dsmt Rd Comprehensive Individual,,G0108,HCPCS,Facility,Inpatient,,,,58,49.3,16.6228,58,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Dsmt Rd Comprehensive Individual,,G0108,HCPCS,Facility,Both,,,,58,49.3,16.6228,58,Sanford Health Plan,Sanford Health Plan,53.36,92,,percent of total billed charges,,
Dsmt Rd Comprehensive Individual,,G0108,HCPCS,Facility,Outpatient,,,,58,49.3,16.6228,58,"UCare Health, Inc.",Individual & Family Plan,32.683,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Dsmt Rd Comprehensive Individual,,G0108,HCPCS,Facility,Inpatient,,,,58,49.3,16.6228,58,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Dsmt Rd Comprehensive Individual,,G0108,HCPCS,Facility,Outpatient,,,,58,49.3,16.6228,58,"UCare Health, Inc.",Medical Assistance,29.2726,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Dsmt Rd Comprehensive Individual,,G0108,HCPCS,Facility,Inpatient,,,,58,49.3,16.6228,58,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Dsmt Rd Comprehensive Individual,,G0108,HCPCS,Facility,Outpatient,,,,58,49.3,16.6228,58,"UCare Health, Inc.",Medicare Advantage,29.2726,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Dsmt Rd Comprehensive Individual,,G0108,HCPCS,Facility,Inpatient,,,,58,49.3,16.6228,58,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Dsmt Rd Comprehensive Individual,,G0108,HCPCS,Facility,Outpatient,,,,58,49.3,16.6228,58,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),29.2726,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Dsmt Rd Comprehensive Individual,,G0108,HCPCS,Facility,Inpatient,,,,58,49.3,16.6228,58,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Dsmt Rd Comprehensive Individual,,G0108,HCPCS,Facility,Both,,,,58,49.3,16.6228,58,UnitedHealthcare,Individual & Family,54.52,94,,percent of total billed charges,,
Dsmt Rd Comprehensive Individual,,G0108,HCPCS,Facility,Outpatient,,,,58,49.3,16.6228,58,UnitedHealthcare,Medicare Advantage,28.42,49,,percent of total billed charges,,
Dsmt Rd Comprehensive Individual,,G0108,HCPCS,Facility,Inpatient,,,,58,49.3,16.6228,58,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Dsmt Rd Comprehensive Individual,,G0108,HCPCS,Facility,Outpatient,,,,58,49.3,16.6228,58,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,27.84,48,,percent of total billed charges,,100% of DHS outpatient percentage
Dsmt Rd Comprehensive Individual,,G0108,HCPCS,Facility,Inpatient,,,,58,49.3,16.6228,58,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Dsmt Rd Comprehensive Initial,,G0108,HCPCS,Facility,Both,,,,65,55.25,18.629,65,Aetna,Commercial,59.8,92,,percent of total billed charges,,
Dsmt Rd Comprehensive Initial,,G0108,HCPCS,Facility,Outpatient,,,,65,55.25,18.629,65,Aetna,Medicare Advantage,31.85,49,,percent of total billed charges,,
Dsmt Rd Comprehensive Initial,,G0108,HCPCS,Facility,Inpatient,,,,65,55.25,18.629,65,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Dsmt Rd Comprehensive Initial,,G0108,HCPCS,Facility,Both,,,,65,55.25,18.629,65,Aetna,PPO,60.45,93,,percent of total billed charges,,
Dsmt Rd Comprehensive Initial,,G0108,HCPCS,Facility,Both,,,,65,55.25,18.629,65,America's PPO,America's PPO,62.4195,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Dsmt Rd Comprehensive Initial,,G0108,HCPCS,Facility,Both,,,,65,55.25,18.629,65,BlueCross BlueShield Minnesota, Federal Employee Program,63.96,98.4,,percent of total billed charges,,
Dsmt Rd Comprehensive Initial,,G0108,HCPCS,Facility,Both,,,,65,55.25,18.629,65,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,65,100,,percent of total billed charges,,
Dsmt Rd Comprehensive Initial,,G0108,HCPCS,Facility,Both,,,,65,55.25,18.629,65,BlueCross BlueShield Minnesota,High Value Network Plan,58.5,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
Dsmt Rd Comprehensive Initial,,G0108,HCPCS,Facility,Outpatient,,,,65,55.25,18.629,65,BlueCross BlueShield Minnesota,Medicare Advantage,31.85,49,,percent of total billed charges,,
Dsmt Rd Comprehensive Initial,,G0108,HCPCS,Facility,Inpatient,,,,65,55.25,18.629,65,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Dsmt Rd Comprehensive Initial,,G0108,HCPCS,Facility,Both,,,,65,55.25,18.629,65,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,57.5705,88.57,,percent of total billed charges,,
Dsmt Rd Comprehensive Initial,,G0108,HCPCS,Facility,Both,,,,65,55.25,18.629,65,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,18.629,28.66,,percent of total billed charges,,
Dsmt Rd Comprehensive Initial,,G0108,HCPCS,Facility,Outpatient,,,,65,55.25,18.629,65,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),31.85,49,,percent of total billed charges,,
Dsmt Rd Comprehensive Initial,,G0108,HCPCS,Facility,Inpatient,,,,65,55.25,18.629,65,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Dsmt Rd Comprehensive Initial,,G0108,HCPCS,Facility,Both,,,,65,55.25,18.629,65,CorVel,Worker's Compensation,65,100,,percent of total billed charges,,
Dsmt Rd Comprehensive Initial,,G0108,HCPCS,Facility,Both,,,,65,55.25,18.629,65,First Health Group Corporation,First Health Network,63.05,97,,percent of total billed charges,,
Dsmt Rd Comprehensive Initial,,G0108,HCPCS,Facility,Both,,,,65,55.25,18.629,65,"Health Partners, Inc.",Commercial,61.49,94.6,,percent of total billed charges,,
Dsmt Rd Comprehensive Initial,,G0108,HCPCS,Facility,Outpatient,,,,65,55.25,18.629,65,"Health Partners, Inc.",Medicare Advantage,31.85,49,,percent of total billed charges,,
Dsmt Rd Comprehensive Initial,,G0108,HCPCS,Facility,Inpatient,,,,65,55.25,18.629,65,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Dsmt Rd Comprehensive Initial,,G0108,HCPCS,Facility,Both,,,,65,55.25,18.629,65,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),39,60,,percent of total billed charges,,
Dsmt Rd Comprehensive Initial,,G0108,HCPCS,Facility,Both,,,,65,55.25,18.629,65,"Health Partners, Inc.",State of Minnesota Advantage Program,52.975,81.5,,percent of total billed charges,,
Dsmt Rd Comprehensive Initial,,G0108,HCPCS,Facility,Both,,,,65,55.25,18.629,65,"Health Partners, Inc.",State Public Programs,32.5,50,,percent of total billed charges,,
Dsmt Rd Comprehensive Initial,,G0108,HCPCS,Facility,Both,,,,65,55.25,18.629,65,Humana Insurance Company,Commercial PPO,61.75,95,,percent of total billed charges,,
Dsmt Rd Comprehensive Initial,,G0108,HCPCS,Facility,Outpatient,,,,65,55.25,18.629,65,Humana Insurance Company,Medicare PPO,31.85,49,,percent of total billed charges,,
Dsmt Rd Comprehensive Initial,,G0108,HCPCS,Facility,Inpatient,,,,65,55.25,18.629,65,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Dsmt Rd Comprehensive Initial,,G0108,HCPCS,Facility,Both,,,,65,55.25,18.629,65,Medica,Individual & Family,64.415,99.1,,percent of total billed charges,,
Dsmt Rd Comprehensive Initial,,G0108,HCPCS,Facility,Outpatient,,,,65,55.25,18.629,65,Medica,Medica Advantage Solution,32.37,49.8,,percent of total billed charges,,
Dsmt Rd Comprehensive Initial,,G0108,HCPCS,Facility,Inpatient,,,,65,55.25,18.629,65,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Dsmt Rd Comprehensive Initial,,G0108,HCPCS,Facility,Outpatient,,,,65,55.25,18.629,65,Medica,Medical Assistance,28.99,44.6,,percent of total billed charges,,
Dsmt Rd Comprehensive Initial,,G0108,HCPCS,Facility,Inpatient,,,,65,55.25,18.629,65,Medica,Medical Assistance,,,,,Included in per diem rate,
Dsmt Rd Comprehensive Initial,,G0108,HCPCS,Facility,Outpatient,,,,65,55.25,18.629,65,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,32.37,49.8,,percent of total billed charges,,
Dsmt Rd Comprehensive Initial,,G0108,HCPCS,Facility,Inpatient,,,,65,55.25,18.629,65,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Dsmt Rd Comprehensive Initial,,G0108,HCPCS,Facility,Both,,,,65,55.25,18.629,65,"Multiplan, Inc.","Multiplan, Inc.",61.1,94,,percent of total billed charges,,
Dsmt Rd Comprehensive Initial,,G0108,HCPCS,Facility,Outpatient,,,,65,55.25,18.629,65,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,58.565,90.1,,percent of total billed charges,,
Dsmt Rd Comprehensive Initial,,G0108,HCPCS,Facility,Inpatient,,,,65,55.25,18.629,65,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Dsmt Rd Comprehensive Initial,,G0108,HCPCS,Facility,Both,,,,65,55.25,18.629,65,"Preferred One Administrative Services, INC.",PPO,64.09,98.6,,percent of total billed charges,,
Dsmt Rd Comprehensive Initial,,G0108,HCPCS,Facility,Outpatient,,,,65,55.25,18.629,65,PrimeWest Health,Minnesota Senior Health Options (MSHO),33.4425,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Dsmt Rd Comprehensive Initial,,G0108,HCPCS,Facility,Inpatient,,,,65,55.25,18.629,65,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Dsmt Rd Comprehensive Initial,,G0108,HCPCS,Facility,Outpatient,,,,65,55.25,18.629,65,PrimeWest Health,MinnesotaCare,33.384,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Dsmt Rd Comprehensive Initial,,G0108,HCPCS,Facility,Inpatient,,,,65,55.25,18.629,65,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Dsmt Rd Comprehensive Initial,,G0108,HCPCS,Facility,Both,,,,65,55.25,18.629,65,Sanford Health Plan,Sanford Health Plan,59.8,92,,percent of total billed charges,,
Dsmt Rd Comprehensive Initial,,G0108,HCPCS,Facility,Outpatient,,,,65,55.25,18.629,65,"UCare Health, Inc.",Individual & Family Plan,36.6275,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Dsmt Rd Comprehensive Initial,,G0108,HCPCS,Facility,Inpatient,,,,65,55.25,18.629,65,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Dsmt Rd Comprehensive Initial,,G0108,HCPCS,Facility,Outpatient,,,,65,55.25,18.629,65,"UCare Health, Inc.",Medical Assistance,32.8055,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Dsmt Rd Comprehensive Initial,,G0108,HCPCS,Facility,Inpatient,,,,65,55.25,18.629,65,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Dsmt Rd Comprehensive Initial,,G0108,HCPCS,Facility,Outpatient,,,,65,55.25,18.629,65,"UCare Health, Inc.",Medicare Advantage,32.8055,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Dsmt Rd Comprehensive Initial,,G0108,HCPCS,Facility,Inpatient,,,,65,55.25,18.629,65,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Dsmt Rd Comprehensive Initial,,G0108,HCPCS,Facility,Outpatient,,,,65,55.25,18.629,65,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),32.8055,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Dsmt Rd Comprehensive Initial,,G0108,HCPCS,Facility,Inpatient,,,,65,55.25,18.629,65,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Dsmt Rd Comprehensive Initial,,G0108,HCPCS,Facility,Both,,,,65,55.25,18.629,65,UnitedHealthcare,Individual & Family,61.1,94,,percent of total billed charges,,
Dsmt Rd Comprehensive Initial,,G0108,HCPCS,Facility,Outpatient,,,,65,55.25,18.629,65,UnitedHealthcare,Medicare Advantage,31.85,49,,percent of total billed charges,,
Dsmt Rd Comprehensive Initial,,G0108,HCPCS,Facility,Inpatient,,,,65,55.25,18.629,65,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Dsmt Rd Comprehensive Initial,,G0108,HCPCS,Facility,Outpatient,,,,65,55.25,18.629,65,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,31.2,48,,percent of total billed charges,,100% of DHS outpatient percentage
Dsmt Rd Comprehensive Initial,,G0108,HCPCS,Facility,Inpatient,,,,65,55.25,18.629,65,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Dsmt Rd Post-Program/Follow Up/Annual,,G0108,HCPCS,Facility,Both,,,,50,42.5,14.33,50,Aetna,Commercial,46,92,,percent of total billed charges,,
Dsmt Rd Post-Program/Follow Up/Annual,,G0108,HCPCS,Facility,Outpatient,,,,50,42.5,14.33,50,Aetna,Medicare Advantage,24.5,49,,percent of total billed charges,,
Dsmt Rd Post-Program/Follow Up/Annual,,G0108,HCPCS,Facility,Inpatient,,,,50,42.5,14.33,50,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Dsmt Rd Post-Program/Follow Up/Annual,,G0108,HCPCS,Facility,Both,,,,50,42.5,14.33,50,Aetna,PPO,46.5,93,,percent of total billed charges,,
Dsmt Rd Post-Program/Follow Up/Annual,,G0108,HCPCS,Facility,Both,,,,50,42.5,14.33,50,America's PPO,America's PPO,48.015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Dsmt Rd Post-Program/Follow Up/Annual,,G0108,HCPCS,Facility,Both,,,,50,42.5,14.33,50,BlueCross BlueShield Minnesota, Federal Employee Program,49.2,98.4,,percent of total billed charges,,
Dsmt Rd Post-Program/Follow Up/Annual,,G0108,HCPCS,Facility,Both,,,,50,42.5,14.33,50,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,50,100,,percent of total billed charges,,
Dsmt Rd Post-Program/Follow Up/Annual,,G0108,HCPCS,Facility,Both,,,,50,42.5,14.33,50,BlueCross BlueShield Minnesota,High Value Network Plan,45,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
Dsmt Rd Post-Program/Follow Up/Annual,,G0108,HCPCS,Facility,Outpatient,,,,50,42.5,14.33,50,BlueCross BlueShield Minnesota,Medicare Advantage,24.5,49,,percent of total billed charges,,
Dsmt Rd Post-Program/Follow Up/Annual,,G0108,HCPCS,Facility,Inpatient,,,,50,42.5,14.33,50,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Dsmt Rd Post-Program/Follow Up/Annual,,G0108,HCPCS,Facility,Both,,,,50,42.5,14.33,50,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,44.285,88.57,,percent of total billed charges,,
Dsmt Rd Post-Program/Follow Up/Annual,,G0108,HCPCS,Facility,Both,,,,50,42.5,14.33,50,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,14.33,28.66,,percent of total billed charges,,
Dsmt Rd Post-Program/Follow Up/Annual,,G0108,HCPCS,Facility,Outpatient,,,,50,42.5,14.33,50,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),24.5,49,,percent of total billed charges,,
Dsmt Rd Post-Program/Follow Up/Annual,,G0108,HCPCS,Facility,Inpatient,,,,50,42.5,14.33,50,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Dsmt Rd Post-Program/Follow Up/Annual,,G0108,HCPCS,Facility,Both,,,,50,42.5,14.33,50,CorVel,Worker's Compensation,50,100,,percent of total billed charges,,
Dsmt Rd Post-Program/Follow Up/Annual,,G0108,HCPCS,Facility,Both,,,,50,42.5,14.33,50,First Health Group Corporation,First Health Network,48.5,97,,percent of total billed charges,,
Dsmt Rd Post-Program/Follow Up/Annual,,G0108,HCPCS,Facility,Both,,,,50,42.5,14.33,50,"Health Partners, Inc.",Commercial,47.3,94.6,,percent of total billed charges,,
Dsmt Rd Post-Program/Follow Up/Annual,,G0108,HCPCS,Facility,Outpatient,,,,50,42.5,14.33,50,"Health Partners, Inc.",Medicare Advantage,24.5,49,,percent of total billed charges,,
Dsmt Rd Post-Program/Follow Up/Annual,,G0108,HCPCS,Facility,Inpatient,,,,50,42.5,14.33,50,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Dsmt Rd Post-Program/Follow Up/Annual,,G0108,HCPCS,Facility,Both,,,,50,42.5,14.33,50,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),30,60,,percent of total billed charges,,
Dsmt Rd Post-Program/Follow Up/Annual,,G0108,HCPCS,Facility,Both,,,,50,42.5,14.33,50,"Health Partners, Inc.",State of Minnesota Advantage Program,40.75,81.5,,percent of total billed charges,,
Dsmt Rd Post-Program/Follow Up/Annual,,G0108,HCPCS,Facility,Both,,,,50,42.5,14.33,50,"Health Partners, Inc.",State Public Programs,25,50,,percent of total billed charges,,
Dsmt Rd Post-Program/Follow Up/Annual,,G0108,HCPCS,Facility,Both,,,,50,42.5,14.33,50,Humana Insurance Company,Commercial PPO,47.5,95,,percent of total billed charges,,
Dsmt Rd Post-Program/Follow Up/Annual,,G0108,HCPCS,Facility,Outpatient,,,,50,42.5,14.33,50,Humana Insurance Company,Medicare PPO,24.5,49,,percent of total billed charges,,
Dsmt Rd Post-Program/Follow Up/Annual,,G0108,HCPCS,Facility,Inpatient,,,,50,42.5,14.33,50,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Dsmt Rd Post-Program/Follow Up/Annual,,G0108,HCPCS,Facility,Both,,,,50,42.5,14.33,50,Medica,Individual & Family,49.55,99.1,,percent of total billed charges,,
Dsmt Rd Post-Program/Follow Up/Annual,,G0108,HCPCS,Facility,Outpatient,,,,50,42.5,14.33,50,Medica,Medica Advantage Solution,24.9,49.8,,percent of total billed charges,,
Dsmt Rd Post-Program/Follow Up/Annual,,G0108,HCPCS,Facility,Inpatient,,,,50,42.5,14.33,50,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Dsmt Rd Post-Program/Follow Up/Annual,,G0108,HCPCS,Facility,Outpatient,,,,50,42.5,14.33,50,Medica,Medical Assistance,22.3,44.6,,percent of total billed charges,,
Dsmt Rd Post-Program/Follow Up/Annual,,G0108,HCPCS,Facility,Inpatient,,,,50,42.5,14.33,50,Medica,Medical Assistance,,,,,Included in per diem rate,
Dsmt Rd Post-Program/Follow Up/Annual,,G0108,HCPCS,Facility,Outpatient,,,,50,42.5,14.33,50,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,24.9,49.8,,percent of total billed charges,,
Dsmt Rd Post-Program/Follow Up/Annual,,G0108,HCPCS,Facility,Inpatient,,,,50,42.5,14.33,50,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Dsmt Rd Post-Program/Follow Up/Annual,,G0108,HCPCS,Facility,Both,,,,50,42.5,14.33,50,"Multiplan, Inc.","Multiplan, Inc.",47,94,,percent of total billed charges,,
Dsmt Rd Post-Program/Follow Up/Annual,,G0108,HCPCS,Facility,Outpatient,,,,50,42.5,14.33,50,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,45.05,90.1,,percent of total billed charges,,
Dsmt Rd Post-Program/Follow Up/Annual,,G0108,HCPCS,Facility,Inpatient,,,,50,42.5,14.33,50,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Dsmt Rd Post-Program/Follow Up/Annual,,G0108,HCPCS,Facility,Both,,,,50,42.5,14.33,50,"Preferred One Administrative Services, INC.",PPO,49.3,98.6,,percent of total billed charges,,
Dsmt Rd Post-Program/Follow Up/Annual,,G0108,HCPCS,Facility,Outpatient,,,,50,42.5,14.33,50,PrimeWest Health,Minnesota Senior Health Options (MSHO),25.725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Dsmt Rd Post-Program/Follow Up/Annual,,G0108,HCPCS,Facility,Inpatient,,,,50,42.5,14.33,50,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Dsmt Rd Post-Program/Follow Up/Annual,,G0108,HCPCS,Facility,Outpatient,,,,50,42.5,14.33,50,PrimeWest Health,MinnesotaCare,25.68,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Dsmt Rd Post-Program/Follow Up/Annual,,G0108,HCPCS,Facility,Inpatient,,,,50,42.5,14.33,50,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Dsmt Rd Post-Program/Follow Up/Annual,,G0108,HCPCS,Facility,Both,,,,50,42.5,14.33,50,Sanford Health Plan,Sanford Health Plan,46,92,,percent of total billed charges,,
Dsmt Rd Post-Program/Follow Up/Annual,,G0108,HCPCS,Facility,Outpatient,,,,50,42.5,14.33,50,"UCare Health, Inc.",Individual & Family Plan,28.175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Dsmt Rd Post-Program/Follow Up/Annual,,G0108,HCPCS,Facility,Inpatient,,,,50,42.5,14.33,50,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Dsmt Rd Post-Program/Follow Up/Annual,,G0108,HCPCS,Facility,Outpatient,,,,50,42.5,14.33,50,"UCare Health, Inc.",Medical Assistance,25.235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Dsmt Rd Post-Program/Follow Up/Annual,,G0108,HCPCS,Facility,Inpatient,,,,50,42.5,14.33,50,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Dsmt Rd Post-Program/Follow Up/Annual,,G0108,HCPCS,Facility,Outpatient,,,,50,42.5,14.33,50,"UCare Health, Inc.",Medicare Advantage,25.235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Dsmt Rd Post-Program/Follow Up/Annual,,G0108,HCPCS,Facility,Inpatient,,,,50,42.5,14.33,50,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Dsmt Rd Post-Program/Follow Up/Annual,,G0108,HCPCS,Facility,Outpatient,,,,50,42.5,14.33,50,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),25.235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Dsmt Rd Post-Program/Follow Up/Annual,,G0108,HCPCS,Facility,Inpatient,,,,50,42.5,14.33,50,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Dsmt Rd Post-Program/Follow Up/Annual,,G0108,HCPCS,Facility,Both,,,,50,42.5,14.33,50,UnitedHealthcare,Individual & Family,47,94,,percent of total billed charges,,
Dsmt Rd Post-Program/Follow Up/Annual,,G0108,HCPCS,Facility,Outpatient,,,,50,42.5,14.33,50,UnitedHealthcare,Medicare Advantage,24.5,49,,percent of total billed charges,,
Dsmt Rd Post-Program/Follow Up/Annual,,G0108,HCPCS,Facility,Inpatient,,,,50,42.5,14.33,50,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Dsmt Rd Post-Program/Follow Up/Annual,,G0108,HCPCS,Facility,Outpatient,,,,50,42.5,14.33,50,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,24,48,,percent of total billed charges,,100% of DHS outpatient percentage
Dsmt Rd Post-Program/Follow Up/Annual,,G0108,HCPCS,Facility,Inpatient,,,,50,42.5,14.33,50,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Dsmt Group (30 Min),,G0109,HCPCS,Facility,Both,,,,34,28.9,9.7444,34,Aetna,Commercial,31.28,92,,percent of total billed charges,,
Dsmt Group (30 Min),,G0109,HCPCS,Facility,Outpatient,,,,34,28.9,9.7444,34,Aetna,Medicare Advantage,16.66,49,,percent of total billed charges,,
Dsmt Group (30 Min),,G0109,HCPCS,Facility,Inpatient,,,,34,28.9,9.7444,34,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Dsmt Group (30 Min),,G0109,HCPCS,Facility,Both,,,,34,28.9,9.7444,34,Aetna,PPO,31.62,93,,percent of total billed charges,,
Dsmt Group (30 Min),,G0109,HCPCS,Facility,Both,,,,34,28.9,9.7444,34,America's PPO,America's PPO,32.6502,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Dsmt Group (30 Min),,G0109,HCPCS,Facility,Both,,,,34,28.9,9.7444,34,BlueCross BlueShield Minnesota, Federal Employee Program,33.456,98.4,,percent of total billed charges,,
Dsmt Group (30 Min),,G0109,HCPCS,Facility,Both,,,,34,28.9,9.7444,34,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,34,100,,percent of total billed charges,,
Dsmt Group (30 Min),,G0109,HCPCS,Facility,Both,,,,34,28.9,9.7444,34,BlueCross BlueShield Minnesota,High Value Network Plan,30.6,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
Dsmt Group (30 Min),,G0109,HCPCS,Facility,Outpatient,,,,34,28.9,9.7444,34,BlueCross BlueShield Minnesota,Medicare Advantage,16.66,49,,percent of total billed charges,,
Dsmt Group (30 Min),,G0109,HCPCS,Facility,Inpatient,,,,34,28.9,9.7444,34,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Dsmt Group (30 Min),,G0109,HCPCS,Facility,Both,,,,34,28.9,9.7444,34,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,30.1138,88.57,,percent of total billed charges,,
Dsmt Group (30 Min),,G0109,HCPCS,Facility,Both,,,,34,28.9,9.7444,34,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,9.7444,28.66,,percent of total billed charges,,
Dsmt Group (30 Min),,G0109,HCPCS,Facility,Outpatient,,,,34,28.9,9.7444,34,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),16.66,49,,percent of total billed charges,,
Dsmt Group (30 Min),,G0109,HCPCS,Facility,Inpatient,,,,34,28.9,9.7444,34,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Dsmt Group (30 Min),,G0109,HCPCS,Facility,Both,,,,34,28.9,9.7444,34,CorVel,Worker's Compensation,34,100,,percent of total billed charges,,
Dsmt Group (30 Min),,G0109,HCPCS,Facility,Both,,,,34,28.9,9.7444,34,First Health Group Corporation,First Health Network,32.98,97,,percent of total billed charges,,
Dsmt Group (30 Min),,G0109,HCPCS,Facility,Both,,,,34,28.9,9.7444,34,"Health Partners, Inc.",Commercial,32.164,94.6,,percent of total billed charges,,
Dsmt Group (30 Min),,G0109,HCPCS,Facility,Outpatient,,,,34,28.9,9.7444,34,"Health Partners, Inc.",Medicare Advantage,16.66,49,,percent of total billed charges,,
Dsmt Group (30 Min),,G0109,HCPCS,Facility,Inpatient,,,,34,28.9,9.7444,34,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Dsmt Group (30 Min),,G0109,HCPCS,Facility,Both,,,,34,28.9,9.7444,34,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),20.4,60,,percent of total billed charges,,
Dsmt Group (30 Min),,G0109,HCPCS,Facility,Both,,,,34,28.9,9.7444,34,"Health Partners, Inc.",State of Minnesota Advantage Program,27.71,81.5,,percent of total billed charges,,
Dsmt Group (30 Min),,G0109,HCPCS,Facility,Both,,,,34,28.9,9.7444,34,"Health Partners, Inc.",State Public Programs,17,50,,percent of total billed charges,,
Dsmt Group (30 Min),,G0109,HCPCS,Facility,Both,,,,34,28.9,9.7444,34,Humana Insurance Company,Commercial PPO,32.3,95,,percent of total billed charges,,
Dsmt Group (30 Min),,G0109,HCPCS,Facility,Outpatient,,,,34,28.9,9.7444,34,Humana Insurance Company,Medicare PPO,16.66,49,,percent of total billed charges,,
Dsmt Group (30 Min),,G0109,HCPCS,Facility,Inpatient,,,,34,28.9,9.7444,34,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Dsmt Group (30 Min),,G0109,HCPCS,Facility,Both,,,,34,28.9,9.7444,34,Medica,Individual & Family,33.694,99.1,,percent of total billed charges,,
Dsmt Group (30 Min),,G0109,HCPCS,Facility,Outpatient,,,,34,28.9,9.7444,34,Medica,Medica Advantage Solution,16.932,49.8,,percent of total billed charges,,
Dsmt Group (30 Min),,G0109,HCPCS,Facility,Inpatient,,,,34,28.9,9.7444,34,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Dsmt Group (30 Min),,G0109,HCPCS,Facility,Outpatient,,,,34,28.9,9.7444,34,Medica,Medical Assistance,15.164,44.6,,percent of total billed charges,,
Dsmt Group (30 Min),,G0109,HCPCS,Facility,Inpatient,,,,34,28.9,9.7444,34,Medica,Medical Assistance,,,,,Included in per diem rate,
Dsmt Group (30 Min),,G0109,HCPCS,Facility,Outpatient,,,,34,28.9,9.7444,34,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,16.932,49.8,,percent of total billed charges,,
Dsmt Group (30 Min),,G0109,HCPCS,Facility,Inpatient,,,,34,28.9,9.7444,34,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Dsmt Group (30 Min),,G0109,HCPCS,Facility,Both,,,,34,28.9,9.7444,34,"Multiplan, Inc.","Multiplan, Inc.",31.96,94,,percent of total billed charges,,
Dsmt Group (30 Min),,G0109,HCPCS,Facility,Outpatient,,,,34,28.9,9.7444,34,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,30.634,90.1,,percent of total billed charges,,
Dsmt Group (30 Min),,G0109,HCPCS,Facility,Inpatient,,,,34,28.9,9.7444,34,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Dsmt Group (30 Min),,G0109,HCPCS,Facility,Both,,,,34,28.9,9.7444,34,"Preferred One Administrative Services, INC.",PPO,33.524,98.6,,percent of total billed charges,,
Dsmt Group (30 Min),,G0109,HCPCS,Facility,Outpatient,,,,34,28.9,9.7444,34,PrimeWest Health,Minnesota Senior Health Options (MSHO),17.493,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Dsmt Group (30 Min),,G0109,HCPCS,Facility,Inpatient,,,,34,28.9,9.7444,34,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Dsmt Group (30 Min),,G0109,HCPCS,Facility,Outpatient,,,,34,28.9,9.7444,34,PrimeWest Health,MinnesotaCare,17.4624,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Dsmt Group (30 Min),,G0109,HCPCS,Facility,Inpatient,,,,34,28.9,9.7444,34,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Dsmt Group (30 Min),,G0109,HCPCS,Facility,Both,,,,34,28.9,9.7444,34,Sanford Health Plan,Sanford Health Plan,31.28,92,,percent of total billed charges,,
Dsmt Group (30 Min),,G0109,HCPCS,Facility,Outpatient,,,,34,28.9,9.7444,34,"UCare Health, Inc.",Individual & Family Plan,19.159,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Dsmt Group (30 Min),,G0109,HCPCS,Facility,Inpatient,,,,34,28.9,9.7444,34,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Dsmt Group (30 Min),,G0109,HCPCS,Facility,Outpatient,,,,34,28.9,9.7444,34,"UCare Health, Inc.",Medical Assistance,17.1598,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Dsmt Group (30 Min),,G0109,HCPCS,Facility,Inpatient,,,,34,28.9,9.7444,34,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Dsmt Group (30 Min),,G0109,HCPCS,Facility,Outpatient,,,,34,28.9,9.7444,34,"UCare Health, Inc.",Medicare Advantage,17.1598,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Dsmt Group (30 Min),,G0109,HCPCS,Facility,Inpatient,,,,34,28.9,9.7444,34,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Dsmt Group (30 Min),,G0109,HCPCS,Facility,Outpatient,,,,34,28.9,9.7444,34,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),17.1598,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Dsmt Group (30 Min),,G0109,HCPCS,Facility,Inpatient,,,,34,28.9,9.7444,34,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Dsmt Group (30 Min),,G0109,HCPCS,Facility,Both,,,,34,28.9,9.7444,34,UnitedHealthcare,Individual & Family,31.96,94,,percent of total billed charges,,
Dsmt Group (30 Min),,G0109,HCPCS,Facility,Outpatient,,,,34,28.9,9.7444,34,UnitedHealthcare,Medicare Advantage,16.66,49,,percent of total billed charges,,
Dsmt Group (30 Min),,G0109,HCPCS,Facility,Inpatient,,,,34,28.9,9.7444,34,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Dsmt Group (30 Min),,G0109,HCPCS,Facility,Outpatient,,,,34,28.9,9.7444,34,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,16.32,48,,percent of total billed charges,,100% of DHS outpatient percentage
Dsmt Group (30 Min),,G0109,HCPCS,Facility,Inpatient,,,,34,28.9,9.7444,34,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Colorectal Cancer Screening;Colonoscopy Not High Risk Patient (Pro Cah),,G0121,HCPCS,Professional,Both,,,,714,606.9,112.78,714,Aetna,Commercial,606.9,85,,percent of total billed charges,,
Colorectal Cancer Screening;Colonoscopy Not High Risk Patient (Pro Cah),,G0121,HCPCS,Professional,Both,,,,714,606.9,112.78,714,Aetna,Medicare Advantage,180.07,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Colorectal Cancer Screening;Colonoscopy Not High Risk Patient (Pro Cah),,G0121,HCPCS,Professional,Both,,,,714,606.9,112.78,714,Aetna,PPO,664.02,93,,percent of total billed charges,,
Colorectal Cancer Screening;Colonoscopy Not High Risk Patient (Pro Cah),,G0121,HCPCS,Professional,Both,,,,714,606.9,112.78,714,America's PPO,America's PPO,610.0416,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
Colorectal Cancer Screening;Colonoscopy Not High Risk Patient (Pro Cah),,G0121,HCPCS,Professional,Both,,,,714,606.9,112.78,714,BlueCross BlueShield Minnesota, Federal Employee Program,316.84,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
Colorectal Cancer Screening;Colonoscopy Not High Risk Patient (Pro Cah),,G0121,HCPCS,Professional,Both,,,,714,606.9,112.78,714,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,321.90944,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Colorectal Cancer Screening;Colonoscopy Not High Risk Patient (Pro Cah),,G0121,HCPCS,Professional,Both,,,,714,606.9,112.78,714,BlueCross BlueShield Minnesota,Medicare Advantage,201.6065,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Colorectal Cancer Screening;Colonoscopy Not High Risk Patient (Pro Cah),,G0121,HCPCS,Professional,Both,,,,714,606.9,112.78,714,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,321.90944,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
Colorectal Cancer Screening;Colonoscopy Not High Risk Patient (Pro Cah),,G0121,HCPCS,Professional,Both,,,,714,606.9,112.78,714,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,130.21056,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Colorectal Cancer Screening;Colonoscopy Not High Risk Patient (Pro Cah),,G0121,HCPCS,Professional,Both,,,,714,606.9,112.78,714,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),201.6065,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Colorectal Cancer Screening;Colonoscopy Not High Risk Patient (Pro Cah),,G0121,HCPCS,Professional,Both,,,,714,606.9,112.78,714,CorVel,Worker's Compensation,347.0908995,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
Colorectal Cancer Screening;Colonoscopy Not High Risk Patient (Pro Cah),,G0121,HCPCS,Professional,Both,,,,714,606.9,112.78,714,First Health Group Corporation,First Health Network,692.58,97,,percent of total billed charges,,
Colorectal Cancer Screening;Colonoscopy Not High Risk Patient (Pro Cah),,G0121,HCPCS,Professional,Both,,,,714,606.9,112.78,714,"Health Partners, Inc.",Commercial,196.6,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Colorectal Cancer Screening;Colonoscopy Not High Risk Patient (Pro Cah),,G0121,HCPCS,Professional,Both,,,,714,606.9,112.78,714,"Health Partners, Inc.",Medicare Advantage,201.6065,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Colorectal Cancer Screening;Colonoscopy Not High Risk Patient (Pro Cah),,G0121,HCPCS,Professional,Both,,,,714,606.9,112.78,714,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),175.2,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
Colorectal Cancer Screening;Colonoscopy Not High Risk Patient (Pro Cah),,G0121,HCPCS,Professional,Both,,,,714,606.9,112.78,714,"Health Partners, Inc.",State of Minnesota Advantage Program,169.3709,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
Colorectal Cancer Screening;Colonoscopy Not High Risk Patient (Pro Cah),,G0121,HCPCS,Professional,Both,,,,714,606.9,112.78,714,"Health Partners, Inc.",State Public Programs,112.78,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
Colorectal Cancer Screening;Colonoscopy Not High Risk Patient (Pro Cah),,G0121,HCPCS,Professional,Both,,,,714,606.9,112.78,714,Humana Insurance Company,Commercial PPO,175.31,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
Colorectal Cancer Screening;Colonoscopy Not High Risk Patient (Pro Cah),,G0121,HCPCS,Professional,Both,,,,714,606.9,112.78,714,Humana Insurance Company,Medicare PPO,714,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
Colorectal Cancer Screening;Colonoscopy Not High Risk Patient (Pro Cah),,G0121,HCPCS,Professional,Both,,,,714,606.9,112.78,714,Medica,Individual & Family,605.472,84.8,,percent of total billed charges,,
Colorectal Cancer Screening;Colonoscopy Not High Risk Patient (Pro Cah),,G0121,HCPCS,Professional,Both,,,,714,606.9,112.78,714,Medica,Medica Advantage Solution,355.572,49.8,,percent of total billed charges,,
Colorectal Cancer Screening;Colonoscopy Not High Risk Patient (Pro Cah),,G0121,HCPCS,Professional,Both,,,,714,606.9,112.78,714,Medica,Medical Assistance,130.21,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
Colorectal Cancer Screening;Colonoscopy Not High Risk Patient (Pro Cah),,G0121,HCPCS,Professional,Both,,,,714,606.9,112.78,714,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,175.31,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
Colorectal Cancer Screening;Colonoscopy Not High Risk Patient (Pro Cah),,G0121,HCPCS,Professional,Both,,,,714,606.9,112.78,714,"Multiplan, Inc.","Multiplan, Inc.",671.16,94,,percent of total billed charges,,
Colorectal Cancer Screening;Colonoscopy Not High Risk Patient (Pro Cah),,G0121,HCPCS,Professional,Both,,,,714,606.9,112.78,714,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,643.314,90.1,,percent of total billed charges,,
Colorectal Cancer Screening;Colonoscopy Not High Risk Patient (Pro Cah),,G0121,HCPCS,Professional,Both,,,,714,606.9,112.78,714,"Preferred One Administrative Services, INC.",PPO,704.004,98.6,,percent of total billed charges,,
Colorectal Cancer Screening;Colonoscopy Not High Risk Patient (Pro Cah),,G0121,HCPCS,Professional,Both,,,,714,606.9,112.78,714,PrimeWest Health,Minnesota Senior Health Options (MSHO),201.6065,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Colorectal Cancer Screening;Colonoscopy Not High Risk Patient (Pro Cah),,G0121,HCPCS,Professional,Both,,,,714,606.9,112.78,714,PrimeWest Health,MinnesotaCare,139.3252992,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
Colorectal Cancer Screening;Colonoscopy Not High Risk Patient (Pro Cah),,G0121,HCPCS,Professional,Both,,,,714,606.9,112.78,714,Sanford Health Plan,Sanford Health Plan,628.32,88,,percent of total billed charges,,
Colorectal Cancer Screening;Colonoscopy Not High Risk Patient (Pro Cah),,G0121,HCPCS,Professional,Both,,,,714,606.9,112.78,714,"UCare Health, Inc.",Individual & Family Plan,284.983936,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
Colorectal Cancer Screening;Colonoscopy Not High Risk Patient (Pro Cah),,G0121,HCPCS,Professional,Both,,,,714,606.9,112.78,714,"UCare Health, Inc.",Medical Assistance,143.231616,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
Colorectal Cancer Screening;Colonoscopy Not High Risk Patient (Pro Cah),,G0121,HCPCS,Professional,Both,,,,714,606.9,112.78,714,"UCare Health, Inc.",Medicare Advantage,201.6065,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
Colorectal Cancer Screening;Colonoscopy Not High Risk Patient (Pro Cah),,G0121,HCPCS,Professional,Both,,,,714,606.9,112.78,714,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),161.2852,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
Colorectal Cancer Screening;Colonoscopy Not High Risk Patient (Pro Cah),,G0121,HCPCS,Professional,Both,,,,714,606.9,112.78,714,UnitedHealthcare,Individual & Family,714,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
Colorectal Cancer Screening;Colonoscopy Not High Risk Patient (Pro Cah),,G0121,HCPCS,Professional,Both,,,,714,606.9,112.78,714,UnitedHealthcare,Medicare Advantage,201.6065,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
Colorectal Cancer Screening;Colonoscopy Not High Risk Patient (Pro Cah),,G0121,HCPCS,Professional,Both,,,,714,606.9,112.78,714,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,130.21056,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
Hha Visit,,G0156,HCPCS,Facility,Both,,,,100,85,28.66,100,Aetna,Commercial,92,92,,percent of total billed charges,,
Hha Visit,,G0156,HCPCS,Facility,Outpatient,,,,100,85,28.66,100,Aetna,Medicare Advantage,49,49,,percent of total billed charges,,
Hha Visit,,G0156,HCPCS,Facility,Inpatient,,,,100,85,28.66,100,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Hha Visit,,G0156,HCPCS,Facility,Both,,,,100,85,28.66,100,Aetna,PPO,93,93,,percent of total billed charges,,
Hha Visit,,G0156,HCPCS,Facility,Both,,,,100,85,28.66,100,America's PPO,America's PPO,96.03,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Hha Visit,,G0156,HCPCS,Facility,Both,,,,100,85,28.66,100,BlueCross BlueShield Minnesota, Federal Employee Program,98.4,98.4,,percent of total billed charges,,
Hha Visit,,G0156,HCPCS,Facility,Both,,,,100,85,28.66,100,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,100,100,,percent of total billed charges,,
Hha Visit,,G0156,HCPCS,Facility,Both,,,,100,85,28.66,100,BlueCross BlueShield Minnesota,High Value Network Plan,90,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
Hha Visit,,G0156,HCPCS,Facility,Outpatient,,,,100,85,28.66,100,BlueCross BlueShield Minnesota,Medicare Advantage,49,49,,percent of total billed charges,,
Hha Visit,,G0156,HCPCS,Facility,Inpatient,,,,100,85,28.66,100,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Hha Visit,,G0156,HCPCS,Facility,Both,,,,100,85,28.66,100,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,88.57,88.57,,percent of total billed charges,,
Hha Visit,,G0156,HCPCS,Facility,Both,,,,100,85,28.66,100,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,28.66,28.66,,percent of total billed charges,,
Hha Visit,,G0156,HCPCS,Facility,Outpatient,,,,100,85,28.66,100,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),49,49,,percent of total billed charges,,
Hha Visit,,G0156,HCPCS,Facility,Inpatient,,,,100,85,28.66,100,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Hha Visit,,G0156,HCPCS,Facility,Both,,,,100,85,28.66,100,CorVel,Worker's Compensation,100,100,,percent of total billed charges,,
Hha Visit,,G0156,HCPCS,Facility,Both,,,,100,85,28.66,100,First Health Group Corporation,First Health Network,97,97,,percent of total billed charges,,
Hha Visit,,G0156,HCPCS,Facility,Both,,,,100,85,28.66,100,"Health Partners, Inc.",Commercial,94.6,94.6,,percent of total billed charges,,
Hha Visit,,G0156,HCPCS,Facility,Outpatient,,,,100,85,28.66,100,"Health Partners, Inc.",Medicare Advantage,49,49,,percent of total billed charges,,
Hha Visit,,G0156,HCPCS,Facility,Inpatient,,,,100,85,28.66,100,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Hha Visit,,G0156,HCPCS,Facility,Both,,,,100,85,28.66,100,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),60,60,,percent of total billed charges,,
Hha Visit,,G0156,HCPCS,Facility,Both,,,,100,85,28.66,100,"Health Partners, Inc.",State of Minnesota Advantage Program,81.5,81.5,,percent of total billed charges,,
Hha Visit,,G0156,HCPCS,Facility,Both,,,,100,85,28.66,100,"Health Partners, Inc.",State Public Programs,50,50,,percent of total billed charges,,
Hha Visit,,G0156,HCPCS,Facility,Both,,,,100,85,28.66,100,Humana Insurance Company,Commercial PPO,95,95,,percent of total billed charges,,
Hha Visit,,G0156,HCPCS,Facility,Outpatient,,,,100,85,28.66,100,Humana Insurance Company,Medicare PPO,49,49,,percent of total billed charges,,
Hha Visit,,G0156,HCPCS,Facility,Inpatient,,,,100,85,28.66,100,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Hha Visit,,G0156,HCPCS,Facility,Both,,,,100,85,28.66,100,Medica,Individual & Family,99.1,99.1,,percent of total billed charges,,
Hha Visit,,G0156,HCPCS,Facility,Outpatient,,,,100,85,28.66,100,Medica,Medica Advantage Solution,49.8,49.8,,percent of total billed charges,,
Hha Visit,,G0156,HCPCS,Facility,Inpatient,,,,100,85,28.66,100,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Hha Visit,,G0156,HCPCS,Facility,Outpatient,,,,100,85,28.66,100,Medica,Medical Assistance,44.6,44.6,,percent of total billed charges,,
Hha Visit,,G0156,HCPCS,Facility,Inpatient,,,,100,85,28.66,100,Medica,Medical Assistance,,,,,Included in per diem rate,
Hha Visit,,G0156,HCPCS,Facility,Outpatient,,,,100,85,28.66,100,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,49.8,49.8,,percent of total billed charges,,
Hha Visit,,G0156,HCPCS,Facility,Inpatient,,,,100,85,28.66,100,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Hha Visit,,G0156,HCPCS,Facility,Both,,,,100,85,28.66,100,"Multiplan, Inc.","Multiplan, Inc.",94,94,,percent of total billed charges,,
Hha Visit,,G0156,HCPCS,Facility,Outpatient,,,,100,85,28.66,100,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,90.1,90.1,,percent of total billed charges,,
Hha Visit,,G0156,HCPCS,Facility,Inpatient,,,,100,85,28.66,100,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Hha Visit,,G0156,HCPCS,Facility,Both,,,,100,85,28.66,100,"Preferred One Administrative Services, INC.",PPO,98.6,98.6,,percent of total billed charges,,
Hha Visit,,G0156,HCPCS,Facility,Outpatient,,,,100,85,28.66,100,PrimeWest Health,Minnesota Senior Health Options (MSHO),51.45,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Hha Visit,,G0156,HCPCS,Facility,Inpatient,,,,100,85,28.66,100,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Hha Visit,,G0156,HCPCS,Facility,Outpatient,,,,100,85,28.66,100,PrimeWest Health,MinnesotaCare,51.36,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Hha Visit,,G0156,HCPCS,Facility,Inpatient,,,,100,85,28.66,100,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Hha Visit,,G0156,HCPCS,Facility,Both,,,,100,85,28.66,100,Sanford Health Plan,Sanford Health Plan,92,92,,percent of total billed charges,,
Hha Visit,,G0156,HCPCS,Facility,Outpatient,,,,100,85,28.66,100,"UCare Health, Inc.",Individual & Family Plan,56.35,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Hha Visit,,G0156,HCPCS,Facility,Inpatient,,,,100,85,28.66,100,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Hha Visit,,G0156,HCPCS,Facility,Outpatient,,,,100,85,28.66,100,"UCare Health, Inc.",Medical Assistance,50.47,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Hha Visit,,G0156,HCPCS,Facility,Inpatient,,,,100,85,28.66,100,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Hha Visit,,G0156,HCPCS,Facility,Outpatient,,,,100,85,28.66,100,"UCare Health, Inc.",Medicare Advantage,50.47,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Hha Visit,,G0156,HCPCS,Facility,Inpatient,,,,100,85,28.66,100,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Hha Visit,,G0156,HCPCS,Facility,Outpatient,,,,100,85,28.66,100,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),50.47,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Hha Visit,,G0156,HCPCS,Facility,Inpatient,,,,100,85,28.66,100,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Hha Visit,,G0156,HCPCS,Facility,Both,,,,100,85,28.66,100,UnitedHealthcare,Individual & Family,94,94,,percent of total billed charges,,
Hha Visit,,G0156,HCPCS,Facility,Outpatient,,,,100,85,28.66,100,UnitedHealthcare,Medicare Advantage,49,49,,percent of total billed charges,,
Hha Visit,,G0156,HCPCS,Facility,Inpatient,,,,100,85,28.66,100,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Hha Visit,,G0156,HCPCS,Facility,Outpatient,,,,100,85,28.66,100,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,48,48,,percent of total billed charges,,100% of DHS outpatient percentage
Hha Visit,,G0156,HCPCS,Facility,Inpatient,,,,100,85,28.66,100,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Mnt Addtl Hours, Second Referral Same Year",,G0270,HCPCS,Facility,Both,,,,35,29.75,10.031,35,Aetna,Commercial,32.2,92,,percent of total billed charges,,
"Mnt Addtl Hours, Second Referral Same Year",,G0270,HCPCS,Facility,Outpatient,,,,35,29.75,10.031,35,Aetna,Medicare Advantage,17.15,49,,percent of total billed charges,,
"Mnt Addtl Hours, Second Referral Same Year",,G0270,HCPCS,Facility,Inpatient,,,,35,29.75,10.031,35,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Mnt Addtl Hours, Second Referral Same Year",,G0270,HCPCS,Facility,Both,,,,35,29.75,10.031,35,Aetna,PPO,32.55,93,,percent of total billed charges,,
"Mnt Addtl Hours, Second Referral Same Year",,G0270,HCPCS,Facility,Both,,,,35,29.75,10.031,35,America's PPO,America's PPO,33.6105,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Mnt Addtl Hours, Second Referral Same Year",,G0270,HCPCS,Facility,Both,,,,35,29.75,10.031,35,BlueCross BlueShield Minnesota, Federal Employee Program,34.44,98.4,,percent of total billed charges,,
"Mnt Addtl Hours, Second Referral Same Year",,G0270,HCPCS,Facility,Both,,,,35,29.75,10.031,35,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,35,100,,percent of total billed charges,,
"Mnt Addtl Hours, Second Referral Same Year",,G0270,HCPCS,Facility,Both,,,,35,29.75,10.031,35,BlueCross BlueShield Minnesota,High Value Network Plan,31.5,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
"Mnt Addtl Hours, Second Referral Same Year",,G0270,HCPCS,Facility,Outpatient,,,,35,29.75,10.031,35,BlueCross BlueShield Minnesota,Medicare Advantage,17.15,49,,percent of total billed charges,,
"Mnt Addtl Hours, Second Referral Same Year",,G0270,HCPCS,Facility,Inpatient,,,,35,29.75,10.031,35,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Mnt Addtl Hours, Second Referral Same Year",,G0270,HCPCS,Facility,Both,,,,35,29.75,10.031,35,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,30.9995,88.57,,percent of total billed charges,,
"Mnt Addtl Hours, Second Referral Same Year",,G0270,HCPCS,Facility,Both,,,,35,29.75,10.031,35,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,10.031,28.66,,percent of total billed charges,,
"Mnt Addtl Hours, Second Referral Same Year",,G0270,HCPCS,Facility,Outpatient,,,,35,29.75,10.031,35,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),17.15,49,,percent of total billed charges,,
"Mnt Addtl Hours, Second Referral Same Year",,G0270,HCPCS,Facility,Inpatient,,,,35,29.75,10.031,35,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Mnt Addtl Hours, Second Referral Same Year",,G0270,HCPCS,Facility,Both,,,,35,29.75,10.031,35,CorVel,Worker's Compensation,35,100,,percent of total billed charges,,
"Mnt Addtl Hours, Second Referral Same Year",,G0270,HCPCS,Facility,Both,,,,35,29.75,10.031,35,First Health Group Corporation,First Health Network,33.95,97,,percent of total billed charges,,
"Mnt Addtl Hours, Second Referral Same Year",,G0270,HCPCS,Facility,Both,,,,35,29.75,10.031,35,"Health Partners, Inc.",Commercial,33.11,94.6,,percent of total billed charges,,
"Mnt Addtl Hours, Second Referral Same Year",,G0270,HCPCS,Facility,Outpatient,,,,35,29.75,10.031,35,"Health Partners, Inc.",Medicare Advantage,17.15,49,,percent of total billed charges,,
"Mnt Addtl Hours, Second Referral Same Year",,G0270,HCPCS,Facility,Inpatient,,,,35,29.75,10.031,35,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Mnt Addtl Hours, Second Referral Same Year",,G0270,HCPCS,Facility,Both,,,,35,29.75,10.031,35,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),21,60,,percent of total billed charges,,
"Mnt Addtl Hours, Second Referral Same Year",,G0270,HCPCS,Facility,Both,,,,35,29.75,10.031,35,"Health Partners, Inc.",State of Minnesota Advantage Program,28.525,81.5,,percent of total billed charges,,
"Mnt Addtl Hours, Second Referral Same Year",,G0270,HCPCS,Facility,Both,,,,35,29.75,10.031,35,"Health Partners, Inc.",State Public Programs,17.5,50,,percent of total billed charges,,
"Mnt Addtl Hours, Second Referral Same Year",,G0270,HCPCS,Facility,Both,,,,35,29.75,10.031,35,Humana Insurance Company,Commercial PPO,33.25,95,,percent of total billed charges,,
"Mnt Addtl Hours, Second Referral Same Year",,G0270,HCPCS,Facility,Outpatient,,,,35,29.75,10.031,35,Humana Insurance Company,Medicare PPO,17.15,49,,percent of total billed charges,,
"Mnt Addtl Hours, Second Referral Same Year",,G0270,HCPCS,Facility,Inpatient,,,,35,29.75,10.031,35,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Mnt Addtl Hours, Second Referral Same Year",,G0270,HCPCS,Facility,Both,,,,35,29.75,10.031,35,Medica,Individual & Family,34.685,99.1,,percent of total billed charges,,
"Mnt Addtl Hours, Second Referral Same Year",,G0270,HCPCS,Facility,Outpatient,,,,35,29.75,10.031,35,Medica,Medica Advantage Solution,17.43,49.8,,percent of total billed charges,,
"Mnt Addtl Hours, Second Referral Same Year",,G0270,HCPCS,Facility,Inpatient,,,,35,29.75,10.031,35,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Mnt Addtl Hours, Second Referral Same Year",,G0270,HCPCS,Facility,Outpatient,,,,35,29.75,10.031,35,Medica,Medical Assistance,15.61,44.6,,percent of total billed charges,,
"Mnt Addtl Hours, Second Referral Same Year",,G0270,HCPCS,Facility,Inpatient,,,,35,29.75,10.031,35,Medica,Medical Assistance,,,,,Included in per diem rate,
"Mnt Addtl Hours, Second Referral Same Year",,G0270,HCPCS,Facility,Outpatient,,,,35,29.75,10.031,35,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,17.43,49.8,,percent of total billed charges,,
"Mnt Addtl Hours, Second Referral Same Year",,G0270,HCPCS,Facility,Inpatient,,,,35,29.75,10.031,35,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Mnt Addtl Hours, Second Referral Same Year",,G0270,HCPCS,Facility,Both,,,,35,29.75,10.031,35,"Multiplan, Inc.","Multiplan, Inc.",32.9,94,,percent of total billed charges,,
"Mnt Addtl Hours, Second Referral Same Year",,G0270,HCPCS,Facility,Outpatient,,,,35,29.75,10.031,35,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,31.535,90.1,,percent of total billed charges,,
"Mnt Addtl Hours, Second Referral Same Year",,G0270,HCPCS,Facility,Inpatient,,,,35,29.75,10.031,35,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Mnt Addtl Hours, Second Referral Same Year",,G0270,HCPCS,Facility,Both,,,,35,29.75,10.031,35,"Preferred One Administrative Services, INC.",PPO,34.51,98.6,,percent of total billed charges,,
"Mnt Addtl Hours, Second Referral Same Year",,G0270,HCPCS,Facility,Outpatient,,,,35,29.75,10.031,35,PrimeWest Health,Minnesota Senior Health Options (MSHO),18.0075,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Mnt Addtl Hours, Second Referral Same Year",,G0270,HCPCS,Facility,Inpatient,,,,35,29.75,10.031,35,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Mnt Addtl Hours, Second Referral Same Year",,G0270,HCPCS,Facility,Outpatient,,,,35,29.75,10.031,35,PrimeWest Health,MinnesotaCare,17.976,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Mnt Addtl Hours, Second Referral Same Year",,G0270,HCPCS,Facility,Inpatient,,,,35,29.75,10.031,35,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Mnt Addtl Hours, Second Referral Same Year",,G0270,HCPCS,Facility,Both,,,,35,29.75,10.031,35,Sanford Health Plan,Sanford Health Plan,32.2,92,,percent of total billed charges,,
"Mnt Addtl Hours, Second Referral Same Year",,G0270,HCPCS,Facility,Outpatient,,,,35,29.75,10.031,35,"UCare Health, Inc.",Individual & Family Plan,19.7225,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Mnt Addtl Hours, Second Referral Same Year",,G0270,HCPCS,Facility,Inpatient,,,,35,29.75,10.031,35,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Mnt Addtl Hours, Second Referral Same Year",,G0270,HCPCS,Facility,Outpatient,,,,35,29.75,10.031,35,"UCare Health, Inc.",Medical Assistance,17.6645,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Mnt Addtl Hours, Second Referral Same Year",,G0270,HCPCS,Facility,Inpatient,,,,35,29.75,10.031,35,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Mnt Addtl Hours, Second Referral Same Year",,G0270,HCPCS,Facility,Outpatient,,,,35,29.75,10.031,35,"UCare Health, Inc.",Medicare Advantage,17.6645,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Mnt Addtl Hours, Second Referral Same Year",,G0270,HCPCS,Facility,Inpatient,,,,35,29.75,10.031,35,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Mnt Addtl Hours, Second Referral Same Year",,G0270,HCPCS,Facility,Outpatient,,,,35,29.75,10.031,35,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),17.6645,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Mnt Addtl Hours, Second Referral Same Year",,G0270,HCPCS,Facility,Inpatient,,,,35,29.75,10.031,35,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Mnt Addtl Hours, Second Referral Same Year",,G0270,HCPCS,Facility,Both,,,,35,29.75,10.031,35,UnitedHealthcare,Individual & Family,32.9,94,,percent of total billed charges,,
"Mnt Addtl Hours, Second Referral Same Year",,G0270,HCPCS,Facility,Outpatient,,,,35,29.75,10.031,35,UnitedHealthcare,Medicare Advantage,17.15,49,,percent of total billed charges,,
"Mnt Addtl Hours, Second Referral Same Year",,G0270,HCPCS,Facility,Inpatient,,,,35,29.75,10.031,35,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Mnt Addtl Hours, Second Referral Same Year",,G0270,HCPCS,Facility,Outpatient,,,,35,29.75,10.031,35,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,16.8,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Mnt Addtl Hours, Second Referral Same Year",,G0270,HCPCS,Facility,Inpatient,,,,35,29.75,10.031,35,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Mnt Addtl Hours, Second Referral Group Same Year",,G0271,HCPCS,Facility,Both,,,,29,24.65,8.3114,29,Aetna,Commercial,26.68,92,,percent of total billed charges,,
"Mnt Addtl Hours, Second Referral Group Same Year",,G0271,HCPCS,Facility,Outpatient,,,,29,24.65,8.3114,29,Aetna,Medicare Advantage,14.21,49,,percent of total billed charges,,
"Mnt Addtl Hours, Second Referral Group Same Year",,G0271,HCPCS,Facility,Inpatient,,,,29,24.65,8.3114,29,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Mnt Addtl Hours, Second Referral Group Same Year",,G0271,HCPCS,Facility,Both,,,,29,24.65,8.3114,29,Aetna,PPO,26.97,93,,percent of total billed charges,,
"Mnt Addtl Hours, Second Referral Group Same Year",,G0271,HCPCS,Facility,Both,,,,29,24.65,8.3114,29,America's PPO,America's PPO,27.8487,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Mnt Addtl Hours, Second Referral Group Same Year",,G0271,HCPCS,Facility,Both,,,,29,24.65,8.3114,29,BlueCross BlueShield Minnesota, Federal Employee Program,28.536,98.4,,percent of total billed charges,,
"Mnt Addtl Hours, Second Referral Group Same Year",,G0271,HCPCS,Facility,Both,,,,29,24.65,8.3114,29,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,29,100,,percent of total billed charges,,
"Mnt Addtl Hours, Second Referral Group Same Year",,G0271,HCPCS,Facility,Both,,,,29,24.65,8.3114,29,BlueCross BlueShield Minnesota,High Value Network Plan,26.1,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
"Mnt Addtl Hours, Second Referral Group Same Year",,G0271,HCPCS,Facility,Outpatient,,,,29,24.65,8.3114,29,BlueCross BlueShield Minnesota,Medicare Advantage,14.21,49,,percent of total billed charges,,
"Mnt Addtl Hours, Second Referral Group Same Year",,G0271,HCPCS,Facility,Inpatient,,,,29,24.65,8.3114,29,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Mnt Addtl Hours, Second Referral Group Same Year",,G0271,HCPCS,Facility,Both,,,,29,24.65,8.3114,29,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,25.6853,88.57,,percent of total billed charges,,
"Mnt Addtl Hours, Second Referral Group Same Year",,G0271,HCPCS,Facility,Both,,,,29,24.65,8.3114,29,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,8.3114,28.66,,percent of total billed charges,,
"Mnt Addtl Hours, Second Referral Group Same Year",,G0271,HCPCS,Facility,Outpatient,,,,29,24.65,8.3114,29,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),14.21,49,,percent of total billed charges,,
"Mnt Addtl Hours, Second Referral Group Same Year",,G0271,HCPCS,Facility,Inpatient,,,,29,24.65,8.3114,29,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Mnt Addtl Hours, Second Referral Group Same Year",,G0271,HCPCS,Facility,Both,,,,29,24.65,8.3114,29,CorVel,Worker's Compensation,29,100,,percent of total billed charges,,
"Mnt Addtl Hours, Second Referral Group Same Year",,G0271,HCPCS,Facility,Both,,,,29,24.65,8.3114,29,First Health Group Corporation,First Health Network,28.13,97,,percent of total billed charges,,
"Mnt Addtl Hours, Second Referral Group Same Year",,G0271,HCPCS,Facility,Both,,,,29,24.65,8.3114,29,"Health Partners, Inc.",Commercial,27.434,94.6,,percent of total billed charges,,
"Mnt Addtl Hours, Second Referral Group Same Year",,G0271,HCPCS,Facility,Outpatient,,,,29,24.65,8.3114,29,"Health Partners, Inc.",Medicare Advantage,14.21,49,,percent of total billed charges,,
"Mnt Addtl Hours, Second Referral Group Same Year",,G0271,HCPCS,Facility,Inpatient,,,,29,24.65,8.3114,29,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Mnt Addtl Hours, Second Referral Group Same Year",,G0271,HCPCS,Facility,Both,,,,29,24.65,8.3114,29,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),17.4,60,,percent of total billed charges,,
"Mnt Addtl Hours, Second Referral Group Same Year",,G0271,HCPCS,Facility,Both,,,,29,24.65,8.3114,29,"Health Partners, Inc.",State of Minnesota Advantage Program,23.635,81.5,,percent of total billed charges,,
"Mnt Addtl Hours, Second Referral Group Same Year",,G0271,HCPCS,Facility,Both,,,,29,24.65,8.3114,29,"Health Partners, Inc.",State Public Programs,14.5,50,,percent of total billed charges,,
"Mnt Addtl Hours, Second Referral Group Same Year",,G0271,HCPCS,Facility,Both,,,,29,24.65,8.3114,29,Humana Insurance Company,Commercial PPO,27.55,95,,percent of total billed charges,,
"Mnt Addtl Hours, Second Referral Group Same Year",,G0271,HCPCS,Facility,Outpatient,,,,29,24.65,8.3114,29,Humana Insurance Company,Medicare PPO,14.21,49,,percent of total billed charges,,
"Mnt Addtl Hours, Second Referral Group Same Year",,G0271,HCPCS,Facility,Inpatient,,,,29,24.65,8.3114,29,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Mnt Addtl Hours, Second Referral Group Same Year",,G0271,HCPCS,Facility,Both,,,,29,24.65,8.3114,29,Medica,Individual & Family,28.739,99.1,,percent of total billed charges,,
"Mnt Addtl Hours, Second Referral Group Same Year",,G0271,HCPCS,Facility,Outpatient,,,,29,24.65,8.3114,29,Medica,Medica Advantage Solution,14.442,49.8,,percent of total billed charges,,
"Mnt Addtl Hours, Second Referral Group Same Year",,G0271,HCPCS,Facility,Inpatient,,,,29,24.65,8.3114,29,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Mnt Addtl Hours, Second Referral Group Same Year",,G0271,HCPCS,Facility,Outpatient,,,,29,24.65,8.3114,29,Medica,Medical Assistance,12.934,44.6,,percent of total billed charges,,
"Mnt Addtl Hours, Second Referral Group Same Year",,G0271,HCPCS,Facility,Inpatient,,,,29,24.65,8.3114,29,Medica,Medical Assistance,,,,,Included in per diem rate,
"Mnt Addtl Hours, Second Referral Group Same Year",,G0271,HCPCS,Facility,Outpatient,,,,29,24.65,8.3114,29,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,14.442,49.8,,percent of total billed charges,,
"Mnt Addtl Hours, Second Referral Group Same Year",,G0271,HCPCS,Facility,Inpatient,,,,29,24.65,8.3114,29,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Mnt Addtl Hours, Second Referral Group Same Year",,G0271,HCPCS,Facility,Both,,,,29,24.65,8.3114,29,"Multiplan, Inc.","Multiplan, Inc.",27.26,94,,percent of total billed charges,,
"Mnt Addtl Hours, Second Referral Group Same Year",,G0271,HCPCS,Facility,Outpatient,,,,29,24.65,8.3114,29,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,26.129,90.1,,percent of total billed charges,,
"Mnt Addtl Hours, Second Referral Group Same Year",,G0271,HCPCS,Facility,Inpatient,,,,29,24.65,8.3114,29,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Mnt Addtl Hours, Second Referral Group Same Year",,G0271,HCPCS,Facility,Both,,,,29,24.65,8.3114,29,"Preferred One Administrative Services, INC.",PPO,28.594,98.6,,percent of total billed charges,,
"Mnt Addtl Hours, Second Referral Group Same Year",,G0271,HCPCS,Facility,Outpatient,,,,29,24.65,8.3114,29,PrimeWest Health,Minnesota Senior Health Options (MSHO),14.9205,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Mnt Addtl Hours, Second Referral Group Same Year",,G0271,HCPCS,Facility,Inpatient,,,,29,24.65,8.3114,29,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Mnt Addtl Hours, Second Referral Group Same Year",,G0271,HCPCS,Facility,Outpatient,,,,29,24.65,8.3114,29,PrimeWest Health,MinnesotaCare,14.8944,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Mnt Addtl Hours, Second Referral Group Same Year",,G0271,HCPCS,Facility,Inpatient,,,,29,24.65,8.3114,29,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Mnt Addtl Hours, Second Referral Group Same Year",,G0271,HCPCS,Facility,Both,,,,29,24.65,8.3114,29,Sanford Health Plan,Sanford Health Plan,26.68,92,,percent of total billed charges,,
"Mnt Addtl Hours, Second Referral Group Same Year",,G0271,HCPCS,Facility,Outpatient,,,,29,24.65,8.3114,29,"UCare Health, Inc.",Individual & Family Plan,16.3415,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Mnt Addtl Hours, Second Referral Group Same Year",,G0271,HCPCS,Facility,Inpatient,,,,29,24.65,8.3114,29,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Mnt Addtl Hours, Second Referral Group Same Year",,G0271,HCPCS,Facility,Outpatient,,,,29,24.65,8.3114,29,"UCare Health, Inc.",Medical Assistance,14.6363,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Mnt Addtl Hours, Second Referral Group Same Year",,G0271,HCPCS,Facility,Inpatient,,,,29,24.65,8.3114,29,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Mnt Addtl Hours, Second Referral Group Same Year",,G0271,HCPCS,Facility,Outpatient,,,,29,24.65,8.3114,29,"UCare Health, Inc.",Medicare Advantage,14.6363,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Mnt Addtl Hours, Second Referral Group Same Year",,G0271,HCPCS,Facility,Inpatient,,,,29,24.65,8.3114,29,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Mnt Addtl Hours, Second Referral Group Same Year",,G0271,HCPCS,Facility,Outpatient,,,,29,24.65,8.3114,29,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),14.6363,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Mnt Addtl Hours, Second Referral Group Same Year",,G0271,HCPCS,Facility,Inpatient,,,,29,24.65,8.3114,29,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Mnt Addtl Hours, Second Referral Group Same Year",,G0271,HCPCS,Facility,Both,,,,29,24.65,8.3114,29,UnitedHealthcare,Individual & Family,27.26,94,,percent of total billed charges,,
"Mnt Addtl Hours, Second Referral Group Same Year",,G0271,HCPCS,Facility,Outpatient,,,,29,24.65,8.3114,29,UnitedHealthcare,Medicare Advantage,14.21,49,,percent of total billed charges,,
"Mnt Addtl Hours, Second Referral Group Same Year",,G0271,HCPCS,Facility,Inpatient,,,,29,24.65,8.3114,29,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Mnt Addtl Hours, Second Referral Group Same Year",,G0271,HCPCS,Facility,Outpatient,,,,29,24.65,8.3114,29,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,13.92,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Mnt Addtl Hours, Second Referral Group Same Year",,G0271,HCPCS,Facility,Inpatient,,,,29,24.65,8.3114,29,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Mammo Tomosyn Diag Bil,,G0279,HCPCS,Facility,Outpatient,,,,60,51,29.4,54,Aetna,Medicare Advantage,29.4,49,,percent of total billed charges,,
Mammo Tomosyn Diag Bil,,G0279,HCPCS,Facility,Inpatient,,,,60,51,29.4,54,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Mammo Tomosyn Diag Bil,,G0279,HCPCS,Facility,Outpatient,,,,60,51,29.4,54,BlueCross BlueShield Minnesota,Medicare Advantage,29.4,49,,percent of total billed charges,,
Mammo Tomosyn Diag Bil,,G0279,HCPCS,Facility,Inpatient,,,,60,51,29.4,54,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Mammo Tomosyn Diag Bil,,G0279,HCPCS,Facility,Outpatient,,,,60,51,29.4,54,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),29.4,49,,percent of total billed charges,,
Mammo Tomosyn Diag Bil,,G0279,HCPCS,Facility,Inpatient,,,,60,51,29.4,54,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Mammo Tomosyn Diag Bil,,G0279,HCPCS,Facility,Outpatient,,,,60,51,29.4,54,"Health Partners, Inc.",Medicare Advantage,29.4,49,,percent of total billed charges,,
Mammo Tomosyn Diag Bil,,G0279,HCPCS,Facility,Inpatient,,,,60,51,29.4,54,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mammo Tomosyn Diag Bil,,G0279,HCPCS,Facility,Both,,,,60,51,29.4,54,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),36,60,,percent of total billed charges,,
Mammo Tomosyn Diag Bil,,G0279,HCPCS,Facility,Outpatient,,,,60,51,29.4,54,Humana Insurance Company,Medicare PPO,29.4,49,,percent of total billed charges,,
Mammo Tomosyn Diag Bil,,G0279,HCPCS,Facility,Inpatient,,,,60,51,29.4,54,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Mammo Tomosyn Diag Bil,,G0279,HCPCS,Facility,Outpatient,,,,60,51,29.4,54,Medica,Medica Advantage Solution,29.88,49.8,,percent of total billed charges,,
Mammo Tomosyn Diag Bil,,G0279,HCPCS,Facility,Inpatient,,,,60,51,29.4,54,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Mammo Tomosyn Diag Bil,,G0279,HCPCS,Facility,Outpatient,,,,60,51,29.4,54,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,29.88,49.8,,percent of total billed charges,,
Mammo Tomosyn Diag Bil,,G0279,HCPCS,Facility,Inpatient,,,,60,51,29.4,54,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Mammo Tomosyn Diag Bil,,G0279,HCPCS,Facility,Outpatient,,,,60,51,29.4,54,PrimeWest Health,Minnesota Senior Health Options (MSHO),30.87,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Mammo Tomosyn Diag Bil,,G0279,HCPCS,Facility,Inpatient,,,,60,51,29.4,54,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mammo Tomosyn Diag Bil,,G0279,HCPCS,Facility,Outpatient,,,,60,51,29.4,54,"UCare Health, Inc.",Medicare Advantage,30.282,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mammo Tomosyn Diag Bil,,G0279,HCPCS,Facility,Inpatient,,,,60,51,29.4,54,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Mammo Tomosyn Diag Bil,,G0279,HCPCS,Facility,Outpatient,,,,60,51,29.4,54,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),30.282,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Mammo Tomosyn Diag Bil,,G0279,HCPCS,Facility,Inpatient,,,,60,51,29.4,54,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Mammo Tomosyn Diag Bil,,G0279,HCPCS,Facility,Outpatient,,,,60,51,29.4,54,UnitedHealthcare,Medicare Advantage,29.4,49,,percent of total billed charges,,
Mammo Tomosyn Diag Bil,,G0279,HCPCS,Facility,Inpatient,,,,60,51,29.4,54,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Sn Visit Rn,,G0299,HCPCS,Facility,Both,,,,180,153,51.588,180,Aetna,Commercial,165.6,92,,percent of total billed charges,,
Sn Visit Rn,,G0299,HCPCS,Facility,Outpatient,,,,180,153,51.588,180,Aetna,Medicare Advantage,88.2,49,,percent of total billed charges,,
Sn Visit Rn,,G0299,HCPCS,Facility,Inpatient,,,,180,153,51.588,180,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Sn Visit Rn,,G0299,HCPCS,Facility,Both,,,,180,153,51.588,180,Aetna,PPO,167.4,93,,percent of total billed charges,,
Sn Visit Rn,,G0299,HCPCS,Facility,Both,,,,180,153,51.588,180,America's PPO,America's PPO,172.854,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Sn Visit Rn,,G0299,HCPCS,Facility,Both,,,,180,153,51.588,180,BlueCross BlueShield Minnesota, Federal Employee Program,177.12,98.4,,percent of total billed charges,,
Sn Visit Rn,,G0299,HCPCS,Facility,Both,,,,180,153,51.588,180,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,180,100,,percent of total billed charges,,
Sn Visit Rn,,G0299,HCPCS,Facility,Both,,,,180,153,51.588,180,BlueCross BlueShield Minnesota,High Value Network Plan,162,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
Sn Visit Rn,,G0299,HCPCS,Facility,Outpatient,,,,180,153,51.588,180,BlueCross BlueShield Minnesota,Medicare Advantage,88.2,49,,percent of total billed charges,,
Sn Visit Rn,,G0299,HCPCS,Facility,Inpatient,,,,180,153,51.588,180,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Sn Visit Rn,,G0299,HCPCS,Facility,Both,,,,180,153,51.588,180,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,159.426,88.57,,percent of total billed charges,,
Sn Visit Rn,,G0299,HCPCS,Facility,Both,,,,180,153,51.588,180,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,51.588,28.66,,percent of total billed charges,,
Sn Visit Rn,,G0299,HCPCS,Facility,Outpatient,,,,180,153,51.588,180,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),88.2,49,,percent of total billed charges,,
Sn Visit Rn,,G0299,HCPCS,Facility,Inpatient,,,,180,153,51.588,180,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Sn Visit Rn,,G0299,HCPCS,Facility,Both,,,,180,153,51.588,180,CorVel,Worker's Compensation,180,100,,percent of total billed charges,,
Sn Visit Rn,,G0299,HCPCS,Facility,Both,,,,180,153,51.588,180,First Health Group Corporation,First Health Network,174.6,97,,percent of total billed charges,,
Sn Visit Rn,,G0299,HCPCS,Facility,Both,,,,180,153,51.588,180,"Health Partners, Inc.",Commercial,170.28,94.6,,percent of total billed charges,,
Sn Visit Rn,,G0299,HCPCS,Facility,Outpatient,,,,180,153,51.588,180,"Health Partners, Inc.",Medicare Advantage,88.2,49,,percent of total billed charges,,
Sn Visit Rn,,G0299,HCPCS,Facility,Inpatient,,,,180,153,51.588,180,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sn Visit Rn,,G0299,HCPCS,Facility,Both,,,,180,153,51.588,180,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),108,60,,percent of total billed charges,,
Sn Visit Rn,,G0299,HCPCS,Facility,Both,,,,180,153,51.588,180,"Health Partners, Inc.",State of Minnesota Advantage Program,146.7,81.5,,percent of total billed charges,,
Sn Visit Rn,,G0299,HCPCS,Facility,Both,,,,180,153,51.588,180,"Health Partners, Inc.",State Public Programs,90,50,,percent of total billed charges,,
Sn Visit Rn,,G0299,HCPCS,Facility,Both,,,,180,153,51.588,180,Humana Insurance Company,Commercial PPO,171,95,,percent of total billed charges,,
Sn Visit Rn,,G0299,HCPCS,Facility,Outpatient,,,,180,153,51.588,180,Humana Insurance Company,Medicare PPO,88.2,49,,percent of total billed charges,,
Sn Visit Rn,,G0299,HCPCS,Facility,Inpatient,,,,180,153,51.588,180,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Sn Visit Rn,,G0299,HCPCS,Facility,Both,,,,180,153,51.588,180,Medica,Individual & Family,178.38,99.1,,percent of total billed charges,,
Sn Visit Rn,,G0299,HCPCS,Facility,Outpatient,,,,180,153,51.588,180,Medica,Medica Advantage Solution,89.64,49.8,,percent of total billed charges,,
Sn Visit Rn,,G0299,HCPCS,Facility,Inpatient,,,,180,153,51.588,180,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Sn Visit Rn,,G0299,HCPCS,Facility,Outpatient,,,,180,153,51.588,180,Medica,Medical Assistance,80.28,44.6,,percent of total billed charges,,
Sn Visit Rn,,G0299,HCPCS,Facility,Inpatient,,,,180,153,51.588,180,Medica,Medical Assistance,,,,,Included in per diem rate,
Sn Visit Rn,,G0299,HCPCS,Facility,Outpatient,,,,180,153,51.588,180,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,89.64,49.8,,percent of total billed charges,,
Sn Visit Rn,,G0299,HCPCS,Facility,Inpatient,,,,180,153,51.588,180,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Sn Visit Rn,,G0299,HCPCS,Facility,Both,,,,180,153,51.588,180,"Multiplan, Inc.","Multiplan, Inc.",169.2,94,,percent of total billed charges,,
Sn Visit Rn,,G0299,HCPCS,Facility,Outpatient,,,,180,153,51.588,180,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,162.18,90.1,,percent of total billed charges,,
Sn Visit Rn,,G0299,HCPCS,Facility,Inpatient,,,,180,153,51.588,180,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Sn Visit Rn,,G0299,HCPCS,Facility,Both,,,,180,153,51.588,180,"Preferred One Administrative Services, INC.",PPO,177.48,98.6,,percent of total billed charges,,
Sn Visit Rn,,G0299,HCPCS,Facility,Outpatient,,,,180,153,51.588,180,PrimeWest Health,Minnesota Senior Health Options (MSHO),92.61,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Sn Visit Rn,,G0299,HCPCS,Facility,Inpatient,,,,180,153,51.588,180,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sn Visit Rn,,G0299,HCPCS,Facility,Outpatient,,,,180,153,51.588,180,PrimeWest Health,MinnesotaCare,92.448,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Sn Visit Rn,,G0299,HCPCS,Facility,Inpatient,,,,180,153,51.588,180,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Sn Visit Rn,,G0299,HCPCS,Facility,Both,,,,180,153,51.588,180,Sanford Health Plan,Sanford Health Plan,165.6,92,,percent of total billed charges,,
Sn Visit Rn,,G0299,HCPCS,Facility,Outpatient,,,,180,153,51.588,180,"UCare Health, Inc.",Individual & Family Plan,101.43,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Sn Visit Rn,,G0299,HCPCS,Facility,Inpatient,,,,180,153,51.588,180,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Sn Visit Rn,,G0299,HCPCS,Facility,Outpatient,,,,180,153,51.588,180,"UCare Health, Inc.",Medical Assistance,90.846,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sn Visit Rn,,G0299,HCPCS,Facility,Inpatient,,,,180,153,51.588,180,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Sn Visit Rn,,G0299,HCPCS,Facility,Outpatient,,,,180,153,51.588,180,"UCare Health, Inc.",Medicare Advantage,90.846,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sn Visit Rn,,G0299,HCPCS,Facility,Inpatient,,,,180,153,51.588,180,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sn Visit Rn,,G0299,HCPCS,Facility,Outpatient,,,,180,153,51.588,180,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),90.846,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sn Visit Rn,,G0299,HCPCS,Facility,Inpatient,,,,180,153,51.588,180,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sn Visit Rn,,G0299,HCPCS,Facility,Both,,,,180,153,51.588,180,UnitedHealthcare,Individual & Family,169.2,94,,percent of total billed charges,,
Sn Visit Rn,,G0299,HCPCS,Facility,Outpatient,,,,180,153,51.588,180,UnitedHealthcare,Medicare Advantage,88.2,49,,percent of total billed charges,,
Sn Visit Rn,,G0299,HCPCS,Facility,Inpatient,,,,180,153,51.588,180,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Sn Visit Rn,,G0299,HCPCS,Facility,Outpatient,,,,180,153,51.588,180,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,86.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
Sn Visit Rn,,G0299,HCPCS,Facility,Inpatient,,,,180,153,51.588,180,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Op Observation Special Services Add On,,G0378,HCPCS,Facility,Outpatient,,,,530,450.5,151.898,530,Aetna,Commercial,487.6,92,,percent of total billed charges,,
Op Observation Special Services Add On,,G0378,HCPCS,Facility,Outpatient,,,,530,450.5,151.898,530,Aetna,Medicare Advantage,259.7,49,,percent of total billed charges,,
Op Observation Special Services Add On,,G0378,HCPCS,Facility,Outpatient,,,,530,450.5,151.898,530,Aetna,PPO,492.9,93,,percent of total billed charges,,
Op Observation Special Services Add On,,G0378,HCPCS,Facility,Outpatient,,,,530,450.5,151.898,530,America's PPO,America's PPO,508.959,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Op Observation Special Services Add On,,G0378,HCPCS,Facility,Outpatient,,,,530,450.5,151.898,530,BlueCross BlueShield Minnesota, Federal Employee Program,521.52,98.4,,percent of total billed charges,,
Op Observation Special Services Add On,,G0378,HCPCS,Facility,Outpatient,,,,530,450.5,151.898,530,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,530,100,,percent of total billed charges,,
Op Observation Special Services Add On,,G0378,HCPCS,Facility,Outpatient,,,,530,450.5,151.898,530,BlueCross BlueShield Minnesota,High Value Network Plan,477,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
Op Observation Special Services Add On,,G0378,HCPCS,Facility,Outpatient,,,,530,450.5,151.898,530,BlueCross BlueShield Minnesota,Medicare Advantage,259.7,49,,percent of total billed charges,,
Op Observation Special Services Add On,,G0378,HCPCS,Facility,Outpatient,,,,530,450.5,151.898,530,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,151.898,28.66,,percent of total billed charges,,
Op Observation Special Services Add On,,G0378,HCPCS,Facility,Outpatient,,,,530,450.5,151.898,530,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),259.7,49,,percent of total billed charges,,
Op Observation Special Services Add On,,G0378,HCPCS,Facility,Outpatient,,,,530,450.5,151.898,530,CorVel,Worker's Compensation,530,100,,percent of total billed charges,,
Op Observation Special Services Add On,,G0378,HCPCS,Facility,Outpatient,,,,530,450.5,151.898,530,First Health Group Corporation,First Health Network,514.1,97,,percent of total billed charges,,
Op Observation Special Services Add On,,G0378,HCPCS,Facility,Outpatient,,,,530,450.5,151.898,530,"Health Partners, Inc.",Commercial,501.38,94.6,,percent of total billed charges,,
Op Observation Special Services Add On,,G0378,HCPCS,Facility,Outpatient,,,,530,450.5,151.898,530,"Health Partners, Inc.",Medicare Advantage,259.7,49,,percent of total billed charges,,
Op Observation Special Services Add On,,G0378,HCPCS,Facility,Outpatient,,,,530,450.5,151.898,530,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),318,60,,percent of total billed charges,,
Op Observation Special Services Add On,,G0378,HCPCS,Facility,Outpatient,,,,530,450.5,151.898,530,"Health Partners, Inc.",State of Minnesota Advantage Program,431.95,81.5,,percent of total billed charges,,
Op Observation Special Services Add On,,G0378,HCPCS,Facility,Outpatient,,,,530,450.5,151.898,530,"Health Partners, Inc.",State Public Programs,265,50,,percent of total billed charges,,
Op Observation Special Services Add On,,G0378,HCPCS,Facility,Outpatient,,,,530,450.5,151.898,530,Humana Insurance Company,Commercial PPO,503.5,95,,percent of total billed charges,,
Op Observation Special Services Add On,,G0378,HCPCS,Facility,Outpatient,,,,530,450.5,151.898,530,Humana Insurance Company,Medicare PPO,259.7,49,,percent of total billed charges,,
Op Observation Special Services Add On,,G0378,HCPCS,Facility,Outpatient,,,,530,450.5,151.898,530,Medica,Individual & Family,525.23,99.1,,percent of total billed charges,,
Op Observation Special Services Add On,,G0378,HCPCS,Facility,Outpatient,,,,530,450.5,151.898,530,Medica,Medica Advantage Solution,263.94,49.8,,percent of total billed charges,,
Op Observation Special Services Add On,,G0378,HCPCS,Facility,Outpatient,,,,530,450.5,151.898,530,Medica,Medical Assistance,236.38,44.6,,percent of total billed charges,,
Op Observation Special Services Add On,,G0378,HCPCS,Facility,Outpatient,,,,530,450.5,151.898,530,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,263.94,49.8,,percent of total billed charges,,
Op Observation Special Services Add On,,G0378,HCPCS,Facility,Outpatient,,,,530,450.5,151.898,530,"Multiplan, Inc.","Multiplan, Inc.",498.2,94,,percent of total billed charges,,
Op Observation Special Services Add On,,G0378,HCPCS,Facility,Outpatient,,,,530,450.5,151.898,530,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,477.53,90.1,,percent of total billed charges,,
Op Observation Special Services Add On,,G0378,HCPCS,Facility,Outpatient,,,,530,450.5,151.898,530,"Preferred One Administrative Services, INC.",PPO,522.58,98.6,,percent of total billed charges,,
Op Observation Special Services Add On,,G0378,HCPCS,Facility,Outpatient,,,,530,450.5,151.898,530,PrimeWest Health,Minnesota Senior Health Options (MSHO),272.685,51.45,,percent of total billed charges,,
Op Observation Special Services Add On,,G0378,HCPCS,Facility,Outpatient,,,,530,450.5,151.898,530,PrimeWest Health,MinnesotaCare,272.208,51.36,,percent of total billed charges,,
Op Observation Special Services Add On,,G0378,HCPCS,Facility,Outpatient,,,,530,450.5,151.898,530,Sanford Health Plan,Sanford Health Plan,487.6,92,,percent of total billed charges,,
Op Observation Special Services Add On,,G0378,HCPCS,Facility,Outpatient,,,,530,450.5,151.898,530,"UCare Health, Inc.",Individual & Family Plan,298.655,56.35,,percent of total billed charges,,
Op Observation Special Services Add On,,G0378,HCPCS,Facility,Outpatient,,,,530,450.5,151.898,530,"UCare Health, Inc.",Medical Assistance,267.491,50.47,,percent of total billed charges,,
Op Observation Special Services Add On,,G0378,HCPCS,Facility,Outpatient,,,,530,450.5,151.898,530,"UCare Health, Inc.",Medicare Advantage,267.491,50.47,,percent of total billed charges,,
Op Observation Special Services Add On,,G0378,HCPCS,Facility,Outpatient,,,,530,450.5,151.898,530,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),267.491,50.47,,percent of total billed charges,,
Op Observation Special Services Add On,,G0378,HCPCS,Facility,Outpatient,,,,530,450.5,151.898,530,UnitedHealthcare,Individual & Family,498.2,94,,percent of total billed charges,,
Op Observation Special Services Add On,,G0378,HCPCS,Facility,Outpatient,,,,530,450.5,151.898,530,UnitedHealthcare,Medicare Advantage,259.7,49,,percent of total billed charges,,
Op Observation Special Services Add On,,G0378,HCPCS,Facility,Outpatient,,,,530,450.5,151.898,530,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,254.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
Op Observation Tiered - additional hours,,G0378,HCPCS,Facility,Both,,,,60,51,17.196,60,Aetna,Commercial,55.2,92,,percent of total billed charges,,
Op Observation Tiered - additional hours,,G0378,HCPCS,Facility,Outpatient,,,,60,51,17.196,60,Aetna,Medicare Advantage,29.4,49,,percent of total billed charges,,
Op Observation Tiered - additional hours,,G0378,HCPCS,Facility,Outpatient,,,,60,51,17.196,60,Aetna,PPO,55.8,93,,percent of total billed charges,,
Op Observation Tiered - additional hours,,G0378,HCPCS,Facility,Outpatient,,,,60,51,17.196,60,America's PPO,America's PPO,57.618,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Op Observation Tiered - additional hours,,G0378,HCPCS,Facility,Outpatient,,,,60,51,17.196,60,BlueCross BlueShield Minnesota, Federal Employee Program,59.04,98.4,,percent of total billed charges,,
Op Observation Tiered - additional hours,,G0378,HCPCS,Facility,Outpatient,,,,60,51,17.196,60,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,60,100,,percent of total billed charges,,
Op Observation Tiered - additional hours,,G0378,HCPCS,Facility,Outpatient,,,,60,51,17.196,60,BlueCross BlueShield Minnesota,High Value Network Plan,54,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
Op Observation Tiered - additional hours,,G0378,HCPCS,Facility,Outpatient,,,,60,51,17.196,60,BlueCross BlueShield Minnesota,Medicare Advantage,29.4,49,,percent of total billed charges,,
Op Observation Tiered - additional hours,,G0378,HCPCS,Facility,Outpatient,,,,60,51,17.196,60,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,17.196,28.66,,percent of total billed charges,,
Op Observation Tiered - additional hours,,G0378,HCPCS,Facility,Outpatient,,,,60,51,17.196,60,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),29.4,49,,percent of total billed charges,,
Op Observation Tiered - additional hours,,G0378,HCPCS,Facility,Outpatient,,,,60,51,17.196,60,CorVel,Worker's Compensation,60,100,,percent of total billed charges,,
Op Observation Tiered - additional hours,,G0378,HCPCS,Facility,Outpatient,,,,60,51,17.196,60,First Health Group Corporation,First Health Network,58.2,97,,percent of total billed charges,,
Op Observation Tiered - additional hours,,G0378,HCPCS,Facility,Outpatient,,,,60,51,17.196,60,"Health Partners, Inc.",Commercial,56.76,94.6,,percent of total billed charges,,
Op Observation Tiered - additional hours,,G0378,HCPCS,Facility,Outpatient,,,,60,51,17.196,60,"Health Partners, Inc.",Medicare Advantage,29.4,49,,percent of total billed charges,,
Op Observation Tiered - additional hours,,G0378,HCPCS,Facility,Outpatient,,,,60,51,17.196,60,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),36,60,,percent of total billed charges,,
Op Observation Tiered - additional hours,,G0378,HCPCS,Facility,Outpatient,,,,60,51,17.196,60,"Health Partners, Inc.",State of Minnesota Advantage Program,48.9,81.5,,percent of total billed charges,,
Op Observation Tiered - additional hours,,G0378,HCPCS,Facility,Outpatient,,,,60,51,17.196,60,"Health Partners, Inc.",State Public Programs,30,50,,percent of total billed charges,,
Op Observation Tiered - additional hours,,G0378,HCPCS,Facility,Outpatient,,,,60,51,17.196,60,Humana Insurance Company,Commercial PPO,57,95,,percent of total billed charges,,
Op Observation Tiered - additional hours,,G0378,HCPCS,Facility,Outpatient,,,,60,51,17.196,60,Humana Insurance Company,Medicare PPO,29.4,49,,percent of total billed charges,,
Op Observation Tiered - additional hours,,G0378,HCPCS,Facility,Outpatient,,,,60,51,17.196,60,Medica,Individual & Family,59.46,99.1,,percent of total billed charges,,
Op Observation Tiered - additional hours,,G0378,HCPCS,Facility,Outpatient,,,,60,51,17.196,60,Medica,Medica Advantage Solution,29.88,49.8,,percent of total billed charges,,
Op Observation Tiered - additional hours,,G0378,HCPCS,Facility,Outpatient,,,,60,51,17.196,60,Medica,Medical Assistance,26.76,44.6,,percent of total billed charges,,
Op Observation Tiered - additional hours,,G0378,HCPCS,Facility,Outpatient,,,,60,51,17.196,60,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,29.88,49.8,,percent of total billed charges,,
Op Observation Tiered - additional hours,,G0378,HCPCS,Facility,Outpatient,,,,60,51,17.196,60,"Multiplan, Inc.","Multiplan, Inc.",56.4,94,,percent of total billed charges,,
Op Observation Tiered - additional hours,,G0378,HCPCS,Facility,Outpatient,,,,60,51,17.196,60,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,54.06,90.1,,percent of total billed charges,,
Op Observation Tiered - additional hours,,G0378,HCPCS,Facility,Outpatient,,,,60,51,17.196,60,"Preferred One Administrative Services, INC.",PPO,59.16,98.6,,percent of total billed charges,,
Op Observation Tiered - additional hours,,G0378,HCPCS,Facility,Outpatient,,,,60,51,17.196,60,PrimeWest Health,Minnesota Senior Health Options (MSHO),30.87,51.45,,percent of total billed charges,,
Op Observation Tiered - additional hours,,G0378,HCPCS,Facility,Outpatient,,,,60,51,17.196,60,PrimeWest Health,MinnesotaCare,30.816,51.36,,percent of total billed charges,,
Op Observation Tiered - additional hours,,G0378,HCPCS,Facility,Outpatient,,,,60,51,17.196,60,Sanford Health Plan,Sanford Health Plan,55.2,92,,percent of total billed charges,,
Op Observation Tiered - additional hours,,G0378,HCPCS,Facility,Outpatient,,,,60,51,17.196,60,"UCare Health, Inc.",Individual & Family Plan,33.81,56.35,,percent of total billed charges,,
Op Observation Tiered - additional hours,,G0378,HCPCS,Facility,Outpatient,,,,60,51,17.196,60,"UCare Health, Inc.",Medical Assistance,30.282,50.47,,percent of total billed charges,,
Op Observation Tiered - additional hours,,G0378,HCPCS,Facility,Outpatient,,,,60,51,17.196,60,"UCare Health, Inc.",Medicare Advantage,30.282,50.47,,percent of total billed charges,,
Op Observation Tiered - additional hours,,G0378,HCPCS,Facility,Outpatient,,,,60,51,17.196,60,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),30.282,50.47,,percent of total billed charges,,
Op Observation Tiered - additional hours,,G0378,HCPCS,Facility,Outpatient,,,,60,51,17.196,60,UnitedHealthcare,Individual & Family,56.4,94,,percent of total billed charges,,
Op Observation Tiered - additional hours,,G0378,HCPCS,Facility,Outpatient,,,,60,51,17.196,60,UnitedHealthcare,Medicare Advantage,29.4,49,,percent of total billed charges,,
Op Observation Tiered - additional hours,,G0378,HCPCS,Facility,Outpatient,,,,60,51,17.196,60,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,28.8,48,,percent of total billed charges,,100% of DHS outpatient percentage
Op Observation Tiered - first hour,,G0378,HCPCS,Facility,Both,,,,530,450.5,151.898,530,Aetna,Commercial,487.6,92,,percent of total billed charges,,
Op Observation Tiered - first hour,,G0378,HCPCS,Facility,Outpatient,,,,530,450.5,151.898,530,Aetna,Medicare Advantage,259.7,49,,percent of total billed charges,,
Op Observation Tiered - first hour,,G0378,HCPCS,Facility,Outpatient,,,,530,450.5,151.898,530,Aetna,PPO,492.9,93,,percent of total billed charges,,
Op Observation Tiered - first hour,,G0378,HCPCS,Facility,Outpatient,,,,530,450.5,151.898,530,America's PPO,America's PPO,508.959,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Op Observation Tiered - first hour,,G0378,HCPCS,Facility,Outpatient,,,,530,450.5,151.898,530,BlueCross BlueShield Minnesota, Federal Employee Program,521.52,98.4,,percent of total billed charges,,
Op Observation Tiered - first hour,,G0378,HCPCS,Facility,Outpatient,,,,530,450.5,151.898,530,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,530,100,,percent of total billed charges,,
Op Observation Tiered - first hour,,G0378,HCPCS,Facility,Outpatient,,,,530,450.5,151.898,530,BlueCross BlueShield Minnesota,High Value Network Plan,477,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
Op Observation Tiered - first hour,,G0378,HCPCS,Facility,Outpatient,,,,530,450.5,151.898,530,BlueCross BlueShield Minnesota,Medicare Advantage,259.7,49,,percent of total billed charges,,
Op Observation Tiered - first hour,,G0378,HCPCS,Facility,Outpatient,,,,530,450.5,151.898,530,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,151.898,28.66,,percent of total billed charges,,
Op Observation Tiered - first hour,,G0378,HCPCS,Facility,Outpatient,,,,530,450.5,151.898,530,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),259.7,49,,percent of total billed charges,,
Op Observation Tiered - first hour,,G0378,HCPCS,Facility,Outpatient,,,,530,450.5,151.898,530,CorVel,Worker's Compensation,530,100,,percent of total billed charges,,
Op Observation Tiered - first hour,,G0378,HCPCS,Facility,Outpatient,,,,530,450.5,151.898,530,First Health Group Corporation,First Health Network,514.1,97,,percent of total billed charges,,
Op Observation Tiered - first hour,,G0378,HCPCS,Facility,Outpatient,,,,530,450.5,151.898,530,"Health Partners, Inc.",Commercial,501.38,94.6,,percent of total billed charges,,
Op Observation Tiered - first hour,,G0378,HCPCS,Facility,Outpatient,,,,530,450.5,151.898,530,"Health Partners, Inc.",Medicare Advantage,259.7,49,,percent of total billed charges,,
Op Observation Tiered - first hour,,G0378,HCPCS,Facility,Outpatient,,,,530,450.5,151.898,530,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),318,60,,percent of total billed charges,,
Op Observation Tiered - first hour,,G0378,HCPCS,Facility,Outpatient,,,,530,450.5,151.898,530,"Health Partners, Inc.",State of Minnesota Advantage Program,431.95,81.5,,percent of total billed charges,,
Op Observation Tiered - first hour,,G0378,HCPCS,Facility,Outpatient,,,,530,450.5,151.898,530,"Health Partners, Inc.",State Public Programs,265,50,,percent of total billed charges,,
Op Observation Tiered - first hour,,G0378,HCPCS,Facility,Outpatient,,,,530,450.5,151.898,530,Humana Insurance Company,Commercial PPO,503.5,95,,percent of total billed charges,,
Op Observation Tiered - first hour,,G0378,HCPCS,Facility,Outpatient,,,,530,450.5,151.898,530,Humana Insurance Company,Medicare PPO,259.7,49,,percent of total billed charges,,
Op Observation Tiered - first hour,,G0378,HCPCS,Facility,Outpatient,,,,530,450.5,151.898,530,Medica,Individual & Family,525.23,99.1,,percent of total billed charges,,
Op Observation Tiered - first hour,,G0378,HCPCS,Facility,Outpatient,,,,530,450.5,151.898,530,Medica,Medica Advantage Solution,263.94,49.8,,percent of total billed charges,,
Op Observation Tiered - first hour,,G0378,HCPCS,Facility,Outpatient,,,,530,450.5,151.898,530,Medica,Medical Assistance,236.38,44.6,,percent of total billed charges,,
Op Observation Tiered - first hour,,G0378,HCPCS,Facility,Outpatient,,,,530,450.5,151.898,530,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,263.94,49.8,,percent of total billed charges,,
Op Observation Tiered - first hour,,G0378,HCPCS,Facility,Outpatient,,,,530,450.5,151.898,530,"Multiplan, Inc.","Multiplan, Inc.",498.2,94,,percent of total billed charges,,
Op Observation Tiered - first hour,,G0378,HCPCS,Facility,Outpatient,,,,530,450.5,151.898,530,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,477.53,90.1,,percent of total billed charges,,
Op Observation Tiered - first hour,,G0378,HCPCS,Facility,Outpatient,,,,530,450.5,151.898,530,"Preferred One Administrative Services, INC.",PPO,522.58,98.6,,percent of total billed charges,,
Op Observation Tiered - first hour,,G0378,HCPCS,Facility,Outpatient,,,,530,450.5,151.898,530,PrimeWest Health,Minnesota Senior Health Options (MSHO),272.685,51.45,,percent of total billed charges,,
Op Observation Tiered - first hour,,G0378,HCPCS,Facility,Outpatient,,,,530,450.5,151.898,530,PrimeWest Health,MinnesotaCare,272.208,51.36,,percent of total billed charges,,
Op Observation Tiered - first hour,,G0378,HCPCS,Facility,Outpatient,,,,530,450.5,151.898,530,Sanford Health Plan,Sanford Health Plan,487.6,92,,percent of total billed charges,,
Op Observation Tiered - first hour,,G0378,HCPCS,Facility,Outpatient,,,,530,450.5,151.898,530,"UCare Health, Inc.",Individual & Family Plan,298.655,56.35,,percent of total billed charges,,
Op Observation Tiered - first hour,,G0378,HCPCS,Facility,Outpatient,,,,530,450.5,151.898,530,"UCare Health, Inc.",Medical Assistance,267.491,50.47,,percent of total billed charges,,
Op Observation Tiered - first hour,,G0378,HCPCS,Facility,Outpatient,,,,530,450.5,151.898,530,"UCare Health, Inc.",Medicare Advantage,267.491,50.47,,percent of total billed charges,,
Op Observation Tiered - first hour,,G0378,HCPCS,Facility,Outpatient,,,,530,450.5,151.898,530,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),267.491,50.47,,percent of total billed charges,,
Op Observation Tiered - first hour,,G0378,HCPCS,Facility,Outpatient,,,,530,450.5,151.898,530,UnitedHealthcare,Individual & Family,498.2,94,,percent of total billed charges,,
Op Observation Tiered - first hour,,G0378,HCPCS,Facility,Outpatient,,,,530,450.5,151.898,530,UnitedHealthcare,Medicare Advantage,259.7,49,,percent of total billed charges,,
Op Observation Tiered - first hour,,G0378,HCPCS,Facility,Outpatient,,,,530,450.5,151.898,530,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,254.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
Op Nursing Observation - Direct Admit,,G0379,HCPCS,Facility,Outpatient,,,,265,225.25,75.949,265,Aetna,Commercial,243.8,92,,percent of total billed charges,,
Op Nursing Observation - Direct Admit,,G0379,HCPCS,Facility,Outpatient,,,,265,225.25,75.949,265,Aetna,Medicare Advantage,129.85,49,,percent of total billed charges,,
Op Nursing Observation - Direct Admit,,G0379,HCPCS,Facility,Outpatient,,,,265,225.25,75.949,265,Aetna,PPO,246.45,93,,percent of total billed charges,,
Op Nursing Observation - Direct Admit,,G0379,HCPCS,Facility,Outpatient,,,,265,225.25,75.949,265,America's PPO,America's PPO,254.4795,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Op Nursing Observation - Direct Admit,,G0379,HCPCS,Facility,Outpatient,,,,265,225.25,75.949,265,BlueCross BlueShield Minnesota, Federal Employee Program,260.76,98.4,,percent of total billed charges,,
Op Nursing Observation - Direct Admit,,G0379,HCPCS,Facility,Outpatient,,,,265,225.25,75.949,265,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,265,100,,percent of total billed charges,,
Op Nursing Observation - Direct Admit,,G0379,HCPCS,Facility,Outpatient,,,,265,225.25,75.949,265,BlueCross BlueShield Minnesota,High Value Network Plan,238.5,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
Op Nursing Observation - Direct Admit,,G0379,HCPCS,Facility,Outpatient,,,,265,225.25,75.949,265,BlueCross BlueShield Minnesota,Medicare Advantage,129.85,49,,percent of total billed charges,,
Op Nursing Observation - Direct Admit,,G0379,HCPCS,Facility,Outpatient,,,,265,225.25,75.949,265,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,75.949,28.66,,percent of total billed charges,,
Op Nursing Observation - Direct Admit,,G0379,HCPCS,Facility,Outpatient,,,,265,225.25,75.949,265,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),129.85,49,,percent of total billed charges,,
Op Nursing Observation - Direct Admit,,G0379,HCPCS,Facility,Outpatient,,,,265,225.25,75.949,265,CorVel,Worker's Compensation,265,100,,percent of total billed charges,,
Op Nursing Observation - Direct Admit,,G0379,HCPCS,Facility,Outpatient,,,,265,225.25,75.949,265,First Health Group Corporation,First Health Network,257.05,97,,percent of total billed charges,,
Op Nursing Observation - Direct Admit,,G0379,HCPCS,Facility,Outpatient,,,,265,225.25,75.949,265,"Health Partners, Inc.",Commercial,250.69,94.6,,percent of total billed charges,,
Op Nursing Observation - Direct Admit,,G0379,HCPCS,Facility,Outpatient,,,,265,225.25,75.949,265,"Health Partners, Inc.",Medicare Advantage,129.85,49,,percent of total billed charges,,
Op Nursing Observation - Direct Admit,,G0379,HCPCS,Facility,Outpatient,,,,265,225.25,75.949,265,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),159,60,,percent of total billed charges,,
Op Nursing Observation - Direct Admit,,G0379,HCPCS,Facility,Outpatient,,,,265,225.25,75.949,265,"Health Partners, Inc.",State of Minnesota Advantage Program,215.975,81.5,,percent of total billed charges,,
Op Nursing Observation - Direct Admit,,G0379,HCPCS,Facility,Outpatient,,,,265,225.25,75.949,265,"Health Partners, Inc.",State Public Programs,132.5,50,,percent of total billed charges,,
Op Nursing Observation - Direct Admit,,G0379,HCPCS,Facility,Outpatient,,,,265,225.25,75.949,265,Humana Insurance Company,Commercial PPO,251.75,95,,percent of total billed charges,,
Op Nursing Observation - Direct Admit,,G0379,HCPCS,Facility,Outpatient,,,,265,225.25,75.949,265,Humana Insurance Company,Medicare PPO,129.85,49,,percent of total billed charges,,
Op Nursing Observation - Direct Admit,,G0379,HCPCS,Facility,Outpatient,,,,265,225.25,75.949,265,Medica,Individual & Family,262.615,99.1,,percent of total billed charges,,
Op Nursing Observation - Direct Admit,,G0379,HCPCS,Facility,Outpatient,,,,265,225.25,75.949,265,Medica,Medica Advantage Solution,131.97,49.8,,percent of total billed charges,,
Op Nursing Observation - Direct Admit,,G0379,HCPCS,Facility,Outpatient,,,,265,225.25,75.949,265,Medica,Medical Assistance,118.19,44.6,,percent of total billed charges,,
Op Nursing Observation - Direct Admit,,G0379,HCPCS,Facility,Outpatient,,,,265,225.25,75.949,265,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,131.97,49.8,,percent of total billed charges,,
Op Nursing Observation - Direct Admit,,G0379,HCPCS,Facility,Outpatient,,,,265,225.25,75.949,265,"Multiplan, Inc.","Multiplan, Inc.",249.1,94,,percent of total billed charges,,
Op Nursing Observation - Direct Admit,,G0379,HCPCS,Facility,Outpatient,,,,265,225.25,75.949,265,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,238.765,90.1,,percent of total billed charges,,
Op Nursing Observation - Direct Admit,,G0379,HCPCS,Facility,Outpatient,,,,265,225.25,75.949,265,"Preferred One Administrative Services, INC.",PPO,261.29,98.6,,percent of total billed charges,,
Op Nursing Observation - Direct Admit,,G0379,HCPCS,Facility,Outpatient,,,,265,225.25,75.949,265,PrimeWest Health,Minnesota Senior Health Options (MSHO),136.3425,51.45,,percent of total billed charges,,
Op Nursing Observation - Direct Admit,,G0379,HCPCS,Facility,Outpatient,,,,265,225.25,75.949,265,PrimeWest Health,MinnesotaCare,136.104,51.36,,percent of total billed charges,,
Op Nursing Observation - Direct Admit,,G0379,HCPCS,Facility,Outpatient,,,,265,225.25,75.949,265,Sanford Health Plan,Sanford Health Plan,243.8,92,,percent of total billed charges,,
Op Nursing Observation - Direct Admit,,G0379,HCPCS,Facility,Outpatient,,,,265,225.25,75.949,265,"UCare Health, Inc.",Individual & Family Plan,149.3275,56.35,,percent of total billed charges,,
Op Nursing Observation - Direct Admit,,G0379,HCPCS,Facility,Outpatient,,,,265,225.25,75.949,265,"UCare Health, Inc.",Medical Assistance,133.7455,50.47,,percent of total billed charges,,
Op Nursing Observation - Direct Admit,,G0379,HCPCS,Facility,Outpatient,,,,265,225.25,75.949,265,"UCare Health, Inc.",Medicare Advantage,133.7455,50.47,,percent of total billed charges,,
Op Nursing Observation - Direct Admit,,G0379,HCPCS,Facility,Outpatient,,,,265,225.25,75.949,265,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),133.7455,50.47,,percent of total billed charges,,
Op Nursing Observation - Direct Admit,,G0379,HCPCS,Facility,Outpatient,,,,265,225.25,75.949,265,UnitedHealthcare,Individual & Family,249.1,94,,percent of total billed charges,,
Op Nursing Observation - Direct Admit,,G0379,HCPCS,Facility,Outpatient,,,,265,225.25,75.949,265,UnitedHealthcare,Medicare Advantage,129.85,49,,percent of total billed charges,,
Op Nursing Observation - Direct Admit,,G0379,HCPCS,Facility,Outpatient,,,,265,225.25,75.949,265,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,127.2,48,,percent of total billed charges,,100% of DHS outpatient percentage
Trauma Activation Critical Care,,G0390,HCPCS,Facility,Both,,,,867,736.95,248.4822,867,Aetna,Commercial,797.64,92,,percent of total billed charges,,
Trauma Activation Critical Care,,G0390,HCPCS,Facility,Outpatient,,,,867,736.95,248.4822,867,Aetna,Medicare Advantage,424.83,49,,percent of total billed charges,,
Trauma Activation Critical Care,,G0390,HCPCS,Facility,Inpatient,,,,867,736.95,248.4822,867,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Trauma Activation Critical Care,,G0390,HCPCS,Facility,Both,,,,867,736.95,248.4822,867,Aetna,PPO,806.31,93,,percent of total billed charges,,
Trauma Activation Critical Care,,G0390,HCPCS,Facility,Both,,,,867,736.95,248.4822,867,America's PPO,America's PPO,832.5801,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Trauma Activation Critical Care,,G0390,HCPCS,Facility,Both,,,,867,736.95,248.4822,867,BlueCross BlueShield Minnesota, Federal Employee Program,853.128,98.4,,percent of total billed charges,,
Trauma Activation Critical Care,,G0390,HCPCS,Facility,Both,,,,867,736.95,248.4822,867,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,867,100,,percent of total billed charges,,
Trauma Activation Critical Care,,G0390,HCPCS,Facility,Both,,,,867,736.95,248.4822,867,BlueCross BlueShield Minnesota,High Value Network Plan,780.3,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
Trauma Activation Critical Care,,G0390,HCPCS,Facility,Outpatient,,,,867,736.95,248.4822,867,BlueCross BlueShield Minnesota,Medicare Advantage,424.83,49,,percent of total billed charges,,
Trauma Activation Critical Care,,G0390,HCPCS,Facility,Inpatient,,,,867,736.95,248.4822,867,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Trauma Activation Critical Care,,G0390,HCPCS,Facility,Both,,,,867,736.95,248.4822,867,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,767.9019,88.57,,percent of total billed charges,,
Trauma Activation Critical Care,,G0390,HCPCS,Facility,Both,,,,867,736.95,248.4822,867,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,248.4822,28.66,,percent of total billed charges,,
Trauma Activation Critical Care,,G0390,HCPCS,Facility,Outpatient,,,,867,736.95,248.4822,867,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),424.83,49,,percent of total billed charges,,
Trauma Activation Critical Care,,G0390,HCPCS,Facility,Inpatient,,,,867,736.95,248.4822,867,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Trauma Activation Critical Care,,G0390,HCPCS,Facility,Both,,,,867,736.95,248.4822,867,CorVel,Worker's Compensation,867,100,,percent of total billed charges,,
Trauma Activation Critical Care,,G0390,HCPCS,Facility,Both,,,,867,736.95,248.4822,867,First Health Group Corporation,First Health Network,840.99,97,,percent of total billed charges,,
Trauma Activation Critical Care,,G0390,HCPCS,Facility,Both,,,,867,736.95,248.4822,867,"Health Partners, Inc.",Commercial,820.182,94.6,,percent of total billed charges,,
Trauma Activation Critical Care,,G0390,HCPCS,Facility,Outpatient,,,,867,736.95,248.4822,867,"Health Partners, Inc.",Medicare Advantage,424.83,49,,percent of total billed charges,,
Trauma Activation Critical Care,,G0390,HCPCS,Facility,Inpatient,,,,867,736.95,248.4822,867,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Trauma Activation Critical Care,,G0390,HCPCS,Facility,Both,,,,867,736.95,248.4822,867,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),520.2,60,,percent of total billed charges,,
Trauma Activation Critical Care,,G0390,HCPCS,Facility,Both,,,,867,736.95,248.4822,867,"Health Partners, Inc.",State of Minnesota Advantage Program,706.605,81.5,,percent of total billed charges,,
Trauma Activation Critical Care,,G0390,HCPCS,Facility,Both,,,,867,736.95,248.4822,867,"Health Partners, Inc.",State Public Programs,433.5,50,,percent of total billed charges,,
Trauma Activation Critical Care,,G0390,HCPCS,Facility,Both,,,,867,736.95,248.4822,867,Humana Insurance Company,Commercial PPO,823.65,95,,percent of total billed charges,,
Trauma Activation Critical Care,,G0390,HCPCS,Facility,Outpatient,,,,867,736.95,248.4822,867,Humana Insurance Company,Medicare PPO,424.83,49,,percent of total billed charges,,
Trauma Activation Critical Care,,G0390,HCPCS,Facility,Inpatient,,,,867,736.95,248.4822,867,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Trauma Activation Critical Care,,G0390,HCPCS,Facility,Both,,,,867,736.95,248.4822,867,Medica,Individual & Family,859.197,99.1,,percent of total billed charges,,
Trauma Activation Critical Care,,G0390,HCPCS,Facility,Outpatient,,,,867,736.95,248.4822,867,Medica,Medica Advantage Solution,431.766,49.8,,percent of total billed charges,,
Trauma Activation Critical Care,,G0390,HCPCS,Facility,Inpatient,,,,867,736.95,248.4822,867,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Trauma Activation Critical Care,,G0390,HCPCS,Facility,Outpatient,,,,867,736.95,248.4822,867,Medica,Medical Assistance,386.682,44.6,,percent of total billed charges,,
Trauma Activation Critical Care,,G0390,HCPCS,Facility,Inpatient,,,,867,736.95,248.4822,867,Medica,Medical Assistance,,,,,Included in per diem rate,
Trauma Activation Critical Care,,G0390,HCPCS,Facility,Outpatient,,,,867,736.95,248.4822,867,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,431.766,49.8,,percent of total billed charges,,
Trauma Activation Critical Care,,G0390,HCPCS,Facility,Inpatient,,,,867,736.95,248.4822,867,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Trauma Activation Critical Care,,G0390,HCPCS,Facility,Both,,,,867,736.95,248.4822,867,"Multiplan, Inc.","Multiplan, Inc.",814.98,94,,percent of total billed charges,,
Trauma Activation Critical Care,,G0390,HCPCS,Facility,Outpatient,,,,867,736.95,248.4822,867,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,781.167,90.1,,percent of total billed charges,,
Trauma Activation Critical Care,,G0390,HCPCS,Facility,Inpatient,,,,867,736.95,248.4822,867,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Trauma Activation Critical Care,,G0390,HCPCS,Facility,Both,,,,867,736.95,248.4822,867,"Preferred One Administrative Services, INC.",PPO,854.862,98.6,,percent of total billed charges,,
Trauma Activation Critical Care,,G0390,HCPCS,Facility,Outpatient,,,,867,736.95,248.4822,867,PrimeWest Health,Minnesota Senior Health Options (MSHO),446.0715,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Trauma Activation Critical Care,,G0390,HCPCS,Facility,Inpatient,,,,867,736.95,248.4822,867,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Trauma Activation Critical Care,,G0390,HCPCS,Facility,Outpatient,,,,867,736.95,248.4822,867,PrimeWest Health,MinnesotaCare,445.2912,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Trauma Activation Critical Care,,G0390,HCPCS,Facility,Inpatient,,,,867,736.95,248.4822,867,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Trauma Activation Critical Care,,G0390,HCPCS,Facility,Both,,,,867,736.95,248.4822,867,Sanford Health Plan,Sanford Health Plan,797.64,92,,percent of total billed charges,,
Trauma Activation Critical Care,,G0390,HCPCS,Facility,Outpatient,,,,867,736.95,248.4822,867,"UCare Health, Inc.",Individual & Family Plan,488.5545,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Trauma Activation Critical Care,,G0390,HCPCS,Facility,Inpatient,,,,867,736.95,248.4822,867,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Trauma Activation Critical Care,,G0390,HCPCS,Facility,Outpatient,,,,867,736.95,248.4822,867,"UCare Health, Inc.",Medical Assistance,437.5749,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Trauma Activation Critical Care,,G0390,HCPCS,Facility,Inpatient,,,,867,736.95,248.4822,867,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Trauma Activation Critical Care,,G0390,HCPCS,Facility,Outpatient,,,,867,736.95,248.4822,867,"UCare Health, Inc.",Medicare Advantage,437.5749,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Trauma Activation Critical Care,,G0390,HCPCS,Facility,Inpatient,,,,867,736.95,248.4822,867,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Trauma Activation Critical Care,,G0390,HCPCS,Facility,Outpatient,,,,867,736.95,248.4822,867,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),437.5749,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Trauma Activation Critical Care,,G0390,HCPCS,Facility,Inpatient,,,,867,736.95,248.4822,867,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Trauma Activation Critical Care,,G0390,HCPCS,Facility,Both,,,,867,736.95,248.4822,867,UnitedHealthcare,Individual & Family,814.98,94,,percent of total billed charges,,
Trauma Activation Critical Care,,G0390,HCPCS,Facility,Outpatient,,,,867,736.95,248.4822,867,UnitedHealthcare,Medicare Advantage,424.83,49,,percent of total billed charges,,
Trauma Activation Critical Care,,G0390,HCPCS,Facility,Inpatient,,,,867,736.95,248.4822,867,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Trauma Activation Critical Care,,G0390,HCPCS,Facility,Outpatient,,,,867,736.95,248.4822,867,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,416.16,48,,percent of total billed charges,,100% of DHS outpatient percentage
Trauma Activation Critical Care,,G0390,HCPCS,Facility,Inpatient,,,,867,736.95,248.4822,867,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Ecg Medicare Ippe W/O Interp And Report,,G0404,HCPCS,Facility,Both,,,,204,173.4,58.4664,204,Aetna,Commercial,187.68,92,,percent of total billed charges,,
Ecg Medicare Ippe W/O Interp And Report,,G0404,HCPCS,Facility,Outpatient,,,,204,173.4,58.4664,204,Aetna,Medicare Advantage,99.96,49,,percent of total billed charges,,
Ecg Medicare Ippe W/O Interp And Report,,G0404,HCPCS,Facility,Inpatient,,,,204,173.4,58.4664,204,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Ecg Medicare Ippe W/O Interp And Report,,G0404,HCPCS,Facility,Both,,,,204,173.4,58.4664,204,Aetna,PPO,189.72,93,,percent of total billed charges,,
Ecg Medicare Ippe W/O Interp And Report,,G0404,HCPCS,Facility,Both,,,,204,173.4,58.4664,204,America's PPO,America's PPO,195.9012,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Ecg Medicare Ippe W/O Interp And Report,,G0404,HCPCS,Facility,Both,,,,204,173.4,58.4664,204,BlueCross BlueShield Minnesota, Federal Employee Program,200.736,98.4,,percent of total billed charges,,
Ecg Medicare Ippe W/O Interp And Report,,G0404,HCPCS,Facility,Both,,,,204,173.4,58.4664,204,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,204,100,,percent of total billed charges,,
Ecg Medicare Ippe W/O Interp And Report,,G0404,HCPCS,Facility,Both,,,,204,173.4,58.4664,204,BlueCross BlueShield Minnesota,High Value Network Plan,183.6,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
Ecg Medicare Ippe W/O Interp And Report,,G0404,HCPCS,Facility,Outpatient,,,,204,173.4,58.4664,204,BlueCross BlueShield Minnesota,Medicare Advantage,99.96,49,,percent of total billed charges,,
Ecg Medicare Ippe W/O Interp And Report,,G0404,HCPCS,Facility,Inpatient,,,,204,173.4,58.4664,204,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Ecg Medicare Ippe W/O Interp And Report,,G0404,HCPCS,Facility,Both,,,,204,173.4,58.4664,204,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,180.6828,88.57,,percent of total billed charges,,
Ecg Medicare Ippe W/O Interp And Report,,G0404,HCPCS,Facility,Both,,,,204,173.4,58.4664,204,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,58.4664,28.66,,percent of total billed charges,,
Ecg Medicare Ippe W/O Interp And Report,,G0404,HCPCS,Facility,Outpatient,,,,204,173.4,58.4664,204,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),99.96,49,,percent of total billed charges,,
Ecg Medicare Ippe W/O Interp And Report,,G0404,HCPCS,Facility,Inpatient,,,,204,173.4,58.4664,204,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Ecg Medicare Ippe W/O Interp And Report,,G0404,HCPCS,Facility,Both,,,,204,173.4,58.4664,204,CorVel,Worker's Compensation,204,100,,percent of total billed charges,,
Ecg Medicare Ippe W/O Interp And Report,,G0404,HCPCS,Facility,Both,,,,204,173.4,58.4664,204,First Health Group Corporation,First Health Network,197.88,97,,percent of total billed charges,,
Ecg Medicare Ippe W/O Interp And Report,,G0404,HCPCS,Facility,Both,,,,204,173.4,58.4664,204,"Health Partners, Inc.",Commercial,192.984,94.6,,percent of total billed charges,,
Ecg Medicare Ippe W/O Interp And Report,,G0404,HCPCS,Facility,Outpatient,,,,204,173.4,58.4664,204,"Health Partners, Inc.",Medicare Advantage,99.96,49,,percent of total billed charges,,
Ecg Medicare Ippe W/O Interp And Report,,G0404,HCPCS,Facility,Inpatient,,,,204,173.4,58.4664,204,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ecg Medicare Ippe W/O Interp And Report,,G0404,HCPCS,Facility,Both,,,,204,173.4,58.4664,204,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),122.4,60,,percent of total billed charges,,
Ecg Medicare Ippe W/O Interp And Report,,G0404,HCPCS,Facility,Both,,,,204,173.4,58.4664,204,"Health Partners, Inc.",State of Minnesota Advantage Program,166.26,81.5,,percent of total billed charges,,
Ecg Medicare Ippe W/O Interp And Report,,G0404,HCPCS,Facility,Both,,,,204,173.4,58.4664,204,"Health Partners, Inc.",State Public Programs,102,50,,percent of total billed charges,,
Ecg Medicare Ippe W/O Interp And Report,,G0404,HCPCS,Facility,Both,,,,204,173.4,58.4664,204,Humana Insurance Company,Commercial PPO,193.8,95,,percent of total billed charges,,
Ecg Medicare Ippe W/O Interp And Report,,G0404,HCPCS,Facility,Outpatient,,,,204,173.4,58.4664,204,Humana Insurance Company,Medicare PPO,99.96,49,,percent of total billed charges,,
Ecg Medicare Ippe W/O Interp And Report,,G0404,HCPCS,Facility,Inpatient,,,,204,173.4,58.4664,204,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Ecg Medicare Ippe W/O Interp And Report,,G0404,HCPCS,Facility,Both,,,,204,173.4,58.4664,204,Medica,Individual & Family,202.164,99.1,,percent of total billed charges,,
Ecg Medicare Ippe W/O Interp And Report,,G0404,HCPCS,Facility,Outpatient,,,,204,173.4,58.4664,204,Medica,Medica Advantage Solution,101.592,49.8,,percent of total billed charges,,
Ecg Medicare Ippe W/O Interp And Report,,G0404,HCPCS,Facility,Inpatient,,,,204,173.4,58.4664,204,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Ecg Medicare Ippe W/O Interp And Report,,G0404,HCPCS,Facility,Outpatient,,,,204,173.4,58.4664,204,Medica,Medical Assistance,90.984,44.6,,percent of total billed charges,,
Ecg Medicare Ippe W/O Interp And Report,,G0404,HCPCS,Facility,Inpatient,,,,204,173.4,58.4664,204,Medica,Medical Assistance,,,,,Included in per diem rate,
Ecg Medicare Ippe W/O Interp And Report,,G0404,HCPCS,Facility,Outpatient,,,,204,173.4,58.4664,204,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,101.592,49.8,,percent of total billed charges,,
Ecg Medicare Ippe W/O Interp And Report,,G0404,HCPCS,Facility,Inpatient,,,,204,173.4,58.4664,204,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Ecg Medicare Ippe W/O Interp And Report,,G0404,HCPCS,Facility,Both,,,,204,173.4,58.4664,204,"Multiplan, Inc.","Multiplan, Inc.",191.76,94,,percent of total billed charges,,
Ecg Medicare Ippe W/O Interp And Report,,G0404,HCPCS,Facility,Outpatient,,,,204,173.4,58.4664,204,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,183.804,90.1,,percent of total billed charges,,
Ecg Medicare Ippe W/O Interp And Report,,G0404,HCPCS,Facility,Inpatient,,,,204,173.4,58.4664,204,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Ecg Medicare Ippe W/O Interp And Report,,G0404,HCPCS,Facility,Both,,,,204,173.4,58.4664,204,"Preferred One Administrative Services, INC.",PPO,201.144,98.6,,percent of total billed charges,,
Ecg Medicare Ippe W/O Interp And Report,,G0404,HCPCS,Facility,Outpatient,,,,204,173.4,58.4664,204,PrimeWest Health,Minnesota Senior Health Options (MSHO),104.958,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Ecg Medicare Ippe W/O Interp And Report,,G0404,HCPCS,Facility,Inpatient,,,,204,173.4,58.4664,204,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ecg Medicare Ippe W/O Interp And Report,,G0404,HCPCS,Facility,Outpatient,,,,204,173.4,58.4664,204,PrimeWest Health,MinnesotaCare,104.7744,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Ecg Medicare Ippe W/O Interp And Report,,G0404,HCPCS,Facility,Inpatient,,,,204,173.4,58.4664,204,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Ecg Medicare Ippe W/O Interp And Report,,G0404,HCPCS,Facility,Both,,,,204,173.4,58.4664,204,Sanford Health Plan,Sanford Health Plan,187.68,92,,percent of total billed charges,,
Ecg Medicare Ippe W/O Interp And Report,,G0404,HCPCS,Facility,Outpatient,,,,204,173.4,58.4664,204,"UCare Health, Inc.",Individual & Family Plan,114.954,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Ecg Medicare Ippe W/O Interp And Report,,G0404,HCPCS,Facility,Inpatient,,,,204,173.4,58.4664,204,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Ecg Medicare Ippe W/O Interp And Report,,G0404,HCPCS,Facility,Outpatient,,,,204,173.4,58.4664,204,"UCare Health, Inc.",Medical Assistance,102.9588,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ecg Medicare Ippe W/O Interp And Report,,G0404,HCPCS,Facility,Inpatient,,,,204,173.4,58.4664,204,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Ecg Medicare Ippe W/O Interp And Report,,G0404,HCPCS,Facility,Outpatient,,,,204,173.4,58.4664,204,"UCare Health, Inc.",Medicare Advantage,102.9588,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ecg Medicare Ippe W/O Interp And Report,,G0404,HCPCS,Facility,Inpatient,,,,204,173.4,58.4664,204,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ecg Medicare Ippe W/O Interp And Report,,G0404,HCPCS,Facility,Outpatient,,,,204,173.4,58.4664,204,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),102.9588,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ecg Medicare Ippe W/O Interp And Report,,G0404,HCPCS,Facility,Inpatient,,,,204,173.4,58.4664,204,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ecg Medicare Ippe W/O Interp And Report,,G0404,HCPCS,Facility,Both,,,,204,173.4,58.4664,204,UnitedHealthcare,Individual & Family,191.76,94,,percent of total billed charges,,
Ecg Medicare Ippe W/O Interp And Report,,G0404,HCPCS,Facility,Outpatient,,,,204,173.4,58.4664,204,UnitedHealthcare,Medicare Advantage,99.96,49,,percent of total billed charges,,
Ecg Medicare Ippe W/O Interp And Report,,G0404,HCPCS,Facility,Inpatient,,,,204,173.4,58.4664,204,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Ecg Medicare Ippe W/O Interp And Report,,G0404,HCPCS,Facility,Outpatient,,,,204,173.4,58.4664,204,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,97.92,48,,percent of total billed charges,,100% of DHS outpatient percentage
Ecg Medicare Ippe W/O Interp And Report,,G0404,HCPCS,Facility,Inpatient,,,,204,173.4,58.4664,204,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Ecg W/12 Leads; Interp And Report Only, Screen For Mc Ippe (Pro Cah)",,G0405,HCPCS,Professional,Both,,,,153,130.05,5.02,153,Aetna,Commercial,130.05,85,,percent of total billed charges,,
"Ecg W/12 Leads; Interp And Report Only, Screen For Mc Ippe (Pro Cah)",,G0405,HCPCS,Professional,Both,,,,153,130.05,5.02,153,Aetna,Medicare Advantage,8.18,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Ecg W/12 Leads; Interp And Report Only, Screen For Mc Ippe (Pro Cah)",,G0405,HCPCS,Professional,Both,,,,153,130.05,5.02,153,Aetna,PPO,142.29,93,,percent of total billed charges,,
"Ecg W/12 Leads; Interp And Report Only, Screen For Mc Ippe (Pro Cah)",,G0405,HCPCS,Professional,Both,,,,153,130.05,5.02,153,America's PPO,America's PPO,130.7232,85.44,,percent of total billed charges,,"89% of charge, less 4% management fee"
"Ecg W/12 Leads; Interp And Report Only, Screen For Mc Ippe (Pro Cah)",,G0405,HCPCS,Professional,Both,,,,153,130.05,5.02,153,BlueCross BlueShield Minnesota, Federal Employee Program,14,,,Fee schedule,,100% of BCBS multispecialty fee schedule; cap at line level; default 55% of chg for new codes
"Ecg W/12 Leads; Interp And Report Only, Screen For Mc Ippe (Pro Cah)",,G0405,HCPCS,Professional,Both,,,,153,130.05,5.02,153,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,14.224,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Ecg W/12 Leads; Interp And Report Only, Screen For Mc Ippe (Pro Cah)",,G0405,HCPCS,Professional,Both,,,,153,130.05,5.02,153,BlueCross BlueShield Minnesota,Medicare Advantage,9.131,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Ecg W/12 Leads; Interp And Report Only, Screen For Mc Ippe (Pro Cah)",,G0405,HCPCS,Professional,Both,,,,153,130.05,5.02,153,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,14.224,,,Fee schedule,,"100% of BCBS multispecialty fee schedule, plus MN Care tax; cap at line level; default 55% of chg for new codes"
"Ecg W/12 Leads; Interp And Report Only, Screen For Mc Ippe (Pro Cah)",,G0405,HCPCS,Professional,Both,,,,153,130.05,5.02,153,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,5.7912,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Ecg W/12 Leads; Interp And Report Only, Screen For Mc Ippe (Pro Cah)",,G0405,HCPCS,Professional,Both,,,,153,130.05,5.02,153,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),9.131,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Ecg W/12 Leads; Interp And Report Only, Screen For Mc Ippe (Pro Cah)",,G0405,HCPCS,Professional,Both,,,,153,130.05,5.02,153,CorVel,Worker's Compensation,15.7386027,,,Fee schedule,,100% of MN Work Comp fees_RBRVS_schedule23; cap at line level
"Ecg W/12 Leads; Interp And Report Only, Screen For Mc Ippe (Pro Cah)",,G0405,HCPCS,Professional,Both,,,,153,130.05,5.02,153,First Health Group Corporation,First Health Network,148.41,97,,percent of total billed charges,,
"Ecg W/12 Leads; Interp And Report Only, Screen For Mc Ippe (Pro Cah)",,G0405,HCPCS,Professional,Both,,,,153,130.05,5.02,153,"Health Partners, Inc.",Commercial,8.77,,,Fee schedule,,HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Ecg W/12 Leads; Interp And Report Only, Screen For Mc Ippe (Pro Cah)",,G0405,HCPCS,Professional,Both,,,,153,130.05,5.02,153,"Health Partners, Inc.",Medicare Advantage,9.131,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Ecg W/12 Leads; Interp And Report Only, Screen For Mc Ippe (Pro Cah)",,G0405,HCPCS,Professional,Both,,,,153,130.05,5.02,153,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),7.79,,,Fee schedule,,100% of HPI MSHO fee schedule; cap at line level
"Ecg W/12 Leads; Interp And Report Only, Screen For Mc Ippe (Pro Cah)",,G0405,HCPCS,Professional,Both,,,,153,130.05,5.02,153,"Health Partners, Inc.",State of Minnesota Advantage Program,7.555355,,,Fee schedule,,86.15% of HPI commercial fee schedule; cap at line level; default 70% of chg for new codes
"Ecg W/12 Leads; Interp And Report Only, Screen For Mc Ippe (Pro Cah)",,G0405,HCPCS,Professional,Both,,,,153,130.05,5.02,153,"Health Partners, Inc.",State Public Programs,5.02,,,Fee schedule,,100% of HPI State Public Programs fee schedule; cap at line level
"Ecg W/12 Leads; Interp And Report Only, Screen For Mc Ippe (Pro Cah)",,G0405,HCPCS,Professional,Both,,,,153,130.05,5.02,153,Humana Insurance Company,Commercial PPO,7.94,,,Fee schedule,,100% of Humana FSC 005-550; cap at line level
"Ecg W/12 Leads; Interp And Report Only, Screen For Mc Ippe (Pro Cah)",,G0405,HCPCS,Professional,Both,,,,153,130.05,5.02,153,Humana Insurance Company,Medicare PPO,153,,,Fee schedule,,100% of Medicare Physician fee schedule; cap at line level
"Ecg W/12 Leads; Interp And Report Only, Screen For Mc Ippe (Pro Cah)",,G0405,HCPCS,Professional,Both,,,,153,130.05,5.02,153,Medica,Individual & Family,129.744,84.8,,percent of total billed charges,,
"Ecg W/12 Leads; Interp And Report Only, Screen For Mc Ippe (Pro Cah)",,G0405,HCPCS,Professional,Both,,,,153,130.05,5.02,153,Medica,Medica Advantage Solution,76.194,49.8,,percent of total billed charges,,
"Ecg W/12 Leads; Interp And Report Only, Screen For Mc Ippe (Pro Cah)",,G0405,HCPCS,Professional,Both,,,,153,130.05,5.02,153,Medica,Medical Assistance,5.79,,,Fee schedule,,100% of Medica Medicaid fee schedule; cap at line level
"Ecg W/12 Leads; Interp And Report Only, Screen For Mc Ippe (Pro Cah)",,G0405,HCPCS,Professional,Both,,,,153,130.05,5.02,153,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,7.94,,,Fee schedule,,100% of Medica Medicare fee schedule; cap at line level
"Ecg W/12 Leads; Interp And Report Only, Screen For Mc Ippe (Pro Cah)",,G0405,HCPCS,Professional,Both,,,,153,130.05,5.02,153,"Multiplan, Inc.","Multiplan, Inc.",143.82,94,,percent of total billed charges,,
"Ecg W/12 Leads; Interp And Report Only, Screen For Mc Ippe (Pro Cah)",,G0405,HCPCS,Professional,Both,,,,153,130.05,5.02,153,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,137.853,90.1,,percent of total billed charges,,
"Ecg W/12 Leads; Interp And Report Only, Screen For Mc Ippe (Pro Cah)",,G0405,HCPCS,Professional,Both,,,,153,130.05,5.02,153,"Preferred One Administrative Services, INC.",PPO,150.858,98.6,,percent of total billed charges,,
"Ecg W/12 Leads; Interp And Report Only, Screen For Mc Ippe (Pro Cah)",,G0405,HCPCS,Professional,Both,,,,153,130.05,5.02,153,PrimeWest Health,Minnesota Senior Health Options (MSHO),9.131,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Ecg W/12 Leads; Interp And Report Only, Screen For Mc Ippe (Pro Cah)",,G0405,HCPCS,Professional,Both,,,,153,130.05,5.02,153,PrimeWest Health,MinnesotaCare,6.196584,,,Fee schedule,,107% of DHS fee schedule; plus MN Care tax; cap at line level
"Ecg W/12 Leads; Interp And Report Only, Screen For Mc Ippe (Pro Cah)",,G0405,HCPCS,Professional,Both,,,,153,130.05,5.02,153,Sanford Health Plan,Sanford Health Plan,134.64,88,,percent of total billed charges,,
"Ecg W/12 Leads; Interp And Report Only, Screen For Mc Ippe (Pro Cah)",,G0405,HCPCS,Professional,Both,,,,153,130.05,5.02,153,"UCare Health, Inc.",Individual & Family Plan,12.907264,,,Fee schedule,,"160% of Ucare Medicare fee schedule, plus MN Care tax; cap at line level"
"Ecg W/12 Leads; Interp And Report Only, Screen For Mc Ippe (Pro Cah)",,G0405,HCPCS,Professional,Both,,,,153,130.05,5.02,153,"UCare Health, Inc.",Medical Assistance,6.37032,,,Fee schedule,,110% of Ucare MHCP fee schedule; plus MN Care tax; cap at line level
"Ecg W/12 Leads; Interp And Report Only, Screen For Mc Ippe (Pro Cah)",,G0405,HCPCS,Professional,Both,,,,153,130.05,5.02,153,"UCare Health, Inc.",Medicare Advantage,9.131,,,Fee schedule,,100% of Ucare Medicare fee schedule; cap at line level
"Ecg W/12 Leads; Interp And Report Only, Screen For Mc Ippe (Pro Cah)",,G0405,HCPCS,Professional,Both,,,,153,130.05,5.02,153,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),7.3048,,,Fee schedule,,100% of Ucare MSHO Method II fee schedule; cap at line level
"Ecg W/12 Leads; Interp And Report Only, Screen For Mc Ippe (Pro Cah)",,G0405,HCPCS,Professional,Both,,,,153,130.05,5.02,153,UnitedHealthcare,Individual & Family,153,,,Fee schedule,,100% of UHC MN 57967  Physician Full Schedule; cap at line level
"Ecg W/12 Leads; Interp And Report Only, Screen For Mc Ippe (Pro Cah)",,G0405,HCPCS,Professional,Both,,,,153,130.05,5.02,153,UnitedHealthcare,Medicare Advantage,9.131,,,Fee schedule,,115% of Medicare Physician fee schedule; cap at line level
"Ecg W/12 Leads; Interp And Report Only, Screen For Mc Ippe (Pro Cah)",,G0405,HCPCS,Professional,Both,,,,153,130.05,5.02,153,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,5.7912,,,Fee schedule,,100% of DHS fee schedule; plus MN Care tax; cap at line level
"Surgical Pathology, Gross And Microscopic Examinations, Prostate Needle Biopsy, Any Method (Path)",,G0416,HCPCS,Facility,Both,,,,1771,1505.35,507.5686,1771,Aetna,Commercial,1629.32,92,,percent of total billed charges,,
"Surgical Pathology, Gross And Microscopic Examinations, Prostate Needle Biopsy, Any Method (Path)",,G0416,HCPCS,Facility,Outpatient,,,,1771,1505.35,507.5686,1771,Aetna,Medicare Advantage,867.79,49,,percent of total billed charges,,
"Surgical Pathology, Gross And Microscopic Examinations, Prostate Needle Biopsy, Any Method (Path)",,G0416,HCPCS,Facility,Inpatient,,,,1771,1505.35,507.5686,1771,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Surgical Pathology, Gross And Microscopic Examinations, Prostate Needle Biopsy, Any Method (Path)",,G0416,HCPCS,Facility,Both,,,,1771,1505.35,507.5686,1771,Aetna,PPO,1647.03,93,,percent of total billed charges,,
"Surgical Pathology, Gross And Microscopic Examinations, Prostate Needle Biopsy, Any Method (Path)",,G0416,HCPCS,Facility,Both,,,,1771,1505.35,507.5686,1771,America's PPO,America's PPO,1700.6913,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Surgical Pathology, Gross And Microscopic Examinations, Prostate Needle Biopsy, Any Method (Path)",,G0416,HCPCS,Facility,Both,,,,1771,1505.35,507.5686,1771,BlueCross BlueShield Minnesota, Federal Employee Program,1742.664,98.4,,percent of total billed charges,,
"Surgical Pathology, Gross And Microscopic Examinations, Prostate Needle Biopsy, Any Method (Path)",,G0416,HCPCS,Facility,Both,,,,1771,1505.35,507.5686,1771,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1771,100,,percent of total billed charges,,
"Surgical Pathology, Gross And Microscopic Examinations, Prostate Needle Biopsy, Any Method (Path)",,G0416,HCPCS,Facility,Both,,,,1771,1505.35,507.5686,1771,BlueCross BlueShield Minnesota,High Value Network Plan,1593.9,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
"Surgical Pathology, Gross And Microscopic Examinations, Prostate Needle Biopsy, Any Method (Path)",,G0416,HCPCS,Facility,Outpatient,,,,1771,1505.35,507.5686,1771,BlueCross BlueShield Minnesota,Medicare Advantage,867.79,49,,percent of total billed charges,,
"Surgical Pathology, Gross And Microscopic Examinations, Prostate Needle Biopsy, Any Method (Path)",,G0416,HCPCS,Facility,Inpatient,,,,1771,1505.35,507.5686,1771,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Surgical Pathology, Gross And Microscopic Examinations, Prostate Needle Biopsy, Any Method (Path)",,G0416,HCPCS,Facility,Both,,,,1771,1505.35,507.5686,1771,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1568.5747,88.57,,percent of total billed charges,,
"Surgical Pathology, Gross And Microscopic Examinations, Prostate Needle Biopsy, Any Method (Path)",,G0416,HCPCS,Facility,Both,,,,1771,1505.35,507.5686,1771,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,507.5686,28.66,,percent of total billed charges,,
"Surgical Pathology, Gross And Microscopic Examinations, Prostate Needle Biopsy, Any Method (Path)",,G0416,HCPCS,Facility,Outpatient,,,,1771,1505.35,507.5686,1771,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),867.79,49,,percent of total billed charges,,
"Surgical Pathology, Gross And Microscopic Examinations, Prostate Needle Biopsy, Any Method (Path)",,G0416,HCPCS,Facility,Inpatient,,,,1771,1505.35,507.5686,1771,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Surgical Pathology, Gross And Microscopic Examinations, Prostate Needle Biopsy, Any Method (Path)",,G0416,HCPCS,Facility,Both,,,,1771,1505.35,507.5686,1771,CorVel,Worker's Compensation,1771,100,,percent of total billed charges,,
"Surgical Pathology, Gross And Microscopic Examinations, Prostate Needle Biopsy, Any Method (Path)",,G0416,HCPCS,Facility,Both,,,,1771,1505.35,507.5686,1771,First Health Group Corporation,First Health Network,1717.87,97,,percent of total billed charges,,
"Surgical Pathology, Gross And Microscopic Examinations, Prostate Needle Biopsy, Any Method (Path)",,G0416,HCPCS,Facility,Both,,,,1771,1505.35,507.5686,1771,"Health Partners, Inc.",Commercial,1675.366,94.6,,percent of total billed charges,,
"Surgical Pathology, Gross And Microscopic Examinations, Prostate Needle Biopsy, Any Method (Path)",,G0416,HCPCS,Facility,Outpatient,,,,1771,1505.35,507.5686,1771,"Health Partners, Inc.",Medicare Advantage,867.79,49,,percent of total billed charges,,
"Surgical Pathology, Gross And Microscopic Examinations, Prostate Needle Biopsy, Any Method (Path)",,G0416,HCPCS,Facility,Inpatient,,,,1771,1505.35,507.5686,1771,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Surgical Pathology, Gross And Microscopic Examinations, Prostate Needle Biopsy, Any Method (Path)",,G0416,HCPCS,Facility,Both,,,,1771,1505.35,507.5686,1771,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1062.6,60,,percent of total billed charges,,
"Surgical Pathology, Gross And Microscopic Examinations, Prostate Needle Biopsy, Any Method (Path)",,G0416,HCPCS,Facility,Both,,,,1771,1505.35,507.5686,1771,"Health Partners, Inc.",State of Minnesota Advantage Program,1443.365,81.5,,percent of total billed charges,,
"Surgical Pathology, Gross And Microscopic Examinations, Prostate Needle Biopsy, Any Method (Path)",,G0416,HCPCS,Facility,Both,,,,1771,1505.35,507.5686,1771,"Health Partners, Inc.",State Public Programs,885.5,50,,percent of total billed charges,,
"Surgical Pathology, Gross And Microscopic Examinations, Prostate Needle Biopsy, Any Method (Path)",,G0416,HCPCS,Facility,Both,,,,1771,1505.35,507.5686,1771,Humana Insurance Company,Commercial PPO,1682.45,95,,percent of total billed charges,,
"Surgical Pathology, Gross And Microscopic Examinations, Prostate Needle Biopsy, Any Method (Path)",,G0416,HCPCS,Facility,Outpatient,,,,1771,1505.35,507.5686,1771,Humana Insurance Company,Medicare PPO,867.79,49,,percent of total billed charges,,
"Surgical Pathology, Gross And Microscopic Examinations, Prostate Needle Biopsy, Any Method (Path)",,G0416,HCPCS,Facility,Inpatient,,,,1771,1505.35,507.5686,1771,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Surgical Pathology, Gross And Microscopic Examinations, Prostate Needle Biopsy, Any Method (Path)",,G0416,HCPCS,Facility,Both,,,,1771,1505.35,507.5686,1771,Medica,Individual & Family,1755.061,99.1,,percent of total billed charges,,
"Surgical Pathology, Gross And Microscopic Examinations, Prostate Needle Biopsy, Any Method (Path)",,G0416,HCPCS,Facility,Outpatient,,,,1771,1505.35,507.5686,1771,Medica,Medica Advantage Solution,881.958,49.8,,percent of total billed charges,,
"Surgical Pathology, Gross And Microscopic Examinations, Prostate Needle Biopsy, Any Method (Path)",,G0416,HCPCS,Facility,Inpatient,,,,1771,1505.35,507.5686,1771,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Surgical Pathology, Gross And Microscopic Examinations, Prostate Needle Biopsy, Any Method (Path)",,G0416,HCPCS,Facility,Outpatient,,,,1771,1505.35,507.5686,1771,Medica,Medical Assistance,789.866,44.6,,percent of total billed charges,,
"Surgical Pathology, Gross And Microscopic Examinations, Prostate Needle Biopsy, Any Method (Path)",,G0416,HCPCS,Facility,Inpatient,,,,1771,1505.35,507.5686,1771,Medica,Medical Assistance,,,,,Included in per diem rate,
"Surgical Pathology, Gross And Microscopic Examinations, Prostate Needle Biopsy, Any Method (Path)",,G0416,HCPCS,Facility,Outpatient,,,,1771,1505.35,507.5686,1771,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,881.958,49.8,,percent of total billed charges,,
"Surgical Pathology, Gross And Microscopic Examinations, Prostate Needle Biopsy, Any Method (Path)",,G0416,HCPCS,Facility,Inpatient,,,,1771,1505.35,507.5686,1771,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Surgical Pathology, Gross And Microscopic Examinations, Prostate Needle Biopsy, Any Method (Path)",,G0416,HCPCS,Facility,Both,,,,1771,1505.35,507.5686,1771,"Multiplan, Inc.","Multiplan, Inc.",1664.74,94,,percent of total billed charges,,
"Surgical Pathology, Gross And Microscopic Examinations, Prostate Needle Biopsy, Any Method (Path)",,G0416,HCPCS,Facility,Outpatient,,,,1771,1505.35,507.5686,1771,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1595.671,90.1,,percent of total billed charges,,
"Surgical Pathology, Gross And Microscopic Examinations, Prostate Needle Biopsy, Any Method (Path)",,G0416,HCPCS,Facility,Inpatient,,,,1771,1505.35,507.5686,1771,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Surgical Pathology, Gross And Microscopic Examinations, Prostate Needle Biopsy, Any Method (Path)",,G0416,HCPCS,Facility,Both,,,,1771,1505.35,507.5686,1771,"Preferred One Administrative Services, INC.",PPO,1746.206,98.6,,percent of total billed charges,,
"Surgical Pathology, Gross And Microscopic Examinations, Prostate Needle Biopsy, Any Method (Path)",,G0416,HCPCS,Facility,Outpatient,,,,1771,1505.35,507.5686,1771,PrimeWest Health,Minnesota Senior Health Options (MSHO),911.1795,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Surgical Pathology, Gross And Microscopic Examinations, Prostate Needle Biopsy, Any Method (Path)",,G0416,HCPCS,Facility,Inpatient,,,,1771,1505.35,507.5686,1771,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Surgical Pathology, Gross And Microscopic Examinations, Prostate Needle Biopsy, Any Method (Path)",,G0416,HCPCS,Facility,Outpatient,,,,1771,1505.35,507.5686,1771,PrimeWest Health,MinnesotaCare,909.5856,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Surgical Pathology, Gross And Microscopic Examinations, Prostate Needle Biopsy, Any Method (Path)",,G0416,HCPCS,Facility,Inpatient,,,,1771,1505.35,507.5686,1771,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Surgical Pathology, Gross And Microscopic Examinations, Prostate Needle Biopsy, Any Method (Path)",,G0416,HCPCS,Facility,Both,,,,1771,1505.35,507.5686,1771,Sanford Health Plan,Sanford Health Plan,1629.32,92,,percent of total billed charges,,
"Surgical Pathology, Gross And Microscopic Examinations, Prostate Needle Biopsy, Any Method (Path)",,G0416,HCPCS,Facility,Outpatient,,,,1771,1505.35,507.5686,1771,"UCare Health, Inc.",Individual & Family Plan,997.9585,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Surgical Pathology, Gross And Microscopic Examinations, Prostate Needle Biopsy, Any Method (Path)",,G0416,HCPCS,Facility,Inpatient,,,,1771,1505.35,507.5686,1771,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Surgical Pathology, Gross And Microscopic Examinations, Prostate Needle Biopsy, Any Method (Path)",,G0416,HCPCS,Facility,Outpatient,,,,1771,1505.35,507.5686,1771,"UCare Health, Inc.",Medical Assistance,893.8237,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Surgical Pathology, Gross And Microscopic Examinations, Prostate Needle Biopsy, Any Method (Path)",,G0416,HCPCS,Facility,Inpatient,,,,1771,1505.35,507.5686,1771,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Surgical Pathology, Gross And Microscopic Examinations, Prostate Needle Biopsy, Any Method (Path)",,G0416,HCPCS,Facility,Outpatient,,,,1771,1505.35,507.5686,1771,"UCare Health, Inc.",Medicare Advantage,893.8237,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Surgical Pathology, Gross And Microscopic Examinations, Prostate Needle Biopsy, Any Method (Path)",,G0416,HCPCS,Facility,Inpatient,,,,1771,1505.35,507.5686,1771,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Surgical Pathology, Gross And Microscopic Examinations, Prostate Needle Biopsy, Any Method (Path)",,G0416,HCPCS,Facility,Outpatient,,,,1771,1505.35,507.5686,1771,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),893.8237,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Surgical Pathology, Gross And Microscopic Examinations, Prostate Needle Biopsy, Any Method (Path)",,G0416,HCPCS,Facility,Inpatient,,,,1771,1505.35,507.5686,1771,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Surgical Pathology, Gross And Microscopic Examinations, Prostate Needle Biopsy, Any Method (Path)",,G0416,HCPCS,Facility,Both,,,,1771,1505.35,507.5686,1771,UnitedHealthcare,Individual & Family,1664.74,94,,percent of total billed charges,,
"Surgical Pathology, Gross And Microscopic Examinations, Prostate Needle Biopsy, Any Method (Path)",,G0416,HCPCS,Facility,Outpatient,,,,1771,1505.35,507.5686,1771,UnitedHealthcare,Medicare Advantage,867.79,49,,percent of total billed charges,,
"Surgical Pathology, Gross And Microscopic Examinations, Prostate Needle Biopsy, Any Method (Path)",,G0416,HCPCS,Facility,Inpatient,,,,1771,1505.35,507.5686,1771,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Surgical Pathology, Gross And Microscopic Examinations, Prostate Needle Biopsy, Any Method (Path)",,G0416,HCPCS,Facility,Outpatient,,,,1771,1505.35,507.5686,1771,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,850.08,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Surgical Pathology, Gross And Microscopic Examinations, Prostate Needle Biopsy, Any Method (Path)",,G0416,HCPCS,Facility,Inpatient,,,,1771,1505.35,507.5686,1771,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Annual, Face-To-Face Intensive Behavioral Therapy For Cardiovascular Disease, Individual, 15 Minutes",,G0446,HCPCS,Facility,Both,,,,31,26.35,8.8846,31,Aetna,Commercial,28.52,92,,percent of total billed charges,,
"Annual, Face-To-Face Intensive Behavioral Therapy For Cardiovascular Disease, Individual, 15 Minutes",,G0446,HCPCS,Facility,Outpatient,,,,31,26.35,8.8846,31,Aetna,Medicare Advantage,15.19,49,,percent of total billed charges,,
"Annual, Face-To-Face Intensive Behavioral Therapy For Cardiovascular Disease, Individual, 15 Minutes",,G0446,HCPCS,Facility,Inpatient,,,,31,26.35,8.8846,31,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Annual, Face-To-Face Intensive Behavioral Therapy For Cardiovascular Disease, Individual, 15 Minutes",,G0446,HCPCS,Facility,Both,,,,31,26.35,8.8846,31,Aetna,PPO,28.83,93,,percent of total billed charges,,
"Annual, Face-To-Face Intensive Behavioral Therapy For Cardiovascular Disease, Individual, 15 Minutes",,G0446,HCPCS,Facility,Both,,,,31,26.35,8.8846,31,America's PPO,America's PPO,29.7693,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Annual, Face-To-Face Intensive Behavioral Therapy For Cardiovascular Disease, Individual, 15 Minutes",,G0446,HCPCS,Facility,Both,,,,31,26.35,8.8846,31,BlueCross BlueShield Minnesota, Federal Employee Program,30.504,98.4,,percent of total billed charges,,
"Annual, Face-To-Face Intensive Behavioral Therapy For Cardiovascular Disease, Individual, 15 Minutes",,G0446,HCPCS,Facility,Both,,,,31,26.35,8.8846,31,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,31,100,,percent of total billed charges,,
"Annual, Face-To-Face Intensive Behavioral Therapy For Cardiovascular Disease, Individual, 15 Minutes",,G0446,HCPCS,Facility,Both,,,,31,26.35,8.8846,31,BlueCross BlueShield Minnesota,High Value Network Plan,27.9,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
"Annual, Face-To-Face Intensive Behavioral Therapy For Cardiovascular Disease, Individual, 15 Minutes",,G0446,HCPCS,Facility,Outpatient,,,,31,26.35,8.8846,31,BlueCross BlueShield Minnesota,Medicare Advantage,15.19,49,,percent of total billed charges,,
"Annual, Face-To-Face Intensive Behavioral Therapy For Cardiovascular Disease, Individual, 15 Minutes",,G0446,HCPCS,Facility,Inpatient,,,,31,26.35,8.8846,31,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Annual, Face-To-Face Intensive Behavioral Therapy For Cardiovascular Disease, Individual, 15 Minutes",,G0446,HCPCS,Facility,Both,,,,31,26.35,8.8846,31,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,27.4567,88.57,,percent of total billed charges,,
"Annual, Face-To-Face Intensive Behavioral Therapy For Cardiovascular Disease, Individual, 15 Minutes",,G0446,HCPCS,Facility,Both,,,,31,26.35,8.8846,31,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,8.8846,28.66,,percent of total billed charges,,
"Annual, Face-To-Face Intensive Behavioral Therapy For Cardiovascular Disease, Individual, 15 Minutes",,G0446,HCPCS,Facility,Outpatient,,,,31,26.35,8.8846,31,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),15.19,49,,percent of total billed charges,,
"Annual, Face-To-Face Intensive Behavioral Therapy For Cardiovascular Disease, Individual, 15 Minutes",,G0446,HCPCS,Facility,Inpatient,,,,31,26.35,8.8846,31,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Annual, Face-To-Face Intensive Behavioral Therapy For Cardiovascular Disease, Individual, 15 Minutes",,G0446,HCPCS,Facility,Both,,,,31,26.35,8.8846,31,CorVel,Worker's Compensation,31,100,,percent of total billed charges,,
"Annual, Face-To-Face Intensive Behavioral Therapy For Cardiovascular Disease, Individual, 15 Minutes",,G0446,HCPCS,Facility,Both,,,,31,26.35,8.8846,31,First Health Group Corporation,First Health Network,30.07,97,,percent of total billed charges,,
"Annual, Face-To-Face Intensive Behavioral Therapy For Cardiovascular Disease, Individual, 15 Minutes",,G0446,HCPCS,Facility,Both,,,,31,26.35,8.8846,31,"Health Partners, Inc.",Commercial,29.326,94.6,,percent of total billed charges,,
"Annual, Face-To-Face Intensive Behavioral Therapy For Cardiovascular Disease, Individual, 15 Minutes",,G0446,HCPCS,Facility,Outpatient,,,,31,26.35,8.8846,31,"Health Partners, Inc.",Medicare Advantage,15.19,49,,percent of total billed charges,,
"Annual, Face-To-Face Intensive Behavioral Therapy For Cardiovascular Disease, Individual, 15 Minutes",,G0446,HCPCS,Facility,Inpatient,,,,31,26.35,8.8846,31,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Annual, Face-To-Face Intensive Behavioral Therapy For Cardiovascular Disease, Individual, 15 Minutes",,G0446,HCPCS,Facility,Both,,,,31,26.35,8.8846,31,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),18.6,60,,percent of total billed charges,,
"Annual, Face-To-Face Intensive Behavioral Therapy For Cardiovascular Disease, Individual, 15 Minutes",,G0446,HCPCS,Facility,Both,,,,31,26.35,8.8846,31,"Health Partners, Inc.",State of Minnesota Advantage Program,25.265,81.5,,percent of total billed charges,,
"Annual, Face-To-Face Intensive Behavioral Therapy For Cardiovascular Disease, Individual, 15 Minutes",,G0446,HCPCS,Facility,Both,,,,31,26.35,8.8846,31,"Health Partners, Inc.",State Public Programs,15.5,50,,percent of total billed charges,,
"Annual, Face-To-Face Intensive Behavioral Therapy For Cardiovascular Disease, Individual, 15 Minutes",,G0446,HCPCS,Facility,Both,,,,31,26.35,8.8846,31,Humana Insurance Company,Commercial PPO,29.45,95,,percent of total billed charges,,
"Annual, Face-To-Face Intensive Behavioral Therapy For Cardiovascular Disease, Individual, 15 Minutes",,G0446,HCPCS,Facility,Outpatient,,,,31,26.35,8.8846,31,Humana Insurance Company,Medicare PPO,15.19,49,,percent of total billed charges,,
"Annual, Face-To-Face Intensive Behavioral Therapy For Cardiovascular Disease, Individual, 15 Minutes",,G0446,HCPCS,Facility,Inpatient,,,,31,26.35,8.8846,31,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Annual, Face-To-Face Intensive Behavioral Therapy For Cardiovascular Disease, Individual, 15 Minutes",,G0446,HCPCS,Facility,Both,,,,31,26.35,8.8846,31,Medica,Individual & Family,30.721,99.1,,percent of total billed charges,,
"Annual, Face-To-Face Intensive Behavioral Therapy For Cardiovascular Disease, Individual, 15 Minutes",,G0446,HCPCS,Facility,Outpatient,,,,31,26.35,8.8846,31,Medica,Medica Advantage Solution,15.438,49.8,,percent of total billed charges,,
"Annual, Face-To-Face Intensive Behavioral Therapy For Cardiovascular Disease, Individual, 15 Minutes",,G0446,HCPCS,Facility,Inpatient,,,,31,26.35,8.8846,31,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Annual, Face-To-Face Intensive Behavioral Therapy For Cardiovascular Disease, Individual, 15 Minutes",,G0446,HCPCS,Facility,Outpatient,,,,31,26.35,8.8846,31,Medica,Medical Assistance,13.826,44.6,,percent of total billed charges,,
"Annual, Face-To-Face Intensive Behavioral Therapy For Cardiovascular Disease, Individual, 15 Minutes",,G0446,HCPCS,Facility,Inpatient,,,,31,26.35,8.8846,31,Medica,Medical Assistance,,,,,Included in per diem rate,
"Annual, Face-To-Face Intensive Behavioral Therapy For Cardiovascular Disease, Individual, 15 Minutes",,G0446,HCPCS,Facility,Outpatient,,,,31,26.35,8.8846,31,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,15.438,49.8,,percent of total billed charges,,
"Annual, Face-To-Face Intensive Behavioral Therapy For Cardiovascular Disease, Individual, 15 Minutes",,G0446,HCPCS,Facility,Inpatient,,,,31,26.35,8.8846,31,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Annual, Face-To-Face Intensive Behavioral Therapy For Cardiovascular Disease, Individual, 15 Minutes",,G0446,HCPCS,Facility,Both,,,,31,26.35,8.8846,31,"Multiplan, Inc.","Multiplan, Inc.",29.14,94,,percent of total billed charges,,
"Annual, Face-To-Face Intensive Behavioral Therapy For Cardiovascular Disease, Individual, 15 Minutes",,G0446,HCPCS,Facility,Outpatient,,,,31,26.35,8.8846,31,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,27.931,90.1,,percent of total billed charges,,
"Annual, Face-To-Face Intensive Behavioral Therapy For Cardiovascular Disease, Individual, 15 Minutes",,G0446,HCPCS,Facility,Inpatient,,,,31,26.35,8.8846,31,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Annual, Face-To-Face Intensive Behavioral Therapy For Cardiovascular Disease, Individual, 15 Minutes",,G0446,HCPCS,Facility,Both,,,,31,26.35,8.8846,31,"Preferred One Administrative Services, INC.",PPO,30.566,98.6,,percent of total billed charges,,
"Annual, Face-To-Face Intensive Behavioral Therapy For Cardiovascular Disease, Individual, 15 Minutes",,G0446,HCPCS,Facility,Outpatient,,,,31,26.35,8.8846,31,PrimeWest Health,Minnesota Senior Health Options (MSHO),15.9495,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Annual, Face-To-Face Intensive Behavioral Therapy For Cardiovascular Disease, Individual, 15 Minutes",,G0446,HCPCS,Facility,Inpatient,,,,31,26.35,8.8846,31,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Annual, Face-To-Face Intensive Behavioral Therapy For Cardiovascular Disease, Individual, 15 Minutes",,G0446,HCPCS,Facility,Outpatient,,,,31,26.35,8.8846,31,PrimeWest Health,MinnesotaCare,15.9216,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Annual, Face-To-Face Intensive Behavioral Therapy For Cardiovascular Disease, Individual, 15 Minutes",,G0446,HCPCS,Facility,Inpatient,,,,31,26.35,8.8846,31,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Annual, Face-To-Face Intensive Behavioral Therapy For Cardiovascular Disease, Individual, 15 Minutes",,G0446,HCPCS,Facility,Both,,,,31,26.35,8.8846,31,Sanford Health Plan,Sanford Health Plan,28.52,92,,percent of total billed charges,,
"Annual, Face-To-Face Intensive Behavioral Therapy For Cardiovascular Disease, Individual, 15 Minutes",,G0446,HCPCS,Facility,Outpatient,,,,31,26.35,8.8846,31,"UCare Health, Inc.",Individual & Family Plan,17.4685,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Annual, Face-To-Face Intensive Behavioral Therapy For Cardiovascular Disease, Individual, 15 Minutes",,G0446,HCPCS,Facility,Inpatient,,,,31,26.35,8.8846,31,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Annual, Face-To-Face Intensive Behavioral Therapy For Cardiovascular Disease, Individual, 15 Minutes",,G0446,HCPCS,Facility,Outpatient,,,,31,26.35,8.8846,31,"UCare Health, Inc.",Medical Assistance,15.6457,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Annual, Face-To-Face Intensive Behavioral Therapy For Cardiovascular Disease, Individual, 15 Minutes",,G0446,HCPCS,Facility,Inpatient,,,,31,26.35,8.8846,31,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Annual, Face-To-Face Intensive Behavioral Therapy For Cardiovascular Disease, Individual, 15 Minutes",,G0446,HCPCS,Facility,Outpatient,,,,31,26.35,8.8846,31,"UCare Health, Inc.",Medicare Advantage,15.6457,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Annual, Face-To-Face Intensive Behavioral Therapy For Cardiovascular Disease, Individual, 15 Minutes",,G0446,HCPCS,Facility,Inpatient,,,,31,26.35,8.8846,31,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Annual, Face-To-Face Intensive Behavioral Therapy For Cardiovascular Disease, Individual, 15 Minutes",,G0446,HCPCS,Facility,Outpatient,,,,31,26.35,8.8846,31,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),15.6457,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Annual, Face-To-Face Intensive Behavioral Therapy For Cardiovascular Disease, Individual, 15 Minutes",,G0446,HCPCS,Facility,Inpatient,,,,31,26.35,8.8846,31,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Annual, Face-To-Face Intensive Behavioral Therapy For Cardiovascular Disease, Individual, 15 Minutes",,G0446,HCPCS,Facility,Both,,,,31,26.35,8.8846,31,UnitedHealthcare,Individual & Family,29.14,94,,percent of total billed charges,,
"Annual, Face-To-Face Intensive Behavioral Therapy For Cardiovascular Disease, Individual, 15 Minutes",,G0446,HCPCS,Facility,Outpatient,,,,31,26.35,8.8846,31,UnitedHealthcare,Medicare Advantage,15.19,49,,percent of total billed charges,,
"Annual, Face-To-Face Intensive Behavioral Therapy For Cardiovascular Disease, Individual, 15 Minutes",,G0446,HCPCS,Facility,Inpatient,,,,31,26.35,8.8846,31,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Annual, Face-To-Face Intensive Behavioral Therapy For Cardiovascular Disease, Individual, 15 Minutes",,G0446,HCPCS,Facility,Outpatient,,,,31,26.35,8.8846,31,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,14.88,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Annual, Face-To-Face Intensive Behavioral Therapy For Cardiovascular Disease, Individual, 15 Minutes",,G0446,HCPCS,Facility,Inpatient,,,,31,26.35,8.8846,31,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Face To Face Behavioral Counseling For Obesity, 15 Min",,G0447,HCPCS,Facility,Both,,,,31,26.35,8.8846,31,Aetna,Commercial,28.52,92,,percent of total billed charges,,
"Face To Face Behavioral Counseling For Obesity, 15 Min",,G0447,HCPCS,Facility,Outpatient,,,,31,26.35,8.8846,31,Aetna,Medicare Advantage,15.19,49,,percent of total billed charges,,
"Face To Face Behavioral Counseling For Obesity, 15 Min",,G0447,HCPCS,Facility,Inpatient,,,,31,26.35,8.8846,31,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Face To Face Behavioral Counseling For Obesity, 15 Min",,G0447,HCPCS,Facility,Both,,,,31,26.35,8.8846,31,Aetna,PPO,28.83,93,,percent of total billed charges,,
"Face To Face Behavioral Counseling For Obesity, 15 Min",,G0447,HCPCS,Facility,Both,,,,31,26.35,8.8846,31,America's PPO,America's PPO,29.7693,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Face To Face Behavioral Counseling For Obesity, 15 Min",,G0447,HCPCS,Facility,Both,,,,31,26.35,8.8846,31,BlueCross BlueShield Minnesota, Federal Employee Program,30.504,98.4,,percent of total billed charges,,
"Face To Face Behavioral Counseling For Obesity, 15 Min",,G0447,HCPCS,Facility,Both,,,,31,26.35,8.8846,31,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,31,100,,percent of total billed charges,,
"Face To Face Behavioral Counseling For Obesity, 15 Min",,G0447,HCPCS,Facility,Both,,,,31,26.35,8.8846,31,BlueCross BlueShield Minnesota,High Value Network Plan,27.9,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
"Face To Face Behavioral Counseling For Obesity, 15 Min",,G0447,HCPCS,Facility,Outpatient,,,,31,26.35,8.8846,31,BlueCross BlueShield Minnesota,Medicare Advantage,15.19,49,,percent of total billed charges,,
"Face To Face Behavioral Counseling For Obesity, 15 Min",,G0447,HCPCS,Facility,Inpatient,,,,31,26.35,8.8846,31,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Face To Face Behavioral Counseling For Obesity, 15 Min",,G0447,HCPCS,Facility,Both,,,,31,26.35,8.8846,31,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,27.4567,88.57,,percent of total billed charges,,
"Face To Face Behavioral Counseling For Obesity, 15 Min",,G0447,HCPCS,Facility,Both,,,,31,26.35,8.8846,31,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,8.8846,28.66,,percent of total billed charges,,
"Face To Face Behavioral Counseling For Obesity, 15 Min",,G0447,HCPCS,Facility,Outpatient,,,,31,26.35,8.8846,31,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),15.19,49,,percent of total billed charges,,
"Face To Face Behavioral Counseling For Obesity, 15 Min",,G0447,HCPCS,Facility,Inpatient,,,,31,26.35,8.8846,31,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Face To Face Behavioral Counseling For Obesity, 15 Min",,G0447,HCPCS,Facility,Both,,,,31,26.35,8.8846,31,CorVel,Worker's Compensation,31,100,,percent of total billed charges,,
"Face To Face Behavioral Counseling For Obesity, 15 Min",,G0447,HCPCS,Facility,Both,,,,31,26.35,8.8846,31,First Health Group Corporation,First Health Network,30.07,97,,percent of total billed charges,,
"Face To Face Behavioral Counseling For Obesity, 15 Min",,G0447,HCPCS,Facility,Both,,,,31,26.35,8.8846,31,"Health Partners, Inc.",Commercial,29.326,94.6,,percent of total billed charges,,
"Face To Face Behavioral Counseling For Obesity, 15 Min",,G0447,HCPCS,Facility,Outpatient,,,,31,26.35,8.8846,31,"Health Partners, Inc.",Medicare Advantage,15.19,49,,percent of total billed charges,,
"Face To Face Behavioral Counseling For Obesity, 15 Min",,G0447,HCPCS,Facility,Inpatient,,,,31,26.35,8.8846,31,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Face To Face Behavioral Counseling For Obesity, 15 Min",,G0447,HCPCS,Facility,Both,,,,31,26.35,8.8846,31,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),18.6,60,,percent of total billed charges,,
"Face To Face Behavioral Counseling For Obesity, 15 Min",,G0447,HCPCS,Facility,Both,,,,31,26.35,8.8846,31,"Health Partners, Inc.",State of Minnesota Advantage Program,25.265,81.5,,percent of total billed charges,,
"Face To Face Behavioral Counseling For Obesity, 15 Min",,G0447,HCPCS,Facility,Both,,,,31,26.35,8.8846,31,"Health Partners, Inc.",State Public Programs,15.5,50,,percent of total billed charges,,
"Face To Face Behavioral Counseling For Obesity, 15 Min",,G0447,HCPCS,Facility,Both,,,,31,26.35,8.8846,31,Humana Insurance Company,Commercial PPO,29.45,95,,percent of total billed charges,,
"Face To Face Behavioral Counseling For Obesity, 15 Min",,G0447,HCPCS,Facility,Outpatient,,,,31,26.35,8.8846,31,Humana Insurance Company,Medicare PPO,15.19,49,,percent of total billed charges,,
"Face To Face Behavioral Counseling For Obesity, 15 Min",,G0447,HCPCS,Facility,Inpatient,,,,31,26.35,8.8846,31,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Face To Face Behavioral Counseling For Obesity, 15 Min",,G0447,HCPCS,Facility,Both,,,,31,26.35,8.8846,31,Medica,Individual & Family,30.721,99.1,,percent of total billed charges,,
"Face To Face Behavioral Counseling For Obesity, 15 Min",,G0447,HCPCS,Facility,Outpatient,,,,31,26.35,8.8846,31,Medica,Medica Advantage Solution,15.438,49.8,,percent of total billed charges,,
"Face To Face Behavioral Counseling For Obesity, 15 Min",,G0447,HCPCS,Facility,Inpatient,,,,31,26.35,8.8846,31,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Face To Face Behavioral Counseling For Obesity, 15 Min",,G0447,HCPCS,Facility,Outpatient,,,,31,26.35,8.8846,31,Medica,Medical Assistance,13.826,44.6,,percent of total billed charges,,
"Face To Face Behavioral Counseling For Obesity, 15 Min",,G0447,HCPCS,Facility,Inpatient,,,,31,26.35,8.8846,31,Medica,Medical Assistance,,,,,Included in per diem rate,
"Face To Face Behavioral Counseling For Obesity, 15 Min",,G0447,HCPCS,Facility,Outpatient,,,,31,26.35,8.8846,31,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,15.438,49.8,,percent of total billed charges,,
"Face To Face Behavioral Counseling For Obesity, 15 Min",,G0447,HCPCS,Facility,Inpatient,,,,31,26.35,8.8846,31,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Face To Face Behavioral Counseling For Obesity, 15 Min",,G0447,HCPCS,Facility,Both,,,,31,26.35,8.8846,31,"Multiplan, Inc.","Multiplan, Inc.",29.14,94,,percent of total billed charges,,
"Face To Face Behavioral Counseling For Obesity, 15 Min",,G0447,HCPCS,Facility,Outpatient,,,,31,26.35,8.8846,31,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,27.931,90.1,,percent of total billed charges,,
"Face To Face Behavioral Counseling For Obesity, 15 Min",,G0447,HCPCS,Facility,Inpatient,,,,31,26.35,8.8846,31,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Face To Face Behavioral Counseling For Obesity, 15 Min",,G0447,HCPCS,Facility,Both,,,,31,26.35,8.8846,31,"Preferred One Administrative Services, INC.",PPO,30.566,98.6,,percent of total billed charges,,
"Face To Face Behavioral Counseling For Obesity, 15 Min",,G0447,HCPCS,Facility,Outpatient,,,,31,26.35,8.8846,31,PrimeWest Health,Minnesota Senior Health Options (MSHO),15.9495,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Face To Face Behavioral Counseling For Obesity, 15 Min",,G0447,HCPCS,Facility,Inpatient,,,,31,26.35,8.8846,31,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Face To Face Behavioral Counseling For Obesity, 15 Min",,G0447,HCPCS,Facility,Outpatient,,,,31,26.35,8.8846,31,PrimeWest Health,MinnesotaCare,15.9216,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Face To Face Behavioral Counseling For Obesity, 15 Min",,G0447,HCPCS,Facility,Inpatient,,,,31,26.35,8.8846,31,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Face To Face Behavioral Counseling For Obesity, 15 Min",,G0447,HCPCS,Facility,Both,,,,31,26.35,8.8846,31,Sanford Health Plan,Sanford Health Plan,28.52,92,,percent of total billed charges,,
"Face To Face Behavioral Counseling For Obesity, 15 Min",,G0447,HCPCS,Facility,Outpatient,,,,31,26.35,8.8846,31,"UCare Health, Inc.",Individual & Family Plan,17.4685,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Face To Face Behavioral Counseling For Obesity, 15 Min",,G0447,HCPCS,Facility,Inpatient,,,,31,26.35,8.8846,31,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Face To Face Behavioral Counseling For Obesity, 15 Min",,G0447,HCPCS,Facility,Outpatient,,,,31,26.35,8.8846,31,"UCare Health, Inc.",Medical Assistance,15.6457,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Face To Face Behavioral Counseling For Obesity, 15 Min",,G0447,HCPCS,Facility,Inpatient,,,,31,26.35,8.8846,31,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Face To Face Behavioral Counseling For Obesity, 15 Min",,G0447,HCPCS,Facility,Outpatient,,,,31,26.35,8.8846,31,"UCare Health, Inc.",Medicare Advantage,15.6457,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Face To Face Behavioral Counseling For Obesity, 15 Min",,G0447,HCPCS,Facility,Inpatient,,,,31,26.35,8.8846,31,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Face To Face Behavioral Counseling For Obesity, 15 Min",,G0447,HCPCS,Facility,Outpatient,,,,31,26.35,8.8846,31,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),15.6457,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Face To Face Behavioral Counseling For Obesity, 15 Min",,G0447,HCPCS,Facility,Inpatient,,,,31,26.35,8.8846,31,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Face To Face Behavioral Counseling For Obesity, 15 Min",,G0447,HCPCS,Facility,Both,,,,31,26.35,8.8846,31,UnitedHealthcare,Individual & Family,29.14,94,,percent of total billed charges,,
"Face To Face Behavioral Counseling For Obesity, 15 Min",,G0447,HCPCS,Facility,Outpatient,,,,31,26.35,8.8846,31,UnitedHealthcare,Medicare Advantage,15.19,49,,percent of total billed charges,,
"Face To Face Behavioral Counseling For Obesity, 15 Min",,G0447,HCPCS,Facility,Inpatient,,,,31,26.35,8.8846,31,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Face To Face Behavioral Counseling For Obesity, 15 Min",,G0447,HCPCS,Facility,Outpatient,,,,31,26.35,8.8846,31,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,14.88,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Face To Face Behavioral Counseling For Obesity, 15 Min",,G0447,HCPCS,Facility,Inpatient,,,,31,26.35,8.8846,31,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Clinical Nursing Level 1 (Ep),,G0463,HCPCS,Facility,Outpatient,,,,75,63.75,21.495,75,Aetna,Medicare Advantage,36.75,49,,percent of total billed charges,,
Clinical Nursing Level 1 (Ep),,G0463,HCPCS,Facility,Inpatient,,,,75,63.75,21.495,75,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Clinical Nursing Level 1 (Ep),,G0463,HCPCS,Facility,Outpatient,,,,75,63.75,21.495,75,BlueCross BlueShield Minnesota,Medicare Advantage,36.75,49,,percent of total billed charges,,
Clinical Nursing Level 1 (Ep),,G0463,HCPCS,Facility,Inpatient,,,,75,63.75,21.495,75,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Clinical Nursing Level 1 (Ep),,G0463,HCPCS,Facility,Both,,,,75,63.75,21.495,75,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,21.495,28.66,,percent of total billed charges,,
Clinical Nursing Level 1 (Ep),,G0463,HCPCS,Facility,Outpatient,,,,75,63.75,21.495,75,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),36.75,49,,percent of total billed charges,,
Clinical Nursing Level 1 (Ep),,G0463,HCPCS,Facility,Inpatient,,,,75,63.75,21.495,75,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Clinical Nursing Level 1 (Ep),,G0463,HCPCS,Facility,Both,,,,75,63.75,21.495,75,CorVel,Worker's Compensation,75,100,,percent of total billed charges,,
Clinical Nursing Level 1 (Ep),,G0463,HCPCS,Facility,Outpatient,,,,75,63.75,21.495,75,"Health Partners, Inc.",Medicare Advantage,36.75,49,,percent of total billed charges,,
Clinical Nursing Level 1 (Ep),,G0463,HCPCS,Facility,Inpatient,,,,75,63.75,21.495,75,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Clinical Nursing Level 1 (Ep),,G0463,HCPCS,Facility,Both,,,,75,63.75,21.495,75,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),45,60,,percent of total billed charges,,
Clinical Nursing Level 1 (Ep),,G0463,HCPCS,Facility,Both,,,,75,63.75,21.495,75,"Health Partners, Inc.",State Public Programs,37.5,50,,percent of total billed charges,,
Clinical Nursing Level 1 (Ep),,G0463,HCPCS,Facility,Outpatient,,,,75,63.75,21.495,75,Humana Insurance Company,Medicare PPO,36.75,49,,percent of total billed charges,,
Clinical Nursing Level 1 (Ep),,G0463,HCPCS,Facility,Inpatient,,,,75,63.75,21.495,75,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Clinical Nursing Level 1 (Ep),,G0463,HCPCS,Facility,Outpatient,,,,75,63.75,21.495,75,Medica,Medica Advantage Solution,37.35,49.8,,percent of total billed charges,,
Clinical Nursing Level 1 (Ep),,G0463,HCPCS,Facility,Inpatient,,,,75,63.75,21.495,75,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Clinical Nursing Level 1 (Ep),,G0463,HCPCS,Facility,Outpatient,,,,75,63.75,21.495,75,Medica,Medical Assistance,33.45,44.6,,percent of total billed charges,,
Clinical Nursing Level 1 (Ep),,G0463,HCPCS,Facility,Inpatient,,,,75,63.75,21.495,75,Medica,Medical Assistance,,,,,Included in per diem rate,
Clinical Nursing Level 1 (Ep),,G0463,HCPCS,Facility,Outpatient,,,,75,63.75,21.495,75,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,37.35,49.8,,percent of total billed charges,,
Clinical Nursing Level 1 (Ep),,G0463,HCPCS,Facility,Inpatient,,,,75,63.75,21.495,75,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Clinical Nursing Level 1 (Ep),,G0463,HCPCS,Facility,Outpatient,,,,75,63.75,21.495,75,PrimeWest Health,Minnesota Senior Health Options (MSHO),38.5875,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Clinical Nursing Level 1 (Ep),,G0463,HCPCS,Facility,Inpatient,,,,75,63.75,21.495,75,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Clinical Nursing Level 1 (Ep),,G0463,HCPCS,Facility,Outpatient,,,,75,63.75,21.495,75,PrimeWest Health,MinnesotaCare,38.52,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Clinical Nursing Level 1 (Ep),,G0463,HCPCS,Facility,Inpatient,,,,75,63.75,21.495,75,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Clinical Nursing Level 1 (Ep),,G0463,HCPCS,Facility,Both,,,,75,63.75,21.495,75,"UCare Health, Inc.",Individual & Family Plan,42.27,56.35,,percent of total billed charges,,
Clinical Nursing Level 1 (Ep),,G0463,HCPCS,Facility,Outpatient,,,,75,63.75,21.495,75,"UCare Health, Inc.",Medical Assistance,37.8525,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Clinical Nursing Level 1 (Ep),,G0463,HCPCS,Facility,Inpatient,,,,75,63.75,21.495,75,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Clinical Nursing Level 1 (Ep),,G0463,HCPCS,Facility,Outpatient,,,,75,63.75,21.495,75,"UCare Health, Inc.",Medicare Advantage,37.8525,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Clinical Nursing Level 1 (Ep),,G0463,HCPCS,Facility,Inpatient,,,,75,63.75,21.495,75,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Clinical Nursing Level 1 (Ep),,G0463,HCPCS,Facility,Outpatient,,,,75,63.75,21.495,75,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),37.8525,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Clinical Nursing Level 1 (Ep),,G0463,HCPCS,Facility,Inpatient,,,,75,63.75,21.495,75,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Clinical Nursing Level 1 (Ep),,G0463,HCPCS,Facility,Outpatient,,,,75,63.75,21.495,75,UnitedHealthcare,Medicare Advantage,36.75,49,,percent of total billed charges,,
Clinical Nursing Level 1 (Ep),,G0463,HCPCS,Facility,Inpatient,,,,75,63.75,21.495,75,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Clinical Nursing Level 1 (Ep),,G0463,HCPCS,Facility,Outpatient,,,,75,63.75,21.495,75,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,36,48,,percent of total billed charges,,100% of DHS outpatient percentage
Clinical Nursing Level 1 (Ep),,G0463,HCPCS,Facility,Inpatient,,,,75,63.75,21.495,75,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Clinical Nursing Level 2 (Ep),,G0463,HCPCS,Facility,Outpatient,,,,130,110.5,37.258,130,Aetna,Medicare Advantage,63.7,49,,percent of total billed charges,,
Clinical Nursing Level 2 (Ep),,G0463,HCPCS,Facility,Inpatient,,,,130,110.5,37.258,130,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Clinical Nursing Level 2 (Ep),,G0463,HCPCS,Facility,Outpatient,,,,130,110.5,37.258,130,BlueCross BlueShield Minnesota,Medicare Advantage,63.7,49,,percent of total billed charges,,
Clinical Nursing Level 2 (Ep),,G0463,HCPCS,Facility,Inpatient,,,,130,110.5,37.258,130,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Clinical Nursing Level 2 (Ep),,G0463,HCPCS,Facility,Both,,,,130,110.5,37.258,130,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,37.258,28.66,,percent of total billed charges,,
Clinical Nursing Level 2 (Ep),,G0463,HCPCS,Facility,Outpatient,,,,130,110.5,37.258,130,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),63.7,49,,percent of total billed charges,,
Clinical Nursing Level 2 (Ep),,G0463,HCPCS,Facility,Inpatient,,,,130,110.5,37.258,130,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Clinical Nursing Level 2 (Ep),,G0463,HCPCS,Facility,Both,,,,130,110.5,37.258,130,CorVel,Worker's Compensation,130,100,,percent of total billed charges,,
Clinical Nursing Level 2 (Ep),,G0463,HCPCS,Facility,Outpatient,,,,130,110.5,37.258,130,"Health Partners, Inc.",Medicare Advantage,63.7,49,,percent of total billed charges,,
Clinical Nursing Level 2 (Ep),,G0463,HCPCS,Facility,Inpatient,,,,130,110.5,37.258,130,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Clinical Nursing Level 2 (Ep),,G0463,HCPCS,Facility,Both,,,,130,110.5,37.258,130,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),78,60,,percent of total billed charges,,
Clinical Nursing Level 2 (Ep),,G0463,HCPCS,Facility,Both,,,,130,110.5,37.258,130,"Health Partners, Inc.",State Public Programs,65,50,,percent of total billed charges,,
Clinical Nursing Level 2 (Ep),,G0463,HCPCS,Facility,Outpatient,,,,130,110.5,37.258,130,Humana Insurance Company,Medicare PPO,63.7,49,,percent of total billed charges,,
Clinical Nursing Level 2 (Ep),,G0463,HCPCS,Facility,Inpatient,,,,130,110.5,37.258,130,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Clinical Nursing Level 2 (Ep),,G0463,HCPCS,Facility,Outpatient,,,,130,110.5,37.258,130,Medica,Medica Advantage Solution,64.74,49.8,,percent of total billed charges,,
Clinical Nursing Level 2 (Ep),,G0463,HCPCS,Facility,Inpatient,,,,130,110.5,37.258,130,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Clinical Nursing Level 2 (Ep),,G0463,HCPCS,Facility,Outpatient,,,,130,110.5,37.258,130,Medica,Medical Assistance,57.98,44.6,,percent of total billed charges,,
Clinical Nursing Level 2 (Ep),,G0463,HCPCS,Facility,Inpatient,,,,130,110.5,37.258,130,Medica,Medical Assistance,,,,,Included in per diem rate,
Clinical Nursing Level 2 (Ep),,G0463,HCPCS,Facility,Outpatient,,,,130,110.5,37.258,130,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,64.74,49.8,,percent of total billed charges,,
Clinical Nursing Level 2 (Ep),,G0463,HCPCS,Facility,Inpatient,,,,130,110.5,37.258,130,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Clinical Nursing Level 2 (Ep),,G0463,HCPCS,Facility,Outpatient,,,,130,110.5,37.258,130,PrimeWest Health,Minnesota Senior Health Options (MSHO),66.885,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Clinical Nursing Level 2 (Ep),,G0463,HCPCS,Facility,Inpatient,,,,130,110.5,37.258,130,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Clinical Nursing Level 2 (Ep),,G0463,HCPCS,Facility,Outpatient,,,,130,110.5,37.258,130,PrimeWest Health,MinnesotaCare,66.768,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Clinical Nursing Level 2 (Ep),,G0463,HCPCS,Facility,Inpatient,,,,130,110.5,37.258,130,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Clinical Nursing Level 2 (Ep),,G0463,HCPCS,Facility,Both,,,,130,110.5,37.258,130,"UCare Health, Inc.",Individual & Family Plan,73.268,56.35,,percent of total billed charges,,
Clinical Nursing Level 2 (Ep),,G0463,HCPCS,Facility,Outpatient,,,,130,110.5,37.258,130,"UCare Health, Inc.",Medical Assistance,65.611,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Clinical Nursing Level 2 (Ep),,G0463,HCPCS,Facility,Inpatient,,,,130,110.5,37.258,130,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Clinical Nursing Level 2 (Ep),,G0463,HCPCS,Facility,Outpatient,,,,130,110.5,37.258,130,"UCare Health, Inc.",Medicare Advantage,65.611,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Clinical Nursing Level 2 (Ep),,G0463,HCPCS,Facility,Inpatient,,,,130,110.5,37.258,130,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Clinical Nursing Level 2 (Ep),,G0463,HCPCS,Facility,Outpatient,,,,130,110.5,37.258,130,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),65.611,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Clinical Nursing Level 2 (Ep),,G0463,HCPCS,Facility,Inpatient,,,,130,110.5,37.258,130,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Clinical Nursing Level 2 (Ep),,G0463,HCPCS,Facility,Outpatient,,,,130,110.5,37.258,130,UnitedHealthcare,Medicare Advantage,63.7,49,,percent of total billed charges,,
Clinical Nursing Level 2 (Ep),,G0463,HCPCS,Facility,Inpatient,,,,130,110.5,37.258,130,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Clinical Nursing Level 2 (Ep),,G0463,HCPCS,Facility,Outpatient,,,,130,110.5,37.258,130,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,62.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
Clinical Nursing Level 2 (Ep),,G0463,HCPCS,Facility,Inpatient,,,,130,110.5,37.258,130,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Clinical Nursing Level 3 (Ep),,G0463,HCPCS,Facility,Outpatient,,,,210,178.5,60.186,210,Aetna,Medicare Advantage,102.9,49,,percent of total billed charges,,
Clinical Nursing Level 3 (Ep),,G0463,HCPCS,Facility,Inpatient,,,,210,178.5,60.186,210,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Clinical Nursing Level 3 (Ep),,G0463,HCPCS,Facility,Outpatient,,,,210,178.5,60.186,210,BlueCross BlueShield Minnesota,Medicare Advantage,102.9,49,,percent of total billed charges,,
Clinical Nursing Level 3 (Ep),,G0463,HCPCS,Facility,Inpatient,,,,210,178.5,60.186,210,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Clinical Nursing Level 3 (Ep),,G0463,HCPCS,Facility,Both,,,,210,178.5,60.186,210,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,60.186,28.66,,percent of total billed charges,,
Clinical Nursing Level 3 (Ep),,G0463,HCPCS,Facility,Outpatient,,,,210,178.5,60.186,210,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),102.9,49,,percent of total billed charges,,
Clinical Nursing Level 3 (Ep),,G0463,HCPCS,Facility,Inpatient,,,,210,178.5,60.186,210,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Clinical Nursing Level 3 (Ep),,G0463,HCPCS,Facility,Both,,,,210,178.5,60.186,210,CorVel,Worker's Compensation,210,100,,percent of total billed charges,,
Clinical Nursing Level 3 (Ep),,G0463,HCPCS,Facility,Outpatient,,,,210,178.5,60.186,210,"Health Partners, Inc.",Medicare Advantage,102.9,49,,percent of total billed charges,,
Clinical Nursing Level 3 (Ep),,G0463,HCPCS,Facility,Inpatient,,,,210,178.5,60.186,210,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Clinical Nursing Level 3 (Ep),,G0463,HCPCS,Facility,Both,,,,210,178.5,60.186,210,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),126,60,,percent of total billed charges,,
Clinical Nursing Level 3 (Ep),,G0463,HCPCS,Facility,Both,,,,210,178.5,60.186,210,"Health Partners, Inc.",State Public Programs,105,50,,percent of total billed charges,,
Clinical Nursing Level 3 (Ep),,G0463,HCPCS,Facility,Outpatient,,,,210,178.5,60.186,210,Humana Insurance Company,Medicare PPO,102.9,49,,percent of total billed charges,,
Clinical Nursing Level 3 (Ep),,G0463,HCPCS,Facility,Inpatient,,,,210,178.5,60.186,210,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Clinical Nursing Level 3 (Ep),,G0463,HCPCS,Facility,Outpatient,,,,210,178.5,60.186,210,Medica,Medica Advantage Solution,104.58,49.8,,percent of total billed charges,,
Clinical Nursing Level 3 (Ep),,G0463,HCPCS,Facility,Inpatient,,,,210,178.5,60.186,210,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Clinical Nursing Level 3 (Ep),,G0463,HCPCS,Facility,Outpatient,,,,210,178.5,60.186,210,Medica,Medical Assistance,93.66,44.6,,percent of total billed charges,,
Clinical Nursing Level 3 (Ep),,G0463,HCPCS,Facility,Inpatient,,,,210,178.5,60.186,210,Medica,Medical Assistance,,,,,Included in per diem rate,
Clinical Nursing Level 3 (Ep),,G0463,HCPCS,Facility,Outpatient,,,,210,178.5,60.186,210,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,104.58,49.8,,percent of total billed charges,,
Clinical Nursing Level 3 (Ep),,G0463,HCPCS,Facility,Inpatient,,,,210,178.5,60.186,210,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Clinical Nursing Level 3 (Ep),,G0463,HCPCS,Facility,Outpatient,,,,210,178.5,60.186,210,PrimeWest Health,Minnesota Senior Health Options (MSHO),108.045,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Clinical Nursing Level 3 (Ep),,G0463,HCPCS,Facility,Inpatient,,,,210,178.5,60.186,210,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Clinical Nursing Level 3 (Ep),,G0463,HCPCS,Facility,Outpatient,,,,210,178.5,60.186,210,PrimeWest Health,MinnesotaCare,107.856,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Clinical Nursing Level 3 (Ep),,G0463,HCPCS,Facility,Inpatient,,,,210,178.5,60.186,210,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Clinical Nursing Level 3 (Ep),,G0463,HCPCS,Facility,Both,,,,210,178.5,60.186,210,"UCare Health, Inc.",Individual & Family Plan,118.356,56.35,,percent of total billed charges,,
Clinical Nursing Level 3 (Ep),,G0463,HCPCS,Facility,Outpatient,,,,210,178.5,60.186,210,"UCare Health, Inc.",Medical Assistance,105.987,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Clinical Nursing Level 3 (Ep),,G0463,HCPCS,Facility,Inpatient,,,,210,178.5,60.186,210,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Clinical Nursing Level 3 (Ep),,G0463,HCPCS,Facility,Outpatient,,,,210,178.5,60.186,210,"UCare Health, Inc.",Medicare Advantage,105.987,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Clinical Nursing Level 3 (Ep),,G0463,HCPCS,Facility,Inpatient,,,,210,178.5,60.186,210,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Clinical Nursing Level 3 (Ep),,G0463,HCPCS,Facility,Outpatient,,,,210,178.5,60.186,210,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),105.987,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Clinical Nursing Level 3 (Ep),,G0463,HCPCS,Facility,Inpatient,,,,210,178.5,60.186,210,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Clinical Nursing Level 3 (Ep),,G0463,HCPCS,Facility,Outpatient,,,,210,178.5,60.186,210,UnitedHealthcare,Medicare Advantage,102.9,49,,percent of total billed charges,,
Clinical Nursing Level 3 (Ep),,G0463,HCPCS,Facility,Inpatient,,,,210,178.5,60.186,210,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Clinical Nursing Level 3 (Ep),,G0463,HCPCS,Facility,Outpatient,,,,210,178.5,60.186,210,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,100.8,48,,percent of total billed charges,,100% of DHS outpatient percentage
Clinical Nursing Level 3 (Ep),,G0463,HCPCS,Facility,Inpatient,,,,210,178.5,60.186,210,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Clinical Nursing Level 4 (Ep),,G0463,HCPCS,Facility,Outpatient,,,,300,255,85.98,300,Aetna,Medicare Advantage,147,49,,percent of total billed charges,,
Clinical Nursing Level 4 (Ep),,G0463,HCPCS,Facility,Inpatient,,,,300,255,85.98,300,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Clinical Nursing Level 4 (Ep),,G0463,HCPCS,Facility,Outpatient,,,,300,255,85.98,300,BlueCross BlueShield Minnesota,Medicare Advantage,147,49,,percent of total billed charges,,
Clinical Nursing Level 4 (Ep),,G0463,HCPCS,Facility,Inpatient,,,,300,255,85.98,300,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Clinical Nursing Level 4 (Ep),,G0463,HCPCS,Facility,Both,,,,300,255,85.98,300,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,85.98,28.66,,percent of total billed charges,,
Clinical Nursing Level 4 (Ep),,G0463,HCPCS,Facility,Outpatient,,,,300,255,85.98,300,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),147,49,,percent of total billed charges,,
Clinical Nursing Level 4 (Ep),,G0463,HCPCS,Facility,Inpatient,,,,300,255,85.98,300,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Clinical Nursing Level 4 (Ep),,G0463,HCPCS,Facility,Both,,,,300,255,85.98,300,CorVel,Worker's Compensation,300,100,,percent of total billed charges,,
Clinical Nursing Level 4 (Ep),,G0463,HCPCS,Facility,Outpatient,,,,300,255,85.98,300,"Health Partners, Inc.",Medicare Advantage,147,49,,percent of total billed charges,,
Clinical Nursing Level 4 (Ep),,G0463,HCPCS,Facility,Inpatient,,,,300,255,85.98,300,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Clinical Nursing Level 4 (Ep),,G0463,HCPCS,Facility,Both,,,,300,255,85.98,300,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),180,60,,percent of total billed charges,,
Clinical Nursing Level 4 (Ep),,G0463,HCPCS,Facility,Both,,,,300,255,85.98,300,"Health Partners, Inc.",State Public Programs,150,50,,percent of total billed charges,,
Clinical Nursing Level 4 (Ep),,G0463,HCPCS,Facility,Outpatient,,,,300,255,85.98,300,Humana Insurance Company,Medicare PPO,147,49,,percent of total billed charges,,
Clinical Nursing Level 4 (Ep),,G0463,HCPCS,Facility,Inpatient,,,,300,255,85.98,300,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Clinical Nursing Level 4 (Ep),,G0463,HCPCS,Facility,Outpatient,,,,300,255,85.98,300,Medica,Medica Advantage Solution,149.4,49.8,,percent of total billed charges,,
Clinical Nursing Level 4 (Ep),,G0463,HCPCS,Facility,Inpatient,,,,300,255,85.98,300,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Clinical Nursing Level 4 (Ep),,G0463,HCPCS,Facility,Outpatient,,,,300,255,85.98,300,Medica,Medical Assistance,133.8,44.6,,percent of total billed charges,,
Clinical Nursing Level 4 (Ep),,G0463,HCPCS,Facility,Inpatient,,,,300,255,85.98,300,Medica,Medical Assistance,,,,,Included in per diem rate,
Clinical Nursing Level 4 (Ep),,G0463,HCPCS,Facility,Outpatient,,,,300,255,85.98,300,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,149.4,49.8,,percent of total billed charges,,
Clinical Nursing Level 4 (Ep),,G0463,HCPCS,Facility,Inpatient,,,,300,255,85.98,300,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Clinical Nursing Level 4 (Ep),,G0463,HCPCS,Facility,Outpatient,,,,300,255,85.98,300,PrimeWest Health,Minnesota Senior Health Options (MSHO),154.35,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Clinical Nursing Level 4 (Ep),,G0463,HCPCS,Facility,Inpatient,,,,300,255,85.98,300,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Clinical Nursing Level 4 (Ep),,G0463,HCPCS,Facility,Outpatient,,,,300,255,85.98,300,PrimeWest Health,MinnesotaCare,154.08,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Clinical Nursing Level 4 (Ep),,G0463,HCPCS,Facility,Inpatient,,,,300,255,85.98,300,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Clinical Nursing Level 4 (Ep),,G0463,HCPCS,Facility,Both,,,,300,255,85.98,300,"UCare Health, Inc.",Individual & Family Plan,169.08,56.35,,percent of total billed charges,,
Clinical Nursing Level 4 (Ep),,G0463,HCPCS,Facility,Outpatient,,,,300,255,85.98,300,"UCare Health, Inc.",Medical Assistance,151.41,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Clinical Nursing Level 4 (Ep),,G0463,HCPCS,Facility,Inpatient,,,,300,255,85.98,300,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Clinical Nursing Level 4 (Ep),,G0463,HCPCS,Facility,Outpatient,,,,300,255,85.98,300,"UCare Health, Inc.",Medicare Advantage,151.41,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Clinical Nursing Level 4 (Ep),,G0463,HCPCS,Facility,Inpatient,,,,300,255,85.98,300,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Clinical Nursing Level 4 (Ep),,G0463,HCPCS,Facility,Outpatient,,,,300,255,85.98,300,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),151.41,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Clinical Nursing Level 4 (Ep),,G0463,HCPCS,Facility,Inpatient,,,,300,255,85.98,300,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Clinical Nursing Level 4 (Ep),,G0463,HCPCS,Facility,Outpatient,,,,300,255,85.98,300,UnitedHealthcare,Medicare Advantage,147,49,,percent of total billed charges,,
Clinical Nursing Level 4 (Ep),,G0463,HCPCS,Facility,Inpatient,,,,300,255,85.98,300,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Clinical Nursing Level 4 (Ep),,G0463,HCPCS,Facility,Outpatient,,,,300,255,85.98,300,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,144,48,,percent of total billed charges,,100% of DHS outpatient percentage
Clinical Nursing Level 4 (Ep),,G0463,HCPCS,Facility,Inpatient,,,,300,255,85.98,300,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Clinical Nursing Level 5 (Ep),,G0463,HCPCS,Facility,Outpatient,,,,400,340,114.64,400,Aetna,Medicare Advantage,196,49,,percent of total billed charges,,
Clinical Nursing Level 5 (Ep),,G0463,HCPCS,Facility,Inpatient,,,,400,340,114.64,400,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Clinical Nursing Level 5 (Ep),,G0463,HCPCS,Facility,Outpatient,,,,400,340,114.64,400,BlueCross BlueShield Minnesota,Medicare Advantage,196,49,,percent of total billed charges,,
Clinical Nursing Level 5 (Ep),,G0463,HCPCS,Facility,Inpatient,,,,400,340,114.64,400,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Clinical Nursing Level 5 (Ep),,G0463,HCPCS,Facility,Both,,,,400,340,114.64,400,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,114.64,28.66,,percent of total billed charges,,
Clinical Nursing Level 5 (Ep),,G0463,HCPCS,Facility,Outpatient,,,,400,340,114.64,400,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),196,49,,percent of total billed charges,,
Clinical Nursing Level 5 (Ep),,G0463,HCPCS,Facility,Inpatient,,,,400,340,114.64,400,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Clinical Nursing Level 5 (Ep),,G0463,HCPCS,Facility,Both,,,,400,340,114.64,400,CorVel,Worker's Compensation,400,100,,percent of total billed charges,,
Clinical Nursing Level 5 (Ep),,G0463,HCPCS,Facility,Outpatient,,,,400,340,114.64,400,"Health Partners, Inc.",Medicare Advantage,196,49,,percent of total billed charges,,
Clinical Nursing Level 5 (Ep),,G0463,HCPCS,Facility,Inpatient,,,,400,340,114.64,400,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Clinical Nursing Level 5 (Ep),,G0463,HCPCS,Facility,Both,,,,400,340,114.64,400,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),240,60,,percent of total billed charges,,
Clinical Nursing Level 5 (Ep),,G0463,HCPCS,Facility,Both,,,,400,340,114.64,400,"Health Partners, Inc.",State Public Programs,200,50,,percent of total billed charges,,
Clinical Nursing Level 5 (Ep),,G0463,HCPCS,Facility,Outpatient,,,,400,340,114.64,400,Humana Insurance Company,Medicare PPO,196,49,,percent of total billed charges,,
Clinical Nursing Level 5 (Ep),,G0463,HCPCS,Facility,Inpatient,,,,400,340,114.64,400,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Clinical Nursing Level 5 (Ep),,G0463,HCPCS,Facility,Outpatient,,,,400,340,114.64,400,Medica,Medica Advantage Solution,199.2,49.8,,percent of total billed charges,,
Clinical Nursing Level 5 (Ep),,G0463,HCPCS,Facility,Inpatient,,,,400,340,114.64,400,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Clinical Nursing Level 5 (Ep),,G0463,HCPCS,Facility,Outpatient,,,,400,340,114.64,400,Medica,Medical Assistance,178.4,44.6,,percent of total billed charges,,
Clinical Nursing Level 5 (Ep),,G0463,HCPCS,Facility,Inpatient,,,,400,340,114.64,400,Medica,Medical Assistance,,,,,Included in per diem rate,
Clinical Nursing Level 5 (Ep),,G0463,HCPCS,Facility,Outpatient,,,,400,340,114.64,400,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,199.2,49.8,,percent of total billed charges,,
Clinical Nursing Level 5 (Ep),,G0463,HCPCS,Facility,Inpatient,,,,400,340,114.64,400,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Clinical Nursing Level 5 (Ep),,G0463,HCPCS,Facility,Outpatient,,,,400,340,114.64,400,PrimeWest Health,Minnesota Senior Health Options (MSHO),205.8,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Clinical Nursing Level 5 (Ep),,G0463,HCPCS,Facility,Inpatient,,,,400,340,114.64,400,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Clinical Nursing Level 5 (Ep),,G0463,HCPCS,Facility,Outpatient,,,,400,340,114.64,400,PrimeWest Health,MinnesotaCare,205.44,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Clinical Nursing Level 5 (Ep),,G0463,HCPCS,Facility,Inpatient,,,,400,340,114.64,400,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Clinical Nursing Level 5 (Ep),,G0463,HCPCS,Facility,Both,,,,400,340,114.64,400,"UCare Health, Inc.",Individual & Family Plan,225.44,56.35,,percent of total billed charges,,
Clinical Nursing Level 5 (Ep),,G0463,HCPCS,Facility,Outpatient,,,,400,340,114.64,400,"UCare Health, Inc.",Medical Assistance,201.88,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Clinical Nursing Level 5 (Ep),,G0463,HCPCS,Facility,Inpatient,,,,400,340,114.64,400,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Clinical Nursing Level 5 (Ep),,G0463,HCPCS,Facility,Outpatient,,,,400,340,114.64,400,"UCare Health, Inc.",Medicare Advantage,201.88,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Clinical Nursing Level 5 (Ep),,G0463,HCPCS,Facility,Inpatient,,,,400,340,114.64,400,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Clinical Nursing Level 5 (Ep),,G0463,HCPCS,Facility,Outpatient,,,,400,340,114.64,400,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),201.88,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Clinical Nursing Level 5 (Ep),,G0463,HCPCS,Facility,Inpatient,,,,400,340,114.64,400,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Clinical Nursing Level 5 (Ep),,G0463,HCPCS,Facility,Outpatient,,,,400,340,114.64,400,UnitedHealthcare,Medicare Advantage,196,49,,percent of total billed charges,,
Clinical Nursing Level 5 (Ep),,G0463,HCPCS,Facility,Inpatient,,,,400,340,114.64,400,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Clinical Nursing Level 5 (Ep),,G0463,HCPCS,Facility,Outpatient,,,,400,340,114.64,400,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,192,48,,percent of total billed charges,,100% of DHS outpatient percentage
Clinical Nursing Level 5 (Ep),,G0463,HCPCS,Facility,Inpatient,,,,400,340,114.64,400,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time",,G0463,HCPCS,Facility,Outpatient,,,,50,42.5,14.33,50,Aetna,Medicare Advantage,24.5,49,,percent of total billed charges,,
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time",,G0463,HCPCS,Facility,Outpatient,,,,50,42.5,14.33,50,BlueCross BlueShield Minnesota,Medicare Advantage,24.5,49,,percent of total billed charges,,
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time",,G0463,HCPCS,Facility,Outpatient,,,,50,42.5,14.33,50,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,14.33,28.66,,percent of total billed charges,,
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time",,G0463,HCPCS,Facility,Outpatient,,,,50,42.5,14.33,50,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),24.5,49,,percent of total billed charges,,
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time",,G0463,HCPCS,Facility,Outpatient,,,,50,42.5,14.33,50,CorVel,Worker's Compensation,50,100,,percent of total billed charges,,
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time",,G0463,HCPCS,Facility,Outpatient,,,,50,42.5,14.33,50,"Health Partners, Inc.",Medicare Advantage,24.5,49,,percent of total billed charges,,
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time",,G0463,HCPCS,Facility,Outpatient,,,,50,42.5,14.33,50,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),30,60,,percent of total billed charges,,
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time",,G0463,HCPCS,Facility,Outpatient,,,,50,42.5,14.33,50,"Health Partners, Inc.",State Public Programs,25,50,,percent of total billed charges,,
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time",,G0463,HCPCS,Facility,Outpatient,,,,50,42.5,14.33,50,Humana Insurance Company,Medicare PPO,24.5,49,,percent of total billed charges,,
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time",,G0463,HCPCS,Facility,Outpatient,,,,50,42.5,14.33,50,Medica,Medica Advantage Solution,24.9,49.8,,percent of total billed charges,,
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time",,G0463,HCPCS,Facility,Outpatient,,,,50,42.5,14.33,50,Medica,Medical Assistance,22.3,44.6,,percent of total billed charges,,
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time",,G0463,HCPCS,Facility,Outpatient,,,,50,42.5,14.33,50,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,24.9,49.8,,percent of total billed charges,,
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time",,G0463,HCPCS,Facility,Outpatient,,,,50,42.5,14.33,50,PrimeWest Health,Minnesota Senior Health Options (MSHO),25.725,51.45,,percent of total billed charges,,
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time",,G0463,HCPCS,Facility,Outpatient,,,,50,42.5,14.33,50,PrimeWest Health,MinnesotaCare,25.68,51.36,,percent of total billed charges,,
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time",,G0463,HCPCS,Facility,Outpatient,,,,50,42.5,14.33,50,"UCare Health, Inc.",Individual & Family Plan,28.18,56.35,,percent of total billed charges,,
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time",,G0463,HCPCS,Facility,Outpatient,,,,50,42.5,14.33,50,"UCare Health, Inc.",Medical Assistance,25.235,50.47,,percent of total billed charges,,
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time",,G0463,HCPCS,Facility,Outpatient,,,,50,42.5,14.33,50,"UCare Health, Inc.",Medicare Advantage,25.235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time",,G0463,HCPCS,Facility,Outpatient,,,,50,42.5,14.33,50,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),25.235,50.47,,percent of total billed charges,,
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time",,G0463,HCPCS,Facility,Outpatient,,,,50,42.5,14.33,50,UnitedHealthcare,Medicare Advantage,24.5,49,,percent of total billed charges,,
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time",,G0463,HCPCS,Facility,Outpatient,,,,50,42.5,14.33,50,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,24,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pbb)",,G0463,HCPCS,Facility,Outpatient,,,,60,51,17.196,60,Aetna,Medicare Advantage,29.4,49,,percent of total billed charges,,
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pbb)",,G0463,HCPCS,Facility,Outpatient,,,,60,51,17.196,60,BlueCross BlueShield Minnesota,Medicare Advantage,29.4,49,,percent of total billed charges,,
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pbb)",,G0463,HCPCS,Facility,Outpatient,,,,60,51,17.196,60,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,17.196,28.66,,percent of total billed charges,,
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pbb)",,G0463,HCPCS,Facility,Outpatient,,,,60,51,17.196,60,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),29.4,49,,percent of total billed charges,,
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pbb)",,G0463,HCPCS,Facility,Outpatient,,,,60,51,17.196,60,CorVel,Worker's Compensation,60,100,,percent of total billed charges,,
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pbb)",,G0463,HCPCS,Facility,Outpatient,,,,60,51,17.196,60,"Health Partners, Inc.",Medicare Advantage,29.4,49,,percent of total billed charges,,
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pbb)",,G0463,HCPCS,Facility,Outpatient,,,,60,51,17.196,60,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),36,60,,percent of total billed charges,,
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pbb)",,G0463,HCPCS,Facility,Outpatient,,,,60,51,17.196,60,"Health Partners, Inc.",State Public Programs,30,50,,percent of total billed charges,,
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pbb)",,G0463,HCPCS,Facility,Outpatient,,,,60,51,17.196,60,Humana Insurance Company,Medicare PPO,29.4,49,,percent of total billed charges,,
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pbb)",,G0463,HCPCS,Facility,Outpatient,,,,60,51,17.196,60,Medica,Medica Advantage Solution,29.88,49.8,,percent of total billed charges,,
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pbb)",,G0463,HCPCS,Facility,Outpatient,,,,60,51,17.196,60,Medica,Medical Assistance,26.76,44.6,,percent of total billed charges,,
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pbb)",,G0463,HCPCS,Facility,Outpatient,,,,60,51,17.196,60,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,29.88,49.8,,percent of total billed charges,,
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pbb)",,G0463,HCPCS,Facility,Outpatient,,,,60,51,17.196,60,PrimeWest Health,Minnesota Senior Health Options (MSHO),30.87,51.45,,percent of total billed charges,,
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pbb)",,G0463,HCPCS,Facility,Outpatient,,,,60,51,17.196,60,PrimeWest Health,MinnesotaCare,30.816,51.36,,percent of total billed charges,,
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pbb)",,G0463,HCPCS,Facility,Outpatient,,,,60,51,17.196,60,"UCare Health, Inc.",Individual & Family Plan,33.816,56.35,,percent of total billed charges,,
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pbb)",,G0463,HCPCS,Facility,Outpatient,,,,60,51,17.196,60,"UCare Health, Inc.",Medical Assistance,30.282,50.47,,percent of total billed charges,,
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pbb)",,G0463,HCPCS,Facility,Outpatient,,,,60,51,17.196,60,"UCare Health, Inc.",Medicare Advantage,30.282,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pbb)",,G0463,HCPCS,Facility,Outpatient,,,,60,51,17.196,60,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),30.282,50.47,,percent of total billed charges,,
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pbb)",,G0463,HCPCS,Facility,Outpatient,,,,60,51,17.196,60,UnitedHealthcare,Medicare Advantage,29.4,49,,percent of total billed charges,,
"Est Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 10-19 Min Total Time (Pbb)",,G0463,HCPCS,Facility,Outpatient,,,,60,51,17.196,60,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,28.8,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time",,G0463,HCPCS,Facility,Outpatient,,,,85,72.25,24.361,85,Aetna,Medicare Advantage,41.65,49,,percent of total billed charges,,
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time",,G0463,HCPCS,Facility,Outpatient,,,,85,72.25,24.361,85,BlueCross BlueShield Minnesota,Medicare Advantage,41.65,49,,percent of total billed charges,,
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time",,G0463,HCPCS,Facility,Outpatient,,,,85,72.25,24.361,85,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,24.361,28.66,,percent of total billed charges,,
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time",,G0463,HCPCS,Facility,Outpatient,,,,85,72.25,24.361,85,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),41.65,49,,percent of total billed charges,,
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time",,G0463,HCPCS,Facility,Outpatient,,,,85,72.25,24.361,85,CorVel,Worker's Compensation,85,100,,percent of total billed charges,,
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time",,G0463,HCPCS,Facility,Outpatient,,,,85,72.25,24.361,85,"Health Partners, Inc.",Medicare Advantage,41.65,49,,percent of total billed charges,,
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time",,G0463,HCPCS,Facility,Outpatient,,,,85,72.25,24.361,85,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),51,60,,percent of total billed charges,,
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time",,G0463,HCPCS,Facility,Outpatient,,,,85,72.25,24.361,85,"Health Partners, Inc.",State Public Programs,42.5,50,,percent of total billed charges,,
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time",,G0463,HCPCS,Facility,Outpatient,,,,85,72.25,24.361,85,Humana Insurance Company,Medicare PPO,41.65,49,,percent of total billed charges,,
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time",,G0463,HCPCS,Facility,Outpatient,,,,85,72.25,24.361,85,Medica,Medica Advantage Solution,42.33,49.8,,percent of total billed charges,,
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time",,G0463,HCPCS,Facility,Outpatient,,,,85,72.25,24.361,85,Medica,Medical Assistance,37.91,44.6,,percent of total billed charges,,
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time",,G0463,HCPCS,Facility,Outpatient,,,,85,72.25,24.361,85,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,42.33,49.8,,percent of total billed charges,,
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time",,G0463,HCPCS,Facility,Outpatient,,,,85,72.25,24.361,85,PrimeWest Health,Minnesota Senior Health Options (MSHO),43.7325,51.45,,percent of total billed charges,,
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time",,G0463,HCPCS,Facility,Outpatient,,,,85,72.25,24.361,85,PrimeWest Health,MinnesotaCare,43.656,51.36,,percent of total billed charges,,
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time",,G0463,HCPCS,Facility,Outpatient,,,,85,72.25,24.361,85,"UCare Health, Inc.",Individual & Family Plan,47.906,56.35,,percent of total billed charges,,
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time",,G0463,HCPCS,Facility,Outpatient,,,,85,72.25,24.361,85,"UCare Health, Inc.",Medical Assistance,42.8995,50.47,,percent of total billed charges,,
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time",,G0463,HCPCS,Facility,Outpatient,,,,85,72.25,24.361,85,"UCare Health, Inc.",Medicare Advantage,42.8995,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time",,G0463,HCPCS,Facility,Outpatient,,,,85,72.25,24.361,85,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),42.8995,50.47,,percent of total billed charges,,
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time",,G0463,HCPCS,Facility,Outpatient,,,,85,72.25,24.361,85,UnitedHealthcare,Medicare Advantage,41.65,49,,percent of total billed charges,,
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time",,G0463,HCPCS,Facility,Outpatient,,,,85,72.25,24.361,85,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,40.8,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pbb)",,G0463,HCPCS,Facility,Outpatient,,,,80,68,22.928,80,Aetna,Medicare Advantage,39.2,49,,percent of total billed charges,,
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pbb)",,G0463,HCPCS,Facility,Outpatient,,,,80,68,22.928,80,BlueCross BlueShield Minnesota,Medicare Advantage,39.2,49,,percent of total billed charges,,
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pbb)",,G0463,HCPCS,Facility,Outpatient,,,,80,68,22.928,80,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,22.928,28.66,,percent of total billed charges,,
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pbb)",,G0463,HCPCS,Facility,Outpatient,,,,80,68,22.928,80,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),39.2,49,,percent of total billed charges,,
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pbb)",,G0463,HCPCS,Facility,Outpatient,,,,80,68,22.928,80,CorVel,Worker's Compensation,80,100,,percent of total billed charges,,
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pbb)",,G0463,HCPCS,Facility,Outpatient,,,,80,68,22.928,80,"Health Partners, Inc.",Medicare Advantage,39.2,49,,percent of total billed charges,,
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pbb)",,G0463,HCPCS,Facility,Outpatient,,,,80,68,22.928,80,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),48,60,,percent of total billed charges,,
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pbb)",,G0463,HCPCS,Facility,Outpatient,,,,80,68,22.928,80,"Health Partners, Inc.",State Public Programs,40,50,,percent of total billed charges,,
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pbb)",,G0463,HCPCS,Facility,Outpatient,,,,80,68,22.928,80,Humana Insurance Company,Medicare PPO,39.2,49,,percent of total billed charges,,
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pbb)",,G0463,HCPCS,Facility,Outpatient,,,,80,68,22.928,80,Medica,Medica Advantage Solution,39.84,49.8,,percent of total billed charges,,
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pbb)",,G0463,HCPCS,Facility,Outpatient,,,,80,68,22.928,80,Medica,Medical Assistance,35.68,44.6,,percent of total billed charges,,
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pbb)",,G0463,HCPCS,Facility,Outpatient,,,,80,68,22.928,80,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,39.84,49.8,,percent of total billed charges,,
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pbb)",,G0463,HCPCS,Facility,Outpatient,,,,80,68,22.928,80,PrimeWest Health,Minnesota Senior Health Options (MSHO),41.16,51.45,,percent of total billed charges,,
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pbb)",,G0463,HCPCS,Facility,Outpatient,,,,80,68,22.928,80,PrimeWest Health,MinnesotaCare,41.088,51.36,,percent of total billed charges,,
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pbb)",,G0463,HCPCS,Facility,Outpatient,,,,80,68,22.928,80,"UCare Health, Inc.",Individual & Family Plan,45.088,56.35,,percent of total billed charges,,
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pbb)",,G0463,HCPCS,Facility,Outpatient,,,,80,68,22.928,80,"UCare Health, Inc.",Medical Assistance,40.376,50.47,,percent of total billed charges,,
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pbb)",,G0463,HCPCS,Facility,Outpatient,,,,80,68,22.928,80,"UCare Health, Inc.",Medicare Advantage,40.376,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pbb)",,G0463,HCPCS,Facility,Outpatient,,,,80,68,22.928,80,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),40.376,50.47,,percent of total billed charges,,
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pbb)",,G0463,HCPCS,Facility,Outpatient,,,,80,68,22.928,80,UnitedHealthcare,Medicare Advantage,39.2,49,,percent of total billed charges,,
"Est Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 20-29 Min Total Time (Pbb)",,G0463,HCPCS,Facility,Outpatient,,,,80,68,22.928,80,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,38.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time",,G0463,HCPCS,Facility,Outpatient,,,,120,102,34.392,120,Aetna,Medicare Advantage,58.8,49,,percent of total billed charges,,
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time",,G0463,HCPCS,Facility,Outpatient,,,,120,102,34.392,120,BlueCross BlueShield Minnesota,Medicare Advantage,58.8,49,,percent of total billed charges,,
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time",,G0463,HCPCS,Facility,Outpatient,,,,120,102,34.392,120,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,34.392,28.66,,percent of total billed charges,,
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time",,G0463,HCPCS,Facility,Outpatient,,,,120,102,34.392,120,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),58.8,49,,percent of total billed charges,,
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time",,G0463,HCPCS,Facility,Outpatient,,,,120,102,34.392,120,CorVel,Worker's Compensation,120,100,,percent of total billed charges,,
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time",,G0463,HCPCS,Facility,Outpatient,,,,120,102,34.392,120,"Health Partners, Inc.",Medicare Advantage,58.8,49,,percent of total billed charges,,
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time",,G0463,HCPCS,Facility,Outpatient,,,,120,102,34.392,120,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),72,60,,percent of total billed charges,,
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time",,G0463,HCPCS,Facility,Outpatient,,,,120,102,34.392,120,"Health Partners, Inc.",State Public Programs,60,50,,percent of total billed charges,,
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time",,G0463,HCPCS,Facility,Outpatient,,,,120,102,34.392,120,Humana Insurance Company,Medicare PPO,58.8,49,,percent of total billed charges,,
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time",,G0463,HCPCS,Facility,Outpatient,,,,120,102,34.392,120,Medica,Medica Advantage Solution,59.76,49.8,,percent of total billed charges,,
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time",,G0463,HCPCS,Facility,Outpatient,,,,120,102,34.392,120,Medica,Medical Assistance,53.52,44.6,,percent of total billed charges,,
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time",,G0463,HCPCS,Facility,Outpatient,,,,120,102,34.392,120,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,59.76,49.8,,percent of total billed charges,,
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time",,G0463,HCPCS,Facility,Outpatient,,,,120,102,34.392,120,PrimeWest Health,Minnesota Senior Health Options (MSHO),61.74,51.45,,percent of total billed charges,,
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time",,G0463,HCPCS,Facility,Outpatient,,,,120,102,34.392,120,PrimeWest Health,MinnesotaCare,61.632,51.36,,percent of total billed charges,,
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time",,G0463,HCPCS,Facility,Outpatient,,,,120,102,34.392,120,"UCare Health, Inc.",Individual & Family Plan,67.632,56.35,,percent of total billed charges,,
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time",,G0463,HCPCS,Facility,Outpatient,,,,120,102,34.392,120,"UCare Health, Inc.",Medical Assistance,60.564,50.47,,percent of total billed charges,,
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time",,G0463,HCPCS,Facility,Outpatient,,,,120,102,34.392,120,"UCare Health, Inc.",Medicare Advantage,60.564,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time",,G0463,HCPCS,Facility,Outpatient,,,,120,102,34.392,120,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),60.564,50.47,,percent of total billed charges,,
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time",,G0463,HCPCS,Facility,Outpatient,,,,120,102,34.392,120,UnitedHealthcare,Medicare Advantage,58.8,49,,percent of total billed charges,,
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time",,G0463,HCPCS,Facility,Outpatient,,,,120,102,34.392,120,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,57.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pbb)",,G0463,HCPCS,Facility,Outpatient,,,,120,102,34.392,120,Aetna,Medicare Advantage,58.8,49,,percent of total billed charges,,
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pbb)",,G0463,HCPCS,Facility,Outpatient,,,,120,102,34.392,120,BlueCross BlueShield Minnesota,Medicare Advantage,58.8,49,,percent of total billed charges,,
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pbb)",,G0463,HCPCS,Facility,Outpatient,,,,120,102,34.392,120,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,34.392,28.66,,percent of total billed charges,,
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pbb)",,G0463,HCPCS,Facility,Outpatient,,,,120,102,34.392,120,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),58.8,49,,percent of total billed charges,,
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pbb)",,G0463,HCPCS,Facility,Outpatient,,,,120,102,34.392,120,CorVel,Worker's Compensation,120,100,,percent of total billed charges,,
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pbb)",,G0463,HCPCS,Facility,Outpatient,,,,120,102,34.392,120,"Health Partners, Inc.",Medicare Advantage,58.8,49,,percent of total billed charges,,
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pbb)",,G0463,HCPCS,Facility,Outpatient,,,,120,102,34.392,120,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),72,60,,percent of total billed charges,,
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pbb)",,G0463,HCPCS,Facility,Outpatient,,,,120,102,34.392,120,"Health Partners, Inc.",State Public Programs,60,50,,percent of total billed charges,,
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pbb)",,G0463,HCPCS,Facility,Outpatient,,,,120,102,34.392,120,Humana Insurance Company,Medicare PPO,58.8,49,,percent of total billed charges,,
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pbb)",,G0463,HCPCS,Facility,Outpatient,,,,120,102,34.392,120,Medica,Medica Advantage Solution,59.76,49.8,,percent of total billed charges,,
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pbb)",,G0463,HCPCS,Facility,Outpatient,,,,120,102,34.392,120,Medica,Medical Assistance,53.52,44.6,,percent of total billed charges,,
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pbb)",,G0463,HCPCS,Facility,Outpatient,,,,120,102,34.392,120,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,59.76,49.8,,percent of total billed charges,,
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pbb)",,G0463,HCPCS,Facility,Outpatient,,,,120,102,34.392,120,PrimeWest Health,Minnesota Senior Health Options (MSHO),61.74,51.45,,percent of total billed charges,,
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pbb)",,G0463,HCPCS,Facility,Outpatient,,,,120,102,34.392,120,PrimeWest Health,MinnesotaCare,61.632,51.36,,percent of total billed charges,,
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pbb)",,G0463,HCPCS,Facility,Outpatient,,,,120,102,34.392,120,"UCare Health, Inc.",Individual & Family Plan,67.632,56.35,,percent of total billed charges,,
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pbb)",,G0463,HCPCS,Facility,Outpatient,,,,120,102,34.392,120,"UCare Health, Inc.",Medical Assistance,60.564,50.47,,percent of total billed charges,,
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pbb)",,G0463,HCPCS,Facility,Outpatient,,,,120,102,34.392,120,"UCare Health, Inc.",Medicare Advantage,60.564,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pbb)",,G0463,HCPCS,Facility,Outpatient,,,,120,102,34.392,120,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),60.564,50.47,,percent of total billed charges,,
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pbb)",,G0463,HCPCS,Facility,Outpatient,,,,120,102,34.392,120,UnitedHealthcare,Medicare Advantage,58.8,49,,percent of total billed charges,,
"Est Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 30-39 Min Total Time (Pbb)",,G0463,HCPCS,Facility,Outpatient,,,,120,102,34.392,120,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,57.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time",,G0463,HCPCS,Facility,Outpatient,,,,75,63.75,21.495,75,Aetna,Medicare Advantage,36.75,49,,percent of total billed charges,,
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time",,G0463,HCPCS,Facility,Outpatient,,,,75,63.75,21.495,75,BlueCross BlueShield Minnesota,Medicare Advantage,36.75,49,,percent of total billed charges,,
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time",,G0463,HCPCS,Facility,Outpatient,,,,75,63.75,21.495,75,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,21.495,28.66,,percent of total billed charges,,
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time",,G0463,HCPCS,Facility,Outpatient,,,,75,63.75,21.495,75,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),36.75,49,,percent of total billed charges,,
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time",,G0463,HCPCS,Facility,Outpatient,,,,75,63.75,21.495,75,CorVel,Worker's Compensation,75,100,,percent of total billed charges,,
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time",,G0463,HCPCS,Facility,Outpatient,,,,75,63.75,21.495,75,"Health Partners, Inc.",Medicare Advantage,36.75,49,,percent of total billed charges,,
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time",,G0463,HCPCS,Facility,Outpatient,,,,75,63.75,21.495,75,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),45,60,,percent of total billed charges,,
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time",,G0463,HCPCS,Facility,Outpatient,,,,75,63.75,21.495,75,"Health Partners, Inc.",State Public Programs,37.5,50,,percent of total billed charges,,
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time",,G0463,HCPCS,Facility,Outpatient,,,,75,63.75,21.495,75,Humana Insurance Company,Medicare PPO,36.75,49,,percent of total billed charges,,
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time",,G0463,HCPCS,Facility,Outpatient,,,,75,63.75,21.495,75,Medica,Medica Advantage Solution,37.35,49.8,,percent of total billed charges,,
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time",,G0463,HCPCS,Facility,Outpatient,,,,75,63.75,21.495,75,Medica,Medical Assistance,33.45,44.6,,percent of total billed charges,,
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time",,G0463,HCPCS,Facility,Outpatient,,,,75,63.75,21.495,75,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,37.35,49.8,,percent of total billed charges,,
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time",,G0463,HCPCS,Facility,Outpatient,,,,75,63.75,21.495,75,PrimeWest Health,Minnesota Senior Health Options (MSHO),38.5875,51.45,,percent of total billed charges,,
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time",,G0463,HCPCS,Facility,Outpatient,,,,75,63.75,21.495,75,PrimeWest Health,MinnesotaCare,38.52,51.36,,percent of total billed charges,,
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time",,G0463,HCPCS,Facility,Outpatient,,,,75,63.75,21.495,75,"UCare Health, Inc.",Individual & Family Plan,42.27,56.35,,percent of total billed charges,,
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time",,G0463,HCPCS,Facility,Outpatient,,,,75,63.75,21.495,75,"UCare Health, Inc.",Medical Assistance,37.8525,50.47,,percent of total billed charges,,
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time",,G0463,HCPCS,Facility,Outpatient,,,,75,63.75,21.495,75,"UCare Health, Inc.",Medicare Advantage,37.8525,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time",,G0463,HCPCS,Facility,Outpatient,,,,75,63.75,21.495,75,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),37.8525,50.47,,percent of total billed charges,,
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time",,G0463,HCPCS,Facility,Outpatient,,,,75,63.75,21.495,75,UnitedHealthcare,Medicare Advantage,36.75,49,,percent of total billed charges,,
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time",,G0463,HCPCS,Facility,Outpatient,,,,75,63.75,21.495,75,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,36,48,,percent of total billed charges,,100% of DHS outpatient percentage
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pbb)",,G0463,HCPCS,Facility,Outpatient,,,,75,63.75,21.495,75,Aetna,Medicare Advantage,36.75,49,,percent of total billed charges,,
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pbb)",,G0463,HCPCS,Facility,Outpatient,,,,75,63.75,21.495,75,BlueCross BlueShield Minnesota,Medicare Advantage,36.75,49,,percent of total billed charges,,
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pbb)",,G0463,HCPCS,Facility,Outpatient,,,,75,63.75,21.495,75,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,21.495,28.66,,percent of total billed charges,,
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pbb)",,G0463,HCPCS,Facility,Outpatient,,,,75,63.75,21.495,75,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),36.75,49,,percent of total billed charges,,
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pbb)",,G0463,HCPCS,Facility,Outpatient,,,,75,63.75,21.495,75,CorVel,Worker's Compensation,75,100,,percent of total billed charges,,
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pbb)",,G0463,HCPCS,Facility,Outpatient,,,,75,63.75,21.495,75,"Health Partners, Inc.",Medicare Advantage,36.75,49,,percent of total billed charges,,
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pbb)",,G0463,HCPCS,Facility,Outpatient,,,,75,63.75,21.495,75,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),45,60,,percent of total billed charges,,
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pbb)",,G0463,HCPCS,Facility,Outpatient,,,,75,63.75,21.495,75,"Health Partners, Inc.",State Public Programs,37.5,50,,percent of total billed charges,,
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pbb)",,G0463,HCPCS,Facility,Outpatient,,,,75,63.75,21.495,75,Humana Insurance Company,Medicare PPO,36.75,49,,percent of total billed charges,,
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pbb)",,G0463,HCPCS,Facility,Outpatient,,,,75,63.75,21.495,75,Medica,Medica Advantage Solution,37.35,49.8,,percent of total billed charges,,
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pbb)",,G0463,HCPCS,Facility,Outpatient,,,,75,63.75,21.495,75,Medica,Medical Assistance,33.45,44.6,,percent of total billed charges,,
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pbb)",,G0463,HCPCS,Facility,Outpatient,,,,75,63.75,21.495,75,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,37.35,49.8,,percent of total billed charges,,
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pbb)",,G0463,HCPCS,Facility,Outpatient,,,,75,63.75,21.495,75,PrimeWest Health,Minnesota Senior Health Options (MSHO),38.5875,51.45,,percent of total billed charges,,
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pbb)",,G0463,HCPCS,Facility,Outpatient,,,,75,63.75,21.495,75,PrimeWest Health,MinnesotaCare,38.52,51.36,,percent of total billed charges,,
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pbb)",,G0463,HCPCS,Facility,Outpatient,,,,75,63.75,21.495,75,"UCare Health, Inc.",Individual & Family Plan,42.27,56.35,,percent of total billed charges,,
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pbb)",,G0463,HCPCS,Facility,Outpatient,,,,75,63.75,21.495,75,"UCare Health, Inc.",Medical Assistance,37.8525,50.47,,percent of total billed charges,,
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pbb)",,G0463,HCPCS,Facility,Outpatient,,,,75,63.75,21.495,75,"UCare Health, Inc.",Medicare Advantage,37.8525,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pbb)",,G0463,HCPCS,Facility,Outpatient,,,,75,63.75,21.495,75,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),37.8525,50.47,,percent of total billed charges,,
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pbb)",,G0463,HCPCS,Facility,Outpatient,,,,75,63.75,21.495,75,UnitedHealthcare,Medicare Advantage,36.75,49,,percent of total billed charges,,
"New Pt Level 2 Office/Other Outpt Visit Eval And Mgmt, Straightforward Mdm Or 15-29 Min Total Time (Pbb)",,G0463,HCPCS,Facility,Outpatient,,,,75,63.75,21.495,75,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,36,48,,percent of total billed charges,,100% of DHS outpatient percentage
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time",,G0463,HCPCS,Facility,Outpatient,,,,100,85,28.66,100,Aetna,Medicare Advantage,49,49,,percent of total billed charges,,
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time",,G0463,HCPCS,Facility,Outpatient,,,,100,85,28.66,100,BlueCross BlueShield Minnesota,Medicare Advantage,49,49,,percent of total billed charges,,
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time",,G0463,HCPCS,Facility,Outpatient,,,,100,85,28.66,100,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,28.66,28.66,,percent of total billed charges,,
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time",,G0463,HCPCS,Facility,Outpatient,,,,100,85,28.66,100,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),49,49,,percent of total billed charges,,
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time",,G0463,HCPCS,Facility,Outpatient,,,,100,85,28.66,100,CorVel,Worker's Compensation,100,100,,percent of total billed charges,,
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time",,G0463,HCPCS,Facility,Outpatient,,,,100,85,28.66,100,"Health Partners, Inc.",Medicare Advantage,49,49,,percent of total billed charges,,
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time",,G0463,HCPCS,Facility,Outpatient,,,,100,85,28.66,100,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),60,60,,percent of total billed charges,,
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time",,G0463,HCPCS,Facility,Outpatient,,,,100,85,28.66,100,"Health Partners, Inc.",State Public Programs,50,50,,percent of total billed charges,,
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time",,G0463,HCPCS,Facility,Outpatient,,,,100,85,28.66,100,Humana Insurance Company,Medicare PPO,49,49,,percent of total billed charges,,
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time",,G0463,HCPCS,Facility,Outpatient,,,,100,85,28.66,100,Medica,Medica Advantage Solution,49.8,49.8,,percent of total billed charges,,
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time",,G0463,HCPCS,Facility,Outpatient,,,,100,85,28.66,100,Medica,Medical Assistance,44.6,44.6,,percent of total billed charges,,
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time",,G0463,HCPCS,Facility,Outpatient,,,,100,85,28.66,100,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,49.8,49.8,,percent of total billed charges,,
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time",,G0463,HCPCS,Facility,Outpatient,,,,100,85,28.66,100,PrimeWest Health,Minnesota Senior Health Options (MSHO),51.45,51.45,,percent of total billed charges,,
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time",,G0463,HCPCS,Facility,Outpatient,,,,100,85,28.66,100,PrimeWest Health,MinnesotaCare,51.36,51.36,,percent of total billed charges,,
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time",,G0463,HCPCS,Facility,Outpatient,,,,100,85,28.66,100,"UCare Health, Inc.",Individual & Family Plan,56.36,56.35,,percent of total billed charges,,
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time",,G0463,HCPCS,Facility,Outpatient,,,,100,85,28.66,100,"UCare Health, Inc.",Medical Assistance,50.47,50.47,,percent of total billed charges,,
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time",,G0463,HCPCS,Facility,Outpatient,,,,100,85,28.66,100,"UCare Health, Inc.",Medicare Advantage,50.47,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time",,G0463,HCPCS,Facility,Outpatient,,,,100,85,28.66,100,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),50.47,50.47,,percent of total billed charges,,
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time",,G0463,HCPCS,Facility,Outpatient,,,,100,85,28.66,100,UnitedHealthcare,Medicare Advantage,49,49,,percent of total billed charges,,
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time",,G0463,HCPCS,Facility,Outpatient,,,,100,85,28.66,100,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,48,48,,percent of total billed charges,,100% of DHS outpatient percentage
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pbb)",,G0463,HCPCS,Facility,Outpatient,,,,100,85,28.66,100,Aetna,Medicare Advantage,49,49,,percent of total billed charges,,
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pbb)",,G0463,HCPCS,Facility,Outpatient,,,,100,85,28.66,100,BlueCross BlueShield Minnesota,Medicare Advantage,49,49,,percent of total billed charges,,
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pbb)",,G0463,HCPCS,Facility,Outpatient,,,,100,85,28.66,100,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,28.66,28.66,,percent of total billed charges,,
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pbb)",,G0463,HCPCS,Facility,Outpatient,,,,100,85,28.66,100,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),49,49,,percent of total billed charges,,
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pbb)",,G0463,HCPCS,Facility,Outpatient,,,,100,85,28.66,100,CorVel,Worker's Compensation,100,100,,percent of total billed charges,,
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pbb)",,G0463,HCPCS,Facility,Outpatient,,,,100,85,28.66,100,"Health Partners, Inc.",Medicare Advantage,49,49,,percent of total billed charges,,
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pbb)",,G0463,HCPCS,Facility,Outpatient,,,,100,85,28.66,100,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),60,60,,percent of total billed charges,,
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pbb)",,G0463,HCPCS,Facility,Outpatient,,,,100,85,28.66,100,"Health Partners, Inc.",State Public Programs,50,50,,percent of total billed charges,,
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pbb)",,G0463,HCPCS,Facility,Outpatient,,,,100,85,28.66,100,Humana Insurance Company,Medicare PPO,49,49,,percent of total billed charges,,
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pbb)",,G0463,HCPCS,Facility,Outpatient,,,,100,85,28.66,100,Medica,Medica Advantage Solution,49.8,49.8,,percent of total billed charges,,
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pbb)",,G0463,HCPCS,Facility,Outpatient,,,,100,85,28.66,100,Medica,Medical Assistance,44.6,44.6,,percent of total billed charges,,
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pbb)",,G0463,HCPCS,Facility,Outpatient,,,,100,85,28.66,100,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,49.8,49.8,,percent of total billed charges,,
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pbb)",,G0463,HCPCS,Facility,Outpatient,,,,100,85,28.66,100,PrimeWest Health,Minnesota Senior Health Options (MSHO),51.45,51.45,,percent of total billed charges,,
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pbb)",,G0463,HCPCS,Facility,Outpatient,,,,100,85,28.66,100,PrimeWest Health,MinnesotaCare,51.36,51.36,,percent of total billed charges,,
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pbb)",,G0463,HCPCS,Facility,Outpatient,,,,100,85,28.66,100,"UCare Health, Inc.",Individual & Family Plan,56.36,56.35,,percent of total billed charges,,
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pbb)",,G0463,HCPCS,Facility,Outpatient,,,,100,85,28.66,100,"UCare Health, Inc.",Medical Assistance,50.47,50.47,,percent of total billed charges,,
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pbb)",,G0463,HCPCS,Facility,Outpatient,,,,100,85,28.66,100,"UCare Health, Inc.",Medicare Advantage,50.47,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pbb)",,G0463,HCPCS,Facility,Outpatient,,,,100,85,28.66,100,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),50.47,50.47,,percent of total billed charges,,
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pbb)",,G0463,HCPCS,Facility,Outpatient,,,,100,85,28.66,100,UnitedHealthcare,Medicare Advantage,49,49,,percent of total billed charges,,
"New Pt Level 3 Office/Other Outpt Visit Eval And Mgmt, Low Level Mdm Or 30-44 Min Total Time (Pbb)",,G0463,HCPCS,Facility,Outpatient,,,,100,85,28.66,100,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,48,48,,percent of total billed charges,,100% of DHS outpatient percentage
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time",,G0463,HCPCS,Facility,Outpatient,,,,125,106.25,35.825,125,Aetna,Medicare Advantage,61.25,49,,percent of total billed charges,,
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time",,G0463,HCPCS,Facility,Outpatient,,,,125,106.25,35.825,125,BlueCross BlueShield Minnesota,Medicare Advantage,61.25,49,,percent of total billed charges,,
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time",,G0463,HCPCS,Facility,Outpatient,,,,125,106.25,35.825,125,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,35.825,28.66,,percent of total billed charges,,
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time",,G0463,HCPCS,Facility,Outpatient,,,,125,106.25,35.825,125,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),61.25,49,,percent of total billed charges,,
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time",,G0463,HCPCS,Facility,Outpatient,,,,125,106.25,35.825,125,CorVel,Worker's Compensation,125,100,,percent of total billed charges,,
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time",,G0463,HCPCS,Facility,Outpatient,,,,125,106.25,35.825,125,"Health Partners, Inc.",Medicare Advantage,61.25,49,,percent of total billed charges,,
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time",,G0463,HCPCS,Facility,Outpatient,,,,125,106.25,35.825,125,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),75,60,,percent of total billed charges,,
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time",,G0463,HCPCS,Facility,Outpatient,,,,125,106.25,35.825,125,"Health Partners, Inc.",State Public Programs,62.5,50,,percent of total billed charges,,
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time",,G0463,HCPCS,Facility,Outpatient,,,,125,106.25,35.825,125,Humana Insurance Company,Medicare PPO,61.25,49,,percent of total billed charges,,
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time",,G0463,HCPCS,Facility,Outpatient,,,,125,106.25,35.825,125,Medica,Medica Advantage Solution,62.25,49.8,,percent of total billed charges,,
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time",,G0463,HCPCS,Facility,Outpatient,,,,125,106.25,35.825,125,Medica,Medical Assistance,55.75,44.6,,percent of total billed charges,,
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time",,G0463,HCPCS,Facility,Outpatient,,,,125,106.25,35.825,125,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,62.25,49.8,,percent of total billed charges,,
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time",,G0463,HCPCS,Facility,Outpatient,,,,125,106.25,35.825,125,PrimeWest Health,Minnesota Senior Health Options (MSHO),64.3125,51.45,,percent of total billed charges,,
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time",,G0463,HCPCS,Facility,Outpatient,,,,125,106.25,35.825,125,PrimeWest Health,MinnesotaCare,64.2,51.36,,percent of total billed charges,,
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time",,G0463,HCPCS,Facility,Outpatient,,,,125,106.25,35.825,125,"UCare Health, Inc.",Individual & Family Plan,70.45,56.35,,percent of total billed charges,,
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time",,G0463,HCPCS,Facility,Outpatient,,,,125,106.25,35.825,125,"UCare Health, Inc.",Medical Assistance,63.0875,50.47,,percent of total billed charges,,
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time",,G0463,HCPCS,Facility,Outpatient,,,,125,106.25,35.825,125,"UCare Health, Inc.",Medicare Advantage,63.0875,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time",,G0463,HCPCS,Facility,Outpatient,,,,125,106.25,35.825,125,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),63.0875,50.47,,percent of total billed charges,,
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time",,G0463,HCPCS,Facility,Outpatient,,,,125,106.25,35.825,125,UnitedHealthcare,Medicare Advantage,61.25,49,,percent of total billed charges,,
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time",,G0463,HCPCS,Facility,Outpatient,,,,125,106.25,35.825,125,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,60,48,,percent of total billed charges,,100% of DHS outpatient percentage
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pbb)",,G0463,HCPCS,Facility,Outpatient,,,,125,106.25,35.825,125,Aetna,Medicare Advantage,61.25,49,,percent of total billed charges,,
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pbb)",,G0463,HCPCS,Facility,Outpatient,,,,125,106.25,35.825,125,BlueCross BlueShield Minnesota,Medicare Advantage,61.25,49,,percent of total billed charges,,
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pbb)",,G0463,HCPCS,Facility,Outpatient,,,,125,106.25,35.825,125,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,35.825,28.66,,percent of total billed charges,,
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pbb)",,G0463,HCPCS,Facility,Outpatient,,,,125,106.25,35.825,125,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),61.25,49,,percent of total billed charges,,
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pbb)",,G0463,HCPCS,Facility,Outpatient,,,,125,106.25,35.825,125,CorVel,Worker's Compensation,125,100,,percent of total billed charges,,
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pbb)",,G0463,HCPCS,Facility,Outpatient,,,,125,106.25,35.825,125,"Health Partners, Inc.",Medicare Advantage,61.25,49,,percent of total billed charges,,
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pbb)",,G0463,HCPCS,Facility,Outpatient,,,,125,106.25,35.825,125,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),75,60,,percent of total billed charges,,
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pbb)",,G0463,HCPCS,Facility,Outpatient,,,,125,106.25,35.825,125,"Health Partners, Inc.",State Public Programs,62.5,50,,percent of total billed charges,,
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pbb)",,G0463,HCPCS,Facility,Outpatient,,,,125,106.25,35.825,125,Humana Insurance Company,Medicare PPO,61.25,49,,percent of total billed charges,,
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pbb)",,G0463,HCPCS,Facility,Outpatient,,,,125,106.25,35.825,125,Medica,Medica Advantage Solution,62.25,49.8,,percent of total billed charges,,
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pbb)",,G0463,HCPCS,Facility,Outpatient,,,,125,106.25,35.825,125,Medica,Medical Assistance,55.75,44.6,,percent of total billed charges,,
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pbb)",,G0463,HCPCS,Facility,Outpatient,,,,125,106.25,35.825,125,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,62.25,49.8,,percent of total billed charges,,
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pbb)",,G0463,HCPCS,Facility,Outpatient,,,,125,106.25,35.825,125,PrimeWest Health,Minnesota Senior Health Options (MSHO),64.3125,51.45,,percent of total billed charges,,
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pbb)",,G0463,HCPCS,Facility,Outpatient,,,,125,106.25,35.825,125,PrimeWest Health,MinnesotaCare,64.2,51.36,,percent of total billed charges,,
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pbb)",,G0463,HCPCS,Facility,Outpatient,,,,125,106.25,35.825,125,"UCare Health, Inc.",Individual & Family Plan,70.45,56.35,,percent of total billed charges,,
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pbb)",,G0463,HCPCS,Facility,Outpatient,,,,125,106.25,35.825,125,"UCare Health, Inc.",Medical Assistance,63.0875,50.47,,percent of total billed charges,,
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pbb)",,G0463,HCPCS,Facility,Outpatient,,,,125,106.25,35.825,125,"UCare Health, Inc.",Medicare Advantage,63.0875,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pbb)",,G0463,HCPCS,Facility,Outpatient,,,,125,106.25,35.825,125,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),63.0875,50.47,,percent of total billed charges,,
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pbb)",,G0463,HCPCS,Facility,Outpatient,,,,125,106.25,35.825,125,UnitedHealthcare,Medicare Advantage,61.25,49,,percent of total billed charges,,
"New Pt Level 4 Office/Other Outpt Visit Eval And Mgmt, Moderate Level Mdm Or 45-59 Min Total Time (Pbb)",,G0463,HCPCS,Facility,Outpatient,,,,125,106.25,35.825,125,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,60,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Hiv Antigen/Antibody, Combination Assay, Screening",,G0475,HCPCS,Facility,Both,,,,128,108.8,36.6848,128,Aetna,Commercial,117.76,92,,percent of total billed charges,,
"Hiv Antigen/Antibody, Combination Assay, Screening",,G0475,HCPCS,Facility,Outpatient,,,,128,108.8,36.6848,128,Aetna,Medicare Advantage,62.72,49,,percent of total billed charges,,
"Hiv Antigen/Antibody, Combination Assay, Screening",,G0475,HCPCS,Facility,Inpatient,,,,128,108.8,36.6848,128,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Hiv Antigen/Antibody, Combination Assay, Screening",,G0475,HCPCS,Facility,Both,,,,128,108.8,36.6848,128,Aetna,PPO,119.04,93,,percent of total billed charges,,
"Hiv Antigen/Antibody, Combination Assay, Screening",,G0475,HCPCS,Facility,Both,,,,128,108.8,36.6848,128,America's PPO,America's PPO,122.9184,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Hiv Antigen/Antibody, Combination Assay, Screening",,G0475,HCPCS,Facility,Both,,,,128,108.8,36.6848,128,BlueCross BlueShield Minnesota, Federal Employee Program,125.952,98.4,,percent of total billed charges,,
"Hiv Antigen/Antibody, Combination Assay, Screening",,G0475,HCPCS,Facility,Both,,,,128,108.8,36.6848,128,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,128,100,,percent of total billed charges,,
"Hiv Antigen/Antibody, Combination Assay, Screening",,G0475,HCPCS,Facility,Both,,,,128,108.8,36.6848,128,BlueCross BlueShield Minnesota,High Value Network Plan,115.2,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
"Hiv Antigen/Antibody, Combination Assay, Screening",,G0475,HCPCS,Facility,Outpatient,,,,128,108.8,36.6848,128,BlueCross BlueShield Minnesota,Medicare Advantage,62.72,49,,percent of total billed charges,,
"Hiv Antigen/Antibody, Combination Assay, Screening",,G0475,HCPCS,Facility,Inpatient,,,,128,108.8,36.6848,128,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Hiv Antigen/Antibody, Combination Assay, Screening",,G0475,HCPCS,Facility,Both,,,,128,108.8,36.6848,128,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,113.3696,88.57,,percent of total billed charges,,
"Hiv Antigen/Antibody, Combination Assay, Screening",,G0475,HCPCS,Facility,Both,,,,128,108.8,36.6848,128,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,36.6848,28.66,,percent of total billed charges,,
"Hiv Antigen/Antibody, Combination Assay, Screening",,G0475,HCPCS,Facility,Outpatient,,,,128,108.8,36.6848,128,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),62.72,49,,percent of total billed charges,,
"Hiv Antigen/Antibody, Combination Assay, Screening",,G0475,HCPCS,Facility,Inpatient,,,,128,108.8,36.6848,128,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Hiv Antigen/Antibody, Combination Assay, Screening",,G0475,HCPCS,Facility,Both,,,,128,108.8,36.6848,128,CorVel,Worker's Compensation,128,100,,percent of total billed charges,,
"Hiv Antigen/Antibody, Combination Assay, Screening",,G0475,HCPCS,Facility,Both,,,,128,108.8,36.6848,128,First Health Group Corporation,First Health Network,124.16,97,,percent of total billed charges,,
"Hiv Antigen/Antibody, Combination Assay, Screening",,G0475,HCPCS,Facility,Both,,,,128,108.8,36.6848,128,"Health Partners, Inc.",Commercial,121.088,94.6,,percent of total billed charges,,
"Hiv Antigen/Antibody, Combination Assay, Screening",,G0475,HCPCS,Facility,Outpatient,,,,128,108.8,36.6848,128,"Health Partners, Inc.",Medicare Advantage,62.72,49,,percent of total billed charges,,
"Hiv Antigen/Antibody, Combination Assay, Screening",,G0475,HCPCS,Facility,Inpatient,,,,128,108.8,36.6848,128,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Hiv Antigen/Antibody, Combination Assay, Screening",,G0475,HCPCS,Facility,Both,,,,128,108.8,36.6848,128,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),76.8,60,,percent of total billed charges,,
"Hiv Antigen/Antibody, Combination Assay, Screening",,G0475,HCPCS,Facility,Both,,,,128,108.8,36.6848,128,"Health Partners, Inc.",State of Minnesota Advantage Program,104.32,81.5,,percent of total billed charges,,
"Hiv Antigen/Antibody, Combination Assay, Screening",,G0475,HCPCS,Facility,Both,,,,128,108.8,36.6848,128,"Health Partners, Inc.",State Public Programs,64,50,,percent of total billed charges,,
"Hiv Antigen/Antibody, Combination Assay, Screening",,G0475,HCPCS,Facility,Both,,,,128,108.8,36.6848,128,Humana Insurance Company,Commercial PPO,121.6,95,,percent of total billed charges,,
"Hiv Antigen/Antibody, Combination Assay, Screening",,G0475,HCPCS,Facility,Outpatient,,,,128,108.8,36.6848,128,Humana Insurance Company,Medicare PPO,62.72,49,,percent of total billed charges,,
"Hiv Antigen/Antibody, Combination Assay, Screening",,G0475,HCPCS,Facility,Inpatient,,,,128,108.8,36.6848,128,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Hiv Antigen/Antibody, Combination Assay, Screening",,G0475,HCPCS,Facility,Both,,,,128,108.8,36.6848,128,Medica,Individual & Family,126.848,99.1,,percent of total billed charges,,
"Hiv Antigen/Antibody, Combination Assay, Screening",,G0475,HCPCS,Facility,Outpatient,,,,128,108.8,36.6848,128,Medica,Medica Advantage Solution,63.744,49.8,,percent of total billed charges,,
"Hiv Antigen/Antibody, Combination Assay, Screening",,G0475,HCPCS,Facility,Inpatient,,,,128,108.8,36.6848,128,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Hiv Antigen/Antibody, Combination Assay, Screening",,G0475,HCPCS,Facility,Outpatient,,,,128,108.8,36.6848,128,Medica,Medical Assistance,57.088,44.6,,percent of total billed charges,,
"Hiv Antigen/Antibody, Combination Assay, Screening",,G0475,HCPCS,Facility,Inpatient,,,,128,108.8,36.6848,128,Medica,Medical Assistance,,,,,Included in per diem rate,
"Hiv Antigen/Antibody, Combination Assay, Screening",,G0475,HCPCS,Facility,Outpatient,,,,128,108.8,36.6848,128,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,63.744,49.8,,percent of total billed charges,,
"Hiv Antigen/Antibody, Combination Assay, Screening",,G0475,HCPCS,Facility,Inpatient,,,,128,108.8,36.6848,128,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Hiv Antigen/Antibody, Combination Assay, Screening",,G0475,HCPCS,Facility,Both,,,,128,108.8,36.6848,128,"Multiplan, Inc.","Multiplan, Inc.",120.32,94,,percent of total billed charges,,
"Hiv Antigen/Antibody, Combination Assay, Screening",,G0475,HCPCS,Facility,Outpatient,,,,128,108.8,36.6848,128,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,110.592,86.4,,percent of total billed charges,,
"Hiv Antigen/Antibody, Combination Assay, Screening",,G0475,HCPCS,Facility,Inpatient,,,,128,108.8,36.6848,128,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Hiv Antigen/Antibody, Combination Assay, Screening",,G0475,HCPCS,Facility,Both,,,,128,108.8,36.6848,128,"Preferred One Administrative Services, INC.",PPO,126.208,98.6,,percent of total billed charges,,
"Hiv Antigen/Antibody, Combination Assay, Screening",,G0475,HCPCS,Facility,Outpatient,,,,128,108.8,36.6848,128,PrimeWest Health,Minnesota Senior Health Options (MSHO),65.856,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Hiv Antigen/Antibody, Combination Assay, Screening",,G0475,HCPCS,Facility,Inpatient,,,,128,108.8,36.6848,128,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Hiv Antigen/Antibody, Combination Assay, Screening",,G0475,HCPCS,Facility,Outpatient,,,,128,108.8,36.6848,128,PrimeWest Health,MinnesotaCare,65.7408,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Hiv Antigen/Antibody, Combination Assay, Screening",,G0475,HCPCS,Facility,Inpatient,,,,128,108.8,36.6848,128,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Hiv Antigen/Antibody, Combination Assay, Screening",,G0475,HCPCS,Facility,Both,,,,128,108.8,36.6848,128,Sanford Health Plan,Sanford Health Plan,117.76,92,,percent of total billed charges,,
"Hiv Antigen/Antibody, Combination Assay, Screening",,G0475,HCPCS,Facility,Outpatient,,,,128,108.8,36.6848,128,"UCare Health, Inc.",Individual & Family Plan,72.128,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Hiv Antigen/Antibody, Combination Assay, Screening",,G0475,HCPCS,Facility,Inpatient,,,,128,108.8,36.6848,128,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Hiv Antigen/Antibody, Combination Assay, Screening",,G0475,HCPCS,Facility,Outpatient,,,,128,108.8,36.6848,128,"UCare Health, Inc.",Medical Assistance,64.6016,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Hiv Antigen/Antibody, Combination Assay, Screening",,G0475,HCPCS,Facility,Inpatient,,,,128,108.8,36.6848,128,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Hiv Antigen/Antibody, Combination Assay, Screening",,G0475,HCPCS,Facility,Outpatient,,,,128,108.8,36.6848,128,"UCare Health, Inc.",Medicare Advantage,64.6016,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Hiv Antigen/Antibody, Combination Assay, Screening",,G0475,HCPCS,Facility,Inpatient,,,,128,108.8,36.6848,128,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Hiv Antigen/Antibody, Combination Assay, Screening",,G0475,HCPCS,Facility,Outpatient,,,,128,108.8,36.6848,128,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),64.6016,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Hiv Antigen/Antibody, Combination Assay, Screening",,G0475,HCPCS,Facility,Inpatient,,,,128,108.8,36.6848,128,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Hiv Antigen/Antibody, Combination Assay, Screening",,G0475,HCPCS,Facility,Both,,,,128,108.8,36.6848,128,UnitedHealthcare,Individual & Family,120.32,94,,percent of total billed charges,,
"Hiv Antigen/Antibody, Combination Assay, Screening",,G0475,HCPCS,Facility,Outpatient,,,,128,108.8,36.6848,128,UnitedHealthcare,Medicare Advantage,62.72,49,,percent of total billed charges,,
"Hiv Antigen/Antibody, Combination Assay, Screening",,G0475,HCPCS,Facility,Inpatient,,,,128,108.8,36.6848,128,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Hiv Antigen/Antibody, Combination Assay, Screening",,G0475,HCPCS,Facility,Outpatient,,,,128,108.8,36.6848,128,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,61.44,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Hiv Antigen/Antibody, Combination Assay, Screening",,G0475,HCPCS,Facility,Inpatient,,,,128,108.8,36.6848,128,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
SUTURE CAPROSYN 4-0,,GC-121,LOCAL,Facility,Both,,,,53.28,45.288,15.270048,53.28,Aetna,Commercial,49.0176,92,,percent of total billed charges,,
SUTURE CAPROSYN 4-0,,GC-121,LOCAL,Facility,Outpatient,,,,53.28,45.288,15.270048,53.28,Aetna,Medicare Advantage,26.1072,49,,percent of total billed charges,,
SUTURE CAPROSYN 4-0,,GC-121,LOCAL,Facility,Inpatient,,,,53.28,45.288,15.270048,53.28,Aetna,Medicare Advantage,,,,,Included in per diem rate,
SUTURE CAPROSYN 4-0,,GC-121,LOCAL,Facility,Both,,,,53.28,45.288,15.270048,53.28,Aetna,PPO,49.5504,93,,percent of total billed charges,,
SUTURE CAPROSYN 4-0,,GC-121,LOCAL,Facility,Both,,,,53.28,45.288,15.270048,53.28,America's PPO,America's PPO,51.164784,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SUTURE CAPROSYN 4-0,,GC-121,LOCAL,Facility,Both,,,,53.28,45.288,15.270048,53.28,BlueCross BlueShield Minnesota, Federal Employee Program,52.42752,98.4,,percent of total billed charges,,
SUTURE CAPROSYN 4-0,,GC-121,LOCAL,Facility,Both,,,,53.28,45.288,15.270048,53.28,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,53.28,100,,percent of total billed charges,,
SUTURE CAPROSYN 4-0,,GC-121,LOCAL,Facility,Both,,,,53.28,45.288,15.270048,53.28,BlueCross BlueShield Minnesota,High Value Network Plan,47.952,90,,percent of total billed charges,,
SUTURE CAPROSYN 4-0,,GC-121,LOCAL,Facility,Outpatient,,,,53.28,45.288,15.270048,53.28,BlueCross BlueShield Minnesota,Medicare Advantage,26.1072,49,,percent of total billed charges,,
SUTURE CAPROSYN 4-0,,GC-121,LOCAL,Facility,Inpatient,,,,53.28,45.288,15.270048,53.28,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
SUTURE CAPROSYN 4-0,,GC-121,LOCAL,Facility,Both,,,,53.28,45.288,15.270048,53.28,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,47.190096,88.57,,percent of total billed charges,,
SUTURE CAPROSYN 4-0,,GC-121,LOCAL,Facility,Both,,,,53.28,45.288,15.270048,53.28,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,15.270048,28.66,,percent of total billed charges,,
SUTURE CAPROSYN 4-0,,GC-121,LOCAL,Facility,Outpatient,,,,53.28,45.288,15.270048,53.28,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),26.1072,49,,percent of total billed charges,,
SUTURE CAPROSYN 4-0,,GC-121,LOCAL,Facility,Inpatient,,,,53.28,45.288,15.270048,53.28,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
SUTURE CAPROSYN 4-0,,GC-121,LOCAL,Facility,Both,,,,53.28,45.288,15.270048,53.28,CorVel,Worker's Compensation,53.28,100,,percent of total billed charges,,
SUTURE CAPROSYN 4-0,,GC-121,LOCAL,Facility,Both,,,,53.28,45.288,15.270048,53.28,First Health Group Corporation,First Health Network,51.6816,97,,percent of total billed charges,,
SUTURE CAPROSYN 4-0,,GC-121,LOCAL,Facility,Both,,,,53.28,45.288,15.270048,53.28,"Health Partners, Inc.",Commercial,50.40288,94.6,,percent of total billed charges,,
SUTURE CAPROSYN 4-0,,GC-121,LOCAL,Facility,Outpatient,,,,53.28,45.288,15.270048,53.28,"Health Partners, Inc.",Medicare Advantage,26.1072,49,,percent of total billed charges,,
SUTURE CAPROSYN 4-0,,GC-121,LOCAL,Facility,Inpatient,,,,53.28,45.288,15.270048,53.28,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE CAPROSYN 4-0,,GC-121,LOCAL,Facility,Both,,,,53.28,45.288,15.270048,53.28,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),31.968,60,,percent of total billed charges,,
SUTURE CAPROSYN 4-0,,GC-121,LOCAL,Facility,Both,,,,53.28,45.288,15.270048,53.28,"Health Partners, Inc.",State of Minnesota Advantage Program,43.4232,81.5,,percent of total billed charges,,
SUTURE CAPROSYN 4-0,,GC-121,LOCAL,Facility,Both,,,,53.28,45.288,15.270048,53.28,"Health Partners, Inc.",State Public Programs,26.64,50,,percent of total billed charges,,
SUTURE CAPROSYN 4-0,,GC-121,LOCAL,Facility,Both,,,,53.28,45.288,15.270048,53.28,Humana Insurance Company,Commercial PPO,50.616,95,,percent of total billed charges,,
SUTURE CAPROSYN 4-0,,GC-121,LOCAL,Facility,Outpatient,,,,53.28,45.288,15.270048,53.28,Humana Insurance Company,Medicare PPO,26.1072,49,,percent of total billed charges,,
SUTURE CAPROSYN 4-0,,GC-121,LOCAL,Facility,Inpatient,,,,53.28,45.288,15.270048,53.28,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
SUTURE CAPROSYN 4-0,,GC-121,LOCAL,Facility,Both,,,,53.28,45.288,15.270048,53.28,Medica,Individual & Family,52.80048,99.1,,percent of total billed charges,,
SUTURE CAPROSYN 4-0,,GC-121,LOCAL,Facility,Outpatient,,,,53.28,45.288,15.270048,53.28,Medica,Medica Advantage Solution,26.53344,49.8,,percent of total billed charges,,
SUTURE CAPROSYN 4-0,,GC-121,LOCAL,Facility,Inpatient,,,,53.28,45.288,15.270048,53.28,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
SUTURE CAPROSYN 4-0,,GC-121,LOCAL,Facility,Outpatient,,,,53.28,45.288,15.270048,53.28,Medica,Medical Assistance,23.76288,44.6,,percent of total billed charges,,
SUTURE CAPROSYN 4-0,,GC-121,LOCAL,Facility,Inpatient,,,,53.28,45.288,15.270048,53.28,Medica,Medical Assistance,,,,,Included in per diem rate,
SUTURE CAPROSYN 4-0,,GC-121,LOCAL,Facility,Outpatient,,,,53.28,45.288,15.270048,53.28,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,26.53344,49.8,,percent of total billed charges,,
SUTURE CAPROSYN 4-0,,GC-121,LOCAL,Facility,Inpatient,,,,53.28,45.288,15.270048,53.28,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
SUTURE CAPROSYN 4-0,,GC-121,LOCAL,Facility,Both,,,,53.28,45.288,15.270048,53.28,"Multiplan, Inc.","Multiplan, Inc.",50.0832,94,,percent of total billed charges,,
SUTURE CAPROSYN 4-0,,GC-121,LOCAL,Facility,Outpatient,,,,53.28,45.288,15.270048,53.28,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,48.00528,90.1,,percent of total billed charges,,
SUTURE CAPROSYN 4-0,,GC-121,LOCAL,Facility,Inpatient,,,,53.28,45.288,15.270048,53.28,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
SUTURE CAPROSYN 4-0,,GC-121,LOCAL,Facility,Both,,,,53.28,45.288,15.270048,53.28,"Preferred One Administrative Services, INC.",PPO,52.53408,98.6,,percent of total billed charges,,
SUTURE CAPROSYN 4-0,,GC-121,LOCAL,Facility,Outpatient,,,,53.28,45.288,15.270048,53.28,PrimeWest Health,Minnesota Senior Health Options (MSHO),27.41256,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
SUTURE CAPROSYN 4-0,,GC-121,LOCAL,Facility,Inpatient,,,,53.28,45.288,15.270048,53.28,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE CAPROSYN 4-0,,GC-121,LOCAL,Facility,Outpatient,,,,53.28,45.288,15.270048,53.28,PrimeWest Health,MinnesotaCare,27.364608,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
SUTURE CAPROSYN 4-0,,GC-121,LOCAL,Facility,Inpatient,,,,53.28,45.288,15.270048,53.28,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
SUTURE CAPROSYN 4-0,,GC-121,LOCAL,Facility,Both,,,,53.28,45.288,15.270048,53.28,Sanford Health Plan,Sanford Health Plan,49.0176,92,,percent of total billed charges,,
SUTURE CAPROSYN 4-0,,GC-121,LOCAL,Facility,Outpatient,,,,53.28,45.288,15.270048,53.28,"UCare Health, Inc.",Individual & Family Plan,30.02328,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
SUTURE CAPROSYN 4-0,,GC-121,LOCAL,Facility,Inpatient,,,,53.28,45.288,15.270048,53.28,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
SUTURE CAPROSYN 4-0,,GC-121,LOCAL,Facility,Outpatient,,,,53.28,45.288,15.270048,53.28,"UCare Health, Inc.",Medical Assistance,26.890416,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE CAPROSYN 4-0,,GC-121,LOCAL,Facility,Inpatient,,,,53.28,45.288,15.270048,53.28,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
SUTURE CAPROSYN 4-0,,GC-121,LOCAL,Facility,Outpatient,,,,53.28,45.288,15.270048,53.28,"UCare Health, Inc.",Medicare Advantage,26.890416,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE CAPROSYN 4-0,,GC-121,LOCAL,Facility,Inpatient,,,,53.28,45.288,15.270048,53.28,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUTURE CAPROSYN 4-0,,GC-121,LOCAL,Facility,Outpatient,,,,53.28,45.288,15.270048,53.28,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),26.890416,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUTURE CAPROSYN 4-0,,GC-121,LOCAL,Facility,Inpatient,,,,53.28,45.288,15.270048,53.28,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUTURE CAPROSYN 4-0,,GC-121,LOCAL,Facility,Both,,,,53.28,45.288,15.270048,53.28,UnitedHealthcare,Individual & Family,50.0832,94,,percent of total billed charges,,
SUTURE CAPROSYN 4-0,,GC-121,LOCAL,Facility,Outpatient,,,,53.28,45.288,15.270048,53.28,UnitedHealthcare,Medicare Advantage,26.1072,49,,percent of total billed charges,,
SUTURE CAPROSYN 4-0,,GC-121,LOCAL,Facility,Inpatient,,,,53.28,45.288,15.270048,53.28,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
SUTURE CAPROSYN 4-0,,GC-121,LOCAL,Facility,Outpatient,,,,53.28,45.288,15.270048,53.28,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,25.5744,48,,percent of total billed charges,,100% of DHS outpatient percentage
SUTURE CAPROSYN 4-0,,GC-121,LOCAL,Facility,Inpatient,,,,53.28,45.288,15.270048,53.28,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
CODEINE-GUAIFENESIN 10-100 MG/5 ML ORAL LIQD,,15949,LOCAL,Facility,Both,120,mL,,66,56.1,18.9156,66,Aetna,Commercial,60.72,92,,percent of total billed charges,,
CODEINE-GUAIFENESIN 10-100 MG/5 ML ORAL LIQD,,15949,LOCAL,Facility,Outpatient,120,mL,,66,56.1,18.9156,66,Aetna,Medicare Advantage,32.34,49,,percent of total billed charges,,
CODEINE-GUAIFENESIN 10-100 MG/5 ML ORAL LIQD,,15949,LOCAL,Facility,Inpatient,120,mL,,66,56.1,18.9156,66,Aetna,Medicare Advantage,,,,,Included in per diem rate,
CODEINE-GUAIFENESIN 10-100 MG/5 ML ORAL LIQD,,15949,LOCAL,Facility,Both,120,mL,,66,56.1,18.9156,66,Aetna,PPO,61.38,93,,percent of total billed charges,,
CODEINE-GUAIFENESIN 10-100 MG/5 ML ORAL LIQD,,15949,LOCAL,Facility,Both,120,mL,,66,56.1,18.9156,66,America's PPO,America's PPO,63.3798,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
CODEINE-GUAIFENESIN 10-100 MG/5 ML ORAL LIQD,,15949,LOCAL,Facility,Both,120,mL,,66,56.1,18.9156,66,BlueCross BlueShield Minnesota, Federal Employee Program,64.944,98.4,,percent of total billed charges,,
CODEINE-GUAIFENESIN 10-100 MG/5 ML ORAL LIQD,,15949,LOCAL,Facility,Both,120,mL,,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,66,100,,percent of total billed charges,,
CODEINE-GUAIFENESIN 10-100 MG/5 ML ORAL LIQD,,15949,LOCAL,Facility,Both,120,mL,,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,High Value Network Plan,59.4,90,,percent of total billed charges,,
CODEINE-GUAIFENESIN 10-100 MG/5 ML ORAL LIQD,,15949,LOCAL,Facility,Outpatient,120,mL,,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,Medicare Advantage,32.34,49,,percent of total billed charges,,
CODEINE-GUAIFENESIN 10-100 MG/5 ML ORAL LIQD,,15949,LOCAL,Facility,Inpatient,120,mL,,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
CODEINE-GUAIFENESIN 10-100 MG/5 ML ORAL LIQD,,15949,LOCAL,Facility,Both,120,mL,,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,58.4562,88.57,,percent of total billed charges,,
CODEINE-GUAIFENESIN 10-100 MG/5 ML ORAL LIQD,,15949,LOCAL,Facility,Both,120,mL,,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,18.9156,28.66,,percent of total billed charges,,
CODEINE-GUAIFENESIN 10-100 MG/5 ML ORAL LIQD,,15949,LOCAL,Facility,Outpatient,120,mL,,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),32.34,49,,percent of total billed charges,,
CODEINE-GUAIFENESIN 10-100 MG/5 ML ORAL LIQD,,15949,LOCAL,Facility,Inpatient,120,mL,,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
CODEINE-GUAIFENESIN 10-100 MG/5 ML ORAL LIQD,,15949,LOCAL,Facility,Both,120,mL,,66,56.1,18.9156,66,CorVel,Worker's Compensation,66,100,,percent of total billed charges,,
CODEINE-GUAIFENESIN 10-100 MG/5 ML ORAL LIQD,,15949,LOCAL,Facility,Both,120,mL,,66,56.1,18.9156,66,First Health Group Corporation,First Health Network,64.02,97,,percent of total billed charges,,
CODEINE-GUAIFENESIN 10-100 MG/5 ML ORAL LIQD,,15949,LOCAL,Facility,Both,120,mL,,66,56.1,18.9156,66,"Health Partners, Inc.",Commercial,62.436,94.6,,percent of total billed charges,,
CODEINE-GUAIFENESIN 10-100 MG/5 ML ORAL LIQD,,15949,LOCAL,Facility,Outpatient,120,mL,,66,56.1,18.9156,66,"Health Partners, Inc.",Medicare Advantage,32.34,49,,percent of total billed charges,,
CODEINE-GUAIFENESIN 10-100 MG/5 ML ORAL LIQD,,15949,LOCAL,Facility,Inpatient,120,mL,,66,56.1,18.9156,66,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CODEINE-GUAIFENESIN 10-100 MG/5 ML ORAL LIQD,,15949,LOCAL,Facility,Both,120,mL,,66,56.1,18.9156,66,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),39.6,60,,percent of total billed charges,,
CODEINE-GUAIFENESIN 10-100 MG/5 ML ORAL LIQD,,15949,LOCAL,Facility,Both,120,mL,,66,56.1,18.9156,66,"Health Partners, Inc.",State of Minnesota Advantage Program,53.79,81.5,,percent of total billed charges,,
CODEINE-GUAIFENESIN 10-100 MG/5 ML ORAL LIQD,,15949,LOCAL,Facility,Both,120,mL,,66,56.1,18.9156,66,"Health Partners, Inc.",State Public Programs,33,50,,percent of total billed charges,,
CODEINE-GUAIFENESIN 10-100 MG/5 ML ORAL LIQD,,15949,LOCAL,Facility,Both,120,mL,,66,56.1,18.9156,66,Humana Insurance Company,Commercial PPO,62.7,95,,percent of total billed charges,,
CODEINE-GUAIFENESIN 10-100 MG/5 ML ORAL LIQD,,15949,LOCAL,Facility,Outpatient,120,mL,,66,56.1,18.9156,66,Humana Insurance Company,Medicare PPO,32.34,49,,percent of total billed charges,,
CODEINE-GUAIFENESIN 10-100 MG/5 ML ORAL LIQD,,15949,LOCAL,Facility,Inpatient,120,mL,,66,56.1,18.9156,66,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
CODEINE-GUAIFENESIN 10-100 MG/5 ML ORAL LIQD,,15949,LOCAL,Facility,Both,120,mL,,66,56.1,18.9156,66,Medica,Individual & Family,65.406,99.1,,percent of total billed charges,,
CODEINE-GUAIFENESIN 10-100 MG/5 ML ORAL LIQD,,15949,LOCAL,Facility,Outpatient,120,mL,,66,56.1,18.9156,66,Medica,Medica Advantage Solution,32.868,49.8,,percent of total billed charges,,
CODEINE-GUAIFENESIN 10-100 MG/5 ML ORAL LIQD,,15949,LOCAL,Facility,Inpatient,120,mL,,66,56.1,18.9156,66,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
CODEINE-GUAIFENESIN 10-100 MG/5 ML ORAL LIQD,,15949,LOCAL,Facility,Outpatient,120,mL,,66,56.1,18.9156,66,Medica,Medical Assistance,29.436,44.6,,percent of total billed charges,,
CODEINE-GUAIFENESIN 10-100 MG/5 ML ORAL LIQD,,15949,LOCAL,Facility,Inpatient,120,mL,,66,56.1,18.9156,66,Medica,Medical Assistance,,,,,Included in per diem rate,
CODEINE-GUAIFENESIN 10-100 MG/5 ML ORAL LIQD,,15949,LOCAL,Facility,Outpatient,120,mL,,66,56.1,18.9156,66,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,32.868,49.8,,percent of total billed charges,,
CODEINE-GUAIFENESIN 10-100 MG/5 ML ORAL LIQD,,15949,LOCAL,Facility,Inpatient,120,mL,,66,56.1,18.9156,66,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
CODEINE-GUAIFENESIN 10-100 MG/5 ML ORAL LIQD,,15949,LOCAL,Facility,Both,120,mL,,66,56.1,18.9156,66,"Multiplan, Inc.","Multiplan, Inc.",62.04,94,,percent of total billed charges,,
CODEINE-GUAIFENESIN 10-100 MG/5 ML ORAL LIQD,,15949,LOCAL,Facility,Outpatient,120,mL,,66,56.1,18.9156,66,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,59.466,90.1,,percent of total billed charges,,
CODEINE-GUAIFENESIN 10-100 MG/5 ML ORAL LIQD,,15949,LOCAL,Facility,Inpatient,120,mL,,66,56.1,18.9156,66,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
CODEINE-GUAIFENESIN 10-100 MG/5 ML ORAL LIQD,,15949,LOCAL,Facility,Both,120,mL,,66,56.1,18.9156,66,"Preferred One Administrative Services, INC.",PPO,65.076,98.6,,percent of total billed charges,,
CODEINE-GUAIFENESIN 10-100 MG/5 ML ORAL LIQD,,15949,LOCAL,Facility,Outpatient,120,mL,,66,56.1,18.9156,66,PrimeWest Health,Minnesota Senior Health Options (MSHO),33.957,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
CODEINE-GUAIFENESIN 10-100 MG/5 ML ORAL LIQD,,15949,LOCAL,Facility,Inpatient,120,mL,,66,56.1,18.9156,66,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CODEINE-GUAIFENESIN 10-100 MG/5 ML ORAL LIQD,,15949,LOCAL,Facility,Outpatient,120,mL,,66,56.1,18.9156,66,PrimeWest Health,MinnesotaCare,33.8976,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
CODEINE-GUAIFENESIN 10-100 MG/5 ML ORAL LIQD,,15949,LOCAL,Facility,Inpatient,120,mL,,66,56.1,18.9156,66,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
CODEINE-GUAIFENESIN 10-100 MG/5 ML ORAL LIQD,,15949,LOCAL,Facility,Both,120,mL,,66,56.1,18.9156,66,Sanford Health Plan,Sanford Health Plan,60.72,92,,percent of total billed charges,,
CODEINE-GUAIFENESIN 10-100 MG/5 ML ORAL LIQD,,15949,LOCAL,Facility,Outpatient,120,mL,,66,56.1,18.9156,66,"UCare Health, Inc.",Individual & Family Plan,37.191,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
CODEINE-GUAIFENESIN 10-100 MG/5 ML ORAL LIQD,,15949,LOCAL,Facility,Inpatient,120,mL,,66,56.1,18.9156,66,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
CODEINE-GUAIFENESIN 10-100 MG/5 ML ORAL LIQD,,15949,LOCAL,Facility,Outpatient,120,mL,,66,56.1,18.9156,66,"UCare Health, Inc.",Medical Assistance,33.3102,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CODEINE-GUAIFENESIN 10-100 MG/5 ML ORAL LIQD,,15949,LOCAL,Facility,Inpatient,120,mL,,66,56.1,18.9156,66,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
CODEINE-GUAIFENESIN 10-100 MG/5 ML ORAL LIQD,,15949,LOCAL,Facility,Outpatient,120,mL,,66,56.1,18.9156,66,"UCare Health, Inc.",Medicare Advantage,33.3102,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CODEINE-GUAIFENESIN 10-100 MG/5 ML ORAL LIQD,,15949,LOCAL,Facility,Inpatient,120,mL,,66,56.1,18.9156,66,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CODEINE-GUAIFENESIN 10-100 MG/5 ML ORAL LIQD,,15949,LOCAL,Facility,Outpatient,120,mL,,66,56.1,18.9156,66,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),33.3102,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CODEINE-GUAIFENESIN 10-100 MG/5 ML ORAL LIQD,,15949,LOCAL,Facility,Inpatient,120,mL,,66,56.1,18.9156,66,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CODEINE-GUAIFENESIN 10-100 MG/5 ML ORAL LIQD,,15949,LOCAL,Facility,Both,120,mL,,66,56.1,18.9156,66,UnitedHealthcare,Individual & Family,62.04,94,,percent of total billed charges,,
CODEINE-GUAIFENESIN 10-100 MG/5 ML ORAL LIQD,,15949,LOCAL,Facility,Outpatient,120,mL,,66,56.1,18.9156,66,UnitedHealthcare,Medicare Advantage,32.34,49,,percent of total billed charges,,
CODEINE-GUAIFENESIN 10-100 MG/5 ML ORAL LIQD,,15949,LOCAL,Facility,Inpatient,120,mL,,66,56.1,18.9156,66,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
CODEINE-GUAIFENESIN 10-100 MG/5 ML ORAL LIQD,,15949,LOCAL,Facility,Outpatient,120,mL,,66,56.1,18.9156,66,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,31.68,48,,percent of total billed charges,,100% of DHS outpatient percentage
CODEINE-GUAIFENESIN 10-100 MG/5 ML ORAL LIQD,,15949,LOCAL,Facility,Inpatient,120,mL,,66,56.1,18.9156,66,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
IBUPROFEN 100 MG/5 ML ORAL SUSP,,17675,LOCAL,Facility,Both,120,mL,,25,21.25,7.165,25,Aetna,Commercial,23,92,,percent of total billed charges,,
IBUPROFEN 100 MG/5 ML ORAL SUSP,,17675,LOCAL,Facility,Outpatient,120,mL,,25,21.25,7.165,25,Aetna,Medicare Advantage,12.25,49,,percent of total billed charges,,
IBUPROFEN 100 MG/5 ML ORAL SUSP,,17675,LOCAL,Facility,Inpatient,120,mL,,25,21.25,7.165,25,Aetna,Medicare Advantage,,,,,Included in per diem rate,
IBUPROFEN 100 MG/5 ML ORAL SUSP,,17675,LOCAL,Facility,Both,120,mL,,25,21.25,7.165,25,Aetna,PPO,23.25,93,,percent of total billed charges,,
IBUPROFEN 100 MG/5 ML ORAL SUSP,,17675,LOCAL,Facility,Both,120,mL,,25,21.25,7.165,25,America's PPO,America's PPO,24.0075,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
IBUPROFEN 100 MG/5 ML ORAL SUSP,,17675,LOCAL,Facility,Both,120,mL,,25,21.25,7.165,25,BlueCross BlueShield Minnesota, Federal Employee Program,24.6,98.4,,percent of total billed charges,,
IBUPROFEN 100 MG/5 ML ORAL SUSP,,17675,LOCAL,Facility,Both,120,mL,,25,21.25,7.165,25,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,25,100,,percent of total billed charges,,
IBUPROFEN 100 MG/5 ML ORAL SUSP,,17675,LOCAL,Facility,Both,120,mL,,25,21.25,7.165,25,BlueCross BlueShield Minnesota,High Value Network Plan,22.5,90,,percent of total billed charges,,
IBUPROFEN 100 MG/5 ML ORAL SUSP,,17675,LOCAL,Facility,Outpatient,120,mL,,25,21.25,7.165,25,BlueCross BlueShield Minnesota,Medicare Advantage,12.25,49,,percent of total billed charges,,
IBUPROFEN 100 MG/5 ML ORAL SUSP,,17675,LOCAL,Facility,Inpatient,120,mL,,25,21.25,7.165,25,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
IBUPROFEN 100 MG/5 ML ORAL SUSP,,17675,LOCAL,Facility,Both,120,mL,,25,21.25,7.165,25,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,22.1425,88.57,,percent of total billed charges,,
IBUPROFEN 100 MG/5 ML ORAL SUSP,,17675,LOCAL,Facility,Both,120,mL,,25,21.25,7.165,25,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,7.165,28.66,,percent of total billed charges,,
IBUPROFEN 100 MG/5 ML ORAL SUSP,,17675,LOCAL,Facility,Outpatient,120,mL,,25,21.25,7.165,25,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),12.25,49,,percent of total billed charges,,
IBUPROFEN 100 MG/5 ML ORAL SUSP,,17675,LOCAL,Facility,Inpatient,120,mL,,25,21.25,7.165,25,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
IBUPROFEN 100 MG/5 ML ORAL SUSP,,17675,LOCAL,Facility,Both,120,mL,,25,21.25,7.165,25,CorVel,Worker's Compensation,25,100,,percent of total billed charges,,
IBUPROFEN 100 MG/5 ML ORAL SUSP,,17675,LOCAL,Facility,Both,120,mL,,25,21.25,7.165,25,First Health Group Corporation,First Health Network,24.25,97,,percent of total billed charges,,
IBUPROFEN 100 MG/5 ML ORAL SUSP,,17675,LOCAL,Facility,Both,120,mL,,25,21.25,7.165,25,"Health Partners, Inc.",Commercial,23.65,94.6,,percent of total billed charges,,
IBUPROFEN 100 MG/5 ML ORAL SUSP,,17675,LOCAL,Facility,Outpatient,120,mL,,25,21.25,7.165,25,"Health Partners, Inc.",Medicare Advantage,12.25,49,,percent of total billed charges,,
IBUPROFEN 100 MG/5 ML ORAL SUSP,,17675,LOCAL,Facility,Inpatient,120,mL,,25,21.25,7.165,25,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
IBUPROFEN 100 MG/5 ML ORAL SUSP,,17675,LOCAL,Facility,Both,120,mL,,25,21.25,7.165,25,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),15,60,,percent of total billed charges,,
IBUPROFEN 100 MG/5 ML ORAL SUSP,,17675,LOCAL,Facility,Both,120,mL,,25,21.25,7.165,25,"Health Partners, Inc.",State of Minnesota Advantage Program,20.375,81.5,,percent of total billed charges,,
IBUPROFEN 100 MG/5 ML ORAL SUSP,,17675,LOCAL,Facility,Both,120,mL,,25,21.25,7.165,25,"Health Partners, Inc.",State Public Programs,12.5,50,,percent of total billed charges,,
IBUPROFEN 100 MG/5 ML ORAL SUSP,,17675,LOCAL,Facility,Both,120,mL,,25,21.25,7.165,25,Humana Insurance Company,Commercial PPO,23.75,95,,percent of total billed charges,,
IBUPROFEN 100 MG/5 ML ORAL SUSP,,17675,LOCAL,Facility,Outpatient,120,mL,,25,21.25,7.165,25,Humana Insurance Company,Medicare PPO,12.25,49,,percent of total billed charges,,
IBUPROFEN 100 MG/5 ML ORAL SUSP,,17675,LOCAL,Facility,Inpatient,120,mL,,25,21.25,7.165,25,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
IBUPROFEN 100 MG/5 ML ORAL SUSP,,17675,LOCAL,Facility,Both,120,mL,,25,21.25,7.165,25,Medica,Individual & Family,24.775,99.1,,percent of total billed charges,,
IBUPROFEN 100 MG/5 ML ORAL SUSP,,17675,LOCAL,Facility,Outpatient,120,mL,,25,21.25,7.165,25,Medica,Medica Advantage Solution,12.45,49.8,,percent of total billed charges,,
IBUPROFEN 100 MG/5 ML ORAL SUSP,,17675,LOCAL,Facility,Inpatient,120,mL,,25,21.25,7.165,25,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
IBUPROFEN 100 MG/5 ML ORAL SUSP,,17675,LOCAL,Facility,Outpatient,120,mL,,25,21.25,7.165,25,Medica,Medical Assistance,11.15,44.6,,percent of total billed charges,,
IBUPROFEN 100 MG/5 ML ORAL SUSP,,17675,LOCAL,Facility,Inpatient,120,mL,,25,21.25,7.165,25,Medica,Medical Assistance,,,,,Included in per diem rate,
IBUPROFEN 100 MG/5 ML ORAL SUSP,,17675,LOCAL,Facility,Outpatient,120,mL,,25,21.25,7.165,25,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,12.45,49.8,,percent of total billed charges,,
IBUPROFEN 100 MG/5 ML ORAL SUSP,,17675,LOCAL,Facility,Inpatient,120,mL,,25,21.25,7.165,25,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
IBUPROFEN 100 MG/5 ML ORAL SUSP,,17675,LOCAL,Facility,Both,120,mL,,25,21.25,7.165,25,"Multiplan, Inc.","Multiplan, Inc.",23.5,94,,percent of total billed charges,,
IBUPROFEN 100 MG/5 ML ORAL SUSP,,17675,LOCAL,Facility,Outpatient,120,mL,,25,21.25,7.165,25,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,22.525,90.1,,percent of total billed charges,,
IBUPROFEN 100 MG/5 ML ORAL SUSP,,17675,LOCAL,Facility,Inpatient,120,mL,,25,21.25,7.165,25,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
IBUPROFEN 100 MG/5 ML ORAL SUSP,,17675,LOCAL,Facility,Both,120,mL,,25,21.25,7.165,25,"Preferred One Administrative Services, INC.",PPO,24.65,98.6,,percent of total billed charges,,
IBUPROFEN 100 MG/5 ML ORAL SUSP,,17675,LOCAL,Facility,Outpatient,120,mL,,25,21.25,7.165,25,PrimeWest Health,Minnesota Senior Health Options (MSHO),12.8625,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
IBUPROFEN 100 MG/5 ML ORAL SUSP,,17675,LOCAL,Facility,Inpatient,120,mL,,25,21.25,7.165,25,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
IBUPROFEN 100 MG/5 ML ORAL SUSP,,17675,LOCAL,Facility,Outpatient,120,mL,,25,21.25,7.165,25,PrimeWest Health,MinnesotaCare,12.84,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
IBUPROFEN 100 MG/5 ML ORAL SUSP,,17675,LOCAL,Facility,Inpatient,120,mL,,25,21.25,7.165,25,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
IBUPROFEN 100 MG/5 ML ORAL SUSP,,17675,LOCAL,Facility,Both,120,mL,,25,21.25,7.165,25,Sanford Health Plan,Sanford Health Plan,23,92,,percent of total billed charges,,
IBUPROFEN 100 MG/5 ML ORAL SUSP,,17675,LOCAL,Facility,Outpatient,120,mL,,25,21.25,7.165,25,"UCare Health, Inc.",Individual & Family Plan,14.0875,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
IBUPROFEN 100 MG/5 ML ORAL SUSP,,17675,LOCAL,Facility,Inpatient,120,mL,,25,21.25,7.165,25,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
IBUPROFEN 100 MG/5 ML ORAL SUSP,,17675,LOCAL,Facility,Outpatient,120,mL,,25,21.25,7.165,25,"UCare Health, Inc.",Medical Assistance,12.6175,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
IBUPROFEN 100 MG/5 ML ORAL SUSP,,17675,LOCAL,Facility,Inpatient,120,mL,,25,21.25,7.165,25,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
IBUPROFEN 100 MG/5 ML ORAL SUSP,,17675,LOCAL,Facility,Outpatient,120,mL,,25,21.25,7.165,25,"UCare Health, Inc.",Medicare Advantage,12.6175,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
IBUPROFEN 100 MG/5 ML ORAL SUSP,,17675,LOCAL,Facility,Inpatient,120,mL,,25,21.25,7.165,25,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
IBUPROFEN 100 MG/5 ML ORAL SUSP,,17675,LOCAL,Facility,Outpatient,120,mL,,25,21.25,7.165,25,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),12.6175,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
IBUPROFEN 100 MG/5 ML ORAL SUSP,,17675,LOCAL,Facility,Inpatient,120,mL,,25,21.25,7.165,25,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
IBUPROFEN 100 MG/5 ML ORAL SUSP,,17675,LOCAL,Facility,Both,120,mL,,25,21.25,7.165,25,UnitedHealthcare,Individual & Family,23.5,94,,percent of total billed charges,,
IBUPROFEN 100 MG/5 ML ORAL SUSP,,17675,LOCAL,Facility,Outpatient,120,mL,,25,21.25,7.165,25,UnitedHealthcare,Medicare Advantage,12.25,49,,percent of total billed charges,,
IBUPROFEN 100 MG/5 ML ORAL SUSP,,17675,LOCAL,Facility,Inpatient,120,mL,,25,21.25,7.165,25,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
IBUPROFEN 100 MG/5 ML ORAL SUSP,,17675,LOCAL,Facility,Outpatient,120,mL,,25,21.25,7.165,25,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,12,48,,percent of total billed charges,,100% of DHS outpatient percentage
IBUPROFEN 100 MG/5 ML ORAL SUSP,,17675,LOCAL,Facility,Inpatient,120,mL,,25,21.25,7.165,25,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
HYDROCODONE-ACETAMINOPHEN 7.5-325 MG/15 ML ORAL SOLN,,31434,LOCAL,Facility,Both,120,mL,,91,77.35,26.0806,91,Aetna,Commercial,83.72,92,,percent of total billed charges,,
HYDROCODONE-ACETAMINOPHEN 7.5-325 MG/15 ML ORAL SOLN,,31434,LOCAL,Facility,Outpatient,120,mL,,91,77.35,26.0806,91,Aetna,Medicare Advantage,44.59,49,,percent of total billed charges,,
HYDROCODONE-ACETAMINOPHEN 7.5-325 MG/15 ML ORAL SOLN,,31434,LOCAL,Facility,Inpatient,120,mL,,91,77.35,26.0806,91,Aetna,Medicare Advantage,,,,,Included in per diem rate,
HYDROCODONE-ACETAMINOPHEN 7.5-325 MG/15 ML ORAL SOLN,,31434,LOCAL,Facility,Both,120,mL,,91,77.35,26.0806,91,Aetna,PPO,84.63,93,,percent of total billed charges,,
HYDROCODONE-ACETAMINOPHEN 7.5-325 MG/15 ML ORAL SOLN,,31434,LOCAL,Facility,Both,120,mL,,91,77.35,26.0806,91,America's PPO,America's PPO,87.3873,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
HYDROCODONE-ACETAMINOPHEN 7.5-325 MG/15 ML ORAL SOLN,,31434,LOCAL,Facility,Both,120,mL,,91,77.35,26.0806,91,BlueCross BlueShield Minnesota, Federal Employee Program,89.544,98.4,,percent of total billed charges,,
HYDROCODONE-ACETAMINOPHEN 7.5-325 MG/15 ML ORAL SOLN,,31434,LOCAL,Facility,Both,120,mL,,91,77.35,26.0806,91,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,91,100,,percent of total billed charges,,
HYDROCODONE-ACETAMINOPHEN 7.5-325 MG/15 ML ORAL SOLN,,31434,LOCAL,Facility,Both,120,mL,,91,77.35,26.0806,91,BlueCross BlueShield Minnesota,High Value Network Plan,81.9,90,,percent of total billed charges,,
HYDROCODONE-ACETAMINOPHEN 7.5-325 MG/15 ML ORAL SOLN,,31434,LOCAL,Facility,Outpatient,120,mL,,91,77.35,26.0806,91,BlueCross BlueShield Minnesota,Medicare Advantage,44.59,49,,percent of total billed charges,,
HYDROCODONE-ACETAMINOPHEN 7.5-325 MG/15 ML ORAL SOLN,,31434,LOCAL,Facility,Inpatient,120,mL,,91,77.35,26.0806,91,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
HYDROCODONE-ACETAMINOPHEN 7.5-325 MG/15 ML ORAL SOLN,,31434,LOCAL,Facility,Both,120,mL,,91,77.35,26.0806,91,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,80.5987,88.57,,percent of total billed charges,,
HYDROCODONE-ACETAMINOPHEN 7.5-325 MG/15 ML ORAL SOLN,,31434,LOCAL,Facility,Both,120,mL,,91,77.35,26.0806,91,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,26.0806,28.66,,percent of total billed charges,,
HYDROCODONE-ACETAMINOPHEN 7.5-325 MG/15 ML ORAL SOLN,,31434,LOCAL,Facility,Outpatient,120,mL,,91,77.35,26.0806,91,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),44.59,49,,percent of total billed charges,,
HYDROCODONE-ACETAMINOPHEN 7.5-325 MG/15 ML ORAL SOLN,,31434,LOCAL,Facility,Inpatient,120,mL,,91,77.35,26.0806,91,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
HYDROCODONE-ACETAMINOPHEN 7.5-325 MG/15 ML ORAL SOLN,,31434,LOCAL,Facility,Both,120,mL,,91,77.35,26.0806,91,CorVel,Worker's Compensation,91,100,,percent of total billed charges,,
HYDROCODONE-ACETAMINOPHEN 7.5-325 MG/15 ML ORAL SOLN,,31434,LOCAL,Facility,Both,120,mL,,91,77.35,26.0806,91,First Health Group Corporation,First Health Network,88.27,97,,percent of total billed charges,,
HYDROCODONE-ACETAMINOPHEN 7.5-325 MG/15 ML ORAL SOLN,,31434,LOCAL,Facility,Both,120,mL,,91,77.35,26.0806,91,"Health Partners, Inc.",Commercial,86.086,94.6,,percent of total billed charges,,
HYDROCODONE-ACETAMINOPHEN 7.5-325 MG/15 ML ORAL SOLN,,31434,LOCAL,Facility,Outpatient,120,mL,,91,77.35,26.0806,91,"Health Partners, Inc.",Medicare Advantage,44.59,49,,percent of total billed charges,,
HYDROCODONE-ACETAMINOPHEN 7.5-325 MG/15 ML ORAL SOLN,,31434,LOCAL,Facility,Inpatient,120,mL,,91,77.35,26.0806,91,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
HYDROCODONE-ACETAMINOPHEN 7.5-325 MG/15 ML ORAL SOLN,,31434,LOCAL,Facility,Both,120,mL,,91,77.35,26.0806,91,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),54.6,60,,percent of total billed charges,,
HYDROCODONE-ACETAMINOPHEN 7.5-325 MG/15 ML ORAL SOLN,,31434,LOCAL,Facility,Both,120,mL,,91,77.35,26.0806,91,"Health Partners, Inc.",State of Minnesota Advantage Program,74.165,81.5,,percent of total billed charges,,
HYDROCODONE-ACETAMINOPHEN 7.5-325 MG/15 ML ORAL SOLN,,31434,LOCAL,Facility,Both,120,mL,,91,77.35,26.0806,91,"Health Partners, Inc.",State Public Programs,45.5,50,,percent of total billed charges,,
HYDROCODONE-ACETAMINOPHEN 7.5-325 MG/15 ML ORAL SOLN,,31434,LOCAL,Facility,Both,120,mL,,91,77.35,26.0806,91,Humana Insurance Company,Commercial PPO,86.45,95,,percent of total billed charges,,
HYDROCODONE-ACETAMINOPHEN 7.5-325 MG/15 ML ORAL SOLN,,31434,LOCAL,Facility,Outpatient,120,mL,,91,77.35,26.0806,91,Humana Insurance Company,Medicare PPO,44.59,49,,percent of total billed charges,,
HYDROCODONE-ACETAMINOPHEN 7.5-325 MG/15 ML ORAL SOLN,,31434,LOCAL,Facility,Inpatient,120,mL,,91,77.35,26.0806,91,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
HYDROCODONE-ACETAMINOPHEN 7.5-325 MG/15 ML ORAL SOLN,,31434,LOCAL,Facility,Both,120,mL,,91,77.35,26.0806,91,Medica,Individual & Family,90.181,99.1,,percent of total billed charges,,
HYDROCODONE-ACETAMINOPHEN 7.5-325 MG/15 ML ORAL SOLN,,31434,LOCAL,Facility,Outpatient,120,mL,,91,77.35,26.0806,91,Medica,Medica Advantage Solution,45.318,49.8,,percent of total billed charges,,
HYDROCODONE-ACETAMINOPHEN 7.5-325 MG/15 ML ORAL SOLN,,31434,LOCAL,Facility,Inpatient,120,mL,,91,77.35,26.0806,91,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
HYDROCODONE-ACETAMINOPHEN 7.5-325 MG/15 ML ORAL SOLN,,31434,LOCAL,Facility,Outpatient,120,mL,,91,77.35,26.0806,91,Medica,Medical Assistance,40.586,44.6,,percent of total billed charges,,
HYDROCODONE-ACETAMINOPHEN 7.5-325 MG/15 ML ORAL SOLN,,31434,LOCAL,Facility,Inpatient,120,mL,,91,77.35,26.0806,91,Medica,Medical Assistance,,,,,Included in per diem rate,
HYDROCODONE-ACETAMINOPHEN 7.5-325 MG/15 ML ORAL SOLN,,31434,LOCAL,Facility,Outpatient,120,mL,,91,77.35,26.0806,91,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,45.318,49.8,,percent of total billed charges,,
HYDROCODONE-ACETAMINOPHEN 7.5-325 MG/15 ML ORAL SOLN,,31434,LOCAL,Facility,Inpatient,120,mL,,91,77.35,26.0806,91,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
HYDROCODONE-ACETAMINOPHEN 7.5-325 MG/15 ML ORAL SOLN,,31434,LOCAL,Facility,Both,120,mL,,91,77.35,26.0806,91,"Multiplan, Inc.","Multiplan, Inc.",85.54,94,,percent of total billed charges,,
HYDROCODONE-ACETAMINOPHEN 7.5-325 MG/15 ML ORAL SOLN,,31434,LOCAL,Facility,Outpatient,120,mL,,91,77.35,26.0806,91,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,81.991,90.1,,percent of total billed charges,,
HYDROCODONE-ACETAMINOPHEN 7.5-325 MG/15 ML ORAL SOLN,,31434,LOCAL,Facility,Inpatient,120,mL,,91,77.35,26.0806,91,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
HYDROCODONE-ACETAMINOPHEN 7.5-325 MG/15 ML ORAL SOLN,,31434,LOCAL,Facility,Both,120,mL,,91,77.35,26.0806,91,"Preferred One Administrative Services, INC.",PPO,89.726,98.6,,percent of total billed charges,,
HYDROCODONE-ACETAMINOPHEN 7.5-325 MG/15 ML ORAL SOLN,,31434,LOCAL,Facility,Outpatient,120,mL,,91,77.35,26.0806,91,PrimeWest Health,Minnesota Senior Health Options (MSHO),46.8195,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
HYDROCODONE-ACETAMINOPHEN 7.5-325 MG/15 ML ORAL SOLN,,31434,LOCAL,Facility,Inpatient,120,mL,,91,77.35,26.0806,91,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
HYDROCODONE-ACETAMINOPHEN 7.5-325 MG/15 ML ORAL SOLN,,31434,LOCAL,Facility,Outpatient,120,mL,,91,77.35,26.0806,91,PrimeWest Health,MinnesotaCare,46.7376,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
HYDROCODONE-ACETAMINOPHEN 7.5-325 MG/15 ML ORAL SOLN,,31434,LOCAL,Facility,Inpatient,120,mL,,91,77.35,26.0806,91,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
HYDROCODONE-ACETAMINOPHEN 7.5-325 MG/15 ML ORAL SOLN,,31434,LOCAL,Facility,Both,120,mL,,91,77.35,26.0806,91,Sanford Health Plan,Sanford Health Plan,83.72,92,,percent of total billed charges,,
HYDROCODONE-ACETAMINOPHEN 7.5-325 MG/15 ML ORAL SOLN,,31434,LOCAL,Facility,Outpatient,120,mL,,91,77.35,26.0806,91,"UCare Health, Inc.",Individual & Family Plan,51.2785,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
HYDROCODONE-ACETAMINOPHEN 7.5-325 MG/15 ML ORAL SOLN,,31434,LOCAL,Facility,Inpatient,120,mL,,91,77.35,26.0806,91,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
HYDROCODONE-ACETAMINOPHEN 7.5-325 MG/15 ML ORAL SOLN,,31434,LOCAL,Facility,Outpatient,120,mL,,91,77.35,26.0806,91,"UCare Health, Inc.",Medical Assistance,45.9277,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
HYDROCODONE-ACETAMINOPHEN 7.5-325 MG/15 ML ORAL SOLN,,31434,LOCAL,Facility,Inpatient,120,mL,,91,77.35,26.0806,91,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
HYDROCODONE-ACETAMINOPHEN 7.5-325 MG/15 ML ORAL SOLN,,31434,LOCAL,Facility,Outpatient,120,mL,,91,77.35,26.0806,91,"UCare Health, Inc.",Medicare Advantage,45.9277,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
HYDROCODONE-ACETAMINOPHEN 7.5-325 MG/15 ML ORAL SOLN,,31434,LOCAL,Facility,Inpatient,120,mL,,91,77.35,26.0806,91,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
HYDROCODONE-ACETAMINOPHEN 7.5-325 MG/15 ML ORAL SOLN,,31434,LOCAL,Facility,Outpatient,120,mL,,91,77.35,26.0806,91,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),45.9277,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
HYDROCODONE-ACETAMINOPHEN 7.5-325 MG/15 ML ORAL SOLN,,31434,LOCAL,Facility,Inpatient,120,mL,,91,77.35,26.0806,91,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
HYDROCODONE-ACETAMINOPHEN 7.5-325 MG/15 ML ORAL SOLN,,31434,LOCAL,Facility,Both,120,mL,,91,77.35,26.0806,91,UnitedHealthcare,Individual & Family,85.54,94,,percent of total billed charges,,
HYDROCODONE-ACETAMINOPHEN 7.5-325 MG/15 ML ORAL SOLN,,31434,LOCAL,Facility,Outpatient,120,mL,,91,77.35,26.0806,91,UnitedHealthcare,Medicare Advantage,44.59,49,,percent of total billed charges,,
HYDROCODONE-ACETAMINOPHEN 7.5-325 MG/15 ML ORAL SOLN,,31434,LOCAL,Facility,Inpatient,120,mL,,91,77.35,26.0806,91,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
HYDROCODONE-ACETAMINOPHEN 7.5-325 MG/15 ML ORAL SOLN,,31434,LOCAL,Facility,Outpatient,120,mL,,91,77.35,26.0806,91,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,43.68,48,,percent of total billed charges,,100% of DHS outpatient percentage
HYDROCODONE-ACETAMINOPHEN 7.5-325 MG/15 ML ORAL SOLN,,31434,LOCAL,Facility,Inpatient,120,mL,,91,77.35,26.0806,91,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
ACTIVATED CHARCOAL-SORBITOL 25 GRAM/120 ML ORAL SUSP,,36051,LOCAL,Facility,Both,120,mL,,134,113.9,38.4044,134,Aetna,Commercial,123.28,92,,percent of total billed charges,,
ACTIVATED CHARCOAL-SORBITOL 25 GRAM/120 ML ORAL SUSP,,36051,LOCAL,Facility,Outpatient,120,mL,,134,113.9,38.4044,134,Aetna,Medicare Advantage,65.66,49,,percent of total billed charges,,
ACTIVATED CHARCOAL-SORBITOL 25 GRAM/120 ML ORAL SUSP,,36051,LOCAL,Facility,Inpatient,120,mL,,134,113.9,38.4044,134,Aetna,Medicare Advantage,,,,,Included in per diem rate,
ACTIVATED CHARCOAL-SORBITOL 25 GRAM/120 ML ORAL SUSP,,36051,LOCAL,Facility,Both,120,mL,,134,113.9,38.4044,134,Aetna,PPO,124.62,93,,percent of total billed charges,,
ACTIVATED CHARCOAL-SORBITOL 25 GRAM/120 ML ORAL SUSP,,36051,LOCAL,Facility,Both,120,mL,,134,113.9,38.4044,134,America's PPO,America's PPO,128.6802,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
ACTIVATED CHARCOAL-SORBITOL 25 GRAM/120 ML ORAL SUSP,,36051,LOCAL,Facility,Both,120,mL,,134,113.9,38.4044,134,BlueCross BlueShield Minnesota, Federal Employee Program,131.856,98.4,,percent of total billed charges,,
ACTIVATED CHARCOAL-SORBITOL 25 GRAM/120 ML ORAL SUSP,,36051,LOCAL,Facility,Both,120,mL,,134,113.9,38.4044,134,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,134,100,,percent of total billed charges,,
ACTIVATED CHARCOAL-SORBITOL 25 GRAM/120 ML ORAL SUSP,,36051,LOCAL,Facility,Both,120,mL,,134,113.9,38.4044,134,BlueCross BlueShield Minnesota,High Value Network Plan,120.6,90,,percent of total billed charges,,
ACTIVATED CHARCOAL-SORBITOL 25 GRAM/120 ML ORAL SUSP,,36051,LOCAL,Facility,Outpatient,120,mL,,134,113.9,38.4044,134,BlueCross BlueShield Minnesota,Medicare Advantage,65.66,49,,percent of total billed charges,,
ACTIVATED CHARCOAL-SORBITOL 25 GRAM/120 ML ORAL SUSP,,36051,LOCAL,Facility,Inpatient,120,mL,,134,113.9,38.4044,134,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
ACTIVATED CHARCOAL-SORBITOL 25 GRAM/120 ML ORAL SUSP,,36051,LOCAL,Facility,Both,120,mL,,134,113.9,38.4044,134,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,118.6838,88.57,,percent of total billed charges,,
ACTIVATED CHARCOAL-SORBITOL 25 GRAM/120 ML ORAL SUSP,,36051,LOCAL,Facility,Both,120,mL,,134,113.9,38.4044,134,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,38.4044,28.66,,percent of total billed charges,,
ACTIVATED CHARCOAL-SORBITOL 25 GRAM/120 ML ORAL SUSP,,36051,LOCAL,Facility,Outpatient,120,mL,,134,113.9,38.4044,134,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),65.66,49,,percent of total billed charges,,
ACTIVATED CHARCOAL-SORBITOL 25 GRAM/120 ML ORAL SUSP,,36051,LOCAL,Facility,Inpatient,120,mL,,134,113.9,38.4044,134,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
ACTIVATED CHARCOAL-SORBITOL 25 GRAM/120 ML ORAL SUSP,,36051,LOCAL,Facility,Both,120,mL,,134,113.9,38.4044,134,CorVel,Worker's Compensation,134,100,,percent of total billed charges,,
ACTIVATED CHARCOAL-SORBITOL 25 GRAM/120 ML ORAL SUSP,,36051,LOCAL,Facility,Both,120,mL,,134,113.9,38.4044,134,First Health Group Corporation,First Health Network,129.98,97,,percent of total billed charges,,
ACTIVATED CHARCOAL-SORBITOL 25 GRAM/120 ML ORAL SUSP,,36051,LOCAL,Facility,Both,120,mL,,134,113.9,38.4044,134,"Health Partners, Inc.",Commercial,126.764,94.6,,percent of total billed charges,,
ACTIVATED CHARCOAL-SORBITOL 25 GRAM/120 ML ORAL SUSP,,36051,LOCAL,Facility,Outpatient,120,mL,,134,113.9,38.4044,134,"Health Partners, Inc.",Medicare Advantage,65.66,49,,percent of total billed charges,,
ACTIVATED CHARCOAL-SORBITOL 25 GRAM/120 ML ORAL SUSP,,36051,LOCAL,Facility,Inpatient,120,mL,,134,113.9,38.4044,134,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ACTIVATED CHARCOAL-SORBITOL 25 GRAM/120 ML ORAL SUSP,,36051,LOCAL,Facility,Both,120,mL,,134,113.9,38.4044,134,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),80.4,60,,percent of total billed charges,,
ACTIVATED CHARCOAL-SORBITOL 25 GRAM/120 ML ORAL SUSP,,36051,LOCAL,Facility,Both,120,mL,,134,113.9,38.4044,134,"Health Partners, Inc.",State of Minnesota Advantage Program,109.21,81.5,,percent of total billed charges,,
ACTIVATED CHARCOAL-SORBITOL 25 GRAM/120 ML ORAL SUSP,,36051,LOCAL,Facility,Both,120,mL,,134,113.9,38.4044,134,"Health Partners, Inc.",State Public Programs,67,50,,percent of total billed charges,,
ACTIVATED CHARCOAL-SORBITOL 25 GRAM/120 ML ORAL SUSP,,36051,LOCAL,Facility,Both,120,mL,,134,113.9,38.4044,134,Humana Insurance Company,Commercial PPO,127.3,95,,percent of total billed charges,,
ACTIVATED CHARCOAL-SORBITOL 25 GRAM/120 ML ORAL SUSP,,36051,LOCAL,Facility,Outpatient,120,mL,,134,113.9,38.4044,134,Humana Insurance Company,Medicare PPO,65.66,49,,percent of total billed charges,,
ACTIVATED CHARCOAL-SORBITOL 25 GRAM/120 ML ORAL SUSP,,36051,LOCAL,Facility,Inpatient,120,mL,,134,113.9,38.4044,134,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
ACTIVATED CHARCOAL-SORBITOL 25 GRAM/120 ML ORAL SUSP,,36051,LOCAL,Facility,Both,120,mL,,134,113.9,38.4044,134,Medica,Individual & Family,132.794,99.1,,percent of total billed charges,,
ACTIVATED CHARCOAL-SORBITOL 25 GRAM/120 ML ORAL SUSP,,36051,LOCAL,Facility,Outpatient,120,mL,,134,113.9,38.4044,134,Medica,Medica Advantage Solution,66.732,49.8,,percent of total billed charges,,
ACTIVATED CHARCOAL-SORBITOL 25 GRAM/120 ML ORAL SUSP,,36051,LOCAL,Facility,Inpatient,120,mL,,134,113.9,38.4044,134,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
ACTIVATED CHARCOAL-SORBITOL 25 GRAM/120 ML ORAL SUSP,,36051,LOCAL,Facility,Outpatient,120,mL,,134,113.9,38.4044,134,Medica,Medical Assistance,59.764,44.6,,percent of total billed charges,,
ACTIVATED CHARCOAL-SORBITOL 25 GRAM/120 ML ORAL SUSP,,36051,LOCAL,Facility,Inpatient,120,mL,,134,113.9,38.4044,134,Medica,Medical Assistance,,,,,Included in per diem rate,
ACTIVATED CHARCOAL-SORBITOL 25 GRAM/120 ML ORAL SUSP,,36051,LOCAL,Facility,Outpatient,120,mL,,134,113.9,38.4044,134,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,66.732,49.8,,percent of total billed charges,,
ACTIVATED CHARCOAL-SORBITOL 25 GRAM/120 ML ORAL SUSP,,36051,LOCAL,Facility,Inpatient,120,mL,,134,113.9,38.4044,134,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
ACTIVATED CHARCOAL-SORBITOL 25 GRAM/120 ML ORAL SUSP,,36051,LOCAL,Facility,Both,120,mL,,134,113.9,38.4044,134,"Multiplan, Inc.","Multiplan, Inc.",125.96,94,,percent of total billed charges,,
ACTIVATED CHARCOAL-SORBITOL 25 GRAM/120 ML ORAL SUSP,,36051,LOCAL,Facility,Outpatient,120,mL,,134,113.9,38.4044,134,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,120.734,90.1,,percent of total billed charges,,
ACTIVATED CHARCOAL-SORBITOL 25 GRAM/120 ML ORAL SUSP,,36051,LOCAL,Facility,Inpatient,120,mL,,134,113.9,38.4044,134,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
ACTIVATED CHARCOAL-SORBITOL 25 GRAM/120 ML ORAL SUSP,,36051,LOCAL,Facility,Both,120,mL,,134,113.9,38.4044,134,"Preferred One Administrative Services, INC.",PPO,132.124,98.6,,percent of total billed charges,,
ACTIVATED CHARCOAL-SORBITOL 25 GRAM/120 ML ORAL SUSP,,36051,LOCAL,Facility,Outpatient,120,mL,,134,113.9,38.4044,134,PrimeWest Health,Minnesota Senior Health Options (MSHO),68.943,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
ACTIVATED CHARCOAL-SORBITOL 25 GRAM/120 ML ORAL SUSP,,36051,LOCAL,Facility,Inpatient,120,mL,,134,113.9,38.4044,134,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ACTIVATED CHARCOAL-SORBITOL 25 GRAM/120 ML ORAL SUSP,,36051,LOCAL,Facility,Outpatient,120,mL,,134,113.9,38.4044,134,PrimeWest Health,MinnesotaCare,68.8224,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
ACTIVATED CHARCOAL-SORBITOL 25 GRAM/120 ML ORAL SUSP,,36051,LOCAL,Facility,Inpatient,120,mL,,134,113.9,38.4044,134,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
ACTIVATED CHARCOAL-SORBITOL 25 GRAM/120 ML ORAL SUSP,,36051,LOCAL,Facility,Both,120,mL,,134,113.9,38.4044,134,Sanford Health Plan,Sanford Health Plan,123.28,92,,percent of total billed charges,,
ACTIVATED CHARCOAL-SORBITOL 25 GRAM/120 ML ORAL SUSP,,36051,LOCAL,Facility,Outpatient,120,mL,,134,113.9,38.4044,134,"UCare Health, Inc.",Individual & Family Plan,75.509,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
ACTIVATED CHARCOAL-SORBITOL 25 GRAM/120 ML ORAL SUSP,,36051,LOCAL,Facility,Inpatient,120,mL,,134,113.9,38.4044,134,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
ACTIVATED CHARCOAL-SORBITOL 25 GRAM/120 ML ORAL SUSP,,36051,LOCAL,Facility,Outpatient,120,mL,,134,113.9,38.4044,134,"UCare Health, Inc.",Medical Assistance,67.6298,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ACTIVATED CHARCOAL-SORBITOL 25 GRAM/120 ML ORAL SUSP,,36051,LOCAL,Facility,Inpatient,120,mL,,134,113.9,38.4044,134,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
ACTIVATED CHARCOAL-SORBITOL 25 GRAM/120 ML ORAL SUSP,,36051,LOCAL,Facility,Outpatient,120,mL,,134,113.9,38.4044,134,"UCare Health, Inc.",Medicare Advantage,67.6298,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ACTIVATED CHARCOAL-SORBITOL 25 GRAM/120 ML ORAL SUSP,,36051,LOCAL,Facility,Inpatient,120,mL,,134,113.9,38.4044,134,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ACTIVATED CHARCOAL-SORBITOL 25 GRAM/120 ML ORAL SUSP,,36051,LOCAL,Facility,Outpatient,120,mL,,134,113.9,38.4044,134,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),67.6298,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ACTIVATED CHARCOAL-SORBITOL 25 GRAM/120 ML ORAL SUSP,,36051,LOCAL,Facility,Inpatient,120,mL,,134,113.9,38.4044,134,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ACTIVATED CHARCOAL-SORBITOL 25 GRAM/120 ML ORAL SUSP,,36051,LOCAL,Facility,Both,120,mL,,134,113.9,38.4044,134,UnitedHealthcare,Individual & Family,125.96,94,,percent of total billed charges,,
ACTIVATED CHARCOAL-SORBITOL 25 GRAM/120 ML ORAL SUSP,,36051,LOCAL,Facility,Outpatient,120,mL,,134,113.9,38.4044,134,UnitedHealthcare,Medicare Advantage,65.66,49,,percent of total billed charges,,
ACTIVATED CHARCOAL-SORBITOL 25 GRAM/120 ML ORAL SUSP,,36051,LOCAL,Facility,Inpatient,120,mL,,134,113.9,38.4044,134,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
ACTIVATED CHARCOAL-SORBITOL 25 GRAM/120 ML ORAL SUSP,,36051,LOCAL,Facility,Outpatient,120,mL,,134,113.9,38.4044,134,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,64.32,48,,percent of total billed charges,,100% of DHS outpatient percentage
ACTIVATED CHARCOAL-SORBITOL 25 GRAM/120 ML ORAL SUSP,,36051,LOCAL,Facility,Inpatient,120,mL,,134,113.9,38.4044,134,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
LOPERAMIDE 1 MG/7.5 ML ORAL LIQD,,38759,LOCAL,Facility,Both,120,mL,,29,24.65,8.3114,29,Aetna,Commercial,26.68,92,,percent of total billed charges,,
LOPERAMIDE 1 MG/7.5 ML ORAL LIQD,,38759,LOCAL,Facility,Outpatient,120,mL,,29,24.65,8.3114,29,Aetna,Medicare Advantage,14.21,49,,percent of total billed charges,,
LOPERAMIDE 1 MG/7.5 ML ORAL LIQD,,38759,LOCAL,Facility,Inpatient,120,mL,,29,24.65,8.3114,29,Aetna,Medicare Advantage,,,,,Included in per diem rate,
LOPERAMIDE 1 MG/7.5 ML ORAL LIQD,,38759,LOCAL,Facility,Both,120,mL,,29,24.65,8.3114,29,Aetna,PPO,26.97,93,,percent of total billed charges,,
LOPERAMIDE 1 MG/7.5 ML ORAL LIQD,,38759,LOCAL,Facility,Both,120,mL,,29,24.65,8.3114,29,America's PPO,America's PPO,27.8487,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
LOPERAMIDE 1 MG/7.5 ML ORAL LIQD,,38759,LOCAL,Facility,Both,120,mL,,29,24.65,8.3114,29,BlueCross BlueShield Minnesota, Federal Employee Program,28.536,98.4,,percent of total billed charges,,
LOPERAMIDE 1 MG/7.5 ML ORAL LIQD,,38759,LOCAL,Facility,Both,120,mL,,29,24.65,8.3114,29,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,29,100,,percent of total billed charges,,
LOPERAMIDE 1 MG/7.5 ML ORAL LIQD,,38759,LOCAL,Facility,Both,120,mL,,29,24.65,8.3114,29,BlueCross BlueShield Minnesota,High Value Network Plan,26.1,90,,percent of total billed charges,,
LOPERAMIDE 1 MG/7.5 ML ORAL LIQD,,38759,LOCAL,Facility,Outpatient,120,mL,,29,24.65,8.3114,29,BlueCross BlueShield Minnesota,Medicare Advantage,14.21,49,,percent of total billed charges,,
LOPERAMIDE 1 MG/7.5 ML ORAL LIQD,,38759,LOCAL,Facility,Inpatient,120,mL,,29,24.65,8.3114,29,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
LOPERAMIDE 1 MG/7.5 ML ORAL LIQD,,38759,LOCAL,Facility,Both,120,mL,,29,24.65,8.3114,29,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,25.6853,88.57,,percent of total billed charges,,
LOPERAMIDE 1 MG/7.5 ML ORAL LIQD,,38759,LOCAL,Facility,Both,120,mL,,29,24.65,8.3114,29,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,8.3114,28.66,,percent of total billed charges,,
LOPERAMIDE 1 MG/7.5 ML ORAL LIQD,,38759,LOCAL,Facility,Outpatient,120,mL,,29,24.65,8.3114,29,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),14.21,49,,percent of total billed charges,,
LOPERAMIDE 1 MG/7.5 ML ORAL LIQD,,38759,LOCAL,Facility,Inpatient,120,mL,,29,24.65,8.3114,29,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
LOPERAMIDE 1 MG/7.5 ML ORAL LIQD,,38759,LOCAL,Facility,Both,120,mL,,29,24.65,8.3114,29,CorVel,Worker's Compensation,29,100,,percent of total billed charges,,
LOPERAMIDE 1 MG/7.5 ML ORAL LIQD,,38759,LOCAL,Facility,Both,120,mL,,29,24.65,8.3114,29,First Health Group Corporation,First Health Network,28.13,97,,percent of total billed charges,,
LOPERAMIDE 1 MG/7.5 ML ORAL LIQD,,38759,LOCAL,Facility,Both,120,mL,,29,24.65,8.3114,29,"Health Partners, Inc.",Commercial,27.434,94.6,,percent of total billed charges,,
LOPERAMIDE 1 MG/7.5 ML ORAL LIQD,,38759,LOCAL,Facility,Outpatient,120,mL,,29,24.65,8.3114,29,"Health Partners, Inc.",Medicare Advantage,14.21,49,,percent of total billed charges,,
LOPERAMIDE 1 MG/7.5 ML ORAL LIQD,,38759,LOCAL,Facility,Inpatient,120,mL,,29,24.65,8.3114,29,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LOPERAMIDE 1 MG/7.5 ML ORAL LIQD,,38759,LOCAL,Facility,Both,120,mL,,29,24.65,8.3114,29,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),17.4,60,,percent of total billed charges,,
LOPERAMIDE 1 MG/7.5 ML ORAL LIQD,,38759,LOCAL,Facility,Both,120,mL,,29,24.65,8.3114,29,"Health Partners, Inc.",State of Minnesota Advantage Program,23.635,81.5,,percent of total billed charges,,
LOPERAMIDE 1 MG/7.5 ML ORAL LIQD,,38759,LOCAL,Facility,Both,120,mL,,29,24.65,8.3114,29,"Health Partners, Inc.",State Public Programs,14.5,50,,percent of total billed charges,,
LOPERAMIDE 1 MG/7.5 ML ORAL LIQD,,38759,LOCAL,Facility,Both,120,mL,,29,24.65,8.3114,29,Humana Insurance Company,Commercial PPO,27.55,95,,percent of total billed charges,,
LOPERAMIDE 1 MG/7.5 ML ORAL LIQD,,38759,LOCAL,Facility,Outpatient,120,mL,,29,24.65,8.3114,29,Humana Insurance Company,Medicare PPO,14.21,49,,percent of total billed charges,,
LOPERAMIDE 1 MG/7.5 ML ORAL LIQD,,38759,LOCAL,Facility,Inpatient,120,mL,,29,24.65,8.3114,29,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
LOPERAMIDE 1 MG/7.5 ML ORAL LIQD,,38759,LOCAL,Facility,Both,120,mL,,29,24.65,8.3114,29,Medica,Individual & Family,28.739,99.1,,percent of total billed charges,,
LOPERAMIDE 1 MG/7.5 ML ORAL LIQD,,38759,LOCAL,Facility,Outpatient,120,mL,,29,24.65,8.3114,29,Medica,Medica Advantage Solution,14.442,49.8,,percent of total billed charges,,
LOPERAMIDE 1 MG/7.5 ML ORAL LIQD,,38759,LOCAL,Facility,Inpatient,120,mL,,29,24.65,8.3114,29,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
LOPERAMIDE 1 MG/7.5 ML ORAL LIQD,,38759,LOCAL,Facility,Outpatient,120,mL,,29,24.65,8.3114,29,Medica,Medical Assistance,12.934,44.6,,percent of total billed charges,,
LOPERAMIDE 1 MG/7.5 ML ORAL LIQD,,38759,LOCAL,Facility,Inpatient,120,mL,,29,24.65,8.3114,29,Medica,Medical Assistance,,,,,Included in per diem rate,
LOPERAMIDE 1 MG/7.5 ML ORAL LIQD,,38759,LOCAL,Facility,Outpatient,120,mL,,29,24.65,8.3114,29,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,14.442,49.8,,percent of total billed charges,,
LOPERAMIDE 1 MG/7.5 ML ORAL LIQD,,38759,LOCAL,Facility,Inpatient,120,mL,,29,24.65,8.3114,29,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
LOPERAMIDE 1 MG/7.5 ML ORAL LIQD,,38759,LOCAL,Facility,Both,120,mL,,29,24.65,8.3114,29,"Multiplan, Inc.","Multiplan, Inc.",27.26,94,,percent of total billed charges,,
LOPERAMIDE 1 MG/7.5 ML ORAL LIQD,,38759,LOCAL,Facility,Outpatient,120,mL,,29,24.65,8.3114,29,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,26.129,90.1,,percent of total billed charges,,
LOPERAMIDE 1 MG/7.5 ML ORAL LIQD,,38759,LOCAL,Facility,Inpatient,120,mL,,29,24.65,8.3114,29,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
LOPERAMIDE 1 MG/7.5 ML ORAL LIQD,,38759,LOCAL,Facility,Both,120,mL,,29,24.65,8.3114,29,"Preferred One Administrative Services, INC.",PPO,28.594,98.6,,percent of total billed charges,,
LOPERAMIDE 1 MG/7.5 ML ORAL LIQD,,38759,LOCAL,Facility,Outpatient,120,mL,,29,24.65,8.3114,29,PrimeWest Health,Minnesota Senior Health Options (MSHO),14.9205,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
LOPERAMIDE 1 MG/7.5 ML ORAL LIQD,,38759,LOCAL,Facility,Inpatient,120,mL,,29,24.65,8.3114,29,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LOPERAMIDE 1 MG/7.5 ML ORAL LIQD,,38759,LOCAL,Facility,Outpatient,120,mL,,29,24.65,8.3114,29,PrimeWest Health,MinnesotaCare,14.8944,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
LOPERAMIDE 1 MG/7.5 ML ORAL LIQD,,38759,LOCAL,Facility,Inpatient,120,mL,,29,24.65,8.3114,29,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
LOPERAMIDE 1 MG/7.5 ML ORAL LIQD,,38759,LOCAL,Facility,Both,120,mL,,29,24.65,8.3114,29,Sanford Health Plan,Sanford Health Plan,26.68,92,,percent of total billed charges,,
LOPERAMIDE 1 MG/7.5 ML ORAL LIQD,,38759,LOCAL,Facility,Outpatient,120,mL,,29,24.65,8.3114,29,"UCare Health, Inc.",Individual & Family Plan,16.3415,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
LOPERAMIDE 1 MG/7.5 ML ORAL LIQD,,38759,LOCAL,Facility,Inpatient,120,mL,,29,24.65,8.3114,29,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
LOPERAMIDE 1 MG/7.5 ML ORAL LIQD,,38759,LOCAL,Facility,Outpatient,120,mL,,29,24.65,8.3114,29,"UCare Health, Inc.",Medical Assistance,14.6363,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LOPERAMIDE 1 MG/7.5 ML ORAL LIQD,,38759,LOCAL,Facility,Inpatient,120,mL,,29,24.65,8.3114,29,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
LOPERAMIDE 1 MG/7.5 ML ORAL LIQD,,38759,LOCAL,Facility,Outpatient,120,mL,,29,24.65,8.3114,29,"UCare Health, Inc.",Medicare Advantage,14.6363,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LOPERAMIDE 1 MG/7.5 ML ORAL LIQD,,38759,LOCAL,Facility,Inpatient,120,mL,,29,24.65,8.3114,29,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LOPERAMIDE 1 MG/7.5 ML ORAL LIQD,,38759,LOCAL,Facility,Outpatient,120,mL,,29,24.65,8.3114,29,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),14.6363,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LOPERAMIDE 1 MG/7.5 ML ORAL LIQD,,38759,LOCAL,Facility,Inpatient,120,mL,,29,24.65,8.3114,29,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LOPERAMIDE 1 MG/7.5 ML ORAL LIQD,,38759,LOCAL,Facility,Both,120,mL,,29,24.65,8.3114,29,UnitedHealthcare,Individual & Family,27.26,94,,percent of total billed charges,,
LOPERAMIDE 1 MG/7.5 ML ORAL LIQD,,38759,LOCAL,Facility,Outpatient,120,mL,,29,24.65,8.3114,29,UnitedHealthcare,Medicare Advantage,14.21,49,,percent of total billed charges,,
LOPERAMIDE 1 MG/7.5 ML ORAL LIQD,,38759,LOCAL,Facility,Inpatient,120,mL,,29,24.65,8.3114,29,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
LOPERAMIDE 1 MG/7.5 ML ORAL LIQD,,38759,LOCAL,Facility,Outpatient,120,mL,,29,24.65,8.3114,29,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,13.92,48,,percent of total billed charges,,100% of DHS outpatient percentage
LOPERAMIDE 1 MG/7.5 ML ORAL LIQD,,38759,LOCAL,Facility,Inpatient,120,mL,,29,24.65,8.3114,29,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
CETIRIZINE 1 MG/ML ORAL SOLN,,82518,LOCAL,Facility,Both,120,mL,,25,21.25,7.165,25,Aetna,Commercial,23,92,,percent of total billed charges,,
CETIRIZINE 1 MG/ML ORAL SOLN,,82518,LOCAL,Facility,Outpatient,120,mL,,25,21.25,7.165,25,Aetna,Medicare Advantage,12.25,49,,percent of total billed charges,,
CETIRIZINE 1 MG/ML ORAL SOLN,,82518,LOCAL,Facility,Inpatient,120,mL,,25,21.25,7.165,25,Aetna,Medicare Advantage,,,,,Included in per diem rate,
CETIRIZINE 1 MG/ML ORAL SOLN,,82518,LOCAL,Facility,Both,120,mL,,25,21.25,7.165,25,Aetna,PPO,23.25,93,,percent of total billed charges,,
CETIRIZINE 1 MG/ML ORAL SOLN,,82518,LOCAL,Facility,Both,120,mL,,25,21.25,7.165,25,America's PPO,America's PPO,24.0075,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
CETIRIZINE 1 MG/ML ORAL SOLN,,82518,LOCAL,Facility,Both,120,mL,,25,21.25,7.165,25,BlueCross BlueShield Minnesota, Federal Employee Program,24.6,98.4,,percent of total billed charges,,
CETIRIZINE 1 MG/ML ORAL SOLN,,82518,LOCAL,Facility,Both,120,mL,,25,21.25,7.165,25,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,25,100,,percent of total billed charges,,
CETIRIZINE 1 MG/ML ORAL SOLN,,82518,LOCAL,Facility,Both,120,mL,,25,21.25,7.165,25,BlueCross BlueShield Minnesota,High Value Network Plan,22.5,90,,percent of total billed charges,,
CETIRIZINE 1 MG/ML ORAL SOLN,,82518,LOCAL,Facility,Outpatient,120,mL,,25,21.25,7.165,25,BlueCross BlueShield Minnesota,Medicare Advantage,12.25,49,,percent of total billed charges,,
CETIRIZINE 1 MG/ML ORAL SOLN,,82518,LOCAL,Facility,Inpatient,120,mL,,25,21.25,7.165,25,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
CETIRIZINE 1 MG/ML ORAL SOLN,,82518,LOCAL,Facility,Both,120,mL,,25,21.25,7.165,25,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,22.1425,88.57,,percent of total billed charges,,
CETIRIZINE 1 MG/ML ORAL SOLN,,82518,LOCAL,Facility,Both,120,mL,,25,21.25,7.165,25,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,7.165,28.66,,percent of total billed charges,,
CETIRIZINE 1 MG/ML ORAL SOLN,,82518,LOCAL,Facility,Outpatient,120,mL,,25,21.25,7.165,25,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),12.25,49,,percent of total billed charges,,
CETIRIZINE 1 MG/ML ORAL SOLN,,82518,LOCAL,Facility,Inpatient,120,mL,,25,21.25,7.165,25,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
CETIRIZINE 1 MG/ML ORAL SOLN,,82518,LOCAL,Facility,Both,120,mL,,25,21.25,7.165,25,CorVel,Worker's Compensation,25,100,,percent of total billed charges,,
CETIRIZINE 1 MG/ML ORAL SOLN,,82518,LOCAL,Facility,Both,120,mL,,25,21.25,7.165,25,First Health Group Corporation,First Health Network,24.25,97,,percent of total billed charges,,
CETIRIZINE 1 MG/ML ORAL SOLN,,82518,LOCAL,Facility,Both,120,mL,,25,21.25,7.165,25,"Health Partners, Inc.",Commercial,23.65,94.6,,percent of total billed charges,,
CETIRIZINE 1 MG/ML ORAL SOLN,,82518,LOCAL,Facility,Outpatient,120,mL,,25,21.25,7.165,25,"Health Partners, Inc.",Medicare Advantage,12.25,49,,percent of total billed charges,,
CETIRIZINE 1 MG/ML ORAL SOLN,,82518,LOCAL,Facility,Inpatient,120,mL,,25,21.25,7.165,25,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CETIRIZINE 1 MG/ML ORAL SOLN,,82518,LOCAL,Facility,Both,120,mL,,25,21.25,7.165,25,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),15,60,,percent of total billed charges,,
CETIRIZINE 1 MG/ML ORAL SOLN,,82518,LOCAL,Facility,Both,120,mL,,25,21.25,7.165,25,"Health Partners, Inc.",State of Minnesota Advantage Program,20.375,81.5,,percent of total billed charges,,
CETIRIZINE 1 MG/ML ORAL SOLN,,82518,LOCAL,Facility,Both,120,mL,,25,21.25,7.165,25,"Health Partners, Inc.",State Public Programs,12.5,50,,percent of total billed charges,,
CETIRIZINE 1 MG/ML ORAL SOLN,,82518,LOCAL,Facility,Both,120,mL,,25,21.25,7.165,25,Humana Insurance Company,Commercial PPO,23.75,95,,percent of total billed charges,,
CETIRIZINE 1 MG/ML ORAL SOLN,,82518,LOCAL,Facility,Outpatient,120,mL,,25,21.25,7.165,25,Humana Insurance Company,Medicare PPO,12.25,49,,percent of total billed charges,,
CETIRIZINE 1 MG/ML ORAL SOLN,,82518,LOCAL,Facility,Inpatient,120,mL,,25,21.25,7.165,25,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
CETIRIZINE 1 MG/ML ORAL SOLN,,82518,LOCAL,Facility,Both,120,mL,,25,21.25,7.165,25,Medica,Individual & Family,24.775,99.1,,percent of total billed charges,,
CETIRIZINE 1 MG/ML ORAL SOLN,,82518,LOCAL,Facility,Outpatient,120,mL,,25,21.25,7.165,25,Medica,Medica Advantage Solution,12.45,49.8,,percent of total billed charges,,
CETIRIZINE 1 MG/ML ORAL SOLN,,82518,LOCAL,Facility,Inpatient,120,mL,,25,21.25,7.165,25,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
CETIRIZINE 1 MG/ML ORAL SOLN,,82518,LOCAL,Facility,Outpatient,120,mL,,25,21.25,7.165,25,Medica,Medical Assistance,11.15,44.6,,percent of total billed charges,,
CETIRIZINE 1 MG/ML ORAL SOLN,,82518,LOCAL,Facility,Inpatient,120,mL,,25,21.25,7.165,25,Medica,Medical Assistance,,,,,Included in per diem rate,
CETIRIZINE 1 MG/ML ORAL SOLN,,82518,LOCAL,Facility,Outpatient,120,mL,,25,21.25,7.165,25,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,12.45,49.8,,percent of total billed charges,,
CETIRIZINE 1 MG/ML ORAL SOLN,,82518,LOCAL,Facility,Inpatient,120,mL,,25,21.25,7.165,25,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
CETIRIZINE 1 MG/ML ORAL SOLN,,82518,LOCAL,Facility,Both,120,mL,,25,21.25,7.165,25,"Multiplan, Inc.","Multiplan, Inc.",23.5,94,,percent of total billed charges,,
CETIRIZINE 1 MG/ML ORAL SOLN,,82518,LOCAL,Facility,Outpatient,120,mL,,25,21.25,7.165,25,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,22.525,90.1,,percent of total billed charges,,
CETIRIZINE 1 MG/ML ORAL SOLN,,82518,LOCAL,Facility,Inpatient,120,mL,,25,21.25,7.165,25,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
CETIRIZINE 1 MG/ML ORAL SOLN,,82518,LOCAL,Facility,Both,120,mL,,25,21.25,7.165,25,"Preferred One Administrative Services, INC.",PPO,24.65,98.6,,percent of total billed charges,,
CETIRIZINE 1 MG/ML ORAL SOLN,,82518,LOCAL,Facility,Outpatient,120,mL,,25,21.25,7.165,25,PrimeWest Health,Minnesota Senior Health Options (MSHO),12.8625,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
CETIRIZINE 1 MG/ML ORAL SOLN,,82518,LOCAL,Facility,Inpatient,120,mL,,25,21.25,7.165,25,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CETIRIZINE 1 MG/ML ORAL SOLN,,82518,LOCAL,Facility,Outpatient,120,mL,,25,21.25,7.165,25,PrimeWest Health,MinnesotaCare,12.84,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
CETIRIZINE 1 MG/ML ORAL SOLN,,82518,LOCAL,Facility,Inpatient,120,mL,,25,21.25,7.165,25,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
CETIRIZINE 1 MG/ML ORAL SOLN,,82518,LOCAL,Facility,Both,120,mL,,25,21.25,7.165,25,Sanford Health Plan,Sanford Health Plan,23,92,,percent of total billed charges,,
CETIRIZINE 1 MG/ML ORAL SOLN,,82518,LOCAL,Facility,Outpatient,120,mL,,25,21.25,7.165,25,"UCare Health, Inc.",Individual & Family Plan,14.0875,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
CETIRIZINE 1 MG/ML ORAL SOLN,,82518,LOCAL,Facility,Inpatient,120,mL,,25,21.25,7.165,25,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
CETIRIZINE 1 MG/ML ORAL SOLN,,82518,LOCAL,Facility,Outpatient,120,mL,,25,21.25,7.165,25,"UCare Health, Inc.",Medical Assistance,12.6175,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CETIRIZINE 1 MG/ML ORAL SOLN,,82518,LOCAL,Facility,Inpatient,120,mL,,25,21.25,7.165,25,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
CETIRIZINE 1 MG/ML ORAL SOLN,,82518,LOCAL,Facility,Outpatient,120,mL,,25,21.25,7.165,25,"UCare Health, Inc.",Medicare Advantage,12.6175,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CETIRIZINE 1 MG/ML ORAL SOLN,,82518,LOCAL,Facility,Inpatient,120,mL,,25,21.25,7.165,25,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CETIRIZINE 1 MG/ML ORAL SOLN,,82518,LOCAL,Facility,Outpatient,120,mL,,25,21.25,7.165,25,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),12.6175,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CETIRIZINE 1 MG/ML ORAL SOLN,,82518,LOCAL,Facility,Inpatient,120,mL,,25,21.25,7.165,25,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CETIRIZINE 1 MG/ML ORAL SOLN,,82518,LOCAL,Facility,Both,120,mL,,25,21.25,7.165,25,UnitedHealthcare,Individual & Family,23.5,94,,percent of total billed charges,,
CETIRIZINE 1 MG/ML ORAL SOLN,,82518,LOCAL,Facility,Outpatient,120,mL,,25,21.25,7.165,25,UnitedHealthcare,Medicare Advantage,12.25,49,,percent of total billed charges,,
CETIRIZINE 1 MG/ML ORAL SOLN,,82518,LOCAL,Facility,Inpatient,120,mL,,25,21.25,7.165,25,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
CETIRIZINE 1 MG/ML ORAL SOLN,,82518,LOCAL,Facility,Outpatient,120,mL,,25,21.25,7.165,25,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,12,48,,percent of total billed charges,,100% of DHS outpatient percentage
CETIRIZINE 1 MG/ML ORAL SOLN,,82518,LOCAL,Facility,Inpatient,120,mL,,25,21.25,7.165,25,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
VANCOMYCIN 50 MG/ML ORAL SOLUTION - MHS,,480112,LOCAL,Facility,Both,125,mL,,12,10.2,3.4392,12,Aetna,Commercial,11.04,92,,percent of total billed charges,,
VANCOMYCIN 50 MG/ML ORAL SOLUTION - MHS,,480112,LOCAL,Facility,Outpatient,125,mL,,12,10.2,3.4392,12,Aetna,Medicare Advantage,5.88,49,,percent of total billed charges,,
VANCOMYCIN 50 MG/ML ORAL SOLUTION - MHS,,480112,LOCAL,Facility,Inpatient,125,mL,,12,10.2,3.4392,12,Aetna,Medicare Advantage,,,,,Included in per diem rate,
VANCOMYCIN 50 MG/ML ORAL SOLUTION - MHS,,480112,LOCAL,Facility,Both,125,mL,,12,10.2,3.4392,12,Aetna,PPO,11.16,93,,percent of total billed charges,,
VANCOMYCIN 50 MG/ML ORAL SOLUTION - MHS,,480112,LOCAL,Facility,Both,125,mL,,12,10.2,3.4392,12,America's PPO,America's PPO,11.5236,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
VANCOMYCIN 50 MG/ML ORAL SOLUTION - MHS,,480112,LOCAL,Facility,Both,125,mL,,12,10.2,3.4392,12,BlueCross BlueShield Minnesota, Federal Employee Program,11.808,98.4,,percent of total billed charges,,
VANCOMYCIN 50 MG/ML ORAL SOLUTION - MHS,,480112,LOCAL,Facility,Both,125,mL,,12,10.2,3.4392,12,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,12,100,,percent of total billed charges,,
VANCOMYCIN 50 MG/ML ORAL SOLUTION - MHS,,480112,LOCAL,Facility,Both,125,mL,,12,10.2,3.4392,12,BlueCross BlueShield Minnesota,High Value Network Plan,10.8,90,,percent of total billed charges,,
VANCOMYCIN 50 MG/ML ORAL SOLUTION - MHS,,480112,LOCAL,Facility,Outpatient,125,mL,,12,10.2,3.4392,12,BlueCross BlueShield Minnesota,Medicare Advantage,5.88,49,,percent of total billed charges,,
VANCOMYCIN 50 MG/ML ORAL SOLUTION - MHS,,480112,LOCAL,Facility,Inpatient,125,mL,,12,10.2,3.4392,12,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
VANCOMYCIN 50 MG/ML ORAL SOLUTION - MHS,,480112,LOCAL,Facility,Both,125,mL,,12,10.2,3.4392,12,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,10.6284,88.57,,percent of total billed charges,,
VANCOMYCIN 50 MG/ML ORAL SOLUTION - MHS,,480112,LOCAL,Facility,Both,125,mL,,12,10.2,3.4392,12,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,3.4392,28.66,,percent of total billed charges,,
VANCOMYCIN 50 MG/ML ORAL SOLUTION - MHS,,480112,LOCAL,Facility,Outpatient,125,mL,,12,10.2,3.4392,12,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),5.88,49,,percent of total billed charges,,
VANCOMYCIN 50 MG/ML ORAL SOLUTION - MHS,,480112,LOCAL,Facility,Inpatient,125,mL,,12,10.2,3.4392,12,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
VANCOMYCIN 50 MG/ML ORAL SOLUTION - MHS,,480112,LOCAL,Facility,Both,125,mL,,12,10.2,3.4392,12,CorVel,Worker's Compensation,12,100,,percent of total billed charges,,
VANCOMYCIN 50 MG/ML ORAL SOLUTION - MHS,,480112,LOCAL,Facility,Both,125,mL,,12,10.2,3.4392,12,First Health Group Corporation,First Health Network,11.64,97,,percent of total billed charges,,
VANCOMYCIN 50 MG/ML ORAL SOLUTION - MHS,,480112,LOCAL,Facility,Both,125,mL,,12,10.2,3.4392,12,"Health Partners, Inc.",Commercial,11.352,94.6,,percent of total billed charges,,
VANCOMYCIN 50 MG/ML ORAL SOLUTION - MHS,,480112,LOCAL,Facility,Outpatient,125,mL,,12,10.2,3.4392,12,"Health Partners, Inc.",Medicare Advantage,5.88,49,,percent of total billed charges,,
VANCOMYCIN 50 MG/ML ORAL SOLUTION - MHS,,480112,LOCAL,Facility,Inpatient,125,mL,,12,10.2,3.4392,12,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
VANCOMYCIN 50 MG/ML ORAL SOLUTION - MHS,,480112,LOCAL,Facility,Both,125,mL,,12,10.2,3.4392,12,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),7.2,60,,percent of total billed charges,,
VANCOMYCIN 50 MG/ML ORAL SOLUTION - MHS,,480112,LOCAL,Facility,Both,125,mL,,12,10.2,3.4392,12,"Health Partners, Inc.",State of Minnesota Advantage Program,9.78,81.5,,percent of total billed charges,,
VANCOMYCIN 50 MG/ML ORAL SOLUTION - MHS,,480112,LOCAL,Facility,Both,125,mL,,12,10.2,3.4392,12,"Health Partners, Inc.",State Public Programs,6,50,,percent of total billed charges,,
VANCOMYCIN 50 MG/ML ORAL SOLUTION - MHS,,480112,LOCAL,Facility,Both,125,mL,,12,10.2,3.4392,12,Humana Insurance Company,Commercial PPO,11.4,95,,percent of total billed charges,,
VANCOMYCIN 50 MG/ML ORAL SOLUTION - MHS,,480112,LOCAL,Facility,Outpatient,125,mL,,12,10.2,3.4392,12,Humana Insurance Company,Medicare PPO,5.88,49,,percent of total billed charges,,
VANCOMYCIN 50 MG/ML ORAL SOLUTION - MHS,,480112,LOCAL,Facility,Inpatient,125,mL,,12,10.2,3.4392,12,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
VANCOMYCIN 50 MG/ML ORAL SOLUTION - MHS,,480112,LOCAL,Facility,Both,125,mL,,12,10.2,3.4392,12,Medica,Individual & Family,11.892,99.1,,percent of total billed charges,,
VANCOMYCIN 50 MG/ML ORAL SOLUTION - MHS,,480112,LOCAL,Facility,Outpatient,125,mL,,12,10.2,3.4392,12,Medica,Medica Advantage Solution,5.976,49.8,,percent of total billed charges,,
VANCOMYCIN 50 MG/ML ORAL SOLUTION - MHS,,480112,LOCAL,Facility,Inpatient,125,mL,,12,10.2,3.4392,12,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
VANCOMYCIN 50 MG/ML ORAL SOLUTION - MHS,,480112,LOCAL,Facility,Outpatient,125,mL,,12,10.2,3.4392,12,Medica,Medical Assistance,5.352,44.6,,percent of total billed charges,,
VANCOMYCIN 50 MG/ML ORAL SOLUTION - MHS,,480112,LOCAL,Facility,Inpatient,125,mL,,12,10.2,3.4392,12,Medica,Medical Assistance,,,,,Included in per diem rate,
VANCOMYCIN 50 MG/ML ORAL SOLUTION - MHS,,480112,LOCAL,Facility,Outpatient,125,mL,,12,10.2,3.4392,12,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,5.976,49.8,,percent of total billed charges,,
VANCOMYCIN 50 MG/ML ORAL SOLUTION - MHS,,480112,LOCAL,Facility,Inpatient,125,mL,,12,10.2,3.4392,12,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
VANCOMYCIN 50 MG/ML ORAL SOLUTION - MHS,,480112,LOCAL,Facility,Both,125,mL,,12,10.2,3.4392,12,"Multiplan, Inc.","Multiplan, Inc.",11.28,94,,percent of total billed charges,,
VANCOMYCIN 50 MG/ML ORAL SOLUTION - MHS,,480112,LOCAL,Facility,Outpatient,125,mL,,12,10.2,3.4392,12,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,10.812,90.1,,percent of total billed charges,,
VANCOMYCIN 50 MG/ML ORAL SOLUTION - MHS,,480112,LOCAL,Facility,Inpatient,125,mL,,12,10.2,3.4392,12,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
VANCOMYCIN 50 MG/ML ORAL SOLUTION - MHS,,480112,LOCAL,Facility,Both,125,mL,,12,10.2,3.4392,12,"Preferred One Administrative Services, INC.",PPO,11.832,98.6,,percent of total billed charges,,
VANCOMYCIN 50 MG/ML ORAL SOLUTION - MHS,,480112,LOCAL,Facility,Outpatient,125,mL,,12,10.2,3.4392,12,PrimeWest Health,Minnesota Senior Health Options (MSHO),6.174,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
VANCOMYCIN 50 MG/ML ORAL SOLUTION - MHS,,480112,LOCAL,Facility,Inpatient,125,mL,,12,10.2,3.4392,12,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
VANCOMYCIN 50 MG/ML ORAL SOLUTION - MHS,,480112,LOCAL,Facility,Outpatient,125,mL,,12,10.2,3.4392,12,PrimeWest Health,MinnesotaCare,6.1632,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
VANCOMYCIN 50 MG/ML ORAL SOLUTION - MHS,,480112,LOCAL,Facility,Inpatient,125,mL,,12,10.2,3.4392,12,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
VANCOMYCIN 50 MG/ML ORAL SOLUTION - MHS,,480112,LOCAL,Facility,Both,125,mL,,12,10.2,3.4392,12,Sanford Health Plan,Sanford Health Plan,11.04,92,,percent of total billed charges,,
VANCOMYCIN 50 MG/ML ORAL SOLUTION - MHS,,480112,LOCAL,Facility,Outpatient,125,mL,,12,10.2,3.4392,12,"UCare Health, Inc.",Individual & Family Plan,6.762,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
VANCOMYCIN 50 MG/ML ORAL SOLUTION - MHS,,480112,LOCAL,Facility,Inpatient,125,mL,,12,10.2,3.4392,12,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
VANCOMYCIN 50 MG/ML ORAL SOLUTION - MHS,,480112,LOCAL,Facility,Outpatient,125,mL,,12,10.2,3.4392,12,"UCare Health, Inc.",Medical Assistance,6.0564,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
VANCOMYCIN 50 MG/ML ORAL SOLUTION - MHS,,480112,LOCAL,Facility,Inpatient,125,mL,,12,10.2,3.4392,12,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
VANCOMYCIN 50 MG/ML ORAL SOLUTION - MHS,,480112,LOCAL,Facility,Outpatient,125,mL,,12,10.2,3.4392,12,"UCare Health, Inc.",Medicare Advantage,6.0564,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
VANCOMYCIN 50 MG/ML ORAL SOLUTION - MHS,,480112,LOCAL,Facility,Inpatient,125,mL,,12,10.2,3.4392,12,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
VANCOMYCIN 50 MG/ML ORAL SOLUTION - MHS,,480112,LOCAL,Facility,Outpatient,125,mL,,12,10.2,3.4392,12,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),6.0564,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
VANCOMYCIN 50 MG/ML ORAL SOLUTION - MHS,,480112,LOCAL,Facility,Inpatient,125,mL,,12,10.2,3.4392,12,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
VANCOMYCIN 50 MG/ML ORAL SOLUTION - MHS,,480112,LOCAL,Facility,Both,125,mL,,12,10.2,3.4392,12,UnitedHealthcare,Individual & Family,11.28,94,,percent of total billed charges,,
VANCOMYCIN 50 MG/ML ORAL SOLUTION - MHS,,480112,LOCAL,Facility,Outpatient,125,mL,,12,10.2,3.4392,12,UnitedHealthcare,Medicare Advantage,5.88,49,,percent of total billed charges,,
VANCOMYCIN 50 MG/ML ORAL SOLUTION - MHS,,480112,LOCAL,Facility,Inpatient,125,mL,,12,10.2,3.4392,12,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
VANCOMYCIN 50 MG/ML ORAL SOLUTION - MHS,,480112,LOCAL,Facility,Outpatient,125,mL,,12,10.2,3.4392,12,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,5.76,48,,percent of total billed charges,,100% of DHS outpatient percentage
VANCOMYCIN 50 MG/ML ORAL SOLUTION - MHS,,480112,LOCAL,Facility,Inpatient,125,mL,,12,10.2,3.4392,12,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Both,125,mL,,344,292.4,98.5904,344,Aetna,Commercial,316.48,92,,percent of total billed charges,,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Outpatient,125,mL,,344,292.4,98.5904,344,Aetna,Medicare Advantage,168.56,49,,percent of total billed charges,,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Inpatient,125,mL,,344,292.4,98.5904,344,Aetna,Medicare Advantage,,,,,Included in per diem rate,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Both,125,mL,,344,292.4,98.5904,344,Aetna,PPO,319.92,93,,percent of total billed charges,,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Both,125,mL,,344,292.4,98.5904,344,America's PPO,America's PPO,330.3432,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Both,125,mL,,344,292.4,98.5904,344,BlueCross BlueShield Minnesota, Federal Employee Program,338.496,98.4,,percent of total billed charges,,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Both,125,mL,,344,292.4,98.5904,344,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,344,100,,percent of total billed charges,,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Both,125,mL,,344,292.4,98.5904,344,BlueCross BlueShield Minnesota,High Value Network Plan,309.6,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Outpatient,125,mL,,344,292.4,98.5904,344,BlueCross BlueShield Minnesota,Medicare Advantage,168.56,49,,percent of total billed charges,,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Inpatient,125,mL,,344,292.4,98.5904,344,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Both,125,mL,,344,292.4,98.5904,344,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,304.6808,88.57,,percent of total billed charges,,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Both,125,mL,,344,292.4,98.5904,344,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,98.5904,28.66,,percent of total billed charges,,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Outpatient,125,mL,,344,292.4,98.5904,344,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),168.56,49,,percent of total billed charges,,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Inpatient,125,mL,,344,292.4,98.5904,344,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Both,125,mL,,344,292.4,98.5904,344,CorVel,Worker's Compensation,344,100,,percent of total billed charges,,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Both,125,mL,,344,292.4,98.5904,344,First Health Group Corporation,First Health Network,333.68,97,,percent of total billed charges,,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Both,125,mL,,344,292.4,98.5904,344,"Health Partners, Inc.",Commercial,325.424,94.6,,percent of total billed charges,,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Outpatient,125,mL,,344,292.4,98.5904,344,"Health Partners, Inc.",Medicare Advantage,168.56,49,,percent of total billed charges,,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Inpatient,125,mL,,344,292.4,98.5904,344,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Both,125,mL,,344,292.4,98.5904,344,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),206.4,60,,percent of total billed charges,,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Both,125,mL,,344,292.4,98.5904,344,"Health Partners, Inc.",State of Minnesota Advantage Program,280.36,81.5,,percent of total billed charges,,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Both,125,mL,,344,292.4,98.5904,344,"Health Partners, Inc.",State Public Programs,172,50,,percent of total billed charges,,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Both,125,mL,,344,292.4,98.5904,344,Humana Insurance Company,Commercial PPO,326.8,95,,percent of total billed charges,,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Outpatient,125,mL,,344,292.4,98.5904,344,Humana Insurance Company,Medicare PPO,168.56,49,,percent of total billed charges,,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Inpatient,125,mL,,344,292.4,98.5904,344,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Both,125,mL,,344,292.4,98.5904,344,Medica,Individual & Family,340.904,99.1,,percent of total billed charges,,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Outpatient,125,mL,,344,292.4,98.5904,344,Medica,Medica Advantage Solution,171.312,49.8,,percent of total billed charges,,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Inpatient,125,mL,,344,292.4,98.5904,344,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Outpatient,125,mL,,344,292.4,98.5904,344,Medica,Medical Assistance,153.424,44.6,,percent of total billed charges,,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Inpatient,125,mL,,344,292.4,98.5904,344,Medica,Medical Assistance,,,,,Included in per diem rate,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Outpatient,125,mL,,344,292.4,98.5904,344,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,171.312,49.8,,percent of total billed charges,,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Inpatient,125,mL,,344,292.4,98.5904,344,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Both,125,mL,,344,292.4,98.5904,344,"Multiplan, Inc.","Multiplan, Inc.",323.36,94,,percent of total billed charges,,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Outpatient,125,mL,,344,292.4,98.5904,344,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,309.944,90.1,,percent of total billed charges,,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Inpatient,125,mL,,344,292.4,98.5904,344,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Both,125,mL,,344,292.4,98.5904,344,"Preferred One Administrative Services, INC.",PPO,339.184,98.6,,percent of total billed charges,,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Outpatient,125,mL,,344,292.4,98.5904,344,PrimeWest Health,Minnesota Senior Health Options (MSHO),176.988,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Inpatient,125,mL,,344,292.4,98.5904,344,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Outpatient,125,mL,,344,292.4,98.5904,344,PrimeWest Health,MinnesotaCare,176.6784,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Inpatient,125,mL,,344,292.4,98.5904,344,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Both,125,mL,,344,292.4,98.5904,344,Sanford Health Plan,Sanford Health Plan,316.48,92,,percent of total billed charges,,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Outpatient,125,mL,,344,292.4,98.5904,344,"UCare Health, Inc.",Individual & Family Plan,193.844,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Inpatient,125,mL,,344,292.4,98.5904,344,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Outpatient,125,mL,,344,292.4,98.5904,344,"UCare Health, Inc.",Medical Assistance,173.6168,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Inpatient,125,mL,,344,292.4,98.5904,344,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Outpatient,125,mL,,344,292.4,98.5904,344,"UCare Health, Inc.",Medicare Advantage,173.6168,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Inpatient,125,mL,,344,292.4,98.5904,344,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Outpatient,125,mL,,344,292.4,98.5904,344,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),173.6168,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Inpatient,125,mL,,344,292.4,98.5904,344,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Both,125,mL,,344,292.4,98.5904,344,UnitedHealthcare,Individual & Family,323.36,94,,percent of total billed charges,,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Outpatient,125,mL,,344,292.4,98.5904,344,UnitedHealthcare,Medicare Advantage,168.56,49,,percent of total billed charges,,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Inpatient,125,mL,,344,292.4,98.5904,344,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Outpatient,125,mL,,344,292.4,98.5904,344,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,165.12,48,,percent of total billed charges,,100% of DHS outpatient percentage
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Inpatient,125,mL,,344,292.4,98.5904,344,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
SODIUM PHOSPHATES 19-7 GRAM/118 ML RECT ENEMA,,14370,LOCAL,Facility,Both,133,mL,,9,7.65,2.5794,9,Aetna,Commercial,8.28,92,,percent of total billed charges,,
SODIUM PHOSPHATES 19-7 GRAM/118 ML RECT ENEMA,,14370,LOCAL,Facility,Outpatient,133,mL,,9,7.65,2.5794,9,Aetna,Medicare Advantage,4.41,49,,percent of total billed charges,,
SODIUM PHOSPHATES 19-7 GRAM/118 ML RECT ENEMA,,14370,LOCAL,Facility,Inpatient,133,mL,,9,7.65,2.5794,9,Aetna,Medicare Advantage,,,,,Included in per diem rate,
SODIUM PHOSPHATES 19-7 GRAM/118 ML RECT ENEMA,,14370,LOCAL,Facility,Both,133,mL,,9,7.65,2.5794,9,Aetna,PPO,8.37,93,,percent of total billed charges,,
SODIUM PHOSPHATES 19-7 GRAM/118 ML RECT ENEMA,,14370,LOCAL,Facility,Both,133,mL,,9,7.65,2.5794,9,America's PPO,America's PPO,8.6427,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SODIUM PHOSPHATES 19-7 GRAM/118 ML RECT ENEMA,,14370,LOCAL,Facility,Both,133,mL,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota, Federal Employee Program,8.856,98.4,,percent of total billed charges,,
SODIUM PHOSPHATES 19-7 GRAM/118 ML RECT ENEMA,,14370,LOCAL,Facility,Both,133,mL,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,9,100,,percent of total billed charges,,
SODIUM PHOSPHATES 19-7 GRAM/118 ML RECT ENEMA,,14370,LOCAL,Facility,Both,133,mL,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota,High Value Network Plan,8.1,90,,percent of total billed charges,,
SODIUM PHOSPHATES 19-7 GRAM/118 ML RECT ENEMA,,14370,LOCAL,Facility,Outpatient,133,mL,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota,Medicare Advantage,4.41,49,,percent of total billed charges,,
SODIUM PHOSPHATES 19-7 GRAM/118 ML RECT ENEMA,,14370,LOCAL,Facility,Inpatient,133,mL,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
SODIUM PHOSPHATES 19-7 GRAM/118 ML RECT ENEMA,,14370,LOCAL,Facility,Both,133,mL,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,7.9713,88.57,,percent of total billed charges,,
SODIUM PHOSPHATES 19-7 GRAM/118 ML RECT ENEMA,,14370,LOCAL,Facility,Both,133,mL,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,2.5794,28.66,,percent of total billed charges,,
SODIUM PHOSPHATES 19-7 GRAM/118 ML RECT ENEMA,,14370,LOCAL,Facility,Outpatient,133,mL,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),4.41,49,,percent of total billed charges,,
SODIUM PHOSPHATES 19-7 GRAM/118 ML RECT ENEMA,,14370,LOCAL,Facility,Inpatient,133,mL,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
SODIUM PHOSPHATES 19-7 GRAM/118 ML RECT ENEMA,,14370,LOCAL,Facility,Both,133,mL,,9,7.65,2.5794,9,CorVel,Worker's Compensation,9,100,,percent of total billed charges,,
SODIUM PHOSPHATES 19-7 GRAM/118 ML RECT ENEMA,,14370,LOCAL,Facility,Both,133,mL,,9,7.65,2.5794,9,First Health Group Corporation,First Health Network,8.73,97,,percent of total billed charges,,
SODIUM PHOSPHATES 19-7 GRAM/118 ML RECT ENEMA,,14370,LOCAL,Facility,Both,133,mL,,9,7.65,2.5794,9,"Health Partners, Inc.",Commercial,8.514,94.6,,percent of total billed charges,,
SODIUM PHOSPHATES 19-7 GRAM/118 ML RECT ENEMA,,14370,LOCAL,Facility,Outpatient,133,mL,,9,7.65,2.5794,9,"Health Partners, Inc.",Medicare Advantage,4.41,49,,percent of total billed charges,,
SODIUM PHOSPHATES 19-7 GRAM/118 ML RECT ENEMA,,14370,LOCAL,Facility,Inpatient,133,mL,,9,7.65,2.5794,9,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SODIUM PHOSPHATES 19-7 GRAM/118 ML RECT ENEMA,,14370,LOCAL,Facility,Both,133,mL,,9,7.65,2.5794,9,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),5.4,60,,percent of total billed charges,,
SODIUM PHOSPHATES 19-7 GRAM/118 ML RECT ENEMA,,14370,LOCAL,Facility,Both,133,mL,,9,7.65,2.5794,9,"Health Partners, Inc.",State of Minnesota Advantage Program,7.335,81.5,,percent of total billed charges,,
SODIUM PHOSPHATES 19-7 GRAM/118 ML RECT ENEMA,,14370,LOCAL,Facility,Both,133,mL,,9,7.65,2.5794,9,"Health Partners, Inc.",State Public Programs,4.5,50,,percent of total billed charges,,
SODIUM PHOSPHATES 19-7 GRAM/118 ML RECT ENEMA,,14370,LOCAL,Facility,Both,133,mL,,9,7.65,2.5794,9,Humana Insurance Company,Commercial PPO,8.55,95,,percent of total billed charges,,
SODIUM PHOSPHATES 19-7 GRAM/118 ML RECT ENEMA,,14370,LOCAL,Facility,Outpatient,133,mL,,9,7.65,2.5794,9,Humana Insurance Company,Medicare PPO,4.41,49,,percent of total billed charges,,
SODIUM PHOSPHATES 19-7 GRAM/118 ML RECT ENEMA,,14370,LOCAL,Facility,Inpatient,133,mL,,9,7.65,2.5794,9,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
SODIUM PHOSPHATES 19-7 GRAM/118 ML RECT ENEMA,,14370,LOCAL,Facility,Both,133,mL,,9,7.65,2.5794,9,Medica,Individual & Family,8.919,99.1,,percent of total billed charges,,
SODIUM PHOSPHATES 19-7 GRAM/118 ML RECT ENEMA,,14370,LOCAL,Facility,Outpatient,133,mL,,9,7.65,2.5794,9,Medica,Medica Advantage Solution,4.482,49.8,,percent of total billed charges,,
SODIUM PHOSPHATES 19-7 GRAM/118 ML RECT ENEMA,,14370,LOCAL,Facility,Inpatient,133,mL,,9,7.65,2.5794,9,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
SODIUM PHOSPHATES 19-7 GRAM/118 ML RECT ENEMA,,14370,LOCAL,Facility,Outpatient,133,mL,,9,7.65,2.5794,9,Medica,Medical Assistance,4.014,44.6,,percent of total billed charges,,
SODIUM PHOSPHATES 19-7 GRAM/118 ML RECT ENEMA,,14370,LOCAL,Facility,Inpatient,133,mL,,9,7.65,2.5794,9,Medica,Medical Assistance,,,,,Included in per diem rate,
SODIUM PHOSPHATES 19-7 GRAM/118 ML RECT ENEMA,,14370,LOCAL,Facility,Outpatient,133,mL,,9,7.65,2.5794,9,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,4.482,49.8,,percent of total billed charges,,
SODIUM PHOSPHATES 19-7 GRAM/118 ML RECT ENEMA,,14370,LOCAL,Facility,Inpatient,133,mL,,9,7.65,2.5794,9,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
SODIUM PHOSPHATES 19-7 GRAM/118 ML RECT ENEMA,,14370,LOCAL,Facility,Both,133,mL,,9,7.65,2.5794,9,"Multiplan, Inc.","Multiplan, Inc.",8.46,94,,percent of total billed charges,,
SODIUM PHOSPHATES 19-7 GRAM/118 ML RECT ENEMA,,14370,LOCAL,Facility,Outpatient,133,mL,,9,7.65,2.5794,9,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,8.109,90.1,,percent of total billed charges,,
SODIUM PHOSPHATES 19-7 GRAM/118 ML RECT ENEMA,,14370,LOCAL,Facility,Inpatient,133,mL,,9,7.65,2.5794,9,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
SODIUM PHOSPHATES 19-7 GRAM/118 ML RECT ENEMA,,14370,LOCAL,Facility,Both,133,mL,,9,7.65,2.5794,9,"Preferred One Administrative Services, INC.",PPO,8.874,98.6,,percent of total billed charges,,
SODIUM PHOSPHATES 19-7 GRAM/118 ML RECT ENEMA,,14370,LOCAL,Facility,Outpatient,133,mL,,9,7.65,2.5794,9,PrimeWest Health,Minnesota Senior Health Options (MSHO),4.6305,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
SODIUM PHOSPHATES 19-7 GRAM/118 ML RECT ENEMA,,14370,LOCAL,Facility,Inpatient,133,mL,,9,7.65,2.5794,9,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SODIUM PHOSPHATES 19-7 GRAM/118 ML RECT ENEMA,,14370,LOCAL,Facility,Outpatient,133,mL,,9,7.65,2.5794,9,PrimeWest Health,MinnesotaCare,4.6224,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
SODIUM PHOSPHATES 19-7 GRAM/118 ML RECT ENEMA,,14370,LOCAL,Facility,Inpatient,133,mL,,9,7.65,2.5794,9,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
SODIUM PHOSPHATES 19-7 GRAM/118 ML RECT ENEMA,,14370,LOCAL,Facility,Both,133,mL,,9,7.65,2.5794,9,Sanford Health Plan,Sanford Health Plan,8.28,92,,percent of total billed charges,,
SODIUM PHOSPHATES 19-7 GRAM/118 ML RECT ENEMA,,14370,LOCAL,Facility,Outpatient,133,mL,,9,7.65,2.5794,9,"UCare Health, Inc.",Individual & Family Plan,5.0715,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
SODIUM PHOSPHATES 19-7 GRAM/118 ML RECT ENEMA,,14370,LOCAL,Facility,Inpatient,133,mL,,9,7.65,2.5794,9,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
SODIUM PHOSPHATES 19-7 GRAM/118 ML RECT ENEMA,,14370,LOCAL,Facility,Outpatient,133,mL,,9,7.65,2.5794,9,"UCare Health, Inc.",Medical Assistance,4.5423,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SODIUM PHOSPHATES 19-7 GRAM/118 ML RECT ENEMA,,14370,LOCAL,Facility,Inpatient,133,mL,,9,7.65,2.5794,9,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
SODIUM PHOSPHATES 19-7 GRAM/118 ML RECT ENEMA,,14370,LOCAL,Facility,Outpatient,133,mL,,9,7.65,2.5794,9,"UCare Health, Inc.",Medicare Advantage,4.5423,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SODIUM PHOSPHATES 19-7 GRAM/118 ML RECT ENEMA,,14370,LOCAL,Facility,Inpatient,133,mL,,9,7.65,2.5794,9,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SODIUM PHOSPHATES 19-7 GRAM/118 ML RECT ENEMA,,14370,LOCAL,Facility,Outpatient,133,mL,,9,7.65,2.5794,9,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),4.5423,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SODIUM PHOSPHATES 19-7 GRAM/118 ML RECT ENEMA,,14370,LOCAL,Facility,Inpatient,133,mL,,9,7.65,2.5794,9,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SODIUM PHOSPHATES 19-7 GRAM/118 ML RECT ENEMA,,14370,LOCAL,Facility,Both,133,mL,,9,7.65,2.5794,9,UnitedHealthcare,Individual & Family,8.46,94,,percent of total billed charges,,
SODIUM PHOSPHATES 19-7 GRAM/118 ML RECT ENEMA,,14370,LOCAL,Facility,Outpatient,133,mL,,9,7.65,2.5794,9,UnitedHealthcare,Medicare Advantage,4.41,49,,percent of total billed charges,,
SODIUM PHOSPHATES 19-7 GRAM/118 ML RECT ENEMA,,14370,LOCAL,Facility,Inpatient,133,mL,,9,7.65,2.5794,9,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
SODIUM PHOSPHATES 19-7 GRAM/118 ML RECT ENEMA,,14370,LOCAL,Facility,Outpatient,133,mL,,9,7.65,2.5794,9,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,4.32,48,,percent of total billed charges,,100% of DHS outpatient percentage
SODIUM PHOSPHATES 19-7 GRAM/118 ML RECT ENEMA,,14370,LOCAL,Facility,Inpatient,133,mL,,9,7.65,2.5794,9,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
LEVOFLOXACIN IN D5W 750 MG/150 ML IV PGBK,,J1956,HCPCS,Facility,Both,150,mL,,14,11.9,4.0124,14,Aetna,Commercial,12.88,92,,percent of total billed charges,,
LEVOFLOXACIN IN D5W 750 MG/150 ML IV PGBK,,J1956,HCPCS,Facility,Outpatient,150,mL,,14,11.9,4.0124,14,Aetna,Medicare Advantage,6.86,49,,percent of total billed charges,,
LEVOFLOXACIN IN D5W 750 MG/150 ML IV PGBK,,J1956,HCPCS,Facility,Inpatient,150,mL,,14,11.9,4.0124,14,Aetna,Medicare Advantage,,,,,Included in per diem rate,
LEVOFLOXACIN IN D5W 750 MG/150 ML IV PGBK,,J1956,HCPCS,Facility,Both,150,mL,,14,11.9,4.0124,14,Aetna,PPO,13.02,93,,percent of total billed charges,,
LEVOFLOXACIN IN D5W 750 MG/150 ML IV PGBK,,J1956,HCPCS,Facility,Both,150,mL,,14,11.9,4.0124,14,America's PPO,America's PPO,13.4442,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
LEVOFLOXACIN IN D5W 750 MG/150 ML IV PGBK,,J1956,HCPCS,Facility,Both,150,mL,,14,11.9,4.0124,14,BlueCross BlueShield Minnesota, Federal Employee Program,13.776,98.4,,percent of total billed charges,,
LEVOFLOXACIN IN D5W 750 MG/150 ML IV PGBK,,J1956,HCPCS,Facility,Both,150,mL,,14,11.9,4.0124,14,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,14,100,,percent of total billed charges,,
LEVOFLOXACIN IN D5W 750 MG/150 ML IV PGBK,,J1956,HCPCS,Facility,Both,150,mL,,14,11.9,4.0124,14,BlueCross BlueShield Minnesota,High Value Network Plan,12.6,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
LEVOFLOXACIN IN D5W 750 MG/150 ML IV PGBK,,J1956,HCPCS,Facility,Outpatient,150,mL,,14,11.9,4.0124,14,BlueCross BlueShield Minnesota,Medicare Advantage,6.86,49,,percent of total billed charges,,
LEVOFLOXACIN IN D5W 750 MG/150 ML IV PGBK,,J1956,HCPCS,Facility,Inpatient,150,mL,,14,11.9,4.0124,14,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
LEVOFLOXACIN IN D5W 750 MG/150 ML IV PGBK,,J1956,HCPCS,Facility,Both,150,mL,,14,11.9,4.0124,14,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,12.3998,88.57,,percent of total billed charges,,
LEVOFLOXACIN IN D5W 750 MG/150 ML IV PGBK,,J1956,HCPCS,Facility,Both,150,mL,,14,11.9,4.0124,14,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,4.0124,28.66,,percent of total billed charges,,
LEVOFLOXACIN IN D5W 750 MG/150 ML IV PGBK,,J1956,HCPCS,Facility,Outpatient,150,mL,,14,11.9,4.0124,14,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),6.86,49,,percent of total billed charges,,
LEVOFLOXACIN IN D5W 750 MG/150 ML IV PGBK,,J1956,HCPCS,Facility,Inpatient,150,mL,,14,11.9,4.0124,14,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
LEVOFLOXACIN IN D5W 750 MG/150 ML IV PGBK,,J1956,HCPCS,Facility,Both,150,mL,,14,11.9,4.0124,14,CorVel,Worker's Compensation,14,100,,percent of total billed charges,,
LEVOFLOXACIN IN D5W 750 MG/150 ML IV PGBK,,J1956,HCPCS,Facility,Both,150,mL,,14,11.9,4.0124,14,First Health Group Corporation,First Health Network,13.58,97,,percent of total billed charges,,
LEVOFLOXACIN IN D5W 750 MG/150 ML IV PGBK,,J1956,HCPCS,Facility,Both,150,mL,,14,11.9,4.0124,14,"Health Partners, Inc.",Commercial,13.244,94.6,,percent of total billed charges,,
LEVOFLOXACIN IN D5W 750 MG/150 ML IV PGBK,,J1956,HCPCS,Facility,Outpatient,150,mL,,14,11.9,4.0124,14,"Health Partners, Inc.",Medicare Advantage,6.86,49,,percent of total billed charges,,
LEVOFLOXACIN IN D5W 750 MG/150 ML IV PGBK,,J1956,HCPCS,Facility,Inpatient,150,mL,,14,11.9,4.0124,14,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LEVOFLOXACIN IN D5W 750 MG/150 ML IV PGBK,,J1956,HCPCS,Facility,Both,150,mL,,14,11.9,4.0124,14,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),8.4,60,,percent of total billed charges,,
LEVOFLOXACIN IN D5W 750 MG/150 ML IV PGBK,,J1956,HCPCS,Facility,Both,150,mL,,14,11.9,4.0124,14,"Health Partners, Inc.",State of Minnesota Advantage Program,11.41,81.5,,percent of total billed charges,,
LEVOFLOXACIN IN D5W 750 MG/150 ML IV PGBK,,J1956,HCPCS,Facility,Both,150,mL,,14,11.9,4.0124,14,"Health Partners, Inc.",State Public Programs,7,50,,percent of total billed charges,,
LEVOFLOXACIN IN D5W 750 MG/150 ML IV PGBK,,J1956,HCPCS,Facility,Both,150,mL,,14,11.9,4.0124,14,Humana Insurance Company,Commercial PPO,13.3,95,,percent of total billed charges,,
LEVOFLOXACIN IN D5W 750 MG/150 ML IV PGBK,,J1956,HCPCS,Facility,Outpatient,150,mL,,14,11.9,4.0124,14,Humana Insurance Company,Medicare PPO,6.86,49,,percent of total billed charges,,
LEVOFLOXACIN IN D5W 750 MG/150 ML IV PGBK,,J1956,HCPCS,Facility,Inpatient,150,mL,,14,11.9,4.0124,14,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
LEVOFLOXACIN IN D5W 750 MG/150 ML IV PGBK,,J1956,HCPCS,Facility,Both,150,mL,,14,11.9,4.0124,14,Medica,Individual & Family,13.874,99.1,,percent of total billed charges,,
LEVOFLOXACIN IN D5W 750 MG/150 ML IV PGBK,,J1956,HCPCS,Facility,Outpatient,150,mL,,14,11.9,4.0124,14,Medica,Medica Advantage Solution,6.972,49.8,,percent of total billed charges,,
LEVOFLOXACIN IN D5W 750 MG/150 ML IV PGBK,,J1956,HCPCS,Facility,Inpatient,150,mL,,14,11.9,4.0124,14,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
LEVOFLOXACIN IN D5W 750 MG/150 ML IV PGBK,,J1956,HCPCS,Facility,Outpatient,150,mL,,14,11.9,4.0124,14,Medica,Medical Assistance,6.244,44.6,,percent of total billed charges,,
LEVOFLOXACIN IN D5W 750 MG/150 ML IV PGBK,,J1956,HCPCS,Facility,Inpatient,150,mL,,14,11.9,4.0124,14,Medica,Medical Assistance,,,,,Included in per diem rate,
LEVOFLOXACIN IN D5W 750 MG/150 ML IV PGBK,,J1956,HCPCS,Facility,Outpatient,150,mL,,14,11.9,4.0124,14,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,6.972,49.8,,percent of total billed charges,,
LEVOFLOXACIN IN D5W 750 MG/150 ML IV PGBK,,J1956,HCPCS,Facility,Inpatient,150,mL,,14,11.9,4.0124,14,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
LEVOFLOXACIN IN D5W 750 MG/150 ML IV PGBK,,J1956,HCPCS,Facility,Both,150,mL,,14,11.9,4.0124,14,"Multiplan, Inc.","Multiplan, Inc.",13.16,94,,percent of total billed charges,,
LEVOFLOXACIN IN D5W 750 MG/150 ML IV PGBK,,J1956,HCPCS,Facility,Outpatient,150,mL,,14,11.9,4.0124,14,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,12.614,90.1,,percent of total billed charges,,
LEVOFLOXACIN IN D5W 750 MG/150 ML IV PGBK,,J1956,HCPCS,Facility,Inpatient,150,mL,,14,11.9,4.0124,14,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
LEVOFLOXACIN IN D5W 750 MG/150 ML IV PGBK,,J1956,HCPCS,Facility,Both,150,mL,,14,11.9,4.0124,14,"Preferred One Administrative Services, INC.",PPO,13.804,98.6,,percent of total billed charges,,
LEVOFLOXACIN IN D5W 750 MG/150 ML IV PGBK,,J1956,HCPCS,Facility,Outpatient,150,mL,,14,11.9,4.0124,14,PrimeWest Health,Minnesota Senior Health Options (MSHO),7.203,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
LEVOFLOXACIN IN D5W 750 MG/150 ML IV PGBK,,J1956,HCPCS,Facility,Inpatient,150,mL,,14,11.9,4.0124,14,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LEVOFLOXACIN IN D5W 750 MG/150 ML IV PGBK,,J1956,HCPCS,Facility,Outpatient,150,mL,,14,11.9,4.0124,14,PrimeWest Health,MinnesotaCare,7.1904,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
LEVOFLOXACIN IN D5W 750 MG/150 ML IV PGBK,,J1956,HCPCS,Facility,Inpatient,150,mL,,14,11.9,4.0124,14,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
LEVOFLOXACIN IN D5W 750 MG/150 ML IV PGBK,,J1956,HCPCS,Facility,Both,150,mL,,14,11.9,4.0124,14,Sanford Health Plan,Sanford Health Plan,12.88,92,,percent of total billed charges,,
LEVOFLOXACIN IN D5W 750 MG/150 ML IV PGBK,,J1956,HCPCS,Facility,Outpatient,150,mL,,14,11.9,4.0124,14,"UCare Health, Inc.",Individual & Family Plan,7.889,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
LEVOFLOXACIN IN D5W 750 MG/150 ML IV PGBK,,J1956,HCPCS,Facility,Inpatient,150,mL,,14,11.9,4.0124,14,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
LEVOFLOXACIN IN D5W 750 MG/150 ML IV PGBK,,J1956,HCPCS,Facility,Outpatient,150,mL,,14,11.9,4.0124,14,"UCare Health, Inc.",Medical Assistance,7.0658,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LEVOFLOXACIN IN D5W 750 MG/150 ML IV PGBK,,J1956,HCPCS,Facility,Inpatient,150,mL,,14,11.9,4.0124,14,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
LEVOFLOXACIN IN D5W 750 MG/150 ML IV PGBK,,J1956,HCPCS,Facility,Outpatient,150,mL,,14,11.9,4.0124,14,"UCare Health, Inc.",Medicare Advantage,7.0658,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LEVOFLOXACIN IN D5W 750 MG/150 ML IV PGBK,,J1956,HCPCS,Facility,Inpatient,150,mL,,14,11.9,4.0124,14,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LEVOFLOXACIN IN D5W 750 MG/150 ML IV PGBK,,J1956,HCPCS,Facility,Outpatient,150,mL,,14,11.9,4.0124,14,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),7.0658,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LEVOFLOXACIN IN D5W 750 MG/150 ML IV PGBK,,J1956,HCPCS,Facility,Inpatient,150,mL,,14,11.9,4.0124,14,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LEVOFLOXACIN IN D5W 750 MG/150 ML IV PGBK,,J1956,HCPCS,Facility,Both,150,mL,,14,11.9,4.0124,14,UnitedHealthcare,Individual & Family,13.16,94,,percent of total billed charges,,
LEVOFLOXACIN IN D5W 750 MG/150 ML IV PGBK,,J1956,HCPCS,Facility,Outpatient,150,mL,,14,11.9,4.0124,14,UnitedHealthcare,Medicare Advantage,6.86,49,,percent of total billed charges,,
LEVOFLOXACIN IN D5W 750 MG/150 ML IV PGBK,,J1956,HCPCS,Facility,Inpatient,150,mL,,14,11.9,4.0124,14,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
LEVOFLOXACIN IN D5W 750 MG/150 ML IV PGBK,,J1956,HCPCS,Facility,Outpatient,150,mL,,14,11.9,4.0124,14,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,6.72,48,,percent of total billed charges,,100% of DHS outpatient percentage
LEVOFLOXACIN IN D5W 750 MG/150 ML IV PGBK,,J1956,HCPCS,Facility,Inpatient,150,mL,,14,11.9,4.0124,14,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 750 MG/150 ML IV PGBK,,J3372,HCPCS,Facility,Both,150,mL,,70,59.5,20.062,70,Aetna,Commercial,64.4,92,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 750 MG/150 ML IV PGBK,,J3372,HCPCS,Facility,Both,150,mL,,70,59.5,20.062,70,Aetna,Commercial,64.4,92,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 750 MG/150 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,150,mL,,70,59.5,20.062,70,Aetna,Medicare Advantage,34.3,49,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 750 MG/150 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,150,mL,,70,59.5,20.062,70,Aetna,Medicare Advantage,34.3,49,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 750 MG/150 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,150,mL,,70,59.5,20.062,70,Aetna,Medicare Advantage,,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 750 MG/150 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,150,mL,,70,59.5,20.062,70,Aetna,Medicare Advantage,,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 750 MG/150 ML IV PGBK,,J3372,HCPCS,Facility,Both,150,mL,,70,59.5,20.062,70,Aetna,PPO,65.1,93,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 750 MG/150 ML IV PGBK,,J3372,HCPCS,Facility,Both,150,mL,,70,59.5,20.062,70,Aetna,PPO,65.1,93,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 750 MG/150 ML IV PGBK,,J3372,HCPCS,Facility,Both,150,mL,,70,59.5,20.062,70,America's PPO,America's PPO,67.221,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
VANCOMYCIN-DILUENT COMBO NO.1 750 MG/150 ML IV PGBK,,J3372,HCPCS,Facility,Both,150,mL,,70,59.5,20.062,70,America's PPO,America's PPO,67.221,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
VANCOMYCIN-DILUENT COMBO NO.1 750 MG/150 ML IV PGBK,,J3372,HCPCS,Facility,Both,150,mL,,70,59.5,20.062,70,BlueCross BlueShield Minnesota, Federal Employee Program,68.88,98.4,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 750 MG/150 ML IV PGBK,,J3372,HCPCS,Facility,Both,150,mL,,70,59.5,20.062,70,BlueCross BlueShield Minnesota, Federal Employee Program,68.88,98.4,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 750 MG/150 ML IV PGBK,,J3372,HCPCS,Facility,Both,150,mL,,70,59.5,20.062,70,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,70,100,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 750 MG/150 ML IV PGBK,,J3372,HCPCS,Facility,Both,150,mL,,70,59.5,20.062,70,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,70,100,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 750 MG/150 ML IV PGBK,,J3372,HCPCS,Facility,Both,150,mL,,70,59.5,20.062,70,BlueCross BlueShield Minnesota,High Value Network Plan,63,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
VANCOMYCIN-DILUENT COMBO NO.1 750 MG/150 ML IV PGBK,,J3372,HCPCS,Facility,Both,150,mL,,70,59.5,20.062,70,BlueCross BlueShield Minnesota,High Value Network Plan,63,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
VANCOMYCIN-DILUENT COMBO NO.1 750 MG/150 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,150,mL,,70,59.5,20.062,70,BlueCross BlueShield Minnesota,Medicare Advantage,34.3,49,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 750 MG/150 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,150,mL,,70,59.5,20.062,70,BlueCross BlueShield Minnesota,Medicare Advantage,34.3,49,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 750 MG/150 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,150,mL,,70,59.5,20.062,70,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 750 MG/150 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,150,mL,,70,59.5,20.062,70,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 750 MG/150 ML IV PGBK,,J3372,HCPCS,Facility,Both,150,mL,,70,59.5,20.062,70,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,61.999,88.57,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 750 MG/150 ML IV PGBK,,J3372,HCPCS,Facility,Both,150,mL,,70,59.5,20.062,70,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,61.999,88.57,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 750 MG/150 ML IV PGBK,,J3372,HCPCS,Facility,Both,150,mL,,70,59.5,20.062,70,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,20.062,28.66,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 750 MG/150 ML IV PGBK,,J3372,HCPCS,Facility,Both,150,mL,,70,59.5,20.062,70,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,20.062,28.66,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 750 MG/150 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,150,mL,,70,59.5,20.062,70,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),34.3,49,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 750 MG/150 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,150,mL,,70,59.5,20.062,70,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),34.3,49,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 750 MG/150 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,150,mL,,70,59.5,20.062,70,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 750 MG/150 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,150,mL,,70,59.5,20.062,70,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 750 MG/150 ML IV PGBK,,J3372,HCPCS,Facility,Both,150,mL,,70,59.5,20.062,70,CorVel,Worker's Compensation,70,100,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 750 MG/150 ML IV PGBK,,J3372,HCPCS,Facility,Both,150,mL,,70,59.5,20.062,70,CorVel,Worker's Compensation,70,100,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 750 MG/150 ML IV PGBK,,J3372,HCPCS,Facility,Both,150,mL,,70,59.5,20.062,70,First Health Group Corporation,First Health Network,67.9,97,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 750 MG/150 ML IV PGBK,,J3372,HCPCS,Facility,Both,150,mL,,70,59.5,20.062,70,First Health Group Corporation,First Health Network,67.9,97,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 750 MG/150 ML IV PGBK,,J3372,HCPCS,Facility,Both,150,mL,,70,59.5,20.062,70,"Health Partners, Inc.",Commercial,66.22,94.6,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 750 MG/150 ML IV PGBK,,J3372,HCPCS,Facility,Both,150,mL,,70,59.5,20.062,70,"Health Partners, Inc.",Commercial,66.22,94.6,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 750 MG/150 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,150,mL,,70,59.5,20.062,70,"Health Partners, Inc.",Medicare Advantage,34.3,49,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 750 MG/150 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,150,mL,,70,59.5,20.062,70,"Health Partners, Inc.",Medicare Advantage,34.3,49,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 750 MG/150 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,150,mL,,70,59.5,20.062,70,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 750 MG/150 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,150,mL,,70,59.5,20.062,70,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 750 MG/150 ML IV PGBK,,J3372,HCPCS,Facility,Both,150,mL,,70,59.5,20.062,70,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),42,60,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 750 MG/150 ML IV PGBK,,J3372,HCPCS,Facility,Both,150,mL,,70,59.5,20.062,70,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),42,60,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 750 MG/150 ML IV PGBK,,J3372,HCPCS,Facility,Both,150,mL,,70,59.5,20.062,70,"Health Partners, Inc.",State of Minnesota Advantage Program,57.05,81.5,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 750 MG/150 ML IV PGBK,,J3372,HCPCS,Facility,Both,150,mL,,70,59.5,20.062,70,"Health Partners, Inc.",State of Minnesota Advantage Program,57.05,81.5,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 750 MG/150 ML IV PGBK,,J3372,HCPCS,Facility,Both,150,mL,,70,59.5,20.062,70,"Health Partners, Inc.",State Public Programs,35,50,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 750 MG/150 ML IV PGBK,,J3372,HCPCS,Facility,Both,150,mL,,70,59.5,20.062,70,"Health Partners, Inc.",State Public Programs,35,50,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 750 MG/150 ML IV PGBK,,J3372,HCPCS,Facility,Both,150,mL,,70,59.5,20.062,70,Humana Insurance Company,Commercial PPO,66.5,95,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 750 MG/150 ML IV PGBK,,J3372,HCPCS,Facility,Both,150,mL,,70,59.5,20.062,70,Humana Insurance Company,Commercial PPO,66.5,95,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 750 MG/150 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,150,mL,,70,59.5,20.062,70,Humana Insurance Company,Medicare PPO,34.3,49,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 750 MG/150 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,150,mL,,70,59.5,20.062,70,Humana Insurance Company,Medicare PPO,34.3,49,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 750 MG/150 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,150,mL,,70,59.5,20.062,70,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 750 MG/150 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,150,mL,,70,59.5,20.062,70,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 750 MG/150 ML IV PGBK,,J3372,HCPCS,Facility,Both,150,mL,,70,59.5,20.062,70,Medica,Individual & Family,69.37,99.1,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 750 MG/150 ML IV PGBK,,J3372,HCPCS,Facility,Both,150,mL,,70,59.5,20.062,70,Medica,Individual & Family,69.37,99.1,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 750 MG/150 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,150,mL,,70,59.5,20.062,70,Medica,Medica Advantage Solution,34.86,49.8,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 750 MG/150 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,150,mL,,70,59.5,20.062,70,Medica,Medica Advantage Solution,34.86,49.8,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 750 MG/150 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,150,mL,,70,59.5,20.062,70,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 750 MG/150 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,150,mL,,70,59.5,20.062,70,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 750 MG/150 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,150,mL,,70,59.5,20.062,70,Medica,Medical Assistance,31.22,44.6,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 750 MG/150 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,150,mL,,70,59.5,20.062,70,Medica,Medical Assistance,31.22,44.6,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 750 MG/150 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,150,mL,,70,59.5,20.062,70,Medica,Medical Assistance,,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 750 MG/150 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,150,mL,,70,59.5,20.062,70,Medica,Medical Assistance,,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 750 MG/150 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,150,mL,,70,59.5,20.062,70,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,34.86,49.8,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 750 MG/150 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,150,mL,,70,59.5,20.062,70,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,34.86,49.8,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 750 MG/150 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,150,mL,,70,59.5,20.062,70,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 750 MG/150 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,150,mL,,70,59.5,20.062,70,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 750 MG/150 ML IV PGBK,,J3372,HCPCS,Facility,Both,150,mL,,70,59.5,20.062,70,"Multiplan, Inc.","Multiplan, Inc.",65.8,94,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 750 MG/150 ML IV PGBK,,J3372,HCPCS,Facility,Both,150,mL,,70,59.5,20.062,70,"Multiplan, Inc.","Multiplan, Inc.",65.8,94,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 750 MG/150 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,150,mL,,70,59.5,20.062,70,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,63.07,90.1,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 750 MG/150 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,150,mL,,70,59.5,20.062,70,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,63.07,90.1,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 750 MG/150 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,150,mL,,70,59.5,20.062,70,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
VANCOMYCIN-DILUENT COMBO NO.1 750 MG/150 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,150,mL,,70,59.5,20.062,70,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
VANCOMYCIN-DILUENT COMBO NO.1 750 MG/150 ML IV PGBK,,J3372,HCPCS,Facility,Both,150,mL,,70,59.5,20.062,70,"Preferred One Administrative Services, INC.",PPO,69.02,98.6,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 750 MG/150 ML IV PGBK,,J3372,HCPCS,Facility,Both,150,mL,,70,59.5,20.062,70,"Preferred One Administrative Services, INC.",PPO,69.02,98.6,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 750 MG/150 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,150,mL,,70,59.5,20.062,70,PrimeWest Health,Minnesota Senior Health Options (MSHO),36.015,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
VANCOMYCIN-DILUENT COMBO NO.1 750 MG/150 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,150,mL,,70,59.5,20.062,70,PrimeWest Health,Minnesota Senior Health Options (MSHO),36.015,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
VANCOMYCIN-DILUENT COMBO NO.1 750 MG/150 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,150,mL,,70,59.5,20.062,70,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 750 MG/150 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,150,mL,,70,59.5,20.062,70,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 750 MG/150 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,150,mL,,70,59.5,20.062,70,PrimeWest Health,MinnesotaCare,35.952,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
VANCOMYCIN-DILUENT COMBO NO.1 750 MG/150 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,150,mL,,70,59.5,20.062,70,PrimeWest Health,MinnesotaCare,35.952,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
VANCOMYCIN-DILUENT COMBO NO.1 750 MG/150 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,150,mL,,70,59.5,20.062,70,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 750 MG/150 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,150,mL,,70,59.5,20.062,70,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 750 MG/150 ML IV PGBK,,J3372,HCPCS,Facility,Both,150,mL,,70,59.5,20.062,70,Sanford Health Plan,Sanford Health Plan,64.4,92,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 750 MG/150 ML IV PGBK,,J3372,HCPCS,Facility,Both,150,mL,,70,59.5,20.062,70,Sanford Health Plan,Sanford Health Plan,64.4,92,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 750 MG/150 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,150,mL,,70,59.5,20.062,70,"UCare Health, Inc.",Individual & Family Plan,39.445,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
VANCOMYCIN-DILUENT COMBO NO.1 750 MG/150 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,150,mL,,70,59.5,20.062,70,"UCare Health, Inc.",Individual & Family Plan,39.445,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
VANCOMYCIN-DILUENT COMBO NO.1 750 MG/150 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,150,mL,,70,59.5,20.062,70,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 750 MG/150 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,150,mL,,70,59.5,20.062,70,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 750 MG/150 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,150,mL,,70,59.5,20.062,70,"UCare Health, Inc.",Medical Assistance,35.329,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
VANCOMYCIN-DILUENT COMBO NO.1 750 MG/150 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,150,mL,,70,59.5,20.062,70,"UCare Health, Inc.",Medical Assistance,35.329,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
VANCOMYCIN-DILUENT COMBO NO.1 750 MG/150 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,150,mL,,70,59.5,20.062,70,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 750 MG/150 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,150,mL,,70,59.5,20.062,70,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 750 MG/150 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,150,mL,,70,59.5,20.062,70,"UCare Health, Inc.",Medicare Advantage,35.329,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
VANCOMYCIN-DILUENT COMBO NO.1 750 MG/150 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,150,mL,,70,59.5,20.062,70,"UCare Health, Inc.",Medicare Advantage,35.329,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
VANCOMYCIN-DILUENT COMBO NO.1 750 MG/150 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,150,mL,,70,59.5,20.062,70,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 750 MG/150 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,150,mL,,70,59.5,20.062,70,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 750 MG/150 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,150,mL,,70,59.5,20.062,70,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),35.329,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
VANCOMYCIN-DILUENT COMBO NO.1 750 MG/150 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,150,mL,,70,59.5,20.062,70,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),35.329,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
VANCOMYCIN-DILUENT COMBO NO.1 750 MG/150 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,150,mL,,70,59.5,20.062,70,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 750 MG/150 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,150,mL,,70,59.5,20.062,70,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 750 MG/150 ML IV PGBK,,J3372,HCPCS,Facility,Both,150,mL,,70,59.5,20.062,70,UnitedHealthcare,Individual & Family,65.8,94,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 750 MG/150 ML IV PGBK,,J3372,HCPCS,Facility,Both,150,mL,,70,59.5,20.062,70,UnitedHealthcare,Individual & Family,65.8,94,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 750 MG/150 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,150,mL,,70,59.5,20.062,70,UnitedHealthcare,Medicare Advantage,34.3,49,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 750 MG/150 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,150,mL,,70,59.5,20.062,70,UnitedHealthcare,Medicare Advantage,34.3,49,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 750 MG/150 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,150,mL,,70,59.5,20.062,70,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 750 MG/150 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,150,mL,,70,59.5,20.062,70,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 750 MG/150 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,150,mL,,70,59.5,20.062,70,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,33.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
VANCOMYCIN-DILUENT COMBO NO.1 750 MG/150 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,150,mL,,70,59.5,20.062,70,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,33.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
VANCOMYCIN-DILUENT COMBO NO.1 750 MG/150 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,150,mL,,70,59.5,20.062,70,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 750 MG/150 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,150,mL,,70,59.5,20.062,70,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Both,150,mL,,413,351.05,118.3658,413,Aetna,Commercial,379.96,92,,percent of total billed charges,,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Outpatient,150,mL,,413,351.05,118.3658,413,Aetna,Medicare Advantage,202.37,49,,percent of total billed charges,,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Inpatient,150,mL,,413,351.05,118.3658,413,Aetna,Medicare Advantage,,,,,Included in per diem rate,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Both,150,mL,,413,351.05,118.3658,413,Aetna,PPO,384.09,93,,percent of total billed charges,,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Both,150,mL,,413,351.05,118.3658,413,America's PPO,America's PPO,396.6039,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Both,150,mL,,413,351.05,118.3658,413,BlueCross BlueShield Minnesota, Federal Employee Program,406.392,98.4,,percent of total billed charges,,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Both,150,mL,,413,351.05,118.3658,413,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,413,100,,percent of total billed charges,,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Both,150,mL,,413,351.05,118.3658,413,BlueCross BlueShield Minnesota,High Value Network Plan,371.7,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Outpatient,150,mL,,413,351.05,118.3658,413,BlueCross BlueShield Minnesota,Medicare Advantage,202.37,49,,percent of total billed charges,,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Inpatient,150,mL,,413,351.05,118.3658,413,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Both,150,mL,,413,351.05,118.3658,413,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,365.7941,88.57,,percent of total billed charges,,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Both,150,mL,,413,351.05,118.3658,413,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,118.3658,28.66,,percent of total billed charges,,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Outpatient,150,mL,,413,351.05,118.3658,413,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),202.37,49,,percent of total billed charges,,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Inpatient,150,mL,,413,351.05,118.3658,413,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Both,150,mL,,413,351.05,118.3658,413,CorVel,Worker's Compensation,413,100,,percent of total billed charges,,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Both,150,mL,,413,351.05,118.3658,413,First Health Group Corporation,First Health Network,400.61,97,,percent of total billed charges,,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Both,150,mL,,413,351.05,118.3658,413,"Health Partners, Inc.",Commercial,390.698,94.6,,percent of total billed charges,,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Outpatient,150,mL,,413,351.05,118.3658,413,"Health Partners, Inc.",Medicare Advantage,202.37,49,,percent of total billed charges,,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Inpatient,150,mL,,413,351.05,118.3658,413,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Both,150,mL,,413,351.05,118.3658,413,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),247.8,60,,percent of total billed charges,,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Both,150,mL,,413,351.05,118.3658,413,"Health Partners, Inc.",State of Minnesota Advantage Program,336.595,81.5,,percent of total billed charges,,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Both,150,mL,,413,351.05,118.3658,413,"Health Partners, Inc.",State Public Programs,206.5,50,,percent of total billed charges,,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Both,150,mL,,413,351.05,118.3658,413,Humana Insurance Company,Commercial PPO,392.35,95,,percent of total billed charges,,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Outpatient,150,mL,,413,351.05,118.3658,413,Humana Insurance Company,Medicare PPO,202.37,49,,percent of total billed charges,,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Inpatient,150,mL,,413,351.05,118.3658,413,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Both,150,mL,,413,351.05,118.3658,413,Medica,Individual & Family,409.283,99.1,,percent of total billed charges,,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Outpatient,150,mL,,413,351.05,118.3658,413,Medica,Medica Advantage Solution,205.674,49.8,,percent of total billed charges,,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Inpatient,150,mL,,413,351.05,118.3658,413,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Outpatient,150,mL,,413,351.05,118.3658,413,Medica,Medical Assistance,184.198,44.6,,percent of total billed charges,,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Inpatient,150,mL,,413,351.05,118.3658,413,Medica,Medical Assistance,,,,,Included in per diem rate,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Outpatient,150,mL,,413,351.05,118.3658,413,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,205.674,49.8,,percent of total billed charges,,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Inpatient,150,mL,,413,351.05,118.3658,413,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Both,150,mL,,413,351.05,118.3658,413,"Multiplan, Inc.","Multiplan, Inc.",388.22,94,,percent of total billed charges,,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Outpatient,150,mL,,413,351.05,118.3658,413,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,372.113,90.1,,percent of total billed charges,,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Inpatient,150,mL,,413,351.05,118.3658,413,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Both,150,mL,,413,351.05,118.3658,413,"Preferred One Administrative Services, INC.",PPO,407.218,98.6,,percent of total billed charges,,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Outpatient,150,mL,,413,351.05,118.3658,413,PrimeWest Health,Minnesota Senior Health Options (MSHO),212.4885,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Inpatient,150,mL,,413,351.05,118.3658,413,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Outpatient,150,mL,,413,351.05,118.3658,413,PrimeWest Health,MinnesotaCare,212.1168,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Inpatient,150,mL,,413,351.05,118.3658,413,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Both,150,mL,,413,351.05,118.3658,413,Sanford Health Plan,Sanford Health Plan,379.96,92,,percent of total billed charges,,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Outpatient,150,mL,,413,351.05,118.3658,413,"UCare Health, Inc.",Individual & Family Plan,232.7255,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Inpatient,150,mL,,413,351.05,118.3658,413,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Outpatient,150,mL,,413,351.05,118.3658,413,"UCare Health, Inc.",Medical Assistance,208.4411,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Inpatient,150,mL,,413,351.05,118.3658,413,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Outpatient,150,mL,,413,351.05,118.3658,413,"UCare Health, Inc.",Medicare Advantage,208.4411,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Inpatient,150,mL,,413,351.05,118.3658,413,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Outpatient,150,mL,,413,351.05,118.3658,413,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),208.4411,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Inpatient,150,mL,,413,351.05,118.3658,413,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Both,150,mL,,413,351.05,118.3658,413,UnitedHealthcare,Individual & Family,388.22,94,,percent of total billed charges,,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Outpatient,150,mL,,413,351.05,118.3658,413,UnitedHealthcare,Medicare Advantage,202.37,49,,percent of total billed charges,,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Inpatient,150,mL,,413,351.05,118.3658,413,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Outpatient,150,mL,,413,351.05,118.3658,413,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,198.24,48,,percent of total billed charges,,100% of DHS outpatient percentage
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Inpatient,150,mL,,413,351.05,118.3658,413,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
WHEAT DEXTRIN 3 GRAM/4 GRAM ORAL POWD,,119072,LOCAL,Facility,Both,152,g,,40,34,11.464,40,Aetna,Commercial,36.8,92,,percent of total billed charges,,
WHEAT DEXTRIN 3 GRAM/4 GRAM ORAL POWD,,119072,LOCAL,Facility,Outpatient,152,g,,40,34,11.464,40,Aetna,Medicare Advantage,19.6,49,,percent of total billed charges,,
WHEAT DEXTRIN 3 GRAM/4 GRAM ORAL POWD,,119072,LOCAL,Facility,Inpatient,152,g,,40,34,11.464,40,Aetna,Medicare Advantage,,,,,Included in per diem rate,
WHEAT DEXTRIN 3 GRAM/4 GRAM ORAL POWD,,119072,LOCAL,Facility,Both,152,g,,40,34,11.464,40,Aetna,PPO,37.2,93,,percent of total billed charges,,
WHEAT DEXTRIN 3 GRAM/4 GRAM ORAL POWD,,119072,LOCAL,Facility,Both,152,g,,40,34,11.464,40,America's PPO,America's PPO,38.412,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
WHEAT DEXTRIN 3 GRAM/4 GRAM ORAL POWD,,119072,LOCAL,Facility,Both,152,g,,40,34,11.464,40,BlueCross BlueShield Minnesota, Federal Employee Program,39.36,98.4,,percent of total billed charges,,
WHEAT DEXTRIN 3 GRAM/4 GRAM ORAL POWD,,119072,LOCAL,Facility,Both,152,g,,40,34,11.464,40,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,40,100,,percent of total billed charges,,
WHEAT DEXTRIN 3 GRAM/4 GRAM ORAL POWD,,119072,LOCAL,Facility,Both,152,g,,40,34,11.464,40,BlueCross BlueShield Minnesota,High Value Network Plan,36,90,,percent of total billed charges,,
WHEAT DEXTRIN 3 GRAM/4 GRAM ORAL POWD,,119072,LOCAL,Facility,Outpatient,152,g,,40,34,11.464,40,BlueCross BlueShield Minnesota,Medicare Advantage,19.6,49,,percent of total billed charges,,
WHEAT DEXTRIN 3 GRAM/4 GRAM ORAL POWD,,119072,LOCAL,Facility,Inpatient,152,g,,40,34,11.464,40,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
WHEAT DEXTRIN 3 GRAM/4 GRAM ORAL POWD,,119072,LOCAL,Facility,Both,152,g,,40,34,11.464,40,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,35.428,88.57,,percent of total billed charges,,
WHEAT DEXTRIN 3 GRAM/4 GRAM ORAL POWD,,119072,LOCAL,Facility,Both,152,g,,40,34,11.464,40,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,11.464,28.66,,percent of total billed charges,,
WHEAT DEXTRIN 3 GRAM/4 GRAM ORAL POWD,,119072,LOCAL,Facility,Outpatient,152,g,,40,34,11.464,40,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),19.6,49,,percent of total billed charges,,
WHEAT DEXTRIN 3 GRAM/4 GRAM ORAL POWD,,119072,LOCAL,Facility,Inpatient,152,g,,40,34,11.464,40,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
WHEAT DEXTRIN 3 GRAM/4 GRAM ORAL POWD,,119072,LOCAL,Facility,Both,152,g,,40,34,11.464,40,CorVel,Worker's Compensation,40,100,,percent of total billed charges,,
WHEAT DEXTRIN 3 GRAM/4 GRAM ORAL POWD,,119072,LOCAL,Facility,Both,152,g,,40,34,11.464,40,First Health Group Corporation,First Health Network,38.8,97,,percent of total billed charges,,
WHEAT DEXTRIN 3 GRAM/4 GRAM ORAL POWD,,119072,LOCAL,Facility,Both,152,g,,40,34,11.464,40,"Health Partners, Inc.",Commercial,37.84,94.6,,percent of total billed charges,,
WHEAT DEXTRIN 3 GRAM/4 GRAM ORAL POWD,,119072,LOCAL,Facility,Outpatient,152,g,,40,34,11.464,40,"Health Partners, Inc.",Medicare Advantage,19.6,49,,percent of total billed charges,,
WHEAT DEXTRIN 3 GRAM/4 GRAM ORAL POWD,,119072,LOCAL,Facility,Inpatient,152,g,,40,34,11.464,40,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
WHEAT DEXTRIN 3 GRAM/4 GRAM ORAL POWD,,119072,LOCAL,Facility,Both,152,g,,40,34,11.464,40,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),24,60,,percent of total billed charges,,
WHEAT DEXTRIN 3 GRAM/4 GRAM ORAL POWD,,119072,LOCAL,Facility,Both,152,g,,40,34,11.464,40,"Health Partners, Inc.",State of Minnesota Advantage Program,32.6,81.5,,percent of total billed charges,,
WHEAT DEXTRIN 3 GRAM/4 GRAM ORAL POWD,,119072,LOCAL,Facility,Both,152,g,,40,34,11.464,40,"Health Partners, Inc.",State Public Programs,20,50,,percent of total billed charges,,
WHEAT DEXTRIN 3 GRAM/4 GRAM ORAL POWD,,119072,LOCAL,Facility,Both,152,g,,40,34,11.464,40,Humana Insurance Company,Commercial PPO,38,95,,percent of total billed charges,,
WHEAT DEXTRIN 3 GRAM/4 GRAM ORAL POWD,,119072,LOCAL,Facility,Outpatient,152,g,,40,34,11.464,40,Humana Insurance Company,Medicare PPO,19.6,49,,percent of total billed charges,,
WHEAT DEXTRIN 3 GRAM/4 GRAM ORAL POWD,,119072,LOCAL,Facility,Inpatient,152,g,,40,34,11.464,40,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
WHEAT DEXTRIN 3 GRAM/4 GRAM ORAL POWD,,119072,LOCAL,Facility,Both,152,g,,40,34,11.464,40,Medica,Individual & Family,39.64,99.1,,percent of total billed charges,,
WHEAT DEXTRIN 3 GRAM/4 GRAM ORAL POWD,,119072,LOCAL,Facility,Outpatient,152,g,,40,34,11.464,40,Medica,Medica Advantage Solution,19.92,49.8,,percent of total billed charges,,
WHEAT DEXTRIN 3 GRAM/4 GRAM ORAL POWD,,119072,LOCAL,Facility,Inpatient,152,g,,40,34,11.464,40,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
WHEAT DEXTRIN 3 GRAM/4 GRAM ORAL POWD,,119072,LOCAL,Facility,Outpatient,152,g,,40,34,11.464,40,Medica,Medical Assistance,17.84,44.6,,percent of total billed charges,,
WHEAT DEXTRIN 3 GRAM/4 GRAM ORAL POWD,,119072,LOCAL,Facility,Inpatient,152,g,,40,34,11.464,40,Medica,Medical Assistance,,,,,Included in per diem rate,
WHEAT DEXTRIN 3 GRAM/4 GRAM ORAL POWD,,119072,LOCAL,Facility,Outpatient,152,g,,40,34,11.464,40,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,19.92,49.8,,percent of total billed charges,,
WHEAT DEXTRIN 3 GRAM/4 GRAM ORAL POWD,,119072,LOCAL,Facility,Inpatient,152,g,,40,34,11.464,40,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
WHEAT DEXTRIN 3 GRAM/4 GRAM ORAL POWD,,119072,LOCAL,Facility,Both,152,g,,40,34,11.464,40,"Multiplan, Inc.","Multiplan, Inc.",37.6,94,,percent of total billed charges,,
WHEAT DEXTRIN 3 GRAM/4 GRAM ORAL POWD,,119072,LOCAL,Facility,Outpatient,152,g,,40,34,11.464,40,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,36.04,90.1,,percent of total billed charges,,
WHEAT DEXTRIN 3 GRAM/4 GRAM ORAL POWD,,119072,LOCAL,Facility,Inpatient,152,g,,40,34,11.464,40,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
WHEAT DEXTRIN 3 GRAM/4 GRAM ORAL POWD,,119072,LOCAL,Facility,Both,152,g,,40,34,11.464,40,"Preferred One Administrative Services, INC.",PPO,39.44,98.6,,percent of total billed charges,,
WHEAT DEXTRIN 3 GRAM/4 GRAM ORAL POWD,,119072,LOCAL,Facility,Outpatient,152,g,,40,34,11.464,40,PrimeWest Health,Minnesota Senior Health Options (MSHO),20.58,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
WHEAT DEXTRIN 3 GRAM/4 GRAM ORAL POWD,,119072,LOCAL,Facility,Inpatient,152,g,,40,34,11.464,40,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
WHEAT DEXTRIN 3 GRAM/4 GRAM ORAL POWD,,119072,LOCAL,Facility,Outpatient,152,g,,40,34,11.464,40,PrimeWest Health,MinnesotaCare,20.544,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
WHEAT DEXTRIN 3 GRAM/4 GRAM ORAL POWD,,119072,LOCAL,Facility,Inpatient,152,g,,40,34,11.464,40,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
WHEAT DEXTRIN 3 GRAM/4 GRAM ORAL POWD,,119072,LOCAL,Facility,Both,152,g,,40,34,11.464,40,Sanford Health Plan,Sanford Health Plan,36.8,92,,percent of total billed charges,,
WHEAT DEXTRIN 3 GRAM/4 GRAM ORAL POWD,,119072,LOCAL,Facility,Outpatient,152,g,,40,34,11.464,40,"UCare Health, Inc.",Individual & Family Plan,22.54,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
WHEAT DEXTRIN 3 GRAM/4 GRAM ORAL POWD,,119072,LOCAL,Facility,Inpatient,152,g,,40,34,11.464,40,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
WHEAT DEXTRIN 3 GRAM/4 GRAM ORAL POWD,,119072,LOCAL,Facility,Outpatient,152,g,,40,34,11.464,40,"UCare Health, Inc.",Medical Assistance,20.188,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
WHEAT DEXTRIN 3 GRAM/4 GRAM ORAL POWD,,119072,LOCAL,Facility,Inpatient,152,g,,40,34,11.464,40,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
WHEAT DEXTRIN 3 GRAM/4 GRAM ORAL POWD,,119072,LOCAL,Facility,Outpatient,152,g,,40,34,11.464,40,"UCare Health, Inc.",Medicare Advantage,20.188,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
WHEAT DEXTRIN 3 GRAM/4 GRAM ORAL POWD,,119072,LOCAL,Facility,Inpatient,152,g,,40,34,11.464,40,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
WHEAT DEXTRIN 3 GRAM/4 GRAM ORAL POWD,,119072,LOCAL,Facility,Outpatient,152,g,,40,34,11.464,40,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),20.188,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
WHEAT DEXTRIN 3 GRAM/4 GRAM ORAL POWD,,119072,LOCAL,Facility,Inpatient,152,g,,40,34,11.464,40,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
WHEAT DEXTRIN 3 GRAM/4 GRAM ORAL POWD,,119072,LOCAL,Facility,Both,152,g,,40,34,11.464,40,UnitedHealthcare,Individual & Family,37.6,94,,percent of total billed charges,,
WHEAT DEXTRIN 3 GRAM/4 GRAM ORAL POWD,,119072,LOCAL,Facility,Outpatient,152,g,,40,34,11.464,40,UnitedHealthcare,Medicare Advantage,19.6,49,,percent of total billed charges,,
WHEAT DEXTRIN 3 GRAM/4 GRAM ORAL POWD,,119072,LOCAL,Facility,Inpatient,152,g,,40,34,11.464,40,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
WHEAT DEXTRIN 3 GRAM/4 GRAM ORAL POWD,,119072,LOCAL,Facility,Outpatient,152,g,,40,34,11.464,40,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,19.2,48,,percent of total billed charges,,100% of DHS outpatient percentage
WHEAT DEXTRIN 3 GRAM/4 GRAM ORAL POWD,,119072,LOCAL,Facility,Inpatient,152,g,,40,34,11.464,40,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
MINERAL OIL ORAL OIL,,503,LOCAL,Facility,Both,473,mL,,22,18.7,6.3052,22,Aetna,Commercial,20.24,92,,percent of total billed charges,,
MINERAL OIL ORAL OIL,,503,LOCAL,Facility,Outpatient,473,mL,,22,18.7,6.3052,22,Aetna,Medicare Advantage,10.78,49,,percent of total billed charges,,
MINERAL OIL ORAL OIL,,503,LOCAL,Facility,Inpatient,473,mL,,22,18.7,6.3052,22,Aetna,Medicare Advantage,,,,,Included in per diem rate,
MINERAL OIL ORAL OIL,,503,LOCAL,Facility,Both,473,mL,,22,18.7,6.3052,22,Aetna,PPO,20.46,93,,percent of total billed charges,,
MINERAL OIL ORAL OIL,,503,LOCAL,Facility,Both,473,mL,,22,18.7,6.3052,22,America's PPO,America's PPO,21.1266,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
MINERAL OIL ORAL OIL,,503,LOCAL,Facility,Both,473,mL,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota, Federal Employee Program,21.648,98.4,,percent of total billed charges,,
MINERAL OIL ORAL OIL,,503,LOCAL,Facility,Both,473,mL,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,22,100,,percent of total billed charges,,
MINERAL OIL ORAL OIL,,503,LOCAL,Facility,Both,473,mL,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota,High Value Network Plan,19.8,90,,percent of total billed charges,,
MINERAL OIL ORAL OIL,,503,LOCAL,Facility,Outpatient,473,mL,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota,Medicare Advantage,10.78,49,,percent of total billed charges,,
MINERAL OIL ORAL OIL,,503,LOCAL,Facility,Inpatient,473,mL,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
MINERAL OIL ORAL OIL,,503,LOCAL,Facility,Both,473,mL,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,19.4854,88.57,,percent of total billed charges,,
MINERAL OIL ORAL OIL,,503,LOCAL,Facility,Both,473,mL,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,6.3052,28.66,,percent of total billed charges,,
MINERAL OIL ORAL OIL,,503,LOCAL,Facility,Outpatient,473,mL,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),10.78,49,,percent of total billed charges,,
MINERAL OIL ORAL OIL,,503,LOCAL,Facility,Inpatient,473,mL,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
MINERAL OIL ORAL OIL,,503,LOCAL,Facility,Both,473,mL,,22,18.7,6.3052,22,CorVel,Worker's Compensation,22,100,,percent of total billed charges,,
MINERAL OIL ORAL OIL,,503,LOCAL,Facility,Both,473,mL,,22,18.7,6.3052,22,First Health Group Corporation,First Health Network,21.34,97,,percent of total billed charges,,
MINERAL OIL ORAL OIL,,503,LOCAL,Facility,Both,473,mL,,22,18.7,6.3052,22,"Health Partners, Inc.",Commercial,20.812,94.6,,percent of total billed charges,,
MINERAL OIL ORAL OIL,,503,LOCAL,Facility,Outpatient,473,mL,,22,18.7,6.3052,22,"Health Partners, Inc.",Medicare Advantage,10.78,49,,percent of total billed charges,,
MINERAL OIL ORAL OIL,,503,LOCAL,Facility,Inpatient,473,mL,,22,18.7,6.3052,22,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
MINERAL OIL ORAL OIL,,503,LOCAL,Facility,Both,473,mL,,22,18.7,6.3052,22,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),13.2,60,,percent of total billed charges,,
MINERAL OIL ORAL OIL,,503,LOCAL,Facility,Both,473,mL,,22,18.7,6.3052,22,"Health Partners, Inc.",State of Minnesota Advantage Program,17.93,81.5,,percent of total billed charges,,
MINERAL OIL ORAL OIL,,503,LOCAL,Facility,Both,473,mL,,22,18.7,6.3052,22,"Health Partners, Inc.",State Public Programs,11,50,,percent of total billed charges,,
MINERAL OIL ORAL OIL,,503,LOCAL,Facility,Both,473,mL,,22,18.7,6.3052,22,Humana Insurance Company,Commercial PPO,20.9,95,,percent of total billed charges,,
MINERAL OIL ORAL OIL,,503,LOCAL,Facility,Outpatient,473,mL,,22,18.7,6.3052,22,Humana Insurance Company,Medicare PPO,10.78,49,,percent of total billed charges,,
MINERAL OIL ORAL OIL,,503,LOCAL,Facility,Inpatient,473,mL,,22,18.7,6.3052,22,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
MINERAL OIL ORAL OIL,,503,LOCAL,Facility,Both,473,mL,,22,18.7,6.3052,22,Medica,Individual & Family,21.802,99.1,,percent of total billed charges,,
MINERAL OIL ORAL OIL,,503,LOCAL,Facility,Outpatient,473,mL,,22,18.7,6.3052,22,Medica,Medica Advantage Solution,10.956,49.8,,percent of total billed charges,,
MINERAL OIL ORAL OIL,,503,LOCAL,Facility,Inpatient,473,mL,,22,18.7,6.3052,22,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
MINERAL OIL ORAL OIL,,503,LOCAL,Facility,Outpatient,473,mL,,22,18.7,6.3052,22,Medica,Medical Assistance,9.812,44.6,,percent of total billed charges,,
MINERAL OIL ORAL OIL,,503,LOCAL,Facility,Inpatient,473,mL,,22,18.7,6.3052,22,Medica,Medical Assistance,,,,,Included in per diem rate,
MINERAL OIL ORAL OIL,,503,LOCAL,Facility,Outpatient,473,mL,,22,18.7,6.3052,22,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,10.956,49.8,,percent of total billed charges,,
MINERAL OIL ORAL OIL,,503,LOCAL,Facility,Inpatient,473,mL,,22,18.7,6.3052,22,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
MINERAL OIL ORAL OIL,,503,LOCAL,Facility,Both,473,mL,,22,18.7,6.3052,22,"Multiplan, Inc.","Multiplan, Inc.",20.68,94,,percent of total billed charges,,
MINERAL OIL ORAL OIL,,503,LOCAL,Facility,Outpatient,473,mL,,22,18.7,6.3052,22,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,19.822,90.1,,percent of total billed charges,,
MINERAL OIL ORAL OIL,,503,LOCAL,Facility,Inpatient,473,mL,,22,18.7,6.3052,22,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
MINERAL OIL ORAL OIL,,503,LOCAL,Facility,Both,473,mL,,22,18.7,6.3052,22,"Preferred One Administrative Services, INC.",PPO,21.692,98.6,,percent of total billed charges,,
MINERAL OIL ORAL OIL,,503,LOCAL,Facility,Outpatient,473,mL,,22,18.7,6.3052,22,PrimeWest Health,Minnesota Senior Health Options (MSHO),11.319,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
MINERAL OIL ORAL OIL,,503,LOCAL,Facility,Inpatient,473,mL,,22,18.7,6.3052,22,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
MINERAL OIL ORAL OIL,,503,LOCAL,Facility,Outpatient,473,mL,,22,18.7,6.3052,22,PrimeWest Health,MinnesotaCare,11.2992,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
MINERAL OIL ORAL OIL,,503,LOCAL,Facility,Inpatient,473,mL,,22,18.7,6.3052,22,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
MINERAL OIL ORAL OIL,,503,LOCAL,Facility,Both,473,mL,,22,18.7,6.3052,22,Sanford Health Plan,Sanford Health Plan,20.24,92,,percent of total billed charges,,
MINERAL OIL ORAL OIL,,503,LOCAL,Facility,Outpatient,473,mL,,22,18.7,6.3052,22,"UCare Health, Inc.",Individual & Family Plan,12.397,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
MINERAL OIL ORAL OIL,,503,LOCAL,Facility,Inpatient,473,mL,,22,18.7,6.3052,22,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
MINERAL OIL ORAL OIL,,503,LOCAL,Facility,Outpatient,473,mL,,22,18.7,6.3052,22,"UCare Health, Inc.",Medical Assistance,11.1034,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MINERAL OIL ORAL OIL,,503,LOCAL,Facility,Inpatient,473,mL,,22,18.7,6.3052,22,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
MINERAL OIL ORAL OIL,,503,LOCAL,Facility,Outpatient,473,mL,,22,18.7,6.3052,22,"UCare Health, Inc.",Medicare Advantage,11.1034,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MINERAL OIL ORAL OIL,,503,LOCAL,Facility,Inpatient,473,mL,,22,18.7,6.3052,22,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
MINERAL OIL ORAL OIL,,503,LOCAL,Facility,Outpatient,473,mL,,22,18.7,6.3052,22,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),11.1034,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MINERAL OIL ORAL OIL,,503,LOCAL,Facility,Inpatient,473,mL,,22,18.7,6.3052,22,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
MINERAL OIL ORAL OIL,,503,LOCAL,Facility,Both,473,mL,,22,18.7,6.3052,22,UnitedHealthcare,Individual & Family,20.68,94,,percent of total billed charges,,
MINERAL OIL ORAL OIL,,503,LOCAL,Facility,Outpatient,473,mL,,22,18.7,6.3052,22,UnitedHealthcare,Medicare Advantage,10.78,49,,percent of total billed charges,,
MINERAL OIL ORAL OIL,,503,LOCAL,Facility,Inpatient,473,mL,,22,18.7,6.3052,22,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
MINERAL OIL ORAL OIL,,503,LOCAL,Facility,Outpatient,473,mL,,22,18.7,6.3052,22,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,10.56,48,,percent of total billed charges,,100% of DHS outpatient percentage
MINERAL OIL ORAL OIL,,503,LOCAL,Facility,Inpatient,473,mL,,22,18.7,6.3052,22,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
DOCUSATE SODIUM 50 MG/5 ML ORAL LIQD,,564,LOCAL,Facility,Both,473,mL,,34,28.9,9.7444,34,Aetna,Commercial,31.28,92,,percent of total billed charges,,
DOCUSATE SODIUM 50 MG/5 ML ORAL LIQD,,564,LOCAL,Facility,Outpatient,473,mL,,34,28.9,9.7444,34,Aetna,Medicare Advantage,16.66,49,,percent of total billed charges,,
DOCUSATE SODIUM 50 MG/5 ML ORAL LIQD,,564,LOCAL,Facility,Inpatient,473,mL,,34,28.9,9.7444,34,Aetna,Medicare Advantage,,,,,Included in per diem rate,
DOCUSATE SODIUM 50 MG/5 ML ORAL LIQD,,564,LOCAL,Facility,Both,473,mL,,34,28.9,9.7444,34,Aetna,PPO,31.62,93,,percent of total billed charges,,
DOCUSATE SODIUM 50 MG/5 ML ORAL LIQD,,564,LOCAL,Facility,Both,473,mL,,34,28.9,9.7444,34,America's PPO,America's PPO,32.6502,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
DOCUSATE SODIUM 50 MG/5 ML ORAL LIQD,,564,LOCAL,Facility,Both,473,mL,,34,28.9,9.7444,34,BlueCross BlueShield Minnesota, Federal Employee Program,33.456,98.4,,percent of total billed charges,,
DOCUSATE SODIUM 50 MG/5 ML ORAL LIQD,,564,LOCAL,Facility,Both,473,mL,,34,28.9,9.7444,34,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,34,100,,percent of total billed charges,,
DOCUSATE SODIUM 50 MG/5 ML ORAL LIQD,,564,LOCAL,Facility,Both,473,mL,,34,28.9,9.7444,34,BlueCross BlueShield Minnesota,High Value Network Plan,30.6,90,,percent of total billed charges,,
DOCUSATE SODIUM 50 MG/5 ML ORAL LIQD,,564,LOCAL,Facility,Outpatient,473,mL,,34,28.9,9.7444,34,BlueCross BlueShield Minnesota,Medicare Advantage,16.66,49,,percent of total billed charges,,
DOCUSATE SODIUM 50 MG/5 ML ORAL LIQD,,564,LOCAL,Facility,Inpatient,473,mL,,34,28.9,9.7444,34,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
DOCUSATE SODIUM 50 MG/5 ML ORAL LIQD,,564,LOCAL,Facility,Both,473,mL,,34,28.9,9.7444,34,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,30.1138,88.57,,percent of total billed charges,,
DOCUSATE SODIUM 50 MG/5 ML ORAL LIQD,,564,LOCAL,Facility,Both,473,mL,,34,28.9,9.7444,34,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,9.7444,28.66,,percent of total billed charges,,
DOCUSATE SODIUM 50 MG/5 ML ORAL LIQD,,564,LOCAL,Facility,Outpatient,473,mL,,34,28.9,9.7444,34,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),16.66,49,,percent of total billed charges,,
DOCUSATE SODIUM 50 MG/5 ML ORAL LIQD,,564,LOCAL,Facility,Inpatient,473,mL,,34,28.9,9.7444,34,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
DOCUSATE SODIUM 50 MG/5 ML ORAL LIQD,,564,LOCAL,Facility,Both,473,mL,,34,28.9,9.7444,34,CorVel,Worker's Compensation,34,100,,percent of total billed charges,,
DOCUSATE SODIUM 50 MG/5 ML ORAL LIQD,,564,LOCAL,Facility,Both,473,mL,,34,28.9,9.7444,34,First Health Group Corporation,First Health Network,32.98,97,,percent of total billed charges,,
DOCUSATE SODIUM 50 MG/5 ML ORAL LIQD,,564,LOCAL,Facility,Both,473,mL,,34,28.9,9.7444,34,"Health Partners, Inc.",Commercial,32.164,94.6,,percent of total billed charges,,
DOCUSATE SODIUM 50 MG/5 ML ORAL LIQD,,564,LOCAL,Facility,Outpatient,473,mL,,34,28.9,9.7444,34,"Health Partners, Inc.",Medicare Advantage,16.66,49,,percent of total billed charges,,
DOCUSATE SODIUM 50 MG/5 ML ORAL LIQD,,564,LOCAL,Facility,Inpatient,473,mL,,34,28.9,9.7444,34,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DOCUSATE SODIUM 50 MG/5 ML ORAL LIQD,,564,LOCAL,Facility,Both,473,mL,,34,28.9,9.7444,34,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),20.4,60,,percent of total billed charges,,
DOCUSATE SODIUM 50 MG/5 ML ORAL LIQD,,564,LOCAL,Facility,Both,473,mL,,34,28.9,9.7444,34,"Health Partners, Inc.",State of Minnesota Advantage Program,27.71,81.5,,percent of total billed charges,,
DOCUSATE SODIUM 50 MG/5 ML ORAL LIQD,,564,LOCAL,Facility,Both,473,mL,,34,28.9,9.7444,34,"Health Partners, Inc.",State Public Programs,17,50,,percent of total billed charges,,
DOCUSATE SODIUM 50 MG/5 ML ORAL LIQD,,564,LOCAL,Facility,Both,473,mL,,34,28.9,9.7444,34,Humana Insurance Company,Commercial PPO,32.3,95,,percent of total billed charges,,
DOCUSATE SODIUM 50 MG/5 ML ORAL LIQD,,564,LOCAL,Facility,Outpatient,473,mL,,34,28.9,9.7444,34,Humana Insurance Company,Medicare PPO,16.66,49,,percent of total billed charges,,
DOCUSATE SODIUM 50 MG/5 ML ORAL LIQD,,564,LOCAL,Facility,Inpatient,473,mL,,34,28.9,9.7444,34,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
DOCUSATE SODIUM 50 MG/5 ML ORAL LIQD,,564,LOCAL,Facility,Both,473,mL,,34,28.9,9.7444,34,Medica,Individual & Family,33.694,99.1,,percent of total billed charges,,
DOCUSATE SODIUM 50 MG/5 ML ORAL LIQD,,564,LOCAL,Facility,Outpatient,473,mL,,34,28.9,9.7444,34,Medica,Medica Advantage Solution,16.932,49.8,,percent of total billed charges,,
DOCUSATE SODIUM 50 MG/5 ML ORAL LIQD,,564,LOCAL,Facility,Inpatient,473,mL,,34,28.9,9.7444,34,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
DOCUSATE SODIUM 50 MG/5 ML ORAL LIQD,,564,LOCAL,Facility,Outpatient,473,mL,,34,28.9,9.7444,34,Medica,Medical Assistance,15.164,44.6,,percent of total billed charges,,
DOCUSATE SODIUM 50 MG/5 ML ORAL LIQD,,564,LOCAL,Facility,Inpatient,473,mL,,34,28.9,9.7444,34,Medica,Medical Assistance,,,,,Included in per diem rate,
DOCUSATE SODIUM 50 MG/5 ML ORAL LIQD,,564,LOCAL,Facility,Outpatient,473,mL,,34,28.9,9.7444,34,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,16.932,49.8,,percent of total billed charges,,
DOCUSATE SODIUM 50 MG/5 ML ORAL LIQD,,564,LOCAL,Facility,Inpatient,473,mL,,34,28.9,9.7444,34,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
DOCUSATE SODIUM 50 MG/5 ML ORAL LIQD,,564,LOCAL,Facility,Both,473,mL,,34,28.9,9.7444,34,"Multiplan, Inc.","Multiplan, Inc.",31.96,94,,percent of total billed charges,,
DOCUSATE SODIUM 50 MG/5 ML ORAL LIQD,,564,LOCAL,Facility,Outpatient,473,mL,,34,28.9,9.7444,34,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,30.634,90.1,,percent of total billed charges,,
DOCUSATE SODIUM 50 MG/5 ML ORAL LIQD,,564,LOCAL,Facility,Inpatient,473,mL,,34,28.9,9.7444,34,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
DOCUSATE SODIUM 50 MG/5 ML ORAL LIQD,,564,LOCAL,Facility,Both,473,mL,,34,28.9,9.7444,34,"Preferred One Administrative Services, INC.",PPO,33.524,98.6,,percent of total billed charges,,
DOCUSATE SODIUM 50 MG/5 ML ORAL LIQD,,564,LOCAL,Facility,Outpatient,473,mL,,34,28.9,9.7444,34,PrimeWest Health,Minnesota Senior Health Options (MSHO),17.493,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
DOCUSATE SODIUM 50 MG/5 ML ORAL LIQD,,564,LOCAL,Facility,Inpatient,473,mL,,34,28.9,9.7444,34,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DOCUSATE SODIUM 50 MG/5 ML ORAL LIQD,,564,LOCAL,Facility,Outpatient,473,mL,,34,28.9,9.7444,34,PrimeWest Health,MinnesotaCare,17.4624,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
DOCUSATE SODIUM 50 MG/5 ML ORAL LIQD,,564,LOCAL,Facility,Inpatient,473,mL,,34,28.9,9.7444,34,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
DOCUSATE SODIUM 50 MG/5 ML ORAL LIQD,,564,LOCAL,Facility,Both,473,mL,,34,28.9,9.7444,34,Sanford Health Plan,Sanford Health Plan,31.28,92,,percent of total billed charges,,
DOCUSATE SODIUM 50 MG/5 ML ORAL LIQD,,564,LOCAL,Facility,Outpatient,473,mL,,34,28.9,9.7444,34,"UCare Health, Inc.",Individual & Family Plan,19.159,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
DOCUSATE SODIUM 50 MG/5 ML ORAL LIQD,,564,LOCAL,Facility,Inpatient,473,mL,,34,28.9,9.7444,34,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
DOCUSATE SODIUM 50 MG/5 ML ORAL LIQD,,564,LOCAL,Facility,Outpatient,473,mL,,34,28.9,9.7444,34,"UCare Health, Inc.",Medical Assistance,17.1598,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DOCUSATE SODIUM 50 MG/5 ML ORAL LIQD,,564,LOCAL,Facility,Inpatient,473,mL,,34,28.9,9.7444,34,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
DOCUSATE SODIUM 50 MG/5 ML ORAL LIQD,,564,LOCAL,Facility,Outpatient,473,mL,,34,28.9,9.7444,34,"UCare Health, Inc.",Medicare Advantage,17.1598,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DOCUSATE SODIUM 50 MG/5 ML ORAL LIQD,,564,LOCAL,Facility,Inpatient,473,mL,,34,28.9,9.7444,34,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DOCUSATE SODIUM 50 MG/5 ML ORAL LIQD,,564,LOCAL,Facility,Outpatient,473,mL,,34,28.9,9.7444,34,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),17.1598,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DOCUSATE SODIUM 50 MG/5 ML ORAL LIQD,,564,LOCAL,Facility,Inpatient,473,mL,,34,28.9,9.7444,34,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DOCUSATE SODIUM 50 MG/5 ML ORAL LIQD,,564,LOCAL,Facility,Both,473,mL,,34,28.9,9.7444,34,UnitedHealthcare,Individual & Family,31.96,94,,percent of total billed charges,,
DOCUSATE SODIUM 50 MG/5 ML ORAL LIQD,,564,LOCAL,Facility,Outpatient,473,mL,,34,28.9,9.7444,34,UnitedHealthcare,Medicare Advantage,16.66,49,,percent of total billed charges,,
DOCUSATE SODIUM 50 MG/5 ML ORAL LIQD,,564,LOCAL,Facility,Inpatient,473,mL,,34,28.9,9.7444,34,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
DOCUSATE SODIUM 50 MG/5 ML ORAL LIQD,,564,LOCAL,Facility,Outpatient,473,mL,,34,28.9,9.7444,34,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,16.32,48,,percent of total billed charges,,100% of DHS outpatient percentage
DOCUSATE SODIUM 50 MG/5 ML ORAL LIQD,,564,LOCAL,Facility,Inpatient,473,mL,,34,28.9,9.7444,34,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
AMINO ACIDS 5 %-LYTES-CA-D20W 5 % IV SOLP,,648,LOCAL,Facility,Both,1000,mL,,227,192.95,65.0582,227,Aetna,Commercial,208.84,92,,percent of total billed charges,,
AMINO ACIDS 5 %-LYTES-CA-D20W 5 % IV SOLP,,648,LOCAL,Facility,Outpatient,1000,mL,,227,192.95,65.0582,227,Aetna,Medicare Advantage,111.23,49,,percent of total billed charges,,
AMINO ACIDS 5 %-LYTES-CA-D20W 5 % IV SOLP,,648,LOCAL,Facility,Inpatient,1000,mL,,227,192.95,65.0582,227,Aetna,Medicare Advantage,,,,,Included in per diem rate,
AMINO ACIDS 5 %-LYTES-CA-D20W 5 % IV SOLP,,648,LOCAL,Facility,Both,1000,mL,,227,192.95,65.0582,227,Aetna,PPO,211.11,93,,percent of total billed charges,,
AMINO ACIDS 5 %-LYTES-CA-D20W 5 % IV SOLP,,648,LOCAL,Facility,Both,1000,mL,,227,192.95,65.0582,227,America's PPO,America's PPO,217.9881,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
AMINO ACIDS 5 %-LYTES-CA-D20W 5 % IV SOLP,,648,LOCAL,Facility,Both,1000,mL,,227,192.95,65.0582,227,BlueCross BlueShield Minnesota, Federal Employee Program,223.368,98.4,,percent of total billed charges,,
AMINO ACIDS 5 %-LYTES-CA-D20W 5 % IV SOLP,,648,LOCAL,Facility,Both,1000,mL,,227,192.95,65.0582,227,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,227,100,,percent of total billed charges,,
AMINO ACIDS 5 %-LYTES-CA-D20W 5 % IV SOLP,,648,LOCAL,Facility,Both,1000,mL,,227,192.95,65.0582,227,BlueCross BlueShield Minnesota,High Value Network Plan,204.3,90,,percent of total billed charges,,
AMINO ACIDS 5 %-LYTES-CA-D20W 5 % IV SOLP,,648,LOCAL,Facility,Outpatient,1000,mL,,227,192.95,65.0582,227,BlueCross BlueShield Minnesota,Medicare Advantage,111.23,49,,percent of total billed charges,,
AMINO ACIDS 5 %-LYTES-CA-D20W 5 % IV SOLP,,648,LOCAL,Facility,Inpatient,1000,mL,,227,192.95,65.0582,227,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
AMINO ACIDS 5 %-LYTES-CA-D20W 5 % IV SOLP,,648,LOCAL,Facility,Both,1000,mL,,227,192.95,65.0582,227,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,201.0539,88.57,,percent of total billed charges,,
AMINO ACIDS 5 %-LYTES-CA-D20W 5 % IV SOLP,,648,LOCAL,Facility,Both,1000,mL,,227,192.95,65.0582,227,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,65.0582,28.66,,percent of total billed charges,,
AMINO ACIDS 5 %-LYTES-CA-D20W 5 % IV SOLP,,648,LOCAL,Facility,Outpatient,1000,mL,,227,192.95,65.0582,227,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),111.23,49,,percent of total billed charges,,
AMINO ACIDS 5 %-LYTES-CA-D20W 5 % IV SOLP,,648,LOCAL,Facility,Inpatient,1000,mL,,227,192.95,65.0582,227,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
AMINO ACIDS 5 %-LYTES-CA-D20W 5 % IV SOLP,,648,LOCAL,Facility,Both,1000,mL,,227,192.95,65.0582,227,CorVel,Worker's Compensation,227,100,,percent of total billed charges,,
AMINO ACIDS 5 %-LYTES-CA-D20W 5 % IV SOLP,,648,LOCAL,Facility,Both,1000,mL,,227,192.95,65.0582,227,First Health Group Corporation,First Health Network,220.19,97,,percent of total billed charges,,
AMINO ACIDS 5 %-LYTES-CA-D20W 5 % IV SOLP,,648,LOCAL,Facility,Both,1000,mL,,227,192.95,65.0582,227,"Health Partners, Inc.",Commercial,214.742,94.6,,percent of total billed charges,,
AMINO ACIDS 5 %-LYTES-CA-D20W 5 % IV SOLP,,648,LOCAL,Facility,Outpatient,1000,mL,,227,192.95,65.0582,227,"Health Partners, Inc.",Medicare Advantage,111.23,49,,percent of total billed charges,,
AMINO ACIDS 5 %-LYTES-CA-D20W 5 % IV SOLP,,648,LOCAL,Facility,Inpatient,1000,mL,,227,192.95,65.0582,227,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
AMINO ACIDS 5 %-LYTES-CA-D20W 5 % IV SOLP,,648,LOCAL,Facility,Both,1000,mL,,227,192.95,65.0582,227,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),136.2,60,,percent of total billed charges,,
AMINO ACIDS 5 %-LYTES-CA-D20W 5 % IV SOLP,,648,LOCAL,Facility,Both,1000,mL,,227,192.95,65.0582,227,"Health Partners, Inc.",State of Minnesota Advantage Program,185.005,81.5,,percent of total billed charges,,
AMINO ACIDS 5 %-LYTES-CA-D20W 5 % IV SOLP,,648,LOCAL,Facility,Both,1000,mL,,227,192.95,65.0582,227,"Health Partners, Inc.",State Public Programs,113.5,50,,percent of total billed charges,,
AMINO ACIDS 5 %-LYTES-CA-D20W 5 % IV SOLP,,648,LOCAL,Facility,Both,1000,mL,,227,192.95,65.0582,227,Humana Insurance Company,Commercial PPO,215.65,95,,percent of total billed charges,,
AMINO ACIDS 5 %-LYTES-CA-D20W 5 % IV SOLP,,648,LOCAL,Facility,Outpatient,1000,mL,,227,192.95,65.0582,227,Humana Insurance Company,Medicare PPO,111.23,49,,percent of total billed charges,,
AMINO ACIDS 5 %-LYTES-CA-D20W 5 % IV SOLP,,648,LOCAL,Facility,Inpatient,1000,mL,,227,192.95,65.0582,227,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
AMINO ACIDS 5 %-LYTES-CA-D20W 5 % IV SOLP,,648,LOCAL,Facility,Both,1000,mL,,227,192.95,65.0582,227,Medica,Individual & Family,224.957,99.1,,percent of total billed charges,,
AMINO ACIDS 5 %-LYTES-CA-D20W 5 % IV SOLP,,648,LOCAL,Facility,Outpatient,1000,mL,,227,192.95,65.0582,227,Medica,Medica Advantage Solution,113.046,49.8,,percent of total billed charges,,
AMINO ACIDS 5 %-LYTES-CA-D20W 5 % IV SOLP,,648,LOCAL,Facility,Inpatient,1000,mL,,227,192.95,65.0582,227,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
AMINO ACIDS 5 %-LYTES-CA-D20W 5 % IV SOLP,,648,LOCAL,Facility,Outpatient,1000,mL,,227,192.95,65.0582,227,Medica,Medical Assistance,101.242,44.6,,percent of total billed charges,,
AMINO ACIDS 5 %-LYTES-CA-D20W 5 % IV SOLP,,648,LOCAL,Facility,Inpatient,1000,mL,,227,192.95,65.0582,227,Medica,Medical Assistance,,,,,Included in per diem rate,
AMINO ACIDS 5 %-LYTES-CA-D20W 5 % IV SOLP,,648,LOCAL,Facility,Outpatient,1000,mL,,227,192.95,65.0582,227,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,113.046,49.8,,percent of total billed charges,,
AMINO ACIDS 5 %-LYTES-CA-D20W 5 % IV SOLP,,648,LOCAL,Facility,Inpatient,1000,mL,,227,192.95,65.0582,227,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
AMINO ACIDS 5 %-LYTES-CA-D20W 5 % IV SOLP,,648,LOCAL,Facility,Both,1000,mL,,227,192.95,65.0582,227,"Multiplan, Inc.","Multiplan, Inc.",213.38,94,,percent of total billed charges,,
AMINO ACIDS 5 %-LYTES-CA-D20W 5 % IV SOLP,,648,LOCAL,Facility,Outpatient,1000,mL,,227,192.95,65.0582,227,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,204.527,90.1,,percent of total billed charges,,
AMINO ACIDS 5 %-LYTES-CA-D20W 5 % IV SOLP,,648,LOCAL,Facility,Inpatient,1000,mL,,227,192.95,65.0582,227,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
AMINO ACIDS 5 %-LYTES-CA-D20W 5 % IV SOLP,,648,LOCAL,Facility,Both,1000,mL,,227,192.95,65.0582,227,"Preferred One Administrative Services, INC.",PPO,223.822,98.6,,percent of total billed charges,,
AMINO ACIDS 5 %-LYTES-CA-D20W 5 % IV SOLP,,648,LOCAL,Facility,Outpatient,1000,mL,,227,192.95,65.0582,227,PrimeWest Health,Minnesota Senior Health Options (MSHO),116.7915,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
AMINO ACIDS 5 %-LYTES-CA-D20W 5 % IV SOLP,,648,LOCAL,Facility,Inpatient,1000,mL,,227,192.95,65.0582,227,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
AMINO ACIDS 5 %-LYTES-CA-D20W 5 % IV SOLP,,648,LOCAL,Facility,Outpatient,1000,mL,,227,192.95,65.0582,227,PrimeWest Health,MinnesotaCare,116.5872,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
AMINO ACIDS 5 %-LYTES-CA-D20W 5 % IV SOLP,,648,LOCAL,Facility,Inpatient,1000,mL,,227,192.95,65.0582,227,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
AMINO ACIDS 5 %-LYTES-CA-D20W 5 % IV SOLP,,648,LOCAL,Facility,Both,1000,mL,,227,192.95,65.0582,227,Sanford Health Plan,Sanford Health Plan,208.84,92,,percent of total billed charges,,
AMINO ACIDS 5 %-LYTES-CA-D20W 5 % IV SOLP,,648,LOCAL,Facility,Outpatient,1000,mL,,227,192.95,65.0582,227,"UCare Health, Inc.",Individual & Family Plan,127.9145,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
AMINO ACIDS 5 %-LYTES-CA-D20W 5 % IV SOLP,,648,LOCAL,Facility,Inpatient,1000,mL,,227,192.95,65.0582,227,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
AMINO ACIDS 5 %-LYTES-CA-D20W 5 % IV SOLP,,648,LOCAL,Facility,Outpatient,1000,mL,,227,192.95,65.0582,227,"UCare Health, Inc.",Medical Assistance,114.5669,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
AMINO ACIDS 5 %-LYTES-CA-D20W 5 % IV SOLP,,648,LOCAL,Facility,Inpatient,1000,mL,,227,192.95,65.0582,227,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
AMINO ACIDS 5 %-LYTES-CA-D20W 5 % IV SOLP,,648,LOCAL,Facility,Outpatient,1000,mL,,227,192.95,65.0582,227,"UCare Health, Inc.",Medicare Advantage,114.5669,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
AMINO ACIDS 5 %-LYTES-CA-D20W 5 % IV SOLP,,648,LOCAL,Facility,Inpatient,1000,mL,,227,192.95,65.0582,227,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
AMINO ACIDS 5 %-LYTES-CA-D20W 5 % IV SOLP,,648,LOCAL,Facility,Outpatient,1000,mL,,227,192.95,65.0582,227,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),114.5669,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
AMINO ACIDS 5 %-LYTES-CA-D20W 5 % IV SOLP,,648,LOCAL,Facility,Inpatient,1000,mL,,227,192.95,65.0582,227,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
AMINO ACIDS 5 %-LYTES-CA-D20W 5 % IV SOLP,,648,LOCAL,Facility,Both,1000,mL,,227,192.95,65.0582,227,UnitedHealthcare,Individual & Family,213.38,94,,percent of total billed charges,,
AMINO ACIDS 5 %-LYTES-CA-D20W 5 % IV SOLP,,648,LOCAL,Facility,Outpatient,1000,mL,,227,192.95,65.0582,227,UnitedHealthcare,Medicare Advantage,111.23,49,,percent of total billed charges,,
AMINO ACIDS 5 %-LYTES-CA-D20W 5 % IV SOLP,,648,LOCAL,Facility,Inpatient,1000,mL,,227,192.95,65.0582,227,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
AMINO ACIDS 5 %-LYTES-CA-D20W 5 % IV SOLP,,648,LOCAL,Facility,Outpatient,1000,mL,,227,192.95,65.0582,227,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,108.96,48,,percent of total billed charges,,100% of DHS outpatient percentage
AMINO ACIDS 5 %-LYTES-CA-D20W 5 % IV SOLP,,648,LOCAL,Facility,Inpatient,1000,mL,,227,192.95,65.0582,227,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Both,1000,mL,,25,21.25,7.165,25,Aetna,Commercial,23,92,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Outpatient,1000,mL,,25,21.25,7.165,25,Aetna,Medicare Advantage,12.25,49,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Inpatient,1000,mL,,25,21.25,7.165,25,Aetna,Medicare Advantage,,,,,Included in per diem rate,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Both,1000,mL,,25,21.25,7.165,25,Aetna,PPO,23.25,93,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Both,1000,mL,,25,21.25,7.165,25,America's PPO,America's PPO,24.0075,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Both,1000,mL,,25,21.25,7.165,25,BlueCross BlueShield Minnesota, Federal Employee Program,24.6,98.4,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Both,1000,mL,,25,21.25,7.165,25,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,25,100,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Both,1000,mL,,25,21.25,7.165,25,BlueCross BlueShield Minnesota,High Value Network Plan,22.5,90,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Outpatient,1000,mL,,25,21.25,7.165,25,BlueCross BlueShield Minnesota,Medicare Advantage,12.25,49,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Inpatient,1000,mL,,25,21.25,7.165,25,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Both,1000,mL,,25,21.25,7.165,25,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,22.1425,88.57,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Both,1000,mL,,25,21.25,7.165,25,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,7.165,28.66,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Outpatient,1000,mL,,25,21.25,7.165,25,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),12.25,49,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Inpatient,1000,mL,,25,21.25,7.165,25,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Both,1000,mL,,25,21.25,7.165,25,CorVel,Worker's Compensation,25,100,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Both,1000,mL,,25,21.25,7.165,25,First Health Group Corporation,First Health Network,24.25,97,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Both,1000,mL,,25,21.25,7.165,25,"Health Partners, Inc.",Commercial,23.65,94.6,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Outpatient,1000,mL,,25,21.25,7.165,25,"Health Partners, Inc.",Medicare Advantage,12.25,49,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Inpatient,1000,mL,,25,21.25,7.165,25,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Both,1000,mL,,25,21.25,7.165,25,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),15,60,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Both,1000,mL,,25,21.25,7.165,25,"Health Partners, Inc.",State of Minnesota Advantage Program,20.375,81.5,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Both,1000,mL,,25,21.25,7.165,25,"Health Partners, Inc.",State Public Programs,12.5,50,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Both,1000,mL,,25,21.25,7.165,25,Humana Insurance Company,Commercial PPO,23.75,95,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Outpatient,1000,mL,,25,21.25,7.165,25,Humana Insurance Company,Medicare PPO,12.25,49,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Inpatient,1000,mL,,25,21.25,7.165,25,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Both,1000,mL,,25,21.25,7.165,25,Medica,Individual & Family,24.775,99.1,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Outpatient,1000,mL,,25,21.25,7.165,25,Medica,Medica Advantage Solution,12.45,49.8,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Inpatient,1000,mL,,25,21.25,7.165,25,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Outpatient,1000,mL,,25,21.25,7.165,25,Medica,Medical Assistance,11.15,44.6,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Inpatient,1000,mL,,25,21.25,7.165,25,Medica,Medical Assistance,,,,,Included in per diem rate,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Outpatient,1000,mL,,25,21.25,7.165,25,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,12.45,49.8,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Inpatient,1000,mL,,25,21.25,7.165,25,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Both,1000,mL,,25,21.25,7.165,25,"Multiplan, Inc.","Multiplan, Inc.",23.5,94,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Outpatient,1000,mL,,25,21.25,7.165,25,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,22.525,90.1,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Inpatient,1000,mL,,25,21.25,7.165,25,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Both,1000,mL,,25,21.25,7.165,25,"Preferred One Administrative Services, INC.",PPO,24.65,98.6,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Outpatient,1000,mL,,25,21.25,7.165,25,PrimeWest Health,Minnesota Senior Health Options (MSHO),12.8625,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Inpatient,1000,mL,,25,21.25,7.165,25,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Outpatient,1000,mL,,25,21.25,7.165,25,PrimeWest Health,MinnesotaCare,12.84,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Inpatient,1000,mL,,25,21.25,7.165,25,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Both,1000,mL,,25,21.25,7.165,25,Sanford Health Plan,Sanford Health Plan,23,92,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Outpatient,1000,mL,,25,21.25,7.165,25,"UCare Health, Inc.",Individual & Family Plan,14.0875,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Inpatient,1000,mL,,25,21.25,7.165,25,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Outpatient,1000,mL,,25,21.25,7.165,25,"UCare Health, Inc.",Medical Assistance,12.6175,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Inpatient,1000,mL,,25,21.25,7.165,25,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Outpatient,1000,mL,,25,21.25,7.165,25,"UCare Health, Inc.",Medicare Advantage,12.6175,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Inpatient,1000,mL,,25,21.25,7.165,25,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Outpatient,1000,mL,,25,21.25,7.165,25,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),12.6175,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Inpatient,1000,mL,,25,21.25,7.165,25,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Both,1000,mL,,25,21.25,7.165,25,UnitedHealthcare,Individual & Family,23.5,94,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Outpatient,1000,mL,,25,21.25,7.165,25,UnitedHealthcare,Medicare Advantage,12.25,49,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Inpatient,1000,mL,,25,21.25,7.165,25,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Outpatient,1000,mL,,25,21.25,7.165,25,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,12,48,,percent of total billed charges,,100% of DHS outpatient percentage
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Inpatient,1000,mL,,25,21.25,7.165,25,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Both,1000,mL,,20,17,5.732,20,Aetna,Commercial,18.4,92,,percent of total billed charges,,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Outpatient,1000,mL,,20,17,5.732,20,Aetna,Medicare Advantage,9.8,49,,percent of total billed charges,,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Inpatient,1000,mL,,20,17,5.732,20,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Both,1000,mL,,20,17,5.732,20,Aetna,PPO,18.6,93,,percent of total billed charges,,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Both,1000,mL,,20,17,5.732,20,America's PPO,America's PPO,19.206,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Both,1000,mL,,20,17,5.732,20,BlueCross BlueShield Minnesota, Federal Employee Program,19.68,98.4,,percent of total billed charges,,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Both,1000,mL,,20,17,5.732,20,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,20,100,,percent of total billed charges,,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Both,1000,mL,,20,17,5.732,20,BlueCross BlueShield Minnesota,High Value Network Plan,18,90,,percent of total billed charges,,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Outpatient,1000,mL,,20,17,5.732,20,BlueCross BlueShield Minnesota,Medicare Advantage,9.8,49,,percent of total billed charges,,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Inpatient,1000,mL,,20,17,5.732,20,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Both,1000,mL,,20,17,5.732,20,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,17.714,88.57,,percent of total billed charges,,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Both,1000,mL,,20,17,5.732,20,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,5.732,28.66,,percent of total billed charges,,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Outpatient,1000,mL,,20,17,5.732,20,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),9.8,49,,percent of total billed charges,,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Inpatient,1000,mL,,20,17,5.732,20,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Both,1000,mL,,20,17,5.732,20,CorVel,Worker's Compensation,20,100,,percent of total billed charges,,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Both,1000,mL,,20,17,5.732,20,First Health Group Corporation,First Health Network,19.4,97,,percent of total billed charges,,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Both,1000,mL,,20,17,5.732,20,"Health Partners, Inc.",Commercial,18.92,94.6,,percent of total billed charges,,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Outpatient,1000,mL,,20,17,5.732,20,"Health Partners, Inc.",Medicare Advantage,9.8,49,,percent of total billed charges,,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Inpatient,1000,mL,,20,17,5.732,20,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Both,1000,mL,,20,17,5.732,20,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),12,60,,percent of total billed charges,,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Both,1000,mL,,20,17,5.732,20,"Health Partners, Inc.",State of Minnesota Advantage Program,16.3,81.5,,percent of total billed charges,,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Both,1000,mL,,20,17,5.732,20,"Health Partners, Inc.",State Public Programs,10,50,,percent of total billed charges,,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Both,1000,mL,,20,17,5.732,20,Humana Insurance Company,Commercial PPO,19,95,,percent of total billed charges,,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Outpatient,1000,mL,,20,17,5.732,20,Humana Insurance Company,Medicare PPO,9.8,49,,percent of total billed charges,,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Inpatient,1000,mL,,20,17,5.732,20,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Both,1000,mL,,20,17,5.732,20,Medica,Individual & Family,19.82,99.1,,percent of total billed charges,,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Outpatient,1000,mL,,20,17,5.732,20,Medica,Medica Advantage Solution,9.96,49.8,,percent of total billed charges,,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Inpatient,1000,mL,,20,17,5.732,20,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Outpatient,1000,mL,,20,17,5.732,20,Medica,Medical Assistance,8.92,44.6,,percent of total billed charges,,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Inpatient,1000,mL,,20,17,5.732,20,Medica,Medical Assistance,,,,,Included in per diem rate,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Outpatient,1000,mL,,20,17,5.732,20,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,9.96,49.8,,percent of total billed charges,,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Inpatient,1000,mL,,20,17,5.732,20,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Both,1000,mL,,20,17,5.732,20,"Multiplan, Inc.","Multiplan, Inc.",18.8,94,,percent of total billed charges,,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Outpatient,1000,mL,,20,17,5.732,20,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,18.02,90.1,,percent of total billed charges,,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Inpatient,1000,mL,,20,17,5.732,20,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Both,1000,mL,,20,17,5.732,20,"Preferred One Administrative Services, INC.",PPO,19.72,98.6,,percent of total billed charges,,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Outpatient,1000,mL,,20,17,5.732,20,PrimeWest Health,Minnesota Senior Health Options (MSHO),10.29,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Inpatient,1000,mL,,20,17,5.732,20,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Outpatient,1000,mL,,20,17,5.732,20,PrimeWest Health,MinnesotaCare,10.272,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Inpatient,1000,mL,,20,17,5.732,20,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Both,1000,mL,,20,17,5.732,20,Sanford Health Plan,Sanford Health Plan,18.4,92,,percent of total billed charges,,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Outpatient,1000,mL,,20,17,5.732,20,"UCare Health, Inc.",Individual & Family Plan,11.27,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Inpatient,1000,mL,,20,17,5.732,20,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Outpatient,1000,mL,,20,17,5.732,20,"UCare Health, Inc.",Medical Assistance,10.094,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Inpatient,1000,mL,,20,17,5.732,20,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Outpatient,1000,mL,,20,17,5.732,20,"UCare Health, Inc.",Medicare Advantage,10.094,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Inpatient,1000,mL,,20,17,5.732,20,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Outpatient,1000,mL,,20,17,5.732,20,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),10.094,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Inpatient,1000,mL,,20,17,5.732,20,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Both,1000,mL,,20,17,5.732,20,UnitedHealthcare,Individual & Family,18.8,94,,percent of total billed charges,,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Outpatient,1000,mL,,20,17,5.732,20,UnitedHealthcare,Medicare Advantage,9.8,49,,percent of total billed charges,,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Inpatient,1000,mL,,20,17,5.732,20,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Outpatient,1000,mL,,20,17,5.732,20,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,9.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Inpatient,1000,mL,,20,17,5.732,20,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
ELECTROLYTES-DEXTROSE ORAL SOLN,,17618,LOCAL,Facility,Both,1000,mL,,35,29.75,10.031,35,Aetna,Commercial,32.2,92,,percent of total billed charges,,
ELECTROLYTES-DEXTROSE ORAL SOLN,,17618,LOCAL,Facility,Outpatient,1000,mL,,35,29.75,10.031,35,Aetna,Medicare Advantage,17.15,49,,percent of total billed charges,,
ELECTROLYTES-DEXTROSE ORAL SOLN,,17618,LOCAL,Facility,Inpatient,1000,mL,,35,29.75,10.031,35,Aetna,Medicare Advantage,,,,,Included in per diem rate,
ELECTROLYTES-DEXTROSE ORAL SOLN,,17618,LOCAL,Facility,Both,1000,mL,,35,29.75,10.031,35,Aetna,PPO,32.55,93,,percent of total billed charges,,
ELECTROLYTES-DEXTROSE ORAL SOLN,,17618,LOCAL,Facility,Both,1000,mL,,35,29.75,10.031,35,America's PPO,America's PPO,33.6105,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
ELECTROLYTES-DEXTROSE ORAL SOLN,,17618,LOCAL,Facility,Both,1000,mL,,35,29.75,10.031,35,BlueCross BlueShield Minnesota, Federal Employee Program,34.44,98.4,,percent of total billed charges,,
ELECTROLYTES-DEXTROSE ORAL SOLN,,17618,LOCAL,Facility,Both,1000,mL,,35,29.75,10.031,35,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,35,100,,percent of total billed charges,,
ELECTROLYTES-DEXTROSE ORAL SOLN,,17618,LOCAL,Facility,Both,1000,mL,,35,29.75,10.031,35,BlueCross BlueShield Minnesota,High Value Network Plan,31.5,90,,percent of total billed charges,,
ELECTROLYTES-DEXTROSE ORAL SOLN,,17618,LOCAL,Facility,Outpatient,1000,mL,,35,29.75,10.031,35,BlueCross BlueShield Minnesota,Medicare Advantage,17.15,49,,percent of total billed charges,,
ELECTROLYTES-DEXTROSE ORAL SOLN,,17618,LOCAL,Facility,Inpatient,1000,mL,,35,29.75,10.031,35,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
ELECTROLYTES-DEXTROSE ORAL SOLN,,17618,LOCAL,Facility,Both,1000,mL,,35,29.75,10.031,35,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,30.9995,88.57,,percent of total billed charges,,
ELECTROLYTES-DEXTROSE ORAL SOLN,,17618,LOCAL,Facility,Both,1000,mL,,35,29.75,10.031,35,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,10.031,28.66,,percent of total billed charges,,
ELECTROLYTES-DEXTROSE ORAL SOLN,,17618,LOCAL,Facility,Outpatient,1000,mL,,35,29.75,10.031,35,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),17.15,49,,percent of total billed charges,,
ELECTROLYTES-DEXTROSE ORAL SOLN,,17618,LOCAL,Facility,Inpatient,1000,mL,,35,29.75,10.031,35,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
ELECTROLYTES-DEXTROSE ORAL SOLN,,17618,LOCAL,Facility,Both,1000,mL,,35,29.75,10.031,35,CorVel,Worker's Compensation,35,100,,percent of total billed charges,,
ELECTROLYTES-DEXTROSE ORAL SOLN,,17618,LOCAL,Facility,Both,1000,mL,,35,29.75,10.031,35,First Health Group Corporation,First Health Network,33.95,97,,percent of total billed charges,,
ELECTROLYTES-DEXTROSE ORAL SOLN,,17618,LOCAL,Facility,Both,1000,mL,,35,29.75,10.031,35,"Health Partners, Inc.",Commercial,33.11,94.6,,percent of total billed charges,,
ELECTROLYTES-DEXTROSE ORAL SOLN,,17618,LOCAL,Facility,Outpatient,1000,mL,,35,29.75,10.031,35,"Health Partners, Inc.",Medicare Advantage,17.15,49,,percent of total billed charges,,
ELECTROLYTES-DEXTROSE ORAL SOLN,,17618,LOCAL,Facility,Inpatient,1000,mL,,35,29.75,10.031,35,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ELECTROLYTES-DEXTROSE ORAL SOLN,,17618,LOCAL,Facility,Both,1000,mL,,35,29.75,10.031,35,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),21,60,,percent of total billed charges,,
ELECTROLYTES-DEXTROSE ORAL SOLN,,17618,LOCAL,Facility,Both,1000,mL,,35,29.75,10.031,35,"Health Partners, Inc.",State of Minnesota Advantage Program,28.525,81.5,,percent of total billed charges,,
ELECTROLYTES-DEXTROSE ORAL SOLN,,17618,LOCAL,Facility,Both,1000,mL,,35,29.75,10.031,35,"Health Partners, Inc.",State Public Programs,17.5,50,,percent of total billed charges,,
ELECTROLYTES-DEXTROSE ORAL SOLN,,17618,LOCAL,Facility,Both,1000,mL,,35,29.75,10.031,35,Humana Insurance Company,Commercial PPO,33.25,95,,percent of total billed charges,,
ELECTROLYTES-DEXTROSE ORAL SOLN,,17618,LOCAL,Facility,Outpatient,1000,mL,,35,29.75,10.031,35,Humana Insurance Company,Medicare PPO,17.15,49,,percent of total billed charges,,
ELECTROLYTES-DEXTROSE ORAL SOLN,,17618,LOCAL,Facility,Inpatient,1000,mL,,35,29.75,10.031,35,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
ELECTROLYTES-DEXTROSE ORAL SOLN,,17618,LOCAL,Facility,Both,1000,mL,,35,29.75,10.031,35,Medica,Individual & Family,34.685,99.1,,percent of total billed charges,,
ELECTROLYTES-DEXTROSE ORAL SOLN,,17618,LOCAL,Facility,Outpatient,1000,mL,,35,29.75,10.031,35,Medica,Medica Advantage Solution,17.43,49.8,,percent of total billed charges,,
ELECTROLYTES-DEXTROSE ORAL SOLN,,17618,LOCAL,Facility,Inpatient,1000,mL,,35,29.75,10.031,35,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
ELECTROLYTES-DEXTROSE ORAL SOLN,,17618,LOCAL,Facility,Outpatient,1000,mL,,35,29.75,10.031,35,Medica,Medical Assistance,15.61,44.6,,percent of total billed charges,,
ELECTROLYTES-DEXTROSE ORAL SOLN,,17618,LOCAL,Facility,Inpatient,1000,mL,,35,29.75,10.031,35,Medica,Medical Assistance,,,,,Included in per diem rate,
ELECTROLYTES-DEXTROSE ORAL SOLN,,17618,LOCAL,Facility,Outpatient,1000,mL,,35,29.75,10.031,35,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,17.43,49.8,,percent of total billed charges,,
ELECTROLYTES-DEXTROSE ORAL SOLN,,17618,LOCAL,Facility,Inpatient,1000,mL,,35,29.75,10.031,35,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
ELECTROLYTES-DEXTROSE ORAL SOLN,,17618,LOCAL,Facility,Both,1000,mL,,35,29.75,10.031,35,"Multiplan, Inc.","Multiplan, Inc.",32.9,94,,percent of total billed charges,,
ELECTROLYTES-DEXTROSE ORAL SOLN,,17618,LOCAL,Facility,Outpatient,1000,mL,,35,29.75,10.031,35,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,31.535,90.1,,percent of total billed charges,,
ELECTROLYTES-DEXTROSE ORAL SOLN,,17618,LOCAL,Facility,Inpatient,1000,mL,,35,29.75,10.031,35,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
ELECTROLYTES-DEXTROSE ORAL SOLN,,17618,LOCAL,Facility,Both,1000,mL,,35,29.75,10.031,35,"Preferred One Administrative Services, INC.",PPO,34.51,98.6,,percent of total billed charges,,
ELECTROLYTES-DEXTROSE ORAL SOLN,,17618,LOCAL,Facility,Outpatient,1000,mL,,35,29.75,10.031,35,PrimeWest Health,Minnesota Senior Health Options (MSHO),18.0075,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
ELECTROLYTES-DEXTROSE ORAL SOLN,,17618,LOCAL,Facility,Inpatient,1000,mL,,35,29.75,10.031,35,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ELECTROLYTES-DEXTROSE ORAL SOLN,,17618,LOCAL,Facility,Outpatient,1000,mL,,35,29.75,10.031,35,PrimeWest Health,MinnesotaCare,17.976,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
ELECTROLYTES-DEXTROSE ORAL SOLN,,17618,LOCAL,Facility,Inpatient,1000,mL,,35,29.75,10.031,35,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
ELECTROLYTES-DEXTROSE ORAL SOLN,,17618,LOCAL,Facility,Both,1000,mL,,35,29.75,10.031,35,Sanford Health Plan,Sanford Health Plan,32.2,92,,percent of total billed charges,,
ELECTROLYTES-DEXTROSE ORAL SOLN,,17618,LOCAL,Facility,Outpatient,1000,mL,,35,29.75,10.031,35,"UCare Health, Inc.",Individual & Family Plan,19.7225,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
ELECTROLYTES-DEXTROSE ORAL SOLN,,17618,LOCAL,Facility,Inpatient,1000,mL,,35,29.75,10.031,35,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
ELECTROLYTES-DEXTROSE ORAL SOLN,,17618,LOCAL,Facility,Outpatient,1000,mL,,35,29.75,10.031,35,"UCare Health, Inc.",Medical Assistance,17.6645,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ELECTROLYTES-DEXTROSE ORAL SOLN,,17618,LOCAL,Facility,Inpatient,1000,mL,,35,29.75,10.031,35,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
ELECTROLYTES-DEXTROSE ORAL SOLN,,17618,LOCAL,Facility,Outpatient,1000,mL,,35,29.75,10.031,35,"UCare Health, Inc.",Medicare Advantage,17.6645,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ELECTROLYTES-DEXTROSE ORAL SOLN,,17618,LOCAL,Facility,Inpatient,1000,mL,,35,29.75,10.031,35,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ELECTROLYTES-DEXTROSE ORAL SOLN,,17618,LOCAL,Facility,Outpatient,1000,mL,,35,29.75,10.031,35,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),17.6645,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ELECTROLYTES-DEXTROSE ORAL SOLN,,17618,LOCAL,Facility,Inpatient,1000,mL,,35,29.75,10.031,35,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ELECTROLYTES-DEXTROSE ORAL SOLN,,17618,LOCAL,Facility,Both,1000,mL,,35,29.75,10.031,35,UnitedHealthcare,Individual & Family,32.9,94,,percent of total billed charges,,
ELECTROLYTES-DEXTROSE ORAL SOLN,,17618,LOCAL,Facility,Outpatient,1000,mL,,35,29.75,10.031,35,UnitedHealthcare,Medicare Advantage,17.15,49,,percent of total billed charges,,
ELECTROLYTES-DEXTROSE ORAL SOLN,,17618,LOCAL,Facility,Inpatient,1000,mL,,35,29.75,10.031,35,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
ELECTROLYTES-DEXTROSE ORAL SOLN,,17618,LOCAL,Facility,Outpatient,1000,mL,,35,29.75,10.031,35,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,16.8,48,,percent of total billed charges,,100% of DHS outpatient percentage
ELECTROLYTES-DEXTROSE ORAL SOLN,,17618,LOCAL,Facility,Inpatient,1000,mL,,35,29.75,10.031,35,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"MAGNESIUM SULFATE IN WATER 40 GRAM/1,000 ML (4 %) IV SOLP",,J3475,HCPCS,Facility,Both,1000,mL,,53,45.05,15.1898,53,Aetna,Commercial,48.76,92,,percent of total billed charges,,
"MAGNESIUM SULFATE IN WATER 40 GRAM/1,000 ML (4 %) IV SOLP",,J3475,HCPCS,Facility,Outpatient,1000,mL,,53,45.05,15.1898,53,Aetna,Medicare Advantage,25.97,49,,percent of total billed charges,,
"MAGNESIUM SULFATE IN WATER 40 GRAM/1,000 ML (4 %) IV SOLP",,J3475,HCPCS,Facility,Inpatient,1000,mL,,53,45.05,15.1898,53,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"MAGNESIUM SULFATE IN WATER 40 GRAM/1,000 ML (4 %) IV SOLP",,J3475,HCPCS,Facility,Both,1000,mL,,53,45.05,15.1898,53,Aetna,PPO,49.29,93,,percent of total billed charges,,
"MAGNESIUM SULFATE IN WATER 40 GRAM/1,000 ML (4 %) IV SOLP",,J3475,HCPCS,Facility,Both,1000,mL,,53,45.05,15.1898,53,America's PPO,America's PPO,50.8959,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"MAGNESIUM SULFATE IN WATER 40 GRAM/1,000 ML (4 %) IV SOLP",,J3475,HCPCS,Facility,Both,1000,mL,,53,45.05,15.1898,53,BlueCross BlueShield Minnesota, Federal Employee Program,52.152,98.4,,percent of total billed charges,,
"MAGNESIUM SULFATE IN WATER 40 GRAM/1,000 ML (4 %) IV SOLP",,J3475,HCPCS,Facility,Both,1000,mL,,53,45.05,15.1898,53,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,53,100,,percent of total billed charges,,
"MAGNESIUM SULFATE IN WATER 40 GRAM/1,000 ML (4 %) IV SOLP",,J3475,HCPCS,Facility,Both,1000,mL,,53,45.05,15.1898,53,BlueCross BlueShield Minnesota,High Value Network Plan,47.7,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
"MAGNESIUM SULFATE IN WATER 40 GRAM/1,000 ML (4 %) IV SOLP",,J3475,HCPCS,Facility,Outpatient,1000,mL,,53,45.05,15.1898,53,BlueCross BlueShield Minnesota,Medicare Advantage,25.97,49,,percent of total billed charges,,
"MAGNESIUM SULFATE IN WATER 40 GRAM/1,000 ML (4 %) IV SOLP",,J3475,HCPCS,Facility,Inpatient,1000,mL,,53,45.05,15.1898,53,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"MAGNESIUM SULFATE IN WATER 40 GRAM/1,000 ML (4 %) IV SOLP",,J3475,HCPCS,Facility,Both,1000,mL,,53,45.05,15.1898,53,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,46.9421,88.57,,percent of total billed charges,,
"MAGNESIUM SULFATE IN WATER 40 GRAM/1,000 ML (4 %) IV SOLP",,J3475,HCPCS,Facility,Both,1000,mL,,53,45.05,15.1898,53,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,15.1898,28.66,,percent of total billed charges,,
"MAGNESIUM SULFATE IN WATER 40 GRAM/1,000 ML (4 %) IV SOLP",,J3475,HCPCS,Facility,Outpatient,1000,mL,,53,45.05,15.1898,53,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),25.97,49,,percent of total billed charges,,
"MAGNESIUM SULFATE IN WATER 40 GRAM/1,000 ML (4 %) IV SOLP",,J3475,HCPCS,Facility,Inpatient,1000,mL,,53,45.05,15.1898,53,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"MAGNESIUM SULFATE IN WATER 40 GRAM/1,000 ML (4 %) IV SOLP",,J3475,HCPCS,Facility,Both,1000,mL,,53,45.05,15.1898,53,CorVel,Worker's Compensation,53,100,,percent of total billed charges,,
"MAGNESIUM SULFATE IN WATER 40 GRAM/1,000 ML (4 %) IV SOLP",,J3475,HCPCS,Facility,Both,1000,mL,,53,45.05,15.1898,53,First Health Group Corporation,First Health Network,51.41,97,,percent of total billed charges,,
"MAGNESIUM SULFATE IN WATER 40 GRAM/1,000 ML (4 %) IV SOLP",,J3475,HCPCS,Facility,Both,1000,mL,,53,45.05,15.1898,53,"Health Partners, Inc.",Commercial,50.138,94.6,,percent of total billed charges,,
"MAGNESIUM SULFATE IN WATER 40 GRAM/1,000 ML (4 %) IV SOLP",,J3475,HCPCS,Facility,Outpatient,1000,mL,,53,45.05,15.1898,53,"Health Partners, Inc.",Medicare Advantage,25.97,49,,percent of total billed charges,,
"MAGNESIUM SULFATE IN WATER 40 GRAM/1,000 ML (4 %) IV SOLP",,J3475,HCPCS,Facility,Inpatient,1000,mL,,53,45.05,15.1898,53,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"MAGNESIUM SULFATE IN WATER 40 GRAM/1,000 ML (4 %) IV SOLP",,J3475,HCPCS,Facility,Both,1000,mL,,53,45.05,15.1898,53,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),31.8,60,,percent of total billed charges,,
"MAGNESIUM SULFATE IN WATER 40 GRAM/1,000 ML (4 %) IV SOLP",,J3475,HCPCS,Facility,Both,1000,mL,,53,45.05,15.1898,53,"Health Partners, Inc.",State of Minnesota Advantage Program,43.195,81.5,,percent of total billed charges,,
"MAGNESIUM SULFATE IN WATER 40 GRAM/1,000 ML (4 %) IV SOLP",,J3475,HCPCS,Facility,Both,1000,mL,,53,45.05,15.1898,53,"Health Partners, Inc.",State Public Programs,26.5,50,,percent of total billed charges,,
"MAGNESIUM SULFATE IN WATER 40 GRAM/1,000 ML (4 %) IV SOLP",,J3475,HCPCS,Facility,Both,1000,mL,,53,45.05,15.1898,53,Humana Insurance Company,Commercial PPO,50.35,95,,percent of total billed charges,,
"MAGNESIUM SULFATE IN WATER 40 GRAM/1,000 ML (4 %) IV SOLP",,J3475,HCPCS,Facility,Outpatient,1000,mL,,53,45.05,15.1898,53,Humana Insurance Company,Medicare PPO,25.97,49,,percent of total billed charges,,
"MAGNESIUM SULFATE IN WATER 40 GRAM/1,000 ML (4 %) IV SOLP",,J3475,HCPCS,Facility,Inpatient,1000,mL,,53,45.05,15.1898,53,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"MAGNESIUM SULFATE IN WATER 40 GRAM/1,000 ML (4 %) IV SOLP",,J3475,HCPCS,Facility,Both,1000,mL,,53,45.05,15.1898,53,Medica,Individual & Family,52.523,99.1,,percent of total billed charges,,
"MAGNESIUM SULFATE IN WATER 40 GRAM/1,000 ML (4 %) IV SOLP",,J3475,HCPCS,Facility,Outpatient,1000,mL,,53,45.05,15.1898,53,Medica,Medica Advantage Solution,26.394,49.8,,percent of total billed charges,,
"MAGNESIUM SULFATE IN WATER 40 GRAM/1,000 ML (4 %) IV SOLP",,J3475,HCPCS,Facility,Inpatient,1000,mL,,53,45.05,15.1898,53,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"MAGNESIUM SULFATE IN WATER 40 GRAM/1,000 ML (4 %) IV SOLP",,J3475,HCPCS,Facility,Outpatient,1000,mL,,53,45.05,15.1898,53,Medica,Medical Assistance,23.638,44.6,,percent of total billed charges,,
"MAGNESIUM SULFATE IN WATER 40 GRAM/1,000 ML (4 %) IV SOLP",,J3475,HCPCS,Facility,Inpatient,1000,mL,,53,45.05,15.1898,53,Medica,Medical Assistance,,,,,Included in per diem rate,
"MAGNESIUM SULFATE IN WATER 40 GRAM/1,000 ML (4 %) IV SOLP",,J3475,HCPCS,Facility,Outpatient,1000,mL,,53,45.05,15.1898,53,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,26.394,49.8,,percent of total billed charges,,
"MAGNESIUM SULFATE IN WATER 40 GRAM/1,000 ML (4 %) IV SOLP",,J3475,HCPCS,Facility,Inpatient,1000,mL,,53,45.05,15.1898,53,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"MAGNESIUM SULFATE IN WATER 40 GRAM/1,000 ML (4 %) IV SOLP",,J3475,HCPCS,Facility,Both,1000,mL,,53,45.05,15.1898,53,"Multiplan, Inc.","Multiplan, Inc.",49.82,94,,percent of total billed charges,,
"MAGNESIUM SULFATE IN WATER 40 GRAM/1,000 ML (4 %) IV SOLP",,J3475,HCPCS,Facility,Outpatient,1000,mL,,53,45.05,15.1898,53,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,47.753,90.1,,percent of total billed charges,,
"MAGNESIUM SULFATE IN WATER 40 GRAM/1,000 ML (4 %) IV SOLP",,J3475,HCPCS,Facility,Inpatient,1000,mL,,53,45.05,15.1898,53,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"MAGNESIUM SULFATE IN WATER 40 GRAM/1,000 ML (4 %) IV SOLP",,J3475,HCPCS,Facility,Both,1000,mL,,53,45.05,15.1898,53,"Preferred One Administrative Services, INC.",PPO,52.258,98.6,,percent of total billed charges,,
"MAGNESIUM SULFATE IN WATER 40 GRAM/1,000 ML (4 %) IV SOLP",,J3475,HCPCS,Facility,Outpatient,1000,mL,,53,45.05,15.1898,53,PrimeWest Health,Minnesota Senior Health Options (MSHO),27.2685,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"MAGNESIUM SULFATE IN WATER 40 GRAM/1,000 ML (4 %) IV SOLP",,J3475,HCPCS,Facility,Inpatient,1000,mL,,53,45.05,15.1898,53,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"MAGNESIUM SULFATE IN WATER 40 GRAM/1,000 ML (4 %) IV SOLP",,J3475,HCPCS,Facility,Outpatient,1000,mL,,53,45.05,15.1898,53,PrimeWest Health,MinnesotaCare,27.2208,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"MAGNESIUM SULFATE IN WATER 40 GRAM/1,000 ML (4 %) IV SOLP",,J3475,HCPCS,Facility,Inpatient,1000,mL,,53,45.05,15.1898,53,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"MAGNESIUM SULFATE IN WATER 40 GRAM/1,000 ML (4 %) IV SOLP",,J3475,HCPCS,Facility,Both,1000,mL,,53,45.05,15.1898,53,Sanford Health Plan,Sanford Health Plan,48.76,92,,percent of total billed charges,,
"MAGNESIUM SULFATE IN WATER 40 GRAM/1,000 ML (4 %) IV SOLP",,J3475,HCPCS,Facility,Outpatient,1000,mL,,53,45.05,15.1898,53,"UCare Health, Inc.",Individual & Family Plan,29.8655,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"MAGNESIUM SULFATE IN WATER 40 GRAM/1,000 ML (4 %) IV SOLP",,J3475,HCPCS,Facility,Inpatient,1000,mL,,53,45.05,15.1898,53,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"MAGNESIUM SULFATE IN WATER 40 GRAM/1,000 ML (4 %) IV SOLP",,J3475,HCPCS,Facility,Outpatient,1000,mL,,53,45.05,15.1898,53,"UCare Health, Inc.",Medical Assistance,26.7491,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"MAGNESIUM SULFATE IN WATER 40 GRAM/1,000 ML (4 %) IV SOLP",,J3475,HCPCS,Facility,Inpatient,1000,mL,,53,45.05,15.1898,53,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"MAGNESIUM SULFATE IN WATER 40 GRAM/1,000 ML (4 %) IV SOLP",,J3475,HCPCS,Facility,Outpatient,1000,mL,,53,45.05,15.1898,53,"UCare Health, Inc.",Medicare Advantage,26.7491,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"MAGNESIUM SULFATE IN WATER 40 GRAM/1,000 ML (4 %) IV SOLP",,J3475,HCPCS,Facility,Inpatient,1000,mL,,53,45.05,15.1898,53,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"MAGNESIUM SULFATE IN WATER 40 GRAM/1,000 ML (4 %) IV SOLP",,J3475,HCPCS,Facility,Outpatient,1000,mL,,53,45.05,15.1898,53,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),26.7491,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"MAGNESIUM SULFATE IN WATER 40 GRAM/1,000 ML (4 %) IV SOLP",,J3475,HCPCS,Facility,Inpatient,1000,mL,,53,45.05,15.1898,53,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"MAGNESIUM SULFATE IN WATER 40 GRAM/1,000 ML (4 %) IV SOLP",,J3475,HCPCS,Facility,Both,1000,mL,,53,45.05,15.1898,53,UnitedHealthcare,Individual & Family,49.82,94,,percent of total billed charges,,
"MAGNESIUM SULFATE IN WATER 40 GRAM/1,000 ML (4 %) IV SOLP",,J3475,HCPCS,Facility,Outpatient,1000,mL,,53,45.05,15.1898,53,UnitedHealthcare,Medicare Advantage,25.97,49,,percent of total billed charges,,
"MAGNESIUM SULFATE IN WATER 40 GRAM/1,000 ML (4 %) IV SOLP",,J3475,HCPCS,Facility,Inpatient,1000,mL,,53,45.05,15.1898,53,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"MAGNESIUM SULFATE IN WATER 40 GRAM/1,000 ML (4 %) IV SOLP",,J3475,HCPCS,Facility,Outpatient,1000,mL,,53,45.05,15.1898,53,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,25.44,48,,percent of total billed charges,,100% of DHS outpatient percentage
"MAGNESIUM SULFATE IN WATER 40 GRAM/1,000 ML (4 %) IV SOLP",,J3475,HCPCS,Facility,Inpatient,1000,mL,,53,45.05,15.1898,53,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
POTASSIUM CHLORIDE IN 0.9%NACL 20 MEQ/L IV SOLP,,J3480,HCPCS,Facility,Both,1000,mL,,58,49.3,16.6228,58,Aetna,Commercial,53.36,92,,percent of total billed charges,,
POTASSIUM CHLORIDE IN 0.9%NACL 20 MEQ/L IV SOLP,,J3480,HCPCS,Facility,Outpatient,1000,mL,,58,49.3,16.6228,58,Aetna,Medicare Advantage,28.42,49,,percent of total billed charges,,
POTASSIUM CHLORIDE IN 0.9%NACL 20 MEQ/L IV SOLP,,J3480,HCPCS,Facility,Inpatient,1000,mL,,58,49.3,16.6228,58,Aetna,Medicare Advantage,,,,,Included in per diem rate,
POTASSIUM CHLORIDE IN 0.9%NACL 20 MEQ/L IV SOLP,,J3480,HCPCS,Facility,Both,1000,mL,,58,49.3,16.6228,58,Aetna,PPO,53.94,93,,percent of total billed charges,,
POTASSIUM CHLORIDE IN 0.9%NACL 20 MEQ/L IV SOLP,,J3480,HCPCS,Facility,Both,1000,mL,,58,49.3,16.6228,58,America's PPO,America's PPO,55.6974,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
POTASSIUM CHLORIDE IN 0.9%NACL 20 MEQ/L IV SOLP,,J3480,HCPCS,Facility,Both,1000,mL,,58,49.3,16.6228,58,BlueCross BlueShield Minnesota, Federal Employee Program,57.072,98.4,,percent of total billed charges,,
POTASSIUM CHLORIDE IN 0.9%NACL 20 MEQ/L IV SOLP,,J3480,HCPCS,Facility,Both,1000,mL,,58,49.3,16.6228,58,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,58,100,,percent of total billed charges,,
POTASSIUM CHLORIDE IN 0.9%NACL 20 MEQ/L IV SOLP,,J3480,HCPCS,Facility,Both,1000,mL,,58,49.3,16.6228,58,BlueCross BlueShield Minnesota,High Value Network Plan,52.2,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
POTASSIUM CHLORIDE IN 0.9%NACL 20 MEQ/L IV SOLP,,J3480,HCPCS,Facility,Outpatient,1000,mL,,58,49.3,16.6228,58,BlueCross BlueShield Minnesota,Medicare Advantage,28.42,49,,percent of total billed charges,,
POTASSIUM CHLORIDE IN 0.9%NACL 20 MEQ/L IV SOLP,,J3480,HCPCS,Facility,Inpatient,1000,mL,,58,49.3,16.6228,58,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
POTASSIUM CHLORIDE IN 0.9%NACL 20 MEQ/L IV SOLP,,J3480,HCPCS,Facility,Both,1000,mL,,58,49.3,16.6228,58,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,51.3706,88.57,,percent of total billed charges,,
POTASSIUM CHLORIDE IN 0.9%NACL 20 MEQ/L IV SOLP,,J3480,HCPCS,Facility,Both,1000,mL,,58,49.3,16.6228,58,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,16.6228,28.66,,percent of total billed charges,,
POTASSIUM CHLORIDE IN 0.9%NACL 20 MEQ/L IV SOLP,,J3480,HCPCS,Facility,Outpatient,1000,mL,,58,49.3,16.6228,58,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),28.42,49,,percent of total billed charges,,
POTASSIUM CHLORIDE IN 0.9%NACL 20 MEQ/L IV SOLP,,J3480,HCPCS,Facility,Inpatient,1000,mL,,58,49.3,16.6228,58,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
POTASSIUM CHLORIDE IN 0.9%NACL 20 MEQ/L IV SOLP,,J3480,HCPCS,Facility,Both,1000,mL,,58,49.3,16.6228,58,CorVel,Worker's Compensation,58,100,,percent of total billed charges,,
POTASSIUM CHLORIDE IN 0.9%NACL 20 MEQ/L IV SOLP,,J3480,HCPCS,Facility,Both,1000,mL,,58,49.3,16.6228,58,First Health Group Corporation,First Health Network,56.26,97,,percent of total billed charges,,
POTASSIUM CHLORIDE IN 0.9%NACL 20 MEQ/L IV SOLP,,J3480,HCPCS,Facility,Both,1000,mL,,58,49.3,16.6228,58,"Health Partners, Inc.",Commercial,54.868,94.6,,percent of total billed charges,,
POTASSIUM CHLORIDE IN 0.9%NACL 20 MEQ/L IV SOLP,,J3480,HCPCS,Facility,Outpatient,1000,mL,,58,49.3,16.6228,58,"Health Partners, Inc.",Medicare Advantage,28.42,49,,percent of total billed charges,,
POTASSIUM CHLORIDE IN 0.9%NACL 20 MEQ/L IV SOLP,,J3480,HCPCS,Facility,Inpatient,1000,mL,,58,49.3,16.6228,58,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
POTASSIUM CHLORIDE IN 0.9%NACL 20 MEQ/L IV SOLP,,J3480,HCPCS,Facility,Both,1000,mL,,58,49.3,16.6228,58,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),34.8,60,,percent of total billed charges,,
POTASSIUM CHLORIDE IN 0.9%NACL 20 MEQ/L IV SOLP,,J3480,HCPCS,Facility,Both,1000,mL,,58,49.3,16.6228,58,"Health Partners, Inc.",State of Minnesota Advantage Program,47.27,81.5,,percent of total billed charges,,
POTASSIUM CHLORIDE IN 0.9%NACL 20 MEQ/L IV SOLP,,J3480,HCPCS,Facility,Both,1000,mL,,58,49.3,16.6228,58,"Health Partners, Inc.",State Public Programs,29,50,,percent of total billed charges,,
POTASSIUM CHLORIDE IN 0.9%NACL 20 MEQ/L IV SOLP,,J3480,HCPCS,Facility,Both,1000,mL,,58,49.3,16.6228,58,Humana Insurance Company,Commercial PPO,55.1,95,,percent of total billed charges,,
POTASSIUM CHLORIDE IN 0.9%NACL 20 MEQ/L IV SOLP,,J3480,HCPCS,Facility,Outpatient,1000,mL,,58,49.3,16.6228,58,Humana Insurance Company,Medicare PPO,28.42,49,,percent of total billed charges,,
POTASSIUM CHLORIDE IN 0.9%NACL 20 MEQ/L IV SOLP,,J3480,HCPCS,Facility,Inpatient,1000,mL,,58,49.3,16.6228,58,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
POTASSIUM CHLORIDE IN 0.9%NACL 20 MEQ/L IV SOLP,,J3480,HCPCS,Facility,Both,1000,mL,,58,49.3,16.6228,58,Medica,Individual & Family,57.478,99.1,,percent of total billed charges,,
POTASSIUM CHLORIDE IN 0.9%NACL 20 MEQ/L IV SOLP,,J3480,HCPCS,Facility,Outpatient,1000,mL,,58,49.3,16.6228,58,Medica,Medica Advantage Solution,28.884,49.8,,percent of total billed charges,,
POTASSIUM CHLORIDE IN 0.9%NACL 20 MEQ/L IV SOLP,,J3480,HCPCS,Facility,Inpatient,1000,mL,,58,49.3,16.6228,58,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
POTASSIUM CHLORIDE IN 0.9%NACL 20 MEQ/L IV SOLP,,J3480,HCPCS,Facility,Outpatient,1000,mL,,58,49.3,16.6228,58,Medica,Medical Assistance,25.868,44.6,,percent of total billed charges,,
POTASSIUM CHLORIDE IN 0.9%NACL 20 MEQ/L IV SOLP,,J3480,HCPCS,Facility,Inpatient,1000,mL,,58,49.3,16.6228,58,Medica,Medical Assistance,,,,,Included in per diem rate,
POTASSIUM CHLORIDE IN 0.9%NACL 20 MEQ/L IV SOLP,,J3480,HCPCS,Facility,Outpatient,1000,mL,,58,49.3,16.6228,58,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,28.884,49.8,,percent of total billed charges,,
POTASSIUM CHLORIDE IN 0.9%NACL 20 MEQ/L IV SOLP,,J3480,HCPCS,Facility,Inpatient,1000,mL,,58,49.3,16.6228,58,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
POTASSIUM CHLORIDE IN 0.9%NACL 20 MEQ/L IV SOLP,,J3480,HCPCS,Facility,Both,1000,mL,,58,49.3,16.6228,58,"Multiplan, Inc.","Multiplan, Inc.",54.52,94,,percent of total billed charges,,
POTASSIUM CHLORIDE IN 0.9%NACL 20 MEQ/L IV SOLP,,J3480,HCPCS,Facility,Outpatient,1000,mL,,58,49.3,16.6228,58,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,52.258,90.1,,percent of total billed charges,,
POTASSIUM CHLORIDE IN 0.9%NACL 20 MEQ/L IV SOLP,,J3480,HCPCS,Facility,Inpatient,1000,mL,,58,49.3,16.6228,58,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
POTASSIUM CHLORIDE IN 0.9%NACL 20 MEQ/L IV SOLP,,J3480,HCPCS,Facility,Both,1000,mL,,58,49.3,16.6228,58,"Preferred One Administrative Services, INC.",PPO,57.188,98.6,,percent of total billed charges,,
POTASSIUM CHLORIDE IN 0.9%NACL 20 MEQ/L IV SOLP,,J3480,HCPCS,Facility,Outpatient,1000,mL,,58,49.3,16.6228,58,PrimeWest Health,Minnesota Senior Health Options (MSHO),29.841,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
POTASSIUM CHLORIDE IN 0.9%NACL 20 MEQ/L IV SOLP,,J3480,HCPCS,Facility,Inpatient,1000,mL,,58,49.3,16.6228,58,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
POTASSIUM CHLORIDE IN 0.9%NACL 20 MEQ/L IV SOLP,,J3480,HCPCS,Facility,Outpatient,1000,mL,,58,49.3,16.6228,58,PrimeWest Health,MinnesotaCare,29.7888,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
POTASSIUM CHLORIDE IN 0.9%NACL 20 MEQ/L IV SOLP,,J3480,HCPCS,Facility,Inpatient,1000,mL,,58,49.3,16.6228,58,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
POTASSIUM CHLORIDE IN 0.9%NACL 20 MEQ/L IV SOLP,,J3480,HCPCS,Facility,Both,1000,mL,,58,49.3,16.6228,58,Sanford Health Plan,Sanford Health Plan,53.36,92,,percent of total billed charges,,
POTASSIUM CHLORIDE IN 0.9%NACL 20 MEQ/L IV SOLP,,J3480,HCPCS,Facility,Outpatient,1000,mL,,58,49.3,16.6228,58,"UCare Health, Inc.",Individual & Family Plan,32.683,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
POTASSIUM CHLORIDE IN 0.9%NACL 20 MEQ/L IV SOLP,,J3480,HCPCS,Facility,Inpatient,1000,mL,,58,49.3,16.6228,58,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
POTASSIUM CHLORIDE IN 0.9%NACL 20 MEQ/L IV SOLP,,J3480,HCPCS,Facility,Outpatient,1000,mL,,58,49.3,16.6228,58,"UCare Health, Inc.",Medical Assistance,29.2726,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
POTASSIUM CHLORIDE IN 0.9%NACL 20 MEQ/L IV SOLP,,J3480,HCPCS,Facility,Inpatient,1000,mL,,58,49.3,16.6228,58,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
POTASSIUM CHLORIDE IN 0.9%NACL 20 MEQ/L IV SOLP,,J3480,HCPCS,Facility,Outpatient,1000,mL,,58,49.3,16.6228,58,"UCare Health, Inc.",Medicare Advantage,29.2726,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
POTASSIUM CHLORIDE IN 0.9%NACL 20 MEQ/L IV SOLP,,J3480,HCPCS,Facility,Inpatient,1000,mL,,58,49.3,16.6228,58,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
POTASSIUM CHLORIDE IN 0.9%NACL 20 MEQ/L IV SOLP,,J3480,HCPCS,Facility,Outpatient,1000,mL,,58,49.3,16.6228,58,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),29.2726,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
POTASSIUM CHLORIDE IN 0.9%NACL 20 MEQ/L IV SOLP,,J3480,HCPCS,Facility,Inpatient,1000,mL,,58,49.3,16.6228,58,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
POTASSIUM CHLORIDE IN 0.9%NACL 20 MEQ/L IV SOLP,,J3480,HCPCS,Facility,Both,1000,mL,,58,49.3,16.6228,58,UnitedHealthcare,Individual & Family,54.52,94,,percent of total billed charges,,
POTASSIUM CHLORIDE IN 0.9%NACL 20 MEQ/L IV SOLP,,J3480,HCPCS,Facility,Outpatient,1000,mL,,58,49.3,16.6228,58,UnitedHealthcare,Medicare Advantage,28.42,49,,percent of total billed charges,,
POTASSIUM CHLORIDE IN 0.9%NACL 20 MEQ/L IV SOLP,,J3480,HCPCS,Facility,Inpatient,1000,mL,,58,49.3,16.6228,58,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
POTASSIUM CHLORIDE IN 0.9%NACL 20 MEQ/L IV SOLP,,J3480,HCPCS,Facility,Outpatient,1000,mL,,58,49.3,16.6228,58,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,27.84,48,,percent of total billed charges,,100% of DHS outpatient percentage
POTASSIUM CHLORIDE IN 0.9%NACL 20 MEQ/L IV SOLP,,J3480,HCPCS,Facility,Inpatient,1000,mL,,58,49.3,16.6228,58,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
D5 % AND 0.9 % SODIUM CHLORIDE IV SOLP,,J7042,HCPCS,Facility,Both,1000,mL,,25,21.25,7.165,25,Aetna,Commercial,23,92,,percent of total billed charges,,
D5 % AND 0.9 % SODIUM CHLORIDE IV SOLP,,J7042,HCPCS,Facility,Outpatient,1000,mL,,25,21.25,7.165,25,Aetna,Medicare Advantage,12.25,49,,percent of total billed charges,,
D5 % AND 0.9 % SODIUM CHLORIDE IV SOLP,,J7042,HCPCS,Facility,Inpatient,1000,mL,,25,21.25,7.165,25,Aetna,Medicare Advantage,,,,,Included in per diem rate,
D5 % AND 0.9 % SODIUM CHLORIDE IV SOLP,,J7042,HCPCS,Facility,Both,1000,mL,,25,21.25,7.165,25,Aetna,PPO,23.25,93,,percent of total billed charges,,
D5 % AND 0.9 % SODIUM CHLORIDE IV SOLP,,J7042,HCPCS,Facility,Both,1000,mL,,25,21.25,7.165,25,America's PPO,America's PPO,24.0075,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
D5 % AND 0.9 % SODIUM CHLORIDE IV SOLP,,J7042,HCPCS,Facility,Both,1000,mL,,25,21.25,7.165,25,BlueCross BlueShield Minnesota, Federal Employee Program,24.6,98.4,,percent of total billed charges,,
D5 % AND 0.9 % SODIUM CHLORIDE IV SOLP,,J7042,HCPCS,Facility,Both,1000,mL,,25,21.25,7.165,25,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,25,100,,percent of total billed charges,,
D5 % AND 0.9 % SODIUM CHLORIDE IV SOLP,,J7042,HCPCS,Facility,Both,1000,mL,,25,21.25,7.165,25,BlueCross BlueShield Minnesota,High Value Network Plan,22.5,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
D5 % AND 0.9 % SODIUM CHLORIDE IV SOLP,,J7042,HCPCS,Facility,Outpatient,1000,mL,,25,21.25,7.165,25,BlueCross BlueShield Minnesota,Medicare Advantage,12.25,49,,percent of total billed charges,,
D5 % AND 0.9 % SODIUM CHLORIDE IV SOLP,,J7042,HCPCS,Facility,Inpatient,1000,mL,,25,21.25,7.165,25,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
D5 % AND 0.9 % SODIUM CHLORIDE IV SOLP,,J7042,HCPCS,Facility,Both,1000,mL,,25,21.25,7.165,25,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,22.1425,88.57,,percent of total billed charges,,
D5 % AND 0.9 % SODIUM CHLORIDE IV SOLP,,J7042,HCPCS,Facility,Both,1000,mL,,25,21.25,7.165,25,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,7.165,28.66,,percent of total billed charges,,
D5 % AND 0.9 % SODIUM CHLORIDE IV SOLP,,J7042,HCPCS,Facility,Outpatient,1000,mL,,25,21.25,7.165,25,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),12.25,49,,percent of total billed charges,,
D5 % AND 0.9 % SODIUM CHLORIDE IV SOLP,,J7042,HCPCS,Facility,Inpatient,1000,mL,,25,21.25,7.165,25,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
D5 % AND 0.9 % SODIUM CHLORIDE IV SOLP,,J7042,HCPCS,Facility,Both,1000,mL,,25,21.25,7.165,25,CorVel,Worker's Compensation,25,100,,percent of total billed charges,,
D5 % AND 0.9 % SODIUM CHLORIDE IV SOLP,,J7042,HCPCS,Facility,Both,1000,mL,,25,21.25,7.165,25,First Health Group Corporation,First Health Network,24.25,97,,percent of total billed charges,,
D5 % AND 0.9 % SODIUM CHLORIDE IV SOLP,,J7042,HCPCS,Facility,Both,1000,mL,,25,21.25,7.165,25,"Health Partners, Inc.",Commercial,23.65,94.6,,percent of total billed charges,,
D5 % AND 0.9 % SODIUM CHLORIDE IV SOLP,,J7042,HCPCS,Facility,Outpatient,1000,mL,,25,21.25,7.165,25,"Health Partners, Inc.",Medicare Advantage,12.25,49,,percent of total billed charges,,
D5 % AND 0.9 % SODIUM CHLORIDE IV SOLP,,J7042,HCPCS,Facility,Inpatient,1000,mL,,25,21.25,7.165,25,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
D5 % AND 0.9 % SODIUM CHLORIDE IV SOLP,,J7042,HCPCS,Facility,Both,1000,mL,,25,21.25,7.165,25,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),15,60,,percent of total billed charges,,
D5 % AND 0.9 % SODIUM CHLORIDE IV SOLP,,J7042,HCPCS,Facility,Both,1000,mL,,25,21.25,7.165,25,"Health Partners, Inc.",State of Minnesota Advantage Program,20.375,81.5,,percent of total billed charges,,
D5 % AND 0.9 % SODIUM CHLORIDE IV SOLP,,J7042,HCPCS,Facility,Both,1000,mL,,25,21.25,7.165,25,"Health Partners, Inc.",State Public Programs,12.5,50,,percent of total billed charges,,
D5 % AND 0.9 % SODIUM CHLORIDE IV SOLP,,J7042,HCPCS,Facility,Both,1000,mL,,25,21.25,7.165,25,Humana Insurance Company,Commercial PPO,23.75,95,,percent of total billed charges,,
D5 % AND 0.9 % SODIUM CHLORIDE IV SOLP,,J7042,HCPCS,Facility,Outpatient,1000,mL,,25,21.25,7.165,25,Humana Insurance Company,Medicare PPO,12.25,49,,percent of total billed charges,,
D5 % AND 0.9 % SODIUM CHLORIDE IV SOLP,,J7042,HCPCS,Facility,Inpatient,1000,mL,,25,21.25,7.165,25,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
D5 % AND 0.9 % SODIUM CHLORIDE IV SOLP,,J7042,HCPCS,Facility,Both,1000,mL,,25,21.25,7.165,25,Medica,Individual & Family,24.775,99.1,,percent of total billed charges,,
D5 % AND 0.9 % SODIUM CHLORIDE IV SOLP,,J7042,HCPCS,Facility,Outpatient,1000,mL,,25,21.25,7.165,25,Medica,Medica Advantage Solution,12.45,49.8,,percent of total billed charges,,
D5 % AND 0.9 % SODIUM CHLORIDE IV SOLP,,J7042,HCPCS,Facility,Inpatient,1000,mL,,25,21.25,7.165,25,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
D5 % AND 0.9 % SODIUM CHLORIDE IV SOLP,,J7042,HCPCS,Facility,Outpatient,1000,mL,,25,21.25,7.165,25,Medica,Medical Assistance,11.15,44.6,,percent of total billed charges,,
D5 % AND 0.9 % SODIUM CHLORIDE IV SOLP,,J7042,HCPCS,Facility,Inpatient,1000,mL,,25,21.25,7.165,25,Medica,Medical Assistance,,,,,Included in per diem rate,
D5 % AND 0.9 % SODIUM CHLORIDE IV SOLP,,J7042,HCPCS,Facility,Outpatient,1000,mL,,25,21.25,7.165,25,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,12.45,49.8,,percent of total billed charges,,
D5 % AND 0.9 % SODIUM CHLORIDE IV SOLP,,J7042,HCPCS,Facility,Inpatient,1000,mL,,25,21.25,7.165,25,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
D5 % AND 0.9 % SODIUM CHLORIDE IV SOLP,,J7042,HCPCS,Facility,Both,1000,mL,,25,21.25,7.165,25,"Multiplan, Inc.","Multiplan, Inc.",23.5,94,,percent of total billed charges,,
D5 % AND 0.9 % SODIUM CHLORIDE IV SOLP,,J7042,HCPCS,Facility,Outpatient,1000,mL,,25,21.25,7.165,25,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,22.525,90.1,,percent of total billed charges,,
D5 % AND 0.9 % SODIUM CHLORIDE IV SOLP,,J7042,HCPCS,Facility,Inpatient,1000,mL,,25,21.25,7.165,25,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
D5 % AND 0.9 % SODIUM CHLORIDE IV SOLP,,J7042,HCPCS,Facility,Both,1000,mL,,25,21.25,7.165,25,"Preferred One Administrative Services, INC.",PPO,24.65,98.6,,percent of total billed charges,,
D5 % AND 0.9 % SODIUM CHLORIDE IV SOLP,,J7042,HCPCS,Facility,Outpatient,1000,mL,,25,21.25,7.165,25,PrimeWest Health,Minnesota Senior Health Options (MSHO),12.8625,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
D5 % AND 0.9 % SODIUM CHLORIDE IV SOLP,,J7042,HCPCS,Facility,Inpatient,1000,mL,,25,21.25,7.165,25,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
D5 % AND 0.9 % SODIUM CHLORIDE IV SOLP,,J7042,HCPCS,Facility,Outpatient,1000,mL,,25,21.25,7.165,25,PrimeWest Health,MinnesotaCare,12.84,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
D5 % AND 0.9 % SODIUM CHLORIDE IV SOLP,,J7042,HCPCS,Facility,Inpatient,1000,mL,,25,21.25,7.165,25,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
D5 % AND 0.9 % SODIUM CHLORIDE IV SOLP,,J7042,HCPCS,Facility,Both,1000,mL,,25,21.25,7.165,25,Sanford Health Plan,Sanford Health Plan,23,92,,percent of total billed charges,,
D5 % AND 0.9 % SODIUM CHLORIDE IV SOLP,,J7042,HCPCS,Facility,Outpatient,1000,mL,,25,21.25,7.165,25,"UCare Health, Inc.",Individual & Family Plan,14.0875,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
D5 % AND 0.9 % SODIUM CHLORIDE IV SOLP,,J7042,HCPCS,Facility,Inpatient,1000,mL,,25,21.25,7.165,25,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
D5 % AND 0.9 % SODIUM CHLORIDE IV SOLP,,J7042,HCPCS,Facility,Outpatient,1000,mL,,25,21.25,7.165,25,"UCare Health, Inc.",Medical Assistance,12.6175,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
D5 % AND 0.9 % SODIUM CHLORIDE IV SOLP,,J7042,HCPCS,Facility,Inpatient,1000,mL,,25,21.25,7.165,25,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
D5 % AND 0.9 % SODIUM CHLORIDE IV SOLP,,J7042,HCPCS,Facility,Outpatient,1000,mL,,25,21.25,7.165,25,"UCare Health, Inc.",Medicare Advantage,12.6175,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
D5 % AND 0.9 % SODIUM CHLORIDE IV SOLP,,J7042,HCPCS,Facility,Inpatient,1000,mL,,25,21.25,7.165,25,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
D5 % AND 0.9 % SODIUM CHLORIDE IV SOLP,,J7042,HCPCS,Facility,Outpatient,1000,mL,,25,21.25,7.165,25,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),12.6175,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
D5 % AND 0.9 % SODIUM CHLORIDE IV SOLP,,J7042,HCPCS,Facility,Inpatient,1000,mL,,25,21.25,7.165,25,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
D5 % AND 0.9 % SODIUM CHLORIDE IV SOLP,,J7042,HCPCS,Facility,Both,1000,mL,,25,21.25,7.165,25,UnitedHealthcare,Individual & Family,23.5,94,,percent of total billed charges,,
D5 % AND 0.9 % SODIUM CHLORIDE IV SOLP,,J7042,HCPCS,Facility,Outpatient,1000,mL,,25,21.25,7.165,25,UnitedHealthcare,Medicare Advantage,12.25,49,,percent of total billed charges,,
D5 % AND 0.9 % SODIUM CHLORIDE IV SOLP,,J7042,HCPCS,Facility,Inpatient,1000,mL,,25,21.25,7.165,25,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
D5 % AND 0.9 % SODIUM CHLORIDE IV SOLP,,J7042,HCPCS,Facility,Outpatient,1000,mL,,25,21.25,7.165,25,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,12,48,,percent of total billed charges,,100% of DHS outpatient percentage
D5 % AND 0.9 % SODIUM CHLORIDE IV SOLP,,J7042,HCPCS,Facility,Inpatient,1000,mL,,25,21.25,7.165,25,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"HUM PROTHROMBIN CPLX(PCC)4FACT 1,000 UNIT (800-1240 UNIT) IV SOLR",,J7168,HCPCS,Facility,Both,1000,Units,,10728,9118.8,3074.6448,10728,Aetna,Commercial,9869.76,92,,percent of total billed charges,,
"HUM PROTHROMBIN CPLX(PCC)4FACT 1,000 UNIT (800-1240 UNIT) IV SOLR",,J7168,HCPCS,Facility,Outpatient,1000,Units,,10728,9118.8,3074.6448,10728,Aetna,Medicare Advantage,5256.72,49,,percent of total billed charges,,
"HUM PROTHROMBIN CPLX(PCC)4FACT 1,000 UNIT (800-1240 UNIT) IV SOLR",,J7168,HCPCS,Facility,Inpatient,1000,Units,,10728,9118.8,3074.6448,10728,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"HUM PROTHROMBIN CPLX(PCC)4FACT 1,000 UNIT (800-1240 UNIT) IV SOLR",,J7168,HCPCS,Facility,Both,1000,Units,,10728,9118.8,3074.6448,10728,Aetna,PPO,9977.04,93,,percent of total billed charges,,
"HUM PROTHROMBIN CPLX(PCC)4FACT 1,000 UNIT (800-1240 UNIT) IV SOLR",,J7168,HCPCS,Facility,Both,1000,Units,,10728,9118.8,3074.6448,10728,America's PPO,America's PPO,10302.0984,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"HUM PROTHROMBIN CPLX(PCC)4FACT 1,000 UNIT (800-1240 UNIT) IV SOLR",,J7168,HCPCS,Facility,Both,1000,Units,,10728,9118.8,3074.6448,10728,BlueCross BlueShield Minnesota, Federal Employee Program,10556.352,98.4,,percent of total billed charges,,
"HUM PROTHROMBIN CPLX(PCC)4FACT 1,000 UNIT (800-1240 UNIT) IV SOLR",,J7168,HCPCS,Facility,Both,1000,Units,,10728,9118.8,3074.6448,10728,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,10728,100,,percent of total billed charges,,
"HUM PROTHROMBIN CPLX(PCC)4FACT 1,000 UNIT (800-1240 UNIT) IV SOLR",,J7168,HCPCS,Facility,Both,1000,Units,,10728,9118.8,3074.6448,10728,BlueCross BlueShield Minnesota,High Value Network Plan,9655.2,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
"HUM PROTHROMBIN CPLX(PCC)4FACT 1,000 UNIT (800-1240 UNIT) IV SOLR",,J7168,HCPCS,Facility,Outpatient,1000,Units,,10728,9118.8,3074.6448,10728,BlueCross BlueShield Minnesota,Medicare Advantage,5256.72,49,,percent of total billed charges,,
"HUM PROTHROMBIN CPLX(PCC)4FACT 1,000 UNIT (800-1240 UNIT) IV SOLR",,J7168,HCPCS,Facility,Inpatient,1000,Units,,10728,9118.8,3074.6448,10728,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"HUM PROTHROMBIN CPLX(PCC)4FACT 1,000 UNIT (800-1240 UNIT) IV SOLR",,J7168,HCPCS,Facility,Both,1000,Units,,10728,9118.8,3074.6448,10728,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,9501.7896,88.57,,percent of total billed charges,,
"HUM PROTHROMBIN CPLX(PCC)4FACT 1,000 UNIT (800-1240 UNIT) IV SOLR",,J7168,HCPCS,Facility,Both,1000,Units,,10728,9118.8,3074.6448,10728,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,3074.6448,28.66,,percent of total billed charges,,
"HUM PROTHROMBIN CPLX(PCC)4FACT 1,000 UNIT (800-1240 UNIT) IV SOLR",,J7168,HCPCS,Facility,Outpatient,1000,Units,,10728,9118.8,3074.6448,10728,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),5256.72,49,,percent of total billed charges,,
"HUM PROTHROMBIN CPLX(PCC)4FACT 1,000 UNIT (800-1240 UNIT) IV SOLR",,J7168,HCPCS,Facility,Inpatient,1000,Units,,10728,9118.8,3074.6448,10728,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"HUM PROTHROMBIN CPLX(PCC)4FACT 1,000 UNIT (800-1240 UNIT) IV SOLR",,J7168,HCPCS,Facility,Both,1000,Units,,10728,9118.8,3074.6448,10728,CorVel,Worker's Compensation,10728,100,,percent of total billed charges,,
"HUM PROTHROMBIN CPLX(PCC)4FACT 1,000 UNIT (800-1240 UNIT) IV SOLR",,J7168,HCPCS,Facility,Both,1000,Units,,10728,9118.8,3074.6448,10728,First Health Group Corporation,First Health Network,10406.16,97,,percent of total billed charges,,
"HUM PROTHROMBIN CPLX(PCC)4FACT 1,000 UNIT (800-1240 UNIT) IV SOLR",,J7168,HCPCS,Facility,Both,1000,Units,,10728,9118.8,3074.6448,10728,"Health Partners, Inc.",Commercial,10148.688,94.6,,percent of total billed charges,,
"HUM PROTHROMBIN CPLX(PCC)4FACT 1,000 UNIT (800-1240 UNIT) IV SOLR",,J7168,HCPCS,Facility,Outpatient,1000,Units,,10728,9118.8,3074.6448,10728,"Health Partners, Inc.",Medicare Advantage,5256.72,49,,percent of total billed charges,,
"HUM PROTHROMBIN CPLX(PCC)4FACT 1,000 UNIT (800-1240 UNIT) IV SOLR",,J7168,HCPCS,Facility,Inpatient,1000,Units,,10728,9118.8,3074.6448,10728,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"HUM PROTHROMBIN CPLX(PCC)4FACT 1,000 UNIT (800-1240 UNIT) IV SOLR",,J7168,HCPCS,Facility,Both,1000,Units,,10728,9118.8,3074.6448,10728,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),6436.8,60,,percent of total billed charges,,
"HUM PROTHROMBIN CPLX(PCC)4FACT 1,000 UNIT (800-1240 UNIT) IV SOLR",,J7168,HCPCS,Facility,Both,1000,Units,,10728,9118.8,3074.6448,10728,"Health Partners, Inc.",State of Minnesota Advantage Program,8743.32,81.5,,percent of total billed charges,,
"HUM PROTHROMBIN CPLX(PCC)4FACT 1,000 UNIT (800-1240 UNIT) IV SOLR",,J7168,HCPCS,Facility,Both,1000,Units,,10728,9118.8,3074.6448,10728,"Health Partners, Inc.",State Public Programs,5364,50,,percent of total billed charges,,
"HUM PROTHROMBIN CPLX(PCC)4FACT 1,000 UNIT (800-1240 UNIT) IV SOLR",,J7168,HCPCS,Facility,Both,1000,Units,,10728,9118.8,3074.6448,10728,Humana Insurance Company,Commercial PPO,10191.6,95,,percent of total billed charges,,
"HUM PROTHROMBIN CPLX(PCC)4FACT 1,000 UNIT (800-1240 UNIT) IV SOLR",,J7168,HCPCS,Facility,Outpatient,1000,Units,,10728,9118.8,3074.6448,10728,Humana Insurance Company,Medicare PPO,5256.72,49,,percent of total billed charges,,
"HUM PROTHROMBIN CPLX(PCC)4FACT 1,000 UNIT (800-1240 UNIT) IV SOLR",,J7168,HCPCS,Facility,Inpatient,1000,Units,,10728,9118.8,3074.6448,10728,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"HUM PROTHROMBIN CPLX(PCC)4FACT 1,000 UNIT (800-1240 UNIT) IV SOLR",,J7168,HCPCS,Facility,Both,1000,Units,,10728,9118.8,3074.6448,10728,Medica,Individual & Family,10631.448,99.1,,percent of total billed charges,,
"HUM PROTHROMBIN CPLX(PCC)4FACT 1,000 UNIT (800-1240 UNIT) IV SOLR",,J7168,HCPCS,Facility,Outpatient,1000,Units,,10728,9118.8,3074.6448,10728,Medica,Medica Advantage Solution,5342.544,49.8,,percent of total billed charges,,
"HUM PROTHROMBIN CPLX(PCC)4FACT 1,000 UNIT (800-1240 UNIT) IV SOLR",,J7168,HCPCS,Facility,Inpatient,1000,Units,,10728,9118.8,3074.6448,10728,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"HUM PROTHROMBIN CPLX(PCC)4FACT 1,000 UNIT (800-1240 UNIT) IV SOLR",,J7168,HCPCS,Facility,Outpatient,1000,Units,,10728,9118.8,3074.6448,10728,Medica,Medical Assistance,4784.688,44.6,,percent of total billed charges,,
"HUM PROTHROMBIN CPLX(PCC)4FACT 1,000 UNIT (800-1240 UNIT) IV SOLR",,J7168,HCPCS,Facility,Inpatient,1000,Units,,10728,9118.8,3074.6448,10728,Medica,Medical Assistance,,,,,Included in per diem rate,
"HUM PROTHROMBIN CPLX(PCC)4FACT 1,000 UNIT (800-1240 UNIT) IV SOLR",,J7168,HCPCS,Facility,Outpatient,1000,Units,,10728,9118.8,3074.6448,10728,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,5342.544,49.8,,percent of total billed charges,,
"HUM PROTHROMBIN CPLX(PCC)4FACT 1,000 UNIT (800-1240 UNIT) IV SOLR",,J7168,HCPCS,Facility,Inpatient,1000,Units,,10728,9118.8,3074.6448,10728,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"HUM PROTHROMBIN CPLX(PCC)4FACT 1,000 UNIT (800-1240 UNIT) IV SOLR",,J7168,HCPCS,Facility,Both,1000,Units,,10728,9118.8,3074.6448,10728,"Multiplan, Inc.","Multiplan, Inc.",10084.32,94,,percent of total billed charges,,
"HUM PROTHROMBIN CPLX(PCC)4FACT 1,000 UNIT (800-1240 UNIT) IV SOLR",,J7168,HCPCS,Facility,Outpatient,1000,Units,,10728,9118.8,3074.6448,10728,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,9665.928,90.1,,percent of total billed charges,,
"HUM PROTHROMBIN CPLX(PCC)4FACT 1,000 UNIT (800-1240 UNIT) IV SOLR",,J7168,HCPCS,Facility,Inpatient,1000,Units,,10728,9118.8,3074.6448,10728,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"HUM PROTHROMBIN CPLX(PCC)4FACT 1,000 UNIT (800-1240 UNIT) IV SOLR",,J7168,HCPCS,Facility,Both,1000,Units,,10728,9118.8,3074.6448,10728,"Preferred One Administrative Services, INC.",PPO,10577.808,98.6,,percent of total billed charges,,
"HUM PROTHROMBIN CPLX(PCC)4FACT 1,000 UNIT (800-1240 UNIT) IV SOLR",,J7168,HCPCS,Facility,Outpatient,1000,Units,,10728,9118.8,3074.6448,10728,PrimeWest Health,Minnesota Senior Health Options (MSHO),5519.556,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"HUM PROTHROMBIN CPLX(PCC)4FACT 1,000 UNIT (800-1240 UNIT) IV SOLR",,J7168,HCPCS,Facility,Inpatient,1000,Units,,10728,9118.8,3074.6448,10728,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"HUM PROTHROMBIN CPLX(PCC)4FACT 1,000 UNIT (800-1240 UNIT) IV SOLR",,J7168,HCPCS,Facility,Outpatient,1000,Units,,10728,9118.8,3074.6448,10728,PrimeWest Health,MinnesotaCare,5509.9008,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"HUM PROTHROMBIN CPLX(PCC)4FACT 1,000 UNIT (800-1240 UNIT) IV SOLR",,J7168,HCPCS,Facility,Inpatient,1000,Units,,10728,9118.8,3074.6448,10728,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"HUM PROTHROMBIN CPLX(PCC)4FACT 1,000 UNIT (800-1240 UNIT) IV SOLR",,J7168,HCPCS,Facility,Both,1000,Units,,10728,9118.8,3074.6448,10728,Sanford Health Plan,Sanford Health Plan,9869.76,92,,percent of total billed charges,,
"HUM PROTHROMBIN CPLX(PCC)4FACT 1,000 UNIT (800-1240 UNIT) IV SOLR",,J7168,HCPCS,Facility,Outpatient,1000,Units,,10728,9118.8,3074.6448,10728,"UCare Health, Inc.",Individual & Family Plan,6045.228,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"HUM PROTHROMBIN CPLX(PCC)4FACT 1,000 UNIT (800-1240 UNIT) IV SOLR",,J7168,HCPCS,Facility,Inpatient,1000,Units,,10728,9118.8,3074.6448,10728,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"HUM PROTHROMBIN CPLX(PCC)4FACT 1,000 UNIT (800-1240 UNIT) IV SOLR",,J7168,HCPCS,Facility,Outpatient,1000,Units,,10728,9118.8,3074.6448,10728,"UCare Health, Inc.",Medical Assistance,5414.4216,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"HUM PROTHROMBIN CPLX(PCC)4FACT 1,000 UNIT (800-1240 UNIT) IV SOLR",,J7168,HCPCS,Facility,Inpatient,1000,Units,,10728,9118.8,3074.6448,10728,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"HUM PROTHROMBIN CPLX(PCC)4FACT 1,000 UNIT (800-1240 UNIT) IV SOLR",,J7168,HCPCS,Facility,Outpatient,1000,Units,,10728,9118.8,3074.6448,10728,"UCare Health, Inc.",Medicare Advantage,5414.4216,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"HUM PROTHROMBIN CPLX(PCC)4FACT 1,000 UNIT (800-1240 UNIT) IV SOLR",,J7168,HCPCS,Facility,Inpatient,1000,Units,,10728,9118.8,3074.6448,10728,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"HUM PROTHROMBIN CPLX(PCC)4FACT 1,000 UNIT (800-1240 UNIT) IV SOLR",,J7168,HCPCS,Facility,Outpatient,1000,Units,,10728,9118.8,3074.6448,10728,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),5414.4216,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"HUM PROTHROMBIN CPLX(PCC)4FACT 1,000 UNIT (800-1240 UNIT) IV SOLR",,J7168,HCPCS,Facility,Inpatient,1000,Units,,10728,9118.8,3074.6448,10728,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"HUM PROTHROMBIN CPLX(PCC)4FACT 1,000 UNIT (800-1240 UNIT) IV SOLR",,J7168,HCPCS,Facility,Both,1000,Units,,10728,9118.8,3074.6448,10728,UnitedHealthcare,Individual & Family,10084.32,94,,percent of total billed charges,,
"HUM PROTHROMBIN CPLX(PCC)4FACT 1,000 UNIT (800-1240 UNIT) IV SOLR",,J7168,HCPCS,Facility,Outpatient,1000,Units,,10728,9118.8,3074.6448,10728,UnitedHealthcare,Medicare Advantage,5256.72,49,,percent of total billed charges,,
"HUM PROTHROMBIN CPLX(PCC)4FACT 1,000 UNIT (800-1240 UNIT) IV SOLR",,J7168,HCPCS,Facility,Inpatient,1000,Units,,10728,9118.8,3074.6448,10728,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"HUM PROTHROMBIN CPLX(PCC)4FACT 1,000 UNIT (800-1240 UNIT) IV SOLR",,J7168,HCPCS,Facility,Outpatient,1000,Units,,10728,9118.8,3074.6448,10728,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,5149.44,48,,percent of total billed charges,,100% of DHS outpatient percentage
"HUM PROTHROMBIN CPLX(PCC)4FACT 1,000 UNIT (800-1240 UNIT) IV SOLR",,J7168,HCPCS,Facility,Inpatient,1000,Units,,10728,9118.8,3074.6448,10728,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Both,1500,mL,,38,32.3,10.8908,38,Aetna,Commercial,34.96,92,,percent of total billed charges,,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Outpatient,1500,mL,,38,32.3,10.8908,38,Aetna,Medicare Advantage,18.62,49,,percent of total billed charges,,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Inpatient,1500,mL,,38,32.3,10.8908,38,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Both,1500,mL,,38,32.3,10.8908,38,Aetna,PPO,35.34,93,,percent of total billed charges,,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Both,1500,mL,,38,32.3,10.8908,38,America's PPO,America's PPO,36.4914,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Both,1500,mL,,38,32.3,10.8908,38,BlueCross BlueShield Minnesota, Federal Employee Program,37.392,98.4,,percent of total billed charges,,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Both,1500,mL,,38,32.3,10.8908,38,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,38,100,,percent of total billed charges,,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Both,1500,mL,,38,32.3,10.8908,38,BlueCross BlueShield Minnesota,High Value Network Plan,34.2,90,,percent of total billed charges,,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Outpatient,1500,mL,,38,32.3,10.8908,38,BlueCross BlueShield Minnesota,Medicare Advantage,18.62,49,,percent of total billed charges,,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Inpatient,1500,mL,,38,32.3,10.8908,38,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Both,1500,mL,,38,32.3,10.8908,38,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,33.6566,88.57,,percent of total billed charges,,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Both,1500,mL,,38,32.3,10.8908,38,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,10.8908,28.66,,percent of total billed charges,,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Outpatient,1500,mL,,38,32.3,10.8908,38,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),18.62,49,,percent of total billed charges,,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Inpatient,1500,mL,,38,32.3,10.8908,38,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Both,1500,mL,,38,32.3,10.8908,38,CorVel,Worker's Compensation,38,100,,percent of total billed charges,,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Both,1500,mL,,38,32.3,10.8908,38,First Health Group Corporation,First Health Network,36.86,97,,percent of total billed charges,,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Both,1500,mL,,38,32.3,10.8908,38,"Health Partners, Inc.",Commercial,35.948,94.6,,percent of total billed charges,,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Outpatient,1500,mL,,38,32.3,10.8908,38,"Health Partners, Inc.",Medicare Advantage,18.62,49,,percent of total billed charges,,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Inpatient,1500,mL,,38,32.3,10.8908,38,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Both,1500,mL,,38,32.3,10.8908,38,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),22.8,60,,percent of total billed charges,,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Both,1500,mL,,38,32.3,10.8908,38,"Health Partners, Inc.",State of Minnesota Advantage Program,30.97,81.5,,percent of total billed charges,,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Both,1500,mL,,38,32.3,10.8908,38,"Health Partners, Inc.",State Public Programs,19,50,,percent of total billed charges,,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Both,1500,mL,,38,32.3,10.8908,38,Humana Insurance Company,Commercial PPO,36.1,95,,percent of total billed charges,,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Outpatient,1500,mL,,38,32.3,10.8908,38,Humana Insurance Company,Medicare PPO,18.62,49,,percent of total billed charges,,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Inpatient,1500,mL,,38,32.3,10.8908,38,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Both,1500,mL,,38,32.3,10.8908,38,Medica,Individual & Family,37.658,99.1,,percent of total billed charges,,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Outpatient,1500,mL,,38,32.3,10.8908,38,Medica,Medica Advantage Solution,18.924,49.8,,percent of total billed charges,,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Inpatient,1500,mL,,38,32.3,10.8908,38,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Outpatient,1500,mL,,38,32.3,10.8908,38,Medica,Medical Assistance,16.948,44.6,,percent of total billed charges,,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Inpatient,1500,mL,,38,32.3,10.8908,38,Medica,Medical Assistance,,,,,Included in per diem rate,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Outpatient,1500,mL,,38,32.3,10.8908,38,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,18.924,49.8,,percent of total billed charges,,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Inpatient,1500,mL,,38,32.3,10.8908,38,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Both,1500,mL,,38,32.3,10.8908,38,"Multiplan, Inc.","Multiplan, Inc.",35.72,94,,percent of total billed charges,,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Outpatient,1500,mL,,38,32.3,10.8908,38,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,34.238,90.1,,percent of total billed charges,,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Inpatient,1500,mL,,38,32.3,10.8908,38,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Both,1500,mL,,38,32.3,10.8908,38,"Preferred One Administrative Services, INC.",PPO,37.468,98.6,,percent of total billed charges,,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Outpatient,1500,mL,,38,32.3,10.8908,38,PrimeWest Health,Minnesota Senior Health Options (MSHO),19.551,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Inpatient,1500,mL,,38,32.3,10.8908,38,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Outpatient,1500,mL,,38,32.3,10.8908,38,PrimeWest Health,MinnesotaCare,19.5168,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Inpatient,1500,mL,,38,32.3,10.8908,38,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Both,1500,mL,,38,32.3,10.8908,38,Sanford Health Plan,Sanford Health Plan,34.96,92,,percent of total billed charges,,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Outpatient,1500,mL,,38,32.3,10.8908,38,"UCare Health, Inc.",Individual & Family Plan,21.413,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Inpatient,1500,mL,,38,32.3,10.8908,38,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Outpatient,1500,mL,,38,32.3,10.8908,38,"UCare Health, Inc.",Medical Assistance,19.1786,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Inpatient,1500,mL,,38,32.3,10.8908,38,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Outpatient,1500,mL,,38,32.3,10.8908,38,"UCare Health, Inc.",Medicare Advantage,19.1786,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Inpatient,1500,mL,,38,32.3,10.8908,38,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Outpatient,1500,mL,,38,32.3,10.8908,38,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),19.1786,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Inpatient,1500,mL,,38,32.3,10.8908,38,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Both,1500,mL,,38,32.3,10.8908,38,UnitedHealthcare,Individual & Family,35.72,94,,percent of total billed charges,,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Outpatient,1500,mL,,38,32.3,10.8908,38,UnitedHealthcare,Medicare Advantage,18.62,49,,percent of total billed charges,,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Inpatient,1500,mL,,38,32.3,10.8908,38,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Outpatient,1500,mL,,38,32.3,10.8908,38,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,18.24,48,,percent of total billed charges,,100% of DHS outpatient percentage
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Inpatient,1500,mL,,38,32.3,10.8908,38,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASL SPSN,,18794,LOCAL,Facility,Both,16 g,AER W/ADAP,,19,16.15,5.4454,19,Aetna,Commercial,17.48,92,,percent of total billed charges,,
FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASL SPSN,,18794,LOCAL,Facility,Outpatient,16 g,AER W/ADAP,,19,16.15,5.4454,19,Aetna,Medicare Advantage,9.31,49,,percent of total billed charges,,
FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASL SPSN,,18794,LOCAL,Facility,Inpatient,16 g,AER W/ADAP,,19,16.15,5.4454,19,Aetna,Medicare Advantage,,,,,Included in per diem rate,
FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASL SPSN,,18794,LOCAL,Facility,Both,16 g,AER W/ADAP,,19,16.15,5.4454,19,Aetna,PPO,17.67,93,,percent of total billed charges,,
FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASL SPSN,,18794,LOCAL,Facility,Both,16 g,AER W/ADAP,,19,16.15,5.4454,19,America's PPO,America's PPO,18.2457,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASL SPSN,,18794,LOCAL,Facility,Both,16 g,AER W/ADAP,,19,16.15,5.4454,19,BlueCross BlueShield Minnesota, Federal Employee Program,18.696,98.4,,percent of total billed charges,,
FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASL SPSN,,18794,LOCAL,Facility,Both,16 g,AER W/ADAP,,19,16.15,5.4454,19,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,19,100,,percent of total billed charges,,
FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASL SPSN,,18794,LOCAL,Facility,Both,16 g,AER W/ADAP,,19,16.15,5.4454,19,BlueCross BlueShield Minnesota,High Value Network Plan,17.1,90,,percent of total billed charges,,
FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASL SPSN,,18794,LOCAL,Facility,Outpatient,16 g,AER W/ADAP,,19,16.15,5.4454,19,BlueCross BlueShield Minnesota,Medicare Advantage,9.31,49,,percent of total billed charges,,
FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASL SPSN,,18794,LOCAL,Facility,Inpatient,16 g,AER W/ADAP,,19,16.15,5.4454,19,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASL SPSN,,18794,LOCAL,Facility,Both,16 g,AER W/ADAP,,19,16.15,5.4454,19,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,16.8283,88.57,,percent of total billed charges,,
FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASL SPSN,,18794,LOCAL,Facility,Both,16 g,AER W/ADAP,,19,16.15,5.4454,19,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,5.4454,28.66,,percent of total billed charges,,
FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASL SPSN,,18794,LOCAL,Facility,Outpatient,16 g,AER W/ADAP,,19,16.15,5.4454,19,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),9.31,49,,percent of total billed charges,,
FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASL SPSN,,18794,LOCAL,Facility,Inpatient,16 g,AER W/ADAP,,19,16.15,5.4454,19,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASL SPSN,,18794,LOCAL,Facility,Both,16 g,AER W/ADAP,,19,16.15,5.4454,19,CorVel,Worker's Compensation,19,100,,percent of total billed charges,,
FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASL SPSN,,18794,LOCAL,Facility,Both,16 g,AER W/ADAP,,19,16.15,5.4454,19,First Health Group Corporation,First Health Network,18.43,97,,percent of total billed charges,,
FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASL SPSN,,18794,LOCAL,Facility,Both,16 g,AER W/ADAP,,19,16.15,5.4454,19,"Health Partners, Inc.",Commercial,17.974,94.6,,percent of total billed charges,,
FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASL SPSN,,18794,LOCAL,Facility,Outpatient,16 g,AER W/ADAP,,19,16.15,5.4454,19,"Health Partners, Inc.",Medicare Advantage,9.31,49,,percent of total billed charges,,
FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASL SPSN,,18794,LOCAL,Facility,Inpatient,16 g,AER W/ADAP,,19,16.15,5.4454,19,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASL SPSN,,18794,LOCAL,Facility,Both,16 g,AER W/ADAP,,19,16.15,5.4454,19,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),11.4,60,,percent of total billed charges,,
FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASL SPSN,,18794,LOCAL,Facility,Both,16 g,AER W/ADAP,,19,16.15,5.4454,19,"Health Partners, Inc.",State of Minnesota Advantage Program,15.485,81.5,,percent of total billed charges,,
FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASL SPSN,,18794,LOCAL,Facility,Both,16 g,AER W/ADAP,,19,16.15,5.4454,19,"Health Partners, Inc.",State Public Programs,9.5,50,,percent of total billed charges,,
FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASL SPSN,,18794,LOCAL,Facility,Both,16 g,AER W/ADAP,,19,16.15,5.4454,19,Humana Insurance Company,Commercial PPO,18.05,95,,percent of total billed charges,,
FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASL SPSN,,18794,LOCAL,Facility,Outpatient,16 g,AER W/ADAP,,19,16.15,5.4454,19,Humana Insurance Company,Medicare PPO,9.31,49,,percent of total billed charges,,
FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASL SPSN,,18794,LOCAL,Facility,Inpatient,16 g,AER W/ADAP,,19,16.15,5.4454,19,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASL SPSN,,18794,LOCAL,Facility,Both,16 g,AER W/ADAP,,19,16.15,5.4454,19,Medica,Individual & Family,18.829,99.1,,percent of total billed charges,,
FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASL SPSN,,18794,LOCAL,Facility,Outpatient,16 g,AER W/ADAP,,19,16.15,5.4454,19,Medica,Medica Advantage Solution,9.462,49.8,,percent of total billed charges,,
FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASL SPSN,,18794,LOCAL,Facility,Inpatient,16 g,AER W/ADAP,,19,16.15,5.4454,19,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASL SPSN,,18794,LOCAL,Facility,Outpatient,16 g,AER W/ADAP,,19,16.15,5.4454,19,Medica,Medical Assistance,8.474,44.6,,percent of total billed charges,,
FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASL SPSN,,18794,LOCAL,Facility,Inpatient,16 g,AER W/ADAP,,19,16.15,5.4454,19,Medica,Medical Assistance,,,,,Included in per diem rate,
FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASL SPSN,,18794,LOCAL,Facility,Outpatient,16 g,AER W/ADAP,,19,16.15,5.4454,19,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,9.462,49.8,,percent of total billed charges,,
FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASL SPSN,,18794,LOCAL,Facility,Inpatient,16 g,AER W/ADAP,,19,16.15,5.4454,19,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASL SPSN,,18794,LOCAL,Facility,Both,16 g,AER W/ADAP,,19,16.15,5.4454,19,"Multiplan, Inc.","Multiplan, Inc.",17.86,94,,percent of total billed charges,,
FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASL SPSN,,18794,LOCAL,Facility,Outpatient,16 g,AER W/ADAP,,19,16.15,5.4454,19,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,17.119,90.1,,percent of total billed charges,,
FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASL SPSN,,18794,LOCAL,Facility,Inpatient,16 g,AER W/ADAP,,19,16.15,5.4454,19,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASL SPSN,,18794,LOCAL,Facility,Both,16 g,AER W/ADAP,,19,16.15,5.4454,19,"Preferred One Administrative Services, INC.",PPO,18.734,98.6,,percent of total billed charges,,
FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASL SPSN,,18794,LOCAL,Facility,Outpatient,16 g,AER W/ADAP,,19,16.15,5.4454,19,PrimeWest Health,Minnesota Senior Health Options (MSHO),9.7755,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASL SPSN,,18794,LOCAL,Facility,Inpatient,16 g,AER W/ADAP,,19,16.15,5.4454,19,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASL SPSN,,18794,LOCAL,Facility,Outpatient,16 g,AER W/ADAP,,19,16.15,5.4454,19,PrimeWest Health,MinnesotaCare,9.7584,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASL SPSN,,18794,LOCAL,Facility,Inpatient,16 g,AER W/ADAP,,19,16.15,5.4454,19,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASL SPSN,,18794,LOCAL,Facility,Both,16 g,AER W/ADAP,,19,16.15,5.4454,19,Sanford Health Plan,Sanford Health Plan,17.48,92,,percent of total billed charges,,
FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASL SPSN,,18794,LOCAL,Facility,Outpatient,16 g,AER W/ADAP,,19,16.15,5.4454,19,"UCare Health, Inc.",Individual & Family Plan,10.7065,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASL SPSN,,18794,LOCAL,Facility,Inpatient,16 g,AER W/ADAP,,19,16.15,5.4454,19,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASL SPSN,,18794,LOCAL,Facility,Outpatient,16 g,AER W/ADAP,,19,16.15,5.4454,19,"UCare Health, Inc.",Medical Assistance,9.5893,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASL SPSN,,18794,LOCAL,Facility,Inpatient,16 g,AER W/ADAP,,19,16.15,5.4454,19,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASL SPSN,,18794,LOCAL,Facility,Outpatient,16 g,AER W/ADAP,,19,16.15,5.4454,19,"UCare Health, Inc.",Medicare Advantage,9.5893,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASL SPSN,,18794,LOCAL,Facility,Inpatient,16 g,AER W/ADAP,,19,16.15,5.4454,19,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASL SPSN,,18794,LOCAL,Facility,Outpatient,16 g,AER W/ADAP,,19,16.15,5.4454,19,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),9.5893,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASL SPSN,,18794,LOCAL,Facility,Inpatient,16 g,AER W/ADAP,,19,16.15,5.4454,19,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASL SPSN,,18794,LOCAL,Facility,Both,16 g,AER W/ADAP,,19,16.15,5.4454,19,UnitedHealthcare,Individual & Family,17.86,94,,percent of total billed charges,,
FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASL SPSN,,18794,LOCAL,Facility,Outpatient,16 g,AER W/ADAP,,19,16.15,5.4454,19,UnitedHealthcare,Medicare Advantage,9.31,49,,percent of total billed charges,,
FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASL SPSN,,18794,LOCAL,Facility,Inpatient,16 g,AER W/ADAP,,19,16.15,5.4454,19,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASL SPSN,,18794,LOCAL,Facility,Outpatient,16 g,AER W/ADAP,,19,16.15,5.4454,19,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,9.12,48,,percent of total billed charges,,100% of DHS outpatient percentage
FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASL SPSN,,18794,LOCAL,Facility,Inpatient,16 g,AER W/ADAP,,19,16.15,5.4454,19,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
MOMETASONE 50 MCG/ACTUATION NASL SPRY,,14927,LOCAL,Facility,Both,17 g,g,,1000,850,286.6,1000,Aetna,Commercial,920,92,,percent of total billed charges,,
MOMETASONE 50 MCG/ACTUATION NASL SPRY,,14927,LOCAL,Facility,Outpatient,17 g,g,,1000,850,286.6,1000,Aetna,Medicare Advantage,490,49,,percent of total billed charges,,
MOMETASONE 50 MCG/ACTUATION NASL SPRY,,14927,LOCAL,Facility,Inpatient,17 g,g,,1000,850,286.6,1000,Aetna,Medicare Advantage,,,,,Included in per diem rate,
MOMETASONE 50 MCG/ACTUATION NASL SPRY,,14927,LOCAL,Facility,Both,17 g,g,,1000,850,286.6,1000,Aetna,PPO,930,93,,percent of total billed charges,,
MOMETASONE 50 MCG/ACTUATION NASL SPRY,,14927,LOCAL,Facility,Both,17 g,g,,1000,850,286.6,1000,America's PPO,America's PPO,960.3,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
MOMETASONE 50 MCG/ACTUATION NASL SPRY,,14927,LOCAL,Facility,Both,17 g,g,,1000,850,286.6,1000,BlueCross BlueShield Minnesota, Federal Employee Program,984,98.4,,percent of total billed charges,,
MOMETASONE 50 MCG/ACTUATION NASL SPRY,,14927,LOCAL,Facility,Both,17 g,g,,1000,850,286.6,1000,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1000,100,,percent of total billed charges,,
MOMETASONE 50 MCG/ACTUATION NASL SPRY,,14927,LOCAL,Facility,Both,17 g,g,,1000,850,286.6,1000,BlueCross BlueShield Minnesota,High Value Network Plan,900,90,,percent of total billed charges,,
MOMETASONE 50 MCG/ACTUATION NASL SPRY,,14927,LOCAL,Facility,Outpatient,17 g,g,,1000,850,286.6,1000,BlueCross BlueShield Minnesota,Medicare Advantage,490,49,,percent of total billed charges,,
MOMETASONE 50 MCG/ACTUATION NASL SPRY,,14927,LOCAL,Facility,Inpatient,17 g,g,,1000,850,286.6,1000,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
MOMETASONE 50 MCG/ACTUATION NASL SPRY,,14927,LOCAL,Facility,Both,17 g,g,,1000,850,286.6,1000,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,885.7,88.57,,percent of total billed charges,,
MOMETASONE 50 MCG/ACTUATION NASL SPRY,,14927,LOCAL,Facility,Both,17 g,g,,1000,850,286.6,1000,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,286.6,28.66,,percent of total billed charges,,
MOMETASONE 50 MCG/ACTUATION NASL SPRY,,14927,LOCAL,Facility,Outpatient,17 g,g,,1000,850,286.6,1000,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),490,49,,percent of total billed charges,,
MOMETASONE 50 MCG/ACTUATION NASL SPRY,,14927,LOCAL,Facility,Inpatient,17 g,g,,1000,850,286.6,1000,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
MOMETASONE 50 MCG/ACTUATION NASL SPRY,,14927,LOCAL,Facility,Both,17 g,g,,1000,850,286.6,1000,CorVel,Worker's Compensation,1000,100,,percent of total billed charges,,
MOMETASONE 50 MCG/ACTUATION NASL SPRY,,14927,LOCAL,Facility,Both,17 g,g,,1000,850,286.6,1000,First Health Group Corporation,First Health Network,970,97,,percent of total billed charges,,
MOMETASONE 50 MCG/ACTUATION NASL SPRY,,14927,LOCAL,Facility,Both,17 g,g,,1000,850,286.6,1000,"Health Partners, Inc.",Commercial,946,94.6,,percent of total billed charges,,
MOMETASONE 50 MCG/ACTUATION NASL SPRY,,14927,LOCAL,Facility,Outpatient,17 g,g,,1000,850,286.6,1000,"Health Partners, Inc.",Medicare Advantage,490,49,,percent of total billed charges,,
MOMETASONE 50 MCG/ACTUATION NASL SPRY,,14927,LOCAL,Facility,Inpatient,17 g,g,,1000,850,286.6,1000,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
MOMETASONE 50 MCG/ACTUATION NASL SPRY,,14927,LOCAL,Facility,Both,17 g,g,,1000,850,286.6,1000,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),600,60,,percent of total billed charges,,
MOMETASONE 50 MCG/ACTUATION NASL SPRY,,14927,LOCAL,Facility,Both,17 g,g,,1000,850,286.6,1000,"Health Partners, Inc.",State of Minnesota Advantage Program,815,81.5,,percent of total billed charges,,
MOMETASONE 50 MCG/ACTUATION NASL SPRY,,14927,LOCAL,Facility,Both,17 g,g,,1000,850,286.6,1000,"Health Partners, Inc.",State Public Programs,500,50,,percent of total billed charges,,
MOMETASONE 50 MCG/ACTUATION NASL SPRY,,14927,LOCAL,Facility,Both,17 g,g,,1000,850,286.6,1000,Humana Insurance Company,Commercial PPO,950,95,,percent of total billed charges,,
MOMETASONE 50 MCG/ACTUATION NASL SPRY,,14927,LOCAL,Facility,Outpatient,17 g,g,,1000,850,286.6,1000,Humana Insurance Company,Medicare PPO,490,49,,percent of total billed charges,,
MOMETASONE 50 MCG/ACTUATION NASL SPRY,,14927,LOCAL,Facility,Inpatient,17 g,g,,1000,850,286.6,1000,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
MOMETASONE 50 MCG/ACTUATION NASL SPRY,,14927,LOCAL,Facility,Both,17 g,g,,1000,850,286.6,1000,Medica,Individual & Family,991,99.1,,percent of total billed charges,,
MOMETASONE 50 MCG/ACTUATION NASL SPRY,,14927,LOCAL,Facility,Outpatient,17 g,g,,1000,850,286.6,1000,Medica,Medica Advantage Solution,498,49.8,,percent of total billed charges,,
MOMETASONE 50 MCG/ACTUATION NASL SPRY,,14927,LOCAL,Facility,Inpatient,17 g,g,,1000,850,286.6,1000,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
MOMETASONE 50 MCG/ACTUATION NASL SPRY,,14927,LOCAL,Facility,Outpatient,17 g,g,,1000,850,286.6,1000,Medica,Medical Assistance,446,44.6,,percent of total billed charges,,
MOMETASONE 50 MCG/ACTUATION NASL SPRY,,14927,LOCAL,Facility,Inpatient,17 g,g,,1000,850,286.6,1000,Medica,Medical Assistance,,,,,Included in per diem rate,
MOMETASONE 50 MCG/ACTUATION NASL SPRY,,14927,LOCAL,Facility,Outpatient,17 g,g,,1000,850,286.6,1000,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,498,49.8,,percent of total billed charges,,
MOMETASONE 50 MCG/ACTUATION NASL SPRY,,14927,LOCAL,Facility,Inpatient,17 g,g,,1000,850,286.6,1000,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
MOMETASONE 50 MCG/ACTUATION NASL SPRY,,14927,LOCAL,Facility,Both,17 g,g,,1000,850,286.6,1000,"Multiplan, Inc.","Multiplan, Inc.",940,94,,percent of total billed charges,,
MOMETASONE 50 MCG/ACTUATION NASL SPRY,,14927,LOCAL,Facility,Outpatient,17 g,g,,1000,850,286.6,1000,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,901,90.1,,percent of total billed charges,,
MOMETASONE 50 MCG/ACTUATION NASL SPRY,,14927,LOCAL,Facility,Inpatient,17 g,g,,1000,850,286.6,1000,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
MOMETASONE 50 MCG/ACTUATION NASL SPRY,,14927,LOCAL,Facility,Both,17 g,g,,1000,850,286.6,1000,"Preferred One Administrative Services, INC.",PPO,986,98.6,,percent of total billed charges,,
MOMETASONE 50 MCG/ACTUATION NASL SPRY,,14927,LOCAL,Facility,Outpatient,17 g,g,,1000,850,286.6,1000,PrimeWest Health,Minnesota Senior Health Options (MSHO),514.5,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
MOMETASONE 50 MCG/ACTUATION NASL SPRY,,14927,LOCAL,Facility,Inpatient,17 g,g,,1000,850,286.6,1000,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
MOMETASONE 50 MCG/ACTUATION NASL SPRY,,14927,LOCAL,Facility,Outpatient,17 g,g,,1000,850,286.6,1000,PrimeWest Health,MinnesotaCare,513.6,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
MOMETASONE 50 MCG/ACTUATION NASL SPRY,,14927,LOCAL,Facility,Inpatient,17 g,g,,1000,850,286.6,1000,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
MOMETASONE 50 MCG/ACTUATION NASL SPRY,,14927,LOCAL,Facility,Both,17 g,g,,1000,850,286.6,1000,Sanford Health Plan,Sanford Health Plan,920,92,,percent of total billed charges,,
MOMETASONE 50 MCG/ACTUATION NASL SPRY,,14927,LOCAL,Facility,Outpatient,17 g,g,,1000,850,286.6,1000,"UCare Health, Inc.",Individual & Family Plan,563.5,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
MOMETASONE 50 MCG/ACTUATION NASL SPRY,,14927,LOCAL,Facility,Inpatient,17 g,g,,1000,850,286.6,1000,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
MOMETASONE 50 MCG/ACTUATION NASL SPRY,,14927,LOCAL,Facility,Outpatient,17 g,g,,1000,850,286.6,1000,"UCare Health, Inc.",Medical Assistance,504.7,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MOMETASONE 50 MCG/ACTUATION NASL SPRY,,14927,LOCAL,Facility,Inpatient,17 g,g,,1000,850,286.6,1000,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
MOMETASONE 50 MCG/ACTUATION NASL SPRY,,14927,LOCAL,Facility,Outpatient,17 g,g,,1000,850,286.6,1000,"UCare Health, Inc.",Medicare Advantage,504.7,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MOMETASONE 50 MCG/ACTUATION NASL SPRY,,14927,LOCAL,Facility,Inpatient,17 g,g,,1000,850,286.6,1000,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
MOMETASONE 50 MCG/ACTUATION NASL SPRY,,14927,LOCAL,Facility,Outpatient,17 g,g,,1000,850,286.6,1000,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),504.7,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MOMETASONE 50 MCG/ACTUATION NASL SPRY,,14927,LOCAL,Facility,Inpatient,17 g,g,,1000,850,286.6,1000,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
MOMETASONE 50 MCG/ACTUATION NASL SPRY,,14927,LOCAL,Facility,Both,17 g,g,,1000,850,286.6,1000,UnitedHealthcare,Individual & Family,940,94,,percent of total billed charges,,
MOMETASONE 50 MCG/ACTUATION NASL SPRY,,14927,LOCAL,Facility,Outpatient,17 g,g,,1000,850,286.6,1000,UnitedHealthcare,Medicare Advantage,490,49,,percent of total billed charges,,
MOMETASONE 50 MCG/ACTUATION NASL SPRY,,14927,LOCAL,Facility,Inpatient,17 g,g,,1000,850,286.6,1000,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
MOMETASONE 50 MCG/ACTUATION NASL SPRY,,14927,LOCAL,Facility,Outpatient,17 g,g,,1000,850,286.6,1000,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,480,48,,percent of total billed charges,,100% of DHS outpatient percentage
MOMETASONE 50 MCG/ACTUATION NASL SPRY,,14927,LOCAL,Facility,Inpatient,17 g,g,,1000,850,286.6,1000,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
FERUMOXYTOL 510 MG/17 ML (30 MG/ML) IV SOLN,,Q0138,HCPCS,Facility,Both,17 mL,mL,,4298,3653.3,1231.8068,4298,Aetna,Commercial,3954.16,92,,percent of total billed charges,,
FERUMOXYTOL 510 MG/17 ML (30 MG/ML) IV SOLN,,Q0138,HCPCS,Facility,Outpatient,17 mL,mL,,4298,3653.3,1231.8068,4298,Aetna,Medicare Advantage,2106.02,49,,percent of total billed charges,,
FERUMOXYTOL 510 MG/17 ML (30 MG/ML) IV SOLN,,Q0138,HCPCS,Facility,Inpatient,17 mL,mL,,4298,3653.3,1231.8068,4298,Aetna,Medicare Advantage,,,,,Included in per diem rate,
FERUMOXYTOL 510 MG/17 ML (30 MG/ML) IV SOLN,,Q0138,HCPCS,Facility,Both,17 mL,mL,,4298,3653.3,1231.8068,4298,Aetna,PPO,3997.14,93,,percent of total billed charges,,
FERUMOXYTOL 510 MG/17 ML (30 MG/ML) IV SOLN,,Q0138,HCPCS,Facility,Both,17 mL,mL,,4298,3653.3,1231.8068,4298,America's PPO,America's PPO,4127.3694,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
FERUMOXYTOL 510 MG/17 ML (30 MG/ML) IV SOLN,,Q0138,HCPCS,Facility,Both,17 mL,mL,,4298,3653.3,1231.8068,4298,BlueCross BlueShield Minnesota, Federal Employee Program,4229.232,98.4,,percent of total billed charges,,
FERUMOXYTOL 510 MG/17 ML (30 MG/ML) IV SOLN,,Q0138,HCPCS,Facility,Both,17 mL,mL,,4298,3653.3,1231.8068,4298,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,4298,100,,percent of total billed charges,,
FERUMOXYTOL 510 MG/17 ML (30 MG/ML) IV SOLN,,Q0138,HCPCS,Facility,Both,17 mL,mL,,4298,3653.3,1231.8068,4298,BlueCross BlueShield Minnesota,High Value Network Plan,3868.2,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
FERUMOXYTOL 510 MG/17 ML (30 MG/ML) IV SOLN,,Q0138,HCPCS,Facility,Outpatient,17 mL,mL,,4298,3653.3,1231.8068,4298,BlueCross BlueShield Minnesota,Medicare Advantage,2106.02,49,,percent of total billed charges,,
FERUMOXYTOL 510 MG/17 ML (30 MG/ML) IV SOLN,,Q0138,HCPCS,Facility,Inpatient,17 mL,mL,,4298,3653.3,1231.8068,4298,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
FERUMOXYTOL 510 MG/17 ML (30 MG/ML) IV SOLN,,Q0138,HCPCS,Facility,Both,17 mL,mL,,4298,3653.3,1231.8068,4298,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,3806.7386,88.57,,percent of total billed charges,,
FERUMOXYTOL 510 MG/17 ML (30 MG/ML) IV SOLN,,Q0138,HCPCS,Facility,Both,17 mL,mL,,4298,3653.3,1231.8068,4298,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1231.8068,28.66,,percent of total billed charges,,
FERUMOXYTOL 510 MG/17 ML (30 MG/ML) IV SOLN,,Q0138,HCPCS,Facility,Outpatient,17 mL,mL,,4298,3653.3,1231.8068,4298,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2106.02,49,,percent of total billed charges,,
FERUMOXYTOL 510 MG/17 ML (30 MG/ML) IV SOLN,,Q0138,HCPCS,Facility,Inpatient,17 mL,mL,,4298,3653.3,1231.8068,4298,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
FERUMOXYTOL 510 MG/17 ML (30 MG/ML) IV SOLN,,Q0138,HCPCS,Facility,Both,17 mL,mL,,4298,3653.3,1231.8068,4298,CorVel,Worker's Compensation,4298,100,,percent of total billed charges,,
FERUMOXYTOL 510 MG/17 ML (30 MG/ML) IV SOLN,,Q0138,HCPCS,Facility,Both,17 mL,mL,,4298,3653.3,1231.8068,4298,First Health Group Corporation,First Health Network,4169.06,97,,percent of total billed charges,,
FERUMOXYTOL 510 MG/17 ML (30 MG/ML) IV SOLN,,Q0138,HCPCS,Facility,Both,17 mL,mL,,4298,3653.3,1231.8068,4298,"Health Partners, Inc.",Commercial,4065.908,94.6,,percent of total billed charges,,
FERUMOXYTOL 510 MG/17 ML (30 MG/ML) IV SOLN,,Q0138,HCPCS,Facility,Outpatient,17 mL,mL,,4298,3653.3,1231.8068,4298,"Health Partners, Inc.",Medicare Advantage,2106.02,49,,percent of total billed charges,,
FERUMOXYTOL 510 MG/17 ML (30 MG/ML) IV SOLN,,Q0138,HCPCS,Facility,Inpatient,17 mL,mL,,4298,3653.3,1231.8068,4298,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
FERUMOXYTOL 510 MG/17 ML (30 MG/ML) IV SOLN,,Q0138,HCPCS,Facility,Both,17 mL,mL,,4298,3653.3,1231.8068,4298,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),2578.8,60,,percent of total billed charges,,
FERUMOXYTOL 510 MG/17 ML (30 MG/ML) IV SOLN,,Q0138,HCPCS,Facility,Both,17 mL,mL,,4298,3653.3,1231.8068,4298,"Health Partners, Inc.",State of Minnesota Advantage Program,3502.87,81.5,,percent of total billed charges,,
FERUMOXYTOL 510 MG/17 ML (30 MG/ML) IV SOLN,,Q0138,HCPCS,Facility,Both,17 mL,mL,,4298,3653.3,1231.8068,4298,"Health Partners, Inc.",State Public Programs,2149,50,,percent of total billed charges,,
FERUMOXYTOL 510 MG/17 ML (30 MG/ML) IV SOLN,,Q0138,HCPCS,Facility,Both,17 mL,mL,,4298,3653.3,1231.8068,4298,Humana Insurance Company,Commercial PPO,4083.1,95,,percent of total billed charges,,
FERUMOXYTOL 510 MG/17 ML (30 MG/ML) IV SOLN,,Q0138,HCPCS,Facility,Outpatient,17 mL,mL,,4298,3653.3,1231.8068,4298,Humana Insurance Company,Medicare PPO,2106.02,49,,percent of total billed charges,,
FERUMOXYTOL 510 MG/17 ML (30 MG/ML) IV SOLN,,Q0138,HCPCS,Facility,Inpatient,17 mL,mL,,4298,3653.3,1231.8068,4298,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
FERUMOXYTOL 510 MG/17 ML (30 MG/ML) IV SOLN,,Q0138,HCPCS,Facility,Both,17 mL,mL,,4298,3653.3,1231.8068,4298,Medica,Individual & Family,4259.318,99.1,,percent of total billed charges,,
FERUMOXYTOL 510 MG/17 ML (30 MG/ML) IV SOLN,,Q0138,HCPCS,Facility,Outpatient,17 mL,mL,,4298,3653.3,1231.8068,4298,Medica,Medica Advantage Solution,2140.404,49.8,,percent of total billed charges,,
FERUMOXYTOL 510 MG/17 ML (30 MG/ML) IV SOLN,,Q0138,HCPCS,Facility,Inpatient,17 mL,mL,,4298,3653.3,1231.8068,4298,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
FERUMOXYTOL 510 MG/17 ML (30 MG/ML) IV SOLN,,Q0138,HCPCS,Facility,Outpatient,17 mL,mL,,4298,3653.3,1231.8068,4298,Medica,Medical Assistance,1916.908,44.6,,percent of total billed charges,,
FERUMOXYTOL 510 MG/17 ML (30 MG/ML) IV SOLN,,Q0138,HCPCS,Facility,Inpatient,17 mL,mL,,4298,3653.3,1231.8068,4298,Medica,Medical Assistance,,,,,Included in per diem rate,
FERUMOXYTOL 510 MG/17 ML (30 MG/ML) IV SOLN,,Q0138,HCPCS,Facility,Outpatient,17 mL,mL,,4298,3653.3,1231.8068,4298,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2140.404,49.8,,percent of total billed charges,,
FERUMOXYTOL 510 MG/17 ML (30 MG/ML) IV SOLN,,Q0138,HCPCS,Facility,Inpatient,17 mL,mL,,4298,3653.3,1231.8068,4298,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
FERUMOXYTOL 510 MG/17 ML (30 MG/ML) IV SOLN,,Q0138,HCPCS,Facility,Both,17 mL,mL,,4298,3653.3,1231.8068,4298,"Multiplan, Inc.","Multiplan, Inc.",4040.12,94,,percent of total billed charges,,
FERUMOXYTOL 510 MG/17 ML (30 MG/ML) IV SOLN,,Q0138,HCPCS,Facility,Outpatient,17 mL,mL,,4298,3653.3,1231.8068,4298,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,3872.498,90.1,,percent of total billed charges,,
FERUMOXYTOL 510 MG/17 ML (30 MG/ML) IV SOLN,,Q0138,HCPCS,Facility,Inpatient,17 mL,mL,,4298,3653.3,1231.8068,4298,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
FERUMOXYTOL 510 MG/17 ML (30 MG/ML) IV SOLN,,Q0138,HCPCS,Facility,Both,17 mL,mL,,4298,3653.3,1231.8068,4298,"Preferred One Administrative Services, INC.",PPO,4237.828,98.6,,percent of total billed charges,,
FERUMOXYTOL 510 MG/17 ML (30 MG/ML) IV SOLN,,Q0138,HCPCS,Facility,Outpatient,17 mL,mL,,4298,3653.3,1231.8068,4298,PrimeWest Health,Minnesota Senior Health Options (MSHO),2211.321,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
FERUMOXYTOL 510 MG/17 ML (30 MG/ML) IV SOLN,,Q0138,HCPCS,Facility,Inpatient,17 mL,mL,,4298,3653.3,1231.8068,4298,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
FERUMOXYTOL 510 MG/17 ML (30 MG/ML) IV SOLN,,Q0138,HCPCS,Facility,Outpatient,17 mL,mL,,4298,3653.3,1231.8068,4298,PrimeWest Health,MinnesotaCare,2207.4528,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
FERUMOXYTOL 510 MG/17 ML (30 MG/ML) IV SOLN,,Q0138,HCPCS,Facility,Inpatient,17 mL,mL,,4298,3653.3,1231.8068,4298,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
FERUMOXYTOL 510 MG/17 ML (30 MG/ML) IV SOLN,,Q0138,HCPCS,Facility,Both,17 mL,mL,,4298,3653.3,1231.8068,4298,Sanford Health Plan,Sanford Health Plan,3954.16,92,,percent of total billed charges,,
FERUMOXYTOL 510 MG/17 ML (30 MG/ML) IV SOLN,,Q0138,HCPCS,Facility,Outpatient,17 mL,mL,,4298,3653.3,1231.8068,4298,"UCare Health, Inc.",Individual & Family Plan,2421.923,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
FERUMOXYTOL 510 MG/17 ML (30 MG/ML) IV SOLN,,Q0138,HCPCS,Facility,Inpatient,17 mL,mL,,4298,3653.3,1231.8068,4298,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
FERUMOXYTOL 510 MG/17 ML (30 MG/ML) IV SOLN,,Q0138,HCPCS,Facility,Outpatient,17 mL,mL,,4298,3653.3,1231.8068,4298,"UCare Health, Inc.",Medical Assistance,2169.2006,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FERUMOXYTOL 510 MG/17 ML (30 MG/ML) IV SOLN,,Q0138,HCPCS,Facility,Inpatient,17 mL,mL,,4298,3653.3,1231.8068,4298,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
FERUMOXYTOL 510 MG/17 ML (30 MG/ML) IV SOLN,,Q0138,HCPCS,Facility,Outpatient,17 mL,mL,,4298,3653.3,1231.8068,4298,"UCare Health, Inc.",Medicare Advantage,2169.2006,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FERUMOXYTOL 510 MG/17 ML (30 MG/ML) IV SOLN,,Q0138,HCPCS,Facility,Inpatient,17 mL,mL,,4298,3653.3,1231.8068,4298,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
FERUMOXYTOL 510 MG/17 ML (30 MG/ML) IV SOLN,,Q0138,HCPCS,Facility,Outpatient,17 mL,mL,,4298,3653.3,1231.8068,4298,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2169.2006,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FERUMOXYTOL 510 MG/17 ML (30 MG/ML) IV SOLN,,Q0138,HCPCS,Facility,Inpatient,17 mL,mL,,4298,3653.3,1231.8068,4298,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
FERUMOXYTOL 510 MG/17 ML (30 MG/ML) IV SOLN,,Q0138,HCPCS,Facility,Both,17 mL,mL,,4298,3653.3,1231.8068,4298,UnitedHealthcare,Individual & Family,4040.12,94,,percent of total billed charges,,
FERUMOXYTOL 510 MG/17 ML (30 MG/ML) IV SOLN,,Q0138,HCPCS,Facility,Outpatient,17 mL,mL,,4298,3653.3,1231.8068,4298,UnitedHealthcare,Medicare Advantage,2106.02,49,,percent of total billed charges,,
FERUMOXYTOL 510 MG/17 ML (30 MG/ML) IV SOLN,,Q0138,HCPCS,Facility,Inpatient,17 mL,mL,,4298,3653.3,1231.8068,4298,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
FERUMOXYTOL 510 MG/17 ML (30 MG/ML) IV SOLN,,Q0138,HCPCS,Facility,Outpatient,17 mL,mL,,4298,3653.3,1231.8068,4298,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2063.04,48,,percent of total billed charges,,100% of DHS outpatient percentage
FERUMOXYTOL 510 MG/17 ML (30 MG/ML) IV SOLN,,Q0138,HCPCS,Facility,Inpatient,17 mL,mL,,4298,3653.3,1231.8068,4298,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
PRAMOXINE-CALAMINE 1-8 % TOP LOTN,,15654,LOCAL,Facility,Both,177 mL,mL,,21,17.85,6.0186,21,Aetna,Commercial,19.32,92,,percent of total billed charges,,
PRAMOXINE-CALAMINE 1-8 % TOP LOTN,,15654,LOCAL,Facility,Outpatient,177 mL,mL,,21,17.85,6.0186,21,Aetna,Medicare Advantage,10.29,49,,percent of total billed charges,,
PRAMOXINE-CALAMINE 1-8 % TOP LOTN,,15654,LOCAL,Facility,Inpatient,177 mL,mL,,21,17.85,6.0186,21,Aetna,Medicare Advantage,,,,,Included in per diem rate,
PRAMOXINE-CALAMINE 1-8 % TOP LOTN,,15654,LOCAL,Facility,Both,177 mL,mL,,21,17.85,6.0186,21,Aetna,PPO,19.53,93,,percent of total billed charges,,
PRAMOXINE-CALAMINE 1-8 % TOP LOTN,,15654,LOCAL,Facility,Both,177 mL,mL,,21,17.85,6.0186,21,America's PPO,America's PPO,20.1663,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
PRAMOXINE-CALAMINE 1-8 % TOP LOTN,,15654,LOCAL,Facility,Both,177 mL,mL,,21,17.85,6.0186,21,BlueCross BlueShield Minnesota, Federal Employee Program,20.664,98.4,,percent of total billed charges,,
PRAMOXINE-CALAMINE 1-8 % TOP LOTN,,15654,LOCAL,Facility,Both,177 mL,mL,,21,17.85,6.0186,21,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,21,100,,percent of total billed charges,,
PRAMOXINE-CALAMINE 1-8 % TOP LOTN,,15654,LOCAL,Facility,Both,177 mL,mL,,21,17.85,6.0186,21,BlueCross BlueShield Minnesota,High Value Network Plan,18.9,90,,percent of total billed charges,,
PRAMOXINE-CALAMINE 1-8 % TOP LOTN,,15654,LOCAL,Facility,Outpatient,177 mL,mL,,21,17.85,6.0186,21,BlueCross BlueShield Minnesota,Medicare Advantage,10.29,49,,percent of total billed charges,,
PRAMOXINE-CALAMINE 1-8 % TOP LOTN,,15654,LOCAL,Facility,Inpatient,177 mL,mL,,21,17.85,6.0186,21,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
PRAMOXINE-CALAMINE 1-8 % TOP LOTN,,15654,LOCAL,Facility,Both,177 mL,mL,,21,17.85,6.0186,21,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,18.5997,88.57,,percent of total billed charges,,
PRAMOXINE-CALAMINE 1-8 % TOP LOTN,,15654,LOCAL,Facility,Both,177 mL,mL,,21,17.85,6.0186,21,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,6.0186,28.66,,percent of total billed charges,,
PRAMOXINE-CALAMINE 1-8 % TOP LOTN,,15654,LOCAL,Facility,Outpatient,177 mL,mL,,21,17.85,6.0186,21,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),10.29,49,,percent of total billed charges,,
PRAMOXINE-CALAMINE 1-8 % TOP LOTN,,15654,LOCAL,Facility,Inpatient,177 mL,mL,,21,17.85,6.0186,21,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
PRAMOXINE-CALAMINE 1-8 % TOP LOTN,,15654,LOCAL,Facility,Both,177 mL,mL,,21,17.85,6.0186,21,CorVel,Worker's Compensation,21,100,,percent of total billed charges,,
PRAMOXINE-CALAMINE 1-8 % TOP LOTN,,15654,LOCAL,Facility,Both,177 mL,mL,,21,17.85,6.0186,21,First Health Group Corporation,First Health Network,20.37,97,,percent of total billed charges,,
PRAMOXINE-CALAMINE 1-8 % TOP LOTN,,15654,LOCAL,Facility,Both,177 mL,mL,,21,17.85,6.0186,21,"Health Partners, Inc.",Commercial,19.866,94.6,,percent of total billed charges,,
PRAMOXINE-CALAMINE 1-8 % TOP LOTN,,15654,LOCAL,Facility,Outpatient,177 mL,mL,,21,17.85,6.0186,21,"Health Partners, Inc.",Medicare Advantage,10.29,49,,percent of total billed charges,,
PRAMOXINE-CALAMINE 1-8 % TOP LOTN,,15654,LOCAL,Facility,Inpatient,177 mL,mL,,21,17.85,6.0186,21,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PRAMOXINE-CALAMINE 1-8 % TOP LOTN,,15654,LOCAL,Facility,Both,177 mL,mL,,21,17.85,6.0186,21,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),12.6,60,,percent of total billed charges,,
PRAMOXINE-CALAMINE 1-8 % TOP LOTN,,15654,LOCAL,Facility,Both,177 mL,mL,,21,17.85,6.0186,21,"Health Partners, Inc.",State of Minnesota Advantage Program,17.115,81.5,,percent of total billed charges,,
PRAMOXINE-CALAMINE 1-8 % TOP LOTN,,15654,LOCAL,Facility,Both,177 mL,mL,,21,17.85,6.0186,21,"Health Partners, Inc.",State Public Programs,10.5,50,,percent of total billed charges,,
PRAMOXINE-CALAMINE 1-8 % TOP LOTN,,15654,LOCAL,Facility,Both,177 mL,mL,,21,17.85,6.0186,21,Humana Insurance Company,Commercial PPO,19.95,95,,percent of total billed charges,,
PRAMOXINE-CALAMINE 1-8 % TOP LOTN,,15654,LOCAL,Facility,Outpatient,177 mL,mL,,21,17.85,6.0186,21,Humana Insurance Company,Medicare PPO,10.29,49,,percent of total billed charges,,
PRAMOXINE-CALAMINE 1-8 % TOP LOTN,,15654,LOCAL,Facility,Inpatient,177 mL,mL,,21,17.85,6.0186,21,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
PRAMOXINE-CALAMINE 1-8 % TOP LOTN,,15654,LOCAL,Facility,Both,177 mL,mL,,21,17.85,6.0186,21,Medica,Individual & Family,20.811,99.1,,percent of total billed charges,,
PRAMOXINE-CALAMINE 1-8 % TOP LOTN,,15654,LOCAL,Facility,Outpatient,177 mL,mL,,21,17.85,6.0186,21,Medica,Medica Advantage Solution,10.458,49.8,,percent of total billed charges,,
PRAMOXINE-CALAMINE 1-8 % TOP LOTN,,15654,LOCAL,Facility,Inpatient,177 mL,mL,,21,17.85,6.0186,21,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
PRAMOXINE-CALAMINE 1-8 % TOP LOTN,,15654,LOCAL,Facility,Outpatient,177 mL,mL,,21,17.85,6.0186,21,Medica,Medical Assistance,9.366,44.6,,percent of total billed charges,,
PRAMOXINE-CALAMINE 1-8 % TOP LOTN,,15654,LOCAL,Facility,Inpatient,177 mL,mL,,21,17.85,6.0186,21,Medica,Medical Assistance,,,,,Included in per diem rate,
PRAMOXINE-CALAMINE 1-8 % TOP LOTN,,15654,LOCAL,Facility,Outpatient,177 mL,mL,,21,17.85,6.0186,21,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,10.458,49.8,,percent of total billed charges,,
PRAMOXINE-CALAMINE 1-8 % TOP LOTN,,15654,LOCAL,Facility,Inpatient,177 mL,mL,,21,17.85,6.0186,21,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
PRAMOXINE-CALAMINE 1-8 % TOP LOTN,,15654,LOCAL,Facility,Both,177 mL,mL,,21,17.85,6.0186,21,"Multiplan, Inc.","Multiplan, Inc.",19.74,94,,percent of total billed charges,,
PRAMOXINE-CALAMINE 1-8 % TOP LOTN,,15654,LOCAL,Facility,Outpatient,177 mL,mL,,21,17.85,6.0186,21,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,18.921,90.1,,percent of total billed charges,,
PRAMOXINE-CALAMINE 1-8 % TOP LOTN,,15654,LOCAL,Facility,Inpatient,177 mL,mL,,21,17.85,6.0186,21,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
PRAMOXINE-CALAMINE 1-8 % TOP LOTN,,15654,LOCAL,Facility,Both,177 mL,mL,,21,17.85,6.0186,21,"Preferred One Administrative Services, INC.",PPO,20.706,98.6,,percent of total billed charges,,
PRAMOXINE-CALAMINE 1-8 % TOP LOTN,,15654,LOCAL,Facility,Outpatient,177 mL,mL,,21,17.85,6.0186,21,PrimeWest Health,Minnesota Senior Health Options (MSHO),10.8045,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
PRAMOXINE-CALAMINE 1-8 % TOP LOTN,,15654,LOCAL,Facility,Inpatient,177 mL,mL,,21,17.85,6.0186,21,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PRAMOXINE-CALAMINE 1-8 % TOP LOTN,,15654,LOCAL,Facility,Outpatient,177 mL,mL,,21,17.85,6.0186,21,PrimeWest Health,MinnesotaCare,10.7856,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
PRAMOXINE-CALAMINE 1-8 % TOP LOTN,,15654,LOCAL,Facility,Inpatient,177 mL,mL,,21,17.85,6.0186,21,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
PRAMOXINE-CALAMINE 1-8 % TOP LOTN,,15654,LOCAL,Facility,Both,177 mL,mL,,21,17.85,6.0186,21,Sanford Health Plan,Sanford Health Plan,19.32,92,,percent of total billed charges,,
PRAMOXINE-CALAMINE 1-8 % TOP LOTN,,15654,LOCAL,Facility,Outpatient,177 mL,mL,,21,17.85,6.0186,21,"UCare Health, Inc.",Individual & Family Plan,11.8335,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
PRAMOXINE-CALAMINE 1-8 % TOP LOTN,,15654,LOCAL,Facility,Inpatient,177 mL,mL,,21,17.85,6.0186,21,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
PRAMOXINE-CALAMINE 1-8 % TOP LOTN,,15654,LOCAL,Facility,Outpatient,177 mL,mL,,21,17.85,6.0186,21,"UCare Health, Inc.",Medical Assistance,10.5987,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PRAMOXINE-CALAMINE 1-8 % TOP LOTN,,15654,LOCAL,Facility,Inpatient,177 mL,mL,,21,17.85,6.0186,21,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
PRAMOXINE-CALAMINE 1-8 % TOP LOTN,,15654,LOCAL,Facility,Outpatient,177 mL,mL,,21,17.85,6.0186,21,"UCare Health, Inc.",Medicare Advantage,10.5987,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PRAMOXINE-CALAMINE 1-8 % TOP LOTN,,15654,LOCAL,Facility,Inpatient,177 mL,mL,,21,17.85,6.0186,21,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PRAMOXINE-CALAMINE 1-8 % TOP LOTN,,15654,LOCAL,Facility,Outpatient,177 mL,mL,,21,17.85,6.0186,21,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),10.5987,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PRAMOXINE-CALAMINE 1-8 % TOP LOTN,,15654,LOCAL,Facility,Inpatient,177 mL,mL,,21,17.85,6.0186,21,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PRAMOXINE-CALAMINE 1-8 % TOP LOTN,,15654,LOCAL,Facility,Both,177 mL,mL,,21,17.85,6.0186,21,UnitedHealthcare,Individual & Family,19.74,94,,percent of total billed charges,,
PRAMOXINE-CALAMINE 1-8 % TOP LOTN,,15654,LOCAL,Facility,Outpatient,177 mL,mL,,21,17.85,6.0186,21,UnitedHealthcare,Medicare Advantage,10.29,49,,percent of total billed charges,,
PRAMOXINE-CALAMINE 1-8 % TOP LOTN,,15654,LOCAL,Facility,Inpatient,177 mL,mL,,21,17.85,6.0186,21,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
PRAMOXINE-CALAMINE 1-8 % TOP LOTN,,15654,LOCAL,Facility,Outpatient,177 mL,mL,,21,17.85,6.0186,21,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,10.08,48,,percent of total billed charges,,100% of DHS outpatient percentage
PRAMOXINE-CALAMINE 1-8 % TOP LOTN,,15654,LOCAL,Facility,Inpatient,177 mL,mL,,21,17.85,6.0186,21,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
PHENOL 1.4 % MM SPRA,,20065,LOCAL,Facility,Both,177 mL,mL,,15,12.75,4.299,15,Aetna,Commercial,13.8,92,,percent of total billed charges,,
PHENOL 1.4 % MM SPRA,,20065,LOCAL,Facility,Outpatient,177 mL,mL,,15,12.75,4.299,15,Aetna,Medicare Advantage,7.35,49,,percent of total billed charges,,
PHENOL 1.4 % MM SPRA,,20065,LOCAL,Facility,Inpatient,177 mL,mL,,15,12.75,4.299,15,Aetna,Medicare Advantage,,,,,Included in per diem rate,
PHENOL 1.4 % MM SPRA,,20065,LOCAL,Facility,Both,177 mL,mL,,15,12.75,4.299,15,Aetna,PPO,13.95,93,,percent of total billed charges,,
PHENOL 1.4 % MM SPRA,,20065,LOCAL,Facility,Both,177 mL,mL,,15,12.75,4.299,15,America's PPO,America's PPO,14.4045,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
PHENOL 1.4 % MM SPRA,,20065,LOCAL,Facility,Both,177 mL,mL,,15,12.75,4.299,15,BlueCross BlueShield Minnesota, Federal Employee Program,14.76,98.4,,percent of total billed charges,,
PHENOL 1.4 % MM SPRA,,20065,LOCAL,Facility,Both,177 mL,mL,,15,12.75,4.299,15,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,15,100,,percent of total billed charges,,
PHENOL 1.4 % MM SPRA,,20065,LOCAL,Facility,Both,177 mL,mL,,15,12.75,4.299,15,BlueCross BlueShield Minnesota,High Value Network Plan,13.5,90,,percent of total billed charges,,
PHENOL 1.4 % MM SPRA,,20065,LOCAL,Facility,Outpatient,177 mL,mL,,15,12.75,4.299,15,BlueCross BlueShield Minnesota,Medicare Advantage,7.35,49,,percent of total billed charges,,
PHENOL 1.4 % MM SPRA,,20065,LOCAL,Facility,Inpatient,177 mL,mL,,15,12.75,4.299,15,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
PHENOL 1.4 % MM SPRA,,20065,LOCAL,Facility,Both,177 mL,mL,,15,12.75,4.299,15,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,13.2855,88.57,,percent of total billed charges,,
PHENOL 1.4 % MM SPRA,,20065,LOCAL,Facility,Both,177 mL,mL,,15,12.75,4.299,15,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,4.299,28.66,,percent of total billed charges,,
PHENOL 1.4 % MM SPRA,,20065,LOCAL,Facility,Outpatient,177 mL,mL,,15,12.75,4.299,15,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),7.35,49,,percent of total billed charges,,
PHENOL 1.4 % MM SPRA,,20065,LOCAL,Facility,Inpatient,177 mL,mL,,15,12.75,4.299,15,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
PHENOL 1.4 % MM SPRA,,20065,LOCAL,Facility,Both,177 mL,mL,,15,12.75,4.299,15,CorVel,Worker's Compensation,15,100,,percent of total billed charges,,
PHENOL 1.4 % MM SPRA,,20065,LOCAL,Facility,Both,177 mL,mL,,15,12.75,4.299,15,First Health Group Corporation,First Health Network,14.55,97,,percent of total billed charges,,
PHENOL 1.4 % MM SPRA,,20065,LOCAL,Facility,Both,177 mL,mL,,15,12.75,4.299,15,"Health Partners, Inc.",Commercial,14.19,94.6,,percent of total billed charges,,
PHENOL 1.4 % MM SPRA,,20065,LOCAL,Facility,Outpatient,177 mL,mL,,15,12.75,4.299,15,"Health Partners, Inc.",Medicare Advantage,7.35,49,,percent of total billed charges,,
PHENOL 1.4 % MM SPRA,,20065,LOCAL,Facility,Inpatient,177 mL,mL,,15,12.75,4.299,15,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PHENOL 1.4 % MM SPRA,,20065,LOCAL,Facility,Both,177 mL,mL,,15,12.75,4.299,15,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),9,60,,percent of total billed charges,,
PHENOL 1.4 % MM SPRA,,20065,LOCAL,Facility,Both,177 mL,mL,,15,12.75,4.299,15,"Health Partners, Inc.",State of Minnesota Advantage Program,12.225,81.5,,percent of total billed charges,,
PHENOL 1.4 % MM SPRA,,20065,LOCAL,Facility,Both,177 mL,mL,,15,12.75,4.299,15,"Health Partners, Inc.",State Public Programs,7.5,50,,percent of total billed charges,,
PHENOL 1.4 % MM SPRA,,20065,LOCAL,Facility,Both,177 mL,mL,,15,12.75,4.299,15,Humana Insurance Company,Commercial PPO,14.25,95,,percent of total billed charges,,
PHENOL 1.4 % MM SPRA,,20065,LOCAL,Facility,Outpatient,177 mL,mL,,15,12.75,4.299,15,Humana Insurance Company,Medicare PPO,7.35,49,,percent of total billed charges,,
PHENOL 1.4 % MM SPRA,,20065,LOCAL,Facility,Inpatient,177 mL,mL,,15,12.75,4.299,15,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
PHENOL 1.4 % MM SPRA,,20065,LOCAL,Facility,Both,177 mL,mL,,15,12.75,4.299,15,Medica,Individual & Family,14.865,99.1,,percent of total billed charges,,
PHENOL 1.4 % MM SPRA,,20065,LOCAL,Facility,Outpatient,177 mL,mL,,15,12.75,4.299,15,Medica,Medica Advantage Solution,7.47,49.8,,percent of total billed charges,,
PHENOL 1.4 % MM SPRA,,20065,LOCAL,Facility,Inpatient,177 mL,mL,,15,12.75,4.299,15,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
PHENOL 1.4 % MM SPRA,,20065,LOCAL,Facility,Outpatient,177 mL,mL,,15,12.75,4.299,15,Medica,Medical Assistance,6.69,44.6,,percent of total billed charges,,
PHENOL 1.4 % MM SPRA,,20065,LOCAL,Facility,Inpatient,177 mL,mL,,15,12.75,4.299,15,Medica,Medical Assistance,,,,,Included in per diem rate,
PHENOL 1.4 % MM SPRA,,20065,LOCAL,Facility,Outpatient,177 mL,mL,,15,12.75,4.299,15,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,7.47,49.8,,percent of total billed charges,,
PHENOL 1.4 % MM SPRA,,20065,LOCAL,Facility,Inpatient,177 mL,mL,,15,12.75,4.299,15,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
PHENOL 1.4 % MM SPRA,,20065,LOCAL,Facility,Both,177 mL,mL,,15,12.75,4.299,15,"Multiplan, Inc.","Multiplan, Inc.",14.1,94,,percent of total billed charges,,
PHENOL 1.4 % MM SPRA,,20065,LOCAL,Facility,Outpatient,177 mL,mL,,15,12.75,4.299,15,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,13.515,90.1,,percent of total billed charges,,
PHENOL 1.4 % MM SPRA,,20065,LOCAL,Facility,Inpatient,177 mL,mL,,15,12.75,4.299,15,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
PHENOL 1.4 % MM SPRA,,20065,LOCAL,Facility,Both,177 mL,mL,,15,12.75,4.299,15,"Preferred One Administrative Services, INC.",PPO,14.79,98.6,,percent of total billed charges,,
PHENOL 1.4 % MM SPRA,,20065,LOCAL,Facility,Outpatient,177 mL,mL,,15,12.75,4.299,15,PrimeWest Health,Minnesota Senior Health Options (MSHO),7.7175,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
PHENOL 1.4 % MM SPRA,,20065,LOCAL,Facility,Inpatient,177 mL,mL,,15,12.75,4.299,15,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PHENOL 1.4 % MM SPRA,,20065,LOCAL,Facility,Outpatient,177 mL,mL,,15,12.75,4.299,15,PrimeWest Health,MinnesotaCare,7.704,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
PHENOL 1.4 % MM SPRA,,20065,LOCAL,Facility,Inpatient,177 mL,mL,,15,12.75,4.299,15,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
PHENOL 1.4 % MM SPRA,,20065,LOCAL,Facility,Both,177 mL,mL,,15,12.75,4.299,15,Sanford Health Plan,Sanford Health Plan,13.8,92,,percent of total billed charges,,
PHENOL 1.4 % MM SPRA,,20065,LOCAL,Facility,Outpatient,177 mL,mL,,15,12.75,4.299,15,"UCare Health, Inc.",Individual & Family Plan,8.4525,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
PHENOL 1.4 % MM SPRA,,20065,LOCAL,Facility,Inpatient,177 mL,mL,,15,12.75,4.299,15,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
PHENOL 1.4 % MM SPRA,,20065,LOCAL,Facility,Outpatient,177 mL,mL,,15,12.75,4.299,15,"UCare Health, Inc.",Medical Assistance,7.5705,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PHENOL 1.4 % MM SPRA,,20065,LOCAL,Facility,Inpatient,177 mL,mL,,15,12.75,4.299,15,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
PHENOL 1.4 % MM SPRA,,20065,LOCAL,Facility,Outpatient,177 mL,mL,,15,12.75,4.299,15,"UCare Health, Inc.",Medicare Advantage,7.5705,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PHENOL 1.4 % MM SPRA,,20065,LOCAL,Facility,Inpatient,177 mL,mL,,15,12.75,4.299,15,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PHENOL 1.4 % MM SPRA,,20065,LOCAL,Facility,Outpatient,177 mL,mL,,15,12.75,4.299,15,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),7.5705,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PHENOL 1.4 % MM SPRA,,20065,LOCAL,Facility,Inpatient,177 mL,mL,,15,12.75,4.299,15,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PHENOL 1.4 % MM SPRA,,20065,LOCAL,Facility,Both,177 mL,mL,,15,12.75,4.299,15,UnitedHealthcare,Individual & Family,14.1,94,,percent of total billed charges,,
PHENOL 1.4 % MM SPRA,,20065,LOCAL,Facility,Outpatient,177 mL,mL,,15,12.75,4.299,15,UnitedHealthcare,Medicare Advantage,7.35,49,,percent of total billed charges,,
PHENOL 1.4 % MM SPRA,,20065,LOCAL,Facility,Inpatient,177 mL,mL,,15,12.75,4.299,15,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
PHENOL 1.4 % MM SPRA,,20065,LOCAL,Facility,Outpatient,177 mL,mL,,15,12.75,4.299,15,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,7.2,48,,percent of total billed charges,,100% of DHS outpatient percentage
PHENOL 1.4 % MM SPRA,,20065,LOCAL,Facility,Inpatient,177 mL,mL,,15,12.75,4.299,15,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
CALAMINE-ZINC OXIDE 8-8 % TOP LOTN,,77354,LOCAL,Facility,Both,177 mL,mL,,9,7.65,2.5794,9,Aetna,Commercial,8.28,92,,percent of total billed charges,,
CALAMINE-ZINC OXIDE 8-8 % TOP LOTN,,77354,LOCAL,Facility,Outpatient,177 mL,mL,,9,7.65,2.5794,9,Aetna,Medicare Advantage,4.41,49,,percent of total billed charges,,
CALAMINE-ZINC OXIDE 8-8 % TOP LOTN,,77354,LOCAL,Facility,Inpatient,177 mL,mL,,9,7.65,2.5794,9,Aetna,Medicare Advantage,,,,,Included in per diem rate,
CALAMINE-ZINC OXIDE 8-8 % TOP LOTN,,77354,LOCAL,Facility,Both,177 mL,mL,,9,7.65,2.5794,9,Aetna,PPO,8.37,93,,percent of total billed charges,,
CALAMINE-ZINC OXIDE 8-8 % TOP LOTN,,77354,LOCAL,Facility,Both,177 mL,mL,,9,7.65,2.5794,9,America's PPO,America's PPO,8.6427,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
CALAMINE-ZINC OXIDE 8-8 % TOP LOTN,,77354,LOCAL,Facility,Both,177 mL,mL,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota, Federal Employee Program,8.856,98.4,,percent of total billed charges,,
CALAMINE-ZINC OXIDE 8-8 % TOP LOTN,,77354,LOCAL,Facility,Both,177 mL,mL,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,9,100,,percent of total billed charges,,
CALAMINE-ZINC OXIDE 8-8 % TOP LOTN,,77354,LOCAL,Facility,Both,177 mL,mL,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota,High Value Network Plan,8.1,90,,percent of total billed charges,,
CALAMINE-ZINC OXIDE 8-8 % TOP LOTN,,77354,LOCAL,Facility,Outpatient,177 mL,mL,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota,Medicare Advantage,4.41,49,,percent of total billed charges,,
CALAMINE-ZINC OXIDE 8-8 % TOP LOTN,,77354,LOCAL,Facility,Inpatient,177 mL,mL,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
CALAMINE-ZINC OXIDE 8-8 % TOP LOTN,,77354,LOCAL,Facility,Both,177 mL,mL,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,7.9713,88.57,,percent of total billed charges,,
CALAMINE-ZINC OXIDE 8-8 % TOP LOTN,,77354,LOCAL,Facility,Both,177 mL,mL,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,2.5794,28.66,,percent of total billed charges,,
CALAMINE-ZINC OXIDE 8-8 % TOP LOTN,,77354,LOCAL,Facility,Outpatient,177 mL,mL,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),4.41,49,,percent of total billed charges,,
CALAMINE-ZINC OXIDE 8-8 % TOP LOTN,,77354,LOCAL,Facility,Inpatient,177 mL,mL,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
CALAMINE-ZINC OXIDE 8-8 % TOP LOTN,,77354,LOCAL,Facility,Both,177 mL,mL,,9,7.65,2.5794,9,CorVel,Worker's Compensation,9,100,,percent of total billed charges,,
CALAMINE-ZINC OXIDE 8-8 % TOP LOTN,,77354,LOCAL,Facility,Both,177 mL,mL,,9,7.65,2.5794,9,First Health Group Corporation,First Health Network,8.73,97,,percent of total billed charges,,
CALAMINE-ZINC OXIDE 8-8 % TOP LOTN,,77354,LOCAL,Facility,Both,177 mL,mL,,9,7.65,2.5794,9,"Health Partners, Inc.",Commercial,8.514,94.6,,percent of total billed charges,,
CALAMINE-ZINC OXIDE 8-8 % TOP LOTN,,77354,LOCAL,Facility,Outpatient,177 mL,mL,,9,7.65,2.5794,9,"Health Partners, Inc.",Medicare Advantage,4.41,49,,percent of total billed charges,,
CALAMINE-ZINC OXIDE 8-8 % TOP LOTN,,77354,LOCAL,Facility,Inpatient,177 mL,mL,,9,7.65,2.5794,9,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CALAMINE-ZINC OXIDE 8-8 % TOP LOTN,,77354,LOCAL,Facility,Both,177 mL,mL,,9,7.65,2.5794,9,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),5.4,60,,percent of total billed charges,,
CALAMINE-ZINC OXIDE 8-8 % TOP LOTN,,77354,LOCAL,Facility,Both,177 mL,mL,,9,7.65,2.5794,9,"Health Partners, Inc.",State of Minnesota Advantage Program,7.335,81.5,,percent of total billed charges,,
CALAMINE-ZINC OXIDE 8-8 % TOP LOTN,,77354,LOCAL,Facility,Both,177 mL,mL,,9,7.65,2.5794,9,"Health Partners, Inc.",State Public Programs,4.5,50,,percent of total billed charges,,
CALAMINE-ZINC OXIDE 8-8 % TOP LOTN,,77354,LOCAL,Facility,Both,177 mL,mL,,9,7.65,2.5794,9,Humana Insurance Company,Commercial PPO,8.55,95,,percent of total billed charges,,
CALAMINE-ZINC OXIDE 8-8 % TOP LOTN,,77354,LOCAL,Facility,Outpatient,177 mL,mL,,9,7.65,2.5794,9,Humana Insurance Company,Medicare PPO,4.41,49,,percent of total billed charges,,
CALAMINE-ZINC OXIDE 8-8 % TOP LOTN,,77354,LOCAL,Facility,Inpatient,177 mL,mL,,9,7.65,2.5794,9,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
CALAMINE-ZINC OXIDE 8-8 % TOP LOTN,,77354,LOCAL,Facility,Both,177 mL,mL,,9,7.65,2.5794,9,Medica,Individual & Family,8.919,99.1,,percent of total billed charges,,
CALAMINE-ZINC OXIDE 8-8 % TOP LOTN,,77354,LOCAL,Facility,Outpatient,177 mL,mL,,9,7.65,2.5794,9,Medica,Medica Advantage Solution,4.482,49.8,,percent of total billed charges,,
CALAMINE-ZINC OXIDE 8-8 % TOP LOTN,,77354,LOCAL,Facility,Inpatient,177 mL,mL,,9,7.65,2.5794,9,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
CALAMINE-ZINC OXIDE 8-8 % TOP LOTN,,77354,LOCAL,Facility,Outpatient,177 mL,mL,,9,7.65,2.5794,9,Medica,Medical Assistance,4.014,44.6,,percent of total billed charges,,
CALAMINE-ZINC OXIDE 8-8 % TOP LOTN,,77354,LOCAL,Facility,Inpatient,177 mL,mL,,9,7.65,2.5794,9,Medica,Medical Assistance,,,,,Included in per diem rate,
CALAMINE-ZINC OXIDE 8-8 % TOP LOTN,,77354,LOCAL,Facility,Outpatient,177 mL,mL,,9,7.65,2.5794,9,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,4.482,49.8,,percent of total billed charges,,
CALAMINE-ZINC OXIDE 8-8 % TOP LOTN,,77354,LOCAL,Facility,Inpatient,177 mL,mL,,9,7.65,2.5794,9,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
CALAMINE-ZINC OXIDE 8-8 % TOP LOTN,,77354,LOCAL,Facility,Both,177 mL,mL,,9,7.65,2.5794,9,"Multiplan, Inc.","Multiplan, Inc.",8.46,94,,percent of total billed charges,,
CALAMINE-ZINC OXIDE 8-8 % TOP LOTN,,77354,LOCAL,Facility,Outpatient,177 mL,mL,,9,7.65,2.5794,9,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,8.109,90.1,,percent of total billed charges,,
CALAMINE-ZINC OXIDE 8-8 % TOP LOTN,,77354,LOCAL,Facility,Inpatient,177 mL,mL,,9,7.65,2.5794,9,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
CALAMINE-ZINC OXIDE 8-8 % TOP LOTN,,77354,LOCAL,Facility,Both,177 mL,mL,,9,7.65,2.5794,9,"Preferred One Administrative Services, INC.",PPO,8.874,98.6,,percent of total billed charges,,
CALAMINE-ZINC OXIDE 8-8 % TOP LOTN,,77354,LOCAL,Facility,Outpatient,177 mL,mL,,9,7.65,2.5794,9,PrimeWest Health,Minnesota Senior Health Options (MSHO),4.6305,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
CALAMINE-ZINC OXIDE 8-8 % TOP LOTN,,77354,LOCAL,Facility,Inpatient,177 mL,mL,,9,7.65,2.5794,9,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CALAMINE-ZINC OXIDE 8-8 % TOP LOTN,,77354,LOCAL,Facility,Outpatient,177 mL,mL,,9,7.65,2.5794,9,PrimeWest Health,MinnesotaCare,4.6224,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
CALAMINE-ZINC OXIDE 8-8 % TOP LOTN,,77354,LOCAL,Facility,Inpatient,177 mL,mL,,9,7.65,2.5794,9,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
CALAMINE-ZINC OXIDE 8-8 % TOP LOTN,,77354,LOCAL,Facility,Both,177 mL,mL,,9,7.65,2.5794,9,Sanford Health Plan,Sanford Health Plan,8.28,92,,percent of total billed charges,,
CALAMINE-ZINC OXIDE 8-8 % TOP LOTN,,77354,LOCAL,Facility,Outpatient,177 mL,mL,,9,7.65,2.5794,9,"UCare Health, Inc.",Individual & Family Plan,5.0715,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
CALAMINE-ZINC OXIDE 8-8 % TOP LOTN,,77354,LOCAL,Facility,Inpatient,177 mL,mL,,9,7.65,2.5794,9,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
CALAMINE-ZINC OXIDE 8-8 % TOP LOTN,,77354,LOCAL,Facility,Outpatient,177 mL,mL,,9,7.65,2.5794,9,"UCare Health, Inc.",Medical Assistance,4.5423,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CALAMINE-ZINC OXIDE 8-8 % TOP LOTN,,77354,LOCAL,Facility,Inpatient,177 mL,mL,,9,7.65,2.5794,9,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
CALAMINE-ZINC OXIDE 8-8 % TOP LOTN,,77354,LOCAL,Facility,Outpatient,177 mL,mL,,9,7.65,2.5794,9,"UCare Health, Inc.",Medicare Advantage,4.5423,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CALAMINE-ZINC OXIDE 8-8 % TOP LOTN,,77354,LOCAL,Facility,Inpatient,177 mL,mL,,9,7.65,2.5794,9,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CALAMINE-ZINC OXIDE 8-8 % TOP LOTN,,77354,LOCAL,Facility,Outpatient,177 mL,mL,,9,7.65,2.5794,9,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),4.5423,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CALAMINE-ZINC OXIDE 8-8 % TOP LOTN,,77354,LOCAL,Facility,Inpatient,177 mL,mL,,9,7.65,2.5794,9,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CALAMINE-ZINC OXIDE 8-8 % TOP LOTN,,77354,LOCAL,Facility,Both,177 mL,mL,,9,7.65,2.5794,9,UnitedHealthcare,Individual & Family,8.46,94,,percent of total billed charges,,
CALAMINE-ZINC OXIDE 8-8 % TOP LOTN,,77354,LOCAL,Facility,Outpatient,177 mL,mL,,9,7.65,2.5794,9,UnitedHealthcare,Medicare Advantage,4.41,49,,percent of total billed charges,,
CALAMINE-ZINC OXIDE 8-8 % TOP LOTN,,77354,LOCAL,Facility,Inpatient,177 mL,mL,,9,7.65,2.5794,9,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
CALAMINE-ZINC OXIDE 8-8 % TOP LOTN,,77354,LOCAL,Facility,Outpatient,177 mL,mL,,9,7.65,2.5794,9,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,4.32,48,,percent of total billed charges,,100% of DHS outpatient percentage
CALAMINE-ZINC OXIDE 8-8 % TOP LOTN,,77354,LOCAL,Facility,Inpatient,177 mL,mL,,9,7.65,2.5794,9,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
ALBUTEROL SULFATE 90 MCG/ACTUATION INHL HFAA,,17736,LOCAL,Facility,Both,18 g,g,,288,244.8,82.5408,288,Aetna,Commercial,264.96,92,,percent of total billed charges,,
ALBUTEROL SULFATE 90 MCG/ACTUATION INHL HFAA,,17736,LOCAL,Facility,Outpatient,18 g,g,,288,244.8,82.5408,288,Aetna,Medicare Advantage,141.12,49,,percent of total billed charges,,
ALBUTEROL SULFATE 90 MCG/ACTUATION INHL HFAA,,17736,LOCAL,Facility,Inpatient,18 g,g,,288,244.8,82.5408,288,Aetna,Medicare Advantage,,,,,Included in per diem rate,
ALBUTEROL SULFATE 90 MCG/ACTUATION INHL HFAA,,17736,LOCAL,Facility,Both,18 g,g,,288,244.8,82.5408,288,Aetna,PPO,267.84,93,,percent of total billed charges,,
ALBUTEROL SULFATE 90 MCG/ACTUATION INHL HFAA,,17736,LOCAL,Facility,Both,18 g,g,,288,244.8,82.5408,288,America's PPO,America's PPO,276.5664,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
ALBUTEROL SULFATE 90 MCG/ACTUATION INHL HFAA,,17736,LOCAL,Facility,Both,18 g,g,,288,244.8,82.5408,288,BlueCross BlueShield Minnesota, Federal Employee Program,283.392,98.4,,percent of total billed charges,,
ALBUTEROL SULFATE 90 MCG/ACTUATION INHL HFAA,,17736,LOCAL,Facility,Both,18 g,g,,288,244.8,82.5408,288,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,288,100,,percent of total billed charges,,
ALBUTEROL SULFATE 90 MCG/ACTUATION INHL HFAA,,17736,LOCAL,Facility,Both,18 g,g,,288,244.8,82.5408,288,BlueCross BlueShield Minnesota,High Value Network Plan,259.2,90,,percent of total billed charges,,
ALBUTEROL SULFATE 90 MCG/ACTUATION INHL HFAA,,17736,LOCAL,Facility,Outpatient,18 g,g,,288,244.8,82.5408,288,BlueCross BlueShield Minnesota,Medicare Advantage,141.12,49,,percent of total billed charges,,
ALBUTEROL SULFATE 90 MCG/ACTUATION INHL HFAA,,17736,LOCAL,Facility,Inpatient,18 g,g,,288,244.8,82.5408,288,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
ALBUTEROL SULFATE 90 MCG/ACTUATION INHL HFAA,,17736,LOCAL,Facility,Both,18 g,g,,288,244.8,82.5408,288,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,255.0816,88.57,,percent of total billed charges,,
ALBUTEROL SULFATE 90 MCG/ACTUATION INHL HFAA,,17736,LOCAL,Facility,Both,18 g,g,,288,244.8,82.5408,288,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,82.5408,28.66,,percent of total billed charges,,
ALBUTEROL SULFATE 90 MCG/ACTUATION INHL HFAA,,17736,LOCAL,Facility,Outpatient,18 g,g,,288,244.8,82.5408,288,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),141.12,49,,percent of total billed charges,,
ALBUTEROL SULFATE 90 MCG/ACTUATION INHL HFAA,,17736,LOCAL,Facility,Inpatient,18 g,g,,288,244.8,82.5408,288,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
ALBUTEROL SULFATE 90 MCG/ACTUATION INHL HFAA,,17736,LOCAL,Facility,Both,18 g,g,,288,244.8,82.5408,288,CorVel,Worker's Compensation,288,100,,percent of total billed charges,,
ALBUTEROL SULFATE 90 MCG/ACTUATION INHL HFAA,,17736,LOCAL,Facility,Both,18 g,g,,288,244.8,82.5408,288,First Health Group Corporation,First Health Network,279.36,97,,percent of total billed charges,,
ALBUTEROL SULFATE 90 MCG/ACTUATION INHL HFAA,,17736,LOCAL,Facility,Both,18 g,g,,288,244.8,82.5408,288,"Health Partners, Inc.",Commercial,272.448,94.6,,percent of total billed charges,,
ALBUTEROL SULFATE 90 MCG/ACTUATION INHL HFAA,,17736,LOCAL,Facility,Outpatient,18 g,g,,288,244.8,82.5408,288,"Health Partners, Inc.",Medicare Advantage,141.12,49,,percent of total billed charges,,
ALBUTEROL SULFATE 90 MCG/ACTUATION INHL HFAA,,17736,LOCAL,Facility,Inpatient,18 g,g,,288,244.8,82.5408,288,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ALBUTEROL SULFATE 90 MCG/ACTUATION INHL HFAA,,17736,LOCAL,Facility,Both,18 g,g,,288,244.8,82.5408,288,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),172.8,60,,percent of total billed charges,,
ALBUTEROL SULFATE 90 MCG/ACTUATION INHL HFAA,,17736,LOCAL,Facility,Both,18 g,g,,288,244.8,82.5408,288,"Health Partners, Inc.",State of Minnesota Advantage Program,234.72,81.5,,percent of total billed charges,,
ALBUTEROL SULFATE 90 MCG/ACTUATION INHL HFAA,,17736,LOCAL,Facility,Both,18 g,g,,288,244.8,82.5408,288,"Health Partners, Inc.",State Public Programs,144,50,,percent of total billed charges,,
ALBUTEROL SULFATE 90 MCG/ACTUATION INHL HFAA,,17736,LOCAL,Facility,Both,18 g,g,,288,244.8,82.5408,288,Humana Insurance Company,Commercial PPO,273.6,95,,percent of total billed charges,,
ALBUTEROL SULFATE 90 MCG/ACTUATION INHL HFAA,,17736,LOCAL,Facility,Outpatient,18 g,g,,288,244.8,82.5408,288,Humana Insurance Company,Medicare PPO,141.12,49,,percent of total billed charges,,
ALBUTEROL SULFATE 90 MCG/ACTUATION INHL HFAA,,17736,LOCAL,Facility,Inpatient,18 g,g,,288,244.8,82.5408,288,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
ALBUTEROL SULFATE 90 MCG/ACTUATION INHL HFAA,,17736,LOCAL,Facility,Both,18 g,g,,288,244.8,82.5408,288,Medica,Individual & Family,285.408,99.1,,percent of total billed charges,,
ALBUTEROL SULFATE 90 MCG/ACTUATION INHL HFAA,,17736,LOCAL,Facility,Outpatient,18 g,g,,288,244.8,82.5408,288,Medica,Medica Advantage Solution,143.424,49.8,,percent of total billed charges,,
ALBUTEROL SULFATE 90 MCG/ACTUATION INHL HFAA,,17736,LOCAL,Facility,Inpatient,18 g,g,,288,244.8,82.5408,288,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
ALBUTEROL SULFATE 90 MCG/ACTUATION INHL HFAA,,17736,LOCAL,Facility,Outpatient,18 g,g,,288,244.8,82.5408,288,Medica,Medical Assistance,128.448,44.6,,percent of total billed charges,,
ALBUTEROL SULFATE 90 MCG/ACTUATION INHL HFAA,,17736,LOCAL,Facility,Inpatient,18 g,g,,288,244.8,82.5408,288,Medica,Medical Assistance,,,,,Included in per diem rate,
ALBUTEROL SULFATE 90 MCG/ACTUATION INHL HFAA,,17736,LOCAL,Facility,Outpatient,18 g,g,,288,244.8,82.5408,288,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,143.424,49.8,,percent of total billed charges,,
ALBUTEROL SULFATE 90 MCG/ACTUATION INHL HFAA,,17736,LOCAL,Facility,Inpatient,18 g,g,,288,244.8,82.5408,288,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
ALBUTEROL SULFATE 90 MCG/ACTUATION INHL HFAA,,17736,LOCAL,Facility,Both,18 g,g,,288,244.8,82.5408,288,"Multiplan, Inc.","Multiplan, Inc.",270.72,94,,percent of total billed charges,,
ALBUTEROL SULFATE 90 MCG/ACTUATION INHL HFAA,,17736,LOCAL,Facility,Outpatient,18 g,g,,288,244.8,82.5408,288,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,259.488,90.1,,percent of total billed charges,,
ALBUTEROL SULFATE 90 MCG/ACTUATION INHL HFAA,,17736,LOCAL,Facility,Inpatient,18 g,g,,288,244.8,82.5408,288,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
ALBUTEROL SULFATE 90 MCG/ACTUATION INHL HFAA,,17736,LOCAL,Facility,Both,18 g,g,,288,244.8,82.5408,288,"Preferred One Administrative Services, INC.",PPO,283.968,98.6,,percent of total billed charges,,
ALBUTEROL SULFATE 90 MCG/ACTUATION INHL HFAA,,17736,LOCAL,Facility,Outpatient,18 g,g,,288,244.8,82.5408,288,PrimeWest Health,Minnesota Senior Health Options (MSHO),148.176,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
ALBUTEROL SULFATE 90 MCG/ACTUATION INHL HFAA,,17736,LOCAL,Facility,Inpatient,18 g,g,,288,244.8,82.5408,288,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ALBUTEROL SULFATE 90 MCG/ACTUATION INHL HFAA,,17736,LOCAL,Facility,Outpatient,18 g,g,,288,244.8,82.5408,288,PrimeWest Health,MinnesotaCare,147.9168,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
ALBUTEROL SULFATE 90 MCG/ACTUATION INHL HFAA,,17736,LOCAL,Facility,Inpatient,18 g,g,,288,244.8,82.5408,288,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
ALBUTEROL SULFATE 90 MCG/ACTUATION INHL HFAA,,17736,LOCAL,Facility,Both,18 g,g,,288,244.8,82.5408,288,Sanford Health Plan,Sanford Health Plan,264.96,92,,percent of total billed charges,,
ALBUTEROL SULFATE 90 MCG/ACTUATION INHL HFAA,,17736,LOCAL,Facility,Outpatient,18 g,g,,288,244.8,82.5408,288,"UCare Health, Inc.",Individual & Family Plan,162.288,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
ALBUTEROL SULFATE 90 MCG/ACTUATION INHL HFAA,,17736,LOCAL,Facility,Inpatient,18 g,g,,288,244.8,82.5408,288,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
ALBUTEROL SULFATE 90 MCG/ACTUATION INHL HFAA,,17736,LOCAL,Facility,Outpatient,18 g,g,,288,244.8,82.5408,288,"UCare Health, Inc.",Medical Assistance,145.3536,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ALBUTEROL SULFATE 90 MCG/ACTUATION INHL HFAA,,17736,LOCAL,Facility,Inpatient,18 g,g,,288,244.8,82.5408,288,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
ALBUTEROL SULFATE 90 MCG/ACTUATION INHL HFAA,,17736,LOCAL,Facility,Outpatient,18 g,g,,288,244.8,82.5408,288,"UCare Health, Inc.",Medicare Advantage,145.3536,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ALBUTEROL SULFATE 90 MCG/ACTUATION INHL HFAA,,17736,LOCAL,Facility,Inpatient,18 g,g,,288,244.8,82.5408,288,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ALBUTEROL SULFATE 90 MCG/ACTUATION INHL HFAA,,17736,LOCAL,Facility,Outpatient,18 g,g,,288,244.8,82.5408,288,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),145.3536,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ALBUTEROL SULFATE 90 MCG/ACTUATION INHL HFAA,,17736,LOCAL,Facility,Inpatient,18 g,g,,288,244.8,82.5408,288,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ALBUTEROL SULFATE 90 MCG/ACTUATION INHL HFAA,,17736,LOCAL,Facility,Both,18 g,g,,288,244.8,82.5408,288,UnitedHealthcare,Individual & Family,270.72,94,,percent of total billed charges,,
ALBUTEROL SULFATE 90 MCG/ACTUATION INHL HFAA,,17736,LOCAL,Facility,Outpatient,18 g,g,,288,244.8,82.5408,288,UnitedHealthcare,Medicare Advantage,141.12,49,,percent of total billed charges,,
ALBUTEROL SULFATE 90 MCG/ACTUATION INHL HFAA,,17736,LOCAL,Facility,Inpatient,18 g,g,,288,244.8,82.5408,288,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
ALBUTEROL SULFATE 90 MCG/ACTUATION INHL HFAA,,17736,LOCAL,Facility,Outpatient,18 g,g,,288,244.8,82.5408,288,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,138.24,48,,percent of total billed charges,,100% of DHS outpatient percentage
ALBUTEROL SULFATE 90 MCG/ACTUATION INHL HFAA,,17736,LOCAL,Facility,Inpatient,18 g,g,,288,244.8,82.5408,288,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
ENALAPRILAT 1.25 MG/ML IV SOLN,,7468,LOCAL,Facility,Both,2 mL,mL,,55,46.75,15.763,55,Aetna,Commercial,50.6,92,,percent of total billed charges,,
ENALAPRILAT 1.25 MG/ML IV SOLN,,7468,LOCAL,Facility,Outpatient,2 mL,mL,,55,46.75,15.763,55,Aetna,Medicare Advantage,26.95,49,,percent of total billed charges,,
ENALAPRILAT 1.25 MG/ML IV SOLN,,7468,LOCAL,Facility,Inpatient,2 mL,mL,,55,46.75,15.763,55,Aetna,Medicare Advantage,,,,,Included in per diem rate,
ENALAPRILAT 1.25 MG/ML IV SOLN,,7468,LOCAL,Facility,Both,2 mL,mL,,55,46.75,15.763,55,Aetna,PPO,51.15,93,,percent of total billed charges,,
ENALAPRILAT 1.25 MG/ML IV SOLN,,7468,LOCAL,Facility,Both,2 mL,mL,,55,46.75,15.763,55,America's PPO,America's PPO,52.8165,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
ENALAPRILAT 1.25 MG/ML IV SOLN,,7468,LOCAL,Facility,Both,2 mL,mL,,55,46.75,15.763,55,BlueCross BlueShield Minnesota, Federal Employee Program,54.12,98.4,,percent of total billed charges,,
ENALAPRILAT 1.25 MG/ML IV SOLN,,7468,LOCAL,Facility,Both,2 mL,mL,,55,46.75,15.763,55,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,55,100,,percent of total billed charges,,
ENALAPRILAT 1.25 MG/ML IV SOLN,,7468,LOCAL,Facility,Both,2 mL,mL,,55,46.75,15.763,55,BlueCross BlueShield Minnesota,High Value Network Plan,49.5,90,,percent of total billed charges,,
ENALAPRILAT 1.25 MG/ML IV SOLN,,7468,LOCAL,Facility,Outpatient,2 mL,mL,,55,46.75,15.763,55,BlueCross BlueShield Minnesota,Medicare Advantage,26.95,49,,percent of total billed charges,,
ENALAPRILAT 1.25 MG/ML IV SOLN,,7468,LOCAL,Facility,Inpatient,2 mL,mL,,55,46.75,15.763,55,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
ENALAPRILAT 1.25 MG/ML IV SOLN,,7468,LOCAL,Facility,Both,2 mL,mL,,55,46.75,15.763,55,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,48.7135,88.57,,percent of total billed charges,,
ENALAPRILAT 1.25 MG/ML IV SOLN,,7468,LOCAL,Facility,Both,2 mL,mL,,55,46.75,15.763,55,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,15.763,28.66,,percent of total billed charges,,
ENALAPRILAT 1.25 MG/ML IV SOLN,,7468,LOCAL,Facility,Outpatient,2 mL,mL,,55,46.75,15.763,55,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),26.95,49,,percent of total billed charges,,
ENALAPRILAT 1.25 MG/ML IV SOLN,,7468,LOCAL,Facility,Inpatient,2 mL,mL,,55,46.75,15.763,55,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
ENALAPRILAT 1.25 MG/ML IV SOLN,,7468,LOCAL,Facility,Both,2 mL,mL,,55,46.75,15.763,55,CorVel,Worker's Compensation,55,100,,percent of total billed charges,,
ENALAPRILAT 1.25 MG/ML IV SOLN,,7468,LOCAL,Facility,Both,2 mL,mL,,55,46.75,15.763,55,First Health Group Corporation,First Health Network,53.35,97,,percent of total billed charges,,
ENALAPRILAT 1.25 MG/ML IV SOLN,,7468,LOCAL,Facility,Both,2 mL,mL,,55,46.75,15.763,55,"Health Partners, Inc.",Commercial,52.03,94.6,,percent of total billed charges,,
ENALAPRILAT 1.25 MG/ML IV SOLN,,7468,LOCAL,Facility,Outpatient,2 mL,mL,,55,46.75,15.763,55,"Health Partners, Inc.",Medicare Advantage,26.95,49,,percent of total billed charges,,
ENALAPRILAT 1.25 MG/ML IV SOLN,,7468,LOCAL,Facility,Inpatient,2 mL,mL,,55,46.75,15.763,55,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ENALAPRILAT 1.25 MG/ML IV SOLN,,7468,LOCAL,Facility,Both,2 mL,mL,,55,46.75,15.763,55,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),33,60,,percent of total billed charges,,
ENALAPRILAT 1.25 MG/ML IV SOLN,,7468,LOCAL,Facility,Both,2 mL,mL,,55,46.75,15.763,55,"Health Partners, Inc.",State of Minnesota Advantage Program,44.825,81.5,,percent of total billed charges,,
ENALAPRILAT 1.25 MG/ML IV SOLN,,7468,LOCAL,Facility,Both,2 mL,mL,,55,46.75,15.763,55,"Health Partners, Inc.",State Public Programs,27.5,50,,percent of total billed charges,,
ENALAPRILAT 1.25 MG/ML IV SOLN,,7468,LOCAL,Facility,Both,2 mL,mL,,55,46.75,15.763,55,Humana Insurance Company,Commercial PPO,52.25,95,,percent of total billed charges,,
ENALAPRILAT 1.25 MG/ML IV SOLN,,7468,LOCAL,Facility,Outpatient,2 mL,mL,,55,46.75,15.763,55,Humana Insurance Company,Medicare PPO,26.95,49,,percent of total billed charges,,
ENALAPRILAT 1.25 MG/ML IV SOLN,,7468,LOCAL,Facility,Inpatient,2 mL,mL,,55,46.75,15.763,55,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
ENALAPRILAT 1.25 MG/ML IV SOLN,,7468,LOCAL,Facility,Both,2 mL,mL,,55,46.75,15.763,55,Medica,Individual & Family,54.505,99.1,,percent of total billed charges,,
ENALAPRILAT 1.25 MG/ML IV SOLN,,7468,LOCAL,Facility,Outpatient,2 mL,mL,,55,46.75,15.763,55,Medica,Medica Advantage Solution,27.39,49.8,,percent of total billed charges,,
ENALAPRILAT 1.25 MG/ML IV SOLN,,7468,LOCAL,Facility,Inpatient,2 mL,mL,,55,46.75,15.763,55,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
ENALAPRILAT 1.25 MG/ML IV SOLN,,7468,LOCAL,Facility,Outpatient,2 mL,mL,,55,46.75,15.763,55,Medica,Medical Assistance,24.53,44.6,,percent of total billed charges,,
ENALAPRILAT 1.25 MG/ML IV SOLN,,7468,LOCAL,Facility,Inpatient,2 mL,mL,,55,46.75,15.763,55,Medica,Medical Assistance,,,,,Included in per diem rate,
ENALAPRILAT 1.25 MG/ML IV SOLN,,7468,LOCAL,Facility,Outpatient,2 mL,mL,,55,46.75,15.763,55,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,27.39,49.8,,percent of total billed charges,,
ENALAPRILAT 1.25 MG/ML IV SOLN,,7468,LOCAL,Facility,Inpatient,2 mL,mL,,55,46.75,15.763,55,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
ENALAPRILAT 1.25 MG/ML IV SOLN,,7468,LOCAL,Facility,Both,2 mL,mL,,55,46.75,15.763,55,"Multiplan, Inc.","Multiplan, Inc.",51.7,94,,percent of total billed charges,,
ENALAPRILAT 1.25 MG/ML IV SOLN,,7468,LOCAL,Facility,Outpatient,2 mL,mL,,55,46.75,15.763,55,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,49.555,90.1,,percent of total billed charges,,
ENALAPRILAT 1.25 MG/ML IV SOLN,,7468,LOCAL,Facility,Inpatient,2 mL,mL,,55,46.75,15.763,55,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
ENALAPRILAT 1.25 MG/ML IV SOLN,,7468,LOCAL,Facility,Both,2 mL,mL,,55,46.75,15.763,55,"Preferred One Administrative Services, INC.",PPO,54.23,98.6,,percent of total billed charges,,
ENALAPRILAT 1.25 MG/ML IV SOLN,,7468,LOCAL,Facility,Outpatient,2 mL,mL,,55,46.75,15.763,55,PrimeWest Health,Minnesota Senior Health Options (MSHO),28.2975,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
ENALAPRILAT 1.25 MG/ML IV SOLN,,7468,LOCAL,Facility,Inpatient,2 mL,mL,,55,46.75,15.763,55,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ENALAPRILAT 1.25 MG/ML IV SOLN,,7468,LOCAL,Facility,Outpatient,2 mL,mL,,55,46.75,15.763,55,PrimeWest Health,MinnesotaCare,28.248,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
ENALAPRILAT 1.25 MG/ML IV SOLN,,7468,LOCAL,Facility,Inpatient,2 mL,mL,,55,46.75,15.763,55,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
ENALAPRILAT 1.25 MG/ML IV SOLN,,7468,LOCAL,Facility,Both,2 mL,mL,,55,46.75,15.763,55,Sanford Health Plan,Sanford Health Plan,50.6,92,,percent of total billed charges,,
ENALAPRILAT 1.25 MG/ML IV SOLN,,7468,LOCAL,Facility,Outpatient,2 mL,mL,,55,46.75,15.763,55,"UCare Health, Inc.",Individual & Family Plan,30.9925,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
ENALAPRILAT 1.25 MG/ML IV SOLN,,7468,LOCAL,Facility,Inpatient,2 mL,mL,,55,46.75,15.763,55,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
ENALAPRILAT 1.25 MG/ML IV SOLN,,7468,LOCAL,Facility,Outpatient,2 mL,mL,,55,46.75,15.763,55,"UCare Health, Inc.",Medical Assistance,27.7585,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ENALAPRILAT 1.25 MG/ML IV SOLN,,7468,LOCAL,Facility,Inpatient,2 mL,mL,,55,46.75,15.763,55,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
ENALAPRILAT 1.25 MG/ML IV SOLN,,7468,LOCAL,Facility,Outpatient,2 mL,mL,,55,46.75,15.763,55,"UCare Health, Inc.",Medicare Advantage,27.7585,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ENALAPRILAT 1.25 MG/ML IV SOLN,,7468,LOCAL,Facility,Inpatient,2 mL,mL,,55,46.75,15.763,55,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ENALAPRILAT 1.25 MG/ML IV SOLN,,7468,LOCAL,Facility,Outpatient,2 mL,mL,,55,46.75,15.763,55,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),27.7585,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ENALAPRILAT 1.25 MG/ML IV SOLN,,7468,LOCAL,Facility,Inpatient,2 mL,mL,,55,46.75,15.763,55,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ENALAPRILAT 1.25 MG/ML IV SOLN,,7468,LOCAL,Facility,Both,2 mL,mL,,55,46.75,15.763,55,UnitedHealthcare,Individual & Family,51.7,94,,percent of total billed charges,,
ENALAPRILAT 1.25 MG/ML IV SOLN,,7468,LOCAL,Facility,Outpatient,2 mL,mL,,55,46.75,15.763,55,UnitedHealthcare,Medicare Advantage,26.95,49,,percent of total billed charges,,
ENALAPRILAT 1.25 MG/ML IV SOLN,,7468,LOCAL,Facility,Inpatient,2 mL,mL,,55,46.75,15.763,55,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
ENALAPRILAT 1.25 MG/ML IV SOLN,,7468,LOCAL,Facility,Outpatient,2 mL,mL,,55,46.75,15.763,55,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,26.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
ENALAPRILAT 1.25 MG/ML IV SOLN,,7468,LOCAL,Facility,Inpatient,2 mL,mL,,55,46.75,15.763,55,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
PHYSOSTIGMINE SALICYLATE 1 MG/ML INJ SOLN,,8037,LOCAL,Facility,Both,2 mL,mL,,395,335.75,113.207,395,Aetna,Commercial,363.4,92,,percent of total billed charges,,
PHYSOSTIGMINE SALICYLATE 1 MG/ML INJ SOLN,,8037,LOCAL,Facility,Outpatient,2 mL,mL,,395,335.75,113.207,395,Aetna,Medicare Advantage,193.55,49,,percent of total billed charges,,
PHYSOSTIGMINE SALICYLATE 1 MG/ML INJ SOLN,,8037,LOCAL,Facility,Inpatient,2 mL,mL,,395,335.75,113.207,395,Aetna,Medicare Advantage,,,,,Included in per diem rate,
PHYSOSTIGMINE SALICYLATE 1 MG/ML INJ SOLN,,8037,LOCAL,Facility,Both,2 mL,mL,,395,335.75,113.207,395,Aetna,PPO,367.35,93,,percent of total billed charges,,
PHYSOSTIGMINE SALICYLATE 1 MG/ML INJ SOLN,,8037,LOCAL,Facility,Both,2 mL,mL,,395,335.75,113.207,395,America's PPO,America's PPO,379.3185,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
PHYSOSTIGMINE SALICYLATE 1 MG/ML INJ SOLN,,8037,LOCAL,Facility,Both,2 mL,mL,,395,335.75,113.207,395,BlueCross BlueShield Minnesota, Federal Employee Program,388.68,98.4,,percent of total billed charges,,
PHYSOSTIGMINE SALICYLATE 1 MG/ML INJ SOLN,,8037,LOCAL,Facility,Both,2 mL,mL,,395,335.75,113.207,395,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,395,100,,percent of total billed charges,,
PHYSOSTIGMINE SALICYLATE 1 MG/ML INJ SOLN,,8037,LOCAL,Facility,Both,2 mL,mL,,395,335.75,113.207,395,BlueCross BlueShield Minnesota,High Value Network Plan,355.5,90,,percent of total billed charges,,
PHYSOSTIGMINE SALICYLATE 1 MG/ML INJ SOLN,,8037,LOCAL,Facility,Outpatient,2 mL,mL,,395,335.75,113.207,395,BlueCross BlueShield Minnesota,Medicare Advantage,193.55,49,,percent of total billed charges,,
PHYSOSTIGMINE SALICYLATE 1 MG/ML INJ SOLN,,8037,LOCAL,Facility,Inpatient,2 mL,mL,,395,335.75,113.207,395,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
PHYSOSTIGMINE SALICYLATE 1 MG/ML INJ SOLN,,8037,LOCAL,Facility,Both,2 mL,mL,,395,335.75,113.207,395,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,349.8515,88.57,,percent of total billed charges,,
PHYSOSTIGMINE SALICYLATE 1 MG/ML INJ SOLN,,8037,LOCAL,Facility,Both,2 mL,mL,,395,335.75,113.207,395,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,113.207,28.66,,percent of total billed charges,,
PHYSOSTIGMINE SALICYLATE 1 MG/ML INJ SOLN,,8037,LOCAL,Facility,Outpatient,2 mL,mL,,395,335.75,113.207,395,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),193.55,49,,percent of total billed charges,,
PHYSOSTIGMINE SALICYLATE 1 MG/ML INJ SOLN,,8037,LOCAL,Facility,Inpatient,2 mL,mL,,395,335.75,113.207,395,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
PHYSOSTIGMINE SALICYLATE 1 MG/ML INJ SOLN,,8037,LOCAL,Facility,Both,2 mL,mL,,395,335.75,113.207,395,CorVel,Worker's Compensation,395,100,,percent of total billed charges,,
PHYSOSTIGMINE SALICYLATE 1 MG/ML INJ SOLN,,8037,LOCAL,Facility,Both,2 mL,mL,,395,335.75,113.207,395,First Health Group Corporation,First Health Network,383.15,97,,percent of total billed charges,,
PHYSOSTIGMINE SALICYLATE 1 MG/ML INJ SOLN,,8037,LOCAL,Facility,Both,2 mL,mL,,395,335.75,113.207,395,"Health Partners, Inc.",Commercial,373.67,94.6,,percent of total billed charges,,
PHYSOSTIGMINE SALICYLATE 1 MG/ML INJ SOLN,,8037,LOCAL,Facility,Outpatient,2 mL,mL,,395,335.75,113.207,395,"Health Partners, Inc.",Medicare Advantage,193.55,49,,percent of total billed charges,,
PHYSOSTIGMINE SALICYLATE 1 MG/ML INJ SOLN,,8037,LOCAL,Facility,Inpatient,2 mL,mL,,395,335.75,113.207,395,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PHYSOSTIGMINE SALICYLATE 1 MG/ML INJ SOLN,,8037,LOCAL,Facility,Both,2 mL,mL,,395,335.75,113.207,395,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),237,60,,percent of total billed charges,,
PHYSOSTIGMINE SALICYLATE 1 MG/ML INJ SOLN,,8037,LOCAL,Facility,Both,2 mL,mL,,395,335.75,113.207,395,"Health Partners, Inc.",State of Minnesota Advantage Program,321.925,81.5,,percent of total billed charges,,
PHYSOSTIGMINE SALICYLATE 1 MG/ML INJ SOLN,,8037,LOCAL,Facility,Both,2 mL,mL,,395,335.75,113.207,395,"Health Partners, Inc.",State Public Programs,197.5,50,,percent of total billed charges,,
PHYSOSTIGMINE SALICYLATE 1 MG/ML INJ SOLN,,8037,LOCAL,Facility,Both,2 mL,mL,,395,335.75,113.207,395,Humana Insurance Company,Commercial PPO,375.25,95,,percent of total billed charges,,
PHYSOSTIGMINE SALICYLATE 1 MG/ML INJ SOLN,,8037,LOCAL,Facility,Outpatient,2 mL,mL,,395,335.75,113.207,395,Humana Insurance Company,Medicare PPO,193.55,49,,percent of total billed charges,,
PHYSOSTIGMINE SALICYLATE 1 MG/ML INJ SOLN,,8037,LOCAL,Facility,Inpatient,2 mL,mL,,395,335.75,113.207,395,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
PHYSOSTIGMINE SALICYLATE 1 MG/ML INJ SOLN,,8037,LOCAL,Facility,Both,2 mL,mL,,395,335.75,113.207,395,Medica,Individual & Family,391.445,99.1,,percent of total billed charges,,
PHYSOSTIGMINE SALICYLATE 1 MG/ML INJ SOLN,,8037,LOCAL,Facility,Outpatient,2 mL,mL,,395,335.75,113.207,395,Medica,Medica Advantage Solution,196.71,49.8,,percent of total billed charges,,
PHYSOSTIGMINE SALICYLATE 1 MG/ML INJ SOLN,,8037,LOCAL,Facility,Inpatient,2 mL,mL,,395,335.75,113.207,395,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
PHYSOSTIGMINE SALICYLATE 1 MG/ML INJ SOLN,,8037,LOCAL,Facility,Outpatient,2 mL,mL,,395,335.75,113.207,395,Medica,Medical Assistance,176.17,44.6,,percent of total billed charges,,
PHYSOSTIGMINE SALICYLATE 1 MG/ML INJ SOLN,,8037,LOCAL,Facility,Inpatient,2 mL,mL,,395,335.75,113.207,395,Medica,Medical Assistance,,,,,Included in per diem rate,
PHYSOSTIGMINE SALICYLATE 1 MG/ML INJ SOLN,,8037,LOCAL,Facility,Outpatient,2 mL,mL,,395,335.75,113.207,395,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,196.71,49.8,,percent of total billed charges,,
PHYSOSTIGMINE SALICYLATE 1 MG/ML INJ SOLN,,8037,LOCAL,Facility,Inpatient,2 mL,mL,,395,335.75,113.207,395,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
PHYSOSTIGMINE SALICYLATE 1 MG/ML INJ SOLN,,8037,LOCAL,Facility,Both,2 mL,mL,,395,335.75,113.207,395,"Multiplan, Inc.","Multiplan, Inc.",371.3,94,,percent of total billed charges,,
PHYSOSTIGMINE SALICYLATE 1 MG/ML INJ SOLN,,8037,LOCAL,Facility,Outpatient,2 mL,mL,,395,335.75,113.207,395,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,355.895,90.1,,percent of total billed charges,,
PHYSOSTIGMINE SALICYLATE 1 MG/ML INJ SOLN,,8037,LOCAL,Facility,Inpatient,2 mL,mL,,395,335.75,113.207,395,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
PHYSOSTIGMINE SALICYLATE 1 MG/ML INJ SOLN,,8037,LOCAL,Facility,Both,2 mL,mL,,395,335.75,113.207,395,"Preferred One Administrative Services, INC.",PPO,389.47,98.6,,percent of total billed charges,,
PHYSOSTIGMINE SALICYLATE 1 MG/ML INJ SOLN,,8037,LOCAL,Facility,Outpatient,2 mL,mL,,395,335.75,113.207,395,PrimeWest Health,Minnesota Senior Health Options (MSHO),203.2275,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
PHYSOSTIGMINE SALICYLATE 1 MG/ML INJ SOLN,,8037,LOCAL,Facility,Inpatient,2 mL,mL,,395,335.75,113.207,395,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PHYSOSTIGMINE SALICYLATE 1 MG/ML INJ SOLN,,8037,LOCAL,Facility,Outpatient,2 mL,mL,,395,335.75,113.207,395,PrimeWest Health,MinnesotaCare,202.872,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
PHYSOSTIGMINE SALICYLATE 1 MG/ML INJ SOLN,,8037,LOCAL,Facility,Inpatient,2 mL,mL,,395,335.75,113.207,395,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
PHYSOSTIGMINE SALICYLATE 1 MG/ML INJ SOLN,,8037,LOCAL,Facility,Both,2 mL,mL,,395,335.75,113.207,395,Sanford Health Plan,Sanford Health Plan,363.4,92,,percent of total billed charges,,
PHYSOSTIGMINE SALICYLATE 1 MG/ML INJ SOLN,,8037,LOCAL,Facility,Outpatient,2 mL,mL,,395,335.75,113.207,395,"UCare Health, Inc.",Individual & Family Plan,222.5825,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
PHYSOSTIGMINE SALICYLATE 1 MG/ML INJ SOLN,,8037,LOCAL,Facility,Inpatient,2 mL,mL,,395,335.75,113.207,395,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
PHYSOSTIGMINE SALICYLATE 1 MG/ML INJ SOLN,,8037,LOCAL,Facility,Outpatient,2 mL,mL,,395,335.75,113.207,395,"UCare Health, Inc.",Medical Assistance,199.3565,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PHYSOSTIGMINE SALICYLATE 1 MG/ML INJ SOLN,,8037,LOCAL,Facility,Inpatient,2 mL,mL,,395,335.75,113.207,395,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
PHYSOSTIGMINE SALICYLATE 1 MG/ML INJ SOLN,,8037,LOCAL,Facility,Outpatient,2 mL,mL,,395,335.75,113.207,395,"UCare Health, Inc.",Medicare Advantage,199.3565,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PHYSOSTIGMINE SALICYLATE 1 MG/ML INJ SOLN,,8037,LOCAL,Facility,Inpatient,2 mL,mL,,395,335.75,113.207,395,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PHYSOSTIGMINE SALICYLATE 1 MG/ML INJ SOLN,,8037,LOCAL,Facility,Outpatient,2 mL,mL,,395,335.75,113.207,395,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),199.3565,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PHYSOSTIGMINE SALICYLATE 1 MG/ML INJ SOLN,,8037,LOCAL,Facility,Inpatient,2 mL,mL,,395,335.75,113.207,395,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PHYSOSTIGMINE SALICYLATE 1 MG/ML INJ SOLN,,8037,LOCAL,Facility,Both,2 mL,mL,,395,335.75,113.207,395,UnitedHealthcare,Individual & Family,371.3,94,,percent of total billed charges,,
PHYSOSTIGMINE SALICYLATE 1 MG/ML INJ SOLN,,8037,LOCAL,Facility,Outpatient,2 mL,mL,,395,335.75,113.207,395,UnitedHealthcare,Medicare Advantage,193.55,49,,percent of total billed charges,,
PHYSOSTIGMINE SALICYLATE 1 MG/ML INJ SOLN,,8037,LOCAL,Facility,Inpatient,2 mL,mL,,395,335.75,113.207,395,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
PHYSOSTIGMINE SALICYLATE 1 MG/ML INJ SOLN,,8037,LOCAL,Facility,Outpatient,2 mL,mL,,395,335.75,113.207,395,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,189.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
PHYSOSTIGMINE SALICYLATE 1 MG/ML INJ SOLN,,8037,LOCAL,Facility,Inpatient,2 mL,mL,,395,335.75,113.207,395,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
CYCLOPENTOLATE 1 % OPHT DROP,,8940,LOCAL,Facility,Both,2 mL,mL,,71,60.35,20.3486,71,Aetna,Commercial,65.32,92,,percent of total billed charges,,
CYCLOPENTOLATE 1 % OPHT DROP,,8940,LOCAL,Facility,Outpatient,2 mL,mL,,71,60.35,20.3486,71,Aetna,Medicare Advantage,34.79,49,,percent of total billed charges,,
CYCLOPENTOLATE 1 % OPHT DROP,,8940,LOCAL,Facility,Inpatient,2 mL,mL,,71,60.35,20.3486,71,Aetna,Medicare Advantage,,,,,Included in per diem rate,
CYCLOPENTOLATE 1 % OPHT DROP,,8940,LOCAL,Facility,Both,2 mL,mL,,71,60.35,20.3486,71,Aetna,PPO,66.03,93,,percent of total billed charges,,
CYCLOPENTOLATE 1 % OPHT DROP,,8940,LOCAL,Facility,Both,2 mL,mL,,71,60.35,20.3486,71,America's PPO,America's PPO,68.1813,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
CYCLOPENTOLATE 1 % OPHT DROP,,8940,LOCAL,Facility,Both,2 mL,mL,,71,60.35,20.3486,71,BlueCross BlueShield Minnesota, Federal Employee Program,69.864,98.4,,percent of total billed charges,,
CYCLOPENTOLATE 1 % OPHT DROP,,8940,LOCAL,Facility,Both,2 mL,mL,,71,60.35,20.3486,71,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,71,100,,percent of total billed charges,,
CYCLOPENTOLATE 1 % OPHT DROP,,8940,LOCAL,Facility,Both,2 mL,mL,,71,60.35,20.3486,71,BlueCross BlueShield Minnesota,High Value Network Plan,63.9,90,,percent of total billed charges,,
CYCLOPENTOLATE 1 % OPHT DROP,,8940,LOCAL,Facility,Outpatient,2 mL,mL,,71,60.35,20.3486,71,BlueCross BlueShield Minnesota,Medicare Advantage,34.79,49,,percent of total billed charges,,
CYCLOPENTOLATE 1 % OPHT DROP,,8940,LOCAL,Facility,Inpatient,2 mL,mL,,71,60.35,20.3486,71,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
CYCLOPENTOLATE 1 % OPHT DROP,,8940,LOCAL,Facility,Both,2 mL,mL,,71,60.35,20.3486,71,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,62.8847,88.57,,percent of total billed charges,,
CYCLOPENTOLATE 1 % OPHT DROP,,8940,LOCAL,Facility,Both,2 mL,mL,,71,60.35,20.3486,71,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,20.3486,28.66,,percent of total billed charges,,
CYCLOPENTOLATE 1 % OPHT DROP,,8940,LOCAL,Facility,Outpatient,2 mL,mL,,71,60.35,20.3486,71,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),34.79,49,,percent of total billed charges,,
CYCLOPENTOLATE 1 % OPHT DROP,,8940,LOCAL,Facility,Inpatient,2 mL,mL,,71,60.35,20.3486,71,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
CYCLOPENTOLATE 1 % OPHT DROP,,8940,LOCAL,Facility,Both,2 mL,mL,,71,60.35,20.3486,71,CorVel,Worker's Compensation,71,100,,percent of total billed charges,,
CYCLOPENTOLATE 1 % OPHT DROP,,8940,LOCAL,Facility,Both,2 mL,mL,,71,60.35,20.3486,71,First Health Group Corporation,First Health Network,68.87,97,,percent of total billed charges,,
CYCLOPENTOLATE 1 % OPHT DROP,,8940,LOCAL,Facility,Both,2 mL,mL,,71,60.35,20.3486,71,"Health Partners, Inc.",Commercial,67.166,94.6,,percent of total billed charges,,
CYCLOPENTOLATE 1 % OPHT DROP,,8940,LOCAL,Facility,Outpatient,2 mL,mL,,71,60.35,20.3486,71,"Health Partners, Inc.",Medicare Advantage,34.79,49,,percent of total billed charges,,
CYCLOPENTOLATE 1 % OPHT DROP,,8940,LOCAL,Facility,Inpatient,2 mL,mL,,71,60.35,20.3486,71,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CYCLOPENTOLATE 1 % OPHT DROP,,8940,LOCAL,Facility,Both,2 mL,mL,,71,60.35,20.3486,71,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),42.6,60,,percent of total billed charges,,
CYCLOPENTOLATE 1 % OPHT DROP,,8940,LOCAL,Facility,Both,2 mL,mL,,71,60.35,20.3486,71,"Health Partners, Inc.",State of Minnesota Advantage Program,57.865,81.5,,percent of total billed charges,,
CYCLOPENTOLATE 1 % OPHT DROP,,8940,LOCAL,Facility,Both,2 mL,mL,,71,60.35,20.3486,71,"Health Partners, Inc.",State Public Programs,35.5,50,,percent of total billed charges,,
CYCLOPENTOLATE 1 % OPHT DROP,,8940,LOCAL,Facility,Both,2 mL,mL,,71,60.35,20.3486,71,Humana Insurance Company,Commercial PPO,67.45,95,,percent of total billed charges,,
CYCLOPENTOLATE 1 % OPHT DROP,,8940,LOCAL,Facility,Outpatient,2 mL,mL,,71,60.35,20.3486,71,Humana Insurance Company,Medicare PPO,34.79,49,,percent of total billed charges,,
CYCLOPENTOLATE 1 % OPHT DROP,,8940,LOCAL,Facility,Inpatient,2 mL,mL,,71,60.35,20.3486,71,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
CYCLOPENTOLATE 1 % OPHT DROP,,8940,LOCAL,Facility,Both,2 mL,mL,,71,60.35,20.3486,71,Medica,Individual & Family,70.361,99.1,,percent of total billed charges,,
CYCLOPENTOLATE 1 % OPHT DROP,,8940,LOCAL,Facility,Outpatient,2 mL,mL,,71,60.35,20.3486,71,Medica,Medica Advantage Solution,35.358,49.8,,percent of total billed charges,,
CYCLOPENTOLATE 1 % OPHT DROP,,8940,LOCAL,Facility,Inpatient,2 mL,mL,,71,60.35,20.3486,71,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
CYCLOPENTOLATE 1 % OPHT DROP,,8940,LOCAL,Facility,Outpatient,2 mL,mL,,71,60.35,20.3486,71,Medica,Medical Assistance,31.666,44.6,,percent of total billed charges,,
CYCLOPENTOLATE 1 % OPHT DROP,,8940,LOCAL,Facility,Inpatient,2 mL,mL,,71,60.35,20.3486,71,Medica,Medical Assistance,,,,,Included in per diem rate,
CYCLOPENTOLATE 1 % OPHT DROP,,8940,LOCAL,Facility,Outpatient,2 mL,mL,,71,60.35,20.3486,71,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,35.358,49.8,,percent of total billed charges,,
CYCLOPENTOLATE 1 % OPHT DROP,,8940,LOCAL,Facility,Inpatient,2 mL,mL,,71,60.35,20.3486,71,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
CYCLOPENTOLATE 1 % OPHT DROP,,8940,LOCAL,Facility,Both,2 mL,mL,,71,60.35,20.3486,71,"Multiplan, Inc.","Multiplan, Inc.",66.74,94,,percent of total billed charges,,
CYCLOPENTOLATE 1 % OPHT DROP,,8940,LOCAL,Facility,Outpatient,2 mL,mL,,71,60.35,20.3486,71,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,63.971,90.1,,percent of total billed charges,,
CYCLOPENTOLATE 1 % OPHT DROP,,8940,LOCAL,Facility,Inpatient,2 mL,mL,,71,60.35,20.3486,71,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
CYCLOPENTOLATE 1 % OPHT DROP,,8940,LOCAL,Facility,Both,2 mL,mL,,71,60.35,20.3486,71,"Preferred One Administrative Services, INC.",PPO,70.006,98.6,,percent of total billed charges,,
CYCLOPENTOLATE 1 % OPHT DROP,,8940,LOCAL,Facility,Outpatient,2 mL,mL,,71,60.35,20.3486,71,PrimeWest Health,Minnesota Senior Health Options (MSHO),36.5295,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
CYCLOPENTOLATE 1 % OPHT DROP,,8940,LOCAL,Facility,Inpatient,2 mL,mL,,71,60.35,20.3486,71,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CYCLOPENTOLATE 1 % OPHT DROP,,8940,LOCAL,Facility,Outpatient,2 mL,mL,,71,60.35,20.3486,71,PrimeWest Health,MinnesotaCare,36.4656,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
CYCLOPENTOLATE 1 % OPHT DROP,,8940,LOCAL,Facility,Inpatient,2 mL,mL,,71,60.35,20.3486,71,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
CYCLOPENTOLATE 1 % OPHT DROP,,8940,LOCAL,Facility,Both,2 mL,mL,,71,60.35,20.3486,71,Sanford Health Plan,Sanford Health Plan,65.32,92,,percent of total billed charges,,
CYCLOPENTOLATE 1 % OPHT DROP,,8940,LOCAL,Facility,Outpatient,2 mL,mL,,71,60.35,20.3486,71,"UCare Health, Inc.",Individual & Family Plan,40.0085,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
CYCLOPENTOLATE 1 % OPHT DROP,,8940,LOCAL,Facility,Inpatient,2 mL,mL,,71,60.35,20.3486,71,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
CYCLOPENTOLATE 1 % OPHT DROP,,8940,LOCAL,Facility,Outpatient,2 mL,mL,,71,60.35,20.3486,71,"UCare Health, Inc.",Medical Assistance,35.8337,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CYCLOPENTOLATE 1 % OPHT DROP,,8940,LOCAL,Facility,Inpatient,2 mL,mL,,71,60.35,20.3486,71,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
CYCLOPENTOLATE 1 % OPHT DROP,,8940,LOCAL,Facility,Outpatient,2 mL,mL,,71,60.35,20.3486,71,"UCare Health, Inc.",Medicare Advantage,35.8337,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CYCLOPENTOLATE 1 % OPHT DROP,,8940,LOCAL,Facility,Inpatient,2 mL,mL,,71,60.35,20.3486,71,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CYCLOPENTOLATE 1 % OPHT DROP,,8940,LOCAL,Facility,Outpatient,2 mL,mL,,71,60.35,20.3486,71,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),35.8337,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CYCLOPENTOLATE 1 % OPHT DROP,,8940,LOCAL,Facility,Inpatient,2 mL,mL,,71,60.35,20.3486,71,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CYCLOPENTOLATE 1 % OPHT DROP,,8940,LOCAL,Facility,Both,2 mL,mL,,71,60.35,20.3486,71,UnitedHealthcare,Individual & Family,66.74,94,,percent of total billed charges,,
CYCLOPENTOLATE 1 % OPHT DROP,,8940,LOCAL,Facility,Outpatient,2 mL,mL,,71,60.35,20.3486,71,UnitedHealthcare,Medicare Advantage,34.79,49,,percent of total billed charges,,
CYCLOPENTOLATE 1 % OPHT DROP,,8940,LOCAL,Facility,Inpatient,2 mL,mL,,71,60.35,20.3486,71,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
CYCLOPENTOLATE 1 % OPHT DROP,,8940,LOCAL,Facility,Outpatient,2 mL,mL,,71,60.35,20.3486,71,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,34.08,48,,percent of total billed charges,,100% of DHS outpatient percentage
CYCLOPENTOLATE 1 % OPHT DROP,,8940,LOCAL,Facility,Inpatient,2 mL,mL,,71,60.35,20.3486,71,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
CYCLOPENTOLATE 2 % OPHT DROP,,12966,LOCAL,Facility,Both,2 mL,mL,,133,113.05,38.1178,133,Aetna,Commercial,122.36,92,,percent of total billed charges,,
CYCLOPENTOLATE 2 % OPHT DROP,,12966,LOCAL,Facility,Outpatient,2 mL,mL,,133,113.05,38.1178,133,Aetna,Medicare Advantage,65.17,49,,percent of total billed charges,,
CYCLOPENTOLATE 2 % OPHT DROP,,12966,LOCAL,Facility,Inpatient,2 mL,mL,,133,113.05,38.1178,133,Aetna,Medicare Advantage,,,,,Included in per diem rate,
CYCLOPENTOLATE 2 % OPHT DROP,,12966,LOCAL,Facility,Both,2 mL,mL,,133,113.05,38.1178,133,Aetna,PPO,123.69,93,,percent of total billed charges,,
CYCLOPENTOLATE 2 % OPHT DROP,,12966,LOCAL,Facility,Both,2 mL,mL,,133,113.05,38.1178,133,America's PPO,America's PPO,127.7199,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
CYCLOPENTOLATE 2 % OPHT DROP,,12966,LOCAL,Facility,Both,2 mL,mL,,133,113.05,38.1178,133,BlueCross BlueShield Minnesota, Federal Employee Program,130.872,98.4,,percent of total billed charges,,
CYCLOPENTOLATE 2 % OPHT DROP,,12966,LOCAL,Facility,Both,2 mL,mL,,133,113.05,38.1178,133,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,133,100,,percent of total billed charges,,
CYCLOPENTOLATE 2 % OPHT DROP,,12966,LOCAL,Facility,Both,2 mL,mL,,133,113.05,38.1178,133,BlueCross BlueShield Minnesota,High Value Network Plan,119.7,90,,percent of total billed charges,,
CYCLOPENTOLATE 2 % OPHT DROP,,12966,LOCAL,Facility,Outpatient,2 mL,mL,,133,113.05,38.1178,133,BlueCross BlueShield Minnesota,Medicare Advantage,65.17,49,,percent of total billed charges,,
CYCLOPENTOLATE 2 % OPHT DROP,,12966,LOCAL,Facility,Inpatient,2 mL,mL,,133,113.05,38.1178,133,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
CYCLOPENTOLATE 2 % OPHT DROP,,12966,LOCAL,Facility,Both,2 mL,mL,,133,113.05,38.1178,133,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,117.7981,88.57,,percent of total billed charges,,
CYCLOPENTOLATE 2 % OPHT DROP,,12966,LOCAL,Facility,Both,2 mL,mL,,133,113.05,38.1178,133,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,38.1178,28.66,,percent of total billed charges,,
CYCLOPENTOLATE 2 % OPHT DROP,,12966,LOCAL,Facility,Outpatient,2 mL,mL,,133,113.05,38.1178,133,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),65.17,49,,percent of total billed charges,,
CYCLOPENTOLATE 2 % OPHT DROP,,12966,LOCAL,Facility,Inpatient,2 mL,mL,,133,113.05,38.1178,133,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
CYCLOPENTOLATE 2 % OPHT DROP,,12966,LOCAL,Facility,Both,2 mL,mL,,133,113.05,38.1178,133,CorVel,Worker's Compensation,133,100,,percent of total billed charges,,
CYCLOPENTOLATE 2 % OPHT DROP,,12966,LOCAL,Facility,Both,2 mL,mL,,133,113.05,38.1178,133,First Health Group Corporation,First Health Network,129.01,97,,percent of total billed charges,,
CYCLOPENTOLATE 2 % OPHT DROP,,12966,LOCAL,Facility,Both,2 mL,mL,,133,113.05,38.1178,133,"Health Partners, Inc.",Commercial,125.818,94.6,,percent of total billed charges,,
CYCLOPENTOLATE 2 % OPHT DROP,,12966,LOCAL,Facility,Outpatient,2 mL,mL,,133,113.05,38.1178,133,"Health Partners, Inc.",Medicare Advantage,65.17,49,,percent of total billed charges,,
CYCLOPENTOLATE 2 % OPHT DROP,,12966,LOCAL,Facility,Inpatient,2 mL,mL,,133,113.05,38.1178,133,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CYCLOPENTOLATE 2 % OPHT DROP,,12966,LOCAL,Facility,Both,2 mL,mL,,133,113.05,38.1178,133,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),79.8,60,,percent of total billed charges,,
CYCLOPENTOLATE 2 % OPHT DROP,,12966,LOCAL,Facility,Both,2 mL,mL,,133,113.05,38.1178,133,"Health Partners, Inc.",State of Minnesota Advantage Program,108.395,81.5,,percent of total billed charges,,
CYCLOPENTOLATE 2 % OPHT DROP,,12966,LOCAL,Facility,Both,2 mL,mL,,133,113.05,38.1178,133,"Health Partners, Inc.",State Public Programs,66.5,50,,percent of total billed charges,,
CYCLOPENTOLATE 2 % OPHT DROP,,12966,LOCAL,Facility,Both,2 mL,mL,,133,113.05,38.1178,133,Humana Insurance Company,Commercial PPO,126.35,95,,percent of total billed charges,,
CYCLOPENTOLATE 2 % OPHT DROP,,12966,LOCAL,Facility,Outpatient,2 mL,mL,,133,113.05,38.1178,133,Humana Insurance Company,Medicare PPO,65.17,49,,percent of total billed charges,,
CYCLOPENTOLATE 2 % OPHT DROP,,12966,LOCAL,Facility,Inpatient,2 mL,mL,,133,113.05,38.1178,133,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
CYCLOPENTOLATE 2 % OPHT DROP,,12966,LOCAL,Facility,Both,2 mL,mL,,133,113.05,38.1178,133,Medica,Individual & Family,131.803,99.1,,percent of total billed charges,,
CYCLOPENTOLATE 2 % OPHT DROP,,12966,LOCAL,Facility,Outpatient,2 mL,mL,,133,113.05,38.1178,133,Medica,Medica Advantage Solution,66.234,49.8,,percent of total billed charges,,
CYCLOPENTOLATE 2 % OPHT DROP,,12966,LOCAL,Facility,Inpatient,2 mL,mL,,133,113.05,38.1178,133,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
CYCLOPENTOLATE 2 % OPHT DROP,,12966,LOCAL,Facility,Outpatient,2 mL,mL,,133,113.05,38.1178,133,Medica,Medical Assistance,59.318,44.6,,percent of total billed charges,,
CYCLOPENTOLATE 2 % OPHT DROP,,12966,LOCAL,Facility,Inpatient,2 mL,mL,,133,113.05,38.1178,133,Medica,Medical Assistance,,,,,Included in per diem rate,
CYCLOPENTOLATE 2 % OPHT DROP,,12966,LOCAL,Facility,Outpatient,2 mL,mL,,133,113.05,38.1178,133,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,66.234,49.8,,percent of total billed charges,,
CYCLOPENTOLATE 2 % OPHT DROP,,12966,LOCAL,Facility,Inpatient,2 mL,mL,,133,113.05,38.1178,133,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
CYCLOPENTOLATE 2 % OPHT DROP,,12966,LOCAL,Facility,Both,2 mL,mL,,133,113.05,38.1178,133,"Multiplan, Inc.","Multiplan, Inc.",125.02,94,,percent of total billed charges,,
CYCLOPENTOLATE 2 % OPHT DROP,,12966,LOCAL,Facility,Outpatient,2 mL,mL,,133,113.05,38.1178,133,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,119.833,90.1,,percent of total billed charges,,
CYCLOPENTOLATE 2 % OPHT DROP,,12966,LOCAL,Facility,Inpatient,2 mL,mL,,133,113.05,38.1178,133,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
CYCLOPENTOLATE 2 % OPHT DROP,,12966,LOCAL,Facility,Both,2 mL,mL,,133,113.05,38.1178,133,"Preferred One Administrative Services, INC.",PPO,131.138,98.6,,percent of total billed charges,,
CYCLOPENTOLATE 2 % OPHT DROP,,12966,LOCAL,Facility,Outpatient,2 mL,mL,,133,113.05,38.1178,133,PrimeWest Health,Minnesota Senior Health Options (MSHO),68.4285,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
CYCLOPENTOLATE 2 % OPHT DROP,,12966,LOCAL,Facility,Inpatient,2 mL,mL,,133,113.05,38.1178,133,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CYCLOPENTOLATE 2 % OPHT DROP,,12966,LOCAL,Facility,Outpatient,2 mL,mL,,133,113.05,38.1178,133,PrimeWest Health,MinnesotaCare,68.3088,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
CYCLOPENTOLATE 2 % OPHT DROP,,12966,LOCAL,Facility,Inpatient,2 mL,mL,,133,113.05,38.1178,133,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
CYCLOPENTOLATE 2 % OPHT DROP,,12966,LOCAL,Facility,Both,2 mL,mL,,133,113.05,38.1178,133,Sanford Health Plan,Sanford Health Plan,122.36,92,,percent of total billed charges,,
CYCLOPENTOLATE 2 % OPHT DROP,,12966,LOCAL,Facility,Outpatient,2 mL,mL,,133,113.05,38.1178,133,"UCare Health, Inc.",Individual & Family Plan,74.9455,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
CYCLOPENTOLATE 2 % OPHT DROP,,12966,LOCAL,Facility,Inpatient,2 mL,mL,,133,113.05,38.1178,133,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
CYCLOPENTOLATE 2 % OPHT DROP,,12966,LOCAL,Facility,Outpatient,2 mL,mL,,133,113.05,38.1178,133,"UCare Health, Inc.",Medical Assistance,67.1251,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CYCLOPENTOLATE 2 % OPHT DROP,,12966,LOCAL,Facility,Inpatient,2 mL,mL,,133,113.05,38.1178,133,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
CYCLOPENTOLATE 2 % OPHT DROP,,12966,LOCAL,Facility,Outpatient,2 mL,mL,,133,113.05,38.1178,133,"UCare Health, Inc.",Medicare Advantage,67.1251,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CYCLOPENTOLATE 2 % OPHT DROP,,12966,LOCAL,Facility,Inpatient,2 mL,mL,,133,113.05,38.1178,133,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CYCLOPENTOLATE 2 % OPHT DROP,,12966,LOCAL,Facility,Outpatient,2 mL,mL,,133,113.05,38.1178,133,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),67.1251,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CYCLOPENTOLATE 2 % OPHT DROP,,12966,LOCAL,Facility,Inpatient,2 mL,mL,,133,113.05,38.1178,133,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CYCLOPENTOLATE 2 % OPHT DROP,,12966,LOCAL,Facility,Both,2 mL,mL,,133,113.05,38.1178,133,UnitedHealthcare,Individual & Family,125.02,94,,percent of total billed charges,,
CYCLOPENTOLATE 2 % OPHT DROP,,12966,LOCAL,Facility,Outpatient,2 mL,mL,,133,113.05,38.1178,133,UnitedHealthcare,Medicare Advantage,65.17,49,,percent of total billed charges,,
CYCLOPENTOLATE 2 % OPHT DROP,,12966,LOCAL,Facility,Inpatient,2 mL,mL,,133,113.05,38.1178,133,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
CYCLOPENTOLATE 2 % OPHT DROP,,12966,LOCAL,Facility,Outpatient,2 mL,mL,,133,113.05,38.1178,133,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,63.84,48,,percent of total billed charges,,100% of DHS outpatient percentage
CYCLOPENTOLATE 2 % OPHT DROP,,12966,LOCAL,Facility,Inpatient,2 mL,mL,,133,113.05,38.1178,133,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
BUDESONIDE 0.25 MG/2 ML INHL NBSP,,14951,LOCAL,Facility,Both,2 mL,mL,,48,40.8,13.7568,48,Aetna,Commercial,44.16,92,,percent of total billed charges,,
BUDESONIDE 0.25 MG/2 ML INHL NBSP,,14951,LOCAL,Facility,Outpatient,2 mL,mL,,48,40.8,13.7568,48,Aetna,Medicare Advantage,23.52,49,,percent of total billed charges,,
BUDESONIDE 0.25 MG/2 ML INHL NBSP,,14951,LOCAL,Facility,Inpatient,2 mL,mL,,48,40.8,13.7568,48,Aetna,Medicare Advantage,,,,,Included in per diem rate,
BUDESONIDE 0.25 MG/2 ML INHL NBSP,,14951,LOCAL,Facility,Both,2 mL,mL,,48,40.8,13.7568,48,Aetna,PPO,44.64,93,,percent of total billed charges,,
BUDESONIDE 0.25 MG/2 ML INHL NBSP,,14951,LOCAL,Facility,Both,2 mL,mL,,48,40.8,13.7568,48,America's PPO,America's PPO,46.0944,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
BUDESONIDE 0.25 MG/2 ML INHL NBSP,,14951,LOCAL,Facility,Both,2 mL,mL,,48,40.8,13.7568,48,BlueCross BlueShield Minnesota, Federal Employee Program,47.232,98.4,,percent of total billed charges,,
BUDESONIDE 0.25 MG/2 ML INHL NBSP,,14951,LOCAL,Facility,Both,2 mL,mL,,48,40.8,13.7568,48,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,48,100,,percent of total billed charges,,
BUDESONIDE 0.25 MG/2 ML INHL NBSP,,14951,LOCAL,Facility,Both,2 mL,mL,,48,40.8,13.7568,48,BlueCross BlueShield Minnesota,High Value Network Plan,43.2,90,,percent of total billed charges,,
BUDESONIDE 0.25 MG/2 ML INHL NBSP,,14951,LOCAL,Facility,Outpatient,2 mL,mL,,48,40.8,13.7568,48,BlueCross BlueShield Minnesota,Medicare Advantage,23.52,49,,percent of total billed charges,,
BUDESONIDE 0.25 MG/2 ML INHL NBSP,,14951,LOCAL,Facility,Inpatient,2 mL,mL,,48,40.8,13.7568,48,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
BUDESONIDE 0.25 MG/2 ML INHL NBSP,,14951,LOCAL,Facility,Both,2 mL,mL,,48,40.8,13.7568,48,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,42.5136,88.57,,percent of total billed charges,,
BUDESONIDE 0.25 MG/2 ML INHL NBSP,,14951,LOCAL,Facility,Both,2 mL,mL,,48,40.8,13.7568,48,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,13.7568,28.66,,percent of total billed charges,,
BUDESONIDE 0.25 MG/2 ML INHL NBSP,,14951,LOCAL,Facility,Outpatient,2 mL,mL,,48,40.8,13.7568,48,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),23.52,49,,percent of total billed charges,,
BUDESONIDE 0.25 MG/2 ML INHL NBSP,,14951,LOCAL,Facility,Inpatient,2 mL,mL,,48,40.8,13.7568,48,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
BUDESONIDE 0.25 MG/2 ML INHL NBSP,,14951,LOCAL,Facility,Both,2 mL,mL,,48,40.8,13.7568,48,CorVel,Worker's Compensation,48,100,,percent of total billed charges,,
BUDESONIDE 0.25 MG/2 ML INHL NBSP,,14951,LOCAL,Facility,Both,2 mL,mL,,48,40.8,13.7568,48,First Health Group Corporation,First Health Network,46.56,97,,percent of total billed charges,,
BUDESONIDE 0.25 MG/2 ML INHL NBSP,,14951,LOCAL,Facility,Both,2 mL,mL,,48,40.8,13.7568,48,"Health Partners, Inc.",Commercial,45.408,94.6,,percent of total billed charges,,
BUDESONIDE 0.25 MG/2 ML INHL NBSP,,14951,LOCAL,Facility,Outpatient,2 mL,mL,,48,40.8,13.7568,48,"Health Partners, Inc.",Medicare Advantage,23.52,49,,percent of total billed charges,,
BUDESONIDE 0.25 MG/2 ML INHL NBSP,,14951,LOCAL,Facility,Inpatient,2 mL,mL,,48,40.8,13.7568,48,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
BUDESONIDE 0.25 MG/2 ML INHL NBSP,,14951,LOCAL,Facility,Both,2 mL,mL,,48,40.8,13.7568,48,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),28.8,60,,percent of total billed charges,,
BUDESONIDE 0.25 MG/2 ML INHL NBSP,,14951,LOCAL,Facility,Both,2 mL,mL,,48,40.8,13.7568,48,"Health Partners, Inc.",State of Minnesota Advantage Program,39.12,81.5,,percent of total billed charges,,
BUDESONIDE 0.25 MG/2 ML INHL NBSP,,14951,LOCAL,Facility,Both,2 mL,mL,,48,40.8,13.7568,48,"Health Partners, Inc.",State Public Programs,24,50,,percent of total billed charges,,
BUDESONIDE 0.25 MG/2 ML INHL NBSP,,14951,LOCAL,Facility,Both,2 mL,mL,,48,40.8,13.7568,48,Humana Insurance Company,Commercial PPO,45.6,95,,percent of total billed charges,,
BUDESONIDE 0.25 MG/2 ML INHL NBSP,,14951,LOCAL,Facility,Outpatient,2 mL,mL,,48,40.8,13.7568,48,Humana Insurance Company,Medicare PPO,23.52,49,,percent of total billed charges,,
BUDESONIDE 0.25 MG/2 ML INHL NBSP,,14951,LOCAL,Facility,Inpatient,2 mL,mL,,48,40.8,13.7568,48,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
BUDESONIDE 0.25 MG/2 ML INHL NBSP,,14951,LOCAL,Facility,Both,2 mL,mL,,48,40.8,13.7568,48,Medica,Individual & Family,47.568,99.1,,percent of total billed charges,,
BUDESONIDE 0.25 MG/2 ML INHL NBSP,,14951,LOCAL,Facility,Outpatient,2 mL,mL,,48,40.8,13.7568,48,Medica,Medica Advantage Solution,23.904,49.8,,percent of total billed charges,,
BUDESONIDE 0.25 MG/2 ML INHL NBSP,,14951,LOCAL,Facility,Inpatient,2 mL,mL,,48,40.8,13.7568,48,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
BUDESONIDE 0.25 MG/2 ML INHL NBSP,,14951,LOCAL,Facility,Outpatient,2 mL,mL,,48,40.8,13.7568,48,Medica,Medical Assistance,21.408,44.6,,percent of total billed charges,,
BUDESONIDE 0.25 MG/2 ML INHL NBSP,,14951,LOCAL,Facility,Inpatient,2 mL,mL,,48,40.8,13.7568,48,Medica,Medical Assistance,,,,,Included in per diem rate,
BUDESONIDE 0.25 MG/2 ML INHL NBSP,,14951,LOCAL,Facility,Outpatient,2 mL,mL,,48,40.8,13.7568,48,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,23.904,49.8,,percent of total billed charges,,
BUDESONIDE 0.25 MG/2 ML INHL NBSP,,14951,LOCAL,Facility,Inpatient,2 mL,mL,,48,40.8,13.7568,48,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
BUDESONIDE 0.25 MG/2 ML INHL NBSP,,14951,LOCAL,Facility,Both,2 mL,mL,,48,40.8,13.7568,48,"Multiplan, Inc.","Multiplan, Inc.",45.12,94,,percent of total billed charges,,
BUDESONIDE 0.25 MG/2 ML INHL NBSP,,14951,LOCAL,Facility,Outpatient,2 mL,mL,,48,40.8,13.7568,48,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,43.248,90.1,,percent of total billed charges,,
BUDESONIDE 0.25 MG/2 ML INHL NBSP,,14951,LOCAL,Facility,Inpatient,2 mL,mL,,48,40.8,13.7568,48,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
BUDESONIDE 0.25 MG/2 ML INHL NBSP,,14951,LOCAL,Facility,Both,2 mL,mL,,48,40.8,13.7568,48,"Preferred One Administrative Services, INC.",PPO,47.328,98.6,,percent of total billed charges,,
BUDESONIDE 0.25 MG/2 ML INHL NBSP,,14951,LOCAL,Facility,Outpatient,2 mL,mL,,48,40.8,13.7568,48,PrimeWest Health,Minnesota Senior Health Options (MSHO),24.696,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
BUDESONIDE 0.25 MG/2 ML INHL NBSP,,14951,LOCAL,Facility,Inpatient,2 mL,mL,,48,40.8,13.7568,48,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
BUDESONIDE 0.25 MG/2 ML INHL NBSP,,14951,LOCAL,Facility,Outpatient,2 mL,mL,,48,40.8,13.7568,48,PrimeWest Health,MinnesotaCare,24.6528,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
BUDESONIDE 0.25 MG/2 ML INHL NBSP,,14951,LOCAL,Facility,Inpatient,2 mL,mL,,48,40.8,13.7568,48,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
BUDESONIDE 0.25 MG/2 ML INHL NBSP,,14951,LOCAL,Facility,Both,2 mL,mL,,48,40.8,13.7568,48,Sanford Health Plan,Sanford Health Plan,44.16,92,,percent of total billed charges,,
BUDESONIDE 0.25 MG/2 ML INHL NBSP,,14951,LOCAL,Facility,Outpatient,2 mL,mL,,48,40.8,13.7568,48,"UCare Health, Inc.",Individual & Family Plan,27.048,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
BUDESONIDE 0.25 MG/2 ML INHL NBSP,,14951,LOCAL,Facility,Inpatient,2 mL,mL,,48,40.8,13.7568,48,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
BUDESONIDE 0.25 MG/2 ML INHL NBSP,,14951,LOCAL,Facility,Outpatient,2 mL,mL,,48,40.8,13.7568,48,"UCare Health, Inc.",Medical Assistance,24.2256,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BUDESONIDE 0.25 MG/2 ML INHL NBSP,,14951,LOCAL,Facility,Inpatient,2 mL,mL,,48,40.8,13.7568,48,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
BUDESONIDE 0.25 MG/2 ML INHL NBSP,,14951,LOCAL,Facility,Outpatient,2 mL,mL,,48,40.8,13.7568,48,"UCare Health, Inc.",Medicare Advantage,24.2256,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BUDESONIDE 0.25 MG/2 ML INHL NBSP,,14951,LOCAL,Facility,Inpatient,2 mL,mL,,48,40.8,13.7568,48,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
BUDESONIDE 0.25 MG/2 ML INHL NBSP,,14951,LOCAL,Facility,Outpatient,2 mL,mL,,48,40.8,13.7568,48,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),24.2256,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BUDESONIDE 0.25 MG/2 ML INHL NBSP,,14951,LOCAL,Facility,Inpatient,2 mL,mL,,48,40.8,13.7568,48,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
BUDESONIDE 0.25 MG/2 ML INHL NBSP,,14951,LOCAL,Facility,Both,2 mL,mL,,48,40.8,13.7568,48,UnitedHealthcare,Individual & Family,45.12,94,,percent of total billed charges,,
BUDESONIDE 0.25 MG/2 ML INHL NBSP,,14951,LOCAL,Facility,Outpatient,2 mL,mL,,48,40.8,13.7568,48,UnitedHealthcare,Medicare Advantage,23.52,49,,percent of total billed charges,,
BUDESONIDE 0.25 MG/2 ML INHL NBSP,,14951,LOCAL,Facility,Inpatient,2 mL,mL,,48,40.8,13.7568,48,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
BUDESONIDE 0.25 MG/2 ML INHL NBSP,,14951,LOCAL,Facility,Outpatient,2 mL,mL,,48,40.8,13.7568,48,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,23.04,48,,percent of total billed charges,,100% of DHS outpatient percentage
BUDESONIDE 0.25 MG/2 ML INHL NBSP,,14951,LOCAL,Facility,Inpatient,2 mL,mL,,48,40.8,13.7568,48,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
BUDESONIDE 0.5 MG/2 ML INHL NBSP,,15130,LOCAL,Facility,Both,2 mL,mL,,54,45.9,15.4764,54,Aetna,Commercial,49.68,92,,percent of total billed charges,,
BUDESONIDE 0.5 MG/2 ML INHL NBSP,,15130,LOCAL,Facility,Outpatient,2 mL,mL,,54,45.9,15.4764,54,Aetna,Medicare Advantage,26.46,49,,percent of total billed charges,,
BUDESONIDE 0.5 MG/2 ML INHL NBSP,,15130,LOCAL,Facility,Inpatient,2 mL,mL,,54,45.9,15.4764,54,Aetna,Medicare Advantage,,,,,Included in per diem rate,
BUDESONIDE 0.5 MG/2 ML INHL NBSP,,15130,LOCAL,Facility,Both,2 mL,mL,,54,45.9,15.4764,54,Aetna,PPO,50.22,93,,percent of total billed charges,,
BUDESONIDE 0.5 MG/2 ML INHL NBSP,,15130,LOCAL,Facility,Both,2 mL,mL,,54,45.9,15.4764,54,America's PPO,America's PPO,51.8562,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
BUDESONIDE 0.5 MG/2 ML INHL NBSP,,15130,LOCAL,Facility,Both,2 mL,mL,,54,45.9,15.4764,54,BlueCross BlueShield Minnesota, Federal Employee Program,53.136,98.4,,percent of total billed charges,,
BUDESONIDE 0.5 MG/2 ML INHL NBSP,,15130,LOCAL,Facility,Both,2 mL,mL,,54,45.9,15.4764,54,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,54,100,,percent of total billed charges,,
BUDESONIDE 0.5 MG/2 ML INHL NBSP,,15130,LOCAL,Facility,Both,2 mL,mL,,54,45.9,15.4764,54,BlueCross BlueShield Minnesota,High Value Network Plan,48.6,90,,percent of total billed charges,,
BUDESONIDE 0.5 MG/2 ML INHL NBSP,,15130,LOCAL,Facility,Outpatient,2 mL,mL,,54,45.9,15.4764,54,BlueCross BlueShield Minnesota,Medicare Advantage,26.46,49,,percent of total billed charges,,
BUDESONIDE 0.5 MG/2 ML INHL NBSP,,15130,LOCAL,Facility,Inpatient,2 mL,mL,,54,45.9,15.4764,54,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
BUDESONIDE 0.5 MG/2 ML INHL NBSP,,15130,LOCAL,Facility,Both,2 mL,mL,,54,45.9,15.4764,54,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,47.8278,88.57,,percent of total billed charges,,
BUDESONIDE 0.5 MG/2 ML INHL NBSP,,15130,LOCAL,Facility,Both,2 mL,mL,,54,45.9,15.4764,54,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,15.4764,28.66,,percent of total billed charges,,
BUDESONIDE 0.5 MG/2 ML INHL NBSP,,15130,LOCAL,Facility,Outpatient,2 mL,mL,,54,45.9,15.4764,54,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),26.46,49,,percent of total billed charges,,
BUDESONIDE 0.5 MG/2 ML INHL NBSP,,15130,LOCAL,Facility,Inpatient,2 mL,mL,,54,45.9,15.4764,54,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
BUDESONIDE 0.5 MG/2 ML INHL NBSP,,15130,LOCAL,Facility,Both,2 mL,mL,,54,45.9,15.4764,54,CorVel,Worker's Compensation,54,100,,percent of total billed charges,,
BUDESONIDE 0.5 MG/2 ML INHL NBSP,,15130,LOCAL,Facility,Both,2 mL,mL,,54,45.9,15.4764,54,First Health Group Corporation,First Health Network,52.38,97,,percent of total billed charges,,
BUDESONIDE 0.5 MG/2 ML INHL NBSP,,15130,LOCAL,Facility,Both,2 mL,mL,,54,45.9,15.4764,54,"Health Partners, Inc.",Commercial,51.084,94.6,,percent of total billed charges,,
BUDESONIDE 0.5 MG/2 ML INHL NBSP,,15130,LOCAL,Facility,Outpatient,2 mL,mL,,54,45.9,15.4764,54,"Health Partners, Inc.",Medicare Advantage,26.46,49,,percent of total billed charges,,
BUDESONIDE 0.5 MG/2 ML INHL NBSP,,15130,LOCAL,Facility,Inpatient,2 mL,mL,,54,45.9,15.4764,54,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
BUDESONIDE 0.5 MG/2 ML INHL NBSP,,15130,LOCAL,Facility,Both,2 mL,mL,,54,45.9,15.4764,54,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),32.4,60,,percent of total billed charges,,
BUDESONIDE 0.5 MG/2 ML INHL NBSP,,15130,LOCAL,Facility,Both,2 mL,mL,,54,45.9,15.4764,54,"Health Partners, Inc.",State of Minnesota Advantage Program,44.01,81.5,,percent of total billed charges,,
BUDESONIDE 0.5 MG/2 ML INHL NBSP,,15130,LOCAL,Facility,Both,2 mL,mL,,54,45.9,15.4764,54,"Health Partners, Inc.",State Public Programs,27,50,,percent of total billed charges,,
BUDESONIDE 0.5 MG/2 ML INHL NBSP,,15130,LOCAL,Facility,Both,2 mL,mL,,54,45.9,15.4764,54,Humana Insurance Company,Commercial PPO,51.3,95,,percent of total billed charges,,
BUDESONIDE 0.5 MG/2 ML INHL NBSP,,15130,LOCAL,Facility,Outpatient,2 mL,mL,,54,45.9,15.4764,54,Humana Insurance Company,Medicare PPO,26.46,49,,percent of total billed charges,,
BUDESONIDE 0.5 MG/2 ML INHL NBSP,,15130,LOCAL,Facility,Inpatient,2 mL,mL,,54,45.9,15.4764,54,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
BUDESONIDE 0.5 MG/2 ML INHL NBSP,,15130,LOCAL,Facility,Both,2 mL,mL,,54,45.9,15.4764,54,Medica,Individual & Family,53.514,99.1,,percent of total billed charges,,
BUDESONIDE 0.5 MG/2 ML INHL NBSP,,15130,LOCAL,Facility,Outpatient,2 mL,mL,,54,45.9,15.4764,54,Medica,Medica Advantage Solution,26.892,49.8,,percent of total billed charges,,
BUDESONIDE 0.5 MG/2 ML INHL NBSP,,15130,LOCAL,Facility,Inpatient,2 mL,mL,,54,45.9,15.4764,54,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
BUDESONIDE 0.5 MG/2 ML INHL NBSP,,15130,LOCAL,Facility,Outpatient,2 mL,mL,,54,45.9,15.4764,54,Medica,Medical Assistance,24.084,44.6,,percent of total billed charges,,
BUDESONIDE 0.5 MG/2 ML INHL NBSP,,15130,LOCAL,Facility,Inpatient,2 mL,mL,,54,45.9,15.4764,54,Medica,Medical Assistance,,,,,Included in per diem rate,
BUDESONIDE 0.5 MG/2 ML INHL NBSP,,15130,LOCAL,Facility,Outpatient,2 mL,mL,,54,45.9,15.4764,54,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,26.892,49.8,,percent of total billed charges,,
BUDESONIDE 0.5 MG/2 ML INHL NBSP,,15130,LOCAL,Facility,Inpatient,2 mL,mL,,54,45.9,15.4764,54,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
BUDESONIDE 0.5 MG/2 ML INHL NBSP,,15130,LOCAL,Facility,Both,2 mL,mL,,54,45.9,15.4764,54,"Multiplan, Inc.","Multiplan, Inc.",50.76,94,,percent of total billed charges,,
BUDESONIDE 0.5 MG/2 ML INHL NBSP,,15130,LOCAL,Facility,Outpatient,2 mL,mL,,54,45.9,15.4764,54,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,48.654,90.1,,percent of total billed charges,,
BUDESONIDE 0.5 MG/2 ML INHL NBSP,,15130,LOCAL,Facility,Inpatient,2 mL,mL,,54,45.9,15.4764,54,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
BUDESONIDE 0.5 MG/2 ML INHL NBSP,,15130,LOCAL,Facility,Both,2 mL,mL,,54,45.9,15.4764,54,"Preferred One Administrative Services, INC.",PPO,53.244,98.6,,percent of total billed charges,,
BUDESONIDE 0.5 MG/2 ML INHL NBSP,,15130,LOCAL,Facility,Outpatient,2 mL,mL,,54,45.9,15.4764,54,PrimeWest Health,Minnesota Senior Health Options (MSHO),27.783,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
BUDESONIDE 0.5 MG/2 ML INHL NBSP,,15130,LOCAL,Facility,Inpatient,2 mL,mL,,54,45.9,15.4764,54,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
BUDESONIDE 0.5 MG/2 ML INHL NBSP,,15130,LOCAL,Facility,Outpatient,2 mL,mL,,54,45.9,15.4764,54,PrimeWest Health,MinnesotaCare,27.7344,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
BUDESONIDE 0.5 MG/2 ML INHL NBSP,,15130,LOCAL,Facility,Inpatient,2 mL,mL,,54,45.9,15.4764,54,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
BUDESONIDE 0.5 MG/2 ML INHL NBSP,,15130,LOCAL,Facility,Both,2 mL,mL,,54,45.9,15.4764,54,Sanford Health Plan,Sanford Health Plan,49.68,92,,percent of total billed charges,,
BUDESONIDE 0.5 MG/2 ML INHL NBSP,,15130,LOCAL,Facility,Outpatient,2 mL,mL,,54,45.9,15.4764,54,"UCare Health, Inc.",Individual & Family Plan,30.429,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
BUDESONIDE 0.5 MG/2 ML INHL NBSP,,15130,LOCAL,Facility,Inpatient,2 mL,mL,,54,45.9,15.4764,54,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
BUDESONIDE 0.5 MG/2 ML INHL NBSP,,15130,LOCAL,Facility,Outpatient,2 mL,mL,,54,45.9,15.4764,54,"UCare Health, Inc.",Medical Assistance,27.2538,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BUDESONIDE 0.5 MG/2 ML INHL NBSP,,15130,LOCAL,Facility,Inpatient,2 mL,mL,,54,45.9,15.4764,54,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
BUDESONIDE 0.5 MG/2 ML INHL NBSP,,15130,LOCAL,Facility,Outpatient,2 mL,mL,,54,45.9,15.4764,54,"UCare Health, Inc.",Medicare Advantage,27.2538,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BUDESONIDE 0.5 MG/2 ML INHL NBSP,,15130,LOCAL,Facility,Inpatient,2 mL,mL,,54,45.9,15.4764,54,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
BUDESONIDE 0.5 MG/2 ML INHL NBSP,,15130,LOCAL,Facility,Outpatient,2 mL,mL,,54,45.9,15.4764,54,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),27.2538,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BUDESONIDE 0.5 MG/2 ML INHL NBSP,,15130,LOCAL,Facility,Inpatient,2 mL,mL,,54,45.9,15.4764,54,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
BUDESONIDE 0.5 MG/2 ML INHL NBSP,,15130,LOCAL,Facility,Both,2 mL,mL,,54,45.9,15.4764,54,UnitedHealthcare,Individual & Family,50.76,94,,percent of total billed charges,,
BUDESONIDE 0.5 MG/2 ML INHL NBSP,,15130,LOCAL,Facility,Outpatient,2 mL,mL,,54,45.9,15.4764,54,UnitedHealthcare,Medicare Advantage,26.46,49,,percent of total billed charges,,
BUDESONIDE 0.5 MG/2 ML INHL NBSP,,15130,LOCAL,Facility,Inpatient,2 mL,mL,,54,45.9,15.4764,54,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
BUDESONIDE 0.5 MG/2 ML INHL NBSP,,15130,LOCAL,Facility,Outpatient,2 mL,mL,,54,45.9,15.4764,54,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,25.92,48,,percent of total billed charges,,100% of DHS outpatient percentage
BUDESONIDE 0.5 MG/2 ML INHL NBSP,,15130,LOCAL,Facility,Inpatient,2 mL,mL,,54,45.9,15.4764,54,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
VERAPAMIL 2.5 MG/ML IV SOLN,,15518,LOCAL,Facility,Both,2 mL,mL,,60,51,17.196,60,Aetna,Commercial,55.2,92,,percent of total billed charges,,
VERAPAMIL 2.5 MG/ML IV SOLN,,15518,LOCAL,Facility,Outpatient,2 mL,mL,,60,51,17.196,60,Aetna,Medicare Advantage,29.4,49,,percent of total billed charges,,
VERAPAMIL 2.5 MG/ML IV SOLN,,15518,LOCAL,Facility,Inpatient,2 mL,mL,,60,51,17.196,60,Aetna,Medicare Advantage,,,,,Included in per diem rate,
VERAPAMIL 2.5 MG/ML IV SOLN,,15518,LOCAL,Facility,Both,2 mL,mL,,60,51,17.196,60,Aetna,PPO,55.8,93,,percent of total billed charges,,
VERAPAMIL 2.5 MG/ML IV SOLN,,15518,LOCAL,Facility,Both,2 mL,mL,,60,51,17.196,60,America's PPO,America's PPO,57.618,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
VERAPAMIL 2.5 MG/ML IV SOLN,,15518,LOCAL,Facility,Both,2 mL,mL,,60,51,17.196,60,BlueCross BlueShield Minnesota, Federal Employee Program,59.04,98.4,,percent of total billed charges,,
VERAPAMIL 2.5 MG/ML IV SOLN,,15518,LOCAL,Facility,Both,2 mL,mL,,60,51,17.196,60,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,60,100,,percent of total billed charges,,
VERAPAMIL 2.5 MG/ML IV SOLN,,15518,LOCAL,Facility,Both,2 mL,mL,,60,51,17.196,60,BlueCross BlueShield Minnesota,High Value Network Plan,54,90,,percent of total billed charges,,
VERAPAMIL 2.5 MG/ML IV SOLN,,15518,LOCAL,Facility,Outpatient,2 mL,mL,,60,51,17.196,60,BlueCross BlueShield Minnesota,Medicare Advantage,29.4,49,,percent of total billed charges,,
VERAPAMIL 2.5 MG/ML IV SOLN,,15518,LOCAL,Facility,Inpatient,2 mL,mL,,60,51,17.196,60,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
VERAPAMIL 2.5 MG/ML IV SOLN,,15518,LOCAL,Facility,Both,2 mL,mL,,60,51,17.196,60,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,53.142,88.57,,percent of total billed charges,,
VERAPAMIL 2.5 MG/ML IV SOLN,,15518,LOCAL,Facility,Both,2 mL,mL,,60,51,17.196,60,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,17.196,28.66,,percent of total billed charges,,
VERAPAMIL 2.5 MG/ML IV SOLN,,15518,LOCAL,Facility,Outpatient,2 mL,mL,,60,51,17.196,60,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),29.4,49,,percent of total billed charges,,
VERAPAMIL 2.5 MG/ML IV SOLN,,15518,LOCAL,Facility,Inpatient,2 mL,mL,,60,51,17.196,60,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
VERAPAMIL 2.5 MG/ML IV SOLN,,15518,LOCAL,Facility,Both,2 mL,mL,,60,51,17.196,60,CorVel,Worker's Compensation,60,100,,percent of total billed charges,,
VERAPAMIL 2.5 MG/ML IV SOLN,,15518,LOCAL,Facility,Both,2 mL,mL,,60,51,17.196,60,First Health Group Corporation,First Health Network,58.2,97,,percent of total billed charges,,
VERAPAMIL 2.5 MG/ML IV SOLN,,15518,LOCAL,Facility,Both,2 mL,mL,,60,51,17.196,60,"Health Partners, Inc.",Commercial,56.76,94.6,,percent of total billed charges,,
VERAPAMIL 2.5 MG/ML IV SOLN,,15518,LOCAL,Facility,Outpatient,2 mL,mL,,60,51,17.196,60,"Health Partners, Inc.",Medicare Advantage,29.4,49,,percent of total billed charges,,
VERAPAMIL 2.5 MG/ML IV SOLN,,15518,LOCAL,Facility,Inpatient,2 mL,mL,,60,51,17.196,60,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
VERAPAMIL 2.5 MG/ML IV SOLN,,15518,LOCAL,Facility,Both,2 mL,mL,,60,51,17.196,60,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),36,60,,percent of total billed charges,,
VERAPAMIL 2.5 MG/ML IV SOLN,,15518,LOCAL,Facility,Both,2 mL,mL,,60,51,17.196,60,"Health Partners, Inc.",State of Minnesota Advantage Program,48.9,81.5,,percent of total billed charges,,
VERAPAMIL 2.5 MG/ML IV SOLN,,15518,LOCAL,Facility,Both,2 mL,mL,,60,51,17.196,60,"Health Partners, Inc.",State Public Programs,30,50,,percent of total billed charges,,
VERAPAMIL 2.5 MG/ML IV SOLN,,15518,LOCAL,Facility,Both,2 mL,mL,,60,51,17.196,60,Humana Insurance Company,Commercial PPO,57,95,,percent of total billed charges,,
VERAPAMIL 2.5 MG/ML IV SOLN,,15518,LOCAL,Facility,Outpatient,2 mL,mL,,60,51,17.196,60,Humana Insurance Company,Medicare PPO,29.4,49,,percent of total billed charges,,
VERAPAMIL 2.5 MG/ML IV SOLN,,15518,LOCAL,Facility,Inpatient,2 mL,mL,,60,51,17.196,60,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
VERAPAMIL 2.5 MG/ML IV SOLN,,15518,LOCAL,Facility,Both,2 mL,mL,,60,51,17.196,60,Medica,Individual & Family,59.46,99.1,,percent of total billed charges,,
VERAPAMIL 2.5 MG/ML IV SOLN,,15518,LOCAL,Facility,Outpatient,2 mL,mL,,60,51,17.196,60,Medica,Medica Advantage Solution,29.88,49.8,,percent of total billed charges,,
VERAPAMIL 2.5 MG/ML IV SOLN,,15518,LOCAL,Facility,Inpatient,2 mL,mL,,60,51,17.196,60,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
VERAPAMIL 2.5 MG/ML IV SOLN,,15518,LOCAL,Facility,Outpatient,2 mL,mL,,60,51,17.196,60,Medica,Medical Assistance,26.76,44.6,,percent of total billed charges,,
VERAPAMIL 2.5 MG/ML IV SOLN,,15518,LOCAL,Facility,Inpatient,2 mL,mL,,60,51,17.196,60,Medica,Medical Assistance,,,,,Included in per diem rate,
VERAPAMIL 2.5 MG/ML IV SOLN,,15518,LOCAL,Facility,Outpatient,2 mL,mL,,60,51,17.196,60,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,29.88,49.8,,percent of total billed charges,,
VERAPAMIL 2.5 MG/ML IV SOLN,,15518,LOCAL,Facility,Inpatient,2 mL,mL,,60,51,17.196,60,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
VERAPAMIL 2.5 MG/ML IV SOLN,,15518,LOCAL,Facility,Both,2 mL,mL,,60,51,17.196,60,"Multiplan, Inc.","Multiplan, Inc.",56.4,94,,percent of total billed charges,,
VERAPAMIL 2.5 MG/ML IV SOLN,,15518,LOCAL,Facility,Outpatient,2 mL,mL,,60,51,17.196,60,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,54.06,90.1,,percent of total billed charges,,
VERAPAMIL 2.5 MG/ML IV SOLN,,15518,LOCAL,Facility,Inpatient,2 mL,mL,,60,51,17.196,60,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
VERAPAMIL 2.5 MG/ML IV SOLN,,15518,LOCAL,Facility,Both,2 mL,mL,,60,51,17.196,60,"Preferred One Administrative Services, INC.",PPO,59.16,98.6,,percent of total billed charges,,
VERAPAMIL 2.5 MG/ML IV SOLN,,15518,LOCAL,Facility,Outpatient,2 mL,mL,,60,51,17.196,60,PrimeWest Health,Minnesota Senior Health Options (MSHO),30.87,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
VERAPAMIL 2.5 MG/ML IV SOLN,,15518,LOCAL,Facility,Inpatient,2 mL,mL,,60,51,17.196,60,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
VERAPAMIL 2.5 MG/ML IV SOLN,,15518,LOCAL,Facility,Outpatient,2 mL,mL,,60,51,17.196,60,PrimeWest Health,MinnesotaCare,30.816,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
VERAPAMIL 2.5 MG/ML IV SOLN,,15518,LOCAL,Facility,Inpatient,2 mL,mL,,60,51,17.196,60,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
VERAPAMIL 2.5 MG/ML IV SOLN,,15518,LOCAL,Facility,Both,2 mL,mL,,60,51,17.196,60,Sanford Health Plan,Sanford Health Plan,55.2,92,,percent of total billed charges,,
VERAPAMIL 2.5 MG/ML IV SOLN,,15518,LOCAL,Facility,Outpatient,2 mL,mL,,60,51,17.196,60,"UCare Health, Inc.",Individual & Family Plan,33.81,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
VERAPAMIL 2.5 MG/ML IV SOLN,,15518,LOCAL,Facility,Inpatient,2 mL,mL,,60,51,17.196,60,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
VERAPAMIL 2.5 MG/ML IV SOLN,,15518,LOCAL,Facility,Outpatient,2 mL,mL,,60,51,17.196,60,"UCare Health, Inc.",Medical Assistance,30.282,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
VERAPAMIL 2.5 MG/ML IV SOLN,,15518,LOCAL,Facility,Inpatient,2 mL,mL,,60,51,17.196,60,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
VERAPAMIL 2.5 MG/ML IV SOLN,,15518,LOCAL,Facility,Outpatient,2 mL,mL,,60,51,17.196,60,"UCare Health, Inc.",Medicare Advantage,30.282,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
VERAPAMIL 2.5 MG/ML IV SOLN,,15518,LOCAL,Facility,Inpatient,2 mL,mL,,60,51,17.196,60,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
VERAPAMIL 2.5 MG/ML IV SOLN,,15518,LOCAL,Facility,Outpatient,2 mL,mL,,60,51,17.196,60,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),30.282,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
VERAPAMIL 2.5 MG/ML IV SOLN,,15518,LOCAL,Facility,Inpatient,2 mL,mL,,60,51,17.196,60,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
VERAPAMIL 2.5 MG/ML IV SOLN,,15518,LOCAL,Facility,Both,2 mL,mL,,60,51,17.196,60,UnitedHealthcare,Individual & Family,56.4,94,,percent of total billed charges,,
VERAPAMIL 2.5 MG/ML IV SOLN,,15518,LOCAL,Facility,Outpatient,2 mL,mL,,60,51,17.196,60,UnitedHealthcare,Medicare Advantage,29.4,49,,percent of total billed charges,,
VERAPAMIL 2.5 MG/ML IV SOLN,,15518,LOCAL,Facility,Inpatient,2 mL,mL,,60,51,17.196,60,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
VERAPAMIL 2.5 MG/ML IV SOLN,,15518,LOCAL,Facility,Outpatient,2 mL,mL,,60,51,17.196,60,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,28.8,48,,percent of total billed charges,,100% of DHS outpatient percentage
VERAPAMIL 2.5 MG/ML IV SOLN,,15518,LOCAL,Facility,Inpatient,2 mL,mL,,60,51,17.196,60,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
PHENYLEPHRINE HCL 2.5 % OPHT DROP,,17196,LOCAL,Facility,Both,2 mL,mL,,183,155.55,52.4478,183,Aetna,Commercial,168.36,92,,percent of total billed charges,,
PHENYLEPHRINE HCL 2.5 % OPHT DROP,,17196,LOCAL,Facility,Outpatient,2 mL,mL,,183,155.55,52.4478,183,Aetna,Medicare Advantage,89.67,49,,percent of total billed charges,,
PHENYLEPHRINE HCL 2.5 % OPHT DROP,,17196,LOCAL,Facility,Inpatient,2 mL,mL,,183,155.55,52.4478,183,Aetna,Medicare Advantage,,,,,Included in per diem rate,
PHENYLEPHRINE HCL 2.5 % OPHT DROP,,17196,LOCAL,Facility,Both,2 mL,mL,,183,155.55,52.4478,183,Aetna,PPO,170.19,93,,percent of total billed charges,,
PHENYLEPHRINE HCL 2.5 % OPHT DROP,,17196,LOCAL,Facility,Both,2 mL,mL,,183,155.55,52.4478,183,America's PPO,America's PPO,175.7349,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
PHENYLEPHRINE HCL 2.5 % OPHT DROP,,17196,LOCAL,Facility,Both,2 mL,mL,,183,155.55,52.4478,183,BlueCross BlueShield Minnesota, Federal Employee Program,180.072,98.4,,percent of total billed charges,,
PHENYLEPHRINE HCL 2.5 % OPHT DROP,,17196,LOCAL,Facility,Both,2 mL,mL,,183,155.55,52.4478,183,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,183,100,,percent of total billed charges,,
PHENYLEPHRINE HCL 2.5 % OPHT DROP,,17196,LOCAL,Facility,Both,2 mL,mL,,183,155.55,52.4478,183,BlueCross BlueShield Minnesota,High Value Network Plan,164.7,90,,percent of total billed charges,,
PHENYLEPHRINE HCL 2.5 % OPHT DROP,,17196,LOCAL,Facility,Outpatient,2 mL,mL,,183,155.55,52.4478,183,BlueCross BlueShield Minnesota,Medicare Advantage,89.67,49,,percent of total billed charges,,
PHENYLEPHRINE HCL 2.5 % OPHT DROP,,17196,LOCAL,Facility,Inpatient,2 mL,mL,,183,155.55,52.4478,183,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
PHENYLEPHRINE HCL 2.5 % OPHT DROP,,17196,LOCAL,Facility,Both,2 mL,mL,,183,155.55,52.4478,183,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,162.0831,88.57,,percent of total billed charges,,
PHENYLEPHRINE HCL 2.5 % OPHT DROP,,17196,LOCAL,Facility,Both,2 mL,mL,,183,155.55,52.4478,183,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,52.4478,28.66,,percent of total billed charges,,
PHENYLEPHRINE HCL 2.5 % OPHT DROP,,17196,LOCAL,Facility,Outpatient,2 mL,mL,,183,155.55,52.4478,183,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),89.67,49,,percent of total billed charges,,
PHENYLEPHRINE HCL 2.5 % OPHT DROP,,17196,LOCAL,Facility,Inpatient,2 mL,mL,,183,155.55,52.4478,183,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
PHENYLEPHRINE HCL 2.5 % OPHT DROP,,17196,LOCAL,Facility,Both,2 mL,mL,,183,155.55,52.4478,183,CorVel,Worker's Compensation,183,100,,percent of total billed charges,,
PHENYLEPHRINE HCL 2.5 % OPHT DROP,,17196,LOCAL,Facility,Both,2 mL,mL,,183,155.55,52.4478,183,First Health Group Corporation,First Health Network,177.51,97,,percent of total billed charges,,
PHENYLEPHRINE HCL 2.5 % OPHT DROP,,17196,LOCAL,Facility,Both,2 mL,mL,,183,155.55,52.4478,183,"Health Partners, Inc.",Commercial,173.118,94.6,,percent of total billed charges,,
PHENYLEPHRINE HCL 2.5 % OPHT DROP,,17196,LOCAL,Facility,Outpatient,2 mL,mL,,183,155.55,52.4478,183,"Health Partners, Inc.",Medicare Advantage,89.67,49,,percent of total billed charges,,
PHENYLEPHRINE HCL 2.5 % OPHT DROP,,17196,LOCAL,Facility,Inpatient,2 mL,mL,,183,155.55,52.4478,183,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PHENYLEPHRINE HCL 2.5 % OPHT DROP,,17196,LOCAL,Facility,Both,2 mL,mL,,183,155.55,52.4478,183,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),109.8,60,,percent of total billed charges,,
PHENYLEPHRINE HCL 2.5 % OPHT DROP,,17196,LOCAL,Facility,Both,2 mL,mL,,183,155.55,52.4478,183,"Health Partners, Inc.",State of Minnesota Advantage Program,149.145,81.5,,percent of total billed charges,,
PHENYLEPHRINE HCL 2.5 % OPHT DROP,,17196,LOCAL,Facility,Both,2 mL,mL,,183,155.55,52.4478,183,"Health Partners, Inc.",State Public Programs,91.5,50,,percent of total billed charges,,
PHENYLEPHRINE HCL 2.5 % OPHT DROP,,17196,LOCAL,Facility,Both,2 mL,mL,,183,155.55,52.4478,183,Humana Insurance Company,Commercial PPO,173.85,95,,percent of total billed charges,,
PHENYLEPHRINE HCL 2.5 % OPHT DROP,,17196,LOCAL,Facility,Outpatient,2 mL,mL,,183,155.55,52.4478,183,Humana Insurance Company,Medicare PPO,89.67,49,,percent of total billed charges,,
PHENYLEPHRINE HCL 2.5 % OPHT DROP,,17196,LOCAL,Facility,Inpatient,2 mL,mL,,183,155.55,52.4478,183,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
PHENYLEPHRINE HCL 2.5 % OPHT DROP,,17196,LOCAL,Facility,Both,2 mL,mL,,183,155.55,52.4478,183,Medica,Individual & Family,181.353,99.1,,percent of total billed charges,,
PHENYLEPHRINE HCL 2.5 % OPHT DROP,,17196,LOCAL,Facility,Outpatient,2 mL,mL,,183,155.55,52.4478,183,Medica,Medica Advantage Solution,91.134,49.8,,percent of total billed charges,,
PHENYLEPHRINE HCL 2.5 % OPHT DROP,,17196,LOCAL,Facility,Inpatient,2 mL,mL,,183,155.55,52.4478,183,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
PHENYLEPHRINE HCL 2.5 % OPHT DROP,,17196,LOCAL,Facility,Outpatient,2 mL,mL,,183,155.55,52.4478,183,Medica,Medical Assistance,81.618,44.6,,percent of total billed charges,,
PHENYLEPHRINE HCL 2.5 % OPHT DROP,,17196,LOCAL,Facility,Inpatient,2 mL,mL,,183,155.55,52.4478,183,Medica,Medical Assistance,,,,,Included in per diem rate,
PHENYLEPHRINE HCL 2.5 % OPHT DROP,,17196,LOCAL,Facility,Outpatient,2 mL,mL,,183,155.55,52.4478,183,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,91.134,49.8,,percent of total billed charges,,
PHENYLEPHRINE HCL 2.5 % OPHT DROP,,17196,LOCAL,Facility,Inpatient,2 mL,mL,,183,155.55,52.4478,183,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
PHENYLEPHRINE HCL 2.5 % OPHT DROP,,17196,LOCAL,Facility,Both,2 mL,mL,,183,155.55,52.4478,183,"Multiplan, Inc.","Multiplan, Inc.",172.02,94,,percent of total billed charges,,
PHENYLEPHRINE HCL 2.5 % OPHT DROP,,17196,LOCAL,Facility,Outpatient,2 mL,mL,,183,155.55,52.4478,183,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,164.883,90.1,,percent of total billed charges,,
PHENYLEPHRINE HCL 2.5 % OPHT DROP,,17196,LOCAL,Facility,Inpatient,2 mL,mL,,183,155.55,52.4478,183,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
PHENYLEPHRINE HCL 2.5 % OPHT DROP,,17196,LOCAL,Facility,Both,2 mL,mL,,183,155.55,52.4478,183,"Preferred One Administrative Services, INC.",PPO,180.438,98.6,,percent of total billed charges,,
PHENYLEPHRINE HCL 2.5 % OPHT DROP,,17196,LOCAL,Facility,Outpatient,2 mL,mL,,183,155.55,52.4478,183,PrimeWest Health,Minnesota Senior Health Options (MSHO),94.1535,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
PHENYLEPHRINE HCL 2.5 % OPHT DROP,,17196,LOCAL,Facility,Inpatient,2 mL,mL,,183,155.55,52.4478,183,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PHENYLEPHRINE HCL 2.5 % OPHT DROP,,17196,LOCAL,Facility,Outpatient,2 mL,mL,,183,155.55,52.4478,183,PrimeWest Health,MinnesotaCare,93.9888,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
PHENYLEPHRINE HCL 2.5 % OPHT DROP,,17196,LOCAL,Facility,Inpatient,2 mL,mL,,183,155.55,52.4478,183,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
PHENYLEPHRINE HCL 2.5 % OPHT DROP,,17196,LOCAL,Facility,Both,2 mL,mL,,183,155.55,52.4478,183,Sanford Health Plan,Sanford Health Plan,168.36,92,,percent of total billed charges,,
PHENYLEPHRINE HCL 2.5 % OPHT DROP,,17196,LOCAL,Facility,Outpatient,2 mL,mL,,183,155.55,52.4478,183,"UCare Health, Inc.",Individual & Family Plan,103.1205,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
PHENYLEPHRINE HCL 2.5 % OPHT DROP,,17196,LOCAL,Facility,Inpatient,2 mL,mL,,183,155.55,52.4478,183,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
PHENYLEPHRINE HCL 2.5 % OPHT DROP,,17196,LOCAL,Facility,Outpatient,2 mL,mL,,183,155.55,52.4478,183,"UCare Health, Inc.",Medical Assistance,92.3601,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PHENYLEPHRINE HCL 2.5 % OPHT DROP,,17196,LOCAL,Facility,Inpatient,2 mL,mL,,183,155.55,52.4478,183,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
PHENYLEPHRINE HCL 2.5 % OPHT DROP,,17196,LOCAL,Facility,Outpatient,2 mL,mL,,183,155.55,52.4478,183,"UCare Health, Inc.",Medicare Advantage,92.3601,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PHENYLEPHRINE HCL 2.5 % OPHT DROP,,17196,LOCAL,Facility,Inpatient,2 mL,mL,,183,155.55,52.4478,183,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PHENYLEPHRINE HCL 2.5 % OPHT DROP,,17196,LOCAL,Facility,Outpatient,2 mL,mL,,183,155.55,52.4478,183,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),92.3601,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PHENYLEPHRINE HCL 2.5 % OPHT DROP,,17196,LOCAL,Facility,Inpatient,2 mL,mL,,183,155.55,52.4478,183,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PHENYLEPHRINE HCL 2.5 % OPHT DROP,,17196,LOCAL,Facility,Both,2 mL,mL,,183,155.55,52.4478,183,UnitedHealthcare,Individual & Family,172.02,94,,percent of total billed charges,,
PHENYLEPHRINE HCL 2.5 % OPHT DROP,,17196,LOCAL,Facility,Outpatient,2 mL,mL,,183,155.55,52.4478,183,UnitedHealthcare,Medicare Advantage,89.67,49,,percent of total billed charges,,
PHENYLEPHRINE HCL 2.5 % OPHT DROP,,17196,LOCAL,Facility,Inpatient,2 mL,mL,,183,155.55,52.4478,183,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
PHENYLEPHRINE HCL 2.5 % OPHT DROP,,17196,LOCAL,Facility,Outpatient,2 mL,mL,,183,155.55,52.4478,183,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,87.84,48,,percent of total billed charges,,100% of DHS outpatient percentage
PHENYLEPHRINE HCL 2.5 % OPHT DROP,,17196,LOCAL,Facility,Inpatient,2 mL,mL,,183,155.55,52.4478,183,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
ATROPINE 1 % OPHT DROP,,18497,LOCAL,Facility,Both,2 mL,mL,,216,183.6,61.9056,216,Aetna,Commercial,198.72,92,,percent of total billed charges,,
ATROPINE 1 % OPHT DROP,,18497,LOCAL,Facility,Outpatient,2 mL,mL,,216,183.6,61.9056,216,Aetna,Medicare Advantage,105.84,49,,percent of total billed charges,,
ATROPINE 1 % OPHT DROP,,18497,LOCAL,Facility,Inpatient,2 mL,mL,,216,183.6,61.9056,216,Aetna,Medicare Advantage,,,,,Included in per diem rate,
ATROPINE 1 % OPHT DROP,,18497,LOCAL,Facility,Both,2 mL,mL,,216,183.6,61.9056,216,Aetna,PPO,200.88,93,,percent of total billed charges,,
ATROPINE 1 % OPHT DROP,,18497,LOCAL,Facility,Both,2 mL,mL,,216,183.6,61.9056,216,America's PPO,America's PPO,207.4248,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
ATROPINE 1 % OPHT DROP,,18497,LOCAL,Facility,Both,2 mL,mL,,216,183.6,61.9056,216,BlueCross BlueShield Minnesota, Federal Employee Program,212.544,98.4,,percent of total billed charges,,
ATROPINE 1 % OPHT DROP,,18497,LOCAL,Facility,Both,2 mL,mL,,216,183.6,61.9056,216,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,216,100,,percent of total billed charges,,
ATROPINE 1 % OPHT DROP,,18497,LOCAL,Facility,Both,2 mL,mL,,216,183.6,61.9056,216,BlueCross BlueShield Minnesota,High Value Network Plan,194.4,90,,percent of total billed charges,,
ATROPINE 1 % OPHT DROP,,18497,LOCAL,Facility,Outpatient,2 mL,mL,,216,183.6,61.9056,216,BlueCross BlueShield Minnesota,Medicare Advantage,105.84,49,,percent of total billed charges,,
ATROPINE 1 % OPHT DROP,,18497,LOCAL,Facility,Inpatient,2 mL,mL,,216,183.6,61.9056,216,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
ATROPINE 1 % OPHT DROP,,18497,LOCAL,Facility,Both,2 mL,mL,,216,183.6,61.9056,216,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,191.3112,88.57,,percent of total billed charges,,
ATROPINE 1 % OPHT DROP,,18497,LOCAL,Facility,Both,2 mL,mL,,216,183.6,61.9056,216,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,61.9056,28.66,,percent of total billed charges,,
ATROPINE 1 % OPHT DROP,,18497,LOCAL,Facility,Outpatient,2 mL,mL,,216,183.6,61.9056,216,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),105.84,49,,percent of total billed charges,,
ATROPINE 1 % OPHT DROP,,18497,LOCAL,Facility,Inpatient,2 mL,mL,,216,183.6,61.9056,216,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
ATROPINE 1 % OPHT DROP,,18497,LOCAL,Facility,Both,2 mL,mL,,216,183.6,61.9056,216,CorVel,Worker's Compensation,216,100,,percent of total billed charges,,
ATROPINE 1 % OPHT DROP,,18497,LOCAL,Facility,Both,2 mL,mL,,216,183.6,61.9056,216,First Health Group Corporation,First Health Network,209.52,97,,percent of total billed charges,,
ATROPINE 1 % OPHT DROP,,18497,LOCAL,Facility,Both,2 mL,mL,,216,183.6,61.9056,216,"Health Partners, Inc.",Commercial,204.336,94.6,,percent of total billed charges,,
ATROPINE 1 % OPHT DROP,,18497,LOCAL,Facility,Outpatient,2 mL,mL,,216,183.6,61.9056,216,"Health Partners, Inc.",Medicare Advantage,105.84,49,,percent of total billed charges,,
ATROPINE 1 % OPHT DROP,,18497,LOCAL,Facility,Inpatient,2 mL,mL,,216,183.6,61.9056,216,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ATROPINE 1 % OPHT DROP,,18497,LOCAL,Facility,Both,2 mL,mL,,216,183.6,61.9056,216,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),129.6,60,,percent of total billed charges,,
ATROPINE 1 % OPHT DROP,,18497,LOCAL,Facility,Both,2 mL,mL,,216,183.6,61.9056,216,"Health Partners, Inc.",State of Minnesota Advantage Program,176.04,81.5,,percent of total billed charges,,
ATROPINE 1 % OPHT DROP,,18497,LOCAL,Facility,Both,2 mL,mL,,216,183.6,61.9056,216,"Health Partners, Inc.",State Public Programs,108,50,,percent of total billed charges,,
ATROPINE 1 % OPHT DROP,,18497,LOCAL,Facility,Both,2 mL,mL,,216,183.6,61.9056,216,Humana Insurance Company,Commercial PPO,205.2,95,,percent of total billed charges,,
ATROPINE 1 % OPHT DROP,,18497,LOCAL,Facility,Outpatient,2 mL,mL,,216,183.6,61.9056,216,Humana Insurance Company,Medicare PPO,105.84,49,,percent of total billed charges,,
ATROPINE 1 % OPHT DROP,,18497,LOCAL,Facility,Inpatient,2 mL,mL,,216,183.6,61.9056,216,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
ATROPINE 1 % OPHT DROP,,18497,LOCAL,Facility,Both,2 mL,mL,,216,183.6,61.9056,216,Medica,Individual & Family,214.056,99.1,,percent of total billed charges,,
ATROPINE 1 % OPHT DROP,,18497,LOCAL,Facility,Outpatient,2 mL,mL,,216,183.6,61.9056,216,Medica,Medica Advantage Solution,107.568,49.8,,percent of total billed charges,,
ATROPINE 1 % OPHT DROP,,18497,LOCAL,Facility,Inpatient,2 mL,mL,,216,183.6,61.9056,216,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
ATROPINE 1 % OPHT DROP,,18497,LOCAL,Facility,Outpatient,2 mL,mL,,216,183.6,61.9056,216,Medica,Medical Assistance,96.336,44.6,,percent of total billed charges,,
ATROPINE 1 % OPHT DROP,,18497,LOCAL,Facility,Inpatient,2 mL,mL,,216,183.6,61.9056,216,Medica,Medical Assistance,,,,,Included in per diem rate,
ATROPINE 1 % OPHT DROP,,18497,LOCAL,Facility,Outpatient,2 mL,mL,,216,183.6,61.9056,216,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,107.568,49.8,,percent of total billed charges,,
ATROPINE 1 % OPHT DROP,,18497,LOCAL,Facility,Inpatient,2 mL,mL,,216,183.6,61.9056,216,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
ATROPINE 1 % OPHT DROP,,18497,LOCAL,Facility,Both,2 mL,mL,,216,183.6,61.9056,216,"Multiplan, Inc.","Multiplan, Inc.",203.04,94,,percent of total billed charges,,
ATROPINE 1 % OPHT DROP,,18497,LOCAL,Facility,Outpatient,2 mL,mL,,216,183.6,61.9056,216,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,194.616,90.1,,percent of total billed charges,,
ATROPINE 1 % OPHT DROP,,18497,LOCAL,Facility,Inpatient,2 mL,mL,,216,183.6,61.9056,216,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
ATROPINE 1 % OPHT DROP,,18497,LOCAL,Facility,Both,2 mL,mL,,216,183.6,61.9056,216,"Preferred One Administrative Services, INC.",PPO,212.976,98.6,,percent of total billed charges,,
ATROPINE 1 % OPHT DROP,,18497,LOCAL,Facility,Outpatient,2 mL,mL,,216,183.6,61.9056,216,PrimeWest Health,Minnesota Senior Health Options (MSHO),111.132,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
ATROPINE 1 % OPHT DROP,,18497,LOCAL,Facility,Inpatient,2 mL,mL,,216,183.6,61.9056,216,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ATROPINE 1 % OPHT DROP,,18497,LOCAL,Facility,Outpatient,2 mL,mL,,216,183.6,61.9056,216,PrimeWest Health,MinnesotaCare,110.9376,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
ATROPINE 1 % OPHT DROP,,18497,LOCAL,Facility,Inpatient,2 mL,mL,,216,183.6,61.9056,216,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
ATROPINE 1 % OPHT DROP,,18497,LOCAL,Facility,Both,2 mL,mL,,216,183.6,61.9056,216,Sanford Health Plan,Sanford Health Plan,198.72,92,,percent of total billed charges,,
ATROPINE 1 % OPHT DROP,,18497,LOCAL,Facility,Outpatient,2 mL,mL,,216,183.6,61.9056,216,"UCare Health, Inc.",Individual & Family Plan,121.716,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
ATROPINE 1 % OPHT DROP,,18497,LOCAL,Facility,Inpatient,2 mL,mL,,216,183.6,61.9056,216,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
ATROPINE 1 % OPHT DROP,,18497,LOCAL,Facility,Outpatient,2 mL,mL,,216,183.6,61.9056,216,"UCare Health, Inc.",Medical Assistance,109.0152,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ATROPINE 1 % OPHT DROP,,18497,LOCAL,Facility,Inpatient,2 mL,mL,,216,183.6,61.9056,216,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
ATROPINE 1 % OPHT DROP,,18497,LOCAL,Facility,Outpatient,2 mL,mL,,216,183.6,61.9056,216,"UCare Health, Inc.",Medicare Advantage,109.0152,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ATROPINE 1 % OPHT DROP,,18497,LOCAL,Facility,Inpatient,2 mL,mL,,216,183.6,61.9056,216,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ATROPINE 1 % OPHT DROP,,18497,LOCAL,Facility,Outpatient,2 mL,mL,,216,183.6,61.9056,216,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),109.0152,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ATROPINE 1 % OPHT DROP,,18497,LOCAL,Facility,Inpatient,2 mL,mL,,216,183.6,61.9056,216,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ATROPINE 1 % OPHT DROP,,18497,LOCAL,Facility,Both,2 mL,mL,,216,183.6,61.9056,216,UnitedHealthcare,Individual & Family,203.04,94,,percent of total billed charges,,
ATROPINE 1 % OPHT DROP,,18497,LOCAL,Facility,Outpatient,2 mL,mL,,216,183.6,61.9056,216,UnitedHealthcare,Medicare Advantage,105.84,49,,percent of total billed charges,,
ATROPINE 1 % OPHT DROP,,18497,LOCAL,Facility,Inpatient,2 mL,mL,,216,183.6,61.9056,216,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
ATROPINE 1 % OPHT DROP,,18497,LOCAL,Facility,Outpatient,2 mL,mL,,216,183.6,61.9056,216,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,103.68,48,,percent of total billed charges,,100% of DHS outpatient percentage
ATROPINE 1 % OPHT DROP,,18497,LOCAL,Facility,Inpatient,2 mL,mL,,216,183.6,61.9056,216,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Both,2 mL,mL,,13,11.05,3.7258,13,Aetna,Commercial,11.96,92,,percent of total billed charges,,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Both,2 mL,mL,,13,11.05,3.7258,13,Aetna,Commercial,11.96,92,,percent of total billed charges,,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Outpatient,2 mL,mL,,13,11.05,3.7258,13,Aetna,Medicare Advantage,6.37,49,,percent of total billed charges,,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Outpatient,2 mL,mL,,13,11.05,3.7258,13,Aetna,Medicare Advantage,6.37,49,,percent of total billed charges,,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Inpatient,2 mL,mL,,13,11.05,3.7258,13,Aetna,Medicare Advantage,,,,,Included in per diem rate,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Inpatient,2 mL,mL,,13,11.05,3.7258,13,Aetna,Medicare Advantage,,,,,Included in per diem rate,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Both,2 mL,mL,,13,11.05,3.7258,13,Aetna,PPO,12.09,93,,percent of total billed charges,,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Both,2 mL,mL,,13,11.05,3.7258,13,Aetna,PPO,12.09,93,,percent of total billed charges,,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Both,2 mL,mL,,13,11.05,3.7258,13,America's PPO,America's PPO,12.4839,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Both,2 mL,mL,,13,11.05,3.7258,13,America's PPO,America's PPO,12.4839,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Both,2 mL,mL,,13,11.05,3.7258,13,BlueCross BlueShield Minnesota, Federal Employee Program,12.792,98.4,,percent of total billed charges,,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Both,2 mL,mL,,13,11.05,3.7258,13,BlueCross BlueShield Minnesota, Federal Employee Program,12.792,98.4,,percent of total billed charges,,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Both,2 mL,mL,,13,11.05,3.7258,13,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,13,100,,percent of total billed charges,,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Both,2 mL,mL,,13,11.05,3.7258,13,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,13,100,,percent of total billed charges,,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Both,2 mL,mL,,13,11.05,3.7258,13,BlueCross BlueShield Minnesota,High Value Network Plan,11.7,90,,percent of total billed charges,,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Both,2 mL,mL,,13,11.05,3.7258,13,BlueCross BlueShield Minnesota,High Value Network Plan,11.7,90,,percent of total billed charges,,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Outpatient,2 mL,mL,,13,11.05,3.7258,13,BlueCross BlueShield Minnesota,Medicare Advantage,6.37,49,,percent of total billed charges,,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Outpatient,2 mL,mL,,13,11.05,3.7258,13,BlueCross BlueShield Minnesota,Medicare Advantage,6.37,49,,percent of total billed charges,,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Inpatient,2 mL,mL,,13,11.05,3.7258,13,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Inpatient,2 mL,mL,,13,11.05,3.7258,13,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Both,2 mL,mL,,13,11.05,3.7258,13,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,11.5141,88.57,,percent of total billed charges,,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Both,2 mL,mL,,13,11.05,3.7258,13,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,11.5141,88.57,,percent of total billed charges,,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Both,2 mL,mL,,13,11.05,3.7258,13,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,3.7258,28.66,,percent of total billed charges,,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Both,2 mL,mL,,13,11.05,3.7258,13,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,3.7258,28.66,,percent of total billed charges,,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Outpatient,2 mL,mL,,13,11.05,3.7258,13,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),6.37,49,,percent of total billed charges,,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Outpatient,2 mL,mL,,13,11.05,3.7258,13,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),6.37,49,,percent of total billed charges,,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Inpatient,2 mL,mL,,13,11.05,3.7258,13,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Inpatient,2 mL,mL,,13,11.05,3.7258,13,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Both,2 mL,mL,,13,11.05,3.7258,13,CorVel,Worker's Compensation,13,100,,percent of total billed charges,,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Both,2 mL,mL,,13,11.05,3.7258,13,CorVel,Worker's Compensation,13,100,,percent of total billed charges,,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Both,2 mL,mL,,13,11.05,3.7258,13,First Health Group Corporation,First Health Network,12.61,97,,percent of total billed charges,,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Both,2 mL,mL,,13,11.05,3.7258,13,First Health Group Corporation,First Health Network,12.61,97,,percent of total billed charges,,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Both,2 mL,mL,,13,11.05,3.7258,13,"Health Partners, Inc.",Commercial,12.298,94.6,,percent of total billed charges,,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Both,2 mL,mL,,13,11.05,3.7258,13,"Health Partners, Inc.",Commercial,12.298,94.6,,percent of total billed charges,,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Outpatient,2 mL,mL,,13,11.05,3.7258,13,"Health Partners, Inc.",Medicare Advantage,6.37,49,,percent of total billed charges,,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Outpatient,2 mL,mL,,13,11.05,3.7258,13,"Health Partners, Inc.",Medicare Advantage,6.37,49,,percent of total billed charges,,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Inpatient,2 mL,mL,,13,11.05,3.7258,13,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Inpatient,2 mL,mL,,13,11.05,3.7258,13,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Both,2 mL,mL,,13,11.05,3.7258,13,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),7.8,60,,percent of total billed charges,,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Both,2 mL,mL,,13,11.05,3.7258,13,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),7.8,60,,percent of total billed charges,,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Both,2 mL,mL,,13,11.05,3.7258,13,"Health Partners, Inc.",State of Minnesota Advantage Program,10.595,81.5,,percent of total billed charges,,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Both,2 mL,mL,,13,11.05,3.7258,13,"Health Partners, Inc.",State of Minnesota Advantage Program,10.595,81.5,,percent of total billed charges,,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Both,2 mL,mL,,13,11.05,3.7258,13,"Health Partners, Inc.",State Public Programs,6.5,50,,percent of total billed charges,,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Both,2 mL,mL,,13,11.05,3.7258,13,"Health Partners, Inc.",State Public Programs,6.5,50,,percent of total billed charges,,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Both,2 mL,mL,,13,11.05,3.7258,13,Humana Insurance Company,Commercial PPO,12.35,95,,percent of total billed charges,,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Both,2 mL,mL,,13,11.05,3.7258,13,Humana Insurance Company,Commercial PPO,12.35,95,,percent of total billed charges,,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Outpatient,2 mL,mL,,13,11.05,3.7258,13,Humana Insurance Company,Medicare PPO,6.37,49,,percent of total billed charges,,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Outpatient,2 mL,mL,,13,11.05,3.7258,13,Humana Insurance Company,Medicare PPO,6.37,49,,percent of total billed charges,,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Inpatient,2 mL,mL,,13,11.05,3.7258,13,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Inpatient,2 mL,mL,,13,11.05,3.7258,13,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Both,2 mL,mL,,13,11.05,3.7258,13,Medica,Individual & Family,12.883,99.1,,percent of total billed charges,,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Both,2 mL,mL,,13,11.05,3.7258,13,Medica,Individual & Family,12.883,99.1,,percent of total billed charges,,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Outpatient,2 mL,mL,,13,11.05,3.7258,13,Medica,Medica Advantage Solution,6.474,49.8,,percent of total billed charges,,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Outpatient,2 mL,mL,,13,11.05,3.7258,13,Medica,Medica Advantage Solution,6.474,49.8,,percent of total billed charges,,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Inpatient,2 mL,mL,,13,11.05,3.7258,13,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Inpatient,2 mL,mL,,13,11.05,3.7258,13,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Outpatient,2 mL,mL,,13,11.05,3.7258,13,Medica,Medical Assistance,5.798,44.6,,percent of total billed charges,,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Outpatient,2 mL,mL,,13,11.05,3.7258,13,Medica,Medical Assistance,5.798,44.6,,percent of total billed charges,,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Inpatient,2 mL,mL,,13,11.05,3.7258,13,Medica,Medical Assistance,,,,,Included in per diem rate,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Inpatient,2 mL,mL,,13,11.05,3.7258,13,Medica,Medical Assistance,,,,,Included in per diem rate,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Outpatient,2 mL,mL,,13,11.05,3.7258,13,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,6.474,49.8,,percent of total billed charges,,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Outpatient,2 mL,mL,,13,11.05,3.7258,13,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,6.474,49.8,,percent of total billed charges,,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Inpatient,2 mL,mL,,13,11.05,3.7258,13,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Inpatient,2 mL,mL,,13,11.05,3.7258,13,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Both,2 mL,mL,,13,11.05,3.7258,13,"Multiplan, Inc.","Multiplan, Inc.",12.22,94,,percent of total billed charges,,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Both,2 mL,mL,,13,11.05,3.7258,13,"Multiplan, Inc.","Multiplan, Inc.",12.22,94,,percent of total billed charges,,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Outpatient,2 mL,mL,,13,11.05,3.7258,13,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,11.713,90.1,,percent of total billed charges,,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Outpatient,2 mL,mL,,13,11.05,3.7258,13,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,11.713,90.1,,percent of total billed charges,,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Inpatient,2 mL,mL,,13,11.05,3.7258,13,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Inpatient,2 mL,mL,,13,11.05,3.7258,13,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Both,2 mL,mL,,13,11.05,3.7258,13,"Preferred One Administrative Services, INC.",PPO,12.818,98.6,,percent of total billed charges,,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Both,2 mL,mL,,13,11.05,3.7258,13,"Preferred One Administrative Services, INC.",PPO,12.818,98.6,,percent of total billed charges,,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Outpatient,2 mL,mL,,13,11.05,3.7258,13,PrimeWest Health,Minnesota Senior Health Options (MSHO),6.6885,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Outpatient,2 mL,mL,,13,11.05,3.7258,13,PrimeWest Health,Minnesota Senior Health Options (MSHO),6.6885,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Inpatient,2 mL,mL,,13,11.05,3.7258,13,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Inpatient,2 mL,mL,,13,11.05,3.7258,13,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Outpatient,2 mL,mL,,13,11.05,3.7258,13,PrimeWest Health,MinnesotaCare,6.6768,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Outpatient,2 mL,mL,,13,11.05,3.7258,13,PrimeWest Health,MinnesotaCare,6.6768,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Inpatient,2 mL,mL,,13,11.05,3.7258,13,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Inpatient,2 mL,mL,,13,11.05,3.7258,13,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Both,2 mL,mL,,13,11.05,3.7258,13,Sanford Health Plan,Sanford Health Plan,11.96,92,,percent of total billed charges,,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Both,2 mL,mL,,13,11.05,3.7258,13,Sanford Health Plan,Sanford Health Plan,11.96,92,,percent of total billed charges,,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Outpatient,2 mL,mL,,13,11.05,3.7258,13,"UCare Health, Inc.",Individual & Family Plan,7.3255,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Outpatient,2 mL,mL,,13,11.05,3.7258,13,"UCare Health, Inc.",Individual & Family Plan,7.3255,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Inpatient,2 mL,mL,,13,11.05,3.7258,13,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Inpatient,2 mL,mL,,13,11.05,3.7258,13,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Outpatient,2 mL,mL,,13,11.05,3.7258,13,"UCare Health, Inc.",Medical Assistance,6.5611,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Outpatient,2 mL,mL,,13,11.05,3.7258,13,"UCare Health, Inc.",Medical Assistance,6.5611,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Inpatient,2 mL,mL,,13,11.05,3.7258,13,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Inpatient,2 mL,mL,,13,11.05,3.7258,13,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Outpatient,2 mL,mL,,13,11.05,3.7258,13,"UCare Health, Inc.",Medicare Advantage,6.5611,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Outpatient,2 mL,mL,,13,11.05,3.7258,13,"UCare Health, Inc.",Medicare Advantage,6.5611,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Inpatient,2 mL,mL,,13,11.05,3.7258,13,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Inpatient,2 mL,mL,,13,11.05,3.7258,13,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Outpatient,2 mL,mL,,13,11.05,3.7258,13,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),6.5611,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Outpatient,2 mL,mL,,13,11.05,3.7258,13,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),6.5611,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Inpatient,2 mL,mL,,13,11.05,3.7258,13,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Inpatient,2 mL,mL,,13,11.05,3.7258,13,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Both,2 mL,mL,,13,11.05,3.7258,13,UnitedHealthcare,Individual & Family,12.22,94,,percent of total billed charges,,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Both,2 mL,mL,,13,11.05,3.7258,13,UnitedHealthcare,Individual & Family,12.22,94,,percent of total billed charges,,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Outpatient,2 mL,mL,,13,11.05,3.7258,13,UnitedHealthcare,Medicare Advantage,6.37,49,,percent of total billed charges,,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Outpatient,2 mL,mL,,13,11.05,3.7258,13,UnitedHealthcare,Medicare Advantage,6.37,49,,percent of total billed charges,,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Inpatient,2 mL,mL,,13,11.05,3.7258,13,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Inpatient,2 mL,mL,,13,11.05,3.7258,13,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Outpatient,2 mL,mL,,13,11.05,3.7258,13,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,6.24,48,,percent of total billed charges,,100% of DHS outpatient percentage
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Outpatient,2 mL,mL,,13,11.05,3.7258,13,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,6.24,48,,percent of total billed charges,,100% of DHS outpatient percentage
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Inpatient,2 mL,mL,,13,11.05,3.7258,13,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Inpatient,2 mL,mL,,13,11.05,3.7258,13,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
FORMOTEROL FUMARATE 20 MCG/2 ML INHL NEBU,,77453,LOCAL,Facility,Both,2 mL,VIAL,,24,20.4,6.8784,24,Aetna,Commercial,22.08,92,,percent of total billed charges,,
FORMOTEROL FUMARATE 20 MCG/2 ML INHL NEBU,,77453,LOCAL,Facility,Outpatient,2 mL,VIAL,,24,20.4,6.8784,24,Aetna,Medicare Advantage,11.76,49,,percent of total billed charges,,
FORMOTEROL FUMARATE 20 MCG/2 ML INHL NEBU,,77453,LOCAL,Facility,Inpatient,2 mL,VIAL,,24,20.4,6.8784,24,Aetna,Medicare Advantage,,,,,Included in per diem rate,
FORMOTEROL FUMARATE 20 MCG/2 ML INHL NEBU,,77453,LOCAL,Facility,Both,2 mL,VIAL,,24,20.4,6.8784,24,Aetna,PPO,22.32,93,,percent of total billed charges,,
FORMOTEROL FUMARATE 20 MCG/2 ML INHL NEBU,,77453,LOCAL,Facility,Both,2 mL,VIAL,,24,20.4,6.8784,24,America's PPO,America's PPO,23.0472,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
FORMOTEROL FUMARATE 20 MCG/2 ML INHL NEBU,,77453,LOCAL,Facility,Both,2 mL,VIAL,,24,20.4,6.8784,24,BlueCross BlueShield Minnesota, Federal Employee Program,23.616,98.4,,percent of total billed charges,,
FORMOTEROL FUMARATE 20 MCG/2 ML INHL NEBU,,77453,LOCAL,Facility,Both,2 mL,VIAL,,24,20.4,6.8784,24,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,24,100,,percent of total billed charges,,
FORMOTEROL FUMARATE 20 MCG/2 ML INHL NEBU,,77453,LOCAL,Facility,Both,2 mL,VIAL,,24,20.4,6.8784,24,BlueCross BlueShield Minnesota,High Value Network Plan,21.6,90,,percent of total billed charges,,
FORMOTEROL FUMARATE 20 MCG/2 ML INHL NEBU,,77453,LOCAL,Facility,Outpatient,2 mL,VIAL,,24,20.4,6.8784,24,BlueCross BlueShield Minnesota,Medicare Advantage,11.76,49,,percent of total billed charges,,
FORMOTEROL FUMARATE 20 MCG/2 ML INHL NEBU,,77453,LOCAL,Facility,Inpatient,2 mL,VIAL,,24,20.4,6.8784,24,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
FORMOTEROL FUMARATE 20 MCG/2 ML INHL NEBU,,77453,LOCAL,Facility,Both,2 mL,VIAL,,24,20.4,6.8784,24,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,21.2568,88.57,,percent of total billed charges,,
FORMOTEROL FUMARATE 20 MCG/2 ML INHL NEBU,,77453,LOCAL,Facility,Both,2 mL,VIAL,,24,20.4,6.8784,24,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,6.8784,28.66,,percent of total billed charges,,
FORMOTEROL FUMARATE 20 MCG/2 ML INHL NEBU,,77453,LOCAL,Facility,Outpatient,2 mL,VIAL,,24,20.4,6.8784,24,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),11.76,49,,percent of total billed charges,,
FORMOTEROL FUMARATE 20 MCG/2 ML INHL NEBU,,77453,LOCAL,Facility,Inpatient,2 mL,VIAL,,24,20.4,6.8784,24,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
FORMOTEROL FUMARATE 20 MCG/2 ML INHL NEBU,,77453,LOCAL,Facility,Both,2 mL,VIAL,,24,20.4,6.8784,24,CorVel,Worker's Compensation,24,100,,percent of total billed charges,,
FORMOTEROL FUMARATE 20 MCG/2 ML INHL NEBU,,77453,LOCAL,Facility,Both,2 mL,VIAL,,24,20.4,6.8784,24,First Health Group Corporation,First Health Network,23.28,97,,percent of total billed charges,,
FORMOTEROL FUMARATE 20 MCG/2 ML INHL NEBU,,77453,LOCAL,Facility,Both,2 mL,VIAL,,24,20.4,6.8784,24,"Health Partners, Inc.",Commercial,22.704,94.6,,percent of total billed charges,,
FORMOTEROL FUMARATE 20 MCG/2 ML INHL NEBU,,77453,LOCAL,Facility,Outpatient,2 mL,VIAL,,24,20.4,6.8784,24,"Health Partners, Inc.",Medicare Advantage,11.76,49,,percent of total billed charges,,
FORMOTEROL FUMARATE 20 MCG/2 ML INHL NEBU,,77453,LOCAL,Facility,Inpatient,2 mL,VIAL,,24,20.4,6.8784,24,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
FORMOTEROL FUMARATE 20 MCG/2 ML INHL NEBU,,77453,LOCAL,Facility,Both,2 mL,VIAL,,24,20.4,6.8784,24,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),14.4,60,,percent of total billed charges,,
FORMOTEROL FUMARATE 20 MCG/2 ML INHL NEBU,,77453,LOCAL,Facility,Both,2 mL,VIAL,,24,20.4,6.8784,24,"Health Partners, Inc.",State of Minnesota Advantage Program,19.56,81.5,,percent of total billed charges,,
FORMOTEROL FUMARATE 20 MCG/2 ML INHL NEBU,,77453,LOCAL,Facility,Both,2 mL,VIAL,,24,20.4,6.8784,24,"Health Partners, Inc.",State Public Programs,12,50,,percent of total billed charges,,
FORMOTEROL FUMARATE 20 MCG/2 ML INHL NEBU,,77453,LOCAL,Facility,Both,2 mL,VIAL,,24,20.4,6.8784,24,Humana Insurance Company,Commercial PPO,22.8,95,,percent of total billed charges,,
FORMOTEROL FUMARATE 20 MCG/2 ML INHL NEBU,,77453,LOCAL,Facility,Outpatient,2 mL,VIAL,,24,20.4,6.8784,24,Humana Insurance Company,Medicare PPO,11.76,49,,percent of total billed charges,,
FORMOTEROL FUMARATE 20 MCG/2 ML INHL NEBU,,77453,LOCAL,Facility,Inpatient,2 mL,VIAL,,24,20.4,6.8784,24,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
FORMOTEROL FUMARATE 20 MCG/2 ML INHL NEBU,,77453,LOCAL,Facility,Both,2 mL,VIAL,,24,20.4,6.8784,24,Medica,Individual & Family,23.784,99.1,,percent of total billed charges,,
FORMOTEROL FUMARATE 20 MCG/2 ML INHL NEBU,,77453,LOCAL,Facility,Outpatient,2 mL,VIAL,,24,20.4,6.8784,24,Medica,Medica Advantage Solution,11.952,49.8,,percent of total billed charges,,
FORMOTEROL FUMARATE 20 MCG/2 ML INHL NEBU,,77453,LOCAL,Facility,Inpatient,2 mL,VIAL,,24,20.4,6.8784,24,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
FORMOTEROL FUMARATE 20 MCG/2 ML INHL NEBU,,77453,LOCAL,Facility,Outpatient,2 mL,VIAL,,24,20.4,6.8784,24,Medica,Medical Assistance,10.704,44.6,,percent of total billed charges,,
FORMOTEROL FUMARATE 20 MCG/2 ML INHL NEBU,,77453,LOCAL,Facility,Inpatient,2 mL,VIAL,,24,20.4,6.8784,24,Medica,Medical Assistance,,,,,Included in per diem rate,
FORMOTEROL FUMARATE 20 MCG/2 ML INHL NEBU,,77453,LOCAL,Facility,Outpatient,2 mL,VIAL,,24,20.4,6.8784,24,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,11.952,49.8,,percent of total billed charges,,
FORMOTEROL FUMARATE 20 MCG/2 ML INHL NEBU,,77453,LOCAL,Facility,Inpatient,2 mL,VIAL,,24,20.4,6.8784,24,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
FORMOTEROL FUMARATE 20 MCG/2 ML INHL NEBU,,77453,LOCAL,Facility,Both,2 mL,VIAL,,24,20.4,6.8784,24,"Multiplan, Inc.","Multiplan, Inc.",22.56,94,,percent of total billed charges,,
FORMOTEROL FUMARATE 20 MCG/2 ML INHL NEBU,,77453,LOCAL,Facility,Outpatient,2 mL,VIAL,,24,20.4,6.8784,24,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,21.624,90.1,,percent of total billed charges,,
FORMOTEROL FUMARATE 20 MCG/2 ML INHL NEBU,,77453,LOCAL,Facility,Inpatient,2 mL,VIAL,,24,20.4,6.8784,24,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
FORMOTEROL FUMARATE 20 MCG/2 ML INHL NEBU,,77453,LOCAL,Facility,Both,2 mL,VIAL,,24,20.4,6.8784,24,"Preferred One Administrative Services, INC.",PPO,23.664,98.6,,percent of total billed charges,,
FORMOTEROL FUMARATE 20 MCG/2 ML INHL NEBU,,77453,LOCAL,Facility,Outpatient,2 mL,VIAL,,24,20.4,6.8784,24,PrimeWest Health,Minnesota Senior Health Options (MSHO),12.348,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
FORMOTEROL FUMARATE 20 MCG/2 ML INHL NEBU,,77453,LOCAL,Facility,Inpatient,2 mL,VIAL,,24,20.4,6.8784,24,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
FORMOTEROL FUMARATE 20 MCG/2 ML INHL NEBU,,77453,LOCAL,Facility,Outpatient,2 mL,VIAL,,24,20.4,6.8784,24,PrimeWest Health,MinnesotaCare,12.3264,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
FORMOTEROL FUMARATE 20 MCG/2 ML INHL NEBU,,77453,LOCAL,Facility,Inpatient,2 mL,VIAL,,24,20.4,6.8784,24,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
FORMOTEROL FUMARATE 20 MCG/2 ML INHL NEBU,,77453,LOCAL,Facility,Both,2 mL,VIAL,,24,20.4,6.8784,24,Sanford Health Plan,Sanford Health Plan,22.08,92,,percent of total billed charges,,
FORMOTEROL FUMARATE 20 MCG/2 ML INHL NEBU,,77453,LOCAL,Facility,Outpatient,2 mL,VIAL,,24,20.4,6.8784,24,"UCare Health, Inc.",Individual & Family Plan,13.524,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
FORMOTEROL FUMARATE 20 MCG/2 ML INHL NEBU,,77453,LOCAL,Facility,Inpatient,2 mL,VIAL,,24,20.4,6.8784,24,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
FORMOTEROL FUMARATE 20 MCG/2 ML INHL NEBU,,77453,LOCAL,Facility,Outpatient,2 mL,VIAL,,24,20.4,6.8784,24,"UCare Health, Inc.",Medical Assistance,12.1128,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FORMOTEROL FUMARATE 20 MCG/2 ML INHL NEBU,,77453,LOCAL,Facility,Inpatient,2 mL,VIAL,,24,20.4,6.8784,24,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
FORMOTEROL FUMARATE 20 MCG/2 ML INHL NEBU,,77453,LOCAL,Facility,Outpatient,2 mL,VIAL,,24,20.4,6.8784,24,"UCare Health, Inc.",Medicare Advantage,12.1128,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FORMOTEROL FUMARATE 20 MCG/2 ML INHL NEBU,,77453,LOCAL,Facility,Inpatient,2 mL,VIAL,,24,20.4,6.8784,24,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
FORMOTEROL FUMARATE 20 MCG/2 ML INHL NEBU,,77453,LOCAL,Facility,Outpatient,2 mL,VIAL,,24,20.4,6.8784,24,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),12.1128,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FORMOTEROL FUMARATE 20 MCG/2 ML INHL NEBU,,77453,LOCAL,Facility,Inpatient,2 mL,VIAL,,24,20.4,6.8784,24,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
FORMOTEROL FUMARATE 20 MCG/2 ML INHL NEBU,,77453,LOCAL,Facility,Both,2 mL,VIAL,,24,20.4,6.8784,24,UnitedHealthcare,Individual & Family,22.56,94,,percent of total billed charges,,
FORMOTEROL FUMARATE 20 MCG/2 ML INHL NEBU,,77453,LOCAL,Facility,Outpatient,2 mL,VIAL,,24,20.4,6.8784,24,UnitedHealthcare,Medicare Advantage,11.76,49,,percent of total billed charges,,
FORMOTEROL FUMARATE 20 MCG/2 ML INHL NEBU,,77453,LOCAL,Facility,Inpatient,2 mL,VIAL,,24,20.4,6.8784,24,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
FORMOTEROL FUMARATE 20 MCG/2 ML INHL NEBU,,77453,LOCAL,Facility,Outpatient,2 mL,VIAL,,24,20.4,6.8784,24,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,11.52,48,,percent of total billed charges,,100% of DHS outpatient percentage
FORMOTEROL FUMARATE 20 MCG/2 ML INHL NEBU,,77453,LOCAL,Facility,Inpatient,2 mL,VIAL,,24,20.4,6.8784,24,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
RABIES IMMUNE GLOBULIN (PF) 150 UNIT/ML IM SOLN,,90375,CPT,Facility,Both,2 mL,mL,,2953,2510.05,846.3298,2953,Aetna,Commercial,2716.76,92,,percent of total billed charges,,
RABIES IMMUNE GLOBULIN (PF) 150 UNIT/ML IM SOLN,,90375,CPT,Facility,Outpatient,2 mL,mL,,2953,2510.05,846.3298,2953,Aetna,Medicare Advantage,1446.97,49,,percent of total billed charges,,
RABIES IMMUNE GLOBULIN (PF) 150 UNIT/ML IM SOLN,,90375,CPT,Facility,Inpatient,2 mL,mL,,2953,2510.05,846.3298,2953,Aetna,Medicare Advantage,,,,,Included in per diem rate,
RABIES IMMUNE GLOBULIN (PF) 150 UNIT/ML IM SOLN,,90375,CPT,Facility,Both,2 mL,mL,,2953,2510.05,846.3298,2953,Aetna,PPO,2746.29,93,,percent of total billed charges,,
RABIES IMMUNE GLOBULIN (PF) 150 UNIT/ML IM SOLN,,90375,CPT,Facility,Both,2 mL,mL,,2953,2510.05,846.3298,2953,America's PPO,America's PPO,2835.7659,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
RABIES IMMUNE GLOBULIN (PF) 150 UNIT/ML IM SOLN,,90375,CPT,Facility,Both,2 mL,mL,,2953,2510.05,846.3298,2953,BlueCross BlueShield Minnesota, Federal Employee Program,2905.752,98.4,,percent of total billed charges,,
RABIES IMMUNE GLOBULIN (PF) 150 UNIT/ML IM SOLN,,90375,CPT,Facility,Both,2 mL,mL,,2953,2510.05,846.3298,2953,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,2953,100,,percent of total billed charges,,
RABIES IMMUNE GLOBULIN (PF) 150 UNIT/ML IM SOLN,,90375,CPT,Facility,Both,2 mL,mL,,2953,2510.05,846.3298,2953,BlueCross BlueShield Minnesota,High Value Network Plan,2657.7,90,,percent of total billed charges,,
RABIES IMMUNE GLOBULIN (PF) 150 UNIT/ML IM SOLN,,90375,CPT,Facility,Outpatient,2 mL,mL,,2953,2510.05,846.3298,2953,BlueCross BlueShield Minnesota,Medicare Advantage,1446.97,49,,percent of total billed charges,,
RABIES IMMUNE GLOBULIN (PF) 150 UNIT/ML IM SOLN,,90375,CPT,Facility,Inpatient,2 mL,mL,,2953,2510.05,846.3298,2953,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
RABIES IMMUNE GLOBULIN (PF) 150 UNIT/ML IM SOLN,,90375,CPT,Facility,Both,2 mL,mL,,2953,2510.05,846.3298,2953,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,2615.4721,88.57,,percent of total billed charges,,
RABIES IMMUNE GLOBULIN (PF) 150 UNIT/ML IM SOLN,,90375,CPT,Facility,Both,2 mL,mL,,2953,2510.05,846.3298,2953,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,846.3298,28.66,,percent of total billed charges,,
RABIES IMMUNE GLOBULIN (PF) 150 UNIT/ML IM SOLN,,90375,CPT,Facility,Outpatient,2 mL,mL,,2953,2510.05,846.3298,2953,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1446.97,49,,percent of total billed charges,,
RABIES IMMUNE GLOBULIN (PF) 150 UNIT/ML IM SOLN,,90375,CPT,Facility,Inpatient,2 mL,mL,,2953,2510.05,846.3298,2953,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
RABIES IMMUNE GLOBULIN (PF) 150 UNIT/ML IM SOLN,,90375,CPT,Facility,Both,2 mL,mL,,2953,2510.05,846.3298,2953,CorVel,Worker's Compensation,2953,100,,percent of total billed charges,,
RABIES IMMUNE GLOBULIN (PF) 150 UNIT/ML IM SOLN,,90375,CPT,Facility,Both,2 mL,mL,,2953,2510.05,846.3298,2953,First Health Group Corporation,First Health Network,2864.41,97,,percent of total billed charges,,
RABIES IMMUNE GLOBULIN (PF) 150 UNIT/ML IM SOLN,,90375,CPT,Facility,Both,2 mL,mL,,2953,2510.05,846.3298,2953,"Health Partners, Inc.",Commercial,2793.538,94.6,,percent of total billed charges,,
RABIES IMMUNE GLOBULIN (PF) 150 UNIT/ML IM SOLN,,90375,CPT,Facility,Outpatient,2 mL,mL,,2953,2510.05,846.3298,2953,"Health Partners, Inc.",Medicare Advantage,1446.97,49,,percent of total billed charges,,
RABIES IMMUNE GLOBULIN (PF) 150 UNIT/ML IM SOLN,,90375,CPT,Facility,Inpatient,2 mL,mL,,2953,2510.05,846.3298,2953,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
RABIES IMMUNE GLOBULIN (PF) 150 UNIT/ML IM SOLN,,90375,CPT,Facility,Both,2 mL,mL,,2953,2510.05,846.3298,2953,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1771.8,60,,percent of total billed charges,,
RABIES IMMUNE GLOBULIN (PF) 150 UNIT/ML IM SOLN,,90375,CPT,Facility,Both,2 mL,mL,,2953,2510.05,846.3298,2953,"Health Partners, Inc.",State of Minnesota Advantage Program,2406.695,81.5,,percent of total billed charges,,
RABIES IMMUNE GLOBULIN (PF) 150 UNIT/ML IM SOLN,,90375,CPT,Facility,Both,2 mL,mL,,2953,2510.05,846.3298,2953,"Health Partners, Inc.",State Public Programs,1476.5,50,,percent of total billed charges,,
RABIES IMMUNE GLOBULIN (PF) 150 UNIT/ML IM SOLN,,90375,CPT,Facility,Both,2 mL,mL,,2953,2510.05,846.3298,2953,Humana Insurance Company,Commercial PPO,2805.35,95,,percent of total billed charges,,
RABIES IMMUNE GLOBULIN (PF) 150 UNIT/ML IM SOLN,,90375,CPT,Facility,Outpatient,2 mL,mL,,2953,2510.05,846.3298,2953,Humana Insurance Company,Medicare PPO,1446.97,49,,percent of total billed charges,,
RABIES IMMUNE GLOBULIN (PF) 150 UNIT/ML IM SOLN,,90375,CPT,Facility,Inpatient,2 mL,mL,,2953,2510.05,846.3298,2953,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
RABIES IMMUNE GLOBULIN (PF) 150 UNIT/ML IM SOLN,,90375,CPT,Facility,Both,2 mL,mL,,2953,2510.05,846.3298,2953,Medica,Individual & Family,2926.423,99.1,,percent of total billed charges,,
RABIES IMMUNE GLOBULIN (PF) 150 UNIT/ML IM SOLN,,90375,CPT,Facility,Outpatient,2 mL,mL,,2953,2510.05,846.3298,2953,Medica,Medica Advantage Solution,1470.594,49.8,,percent of total billed charges,,
RABIES IMMUNE GLOBULIN (PF) 150 UNIT/ML IM SOLN,,90375,CPT,Facility,Inpatient,2 mL,mL,,2953,2510.05,846.3298,2953,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
RABIES IMMUNE GLOBULIN (PF) 150 UNIT/ML IM SOLN,,90375,CPT,Facility,Outpatient,2 mL,mL,,2953,2510.05,846.3298,2953,Medica,Medical Assistance,1317.038,44.6,,percent of total billed charges,,
RABIES IMMUNE GLOBULIN (PF) 150 UNIT/ML IM SOLN,,90375,CPT,Facility,Inpatient,2 mL,mL,,2953,2510.05,846.3298,2953,Medica,Medical Assistance,,,,,Included in per diem rate,
RABIES IMMUNE GLOBULIN (PF) 150 UNIT/ML IM SOLN,,90375,CPT,Facility,Outpatient,2 mL,mL,,2953,2510.05,846.3298,2953,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1470.594,49.8,,percent of total billed charges,,
RABIES IMMUNE GLOBULIN (PF) 150 UNIT/ML IM SOLN,,90375,CPT,Facility,Inpatient,2 mL,mL,,2953,2510.05,846.3298,2953,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
RABIES IMMUNE GLOBULIN (PF) 150 UNIT/ML IM SOLN,,90375,CPT,Facility,Both,2 mL,mL,,2953,2510.05,846.3298,2953,"Multiplan, Inc.","Multiplan, Inc.",2775.82,94,,percent of total billed charges,,
RABIES IMMUNE GLOBULIN (PF) 150 UNIT/ML IM SOLN,,90375,CPT,Facility,Outpatient,2 mL,mL,,2953,2510.05,846.3298,2953,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,2660.653,90.1,,percent of total billed charges,,
RABIES IMMUNE GLOBULIN (PF) 150 UNIT/ML IM SOLN,,90375,CPT,Facility,Inpatient,2 mL,mL,,2953,2510.05,846.3298,2953,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
RABIES IMMUNE GLOBULIN (PF) 150 UNIT/ML IM SOLN,,90375,CPT,Facility,Both,2 mL,mL,,2953,2510.05,846.3298,2953,"Preferred One Administrative Services, INC.",PPO,2911.658,98.6,,percent of total billed charges,,
RABIES IMMUNE GLOBULIN (PF) 150 UNIT/ML IM SOLN,,90375,CPT,Facility,Outpatient,2 mL,mL,,2953,2510.05,846.3298,2953,PrimeWest Health,Minnesota Senior Health Options (MSHO),1519.3185,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
RABIES IMMUNE GLOBULIN (PF) 150 UNIT/ML IM SOLN,,90375,CPT,Facility,Inpatient,2 mL,mL,,2953,2510.05,846.3298,2953,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
RABIES IMMUNE GLOBULIN (PF) 150 UNIT/ML IM SOLN,,90375,CPT,Facility,Outpatient,2 mL,mL,,2953,2510.05,846.3298,2953,PrimeWest Health,MinnesotaCare,1516.6608,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
RABIES IMMUNE GLOBULIN (PF) 150 UNIT/ML IM SOLN,,90375,CPT,Facility,Inpatient,2 mL,mL,,2953,2510.05,846.3298,2953,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
RABIES IMMUNE GLOBULIN (PF) 150 UNIT/ML IM SOLN,,90375,CPT,Facility,Both,2 mL,mL,,2953,2510.05,846.3298,2953,Sanford Health Plan,Sanford Health Plan,2716.76,92,,percent of total billed charges,,
RABIES IMMUNE GLOBULIN (PF) 150 UNIT/ML IM SOLN,,90375,CPT,Facility,Outpatient,2 mL,mL,,2953,2510.05,846.3298,2953,"UCare Health, Inc.",Individual & Family Plan,1664.0155,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
RABIES IMMUNE GLOBULIN (PF) 150 UNIT/ML IM SOLN,,90375,CPT,Facility,Inpatient,2 mL,mL,,2953,2510.05,846.3298,2953,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
RABIES IMMUNE GLOBULIN (PF) 150 UNIT/ML IM SOLN,,90375,CPT,Facility,Outpatient,2 mL,mL,,2953,2510.05,846.3298,2953,"UCare Health, Inc.",Medical Assistance,1490.3791,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
RABIES IMMUNE GLOBULIN (PF) 150 UNIT/ML IM SOLN,,90375,CPT,Facility,Inpatient,2 mL,mL,,2953,2510.05,846.3298,2953,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
RABIES IMMUNE GLOBULIN (PF) 150 UNIT/ML IM SOLN,,90375,CPT,Facility,Outpatient,2 mL,mL,,2953,2510.05,846.3298,2953,"UCare Health, Inc.",Medicare Advantage,1490.3791,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
RABIES IMMUNE GLOBULIN (PF) 150 UNIT/ML IM SOLN,,90375,CPT,Facility,Inpatient,2 mL,mL,,2953,2510.05,846.3298,2953,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
RABIES IMMUNE GLOBULIN (PF) 150 UNIT/ML IM SOLN,,90375,CPT,Facility,Outpatient,2 mL,mL,,2953,2510.05,846.3298,2953,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1490.3791,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
RABIES IMMUNE GLOBULIN (PF) 150 UNIT/ML IM SOLN,,90375,CPT,Facility,Inpatient,2 mL,mL,,2953,2510.05,846.3298,2953,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
RABIES IMMUNE GLOBULIN (PF) 150 UNIT/ML IM SOLN,,90375,CPT,Facility,Both,2 mL,mL,,2953,2510.05,846.3298,2953,UnitedHealthcare,Individual & Family,2775.82,94,,percent of total billed charges,,
RABIES IMMUNE GLOBULIN (PF) 150 UNIT/ML IM SOLN,,90375,CPT,Facility,Outpatient,2 mL,mL,,2953,2510.05,846.3298,2953,UnitedHealthcare,Medicare Advantage,1446.97,49,,percent of total billed charges,,
RABIES IMMUNE GLOBULIN (PF) 150 UNIT/ML IM SOLN,,90375,CPT,Facility,Inpatient,2 mL,mL,,2953,2510.05,846.3298,2953,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
RABIES IMMUNE GLOBULIN (PF) 150 UNIT/ML IM SOLN,,90375,CPT,Facility,Outpatient,2 mL,mL,,2953,2510.05,846.3298,2953,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1417.44,48,,percent of total billed charges,,100% of DHS outpatient percentage
RABIES IMMUNE GLOBULIN (PF) 150 UNIT/ML IM SOLN,,90375,CPT,Facility,Inpatient,2 mL,mL,,2953,2510.05,846.3298,2953,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"ROTAVIRUS VACCINE LIVE, PENTA 2 ML ORAL SOLN",,90680,CPT,Facility,Both,2 mL,mL,,433,368.05,124.0978,433,Aetna,Commercial,398.36,92,,percent of total billed charges,,
"ROTAVIRUS VACCINE LIVE, PENTA 2 ML ORAL SOLN",,90680,CPT,Facility,Outpatient,2 mL,mL,,433,368.05,124.0978,433,Aetna,Medicare Advantage,212.17,49,,percent of total billed charges,,
"ROTAVIRUS VACCINE LIVE, PENTA 2 ML ORAL SOLN",,90680,CPT,Facility,Inpatient,2 mL,mL,,433,368.05,124.0978,433,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"ROTAVIRUS VACCINE LIVE, PENTA 2 ML ORAL SOLN",,90680,CPT,Facility,Both,2 mL,mL,,433,368.05,124.0978,433,Aetna,PPO,402.69,93,,percent of total billed charges,,
"ROTAVIRUS VACCINE LIVE, PENTA 2 ML ORAL SOLN",,90680,CPT,Facility,Both,2 mL,mL,,433,368.05,124.0978,433,America's PPO,America's PPO,415.8099,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"ROTAVIRUS VACCINE LIVE, PENTA 2 ML ORAL SOLN",,90680,CPT,Facility,Both,2 mL,mL,,433,368.05,124.0978,433,BlueCross BlueShield Minnesota, Federal Employee Program,426.072,98.4,,percent of total billed charges,,
"ROTAVIRUS VACCINE LIVE, PENTA 2 ML ORAL SOLN",,90680,CPT,Facility,Both,2 mL,mL,,433,368.05,124.0978,433,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,433,100,,percent of total billed charges,,
"ROTAVIRUS VACCINE LIVE, PENTA 2 ML ORAL SOLN",,90680,CPT,Facility,Both,2 mL,mL,,433,368.05,124.0978,433,BlueCross BlueShield Minnesota,High Value Network Plan,389.7,90,,percent of total billed charges,,
"ROTAVIRUS VACCINE LIVE, PENTA 2 ML ORAL SOLN",,90680,CPT,Facility,Outpatient,2 mL,mL,,433,368.05,124.0978,433,BlueCross BlueShield Minnesota,Medicare Advantage,212.17,49,,percent of total billed charges,,
"ROTAVIRUS VACCINE LIVE, PENTA 2 ML ORAL SOLN",,90680,CPT,Facility,Inpatient,2 mL,mL,,433,368.05,124.0978,433,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"ROTAVIRUS VACCINE LIVE, PENTA 2 ML ORAL SOLN",,90680,CPT,Facility,Both,2 mL,mL,,433,368.05,124.0978,433,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,383.5081,88.57,,percent of total billed charges,,
"ROTAVIRUS VACCINE LIVE, PENTA 2 ML ORAL SOLN",,90680,CPT,Facility,Both,2 mL,mL,,433,368.05,124.0978,433,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,124.0978,28.66,,percent of total billed charges,,
"ROTAVIRUS VACCINE LIVE, PENTA 2 ML ORAL SOLN",,90680,CPT,Facility,Outpatient,2 mL,mL,,433,368.05,124.0978,433,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),212.17,49,,percent of total billed charges,,
"ROTAVIRUS VACCINE LIVE, PENTA 2 ML ORAL SOLN",,90680,CPT,Facility,Inpatient,2 mL,mL,,433,368.05,124.0978,433,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"ROTAVIRUS VACCINE LIVE, PENTA 2 ML ORAL SOLN",,90680,CPT,Facility,Both,2 mL,mL,,433,368.05,124.0978,433,CorVel,Worker's Compensation,433,100,,percent of total billed charges,,
"ROTAVIRUS VACCINE LIVE, PENTA 2 ML ORAL SOLN",,90680,CPT,Facility,Both,2 mL,mL,,433,368.05,124.0978,433,First Health Group Corporation,First Health Network,420.01,97,,percent of total billed charges,,
"ROTAVIRUS VACCINE LIVE, PENTA 2 ML ORAL SOLN",,90680,CPT,Facility,Both,2 mL,mL,,433,368.05,124.0978,433,"Health Partners, Inc.",Commercial,409.618,94.6,,percent of total billed charges,,
"ROTAVIRUS VACCINE LIVE, PENTA 2 ML ORAL SOLN",,90680,CPT,Facility,Outpatient,2 mL,mL,,433,368.05,124.0978,433,"Health Partners, Inc.",Medicare Advantage,212.17,49,,percent of total billed charges,,
"ROTAVIRUS VACCINE LIVE, PENTA 2 ML ORAL SOLN",,90680,CPT,Facility,Inpatient,2 mL,mL,,433,368.05,124.0978,433,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"ROTAVIRUS VACCINE LIVE, PENTA 2 ML ORAL SOLN",,90680,CPT,Facility,Both,2 mL,mL,,433,368.05,124.0978,433,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),259.8,60,,percent of total billed charges,,
"ROTAVIRUS VACCINE LIVE, PENTA 2 ML ORAL SOLN",,90680,CPT,Facility,Both,2 mL,mL,,433,368.05,124.0978,433,"Health Partners, Inc.",State of Minnesota Advantage Program,352.895,81.5,,percent of total billed charges,,
"ROTAVIRUS VACCINE LIVE, PENTA 2 ML ORAL SOLN",,90680,CPT,Facility,Both,2 mL,mL,,433,368.05,124.0978,433,"Health Partners, Inc.",State Public Programs,216.5,50,,percent of total billed charges,,
"ROTAVIRUS VACCINE LIVE, PENTA 2 ML ORAL SOLN",,90680,CPT,Facility,Both,2 mL,mL,,433,368.05,124.0978,433,Humana Insurance Company,Commercial PPO,411.35,95,,percent of total billed charges,,
"ROTAVIRUS VACCINE LIVE, PENTA 2 ML ORAL SOLN",,90680,CPT,Facility,Outpatient,2 mL,mL,,433,368.05,124.0978,433,Humana Insurance Company,Medicare PPO,212.17,49,,percent of total billed charges,,
"ROTAVIRUS VACCINE LIVE, PENTA 2 ML ORAL SOLN",,90680,CPT,Facility,Inpatient,2 mL,mL,,433,368.05,124.0978,433,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"ROTAVIRUS VACCINE LIVE, PENTA 2 ML ORAL SOLN",,90680,CPT,Facility,Both,2 mL,mL,,433,368.05,124.0978,433,Medica,Individual & Family,429.103,99.1,,percent of total billed charges,,
"ROTAVIRUS VACCINE LIVE, PENTA 2 ML ORAL SOLN",,90680,CPT,Facility,Outpatient,2 mL,mL,,433,368.05,124.0978,433,Medica,Medica Advantage Solution,215.634,49.8,,percent of total billed charges,,
"ROTAVIRUS VACCINE LIVE, PENTA 2 ML ORAL SOLN",,90680,CPT,Facility,Inpatient,2 mL,mL,,433,368.05,124.0978,433,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"ROTAVIRUS VACCINE LIVE, PENTA 2 ML ORAL SOLN",,90680,CPT,Facility,Outpatient,2 mL,mL,,433,368.05,124.0978,433,Medica,Medical Assistance,193.118,44.6,,percent of total billed charges,,
"ROTAVIRUS VACCINE LIVE, PENTA 2 ML ORAL SOLN",,90680,CPT,Facility,Inpatient,2 mL,mL,,433,368.05,124.0978,433,Medica,Medical Assistance,,,,,Included in per diem rate,
"ROTAVIRUS VACCINE LIVE, PENTA 2 ML ORAL SOLN",,90680,CPT,Facility,Outpatient,2 mL,mL,,433,368.05,124.0978,433,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,215.634,49.8,,percent of total billed charges,,
"ROTAVIRUS VACCINE LIVE, PENTA 2 ML ORAL SOLN",,90680,CPT,Facility,Inpatient,2 mL,mL,,433,368.05,124.0978,433,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"ROTAVIRUS VACCINE LIVE, PENTA 2 ML ORAL SOLN",,90680,CPT,Facility,Both,2 mL,mL,,433,368.05,124.0978,433,"Multiplan, Inc.","Multiplan, Inc.",407.02,94,,percent of total billed charges,,
"ROTAVIRUS VACCINE LIVE, PENTA 2 ML ORAL SOLN",,90680,CPT,Facility,Outpatient,2 mL,mL,,433,368.05,124.0978,433,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,390.133,90.1,,percent of total billed charges,,
"ROTAVIRUS VACCINE LIVE, PENTA 2 ML ORAL SOLN",,90680,CPT,Facility,Inpatient,2 mL,mL,,433,368.05,124.0978,433,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"ROTAVIRUS VACCINE LIVE, PENTA 2 ML ORAL SOLN",,90680,CPT,Facility,Both,2 mL,mL,,433,368.05,124.0978,433,"Preferred One Administrative Services, INC.",PPO,426.938,98.6,,percent of total billed charges,,
"ROTAVIRUS VACCINE LIVE, PENTA 2 ML ORAL SOLN",,90680,CPT,Facility,Outpatient,2 mL,mL,,433,368.05,124.0978,433,PrimeWest Health,Minnesota Senior Health Options (MSHO),222.7785,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"ROTAVIRUS VACCINE LIVE, PENTA 2 ML ORAL SOLN",,90680,CPT,Facility,Inpatient,2 mL,mL,,433,368.05,124.0978,433,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"ROTAVIRUS VACCINE LIVE, PENTA 2 ML ORAL SOLN",,90680,CPT,Facility,Outpatient,2 mL,mL,,433,368.05,124.0978,433,PrimeWest Health,MinnesotaCare,222.3888,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"ROTAVIRUS VACCINE LIVE, PENTA 2 ML ORAL SOLN",,90680,CPT,Facility,Inpatient,2 mL,mL,,433,368.05,124.0978,433,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"ROTAVIRUS VACCINE LIVE, PENTA 2 ML ORAL SOLN",,90680,CPT,Facility,Both,2 mL,mL,,433,368.05,124.0978,433,Sanford Health Plan,Sanford Health Plan,398.36,92,,percent of total billed charges,,
"ROTAVIRUS VACCINE LIVE, PENTA 2 ML ORAL SOLN",,90680,CPT,Facility,Outpatient,2 mL,mL,,433,368.05,124.0978,433,"UCare Health, Inc.",Individual & Family Plan,243.9955,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"ROTAVIRUS VACCINE LIVE, PENTA 2 ML ORAL SOLN",,90680,CPT,Facility,Inpatient,2 mL,mL,,433,368.05,124.0978,433,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"ROTAVIRUS VACCINE LIVE, PENTA 2 ML ORAL SOLN",,90680,CPT,Facility,Outpatient,2 mL,mL,,433,368.05,124.0978,433,"UCare Health, Inc.",Medical Assistance,218.5351,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"ROTAVIRUS VACCINE LIVE, PENTA 2 ML ORAL SOLN",,90680,CPT,Facility,Inpatient,2 mL,mL,,433,368.05,124.0978,433,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"ROTAVIRUS VACCINE LIVE, PENTA 2 ML ORAL SOLN",,90680,CPT,Facility,Outpatient,2 mL,mL,,433,368.05,124.0978,433,"UCare Health, Inc.",Medicare Advantage,218.5351,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"ROTAVIRUS VACCINE LIVE, PENTA 2 ML ORAL SOLN",,90680,CPT,Facility,Inpatient,2 mL,mL,,433,368.05,124.0978,433,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"ROTAVIRUS VACCINE LIVE, PENTA 2 ML ORAL SOLN",,90680,CPT,Facility,Outpatient,2 mL,mL,,433,368.05,124.0978,433,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),218.5351,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"ROTAVIRUS VACCINE LIVE, PENTA 2 ML ORAL SOLN",,90680,CPT,Facility,Inpatient,2 mL,mL,,433,368.05,124.0978,433,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"ROTAVIRUS VACCINE LIVE, PENTA 2 ML ORAL SOLN",,90680,CPT,Facility,Both,2 mL,mL,,433,368.05,124.0978,433,UnitedHealthcare,Individual & Family,407.02,94,,percent of total billed charges,,
"ROTAVIRUS VACCINE LIVE, PENTA 2 ML ORAL SOLN",,90680,CPT,Facility,Outpatient,2 mL,mL,,433,368.05,124.0978,433,UnitedHealthcare,Medicare Advantage,212.17,49,,percent of total billed charges,,
"ROTAVIRUS VACCINE LIVE, PENTA 2 ML ORAL SOLN",,90680,CPT,Facility,Inpatient,2 mL,mL,,433,368.05,124.0978,433,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"ROTAVIRUS VACCINE LIVE, PENTA 2 ML ORAL SOLN",,90680,CPT,Facility,Outpatient,2 mL,mL,,433,368.05,124.0978,433,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,207.84,48,,percent of total billed charges,,100% of DHS outpatient percentage
"ROTAVIRUS VACCINE LIVE, PENTA 2 ML ORAL SOLN",,90680,CPT,Facility,Inpatient,2 mL,mL,,433,368.05,124.0978,433,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
SUGAMMADEX 100 MG/ML IV SOLN,,119758,LOCAL,Facility,Both,2 mL,mL,,578,491.3,165.6548,578,Aetna,Commercial,531.76,92,,percent of total billed charges,,
SUGAMMADEX 100 MG/ML IV SOLN,,119758,LOCAL,Facility,Outpatient,2 mL,mL,,578,491.3,165.6548,578,Aetna,Medicare Advantage,283.22,49,,percent of total billed charges,,
SUGAMMADEX 100 MG/ML IV SOLN,,119758,LOCAL,Facility,Inpatient,2 mL,mL,,578,491.3,165.6548,578,Aetna,Medicare Advantage,,,,,Included in per diem rate,
SUGAMMADEX 100 MG/ML IV SOLN,,119758,LOCAL,Facility,Both,2 mL,mL,,578,491.3,165.6548,578,Aetna,PPO,537.54,93,,percent of total billed charges,,
SUGAMMADEX 100 MG/ML IV SOLN,,119758,LOCAL,Facility,Both,2 mL,mL,,578,491.3,165.6548,578,America's PPO,America's PPO,555.0534,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SUGAMMADEX 100 MG/ML IV SOLN,,119758,LOCAL,Facility,Both,2 mL,mL,,578,491.3,165.6548,578,BlueCross BlueShield Minnesota, Federal Employee Program,568.752,98.4,,percent of total billed charges,,
SUGAMMADEX 100 MG/ML IV SOLN,,119758,LOCAL,Facility,Both,2 mL,mL,,578,491.3,165.6548,578,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,578,100,,percent of total billed charges,,
SUGAMMADEX 100 MG/ML IV SOLN,,119758,LOCAL,Facility,Both,2 mL,mL,,578,491.3,165.6548,578,BlueCross BlueShield Minnesota,High Value Network Plan,520.2,90,,percent of total billed charges,,
SUGAMMADEX 100 MG/ML IV SOLN,,119758,LOCAL,Facility,Outpatient,2 mL,mL,,578,491.3,165.6548,578,BlueCross BlueShield Minnesota,Medicare Advantage,283.22,49,,percent of total billed charges,,
SUGAMMADEX 100 MG/ML IV SOLN,,119758,LOCAL,Facility,Inpatient,2 mL,mL,,578,491.3,165.6548,578,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
SUGAMMADEX 100 MG/ML IV SOLN,,119758,LOCAL,Facility,Both,2 mL,mL,,578,491.3,165.6548,578,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,511.9346,88.57,,percent of total billed charges,,
SUGAMMADEX 100 MG/ML IV SOLN,,119758,LOCAL,Facility,Both,2 mL,mL,,578,491.3,165.6548,578,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,165.6548,28.66,,percent of total billed charges,,
SUGAMMADEX 100 MG/ML IV SOLN,,119758,LOCAL,Facility,Outpatient,2 mL,mL,,578,491.3,165.6548,578,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),283.22,49,,percent of total billed charges,,
SUGAMMADEX 100 MG/ML IV SOLN,,119758,LOCAL,Facility,Inpatient,2 mL,mL,,578,491.3,165.6548,578,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
SUGAMMADEX 100 MG/ML IV SOLN,,119758,LOCAL,Facility,Both,2 mL,mL,,578,491.3,165.6548,578,CorVel,Worker's Compensation,578,100,,percent of total billed charges,,
SUGAMMADEX 100 MG/ML IV SOLN,,119758,LOCAL,Facility,Both,2 mL,mL,,578,491.3,165.6548,578,First Health Group Corporation,First Health Network,560.66,97,,percent of total billed charges,,
SUGAMMADEX 100 MG/ML IV SOLN,,119758,LOCAL,Facility,Both,2 mL,mL,,578,491.3,165.6548,578,"Health Partners, Inc.",Commercial,546.788,94.6,,percent of total billed charges,,
SUGAMMADEX 100 MG/ML IV SOLN,,119758,LOCAL,Facility,Outpatient,2 mL,mL,,578,491.3,165.6548,578,"Health Partners, Inc.",Medicare Advantage,283.22,49,,percent of total billed charges,,
SUGAMMADEX 100 MG/ML IV SOLN,,119758,LOCAL,Facility,Inpatient,2 mL,mL,,578,491.3,165.6548,578,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUGAMMADEX 100 MG/ML IV SOLN,,119758,LOCAL,Facility,Both,2 mL,mL,,578,491.3,165.6548,578,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),346.8,60,,percent of total billed charges,,
SUGAMMADEX 100 MG/ML IV SOLN,,119758,LOCAL,Facility,Both,2 mL,mL,,578,491.3,165.6548,578,"Health Partners, Inc.",State of Minnesota Advantage Program,471.07,81.5,,percent of total billed charges,,
SUGAMMADEX 100 MG/ML IV SOLN,,119758,LOCAL,Facility,Both,2 mL,mL,,578,491.3,165.6548,578,"Health Partners, Inc.",State Public Programs,289,50,,percent of total billed charges,,
SUGAMMADEX 100 MG/ML IV SOLN,,119758,LOCAL,Facility,Both,2 mL,mL,,578,491.3,165.6548,578,Humana Insurance Company,Commercial PPO,549.1,95,,percent of total billed charges,,
SUGAMMADEX 100 MG/ML IV SOLN,,119758,LOCAL,Facility,Outpatient,2 mL,mL,,578,491.3,165.6548,578,Humana Insurance Company,Medicare PPO,283.22,49,,percent of total billed charges,,
SUGAMMADEX 100 MG/ML IV SOLN,,119758,LOCAL,Facility,Inpatient,2 mL,mL,,578,491.3,165.6548,578,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
SUGAMMADEX 100 MG/ML IV SOLN,,119758,LOCAL,Facility,Both,2 mL,mL,,578,491.3,165.6548,578,Medica,Individual & Family,572.798,99.1,,percent of total billed charges,,
SUGAMMADEX 100 MG/ML IV SOLN,,119758,LOCAL,Facility,Outpatient,2 mL,mL,,578,491.3,165.6548,578,Medica,Medica Advantage Solution,287.844,49.8,,percent of total billed charges,,
SUGAMMADEX 100 MG/ML IV SOLN,,119758,LOCAL,Facility,Inpatient,2 mL,mL,,578,491.3,165.6548,578,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
SUGAMMADEX 100 MG/ML IV SOLN,,119758,LOCAL,Facility,Outpatient,2 mL,mL,,578,491.3,165.6548,578,Medica,Medical Assistance,257.788,44.6,,percent of total billed charges,,
SUGAMMADEX 100 MG/ML IV SOLN,,119758,LOCAL,Facility,Inpatient,2 mL,mL,,578,491.3,165.6548,578,Medica,Medical Assistance,,,,,Included in per diem rate,
SUGAMMADEX 100 MG/ML IV SOLN,,119758,LOCAL,Facility,Outpatient,2 mL,mL,,578,491.3,165.6548,578,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,287.844,49.8,,percent of total billed charges,,
SUGAMMADEX 100 MG/ML IV SOLN,,119758,LOCAL,Facility,Inpatient,2 mL,mL,,578,491.3,165.6548,578,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
SUGAMMADEX 100 MG/ML IV SOLN,,119758,LOCAL,Facility,Both,2 mL,mL,,578,491.3,165.6548,578,"Multiplan, Inc.","Multiplan, Inc.",543.32,94,,percent of total billed charges,,
SUGAMMADEX 100 MG/ML IV SOLN,,119758,LOCAL,Facility,Outpatient,2 mL,mL,,578,491.3,165.6548,578,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,520.778,90.1,,percent of total billed charges,,
SUGAMMADEX 100 MG/ML IV SOLN,,119758,LOCAL,Facility,Inpatient,2 mL,mL,,578,491.3,165.6548,578,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
SUGAMMADEX 100 MG/ML IV SOLN,,119758,LOCAL,Facility,Both,2 mL,mL,,578,491.3,165.6548,578,"Preferred One Administrative Services, INC.",PPO,569.908,98.6,,percent of total billed charges,,
SUGAMMADEX 100 MG/ML IV SOLN,,119758,LOCAL,Facility,Outpatient,2 mL,mL,,578,491.3,165.6548,578,PrimeWest Health,Minnesota Senior Health Options (MSHO),297.381,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
SUGAMMADEX 100 MG/ML IV SOLN,,119758,LOCAL,Facility,Inpatient,2 mL,mL,,578,491.3,165.6548,578,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUGAMMADEX 100 MG/ML IV SOLN,,119758,LOCAL,Facility,Outpatient,2 mL,mL,,578,491.3,165.6548,578,PrimeWest Health,MinnesotaCare,296.8608,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
SUGAMMADEX 100 MG/ML IV SOLN,,119758,LOCAL,Facility,Inpatient,2 mL,mL,,578,491.3,165.6548,578,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
SUGAMMADEX 100 MG/ML IV SOLN,,119758,LOCAL,Facility,Both,2 mL,mL,,578,491.3,165.6548,578,Sanford Health Plan,Sanford Health Plan,531.76,92,,percent of total billed charges,,
SUGAMMADEX 100 MG/ML IV SOLN,,119758,LOCAL,Facility,Outpatient,2 mL,mL,,578,491.3,165.6548,578,"UCare Health, Inc.",Individual & Family Plan,325.703,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
SUGAMMADEX 100 MG/ML IV SOLN,,119758,LOCAL,Facility,Inpatient,2 mL,mL,,578,491.3,165.6548,578,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
SUGAMMADEX 100 MG/ML IV SOLN,,119758,LOCAL,Facility,Outpatient,2 mL,mL,,578,491.3,165.6548,578,"UCare Health, Inc.",Medical Assistance,291.7166,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUGAMMADEX 100 MG/ML IV SOLN,,119758,LOCAL,Facility,Inpatient,2 mL,mL,,578,491.3,165.6548,578,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
SUGAMMADEX 100 MG/ML IV SOLN,,119758,LOCAL,Facility,Outpatient,2 mL,mL,,578,491.3,165.6548,578,"UCare Health, Inc.",Medicare Advantage,291.7166,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUGAMMADEX 100 MG/ML IV SOLN,,119758,LOCAL,Facility,Inpatient,2 mL,mL,,578,491.3,165.6548,578,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SUGAMMADEX 100 MG/ML IV SOLN,,119758,LOCAL,Facility,Outpatient,2 mL,mL,,578,491.3,165.6548,578,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),291.7166,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SUGAMMADEX 100 MG/ML IV SOLN,,119758,LOCAL,Facility,Inpatient,2 mL,mL,,578,491.3,165.6548,578,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SUGAMMADEX 100 MG/ML IV SOLN,,119758,LOCAL,Facility,Both,2 mL,mL,,578,491.3,165.6548,578,UnitedHealthcare,Individual & Family,543.32,94,,percent of total billed charges,,
SUGAMMADEX 100 MG/ML IV SOLN,,119758,LOCAL,Facility,Outpatient,2 mL,mL,,578,491.3,165.6548,578,UnitedHealthcare,Medicare Advantage,283.22,49,,percent of total billed charges,,
SUGAMMADEX 100 MG/ML IV SOLN,,119758,LOCAL,Facility,Inpatient,2 mL,mL,,578,491.3,165.6548,578,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
SUGAMMADEX 100 MG/ML IV SOLN,,119758,LOCAL,Facility,Outpatient,2 mL,mL,,578,491.3,165.6548,578,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,277.44,48,,percent of total billed charges,,100% of DHS outpatient percentage
SUGAMMADEX 100 MG/ML IV SOLN,,119758,LOCAL,Facility,Inpatient,2 mL,mL,,578,491.3,165.6548,578,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
ADENOSINE 3 MG/ML IV SOLN,,J0153,HCPCS,Facility,Both,2 mL,mL,,38,32.3,10.8908,38,Aetna,Commercial,34.96,92,,percent of total billed charges,,
ADENOSINE 3 MG/ML IV SOLN,,J0153,HCPCS,Facility,Outpatient,2 mL,mL,,38,32.3,10.8908,38,Aetna,Medicare Advantage,18.62,49,,percent of total billed charges,,
ADENOSINE 3 MG/ML IV SOLN,,J0153,HCPCS,Facility,Inpatient,2 mL,mL,,38,32.3,10.8908,38,Aetna,Medicare Advantage,,,,,Included in per diem rate,
ADENOSINE 3 MG/ML IV SOLN,,J0153,HCPCS,Facility,Both,2 mL,mL,,38,32.3,10.8908,38,Aetna,PPO,35.34,93,,percent of total billed charges,,
ADENOSINE 3 MG/ML IV SOLN,,J0153,HCPCS,Facility,Both,2 mL,mL,,38,32.3,10.8908,38,America's PPO,America's PPO,36.4914,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
ADENOSINE 3 MG/ML IV SOLN,,J0153,HCPCS,Facility,Both,2 mL,mL,,38,32.3,10.8908,38,BlueCross BlueShield Minnesota, Federal Employee Program,37.392,98.4,,percent of total billed charges,,
ADENOSINE 3 MG/ML IV SOLN,,J0153,HCPCS,Facility,Both,2 mL,mL,,38,32.3,10.8908,38,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,38,100,,percent of total billed charges,,
ADENOSINE 3 MG/ML IV SOLN,,J0153,HCPCS,Facility,Both,2 mL,mL,,38,32.3,10.8908,38,BlueCross BlueShield Minnesota,High Value Network Plan,34.2,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
ADENOSINE 3 MG/ML IV SOLN,,J0153,HCPCS,Facility,Outpatient,2 mL,mL,,38,32.3,10.8908,38,BlueCross BlueShield Minnesota,Medicare Advantage,18.62,49,,percent of total billed charges,,
ADENOSINE 3 MG/ML IV SOLN,,J0153,HCPCS,Facility,Inpatient,2 mL,mL,,38,32.3,10.8908,38,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
ADENOSINE 3 MG/ML IV SOLN,,J0153,HCPCS,Facility,Both,2 mL,mL,,38,32.3,10.8908,38,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,33.6566,88.57,,percent of total billed charges,,
ADENOSINE 3 MG/ML IV SOLN,,J0153,HCPCS,Facility,Both,2 mL,mL,,38,32.3,10.8908,38,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,10.8908,28.66,,percent of total billed charges,,
ADENOSINE 3 MG/ML IV SOLN,,J0153,HCPCS,Facility,Outpatient,2 mL,mL,,38,32.3,10.8908,38,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),18.62,49,,percent of total billed charges,,
ADENOSINE 3 MG/ML IV SOLN,,J0153,HCPCS,Facility,Inpatient,2 mL,mL,,38,32.3,10.8908,38,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
ADENOSINE 3 MG/ML IV SOLN,,J0153,HCPCS,Facility,Both,2 mL,mL,,38,32.3,10.8908,38,CorVel,Worker's Compensation,38,100,,percent of total billed charges,,
ADENOSINE 3 MG/ML IV SOLN,,J0153,HCPCS,Facility,Both,2 mL,mL,,38,32.3,10.8908,38,First Health Group Corporation,First Health Network,36.86,97,,percent of total billed charges,,
ADENOSINE 3 MG/ML IV SOLN,,J0153,HCPCS,Facility,Both,2 mL,mL,,38,32.3,10.8908,38,"Health Partners, Inc.",Commercial,35.948,94.6,,percent of total billed charges,,
ADENOSINE 3 MG/ML IV SOLN,,J0153,HCPCS,Facility,Outpatient,2 mL,mL,,38,32.3,10.8908,38,"Health Partners, Inc.",Medicare Advantage,18.62,49,,percent of total billed charges,,
ADENOSINE 3 MG/ML IV SOLN,,J0153,HCPCS,Facility,Inpatient,2 mL,mL,,38,32.3,10.8908,38,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ADENOSINE 3 MG/ML IV SOLN,,J0153,HCPCS,Facility,Both,2 mL,mL,,38,32.3,10.8908,38,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),22.8,60,,percent of total billed charges,,
ADENOSINE 3 MG/ML IV SOLN,,J0153,HCPCS,Facility,Both,2 mL,mL,,38,32.3,10.8908,38,"Health Partners, Inc.",State of Minnesota Advantage Program,30.97,81.5,,percent of total billed charges,,
ADENOSINE 3 MG/ML IV SOLN,,J0153,HCPCS,Facility,Both,2 mL,mL,,38,32.3,10.8908,38,"Health Partners, Inc.",State Public Programs,19,50,,percent of total billed charges,,
ADENOSINE 3 MG/ML IV SOLN,,J0153,HCPCS,Facility,Both,2 mL,mL,,38,32.3,10.8908,38,Humana Insurance Company,Commercial PPO,36.1,95,,percent of total billed charges,,
ADENOSINE 3 MG/ML IV SOLN,,J0153,HCPCS,Facility,Outpatient,2 mL,mL,,38,32.3,10.8908,38,Humana Insurance Company,Medicare PPO,18.62,49,,percent of total billed charges,,
ADENOSINE 3 MG/ML IV SOLN,,J0153,HCPCS,Facility,Inpatient,2 mL,mL,,38,32.3,10.8908,38,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
ADENOSINE 3 MG/ML IV SOLN,,J0153,HCPCS,Facility,Both,2 mL,mL,,38,32.3,10.8908,38,Medica,Individual & Family,37.658,99.1,,percent of total billed charges,,
ADENOSINE 3 MG/ML IV SOLN,,J0153,HCPCS,Facility,Outpatient,2 mL,mL,,38,32.3,10.8908,38,Medica,Medica Advantage Solution,18.924,49.8,,percent of total billed charges,,
ADENOSINE 3 MG/ML IV SOLN,,J0153,HCPCS,Facility,Inpatient,2 mL,mL,,38,32.3,10.8908,38,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
ADENOSINE 3 MG/ML IV SOLN,,J0153,HCPCS,Facility,Outpatient,2 mL,mL,,38,32.3,10.8908,38,Medica,Medical Assistance,16.948,44.6,,percent of total billed charges,,
ADENOSINE 3 MG/ML IV SOLN,,J0153,HCPCS,Facility,Inpatient,2 mL,mL,,38,32.3,10.8908,38,Medica,Medical Assistance,,,,,Included in per diem rate,
ADENOSINE 3 MG/ML IV SOLN,,J0153,HCPCS,Facility,Outpatient,2 mL,mL,,38,32.3,10.8908,38,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,18.924,49.8,,percent of total billed charges,,
ADENOSINE 3 MG/ML IV SOLN,,J0153,HCPCS,Facility,Inpatient,2 mL,mL,,38,32.3,10.8908,38,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
ADENOSINE 3 MG/ML IV SOLN,,J0153,HCPCS,Facility,Both,2 mL,mL,,38,32.3,10.8908,38,"Multiplan, Inc.","Multiplan, Inc.",35.72,94,,percent of total billed charges,,
ADENOSINE 3 MG/ML IV SOLN,,J0153,HCPCS,Facility,Outpatient,2 mL,mL,,38,32.3,10.8908,38,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,34.238,90.1,,percent of total billed charges,,
ADENOSINE 3 MG/ML IV SOLN,,J0153,HCPCS,Facility,Inpatient,2 mL,mL,,38,32.3,10.8908,38,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
ADENOSINE 3 MG/ML IV SOLN,,J0153,HCPCS,Facility,Both,2 mL,mL,,38,32.3,10.8908,38,"Preferred One Administrative Services, INC.",PPO,37.468,98.6,,percent of total billed charges,,
ADENOSINE 3 MG/ML IV SOLN,,J0153,HCPCS,Facility,Outpatient,2 mL,mL,,38,32.3,10.8908,38,PrimeWest Health,Minnesota Senior Health Options (MSHO),19.551,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
ADENOSINE 3 MG/ML IV SOLN,,J0153,HCPCS,Facility,Inpatient,2 mL,mL,,38,32.3,10.8908,38,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ADENOSINE 3 MG/ML IV SOLN,,J0153,HCPCS,Facility,Outpatient,2 mL,mL,,38,32.3,10.8908,38,PrimeWest Health,MinnesotaCare,19.5168,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
ADENOSINE 3 MG/ML IV SOLN,,J0153,HCPCS,Facility,Inpatient,2 mL,mL,,38,32.3,10.8908,38,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
ADENOSINE 3 MG/ML IV SOLN,,J0153,HCPCS,Facility,Both,2 mL,mL,,38,32.3,10.8908,38,Sanford Health Plan,Sanford Health Plan,34.96,92,,percent of total billed charges,,
ADENOSINE 3 MG/ML IV SOLN,,J0153,HCPCS,Facility,Outpatient,2 mL,mL,,38,32.3,10.8908,38,"UCare Health, Inc.",Individual & Family Plan,21.413,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
ADENOSINE 3 MG/ML IV SOLN,,J0153,HCPCS,Facility,Inpatient,2 mL,mL,,38,32.3,10.8908,38,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
ADENOSINE 3 MG/ML IV SOLN,,J0153,HCPCS,Facility,Outpatient,2 mL,mL,,38,32.3,10.8908,38,"UCare Health, Inc.",Medical Assistance,19.1786,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ADENOSINE 3 MG/ML IV SOLN,,J0153,HCPCS,Facility,Inpatient,2 mL,mL,,38,32.3,10.8908,38,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
ADENOSINE 3 MG/ML IV SOLN,,J0153,HCPCS,Facility,Outpatient,2 mL,mL,,38,32.3,10.8908,38,"UCare Health, Inc.",Medicare Advantage,19.1786,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ADENOSINE 3 MG/ML IV SOLN,,J0153,HCPCS,Facility,Inpatient,2 mL,mL,,38,32.3,10.8908,38,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ADENOSINE 3 MG/ML IV SOLN,,J0153,HCPCS,Facility,Outpatient,2 mL,mL,,38,32.3,10.8908,38,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),19.1786,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ADENOSINE 3 MG/ML IV SOLN,,J0153,HCPCS,Facility,Inpatient,2 mL,mL,,38,32.3,10.8908,38,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ADENOSINE 3 MG/ML IV SOLN,,J0153,HCPCS,Facility,Both,2 mL,mL,,38,32.3,10.8908,38,UnitedHealthcare,Individual & Family,35.72,94,,percent of total billed charges,,
ADENOSINE 3 MG/ML IV SOLN,,J0153,HCPCS,Facility,Outpatient,2 mL,mL,,38,32.3,10.8908,38,UnitedHealthcare,Medicare Advantage,18.62,49,,percent of total billed charges,,
ADENOSINE 3 MG/ML IV SOLN,,J0153,HCPCS,Facility,Inpatient,2 mL,mL,,38,32.3,10.8908,38,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
ADENOSINE 3 MG/ML IV SOLN,,J0153,HCPCS,Facility,Outpatient,2 mL,mL,,38,32.3,10.8908,38,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,18.24,48,,percent of total billed charges,,100% of DHS outpatient percentage
ADENOSINE 3 MG/ML IV SOLN,,J0153,HCPCS,Facility,Inpatient,2 mL,mL,,38,32.3,10.8908,38,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
ADENOSINE 3 MG/ML IV SYRG,,J0153,HCPCS,Facility,Both,2 mL,mL,,92,78.2,26.3672,92,Aetna,Commercial,84.64,92,,percent of total billed charges,,
ADENOSINE 3 MG/ML IV SYRG,,J0153,HCPCS,Facility,Both,2 mL,mL,,92,78.2,26.3672,92,Aetna,Commercial,84.64,92,,percent of total billed charges,,
ADENOSINE 3 MG/ML IV SYRG,,J0153,HCPCS,Facility,Outpatient,2 mL,mL,,92,78.2,26.3672,92,Aetna,Medicare Advantage,45.08,49,,percent of total billed charges,,
ADENOSINE 3 MG/ML IV SYRG,,J0153,HCPCS,Facility,Outpatient,2 mL,mL,,92,78.2,26.3672,92,Aetna,Medicare Advantage,45.08,49,,percent of total billed charges,,
ADENOSINE 3 MG/ML IV SYRG,,J0153,HCPCS,Facility,Inpatient,2 mL,mL,,92,78.2,26.3672,92,Aetna,Medicare Advantage,,,,,Included in per diem rate,
ADENOSINE 3 MG/ML IV SYRG,,J0153,HCPCS,Facility,Inpatient,2 mL,mL,,92,78.2,26.3672,92,Aetna,Medicare Advantage,,,,,Included in per diem rate,
ADENOSINE 3 MG/ML IV SYRG,,J0153,HCPCS,Facility,Both,2 mL,mL,,92,78.2,26.3672,92,Aetna,PPO,85.56,93,,percent of total billed charges,,
ADENOSINE 3 MG/ML IV SYRG,,J0153,HCPCS,Facility,Both,2 mL,mL,,92,78.2,26.3672,92,Aetna,PPO,85.56,93,,percent of total billed charges,,
ADENOSINE 3 MG/ML IV SYRG,,J0153,HCPCS,Facility,Both,2 mL,mL,,92,78.2,26.3672,92,America's PPO,America's PPO,88.3476,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
ADENOSINE 3 MG/ML IV SYRG,,J0153,HCPCS,Facility,Both,2 mL,mL,,92,78.2,26.3672,92,America's PPO,America's PPO,88.3476,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
ADENOSINE 3 MG/ML IV SYRG,,J0153,HCPCS,Facility,Both,2 mL,mL,,92,78.2,26.3672,92,BlueCross BlueShield Minnesota, Federal Employee Program,90.528,98.4,,percent of total billed charges,,
ADENOSINE 3 MG/ML IV SYRG,,J0153,HCPCS,Facility,Both,2 mL,mL,,92,78.2,26.3672,92,BlueCross BlueShield Minnesota, Federal Employee Program,90.528,98.4,,percent of total billed charges,,
ADENOSINE 3 MG/ML IV SYRG,,J0153,HCPCS,Facility,Both,2 mL,mL,,92,78.2,26.3672,92,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,92,100,,percent of total billed charges,,
ADENOSINE 3 MG/ML IV SYRG,,J0153,HCPCS,Facility,Both,2 mL,mL,,92,78.2,26.3672,92,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,92,100,,percent of total billed charges,,
ADENOSINE 3 MG/ML IV SYRG,,J0153,HCPCS,Facility,Both,2 mL,mL,,92,78.2,26.3672,92,BlueCross BlueShield Minnesota,High Value Network Plan,82.8,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
ADENOSINE 3 MG/ML IV SYRG,,J0153,HCPCS,Facility,Both,2 mL,mL,,92,78.2,26.3672,92,BlueCross BlueShield Minnesota,High Value Network Plan,82.8,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
ADENOSINE 3 MG/ML IV SYRG,,J0153,HCPCS,Facility,Outpatient,2 mL,mL,,92,78.2,26.3672,92,BlueCross BlueShield Minnesota,Medicare Advantage,45.08,49,,percent of total billed charges,,
ADENOSINE 3 MG/ML IV SYRG,,J0153,HCPCS,Facility,Outpatient,2 mL,mL,,92,78.2,26.3672,92,BlueCross BlueShield Minnesota,Medicare Advantage,45.08,49,,percent of total billed charges,,
ADENOSINE 3 MG/ML IV SYRG,,J0153,HCPCS,Facility,Inpatient,2 mL,mL,,92,78.2,26.3672,92,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
ADENOSINE 3 MG/ML IV SYRG,,J0153,HCPCS,Facility,Inpatient,2 mL,mL,,92,78.2,26.3672,92,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
ADENOSINE 3 MG/ML IV SYRG,,J0153,HCPCS,Facility,Both,2 mL,mL,,92,78.2,26.3672,92,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,81.4844,88.57,,percent of total billed charges,,
ADENOSINE 3 MG/ML IV SYRG,,J0153,HCPCS,Facility,Both,2 mL,mL,,92,78.2,26.3672,92,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,81.4844,88.57,,percent of total billed charges,,
ADENOSINE 3 MG/ML IV SYRG,,J0153,HCPCS,Facility,Both,2 mL,mL,,92,78.2,26.3672,92,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,26.3672,28.66,,percent of total billed charges,,
ADENOSINE 3 MG/ML IV SYRG,,J0153,HCPCS,Facility,Both,2 mL,mL,,92,78.2,26.3672,92,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,26.3672,28.66,,percent of total billed charges,,
ADENOSINE 3 MG/ML IV SYRG,,J0153,HCPCS,Facility,Outpatient,2 mL,mL,,92,78.2,26.3672,92,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),45.08,49,,percent of total billed charges,,
ADENOSINE 3 MG/ML IV SYRG,,J0153,HCPCS,Facility,Outpatient,2 mL,mL,,92,78.2,26.3672,92,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),45.08,49,,percent of total billed charges,,
ADENOSINE 3 MG/ML IV SYRG,,J0153,HCPCS,Facility,Inpatient,2 mL,mL,,92,78.2,26.3672,92,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
ADENOSINE 3 MG/ML IV SYRG,,J0153,HCPCS,Facility,Inpatient,2 mL,mL,,92,78.2,26.3672,92,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
ADENOSINE 3 MG/ML IV SYRG,,J0153,HCPCS,Facility,Both,2 mL,mL,,92,78.2,26.3672,92,CorVel,Worker's Compensation,92,100,,percent of total billed charges,,
ADENOSINE 3 MG/ML IV SYRG,,J0153,HCPCS,Facility,Both,2 mL,mL,,92,78.2,26.3672,92,CorVel,Worker's Compensation,92,100,,percent of total billed charges,,
ADENOSINE 3 MG/ML IV SYRG,,J0153,HCPCS,Facility,Both,2 mL,mL,,92,78.2,26.3672,92,First Health Group Corporation,First Health Network,89.24,97,,percent of total billed charges,,
ADENOSINE 3 MG/ML IV SYRG,,J0153,HCPCS,Facility,Both,2 mL,mL,,92,78.2,26.3672,92,First Health Group Corporation,First Health Network,89.24,97,,percent of total billed charges,,
ADENOSINE 3 MG/ML IV SYRG,,J0153,HCPCS,Facility,Both,2 mL,mL,,92,78.2,26.3672,92,"Health Partners, Inc.",Commercial,87.032,94.6,,percent of total billed charges,,
ADENOSINE 3 MG/ML IV SYRG,,J0153,HCPCS,Facility,Both,2 mL,mL,,92,78.2,26.3672,92,"Health Partners, Inc.",Commercial,87.032,94.6,,percent of total billed charges,,
ADENOSINE 3 MG/ML IV SYRG,,J0153,HCPCS,Facility,Outpatient,2 mL,mL,,92,78.2,26.3672,92,"Health Partners, Inc.",Medicare Advantage,45.08,49,,percent of total billed charges,,
ADENOSINE 3 MG/ML IV SYRG,,J0153,HCPCS,Facility,Outpatient,2 mL,mL,,92,78.2,26.3672,92,"Health Partners, Inc.",Medicare Advantage,45.08,49,,percent of total billed charges,,
ADENOSINE 3 MG/ML IV SYRG,,J0153,HCPCS,Facility,Inpatient,2 mL,mL,,92,78.2,26.3672,92,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ADENOSINE 3 MG/ML IV SYRG,,J0153,HCPCS,Facility,Inpatient,2 mL,mL,,92,78.2,26.3672,92,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ADENOSINE 3 MG/ML IV SYRG,,J0153,HCPCS,Facility,Both,2 mL,mL,,92,78.2,26.3672,92,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),55.2,60,,percent of total billed charges,,
ADENOSINE 3 MG/ML IV SYRG,,J0153,HCPCS,Facility,Both,2 mL,mL,,92,78.2,26.3672,92,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),55.2,60,,percent of total billed charges,,
ADENOSINE 3 MG/ML IV SYRG,,J0153,HCPCS,Facility,Both,2 mL,mL,,92,78.2,26.3672,92,"Health Partners, Inc.",State of Minnesota Advantage Program,74.98,81.5,,percent of total billed charges,,
ADENOSINE 3 MG/ML IV SYRG,,J0153,HCPCS,Facility,Both,2 mL,mL,,92,78.2,26.3672,92,"Health Partners, Inc.",State of Minnesota Advantage Program,74.98,81.5,,percent of total billed charges,,
ADENOSINE 3 MG/ML IV SYRG,,J0153,HCPCS,Facility,Both,2 mL,mL,,92,78.2,26.3672,92,"Health Partners, Inc.",State Public Programs,46,50,,percent of total billed charges,,
ADENOSINE 3 MG/ML IV SYRG,,J0153,HCPCS,Facility,Both,2 mL,mL,,92,78.2,26.3672,92,"Health Partners, Inc.",State Public Programs,46,50,,percent of total billed charges,,
ADENOSINE 3 MG/ML IV SYRG,,J0153,HCPCS,Facility,Both,2 mL,mL,,92,78.2,26.3672,92,Humana Insurance Company,Commercial PPO,87.4,95,,percent of total billed charges,,
ADENOSINE 3 MG/ML IV SYRG,,J0153,HCPCS,Facility,Both,2 mL,mL,,92,78.2,26.3672,92,Humana Insurance Company,Commercial PPO,87.4,95,,percent of total billed charges,,
ADENOSINE 3 MG/ML IV SYRG,,J0153,HCPCS,Facility,Outpatient,2 mL,mL,,92,78.2,26.3672,92,Humana Insurance Company,Medicare PPO,45.08,49,,percent of total billed charges,,
ADENOSINE 3 MG/ML IV SYRG,,J0153,HCPCS,Facility,Outpatient,2 mL,mL,,92,78.2,26.3672,92,Humana Insurance Company,Medicare PPO,45.08,49,,percent of total billed charges,,
ADENOSINE 3 MG/ML IV SYRG,,J0153,HCPCS,Facility,Inpatient,2 mL,mL,,92,78.2,26.3672,92,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
ADENOSINE 3 MG/ML IV SYRG,,J0153,HCPCS,Facility,Inpatient,2 mL,mL,,92,78.2,26.3672,92,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
ADENOSINE 3 MG/ML IV SYRG,,J0153,HCPCS,Facility,Both,2 mL,mL,,92,78.2,26.3672,92,Medica,Individual & Family,91.172,99.1,,percent of total billed charges,,
ADENOSINE 3 MG/ML IV SYRG,,J0153,HCPCS,Facility,Both,2 mL,mL,,92,78.2,26.3672,92,Medica,Individual & Family,91.172,99.1,,percent of total billed charges,,
ADENOSINE 3 MG/ML IV SYRG,,J0153,HCPCS,Facility,Outpatient,2 mL,mL,,92,78.2,26.3672,92,Medica,Medica Advantage Solution,45.816,49.8,,percent of total billed charges,,
ADENOSINE 3 MG/ML IV SYRG,,J0153,HCPCS,Facility,Outpatient,2 mL,mL,,92,78.2,26.3672,92,Medica,Medica Advantage Solution,45.816,49.8,,percent of total billed charges,,
ADENOSINE 3 MG/ML IV SYRG,,J0153,HCPCS,Facility,Inpatient,2 mL,mL,,92,78.2,26.3672,92,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
ADENOSINE 3 MG/ML IV SYRG,,J0153,HCPCS,Facility,Inpatient,2 mL,mL,,92,78.2,26.3672,92,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
ADENOSINE 3 MG/ML IV SYRG,,J0153,HCPCS,Facility,Outpatient,2 mL,mL,,92,78.2,26.3672,92,Medica,Medical Assistance,41.032,44.6,,percent of total billed charges,,
ADENOSINE 3 MG/ML IV SYRG,,J0153,HCPCS,Facility,Outpatient,2 mL,mL,,92,78.2,26.3672,92,Medica,Medical Assistance,41.032,44.6,,percent of total billed charges,,
ADENOSINE 3 MG/ML IV SYRG,,J0153,HCPCS,Facility,Inpatient,2 mL,mL,,92,78.2,26.3672,92,Medica,Medical Assistance,,,,,Included in per diem rate,
ADENOSINE 3 MG/ML IV SYRG,,J0153,HCPCS,Facility,Inpatient,2 mL,mL,,92,78.2,26.3672,92,Medica,Medical Assistance,,,,,Included in per diem rate,
ADENOSINE 3 MG/ML IV SYRG,,J0153,HCPCS,Facility,Outpatient,2 mL,mL,,92,78.2,26.3672,92,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,45.816,49.8,,percent of total billed charges,,
ADENOSINE 3 MG/ML IV SYRG,,J0153,HCPCS,Facility,Outpatient,2 mL,mL,,92,78.2,26.3672,92,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,45.816,49.8,,percent of total billed charges,,
ADENOSINE 3 MG/ML IV SYRG,,J0153,HCPCS,Facility,Inpatient,2 mL,mL,,92,78.2,26.3672,92,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
ADENOSINE 3 MG/ML IV SYRG,,J0153,HCPCS,Facility,Inpatient,2 mL,mL,,92,78.2,26.3672,92,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
ADENOSINE 3 MG/ML IV SYRG,,J0153,HCPCS,Facility,Both,2 mL,mL,,92,78.2,26.3672,92,"Multiplan, Inc.","Multiplan, Inc.",86.48,94,,percent of total billed charges,,
ADENOSINE 3 MG/ML IV SYRG,,J0153,HCPCS,Facility,Both,2 mL,mL,,92,78.2,26.3672,92,"Multiplan, Inc.","Multiplan, Inc.",86.48,94,,percent of total billed charges,,
ADENOSINE 3 MG/ML IV SYRG,,J0153,HCPCS,Facility,Outpatient,2 mL,mL,,92,78.2,26.3672,92,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,82.892,90.1,,percent of total billed charges,,
ADENOSINE 3 MG/ML IV SYRG,,J0153,HCPCS,Facility,Outpatient,2 mL,mL,,92,78.2,26.3672,92,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,82.892,90.1,,percent of total billed charges,,
ADENOSINE 3 MG/ML IV SYRG,,J0153,HCPCS,Facility,Inpatient,2 mL,mL,,92,78.2,26.3672,92,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
ADENOSINE 3 MG/ML IV SYRG,,J0153,HCPCS,Facility,Inpatient,2 mL,mL,,92,78.2,26.3672,92,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
ADENOSINE 3 MG/ML IV SYRG,,J0153,HCPCS,Facility,Both,2 mL,mL,,92,78.2,26.3672,92,"Preferred One Administrative Services, INC.",PPO,90.712,98.6,,percent of total billed charges,,
ADENOSINE 3 MG/ML IV SYRG,,J0153,HCPCS,Facility,Both,2 mL,mL,,92,78.2,26.3672,92,"Preferred One Administrative Services, INC.",PPO,90.712,98.6,,percent of total billed charges,,
ADENOSINE 3 MG/ML IV SYRG,,J0153,HCPCS,Facility,Outpatient,2 mL,mL,,92,78.2,26.3672,92,PrimeWest Health,Minnesota Senior Health Options (MSHO),47.334,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
ADENOSINE 3 MG/ML IV SYRG,,J0153,HCPCS,Facility,Outpatient,2 mL,mL,,92,78.2,26.3672,92,PrimeWest Health,Minnesota Senior Health Options (MSHO),47.334,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
ADENOSINE 3 MG/ML IV SYRG,,J0153,HCPCS,Facility,Inpatient,2 mL,mL,,92,78.2,26.3672,92,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ADENOSINE 3 MG/ML IV SYRG,,J0153,HCPCS,Facility,Inpatient,2 mL,mL,,92,78.2,26.3672,92,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ADENOSINE 3 MG/ML IV SYRG,,J0153,HCPCS,Facility,Outpatient,2 mL,mL,,92,78.2,26.3672,92,PrimeWest Health,MinnesotaCare,47.2512,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
ADENOSINE 3 MG/ML IV SYRG,,J0153,HCPCS,Facility,Outpatient,2 mL,mL,,92,78.2,26.3672,92,PrimeWest Health,MinnesotaCare,47.2512,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
ADENOSINE 3 MG/ML IV SYRG,,J0153,HCPCS,Facility,Inpatient,2 mL,mL,,92,78.2,26.3672,92,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
ADENOSINE 3 MG/ML IV SYRG,,J0153,HCPCS,Facility,Inpatient,2 mL,mL,,92,78.2,26.3672,92,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
ADENOSINE 3 MG/ML IV SYRG,,J0153,HCPCS,Facility,Both,2 mL,mL,,92,78.2,26.3672,92,Sanford Health Plan,Sanford Health Plan,84.64,92,,percent of total billed charges,,
ADENOSINE 3 MG/ML IV SYRG,,J0153,HCPCS,Facility,Both,2 mL,mL,,92,78.2,26.3672,92,Sanford Health Plan,Sanford Health Plan,84.64,92,,percent of total billed charges,,
ADENOSINE 3 MG/ML IV SYRG,,J0153,HCPCS,Facility,Outpatient,2 mL,mL,,92,78.2,26.3672,92,"UCare Health, Inc.",Individual & Family Plan,51.842,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
ADENOSINE 3 MG/ML IV SYRG,,J0153,HCPCS,Facility,Outpatient,2 mL,mL,,92,78.2,26.3672,92,"UCare Health, Inc.",Individual & Family Plan,51.842,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
ADENOSINE 3 MG/ML IV SYRG,,J0153,HCPCS,Facility,Inpatient,2 mL,mL,,92,78.2,26.3672,92,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
ADENOSINE 3 MG/ML IV SYRG,,J0153,HCPCS,Facility,Inpatient,2 mL,mL,,92,78.2,26.3672,92,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
ADENOSINE 3 MG/ML IV SYRG,,J0153,HCPCS,Facility,Outpatient,2 mL,mL,,92,78.2,26.3672,92,"UCare Health, Inc.",Medical Assistance,46.4324,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ADENOSINE 3 MG/ML IV SYRG,,J0153,HCPCS,Facility,Outpatient,2 mL,mL,,92,78.2,26.3672,92,"UCare Health, Inc.",Medical Assistance,46.4324,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ADENOSINE 3 MG/ML IV SYRG,,J0153,HCPCS,Facility,Inpatient,2 mL,mL,,92,78.2,26.3672,92,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
ADENOSINE 3 MG/ML IV SYRG,,J0153,HCPCS,Facility,Inpatient,2 mL,mL,,92,78.2,26.3672,92,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
ADENOSINE 3 MG/ML IV SYRG,,J0153,HCPCS,Facility,Outpatient,2 mL,mL,,92,78.2,26.3672,92,"UCare Health, Inc.",Medicare Advantage,46.4324,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ADENOSINE 3 MG/ML IV SYRG,,J0153,HCPCS,Facility,Outpatient,2 mL,mL,,92,78.2,26.3672,92,"UCare Health, Inc.",Medicare Advantage,46.4324,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ADENOSINE 3 MG/ML IV SYRG,,J0153,HCPCS,Facility,Inpatient,2 mL,mL,,92,78.2,26.3672,92,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ADENOSINE 3 MG/ML IV SYRG,,J0153,HCPCS,Facility,Inpatient,2 mL,mL,,92,78.2,26.3672,92,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ADENOSINE 3 MG/ML IV SYRG,,J0153,HCPCS,Facility,Outpatient,2 mL,mL,,92,78.2,26.3672,92,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),46.4324,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ADENOSINE 3 MG/ML IV SYRG,,J0153,HCPCS,Facility,Outpatient,2 mL,mL,,92,78.2,26.3672,92,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),46.4324,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ADENOSINE 3 MG/ML IV SYRG,,J0153,HCPCS,Facility,Inpatient,2 mL,mL,,92,78.2,26.3672,92,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ADENOSINE 3 MG/ML IV SYRG,,J0153,HCPCS,Facility,Inpatient,2 mL,mL,,92,78.2,26.3672,92,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ADENOSINE 3 MG/ML IV SYRG,,J0153,HCPCS,Facility,Both,2 mL,mL,,92,78.2,26.3672,92,UnitedHealthcare,Individual & Family,86.48,94,,percent of total billed charges,,
ADENOSINE 3 MG/ML IV SYRG,,J0153,HCPCS,Facility,Both,2 mL,mL,,92,78.2,26.3672,92,UnitedHealthcare,Individual & Family,86.48,94,,percent of total billed charges,,
ADENOSINE 3 MG/ML IV SYRG,,J0153,HCPCS,Facility,Outpatient,2 mL,mL,,92,78.2,26.3672,92,UnitedHealthcare,Medicare Advantage,45.08,49,,percent of total billed charges,,
ADENOSINE 3 MG/ML IV SYRG,,J0153,HCPCS,Facility,Outpatient,2 mL,mL,,92,78.2,26.3672,92,UnitedHealthcare,Medicare Advantage,45.08,49,,percent of total billed charges,,
ADENOSINE 3 MG/ML IV SYRG,,J0153,HCPCS,Facility,Inpatient,2 mL,mL,,92,78.2,26.3672,92,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
ADENOSINE 3 MG/ML IV SYRG,,J0153,HCPCS,Facility,Inpatient,2 mL,mL,,92,78.2,26.3672,92,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
ADENOSINE 3 MG/ML IV SYRG,,J0153,HCPCS,Facility,Outpatient,2 mL,mL,,92,78.2,26.3672,92,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,44.16,48,,percent of total billed charges,,100% of DHS outpatient percentage
ADENOSINE 3 MG/ML IV SYRG,,J0153,HCPCS,Facility,Outpatient,2 mL,mL,,92,78.2,26.3672,92,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,44.16,48,,percent of total billed charges,,100% of DHS outpatient percentage
ADENOSINE 3 MG/ML IV SYRG,,J0153,HCPCS,Facility,Inpatient,2 mL,mL,,92,78.2,26.3672,92,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
ADENOSINE 3 MG/ML IV SYRG,,J0153,HCPCS,Facility,Inpatient,2 mL,mL,,92,78.2,26.3672,92,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
AMIKACIN 500 MG/2 ML INJ SOLN,,J0278,HCPCS,Facility,Both,2 mL,mL,,34,28.9,9.7444,34,Aetna,Commercial,31.28,92,,percent of total billed charges,,
AMIKACIN 500 MG/2 ML INJ SOLN,,J0278,HCPCS,Facility,Both,2 mL,mL,,34,28.9,9.7444,34,Aetna,Commercial,31.28,92,,percent of total billed charges,,
AMIKACIN 500 MG/2 ML INJ SOLN,,J0278,HCPCS,Facility,Outpatient,2 mL,mL,,34,28.9,9.7444,34,Aetna,Medicare Advantage,16.66,49,,percent of total billed charges,,
AMIKACIN 500 MG/2 ML INJ SOLN,,J0278,HCPCS,Facility,Outpatient,2 mL,mL,,34,28.9,9.7444,34,Aetna,Medicare Advantage,16.66,49,,percent of total billed charges,,
AMIKACIN 500 MG/2 ML INJ SOLN,,J0278,HCPCS,Facility,Inpatient,2 mL,mL,,34,28.9,9.7444,34,Aetna,Medicare Advantage,,,,,Included in per diem rate,
AMIKACIN 500 MG/2 ML INJ SOLN,,J0278,HCPCS,Facility,Inpatient,2 mL,mL,,34,28.9,9.7444,34,Aetna,Medicare Advantage,,,,,Included in per diem rate,
AMIKACIN 500 MG/2 ML INJ SOLN,,J0278,HCPCS,Facility,Both,2 mL,mL,,34,28.9,9.7444,34,Aetna,PPO,31.62,93,,percent of total billed charges,,
AMIKACIN 500 MG/2 ML INJ SOLN,,J0278,HCPCS,Facility,Both,2 mL,mL,,34,28.9,9.7444,34,Aetna,PPO,31.62,93,,percent of total billed charges,,
AMIKACIN 500 MG/2 ML INJ SOLN,,J0278,HCPCS,Facility,Both,2 mL,mL,,34,28.9,9.7444,34,America's PPO,America's PPO,32.6502,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
AMIKACIN 500 MG/2 ML INJ SOLN,,J0278,HCPCS,Facility,Both,2 mL,mL,,34,28.9,9.7444,34,America's PPO,America's PPO,32.6502,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
AMIKACIN 500 MG/2 ML INJ SOLN,,J0278,HCPCS,Facility,Both,2 mL,mL,,34,28.9,9.7444,34,BlueCross BlueShield Minnesota, Federal Employee Program,33.456,98.4,,percent of total billed charges,,
AMIKACIN 500 MG/2 ML INJ SOLN,,J0278,HCPCS,Facility,Both,2 mL,mL,,34,28.9,9.7444,34,BlueCross BlueShield Minnesota, Federal Employee Program,33.456,98.4,,percent of total billed charges,,
AMIKACIN 500 MG/2 ML INJ SOLN,,J0278,HCPCS,Facility,Both,2 mL,mL,,34,28.9,9.7444,34,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,34,100,,percent of total billed charges,,
AMIKACIN 500 MG/2 ML INJ SOLN,,J0278,HCPCS,Facility,Both,2 mL,mL,,34,28.9,9.7444,34,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,34,100,,percent of total billed charges,,
AMIKACIN 500 MG/2 ML INJ SOLN,,J0278,HCPCS,Facility,Both,2 mL,mL,,34,28.9,9.7444,34,BlueCross BlueShield Minnesota,High Value Network Plan,30.6,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
AMIKACIN 500 MG/2 ML INJ SOLN,,J0278,HCPCS,Facility,Both,2 mL,mL,,34,28.9,9.7444,34,BlueCross BlueShield Minnesota,High Value Network Plan,30.6,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
AMIKACIN 500 MG/2 ML INJ SOLN,,J0278,HCPCS,Facility,Outpatient,2 mL,mL,,34,28.9,9.7444,34,BlueCross BlueShield Minnesota,Medicare Advantage,16.66,49,,percent of total billed charges,,
AMIKACIN 500 MG/2 ML INJ SOLN,,J0278,HCPCS,Facility,Outpatient,2 mL,mL,,34,28.9,9.7444,34,BlueCross BlueShield Minnesota,Medicare Advantage,16.66,49,,percent of total billed charges,,
AMIKACIN 500 MG/2 ML INJ SOLN,,J0278,HCPCS,Facility,Inpatient,2 mL,mL,,34,28.9,9.7444,34,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
AMIKACIN 500 MG/2 ML INJ SOLN,,J0278,HCPCS,Facility,Inpatient,2 mL,mL,,34,28.9,9.7444,34,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
AMIKACIN 500 MG/2 ML INJ SOLN,,J0278,HCPCS,Facility,Both,2 mL,mL,,34,28.9,9.7444,34,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,30.1138,88.57,,percent of total billed charges,,
AMIKACIN 500 MG/2 ML INJ SOLN,,J0278,HCPCS,Facility,Both,2 mL,mL,,34,28.9,9.7444,34,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,30.1138,88.57,,percent of total billed charges,,
AMIKACIN 500 MG/2 ML INJ SOLN,,J0278,HCPCS,Facility,Both,2 mL,mL,,34,28.9,9.7444,34,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,9.7444,28.66,,percent of total billed charges,,
AMIKACIN 500 MG/2 ML INJ SOLN,,J0278,HCPCS,Facility,Both,2 mL,mL,,34,28.9,9.7444,34,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,9.7444,28.66,,percent of total billed charges,,
AMIKACIN 500 MG/2 ML INJ SOLN,,J0278,HCPCS,Facility,Outpatient,2 mL,mL,,34,28.9,9.7444,34,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),16.66,49,,percent of total billed charges,,
AMIKACIN 500 MG/2 ML INJ SOLN,,J0278,HCPCS,Facility,Outpatient,2 mL,mL,,34,28.9,9.7444,34,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),16.66,49,,percent of total billed charges,,
AMIKACIN 500 MG/2 ML INJ SOLN,,J0278,HCPCS,Facility,Inpatient,2 mL,mL,,34,28.9,9.7444,34,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
AMIKACIN 500 MG/2 ML INJ SOLN,,J0278,HCPCS,Facility,Inpatient,2 mL,mL,,34,28.9,9.7444,34,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
AMIKACIN 500 MG/2 ML INJ SOLN,,J0278,HCPCS,Facility,Both,2 mL,mL,,34,28.9,9.7444,34,CorVel,Worker's Compensation,34,100,,percent of total billed charges,,
AMIKACIN 500 MG/2 ML INJ SOLN,,J0278,HCPCS,Facility,Both,2 mL,mL,,34,28.9,9.7444,34,CorVel,Worker's Compensation,34,100,,percent of total billed charges,,
AMIKACIN 500 MG/2 ML INJ SOLN,,J0278,HCPCS,Facility,Both,2 mL,mL,,34,28.9,9.7444,34,First Health Group Corporation,First Health Network,32.98,97,,percent of total billed charges,,
AMIKACIN 500 MG/2 ML INJ SOLN,,J0278,HCPCS,Facility,Both,2 mL,mL,,34,28.9,9.7444,34,First Health Group Corporation,First Health Network,32.98,97,,percent of total billed charges,,
AMIKACIN 500 MG/2 ML INJ SOLN,,J0278,HCPCS,Facility,Both,2 mL,mL,,34,28.9,9.7444,34,"Health Partners, Inc.",Commercial,32.164,94.6,,percent of total billed charges,,
AMIKACIN 500 MG/2 ML INJ SOLN,,J0278,HCPCS,Facility,Both,2 mL,mL,,34,28.9,9.7444,34,"Health Partners, Inc.",Commercial,32.164,94.6,,percent of total billed charges,,
AMIKACIN 500 MG/2 ML INJ SOLN,,J0278,HCPCS,Facility,Outpatient,2 mL,mL,,34,28.9,9.7444,34,"Health Partners, Inc.",Medicare Advantage,16.66,49,,percent of total billed charges,,
AMIKACIN 500 MG/2 ML INJ SOLN,,J0278,HCPCS,Facility,Outpatient,2 mL,mL,,34,28.9,9.7444,34,"Health Partners, Inc.",Medicare Advantage,16.66,49,,percent of total billed charges,,
AMIKACIN 500 MG/2 ML INJ SOLN,,J0278,HCPCS,Facility,Inpatient,2 mL,mL,,34,28.9,9.7444,34,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
AMIKACIN 500 MG/2 ML INJ SOLN,,J0278,HCPCS,Facility,Inpatient,2 mL,mL,,34,28.9,9.7444,34,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
AMIKACIN 500 MG/2 ML INJ SOLN,,J0278,HCPCS,Facility,Both,2 mL,mL,,34,28.9,9.7444,34,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),20.4,60,,percent of total billed charges,,
AMIKACIN 500 MG/2 ML INJ SOLN,,J0278,HCPCS,Facility,Both,2 mL,mL,,34,28.9,9.7444,34,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),20.4,60,,percent of total billed charges,,
AMIKACIN 500 MG/2 ML INJ SOLN,,J0278,HCPCS,Facility,Both,2 mL,mL,,34,28.9,9.7444,34,"Health Partners, Inc.",State of Minnesota Advantage Program,27.71,81.5,,percent of total billed charges,,
AMIKACIN 500 MG/2 ML INJ SOLN,,J0278,HCPCS,Facility,Both,2 mL,mL,,34,28.9,9.7444,34,"Health Partners, Inc.",State of Minnesota Advantage Program,27.71,81.5,,percent of total billed charges,,
AMIKACIN 500 MG/2 ML INJ SOLN,,J0278,HCPCS,Facility,Both,2 mL,mL,,34,28.9,9.7444,34,"Health Partners, Inc.",State Public Programs,17,50,,percent of total billed charges,,
AMIKACIN 500 MG/2 ML INJ SOLN,,J0278,HCPCS,Facility,Both,2 mL,mL,,34,28.9,9.7444,34,"Health Partners, Inc.",State Public Programs,17,50,,percent of total billed charges,,
AMIKACIN 500 MG/2 ML INJ SOLN,,J0278,HCPCS,Facility,Both,2 mL,mL,,34,28.9,9.7444,34,Humana Insurance Company,Commercial PPO,32.3,95,,percent of total billed charges,,
AMIKACIN 500 MG/2 ML INJ SOLN,,J0278,HCPCS,Facility,Both,2 mL,mL,,34,28.9,9.7444,34,Humana Insurance Company,Commercial PPO,32.3,95,,percent of total billed charges,,
AMIKACIN 500 MG/2 ML INJ SOLN,,J0278,HCPCS,Facility,Outpatient,2 mL,mL,,34,28.9,9.7444,34,Humana Insurance Company,Medicare PPO,16.66,49,,percent of total billed charges,,
AMIKACIN 500 MG/2 ML INJ SOLN,,J0278,HCPCS,Facility,Outpatient,2 mL,mL,,34,28.9,9.7444,34,Humana Insurance Company,Medicare PPO,16.66,49,,percent of total billed charges,,
AMIKACIN 500 MG/2 ML INJ SOLN,,J0278,HCPCS,Facility,Inpatient,2 mL,mL,,34,28.9,9.7444,34,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
AMIKACIN 500 MG/2 ML INJ SOLN,,J0278,HCPCS,Facility,Inpatient,2 mL,mL,,34,28.9,9.7444,34,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
AMIKACIN 500 MG/2 ML INJ SOLN,,J0278,HCPCS,Facility,Both,2 mL,mL,,34,28.9,9.7444,34,Medica,Individual & Family,33.694,99.1,,percent of total billed charges,,
AMIKACIN 500 MG/2 ML INJ SOLN,,J0278,HCPCS,Facility,Both,2 mL,mL,,34,28.9,9.7444,34,Medica,Individual & Family,33.694,99.1,,percent of total billed charges,,
AMIKACIN 500 MG/2 ML INJ SOLN,,J0278,HCPCS,Facility,Outpatient,2 mL,mL,,34,28.9,9.7444,34,Medica,Medica Advantage Solution,16.932,49.8,,percent of total billed charges,,
AMIKACIN 500 MG/2 ML INJ SOLN,,J0278,HCPCS,Facility,Outpatient,2 mL,mL,,34,28.9,9.7444,34,Medica,Medica Advantage Solution,16.932,49.8,,percent of total billed charges,,
AMIKACIN 500 MG/2 ML INJ SOLN,,J0278,HCPCS,Facility,Inpatient,2 mL,mL,,34,28.9,9.7444,34,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
AMIKACIN 500 MG/2 ML INJ SOLN,,J0278,HCPCS,Facility,Inpatient,2 mL,mL,,34,28.9,9.7444,34,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
AMIKACIN 500 MG/2 ML INJ SOLN,,J0278,HCPCS,Facility,Outpatient,2 mL,mL,,34,28.9,9.7444,34,Medica,Medical Assistance,15.164,44.6,,percent of total billed charges,,
AMIKACIN 500 MG/2 ML INJ SOLN,,J0278,HCPCS,Facility,Outpatient,2 mL,mL,,34,28.9,9.7444,34,Medica,Medical Assistance,15.164,44.6,,percent of total billed charges,,
AMIKACIN 500 MG/2 ML INJ SOLN,,J0278,HCPCS,Facility,Inpatient,2 mL,mL,,34,28.9,9.7444,34,Medica,Medical Assistance,,,,,Included in per diem rate,
AMIKACIN 500 MG/2 ML INJ SOLN,,J0278,HCPCS,Facility,Inpatient,2 mL,mL,,34,28.9,9.7444,34,Medica,Medical Assistance,,,,,Included in per diem rate,
AMIKACIN 500 MG/2 ML INJ SOLN,,J0278,HCPCS,Facility,Outpatient,2 mL,mL,,34,28.9,9.7444,34,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,16.932,49.8,,percent of total billed charges,,
AMIKACIN 500 MG/2 ML INJ SOLN,,J0278,HCPCS,Facility,Outpatient,2 mL,mL,,34,28.9,9.7444,34,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,16.932,49.8,,percent of total billed charges,,
AMIKACIN 500 MG/2 ML INJ SOLN,,J0278,HCPCS,Facility,Inpatient,2 mL,mL,,34,28.9,9.7444,34,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
AMIKACIN 500 MG/2 ML INJ SOLN,,J0278,HCPCS,Facility,Inpatient,2 mL,mL,,34,28.9,9.7444,34,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
AMIKACIN 500 MG/2 ML INJ SOLN,,J0278,HCPCS,Facility,Both,2 mL,mL,,34,28.9,9.7444,34,"Multiplan, Inc.","Multiplan, Inc.",31.96,94,,percent of total billed charges,,
AMIKACIN 500 MG/2 ML INJ SOLN,,J0278,HCPCS,Facility,Both,2 mL,mL,,34,28.9,9.7444,34,"Multiplan, Inc.","Multiplan, Inc.",31.96,94,,percent of total billed charges,,
AMIKACIN 500 MG/2 ML INJ SOLN,,J0278,HCPCS,Facility,Outpatient,2 mL,mL,,34,28.9,9.7444,34,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,30.634,90.1,,percent of total billed charges,,
AMIKACIN 500 MG/2 ML INJ SOLN,,J0278,HCPCS,Facility,Outpatient,2 mL,mL,,34,28.9,9.7444,34,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,30.634,90.1,,percent of total billed charges,,
AMIKACIN 500 MG/2 ML INJ SOLN,,J0278,HCPCS,Facility,Inpatient,2 mL,mL,,34,28.9,9.7444,34,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
AMIKACIN 500 MG/2 ML INJ SOLN,,J0278,HCPCS,Facility,Inpatient,2 mL,mL,,34,28.9,9.7444,34,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
AMIKACIN 500 MG/2 ML INJ SOLN,,J0278,HCPCS,Facility,Both,2 mL,mL,,34,28.9,9.7444,34,"Preferred One Administrative Services, INC.",PPO,33.524,98.6,,percent of total billed charges,,
AMIKACIN 500 MG/2 ML INJ SOLN,,J0278,HCPCS,Facility,Both,2 mL,mL,,34,28.9,9.7444,34,"Preferred One Administrative Services, INC.",PPO,33.524,98.6,,percent of total billed charges,,
AMIKACIN 500 MG/2 ML INJ SOLN,,J0278,HCPCS,Facility,Outpatient,2 mL,mL,,34,28.9,9.7444,34,PrimeWest Health,Minnesota Senior Health Options (MSHO),17.493,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
AMIKACIN 500 MG/2 ML INJ SOLN,,J0278,HCPCS,Facility,Outpatient,2 mL,mL,,34,28.9,9.7444,34,PrimeWest Health,Minnesota Senior Health Options (MSHO),17.493,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
AMIKACIN 500 MG/2 ML INJ SOLN,,J0278,HCPCS,Facility,Inpatient,2 mL,mL,,34,28.9,9.7444,34,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
AMIKACIN 500 MG/2 ML INJ SOLN,,J0278,HCPCS,Facility,Inpatient,2 mL,mL,,34,28.9,9.7444,34,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
AMIKACIN 500 MG/2 ML INJ SOLN,,J0278,HCPCS,Facility,Outpatient,2 mL,mL,,34,28.9,9.7444,34,PrimeWest Health,MinnesotaCare,17.4624,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
AMIKACIN 500 MG/2 ML INJ SOLN,,J0278,HCPCS,Facility,Outpatient,2 mL,mL,,34,28.9,9.7444,34,PrimeWest Health,MinnesotaCare,17.4624,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
AMIKACIN 500 MG/2 ML INJ SOLN,,J0278,HCPCS,Facility,Inpatient,2 mL,mL,,34,28.9,9.7444,34,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
AMIKACIN 500 MG/2 ML INJ SOLN,,J0278,HCPCS,Facility,Inpatient,2 mL,mL,,34,28.9,9.7444,34,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
AMIKACIN 500 MG/2 ML INJ SOLN,,J0278,HCPCS,Facility,Both,2 mL,mL,,34,28.9,9.7444,34,Sanford Health Plan,Sanford Health Plan,31.28,92,,percent of total billed charges,,
AMIKACIN 500 MG/2 ML INJ SOLN,,J0278,HCPCS,Facility,Both,2 mL,mL,,34,28.9,9.7444,34,Sanford Health Plan,Sanford Health Plan,31.28,92,,percent of total billed charges,,
AMIKACIN 500 MG/2 ML INJ SOLN,,J0278,HCPCS,Facility,Outpatient,2 mL,mL,,34,28.9,9.7444,34,"UCare Health, Inc.",Individual & Family Plan,19.159,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
AMIKACIN 500 MG/2 ML INJ SOLN,,J0278,HCPCS,Facility,Outpatient,2 mL,mL,,34,28.9,9.7444,34,"UCare Health, Inc.",Individual & Family Plan,19.159,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
AMIKACIN 500 MG/2 ML INJ SOLN,,J0278,HCPCS,Facility,Inpatient,2 mL,mL,,34,28.9,9.7444,34,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
AMIKACIN 500 MG/2 ML INJ SOLN,,J0278,HCPCS,Facility,Inpatient,2 mL,mL,,34,28.9,9.7444,34,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
AMIKACIN 500 MG/2 ML INJ SOLN,,J0278,HCPCS,Facility,Outpatient,2 mL,mL,,34,28.9,9.7444,34,"UCare Health, Inc.",Medical Assistance,17.1598,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
AMIKACIN 500 MG/2 ML INJ SOLN,,J0278,HCPCS,Facility,Outpatient,2 mL,mL,,34,28.9,9.7444,34,"UCare Health, Inc.",Medical Assistance,17.1598,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
AMIKACIN 500 MG/2 ML INJ SOLN,,J0278,HCPCS,Facility,Inpatient,2 mL,mL,,34,28.9,9.7444,34,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
AMIKACIN 500 MG/2 ML INJ SOLN,,J0278,HCPCS,Facility,Inpatient,2 mL,mL,,34,28.9,9.7444,34,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
AMIKACIN 500 MG/2 ML INJ SOLN,,J0278,HCPCS,Facility,Outpatient,2 mL,mL,,34,28.9,9.7444,34,"UCare Health, Inc.",Medicare Advantage,17.1598,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
AMIKACIN 500 MG/2 ML INJ SOLN,,J0278,HCPCS,Facility,Outpatient,2 mL,mL,,34,28.9,9.7444,34,"UCare Health, Inc.",Medicare Advantage,17.1598,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
AMIKACIN 500 MG/2 ML INJ SOLN,,J0278,HCPCS,Facility,Inpatient,2 mL,mL,,34,28.9,9.7444,34,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
AMIKACIN 500 MG/2 ML INJ SOLN,,J0278,HCPCS,Facility,Inpatient,2 mL,mL,,34,28.9,9.7444,34,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
AMIKACIN 500 MG/2 ML INJ SOLN,,J0278,HCPCS,Facility,Outpatient,2 mL,mL,,34,28.9,9.7444,34,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),17.1598,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
AMIKACIN 500 MG/2 ML INJ SOLN,,J0278,HCPCS,Facility,Outpatient,2 mL,mL,,34,28.9,9.7444,34,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),17.1598,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
AMIKACIN 500 MG/2 ML INJ SOLN,,J0278,HCPCS,Facility,Inpatient,2 mL,mL,,34,28.9,9.7444,34,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
AMIKACIN 500 MG/2 ML INJ SOLN,,J0278,HCPCS,Facility,Inpatient,2 mL,mL,,34,28.9,9.7444,34,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
AMIKACIN 500 MG/2 ML INJ SOLN,,J0278,HCPCS,Facility,Both,2 mL,mL,,34,28.9,9.7444,34,UnitedHealthcare,Individual & Family,31.96,94,,percent of total billed charges,,
AMIKACIN 500 MG/2 ML INJ SOLN,,J0278,HCPCS,Facility,Both,2 mL,mL,,34,28.9,9.7444,34,UnitedHealthcare,Individual & Family,31.96,94,,percent of total billed charges,,
AMIKACIN 500 MG/2 ML INJ SOLN,,J0278,HCPCS,Facility,Outpatient,2 mL,mL,,34,28.9,9.7444,34,UnitedHealthcare,Medicare Advantage,16.66,49,,percent of total billed charges,,
AMIKACIN 500 MG/2 ML INJ SOLN,,J0278,HCPCS,Facility,Outpatient,2 mL,mL,,34,28.9,9.7444,34,UnitedHealthcare,Medicare Advantage,16.66,49,,percent of total billed charges,,
AMIKACIN 500 MG/2 ML INJ SOLN,,J0278,HCPCS,Facility,Inpatient,2 mL,mL,,34,28.9,9.7444,34,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
AMIKACIN 500 MG/2 ML INJ SOLN,,J0278,HCPCS,Facility,Inpatient,2 mL,mL,,34,28.9,9.7444,34,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
AMIKACIN 500 MG/2 ML INJ SOLN,,J0278,HCPCS,Facility,Outpatient,2 mL,mL,,34,28.9,9.7444,34,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,16.32,48,,percent of total billed charges,,100% of DHS outpatient percentage
AMIKACIN 500 MG/2 ML INJ SOLN,,J0278,HCPCS,Facility,Outpatient,2 mL,mL,,34,28.9,9.7444,34,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,16.32,48,,percent of total billed charges,,100% of DHS outpatient percentage
AMIKACIN 500 MG/2 ML INJ SOLN,,J0278,HCPCS,Facility,Inpatient,2 mL,mL,,34,28.9,9.7444,34,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
AMIKACIN 500 MG/2 ML INJ SOLN,,J0278,HCPCS,Facility,Inpatient,2 mL,mL,,34,28.9,9.7444,34,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"PENICILLIN G BENZATHIN,PROCAIN 1,200,000 UNIT/ 2 ML(600K/600K) IM SYRG",,J0558,HCPCS,Facility,Both,2 mL,mL,,941,799.85,269.6906,941,Aetna,Commercial,865.72,92,,percent of total billed charges,,
"PENICILLIN G BENZATHIN,PROCAIN 1,200,000 UNIT/ 2 ML(600K/600K) IM SYRG",,J0558,HCPCS,Facility,Outpatient,2 mL,mL,,941,799.85,269.6906,941,Aetna,Medicare Advantage,461.09,49,,percent of total billed charges,,
"PENICILLIN G BENZATHIN,PROCAIN 1,200,000 UNIT/ 2 ML(600K/600K) IM SYRG",,J0558,HCPCS,Facility,Inpatient,2 mL,mL,,941,799.85,269.6906,941,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"PENICILLIN G BENZATHIN,PROCAIN 1,200,000 UNIT/ 2 ML(600K/600K) IM SYRG",,J0558,HCPCS,Facility,Both,2 mL,mL,,941,799.85,269.6906,941,Aetna,PPO,875.13,93,,percent of total billed charges,,
"PENICILLIN G BENZATHIN,PROCAIN 1,200,000 UNIT/ 2 ML(600K/600K) IM SYRG",,J0558,HCPCS,Facility,Both,2 mL,mL,,941,799.85,269.6906,941,America's PPO,America's PPO,903.6423,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"PENICILLIN G BENZATHIN,PROCAIN 1,200,000 UNIT/ 2 ML(600K/600K) IM SYRG",,J0558,HCPCS,Facility,Both,2 mL,mL,,941,799.85,269.6906,941,BlueCross BlueShield Minnesota, Federal Employee Program,925.944,98.4,,percent of total billed charges,,
"PENICILLIN G BENZATHIN,PROCAIN 1,200,000 UNIT/ 2 ML(600K/600K) IM SYRG",,J0558,HCPCS,Facility,Both,2 mL,mL,,941,799.85,269.6906,941,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,941,100,,percent of total billed charges,,
"PENICILLIN G BENZATHIN,PROCAIN 1,200,000 UNIT/ 2 ML(600K/600K) IM SYRG",,J0558,HCPCS,Facility,Both,2 mL,mL,,941,799.85,269.6906,941,BlueCross BlueShield Minnesota,High Value Network Plan,846.9,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
"PENICILLIN G BENZATHIN,PROCAIN 1,200,000 UNIT/ 2 ML(600K/600K) IM SYRG",,J0558,HCPCS,Facility,Outpatient,2 mL,mL,,941,799.85,269.6906,941,BlueCross BlueShield Minnesota,Medicare Advantage,461.09,49,,percent of total billed charges,,
"PENICILLIN G BENZATHIN,PROCAIN 1,200,000 UNIT/ 2 ML(600K/600K) IM SYRG",,J0558,HCPCS,Facility,Inpatient,2 mL,mL,,941,799.85,269.6906,941,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"PENICILLIN G BENZATHIN,PROCAIN 1,200,000 UNIT/ 2 ML(600K/600K) IM SYRG",,J0558,HCPCS,Facility,Both,2 mL,mL,,941,799.85,269.6906,941,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,833.4437,88.57,,percent of total billed charges,,
"PENICILLIN G BENZATHIN,PROCAIN 1,200,000 UNIT/ 2 ML(600K/600K) IM SYRG",,J0558,HCPCS,Facility,Both,2 mL,mL,,941,799.85,269.6906,941,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,269.6906,28.66,,percent of total billed charges,,
"PENICILLIN G BENZATHIN,PROCAIN 1,200,000 UNIT/ 2 ML(600K/600K) IM SYRG",,J0558,HCPCS,Facility,Outpatient,2 mL,mL,,941,799.85,269.6906,941,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),461.09,49,,percent of total billed charges,,
"PENICILLIN G BENZATHIN,PROCAIN 1,200,000 UNIT/ 2 ML(600K/600K) IM SYRG",,J0558,HCPCS,Facility,Inpatient,2 mL,mL,,941,799.85,269.6906,941,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"PENICILLIN G BENZATHIN,PROCAIN 1,200,000 UNIT/ 2 ML(600K/600K) IM SYRG",,J0558,HCPCS,Facility,Both,2 mL,mL,,941,799.85,269.6906,941,CorVel,Worker's Compensation,941,100,,percent of total billed charges,,
"PENICILLIN G BENZATHIN,PROCAIN 1,200,000 UNIT/ 2 ML(600K/600K) IM SYRG",,J0558,HCPCS,Facility,Both,2 mL,mL,,941,799.85,269.6906,941,First Health Group Corporation,First Health Network,912.77,97,,percent of total billed charges,,
"PENICILLIN G BENZATHIN,PROCAIN 1,200,000 UNIT/ 2 ML(600K/600K) IM SYRG",,J0558,HCPCS,Facility,Both,2 mL,mL,,941,799.85,269.6906,941,"Health Partners, Inc.",Commercial,890.186,94.6,,percent of total billed charges,,
"PENICILLIN G BENZATHIN,PROCAIN 1,200,000 UNIT/ 2 ML(600K/600K) IM SYRG",,J0558,HCPCS,Facility,Outpatient,2 mL,mL,,941,799.85,269.6906,941,"Health Partners, Inc.",Medicare Advantage,461.09,49,,percent of total billed charges,,
"PENICILLIN G BENZATHIN,PROCAIN 1,200,000 UNIT/ 2 ML(600K/600K) IM SYRG",,J0558,HCPCS,Facility,Inpatient,2 mL,mL,,941,799.85,269.6906,941,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"PENICILLIN G BENZATHIN,PROCAIN 1,200,000 UNIT/ 2 ML(600K/600K) IM SYRG",,J0558,HCPCS,Facility,Both,2 mL,mL,,941,799.85,269.6906,941,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),564.6,60,,percent of total billed charges,,
"PENICILLIN G BENZATHIN,PROCAIN 1,200,000 UNIT/ 2 ML(600K/600K) IM SYRG",,J0558,HCPCS,Facility,Both,2 mL,mL,,941,799.85,269.6906,941,"Health Partners, Inc.",State of Minnesota Advantage Program,766.915,81.5,,percent of total billed charges,,
"PENICILLIN G BENZATHIN,PROCAIN 1,200,000 UNIT/ 2 ML(600K/600K) IM SYRG",,J0558,HCPCS,Facility,Both,2 mL,mL,,941,799.85,269.6906,941,"Health Partners, Inc.",State Public Programs,470.5,50,,percent of total billed charges,,
"PENICILLIN G BENZATHIN,PROCAIN 1,200,000 UNIT/ 2 ML(600K/600K) IM SYRG",,J0558,HCPCS,Facility,Both,2 mL,mL,,941,799.85,269.6906,941,Humana Insurance Company,Commercial PPO,893.95,95,,percent of total billed charges,,
"PENICILLIN G BENZATHIN,PROCAIN 1,200,000 UNIT/ 2 ML(600K/600K) IM SYRG",,J0558,HCPCS,Facility,Outpatient,2 mL,mL,,941,799.85,269.6906,941,Humana Insurance Company,Medicare PPO,461.09,49,,percent of total billed charges,,
"PENICILLIN G BENZATHIN,PROCAIN 1,200,000 UNIT/ 2 ML(600K/600K) IM SYRG",,J0558,HCPCS,Facility,Inpatient,2 mL,mL,,941,799.85,269.6906,941,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"PENICILLIN G BENZATHIN,PROCAIN 1,200,000 UNIT/ 2 ML(600K/600K) IM SYRG",,J0558,HCPCS,Facility,Both,2 mL,mL,,941,799.85,269.6906,941,Medica,Individual & Family,932.531,99.1,,percent of total billed charges,,
"PENICILLIN G BENZATHIN,PROCAIN 1,200,000 UNIT/ 2 ML(600K/600K) IM SYRG",,J0558,HCPCS,Facility,Outpatient,2 mL,mL,,941,799.85,269.6906,941,Medica,Medica Advantage Solution,468.618,49.8,,percent of total billed charges,,
"PENICILLIN G BENZATHIN,PROCAIN 1,200,000 UNIT/ 2 ML(600K/600K) IM SYRG",,J0558,HCPCS,Facility,Inpatient,2 mL,mL,,941,799.85,269.6906,941,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"PENICILLIN G BENZATHIN,PROCAIN 1,200,000 UNIT/ 2 ML(600K/600K) IM SYRG",,J0558,HCPCS,Facility,Outpatient,2 mL,mL,,941,799.85,269.6906,941,Medica,Medical Assistance,419.686,44.6,,percent of total billed charges,,
"PENICILLIN G BENZATHIN,PROCAIN 1,200,000 UNIT/ 2 ML(600K/600K) IM SYRG",,J0558,HCPCS,Facility,Inpatient,2 mL,mL,,941,799.85,269.6906,941,Medica,Medical Assistance,,,,,Included in per diem rate,
"PENICILLIN G BENZATHIN,PROCAIN 1,200,000 UNIT/ 2 ML(600K/600K) IM SYRG",,J0558,HCPCS,Facility,Outpatient,2 mL,mL,,941,799.85,269.6906,941,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,468.618,49.8,,percent of total billed charges,,
"PENICILLIN G BENZATHIN,PROCAIN 1,200,000 UNIT/ 2 ML(600K/600K) IM SYRG",,J0558,HCPCS,Facility,Inpatient,2 mL,mL,,941,799.85,269.6906,941,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"PENICILLIN G BENZATHIN,PROCAIN 1,200,000 UNIT/ 2 ML(600K/600K) IM SYRG",,J0558,HCPCS,Facility,Both,2 mL,mL,,941,799.85,269.6906,941,"Multiplan, Inc.","Multiplan, Inc.",884.54,94,,percent of total billed charges,,
"PENICILLIN G BENZATHIN,PROCAIN 1,200,000 UNIT/ 2 ML(600K/600K) IM SYRG",,J0558,HCPCS,Facility,Outpatient,2 mL,mL,,941,799.85,269.6906,941,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,847.841,90.1,,percent of total billed charges,,
"PENICILLIN G BENZATHIN,PROCAIN 1,200,000 UNIT/ 2 ML(600K/600K) IM SYRG",,J0558,HCPCS,Facility,Inpatient,2 mL,mL,,941,799.85,269.6906,941,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"PENICILLIN G BENZATHIN,PROCAIN 1,200,000 UNIT/ 2 ML(600K/600K) IM SYRG",,J0558,HCPCS,Facility,Both,2 mL,mL,,941,799.85,269.6906,941,"Preferred One Administrative Services, INC.",PPO,927.826,98.6,,percent of total billed charges,,
"PENICILLIN G BENZATHIN,PROCAIN 1,200,000 UNIT/ 2 ML(600K/600K) IM SYRG",,J0558,HCPCS,Facility,Outpatient,2 mL,mL,,941,799.85,269.6906,941,PrimeWest Health,Minnesota Senior Health Options (MSHO),484.1445,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"PENICILLIN G BENZATHIN,PROCAIN 1,200,000 UNIT/ 2 ML(600K/600K) IM SYRG",,J0558,HCPCS,Facility,Inpatient,2 mL,mL,,941,799.85,269.6906,941,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"PENICILLIN G BENZATHIN,PROCAIN 1,200,000 UNIT/ 2 ML(600K/600K) IM SYRG",,J0558,HCPCS,Facility,Outpatient,2 mL,mL,,941,799.85,269.6906,941,PrimeWest Health,MinnesotaCare,483.2976,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"PENICILLIN G BENZATHIN,PROCAIN 1,200,000 UNIT/ 2 ML(600K/600K) IM SYRG",,J0558,HCPCS,Facility,Inpatient,2 mL,mL,,941,799.85,269.6906,941,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"PENICILLIN G BENZATHIN,PROCAIN 1,200,000 UNIT/ 2 ML(600K/600K) IM SYRG",,J0558,HCPCS,Facility,Both,2 mL,mL,,941,799.85,269.6906,941,Sanford Health Plan,Sanford Health Plan,865.72,92,,percent of total billed charges,,
"PENICILLIN G BENZATHIN,PROCAIN 1,200,000 UNIT/ 2 ML(600K/600K) IM SYRG",,J0558,HCPCS,Facility,Outpatient,2 mL,mL,,941,799.85,269.6906,941,"UCare Health, Inc.",Individual & Family Plan,530.2535,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"PENICILLIN G BENZATHIN,PROCAIN 1,200,000 UNIT/ 2 ML(600K/600K) IM SYRG",,J0558,HCPCS,Facility,Inpatient,2 mL,mL,,941,799.85,269.6906,941,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"PENICILLIN G BENZATHIN,PROCAIN 1,200,000 UNIT/ 2 ML(600K/600K) IM SYRG",,J0558,HCPCS,Facility,Outpatient,2 mL,mL,,941,799.85,269.6906,941,"UCare Health, Inc.",Medical Assistance,474.9227,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"PENICILLIN G BENZATHIN,PROCAIN 1,200,000 UNIT/ 2 ML(600K/600K) IM SYRG",,J0558,HCPCS,Facility,Inpatient,2 mL,mL,,941,799.85,269.6906,941,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"PENICILLIN G BENZATHIN,PROCAIN 1,200,000 UNIT/ 2 ML(600K/600K) IM SYRG",,J0558,HCPCS,Facility,Outpatient,2 mL,mL,,941,799.85,269.6906,941,"UCare Health, Inc.",Medicare Advantage,474.9227,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"PENICILLIN G BENZATHIN,PROCAIN 1,200,000 UNIT/ 2 ML(600K/600K) IM SYRG",,J0558,HCPCS,Facility,Inpatient,2 mL,mL,,941,799.85,269.6906,941,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"PENICILLIN G BENZATHIN,PROCAIN 1,200,000 UNIT/ 2 ML(600K/600K) IM SYRG",,J0558,HCPCS,Facility,Outpatient,2 mL,mL,,941,799.85,269.6906,941,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),474.9227,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"PENICILLIN G BENZATHIN,PROCAIN 1,200,000 UNIT/ 2 ML(600K/600K) IM SYRG",,J0558,HCPCS,Facility,Inpatient,2 mL,mL,,941,799.85,269.6906,941,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"PENICILLIN G BENZATHIN,PROCAIN 1,200,000 UNIT/ 2 ML(600K/600K) IM SYRG",,J0558,HCPCS,Facility,Both,2 mL,mL,,941,799.85,269.6906,941,UnitedHealthcare,Individual & Family,884.54,94,,percent of total billed charges,,
"PENICILLIN G BENZATHIN,PROCAIN 1,200,000 UNIT/ 2 ML(600K/600K) IM SYRG",,J0558,HCPCS,Facility,Outpatient,2 mL,mL,,941,799.85,269.6906,941,UnitedHealthcare,Medicare Advantage,461.09,49,,percent of total billed charges,,
"PENICILLIN G BENZATHIN,PROCAIN 1,200,000 UNIT/ 2 ML(600K/600K) IM SYRG",,J0558,HCPCS,Facility,Inpatient,2 mL,mL,,941,799.85,269.6906,941,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"PENICILLIN G BENZATHIN,PROCAIN 1,200,000 UNIT/ 2 ML(600K/600K) IM SYRG",,J0558,HCPCS,Facility,Outpatient,2 mL,mL,,941,799.85,269.6906,941,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,451.68,48,,percent of total billed charges,,100% of DHS outpatient percentage
"PENICILLIN G BENZATHIN,PROCAIN 1,200,000 UNIT/ 2 ML(600K/600K) IM SYRG",,J0558,HCPCS,Facility,Inpatient,2 mL,mL,,941,799.85,269.6906,941,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"PENICILLIN G BENZATHIN,PROCAIN 1,200,000 UNIT/ 2 ML(900K/300K) IM SYRG",,J0558,HCPCS,Facility,Both,2 mL,mL,,941,799.85,269.6906,941,Aetna,Commercial,865.72,92,,percent of total billed charges,,
"PENICILLIN G BENZATHIN,PROCAIN 1,200,000 UNIT/ 2 ML(900K/300K) IM SYRG",,J0558,HCPCS,Facility,Outpatient,2 mL,mL,,941,799.85,269.6906,941,Aetna,Medicare Advantage,461.09,49,,percent of total billed charges,,
"PENICILLIN G BENZATHIN,PROCAIN 1,200,000 UNIT/ 2 ML(900K/300K) IM SYRG",,J0558,HCPCS,Facility,Inpatient,2 mL,mL,,941,799.85,269.6906,941,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"PENICILLIN G BENZATHIN,PROCAIN 1,200,000 UNIT/ 2 ML(900K/300K) IM SYRG",,J0558,HCPCS,Facility,Both,2 mL,mL,,941,799.85,269.6906,941,Aetna,PPO,875.13,93,,percent of total billed charges,,
"PENICILLIN G BENZATHIN,PROCAIN 1,200,000 UNIT/ 2 ML(900K/300K) IM SYRG",,J0558,HCPCS,Facility,Both,2 mL,mL,,941,799.85,269.6906,941,America's PPO,America's PPO,903.6423,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"PENICILLIN G BENZATHIN,PROCAIN 1,200,000 UNIT/ 2 ML(900K/300K) IM SYRG",,J0558,HCPCS,Facility,Both,2 mL,mL,,941,799.85,269.6906,941,BlueCross BlueShield Minnesota, Federal Employee Program,925.944,98.4,,percent of total billed charges,,
"PENICILLIN G BENZATHIN,PROCAIN 1,200,000 UNIT/ 2 ML(900K/300K) IM SYRG",,J0558,HCPCS,Facility,Both,2 mL,mL,,941,799.85,269.6906,941,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,941,100,,percent of total billed charges,,
"PENICILLIN G BENZATHIN,PROCAIN 1,200,000 UNIT/ 2 ML(900K/300K) IM SYRG",,J0558,HCPCS,Facility,Both,2 mL,mL,,941,799.85,269.6906,941,BlueCross BlueShield Minnesota,High Value Network Plan,846.9,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
"PENICILLIN G BENZATHIN,PROCAIN 1,200,000 UNIT/ 2 ML(900K/300K) IM SYRG",,J0558,HCPCS,Facility,Outpatient,2 mL,mL,,941,799.85,269.6906,941,BlueCross BlueShield Minnesota,Medicare Advantage,461.09,49,,percent of total billed charges,,
"PENICILLIN G BENZATHIN,PROCAIN 1,200,000 UNIT/ 2 ML(900K/300K) IM SYRG",,J0558,HCPCS,Facility,Inpatient,2 mL,mL,,941,799.85,269.6906,941,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"PENICILLIN G BENZATHIN,PROCAIN 1,200,000 UNIT/ 2 ML(900K/300K) IM SYRG",,J0558,HCPCS,Facility,Both,2 mL,mL,,941,799.85,269.6906,941,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,833.4437,88.57,,percent of total billed charges,,
"PENICILLIN G BENZATHIN,PROCAIN 1,200,000 UNIT/ 2 ML(900K/300K) IM SYRG",,J0558,HCPCS,Facility,Both,2 mL,mL,,941,799.85,269.6906,941,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,269.6906,28.66,,percent of total billed charges,,
"PENICILLIN G BENZATHIN,PROCAIN 1,200,000 UNIT/ 2 ML(900K/300K) IM SYRG",,J0558,HCPCS,Facility,Outpatient,2 mL,mL,,941,799.85,269.6906,941,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),461.09,49,,percent of total billed charges,,
"PENICILLIN G BENZATHIN,PROCAIN 1,200,000 UNIT/ 2 ML(900K/300K) IM SYRG",,J0558,HCPCS,Facility,Inpatient,2 mL,mL,,941,799.85,269.6906,941,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"PENICILLIN G BENZATHIN,PROCAIN 1,200,000 UNIT/ 2 ML(900K/300K) IM SYRG",,J0558,HCPCS,Facility,Both,2 mL,mL,,941,799.85,269.6906,941,CorVel,Worker's Compensation,941,100,,percent of total billed charges,,
"PENICILLIN G BENZATHIN,PROCAIN 1,200,000 UNIT/ 2 ML(900K/300K) IM SYRG",,J0558,HCPCS,Facility,Both,2 mL,mL,,941,799.85,269.6906,941,First Health Group Corporation,First Health Network,912.77,97,,percent of total billed charges,,
"PENICILLIN G BENZATHIN,PROCAIN 1,200,000 UNIT/ 2 ML(900K/300K) IM SYRG",,J0558,HCPCS,Facility,Both,2 mL,mL,,941,799.85,269.6906,941,"Health Partners, Inc.",Commercial,890.186,94.6,,percent of total billed charges,,
"PENICILLIN G BENZATHIN,PROCAIN 1,200,000 UNIT/ 2 ML(900K/300K) IM SYRG",,J0558,HCPCS,Facility,Outpatient,2 mL,mL,,941,799.85,269.6906,941,"Health Partners, Inc.",Medicare Advantage,461.09,49,,percent of total billed charges,,
"PENICILLIN G BENZATHIN,PROCAIN 1,200,000 UNIT/ 2 ML(900K/300K) IM SYRG",,J0558,HCPCS,Facility,Inpatient,2 mL,mL,,941,799.85,269.6906,941,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"PENICILLIN G BENZATHIN,PROCAIN 1,200,000 UNIT/ 2 ML(900K/300K) IM SYRG",,J0558,HCPCS,Facility,Both,2 mL,mL,,941,799.85,269.6906,941,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),564.6,60,,percent of total billed charges,,
"PENICILLIN G BENZATHIN,PROCAIN 1,200,000 UNIT/ 2 ML(900K/300K) IM SYRG",,J0558,HCPCS,Facility,Both,2 mL,mL,,941,799.85,269.6906,941,"Health Partners, Inc.",State of Minnesota Advantage Program,766.915,81.5,,percent of total billed charges,,
"PENICILLIN G BENZATHIN,PROCAIN 1,200,000 UNIT/ 2 ML(900K/300K) IM SYRG",,J0558,HCPCS,Facility,Both,2 mL,mL,,941,799.85,269.6906,941,"Health Partners, Inc.",State Public Programs,470.5,50,,percent of total billed charges,,
"PENICILLIN G BENZATHIN,PROCAIN 1,200,000 UNIT/ 2 ML(900K/300K) IM SYRG",,J0558,HCPCS,Facility,Both,2 mL,mL,,941,799.85,269.6906,941,Humana Insurance Company,Commercial PPO,893.95,95,,percent of total billed charges,,
"PENICILLIN G BENZATHIN,PROCAIN 1,200,000 UNIT/ 2 ML(900K/300K) IM SYRG",,J0558,HCPCS,Facility,Outpatient,2 mL,mL,,941,799.85,269.6906,941,Humana Insurance Company,Medicare PPO,461.09,49,,percent of total billed charges,,
"PENICILLIN G BENZATHIN,PROCAIN 1,200,000 UNIT/ 2 ML(900K/300K) IM SYRG",,J0558,HCPCS,Facility,Inpatient,2 mL,mL,,941,799.85,269.6906,941,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"PENICILLIN G BENZATHIN,PROCAIN 1,200,000 UNIT/ 2 ML(900K/300K) IM SYRG",,J0558,HCPCS,Facility,Both,2 mL,mL,,941,799.85,269.6906,941,Medica,Individual & Family,932.531,99.1,,percent of total billed charges,,
"PENICILLIN G BENZATHIN,PROCAIN 1,200,000 UNIT/ 2 ML(900K/300K) IM SYRG",,J0558,HCPCS,Facility,Outpatient,2 mL,mL,,941,799.85,269.6906,941,Medica,Medica Advantage Solution,468.618,49.8,,percent of total billed charges,,
"PENICILLIN G BENZATHIN,PROCAIN 1,200,000 UNIT/ 2 ML(900K/300K) IM SYRG",,J0558,HCPCS,Facility,Inpatient,2 mL,mL,,941,799.85,269.6906,941,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"PENICILLIN G BENZATHIN,PROCAIN 1,200,000 UNIT/ 2 ML(900K/300K) IM SYRG",,J0558,HCPCS,Facility,Outpatient,2 mL,mL,,941,799.85,269.6906,941,Medica,Medical Assistance,419.686,44.6,,percent of total billed charges,,
"PENICILLIN G BENZATHIN,PROCAIN 1,200,000 UNIT/ 2 ML(900K/300K) IM SYRG",,J0558,HCPCS,Facility,Inpatient,2 mL,mL,,941,799.85,269.6906,941,Medica,Medical Assistance,,,,,Included in per diem rate,
"PENICILLIN G BENZATHIN,PROCAIN 1,200,000 UNIT/ 2 ML(900K/300K) IM SYRG",,J0558,HCPCS,Facility,Outpatient,2 mL,mL,,941,799.85,269.6906,941,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,468.618,49.8,,percent of total billed charges,,
"PENICILLIN G BENZATHIN,PROCAIN 1,200,000 UNIT/ 2 ML(900K/300K) IM SYRG",,J0558,HCPCS,Facility,Inpatient,2 mL,mL,,941,799.85,269.6906,941,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"PENICILLIN G BENZATHIN,PROCAIN 1,200,000 UNIT/ 2 ML(900K/300K) IM SYRG",,J0558,HCPCS,Facility,Both,2 mL,mL,,941,799.85,269.6906,941,"Multiplan, Inc.","Multiplan, Inc.",884.54,94,,percent of total billed charges,,
"PENICILLIN G BENZATHIN,PROCAIN 1,200,000 UNIT/ 2 ML(900K/300K) IM SYRG",,J0558,HCPCS,Facility,Outpatient,2 mL,mL,,941,799.85,269.6906,941,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,847.841,90.1,,percent of total billed charges,,
"PENICILLIN G BENZATHIN,PROCAIN 1,200,000 UNIT/ 2 ML(900K/300K) IM SYRG",,J0558,HCPCS,Facility,Inpatient,2 mL,mL,,941,799.85,269.6906,941,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"PENICILLIN G BENZATHIN,PROCAIN 1,200,000 UNIT/ 2 ML(900K/300K) IM SYRG",,J0558,HCPCS,Facility,Both,2 mL,mL,,941,799.85,269.6906,941,"Preferred One Administrative Services, INC.",PPO,927.826,98.6,,percent of total billed charges,,
"PENICILLIN G BENZATHIN,PROCAIN 1,200,000 UNIT/ 2 ML(900K/300K) IM SYRG",,J0558,HCPCS,Facility,Outpatient,2 mL,mL,,941,799.85,269.6906,941,PrimeWest Health,Minnesota Senior Health Options (MSHO),484.1445,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"PENICILLIN G BENZATHIN,PROCAIN 1,200,000 UNIT/ 2 ML(900K/300K) IM SYRG",,J0558,HCPCS,Facility,Inpatient,2 mL,mL,,941,799.85,269.6906,941,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"PENICILLIN G BENZATHIN,PROCAIN 1,200,000 UNIT/ 2 ML(900K/300K) IM SYRG",,J0558,HCPCS,Facility,Outpatient,2 mL,mL,,941,799.85,269.6906,941,PrimeWest Health,MinnesotaCare,483.2976,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"PENICILLIN G BENZATHIN,PROCAIN 1,200,000 UNIT/ 2 ML(900K/300K) IM SYRG",,J0558,HCPCS,Facility,Inpatient,2 mL,mL,,941,799.85,269.6906,941,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"PENICILLIN G BENZATHIN,PROCAIN 1,200,000 UNIT/ 2 ML(900K/300K) IM SYRG",,J0558,HCPCS,Facility,Both,2 mL,mL,,941,799.85,269.6906,941,Sanford Health Plan,Sanford Health Plan,865.72,92,,percent of total billed charges,,
"PENICILLIN G BENZATHIN,PROCAIN 1,200,000 UNIT/ 2 ML(900K/300K) IM SYRG",,J0558,HCPCS,Facility,Outpatient,2 mL,mL,,941,799.85,269.6906,941,"UCare Health, Inc.",Individual & Family Plan,530.2535,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"PENICILLIN G BENZATHIN,PROCAIN 1,200,000 UNIT/ 2 ML(900K/300K) IM SYRG",,J0558,HCPCS,Facility,Inpatient,2 mL,mL,,941,799.85,269.6906,941,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"PENICILLIN G BENZATHIN,PROCAIN 1,200,000 UNIT/ 2 ML(900K/300K) IM SYRG",,J0558,HCPCS,Facility,Outpatient,2 mL,mL,,941,799.85,269.6906,941,"UCare Health, Inc.",Medical Assistance,474.9227,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"PENICILLIN G BENZATHIN,PROCAIN 1,200,000 UNIT/ 2 ML(900K/300K) IM SYRG",,J0558,HCPCS,Facility,Inpatient,2 mL,mL,,941,799.85,269.6906,941,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"PENICILLIN G BENZATHIN,PROCAIN 1,200,000 UNIT/ 2 ML(900K/300K) IM SYRG",,J0558,HCPCS,Facility,Outpatient,2 mL,mL,,941,799.85,269.6906,941,"UCare Health, Inc.",Medicare Advantage,474.9227,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"PENICILLIN G BENZATHIN,PROCAIN 1,200,000 UNIT/ 2 ML(900K/300K) IM SYRG",,J0558,HCPCS,Facility,Inpatient,2 mL,mL,,941,799.85,269.6906,941,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"PENICILLIN G BENZATHIN,PROCAIN 1,200,000 UNIT/ 2 ML(900K/300K) IM SYRG",,J0558,HCPCS,Facility,Outpatient,2 mL,mL,,941,799.85,269.6906,941,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),474.9227,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"PENICILLIN G BENZATHIN,PROCAIN 1,200,000 UNIT/ 2 ML(900K/300K) IM SYRG",,J0558,HCPCS,Facility,Inpatient,2 mL,mL,,941,799.85,269.6906,941,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"PENICILLIN G BENZATHIN,PROCAIN 1,200,000 UNIT/ 2 ML(900K/300K) IM SYRG",,J0558,HCPCS,Facility,Both,2 mL,mL,,941,799.85,269.6906,941,UnitedHealthcare,Individual & Family,884.54,94,,percent of total billed charges,,
"PENICILLIN G BENZATHIN,PROCAIN 1,200,000 UNIT/ 2 ML(900K/300K) IM SYRG",,J0558,HCPCS,Facility,Outpatient,2 mL,mL,,941,799.85,269.6906,941,UnitedHealthcare,Medicare Advantage,461.09,49,,percent of total billed charges,,
"PENICILLIN G BENZATHIN,PROCAIN 1,200,000 UNIT/ 2 ML(900K/300K) IM SYRG",,J0558,HCPCS,Facility,Inpatient,2 mL,mL,,941,799.85,269.6906,941,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"PENICILLIN G BENZATHIN,PROCAIN 1,200,000 UNIT/ 2 ML(900K/300K) IM SYRG",,J0558,HCPCS,Facility,Outpatient,2 mL,mL,,941,799.85,269.6906,941,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,451.68,48,,percent of total billed charges,,100% of DHS outpatient percentage
"PENICILLIN G BENZATHIN,PROCAIN 1,200,000 UNIT/ 2 ML(900K/300K) IM SYRG",,J0558,HCPCS,Facility,Inpatient,2 mL,mL,,941,799.85,269.6906,941,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"PENICILLIN G BENZATHINE 1,200,000 UNIT/2 ML IM SYRG",,J0561,HCPCS,Facility,Both,2 mL,mL,,1089,925.65,312.1074,1089,Aetna,Commercial,1001.88,92,,percent of total billed charges,,
"PENICILLIN G BENZATHINE 1,200,000 UNIT/2 ML IM SYRG",,J0561,HCPCS,Facility,Outpatient,2 mL,mL,,1089,925.65,312.1074,1089,Aetna,Medicare Advantage,533.61,49,,percent of total billed charges,,
"PENICILLIN G BENZATHINE 1,200,000 UNIT/2 ML IM SYRG",,J0561,HCPCS,Facility,Inpatient,2 mL,mL,,1089,925.65,312.1074,1089,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"PENICILLIN G BENZATHINE 1,200,000 UNIT/2 ML IM SYRG",,J0561,HCPCS,Facility,Both,2 mL,mL,,1089,925.65,312.1074,1089,Aetna,PPO,1012.77,93,,percent of total billed charges,,
"PENICILLIN G BENZATHINE 1,200,000 UNIT/2 ML IM SYRG",,J0561,HCPCS,Facility,Both,2 mL,mL,,1089,925.65,312.1074,1089,America's PPO,America's PPO,1045.7667,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"PENICILLIN G BENZATHINE 1,200,000 UNIT/2 ML IM SYRG",,J0561,HCPCS,Facility,Both,2 mL,mL,,1089,925.65,312.1074,1089,BlueCross BlueShield Minnesota, Federal Employee Program,1071.576,98.4,,percent of total billed charges,,
"PENICILLIN G BENZATHINE 1,200,000 UNIT/2 ML IM SYRG",,J0561,HCPCS,Facility,Both,2 mL,mL,,1089,925.65,312.1074,1089,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1089,100,,percent of total billed charges,,
"PENICILLIN G BENZATHINE 1,200,000 UNIT/2 ML IM SYRG",,J0561,HCPCS,Facility,Both,2 mL,mL,,1089,925.65,312.1074,1089,BlueCross BlueShield Minnesota,High Value Network Plan,980.1,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
"PENICILLIN G BENZATHINE 1,200,000 UNIT/2 ML IM SYRG",,J0561,HCPCS,Facility,Outpatient,2 mL,mL,,1089,925.65,312.1074,1089,BlueCross BlueShield Minnesota,Medicare Advantage,533.61,49,,percent of total billed charges,,
"PENICILLIN G BENZATHINE 1,200,000 UNIT/2 ML IM SYRG",,J0561,HCPCS,Facility,Inpatient,2 mL,mL,,1089,925.65,312.1074,1089,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"PENICILLIN G BENZATHINE 1,200,000 UNIT/2 ML IM SYRG",,J0561,HCPCS,Facility,Both,2 mL,mL,,1089,925.65,312.1074,1089,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,964.5273,88.57,,percent of total billed charges,,
"PENICILLIN G BENZATHINE 1,200,000 UNIT/2 ML IM SYRG",,J0561,HCPCS,Facility,Both,2 mL,mL,,1089,925.65,312.1074,1089,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,312.1074,28.66,,percent of total billed charges,,
"PENICILLIN G BENZATHINE 1,200,000 UNIT/2 ML IM SYRG",,J0561,HCPCS,Facility,Outpatient,2 mL,mL,,1089,925.65,312.1074,1089,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),533.61,49,,percent of total billed charges,,
"PENICILLIN G BENZATHINE 1,200,000 UNIT/2 ML IM SYRG",,J0561,HCPCS,Facility,Inpatient,2 mL,mL,,1089,925.65,312.1074,1089,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"PENICILLIN G BENZATHINE 1,200,000 UNIT/2 ML IM SYRG",,J0561,HCPCS,Facility,Both,2 mL,mL,,1089,925.65,312.1074,1089,CorVel,Worker's Compensation,1089,100,,percent of total billed charges,,
"PENICILLIN G BENZATHINE 1,200,000 UNIT/2 ML IM SYRG",,J0561,HCPCS,Facility,Both,2 mL,mL,,1089,925.65,312.1074,1089,First Health Group Corporation,First Health Network,1056.33,97,,percent of total billed charges,,
"PENICILLIN G BENZATHINE 1,200,000 UNIT/2 ML IM SYRG",,J0561,HCPCS,Facility,Both,2 mL,mL,,1089,925.65,312.1074,1089,"Health Partners, Inc.",Commercial,1030.194,94.6,,percent of total billed charges,,
"PENICILLIN G BENZATHINE 1,200,000 UNIT/2 ML IM SYRG",,J0561,HCPCS,Facility,Outpatient,2 mL,mL,,1089,925.65,312.1074,1089,"Health Partners, Inc.",Medicare Advantage,533.61,49,,percent of total billed charges,,
"PENICILLIN G BENZATHINE 1,200,000 UNIT/2 ML IM SYRG",,J0561,HCPCS,Facility,Inpatient,2 mL,mL,,1089,925.65,312.1074,1089,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"PENICILLIN G BENZATHINE 1,200,000 UNIT/2 ML IM SYRG",,J0561,HCPCS,Facility,Both,2 mL,mL,,1089,925.65,312.1074,1089,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),653.4,60,,percent of total billed charges,,
"PENICILLIN G BENZATHINE 1,200,000 UNIT/2 ML IM SYRG",,J0561,HCPCS,Facility,Both,2 mL,mL,,1089,925.65,312.1074,1089,"Health Partners, Inc.",State of Minnesota Advantage Program,887.535,81.5,,percent of total billed charges,,
"PENICILLIN G BENZATHINE 1,200,000 UNIT/2 ML IM SYRG",,J0561,HCPCS,Facility,Both,2 mL,mL,,1089,925.65,312.1074,1089,"Health Partners, Inc.",State Public Programs,544.5,50,,percent of total billed charges,,
"PENICILLIN G BENZATHINE 1,200,000 UNIT/2 ML IM SYRG",,J0561,HCPCS,Facility,Both,2 mL,mL,,1089,925.65,312.1074,1089,Humana Insurance Company,Commercial PPO,1034.55,95,,percent of total billed charges,,
"PENICILLIN G BENZATHINE 1,200,000 UNIT/2 ML IM SYRG",,J0561,HCPCS,Facility,Outpatient,2 mL,mL,,1089,925.65,312.1074,1089,Humana Insurance Company,Medicare PPO,533.61,49,,percent of total billed charges,,
"PENICILLIN G BENZATHINE 1,200,000 UNIT/2 ML IM SYRG",,J0561,HCPCS,Facility,Inpatient,2 mL,mL,,1089,925.65,312.1074,1089,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"PENICILLIN G BENZATHINE 1,200,000 UNIT/2 ML IM SYRG",,J0561,HCPCS,Facility,Both,2 mL,mL,,1089,925.65,312.1074,1089,Medica,Individual & Family,1079.199,99.1,,percent of total billed charges,,
"PENICILLIN G BENZATHINE 1,200,000 UNIT/2 ML IM SYRG",,J0561,HCPCS,Facility,Outpatient,2 mL,mL,,1089,925.65,312.1074,1089,Medica,Medica Advantage Solution,542.322,49.8,,percent of total billed charges,,
"PENICILLIN G BENZATHINE 1,200,000 UNIT/2 ML IM SYRG",,J0561,HCPCS,Facility,Inpatient,2 mL,mL,,1089,925.65,312.1074,1089,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"PENICILLIN G BENZATHINE 1,200,000 UNIT/2 ML IM SYRG",,J0561,HCPCS,Facility,Outpatient,2 mL,mL,,1089,925.65,312.1074,1089,Medica,Medical Assistance,485.694,44.6,,percent of total billed charges,,
"PENICILLIN G BENZATHINE 1,200,000 UNIT/2 ML IM SYRG",,J0561,HCPCS,Facility,Inpatient,2 mL,mL,,1089,925.65,312.1074,1089,Medica,Medical Assistance,,,,,Included in per diem rate,
"PENICILLIN G BENZATHINE 1,200,000 UNIT/2 ML IM SYRG",,J0561,HCPCS,Facility,Outpatient,2 mL,mL,,1089,925.65,312.1074,1089,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,542.322,49.8,,percent of total billed charges,,
"PENICILLIN G BENZATHINE 1,200,000 UNIT/2 ML IM SYRG",,J0561,HCPCS,Facility,Inpatient,2 mL,mL,,1089,925.65,312.1074,1089,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"PENICILLIN G BENZATHINE 1,200,000 UNIT/2 ML IM SYRG",,J0561,HCPCS,Facility,Both,2 mL,mL,,1089,925.65,312.1074,1089,"Multiplan, Inc.","Multiplan, Inc.",1023.66,94,,percent of total billed charges,,
"PENICILLIN G BENZATHINE 1,200,000 UNIT/2 ML IM SYRG",,J0561,HCPCS,Facility,Outpatient,2 mL,mL,,1089,925.65,312.1074,1089,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,981.189,90.1,,percent of total billed charges,,
"PENICILLIN G BENZATHINE 1,200,000 UNIT/2 ML IM SYRG",,J0561,HCPCS,Facility,Inpatient,2 mL,mL,,1089,925.65,312.1074,1089,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"PENICILLIN G BENZATHINE 1,200,000 UNIT/2 ML IM SYRG",,J0561,HCPCS,Facility,Both,2 mL,mL,,1089,925.65,312.1074,1089,"Preferred One Administrative Services, INC.",PPO,1073.754,98.6,,percent of total billed charges,,
"PENICILLIN G BENZATHINE 1,200,000 UNIT/2 ML IM SYRG",,J0561,HCPCS,Facility,Outpatient,2 mL,mL,,1089,925.65,312.1074,1089,PrimeWest Health,Minnesota Senior Health Options (MSHO),560.2905,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"PENICILLIN G BENZATHINE 1,200,000 UNIT/2 ML IM SYRG",,J0561,HCPCS,Facility,Inpatient,2 mL,mL,,1089,925.65,312.1074,1089,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"PENICILLIN G BENZATHINE 1,200,000 UNIT/2 ML IM SYRG",,J0561,HCPCS,Facility,Outpatient,2 mL,mL,,1089,925.65,312.1074,1089,PrimeWest Health,MinnesotaCare,559.3104,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"PENICILLIN G BENZATHINE 1,200,000 UNIT/2 ML IM SYRG",,J0561,HCPCS,Facility,Inpatient,2 mL,mL,,1089,925.65,312.1074,1089,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"PENICILLIN G BENZATHINE 1,200,000 UNIT/2 ML IM SYRG",,J0561,HCPCS,Facility,Both,2 mL,mL,,1089,925.65,312.1074,1089,Sanford Health Plan,Sanford Health Plan,1001.88,92,,percent of total billed charges,,
"PENICILLIN G BENZATHINE 1,200,000 UNIT/2 ML IM SYRG",,J0561,HCPCS,Facility,Outpatient,2 mL,mL,,1089,925.65,312.1074,1089,"UCare Health, Inc.",Individual & Family Plan,613.6515,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"PENICILLIN G BENZATHINE 1,200,000 UNIT/2 ML IM SYRG",,J0561,HCPCS,Facility,Inpatient,2 mL,mL,,1089,925.65,312.1074,1089,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"PENICILLIN G BENZATHINE 1,200,000 UNIT/2 ML IM SYRG",,J0561,HCPCS,Facility,Outpatient,2 mL,mL,,1089,925.65,312.1074,1089,"UCare Health, Inc.",Medical Assistance,549.6183,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"PENICILLIN G BENZATHINE 1,200,000 UNIT/2 ML IM SYRG",,J0561,HCPCS,Facility,Inpatient,2 mL,mL,,1089,925.65,312.1074,1089,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"PENICILLIN G BENZATHINE 1,200,000 UNIT/2 ML IM SYRG",,J0561,HCPCS,Facility,Outpatient,2 mL,mL,,1089,925.65,312.1074,1089,"UCare Health, Inc.",Medicare Advantage,549.6183,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"PENICILLIN G BENZATHINE 1,200,000 UNIT/2 ML IM SYRG",,J0561,HCPCS,Facility,Inpatient,2 mL,mL,,1089,925.65,312.1074,1089,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"PENICILLIN G BENZATHINE 1,200,000 UNIT/2 ML IM SYRG",,J0561,HCPCS,Facility,Outpatient,2 mL,mL,,1089,925.65,312.1074,1089,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),549.6183,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"PENICILLIN G BENZATHINE 1,200,000 UNIT/2 ML IM SYRG",,J0561,HCPCS,Facility,Inpatient,2 mL,mL,,1089,925.65,312.1074,1089,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"PENICILLIN G BENZATHINE 1,200,000 UNIT/2 ML IM SYRG",,J0561,HCPCS,Facility,Both,2 mL,mL,,1089,925.65,312.1074,1089,UnitedHealthcare,Individual & Family,1023.66,94,,percent of total billed charges,,
"PENICILLIN G BENZATHINE 1,200,000 UNIT/2 ML IM SYRG",,J0561,HCPCS,Facility,Outpatient,2 mL,mL,,1089,925.65,312.1074,1089,UnitedHealthcare,Medicare Advantage,533.61,49,,percent of total billed charges,,
"PENICILLIN G BENZATHINE 1,200,000 UNIT/2 ML IM SYRG",,J0561,HCPCS,Facility,Inpatient,2 mL,mL,,1089,925.65,312.1074,1089,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"PENICILLIN G BENZATHINE 1,200,000 UNIT/2 ML IM SYRG",,J0561,HCPCS,Facility,Outpatient,2 mL,mL,,1089,925.65,312.1074,1089,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,522.72,48,,percent of total billed charges,,100% of DHS outpatient percentage
"PENICILLIN G BENZATHINE 1,200,000 UNIT/2 ML IM SYRG",,J0561,HCPCS,Facility,Inpatient,2 mL,mL,,1089,925.65,312.1074,1089,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJ SOLN,,J0780,HCPCS,Facility,Both,2 mL,mL,,52,44.2,14.9032,52,Aetna,Commercial,47.84,92,,percent of total billed charges,,
PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJ SOLN,,J0780,HCPCS,Facility,Both,2 mL,mL,,52,44.2,14.9032,52,Aetna,Commercial,47.84,92,,percent of total billed charges,,
PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJ SOLN,,J0780,HCPCS,Facility,Outpatient,2 mL,mL,,52,44.2,14.9032,52,Aetna,Medicare Advantage,25.48,49,,percent of total billed charges,,
PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJ SOLN,,J0780,HCPCS,Facility,Outpatient,2 mL,mL,,52,44.2,14.9032,52,Aetna,Medicare Advantage,25.48,49,,percent of total billed charges,,
PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJ SOLN,,J0780,HCPCS,Facility,Inpatient,2 mL,mL,,52,44.2,14.9032,52,Aetna,Medicare Advantage,,,,,Included in per diem rate,
PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJ SOLN,,J0780,HCPCS,Facility,Inpatient,2 mL,mL,,52,44.2,14.9032,52,Aetna,Medicare Advantage,,,,,Included in per diem rate,
PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJ SOLN,,J0780,HCPCS,Facility,Both,2 mL,mL,,52,44.2,14.9032,52,Aetna,PPO,48.36,93,,percent of total billed charges,,
PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJ SOLN,,J0780,HCPCS,Facility,Both,2 mL,mL,,52,44.2,14.9032,52,Aetna,PPO,48.36,93,,percent of total billed charges,,
PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJ SOLN,,J0780,HCPCS,Facility,Both,2 mL,mL,,52,44.2,14.9032,52,America's PPO,America's PPO,49.9356,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJ SOLN,,J0780,HCPCS,Facility,Both,2 mL,mL,,52,44.2,14.9032,52,America's PPO,America's PPO,49.9356,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJ SOLN,,J0780,HCPCS,Facility,Both,2 mL,mL,,52,44.2,14.9032,52,BlueCross BlueShield Minnesota, Federal Employee Program,51.168,98.4,,percent of total billed charges,,
PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJ SOLN,,J0780,HCPCS,Facility,Both,2 mL,mL,,52,44.2,14.9032,52,BlueCross BlueShield Minnesota, Federal Employee Program,51.168,98.4,,percent of total billed charges,,
PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJ SOLN,,J0780,HCPCS,Facility,Both,2 mL,mL,,52,44.2,14.9032,52,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,52,100,,percent of total billed charges,,
PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJ SOLN,,J0780,HCPCS,Facility,Both,2 mL,mL,,52,44.2,14.9032,52,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,52,100,,percent of total billed charges,,
PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJ SOLN,,J0780,HCPCS,Facility,Both,2 mL,mL,,52,44.2,14.9032,52,BlueCross BlueShield Minnesota,High Value Network Plan,46.8,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJ SOLN,,J0780,HCPCS,Facility,Both,2 mL,mL,,52,44.2,14.9032,52,BlueCross BlueShield Minnesota,High Value Network Plan,46.8,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJ SOLN,,J0780,HCPCS,Facility,Outpatient,2 mL,mL,,52,44.2,14.9032,52,BlueCross BlueShield Minnesota,Medicare Advantage,25.48,49,,percent of total billed charges,,
PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJ SOLN,,J0780,HCPCS,Facility,Outpatient,2 mL,mL,,52,44.2,14.9032,52,BlueCross BlueShield Minnesota,Medicare Advantage,25.48,49,,percent of total billed charges,,
PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJ SOLN,,J0780,HCPCS,Facility,Inpatient,2 mL,mL,,52,44.2,14.9032,52,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJ SOLN,,J0780,HCPCS,Facility,Inpatient,2 mL,mL,,52,44.2,14.9032,52,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJ SOLN,,J0780,HCPCS,Facility,Both,2 mL,mL,,52,44.2,14.9032,52,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,46.0564,88.57,,percent of total billed charges,,
PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJ SOLN,,J0780,HCPCS,Facility,Both,2 mL,mL,,52,44.2,14.9032,52,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,46.0564,88.57,,percent of total billed charges,,
PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJ SOLN,,J0780,HCPCS,Facility,Both,2 mL,mL,,52,44.2,14.9032,52,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,14.9032,28.66,,percent of total billed charges,,
PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJ SOLN,,J0780,HCPCS,Facility,Both,2 mL,mL,,52,44.2,14.9032,52,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,14.9032,28.66,,percent of total billed charges,,
PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJ SOLN,,J0780,HCPCS,Facility,Outpatient,2 mL,mL,,52,44.2,14.9032,52,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),25.48,49,,percent of total billed charges,,
PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJ SOLN,,J0780,HCPCS,Facility,Outpatient,2 mL,mL,,52,44.2,14.9032,52,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),25.48,49,,percent of total billed charges,,
PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJ SOLN,,J0780,HCPCS,Facility,Inpatient,2 mL,mL,,52,44.2,14.9032,52,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJ SOLN,,J0780,HCPCS,Facility,Inpatient,2 mL,mL,,52,44.2,14.9032,52,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJ SOLN,,J0780,HCPCS,Facility,Both,2 mL,mL,,52,44.2,14.9032,52,CorVel,Worker's Compensation,52,100,,percent of total billed charges,,
PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJ SOLN,,J0780,HCPCS,Facility,Both,2 mL,mL,,52,44.2,14.9032,52,CorVel,Worker's Compensation,52,100,,percent of total billed charges,,
PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJ SOLN,,J0780,HCPCS,Facility,Both,2 mL,mL,,52,44.2,14.9032,52,First Health Group Corporation,First Health Network,50.44,97,,percent of total billed charges,,
PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJ SOLN,,J0780,HCPCS,Facility,Both,2 mL,mL,,52,44.2,14.9032,52,First Health Group Corporation,First Health Network,50.44,97,,percent of total billed charges,,
PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJ SOLN,,J0780,HCPCS,Facility,Both,2 mL,mL,,52,44.2,14.9032,52,"Health Partners, Inc.",Commercial,49.192,94.6,,percent of total billed charges,,
PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJ SOLN,,J0780,HCPCS,Facility,Both,2 mL,mL,,52,44.2,14.9032,52,"Health Partners, Inc.",Commercial,49.192,94.6,,percent of total billed charges,,
PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJ SOLN,,J0780,HCPCS,Facility,Outpatient,2 mL,mL,,52,44.2,14.9032,52,"Health Partners, Inc.",Medicare Advantage,25.48,49,,percent of total billed charges,,
PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJ SOLN,,J0780,HCPCS,Facility,Outpatient,2 mL,mL,,52,44.2,14.9032,52,"Health Partners, Inc.",Medicare Advantage,25.48,49,,percent of total billed charges,,
PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJ SOLN,,J0780,HCPCS,Facility,Inpatient,2 mL,mL,,52,44.2,14.9032,52,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJ SOLN,,J0780,HCPCS,Facility,Inpatient,2 mL,mL,,52,44.2,14.9032,52,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJ SOLN,,J0780,HCPCS,Facility,Both,2 mL,mL,,52,44.2,14.9032,52,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),31.2,60,,percent of total billed charges,,
PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJ SOLN,,J0780,HCPCS,Facility,Both,2 mL,mL,,52,44.2,14.9032,52,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),31.2,60,,percent of total billed charges,,
PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJ SOLN,,J0780,HCPCS,Facility,Both,2 mL,mL,,52,44.2,14.9032,52,"Health Partners, Inc.",State of Minnesota Advantage Program,42.38,81.5,,percent of total billed charges,,
PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJ SOLN,,J0780,HCPCS,Facility,Both,2 mL,mL,,52,44.2,14.9032,52,"Health Partners, Inc.",State of Minnesota Advantage Program,42.38,81.5,,percent of total billed charges,,
PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJ SOLN,,J0780,HCPCS,Facility,Both,2 mL,mL,,52,44.2,14.9032,52,"Health Partners, Inc.",State Public Programs,26,50,,percent of total billed charges,,
PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJ SOLN,,J0780,HCPCS,Facility,Both,2 mL,mL,,52,44.2,14.9032,52,"Health Partners, Inc.",State Public Programs,26,50,,percent of total billed charges,,
PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJ SOLN,,J0780,HCPCS,Facility,Both,2 mL,mL,,52,44.2,14.9032,52,Humana Insurance Company,Commercial PPO,49.4,95,,percent of total billed charges,,
PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJ SOLN,,J0780,HCPCS,Facility,Both,2 mL,mL,,52,44.2,14.9032,52,Humana Insurance Company,Commercial PPO,49.4,95,,percent of total billed charges,,
PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJ SOLN,,J0780,HCPCS,Facility,Outpatient,2 mL,mL,,52,44.2,14.9032,52,Humana Insurance Company,Medicare PPO,25.48,49,,percent of total billed charges,,
PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJ SOLN,,J0780,HCPCS,Facility,Outpatient,2 mL,mL,,52,44.2,14.9032,52,Humana Insurance Company,Medicare PPO,25.48,49,,percent of total billed charges,,
PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJ SOLN,,J0780,HCPCS,Facility,Inpatient,2 mL,mL,,52,44.2,14.9032,52,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJ SOLN,,J0780,HCPCS,Facility,Inpatient,2 mL,mL,,52,44.2,14.9032,52,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJ SOLN,,J0780,HCPCS,Facility,Both,2 mL,mL,,52,44.2,14.9032,52,Medica,Individual & Family,51.532,99.1,,percent of total billed charges,,
PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJ SOLN,,J0780,HCPCS,Facility,Both,2 mL,mL,,52,44.2,14.9032,52,Medica,Individual & Family,51.532,99.1,,percent of total billed charges,,
PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJ SOLN,,J0780,HCPCS,Facility,Outpatient,2 mL,mL,,52,44.2,14.9032,52,Medica,Medica Advantage Solution,25.896,49.8,,percent of total billed charges,,
PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJ SOLN,,J0780,HCPCS,Facility,Outpatient,2 mL,mL,,52,44.2,14.9032,52,Medica,Medica Advantage Solution,25.896,49.8,,percent of total billed charges,,
PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJ SOLN,,J0780,HCPCS,Facility,Inpatient,2 mL,mL,,52,44.2,14.9032,52,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJ SOLN,,J0780,HCPCS,Facility,Inpatient,2 mL,mL,,52,44.2,14.9032,52,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJ SOLN,,J0780,HCPCS,Facility,Outpatient,2 mL,mL,,52,44.2,14.9032,52,Medica,Medical Assistance,23.192,44.6,,percent of total billed charges,,
PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJ SOLN,,J0780,HCPCS,Facility,Outpatient,2 mL,mL,,52,44.2,14.9032,52,Medica,Medical Assistance,23.192,44.6,,percent of total billed charges,,
PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJ SOLN,,J0780,HCPCS,Facility,Inpatient,2 mL,mL,,52,44.2,14.9032,52,Medica,Medical Assistance,,,,,Included in per diem rate,
PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJ SOLN,,J0780,HCPCS,Facility,Inpatient,2 mL,mL,,52,44.2,14.9032,52,Medica,Medical Assistance,,,,,Included in per diem rate,
PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJ SOLN,,J0780,HCPCS,Facility,Outpatient,2 mL,mL,,52,44.2,14.9032,52,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,25.896,49.8,,percent of total billed charges,,
PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJ SOLN,,J0780,HCPCS,Facility,Outpatient,2 mL,mL,,52,44.2,14.9032,52,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,25.896,49.8,,percent of total billed charges,,
PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJ SOLN,,J0780,HCPCS,Facility,Inpatient,2 mL,mL,,52,44.2,14.9032,52,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJ SOLN,,J0780,HCPCS,Facility,Inpatient,2 mL,mL,,52,44.2,14.9032,52,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJ SOLN,,J0780,HCPCS,Facility,Both,2 mL,mL,,52,44.2,14.9032,52,"Multiplan, Inc.","Multiplan, Inc.",48.88,94,,percent of total billed charges,,
PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJ SOLN,,J0780,HCPCS,Facility,Both,2 mL,mL,,52,44.2,14.9032,52,"Multiplan, Inc.","Multiplan, Inc.",48.88,94,,percent of total billed charges,,
PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJ SOLN,,J0780,HCPCS,Facility,Outpatient,2 mL,mL,,52,44.2,14.9032,52,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,46.852,90.1,,percent of total billed charges,,
PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJ SOLN,,J0780,HCPCS,Facility,Outpatient,2 mL,mL,,52,44.2,14.9032,52,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,46.852,90.1,,percent of total billed charges,,
PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJ SOLN,,J0780,HCPCS,Facility,Inpatient,2 mL,mL,,52,44.2,14.9032,52,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJ SOLN,,J0780,HCPCS,Facility,Inpatient,2 mL,mL,,52,44.2,14.9032,52,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJ SOLN,,J0780,HCPCS,Facility,Both,2 mL,mL,,52,44.2,14.9032,52,"Preferred One Administrative Services, INC.",PPO,51.272,98.6,,percent of total billed charges,,
PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJ SOLN,,J0780,HCPCS,Facility,Both,2 mL,mL,,52,44.2,14.9032,52,"Preferred One Administrative Services, INC.",PPO,51.272,98.6,,percent of total billed charges,,
PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJ SOLN,,J0780,HCPCS,Facility,Outpatient,2 mL,mL,,52,44.2,14.9032,52,PrimeWest Health,Minnesota Senior Health Options (MSHO),26.754,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJ SOLN,,J0780,HCPCS,Facility,Outpatient,2 mL,mL,,52,44.2,14.9032,52,PrimeWest Health,Minnesota Senior Health Options (MSHO),26.754,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJ SOLN,,J0780,HCPCS,Facility,Inpatient,2 mL,mL,,52,44.2,14.9032,52,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJ SOLN,,J0780,HCPCS,Facility,Inpatient,2 mL,mL,,52,44.2,14.9032,52,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJ SOLN,,J0780,HCPCS,Facility,Outpatient,2 mL,mL,,52,44.2,14.9032,52,PrimeWest Health,MinnesotaCare,26.7072,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJ SOLN,,J0780,HCPCS,Facility,Outpatient,2 mL,mL,,52,44.2,14.9032,52,PrimeWest Health,MinnesotaCare,26.7072,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJ SOLN,,J0780,HCPCS,Facility,Inpatient,2 mL,mL,,52,44.2,14.9032,52,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJ SOLN,,J0780,HCPCS,Facility,Inpatient,2 mL,mL,,52,44.2,14.9032,52,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJ SOLN,,J0780,HCPCS,Facility,Both,2 mL,mL,,52,44.2,14.9032,52,Sanford Health Plan,Sanford Health Plan,47.84,92,,percent of total billed charges,,
PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJ SOLN,,J0780,HCPCS,Facility,Both,2 mL,mL,,52,44.2,14.9032,52,Sanford Health Plan,Sanford Health Plan,47.84,92,,percent of total billed charges,,
PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJ SOLN,,J0780,HCPCS,Facility,Outpatient,2 mL,mL,,52,44.2,14.9032,52,"UCare Health, Inc.",Individual & Family Plan,29.302,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJ SOLN,,J0780,HCPCS,Facility,Outpatient,2 mL,mL,,52,44.2,14.9032,52,"UCare Health, Inc.",Individual & Family Plan,29.302,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJ SOLN,,J0780,HCPCS,Facility,Inpatient,2 mL,mL,,52,44.2,14.9032,52,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJ SOLN,,J0780,HCPCS,Facility,Inpatient,2 mL,mL,,52,44.2,14.9032,52,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJ SOLN,,J0780,HCPCS,Facility,Outpatient,2 mL,mL,,52,44.2,14.9032,52,"UCare Health, Inc.",Medical Assistance,26.2444,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJ SOLN,,J0780,HCPCS,Facility,Outpatient,2 mL,mL,,52,44.2,14.9032,52,"UCare Health, Inc.",Medical Assistance,26.2444,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJ SOLN,,J0780,HCPCS,Facility,Inpatient,2 mL,mL,,52,44.2,14.9032,52,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJ SOLN,,J0780,HCPCS,Facility,Inpatient,2 mL,mL,,52,44.2,14.9032,52,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJ SOLN,,J0780,HCPCS,Facility,Outpatient,2 mL,mL,,52,44.2,14.9032,52,"UCare Health, Inc.",Medicare Advantage,26.2444,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJ SOLN,,J0780,HCPCS,Facility,Outpatient,2 mL,mL,,52,44.2,14.9032,52,"UCare Health, Inc.",Medicare Advantage,26.2444,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJ SOLN,,J0780,HCPCS,Facility,Inpatient,2 mL,mL,,52,44.2,14.9032,52,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJ SOLN,,J0780,HCPCS,Facility,Inpatient,2 mL,mL,,52,44.2,14.9032,52,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJ SOLN,,J0780,HCPCS,Facility,Outpatient,2 mL,mL,,52,44.2,14.9032,52,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),26.2444,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJ SOLN,,J0780,HCPCS,Facility,Outpatient,2 mL,mL,,52,44.2,14.9032,52,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),26.2444,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJ SOLN,,J0780,HCPCS,Facility,Inpatient,2 mL,mL,,52,44.2,14.9032,52,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJ SOLN,,J0780,HCPCS,Facility,Inpatient,2 mL,mL,,52,44.2,14.9032,52,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJ SOLN,,J0780,HCPCS,Facility,Both,2 mL,mL,,52,44.2,14.9032,52,UnitedHealthcare,Individual & Family,48.88,94,,percent of total billed charges,,
PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJ SOLN,,J0780,HCPCS,Facility,Both,2 mL,mL,,52,44.2,14.9032,52,UnitedHealthcare,Individual & Family,48.88,94,,percent of total billed charges,,
PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJ SOLN,,J0780,HCPCS,Facility,Outpatient,2 mL,mL,,52,44.2,14.9032,52,UnitedHealthcare,Medicare Advantage,25.48,49,,percent of total billed charges,,
PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJ SOLN,,J0780,HCPCS,Facility,Outpatient,2 mL,mL,,52,44.2,14.9032,52,UnitedHealthcare,Medicare Advantage,25.48,49,,percent of total billed charges,,
PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJ SOLN,,J0780,HCPCS,Facility,Inpatient,2 mL,mL,,52,44.2,14.9032,52,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJ SOLN,,J0780,HCPCS,Facility,Inpatient,2 mL,mL,,52,44.2,14.9032,52,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJ SOLN,,J0780,HCPCS,Facility,Outpatient,2 mL,mL,,52,44.2,14.9032,52,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,24.96,48,,percent of total billed charges,,100% of DHS outpatient percentage
PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJ SOLN,,J0780,HCPCS,Facility,Outpatient,2 mL,mL,,52,44.2,14.9032,52,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,24.96,48,,percent of total billed charges,,100% of DHS outpatient percentage
PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJ SOLN,,J0780,HCPCS,Facility,Inpatient,2 mL,mL,,52,44.2,14.9032,52,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJ SOLN,,J0780,HCPCS,Facility,Inpatient,2 mL,mL,,52,44.2,14.9032,52,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
DIGOXIN 250 MCG/ML (0.25 MG/ML) INJ SOLN,,J1160,HCPCS,Facility,Both,2 mL,mL,,33,28.05,9.4578,33,Aetna,Commercial,30.36,92,,percent of total billed charges,,
DIGOXIN 250 MCG/ML (0.25 MG/ML) INJ SOLN,,J1160,HCPCS,Facility,Outpatient,2 mL,mL,,33,28.05,9.4578,33,Aetna,Medicare Advantage,16.17,49,,percent of total billed charges,,
DIGOXIN 250 MCG/ML (0.25 MG/ML) INJ SOLN,,J1160,HCPCS,Facility,Inpatient,2 mL,mL,,33,28.05,9.4578,33,Aetna,Medicare Advantage,,,,,Included in per diem rate,
DIGOXIN 250 MCG/ML (0.25 MG/ML) INJ SOLN,,J1160,HCPCS,Facility,Both,2 mL,mL,,33,28.05,9.4578,33,Aetna,PPO,30.69,93,,percent of total billed charges,,
DIGOXIN 250 MCG/ML (0.25 MG/ML) INJ SOLN,,J1160,HCPCS,Facility,Both,2 mL,mL,,33,28.05,9.4578,33,America's PPO,America's PPO,31.6899,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
DIGOXIN 250 MCG/ML (0.25 MG/ML) INJ SOLN,,J1160,HCPCS,Facility,Both,2 mL,mL,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota, Federal Employee Program,32.472,98.4,,percent of total billed charges,,
DIGOXIN 250 MCG/ML (0.25 MG/ML) INJ SOLN,,J1160,HCPCS,Facility,Both,2 mL,mL,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,33,100,,percent of total billed charges,,
DIGOXIN 250 MCG/ML (0.25 MG/ML) INJ SOLN,,J1160,HCPCS,Facility,Both,2 mL,mL,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota,High Value Network Plan,29.7,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
DIGOXIN 250 MCG/ML (0.25 MG/ML) INJ SOLN,,J1160,HCPCS,Facility,Outpatient,2 mL,mL,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota,Medicare Advantage,16.17,49,,percent of total billed charges,,
DIGOXIN 250 MCG/ML (0.25 MG/ML) INJ SOLN,,J1160,HCPCS,Facility,Inpatient,2 mL,mL,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
DIGOXIN 250 MCG/ML (0.25 MG/ML) INJ SOLN,,J1160,HCPCS,Facility,Both,2 mL,mL,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,29.2281,88.57,,percent of total billed charges,,
DIGOXIN 250 MCG/ML (0.25 MG/ML) INJ SOLN,,J1160,HCPCS,Facility,Both,2 mL,mL,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,9.4578,28.66,,percent of total billed charges,,
DIGOXIN 250 MCG/ML (0.25 MG/ML) INJ SOLN,,J1160,HCPCS,Facility,Outpatient,2 mL,mL,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),16.17,49,,percent of total billed charges,,
DIGOXIN 250 MCG/ML (0.25 MG/ML) INJ SOLN,,J1160,HCPCS,Facility,Inpatient,2 mL,mL,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
DIGOXIN 250 MCG/ML (0.25 MG/ML) INJ SOLN,,J1160,HCPCS,Facility,Both,2 mL,mL,,33,28.05,9.4578,33,CorVel,Worker's Compensation,33,100,,percent of total billed charges,,
DIGOXIN 250 MCG/ML (0.25 MG/ML) INJ SOLN,,J1160,HCPCS,Facility,Both,2 mL,mL,,33,28.05,9.4578,33,First Health Group Corporation,First Health Network,32.01,97,,percent of total billed charges,,
DIGOXIN 250 MCG/ML (0.25 MG/ML) INJ SOLN,,J1160,HCPCS,Facility,Both,2 mL,mL,,33,28.05,9.4578,33,"Health Partners, Inc.",Commercial,31.218,94.6,,percent of total billed charges,,
DIGOXIN 250 MCG/ML (0.25 MG/ML) INJ SOLN,,J1160,HCPCS,Facility,Outpatient,2 mL,mL,,33,28.05,9.4578,33,"Health Partners, Inc.",Medicare Advantage,16.17,49,,percent of total billed charges,,
DIGOXIN 250 MCG/ML (0.25 MG/ML) INJ SOLN,,J1160,HCPCS,Facility,Inpatient,2 mL,mL,,33,28.05,9.4578,33,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DIGOXIN 250 MCG/ML (0.25 MG/ML) INJ SOLN,,J1160,HCPCS,Facility,Both,2 mL,mL,,33,28.05,9.4578,33,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),19.8,60,,percent of total billed charges,,
DIGOXIN 250 MCG/ML (0.25 MG/ML) INJ SOLN,,J1160,HCPCS,Facility,Both,2 mL,mL,,33,28.05,9.4578,33,"Health Partners, Inc.",State of Minnesota Advantage Program,26.895,81.5,,percent of total billed charges,,
DIGOXIN 250 MCG/ML (0.25 MG/ML) INJ SOLN,,J1160,HCPCS,Facility,Both,2 mL,mL,,33,28.05,9.4578,33,"Health Partners, Inc.",State Public Programs,16.5,50,,percent of total billed charges,,
DIGOXIN 250 MCG/ML (0.25 MG/ML) INJ SOLN,,J1160,HCPCS,Facility,Both,2 mL,mL,,33,28.05,9.4578,33,Humana Insurance Company,Commercial PPO,31.35,95,,percent of total billed charges,,
DIGOXIN 250 MCG/ML (0.25 MG/ML) INJ SOLN,,J1160,HCPCS,Facility,Outpatient,2 mL,mL,,33,28.05,9.4578,33,Humana Insurance Company,Medicare PPO,16.17,49,,percent of total billed charges,,
DIGOXIN 250 MCG/ML (0.25 MG/ML) INJ SOLN,,J1160,HCPCS,Facility,Inpatient,2 mL,mL,,33,28.05,9.4578,33,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
DIGOXIN 250 MCG/ML (0.25 MG/ML) INJ SOLN,,J1160,HCPCS,Facility,Both,2 mL,mL,,33,28.05,9.4578,33,Medica,Individual & Family,32.703,99.1,,percent of total billed charges,,
DIGOXIN 250 MCG/ML (0.25 MG/ML) INJ SOLN,,J1160,HCPCS,Facility,Outpatient,2 mL,mL,,33,28.05,9.4578,33,Medica,Medica Advantage Solution,16.434,49.8,,percent of total billed charges,,
DIGOXIN 250 MCG/ML (0.25 MG/ML) INJ SOLN,,J1160,HCPCS,Facility,Inpatient,2 mL,mL,,33,28.05,9.4578,33,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
DIGOXIN 250 MCG/ML (0.25 MG/ML) INJ SOLN,,J1160,HCPCS,Facility,Outpatient,2 mL,mL,,33,28.05,9.4578,33,Medica,Medical Assistance,14.718,44.6,,percent of total billed charges,,
DIGOXIN 250 MCG/ML (0.25 MG/ML) INJ SOLN,,J1160,HCPCS,Facility,Inpatient,2 mL,mL,,33,28.05,9.4578,33,Medica,Medical Assistance,,,,,Included in per diem rate,
DIGOXIN 250 MCG/ML (0.25 MG/ML) INJ SOLN,,J1160,HCPCS,Facility,Outpatient,2 mL,mL,,33,28.05,9.4578,33,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,16.434,49.8,,percent of total billed charges,,
DIGOXIN 250 MCG/ML (0.25 MG/ML) INJ SOLN,,J1160,HCPCS,Facility,Inpatient,2 mL,mL,,33,28.05,9.4578,33,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
DIGOXIN 250 MCG/ML (0.25 MG/ML) INJ SOLN,,J1160,HCPCS,Facility,Both,2 mL,mL,,33,28.05,9.4578,33,"Multiplan, Inc.","Multiplan, Inc.",31.02,94,,percent of total billed charges,,
DIGOXIN 250 MCG/ML (0.25 MG/ML) INJ SOLN,,J1160,HCPCS,Facility,Outpatient,2 mL,mL,,33,28.05,9.4578,33,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,29.733,90.1,,percent of total billed charges,,
DIGOXIN 250 MCG/ML (0.25 MG/ML) INJ SOLN,,J1160,HCPCS,Facility,Inpatient,2 mL,mL,,33,28.05,9.4578,33,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
DIGOXIN 250 MCG/ML (0.25 MG/ML) INJ SOLN,,J1160,HCPCS,Facility,Both,2 mL,mL,,33,28.05,9.4578,33,"Preferred One Administrative Services, INC.",PPO,32.538,98.6,,percent of total billed charges,,
DIGOXIN 250 MCG/ML (0.25 MG/ML) INJ SOLN,,J1160,HCPCS,Facility,Outpatient,2 mL,mL,,33,28.05,9.4578,33,PrimeWest Health,Minnesota Senior Health Options (MSHO),16.9785,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
DIGOXIN 250 MCG/ML (0.25 MG/ML) INJ SOLN,,J1160,HCPCS,Facility,Inpatient,2 mL,mL,,33,28.05,9.4578,33,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DIGOXIN 250 MCG/ML (0.25 MG/ML) INJ SOLN,,J1160,HCPCS,Facility,Outpatient,2 mL,mL,,33,28.05,9.4578,33,PrimeWest Health,MinnesotaCare,16.9488,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
DIGOXIN 250 MCG/ML (0.25 MG/ML) INJ SOLN,,J1160,HCPCS,Facility,Inpatient,2 mL,mL,,33,28.05,9.4578,33,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
DIGOXIN 250 MCG/ML (0.25 MG/ML) INJ SOLN,,J1160,HCPCS,Facility,Both,2 mL,mL,,33,28.05,9.4578,33,Sanford Health Plan,Sanford Health Plan,30.36,92,,percent of total billed charges,,
DIGOXIN 250 MCG/ML (0.25 MG/ML) INJ SOLN,,J1160,HCPCS,Facility,Outpatient,2 mL,mL,,33,28.05,9.4578,33,"UCare Health, Inc.",Individual & Family Plan,18.5955,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
DIGOXIN 250 MCG/ML (0.25 MG/ML) INJ SOLN,,J1160,HCPCS,Facility,Inpatient,2 mL,mL,,33,28.05,9.4578,33,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
DIGOXIN 250 MCG/ML (0.25 MG/ML) INJ SOLN,,J1160,HCPCS,Facility,Outpatient,2 mL,mL,,33,28.05,9.4578,33,"UCare Health, Inc.",Medical Assistance,16.6551,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DIGOXIN 250 MCG/ML (0.25 MG/ML) INJ SOLN,,J1160,HCPCS,Facility,Inpatient,2 mL,mL,,33,28.05,9.4578,33,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
DIGOXIN 250 MCG/ML (0.25 MG/ML) INJ SOLN,,J1160,HCPCS,Facility,Outpatient,2 mL,mL,,33,28.05,9.4578,33,"UCare Health, Inc.",Medicare Advantage,16.6551,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DIGOXIN 250 MCG/ML (0.25 MG/ML) INJ SOLN,,J1160,HCPCS,Facility,Inpatient,2 mL,mL,,33,28.05,9.4578,33,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DIGOXIN 250 MCG/ML (0.25 MG/ML) INJ SOLN,,J1160,HCPCS,Facility,Outpatient,2 mL,mL,,33,28.05,9.4578,33,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),16.6551,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DIGOXIN 250 MCG/ML (0.25 MG/ML) INJ SOLN,,J1160,HCPCS,Facility,Inpatient,2 mL,mL,,33,28.05,9.4578,33,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DIGOXIN 250 MCG/ML (0.25 MG/ML) INJ SOLN,,J1160,HCPCS,Facility,Both,2 mL,mL,,33,28.05,9.4578,33,UnitedHealthcare,Individual & Family,31.02,94,,percent of total billed charges,,
DIGOXIN 250 MCG/ML (0.25 MG/ML) INJ SOLN,,J1160,HCPCS,Facility,Outpatient,2 mL,mL,,33,28.05,9.4578,33,UnitedHealthcare,Medicare Advantage,16.17,49,,percent of total billed charges,,
DIGOXIN 250 MCG/ML (0.25 MG/ML) INJ SOLN,,J1160,HCPCS,Facility,Inpatient,2 mL,mL,,33,28.05,9.4578,33,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
DIGOXIN 250 MCG/ML (0.25 MG/ML) INJ SOLN,,J1160,HCPCS,Facility,Outpatient,2 mL,mL,,33,28.05,9.4578,33,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,15.84,48,,percent of total billed charges,,100% of DHS outpatient percentage
DIGOXIN 250 MCG/ML (0.25 MG/ML) INJ SOLN,,J1160,HCPCS,Facility,Inpatient,2 mL,mL,,33,28.05,9.4578,33,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
PHENYTOIN SODIUM 50 MG/ML IV SOLN,,J1165,HCPCS,Facility,Both,2 mL,mL,,9,7.65,2.5794,9,Aetna,Commercial,8.28,92,,percent of total billed charges,,
PHENYTOIN SODIUM 50 MG/ML IV SOLN,,J1165,HCPCS,Facility,Outpatient,2 mL,mL,,9,7.65,2.5794,9,Aetna,Medicare Advantage,4.41,49,,percent of total billed charges,,
PHENYTOIN SODIUM 50 MG/ML IV SOLN,,J1165,HCPCS,Facility,Inpatient,2 mL,mL,,9,7.65,2.5794,9,Aetna,Medicare Advantage,,,,,Included in per diem rate,
PHENYTOIN SODIUM 50 MG/ML IV SOLN,,J1165,HCPCS,Facility,Both,2 mL,mL,,9,7.65,2.5794,9,Aetna,PPO,8.37,93,,percent of total billed charges,,
PHENYTOIN SODIUM 50 MG/ML IV SOLN,,J1165,HCPCS,Facility,Both,2 mL,mL,,9,7.65,2.5794,9,America's PPO,America's PPO,8.6427,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
PHENYTOIN SODIUM 50 MG/ML IV SOLN,,J1165,HCPCS,Facility,Both,2 mL,mL,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota, Federal Employee Program,8.856,98.4,,percent of total billed charges,,
PHENYTOIN SODIUM 50 MG/ML IV SOLN,,J1165,HCPCS,Facility,Both,2 mL,mL,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,9,100,,percent of total billed charges,,
PHENYTOIN SODIUM 50 MG/ML IV SOLN,,J1165,HCPCS,Facility,Both,2 mL,mL,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota,High Value Network Plan,8.1,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
PHENYTOIN SODIUM 50 MG/ML IV SOLN,,J1165,HCPCS,Facility,Outpatient,2 mL,mL,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota,Medicare Advantage,4.41,49,,percent of total billed charges,,
PHENYTOIN SODIUM 50 MG/ML IV SOLN,,J1165,HCPCS,Facility,Inpatient,2 mL,mL,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
PHENYTOIN SODIUM 50 MG/ML IV SOLN,,J1165,HCPCS,Facility,Both,2 mL,mL,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,7.9713,88.57,,percent of total billed charges,,
PHENYTOIN SODIUM 50 MG/ML IV SOLN,,J1165,HCPCS,Facility,Both,2 mL,mL,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,2.5794,28.66,,percent of total billed charges,,
PHENYTOIN SODIUM 50 MG/ML IV SOLN,,J1165,HCPCS,Facility,Outpatient,2 mL,mL,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),4.41,49,,percent of total billed charges,,
PHENYTOIN SODIUM 50 MG/ML IV SOLN,,J1165,HCPCS,Facility,Inpatient,2 mL,mL,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
PHENYTOIN SODIUM 50 MG/ML IV SOLN,,J1165,HCPCS,Facility,Both,2 mL,mL,,9,7.65,2.5794,9,CorVel,Worker's Compensation,9,100,,percent of total billed charges,,
PHENYTOIN SODIUM 50 MG/ML IV SOLN,,J1165,HCPCS,Facility,Both,2 mL,mL,,9,7.65,2.5794,9,First Health Group Corporation,First Health Network,8.73,97,,percent of total billed charges,,
PHENYTOIN SODIUM 50 MG/ML IV SOLN,,J1165,HCPCS,Facility,Both,2 mL,mL,,9,7.65,2.5794,9,"Health Partners, Inc.",Commercial,8.514,94.6,,percent of total billed charges,,
PHENYTOIN SODIUM 50 MG/ML IV SOLN,,J1165,HCPCS,Facility,Outpatient,2 mL,mL,,9,7.65,2.5794,9,"Health Partners, Inc.",Medicare Advantage,4.41,49,,percent of total billed charges,,
PHENYTOIN SODIUM 50 MG/ML IV SOLN,,J1165,HCPCS,Facility,Inpatient,2 mL,mL,,9,7.65,2.5794,9,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PHENYTOIN SODIUM 50 MG/ML IV SOLN,,J1165,HCPCS,Facility,Both,2 mL,mL,,9,7.65,2.5794,9,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),5.4,60,,percent of total billed charges,,
PHENYTOIN SODIUM 50 MG/ML IV SOLN,,J1165,HCPCS,Facility,Both,2 mL,mL,,9,7.65,2.5794,9,"Health Partners, Inc.",State of Minnesota Advantage Program,7.335,81.5,,percent of total billed charges,,
PHENYTOIN SODIUM 50 MG/ML IV SOLN,,J1165,HCPCS,Facility,Both,2 mL,mL,,9,7.65,2.5794,9,"Health Partners, Inc.",State Public Programs,4.5,50,,percent of total billed charges,,
PHENYTOIN SODIUM 50 MG/ML IV SOLN,,J1165,HCPCS,Facility,Both,2 mL,mL,,9,7.65,2.5794,9,Humana Insurance Company,Commercial PPO,8.55,95,,percent of total billed charges,,
PHENYTOIN SODIUM 50 MG/ML IV SOLN,,J1165,HCPCS,Facility,Outpatient,2 mL,mL,,9,7.65,2.5794,9,Humana Insurance Company,Medicare PPO,4.41,49,,percent of total billed charges,,
PHENYTOIN SODIUM 50 MG/ML IV SOLN,,J1165,HCPCS,Facility,Inpatient,2 mL,mL,,9,7.65,2.5794,9,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
PHENYTOIN SODIUM 50 MG/ML IV SOLN,,J1165,HCPCS,Facility,Both,2 mL,mL,,9,7.65,2.5794,9,Medica,Individual & Family,8.919,99.1,,percent of total billed charges,,
PHENYTOIN SODIUM 50 MG/ML IV SOLN,,J1165,HCPCS,Facility,Outpatient,2 mL,mL,,9,7.65,2.5794,9,Medica,Medica Advantage Solution,4.482,49.8,,percent of total billed charges,,
PHENYTOIN SODIUM 50 MG/ML IV SOLN,,J1165,HCPCS,Facility,Inpatient,2 mL,mL,,9,7.65,2.5794,9,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
PHENYTOIN SODIUM 50 MG/ML IV SOLN,,J1165,HCPCS,Facility,Outpatient,2 mL,mL,,9,7.65,2.5794,9,Medica,Medical Assistance,4.014,44.6,,percent of total billed charges,,
PHENYTOIN SODIUM 50 MG/ML IV SOLN,,J1165,HCPCS,Facility,Inpatient,2 mL,mL,,9,7.65,2.5794,9,Medica,Medical Assistance,,,,,Included in per diem rate,
PHENYTOIN SODIUM 50 MG/ML IV SOLN,,J1165,HCPCS,Facility,Outpatient,2 mL,mL,,9,7.65,2.5794,9,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,4.482,49.8,,percent of total billed charges,,
PHENYTOIN SODIUM 50 MG/ML IV SOLN,,J1165,HCPCS,Facility,Inpatient,2 mL,mL,,9,7.65,2.5794,9,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
PHENYTOIN SODIUM 50 MG/ML IV SOLN,,J1165,HCPCS,Facility,Both,2 mL,mL,,9,7.65,2.5794,9,"Multiplan, Inc.","Multiplan, Inc.",8.46,94,,percent of total billed charges,,
PHENYTOIN SODIUM 50 MG/ML IV SOLN,,J1165,HCPCS,Facility,Outpatient,2 mL,mL,,9,7.65,2.5794,9,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,8.109,90.1,,percent of total billed charges,,
PHENYTOIN SODIUM 50 MG/ML IV SOLN,,J1165,HCPCS,Facility,Inpatient,2 mL,mL,,9,7.65,2.5794,9,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
PHENYTOIN SODIUM 50 MG/ML IV SOLN,,J1165,HCPCS,Facility,Both,2 mL,mL,,9,7.65,2.5794,9,"Preferred One Administrative Services, INC.",PPO,8.874,98.6,,percent of total billed charges,,
PHENYTOIN SODIUM 50 MG/ML IV SOLN,,J1165,HCPCS,Facility,Outpatient,2 mL,mL,,9,7.65,2.5794,9,PrimeWest Health,Minnesota Senior Health Options (MSHO),4.6305,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
PHENYTOIN SODIUM 50 MG/ML IV SOLN,,J1165,HCPCS,Facility,Inpatient,2 mL,mL,,9,7.65,2.5794,9,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PHENYTOIN SODIUM 50 MG/ML IV SOLN,,J1165,HCPCS,Facility,Outpatient,2 mL,mL,,9,7.65,2.5794,9,PrimeWest Health,MinnesotaCare,4.6224,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
PHENYTOIN SODIUM 50 MG/ML IV SOLN,,J1165,HCPCS,Facility,Inpatient,2 mL,mL,,9,7.65,2.5794,9,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
PHENYTOIN SODIUM 50 MG/ML IV SOLN,,J1165,HCPCS,Facility,Both,2 mL,mL,,9,7.65,2.5794,9,Sanford Health Plan,Sanford Health Plan,8.28,92,,percent of total billed charges,,
PHENYTOIN SODIUM 50 MG/ML IV SOLN,,J1165,HCPCS,Facility,Outpatient,2 mL,mL,,9,7.65,2.5794,9,"UCare Health, Inc.",Individual & Family Plan,5.0715,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
PHENYTOIN SODIUM 50 MG/ML IV SOLN,,J1165,HCPCS,Facility,Inpatient,2 mL,mL,,9,7.65,2.5794,9,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
PHENYTOIN SODIUM 50 MG/ML IV SOLN,,J1165,HCPCS,Facility,Outpatient,2 mL,mL,,9,7.65,2.5794,9,"UCare Health, Inc.",Medical Assistance,4.5423,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PHENYTOIN SODIUM 50 MG/ML IV SOLN,,J1165,HCPCS,Facility,Inpatient,2 mL,mL,,9,7.65,2.5794,9,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
PHENYTOIN SODIUM 50 MG/ML IV SOLN,,J1165,HCPCS,Facility,Outpatient,2 mL,mL,,9,7.65,2.5794,9,"UCare Health, Inc.",Medicare Advantage,4.5423,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PHENYTOIN SODIUM 50 MG/ML IV SOLN,,J1165,HCPCS,Facility,Inpatient,2 mL,mL,,9,7.65,2.5794,9,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PHENYTOIN SODIUM 50 MG/ML IV SOLN,,J1165,HCPCS,Facility,Outpatient,2 mL,mL,,9,7.65,2.5794,9,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),4.5423,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PHENYTOIN SODIUM 50 MG/ML IV SOLN,,J1165,HCPCS,Facility,Inpatient,2 mL,mL,,9,7.65,2.5794,9,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PHENYTOIN SODIUM 50 MG/ML IV SOLN,,J1165,HCPCS,Facility,Both,2 mL,mL,,9,7.65,2.5794,9,UnitedHealthcare,Individual & Family,8.46,94,,percent of total billed charges,,
PHENYTOIN SODIUM 50 MG/ML IV SOLN,,J1165,HCPCS,Facility,Outpatient,2 mL,mL,,9,7.65,2.5794,9,UnitedHealthcare,Medicare Advantage,4.41,49,,percent of total billed charges,,
PHENYTOIN SODIUM 50 MG/ML IV SOLN,,J1165,HCPCS,Facility,Inpatient,2 mL,mL,,9,7.65,2.5794,9,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
PHENYTOIN SODIUM 50 MG/ML IV SOLN,,J1165,HCPCS,Facility,Outpatient,2 mL,mL,,9,7.65,2.5794,9,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,4.32,48,,percent of total billed charges,,100% of DHS outpatient percentage
PHENYTOIN SODIUM 50 MG/ML IV SOLN,,J1165,HCPCS,Facility,Inpatient,2 mL,mL,,9,7.65,2.5794,9,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
GENTAMICIN 40 MG/ML INJ SOLN,,J1580,HCPCS,Facility,Both,2 mL,mL,,25,21.25,7.165,25,Aetna,Commercial,23,92,,percent of total billed charges,,
GENTAMICIN 40 MG/ML INJ SOLN,,J1580,HCPCS,Facility,Outpatient,2 mL,mL,,25,21.25,7.165,25,Aetna,Medicare Advantage,12.25,49,,percent of total billed charges,,
GENTAMICIN 40 MG/ML INJ SOLN,,J1580,HCPCS,Facility,Inpatient,2 mL,mL,,25,21.25,7.165,25,Aetna,Medicare Advantage,,,,,Included in per diem rate,
GENTAMICIN 40 MG/ML INJ SOLN,,J1580,HCPCS,Facility,Both,2 mL,mL,,25,21.25,7.165,25,Aetna,PPO,23.25,93,,percent of total billed charges,,
GENTAMICIN 40 MG/ML INJ SOLN,,J1580,HCPCS,Facility,Both,2 mL,mL,,25,21.25,7.165,25,America's PPO,America's PPO,24.0075,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
GENTAMICIN 40 MG/ML INJ SOLN,,J1580,HCPCS,Facility,Both,2 mL,mL,,25,21.25,7.165,25,BlueCross BlueShield Minnesota, Federal Employee Program,24.6,98.4,,percent of total billed charges,,
GENTAMICIN 40 MG/ML INJ SOLN,,J1580,HCPCS,Facility,Both,2 mL,mL,,25,21.25,7.165,25,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,25,100,,percent of total billed charges,,
GENTAMICIN 40 MG/ML INJ SOLN,,J1580,HCPCS,Facility,Both,2 mL,mL,,25,21.25,7.165,25,BlueCross BlueShield Minnesota,High Value Network Plan,22.5,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
GENTAMICIN 40 MG/ML INJ SOLN,,J1580,HCPCS,Facility,Outpatient,2 mL,mL,,25,21.25,7.165,25,BlueCross BlueShield Minnesota,Medicare Advantage,12.25,49,,percent of total billed charges,,
GENTAMICIN 40 MG/ML INJ SOLN,,J1580,HCPCS,Facility,Inpatient,2 mL,mL,,25,21.25,7.165,25,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
GENTAMICIN 40 MG/ML INJ SOLN,,J1580,HCPCS,Facility,Both,2 mL,mL,,25,21.25,7.165,25,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,22.1425,88.57,,percent of total billed charges,,
GENTAMICIN 40 MG/ML INJ SOLN,,J1580,HCPCS,Facility,Both,2 mL,mL,,25,21.25,7.165,25,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,7.165,28.66,,percent of total billed charges,,
GENTAMICIN 40 MG/ML INJ SOLN,,J1580,HCPCS,Facility,Outpatient,2 mL,mL,,25,21.25,7.165,25,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),12.25,49,,percent of total billed charges,,
GENTAMICIN 40 MG/ML INJ SOLN,,J1580,HCPCS,Facility,Inpatient,2 mL,mL,,25,21.25,7.165,25,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
GENTAMICIN 40 MG/ML INJ SOLN,,J1580,HCPCS,Facility,Both,2 mL,mL,,25,21.25,7.165,25,CorVel,Worker's Compensation,25,100,,percent of total billed charges,,
GENTAMICIN 40 MG/ML INJ SOLN,,J1580,HCPCS,Facility,Both,2 mL,mL,,25,21.25,7.165,25,First Health Group Corporation,First Health Network,24.25,97,,percent of total billed charges,,
GENTAMICIN 40 MG/ML INJ SOLN,,J1580,HCPCS,Facility,Both,2 mL,mL,,25,21.25,7.165,25,"Health Partners, Inc.",Commercial,23.65,94.6,,percent of total billed charges,,
GENTAMICIN 40 MG/ML INJ SOLN,,J1580,HCPCS,Facility,Outpatient,2 mL,mL,,25,21.25,7.165,25,"Health Partners, Inc.",Medicare Advantage,12.25,49,,percent of total billed charges,,
GENTAMICIN 40 MG/ML INJ SOLN,,J1580,HCPCS,Facility,Inpatient,2 mL,mL,,25,21.25,7.165,25,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
GENTAMICIN 40 MG/ML INJ SOLN,,J1580,HCPCS,Facility,Both,2 mL,mL,,25,21.25,7.165,25,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),15,60,,percent of total billed charges,,
GENTAMICIN 40 MG/ML INJ SOLN,,J1580,HCPCS,Facility,Both,2 mL,mL,,25,21.25,7.165,25,"Health Partners, Inc.",State of Minnesota Advantage Program,20.375,81.5,,percent of total billed charges,,
GENTAMICIN 40 MG/ML INJ SOLN,,J1580,HCPCS,Facility,Both,2 mL,mL,,25,21.25,7.165,25,"Health Partners, Inc.",State Public Programs,12.5,50,,percent of total billed charges,,
GENTAMICIN 40 MG/ML INJ SOLN,,J1580,HCPCS,Facility,Both,2 mL,mL,,25,21.25,7.165,25,Humana Insurance Company,Commercial PPO,23.75,95,,percent of total billed charges,,
GENTAMICIN 40 MG/ML INJ SOLN,,J1580,HCPCS,Facility,Outpatient,2 mL,mL,,25,21.25,7.165,25,Humana Insurance Company,Medicare PPO,12.25,49,,percent of total billed charges,,
GENTAMICIN 40 MG/ML INJ SOLN,,J1580,HCPCS,Facility,Inpatient,2 mL,mL,,25,21.25,7.165,25,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
GENTAMICIN 40 MG/ML INJ SOLN,,J1580,HCPCS,Facility,Both,2 mL,mL,,25,21.25,7.165,25,Medica,Individual & Family,24.775,99.1,,percent of total billed charges,,
GENTAMICIN 40 MG/ML INJ SOLN,,J1580,HCPCS,Facility,Outpatient,2 mL,mL,,25,21.25,7.165,25,Medica,Medica Advantage Solution,12.45,49.8,,percent of total billed charges,,
GENTAMICIN 40 MG/ML INJ SOLN,,J1580,HCPCS,Facility,Inpatient,2 mL,mL,,25,21.25,7.165,25,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
GENTAMICIN 40 MG/ML INJ SOLN,,J1580,HCPCS,Facility,Outpatient,2 mL,mL,,25,21.25,7.165,25,Medica,Medical Assistance,11.15,44.6,,percent of total billed charges,,
GENTAMICIN 40 MG/ML INJ SOLN,,J1580,HCPCS,Facility,Inpatient,2 mL,mL,,25,21.25,7.165,25,Medica,Medical Assistance,,,,,Included in per diem rate,
GENTAMICIN 40 MG/ML INJ SOLN,,J1580,HCPCS,Facility,Outpatient,2 mL,mL,,25,21.25,7.165,25,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,12.45,49.8,,percent of total billed charges,,
GENTAMICIN 40 MG/ML INJ SOLN,,J1580,HCPCS,Facility,Inpatient,2 mL,mL,,25,21.25,7.165,25,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
GENTAMICIN 40 MG/ML INJ SOLN,,J1580,HCPCS,Facility,Both,2 mL,mL,,25,21.25,7.165,25,"Multiplan, Inc.","Multiplan, Inc.",23.5,94,,percent of total billed charges,,
GENTAMICIN 40 MG/ML INJ SOLN,,J1580,HCPCS,Facility,Outpatient,2 mL,mL,,25,21.25,7.165,25,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,22.525,90.1,,percent of total billed charges,,
GENTAMICIN 40 MG/ML INJ SOLN,,J1580,HCPCS,Facility,Inpatient,2 mL,mL,,25,21.25,7.165,25,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
GENTAMICIN 40 MG/ML INJ SOLN,,J1580,HCPCS,Facility,Both,2 mL,mL,,25,21.25,7.165,25,"Preferred One Administrative Services, INC.",PPO,24.65,98.6,,percent of total billed charges,,
GENTAMICIN 40 MG/ML INJ SOLN,,J1580,HCPCS,Facility,Outpatient,2 mL,mL,,25,21.25,7.165,25,PrimeWest Health,Minnesota Senior Health Options (MSHO),12.8625,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
GENTAMICIN 40 MG/ML INJ SOLN,,J1580,HCPCS,Facility,Inpatient,2 mL,mL,,25,21.25,7.165,25,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
GENTAMICIN 40 MG/ML INJ SOLN,,J1580,HCPCS,Facility,Outpatient,2 mL,mL,,25,21.25,7.165,25,PrimeWest Health,MinnesotaCare,12.84,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
GENTAMICIN 40 MG/ML INJ SOLN,,J1580,HCPCS,Facility,Inpatient,2 mL,mL,,25,21.25,7.165,25,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
GENTAMICIN 40 MG/ML INJ SOLN,,J1580,HCPCS,Facility,Both,2 mL,mL,,25,21.25,7.165,25,Sanford Health Plan,Sanford Health Plan,23,92,,percent of total billed charges,,
GENTAMICIN 40 MG/ML INJ SOLN,,J1580,HCPCS,Facility,Outpatient,2 mL,mL,,25,21.25,7.165,25,"UCare Health, Inc.",Individual & Family Plan,14.0875,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
GENTAMICIN 40 MG/ML INJ SOLN,,J1580,HCPCS,Facility,Inpatient,2 mL,mL,,25,21.25,7.165,25,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
GENTAMICIN 40 MG/ML INJ SOLN,,J1580,HCPCS,Facility,Outpatient,2 mL,mL,,25,21.25,7.165,25,"UCare Health, Inc.",Medical Assistance,12.6175,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
GENTAMICIN 40 MG/ML INJ SOLN,,J1580,HCPCS,Facility,Inpatient,2 mL,mL,,25,21.25,7.165,25,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
GENTAMICIN 40 MG/ML INJ SOLN,,J1580,HCPCS,Facility,Outpatient,2 mL,mL,,25,21.25,7.165,25,"UCare Health, Inc.",Medicare Advantage,12.6175,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
GENTAMICIN 40 MG/ML INJ SOLN,,J1580,HCPCS,Facility,Inpatient,2 mL,mL,,25,21.25,7.165,25,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
GENTAMICIN 40 MG/ML INJ SOLN,,J1580,HCPCS,Facility,Outpatient,2 mL,mL,,25,21.25,7.165,25,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),12.6175,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
GENTAMICIN 40 MG/ML INJ SOLN,,J1580,HCPCS,Facility,Inpatient,2 mL,mL,,25,21.25,7.165,25,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
GENTAMICIN 40 MG/ML INJ SOLN,,J1580,HCPCS,Facility,Both,2 mL,mL,,25,21.25,7.165,25,UnitedHealthcare,Individual & Family,23.5,94,,percent of total billed charges,,
GENTAMICIN 40 MG/ML INJ SOLN,,J1580,HCPCS,Facility,Outpatient,2 mL,mL,,25,21.25,7.165,25,UnitedHealthcare,Medicare Advantage,12.25,49,,percent of total billed charges,,
GENTAMICIN 40 MG/ML INJ SOLN,,J1580,HCPCS,Facility,Inpatient,2 mL,mL,,25,21.25,7.165,25,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
GENTAMICIN 40 MG/ML INJ SOLN,,J1580,HCPCS,Facility,Outpatient,2 mL,mL,,25,21.25,7.165,25,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,12,48,,percent of total billed charges,,100% of DHS outpatient percentage
GENTAMICIN 40 MG/ML INJ SOLN,,J1580,HCPCS,Facility,Inpatient,2 mL,mL,,25,21.25,7.165,25,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
FUROSEMIDE 10 MG/ML INJ SOLN,,J1940,HCPCS,Facility,Both,2 mL,mL,,26,22.1,7.4516,26,Aetna,Commercial,23.92,92,,percent of total billed charges,,
FUROSEMIDE 10 MG/ML INJ SOLN,,J1940,HCPCS,Facility,Outpatient,2 mL,mL,,26,22.1,7.4516,26,Aetna,Medicare Advantage,12.74,49,,percent of total billed charges,,
FUROSEMIDE 10 MG/ML INJ SOLN,,J1940,HCPCS,Facility,Inpatient,2 mL,mL,,26,22.1,7.4516,26,Aetna,Medicare Advantage,,,,,Included in per diem rate,
FUROSEMIDE 10 MG/ML INJ SOLN,,J1940,HCPCS,Facility,Both,2 mL,mL,,26,22.1,7.4516,26,Aetna,PPO,24.18,93,,percent of total billed charges,,
FUROSEMIDE 10 MG/ML INJ SOLN,,J1940,HCPCS,Facility,Both,2 mL,mL,,26,22.1,7.4516,26,America's PPO,America's PPO,24.9678,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
FUROSEMIDE 10 MG/ML INJ SOLN,,J1940,HCPCS,Facility,Both,2 mL,mL,,26,22.1,7.4516,26,BlueCross BlueShield Minnesota, Federal Employee Program,25.584,98.4,,percent of total billed charges,,
FUROSEMIDE 10 MG/ML INJ SOLN,,J1940,HCPCS,Facility,Both,2 mL,mL,,26,22.1,7.4516,26,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,26,100,,percent of total billed charges,,
FUROSEMIDE 10 MG/ML INJ SOLN,,J1940,HCPCS,Facility,Both,2 mL,mL,,26,22.1,7.4516,26,BlueCross BlueShield Minnesota,High Value Network Plan,23.4,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
FUROSEMIDE 10 MG/ML INJ SOLN,,J1940,HCPCS,Facility,Outpatient,2 mL,mL,,26,22.1,7.4516,26,BlueCross BlueShield Minnesota,Medicare Advantage,12.74,49,,percent of total billed charges,,
FUROSEMIDE 10 MG/ML INJ SOLN,,J1940,HCPCS,Facility,Inpatient,2 mL,mL,,26,22.1,7.4516,26,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
FUROSEMIDE 10 MG/ML INJ SOLN,,J1940,HCPCS,Facility,Both,2 mL,mL,,26,22.1,7.4516,26,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,23.0282,88.57,,percent of total billed charges,,
FUROSEMIDE 10 MG/ML INJ SOLN,,J1940,HCPCS,Facility,Both,2 mL,mL,,26,22.1,7.4516,26,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,7.4516,28.66,,percent of total billed charges,,
FUROSEMIDE 10 MG/ML INJ SOLN,,J1940,HCPCS,Facility,Outpatient,2 mL,mL,,26,22.1,7.4516,26,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),12.74,49,,percent of total billed charges,,
FUROSEMIDE 10 MG/ML INJ SOLN,,J1940,HCPCS,Facility,Inpatient,2 mL,mL,,26,22.1,7.4516,26,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
FUROSEMIDE 10 MG/ML INJ SOLN,,J1940,HCPCS,Facility,Both,2 mL,mL,,26,22.1,7.4516,26,CorVel,Worker's Compensation,26,100,,percent of total billed charges,,
FUROSEMIDE 10 MG/ML INJ SOLN,,J1940,HCPCS,Facility,Both,2 mL,mL,,26,22.1,7.4516,26,First Health Group Corporation,First Health Network,25.22,97,,percent of total billed charges,,
FUROSEMIDE 10 MG/ML INJ SOLN,,J1940,HCPCS,Facility,Both,2 mL,mL,,26,22.1,7.4516,26,"Health Partners, Inc.",Commercial,24.596,94.6,,percent of total billed charges,,
FUROSEMIDE 10 MG/ML INJ SOLN,,J1940,HCPCS,Facility,Outpatient,2 mL,mL,,26,22.1,7.4516,26,"Health Partners, Inc.",Medicare Advantage,12.74,49,,percent of total billed charges,,
FUROSEMIDE 10 MG/ML INJ SOLN,,J1940,HCPCS,Facility,Inpatient,2 mL,mL,,26,22.1,7.4516,26,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
FUROSEMIDE 10 MG/ML INJ SOLN,,J1940,HCPCS,Facility,Both,2 mL,mL,,26,22.1,7.4516,26,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),15.6,60,,percent of total billed charges,,
FUROSEMIDE 10 MG/ML INJ SOLN,,J1940,HCPCS,Facility,Both,2 mL,mL,,26,22.1,7.4516,26,"Health Partners, Inc.",State of Minnesota Advantage Program,21.19,81.5,,percent of total billed charges,,
FUROSEMIDE 10 MG/ML INJ SOLN,,J1940,HCPCS,Facility,Both,2 mL,mL,,26,22.1,7.4516,26,"Health Partners, Inc.",State Public Programs,13,50,,percent of total billed charges,,
FUROSEMIDE 10 MG/ML INJ SOLN,,J1940,HCPCS,Facility,Both,2 mL,mL,,26,22.1,7.4516,26,Humana Insurance Company,Commercial PPO,24.7,95,,percent of total billed charges,,
FUROSEMIDE 10 MG/ML INJ SOLN,,J1940,HCPCS,Facility,Outpatient,2 mL,mL,,26,22.1,7.4516,26,Humana Insurance Company,Medicare PPO,12.74,49,,percent of total billed charges,,
FUROSEMIDE 10 MG/ML INJ SOLN,,J1940,HCPCS,Facility,Inpatient,2 mL,mL,,26,22.1,7.4516,26,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
FUROSEMIDE 10 MG/ML INJ SOLN,,J1940,HCPCS,Facility,Both,2 mL,mL,,26,22.1,7.4516,26,Medica,Individual & Family,25.766,99.1,,percent of total billed charges,,
FUROSEMIDE 10 MG/ML INJ SOLN,,J1940,HCPCS,Facility,Outpatient,2 mL,mL,,26,22.1,7.4516,26,Medica,Medica Advantage Solution,12.948,49.8,,percent of total billed charges,,
FUROSEMIDE 10 MG/ML INJ SOLN,,J1940,HCPCS,Facility,Inpatient,2 mL,mL,,26,22.1,7.4516,26,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
FUROSEMIDE 10 MG/ML INJ SOLN,,J1940,HCPCS,Facility,Outpatient,2 mL,mL,,26,22.1,7.4516,26,Medica,Medical Assistance,11.596,44.6,,percent of total billed charges,,
FUROSEMIDE 10 MG/ML INJ SOLN,,J1940,HCPCS,Facility,Inpatient,2 mL,mL,,26,22.1,7.4516,26,Medica,Medical Assistance,,,,,Included in per diem rate,
FUROSEMIDE 10 MG/ML INJ SOLN,,J1940,HCPCS,Facility,Outpatient,2 mL,mL,,26,22.1,7.4516,26,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,12.948,49.8,,percent of total billed charges,,
FUROSEMIDE 10 MG/ML INJ SOLN,,J1940,HCPCS,Facility,Inpatient,2 mL,mL,,26,22.1,7.4516,26,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
FUROSEMIDE 10 MG/ML INJ SOLN,,J1940,HCPCS,Facility,Both,2 mL,mL,,26,22.1,7.4516,26,"Multiplan, Inc.","Multiplan, Inc.",24.44,94,,percent of total billed charges,,
FUROSEMIDE 10 MG/ML INJ SOLN,,J1940,HCPCS,Facility,Outpatient,2 mL,mL,,26,22.1,7.4516,26,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,23.426,90.1,,percent of total billed charges,,
FUROSEMIDE 10 MG/ML INJ SOLN,,J1940,HCPCS,Facility,Inpatient,2 mL,mL,,26,22.1,7.4516,26,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
FUROSEMIDE 10 MG/ML INJ SOLN,,J1940,HCPCS,Facility,Both,2 mL,mL,,26,22.1,7.4516,26,"Preferred One Administrative Services, INC.",PPO,25.636,98.6,,percent of total billed charges,,
FUROSEMIDE 10 MG/ML INJ SOLN,,J1940,HCPCS,Facility,Outpatient,2 mL,mL,,26,22.1,7.4516,26,PrimeWest Health,Minnesota Senior Health Options (MSHO),13.377,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
FUROSEMIDE 10 MG/ML INJ SOLN,,J1940,HCPCS,Facility,Inpatient,2 mL,mL,,26,22.1,7.4516,26,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
FUROSEMIDE 10 MG/ML INJ SOLN,,J1940,HCPCS,Facility,Outpatient,2 mL,mL,,26,22.1,7.4516,26,PrimeWest Health,MinnesotaCare,13.3536,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
FUROSEMIDE 10 MG/ML INJ SOLN,,J1940,HCPCS,Facility,Inpatient,2 mL,mL,,26,22.1,7.4516,26,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
FUROSEMIDE 10 MG/ML INJ SOLN,,J1940,HCPCS,Facility,Both,2 mL,mL,,26,22.1,7.4516,26,Sanford Health Plan,Sanford Health Plan,23.92,92,,percent of total billed charges,,
FUROSEMIDE 10 MG/ML INJ SOLN,,J1940,HCPCS,Facility,Outpatient,2 mL,mL,,26,22.1,7.4516,26,"UCare Health, Inc.",Individual & Family Plan,14.651,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
FUROSEMIDE 10 MG/ML INJ SOLN,,J1940,HCPCS,Facility,Inpatient,2 mL,mL,,26,22.1,7.4516,26,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
FUROSEMIDE 10 MG/ML INJ SOLN,,J1940,HCPCS,Facility,Outpatient,2 mL,mL,,26,22.1,7.4516,26,"UCare Health, Inc.",Medical Assistance,13.1222,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FUROSEMIDE 10 MG/ML INJ SOLN,,J1940,HCPCS,Facility,Inpatient,2 mL,mL,,26,22.1,7.4516,26,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
FUROSEMIDE 10 MG/ML INJ SOLN,,J1940,HCPCS,Facility,Outpatient,2 mL,mL,,26,22.1,7.4516,26,"UCare Health, Inc.",Medicare Advantage,13.1222,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FUROSEMIDE 10 MG/ML INJ SOLN,,J1940,HCPCS,Facility,Inpatient,2 mL,mL,,26,22.1,7.4516,26,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
FUROSEMIDE 10 MG/ML INJ SOLN,,J1940,HCPCS,Facility,Outpatient,2 mL,mL,,26,22.1,7.4516,26,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),13.1222,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FUROSEMIDE 10 MG/ML INJ SOLN,,J1940,HCPCS,Facility,Inpatient,2 mL,mL,,26,22.1,7.4516,26,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
FUROSEMIDE 10 MG/ML INJ SOLN,,J1940,HCPCS,Facility,Both,2 mL,mL,,26,22.1,7.4516,26,UnitedHealthcare,Individual & Family,24.44,94,,percent of total billed charges,,
FUROSEMIDE 10 MG/ML INJ SOLN,,J1940,HCPCS,Facility,Outpatient,2 mL,mL,,26,22.1,7.4516,26,UnitedHealthcare,Medicare Advantage,12.74,49,,percent of total billed charges,,
FUROSEMIDE 10 MG/ML INJ SOLN,,J1940,HCPCS,Facility,Inpatient,2 mL,mL,,26,22.1,7.4516,26,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
FUROSEMIDE 10 MG/ML INJ SOLN,,J1940,HCPCS,Facility,Outpatient,2 mL,mL,,26,22.1,7.4516,26,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,12.48,48,,percent of total billed charges,,100% of DHS outpatient percentage
FUROSEMIDE 10 MG/ML INJ SOLN,,J1940,HCPCS,Facility,Inpatient,2 mL,mL,,26,22.1,7.4516,26,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
MIDAZOLAM (PF) 5 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Both,2 mL,mL,,7,5.95,2.0062,7,Aetna,Commercial,6.44,92,,percent of total billed charges,,
MIDAZOLAM (PF) 5 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Outpatient,2 mL,mL,,7,5.95,2.0062,7,Aetna,Medicare Advantage,3.43,49,,percent of total billed charges,,
MIDAZOLAM (PF) 5 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Inpatient,2 mL,mL,,7,5.95,2.0062,7,Aetna,Medicare Advantage,,,,,Included in per diem rate,
MIDAZOLAM (PF) 5 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Both,2 mL,mL,,7,5.95,2.0062,7,Aetna,PPO,6.51,93,,percent of total billed charges,,
MIDAZOLAM (PF) 5 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Both,2 mL,mL,,7,5.95,2.0062,7,America's PPO,America's PPO,6.7221,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
MIDAZOLAM (PF) 5 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Both,2 mL,mL,,7,5.95,2.0062,7,BlueCross BlueShield Minnesota, Federal Employee Program,6.888,98.4,,percent of total billed charges,,
MIDAZOLAM (PF) 5 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Both,2 mL,mL,,7,5.95,2.0062,7,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,7,100,,percent of total billed charges,,
MIDAZOLAM (PF) 5 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Both,2 mL,mL,,7,5.95,2.0062,7,BlueCross BlueShield Minnesota,High Value Network Plan,6.3,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
MIDAZOLAM (PF) 5 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Outpatient,2 mL,mL,,7,5.95,2.0062,7,BlueCross BlueShield Minnesota,Medicare Advantage,3.43,49,,percent of total billed charges,,
MIDAZOLAM (PF) 5 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Inpatient,2 mL,mL,,7,5.95,2.0062,7,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
MIDAZOLAM (PF) 5 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Both,2 mL,mL,,7,5.95,2.0062,7,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,6.1999,88.57,,percent of total billed charges,,
MIDAZOLAM (PF) 5 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Both,2 mL,mL,,7,5.95,2.0062,7,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,2.0062,28.66,,percent of total billed charges,,
MIDAZOLAM (PF) 5 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Outpatient,2 mL,mL,,7,5.95,2.0062,7,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),3.43,49,,percent of total billed charges,,
MIDAZOLAM (PF) 5 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Inpatient,2 mL,mL,,7,5.95,2.0062,7,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
MIDAZOLAM (PF) 5 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Both,2 mL,mL,,7,5.95,2.0062,7,CorVel,Worker's Compensation,7,100,,percent of total billed charges,,
MIDAZOLAM (PF) 5 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Both,2 mL,mL,,7,5.95,2.0062,7,First Health Group Corporation,First Health Network,6.79,97,,percent of total billed charges,,
MIDAZOLAM (PF) 5 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Both,2 mL,mL,,7,5.95,2.0062,7,"Health Partners, Inc.",Commercial,6.622,94.6,,percent of total billed charges,,
MIDAZOLAM (PF) 5 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Outpatient,2 mL,mL,,7,5.95,2.0062,7,"Health Partners, Inc.",Medicare Advantage,3.43,49,,percent of total billed charges,,
MIDAZOLAM (PF) 5 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Inpatient,2 mL,mL,,7,5.95,2.0062,7,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
MIDAZOLAM (PF) 5 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Both,2 mL,mL,,7,5.95,2.0062,7,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),4.2,60,,percent of total billed charges,,
MIDAZOLAM (PF) 5 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Both,2 mL,mL,,7,5.95,2.0062,7,"Health Partners, Inc.",State of Minnesota Advantage Program,5.705,81.5,,percent of total billed charges,,
MIDAZOLAM (PF) 5 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Both,2 mL,mL,,7,5.95,2.0062,7,"Health Partners, Inc.",State Public Programs,3.5,50,,percent of total billed charges,,
MIDAZOLAM (PF) 5 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Both,2 mL,mL,,7,5.95,2.0062,7,Humana Insurance Company,Commercial PPO,6.65,95,,percent of total billed charges,,
MIDAZOLAM (PF) 5 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Outpatient,2 mL,mL,,7,5.95,2.0062,7,Humana Insurance Company,Medicare PPO,3.43,49,,percent of total billed charges,,
MIDAZOLAM (PF) 5 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Inpatient,2 mL,mL,,7,5.95,2.0062,7,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
MIDAZOLAM (PF) 5 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Both,2 mL,mL,,7,5.95,2.0062,7,Medica,Individual & Family,6.937,99.1,,percent of total billed charges,,
MIDAZOLAM (PF) 5 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Outpatient,2 mL,mL,,7,5.95,2.0062,7,Medica,Medica Advantage Solution,3.486,49.8,,percent of total billed charges,,
MIDAZOLAM (PF) 5 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Inpatient,2 mL,mL,,7,5.95,2.0062,7,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
MIDAZOLAM (PF) 5 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Outpatient,2 mL,mL,,7,5.95,2.0062,7,Medica,Medical Assistance,3.122,44.6,,percent of total billed charges,,
MIDAZOLAM (PF) 5 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Inpatient,2 mL,mL,,7,5.95,2.0062,7,Medica,Medical Assistance,,,,,Included in per diem rate,
MIDAZOLAM (PF) 5 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Outpatient,2 mL,mL,,7,5.95,2.0062,7,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,3.486,49.8,,percent of total billed charges,,
MIDAZOLAM (PF) 5 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Inpatient,2 mL,mL,,7,5.95,2.0062,7,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
MIDAZOLAM (PF) 5 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Both,2 mL,mL,,7,5.95,2.0062,7,"Multiplan, Inc.","Multiplan, Inc.",6.58,94,,percent of total billed charges,,
MIDAZOLAM (PF) 5 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Outpatient,2 mL,mL,,7,5.95,2.0062,7,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,6.307,90.1,,percent of total billed charges,,
MIDAZOLAM (PF) 5 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Inpatient,2 mL,mL,,7,5.95,2.0062,7,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
MIDAZOLAM (PF) 5 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Both,2 mL,mL,,7,5.95,2.0062,7,"Preferred One Administrative Services, INC.",PPO,6.902,98.6,,percent of total billed charges,,
MIDAZOLAM (PF) 5 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Outpatient,2 mL,mL,,7,5.95,2.0062,7,PrimeWest Health,Minnesota Senior Health Options (MSHO),3.6015,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
MIDAZOLAM (PF) 5 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Inpatient,2 mL,mL,,7,5.95,2.0062,7,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
MIDAZOLAM (PF) 5 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Outpatient,2 mL,mL,,7,5.95,2.0062,7,PrimeWest Health,MinnesotaCare,3.5952,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
MIDAZOLAM (PF) 5 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Inpatient,2 mL,mL,,7,5.95,2.0062,7,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
MIDAZOLAM (PF) 5 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Both,2 mL,mL,,7,5.95,2.0062,7,Sanford Health Plan,Sanford Health Plan,6.44,92,,percent of total billed charges,,
MIDAZOLAM (PF) 5 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Outpatient,2 mL,mL,,7,5.95,2.0062,7,"UCare Health, Inc.",Individual & Family Plan,3.9445,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
MIDAZOLAM (PF) 5 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Inpatient,2 mL,mL,,7,5.95,2.0062,7,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
MIDAZOLAM (PF) 5 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Outpatient,2 mL,mL,,7,5.95,2.0062,7,"UCare Health, Inc.",Medical Assistance,3.5329,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MIDAZOLAM (PF) 5 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Inpatient,2 mL,mL,,7,5.95,2.0062,7,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
MIDAZOLAM (PF) 5 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Outpatient,2 mL,mL,,7,5.95,2.0062,7,"UCare Health, Inc.",Medicare Advantage,3.5329,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MIDAZOLAM (PF) 5 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Inpatient,2 mL,mL,,7,5.95,2.0062,7,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
MIDAZOLAM (PF) 5 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Outpatient,2 mL,mL,,7,5.95,2.0062,7,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),3.5329,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MIDAZOLAM (PF) 5 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Inpatient,2 mL,mL,,7,5.95,2.0062,7,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
MIDAZOLAM (PF) 5 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Both,2 mL,mL,,7,5.95,2.0062,7,UnitedHealthcare,Individual & Family,6.58,94,,percent of total billed charges,,
MIDAZOLAM (PF) 5 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Outpatient,2 mL,mL,,7,5.95,2.0062,7,UnitedHealthcare,Medicare Advantage,3.43,49,,percent of total billed charges,,
MIDAZOLAM (PF) 5 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Inpatient,2 mL,mL,,7,5.95,2.0062,7,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
MIDAZOLAM (PF) 5 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Outpatient,2 mL,mL,,7,5.95,2.0062,7,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,3.36,48,,percent of total billed charges,,100% of DHS outpatient percentage
MIDAZOLAM (PF) 5 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Inpatient,2 mL,mL,,7,5.95,2.0062,7,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
MIDAZOLAM (PF) 5 MG/ML INTRANASAL SOLN,,J2250,HCPCS,Facility,Both,2 mL,mL,,8,6.8,2.2928,8,Aetna,Commercial,7.36,92,,percent of total billed charges,,
MIDAZOLAM (PF) 5 MG/ML INTRANASAL SOLN,,J2250,HCPCS,Facility,Outpatient,2 mL,mL,,8,6.8,2.2928,8,Aetna,Medicare Advantage,3.92,49,,percent of total billed charges,,
MIDAZOLAM (PF) 5 MG/ML INTRANASAL SOLN,,J2250,HCPCS,Facility,Inpatient,2 mL,mL,,8,6.8,2.2928,8,Aetna,Medicare Advantage,,,,,Included in per diem rate,
MIDAZOLAM (PF) 5 MG/ML INTRANASAL SOLN,,J2250,HCPCS,Facility,Both,2 mL,mL,,8,6.8,2.2928,8,Aetna,PPO,7.44,93,,percent of total billed charges,,
MIDAZOLAM (PF) 5 MG/ML INTRANASAL SOLN,,J2250,HCPCS,Facility,Both,2 mL,mL,,8,6.8,2.2928,8,America's PPO,America's PPO,7.6824,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
MIDAZOLAM (PF) 5 MG/ML INTRANASAL SOLN,,J2250,HCPCS,Facility,Both,2 mL,mL,,8,6.8,2.2928,8,BlueCross BlueShield Minnesota, Federal Employee Program,7.872,98.4,,percent of total billed charges,,
MIDAZOLAM (PF) 5 MG/ML INTRANASAL SOLN,,J2250,HCPCS,Facility,Both,2 mL,mL,,8,6.8,2.2928,8,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,8,100,,percent of total billed charges,,
MIDAZOLAM (PF) 5 MG/ML INTRANASAL SOLN,,J2250,HCPCS,Facility,Both,2 mL,mL,,8,6.8,2.2928,8,BlueCross BlueShield Minnesota,High Value Network Plan,7.2,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
MIDAZOLAM (PF) 5 MG/ML INTRANASAL SOLN,,J2250,HCPCS,Facility,Outpatient,2 mL,mL,,8,6.8,2.2928,8,BlueCross BlueShield Minnesota,Medicare Advantage,3.92,49,,percent of total billed charges,,
MIDAZOLAM (PF) 5 MG/ML INTRANASAL SOLN,,J2250,HCPCS,Facility,Inpatient,2 mL,mL,,8,6.8,2.2928,8,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
MIDAZOLAM (PF) 5 MG/ML INTRANASAL SOLN,,J2250,HCPCS,Facility,Both,2 mL,mL,,8,6.8,2.2928,8,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,7.0856,88.57,,percent of total billed charges,,
MIDAZOLAM (PF) 5 MG/ML INTRANASAL SOLN,,J2250,HCPCS,Facility,Both,2 mL,mL,,8,6.8,2.2928,8,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,2.2928,28.66,,percent of total billed charges,,
MIDAZOLAM (PF) 5 MG/ML INTRANASAL SOLN,,J2250,HCPCS,Facility,Outpatient,2 mL,mL,,8,6.8,2.2928,8,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),3.92,49,,percent of total billed charges,,
MIDAZOLAM (PF) 5 MG/ML INTRANASAL SOLN,,J2250,HCPCS,Facility,Inpatient,2 mL,mL,,8,6.8,2.2928,8,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
MIDAZOLAM (PF) 5 MG/ML INTRANASAL SOLN,,J2250,HCPCS,Facility,Both,2 mL,mL,,8,6.8,2.2928,8,CorVel,Worker's Compensation,8,100,,percent of total billed charges,,
MIDAZOLAM (PF) 5 MG/ML INTRANASAL SOLN,,J2250,HCPCS,Facility,Both,2 mL,mL,,8,6.8,2.2928,8,First Health Group Corporation,First Health Network,7.76,97,,percent of total billed charges,,
MIDAZOLAM (PF) 5 MG/ML INTRANASAL SOLN,,J2250,HCPCS,Facility,Both,2 mL,mL,,8,6.8,2.2928,8,"Health Partners, Inc.",Commercial,7.568,94.6,,percent of total billed charges,,
MIDAZOLAM (PF) 5 MG/ML INTRANASAL SOLN,,J2250,HCPCS,Facility,Outpatient,2 mL,mL,,8,6.8,2.2928,8,"Health Partners, Inc.",Medicare Advantage,3.92,49,,percent of total billed charges,,
MIDAZOLAM (PF) 5 MG/ML INTRANASAL SOLN,,J2250,HCPCS,Facility,Inpatient,2 mL,mL,,8,6.8,2.2928,8,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
MIDAZOLAM (PF) 5 MG/ML INTRANASAL SOLN,,J2250,HCPCS,Facility,Both,2 mL,mL,,8,6.8,2.2928,8,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),4.8,60,,percent of total billed charges,,
MIDAZOLAM (PF) 5 MG/ML INTRANASAL SOLN,,J2250,HCPCS,Facility,Both,2 mL,mL,,8,6.8,2.2928,8,"Health Partners, Inc.",State of Minnesota Advantage Program,6.52,81.5,,percent of total billed charges,,
MIDAZOLAM (PF) 5 MG/ML INTRANASAL SOLN,,J2250,HCPCS,Facility,Both,2 mL,mL,,8,6.8,2.2928,8,"Health Partners, Inc.",State Public Programs,4,50,,percent of total billed charges,,
MIDAZOLAM (PF) 5 MG/ML INTRANASAL SOLN,,J2250,HCPCS,Facility,Both,2 mL,mL,,8,6.8,2.2928,8,Humana Insurance Company,Commercial PPO,7.6,95,,percent of total billed charges,,
MIDAZOLAM (PF) 5 MG/ML INTRANASAL SOLN,,J2250,HCPCS,Facility,Outpatient,2 mL,mL,,8,6.8,2.2928,8,Humana Insurance Company,Medicare PPO,3.92,49,,percent of total billed charges,,
MIDAZOLAM (PF) 5 MG/ML INTRANASAL SOLN,,J2250,HCPCS,Facility,Inpatient,2 mL,mL,,8,6.8,2.2928,8,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
MIDAZOLAM (PF) 5 MG/ML INTRANASAL SOLN,,J2250,HCPCS,Facility,Both,2 mL,mL,,8,6.8,2.2928,8,Medica,Individual & Family,7.928,99.1,,percent of total billed charges,,
MIDAZOLAM (PF) 5 MG/ML INTRANASAL SOLN,,J2250,HCPCS,Facility,Outpatient,2 mL,mL,,8,6.8,2.2928,8,Medica,Medica Advantage Solution,3.984,49.8,,percent of total billed charges,,
MIDAZOLAM (PF) 5 MG/ML INTRANASAL SOLN,,J2250,HCPCS,Facility,Inpatient,2 mL,mL,,8,6.8,2.2928,8,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
MIDAZOLAM (PF) 5 MG/ML INTRANASAL SOLN,,J2250,HCPCS,Facility,Outpatient,2 mL,mL,,8,6.8,2.2928,8,Medica,Medical Assistance,3.568,44.6,,percent of total billed charges,,
MIDAZOLAM (PF) 5 MG/ML INTRANASAL SOLN,,J2250,HCPCS,Facility,Inpatient,2 mL,mL,,8,6.8,2.2928,8,Medica,Medical Assistance,,,,,Included in per diem rate,
MIDAZOLAM (PF) 5 MG/ML INTRANASAL SOLN,,J2250,HCPCS,Facility,Outpatient,2 mL,mL,,8,6.8,2.2928,8,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,3.984,49.8,,percent of total billed charges,,
MIDAZOLAM (PF) 5 MG/ML INTRANASAL SOLN,,J2250,HCPCS,Facility,Inpatient,2 mL,mL,,8,6.8,2.2928,8,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
MIDAZOLAM (PF) 5 MG/ML INTRANASAL SOLN,,J2250,HCPCS,Facility,Both,2 mL,mL,,8,6.8,2.2928,8,"Multiplan, Inc.","Multiplan, Inc.",7.52,94,,percent of total billed charges,,
MIDAZOLAM (PF) 5 MG/ML INTRANASAL SOLN,,J2250,HCPCS,Facility,Outpatient,2 mL,mL,,8,6.8,2.2928,8,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,7.208,90.1,,percent of total billed charges,,
MIDAZOLAM (PF) 5 MG/ML INTRANASAL SOLN,,J2250,HCPCS,Facility,Inpatient,2 mL,mL,,8,6.8,2.2928,8,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
MIDAZOLAM (PF) 5 MG/ML INTRANASAL SOLN,,J2250,HCPCS,Facility,Both,2 mL,mL,,8,6.8,2.2928,8,"Preferred One Administrative Services, INC.",PPO,7.888,98.6,,percent of total billed charges,,
MIDAZOLAM (PF) 5 MG/ML INTRANASAL SOLN,,J2250,HCPCS,Facility,Outpatient,2 mL,mL,,8,6.8,2.2928,8,PrimeWest Health,Minnesota Senior Health Options (MSHO),4.116,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
MIDAZOLAM (PF) 5 MG/ML INTRANASAL SOLN,,J2250,HCPCS,Facility,Inpatient,2 mL,mL,,8,6.8,2.2928,8,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
MIDAZOLAM (PF) 5 MG/ML INTRANASAL SOLN,,J2250,HCPCS,Facility,Outpatient,2 mL,mL,,8,6.8,2.2928,8,PrimeWest Health,MinnesotaCare,4.1088,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
MIDAZOLAM (PF) 5 MG/ML INTRANASAL SOLN,,J2250,HCPCS,Facility,Inpatient,2 mL,mL,,8,6.8,2.2928,8,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
MIDAZOLAM (PF) 5 MG/ML INTRANASAL SOLN,,J2250,HCPCS,Facility,Both,2 mL,mL,,8,6.8,2.2928,8,Sanford Health Plan,Sanford Health Plan,7.36,92,,percent of total billed charges,,
MIDAZOLAM (PF) 5 MG/ML INTRANASAL SOLN,,J2250,HCPCS,Facility,Outpatient,2 mL,mL,,8,6.8,2.2928,8,"UCare Health, Inc.",Individual & Family Plan,4.508,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
MIDAZOLAM (PF) 5 MG/ML INTRANASAL SOLN,,J2250,HCPCS,Facility,Inpatient,2 mL,mL,,8,6.8,2.2928,8,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
MIDAZOLAM (PF) 5 MG/ML INTRANASAL SOLN,,J2250,HCPCS,Facility,Outpatient,2 mL,mL,,8,6.8,2.2928,8,"UCare Health, Inc.",Medical Assistance,4.0376,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MIDAZOLAM (PF) 5 MG/ML INTRANASAL SOLN,,J2250,HCPCS,Facility,Inpatient,2 mL,mL,,8,6.8,2.2928,8,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
MIDAZOLAM (PF) 5 MG/ML INTRANASAL SOLN,,J2250,HCPCS,Facility,Outpatient,2 mL,mL,,8,6.8,2.2928,8,"UCare Health, Inc.",Medicare Advantage,4.0376,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MIDAZOLAM (PF) 5 MG/ML INTRANASAL SOLN,,J2250,HCPCS,Facility,Inpatient,2 mL,mL,,8,6.8,2.2928,8,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
MIDAZOLAM (PF) 5 MG/ML INTRANASAL SOLN,,J2250,HCPCS,Facility,Outpatient,2 mL,mL,,8,6.8,2.2928,8,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),4.0376,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MIDAZOLAM (PF) 5 MG/ML INTRANASAL SOLN,,J2250,HCPCS,Facility,Inpatient,2 mL,mL,,8,6.8,2.2928,8,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
MIDAZOLAM (PF) 5 MG/ML INTRANASAL SOLN,,J2250,HCPCS,Facility,Both,2 mL,mL,,8,6.8,2.2928,8,UnitedHealthcare,Individual & Family,7.52,94,,percent of total billed charges,,
MIDAZOLAM (PF) 5 MG/ML INTRANASAL SOLN,,J2250,HCPCS,Facility,Outpatient,2 mL,mL,,8,6.8,2.2928,8,UnitedHealthcare,Medicare Advantage,3.92,49,,percent of total billed charges,,
MIDAZOLAM (PF) 5 MG/ML INTRANASAL SOLN,,J2250,HCPCS,Facility,Inpatient,2 mL,mL,,8,6.8,2.2928,8,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
MIDAZOLAM (PF) 5 MG/ML INTRANASAL SOLN,,J2250,HCPCS,Facility,Outpatient,2 mL,mL,,8,6.8,2.2928,8,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,3.84,48,,percent of total billed charges,,100% of DHS outpatient percentage
MIDAZOLAM (PF) 5 MG/ML INTRANASAL SOLN,,J2250,HCPCS,Facility,Inpatient,2 mL,mL,,8,6.8,2.2928,8,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
MIDAZOLAM 1 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Both,2 mL,mL,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
MIDAZOLAM 1 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Both,2 mL,mL,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
MIDAZOLAM 1 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Outpatient,2 mL,mL,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
MIDAZOLAM 1 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Outpatient,2 mL,mL,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
MIDAZOLAM 1 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Inpatient,2 mL,mL,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
MIDAZOLAM 1 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Inpatient,2 mL,mL,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
MIDAZOLAM 1 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Both,2 mL,mL,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
MIDAZOLAM 1 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Both,2 mL,mL,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
MIDAZOLAM 1 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Both,2 mL,mL,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
MIDAZOLAM 1 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Both,2 mL,mL,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
MIDAZOLAM 1 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Both,2 mL,mL,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
MIDAZOLAM 1 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Both,2 mL,mL,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
MIDAZOLAM 1 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Both,2 mL,mL,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
MIDAZOLAM 1 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Both,2 mL,mL,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
MIDAZOLAM 1 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Both,2 mL,mL,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
MIDAZOLAM 1 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Both,2 mL,mL,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
MIDAZOLAM 1 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Outpatient,2 mL,mL,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
MIDAZOLAM 1 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Outpatient,2 mL,mL,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
MIDAZOLAM 1 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Inpatient,2 mL,mL,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
MIDAZOLAM 1 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Inpatient,2 mL,mL,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
MIDAZOLAM 1 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Both,2 mL,mL,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
MIDAZOLAM 1 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Both,2 mL,mL,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
MIDAZOLAM 1 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Both,2 mL,mL,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
MIDAZOLAM 1 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Both,2 mL,mL,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
MIDAZOLAM 1 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Outpatient,2 mL,mL,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
MIDAZOLAM 1 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Outpatient,2 mL,mL,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
MIDAZOLAM 1 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Inpatient,2 mL,mL,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
MIDAZOLAM 1 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Inpatient,2 mL,mL,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
MIDAZOLAM 1 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Both,2 mL,mL,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
MIDAZOLAM 1 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Both,2 mL,mL,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
MIDAZOLAM 1 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Both,2 mL,mL,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
MIDAZOLAM 1 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Both,2 mL,mL,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
MIDAZOLAM 1 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Both,2 mL,mL,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
MIDAZOLAM 1 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Both,2 mL,mL,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
MIDAZOLAM 1 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Outpatient,2 mL,mL,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
MIDAZOLAM 1 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Outpatient,2 mL,mL,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
MIDAZOLAM 1 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Inpatient,2 mL,mL,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
MIDAZOLAM 1 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Inpatient,2 mL,mL,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
MIDAZOLAM 1 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Both,2 mL,mL,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
MIDAZOLAM 1 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Both,2 mL,mL,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
MIDAZOLAM 1 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Both,2 mL,mL,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
MIDAZOLAM 1 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Both,2 mL,mL,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
MIDAZOLAM 1 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Both,2 mL,mL,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
MIDAZOLAM 1 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Both,2 mL,mL,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
MIDAZOLAM 1 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Both,2 mL,mL,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
MIDAZOLAM 1 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Both,2 mL,mL,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
MIDAZOLAM 1 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Outpatient,2 mL,mL,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
MIDAZOLAM 1 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Outpatient,2 mL,mL,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
MIDAZOLAM 1 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Inpatient,2 mL,mL,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
MIDAZOLAM 1 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Inpatient,2 mL,mL,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
MIDAZOLAM 1 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Both,2 mL,mL,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
MIDAZOLAM 1 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Both,2 mL,mL,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
MIDAZOLAM 1 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Outpatient,2 mL,mL,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
MIDAZOLAM 1 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Outpatient,2 mL,mL,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
MIDAZOLAM 1 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Inpatient,2 mL,mL,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
MIDAZOLAM 1 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Inpatient,2 mL,mL,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
MIDAZOLAM 1 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Outpatient,2 mL,mL,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
MIDAZOLAM 1 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Outpatient,2 mL,mL,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
MIDAZOLAM 1 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Inpatient,2 mL,mL,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
MIDAZOLAM 1 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Inpatient,2 mL,mL,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
MIDAZOLAM 1 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Outpatient,2 mL,mL,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
MIDAZOLAM 1 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Outpatient,2 mL,mL,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
MIDAZOLAM 1 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Inpatient,2 mL,mL,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
MIDAZOLAM 1 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Inpatient,2 mL,mL,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
MIDAZOLAM 1 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Both,2 mL,mL,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
MIDAZOLAM 1 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Both,2 mL,mL,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
MIDAZOLAM 1 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Outpatient,2 mL,mL,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
MIDAZOLAM 1 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Outpatient,2 mL,mL,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
MIDAZOLAM 1 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Inpatient,2 mL,mL,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
MIDAZOLAM 1 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Inpatient,2 mL,mL,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
MIDAZOLAM 1 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Both,2 mL,mL,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
MIDAZOLAM 1 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Both,2 mL,mL,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
MIDAZOLAM 1 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Outpatient,2 mL,mL,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
MIDAZOLAM 1 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Outpatient,2 mL,mL,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
MIDAZOLAM 1 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Inpatient,2 mL,mL,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
MIDAZOLAM 1 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Inpatient,2 mL,mL,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
MIDAZOLAM 1 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Outpatient,2 mL,mL,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
MIDAZOLAM 1 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Outpatient,2 mL,mL,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
MIDAZOLAM 1 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Inpatient,2 mL,mL,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
MIDAZOLAM 1 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Inpatient,2 mL,mL,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
MIDAZOLAM 1 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Both,2 mL,mL,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
MIDAZOLAM 1 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Both,2 mL,mL,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
MIDAZOLAM 1 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Outpatient,2 mL,mL,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
MIDAZOLAM 1 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Outpatient,2 mL,mL,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
MIDAZOLAM 1 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Inpatient,2 mL,mL,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
MIDAZOLAM 1 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Inpatient,2 mL,mL,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
MIDAZOLAM 1 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Outpatient,2 mL,mL,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MIDAZOLAM 1 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Outpatient,2 mL,mL,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MIDAZOLAM 1 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Inpatient,2 mL,mL,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
MIDAZOLAM 1 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Inpatient,2 mL,mL,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
MIDAZOLAM 1 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Outpatient,2 mL,mL,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MIDAZOLAM 1 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Outpatient,2 mL,mL,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MIDAZOLAM 1 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Inpatient,2 mL,mL,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
MIDAZOLAM 1 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Inpatient,2 mL,mL,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
MIDAZOLAM 1 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Outpatient,2 mL,mL,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MIDAZOLAM 1 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Outpatient,2 mL,mL,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MIDAZOLAM 1 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Inpatient,2 mL,mL,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
MIDAZOLAM 1 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Inpatient,2 mL,mL,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
MIDAZOLAM 1 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Both,2 mL,mL,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
MIDAZOLAM 1 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Both,2 mL,mL,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
MIDAZOLAM 1 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Outpatient,2 mL,mL,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
MIDAZOLAM 1 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Outpatient,2 mL,mL,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
MIDAZOLAM 1 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Inpatient,2 mL,mL,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
MIDAZOLAM 1 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Inpatient,2 mL,mL,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
MIDAZOLAM 1 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Outpatient,2 mL,mL,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
MIDAZOLAM 1 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Outpatient,2 mL,mL,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
MIDAZOLAM 1 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Inpatient,2 mL,mL,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
MIDAZOLAM 1 MG/ML INJ SOLN,,J2250,HCPCS,Facility,Inpatient,2 mL,mL,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
ONDANSETRON HCL (PF) 4 MG/2 ML INJ SOLN,,J2405,HCPCS,Facility,Both,2 mL,mL,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
ONDANSETRON HCL (PF) 4 MG/2 ML INJ SOLN,,J2405,HCPCS,Facility,Both,2 mL,mL,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
ONDANSETRON HCL (PF) 4 MG/2 ML INJ SOLN,,J2405,HCPCS,Facility,Outpatient,2 mL,mL,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
ONDANSETRON HCL (PF) 4 MG/2 ML INJ SOLN,,J2405,HCPCS,Facility,Outpatient,2 mL,mL,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
ONDANSETRON HCL (PF) 4 MG/2 ML INJ SOLN,,J2405,HCPCS,Facility,Inpatient,2 mL,mL,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
ONDANSETRON HCL (PF) 4 MG/2 ML INJ SOLN,,J2405,HCPCS,Facility,Inpatient,2 mL,mL,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
ONDANSETRON HCL (PF) 4 MG/2 ML INJ SOLN,,J2405,HCPCS,Facility,Both,2 mL,mL,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
ONDANSETRON HCL (PF) 4 MG/2 ML INJ SOLN,,J2405,HCPCS,Facility,Both,2 mL,mL,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
ONDANSETRON HCL (PF) 4 MG/2 ML INJ SOLN,,J2405,HCPCS,Facility,Both,2 mL,mL,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
ONDANSETRON HCL (PF) 4 MG/2 ML INJ SOLN,,J2405,HCPCS,Facility,Both,2 mL,mL,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
ONDANSETRON HCL (PF) 4 MG/2 ML INJ SOLN,,J2405,HCPCS,Facility,Both,2 mL,mL,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
ONDANSETRON HCL (PF) 4 MG/2 ML INJ SOLN,,J2405,HCPCS,Facility,Both,2 mL,mL,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
ONDANSETRON HCL (PF) 4 MG/2 ML INJ SOLN,,J2405,HCPCS,Facility,Both,2 mL,mL,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
ONDANSETRON HCL (PF) 4 MG/2 ML INJ SOLN,,J2405,HCPCS,Facility,Both,2 mL,mL,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
ONDANSETRON HCL (PF) 4 MG/2 ML INJ SOLN,,J2405,HCPCS,Facility,Both,2 mL,mL,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
ONDANSETRON HCL (PF) 4 MG/2 ML INJ SOLN,,J2405,HCPCS,Facility,Both,2 mL,mL,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
ONDANSETRON HCL (PF) 4 MG/2 ML INJ SOLN,,J2405,HCPCS,Facility,Outpatient,2 mL,mL,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
ONDANSETRON HCL (PF) 4 MG/2 ML INJ SOLN,,J2405,HCPCS,Facility,Outpatient,2 mL,mL,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
ONDANSETRON HCL (PF) 4 MG/2 ML INJ SOLN,,J2405,HCPCS,Facility,Inpatient,2 mL,mL,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
ONDANSETRON HCL (PF) 4 MG/2 ML INJ SOLN,,J2405,HCPCS,Facility,Inpatient,2 mL,mL,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
ONDANSETRON HCL (PF) 4 MG/2 ML INJ SOLN,,J2405,HCPCS,Facility,Both,2 mL,mL,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
ONDANSETRON HCL (PF) 4 MG/2 ML INJ SOLN,,J2405,HCPCS,Facility,Both,2 mL,mL,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
ONDANSETRON HCL (PF) 4 MG/2 ML INJ SOLN,,J2405,HCPCS,Facility,Both,2 mL,mL,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
ONDANSETRON HCL (PF) 4 MG/2 ML INJ SOLN,,J2405,HCPCS,Facility,Both,2 mL,mL,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
ONDANSETRON HCL (PF) 4 MG/2 ML INJ SOLN,,J2405,HCPCS,Facility,Outpatient,2 mL,mL,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
ONDANSETRON HCL (PF) 4 MG/2 ML INJ SOLN,,J2405,HCPCS,Facility,Outpatient,2 mL,mL,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
ONDANSETRON HCL (PF) 4 MG/2 ML INJ SOLN,,J2405,HCPCS,Facility,Inpatient,2 mL,mL,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
ONDANSETRON HCL (PF) 4 MG/2 ML INJ SOLN,,J2405,HCPCS,Facility,Inpatient,2 mL,mL,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
ONDANSETRON HCL (PF) 4 MG/2 ML INJ SOLN,,J2405,HCPCS,Facility,Both,2 mL,mL,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
ONDANSETRON HCL (PF) 4 MG/2 ML INJ SOLN,,J2405,HCPCS,Facility,Both,2 mL,mL,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
ONDANSETRON HCL (PF) 4 MG/2 ML INJ SOLN,,J2405,HCPCS,Facility,Both,2 mL,mL,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
ONDANSETRON HCL (PF) 4 MG/2 ML INJ SOLN,,J2405,HCPCS,Facility,Both,2 mL,mL,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
ONDANSETRON HCL (PF) 4 MG/2 ML INJ SOLN,,J2405,HCPCS,Facility,Both,2 mL,mL,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
ONDANSETRON HCL (PF) 4 MG/2 ML INJ SOLN,,J2405,HCPCS,Facility,Both,2 mL,mL,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
ONDANSETRON HCL (PF) 4 MG/2 ML INJ SOLN,,J2405,HCPCS,Facility,Outpatient,2 mL,mL,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
ONDANSETRON HCL (PF) 4 MG/2 ML INJ SOLN,,J2405,HCPCS,Facility,Outpatient,2 mL,mL,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
ONDANSETRON HCL (PF) 4 MG/2 ML INJ SOLN,,J2405,HCPCS,Facility,Inpatient,2 mL,mL,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ONDANSETRON HCL (PF) 4 MG/2 ML INJ SOLN,,J2405,HCPCS,Facility,Inpatient,2 mL,mL,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ONDANSETRON HCL (PF) 4 MG/2 ML INJ SOLN,,J2405,HCPCS,Facility,Both,2 mL,mL,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
ONDANSETRON HCL (PF) 4 MG/2 ML INJ SOLN,,J2405,HCPCS,Facility,Both,2 mL,mL,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
ONDANSETRON HCL (PF) 4 MG/2 ML INJ SOLN,,J2405,HCPCS,Facility,Both,2 mL,mL,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
ONDANSETRON HCL (PF) 4 MG/2 ML INJ SOLN,,J2405,HCPCS,Facility,Both,2 mL,mL,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
ONDANSETRON HCL (PF) 4 MG/2 ML INJ SOLN,,J2405,HCPCS,Facility,Both,2 mL,mL,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
ONDANSETRON HCL (PF) 4 MG/2 ML INJ SOLN,,J2405,HCPCS,Facility,Both,2 mL,mL,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
ONDANSETRON HCL (PF) 4 MG/2 ML INJ SOLN,,J2405,HCPCS,Facility,Both,2 mL,mL,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
ONDANSETRON HCL (PF) 4 MG/2 ML INJ SOLN,,J2405,HCPCS,Facility,Both,2 mL,mL,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
ONDANSETRON HCL (PF) 4 MG/2 ML INJ SOLN,,J2405,HCPCS,Facility,Outpatient,2 mL,mL,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
ONDANSETRON HCL (PF) 4 MG/2 ML INJ SOLN,,J2405,HCPCS,Facility,Outpatient,2 mL,mL,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
ONDANSETRON HCL (PF) 4 MG/2 ML INJ SOLN,,J2405,HCPCS,Facility,Inpatient,2 mL,mL,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
ONDANSETRON HCL (PF) 4 MG/2 ML INJ SOLN,,J2405,HCPCS,Facility,Inpatient,2 mL,mL,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
ONDANSETRON HCL (PF) 4 MG/2 ML INJ SOLN,,J2405,HCPCS,Facility,Both,2 mL,mL,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
ONDANSETRON HCL (PF) 4 MG/2 ML INJ SOLN,,J2405,HCPCS,Facility,Both,2 mL,mL,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
ONDANSETRON HCL (PF) 4 MG/2 ML INJ SOLN,,J2405,HCPCS,Facility,Outpatient,2 mL,mL,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
ONDANSETRON HCL (PF) 4 MG/2 ML INJ SOLN,,J2405,HCPCS,Facility,Outpatient,2 mL,mL,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
ONDANSETRON HCL (PF) 4 MG/2 ML INJ SOLN,,J2405,HCPCS,Facility,Inpatient,2 mL,mL,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
ONDANSETRON HCL (PF) 4 MG/2 ML INJ SOLN,,J2405,HCPCS,Facility,Inpatient,2 mL,mL,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
ONDANSETRON HCL (PF) 4 MG/2 ML INJ SOLN,,J2405,HCPCS,Facility,Outpatient,2 mL,mL,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
ONDANSETRON HCL (PF) 4 MG/2 ML INJ SOLN,,J2405,HCPCS,Facility,Outpatient,2 mL,mL,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
ONDANSETRON HCL (PF) 4 MG/2 ML INJ SOLN,,J2405,HCPCS,Facility,Inpatient,2 mL,mL,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
ONDANSETRON HCL (PF) 4 MG/2 ML INJ SOLN,,J2405,HCPCS,Facility,Inpatient,2 mL,mL,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
ONDANSETRON HCL (PF) 4 MG/2 ML INJ SOLN,,J2405,HCPCS,Facility,Outpatient,2 mL,mL,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
ONDANSETRON HCL (PF) 4 MG/2 ML INJ SOLN,,J2405,HCPCS,Facility,Outpatient,2 mL,mL,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
ONDANSETRON HCL (PF) 4 MG/2 ML INJ SOLN,,J2405,HCPCS,Facility,Inpatient,2 mL,mL,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
ONDANSETRON HCL (PF) 4 MG/2 ML INJ SOLN,,J2405,HCPCS,Facility,Inpatient,2 mL,mL,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
ONDANSETRON HCL (PF) 4 MG/2 ML INJ SOLN,,J2405,HCPCS,Facility,Both,2 mL,mL,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
ONDANSETRON HCL (PF) 4 MG/2 ML INJ SOLN,,J2405,HCPCS,Facility,Both,2 mL,mL,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
ONDANSETRON HCL (PF) 4 MG/2 ML INJ SOLN,,J2405,HCPCS,Facility,Outpatient,2 mL,mL,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
ONDANSETRON HCL (PF) 4 MG/2 ML INJ SOLN,,J2405,HCPCS,Facility,Outpatient,2 mL,mL,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
ONDANSETRON HCL (PF) 4 MG/2 ML INJ SOLN,,J2405,HCPCS,Facility,Inpatient,2 mL,mL,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
ONDANSETRON HCL (PF) 4 MG/2 ML INJ SOLN,,J2405,HCPCS,Facility,Inpatient,2 mL,mL,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
ONDANSETRON HCL (PF) 4 MG/2 ML INJ SOLN,,J2405,HCPCS,Facility,Both,2 mL,mL,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
ONDANSETRON HCL (PF) 4 MG/2 ML INJ SOLN,,J2405,HCPCS,Facility,Both,2 mL,mL,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
ONDANSETRON HCL (PF) 4 MG/2 ML INJ SOLN,,J2405,HCPCS,Facility,Outpatient,2 mL,mL,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
ONDANSETRON HCL (PF) 4 MG/2 ML INJ SOLN,,J2405,HCPCS,Facility,Outpatient,2 mL,mL,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
ONDANSETRON HCL (PF) 4 MG/2 ML INJ SOLN,,J2405,HCPCS,Facility,Inpatient,2 mL,mL,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ONDANSETRON HCL (PF) 4 MG/2 ML INJ SOLN,,J2405,HCPCS,Facility,Inpatient,2 mL,mL,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ONDANSETRON HCL (PF) 4 MG/2 ML INJ SOLN,,J2405,HCPCS,Facility,Outpatient,2 mL,mL,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
ONDANSETRON HCL (PF) 4 MG/2 ML INJ SOLN,,J2405,HCPCS,Facility,Outpatient,2 mL,mL,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
ONDANSETRON HCL (PF) 4 MG/2 ML INJ SOLN,,J2405,HCPCS,Facility,Inpatient,2 mL,mL,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
ONDANSETRON HCL (PF) 4 MG/2 ML INJ SOLN,,J2405,HCPCS,Facility,Inpatient,2 mL,mL,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
ONDANSETRON HCL (PF) 4 MG/2 ML INJ SOLN,,J2405,HCPCS,Facility,Both,2 mL,mL,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
ONDANSETRON HCL (PF) 4 MG/2 ML INJ SOLN,,J2405,HCPCS,Facility,Both,2 mL,mL,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
ONDANSETRON HCL (PF) 4 MG/2 ML INJ SOLN,,J2405,HCPCS,Facility,Outpatient,2 mL,mL,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
ONDANSETRON HCL (PF) 4 MG/2 ML INJ SOLN,,J2405,HCPCS,Facility,Outpatient,2 mL,mL,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
ONDANSETRON HCL (PF) 4 MG/2 ML INJ SOLN,,J2405,HCPCS,Facility,Inpatient,2 mL,mL,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
ONDANSETRON HCL (PF) 4 MG/2 ML INJ SOLN,,J2405,HCPCS,Facility,Inpatient,2 mL,mL,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
ONDANSETRON HCL (PF) 4 MG/2 ML INJ SOLN,,J2405,HCPCS,Facility,Outpatient,2 mL,mL,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ONDANSETRON HCL (PF) 4 MG/2 ML INJ SOLN,,J2405,HCPCS,Facility,Outpatient,2 mL,mL,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ONDANSETRON HCL (PF) 4 MG/2 ML INJ SOLN,,J2405,HCPCS,Facility,Inpatient,2 mL,mL,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
ONDANSETRON HCL (PF) 4 MG/2 ML INJ SOLN,,J2405,HCPCS,Facility,Inpatient,2 mL,mL,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
ONDANSETRON HCL (PF) 4 MG/2 ML INJ SOLN,,J2405,HCPCS,Facility,Outpatient,2 mL,mL,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ONDANSETRON HCL (PF) 4 MG/2 ML INJ SOLN,,J2405,HCPCS,Facility,Outpatient,2 mL,mL,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ONDANSETRON HCL (PF) 4 MG/2 ML INJ SOLN,,J2405,HCPCS,Facility,Inpatient,2 mL,mL,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ONDANSETRON HCL (PF) 4 MG/2 ML INJ SOLN,,J2405,HCPCS,Facility,Inpatient,2 mL,mL,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ONDANSETRON HCL (PF) 4 MG/2 ML INJ SOLN,,J2405,HCPCS,Facility,Outpatient,2 mL,mL,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ONDANSETRON HCL (PF) 4 MG/2 ML INJ SOLN,,J2405,HCPCS,Facility,Outpatient,2 mL,mL,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ONDANSETRON HCL (PF) 4 MG/2 ML INJ SOLN,,J2405,HCPCS,Facility,Inpatient,2 mL,mL,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ONDANSETRON HCL (PF) 4 MG/2 ML INJ SOLN,,J2405,HCPCS,Facility,Inpatient,2 mL,mL,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ONDANSETRON HCL (PF) 4 MG/2 ML INJ SOLN,,J2405,HCPCS,Facility,Both,2 mL,mL,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
ONDANSETRON HCL (PF) 4 MG/2 ML INJ SOLN,,J2405,HCPCS,Facility,Both,2 mL,mL,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
ONDANSETRON HCL (PF) 4 MG/2 ML INJ SOLN,,J2405,HCPCS,Facility,Outpatient,2 mL,mL,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
ONDANSETRON HCL (PF) 4 MG/2 ML INJ SOLN,,J2405,HCPCS,Facility,Outpatient,2 mL,mL,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
ONDANSETRON HCL (PF) 4 MG/2 ML INJ SOLN,,J2405,HCPCS,Facility,Inpatient,2 mL,mL,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
ONDANSETRON HCL (PF) 4 MG/2 ML INJ SOLN,,J2405,HCPCS,Facility,Inpatient,2 mL,mL,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
ONDANSETRON HCL (PF) 4 MG/2 ML INJ SOLN,,J2405,HCPCS,Facility,Outpatient,2 mL,mL,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
ONDANSETRON HCL (PF) 4 MG/2 ML INJ SOLN,,J2405,HCPCS,Facility,Outpatient,2 mL,mL,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
ONDANSETRON HCL (PF) 4 MG/2 ML INJ SOLN,,J2405,HCPCS,Facility,Inpatient,2 mL,mL,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
ONDANSETRON HCL (PF) 4 MG/2 ML INJ SOLN,,J2405,HCPCS,Facility,Inpatient,2 mL,mL,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
METOCLOPRAMIDE HCL 5 MG/ML INJ SOLN,,J2765,HCPCS,Facility,Both,2 mL,mL,,21,17.85,6.0186,21,Aetna,Commercial,19.32,92,,percent of total billed charges,,
METOCLOPRAMIDE HCL 5 MG/ML INJ SOLN,,J2765,HCPCS,Facility,Outpatient,2 mL,mL,,21,17.85,6.0186,21,Aetna,Medicare Advantage,10.29,49,,percent of total billed charges,,
METOCLOPRAMIDE HCL 5 MG/ML INJ SOLN,,J2765,HCPCS,Facility,Inpatient,2 mL,mL,,21,17.85,6.0186,21,Aetna,Medicare Advantage,,,,,Included in per diem rate,
METOCLOPRAMIDE HCL 5 MG/ML INJ SOLN,,J2765,HCPCS,Facility,Both,2 mL,mL,,21,17.85,6.0186,21,Aetna,PPO,19.53,93,,percent of total billed charges,,
METOCLOPRAMIDE HCL 5 MG/ML INJ SOLN,,J2765,HCPCS,Facility,Both,2 mL,mL,,21,17.85,6.0186,21,America's PPO,America's PPO,20.1663,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
METOCLOPRAMIDE HCL 5 MG/ML INJ SOLN,,J2765,HCPCS,Facility,Both,2 mL,mL,,21,17.85,6.0186,21,BlueCross BlueShield Minnesota, Federal Employee Program,20.664,98.4,,percent of total billed charges,,
METOCLOPRAMIDE HCL 5 MG/ML INJ SOLN,,J2765,HCPCS,Facility,Both,2 mL,mL,,21,17.85,6.0186,21,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,21,100,,percent of total billed charges,,
METOCLOPRAMIDE HCL 5 MG/ML INJ SOLN,,J2765,HCPCS,Facility,Both,2 mL,mL,,21,17.85,6.0186,21,BlueCross BlueShield Minnesota,High Value Network Plan,18.9,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
METOCLOPRAMIDE HCL 5 MG/ML INJ SOLN,,J2765,HCPCS,Facility,Outpatient,2 mL,mL,,21,17.85,6.0186,21,BlueCross BlueShield Minnesota,Medicare Advantage,10.29,49,,percent of total billed charges,,
METOCLOPRAMIDE HCL 5 MG/ML INJ SOLN,,J2765,HCPCS,Facility,Inpatient,2 mL,mL,,21,17.85,6.0186,21,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
METOCLOPRAMIDE HCL 5 MG/ML INJ SOLN,,J2765,HCPCS,Facility,Both,2 mL,mL,,21,17.85,6.0186,21,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,18.5997,88.57,,percent of total billed charges,,
METOCLOPRAMIDE HCL 5 MG/ML INJ SOLN,,J2765,HCPCS,Facility,Both,2 mL,mL,,21,17.85,6.0186,21,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,6.0186,28.66,,percent of total billed charges,,
METOCLOPRAMIDE HCL 5 MG/ML INJ SOLN,,J2765,HCPCS,Facility,Outpatient,2 mL,mL,,21,17.85,6.0186,21,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),10.29,49,,percent of total billed charges,,
METOCLOPRAMIDE HCL 5 MG/ML INJ SOLN,,J2765,HCPCS,Facility,Inpatient,2 mL,mL,,21,17.85,6.0186,21,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
METOCLOPRAMIDE HCL 5 MG/ML INJ SOLN,,J2765,HCPCS,Facility,Both,2 mL,mL,,21,17.85,6.0186,21,CorVel,Worker's Compensation,21,100,,percent of total billed charges,,
METOCLOPRAMIDE HCL 5 MG/ML INJ SOLN,,J2765,HCPCS,Facility,Both,2 mL,mL,,21,17.85,6.0186,21,First Health Group Corporation,First Health Network,20.37,97,,percent of total billed charges,,
METOCLOPRAMIDE HCL 5 MG/ML INJ SOLN,,J2765,HCPCS,Facility,Both,2 mL,mL,,21,17.85,6.0186,21,"Health Partners, Inc.",Commercial,19.866,94.6,,percent of total billed charges,,
METOCLOPRAMIDE HCL 5 MG/ML INJ SOLN,,J2765,HCPCS,Facility,Outpatient,2 mL,mL,,21,17.85,6.0186,21,"Health Partners, Inc.",Medicare Advantage,10.29,49,,percent of total billed charges,,
METOCLOPRAMIDE HCL 5 MG/ML INJ SOLN,,J2765,HCPCS,Facility,Inpatient,2 mL,mL,,21,17.85,6.0186,21,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
METOCLOPRAMIDE HCL 5 MG/ML INJ SOLN,,J2765,HCPCS,Facility,Both,2 mL,mL,,21,17.85,6.0186,21,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),12.6,60,,percent of total billed charges,,
METOCLOPRAMIDE HCL 5 MG/ML INJ SOLN,,J2765,HCPCS,Facility,Both,2 mL,mL,,21,17.85,6.0186,21,"Health Partners, Inc.",State of Minnesota Advantage Program,17.115,81.5,,percent of total billed charges,,
METOCLOPRAMIDE HCL 5 MG/ML INJ SOLN,,J2765,HCPCS,Facility,Both,2 mL,mL,,21,17.85,6.0186,21,"Health Partners, Inc.",State Public Programs,10.5,50,,percent of total billed charges,,
METOCLOPRAMIDE HCL 5 MG/ML INJ SOLN,,J2765,HCPCS,Facility,Both,2 mL,mL,,21,17.85,6.0186,21,Humana Insurance Company,Commercial PPO,19.95,95,,percent of total billed charges,,
METOCLOPRAMIDE HCL 5 MG/ML INJ SOLN,,J2765,HCPCS,Facility,Outpatient,2 mL,mL,,21,17.85,6.0186,21,Humana Insurance Company,Medicare PPO,10.29,49,,percent of total billed charges,,
METOCLOPRAMIDE HCL 5 MG/ML INJ SOLN,,J2765,HCPCS,Facility,Inpatient,2 mL,mL,,21,17.85,6.0186,21,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
METOCLOPRAMIDE HCL 5 MG/ML INJ SOLN,,J2765,HCPCS,Facility,Both,2 mL,mL,,21,17.85,6.0186,21,Medica,Individual & Family,20.811,99.1,,percent of total billed charges,,
METOCLOPRAMIDE HCL 5 MG/ML INJ SOLN,,J2765,HCPCS,Facility,Outpatient,2 mL,mL,,21,17.85,6.0186,21,Medica,Medica Advantage Solution,10.458,49.8,,percent of total billed charges,,
METOCLOPRAMIDE HCL 5 MG/ML INJ SOLN,,J2765,HCPCS,Facility,Inpatient,2 mL,mL,,21,17.85,6.0186,21,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
METOCLOPRAMIDE HCL 5 MG/ML INJ SOLN,,J2765,HCPCS,Facility,Outpatient,2 mL,mL,,21,17.85,6.0186,21,Medica,Medical Assistance,9.366,44.6,,percent of total billed charges,,
METOCLOPRAMIDE HCL 5 MG/ML INJ SOLN,,J2765,HCPCS,Facility,Inpatient,2 mL,mL,,21,17.85,6.0186,21,Medica,Medical Assistance,,,,,Included in per diem rate,
METOCLOPRAMIDE HCL 5 MG/ML INJ SOLN,,J2765,HCPCS,Facility,Outpatient,2 mL,mL,,21,17.85,6.0186,21,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,10.458,49.8,,percent of total billed charges,,
METOCLOPRAMIDE HCL 5 MG/ML INJ SOLN,,J2765,HCPCS,Facility,Inpatient,2 mL,mL,,21,17.85,6.0186,21,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
METOCLOPRAMIDE HCL 5 MG/ML INJ SOLN,,J2765,HCPCS,Facility,Both,2 mL,mL,,21,17.85,6.0186,21,"Multiplan, Inc.","Multiplan, Inc.",19.74,94,,percent of total billed charges,,
METOCLOPRAMIDE HCL 5 MG/ML INJ SOLN,,J2765,HCPCS,Facility,Outpatient,2 mL,mL,,21,17.85,6.0186,21,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,18.921,90.1,,percent of total billed charges,,
METOCLOPRAMIDE HCL 5 MG/ML INJ SOLN,,J2765,HCPCS,Facility,Inpatient,2 mL,mL,,21,17.85,6.0186,21,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
METOCLOPRAMIDE HCL 5 MG/ML INJ SOLN,,J2765,HCPCS,Facility,Both,2 mL,mL,,21,17.85,6.0186,21,"Preferred One Administrative Services, INC.",PPO,20.706,98.6,,percent of total billed charges,,
METOCLOPRAMIDE HCL 5 MG/ML INJ SOLN,,J2765,HCPCS,Facility,Outpatient,2 mL,mL,,21,17.85,6.0186,21,PrimeWest Health,Minnesota Senior Health Options (MSHO),10.8045,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
METOCLOPRAMIDE HCL 5 MG/ML INJ SOLN,,J2765,HCPCS,Facility,Inpatient,2 mL,mL,,21,17.85,6.0186,21,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
METOCLOPRAMIDE HCL 5 MG/ML INJ SOLN,,J2765,HCPCS,Facility,Outpatient,2 mL,mL,,21,17.85,6.0186,21,PrimeWest Health,MinnesotaCare,10.7856,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
METOCLOPRAMIDE HCL 5 MG/ML INJ SOLN,,J2765,HCPCS,Facility,Inpatient,2 mL,mL,,21,17.85,6.0186,21,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
METOCLOPRAMIDE HCL 5 MG/ML INJ SOLN,,J2765,HCPCS,Facility,Both,2 mL,mL,,21,17.85,6.0186,21,Sanford Health Plan,Sanford Health Plan,19.32,92,,percent of total billed charges,,
METOCLOPRAMIDE HCL 5 MG/ML INJ SOLN,,J2765,HCPCS,Facility,Outpatient,2 mL,mL,,21,17.85,6.0186,21,"UCare Health, Inc.",Individual & Family Plan,11.8335,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
METOCLOPRAMIDE HCL 5 MG/ML INJ SOLN,,J2765,HCPCS,Facility,Inpatient,2 mL,mL,,21,17.85,6.0186,21,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
METOCLOPRAMIDE HCL 5 MG/ML INJ SOLN,,J2765,HCPCS,Facility,Outpatient,2 mL,mL,,21,17.85,6.0186,21,"UCare Health, Inc.",Medical Assistance,10.5987,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
METOCLOPRAMIDE HCL 5 MG/ML INJ SOLN,,J2765,HCPCS,Facility,Inpatient,2 mL,mL,,21,17.85,6.0186,21,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
METOCLOPRAMIDE HCL 5 MG/ML INJ SOLN,,J2765,HCPCS,Facility,Outpatient,2 mL,mL,,21,17.85,6.0186,21,"UCare Health, Inc.",Medicare Advantage,10.5987,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
METOCLOPRAMIDE HCL 5 MG/ML INJ SOLN,,J2765,HCPCS,Facility,Inpatient,2 mL,mL,,21,17.85,6.0186,21,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
METOCLOPRAMIDE HCL 5 MG/ML INJ SOLN,,J2765,HCPCS,Facility,Outpatient,2 mL,mL,,21,17.85,6.0186,21,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),10.5987,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
METOCLOPRAMIDE HCL 5 MG/ML INJ SOLN,,J2765,HCPCS,Facility,Inpatient,2 mL,mL,,21,17.85,6.0186,21,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
METOCLOPRAMIDE HCL 5 MG/ML INJ SOLN,,J2765,HCPCS,Facility,Both,2 mL,mL,,21,17.85,6.0186,21,UnitedHealthcare,Individual & Family,19.74,94,,percent of total billed charges,,
METOCLOPRAMIDE HCL 5 MG/ML INJ SOLN,,J2765,HCPCS,Facility,Outpatient,2 mL,mL,,21,17.85,6.0186,21,UnitedHealthcare,Medicare Advantage,10.29,49,,percent of total billed charges,,
METOCLOPRAMIDE HCL 5 MG/ML INJ SOLN,,J2765,HCPCS,Facility,Inpatient,2 mL,mL,,21,17.85,6.0186,21,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
METOCLOPRAMIDE HCL 5 MG/ML INJ SOLN,,J2765,HCPCS,Facility,Outpatient,2 mL,mL,,21,17.85,6.0186,21,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,10.08,48,,percent of total billed charges,,100% of DHS outpatient percentage
METOCLOPRAMIDE HCL 5 MG/ML INJ SOLN,,J2765,HCPCS,Facility,Inpatient,2 mL,mL,,21,17.85,6.0186,21,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
FENTANYL CITRATE (PF) 50 MCG/ML INJ SOLN,,J3010,HCPCS,Facility,Both,2 mL,mL,,11,9.35,3.1526,11,Aetna,Commercial,10.12,92,,percent of total billed charges,,
FENTANYL CITRATE (PF) 50 MCG/ML INJ SOLN,,J3010,HCPCS,Facility,Outpatient,2 mL,mL,,11,9.35,3.1526,11,Aetna,Medicare Advantage,5.39,49,,percent of total billed charges,,
FENTANYL CITRATE (PF) 50 MCG/ML INJ SOLN,,J3010,HCPCS,Facility,Inpatient,2 mL,mL,,11,9.35,3.1526,11,Aetna,Medicare Advantage,,,,,Included in per diem rate,
FENTANYL CITRATE (PF) 50 MCG/ML INJ SOLN,,J3010,HCPCS,Facility,Both,2 mL,mL,,11,9.35,3.1526,11,Aetna,PPO,10.23,93,,percent of total billed charges,,
FENTANYL CITRATE (PF) 50 MCG/ML INJ SOLN,,J3010,HCPCS,Facility,Both,2 mL,mL,,11,9.35,3.1526,11,America's PPO,America's PPO,10.5633,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
FENTANYL CITRATE (PF) 50 MCG/ML INJ SOLN,,J3010,HCPCS,Facility,Both,2 mL,mL,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota, Federal Employee Program,10.824,98.4,,percent of total billed charges,,
FENTANYL CITRATE (PF) 50 MCG/ML INJ SOLN,,J3010,HCPCS,Facility,Both,2 mL,mL,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,11,100,,percent of total billed charges,,
FENTANYL CITRATE (PF) 50 MCG/ML INJ SOLN,,J3010,HCPCS,Facility,Both,2 mL,mL,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,High Value Network Plan,9.9,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
FENTANYL CITRATE (PF) 50 MCG/ML INJ SOLN,,J3010,HCPCS,Facility,Outpatient,2 mL,mL,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,Medicare Advantage,5.39,49,,percent of total billed charges,,
FENTANYL CITRATE (PF) 50 MCG/ML INJ SOLN,,J3010,HCPCS,Facility,Inpatient,2 mL,mL,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
FENTANYL CITRATE (PF) 50 MCG/ML INJ SOLN,,J3010,HCPCS,Facility,Both,2 mL,mL,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,9.7427,88.57,,percent of total billed charges,,
FENTANYL CITRATE (PF) 50 MCG/ML INJ SOLN,,J3010,HCPCS,Facility,Both,2 mL,mL,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,3.1526,28.66,,percent of total billed charges,,
FENTANYL CITRATE (PF) 50 MCG/ML INJ SOLN,,J3010,HCPCS,Facility,Outpatient,2 mL,mL,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),5.39,49,,percent of total billed charges,,
FENTANYL CITRATE (PF) 50 MCG/ML INJ SOLN,,J3010,HCPCS,Facility,Inpatient,2 mL,mL,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
FENTANYL CITRATE (PF) 50 MCG/ML INJ SOLN,,J3010,HCPCS,Facility,Both,2 mL,mL,,11,9.35,3.1526,11,CorVel,Worker's Compensation,11,100,,percent of total billed charges,,
FENTANYL CITRATE (PF) 50 MCG/ML INJ SOLN,,J3010,HCPCS,Facility,Both,2 mL,mL,,11,9.35,3.1526,11,First Health Group Corporation,First Health Network,10.67,97,,percent of total billed charges,,
FENTANYL CITRATE (PF) 50 MCG/ML INJ SOLN,,J3010,HCPCS,Facility,Both,2 mL,mL,,11,9.35,3.1526,11,"Health Partners, Inc.",Commercial,10.406,94.6,,percent of total billed charges,,
FENTANYL CITRATE (PF) 50 MCG/ML INJ SOLN,,J3010,HCPCS,Facility,Outpatient,2 mL,mL,,11,9.35,3.1526,11,"Health Partners, Inc.",Medicare Advantage,5.39,49,,percent of total billed charges,,
FENTANYL CITRATE (PF) 50 MCG/ML INJ SOLN,,J3010,HCPCS,Facility,Inpatient,2 mL,mL,,11,9.35,3.1526,11,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
FENTANYL CITRATE (PF) 50 MCG/ML INJ SOLN,,J3010,HCPCS,Facility,Both,2 mL,mL,,11,9.35,3.1526,11,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),6.6,60,,percent of total billed charges,,
FENTANYL CITRATE (PF) 50 MCG/ML INJ SOLN,,J3010,HCPCS,Facility,Both,2 mL,mL,,11,9.35,3.1526,11,"Health Partners, Inc.",State of Minnesota Advantage Program,8.965,81.5,,percent of total billed charges,,
FENTANYL CITRATE (PF) 50 MCG/ML INJ SOLN,,J3010,HCPCS,Facility,Both,2 mL,mL,,11,9.35,3.1526,11,"Health Partners, Inc.",State Public Programs,5.5,50,,percent of total billed charges,,
FENTANYL CITRATE (PF) 50 MCG/ML INJ SOLN,,J3010,HCPCS,Facility,Both,2 mL,mL,,11,9.35,3.1526,11,Humana Insurance Company,Commercial PPO,10.45,95,,percent of total billed charges,,
FENTANYL CITRATE (PF) 50 MCG/ML INJ SOLN,,J3010,HCPCS,Facility,Outpatient,2 mL,mL,,11,9.35,3.1526,11,Humana Insurance Company,Medicare PPO,5.39,49,,percent of total billed charges,,
FENTANYL CITRATE (PF) 50 MCG/ML INJ SOLN,,J3010,HCPCS,Facility,Inpatient,2 mL,mL,,11,9.35,3.1526,11,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
FENTANYL CITRATE (PF) 50 MCG/ML INJ SOLN,,J3010,HCPCS,Facility,Both,2 mL,mL,,11,9.35,3.1526,11,Medica,Individual & Family,10.901,99.1,,percent of total billed charges,,
FENTANYL CITRATE (PF) 50 MCG/ML INJ SOLN,,J3010,HCPCS,Facility,Outpatient,2 mL,mL,,11,9.35,3.1526,11,Medica,Medica Advantage Solution,5.478,49.8,,percent of total billed charges,,
FENTANYL CITRATE (PF) 50 MCG/ML INJ SOLN,,J3010,HCPCS,Facility,Inpatient,2 mL,mL,,11,9.35,3.1526,11,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
FENTANYL CITRATE (PF) 50 MCG/ML INJ SOLN,,J3010,HCPCS,Facility,Outpatient,2 mL,mL,,11,9.35,3.1526,11,Medica,Medical Assistance,4.906,44.6,,percent of total billed charges,,
FENTANYL CITRATE (PF) 50 MCG/ML INJ SOLN,,J3010,HCPCS,Facility,Inpatient,2 mL,mL,,11,9.35,3.1526,11,Medica,Medical Assistance,,,,,Included in per diem rate,
FENTANYL CITRATE (PF) 50 MCG/ML INJ SOLN,,J3010,HCPCS,Facility,Outpatient,2 mL,mL,,11,9.35,3.1526,11,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,5.478,49.8,,percent of total billed charges,,
FENTANYL CITRATE (PF) 50 MCG/ML INJ SOLN,,J3010,HCPCS,Facility,Inpatient,2 mL,mL,,11,9.35,3.1526,11,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
FENTANYL CITRATE (PF) 50 MCG/ML INJ SOLN,,J3010,HCPCS,Facility,Both,2 mL,mL,,11,9.35,3.1526,11,"Multiplan, Inc.","Multiplan, Inc.",10.34,94,,percent of total billed charges,,
FENTANYL CITRATE (PF) 50 MCG/ML INJ SOLN,,J3010,HCPCS,Facility,Outpatient,2 mL,mL,,11,9.35,3.1526,11,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,9.911,90.1,,percent of total billed charges,,
FENTANYL CITRATE (PF) 50 MCG/ML INJ SOLN,,J3010,HCPCS,Facility,Inpatient,2 mL,mL,,11,9.35,3.1526,11,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
FENTANYL CITRATE (PF) 50 MCG/ML INJ SOLN,,J3010,HCPCS,Facility,Both,2 mL,mL,,11,9.35,3.1526,11,"Preferred One Administrative Services, INC.",PPO,10.846,98.6,,percent of total billed charges,,
FENTANYL CITRATE (PF) 50 MCG/ML INJ SOLN,,J3010,HCPCS,Facility,Outpatient,2 mL,mL,,11,9.35,3.1526,11,PrimeWest Health,Minnesota Senior Health Options (MSHO),5.6595,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
FENTANYL CITRATE (PF) 50 MCG/ML INJ SOLN,,J3010,HCPCS,Facility,Inpatient,2 mL,mL,,11,9.35,3.1526,11,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
FENTANYL CITRATE (PF) 50 MCG/ML INJ SOLN,,J3010,HCPCS,Facility,Outpatient,2 mL,mL,,11,9.35,3.1526,11,PrimeWest Health,MinnesotaCare,5.6496,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
FENTANYL CITRATE (PF) 50 MCG/ML INJ SOLN,,J3010,HCPCS,Facility,Inpatient,2 mL,mL,,11,9.35,3.1526,11,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
FENTANYL CITRATE (PF) 50 MCG/ML INJ SOLN,,J3010,HCPCS,Facility,Both,2 mL,mL,,11,9.35,3.1526,11,Sanford Health Plan,Sanford Health Plan,10.12,92,,percent of total billed charges,,
FENTANYL CITRATE (PF) 50 MCG/ML INJ SOLN,,J3010,HCPCS,Facility,Outpatient,2 mL,mL,,11,9.35,3.1526,11,"UCare Health, Inc.",Individual & Family Plan,6.1985,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
FENTANYL CITRATE (PF) 50 MCG/ML INJ SOLN,,J3010,HCPCS,Facility,Inpatient,2 mL,mL,,11,9.35,3.1526,11,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
FENTANYL CITRATE (PF) 50 MCG/ML INJ SOLN,,J3010,HCPCS,Facility,Outpatient,2 mL,mL,,11,9.35,3.1526,11,"UCare Health, Inc.",Medical Assistance,5.5517,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FENTANYL CITRATE (PF) 50 MCG/ML INJ SOLN,,J3010,HCPCS,Facility,Inpatient,2 mL,mL,,11,9.35,3.1526,11,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
FENTANYL CITRATE (PF) 50 MCG/ML INJ SOLN,,J3010,HCPCS,Facility,Outpatient,2 mL,mL,,11,9.35,3.1526,11,"UCare Health, Inc.",Medicare Advantage,5.5517,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FENTANYL CITRATE (PF) 50 MCG/ML INJ SOLN,,J3010,HCPCS,Facility,Inpatient,2 mL,mL,,11,9.35,3.1526,11,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
FENTANYL CITRATE (PF) 50 MCG/ML INJ SOLN,,J3010,HCPCS,Facility,Outpatient,2 mL,mL,,11,9.35,3.1526,11,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),5.5517,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FENTANYL CITRATE (PF) 50 MCG/ML INJ SOLN,,J3010,HCPCS,Facility,Inpatient,2 mL,mL,,11,9.35,3.1526,11,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
FENTANYL CITRATE (PF) 50 MCG/ML INJ SOLN,,J3010,HCPCS,Facility,Both,2 mL,mL,,11,9.35,3.1526,11,UnitedHealthcare,Individual & Family,10.34,94,,percent of total billed charges,,
FENTANYL CITRATE (PF) 50 MCG/ML INJ SOLN,,J3010,HCPCS,Facility,Outpatient,2 mL,mL,,11,9.35,3.1526,11,UnitedHealthcare,Medicare Advantage,5.39,49,,percent of total billed charges,,
FENTANYL CITRATE (PF) 50 MCG/ML INJ SOLN,,J3010,HCPCS,Facility,Inpatient,2 mL,mL,,11,9.35,3.1526,11,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
FENTANYL CITRATE (PF) 50 MCG/ML INJ SOLN,,J3010,HCPCS,Facility,Outpatient,2 mL,mL,,11,9.35,3.1526,11,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,5.28,48,,percent of total billed charges,,100% of DHS outpatient percentage
FENTANYL CITRATE (PF) 50 MCG/ML INJ SOLN,,J3010,HCPCS,Facility,Inpatient,2 mL,mL,,11,9.35,3.1526,11,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
DIAZEPAM 5 MG/ML INJ SYRG,,J3360,HCPCS,Facility,Both,2 mL,mL,,182,154.7,52.1612,182,Aetna,Commercial,167.44,92,,percent of total billed charges,,
DIAZEPAM 5 MG/ML INJ SYRG,,J3360,HCPCS,Facility,Both,2 mL,mL,,182,154.7,52.1612,182,Aetna,Commercial,167.44,92,,percent of total billed charges,,
DIAZEPAM 5 MG/ML INJ SYRG,,J3360,HCPCS,Facility,Outpatient,2 mL,mL,,182,154.7,52.1612,182,Aetna,Medicare Advantage,89.18,49,,percent of total billed charges,,
DIAZEPAM 5 MG/ML INJ SYRG,,J3360,HCPCS,Facility,Outpatient,2 mL,mL,,182,154.7,52.1612,182,Aetna,Medicare Advantage,89.18,49,,percent of total billed charges,,
DIAZEPAM 5 MG/ML INJ SYRG,,J3360,HCPCS,Facility,Inpatient,2 mL,mL,,182,154.7,52.1612,182,Aetna,Medicare Advantage,,,,,Included in per diem rate,
DIAZEPAM 5 MG/ML INJ SYRG,,J3360,HCPCS,Facility,Inpatient,2 mL,mL,,182,154.7,52.1612,182,Aetna,Medicare Advantage,,,,,Included in per diem rate,
DIAZEPAM 5 MG/ML INJ SYRG,,J3360,HCPCS,Facility,Both,2 mL,mL,,182,154.7,52.1612,182,Aetna,PPO,169.26,93,,percent of total billed charges,,
DIAZEPAM 5 MG/ML INJ SYRG,,J3360,HCPCS,Facility,Both,2 mL,mL,,182,154.7,52.1612,182,Aetna,PPO,169.26,93,,percent of total billed charges,,
DIAZEPAM 5 MG/ML INJ SYRG,,J3360,HCPCS,Facility,Both,2 mL,mL,,182,154.7,52.1612,182,America's PPO,America's PPO,174.7746,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
DIAZEPAM 5 MG/ML INJ SYRG,,J3360,HCPCS,Facility,Both,2 mL,mL,,182,154.7,52.1612,182,America's PPO,America's PPO,174.7746,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
DIAZEPAM 5 MG/ML INJ SYRG,,J3360,HCPCS,Facility,Both,2 mL,mL,,182,154.7,52.1612,182,BlueCross BlueShield Minnesota, Federal Employee Program,179.088,98.4,,percent of total billed charges,,
DIAZEPAM 5 MG/ML INJ SYRG,,J3360,HCPCS,Facility,Both,2 mL,mL,,182,154.7,52.1612,182,BlueCross BlueShield Minnesota, Federal Employee Program,179.088,98.4,,percent of total billed charges,,
DIAZEPAM 5 MG/ML INJ SYRG,,J3360,HCPCS,Facility,Both,2 mL,mL,,182,154.7,52.1612,182,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,182,100,,percent of total billed charges,,
DIAZEPAM 5 MG/ML INJ SYRG,,J3360,HCPCS,Facility,Both,2 mL,mL,,182,154.7,52.1612,182,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,182,100,,percent of total billed charges,,
DIAZEPAM 5 MG/ML INJ SYRG,,J3360,HCPCS,Facility,Both,2 mL,mL,,182,154.7,52.1612,182,BlueCross BlueShield Minnesota,High Value Network Plan,163.8,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
DIAZEPAM 5 MG/ML INJ SYRG,,J3360,HCPCS,Facility,Both,2 mL,mL,,182,154.7,52.1612,182,BlueCross BlueShield Minnesota,High Value Network Plan,163.8,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
DIAZEPAM 5 MG/ML INJ SYRG,,J3360,HCPCS,Facility,Outpatient,2 mL,mL,,182,154.7,52.1612,182,BlueCross BlueShield Minnesota,Medicare Advantage,89.18,49,,percent of total billed charges,,
DIAZEPAM 5 MG/ML INJ SYRG,,J3360,HCPCS,Facility,Outpatient,2 mL,mL,,182,154.7,52.1612,182,BlueCross BlueShield Minnesota,Medicare Advantage,89.18,49,,percent of total billed charges,,
DIAZEPAM 5 MG/ML INJ SYRG,,J3360,HCPCS,Facility,Inpatient,2 mL,mL,,182,154.7,52.1612,182,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
DIAZEPAM 5 MG/ML INJ SYRG,,J3360,HCPCS,Facility,Inpatient,2 mL,mL,,182,154.7,52.1612,182,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
DIAZEPAM 5 MG/ML INJ SYRG,,J3360,HCPCS,Facility,Both,2 mL,mL,,182,154.7,52.1612,182,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,161.1974,88.57,,percent of total billed charges,,
DIAZEPAM 5 MG/ML INJ SYRG,,J3360,HCPCS,Facility,Both,2 mL,mL,,182,154.7,52.1612,182,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,161.1974,88.57,,percent of total billed charges,,
DIAZEPAM 5 MG/ML INJ SYRG,,J3360,HCPCS,Facility,Both,2 mL,mL,,182,154.7,52.1612,182,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,52.1612,28.66,,percent of total billed charges,,
DIAZEPAM 5 MG/ML INJ SYRG,,J3360,HCPCS,Facility,Both,2 mL,mL,,182,154.7,52.1612,182,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,52.1612,28.66,,percent of total billed charges,,
DIAZEPAM 5 MG/ML INJ SYRG,,J3360,HCPCS,Facility,Outpatient,2 mL,mL,,182,154.7,52.1612,182,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),89.18,49,,percent of total billed charges,,
DIAZEPAM 5 MG/ML INJ SYRG,,J3360,HCPCS,Facility,Outpatient,2 mL,mL,,182,154.7,52.1612,182,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),89.18,49,,percent of total billed charges,,
DIAZEPAM 5 MG/ML INJ SYRG,,J3360,HCPCS,Facility,Inpatient,2 mL,mL,,182,154.7,52.1612,182,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
DIAZEPAM 5 MG/ML INJ SYRG,,J3360,HCPCS,Facility,Inpatient,2 mL,mL,,182,154.7,52.1612,182,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
DIAZEPAM 5 MG/ML INJ SYRG,,J3360,HCPCS,Facility,Both,2 mL,mL,,182,154.7,52.1612,182,CorVel,Worker's Compensation,182,100,,percent of total billed charges,,
DIAZEPAM 5 MG/ML INJ SYRG,,J3360,HCPCS,Facility,Both,2 mL,mL,,182,154.7,52.1612,182,CorVel,Worker's Compensation,182,100,,percent of total billed charges,,
DIAZEPAM 5 MG/ML INJ SYRG,,J3360,HCPCS,Facility,Both,2 mL,mL,,182,154.7,52.1612,182,First Health Group Corporation,First Health Network,176.54,97,,percent of total billed charges,,
DIAZEPAM 5 MG/ML INJ SYRG,,J3360,HCPCS,Facility,Both,2 mL,mL,,182,154.7,52.1612,182,First Health Group Corporation,First Health Network,176.54,97,,percent of total billed charges,,
DIAZEPAM 5 MG/ML INJ SYRG,,J3360,HCPCS,Facility,Both,2 mL,mL,,182,154.7,52.1612,182,"Health Partners, Inc.",Commercial,172.172,94.6,,percent of total billed charges,,
DIAZEPAM 5 MG/ML INJ SYRG,,J3360,HCPCS,Facility,Both,2 mL,mL,,182,154.7,52.1612,182,"Health Partners, Inc.",Commercial,172.172,94.6,,percent of total billed charges,,
DIAZEPAM 5 MG/ML INJ SYRG,,J3360,HCPCS,Facility,Outpatient,2 mL,mL,,182,154.7,52.1612,182,"Health Partners, Inc.",Medicare Advantage,89.18,49,,percent of total billed charges,,
DIAZEPAM 5 MG/ML INJ SYRG,,J3360,HCPCS,Facility,Outpatient,2 mL,mL,,182,154.7,52.1612,182,"Health Partners, Inc.",Medicare Advantage,89.18,49,,percent of total billed charges,,
DIAZEPAM 5 MG/ML INJ SYRG,,J3360,HCPCS,Facility,Inpatient,2 mL,mL,,182,154.7,52.1612,182,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DIAZEPAM 5 MG/ML INJ SYRG,,J3360,HCPCS,Facility,Inpatient,2 mL,mL,,182,154.7,52.1612,182,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DIAZEPAM 5 MG/ML INJ SYRG,,J3360,HCPCS,Facility,Both,2 mL,mL,,182,154.7,52.1612,182,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),109.2,60,,percent of total billed charges,,
DIAZEPAM 5 MG/ML INJ SYRG,,J3360,HCPCS,Facility,Both,2 mL,mL,,182,154.7,52.1612,182,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),109.2,60,,percent of total billed charges,,
DIAZEPAM 5 MG/ML INJ SYRG,,J3360,HCPCS,Facility,Both,2 mL,mL,,182,154.7,52.1612,182,"Health Partners, Inc.",State of Minnesota Advantage Program,148.33,81.5,,percent of total billed charges,,
DIAZEPAM 5 MG/ML INJ SYRG,,J3360,HCPCS,Facility,Both,2 mL,mL,,182,154.7,52.1612,182,"Health Partners, Inc.",State of Minnesota Advantage Program,148.33,81.5,,percent of total billed charges,,
DIAZEPAM 5 MG/ML INJ SYRG,,J3360,HCPCS,Facility,Both,2 mL,mL,,182,154.7,52.1612,182,"Health Partners, Inc.",State Public Programs,91,50,,percent of total billed charges,,
DIAZEPAM 5 MG/ML INJ SYRG,,J3360,HCPCS,Facility,Both,2 mL,mL,,182,154.7,52.1612,182,"Health Partners, Inc.",State Public Programs,91,50,,percent of total billed charges,,
DIAZEPAM 5 MG/ML INJ SYRG,,J3360,HCPCS,Facility,Both,2 mL,mL,,182,154.7,52.1612,182,Humana Insurance Company,Commercial PPO,172.9,95,,percent of total billed charges,,
DIAZEPAM 5 MG/ML INJ SYRG,,J3360,HCPCS,Facility,Both,2 mL,mL,,182,154.7,52.1612,182,Humana Insurance Company,Commercial PPO,172.9,95,,percent of total billed charges,,
DIAZEPAM 5 MG/ML INJ SYRG,,J3360,HCPCS,Facility,Outpatient,2 mL,mL,,182,154.7,52.1612,182,Humana Insurance Company,Medicare PPO,89.18,49,,percent of total billed charges,,
DIAZEPAM 5 MG/ML INJ SYRG,,J3360,HCPCS,Facility,Outpatient,2 mL,mL,,182,154.7,52.1612,182,Humana Insurance Company,Medicare PPO,89.18,49,,percent of total billed charges,,
DIAZEPAM 5 MG/ML INJ SYRG,,J3360,HCPCS,Facility,Inpatient,2 mL,mL,,182,154.7,52.1612,182,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
DIAZEPAM 5 MG/ML INJ SYRG,,J3360,HCPCS,Facility,Inpatient,2 mL,mL,,182,154.7,52.1612,182,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
DIAZEPAM 5 MG/ML INJ SYRG,,J3360,HCPCS,Facility,Both,2 mL,mL,,182,154.7,52.1612,182,Medica,Individual & Family,180.362,99.1,,percent of total billed charges,,
DIAZEPAM 5 MG/ML INJ SYRG,,J3360,HCPCS,Facility,Both,2 mL,mL,,182,154.7,52.1612,182,Medica,Individual & Family,180.362,99.1,,percent of total billed charges,,
DIAZEPAM 5 MG/ML INJ SYRG,,J3360,HCPCS,Facility,Outpatient,2 mL,mL,,182,154.7,52.1612,182,Medica,Medica Advantage Solution,90.636,49.8,,percent of total billed charges,,
DIAZEPAM 5 MG/ML INJ SYRG,,J3360,HCPCS,Facility,Outpatient,2 mL,mL,,182,154.7,52.1612,182,Medica,Medica Advantage Solution,90.636,49.8,,percent of total billed charges,,
DIAZEPAM 5 MG/ML INJ SYRG,,J3360,HCPCS,Facility,Inpatient,2 mL,mL,,182,154.7,52.1612,182,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
DIAZEPAM 5 MG/ML INJ SYRG,,J3360,HCPCS,Facility,Inpatient,2 mL,mL,,182,154.7,52.1612,182,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
DIAZEPAM 5 MG/ML INJ SYRG,,J3360,HCPCS,Facility,Outpatient,2 mL,mL,,182,154.7,52.1612,182,Medica,Medical Assistance,81.172,44.6,,percent of total billed charges,,
DIAZEPAM 5 MG/ML INJ SYRG,,J3360,HCPCS,Facility,Outpatient,2 mL,mL,,182,154.7,52.1612,182,Medica,Medical Assistance,81.172,44.6,,percent of total billed charges,,
DIAZEPAM 5 MG/ML INJ SYRG,,J3360,HCPCS,Facility,Inpatient,2 mL,mL,,182,154.7,52.1612,182,Medica,Medical Assistance,,,,,Included in per diem rate,
DIAZEPAM 5 MG/ML INJ SYRG,,J3360,HCPCS,Facility,Inpatient,2 mL,mL,,182,154.7,52.1612,182,Medica,Medical Assistance,,,,,Included in per diem rate,
DIAZEPAM 5 MG/ML INJ SYRG,,J3360,HCPCS,Facility,Outpatient,2 mL,mL,,182,154.7,52.1612,182,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,90.636,49.8,,percent of total billed charges,,
DIAZEPAM 5 MG/ML INJ SYRG,,J3360,HCPCS,Facility,Outpatient,2 mL,mL,,182,154.7,52.1612,182,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,90.636,49.8,,percent of total billed charges,,
DIAZEPAM 5 MG/ML INJ SYRG,,J3360,HCPCS,Facility,Inpatient,2 mL,mL,,182,154.7,52.1612,182,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
DIAZEPAM 5 MG/ML INJ SYRG,,J3360,HCPCS,Facility,Inpatient,2 mL,mL,,182,154.7,52.1612,182,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
DIAZEPAM 5 MG/ML INJ SYRG,,J3360,HCPCS,Facility,Both,2 mL,mL,,182,154.7,52.1612,182,"Multiplan, Inc.","Multiplan, Inc.",171.08,94,,percent of total billed charges,,
DIAZEPAM 5 MG/ML INJ SYRG,,J3360,HCPCS,Facility,Both,2 mL,mL,,182,154.7,52.1612,182,"Multiplan, Inc.","Multiplan, Inc.",171.08,94,,percent of total billed charges,,
DIAZEPAM 5 MG/ML INJ SYRG,,J3360,HCPCS,Facility,Outpatient,2 mL,mL,,182,154.7,52.1612,182,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,163.982,90.1,,percent of total billed charges,,
DIAZEPAM 5 MG/ML INJ SYRG,,J3360,HCPCS,Facility,Outpatient,2 mL,mL,,182,154.7,52.1612,182,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,163.982,90.1,,percent of total billed charges,,
DIAZEPAM 5 MG/ML INJ SYRG,,J3360,HCPCS,Facility,Inpatient,2 mL,mL,,182,154.7,52.1612,182,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
DIAZEPAM 5 MG/ML INJ SYRG,,J3360,HCPCS,Facility,Inpatient,2 mL,mL,,182,154.7,52.1612,182,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
DIAZEPAM 5 MG/ML INJ SYRG,,J3360,HCPCS,Facility,Both,2 mL,mL,,182,154.7,52.1612,182,"Preferred One Administrative Services, INC.",PPO,179.452,98.6,,percent of total billed charges,,
DIAZEPAM 5 MG/ML INJ SYRG,,J3360,HCPCS,Facility,Both,2 mL,mL,,182,154.7,52.1612,182,"Preferred One Administrative Services, INC.",PPO,179.452,98.6,,percent of total billed charges,,
DIAZEPAM 5 MG/ML INJ SYRG,,J3360,HCPCS,Facility,Outpatient,2 mL,mL,,182,154.7,52.1612,182,PrimeWest Health,Minnesota Senior Health Options (MSHO),93.639,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
DIAZEPAM 5 MG/ML INJ SYRG,,J3360,HCPCS,Facility,Outpatient,2 mL,mL,,182,154.7,52.1612,182,PrimeWest Health,Minnesota Senior Health Options (MSHO),93.639,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
DIAZEPAM 5 MG/ML INJ SYRG,,J3360,HCPCS,Facility,Inpatient,2 mL,mL,,182,154.7,52.1612,182,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DIAZEPAM 5 MG/ML INJ SYRG,,J3360,HCPCS,Facility,Inpatient,2 mL,mL,,182,154.7,52.1612,182,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DIAZEPAM 5 MG/ML INJ SYRG,,J3360,HCPCS,Facility,Outpatient,2 mL,mL,,182,154.7,52.1612,182,PrimeWest Health,MinnesotaCare,93.4752,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
DIAZEPAM 5 MG/ML INJ SYRG,,J3360,HCPCS,Facility,Outpatient,2 mL,mL,,182,154.7,52.1612,182,PrimeWest Health,MinnesotaCare,93.4752,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
DIAZEPAM 5 MG/ML INJ SYRG,,J3360,HCPCS,Facility,Inpatient,2 mL,mL,,182,154.7,52.1612,182,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
DIAZEPAM 5 MG/ML INJ SYRG,,J3360,HCPCS,Facility,Inpatient,2 mL,mL,,182,154.7,52.1612,182,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
DIAZEPAM 5 MG/ML INJ SYRG,,J3360,HCPCS,Facility,Both,2 mL,mL,,182,154.7,52.1612,182,Sanford Health Plan,Sanford Health Plan,167.44,92,,percent of total billed charges,,
DIAZEPAM 5 MG/ML INJ SYRG,,J3360,HCPCS,Facility,Both,2 mL,mL,,182,154.7,52.1612,182,Sanford Health Plan,Sanford Health Plan,167.44,92,,percent of total billed charges,,
DIAZEPAM 5 MG/ML INJ SYRG,,J3360,HCPCS,Facility,Outpatient,2 mL,mL,,182,154.7,52.1612,182,"UCare Health, Inc.",Individual & Family Plan,102.557,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
DIAZEPAM 5 MG/ML INJ SYRG,,J3360,HCPCS,Facility,Outpatient,2 mL,mL,,182,154.7,52.1612,182,"UCare Health, Inc.",Individual & Family Plan,102.557,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
DIAZEPAM 5 MG/ML INJ SYRG,,J3360,HCPCS,Facility,Inpatient,2 mL,mL,,182,154.7,52.1612,182,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
DIAZEPAM 5 MG/ML INJ SYRG,,J3360,HCPCS,Facility,Inpatient,2 mL,mL,,182,154.7,52.1612,182,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
DIAZEPAM 5 MG/ML INJ SYRG,,J3360,HCPCS,Facility,Outpatient,2 mL,mL,,182,154.7,52.1612,182,"UCare Health, Inc.",Medical Assistance,91.8554,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DIAZEPAM 5 MG/ML INJ SYRG,,J3360,HCPCS,Facility,Outpatient,2 mL,mL,,182,154.7,52.1612,182,"UCare Health, Inc.",Medical Assistance,91.8554,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DIAZEPAM 5 MG/ML INJ SYRG,,J3360,HCPCS,Facility,Inpatient,2 mL,mL,,182,154.7,52.1612,182,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
DIAZEPAM 5 MG/ML INJ SYRG,,J3360,HCPCS,Facility,Inpatient,2 mL,mL,,182,154.7,52.1612,182,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
DIAZEPAM 5 MG/ML INJ SYRG,,J3360,HCPCS,Facility,Outpatient,2 mL,mL,,182,154.7,52.1612,182,"UCare Health, Inc.",Medicare Advantage,91.8554,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DIAZEPAM 5 MG/ML INJ SYRG,,J3360,HCPCS,Facility,Outpatient,2 mL,mL,,182,154.7,52.1612,182,"UCare Health, Inc.",Medicare Advantage,91.8554,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DIAZEPAM 5 MG/ML INJ SYRG,,J3360,HCPCS,Facility,Inpatient,2 mL,mL,,182,154.7,52.1612,182,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DIAZEPAM 5 MG/ML INJ SYRG,,J3360,HCPCS,Facility,Inpatient,2 mL,mL,,182,154.7,52.1612,182,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DIAZEPAM 5 MG/ML INJ SYRG,,J3360,HCPCS,Facility,Outpatient,2 mL,mL,,182,154.7,52.1612,182,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),91.8554,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DIAZEPAM 5 MG/ML INJ SYRG,,J3360,HCPCS,Facility,Outpatient,2 mL,mL,,182,154.7,52.1612,182,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),91.8554,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DIAZEPAM 5 MG/ML INJ SYRG,,J3360,HCPCS,Facility,Inpatient,2 mL,mL,,182,154.7,52.1612,182,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DIAZEPAM 5 MG/ML INJ SYRG,,J3360,HCPCS,Facility,Inpatient,2 mL,mL,,182,154.7,52.1612,182,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DIAZEPAM 5 MG/ML INJ SYRG,,J3360,HCPCS,Facility,Both,2 mL,mL,,182,154.7,52.1612,182,UnitedHealthcare,Individual & Family,171.08,94,,percent of total billed charges,,
DIAZEPAM 5 MG/ML INJ SYRG,,J3360,HCPCS,Facility,Both,2 mL,mL,,182,154.7,52.1612,182,UnitedHealthcare,Individual & Family,171.08,94,,percent of total billed charges,,
DIAZEPAM 5 MG/ML INJ SYRG,,J3360,HCPCS,Facility,Outpatient,2 mL,mL,,182,154.7,52.1612,182,UnitedHealthcare,Medicare Advantage,89.18,49,,percent of total billed charges,,
DIAZEPAM 5 MG/ML INJ SYRG,,J3360,HCPCS,Facility,Outpatient,2 mL,mL,,182,154.7,52.1612,182,UnitedHealthcare,Medicare Advantage,89.18,49,,percent of total billed charges,,
DIAZEPAM 5 MG/ML INJ SYRG,,J3360,HCPCS,Facility,Inpatient,2 mL,mL,,182,154.7,52.1612,182,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
DIAZEPAM 5 MG/ML INJ SYRG,,J3360,HCPCS,Facility,Inpatient,2 mL,mL,,182,154.7,52.1612,182,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
DIAZEPAM 5 MG/ML INJ SYRG,,J3360,HCPCS,Facility,Outpatient,2 mL,mL,,182,154.7,52.1612,182,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,87.36,48,,percent of total billed charges,,100% of DHS outpatient percentage
DIAZEPAM 5 MG/ML INJ SYRG,,J3360,HCPCS,Facility,Outpatient,2 mL,mL,,182,154.7,52.1612,182,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,87.36,48,,percent of total billed charges,,100% of DHS outpatient percentage
DIAZEPAM 5 MG/ML INJ SYRG,,J3360,HCPCS,Facility,Inpatient,2 mL,mL,,182,154.7,52.1612,182,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
DIAZEPAM 5 MG/ML INJ SYRG,,J3360,HCPCS,Facility,Inpatient,2 mL,mL,,182,154.7,52.1612,182,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
THIAMINE HCL (VITAMIN B1) 100 MG/ML INJ SOLN,,J3411,HCPCS,Facility,Both,2 mL,mL,,42,35.7,12.0372,42,Aetna,Commercial,38.64,92,,percent of total billed charges,,
THIAMINE HCL (VITAMIN B1) 100 MG/ML INJ SOLN,,J3411,HCPCS,Facility,Outpatient,2 mL,mL,,42,35.7,12.0372,42,Aetna,Medicare Advantage,20.58,49,,percent of total billed charges,,
THIAMINE HCL (VITAMIN B1) 100 MG/ML INJ SOLN,,J3411,HCPCS,Facility,Inpatient,2 mL,mL,,42,35.7,12.0372,42,Aetna,Medicare Advantage,,,,,Included in per diem rate,
THIAMINE HCL (VITAMIN B1) 100 MG/ML INJ SOLN,,J3411,HCPCS,Facility,Both,2 mL,mL,,42,35.7,12.0372,42,Aetna,PPO,39.06,93,,percent of total billed charges,,
THIAMINE HCL (VITAMIN B1) 100 MG/ML INJ SOLN,,J3411,HCPCS,Facility,Both,2 mL,mL,,42,35.7,12.0372,42,America's PPO,America's PPO,40.3326,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
THIAMINE HCL (VITAMIN B1) 100 MG/ML INJ SOLN,,J3411,HCPCS,Facility,Both,2 mL,mL,,42,35.7,12.0372,42,BlueCross BlueShield Minnesota, Federal Employee Program,41.328,98.4,,percent of total billed charges,,
THIAMINE HCL (VITAMIN B1) 100 MG/ML INJ SOLN,,J3411,HCPCS,Facility,Both,2 mL,mL,,42,35.7,12.0372,42,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,42,100,,percent of total billed charges,,
THIAMINE HCL (VITAMIN B1) 100 MG/ML INJ SOLN,,J3411,HCPCS,Facility,Both,2 mL,mL,,42,35.7,12.0372,42,BlueCross BlueShield Minnesota,High Value Network Plan,37.8,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
THIAMINE HCL (VITAMIN B1) 100 MG/ML INJ SOLN,,J3411,HCPCS,Facility,Outpatient,2 mL,mL,,42,35.7,12.0372,42,BlueCross BlueShield Minnesota,Medicare Advantage,20.58,49,,percent of total billed charges,,
THIAMINE HCL (VITAMIN B1) 100 MG/ML INJ SOLN,,J3411,HCPCS,Facility,Inpatient,2 mL,mL,,42,35.7,12.0372,42,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
THIAMINE HCL (VITAMIN B1) 100 MG/ML INJ SOLN,,J3411,HCPCS,Facility,Both,2 mL,mL,,42,35.7,12.0372,42,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,37.1994,88.57,,percent of total billed charges,,
THIAMINE HCL (VITAMIN B1) 100 MG/ML INJ SOLN,,J3411,HCPCS,Facility,Both,2 mL,mL,,42,35.7,12.0372,42,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,12.0372,28.66,,percent of total billed charges,,
THIAMINE HCL (VITAMIN B1) 100 MG/ML INJ SOLN,,J3411,HCPCS,Facility,Outpatient,2 mL,mL,,42,35.7,12.0372,42,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),20.58,49,,percent of total billed charges,,
THIAMINE HCL (VITAMIN B1) 100 MG/ML INJ SOLN,,J3411,HCPCS,Facility,Inpatient,2 mL,mL,,42,35.7,12.0372,42,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
THIAMINE HCL (VITAMIN B1) 100 MG/ML INJ SOLN,,J3411,HCPCS,Facility,Both,2 mL,mL,,42,35.7,12.0372,42,CorVel,Worker's Compensation,42,100,,percent of total billed charges,,
THIAMINE HCL (VITAMIN B1) 100 MG/ML INJ SOLN,,J3411,HCPCS,Facility,Both,2 mL,mL,,42,35.7,12.0372,42,First Health Group Corporation,First Health Network,40.74,97,,percent of total billed charges,,
THIAMINE HCL (VITAMIN B1) 100 MG/ML INJ SOLN,,J3411,HCPCS,Facility,Both,2 mL,mL,,42,35.7,12.0372,42,"Health Partners, Inc.",Commercial,39.732,94.6,,percent of total billed charges,,
THIAMINE HCL (VITAMIN B1) 100 MG/ML INJ SOLN,,J3411,HCPCS,Facility,Outpatient,2 mL,mL,,42,35.7,12.0372,42,"Health Partners, Inc.",Medicare Advantage,20.58,49,,percent of total billed charges,,
THIAMINE HCL (VITAMIN B1) 100 MG/ML INJ SOLN,,J3411,HCPCS,Facility,Inpatient,2 mL,mL,,42,35.7,12.0372,42,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
THIAMINE HCL (VITAMIN B1) 100 MG/ML INJ SOLN,,J3411,HCPCS,Facility,Both,2 mL,mL,,42,35.7,12.0372,42,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),25.2,60,,percent of total billed charges,,
THIAMINE HCL (VITAMIN B1) 100 MG/ML INJ SOLN,,J3411,HCPCS,Facility,Both,2 mL,mL,,42,35.7,12.0372,42,"Health Partners, Inc.",State of Minnesota Advantage Program,34.23,81.5,,percent of total billed charges,,
THIAMINE HCL (VITAMIN B1) 100 MG/ML INJ SOLN,,J3411,HCPCS,Facility,Both,2 mL,mL,,42,35.7,12.0372,42,"Health Partners, Inc.",State Public Programs,21,50,,percent of total billed charges,,
THIAMINE HCL (VITAMIN B1) 100 MG/ML INJ SOLN,,J3411,HCPCS,Facility,Both,2 mL,mL,,42,35.7,12.0372,42,Humana Insurance Company,Commercial PPO,39.9,95,,percent of total billed charges,,
THIAMINE HCL (VITAMIN B1) 100 MG/ML INJ SOLN,,J3411,HCPCS,Facility,Outpatient,2 mL,mL,,42,35.7,12.0372,42,Humana Insurance Company,Medicare PPO,20.58,49,,percent of total billed charges,,
THIAMINE HCL (VITAMIN B1) 100 MG/ML INJ SOLN,,J3411,HCPCS,Facility,Inpatient,2 mL,mL,,42,35.7,12.0372,42,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
THIAMINE HCL (VITAMIN B1) 100 MG/ML INJ SOLN,,J3411,HCPCS,Facility,Both,2 mL,mL,,42,35.7,12.0372,42,Medica,Individual & Family,41.622,99.1,,percent of total billed charges,,
THIAMINE HCL (VITAMIN B1) 100 MG/ML INJ SOLN,,J3411,HCPCS,Facility,Outpatient,2 mL,mL,,42,35.7,12.0372,42,Medica,Medica Advantage Solution,20.916,49.8,,percent of total billed charges,,
THIAMINE HCL (VITAMIN B1) 100 MG/ML INJ SOLN,,J3411,HCPCS,Facility,Inpatient,2 mL,mL,,42,35.7,12.0372,42,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
THIAMINE HCL (VITAMIN B1) 100 MG/ML INJ SOLN,,J3411,HCPCS,Facility,Outpatient,2 mL,mL,,42,35.7,12.0372,42,Medica,Medical Assistance,18.732,44.6,,percent of total billed charges,,
THIAMINE HCL (VITAMIN B1) 100 MG/ML INJ SOLN,,J3411,HCPCS,Facility,Inpatient,2 mL,mL,,42,35.7,12.0372,42,Medica,Medical Assistance,,,,,Included in per diem rate,
THIAMINE HCL (VITAMIN B1) 100 MG/ML INJ SOLN,,J3411,HCPCS,Facility,Outpatient,2 mL,mL,,42,35.7,12.0372,42,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,20.916,49.8,,percent of total billed charges,,
THIAMINE HCL (VITAMIN B1) 100 MG/ML INJ SOLN,,J3411,HCPCS,Facility,Inpatient,2 mL,mL,,42,35.7,12.0372,42,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
THIAMINE HCL (VITAMIN B1) 100 MG/ML INJ SOLN,,J3411,HCPCS,Facility,Both,2 mL,mL,,42,35.7,12.0372,42,"Multiplan, Inc.","Multiplan, Inc.",39.48,94,,percent of total billed charges,,
THIAMINE HCL (VITAMIN B1) 100 MG/ML INJ SOLN,,J3411,HCPCS,Facility,Outpatient,2 mL,mL,,42,35.7,12.0372,42,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,37.842,90.1,,percent of total billed charges,,
THIAMINE HCL (VITAMIN B1) 100 MG/ML INJ SOLN,,J3411,HCPCS,Facility,Inpatient,2 mL,mL,,42,35.7,12.0372,42,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
THIAMINE HCL (VITAMIN B1) 100 MG/ML INJ SOLN,,J3411,HCPCS,Facility,Both,2 mL,mL,,42,35.7,12.0372,42,"Preferred One Administrative Services, INC.",PPO,41.412,98.6,,percent of total billed charges,,
THIAMINE HCL (VITAMIN B1) 100 MG/ML INJ SOLN,,J3411,HCPCS,Facility,Outpatient,2 mL,mL,,42,35.7,12.0372,42,PrimeWest Health,Minnesota Senior Health Options (MSHO),21.609,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
THIAMINE HCL (VITAMIN B1) 100 MG/ML INJ SOLN,,J3411,HCPCS,Facility,Inpatient,2 mL,mL,,42,35.7,12.0372,42,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
THIAMINE HCL (VITAMIN B1) 100 MG/ML INJ SOLN,,J3411,HCPCS,Facility,Outpatient,2 mL,mL,,42,35.7,12.0372,42,PrimeWest Health,MinnesotaCare,21.5712,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
THIAMINE HCL (VITAMIN B1) 100 MG/ML INJ SOLN,,J3411,HCPCS,Facility,Inpatient,2 mL,mL,,42,35.7,12.0372,42,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
THIAMINE HCL (VITAMIN B1) 100 MG/ML INJ SOLN,,J3411,HCPCS,Facility,Both,2 mL,mL,,42,35.7,12.0372,42,Sanford Health Plan,Sanford Health Plan,38.64,92,,percent of total billed charges,,
THIAMINE HCL (VITAMIN B1) 100 MG/ML INJ SOLN,,J3411,HCPCS,Facility,Outpatient,2 mL,mL,,42,35.7,12.0372,42,"UCare Health, Inc.",Individual & Family Plan,23.667,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
THIAMINE HCL (VITAMIN B1) 100 MG/ML INJ SOLN,,J3411,HCPCS,Facility,Inpatient,2 mL,mL,,42,35.7,12.0372,42,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
THIAMINE HCL (VITAMIN B1) 100 MG/ML INJ SOLN,,J3411,HCPCS,Facility,Outpatient,2 mL,mL,,42,35.7,12.0372,42,"UCare Health, Inc.",Medical Assistance,21.1974,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
THIAMINE HCL (VITAMIN B1) 100 MG/ML INJ SOLN,,J3411,HCPCS,Facility,Inpatient,2 mL,mL,,42,35.7,12.0372,42,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
THIAMINE HCL (VITAMIN B1) 100 MG/ML INJ SOLN,,J3411,HCPCS,Facility,Outpatient,2 mL,mL,,42,35.7,12.0372,42,"UCare Health, Inc.",Medicare Advantage,21.1974,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
THIAMINE HCL (VITAMIN B1) 100 MG/ML INJ SOLN,,J3411,HCPCS,Facility,Inpatient,2 mL,mL,,42,35.7,12.0372,42,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
THIAMINE HCL (VITAMIN B1) 100 MG/ML INJ SOLN,,J3411,HCPCS,Facility,Outpatient,2 mL,mL,,42,35.7,12.0372,42,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),21.1974,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
THIAMINE HCL (VITAMIN B1) 100 MG/ML INJ SOLN,,J3411,HCPCS,Facility,Inpatient,2 mL,mL,,42,35.7,12.0372,42,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
THIAMINE HCL (VITAMIN B1) 100 MG/ML INJ SOLN,,J3411,HCPCS,Facility,Both,2 mL,mL,,42,35.7,12.0372,42,UnitedHealthcare,Individual & Family,39.48,94,,percent of total billed charges,,
THIAMINE HCL (VITAMIN B1) 100 MG/ML INJ SOLN,,J3411,HCPCS,Facility,Outpatient,2 mL,mL,,42,35.7,12.0372,42,UnitedHealthcare,Medicare Advantage,20.58,49,,percent of total billed charges,,
THIAMINE HCL (VITAMIN B1) 100 MG/ML INJ SOLN,,J3411,HCPCS,Facility,Inpatient,2 mL,mL,,42,35.7,12.0372,42,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
THIAMINE HCL (VITAMIN B1) 100 MG/ML INJ SOLN,,J3411,HCPCS,Facility,Outpatient,2 mL,mL,,42,35.7,12.0372,42,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,20.16,48,,percent of total billed charges,,100% of DHS outpatient percentage
THIAMINE HCL (VITAMIN B1) 100 MG/ML INJ SOLN,,J3411,HCPCS,Facility,Inpatient,2 mL,mL,,42,35.7,12.0372,42,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
ALFENTANIL 500 MCG/ML INJ SOLN,,J3490,HCPCS,Facility,Both,2 mL,mL,,51,43.35,14.6166,51,Aetna,Commercial,46.92,92,,percent of total billed charges,,
ALFENTANIL 500 MCG/ML INJ SOLN,,J3490,HCPCS,Facility,Both,2 mL,mL,,22,18.7,6.3052,22,Aetna,Commercial,20.24,92,,percent of total billed charges,,
ALFENTANIL 500 MCG/ML INJ SOLN,,J3490,HCPCS,Facility,Outpatient,2 mL,mL,,51,43.35,14.6166,51,Aetna,Medicare Advantage,24.99,49,,percent of total billed charges,,
ALFENTANIL 500 MCG/ML INJ SOLN,,J3490,HCPCS,Facility,Outpatient,2 mL,mL,,22,18.7,6.3052,22,Aetna,Medicare Advantage,10.78,49,,percent of total billed charges,,
ALFENTANIL 500 MCG/ML INJ SOLN,,J3490,HCPCS,Facility,Inpatient,2 mL,mL,,51,43.35,14.6166,51,Aetna,Medicare Advantage,,,,,Included in per diem rate,
ALFENTANIL 500 MCG/ML INJ SOLN,,J3490,HCPCS,Facility,Inpatient,2 mL,mL,,22,18.7,6.3052,22,Aetna,Medicare Advantage,,,,,Included in per diem rate,
ALFENTANIL 500 MCG/ML INJ SOLN,,J3490,HCPCS,Facility,Both,2 mL,mL,,51,43.35,14.6166,51,Aetna,PPO,47.43,93,,percent of total billed charges,,
ALFENTANIL 500 MCG/ML INJ SOLN,,J3490,HCPCS,Facility,Both,2 mL,mL,,22,18.7,6.3052,22,Aetna,PPO,20.46,93,,percent of total billed charges,,
ALFENTANIL 500 MCG/ML INJ SOLN,,J3490,HCPCS,Facility,Both,2 mL,mL,,51,43.35,14.6166,51,America's PPO,America's PPO,48.9753,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
ALFENTANIL 500 MCG/ML INJ SOLN,,J3490,HCPCS,Facility,Both,2 mL,mL,,22,18.7,6.3052,22,America's PPO,America's PPO,21.1266,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
ALFENTANIL 500 MCG/ML INJ SOLN,,J3490,HCPCS,Facility,Both,2 mL,mL,,51,43.35,14.6166,51,BlueCross BlueShield Minnesota, Federal Employee Program,50.184,98.4,,percent of total billed charges,,
ALFENTANIL 500 MCG/ML INJ SOLN,,J3490,HCPCS,Facility,Both,2 mL,mL,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota, Federal Employee Program,21.648,98.4,,percent of total billed charges,,
ALFENTANIL 500 MCG/ML INJ SOLN,,J3490,HCPCS,Facility,Both,2 mL,mL,,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,51,100,,percent of total billed charges,,
ALFENTANIL 500 MCG/ML INJ SOLN,,J3490,HCPCS,Facility,Both,2 mL,mL,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,22,100,,percent of total billed charges,,
ALFENTANIL 500 MCG/ML INJ SOLN,,J3490,HCPCS,Facility,Both,2 mL,mL,,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,High Value Network Plan,45.9,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
ALFENTANIL 500 MCG/ML INJ SOLN,,J3490,HCPCS,Facility,Both,2 mL,mL,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota,High Value Network Plan,19.8,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
ALFENTANIL 500 MCG/ML INJ SOLN,,J3490,HCPCS,Facility,Outpatient,2 mL,mL,,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,Medicare Advantage,24.99,49,,percent of total billed charges,,
ALFENTANIL 500 MCG/ML INJ SOLN,,J3490,HCPCS,Facility,Outpatient,2 mL,mL,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota,Medicare Advantage,10.78,49,,percent of total billed charges,,
ALFENTANIL 500 MCG/ML INJ SOLN,,J3490,HCPCS,Facility,Inpatient,2 mL,mL,,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
ALFENTANIL 500 MCG/ML INJ SOLN,,J3490,HCPCS,Facility,Inpatient,2 mL,mL,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
ALFENTANIL 500 MCG/ML INJ SOLN,,J3490,HCPCS,Facility,Both,2 mL,mL,,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,45.1707,88.57,,percent of total billed charges,,
ALFENTANIL 500 MCG/ML INJ SOLN,,J3490,HCPCS,Facility,Both,2 mL,mL,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,19.4854,88.57,,percent of total billed charges,,
ALFENTANIL 500 MCG/ML INJ SOLN,,J3490,HCPCS,Facility,Both,2 mL,mL,,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,14.6166,28.66,,percent of total billed charges,,
ALFENTANIL 500 MCG/ML INJ SOLN,,J3490,HCPCS,Facility,Both,2 mL,mL,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,6.3052,28.66,,percent of total billed charges,,
ALFENTANIL 500 MCG/ML INJ SOLN,,J3490,HCPCS,Facility,Outpatient,2 mL,mL,,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),24.99,49,,percent of total billed charges,,
ALFENTANIL 500 MCG/ML INJ SOLN,,J3490,HCPCS,Facility,Outpatient,2 mL,mL,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),10.78,49,,percent of total billed charges,,
ALFENTANIL 500 MCG/ML INJ SOLN,,J3490,HCPCS,Facility,Inpatient,2 mL,mL,,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
ALFENTANIL 500 MCG/ML INJ SOLN,,J3490,HCPCS,Facility,Inpatient,2 mL,mL,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
ALFENTANIL 500 MCG/ML INJ SOLN,,J3490,HCPCS,Facility,Both,2 mL,mL,,51,43.35,14.6166,51,CorVel,Worker's Compensation,51,100,,percent of total billed charges,,
ALFENTANIL 500 MCG/ML INJ SOLN,,J3490,HCPCS,Facility,Both,2 mL,mL,,22,18.7,6.3052,22,CorVel,Worker's Compensation,22,100,,percent of total billed charges,,
ALFENTANIL 500 MCG/ML INJ SOLN,,J3490,HCPCS,Facility,Both,2 mL,mL,,51,43.35,14.6166,51,First Health Group Corporation,First Health Network,49.47,97,,percent of total billed charges,,
ALFENTANIL 500 MCG/ML INJ SOLN,,J3490,HCPCS,Facility,Both,2 mL,mL,,22,18.7,6.3052,22,First Health Group Corporation,First Health Network,21.34,97,,percent of total billed charges,,
ALFENTANIL 500 MCG/ML INJ SOLN,,J3490,HCPCS,Facility,Both,2 mL,mL,,51,43.35,14.6166,51,"Health Partners, Inc.",Commercial,48.246,94.6,,percent of total billed charges,,
ALFENTANIL 500 MCG/ML INJ SOLN,,J3490,HCPCS,Facility,Both,2 mL,mL,,22,18.7,6.3052,22,"Health Partners, Inc.",Commercial,20.812,94.6,,percent of total billed charges,,
ALFENTANIL 500 MCG/ML INJ SOLN,,J3490,HCPCS,Facility,Outpatient,2 mL,mL,,51,43.35,14.6166,51,"Health Partners, Inc.",Medicare Advantage,24.99,49,,percent of total billed charges,,
ALFENTANIL 500 MCG/ML INJ SOLN,,J3490,HCPCS,Facility,Outpatient,2 mL,mL,,22,18.7,6.3052,22,"Health Partners, Inc.",Medicare Advantage,10.78,49,,percent of total billed charges,,
ALFENTANIL 500 MCG/ML INJ SOLN,,J3490,HCPCS,Facility,Inpatient,2 mL,mL,,51,43.35,14.6166,51,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ALFENTANIL 500 MCG/ML INJ SOLN,,J3490,HCPCS,Facility,Inpatient,2 mL,mL,,22,18.7,6.3052,22,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ALFENTANIL 500 MCG/ML INJ SOLN,,J3490,HCPCS,Facility,Both,2 mL,mL,,51,43.35,14.6166,51,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),30.6,60,,percent of total billed charges,,
ALFENTANIL 500 MCG/ML INJ SOLN,,J3490,HCPCS,Facility,Both,2 mL,mL,,22,18.7,6.3052,22,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),13.2,60,,percent of total billed charges,,
ALFENTANIL 500 MCG/ML INJ SOLN,,J3490,HCPCS,Facility,Both,2 mL,mL,,51,43.35,14.6166,51,"Health Partners, Inc.",State of Minnesota Advantage Program,41.565,81.5,,percent of total billed charges,,
ALFENTANIL 500 MCG/ML INJ SOLN,,J3490,HCPCS,Facility,Both,2 mL,mL,,22,18.7,6.3052,22,"Health Partners, Inc.",State of Minnesota Advantage Program,17.93,81.5,,percent of total billed charges,,
ALFENTANIL 500 MCG/ML INJ SOLN,,J3490,HCPCS,Facility,Both,2 mL,mL,,51,43.35,14.6166,51,"Health Partners, Inc.",State Public Programs,25.5,50,,percent of total billed charges,,
ALFENTANIL 500 MCG/ML INJ SOLN,,J3490,HCPCS,Facility,Both,2 mL,mL,,22,18.7,6.3052,22,"Health Partners, Inc.",State Public Programs,11,50,,percent of total billed charges,,
ALFENTANIL 500 MCG/ML INJ SOLN,,J3490,HCPCS,Facility,Both,2 mL,mL,,51,43.35,14.6166,51,Humana Insurance Company,Commercial PPO,48.45,95,,percent of total billed charges,,
ALFENTANIL 500 MCG/ML INJ SOLN,,J3490,HCPCS,Facility,Both,2 mL,mL,,22,18.7,6.3052,22,Humana Insurance Company,Commercial PPO,20.9,95,,percent of total billed charges,,
ALFENTANIL 500 MCG/ML INJ SOLN,,J3490,HCPCS,Facility,Outpatient,2 mL,mL,,51,43.35,14.6166,51,Humana Insurance Company,Medicare PPO,24.99,49,,percent of total billed charges,,
ALFENTANIL 500 MCG/ML INJ SOLN,,J3490,HCPCS,Facility,Outpatient,2 mL,mL,,22,18.7,6.3052,22,Humana Insurance Company,Medicare PPO,10.78,49,,percent of total billed charges,,
ALFENTANIL 500 MCG/ML INJ SOLN,,J3490,HCPCS,Facility,Inpatient,2 mL,mL,,51,43.35,14.6166,51,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
ALFENTANIL 500 MCG/ML INJ SOLN,,J3490,HCPCS,Facility,Inpatient,2 mL,mL,,22,18.7,6.3052,22,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
ALFENTANIL 500 MCG/ML INJ SOLN,,J3490,HCPCS,Facility,Both,2 mL,mL,,51,43.35,14.6166,51,Medica,Individual & Family,50.541,99.1,,percent of total billed charges,,
ALFENTANIL 500 MCG/ML INJ SOLN,,J3490,HCPCS,Facility,Both,2 mL,mL,,22,18.7,6.3052,22,Medica,Individual & Family,21.802,99.1,,percent of total billed charges,,
ALFENTANIL 500 MCG/ML INJ SOLN,,J3490,HCPCS,Facility,Outpatient,2 mL,mL,,51,43.35,14.6166,51,Medica,Medica Advantage Solution,25.398,49.8,,percent of total billed charges,,
ALFENTANIL 500 MCG/ML INJ SOLN,,J3490,HCPCS,Facility,Outpatient,2 mL,mL,,22,18.7,6.3052,22,Medica,Medica Advantage Solution,10.956,49.8,,percent of total billed charges,,
ALFENTANIL 500 MCG/ML INJ SOLN,,J3490,HCPCS,Facility,Inpatient,2 mL,mL,,51,43.35,14.6166,51,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
ALFENTANIL 500 MCG/ML INJ SOLN,,J3490,HCPCS,Facility,Inpatient,2 mL,mL,,22,18.7,6.3052,22,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
ALFENTANIL 500 MCG/ML INJ SOLN,,J3490,HCPCS,Facility,Outpatient,2 mL,mL,,51,43.35,14.6166,51,Medica,Medical Assistance,22.746,44.6,,percent of total billed charges,,
ALFENTANIL 500 MCG/ML INJ SOLN,,J3490,HCPCS,Facility,Outpatient,2 mL,mL,,22,18.7,6.3052,22,Medica,Medical Assistance,9.812,44.6,,percent of total billed charges,,
ALFENTANIL 500 MCG/ML INJ SOLN,,J3490,HCPCS,Facility,Inpatient,2 mL,mL,,51,43.35,14.6166,51,Medica,Medical Assistance,,,,,Included in per diem rate,
ALFENTANIL 500 MCG/ML INJ SOLN,,J3490,HCPCS,Facility,Inpatient,2 mL,mL,,22,18.7,6.3052,22,Medica,Medical Assistance,,,,,Included in per diem rate,
ALFENTANIL 500 MCG/ML INJ SOLN,,J3490,HCPCS,Facility,Outpatient,2 mL,mL,,51,43.35,14.6166,51,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,25.398,49.8,,percent of total billed charges,,
ALFENTANIL 500 MCG/ML INJ SOLN,,J3490,HCPCS,Facility,Outpatient,2 mL,mL,,22,18.7,6.3052,22,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,10.956,49.8,,percent of total billed charges,,
ALFENTANIL 500 MCG/ML INJ SOLN,,J3490,HCPCS,Facility,Inpatient,2 mL,mL,,51,43.35,14.6166,51,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
ALFENTANIL 500 MCG/ML INJ SOLN,,J3490,HCPCS,Facility,Inpatient,2 mL,mL,,22,18.7,6.3052,22,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
ALFENTANIL 500 MCG/ML INJ SOLN,,J3490,HCPCS,Facility,Both,2 mL,mL,,51,43.35,14.6166,51,"Multiplan, Inc.","Multiplan, Inc.",47.94,94,,percent of total billed charges,,
ALFENTANIL 500 MCG/ML INJ SOLN,,J3490,HCPCS,Facility,Both,2 mL,mL,,22,18.7,6.3052,22,"Multiplan, Inc.","Multiplan, Inc.",20.68,94,,percent of total billed charges,,
ALFENTANIL 500 MCG/ML INJ SOLN,,J3490,HCPCS,Facility,Outpatient,2 mL,mL,,51,43.35,14.6166,51,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,45.951,90.1,,percent of total billed charges,,
ALFENTANIL 500 MCG/ML INJ SOLN,,J3490,HCPCS,Facility,Outpatient,2 mL,mL,,22,18.7,6.3052,22,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,19.822,90.1,,percent of total billed charges,,
ALFENTANIL 500 MCG/ML INJ SOLN,,J3490,HCPCS,Facility,Inpatient,2 mL,mL,,51,43.35,14.6166,51,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
ALFENTANIL 500 MCG/ML INJ SOLN,,J3490,HCPCS,Facility,Inpatient,2 mL,mL,,22,18.7,6.3052,22,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
ALFENTANIL 500 MCG/ML INJ SOLN,,J3490,HCPCS,Facility,Both,2 mL,mL,,51,43.35,14.6166,51,"Preferred One Administrative Services, INC.",PPO,50.286,98.6,,percent of total billed charges,,
ALFENTANIL 500 MCG/ML INJ SOLN,,J3490,HCPCS,Facility,Both,2 mL,mL,,22,18.7,6.3052,22,"Preferred One Administrative Services, INC.",PPO,21.692,98.6,,percent of total billed charges,,
ALFENTANIL 500 MCG/ML INJ SOLN,,J3490,HCPCS,Facility,Outpatient,2 mL,mL,,51,43.35,14.6166,51,PrimeWest Health,Minnesota Senior Health Options (MSHO),26.2395,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
ALFENTANIL 500 MCG/ML INJ SOLN,,J3490,HCPCS,Facility,Outpatient,2 mL,mL,,22,18.7,6.3052,22,PrimeWest Health,Minnesota Senior Health Options (MSHO),11.319,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
ALFENTANIL 500 MCG/ML INJ SOLN,,J3490,HCPCS,Facility,Inpatient,2 mL,mL,,51,43.35,14.6166,51,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ALFENTANIL 500 MCG/ML INJ SOLN,,J3490,HCPCS,Facility,Inpatient,2 mL,mL,,22,18.7,6.3052,22,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ALFENTANIL 500 MCG/ML INJ SOLN,,J3490,HCPCS,Facility,Outpatient,2 mL,mL,,51,43.35,14.6166,51,PrimeWest Health,MinnesotaCare,26.1936,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
ALFENTANIL 500 MCG/ML INJ SOLN,,J3490,HCPCS,Facility,Outpatient,2 mL,mL,,22,18.7,6.3052,22,PrimeWest Health,MinnesotaCare,11.2992,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
ALFENTANIL 500 MCG/ML INJ SOLN,,J3490,HCPCS,Facility,Inpatient,2 mL,mL,,51,43.35,14.6166,51,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
ALFENTANIL 500 MCG/ML INJ SOLN,,J3490,HCPCS,Facility,Inpatient,2 mL,mL,,22,18.7,6.3052,22,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
ALFENTANIL 500 MCG/ML INJ SOLN,,J3490,HCPCS,Facility,Both,2 mL,mL,,51,43.35,14.6166,51,Sanford Health Plan,Sanford Health Plan,46.92,92,,percent of total billed charges,,
ALFENTANIL 500 MCG/ML INJ SOLN,,J3490,HCPCS,Facility,Both,2 mL,mL,,22,18.7,6.3052,22,Sanford Health Plan,Sanford Health Plan,20.24,92,,percent of total billed charges,,
ALFENTANIL 500 MCG/ML INJ SOLN,,J3490,HCPCS,Facility,Outpatient,2 mL,mL,,51,43.35,14.6166,51,"UCare Health, Inc.",Individual & Family Plan,28.7385,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
ALFENTANIL 500 MCG/ML INJ SOLN,,J3490,HCPCS,Facility,Outpatient,2 mL,mL,,22,18.7,6.3052,22,"UCare Health, Inc.",Individual & Family Plan,12.397,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
ALFENTANIL 500 MCG/ML INJ SOLN,,J3490,HCPCS,Facility,Inpatient,2 mL,mL,,51,43.35,14.6166,51,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
ALFENTANIL 500 MCG/ML INJ SOLN,,J3490,HCPCS,Facility,Inpatient,2 mL,mL,,22,18.7,6.3052,22,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
ALFENTANIL 500 MCG/ML INJ SOLN,,J3490,HCPCS,Facility,Outpatient,2 mL,mL,,51,43.35,14.6166,51,"UCare Health, Inc.",Medical Assistance,25.7397,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ALFENTANIL 500 MCG/ML INJ SOLN,,J3490,HCPCS,Facility,Outpatient,2 mL,mL,,22,18.7,6.3052,22,"UCare Health, Inc.",Medical Assistance,11.1034,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ALFENTANIL 500 MCG/ML INJ SOLN,,J3490,HCPCS,Facility,Inpatient,2 mL,mL,,51,43.35,14.6166,51,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
ALFENTANIL 500 MCG/ML INJ SOLN,,J3490,HCPCS,Facility,Inpatient,2 mL,mL,,22,18.7,6.3052,22,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
ALFENTANIL 500 MCG/ML INJ SOLN,,J3490,HCPCS,Facility,Outpatient,2 mL,mL,,51,43.35,14.6166,51,"UCare Health, Inc.",Medicare Advantage,25.7397,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ALFENTANIL 500 MCG/ML INJ SOLN,,J3490,HCPCS,Facility,Outpatient,2 mL,mL,,22,18.7,6.3052,22,"UCare Health, Inc.",Medicare Advantage,11.1034,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ALFENTANIL 500 MCG/ML INJ SOLN,,J3490,HCPCS,Facility,Inpatient,2 mL,mL,,51,43.35,14.6166,51,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ALFENTANIL 500 MCG/ML INJ SOLN,,J3490,HCPCS,Facility,Inpatient,2 mL,mL,,22,18.7,6.3052,22,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ALFENTANIL 500 MCG/ML INJ SOLN,,J3490,HCPCS,Facility,Outpatient,2 mL,mL,,51,43.35,14.6166,51,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),25.7397,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ALFENTANIL 500 MCG/ML INJ SOLN,,J3490,HCPCS,Facility,Outpatient,2 mL,mL,,22,18.7,6.3052,22,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),11.1034,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ALFENTANIL 500 MCG/ML INJ SOLN,,J3490,HCPCS,Facility,Inpatient,2 mL,mL,,51,43.35,14.6166,51,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ALFENTANIL 500 MCG/ML INJ SOLN,,J3490,HCPCS,Facility,Inpatient,2 mL,mL,,22,18.7,6.3052,22,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ALFENTANIL 500 MCG/ML INJ SOLN,,J3490,HCPCS,Facility,Both,2 mL,mL,,51,43.35,14.6166,51,UnitedHealthcare,Individual & Family,47.94,94,,percent of total billed charges,,
ALFENTANIL 500 MCG/ML INJ SOLN,,J3490,HCPCS,Facility,Both,2 mL,mL,,22,18.7,6.3052,22,UnitedHealthcare,Individual & Family,20.68,94,,percent of total billed charges,,
ALFENTANIL 500 MCG/ML INJ SOLN,,J3490,HCPCS,Facility,Outpatient,2 mL,mL,,51,43.35,14.6166,51,UnitedHealthcare,Medicare Advantage,24.99,49,,percent of total billed charges,,
ALFENTANIL 500 MCG/ML INJ SOLN,,J3490,HCPCS,Facility,Outpatient,2 mL,mL,,22,18.7,6.3052,22,UnitedHealthcare,Medicare Advantage,10.78,49,,percent of total billed charges,,
ALFENTANIL 500 MCG/ML INJ SOLN,,J3490,HCPCS,Facility,Inpatient,2 mL,mL,,51,43.35,14.6166,51,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
ALFENTANIL 500 MCG/ML INJ SOLN,,J3490,HCPCS,Facility,Inpatient,2 mL,mL,,22,18.7,6.3052,22,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
ALFENTANIL 500 MCG/ML INJ SOLN,,J3490,HCPCS,Facility,Outpatient,2 mL,mL,,51,43.35,14.6166,51,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,24.48,48,,percent of total billed charges,,100% of DHS outpatient percentage
ALFENTANIL 500 MCG/ML INJ SOLN,,J3490,HCPCS,Facility,Outpatient,2 mL,mL,,22,18.7,6.3052,22,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,10.56,48,,percent of total billed charges,,100% of DHS outpatient percentage
ALFENTANIL 500 MCG/ML INJ SOLN,,J3490,HCPCS,Facility,Inpatient,2 mL,mL,,51,43.35,14.6166,51,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
ALFENTANIL 500 MCG/ML INJ SOLN,,J3490,HCPCS,Facility,Inpatient,2 mL,mL,,22,18.7,6.3052,22,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
BUPIVACAINE-DEXTROSE-WATER(PF) 0.75 % (7.5 MG/ML) INJ SOLN,,J3490,HCPCS,Facility,Both,2 mL,mL,,30,25.5,8.598,30,Aetna,Commercial,27.6,92,,percent of total billed charges,,
BUPIVACAINE-DEXTROSE-WATER(PF) 0.75 % (7.5 MG/ML) INJ SOLN,,J3490,HCPCS,Facility,Outpatient,2 mL,mL,,30,25.5,8.598,30,Aetna,Medicare Advantage,14.7,49,,percent of total billed charges,,
BUPIVACAINE-DEXTROSE-WATER(PF) 0.75 % (7.5 MG/ML) INJ SOLN,,J3490,HCPCS,Facility,Inpatient,2 mL,mL,,30,25.5,8.598,30,Aetna,Medicare Advantage,,,,,Included in per diem rate,
BUPIVACAINE-DEXTROSE-WATER(PF) 0.75 % (7.5 MG/ML) INJ SOLN,,J3490,HCPCS,Facility,Both,2 mL,mL,,30,25.5,8.598,30,Aetna,PPO,27.9,93,,percent of total billed charges,,
BUPIVACAINE-DEXTROSE-WATER(PF) 0.75 % (7.5 MG/ML) INJ SOLN,,J3490,HCPCS,Facility,Both,2 mL,mL,,30,25.5,8.598,30,America's PPO,America's PPO,28.809,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
BUPIVACAINE-DEXTROSE-WATER(PF) 0.75 % (7.5 MG/ML) INJ SOLN,,J3490,HCPCS,Facility,Both,2 mL,mL,,30,25.5,8.598,30,BlueCross BlueShield Minnesota, Federal Employee Program,29.52,98.4,,percent of total billed charges,,
BUPIVACAINE-DEXTROSE-WATER(PF) 0.75 % (7.5 MG/ML) INJ SOLN,,J3490,HCPCS,Facility,Both,2 mL,mL,,30,25.5,8.598,30,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,30,100,,percent of total billed charges,,
BUPIVACAINE-DEXTROSE-WATER(PF) 0.75 % (7.5 MG/ML) INJ SOLN,,J3490,HCPCS,Facility,Both,2 mL,mL,,30,25.5,8.598,30,BlueCross BlueShield Minnesota,High Value Network Plan,27,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
BUPIVACAINE-DEXTROSE-WATER(PF) 0.75 % (7.5 MG/ML) INJ SOLN,,J3490,HCPCS,Facility,Outpatient,2 mL,mL,,30,25.5,8.598,30,BlueCross BlueShield Minnesota,Medicare Advantage,14.7,49,,percent of total billed charges,,
BUPIVACAINE-DEXTROSE-WATER(PF) 0.75 % (7.5 MG/ML) INJ SOLN,,J3490,HCPCS,Facility,Inpatient,2 mL,mL,,30,25.5,8.598,30,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
BUPIVACAINE-DEXTROSE-WATER(PF) 0.75 % (7.5 MG/ML) INJ SOLN,,J3490,HCPCS,Facility,Both,2 mL,mL,,30,25.5,8.598,30,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,26.571,88.57,,percent of total billed charges,,
BUPIVACAINE-DEXTROSE-WATER(PF) 0.75 % (7.5 MG/ML) INJ SOLN,,J3490,HCPCS,Facility,Both,2 mL,mL,,30,25.5,8.598,30,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,8.598,28.66,,percent of total billed charges,,
BUPIVACAINE-DEXTROSE-WATER(PF) 0.75 % (7.5 MG/ML) INJ SOLN,,J3490,HCPCS,Facility,Outpatient,2 mL,mL,,30,25.5,8.598,30,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),14.7,49,,percent of total billed charges,,
BUPIVACAINE-DEXTROSE-WATER(PF) 0.75 % (7.5 MG/ML) INJ SOLN,,J3490,HCPCS,Facility,Inpatient,2 mL,mL,,30,25.5,8.598,30,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
BUPIVACAINE-DEXTROSE-WATER(PF) 0.75 % (7.5 MG/ML) INJ SOLN,,J3490,HCPCS,Facility,Both,2 mL,mL,,30,25.5,8.598,30,CorVel,Worker's Compensation,30,100,,percent of total billed charges,,
BUPIVACAINE-DEXTROSE-WATER(PF) 0.75 % (7.5 MG/ML) INJ SOLN,,J3490,HCPCS,Facility,Both,2 mL,mL,,30,25.5,8.598,30,First Health Group Corporation,First Health Network,29.1,97,,percent of total billed charges,,
BUPIVACAINE-DEXTROSE-WATER(PF) 0.75 % (7.5 MG/ML) INJ SOLN,,J3490,HCPCS,Facility,Both,2 mL,mL,,30,25.5,8.598,30,"Health Partners, Inc.",Commercial,28.38,94.6,,percent of total billed charges,,
BUPIVACAINE-DEXTROSE-WATER(PF) 0.75 % (7.5 MG/ML) INJ SOLN,,J3490,HCPCS,Facility,Outpatient,2 mL,mL,,30,25.5,8.598,30,"Health Partners, Inc.",Medicare Advantage,14.7,49,,percent of total billed charges,,
BUPIVACAINE-DEXTROSE-WATER(PF) 0.75 % (7.5 MG/ML) INJ SOLN,,J3490,HCPCS,Facility,Inpatient,2 mL,mL,,30,25.5,8.598,30,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
BUPIVACAINE-DEXTROSE-WATER(PF) 0.75 % (7.5 MG/ML) INJ SOLN,,J3490,HCPCS,Facility,Both,2 mL,mL,,30,25.5,8.598,30,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),18,60,,percent of total billed charges,,
BUPIVACAINE-DEXTROSE-WATER(PF) 0.75 % (7.5 MG/ML) INJ SOLN,,J3490,HCPCS,Facility,Both,2 mL,mL,,30,25.5,8.598,30,"Health Partners, Inc.",State of Minnesota Advantage Program,24.45,81.5,,percent of total billed charges,,
BUPIVACAINE-DEXTROSE-WATER(PF) 0.75 % (7.5 MG/ML) INJ SOLN,,J3490,HCPCS,Facility,Both,2 mL,mL,,30,25.5,8.598,30,"Health Partners, Inc.",State Public Programs,15,50,,percent of total billed charges,,
BUPIVACAINE-DEXTROSE-WATER(PF) 0.75 % (7.5 MG/ML) INJ SOLN,,J3490,HCPCS,Facility,Both,2 mL,mL,,30,25.5,8.598,30,Humana Insurance Company,Commercial PPO,28.5,95,,percent of total billed charges,,
BUPIVACAINE-DEXTROSE-WATER(PF) 0.75 % (7.5 MG/ML) INJ SOLN,,J3490,HCPCS,Facility,Outpatient,2 mL,mL,,30,25.5,8.598,30,Humana Insurance Company,Medicare PPO,14.7,49,,percent of total billed charges,,
BUPIVACAINE-DEXTROSE-WATER(PF) 0.75 % (7.5 MG/ML) INJ SOLN,,J3490,HCPCS,Facility,Inpatient,2 mL,mL,,30,25.5,8.598,30,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
BUPIVACAINE-DEXTROSE-WATER(PF) 0.75 % (7.5 MG/ML) INJ SOLN,,J3490,HCPCS,Facility,Both,2 mL,mL,,30,25.5,8.598,30,Medica,Individual & Family,29.73,99.1,,percent of total billed charges,,
BUPIVACAINE-DEXTROSE-WATER(PF) 0.75 % (7.5 MG/ML) INJ SOLN,,J3490,HCPCS,Facility,Outpatient,2 mL,mL,,30,25.5,8.598,30,Medica,Medica Advantage Solution,14.94,49.8,,percent of total billed charges,,
BUPIVACAINE-DEXTROSE-WATER(PF) 0.75 % (7.5 MG/ML) INJ SOLN,,J3490,HCPCS,Facility,Inpatient,2 mL,mL,,30,25.5,8.598,30,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
BUPIVACAINE-DEXTROSE-WATER(PF) 0.75 % (7.5 MG/ML) INJ SOLN,,J3490,HCPCS,Facility,Outpatient,2 mL,mL,,30,25.5,8.598,30,Medica,Medical Assistance,13.38,44.6,,percent of total billed charges,,
BUPIVACAINE-DEXTROSE-WATER(PF) 0.75 % (7.5 MG/ML) INJ SOLN,,J3490,HCPCS,Facility,Inpatient,2 mL,mL,,30,25.5,8.598,30,Medica,Medical Assistance,,,,,Included in per diem rate,
BUPIVACAINE-DEXTROSE-WATER(PF) 0.75 % (7.5 MG/ML) INJ SOLN,,J3490,HCPCS,Facility,Outpatient,2 mL,mL,,30,25.5,8.598,30,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,14.94,49.8,,percent of total billed charges,,
BUPIVACAINE-DEXTROSE-WATER(PF) 0.75 % (7.5 MG/ML) INJ SOLN,,J3490,HCPCS,Facility,Inpatient,2 mL,mL,,30,25.5,8.598,30,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
BUPIVACAINE-DEXTROSE-WATER(PF) 0.75 % (7.5 MG/ML) INJ SOLN,,J3490,HCPCS,Facility,Both,2 mL,mL,,30,25.5,8.598,30,"Multiplan, Inc.","Multiplan, Inc.",28.2,94,,percent of total billed charges,,
BUPIVACAINE-DEXTROSE-WATER(PF) 0.75 % (7.5 MG/ML) INJ SOLN,,J3490,HCPCS,Facility,Outpatient,2 mL,mL,,30,25.5,8.598,30,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,27.03,90.1,,percent of total billed charges,,
BUPIVACAINE-DEXTROSE-WATER(PF) 0.75 % (7.5 MG/ML) INJ SOLN,,J3490,HCPCS,Facility,Inpatient,2 mL,mL,,30,25.5,8.598,30,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
BUPIVACAINE-DEXTROSE-WATER(PF) 0.75 % (7.5 MG/ML) INJ SOLN,,J3490,HCPCS,Facility,Both,2 mL,mL,,30,25.5,8.598,30,"Preferred One Administrative Services, INC.",PPO,29.58,98.6,,percent of total billed charges,,
BUPIVACAINE-DEXTROSE-WATER(PF) 0.75 % (7.5 MG/ML) INJ SOLN,,J3490,HCPCS,Facility,Outpatient,2 mL,mL,,30,25.5,8.598,30,PrimeWest Health,Minnesota Senior Health Options (MSHO),15.435,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
BUPIVACAINE-DEXTROSE-WATER(PF) 0.75 % (7.5 MG/ML) INJ SOLN,,J3490,HCPCS,Facility,Inpatient,2 mL,mL,,30,25.5,8.598,30,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
BUPIVACAINE-DEXTROSE-WATER(PF) 0.75 % (7.5 MG/ML) INJ SOLN,,J3490,HCPCS,Facility,Outpatient,2 mL,mL,,30,25.5,8.598,30,PrimeWest Health,MinnesotaCare,15.408,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
BUPIVACAINE-DEXTROSE-WATER(PF) 0.75 % (7.5 MG/ML) INJ SOLN,,J3490,HCPCS,Facility,Inpatient,2 mL,mL,,30,25.5,8.598,30,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
BUPIVACAINE-DEXTROSE-WATER(PF) 0.75 % (7.5 MG/ML) INJ SOLN,,J3490,HCPCS,Facility,Both,2 mL,mL,,30,25.5,8.598,30,Sanford Health Plan,Sanford Health Plan,27.6,92,,percent of total billed charges,,
BUPIVACAINE-DEXTROSE-WATER(PF) 0.75 % (7.5 MG/ML) INJ SOLN,,J3490,HCPCS,Facility,Outpatient,2 mL,mL,,30,25.5,8.598,30,"UCare Health, Inc.",Individual & Family Plan,16.905,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
BUPIVACAINE-DEXTROSE-WATER(PF) 0.75 % (7.5 MG/ML) INJ SOLN,,J3490,HCPCS,Facility,Inpatient,2 mL,mL,,30,25.5,8.598,30,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
BUPIVACAINE-DEXTROSE-WATER(PF) 0.75 % (7.5 MG/ML) INJ SOLN,,J3490,HCPCS,Facility,Outpatient,2 mL,mL,,30,25.5,8.598,30,"UCare Health, Inc.",Medical Assistance,15.141,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BUPIVACAINE-DEXTROSE-WATER(PF) 0.75 % (7.5 MG/ML) INJ SOLN,,J3490,HCPCS,Facility,Inpatient,2 mL,mL,,30,25.5,8.598,30,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
BUPIVACAINE-DEXTROSE-WATER(PF) 0.75 % (7.5 MG/ML) INJ SOLN,,J3490,HCPCS,Facility,Outpatient,2 mL,mL,,30,25.5,8.598,30,"UCare Health, Inc.",Medicare Advantage,15.141,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BUPIVACAINE-DEXTROSE-WATER(PF) 0.75 % (7.5 MG/ML) INJ SOLN,,J3490,HCPCS,Facility,Inpatient,2 mL,mL,,30,25.5,8.598,30,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
BUPIVACAINE-DEXTROSE-WATER(PF) 0.75 % (7.5 MG/ML) INJ SOLN,,J3490,HCPCS,Facility,Outpatient,2 mL,mL,,30,25.5,8.598,30,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),15.141,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BUPIVACAINE-DEXTROSE-WATER(PF) 0.75 % (7.5 MG/ML) INJ SOLN,,J3490,HCPCS,Facility,Inpatient,2 mL,mL,,30,25.5,8.598,30,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
BUPIVACAINE-DEXTROSE-WATER(PF) 0.75 % (7.5 MG/ML) INJ SOLN,,J3490,HCPCS,Facility,Both,2 mL,mL,,30,25.5,8.598,30,UnitedHealthcare,Individual & Family,28.2,94,,percent of total billed charges,,
BUPIVACAINE-DEXTROSE-WATER(PF) 0.75 % (7.5 MG/ML) INJ SOLN,,J3490,HCPCS,Facility,Outpatient,2 mL,mL,,30,25.5,8.598,30,UnitedHealthcare,Medicare Advantage,14.7,49,,percent of total billed charges,,
BUPIVACAINE-DEXTROSE-WATER(PF) 0.75 % (7.5 MG/ML) INJ SOLN,,J3490,HCPCS,Facility,Inpatient,2 mL,mL,,30,25.5,8.598,30,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
BUPIVACAINE-DEXTROSE-WATER(PF) 0.75 % (7.5 MG/ML) INJ SOLN,,J3490,HCPCS,Facility,Outpatient,2 mL,mL,,30,25.5,8.598,30,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,14.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
BUPIVACAINE-DEXTROSE-WATER(PF) 0.75 % (7.5 MG/ML) INJ SOLN,,J3490,HCPCS,Facility,Inpatient,2 mL,mL,,30,25.5,8.598,30,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
METHOTREXATE SODIUM 25 MG/ML INJ SOLN,,J9250,HCPCS,Facility,Both,2 mL,mL,,44,37.4,12.6104,44,Aetna,Commercial,40.48,92,,percent of total billed charges,,
METHOTREXATE SODIUM 25 MG/ML INJ SOLN,,J9250,HCPCS,Facility,Outpatient,2 mL,mL,,44,37.4,12.6104,44,Aetna,Medicare Advantage,21.56,49,,percent of total billed charges,,
METHOTREXATE SODIUM 25 MG/ML INJ SOLN,,J9250,HCPCS,Facility,Inpatient,2 mL,mL,,44,37.4,12.6104,44,Aetna,Medicare Advantage,,,,,Included in per diem rate,
METHOTREXATE SODIUM 25 MG/ML INJ SOLN,,J9250,HCPCS,Facility,Both,2 mL,mL,,44,37.4,12.6104,44,Aetna,PPO,40.92,93,,percent of total billed charges,,
METHOTREXATE SODIUM 25 MG/ML INJ SOLN,,J9250,HCPCS,Facility,Both,2 mL,mL,,44,37.4,12.6104,44,America's PPO,America's PPO,42.2532,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
METHOTREXATE SODIUM 25 MG/ML INJ SOLN,,J9250,HCPCS,Facility,Both,2 mL,mL,,44,37.4,12.6104,44,BlueCross BlueShield Minnesota, Federal Employee Program,43.296,98.4,,percent of total billed charges,,
METHOTREXATE SODIUM 25 MG/ML INJ SOLN,,J9250,HCPCS,Facility,Both,2 mL,mL,,44,37.4,12.6104,44,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,44,100,,percent of total billed charges,,
METHOTREXATE SODIUM 25 MG/ML INJ SOLN,,J9250,HCPCS,Facility,Both,2 mL,mL,,44,37.4,12.6104,44,BlueCross BlueShield Minnesota,High Value Network Plan,39.6,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
METHOTREXATE SODIUM 25 MG/ML INJ SOLN,,J9250,HCPCS,Facility,Outpatient,2 mL,mL,,44,37.4,12.6104,44,BlueCross BlueShield Minnesota,Medicare Advantage,21.56,49,,percent of total billed charges,,
METHOTREXATE SODIUM 25 MG/ML INJ SOLN,,J9250,HCPCS,Facility,Inpatient,2 mL,mL,,44,37.4,12.6104,44,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
METHOTREXATE SODIUM 25 MG/ML INJ SOLN,,J9250,HCPCS,Facility,Both,2 mL,mL,,44,37.4,12.6104,44,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,38.9708,88.57,,percent of total billed charges,,
METHOTREXATE SODIUM 25 MG/ML INJ SOLN,,J9250,HCPCS,Facility,Both,2 mL,mL,,44,37.4,12.6104,44,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,12.6104,28.66,,percent of total billed charges,,
METHOTREXATE SODIUM 25 MG/ML INJ SOLN,,J9250,HCPCS,Facility,Outpatient,2 mL,mL,,44,37.4,12.6104,44,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),21.56,49,,percent of total billed charges,,
METHOTREXATE SODIUM 25 MG/ML INJ SOLN,,J9250,HCPCS,Facility,Inpatient,2 mL,mL,,44,37.4,12.6104,44,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
METHOTREXATE SODIUM 25 MG/ML INJ SOLN,,J9250,HCPCS,Facility,Both,2 mL,mL,,44,37.4,12.6104,44,CorVel,Worker's Compensation,44,100,,percent of total billed charges,,
METHOTREXATE SODIUM 25 MG/ML INJ SOLN,,J9250,HCPCS,Facility,Both,2 mL,mL,,44,37.4,12.6104,44,First Health Group Corporation,First Health Network,42.68,97,,percent of total billed charges,,
METHOTREXATE SODIUM 25 MG/ML INJ SOLN,,J9250,HCPCS,Facility,Both,2 mL,mL,,44,37.4,12.6104,44,"Health Partners, Inc.",Commercial,41.624,94.6,,percent of total billed charges,,
METHOTREXATE SODIUM 25 MG/ML INJ SOLN,,J9250,HCPCS,Facility,Outpatient,2 mL,mL,,44,37.4,12.6104,44,"Health Partners, Inc.",Medicare Advantage,21.56,49,,percent of total billed charges,,
METHOTREXATE SODIUM 25 MG/ML INJ SOLN,,J9250,HCPCS,Facility,Inpatient,2 mL,mL,,44,37.4,12.6104,44,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
METHOTREXATE SODIUM 25 MG/ML INJ SOLN,,J9250,HCPCS,Facility,Both,2 mL,mL,,44,37.4,12.6104,44,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),26.4,60,,percent of total billed charges,,
METHOTREXATE SODIUM 25 MG/ML INJ SOLN,,J9250,HCPCS,Facility,Both,2 mL,mL,,44,37.4,12.6104,44,"Health Partners, Inc.",State of Minnesota Advantage Program,35.86,81.5,,percent of total billed charges,,
METHOTREXATE SODIUM 25 MG/ML INJ SOLN,,J9250,HCPCS,Facility,Both,2 mL,mL,,44,37.4,12.6104,44,"Health Partners, Inc.",State Public Programs,22,50,,percent of total billed charges,,
METHOTREXATE SODIUM 25 MG/ML INJ SOLN,,J9250,HCPCS,Facility,Both,2 mL,mL,,44,37.4,12.6104,44,Humana Insurance Company,Commercial PPO,41.8,95,,percent of total billed charges,,
METHOTREXATE SODIUM 25 MG/ML INJ SOLN,,J9250,HCPCS,Facility,Outpatient,2 mL,mL,,44,37.4,12.6104,44,Humana Insurance Company,Medicare PPO,21.56,49,,percent of total billed charges,,
METHOTREXATE SODIUM 25 MG/ML INJ SOLN,,J9250,HCPCS,Facility,Inpatient,2 mL,mL,,44,37.4,12.6104,44,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
METHOTREXATE SODIUM 25 MG/ML INJ SOLN,,J9250,HCPCS,Facility,Both,2 mL,mL,,44,37.4,12.6104,44,Medica,Individual & Family,43.604,99.1,,percent of total billed charges,,
METHOTREXATE SODIUM 25 MG/ML INJ SOLN,,J9250,HCPCS,Facility,Outpatient,2 mL,mL,,44,37.4,12.6104,44,Medica,Medica Advantage Solution,21.912,49.8,,percent of total billed charges,,
METHOTREXATE SODIUM 25 MG/ML INJ SOLN,,J9250,HCPCS,Facility,Inpatient,2 mL,mL,,44,37.4,12.6104,44,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
METHOTREXATE SODIUM 25 MG/ML INJ SOLN,,J9250,HCPCS,Facility,Outpatient,2 mL,mL,,44,37.4,12.6104,44,Medica,Medical Assistance,19.624,44.6,,percent of total billed charges,,
METHOTREXATE SODIUM 25 MG/ML INJ SOLN,,J9250,HCPCS,Facility,Inpatient,2 mL,mL,,44,37.4,12.6104,44,Medica,Medical Assistance,,,,,Included in per diem rate,
METHOTREXATE SODIUM 25 MG/ML INJ SOLN,,J9250,HCPCS,Facility,Outpatient,2 mL,mL,,44,37.4,12.6104,44,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,21.912,49.8,,percent of total billed charges,,
METHOTREXATE SODIUM 25 MG/ML INJ SOLN,,J9250,HCPCS,Facility,Inpatient,2 mL,mL,,44,37.4,12.6104,44,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
METHOTREXATE SODIUM 25 MG/ML INJ SOLN,,J9250,HCPCS,Facility,Both,2 mL,mL,,44,37.4,12.6104,44,"Multiplan, Inc.","Multiplan, Inc.",41.36,94,,percent of total billed charges,,
METHOTREXATE SODIUM 25 MG/ML INJ SOLN,,J9250,HCPCS,Facility,Outpatient,2 mL,mL,,44,37.4,12.6104,44,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,39.644,90.1,,percent of total billed charges,,
METHOTREXATE SODIUM 25 MG/ML INJ SOLN,,J9250,HCPCS,Facility,Inpatient,2 mL,mL,,44,37.4,12.6104,44,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
METHOTREXATE SODIUM 25 MG/ML INJ SOLN,,J9250,HCPCS,Facility,Both,2 mL,mL,,44,37.4,12.6104,44,"Preferred One Administrative Services, INC.",PPO,43.384,98.6,,percent of total billed charges,,
METHOTREXATE SODIUM 25 MG/ML INJ SOLN,,J9250,HCPCS,Facility,Outpatient,2 mL,mL,,44,37.4,12.6104,44,PrimeWest Health,Minnesota Senior Health Options (MSHO),22.638,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
METHOTREXATE SODIUM 25 MG/ML INJ SOLN,,J9250,HCPCS,Facility,Inpatient,2 mL,mL,,44,37.4,12.6104,44,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
METHOTREXATE SODIUM 25 MG/ML INJ SOLN,,J9250,HCPCS,Facility,Outpatient,2 mL,mL,,44,37.4,12.6104,44,PrimeWest Health,MinnesotaCare,22.5984,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
METHOTREXATE SODIUM 25 MG/ML INJ SOLN,,J9250,HCPCS,Facility,Inpatient,2 mL,mL,,44,37.4,12.6104,44,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
METHOTREXATE SODIUM 25 MG/ML INJ SOLN,,J9250,HCPCS,Facility,Both,2 mL,mL,,44,37.4,12.6104,44,Sanford Health Plan,Sanford Health Plan,40.48,92,,percent of total billed charges,,
METHOTREXATE SODIUM 25 MG/ML INJ SOLN,,J9250,HCPCS,Facility,Outpatient,2 mL,mL,,44,37.4,12.6104,44,"UCare Health, Inc.",Individual & Family Plan,24.794,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
METHOTREXATE SODIUM 25 MG/ML INJ SOLN,,J9250,HCPCS,Facility,Inpatient,2 mL,mL,,44,37.4,12.6104,44,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
METHOTREXATE SODIUM 25 MG/ML INJ SOLN,,J9250,HCPCS,Facility,Outpatient,2 mL,mL,,44,37.4,12.6104,44,"UCare Health, Inc.",Medical Assistance,22.2068,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
METHOTREXATE SODIUM 25 MG/ML INJ SOLN,,J9250,HCPCS,Facility,Inpatient,2 mL,mL,,44,37.4,12.6104,44,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
METHOTREXATE SODIUM 25 MG/ML INJ SOLN,,J9250,HCPCS,Facility,Outpatient,2 mL,mL,,44,37.4,12.6104,44,"UCare Health, Inc.",Medicare Advantage,22.2068,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
METHOTREXATE SODIUM 25 MG/ML INJ SOLN,,J9250,HCPCS,Facility,Inpatient,2 mL,mL,,44,37.4,12.6104,44,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
METHOTREXATE SODIUM 25 MG/ML INJ SOLN,,J9250,HCPCS,Facility,Outpatient,2 mL,mL,,44,37.4,12.6104,44,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),22.2068,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
METHOTREXATE SODIUM 25 MG/ML INJ SOLN,,J9250,HCPCS,Facility,Inpatient,2 mL,mL,,44,37.4,12.6104,44,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
METHOTREXATE SODIUM 25 MG/ML INJ SOLN,,J9250,HCPCS,Facility,Both,2 mL,mL,,44,37.4,12.6104,44,UnitedHealthcare,Individual & Family,41.36,94,,percent of total billed charges,,
METHOTREXATE SODIUM 25 MG/ML INJ SOLN,,J9250,HCPCS,Facility,Outpatient,2 mL,mL,,44,37.4,12.6104,44,UnitedHealthcare,Medicare Advantage,21.56,49,,percent of total billed charges,,
METHOTREXATE SODIUM 25 MG/ML INJ SOLN,,J9250,HCPCS,Facility,Inpatient,2 mL,mL,,44,37.4,12.6104,44,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
METHOTREXATE SODIUM 25 MG/ML INJ SOLN,,J9250,HCPCS,Facility,Outpatient,2 mL,mL,,44,37.4,12.6104,44,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,21.12,48,,percent of total billed charges,,100% of DHS outpatient percentage
METHOTREXATE SODIUM 25 MG/ML INJ SOLN,,J9250,HCPCS,Facility,Inpatient,2 mL,mL,,44,37.4,12.6104,44,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
TRAVOPROST 0.004 % OPHT DROP,,6092,LOCAL,Facility,Both,2.5 mL,mL,,908,771.8,260.2328,908,Aetna,Commercial,835.36,92,,percent of total billed charges,,
TRAVOPROST 0.004 % OPHT DROP,,6092,LOCAL,Facility,Outpatient,2.5 mL,mL,,908,771.8,260.2328,908,Aetna,Medicare Advantage,444.92,49,,percent of total billed charges,,
TRAVOPROST 0.004 % OPHT DROP,,6092,LOCAL,Facility,Inpatient,2.5 mL,mL,,908,771.8,260.2328,908,Aetna,Medicare Advantage,,,,,Included in per diem rate,
TRAVOPROST 0.004 % OPHT DROP,,6092,LOCAL,Facility,Both,2.5 mL,mL,,908,771.8,260.2328,908,Aetna,PPO,844.44,93,,percent of total billed charges,,
TRAVOPROST 0.004 % OPHT DROP,,6092,LOCAL,Facility,Both,2.5 mL,mL,,908,771.8,260.2328,908,America's PPO,America's PPO,871.9524,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
TRAVOPROST 0.004 % OPHT DROP,,6092,LOCAL,Facility,Both,2.5 mL,mL,,908,771.8,260.2328,908,BlueCross BlueShield Minnesota, Federal Employee Program,893.472,98.4,,percent of total billed charges,,
TRAVOPROST 0.004 % OPHT DROP,,6092,LOCAL,Facility,Both,2.5 mL,mL,,908,771.8,260.2328,908,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,908,100,,percent of total billed charges,,
TRAVOPROST 0.004 % OPHT DROP,,6092,LOCAL,Facility,Both,2.5 mL,mL,,908,771.8,260.2328,908,BlueCross BlueShield Minnesota,High Value Network Plan,817.2,90,,percent of total billed charges,,
TRAVOPROST 0.004 % OPHT DROP,,6092,LOCAL,Facility,Outpatient,2.5 mL,mL,,908,771.8,260.2328,908,BlueCross BlueShield Minnesota,Medicare Advantage,444.92,49,,percent of total billed charges,,
TRAVOPROST 0.004 % OPHT DROP,,6092,LOCAL,Facility,Inpatient,2.5 mL,mL,,908,771.8,260.2328,908,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
TRAVOPROST 0.004 % OPHT DROP,,6092,LOCAL,Facility,Both,2.5 mL,mL,,908,771.8,260.2328,908,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,804.2156,88.57,,percent of total billed charges,,
TRAVOPROST 0.004 % OPHT DROP,,6092,LOCAL,Facility,Both,2.5 mL,mL,,908,771.8,260.2328,908,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,260.2328,28.66,,percent of total billed charges,,
TRAVOPROST 0.004 % OPHT DROP,,6092,LOCAL,Facility,Outpatient,2.5 mL,mL,,908,771.8,260.2328,908,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),444.92,49,,percent of total billed charges,,
TRAVOPROST 0.004 % OPHT DROP,,6092,LOCAL,Facility,Inpatient,2.5 mL,mL,,908,771.8,260.2328,908,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
TRAVOPROST 0.004 % OPHT DROP,,6092,LOCAL,Facility,Both,2.5 mL,mL,,908,771.8,260.2328,908,CorVel,Worker's Compensation,908,100,,percent of total billed charges,,
TRAVOPROST 0.004 % OPHT DROP,,6092,LOCAL,Facility,Both,2.5 mL,mL,,908,771.8,260.2328,908,First Health Group Corporation,First Health Network,880.76,97,,percent of total billed charges,,
TRAVOPROST 0.004 % OPHT DROP,,6092,LOCAL,Facility,Both,2.5 mL,mL,,908,771.8,260.2328,908,"Health Partners, Inc.",Commercial,858.968,94.6,,percent of total billed charges,,
TRAVOPROST 0.004 % OPHT DROP,,6092,LOCAL,Facility,Outpatient,2.5 mL,mL,,908,771.8,260.2328,908,"Health Partners, Inc.",Medicare Advantage,444.92,49,,percent of total billed charges,,
TRAVOPROST 0.004 % OPHT DROP,,6092,LOCAL,Facility,Inpatient,2.5 mL,mL,,908,771.8,260.2328,908,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
TRAVOPROST 0.004 % OPHT DROP,,6092,LOCAL,Facility,Both,2.5 mL,mL,,908,771.8,260.2328,908,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),544.8,60,,percent of total billed charges,,
TRAVOPROST 0.004 % OPHT DROP,,6092,LOCAL,Facility,Both,2.5 mL,mL,,908,771.8,260.2328,908,"Health Partners, Inc.",State of Minnesota Advantage Program,740.02,81.5,,percent of total billed charges,,
TRAVOPROST 0.004 % OPHT DROP,,6092,LOCAL,Facility,Both,2.5 mL,mL,,908,771.8,260.2328,908,"Health Partners, Inc.",State Public Programs,454,50,,percent of total billed charges,,
TRAVOPROST 0.004 % OPHT DROP,,6092,LOCAL,Facility,Both,2.5 mL,mL,,908,771.8,260.2328,908,Humana Insurance Company,Commercial PPO,862.6,95,,percent of total billed charges,,
TRAVOPROST 0.004 % OPHT DROP,,6092,LOCAL,Facility,Outpatient,2.5 mL,mL,,908,771.8,260.2328,908,Humana Insurance Company,Medicare PPO,444.92,49,,percent of total billed charges,,
TRAVOPROST 0.004 % OPHT DROP,,6092,LOCAL,Facility,Inpatient,2.5 mL,mL,,908,771.8,260.2328,908,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
TRAVOPROST 0.004 % OPHT DROP,,6092,LOCAL,Facility,Both,2.5 mL,mL,,908,771.8,260.2328,908,Medica,Individual & Family,899.828,99.1,,percent of total billed charges,,
TRAVOPROST 0.004 % OPHT DROP,,6092,LOCAL,Facility,Outpatient,2.5 mL,mL,,908,771.8,260.2328,908,Medica,Medica Advantage Solution,452.184,49.8,,percent of total billed charges,,
TRAVOPROST 0.004 % OPHT DROP,,6092,LOCAL,Facility,Inpatient,2.5 mL,mL,,908,771.8,260.2328,908,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
TRAVOPROST 0.004 % OPHT DROP,,6092,LOCAL,Facility,Outpatient,2.5 mL,mL,,908,771.8,260.2328,908,Medica,Medical Assistance,404.968,44.6,,percent of total billed charges,,
TRAVOPROST 0.004 % OPHT DROP,,6092,LOCAL,Facility,Inpatient,2.5 mL,mL,,908,771.8,260.2328,908,Medica,Medical Assistance,,,,,Included in per diem rate,
TRAVOPROST 0.004 % OPHT DROP,,6092,LOCAL,Facility,Outpatient,2.5 mL,mL,,908,771.8,260.2328,908,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,452.184,49.8,,percent of total billed charges,,
TRAVOPROST 0.004 % OPHT DROP,,6092,LOCAL,Facility,Inpatient,2.5 mL,mL,,908,771.8,260.2328,908,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
TRAVOPROST 0.004 % OPHT DROP,,6092,LOCAL,Facility,Both,2.5 mL,mL,,908,771.8,260.2328,908,"Multiplan, Inc.","Multiplan, Inc.",853.52,94,,percent of total billed charges,,
TRAVOPROST 0.004 % OPHT DROP,,6092,LOCAL,Facility,Outpatient,2.5 mL,mL,,908,771.8,260.2328,908,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,818.108,90.1,,percent of total billed charges,,
TRAVOPROST 0.004 % OPHT DROP,,6092,LOCAL,Facility,Inpatient,2.5 mL,mL,,908,771.8,260.2328,908,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
TRAVOPROST 0.004 % OPHT DROP,,6092,LOCAL,Facility,Both,2.5 mL,mL,,908,771.8,260.2328,908,"Preferred One Administrative Services, INC.",PPO,895.288,98.6,,percent of total billed charges,,
TRAVOPROST 0.004 % OPHT DROP,,6092,LOCAL,Facility,Outpatient,2.5 mL,mL,,908,771.8,260.2328,908,PrimeWest Health,Minnesota Senior Health Options (MSHO),467.166,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
TRAVOPROST 0.004 % OPHT DROP,,6092,LOCAL,Facility,Inpatient,2.5 mL,mL,,908,771.8,260.2328,908,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
TRAVOPROST 0.004 % OPHT DROP,,6092,LOCAL,Facility,Outpatient,2.5 mL,mL,,908,771.8,260.2328,908,PrimeWest Health,MinnesotaCare,466.3488,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
TRAVOPROST 0.004 % OPHT DROP,,6092,LOCAL,Facility,Inpatient,2.5 mL,mL,,908,771.8,260.2328,908,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
TRAVOPROST 0.004 % OPHT DROP,,6092,LOCAL,Facility,Both,2.5 mL,mL,,908,771.8,260.2328,908,Sanford Health Plan,Sanford Health Plan,835.36,92,,percent of total billed charges,,
TRAVOPROST 0.004 % OPHT DROP,,6092,LOCAL,Facility,Outpatient,2.5 mL,mL,,908,771.8,260.2328,908,"UCare Health, Inc.",Individual & Family Plan,511.658,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
TRAVOPROST 0.004 % OPHT DROP,,6092,LOCAL,Facility,Inpatient,2.5 mL,mL,,908,771.8,260.2328,908,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
TRAVOPROST 0.004 % OPHT DROP,,6092,LOCAL,Facility,Outpatient,2.5 mL,mL,,908,771.8,260.2328,908,"UCare Health, Inc.",Medical Assistance,458.2676,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TRAVOPROST 0.004 % OPHT DROP,,6092,LOCAL,Facility,Inpatient,2.5 mL,mL,,908,771.8,260.2328,908,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
TRAVOPROST 0.004 % OPHT DROP,,6092,LOCAL,Facility,Outpatient,2.5 mL,mL,,908,771.8,260.2328,908,"UCare Health, Inc.",Medicare Advantage,458.2676,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TRAVOPROST 0.004 % OPHT DROP,,6092,LOCAL,Facility,Inpatient,2.5 mL,mL,,908,771.8,260.2328,908,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
TRAVOPROST 0.004 % OPHT DROP,,6092,LOCAL,Facility,Outpatient,2.5 mL,mL,,908,771.8,260.2328,908,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),458.2676,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TRAVOPROST 0.004 % OPHT DROP,,6092,LOCAL,Facility,Inpatient,2.5 mL,mL,,908,771.8,260.2328,908,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
TRAVOPROST 0.004 % OPHT DROP,,6092,LOCAL,Facility,Both,2.5 mL,mL,,908,771.8,260.2328,908,UnitedHealthcare,Individual & Family,853.52,94,,percent of total billed charges,,
TRAVOPROST 0.004 % OPHT DROP,,6092,LOCAL,Facility,Outpatient,2.5 mL,mL,,908,771.8,260.2328,908,UnitedHealthcare,Medicare Advantage,444.92,49,,percent of total billed charges,,
TRAVOPROST 0.004 % OPHT DROP,,6092,LOCAL,Facility,Inpatient,2.5 mL,mL,,908,771.8,260.2328,908,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
TRAVOPROST 0.004 % OPHT DROP,,6092,LOCAL,Facility,Outpatient,2.5 mL,mL,,908,771.8,260.2328,908,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,435.84,48,,percent of total billed charges,,100% of DHS outpatient percentage
TRAVOPROST 0.004 % OPHT DROP,,6092,LOCAL,Facility,Inpatient,2.5 mL,mL,,908,771.8,260.2328,908,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
CIPROFLOXACIN HCL 0.3 % OPHT DROP,,11296,LOCAL,Facility,Both,2.5 mL,mL,,61,51.85,17.4826,61,Aetna,Commercial,56.12,92,,percent of total billed charges,,
CIPROFLOXACIN HCL 0.3 % OPHT DROP,,11296,LOCAL,Facility,Outpatient,2.5 mL,mL,,61,51.85,17.4826,61,Aetna,Medicare Advantage,29.89,49,,percent of total billed charges,,
CIPROFLOXACIN HCL 0.3 % OPHT DROP,,11296,LOCAL,Facility,Inpatient,2.5 mL,mL,,61,51.85,17.4826,61,Aetna,Medicare Advantage,,,,,Included in per diem rate,
CIPROFLOXACIN HCL 0.3 % OPHT DROP,,11296,LOCAL,Facility,Both,2.5 mL,mL,,61,51.85,17.4826,61,Aetna,PPO,56.73,93,,percent of total billed charges,,
CIPROFLOXACIN HCL 0.3 % OPHT DROP,,11296,LOCAL,Facility,Both,2.5 mL,mL,,61,51.85,17.4826,61,America's PPO,America's PPO,58.5783,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
CIPROFLOXACIN HCL 0.3 % OPHT DROP,,11296,LOCAL,Facility,Both,2.5 mL,mL,,61,51.85,17.4826,61,BlueCross BlueShield Minnesota, Federal Employee Program,60.024,98.4,,percent of total billed charges,,
CIPROFLOXACIN HCL 0.3 % OPHT DROP,,11296,LOCAL,Facility,Both,2.5 mL,mL,,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,61,100,,percent of total billed charges,,
CIPROFLOXACIN HCL 0.3 % OPHT DROP,,11296,LOCAL,Facility,Both,2.5 mL,mL,,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,High Value Network Plan,54.9,90,,percent of total billed charges,,
CIPROFLOXACIN HCL 0.3 % OPHT DROP,,11296,LOCAL,Facility,Outpatient,2.5 mL,mL,,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,Medicare Advantage,29.89,49,,percent of total billed charges,,
CIPROFLOXACIN HCL 0.3 % OPHT DROP,,11296,LOCAL,Facility,Inpatient,2.5 mL,mL,,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
CIPROFLOXACIN HCL 0.3 % OPHT DROP,,11296,LOCAL,Facility,Both,2.5 mL,mL,,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,54.0277,88.57,,percent of total billed charges,,
CIPROFLOXACIN HCL 0.3 % OPHT DROP,,11296,LOCAL,Facility,Both,2.5 mL,mL,,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,17.4826,28.66,,percent of total billed charges,,
CIPROFLOXACIN HCL 0.3 % OPHT DROP,,11296,LOCAL,Facility,Outpatient,2.5 mL,mL,,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),29.89,49,,percent of total billed charges,,
CIPROFLOXACIN HCL 0.3 % OPHT DROP,,11296,LOCAL,Facility,Inpatient,2.5 mL,mL,,61,51.85,17.4826,61,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
CIPROFLOXACIN HCL 0.3 % OPHT DROP,,11296,LOCAL,Facility,Both,2.5 mL,mL,,61,51.85,17.4826,61,CorVel,Worker's Compensation,61,100,,percent of total billed charges,,
CIPROFLOXACIN HCL 0.3 % OPHT DROP,,11296,LOCAL,Facility,Both,2.5 mL,mL,,61,51.85,17.4826,61,First Health Group Corporation,First Health Network,59.17,97,,percent of total billed charges,,
CIPROFLOXACIN HCL 0.3 % OPHT DROP,,11296,LOCAL,Facility,Both,2.5 mL,mL,,61,51.85,17.4826,61,"Health Partners, Inc.",Commercial,57.706,94.6,,percent of total billed charges,,
CIPROFLOXACIN HCL 0.3 % OPHT DROP,,11296,LOCAL,Facility,Outpatient,2.5 mL,mL,,61,51.85,17.4826,61,"Health Partners, Inc.",Medicare Advantage,29.89,49,,percent of total billed charges,,
CIPROFLOXACIN HCL 0.3 % OPHT DROP,,11296,LOCAL,Facility,Inpatient,2.5 mL,mL,,61,51.85,17.4826,61,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CIPROFLOXACIN HCL 0.3 % OPHT DROP,,11296,LOCAL,Facility,Both,2.5 mL,mL,,61,51.85,17.4826,61,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),36.6,60,,percent of total billed charges,,
CIPROFLOXACIN HCL 0.3 % OPHT DROP,,11296,LOCAL,Facility,Both,2.5 mL,mL,,61,51.85,17.4826,61,"Health Partners, Inc.",State of Minnesota Advantage Program,49.715,81.5,,percent of total billed charges,,
CIPROFLOXACIN HCL 0.3 % OPHT DROP,,11296,LOCAL,Facility,Both,2.5 mL,mL,,61,51.85,17.4826,61,"Health Partners, Inc.",State Public Programs,30.5,50,,percent of total billed charges,,
CIPROFLOXACIN HCL 0.3 % OPHT DROP,,11296,LOCAL,Facility,Both,2.5 mL,mL,,61,51.85,17.4826,61,Humana Insurance Company,Commercial PPO,57.95,95,,percent of total billed charges,,
CIPROFLOXACIN HCL 0.3 % OPHT DROP,,11296,LOCAL,Facility,Outpatient,2.5 mL,mL,,61,51.85,17.4826,61,Humana Insurance Company,Medicare PPO,29.89,49,,percent of total billed charges,,
CIPROFLOXACIN HCL 0.3 % OPHT DROP,,11296,LOCAL,Facility,Inpatient,2.5 mL,mL,,61,51.85,17.4826,61,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
CIPROFLOXACIN HCL 0.3 % OPHT DROP,,11296,LOCAL,Facility,Both,2.5 mL,mL,,61,51.85,17.4826,61,Medica,Individual & Family,60.451,99.1,,percent of total billed charges,,
CIPROFLOXACIN HCL 0.3 % OPHT DROP,,11296,LOCAL,Facility,Outpatient,2.5 mL,mL,,61,51.85,17.4826,61,Medica,Medica Advantage Solution,30.378,49.8,,percent of total billed charges,,
CIPROFLOXACIN HCL 0.3 % OPHT DROP,,11296,LOCAL,Facility,Inpatient,2.5 mL,mL,,61,51.85,17.4826,61,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
CIPROFLOXACIN HCL 0.3 % OPHT DROP,,11296,LOCAL,Facility,Outpatient,2.5 mL,mL,,61,51.85,17.4826,61,Medica,Medical Assistance,27.206,44.6,,percent of total billed charges,,
CIPROFLOXACIN HCL 0.3 % OPHT DROP,,11296,LOCAL,Facility,Inpatient,2.5 mL,mL,,61,51.85,17.4826,61,Medica,Medical Assistance,,,,,Included in per diem rate,
CIPROFLOXACIN HCL 0.3 % OPHT DROP,,11296,LOCAL,Facility,Outpatient,2.5 mL,mL,,61,51.85,17.4826,61,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,30.378,49.8,,percent of total billed charges,,
CIPROFLOXACIN HCL 0.3 % OPHT DROP,,11296,LOCAL,Facility,Inpatient,2.5 mL,mL,,61,51.85,17.4826,61,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
CIPROFLOXACIN HCL 0.3 % OPHT DROP,,11296,LOCAL,Facility,Both,2.5 mL,mL,,61,51.85,17.4826,61,"Multiplan, Inc.","Multiplan, Inc.",57.34,94,,percent of total billed charges,,
CIPROFLOXACIN HCL 0.3 % OPHT DROP,,11296,LOCAL,Facility,Outpatient,2.5 mL,mL,,61,51.85,17.4826,61,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,54.961,90.1,,percent of total billed charges,,
CIPROFLOXACIN HCL 0.3 % OPHT DROP,,11296,LOCAL,Facility,Inpatient,2.5 mL,mL,,61,51.85,17.4826,61,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
CIPROFLOXACIN HCL 0.3 % OPHT DROP,,11296,LOCAL,Facility,Both,2.5 mL,mL,,61,51.85,17.4826,61,"Preferred One Administrative Services, INC.",PPO,60.146,98.6,,percent of total billed charges,,
CIPROFLOXACIN HCL 0.3 % OPHT DROP,,11296,LOCAL,Facility,Outpatient,2.5 mL,mL,,61,51.85,17.4826,61,PrimeWest Health,Minnesota Senior Health Options (MSHO),31.3845,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
CIPROFLOXACIN HCL 0.3 % OPHT DROP,,11296,LOCAL,Facility,Inpatient,2.5 mL,mL,,61,51.85,17.4826,61,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CIPROFLOXACIN HCL 0.3 % OPHT DROP,,11296,LOCAL,Facility,Outpatient,2.5 mL,mL,,61,51.85,17.4826,61,PrimeWest Health,MinnesotaCare,31.3296,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
CIPROFLOXACIN HCL 0.3 % OPHT DROP,,11296,LOCAL,Facility,Inpatient,2.5 mL,mL,,61,51.85,17.4826,61,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
CIPROFLOXACIN HCL 0.3 % OPHT DROP,,11296,LOCAL,Facility,Both,2.5 mL,mL,,61,51.85,17.4826,61,Sanford Health Plan,Sanford Health Plan,56.12,92,,percent of total billed charges,,
CIPROFLOXACIN HCL 0.3 % OPHT DROP,,11296,LOCAL,Facility,Outpatient,2.5 mL,mL,,61,51.85,17.4826,61,"UCare Health, Inc.",Individual & Family Plan,34.3735,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
CIPROFLOXACIN HCL 0.3 % OPHT DROP,,11296,LOCAL,Facility,Inpatient,2.5 mL,mL,,61,51.85,17.4826,61,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
CIPROFLOXACIN HCL 0.3 % OPHT DROP,,11296,LOCAL,Facility,Outpatient,2.5 mL,mL,,61,51.85,17.4826,61,"UCare Health, Inc.",Medical Assistance,30.7867,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CIPROFLOXACIN HCL 0.3 % OPHT DROP,,11296,LOCAL,Facility,Inpatient,2.5 mL,mL,,61,51.85,17.4826,61,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
CIPROFLOXACIN HCL 0.3 % OPHT DROP,,11296,LOCAL,Facility,Outpatient,2.5 mL,mL,,61,51.85,17.4826,61,"UCare Health, Inc.",Medicare Advantage,30.7867,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CIPROFLOXACIN HCL 0.3 % OPHT DROP,,11296,LOCAL,Facility,Inpatient,2.5 mL,mL,,61,51.85,17.4826,61,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CIPROFLOXACIN HCL 0.3 % OPHT DROP,,11296,LOCAL,Facility,Outpatient,2.5 mL,mL,,61,51.85,17.4826,61,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),30.7867,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CIPROFLOXACIN HCL 0.3 % OPHT DROP,,11296,LOCAL,Facility,Inpatient,2.5 mL,mL,,61,51.85,17.4826,61,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CIPROFLOXACIN HCL 0.3 % OPHT DROP,,11296,LOCAL,Facility,Both,2.5 mL,mL,,61,51.85,17.4826,61,UnitedHealthcare,Individual & Family,57.34,94,,percent of total billed charges,,
CIPROFLOXACIN HCL 0.3 % OPHT DROP,,11296,LOCAL,Facility,Outpatient,2.5 mL,mL,,61,51.85,17.4826,61,UnitedHealthcare,Medicare Advantage,29.89,49,,percent of total billed charges,,
CIPROFLOXACIN HCL 0.3 % OPHT DROP,,11296,LOCAL,Facility,Inpatient,2.5 mL,mL,,61,51.85,17.4826,61,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
CIPROFLOXACIN HCL 0.3 % OPHT DROP,,11296,LOCAL,Facility,Outpatient,2.5 mL,mL,,61,51.85,17.4826,61,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,29.28,48,,percent of total billed charges,,100% of DHS outpatient percentage
CIPROFLOXACIN HCL 0.3 % OPHT DROP,,11296,LOCAL,Facility,Inpatient,2.5 mL,mL,,61,51.85,17.4826,61,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
IPRATROPIUM BROMIDE 0.02 % INHL SOLN,,19634,LOCAL,Facility,Both,2.5 mL,mL,,10,8.5,2.866,10,Aetna,Commercial,9.2,92,,percent of total billed charges,,
IPRATROPIUM BROMIDE 0.02 % INHL SOLN,,19634,LOCAL,Facility,Outpatient,2.5 mL,mL,,10,8.5,2.866,10,Aetna,Medicare Advantage,4.9,49,,percent of total billed charges,,
IPRATROPIUM BROMIDE 0.02 % INHL SOLN,,19634,LOCAL,Facility,Inpatient,2.5 mL,mL,,10,8.5,2.866,10,Aetna,Medicare Advantage,,,,,Included in per diem rate,
IPRATROPIUM BROMIDE 0.02 % INHL SOLN,,19634,LOCAL,Facility,Both,2.5 mL,mL,,10,8.5,2.866,10,Aetna,PPO,9.3,93,,percent of total billed charges,,
IPRATROPIUM BROMIDE 0.02 % INHL SOLN,,19634,LOCAL,Facility,Both,2.5 mL,mL,,10,8.5,2.866,10,America's PPO,America's PPO,9.603,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
IPRATROPIUM BROMIDE 0.02 % INHL SOLN,,19634,LOCAL,Facility,Both,2.5 mL,mL,,10,8.5,2.866,10,BlueCross BlueShield Minnesota, Federal Employee Program,9.84,98.4,,percent of total billed charges,,
IPRATROPIUM BROMIDE 0.02 % INHL SOLN,,19634,LOCAL,Facility,Both,2.5 mL,mL,,10,8.5,2.866,10,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,10,100,,percent of total billed charges,,
IPRATROPIUM BROMIDE 0.02 % INHL SOLN,,19634,LOCAL,Facility,Both,2.5 mL,mL,,10,8.5,2.866,10,BlueCross BlueShield Minnesota,High Value Network Plan,9,90,,percent of total billed charges,,
IPRATROPIUM BROMIDE 0.02 % INHL SOLN,,19634,LOCAL,Facility,Outpatient,2.5 mL,mL,,10,8.5,2.866,10,BlueCross BlueShield Minnesota,Medicare Advantage,4.9,49,,percent of total billed charges,,
IPRATROPIUM BROMIDE 0.02 % INHL SOLN,,19634,LOCAL,Facility,Inpatient,2.5 mL,mL,,10,8.5,2.866,10,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
IPRATROPIUM BROMIDE 0.02 % INHL SOLN,,19634,LOCAL,Facility,Both,2.5 mL,mL,,10,8.5,2.866,10,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,8.857,88.57,,percent of total billed charges,,
IPRATROPIUM BROMIDE 0.02 % INHL SOLN,,19634,LOCAL,Facility,Both,2.5 mL,mL,,10,8.5,2.866,10,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,2.866,28.66,,percent of total billed charges,,
IPRATROPIUM BROMIDE 0.02 % INHL SOLN,,19634,LOCAL,Facility,Outpatient,2.5 mL,mL,,10,8.5,2.866,10,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),4.9,49,,percent of total billed charges,,
IPRATROPIUM BROMIDE 0.02 % INHL SOLN,,19634,LOCAL,Facility,Inpatient,2.5 mL,mL,,10,8.5,2.866,10,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
IPRATROPIUM BROMIDE 0.02 % INHL SOLN,,19634,LOCAL,Facility,Both,2.5 mL,mL,,10,8.5,2.866,10,CorVel,Worker's Compensation,10,100,,percent of total billed charges,,
IPRATROPIUM BROMIDE 0.02 % INHL SOLN,,19634,LOCAL,Facility,Both,2.5 mL,mL,,10,8.5,2.866,10,First Health Group Corporation,First Health Network,9.7,97,,percent of total billed charges,,
IPRATROPIUM BROMIDE 0.02 % INHL SOLN,,19634,LOCAL,Facility,Both,2.5 mL,mL,,10,8.5,2.866,10,"Health Partners, Inc.",Commercial,9.46,94.6,,percent of total billed charges,,
IPRATROPIUM BROMIDE 0.02 % INHL SOLN,,19634,LOCAL,Facility,Outpatient,2.5 mL,mL,,10,8.5,2.866,10,"Health Partners, Inc.",Medicare Advantage,4.9,49,,percent of total billed charges,,
IPRATROPIUM BROMIDE 0.02 % INHL SOLN,,19634,LOCAL,Facility,Inpatient,2.5 mL,mL,,10,8.5,2.866,10,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
IPRATROPIUM BROMIDE 0.02 % INHL SOLN,,19634,LOCAL,Facility,Both,2.5 mL,mL,,10,8.5,2.866,10,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),6,60,,percent of total billed charges,,
IPRATROPIUM BROMIDE 0.02 % INHL SOLN,,19634,LOCAL,Facility,Both,2.5 mL,mL,,10,8.5,2.866,10,"Health Partners, Inc.",State of Minnesota Advantage Program,8.15,81.5,,percent of total billed charges,,
IPRATROPIUM BROMIDE 0.02 % INHL SOLN,,19634,LOCAL,Facility,Both,2.5 mL,mL,,10,8.5,2.866,10,"Health Partners, Inc.",State Public Programs,5,50,,percent of total billed charges,,
IPRATROPIUM BROMIDE 0.02 % INHL SOLN,,19634,LOCAL,Facility,Both,2.5 mL,mL,,10,8.5,2.866,10,Humana Insurance Company,Commercial PPO,9.5,95,,percent of total billed charges,,
IPRATROPIUM BROMIDE 0.02 % INHL SOLN,,19634,LOCAL,Facility,Outpatient,2.5 mL,mL,,10,8.5,2.866,10,Humana Insurance Company,Medicare PPO,4.9,49,,percent of total billed charges,,
IPRATROPIUM BROMIDE 0.02 % INHL SOLN,,19634,LOCAL,Facility,Inpatient,2.5 mL,mL,,10,8.5,2.866,10,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
IPRATROPIUM BROMIDE 0.02 % INHL SOLN,,19634,LOCAL,Facility,Both,2.5 mL,mL,,10,8.5,2.866,10,Medica,Individual & Family,9.91,99.1,,percent of total billed charges,,
IPRATROPIUM BROMIDE 0.02 % INHL SOLN,,19634,LOCAL,Facility,Outpatient,2.5 mL,mL,,10,8.5,2.866,10,Medica,Medica Advantage Solution,4.98,49.8,,percent of total billed charges,,
IPRATROPIUM BROMIDE 0.02 % INHL SOLN,,19634,LOCAL,Facility,Inpatient,2.5 mL,mL,,10,8.5,2.866,10,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
IPRATROPIUM BROMIDE 0.02 % INHL SOLN,,19634,LOCAL,Facility,Outpatient,2.5 mL,mL,,10,8.5,2.866,10,Medica,Medical Assistance,4.46,44.6,,percent of total billed charges,,
IPRATROPIUM BROMIDE 0.02 % INHL SOLN,,19634,LOCAL,Facility,Inpatient,2.5 mL,mL,,10,8.5,2.866,10,Medica,Medical Assistance,,,,,Included in per diem rate,
IPRATROPIUM BROMIDE 0.02 % INHL SOLN,,19634,LOCAL,Facility,Outpatient,2.5 mL,mL,,10,8.5,2.866,10,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,4.98,49.8,,percent of total billed charges,,
IPRATROPIUM BROMIDE 0.02 % INHL SOLN,,19634,LOCAL,Facility,Inpatient,2.5 mL,mL,,10,8.5,2.866,10,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
IPRATROPIUM BROMIDE 0.02 % INHL SOLN,,19634,LOCAL,Facility,Both,2.5 mL,mL,,10,8.5,2.866,10,"Multiplan, Inc.","Multiplan, Inc.",9.4,94,,percent of total billed charges,,
IPRATROPIUM BROMIDE 0.02 % INHL SOLN,,19634,LOCAL,Facility,Outpatient,2.5 mL,mL,,10,8.5,2.866,10,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,9.01,90.1,,percent of total billed charges,,
IPRATROPIUM BROMIDE 0.02 % INHL SOLN,,19634,LOCAL,Facility,Inpatient,2.5 mL,mL,,10,8.5,2.866,10,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
IPRATROPIUM BROMIDE 0.02 % INHL SOLN,,19634,LOCAL,Facility,Both,2.5 mL,mL,,10,8.5,2.866,10,"Preferred One Administrative Services, INC.",PPO,9.86,98.6,,percent of total billed charges,,
IPRATROPIUM BROMIDE 0.02 % INHL SOLN,,19634,LOCAL,Facility,Outpatient,2.5 mL,mL,,10,8.5,2.866,10,PrimeWest Health,Minnesota Senior Health Options (MSHO),5.145,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
IPRATROPIUM BROMIDE 0.02 % INHL SOLN,,19634,LOCAL,Facility,Inpatient,2.5 mL,mL,,10,8.5,2.866,10,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
IPRATROPIUM BROMIDE 0.02 % INHL SOLN,,19634,LOCAL,Facility,Outpatient,2.5 mL,mL,,10,8.5,2.866,10,PrimeWest Health,MinnesotaCare,5.136,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
IPRATROPIUM BROMIDE 0.02 % INHL SOLN,,19634,LOCAL,Facility,Inpatient,2.5 mL,mL,,10,8.5,2.866,10,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
IPRATROPIUM BROMIDE 0.02 % INHL SOLN,,19634,LOCAL,Facility,Both,2.5 mL,mL,,10,8.5,2.866,10,Sanford Health Plan,Sanford Health Plan,9.2,92,,percent of total billed charges,,
IPRATROPIUM BROMIDE 0.02 % INHL SOLN,,19634,LOCAL,Facility,Outpatient,2.5 mL,mL,,10,8.5,2.866,10,"UCare Health, Inc.",Individual & Family Plan,5.635,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
IPRATROPIUM BROMIDE 0.02 % INHL SOLN,,19634,LOCAL,Facility,Inpatient,2.5 mL,mL,,10,8.5,2.866,10,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
IPRATROPIUM BROMIDE 0.02 % INHL SOLN,,19634,LOCAL,Facility,Outpatient,2.5 mL,mL,,10,8.5,2.866,10,"UCare Health, Inc.",Medical Assistance,5.047,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
IPRATROPIUM BROMIDE 0.02 % INHL SOLN,,19634,LOCAL,Facility,Inpatient,2.5 mL,mL,,10,8.5,2.866,10,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
IPRATROPIUM BROMIDE 0.02 % INHL SOLN,,19634,LOCAL,Facility,Outpatient,2.5 mL,mL,,10,8.5,2.866,10,"UCare Health, Inc.",Medicare Advantage,5.047,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
IPRATROPIUM BROMIDE 0.02 % INHL SOLN,,19634,LOCAL,Facility,Inpatient,2.5 mL,mL,,10,8.5,2.866,10,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
IPRATROPIUM BROMIDE 0.02 % INHL SOLN,,19634,LOCAL,Facility,Outpatient,2.5 mL,mL,,10,8.5,2.866,10,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),5.047,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
IPRATROPIUM BROMIDE 0.02 % INHL SOLN,,19634,LOCAL,Facility,Inpatient,2.5 mL,mL,,10,8.5,2.866,10,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
IPRATROPIUM BROMIDE 0.02 % INHL SOLN,,19634,LOCAL,Facility,Both,2.5 mL,mL,,10,8.5,2.866,10,UnitedHealthcare,Individual & Family,9.4,94,,percent of total billed charges,,
IPRATROPIUM BROMIDE 0.02 % INHL SOLN,,19634,LOCAL,Facility,Outpatient,2.5 mL,mL,,10,8.5,2.866,10,UnitedHealthcare,Medicare Advantage,4.9,49,,percent of total billed charges,,
IPRATROPIUM BROMIDE 0.02 % INHL SOLN,,19634,LOCAL,Facility,Inpatient,2.5 mL,mL,,10,8.5,2.866,10,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
IPRATROPIUM BROMIDE 0.02 % INHL SOLN,,19634,LOCAL,Facility,Outpatient,2.5 mL,mL,,10,8.5,2.866,10,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,4.8,48,,percent of total billed charges,,100% of DHS outpatient percentage
IPRATROPIUM BROMIDE 0.02 % INHL SOLN,,19634,LOCAL,Facility,Inpatient,2.5 mL,mL,,10,8.5,2.866,10,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT DRPS,,20431,LOCAL,Facility,Both,2.5 mL,mL,,275,233.75,78.815,275,Aetna,Commercial,253,92,,percent of total billed charges,,
TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT DRPS,,20431,LOCAL,Facility,Both,2.5 mL,mL,,305,259.25,87.413,305,Aetna,Commercial,280.6,92,,percent of total billed charges,,
TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT DRPS,,20431,LOCAL,Facility,Outpatient,2.5 mL,mL,,275,233.75,78.815,275,Aetna,Medicare Advantage,134.75,49,,percent of total billed charges,,
TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT DRPS,,20431,LOCAL,Facility,Outpatient,2.5 mL,mL,,305,259.25,87.413,305,Aetna,Medicare Advantage,149.45,49,,percent of total billed charges,,
TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT DRPS,,20431,LOCAL,Facility,Inpatient,2.5 mL,mL,,275,233.75,78.815,275,Aetna,Medicare Advantage,,,,,Included in per diem rate,
TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT DRPS,,20431,LOCAL,Facility,Inpatient,2.5 mL,mL,,305,259.25,87.413,305,Aetna,Medicare Advantage,,,,,Included in per diem rate,
TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT DRPS,,20431,LOCAL,Facility,Both,2.5 mL,mL,,275,233.75,78.815,275,Aetna,PPO,255.75,93,,percent of total billed charges,,
TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT DRPS,,20431,LOCAL,Facility,Both,2.5 mL,mL,,305,259.25,87.413,305,Aetna,PPO,283.65,93,,percent of total billed charges,,
TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT DRPS,,20431,LOCAL,Facility,Both,2.5 mL,mL,,275,233.75,78.815,275,America's PPO,America's PPO,264.0825,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT DRPS,,20431,LOCAL,Facility,Both,2.5 mL,mL,,305,259.25,87.413,305,America's PPO,America's PPO,292.8915,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT DRPS,,20431,LOCAL,Facility,Both,2.5 mL,mL,,275,233.75,78.815,275,BlueCross BlueShield Minnesota, Federal Employee Program,270.6,98.4,,percent of total billed charges,,
TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT DRPS,,20431,LOCAL,Facility,Both,2.5 mL,mL,,305,259.25,87.413,305,BlueCross BlueShield Minnesota, Federal Employee Program,300.12,98.4,,percent of total billed charges,,
TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT DRPS,,20431,LOCAL,Facility,Both,2.5 mL,mL,,275,233.75,78.815,275,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,275,100,,percent of total billed charges,,
TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT DRPS,,20431,LOCAL,Facility,Both,2.5 mL,mL,,305,259.25,87.413,305,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,305,100,,percent of total billed charges,,
TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT DRPS,,20431,LOCAL,Facility,Both,2.5 mL,mL,,275,233.75,78.815,275,BlueCross BlueShield Minnesota,High Value Network Plan,247.5,90,,percent of total billed charges,,
TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT DRPS,,20431,LOCAL,Facility,Both,2.5 mL,mL,,305,259.25,87.413,305,BlueCross BlueShield Minnesota,High Value Network Plan,274.5,90,,percent of total billed charges,,
TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT DRPS,,20431,LOCAL,Facility,Outpatient,2.5 mL,mL,,275,233.75,78.815,275,BlueCross BlueShield Minnesota,Medicare Advantage,134.75,49,,percent of total billed charges,,
TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT DRPS,,20431,LOCAL,Facility,Outpatient,2.5 mL,mL,,305,259.25,87.413,305,BlueCross BlueShield Minnesota,Medicare Advantage,149.45,49,,percent of total billed charges,,
TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT DRPS,,20431,LOCAL,Facility,Inpatient,2.5 mL,mL,,275,233.75,78.815,275,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT DRPS,,20431,LOCAL,Facility,Inpatient,2.5 mL,mL,,305,259.25,87.413,305,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT DRPS,,20431,LOCAL,Facility,Both,2.5 mL,mL,,275,233.75,78.815,275,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,243.5675,88.57,,percent of total billed charges,,
TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT DRPS,,20431,LOCAL,Facility,Both,2.5 mL,mL,,305,259.25,87.413,305,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,270.1385,88.57,,percent of total billed charges,,
TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT DRPS,,20431,LOCAL,Facility,Both,2.5 mL,mL,,275,233.75,78.815,275,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,78.815,28.66,,percent of total billed charges,,
TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT DRPS,,20431,LOCAL,Facility,Both,2.5 mL,mL,,305,259.25,87.413,305,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,87.413,28.66,,percent of total billed charges,,
TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT DRPS,,20431,LOCAL,Facility,Outpatient,2.5 mL,mL,,275,233.75,78.815,275,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),134.75,49,,percent of total billed charges,,
TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT DRPS,,20431,LOCAL,Facility,Outpatient,2.5 mL,mL,,305,259.25,87.413,305,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),149.45,49,,percent of total billed charges,,
TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT DRPS,,20431,LOCAL,Facility,Inpatient,2.5 mL,mL,,275,233.75,78.815,275,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT DRPS,,20431,LOCAL,Facility,Inpatient,2.5 mL,mL,,305,259.25,87.413,305,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT DRPS,,20431,LOCAL,Facility,Both,2.5 mL,mL,,275,233.75,78.815,275,CorVel,Worker's Compensation,275,100,,percent of total billed charges,,
TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT DRPS,,20431,LOCAL,Facility,Both,2.5 mL,mL,,305,259.25,87.413,305,CorVel,Worker's Compensation,305,100,,percent of total billed charges,,
TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT DRPS,,20431,LOCAL,Facility,Both,2.5 mL,mL,,275,233.75,78.815,275,First Health Group Corporation,First Health Network,266.75,97,,percent of total billed charges,,
TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT DRPS,,20431,LOCAL,Facility,Both,2.5 mL,mL,,305,259.25,87.413,305,First Health Group Corporation,First Health Network,295.85,97,,percent of total billed charges,,
TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT DRPS,,20431,LOCAL,Facility,Both,2.5 mL,mL,,275,233.75,78.815,275,"Health Partners, Inc.",Commercial,260.15,94.6,,percent of total billed charges,,
TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT DRPS,,20431,LOCAL,Facility,Both,2.5 mL,mL,,305,259.25,87.413,305,"Health Partners, Inc.",Commercial,288.53,94.6,,percent of total billed charges,,
TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT DRPS,,20431,LOCAL,Facility,Outpatient,2.5 mL,mL,,275,233.75,78.815,275,"Health Partners, Inc.",Medicare Advantage,134.75,49,,percent of total billed charges,,
TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT DRPS,,20431,LOCAL,Facility,Outpatient,2.5 mL,mL,,305,259.25,87.413,305,"Health Partners, Inc.",Medicare Advantage,149.45,49,,percent of total billed charges,,
TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT DRPS,,20431,LOCAL,Facility,Inpatient,2.5 mL,mL,,275,233.75,78.815,275,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT DRPS,,20431,LOCAL,Facility,Inpatient,2.5 mL,mL,,305,259.25,87.413,305,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT DRPS,,20431,LOCAL,Facility,Both,2.5 mL,mL,,275,233.75,78.815,275,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),165,60,,percent of total billed charges,,
TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT DRPS,,20431,LOCAL,Facility,Both,2.5 mL,mL,,305,259.25,87.413,305,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),183,60,,percent of total billed charges,,
TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT DRPS,,20431,LOCAL,Facility,Both,2.5 mL,mL,,275,233.75,78.815,275,"Health Partners, Inc.",State of Minnesota Advantage Program,224.125,81.5,,percent of total billed charges,,
TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT DRPS,,20431,LOCAL,Facility,Both,2.5 mL,mL,,305,259.25,87.413,305,"Health Partners, Inc.",State of Minnesota Advantage Program,248.575,81.5,,percent of total billed charges,,
TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT DRPS,,20431,LOCAL,Facility,Both,2.5 mL,mL,,275,233.75,78.815,275,"Health Partners, Inc.",State Public Programs,137.5,50,,percent of total billed charges,,
TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT DRPS,,20431,LOCAL,Facility,Both,2.5 mL,mL,,305,259.25,87.413,305,"Health Partners, Inc.",State Public Programs,152.5,50,,percent of total billed charges,,
TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT DRPS,,20431,LOCAL,Facility,Both,2.5 mL,mL,,275,233.75,78.815,275,Humana Insurance Company,Commercial PPO,261.25,95,,percent of total billed charges,,
TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT DRPS,,20431,LOCAL,Facility,Both,2.5 mL,mL,,305,259.25,87.413,305,Humana Insurance Company,Commercial PPO,289.75,95,,percent of total billed charges,,
TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT DRPS,,20431,LOCAL,Facility,Outpatient,2.5 mL,mL,,275,233.75,78.815,275,Humana Insurance Company,Medicare PPO,134.75,49,,percent of total billed charges,,
TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT DRPS,,20431,LOCAL,Facility,Outpatient,2.5 mL,mL,,305,259.25,87.413,305,Humana Insurance Company,Medicare PPO,149.45,49,,percent of total billed charges,,
TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT DRPS,,20431,LOCAL,Facility,Inpatient,2.5 mL,mL,,275,233.75,78.815,275,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT DRPS,,20431,LOCAL,Facility,Inpatient,2.5 mL,mL,,305,259.25,87.413,305,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT DRPS,,20431,LOCAL,Facility,Both,2.5 mL,mL,,275,233.75,78.815,275,Medica,Individual & Family,272.525,99.1,,percent of total billed charges,,
TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT DRPS,,20431,LOCAL,Facility,Both,2.5 mL,mL,,305,259.25,87.413,305,Medica,Individual & Family,302.255,99.1,,percent of total billed charges,,
TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT DRPS,,20431,LOCAL,Facility,Outpatient,2.5 mL,mL,,275,233.75,78.815,275,Medica,Medica Advantage Solution,136.95,49.8,,percent of total billed charges,,
TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT DRPS,,20431,LOCAL,Facility,Outpatient,2.5 mL,mL,,305,259.25,87.413,305,Medica,Medica Advantage Solution,151.89,49.8,,percent of total billed charges,,
TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT DRPS,,20431,LOCAL,Facility,Inpatient,2.5 mL,mL,,275,233.75,78.815,275,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT DRPS,,20431,LOCAL,Facility,Inpatient,2.5 mL,mL,,305,259.25,87.413,305,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT DRPS,,20431,LOCAL,Facility,Outpatient,2.5 mL,mL,,275,233.75,78.815,275,Medica,Medical Assistance,122.65,44.6,,percent of total billed charges,,
TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT DRPS,,20431,LOCAL,Facility,Outpatient,2.5 mL,mL,,305,259.25,87.413,305,Medica,Medical Assistance,136.03,44.6,,percent of total billed charges,,
TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT DRPS,,20431,LOCAL,Facility,Inpatient,2.5 mL,mL,,275,233.75,78.815,275,Medica,Medical Assistance,,,,,Included in per diem rate,
TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT DRPS,,20431,LOCAL,Facility,Inpatient,2.5 mL,mL,,305,259.25,87.413,305,Medica,Medical Assistance,,,,,Included in per diem rate,
TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT DRPS,,20431,LOCAL,Facility,Outpatient,2.5 mL,mL,,275,233.75,78.815,275,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,136.95,49.8,,percent of total billed charges,,
TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT DRPS,,20431,LOCAL,Facility,Outpatient,2.5 mL,mL,,305,259.25,87.413,305,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,151.89,49.8,,percent of total billed charges,,
TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT DRPS,,20431,LOCAL,Facility,Inpatient,2.5 mL,mL,,275,233.75,78.815,275,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT DRPS,,20431,LOCAL,Facility,Inpatient,2.5 mL,mL,,305,259.25,87.413,305,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT DRPS,,20431,LOCAL,Facility,Both,2.5 mL,mL,,275,233.75,78.815,275,"Multiplan, Inc.","Multiplan, Inc.",258.5,94,,percent of total billed charges,,
TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT DRPS,,20431,LOCAL,Facility,Both,2.5 mL,mL,,305,259.25,87.413,305,"Multiplan, Inc.","Multiplan, Inc.",286.7,94,,percent of total billed charges,,
TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT DRPS,,20431,LOCAL,Facility,Outpatient,2.5 mL,mL,,275,233.75,78.815,275,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,247.775,90.1,,percent of total billed charges,,
TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT DRPS,,20431,LOCAL,Facility,Outpatient,2.5 mL,mL,,305,259.25,87.413,305,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,274.805,90.1,,percent of total billed charges,,
TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT DRPS,,20431,LOCAL,Facility,Inpatient,2.5 mL,mL,,275,233.75,78.815,275,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT DRPS,,20431,LOCAL,Facility,Inpatient,2.5 mL,mL,,305,259.25,87.413,305,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT DRPS,,20431,LOCAL,Facility,Both,2.5 mL,mL,,275,233.75,78.815,275,"Preferred One Administrative Services, INC.",PPO,271.15,98.6,,percent of total billed charges,,
TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT DRPS,,20431,LOCAL,Facility,Both,2.5 mL,mL,,305,259.25,87.413,305,"Preferred One Administrative Services, INC.",PPO,300.73,98.6,,percent of total billed charges,,
TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT DRPS,,20431,LOCAL,Facility,Outpatient,2.5 mL,mL,,275,233.75,78.815,275,PrimeWest Health,Minnesota Senior Health Options (MSHO),141.4875,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT DRPS,,20431,LOCAL,Facility,Outpatient,2.5 mL,mL,,305,259.25,87.413,305,PrimeWest Health,Minnesota Senior Health Options (MSHO),156.9225,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT DRPS,,20431,LOCAL,Facility,Inpatient,2.5 mL,mL,,275,233.75,78.815,275,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT DRPS,,20431,LOCAL,Facility,Inpatient,2.5 mL,mL,,305,259.25,87.413,305,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT DRPS,,20431,LOCAL,Facility,Outpatient,2.5 mL,mL,,275,233.75,78.815,275,PrimeWest Health,MinnesotaCare,141.24,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT DRPS,,20431,LOCAL,Facility,Outpatient,2.5 mL,mL,,305,259.25,87.413,305,PrimeWest Health,MinnesotaCare,156.648,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT DRPS,,20431,LOCAL,Facility,Inpatient,2.5 mL,mL,,275,233.75,78.815,275,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT DRPS,,20431,LOCAL,Facility,Inpatient,2.5 mL,mL,,305,259.25,87.413,305,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT DRPS,,20431,LOCAL,Facility,Both,2.5 mL,mL,,275,233.75,78.815,275,Sanford Health Plan,Sanford Health Plan,253,92,,percent of total billed charges,,
TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT DRPS,,20431,LOCAL,Facility,Both,2.5 mL,mL,,305,259.25,87.413,305,Sanford Health Plan,Sanford Health Plan,280.6,92,,percent of total billed charges,,
TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT DRPS,,20431,LOCAL,Facility,Outpatient,2.5 mL,mL,,275,233.75,78.815,275,"UCare Health, Inc.",Individual & Family Plan,154.9625,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT DRPS,,20431,LOCAL,Facility,Outpatient,2.5 mL,mL,,305,259.25,87.413,305,"UCare Health, Inc.",Individual & Family Plan,171.8675,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT DRPS,,20431,LOCAL,Facility,Inpatient,2.5 mL,mL,,275,233.75,78.815,275,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT DRPS,,20431,LOCAL,Facility,Inpatient,2.5 mL,mL,,305,259.25,87.413,305,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT DRPS,,20431,LOCAL,Facility,Outpatient,2.5 mL,mL,,275,233.75,78.815,275,"UCare Health, Inc.",Medical Assistance,138.7925,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT DRPS,,20431,LOCAL,Facility,Outpatient,2.5 mL,mL,,305,259.25,87.413,305,"UCare Health, Inc.",Medical Assistance,153.9335,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT DRPS,,20431,LOCAL,Facility,Inpatient,2.5 mL,mL,,275,233.75,78.815,275,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT DRPS,,20431,LOCAL,Facility,Inpatient,2.5 mL,mL,,305,259.25,87.413,305,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT DRPS,,20431,LOCAL,Facility,Outpatient,2.5 mL,mL,,275,233.75,78.815,275,"UCare Health, Inc.",Medicare Advantage,138.7925,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT DRPS,,20431,LOCAL,Facility,Outpatient,2.5 mL,mL,,305,259.25,87.413,305,"UCare Health, Inc.",Medicare Advantage,153.9335,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT DRPS,,20431,LOCAL,Facility,Inpatient,2.5 mL,mL,,275,233.75,78.815,275,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT DRPS,,20431,LOCAL,Facility,Inpatient,2.5 mL,mL,,305,259.25,87.413,305,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT DRPS,,20431,LOCAL,Facility,Outpatient,2.5 mL,mL,,275,233.75,78.815,275,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),138.7925,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT DRPS,,20431,LOCAL,Facility,Outpatient,2.5 mL,mL,,305,259.25,87.413,305,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),153.9335,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT DRPS,,20431,LOCAL,Facility,Inpatient,2.5 mL,mL,,275,233.75,78.815,275,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT DRPS,,20431,LOCAL,Facility,Inpatient,2.5 mL,mL,,305,259.25,87.413,305,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT DRPS,,20431,LOCAL,Facility,Both,2.5 mL,mL,,275,233.75,78.815,275,UnitedHealthcare,Individual & Family,258.5,94,,percent of total billed charges,,
TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT DRPS,,20431,LOCAL,Facility,Both,2.5 mL,mL,,305,259.25,87.413,305,UnitedHealthcare,Individual & Family,286.7,94,,percent of total billed charges,,
TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT DRPS,,20431,LOCAL,Facility,Outpatient,2.5 mL,mL,,275,233.75,78.815,275,UnitedHealthcare,Medicare Advantage,134.75,49,,percent of total billed charges,,
TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT DRPS,,20431,LOCAL,Facility,Outpatient,2.5 mL,mL,,305,259.25,87.413,305,UnitedHealthcare,Medicare Advantage,149.45,49,,percent of total billed charges,,
TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT DRPS,,20431,LOCAL,Facility,Inpatient,2.5 mL,mL,,275,233.75,78.815,275,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT DRPS,,20431,LOCAL,Facility,Inpatient,2.5 mL,mL,,305,259.25,87.413,305,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT DRPS,,20431,LOCAL,Facility,Outpatient,2.5 mL,mL,,275,233.75,78.815,275,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,132,48,,percent of total billed charges,,100% of DHS outpatient percentage
TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT DRPS,,20431,LOCAL,Facility,Outpatient,2.5 mL,mL,,305,259.25,87.413,305,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,146.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT DRPS,,20431,LOCAL,Facility,Inpatient,2.5 mL,mL,,275,233.75,78.815,275,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT DRPS,,20431,LOCAL,Facility,Inpatient,2.5 mL,mL,,305,259.25,87.413,305,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
OLOPATADINE 0.2 % OPHT DROP,,69036,LOCAL,Facility,Both,2.5 mL,mL,,81,68.85,23.2146,81,Aetna,Commercial,74.52,92,,percent of total billed charges,,
OLOPATADINE 0.2 % OPHT DROP,,69036,LOCAL,Facility,Outpatient,2.5 mL,mL,,81,68.85,23.2146,81,Aetna,Medicare Advantage,39.69,49,,percent of total billed charges,,
OLOPATADINE 0.2 % OPHT DROP,,69036,LOCAL,Facility,Inpatient,2.5 mL,mL,,81,68.85,23.2146,81,Aetna,Medicare Advantage,,,,,Included in per diem rate,
OLOPATADINE 0.2 % OPHT DROP,,69036,LOCAL,Facility,Both,2.5 mL,mL,,81,68.85,23.2146,81,Aetna,PPO,75.33,93,,percent of total billed charges,,
OLOPATADINE 0.2 % OPHT DROP,,69036,LOCAL,Facility,Both,2.5 mL,mL,,81,68.85,23.2146,81,America's PPO,America's PPO,77.7843,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
OLOPATADINE 0.2 % OPHT DROP,,69036,LOCAL,Facility,Both,2.5 mL,mL,,81,68.85,23.2146,81,BlueCross BlueShield Minnesota, Federal Employee Program,79.704,98.4,,percent of total billed charges,,
OLOPATADINE 0.2 % OPHT DROP,,69036,LOCAL,Facility,Both,2.5 mL,mL,,81,68.85,23.2146,81,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,81,100,,percent of total billed charges,,
OLOPATADINE 0.2 % OPHT DROP,,69036,LOCAL,Facility,Both,2.5 mL,mL,,81,68.85,23.2146,81,BlueCross BlueShield Minnesota,High Value Network Plan,72.9,90,,percent of total billed charges,,
OLOPATADINE 0.2 % OPHT DROP,,69036,LOCAL,Facility,Outpatient,2.5 mL,mL,,81,68.85,23.2146,81,BlueCross BlueShield Minnesota,Medicare Advantage,39.69,49,,percent of total billed charges,,
OLOPATADINE 0.2 % OPHT DROP,,69036,LOCAL,Facility,Inpatient,2.5 mL,mL,,81,68.85,23.2146,81,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
OLOPATADINE 0.2 % OPHT DROP,,69036,LOCAL,Facility,Both,2.5 mL,mL,,81,68.85,23.2146,81,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,71.7417,88.57,,percent of total billed charges,,
OLOPATADINE 0.2 % OPHT DROP,,69036,LOCAL,Facility,Both,2.5 mL,mL,,81,68.85,23.2146,81,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,23.2146,28.66,,percent of total billed charges,,
OLOPATADINE 0.2 % OPHT DROP,,69036,LOCAL,Facility,Outpatient,2.5 mL,mL,,81,68.85,23.2146,81,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),39.69,49,,percent of total billed charges,,
OLOPATADINE 0.2 % OPHT DROP,,69036,LOCAL,Facility,Inpatient,2.5 mL,mL,,81,68.85,23.2146,81,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
OLOPATADINE 0.2 % OPHT DROP,,69036,LOCAL,Facility,Both,2.5 mL,mL,,81,68.85,23.2146,81,CorVel,Worker's Compensation,81,100,,percent of total billed charges,,
OLOPATADINE 0.2 % OPHT DROP,,69036,LOCAL,Facility,Both,2.5 mL,mL,,81,68.85,23.2146,81,First Health Group Corporation,First Health Network,78.57,97,,percent of total billed charges,,
OLOPATADINE 0.2 % OPHT DROP,,69036,LOCAL,Facility,Both,2.5 mL,mL,,81,68.85,23.2146,81,"Health Partners, Inc.",Commercial,76.626,94.6,,percent of total billed charges,,
OLOPATADINE 0.2 % OPHT DROP,,69036,LOCAL,Facility,Outpatient,2.5 mL,mL,,81,68.85,23.2146,81,"Health Partners, Inc.",Medicare Advantage,39.69,49,,percent of total billed charges,,
OLOPATADINE 0.2 % OPHT DROP,,69036,LOCAL,Facility,Inpatient,2.5 mL,mL,,81,68.85,23.2146,81,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
OLOPATADINE 0.2 % OPHT DROP,,69036,LOCAL,Facility,Both,2.5 mL,mL,,81,68.85,23.2146,81,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),48.6,60,,percent of total billed charges,,
OLOPATADINE 0.2 % OPHT DROP,,69036,LOCAL,Facility,Both,2.5 mL,mL,,81,68.85,23.2146,81,"Health Partners, Inc.",State of Minnesota Advantage Program,66.015,81.5,,percent of total billed charges,,
OLOPATADINE 0.2 % OPHT DROP,,69036,LOCAL,Facility,Both,2.5 mL,mL,,81,68.85,23.2146,81,"Health Partners, Inc.",State Public Programs,40.5,50,,percent of total billed charges,,
OLOPATADINE 0.2 % OPHT DROP,,69036,LOCAL,Facility,Both,2.5 mL,mL,,81,68.85,23.2146,81,Humana Insurance Company,Commercial PPO,76.95,95,,percent of total billed charges,,
OLOPATADINE 0.2 % OPHT DROP,,69036,LOCAL,Facility,Outpatient,2.5 mL,mL,,81,68.85,23.2146,81,Humana Insurance Company,Medicare PPO,39.69,49,,percent of total billed charges,,
OLOPATADINE 0.2 % OPHT DROP,,69036,LOCAL,Facility,Inpatient,2.5 mL,mL,,81,68.85,23.2146,81,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
OLOPATADINE 0.2 % OPHT DROP,,69036,LOCAL,Facility,Both,2.5 mL,mL,,81,68.85,23.2146,81,Medica,Individual & Family,80.271,99.1,,percent of total billed charges,,
OLOPATADINE 0.2 % OPHT DROP,,69036,LOCAL,Facility,Outpatient,2.5 mL,mL,,81,68.85,23.2146,81,Medica,Medica Advantage Solution,40.338,49.8,,percent of total billed charges,,
OLOPATADINE 0.2 % OPHT DROP,,69036,LOCAL,Facility,Inpatient,2.5 mL,mL,,81,68.85,23.2146,81,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
OLOPATADINE 0.2 % OPHT DROP,,69036,LOCAL,Facility,Outpatient,2.5 mL,mL,,81,68.85,23.2146,81,Medica,Medical Assistance,36.126,44.6,,percent of total billed charges,,
OLOPATADINE 0.2 % OPHT DROP,,69036,LOCAL,Facility,Inpatient,2.5 mL,mL,,81,68.85,23.2146,81,Medica,Medical Assistance,,,,,Included in per diem rate,
OLOPATADINE 0.2 % OPHT DROP,,69036,LOCAL,Facility,Outpatient,2.5 mL,mL,,81,68.85,23.2146,81,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,40.338,49.8,,percent of total billed charges,,
OLOPATADINE 0.2 % OPHT DROP,,69036,LOCAL,Facility,Inpatient,2.5 mL,mL,,81,68.85,23.2146,81,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
OLOPATADINE 0.2 % OPHT DROP,,69036,LOCAL,Facility,Both,2.5 mL,mL,,81,68.85,23.2146,81,"Multiplan, Inc.","Multiplan, Inc.",76.14,94,,percent of total billed charges,,
OLOPATADINE 0.2 % OPHT DROP,,69036,LOCAL,Facility,Outpatient,2.5 mL,mL,,81,68.85,23.2146,81,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,72.981,90.1,,percent of total billed charges,,
OLOPATADINE 0.2 % OPHT DROP,,69036,LOCAL,Facility,Inpatient,2.5 mL,mL,,81,68.85,23.2146,81,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
OLOPATADINE 0.2 % OPHT DROP,,69036,LOCAL,Facility,Both,2.5 mL,mL,,81,68.85,23.2146,81,"Preferred One Administrative Services, INC.",PPO,79.866,98.6,,percent of total billed charges,,
OLOPATADINE 0.2 % OPHT DROP,,69036,LOCAL,Facility,Outpatient,2.5 mL,mL,,81,68.85,23.2146,81,PrimeWest Health,Minnesota Senior Health Options (MSHO),41.6745,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
OLOPATADINE 0.2 % OPHT DROP,,69036,LOCAL,Facility,Inpatient,2.5 mL,mL,,81,68.85,23.2146,81,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
OLOPATADINE 0.2 % OPHT DROP,,69036,LOCAL,Facility,Outpatient,2.5 mL,mL,,81,68.85,23.2146,81,PrimeWest Health,MinnesotaCare,41.6016,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
OLOPATADINE 0.2 % OPHT DROP,,69036,LOCAL,Facility,Inpatient,2.5 mL,mL,,81,68.85,23.2146,81,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
OLOPATADINE 0.2 % OPHT DROP,,69036,LOCAL,Facility,Both,2.5 mL,mL,,81,68.85,23.2146,81,Sanford Health Plan,Sanford Health Plan,74.52,92,,percent of total billed charges,,
OLOPATADINE 0.2 % OPHT DROP,,69036,LOCAL,Facility,Outpatient,2.5 mL,mL,,81,68.85,23.2146,81,"UCare Health, Inc.",Individual & Family Plan,45.6435,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
OLOPATADINE 0.2 % OPHT DROP,,69036,LOCAL,Facility,Inpatient,2.5 mL,mL,,81,68.85,23.2146,81,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
OLOPATADINE 0.2 % OPHT DROP,,69036,LOCAL,Facility,Outpatient,2.5 mL,mL,,81,68.85,23.2146,81,"UCare Health, Inc.",Medical Assistance,40.8807,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
OLOPATADINE 0.2 % OPHT DROP,,69036,LOCAL,Facility,Inpatient,2.5 mL,mL,,81,68.85,23.2146,81,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
OLOPATADINE 0.2 % OPHT DROP,,69036,LOCAL,Facility,Outpatient,2.5 mL,mL,,81,68.85,23.2146,81,"UCare Health, Inc.",Medicare Advantage,40.8807,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
OLOPATADINE 0.2 % OPHT DROP,,69036,LOCAL,Facility,Inpatient,2.5 mL,mL,,81,68.85,23.2146,81,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
OLOPATADINE 0.2 % OPHT DROP,,69036,LOCAL,Facility,Outpatient,2.5 mL,mL,,81,68.85,23.2146,81,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),40.8807,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
OLOPATADINE 0.2 % OPHT DROP,,69036,LOCAL,Facility,Inpatient,2.5 mL,mL,,81,68.85,23.2146,81,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
OLOPATADINE 0.2 % OPHT DROP,,69036,LOCAL,Facility,Both,2.5 mL,mL,,81,68.85,23.2146,81,UnitedHealthcare,Individual & Family,76.14,94,,percent of total billed charges,,
OLOPATADINE 0.2 % OPHT DROP,,69036,LOCAL,Facility,Outpatient,2.5 mL,mL,,81,68.85,23.2146,81,UnitedHealthcare,Medicare Advantage,39.69,49,,percent of total billed charges,,
OLOPATADINE 0.2 % OPHT DROP,,69036,LOCAL,Facility,Inpatient,2.5 mL,mL,,81,68.85,23.2146,81,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
OLOPATADINE 0.2 % OPHT DROP,,69036,LOCAL,Facility,Outpatient,2.5 mL,mL,,81,68.85,23.2146,81,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,38.88,48,,percent of total billed charges,,100% of DHS outpatient percentage
OLOPATADINE 0.2 % OPHT DROP,,69036,LOCAL,Facility,Inpatient,2.5 mL,mL,,81,68.85,23.2146,81,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
BUTAMBEN-TETRACAINE-BENZOCAINE 2 %-2 %-14 % (200 MG/SEC) TOP SPRA,,5732,LOCAL,Facility,Both,20 g,g,,715,607.75,204.919,715,Aetna,Commercial,657.8,92,,percent of total billed charges,,
BUTAMBEN-TETRACAINE-BENZOCAINE 2 %-2 %-14 % (200 MG/SEC) TOP SPRA,,5732,LOCAL,Facility,Outpatient,20 g,g,,715,607.75,204.919,715,Aetna,Medicare Advantage,350.35,49,,percent of total billed charges,,
BUTAMBEN-TETRACAINE-BENZOCAINE 2 %-2 %-14 % (200 MG/SEC) TOP SPRA,,5732,LOCAL,Facility,Inpatient,20 g,g,,715,607.75,204.919,715,Aetna,Medicare Advantage,,,,,Included in per diem rate,
BUTAMBEN-TETRACAINE-BENZOCAINE 2 %-2 %-14 % (200 MG/SEC) TOP SPRA,,5732,LOCAL,Facility,Both,20 g,g,,715,607.75,204.919,715,Aetna,PPO,664.95,93,,percent of total billed charges,,
BUTAMBEN-TETRACAINE-BENZOCAINE 2 %-2 %-14 % (200 MG/SEC) TOP SPRA,,5732,LOCAL,Facility,Both,20 g,g,,715,607.75,204.919,715,America's PPO,America's PPO,686.6145,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
BUTAMBEN-TETRACAINE-BENZOCAINE 2 %-2 %-14 % (200 MG/SEC) TOP SPRA,,5732,LOCAL,Facility,Both,20 g,g,,715,607.75,204.919,715,BlueCross BlueShield Minnesota, Federal Employee Program,703.56,98.4,,percent of total billed charges,,
BUTAMBEN-TETRACAINE-BENZOCAINE 2 %-2 %-14 % (200 MG/SEC) TOP SPRA,,5732,LOCAL,Facility,Both,20 g,g,,715,607.75,204.919,715,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,715,100,,percent of total billed charges,,
BUTAMBEN-TETRACAINE-BENZOCAINE 2 %-2 %-14 % (200 MG/SEC) TOP SPRA,,5732,LOCAL,Facility,Both,20 g,g,,715,607.75,204.919,715,BlueCross BlueShield Minnesota,High Value Network Plan,643.5,90,,percent of total billed charges,,
BUTAMBEN-TETRACAINE-BENZOCAINE 2 %-2 %-14 % (200 MG/SEC) TOP SPRA,,5732,LOCAL,Facility,Outpatient,20 g,g,,715,607.75,204.919,715,BlueCross BlueShield Minnesota,Medicare Advantage,350.35,49,,percent of total billed charges,,
BUTAMBEN-TETRACAINE-BENZOCAINE 2 %-2 %-14 % (200 MG/SEC) TOP SPRA,,5732,LOCAL,Facility,Inpatient,20 g,g,,715,607.75,204.919,715,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
BUTAMBEN-TETRACAINE-BENZOCAINE 2 %-2 %-14 % (200 MG/SEC) TOP SPRA,,5732,LOCAL,Facility,Both,20 g,g,,715,607.75,204.919,715,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,633.2755,88.57,,percent of total billed charges,,
BUTAMBEN-TETRACAINE-BENZOCAINE 2 %-2 %-14 % (200 MG/SEC) TOP SPRA,,5732,LOCAL,Facility,Both,20 g,g,,715,607.75,204.919,715,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,204.919,28.66,,percent of total billed charges,,
BUTAMBEN-TETRACAINE-BENZOCAINE 2 %-2 %-14 % (200 MG/SEC) TOP SPRA,,5732,LOCAL,Facility,Outpatient,20 g,g,,715,607.75,204.919,715,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),350.35,49,,percent of total billed charges,,
BUTAMBEN-TETRACAINE-BENZOCAINE 2 %-2 %-14 % (200 MG/SEC) TOP SPRA,,5732,LOCAL,Facility,Inpatient,20 g,g,,715,607.75,204.919,715,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
BUTAMBEN-TETRACAINE-BENZOCAINE 2 %-2 %-14 % (200 MG/SEC) TOP SPRA,,5732,LOCAL,Facility,Both,20 g,g,,715,607.75,204.919,715,CorVel,Worker's Compensation,715,100,,percent of total billed charges,,
BUTAMBEN-TETRACAINE-BENZOCAINE 2 %-2 %-14 % (200 MG/SEC) TOP SPRA,,5732,LOCAL,Facility,Both,20 g,g,,715,607.75,204.919,715,First Health Group Corporation,First Health Network,693.55,97,,percent of total billed charges,,
BUTAMBEN-TETRACAINE-BENZOCAINE 2 %-2 %-14 % (200 MG/SEC) TOP SPRA,,5732,LOCAL,Facility,Both,20 g,g,,715,607.75,204.919,715,"Health Partners, Inc.",Commercial,676.39,94.6,,percent of total billed charges,,
BUTAMBEN-TETRACAINE-BENZOCAINE 2 %-2 %-14 % (200 MG/SEC) TOP SPRA,,5732,LOCAL,Facility,Outpatient,20 g,g,,715,607.75,204.919,715,"Health Partners, Inc.",Medicare Advantage,350.35,49,,percent of total billed charges,,
BUTAMBEN-TETRACAINE-BENZOCAINE 2 %-2 %-14 % (200 MG/SEC) TOP SPRA,,5732,LOCAL,Facility,Inpatient,20 g,g,,715,607.75,204.919,715,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
BUTAMBEN-TETRACAINE-BENZOCAINE 2 %-2 %-14 % (200 MG/SEC) TOP SPRA,,5732,LOCAL,Facility,Both,20 g,g,,715,607.75,204.919,715,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),429,60,,percent of total billed charges,,
BUTAMBEN-TETRACAINE-BENZOCAINE 2 %-2 %-14 % (200 MG/SEC) TOP SPRA,,5732,LOCAL,Facility,Both,20 g,g,,715,607.75,204.919,715,"Health Partners, Inc.",State of Minnesota Advantage Program,582.725,81.5,,percent of total billed charges,,
BUTAMBEN-TETRACAINE-BENZOCAINE 2 %-2 %-14 % (200 MG/SEC) TOP SPRA,,5732,LOCAL,Facility,Both,20 g,g,,715,607.75,204.919,715,"Health Partners, Inc.",State Public Programs,357.5,50,,percent of total billed charges,,
BUTAMBEN-TETRACAINE-BENZOCAINE 2 %-2 %-14 % (200 MG/SEC) TOP SPRA,,5732,LOCAL,Facility,Both,20 g,g,,715,607.75,204.919,715,Humana Insurance Company,Commercial PPO,679.25,95,,percent of total billed charges,,
BUTAMBEN-TETRACAINE-BENZOCAINE 2 %-2 %-14 % (200 MG/SEC) TOP SPRA,,5732,LOCAL,Facility,Outpatient,20 g,g,,715,607.75,204.919,715,Humana Insurance Company,Medicare PPO,350.35,49,,percent of total billed charges,,
BUTAMBEN-TETRACAINE-BENZOCAINE 2 %-2 %-14 % (200 MG/SEC) TOP SPRA,,5732,LOCAL,Facility,Inpatient,20 g,g,,715,607.75,204.919,715,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
BUTAMBEN-TETRACAINE-BENZOCAINE 2 %-2 %-14 % (200 MG/SEC) TOP SPRA,,5732,LOCAL,Facility,Both,20 g,g,,715,607.75,204.919,715,Medica,Individual & Family,708.565,99.1,,percent of total billed charges,,
BUTAMBEN-TETRACAINE-BENZOCAINE 2 %-2 %-14 % (200 MG/SEC) TOP SPRA,,5732,LOCAL,Facility,Outpatient,20 g,g,,715,607.75,204.919,715,Medica,Medica Advantage Solution,356.07,49.8,,percent of total billed charges,,
BUTAMBEN-TETRACAINE-BENZOCAINE 2 %-2 %-14 % (200 MG/SEC) TOP SPRA,,5732,LOCAL,Facility,Inpatient,20 g,g,,715,607.75,204.919,715,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
BUTAMBEN-TETRACAINE-BENZOCAINE 2 %-2 %-14 % (200 MG/SEC) TOP SPRA,,5732,LOCAL,Facility,Outpatient,20 g,g,,715,607.75,204.919,715,Medica,Medical Assistance,318.89,44.6,,percent of total billed charges,,
BUTAMBEN-TETRACAINE-BENZOCAINE 2 %-2 %-14 % (200 MG/SEC) TOP SPRA,,5732,LOCAL,Facility,Inpatient,20 g,g,,715,607.75,204.919,715,Medica,Medical Assistance,,,,,Included in per diem rate,
BUTAMBEN-TETRACAINE-BENZOCAINE 2 %-2 %-14 % (200 MG/SEC) TOP SPRA,,5732,LOCAL,Facility,Outpatient,20 g,g,,715,607.75,204.919,715,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,356.07,49.8,,percent of total billed charges,,
BUTAMBEN-TETRACAINE-BENZOCAINE 2 %-2 %-14 % (200 MG/SEC) TOP SPRA,,5732,LOCAL,Facility,Inpatient,20 g,g,,715,607.75,204.919,715,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
BUTAMBEN-TETRACAINE-BENZOCAINE 2 %-2 %-14 % (200 MG/SEC) TOP SPRA,,5732,LOCAL,Facility,Both,20 g,g,,715,607.75,204.919,715,"Multiplan, Inc.","Multiplan, Inc.",672.1,94,,percent of total billed charges,,
BUTAMBEN-TETRACAINE-BENZOCAINE 2 %-2 %-14 % (200 MG/SEC) TOP SPRA,,5732,LOCAL,Facility,Outpatient,20 g,g,,715,607.75,204.919,715,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,644.215,90.1,,percent of total billed charges,,
BUTAMBEN-TETRACAINE-BENZOCAINE 2 %-2 %-14 % (200 MG/SEC) TOP SPRA,,5732,LOCAL,Facility,Inpatient,20 g,g,,715,607.75,204.919,715,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
BUTAMBEN-TETRACAINE-BENZOCAINE 2 %-2 %-14 % (200 MG/SEC) TOP SPRA,,5732,LOCAL,Facility,Both,20 g,g,,715,607.75,204.919,715,"Preferred One Administrative Services, INC.",PPO,704.99,98.6,,percent of total billed charges,,
BUTAMBEN-TETRACAINE-BENZOCAINE 2 %-2 %-14 % (200 MG/SEC) TOP SPRA,,5732,LOCAL,Facility,Outpatient,20 g,g,,715,607.75,204.919,715,PrimeWest Health,Minnesota Senior Health Options (MSHO),367.8675,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
BUTAMBEN-TETRACAINE-BENZOCAINE 2 %-2 %-14 % (200 MG/SEC) TOP SPRA,,5732,LOCAL,Facility,Inpatient,20 g,g,,715,607.75,204.919,715,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
BUTAMBEN-TETRACAINE-BENZOCAINE 2 %-2 %-14 % (200 MG/SEC) TOP SPRA,,5732,LOCAL,Facility,Outpatient,20 g,g,,715,607.75,204.919,715,PrimeWest Health,MinnesotaCare,367.224,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
BUTAMBEN-TETRACAINE-BENZOCAINE 2 %-2 %-14 % (200 MG/SEC) TOP SPRA,,5732,LOCAL,Facility,Inpatient,20 g,g,,715,607.75,204.919,715,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
BUTAMBEN-TETRACAINE-BENZOCAINE 2 %-2 %-14 % (200 MG/SEC) TOP SPRA,,5732,LOCAL,Facility,Both,20 g,g,,715,607.75,204.919,715,Sanford Health Plan,Sanford Health Plan,657.8,92,,percent of total billed charges,,
BUTAMBEN-TETRACAINE-BENZOCAINE 2 %-2 %-14 % (200 MG/SEC) TOP SPRA,,5732,LOCAL,Facility,Outpatient,20 g,g,,715,607.75,204.919,715,"UCare Health, Inc.",Individual & Family Plan,402.9025,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
BUTAMBEN-TETRACAINE-BENZOCAINE 2 %-2 %-14 % (200 MG/SEC) TOP SPRA,,5732,LOCAL,Facility,Inpatient,20 g,g,,715,607.75,204.919,715,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
BUTAMBEN-TETRACAINE-BENZOCAINE 2 %-2 %-14 % (200 MG/SEC) TOP SPRA,,5732,LOCAL,Facility,Outpatient,20 g,g,,715,607.75,204.919,715,"UCare Health, Inc.",Medical Assistance,360.8605,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BUTAMBEN-TETRACAINE-BENZOCAINE 2 %-2 %-14 % (200 MG/SEC) TOP SPRA,,5732,LOCAL,Facility,Inpatient,20 g,g,,715,607.75,204.919,715,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
BUTAMBEN-TETRACAINE-BENZOCAINE 2 %-2 %-14 % (200 MG/SEC) TOP SPRA,,5732,LOCAL,Facility,Outpatient,20 g,g,,715,607.75,204.919,715,"UCare Health, Inc.",Medicare Advantage,360.8605,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BUTAMBEN-TETRACAINE-BENZOCAINE 2 %-2 %-14 % (200 MG/SEC) TOP SPRA,,5732,LOCAL,Facility,Inpatient,20 g,g,,715,607.75,204.919,715,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
BUTAMBEN-TETRACAINE-BENZOCAINE 2 %-2 %-14 % (200 MG/SEC) TOP SPRA,,5732,LOCAL,Facility,Outpatient,20 g,g,,715,607.75,204.919,715,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),360.8605,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BUTAMBEN-TETRACAINE-BENZOCAINE 2 %-2 %-14 % (200 MG/SEC) TOP SPRA,,5732,LOCAL,Facility,Inpatient,20 g,g,,715,607.75,204.919,715,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
BUTAMBEN-TETRACAINE-BENZOCAINE 2 %-2 %-14 % (200 MG/SEC) TOP SPRA,,5732,LOCAL,Facility,Both,20 g,g,,715,607.75,204.919,715,UnitedHealthcare,Individual & Family,672.1,94,,percent of total billed charges,,
BUTAMBEN-TETRACAINE-BENZOCAINE 2 %-2 %-14 % (200 MG/SEC) TOP SPRA,,5732,LOCAL,Facility,Outpatient,20 g,g,,715,607.75,204.919,715,UnitedHealthcare,Medicare Advantage,350.35,49,,percent of total billed charges,,
BUTAMBEN-TETRACAINE-BENZOCAINE 2 %-2 %-14 % (200 MG/SEC) TOP SPRA,,5732,LOCAL,Facility,Inpatient,20 g,g,,715,607.75,204.919,715,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
BUTAMBEN-TETRACAINE-BENZOCAINE 2 %-2 %-14 % (200 MG/SEC) TOP SPRA,,5732,LOCAL,Facility,Outpatient,20 g,g,,715,607.75,204.919,715,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,343.2,48,,percent of total billed charges,,100% of DHS outpatient percentage
BUTAMBEN-TETRACAINE-BENZOCAINE 2 %-2 %-14 % (200 MG/SEC) TOP SPRA,,5732,LOCAL,Facility,Inpatient,20 g,g,,715,607.75,204.919,715,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Both,20 mL,mL,,21,17.85,6.0186,21,Aetna,Commercial,19.32,92,,percent of total billed charges,,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Outpatient,20 mL,mL,,21,17.85,6.0186,21,Aetna,Medicare Advantage,10.29,49,,percent of total billed charges,,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Inpatient,20 mL,mL,,21,17.85,6.0186,21,Aetna,Medicare Advantage,,,,,Included in per diem rate,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Both,20 mL,mL,,21,17.85,6.0186,21,Aetna,PPO,19.53,93,,percent of total billed charges,,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Both,20 mL,mL,,21,17.85,6.0186,21,America's PPO,America's PPO,20.1663,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Both,20 mL,mL,,21,17.85,6.0186,21,BlueCross BlueShield Minnesota, Federal Employee Program,20.664,98.4,,percent of total billed charges,,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Both,20 mL,mL,,21,17.85,6.0186,21,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,21,100,,percent of total billed charges,,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Both,20 mL,mL,,21,17.85,6.0186,21,BlueCross BlueShield Minnesota,High Value Network Plan,18.9,90,,percent of total billed charges,,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Outpatient,20 mL,mL,,21,17.85,6.0186,21,BlueCross BlueShield Minnesota,Medicare Advantage,10.29,49,,percent of total billed charges,,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Inpatient,20 mL,mL,,21,17.85,6.0186,21,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Both,20 mL,mL,,21,17.85,6.0186,21,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,18.5997,88.57,,percent of total billed charges,,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Both,20 mL,mL,,21,17.85,6.0186,21,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,6.0186,28.66,,percent of total billed charges,,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Outpatient,20 mL,mL,,21,17.85,6.0186,21,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),10.29,49,,percent of total billed charges,,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Inpatient,20 mL,mL,,21,17.85,6.0186,21,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Both,20 mL,mL,,21,17.85,6.0186,21,CorVel,Worker's Compensation,21,100,,percent of total billed charges,,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Both,20 mL,mL,,21,17.85,6.0186,21,First Health Group Corporation,First Health Network,20.37,97,,percent of total billed charges,,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Both,20 mL,mL,,21,17.85,6.0186,21,"Health Partners, Inc.",Commercial,19.866,94.6,,percent of total billed charges,,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Outpatient,20 mL,mL,,21,17.85,6.0186,21,"Health Partners, Inc.",Medicare Advantage,10.29,49,,percent of total billed charges,,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Inpatient,20 mL,mL,,21,17.85,6.0186,21,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Both,20 mL,mL,,21,17.85,6.0186,21,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),12.6,60,,percent of total billed charges,,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Both,20 mL,mL,,21,17.85,6.0186,21,"Health Partners, Inc.",State of Minnesota Advantage Program,17.115,81.5,,percent of total billed charges,,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Both,20 mL,mL,,21,17.85,6.0186,21,"Health Partners, Inc.",State Public Programs,10.5,50,,percent of total billed charges,,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Both,20 mL,mL,,21,17.85,6.0186,21,Humana Insurance Company,Commercial PPO,19.95,95,,percent of total billed charges,,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Outpatient,20 mL,mL,,21,17.85,6.0186,21,Humana Insurance Company,Medicare PPO,10.29,49,,percent of total billed charges,,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Inpatient,20 mL,mL,,21,17.85,6.0186,21,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Both,20 mL,mL,,21,17.85,6.0186,21,Medica,Individual & Family,20.811,99.1,,percent of total billed charges,,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Outpatient,20 mL,mL,,21,17.85,6.0186,21,Medica,Medica Advantage Solution,10.458,49.8,,percent of total billed charges,,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Inpatient,20 mL,mL,,21,17.85,6.0186,21,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Outpatient,20 mL,mL,,21,17.85,6.0186,21,Medica,Medical Assistance,9.366,44.6,,percent of total billed charges,,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Inpatient,20 mL,mL,,21,17.85,6.0186,21,Medica,Medical Assistance,,,,,Included in per diem rate,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Outpatient,20 mL,mL,,21,17.85,6.0186,21,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,10.458,49.8,,percent of total billed charges,,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Inpatient,20 mL,mL,,21,17.85,6.0186,21,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Both,20 mL,mL,,21,17.85,6.0186,21,"Multiplan, Inc.","Multiplan, Inc.",19.74,94,,percent of total billed charges,,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Outpatient,20 mL,mL,,21,17.85,6.0186,21,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,18.921,90.1,,percent of total billed charges,,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Inpatient,20 mL,mL,,21,17.85,6.0186,21,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Both,20 mL,mL,,21,17.85,6.0186,21,"Preferred One Administrative Services, INC.",PPO,20.706,98.6,,percent of total billed charges,,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Outpatient,20 mL,mL,,21,17.85,6.0186,21,PrimeWest Health,Minnesota Senior Health Options (MSHO),10.8045,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Inpatient,20 mL,mL,,21,17.85,6.0186,21,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Outpatient,20 mL,mL,,21,17.85,6.0186,21,PrimeWest Health,MinnesotaCare,10.7856,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Inpatient,20 mL,mL,,21,17.85,6.0186,21,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Both,20 mL,mL,,21,17.85,6.0186,21,Sanford Health Plan,Sanford Health Plan,19.32,92,,percent of total billed charges,,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Outpatient,20 mL,mL,,21,17.85,6.0186,21,"UCare Health, Inc.",Individual & Family Plan,11.8335,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Inpatient,20 mL,mL,,21,17.85,6.0186,21,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Outpatient,20 mL,mL,,21,17.85,6.0186,21,"UCare Health, Inc.",Medical Assistance,10.5987,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Inpatient,20 mL,mL,,21,17.85,6.0186,21,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Outpatient,20 mL,mL,,21,17.85,6.0186,21,"UCare Health, Inc.",Medicare Advantage,10.5987,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Inpatient,20 mL,mL,,21,17.85,6.0186,21,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Outpatient,20 mL,mL,,21,17.85,6.0186,21,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),10.5987,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Inpatient,20 mL,mL,,21,17.85,6.0186,21,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Both,20 mL,mL,,21,17.85,6.0186,21,UnitedHealthcare,Individual & Family,19.74,94,,percent of total billed charges,,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Outpatient,20 mL,mL,,21,17.85,6.0186,21,UnitedHealthcare,Medicare Advantage,10.29,49,,percent of total billed charges,,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Inpatient,20 mL,mL,,21,17.85,6.0186,21,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Outpatient,20 mL,mL,,21,17.85,6.0186,21,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,10.08,48,,percent of total billed charges,,100% of DHS outpatient percentage
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Inpatient,20 mL,mL,,21,17.85,6.0186,21,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"LIDOCAINE-EPINEPHRINE 1 %-1:100,000 INJ SOLN",,9559,LOCAL,Facility,Both,20 mL,mL,,15,12.75,4.299,15,Aetna,Commercial,13.8,92,,percent of total billed charges,,
"LIDOCAINE-EPINEPHRINE 1 %-1:100,000 INJ SOLN",,9559,LOCAL,Facility,Outpatient,20 mL,mL,,15,12.75,4.299,15,Aetna,Medicare Advantage,7.35,49,,percent of total billed charges,,
"LIDOCAINE-EPINEPHRINE 1 %-1:100,000 INJ SOLN",,9559,LOCAL,Facility,Inpatient,20 mL,mL,,15,12.75,4.299,15,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"LIDOCAINE-EPINEPHRINE 1 %-1:100,000 INJ SOLN",,9559,LOCAL,Facility,Both,20 mL,mL,,15,12.75,4.299,15,Aetna,PPO,13.95,93,,percent of total billed charges,,
"LIDOCAINE-EPINEPHRINE 1 %-1:100,000 INJ SOLN",,9559,LOCAL,Facility,Both,20 mL,mL,,15,12.75,4.299,15,America's PPO,America's PPO,14.4045,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"LIDOCAINE-EPINEPHRINE 1 %-1:100,000 INJ SOLN",,9559,LOCAL,Facility,Both,20 mL,mL,,15,12.75,4.299,15,BlueCross BlueShield Minnesota, Federal Employee Program,14.76,98.4,,percent of total billed charges,,
"LIDOCAINE-EPINEPHRINE 1 %-1:100,000 INJ SOLN",,9559,LOCAL,Facility,Both,20 mL,mL,,15,12.75,4.299,15,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,15,100,,percent of total billed charges,,
"LIDOCAINE-EPINEPHRINE 1 %-1:100,000 INJ SOLN",,9559,LOCAL,Facility,Both,20 mL,mL,,15,12.75,4.299,15,BlueCross BlueShield Minnesota,High Value Network Plan,13.5,90,,percent of total billed charges,,
"LIDOCAINE-EPINEPHRINE 1 %-1:100,000 INJ SOLN",,9559,LOCAL,Facility,Outpatient,20 mL,mL,,15,12.75,4.299,15,BlueCross BlueShield Minnesota,Medicare Advantage,7.35,49,,percent of total billed charges,,
"LIDOCAINE-EPINEPHRINE 1 %-1:100,000 INJ SOLN",,9559,LOCAL,Facility,Inpatient,20 mL,mL,,15,12.75,4.299,15,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"LIDOCAINE-EPINEPHRINE 1 %-1:100,000 INJ SOLN",,9559,LOCAL,Facility,Both,20 mL,mL,,15,12.75,4.299,15,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,13.2855,88.57,,percent of total billed charges,,
"LIDOCAINE-EPINEPHRINE 1 %-1:100,000 INJ SOLN",,9559,LOCAL,Facility,Both,20 mL,mL,,15,12.75,4.299,15,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,4.299,28.66,,percent of total billed charges,,
"LIDOCAINE-EPINEPHRINE 1 %-1:100,000 INJ SOLN",,9559,LOCAL,Facility,Outpatient,20 mL,mL,,15,12.75,4.299,15,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),7.35,49,,percent of total billed charges,,
"LIDOCAINE-EPINEPHRINE 1 %-1:100,000 INJ SOLN",,9559,LOCAL,Facility,Inpatient,20 mL,mL,,15,12.75,4.299,15,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"LIDOCAINE-EPINEPHRINE 1 %-1:100,000 INJ SOLN",,9559,LOCAL,Facility,Both,20 mL,mL,,15,12.75,4.299,15,CorVel,Worker's Compensation,15,100,,percent of total billed charges,,
"LIDOCAINE-EPINEPHRINE 1 %-1:100,000 INJ SOLN",,9559,LOCAL,Facility,Both,20 mL,mL,,15,12.75,4.299,15,First Health Group Corporation,First Health Network,14.55,97,,percent of total billed charges,,
"LIDOCAINE-EPINEPHRINE 1 %-1:100,000 INJ SOLN",,9559,LOCAL,Facility,Both,20 mL,mL,,15,12.75,4.299,15,"Health Partners, Inc.",Commercial,14.19,94.6,,percent of total billed charges,,
"LIDOCAINE-EPINEPHRINE 1 %-1:100,000 INJ SOLN",,9559,LOCAL,Facility,Outpatient,20 mL,mL,,15,12.75,4.299,15,"Health Partners, Inc.",Medicare Advantage,7.35,49,,percent of total billed charges,,
"LIDOCAINE-EPINEPHRINE 1 %-1:100,000 INJ SOLN",,9559,LOCAL,Facility,Inpatient,20 mL,mL,,15,12.75,4.299,15,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"LIDOCAINE-EPINEPHRINE 1 %-1:100,000 INJ SOLN",,9559,LOCAL,Facility,Both,20 mL,mL,,15,12.75,4.299,15,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),9,60,,percent of total billed charges,,
"LIDOCAINE-EPINEPHRINE 1 %-1:100,000 INJ SOLN",,9559,LOCAL,Facility,Both,20 mL,mL,,15,12.75,4.299,15,"Health Partners, Inc.",State of Minnesota Advantage Program,12.225,81.5,,percent of total billed charges,,
"LIDOCAINE-EPINEPHRINE 1 %-1:100,000 INJ SOLN",,9559,LOCAL,Facility,Both,20 mL,mL,,15,12.75,4.299,15,"Health Partners, Inc.",State Public Programs,7.5,50,,percent of total billed charges,,
"LIDOCAINE-EPINEPHRINE 1 %-1:100,000 INJ SOLN",,9559,LOCAL,Facility,Both,20 mL,mL,,15,12.75,4.299,15,Humana Insurance Company,Commercial PPO,14.25,95,,percent of total billed charges,,
"LIDOCAINE-EPINEPHRINE 1 %-1:100,000 INJ SOLN",,9559,LOCAL,Facility,Outpatient,20 mL,mL,,15,12.75,4.299,15,Humana Insurance Company,Medicare PPO,7.35,49,,percent of total billed charges,,
"LIDOCAINE-EPINEPHRINE 1 %-1:100,000 INJ SOLN",,9559,LOCAL,Facility,Inpatient,20 mL,mL,,15,12.75,4.299,15,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"LIDOCAINE-EPINEPHRINE 1 %-1:100,000 INJ SOLN",,9559,LOCAL,Facility,Both,20 mL,mL,,15,12.75,4.299,15,Medica,Individual & Family,14.865,99.1,,percent of total billed charges,,
"LIDOCAINE-EPINEPHRINE 1 %-1:100,000 INJ SOLN",,9559,LOCAL,Facility,Outpatient,20 mL,mL,,15,12.75,4.299,15,Medica,Medica Advantage Solution,7.47,49.8,,percent of total billed charges,,
"LIDOCAINE-EPINEPHRINE 1 %-1:100,000 INJ SOLN",,9559,LOCAL,Facility,Inpatient,20 mL,mL,,15,12.75,4.299,15,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"LIDOCAINE-EPINEPHRINE 1 %-1:100,000 INJ SOLN",,9559,LOCAL,Facility,Outpatient,20 mL,mL,,15,12.75,4.299,15,Medica,Medical Assistance,6.69,44.6,,percent of total billed charges,,
"LIDOCAINE-EPINEPHRINE 1 %-1:100,000 INJ SOLN",,9559,LOCAL,Facility,Inpatient,20 mL,mL,,15,12.75,4.299,15,Medica,Medical Assistance,,,,,Included in per diem rate,
"LIDOCAINE-EPINEPHRINE 1 %-1:100,000 INJ SOLN",,9559,LOCAL,Facility,Outpatient,20 mL,mL,,15,12.75,4.299,15,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,7.47,49.8,,percent of total billed charges,,
"LIDOCAINE-EPINEPHRINE 1 %-1:100,000 INJ SOLN",,9559,LOCAL,Facility,Inpatient,20 mL,mL,,15,12.75,4.299,15,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"LIDOCAINE-EPINEPHRINE 1 %-1:100,000 INJ SOLN",,9559,LOCAL,Facility,Both,20 mL,mL,,15,12.75,4.299,15,"Multiplan, Inc.","Multiplan, Inc.",14.1,94,,percent of total billed charges,,
"LIDOCAINE-EPINEPHRINE 1 %-1:100,000 INJ SOLN",,9559,LOCAL,Facility,Outpatient,20 mL,mL,,15,12.75,4.299,15,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,13.515,90.1,,percent of total billed charges,,
"LIDOCAINE-EPINEPHRINE 1 %-1:100,000 INJ SOLN",,9559,LOCAL,Facility,Inpatient,20 mL,mL,,15,12.75,4.299,15,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"LIDOCAINE-EPINEPHRINE 1 %-1:100,000 INJ SOLN",,9559,LOCAL,Facility,Both,20 mL,mL,,15,12.75,4.299,15,"Preferred One Administrative Services, INC.",PPO,14.79,98.6,,percent of total billed charges,,
"LIDOCAINE-EPINEPHRINE 1 %-1:100,000 INJ SOLN",,9559,LOCAL,Facility,Outpatient,20 mL,mL,,15,12.75,4.299,15,PrimeWest Health,Minnesota Senior Health Options (MSHO),7.7175,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"LIDOCAINE-EPINEPHRINE 1 %-1:100,000 INJ SOLN",,9559,LOCAL,Facility,Inpatient,20 mL,mL,,15,12.75,4.299,15,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"LIDOCAINE-EPINEPHRINE 1 %-1:100,000 INJ SOLN",,9559,LOCAL,Facility,Outpatient,20 mL,mL,,15,12.75,4.299,15,PrimeWest Health,MinnesotaCare,7.704,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"LIDOCAINE-EPINEPHRINE 1 %-1:100,000 INJ SOLN",,9559,LOCAL,Facility,Inpatient,20 mL,mL,,15,12.75,4.299,15,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"LIDOCAINE-EPINEPHRINE 1 %-1:100,000 INJ SOLN",,9559,LOCAL,Facility,Both,20 mL,mL,,15,12.75,4.299,15,Sanford Health Plan,Sanford Health Plan,13.8,92,,percent of total billed charges,,
"LIDOCAINE-EPINEPHRINE 1 %-1:100,000 INJ SOLN",,9559,LOCAL,Facility,Outpatient,20 mL,mL,,15,12.75,4.299,15,"UCare Health, Inc.",Individual & Family Plan,8.4525,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"LIDOCAINE-EPINEPHRINE 1 %-1:100,000 INJ SOLN",,9559,LOCAL,Facility,Inpatient,20 mL,mL,,15,12.75,4.299,15,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"LIDOCAINE-EPINEPHRINE 1 %-1:100,000 INJ SOLN",,9559,LOCAL,Facility,Outpatient,20 mL,mL,,15,12.75,4.299,15,"UCare Health, Inc.",Medical Assistance,7.5705,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"LIDOCAINE-EPINEPHRINE 1 %-1:100,000 INJ SOLN",,9559,LOCAL,Facility,Inpatient,20 mL,mL,,15,12.75,4.299,15,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"LIDOCAINE-EPINEPHRINE 1 %-1:100,000 INJ SOLN",,9559,LOCAL,Facility,Outpatient,20 mL,mL,,15,12.75,4.299,15,"UCare Health, Inc.",Medicare Advantage,7.5705,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"LIDOCAINE-EPINEPHRINE 1 %-1:100,000 INJ SOLN",,9559,LOCAL,Facility,Inpatient,20 mL,mL,,15,12.75,4.299,15,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"LIDOCAINE-EPINEPHRINE 1 %-1:100,000 INJ SOLN",,9559,LOCAL,Facility,Outpatient,20 mL,mL,,15,12.75,4.299,15,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),7.5705,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"LIDOCAINE-EPINEPHRINE 1 %-1:100,000 INJ SOLN",,9559,LOCAL,Facility,Inpatient,20 mL,mL,,15,12.75,4.299,15,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"LIDOCAINE-EPINEPHRINE 1 %-1:100,000 INJ SOLN",,9559,LOCAL,Facility,Both,20 mL,mL,,15,12.75,4.299,15,UnitedHealthcare,Individual & Family,14.1,94,,percent of total billed charges,,
"LIDOCAINE-EPINEPHRINE 1 %-1:100,000 INJ SOLN",,9559,LOCAL,Facility,Outpatient,20 mL,mL,,15,12.75,4.299,15,UnitedHealthcare,Medicare Advantage,7.35,49,,percent of total billed charges,,
"LIDOCAINE-EPINEPHRINE 1 %-1:100,000 INJ SOLN",,9559,LOCAL,Facility,Inpatient,20 mL,mL,,15,12.75,4.299,15,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"LIDOCAINE-EPINEPHRINE 1 %-1:100,000 INJ SOLN",,9559,LOCAL,Facility,Outpatient,20 mL,mL,,15,12.75,4.299,15,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,7.2,48,,percent of total billed charges,,100% of DHS outpatient percentage
"LIDOCAINE-EPINEPHRINE 1 %-1:100,000 INJ SOLN",,9559,LOCAL,Facility,Inpatient,20 mL,mL,,15,12.75,4.299,15,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
LIDOCAINE HCL 20 MG/ML (2 %) INJ SOLN,,16516,LOCAL,Facility,Both,20 mL,mL,,23,19.55,6.5918,23,Aetna,Commercial,21.16,92,,percent of total billed charges,,
LIDOCAINE HCL 20 MG/ML (2 %) INJ SOLN,,16516,LOCAL,Facility,Outpatient,20 mL,mL,,23,19.55,6.5918,23,Aetna,Medicare Advantage,11.27,49,,percent of total billed charges,,
LIDOCAINE HCL 20 MG/ML (2 %) INJ SOLN,,16516,LOCAL,Facility,Inpatient,20 mL,mL,,23,19.55,6.5918,23,Aetna,Medicare Advantage,,,,,Included in per diem rate,
LIDOCAINE HCL 20 MG/ML (2 %) INJ SOLN,,16516,LOCAL,Facility,Both,20 mL,mL,,23,19.55,6.5918,23,Aetna,PPO,21.39,93,,percent of total billed charges,,
LIDOCAINE HCL 20 MG/ML (2 %) INJ SOLN,,16516,LOCAL,Facility,Both,20 mL,mL,,23,19.55,6.5918,23,America's PPO,America's PPO,22.0869,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
LIDOCAINE HCL 20 MG/ML (2 %) INJ SOLN,,16516,LOCAL,Facility,Both,20 mL,mL,,23,19.55,6.5918,23,BlueCross BlueShield Minnesota, Federal Employee Program,22.632,98.4,,percent of total billed charges,,
LIDOCAINE HCL 20 MG/ML (2 %) INJ SOLN,,16516,LOCAL,Facility,Both,20 mL,mL,,23,19.55,6.5918,23,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,23,100,,percent of total billed charges,,
LIDOCAINE HCL 20 MG/ML (2 %) INJ SOLN,,16516,LOCAL,Facility,Both,20 mL,mL,,23,19.55,6.5918,23,BlueCross BlueShield Minnesota,High Value Network Plan,20.7,90,,percent of total billed charges,,
LIDOCAINE HCL 20 MG/ML (2 %) INJ SOLN,,16516,LOCAL,Facility,Outpatient,20 mL,mL,,23,19.55,6.5918,23,BlueCross BlueShield Minnesota,Medicare Advantage,11.27,49,,percent of total billed charges,,
LIDOCAINE HCL 20 MG/ML (2 %) INJ SOLN,,16516,LOCAL,Facility,Inpatient,20 mL,mL,,23,19.55,6.5918,23,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
LIDOCAINE HCL 20 MG/ML (2 %) INJ SOLN,,16516,LOCAL,Facility,Both,20 mL,mL,,23,19.55,6.5918,23,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,20.3711,88.57,,percent of total billed charges,,
LIDOCAINE HCL 20 MG/ML (2 %) INJ SOLN,,16516,LOCAL,Facility,Both,20 mL,mL,,23,19.55,6.5918,23,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,6.5918,28.66,,percent of total billed charges,,
LIDOCAINE HCL 20 MG/ML (2 %) INJ SOLN,,16516,LOCAL,Facility,Outpatient,20 mL,mL,,23,19.55,6.5918,23,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),11.27,49,,percent of total billed charges,,
LIDOCAINE HCL 20 MG/ML (2 %) INJ SOLN,,16516,LOCAL,Facility,Inpatient,20 mL,mL,,23,19.55,6.5918,23,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
LIDOCAINE HCL 20 MG/ML (2 %) INJ SOLN,,16516,LOCAL,Facility,Both,20 mL,mL,,23,19.55,6.5918,23,CorVel,Worker's Compensation,23,100,,percent of total billed charges,,
LIDOCAINE HCL 20 MG/ML (2 %) INJ SOLN,,16516,LOCAL,Facility,Both,20 mL,mL,,23,19.55,6.5918,23,First Health Group Corporation,First Health Network,22.31,97,,percent of total billed charges,,
LIDOCAINE HCL 20 MG/ML (2 %) INJ SOLN,,16516,LOCAL,Facility,Both,20 mL,mL,,23,19.55,6.5918,23,"Health Partners, Inc.",Commercial,21.758,94.6,,percent of total billed charges,,
LIDOCAINE HCL 20 MG/ML (2 %) INJ SOLN,,16516,LOCAL,Facility,Outpatient,20 mL,mL,,23,19.55,6.5918,23,"Health Partners, Inc.",Medicare Advantage,11.27,49,,percent of total billed charges,,
LIDOCAINE HCL 20 MG/ML (2 %) INJ SOLN,,16516,LOCAL,Facility,Inpatient,20 mL,mL,,23,19.55,6.5918,23,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LIDOCAINE HCL 20 MG/ML (2 %) INJ SOLN,,16516,LOCAL,Facility,Both,20 mL,mL,,23,19.55,6.5918,23,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),13.8,60,,percent of total billed charges,,
LIDOCAINE HCL 20 MG/ML (2 %) INJ SOLN,,16516,LOCAL,Facility,Both,20 mL,mL,,23,19.55,6.5918,23,"Health Partners, Inc.",State of Minnesota Advantage Program,18.745,81.5,,percent of total billed charges,,
LIDOCAINE HCL 20 MG/ML (2 %) INJ SOLN,,16516,LOCAL,Facility,Both,20 mL,mL,,23,19.55,6.5918,23,"Health Partners, Inc.",State Public Programs,11.5,50,,percent of total billed charges,,
LIDOCAINE HCL 20 MG/ML (2 %) INJ SOLN,,16516,LOCAL,Facility,Both,20 mL,mL,,23,19.55,6.5918,23,Humana Insurance Company,Commercial PPO,21.85,95,,percent of total billed charges,,
LIDOCAINE HCL 20 MG/ML (2 %) INJ SOLN,,16516,LOCAL,Facility,Outpatient,20 mL,mL,,23,19.55,6.5918,23,Humana Insurance Company,Medicare PPO,11.27,49,,percent of total billed charges,,
LIDOCAINE HCL 20 MG/ML (2 %) INJ SOLN,,16516,LOCAL,Facility,Inpatient,20 mL,mL,,23,19.55,6.5918,23,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
LIDOCAINE HCL 20 MG/ML (2 %) INJ SOLN,,16516,LOCAL,Facility,Both,20 mL,mL,,23,19.55,6.5918,23,Medica,Individual & Family,22.793,99.1,,percent of total billed charges,,
LIDOCAINE HCL 20 MG/ML (2 %) INJ SOLN,,16516,LOCAL,Facility,Outpatient,20 mL,mL,,23,19.55,6.5918,23,Medica,Medica Advantage Solution,11.454,49.8,,percent of total billed charges,,
LIDOCAINE HCL 20 MG/ML (2 %) INJ SOLN,,16516,LOCAL,Facility,Inpatient,20 mL,mL,,23,19.55,6.5918,23,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
LIDOCAINE HCL 20 MG/ML (2 %) INJ SOLN,,16516,LOCAL,Facility,Outpatient,20 mL,mL,,23,19.55,6.5918,23,Medica,Medical Assistance,10.258,44.6,,percent of total billed charges,,
LIDOCAINE HCL 20 MG/ML (2 %) INJ SOLN,,16516,LOCAL,Facility,Inpatient,20 mL,mL,,23,19.55,6.5918,23,Medica,Medical Assistance,,,,,Included in per diem rate,
LIDOCAINE HCL 20 MG/ML (2 %) INJ SOLN,,16516,LOCAL,Facility,Outpatient,20 mL,mL,,23,19.55,6.5918,23,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,11.454,49.8,,percent of total billed charges,,
LIDOCAINE HCL 20 MG/ML (2 %) INJ SOLN,,16516,LOCAL,Facility,Inpatient,20 mL,mL,,23,19.55,6.5918,23,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
LIDOCAINE HCL 20 MG/ML (2 %) INJ SOLN,,16516,LOCAL,Facility,Both,20 mL,mL,,23,19.55,6.5918,23,"Multiplan, Inc.","Multiplan, Inc.",21.62,94,,percent of total billed charges,,
LIDOCAINE HCL 20 MG/ML (2 %) INJ SOLN,,16516,LOCAL,Facility,Outpatient,20 mL,mL,,23,19.55,6.5918,23,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,20.723,90.1,,percent of total billed charges,,
LIDOCAINE HCL 20 MG/ML (2 %) INJ SOLN,,16516,LOCAL,Facility,Inpatient,20 mL,mL,,23,19.55,6.5918,23,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
LIDOCAINE HCL 20 MG/ML (2 %) INJ SOLN,,16516,LOCAL,Facility,Both,20 mL,mL,,23,19.55,6.5918,23,"Preferred One Administrative Services, INC.",PPO,22.678,98.6,,percent of total billed charges,,
LIDOCAINE HCL 20 MG/ML (2 %) INJ SOLN,,16516,LOCAL,Facility,Outpatient,20 mL,mL,,23,19.55,6.5918,23,PrimeWest Health,Minnesota Senior Health Options (MSHO),11.8335,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
LIDOCAINE HCL 20 MG/ML (2 %) INJ SOLN,,16516,LOCAL,Facility,Inpatient,20 mL,mL,,23,19.55,6.5918,23,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LIDOCAINE HCL 20 MG/ML (2 %) INJ SOLN,,16516,LOCAL,Facility,Outpatient,20 mL,mL,,23,19.55,6.5918,23,PrimeWest Health,MinnesotaCare,11.8128,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
LIDOCAINE HCL 20 MG/ML (2 %) INJ SOLN,,16516,LOCAL,Facility,Inpatient,20 mL,mL,,23,19.55,6.5918,23,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
LIDOCAINE HCL 20 MG/ML (2 %) INJ SOLN,,16516,LOCAL,Facility,Both,20 mL,mL,,23,19.55,6.5918,23,Sanford Health Plan,Sanford Health Plan,21.16,92,,percent of total billed charges,,
LIDOCAINE HCL 20 MG/ML (2 %) INJ SOLN,,16516,LOCAL,Facility,Outpatient,20 mL,mL,,23,19.55,6.5918,23,"UCare Health, Inc.",Individual & Family Plan,12.9605,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
LIDOCAINE HCL 20 MG/ML (2 %) INJ SOLN,,16516,LOCAL,Facility,Inpatient,20 mL,mL,,23,19.55,6.5918,23,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
LIDOCAINE HCL 20 MG/ML (2 %) INJ SOLN,,16516,LOCAL,Facility,Outpatient,20 mL,mL,,23,19.55,6.5918,23,"UCare Health, Inc.",Medical Assistance,11.6081,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LIDOCAINE HCL 20 MG/ML (2 %) INJ SOLN,,16516,LOCAL,Facility,Inpatient,20 mL,mL,,23,19.55,6.5918,23,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
LIDOCAINE HCL 20 MG/ML (2 %) INJ SOLN,,16516,LOCAL,Facility,Outpatient,20 mL,mL,,23,19.55,6.5918,23,"UCare Health, Inc.",Medicare Advantage,11.6081,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LIDOCAINE HCL 20 MG/ML (2 %) INJ SOLN,,16516,LOCAL,Facility,Inpatient,20 mL,mL,,23,19.55,6.5918,23,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LIDOCAINE HCL 20 MG/ML (2 %) INJ SOLN,,16516,LOCAL,Facility,Outpatient,20 mL,mL,,23,19.55,6.5918,23,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),11.6081,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LIDOCAINE HCL 20 MG/ML (2 %) INJ SOLN,,16516,LOCAL,Facility,Inpatient,20 mL,mL,,23,19.55,6.5918,23,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LIDOCAINE HCL 20 MG/ML (2 %) INJ SOLN,,16516,LOCAL,Facility,Both,20 mL,mL,,23,19.55,6.5918,23,UnitedHealthcare,Individual & Family,21.62,94,,percent of total billed charges,,
LIDOCAINE HCL 20 MG/ML (2 %) INJ SOLN,,16516,LOCAL,Facility,Outpatient,20 mL,mL,,23,19.55,6.5918,23,UnitedHealthcare,Medicare Advantage,11.27,49,,percent of total billed charges,,
LIDOCAINE HCL 20 MG/ML (2 %) INJ SOLN,,16516,LOCAL,Facility,Inpatient,20 mL,mL,,23,19.55,6.5918,23,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
LIDOCAINE HCL 20 MG/ML (2 %) INJ SOLN,,16516,LOCAL,Facility,Outpatient,20 mL,mL,,23,19.55,6.5918,23,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,11.04,48,,percent of total billed charges,,100% of DHS outpatient percentage
LIDOCAINE HCL 20 MG/ML (2 %) INJ SOLN,,16516,LOCAL,Facility,Inpatient,20 mL,mL,,23,19.55,6.5918,23,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"LIDOCAINE-EPINEPHRINE 2 %-1:100,000 INJ SOLN",,18439,LOCAL,Facility,Both,20 mL,mL,,27,22.95,7.7382,27,Aetna,Commercial,24.84,92,,percent of total billed charges,,
"LIDOCAINE-EPINEPHRINE 2 %-1:100,000 INJ SOLN",,18439,LOCAL,Facility,Outpatient,20 mL,mL,,27,22.95,7.7382,27,Aetna,Medicare Advantage,13.23,49,,percent of total billed charges,,
"LIDOCAINE-EPINEPHRINE 2 %-1:100,000 INJ SOLN",,18439,LOCAL,Facility,Inpatient,20 mL,mL,,27,22.95,7.7382,27,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"LIDOCAINE-EPINEPHRINE 2 %-1:100,000 INJ SOLN",,18439,LOCAL,Facility,Both,20 mL,mL,,27,22.95,7.7382,27,Aetna,PPO,25.11,93,,percent of total billed charges,,
"LIDOCAINE-EPINEPHRINE 2 %-1:100,000 INJ SOLN",,18439,LOCAL,Facility,Both,20 mL,mL,,27,22.95,7.7382,27,America's PPO,America's PPO,25.9281,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"LIDOCAINE-EPINEPHRINE 2 %-1:100,000 INJ SOLN",,18439,LOCAL,Facility,Both,20 mL,mL,,27,22.95,7.7382,27,BlueCross BlueShield Minnesota, Federal Employee Program,26.568,98.4,,percent of total billed charges,,
"LIDOCAINE-EPINEPHRINE 2 %-1:100,000 INJ SOLN",,18439,LOCAL,Facility,Both,20 mL,mL,,27,22.95,7.7382,27,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,27,100,,percent of total billed charges,,
"LIDOCAINE-EPINEPHRINE 2 %-1:100,000 INJ SOLN",,18439,LOCAL,Facility,Both,20 mL,mL,,27,22.95,7.7382,27,BlueCross BlueShield Minnesota,High Value Network Plan,24.3,90,,percent of total billed charges,,
"LIDOCAINE-EPINEPHRINE 2 %-1:100,000 INJ SOLN",,18439,LOCAL,Facility,Outpatient,20 mL,mL,,27,22.95,7.7382,27,BlueCross BlueShield Minnesota,Medicare Advantage,13.23,49,,percent of total billed charges,,
"LIDOCAINE-EPINEPHRINE 2 %-1:100,000 INJ SOLN",,18439,LOCAL,Facility,Inpatient,20 mL,mL,,27,22.95,7.7382,27,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"LIDOCAINE-EPINEPHRINE 2 %-1:100,000 INJ SOLN",,18439,LOCAL,Facility,Both,20 mL,mL,,27,22.95,7.7382,27,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,23.9139,88.57,,percent of total billed charges,,
"LIDOCAINE-EPINEPHRINE 2 %-1:100,000 INJ SOLN",,18439,LOCAL,Facility,Both,20 mL,mL,,27,22.95,7.7382,27,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,7.7382,28.66,,percent of total billed charges,,
"LIDOCAINE-EPINEPHRINE 2 %-1:100,000 INJ SOLN",,18439,LOCAL,Facility,Outpatient,20 mL,mL,,27,22.95,7.7382,27,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),13.23,49,,percent of total billed charges,,
"LIDOCAINE-EPINEPHRINE 2 %-1:100,000 INJ SOLN",,18439,LOCAL,Facility,Inpatient,20 mL,mL,,27,22.95,7.7382,27,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"LIDOCAINE-EPINEPHRINE 2 %-1:100,000 INJ SOLN",,18439,LOCAL,Facility,Both,20 mL,mL,,27,22.95,7.7382,27,CorVel,Worker's Compensation,27,100,,percent of total billed charges,,
"LIDOCAINE-EPINEPHRINE 2 %-1:100,000 INJ SOLN",,18439,LOCAL,Facility,Both,20 mL,mL,,27,22.95,7.7382,27,First Health Group Corporation,First Health Network,26.19,97,,percent of total billed charges,,
"LIDOCAINE-EPINEPHRINE 2 %-1:100,000 INJ SOLN",,18439,LOCAL,Facility,Both,20 mL,mL,,27,22.95,7.7382,27,"Health Partners, Inc.",Commercial,25.542,94.6,,percent of total billed charges,,
"LIDOCAINE-EPINEPHRINE 2 %-1:100,000 INJ SOLN",,18439,LOCAL,Facility,Outpatient,20 mL,mL,,27,22.95,7.7382,27,"Health Partners, Inc.",Medicare Advantage,13.23,49,,percent of total billed charges,,
"LIDOCAINE-EPINEPHRINE 2 %-1:100,000 INJ SOLN",,18439,LOCAL,Facility,Inpatient,20 mL,mL,,27,22.95,7.7382,27,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"LIDOCAINE-EPINEPHRINE 2 %-1:100,000 INJ SOLN",,18439,LOCAL,Facility,Both,20 mL,mL,,27,22.95,7.7382,27,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),16.2,60,,percent of total billed charges,,
"LIDOCAINE-EPINEPHRINE 2 %-1:100,000 INJ SOLN",,18439,LOCAL,Facility,Both,20 mL,mL,,27,22.95,7.7382,27,"Health Partners, Inc.",State of Minnesota Advantage Program,22.005,81.5,,percent of total billed charges,,
"LIDOCAINE-EPINEPHRINE 2 %-1:100,000 INJ SOLN",,18439,LOCAL,Facility,Both,20 mL,mL,,27,22.95,7.7382,27,"Health Partners, Inc.",State Public Programs,13.5,50,,percent of total billed charges,,
"LIDOCAINE-EPINEPHRINE 2 %-1:100,000 INJ SOLN",,18439,LOCAL,Facility,Both,20 mL,mL,,27,22.95,7.7382,27,Humana Insurance Company,Commercial PPO,25.65,95,,percent of total billed charges,,
"LIDOCAINE-EPINEPHRINE 2 %-1:100,000 INJ SOLN",,18439,LOCAL,Facility,Outpatient,20 mL,mL,,27,22.95,7.7382,27,Humana Insurance Company,Medicare PPO,13.23,49,,percent of total billed charges,,
"LIDOCAINE-EPINEPHRINE 2 %-1:100,000 INJ SOLN",,18439,LOCAL,Facility,Inpatient,20 mL,mL,,27,22.95,7.7382,27,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"LIDOCAINE-EPINEPHRINE 2 %-1:100,000 INJ SOLN",,18439,LOCAL,Facility,Both,20 mL,mL,,27,22.95,7.7382,27,Medica,Individual & Family,26.757,99.1,,percent of total billed charges,,
"LIDOCAINE-EPINEPHRINE 2 %-1:100,000 INJ SOLN",,18439,LOCAL,Facility,Outpatient,20 mL,mL,,27,22.95,7.7382,27,Medica,Medica Advantage Solution,13.446,49.8,,percent of total billed charges,,
"LIDOCAINE-EPINEPHRINE 2 %-1:100,000 INJ SOLN",,18439,LOCAL,Facility,Inpatient,20 mL,mL,,27,22.95,7.7382,27,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"LIDOCAINE-EPINEPHRINE 2 %-1:100,000 INJ SOLN",,18439,LOCAL,Facility,Outpatient,20 mL,mL,,27,22.95,7.7382,27,Medica,Medical Assistance,12.042,44.6,,percent of total billed charges,,
"LIDOCAINE-EPINEPHRINE 2 %-1:100,000 INJ SOLN",,18439,LOCAL,Facility,Inpatient,20 mL,mL,,27,22.95,7.7382,27,Medica,Medical Assistance,,,,,Included in per diem rate,
"LIDOCAINE-EPINEPHRINE 2 %-1:100,000 INJ SOLN",,18439,LOCAL,Facility,Outpatient,20 mL,mL,,27,22.95,7.7382,27,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,13.446,49.8,,percent of total billed charges,,
"LIDOCAINE-EPINEPHRINE 2 %-1:100,000 INJ SOLN",,18439,LOCAL,Facility,Inpatient,20 mL,mL,,27,22.95,7.7382,27,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"LIDOCAINE-EPINEPHRINE 2 %-1:100,000 INJ SOLN",,18439,LOCAL,Facility,Both,20 mL,mL,,27,22.95,7.7382,27,"Multiplan, Inc.","Multiplan, Inc.",25.38,94,,percent of total billed charges,,
"LIDOCAINE-EPINEPHRINE 2 %-1:100,000 INJ SOLN",,18439,LOCAL,Facility,Outpatient,20 mL,mL,,27,22.95,7.7382,27,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,24.327,90.1,,percent of total billed charges,,
"LIDOCAINE-EPINEPHRINE 2 %-1:100,000 INJ SOLN",,18439,LOCAL,Facility,Inpatient,20 mL,mL,,27,22.95,7.7382,27,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"LIDOCAINE-EPINEPHRINE 2 %-1:100,000 INJ SOLN",,18439,LOCAL,Facility,Both,20 mL,mL,,27,22.95,7.7382,27,"Preferred One Administrative Services, INC.",PPO,26.622,98.6,,percent of total billed charges,,
"LIDOCAINE-EPINEPHRINE 2 %-1:100,000 INJ SOLN",,18439,LOCAL,Facility,Outpatient,20 mL,mL,,27,22.95,7.7382,27,PrimeWest Health,Minnesota Senior Health Options (MSHO),13.8915,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"LIDOCAINE-EPINEPHRINE 2 %-1:100,000 INJ SOLN",,18439,LOCAL,Facility,Inpatient,20 mL,mL,,27,22.95,7.7382,27,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"LIDOCAINE-EPINEPHRINE 2 %-1:100,000 INJ SOLN",,18439,LOCAL,Facility,Outpatient,20 mL,mL,,27,22.95,7.7382,27,PrimeWest Health,MinnesotaCare,13.8672,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"LIDOCAINE-EPINEPHRINE 2 %-1:100,000 INJ SOLN",,18439,LOCAL,Facility,Inpatient,20 mL,mL,,27,22.95,7.7382,27,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"LIDOCAINE-EPINEPHRINE 2 %-1:100,000 INJ SOLN",,18439,LOCAL,Facility,Both,20 mL,mL,,27,22.95,7.7382,27,Sanford Health Plan,Sanford Health Plan,24.84,92,,percent of total billed charges,,
"LIDOCAINE-EPINEPHRINE 2 %-1:100,000 INJ SOLN",,18439,LOCAL,Facility,Outpatient,20 mL,mL,,27,22.95,7.7382,27,"UCare Health, Inc.",Individual & Family Plan,15.2145,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"LIDOCAINE-EPINEPHRINE 2 %-1:100,000 INJ SOLN",,18439,LOCAL,Facility,Inpatient,20 mL,mL,,27,22.95,7.7382,27,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"LIDOCAINE-EPINEPHRINE 2 %-1:100,000 INJ SOLN",,18439,LOCAL,Facility,Outpatient,20 mL,mL,,27,22.95,7.7382,27,"UCare Health, Inc.",Medical Assistance,13.6269,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"LIDOCAINE-EPINEPHRINE 2 %-1:100,000 INJ SOLN",,18439,LOCAL,Facility,Inpatient,20 mL,mL,,27,22.95,7.7382,27,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"LIDOCAINE-EPINEPHRINE 2 %-1:100,000 INJ SOLN",,18439,LOCAL,Facility,Outpatient,20 mL,mL,,27,22.95,7.7382,27,"UCare Health, Inc.",Medicare Advantage,13.6269,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"LIDOCAINE-EPINEPHRINE 2 %-1:100,000 INJ SOLN",,18439,LOCAL,Facility,Inpatient,20 mL,mL,,27,22.95,7.7382,27,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"LIDOCAINE-EPINEPHRINE 2 %-1:100,000 INJ SOLN",,18439,LOCAL,Facility,Outpatient,20 mL,mL,,27,22.95,7.7382,27,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),13.6269,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"LIDOCAINE-EPINEPHRINE 2 %-1:100,000 INJ SOLN",,18439,LOCAL,Facility,Inpatient,20 mL,mL,,27,22.95,7.7382,27,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"LIDOCAINE-EPINEPHRINE 2 %-1:100,000 INJ SOLN",,18439,LOCAL,Facility,Both,20 mL,mL,,27,22.95,7.7382,27,UnitedHealthcare,Individual & Family,25.38,94,,percent of total billed charges,,
"LIDOCAINE-EPINEPHRINE 2 %-1:100,000 INJ SOLN",,18439,LOCAL,Facility,Outpatient,20 mL,mL,,27,22.95,7.7382,27,UnitedHealthcare,Medicare Advantage,13.23,49,,percent of total billed charges,,
"LIDOCAINE-EPINEPHRINE 2 %-1:100,000 INJ SOLN",,18439,LOCAL,Facility,Inpatient,20 mL,mL,,27,22.95,7.7382,27,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"LIDOCAINE-EPINEPHRINE 2 %-1:100,000 INJ SOLN",,18439,LOCAL,Facility,Outpatient,20 mL,mL,,27,22.95,7.7382,27,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,12.96,48,,percent of total billed charges,,100% of DHS outpatient percentage
"LIDOCAINE-EPINEPHRINE 2 %-1:100,000 INJ SOLN",,18439,LOCAL,Facility,Inpatient,20 mL,mL,,27,22.95,7.7382,27,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
GADOTERATE MEGLUMINE 0.5 MMOL/ML (376.9 MG/ML) IV SOLN,,A9575,HCPCS,Facility,Both,20 mL,mL,,283,240.55,81.1078,283,Aetna,Commercial,260.36,92,,percent of total billed charges,,
GADOTERATE MEGLUMINE 0.5 MMOL/ML (376.9 MG/ML) IV SOLN,,A9575,HCPCS,Facility,Outpatient,20 mL,mL,,283,240.55,81.1078,283,Aetna,Medicare Advantage,138.67,49,,percent of total billed charges,,
GADOTERATE MEGLUMINE 0.5 MMOL/ML (376.9 MG/ML) IV SOLN,,A9575,HCPCS,Facility,Inpatient,20 mL,mL,,283,240.55,81.1078,283,Aetna,Medicare Advantage,,,,,Included in per diem rate,
GADOTERATE MEGLUMINE 0.5 MMOL/ML (376.9 MG/ML) IV SOLN,,A9575,HCPCS,Facility,Both,20 mL,mL,,283,240.55,81.1078,283,Aetna,PPO,263.19,93,,percent of total billed charges,,
GADOTERATE MEGLUMINE 0.5 MMOL/ML (376.9 MG/ML) IV SOLN,,A9575,HCPCS,Facility,Both,20 mL,mL,,283,240.55,81.1078,283,America's PPO,America's PPO,271.7649,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
GADOTERATE MEGLUMINE 0.5 MMOL/ML (376.9 MG/ML) IV SOLN,,A9575,HCPCS,Facility,Both,20 mL,mL,,283,240.55,81.1078,283,BlueCross BlueShield Minnesota, Federal Employee Program,278.472,98.4,,percent of total billed charges,,
GADOTERATE MEGLUMINE 0.5 MMOL/ML (376.9 MG/ML) IV SOLN,,A9575,HCPCS,Facility,Both,20 mL,mL,,283,240.55,81.1078,283,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,283,100,,percent of total billed charges,,
GADOTERATE MEGLUMINE 0.5 MMOL/ML (376.9 MG/ML) IV SOLN,,A9575,HCPCS,Facility,Both,20 mL,mL,,283,240.55,81.1078,283,BlueCross BlueShield Minnesota,High Value Network Plan,254.7,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
GADOTERATE MEGLUMINE 0.5 MMOL/ML (376.9 MG/ML) IV SOLN,,A9575,HCPCS,Facility,Outpatient,20 mL,mL,,283,240.55,81.1078,283,BlueCross BlueShield Minnesota,Medicare Advantage,138.67,49,,percent of total billed charges,,
GADOTERATE MEGLUMINE 0.5 MMOL/ML (376.9 MG/ML) IV SOLN,,A9575,HCPCS,Facility,Inpatient,20 mL,mL,,283,240.55,81.1078,283,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
GADOTERATE MEGLUMINE 0.5 MMOL/ML (376.9 MG/ML) IV SOLN,,A9575,HCPCS,Facility,Both,20 mL,mL,,283,240.55,81.1078,283,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,250.6531,88.57,,percent of total billed charges,,
GADOTERATE MEGLUMINE 0.5 MMOL/ML (376.9 MG/ML) IV SOLN,,A9575,HCPCS,Facility,Both,20 mL,mL,,283,240.55,81.1078,283,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,81.1078,28.66,,percent of total billed charges,,
GADOTERATE MEGLUMINE 0.5 MMOL/ML (376.9 MG/ML) IV SOLN,,A9575,HCPCS,Facility,Outpatient,20 mL,mL,,283,240.55,81.1078,283,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),138.67,49,,percent of total billed charges,,
GADOTERATE MEGLUMINE 0.5 MMOL/ML (376.9 MG/ML) IV SOLN,,A9575,HCPCS,Facility,Inpatient,20 mL,mL,,283,240.55,81.1078,283,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
GADOTERATE MEGLUMINE 0.5 MMOL/ML (376.9 MG/ML) IV SOLN,,A9575,HCPCS,Facility,Both,20 mL,mL,,283,240.55,81.1078,283,CorVel,Worker's Compensation,283,100,,percent of total billed charges,,
GADOTERATE MEGLUMINE 0.5 MMOL/ML (376.9 MG/ML) IV SOLN,,A9575,HCPCS,Facility,Both,20 mL,mL,,283,240.55,81.1078,283,First Health Group Corporation,First Health Network,274.51,97,,percent of total billed charges,,
GADOTERATE MEGLUMINE 0.5 MMOL/ML (376.9 MG/ML) IV SOLN,,A9575,HCPCS,Facility,Both,20 mL,mL,,283,240.55,81.1078,283,"Health Partners, Inc.",Commercial,267.718,94.6,,percent of total billed charges,,
GADOTERATE MEGLUMINE 0.5 MMOL/ML (376.9 MG/ML) IV SOLN,,A9575,HCPCS,Facility,Outpatient,20 mL,mL,,283,240.55,81.1078,283,"Health Partners, Inc.",Medicare Advantage,138.67,49,,percent of total billed charges,,
GADOTERATE MEGLUMINE 0.5 MMOL/ML (376.9 MG/ML) IV SOLN,,A9575,HCPCS,Facility,Inpatient,20 mL,mL,,283,240.55,81.1078,283,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
GADOTERATE MEGLUMINE 0.5 MMOL/ML (376.9 MG/ML) IV SOLN,,A9575,HCPCS,Facility,Both,20 mL,mL,,283,240.55,81.1078,283,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),169.8,60,,percent of total billed charges,,
GADOTERATE MEGLUMINE 0.5 MMOL/ML (376.9 MG/ML) IV SOLN,,A9575,HCPCS,Facility,Both,20 mL,mL,,283,240.55,81.1078,283,"Health Partners, Inc.",State of Minnesota Advantage Program,230.645,81.5,,percent of total billed charges,,
GADOTERATE MEGLUMINE 0.5 MMOL/ML (376.9 MG/ML) IV SOLN,,A9575,HCPCS,Facility,Both,20 mL,mL,,283,240.55,81.1078,283,"Health Partners, Inc.",State Public Programs,141.5,50,,percent of total billed charges,,
GADOTERATE MEGLUMINE 0.5 MMOL/ML (376.9 MG/ML) IV SOLN,,A9575,HCPCS,Facility,Both,20 mL,mL,,283,240.55,81.1078,283,Humana Insurance Company,Commercial PPO,268.85,95,,percent of total billed charges,,
GADOTERATE MEGLUMINE 0.5 MMOL/ML (376.9 MG/ML) IV SOLN,,A9575,HCPCS,Facility,Outpatient,20 mL,mL,,283,240.55,81.1078,283,Humana Insurance Company,Medicare PPO,138.67,49,,percent of total billed charges,,
GADOTERATE MEGLUMINE 0.5 MMOL/ML (376.9 MG/ML) IV SOLN,,A9575,HCPCS,Facility,Inpatient,20 mL,mL,,283,240.55,81.1078,283,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
GADOTERATE MEGLUMINE 0.5 MMOL/ML (376.9 MG/ML) IV SOLN,,A9575,HCPCS,Facility,Both,20 mL,mL,,283,240.55,81.1078,283,Medica,Individual & Family,280.453,99.1,,percent of total billed charges,,
GADOTERATE MEGLUMINE 0.5 MMOL/ML (376.9 MG/ML) IV SOLN,,A9575,HCPCS,Facility,Outpatient,20 mL,mL,,283,240.55,81.1078,283,Medica,Medica Advantage Solution,140.934,49.8,,percent of total billed charges,,
GADOTERATE MEGLUMINE 0.5 MMOL/ML (376.9 MG/ML) IV SOLN,,A9575,HCPCS,Facility,Inpatient,20 mL,mL,,283,240.55,81.1078,283,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
GADOTERATE MEGLUMINE 0.5 MMOL/ML (376.9 MG/ML) IV SOLN,,A9575,HCPCS,Facility,Outpatient,20 mL,mL,,283,240.55,81.1078,283,Medica,Medical Assistance,126.218,44.6,,percent of total billed charges,,
GADOTERATE MEGLUMINE 0.5 MMOL/ML (376.9 MG/ML) IV SOLN,,A9575,HCPCS,Facility,Inpatient,20 mL,mL,,283,240.55,81.1078,283,Medica,Medical Assistance,,,,,Included in per diem rate,
GADOTERATE MEGLUMINE 0.5 MMOL/ML (376.9 MG/ML) IV SOLN,,A9575,HCPCS,Facility,Outpatient,20 mL,mL,,283,240.55,81.1078,283,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,140.934,49.8,,percent of total billed charges,,
GADOTERATE MEGLUMINE 0.5 MMOL/ML (376.9 MG/ML) IV SOLN,,A9575,HCPCS,Facility,Inpatient,20 mL,mL,,283,240.55,81.1078,283,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
GADOTERATE MEGLUMINE 0.5 MMOL/ML (376.9 MG/ML) IV SOLN,,A9575,HCPCS,Facility,Both,20 mL,mL,,283,240.55,81.1078,283,"Multiplan, Inc.","Multiplan, Inc.",266.02,94,,percent of total billed charges,,
GADOTERATE MEGLUMINE 0.5 MMOL/ML (376.9 MG/ML) IV SOLN,,A9575,HCPCS,Facility,Outpatient,20 mL,mL,,283,240.55,81.1078,283,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,254.983,90.1,,percent of total billed charges,,
GADOTERATE MEGLUMINE 0.5 MMOL/ML (376.9 MG/ML) IV SOLN,,A9575,HCPCS,Facility,Inpatient,20 mL,mL,,283,240.55,81.1078,283,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
GADOTERATE MEGLUMINE 0.5 MMOL/ML (376.9 MG/ML) IV SOLN,,A9575,HCPCS,Facility,Both,20 mL,mL,,283,240.55,81.1078,283,"Preferred One Administrative Services, INC.",PPO,279.038,98.6,,percent of total billed charges,,
GADOTERATE MEGLUMINE 0.5 MMOL/ML (376.9 MG/ML) IV SOLN,,A9575,HCPCS,Facility,Outpatient,20 mL,mL,,283,240.55,81.1078,283,PrimeWest Health,Minnesota Senior Health Options (MSHO),145.6035,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
GADOTERATE MEGLUMINE 0.5 MMOL/ML (376.9 MG/ML) IV SOLN,,A9575,HCPCS,Facility,Inpatient,20 mL,mL,,283,240.55,81.1078,283,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
GADOTERATE MEGLUMINE 0.5 MMOL/ML (376.9 MG/ML) IV SOLN,,A9575,HCPCS,Facility,Outpatient,20 mL,mL,,283,240.55,81.1078,283,PrimeWest Health,MinnesotaCare,145.3488,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
GADOTERATE MEGLUMINE 0.5 MMOL/ML (376.9 MG/ML) IV SOLN,,A9575,HCPCS,Facility,Inpatient,20 mL,mL,,283,240.55,81.1078,283,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
GADOTERATE MEGLUMINE 0.5 MMOL/ML (376.9 MG/ML) IV SOLN,,A9575,HCPCS,Facility,Both,20 mL,mL,,283,240.55,81.1078,283,Sanford Health Plan,Sanford Health Plan,260.36,92,,percent of total billed charges,,
GADOTERATE MEGLUMINE 0.5 MMOL/ML (376.9 MG/ML) IV SOLN,,A9575,HCPCS,Facility,Outpatient,20 mL,mL,,283,240.55,81.1078,283,"UCare Health, Inc.",Individual & Family Plan,159.4705,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
GADOTERATE MEGLUMINE 0.5 MMOL/ML (376.9 MG/ML) IV SOLN,,A9575,HCPCS,Facility,Inpatient,20 mL,mL,,283,240.55,81.1078,283,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
GADOTERATE MEGLUMINE 0.5 MMOL/ML (376.9 MG/ML) IV SOLN,,A9575,HCPCS,Facility,Outpatient,20 mL,mL,,283,240.55,81.1078,283,"UCare Health, Inc.",Medical Assistance,142.8301,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
GADOTERATE MEGLUMINE 0.5 MMOL/ML (376.9 MG/ML) IV SOLN,,A9575,HCPCS,Facility,Inpatient,20 mL,mL,,283,240.55,81.1078,283,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
GADOTERATE MEGLUMINE 0.5 MMOL/ML (376.9 MG/ML) IV SOLN,,A9575,HCPCS,Facility,Outpatient,20 mL,mL,,283,240.55,81.1078,283,"UCare Health, Inc.",Medicare Advantage,142.8301,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
GADOTERATE MEGLUMINE 0.5 MMOL/ML (376.9 MG/ML) IV SOLN,,A9575,HCPCS,Facility,Inpatient,20 mL,mL,,283,240.55,81.1078,283,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
GADOTERATE MEGLUMINE 0.5 MMOL/ML (376.9 MG/ML) IV SOLN,,A9575,HCPCS,Facility,Outpatient,20 mL,mL,,283,240.55,81.1078,283,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),142.8301,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
GADOTERATE MEGLUMINE 0.5 MMOL/ML (376.9 MG/ML) IV SOLN,,A9575,HCPCS,Facility,Inpatient,20 mL,mL,,283,240.55,81.1078,283,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
GADOTERATE MEGLUMINE 0.5 MMOL/ML (376.9 MG/ML) IV SOLN,,A9575,HCPCS,Facility,Both,20 mL,mL,,283,240.55,81.1078,283,UnitedHealthcare,Individual & Family,266.02,94,,percent of total billed charges,,
GADOTERATE MEGLUMINE 0.5 MMOL/ML (376.9 MG/ML) IV SOLN,,A9575,HCPCS,Facility,Outpatient,20 mL,mL,,283,240.55,81.1078,283,UnitedHealthcare,Medicare Advantage,138.67,49,,percent of total billed charges,,
GADOTERATE MEGLUMINE 0.5 MMOL/ML (376.9 MG/ML) IV SOLN,,A9575,HCPCS,Facility,Inpatient,20 mL,mL,,283,240.55,81.1078,283,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
GADOTERATE MEGLUMINE 0.5 MMOL/ML (376.9 MG/ML) IV SOLN,,A9575,HCPCS,Facility,Outpatient,20 mL,mL,,283,240.55,81.1078,283,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,135.84,48,,percent of total billed charges,,100% of DHS outpatient percentage
GADOTERATE MEGLUMINE 0.5 MMOL/ML (376.9 MG/ML) IV SOLN,,A9575,HCPCS,Facility,Inpatient,20 mL,mL,,283,240.55,81.1078,283,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
GADOTERATE MEGLUMINE 0.5 MMOL/ML IV SYRG,,A9575,HCPCS,Facility,Both,20 mL,mL,,509,432.65,145.8794,509,Aetna,Commercial,468.28,92,,percent of total billed charges,,
GADOTERATE MEGLUMINE 0.5 MMOL/ML IV SYRG,,A9575,HCPCS,Facility,Outpatient,20 mL,mL,,509,432.65,145.8794,509,Aetna,Medicare Advantage,249.41,49,,percent of total billed charges,,
GADOTERATE MEGLUMINE 0.5 MMOL/ML IV SYRG,,A9575,HCPCS,Facility,Inpatient,20 mL,mL,,509,432.65,145.8794,509,Aetna,Medicare Advantage,,,,,Included in per diem rate,
GADOTERATE MEGLUMINE 0.5 MMOL/ML IV SYRG,,A9575,HCPCS,Facility,Both,20 mL,mL,,509,432.65,145.8794,509,Aetna,PPO,473.37,93,,percent of total billed charges,,
GADOTERATE MEGLUMINE 0.5 MMOL/ML IV SYRG,,A9575,HCPCS,Facility,Both,20 mL,mL,,509,432.65,145.8794,509,America's PPO,America's PPO,488.7927,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
GADOTERATE MEGLUMINE 0.5 MMOL/ML IV SYRG,,A9575,HCPCS,Facility,Both,20 mL,mL,,509,432.65,145.8794,509,BlueCross BlueShield Minnesota, Federal Employee Program,500.856,98.4,,percent of total billed charges,,
GADOTERATE MEGLUMINE 0.5 MMOL/ML IV SYRG,,A9575,HCPCS,Facility,Both,20 mL,mL,,509,432.65,145.8794,509,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,509,100,,percent of total billed charges,,
GADOTERATE MEGLUMINE 0.5 MMOL/ML IV SYRG,,A9575,HCPCS,Facility,Both,20 mL,mL,,509,432.65,145.8794,509,BlueCross BlueShield Minnesota,High Value Network Plan,458.1,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
GADOTERATE MEGLUMINE 0.5 MMOL/ML IV SYRG,,A9575,HCPCS,Facility,Outpatient,20 mL,mL,,509,432.65,145.8794,509,BlueCross BlueShield Minnesota,Medicare Advantage,249.41,49,,percent of total billed charges,,
GADOTERATE MEGLUMINE 0.5 MMOL/ML IV SYRG,,A9575,HCPCS,Facility,Inpatient,20 mL,mL,,509,432.65,145.8794,509,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
GADOTERATE MEGLUMINE 0.5 MMOL/ML IV SYRG,,A9575,HCPCS,Facility,Both,20 mL,mL,,509,432.65,145.8794,509,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,450.8213,88.57,,percent of total billed charges,,
GADOTERATE MEGLUMINE 0.5 MMOL/ML IV SYRG,,A9575,HCPCS,Facility,Both,20 mL,mL,,509,432.65,145.8794,509,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,145.8794,28.66,,percent of total billed charges,,
GADOTERATE MEGLUMINE 0.5 MMOL/ML IV SYRG,,A9575,HCPCS,Facility,Outpatient,20 mL,mL,,509,432.65,145.8794,509,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),249.41,49,,percent of total billed charges,,
GADOTERATE MEGLUMINE 0.5 MMOL/ML IV SYRG,,A9575,HCPCS,Facility,Inpatient,20 mL,mL,,509,432.65,145.8794,509,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
GADOTERATE MEGLUMINE 0.5 MMOL/ML IV SYRG,,A9575,HCPCS,Facility,Both,20 mL,mL,,509,432.65,145.8794,509,CorVel,Worker's Compensation,509,100,,percent of total billed charges,,
GADOTERATE MEGLUMINE 0.5 MMOL/ML IV SYRG,,A9575,HCPCS,Facility,Both,20 mL,mL,,509,432.65,145.8794,509,First Health Group Corporation,First Health Network,493.73,97,,percent of total billed charges,,
GADOTERATE MEGLUMINE 0.5 MMOL/ML IV SYRG,,A9575,HCPCS,Facility,Both,20 mL,mL,,509,432.65,145.8794,509,"Health Partners, Inc.",Commercial,481.514,94.6,,percent of total billed charges,,
GADOTERATE MEGLUMINE 0.5 MMOL/ML IV SYRG,,A9575,HCPCS,Facility,Outpatient,20 mL,mL,,509,432.65,145.8794,509,"Health Partners, Inc.",Medicare Advantage,249.41,49,,percent of total billed charges,,
GADOTERATE MEGLUMINE 0.5 MMOL/ML IV SYRG,,A9575,HCPCS,Facility,Inpatient,20 mL,mL,,509,432.65,145.8794,509,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
GADOTERATE MEGLUMINE 0.5 MMOL/ML IV SYRG,,A9575,HCPCS,Facility,Both,20 mL,mL,,509,432.65,145.8794,509,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),305.4,60,,percent of total billed charges,,
GADOTERATE MEGLUMINE 0.5 MMOL/ML IV SYRG,,A9575,HCPCS,Facility,Both,20 mL,mL,,509,432.65,145.8794,509,"Health Partners, Inc.",State of Minnesota Advantage Program,414.835,81.5,,percent of total billed charges,,
GADOTERATE MEGLUMINE 0.5 MMOL/ML IV SYRG,,A9575,HCPCS,Facility,Both,20 mL,mL,,509,432.65,145.8794,509,"Health Partners, Inc.",State Public Programs,254.5,50,,percent of total billed charges,,
GADOTERATE MEGLUMINE 0.5 MMOL/ML IV SYRG,,A9575,HCPCS,Facility,Both,20 mL,mL,,509,432.65,145.8794,509,Humana Insurance Company,Commercial PPO,483.55,95,,percent of total billed charges,,
GADOTERATE MEGLUMINE 0.5 MMOL/ML IV SYRG,,A9575,HCPCS,Facility,Outpatient,20 mL,mL,,509,432.65,145.8794,509,Humana Insurance Company,Medicare PPO,249.41,49,,percent of total billed charges,,
GADOTERATE MEGLUMINE 0.5 MMOL/ML IV SYRG,,A9575,HCPCS,Facility,Inpatient,20 mL,mL,,509,432.65,145.8794,509,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
GADOTERATE MEGLUMINE 0.5 MMOL/ML IV SYRG,,A9575,HCPCS,Facility,Both,20 mL,mL,,509,432.65,145.8794,509,Medica,Individual & Family,504.419,99.1,,percent of total billed charges,,
GADOTERATE MEGLUMINE 0.5 MMOL/ML IV SYRG,,A9575,HCPCS,Facility,Outpatient,20 mL,mL,,509,432.65,145.8794,509,Medica,Medica Advantage Solution,253.482,49.8,,percent of total billed charges,,
GADOTERATE MEGLUMINE 0.5 MMOL/ML IV SYRG,,A9575,HCPCS,Facility,Inpatient,20 mL,mL,,509,432.65,145.8794,509,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
GADOTERATE MEGLUMINE 0.5 MMOL/ML IV SYRG,,A9575,HCPCS,Facility,Outpatient,20 mL,mL,,509,432.65,145.8794,509,Medica,Medical Assistance,227.014,44.6,,percent of total billed charges,,
GADOTERATE MEGLUMINE 0.5 MMOL/ML IV SYRG,,A9575,HCPCS,Facility,Inpatient,20 mL,mL,,509,432.65,145.8794,509,Medica,Medical Assistance,,,,,Included in per diem rate,
GADOTERATE MEGLUMINE 0.5 MMOL/ML IV SYRG,,A9575,HCPCS,Facility,Outpatient,20 mL,mL,,509,432.65,145.8794,509,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,253.482,49.8,,percent of total billed charges,,
GADOTERATE MEGLUMINE 0.5 MMOL/ML IV SYRG,,A9575,HCPCS,Facility,Inpatient,20 mL,mL,,509,432.65,145.8794,509,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
GADOTERATE MEGLUMINE 0.5 MMOL/ML IV SYRG,,A9575,HCPCS,Facility,Both,20 mL,mL,,509,432.65,145.8794,509,"Multiplan, Inc.","Multiplan, Inc.",478.46,94,,percent of total billed charges,,
GADOTERATE MEGLUMINE 0.5 MMOL/ML IV SYRG,,A9575,HCPCS,Facility,Outpatient,20 mL,mL,,509,432.65,145.8794,509,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,458.609,90.1,,percent of total billed charges,,
GADOTERATE MEGLUMINE 0.5 MMOL/ML IV SYRG,,A9575,HCPCS,Facility,Inpatient,20 mL,mL,,509,432.65,145.8794,509,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
GADOTERATE MEGLUMINE 0.5 MMOL/ML IV SYRG,,A9575,HCPCS,Facility,Both,20 mL,mL,,509,432.65,145.8794,509,"Preferred One Administrative Services, INC.",PPO,501.874,98.6,,percent of total billed charges,,
GADOTERATE MEGLUMINE 0.5 MMOL/ML IV SYRG,,A9575,HCPCS,Facility,Outpatient,20 mL,mL,,509,432.65,145.8794,509,PrimeWest Health,Minnesota Senior Health Options (MSHO),261.8805,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
GADOTERATE MEGLUMINE 0.5 MMOL/ML IV SYRG,,A9575,HCPCS,Facility,Inpatient,20 mL,mL,,509,432.65,145.8794,509,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
GADOTERATE MEGLUMINE 0.5 MMOL/ML IV SYRG,,A9575,HCPCS,Facility,Outpatient,20 mL,mL,,509,432.65,145.8794,509,PrimeWest Health,MinnesotaCare,261.4224,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
GADOTERATE MEGLUMINE 0.5 MMOL/ML IV SYRG,,A9575,HCPCS,Facility,Inpatient,20 mL,mL,,509,432.65,145.8794,509,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
GADOTERATE MEGLUMINE 0.5 MMOL/ML IV SYRG,,A9575,HCPCS,Facility,Both,20 mL,mL,,509,432.65,145.8794,509,Sanford Health Plan,Sanford Health Plan,468.28,92,,percent of total billed charges,,
GADOTERATE MEGLUMINE 0.5 MMOL/ML IV SYRG,,A9575,HCPCS,Facility,Outpatient,20 mL,mL,,509,432.65,145.8794,509,"UCare Health, Inc.",Individual & Family Plan,286.8215,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
GADOTERATE MEGLUMINE 0.5 MMOL/ML IV SYRG,,A9575,HCPCS,Facility,Inpatient,20 mL,mL,,509,432.65,145.8794,509,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
GADOTERATE MEGLUMINE 0.5 MMOL/ML IV SYRG,,A9575,HCPCS,Facility,Outpatient,20 mL,mL,,509,432.65,145.8794,509,"UCare Health, Inc.",Medical Assistance,256.8923,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
GADOTERATE MEGLUMINE 0.5 MMOL/ML IV SYRG,,A9575,HCPCS,Facility,Inpatient,20 mL,mL,,509,432.65,145.8794,509,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
GADOTERATE MEGLUMINE 0.5 MMOL/ML IV SYRG,,A9575,HCPCS,Facility,Outpatient,20 mL,mL,,509,432.65,145.8794,509,"UCare Health, Inc.",Medicare Advantage,256.8923,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
GADOTERATE MEGLUMINE 0.5 MMOL/ML IV SYRG,,A9575,HCPCS,Facility,Inpatient,20 mL,mL,,509,432.65,145.8794,509,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
GADOTERATE MEGLUMINE 0.5 MMOL/ML IV SYRG,,A9575,HCPCS,Facility,Outpatient,20 mL,mL,,509,432.65,145.8794,509,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),256.8923,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
GADOTERATE MEGLUMINE 0.5 MMOL/ML IV SYRG,,A9575,HCPCS,Facility,Inpatient,20 mL,mL,,509,432.65,145.8794,509,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
GADOTERATE MEGLUMINE 0.5 MMOL/ML IV SYRG,,A9575,HCPCS,Facility,Both,20 mL,mL,,509,432.65,145.8794,509,UnitedHealthcare,Individual & Family,478.46,94,,percent of total billed charges,,
GADOTERATE MEGLUMINE 0.5 MMOL/ML IV SYRG,,A9575,HCPCS,Facility,Outpatient,20 mL,mL,,509,432.65,145.8794,509,UnitedHealthcare,Medicare Advantage,249.41,49,,percent of total billed charges,,
GADOTERATE MEGLUMINE 0.5 MMOL/ML IV SYRG,,A9575,HCPCS,Facility,Inpatient,20 mL,mL,,509,432.65,145.8794,509,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
GADOTERATE MEGLUMINE 0.5 MMOL/ML IV SYRG,,A9575,HCPCS,Facility,Outpatient,20 mL,mL,,509,432.65,145.8794,509,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,244.32,48,,percent of total billed charges,,100% of DHS outpatient percentage
GADOTERATE MEGLUMINE 0.5 MMOL/ML IV SYRG,,A9575,HCPCS,Facility,Inpatient,20 mL,mL,,509,432.65,145.8794,509,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
GADOPENTETATE DIMEGLUMINE 10 MMOL/20 ML (469.01 MG/ML) IV SYRG,,A9579,HCPCS,Facility,Both,20 mL,mL,,130,110.5,37.258,130,Aetna,Commercial,119.6,92,,percent of total billed charges,,
GADOPENTETATE DIMEGLUMINE 10 MMOL/20 ML (469.01 MG/ML) IV SYRG,,A9579,HCPCS,Facility,Outpatient,20 mL,mL,,130,110.5,37.258,130,Aetna,Medicare Advantage,63.7,49,,percent of total billed charges,,
GADOPENTETATE DIMEGLUMINE 10 MMOL/20 ML (469.01 MG/ML) IV SYRG,,A9579,HCPCS,Facility,Inpatient,20 mL,mL,,130,110.5,37.258,130,Aetna,Medicare Advantage,,,,,Included in per diem rate,
GADOPENTETATE DIMEGLUMINE 10 MMOL/20 ML (469.01 MG/ML) IV SYRG,,A9579,HCPCS,Facility,Both,20 mL,mL,,130,110.5,37.258,130,Aetna,PPO,120.9,93,,percent of total billed charges,,
GADOPENTETATE DIMEGLUMINE 10 MMOL/20 ML (469.01 MG/ML) IV SYRG,,A9579,HCPCS,Facility,Both,20 mL,mL,,130,110.5,37.258,130,America's PPO,America's PPO,124.839,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
GADOPENTETATE DIMEGLUMINE 10 MMOL/20 ML (469.01 MG/ML) IV SYRG,,A9579,HCPCS,Facility,Both,20 mL,mL,,130,110.5,37.258,130,BlueCross BlueShield Minnesota, Federal Employee Program,127.92,98.4,,percent of total billed charges,,
GADOPENTETATE DIMEGLUMINE 10 MMOL/20 ML (469.01 MG/ML) IV SYRG,,A9579,HCPCS,Facility,Both,20 mL,mL,,130,110.5,37.258,130,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,130,100,,percent of total billed charges,,
GADOPENTETATE DIMEGLUMINE 10 MMOL/20 ML (469.01 MG/ML) IV SYRG,,A9579,HCPCS,Facility,Both,20 mL,mL,,130,110.5,37.258,130,BlueCross BlueShield Minnesota,High Value Network Plan,117,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
GADOPENTETATE DIMEGLUMINE 10 MMOL/20 ML (469.01 MG/ML) IV SYRG,,A9579,HCPCS,Facility,Outpatient,20 mL,mL,,130,110.5,37.258,130,BlueCross BlueShield Minnesota,Medicare Advantage,63.7,49,,percent of total billed charges,,
GADOPENTETATE DIMEGLUMINE 10 MMOL/20 ML (469.01 MG/ML) IV SYRG,,A9579,HCPCS,Facility,Inpatient,20 mL,mL,,130,110.5,37.258,130,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
GADOPENTETATE DIMEGLUMINE 10 MMOL/20 ML (469.01 MG/ML) IV SYRG,,A9579,HCPCS,Facility,Both,20 mL,mL,,130,110.5,37.258,130,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,115.141,88.57,,percent of total billed charges,,
GADOPENTETATE DIMEGLUMINE 10 MMOL/20 ML (469.01 MG/ML) IV SYRG,,A9579,HCPCS,Facility,Both,20 mL,mL,,130,110.5,37.258,130,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,37.258,28.66,,percent of total billed charges,,
GADOPENTETATE DIMEGLUMINE 10 MMOL/20 ML (469.01 MG/ML) IV SYRG,,A9579,HCPCS,Facility,Outpatient,20 mL,mL,,130,110.5,37.258,130,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),63.7,49,,percent of total billed charges,,
GADOPENTETATE DIMEGLUMINE 10 MMOL/20 ML (469.01 MG/ML) IV SYRG,,A9579,HCPCS,Facility,Inpatient,20 mL,mL,,130,110.5,37.258,130,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
GADOPENTETATE DIMEGLUMINE 10 MMOL/20 ML (469.01 MG/ML) IV SYRG,,A9579,HCPCS,Facility,Both,20 mL,mL,,130,110.5,37.258,130,CorVel,Worker's Compensation,130,100,,percent of total billed charges,,
GADOPENTETATE DIMEGLUMINE 10 MMOL/20 ML (469.01 MG/ML) IV SYRG,,A9579,HCPCS,Facility,Both,20 mL,mL,,130,110.5,37.258,130,First Health Group Corporation,First Health Network,126.1,97,,percent of total billed charges,,
GADOPENTETATE DIMEGLUMINE 10 MMOL/20 ML (469.01 MG/ML) IV SYRG,,A9579,HCPCS,Facility,Both,20 mL,mL,,130,110.5,37.258,130,"Health Partners, Inc.",Commercial,122.98,94.6,,percent of total billed charges,,
GADOPENTETATE DIMEGLUMINE 10 MMOL/20 ML (469.01 MG/ML) IV SYRG,,A9579,HCPCS,Facility,Outpatient,20 mL,mL,,130,110.5,37.258,130,"Health Partners, Inc.",Medicare Advantage,63.7,49,,percent of total billed charges,,
GADOPENTETATE DIMEGLUMINE 10 MMOL/20 ML (469.01 MG/ML) IV SYRG,,A9579,HCPCS,Facility,Inpatient,20 mL,mL,,130,110.5,37.258,130,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
GADOPENTETATE DIMEGLUMINE 10 MMOL/20 ML (469.01 MG/ML) IV SYRG,,A9579,HCPCS,Facility,Both,20 mL,mL,,130,110.5,37.258,130,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),78,60,,percent of total billed charges,,
GADOPENTETATE DIMEGLUMINE 10 MMOL/20 ML (469.01 MG/ML) IV SYRG,,A9579,HCPCS,Facility,Both,20 mL,mL,,130,110.5,37.258,130,"Health Partners, Inc.",State of Minnesota Advantage Program,105.95,81.5,,percent of total billed charges,,
GADOPENTETATE DIMEGLUMINE 10 MMOL/20 ML (469.01 MG/ML) IV SYRG,,A9579,HCPCS,Facility,Both,20 mL,mL,,130,110.5,37.258,130,"Health Partners, Inc.",State Public Programs,65,50,,percent of total billed charges,,
GADOPENTETATE DIMEGLUMINE 10 MMOL/20 ML (469.01 MG/ML) IV SYRG,,A9579,HCPCS,Facility,Both,20 mL,mL,,130,110.5,37.258,130,Humana Insurance Company,Commercial PPO,123.5,95,,percent of total billed charges,,
GADOPENTETATE DIMEGLUMINE 10 MMOL/20 ML (469.01 MG/ML) IV SYRG,,A9579,HCPCS,Facility,Outpatient,20 mL,mL,,130,110.5,37.258,130,Humana Insurance Company,Medicare PPO,63.7,49,,percent of total billed charges,,
GADOPENTETATE DIMEGLUMINE 10 MMOL/20 ML (469.01 MG/ML) IV SYRG,,A9579,HCPCS,Facility,Inpatient,20 mL,mL,,130,110.5,37.258,130,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
GADOPENTETATE DIMEGLUMINE 10 MMOL/20 ML (469.01 MG/ML) IV SYRG,,A9579,HCPCS,Facility,Both,20 mL,mL,,130,110.5,37.258,130,Medica,Individual & Family,128.83,99.1,,percent of total billed charges,,
GADOPENTETATE DIMEGLUMINE 10 MMOL/20 ML (469.01 MG/ML) IV SYRG,,A9579,HCPCS,Facility,Outpatient,20 mL,mL,,130,110.5,37.258,130,Medica,Medica Advantage Solution,64.74,49.8,,percent of total billed charges,,
GADOPENTETATE DIMEGLUMINE 10 MMOL/20 ML (469.01 MG/ML) IV SYRG,,A9579,HCPCS,Facility,Inpatient,20 mL,mL,,130,110.5,37.258,130,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
GADOPENTETATE DIMEGLUMINE 10 MMOL/20 ML (469.01 MG/ML) IV SYRG,,A9579,HCPCS,Facility,Outpatient,20 mL,mL,,130,110.5,37.258,130,Medica,Medical Assistance,57.98,44.6,,percent of total billed charges,,
GADOPENTETATE DIMEGLUMINE 10 MMOL/20 ML (469.01 MG/ML) IV SYRG,,A9579,HCPCS,Facility,Inpatient,20 mL,mL,,130,110.5,37.258,130,Medica,Medical Assistance,,,,,Included in per diem rate,
GADOPENTETATE DIMEGLUMINE 10 MMOL/20 ML (469.01 MG/ML) IV SYRG,,A9579,HCPCS,Facility,Outpatient,20 mL,mL,,130,110.5,37.258,130,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,64.74,49.8,,percent of total billed charges,,
GADOPENTETATE DIMEGLUMINE 10 MMOL/20 ML (469.01 MG/ML) IV SYRG,,A9579,HCPCS,Facility,Inpatient,20 mL,mL,,130,110.5,37.258,130,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
GADOPENTETATE DIMEGLUMINE 10 MMOL/20 ML (469.01 MG/ML) IV SYRG,,A9579,HCPCS,Facility,Both,20 mL,mL,,130,110.5,37.258,130,"Multiplan, Inc.","Multiplan, Inc.",122.2,94,,percent of total billed charges,,
GADOPENTETATE DIMEGLUMINE 10 MMOL/20 ML (469.01 MG/ML) IV SYRG,,A9579,HCPCS,Facility,Outpatient,20 mL,mL,,130,110.5,37.258,130,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,117.13,90.1,,percent of total billed charges,,
GADOPENTETATE DIMEGLUMINE 10 MMOL/20 ML (469.01 MG/ML) IV SYRG,,A9579,HCPCS,Facility,Inpatient,20 mL,mL,,130,110.5,37.258,130,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
GADOPENTETATE DIMEGLUMINE 10 MMOL/20 ML (469.01 MG/ML) IV SYRG,,A9579,HCPCS,Facility,Both,20 mL,mL,,130,110.5,37.258,130,"Preferred One Administrative Services, INC.",PPO,128.18,98.6,,percent of total billed charges,,
GADOPENTETATE DIMEGLUMINE 10 MMOL/20 ML (469.01 MG/ML) IV SYRG,,A9579,HCPCS,Facility,Outpatient,20 mL,mL,,130,110.5,37.258,130,PrimeWest Health,Minnesota Senior Health Options (MSHO),66.885,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
GADOPENTETATE DIMEGLUMINE 10 MMOL/20 ML (469.01 MG/ML) IV SYRG,,A9579,HCPCS,Facility,Inpatient,20 mL,mL,,130,110.5,37.258,130,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
GADOPENTETATE DIMEGLUMINE 10 MMOL/20 ML (469.01 MG/ML) IV SYRG,,A9579,HCPCS,Facility,Outpatient,20 mL,mL,,130,110.5,37.258,130,PrimeWest Health,MinnesotaCare,66.768,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
GADOPENTETATE DIMEGLUMINE 10 MMOL/20 ML (469.01 MG/ML) IV SYRG,,A9579,HCPCS,Facility,Inpatient,20 mL,mL,,130,110.5,37.258,130,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
GADOPENTETATE DIMEGLUMINE 10 MMOL/20 ML (469.01 MG/ML) IV SYRG,,A9579,HCPCS,Facility,Both,20 mL,mL,,130,110.5,37.258,130,Sanford Health Plan,Sanford Health Plan,119.6,92,,percent of total billed charges,,
GADOPENTETATE DIMEGLUMINE 10 MMOL/20 ML (469.01 MG/ML) IV SYRG,,A9579,HCPCS,Facility,Outpatient,20 mL,mL,,130,110.5,37.258,130,"UCare Health, Inc.",Individual & Family Plan,73.255,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
GADOPENTETATE DIMEGLUMINE 10 MMOL/20 ML (469.01 MG/ML) IV SYRG,,A9579,HCPCS,Facility,Inpatient,20 mL,mL,,130,110.5,37.258,130,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
GADOPENTETATE DIMEGLUMINE 10 MMOL/20 ML (469.01 MG/ML) IV SYRG,,A9579,HCPCS,Facility,Outpatient,20 mL,mL,,130,110.5,37.258,130,"UCare Health, Inc.",Medical Assistance,65.611,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
GADOPENTETATE DIMEGLUMINE 10 MMOL/20 ML (469.01 MG/ML) IV SYRG,,A9579,HCPCS,Facility,Inpatient,20 mL,mL,,130,110.5,37.258,130,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
GADOPENTETATE DIMEGLUMINE 10 MMOL/20 ML (469.01 MG/ML) IV SYRG,,A9579,HCPCS,Facility,Outpatient,20 mL,mL,,130,110.5,37.258,130,"UCare Health, Inc.",Medicare Advantage,65.611,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
GADOPENTETATE DIMEGLUMINE 10 MMOL/20 ML (469.01 MG/ML) IV SYRG,,A9579,HCPCS,Facility,Inpatient,20 mL,mL,,130,110.5,37.258,130,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
GADOPENTETATE DIMEGLUMINE 10 MMOL/20 ML (469.01 MG/ML) IV SYRG,,A9579,HCPCS,Facility,Outpatient,20 mL,mL,,130,110.5,37.258,130,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),65.611,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
GADOPENTETATE DIMEGLUMINE 10 MMOL/20 ML (469.01 MG/ML) IV SYRG,,A9579,HCPCS,Facility,Inpatient,20 mL,mL,,130,110.5,37.258,130,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
GADOPENTETATE DIMEGLUMINE 10 MMOL/20 ML (469.01 MG/ML) IV SYRG,,A9579,HCPCS,Facility,Both,20 mL,mL,,130,110.5,37.258,130,UnitedHealthcare,Individual & Family,122.2,94,,percent of total billed charges,,
GADOPENTETATE DIMEGLUMINE 10 MMOL/20 ML (469.01 MG/ML) IV SYRG,,A9579,HCPCS,Facility,Outpatient,20 mL,mL,,130,110.5,37.258,130,UnitedHealthcare,Medicare Advantage,63.7,49,,percent of total billed charges,,
GADOPENTETATE DIMEGLUMINE 10 MMOL/20 ML (469.01 MG/ML) IV SYRG,,A9579,HCPCS,Facility,Inpatient,20 mL,mL,,130,110.5,37.258,130,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
GADOPENTETATE DIMEGLUMINE 10 MMOL/20 ML (469.01 MG/ML) IV SYRG,,A9579,HCPCS,Facility,Outpatient,20 mL,mL,,130,110.5,37.258,130,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,62.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
GADOPENTETATE DIMEGLUMINE 10 MMOL/20 ML (469.01 MG/ML) IV SYRG,,A9579,HCPCS,Facility,Inpatient,20 mL,mL,,130,110.5,37.258,130,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
ADENOSINE (DIAGNOSTIC) 3 MG/ML IV SOLN,,J0153,HCPCS,Facility,Both,20 mL,mL,,406,345.1,116.3596,406,Aetna,Commercial,373.52,92,,percent of total billed charges,,
ADENOSINE (DIAGNOSTIC) 3 MG/ML IV SOLN,,J0153,HCPCS,Facility,Outpatient,20 mL,mL,,406,345.1,116.3596,406,Aetna,Medicare Advantage,198.94,49,,percent of total billed charges,,
ADENOSINE (DIAGNOSTIC) 3 MG/ML IV SOLN,,J0153,HCPCS,Facility,Inpatient,20 mL,mL,,406,345.1,116.3596,406,Aetna,Medicare Advantage,,,,,Included in per diem rate,
ADENOSINE (DIAGNOSTIC) 3 MG/ML IV SOLN,,J0153,HCPCS,Facility,Both,20 mL,mL,,406,345.1,116.3596,406,Aetna,PPO,377.58,93,,percent of total billed charges,,
ADENOSINE (DIAGNOSTIC) 3 MG/ML IV SOLN,,J0153,HCPCS,Facility,Both,20 mL,mL,,406,345.1,116.3596,406,America's PPO,America's PPO,389.8818,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
ADENOSINE (DIAGNOSTIC) 3 MG/ML IV SOLN,,J0153,HCPCS,Facility,Both,20 mL,mL,,406,345.1,116.3596,406,BlueCross BlueShield Minnesota, Federal Employee Program,399.504,98.4,,percent of total billed charges,,
ADENOSINE (DIAGNOSTIC) 3 MG/ML IV SOLN,,J0153,HCPCS,Facility,Both,20 mL,mL,,406,345.1,116.3596,406,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,406,100,,percent of total billed charges,,
ADENOSINE (DIAGNOSTIC) 3 MG/ML IV SOLN,,J0153,HCPCS,Facility,Both,20 mL,mL,,406,345.1,116.3596,406,BlueCross BlueShield Minnesota,High Value Network Plan,365.4,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
ADENOSINE (DIAGNOSTIC) 3 MG/ML IV SOLN,,J0153,HCPCS,Facility,Outpatient,20 mL,mL,,406,345.1,116.3596,406,BlueCross BlueShield Minnesota,Medicare Advantage,198.94,49,,percent of total billed charges,,
ADENOSINE (DIAGNOSTIC) 3 MG/ML IV SOLN,,J0153,HCPCS,Facility,Inpatient,20 mL,mL,,406,345.1,116.3596,406,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
ADENOSINE (DIAGNOSTIC) 3 MG/ML IV SOLN,,J0153,HCPCS,Facility,Both,20 mL,mL,,406,345.1,116.3596,406,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,359.5942,88.57,,percent of total billed charges,,
ADENOSINE (DIAGNOSTIC) 3 MG/ML IV SOLN,,J0153,HCPCS,Facility,Both,20 mL,mL,,406,345.1,116.3596,406,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,116.3596,28.66,,percent of total billed charges,,
ADENOSINE (DIAGNOSTIC) 3 MG/ML IV SOLN,,J0153,HCPCS,Facility,Outpatient,20 mL,mL,,406,345.1,116.3596,406,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),198.94,49,,percent of total billed charges,,
ADENOSINE (DIAGNOSTIC) 3 MG/ML IV SOLN,,J0153,HCPCS,Facility,Inpatient,20 mL,mL,,406,345.1,116.3596,406,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
ADENOSINE (DIAGNOSTIC) 3 MG/ML IV SOLN,,J0153,HCPCS,Facility,Both,20 mL,mL,,406,345.1,116.3596,406,CorVel,Worker's Compensation,406,100,,percent of total billed charges,,
ADENOSINE (DIAGNOSTIC) 3 MG/ML IV SOLN,,J0153,HCPCS,Facility,Both,20 mL,mL,,406,345.1,116.3596,406,First Health Group Corporation,First Health Network,393.82,97,,percent of total billed charges,,
ADENOSINE (DIAGNOSTIC) 3 MG/ML IV SOLN,,J0153,HCPCS,Facility,Both,20 mL,mL,,406,345.1,116.3596,406,"Health Partners, Inc.",Commercial,384.076,94.6,,percent of total billed charges,,
ADENOSINE (DIAGNOSTIC) 3 MG/ML IV SOLN,,J0153,HCPCS,Facility,Outpatient,20 mL,mL,,406,345.1,116.3596,406,"Health Partners, Inc.",Medicare Advantage,198.94,49,,percent of total billed charges,,
ADENOSINE (DIAGNOSTIC) 3 MG/ML IV SOLN,,J0153,HCPCS,Facility,Inpatient,20 mL,mL,,406,345.1,116.3596,406,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ADENOSINE (DIAGNOSTIC) 3 MG/ML IV SOLN,,J0153,HCPCS,Facility,Both,20 mL,mL,,406,345.1,116.3596,406,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),243.6,60,,percent of total billed charges,,
ADENOSINE (DIAGNOSTIC) 3 MG/ML IV SOLN,,J0153,HCPCS,Facility,Both,20 mL,mL,,406,345.1,116.3596,406,"Health Partners, Inc.",State of Minnesota Advantage Program,330.89,81.5,,percent of total billed charges,,
ADENOSINE (DIAGNOSTIC) 3 MG/ML IV SOLN,,J0153,HCPCS,Facility,Both,20 mL,mL,,406,345.1,116.3596,406,"Health Partners, Inc.",State Public Programs,203,50,,percent of total billed charges,,
ADENOSINE (DIAGNOSTIC) 3 MG/ML IV SOLN,,J0153,HCPCS,Facility,Both,20 mL,mL,,406,345.1,116.3596,406,Humana Insurance Company,Commercial PPO,385.7,95,,percent of total billed charges,,
ADENOSINE (DIAGNOSTIC) 3 MG/ML IV SOLN,,J0153,HCPCS,Facility,Outpatient,20 mL,mL,,406,345.1,116.3596,406,Humana Insurance Company,Medicare PPO,198.94,49,,percent of total billed charges,,
ADENOSINE (DIAGNOSTIC) 3 MG/ML IV SOLN,,J0153,HCPCS,Facility,Inpatient,20 mL,mL,,406,345.1,116.3596,406,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
ADENOSINE (DIAGNOSTIC) 3 MG/ML IV SOLN,,J0153,HCPCS,Facility,Both,20 mL,mL,,406,345.1,116.3596,406,Medica,Individual & Family,402.346,99.1,,percent of total billed charges,,
ADENOSINE (DIAGNOSTIC) 3 MG/ML IV SOLN,,J0153,HCPCS,Facility,Outpatient,20 mL,mL,,406,345.1,116.3596,406,Medica,Medica Advantage Solution,202.188,49.8,,percent of total billed charges,,
ADENOSINE (DIAGNOSTIC) 3 MG/ML IV SOLN,,J0153,HCPCS,Facility,Inpatient,20 mL,mL,,406,345.1,116.3596,406,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
ADENOSINE (DIAGNOSTIC) 3 MG/ML IV SOLN,,J0153,HCPCS,Facility,Outpatient,20 mL,mL,,406,345.1,116.3596,406,Medica,Medical Assistance,181.076,44.6,,percent of total billed charges,,
ADENOSINE (DIAGNOSTIC) 3 MG/ML IV SOLN,,J0153,HCPCS,Facility,Inpatient,20 mL,mL,,406,345.1,116.3596,406,Medica,Medical Assistance,,,,,Included in per diem rate,
ADENOSINE (DIAGNOSTIC) 3 MG/ML IV SOLN,,J0153,HCPCS,Facility,Outpatient,20 mL,mL,,406,345.1,116.3596,406,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,202.188,49.8,,percent of total billed charges,,
ADENOSINE (DIAGNOSTIC) 3 MG/ML IV SOLN,,J0153,HCPCS,Facility,Inpatient,20 mL,mL,,406,345.1,116.3596,406,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
ADENOSINE (DIAGNOSTIC) 3 MG/ML IV SOLN,,J0153,HCPCS,Facility,Both,20 mL,mL,,406,345.1,116.3596,406,"Multiplan, Inc.","Multiplan, Inc.",381.64,94,,percent of total billed charges,,
ADENOSINE (DIAGNOSTIC) 3 MG/ML IV SOLN,,J0153,HCPCS,Facility,Outpatient,20 mL,mL,,406,345.1,116.3596,406,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,365.806,90.1,,percent of total billed charges,,
ADENOSINE (DIAGNOSTIC) 3 MG/ML IV SOLN,,J0153,HCPCS,Facility,Inpatient,20 mL,mL,,406,345.1,116.3596,406,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
ADENOSINE (DIAGNOSTIC) 3 MG/ML IV SOLN,,J0153,HCPCS,Facility,Both,20 mL,mL,,406,345.1,116.3596,406,"Preferred One Administrative Services, INC.",PPO,400.316,98.6,,percent of total billed charges,,
ADENOSINE (DIAGNOSTIC) 3 MG/ML IV SOLN,,J0153,HCPCS,Facility,Outpatient,20 mL,mL,,406,345.1,116.3596,406,PrimeWest Health,Minnesota Senior Health Options (MSHO),208.887,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
ADENOSINE (DIAGNOSTIC) 3 MG/ML IV SOLN,,J0153,HCPCS,Facility,Inpatient,20 mL,mL,,406,345.1,116.3596,406,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ADENOSINE (DIAGNOSTIC) 3 MG/ML IV SOLN,,J0153,HCPCS,Facility,Outpatient,20 mL,mL,,406,345.1,116.3596,406,PrimeWest Health,MinnesotaCare,208.5216,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
ADENOSINE (DIAGNOSTIC) 3 MG/ML IV SOLN,,J0153,HCPCS,Facility,Inpatient,20 mL,mL,,406,345.1,116.3596,406,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
ADENOSINE (DIAGNOSTIC) 3 MG/ML IV SOLN,,J0153,HCPCS,Facility,Both,20 mL,mL,,406,345.1,116.3596,406,Sanford Health Plan,Sanford Health Plan,373.52,92,,percent of total billed charges,,
ADENOSINE (DIAGNOSTIC) 3 MG/ML IV SOLN,,J0153,HCPCS,Facility,Outpatient,20 mL,mL,,406,345.1,116.3596,406,"UCare Health, Inc.",Individual & Family Plan,228.781,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
ADENOSINE (DIAGNOSTIC) 3 MG/ML IV SOLN,,J0153,HCPCS,Facility,Inpatient,20 mL,mL,,406,345.1,116.3596,406,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
ADENOSINE (DIAGNOSTIC) 3 MG/ML IV SOLN,,J0153,HCPCS,Facility,Outpatient,20 mL,mL,,406,345.1,116.3596,406,"UCare Health, Inc.",Medical Assistance,204.9082,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ADENOSINE (DIAGNOSTIC) 3 MG/ML IV SOLN,,J0153,HCPCS,Facility,Inpatient,20 mL,mL,,406,345.1,116.3596,406,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
ADENOSINE (DIAGNOSTIC) 3 MG/ML IV SOLN,,J0153,HCPCS,Facility,Outpatient,20 mL,mL,,406,345.1,116.3596,406,"UCare Health, Inc.",Medicare Advantage,204.9082,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ADENOSINE (DIAGNOSTIC) 3 MG/ML IV SOLN,,J0153,HCPCS,Facility,Inpatient,20 mL,mL,,406,345.1,116.3596,406,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ADENOSINE (DIAGNOSTIC) 3 MG/ML IV SOLN,,J0153,HCPCS,Facility,Outpatient,20 mL,mL,,406,345.1,116.3596,406,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),204.9082,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ADENOSINE (DIAGNOSTIC) 3 MG/ML IV SOLN,,J0153,HCPCS,Facility,Inpatient,20 mL,mL,,406,345.1,116.3596,406,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ADENOSINE (DIAGNOSTIC) 3 MG/ML IV SOLN,,J0153,HCPCS,Facility,Both,20 mL,mL,,406,345.1,116.3596,406,UnitedHealthcare,Individual & Family,381.64,94,,percent of total billed charges,,
ADENOSINE (DIAGNOSTIC) 3 MG/ML IV SOLN,,J0153,HCPCS,Facility,Outpatient,20 mL,mL,,406,345.1,116.3596,406,UnitedHealthcare,Medicare Advantage,198.94,49,,percent of total billed charges,,
ADENOSINE (DIAGNOSTIC) 3 MG/ML IV SOLN,,J0153,HCPCS,Facility,Inpatient,20 mL,mL,,406,345.1,116.3596,406,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
ADENOSINE (DIAGNOSTIC) 3 MG/ML IV SOLN,,J0153,HCPCS,Facility,Outpatient,20 mL,mL,,406,345.1,116.3596,406,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,194.88,48,,percent of total billed charges,,100% of DHS outpatient percentage
ADENOSINE (DIAGNOSTIC) 3 MG/ML IV SOLN,,J0153,HCPCS,Facility,Inpatient,20 mL,mL,,406,345.1,116.3596,406,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
AMINOPHYLLINE 500 MG/20 ML IV SOLN,,J0280,HCPCS,Facility,Both,20 mL,mL,,53,45.05,15.1898,53,Aetna,Commercial,48.76,92,,percent of total billed charges,,
AMINOPHYLLINE 500 MG/20 ML IV SOLN,,J0280,HCPCS,Facility,Outpatient,20 mL,mL,,53,45.05,15.1898,53,Aetna,Medicare Advantage,25.97,49,,percent of total billed charges,,
AMINOPHYLLINE 500 MG/20 ML IV SOLN,,J0280,HCPCS,Facility,Inpatient,20 mL,mL,,53,45.05,15.1898,53,Aetna,Medicare Advantage,,,,,Included in per diem rate,
AMINOPHYLLINE 500 MG/20 ML IV SOLN,,J0280,HCPCS,Facility,Both,20 mL,mL,,53,45.05,15.1898,53,Aetna,PPO,49.29,93,,percent of total billed charges,,
AMINOPHYLLINE 500 MG/20 ML IV SOLN,,J0280,HCPCS,Facility,Both,20 mL,mL,,53,45.05,15.1898,53,America's PPO,America's PPO,50.8959,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
AMINOPHYLLINE 500 MG/20 ML IV SOLN,,J0280,HCPCS,Facility,Both,20 mL,mL,,53,45.05,15.1898,53,BlueCross BlueShield Minnesota, Federal Employee Program,52.152,98.4,,percent of total billed charges,,
AMINOPHYLLINE 500 MG/20 ML IV SOLN,,J0280,HCPCS,Facility,Both,20 mL,mL,,53,45.05,15.1898,53,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,53,100,,percent of total billed charges,,
AMINOPHYLLINE 500 MG/20 ML IV SOLN,,J0280,HCPCS,Facility,Both,20 mL,mL,,53,45.05,15.1898,53,BlueCross BlueShield Minnesota,High Value Network Plan,47.7,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
AMINOPHYLLINE 500 MG/20 ML IV SOLN,,J0280,HCPCS,Facility,Outpatient,20 mL,mL,,53,45.05,15.1898,53,BlueCross BlueShield Minnesota,Medicare Advantage,25.97,49,,percent of total billed charges,,
AMINOPHYLLINE 500 MG/20 ML IV SOLN,,J0280,HCPCS,Facility,Inpatient,20 mL,mL,,53,45.05,15.1898,53,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
AMINOPHYLLINE 500 MG/20 ML IV SOLN,,J0280,HCPCS,Facility,Both,20 mL,mL,,53,45.05,15.1898,53,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,46.9421,88.57,,percent of total billed charges,,
AMINOPHYLLINE 500 MG/20 ML IV SOLN,,J0280,HCPCS,Facility,Both,20 mL,mL,,53,45.05,15.1898,53,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,15.1898,28.66,,percent of total billed charges,,
AMINOPHYLLINE 500 MG/20 ML IV SOLN,,J0280,HCPCS,Facility,Outpatient,20 mL,mL,,53,45.05,15.1898,53,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),25.97,49,,percent of total billed charges,,
AMINOPHYLLINE 500 MG/20 ML IV SOLN,,J0280,HCPCS,Facility,Inpatient,20 mL,mL,,53,45.05,15.1898,53,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
AMINOPHYLLINE 500 MG/20 ML IV SOLN,,J0280,HCPCS,Facility,Both,20 mL,mL,,53,45.05,15.1898,53,CorVel,Worker's Compensation,53,100,,percent of total billed charges,,
AMINOPHYLLINE 500 MG/20 ML IV SOLN,,J0280,HCPCS,Facility,Both,20 mL,mL,,53,45.05,15.1898,53,First Health Group Corporation,First Health Network,51.41,97,,percent of total billed charges,,
AMINOPHYLLINE 500 MG/20 ML IV SOLN,,J0280,HCPCS,Facility,Both,20 mL,mL,,53,45.05,15.1898,53,"Health Partners, Inc.",Commercial,50.138,94.6,,percent of total billed charges,,
AMINOPHYLLINE 500 MG/20 ML IV SOLN,,J0280,HCPCS,Facility,Outpatient,20 mL,mL,,53,45.05,15.1898,53,"Health Partners, Inc.",Medicare Advantage,25.97,49,,percent of total billed charges,,
AMINOPHYLLINE 500 MG/20 ML IV SOLN,,J0280,HCPCS,Facility,Inpatient,20 mL,mL,,53,45.05,15.1898,53,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
AMINOPHYLLINE 500 MG/20 ML IV SOLN,,J0280,HCPCS,Facility,Both,20 mL,mL,,53,45.05,15.1898,53,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),31.8,60,,percent of total billed charges,,
AMINOPHYLLINE 500 MG/20 ML IV SOLN,,J0280,HCPCS,Facility,Both,20 mL,mL,,53,45.05,15.1898,53,"Health Partners, Inc.",State of Minnesota Advantage Program,43.195,81.5,,percent of total billed charges,,
AMINOPHYLLINE 500 MG/20 ML IV SOLN,,J0280,HCPCS,Facility,Both,20 mL,mL,,53,45.05,15.1898,53,"Health Partners, Inc.",State Public Programs,26.5,50,,percent of total billed charges,,
AMINOPHYLLINE 500 MG/20 ML IV SOLN,,J0280,HCPCS,Facility,Both,20 mL,mL,,53,45.05,15.1898,53,Humana Insurance Company,Commercial PPO,50.35,95,,percent of total billed charges,,
AMINOPHYLLINE 500 MG/20 ML IV SOLN,,J0280,HCPCS,Facility,Outpatient,20 mL,mL,,53,45.05,15.1898,53,Humana Insurance Company,Medicare PPO,25.97,49,,percent of total billed charges,,
AMINOPHYLLINE 500 MG/20 ML IV SOLN,,J0280,HCPCS,Facility,Inpatient,20 mL,mL,,53,45.05,15.1898,53,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
AMINOPHYLLINE 500 MG/20 ML IV SOLN,,J0280,HCPCS,Facility,Both,20 mL,mL,,53,45.05,15.1898,53,Medica,Individual & Family,52.523,99.1,,percent of total billed charges,,
AMINOPHYLLINE 500 MG/20 ML IV SOLN,,J0280,HCPCS,Facility,Outpatient,20 mL,mL,,53,45.05,15.1898,53,Medica,Medica Advantage Solution,26.394,49.8,,percent of total billed charges,,
AMINOPHYLLINE 500 MG/20 ML IV SOLN,,J0280,HCPCS,Facility,Inpatient,20 mL,mL,,53,45.05,15.1898,53,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
AMINOPHYLLINE 500 MG/20 ML IV SOLN,,J0280,HCPCS,Facility,Outpatient,20 mL,mL,,53,45.05,15.1898,53,Medica,Medical Assistance,23.638,44.6,,percent of total billed charges,,
AMINOPHYLLINE 500 MG/20 ML IV SOLN,,J0280,HCPCS,Facility,Inpatient,20 mL,mL,,53,45.05,15.1898,53,Medica,Medical Assistance,,,,,Included in per diem rate,
AMINOPHYLLINE 500 MG/20 ML IV SOLN,,J0280,HCPCS,Facility,Outpatient,20 mL,mL,,53,45.05,15.1898,53,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,26.394,49.8,,percent of total billed charges,,
AMINOPHYLLINE 500 MG/20 ML IV SOLN,,J0280,HCPCS,Facility,Inpatient,20 mL,mL,,53,45.05,15.1898,53,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
AMINOPHYLLINE 500 MG/20 ML IV SOLN,,J0280,HCPCS,Facility,Both,20 mL,mL,,53,45.05,15.1898,53,"Multiplan, Inc.","Multiplan, Inc.",49.82,94,,percent of total billed charges,,
AMINOPHYLLINE 500 MG/20 ML IV SOLN,,J0280,HCPCS,Facility,Outpatient,20 mL,mL,,53,45.05,15.1898,53,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,47.753,90.1,,percent of total billed charges,,
AMINOPHYLLINE 500 MG/20 ML IV SOLN,,J0280,HCPCS,Facility,Inpatient,20 mL,mL,,53,45.05,15.1898,53,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
AMINOPHYLLINE 500 MG/20 ML IV SOLN,,J0280,HCPCS,Facility,Both,20 mL,mL,,53,45.05,15.1898,53,"Preferred One Administrative Services, INC.",PPO,52.258,98.6,,percent of total billed charges,,
AMINOPHYLLINE 500 MG/20 ML IV SOLN,,J0280,HCPCS,Facility,Outpatient,20 mL,mL,,53,45.05,15.1898,53,PrimeWest Health,Minnesota Senior Health Options (MSHO),27.2685,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
AMINOPHYLLINE 500 MG/20 ML IV SOLN,,J0280,HCPCS,Facility,Inpatient,20 mL,mL,,53,45.05,15.1898,53,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
AMINOPHYLLINE 500 MG/20 ML IV SOLN,,J0280,HCPCS,Facility,Outpatient,20 mL,mL,,53,45.05,15.1898,53,PrimeWest Health,MinnesotaCare,27.2208,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
AMINOPHYLLINE 500 MG/20 ML IV SOLN,,J0280,HCPCS,Facility,Inpatient,20 mL,mL,,53,45.05,15.1898,53,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
AMINOPHYLLINE 500 MG/20 ML IV SOLN,,J0280,HCPCS,Facility,Both,20 mL,mL,,53,45.05,15.1898,53,Sanford Health Plan,Sanford Health Plan,48.76,92,,percent of total billed charges,,
AMINOPHYLLINE 500 MG/20 ML IV SOLN,,J0280,HCPCS,Facility,Outpatient,20 mL,mL,,53,45.05,15.1898,53,"UCare Health, Inc.",Individual & Family Plan,29.8655,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
AMINOPHYLLINE 500 MG/20 ML IV SOLN,,J0280,HCPCS,Facility,Inpatient,20 mL,mL,,53,45.05,15.1898,53,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
AMINOPHYLLINE 500 MG/20 ML IV SOLN,,J0280,HCPCS,Facility,Outpatient,20 mL,mL,,53,45.05,15.1898,53,"UCare Health, Inc.",Medical Assistance,26.7491,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
AMINOPHYLLINE 500 MG/20 ML IV SOLN,,J0280,HCPCS,Facility,Inpatient,20 mL,mL,,53,45.05,15.1898,53,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
AMINOPHYLLINE 500 MG/20 ML IV SOLN,,J0280,HCPCS,Facility,Outpatient,20 mL,mL,,53,45.05,15.1898,53,"UCare Health, Inc.",Medicare Advantage,26.7491,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
AMINOPHYLLINE 500 MG/20 ML IV SOLN,,J0280,HCPCS,Facility,Inpatient,20 mL,mL,,53,45.05,15.1898,53,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
AMINOPHYLLINE 500 MG/20 ML IV SOLN,,J0280,HCPCS,Facility,Outpatient,20 mL,mL,,53,45.05,15.1898,53,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),26.7491,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
AMINOPHYLLINE 500 MG/20 ML IV SOLN,,J0280,HCPCS,Facility,Inpatient,20 mL,mL,,53,45.05,15.1898,53,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
AMINOPHYLLINE 500 MG/20 ML IV SOLN,,J0280,HCPCS,Facility,Both,20 mL,mL,,53,45.05,15.1898,53,UnitedHealthcare,Individual & Family,49.82,94,,percent of total billed charges,,
AMINOPHYLLINE 500 MG/20 ML IV SOLN,,J0280,HCPCS,Facility,Outpatient,20 mL,mL,,53,45.05,15.1898,53,UnitedHealthcare,Medicare Advantage,25.97,49,,percent of total billed charges,,
AMINOPHYLLINE 500 MG/20 ML IV SOLN,,J0280,HCPCS,Facility,Inpatient,20 mL,mL,,53,45.05,15.1898,53,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
AMINOPHYLLINE 500 MG/20 ML IV SOLN,,J0280,HCPCS,Facility,Outpatient,20 mL,mL,,53,45.05,15.1898,53,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,25.44,48,,percent of total billed charges,,100% of DHS outpatient percentage
AMINOPHYLLINE 500 MG/20 ML IV SOLN,,J0280,HCPCS,Facility,Inpatient,20 mL,mL,,53,45.05,15.1898,53,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
ATROPINE 0.4 MG/ML INJ SOLN,,J0461,HCPCS,Facility,Both,20 mL,mL,,190,161.5,54.454,190,Aetna,Commercial,174.8,92,,percent of total billed charges,,
ATROPINE 0.4 MG/ML INJ SOLN,,J0461,HCPCS,Facility,Outpatient,20 mL,mL,,190,161.5,54.454,190,Aetna,Medicare Advantage,93.1,49,,percent of total billed charges,,
ATROPINE 0.4 MG/ML INJ SOLN,,J0461,HCPCS,Facility,Inpatient,20 mL,mL,,190,161.5,54.454,190,Aetna,Medicare Advantage,,,,,Included in per diem rate,
ATROPINE 0.4 MG/ML INJ SOLN,,J0461,HCPCS,Facility,Both,20 mL,mL,,190,161.5,54.454,190,Aetna,PPO,176.7,93,,percent of total billed charges,,
ATROPINE 0.4 MG/ML INJ SOLN,,J0461,HCPCS,Facility,Both,20 mL,mL,,190,161.5,54.454,190,America's PPO,America's PPO,182.457,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
ATROPINE 0.4 MG/ML INJ SOLN,,J0461,HCPCS,Facility,Both,20 mL,mL,,190,161.5,54.454,190,BlueCross BlueShield Minnesota, Federal Employee Program,186.96,98.4,,percent of total billed charges,,
ATROPINE 0.4 MG/ML INJ SOLN,,J0461,HCPCS,Facility,Both,20 mL,mL,,190,161.5,54.454,190,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,190,100,,percent of total billed charges,,
ATROPINE 0.4 MG/ML INJ SOLN,,J0461,HCPCS,Facility,Both,20 mL,mL,,190,161.5,54.454,190,BlueCross BlueShield Minnesota,High Value Network Plan,171,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
ATROPINE 0.4 MG/ML INJ SOLN,,J0461,HCPCS,Facility,Outpatient,20 mL,mL,,190,161.5,54.454,190,BlueCross BlueShield Minnesota,Medicare Advantage,93.1,49,,percent of total billed charges,,
ATROPINE 0.4 MG/ML INJ SOLN,,J0461,HCPCS,Facility,Inpatient,20 mL,mL,,190,161.5,54.454,190,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
ATROPINE 0.4 MG/ML INJ SOLN,,J0461,HCPCS,Facility,Both,20 mL,mL,,190,161.5,54.454,190,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,168.283,88.57,,percent of total billed charges,,
ATROPINE 0.4 MG/ML INJ SOLN,,J0461,HCPCS,Facility,Both,20 mL,mL,,190,161.5,54.454,190,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,54.454,28.66,,percent of total billed charges,,
ATROPINE 0.4 MG/ML INJ SOLN,,J0461,HCPCS,Facility,Outpatient,20 mL,mL,,190,161.5,54.454,190,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),93.1,49,,percent of total billed charges,,
ATROPINE 0.4 MG/ML INJ SOLN,,J0461,HCPCS,Facility,Inpatient,20 mL,mL,,190,161.5,54.454,190,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
ATROPINE 0.4 MG/ML INJ SOLN,,J0461,HCPCS,Facility,Both,20 mL,mL,,190,161.5,54.454,190,CorVel,Worker's Compensation,190,100,,percent of total billed charges,,
ATROPINE 0.4 MG/ML INJ SOLN,,J0461,HCPCS,Facility,Both,20 mL,mL,,190,161.5,54.454,190,First Health Group Corporation,First Health Network,184.3,97,,percent of total billed charges,,
ATROPINE 0.4 MG/ML INJ SOLN,,J0461,HCPCS,Facility,Both,20 mL,mL,,190,161.5,54.454,190,"Health Partners, Inc.",Commercial,179.74,94.6,,percent of total billed charges,,
ATROPINE 0.4 MG/ML INJ SOLN,,J0461,HCPCS,Facility,Outpatient,20 mL,mL,,190,161.5,54.454,190,"Health Partners, Inc.",Medicare Advantage,93.1,49,,percent of total billed charges,,
ATROPINE 0.4 MG/ML INJ SOLN,,J0461,HCPCS,Facility,Inpatient,20 mL,mL,,190,161.5,54.454,190,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ATROPINE 0.4 MG/ML INJ SOLN,,J0461,HCPCS,Facility,Both,20 mL,mL,,190,161.5,54.454,190,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),114,60,,percent of total billed charges,,
ATROPINE 0.4 MG/ML INJ SOLN,,J0461,HCPCS,Facility,Both,20 mL,mL,,190,161.5,54.454,190,"Health Partners, Inc.",State of Minnesota Advantage Program,154.85,81.5,,percent of total billed charges,,
ATROPINE 0.4 MG/ML INJ SOLN,,J0461,HCPCS,Facility,Both,20 mL,mL,,190,161.5,54.454,190,"Health Partners, Inc.",State Public Programs,95,50,,percent of total billed charges,,
ATROPINE 0.4 MG/ML INJ SOLN,,J0461,HCPCS,Facility,Both,20 mL,mL,,190,161.5,54.454,190,Humana Insurance Company,Commercial PPO,180.5,95,,percent of total billed charges,,
ATROPINE 0.4 MG/ML INJ SOLN,,J0461,HCPCS,Facility,Outpatient,20 mL,mL,,190,161.5,54.454,190,Humana Insurance Company,Medicare PPO,93.1,49,,percent of total billed charges,,
ATROPINE 0.4 MG/ML INJ SOLN,,J0461,HCPCS,Facility,Inpatient,20 mL,mL,,190,161.5,54.454,190,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
ATROPINE 0.4 MG/ML INJ SOLN,,J0461,HCPCS,Facility,Both,20 mL,mL,,190,161.5,54.454,190,Medica,Individual & Family,188.29,99.1,,percent of total billed charges,,
ATROPINE 0.4 MG/ML INJ SOLN,,J0461,HCPCS,Facility,Outpatient,20 mL,mL,,190,161.5,54.454,190,Medica,Medica Advantage Solution,94.62,49.8,,percent of total billed charges,,
ATROPINE 0.4 MG/ML INJ SOLN,,J0461,HCPCS,Facility,Inpatient,20 mL,mL,,190,161.5,54.454,190,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
ATROPINE 0.4 MG/ML INJ SOLN,,J0461,HCPCS,Facility,Outpatient,20 mL,mL,,190,161.5,54.454,190,Medica,Medical Assistance,84.74,44.6,,percent of total billed charges,,
ATROPINE 0.4 MG/ML INJ SOLN,,J0461,HCPCS,Facility,Inpatient,20 mL,mL,,190,161.5,54.454,190,Medica,Medical Assistance,,,,,Included in per diem rate,
ATROPINE 0.4 MG/ML INJ SOLN,,J0461,HCPCS,Facility,Outpatient,20 mL,mL,,190,161.5,54.454,190,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,94.62,49.8,,percent of total billed charges,,
ATROPINE 0.4 MG/ML INJ SOLN,,J0461,HCPCS,Facility,Inpatient,20 mL,mL,,190,161.5,54.454,190,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
ATROPINE 0.4 MG/ML INJ SOLN,,J0461,HCPCS,Facility,Both,20 mL,mL,,190,161.5,54.454,190,"Multiplan, Inc.","Multiplan, Inc.",178.6,94,,percent of total billed charges,,
ATROPINE 0.4 MG/ML INJ SOLN,,J0461,HCPCS,Facility,Outpatient,20 mL,mL,,190,161.5,54.454,190,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,171.19,90.1,,percent of total billed charges,,
ATROPINE 0.4 MG/ML INJ SOLN,,J0461,HCPCS,Facility,Inpatient,20 mL,mL,,190,161.5,54.454,190,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
ATROPINE 0.4 MG/ML INJ SOLN,,J0461,HCPCS,Facility,Both,20 mL,mL,,190,161.5,54.454,190,"Preferred One Administrative Services, INC.",PPO,187.34,98.6,,percent of total billed charges,,
ATROPINE 0.4 MG/ML INJ SOLN,,J0461,HCPCS,Facility,Outpatient,20 mL,mL,,190,161.5,54.454,190,PrimeWest Health,Minnesota Senior Health Options (MSHO),97.755,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
ATROPINE 0.4 MG/ML INJ SOLN,,J0461,HCPCS,Facility,Inpatient,20 mL,mL,,190,161.5,54.454,190,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ATROPINE 0.4 MG/ML INJ SOLN,,J0461,HCPCS,Facility,Outpatient,20 mL,mL,,190,161.5,54.454,190,PrimeWest Health,MinnesotaCare,97.584,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
ATROPINE 0.4 MG/ML INJ SOLN,,J0461,HCPCS,Facility,Inpatient,20 mL,mL,,190,161.5,54.454,190,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
ATROPINE 0.4 MG/ML INJ SOLN,,J0461,HCPCS,Facility,Both,20 mL,mL,,190,161.5,54.454,190,Sanford Health Plan,Sanford Health Plan,174.8,92,,percent of total billed charges,,
ATROPINE 0.4 MG/ML INJ SOLN,,J0461,HCPCS,Facility,Outpatient,20 mL,mL,,190,161.5,54.454,190,"UCare Health, Inc.",Individual & Family Plan,107.065,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
ATROPINE 0.4 MG/ML INJ SOLN,,J0461,HCPCS,Facility,Inpatient,20 mL,mL,,190,161.5,54.454,190,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
ATROPINE 0.4 MG/ML INJ SOLN,,J0461,HCPCS,Facility,Outpatient,20 mL,mL,,190,161.5,54.454,190,"UCare Health, Inc.",Medical Assistance,95.893,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ATROPINE 0.4 MG/ML INJ SOLN,,J0461,HCPCS,Facility,Inpatient,20 mL,mL,,190,161.5,54.454,190,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
ATROPINE 0.4 MG/ML INJ SOLN,,J0461,HCPCS,Facility,Outpatient,20 mL,mL,,190,161.5,54.454,190,"UCare Health, Inc.",Medicare Advantage,95.893,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ATROPINE 0.4 MG/ML INJ SOLN,,J0461,HCPCS,Facility,Inpatient,20 mL,mL,,190,161.5,54.454,190,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ATROPINE 0.4 MG/ML INJ SOLN,,J0461,HCPCS,Facility,Outpatient,20 mL,mL,,190,161.5,54.454,190,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),95.893,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ATROPINE 0.4 MG/ML INJ SOLN,,J0461,HCPCS,Facility,Inpatient,20 mL,mL,,190,161.5,54.454,190,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ATROPINE 0.4 MG/ML INJ SOLN,,J0461,HCPCS,Facility,Both,20 mL,mL,,190,161.5,54.454,190,UnitedHealthcare,Individual & Family,178.6,94,,percent of total billed charges,,
ATROPINE 0.4 MG/ML INJ SOLN,,J0461,HCPCS,Facility,Outpatient,20 mL,mL,,190,161.5,54.454,190,UnitedHealthcare,Medicare Advantage,93.1,49,,percent of total billed charges,,
ATROPINE 0.4 MG/ML INJ SOLN,,J0461,HCPCS,Facility,Inpatient,20 mL,mL,,190,161.5,54.454,190,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
ATROPINE 0.4 MG/ML INJ SOLN,,J0461,HCPCS,Facility,Outpatient,20 mL,mL,,190,161.5,54.454,190,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,91.2,48,,percent of total billed charges,,100% of DHS outpatient percentage
ATROPINE 0.4 MG/ML INJ SOLN,,J0461,HCPCS,Facility,Inpatient,20 mL,mL,,190,161.5,54.454,190,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
GENTAMICIN 40 MG/ML INJ SOLN,,J1580,HCPCS,Facility,Both,20 mL,mL,,158,134.3,45.2828,158,Aetna,Commercial,145.36,92,,percent of total billed charges,,
GENTAMICIN 40 MG/ML INJ SOLN,,J1580,HCPCS,Facility,Outpatient,20 mL,mL,,158,134.3,45.2828,158,Aetna,Medicare Advantage,77.42,49,,percent of total billed charges,,
GENTAMICIN 40 MG/ML INJ SOLN,,J1580,HCPCS,Facility,Inpatient,20 mL,mL,,158,134.3,45.2828,158,Aetna,Medicare Advantage,,,,,Included in per diem rate,
GENTAMICIN 40 MG/ML INJ SOLN,,J1580,HCPCS,Facility,Both,20 mL,mL,,158,134.3,45.2828,158,Aetna,PPO,146.94,93,,percent of total billed charges,,
GENTAMICIN 40 MG/ML INJ SOLN,,J1580,HCPCS,Facility,Both,20 mL,mL,,158,134.3,45.2828,158,America's PPO,America's PPO,151.7274,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
GENTAMICIN 40 MG/ML INJ SOLN,,J1580,HCPCS,Facility,Both,20 mL,mL,,158,134.3,45.2828,158,BlueCross BlueShield Minnesota, Federal Employee Program,155.472,98.4,,percent of total billed charges,,
GENTAMICIN 40 MG/ML INJ SOLN,,J1580,HCPCS,Facility,Both,20 mL,mL,,158,134.3,45.2828,158,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,158,100,,percent of total billed charges,,
GENTAMICIN 40 MG/ML INJ SOLN,,J1580,HCPCS,Facility,Both,20 mL,mL,,158,134.3,45.2828,158,BlueCross BlueShield Minnesota,High Value Network Plan,142.2,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
GENTAMICIN 40 MG/ML INJ SOLN,,J1580,HCPCS,Facility,Outpatient,20 mL,mL,,158,134.3,45.2828,158,BlueCross BlueShield Minnesota,Medicare Advantage,77.42,49,,percent of total billed charges,,
GENTAMICIN 40 MG/ML INJ SOLN,,J1580,HCPCS,Facility,Inpatient,20 mL,mL,,158,134.3,45.2828,158,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
GENTAMICIN 40 MG/ML INJ SOLN,,J1580,HCPCS,Facility,Both,20 mL,mL,,158,134.3,45.2828,158,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,139.9406,88.57,,percent of total billed charges,,
GENTAMICIN 40 MG/ML INJ SOLN,,J1580,HCPCS,Facility,Both,20 mL,mL,,158,134.3,45.2828,158,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,45.2828,28.66,,percent of total billed charges,,
GENTAMICIN 40 MG/ML INJ SOLN,,J1580,HCPCS,Facility,Outpatient,20 mL,mL,,158,134.3,45.2828,158,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),77.42,49,,percent of total billed charges,,
GENTAMICIN 40 MG/ML INJ SOLN,,J1580,HCPCS,Facility,Inpatient,20 mL,mL,,158,134.3,45.2828,158,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
GENTAMICIN 40 MG/ML INJ SOLN,,J1580,HCPCS,Facility,Both,20 mL,mL,,158,134.3,45.2828,158,CorVel,Worker's Compensation,158,100,,percent of total billed charges,,
GENTAMICIN 40 MG/ML INJ SOLN,,J1580,HCPCS,Facility,Both,20 mL,mL,,158,134.3,45.2828,158,First Health Group Corporation,First Health Network,153.26,97,,percent of total billed charges,,
GENTAMICIN 40 MG/ML INJ SOLN,,J1580,HCPCS,Facility,Both,20 mL,mL,,158,134.3,45.2828,158,"Health Partners, Inc.",Commercial,149.468,94.6,,percent of total billed charges,,
GENTAMICIN 40 MG/ML INJ SOLN,,J1580,HCPCS,Facility,Outpatient,20 mL,mL,,158,134.3,45.2828,158,"Health Partners, Inc.",Medicare Advantage,77.42,49,,percent of total billed charges,,
GENTAMICIN 40 MG/ML INJ SOLN,,J1580,HCPCS,Facility,Inpatient,20 mL,mL,,158,134.3,45.2828,158,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
GENTAMICIN 40 MG/ML INJ SOLN,,J1580,HCPCS,Facility,Both,20 mL,mL,,158,134.3,45.2828,158,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),94.8,60,,percent of total billed charges,,
GENTAMICIN 40 MG/ML INJ SOLN,,J1580,HCPCS,Facility,Both,20 mL,mL,,158,134.3,45.2828,158,"Health Partners, Inc.",State of Minnesota Advantage Program,128.77,81.5,,percent of total billed charges,,
GENTAMICIN 40 MG/ML INJ SOLN,,J1580,HCPCS,Facility,Both,20 mL,mL,,158,134.3,45.2828,158,"Health Partners, Inc.",State Public Programs,79,50,,percent of total billed charges,,
GENTAMICIN 40 MG/ML INJ SOLN,,J1580,HCPCS,Facility,Both,20 mL,mL,,158,134.3,45.2828,158,Humana Insurance Company,Commercial PPO,150.1,95,,percent of total billed charges,,
GENTAMICIN 40 MG/ML INJ SOLN,,J1580,HCPCS,Facility,Outpatient,20 mL,mL,,158,134.3,45.2828,158,Humana Insurance Company,Medicare PPO,77.42,49,,percent of total billed charges,,
GENTAMICIN 40 MG/ML INJ SOLN,,J1580,HCPCS,Facility,Inpatient,20 mL,mL,,158,134.3,45.2828,158,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
GENTAMICIN 40 MG/ML INJ SOLN,,J1580,HCPCS,Facility,Both,20 mL,mL,,158,134.3,45.2828,158,Medica,Individual & Family,156.578,99.1,,percent of total billed charges,,
GENTAMICIN 40 MG/ML INJ SOLN,,J1580,HCPCS,Facility,Outpatient,20 mL,mL,,158,134.3,45.2828,158,Medica,Medica Advantage Solution,78.684,49.8,,percent of total billed charges,,
GENTAMICIN 40 MG/ML INJ SOLN,,J1580,HCPCS,Facility,Inpatient,20 mL,mL,,158,134.3,45.2828,158,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
GENTAMICIN 40 MG/ML INJ SOLN,,J1580,HCPCS,Facility,Outpatient,20 mL,mL,,158,134.3,45.2828,158,Medica,Medical Assistance,70.468,44.6,,percent of total billed charges,,
GENTAMICIN 40 MG/ML INJ SOLN,,J1580,HCPCS,Facility,Inpatient,20 mL,mL,,158,134.3,45.2828,158,Medica,Medical Assistance,,,,,Included in per diem rate,
GENTAMICIN 40 MG/ML INJ SOLN,,J1580,HCPCS,Facility,Outpatient,20 mL,mL,,158,134.3,45.2828,158,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,78.684,49.8,,percent of total billed charges,,
GENTAMICIN 40 MG/ML INJ SOLN,,J1580,HCPCS,Facility,Inpatient,20 mL,mL,,158,134.3,45.2828,158,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
GENTAMICIN 40 MG/ML INJ SOLN,,J1580,HCPCS,Facility,Both,20 mL,mL,,158,134.3,45.2828,158,"Multiplan, Inc.","Multiplan, Inc.",148.52,94,,percent of total billed charges,,
GENTAMICIN 40 MG/ML INJ SOLN,,J1580,HCPCS,Facility,Outpatient,20 mL,mL,,158,134.3,45.2828,158,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,142.358,90.1,,percent of total billed charges,,
GENTAMICIN 40 MG/ML INJ SOLN,,J1580,HCPCS,Facility,Inpatient,20 mL,mL,,158,134.3,45.2828,158,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
GENTAMICIN 40 MG/ML INJ SOLN,,J1580,HCPCS,Facility,Both,20 mL,mL,,158,134.3,45.2828,158,"Preferred One Administrative Services, INC.",PPO,155.788,98.6,,percent of total billed charges,,
GENTAMICIN 40 MG/ML INJ SOLN,,J1580,HCPCS,Facility,Outpatient,20 mL,mL,,158,134.3,45.2828,158,PrimeWest Health,Minnesota Senior Health Options (MSHO),81.291,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
GENTAMICIN 40 MG/ML INJ SOLN,,J1580,HCPCS,Facility,Inpatient,20 mL,mL,,158,134.3,45.2828,158,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
GENTAMICIN 40 MG/ML INJ SOLN,,J1580,HCPCS,Facility,Outpatient,20 mL,mL,,158,134.3,45.2828,158,PrimeWest Health,MinnesotaCare,81.1488,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
GENTAMICIN 40 MG/ML INJ SOLN,,J1580,HCPCS,Facility,Inpatient,20 mL,mL,,158,134.3,45.2828,158,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
GENTAMICIN 40 MG/ML INJ SOLN,,J1580,HCPCS,Facility,Both,20 mL,mL,,158,134.3,45.2828,158,Sanford Health Plan,Sanford Health Plan,145.36,92,,percent of total billed charges,,
GENTAMICIN 40 MG/ML INJ SOLN,,J1580,HCPCS,Facility,Outpatient,20 mL,mL,,158,134.3,45.2828,158,"UCare Health, Inc.",Individual & Family Plan,89.033,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
GENTAMICIN 40 MG/ML INJ SOLN,,J1580,HCPCS,Facility,Inpatient,20 mL,mL,,158,134.3,45.2828,158,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
GENTAMICIN 40 MG/ML INJ SOLN,,J1580,HCPCS,Facility,Outpatient,20 mL,mL,,158,134.3,45.2828,158,"UCare Health, Inc.",Medical Assistance,79.7426,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
GENTAMICIN 40 MG/ML INJ SOLN,,J1580,HCPCS,Facility,Inpatient,20 mL,mL,,158,134.3,45.2828,158,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
GENTAMICIN 40 MG/ML INJ SOLN,,J1580,HCPCS,Facility,Outpatient,20 mL,mL,,158,134.3,45.2828,158,"UCare Health, Inc.",Medicare Advantage,79.7426,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
GENTAMICIN 40 MG/ML INJ SOLN,,J1580,HCPCS,Facility,Inpatient,20 mL,mL,,158,134.3,45.2828,158,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
GENTAMICIN 40 MG/ML INJ SOLN,,J1580,HCPCS,Facility,Outpatient,20 mL,mL,,158,134.3,45.2828,158,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),79.7426,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
GENTAMICIN 40 MG/ML INJ SOLN,,J1580,HCPCS,Facility,Inpatient,20 mL,mL,,158,134.3,45.2828,158,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
GENTAMICIN 40 MG/ML INJ SOLN,,J1580,HCPCS,Facility,Both,20 mL,mL,,158,134.3,45.2828,158,UnitedHealthcare,Individual & Family,148.52,94,,percent of total billed charges,,
GENTAMICIN 40 MG/ML INJ SOLN,,J1580,HCPCS,Facility,Outpatient,20 mL,mL,,158,134.3,45.2828,158,UnitedHealthcare,Medicare Advantage,77.42,49,,percent of total billed charges,,
GENTAMICIN 40 MG/ML INJ SOLN,,J1580,HCPCS,Facility,Inpatient,20 mL,mL,,158,134.3,45.2828,158,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
GENTAMICIN 40 MG/ML INJ SOLN,,J1580,HCPCS,Facility,Outpatient,20 mL,mL,,158,134.3,45.2828,158,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,75.84,48,,percent of total billed charges,,100% of DHS outpatient percentage
GENTAMICIN 40 MG/ML INJ SOLN,,J1580,HCPCS,Facility,Inpatient,20 mL,mL,,158,134.3,45.2828,158,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
PROPOFOL 10 MG/ML IV BOLUS,,J2704,HCPCS,Facility,Both,20 mL,mL,,26,22.1,7.4516,26,Aetna,Commercial,23.92,92,,percent of total billed charges,,
PROPOFOL 10 MG/ML IV BOLUS,,J2704,HCPCS,Facility,Outpatient,20 mL,mL,,26,22.1,7.4516,26,Aetna,Medicare Advantage,12.74,49,,percent of total billed charges,,
PROPOFOL 10 MG/ML IV BOLUS,,J2704,HCPCS,Facility,Inpatient,20 mL,mL,,26,22.1,7.4516,26,Aetna,Medicare Advantage,,,,,Included in per diem rate,
PROPOFOL 10 MG/ML IV BOLUS,,J2704,HCPCS,Facility,Both,20 mL,mL,,26,22.1,7.4516,26,Aetna,PPO,24.18,93,,percent of total billed charges,,
PROPOFOL 10 MG/ML IV BOLUS,,J2704,HCPCS,Facility,Both,20 mL,mL,,26,22.1,7.4516,26,America's PPO,America's PPO,24.9678,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
PROPOFOL 10 MG/ML IV BOLUS,,J2704,HCPCS,Facility,Both,20 mL,mL,,26,22.1,7.4516,26,BlueCross BlueShield Minnesota, Federal Employee Program,25.584,98.4,,percent of total billed charges,,
PROPOFOL 10 MG/ML IV BOLUS,,J2704,HCPCS,Facility,Both,20 mL,mL,,26,22.1,7.4516,26,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,26,100,,percent of total billed charges,,
PROPOFOL 10 MG/ML IV BOLUS,,J2704,HCPCS,Facility,Both,20 mL,mL,,26,22.1,7.4516,26,BlueCross BlueShield Minnesota,High Value Network Plan,23.4,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
PROPOFOL 10 MG/ML IV BOLUS,,J2704,HCPCS,Facility,Outpatient,20 mL,mL,,26,22.1,7.4516,26,BlueCross BlueShield Minnesota,Medicare Advantage,12.74,49,,percent of total billed charges,,
PROPOFOL 10 MG/ML IV BOLUS,,J2704,HCPCS,Facility,Inpatient,20 mL,mL,,26,22.1,7.4516,26,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
PROPOFOL 10 MG/ML IV BOLUS,,J2704,HCPCS,Facility,Both,20 mL,mL,,26,22.1,7.4516,26,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,23.0282,88.57,,percent of total billed charges,,
PROPOFOL 10 MG/ML IV BOLUS,,J2704,HCPCS,Facility,Both,20 mL,mL,,26,22.1,7.4516,26,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,7.4516,28.66,,percent of total billed charges,,
PROPOFOL 10 MG/ML IV BOLUS,,J2704,HCPCS,Facility,Outpatient,20 mL,mL,,26,22.1,7.4516,26,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),12.74,49,,percent of total billed charges,,
PROPOFOL 10 MG/ML IV BOLUS,,J2704,HCPCS,Facility,Inpatient,20 mL,mL,,26,22.1,7.4516,26,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
PROPOFOL 10 MG/ML IV BOLUS,,J2704,HCPCS,Facility,Both,20 mL,mL,,26,22.1,7.4516,26,CorVel,Worker's Compensation,26,100,,percent of total billed charges,,
PROPOFOL 10 MG/ML IV BOLUS,,J2704,HCPCS,Facility,Both,20 mL,mL,,26,22.1,7.4516,26,First Health Group Corporation,First Health Network,25.22,97,,percent of total billed charges,,
PROPOFOL 10 MG/ML IV BOLUS,,J2704,HCPCS,Facility,Both,20 mL,mL,,26,22.1,7.4516,26,"Health Partners, Inc.",Commercial,24.596,94.6,,percent of total billed charges,,
PROPOFOL 10 MG/ML IV BOLUS,,J2704,HCPCS,Facility,Outpatient,20 mL,mL,,26,22.1,7.4516,26,"Health Partners, Inc.",Medicare Advantage,12.74,49,,percent of total billed charges,,
PROPOFOL 10 MG/ML IV BOLUS,,J2704,HCPCS,Facility,Inpatient,20 mL,mL,,26,22.1,7.4516,26,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PROPOFOL 10 MG/ML IV BOLUS,,J2704,HCPCS,Facility,Both,20 mL,mL,,26,22.1,7.4516,26,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),15.6,60,,percent of total billed charges,,
PROPOFOL 10 MG/ML IV BOLUS,,J2704,HCPCS,Facility,Both,20 mL,mL,,26,22.1,7.4516,26,"Health Partners, Inc.",State of Minnesota Advantage Program,21.19,81.5,,percent of total billed charges,,
PROPOFOL 10 MG/ML IV BOLUS,,J2704,HCPCS,Facility,Both,20 mL,mL,,26,22.1,7.4516,26,"Health Partners, Inc.",State Public Programs,13,50,,percent of total billed charges,,
PROPOFOL 10 MG/ML IV BOLUS,,J2704,HCPCS,Facility,Both,20 mL,mL,,26,22.1,7.4516,26,Humana Insurance Company,Commercial PPO,24.7,95,,percent of total billed charges,,
PROPOFOL 10 MG/ML IV BOLUS,,J2704,HCPCS,Facility,Outpatient,20 mL,mL,,26,22.1,7.4516,26,Humana Insurance Company,Medicare PPO,12.74,49,,percent of total billed charges,,
PROPOFOL 10 MG/ML IV BOLUS,,J2704,HCPCS,Facility,Inpatient,20 mL,mL,,26,22.1,7.4516,26,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
PROPOFOL 10 MG/ML IV BOLUS,,J2704,HCPCS,Facility,Both,20 mL,mL,,26,22.1,7.4516,26,Medica,Individual & Family,25.766,99.1,,percent of total billed charges,,
PROPOFOL 10 MG/ML IV BOLUS,,J2704,HCPCS,Facility,Outpatient,20 mL,mL,,26,22.1,7.4516,26,Medica,Medica Advantage Solution,12.948,49.8,,percent of total billed charges,,
PROPOFOL 10 MG/ML IV BOLUS,,J2704,HCPCS,Facility,Inpatient,20 mL,mL,,26,22.1,7.4516,26,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
PROPOFOL 10 MG/ML IV BOLUS,,J2704,HCPCS,Facility,Outpatient,20 mL,mL,,26,22.1,7.4516,26,Medica,Medical Assistance,11.596,44.6,,percent of total billed charges,,
PROPOFOL 10 MG/ML IV BOLUS,,J2704,HCPCS,Facility,Inpatient,20 mL,mL,,26,22.1,7.4516,26,Medica,Medical Assistance,,,,,Included in per diem rate,
PROPOFOL 10 MG/ML IV BOLUS,,J2704,HCPCS,Facility,Outpatient,20 mL,mL,,26,22.1,7.4516,26,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,12.948,49.8,,percent of total billed charges,,
PROPOFOL 10 MG/ML IV BOLUS,,J2704,HCPCS,Facility,Inpatient,20 mL,mL,,26,22.1,7.4516,26,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
PROPOFOL 10 MG/ML IV BOLUS,,J2704,HCPCS,Facility,Both,20 mL,mL,,26,22.1,7.4516,26,"Multiplan, Inc.","Multiplan, Inc.",24.44,94,,percent of total billed charges,,
PROPOFOL 10 MG/ML IV BOLUS,,J2704,HCPCS,Facility,Outpatient,20 mL,mL,,26,22.1,7.4516,26,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,23.426,90.1,,percent of total billed charges,,
PROPOFOL 10 MG/ML IV BOLUS,,J2704,HCPCS,Facility,Inpatient,20 mL,mL,,26,22.1,7.4516,26,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
PROPOFOL 10 MG/ML IV BOLUS,,J2704,HCPCS,Facility,Both,20 mL,mL,,26,22.1,7.4516,26,"Preferred One Administrative Services, INC.",PPO,25.636,98.6,,percent of total billed charges,,
PROPOFOL 10 MG/ML IV BOLUS,,J2704,HCPCS,Facility,Outpatient,20 mL,mL,,26,22.1,7.4516,26,PrimeWest Health,Minnesota Senior Health Options (MSHO),13.377,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
PROPOFOL 10 MG/ML IV BOLUS,,J2704,HCPCS,Facility,Inpatient,20 mL,mL,,26,22.1,7.4516,26,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PROPOFOL 10 MG/ML IV BOLUS,,J2704,HCPCS,Facility,Outpatient,20 mL,mL,,26,22.1,7.4516,26,PrimeWest Health,MinnesotaCare,13.3536,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
PROPOFOL 10 MG/ML IV BOLUS,,J2704,HCPCS,Facility,Inpatient,20 mL,mL,,26,22.1,7.4516,26,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
PROPOFOL 10 MG/ML IV BOLUS,,J2704,HCPCS,Facility,Both,20 mL,mL,,26,22.1,7.4516,26,Sanford Health Plan,Sanford Health Plan,23.92,92,,percent of total billed charges,,
PROPOFOL 10 MG/ML IV BOLUS,,J2704,HCPCS,Facility,Outpatient,20 mL,mL,,26,22.1,7.4516,26,"UCare Health, Inc.",Individual & Family Plan,14.651,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
PROPOFOL 10 MG/ML IV BOLUS,,J2704,HCPCS,Facility,Inpatient,20 mL,mL,,26,22.1,7.4516,26,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
PROPOFOL 10 MG/ML IV BOLUS,,J2704,HCPCS,Facility,Outpatient,20 mL,mL,,26,22.1,7.4516,26,"UCare Health, Inc.",Medical Assistance,13.1222,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PROPOFOL 10 MG/ML IV BOLUS,,J2704,HCPCS,Facility,Inpatient,20 mL,mL,,26,22.1,7.4516,26,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
PROPOFOL 10 MG/ML IV BOLUS,,J2704,HCPCS,Facility,Outpatient,20 mL,mL,,26,22.1,7.4516,26,"UCare Health, Inc.",Medicare Advantage,13.1222,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PROPOFOL 10 MG/ML IV BOLUS,,J2704,HCPCS,Facility,Inpatient,20 mL,mL,,26,22.1,7.4516,26,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PROPOFOL 10 MG/ML IV BOLUS,,J2704,HCPCS,Facility,Outpatient,20 mL,mL,,26,22.1,7.4516,26,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),13.1222,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PROPOFOL 10 MG/ML IV BOLUS,,J2704,HCPCS,Facility,Inpatient,20 mL,mL,,26,22.1,7.4516,26,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PROPOFOL 10 MG/ML IV BOLUS,,J2704,HCPCS,Facility,Both,20 mL,mL,,26,22.1,7.4516,26,UnitedHealthcare,Individual & Family,24.44,94,,percent of total billed charges,,
PROPOFOL 10 MG/ML IV BOLUS,,J2704,HCPCS,Facility,Outpatient,20 mL,mL,,26,22.1,7.4516,26,UnitedHealthcare,Medicare Advantage,12.74,49,,percent of total billed charges,,
PROPOFOL 10 MG/ML IV BOLUS,,J2704,HCPCS,Facility,Inpatient,20 mL,mL,,26,22.1,7.4516,26,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
PROPOFOL 10 MG/ML IV BOLUS,,J2704,HCPCS,Facility,Outpatient,20 mL,mL,,26,22.1,7.4516,26,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,12.48,48,,percent of total billed charges,,100% of DHS outpatient percentage
PROPOFOL 10 MG/ML IV BOLUS,,J2704,HCPCS,Facility,Inpatient,20 mL,mL,,26,22.1,7.4516,26,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
PROPOFOL 10 MG/ML IV EMUL,,J2704,HCPCS,Facility,Both,20 mL,mL,,15,12.75,4.299,15,Aetna,Commercial,13.8,92,,percent of total billed charges,,
PROPOFOL 10 MG/ML IV EMUL,,J2704,HCPCS,Facility,Outpatient,20 mL,mL,,15,12.75,4.299,15,Aetna,Medicare Advantage,7.35,49,,percent of total billed charges,,
PROPOFOL 10 MG/ML IV EMUL,,J2704,HCPCS,Facility,Inpatient,20 mL,mL,,15,12.75,4.299,15,Aetna,Medicare Advantage,,,,,Included in per diem rate,
PROPOFOL 10 MG/ML IV EMUL,,J2704,HCPCS,Facility,Both,20 mL,mL,,15,12.75,4.299,15,Aetna,PPO,13.95,93,,percent of total billed charges,,
PROPOFOL 10 MG/ML IV EMUL,,J2704,HCPCS,Facility,Both,20 mL,mL,,15,12.75,4.299,15,America's PPO,America's PPO,14.4045,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
PROPOFOL 10 MG/ML IV EMUL,,J2704,HCPCS,Facility,Both,20 mL,mL,,15,12.75,4.299,15,BlueCross BlueShield Minnesota, Federal Employee Program,14.76,98.4,,percent of total billed charges,,
PROPOFOL 10 MG/ML IV EMUL,,J2704,HCPCS,Facility,Both,20 mL,mL,,15,12.75,4.299,15,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,15,100,,percent of total billed charges,,
PROPOFOL 10 MG/ML IV EMUL,,J2704,HCPCS,Facility,Both,20 mL,mL,,15,12.75,4.299,15,BlueCross BlueShield Minnesota,High Value Network Plan,13.5,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
PROPOFOL 10 MG/ML IV EMUL,,J2704,HCPCS,Facility,Outpatient,20 mL,mL,,15,12.75,4.299,15,BlueCross BlueShield Minnesota,Medicare Advantage,7.35,49,,percent of total billed charges,,
PROPOFOL 10 MG/ML IV EMUL,,J2704,HCPCS,Facility,Inpatient,20 mL,mL,,15,12.75,4.299,15,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
PROPOFOL 10 MG/ML IV EMUL,,J2704,HCPCS,Facility,Both,20 mL,mL,,15,12.75,4.299,15,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,13.2855,88.57,,percent of total billed charges,,
PROPOFOL 10 MG/ML IV EMUL,,J2704,HCPCS,Facility,Both,20 mL,mL,,15,12.75,4.299,15,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,4.299,28.66,,percent of total billed charges,,
PROPOFOL 10 MG/ML IV EMUL,,J2704,HCPCS,Facility,Outpatient,20 mL,mL,,15,12.75,4.299,15,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),7.35,49,,percent of total billed charges,,
PROPOFOL 10 MG/ML IV EMUL,,J2704,HCPCS,Facility,Inpatient,20 mL,mL,,15,12.75,4.299,15,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
PROPOFOL 10 MG/ML IV EMUL,,J2704,HCPCS,Facility,Both,20 mL,mL,,15,12.75,4.299,15,CorVel,Worker's Compensation,15,100,,percent of total billed charges,,
PROPOFOL 10 MG/ML IV EMUL,,J2704,HCPCS,Facility,Both,20 mL,mL,,15,12.75,4.299,15,First Health Group Corporation,First Health Network,14.55,97,,percent of total billed charges,,
PROPOFOL 10 MG/ML IV EMUL,,J2704,HCPCS,Facility,Both,20 mL,mL,,15,12.75,4.299,15,"Health Partners, Inc.",Commercial,14.19,94.6,,percent of total billed charges,,
PROPOFOL 10 MG/ML IV EMUL,,J2704,HCPCS,Facility,Outpatient,20 mL,mL,,15,12.75,4.299,15,"Health Partners, Inc.",Medicare Advantage,7.35,49,,percent of total billed charges,,
PROPOFOL 10 MG/ML IV EMUL,,J2704,HCPCS,Facility,Inpatient,20 mL,mL,,15,12.75,4.299,15,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PROPOFOL 10 MG/ML IV EMUL,,J2704,HCPCS,Facility,Both,20 mL,mL,,15,12.75,4.299,15,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),9,60,,percent of total billed charges,,
PROPOFOL 10 MG/ML IV EMUL,,J2704,HCPCS,Facility,Both,20 mL,mL,,15,12.75,4.299,15,"Health Partners, Inc.",State of Minnesota Advantage Program,12.225,81.5,,percent of total billed charges,,
PROPOFOL 10 MG/ML IV EMUL,,J2704,HCPCS,Facility,Both,20 mL,mL,,15,12.75,4.299,15,"Health Partners, Inc.",State Public Programs,7.5,50,,percent of total billed charges,,
PROPOFOL 10 MG/ML IV EMUL,,J2704,HCPCS,Facility,Both,20 mL,mL,,15,12.75,4.299,15,Humana Insurance Company,Commercial PPO,14.25,95,,percent of total billed charges,,
PROPOFOL 10 MG/ML IV EMUL,,J2704,HCPCS,Facility,Outpatient,20 mL,mL,,15,12.75,4.299,15,Humana Insurance Company,Medicare PPO,7.35,49,,percent of total billed charges,,
PROPOFOL 10 MG/ML IV EMUL,,J2704,HCPCS,Facility,Inpatient,20 mL,mL,,15,12.75,4.299,15,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
PROPOFOL 10 MG/ML IV EMUL,,J2704,HCPCS,Facility,Both,20 mL,mL,,15,12.75,4.299,15,Medica,Individual & Family,14.865,99.1,,percent of total billed charges,,
PROPOFOL 10 MG/ML IV EMUL,,J2704,HCPCS,Facility,Outpatient,20 mL,mL,,15,12.75,4.299,15,Medica,Medica Advantage Solution,7.47,49.8,,percent of total billed charges,,
PROPOFOL 10 MG/ML IV EMUL,,J2704,HCPCS,Facility,Inpatient,20 mL,mL,,15,12.75,4.299,15,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
PROPOFOL 10 MG/ML IV EMUL,,J2704,HCPCS,Facility,Outpatient,20 mL,mL,,15,12.75,4.299,15,Medica,Medical Assistance,6.69,44.6,,percent of total billed charges,,
PROPOFOL 10 MG/ML IV EMUL,,J2704,HCPCS,Facility,Inpatient,20 mL,mL,,15,12.75,4.299,15,Medica,Medical Assistance,,,,,Included in per diem rate,
PROPOFOL 10 MG/ML IV EMUL,,J2704,HCPCS,Facility,Outpatient,20 mL,mL,,15,12.75,4.299,15,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,7.47,49.8,,percent of total billed charges,,
PROPOFOL 10 MG/ML IV EMUL,,J2704,HCPCS,Facility,Inpatient,20 mL,mL,,15,12.75,4.299,15,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
PROPOFOL 10 MG/ML IV EMUL,,J2704,HCPCS,Facility,Both,20 mL,mL,,15,12.75,4.299,15,"Multiplan, Inc.","Multiplan, Inc.",14.1,94,,percent of total billed charges,,
PROPOFOL 10 MG/ML IV EMUL,,J2704,HCPCS,Facility,Outpatient,20 mL,mL,,15,12.75,4.299,15,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,13.515,90.1,,percent of total billed charges,,
PROPOFOL 10 MG/ML IV EMUL,,J2704,HCPCS,Facility,Inpatient,20 mL,mL,,15,12.75,4.299,15,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
PROPOFOL 10 MG/ML IV EMUL,,J2704,HCPCS,Facility,Both,20 mL,mL,,15,12.75,4.299,15,"Preferred One Administrative Services, INC.",PPO,14.79,98.6,,percent of total billed charges,,
PROPOFOL 10 MG/ML IV EMUL,,J2704,HCPCS,Facility,Outpatient,20 mL,mL,,15,12.75,4.299,15,PrimeWest Health,Minnesota Senior Health Options (MSHO),7.7175,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
PROPOFOL 10 MG/ML IV EMUL,,J2704,HCPCS,Facility,Inpatient,20 mL,mL,,15,12.75,4.299,15,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PROPOFOL 10 MG/ML IV EMUL,,J2704,HCPCS,Facility,Outpatient,20 mL,mL,,15,12.75,4.299,15,PrimeWest Health,MinnesotaCare,7.704,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
PROPOFOL 10 MG/ML IV EMUL,,J2704,HCPCS,Facility,Inpatient,20 mL,mL,,15,12.75,4.299,15,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
PROPOFOL 10 MG/ML IV EMUL,,J2704,HCPCS,Facility,Both,20 mL,mL,,15,12.75,4.299,15,Sanford Health Plan,Sanford Health Plan,13.8,92,,percent of total billed charges,,
PROPOFOL 10 MG/ML IV EMUL,,J2704,HCPCS,Facility,Outpatient,20 mL,mL,,15,12.75,4.299,15,"UCare Health, Inc.",Individual & Family Plan,8.4525,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
PROPOFOL 10 MG/ML IV EMUL,,J2704,HCPCS,Facility,Inpatient,20 mL,mL,,15,12.75,4.299,15,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
PROPOFOL 10 MG/ML IV EMUL,,J2704,HCPCS,Facility,Outpatient,20 mL,mL,,15,12.75,4.299,15,"UCare Health, Inc.",Medical Assistance,7.5705,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PROPOFOL 10 MG/ML IV EMUL,,J2704,HCPCS,Facility,Inpatient,20 mL,mL,,15,12.75,4.299,15,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
PROPOFOL 10 MG/ML IV EMUL,,J2704,HCPCS,Facility,Outpatient,20 mL,mL,,15,12.75,4.299,15,"UCare Health, Inc.",Medicare Advantage,7.5705,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PROPOFOL 10 MG/ML IV EMUL,,J2704,HCPCS,Facility,Inpatient,20 mL,mL,,15,12.75,4.299,15,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PROPOFOL 10 MG/ML IV EMUL,,J2704,HCPCS,Facility,Outpatient,20 mL,mL,,15,12.75,4.299,15,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),7.5705,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PROPOFOL 10 MG/ML IV EMUL,,J2704,HCPCS,Facility,Inpatient,20 mL,mL,,15,12.75,4.299,15,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PROPOFOL 10 MG/ML IV EMUL,,J2704,HCPCS,Facility,Both,20 mL,mL,,15,12.75,4.299,15,UnitedHealthcare,Individual & Family,14.1,94,,percent of total billed charges,,
PROPOFOL 10 MG/ML IV EMUL,,J2704,HCPCS,Facility,Outpatient,20 mL,mL,,15,12.75,4.299,15,UnitedHealthcare,Medicare Advantage,7.35,49,,percent of total billed charges,,
PROPOFOL 10 MG/ML IV EMUL,,J2704,HCPCS,Facility,Inpatient,20 mL,mL,,15,12.75,4.299,15,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
PROPOFOL 10 MG/ML IV EMUL,,J2704,HCPCS,Facility,Outpatient,20 mL,mL,,15,12.75,4.299,15,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,7.2,48,,percent of total billed charges,,100% of DHS outpatient percentage
PROPOFOL 10 MG/ML IV EMUL,,J2704,HCPCS,Facility,Inpatient,20 mL,mL,,15,12.75,4.299,15,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
ROPIVACAINE (PF) 10 MG/ML (1 %) INJ SOLN,,J2795,HCPCS,Facility,Both,20 mL,mL,,50,42.5,14.33,50,Aetna,Commercial,46,92,,percent of total billed charges,,
ROPIVACAINE (PF) 10 MG/ML (1 %) INJ SOLN,,J2795,HCPCS,Facility,Both,20 mL,mL,,123,104.55,35.2518,123,Aetna,Commercial,113.16,92,,percent of total billed charges,,
ROPIVACAINE (PF) 10 MG/ML (1 %) INJ SOLN,,J2795,HCPCS,Facility,Outpatient,20 mL,mL,,50,42.5,14.33,50,Aetna,Medicare Advantage,24.5,49,,percent of total billed charges,,
ROPIVACAINE (PF) 10 MG/ML (1 %) INJ SOLN,,J2795,HCPCS,Facility,Outpatient,20 mL,mL,,123,104.55,35.2518,123,Aetna,Medicare Advantage,60.27,49,,percent of total billed charges,,
ROPIVACAINE (PF) 10 MG/ML (1 %) INJ SOLN,,J2795,HCPCS,Facility,Inpatient,20 mL,mL,,50,42.5,14.33,50,Aetna,Medicare Advantage,,,,,Included in per diem rate,
ROPIVACAINE (PF) 10 MG/ML (1 %) INJ SOLN,,J2795,HCPCS,Facility,Inpatient,20 mL,mL,,123,104.55,35.2518,123,Aetna,Medicare Advantage,,,,,Included in per diem rate,
ROPIVACAINE (PF) 10 MG/ML (1 %) INJ SOLN,,J2795,HCPCS,Facility,Both,20 mL,mL,,50,42.5,14.33,50,Aetna,PPO,46.5,93,,percent of total billed charges,,
ROPIVACAINE (PF) 10 MG/ML (1 %) INJ SOLN,,J2795,HCPCS,Facility,Both,20 mL,mL,,123,104.55,35.2518,123,Aetna,PPO,114.39,93,,percent of total billed charges,,
ROPIVACAINE (PF) 10 MG/ML (1 %) INJ SOLN,,J2795,HCPCS,Facility,Both,20 mL,mL,,50,42.5,14.33,50,America's PPO,America's PPO,48.015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
ROPIVACAINE (PF) 10 MG/ML (1 %) INJ SOLN,,J2795,HCPCS,Facility,Both,20 mL,mL,,123,104.55,35.2518,123,America's PPO,America's PPO,118.1169,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
ROPIVACAINE (PF) 10 MG/ML (1 %) INJ SOLN,,J2795,HCPCS,Facility,Both,20 mL,mL,,50,42.5,14.33,50,BlueCross BlueShield Minnesota, Federal Employee Program,49.2,98.4,,percent of total billed charges,,
ROPIVACAINE (PF) 10 MG/ML (1 %) INJ SOLN,,J2795,HCPCS,Facility,Both,20 mL,mL,,123,104.55,35.2518,123,BlueCross BlueShield Minnesota, Federal Employee Program,121.032,98.4,,percent of total billed charges,,
ROPIVACAINE (PF) 10 MG/ML (1 %) INJ SOLN,,J2795,HCPCS,Facility,Both,20 mL,mL,,50,42.5,14.33,50,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,50,100,,percent of total billed charges,,
ROPIVACAINE (PF) 10 MG/ML (1 %) INJ SOLN,,J2795,HCPCS,Facility,Both,20 mL,mL,,123,104.55,35.2518,123,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,123,100,,percent of total billed charges,,
ROPIVACAINE (PF) 10 MG/ML (1 %) INJ SOLN,,J2795,HCPCS,Facility,Both,20 mL,mL,,50,42.5,14.33,50,BlueCross BlueShield Minnesota,High Value Network Plan,45,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
ROPIVACAINE (PF) 10 MG/ML (1 %) INJ SOLN,,J2795,HCPCS,Facility,Both,20 mL,mL,,123,104.55,35.2518,123,BlueCross BlueShield Minnesota,High Value Network Plan,110.7,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
ROPIVACAINE (PF) 10 MG/ML (1 %) INJ SOLN,,J2795,HCPCS,Facility,Outpatient,20 mL,mL,,50,42.5,14.33,50,BlueCross BlueShield Minnesota,Medicare Advantage,24.5,49,,percent of total billed charges,,
ROPIVACAINE (PF) 10 MG/ML (1 %) INJ SOLN,,J2795,HCPCS,Facility,Outpatient,20 mL,mL,,123,104.55,35.2518,123,BlueCross BlueShield Minnesota,Medicare Advantage,60.27,49,,percent of total billed charges,,
ROPIVACAINE (PF) 10 MG/ML (1 %) INJ SOLN,,J2795,HCPCS,Facility,Inpatient,20 mL,mL,,50,42.5,14.33,50,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
ROPIVACAINE (PF) 10 MG/ML (1 %) INJ SOLN,,J2795,HCPCS,Facility,Inpatient,20 mL,mL,,123,104.55,35.2518,123,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
ROPIVACAINE (PF) 10 MG/ML (1 %) INJ SOLN,,J2795,HCPCS,Facility,Both,20 mL,mL,,50,42.5,14.33,50,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,44.285,88.57,,percent of total billed charges,,
ROPIVACAINE (PF) 10 MG/ML (1 %) INJ SOLN,,J2795,HCPCS,Facility,Both,20 mL,mL,,123,104.55,35.2518,123,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,108.9411,88.57,,percent of total billed charges,,
ROPIVACAINE (PF) 10 MG/ML (1 %) INJ SOLN,,J2795,HCPCS,Facility,Both,20 mL,mL,,50,42.5,14.33,50,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,14.33,28.66,,percent of total billed charges,,
ROPIVACAINE (PF) 10 MG/ML (1 %) INJ SOLN,,J2795,HCPCS,Facility,Both,20 mL,mL,,123,104.55,35.2518,123,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,35.2518,28.66,,percent of total billed charges,,
ROPIVACAINE (PF) 10 MG/ML (1 %) INJ SOLN,,J2795,HCPCS,Facility,Outpatient,20 mL,mL,,50,42.5,14.33,50,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),24.5,49,,percent of total billed charges,,
ROPIVACAINE (PF) 10 MG/ML (1 %) INJ SOLN,,J2795,HCPCS,Facility,Outpatient,20 mL,mL,,123,104.55,35.2518,123,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),60.27,49,,percent of total billed charges,,
ROPIVACAINE (PF) 10 MG/ML (1 %) INJ SOLN,,J2795,HCPCS,Facility,Inpatient,20 mL,mL,,50,42.5,14.33,50,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
ROPIVACAINE (PF) 10 MG/ML (1 %) INJ SOLN,,J2795,HCPCS,Facility,Inpatient,20 mL,mL,,123,104.55,35.2518,123,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
ROPIVACAINE (PF) 10 MG/ML (1 %) INJ SOLN,,J2795,HCPCS,Facility,Both,20 mL,mL,,50,42.5,14.33,50,CorVel,Worker's Compensation,50,100,,percent of total billed charges,,
ROPIVACAINE (PF) 10 MG/ML (1 %) INJ SOLN,,J2795,HCPCS,Facility,Both,20 mL,mL,,123,104.55,35.2518,123,CorVel,Worker's Compensation,123,100,,percent of total billed charges,,
ROPIVACAINE (PF) 10 MG/ML (1 %) INJ SOLN,,J2795,HCPCS,Facility,Both,20 mL,mL,,50,42.5,14.33,50,First Health Group Corporation,First Health Network,48.5,97,,percent of total billed charges,,
ROPIVACAINE (PF) 10 MG/ML (1 %) INJ SOLN,,J2795,HCPCS,Facility,Both,20 mL,mL,,123,104.55,35.2518,123,First Health Group Corporation,First Health Network,119.31,97,,percent of total billed charges,,
ROPIVACAINE (PF) 10 MG/ML (1 %) INJ SOLN,,J2795,HCPCS,Facility,Both,20 mL,mL,,50,42.5,14.33,50,"Health Partners, Inc.",Commercial,47.3,94.6,,percent of total billed charges,,
ROPIVACAINE (PF) 10 MG/ML (1 %) INJ SOLN,,J2795,HCPCS,Facility,Both,20 mL,mL,,123,104.55,35.2518,123,"Health Partners, Inc.",Commercial,116.358,94.6,,percent of total billed charges,,
ROPIVACAINE (PF) 10 MG/ML (1 %) INJ SOLN,,J2795,HCPCS,Facility,Outpatient,20 mL,mL,,50,42.5,14.33,50,"Health Partners, Inc.",Medicare Advantage,24.5,49,,percent of total billed charges,,
ROPIVACAINE (PF) 10 MG/ML (1 %) INJ SOLN,,J2795,HCPCS,Facility,Outpatient,20 mL,mL,,123,104.55,35.2518,123,"Health Partners, Inc.",Medicare Advantage,60.27,49,,percent of total billed charges,,
ROPIVACAINE (PF) 10 MG/ML (1 %) INJ SOLN,,J2795,HCPCS,Facility,Inpatient,20 mL,mL,,50,42.5,14.33,50,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ROPIVACAINE (PF) 10 MG/ML (1 %) INJ SOLN,,J2795,HCPCS,Facility,Inpatient,20 mL,mL,,123,104.55,35.2518,123,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ROPIVACAINE (PF) 10 MG/ML (1 %) INJ SOLN,,J2795,HCPCS,Facility,Both,20 mL,mL,,50,42.5,14.33,50,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),30,60,,percent of total billed charges,,
ROPIVACAINE (PF) 10 MG/ML (1 %) INJ SOLN,,J2795,HCPCS,Facility,Both,20 mL,mL,,123,104.55,35.2518,123,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),73.8,60,,percent of total billed charges,,
ROPIVACAINE (PF) 10 MG/ML (1 %) INJ SOLN,,J2795,HCPCS,Facility,Both,20 mL,mL,,50,42.5,14.33,50,"Health Partners, Inc.",State of Minnesota Advantage Program,40.75,81.5,,percent of total billed charges,,
ROPIVACAINE (PF) 10 MG/ML (1 %) INJ SOLN,,J2795,HCPCS,Facility,Both,20 mL,mL,,123,104.55,35.2518,123,"Health Partners, Inc.",State of Minnesota Advantage Program,100.245,81.5,,percent of total billed charges,,
ROPIVACAINE (PF) 10 MG/ML (1 %) INJ SOLN,,J2795,HCPCS,Facility,Both,20 mL,mL,,50,42.5,14.33,50,"Health Partners, Inc.",State Public Programs,25,50,,percent of total billed charges,,
ROPIVACAINE (PF) 10 MG/ML (1 %) INJ SOLN,,J2795,HCPCS,Facility,Both,20 mL,mL,,123,104.55,35.2518,123,"Health Partners, Inc.",State Public Programs,61.5,50,,percent of total billed charges,,
ROPIVACAINE (PF) 10 MG/ML (1 %) INJ SOLN,,J2795,HCPCS,Facility,Both,20 mL,mL,,50,42.5,14.33,50,Humana Insurance Company,Commercial PPO,47.5,95,,percent of total billed charges,,
ROPIVACAINE (PF) 10 MG/ML (1 %) INJ SOLN,,J2795,HCPCS,Facility,Both,20 mL,mL,,123,104.55,35.2518,123,Humana Insurance Company,Commercial PPO,116.85,95,,percent of total billed charges,,
ROPIVACAINE (PF) 10 MG/ML (1 %) INJ SOLN,,J2795,HCPCS,Facility,Outpatient,20 mL,mL,,50,42.5,14.33,50,Humana Insurance Company,Medicare PPO,24.5,49,,percent of total billed charges,,
ROPIVACAINE (PF) 10 MG/ML (1 %) INJ SOLN,,J2795,HCPCS,Facility,Outpatient,20 mL,mL,,123,104.55,35.2518,123,Humana Insurance Company,Medicare PPO,60.27,49,,percent of total billed charges,,
ROPIVACAINE (PF) 10 MG/ML (1 %) INJ SOLN,,J2795,HCPCS,Facility,Inpatient,20 mL,mL,,50,42.5,14.33,50,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
ROPIVACAINE (PF) 10 MG/ML (1 %) INJ SOLN,,J2795,HCPCS,Facility,Inpatient,20 mL,mL,,123,104.55,35.2518,123,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
ROPIVACAINE (PF) 10 MG/ML (1 %) INJ SOLN,,J2795,HCPCS,Facility,Both,20 mL,mL,,50,42.5,14.33,50,Medica,Individual & Family,49.55,99.1,,percent of total billed charges,,
ROPIVACAINE (PF) 10 MG/ML (1 %) INJ SOLN,,J2795,HCPCS,Facility,Both,20 mL,mL,,123,104.55,35.2518,123,Medica,Individual & Family,121.893,99.1,,percent of total billed charges,,
ROPIVACAINE (PF) 10 MG/ML (1 %) INJ SOLN,,J2795,HCPCS,Facility,Outpatient,20 mL,mL,,50,42.5,14.33,50,Medica,Medica Advantage Solution,24.9,49.8,,percent of total billed charges,,
ROPIVACAINE (PF) 10 MG/ML (1 %) INJ SOLN,,J2795,HCPCS,Facility,Outpatient,20 mL,mL,,123,104.55,35.2518,123,Medica,Medica Advantage Solution,61.254,49.8,,percent of total billed charges,,
ROPIVACAINE (PF) 10 MG/ML (1 %) INJ SOLN,,J2795,HCPCS,Facility,Inpatient,20 mL,mL,,50,42.5,14.33,50,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
ROPIVACAINE (PF) 10 MG/ML (1 %) INJ SOLN,,J2795,HCPCS,Facility,Inpatient,20 mL,mL,,123,104.55,35.2518,123,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
ROPIVACAINE (PF) 10 MG/ML (1 %) INJ SOLN,,J2795,HCPCS,Facility,Outpatient,20 mL,mL,,50,42.5,14.33,50,Medica,Medical Assistance,22.3,44.6,,percent of total billed charges,,
ROPIVACAINE (PF) 10 MG/ML (1 %) INJ SOLN,,J2795,HCPCS,Facility,Outpatient,20 mL,mL,,123,104.55,35.2518,123,Medica,Medical Assistance,54.858,44.6,,percent of total billed charges,,
ROPIVACAINE (PF) 10 MG/ML (1 %) INJ SOLN,,J2795,HCPCS,Facility,Inpatient,20 mL,mL,,50,42.5,14.33,50,Medica,Medical Assistance,,,,,Included in per diem rate,
ROPIVACAINE (PF) 10 MG/ML (1 %) INJ SOLN,,J2795,HCPCS,Facility,Inpatient,20 mL,mL,,123,104.55,35.2518,123,Medica,Medical Assistance,,,,,Included in per diem rate,
ROPIVACAINE (PF) 10 MG/ML (1 %) INJ SOLN,,J2795,HCPCS,Facility,Outpatient,20 mL,mL,,50,42.5,14.33,50,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,24.9,49.8,,percent of total billed charges,,
ROPIVACAINE (PF) 10 MG/ML (1 %) INJ SOLN,,J2795,HCPCS,Facility,Outpatient,20 mL,mL,,123,104.55,35.2518,123,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,61.254,49.8,,percent of total billed charges,,
ROPIVACAINE (PF) 10 MG/ML (1 %) INJ SOLN,,J2795,HCPCS,Facility,Inpatient,20 mL,mL,,50,42.5,14.33,50,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
ROPIVACAINE (PF) 10 MG/ML (1 %) INJ SOLN,,J2795,HCPCS,Facility,Inpatient,20 mL,mL,,123,104.55,35.2518,123,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
ROPIVACAINE (PF) 10 MG/ML (1 %) INJ SOLN,,J2795,HCPCS,Facility,Both,20 mL,mL,,50,42.5,14.33,50,"Multiplan, Inc.","Multiplan, Inc.",47,94,,percent of total billed charges,,
ROPIVACAINE (PF) 10 MG/ML (1 %) INJ SOLN,,J2795,HCPCS,Facility,Both,20 mL,mL,,123,104.55,35.2518,123,"Multiplan, Inc.","Multiplan, Inc.",115.62,94,,percent of total billed charges,,
ROPIVACAINE (PF) 10 MG/ML (1 %) INJ SOLN,,J2795,HCPCS,Facility,Outpatient,20 mL,mL,,50,42.5,14.33,50,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,45.05,90.1,,percent of total billed charges,,
ROPIVACAINE (PF) 10 MG/ML (1 %) INJ SOLN,,J2795,HCPCS,Facility,Outpatient,20 mL,mL,,123,104.55,35.2518,123,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,110.823,90.1,,percent of total billed charges,,
ROPIVACAINE (PF) 10 MG/ML (1 %) INJ SOLN,,J2795,HCPCS,Facility,Inpatient,20 mL,mL,,50,42.5,14.33,50,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
ROPIVACAINE (PF) 10 MG/ML (1 %) INJ SOLN,,J2795,HCPCS,Facility,Inpatient,20 mL,mL,,123,104.55,35.2518,123,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
ROPIVACAINE (PF) 10 MG/ML (1 %) INJ SOLN,,J2795,HCPCS,Facility,Both,20 mL,mL,,50,42.5,14.33,50,"Preferred One Administrative Services, INC.",PPO,49.3,98.6,,percent of total billed charges,,
ROPIVACAINE (PF) 10 MG/ML (1 %) INJ SOLN,,J2795,HCPCS,Facility,Both,20 mL,mL,,123,104.55,35.2518,123,"Preferred One Administrative Services, INC.",PPO,121.278,98.6,,percent of total billed charges,,
ROPIVACAINE (PF) 10 MG/ML (1 %) INJ SOLN,,J2795,HCPCS,Facility,Outpatient,20 mL,mL,,50,42.5,14.33,50,PrimeWest Health,Minnesota Senior Health Options (MSHO),25.725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
ROPIVACAINE (PF) 10 MG/ML (1 %) INJ SOLN,,J2795,HCPCS,Facility,Outpatient,20 mL,mL,,123,104.55,35.2518,123,PrimeWest Health,Minnesota Senior Health Options (MSHO),63.2835,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
ROPIVACAINE (PF) 10 MG/ML (1 %) INJ SOLN,,J2795,HCPCS,Facility,Inpatient,20 mL,mL,,50,42.5,14.33,50,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ROPIVACAINE (PF) 10 MG/ML (1 %) INJ SOLN,,J2795,HCPCS,Facility,Inpatient,20 mL,mL,,123,104.55,35.2518,123,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ROPIVACAINE (PF) 10 MG/ML (1 %) INJ SOLN,,J2795,HCPCS,Facility,Outpatient,20 mL,mL,,50,42.5,14.33,50,PrimeWest Health,MinnesotaCare,25.68,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
ROPIVACAINE (PF) 10 MG/ML (1 %) INJ SOLN,,J2795,HCPCS,Facility,Outpatient,20 mL,mL,,123,104.55,35.2518,123,PrimeWest Health,MinnesotaCare,63.1728,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
ROPIVACAINE (PF) 10 MG/ML (1 %) INJ SOLN,,J2795,HCPCS,Facility,Inpatient,20 mL,mL,,50,42.5,14.33,50,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
ROPIVACAINE (PF) 10 MG/ML (1 %) INJ SOLN,,J2795,HCPCS,Facility,Inpatient,20 mL,mL,,123,104.55,35.2518,123,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
ROPIVACAINE (PF) 10 MG/ML (1 %) INJ SOLN,,J2795,HCPCS,Facility,Both,20 mL,mL,,50,42.5,14.33,50,Sanford Health Plan,Sanford Health Plan,46,92,,percent of total billed charges,,
ROPIVACAINE (PF) 10 MG/ML (1 %) INJ SOLN,,J2795,HCPCS,Facility,Both,20 mL,mL,,123,104.55,35.2518,123,Sanford Health Plan,Sanford Health Plan,113.16,92,,percent of total billed charges,,
ROPIVACAINE (PF) 10 MG/ML (1 %) INJ SOLN,,J2795,HCPCS,Facility,Outpatient,20 mL,mL,,50,42.5,14.33,50,"UCare Health, Inc.",Individual & Family Plan,28.175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
ROPIVACAINE (PF) 10 MG/ML (1 %) INJ SOLN,,J2795,HCPCS,Facility,Outpatient,20 mL,mL,,123,104.55,35.2518,123,"UCare Health, Inc.",Individual & Family Plan,69.3105,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
ROPIVACAINE (PF) 10 MG/ML (1 %) INJ SOLN,,J2795,HCPCS,Facility,Inpatient,20 mL,mL,,50,42.5,14.33,50,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
ROPIVACAINE (PF) 10 MG/ML (1 %) INJ SOLN,,J2795,HCPCS,Facility,Inpatient,20 mL,mL,,123,104.55,35.2518,123,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
ROPIVACAINE (PF) 10 MG/ML (1 %) INJ SOLN,,J2795,HCPCS,Facility,Outpatient,20 mL,mL,,50,42.5,14.33,50,"UCare Health, Inc.",Medical Assistance,25.235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ROPIVACAINE (PF) 10 MG/ML (1 %) INJ SOLN,,J2795,HCPCS,Facility,Outpatient,20 mL,mL,,123,104.55,35.2518,123,"UCare Health, Inc.",Medical Assistance,62.0781,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ROPIVACAINE (PF) 10 MG/ML (1 %) INJ SOLN,,J2795,HCPCS,Facility,Inpatient,20 mL,mL,,50,42.5,14.33,50,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
ROPIVACAINE (PF) 10 MG/ML (1 %) INJ SOLN,,J2795,HCPCS,Facility,Inpatient,20 mL,mL,,123,104.55,35.2518,123,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
ROPIVACAINE (PF) 10 MG/ML (1 %) INJ SOLN,,J2795,HCPCS,Facility,Outpatient,20 mL,mL,,50,42.5,14.33,50,"UCare Health, Inc.",Medicare Advantage,25.235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ROPIVACAINE (PF) 10 MG/ML (1 %) INJ SOLN,,J2795,HCPCS,Facility,Outpatient,20 mL,mL,,123,104.55,35.2518,123,"UCare Health, Inc.",Medicare Advantage,62.0781,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ROPIVACAINE (PF) 10 MG/ML (1 %) INJ SOLN,,J2795,HCPCS,Facility,Inpatient,20 mL,mL,,50,42.5,14.33,50,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ROPIVACAINE (PF) 10 MG/ML (1 %) INJ SOLN,,J2795,HCPCS,Facility,Inpatient,20 mL,mL,,123,104.55,35.2518,123,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ROPIVACAINE (PF) 10 MG/ML (1 %) INJ SOLN,,J2795,HCPCS,Facility,Outpatient,20 mL,mL,,50,42.5,14.33,50,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),25.235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ROPIVACAINE (PF) 10 MG/ML (1 %) INJ SOLN,,J2795,HCPCS,Facility,Outpatient,20 mL,mL,,123,104.55,35.2518,123,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),62.0781,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ROPIVACAINE (PF) 10 MG/ML (1 %) INJ SOLN,,J2795,HCPCS,Facility,Inpatient,20 mL,mL,,50,42.5,14.33,50,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ROPIVACAINE (PF) 10 MG/ML (1 %) INJ SOLN,,J2795,HCPCS,Facility,Inpatient,20 mL,mL,,123,104.55,35.2518,123,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ROPIVACAINE (PF) 10 MG/ML (1 %) INJ SOLN,,J2795,HCPCS,Facility,Both,20 mL,mL,,50,42.5,14.33,50,UnitedHealthcare,Individual & Family,47,94,,percent of total billed charges,,
ROPIVACAINE (PF) 10 MG/ML (1 %) INJ SOLN,,J2795,HCPCS,Facility,Both,20 mL,mL,,123,104.55,35.2518,123,UnitedHealthcare,Individual & Family,115.62,94,,percent of total billed charges,,
ROPIVACAINE (PF) 10 MG/ML (1 %) INJ SOLN,,J2795,HCPCS,Facility,Outpatient,20 mL,mL,,50,42.5,14.33,50,UnitedHealthcare,Medicare Advantage,24.5,49,,percent of total billed charges,,
ROPIVACAINE (PF) 10 MG/ML (1 %) INJ SOLN,,J2795,HCPCS,Facility,Outpatient,20 mL,mL,,123,104.55,35.2518,123,UnitedHealthcare,Medicare Advantage,60.27,49,,percent of total billed charges,,
ROPIVACAINE (PF) 10 MG/ML (1 %) INJ SOLN,,J2795,HCPCS,Facility,Inpatient,20 mL,mL,,50,42.5,14.33,50,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
ROPIVACAINE (PF) 10 MG/ML (1 %) INJ SOLN,,J2795,HCPCS,Facility,Inpatient,20 mL,mL,,123,104.55,35.2518,123,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
ROPIVACAINE (PF) 10 MG/ML (1 %) INJ SOLN,,J2795,HCPCS,Facility,Outpatient,20 mL,mL,,50,42.5,14.33,50,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,24,48,,percent of total billed charges,,100% of DHS outpatient percentage
ROPIVACAINE (PF) 10 MG/ML (1 %) INJ SOLN,,J2795,HCPCS,Facility,Outpatient,20 mL,mL,,123,104.55,35.2518,123,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,59.04,48,,percent of total billed charges,,100% of DHS outpatient percentage
ROPIVACAINE (PF) 10 MG/ML (1 %) INJ SOLN,,J2795,HCPCS,Facility,Inpatient,20 mL,mL,,50,42.5,14.33,50,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
ROPIVACAINE (PF) 10 MG/ML (1 %) INJ SOLN,,J2795,HCPCS,Facility,Inpatient,20 mL,mL,,123,104.55,35.2518,123,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
ROPIVACAINE (PF) 5 MG/ML (0.5 %) INJ SOLN,,J2795,HCPCS,Facility,Both,20 mL,mL,,84,71.4,24.0744,84,Aetna,Commercial,77.28,92,,percent of total billed charges,,
ROPIVACAINE (PF) 5 MG/ML (0.5 %) INJ SOLN,,J2795,HCPCS,Facility,Outpatient,20 mL,mL,,84,71.4,24.0744,84,Aetna,Medicare Advantage,41.16,49,,percent of total billed charges,,
ROPIVACAINE (PF) 5 MG/ML (0.5 %) INJ SOLN,,J2795,HCPCS,Facility,Inpatient,20 mL,mL,,84,71.4,24.0744,84,Aetna,Medicare Advantage,,,,,Included in per diem rate,
ROPIVACAINE (PF) 5 MG/ML (0.5 %) INJ SOLN,,J2795,HCPCS,Facility,Both,20 mL,mL,,84,71.4,24.0744,84,Aetna,PPO,78.12,93,,percent of total billed charges,,
ROPIVACAINE (PF) 5 MG/ML (0.5 %) INJ SOLN,,J2795,HCPCS,Facility,Both,20 mL,mL,,84,71.4,24.0744,84,America's PPO,America's PPO,80.6652,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
ROPIVACAINE (PF) 5 MG/ML (0.5 %) INJ SOLN,,J2795,HCPCS,Facility,Both,20 mL,mL,,84,71.4,24.0744,84,BlueCross BlueShield Minnesota, Federal Employee Program,82.656,98.4,,percent of total billed charges,,
ROPIVACAINE (PF) 5 MG/ML (0.5 %) INJ SOLN,,J2795,HCPCS,Facility,Both,20 mL,mL,,84,71.4,24.0744,84,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,84,100,,percent of total billed charges,,
ROPIVACAINE (PF) 5 MG/ML (0.5 %) INJ SOLN,,J2795,HCPCS,Facility,Both,20 mL,mL,,84,71.4,24.0744,84,BlueCross BlueShield Minnesota,High Value Network Plan,75.6,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
ROPIVACAINE (PF) 5 MG/ML (0.5 %) INJ SOLN,,J2795,HCPCS,Facility,Outpatient,20 mL,mL,,84,71.4,24.0744,84,BlueCross BlueShield Minnesota,Medicare Advantage,41.16,49,,percent of total billed charges,,
ROPIVACAINE (PF) 5 MG/ML (0.5 %) INJ SOLN,,J2795,HCPCS,Facility,Inpatient,20 mL,mL,,84,71.4,24.0744,84,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
ROPIVACAINE (PF) 5 MG/ML (0.5 %) INJ SOLN,,J2795,HCPCS,Facility,Both,20 mL,mL,,84,71.4,24.0744,84,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,74.3988,88.57,,percent of total billed charges,,
ROPIVACAINE (PF) 5 MG/ML (0.5 %) INJ SOLN,,J2795,HCPCS,Facility,Both,20 mL,mL,,84,71.4,24.0744,84,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,24.0744,28.66,,percent of total billed charges,,
ROPIVACAINE (PF) 5 MG/ML (0.5 %) INJ SOLN,,J2795,HCPCS,Facility,Outpatient,20 mL,mL,,84,71.4,24.0744,84,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),41.16,49,,percent of total billed charges,,
ROPIVACAINE (PF) 5 MG/ML (0.5 %) INJ SOLN,,J2795,HCPCS,Facility,Inpatient,20 mL,mL,,84,71.4,24.0744,84,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
ROPIVACAINE (PF) 5 MG/ML (0.5 %) INJ SOLN,,J2795,HCPCS,Facility,Both,20 mL,mL,,84,71.4,24.0744,84,CorVel,Worker's Compensation,84,100,,percent of total billed charges,,
ROPIVACAINE (PF) 5 MG/ML (0.5 %) INJ SOLN,,J2795,HCPCS,Facility,Both,20 mL,mL,,84,71.4,24.0744,84,First Health Group Corporation,First Health Network,81.48,97,,percent of total billed charges,,
ROPIVACAINE (PF) 5 MG/ML (0.5 %) INJ SOLN,,J2795,HCPCS,Facility,Both,20 mL,mL,,84,71.4,24.0744,84,"Health Partners, Inc.",Commercial,79.464,94.6,,percent of total billed charges,,
ROPIVACAINE (PF) 5 MG/ML (0.5 %) INJ SOLN,,J2795,HCPCS,Facility,Outpatient,20 mL,mL,,84,71.4,24.0744,84,"Health Partners, Inc.",Medicare Advantage,41.16,49,,percent of total billed charges,,
ROPIVACAINE (PF) 5 MG/ML (0.5 %) INJ SOLN,,J2795,HCPCS,Facility,Inpatient,20 mL,mL,,84,71.4,24.0744,84,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ROPIVACAINE (PF) 5 MG/ML (0.5 %) INJ SOLN,,J2795,HCPCS,Facility,Both,20 mL,mL,,84,71.4,24.0744,84,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),50.4,60,,percent of total billed charges,,
ROPIVACAINE (PF) 5 MG/ML (0.5 %) INJ SOLN,,J2795,HCPCS,Facility,Both,20 mL,mL,,84,71.4,24.0744,84,"Health Partners, Inc.",State of Minnesota Advantage Program,68.46,81.5,,percent of total billed charges,,
ROPIVACAINE (PF) 5 MG/ML (0.5 %) INJ SOLN,,J2795,HCPCS,Facility,Both,20 mL,mL,,84,71.4,24.0744,84,"Health Partners, Inc.",State Public Programs,42,50,,percent of total billed charges,,
ROPIVACAINE (PF) 5 MG/ML (0.5 %) INJ SOLN,,J2795,HCPCS,Facility,Both,20 mL,mL,,84,71.4,24.0744,84,Humana Insurance Company,Commercial PPO,79.8,95,,percent of total billed charges,,
ROPIVACAINE (PF) 5 MG/ML (0.5 %) INJ SOLN,,J2795,HCPCS,Facility,Outpatient,20 mL,mL,,84,71.4,24.0744,84,Humana Insurance Company,Medicare PPO,41.16,49,,percent of total billed charges,,
ROPIVACAINE (PF) 5 MG/ML (0.5 %) INJ SOLN,,J2795,HCPCS,Facility,Inpatient,20 mL,mL,,84,71.4,24.0744,84,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
ROPIVACAINE (PF) 5 MG/ML (0.5 %) INJ SOLN,,J2795,HCPCS,Facility,Both,20 mL,mL,,84,71.4,24.0744,84,Medica,Individual & Family,83.244,99.1,,percent of total billed charges,,
ROPIVACAINE (PF) 5 MG/ML (0.5 %) INJ SOLN,,J2795,HCPCS,Facility,Outpatient,20 mL,mL,,84,71.4,24.0744,84,Medica,Medica Advantage Solution,41.832,49.8,,percent of total billed charges,,
ROPIVACAINE (PF) 5 MG/ML (0.5 %) INJ SOLN,,J2795,HCPCS,Facility,Inpatient,20 mL,mL,,84,71.4,24.0744,84,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
ROPIVACAINE (PF) 5 MG/ML (0.5 %) INJ SOLN,,J2795,HCPCS,Facility,Outpatient,20 mL,mL,,84,71.4,24.0744,84,Medica,Medical Assistance,37.464,44.6,,percent of total billed charges,,
ROPIVACAINE (PF) 5 MG/ML (0.5 %) INJ SOLN,,J2795,HCPCS,Facility,Inpatient,20 mL,mL,,84,71.4,24.0744,84,Medica,Medical Assistance,,,,,Included in per diem rate,
ROPIVACAINE (PF) 5 MG/ML (0.5 %) INJ SOLN,,J2795,HCPCS,Facility,Outpatient,20 mL,mL,,84,71.4,24.0744,84,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,41.832,49.8,,percent of total billed charges,,
ROPIVACAINE (PF) 5 MG/ML (0.5 %) INJ SOLN,,J2795,HCPCS,Facility,Inpatient,20 mL,mL,,84,71.4,24.0744,84,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
ROPIVACAINE (PF) 5 MG/ML (0.5 %) INJ SOLN,,J2795,HCPCS,Facility,Both,20 mL,mL,,84,71.4,24.0744,84,"Multiplan, Inc.","Multiplan, Inc.",78.96,94,,percent of total billed charges,,
ROPIVACAINE (PF) 5 MG/ML (0.5 %) INJ SOLN,,J2795,HCPCS,Facility,Outpatient,20 mL,mL,,84,71.4,24.0744,84,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,75.684,90.1,,percent of total billed charges,,
ROPIVACAINE (PF) 5 MG/ML (0.5 %) INJ SOLN,,J2795,HCPCS,Facility,Inpatient,20 mL,mL,,84,71.4,24.0744,84,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
ROPIVACAINE (PF) 5 MG/ML (0.5 %) INJ SOLN,,J2795,HCPCS,Facility,Both,20 mL,mL,,84,71.4,24.0744,84,"Preferred One Administrative Services, INC.",PPO,82.824,98.6,,percent of total billed charges,,
ROPIVACAINE (PF) 5 MG/ML (0.5 %) INJ SOLN,,J2795,HCPCS,Facility,Outpatient,20 mL,mL,,84,71.4,24.0744,84,PrimeWest Health,Minnesota Senior Health Options (MSHO),43.218,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
ROPIVACAINE (PF) 5 MG/ML (0.5 %) INJ SOLN,,J2795,HCPCS,Facility,Inpatient,20 mL,mL,,84,71.4,24.0744,84,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ROPIVACAINE (PF) 5 MG/ML (0.5 %) INJ SOLN,,J2795,HCPCS,Facility,Outpatient,20 mL,mL,,84,71.4,24.0744,84,PrimeWest Health,MinnesotaCare,43.1424,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
ROPIVACAINE (PF) 5 MG/ML (0.5 %) INJ SOLN,,J2795,HCPCS,Facility,Inpatient,20 mL,mL,,84,71.4,24.0744,84,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
ROPIVACAINE (PF) 5 MG/ML (0.5 %) INJ SOLN,,J2795,HCPCS,Facility,Both,20 mL,mL,,84,71.4,24.0744,84,Sanford Health Plan,Sanford Health Plan,77.28,92,,percent of total billed charges,,
ROPIVACAINE (PF) 5 MG/ML (0.5 %) INJ SOLN,,J2795,HCPCS,Facility,Outpatient,20 mL,mL,,84,71.4,24.0744,84,"UCare Health, Inc.",Individual & Family Plan,47.334,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
ROPIVACAINE (PF) 5 MG/ML (0.5 %) INJ SOLN,,J2795,HCPCS,Facility,Inpatient,20 mL,mL,,84,71.4,24.0744,84,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
ROPIVACAINE (PF) 5 MG/ML (0.5 %) INJ SOLN,,J2795,HCPCS,Facility,Outpatient,20 mL,mL,,84,71.4,24.0744,84,"UCare Health, Inc.",Medical Assistance,42.3948,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ROPIVACAINE (PF) 5 MG/ML (0.5 %) INJ SOLN,,J2795,HCPCS,Facility,Inpatient,20 mL,mL,,84,71.4,24.0744,84,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
ROPIVACAINE (PF) 5 MG/ML (0.5 %) INJ SOLN,,J2795,HCPCS,Facility,Outpatient,20 mL,mL,,84,71.4,24.0744,84,"UCare Health, Inc.",Medicare Advantage,42.3948,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ROPIVACAINE (PF) 5 MG/ML (0.5 %) INJ SOLN,,J2795,HCPCS,Facility,Inpatient,20 mL,mL,,84,71.4,24.0744,84,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ROPIVACAINE (PF) 5 MG/ML (0.5 %) INJ SOLN,,J2795,HCPCS,Facility,Outpatient,20 mL,mL,,84,71.4,24.0744,84,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),42.3948,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ROPIVACAINE (PF) 5 MG/ML (0.5 %) INJ SOLN,,J2795,HCPCS,Facility,Inpatient,20 mL,mL,,84,71.4,24.0744,84,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ROPIVACAINE (PF) 5 MG/ML (0.5 %) INJ SOLN,,J2795,HCPCS,Facility,Both,20 mL,mL,,84,71.4,24.0744,84,UnitedHealthcare,Individual & Family,78.96,94,,percent of total billed charges,,
ROPIVACAINE (PF) 5 MG/ML (0.5 %) INJ SOLN,,J2795,HCPCS,Facility,Outpatient,20 mL,mL,,84,71.4,24.0744,84,UnitedHealthcare,Medicare Advantage,41.16,49,,percent of total billed charges,,
ROPIVACAINE (PF) 5 MG/ML (0.5 %) INJ SOLN,,J2795,HCPCS,Facility,Inpatient,20 mL,mL,,84,71.4,24.0744,84,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
ROPIVACAINE (PF) 5 MG/ML (0.5 %) INJ SOLN,,J2795,HCPCS,Facility,Outpatient,20 mL,mL,,84,71.4,24.0744,84,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,40.32,48,,percent of total billed charges,,100% of DHS outpatient percentage
ROPIVACAINE (PF) 5 MG/ML (0.5 %) INJ SOLN,,J2795,HCPCS,Facility,Inpatient,20 mL,mL,,84,71.4,24.0744,84,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
ETOMIDATE 2 MG/ML IV SOLN,,J3490,HCPCS,Facility,Both,20 mL,mL,,39,33.15,11.1774,39,Aetna,Commercial,35.88,92,,percent of total billed charges,,
ETOMIDATE 2 MG/ML IV SOLN,,J3490,HCPCS,Facility,Outpatient,20 mL,mL,,39,33.15,11.1774,39,Aetna,Medicare Advantage,19.11,49,,percent of total billed charges,,
ETOMIDATE 2 MG/ML IV SOLN,,J3490,HCPCS,Facility,Inpatient,20 mL,mL,,39,33.15,11.1774,39,Aetna,Medicare Advantage,,,,,Included in per diem rate,
ETOMIDATE 2 MG/ML IV SOLN,,J3490,HCPCS,Facility,Both,20 mL,mL,,39,33.15,11.1774,39,Aetna,PPO,36.27,93,,percent of total billed charges,,
ETOMIDATE 2 MG/ML IV SOLN,,J3490,HCPCS,Facility,Both,20 mL,mL,,39,33.15,11.1774,39,America's PPO,America's PPO,37.4517,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
ETOMIDATE 2 MG/ML IV SOLN,,J3490,HCPCS,Facility,Both,20 mL,mL,,39,33.15,11.1774,39,BlueCross BlueShield Minnesota, Federal Employee Program,38.376,98.4,,percent of total billed charges,,
ETOMIDATE 2 MG/ML IV SOLN,,J3490,HCPCS,Facility,Both,20 mL,mL,,39,33.15,11.1774,39,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,39,100,,percent of total billed charges,,
ETOMIDATE 2 MG/ML IV SOLN,,J3490,HCPCS,Facility,Both,20 mL,mL,,39,33.15,11.1774,39,BlueCross BlueShield Minnesota,High Value Network Plan,35.1,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
ETOMIDATE 2 MG/ML IV SOLN,,J3490,HCPCS,Facility,Outpatient,20 mL,mL,,39,33.15,11.1774,39,BlueCross BlueShield Minnesota,Medicare Advantage,19.11,49,,percent of total billed charges,,
ETOMIDATE 2 MG/ML IV SOLN,,J3490,HCPCS,Facility,Inpatient,20 mL,mL,,39,33.15,11.1774,39,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
ETOMIDATE 2 MG/ML IV SOLN,,J3490,HCPCS,Facility,Both,20 mL,mL,,39,33.15,11.1774,39,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,34.5423,88.57,,percent of total billed charges,,
ETOMIDATE 2 MG/ML IV SOLN,,J3490,HCPCS,Facility,Both,20 mL,mL,,39,33.15,11.1774,39,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,11.1774,28.66,,percent of total billed charges,,
ETOMIDATE 2 MG/ML IV SOLN,,J3490,HCPCS,Facility,Outpatient,20 mL,mL,,39,33.15,11.1774,39,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),19.11,49,,percent of total billed charges,,
ETOMIDATE 2 MG/ML IV SOLN,,J3490,HCPCS,Facility,Inpatient,20 mL,mL,,39,33.15,11.1774,39,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
ETOMIDATE 2 MG/ML IV SOLN,,J3490,HCPCS,Facility,Both,20 mL,mL,,39,33.15,11.1774,39,CorVel,Worker's Compensation,39,100,,percent of total billed charges,,
ETOMIDATE 2 MG/ML IV SOLN,,J3490,HCPCS,Facility,Both,20 mL,mL,,39,33.15,11.1774,39,First Health Group Corporation,First Health Network,37.83,97,,percent of total billed charges,,
ETOMIDATE 2 MG/ML IV SOLN,,J3490,HCPCS,Facility,Both,20 mL,mL,,39,33.15,11.1774,39,"Health Partners, Inc.",Commercial,36.894,94.6,,percent of total billed charges,,
ETOMIDATE 2 MG/ML IV SOLN,,J3490,HCPCS,Facility,Outpatient,20 mL,mL,,39,33.15,11.1774,39,"Health Partners, Inc.",Medicare Advantage,19.11,49,,percent of total billed charges,,
ETOMIDATE 2 MG/ML IV SOLN,,J3490,HCPCS,Facility,Inpatient,20 mL,mL,,39,33.15,11.1774,39,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ETOMIDATE 2 MG/ML IV SOLN,,J3490,HCPCS,Facility,Both,20 mL,mL,,39,33.15,11.1774,39,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),23.4,60,,percent of total billed charges,,
ETOMIDATE 2 MG/ML IV SOLN,,J3490,HCPCS,Facility,Both,20 mL,mL,,39,33.15,11.1774,39,"Health Partners, Inc.",State of Minnesota Advantage Program,31.785,81.5,,percent of total billed charges,,
ETOMIDATE 2 MG/ML IV SOLN,,J3490,HCPCS,Facility,Both,20 mL,mL,,39,33.15,11.1774,39,"Health Partners, Inc.",State Public Programs,19.5,50,,percent of total billed charges,,
ETOMIDATE 2 MG/ML IV SOLN,,J3490,HCPCS,Facility,Both,20 mL,mL,,39,33.15,11.1774,39,Humana Insurance Company,Commercial PPO,37.05,95,,percent of total billed charges,,
ETOMIDATE 2 MG/ML IV SOLN,,J3490,HCPCS,Facility,Outpatient,20 mL,mL,,39,33.15,11.1774,39,Humana Insurance Company,Medicare PPO,19.11,49,,percent of total billed charges,,
ETOMIDATE 2 MG/ML IV SOLN,,J3490,HCPCS,Facility,Inpatient,20 mL,mL,,39,33.15,11.1774,39,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
ETOMIDATE 2 MG/ML IV SOLN,,J3490,HCPCS,Facility,Both,20 mL,mL,,39,33.15,11.1774,39,Medica,Individual & Family,38.649,99.1,,percent of total billed charges,,
ETOMIDATE 2 MG/ML IV SOLN,,J3490,HCPCS,Facility,Outpatient,20 mL,mL,,39,33.15,11.1774,39,Medica,Medica Advantage Solution,19.422,49.8,,percent of total billed charges,,
ETOMIDATE 2 MG/ML IV SOLN,,J3490,HCPCS,Facility,Inpatient,20 mL,mL,,39,33.15,11.1774,39,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
ETOMIDATE 2 MG/ML IV SOLN,,J3490,HCPCS,Facility,Outpatient,20 mL,mL,,39,33.15,11.1774,39,Medica,Medical Assistance,17.394,44.6,,percent of total billed charges,,
ETOMIDATE 2 MG/ML IV SOLN,,J3490,HCPCS,Facility,Inpatient,20 mL,mL,,39,33.15,11.1774,39,Medica,Medical Assistance,,,,,Included in per diem rate,
ETOMIDATE 2 MG/ML IV SOLN,,J3490,HCPCS,Facility,Outpatient,20 mL,mL,,39,33.15,11.1774,39,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,19.422,49.8,,percent of total billed charges,,
ETOMIDATE 2 MG/ML IV SOLN,,J3490,HCPCS,Facility,Inpatient,20 mL,mL,,39,33.15,11.1774,39,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
ETOMIDATE 2 MG/ML IV SOLN,,J3490,HCPCS,Facility,Both,20 mL,mL,,39,33.15,11.1774,39,"Multiplan, Inc.","Multiplan, Inc.",36.66,94,,percent of total billed charges,,
ETOMIDATE 2 MG/ML IV SOLN,,J3490,HCPCS,Facility,Outpatient,20 mL,mL,,39,33.15,11.1774,39,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,35.139,90.1,,percent of total billed charges,,
ETOMIDATE 2 MG/ML IV SOLN,,J3490,HCPCS,Facility,Inpatient,20 mL,mL,,39,33.15,11.1774,39,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
ETOMIDATE 2 MG/ML IV SOLN,,J3490,HCPCS,Facility,Both,20 mL,mL,,39,33.15,11.1774,39,"Preferred One Administrative Services, INC.",PPO,38.454,98.6,,percent of total billed charges,,
ETOMIDATE 2 MG/ML IV SOLN,,J3490,HCPCS,Facility,Outpatient,20 mL,mL,,39,33.15,11.1774,39,PrimeWest Health,Minnesota Senior Health Options (MSHO),20.0655,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
ETOMIDATE 2 MG/ML IV SOLN,,J3490,HCPCS,Facility,Inpatient,20 mL,mL,,39,33.15,11.1774,39,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ETOMIDATE 2 MG/ML IV SOLN,,J3490,HCPCS,Facility,Outpatient,20 mL,mL,,39,33.15,11.1774,39,PrimeWest Health,MinnesotaCare,20.0304,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
ETOMIDATE 2 MG/ML IV SOLN,,J3490,HCPCS,Facility,Inpatient,20 mL,mL,,39,33.15,11.1774,39,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
ETOMIDATE 2 MG/ML IV SOLN,,J3490,HCPCS,Facility,Both,20 mL,mL,,39,33.15,11.1774,39,Sanford Health Plan,Sanford Health Plan,35.88,92,,percent of total billed charges,,
ETOMIDATE 2 MG/ML IV SOLN,,J3490,HCPCS,Facility,Outpatient,20 mL,mL,,39,33.15,11.1774,39,"UCare Health, Inc.",Individual & Family Plan,21.9765,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
ETOMIDATE 2 MG/ML IV SOLN,,J3490,HCPCS,Facility,Inpatient,20 mL,mL,,39,33.15,11.1774,39,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
ETOMIDATE 2 MG/ML IV SOLN,,J3490,HCPCS,Facility,Outpatient,20 mL,mL,,39,33.15,11.1774,39,"UCare Health, Inc.",Medical Assistance,19.6833,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ETOMIDATE 2 MG/ML IV SOLN,,J3490,HCPCS,Facility,Inpatient,20 mL,mL,,39,33.15,11.1774,39,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
ETOMIDATE 2 MG/ML IV SOLN,,J3490,HCPCS,Facility,Outpatient,20 mL,mL,,39,33.15,11.1774,39,"UCare Health, Inc.",Medicare Advantage,19.6833,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ETOMIDATE 2 MG/ML IV SOLN,,J3490,HCPCS,Facility,Inpatient,20 mL,mL,,39,33.15,11.1774,39,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ETOMIDATE 2 MG/ML IV SOLN,,J3490,HCPCS,Facility,Outpatient,20 mL,mL,,39,33.15,11.1774,39,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),19.6833,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ETOMIDATE 2 MG/ML IV SOLN,,J3490,HCPCS,Facility,Inpatient,20 mL,mL,,39,33.15,11.1774,39,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ETOMIDATE 2 MG/ML IV SOLN,,J3490,HCPCS,Facility,Both,20 mL,mL,,39,33.15,11.1774,39,UnitedHealthcare,Individual & Family,36.66,94,,percent of total billed charges,,
ETOMIDATE 2 MG/ML IV SOLN,,J3490,HCPCS,Facility,Outpatient,20 mL,mL,,39,33.15,11.1774,39,UnitedHealthcare,Medicare Advantage,19.11,49,,percent of total billed charges,,
ETOMIDATE 2 MG/ML IV SOLN,,J3490,HCPCS,Facility,Inpatient,20 mL,mL,,39,33.15,11.1774,39,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
ETOMIDATE 2 MG/ML IV SOLN,,J3490,HCPCS,Facility,Outpatient,20 mL,mL,,39,33.15,11.1774,39,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,18.72,48,,percent of total billed charges,,100% of DHS outpatient percentage
ETOMIDATE 2 MG/ML IV SOLN,,J3490,HCPCS,Facility,Inpatient,20 mL,mL,,39,33.15,11.1774,39,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
NICARDIPINE IN NACL (ISO-OS) 20 MG/200 ML (0.1 MG/ML) IV PGBK,,83897,LOCAL,Facility,Both,200 mL,mL,,476,404.6,136.4216,476,Aetna,Commercial,437.92,92,,percent of total billed charges,,
NICARDIPINE IN NACL (ISO-OS) 20 MG/200 ML (0.1 MG/ML) IV PGBK,,83897,LOCAL,Facility,Outpatient,200 mL,mL,,476,404.6,136.4216,476,Aetna,Medicare Advantage,233.24,49,,percent of total billed charges,,
NICARDIPINE IN NACL (ISO-OS) 20 MG/200 ML (0.1 MG/ML) IV PGBK,,83897,LOCAL,Facility,Inpatient,200 mL,mL,,476,404.6,136.4216,476,Aetna,Medicare Advantage,,,,,Included in per diem rate,
NICARDIPINE IN NACL (ISO-OS) 20 MG/200 ML (0.1 MG/ML) IV PGBK,,83897,LOCAL,Facility,Both,200 mL,mL,,476,404.6,136.4216,476,Aetna,PPO,442.68,93,,percent of total billed charges,,
NICARDIPINE IN NACL (ISO-OS) 20 MG/200 ML (0.1 MG/ML) IV PGBK,,83897,LOCAL,Facility,Both,200 mL,mL,,476,404.6,136.4216,476,America's PPO,America's PPO,457.1028,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
NICARDIPINE IN NACL (ISO-OS) 20 MG/200 ML (0.1 MG/ML) IV PGBK,,83897,LOCAL,Facility,Both,200 mL,mL,,476,404.6,136.4216,476,BlueCross BlueShield Minnesota, Federal Employee Program,468.384,98.4,,percent of total billed charges,,
NICARDIPINE IN NACL (ISO-OS) 20 MG/200 ML (0.1 MG/ML) IV PGBK,,83897,LOCAL,Facility,Both,200 mL,mL,,476,404.6,136.4216,476,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,476,100,,percent of total billed charges,,
NICARDIPINE IN NACL (ISO-OS) 20 MG/200 ML (0.1 MG/ML) IV PGBK,,83897,LOCAL,Facility,Both,200 mL,mL,,476,404.6,136.4216,476,BlueCross BlueShield Minnesota,High Value Network Plan,428.4,90,,percent of total billed charges,,
NICARDIPINE IN NACL (ISO-OS) 20 MG/200 ML (0.1 MG/ML) IV PGBK,,83897,LOCAL,Facility,Outpatient,200 mL,mL,,476,404.6,136.4216,476,BlueCross BlueShield Minnesota,Medicare Advantage,233.24,49,,percent of total billed charges,,
NICARDIPINE IN NACL (ISO-OS) 20 MG/200 ML (0.1 MG/ML) IV PGBK,,83897,LOCAL,Facility,Inpatient,200 mL,mL,,476,404.6,136.4216,476,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
NICARDIPINE IN NACL (ISO-OS) 20 MG/200 ML (0.1 MG/ML) IV PGBK,,83897,LOCAL,Facility,Both,200 mL,mL,,476,404.6,136.4216,476,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,421.5932,88.57,,percent of total billed charges,,
NICARDIPINE IN NACL (ISO-OS) 20 MG/200 ML (0.1 MG/ML) IV PGBK,,83897,LOCAL,Facility,Both,200 mL,mL,,476,404.6,136.4216,476,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,136.4216,28.66,,percent of total billed charges,,
NICARDIPINE IN NACL (ISO-OS) 20 MG/200 ML (0.1 MG/ML) IV PGBK,,83897,LOCAL,Facility,Outpatient,200 mL,mL,,476,404.6,136.4216,476,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),233.24,49,,percent of total billed charges,,
NICARDIPINE IN NACL (ISO-OS) 20 MG/200 ML (0.1 MG/ML) IV PGBK,,83897,LOCAL,Facility,Inpatient,200 mL,mL,,476,404.6,136.4216,476,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
NICARDIPINE IN NACL (ISO-OS) 20 MG/200 ML (0.1 MG/ML) IV PGBK,,83897,LOCAL,Facility,Both,200 mL,mL,,476,404.6,136.4216,476,CorVel,Worker's Compensation,476,100,,percent of total billed charges,,
NICARDIPINE IN NACL (ISO-OS) 20 MG/200 ML (0.1 MG/ML) IV PGBK,,83897,LOCAL,Facility,Both,200 mL,mL,,476,404.6,136.4216,476,First Health Group Corporation,First Health Network,461.72,97,,percent of total billed charges,,
NICARDIPINE IN NACL (ISO-OS) 20 MG/200 ML (0.1 MG/ML) IV PGBK,,83897,LOCAL,Facility,Both,200 mL,mL,,476,404.6,136.4216,476,"Health Partners, Inc.",Commercial,450.296,94.6,,percent of total billed charges,,
NICARDIPINE IN NACL (ISO-OS) 20 MG/200 ML (0.1 MG/ML) IV PGBK,,83897,LOCAL,Facility,Outpatient,200 mL,mL,,476,404.6,136.4216,476,"Health Partners, Inc.",Medicare Advantage,233.24,49,,percent of total billed charges,,
NICARDIPINE IN NACL (ISO-OS) 20 MG/200 ML (0.1 MG/ML) IV PGBK,,83897,LOCAL,Facility,Inpatient,200 mL,mL,,476,404.6,136.4216,476,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
NICARDIPINE IN NACL (ISO-OS) 20 MG/200 ML (0.1 MG/ML) IV PGBK,,83897,LOCAL,Facility,Both,200 mL,mL,,476,404.6,136.4216,476,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),285.6,60,,percent of total billed charges,,
NICARDIPINE IN NACL (ISO-OS) 20 MG/200 ML (0.1 MG/ML) IV PGBK,,83897,LOCAL,Facility,Both,200 mL,mL,,476,404.6,136.4216,476,"Health Partners, Inc.",State of Minnesota Advantage Program,387.94,81.5,,percent of total billed charges,,
NICARDIPINE IN NACL (ISO-OS) 20 MG/200 ML (0.1 MG/ML) IV PGBK,,83897,LOCAL,Facility,Both,200 mL,mL,,476,404.6,136.4216,476,"Health Partners, Inc.",State Public Programs,238,50,,percent of total billed charges,,
NICARDIPINE IN NACL (ISO-OS) 20 MG/200 ML (0.1 MG/ML) IV PGBK,,83897,LOCAL,Facility,Both,200 mL,mL,,476,404.6,136.4216,476,Humana Insurance Company,Commercial PPO,452.2,95,,percent of total billed charges,,
NICARDIPINE IN NACL (ISO-OS) 20 MG/200 ML (0.1 MG/ML) IV PGBK,,83897,LOCAL,Facility,Outpatient,200 mL,mL,,476,404.6,136.4216,476,Humana Insurance Company,Medicare PPO,233.24,49,,percent of total billed charges,,
NICARDIPINE IN NACL (ISO-OS) 20 MG/200 ML (0.1 MG/ML) IV PGBK,,83897,LOCAL,Facility,Inpatient,200 mL,mL,,476,404.6,136.4216,476,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
NICARDIPINE IN NACL (ISO-OS) 20 MG/200 ML (0.1 MG/ML) IV PGBK,,83897,LOCAL,Facility,Both,200 mL,mL,,476,404.6,136.4216,476,Medica,Individual & Family,471.716,99.1,,percent of total billed charges,,
NICARDIPINE IN NACL (ISO-OS) 20 MG/200 ML (0.1 MG/ML) IV PGBK,,83897,LOCAL,Facility,Outpatient,200 mL,mL,,476,404.6,136.4216,476,Medica,Medica Advantage Solution,237.048,49.8,,percent of total billed charges,,
NICARDIPINE IN NACL (ISO-OS) 20 MG/200 ML (0.1 MG/ML) IV PGBK,,83897,LOCAL,Facility,Inpatient,200 mL,mL,,476,404.6,136.4216,476,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
NICARDIPINE IN NACL (ISO-OS) 20 MG/200 ML (0.1 MG/ML) IV PGBK,,83897,LOCAL,Facility,Outpatient,200 mL,mL,,476,404.6,136.4216,476,Medica,Medical Assistance,212.296,44.6,,percent of total billed charges,,
NICARDIPINE IN NACL (ISO-OS) 20 MG/200 ML (0.1 MG/ML) IV PGBK,,83897,LOCAL,Facility,Inpatient,200 mL,mL,,476,404.6,136.4216,476,Medica,Medical Assistance,,,,,Included in per diem rate,
NICARDIPINE IN NACL (ISO-OS) 20 MG/200 ML (0.1 MG/ML) IV PGBK,,83897,LOCAL,Facility,Outpatient,200 mL,mL,,476,404.6,136.4216,476,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,237.048,49.8,,percent of total billed charges,,
NICARDIPINE IN NACL (ISO-OS) 20 MG/200 ML (0.1 MG/ML) IV PGBK,,83897,LOCAL,Facility,Inpatient,200 mL,mL,,476,404.6,136.4216,476,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
NICARDIPINE IN NACL (ISO-OS) 20 MG/200 ML (0.1 MG/ML) IV PGBK,,83897,LOCAL,Facility,Both,200 mL,mL,,476,404.6,136.4216,476,"Multiplan, Inc.","Multiplan, Inc.",447.44,94,,percent of total billed charges,,
NICARDIPINE IN NACL (ISO-OS) 20 MG/200 ML (0.1 MG/ML) IV PGBK,,83897,LOCAL,Facility,Outpatient,200 mL,mL,,476,404.6,136.4216,476,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,428.876,90.1,,percent of total billed charges,,
NICARDIPINE IN NACL (ISO-OS) 20 MG/200 ML (0.1 MG/ML) IV PGBK,,83897,LOCAL,Facility,Inpatient,200 mL,mL,,476,404.6,136.4216,476,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
NICARDIPINE IN NACL (ISO-OS) 20 MG/200 ML (0.1 MG/ML) IV PGBK,,83897,LOCAL,Facility,Both,200 mL,mL,,476,404.6,136.4216,476,"Preferred One Administrative Services, INC.",PPO,469.336,98.6,,percent of total billed charges,,
NICARDIPINE IN NACL (ISO-OS) 20 MG/200 ML (0.1 MG/ML) IV PGBK,,83897,LOCAL,Facility,Outpatient,200 mL,mL,,476,404.6,136.4216,476,PrimeWest Health,Minnesota Senior Health Options (MSHO),244.902,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
NICARDIPINE IN NACL (ISO-OS) 20 MG/200 ML (0.1 MG/ML) IV PGBK,,83897,LOCAL,Facility,Inpatient,200 mL,mL,,476,404.6,136.4216,476,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
NICARDIPINE IN NACL (ISO-OS) 20 MG/200 ML (0.1 MG/ML) IV PGBK,,83897,LOCAL,Facility,Outpatient,200 mL,mL,,476,404.6,136.4216,476,PrimeWest Health,MinnesotaCare,244.4736,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
NICARDIPINE IN NACL (ISO-OS) 20 MG/200 ML (0.1 MG/ML) IV PGBK,,83897,LOCAL,Facility,Inpatient,200 mL,mL,,476,404.6,136.4216,476,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
NICARDIPINE IN NACL (ISO-OS) 20 MG/200 ML (0.1 MG/ML) IV PGBK,,83897,LOCAL,Facility,Both,200 mL,mL,,476,404.6,136.4216,476,Sanford Health Plan,Sanford Health Plan,437.92,92,,percent of total billed charges,,
NICARDIPINE IN NACL (ISO-OS) 20 MG/200 ML (0.1 MG/ML) IV PGBK,,83897,LOCAL,Facility,Outpatient,200 mL,mL,,476,404.6,136.4216,476,"UCare Health, Inc.",Individual & Family Plan,268.226,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
NICARDIPINE IN NACL (ISO-OS) 20 MG/200 ML (0.1 MG/ML) IV PGBK,,83897,LOCAL,Facility,Inpatient,200 mL,mL,,476,404.6,136.4216,476,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
NICARDIPINE IN NACL (ISO-OS) 20 MG/200 ML (0.1 MG/ML) IV PGBK,,83897,LOCAL,Facility,Outpatient,200 mL,mL,,476,404.6,136.4216,476,"UCare Health, Inc.",Medical Assistance,240.2372,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
NICARDIPINE IN NACL (ISO-OS) 20 MG/200 ML (0.1 MG/ML) IV PGBK,,83897,LOCAL,Facility,Inpatient,200 mL,mL,,476,404.6,136.4216,476,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
NICARDIPINE IN NACL (ISO-OS) 20 MG/200 ML (0.1 MG/ML) IV PGBK,,83897,LOCAL,Facility,Outpatient,200 mL,mL,,476,404.6,136.4216,476,"UCare Health, Inc.",Medicare Advantage,240.2372,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
NICARDIPINE IN NACL (ISO-OS) 20 MG/200 ML (0.1 MG/ML) IV PGBK,,83897,LOCAL,Facility,Inpatient,200 mL,mL,,476,404.6,136.4216,476,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
NICARDIPINE IN NACL (ISO-OS) 20 MG/200 ML (0.1 MG/ML) IV PGBK,,83897,LOCAL,Facility,Outpatient,200 mL,mL,,476,404.6,136.4216,476,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),240.2372,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
NICARDIPINE IN NACL (ISO-OS) 20 MG/200 ML (0.1 MG/ML) IV PGBK,,83897,LOCAL,Facility,Inpatient,200 mL,mL,,476,404.6,136.4216,476,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
NICARDIPINE IN NACL (ISO-OS) 20 MG/200 ML (0.1 MG/ML) IV PGBK,,83897,LOCAL,Facility,Both,200 mL,mL,,476,404.6,136.4216,476,UnitedHealthcare,Individual & Family,447.44,94,,percent of total billed charges,,
NICARDIPINE IN NACL (ISO-OS) 20 MG/200 ML (0.1 MG/ML) IV PGBK,,83897,LOCAL,Facility,Outpatient,200 mL,mL,,476,404.6,136.4216,476,UnitedHealthcare,Medicare Advantage,233.24,49,,percent of total billed charges,,
NICARDIPINE IN NACL (ISO-OS) 20 MG/200 ML (0.1 MG/ML) IV PGBK,,83897,LOCAL,Facility,Inpatient,200 mL,mL,,476,404.6,136.4216,476,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
NICARDIPINE IN NACL (ISO-OS) 20 MG/200 ML (0.1 MG/ML) IV PGBK,,83897,LOCAL,Facility,Outpatient,200 mL,mL,,476,404.6,136.4216,476,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,228.48,48,,percent of total billed charges,,100% of DHS outpatient percentage
NICARDIPINE IN NACL (ISO-OS) 20 MG/200 ML (0.1 MG/ML) IV PGBK,,83897,LOCAL,Facility,Inpatient,200 mL,mL,,476,404.6,136.4216,476,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
CIPROFLOXACIN IN 5 % DEXTROSE 400 MG/200 ML IV PGBK,,J0744,HCPCS,Facility,Both,200 mL,mL,,42,35.7,12.0372,42,Aetna,Commercial,38.64,92,,percent of total billed charges,,
CIPROFLOXACIN IN 5 % DEXTROSE 400 MG/200 ML IV PGBK,,J0744,HCPCS,Facility,Outpatient,200 mL,mL,,42,35.7,12.0372,42,Aetna,Medicare Advantage,20.58,49,,percent of total billed charges,,
CIPROFLOXACIN IN 5 % DEXTROSE 400 MG/200 ML IV PGBK,,J0744,HCPCS,Facility,Inpatient,200 mL,mL,,42,35.7,12.0372,42,Aetna,Medicare Advantage,,,,,Included in per diem rate,
CIPROFLOXACIN IN 5 % DEXTROSE 400 MG/200 ML IV PGBK,,J0744,HCPCS,Facility,Both,200 mL,mL,,42,35.7,12.0372,42,Aetna,PPO,39.06,93,,percent of total billed charges,,
CIPROFLOXACIN IN 5 % DEXTROSE 400 MG/200 ML IV PGBK,,J0744,HCPCS,Facility,Both,200 mL,mL,,42,35.7,12.0372,42,America's PPO,America's PPO,40.3326,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
CIPROFLOXACIN IN 5 % DEXTROSE 400 MG/200 ML IV PGBK,,J0744,HCPCS,Facility,Both,200 mL,mL,,42,35.7,12.0372,42,BlueCross BlueShield Minnesota, Federal Employee Program,41.328,98.4,,percent of total billed charges,,
CIPROFLOXACIN IN 5 % DEXTROSE 400 MG/200 ML IV PGBK,,J0744,HCPCS,Facility,Both,200 mL,mL,,42,35.7,12.0372,42,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,42,100,,percent of total billed charges,,
CIPROFLOXACIN IN 5 % DEXTROSE 400 MG/200 ML IV PGBK,,J0744,HCPCS,Facility,Both,200 mL,mL,,42,35.7,12.0372,42,BlueCross BlueShield Minnesota,High Value Network Plan,37.8,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
CIPROFLOXACIN IN 5 % DEXTROSE 400 MG/200 ML IV PGBK,,J0744,HCPCS,Facility,Outpatient,200 mL,mL,,42,35.7,12.0372,42,BlueCross BlueShield Minnesota,Medicare Advantage,20.58,49,,percent of total billed charges,,
CIPROFLOXACIN IN 5 % DEXTROSE 400 MG/200 ML IV PGBK,,J0744,HCPCS,Facility,Inpatient,200 mL,mL,,42,35.7,12.0372,42,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
CIPROFLOXACIN IN 5 % DEXTROSE 400 MG/200 ML IV PGBK,,J0744,HCPCS,Facility,Both,200 mL,mL,,42,35.7,12.0372,42,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,37.1994,88.57,,percent of total billed charges,,
CIPROFLOXACIN IN 5 % DEXTROSE 400 MG/200 ML IV PGBK,,J0744,HCPCS,Facility,Both,200 mL,mL,,42,35.7,12.0372,42,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,12.0372,28.66,,percent of total billed charges,,
CIPROFLOXACIN IN 5 % DEXTROSE 400 MG/200 ML IV PGBK,,J0744,HCPCS,Facility,Outpatient,200 mL,mL,,42,35.7,12.0372,42,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),20.58,49,,percent of total billed charges,,
CIPROFLOXACIN IN 5 % DEXTROSE 400 MG/200 ML IV PGBK,,J0744,HCPCS,Facility,Inpatient,200 mL,mL,,42,35.7,12.0372,42,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
CIPROFLOXACIN IN 5 % DEXTROSE 400 MG/200 ML IV PGBK,,J0744,HCPCS,Facility,Both,200 mL,mL,,42,35.7,12.0372,42,CorVel,Worker's Compensation,42,100,,percent of total billed charges,,
CIPROFLOXACIN IN 5 % DEXTROSE 400 MG/200 ML IV PGBK,,J0744,HCPCS,Facility,Both,200 mL,mL,,42,35.7,12.0372,42,First Health Group Corporation,First Health Network,40.74,97,,percent of total billed charges,,
CIPROFLOXACIN IN 5 % DEXTROSE 400 MG/200 ML IV PGBK,,J0744,HCPCS,Facility,Both,200 mL,mL,,42,35.7,12.0372,42,"Health Partners, Inc.",Commercial,39.732,94.6,,percent of total billed charges,,
CIPROFLOXACIN IN 5 % DEXTROSE 400 MG/200 ML IV PGBK,,J0744,HCPCS,Facility,Outpatient,200 mL,mL,,42,35.7,12.0372,42,"Health Partners, Inc.",Medicare Advantage,20.58,49,,percent of total billed charges,,
CIPROFLOXACIN IN 5 % DEXTROSE 400 MG/200 ML IV PGBK,,J0744,HCPCS,Facility,Inpatient,200 mL,mL,,42,35.7,12.0372,42,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CIPROFLOXACIN IN 5 % DEXTROSE 400 MG/200 ML IV PGBK,,J0744,HCPCS,Facility,Both,200 mL,mL,,42,35.7,12.0372,42,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),25.2,60,,percent of total billed charges,,
CIPROFLOXACIN IN 5 % DEXTROSE 400 MG/200 ML IV PGBK,,J0744,HCPCS,Facility,Both,200 mL,mL,,42,35.7,12.0372,42,"Health Partners, Inc.",State of Minnesota Advantage Program,34.23,81.5,,percent of total billed charges,,
CIPROFLOXACIN IN 5 % DEXTROSE 400 MG/200 ML IV PGBK,,J0744,HCPCS,Facility,Both,200 mL,mL,,42,35.7,12.0372,42,"Health Partners, Inc.",State Public Programs,21,50,,percent of total billed charges,,
CIPROFLOXACIN IN 5 % DEXTROSE 400 MG/200 ML IV PGBK,,J0744,HCPCS,Facility,Both,200 mL,mL,,42,35.7,12.0372,42,Humana Insurance Company,Commercial PPO,39.9,95,,percent of total billed charges,,
CIPROFLOXACIN IN 5 % DEXTROSE 400 MG/200 ML IV PGBK,,J0744,HCPCS,Facility,Outpatient,200 mL,mL,,42,35.7,12.0372,42,Humana Insurance Company,Medicare PPO,20.58,49,,percent of total billed charges,,
CIPROFLOXACIN IN 5 % DEXTROSE 400 MG/200 ML IV PGBK,,J0744,HCPCS,Facility,Inpatient,200 mL,mL,,42,35.7,12.0372,42,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
CIPROFLOXACIN IN 5 % DEXTROSE 400 MG/200 ML IV PGBK,,J0744,HCPCS,Facility,Both,200 mL,mL,,42,35.7,12.0372,42,Medica,Individual & Family,41.622,99.1,,percent of total billed charges,,
CIPROFLOXACIN IN 5 % DEXTROSE 400 MG/200 ML IV PGBK,,J0744,HCPCS,Facility,Outpatient,200 mL,mL,,42,35.7,12.0372,42,Medica,Medica Advantage Solution,20.916,49.8,,percent of total billed charges,,
CIPROFLOXACIN IN 5 % DEXTROSE 400 MG/200 ML IV PGBK,,J0744,HCPCS,Facility,Inpatient,200 mL,mL,,42,35.7,12.0372,42,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
CIPROFLOXACIN IN 5 % DEXTROSE 400 MG/200 ML IV PGBK,,J0744,HCPCS,Facility,Outpatient,200 mL,mL,,42,35.7,12.0372,42,Medica,Medical Assistance,18.732,44.6,,percent of total billed charges,,
CIPROFLOXACIN IN 5 % DEXTROSE 400 MG/200 ML IV PGBK,,J0744,HCPCS,Facility,Inpatient,200 mL,mL,,42,35.7,12.0372,42,Medica,Medical Assistance,,,,,Included in per diem rate,
CIPROFLOXACIN IN 5 % DEXTROSE 400 MG/200 ML IV PGBK,,J0744,HCPCS,Facility,Outpatient,200 mL,mL,,42,35.7,12.0372,42,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,20.916,49.8,,percent of total billed charges,,
CIPROFLOXACIN IN 5 % DEXTROSE 400 MG/200 ML IV PGBK,,J0744,HCPCS,Facility,Inpatient,200 mL,mL,,42,35.7,12.0372,42,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
CIPROFLOXACIN IN 5 % DEXTROSE 400 MG/200 ML IV PGBK,,J0744,HCPCS,Facility,Both,200 mL,mL,,42,35.7,12.0372,42,"Multiplan, Inc.","Multiplan, Inc.",39.48,94,,percent of total billed charges,,
CIPROFLOXACIN IN 5 % DEXTROSE 400 MG/200 ML IV PGBK,,J0744,HCPCS,Facility,Outpatient,200 mL,mL,,42,35.7,12.0372,42,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,37.842,90.1,,percent of total billed charges,,
CIPROFLOXACIN IN 5 % DEXTROSE 400 MG/200 ML IV PGBK,,J0744,HCPCS,Facility,Inpatient,200 mL,mL,,42,35.7,12.0372,42,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
CIPROFLOXACIN IN 5 % DEXTROSE 400 MG/200 ML IV PGBK,,J0744,HCPCS,Facility,Both,200 mL,mL,,42,35.7,12.0372,42,"Preferred One Administrative Services, INC.",PPO,41.412,98.6,,percent of total billed charges,,
CIPROFLOXACIN IN 5 % DEXTROSE 400 MG/200 ML IV PGBK,,J0744,HCPCS,Facility,Outpatient,200 mL,mL,,42,35.7,12.0372,42,PrimeWest Health,Minnesota Senior Health Options (MSHO),21.609,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
CIPROFLOXACIN IN 5 % DEXTROSE 400 MG/200 ML IV PGBK,,J0744,HCPCS,Facility,Inpatient,200 mL,mL,,42,35.7,12.0372,42,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CIPROFLOXACIN IN 5 % DEXTROSE 400 MG/200 ML IV PGBK,,J0744,HCPCS,Facility,Outpatient,200 mL,mL,,42,35.7,12.0372,42,PrimeWest Health,MinnesotaCare,21.5712,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
CIPROFLOXACIN IN 5 % DEXTROSE 400 MG/200 ML IV PGBK,,J0744,HCPCS,Facility,Inpatient,200 mL,mL,,42,35.7,12.0372,42,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
CIPROFLOXACIN IN 5 % DEXTROSE 400 MG/200 ML IV PGBK,,J0744,HCPCS,Facility,Both,200 mL,mL,,42,35.7,12.0372,42,Sanford Health Plan,Sanford Health Plan,38.64,92,,percent of total billed charges,,
CIPROFLOXACIN IN 5 % DEXTROSE 400 MG/200 ML IV PGBK,,J0744,HCPCS,Facility,Outpatient,200 mL,mL,,42,35.7,12.0372,42,"UCare Health, Inc.",Individual & Family Plan,23.667,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
CIPROFLOXACIN IN 5 % DEXTROSE 400 MG/200 ML IV PGBK,,J0744,HCPCS,Facility,Inpatient,200 mL,mL,,42,35.7,12.0372,42,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
CIPROFLOXACIN IN 5 % DEXTROSE 400 MG/200 ML IV PGBK,,J0744,HCPCS,Facility,Outpatient,200 mL,mL,,42,35.7,12.0372,42,"UCare Health, Inc.",Medical Assistance,21.1974,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CIPROFLOXACIN IN 5 % DEXTROSE 400 MG/200 ML IV PGBK,,J0744,HCPCS,Facility,Inpatient,200 mL,mL,,42,35.7,12.0372,42,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
CIPROFLOXACIN IN 5 % DEXTROSE 400 MG/200 ML IV PGBK,,J0744,HCPCS,Facility,Outpatient,200 mL,mL,,42,35.7,12.0372,42,"UCare Health, Inc.",Medicare Advantage,21.1974,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CIPROFLOXACIN IN 5 % DEXTROSE 400 MG/200 ML IV PGBK,,J0744,HCPCS,Facility,Inpatient,200 mL,mL,,42,35.7,12.0372,42,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CIPROFLOXACIN IN 5 % DEXTROSE 400 MG/200 ML IV PGBK,,J0744,HCPCS,Facility,Outpatient,200 mL,mL,,42,35.7,12.0372,42,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),21.1974,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CIPROFLOXACIN IN 5 % DEXTROSE 400 MG/200 ML IV PGBK,,J0744,HCPCS,Facility,Inpatient,200 mL,mL,,42,35.7,12.0372,42,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CIPROFLOXACIN IN 5 % DEXTROSE 400 MG/200 ML IV PGBK,,J0744,HCPCS,Facility,Both,200 mL,mL,,42,35.7,12.0372,42,UnitedHealthcare,Individual & Family,39.48,94,,percent of total billed charges,,
CIPROFLOXACIN IN 5 % DEXTROSE 400 MG/200 ML IV PGBK,,J0744,HCPCS,Facility,Outpatient,200 mL,mL,,42,35.7,12.0372,42,UnitedHealthcare,Medicare Advantage,20.58,49,,percent of total billed charges,,
CIPROFLOXACIN IN 5 % DEXTROSE 400 MG/200 ML IV PGBK,,J0744,HCPCS,Facility,Inpatient,200 mL,mL,,42,35.7,12.0372,42,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
CIPROFLOXACIN IN 5 % DEXTROSE 400 MG/200 ML IV PGBK,,J0744,HCPCS,Facility,Outpatient,200 mL,mL,,42,35.7,12.0372,42,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,20.16,48,,percent of total billed charges,,100% of DHS outpatient percentage
CIPROFLOXACIN IN 5 % DEXTROSE 400 MG/200 ML IV PGBK,,J0744,HCPCS,Facility,Inpatient,200 mL,mL,,42,35.7,12.0372,42,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
FLUCONAZOLE IN NACL (ISO-OSM) 400 MG/200 ML IV PGBK,,J1450,HCPCS,Facility,Both,200 mL,mL,,42,35.7,12.0372,42,Aetna,Commercial,38.64,92,,percent of total billed charges,,
FLUCONAZOLE IN NACL (ISO-OSM) 400 MG/200 ML IV PGBK,,J1450,HCPCS,Facility,Outpatient,200 mL,mL,,42,35.7,12.0372,42,Aetna,Medicare Advantage,20.58,49,,percent of total billed charges,,
FLUCONAZOLE IN NACL (ISO-OSM) 400 MG/200 ML IV PGBK,,J1450,HCPCS,Facility,Inpatient,200 mL,mL,,42,35.7,12.0372,42,Aetna,Medicare Advantage,,,,,Included in per diem rate,
FLUCONAZOLE IN NACL (ISO-OSM) 400 MG/200 ML IV PGBK,,J1450,HCPCS,Facility,Both,200 mL,mL,,42,35.7,12.0372,42,Aetna,PPO,39.06,93,,percent of total billed charges,,
FLUCONAZOLE IN NACL (ISO-OSM) 400 MG/200 ML IV PGBK,,J1450,HCPCS,Facility,Both,200 mL,mL,,42,35.7,12.0372,42,America's PPO,America's PPO,40.3326,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
FLUCONAZOLE IN NACL (ISO-OSM) 400 MG/200 ML IV PGBK,,J1450,HCPCS,Facility,Both,200 mL,mL,,42,35.7,12.0372,42,BlueCross BlueShield Minnesota, Federal Employee Program,41.328,98.4,,percent of total billed charges,,
FLUCONAZOLE IN NACL (ISO-OSM) 400 MG/200 ML IV PGBK,,J1450,HCPCS,Facility,Both,200 mL,mL,,42,35.7,12.0372,42,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,42,100,,percent of total billed charges,,
FLUCONAZOLE IN NACL (ISO-OSM) 400 MG/200 ML IV PGBK,,J1450,HCPCS,Facility,Both,200 mL,mL,,42,35.7,12.0372,42,BlueCross BlueShield Minnesota,High Value Network Plan,37.8,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
FLUCONAZOLE IN NACL (ISO-OSM) 400 MG/200 ML IV PGBK,,J1450,HCPCS,Facility,Outpatient,200 mL,mL,,42,35.7,12.0372,42,BlueCross BlueShield Minnesota,Medicare Advantage,20.58,49,,percent of total billed charges,,
FLUCONAZOLE IN NACL (ISO-OSM) 400 MG/200 ML IV PGBK,,J1450,HCPCS,Facility,Inpatient,200 mL,mL,,42,35.7,12.0372,42,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
FLUCONAZOLE IN NACL (ISO-OSM) 400 MG/200 ML IV PGBK,,J1450,HCPCS,Facility,Both,200 mL,mL,,42,35.7,12.0372,42,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,37.1994,88.57,,percent of total billed charges,,
FLUCONAZOLE IN NACL (ISO-OSM) 400 MG/200 ML IV PGBK,,J1450,HCPCS,Facility,Both,200 mL,mL,,42,35.7,12.0372,42,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,12.0372,28.66,,percent of total billed charges,,
FLUCONAZOLE IN NACL (ISO-OSM) 400 MG/200 ML IV PGBK,,J1450,HCPCS,Facility,Outpatient,200 mL,mL,,42,35.7,12.0372,42,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),20.58,49,,percent of total billed charges,,
FLUCONAZOLE IN NACL (ISO-OSM) 400 MG/200 ML IV PGBK,,J1450,HCPCS,Facility,Inpatient,200 mL,mL,,42,35.7,12.0372,42,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
FLUCONAZOLE IN NACL (ISO-OSM) 400 MG/200 ML IV PGBK,,J1450,HCPCS,Facility,Both,200 mL,mL,,42,35.7,12.0372,42,CorVel,Worker's Compensation,42,100,,percent of total billed charges,,
FLUCONAZOLE IN NACL (ISO-OSM) 400 MG/200 ML IV PGBK,,J1450,HCPCS,Facility,Both,200 mL,mL,,42,35.7,12.0372,42,First Health Group Corporation,First Health Network,40.74,97,,percent of total billed charges,,
FLUCONAZOLE IN NACL (ISO-OSM) 400 MG/200 ML IV PGBK,,J1450,HCPCS,Facility,Both,200 mL,mL,,42,35.7,12.0372,42,"Health Partners, Inc.",Commercial,39.732,94.6,,percent of total billed charges,,
FLUCONAZOLE IN NACL (ISO-OSM) 400 MG/200 ML IV PGBK,,J1450,HCPCS,Facility,Outpatient,200 mL,mL,,42,35.7,12.0372,42,"Health Partners, Inc.",Medicare Advantage,20.58,49,,percent of total billed charges,,
FLUCONAZOLE IN NACL (ISO-OSM) 400 MG/200 ML IV PGBK,,J1450,HCPCS,Facility,Inpatient,200 mL,mL,,42,35.7,12.0372,42,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
FLUCONAZOLE IN NACL (ISO-OSM) 400 MG/200 ML IV PGBK,,J1450,HCPCS,Facility,Both,200 mL,mL,,42,35.7,12.0372,42,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),25.2,60,,percent of total billed charges,,
FLUCONAZOLE IN NACL (ISO-OSM) 400 MG/200 ML IV PGBK,,J1450,HCPCS,Facility,Both,200 mL,mL,,42,35.7,12.0372,42,"Health Partners, Inc.",State of Minnesota Advantage Program,34.23,81.5,,percent of total billed charges,,
FLUCONAZOLE IN NACL (ISO-OSM) 400 MG/200 ML IV PGBK,,J1450,HCPCS,Facility,Both,200 mL,mL,,42,35.7,12.0372,42,"Health Partners, Inc.",State Public Programs,21,50,,percent of total billed charges,,
FLUCONAZOLE IN NACL (ISO-OSM) 400 MG/200 ML IV PGBK,,J1450,HCPCS,Facility,Both,200 mL,mL,,42,35.7,12.0372,42,Humana Insurance Company,Commercial PPO,39.9,95,,percent of total billed charges,,
FLUCONAZOLE IN NACL (ISO-OSM) 400 MG/200 ML IV PGBK,,J1450,HCPCS,Facility,Outpatient,200 mL,mL,,42,35.7,12.0372,42,Humana Insurance Company,Medicare PPO,20.58,49,,percent of total billed charges,,
FLUCONAZOLE IN NACL (ISO-OSM) 400 MG/200 ML IV PGBK,,J1450,HCPCS,Facility,Inpatient,200 mL,mL,,42,35.7,12.0372,42,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
FLUCONAZOLE IN NACL (ISO-OSM) 400 MG/200 ML IV PGBK,,J1450,HCPCS,Facility,Both,200 mL,mL,,42,35.7,12.0372,42,Medica,Individual & Family,41.622,99.1,,percent of total billed charges,,
FLUCONAZOLE IN NACL (ISO-OSM) 400 MG/200 ML IV PGBK,,J1450,HCPCS,Facility,Outpatient,200 mL,mL,,42,35.7,12.0372,42,Medica,Medica Advantage Solution,20.916,49.8,,percent of total billed charges,,
FLUCONAZOLE IN NACL (ISO-OSM) 400 MG/200 ML IV PGBK,,J1450,HCPCS,Facility,Inpatient,200 mL,mL,,42,35.7,12.0372,42,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
FLUCONAZOLE IN NACL (ISO-OSM) 400 MG/200 ML IV PGBK,,J1450,HCPCS,Facility,Outpatient,200 mL,mL,,42,35.7,12.0372,42,Medica,Medical Assistance,18.732,44.6,,percent of total billed charges,,
FLUCONAZOLE IN NACL (ISO-OSM) 400 MG/200 ML IV PGBK,,J1450,HCPCS,Facility,Inpatient,200 mL,mL,,42,35.7,12.0372,42,Medica,Medical Assistance,,,,,Included in per diem rate,
FLUCONAZOLE IN NACL (ISO-OSM) 400 MG/200 ML IV PGBK,,J1450,HCPCS,Facility,Outpatient,200 mL,mL,,42,35.7,12.0372,42,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,20.916,49.8,,percent of total billed charges,,
FLUCONAZOLE IN NACL (ISO-OSM) 400 MG/200 ML IV PGBK,,J1450,HCPCS,Facility,Inpatient,200 mL,mL,,42,35.7,12.0372,42,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
FLUCONAZOLE IN NACL (ISO-OSM) 400 MG/200 ML IV PGBK,,J1450,HCPCS,Facility,Both,200 mL,mL,,42,35.7,12.0372,42,"Multiplan, Inc.","Multiplan, Inc.",39.48,94,,percent of total billed charges,,
FLUCONAZOLE IN NACL (ISO-OSM) 400 MG/200 ML IV PGBK,,J1450,HCPCS,Facility,Outpatient,200 mL,mL,,42,35.7,12.0372,42,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,37.842,90.1,,percent of total billed charges,,
FLUCONAZOLE IN NACL (ISO-OSM) 400 MG/200 ML IV PGBK,,J1450,HCPCS,Facility,Inpatient,200 mL,mL,,42,35.7,12.0372,42,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
FLUCONAZOLE IN NACL (ISO-OSM) 400 MG/200 ML IV PGBK,,J1450,HCPCS,Facility,Both,200 mL,mL,,42,35.7,12.0372,42,"Preferred One Administrative Services, INC.",PPO,41.412,98.6,,percent of total billed charges,,
FLUCONAZOLE IN NACL (ISO-OSM) 400 MG/200 ML IV PGBK,,J1450,HCPCS,Facility,Outpatient,200 mL,mL,,42,35.7,12.0372,42,PrimeWest Health,Minnesota Senior Health Options (MSHO),21.609,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
FLUCONAZOLE IN NACL (ISO-OSM) 400 MG/200 ML IV PGBK,,J1450,HCPCS,Facility,Inpatient,200 mL,mL,,42,35.7,12.0372,42,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
FLUCONAZOLE IN NACL (ISO-OSM) 400 MG/200 ML IV PGBK,,J1450,HCPCS,Facility,Outpatient,200 mL,mL,,42,35.7,12.0372,42,PrimeWest Health,MinnesotaCare,21.5712,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
FLUCONAZOLE IN NACL (ISO-OSM) 400 MG/200 ML IV PGBK,,J1450,HCPCS,Facility,Inpatient,200 mL,mL,,42,35.7,12.0372,42,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
FLUCONAZOLE IN NACL (ISO-OSM) 400 MG/200 ML IV PGBK,,J1450,HCPCS,Facility,Both,200 mL,mL,,42,35.7,12.0372,42,Sanford Health Plan,Sanford Health Plan,38.64,92,,percent of total billed charges,,
FLUCONAZOLE IN NACL (ISO-OSM) 400 MG/200 ML IV PGBK,,J1450,HCPCS,Facility,Outpatient,200 mL,mL,,42,35.7,12.0372,42,"UCare Health, Inc.",Individual & Family Plan,23.667,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
FLUCONAZOLE IN NACL (ISO-OSM) 400 MG/200 ML IV PGBK,,J1450,HCPCS,Facility,Inpatient,200 mL,mL,,42,35.7,12.0372,42,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
FLUCONAZOLE IN NACL (ISO-OSM) 400 MG/200 ML IV PGBK,,J1450,HCPCS,Facility,Outpatient,200 mL,mL,,42,35.7,12.0372,42,"UCare Health, Inc.",Medical Assistance,21.1974,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FLUCONAZOLE IN NACL (ISO-OSM) 400 MG/200 ML IV PGBK,,J1450,HCPCS,Facility,Inpatient,200 mL,mL,,42,35.7,12.0372,42,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
FLUCONAZOLE IN NACL (ISO-OSM) 400 MG/200 ML IV PGBK,,J1450,HCPCS,Facility,Outpatient,200 mL,mL,,42,35.7,12.0372,42,"UCare Health, Inc.",Medicare Advantage,21.1974,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FLUCONAZOLE IN NACL (ISO-OSM) 400 MG/200 ML IV PGBK,,J1450,HCPCS,Facility,Inpatient,200 mL,mL,,42,35.7,12.0372,42,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
FLUCONAZOLE IN NACL (ISO-OSM) 400 MG/200 ML IV PGBK,,J1450,HCPCS,Facility,Outpatient,200 mL,mL,,42,35.7,12.0372,42,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),21.1974,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FLUCONAZOLE IN NACL (ISO-OSM) 400 MG/200 ML IV PGBK,,J1450,HCPCS,Facility,Inpatient,200 mL,mL,,42,35.7,12.0372,42,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
FLUCONAZOLE IN NACL (ISO-OSM) 400 MG/200 ML IV PGBK,,J1450,HCPCS,Facility,Both,200 mL,mL,,42,35.7,12.0372,42,UnitedHealthcare,Individual & Family,39.48,94,,percent of total billed charges,,
FLUCONAZOLE IN NACL (ISO-OSM) 400 MG/200 ML IV PGBK,,J1450,HCPCS,Facility,Outpatient,200 mL,mL,,42,35.7,12.0372,42,UnitedHealthcare,Medicare Advantage,20.58,49,,percent of total billed charges,,
FLUCONAZOLE IN NACL (ISO-OSM) 400 MG/200 ML IV PGBK,,J1450,HCPCS,Facility,Inpatient,200 mL,mL,,42,35.7,12.0372,42,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
FLUCONAZOLE IN NACL (ISO-OSM) 400 MG/200 ML IV PGBK,,J1450,HCPCS,Facility,Outpatient,200 mL,mL,,42,35.7,12.0372,42,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,20.16,48,,percent of total billed charges,,100% of DHS outpatient percentage
FLUCONAZOLE IN NACL (ISO-OSM) 400 MG/200 ML IV PGBK,,J1450,HCPCS,Facility,Inpatient,200 mL,mL,,42,35.7,12.0372,42,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
IMMUN GLOB G(IGG)-PRO-IGA 0-50 10 % IV SOLN,,J1459,HCPCS,Facility,Both,200 mL,mL,,12299,10454.15,48.33112,12299,Aetna,Commercial,11315.08,92,,percent of total billed charges,,
IMMUN GLOB G(IGG)-PRO-IGA 0-50 10 % IV SOLN,,J1459,HCPCS,Facility,Outpatient,200 mL,mL,,12299,10454.15,48.33112,12299,Aetna,Medicare Advantage,6026.51,49,,percent of total billed charges,,
IMMUN GLOB G(IGG)-PRO-IGA 0-50 10 % IV SOLN,,J1459,HCPCS,Facility,Inpatient,200 mL,mL,,12299,10454.15,48.33112,12299,Aetna,Medicare Advantage,,,,,Included in per diem rate,
IMMUN GLOB G(IGG)-PRO-IGA 0-50 10 % IV SOLN,,J1459,HCPCS,Facility,Both,200 mL,mL,,12299,10454.15,48.33112,12299,Aetna,PPO,11438.07,93,,percent of total billed charges,,
IMMUN GLOB G(IGG)-PRO-IGA 0-50 10 % IV SOLN,,J1459,HCPCS,Facility,Both,200 mL,mL,,12299,10454.15,48.33112,12299,America's PPO,America's PPO,11810.7297,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
IMMUN GLOB G(IGG)-PRO-IGA 0-50 10 % IV SOLN,,J1459,HCPCS,Facility,Both,200 mL,mL,,12299,10454.15,48.33112,12299,BlueCross BlueShield Minnesota, Federal Employee Program,95.14,,,Fee schedule,,100% of BCBS commercial commodity fee schedule
IMMUN GLOB G(IGG)-PRO-IGA 0-50 10 % IV SOLN,,J1459,HCPCS,Facility,Both,200 mL,mL,,12299,10454.15,48.33112,12299,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,96.66224,,,Fee schedule,,"100% of BCBS commercial commodity fee schedule, plus MN Care tax"
IMMUN GLOB G(IGG)-PRO-IGA 0-50 10 % IV SOLN,,J1459,HCPCS,Facility,Both,200 mL,mL,,12299,10454.15,48.33112,12299,BlueCross BlueShield Minnesota,High Value Network Plan,11069.1,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
IMMUN GLOB G(IGG)-PRO-IGA 0-50 10 % IV SOLN,,J1459,HCPCS,Facility,Outpatient,200 mL,mL,,12299,10454.15,48.33112,12299,BlueCross BlueShield Minnesota,Medicare Advantage,6026.51,49,,percent of total billed charges,,
IMMUN GLOB G(IGG)-PRO-IGA 0-50 10 % IV SOLN,,J1459,HCPCS,Facility,Inpatient,200 mL,mL,,12299,10454.15,48.33112,12299,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
IMMUN GLOB G(IGG)-PRO-IGA 0-50 10 % IV SOLN,,J1459,HCPCS,Facility,Both,200 mL,mL,,12299,10454.15,48.33112,12299,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,85.61374597,,,Fee schedule,,"88.57% of BCBS commercial commodity fee schedule, plus MN Care tax"
IMMUN GLOB G(IGG)-PRO-IGA 0-50 10 % IV SOLN,,J1459,HCPCS,Facility,Both,200 mL,mL,,12299,10454.15,48.33112,12299,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,48.33112,,,Fee schedule,,"100% of BCBS Medicaid commodity fee schedule, plus MN Care tax"
IMMUN GLOB G(IGG)-PRO-IGA 0-50 10 % IV SOLN,,J1459,HCPCS,Facility,Outpatient,200 mL,mL,,12299,10454.15,48.33112,12299,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),6026.51,49,,percent of total billed charges,,
IMMUN GLOB G(IGG)-PRO-IGA 0-50 10 % IV SOLN,,J1459,HCPCS,Facility,Inpatient,200 mL,mL,,12299,10454.15,48.33112,12299,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
IMMUN GLOB G(IGG)-PRO-IGA 0-50 10 % IV SOLN,,J1459,HCPCS,Facility,Both,200 mL,mL,,12299,10454.15,48.33112,12299,CorVel,Worker's Compensation,12299,100,,percent of total billed charges,,
IMMUN GLOB G(IGG)-PRO-IGA 0-50 10 % IV SOLN,,J1459,HCPCS,Facility,Both,200 mL,mL,,12299,10454.15,48.33112,12299,First Health Group Corporation,First Health Network,11930.03,97,,percent of total billed charges,,
IMMUN GLOB G(IGG)-PRO-IGA 0-50 10 % IV SOLN,,J1459,HCPCS,Facility,Both,200 mL,mL,,12299,10454.15,48.33112,12299,"Health Partners, Inc.",Commercial,11634.854,94.6,,percent of total billed charges,,
IMMUN GLOB G(IGG)-PRO-IGA 0-50 10 % IV SOLN,,J1459,HCPCS,Facility,Outpatient,200 mL,mL,,12299,10454.15,48.33112,12299,"Health Partners, Inc.",Medicare Advantage,6026.51,49,,percent of total billed charges,,
IMMUN GLOB G(IGG)-PRO-IGA 0-50 10 % IV SOLN,,J1459,HCPCS,Facility,Inpatient,200 mL,mL,,12299,10454.15,48.33112,12299,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
IMMUN GLOB G(IGG)-PRO-IGA 0-50 10 % IV SOLN,,J1459,HCPCS,Facility,Both,200 mL,mL,,12299,10454.15,48.33112,12299,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),7379.4,60,,percent of total billed charges,,
IMMUN GLOB G(IGG)-PRO-IGA 0-50 10 % IV SOLN,,J1459,HCPCS,Facility,Both,200 mL,mL,,12299,10454.15,48.33112,12299,"Health Partners, Inc.",State of Minnesota Advantage Program,10023.685,81.5,,percent of total billed charges,,
IMMUN GLOB G(IGG)-PRO-IGA 0-50 10 % IV SOLN,,J1459,HCPCS,Facility,Both,200 mL,mL,,12299,10454.15,48.33112,12299,"Health Partners, Inc.",State Public Programs,6149.5,50,,percent of total billed charges,,
IMMUN GLOB G(IGG)-PRO-IGA 0-50 10 % IV SOLN,,J1459,HCPCS,Facility,Both,200 mL,mL,,12299,10454.15,48.33112,12299,Humana Insurance Company,Commercial PPO,11684.05,95,,percent of total billed charges,,
IMMUN GLOB G(IGG)-PRO-IGA 0-50 10 % IV SOLN,,J1459,HCPCS,Facility,Outpatient,200 mL,mL,,12299,10454.15,48.33112,12299,Humana Insurance Company,Medicare PPO,6026.51,49,,percent of total billed charges,,
IMMUN GLOB G(IGG)-PRO-IGA 0-50 10 % IV SOLN,,J1459,HCPCS,Facility,Inpatient,200 mL,mL,,12299,10454.15,48.33112,12299,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
IMMUN GLOB G(IGG)-PRO-IGA 0-50 10 % IV SOLN,,J1459,HCPCS,Facility,Both,200 mL,mL,,12299,10454.15,48.33112,12299,Medica,Individual & Family,12188.309,99.1,,percent of total billed charges,,
IMMUN GLOB G(IGG)-PRO-IGA 0-50 10 % IV SOLN,,J1459,HCPCS,Facility,Outpatient,200 mL,mL,,12299,10454.15,48.33112,12299,Medica,Medica Advantage Solution,6124.902,49.8,,percent of total billed charges,,
IMMUN GLOB G(IGG)-PRO-IGA 0-50 10 % IV SOLN,,J1459,HCPCS,Facility,Inpatient,200 mL,mL,,12299,10454.15,48.33112,12299,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
IMMUN GLOB G(IGG)-PRO-IGA 0-50 10 % IV SOLN,,J1459,HCPCS,Facility,Outpatient,200 mL,mL,,12299,10454.15,48.33112,12299,Medica,Medical Assistance,5485.354,44.6,,percent of total billed charges,,
IMMUN GLOB G(IGG)-PRO-IGA 0-50 10 % IV SOLN,,J1459,HCPCS,Facility,Inpatient,200 mL,mL,,12299,10454.15,48.33112,12299,Medica,Medical Assistance,,,,,Included in per diem rate,
IMMUN GLOB G(IGG)-PRO-IGA 0-50 10 % IV SOLN,,J1459,HCPCS,Facility,Outpatient,200 mL,mL,,12299,10454.15,48.33112,12299,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,6124.902,49.8,,percent of total billed charges,,
IMMUN GLOB G(IGG)-PRO-IGA 0-50 10 % IV SOLN,,J1459,HCPCS,Facility,Inpatient,200 mL,mL,,12299,10454.15,48.33112,12299,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
IMMUN GLOB G(IGG)-PRO-IGA 0-50 10 % IV SOLN,,J1459,HCPCS,Facility,Both,200 mL,mL,,12299,10454.15,48.33112,12299,"Multiplan, Inc.","Multiplan, Inc.",11561.06,94,,percent of total billed charges,,
IMMUN GLOB G(IGG)-PRO-IGA 0-50 10 % IV SOLN,,J1459,HCPCS,Facility,Outpatient,200 mL,mL,,12299,10454.15,48.33112,12299,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,11081.399,90.1,,percent of total billed charges,,
IMMUN GLOB G(IGG)-PRO-IGA 0-50 10 % IV SOLN,,J1459,HCPCS,Facility,Inpatient,200 mL,mL,,12299,10454.15,48.33112,12299,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
IMMUN GLOB G(IGG)-PRO-IGA 0-50 10 % IV SOLN,,J1459,HCPCS,Facility,Both,200 mL,mL,,12299,10454.15,48.33112,12299,"Preferred One Administrative Services, INC.",PPO,12126.814,98.6,,percent of total billed charges,,
IMMUN GLOB G(IGG)-PRO-IGA 0-50 10 % IV SOLN,,J1459,HCPCS,Facility,Outpatient,200 mL,mL,,12299,10454.15,48.33112,12299,PrimeWest Health,Minnesota Senior Health Options (MSHO),6327.8355,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
IMMUN GLOB G(IGG)-PRO-IGA 0-50 10 % IV SOLN,,J1459,HCPCS,Facility,Inpatient,200 mL,mL,,12299,10454.15,48.33112,12299,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
IMMUN GLOB G(IGG)-PRO-IGA 0-50 10 % IV SOLN,,J1459,HCPCS,Facility,Outpatient,200 mL,mL,,12299,10454.15,48.33112,12299,PrimeWest Health,MinnesotaCare,6316.7664,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
IMMUN GLOB G(IGG)-PRO-IGA 0-50 10 % IV SOLN,,J1459,HCPCS,Facility,Inpatient,200 mL,mL,,12299,10454.15,48.33112,12299,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
IMMUN GLOB G(IGG)-PRO-IGA 0-50 10 % IV SOLN,,J1459,HCPCS,Facility,Both,200 mL,mL,,12299,10454.15,48.33112,12299,Sanford Health Plan,Sanford Health Plan,11315.08,92,,percent of total billed charges,,
IMMUN GLOB G(IGG)-PRO-IGA 0-50 10 % IV SOLN,,J1459,HCPCS,Facility,Outpatient,200 mL,mL,,12299,10454.15,48.33112,12299,"UCare Health, Inc.",Individual & Family Plan,6930.4865,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
IMMUN GLOB G(IGG)-PRO-IGA 0-50 10 % IV SOLN,,J1459,HCPCS,Facility,Inpatient,200 mL,mL,,12299,10454.15,48.33112,12299,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
IMMUN GLOB G(IGG)-PRO-IGA 0-50 10 % IV SOLN,,J1459,HCPCS,Facility,Outpatient,200 mL,mL,,12299,10454.15,48.33112,12299,"UCare Health, Inc.",Medical Assistance,6207.3053,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
IMMUN GLOB G(IGG)-PRO-IGA 0-50 10 % IV SOLN,,J1459,HCPCS,Facility,Inpatient,200 mL,mL,,12299,10454.15,48.33112,12299,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
IMMUN GLOB G(IGG)-PRO-IGA 0-50 10 % IV SOLN,,J1459,HCPCS,Facility,Outpatient,200 mL,mL,,12299,10454.15,48.33112,12299,"UCare Health, Inc.",Medicare Advantage,6207.3053,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
IMMUN GLOB G(IGG)-PRO-IGA 0-50 10 % IV SOLN,,J1459,HCPCS,Facility,Inpatient,200 mL,mL,,12299,10454.15,48.33112,12299,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
IMMUN GLOB G(IGG)-PRO-IGA 0-50 10 % IV SOLN,,J1459,HCPCS,Facility,Outpatient,200 mL,mL,,12299,10454.15,48.33112,12299,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),6207.3053,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
IMMUN GLOB G(IGG)-PRO-IGA 0-50 10 % IV SOLN,,J1459,HCPCS,Facility,Inpatient,200 mL,mL,,12299,10454.15,48.33112,12299,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
IMMUN GLOB G(IGG)-PRO-IGA 0-50 10 % IV SOLN,,J1459,HCPCS,Facility,Both,200 mL,mL,,12299,10454.15,48.33112,12299,UnitedHealthcare,Individual & Family,11561.06,94,,percent of total billed charges,,
IMMUN GLOB G(IGG)-PRO-IGA 0-50 10 % IV SOLN,,J1459,HCPCS,Facility,Outpatient,200 mL,mL,,12299,10454.15,48.33112,12299,UnitedHealthcare,Medicare Advantage,6026.51,49,,percent of total billed charges,,
IMMUN GLOB G(IGG)-PRO-IGA 0-50 10 % IV SOLN,,J1459,HCPCS,Facility,Inpatient,200 mL,mL,,12299,10454.15,48.33112,12299,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
IMMUN GLOB G(IGG)-PRO-IGA 0-50 10 % IV SOLN,,J1459,HCPCS,Facility,Outpatient,200 mL,mL,,12299,10454.15,48.33112,12299,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,5903.52,48,,percent of total billed charges,,100% of DHS outpatient percentage
IMMUN GLOB G(IGG)-PRO-IGA 0-50 10 % IV SOLN,,J1459,HCPCS,Facility,Inpatient,200 mL,mL,,12299,10454.15,48.33112,12299,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 1 GRAM/200 ML IV PGBK,,J3372,HCPCS,Facility,Both,200 mL,mL,,93,79.05,26.6538,93,Aetna,Commercial,85.56,92,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1 GRAM/200 ML IV PGBK,,J3372,HCPCS,Facility,Both,200 mL,mL,,93,79.05,26.6538,93,Aetna,Commercial,85.56,92,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1 GRAM/200 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,200 mL,mL,,93,79.05,26.6538,93,Aetna,Medicare Advantage,45.57,49,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1 GRAM/200 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,200 mL,mL,,93,79.05,26.6538,93,Aetna,Medicare Advantage,45.57,49,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1 GRAM/200 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,200 mL,mL,,93,79.05,26.6538,93,Aetna,Medicare Advantage,,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 1 GRAM/200 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,200 mL,mL,,93,79.05,26.6538,93,Aetna,Medicare Advantage,,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 1 GRAM/200 ML IV PGBK,,J3372,HCPCS,Facility,Both,200 mL,mL,,93,79.05,26.6538,93,Aetna,PPO,86.49,93,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1 GRAM/200 ML IV PGBK,,J3372,HCPCS,Facility,Both,200 mL,mL,,93,79.05,26.6538,93,Aetna,PPO,86.49,93,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1 GRAM/200 ML IV PGBK,,J3372,HCPCS,Facility,Both,200 mL,mL,,93,79.05,26.6538,93,America's PPO,America's PPO,89.3079,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
VANCOMYCIN-DILUENT COMBO NO.1 1 GRAM/200 ML IV PGBK,,J3372,HCPCS,Facility,Both,200 mL,mL,,93,79.05,26.6538,93,America's PPO,America's PPO,89.3079,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
VANCOMYCIN-DILUENT COMBO NO.1 1 GRAM/200 ML IV PGBK,,J3372,HCPCS,Facility,Both,200 mL,mL,,93,79.05,26.6538,93,BlueCross BlueShield Minnesota, Federal Employee Program,91.512,98.4,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1 GRAM/200 ML IV PGBK,,J3372,HCPCS,Facility,Both,200 mL,mL,,93,79.05,26.6538,93,BlueCross BlueShield Minnesota, Federal Employee Program,91.512,98.4,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1 GRAM/200 ML IV PGBK,,J3372,HCPCS,Facility,Both,200 mL,mL,,93,79.05,26.6538,93,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,93,100,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1 GRAM/200 ML IV PGBK,,J3372,HCPCS,Facility,Both,200 mL,mL,,93,79.05,26.6538,93,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,93,100,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1 GRAM/200 ML IV PGBK,,J3372,HCPCS,Facility,Both,200 mL,mL,,93,79.05,26.6538,93,BlueCross BlueShield Minnesota,High Value Network Plan,83.7,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
VANCOMYCIN-DILUENT COMBO NO.1 1 GRAM/200 ML IV PGBK,,J3372,HCPCS,Facility,Both,200 mL,mL,,93,79.05,26.6538,93,BlueCross BlueShield Minnesota,High Value Network Plan,83.7,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
VANCOMYCIN-DILUENT COMBO NO.1 1 GRAM/200 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,200 mL,mL,,93,79.05,26.6538,93,BlueCross BlueShield Minnesota,Medicare Advantage,45.57,49,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1 GRAM/200 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,200 mL,mL,,93,79.05,26.6538,93,BlueCross BlueShield Minnesota,Medicare Advantage,45.57,49,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1 GRAM/200 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,200 mL,mL,,93,79.05,26.6538,93,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 1 GRAM/200 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,200 mL,mL,,93,79.05,26.6538,93,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 1 GRAM/200 ML IV PGBK,,J3372,HCPCS,Facility,Both,200 mL,mL,,93,79.05,26.6538,93,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,82.3701,88.57,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1 GRAM/200 ML IV PGBK,,J3372,HCPCS,Facility,Both,200 mL,mL,,93,79.05,26.6538,93,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,82.3701,88.57,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1 GRAM/200 ML IV PGBK,,J3372,HCPCS,Facility,Both,200 mL,mL,,93,79.05,26.6538,93,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,26.6538,28.66,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1 GRAM/200 ML IV PGBK,,J3372,HCPCS,Facility,Both,200 mL,mL,,93,79.05,26.6538,93,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,26.6538,28.66,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1 GRAM/200 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,200 mL,mL,,93,79.05,26.6538,93,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),45.57,49,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1 GRAM/200 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,200 mL,mL,,93,79.05,26.6538,93,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),45.57,49,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1 GRAM/200 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,200 mL,mL,,93,79.05,26.6538,93,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 1 GRAM/200 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,200 mL,mL,,93,79.05,26.6538,93,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 1 GRAM/200 ML IV PGBK,,J3372,HCPCS,Facility,Both,200 mL,mL,,93,79.05,26.6538,93,CorVel,Worker's Compensation,93,100,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1 GRAM/200 ML IV PGBK,,J3372,HCPCS,Facility,Both,200 mL,mL,,93,79.05,26.6538,93,CorVel,Worker's Compensation,93,100,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1 GRAM/200 ML IV PGBK,,J3372,HCPCS,Facility,Both,200 mL,mL,,93,79.05,26.6538,93,First Health Group Corporation,First Health Network,90.21,97,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1 GRAM/200 ML IV PGBK,,J3372,HCPCS,Facility,Both,200 mL,mL,,93,79.05,26.6538,93,First Health Group Corporation,First Health Network,90.21,97,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1 GRAM/200 ML IV PGBK,,J3372,HCPCS,Facility,Both,200 mL,mL,,93,79.05,26.6538,93,"Health Partners, Inc.",Commercial,87.978,94.6,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1 GRAM/200 ML IV PGBK,,J3372,HCPCS,Facility,Both,200 mL,mL,,93,79.05,26.6538,93,"Health Partners, Inc.",Commercial,87.978,94.6,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1 GRAM/200 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,200 mL,mL,,93,79.05,26.6538,93,"Health Partners, Inc.",Medicare Advantage,45.57,49,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1 GRAM/200 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,200 mL,mL,,93,79.05,26.6538,93,"Health Partners, Inc.",Medicare Advantage,45.57,49,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1 GRAM/200 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,200 mL,mL,,93,79.05,26.6538,93,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 1 GRAM/200 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,200 mL,mL,,93,79.05,26.6538,93,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 1 GRAM/200 ML IV PGBK,,J3372,HCPCS,Facility,Both,200 mL,mL,,93,79.05,26.6538,93,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),55.8,60,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1 GRAM/200 ML IV PGBK,,J3372,HCPCS,Facility,Both,200 mL,mL,,93,79.05,26.6538,93,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),55.8,60,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1 GRAM/200 ML IV PGBK,,J3372,HCPCS,Facility,Both,200 mL,mL,,93,79.05,26.6538,93,"Health Partners, Inc.",State of Minnesota Advantage Program,75.795,81.5,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1 GRAM/200 ML IV PGBK,,J3372,HCPCS,Facility,Both,200 mL,mL,,93,79.05,26.6538,93,"Health Partners, Inc.",State of Minnesota Advantage Program,75.795,81.5,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1 GRAM/200 ML IV PGBK,,J3372,HCPCS,Facility,Both,200 mL,mL,,93,79.05,26.6538,93,"Health Partners, Inc.",State Public Programs,46.5,50,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1 GRAM/200 ML IV PGBK,,J3372,HCPCS,Facility,Both,200 mL,mL,,93,79.05,26.6538,93,"Health Partners, Inc.",State Public Programs,46.5,50,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1 GRAM/200 ML IV PGBK,,J3372,HCPCS,Facility,Both,200 mL,mL,,93,79.05,26.6538,93,Humana Insurance Company,Commercial PPO,88.35,95,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1 GRAM/200 ML IV PGBK,,J3372,HCPCS,Facility,Both,200 mL,mL,,93,79.05,26.6538,93,Humana Insurance Company,Commercial PPO,88.35,95,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1 GRAM/200 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,200 mL,mL,,93,79.05,26.6538,93,Humana Insurance Company,Medicare PPO,45.57,49,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1 GRAM/200 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,200 mL,mL,,93,79.05,26.6538,93,Humana Insurance Company,Medicare PPO,45.57,49,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1 GRAM/200 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,200 mL,mL,,93,79.05,26.6538,93,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 1 GRAM/200 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,200 mL,mL,,93,79.05,26.6538,93,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 1 GRAM/200 ML IV PGBK,,J3372,HCPCS,Facility,Both,200 mL,mL,,93,79.05,26.6538,93,Medica,Individual & Family,92.163,99.1,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1 GRAM/200 ML IV PGBK,,J3372,HCPCS,Facility,Both,200 mL,mL,,93,79.05,26.6538,93,Medica,Individual & Family,92.163,99.1,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1 GRAM/200 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,200 mL,mL,,93,79.05,26.6538,93,Medica,Medica Advantage Solution,46.314,49.8,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1 GRAM/200 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,200 mL,mL,,93,79.05,26.6538,93,Medica,Medica Advantage Solution,46.314,49.8,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1 GRAM/200 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,200 mL,mL,,93,79.05,26.6538,93,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 1 GRAM/200 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,200 mL,mL,,93,79.05,26.6538,93,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 1 GRAM/200 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,200 mL,mL,,93,79.05,26.6538,93,Medica,Medical Assistance,41.478,44.6,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1 GRAM/200 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,200 mL,mL,,93,79.05,26.6538,93,Medica,Medical Assistance,41.478,44.6,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1 GRAM/200 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,200 mL,mL,,93,79.05,26.6538,93,Medica,Medical Assistance,,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 1 GRAM/200 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,200 mL,mL,,93,79.05,26.6538,93,Medica,Medical Assistance,,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 1 GRAM/200 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,200 mL,mL,,93,79.05,26.6538,93,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,46.314,49.8,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1 GRAM/200 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,200 mL,mL,,93,79.05,26.6538,93,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,46.314,49.8,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1 GRAM/200 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,200 mL,mL,,93,79.05,26.6538,93,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 1 GRAM/200 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,200 mL,mL,,93,79.05,26.6538,93,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 1 GRAM/200 ML IV PGBK,,J3372,HCPCS,Facility,Both,200 mL,mL,,93,79.05,26.6538,93,"Multiplan, Inc.","Multiplan, Inc.",87.42,94,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1 GRAM/200 ML IV PGBK,,J3372,HCPCS,Facility,Both,200 mL,mL,,93,79.05,26.6538,93,"Multiplan, Inc.","Multiplan, Inc.",87.42,94,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1 GRAM/200 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,200 mL,mL,,93,79.05,26.6538,93,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,83.793,90.1,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1 GRAM/200 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,200 mL,mL,,93,79.05,26.6538,93,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,83.793,90.1,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1 GRAM/200 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,200 mL,mL,,93,79.05,26.6538,93,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
VANCOMYCIN-DILUENT COMBO NO.1 1 GRAM/200 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,200 mL,mL,,93,79.05,26.6538,93,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
VANCOMYCIN-DILUENT COMBO NO.1 1 GRAM/200 ML IV PGBK,,J3372,HCPCS,Facility,Both,200 mL,mL,,93,79.05,26.6538,93,"Preferred One Administrative Services, INC.",PPO,91.698,98.6,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1 GRAM/200 ML IV PGBK,,J3372,HCPCS,Facility,Both,200 mL,mL,,93,79.05,26.6538,93,"Preferred One Administrative Services, INC.",PPO,91.698,98.6,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1 GRAM/200 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,200 mL,mL,,93,79.05,26.6538,93,PrimeWest Health,Minnesota Senior Health Options (MSHO),47.8485,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
VANCOMYCIN-DILUENT COMBO NO.1 1 GRAM/200 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,200 mL,mL,,93,79.05,26.6538,93,PrimeWest Health,Minnesota Senior Health Options (MSHO),47.8485,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
VANCOMYCIN-DILUENT COMBO NO.1 1 GRAM/200 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,200 mL,mL,,93,79.05,26.6538,93,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 1 GRAM/200 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,200 mL,mL,,93,79.05,26.6538,93,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 1 GRAM/200 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,200 mL,mL,,93,79.05,26.6538,93,PrimeWest Health,MinnesotaCare,47.7648,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
VANCOMYCIN-DILUENT COMBO NO.1 1 GRAM/200 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,200 mL,mL,,93,79.05,26.6538,93,PrimeWest Health,MinnesotaCare,47.7648,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
VANCOMYCIN-DILUENT COMBO NO.1 1 GRAM/200 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,200 mL,mL,,93,79.05,26.6538,93,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 1 GRAM/200 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,200 mL,mL,,93,79.05,26.6538,93,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 1 GRAM/200 ML IV PGBK,,J3372,HCPCS,Facility,Both,200 mL,mL,,93,79.05,26.6538,93,Sanford Health Plan,Sanford Health Plan,85.56,92,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1 GRAM/200 ML IV PGBK,,J3372,HCPCS,Facility,Both,200 mL,mL,,93,79.05,26.6538,93,Sanford Health Plan,Sanford Health Plan,85.56,92,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1 GRAM/200 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,200 mL,mL,,93,79.05,26.6538,93,"UCare Health, Inc.",Individual & Family Plan,52.4055,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
VANCOMYCIN-DILUENT COMBO NO.1 1 GRAM/200 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,200 mL,mL,,93,79.05,26.6538,93,"UCare Health, Inc.",Individual & Family Plan,52.4055,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
VANCOMYCIN-DILUENT COMBO NO.1 1 GRAM/200 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,200 mL,mL,,93,79.05,26.6538,93,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 1 GRAM/200 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,200 mL,mL,,93,79.05,26.6538,93,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 1 GRAM/200 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,200 mL,mL,,93,79.05,26.6538,93,"UCare Health, Inc.",Medical Assistance,46.9371,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
VANCOMYCIN-DILUENT COMBO NO.1 1 GRAM/200 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,200 mL,mL,,93,79.05,26.6538,93,"UCare Health, Inc.",Medical Assistance,46.9371,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
VANCOMYCIN-DILUENT COMBO NO.1 1 GRAM/200 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,200 mL,mL,,93,79.05,26.6538,93,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 1 GRAM/200 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,200 mL,mL,,93,79.05,26.6538,93,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 1 GRAM/200 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,200 mL,mL,,93,79.05,26.6538,93,"UCare Health, Inc.",Medicare Advantage,46.9371,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
VANCOMYCIN-DILUENT COMBO NO.1 1 GRAM/200 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,200 mL,mL,,93,79.05,26.6538,93,"UCare Health, Inc.",Medicare Advantage,46.9371,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
VANCOMYCIN-DILUENT COMBO NO.1 1 GRAM/200 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,200 mL,mL,,93,79.05,26.6538,93,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 1 GRAM/200 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,200 mL,mL,,93,79.05,26.6538,93,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 1 GRAM/200 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,200 mL,mL,,93,79.05,26.6538,93,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),46.9371,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
VANCOMYCIN-DILUENT COMBO NO.1 1 GRAM/200 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,200 mL,mL,,93,79.05,26.6538,93,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),46.9371,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
VANCOMYCIN-DILUENT COMBO NO.1 1 GRAM/200 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,200 mL,mL,,93,79.05,26.6538,93,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 1 GRAM/200 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,200 mL,mL,,93,79.05,26.6538,93,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 1 GRAM/200 ML IV PGBK,,J3372,HCPCS,Facility,Both,200 mL,mL,,93,79.05,26.6538,93,UnitedHealthcare,Individual & Family,87.42,94,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1 GRAM/200 ML IV PGBK,,J3372,HCPCS,Facility,Both,200 mL,mL,,93,79.05,26.6538,93,UnitedHealthcare,Individual & Family,87.42,94,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1 GRAM/200 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,200 mL,mL,,93,79.05,26.6538,93,UnitedHealthcare,Medicare Advantage,45.57,49,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1 GRAM/200 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,200 mL,mL,,93,79.05,26.6538,93,UnitedHealthcare,Medicare Advantage,45.57,49,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1 GRAM/200 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,200 mL,mL,,93,79.05,26.6538,93,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 1 GRAM/200 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,200 mL,mL,,93,79.05,26.6538,93,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 1 GRAM/200 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,200 mL,mL,,93,79.05,26.6538,93,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,44.64,48,,percent of total billed charges,,100% of DHS outpatient percentage
VANCOMYCIN-DILUENT COMBO NO.1 1 GRAM/200 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,200 mL,mL,,93,79.05,26.6538,93,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,44.64,48,,percent of total billed charges,,100% of DHS outpatient percentage
VANCOMYCIN-DILUENT COMBO NO.1 1 GRAM/200 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,200 mL,mL,,93,79.05,26.6538,93,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 1 GRAM/200 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,200 mL,mL,,93,79.05,26.6538,93,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWD,,76896,LOCAL,Facility,Both,231 g,g,,372,316.2,106.6152,372,Aetna,Commercial,342.24,92,,percent of total billed charges,,
CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWD,,76896,LOCAL,Facility,Outpatient,231 g,g,,372,316.2,106.6152,372,Aetna,Medicare Advantage,182.28,49,,percent of total billed charges,,
CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWD,,76896,LOCAL,Facility,Inpatient,231 g,g,,372,316.2,106.6152,372,Aetna,Medicare Advantage,,,,,Included in per diem rate,
CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWD,,76896,LOCAL,Facility,Both,231 g,g,,372,316.2,106.6152,372,Aetna,PPO,345.96,93,,percent of total billed charges,,
CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWD,,76896,LOCAL,Facility,Both,231 g,g,,372,316.2,106.6152,372,America's PPO,America's PPO,357.2316,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWD,,76896,LOCAL,Facility,Both,231 g,g,,372,316.2,106.6152,372,BlueCross BlueShield Minnesota, Federal Employee Program,366.048,98.4,,percent of total billed charges,,
CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWD,,76896,LOCAL,Facility,Both,231 g,g,,372,316.2,106.6152,372,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,372,100,,percent of total billed charges,,
CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWD,,76896,LOCAL,Facility,Both,231 g,g,,372,316.2,106.6152,372,BlueCross BlueShield Minnesota,High Value Network Plan,334.8,90,,percent of total billed charges,,
CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWD,,76896,LOCAL,Facility,Outpatient,231 g,g,,372,316.2,106.6152,372,BlueCross BlueShield Minnesota,Medicare Advantage,182.28,49,,percent of total billed charges,,
CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWD,,76896,LOCAL,Facility,Inpatient,231 g,g,,372,316.2,106.6152,372,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWD,,76896,LOCAL,Facility,Both,231 g,g,,372,316.2,106.6152,372,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,329.4804,88.57,,percent of total billed charges,,
CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWD,,76896,LOCAL,Facility,Both,231 g,g,,372,316.2,106.6152,372,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,106.6152,28.66,,percent of total billed charges,,
CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWD,,76896,LOCAL,Facility,Outpatient,231 g,g,,372,316.2,106.6152,372,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),182.28,49,,percent of total billed charges,,
CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWD,,76896,LOCAL,Facility,Inpatient,231 g,g,,372,316.2,106.6152,372,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWD,,76896,LOCAL,Facility,Both,231 g,g,,372,316.2,106.6152,372,CorVel,Worker's Compensation,372,100,,percent of total billed charges,,
CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWD,,76896,LOCAL,Facility,Both,231 g,g,,372,316.2,106.6152,372,First Health Group Corporation,First Health Network,360.84,97,,percent of total billed charges,,
CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWD,,76896,LOCAL,Facility,Both,231 g,g,,372,316.2,106.6152,372,"Health Partners, Inc.",Commercial,351.912,94.6,,percent of total billed charges,,
CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWD,,76896,LOCAL,Facility,Outpatient,231 g,g,,372,316.2,106.6152,372,"Health Partners, Inc.",Medicare Advantage,182.28,49,,percent of total billed charges,,
CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWD,,76896,LOCAL,Facility,Inpatient,231 g,g,,372,316.2,106.6152,372,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWD,,76896,LOCAL,Facility,Both,231 g,g,,372,316.2,106.6152,372,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),223.2,60,,percent of total billed charges,,
CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWD,,76896,LOCAL,Facility,Both,231 g,g,,372,316.2,106.6152,372,"Health Partners, Inc.",State of Minnesota Advantage Program,303.18,81.5,,percent of total billed charges,,
CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWD,,76896,LOCAL,Facility,Both,231 g,g,,372,316.2,106.6152,372,"Health Partners, Inc.",State Public Programs,186,50,,percent of total billed charges,,
CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWD,,76896,LOCAL,Facility,Both,231 g,g,,372,316.2,106.6152,372,Humana Insurance Company,Commercial PPO,353.4,95,,percent of total billed charges,,
CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWD,,76896,LOCAL,Facility,Outpatient,231 g,g,,372,316.2,106.6152,372,Humana Insurance Company,Medicare PPO,182.28,49,,percent of total billed charges,,
CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWD,,76896,LOCAL,Facility,Inpatient,231 g,g,,372,316.2,106.6152,372,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWD,,76896,LOCAL,Facility,Both,231 g,g,,372,316.2,106.6152,372,Medica,Individual & Family,368.652,99.1,,percent of total billed charges,,
CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWD,,76896,LOCAL,Facility,Outpatient,231 g,g,,372,316.2,106.6152,372,Medica,Medica Advantage Solution,185.256,49.8,,percent of total billed charges,,
CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWD,,76896,LOCAL,Facility,Inpatient,231 g,g,,372,316.2,106.6152,372,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWD,,76896,LOCAL,Facility,Outpatient,231 g,g,,372,316.2,106.6152,372,Medica,Medical Assistance,165.912,44.6,,percent of total billed charges,,
CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWD,,76896,LOCAL,Facility,Inpatient,231 g,g,,372,316.2,106.6152,372,Medica,Medical Assistance,,,,,Included in per diem rate,
CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWD,,76896,LOCAL,Facility,Outpatient,231 g,g,,372,316.2,106.6152,372,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,185.256,49.8,,percent of total billed charges,,
CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWD,,76896,LOCAL,Facility,Inpatient,231 g,g,,372,316.2,106.6152,372,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWD,,76896,LOCAL,Facility,Both,231 g,g,,372,316.2,106.6152,372,"Multiplan, Inc.","Multiplan, Inc.",349.68,94,,percent of total billed charges,,
CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWD,,76896,LOCAL,Facility,Outpatient,231 g,g,,372,316.2,106.6152,372,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,335.172,90.1,,percent of total billed charges,,
CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWD,,76896,LOCAL,Facility,Inpatient,231 g,g,,372,316.2,106.6152,372,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWD,,76896,LOCAL,Facility,Both,231 g,g,,372,316.2,106.6152,372,"Preferred One Administrative Services, INC.",PPO,366.792,98.6,,percent of total billed charges,,
CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWD,,76896,LOCAL,Facility,Outpatient,231 g,g,,372,316.2,106.6152,372,PrimeWest Health,Minnesota Senior Health Options (MSHO),191.394,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWD,,76896,LOCAL,Facility,Inpatient,231 g,g,,372,316.2,106.6152,372,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWD,,76896,LOCAL,Facility,Outpatient,231 g,g,,372,316.2,106.6152,372,PrimeWest Health,MinnesotaCare,191.0592,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWD,,76896,LOCAL,Facility,Inpatient,231 g,g,,372,316.2,106.6152,372,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWD,,76896,LOCAL,Facility,Both,231 g,g,,372,316.2,106.6152,372,Sanford Health Plan,Sanford Health Plan,342.24,92,,percent of total billed charges,,
CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWD,,76896,LOCAL,Facility,Outpatient,231 g,g,,372,316.2,106.6152,372,"UCare Health, Inc.",Individual & Family Plan,209.622,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWD,,76896,LOCAL,Facility,Inpatient,231 g,g,,372,316.2,106.6152,372,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWD,,76896,LOCAL,Facility,Outpatient,231 g,g,,372,316.2,106.6152,372,"UCare Health, Inc.",Medical Assistance,187.7484,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWD,,76896,LOCAL,Facility,Inpatient,231 g,g,,372,316.2,106.6152,372,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWD,,76896,LOCAL,Facility,Outpatient,231 g,g,,372,316.2,106.6152,372,"UCare Health, Inc.",Medicare Advantage,187.7484,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWD,,76896,LOCAL,Facility,Inpatient,231 g,g,,372,316.2,106.6152,372,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWD,,76896,LOCAL,Facility,Outpatient,231 g,g,,372,316.2,106.6152,372,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),187.7484,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWD,,76896,LOCAL,Facility,Inpatient,231 g,g,,372,316.2,106.6152,372,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWD,,76896,LOCAL,Facility,Both,231 g,g,,372,316.2,106.6152,372,UnitedHealthcare,Individual & Family,349.68,94,,percent of total billed charges,,
CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWD,,76896,LOCAL,Facility,Outpatient,231 g,g,,372,316.2,106.6152,372,UnitedHealthcare,Medicare Advantage,182.28,49,,percent of total billed charges,,
CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWD,,76896,LOCAL,Facility,Inpatient,231 g,g,,372,316.2,106.6152,372,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWD,,76896,LOCAL,Facility,Outpatient,231 g,g,,372,316.2,106.6152,372,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,178.56,48,,percent of total billed charges,,100% of DHS outpatient percentage
CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWD,,76896,LOCAL,Facility,Inpatient,231 g,g,,372,316.2,106.6152,372,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
BISMUTH SUBSALICYLATE 262 MG/15 ML ORAL SUSP,,12547,LOCAL,Facility,Both,236 mL,mL,,16,13.6,4.5856,16,Aetna,Commercial,14.72,92,,percent of total billed charges,,
BISMUTH SUBSALICYLATE 262 MG/15 ML ORAL SUSP,,12547,LOCAL,Facility,Outpatient,236 mL,mL,,16,13.6,4.5856,16,Aetna,Medicare Advantage,7.84,49,,percent of total billed charges,,
BISMUTH SUBSALICYLATE 262 MG/15 ML ORAL SUSP,,12547,LOCAL,Facility,Inpatient,236 mL,mL,,16,13.6,4.5856,16,Aetna,Medicare Advantage,,,,,Included in per diem rate,
BISMUTH SUBSALICYLATE 262 MG/15 ML ORAL SUSP,,12547,LOCAL,Facility,Both,236 mL,mL,,16,13.6,4.5856,16,Aetna,PPO,14.88,93,,percent of total billed charges,,
BISMUTH SUBSALICYLATE 262 MG/15 ML ORAL SUSP,,12547,LOCAL,Facility,Both,236 mL,mL,,16,13.6,4.5856,16,America's PPO,America's PPO,15.3648,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
BISMUTH SUBSALICYLATE 262 MG/15 ML ORAL SUSP,,12547,LOCAL,Facility,Both,236 mL,mL,,16,13.6,4.5856,16,BlueCross BlueShield Minnesota, Federal Employee Program,15.744,98.4,,percent of total billed charges,,
BISMUTH SUBSALICYLATE 262 MG/15 ML ORAL SUSP,,12547,LOCAL,Facility,Both,236 mL,mL,,16,13.6,4.5856,16,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,16,100,,percent of total billed charges,,
BISMUTH SUBSALICYLATE 262 MG/15 ML ORAL SUSP,,12547,LOCAL,Facility,Both,236 mL,mL,,16,13.6,4.5856,16,BlueCross BlueShield Minnesota,High Value Network Plan,14.4,90,,percent of total billed charges,,
BISMUTH SUBSALICYLATE 262 MG/15 ML ORAL SUSP,,12547,LOCAL,Facility,Outpatient,236 mL,mL,,16,13.6,4.5856,16,BlueCross BlueShield Minnesota,Medicare Advantage,7.84,49,,percent of total billed charges,,
BISMUTH SUBSALICYLATE 262 MG/15 ML ORAL SUSP,,12547,LOCAL,Facility,Inpatient,236 mL,mL,,16,13.6,4.5856,16,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
BISMUTH SUBSALICYLATE 262 MG/15 ML ORAL SUSP,,12547,LOCAL,Facility,Both,236 mL,mL,,16,13.6,4.5856,16,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,14.1712,88.57,,percent of total billed charges,,
BISMUTH SUBSALICYLATE 262 MG/15 ML ORAL SUSP,,12547,LOCAL,Facility,Both,236 mL,mL,,16,13.6,4.5856,16,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,4.5856,28.66,,percent of total billed charges,,
BISMUTH SUBSALICYLATE 262 MG/15 ML ORAL SUSP,,12547,LOCAL,Facility,Outpatient,236 mL,mL,,16,13.6,4.5856,16,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),7.84,49,,percent of total billed charges,,
BISMUTH SUBSALICYLATE 262 MG/15 ML ORAL SUSP,,12547,LOCAL,Facility,Inpatient,236 mL,mL,,16,13.6,4.5856,16,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
BISMUTH SUBSALICYLATE 262 MG/15 ML ORAL SUSP,,12547,LOCAL,Facility,Both,236 mL,mL,,16,13.6,4.5856,16,CorVel,Worker's Compensation,16,100,,percent of total billed charges,,
BISMUTH SUBSALICYLATE 262 MG/15 ML ORAL SUSP,,12547,LOCAL,Facility,Both,236 mL,mL,,16,13.6,4.5856,16,First Health Group Corporation,First Health Network,15.52,97,,percent of total billed charges,,
BISMUTH SUBSALICYLATE 262 MG/15 ML ORAL SUSP,,12547,LOCAL,Facility,Both,236 mL,mL,,16,13.6,4.5856,16,"Health Partners, Inc.",Commercial,15.136,94.6,,percent of total billed charges,,
BISMUTH SUBSALICYLATE 262 MG/15 ML ORAL SUSP,,12547,LOCAL,Facility,Outpatient,236 mL,mL,,16,13.6,4.5856,16,"Health Partners, Inc.",Medicare Advantage,7.84,49,,percent of total billed charges,,
BISMUTH SUBSALICYLATE 262 MG/15 ML ORAL SUSP,,12547,LOCAL,Facility,Inpatient,236 mL,mL,,16,13.6,4.5856,16,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
BISMUTH SUBSALICYLATE 262 MG/15 ML ORAL SUSP,,12547,LOCAL,Facility,Both,236 mL,mL,,16,13.6,4.5856,16,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),9.6,60,,percent of total billed charges,,
BISMUTH SUBSALICYLATE 262 MG/15 ML ORAL SUSP,,12547,LOCAL,Facility,Both,236 mL,mL,,16,13.6,4.5856,16,"Health Partners, Inc.",State of Minnesota Advantage Program,13.04,81.5,,percent of total billed charges,,
BISMUTH SUBSALICYLATE 262 MG/15 ML ORAL SUSP,,12547,LOCAL,Facility,Both,236 mL,mL,,16,13.6,4.5856,16,"Health Partners, Inc.",State Public Programs,8,50,,percent of total billed charges,,
BISMUTH SUBSALICYLATE 262 MG/15 ML ORAL SUSP,,12547,LOCAL,Facility,Both,236 mL,mL,,16,13.6,4.5856,16,Humana Insurance Company,Commercial PPO,15.2,95,,percent of total billed charges,,
BISMUTH SUBSALICYLATE 262 MG/15 ML ORAL SUSP,,12547,LOCAL,Facility,Outpatient,236 mL,mL,,16,13.6,4.5856,16,Humana Insurance Company,Medicare PPO,7.84,49,,percent of total billed charges,,
BISMUTH SUBSALICYLATE 262 MG/15 ML ORAL SUSP,,12547,LOCAL,Facility,Inpatient,236 mL,mL,,16,13.6,4.5856,16,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
BISMUTH SUBSALICYLATE 262 MG/15 ML ORAL SUSP,,12547,LOCAL,Facility,Both,236 mL,mL,,16,13.6,4.5856,16,Medica,Individual & Family,15.856,99.1,,percent of total billed charges,,
BISMUTH SUBSALICYLATE 262 MG/15 ML ORAL SUSP,,12547,LOCAL,Facility,Outpatient,236 mL,mL,,16,13.6,4.5856,16,Medica,Medica Advantage Solution,7.968,49.8,,percent of total billed charges,,
BISMUTH SUBSALICYLATE 262 MG/15 ML ORAL SUSP,,12547,LOCAL,Facility,Inpatient,236 mL,mL,,16,13.6,4.5856,16,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
BISMUTH SUBSALICYLATE 262 MG/15 ML ORAL SUSP,,12547,LOCAL,Facility,Outpatient,236 mL,mL,,16,13.6,4.5856,16,Medica,Medical Assistance,7.136,44.6,,percent of total billed charges,,
BISMUTH SUBSALICYLATE 262 MG/15 ML ORAL SUSP,,12547,LOCAL,Facility,Inpatient,236 mL,mL,,16,13.6,4.5856,16,Medica,Medical Assistance,,,,,Included in per diem rate,
BISMUTH SUBSALICYLATE 262 MG/15 ML ORAL SUSP,,12547,LOCAL,Facility,Outpatient,236 mL,mL,,16,13.6,4.5856,16,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,7.968,49.8,,percent of total billed charges,,
BISMUTH SUBSALICYLATE 262 MG/15 ML ORAL SUSP,,12547,LOCAL,Facility,Inpatient,236 mL,mL,,16,13.6,4.5856,16,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
BISMUTH SUBSALICYLATE 262 MG/15 ML ORAL SUSP,,12547,LOCAL,Facility,Both,236 mL,mL,,16,13.6,4.5856,16,"Multiplan, Inc.","Multiplan, Inc.",15.04,94,,percent of total billed charges,,
BISMUTH SUBSALICYLATE 262 MG/15 ML ORAL SUSP,,12547,LOCAL,Facility,Outpatient,236 mL,mL,,16,13.6,4.5856,16,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,14.416,90.1,,percent of total billed charges,,
BISMUTH SUBSALICYLATE 262 MG/15 ML ORAL SUSP,,12547,LOCAL,Facility,Inpatient,236 mL,mL,,16,13.6,4.5856,16,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
BISMUTH SUBSALICYLATE 262 MG/15 ML ORAL SUSP,,12547,LOCAL,Facility,Both,236 mL,mL,,16,13.6,4.5856,16,"Preferred One Administrative Services, INC.",PPO,15.776,98.6,,percent of total billed charges,,
BISMUTH SUBSALICYLATE 262 MG/15 ML ORAL SUSP,,12547,LOCAL,Facility,Outpatient,236 mL,mL,,16,13.6,4.5856,16,PrimeWest Health,Minnesota Senior Health Options (MSHO),8.232,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
BISMUTH SUBSALICYLATE 262 MG/15 ML ORAL SUSP,,12547,LOCAL,Facility,Inpatient,236 mL,mL,,16,13.6,4.5856,16,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
BISMUTH SUBSALICYLATE 262 MG/15 ML ORAL SUSP,,12547,LOCAL,Facility,Outpatient,236 mL,mL,,16,13.6,4.5856,16,PrimeWest Health,MinnesotaCare,8.2176,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
BISMUTH SUBSALICYLATE 262 MG/15 ML ORAL SUSP,,12547,LOCAL,Facility,Inpatient,236 mL,mL,,16,13.6,4.5856,16,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
BISMUTH SUBSALICYLATE 262 MG/15 ML ORAL SUSP,,12547,LOCAL,Facility,Both,236 mL,mL,,16,13.6,4.5856,16,Sanford Health Plan,Sanford Health Plan,14.72,92,,percent of total billed charges,,
BISMUTH SUBSALICYLATE 262 MG/15 ML ORAL SUSP,,12547,LOCAL,Facility,Outpatient,236 mL,mL,,16,13.6,4.5856,16,"UCare Health, Inc.",Individual & Family Plan,9.016,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
BISMUTH SUBSALICYLATE 262 MG/15 ML ORAL SUSP,,12547,LOCAL,Facility,Inpatient,236 mL,mL,,16,13.6,4.5856,16,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
BISMUTH SUBSALICYLATE 262 MG/15 ML ORAL SUSP,,12547,LOCAL,Facility,Outpatient,236 mL,mL,,16,13.6,4.5856,16,"UCare Health, Inc.",Medical Assistance,8.0752,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BISMUTH SUBSALICYLATE 262 MG/15 ML ORAL SUSP,,12547,LOCAL,Facility,Inpatient,236 mL,mL,,16,13.6,4.5856,16,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
BISMUTH SUBSALICYLATE 262 MG/15 ML ORAL SUSP,,12547,LOCAL,Facility,Outpatient,236 mL,mL,,16,13.6,4.5856,16,"UCare Health, Inc.",Medicare Advantage,8.0752,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BISMUTH SUBSALICYLATE 262 MG/15 ML ORAL SUSP,,12547,LOCAL,Facility,Inpatient,236 mL,mL,,16,13.6,4.5856,16,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
BISMUTH SUBSALICYLATE 262 MG/15 ML ORAL SUSP,,12547,LOCAL,Facility,Outpatient,236 mL,mL,,16,13.6,4.5856,16,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),8.0752,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BISMUTH SUBSALICYLATE 262 MG/15 ML ORAL SUSP,,12547,LOCAL,Facility,Inpatient,236 mL,mL,,16,13.6,4.5856,16,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
BISMUTH SUBSALICYLATE 262 MG/15 ML ORAL SUSP,,12547,LOCAL,Facility,Both,236 mL,mL,,16,13.6,4.5856,16,UnitedHealthcare,Individual & Family,15.04,94,,percent of total billed charges,,
BISMUTH SUBSALICYLATE 262 MG/15 ML ORAL SUSP,,12547,LOCAL,Facility,Outpatient,236 mL,mL,,16,13.6,4.5856,16,UnitedHealthcare,Medicare Advantage,7.84,49,,percent of total billed charges,,
BISMUTH SUBSALICYLATE 262 MG/15 ML ORAL SUSP,,12547,LOCAL,Facility,Inpatient,236 mL,mL,,16,13.6,4.5856,16,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
BISMUTH SUBSALICYLATE 262 MG/15 ML ORAL SUSP,,12547,LOCAL,Facility,Outpatient,236 mL,mL,,16,13.6,4.5856,16,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,7.68,48,,percent of total billed charges,,100% of DHS outpatient percentage
BISMUTH SUBSALICYLATE 262 MG/15 ML ORAL SUSP,,12547,LOCAL,Facility,Inpatient,236 mL,mL,,16,13.6,4.5856,16,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
LANOLIN-MINERAL OIL TOP LOTN,,28318,LOCAL,Facility,Both,236 mL,mL,,11,9.35,3.1526,11,Aetna,Commercial,10.12,92,,percent of total billed charges,,
LANOLIN-MINERAL OIL TOP LOTN,,28318,LOCAL,Facility,Outpatient,236 mL,mL,,11,9.35,3.1526,11,Aetna,Medicare Advantage,5.39,49,,percent of total billed charges,,
LANOLIN-MINERAL OIL TOP LOTN,,28318,LOCAL,Facility,Inpatient,236 mL,mL,,11,9.35,3.1526,11,Aetna,Medicare Advantage,,,,,Included in per diem rate,
LANOLIN-MINERAL OIL TOP LOTN,,28318,LOCAL,Facility,Both,236 mL,mL,,11,9.35,3.1526,11,Aetna,PPO,10.23,93,,percent of total billed charges,,
LANOLIN-MINERAL OIL TOP LOTN,,28318,LOCAL,Facility,Both,236 mL,mL,,11,9.35,3.1526,11,America's PPO,America's PPO,10.5633,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
LANOLIN-MINERAL OIL TOP LOTN,,28318,LOCAL,Facility,Both,236 mL,mL,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota, Federal Employee Program,10.824,98.4,,percent of total billed charges,,
LANOLIN-MINERAL OIL TOP LOTN,,28318,LOCAL,Facility,Both,236 mL,mL,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,11,100,,percent of total billed charges,,
LANOLIN-MINERAL OIL TOP LOTN,,28318,LOCAL,Facility,Both,236 mL,mL,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,High Value Network Plan,9.9,90,,percent of total billed charges,,
LANOLIN-MINERAL OIL TOP LOTN,,28318,LOCAL,Facility,Outpatient,236 mL,mL,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,Medicare Advantage,5.39,49,,percent of total billed charges,,
LANOLIN-MINERAL OIL TOP LOTN,,28318,LOCAL,Facility,Inpatient,236 mL,mL,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
LANOLIN-MINERAL OIL TOP LOTN,,28318,LOCAL,Facility,Both,236 mL,mL,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,9.7427,88.57,,percent of total billed charges,,
LANOLIN-MINERAL OIL TOP LOTN,,28318,LOCAL,Facility,Both,236 mL,mL,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,3.1526,28.66,,percent of total billed charges,,
LANOLIN-MINERAL OIL TOP LOTN,,28318,LOCAL,Facility,Outpatient,236 mL,mL,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),5.39,49,,percent of total billed charges,,
LANOLIN-MINERAL OIL TOP LOTN,,28318,LOCAL,Facility,Inpatient,236 mL,mL,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
LANOLIN-MINERAL OIL TOP LOTN,,28318,LOCAL,Facility,Both,236 mL,mL,,11,9.35,3.1526,11,CorVel,Worker's Compensation,11,100,,percent of total billed charges,,
LANOLIN-MINERAL OIL TOP LOTN,,28318,LOCAL,Facility,Both,236 mL,mL,,11,9.35,3.1526,11,First Health Group Corporation,First Health Network,10.67,97,,percent of total billed charges,,
LANOLIN-MINERAL OIL TOP LOTN,,28318,LOCAL,Facility,Both,236 mL,mL,,11,9.35,3.1526,11,"Health Partners, Inc.",Commercial,10.406,94.6,,percent of total billed charges,,
LANOLIN-MINERAL OIL TOP LOTN,,28318,LOCAL,Facility,Outpatient,236 mL,mL,,11,9.35,3.1526,11,"Health Partners, Inc.",Medicare Advantage,5.39,49,,percent of total billed charges,,
LANOLIN-MINERAL OIL TOP LOTN,,28318,LOCAL,Facility,Inpatient,236 mL,mL,,11,9.35,3.1526,11,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LANOLIN-MINERAL OIL TOP LOTN,,28318,LOCAL,Facility,Both,236 mL,mL,,11,9.35,3.1526,11,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),6.6,60,,percent of total billed charges,,
LANOLIN-MINERAL OIL TOP LOTN,,28318,LOCAL,Facility,Both,236 mL,mL,,11,9.35,3.1526,11,"Health Partners, Inc.",State of Minnesota Advantage Program,8.965,81.5,,percent of total billed charges,,
LANOLIN-MINERAL OIL TOP LOTN,,28318,LOCAL,Facility,Both,236 mL,mL,,11,9.35,3.1526,11,"Health Partners, Inc.",State Public Programs,5.5,50,,percent of total billed charges,,
LANOLIN-MINERAL OIL TOP LOTN,,28318,LOCAL,Facility,Both,236 mL,mL,,11,9.35,3.1526,11,Humana Insurance Company,Commercial PPO,10.45,95,,percent of total billed charges,,
LANOLIN-MINERAL OIL TOP LOTN,,28318,LOCAL,Facility,Outpatient,236 mL,mL,,11,9.35,3.1526,11,Humana Insurance Company,Medicare PPO,5.39,49,,percent of total billed charges,,
LANOLIN-MINERAL OIL TOP LOTN,,28318,LOCAL,Facility,Inpatient,236 mL,mL,,11,9.35,3.1526,11,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
LANOLIN-MINERAL OIL TOP LOTN,,28318,LOCAL,Facility,Both,236 mL,mL,,11,9.35,3.1526,11,Medica,Individual & Family,10.901,99.1,,percent of total billed charges,,
LANOLIN-MINERAL OIL TOP LOTN,,28318,LOCAL,Facility,Outpatient,236 mL,mL,,11,9.35,3.1526,11,Medica,Medica Advantage Solution,5.478,49.8,,percent of total billed charges,,
LANOLIN-MINERAL OIL TOP LOTN,,28318,LOCAL,Facility,Inpatient,236 mL,mL,,11,9.35,3.1526,11,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
LANOLIN-MINERAL OIL TOP LOTN,,28318,LOCAL,Facility,Outpatient,236 mL,mL,,11,9.35,3.1526,11,Medica,Medical Assistance,4.906,44.6,,percent of total billed charges,,
LANOLIN-MINERAL OIL TOP LOTN,,28318,LOCAL,Facility,Inpatient,236 mL,mL,,11,9.35,3.1526,11,Medica,Medical Assistance,,,,,Included in per diem rate,
LANOLIN-MINERAL OIL TOP LOTN,,28318,LOCAL,Facility,Outpatient,236 mL,mL,,11,9.35,3.1526,11,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,5.478,49.8,,percent of total billed charges,,
LANOLIN-MINERAL OIL TOP LOTN,,28318,LOCAL,Facility,Inpatient,236 mL,mL,,11,9.35,3.1526,11,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
LANOLIN-MINERAL OIL TOP LOTN,,28318,LOCAL,Facility,Both,236 mL,mL,,11,9.35,3.1526,11,"Multiplan, Inc.","Multiplan, Inc.",10.34,94,,percent of total billed charges,,
LANOLIN-MINERAL OIL TOP LOTN,,28318,LOCAL,Facility,Outpatient,236 mL,mL,,11,9.35,3.1526,11,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,9.911,90.1,,percent of total billed charges,,
LANOLIN-MINERAL OIL TOP LOTN,,28318,LOCAL,Facility,Inpatient,236 mL,mL,,11,9.35,3.1526,11,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
LANOLIN-MINERAL OIL TOP LOTN,,28318,LOCAL,Facility,Both,236 mL,mL,,11,9.35,3.1526,11,"Preferred One Administrative Services, INC.",PPO,10.846,98.6,,percent of total billed charges,,
LANOLIN-MINERAL OIL TOP LOTN,,28318,LOCAL,Facility,Outpatient,236 mL,mL,,11,9.35,3.1526,11,PrimeWest Health,Minnesota Senior Health Options (MSHO),5.6595,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
LANOLIN-MINERAL OIL TOP LOTN,,28318,LOCAL,Facility,Inpatient,236 mL,mL,,11,9.35,3.1526,11,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LANOLIN-MINERAL OIL TOP LOTN,,28318,LOCAL,Facility,Outpatient,236 mL,mL,,11,9.35,3.1526,11,PrimeWest Health,MinnesotaCare,5.6496,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
LANOLIN-MINERAL OIL TOP LOTN,,28318,LOCAL,Facility,Inpatient,236 mL,mL,,11,9.35,3.1526,11,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
LANOLIN-MINERAL OIL TOP LOTN,,28318,LOCAL,Facility,Both,236 mL,mL,,11,9.35,3.1526,11,Sanford Health Plan,Sanford Health Plan,10.12,92,,percent of total billed charges,,
LANOLIN-MINERAL OIL TOP LOTN,,28318,LOCAL,Facility,Outpatient,236 mL,mL,,11,9.35,3.1526,11,"UCare Health, Inc.",Individual & Family Plan,6.1985,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
LANOLIN-MINERAL OIL TOP LOTN,,28318,LOCAL,Facility,Inpatient,236 mL,mL,,11,9.35,3.1526,11,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
LANOLIN-MINERAL OIL TOP LOTN,,28318,LOCAL,Facility,Outpatient,236 mL,mL,,11,9.35,3.1526,11,"UCare Health, Inc.",Medical Assistance,5.5517,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LANOLIN-MINERAL OIL TOP LOTN,,28318,LOCAL,Facility,Inpatient,236 mL,mL,,11,9.35,3.1526,11,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
LANOLIN-MINERAL OIL TOP LOTN,,28318,LOCAL,Facility,Outpatient,236 mL,mL,,11,9.35,3.1526,11,"UCare Health, Inc.",Medicare Advantage,5.5517,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LANOLIN-MINERAL OIL TOP LOTN,,28318,LOCAL,Facility,Inpatient,236 mL,mL,,11,9.35,3.1526,11,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LANOLIN-MINERAL OIL TOP LOTN,,28318,LOCAL,Facility,Outpatient,236 mL,mL,,11,9.35,3.1526,11,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),5.5517,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LANOLIN-MINERAL OIL TOP LOTN,,28318,LOCAL,Facility,Inpatient,236 mL,mL,,11,9.35,3.1526,11,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LANOLIN-MINERAL OIL TOP LOTN,,28318,LOCAL,Facility,Both,236 mL,mL,,11,9.35,3.1526,11,UnitedHealthcare,Individual & Family,10.34,94,,percent of total billed charges,,
LANOLIN-MINERAL OIL TOP LOTN,,28318,LOCAL,Facility,Outpatient,236 mL,mL,,11,9.35,3.1526,11,UnitedHealthcare,Medicare Advantage,5.39,49,,percent of total billed charges,,
LANOLIN-MINERAL OIL TOP LOTN,,28318,LOCAL,Facility,Inpatient,236 mL,mL,,11,9.35,3.1526,11,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
LANOLIN-MINERAL OIL TOP LOTN,,28318,LOCAL,Facility,Outpatient,236 mL,mL,,11,9.35,3.1526,11,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,5.28,48,,percent of total billed charges,,100% of DHS outpatient percentage
LANOLIN-MINERAL OIL TOP LOTN,,28318,LOCAL,Facility,Inpatient,236 mL,mL,,11,9.35,3.1526,11,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
PHENYTOIN 125 MG/5 ML ORAL SUSP,,8369,LOCAL,Facility,Both,237 mL,mL,,167,141.95,47.8622,167,Aetna,Commercial,153.64,92,,percent of total billed charges,,
PHENYTOIN 125 MG/5 ML ORAL SUSP,,8369,LOCAL,Facility,Outpatient,237 mL,mL,,167,141.95,47.8622,167,Aetna,Medicare Advantage,81.83,49,,percent of total billed charges,,
PHENYTOIN 125 MG/5 ML ORAL SUSP,,8369,LOCAL,Facility,Inpatient,237 mL,mL,,167,141.95,47.8622,167,Aetna,Medicare Advantage,,,,,Included in per diem rate,
PHENYTOIN 125 MG/5 ML ORAL SUSP,,8369,LOCAL,Facility,Both,237 mL,mL,,167,141.95,47.8622,167,Aetna,PPO,155.31,93,,percent of total billed charges,,
PHENYTOIN 125 MG/5 ML ORAL SUSP,,8369,LOCAL,Facility,Both,237 mL,mL,,167,141.95,47.8622,167,America's PPO,America's PPO,160.3701,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
PHENYTOIN 125 MG/5 ML ORAL SUSP,,8369,LOCAL,Facility,Both,237 mL,mL,,167,141.95,47.8622,167,BlueCross BlueShield Minnesota, Federal Employee Program,164.328,98.4,,percent of total billed charges,,
PHENYTOIN 125 MG/5 ML ORAL SUSP,,8369,LOCAL,Facility,Both,237 mL,mL,,167,141.95,47.8622,167,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,167,100,,percent of total billed charges,,
PHENYTOIN 125 MG/5 ML ORAL SUSP,,8369,LOCAL,Facility,Both,237 mL,mL,,167,141.95,47.8622,167,BlueCross BlueShield Minnesota,High Value Network Plan,150.3,90,,percent of total billed charges,,
PHENYTOIN 125 MG/5 ML ORAL SUSP,,8369,LOCAL,Facility,Outpatient,237 mL,mL,,167,141.95,47.8622,167,BlueCross BlueShield Minnesota,Medicare Advantage,81.83,49,,percent of total billed charges,,
PHENYTOIN 125 MG/5 ML ORAL SUSP,,8369,LOCAL,Facility,Inpatient,237 mL,mL,,167,141.95,47.8622,167,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
PHENYTOIN 125 MG/5 ML ORAL SUSP,,8369,LOCAL,Facility,Both,237 mL,mL,,167,141.95,47.8622,167,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,147.9119,88.57,,percent of total billed charges,,
PHENYTOIN 125 MG/5 ML ORAL SUSP,,8369,LOCAL,Facility,Both,237 mL,mL,,167,141.95,47.8622,167,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,47.8622,28.66,,percent of total billed charges,,
PHENYTOIN 125 MG/5 ML ORAL SUSP,,8369,LOCAL,Facility,Outpatient,237 mL,mL,,167,141.95,47.8622,167,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),81.83,49,,percent of total billed charges,,
PHENYTOIN 125 MG/5 ML ORAL SUSP,,8369,LOCAL,Facility,Inpatient,237 mL,mL,,167,141.95,47.8622,167,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
PHENYTOIN 125 MG/5 ML ORAL SUSP,,8369,LOCAL,Facility,Both,237 mL,mL,,167,141.95,47.8622,167,CorVel,Worker's Compensation,167,100,,percent of total billed charges,,
PHENYTOIN 125 MG/5 ML ORAL SUSP,,8369,LOCAL,Facility,Both,237 mL,mL,,167,141.95,47.8622,167,First Health Group Corporation,First Health Network,161.99,97,,percent of total billed charges,,
PHENYTOIN 125 MG/5 ML ORAL SUSP,,8369,LOCAL,Facility,Both,237 mL,mL,,167,141.95,47.8622,167,"Health Partners, Inc.",Commercial,157.982,94.6,,percent of total billed charges,,
PHENYTOIN 125 MG/5 ML ORAL SUSP,,8369,LOCAL,Facility,Outpatient,237 mL,mL,,167,141.95,47.8622,167,"Health Partners, Inc.",Medicare Advantage,81.83,49,,percent of total billed charges,,
PHENYTOIN 125 MG/5 ML ORAL SUSP,,8369,LOCAL,Facility,Inpatient,237 mL,mL,,167,141.95,47.8622,167,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PHENYTOIN 125 MG/5 ML ORAL SUSP,,8369,LOCAL,Facility,Both,237 mL,mL,,167,141.95,47.8622,167,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),100.2,60,,percent of total billed charges,,
PHENYTOIN 125 MG/5 ML ORAL SUSP,,8369,LOCAL,Facility,Both,237 mL,mL,,167,141.95,47.8622,167,"Health Partners, Inc.",State of Minnesota Advantage Program,136.105,81.5,,percent of total billed charges,,
PHENYTOIN 125 MG/5 ML ORAL SUSP,,8369,LOCAL,Facility,Both,237 mL,mL,,167,141.95,47.8622,167,"Health Partners, Inc.",State Public Programs,83.5,50,,percent of total billed charges,,
PHENYTOIN 125 MG/5 ML ORAL SUSP,,8369,LOCAL,Facility,Both,237 mL,mL,,167,141.95,47.8622,167,Humana Insurance Company,Commercial PPO,158.65,95,,percent of total billed charges,,
PHENYTOIN 125 MG/5 ML ORAL SUSP,,8369,LOCAL,Facility,Outpatient,237 mL,mL,,167,141.95,47.8622,167,Humana Insurance Company,Medicare PPO,81.83,49,,percent of total billed charges,,
PHENYTOIN 125 MG/5 ML ORAL SUSP,,8369,LOCAL,Facility,Inpatient,237 mL,mL,,167,141.95,47.8622,167,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
PHENYTOIN 125 MG/5 ML ORAL SUSP,,8369,LOCAL,Facility,Both,237 mL,mL,,167,141.95,47.8622,167,Medica,Individual & Family,165.497,99.1,,percent of total billed charges,,
PHENYTOIN 125 MG/5 ML ORAL SUSP,,8369,LOCAL,Facility,Outpatient,237 mL,mL,,167,141.95,47.8622,167,Medica,Medica Advantage Solution,83.166,49.8,,percent of total billed charges,,
PHENYTOIN 125 MG/5 ML ORAL SUSP,,8369,LOCAL,Facility,Inpatient,237 mL,mL,,167,141.95,47.8622,167,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
PHENYTOIN 125 MG/5 ML ORAL SUSP,,8369,LOCAL,Facility,Outpatient,237 mL,mL,,167,141.95,47.8622,167,Medica,Medical Assistance,74.482,44.6,,percent of total billed charges,,
PHENYTOIN 125 MG/5 ML ORAL SUSP,,8369,LOCAL,Facility,Inpatient,237 mL,mL,,167,141.95,47.8622,167,Medica,Medical Assistance,,,,,Included in per diem rate,
PHENYTOIN 125 MG/5 ML ORAL SUSP,,8369,LOCAL,Facility,Outpatient,237 mL,mL,,167,141.95,47.8622,167,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,83.166,49.8,,percent of total billed charges,,
PHENYTOIN 125 MG/5 ML ORAL SUSP,,8369,LOCAL,Facility,Inpatient,237 mL,mL,,167,141.95,47.8622,167,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
PHENYTOIN 125 MG/5 ML ORAL SUSP,,8369,LOCAL,Facility,Both,237 mL,mL,,167,141.95,47.8622,167,"Multiplan, Inc.","Multiplan, Inc.",156.98,94,,percent of total billed charges,,
PHENYTOIN 125 MG/5 ML ORAL SUSP,,8369,LOCAL,Facility,Outpatient,237 mL,mL,,167,141.95,47.8622,167,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,150.467,90.1,,percent of total billed charges,,
PHENYTOIN 125 MG/5 ML ORAL SUSP,,8369,LOCAL,Facility,Inpatient,237 mL,mL,,167,141.95,47.8622,167,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
PHENYTOIN 125 MG/5 ML ORAL SUSP,,8369,LOCAL,Facility,Both,237 mL,mL,,167,141.95,47.8622,167,"Preferred One Administrative Services, INC.",PPO,164.662,98.6,,percent of total billed charges,,
PHENYTOIN 125 MG/5 ML ORAL SUSP,,8369,LOCAL,Facility,Outpatient,237 mL,mL,,167,141.95,47.8622,167,PrimeWest Health,Minnesota Senior Health Options (MSHO),85.9215,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
PHENYTOIN 125 MG/5 ML ORAL SUSP,,8369,LOCAL,Facility,Inpatient,237 mL,mL,,167,141.95,47.8622,167,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PHENYTOIN 125 MG/5 ML ORAL SUSP,,8369,LOCAL,Facility,Outpatient,237 mL,mL,,167,141.95,47.8622,167,PrimeWest Health,MinnesotaCare,85.7712,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
PHENYTOIN 125 MG/5 ML ORAL SUSP,,8369,LOCAL,Facility,Inpatient,237 mL,mL,,167,141.95,47.8622,167,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
PHENYTOIN 125 MG/5 ML ORAL SUSP,,8369,LOCAL,Facility,Both,237 mL,mL,,167,141.95,47.8622,167,Sanford Health Plan,Sanford Health Plan,153.64,92,,percent of total billed charges,,
PHENYTOIN 125 MG/5 ML ORAL SUSP,,8369,LOCAL,Facility,Outpatient,237 mL,mL,,167,141.95,47.8622,167,"UCare Health, Inc.",Individual & Family Plan,94.1045,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
PHENYTOIN 125 MG/5 ML ORAL SUSP,,8369,LOCAL,Facility,Inpatient,237 mL,mL,,167,141.95,47.8622,167,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
PHENYTOIN 125 MG/5 ML ORAL SUSP,,8369,LOCAL,Facility,Outpatient,237 mL,mL,,167,141.95,47.8622,167,"UCare Health, Inc.",Medical Assistance,84.2849,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PHENYTOIN 125 MG/5 ML ORAL SUSP,,8369,LOCAL,Facility,Inpatient,237 mL,mL,,167,141.95,47.8622,167,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
PHENYTOIN 125 MG/5 ML ORAL SUSP,,8369,LOCAL,Facility,Outpatient,237 mL,mL,,167,141.95,47.8622,167,"UCare Health, Inc.",Medicare Advantage,84.2849,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PHENYTOIN 125 MG/5 ML ORAL SUSP,,8369,LOCAL,Facility,Inpatient,237 mL,mL,,167,141.95,47.8622,167,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PHENYTOIN 125 MG/5 ML ORAL SUSP,,8369,LOCAL,Facility,Outpatient,237 mL,mL,,167,141.95,47.8622,167,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),84.2849,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PHENYTOIN 125 MG/5 ML ORAL SUSP,,8369,LOCAL,Facility,Inpatient,237 mL,mL,,167,141.95,47.8622,167,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PHENYTOIN 125 MG/5 ML ORAL SUSP,,8369,LOCAL,Facility,Both,237 mL,mL,,167,141.95,47.8622,167,UnitedHealthcare,Individual & Family,156.98,94,,percent of total billed charges,,
PHENYTOIN 125 MG/5 ML ORAL SUSP,,8369,LOCAL,Facility,Outpatient,237 mL,mL,,167,141.95,47.8622,167,UnitedHealthcare,Medicare Advantage,81.83,49,,percent of total billed charges,,
PHENYTOIN 125 MG/5 ML ORAL SUSP,,8369,LOCAL,Facility,Inpatient,237 mL,mL,,167,141.95,47.8622,167,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
PHENYTOIN 125 MG/5 ML ORAL SUSP,,8369,LOCAL,Facility,Outpatient,237 mL,mL,,167,141.95,47.8622,167,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,80.16,48,,percent of total billed charges,,100% of DHS outpatient percentage
PHENYTOIN 125 MG/5 ML ORAL SUSP,,8369,LOCAL,Facility,Inpatient,237 mL,mL,,167,141.95,47.8622,167,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
PREDNISOLONE SODIUM PHOSPHATE 15 MG/5 ML (3 MG/ML) ORAL SOLN,,J7510,HCPCS,Facility,Both,237 mL,mL,,311,264.35,89.1326,311,Aetna,Commercial,286.12,92,,percent of total billed charges,,
PREDNISOLONE SODIUM PHOSPHATE 15 MG/5 ML (3 MG/ML) ORAL SOLN,,J7510,HCPCS,Facility,Outpatient,237 mL,mL,,311,264.35,89.1326,311,Aetna,Medicare Advantage,152.39,49,,percent of total billed charges,,
PREDNISOLONE SODIUM PHOSPHATE 15 MG/5 ML (3 MG/ML) ORAL SOLN,,J7510,HCPCS,Facility,Inpatient,237 mL,mL,,311,264.35,89.1326,311,Aetna,Medicare Advantage,,,,,Included in per diem rate,
PREDNISOLONE SODIUM PHOSPHATE 15 MG/5 ML (3 MG/ML) ORAL SOLN,,J7510,HCPCS,Facility,Both,237 mL,mL,,311,264.35,89.1326,311,Aetna,PPO,289.23,93,,percent of total billed charges,,
PREDNISOLONE SODIUM PHOSPHATE 15 MG/5 ML (3 MG/ML) ORAL SOLN,,J7510,HCPCS,Facility,Both,237 mL,mL,,311,264.35,89.1326,311,America's PPO,America's PPO,298.6533,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
PREDNISOLONE SODIUM PHOSPHATE 15 MG/5 ML (3 MG/ML) ORAL SOLN,,J7510,HCPCS,Facility,Both,237 mL,mL,,311,264.35,89.1326,311,BlueCross BlueShield Minnesota, Federal Employee Program,306.024,98.4,,percent of total billed charges,,
PREDNISOLONE SODIUM PHOSPHATE 15 MG/5 ML (3 MG/ML) ORAL SOLN,,J7510,HCPCS,Facility,Both,237 mL,mL,,311,264.35,89.1326,311,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,311,100,,percent of total billed charges,,
PREDNISOLONE SODIUM PHOSPHATE 15 MG/5 ML (3 MG/ML) ORAL SOLN,,J7510,HCPCS,Facility,Both,237 mL,mL,,311,264.35,89.1326,311,BlueCross BlueShield Minnesota,High Value Network Plan,279.9,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
PREDNISOLONE SODIUM PHOSPHATE 15 MG/5 ML (3 MG/ML) ORAL SOLN,,J7510,HCPCS,Facility,Outpatient,237 mL,mL,,311,264.35,89.1326,311,BlueCross BlueShield Minnesota,Medicare Advantage,152.39,49,,percent of total billed charges,,
PREDNISOLONE SODIUM PHOSPHATE 15 MG/5 ML (3 MG/ML) ORAL SOLN,,J7510,HCPCS,Facility,Inpatient,237 mL,mL,,311,264.35,89.1326,311,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
PREDNISOLONE SODIUM PHOSPHATE 15 MG/5 ML (3 MG/ML) ORAL SOLN,,J7510,HCPCS,Facility,Both,237 mL,mL,,311,264.35,89.1326,311,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,275.4527,88.57,,percent of total billed charges,,
PREDNISOLONE SODIUM PHOSPHATE 15 MG/5 ML (3 MG/ML) ORAL SOLN,,J7510,HCPCS,Facility,Both,237 mL,mL,,311,264.35,89.1326,311,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,89.1326,28.66,,percent of total billed charges,,
PREDNISOLONE SODIUM PHOSPHATE 15 MG/5 ML (3 MG/ML) ORAL SOLN,,J7510,HCPCS,Facility,Outpatient,237 mL,mL,,311,264.35,89.1326,311,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),152.39,49,,percent of total billed charges,,
PREDNISOLONE SODIUM PHOSPHATE 15 MG/5 ML (3 MG/ML) ORAL SOLN,,J7510,HCPCS,Facility,Inpatient,237 mL,mL,,311,264.35,89.1326,311,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
PREDNISOLONE SODIUM PHOSPHATE 15 MG/5 ML (3 MG/ML) ORAL SOLN,,J7510,HCPCS,Facility,Both,237 mL,mL,,311,264.35,89.1326,311,CorVel,Worker's Compensation,311,100,,percent of total billed charges,,
PREDNISOLONE SODIUM PHOSPHATE 15 MG/5 ML (3 MG/ML) ORAL SOLN,,J7510,HCPCS,Facility,Both,237 mL,mL,,311,264.35,89.1326,311,First Health Group Corporation,First Health Network,301.67,97,,percent of total billed charges,,
PREDNISOLONE SODIUM PHOSPHATE 15 MG/5 ML (3 MG/ML) ORAL SOLN,,J7510,HCPCS,Facility,Both,237 mL,mL,,311,264.35,89.1326,311,"Health Partners, Inc.",Commercial,294.206,94.6,,percent of total billed charges,,
PREDNISOLONE SODIUM PHOSPHATE 15 MG/5 ML (3 MG/ML) ORAL SOLN,,J7510,HCPCS,Facility,Outpatient,237 mL,mL,,311,264.35,89.1326,311,"Health Partners, Inc.",Medicare Advantage,152.39,49,,percent of total billed charges,,
PREDNISOLONE SODIUM PHOSPHATE 15 MG/5 ML (3 MG/ML) ORAL SOLN,,J7510,HCPCS,Facility,Inpatient,237 mL,mL,,311,264.35,89.1326,311,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PREDNISOLONE SODIUM PHOSPHATE 15 MG/5 ML (3 MG/ML) ORAL SOLN,,J7510,HCPCS,Facility,Both,237 mL,mL,,311,264.35,89.1326,311,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),186.6,60,,percent of total billed charges,,
PREDNISOLONE SODIUM PHOSPHATE 15 MG/5 ML (3 MG/ML) ORAL SOLN,,J7510,HCPCS,Facility,Both,237 mL,mL,,311,264.35,89.1326,311,"Health Partners, Inc.",State of Minnesota Advantage Program,253.465,81.5,,percent of total billed charges,,
PREDNISOLONE SODIUM PHOSPHATE 15 MG/5 ML (3 MG/ML) ORAL SOLN,,J7510,HCPCS,Facility,Both,237 mL,mL,,311,264.35,89.1326,311,"Health Partners, Inc.",State Public Programs,155.5,50,,percent of total billed charges,,
PREDNISOLONE SODIUM PHOSPHATE 15 MG/5 ML (3 MG/ML) ORAL SOLN,,J7510,HCPCS,Facility,Both,237 mL,mL,,311,264.35,89.1326,311,Humana Insurance Company,Commercial PPO,295.45,95,,percent of total billed charges,,
PREDNISOLONE SODIUM PHOSPHATE 15 MG/5 ML (3 MG/ML) ORAL SOLN,,J7510,HCPCS,Facility,Outpatient,237 mL,mL,,311,264.35,89.1326,311,Humana Insurance Company,Medicare PPO,152.39,49,,percent of total billed charges,,
PREDNISOLONE SODIUM PHOSPHATE 15 MG/5 ML (3 MG/ML) ORAL SOLN,,J7510,HCPCS,Facility,Inpatient,237 mL,mL,,311,264.35,89.1326,311,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
PREDNISOLONE SODIUM PHOSPHATE 15 MG/5 ML (3 MG/ML) ORAL SOLN,,J7510,HCPCS,Facility,Both,237 mL,mL,,311,264.35,89.1326,311,Medica,Individual & Family,308.201,99.1,,percent of total billed charges,,
PREDNISOLONE SODIUM PHOSPHATE 15 MG/5 ML (3 MG/ML) ORAL SOLN,,J7510,HCPCS,Facility,Outpatient,237 mL,mL,,311,264.35,89.1326,311,Medica,Medica Advantage Solution,154.878,49.8,,percent of total billed charges,,
PREDNISOLONE SODIUM PHOSPHATE 15 MG/5 ML (3 MG/ML) ORAL SOLN,,J7510,HCPCS,Facility,Inpatient,237 mL,mL,,311,264.35,89.1326,311,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
PREDNISOLONE SODIUM PHOSPHATE 15 MG/5 ML (3 MG/ML) ORAL SOLN,,J7510,HCPCS,Facility,Outpatient,237 mL,mL,,311,264.35,89.1326,311,Medica,Medical Assistance,138.706,44.6,,percent of total billed charges,,
PREDNISOLONE SODIUM PHOSPHATE 15 MG/5 ML (3 MG/ML) ORAL SOLN,,J7510,HCPCS,Facility,Inpatient,237 mL,mL,,311,264.35,89.1326,311,Medica,Medical Assistance,,,,,Included in per diem rate,
PREDNISOLONE SODIUM PHOSPHATE 15 MG/5 ML (3 MG/ML) ORAL SOLN,,J7510,HCPCS,Facility,Outpatient,237 mL,mL,,311,264.35,89.1326,311,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,154.878,49.8,,percent of total billed charges,,
PREDNISOLONE SODIUM PHOSPHATE 15 MG/5 ML (3 MG/ML) ORAL SOLN,,J7510,HCPCS,Facility,Inpatient,237 mL,mL,,311,264.35,89.1326,311,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
PREDNISOLONE SODIUM PHOSPHATE 15 MG/5 ML (3 MG/ML) ORAL SOLN,,J7510,HCPCS,Facility,Both,237 mL,mL,,311,264.35,89.1326,311,"Multiplan, Inc.","Multiplan, Inc.",292.34,94,,percent of total billed charges,,
PREDNISOLONE SODIUM PHOSPHATE 15 MG/5 ML (3 MG/ML) ORAL SOLN,,J7510,HCPCS,Facility,Outpatient,237 mL,mL,,311,264.35,89.1326,311,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,280.211,90.1,,percent of total billed charges,,
PREDNISOLONE SODIUM PHOSPHATE 15 MG/5 ML (3 MG/ML) ORAL SOLN,,J7510,HCPCS,Facility,Inpatient,237 mL,mL,,311,264.35,89.1326,311,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
PREDNISOLONE SODIUM PHOSPHATE 15 MG/5 ML (3 MG/ML) ORAL SOLN,,J7510,HCPCS,Facility,Both,237 mL,mL,,311,264.35,89.1326,311,"Preferred One Administrative Services, INC.",PPO,306.646,98.6,,percent of total billed charges,,
PREDNISOLONE SODIUM PHOSPHATE 15 MG/5 ML (3 MG/ML) ORAL SOLN,,J7510,HCPCS,Facility,Outpatient,237 mL,mL,,311,264.35,89.1326,311,PrimeWest Health,Minnesota Senior Health Options (MSHO),160.0095,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
PREDNISOLONE SODIUM PHOSPHATE 15 MG/5 ML (3 MG/ML) ORAL SOLN,,J7510,HCPCS,Facility,Inpatient,237 mL,mL,,311,264.35,89.1326,311,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PREDNISOLONE SODIUM PHOSPHATE 15 MG/5 ML (3 MG/ML) ORAL SOLN,,J7510,HCPCS,Facility,Outpatient,237 mL,mL,,311,264.35,89.1326,311,PrimeWest Health,MinnesotaCare,159.7296,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
PREDNISOLONE SODIUM PHOSPHATE 15 MG/5 ML (3 MG/ML) ORAL SOLN,,J7510,HCPCS,Facility,Inpatient,237 mL,mL,,311,264.35,89.1326,311,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
PREDNISOLONE SODIUM PHOSPHATE 15 MG/5 ML (3 MG/ML) ORAL SOLN,,J7510,HCPCS,Facility,Both,237 mL,mL,,311,264.35,89.1326,311,Sanford Health Plan,Sanford Health Plan,286.12,92,,percent of total billed charges,,
PREDNISOLONE SODIUM PHOSPHATE 15 MG/5 ML (3 MG/ML) ORAL SOLN,,J7510,HCPCS,Facility,Outpatient,237 mL,mL,,311,264.35,89.1326,311,"UCare Health, Inc.",Individual & Family Plan,175.2485,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
PREDNISOLONE SODIUM PHOSPHATE 15 MG/5 ML (3 MG/ML) ORAL SOLN,,J7510,HCPCS,Facility,Inpatient,237 mL,mL,,311,264.35,89.1326,311,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
PREDNISOLONE SODIUM PHOSPHATE 15 MG/5 ML (3 MG/ML) ORAL SOLN,,J7510,HCPCS,Facility,Outpatient,237 mL,mL,,311,264.35,89.1326,311,"UCare Health, Inc.",Medical Assistance,156.9617,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PREDNISOLONE SODIUM PHOSPHATE 15 MG/5 ML (3 MG/ML) ORAL SOLN,,J7510,HCPCS,Facility,Inpatient,237 mL,mL,,311,264.35,89.1326,311,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
PREDNISOLONE SODIUM PHOSPHATE 15 MG/5 ML (3 MG/ML) ORAL SOLN,,J7510,HCPCS,Facility,Outpatient,237 mL,mL,,311,264.35,89.1326,311,"UCare Health, Inc.",Medicare Advantage,156.9617,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PREDNISOLONE SODIUM PHOSPHATE 15 MG/5 ML (3 MG/ML) ORAL SOLN,,J7510,HCPCS,Facility,Inpatient,237 mL,mL,,311,264.35,89.1326,311,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PREDNISOLONE SODIUM PHOSPHATE 15 MG/5 ML (3 MG/ML) ORAL SOLN,,J7510,HCPCS,Facility,Outpatient,237 mL,mL,,311,264.35,89.1326,311,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),156.9617,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PREDNISOLONE SODIUM PHOSPHATE 15 MG/5 ML (3 MG/ML) ORAL SOLN,,J7510,HCPCS,Facility,Inpatient,237 mL,mL,,311,264.35,89.1326,311,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PREDNISOLONE SODIUM PHOSPHATE 15 MG/5 ML (3 MG/ML) ORAL SOLN,,J7510,HCPCS,Facility,Both,237 mL,mL,,311,264.35,89.1326,311,UnitedHealthcare,Individual & Family,292.34,94,,percent of total billed charges,,
PREDNISOLONE SODIUM PHOSPHATE 15 MG/5 ML (3 MG/ML) ORAL SOLN,,J7510,HCPCS,Facility,Outpatient,237 mL,mL,,311,264.35,89.1326,311,UnitedHealthcare,Medicare Advantage,152.39,49,,percent of total billed charges,,
PREDNISOLONE SODIUM PHOSPHATE 15 MG/5 ML (3 MG/ML) ORAL SOLN,,J7510,HCPCS,Facility,Inpatient,237 mL,mL,,311,264.35,89.1326,311,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
PREDNISOLONE SODIUM PHOSPHATE 15 MG/5 ML (3 MG/ML) ORAL SOLN,,J7510,HCPCS,Facility,Outpatient,237 mL,mL,,311,264.35,89.1326,311,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,149.28,48,,percent of total billed charges,,100% of DHS outpatient percentage
PREDNISOLONE SODIUM PHOSPHATE 15 MG/5 ML (3 MG/ML) ORAL SOLN,,J7510,HCPCS,Facility,Inpatient,237 mL,mL,,311,264.35,89.1326,311,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
DEXAMETHASONE 0.5 MG/5 ML ORAL ELIXIR,,J8540,HCPCS,Facility,Both,237 mL,mL,,268,227.8,76.8088,268,Aetna,Commercial,246.56,92,,percent of total billed charges,,
DEXAMETHASONE 0.5 MG/5 ML ORAL ELIXIR,,J8540,HCPCS,Facility,Outpatient,237 mL,mL,,268,227.8,76.8088,268,Aetna,Medicare Advantage,131.32,49,,percent of total billed charges,,
DEXAMETHASONE 0.5 MG/5 ML ORAL ELIXIR,,J8540,HCPCS,Facility,Inpatient,237 mL,mL,,268,227.8,76.8088,268,Aetna,Medicare Advantage,,,,,Included in per diem rate,
DEXAMETHASONE 0.5 MG/5 ML ORAL ELIXIR,,J8540,HCPCS,Facility,Both,237 mL,mL,,268,227.8,76.8088,268,Aetna,PPO,249.24,93,,percent of total billed charges,,
DEXAMETHASONE 0.5 MG/5 ML ORAL ELIXIR,,J8540,HCPCS,Facility,Both,237 mL,mL,,268,227.8,76.8088,268,America's PPO,America's PPO,257.3604,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
DEXAMETHASONE 0.5 MG/5 ML ORAL ELIXIR,,J8540,HCPCS,Facility,Both,237 mL,mL,,268,227.8,76.8088,268,BlueCross BlueShield Minnesota, Federal Employee Program,263.712,98.4,,percent of total billed charges,,
DEXAMETHASONE 0.5 MG/5 ML ORAL ELIXIR,,J8540,HCPCS,Facility,Both,237 mL,mL,,268,227.8,76.8088,268,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,268,100,,percent of total billed charges,,
DEXAMETHASONE 0.5 MG/5 ML ORAL ELIXIR,,J8540,HCPCS,Facility,Both,237 mL,mL,,268,227.8,76.8088,268,BlueCross BlueShield Minnesota,High Value Network Plan,241.2,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
DEXAMETHASONE 0.5 MG/5 ML ORAL ELIXIR,,J8540,HCPCS,Facility,Outpatient,237 mL,mL,,268,227.8,76.8088,268,BlueCross BlueShield Minnesota,Medicare Advantage,131.32,49,,percent of total billed charges,,
DEXAMETHASONE 0.5 MG/5 ML ORAL ELIXIR,,J8540,HCPCS,Facility,Inpatient,237 mL,mL,,268,227.8,76.8088,268,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
DEXAMETHASONE 0.5 MG/5 ML ORAL ELIXIR,,J8540,HCPCS,Facility,Both,237 mL,mL,,268,227.8,76.8088,268,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,237.3676,88.57,,percent of total billed charges,,
DEXAMETHASONE 0.5 MG/5 ML ORAL ELIXIR,,J8540,HCPCS,Facility,Both,237 mL,mL,,268,227.8,76.8088,268,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,76.8088,28.66,,percent of total billed charges,,
DEXAMETHASONE 0.5 MG/5 ML ORAL ELIXIR,,J8540,HCPCS,Facility,Outpatient,237 mL,mL,,268,227.8,76.8088,268,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),131.32,49,,percent of total billed charges,,
DEXAMETHASONE 0.5 MG/5 ML ORAL ELIXIR,,J8540,HCPCS,Facility,Inpatient,237 mL,mL,,268,227.8,76.8088,268,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
DEXAMETHASONE 0.5 MG/5 ML ORAL ELIXIR,,J8540,HCPCS,Facility,Both,237 mL,mL,,268,227.8,76.8088,268,CorVel,Worker's Compensation,268,100,,percent of total billed charges,,
DEXAMETHASONE 0.5 MG/5 ML ORAL ELIXIR,,J8540,HCPCS,Facility,Both,237 mL,mL,,268,227.8,76.8088,268,First Health Group Corporation,First Health Network,259.96,97,,percent of total billed charges,,
DEXAMETHASONE 0.5 MG/5 ML ORAL ELIXIR,,J8540,HCPCS,Facility,Both,237 mL,mL,,268,227.8,76.8088,268,"Health Partners, Inc.",Commercial,253.528,94.6,,percent of total billed charges,,
DEXAMETHASONE 0.5 MG/5 ML ORAL ELIXIR,,J8540,HCPCS,Facility,Outpatient,237 mL,mL,,268,227.8,76.8088,268,"Health Partners, Inc.",Medicare Advantage,131.32,49,,percent of total billed charges,,
DEXAMETHASONE 0.5 MG/5 ML ORAL ELIXIR,,J8540,HCPCS,Facility,Inpatient,237 mL,mL,,268,227.8,76.8088,268,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DEXAMETHASONE 0.5 MG/5 ML ORAL ELIXIR,,J8540,HCPCS,Facility,Both,237 mL,mL,,268,227.8,76.8088,268,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),160.8,60,,percent of total billed charges,,
DEXAMETHASONE 0.5 MG/5 ML ORAL ELIXIR,,J8540,HCPCS,Facility,Both,237 mL,mL,,268,227.8,76.8088,268,"Health Partners, Inc.",State of Minnesota Advantage Program,218.42,81.5,,percent of total billed charges,,
DEXAMETHASONE 0.5 MG/5 ML ORAL ELIXIR,,J8540,HCPCS,Facility,Both,237 mL,mL,,268,227.8,76.8088,268,"Health Partners, Inc.",State Public Programs,134,50,,percent of total billed charges,,
DEXAMETHASONE 0.5 MG/5 ML ORAL ELIXIR,,J8540,HCPCS,Facility,Both,237 mL,mL,,268,227.8,76.8088,268,Humana Insurance Company,Commercial PPO,254.6,95,,percent of total billed charges,,
DEXAMETHASONE 0.5 MG/5 ML ORAL ELIXIR,,J8540,HCPCS,Facility,Outpatient,237 mL,mL,,268,227.8,76.8088,268,Humana Insurance Company,Medicare PPO,131.32,49,,percent of total billed charges,,
DEXAMETHASONE 0.5 MG/5 ML ORAL ELIXIR,,J8540,HCPCS,Facility,Inpatient,237 mL,mL,,268,227.8,76.8088,268,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
DEXAMETHASONE 0.5 MG/5 ML ORAL ELIXIR,,J8540,HCPCS,Facility,Both,237 mL,mL,,268,227.8,76.8088,268,Medica,Individual & Family,265.588,99.1,,percent of total billed charges,,
DEXAMETHASONE 0.5 MG/5 ML ORAL ELIXIR,,J8540,HCPCS,Facility,Outpatient,237 mL,mL,,268,227.8,76.8088,268,Medica,Medica Advantage Solution,133.464,49.8,,percent of total billed charges,,
DEXAMETHASONE 0.5 MG/5 ML ORAL ELIXIR,,J8540,HCPCS,Facility,Inpatient,237 mL,mL,,268,227.8,76.8088,268,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
DEXAMETHASONE 0.5 MG/5 ML ORAL ELIXIR,,J8540,HCPCS,Facility,Outpatient,237 mL,mL,,268,227.8,76.8088,268,Medica,Medical Assistance,119.528,44.6,,percent of total billed charges,,
DEXAMETHASONE 0.5 MG/5 ML ORAL ELIXIR,,J8540,HCPCS,Facility,Inpatient,237 mL,mL,,268,227.8,76.8088,268,Medica,Medical Assistance,,,,,Included in per diem rate,
DEXAMETHASONE 0.5 MG/5 ML ORAL ELIXIR,,J8540,HCPCS,Facility,Outpatient,237 mL,mL,,268,227.8,76.8088,268,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,133.464,49.8,,percent of total billed charges,,
DEXAMETHASONE 0.5 MG/5 ML ORAL ELIXIR,,J8540,HCPCS,Facility,Inpatient,237 mL,mL,,268,227.8,76.8088,268,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
DEXAMETHASONE 0.5 MG/5 ML ORAL ELIXIR,,J8540,HCPCS,Facility,Both,237 mL,mL,,268,227.8,76.8088,268,"Multiplan, Inc.","Multiplan, Inc.",251.92,94,,percent of total billed charges,,
DEXAMETHASONE 0.5 MG/5 ML ORAL ELIXIR,,J8540,HCPCS,Facility,Outpatient,237 mL,mL,,268,227.8,76.8088,268,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,241.468,90.1,,percent of total billed charges,,
DEXAMETHASONE 0.5 MG/5 ML ORAL ELIXIR,,J8540,HCPCS,Facility,Inpatient,237 mL,mL,,268,227.8,76.8088,268,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
DEXAMETHASONE 0.5 MG/5 ML ORAL ELIXIR,,J8540,HCPCS,Facility,Both,237 mL,mL,,268,227.8,76.8088,268,"Preferred One Administrative Services, INC.",PPO,264.248,98.6,,percent of total billed charges,,
DEXAMETHASONE 0.5 MG/5 ML ORAL ELIXIR,,J8540,HCPCS,Facility,Outpatient,237 mL,mL,,268,227.8,76.8088,268,PrimeWest Health,Minnesota Senior Health Options (MSHO),137.886,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
DEXAMETHASONE 0.5 MG/5 ML ORAL ELIXIR,,J8540,HCPCS,Facility,Inpatient,237 mL,mL,,268,227.8,76.8088,268,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DEXAMETHASONE 0.5 MG/5 ML ORAL ELIXIR,,J8540,HCPCS,Facility,Outpatient,237 mL,mL,,268,227.8,76.8088,268,PrimeWest Health,MinnesotaCare,137.6448,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
DEXAMETHASONE 0.5 MG/5 ML ORAL ELIXIR,,J8540,HCPCS,Facility,Inpatient,237 mL,mL,,268,227.8,76.8088,268,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
DEXAMETHASONE 0.5 MG/5 ML ORAL ELIXIR,,J8540,HCPCS,Facility,Both,237 mL,mL,,268,227.8,76.8088,268,Sanford Health Plan,Sanford Health Plan,246.56,92,,percent of total billed charges,,
DEXAMETHASONE 0.5 MG/5 ML ORAL ELIXIR,,J8540,HCPCS,Facility,Outpatient,237 mL,mL,,268,227.8,76.8088,268,"UCare Health, Inc.",Individual & Family Plan,151.018,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
DEXAMETHASONE 0.5 MG/5 ML ORAL ELIXIR,,J8540,HCPCS,Facility,Inpatient,237 mL,mL,,268,227.8,76.8088,268,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
DEXAMETHASONE 0.5 MG/5 ML ORAL ELIXIR,,J8540,HCPCS,Facility,Outpatient,237 mL,mL,,268,227.8,76.8088,268,"UCare Health, Inc.",Medical Assistance,135.2596,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DEXAMETHASONE 0.5 MG/5 ML ORAL ELIXIR,,J8540,HCPCS,Facility,Inpatient,237 mL,mL,,268,227.8,76.8088,268,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
DEXAMETHASONE 0.5 MG/5 ML ORAL ELIXIR,,J8540,HCPCS,Facility,Outpatient,237 mL,mL,,268,227.8,76.8088,268,"UCare Health, Inc.",Medicare Advantage,135.2596,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DEXAMETHASONE 0.5 MG/5 ML ORAL ELIXIR,,J8540,HCPCS,Facility,Inpatient,237 mL,mL,,268,227.8,76.8088,268,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DEXAMETHASONE 0.5 MG/5 ML ORAL ELIXIR,,J8540,HCPCS,Facility,Outpatient,237 mL,mL,,268,227.8,76.8088,268,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),135.2596,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DEXAMETHASONE 0.5 MG/5 ML ORAL ELIXIR,,J8540,HCPCS,Facility,Inpatient,237 mL,mL,,268,227.8,76.8088,268,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DEXAMETHASONE 0.5 MG/5 ML ORAL ELIXIR,,J8540,HCPCS,Facility,Both,237 mL,mL,,268,227.8,76.8088,268,UnitedHealthcare,Individual & Family,251.92,94,,percent of total billed charges,,
DEXAMETHASONE 0.5 MG/5 ML ORAL ELIXIR,,J8540,HCPCS,Facility,Outpatient,237 mL,mL,,268,227.8,76.8088,268,UnitedHealthcare,Medicare Advantage,131.32,49,,percent of total billed charges,,
DEXAMETHASONE 0.5 MG/5 ML ORAL ELIXIR,,J8540,HCPCS,Facility,Inpatient,237 mL,mL,,268,227.8,76.8088,268,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
DEXAMETHASONE 0.5 MG/5 ML ORAL ELIXIR,,J8540,HCPCS,Facility,Outpatient,237 mL,mL,,268,227.8,76.8088,268,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,128.64,48,,percent of total billed charges,,100% of DHS outpatient percentage
DEXAMETHASONE 0.5 MG/5 ML ORAL ELIXIR,,J8540,HCPCS,Facility,Inpatient,237 mL,mL,,268,227.8,76.8088,268,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
POLYETHYLENE GLYCOL 3350 17 GRAM/DOSE ORAL POWD,,17475,LOCAL,Facility,Both,238 g,g,,45,38.25,12.897,45,Aetna,Commercial,41.4,92,,percent of total billed charges,,
POLYETHYLENE GLYCOL 3350 17 GRAM/DOSE ORAL POWD,,17475,LOCAL,Facility,Outpatient,238 g,g,,45,38.25,12.897,45,Aetna,Medicare Advantage,22.05,49,,percent of total billed charges,,
POLYETHYLENE GLYCOL 3350 17 GRAM/DOSE ORAL POWD,,17475,LOCAL,Facility,Inpatient,238 g,g,,45,38.25,12.897,45,Aetna,Medicare Advantage,,,,,Included in per diem rate,
POLYETHYLENE GLYCOL 3350 17 GRAM/DOSE ORAL POWD,,17475,LOCAL,Facility,Both,238 g,g,,45,38.25,12.897,45,Aetna,PPO,41.85,93,,percent of total billed charges,,
POLYETHYLENE GLYCOL 3350 17 GRAM/DOSE ORAL POWD,,17475,LOCAL,Facility,Both,238 g,g,,45,38.25,12.897,45,America's PPO,America's PPO,43.2135,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
POLYETHYLENE GLYCOL 3350 17 GRAM/DOSE ORAL POWD,,17475,LOCAL,Facility,Both,238 g,g,,45,38.25,12.897,45,BlueCross BlueShield Minnesota, Federal Employee Program,44.28,98.4,,percent of total billed charges,,
POLYETHYLENE GLYCOL 3350 17 GRAM/DOSE ORAL POWD,,17475,LOCAL,Facility,Both,238 g,g,,45,38.25,12.897,45,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,45,100,,percent of total billed charges,,
POLYETHYLENE GLYCOL 3350 17 GRAM/DOSE ORAL POWD,,17475,LOCAL,Facility,Both,238 g,g,,45,38.25,12.897,45,BlueCross BlueShield Minnesota,High Value Network Plan,40.5,90,,percent of total billed charges,,
POLYETHYLENE GLYCOL 3350 17 GRAM/DOSE ORAL POWD,,17475,LOCAL,Facility,Outpatient,238 g,g,,45,38.25,12.897,45,BlueCross BlueShield Minnesota,Medicare Advantage,22.05,49,,percent of total billed charges,,
POLYETHYLENE GLYCOL 3350 17 GRAM/DOSE ORAL POWD,,17475,LOCAL,Facility,Inpatient,238 g,g,,45,38.25,12.897,45,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
POLYETHYLENE GLYCOL 3350 17 GRAM/DOSE ORAL POWD,,17475,LOCAL,Facility,Both,238 g,g,,45,38.25,12.897,45,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,39.8565,88.57,,percent of total billed charges,,
POLYETHYLENE GLYCOL 3350 17 GRAM/DOSE ORAL POWD,,17475,LOCAL,Facility,Both,238 g,g,,45,38.25,12.897,45,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,12.897,28.66,,percent of total billed charges,,
POLYETHYLENE GLYCOL 3350 17 GRAM/DOSE ORAL POWD,,17475,LOCAL,Facility,Outpatient,238 g,g,,45,38.25,12.897,45,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),22.05,49,,percent of total billed charges,,
POLYETHYLENE GLYCOL 3350 17 GRAM/DOSE ORAL POWD,,17475,LOCAL,Facility,Inpatient,238 g,g,,45,38.25,12.897,45,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
POLYETHYLENE GLYCOL 3350 17 GRAM/DOSE ORAL POWD,,17475,LOCAL,Facility,Both,238 g,g,,45,38.25,12.897,45,CorVel,Worker's Compensation,45,100,,percent of total billed charges,,
POLYETHYLENE GLYCOL 3350 17 GRAM/DOSE ORAL POWD,,17475,LOCAL,Facility,Both,238 g,g,,45,38.25,12.897,45,First Health Group Corporation,First Health Network,43.65,97,,percent of total billed charges,,
POLYETHYLENE GLYCOL 3350 17 GRAM/DOSE ORAL POWD,,17475,LOCAL,Facility,Both,238 g,g,,45,38.25,12.897,45,"Health Partners, Inc.",Commercial,42.57,94.6,,percent of total billed charges,,
POLYETHYLENE GLYCOL 3350 17 GRAM/DOSE ORAL POWD,,17475,LOCAL,Facility,Outpatient,238 g,g,,45,38.25,12.897,45,"Health Partners, Inc.",Medicare Advantage,22.05,49,,percent of total billed charges,,
POLYETHYLENE GLYCOL 3350 17 GRAM/DOSE ORAL POWD,,17475,LOCAL,Facility,Inpatient,238 g,g,,45,38.25,12.897,45,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
POLYETHYLENE GLYCOL 3350 17 GRAM/DOSE ORAL POWD,,17475,LOCAL,Facility,Both,238 g,g,,45,38.25,12.897,45,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),27,60,,percent of total billed charges,,
POLYETHYLENE GLYCOL 3350 17 GRAM/DOSE ORAL POWD,,17475,LOCAL,Facility,Both,238 g,g,,45,38.25,12.897,45,"Health Partners, Inc.",State of Minnesota Advantage Program,36.675,81.5,,percent of total billed charges,,
POLYETHYLENE GLYCOL 3350 17 GRAM/DOSE ORAL POWD,,17475,LOCAL,Facility,Both,238 g,g,,45,38.25,12.897,45,"Health Partners, Inc.",State Public Programs,22.5,50,,percent of total billed charges,,
POLYETHYLENE GLYCOL 3350 17 GRAM/DOSE ORAL POWD,,17475,LOCAL,Facility,Both,238 g,g,,45,38.25,12.897,45,Humana Insurance Company,Commercial PPO,42.75,95,,percent of total billed charges,,
POLYETHYLENE GLYCOL 3350 17 GRAM/DOSE ORAL POWD,,17475,LOCAL,Facility,Outpatient,238 g,g,,45,38.25,12.897,45,Humana Insurance Company,Medicare PPO,22.05,49,,percent of total billed charges,,
POLYETHYLENE GLYCOL 3350 17 GRAM/DOSE ORAL POWD,,17475,LOCAL,Facility,Inpatient,238 g,g,,45,38.25,12.897,45,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
POLYETHYLENE GLYCOL 3350 17 GRAM/DOSE ORAL POWD,,17475,LOCAL,Facility,Both,238 g,g,,45,38.25,12.897,45,Medica,Individual & Family,44.595,99.1,,percent of total billed charges,,
POLYETHYLENE GLYCOL 3350 17 GRAM/DOSE ORAL POWD,,17475,LOCAL,Facility,Outpatient,238 g,g,,45,38.25,12.897,45,Medica,Medica Advantage Solution,22.41,49.8,,percent of total billed charges,,
POLYETHYLENE GLYCOL 3350 17 GRAM/DOSE ORAL POWD,,17475,LOCAL,Facility,Inpatient,238 g,g,,45,38.25,12.897,45,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
POLYETHYLENE GLYCOL 3350 17 GRAM/DOSE ORAL POWD,,17475,LOCAL,Facility,Outpatient,238 g,g,,45,38.25,12.897,45,Medica,Medical Assistance,20.07,44.6,,percent of total billed charges,,
POLYETHYLENE GLYCOL 3350 17 GRAM/DOSE ORAL POWD,,17475,LOCAL,Facility,Inpatient,238 g,g,,45,38.25,12.897,45,Medica,Medical Assistance,,,,,Included in per diem rate,
POLYETHYLENE GLYCOL 3350 17 GRAM/DOSE ORAL POWD,,17475,LOCAL,Facility,Outpatient,238 g,g,,45,38.25,12.897,45,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,22.41,49.8,,percent of total billed charges,,
POLYETHYLENE GLYCOL 3350 17 GRAM/DOSE ORAL POWD,,17475,LOCAL,Facility,Inpatient,238 g,g,,45,38.25,12.897,45,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
POLYETHYLENE GLYCOL 3350 17 GRAM/DOSE ORAL POWD,,17475,LOCAL,Facility,Both,238 g,g,,45,38.25,12.897,45,"Multiplan, Inc.","Multiplan, Inc.",42.3,94,,percent of total billed charges,,
POLYETHYLENE GLYCOL 3350 17 GRAM/DOSE ORAL POWD,,17475,LOCAL,Facility,Outpatient,238 g,g,,45,38.25,12.897,45,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,40.545,90.1,,percent of total billed charges,,
POLYETHYLENE GLYCOL 3350 17 GRAM/DOSE ORAL POWD,,17475,LOCAL,Facility,Inpatient,238 g,g,,45,38.25,12.897,45,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
POLYETHYLENE GLYCOL 3350 17 GRAM/DOSE ORAL POWD,,17475,LOCAL,Facility,Both,238 g,g,,45,38.25,12.897,45,"Preferred One Administrative Services, INC.",PPO,44.37,98.6,,percent of total billed charges,,
POLYETHYLENE GLYCOL 3350 17 GRAM/DOSE ORAL POWD,,17475,LOCAL,Facility,Outpatient,238 g,g,,45,38.25,12.897,45,PrimeWest Health,Minnesota Senior Health Options (MSHO),23.1525,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
POLYETHYLENE GLYCOL 3350 17 GRAM/DOSE ORAL POWD,,17475,LOCAL,Facility,Inpatient,238 g,g,,45,38.25,12.897,45,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
POLYETHYLENE GLYCOL 3350 17 GRAM/DOSE ORAL POWD,,17475,LOCAL,Facility,Outpatient,238 g,g,,45,38.25,12.897,45,PrimeWest Health,MinnesotaCare,23.112,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
POLYETHYLENE GLYCOL 3350 17 GRAM/DOSE ORAL POWD,,17475,LOCAL,Facility,Inpatient,238 g,g,,45,38.25,12.897,45,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
POLYETHYLENE GLYCOL 3350 17 GRAM/DOSE ORAL POWD,,17475,LOCAL,Facility,Both,238 g,g,,45,38.25,12.897,45,Sanford Health Plan,Sanford Health Plan,41.4,92,,percent of total billed charges,,
POLYETHYLENE GLYCOL 3350 17 GRAM/DOSE ORAL POWD,,17475,LOCAL,Facility,Outpatient,238 g,g,,45,38.25,12.897,45,"UCare Health, Inc.",Individual & Family Plan,25.3575,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
POLYETHYLENE GLYCOL 3350 17 GRAM/DOSE ORAL POWD,,17475,LOCAL,Facility,Inpatient,238 g,g,,45,38.25,12.897,45,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
POLYETHYLENE GLYCOL 3350 17 GRAM/DOSE ORAL POWD,,17475,LOCAL,Facility,Outpatient,238 g,g,,45,38.25,12.897,45,"UCare Health, Inc.",Medical Assistance,22.7115,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
POLYETHYLENE GLYCOL 3350 17 GRAM/DOSE ORAL POWD,,17475,LOCAL,Facility,Inpatient,238 g,g,,45,38.25,12.897,45,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
POLYETHYLENE GLYCOL 3350 17 GRAM/DOSE ORAL POWD,,17475,LOCAL,Facility,Outpatient,238 g,g,,45,38.25,12.897,45,"UCare Health, Inc.",Medicare Advantage,22.7115,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
POLYETHYLENE GLYCOL 3350 17 GRAM/DOSE ORAL POWD,,17475,LOCAL,Facility,Inpatient,238 g,g,,45,38.25,12.897,45,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
POLYETHYLENE GLYCOL 3350 17 GRAM/DOSE ORAL POWD,,17475,LOCAL,Facility,Outpatient,238 g,g,,45,38.25,12.897,45,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),22.7115,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
POLYETHYLENE GLYCOL 3350 17 GRAM/DOSE ORAL POWD,,17475,LOCAL,Facility,Inpatient,238 g,g,,45,38.25,12.897,45,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
POLYETHYLENE GLYCOL 3350 17 GRAM/DOSE ORAL POWD,,17475,LOCAL,Facility,Both,238 g,g,,45,38.25,12.897,45,UnitedHealthcare,Individual & Family,42.3,94,,percent of total billed charges,,
POLYETHYLENE GLYCOL 3350 17 GRAM/DOSE ORAL POWD,,17475,LOCAL,Facility,Outpatient,238 g,g,,45,38.25,12.897,45,UnitedHealthcare,Medicare Advantage,22.05,49,,percent of total billed charges,,
POLYETHYLENE GLYCOL 3350 17 GRAM/DOSE ORAL POWD,,17475,LOCAL,Facility,Inpatient,238 g,g,,45,38.25,12.897,45,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
POLYETHYLENE GLYCOL 3350 17 GRAM/DOSE ORAL POWD,,17475,LOCAL,Facility,Outpatient,238 g,g,,45,38.25,12.897,45,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,21.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
POLYETHYLENE GLYCOL 3350 17 GRAM/DOSE ORAL POWD,,17475,LOCAL,Facility,Inpatient,238 g,g,,45,38.25,12.897,45,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
DESFLURANE 100 % INHL LIQD,,6239,LOCAL,Facility,Both,240 mL,mL,,750,637.5,214.95,750,Aetna,Commercial,690,92,,percent of total billed charges,,
DESFLURANE 100 % INHL LIQD,,6239,LOCAL,Facility,Outpatient,240 mL,mL,,750,637.5,214.95,750,Aetna,Medicare Advantage,367.5,49,,percent of total billed charges,,
DESFLURANE 100 % INHL LIQD,,6239,LOCAL,Facility,Inpatient,240 mL,mL,,750,637.5,214.95,750,Aetna,Medicare Advantage,,,,,Included in per diem rate,
DESFLURANE 100 % INHL LIQD,,6239,LOCAL,Facility,Both,240 mL,mL,,750,637.5,214.95,750,Aetna,PPO,697.5,93,,percent of total billed charges,,
DESFLURANE 100 % INHL LIQD,,6239,LOCAL,Facility,Both,240 mL,mL,,750,637.5,214.95,750,America's PPO,America's PPO,720.225,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
DESFLURANE 100 % INHL LIQD,,6239,LOCAL,Facility,Both,240 mL,mL,,750,637.5,214.95,750,BlueCross BlueShield Minnesota, Federal Employee Program,738,98.4,,percent of total billed charges,,
DESFLURANE 100 % INHL LIQD,,6239,LOCAL,Facility,Both,240 mL,mL,,750,637.5,214.95,750,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,750,100,,percent of total billed charges,,
DESFLURANE 100 % INHL LIQD,,6239,LOCAL,Facility,Both,240 mL,mL,,750,637.5,214.95,750,BlueCross BlueShield Minnesota,High Value Network Plan,675,90,,percent of total billed charges,,
DESFLURANE 100 % INHL LIQD,,6239,LOCAL,Facility,Outpatient,240 mL,mL,,750,637.5,214.95,750,BlueCross BlueShield Minnesota,Medicare Advantage,367.5,49,,percent of total billed charges,,
DESFLURANE 100 % INHL LIQD,,6239,LOCAL,Facility,Inpatient,240 mL,mL,,750,637.5,214.95,750,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
DESFLURANE 100 % INHL LIQD,,6239,LOCAL,Facility,Both,240 mL,mL,,750,637.5,214.95,750,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,664.275,88.57,,percent of total billed charges,,
DESFLURANE 100 % INHL LIQD,,6239,LOCAL,Facility,Both,240 mL,mL,,750,637.5,214.95,750,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,214.95,28.66,,percent of total billed charges,,
DESFLURANE 100 % INHL LIQD,,6239,LOCAL,Facility,Outpatient,240 mL,mL,,750,637.5,214.95,750,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),367.5,49,,percent of total billed charges,,
DESFLURANE 100 % INHL LIQD,,6239,LOCAL,Facility,Inpatient,240 mL,mL,,750,637.5,214.95,750,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
DESFLURANE 100 % INHL LIQD,,6239,LOCAL,Facility,Both,240 mL,mL,,750,637.5,214.95,750,CorVel,Worker's Compensation,750,100,,percent of total billed charges,,
DESFLURANE 100 % INHL LIQD,,6239,LOCAL,Facility,Both,240 mL,mL,,750,637.5,214.95,750,First Health Group Corporation,First Health Network,727.5,97,,percent of total billed charges,,
DESFLURANE 100 % INHL LIQD,,6239,LOCAL,Facility,Both,240 mL,mL,,750,637.5,214.95,750,"Health Partners, Inc.",Commercial,709.5,94.6,,percent of total billed charges,,
DESFLURANE 100 % INHL LIQD,,6239,LOCAL,Facility,Outpatient,240 mL,mL,,750,637.5,214.95,750,"Health Partners, Inc.",Medicare Advantage,367.5,49,,percent of total billed charges,,
DESFLURANE 100 % INHL LIQD,,6239,LOCAL,Facility,Inpatient,240 mL,mL,,750,637.5,214.95,750,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DESFLURANE 100 % INHL LIQD,,6239,LOCAL,Facility,Both,240 mL,mL,,750,637.5,214.95,750,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),450,60,,percent of total billed charges,,
DESFLURANE 100 % INHL LIQD,,6239,LOCAL,Facility,Both,240 mL,mL,,750,637.5,214.95,750,"Health Partners, Inc.",State of Minnesota Advantage Program,611.25,81.5,,percent of total billed charges,,
DESFLURANE 100 % INHL LIQD,,6239,LOCAL,Facility,Both,240 mL,mL,,750,637.5,214.95,750,"Health Partners, Inc.",State Public Programs,375,50,,percent of total billed charges,,
DESFLURANE 100 % INHL LIQD,,6239,LOCAL,Facility,Both,240 mL,mL,,750,637.5,214.95,750,Humana Insurance Company,Commercial PPO,712.5,95,,percent of total billed charges,,
DESFLURANE 100 % INHL LIQD,,6239,LOCAL,Facility,Outpatient,240 mL,mL,,750,637.5,214.95,750,Humana Insurance Company,Medicare PPO,367.5,49,,percent of total billed charges,,
DESFLURANE 100 % INHL LIQD,,6239,LOCAL,Facility,Inpatient,240 mL,mL,,750,637.5,214.95,750,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
DESFLURANE 100 % INHL LIQD,,6239,LOCAL,Facility,Both,240 mL,mL,,750,637.5,214.95,750,Medica,Individual & Family,743.25,99.1,,percent of total billed charges,,
DESFLURANE 100 % INHL LIQD,,6239,LOCAL,Facility,Outpatient,240 mL,mL,,750,637.5,214.95,750,Medica,Medica Advantage Solution,373.5,49.8,,percent of total billed charges,,
DESFLURANE 100 % INHL LIQD,,6239,LOCAL,Facility,Inpatient,240 mL,mL,,750,637.5,214.95,750,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
DESFLURANE 100 % INHL LIQD,,6239,LOCAL,Facility,Outpatient,240 mL,mL,,750,637.5,214.95,750,Medica,Medical Assistance,334.5,44.6,,percent of total billed charges,,
DESFLURANE 100 % INHL LIQD,,6239,LOCAL,Facility,Inpatient,240 mL,mL,,750,637.5,214.95,750,Medica,Medical Assistance,,,,,Included in per diem rate,
DESFLURANE 100 % INHL LIQD,,6239,LOCAL,Facility,Outpatient,240 mL,mL,,750,637.5,214.95,750,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,373.5,49.8,,percent of total billed charges,,
DESFLURANE 100 % INHL LIQD,,6239,LOCAL,Facility,Inpatient,240 mL,mL,,750,637.5,214.95,750,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
DESFLURANE 100 % INHL LIQD,,6239,LOCAL,Facility,Both,240 mL,mL,,750,637.5,214.95,750,"Multiplan, Inc.","Multiplan, Inc.",705,94,,percent of total billed charges,,
DESFLURANE 100 % INHL LIQD,,6239,LOCAL,Facility,Outpatient,240 mL,mL,,750,637.5,214.95,750,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,675.75,90.1,,percent of total billed charges,,
DESFLURANE 100 % INHL LIQD,,6239,LOCAL,Facility,Inpatient,240 mL,mL,,750,637.5,214.95,750,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
DESFLURANE 100 % INHL LIQD,,6239,LOCAL,Facility,Both,240 mL,mL,,750,637.5,214.95,750,"Preferred One Administrative Services, INC.",PPO,739.5,98.6,,percent of total billed charges,,
DESFLURANE 100 % INHL LIQD,,6239,LOCAL,Facility,Outpatient,240 mL,mL,,750,637.5,214.95,750,PrimeWest Health,Minnesota Senior Health Options (MSHO),385.875,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
DESFLURANE 100 % INHL LIQD,,6239,LOCAL,Facility,Inpatient,240 mL,mL,,750,637.5,214.95,750,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DESFLURANE 100 % INHL LIQD,,6239,LOCAL,Facility,Outpatient,240 mL,mL,,750,637.5,214.95,750,PrimeWest Health,MinnesotaCare,385.2,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
DESFLURANE 100 % INHL LIQD,,6239,LOCAL,Facility,Inpatient,240 mL,mL,,750,637.5,214.95,750,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
DESFLURANE 100 % INHL LIQD,,6239,LOCAL,Facility,Both,240 mL,mL,,750,637.5,214.95,750,Sanford Health Plan,Sanford Health Plan,690,92,,percent of total billed charges,,
DESFLURANE 100 % INHL LIQD,,6239,LOCAL,Facility,Outpatient,240 mL,mL,,750,637.5,214.95,750,"UCare Health, Inc.",Individual & Family Plan,422.625,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
DESFLURANE 100 % INHL LIQD,,6239,LOCAL,Facility,Inpatient,240 mL,mL,,750,637.5,214.95,750,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
DESFLURANE 100 % INHL LIQD,,6239,LOCAL,Facility,Outpatient,240 mL,mL,,750,637.5,214.95,750,"UCare Health, Inc.",Medical Assistance,378.525,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DESFLURANE 100 % INHL LIQD,,6239,LOCAL,Facility,Inpatient,240 mL,mL,,750,637.5,214.95,750,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
DESFLURANE 100 % INHL LIQD,,6239,LOCAL,Facility,Outpatient,240 mL,mL,,750,637.5,214.95,750,"UCare Health, Inc.",Medicare Advantage,378.525,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DESFLURANE 100 % INHL LIQD,,6239,LOCAL,Facility,Inpatient,240 mL,mL,,750,637.5,214.95,750,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DESFLURANE 100 % INHL LIQD,,6239,LOCAL,Facility,Outpatient,240 mL,mL,,750,637.5,214.95,750,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),378.525,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DESFLURANE 100 % INHL LIQD,,6239,LOCAL,Facility,Inpatient,240 mL,mL,,750,637.5,214.95,750,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DESFLURANE 100 % INHL LIQD,,6239,LOCAL,Facility,Both,240 mL,mL,,750,637.5,214.95,750,UnitedHealthcare,Individual & Family,705,94,,percent of total billed charges,,
DESFLURANE 100 % INHL LIQD,,6239,LOCAL,Facility,Outpatient,240 mL,mL,,750,637.5,214.95,750,UnitedHealthcare,Medicare Advantage,367.5,49,,percent of total billed charges,,
DESFLURANE 100 % INHL LIQD,,6239,LOCAL,Facility,Inpatient,240 mL,mL,,750,637.5,214.95,750,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
DESFLURANE 100 % INHL LIQD,,6239,LOCAL,Facility,Outpatient,240 mL,mL,,750,637.5,214.95,750,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,360,48,,percent of total billed charges,,100% of DHS outpatient percentage
DESFLURANE 100 % INHL LIQD,,6239,LOCAL,Facility,Inpatient,240 mL,mL,,750,637.5,214.95,750,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
ACTIVATED CHARCOAL 50 GRAM/240 ML ORAL SUSP,,36054,LOCAL,Facility,Both,240 mL,mL,,183,155.55,52.4478,183,Aetna,Commercial,168.36,92,,percent of total billed charges,,
ACTIVATED CHARCOAL 50 GRAM/240 ML ORAL SUSP,,36054,LOCAL,Facility,Outpatient,240 mL,mL,,183,155.55,52.4478,183,Aetna,Medicare Advantage,89.67,49,,percent of total billed charges,,
ACTIVATED CHARCOAL 50 GRAM/240 ML ORAL SUSP,,36054,LOCAL,Facility,Inpatient,240 mL,mL,,183,155.55,52.4478,183,Aetna,Medicare Advantage,,,,,Included in per diem rate,
ACTIVATED CHARCOAL 50 GRAM/240 ML ORAL SUSP,,36054,LOCAL,Facility,Both,240 mL,mL,,183,155.55,52.4478,183,Aetna,PPO,170.19,93,,percent of total billed charges,,
ACTIVATED CHARCOAL 50 GRAM/240 ML ORAL SUSP,,36054,LOCAL,Facility,Both,240 mL,mL,,183,155.55,52.4478,183,America's PPO,America's PPO,175.7349,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
ACTIVATED CHARCOAL 50 GRAM/240 ML ORAL SUSP,,36054,LOCAL,Facility,Both,240 mL,mL,,183,155.55,52.4478,183,BlueCross BlueShield Minnesota, Federal Employee Program,180.072,98.4,,percent of total billed charges,,
ACTIVATED CHARCOAL 50 GRAM/240 ML ORAL SUSP,,36054,LOCAL,Facility,Both,240 mL,mL,,183,155.55,52.4478,183,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,183,100,,percent of total billed charges,,
ACTIVATED CHARCOAL 50 GRAM/240 ML ORAL SUSP,,36054,LOCAL,Facility,Both,240 mL,mL,,183,155.55,52.4478,183,BlueCross BlueShield Minnesota,High Value Network Plan,164.7,90,,percent of total billed charges,,
ACTIVATED CHARCOAL 50 GRAM/240 ML ORAL SUSP,,36054,LOCAL,Facility,Outpatient,240 mL,mL,,183,155.55,52.4478,183,BlueCross BlueShield Minnesota,Medicare Advantage,89.67,49,,percent of total billed charges,,
ACTIVATED CHARCOAL 50 GRAM/240 ML ORAL SUSP,,36054,LOCAL,Facility,Inpatient,240 mL,mL,,183,155.55,52.4478,183,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
ACTIVATED CHARCOAL 50 GRAM/240 ML ORAL SUSP,,36054,LOCAL,Facility,Both,240 mL,mL,,183,155.55,52.4478,183,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,162.0831,88.57,,percent of total billed charges,,
ACTIVATED CHARCOAL 50 GRAM/240 ML ORAL SUSP,,36054,LOCAL,Facility,Both,240 mL,mL,,183,155.55,52.4478,183,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,52.4478,28.66,,percent of total billed charges,,
ACTIVATED CHARCOAL 50 GRAM/240 ML ORAL SUSP,,36054,LOCAL,Facility,Outpatient,240 mL,mL,,183,155.55,52.4478,183,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),89.67,49,,percent of total billed charges,,
ACTIVATED CHARCOAL 50 GRAM/240 ML ORAL SUSP,,36054,LOCAL,Facility,Inpatient,240 mL,mL,,183,155.55,52.4478,183,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
ACTIVATED CHARCOAL 50 GRAM/240 ML ORAL SUSP,,36054,LOCAL,Facility,Both,240 mL,mL,,183,155.55,52.4478,183,CorVel,Worker's Compensation,183,100,,percent of total billed charges,,
ACTIVATED CHARCOAL 50 GRAM/240 ML ORAL SUSP,,36054,LOCAL,Facility,Both,240 mL,mL,,183,155.55,52.4478,183,First Health Group Corporation,First Health Network,177.51,97,,percent of total billed charges,,
ACTIVATED CHARCOAL 50 GRAM/240 ML ORAL SUSP,,36054,LOCAL,Facility,Both,240 mL,mL,,183,155.55,52.4478,183,"Health Partners, Inc.",Commercial,173.118,94.6,,percent of total billed charges,,
ACTIVATED CHARCOAL 50 GRAM/240 ML ORAL SUSP,,36054,LOCAL,Facility,Outpatient,240 mL,mL,,183,155.55,52.4478,183,"Health Partners, Inc.",Medicare Advantage,89.67,49,,percent of total billed charges,,
ACTIVATED CHARCOAL 50 GRAM/240 ML ORAL SUSP,,36054,LOCAL,Facility,Inpatient,240 mL,mL,,183,155.55,52.4478,183,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ACTIVATED CHARCOAL 50 GRAM/240 ML ORAL SUSP,,36054,LOCAL,Facility,Both,240 mL,mL,,183,155.55,52.4478,183,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),109.8,60,,percent of total billed charges,,
ACTIVATED CHARCOAL 50 GRAM/240 ML ORAL SUSP,,36054,LOCAL,Facility,Both,240 mL,mL,,183,155.55,52.4478,183,"Health Partners, Inc.",State of Minnesota Advantage Program,149.145,81.5,,percent of total billed charges,,
ACTIVATED CHARCOAL 50 GRAM/240 ML ORAL SUSP,,36054,LOCAL,Facility,Both,240 mL,mL,,183,155.55,52.4478,183,"Health Partners, Inc.",State Public Programs,91.5,50,,percent of total billed charges,,
ACTIVATED CHARCOAL 50 GRAM/240 ML ORAL SUSP,,36054,LOCAL,Facility,Both,240 mL,mL,,183,155.55,52.4478,183,Humana Insurance Company,Commercial PPO,173.85,95,,percent of total billed charges,,
ACTIVATED CHARCOAL 50 GRAM/240 ML ORAL SUSP,,36054,LOCAL,Facility,Outpatient,240 mL,mL,,183,155.55,52.4478,183,Humana Insurance Company,Medicare PPO,89.67,49,,percent of total billed charges,,
ACTIVATED CHARCOAL 50 GRAM/240 ML ORAL SUSP,,36054,LOCAL,Facility,Inpatient,240 mL,mL,,183,155.55,52.4478,183,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
ACTIVATED CHARCOAL 50 GRAM/240 ML ORAL SUSP,,36054,LOCAL,Facility,Both,240 mL,mL,,183,155.55,52.4478,183,Medica,Individual & Family,181.353,99.1,,percent of total billed charges,,
ACTIVATED CHARCOAL 50 GRAM/240 ML ORAL SUSP,,36054,LOCAL,Facility,Outpatient,240 mL,mL,,183,155.55,52.4478,183,Medica,Medica Advantage Solution,91.134,49.8,,percent of total billed charges,,
ACTIVATED CHARCOAL 50 GRAM/240 ML ORAL SUSP,,36054,LOCAL,Facility,Inpatient,240 mL,mL,,183,155.55,52.4478,183,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
ACTIVATED CHARCOAL 50 GRAM/240 ML ORAL SUSP,,36054,LOCAL,Facility,Outpatient,240 mL,mL,,183,155.55,52.4478,183,Medica,Medical Assistance,81.618,44.6,,percent of total billed charges,,
ACTIVATED CHARCOAL 50 GRAM/240 ML ORAL SUSP,,36054,LOCAL,Facility,Inpatient,240 mL,mL,,183,155.55,52.4478,183,Medica,Medical Assistance,,,,,Included in per diem rate,
ACTIVATED CHARCOAL 50 GRAM/240 ML ORAL SUSP,,36054,LOCAL,Facility,Outpatient,240 mL,mL,,183,155.55,52.4478,183,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,91.134,49.8,,percent of total billed charges,,
ACTIVATED CHARCOAL 50 GRAM/240 ML ORAL SUSP,,36054,LOCAL,Facility,Inpatient,240 mL,mL,,183,155.55,52.4478,183,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
ACTIVATED CHARCOAL 50 GRAM/240 ML ORAL SUSP,,36054,LOCAL,Facility,Both,240 mL,mL,,183,155.55,52.4478,183,"Multiplan, Inc.","Multiplan, Inc.",172.02,94,,percent of total billed charges,,
ACTIVATED CHARCOAL 50 GRAM/240 ML ORAL SUSP,,36054,LOCAL,Facility,Outpatient,240 mL,mL,,183,155.55,52.4478,183,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,164.883,90.1,,percent of total billed charges,,
ACTIVATED CHARCOAL 50 GRAM/240 ML ORAL SUSP,,36054,LOCAL,Facility,Inpatient,240 mL,mL,,183,155.55,52.4478,183,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
ACTIVATED CHARCOAL 50 GRAM/240 ML ORAL SUSP,,36054,LOCAL,Facility,Both,240 mL,mL,,183,155.55,52.4478,183,"Preferred One Administrative Services, INC.",PPO,180.438,98.6,,percent of total billed charges,,
ACTIVATED CHARCOAL 50 GRAM/240 ML ORAL SUSP,,36054,LOCAL,Facility,Outpatient,240 mL,mL,,183,155.55,52.4478,183,PrimeWest Health,Minnesota Senior Health Options (MSHO),94.1535,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
ACTIVATED CHARCOAL 50 GRAM/240 ML ORAL SUSP,,36054,LOCAL,Facility,Inpatient,240 mL,mL,,183,155.55,52.4478,183,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ACTIVATED CHARCOAL 50 GRAM/240 ML ORAL SUSP,,36054,LOCAL,Facility,Outpatient,240 mL,mL,,183,155.55,52.4478,183,PrimeWest Health,MinnesotaCare,93.9888,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
ACTIVATED CHARCOAL 50 GRAM/240 ML ORAL SUSP,,36054,LOCAL,Facility,Inpatient,240 mL,mL,,183,155.55,52.4478,183,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
ACTIVATED CHARCOAL 50 GRAM/240 ML ORAL SUSP,,36054,LOCAL,Facility,Both,240 mL,mL,,183,155.55,52.4478,183,Sanford Health Plan,Sanford Health Plan,168.36,92,,percent of total billed charges,,
ACTIVATED CHARCOAL 50 GRAM/240 ML ORAL SUSP,,36054,LOCAL,Facility,Outpatient,240 mL,mL,,183,155.55,52.4478,183,"UCare Health, Inc.",Individual & Family Plan,103.1205,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
ACTIVATED CHARCOAL 50 GRAM/240 ML ORAL SUSP,,36054,LOCAL,Facility,Inpatient,240 mL,mL,,183,155.55,52.4478,183,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
ACTIVATED CHARCOAL 50 GRAM/240 ML ORAL SUSP,,36054,LOCAL,Facility,Outpatient,240 mL,mL,,183,155.55,52.4478,183,"UCare Health, Inc.",Medical Assistance,92.3601,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ACTIVATED CHARCOAL 50 GRAM/240 ML ORAL SUSP,,36054,LOCAL,Facility,Inpatient,240 mL,mL,,183,155.55,52.4478,183,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
ACTIVATED CHARCOAL 50 GRAM/240 ML ORAL SUSP,,36054,LOCAL,Facility,Outpatient,240 mL,mL,,183,155.55,52.4478,183,"UCare Health, Inc.",Medicare Advantage,92.3601,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ACTIVATED CHARCOAL 50 GRAM/240 ML ORAL SUSP,,36054,LOCAL,Facility,Inpatient,240 mL,mL,,183,155.55,52.4478,183,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ACTIVATED CHARCOAL 50 GRAM/240 ML ORAL SUSP,,36054,LOCAL,Facility,Outpatient,240 mL,mL,,183,155.55,52.4478,183,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),92.3601,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ACTIVATED CHARCOAL 50 GRAM/240 ML ORAL SUSP,,36054,LOCAL,Facility,Inpatient,240 mL,mL,,183,155.55,52.4478,183,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ACTIVATED CHARCOAL 50 GRAM/240 ML ORAL SUSP,,36054,LOCAL,Facility,Both,240 mL,mL,,183,155.55,52.4478,183,UnitedHealthcare,Individual & Family,172.02,94,,percent of total billed charges,,
ACTIVATED CHARCOAL 50 GRAM/240 ML ORAL SUSP,,36054,LOCAL,Facility,Outpatient,240 mL,mL,,183,155.55,52.4478,183,UnitedHealthcare,Medicare Advantage,89.67,49,,percent of total billed charges,,
ACTIVATED CHARCOAL 50 GRAM/240 ML ORAL SUSP,,36054,LOCAL,Facility,Inpatient,240 mL,mL,,183,155.55,52.4478,183,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
ACTIVATED CHARCOAL 50 GRAM/240 ML ORAL SUSP,,36054,LOCAL,Facility,Outpatient,240 mL,mL,,183,155.55,52.4478,183,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,87.84,48,,percent of total billed charges,,100% of DHS outpatient percentage
ACTIVATED CHARCOAL 50 GRAM/240 ML ORAL SUSP,,36054,LOCAL,Facility,Inpatient,240 mL,mL,,183,155.55,52.4478,183,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
SILVER SULFADIAZINE 1 % TOP CREAM,,810,LOCAL,Facility,Both,25 g,g,,46,39.1,13.1836,46,Aetna,Commercial,42.32,92,,percent of total billed charges,,
SILVER SULFADIAZINE 1 % TOP CREAM,,810,LOCAL,Facility,Outpatient,25 g,g,,46,39.1,13.1836,46,Aetna,Medicare Advantage,22.54,49,,percent of total billed charges,,
SILVER SULFADIAZINE 1 % TOP CREAM,,810,LOCAL,Facility,Inpatient,25 g,g,,46,39.1,13.1836,46,Aetna,Medicare Advantage,,,,,Included in per diem rate,
SILVER SULFADIAZINE 1 % TOP CREAM,,810,LOCAL,Facility,Both,25 g,g,,46,39.1,13.1836,46,Aetna,PPO,42.78,93,,percent of total billed charges,,
SILVER SULFADIAZINE 1 % TOP CREAM,,810,LOCAL,Facility,Both,25 g,g,,46,39.1,13.1836,46,America's PPO,America's PPO,44.1738,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SILVER SULFADIAZINE 1 % TOP CREAM,,810,LOCAL,Facility,Both,25 g,g,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota, Federal Employee Program,45.264,98.4,,percent of total billed charges,,
SILVER SULFADIAZINE 1 % TOP CREAM,,810,LOCAL,Facility,Both,25 g,g,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,46,100,,percent of total billed charges,,
SILVER SULFADIAZINE 1 % TOP CREAM,,810,LOCAL,Facility,Both,25 g,g,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,High Value Network Plan,41.4,90,,percent of total billed charges,,
SILVER SULFADIAZINE 1 % TOP CREAM,,810,LOCAL,Facility,Outpatient,25 g,g,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Medicare Advantage,22.54,49,,percent of total billed charges,,
SILVER SULFADIAZINE 1 % TOP CREAM,,810,LOCAL,Facility,Inpatient,25 g,g,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
SILVER SULFADIAZINE 1 % TOP CREAM,,810,LOCAL,Facility,Both,25 g,g,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,40.7422,88.57,,percent of total billed charges,,
SILVER SULFADIAZINE 1 % TOP CREAM,,810,LOCAL,Facility,Both,25 g,g,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,13.1836,28.66,,percent of total billed charges,,
SILVER SULFADIAZINE 1 % TOP CREAM,,810,LOCAL,Facility,Outpatient,25 g,g,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),22.54,49,,percent of total billed charges,,
SILVER SULFADIAZINE 1 % TOP CREAM,,810,LOCAL,Facility,Inpatient,25 g,g,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
SILVER SULFADIAZINE 1 % TOP CREAM,,810,LOCAL,Facility,Both,25 g,g,,46,39.1,13.1836,46,CorVel,Worker's Compensation,46,100,,percent of total billed charges,,
SILVER SULFADIAZINE 1 % TOP CREAM,,810,LOCAL,Facility,Both,25 g,g,,46,39.1,13.1836,46,First Health Group Corporation,First Health Network,44.62,97,,percent of total billed charges,,
SILVER SULFADIAZINE 1 % TOP CREAM,,810,LOCAL,Facility,Both,25 g,g,,46,39.1,13.1836,46,"Health Partners, Inc.",Commercial,43.516,94.6,,percent of total billed charges,,
SILVER SULFADIAZINE 1 % TOP CREAM,,810,LOCAL,Facility,Outpatient,25 g,g,,46,39.1,13.1836,46,"Health Partners, Inc.",Medicare Advantage,22.54,49,,percent of total billed charges,,
SILVER SULFADIAZINE 1 % TOP CREAM,,810,LOCAL,Facility,Inpatient,25 g,g,,46,39.1,13.1836,46,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SILVER SULFADIAZINE 1 % TOP CREAM,,810,LOCAL,Facility,Both,25 g,g,,46,39.1,13.1836,46,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),27.6,60,,percent of total billed charges,,
SILVER SULFADIAZINE 1 % TOP CREAM,,810,LOCAL,Facility,Both,25 g,g,,46,39.1,13.1836,46,"Health Partners, Inc.",State of Minnesota Advantage Program,37.49,81.5,,percent of total billed charges,,
SILVER SULFADIAZINE 1 % TOP CREAM,,810,LOCAL,Facility,Both,25 g,g,,46,39.1,13.1836,46,"Health Partners, Inc.",State Public Programs,23,50,,percent of total billed charges,,
SILVER SULFADIAZINE 1 % TOP CREAM,,810,LOCAL,Facility,Both,25 g,g,,46,39.1,13.1836,46,Humana Insurance Company,Commercial PPO,43.7,95,,percent of total billed charges,,
SILVER SULFADIAZINE 1 % TOP CREAM,,810,LOCAL,Facility,Outpatient,25 g,g,,46,39.1,13.1836,46,Humana Insurance Company,Medicare PPO,22.54,49,,percent of total billed charges,,
SILVER SULFADIAZINE 1 % TOP CREAM,,810,LOCAL,Facility,Inpatient,25 g,g,,46,39.1,13.1836,46,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
SILVER SULFADIAZINE 1 % TOP CREAM,,810,LOCAL,Facility,Both,25 g,g,,46,39.1,13.1836,46,Medica,Individual & Family,45.586,99.1,,percent of total billed charges,,
SILVER SULFADIAZINE 1 % TOP CREAM,,810,LOCAL,Facility,Outpatient,25 g,g,,46,39.1,13.1836,46,Medica,Medica Advantage Solution,22.908,49.8,,percent of total billed charges,,
SILVER SULFADIAZINE 1 % TOP CREAM,,810,LOCAL,Facility,Inpatient,25 g,g,,46,39.1,13.1836,46,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
SILVER SULFADIAZINE 1 % TOP CREAM,,810,LOCAL,Facility,Outpatient,25 g,g,,46,39.1,13.1836,46,Medica,Medical Assistance,20.516,44.6,,percent of total billed charges,,
SILVER SULFADIAZINE 1 % TOP CREAM,,810,LOCAL,Facility,Inpatient,25 g,g,,46,39.1,13.1836,46,Medica,Medical Assistance,,,,,Included in per diem rate,
SILVER SULFADIAZINE 1 % TOP CREAM,,810,LOCAL,Facility,Outpatient,25 g,g,,46,39.1,13.1836,46,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,22.908,49.8,,percent of total billed charges,,
SILVER SULFADIAZINE 1 % TOP CREAM,,810,LOCAL,Facility,Inpatient,25 g,g,,46,39.1,13.1836,46,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
SILVER SULFADIAZINE 1 % TOP CREAM,,810,LOCAL,Facility,Both,25 g,g,,46,39.1,13.1836,46,"Multiplan, Inc.","Multiplan, Inc.",43.24,94,,percent of total billed charges,,
SILVER SULFADIAZINE 1 % TOP CREAM,,810,LOCAL,Facility,Outpatient,25 g,g,,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,41.446,90.1,,percent of total billed charges,,
SILVER SULFADIAZINE 1 % TOP CREAM,,810,LOCAL,Facility,Inpatient,25 g,g,,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
SILVER SULFADIAZINE 1 % TOP CREAM,,810,LOCAL,Facility,Both,25 g,g,,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PPO,45.356,98.6,,percent of total billed charges,,
SILVER SULFADIAZINE 1 % TOP CREAM,,810,LOCAL,Facility,Outpatient,25 g,g,,46,39.1,13.1836,46,PrimeWest Health,Minnesota Senior Health Options (MSHO),23.667,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
SILVER SULFADIAZINE 1 % TOP CREAM,,810,LOCAL,Facility,Inpatient,25 g,g,,46,39.1,13.1836,46,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SILVER SULFADIAZINE 1 % TOP CREAM,,810,LOCAL,Facility,Outpatient,25 g,g,,46,39.1,13.1836,46,PrimeWest Health,MinnesotaCare,23.6256,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
SILVER SULFADIAZINE 1 % TOP CREAM,,810,LOCAL,Facility,Inpatient,25 g,g,,46,39.1,13.1836,46,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
SILVER SULFADIAZINE 1 % TOP CREAM,,810,LOCAL,Facility,Both,25 g,g,,46,39.1,13.1836,46,Sanford Health Plan,Sanford Health Plan,42.32,92,,percent of total billed charges,,
SILVER SULFADIAZINE 1 % TOP CREAM,,810,LOCAL,Facility,Outpatient,25 g,g,,46,39.1,13.1836,46,"UCare Health, Inc.",Individual & Family Plan,25.921,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
SILVER SULFADIAZINE 1 % TOP CREAM,,810,LOCAL,Facility,Inpatient,25 g,g,,46,39.1,13.1836,46,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
SILVER SULFADIAZINE 1 % TOP CREAM,,810,LOCAL,Facility,Outpatient,25 g,g,,46,39.1,13.1836,46,"UCare Health, Inc.",Medical Assistance,23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SILVER SULFADIAZINE 1 % TOP CREAM,,810,LOCAL,Facility,Inpatient,25 g,g,,46,39.1,13.1836,46,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
SILVER SULFADIAZINE 1 % TOP CREAM,,810,LOCAL,Facility,Outpatient,25 g,g,,46,39.1,13.1836,46,"UCare Health, Inc.",Medicare Advantage,23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SILVER SULFADIAZINE 1 % TOP CREAM,,810,LOCAL,Facility,Inpatient,25 g,g,,46,39.1,13.1836,46,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SILVER SULFADIAZINE 1 % TOP CREAM,,810,LOCAL,Facility,Outpatient,25 g,g,,46,39.1,13.1836,46,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SILVER SULFADIAZINE 1 % TOP CREAM,,810,LOCAL,Facility,Inpatient,25 g,g,,46,39.1,13.1836,46,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SILVER SULFADIAZINE 1 % TOP CREAM,,810,LOCAL,Facility,Both,25 g,g,,46,39.1,13.1836,46,UnitedHealthcare,Individual & Family,43.24,94,,percent of total billed charges,,
SILVER SULFADIAZINE 1 % TOP CREAM,,810,LOCAL,Facility,Outpatient,25 g,g,,46,39.1,13.1836,46,UnitedHealthcare,Medicare Advantage,22.54,49,,percent of total billed charges,,
SILVER SULFADIAZINE 1 % TOP CREAM,,810,LOCAL,Facility,Inpatient,25 g,g,,46,39.1,13.1836,46,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
SILVER SULFADIAZINE 1 % TOP CREAM,,810,LOCAL,Facility,Outpatient,25 g,g,,46,39.1,13.1836,46,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,22.08,48,,percent of total billed charges,,100% of DHS outpatient percentage
SILVER SULFADIAZINE 1 % TOP CREAM,,810,LOCAL,Facility,Inpatient,25 g,g,,46,39.1,13.1836,46,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
SULFUR HEXAFLUORIDE MICROSPHR 25 MG IV SUSR,,Q9950,HCPCS,Facility,Both,25 mg,mg,,290,246.5,83.114,290,Aetna,Commercial,266.8,92,,percent of total billed charges,,
SULFUR HEXAFLUORIDE MICROSPHR 25 MG IV SUSR,,Q9950,HCPCS,Facility,Outpatient,25 mg,mg,,290,246.5,83.114,290,Aetna,Medicare Advantage,142.1,49,,percent of total billed charges,,
SULFUR HEXAFLUORIDE MICROSPHR 25 MG IV SUSR,,Q9950,HCPCS,Facility,Inpatient,25 mg,mg,,290,246.5,83.114,290,Aetna,Medicare Advantage,,,,,Included in per diem rate,
SULFUR HEXAFLUORIDE MICROSPHR 25 MG IV SUSR,,Q9950,HCPCS,Facility,Both,25 mg,mg,,290,246.5,83.114,290,Aetna,PPO,269.7,93,,percent of total billed charges,,
SULFUR HEXAFLUORIDE MICROSPHR 25 MG IV SUSR,,Q9950,HCPCS,Facility,Both,25 mg,mg,,290,246.5,83.114,290,America's PPO,America's PPO,278.487,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SULFUR HEXAFLUORIDE MICROSPHR 25 MG IV SUSR,,Q9950,HCPCS,Facility,Both,25 mg,mg,,290,246.5,83.114,290,BlueCross BlueShield Minnesota, Federal Employee Program,285.36,98.4,,percent of total billed charges,,
SULFUR HEXAFLUORIDE MICROSPHR 25 MG IV SUSR,,Q9950,HCPCS,Facility,Both,25 mg,mg,,290,246.5,83.114,290,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,290,100,,percent of total billed charges,,
SULFUR HEXAFLUORIDE MICROSPHR 25 MG IV SUSR,,Q9950,HCPCS,Facility,Both,25 mg,mg,,290,246.5,83.114,290,BlueCross BlueShield Minnesota,High Value Network Plan,261,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
SULFUR HEXAFLUORIDE MICROSPHR 25 MG IV SUSR,,Q9950,HCPCS,Facility,Outpatient,25 mg,mg,,290,246.5,83.114,290,BlueCross BlueShield Minnesota,Medicare Advantage,142.1,49,,percent of total billed charges,,
SULFUR HEXAFLUORIDE MICROSPHR 25 MG IV SUSR,,Q9950,HCPCS,Facility,Inpatient,25 mg,mg,,290,246.5,83.114,290,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
SULFUR HEXAFLUORIDE MICROSPHR 25 MG IV SUSR,,Q9950,HCPCS,Facility,Both,25 mg,mg,,290,246.5,83.114,290,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,256.853,88.57,,percent of total billed charges,,
SULFUR HEXAFLUORIDE MICROSPHR 25 MG IV SUSR,,Q9950,HCPCS,Facility,Both,25 mg,mg,,290,246.5,83.114,290,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,83.114,28.66,,percent of total billed charges,,
SULFUR HEXAFLUORIDE MICROSPHR 25 MG IV SUSR,,Q9950,HCPCS,Facility,Outpatient,25 mg,mg,,290,246.5,83.114,290,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),142.1,49,,percent of total billed charges,,
SULFUR HEXAFLUORIDE MICROSPHR 25 MG IV SUSR,,Q9950,HCPCS,Facility,Inpatient,25 mg,mg,,290,246.5,83.114,290,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
SULFUR HEXAFLUORIDE MICROSPHR 25 MG IV SUSR,,Q9950,HCPCS,Facility,Both,25 mg,mg,,290,246.5,83.114,290,CorVel,Worker's Compensation,290,100,,percent of total billed charges,,
SULFUR HEXAFLUORIDE MICROSPHR 25 MG IV SUSR,,Q9950,HCPCS,Facility,Both,25 mg,mg,,290,246.5,83.114,290,First Health Group Corporation,First Health Network,281.3,97,,percent of total billed charges,,
SULFUR HEXAFLUORIDE MICROSPHR 25 MG IV SUSR,,Q9950,HCPCS,Facility,Both,25 mg,mg,,290,246.5,83.114,290,"Health Partners, Inc.",Commercial,274.34,94.6,,percent of total billed charges,,
SULFUR HEXAFLUORIDE MICROSPHR 25 MG IV SUSR,,Q9950,HCPCS,Facility,Outpatient,25 mg,mg,,290,246.5,83.114,290,"Health Partners, Inc.",Medicare Advantage,142.1,49,,percent of total billed charges,,
SULFUR HEXAFLUORIDE MICROSPHR 25 MG IV SUSR,,Q9950,HCPCS,Facility,Inpatient,25 mg,mg,,290,246.5,83.114,290,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SULFUR HEXAFLUORIDE MICROSPHR 25 MG IV SUSR,,Q9950,HCPCS,Facility,Both,25 mg,mg,,290,246.5,83.114,290,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),174,60,,percent of total billed charges,,
SULFUR HEXAFLUORIDE MICROSPHR 25 MG IV SUSR,,Q9950,HCPCS,Facility,Both,25 mg,mg,,290,246.5,83.114,290,"Health Partners, Inc.",State of Minnesota Advantage Program,236.35,81.5,,percent of total billed charges,,
SULFUR HEXAFLUORIDE MICROSPHR 25 MG IV SUSR,,Q9950,HCPCS,Facility,Both,25 mg,mg,,290,246.5,83.114,290,"Health Partners, Inc.",State Public Programs,145,50,,percent of total billed charges,,
SULFUR HEXAFLUORIDE MICROSPHR 25 MG IV SUSR,,Q9950,HCPCS,Facility,Both,25 mg,mg,,290,246.5,83.114,290,Humana Insurance Company,Commercial PPO,275.5,95,,percent of total billed charges,,
SULFUR HEXAFLUORIDE MICROSPHR 25 MG IV SUSR,,Q9950,HCPCS,Facility,Outpatient,25 mg,mg,,290,246.5,83.114,290,Humana Insurance Company,Medicare PPO,142.1,49,,percent of total billed charges,,
SULFUR HEXAFLUORIDE MICROSPHR 25 MG IV SUSR,,Q9950,HCPCS,Facility,Inpatient,25 mg,mg,,290,246.5,83.114,290,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
SULFUR HEXAFLUORIDE MICROSPHR 25 MG IV SUSR,,Q9950,HCPCS,Facility,Both,25 mg,mg,,290,246.5,83.114,290,Medica,Individual & Family,287.39,99.1,,percent of total billed charges,,
SULFUR HEXAFLUORIDE MICROSPHR 25 MG IV SUSR,,Q9950,HCPCS,Facility,Outpatient,25 mg,mg,,290,246.5,83.114,290,Medica,Medica Advantage Solution,144.42,49.8,,percent of total billed charges,,
SULFUR HEXAFLUORIDE MICROSPHR 25 MG IV SUSR,,Q9950,HCPCS,Facility,Inpatient,25 mg,mg,,290,246.5,83.114,290,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
SULFUR HEXAFLUORIDE MICROSPHR 25 MG IV SUSR,,Q9950,HCPCS,Facility,Outpatient,25 mg,mg,,290,246.5,83.114,290,Medica,Medical Assistance,129.34,44.6,,percent of total billed charges,,
SULFUR HEXAFLUORIDE MICROSPHR 25 MG IV SUSR,,Q9950,HCPCS,Facility,Inpatient,25 mg,mg,,290,246.5,83.114,290,Medica,Medical Assistance,,,,,Included in per diem rate,
SULFUR HEXAFLUORIDE MICROSPHR 25 MG IV SUSR,,Q9950,HCPCS,Facility,Outpatient,25 mg,mg,,290,246.5,83.114,290,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,144.42,49.8,,percent of total billed charges,,
SULFUR HEXAFLUORIDE MICROSPHR 25 MG IV SUSR,,Q9950,HCPCS,Facility,Inpatient,25 mg,mg,,290,246.5,83.114,290,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
SULFUR HEXAFLUORIDE MICROSPHR 25 MG IV SUSR,,Q9950,HCPCS,Facility,Both,25 mg,mg,,290,246.5,83.114,290,"Multiplan, Inc.","Multiplan, Inc.",272.6,94,,percent of total billed charges,,
SULFUR HEXAFLUORIDE MICROSPHR 25 MG IV SUSR,,Q9950,HCPCS,Facility,Outpatient,25 mg,mg,,290,246.5,83.114,290,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,261.29,90.1,,percent of total billed charges,,
SULFUR HEXAFLUORIDE MICROSPHR 25 MG IV SUSR,,Q9950,HCPCS,Facility,Inpatient,25 mg,mg,,290,246.5,83.114,290,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
SULFUR HEXAFLUORIDE MICROSPHR 25 MG IV SUSR,,Q9950,HCPCS,Facility,Both,25 mg,mg,,290,246.5,83.114,290,"Preferred One Administrative Services, INC.",PPO,285.94,98.6,,percent of total billed charges,,
SULFUR HEXAFLUORIDE MICROSPHR 25 MG IV SUSR,,Q9950,HCPCS,Facility,Outpatient,25 mg,mg,,290,246.5,83.114,290,PrimeWest Health,Minnesota Senior Health Options (MSHO),149.205,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
SULFUR HEXAFLUORIDE MICROSPHR 25 MG IV SUSR,,Q9950,HCPCS,Facility,Inpatient,25 mg,mg,,290,246.5,83.114,290,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SULFUR HEXAFLUORIDE MICROSPHR 25 MG IV SUSR,,Q9950,HCPCS,Facility,Outpatient,25 mg,mg,,290,246.5,83.114,290,PrimeWest Health,MinnesotaCare,148.944,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
SULFUR HEXAFLUORIDE MICROSPHR 25 MG IV SUSR,,Q9950,HCPCS,Facility,Inpatient,25 mg,mg,,290,246.5,83.114,290,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
SULFUR HEXAFLUORIDE MICROSPHR 25 MG IV SUSR,,Q9950,HCPCS,Facility,Both,25 mg,mg,,290,246.5,83.114,290,Sanford Health Plan,Sanford Health Plan,266.8,92,,percent of total billed charges,,
SULFUR HEXAFLUORIDE MICROSPHR 25 MG IV SUSR,,Q9950,HCPCS,Facility,Outpatient,25 mg,mg,,290,246.5,83.114,290,"UCare Health, Inc.",Individual & Family Plan,163.415,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
SULFUR HEXAFLUORIDE MICROSPHR 25 MG IV SUSR,,Q9950,HCPCS,Facility,Inpatient,25 mg,mg,,290,246.5,83.114,290,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
SULFUR HEXAFLUORIDE MICROSPHR 25 MG IV SUSR,,Q9950,HCPCS,Facility,Outpatient,25 mg,mg,,290,246.5,83.114,290,"UCare Health, Inc.",Medical Assistance,146.363,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SULFUR HEXAFLUORIDE MICROSPHR 25 MG IV SUSR,,Q9950,HCPCS,Facility,Inpatient,25 mg,mg,,290,246.5,83.114,290,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
SULFUR HEXAFLUORIDE MICROSPHR 25 MG IV SUSR,,Q9950,HCPCS,Facility,Outpatient,25 mg,mg,,290,246.5,83.114,290,"UCare Health, Inc.",Medicare Advantage,146.363,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SULFUR HEXAFLUORIDE MICROSPHR 25 MG IV SUSR,,Q9950,HCPCS,Facility,Inpatient,25 mg,mg,,290,246.5,83.114,290,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SULFUR HEXAFLUORIDE MICROSPHR 25 MG IV SUSR,,Q9950,HCPCS,Facility,Outpatient,25 mg,mg,,290,246.5,83.114,290,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),146.363,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SULFUR HEXAFLUORIDE MICROSPHR 25 MG IV SUSR,,Q9950,HCPCS,Facility,Inpatient,25 mg,mg,,290,246.5,83.114,290,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SULFUR HEXAFLUORIDE MICROSPHR 25 MG IV SUSR,,Q9950,HCPCS,Facility,Both,25 mg,mg,,290,246.5,83.114,290,UnitedHealthcare,Individual & Family,272.6,94,,percent of total billed charges,,
SULFUR HEXAFLUORIDE MICROSPHR 25 MG IV SUSR,,Q9950,HCPCS,Facility,Outpatient,25 mg,mg,,290,246.5,83.114,290,UnitedHealthcare,Medicare Advantage,142.1,49,,percent of total billed charges,,
SULFUR HEXAFLUORIDE MICROSPHR 25 MG IV SUSR,,Q9950,HCPCS,Facility,Inpatient,25 mg,mg,,290,246.5,83.114,290,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
SULFUR HEXAFLUORIDE MICROSPHR 25 MG IV SUSR,,Q9950,HCPCS,Facility,Outpatient,25 mg,mg,,290,246.5,83.114,290,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,139.2,48,,percent of total billed charges,,100% of DHS outpatient percentage
SULFUR HEXAFLUORIDE MICROSPHR 25 MG IV SUSR,,Q9950,HCPCS,Facility,Inpatient,25 mg,mg,,290,246.5,83.114,290,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
PROTAMINE 10 MG/ML IV SOLN,,J2720,HCPCS,Facility,Both,25 mL,mL,,234,198.9,67.0644,234,Aetna,Commercial,215.28,92,,percent of total billed charges,,
PROTAMINE 10 MG/ML IV SOLN,,J2720,HCPCS,Facility,Both,25 mL,mL,,179,152.15,51.3014,179,Aetna,Commercial,164.68,92,,percent of total billed charges,,
PROTAMINE 10 MG/ML IV SOLN,,J2720,HCPCS,Facility,Outpatient,25 mL,mL,,234,198.9,67.0644,234,Aetna,Medicare Advantage,114.66,49,,percent of total billed charges,,
PROTAMINE 10 MG/ML IV SOLN,,J2720,HCPCS,Facility,Outpatient,25 mL,mL,,179,152.15,51.3014,179,Aetna,Medicare Advantage,87.71,49,,percent of total billed charges,,
PROTAMINE 10 MG/ML IV SOLN,,J2720,HCPCS,Facility,Inpatient,25 mL,mL,,234,198.9,67.0644,234,Aetna,Medicare Advantage,,,,,Included in per diem rate,
PROTAMINE 10 MG/ML IV SOLN,,J2720,HCPCS,Facility,Inpatient,25 mL,mL,,179,152.15,51.3014,179,Aetna,Medicare Advantage,,,,,Included in per diem rate,
PROTAMINE 10 MG/ML IV SOLN,,J2720,HCPCS,Facility,Both,25 mL,mL,,234,198.9,67.0644,234,Aetna,PPO,217.62,93,,percent of total billed charges,,
PROTAMINE 10 MG/ML IV SOLN,,J2720,HCPCS,Facility,Both,25 mL,mL,,179,152.15,51.3014,179,Aetna,PPO,166.47,93,,percent of total billed charges,,
PROTAMINE 10 MG/ML IV SOLN,,J2720,HCPCS,Facility,Both,25 mL,mL,,234,198.9,67.0644,234,America's PPO,America's PPO,224.7102,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
PROTAMINE 10 MG/ML IV SOLN,,J2720,HCPCS,Facility,Both,25 mL,mL,,179,152.15,51.3014,179,America's PPO,America's PPO,171.8937,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
PROTAMINE 10 MG/ML IV SOLN,,J2720,HCPCS,Facility,Both,25 mL,mL,,234,198.9,67.0644,234,BlueCross BlueShield Minnesota, Federal Employee Program,230.256,98.4,,percent of total billed charges,,
PROTAMINE 10 MG/ML IV SOLN,,J2720,HCPCS,Facility,Both,25 mL,mL,,179,152.15,51.3014,179,BlueCross BlueShield Minnesota, Federal Employee Program,176.136,98.4,,percent of total billed charges,,
PROTAMINE 10 MG/ML IV SOLN,,J2720,HCPCS,Facility,Both,25 mL,mL,,234,198.9,67.0644,234,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,234,100,,percent of total billed charges,,
PROTAMINE 10 MG/ML IV SOLN,,J2720,HCPCS,Facility,Both,25 mL,mL,,179,152.15,51.3014,179,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,179,100,,percent of total billed charges,,
PROTAMINE 10 MG/ML IV SOLN,,J2720,HCPCS,Facility,Both,25 mL,mL,,234,198.9,67.0644,234,BlueCross BlueShield Minnesota,High Value Network Plan,210.6,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
PROTAMINE 10 MG/ML IV SOLN,,J2720,HCPCS,Facility,Both,25 mL,mL,,179,152.15,51.3014,179,BlueCross BlueShield Minnesota,High Value Network Plan,161.1,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
PROTAMINE 10 MG/ML IV SOLN,,J2720,HCPCS,Facility,Outpatient,25 mL,mL,,234,198.9,67.0644,234,BlueCross BlueShield Minnesota,Medicare Advantage,114.66,49,,percent of total billed charges,,
PROTAMINE 10 MG/ML IV SOLN,,J2720,HCPCS,Facility,Outpatient,25 mL,mL,,179,152.15,51.3014,179,BlueCross BlueShield Minnesota,Medicare Advantage,87.71,49,,percent of total billed charges,,
PROTAMINE 10 MG/ML IV SOLN,,J2720,HCPCS,Facility,Inpatient,25 mL,mL,,234,198.9,67.0644,234,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
PROTAMINE 10 MG/ML IV SOLN,,J2720,HCPCS,Facility,Inpatient,25 mL,mL,,179,152.15,51.3014,179,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
PROTAMINE 10 MG/ML IV SOLN,,J2720,HCPCS,Facility,Both,25 mL,mL,,234,198.9,67.0644,234,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,207.2538,88.57,,percent of total billed charges,,
PROTAMINE 10 MG/ML IV SOLN,,J2720,HCPCS,Facility,Both,25 mL,mL,,179,152.15,51.3014,179,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,158.5403,88.57,,percent of total billed charges,,
PROTAMINE 10 MG/ML IV SOLN,,J2720,HCPCS,Facility,Both,25 mL,mL,,234,198.9,67.0644,234,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,67.0644,28.66,,percent of total billed charges,,
PROTAMINE 10 MG/ML IV SOLN,,J2720,HCPCS,Facility,Both,25 mL,mL,,179,152.15,51.3014,179,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,51.3014,28.66,,percent of total billed charges,,
PROTAMINE 10 MG/ML IV SOLN,,J2720,HCPCS,Facility,Outpatient,25 mL,mL,,234,198.9,67.0644,234,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),114.66,49,,percent of total billed charges,,
PROTAMINE 10 MG/ML IV SOLN,,J2720,HCPCS,Facility,Outpatient,25 mL,mL,,179,152.15,51.3014,179,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),87.71,49,,percent of total billed charges,,
PROTAMINE 10 MG/ML IV SOLN,,J2720,HCPCS,Facility,Inpatient,25 mL,mL,,234,198.9,67.0644,234,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
PROTAMINE 10 MG/ML IV SOLN,,J2720,HCPCS,Facility,Inpatient,25 mL,mL,,179,152.15,51.3014,179,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
PROTAMINE 10 MG/ML IV SOLN,,J2720,HCPCS,Facility,Both,25 mL,mL,,234,198.9,67.0644,234,CorVel,Worker's Compensation,234,100,,percent of total billed charges,,
PROTAMINE 10 MG/ML IV SOLN,,J2720,HCPCS,Facility,Both,25 mL,mL,,179,152.15,51.3014,179,CorVel,Worker's Compensation,179,100,,percent of total billed charges,,
PROTAMINE 10 MG/ML IV SOLN,,J2720,HCPCS,Facility,Both,25 mL,mL,,234,198.9,67.0644,234,First Health Group Corporation,First Health Network,226.98,97,,percent of total billed charges,,
PROTAMINE 10 MG/ML IV SOLN,,J2720,HCPCS,Facility,Both,25 mL,mL,,179,152.15,51.3014,179,First Health Group Corporation,First Health Network,173.63,97,,percent of total billed charges,,
PROTAMINE 10 MG/ML IV SOLN,,J2720,HCPCS,Facility,Both,25 mL,mL,,234,198.9,67.0644,234,"Health Partners, Inc.",Commercial,221.364,94.6,,percent of total billed charges,,
PROTAMINE 10 MG/ML IV SOLN,,J2720,HCPCS,Facility,Both,25 mL,mL,,179,152.15,51.3014,179,"Health Partners, Inc.",Commercial,169.334,94.6,,percent of total billed charges,,
PROTAMINE 10 MG/ML IV SOLN,,J2720,HCPCS,Facility,Outpatient,25 mL,mL,,234,198.9,67.0644,234,"Health Partners, Inc.",Medicare Advantage,114.66,49,,percent of total billed charges,,
PROTAMINE 10 MG/ML IV SOLN,,J2720,HCPCS,Facility,Outpatient,25 mL,mL,,179,152.15,51.3014,179,"Health Partners, Inc.",Medicare Advantage,87.71,49,,percent of total billed charges,,
PROTAMINE 10 MG/ML IV SOLN,,J2720,HCPCS,Facility,Inpatient,25 mL,mL,,234,198.9,67.0644,234,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PROTAMINE 10 MG/ML IV SOLN,,J2720,HCPCS,Facility,Inpatient,25 mL,mL,,179,152.15,51.3014,179,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PROTAMINE 10 MG/ML IV SOLN,,J2720,HCPCS,Facility,Both,25 mL,mL,,234,198.9,67.0644,234,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),140.4,60,,percent of total billed charges,,
PROTAMINE 10 MG/ML IV SOLN,,J2720,HCPCS,Facility,Both,25 mL,mL,,179,152.15,51.3014,179,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),107.4,60,,percent of total billed charges,,
PROTAMINE 10 MG/ML IV SOLN,,J2720,HCPCS,Facility,Both,25 mL,mL,,234,198.9,67.0644,234,"Health Partners, Inc.",State of Minnesota Advantage Program,190.71,81.5,,percent of total billed charges,,
PROTAMINE 10 MG/ML IV SOLN,,J2720,HCPCS,Facility,Both,25 mL,mL,,179,152.15,51.3014,179,"Health Partners, Inc.",State of Minnesota Advantage Program,145.885,81.5,,percent of total billed charges,,
PROTAMINE 10 MG/ML IV SOLN,,J2720,HCPCS,Facility,Both,25 mL,mL,,234,198.9,67.0644,234,"Health Partners, Inc.",State Public Programs,117,50,,percent of total billed charges,,
PROTAMINE 10 MG/ML IV SOLN,,J2720,HCPCS,Facility,Both,25 mL,mL,,179,152.15,51.3014,179,"Health Partners, Inc.",State Public Programs,89.5,50,,percent of total billed charges,,
PROTAMINE 10 MG/ML IV SOLN,,J2720,HCPCS,Facility,Both,25 mL,mL,,234,198.9,67.0644,234,Humana Insurance Company,Commercial PPO,222.3,95,,percent of total billed charges,,
PROTAMINE 10 MG/ML IV SOLN,,J2720,HCPCS,Facility,Both,25 mL,mL,,179,152.15,51.3014,179,Humana Insurance Company,Commercial PPO,170.05,95,,percent of total billed charges,,
PROTAMINE 10 MG/ML IV SOLN,,J2720,HCPCS,Facility,Outpatient,25 mL,mL,,234,198.9,67.0644,234,Humana Insurance Company,Medicare PPO,114.66,49,,percent of total billed charges,,
PROTAMINE 10 MG/ML IV SOLN,,J2720,HCPCS,Facility,Outpatient,25 mL,mL,,179,152.15,51.3014,179,Humana Insurance Company,Medicare PPO,87.71,49,,percent of total billed charges,,
PROTAMINE 10 MG/ML IV SOLN,,J2720,HCPCS,Facility,Inpatient,25 mL,mL,,234,198.9,67.0644,234,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
PROTAMINE 10 MG/ML IV SOLN,,J2720,HCPCS,Facility,Inpatient,25 mL,mL,,179,152.15,51.3014,179,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
PROTAMINE 10 MG/ML IV SOLN,,J2720,HCPCS,Facility,Both,25 mL,mL,,234,198.9,67.0644,234,Medica,Individual & Family,231.894,99.1,,percent of total billed charges,,
PROTAMINE 10 MG/ML IV SOLN,,J2720,HCPCS,Facility,Both,25 mL,mL,,179,152.15,51.3014,179,Medica,Individual & Family,177.389,99.1,,percent of total billed charges,,
PROTAMINE 10 MG/ML IV SOLN,,J2720,HCPCS,Facility,Outpatient,25 mL,mL,,234,198.9,67.0644,234,Medica,Medica Advantage Solution,116.532,49.8,,percent of total billed charges,,
PROTAMINE 10 MG/ML IV SOLN,,J2720,HCPCS,Facility,Outpatient,25 mL,mL,,179,152.15,51.3014,179,Medica,Medica Advantage Solution,89.142,49.8,,percent of total billed charges,,
PROTAMINE 10 MG/ML IV SOLN,,J2720,HCPCS,Facility,Inpatient,25 mL,mL,,234,198.9,67.0644,234,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
PROTAMINE 10 MG/ML IV SOLN,,J2720,HCPCS,Facility,Inpatient,25 mL,mL,,179,152.15,51.3014,179,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
PROTAMINE 10 MG/ML IV SOLN,,J2720,HCPCS,Facility,Outpatient,25 mL,mL,,234,198.9,67.0644,234,Medica,Medical Assistance,104.364,44.6,,percent of total billed charges,,
PROTAMINE 10 MG/ML IV SOLN,,J2720,HCPCS,Facility,Outpatient,25 mL,mL,,179,152.15,51.3014,179,Medica,Medical Assistance,79.834,44.6,,percent of total billed charges,,
PROTAMINE 10 MG/ML IV SOLN,,J2720,HCPCS,Facility,Inpatient,25 mL,mL,,234,198.9,67.0644,234,Medica,Medical Assistance,,,,,Included in per diem rate,
PROTAMINE 10 MG/ML IV SOLN,,J2720,HCPCS,Facility,Inpatient,25 mL,mL,,179,152.15,51.3014,179,Medica,Medical Assistance,,,,,Included in per diem rate,
PROTAMINE 10 MG/ML IV SOLN,,J2720,HCPCS,Facility,Outpatient,25 mL,mL,,234,198.9,67.0644,234,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,116.532,49.8,,percent of total billed charges,,
PROTAMINE 10 MG/ML IV SOLN,,J2720,HCPCS,Facility,Outpatient,25 mL,mL,,179,152.15,51.3014,179,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,89.142,49.8,,percent of total billed charges,,
PROTAMINE 10 MG/ML IV SOLN,,J2720,HCPCS,Facility,Inpatient,25 mL,mL,,234,198.9,67.0644,234,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
PROTAMINE 10 MG/ML IV SOLN,,J2720,HCPCS,Facility,Inpatient,25 mL,mL,,179,152.15,51.3014,179,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
PROTAMINE 10 MG/ML IV SOLN,,J2720,HCPCS,Facility,Both,25 mL,mL,,234,198.9,67.0644,234,"Multiplan, Inc.","Multiplan, Inc.",219.96,94,,percent of total billed charges,,
PROTAMINE 10 MG/ML IV SOLN,,J2720,HCPCS,Facility,Both,25 mL,mL,,179,152.15,51.3014,179,"Multiplan, Inc.","Multiplan, Inc.",168.26,94,,percent of total billed charges,,
PROTAMINE 10 MG/ML IV SOLN,,J2720,HCPCS,Facility,Outpatient,25 mL,mL,,234,198.9,67.0644,234,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,210.834,90.1,,percent of total billed charges,,
PROTAMINE 10 MG/ML IV SOLN,,J2720,HCPCS,Facility,Outpatient,25 mL,mL,,179,152.15,51.3014,179,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,161.279,90.1,,percent of total billed charges,,
PROTAMINE 10 MG/ML IV SOLN,,J2720,HCPCS,Facility,Inpatient,25 mL,mL,,234,198.9,67.0644,234,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
PROTAMINE 10 MG/ML IV SOLN,,J2720,HCPCS,Facility,Inpatient,25 mL,mL,,179,152.15,51.3014,179,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
PROTAMINE 10 MG/ML IV SOLN,,J2720,HCPCS,Facility,Both,25 mL,mL,,234,198.9,67.0644,234,"Preferred One Administrative Services, INC.",PPO,230.724,98.6,,percent of total billed charges,,
PROTAMINE 10 MG/ML IV SOLN,,J2720,HCPCS,Facility,Both,25 mL,mL,,179,152.15,51.3014,179,"Preferred One Administrative Services, INC.",PPO,176.494,98.6,,percent of total billed charges,,
PROTAMINE 10 MG/ML IV SOLN,,J2720,HCPCS,Facility,Outpatient,25 mL,mL,,234,198.9,67.0644,234,PrimeWest Health,Minnesota Senior Health Options (MSHO),120.393,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
PROTAMINE 10 MG/ML IV SOLN,,J2720,HCPCS,Facility,Outpatient,25 mL,mL,,179,152.15,51.3014,179,PrimeWest Health,Minnesota Senior Health Options (MSHO),92.0955,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
PROTAMINE 10 MG/ML IV SOLN,,J2720,HCPCS,Facility,Inpatient,25 mL,mL,,234,198.9,67.0644,234,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PROTAMINE 10 MG/ML IV SOLN,,J2720,HCPCS,Facility,Inpatient,25 mL,mL,,179,152.15,51.3014,179,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PROTAMINE 10 MG/ML IV SOLN,,J2720,HCPCS,Facility,Outpatient,25 mL,mL,,234,198.9,67.0644,234,PrimeWest Health,MinnesotaCare,120.1824,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
PROTAMINE 10 MG/ML IV SOLN,,J2720,HCPCS,Facility,Outpatient,25 mL,mL,,179,152.15,51.3014,179,PrimeWest Health,MinnesotaCare,91.9344,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
PROTAMINE 10 MG/ML IV SOLN,,J2720,HCPCS,Facility,Inpatient,25 mL,mL,,234,198.9,67.0644,234,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
PROTAMINE 10 MG/ML IV SOLN,,J2720,HCPCS,Facility,Inpatient,25 mL,mL,,179,152.15,51.3014,179,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
PROTAMINE 10 MG/ML IV SOLN,,J2720,HCPCS,Facility,Both,25 mL,mL,,234,198.9,67.0644,234,Sanford Health Plan,Sanford Health Plan,215.28,92,,percent of total billed charges,,
PROTAMINE 10 MG/ML IV SOLN,,J2720,HCPCS,Facility,Both,25 mL,mL,,179,152.15,51.3014,179,Sanford Health Plan,Sanford Health Plan,164.68,92,,percent of total billed charges,,
PROTAMINE 10 MG/ML IV SOLN,,J2720,HCPCS,Facility,Outpatient,25 mL,mL,,234,198.9,67.0644,234,"UCare Health, Inc.",Individual & Family Plan,131.859,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
PROTAMINE 10 MG/ML IV SOLN,,J2720,HCPCS,Facility,Outpatient,25 mL,mL,,179,152.15,51.3014,179,"UCare Health, Inc.",Individual & Family Plan,100.8665,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
PROTAMINE 10 MG/ML IV SOLN,,J2720,HCPCS,Facility,Inpatient,25 mL,mL,,234,198.9,67.0644,234,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
PROTAMINE 10 MG/ML IV SOLN,,J2720,HCPCS,Facility,Inpatient,25 mL,mL,,179,152.15,51.3014,179,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
PROTAMINE 10 MG/ML IV SOLN,,J2720,HCPCS,Facility,Outpatient,25 mL,mL,,234,198.9,67.0644,234,"UCare Health, Inc.",Medical Assistance,118.0998,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PROTAMINE 10 MG/ML IV SOLN,,J2720,HCPCS,Facility,Outpatient,25 mL,mL,,179,152.15,51.3014,179,"UCare Health, Inc.",Medical Assistance,90.3413,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PROTAMINE 10 MG/ML IV SOLN,,J2720,HCPCS,Facility,Inpatient,25 mL,mL,,234,198.9,67.0644,234,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
PROTAMINE 10 MG/ML IV SOLN,,J2720,HCPCS,Facility,Inpatient,25 mL,mL,,179,152.15,51.3014,179,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
PROTAMINE 10 MG/ML IV SOLN,,J2720,HCPCS,Facility,Outpatient,25 mL,mL,,234,198.9,67.0644,234,"UCare Health, Inc.",Medicare Advantage,118.0998,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PROTAMINE 10 MG/ML IV SOLN,,J2720,HCPCS,Facility,Outpatient,25 mL,mL,,179,152.15,51.3014,179,"UCare Health, Inc.",Medicare Advantage,90.3413,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PROTAMINE 10 MG/ML IV SOLN,,J2720,HCPCS,Facility,Inpatient,25 mL,mL,,234,198.9,67.0644,234,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PROTAMINE 10 MG/ML IV SOLN,,J2720,HCPCS,Facility,Inpatient,25 mL,mL,,179,152.15,51.3014,179,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PROTAMINE 10 MG/ML IV SOLN,,J2720,HCPCS,Facility,Outpatient,25 mL,mL,,234,198.9,67.0644,234,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),118.0998,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PROTAMINE 10 MG/ML IV SOLN,,J2720,HCPCS,Facility,Outpatient,25 mL,mL,,179,152.15,51.3014,179,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),90.3413,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PROTAMINE 10 MG/ML IV SOLN,,J2720,HCPCS,Facility,Inpatient,25 mL,mL,,234,198.9,67.0644,234,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PROTAMINE 10 MG/ML IV SOLN,,J2720,HCPCS,Facility,Inpatient,25 mL,mL,,179,152.15,51.3014,179,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PROTAMINE 10 MG/ML IV SOLN,,J2720,HCPCS,Facility,Both,25 mL,mL,,234,198.9,67.0644,234,UnitedHealthcare,Individual & Family,219.96,94,,percent of total billed charges,,
PROTAMINE 10 MG/ML IV SOLN,,J2720,HCPCS,Facility,Both,25 mL,mL,,179,152.15,51.3014,179,UnitedHealthcare,Individual & Family,168.26,94,,percent of total billed charges,,
PROTAMINE 10 MG/ML IV SOLN,,J2720,HCPCS,Facility,Outpatient,25 mL,mL,,234,198.9,67.0644,234,UnitedHealthcare,Medicare Advantage,114.66,49,,percent of total billed charges,,
PROTAMINE 10 MG/ML IV SOLN,,J2720,HCPCS,Facility,Outpatient,25 mL,mL,,179,152.15,51.3014,179,UnitedHealthcare,Medicare Advantage,87.71,49,,percent of total billed charges,,
PROTAMINE 10 MG/ML IV SOLN,,J2720,HCPCS,Facility,Inpatient,25 mL,mL,,234,198.9,67.0644,234,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
PROTAMINE 10 MG/ML IV SOLN,,J2720,HCPCS,Facility,Inpatient,25 mL,mL,,179,152.15,51.3014,179,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
PROTAMINE 10 MG/ML IV SOLN,,J2720,HCPCS,Facility,Outpatient,25 mL,mL,,234,198.9,67.0644,234,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,112.32,48,,percent of total billed charges,,100% of DHS outpatient percentage
PROTAMINE 10 MG/ML IV SOLN,,J2720,HCPCS,Facility,Outpatient,25 mL,mL,,179,152.15,51.3014,179,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,85.92,48,,percent of total billed charges,,100% of DHS outpatient percentage
PROTAMINE 10 MG/ML IV SOLN,,J2720,HCPCS,Facility,Inpatient,25 mL,mL,,234,198.9,67.0644,234,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
PROTAMINE 10 MG/ML IV SOLN,,J2720,HCPCS,Facility,Inpatient,25 mL,mL,,179,152.15,51.3014,179,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
DILTIAZEM HCL 5 MG/ML IV SOLN,,J3490,HCPCS,Facility,Both,25 mL,mL,,60,51,17.196,60,Aetna,Commercial,55.2,92,,percent of total billed charges,,
DILTIAZEM HCL 5 MG/ML IV SOLN,,J3490,HCPCS,Facility,Outpatient,25 mL,mL,,60,51,17.196,60,Aetna,Medicare Advantage,29.4,49,,percent of total billed charges,,
DILTIAZEM HCL 5 MG/ML IV SOLN,,J3490,HCPCS,Facility,Inpatient,25 mL,mL,,60,51,17.196,60,Aetna,Medicare Advantage,,,,,Included in per diem rate,
DILTIAZEM HCL 5 MG/ML IV SOLN,,J3490,HCPCS,Facility,Both,25 mL,mL,,60,51,17.196,60,Aetna,PPO,55.8,93,,percent of total billed charges,,
DILTIAZEM HCL 5 MG/ML IV SOLN,,J3490,HCPCS,Facility,Both,25 mL,mL,,60,51,17.196,60,America's PPO,America's PPO,57.618,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
DILTIAZEM HCL 5 MG/ML IV SOLN,,J3490,HCPCS,Facility,Both,25 mL,mL,,60,51,17.196,60,BlueCross BlueShield Minnesota, Federal Employee Program,59.04,98.4,,percent of total billed charges,,
DILTIAZEM HCL 5 MG/ML IV SOLN,,J3490,HCPCS,Facility,Both,25 mL,mL,,60,51,17.196,60,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,60,100,,percent of total billed charges,,
DILTIAZEM HCL 5 MG/ML IV SOLN,,J3490,HCPCS,Facility,Both,25 mL,mL,,60,51,17.196,60,BlueCross BlueShield Minnesota,High Value Network Plan,54,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
DILTIAZEM HCL 5 MG/ML IV SOLN,,J3490,HCPCS,Facility,Outpatient,25 mL,mL,,60,51,17.196,60,BlueCross BlueShield Minnesota,Medicare Advantage,29.4,49,,percent of total billed charges,,
DILTIAZEM HCL 5 MG/ML IV SOLN,,J3490,HCPCS,Facility,Inpatient,25 mL,mL,,60,51,17.196,60,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
DILTIAZEM HCL 5 MG/ML IV SOLN,,J3490,HCPCS,Facility,Both,25 mL,mL,,60,51,17.196,60,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,53.142,88.57,,percent of total billed charges,,
DILTIAZEM HCL 5 MG/ML IV SOLN,,J3490,HCPCS,Facility,Both,25 mL,mL,,60,51,17.196,60,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,17.196,28.66,,percent of total billed charges,,
DILTIAZEM HCL 5 MG/ML IV SOLN,,J3490,HCPCS,Facility,Outpatient,25 mL,mL,,60,51,17.196,60,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),29.4,49,,percent of total billed charges,,
DILTIAZEM HCL 5 MG/ML IV SOLN,,J3490,HCPCS,Facility,Inpatient,25 mL,mL,,60,51,17.196,60,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
DILTIAZEM HCL 5 MG/ML IV SOLN,,J3490,HCPCS,Facility,Both,25 mL,mL,,60,51,17.196,60,CorVel,Worker's Compensation,60,100,,percent of total billed charges,,
DILTIAZEM HCL 5 MG/ML IV SOLN,,J3490,HCPCS,Facility,Both,25 mL,mL,,60,51,17.196,60,First Health Group Corporation,First Health Network,58.2,97,,percent of total billed charges,,
DILTIAZEM HCL 5 MG/ML IV SOLN,,J3490,HCPCS,Facility,Both,25 mL,mL,,60,51,17.196,60,"Health Partners, Inc.",Commercial,56.76,94.6,,percent of total billed charges,,
DILTIAZEM HCL 5 MG/ML IV SOLN,,J3490,HCPCS,Facility,Outpatient,25 mL,mL,,60,51,17.196,60,"Health Partners, Inc.",Medicare Advantage,29.4,49,,percent of total billed charges,,
DILTIAZEM HCL 5 MG/ML IV SOLN,,J3490,HCPCS,Facility,Inpatient,25 mL,mL,,60,51,17.196,60,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DILTIAZEM HCL 5 MG/ML IV SOLN,,J3490,HCPCS,Facility,Both,25 mL,mL,,60,51,17.196,60,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),36,60,,percent of total billed charges,,
DILTIAZEM HCL 5 MG/ML IV SOLN,,J3490,HCPCS,Facility,Both,25 mL,mL,,60,51,17.196,60,"Health Partners, Inc.",State of Minnesota Advantage Program,48.9,81.5,,percent of total billed charges,,
DILTIAZEM HCL 5 MG/ML IV SOLN,,J3490,HCPCS,Facility,Both,25 mL,mL,,60,51,17.196,60,"Health Partners, Inc.",State Public Programs,30,50,,percent of total billed charges,,
DILTIAZEM HCL 5 MG/ML IV SOLN,,J3490,HCPCS,Facility,Both,25 mL,mL,,60,51,17.196,60,Humana Insurance Company,Commercial PPO,57,95,,percent of total billed charges,,
DILTIAZEM HCL 5 MG/ML IV SOLN,,J3490,HCPCS,Facility,Outpatient,25 mL,mL,,60,51,17.196,60,Humana Insurance Company,Medicare PPO,29.4,49,,percent of total billed charges,,
DILTIAZEM HCL 5 MG/ML IV SOLN,,J3490,HCPCS,Facility,Inpatient,25 mL,mL,,60,51,17.196,60,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
DILTIAZEM HCL 5 MG/ML IV SOLN,,J3490,HCPCS,Facility,Both,25 mL,mL,,60,51,17.196,60,Medica,Individual & Family,59.46,99.1,,percent of total billed charges,,
DILTIAZEM HCL 5 MG/ML IV SOLN,,J3490,HCPCS,Facility,Outpatient,25 mL,mL,,60,51,17.196,60,Medica,Medica Advantage Solution,29.88,49.8,,percent of total billed charges,,
DILTIAZEM HCL 5 MG/ML IV SOLN,,J3490,HCPCS,Facility,Inpatient,25 mL,mL,,60,51,17.196,60,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
DILTIAZEM HCL 5 MG/ML IV SOLN,,J3490,HCPCS,Facility,Outpatient,25 mL,mL,,60,51,17.196,60,Medica,Medical Assistance,26.76,44.6,,percent of total billed charges,,
DILTIAZEM HCL 5 MG/ML IV SOLN,,J3490,HCPCS,Facility,Inpatient,25 mL,mL,,60,51,17.196,60,Medica,Medical Assistance,,,,,Included in per diem rate,
DILTIAZEM HCL 5 MG/ML IV SOLN,,J3490,HCPCS,Facility,Outpatient,25 mL,mL,,60,51,17.196,60,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,29.88,49.8,,percent of total billed charges,,
DILTIAZEM HCL 5 MG/ML IV SOLN,,J3490,HCPCS,Facility,Inpatient,25 mL,mL,,60,51,17.196,60,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
DILTIAZEM HCL 5 MG/ML IV SOLN,,J3490,HCPCS,Facility,Both,25 mL,mL,,60,51,17.196,60,"Multiplan, Inc.","Multiplan, Inc.",56.4,94,,percent of total billed charges,,
DILTIAZEM HCL 5 MG/ML IV SOLN,,J3490,HCPCS,Facility,Outpatient,25 mL,mL,,60,51,17.196,60,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,54.06,90.1,,percent of total billed charges,,
DILTIAZEM HCL 5 MG/ML IV SOLN,,J3490,HCPCS,Facility,Inpatient,25 mL,mL,,60,51,17.196,60,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
DILTIAZEM HCL 5 MG/ML IV SOLN,,J3490,HCPCS,Facility,Both,25 mL,mL,,60,51,17.196,60,"Preferred One Administrative Services, INC.",PPO,59.16,98.6,,percent of total billed charges,,
DILTIAZEM HCL 5 MG/ML IV SOLN,,J3490,HCPCS,Facility,Outpatient,25 mL,mL,,60,51,17.196,60,PrimeWest Health,Minnesota Senior Health Options (MSHO),30.87,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
DILTIAZEM HCL 5 MG/ML IV SOLN,,J3490,HCPCS,Facility,Inpatient,25 mL,mL,,60,51,17.196,60,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DILTIAZEM HCL 5 MG/ML IV SOLN,,J3490,HCPCS,Facility,Outpatient,25 mL,mL,,60,51,17.196,60,PrimeWest Health,MinnesotaCare,30.816,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
DILTIAZEM HCL 5 MG/ML IV SOLN,,J3490,HCPCS,Facility,Inpatient,25 mL,mL,,60,51,17.196,60,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
DILTIAZEM HCL 5 MG/ML IV SOLN,,J3490,HCPCS,Facility,Both,25 mL,mL,,60,51,17.196,60,Sanford Health Plan,Sanford Health Plan,55.2,92,,percent of total billed charges,,
DILTIAZEM HCL 5 MG/ML IV SOLN,,J3490,HCPCS,Facility,Outpatient,25 mL,mL,,60,51,17.196,60,"UCare Health, Inc.",Individual & Family Plan,33.81,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
DILTIAZEM HCL 5 MG/ML IV SOLN,,J3490,HCPCS,Facility,Inpatient,25 mL,mL,,60,51,17.196,60,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
DILTIAZEM HCL 5 MG/ML IV SOLN,,J3490,HCPCS,Facility,Outpatient,25 mL,mL,,60,51,17.196,60,"UCare Health, Inc.",Medical Assistance,30.282,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DILTIAZEM HCL 5 MG/ML IV SOLN,,J3490,HCPCS,Facility,Inpatient,25 mL,mL,,60,51,17.196,60,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
DILTIAZEM HCL 5 MG/ML IV SOLN,,J3490,HCPCS,Facility,Outpatient,25 mL,mL,,60,51,17.196,60,"UCare Health, Inc.",Medicare Advantage,30.282,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DILTIAZEM HCL 5 MG/ML IV SOLN,,J3490,HCPCS,Facility,Inpatient,25 mL,mL,,60,51,17.196,60,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DILTIAZEM HCL 5 MG/ML IV SOLN,,J3490,HCPCS,Facility,Outpatient,25 mL,mL,,60,51,17.196,60,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),30.282,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DILTIAZEM HCL 5 MG/ML IV SOLN,,J3490,HCPCS,Facility,Inpatient,25 mL,mL,,60,51,17.196,60,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DILTIAZEM HCL 5 MG/ML IV SOLN,,J3490,HCPCS,Facility,Both,25 mL,mL,,60,51,17.196,60,UnitedHealthcare,Individual & Family,56.4,94,,percent of total billed charges,,
DILTIAZEM HCL 5 MG/ML IV SOLN,,J3490,HCPCS,Facility,Outpatient,25 mL,mL,,60,51,17.196,60,UnitedHealthcare,Medicare Advantage,29.4,49,,percent of total billed charges,,
DILTIAZEM HCL 5 MG/ML IV SOLN,,J3490,HCPCS,Facility,Inpatient,25 mL,mL,,60,51,17.196,60,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
DILTIAZEM HCL 5 MG/ML IV SOLN,,J3490,HCPCS,Facility,Outpatient,25 mL,mL,,60,51,17.196,60,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,28.8,48,,percent of total billed charges,,100% of DHS outpatient percentage
DILTIAZEM HCL 5 MG/ML IV SOLN,,J3490,HCPCS,Facility,Inpatient,25 mL,mL,,60,51,17.196,60,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Both,250 mL,mL,,24,20.4,6.8784,24,Aetna,Commercial,22.08,92,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Outpatient,250 mL,mL,,24,20.4,6.8784,24,Aetna,Medicare Advantage,11.76,49,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Inpatient,250 mL,mL,,24,20.4,6.8784,24,Aetna,Medicare Advantage,,,,,Included in per diem rate,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Both,250 mL,mL,,24,20.4,6.8784,24,Aetna,PPO,22.32,93,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Both,250 mL,mL,,24,20.4,6.8784,24,America's PPO,America's PPO,23.0472,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Both,250 mL,mL,,24,20.4,6.8784,24,BlueCross BlueShield Minnesota, Federal Employee Program,23.616,98.4,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Both,250 mL,mL,,24,20.4,6.8784,24,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,24,100,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Both,250 mL,mL,,24,20.4,6.8784,24,BlueCross BlueShield Minnesota,High Value Network Plan,21.6,90,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Outpatient,250 mL,mL,,24,20.4,6.8784,24,BlueCross BlueShield Minnesota,Medicare Advantage,11.76,49,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Inpatient,250 mL,mL,,24,20.4,6.8784,24,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Both,250 mL,mL,,24,20.4,6.8784,24,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,21.2568,88.57,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Both,250 mL,mL,,24,20.4,6.8784,24,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,6.8784,28.66,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Outpatient,250 mL,mL,,24,20.4,6.8784,24,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),11.76,49,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Inpatient,250 mL,mL,,24,20.4,6.8784,24,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Both,250 mL,mL,,24,20.4,6.8784,24,CorVel,Worker's Compensation,24,100,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Both,250 mL,mL,,24,20.4,6.8784,24,First Health Group Corporation,First Health Network,23.28,97,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Both,250 mL,mL,,24,20.4,6.8784,24,"Health Partners, Inc.",Commercial,22.704,94.6,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Outpatient,250 mL,mL,,24,20.4,6.8784,24,"Health Partners, Inc.",Medicare Advantage,11.76,49,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Inpatient,250 mL,mL,,24,20.4,6.8784,24,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Both,250 mL,mL,,24,20.4,6.8784,24,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),14.4,60,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Both,250 mL,mL,,24,20.4,6.8784,24,"Health Partners, Inc.",State of Minnesota Advantage Program,19.56,81.5,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Both,250 mL,mL,,24,20.4,6.8784,24,"Health Partners, Inc.",State Public Programs,12,50,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Both,250 mL,mL,,24,20.4,6.8784,24,Humana Insurance Company,Commercial PPO,22.8,95,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Outpatient,250 mL,mL,,24,20.4,6.8784,24,Humana Insurance Company,Medicare PPO,11.76,49,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Inpatient,250 mL,mL,,24,20.4,6.8784,24,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Both,250 mL,mL,,24,20.4,6.8784,24,Medica,Individual & Family,23.784,99.1,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Outpatient,250 mL,mL,,24,20.4,6.8784,24,Medica,Medica Advantage Solution,11.952,49.8,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Inpatient,250 mL,mL,,24,20.4,6.8784,24,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Outpatient,250 mL,mL,,24,20.4,6.8784,24,Medica,Medical Assistance,10.704,44.6,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Inpatient,250 mL,mL,,24,20.4,6.8784,24,Medica,Medical Assistance,,,,,Included in per diem rate,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Outpatient,250 mL,mL,,24,20.4,6.8784,24,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,11.952,49.8,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Inpatient,250 mL,mL,,24,20.4,6.8784,24,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Both,250 mL,mL,,24,20.4,6.8784,24,"Multiplan, Inc.","Multiplan, Inc.",22.56,94,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Outpatient,250 mL,mL,,24,20.4,6.8784,24,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,21.624,90.1,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Inpatient,250 mL,mL,,24,20.4,6.8784,24,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Both,250 mL,mL,,24,20.4,6.8784,24,"Preferred One Administrative Services, INC.",PPO,23.664,98.6,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Outpatient,250 mL,mL,,24,20.4,6.8784,24,PrimeWest Health,Minnesota Senior Health Options (MSHO),12.348,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Inpatient,250 mL,mL,,24,20.4,6.8784,24,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Outpatient,250 mL,mL,,24,20.4,6.8784,24,PrimeWest Health,MinnesotaCare,12.3264,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Inpatient,250 mL,mL,,24,20.4,6.8784,24,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Both,250 mL,mL,,24,20.4,6.8784,24,Sanford Health Plan,Sanford Health Plan,22.08,92,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Outpatient,250 mL,mL,,24,20.4,6.8784,24,"UCare Health, Inc.",Individual & Family Plan,13.524,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Inpatient,250 mL,mL,,24,20.4,6.8784,24,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Outpatient,250 mL,mL,,24,20.4,6.8784,24,"UCare Health, Inc.",Medical Assistance,12.1128,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Inpatient,250 mL,mL,,24,20.4,6.8784,24,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Outpatient,250 mL,mL,,24,20.4,6.8784,24,"UCare Health, Inc.",Medicare Advantage,12.1128,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Inpatient,250 mL,mL,,24,20.4,6.8784,24,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Outpatient,250 mL,mL,,24,20.4,6.8784,24,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),12.1128,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Inpatient,250 mL,mL,,24,20.4,6.8784,24,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Both,250 mL,mL,,24,20.4,6.8784,24,UnitedHealthcare,Individual & Family,22.56,94,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Outpatient,250 mL,mL,,24,20.4,6.8784,24,UnitedHealthcare,Medicare Advantage,11.76,49,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Inpatient,250 mL,mL,,24,20.4,6.8784,24,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Outpatient,250 mL,mL,,24,20.4,6.8784,24,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,11.52,48,,percent of total billed charges,,100% of DHS outpatient percentage
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Inpatient,250 mL,mL,,24,20.4,6.8784,24,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Both,250 mL,mL,,25,21.25,7.165,25,Aetna,Commercial,23,92,,percent of total billed charges,,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Outpatient,250 mL,mL,,25,21.25,7.165,25,Aetna,Medicare Advantage,12.25,49,,percent of total billed charges,,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Inpatient,250 mL,mL,,25,21.25,7.165,25,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Both,250 mL,mL,,25,21.25,7.165,25,Aetna,PPO,23.25,93,,percent of total billed charges,,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Both,250 mL,mL,,25,21.25,7.165,25,America's PPO,America's PPO,24.0075,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Both,250 mL,mL,,25,21.25,7.165,25,BlueCross BlueShield Minnesota, Federal Employee Program,24.6,98.4,,percent of total billed charges,,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Both,250 mL,mL,,25,21.25,7.165,25,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,25,100,,percent of total billed charges,,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Both,250 mL,mL,,25,21.25,7.165,25,BlueCross BlueShield Minnesota,High Value Network Plan,22.5,90,,percent of total billed charges,,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Outpatient,250 mL,mL,,25,21.25,7.165,25,BlueCross BlueShield Minnesota,Medicare Advantage,12.25,49,,percent of total billed charges,,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Inpatient,250 mL,mL,,25,21.25,7.165,25,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Both,250 mL,mL,,25,21.25,7.165,25,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,22.1425,88.57,,percent of total billed charges,,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Both,250 mL,mL,,25,21.25,7.165,25,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,7.165,28.66,,percent of total billed charges,,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Outpatient,250 mL,mL,,25,21.25,7.165,25,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),12.25,49,,percent of total billed charges,,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Inpatient,250 mL,mL,,25,21.25,7.165,25,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Both,250 mL,mL,,25,21.25,7.165,25,CorVel,Worker's Compensation,25,100,,percent of total billed charges,,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Both,250 mL,mL,,25,21.25,7.165,25,First Health Group Corporation,First Health Network,24.25,97,,percent of total billed charges,,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Both,250 mL,mL,,25,21.25,7.165,25,"Health Partners, Inc.",Commercial,23.65,94.6,,percent of total billed charges,,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Outpatient,250 mL,mL,,25,21.25,7.165,25,"Health Partners, Inc.",Medicare Advantage,12.25,49,,percent of total billed charges,,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Inpatient,250 mL,mL,,25,21.25,7.165,25,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Both,250 mL,mL,,25,21.25,7.165,25,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),15,60,,percent of total billed charges,,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Both,250 mL,mL,,25,21.25,7.165,25,"Health Partners, Inc.",State of Minnesota Advantage Program,20.375,81.5,,percent of total billed charges,,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Both,250 mL,mL,,25,21.25,7.165,25,"Health Partners, Inc.",State Public Programs,12.5,50,,percent of total billed charges,,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Both,250 mL,mL,,25,21.25,7.165,25,Humana Insurance Company,Commercial PPO,23.75,95,,percent of total billed charges,,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Outpatient,250 mL,mL,,25,21.25,7.165,25,Humana Insurance Company,Medicare PPO,12.25,49,,percent of total billed charges,,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Inpatient,250 mL,mL,,25,21.25,7.165,25,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Both,250 mL,mL,,25,21.25,7.165,25,Medica,Individual & Family,24.775,99.1,,percent of total billed charges,,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Outpatient,250 mL,mL,,25,21.25,7.165,25,Medica,Medica Advantage Solution,12.45,49.8,,percent of total billed charges,,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Inpatient,250 mL,mL,,25,21.25,7.165,25,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Outpatient,250 mL,mL,,25,21.25,7.165,25,Medica,Medical Assistance,11.15,44.6,,percent of total billed charges,,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Inpatient,250 mL,mL,,25,21.25,7.165,25,Medica,Medical Assistance,,,,,Included in per diem rate,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Outpatient,250 mL,mL,,25,21.25,7.165,25,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,12.45,49.8,,percent of total billed charges,,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Inpatient,250 mL,mL,,25,21.25,7.165,25,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Both,250 mL,mL,,25,21.25,7.165,25,"Multiplan, Inc.","Multiplan, Inc.",23.5,94,,percent of total billed charges,,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Outpatient,250 mL,mL,,25,21.25,7.165,25,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,22.525,90.1,,percent of total billed charges,,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Inpatient,250 mL,mL,,25,21.25,7.165,25,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Both,250 mL,mL,,25,21.25,7.165,25,"Preferred One Administrative Services, INC.",PPO,24.65,98.6,,percent of total billed charges,,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Outpatient,250 mL,mL,,25,21.25,7.165,25,PrimeWest Health,Minnesota Senior Health Options (MSHO),12.8625,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Inpatient,250 mL,mL,,25,21.25,7.165,25,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Outpatient,250 mL,mL,,25,21.25,7.165,25,PrimeWest Health,MinnesotaCare,12.84,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Inpatient,250 mL,mL,,25,21.25,7.165,25,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Both,250 mL,mL,,25,21.25,7.165,25,Sanford Health Plan,Sanford Health Plan,23,92,,percent of total billed charges,,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Outpatient,250 mL,mL,,25,21.25,7.165,25,"UCare Health, Inc.",Individual & Family Plan,14.0875,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Inpatient,250 mL,mL,,25,21.25,7.165,25,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Outpatient,250 mL,mL,,25,21.25,7.165,25,"UCare Health, Inc.",Medical Assistance,12.6175,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Inpatient,250 mL,mL,,25,21.25,7.165,25,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Outpatient,250 mL,mL,,25,21.25,7.165,25,"UCare Health, Inc.",Medicare Advantage,12.6175,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Inpatient,250 mL,mL,,25,21.25,7.165,25,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Outpatient,250 mL,mL,,25,21.25,7.165,25,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),12.6175,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Inpatient,250 mL,mL,,25,21.25,7.165,25,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Both,250 mL,mL,,25,21.25,7.165,25,UnitedHealthcare,Individual & Family,23.5,94,,percent of total billed charges,,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Outpatient,250 mL,mL,,25,21.25,7.165,25,UnitedHealthcare,Medicare Advantage,12.25,49,,percent of total billed charges,,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Inpatient,250 mL,mL,,25,21.25,7.165,25,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Outpatient,250 mL,mL,,25,21.25,7.165,25,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,12,48,,percent of total billed charges,,100% of DHS outpatient percentage
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Inpatient,250 mL,mL,,25,21.25,7.165,25,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
SEVOFLURANE INHL LIQD,,11942,LOCAL,Facility,Both,250 mL,mL,,927,787.95,265.6782,927,Aetna,Commercial,852.84,92,,percent of total billed charges,,
SEVOFLURANE INHL LIQD,,11942,LOCAL,Facility,Outpatient,250 mL,mL,,927,787.95,265.6782,927,Aetna,Medicare Advantage,454.23,49,,percent of total billed charges,,
SEVOFLURANE INHL LIQD,,11942,LOCAL,Facility,Inpatient,250 mL,mL,,927,787.95,265.6782,927,Aetna,Medicare Advantage,,,,,Included in per diem rate,
SEVOFLURANE INHL LIQD,,11942,LOCAL,Facility,Both,250 mL,mL,,927,787.95,265.6782,927,Aetna,PPO,862.11,93,,percent of total billed charges,,
SEVOFLURANE INHL LIQD,,11942,LOCAL,Facility,Both,250 mL,mL,,927,787.95,265.6782,927,America's PPO,America's PPO,890.1981,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SEVOFLURANE INHL LIQD,,11942,LOCAL,Facility,Both,250 mL,mL,,927,787.95,265.6782,927,BlueCross BlueShield Minnesota, Federal Employee Program,912.168,98.4,,percent of total billed charges,,
SEVOFLURANE INHL LIQD,,11942,LOCAL,Facility,Both,250 mL,mL,,927,787.95,265.6782,927,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,927,100,,percent of total billed charges,,
SEVOFLURANE INHL LIQD,,11942,LOCAL,Facility,Both,250 mL,mL,,927,787.95,265.6782,927,BlueCross BlueShield Minnesota,High Value Network Plan,834.3,90,,percent of total billed charges,,
SEVOFLURANE INHL LIQD,,11942,LOCAL,Facility,Outpatient,250 mL,mL,,927,787.95,265.6782,927,BlueCross BlueShield Minnesota,Medicare Advantage,454.23,49,,percent of total billed charges,,
SEVOFLURANE INHL LIQD,,11942,LOCAL,Facility,Inpatient,250 mL,mL,,927,787.95,265.6782,927,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
SEVOFLURANE INHL LIQD,,11942,LOCAL,Facility,Both,250 mL,mL,,927,787.95,265.6782,927,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,821.0439,88.57,,percent of total billed charges,,
SEVOFLURANE INHL LIQD,,11942,LOCAL,Facility,Both,250 mL,mL,,927,787.95,265.6782,927,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,265.6782,28.66,,percent of total billed charges,,
SEVOFLURANE INHL LIQD,,11942,LOCAL,Facility,Outpatient,250 mL,mL,,927,787.95,265.6782,927,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),454.23,49,,percent of total billed charges,,
SEVOFLURANE INHL LIQD,,11942,LOCAL,Facility,Inpatient,250 mL,mL,,927,787.95,265.6782,927,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
SEVOFLURANE INHL LIQD,,11942,LOCAL,Facility,Both,250 mL,mL,,927,787.95,265.6782,927,CorVel,Worker's Compensation,927,100,,percent of total billed charges,,
SEVOFLURANE INHL LIQD,,11942,LOCAL,Facility,Both,250 mL,mL,,927,787.95,265.6782,927,First Health Group Corporation,First Health Network,899.19,97,,percent of total billed charges,,
SEVOFLURANE INHL LIQD,,11942,LOCAL,Facility,Both,250 mL,mL,,927,787.95,265.6782,927,"Health Partners, Inc.",Commercial,876.942,94.6,,percent of total billed charges,,
SEVOFLURANE INHL LIQD,,11942,LOCAL,Facility,Outpatient,250 mL,mL,,927,787.95,265.6782,927,"Health Partners, Inc.",Medicare Advantage,454.23,49,,percent of total billed charges,,
SEVOFLURANE INHL LIQD,,11942,LOCAL,Facility,Inpatient,250 mL,mL,,927,787.95,265.6782,927,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SEVOFLURANE INHL LIQD,,11942,LOCAL,Facility,Both,250 mL,mL,,927,787.95,265.6782,927,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),556.2,60,,percent of total billed charges,,
SEVOFLURANE INHL LIQD,,11942,LOCAL,Facility,Both,250 mL,mL,,927,787.95,265.6782,927,"Health Partners, Inc.",State of Minnesota Advantage Program,755.505,81.5,,percent of total billed charges,,
SEVOFLURANE INHL LIQD,,11942,LOCAL,Facility,Both,250 mL,mL,,927,787.95,265.6782,927,"Health Partners, Inc.",State Public Programs,463.5,50,,percent of total billed charges,,
SEVOFLURANE INHL LIQD,,11942,LOCAL,Facility,Both,250 mL,mL,,927,787.95,265.6782,927,Humana Insurance Company,Commercial PPO,880.65,95,,percent of total billed charges,,
SEVOFLURANE INHL LIQD,,11942,LOCAL,Facility,Outpatient,250 mL,mL,,927,787.95,265.6782,927,Humana Insurance Company,Medicare PPO,454.23,49,,percent of total billed charges,,
SEVOFLURANE INHL LIQD,,11942,LOCAL,Facility,Inpatient,250 mL,mL,,927,787.95,265.6782,927,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
SEVOFLURANE INHL LIQD,,11942,LOCAL,Facility,Both,250 mL,mL,,927,787.95,265.6782,927,Medica,Individual & Family,918.657,99.1,,percent of total billed charges,,
SEVOFLURANE INHL LIQD,,11942,LOCAL,Facility,Outpatient,250 mL,mL,,927,787.95,265.6782,927,Medica,Medica Advantage Solution,461.646,49.8,,percent of total billed charges,,
SEVOFLURANE INHL LIQD,,11942,LOCAL,Facility,Inpatient,250 mL,mL,,927,787.95,265.6782,927,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
SEVOFLURANE INHL LIQD,,11942,LOCAL,Facility,Outpatient,250 mL,mL,,927,787.95,265.6782,927,Medica,Medical Assistance,413.442,44.6,,percent of total billed charges,,
SEVOFLURANE INHL LIQD,,11942,LOCAL,Facility,Inpatient,250 mL,mL,,927,787.95,265.6782,927,Medica,Medical Assistance,,,,,Included in per diem rate,
SEVOFLURANE INHL LIQD,,11942,LOCAL,Facility,Outpatient,250 mL,mL,,927,787.95,265.6782,927,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,461.646,49.8,,percent of total billed charges,,
SEVOFLURANE INHL LIQD,,11942,LOCAL,Facility,Inpatient,250 mL,mL,,927,787.95,265.6782,927,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
SEVOFLURANE INHL LIQD,,11942,LOCAL,Facility,Both,250 mL,mL,,927,787.95,265.6782,927,"Multiplan, Inc.","Multiplan, Inc.",871.38,94,,percent of total billed charges,,
SEVOFLURANE INHL LIQD,,11942,LOCAL,Facility,Outpatient,250 mL,mL,,927,787.95,265.6782,927,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,835.227,90.1,,percent of total billed charges,,
SEVOFLURANE INHL LIQD,,11942,LOCAL,Facility,Inpatient,250 mL,mL,,927,787.95,265.6782,927,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
SEVOFLURANE INHL LIQD,,11942,LOCAL,Facility,Both,250 mL,mL,,927,787.95,265.6782,927,"Preferred One Administrative Services, INC.",PPO,914.022,98.6,,percent of total billed charges,,
SEVOFLURANE INHL LIQD,,11942,LOCAL,Facility,Outpatient,250 mL,mL,,927,787.95,265.6782,927,PrimeWest Health,Minnesota Senior Health Options (MSHO),476.9415,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
SEVOFLURANE INHL LIQD,,11942,LOCAL,Facility,Inpatient,250 mL,mL,,927,787.95,265.6782,927,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SEVOFLURANE INHL LIQD,,11942,LOCAL,Facility,Outpatient,250 mL,mL,,927,787.95,265.6782,927,PrimeWest Health,MinnesotaCare,476.1072,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
SEVOFLURANE INHL LIQD,,11942,LOCAL,Facility,Inpatient,250 mL,mL,,927,787.95,265.6782,927,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
SEVOFLURANE INHL LIQD,,11942,LOCAL,Facility,Both,250 mL,mL,,927,787.95,265.6782,927,Sanford Health Plan,Sanford Health Plan,852.84,92,,percent of total billed charges,,
SEVOFLURANE INHL LIQD,,11942,LOCAL,Facility,Outpatient,250 mL,mL,,927,787.95,265.6782,927,"UCare Health, Inc.",Individual & Family Plan,522.3645,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
SEVOFLURANE INHL LIQD,,11942,LOCAL,Facility,Inpatient,250 mL,mL,,927,787.95,265.6782,927,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
SEVOFLURANE INHL LIQD,,11942,LOCAL,Facility,Outpatient,250 mL,mL,,927,787.95,265.6782,927,"UCare Health, Inc.",Medical Assistance,467.8569,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SEVOFLURANE INHL LIQD,,11942,LOCAL,Facility,Inpatient,250 mL,mL,,927,787.95,265.6782,927,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
SEVOFLURANE INHL LIQD,,11942,LOCAL,Facility,Outpatient,250 mL,mL,,927,787.95,265.6782,927,"UCare Health, Inc.",Medicare Advantage,467.8569,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SEVOFLURANE INHL LIQD,,11942,LOCAL,Facility,Inpatient,250 mL,mL,,927,787.95,265.6782,927,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SEVOFLURANE INHL LIQD,,11942,LOCAL,Facility,Outpatient,250 mL,mL,,927,787.95,265.6782,927,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),467.8569,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SEVOFLURANE INHL LIQD,,11942,LOCAL,Facility,Inpatient,250 mL,mL,,927,787.95,265.6782,927,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SEVOFLURANE INHL LIQD,,11942,LOCAL,Facility,Both,250 mL,mL,,927,787.95,265.6782,927,UnitedHealthcare,Individual & Family,871.38,94,,percent of total billed charges,,
SEVOFLURANE INHL LIQD,,11942,LOCAL,Facility,Outpatient,250 mL,mL,,927,787.95,265.6782,927,UnitedHealthcare,Medicare Advantage,454.23,49,,percent of total billed charges,,
SEVOFLURANE INHL LIQD,,11942,LOCAL,Facility,Inpatient,250 mL,mL,,927,787.95,265.6782,927,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
SEVOFLURANE INHL LIQD,,11942,LOCAL,Facility,Outpatient,250 mL,mL,,927,787.95,265.6782,927,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,444.96,48,,percent of total billed charges,,100% of DHS outpatient percentage
SEVOFLURANE INHL LIQD,,11942,LOCAL,Facility,Inpatient,250 mL,mL,,927,787.95,265.6782,927,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"DOBUTAMINE IN D5W 1,000 MG/250 ML (4,000 MCG/ML) IV SOLP",,19951,LOCAL,Facility,Both,250 mL,mL,,158,134.3,45.2828,158,Aetna,Commercial,145.36,92,,percent of total billed charges,,
"DOBUTAMINE IN D5W 1,000 MG/250 ML (4,000 MCG/ML) IV SOLP",,19951,LOCAL,Facility,Outpatient,250 mL,mL,,158,134.3,45.2828,158,Aetna,Medicare Advantage,77.42,49,,percent of total billed charges,,
"DOBUTAMINE IN D5W 1,000 MG/250 ML (4,000 MCG/ML) IV SOLP",,19951,LOCAL,Facility,Inpatient,250 mL,mL,,158,134.3,45.2828,158,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"DOBUTAMINE IN D5W 1,000 MG/250 ML (4,000 MCG/ML) IV SOLP",,19951,LOCAL,Facility,Both,250 mL,mL,,158,134.3,45.2828,158,Aetna,PPO,146.94,93,,percent of total billed charges,,
"DOBUTAMINE IN D5W 1,000 MG/250 ML (4,000 MCG/ML) IV SOLP",,19951,LOCAL,Facility,Both,250 mL,mL,,158,134.3,45.2828,158,America's PPO,America's PPO,151.7274,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"DOBUTAMINE IN D5W 1,000 MG/250 ML (4,000 MCG/ML) IV SOLP",,19951,LOCAL,Facility,Both,250 mL,mL,,158,134.3,45.2828,158,BlueCross BlueShield Minnesota, Federal Employee Program,155.472,98.4,,percent of total billed charges,,
"DOBUTAMINE IN D5W 1,000 MG/250 ML (4,000 MCG/ML) IV SOLP",,19951,LOCAL,Facility,Both,250 mL,mL,,158,134.3,45.2828,158,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,158,100,,percent of total billed charges,,
"DOBUTAMINE IN D5W 1,000 MG/250 ML (4,000 MCG/ML) IV SOLP",,19951,LOCAL,Facility,Both,250 mL,mL,,158,134.3,45.2828,158,BlueCross BlueShield Minnesota,High Value Network Plan,142.2,90,,percent of total billed charges,,
"DOBUTAMINE IN D5W 1,000 MG/250 ML (4,000 MCG/ML) IV SOLP",,19951,LOCAL,Facility,Outpatient,250 mL,mL,,158,134.3,45.2828,158,BlueCross BlueShield Minnesota,Medicare Advantage,77.42,49,,percent of total billed charges,,
"DOBUTAMINE IN D5W 1,000 MG/250 ML (4,000 MCG/ML) IV SOLP",,19951,LOCAL,Facility,Inpatient,250 mL,mL,,158,134.3,45.2828,158,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"DOBUTAMINE IN D5W 1,000 MG/250 ML (4,000 MCG/ML) IV SOLP",,19951,LOCAL,Facility,Both,250 mL,mL,,158,134.3,45.2828,158,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,139.9406,88.57,,percent of total billed charges,,
"DOBUTAMINE IN D5W 1,000 MG/250 ML (4,000 MCG/ML) IV SOLP",,19951,LOCAL,Facility,Both,250 mL,mL,,158,134.3,45.2828,158,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,45.2828,28.66,,percent of total billed charges,,
"DOBUTAMINE IN D5W 1,000 MG/250 ML (4,000 MCG/ML) IV SOLP",,19951,LOCAL,Facility,Outpatient,250 mL,mL,,158,134.3,45.2828,158,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),77.42,49,,percent of total billed charges,,
"DOBUTAMINE IN D5W 1,000 MG/250 ML (4,000 MCG/ML) IV SOLP",,19951,LOCAL,Facility,Inpatient,250 mL,mL,,158,134.3,45.2828,158,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"DOBUTAMINE IN D5W 1,000 MG/250 ML (4,000 MCG/ML) IV SOLP",,19951,LOCAL,Facility,Both,250 mL,mL,,158,134.3,45.2828,158,CorVel,Worker's Compensation,158,100,,percent of total billed charges,,
"DOBUTAMINE IN D5W 1,000 MG/250 ML (4,000 MCG/ML) IV SOLP",,19951,LOCAL,Facility,Both,250 mL,mL,,158,134.3,45.2828,158,First Health Group Corporation,First Health Network,153.26,97,,percent of total billed charges,,
"DOBUTAMINE IN D5W 1,000 MG/250 ML (4,000 MCG/ML) IV SOLP",,19951,LOCAL,Facility,Both,250 mL,mL,,158,134.3,45.2828,158,"Health Partners, Inc.",Commercial,149.468,94.6,,percent of total billed charges,,
"DOBUTAMINE IN D5W 1,000 MG/250 ML (4,000 MCG/ML) IV SOLP",,19951,LOCAL,Facility,Outpatient,250 mL,mL,,158,134.3,45.2828,158,"Health Partners, Inc.",Medicare Advantage,77.42,49,,percent of total billed charges,,
"DOBUTAMINE IN D5W 1,000 MG/250 ML (4,000 MCG/ML) IV SOLP",,19951,LOCAL,Facility,Inpatient,250 mL,mL,,158,134.3,45.2828,158,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"DOBUTAMINE IN D5W 1,000 MG/250 ML (4,000 MCG/ML) IV SOLP",,19951,LOCAL,Facility,Both,250 mL,mL,,158,134.3,45.2828,158,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),94.8,60,,percent of total billed charges,,
"DOBUTAMINE IN D5W 1,000 MG/250 ML (4,000 MCG/ML) IV SOLP",,19951,LOCAL,Facility,Both,250 mL,mL,,158,134.3,45.2828,158,"Health Partners, Inc.",State of Minnesota Advantage Program,128.77,81.5,,percent of total billed charges,,
"DOBUTAMINE IN D5W 1,000 MG/250 ML (4,000 MCG/ML) IV SOLP",,19951,LOCAL,Facility,Both,250 mL,mL,,158,134.3,45.2828,158,"Health Partners, Inc.",State Public Programs,79,50,,percent of total billed charges,,
"DOBUTAMINE IN D5W 1,000 MG/250 ML (4,000 MCG/ML) IV SOLP",,19951,LOCAL,Facility,Both,250 mL,mL,,158,134.3,45.2828,158,Humana Insurance Company,Commercial PPO,150.1,95,,percent of total billed charges,,
"DOBUTAMINE IN D5W 1,000 MG/250 ML (4,000 MCG/ML) IV SOLP",,19951,LOCAL,Facility,Outpatient,250 mL,mL,,158,134.3,45.2828,158,Humana Insurance Company,Medicare PPO,77.42,49,,percent of total billed charges,,
"DOBUTAMINE IN D5W 1,000 MG/250 ML (4,000 MCG/ML) IV SOLP",,19951,LOCAL,Facility,Inpatient,250 mL,mL,,158,134.3,45.2828,158,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"DOBUTAMINE IN D5W 1,000 MG/250 ML (4,000 MCG/ML) IV SOLP",,19951,LOCAL,Facility,Both,250 mL,mL,,158,134.3,45.2828,158,Medica,Individual & Family,156.578,99.1,,percent of total billed charges,,
"DOBUTAMINE IN D5W 1,000 MG/250 ML (4,000 MCG/ML) IV SOLP",,19951,LOCAL,Facility,Outpatient,250 mL,mL,,158,134.3,45.2828,158,Medica,Medica Advantage Solution,78.684,49.8,,percent of total billed charges,,
"DOBUTAMINE IN D5W 1,000 MG/250 ML (4,000 MCG/ML) IV SOLP",,19951,LOCAL,Facility,Inpatient,250 mL,mL,,158,134.3,45.2828,158,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"DOBUTAMINE IN D5W 1,000 MG/250 ML (4,000 MCG/ML) IV SOLP",,19951,LOCAL,Facility,Outpatient,250 mL,mL,,158,134.3,45.2828,158,Medica,Medical Assistance,70.468,44.6,,percent of total billed charges,,
"DOBUTAMINE IN D5W 1,000 MG/250 ML (4,000 MCG/ML) IV SOLP",,19951,LOCAL,Facility,Inpatient,250 mL,mL,,158,134.3,45.2828,158,Medica,Medical Assistance,,,,,Included in per diem rate,
"DOBUTAMINE IN D5W 1,000 MG/250 ML (4,000 MCG/ML) IV SOLP",,19951,LOCAL,Facility,Outpatient,250 mL,mL,,158,134.3,45.2828,158,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,78.684,49.8,,percent of total billed charges,,
"DOBUTAMINE IN D5W 1,000 MG/250 ML (4,000 MCG/ML) IV SOLP",,19951,LOCAL,Facility,Inpatient,250 mL,mL,,158,134.3,45.2828,158,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"DOBUTAMINE IN D5W 1,000 MG/250 ML (4,000 MCG/ML) IV SOLP",,19951,LOCAL,Facility,Both,250 mL,mL,,158,134.3,45.2828,158,"Multiplan, Inc.","Multiplan, Inc.",148.52,94,,percent of total billed charges,,
"DOBUTAMINE IN D5W 1,000 MG/250 ML (4,000 MCG/ML) IV SOLP",,19951,LOCAL,Facility,Outpatient,250 mL,mL,,158,134.3,45.2828,158,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,142.358,90.1,,percent of total billed charges,,
"DOBUTAMINE IN D5W 1,000 MG/250 ML (4,000 MCG/ML) IV SOLP",,19951,LOCAL,Facility,Inpatient,250 mL,mL,,158,134.3,45.2828,158,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"DOBUTAMINE IN D5W 1,000 MG/250 ML (4,000 MCG/ML) IV SOLP",,19951,LOCAL,Facility,Both,250 mL,mL,,158,134.3,45.2828,158,"Preferred One Administrative Services, INC.",PPO,155.788,98.6,,percent of total billed charges,,
"DOBUTAMINE IN D5W 1,000 MG/250 ML (4,000 MCG/ML) IV SOLP",,19951,LOCAL,Facility,Outpatient,250 mL,mL,,158,134.3,45.2828,158,PrimeWest Health,Minnesota Senior Health Options (MSHO),81.291,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"DOBUTAMINE IN D5W 1,000 MG/250 ML (4,000 MCG/ML) IV SOLP",,19951,LOCAL,Facility,Inpatient,250 mL,mL,,158,134.3,45.2828,158,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"DOBUTAMINE IN D5W 1,000 MG/250 ML (4,000 MCG/ML) IV SOLP",,19951,LOCAL,Facility,Outpatient,250 mL,mL,,158,134.3,45.2828,158,PrimeWest Health,MinnesotaCare,81.1488,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"DOBUTAMINE IN D5W 1,000 MG/250 ML (4,000 MCG/ML) IV SOLP",,19951,LOCAL,Facility,Inpatient,250 mL,mL,,158,134.3,45.2828,158,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"DOBUTAMINE IN D5W 1,000 MG/250 ML (4,000 MCG/ML) IV SOLP",,19951,LOCAL,Facility,Both,250 mL,mL,,158,134.3,45.2828,158,Sanford Health Plan,Sanford Health Plan,145.36,92,,percent of total billed charges,,
"DOBUTAMINE IN D5W 1,000 MG/250 ML (4,000 MCG/ML) IV SOLP",,19951,LOCAL,Facility,Outpatient,250 mL,mL,,158,134.3,45.2828,158,"UCare Health, Inc.",Individual & Family Plan,89.033,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"DOBUTAMINE IN D5W 1,000 MG/250 ML (4,000 MCG/ML) IV SOLP",,19951,LOCAL,Facility,Inpatient,250 mL,mL,,158,134.3,45.2828,158,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"DOBUTAMINE IN D5W 1,000 MG/250 ML (4,000 MCG/ML) IV SOLP",,19951,LOCAL,Facility,Outpatient,250 mL,mL,,158,134.3,45.2828,158,"UCare Health, Inc.",Medical Assistance,79.7426,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"DOBUTAMINE IN D5W 1,000 MG/250 ML (4,000 MCG/ML) IV SOLP",,19951,LOCAL,Facility,Inpatient,250 mL,mL,,158,134.3,45.2828,158,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"DOBUTAMINE IN D5W 1,000 MG/250 ML (4,000 MCG/ML) IV SOLP",,19951,LOCAL,Facility,Outpatient,250 mL,mL,,158,134.3,45.2828,158,"UCare Health, Inc.",Medicare Advantage,79.7426,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"DOBUTAMINE IN D5W 1,000 MG/250 ML (4,000 MCG/ML) IV SOLP",,19951,LOCAL,Facility,Inpatient,250 mL,mL,,158,134.3,45.2828,158,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"DOBUTAMINE IN D5W 1,000 MG/250 ML (4,000 MCG/ML) IV SOLP",,19951,LOCAL,Facility,Outpatient,250 mL,mL,,158,134.3,45.2828,158,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),79.7426,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"DOBUTAMINE IN D5W 1,000 MG/250 ML (4,000 MCG/ML) IV SOLP",,19951,LOCAL,Facility,Inpatient,250 mL,mL,,158,134.3,45.2828,158,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"DOBUTAMINE IN D5W 1,000 MG/250 ML (4,000 MCG/ML) IV SOLP",,19951,LOCAL,Facility,Both,250 mL,mL,,158,134.3,45.2828,158,UnitedHealthcare,Individual & Family,148.52,94,,percent of total billed charges,,
"DOBUTAMINE IN D5W 1,000 MG/250 ML (4,000 MCG/ML) IV SOLP",,19951,LOCAL,Facility,Outpatient,250 mL,mL,,158,134.3,45.2828,158,UnitedHealthcare,Medicare Advantage,77.42,49,,percent of total billed charges,,
"DOBUTAMINE IN D5W 1,000 MG/250 ML (4,000 MCG/ML) IV SOLP",,19951,LOCAL,Facility,Inpatient,250 mL,mL,,158,134.3,45.2828,158,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"DOBUTAMINE IN D5W 1,000 MG/250 ML (4,000 MCG/ML) IV SOLP",,19951,LOCAL,Facility,Outpatient,250 mL,mL,,158,134.3,45.2828,158,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,75.84,48,,percent of total billed charges,,100% of DHS outpatient percentage
"DOBUTAMINE IN D5W 1,000 MG/250 ML (4,000 MCG/ML) IV SOLP",,19951,LOCAL,Facility,Inpatient,250 mL,mL,,158,134.3,45.2828,158,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
DOBUTAMINE IN D5W 250 MG/250 ML (1 MG/ML) IV SOLP,,J1250,HCPCS,Facility,Both,250 mL,mL,,53,45.05,15.1898,53,Aetna,Commercial,48.76,92,,percent of total billed charges,,
DOBUTAMINE IN D5W 250 MG/250 ML (1 MG/ML) IV SOLP,,J1250,HCPCS,Facility,Outpatient,250 mL,mL,,53,45.05,15.1898,53,Aetna,Medicare Advantage,25.97,49,,percent of total billed charges,,
DOBUTAMINE IN D5W 250 MG/250 ML (1 MG/ML) IV SOLP,,J1250,HCPCS,Facility,Inpatient,250 mL,mL,,53,45.05,15.1898,53,Aetna,Medicare Advantage,,,,,Included in per diem rate,
DOBUTAMINE IN D5W 250 MG/250 ML (1 MG/ML) IV SOLP,,J1250,HCPCS,Facility,Both,250 mL,mL,,53,45.05,15.1898,53,Aetna,PPO,49.29,93,,percent of total billed charges,,
DOBUTAMINE IN D5W 250 MG/250 ML (1 MG/ML) IV SOLP,,J1250,HCPCS,Facility,Both,250 mL,mL,,53,45.05,15.1898,53,America's PPO,America's PPO,50.8959,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
DOBUTAMINE IN D5W 250 MG/250 ML (1 MG/ML) IV SOLP,,J1250,HCPCS,Facility,Both,250 mL,mL,,53,45.05,15.1898,53,BlueCross BlueShield Minnesota, Federal Employee Program,52.152,98.4,,percent of total billed charges,,
DOBUTAMINE IN D5W 250 MG/250 ML (1 MG/ML) IV SOLP,,J1250,HCPCS,Facility,Both,250 mL,mL,,53,45.05,15.1898,53,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,53,100,,percent of total billed charges,,
DOBUTAMINE IN D5W 250 MG/250 ML (1 MG/ML) IV SOLP,,J1250,HCPCS,Facility,Both,250 mL,mL,,53,45.05,15.1898,53,BlueCross BlueShield Minnesota,High Value Network Plan,47.7,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
DOBUTAMINE IN D5W 250 MG/250 ML (1 MG/ML) IV SOLP,,J1250,HCPCS,Facility,Outpatient,250 mL,mL,,53,45.05,15.1898,53,BlueCross BlueShield Minnesota,Medicare Advantage,25.97,49,,percent of total billed charges,,
DOBUTAMINE IN D5W 250 MG/250 ML (1 MG/ML) IV SOLP,,J1250,HCPCS,Facility,Inpatient,250 mL,mL,,53,45.05,15.1898,53,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
DOBUTAMINE IN D5W 250 MG/250 ML (1 MG/ML) IV SOLP,,J1250,HCPCS,Facility,Both,250 mL,mL,,53,45.05,15.1898,53,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,46.9421,88.57,,percent of total billed charges,,
DOBUTAMINE IN D5W 250 MG/250 ML (1 MG/ML) IV SOLP,,J1250,HCPCS,Facility,Both,250 mL,mL,,53,45.05,15.1898,53,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,15.1898,28.66,,percent of total billed charges,,
DOBUTAMINE IN D5W 250 MG/250 ML (1 MG/ML) IV SOLP,,J1250,HCPCS,Facility,Outpatient,250 mL,mL,,53,45.05,15.1898,53,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),25.97,49,,percent of total billed charges,,
DOBUTAMINE IN D5W 250 MG/250 ML (1 MG/ML) IV SOLP,,J1250,HCPCS,Facility,Inpatient,250 mL,mL,,53,45.05,15.1898,53,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
DOBUTAMINE IN D5W 250 MG/250 ML (1 MG/ML) IV SOLP,,J1250,HCPCS,Facility,Both,250 mL,mL,,53,45.05,15.1898,53,CorVel,Worker's Compensation,53,100,,percent of total billed charges,,
DOBUTAMINE IN D5W 250 MG/250 ML (1 MG/ML) IV SOLP,,J1250,HCPCS,Facility,Both,250 mL,mL,,53,45.05,15.1898,53,First Health Group Corporation,First Health Network,51.41,97,,percent of total billed charges,,
DOBUTAMINE IN D5W 250 MG/250 ML (1 MG/ML) IV SOLP,,J1250,HCPCS,Facility,Both,250 mL,mL,,53,45.05,15.1898,53,"Health Partners, Inc.",Commercial,50.138,94.6,,percent of total billed charges,,
DOBUTAMINE IN D5W 250 MG/250 ML (1 MG/ML) IV SOLP,,J1250,HCPCS,Facility,Outpatient,250 mL,mL,,53,45.05,15.1898,53,"Health Partners, Inc.",Medicare Advantage,25.97,49,,percent of total billed charges,,
DOBUTAMINE IN D5W 250 MG/250 ML (1 MG/ML) IV SOLP,,J1250,HCPCS,Facility,Inpatient,250 mL,mL,,53,45.05,15.1898,53,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DOBUTAMINE IN D5W 250 MG/250 ML (1 MG/ML) IV SOLP,,J1250,HCPCS,Facility,Both,250 mL,mL,,53,45.05,15.1898,53,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),31.8,60,,percent of total billed charges,,
DOBUTAMINE IN D5W 250 MG/250 ML (1 MG/ML) IV SOLP,,J1250,HCPCS,Facility,Both,250 mL,mL,,53,45.05,15.1898,53,"Health Partners, Inc.",State of Minnesota Advantage Program,43.195,81.5,,percent of total billed charges,,
DOBUTAMINE IN D5W 250 MG/250 ML (1 MG/ML) IV SOLP,,J1250,HCPCS,Facility,Both,250 mL,mL,,53,45.05,15.1898,53,"Health Partners, Inc.",State Public Programs,26.5,50,,percent of total billed charges,,
DOBUTAMINE IN D5W 250 MG/250 ML (1 MG/ML) IV SOLP,,J1250,HCPCS,Facility,Both,250 mL,mL,,53,45.05,15.1898,53,Humana Insurance Company,Commercial PPO,50.35,95,,percent of total billed charges,,
DOBUTAMINE IN D5W 250 MG/250 ML (1 MG/ML) IV SOLP,,J1250,HCPCS,Facility,Outpatient,250 mL,mL,,53,45.05,15.1898,53,Humana Insurance Company,Medicare PPO,25.97,49,,percent of total billed charges,,
DOBUTAMINE IN D5W 250 MG/250 ML (1 MG/ML) IV SOLP,,J1250,HCPCS,Facility,Inpatient,250 mL,mL,,53,45.05,15.1898,53,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
DOBUTAMINE IN D5W 250 MG/250 ML (1 MG/ML) IV SOLP,,J1250,HCPCS,Facility,Both,250 mL,mL,,53,45.05,15.1898,53,Medica,Individual & Family,52.523,99.1,,percent of total billed charges,,
DOBUTAMINE IN D5W 250 MG/250 ML (1 MG/ML) IV SOLP,,J1250,HCPCS,Facility,Outpatient,250 mL,mL,,53,45.05,15.1898,53,Medica,Medica Advantage Solution,26.394,49.8,,percent of total billed charges,,
DOBUTAMINE IN D5W 250 MG/250 ML (1 MG/ML) IV SOLP,,J1250,HCPCS,Facility,Inpatient,250 mL,mL,,53,45.05,15.1898,53,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
DOBUTAMINE IN D5W 250 MG/250 ML (1 MG/ML) IV SOLP,,J1250,HCPCS,Facility,Outpatient,250 mL,mL,,53,45.05,15.1898,53,Medica,Medical Assistance,23.638,44.6,,percent of total billed charges,,
DOBUTAMINE IN D5W 250 MG/250 ML (1 MG/ML) IV SOLP,,J1250,HCPCS,Facility,Inpatient,250 mL,mL,,53,45.05,15.1898,53,Medica,Medical Assistance,,,,,Included in per diem rate,
DOBUTAMINE IN D5W 250 MG/250 ML (1 MG/ML) IV SOLP,,J1250,HCPCS,Facility,Outpatient,250 mL,mL,,53,45.05,15.1898,53,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,26.394,49.8,,percent of total billed charges,,
DOBUTAMINE IN D5W 250 MG/250 ML (1 MG/ML) IV SOLP,,J1250,HCPCS,Facility,Inpatient,250 mL,mL,,53,45.05,15.1898,53,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
DOBUTAMINE IN D5W 250 MG/250 ML (1 MG/ML) IV SOLP,,J1250,HCPCS,Facility,Both,250 mL,mL,,53,45.05,15.1898,53,"Multiplan, Inc.","Multiplan, Inc.",49.82,94,,percent of total billed charges,,
DOBUTAMINE IN D5W 250 MG/250 ML (1 MG/ML) IV SOLP,,J1250,HCPCS,Facility,Outpatient,250 mL,mL,,53,45.05,15.1898,53,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,47.753,90.1,,percent of total billed charges,,
DOBUTAMINE IN D5W 250 MG/250 ML (1 MG/ML) IV SOLP,,J1250,HCPCS,Facility,Inpatient,250 mL,mL,,53,45.05,15.1898,53,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
DOBUTAMINE IN D5W 250 MG/250 ML (1 MG/ML) IV SOLP,,J1250,HCPCS,Facility,Both,250 mL,mL,,53,45.05,15.1898,53,"Preferred One Administrative Services, INC.",PPO,52.258,98.6,,percent of total billed charges,,
DOBUTAMINE IN D5W 250 MG/250 ML (1 MG/ML) IV SOLP,,J1250,HCPCS,Facility,Outpatient,250 mL,mL,,53,45.05,15.1898,53,PrimeWest Health,Minnesota Senior Health Options (MSHO),27.2685,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
DOBUTAMINE IN D5W 250 MG/250 ML (1 MG/ML) IV SOLP,,J1250,HCPCS,Facility,Inpatient,250 mL,mL,,53,45.05,15.1898,53,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DOBUTAMINE IN D5W 250 MG/250 ML (1 MG/ML) IV SOLP,,J1250,HCPCS,Facility,Outpatient,250 mL,mL,,53,45.05,15.1898,53,PrimeWest Health,MinnesotaCare,27.2208,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
DOBUTAMINE IN D5W 250 MG/250 ML (1 MG/ML) IV SOLP,,J1250,HCPCS,Facility,Inpatient,250 mL,mL,,53,45.05,15.1898,53,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
DOBUTAMINE IN D5W 250 MG/250 ML (1 MG/ML) IV SOLP,,J1250,HCPCS,Facility,Both,250 mL,mL,,53,45.05,15.1898,53,Sanford Health Plan,Sanford Health Plan,48.76,92,,percent of total billed charges,,
DOBUTAMINE IN D5W 250 MG/250 ML (1 MG/ML) IV SOLP,,J1250,HCPCS,Facility,Outpatient,250 mL,mL,,53,45.05,15.1898,53,"UCare Health, Inc.",Individual & Family Plan,29.8655,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
DOBUTAMINE IN D5W 250 MG/250 ML (1 MG/ML) IV SOLP,,J1250,HCPCS,Facility,Inpatient,250 mL,mL,,53,45.05,15.1898,53,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
DOBUTAMINE IN D5W 250 MG/250 ML (1 MG/ML) IV SOLP,,J1250,HCPCS,Facility,Outpatient,250 mL,mL,,53,45.05,15.1898,53,"UCare Health, Inc.",Medical Assistance,26.7491,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DOBUTAMINE IN D5W 250 MG/250 ML (1 MG/ML) IV SOLP,,J1250,HCPCS,Facility,Inpatient,250 mL,mL,,53,45.05,15.1898,53,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
DOBUTAMINE IN D5W 250 MG/250 ML (1 MG/ML) IV SOLP,,J1250,HCPCS,Facility,Outpatient,250 mL,mL,,53,45.05,15.1898,53,"UCare Health, Inc.",Medicare Advantage,26.7491,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DOBUTAMINE IN D5W 250 MG/250 ML (1 MG/ML) IV SOLP,,J1250,HCPCS,Facility,Inpatient,250 mL,mL,,53,45.05,15.1898,53,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DOBUTAMINE IN D5W 250 MG/250 ML (1 MG/ML) IV SOLP,,J1250,HCPCS,Facility,Outpatient,250 mL,mL,,53,45.05,15.1898,53,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),26.7491,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DOBUTAMINE IN D5W 250 MG/250 ML (1 MG/ML) IV SOLP,,J1250,HCPCS,Facility,Inpatient,250 mL,mL,,53,45.05,15.1898,53,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DOBUTAMINE IN D5W 250 MG/250 ML (1 MG/ML) IV SOLP,,J1250,HCPCS,Facility,Both,250 mL,mL,,53,45.05,15.1898,53,UnitedHealthcare,Individual & Family,49.82,94,,percent of total billed charges,,
DOBUTAMINE IN D5W 250 MG/250 ML (1 MG/ML) IV SOLP,,J1250,HCPCS,Facility,Outpatient,250 mL,mL,,53,45.05,15.1898,53,UnitedHealthcare,Medicare Advantage,25.97,49,,percent of total billed charges,,
DOBUTAMINE IN D5W 250 MG/250 ML (1 MG/ML) IV SOLP,,J1250,HCPCS,Facility,Inpatient,250 mL,mL,,53,45.05,15.1898,53,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
DOBUTAMINE IN D5W 250 MG/250 ML (1 MG/ML) IV SOLP,,J1250,HCPCS,Facility,Outpatient,250 mL,mL,,53,45.05,15.1898,53,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,25.44,48,,percent of total billed charges,,100% of DHS outpatient percentage
DOBUTAMINE IN D5W 250 MG/250 ML (1 MG/ML) IV SOLP,,J1250,HCPCS,Facility,Inpatient,250 mL,mL,,53,45.05,15.1898,53,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"DOPAMINE IN 5 % DEXTROSE 400 MG/250 ML (1,600 MCG/ML) IV SOLN",,J1265,HCPCS,Facility,Both,250 mL,mL,,80,68,22.928,80,Aetna,Commercial,73.6,92,,percent of total billed charges,,
"DOPAMINE IN 5 % DEXTROSE 400 MG/250 ML (1,600 MCG/ML) IV SOLN",,J1265,HCPCS,Facility,Outpatient,250 mL,mL,,80,68,22.928,80,Aetna,Medicare Advantage,39.2,49,,percent of total billed charges,,
"DOPAMINE IN 5 % DEXTROSE 400 MG/250 ML (1,600 MCG/ML) IV SOLN",,J1265,HCPCS,Facility,Inpatient,250 mL,mL,,80,68,22.928,80,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"DOPAMINE IN 5 % DEXTROSE 400 MG/250 ML (1,600 MCG/ML) IV SOLN",,J1265,HCPCS,Facility,Both,250 mL,mL,,80,68,22.928,80,Aetna,PPO,74.4,93,,percent of total billed charges,,
"DOPAMINE IN 5 % DEXTROSE 400 MG/250 ML (1,600 MCG/ML) IV SOLN",,J1265,HCPCS,Facility,Both,250 mL,mL,,80,68,22.928,80,America's PPO,America's PPO,76.824,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"DOPAMINE IN 5 % DEXTROSE 400 MG/250 ML (1,600 MCG/ML) IV SOLN",,J1265,HCPCS,Facility,Both,250 mL,mL,,80,68,22.928,80,BlueCross BlueShield Minnesota, Federal Employee Program,78.72,98.4,,percent of total billed charges,,
"DOPAMINE IN 5 % DEXTROSE 400 MG/250 ML (1,600 MCG/ML) IV SOLN",,J1265,HCPCS,Facility,Both,250 mL,mL,,80,68,22.928,80,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,80,100,,percent of total billed charges,,
"DOPAMINE IN 5 % DEXTROSE 400 MG/250 ML (1,600 MCG/ML) IV SOLN",,J1265,HCPCS,Facility,Both,250 mL,mL,,80,68,22.928,80,BlueCross BlueShield Minnesota,High Value Network Plan,72,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
"DOPAMINE IN 5 % DEXTROSE 400 MG/250 ML (1,600 MCG/ML) IV SOLN",,J1265,HCPCS,Facility,Outpatient,250 mL,mL,,80,68,22.928,80,BlueCross BlueShield Minnesota,Medicare Advantage,39.2,49,,percent of total billed charges,,
"DOPAMINE IN 5 % DEXTROSE 400 MG/250 ML (1,600 MCG/ML) IV SOLN",,J1265,HCPCS,Facility,Inpatient,250 mL,mL,,80,68,22.928,80,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"DOPAMINE IN 5 % DEXTROSE 400 MG/250 ML (1,600 MCG/ML) IV SOLN",,J1265,HCPCS,Facility,Both,250 mL,mL,,80,68,22.928,80,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,70.856,88.57,,percent of total billed charges,,
"DOPAMINE IN 5 % DEXTROSE 400 MG/250 ML (1,600 MCG/ML) IV SOLN",,J1265,HCPCS,Facility,Both,250 mL,mL,,80,68,22.928,80,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,22.928,28.66,,percent of total billed charges,,
"DOPAMINE IN 5 % DEXTROSE 400 MG/250 ML (1,600 MCG/ML) IV SOLN",,J1265,HCPCS,Facility,Outpatient,250 mL,mL,,80,68,22.928,80,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),39.2,49,,percent of total billed charges,,
"DOPAMINE IN 5 % DEXTROSE 400 MG/250 ML (1,600 MCG/ML) IV SOLN",,J1265,HCPCS,Facility,Inpatient,250 mL,mL,,80,68,22.928,80,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"DOPAMINE IN 5 % DEXTROSE 400 MG/250 ML (1,600 MCG/ML) IV SOLN",,J1265,HCPCS,Facility,Both,250 mL,mL,,80,68,22.928,80,CorVel,Worker's Compensation,80,100,,percent of total billed charges,,
"DOPAMINE IN 5 % DEXTROSE 400 MG/250 ML (1,600 MCG/ML) IV SOLN",,J1265,HCPCS,Facility,Both,250 mL,mL,,80,68,22.928,80,First Health Group Corporation,First Health Network,77.6,97,,percent of total billed charges,,
"DOPAMINE IN 5 % DEXTROSE 400 MG/250 ML (1,600 MCG/ML) IV SOLN",,J1265,HCPCS,Facility,Both,250 mL,mL,,80,68,22.928,80,"Health Partners, Inc.",Commercial,75.68,94.6,,percent of total billed charges,,
"DOPAMINE IN 5 % DEXTROSE 400 MG/250 ML (1,600 MCG/ML) IV SOLN",,J1265,HCPCS,Facility,Outpatient,250 mL,mL,,80,68,22.928,80,"Health Partners, Inc.",Medicare Advantage,39.2,49,,percent of total billed charges,,
"DOPAMINE IN 5 % DEXTROSE 400 MG/250 ML (1,600 MCG/ML) IV SOLN",,J1265,HCPCS,Facility,Inpatient,250 mL,mL,,80,68,22.928,80,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"DOPAMINE IN 5 % DEXTROSE 400 MG/250 ML (1,600 MCG/ML) IV SOLN",,J1265,HCPCS,Facility,Both,250 mL,mL,,80,68,22.928,80,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),48,60,,percent of total billed charges,,
"DOPAMINE IN 5 % DEXTROSE 400 MG/250 ML (1,600 MCG/ML) IV SOLN",,J1265,HCPCS,Facility,Both,250 mL,mL,,80,68,22.928,80,"Health Partners, Inc.",State of Minnesota Advantage Program,65.2,81.5,,percent of total billed charges,,
"DOPAMINE IN 5 % DEXTROSE 400 MG/250 ML (1,600 MCG/ML) IV SOLN",,J1265,HCPCS,Facility,Both,250 mL,mL,,80,68,22.928,80,"Health Partners, Inc.",State Public Programs,40,50,,percent of total billed charges,,
"DOPAMINE IN 5 % DEXTROSE 400 MG/250 ML (1,600 MCG/ML) IV SOLN",,J1265,HCPCS,Facility,Both,250 mL,mL,,80,68,22.928,80,Humana Insurance Company,Commercial PPO,76,95,,percent of total billed charges,,
"DOPAMINE IN 5 % DEXTROSE 400 MG/250 ML (1,600 MCG/ML) IV SOLN",,J1265,HCPCS,Facility,Outpatient,250 mL,mL,,80,68,22.928,80,Humana Insurance Company,Medicare PPO,39.2,49,,percent of total billed charges,,
"DOPAMINE IN 5 % DEXTROSE 400 MG/250 ML (1,600 MCG/ML) IV SOLN",,J1265,HCPCS,Facility,Inpatient,250 mL,mL,,80,68,22.928,80,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"DOPAMINE IN 5 % DEXTROSE 400 MG/250 ML (1,600 MCG/ML) IV SOLN",,J1265,HCPCS,Facility,Both,250 mL,mL,,80,68,22.928,80,Medica,Individual & Family,79.28,99.1,,percent of total billed charges,,
"DOPAMINE IN 5 % DEXTROSE 400 MG/250 ML (1,600 MCG/ML) IV SOLN",,J1265,HCPCS,Facility,Outpatient,250 mL,mL,,80,68,22.928,80,Medica,Medica Advantage Solution,39.84,49.8,,percent of total billed charges,,
"DOPAMINE IN 5 % DEXTROSE 400 MG/250 ML (1,600 MCG/ML) IV SOLN",,J1265,HCPCS,Facility,Inpatient,250 mL,mL,,80,68,22.928,80,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"DOPAMINE IN 5 % DEXTROSE 400 MG/250 ML (1,600 MCG/ML) IV SOLN",,J1265,HCPCS,Facility,Outpatient,250 mL,mL,,80,68,22.928,80,Medica,Medical Assistance,35.68,44.6,,percent of total billed charges,,
"DOPAMINE IN 5 % DEXTROSE 400 MG/250 ML (1,600 MCG/ML) IV SOLN",,J1265,HCPCS,Facility,Inpatient,250 mL,mL,,80,68,22.928,80,Medica,Medical Assistance,,,,,Included in per diem rate,
"DOPAMINE IN 5 % DEXTROSE 400 MG/250 ML (1,600 MCG/ML) IV SOLN",,J1265,HCPCS,Facility,Outpatient,250 mL,mL,,80,68,22.928,80,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,39.84,49.8,,percent of total billed charges,,
"DOPAMINE IN 5 % DEXTROSE 400 MG/250 ML (1,600 MCG/ML) IV SOLN",,J1265,HCPCS,Facility,Inpatient,250 mL,mL,,80,68,22.928,80,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"DOPAMINE IN 5 % DEXTROSE 400 MG/250 ML (1,600 MCG/ML) IV SOLN",,J1265,HCPCS,Facility,Both,250 mL,mL,,80,68,22.928,80,"Multiplan, Inc.","Multiplan, Inc.",75.2,94,,percent of total billed charges,,
"DOPAMINE IN 5 % DEXTROSE 400 MG/250 ML (1,600 MCG/ML) IV SOLN",,J1265,HCPCS,Facility,Outpatient,250 mL,mL,,80,68,22.928,80,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,72.08,90.1,,percent of total billed charges,,
"DOPAMINE IN 5 % DEXTROSE 400 MG/250 ML (1,600 MCG/ML) IV SOLN",,J1265,HCPCS,Facility,Inpatient,250 mL,mL,,80,68,22.928,80,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"DOPAMINE IN 5 % DEXTROSE 400 MG/250 ML (1,600 MCG/ML) IV SOLN",,J1265,HCPCS,Facility,Both,250 mL,mL,,80,68,22.928,80,"Preferred One Administrative Services, INC.",PPO,78.88,98.6,,percent of total billed charges,,
"DOPAMINE IN 5 % DEXTROSE 400 MG/250 ML (1,600 MCG/ML) IV SOLN",,J1265,HCPCS,Facility,Outpatient,250 mL,mL,,80,68,22.928,80,PrimeWest Health,Minnesota Senior Health Options (MSHO),41.16,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"DOPAMINE IN 5 % DEXTROSE 400 MG/250 ML (1,600 MCG/ML) IV SOLN",,J1265,HCPCS,Facility,Inpatient,250 mL,mL,,80,68,22.928,80,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"DOPAMINE IN 5 % DEXTROSE 400 MG/250 ML (1,600 MCG/ML) IV SOLN",,J1265,HCPCS,Facility,Outpatient,250 mL,mL,,80,68,22.928,80,PrimeWest Health,MinnesotaCare,41.088,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"DOPAMINE IN 5 % DEXTROSE 400 MG/250 ML (1,600 MCG/ML) IV SOLN",,J1265,HCPCS,Facility,Inpatient,250 mL,mL,,80,68,22.928,80,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"DOPAMINE IN 5 % DEXTROSE 400 MG/250 ML (1,600 MCG/ML) IV SOLN",,J1265,HCPCS,Facility,Both,250 mL,mL,,80,68,22.928,80,Sanford Health Plan,Sanford Health Plan,73.6,92,,percent of total billed charges,,
"DOPAMINE IN 5 % DEXTROSE 400 MG/250 ML (1,600 MCG/ML) IV SOLN",,J1265,HCPCS,Facility,Outpatient,250 mL,mL,,80,68,22.928,80,"UCare Health, Inc.",Individual & Family Plan,45.08,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"DOPAMINE IN 5 % DEXTROSE 400 MG/250 ML (1,600 MCG/ML) IV SOLN",,J1265,HCPCS,Facility,Inpatient,250 mL,mL,,80,68,22.928,80,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"DOPAMINE IN 5 % DEXTROSE 400 MG/250 ML (1,600 MCG/ML) IV SOLN",,J1265,HCPCS,Facility,Outpatient,250 mL,mL,,80,68,22.928,80,"UCare Health, Inc.",Medical Assistance,40.376,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"DOPAMINE IN 5 % DEXTROSE 400 MG/250 ML (1,600 MCG/ML) IV SOLN",,J1265,HCPCS,Facility,Inpatient,250 mL,mL,,80,68,22.928,80,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"DOPAMINE IN 5 % DEXTROSE 400 MG/250 ML (1,600 MCG/ML) IV SOLN",,J1265,HCPCS,Facility,Outpatient,250 mL,mL,,80,68,22.928,80,"UCare Health, Inc.",Medicare Advantage,40.376,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"DOPAMINE IN 5 % DEXTROSE 400 MG/250 ML (1,600 MCG/ML) IV SOLN",,J1265,HCPCS,Facility,Inpatient,250 mL,mL,,80,68,22.928,80,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"DOPAMINE IN 5 % DEXTROSE 400 MG/250 ML (1,600 MCG/ML) IV SOLN",,J1265,HCPCS,Facility,Outpatient,250 mL,mL,,80,68,22.928,80,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),40.376,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"DOPAMINE IN 5 % DEXTROSE 400 MG/250 ML (1,600 MCG/ML) IV SOLN",,J1265,HCPCS,Facility,Inpatient,250 mL,mL,,80,68,22.928,80,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"DOPAMINE IN 5 % DEXTROSE 400 MG/250 ML (1,600 MCG/ML) IV SOLN",,J1265,HCPCS,Facility,Both,250 mL,mL,,80,68,22.928,80,UnitedHealthcare,Individual & Family,75.2,94,,percent of total billed charges,,
"DOPAMINE IN 5 % DEXTROSE 400 MG/250 ML (1,600 MCG/ML) IV SOLN",,J1265,HCPCS,Facility,Outpatient,250 mL,mL,,80,68,22.928,80,UnitedHealthcare,Medicare Advantage,39.2,49,,percent of total billed charges,,
"DOPAMINE IN 5 % DEXTROSE 400 MG/250 ML (1,600 MCG/ML) IV SOLN",,J1265,HCPCS,Facility,Inpatient,250 mL,mL,,80,68,22.928,80,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"DOPAMINE IN 5 % DEXTROSE 400 MG/250 ML (1,600 MCG/ML) IV SOLN",,J1265,HCPCS,Facility,Outpatient,250 mL,mL,,80,68,22.928,80,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,38.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
"DOPAMINE IN 5 % DEXTROSE 400 MG/250 ML (1,600 MCG/ML) IV SOLN",,J1265,HCPCS,Facility,Inpatient,250 mL,mL,,80,68,22.928,80,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"HEPARIN (PORCINE) IN 5 % DEX 25,000 UNIT/250 ML(100 UNIT/ML) IV SOLP",,J1644,HCPCS,Facility,Both,250 mL,mL,,89,75.65,25.5074,89,Aetna,Commercial,81.88,92,,percent of total billed charges,,
"HEPARIN (PORCINE) IN 5 % DEX 25,000 UNIT/250 ML(100 UNIT/ML) IV SOLP",,J1644,HCPCS,Facility,Outpatient,250 mL,mL,,89,75.65,25.5074,89,Aetna,Medicare Advantage,43.61,49,,percent of total billed charges,,
"HEPARIN (PORCINE) IN 5 % DEX 25,000 UNIT/250 ML(100 UNIT/ML) IV SOLP",,J1644,HCPCS,Facility,Inpatient,250 mL,mL,,89,75.65,25.5074,89,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"HEPARIN (PORCINE) IN 5 % DEX 25,000 UNIT/250 ML(100 UNIT/ML) IV SOLP",,J1644,HCPCS,Facility,Both,250 mL,mL,,89,75.65,25.5074,89,Aetna,PPO,82.77,93,,percent of total billed charges,,
"HEPARIN (PORCINE) IN 5 % DEX 25,000 UNIT/250 ML(100 UNIT/ML) IV SOLP",,J1644,HCPCS,Facility,Both,250 mL,mL,,89,75.65,25.5074,89,America's PPO,America's PPO,85.4667,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"HEPARIN (PORCINE) IN 5 % DEX 25,000 UNIT/250 ML(100 UNIT/ML) IV SOLP",,J1644,HCPCS,Facility,Both,250 mL,mL,,89,75.65,25.5074,89,BlueCross BlueShield Minnesota, Federal Employee Program,87.576,98.4,,percent of total billed charges,,
"HEPARIN (PORCINE) IN 5 % DEX 25,000 UNIT/250 ML(100 UNIT/ML) IV SOLP",,J1644,HCPCS,Facility,Both,250 mL,mL,,89,75.65,25.5074,89,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,89,100,,percent of total billed charges,,
"HEPARIN (PORCINE) IN 5 % DEX 25,000 UNIT/250 ML(100 UNIT/ML) IV SOLP",,J1644,HCPCS,Facility,Both,250 mL,mL,,89,75.65,25.5074,89,BlueCross BlueShield Minnesota,High Value Network Plan,80.1,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
"HEPARIN (PORCINE) IN 5 % DEX 25,000 UNIT/250 ML(100 UNIT/ML) IV SOLP",,J1644,HCPCS,Facility,Outpatient,250 mL,mL,,89,75.65,25.5074,89,BlueCross BlueShield Minnesota,Medicare Advantage,43.61,49,,percent of total billed charges,,
"HEPARIN (PORCINE) IN 5 % DEX 25,000 UNIT/250 ML(100 UNIT/ML) IV SOLP",,J1644,HCPCS,Facility,Inpatient,250 mL,mL,,89,75.65,25.5074,89,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"HEPARIN (PORCINE) IN 5 % DEX 25,000 UNIT/250 ML(100 UNIT/ML) IV SOLP",,J1644,HCPCS,Facility,Both,250 mL,mL,,89,75.65,25.5074,89,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,78.8273,88.57,,percent of total billed charges,,
"HEPARIN (PORCINE) IN 5 % DEX 25,000 UNIT/250 ML(100 UNIT/ML) IV SOLP",,J1644,HCPCS,Facility,Both,250 mL,mL,,89,75.65,25.5074,89,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,25.5074,28.66,,percent of total billed charges,,
"HEPARIN (PORCINE) IN 5 % DEX 25,000 UNIT/250 ML(100 UNIT/ML) IV SOLP",,J1644,HCPCS,Facility,Outpatient,250 mL,mL,,89,75.65,25.5074,89,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),43.61,49,,percent of total billed charges,,
"HEPARIN (PORCINE) IN 5 % DEX 25,000 UNIT/250 ML(100 UNIT/ML) IV SOLP",,J1644,HCPCS,Facility,Inpatient,250 mL,mL,,89,75.65,25.5074,89,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"HEPARIN (PORCINE) IN 5 % DEX 25,000 UNIT/250 ML(100 UNIT/ML) IV SOLP",,J1644,HCPCS,Facility,Both,250 mL,mL,,89,75.65,25.5074,89,CorVel,Worker's Compensation,89,100,,percent of total billed charges,,
"HEPARIN (PORCINE) IN 5 % DEX 25,000 UNIT/250 ML(100 UNIT/ML) IV SOLP",,J1644,HCPCS,Facility,Both,250 mL,mL,,89,75.65,25.5074,89,First Health Group Corporation,First Health Network,86.33,97,,percent of total billed charges,,
"HEPARIN (PORCINE) IN 5 % DEX 25,000 UNIT/250 ML(100 UNIT/ML) IV SOLP",,J1644,HCPCS,Facility,Both,250 mL,mL,,89,75.65,25.5074,89,"Health Partners, Inc.",Commercial,84.194,94.6,,percent of total billed charges,,
"HEPARIN (PORCINE) IN 5 % DEX 25,000 UNIT/250 ML(100 UNIT/ML) IV SOLP",,J1644,HCPCS,Facility,Outpatient,250 mL,mL,,89,75.65,25.5074,89,"Health Partners, Inc.",Medicare Advantage,43.61,49,,percent of total billed charges,,
"HEPARIN (PORCINE) IN 5 % DEX 25,000 UNIT/250 ML(100 UNIT/ML) IV SOLP",,J1644,HCPCS,Facility,Inpatient,250 mL,mL,,89,75.65,25.5074,89,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"HEPARIN (PORCINE) IN 5 % DEX 25,000 UNIT/250 ML(100 UNIT/ML) IV SOLP",,J1644,HCPCS,Facility,Both,250 mL,mL,,89,75.65,25.5074,89,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),53.4,60,,percent of total billed charges,,
"HEPARIN (PORCINE) IN 5 % DEX 25,000 UNIT/250 ML(100 UNIT/ML) IV SOLP",,J1644,HCPCS,Facility,Both,250 mL,mL,,89,75.65,25.5074,89,"Health Partners, Inc.",State of Minnesota Advantage Program,72.535,81.5,,percent of total billed charges,,
"HEPARIN (PORCINE) IN 5 % DEX 25,000 UNIT/250 ML(100 UNIT/ML) IV SOLP",,J1644,HCPCS,Facility,Both,250 mL,mL,,89,75.65,25.5074,89,"Health Partners, Inc.",State Public Programs,44.5,50,,percent of total billed charges,,
"HEPARIN (PORCINE) IN 5 % DEX 25,000 UNIT/250 ML(100 UNIT/ML) IV SOLP",,J1644,HCPCS,Facility,Both,250 mL,mL,,89,75.65,25.5074,89,Humana Insurance Company,Commercial PPO,84.55,95,,percent of total billed charges,,
"HEPARIN (PORCINE) IN 5 % DEX 25,000 UNIT/250 ML(100 UNIT/ML) IV SOLP",,J1644,HCPCS,Facility,Outpatient,250 mL,mL,,89,75.65,25.5074,89,Humana Insurance Company,Medicare PPO,43.61,49,,percent of total billed charges,,
"HEPARIN (PORCINE) IN 5 % DEX 25,000 UNIT/250 ML(100 UNIT/ML) IV SOLP",,J1644,HCPCS,Facility,Inpatient,250 mL,mL,,89,75.65,25.5074,89,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"HEPARIN (PORCINE) IN 5 % DEX 25,000 UNIT/250 ML(100 UNIT/ML) IV SOLP",,J1644,HCPCS,Facility,Both,250 mL,mL,,89,75.65,25.5074,89,Medica,Individual & Family,88.199,99.1,,percent of total billed charges,,
"HEPARIN (PORCINE) IN 5 % DEX 25,000 UNIT/250 ML(100 UNIT/ML) IV SOLP",,J1644,HCPCS,Facility,Outpatient,250 mL,mL,,89,75.65,25.5074,89,Medica,Medica Advantage Solution,44.322,49.8,,percent of total billed charges,,
"HEPARIN (PORCINE) IN 5 % DEX 25,000 UNIT/250 ML(100 UNIT/ML) IV SOLP",,J1644,HCPCS,Facility,Inpatient,250 mL,mL,,89,75.65,25.5074,89,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"HEPARIN (PORCINE) IN 5 % DEX 25,000 UNIT/250 ML(100 UNIT/ML) IV SOLP",,J1644,HCPCS,Facility,Outpatient,250 mL,mL,,89,75.65,25.5074,89,Medica,Medical Assistance,39.694,44.6,,percent of total billed charges,,
"HEPARIN (PORCINE) IN 5 % DEX 25,000 UNIT/250 ML(100 UNIT/ML) IV SOLP",,J1644,HCPCS,Facility,Inpatient,250 mL,mL,,89,75.65,25.5074,89,Medica,Medical Assistance,,,,,Included in per diem rate,
"HEPARIN (PORCINE) IN 5 % DEX 25,000 UNIT/250 ML(100 UNIT/ML) IV SOLP",,J1644,HCPCS,Facility,Outpatient,250 mL,mL,,89,75.65,25.5074,89,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,44.322,49.8,,percent of total billed charges,,
"HEPARIN (PORCINE) IN 5 % DEX 25,000 UNIT/250 ML(100 UNIT/ML) IV SOLP",,J1644,HCPCS,Facility,Inpatient,250 mL,mL,,89,75.65,25.5074,89,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"HEPARIN (PORCINE) IN 5 % DEX 25,000 UNIT/250 ML(100 UNIT/ML) IV SOLP",,J1644,HCPCS,Facility,Both,250 mL,mL,,89,75.65,25.5074,89,"Multiplan, Inc.","Multiplan, Inc.",83.66,94,,percent of total billed charges,,
"HEPARIN (PORCINE) IN 5 % DEX 25,000 UNIT/250 ML(100 UNIT/ML) IV SOLP",,J1644,HCPCS,Facility,Outpatient,250 mL,mL,,89,75.65,25.5074,89,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,80.189,90.1,,percent of total billed charges,,
"HEPARIN (PORCINE) IN 5 % DEX 25,000 UNIT/250 ML(100 UNIT/ML) IV SOLP",,J1644,HCPCS,Facility,Inpatient,250 mL,mL,,89,75.65,25.5074,89,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"HEPARIN (PORCINE) IN 5 % DEX 25,000 UNIT/250 ML(100 UNIT/ML) IV SOLP",,J1644,HCPCS,Facility,Both,250 mL,mL,,89,75.65,25.5074,89,"Preferred One Administrative Services, INC.",PPO,87.754,98.6,,percent of total billed charges,,
"HEPARIN (PORCINE) IN 5 % DEX 25,000 UNIT/250 ML(100 UNIT/ML) IV SOLP",,J1644,HCPCS,Facility,Outpatient,250 mL,mL,,89,75.65,25.5074,89,PrimeWest Health,Minnesota Senior Health Options (MSHO),45.7905,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"HEPARIN (PORCINE) IN 5 % DEX 25,000 UNIT/250 ML(100 UNIT/ML) IV SOLP",,J1644,HCPCS,Facility,Inpatient,250 mL,mL,,89,75.65,25.5074,89,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"HEPARIN (PORCINE) IN 5 % DEX 25,000 UNIT/250 ML(100 UNIT/ML) IV SOLP",,J1644,HCPCS,Facility,Outpatient,250 mL,mL,,89,75.65,25.5074,89,PrimeWest Health,MinnesotaCare,45.7104,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"HEPARIN (PORCINE) IN 5 % DEX 25,000 UNIT/250 ML(100 UNIT/ML) IV SOLP",,J1644,HCPCS,Facility,Inpatient,250 mL,mL,,89,75.65,25.5074,89,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"HEPARIN (PORCINE) IN 5 % DEX 25,000 UNIT/250 ML(100 UNIT/ML) IV SOLP",,J1644,HCPCS,Facility,Both,250 mL,mL,,89,75.65,25.5074,89,Sanford Health Plan,Sanford Health Plan,81.88,92,,percent of total billed charges,,
"HEPARIN (PORCINE) IN 5 % DEX 25,000 UNIT/250 ML(100 UNIT/ML) IV SOLP",,J1644,HCPCS,Facility,Outpatient,250 mL,mL,,89,75.65,25.5074,89,"UCare Health, Inc.",Individual & Family Plan,50.1515,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"HEPARIN (PORCINE) IN 5 % DEX 25,000 UNIT/250 ML(100 UNIT/ML) IV SOLP",,J1644,HCPCS,Facility,Inpatient,250 mL,mL,,89,75.65,25.5074,89,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"HEPARIN (PORCINE) IN 5 % DEX 25,000 UNIT/250 ML(100 UNIT/ML) IV SOLP",,J1644,HCPCS,Facility,Outpatient,250 mL,mL,,89,75.65,25.5074,89,"UCare Health, Inc.",Medical Assistance,44.9183,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"HEPARIN (PORCINE) IN 5 % DEX 25,000 UNIT/250 ML(100 UNIT/ML) IV SOLP",,J1644,HCPCS,Facility,Inpatient,250 mL,mL,,89,75.65,25.5074,89,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"HEPARIN (PORCINE) IN 5 % DEX 25,000 UNIT/250 ML(100 UNIT/ML) IV SOLP",,J1644,HCPCS,Facility,Outpatient,250 mL,mL,,89,75.65,25.5074,89,"UCare Health, Inc.",Medicare Advantage,44.9183,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"HEPARIN (PORCINE) IN 5 % DEX 25,000 UNIT/250 ML(100 UNIT/ML) IV SOLP",,J1644,HCPCS,Facility,Inpatient,250 mL,mL,,89,75.65,25.5074,89,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"HEPARIN (PORCINE) IN 5 % DEX 25,000 UNIT/250 ML(100 UNIT/ML) IV SOLP",,J1644,HCPCS,Facility,Outpatient,250 mL,mL,,89,75.65,25.5074,89,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),44.9183,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"HEPARIN (PORCINE) IN 5 % DEX 25,000 UNIT/250 ML(100 UNIT/ML) IV SOLP",,J1644,HCPCS,Facility,Inpatient,250 mL,mL,,89,75.65,25.5074,89,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"HEPARIN (PORCINE) IN 5 % DEX 25,000 UNIT/250 ML(100 UNIT/ML) IV SOLP",,J1644,HCPCS,Facility,Both,250 mL,mL,,89,75.65,25.5074,89,UnitedHealthcare,Individual & Family,83.66,94,,percent of total billed charges,,
"HEPARIN (PORCINE) IN 5 % DEX 25,000 UNIT/250 ML(100 UNIT/ML) IV SOLP",,J1644,HCPCS,Facility,Outpatient,250 mL,mL,,89,75.65,25.5074,89,UnitedHealthcare,Medicare Advantage,43.61,49,,percent of total billed charges,,
"HEPARIN (PORCINE) IN 5 % DEX 25,000 UNIT/250 ML(100 UNIT/ML) IV SOLP",,J1644,HCPCS,Facility,Inpatient,250 mL,mL,,89,75.65,25.5074,89,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"HEPARIN (PORCINE) IN 5 % DEX 25,000 UNIT/250 ML(100 UNIT/ML) IV SOLP",,J1644,HCPCS,Facility,Outpatient,250 mL,mL,,89,75.65,25.5074,89,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,42.72,48,,percent of total billed charges,,100% of DHS outpatient percentage
"HEPARIN (PORCINE) IN 5 % DEX 25,000 UNIT/250 ML(100 UNIT/ML) IV SOLP",,J1644,HCPCS,Facility,Inpatient,250 mL,mL,,89,75.65,25.5074,89,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
LIDOCAINE IN 5 % DEXTROSE (PF) 8 MG/ML (0.8 %) IV SOLP,,J2001,HCPCS,Facility,Both,250 mL,mL,,47,39.95,13.4702,47,Aetna,Commercial,43.24,92,,percent of total billed charges,,
LIDOCAINE IN 5 % DEXTROSE (PF) 8 MG/ML (0.8 %) IV SOLP,,J2001,HCPCS,Facility,Outpatient,250 mL,mL,,47,39.95,13.4702,47,Aetna,Medicare Advantage,23.03,49,,percent of total billed charges,,
LIDOCAINE IN 5 % DEXTROSE (PF) 8 MG/ML (0.8 %) IV SOLP,,J2001,HCPCS,Facility,Inpatient,250 mL,mL,,47,39.95,13.4702,47,Aetna,Medicare Advantage,,,,,Included in per diem rate,
LIDOCAINE IN 5 % DEXTROSE (PF) 8 MG/ML (0.8 %) IV SOLP,,J2001,HCPCS,Facility,Both,250 mL,mL,,47,39.95,13.4702,47,Aetna,PPO,43.71,93,,percent of total billed charges,,
LIDOCAINE IN 5 % DEXTROSE (PF) 8 MG/ML (0.8 %) IV SOLP,,J2001,HCPCS,Facility,Both,250 mL,mL,,47,39.95,13.4702,47,America's PPO,America's PPO,45.1341,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
LIDOCAINE IN 5 % DEXTROSE (PF) 8 MG/ML (0.8 %) IV SOLP,,J2001,HCPCS,Facility,Both,250 mL,mL,,47,39.95,13.4702,47,BlueCross BlueShield Minnesota, Federal Employee Program,46.248,98.4,,percent of total billed charges,,
LIDOCAINE IN 5 % DEXTROSE (PF) 8 MG/ML (0.8 %) IV SOLP,,J2001,HCPCS,Facility,Both,250 mL,mL,,47,39.95,13.4702,47,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,47,100,,percent of total billed charges,,
LIDOCAINE IN 5 % DEXTROSE (PF) 8 MG/ML (0.8 %) IV SOLP,,J2001,HCPCS,Facility,Both,250 mL,mL,,47,39.95,13.4702,47,BlueCross BlueShield Minnesota,High Value Network Plan,42.3,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
LIDOCAINE IN 5 % DEXTROSE (PF) 8 MG/ML (0.8 %) IV SOLP,,J2001,HCPCS,Facility,Outpatient,250 mL,mL,,47,39.95,13.4702,47,BlueCross BlueShield Minnesota,Medicare Advantage,23.03,49,,percent of total billed charges,,
LIDOCAINE IN 5 % DEXTROSE (PF) 8 MG/ML (0.8 %) IV SOLP,,J2001,HCPCS,Facility,Inpatient,250 mL,mL,,47,39.95,13.4702,47,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
LIDOCAINE IN 5 % DEXTROSE (PF) 8 MG/ML (0.8 %) IV SOLP,,J2001,HCPCS,Facility,Both,250 mL,mL,,47,39.95,13.4702,47,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,41.6279,88.57,,percent of total billed charges,,
LIDOCAINE IN 5 % DEXTROSE (PF) 8 MG/ML (0.8 %) IV SOLP,,J2001,HCPCS,Facility,Both,250 mL,mL,,47,39.95,13.4702,47,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,13.4702,28.66,,percent of total billed charges,,
LIDOCAINE IN 5 % DEXTROSE (PF) 8 MG/ML (0.8 %) IV SOLP,,J2001,HCPCS,Facility,Outpatient,250 mL,mL,,47,39.95,13.4702,47,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),23.03,49,,percent of total billed charges,,
LIDOCAINE IN 5 % DEXTROSE (PF) 8 MG/ML (0.8 %) IV SOLP,,J2001,HCPCS,Facility,Inpatient,250 mL,mL,,47,39.95,13.4702,47,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
LIDOCAINE IN 5 % DEXTROSE (PF) 8 MG/ML (0.8 %) IV SOLP,,J2001,HCPCS,Facility,Both,250 mL,mL,,47,39.95,13.4702,47,CorVel,Worker's Compensation,47,100,,percent of total billed charges,,
LIDOCAINE IN 5 % DEXTROSE (PF) 8 MG/ML (0.8 %) IV SOLP,,J2001,HCPCS,Facility,Both,250 mL,mL,,47,39.95,13.4702,47,First Health Group Corporation,First Health Network,45.59,97,,percent of total billed charges,,
LIDOCAINE IN 5 % DEXTROSE (PF) 8 MG/ML (0.8 %) IV SOLP,,J2001,HCPCS,Facility,Both,250 mL,mL,,47,39.95,13.4702,47,"Health Partners, Inc.",Commercial,44.462,94.6,,percent of total billed charges,,
LIDOCAINE IN 5 % DEXTROSE (PF) 8 MG/ML (0.8 %) IV SOLP,,J2001,HCPCS,Facility,Outpatient,250 mL,mL,,47,39.95,13.4702,47,"Health Partners, Inc.",Medicare Advantage,23.03,49,,percent of total billed charges,,
LIDOCAINE IN 5 % DEXTROSE (PF) 8 MG/ML (0.8 %) IV SOLP,,J2001,HCPCS,Facility,Inpatient,250 mL,mL,,47,39.95,13.4702,47,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LIDOCAINE IN 5 % DEXTROSE (PF) 8 MG/ML (0.8 %) IV SOLP,,J2001,HCPCS,Facility,Both,250 mL,mL,,47,39.95,13.4702,47,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),28.2,60,,percent of total billed charges,,
LIDOCAINE IN 5 % DEXTROSE (PF) 8 MG/ML (0.8 %) IV SOLP,,J2001,HCPCS,Facility,Both,250 mL,mL,,47,39.95,13.4702,47,"Health Partners, Inc.",State of Minnesota Advantage Program,38.305,81.5,,percent of total billed charges,,
LIDOCAINE IN 5 % DEXTROSE (PF) 8 MG/ML (0.8 %) IV SOLP,,J2001,HCPCS,Facility,Both,250 mL,mL,,47,39.95,13.4702,47,"Health Partners, Inc.",State Public Programs,23.5,50,,percent of total billed charges,,
LIDOCAINE IN 5 % DEXTROSE (PF) 8 MG/ML (0.8 %) IV SOLP,,J2001,HCPCS,Facility,Both,250 mL,mL,,47,39.95,13.4702,47,Humana Insurance Company,Commercial PPO,44.65,95,,percent of total billed charges,,
LIDOCAINE IN 5 % DEXTROSE (PF) 8 MG/ML (0.8 %) IV SOLP,,J2001,HCPCS,Facility,Outpatient,250 mL,mL,,47,39.95,13.4702,47,Humana Insurance Company,Medicare PPO,23.03,49,,percent of total billed charges,,
LIDOCAINE IN 5 % DEXTROSE (PF) 8 MG/ML (0.8 %) IV SOLP,,J2001,HCPCS,Facility,Inpatient,250 mL,mL,,47,39.95,13.4702,47,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
LIDOCAINE IN 5 % DEXTROSE (PF) 8 MG/ML (0.8 %) IV SOLP,,J2001,HCPCS,Facility,Both,250 mL,mL,,47,39.95,13.4702,47,Medica,Individual & Family,46.577,99.1,,percent of total billed charges,,
LIDOCAINE IN 5 % DEXTROSE (PF) 8 MG/ML (0.8 %) IV SOLP,,J2001,HCPCS,Facility,Outpatient,250 mL,mL,,47,39.95,13.4702,47,Medica,Medica Advantage Solution,23.406,49.8,,percent of total billed charges,,
LIDOCAINE IN 5 % DEXTROSE (PF) 8 MG/ML (0.8 %) IV SOLP,,J2001,HCPCS,Facility,Inpatient,250 mL,mL,,47,39.95,13.4702,47,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
LIDOCAINE IN 5 % DEXTROSE (PF) 8 MG/ML (0.8 %) IV SOLP,,J2001,HCPCS,Facility,Outpatient,250 mL,mL,,47,39.95,13.4702,47,Medica,Medical Assistance,20.962,44.6,,percent of total billed charges,,
LIDOCAINE IN 5 % DEXTROSE (PF) 8 MG/ML (0.8 %) IV SOLP,,J2001,HCPCS,Facility,Inpatient,250 mL,mL,,47,39.95,13.4702,47,Medica,Medical Assistance,,,,,Included in per diem rate,
LIDOCAINE IN 5 % DEXTROSE (PF) 8 MG/ML (0.8 %) IV SOLP,,J2001,HCPCS,Facility,Outpatient,250 mL,mL,,47,39.95,13.4702,47,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,23.406,49.8,,percent of total billed charges,,
LIDOCAINE IN 5 % DEXTROSE (PF) 8 MG/ML (0.8 %) IV SOLP,,J2001,HCPCS,Facility,Inpatient,250 mL,mL,,47,39.95,13.4702,47,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
LIDOCAINE IN 5 % DEXTROSE (PF) 8 MG/ML (0.8 %) IV SOLP,,J2001,HCPCS,Facility,Both,250 mL,mL,,47,39.95,13.4702,47,"Multiplan, Inc.","Multiplan, Inc.",44.18,94,,percent of total billed charges,,
LIDOCAINE IN 5 % DEXTROSE (PF) 8 MG/ML (0.8 %) IV SOLP,,J2001,HCPCS,Facility,Outpatient,250 mL,mL,,47,39.95,13.4702,47,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,42.347,90.1,,percent of total billed charges,,
LIDOCAINE IN 5 % DEXTROSE (PF) 8 MG/ML (0.8 %) IV SOLP,,J2001,HCPCS,Facility,Inpatient,250 mL,mL,,47,39.95,13.4702,47,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
LIDOCAINE IN 5 % DEXTROSE (PF) 8 MG/ML (0.8 %) IV SOLP,,J2001,HCPCS,Facility,Both,250 mL,mL,,47,39.95,13.4702,47,"Preferred One Administrative Services, INC.",PPO,46.342,98.6,,percent of total billed charges,,
LIDOCAINE IN 5 % DEXTROSE (PF) 8 MG/ML (0.8 %) IV SOLP,,J2001,HCPCS,Facility,Outpatient,250 mL,mL,,47,39.95,13.4702,47,PrimeWest Health,Minnesota Senior Health Options (MSHO),24.1815,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
LIDOCAINE IN 5 % DEXTROSE (PF) 8 MG/ML (0.8 %) IV SOLP,,J2001,HCPCS,Facility,Inpatient,250 mL,mL,,47,39.95,13.4702,47,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LIDOCAINE IN 5 % DEXTROSE (PF) 8 MG/ML (0.8 %) IV SOLP,,J2001,HCPCS,Facility,Outpatient,250 mL,mL,,47,39.95,13.4702,47,PrimeWest Health,MinnesotaCare,24.1392,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
LIDOCAINE IN 5 % DEXTROSE (PF) 8 MG/ML (0.8 %) IV SOLP,,J2001,HCPCS,Facility,Inpatient,250 mL,mL,,47,39.95,13.4702,47,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
LIDOCAINE IN 5 % DEXTROSE (PF) 8 MG/ML (0.8 %) IV SOLP,,J2001,HCPCS,Facility,Both,250 mL,mL,,47,39.95,13.4702,47,Sanford Health Plan,Sanford Health Plan,43.24,92,,percent of total billed charges,,
LIDOCAINE IN 5 % DEXTROSE (PF) 8 MG/ML (0.8 %) IV SOLP,,J2001,HCPCS,Facility,Outpatient,250 mL,mL,,47,39.95,13.4702,47,"UCare Health, Inc.",Individual & Family Plan,26.4845,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
LIDOCAINE IN 5 % DEXTROSE (PF) 8 MG/ML (0.8 %) IV SOLP,,J2001,HCPCS,Facility,Inpatient,250 mL,mL,,47,39.95,13.4702,47,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
LIDOCAINE IN 5 % DEXTROSE (PF) 8 MG/ML (0.8 %) IV SOLP,,J2001,HCPCS,Facility,Outpatient,250 mL,mL,,47,39.95,13.4702,47,"UCare Health, Inc.",Medical Assistance,23.7209,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LIDOCAINE IN 5 % DEXTROSE (PF) 8 MG/ML (0.8 %) IV SOLP,,J2001,HCPCS,Facility,Inpatient,250 mL,mL,,47,39.95,13.4702,47,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
LIDOCAINE IN 5 % DEXTROSE (PF) 8 MG/ML (0.8 %) IV SOLP,,J2001,HCPCS,Facility,Outpatient,250 mL,mL,,47,39.95,13.4702,47,"UCare Health, Inc.",Medicare Advantage,23.7209,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LIDOCAINE IN 5 % DEXTROSE (PF) 8 MG/ML (0.8 %) IV SOLP,,J2001,HCPCS,Facility,Inpatient,250 mL,mL,,47,39.95,13.4702,47,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LIDOCAINE IN 5 % DEXTROSE (PF) 8 MG/ML (0.8 %) IV SOLP,,J2001,HCPCS,Facility,Outpatient,250 mL,mL,,47,39.95,13.4702,47,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),23.7209,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LIDOCAINE IN 5 % DEXTROSE (PF) 8 MG/ML (0.8 %) IV SOLP,,J2001,HCPCS,Facility,Inpatient,250 mL,mL,,47,39.95,13.4702,47,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LIDOCAINE IN 5 % DEXTROSE (PF) 8 MG/ML (0.8 %) IV SOLP,,J2001,HCPCS,Facility,Both,250 mL,mL,,47,39.95,13.4702,47,UnitedHealthcare,Individual & Family,44.18,94,,percent of total billed charges,,
LIDOCAINE IN 5 % DEXTROSE (PF) 8 MG/ML (0.8 %) IV SOLP,,J2001,HCPCS,Facility,Outpatient,250 mL,mL,,47,39.95,13.4702,47,UnitedHealthcare,Medicare Advantage,23.03,49,,percent of total billed charges,,
LIDOCAINE IN 5 % DEXTROSE (PF) 8 MG/ML (0.8 %) IV SOLP,,J2001,HCPCS,Facility,Inpatient,250 mL,mL,,47,39.95,13.4702,47,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
LIDOCAINE IN 5 % DEXTROSE (PF) 8 MG/ML (0.8 %) IV SOLP,,J2001,HCPCS,Facility,Outpatient,250 mL,mL,,47,39.95,13.4702,47,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,22.56,48,,percent of total billed charges,,100% of DHS outpatient percentage
LIDOCAINE IN 5 % DEXTROSE (PF) 8 MG/ML (0.8 %) IV SOLP,,J2001,HCPCS,Facility,Inpatient,250 mL,mL,,47,39.95,13.4702,47,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
NITROGLYCERIN IN 5 % DEXTROSE 25 MG/250 ML (100 MCG/ML) IV SOLN,,J2305,HCPCS,Facility,Both,250 mL,mL,,111,94.35,31.8126,111,Aetna,Commercial,102.12,92,,percent of total billed charges,,
NITROGLYCERIN IN 5 % DEXTROSE 25 MG/250 ML (100 MCG/ML) IV SOLN,,J2305,HCPCS,Facility,Outpatient,250 mL,mL,,111,94.35,31.8126,111,Aetna,Medicare Advantage,54.39,49,,percent of total billed charges,,
NITROGLYCERIN IN 5 % DEXTROSE 25 MG/250 ML (100 MCG/ML) IV SOLN,,J2305,HCPCS,Facility,Inpatient,250 mL,mL,,111,94.35,31.8126,111,Aetna,Medicare Advantage,,,,,Included in per diem rate,
NITROGLYCERIN IN 5 % DEXTROSE 25 MG/250 ML (100 MCG/ML) IV SOLN,,J2305,HCPCS,Facility,Both,250 mL,mL,,111,94.35,31.8126,111,Aetna,PPO,103.23,93,,percent of total billed charges,,
NITROGLYCERIN IN 5 % DEXTROSE 25 MG/250 ML (100 MCG/ML) IV SOLN,,J2305,HCPCS,Facility,Both,250 mL,mL,,111,94.35,31.8126,111,America's PPO,America's PPO,106.5933,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
NITROGLYCERIN IN 5 % DEXTROSE 25 MG/250 ML (100 MCG/ML) IV SOLN,,J2305,HCPCS,Facility,Both,250 mL,mL,,111,94.35,31.8126,111,BlueCross BlueShield Minnesota, Federal Employee Program,109.224,98.4,,percent of total billed charges,,
NITROGLYCERIN IN 5 % DEXTROSE 25 MG/250 ML (100 MCG/ML) IV SOLN,,J2305,HCPCS,Facility,Both,250 mL,mL,,111,94.35,31.8126,111,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,111,100,,percent of total billed charges,,
NITROGLYCERIN IN 5 % DEXTROSE 25 MG/250 ML (100 MCG/ML) IV SOLN,,J2305,HCPCS,Facility,Both,250 mL,mL,,111,94.35,31.8126,111,BlueCross BlueShield Minnesota,High Value Network Plan,99.9,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
NITROGLYCERIN IN 5 % DEXTROSE 25 MG/250 ML (100 MCG/ML) IV SOLN,,J2305,HCPCS,Facility,Outpatient,250 mL,mL,,111,94.35,31.8126,111,BlueCross BlueShield Minnesota,Medicare Advantage,54.39,49,,percent of total billed charges,,
NITROGLYCERIN IN 5 % DEXTROSE 25 MG/250 ML (100 MCG/ML) IV SOLN,,J2305,HCPCS,Facility,Inpatient,250 mL,mL,,111,94.35,31.8126,111,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
NITROGLYCERIN IN 5 % DEXTROSE 25 MG/250 ML (100 MCG/ML) IV SOLN,,J2305,HCPCS,Facility,Both,250 mL,mL,,111,94.35,31.8126,111,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,98.3127,88.57,,percent of total billed charges,,
NITROGLYCERIN IN 5 % DEXTROSE 25 MG/250 ML (100 MCG/ML) IV SOLN,,J2305,HCPCS,Facility,Both,250 mL,mL,,111,94.35,31.8126,111,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,31.8126,28.66,,percent of total billed charges,,
NITROGLYCERIN IN 5 % DEXTROSE 25 MG/250 ML (100 MCG/ML) IV SOLN,,J2305,HCPCS,Facility,Outpatient,250 mL,mL,,111,94.35,31.8126,111,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),54.39,49,,percent of total billed charges,,
NITROGLYCERIN IN 5 % DEXTROSE 25 MG/250 ML (100 MCG/ML) IV SOLN,,J2305,HCPCS,Facility,Inpatient,250 mL,mL,,111,94.35,31.8126,111,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
NITROGLYCERIN IN 5 % DEXTROSE 25 MG/250 ML (100 MCG/ML) IV SOLN,,J2305,HCPCS,Facility,Both,250 mL,mL,,111,94.35,31.8126,111,CorVel,Worker's Compensation,111,100,,percent of total billed charges,,
NITROGLYCERIN IN 5 % DEXTROSE 25 MG/250 ML (100 MCG/ML) IV SOLN,,J2305,HCPCS,Facility,Both,250 mL,mL,,111,94.35,31.8126,111,First Health Group Corporation,First Health Network,107.67,97,,percent of total billed charges,,
NITROGLYCERIN IN 5 % DEXTROSE 25 MG/250 ML (100 MCG/ML) IV SOLN,,J2305,HCPCS,Facility,Both,250 mL,mL,,111,94.35,31.8126,111,"Health Partners, Inc.",Commercial,105.006,94.6,,percent of total billed charges,,
NITROGLYCERIN IN 5 % DEXTROSE 25 MG/250 ML (100 MCG/ML) IV SOLN,,J2305,HCPCS,Facility,Outpatient,250 mL,mL,,111,94.35,31.8126,111,"Health Partners, Inc.",Medicare Advantage,54.39,49,,percent of total billed charges,,
NITROGLYCERIN IN 5 % DEXTROSE 25 MG/250 ML (100 MCG/ML) IV SOLN,,J2305,HCPCS,Facility,Inpatient,250 mL,mL,,111,94.35,31.8126,111,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
NITROGLYCERIN IN 5 % DEXTROSE 25 MG/250 ML (100 MCG/ML) IV SOLN,,J2305,HCPCS,Facility,Both,250 mL,mL,,111,94.35,31.8126,111,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),66.6,60,,percent of total billed charges,,
NITROGLYCERIN IN 5 % DEXTROSE 25 MG/250 ML (100 MCG/ML) IV SOLN,,J2305,HCPCS,Facility,Both,250 mL,mL,,111,94.35,31.8126,111,"Health Partners, Inc.",State of Minnesota Advantage Program,90.465,81.5,,percent of total billed charges,,
NITROGLYCERIN IN 5 % DEXTROSE 25 MG/250 ML (100 MCG/ML) IV SOLN,,J2305,HCPCS,Facility,Both,250 mL,mL,,111,94.35,31.8126,111,"Health Partners, Inc.",State Public Programs,55.5,50,,percent of total billed charges,,
NITROGLYCERIN IN 5 % DEXTROSE 25 MG/250 ML (100 MCG/ML) IV SOLN,,J2305,HCPCS,Facility,Both,250 mL,mL,,111,94.35,31.8126,111,Humana Insurance Company,Commercial PPO,105.45,95,,percent of total billed charges,,
NITROGLYCERIN IN 5 % DEXTROSE 25 MG/250 ML (100 MCG/ML) IV SOLN,,J2305,HCPCS,Facility,Outpatient,250 mL,mL,,111,94.35,31.8126,111,Humana Insurance Company,Medicare PPO,54.39,49,,percent of total billed charges,,
NITROGLYCERIN IN 5 % DEXTROSE 25 MG/250 ML (100 MCG/ML) IV SOLN,,J2305,HCPCS,Facility,Inpatient,250 mL,mL,,111,94.35,31.8126,111,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
NITROGLYCERIN IN 5 % DEXTROSE 25 MG/250 ML (100 MCG/ML) IV SOLN,,J2305,HCPCS,Facility,Both,250 mL,mL,,111,94.35,31.8126,111,Medica,Individual & Family,110.001,99.1,,percent of total billed charges,,
NITROGLYCERIN IN 5 % DEXTROSE 25 MG/250 ML (100 MCG/ML) IV SOLN,,J2305,HCPCS,Facility,Outpatient,250 mL,mL,,111,94.35,31.8126,111,Medica,Medica Advantage Solution,55.278,49.8,,percent of total billed charges,,
NITROGLYCERIN IN 5 % DEXTROSE 25 MG/250 ML (100 MCG/ML) IV SOLN,,J2305,HCPCS,Facility,Inpatient,250 mL,mL,,111,94.35,31.8126,111,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
NITROGLYCERIN IN 5 % DEXTROSE 25 MG/250 ML (100 MCG/ML) IV SOLN,,J2305,HCPCS,Facility,Outpatient,250 mL,mL,,111,94.35,31.8126,111,Medica,Medical Assistance,49.506,44.6,,percent of total billed charges,,
NITROGLYCERIN IN 5 % DEXTROSE 25 MG/250 ML (100 MCG/ML) IV SOLN,,J2305,HCPCS,Facility,Inpatient,250 mL,mL,,111,94.35,31.8126,111,Medica,Medical Assistance,,,,,Included in per diem rate,
NITROGLYCERIN IN 5 % DEXTROSE 25 MG/250 ML (100 MCG/ML) IV SOLN,,J2305,HCPCS,Facility,Outpatient,250 mL,mL,,111,94.35,31.8126,111,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,55.278,49.8,,percent of total billed charges,,
NITROGLYCERIN IN 5 % DEXTROSE 25 MG/250 ML (100 MCG/ML) IV SOLN,,J2305,HCPCS,Facility,Inpatient,250 mL,mL,,111,94.35,31.8126,111,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
NITROGLYCERIN IN 5 % DEXTROSE 25 MG/250 ML (100 MCG/ML) IV SOLN,,J2305,HCPCS,Facility,Both,250 mL,mL,,111,94.35,31.8126,111,"Multiplan, Inc.","Multiplan, Inc.",104.34,94,,percent of total billed charges,,
NITROGLYCERIN IN 5 % DEXTROSE 25 MG/250 ML (100 MCG/ML) IV SOLN,,J2305,HCPCS,Facility,Outpatient,250 mL,mL,,111,94.35,31.8126,111,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,100.011,90.1,,percent of total billed charges,,
NITROGLYCERIN IN 5 % DEXTROSE 25 MG/250 ML (100 MCG/ML) IV SOLN,,J2305,HCPCS,Facility,Inpatient,250 mL,mL,,111,94.35,31.8126,111,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
NITROGLYCERIN IN 5 % DEXTROSE 25 MG/250 ML (100 MCG/ML) IV SOLN,,J2305,HCPCS,Facility,Both,250 mL,mL,,111,94.35,31.8126,111,"Preferred One Administrative Services, INC.",PPO,109.446,98.6,,percent of total billed charges,,
NITROGLYCERIN IN 5 % DEXTROSE 25 MG/250 ML (100 MCG/ML) IV SOLN,,J2305,HCPCS,Facility,Outpatient,250 mL,mL,,111,94.35,31.8126,111,PrimeWest Health,Minnesota Senior Health Options (MSHO),57.1095,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
NITROGLYCERIN IN 5 % DEXTROSE 25 MG/250 ML (100 MCG/ML) IV SOLN,,J2305,HCPCS,Facility,Inpatient,250 mL,mL,,111,94.35,31.8126,111,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
NITROGLYCERIN IN 5 % DEXTROSE 25 MG/250 ML (100 MCG/ML) IV SOLN,,J2305,HCPCS,Facility,Outpatient,250 mL,mL,,111,94.35,31.8126,111,PrimeWest Health,MinnesotaCare,57.0096,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
NITROGLYCERIN IN 5 % DEXTROSE 25 MG/250 ML (100 MCG/ML) IV SOLN,,J2305,HCPCS,Facility,Inpatient,250 mL,mL,,111,94.35,31.8126,111,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
NITROGLYCERIN IN 5 % DEXTROSE 25 MG/250 ML (100 MCG/ML) IV SOLN,,J2305,HCPCS,Facility,Both,250 mL,mL,,111,94.35,31.8126,111,Sanford Health Plan,Sanford Health Plan,102.12,92,,percent of total billed charges,,
NITROGLYCERIN IN 5 % DEXTROSE 25 MG/250 ML (100 MCG/ML) IV SOLN,,J2305,HCPCS,Facility,Outpatient,250 mL,mL,,111,94.35,31.8126,111,"UCare Health, Inc.",Individual & Family Plan,62.5485,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
NITROGLYCERIN IN 5 % DEXTROSE 25 MG/250 ML (100 MCG/ML) IV SOLN,,J2305,HCPCS,Facility,Inpatient,250 mL,mL,,111,94.35,31.8126,111,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
NITROGLYCERIN IN 5 % DEXTROSE 25 MG/250 ML (100 MCG/ML) IV SOLN,,J2305,HCPCS,Facility,Outpatient,250 mL,mL,,111,94.35,31.8126,111,"UCare Health, Inc.",Medical Assistance,56.0217,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
NITROGLYCERIN IN 5 % DEXTROSE 25 MG/250 ML (100 MCG/ML) IV SOLN,,J2305,HCPCS,Facility,Inpatient,250 mL,mL,,111,94.35,31.8126,111,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
NITROGLYCERIN IN 5 % DEXTROSE 25 MG/250 ML (100 MCG/ML) IV SOLN,,J2305,HCPCS,Facility,Outpatient,250 mL,mL,,111,94.35,31.8126,111,"UCare Health, Inc.",Medicare Advantage,56.0217,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
NITROGLYCERIN IN 5 % DEXTROSE 25 MG/250 ML (100 MCG/ML) IV SOLN,,J2305,HCPCS,Facility,Inpatient,250 mL,mL,,111,94.35,31.8126,111,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
NITROGLYCERIN IN 5 % DEXTROSE 25 MG/250 ML (100 MCG/ML) IV SOLN,,J2305,HCPCS,Facility,Outpatient,250 mL,mL,,111,94.35,31.8126,111,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),56.0217,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
NITROGLYCERIN IN 5 % DEXTROSE 25 MG/250 ML (100 MCG/ML) IV SOLN,,J2305,HCPCS,Facility,Inpatient,250 mL,mL,,111,94.35,31.8126,111,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
NITROGLYCERIN IN 5 % DEXTROSE 25 MG/250 ML (100 MCG/ML) IV SOLN,,J2305,HCPCS,Facility,Both,250 mL,mL,,111,94.35,31.8126,111,UnitedHealthcare,Individual & Family,104.34,94,,percent of total billed charges,,
NITROGLYCERIN IN 5 % DEXTROSE 25 MG/250 ML (100 MCG/ML) IV SOLN,,J2305,HCPCS,Facility,Outpatient,250 mL,mL,,111,94.35,31.8126,111,UnitedHealthcare,Medicare Advantage,54.39,49,,percent of total billed charges,,
NITROGLYCERIN IN 5 % DEXTROSE 25 MG/250 ML (100 MCG/ML) IV SOLN,,J2305,HCPCS,Facility,Inpatient,250 mL,mL,,111,94.35,31.8126,111,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
NITROGLYCERIN IN 5 % DEXTROSE 25 MG/250 ML (100 MCG/ML) IV SOLN,,J2305,HCPCS,Facility,Outpatient,250 mL,mL,,111,94.35,31.8126,111,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,53.28,48,,percent of total billed charges,,100% of DHS outpatient percentage
NITROGLYCERIN IN 5 % DEXTROSE 25 MG/250 ML (100 MCG/ML) IV SOLN,,J2305,HCPCS,Facility,Inpatient,250 mL,mL,,111,94.35,31.8126,111,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
TIROFIBAN-0.9% SODIUM CHLORIDE 12.5 MG/250 ML (50 MCG/ML) IV SOLN,,J3246,HCPCS,Facility,Both,250 mL,mL,,1119,951.15,320.7054,1119,Aetna,Commercial,1029.48,92,,percent of total billed charges,,
TIROFIBAN-0.9% SODIUM CHLORIDE 12.5 MG/250 ML (50 MCG/ML) IV SOLN,,J3246,HCPCS,Facility,Outpatient,250 mL,mL,,1119,951.15,320.7054,1119,Aetna,Medicare Advantage,548.31,49,,percent of total billed charges,,
TIROFIBAN-0.9% SODIUM CHLORIDE 12.5 MG/250 ML (50 MCG/ML) IV SOLN,,J3246,HCPCS,Facility,Inpatient,250 mL,mL,,1119,951.15,320.7054,1119,Aetna,Medicare Advantage,,,,,Included in per diem rate,
TIROFIBAN-0.9% SODIUM CHLORIDE 12.5 MG/250 ML (50 MCG/ML) IV SOLN,,J3246,HCPCS,Facility,Both,250 mL,mL,,1119,951.15,320.7054,1119,Aetna,PPO,1040.67,93,,percent of total billed charges,,
TIROFIBAN-0.9% SODIUM CHLORIDE 12.5 MG/250 ML (50 MCG/ML) IV SOLN,,J3246,HCPCS,Facility,Both,250 mL,mL,,1119,951.15,320.7054,1119,America's PPO,America's PPO,1074.5757,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
TIROFIBAN-0.9% SODIUM CHLORIDE 12.5 MG/250 ML (50 MCG/ML) IV SOLN,,J3246,HCPCS,Facility,Both,250 mL,mL,,1119,951.15,320.7054,1119,BlueCross BlueShield Minnesota, Federal Employee Program,1101.096,98.4,,percent of total billed charges,,
TIROFIBAN-0.9% SODIUM CHLORIDE 12.5 MG/250 ML (50 MCG/ML) IV SOLN,,J3246,HCPCS,Facility,Both,250 mL,mL,,1119,951.15,320.7054,1119,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1119,100,,percent of total billed charges,,
TIROFIBAN-0.9% SODIUM CHLORIDE 12.5 MG/250 ML (50 MCG/ML) IV SOLN,,J3246,HCPCS,Facility,Both,250 mL,mL,,1119,951.15,320.7054,1119,BlueCross BlueShield Minnesota,High Value Network Plan,1007.1,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
TIROFIBAN-0.9% SODIUM CHLORIDE 12.5 MG/250 ML (50 MCG/ML) IV SOLN,,J3246,HCPCS,Facility,Outpatient,250 mL,mL,,1119,951.15,320.7054,1119,BlueCross BlueShield Minnesota,Medicare Advantage,548.31,49,,percent of total billed charges,,
TIROFIBAN-0.9% SODIUM CHLORIDE 12.5 MG/250 ML (50 MCG/ML) IV SOLN,,J3246,HCPCS,Facility,Inpatient,250 mL,mL,,1119,951.15,320.7054,1119,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
TIROFIBAN-0.9% SODIUM CHLORIDE 12.5 MG/250 ML (50 MCG/ML) IV SOLN,,J3246,HCPCS,Facility,Both,250 mL,mL,,1119,951.15,320.7054,1119,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,991.0983,88.57,,percent of total billed charges,,
TIROFIBAN-0.9% SODIUM CHLORIDE 12.5 MG/250 ML (50 MCG/ML) IV SOLN,,J3246,HCPCS,Facility,Both,250 mL,mL,,1119,951.15,320.7054,1119,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,320.7054,28.66,,percent of total billed charges,,
TIROFIBAN-0.9% SODIUM CHLORIDE 12.5 MG/250 ML (50 MCG/ML) IV SOLN,,J3246,HCPCS,Facility,Outpatient,250 mL,mL,,1119,951.15,320.7054,1119,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),548.31,49,,percent of total billed charges,,
TIROFIBAN-0.9% SODIUM CHLORIDE 12.5 MG/250 ML (50 MCG/ML) IV SOLN,,J3246,HCPCS,Facility,Inpatient,250 mL,mL,,1119,951.15,320.7054,1119,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
TIROFIBAN-0.9% SODIUM CHLORIDE 12.5 MG/250 ML (50 MCG/ML) IV SOLN,,J3246,HCPCS,Facility,Both,250 mL,mL,,1119,951.15,320.7054,1119,CorVel,Worker's Compensation,1119,100,,percent of total billed charges,,
TIROFIBAN-0.9% SODIUM CHLORIDE 12.5 MG/250 ML (50 MCG/ML) IV SOLN,,J3246,HCPCS,Facility,Both,250 mL,mL,,1119,951.15,320.7054,1119,First Health Group Corporation,First Health Network,1085.43,97,,percent of total billed charges,,
TIROFIBAN-0.9% SODIUM CHLORIDE 12.5 MG/250 ML (50 MCG/ML) IV SOLN,,J3246,HCPCS,Facility,Both,250 mL,mL,,1119,951.15,320.7054,1119,"Health Partners, Inc.",Commercial,1058.574,94.6,,percent of total billed charges,,
TIROFIBAN-0.9% SODIUM CHLORIDE 12.5 MG/250 ML (50 MCG/ML) IV SOLN,,J3246,HCPCS,Facility,Outpatient,250 mL,mL,,1119,951.15,320.7054,1119,"Health Partners, Inc.",Medicare Advantage,548.31,49,,percent of total billed charges,,
TIROFIBAN-0.9% SODIUM CHLORIDE 12.5 MG/250 ML (50 MCG/ML) IV SOLN,,J3246,HCPCS,Facility,Inpatient,250 mL,mL,,1119,951.15,320.7054,1119,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
TIROFIBAN-0.9% SODIUM CHLORIDE 12.5 MG/250 ML (50 MCG/ML) IV SOLN,,J3246,HCPCS,Facility,Both,250 mL,mL,,1119,951.15,320.7054,1119,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),671.4,60,,percent of total billed charges,,
TIROFIBAN-0.9% SODIUM CHLORIDE 12.5 MG/250 ML (50 MCG/ML) IV SOLN,,J3246,HCPCS,Facility,Both,250 mL,mL,,1119,951.15,320.7054,1119,"Health Partners, Inc.",State of Minnesota Advantage Program,911.985,81.5,,percent of total billed charges,,
TIROFIBAN-0.9% SODIUM CHLORIDE 12.5 MG/250 ML (50 MCG/ML) IV SOLN,,J3246,HCPCS,Facility,Both,250 mL,mL,,1119,951.15,320.7054,1119,"Health Partners, Inc.",State Public Programs,559.5,50,,percent of total billed charges,,
TIROFIBAN-0.9% SODIUM CHLORIDE 12.5 MG/250 ML (50 MCG/ML) IV SOLN,,J3246,HCPCS,Facility,Both,250 mL,mL,,1119,951.15,320.7054,1119,Humana Insurance Company,Commercial PPO,1063.05,95,,percent of total billed charges,,
TIROFIBAN-0.9% SODIUM CHLORIDE 12.5 MG/250 ML (50 MCG/ML) IV SOLN,,J3246,HCPCS,Facility,Outpatient,250 mL,mL,,1119,951.15,320.7054,1119,Humana Insurance Company,Medicare PPO,548.31,49,,percent of total billed charges,,
TIROFIBAN-0.9% SODIUM CHLORIDE 12.5 MG/250 ML (50 MCG/ML) IV SOLN,,J3246,HCPCS,Facility,Inpatient,250 mL,mL,,1119,951.15,320.7054,1119,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
TIROFIBAN-0.9% SODIUM CHLORIDE 12.5 MG/250 ML (50 MCG/ML) IV SOLN,,J3246,HCPCS,Facility,Both,250 mL,mL,,1119,951.15,320.7054,1119,Medica,Individual & Family,1108.929,99.1,,percent of total billed charges,,
TIROFIBAN-0.9% SODIUM CHLORIDE 12.5 MG/250 ML (50 MCG/ML) IV SOLN,,J3246,HCPCS,Facility,Outpatient,250 mL,mL,,1119,951.15,320.7054,1119,Medica,Medica Advantage Solution,557.262,49.8,,percent of total billed charges,,
TIROFIBAN-0.9% SODIUM CHLORIDE 12.5 MG/250 ML (50 MCG/ML) IV SOLN,,J3246,HCPCS,Facility,Inpatient,250 mL,mL,,1119,951.15,320.7054,1119,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
TIROFIBAN-0.9% SODIUM CHLORIDE 12.5 MG/250 ML (50 MCG/ML) IV SOLN,,J3246,HCPCS,Facility,Outpatient,250 mL,mL,,1119,951.15,320.7054,1119,Medica,Medical Assistance,499.074,44.6,,percent of total billed charges,,
TIROFIBAN-0.9% SODIUM CHLORIDE 12.5 MG/250 ML (50 MCG/ML) IV SOLN,,J3246,HCPCS,Facility,Inpatient,250 mL,mL,,1119,951.15,320.7054,1119,Medica,Medical Assistance,,,,,Included in per diem rate,
TIROFIBAN-0.9% SODIUM CHLORIDE 12.5 MG/250 ML (50 MCG/ML) IV SOLN,,J3246,HCPCS,Facility,Outpatient,250 mL,mL,,1119,951.15,320.7054,1119,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,557.262,49.8,,percent of total billed charges,,
TIROFIBAN-0.9% SODIUM CHLORIDE 12.5 MG/250 ML (50 MCG/ML) IV SOLN,,J3246,HCPCS,Facility,Inpatient,250 mL,mL,,1119,951.15,320.7054,1119,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
TIROFIBAN-0.9% SODIUM CHLORIDE 12.5 MG/250 ML (50 MCG/ML) IV SOLN,,J3246,HCPCS,Facility,Both,250 mL,mL,,1119,951.15,320.7054,1119,"Multiplan, Inc.","Multiplan, Inc.",1051.86,94,,percent of total billed charges,,
TIROFIBAN-0.9% SODIUM CHLORIDE 12.5 MG/250 ML (50 MCG/ML) IV SOLN,,J3246,HCPCS,Facility,Outpatient,250 mL,mL,,1119,951.15,320.7054,1119,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1008.219,90.1,,percent of total billed charges,,
TIROFIBAN-0.9% SODIUM CHLORIDE 12.5 MG/250 ML (50 MCG/ML) IV SOLN,,J3246,HCPCS,Facility,Inpatient,250 mL,mL,,1119,951.15,320.7054,1119,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
TIROFIBAN-0.9% SODIUM CHLORIDE 12.5 MG/250 ML (50 MCG/ML) IV SOLN,,J3246,HCPCS,Facility,Both,250 mL,mL,,1119,951.15,320.7054,1119,"Preferred One Administrative Services, INC.",PPO,1103.334,98.6,,percent of total billed charges,,
TIROFIBAN-0.9% SODIUM CHLORIDE 12.5 MG/250 ML (50 MCG/ML) IV SOLN,,J3246,HCPCS,Facility,Outpatient,250 mL,mL,,1119,951.15,320.7054,1119,PrimeWest Health,Minnesota Senior Health Options (MSHO),575.7255,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
TIROFIBAN-0.9% SODIUM CHLORIDE 12.5 MG/250 ML (50 MCG/ML) IV SOLN,,J3246,HCPCS,Facility,Inpatient,250 mL,mL,,1119,951.15,320.7054,1119,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
TIROFIBAN-0.9% SODIUM CHLORIDE 12.5 MG/250 ML (50 MCG/ML) IV SOLN,,J3246,HCPCS,Facility,Outpatient,250 mL,mL,,1119,951.15,320.7054,1119,PrimeWest Health,MinnesotaCare,574.7184,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
TIROFIBAN-0.9% SODIUM CHLORIDE 12.5 MG/250 ML (50 MCG/ML) IV SOLN,,J3246,HCPCS,Facility,Inpatient,250 mL,mL,,1119,951.15,320.7054,1119,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
TIROFIBAN-0.9% SODIUM CHLORIDE 12.5 MG/250 ML (50 MCG/ML) IV SOLN,,J3246,HCPCS,Facility,Both,250 mL,mL,,1119,951.15,320.7054,1119,Sanford Health Plan,Sanford Health Plan,1029.48,92,,percent of total billed charges,,
TIROFIBAN-0.9% SODIUM CHLORIDE 12.5 MG/250 ML (50 MCG/ML) IV SOLN,,J3246,HCPCS,Facility,Outpatient,250 mL,mL,,1119,951.15,320.7054,1119,"UCare Health, Inc.",Individual & Family Plan,630.5565,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
TIROFIBAN-0.9% SODIUM CHLORIDE 12.5 MG/250 ML (50 MCG/ML) IV SOLN,,J3246,HCPCS,Facility,Inpatient,250 mL,mL,,1119,951.15,320.7054,1119,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
TIROFIBAN-0.9% SODIUM CHLORIDE 12.5 MG/250 ML (50 MCG/ML) IV SOLN,,J3246,HCPCS,Facility,Outpatient,250 mL,mL,,1119,951.15,320.7054,1119,"UCare Health, Inc.",Medical Assistance,564.7593,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TIROFIBAN-0.9% SODIUM CHLORIDE 12.5 MG/250 ML (50 MCG/ML) IV SOLN,,J3246,HCPCS,Facility,Inpatient,250 mL,mL,,1119,951.15,320.7054,1119,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
TIROFIBAN-0.9% SODIUM CHLORIDE 12.5 MG/250 ML (50 MCG/ML) IV SOLN,,J3246,HCPCS,Facility,Outpatient,250 mL,mL,,1119,951.15,320.7054,1119,"UCare Health, Inc.",Medicare Advantage,564.7593,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TIROFIBAN-0.9% SODIUM CHLORIDE 12.5 MG/250 ML (50 MCG/ML) IV SOLN,,J3246,HCPCS,Facility,Inpatient,250 mL,mL,,1119,951.15,320.7054,1119,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
TIROFIBAN-0.9% SODIUM CHLORIDE 12.5 MG/250 ML (50 MCG/ML) IV SOLN,,J3246,HCPCS,Facility,Outpatient,250 mL,mL,,1119,951.15,320.7054,1119,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),564.7593,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TIROFIBAN-0.9% SODIUM CHLORIDE 12.5 MG/250 ML (50 MCG/ML) IV SOLN,,J3246,HCPCS,Facility,Inpatient,250 mL,mL,,1119,951.15,320.7054,1119,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
TIROFIBAN-0.9% SODIUM CHLORIDE 12.5 MG/250 ML (50 MCG/ML) IV SOLN,,J3246,HCPCS,Facility,Both,250 mL,mL,,1119,951.15,320.7054,1119,UnitedHealthcare,Individual & Family,1051.86,94,,percent of total billed charges,,
TIROFIBAN-0.9% SODIUM CHLORIDE 12.5 MG/250 ML (50 MCG/ML) IV SOLN,,J3246,HCPCS,Facility,Outpatient,250 mL,mL,,1119,951.15,320.7054,1119,UnitedHealthcare,Medicare Advantage,548.31,49,,percent of total billed charges,,
TIROFIBAN-0.9% SODIUM CHLORIDE 12.5 MG/250 ML (50 MCG/ML) IV SOLN,,J3246,HCPCS,Facility,Inpatient,250 mL,mL,,1119,951.15,320.7054,1119,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
TIROFIBAN-0.9% SODIUM CHLORIDE 12.5 MG/250 ML (50 MCG/ML) IV SOLN,,J3246,HCPCS,Facility,Outpatient,250 mL,mL,,1119,951.15,320.7054,1119,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,537.12,48,,percent of total billed charges,,100% of DHS outpatient percentage
TIROFIBAN-0.9% SODIUM CHLORIDE 12.5 MG/250 ML (50 MCG/ML) IV SOLN,,J3246,HCPCS,Facility,Inpatient,250 mL,mL,,1119,951.15,320.7054,1119,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 1.25 GRAM/250 ML IV PGBK,,J3372,HCPCS,Facility,Both,250 mL,mL,,103,87.55,29.5198,103,Aetna,Commercial,94.76,92,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.25 GRAM/250 ML IV PGBK,,J3372,HCPCS,Facility,Both,250 mL,mL,,103,87.55,29.5198,103,Aetna,Commercial,94.76,92,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.25 GRAM/250 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,250 mL,mL,,103,87.55,29.5198,103,Aetna,Medicare Advantage,50.47,49,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.25 GRAM/250 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,250 mL,mL,,103,87.55,29.5198,103,Aetna,Medicare Advantage,50.47,49,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.25 GRAM/250 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,250 mL,mL,,103,87.55,29.5198,103,Aetna,Medicare Advantage,,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 1.25 GRAM/250 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,250 mL,mL,,103,87.55,29.5198,103,Aetna,Medicare Advantage,,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 1.25 GRAM/250 ML IV PGBK,,J3372,HCPCS,Facility,Both,250 mL,mL,,103,87.55,29.5198,103,Aetna,PPO,95.79,93,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.25 GRAM/250 ML IV PGBK,,J3372,HCPCS,Facility,Both,250 mL,mL,,103,87.55,29.5198,103,Aetna,PPO,95.79,93,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.25 GRAM/250 ML IV PGBK,,J3372,HCPCS,Facility,Both,250 mL,mL,,103,87.55,29.5198,103,America's PPO,America's PPO,98.9109,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
VANCOMYCIN-DILUENT COMBO NO.1 1.25 GRAM/250 ML IV PGBK,,J3372,HCPCS,Facility,Both,250 mL,mL,,103,87.55,29.5198,103,America's PPO,America's PPO,98.9109,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
VANCOMYCIN-DILUENT COMBO NO.1 1.25 GRAM/250 ML IV PGBK,,J3372,HCPCS,Facility,Both,250 mL,mL,,103,87.55,29.5198,103,BlueCross BlueShield Minnesota, Federal Employee Program,101.352,98.4,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.25 GRAM/250 ML IV PGBK,,J3372,HCPCS,Facility,Both,250 mL,mL,,103,87.55,29.5198,103,BlueCross BlueShield Minnesota, Federal Employee Program,101.352,98.4,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.25 GRAM/250 ML IV PGBK,,J3372,HCPCS,Facility,Both,250 mL,mL,,103,87.55,29.5198,103,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,103,100,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.25 GRAM/250 ML IV PGBK,,J3372,HCPCS,Facility,Both,250 mL,mL,,103,87.55,29.5198,103,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,103,100,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.25 GRAM/250 ML IV PGBK,,J3372,HCPCS,Facility,Both,250 mL,mL,,103,87.55,29.5198,103,BlueCross BlueShield Minnesota,High Value Network Plan,92.7,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
VANCOMYCIN-DILUENT COMBO NO.1 1.25 GRAM/250 ML IV PGBK,,J3372,HCPCS,Facility,Both,250 mL,mL,,103,87.55,29.5198,103,BlueCross BlueShield Minnesota,High Value Network Plan,92.7,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
VANCOMYCIN-DILUENT COMBO NO.1 1.25 GRAM/250 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,250 mL,mL,,103,87.55,29.5198,103,BlueCross BlueShield Minnesota,Medicare Advantage,50.47,49,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.25 GRAM/250 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,250 mL,mL,,103,87.55,29.5198,103,BlueCross BlueShield Minnesota,Medicare Advantage,50.47,49,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.25 GRAM/250 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,250 mL,mL,,103,87.55,29.5198,103,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 1.25 GRAM/250 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,250 mL,mL,,103,87.55,29.5198,103,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 1.25 GRAM/250 ML IV PGBK,,J3372,HCPCS,Facility,Both,250 mL,mL,,103,87.55,29.5198,103,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,91.2271,88.57,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.25 GRAM/250 ML IV PGBK,,J3372,HCPCS,Facility,Both,250 mL,mL,,103,87.55,29.5198,103,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,91.2271,88.57,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.25 GRAM/250 ML IV PGBK,,J3372,HCPCS,Facility,Both,250 mL,mL,,103,87.55,29.5198,103,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,29.5198,28.66,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.25 GRAM/250 ML IV PGBK,,J3372,HCPCS,Facility,Both,250 mL,mL,,103,87.55,29.5198,103,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,29.5198,28.66,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.25 GRAM/250 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,250 mL,mL,,103,87.55,29.5198,103,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),50.47,49,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.25 GRAM/250 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,250 mL,mL,,103,87.55,29.5198,103,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),50.47,49,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.25 GRAM/250 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,250 mL,mL,,103,87.55,29.5198,103,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 1.25 GRAM/250 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,250 mL,mL,,103,87.55,29.5198,103,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 1.25 GRAM/250 ML IV PGBK,,J3372,HCPCS,Facility,Both,250 mL,mL,,103,87.55,29.5198,103,CorVel,Worker's Compensation,103,100,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.25 GRAM/250 ML IV PGBK,,J3372,HCPCS,Facility,Both,250 mL,mL,,103,87.55,29.5198,103,CorVel,Worker's Compensation,103,100,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.25 GRAM/250 ML IV PGBK,,J3372,HCPCS,Facility,Both,250 mL,mL,,103,87.55,29.5198,103,First Health Group Corporation,First Health Network,99.91,97,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.25 GRAM/250 ML IV PGBK,,J3372,HCPCS,Facility,Both,250 mL,mL,,103,87.55,29.5198,103,First Health Group Corporation,First Health Network,99.91,97,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.25 GRAM/250 ML IV PGBK,,J3372,HCPCS,Facility,Both,250 mL,mL,,103,87.55,29.5198,103,"Health Partners, Inc.",Commercial,97.438,94.6,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.25 GRAM/250 ML IV PGBK,,J3372,HCPCS,Facility,Both,250 mL,mL,,103,87.55,29.5198,103,"Health Partners, Inc.",Commercial,97.438,94.6,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.25 GRAM/250 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,250 mL,mL,,103,87.55,29.5198,103,"Health Partners, Inc.",Medicare Advantage,50.47,49,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.25 GRAM/250 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,250 mL,mL,,103,87.55,29.5198,103,"Health Partners, Inc.",Medicare Advantage,50.47,49,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.25 GRAM/250 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,250 mL,mL,,103,87.55,29.5198,103,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 1.25 GRAM/250 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,250 mL,mL,,103,87.55,29.5198,103,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 1.25 GRAM/250 ML IV PGBK,,J3372,HCPCS,Facility,Both,250 mL,mL,,103,87.55,29.5198,103,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),61.8,60,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.25 GRAM/250 ML IV PGBK,,J3372,HCPCS,Facility,Both,250 mL,mL,,103,87.55,29.5198,103,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),61.8,60,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.25 GRAM/250 ML IV PGBK,,J3372,HCPCS,Facility,Both,250 mL,mL,,103,87.55,29.5198,103,"Health Partners, Inc.",State of Minnesota Advantage Program,83.945,81.5,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.25 GRAM/250 ML IV PGBK,,J3372,HCPCS,Facility,Both,250 mL,mL,,103,87.55,29.5198,103,"Health Partners, Inc.",State of Minnesota Advantage Program,83.945,81.5,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.25 GRAM/250 ML IV PGBK,,J3372,HCPCS,Facility,Both,250 mL,mL,,103,87.55,29.5198,103,"Health Partners, Inc.",State Public Programs,51.5,50,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.25 GRAM/250 ML IV PGBK,,J3372,HCPCS,Facility,Both,250 mL,mL,,103,87.55,29.5198,103,"Health Partners, Inc.",State Public Programs,51.5,50,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.25 GRAM/250 ML IV PGBK,,J3372,HCPCS,Facility,Both,250 mL,mL,,103,87.55,29.5198,103,Humana Insurance Company,Commercial PPO,97.85,95,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.25 GRAM/250 ML IV PGBK,,J3372,HCPCS,Facility,Both,250 mL,mL,,103,87.55,29.5198,103,Humana Insurance Company,Commercial PPO,97.85,95,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.25 GRAM/250 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,250 mL,mL,,103,87.55,29.5198,103,Humana Insurance Company,Medicare PPO,50.47,49,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.25 GRAM/250 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,250 mL,mL,,103,87.55,29.5198,103,Humana Insurance Company,Medicare PPO,50.47,49,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.25 GRAM/250 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,250 mL,mL,,103,87.55,29.5198,103,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 1.25 GRAM/250 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,250 mL,mL,,103,87.55,29.5198,103,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 1.25 GRAM/250 ML IV PGBK,,J3372,HCPCS,Facility,Both,250 mL,mL,,103,87.55,29.5198,103,Medica,Individual & Family,102.073,99.1,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.25 GRAM/250 ML IV PGBK,,J3372,HCPCS,Facility,Both,250 mL,mL,,103,87.55,29.5198,103,Medica,Individual & Family,102.073,99.1,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.25 GRAM/250 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,250 mL,mL,,103,87.55,29.5198,103,Medica,Medica Advantage Solution,51.294,49.8,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.25 GRAM/250 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,250 mL,mL,,103,87.55,29.5198,103,Medica,Medica Advantage Solution,51.294,49.8,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.25 GRAM/250 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,250 mL,mL,,103,87.55,29.5198,103,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 1.25 GRAM/250 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,250 mL,mL,,103,87.55,29.5198,103,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 1.25 GRAM/250 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,250 mL,mL,,103,87.55,29.5198,103,Medica,Medical Assistance,45.938,44.6,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.25 GRAM/250 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,250 mL,mL,,103,87.55,29.5198,103,Medica,Medical Assistance,45.938,44.6,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.25 GRAM/250 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,250 mL,mL,,103,87.55,29.5198,103,Medica,Medical Assistance,,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 1.25 GRAM/250 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,250 mL,mL,,103,87.55,29.5198,103,Medica,Medical Assistance,,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 1.25 GRAM/250 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,250 mL,mL,,103,87.55,29.5198,103,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,51.294,49.8,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.25 GRAM/250 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,250 mL,mL,,103,87.55,29.5198,103,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,51.294,49.8,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.25 GRAM/250 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,250 mL,mL,,103,87.55,29.5198,103,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 1.25 GRAM/250 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,250 mL,mL,,103,87.55,29.5198,103,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 1.25 GRAM/250 ML IV PGBK,,J3372,HCPCS,Facility,Both,250 mL,mL,,103,87.55,29.5198,103,"Multiplan, Inc.","Multiplan, Inc.",96.82,94,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.25 GRAM/250 ML IV PGBK,,J3372,HCPCS,Facility,Both,250 mL,mL,,103,87.55,29.5198,103,"Multiplan, Inc.","Multiplan, Inc.",96.82,94,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.25 GRAM/250 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,250 mL,mL,,103,87.55,29.5198,103,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,92.803,90.1,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.25 GRAM/250 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,250 mL,mL,,103,87.55,29.5198,103,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,92.803,90.1,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.25 GRAM/250 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,250 mL,mL,,103,87.55,29.5198,103,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
VANCOMYCIN-DILUENT COMBO NO.1 1.25 GRAM/250 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,250 mL,mL,,103,87.55,29.5198,103,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
VANCOMYCIN-DILUENT COMBO NO.1 1.25 GRAM/250 ML IV PGBK,,J3372,HCPCS,Facility,Both,250 mL,mL,,103,87.55,29.5198,103,"Preferred One Administrative Services, INC.",PPO,101.558,98.6,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.25 GRAM/250 ML IV PGBK,,J3372,HCPCS,Facility,Both,250 mL,mL,,103,87.55,29.5198,103,"Preferred One Administrative Services, INC.",PPO,101.558,98.6,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.25 GRAM/250 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,250 mL,mL,,103,87.55,29.5198,103,PrimeWest Health,Minnesota Senior Health Options (MSHO),52.9935,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
VANCOMYCIN-DILUENT COMBO NO.1 1.25 GRAM/250 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,250 mL,mL,,103,87.55,29.5198,103,PrimeWest Health,Minnesota Senior Health Options (MSHO),52.9935,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
VANCOMYCIN-DILUENT COMBO NO.1 1.25 GRAM/250 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,250 mL,mL,,103,87.55,29.5198,103,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 1.25 GRAM/250 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,250 mL,mL,,103,87.55,29.5198,103,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 1.25 GRAM/250 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,250 mL,mL,,103,87.55,29.5198,103,PrimeWest Health,MinnesotaCare,52.9008,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
VANCOMYCIN-DILUENT COMBO NO.1 1.25 GRAM/250 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,250 mL,mL,,103,87.55,29.5198,103,PrimeWest Health,MinnesotaCare,52.9008,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
VANCOMYCIN-DILUENT COMBO NO.1 1.25 GRAM/250 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,250 mL,mL,,103,87.55,29.5198,103,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 1.25 GRAM/250 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,250 mL,mL,,103,87.55,29.5198,103,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 1.25 GRAM/250 ML IV PGBK,,J3372,HCPCS,Facility,Both,250 mL,mL,,103,87.55,29.5198,103,Sanford Health Plan,Sanford Health Plan,94.76,92,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.25 GRAM/250 ML IV PGBK,,J3372,HCPCS,Facility,Both,250 mL,mL,,103,87.55,29.5198,103,Sanford Health Plan,Sanford Health Plan,94.76,92,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.25 GRAM/250 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,250 mL,mL,,103,87.55,29.5198,103,"UCare Health, Inc.",Individual & Family Plan,58.0405,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
VANCOMYCIN-DILUENT COMBO NO.1 1.25 GRAM/250 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,250 mL,mL,,103,87.55,29.5198,103,"UCare Health, Inc.",Individual & Family Plan,58.0405,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
VANCOMYCIN-DILUENT COMBO NO.1 1.25 GRAM/250 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,250 mL,mL,,103,87.55,29.5198,103,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 1.25 GRAM/250 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,250 mL,mL,,103,87.55,29.5198,103,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 1.25 GRAM/250 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,250 mL,mL,,103,87.55,29.5198,103,"UCare Health, Inc.",Medical Assistance,51.9841,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
VANCOMYCIN-DILUENT COMBO NO.1 1.25 GRAM/250 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,250 mL,mL,,103,87.55,29.5198,103,"UCare Health, Inc.",Medical Assistance,51.9841,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
VANCOMYCIN-DILUENT COMBO NO.1 1.25 GRAM/250 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,250 mL,mL,,103,87.55,29.5198,103,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 1.25 GRAM/250 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,250 mL,mL,,103,87.55,29.5198,103,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 1.25 GRAM/250 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,250 mL,mL,,103,87.55,29.5198,103,"UCare Health, Inc.",Medicare Advantage,51.9841,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
VANCOMYCIN-DILUENT COMBO NO.1 1.25 GRAM/250 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,250 mL,mL,,103,87.55,29.5198,103,"UCare Health, Inc.",Medicare Advantage,51.9841,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
VANCOMYCIN-DILUENT COMBO NO.1 1.25 GRAM/250 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,250 mL,mL,,103,87.55,29.5198,103,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 1.25 GRAM/250 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,250 mL,mL,,103,87.55,29.5198,103,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 1.25 GRAM/250 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,250 mL,mL,,103,87.55,29.5198,103,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),51.9841,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
VANCOMYCIN-DILUENT COMBO NO.1 1.25 GRAM/250 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,250 mL,mL,,103,87.55,29.5198,103,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),51.9841,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
VANCOMYCIN-DILUENT COMBO NO.1 1.25 GRAM/250 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,250 mL,mL,,103,87.55,29.5198,103,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 1.25 GRAM/250 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,250 mL,mL,,103,87.55,29.5198,103,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 1.25 GRAM/250 ML IV PGBK,,J3372,HCPCS,Facility,Both,250 mL,mL,,103,87.55,29.5198,103,UnitedHealthcare,Individual & Family,96.82,94,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.25 GRAM/250 ML IV PGBK,,J3372,HCPCS,Facility,Both,250 mL,mL,,103,87.55,29.5198,103,UnitedHealthcare,Individual & Family,96.82,94,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.25 GRAM/250 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,250 mL,mL,,103,87.55,29.5198,103,UnitedHealthcare,Medicare Advantage,50.47,49,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.25 GRAM/250 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,250 mL,mL,,103,87.55,29.5198,103,UnitedHealthcare,Medicare Advantage,50.47,49,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.25 GRAM/250 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,250 mL,mL,,103,87.55,29.5198,103,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 1.25 GRAM/250 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,250 mL,mL,,103,87.55,29.5198,103,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 1.25 GRAM/250 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,250 mL,mL,,103,87.55,29.5198,103,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,49.44,48,,percent of total billed charges,,100% of DHS outpatient percentage
VANCOMYCIN-DILUENT COMBO NO.1 1.25 GRAM/250 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,250 mL,mL,,103,87.55,29.5198,103,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,49.44,48,,percent of total billed charges,,100% of DHS outpatient percentage
VANCOMYCIN-DILUENT COMBO NO.1 1.25 GRAM/250 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,250 mL,mL,,103,87.55,29.5198,103,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 1.25 GRAM/250 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,250 mL,mL,,103,87.55,29.5198,103,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
PHENYLEPH-PRAMOXIN-GLYCR-W.PET 0.25-1 % RECT CREAM,,68023,LOCAL,Facility,Both,26 g,g,,60,51,17.196,60,Aetna,Commercial,55.2,92,,percent of total billed charges,,
PHENYLEPH-PRAMOXIN-GLYCR-W.PET 0.25-1 % RECT CREAM,,68023,LOCAL,Facility,Outpatient,26 g,g,,60,51,17.196,60,Aetna,Medicare Advantage,29.4,49,,percent of total billed charges,,
PHENYLEPH-PRAMOXIN-GLYCR-W.PET 0.25-1 % RECT CREAM,,68023,LOCAL,Facility,Inpatient,26 g,g,,60,51,17.196,60,Aetna,Medicare Advantage,,,,,Included in per diem rate,
PHENYLEPH-PRAMOXIN-GLYCR-W.PET 0.25-1 % RECT CREAM,,68023,LOCAL,Facility,Both,26 g,g,,60,51,17.196,60,Aetna,PPO,55.8,93,,percent of total billed charges,,
PHENYLEPH-PRAMOXIN-GLYCR-W.PET 0.25-1 % RECT CREAM,,68023,LOCAL,Facility,Both,26 g,g,,60,51,17.196,60,America's PPO,America's PPO,57.618,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
PHENYLEPH-PRAMOXIN-GLYCR-W.PET 0.25-1 % RECT CREAM,,68023,LOCAL,Facility,Both,26 g,g,,60,51,17.196,60,BlueCross BlueShield Minnesota, Federal Employee Program,59.04,98.4,,percent of total billed charges,,
PHENYLEPH-PRAMOXIN-GLYCR-W.PET 0.25-1 % RECT CREAM,,68023,LOCAL,Facility,Both,26 g,g,,60,51,17.196,60,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,60,100,,percent of total billed charges,,
PHENYLEPH-PRAMOXIN-GLYCR-W.PET 0.25-1 % RECT CREAM,,68023,LOCAL,Facility,Both,26 g,g,,60,51,17.196,60,BlueCross BlueShield Minnesota,High Value Network Plan,54,90,,percent of total billed charges,,
PHENYLEPH-PRAMOXIN-GLYCR-W.PET 0.25-1 % RECT CREAM,,68023,LOCAL,Facility,Outpatient,26 g,g,,60,51,17.196,60,BlueCross BlueShield Minnesota,Medicare Advantage,29.4,49,,percent of total billed charges,,
PHENYLEPH-PRAMOXIN-GLYCR-W.PET 0.25-1 % RECT CREAM,,68023,LOCAL,Facility,Inpatient,26 g,g,,60,51,17.196,60,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
PHENYLEPH-PRAMOXIN-GLYCR-W.PET 0.25-1 % RECT CREAM,,68023,LOCAL,Facility,Both,26 g,g,,60,51,17.196,60,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,53.142,88.57,,percent of total billed charges,,
PHENYLEPH-PRAMOXIN-GLYCR-W.PET 0.25-1 % RECT CREAM,,68023,LOCAL,Facility,Both,26 g,g,,60,51,17.196,60,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,17.196,28.66,,percent of total billed charges,,
PHENYLEPH-PRAMOXIN-GLYCR-W.PET 0.25-1 % RECT CREAM,,68023,LOCAL,Facility,Outpatient,26 g,g,,60,51,17.196,60,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),29.4,49,,percent of total billed charges,,
PHENYLEPH-PRAMOXIN-GLYCR-W.PET 0.25-1 % RECT CREAM,,68023,LOCAL,Facility,Inpatient,26 g,g,,60,51,17.196,60,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
PHENYLEPH-PRAMOXIN-GLYCR-W.PET 0.25-1 % RECT CREAM,,68023,LOCAL,Facility,Both,26 g,g,,60,51,17.196,60,CorVel,Worker's Compensation,60,100,,percent of total billed charges,,
PHENYLEPH-PRAMOXIN-GLYCR-W.PET 0.25-1 % RECT CREAM,,68023,LOCAL,Facility,Both,26 g,g,,60,51,17.196,60,First Health Group Corporation,First Health Network,58.2,97,,percent of total billed charges,,
PHENYLEPH-PRAMOXIN-GLYCR-W.PET 0.25-1 % RECT CREAM,,68023,LOCAL,Facility,Both,26 g,g,,60,51,17.196,60,"Health Partners, Inc.",Commercial,56.76,94.6,,percent of total billed charges,,
PHENYLEPH-PRAMOXIN-GLYCR-W.PET 0.25-1 % RECT CREAM,,68023,LOCAL,Facility,Outpatient,26 g,g,,60,51,17.196,60,"Health Partners, Inc.",Medicare Advantage,29.4,49,,percent of total billed charges,,
PHENYLEPH-PRAMOXIN-GLYCR-W.PET 0.25-1 % RECT CREAM,,68023,LOCAL,Facility,Inpatient,26 g,g,,60,51,17.196,60,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PHENYLEPH-PRAMOXIN-GLYCR-W.PET 0.25-1 % RECT CREAM,,68023,LOCAL,Facility,Both,26 g,g,,60,51,17.196,60,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),36,60,,percent of total billed charges,,
PHENYLEPH-PRAMOXIN-GLYCR-W.PET 0.25-1 % RECT CREAM,,68023,LOCAL,Facility,Both,26 g,g,,60,51,17.196,60,"Health Partners, Inc.",State of Minnesota Advantage Program,48.9,81.5,,percent of total billed charges,,
PHENYLEPH-PRAMOXIN-GLYCR-W.PET 0.25-1 % RECT CREAM,,68023,LOCAL,Facility,Both,26 g,g,,60,51,17.196,60,"Health Partners, Inc.",State Public Programs,30,50,,percent of total billed charges,,
PHENYLEPH-PRAMOXIN-GLYCR-W.PET 0.25-1 % RECT CREAM,,68023,LOCAL,Facility,Both,26 g,g,,60,51,17.196,60,Humana Insurance Company,Commercial PPO,57,95,,percent of total billed charges,,
PHENYLEPH-PRAMOXIN-GLYCR-W.PET 0.25-1 % RECT CREAM,,68023,LOCAL,Facility,Outpatient,26 g,g,,60,51,17.196,60,Humana Insurance Company,Medicare PPO,29.4,49,,percent of total billed charges,,
PHENYLEPH-PRAMOXIN-GLYCR-W.PET 0.25-1 % RECT CREAM,,68023,LOCAL,Facility,Inpatient,26 g,g,,60,51,17.196,60,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
PHENYLEPH-PRAMOXIN-GLYCR-W.PET 0.25-1 % RECT CREAM,,68023,LOCAL,Facility,Both,26 g,g,,60,51,17.196,60,Medica,Individual & Family,59.46,99.1,,percent of total billed charges,,
PHENYLEPH-PRAMOXIN-GLYCR-W.PET 0.25-1 % RECT CREAM,,68023,LOCAL,Facility,Outpatient,26 g,g,,60,51,17.196,60,Medica,Medica Advantage Solution,29.88,49.8,,percent of total billed charges,,
PHENYLEPH-PRAMOXIN-GLYCR-W.PET 0.25-1 % RECT CREAM,,68023,LOCAL,Facility,Inpatient,26 g,g,,60,51,17.196,60,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
PHENYLEPH-PRAMOXIN-GLYCR-W.PET 0.25-1 % RECT CREAM,,68023,LOCAL,Facility,Outpatient,26 g,g,,60,51,17.196,60,Medica,Medical Assistance,26.76,44.6,,percent of total billed charges,,
PHENYLEPH-PRAMOXIN-GLYCR-W.PET 0.25-1 % RECT CREAM,,68023,LOCAL,Facility,Inpatient,26 g,g,,60,51,17.196,60,Medica,Medical Assistance,,,,,Included in per diem rate,
PHENYLEPH-PRAMOXIN-GLYCR-W.PET 0.25-1 % RECT CREAM,,68023,LOCAL,Facility,Outpatient,26 g,g,,60,51,17.196,60,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,29.88,49.8,,percent of total billed charges,,
PHENYLEPH-PRAMOXIN-GLYCR-W.PET 0.25-1 % RECT CREAM,,68023,LOCAL,Facility,Inpatient,26 g,g,,60,51,17.196,60,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
PHENYLEPH-PRAMOXIN-GLYCR-W.PET 0.25-1 % RECT CREAM,,68023,LOCAL,Facility,Both,26 g,g,,60,51,17.196,60,"Multiplan, Inc.","Multiplan, Inc.",56.4,94,,percent of total billed charges,,
PHENYLEPH-PRAMOXIN-GLYCR-W.PET 0.25-1 % RECT CREAM,,68023,LOCAL,Facility,Outpatient,26 g,g,,60,51,17.196,60,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,54.06,90.1,,percent of total billed charges,,
PHENYLEPH-PRAMOXIN-GLYCR-W.PET 0.25-1 % RECT CREAM,,68023,LOCAL,Facility,Inpatient,26 g,g,,60,51,17.196,60,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
PHENYLEPH-PRAMOXIN-GLYCR-W.PET 0.25-1 % RECT CREAM,,68023,LOCAL,Facility,Both,26 g,g,,60,51,17.196,60,"Preferred One Administrative Services, INC.",PPO,59.16,98.6,,percent of total billed charges,,
PHENYLEPH-PRAMOXIN-GLYCR-W.PET 0.25-1 % RECT CREAM,,68023,LOCAL,Facility,Outpatient,26 g,g,,60,51,17.196,60,PrimeWest Health,Minnesota Senior Health Options (MSHO),30.87,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
PHENYLEPH-PRAMOXIN-GLYCR-W.PET 0.25-1 % RECT CREAM,,68023,LOCAL,Facility,Inpatient,26 g,g,,60,51,17.196,60,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PHENYLEPH-PRAMOXIN-GLYCR-W.PET 0.25-1 % RECT CREAM,,68023,LOCAL,Facility,Outpatient,26 g,g,,60,51,17.196,60,PrimeWest Health,MinnesotaCare,30.816,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
PHENYLEPH-PRAMOXIN-GLYCR-W.PET 0.25-1 % RECT CREAM,,68023,LOCAL,Facility,Inpatient,26 g,g,,60,51,17.196,60,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
PHENYLEPH-PRAMOXIN-GLYCR-W.PET 0.25-1 % RECT CREAM,,68023,LOCAL,Facility,Both,26 g,g,,60,51,17.196,60,Sanford Health Plan,Sanford Health Plan,55.2,92,,percent of total billed charges,,
PHENYLEPH-PRAMOXIN-GLYCR-W.PET 0.25-1 % RECT CREAM,,68023,LOCAL,Facility,Outpatient,26 g,g,,60,51,17.196,60,"UCare Health, Inc.",Individual & Family Plan,33.81,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
PHENYLEPH-PRAMOXIN-GLYCR-W.PET 0.25-1 % RECT CREAM,,68023,LOCAL,Facility,Inpatient,26 g,g,,60,51,17.196,60,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
PHENYLEPH-PRAMOXIN-GLYCR-W.PET 0.25-1 % RECT CREAM,,68023,LOCAL,Facility,Outpatient,26 g,g,,60,51,17.196,60,"UCare Health, Inc.",Medical Assistance,30.282,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PHENYLEPH-PRAMOXIN-GLYCR-W.PET 0.25-1 % RECT CREAM,,68023,LOCAL,Facility,Inpatient,26 g,g,,60,51,17.196,60,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
PHENYLEPH-PRAMOXIN-GLYCR-W.PET 0.25-1 % RECT CREAM,,68023,LOCAL,Facility,Outpatient,26 g,g,,60,51,17.196,60,"UCare Health, Inc.",Medicare Advantage,30.282,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PHENYLEPH-PRAMOXIN-GLYCR-W.PET 0.25-1 % RECT CREAM,,68023,LOCAL,Facility,Inpatient,26 g,g,,60,51,17.196,60,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PHENYLEPH-PRAMOXIN-GLYCR-W.PET 0.25-1 % RECT CREAM,,68023,LOCAL,Facility,Outpatient,26 g,g,,60,51,17.196,60,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),30.282,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PHENYLEPH-PRAMOXIN-GLYCR-W.PET 0.25-1 % RECT CREAM,,68023,LOCAL,Facility,Inpatient,26 g,g,,60,51,17.196,60,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PHENYLEPH-PRAMOXIN-GLYCR-W.PET 0.25-1 % RECT CREAM,,68023,LOCAL,Facility,Both,26 g,g,,60,51,17.196,60,UnitedHealthcare,Individual & Family,56.4,94,,percent of total billed charges,,
PHENYLEPH-PRAMOXIN-GLYCR-W.PET 0.25-1 % RECT CREAM,,68023,LOCAL,Facility,Outpatient,26 g,g,,60,51,17.196,60,UnitedHealthcare,Medicare Advantage,29.4,49,,percent of total billed charges,,
PHENYLEPH-PRAMOXIN-GLYCR-W.PET 0.25-1 % RECT CREAM,,68023,LOCAL,Facility,Inpatient,26 g,g,,60,51,17.196,60,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
PHENYLEPH-PRAMOXIN-GLYCR-W.PET 0.25-1 % RECT CREAM,,68023,LOCAL,Facility,Outpatient,26 g,g,,60,51,17.196,60,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,28.8,48,,percent of total billed charges,,100% of DHS outpatient percentage
PHENYLEPH-PRAMOXIN-GLYCR-W.PET 0.25-1 % RECT CREAM,,68023,LOCAL,Facility,Inpatient,26 g,g,,60,51,17.196,60,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
POVIDONE-IODINE 0.3 % VAGL SOLN,,11075,LOCAL,Facility,Both,274 mL,mL,,22,18.7,6.3052,22,Aetna,Commercial,20.24,92,,percent of total billed charges,,
POVIDONE-IODINE 0.3 % VAGL SOLN,,11075,LOCAL,Facility,Outpatient,274 mL,mL,,22,18.7,6.3052,22,Aetna,Medicare Advantage,10.78,49,,percent of total billed charges,,
POVIDONE-IODINE 0.3 % VAGL SOLN,,11075,LOCAL,Facility,Inpatient,274 mL,mL,,22,18.7,6.3052,22,Aetna,Medicare Advantage,,,,,Included in per diem rate,
POVIDONE-IODINE 0.3 % VAGL SOLN,,11075,LOCAL,Facility,Both,274 mL,mL,,22,18.7,6.3052,22,Aetna,PPO,20.46,93,,percent of total billed charges,,
POVIDONE-IODINE 0.3 % VAGL SOLN,,11075,LOCAL,Facility,Both,274 mL,mL,,22,18.7,6.3052,22,America's PPO,America's PPO,21.1266,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
POVIDONE-IODINE 0.3 % VAGL SOLN,,11075,LOCAL,Facility,Both,274 mL,mL,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota, Federal Employee Program,21.648,98.4,,percent of total billed charges,,
POVIDONE-IODINE 0.3 % VAGL SOLN,,11075,LOCAL,Facility,Both,274 mL,mL,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,22,100,,percent of total billed charges,,
POVIDONE-IODINE 0.3 % VAGL SOLN,,11075,LOCAL,Facility,Both,274 mL,mL,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota,High Value Network Plan,19.8,90,,percent of total billed charges,,
POVIDONE-IODINE 0.3 % VAGL SOLN,,11075,LOCAL,Facility,Outpatient,274 mL,mL,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota,Medicare Advantage,10.78,49,,percent of total billed charges,,
POVIDONE-IODINE 0.3 % VAGL SOLN,,11075,LOCAL,Facility,Inpatient,274 mL,mL,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
POVIDONE-IODINE 0.3 % VAGL SOLN,,11075,LOCAL,Facility,Both,274 mL,mL,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,19.4854,88.57,,percent of total billed charges,,
POVIDONE-IODINE 0.3 % VAGL SOLN,,11075,LOCAL,Facility,Both,274 mL,mL,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,6.3052,28.66,,percent of total billed charges,,
POVIDONE-IODINE 0.3 % VAGL SOLN,,11075,LOCAL,Facility,Outpatient,274 mL,mL,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),10.78,49,,percent of total billed charges,,
POVIDONE-IODINE 0.3 % VAGL SOLN,,11075,LOCAL,Facility,Inpatient,274 mL,mL,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
POVIDONE-IODINE 0.3 % VAGL SOLN,,11075,LOCAL,Facility,Both,274 mL,mL,,22,18.7,6.3052,22,CorVel,Worker's Compensation,22,100,,percent of total billed charges,,
POVIDONE-IODINE 0.3 % VAGL SOLN,,11075,LOCAL,Facility,Both,274 mL,mL,,22,18.7,6.3052,22,First Health Group Corporation,First Health Network,21.34,97,,percent of total billed charges,,
POVIDONE-IODINE 0.3 % VAGL SOLN,,11075,LOCAL,Facility,Both,274 mL,mL,,22,18.7,6.3052,22,"Health Partners, Inc.",Commercial,20.812,94.6,,percent of total billed charges,,
POVIDONE-IODINE 0.3 % VAGL SOLN,,11075,LOCAL,Facility,Outpatient,274 mL,mL,,22,18.7,6.3052,22,"Health Partners, Inc.",Medicare Advantage,10.78,49,,percent of total billed charges,,
POVIDONE-IODINE 0.3 % VAGL SOLN,,11075,LOCAL,Facility,Inpatient,274 mL,mL,,22,18.7,6.3052,22,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
POVIDONE-IODINE 0.3 % VAGL SOLN,,11075,LOCAL,Facility,Both,274 mL,mL,,22,18.7,6.3052,22,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),13.2,60,,percent of total billed charges,,
POVIDONE-IODINE 0.3 % VAGL SOLN,,11075,LOCAL,Facility,Both,274 mL,mL,,22,18.7,6.3052,22,"Health Partners, Inc.",State of Minnesota Advantage Program,17.93,81.5,,percent of total billed charges,,
POVIDONE-IODINE 0.3 % VAGL SOLN,,11075,LOCAL,Facility,Both,274 mL,mL,,22,18.7,6.3052,22,"Health Partners, Inc.",State Public Programs,11,50,,percent of total billed charges,,
POVIDONE-IODINE 0.3 % VAGL SOLN,,11075,LOCAL,Facility,Both,274 mL,mL,,22,18.7,6.3052,22,Humana Insurance Company,Commercial PPO,20.9,95,,percent of total billed charges,,
POVIDONE-IODINE 0.3 % VAGL SOLN,,11075,LOCAL,Facility,Outpatient,274 mL,mL,,22,18.7,6.3052,22,Humana Insurance Company,Medicare PPO,10.78,49,,percent of total billed charges,,
POVIDONE-IODINE 0.3 % VAGL SOLN,,11075,LOCAL,Facility,Inpatient,274 mL,mL,,22,18.7,6.3052,22,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
POVIDONE-IODINE 0.3 % VAGL SOLN,,11075,LOCAL,Facility,Both,274 mL,mL,,22,18.7,6.3052,22,Medica,Individual & Family,21.802,99.1,,percent of total billed charges,,
POVIDONE-IODINE 0.3 % VAGL SOLN,,11075,LOCAL,Facility,Outpatient,274 mL,mL,,22,18.7,6.3052,22,Medica,Medica Advantage Solution,10.956,49.8,,percent of total billed charges,,
POVIDONE-IODINE 0.3 % VAGL SOLN,,11075,LOCAL,Facility,Inpatient,274 mL,mL,,22,18.7,6.3052,22,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
POVIDONE-IODINE 0.3 % VAGL SOLN,,11075,LOCAL,Facility,Outpatient,274 mL,mL,,22,18.7,6.3052,22,Medica,Medical Assistance,9.812,44.6,,percent of total billed charges,,
POVIDONE-IODINE 0.3 % VAGL SOLN,,11075,LOCAL,Facility,Inpatient,274 mL,mL,,22,18.7,6.3052,22,Medica,Medical Assistance,,,,,Included in per diem rate,
POVIDONE-IODINE 0.3 % VAGL SOLN,,11075,LOCAL,Facility,Outpatient,274 mL,mL,,22,18.7,6.3052,22,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,10.956,49.8,,percent of total billed charges,,
POVIDONE-IODINE 0.3 % VAGL SOLN,,11075,LOCAL,Facility,Inpatient,274 mL,mL,,22,18.7,6.3052,22,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
POVIDONE-IODINE 0.3 % VAGL SOLN,,11075,LOCAL,Facility,Both,274 mL,mL,,22,18.7,6.3052,22,"Multiplan, Inc.","Multiplan, Inc.",20.68,94,,percent of total billed charges,,
POVIDONE-IODINE 0.3 % VAGL SOLN,,11075,LOCAL,Facility,Outpatient,274 mL,mL,,22,18.7,6.3052,22,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,19.822,90.1,,percent of total billed charges,,
POVIDONE-IODINE 0.3 % VAGL SOLN,,11075,LOCAL,Facility,Inpatient,274 mL,mL,,22,18.7,6.3052,22,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
POVIDONE-IODINE 0.3 % VAGL SOLN,,11075,LOCAL,Facility,Both,274 mL,mL,,22,18.7,6.3052,22,"Preferred One Administrative Services, INC.",PPO,21.692,98.6,,percent of total billed charges,,
POVIDONE-IODINE 0.3 % VAGL SOLN,,11075,LOCAL,Facility,Outpatient,274 mL,mL,,22,18.7,6.3052,22,PrimeWest Health,Minnesota Senior Health Options (MSHO),11.319,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
POVIDONE-IODINE 0.3 % VAGL SOLN,,11075,LOCAL,Facility,Inpatient,274 mL,mL,,22,18.7,6.3052,22,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
POVIDONE-IODINE 0.3 % VAGL SOLN,,11075,LOCAL,Facility,Outpatient,274 mL,mL,,22,18.7,6.3052,22,PrimeWest Health,MinnesotaCare,11.2992,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
POVIDONE-IODINE 0.3 % VAGL SOLN,,11075,LOCAL,Facility,Inpatient,274 mL,mL,,22,18.7,6.3052,22,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
POVIDONE-IODINE 0.3 % VAGL SOLN,,11075,LOCAL,Facility,Both,274 mL,mL,,22,18.7,6.3052,22,Sanford Health Plan,Sanford Health Plan,20.24,92,,percent of total billed charges,,
POVIDONE-IODINE 0.3 % VAGL SOLN,,11075,LOCAL,Facility,Outpatient,274 mL,mL,,22,18.7,6.3052,22,"UCare Health, Inc.",Individual & Family Plan,12.397,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
POVIDONE-IODINE 0.3 % VAGL SOLN,,11075,LOCAL,Facility,Inpatient,274 mL,mL,,22,18.7,6.3052,22,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
POVIDONE-IODINE 0.3 % VAGL SOLN,,11075,LOCAL,Facility,Outpatient,274 mL,mL,,22,18.7,6.3052,22,"UCare Health, Inc.",Medical Assistance,11.1034,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
POVIDONE-IODINE 0.3 % VAGL SOLN,,11075,LOCAL,Facility,Inpatient,274 mL,mL,,22,18.7,6.3052,22,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
POVIDONE-IODINE 0.3 % VAGL SOLN,,11075,LOCAL,Facility,Outpatient,274 mL,mL,,22,18.7,6.3052,22,"UCare Health, Inc.",Medicare Advantage,11.1034,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
POVIDONE-IODINE 0.3 % VAGL SOLN,,11075,LOCAL,Facility,Inpatient,274 mL,mL,,22,18.7,6.3052,22,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
POVIDONE-IODINE 0.3 % VAGL SOLN,,11075,LOCAL,Facility,Outpatient,274 mL,mL,,22,18.7,6.3052,22,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),11.1034,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
POVIDONE-IODINE 0.3 % VAGL SOLN,,11075,LOCAL,Facility,Inpatient,274 mL,mL,,22,18.7,6.3052,22,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
POVIDONE-IODINE 0.3 % VAGL SOLN,,11075,LOCAL,Facility,Both,274 mL,mL,,22,18.7,6.3052,22,UnitedHealthcare,Individual & Family,20.68,94,,percent of total billed charges,,
POVIDONE-IODINE 0.3 % VAGL SOLN,,11075,LOCAL,Facility,Outpatient,274 mL,mL,,22,18.7,6.3052,22,UnitedHealthcare,Medicare Advantage,10.78,49,,percent of total billed charges,,
POVIDONE-IODINE 0.3 % VAGL SOLN,,11075,LOCAL,Facility,Inpatient,274 mL,mL,,22,18.7,6.3052,22,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
POVIDONE-IODINE 0.3 % VAGL SOLN,,11075,LOCAL,Facility,Outpatient,274 mL,mL,,22,18.7,6.3052,22,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,10.56,48,,percent of total billed charges,,100% of DHS outpatient percentage
POVIDONE-IODINE 0.3 % VAGL SOLN,,11075,LOCAL,Facility,Inpatient,274 mL,mL,,22,18.7,6.3052,22,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5MG-400 UNIT- 5,000 UNIT/GRAM TOP OINT",,1727,LOCAL,Facility,Both,28 g,g,,13,11.05,3.7258,13,Aetna,Commercial,11.96,92,,percent of total billed charges,,
"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5MG-400 UNIT- 5,000 UNIT/GRAM TOP OINT",,1727,LOCAL,Facility,Outpatient,28 g,g,,13,11.05,3.7258,13,Aetna,Medicare Advantage,6.37,49,,percent of total billed charges,,
"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5MG-400 UNIT- 5,000 UNIT/GRAM TOP OINT",,1727,LOCAL,Facility,Inpatient,28 g,g,,13,11.05,3.7258,13,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5MG-400 UNIT- 5,000 UNIT/GRAM TOP OINT",,1727,LOCAL,Facility,Both,28 g,g,,13,11.05,3.7258,13,Aetna,PPO,12.09,93,,percent of total billed charges,,
"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5MG-400 UNIT- 5,000 UNIT/GRAM TOP OINT",,1727,LOCAL,Facility,Both,28 g,g,,13,11.05,3.7258,13,America's PPO,America's PPO,12.4839,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5MG-400 UNIT- 5,000 UNIT/GRAM TOP OINT",,1727,LOCAL,Facility,Both,28 g,g,,13,11.05,3.7258,13,BlueCross BlueShield Minnesota, Federal Employee Program,12.792,98.4,,percent of total billed charges,,
"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5MG-400 UNIT- 5,000 UNIT/GRAM TOP OINT",,1727,LOCAL,Facility,Both,28 g,g,,13,11.05,3.7258,13,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,13,100,,percent of total billed charges,,
"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5MG-400 UNIT- 5,000 UNIT/GRAM TOP OINT",,1727,LOCAL,Facility,Both,28 g,g,,13,11.05,3.7258,13,BlueCross BlueShield Minnesota,High Value Network Plan,11.7,90,,percent of total billed charges,,
"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5MG-400 UNIT- 5,000 UNIT/GRAM TOP OINT",,1727,LOCAL,Facility,Outpatient,28 g,g,,13,11.05,3.7258,13,BlueCross BlueShield Minnesota,Medicare Advantage,6.37,49,,percent of total billed charges,,
"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5MG-400 UNIT- 5,000 UNIT/GRAM TOP OINT",,1727,LOCAL,Facility,Inpatient,28 g,g,,13,11.05,3.7258,13,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5MG-400 UNIT- 5,000 UNIT/GRAM TOP OINT",,1727,LOCAL,Facility,Both,28 g,g,,13,11.05,3.7258,13,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,11.5141,88.57,,percent of total billed charges,,
"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5MG-400 UNIT- 5,000 UNIT/GRAM TOP OINT",,1727,LOCAL,Facility,Both,28 g,g,,13,11.05,3.7258,13,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,3.7258,28.66,,percent of total billed charges,,
"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5MG-400 UNIT- 5,000 UNIT/GRAM TOP OINT",,1727,LOCAL,Facility,Outpatient,28 g,g,,13,11.05,3.7258,13,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),6.37,49,,percent of total billed charges,,
"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5MG-400 UNIT- 5,000 UNIT/GRAM TOP OINT",,1727,LOCAL,Facility,Inpatient,28 g,g,,13,11.05,3.7258,13,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5MG-400 UNIT- 5,000 UNIT/GRAM TOP OINT",,1727,LOCAL,Facility,Both,28 g,g,,13,11.05,3.7258,13,CorVel,Worker's Compensation,13,100,,percent of total billed charges,,
"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5MG-400 UNIT- 5,000 UNIT/GRAM TOP OINT",,1727,LOCAL,Facility,Both,28 g,g,,13,11.05,3.7258,13,First Health Group Corporation,First Health Network,12.61,97,,percent of total billed charges,,
"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5MG-400 UNIT- 5,000 UNIT/GRAM TOP OINT",,1727,LOCAL,Facility,Both,28 g,g,,13,11.05,3.7258,13,"Health Partners, Inc.",Commercial,12.298,94.6,,percent of total billed charges,,
"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5MG-400 UNIT- 5,000 UNIT/GRAM TOP OINT",,1727,LOCAL,Facility,Outpatient,28 g,g,,13,11.05,3.7258,13,"Health Partners, Inc.",Medicare Advantage,6.37,49,,percent of total billed charges,,
"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5MG-400 UNIT- 5,000 UNIT/GRAM TOP OINT",,1727,LOCAL,Facility,Inpatient,28 g,g,,13,11.05,3.7258,13,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5MG-400 UNIT- 5,000 UNIT/GRAM TOP OINT",,1727,LOCAL,Facility,Both,28 g,g,,13,11.05,3.7258,13,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),7.8,60,,percent of total billed charges,,
"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5MG-400 UNIT- 5,000 UNIT/GRAM TOP OINT",,1727,LOCAL,Facility,Both,28 g,g,,13,11.05,3.7258,13,"Health Partners, Inc.",State of Minnesota Advantage Program,10.595,81.5,,percent of total billed charges,,
"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5MG-400 UNIT- 5,000 UNIT/GRAM TOP OINT",,1727,LOCAL,Facility,Both,28 g,g,,13,11.05,3.7258,13,"Health Partners, Inc.",State Public Programs,6.5,50,,percent of total billed charges,,
"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5MG-400 UNIT- 5,000 UNIT/GRAM TOP OINT",,1727,LOCAL,Facility,Both,28 g,g,,13,11.05,3.7258,13,Humana Insurance Company,Commercial PPO,12.35,95,,percent of total billed charges,,
"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5MG-400 UNIT- 5,000 UNIT/GRAM TOP OINT",,1727,LOCAL,Facility,Outpatient,28 g,g,,13,11.05,3.7258,13,Humana Insurance Company,Medicare PPO,6.37,49,,percent of total billed charges,,
"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5MG-400 UNIT- 5,000 UNIT/GRAM TOP OINT",,1727,LOCAL,Facility,Inpatient,28 g,g,,13,11.05,3.7258,13,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5MG-400 UNIT- 5,000 UNIT/GRAM TOP OINT",,1727,LOCAL,Facility,Both,28 g,g,,13,11.05,3.7258,13,Medica,Individual & Family,12.883,99.1,,percent of total billed charges,,
"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5MG-400 UNIT- 5,000 UNIT/GRAM TOP OINT",,1727,LOCAL,Facility,Outpatient,28 g,g,,13,11.05,3.7258,13,Medica,Medica Advantage Solution,6.474,49.8,,percent of total billed charges,,
"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5MG-400 UNIT- 5,000 UNIT/GRAM TOP OINT",,1727,LOCAL,Facility,Inpatient,28 g,g,,13,11.05,3.7258,13,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5MG-400 UNIT- 5,000 UNIT/GRAM TOP OINT",,1727,LOCAL,Facility,Outpatient,28 g,g,,13,11.05,3.7258,13,Medica,Medical Assistance,5.798,44.6,,percent of total billed charges,,
"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5MG-400 UNIT- 5,000 UNIT/GRAM TOP OINT",,1727,LOCAL,Facility,Inpatient,28 g,g,,13,11.05,3.7258,13,Medica,Medical Assistance,,,,,Included in per diem rate,
"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5MG-400 UNIT- 5,000 UNIT/GRAM TOP OINT",,1727,LOCAL,Facility,Outpatient,28 g,g,,13,11.05,3.7258,13,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,6.474,49.8,,percent of total billed charges,,
"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5MG-400 UNIT- 5,000 UNIT/GRAM TOP OINT",,1727,LOCAL,Facility,Inpatient,28 g,g,,13,11.05,3.7258,13,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5MG-400 UNIT- 5,000 UNIT/GRAM TOP OINT",,1727,LOCAL,Facility,Both,28 g,g,,13,11.05,3.7258,13,"Multiplan, Inc.","Multiplan, Inc.",12.22,94,,percent of total billed charges,,
"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5MG-400 UNIT- 5,000 UNIT/GRAM TOP OINT",,1727,LOCAL,Facility,Outpatient,28 g,g,,13,11.05,3.7258,13,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,11.713,90.1,,percent of total billed charges,,
"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5MG-400 UNIT- 5,000 UNIT/GRAM TOP OINT",,1727,LOCAL,Facility,Inpatient,28 g,g,,13,11.05,3.7258,13,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5MG-400 UNIT- 5,000 UNIT/GRAM TOP OINT",,1727,LOCAL,Facility,Both,28 g,g,,13,11.05,3.7258,13,"Preferred One Administrative Services, INC.",PPO,12.818,98.6,,percent of total billed charges,,
"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5MG-400 UNIT- 5,000 UNIT/GRAM TOP OINT",,1727,LOCAL,Facility,Outpatient,28 g,g,,13,11.05,3.7258,13,PrimeWest Health,Minnesota Senior Health Options (MSHO),6.6885,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5MG-400 UNIT- 5,000 UNIT/GRAM TOP OINT",,1727,LOCAL,Facility,Inpatient,28 g,g,,13,11.05,3.7258,13,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5MG-400 UNIT- 5,000 UNIT/GRAM TOP OINT",,1727,LOCAL,Facility,Outpatient,28 g,g,,13,11.05,3.7258,13,PrimeWest Health,MinnesotaCare,6.6768,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5MG-400 UNIT- 5,000 UNIT/GRAM TOP OINT",,1727,LOCAL,Facility,Inpatient,28 g,g,,13,11.05,3.7258,13,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5MG-400 UNIT- 5,000 UNIT/GRAM TOP OINT",,1727,LOCAL,Facility,Both,28 g,g,,13,11.05,3.7258,13,Sanford Health Plan,Sanford Health Plan,11.96,92,,percent of total billed charges,,
"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5MG-400 UNIT- 5,000 UNIT/GRAM TOP OINT",,1727,LOCAL,Facility,Outpatient,28 g,g,,13,11.05,3.7258,13,"UCare Health, Inc.",Individual & Family Plan,7.3255,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5MG-400 UNIT- 5,000 UNIT/GRAM TOP OINT",,1727,LOCAL,Facility,Inpatient,28 g,g,,13,11.05,3.7258,13,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5MG-400 UNIT- 5,000 UNIT/GRAM TOP OINT",,1727,LOCAL,Facility,Outpatient,28 g,g,,13,11.05,3.7258,13,"UCare Health, Inc.",Medical Assistance,6.5611,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5MG-400 UNIT- 5,000 UNIT/GRAM TOP OINT",,1727,LOCAL,Facility,Inpatient,28 g,g,,13,11.05,3.7258,13,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5MG-400 UNIT- 5,000 UNIT/GRAM TOP OINT",,1727,LOCAL,Facility,Outpatient,28 g,g,,13,11.05,3.7258,13,"UCare Health, Inc.",Medicare Advantage,6.5611,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5MG-400 UNIT- 5,000 UNIT/GRAM TOP OINT",,1727,LOCAL,Facility,Inpatient,28 g,g,,13,11.05,3.7258,13,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5MG-400 UNIT- 5,000 UNIT/GRAM TOP OINT",,1727,LOCAL,Facility,Outpatient,28 g,g,,13,11.05,3.7258,13,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),6.5611,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5MG-400 UNIT- 5,000 UNIT/GRAM TOP OINT",,1727,LOCAL,Facility,Inpatient,28 g,g,,13,11.05,3.7258,13,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5MG-400 UNIT- 5,000 UNIT/GRAM TOP OINT",,1727,LOCAL,Facility,Both,28 g,g,,13,11.05,3.7258,13,UnitedHealthcare,Individual & Family,12.22,94,,percent of total billed charges,,
"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5MG-400 UNIT- 5,000 UNIT/GRAM TOP OINT",,1727,LOCAL,Facility,Outpatient,28 g,g,,13,11.05,3.7258,13,UnitedHealthcare,Medicare Advantage,6.37,49,,percent of total billed charges,,
"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5MG-400 UNIT- 5,000 UNIT/GRAM TOP OINT",,1727,LOCAL,Facility,Inpatient,28 g,g,,13,11.05,3.7258,13,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5MG-400 UNIT- 5,000 UNIT/GRAM TOP OINT",,1727,LOCAL,Facility,Outpatient,28 g,g,,13,11.05,3.7258,13,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,6.24,48,,percent of total billed charges,,100% of DHS outpatient percentage
"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5MG-400 UNIT- 5,000 UNIT/GRAM TOP OINT",,1727,LOCAL,Facility,Inpatient,28 g,g,,13,11.05,3.7258,13,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
BACITRACIN 500 UNIT/GRAM TOP OINT,,6209,LOCAL,Facility,Both,28 g,g,,15,12.75,4.299,15,Aetna,Commercial,13.8,92,,percent of total billed charges,,
BACITRACIN 500 UNIT/GRAM TOP OINT,,6209,LOCAL,Facility,Outpatient,28 g,g,,15,12.75,4.299,15,Aetna,Medicare Advantage,7.35,49,,percent of total billed charges,,
BACITRACIN 500 UNIT/GRAM TOP OINT,,6209,LOCAL,Facility,Inpatient,28 g,g,,15,12.75,4.299,15,Aetna,Medicare Advantage,,,,,Included in per diem rate,
BACITRACIN 500 UNIT/GRAM TOP OINT,,6209,LOCAL,Facility,Both,28 g,g,,15,12.75,4.299,15,Aetna,PPO,13.95,93,,percent of total billed charges,,
BACITRACIN 500 UNIT/GRAM TOP OINT,,6209,LOCAL,Facility,Both,28 g,g,,15,12.75,4.299,15,America's PPO,America's PPO,14.4045,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
BACITRACIN 500 UNIT/GRAM TOP OINT,,6209,LOCAL,Facility,Both,28 g,g,,15,12.75,4.299,15,BlueCross BlueShield Minnesota, Federal Employee Program,14.76,98.4,,percent of total billed charges,,
BACITRACIN 500 UNIT/GRAM TOP OINT,,6209,LOCAL,Facility,Both,28 g,g,,15,12.75,4.299,15,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,15,100,,percent of total billed charges,,
BACITRACIN 500 UNIT/GRAM TOP OINT,,6209,LOCAL,Facility,Both,28 g,g,,15,12.75,4.299,15,BlueCross BlueShield Minnesota,High Value Network Plan,13.5,90,,percent of total billed charges,,
BACITRACIN 500 UNIT/GRAM TOP OINT,,6209,LOCAL,Facility,Outpatient,28 g,g,,15,12.75,4.299,15,BlueCross BlueShield Minnesota,Medicare Advantage,7.35,49,,percent of total billed charges,,
BACITRACIN 500 UNIT/GRAM TOP OINT,,6209,LOCAL,Facility,Inpatient,28 g,g,,15,12.75,4.299,15,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
BACITRACIN 500 UNIT/GRAM TOP OINT,,6209,LOCAL,Facility,Both,28 g,g,,15,12.75,4.299,15,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,13.2855,88.57,,percent of total billed charges,,
BACITRACIN 500 UNIT/GRAM TOP OINT,,6209,LOCAL,Facility,Both,28 g,g,,15,12.75,4.299,15,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,4.299,28.66,,percent of total billed charges,,
BACITRACIN 500 UNIT/GRAM TOP OINT,,6209,LOCAL,Facility,Outpatient,28 g,g,,15,12.75,4.299,15,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),7.35,49,,percent of total billed charges,,
BACITRACIN 500 UNIT/GRAM TOP OINT,,6209,LOCAL,Facility,Inpatient,28 g,g,,15,12.75,4.299,15,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
BACITRACIN 500 UNIT/GRAM TOP OINT,,6209,LOCAL,Facility,Both,28 g,g,,15,12.75,4.299,15,CorVel,Worker's Compensation,15,100,,percent of total billed charges,,
BACITRACIN 500 UNIT/GRAM TOP OINT,,6209,LOCAL,Facility,Both,28 g,g,,15,12.75,4.299,15,First Health Group Corporation,First Health Network,14.55,97,,percent of total billed charges,,
BACITRACIN 500 UNIT/GRAM TOP OINT,,6209,LOCAL,Facility,Both,28 g,g,,15,12.75,4.299,15,"Health Partners, Inc.",Commercial,14.19,94.6,,percent of total billed charges,,
BACITRACIN 500 UNIT/GRAM TOP OINT,,6209,LOCAL,Facility,Outpatient,28 g,g,,15,12.75,4.299,15,"Health Partners, Inc.",Medicare Advantage,7.35,49,,percent of total billed charges,,
BACITRACIN 500 UNIT/GRAM TOP OINT,,6209,LOCAL,Facility,Inpatient,28 g,g,,15,12.75,4.299,15,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
BACITRACIN 500 UNIT/GRAM TOP OINT,,6209,LOCAL,Facility,Both,28 g,g,,15,12.75,4.299,15,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),9,60,,percent of total billed charges,,
BACITRACIN 500 UNIT/GRAM TOP OINT,,6209,LOCAL,Facility,Both,28 g,g,,15,12.75,4.299,15,"Health Partners, Inc.",State of Minnesota Advantage Program,12.225,81.5,,percent of total billed charges,,
BACITRACIN 500 UNIT/GRAM TOP OINT,,6209,LOCAL,Facility,Both,28 g,g,,15,12.75,4.299,15,"Health Partners, Inc.",State Public Programs,7.5,50,,percent of total billed charges,,
BACITRACIN 500 UNIT/GRAM TOP OINT,,6209,LOCAL,Facility,Both,28 g,g,,15,12.75,4.299,15,Humana Insurance Company,Commercial PPO,14.25,95,,percent of total billed charges,,
BACITRACIN 500 UNIT/GRAM TOP OINT,,6209,LOCAL,Facility,Outpatient,28 g,g,,15,12.75,4.299,15,Humana Insurance Company,Medicare PPO,7.35,49,,percent of total billed charges,,
BACITRACIN 500 UNIT/GRAM TOP OINT,,6209,LOCAL,Facility,Inpatient,28 g,g,,15,12.75,4.299,15,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
BACITRACIN 500 UNIT/GRAM TOP OINT,,6209,LOCAL,Facility,Both,28 g,g,,15,12.75,4.299,15,Medica,Individual & Family,14.865,99.1,,percent of total billed charges,,
BACITRACIN 500 UNIT/GRAM TOP OINT,,6209,LOCAL,Facility,Outpatient,28 g,g,,15,12.75,4.299,15,Medica,Medica Advantage Solution,7.47,49.8,,percent of total billed charges,,
BACITRACIN 500 UNIT/GRAM TOP OINT,,6209,LOCAL,Facility,Inpatient,28 g,g,,15,12.75,4.299,15,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
BACITRACIN 500 UNIT/GRAM TOP OINT,,6209,LOCAL,Facility,Outpatient,28 g,g,,15,12.75,4.299,15,Medica,Medical Assistance,6.69,44.6,,percent of total billed charges,,
BACITRACIN 500 UNIT/GRAM TOP OINT,,6209,LOCAL,Facility,Inpatient,28 g,g,,15,12.75,4.299,15,Medica,Medical Assistance,,,,,Included in per diem rate,
BACITRACIN 500 UNIT/GRAM TOP OINT,,6209,LOCAL,Facility,Outpatient,28 g,g,,15,12.75,4.299,15,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,7.47,49.8,,percent of total billed charges,,
BACITRACIN 500 UNIT/GRAM TOP OINT,,6209,LOCAL,Facility,Inpatient,28 g,g,,15,12.75,4.299,15,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
BACITRACIN 500 UNIT/GRAM TOP OINT,,6209,LOCAL,Facility,Both,28 g,g,,15,12.75,4.299,15,"Multiplan, Inc.","Multiplan, Inc.",14.1,94,,percent of total billed charges,,
BACITRACIN 500 UNIT/GRAM TOP OINT,,6209,LOCAL,Facility,Outpatient,28 g,g,,15,12.75,4.299,15,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,13.515,90.1,,percent of total billed charges,,
BACITRACIN 500 UNIT/GRAM TOP OINT,,6209,LOCAL,Facility,Inpatient,28 g,g,,15,12.75,4.299,15,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
BACITRACIN 500 UNIT/GRAM TOP OINT,,6209,LOCAL,Facility,Both,28 g,g,,15,12.75,4.299,15,"Preferred One Administrative Services, INC.",PPO,14.79,98.6,,percent of total billed charges,,
BACITRACIN 500 UNIT/GRAM TOP OINT,,6209,LOCAL,Facility,Outpatient,28 g,g,,15,12.75,4.299,15,PrimeWest Health,Minnesota Senior Health Options (MSHO),7.7175,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
BACITRACIN 500 UNIT/GRAM TOP OINT,,6209,LOCAL,Facility,Inpatient,28 g,g,,15,12.75,4.299,15,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
BACITRACIN 500 UNIT/GRAM TOP OINT,,6209,LOCAL,Facility,Outpatient,28 g,g,,15,12.75,4.299,15,PrimeWest Health,MinnesotaCare,7.704,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
BACITRACIN 500 UNIT/GRAM TOP OINT,,6209,LOCAL,Facility,Inpatient,28 g,g,,15,12.75,4.299,15,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
BACITRACIN 500 UNIT/GRAM TOP OINT,,6209,LOCAL,Facility,Both,28 g,g,,15,12.75,4.299,15,Sanford Health Plan,Sanford Health Plan,13.8,92,,percent of total billed charges,,
BACITRACIN 500 UNIT/GRAM TOP OINT,,6209,LOCAL,Facility,Outpatient,28 g,g,,15,12.75,4.299,15,"UCare Health, Inc.",Individual & Family Plan,8.4525,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
BACITRACIN 500 UNIT/GRAM TOP OINT,,6209,LOCAL,Facility,Inpatient,28 g,g,,15,12.75,4.299,15,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
BACITRACIN 500 UNIT/GRAM TOP OINT,,6209,LOCAL,Facility,Outpatient,28 g,g,,15,12.75,4.299,15,"UCare Health, Inc.",Medical Assistance,7.5705,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BACITRACIN 500 UNIT/GRAM TOP OINT,,6209,LOCAL,Facility,Inpatient,28 g,g,,15,12.75,4.299,15,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
BACITRACIN 500 UNIT/GRAM TOP OINT,,6209,LOCAL,Facility,Outpatient,28 g,g,,15,12.75,4.299,15,"UCare Health, Inc.",Medicare Advantage,7.5705,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BACITRACIN 500 UNIT/GRAM TOP OINT,,6209,LOCAL,Facility,Inpatient,28 g,g,,15,12.75,4.299,15,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
BACITRACIN 500 UNIT/GRAM TOP OINT,,6209,LOCAL,Facility,Outpatient,28 g,g,,15,12.75,4.299,15,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),7.5705,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BACITRACIN 500 UNIT/GRAM TOP OINT,,6209,LOCAL,Facility,Inpatient,28 g,g,,15,12.75,4.299,15,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
BACITRACIN 500 UNIT/GRAM TOP OINT,,6209,LOCAL,Facility,Both,28 g,g,,15,12.75,4.299,15,UnitedHealthcare,Individual & Family,14.1,94,,percent of total billed charges,,
BACITRACIN 500 UNIT/GRAM TOP OINT,,6209,LOCAL,Facility,Outpatient,28 g,g,,15,12.75,4.299,15,UnitedHealthcare,Medicare Advantage,7.35,49,,percent of total billed charges,,
BACITRACIN 500 UNIT/GRAM TOP OINT,,6209,LOCAL,Facility,Inpatient,28 g,g,,15,12.75,4.299,15,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
BACITRACIN 500 UNIT/GRAM TOP OINT,,6209,LOCAL,Facility,Outpatient,28 g,g,,15,12.75,4.299,15,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,7.2,48,,percent of total billed charges,,100% of DHS outpatient percentage
BACITRACIN 500 UNIT/GRAM TOP OINT,,6209,LOCAL,Facility,Inpatient,28 g,g,,15,12.75,4.299,15,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
HYDROCORTISONE-ALOE VERA 1 % TOP CREAM,,14640,LOCAL,Facility,Both,28 g,g,,9,7.65,2.5794,9,Aetna,Commercial,8.28,92,,percent of total billed charges,,
HYDROCORTISONE-ALOE VERA 1 % TOP CREAM,,14640,LOCAL,Facility,Outpatient,28 g,g,,9,7.65,2.5794,9,Aetna,Medicare Advantage,4.41,49,,percent of total billed charges,,
HYDROCORTISONE-ALOE VERA 1 % TOP CREAM,,14640,LOCAL,Facility,Inpatient,28 g,g,,9,7.65,2.5794,9,Aetna,Medicare Advantage,,,,,Included in per diem rate,
HYDROCORTISONE-ALOE VERA 1 % TOP CREAM,,14640,LOCAL,Facility,Both,28 g,g,,9,7.65,2.5794,9,Aetna,PPO,8.37,93,,percent of total billed charges,,
HYDROCORTISONE-ALOE VERA 1 % TOP CREAM,,14640,LOCAL,Facility,Both,28 g,g,,9,7.65,2.5794,9,America's PPO,America's PPO,8.6427,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
HYDROCORTISONE-ALOE VERA 1 % TOP CREAM,,14640,LOCAL,Facility,Both,28 g,g,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota, Federal Employee Program,8.856,98.4,,percent of total billed charges,,
HYDROCORTISONE-ALOE VERA 1 % TOP CREAM,,14640,LOCAL,Facility,Both,28 g,g,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,9,100,,percent of total billed charges,,
HYDROCORTISONE-ALOE VERA 1 % TOP CREAM,,14640,LOCAL,Facility,Both,28 g,g,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota,High Value Network Plan,8.1,90,,percent of total billed charges,,
HYDROCORTISONE-ALOE VERA 1 % TOP CREAM,,14640,LOCAL,Facility,Outpatient,28 g,g,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota,Medicare Advantage,4.41,49,,percent of total billed charges,,
HYDROCORTISONE-ALOE VERA 1 % TOP CREAM,,14640,LOCAL,Facility,Inpatient,28 g,g,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
HYDROCORTISONE-ALOE VERA 1 % TOP CREAM,,14640,LOCAL,Facility,Both,28 g,g,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,7.9713,88.57,,percent of total billed charges,,
HYDROCORTISONE-ALOE VERA 1 % TOP CREAM,,14640,LOCAL,Facility,Both,28 g,g,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,2.5794,28.66,,percent of total billed charges,,
HYDROCORTISONE-ALOE VERA 1 % TOP CREAM,,14640,LOCAL,Facility,Outpatient,28 g,g,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),4.41,49,,percent of total billed charges,,
HYDROCORTISONE-ALOE VERA 1 % TOP CREAM,,14640,LOCAL,Facility,Inpatient,28 g,g,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
HYDROCORTISONE-ALOE VERA 1 % TOP CREAM,,14640,LOCAL,Facility,Both,28 g,g,,9,7.65,2.5794,9,CorVel,Worker's Compensation,9,100,,percent of total billed charges,,
HYDROCORTISONE-ALOE VERA 1 % TOP CREAM,,14640,LOCAL,Facility,Both,28 g,g,,9,7.65,2.5794,9,First Health Group Corporation,First Health Network,8.73,97,,percent of total billed charges,,
HYDROCORTISONE-ALOE VERA 1 % TOP CREAM,,14640,LOCAL,Facility,Both,28 g,g,,9,7.65,2.5794,9,"Health Partners, Inc.",Commercial,8.514,94.6,,percent of total billed charges,,
HYDROCORTISONE-ALOE VERA 1 % TOP CREAM,,14640,LOCAL,Facility,Outpatient,28 g,g,,9,7.65,2.5794,9,"Health Partners, Inc.",Medicare Advantage,4.41,49,,percent of total billed charges,,
HYDROCORTISONE-ALOE VERA 1 % TOP CREAM,,14640,LOCAL,Facility,Inpatient,28 g,g,,9,7.65,2.5794,9,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
HYDROCORTISONE-ALOE VERA 1 % TOP CREAM,,14640,LOCAL,Facility,Both,28 g,g,,9,7.65,2.5794,9,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),5.4,60,,percent of total billed charges,,
HYDROCORTISONE-ALOE VERA 1 % TOP CREAM,,14640,LOCAL,Facility,Both,28 g,g,,9,7.65,2.5794,9,"Health Partners, Inc.",State of Minnesota Advantage Program,7.335,81.5,,percent of total billed charges,,
HYDROCORTISONE-ALOE VERA 1 % TOP CREAM,,14640,LOCAL,Facility,Both,28 g,g,,9,7.65,2.5794,9,"Health Partners, Inc.",State Public Programs,4.5,50,,percent of total billed charges,,
HYDROCORTISONE-ALOE VERA 1 % TOP CREAM,,14640,LOCAL,Facility,Both,28 g,g,,9,7.65,2.5794,9,Humana Insurance Company,Commercial PPO,8.55,95,,percent of total billed charges,,
HYDROCORTISONE-ALOE VERA 1 % TOP CREAM,,14640,LOCAL,Facility,Outpatient,28 g,g,,9,7.65,2.5794,9,Humana Insurance Company,Medicare PPO,4.41,49,,percent of total billed charges,,
HYDROCORTISONE-ALOE VERA 1 % TOP CREAM,,14640,LOCAL,Facility,Inpatient,28 g,g,,9,7.65,2.5794,9,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
HYDROCORTISONE-ALOE VERA 1 % TOP CREAM,,14640,LOCAL,Facility,Both,28 g,g,,9,7.65,2.5794,9,Medica,Individual & Family,8.919,99.1,,percent of total billed charges,,
HYDROCORTISONE-ALOE VERA 1 % TOP CREAM,,14640,LOCAL,Facility,Outpatient,28 g,g,,9,7.65,2.5794,9,Medica,Medica Advantage Solution,4.482,49.8,,percent of total billed charges,,
HYDROCORTISONE-ALOE VERA 1 % TOP CREAM,,14640,LOCAL,Facility,Inpatient,28 g,g,,9,7.65,2.5794,9,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
HYDROCORTISONE-ALOE VERA 1 % TOP CREAM,,14640,LOCAL,Facility,Outpatient,28 g,g,,9,7.65,2.5794,9,Medica,Medical Assistance,4.014,44.6,,percent of total billed charges,,
HYDROCORTISONE-ALOE VERA 1 % TOP CREAM,,14640,LOCAL,Facility,Inpatient,28 g,g,,9,7.65,2.5794,9,Medica,Medical Assistance,,,,,Included in per diem rate,
HYDROCORTISONE-ALOE VERA 1 % TOP CREAM,,14640,LOCAL,Facility,Outpatient,28 g,g,,9,7.65,2.5794,9,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,4.482,49.8,,percent of total billed charges,,
HYDROCORTISONE-ALOE VERA 1 % TOP CREAM,,14640,LOCAL,Facility,Inpatient,28 g,g,,9,7.65,2.5794,9,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
HYDROCORTISONE-ALOE VERA 1 % TOP CREAM,,14640,LOCAL,Facility,Both,28 g,g,,9,7.65,2.5794,9,"Multiplan, Inc.","Multiplan, Inc.",8.46,94,,percent of total billed charges,,
HYDROCORTISONE-ALOE VERA 1 % TOP CREAM,,14640,LOCAL,Facility,Outpatient,28 g,g,,9,7.65,2.5794,9,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,8.109,90.1,,percent of total billed charges,,
HYDROCORTISONE-ALOE VERA 1 % TOP CREAM,,14640,LOCAL,Facility,Inpatient,28 g,g,,9,7.65,2.5794,9,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
HYDROCORTISONE-ALOE VERA 1 % TOP CREAM,,14640,LOCAL,Facility,Both,28 g,g,,9,7.65,2.5794,9,"Preferred One Administrative Services, INC.",PPO,8.874,98.6,,percent of total billed charges,,
HYDROCORTISONE-ALOE VERA 1 % TOP CREAM,,14640,LOCAL,Facility,Outpatient,28 g,g,,9,7.65,2.5794,9,PrimeWest Health,Minnesota Senior Health Options (MSHO),4.6305,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
HYDROCORTISONE-ALOE VERA 1 % TOP CREAM,,14640,LOCAL,Facility,Inpatient,28 g,g,,9,7.65,2.5794,9,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
HYDROCORTISONE-ALOE VERA 1 % TOP CREAM,,14640,LOCAL,Facility,Outpatient,28 g,g,,9,7.65,2.5794,9,PrimeWest Health,MinnesotaCare,4.6224,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
HYDROCORTISONE-ALOE VERA 1 % TOP CREAM,,14640,LOCAL,Facility,Inpatient,28 g,g,,9,7.65,2.5794,9,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
HYDROCORTISONE-ALOE VERA 1 % TOP CREAM,,14640,LOCAL,Facility,Both,28 g,g,,9,7.65,2.5794,9,Sanford Health Plan,Sanford Health Plan,8.28,92,,percent of total billed charges,,
HYDROCORTISONE-ALOE VERA 1 % TOP CREAM,,14640,LOCAL,Facility,Outpatient,28 g,g,,9,7.65,2.5794,9,"UCare Health, Inc.",Individual & Family Plan,5.0715,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
HYDROCORTISONE-ALOE VERA 1 % TOP CREAM,,14640,LOCAL,Facility,Inpatient,28 g,g,,9,7.65,2.5794,9,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
HYDROCORTISONE-ALOE VERA 1 % TOP CREAM,,14640,LOCAL,Facility,Outpatient,28 g,g,,9,7.65,2.5794,9,"UCare Health, Inc.",Medical Assistance,4.5423,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
HYDROCORTISONE-ALOE VERA 1 % TOP CREAM,,14640,LOCAL,Facility,Inpatient,28 g,g,,9,7.65,2.5794,9,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
HYDROCORTISONE-ALOE VERA 1 % TOP CREAM,,14640,LOCAL,Facility,Outpatient,28 g,g,,9,7.65,2.5794,9,"UCare Health, Inc.",Medicare Advantage,4.5423,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
HYDROCORTISONE-ALOE VERA 1 % TOP CREAM,,14640,LOCAL,Facility,Inpatient,28 g,g,,9,7.65,2.5794,9,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
HYDROCORTISONE-ALOE VERA 1 % TOP CREAM,,14640,LOCAL,Facility,Outpatient,28 g,g,,9,7.65,2.5794,9,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),4.5423,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
HYDROCORTISONE-ALOE VERA 1 % TOP CREAM,,14640,LOCAL,Facility,Inpatient,28 g,g,,9,7.65,2.5794,9,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
HYDROCORTISONE-ALOE VERA 1 % TOP CREAM,,14640,LOCAL,Facility,Both,28 g,g,,9,7.65,2.5794,9,UnitedHealthcare,Individual & Family,8.46,94,,percent of total billed charges,,
HYDROCORTISONE-ALOE VERA 1 % TOP CREAM,,14640,LOCAL,Facility,Outpatient,28 g,g,,9,7.65,2.5794,9,UnitedHealthcare,Medicare Advantage,4.41,49,,percent of total billed charges,,
HYDROCORTISONE-ALOE VERA 1 % TOP CREAM,,14640,LOCAL,Facility,Inpatient,28 g,g,,9,7.65,2.5794,9,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
HYDROCORTISONE-ALOE VERA 1 % TOP CREAM,,14640,LOCAL,Facility,Outpatient,28 g,g,,9,7.65,2.5794,9,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,4.32,48,,percent of total billed charges,,100% of DHS outpatient percentage
HYDROCORTISONE-ALOE VERA 1 % TOP CREAM,,14640,LOCAL,Facility,Inpatient,28 g,g,,9,7.65,2.5794,9,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
CLOTRIMAZOLE 1 % TOP CREAM,,18845,LOCAL,Facility,Both,28 g,g,,13,11.05,3.7258,13,Aetna,Commercial,11.96,92,,percent of total billed charges,,
CLOTRIMAZOLE 1 % TOP CREAM,,18845,LOCAL,Facility,Outpatient,28 g,g,,13,11.05,3.7258,13,Aetna,Medicare Advantage,6.37,49,,percent of total billed charges,,
CLOTRIMAZOLE 1 % TOP CREAM,,18845,LOCAL,Facility,Inpatient,28 g,g,,13,11.05,3.7258,13,Aetna,Medicare Advantage,,,,,Included in per diem rate,
CLOTRIMAZOLE 1 % TOP CREAM,,18845,LOCAL,Facility,Both,28 g,g,,13,11.05,3.7258,13,Aetna,PPO,12.09,93,,percent of total billed charges,,
CLOTRIMAZOLE 1 % TOP CREAM,,18845,LOCAL,Facility,Both,28 g,g,,13,11.05,3.7258,13,America's PPO,America's PPO,12.4839,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
CLOTRIMAZOLE 1 % TOP CREAM,,18845,LOCAL,Facility,Both,28 g,g,,13,11.05,3.7258,13,BlueCross BlueShield Minnesota, Federal Employee Program,12.792,98.4,,percent of total billed charges,,
CLOTRIMAZOLE 1 % TOP CREAM,,18845,LOCAL,Facility,Both,28 g,g,,13,11.05,3.7258,13,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,13,100,,percent of total billed charges,,
CLOTRIMAZOLE 1 % TOP CREAM,,18845,LOCAL,Facility,Both,28 g,g,,13,11.05,3.7258,13,BlueCross BlueShield Minnesota,High Value Network Plan,11.7,90,,percent of total billed charges,,
CLOTRIMAZOLE 1 % TOP CREAM,,18845,LOCAL,Facility,Outpatient,28 g,g,,13,11.05,3.7258,13,BlueCross BlueShield Minnesota,Medicare Advantage,6.37,49,,percent of total billed charges,,
CLOTRIMAZOLE 1 % TOP CREAM,,18845,LOCAL,Facility,Inpatient,28 g,g,,13,11.05,3.7258,13,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
CLOTRIMAZOLE 1 % TOP CREAM,,18845,LOCAL,Facility,Both,28 g,g,,13,11.05,3.7258,13,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,11.5141,88.57,,percent of total billed charges,,
CLOTRIMAZOLE 1 % TOP CREAM,,18845,LOCAL,Facility,Both,28 g,g,,13,11.05,3.7258,13,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,3.7258,28.66,,percent of total billed charges,,
CLOTRIMAZOLE 1 % TOP CREAM,,18845,LOCAL,Facility,Outpatient,28 g,g,,13,11.05,3.7258,13,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),6.37,49,,percent of total billed charges,,
CLOTRIMAZOLE 1 % TOP CREAM,,18845,LOCAL,Facility,Inpatient,28 g,g,,13,11.05,3.7258,13,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
CLOTRIMAZOLE 1 % TOP CREAM,,18845,LOCAL,Facility,Both,28 g,g,,13,11.05,3.7258,13,CorVel,Worker's Compensation,13,100,,percent of total billed charges,,
CLOTRIMAZOLE 1 % TOP CREAM,,18845,LOCAL,Facility,Both,28 g,g,,13,11.05,3.7258,13,First Health Group Corporation,First Health Network,12.61,97,,percent of total billed charges,,
CLOTRIMAZOLE 1 % TOP CREAM,,18845,LOCAL,Facility,Both,28 g,g,,13,11.05,3.7258,13,"Health Partners, Inc.",Commercial,12.298,94.6,,percent of total billed charges,,
CLOTRIMAZOLE 1 % TOP CREAM,,18845,LOCAL,Facility,Outpatient,28 g,g,,13,11.05,3.7258,13,"Health Partners, Inc.",Medicare Advantage,6.37,49,,percent of total billed charges,,
CLOTRIMAZOLE 1 % TOP CREAM,,18845,LOCAL,Facility,Inpatient,28 g,g,,13,11.05,3.7258,13,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CLOTRIMAZOLE 1 % TOP CREAM,,18845,LOCAL,Facility,Both,28 g,g,,13,11.05,3.7258,13,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),7.8,60,,percent of total billed charges,,
CLOTRIMAZOLE 1 % TOP CREAM,,18845,LOCAL,Facility,Both,28 g,g,,13,11.05,3.7258,13,"Health Partners, Inc.",State of Minnesota Advantage Program,10.595,81.5,,percent of total billed charges,,
CLOTRIMAZOLE 1 % TOP CREAM,,18845,LOCAL,Facility,Both,28 g,g,,13,11.05,3.7258,13,"Health Partners, Inc.",State Public Programs,6.5,50,,percent of total billed charges,,
CLOTRIMAZOLE 1 % TOP CREAM,,18845,LOCAL,Facility,Both,28 g,g,,13,11.05,3.7258,13,Humana Insurance Company,Commercial PPO,12.35,95,,percent of total billed charges,,
CLOTRIMAZOLE 1 % TOP CREAM,,18845,LOCAL,Facility,Outpatient,28 g,g,,13,11.05,3.7258,13,Humana Insurance Company,Medicare PPO,6.37,49,,percent of total billed charges,,
CLOTRIMAZOLE 1 % TOP CREAM,,18845,LOCAL,Facility,Inpatient,28 g,g,,13,11.05,3.7258,13,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
CLOTRIMAZOLE 1 % TOP CREAM,,18845,LOCAL,Facility,Both,28 g,g,,13,11.05,3.7258,13,Medica,Individual & Family,12.883,99.1,,percent of total billed charges,,
CLOTRIMAZOLE 1 % TOP CREAM,,18845,LOCAL,Facility,Outpatient,28 g,g,,13,11.05,3.7258,13,Medica,Medica Advantage Solution,6.474,49.8,,percent of total billed charges,,
CLOTRIMAZOLE 1 % TOP CREAM,,18845,LOCAL,Facility,Inpatient,28 g,g,,13,11.05,3.7258,13,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
CLOTRIMAZOLE 1 % TOP CREAM,,18845,LOCAL,Facility,Outpatient,28 g,g,,13,11.05,3.7258,13,Medica,Medical Assistance,5.798,44.6,,percent of total billed charges,,
CLOTRIMAZOLE 1 % TOP CREAM,,18845,LOCAL,Facility,Inpatient,28 g,g,,13,11.05,3.7258,13,Medica,Medical Assistance,,,,,Included in per diem rate,
CLOTRIMAZOLE 1 % TOP CREAM,,18845,LOCAL,Facility,Outpatient,28 g,g,,13,11.05,3.7258,13,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,6.474,49.8,,percent of total billed charges,,
CLOTRIMAZOLE 1 % TOP CREAM,,18845,LOCAL,Facility,Inpatient,28 g,g,,13,11.05,3.7258,13,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
CLOTRIMAZOLE 1 % TOP CREAM,,18845,LOCAL,Facility,Both,28 g,g,,13,11.05,3.7258,13,"Multiplan, Inc.","Multiplan, Inc.",12.22,94,,percent of total billed charges,,
CLOTRIMAZOLE 1 % TOP CREAM,,18845,LOCAL,Facility,Outpatient,28 g,g,,13,11.05,3.7258,13,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,11.713,90.1,,percent of total billed charges,,
CLOTRIMAZOLE 1 % TOP CREAM,,18845,LOCAL,Facility,Inpatient,28 g,g,,13,11.05,3.7258,13,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
CLOTRIMAZOLE 1 % TOP CREAM,,18845,LOCAL,Facility,Both,28 g,g,,13,11.05,3.7258,13,"Preferred One Administrative Services, INC.",PPO,12.818,98.6,,percent of total billed charges,,
CLOTRIMAZOLE 1 % TOP CREAM,,18845,LOCAL,Facility,Outpatient,28 g,g,,13,11.05,3.7258,13,PrimeWest Health,Minnesota Senior Health Options (MSHO),6.6885,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
CLOTRIMAZOLE 1 % TOP CREAM,,18845,LOCAL,Facility,Inpatient,28 g,g,,13,11.05,3.7258,13,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CLOTRIMAZOLE 1 % TOP CREAM,,18845,LOCAL,Facility,Outpatient,28 g,g,,13,11.05,3.7258,13,PrimeWest Health,MinnesotaCare,6.6768,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
CLOTRIMAZOLE 1 % TOP CREAM,,18845,LOCAL,Facility,Inpatient,28 g,g,,13,11.05,3.7258,13,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
CLOTRIMAZOLE 1 % TOP CREAM,,18845,LOCAL,Facility,Both,28 g,g,,13,11.05,3.7258,13,Sanford Health Plan,Sanford Health Plan,11.96,92,,percent of total billed charges,,
CLOTRIMAZOLE 1 % TOP CREAM,,18845,LOCAL,Facility,Outpatient,28 g,g,,13,11.05,3.7258,13,"UCare Health, Inc.",Individual & Family Plan,7.3255,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
CLOTRIMAZOLE 1 % TOP CREAM,,18845,LOCAL,Facility,Inpatient,28 g,g,,13,11.05,3.7258,13,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
CLOTRIMAZOLE 1 % TOP CREAM,,18845,LOCAL,Facility,Outpatient,28 g,g,,13,11.05,3.7258,13,"UCare Health, Inc.",Medical Assistance,6.5611,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CLOTRIMAZOLE 1 % TOP CREAM,,18845,LOCAL,Facility,Inpatient,28 g,g,,13,11.05,3.7258,13,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
CLOTRIMAZOLE 1 % TOP CREAM,,18845,LOCAL,Facility,Outpatient,28 g,g,,13,11.05,3.7258,13,"UCare Health, Inc.",Medicare Advantage,6.5611,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CLOTRIMAZOLE 1 % TOP CREAM,,18845,LOCAL,Facility,Inpatient,28 g,g,,13,11.05,3.7258,13,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CLOTRIMAZOLE 1 % TOP CREAM,,18845,LOCAL,Facility,Outpatient,28 g,g,,13,11.05,3.7258,13,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),6.5611,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CLOTRIMAZOLE 1 % TOP CREAM,,18845,LOCAL,Facility,Inpatient,28 g,g,,13,11.05,3.7258,13,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CLOTRIMAZOLE 1 % TOP CREAM,,18845,LOCAL,Facility,Both,28 g,g,,13,11.05,3.7258,13,UnitedHealthcare,Individual & Family,12.22,94,,percent of total billed charges,,
CLOTRIMAZOLE 1 % TOP CREAM,,18845,LOCAL,Facility,Outpatient,28 g,g,,13,11.05,3.7258,13,UnitedHealthcare,Medicare Advantage,6.37,49,,percent of total billed charges,,
CLOTRIMAZOLE 1 % TOP CREAM,,18845,LOCAL,Facility,Inpatient,28 g,g,,13,11.05,3.7258,13,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
CLOTRIMAZOLE 1 % TOP CREAM,,18845,LOCAL,Facility,Outpatient,28 g,g,,13,11.05,3.7258,13,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,6.24,48,,percent of total billed charges,,100% of DHS outpatient percentage
CLOTRIMAZOLE 1 % TOP CREAM,,18845,LOCAL,Facility,Inpatient,28 g,g,,13,11.05,3.7258,13,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5MG-400 UNIT- 5,000 UNIT/GRAM TOP OINT",,1727,LOCAL,Facility,Both,28.4 g,g,,18,15.3,5.1588,18,Aetna,Commercial,16.56,92,,percent of total billed charges,,
"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5MG-400 UNIT- 5,000 UNIT/GRAM TOP OINT",,1727,LOCAL,Facility,Outpatient,28.4 g,g,,18,15.3,5.1588,18,Aetna,Medicare Advantage,8.82,49,,percent of total billed charges,,
"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5MG-400 UNIT- 5,000 UNIT/GRAM TOP OINT",,1727,LOCAL,Facility,Inpatient,28.4 g,g,,18,15.3,5.1588,18,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5MG-400 UNIT- 5,000 UNIT/GRAM TOP OINT",,1727,LOCAL,Facility,Both,28.4 g,g,,18,15.3,5.1588,18,Aetna,PPO,16.74,93,,percent of total billed charges,,
"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5MG-400 UNIT- 5,000 UNIT/GRAM TOP OINT",,1727,LOCAL,Facility,Both,28.4 g,g,,18,15.3,5.1588,18,America's PPO,America's PPO,17.2854,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5MG-400 UNIT- 5,000 UNIT/GRAM TOP OINT",,1727,LOCAL,Facility,Both,28.4 g,g,,18,15.3,5.1588,18,BlueCross BlueShield Minnesota, Federal Employee Program,17.712,98.4,,percent of total billed charges,,
"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5MG-400 UNIT- 5,000 UNIT/GRAM TOP OINT",,1727,LOCAL,Facility,Both,28.4 g,g,,18,15.3,5.1588,18,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,18,100,,percent of total billed charges,,
"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5MG-400 UNIT- 5,000 UNIT/GRAM TOP OINT",,1727,LOCAL,Facility,Both,28.4 g,g,,18,15.3,5.1588,18,BlueCross BlueShield Minnesota,High Value Network Plan,16.2,90,,percent of total billed charges,,
"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5MG-400 UNIT- 5,000 UNIT/GRAM TOP OINT",,1727,LOCAL,Facility,Outpatient,28.4 g,g,,18,15.3,5.1588,18,BlueCross BlueShield Minnesota,Medicare Advantage,8.82,49,,percent of total billed charges,,
"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5MG-400 UNIT- 5,000 UNIT/GRAM TOP OINT",,1727,LOCAL,Facility,Inpatient,28.4 g,g,,18,15.3,5.1588,18,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5MG-400 UNIT- 5,000 UNIT/GRAM TOP OINT",,1727,LOCAL,Facility,Both,28.4 g,g,,18,15.3,5.1588,18,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,15.9426,88.57,,percent of total billed charges,,
"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5MG-400 UNIT- 5,000 UNIT/GRAM TOP OINT",,1727,LOCAL,Facility,Both,28.4 g,g,,18,15.3,5.1588,18,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,5.1588,28.66,,percent of total billed charges,,
"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5MG-400 UNIT- 5,000 UNIT/GRAM TOP OINT",,1727,LOCAL,Facility,Outpatient,28.4 g,g,,18,15.3,5.1588,18,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),8.82,49,,percent of total billed charges,,
"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5MG-400 UNIT- 5,000 UNIT/GRAM TOP OINT",,1727,LOCAL,Facility,Inpatient,28.4 g,g,,18,15.3,5.1588,18,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5MG-400 UNIT- 5,000 UNIT/GRAM TOP OINT",,1727,LOCAL,Facility,Both,28.4 g,g,,18,15.3,5.1588,18,CorVel,Worker's Compensation,18,100,,percent of total billed charges,,
"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5MG-400 UNIT- 5,000 UNIT/GRAM TOP OINT",,1727,LOCAL,Facility,Both,28.4 g,g,,18,15.3,5.1588,18,First Health Group Corporation,First Health Network,17.46,97,,percent of total billed charges,,
"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5MG-400 UNIT- 5,000 UNIT/GRAM TOP OINT",,1727,LOCAL,Facility,Both,28.4 g,g,,18,15.3,5.1588,18,"Health Partners, Inc.",Commercial,17.028,94.6,,percent of total billed charges,,
"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5MG-400 UNIT- 5,000 UNIT/GRAM TOP OINT",,1727,LOCAL,Facility,Outpatient,28.4 g,g,,18,15.3,5.1588,18,"Health Partners, Inc.",Medicare Advantage,8.82,49,,percent of total billed charges,,
"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5MG-400 UNIT- 5,000 UNIT/GRAM TOP OINT",,1727,LOCAL,Facility,Inpatient,28.4 g,g,,18,15.3,5.1588,18,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5MG-400 UNIT- 5,000 UNIT/GRAM TOP OINT",,1727,LOCAL,Facility,Both,28.4 g,g,,18,15.3,5.1588,18,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),10.8,60,,percent of total billed charges,,
"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5MG-400 UNIT- 5,000 UNIT/GRAM TOP OINT",,1727,LOCAL,Facility,Both,28.4 g,g,,18,15.3,5.1588,18,"Health Partners, Inc.",State of Minnesota Advantage Program,14.67,81.5,,percent of total billed charges,,
"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5MG-400 UNIT- 5,000 UNIT/GRAM TOP OINT",,1727,LOCAL,Facility,Both,28.4 g,g,,18,15.3,5.1588,18,"Health Partners, Inc.",State Public Programs,9,50,,percent of total billed charges,,
"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5MG-400 UNIT- 5,000 UNIT/GRAM TOP OINT",,1727,LOCAL,Facility,Both,28.4 g,g,,18,15.3,5.1588,18,Humana Insurance Company,Commercial PPO,17.1,95,,percent of total billed charges,,
"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5MG-400 UNIT- 5,000 UNIT/GRAM TOP OINT",,1727,LOCAL,Facility,Outpatient,28.4 g,g,,18,15.3,5.1588,18,Humana Insurance Company,Medicare PPO,8.82,49,,percent of total billed charges,,
"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5MG-400 UNIT- 5,000 UNIT/GRAM TOP OINT",,1727,LOCAL,Facility,Inpatient,28.4 g,g,,18,15.3,5.1588,18,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5MG-400 UNIT- 5,000 UNIT/GRAM TOP OINT",,1727,LOCAL,Facility,Both,28.4 g,g,,18,15.3,5.1588,18,Medica,Individual & Family,17.838,99.1,,percent of total billed charges,,
"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5MG-400 UNIT- 5,000 UNIT/GRAM TOP OINT",,1727,LOCAL,Facility,Outpatient,28.4 g,g,,18,15.3,5.1588,18,Medica,Medica Advantage Solution,8.964,49.8,,percent of total billed charges,,
"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5MG-400 UNIT- 5,000 UNIT/GRAM TOP OINT",,1727,LOCAL,Facility,Inpatient,28.4 g,g,,18,15.3,5.1588,18,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5MG-400 UNIT- 5,000 UNIT/GRAM TOP OINT",,1727,LOCAL,Facility,Outpatient,28.4 g,g,,18,15.3,5.1588,18,Medica,Medical Assistance,8.028,44.6,,percent of total billed charges,,
"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5MG-400 UNIT- 5,000 UNIT/GRAM TOP OINT",,1727,LOCAL,Facility,Inpatient,28.4 g,g,,18,15.3,5.1588,18,Medica,Medical Assistance,,,,,Included in per diem rate,
"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5MG-400 UNIT- 5,000 UNIT/GRAM TOP OINT",,1727,LOCAL,Facility,Outpatient,28.4 g,g,,18,15.3,5.1588,18,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,8.964,49.8,,percent of total billed charges,,
"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5MG-400 UNIT- 5,000 UNIT/GRAM TOP OINT",,1727,LOCAL,Facility,Inpatient,28.4 g,g,,18,15.3,5.1588,18,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5MG-400 UNIT- 5,000 UNIT/GRAM TOP OINT",,1727,LOCAL,Facility,Both,28.4 g,g,,18,15.3,5.1588,18,"Multiplan, Inc.","Multiplan, Inc.",16.92,94,,percent of total billed charges,,
"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5MG-400 UNIT- 5,000 UNIT/GRAM TOP OINT",,1727,LOCAL,Facility,Outpatient,28.4 g,g,,18,15.3,5.1588,18,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,16.218,90.1,,percent of total billed charges,,
"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5MG-400 UNIT- 5,000 UNIT/GRAM TOP OINT",,1727,LOCAL,Facility,Inpatient,28.4 g,g,,18,15.3,5.1588,18,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5MG-400 UNIT- 5,000 UNIT/GRAM TOP OINT",,1727,LOCAL,Facility,Both,28.4 g,g,,18,15.3,5.1588,18,"Preferred One Administrative Services, INC.",PPO,17.748,98.6,,percent of total billed charges,,
"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5MG-400 UNIT- 5,000 UNIT/GRAM TOP OINT",,1727,LOCAL,Facility,Outpatient,28.4 g,g,,18,15.3,5.1588,18,PrimeWest Health,Minnesota Senior Health Options (MSHO),9.261,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5MG-400 UNIT- 5,000 UNIT/GRAM TOP OINT",,1727,LOCAL,Facility,Inpatient,28.4 g,g,,18,15.3,5.1588,18,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5MG-400 UNIT- 5,000 UNIT/GRAM TOP OINT",,1727,LOCAL,Facility,Outpatient,28.4 g,g,,18,15.3,5.1588,18,PrimeWest Health,MinnesotaCare,9.2448,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5MG-400 UNIT- 5,000 UNIT/GRAM TOP OINT",,1727,LOCAL,Facility,Inpatient,28.4 g,g,,18,15.3,5.1588,18,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5MG-400 UNIT- 5,000 UNIT/GRAM TOP OINT",,1727,LOCAL,Facility,Both,28.4 g,g,,18,15.3,5.1588,18,Sanford Health Plan,Sanford Health Plan,16.56,92,,percent of total billed charges,,
"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5MG-400 UNIT- 5,000 UNIT/GRAM TOP OINT",,1727,LOCAL,Facility,Outpatient,28.4 g,g,,18,15.3,5.1588,18,"UCare Health, Inc.",Individual & Family Plan,10.143,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5MG-400 UNIT- 5,000 UNIT/GRAM TOP OINT",,1727,LOCAL,Facility,Inpatient,28.4 g,g,,18,15.3,5.1588,18,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5MG-400 UNIT- 5,000 UNIT/GRAM TOP OINT",,1727,LOCAL,Facility,Outpatient,28.4 g,g,,18,15.3,5.1588,18,"UCare Health, Inc.",Medical Assistance,9.0846,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5MG-400 UNIT- 5,000 UNIT/GRAM TOP OINT",,1727,LOCAL,Facility,Inpatient,28.4 g,g,,18,15.3,5.1588,18,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5MG-400 UNIT- 5,000 UNIT/GRAM TOP OINT",,1727,LOCAL,Facility,Outpatient,28.4 g,g,,18,15.3,5.1588,18,"UCare Health, Inc.",Medicare Advantage,9.0846,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5MG-400 UNIT- 5,000 UNIT/GRAM TOP OINT",,1727,LOCAL,Facility,Inpatient,28.4 g,g,,18,15.3,5.1588,18,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5MG-400 UNIT- 5,000 UNIT/GRAM TOP OINT",,1727,LOCAL,Facility,Outpatient,28.4 g,g,,18,15.3,5.1588,18,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),9.0846,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5MG-400 UNIT- 5,000 UNIT/GRAM TOP OINT",,1727,LOCAL,Facility,Inpatient,28.4 g,g,,18,15.3,5.1588,18,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5MG-400 UNIT- 5,000 UNIT/GRAM TOP OINT",,1727,LOCAL,Facility,Both,28.4 g,g,,18,15.3,5.1588,18,UnitedHealthcare,Individual & Family,16.92,94,,percent of total billed charges,,
"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5MG-400 UNIT- 5,000 UNIT/GRAM TOP OINT",,1727,LOCAL,Facility,Outpatient,28.4 g,g,,18,15.3,5.1588,18,UnitedHealthcare,Medicare Advantage,8.82,49,,percent of total billed charges,,
"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5MG-400 UNIT- 5,000 UNIT/GRAM TOP OINT",,1727,LOCAL,Facility,Inpatient,28.4 g,g,,18,15.3,5.1588,18,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5MG-400 UNIT- 5,000 UNIT/GRAM TOP OINT",,1727,LOCAL,Facility,Outpatient,28.4 g,g,,18,15.3,5.1588,18,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,8.64,48,,percent of total billed charges,,100% of DHS outpatient percentage
"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5MG-400 UNIT- 5,000 UNIT/GRAM TOP OINT",,1727,LOCAL,Facility,Inpatient,28.4 g,g,,18,15.3,5.1588,18,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
ZINC OXIDE 20 % TOP OINT,,7809,LOCAL,Facility,Both,28.4 g,g,,33,28.05,9.4578,33,Aetna,Commercial,30.36,92,,percent of total billed charges,,
ZINC OXIDE 20 % TOP OINT,,7809,LOCAL,Facility,Outpatient,28.4 g,g,,33,28.05,9.4578,33,Aetna,Medicare Advantage,16.17,49,,percent of total billed charges,,
ZINC OXIDE 20 % TOP OINT,,7809,LOCAL,Facility,Inpatient,28.4 g,g,,33,28.05,9.4578,33,Aetna,Medicare Advantage,,,,,Included in per diem rate,
ZINC OXIDE 20 % TOP OINT,,7809,LOCAL,Facility,Both,28.4 g,g,,33,28.05,9.4578,33,Aetna,PPO,30.69,93,,percent of total billed charges,,
ZINC OXIDE 20 % TOP OINT,,7809,LOCAL,Facility,Both,28.4 g,g,,33,28.05,9.4578,33,America's PPO,America's PPO,31.6899,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
ZINC OXIDE 20 % TOP OINT,,7809,LOCAL,Facility,Both,28.4 g,g,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota, Federal Employee Program,32.472,98.4,,percent of total billed charges,,
ZINC OXIDE 20 % TOP OINT,,7809,LOCAL,Facility,Both,28.4 g,g,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,33,100,,percent of total billed charges,,
ZINC OXIDE 20 % TOP OINT,,7809,LOCAL,Facility,Both,28.4 g,g,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota,High Value Network Plan,29.7,90,,percent of total billed charges,,
ZINC OXIDE 20 % TOP OINT,,7809,LOCAL,Facility,Outpatient,28.4 g,g,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota,Medicare Advantage,16.17,49,,percent of total billed charges,,
ZINC OXIDE 20 % TOP OINT,,7809,LOCAL,Facility,Inpatient,28.4 g,g,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
ZINC OXIDE 20 % TOP OINT,,7809,LOCAL,Facility,Both,28.4 g,g,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,29.2281,88.57,,percent of total billed charges,,
ZINC OXIDE 20 % TOP OINT,,7809,LOCAL,Facility,Both,28.4 g,g,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,9.4578,28.66,,percent of total billed charges,,
ZINC OXIDE 20 % TOP OINT,,7809,LOCAL,Facility,Outpatient,28.4 g,g,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),16.17,49,,percent of total billed charges,,
ZINC OXIDE 20 % TOP OINT,,7809,LOCAL,Facility,Inpatient,28.4 g,g,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
ZINC OXIDE 20 % TOP OINT,,7809,LOCAL,Facility,Both,28.4 g,g,,33,28.05,9.4578,33,CorVel,Worker's Compensation,33,100,,percent of total billed charges,,
ZINC OXIDE 20 % TOP OINT,,7809,LOCAL,Facility,Both,28.4 g,g,,33,28.05,9.4578,33,First Health Group Corporation,First Health Network,32.01,97,,percent of total billed charges,,
ZINC OXIDE 20 % TOP OINT,,7809,LOCAL,Facility,Both,28.4 g,g,,33,28.05,9.4578,33,"Health Partners, Inc.",Commercial,31.218,94.6,,percent of total billed charges,,
ZINC OXIDE 20 % TOP OINT,,7809,LOCAL,Facility,Outpatient,28.4 g,g,,33,28.05,9.4578,33,"Health Partners, Inc.",Medicare Advantage,16.17,49,,percent of total billed charges,,
ZINC OXIDE 20 % TOP OINT,,7809,LOCAL,Facility,Inpatient,28.4 g,g,,33,28.05,9.4578,33,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ZINC OXIDE 20 % TOP OINT,,7809,LOCAL,Facility,Both,28.4 g,g,,33,28.05,9.4578,33,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),19.8,60,,percent of total billed charges,,
ZINC OXIDE 20 % TOP OINT,,7809,LOCAL,Facility,Both,28.4 g,g,,33,28.05,9.4578,33,"Health Partners, Inc.",State of Minnesota Advantage Program,26.895,81.5,,percent of total billed charges,,
ZINC OXIDE 20 % TOP OINT,,7809,LOCAL,Facility,Both,28.4 g,g,,33,28.05,9.4578,33,"Health Partners, Inc.",State Public Programs,16.5,50,,percent of total billed charges,,
ZINC OXIDE 20 % TOP OINT,,7809,LOCAL,Facility,Both,28.4 g,g,,33,28.05,9.4578,33,Humana Insurance Company,Commercial PPO,31.35,95,,percent of total billed charges,,
ZINC OXIDE 20 % TOP OINT,,7809,LOCAL,Facility,Outpatient,28.4 g,g,,33,28.05,9.4578,33,Humana Insurance Company,Medicare PPO,16.17,49,,percent of total billed charges,,
ZINC OXIDE 20 % TOP OINT,,7809,LOCAL,Facility,Inpatient,28.4 g,g,,33,28.05,9.4578,33,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
ZINC OXIDE 20 % TOP OINT,,7809,LOCAL,Facility,Both,28.4 g,g,,33,28.05,9.4578,33,Medica,Individual & Family,32.703,99.1,,percent of total billed charges,,
ZINC OXIDE 20 % TOP OINT,,7809,LOCAL,Facility,Outpatient,28.4 g,g,,33,28.05,9.4578,33,Medica,Medica Advantage Solution,16.434,49.8,,percent of total billed charges,,
ZINC OXIDE 20 % TOP OINT,,7809,LOCAL,Facility,Inpatient,28.4 g,g,,33,28.05,9.4578,33,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
ZINC OXIDE 20 % TOP OINT,,7809,LOCAL,Facility,Outpatient,28.4 g,g,,33,28.05,9.4578,33,Medica,Medical Assistance,14.718,44.6,,percent of total billed charges,,
ZINC OXIDE 20 % TOP OINT,,7809,LOCAL,Facility,Inpatient,28.4 g,g,,33,28.05,9.4578,33,Medica,Medical Assistance,,,,,Included in per diem rate,
ZINC OXIDE 20 % TOP OINT,,7809,LOCAL,Facility,Outpatient,28.4 g,g,,33,28.05,9.4578,33,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,16.434,49.8,,percent of total billed charges,,
ZINC OXIDE 20 % TOP OINT,,7809,LOCAL,Facility,Inpatient,28.4 g,g,,33,28.05,9.4578,33,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
ZINC OXIDE 20 % TOP OINT,,7809,LOCAL,Facility,Both,28.4 g,g,,33,28.05,9.4578,33,"Multiplan, Inc.","Multiplan, Inc.",31.02,94,,percent of total billed charges,,
ZINC OXIDE 20 % TOP OINT,,7809,LOCAL,Facility,Outpatient,28.4 g,g,,33,28.05,9.4578,33,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,29.733,90.1,,percent of total billed charges,,
ZINC OXIDE 20 % TOP OINT,,7809,LOCAL,Facility,Inpatient,28.4 g,g,,33,28.05,9.4578,33,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
ZINC OXIDE 20 % TOP OINT,,7809,LOCAL,Facility,Both,28.4 g,g,,33,28.05,9.4578,33,"Preferred One Administrative Services, INC.",PPO,32.538,98.6,,percent of total billed charges,,
ZINC OXIDE 20 % TOP OINT,,7809,LOCAL,Facility,Outpatient,28.4 g,g,,33,28.05,9.4578,33,PrimeWest Health,Minnesota Senior Health Options (MSHO),16.9785,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
ZINC OXIDE 20 % TOP OINT,,7809,LOCAL,Facility,Inpatient,28.4 g,g,,33,28.05,9.4578,33,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ZINC OXIDE 20 % TOP OINT,,7809,LOCAL,Facility,Outpatient,28.4 g,g,,33,28.05,9.4578,33,PrimeWest Health,MinnesotaCare,16.9488,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
ZINC OXIDE 20 % TOP OINT,,7809,LOCAL,Facility,Inpatient,28.4 g,g,,33,28.05,9.4578,33,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
ZINC OXIDE 20 % TOP OINT,,7809,LOCAL,Facility,Both,28.4 g,g,,33,28.05,9.4578,33,Sanford Health Plan,Sanford Health Plan,30.36,92,,percent of total billed charges,,
ZINC OXIDE 20 % TOP OINT,,7809,LOCAL,Facility,Outpatient,28.4 g,g,,33,28.05,9.4578,33,"UCare Health, Inc.",Individual & Family Plan,18.5955,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
ZINC OXIDE 20 % TOP OINT,,7809,LOCAL,Facility,Inpatient,28.4 g,g,,33,28.05,9.4578,33,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
ZINC OXIDE 20 % TOP OINT,,7809,LOCAL,Facility,Outpatient,28.4 g,g,,33,28.05,9.4578,33,"UCare Health, Inc.",Medical Assistance,16.6551,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ZINC OXIDE 20 % TOP OINT,,7809,LOCAL,Facility,Inpatient,28.4 g,g,,33,28.05,9.4578,33,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
ZINC OXIDE 20 % TOP OINT,,7809,LOCAL,Facility,Outpatient,28.4 g,g,,33,28.05,9.4578,33,"UCare Health, Inc.",Medicare Advantage,16.6551,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ZINC OXIDE 20 % TOP OINT,,7809,LOCAL,Facility,Inpatient,28.4 g,g,,33,28.05,9.4578,33,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ZINC OXIDE 20 % TOP OINT,,7809,LOCAL,Facility,Outpatient,28.4 g,g,,33,28.05,9.4578,33,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),16.6551,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ZINC OXIDE 20 % TOP OINT,,7809,LOCAL,Facility,Inpatient,28.4 g,g,,33,28.05,9.4578,33,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ZINC OXIDE 20 % TOP OINT,,7809,LOCAL,Facility,Both,28.4 g,g,,33,28.05,9.4578,33,UnitedHealthcare,Individual & Family,31.02,94,,percent of total billed charges,,
ZINC OXIDE 20 % TOP OINT,,7809,LOCAL,Facility,Outpatient,28.4 g,g,,33,28.05,9.4578,33,UnitedHealthcare,Medicare Advantage,16.17,49,,percent of total billed charges,,
ZINC OXIDE 20 % TOP OINT,,7809,LOCAL,Facility,Inpatient,28.4 g,g,,33,28.05,9.4578,33,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
ZINC OXIDE 20 % TOP OINT,,7809,LOCAL,Facility,Outpatient,28.4 g,g,,33,28.05,9.4578,33,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,15.84,48,,percent of total billed charges,,100% of DHS outpatient percentage
ZINC OXIDE 20 % TOP OINT,,7809,LOCAL,Facility,Inpatient,28.4 g,g,,33,28.05,9.4578,33,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
MAGNESIUM CITRATE ORAL SOLN,,15140,LOCAL,Facility,Both,296 mL,mL,,11,9.35,3.1526,11,Aetna,Commercial,10.12,92,,percent of total billed charges,,
MAGNESIUM CITRATE ORAL SOLN,,15140,LOCAL,Facility,Outpatient,296 mL,mL,,11,9.35,3.1526,11,Aetna,Medicare Advantage,5.39,49,,percent of total billed charges,,
MAGNESIUM CITRATE ORAL SOLN,,15140,LOCAL,Facility,Inpatient,296 mL,mL,,11,9.35,3.1526,11,Aetna,Medicare Advantage,,,,,Included in per diem rate,
MAGNESIUM CITRATE ORAL SOLN,,15140,LOCAL,Facility,Both,296 mL,mL,,11,9.35,3.1526,11,Aetna,PPO,10.23,93,,percent of total billed charges,,
MAGNESIUM CITRATE ORAL SOLN,,15140,LOCAL,Facility,Both,296 mL,mL,,11,9.35,3.1526,11,America's PPO,America's PPO,10.5633,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
MAGNESIUM CITRATE ORAL SOLN,,15140,LOCAL,Facility,Both,296 mL,mL,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota, Federal Employee Program,10.824,98.4,,percent of total billed charges,,
MAGNESIUM CITRATE ORAL SOLN,,15140,LOCAL,Facility,Both,296 mL,mL,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,11,100,,percent of total billed charges,,
MAGNESIUM CITRATE ORAL SOLN,,15140,LOCAL,Facility,Both,296 mL,mL,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,High Value Network Plan,9.9,90,,percent of total billed charges,,
MAGNESIUM CITRATE ORAL SOLN,,15140,LOCAL,Facility,Outpatient,296 mL,mL,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,Medicare Advantage,5.39,49,,percent of total billed charges,,
MAGNESIUM CITRATE ORAL SOLN,,15140,LOCAL,Facility,Inpatient,296 mL,mL,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
MAGNESIUM CITRATE ORAL SOLN,,15140,LOCAL,Facility,Both,296 mL,mL,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,9.7427,88.57,,percent of total billed charges,,
MAGNESIUM CITRATE ORAL SOLN,,15140,LOCAL,Facility,Both,296 mL,mL,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,3.1526,28.66,,percent of total billed charges,,
MAGNESIUM CITRATE ORAL SOLN,,15140,LOCAL,Facility,Outpatient,296 mL,mL,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),5.39,49,,percent of total billed charges,,
MAGNESIUM CITRATE ORAL SOLN,,15140,LOCAL,Facility,Inpatient,296 mL,mL,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
MAGNESIUM CITRATE ORAL SOLN,,15140,LOCAL,Facility,Both,296 mL,mL,,11,9.35,3.1526,11,CorVel,Worker's Compensation,11,100,,percent of total billed charges,,
MAGNESIUM CITRATE ORAL SOLN,,15140,LOCAL,Facility,Both,296 mL,mL,,11,9.35,3.1526,11,First Health Group Corporation,First Health Network,10.67,97,,percent of total billed charges,,
MAGNESIUM CITRATE ORAL SOLN,,15140,LOCAL,Facility,Both,296 mL,mL,,11,9.35,3.1526,11,"Health Partners, Inc.",Commercial,10.406,94.6,,percent of total billed charges,,
MAGNESIUM CITRATE ORAL SOLN,,15140,LOCAL,Facility,Outpatient,296 mL,mL,,11,9.35,3.1526,11,"Health Partners, Inc.",Medicare Advantage,5.39,49,,percent of total billed charges,,
MAGNESIUM CITRATE ORAL SOLN,,15140,LOCAL,Facility,Inpatient,296 mL,mL,,11,9.35,3.1526,11,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
MAGNESIUM CITRATE ORAL SOLN,,15140,LOCAL,Facility,Both,296 mL,mL,,11,9.35,3.1526,11,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),6.6,60,,percent of total billed charges,,
MAGNESIUM CITRATE ORAL SOLN,,15140,LOCAL,Facility,Both,296 mL,mL,,11,9.35,3.1526,11,"Health Partners, Inc.",State of Minnesota Advantage Program,8.965,81.5,,percent of total billed charges,,
MAGNESIUM CITRATE ORAL SOLN,,15140,LOCAL,Facility,Both,296 mL,mL,,11,9.35,3.1526,11,"Health Partners, Inc.",State Public Programs,5.5,50,,percent of total billed charges,,
MAGNESIUM CITRATE ORAL SOLN,,15140,LOCAL,Facility,Both,296 mL,mL,,11,9.35,3.1526,11,Humana Insurance Company,Commercial PPO,10.45,95,,percent of total billed charges,,
MAGNESIUM CITRATE ORAL SOLN,,15140,LOCAL,Facility,Outpatient,296 mL,mL,,11,9.35,3.1526,11,Humana Insurance Company,Medicare PPO,5.39,49,,percent of total billed charges,,
MAGNESIUM CITRATE ORAL SOLN,,15140,LOCAL,Facility,Inpatient,296 mL,mL,,11,9.35,3.1526,11,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
MAGNESIUM CITRATE ORAL SOLN,,15140,LOCAL,Facility,Both,296 mL,mL,,11,9.35,3.1526,11,Medica,Individual & Family,10.901,99.1,,percent of total billed charges,,
MAGNESIUM CITRATE ORAL SOLN,,15140,LOCAL,Facility,Outpatient,296 mL,mL,,11,9.35,3.1526,11,Medica,Medica Advantage Solution,5.478,49.8,,percent of total billed charges,,
MAGNESIUM CITRATE ORAL SOLN,,15140,LOCAL,Facility,Inpatient,296 mL,mL,,11,9.35,3.1526,11,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
MAGNESIUM CITRATE ORAL SOLN,,15140,LOCAL,Facility,Outpatient,296 mL,mL,,11,9.35,3.1526,11,Medica,Medical Assistance,4.906,44.6,,percent of total billed charges,,
MAGNESIUM CITRATE ORAL SOLN,,15140,LOCAL,Facility,Inpatient,296 mL,mL,,11,9.35,3.1526,11,Medica,Medical Assistance,,,,,Included in per diem rate,
MAGNESIUM CITRATE ORAL SOLN,,15140,LOCAL,Facility,Outpatient,296 mL,mL,,11,9.35,3.1526,11,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,5.478,49.8,,percent of total billed charges,,
MAGNESIUM CITRATE ORAL SOLN,,15140,LOCAL,Facility,Inpatient,296 mL,mL,,11,9.35,3.1526,11,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
MAGNESIUM CITRATE ORAL SOLN,,15140,LOCAL,Facility,Both,296 mL,mL,,11,9.35,3.1526,11,"Multiplan, Inc.","Multiplan, Inc.",10.34,94,,percent of total billed charges,,
MAGNESIUM CITRATE ORAL SOLN,,15140,LOCAL,Facility,Outpatient,296 mL,mL,,11,9.35,3.1526,11,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,9.911,90.1,,percent of total billed charges,,
MAGNESIUM CITRATE ORAL SOLN,,15140,LOCAL,Facility,Inpatient,296 mL,mL,,11,9.35,3.1526,11,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
MAGNESIUM CITRATE ORAL SOLN,,15140,LOCAL,Facility,Both,296 mL,mL,,11,9.35,3.1526,11,"Preferred One Administrative Services, INC.",PPO,10.846,98.6,,percent of total billed charges,,
MAGNESIUM CITRATE ORAL SOLN,,15140,LOCAL,Facility,Outpatient,296 mL,mL,,11,9.35,3.1526,11,PrimeWest Health,Minnesota Senior Health Options (MSHO),5.6595,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
MAGNESIUM CITRATE ORAL SOLN,,15140,LOCAL,Facility,Inpatient,296 mL,mL,,11,9.35,3.1526,11,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
MAGNESIUM CITRATE ORAL SOLN,,15140,LOCAL,Facility,Outpatient,296 mL,mL,,11,9.35,3.1526,11,PrimeWest Health,MinnesotaCare,5.6496,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
MAGNESIUM CITRATE ORAL SOLN,,15140,LOCAL,Facility,Inpatient,296 mL,mL,,11,9.35,3.1526,11,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
MAGNESIUM CITRATE ORAL SOLN,,15140,LOCAL,Facility,Both,296 mL,mL,,11,9.35,3.1526,11,Sanford Health Plan,Sanford Health Plan,10.12,92,,percent of total billed charges,,
MAGNESIUM CITRATE ORAL SOLN,,15140,LOCAL,Facility,Outpatient,296 mL,mL,,11,9.35,3.1526,11,"UCare Health, Inc.",Individual & Family Plan,6.1985,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
MAGNESIUM CITRATE ORAL SOLN,,15140,LOCAL,Facility,Inpatient,296 mL,mL,,11,9.35,3.1526,11,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
MAGNESIUM CITRATE ORAL SOLN,,15140,LOCAL,Facility,Outpatient,296 mL,mL,,11,9.35,3.1526,11,"UCare Health, Inc.",Medical Assistance,5.5517,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MAGNESIUM CITRATE ORAL SOLN,,15140,LOCAL,Facility,Inpatient,296 mL,mL,,11,9.35,3.1526,11,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
MAGNESIUM CITRATE ORAL SOLN,,15140,LOCAL,Facility,Outpatient,296 mL,mL,,11,9.35,3.1526,11,"UCare Health, Inc.",Medicare Advantage,5.5517,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MAGNESIUM CITRATE ORAL SOLN,,15140,LOCAL,Facility,Inpatient,296 mL,mL,,11,9.35,3.1526,11,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
MAGNESIUM CITRATE ORAL SOLN,,15140,LOCAL,Facility,Outpatient,296 mL,mL,,11,9.35,3.1526,11,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),5.5517,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MAGNESIUM CITRATE ORAL SOLN,,15140,LOCAL,Facility,Inpatient,296 mL,mL,,11,9.35,3.1526,11,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
MAGNESIUM CITRATE ORAL SOLN,,15140,LOCAL,Facility,Both,296 mL,mL,,11,9.35,3.1526,11,UnitedHealthcare,Individual & Family,10.34,94,,percent of total billed charges,,
MAGNESIUM CITRATE ORAL SOLN,,15140,LOCAL,Facility,Outpatient,296 mL,mL,,11,9.35,3.1526,11,UnitedHealthcare,Medicare Advantage,5.39,49,,percent of total billed charges,,
MAGNESIUM CITRATE ORAL SOLN,,15140,LOCAL,Facility,Inpatient,296 mL,mL,,11,9.35,3.1526,11,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
MAGNESIUM CITRATE ORAL SOLN,,15140,LOCAL,Facility,Outpatient,296 mL,mL,,11,9.35,3.1526,11,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,5.28,48,,percent of total billed charges,,100% of DHS outpatient percentage
MAGNESIUM CITRATE ORAL SOLN,,15140,LOCAL,Facility,Inpatient,296 mL,mL,,11,9.35,3.1526,11,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
ALBUTEROL SULFATE 0.63 MG/3 ML INHL NEBU,,1052,LOCAL,Facility,Both,3 mL,mL,,9,7.65,2.5794,9,Aetna,Commercial,8.28,92,,percent of total billed charges,,
ALBUTEROL SULFATE 0.63 MG/3 ML INHL NEBU,,1052,LOCAL,Facility,Outpatient,3 mL,mL,,9,7.65,2.5794,9,Aetna,Medicare Advantage,4.41,49,,percent of total billed charges,,
ALBUTEROL SULFATE 0.63 MG/3 ML INHL NEBU,,1052,LOCAL,Facility,Inpatient,3 mL,mL,,9,7.65,2.5794,9,Aetna,Medicare Advantage,,,,,Included in per diem rate,
ALBUTEROL SULFATE 0.63 MG/3 ML INHL NEBU,,1052,LOCAL,Facility,Both,3 mL,mL,,9,7.65,2.5794,9,Aetna,PPO,8.37,93,,percent of total billed charges,,
ALBUTEROL SULFATE 0.63 MG/3 ML INHL NEBU,,1052,LOCAL,Facility,Both,3 mL,mL,,9,7.65,2.5794,9,America's PPO,America's PPO,8.6427,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
ALBUTEROL SULFATE 0.63 MG/3 ML INHL NEBU,,1052,LOCAL,Facility,Both,3 mL,mL,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota, Federal Employee Program,8.856,98.4,,percent of total billed charges,,
ALBUTEROL SULFATE 0.63 MG/3 ML INHL NEBU,,1052,LOCAL,Facility,Both,3 mL,mL,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,9,100,,percent of total billed charges,,
ALBUTEROL SULFATE 0.63 MG/3 ML INHL NEBU,,1052,LOCAL,Facility,Both,3 mL,mL,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota,High Value Network Plan,8.1,90,,percent of total billed charges,,
ALBUTEROL SULFATE 0.63 MG/3 ML INHL NEBU,,1052,LOCAL,Facility,Outpatient,3 mL,mL,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota,Medicare Advantage,4.41,49,,percent of total billed charges,,
ALBUTEROL SULFATE 0.63 MG/3 ML INHL NEBU,,1052,LOCAL,Facility,Inpatient,3 mL,mL,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
ALBUTEROL SULFATE 0.63 MG/3 ML INHL NEBU,,1052,LOCAL,Facility,Both,3 mL,mL,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,7.9713,88.57,,percent of total billed charges,,
ALBUTEROL SULFATE 0.63 MG/3 ML INHL NEBU,,1052,LOCAL,Facility,Both,3 mL,mL,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,2.5794,28.66,,percent of total billed charges,,
ALBUTEROL SULFATE 0.63 MG/3 ML INHL NEBU,,1052,LOCAL,Facility,Outpatient,3 mL,mL,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),4.41,49,,percent of total billed charges,,
ALBUTEROL SULFATE 0.63 MG/3 ML INHL NEBU,,1052,LOCAL,Facility,Inpatient,3 mL,mL,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
ALBUTEROL SULFATE 0.63 MG/3 ML INHL NEBU,,1052,LOCAL,Facility,Both,3 mL,mL,,9,7.65,2.5794,9,CorVel,Worker's Compensation,9,100,,percent of total billed charges,,
ALBUTEROL SULFATE 0.63 MG/3 ML INHL NEBU,,1052,LOCAL,Facility,Both,3 mL,mL,,9,7.65,2.5794,9,First Health Group Corporation,First Health Network,8.73,97,,percent of total billed charges,,
ALBUTEROL SULFATE 0.63 MG/3 ML INHL NEBU,,1052,LOCAL,Facility,Both,3 mL,mL,,9,7.65,2.5794,9,"Health Partners, Inc.",Commercial,8.514,94.6,,percent of total billed charges,,
ALBUTEROL SULFATE 0.63 MG/3 ML INHL NEBU,,1052,LOCAL,Facility,Outpatient,3 mL,mL,,9,7.65,2.5794,9,"Health Partners, Inc.",Medicare Advantage,4.41,49,,percent of total billed charges,,
ALBUTEROL SULFATE 0.63 MG/3 ML INHL NEBU,,1052,LOCAL,Facility,Inpatient,3 mL,mL,,9,7.65,2.5794,9,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ALBUTEROL SULFATE 0.63 MG/3 ML INHL NEBU,,1052,LOCAL,Facility,Both,3 mL,mL,,9,7.65,2.5794,9,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),5.4,60,,percent of total billed charges,,
ALBUTEROL SULFATE 0.63 MG/3 ML INHL NEBU,,1052,LOCAL,Facility,Both,3 mL,mL,,9,7.65,2.5794,9,"Health Partners, Inc.",State of Minnesota Advantage Program,7.335,81.5,,percent of total billed charges,,
ALBUTEROL SULFATE 0.63 MG/3 ML INHL NEBU,,1052,LOCAL,Facility,Both,3 mL,mL,,9,7.65,2.5794,9,"Health Partners, Inc.",State Public Programs,4.5,50,,percent of total billed charges,,
ALBUTEROL SULFATE 0.63 MG/3 ML INHL NEBU,,1052,LOCAL,Facility,Both,3 mL,mL,,9,7.65,2.5794,9,Humana Insurance Company,Commercial PPO,8.55,95,,percent of total billed charges,,
ALBUTEROL SULFATE 0.63 MG/3 ML INHL NEBU,,1052,LOCAL,Facility,Outpatient,3 mL,mL,,9,7.65,2.5794,9,Humana Insurance Company,Medicare PPO,4.41,49,,percent of total billed charges,,
ALBUTEROL SULFATE 0.63 MG/3 ML INHL NEBU,,1052,LOCAL,Facility,Inpatient,3 mL,mL,,9,7.65,2.5794,9,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
ALBUTEROL SULFATE 0.63 MG/3 ML INHL NEBU,,1052,LOCAL,Facility,Both,3 mL,mL,,9,7.65,2.5794,9,Medica,Individual & Family,8.919,99.1,,percent of total billed charges,,
ALBUTEROL SULFATE 0.63 MG/3 ML INHL NEBU,,1052,LOCAL,Facility,Outpatient,3 mL,mL,,9,7.65,2.5794,9,Medica,Medica Advantage Solution,4.482,49.8,,percent of total billed charges,,
ALBUTEROL SULFATE 0.63 MG/3 ML INHL NEBU,,1052,LOCAL,Facility,Inpatient,3 mL,mL,,9,7.65,2.5794,9,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
ALBUTEROL SULFATE 0.63 MG/3 ML INHL NEBU,,1052,LOCAL,Facility,Outpatient,3 mL,mL,,9,7.65,2.5794,9,Medica,Medical Assistance,4.014,44.6,,percent of total billed charges,,
ALBUTEROL SULFATE 0.63 MG/3 ML INHL NEBU,,1052,LOCAL,Facility,Inpatient,3 mL,mL,,9,7.65,2.5794,9,Medica,Medical Assistance,,,,,Included in per diem rate,
ALBUTEROL SULFATE 0.63 MG/3 ML INHL NEBU,,1052,LOCAL,Facility,Outpatient,3 mL,mL,,9,7.65,2.5794,9,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,4.482,49.8,,percent of total billed charges,,
ALBUTEROL SULFATE 0.63 MG/3 ML INHL NEBU,,1052,LOCAL,Facility,Inpatient,3 mL,mL,,9,7.65,2.5794,9,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
ALBUTEROL SULFATE 0.63 MG/3 ML INHL NEBU,,1052,LOCAL,Facility,Both,3 mL,mL,,9,7.65,2.5794,9,"Multiplan, Inc.","Multiplan, Inc.",8.46,94,,percent of total billed charges,,
ALBUTEROL SULFATE 0.63 MG/3 ML INHL NEBU,,1052,LOCAL,Facility,Outpatient,3 mL,mL,,9,7.65,2.5794,9,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,8.109,90.1,,percent of total billed charges,,
ALBUTEROL SULFATE 0.63 MG/3 ML INHL NEBU,,1052,LOCAL,Facility,Inpatient,3 mL,mL,,9,7.65,2.5794,9,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
ALBUTEROL SULFATE 0.63 MG/3 ML INHL NEBU,,1052,LOCAL,Facility,Both,3 mL,mL,,9,7.65,2.5794,9,"Preferred One Administrative Services, INC.",PPO,8.874,98.6,,percent of total billed charges,,
ALBUTEROL SULFATE 0.63 MG/3 ML INHL NEBU,,1052,LOCAL,Facility,Outpatient,3 mL,mL,,9,7.65,2.5794,9,PrimeWest Health,Minnesota Senior Health Options (MSHO),4.6305,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
ALBUTEROL SULFATE 0.63 MG/3 ML INHL NEBU,,1052,LOCAL,Facility,Inpatient,3 mL,mL,,9,7.65,2.5794,9,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ALBUTEROL SULFATE 0.63 MG/3 ML INHL NEBU,,1052,LOCAL,Facility,Outpatient,3 mL,mL,,9,7.65,2.5794,9,PrimeWest Health,MinnesotaCare,4.6224,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
ALBUTEROL SULFATE 0.63 MG/3 ML INHL NEBU,,1052,LOCAL,Facility,Inpatient,3 mL,mL,,9,7.65,2.5794,9,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
ALBUTEROL SULFATE 0.63 MG/3 ML INHL NEBU,,1052,LOCAL,Facility,Both,3 mL,mL,,9,7.65,2.5794,9,Sanford Health Plan,Sanford Health Plan,8.28,92,,percent of total billed charges,,
ALBUTEROL SULFATE 0.63 MG/3 ML INHL NEBU,,1052,LOCAL,Facility,Outpatient,3 mL,mL,,9,7.65,2.5794,9,"UCare Health, Inc.",Individual & Family Plan,5.0715,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
ALBUTEROL SULFATE 0.63 MG/3 ML INHL NEBU,,1052,LOCAL,Facility,Inpatient,3 mL,mL,,9,7.65,2.5794,9,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
ALBUTEROL SULFATE 0.63 MG/3 ML INHL NEBU,,1052,LOCAL,Facility,Outpatient,3 mL,mL,,9,7.65,2.5794,9,"UCare Health, Inc.",Medical Assistance,4.5423,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ALBUTEROL SULFATE 0.63 MG/3 ML INHL NEBU,,1052,LOCAL,Facility,Inpatient,3 mL,mL,,9,7.65,2.5794,9,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
ALBUTEROL SULFATE 0.63 MG/3 ML INHL NEBU,,1052,LOCAL,Facility,Outpatient,3 mL,mL,,9,7.65,2.5794,9,"UCare Health, Inc.",Medicare Advantage,4.5423,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ALBUTEROL SULFATE 0.63 MG/3 ML INHL NEBU,,1052,LOCAL,Facility,Inpatient,3 mL,mL,,9,7.65,2.5794,9,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ALBUTEROL SULFATE 0.63 MG/3 ML INHL NEBU,,1052,LOCAL,Facility,Outpatient,3 mL,mL,,9,7.65,2.5794,9,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),4.5423,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ALBUTEROL SULFATE 0.63 MG/3 ML INHL NEBU,,1052,LOCAL,Facility,Inpatient,3 mL,mL,,9,7.65,2.5794,9,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ALBUTEROL SULFATE 0.63 MG/3 ML INHL NEBU,,1052,LOCAL,Facility,Both,3 mL,mL,,9,7.65,2.5794,9,UnitedHealthcare,Individual & Family,8.46,94,,percent of total billed charges,,
ALBUTEROL SULFATE 0.63 MG/3 ML INHL NEBU,,1052,LOCAL,Facility,Outpatient,3 mL,mL,,9,7.65,2.5794,9,UnitedHealthcare,Medicare Advantage,4.41,49,,percent of total billed charges,,
ALBUTEROL SULFATE 0.63 MG/3 ML INHL NEBU,,1052,LOCAL,Facility,Inpatient,3 mL,mL,,9,7.65,2.5794,9,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
ALBUTEROL SULFATE 0.63 MG/3 ML INHL NEBU,,1052,LOCAL,Facility,Outpatient,3 mL,mL,,9,7.65,2.5794,9,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,4.32,48,,percent of total billed charges,,100% of DHS outpatient percentage
ALBUTEROL SULFATE 0.63 MG/3 ML INHL NEBU,,1052,LOCAL,Facility,Inpatient,3 mL,mL,,9,7.65,2.5794,9,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
LEVALBUTEROL HCL 0.63 MG/3 ML INHL NEBU,,3153,LOCAL,Facility,Both,3 mL,mL,,34,28.9,9.7444,34,Aetna,Commercial,31.28,92,,percent of total billed charges,,
LEVALBUTEROL HCL 0.63 MG/3 ML INHL NEBU,,3153,LOCAL,Facility,Both,3 mL,mL,,11,9.35,3.1526,11,Aetna,Commercial,10.12,92,,percent of total billed charges,,
LEVALBUTEROL HCL 0.63 MG/3 ML INHL NEBU,,3153,LOCAL,Facility,Both,3 mL,mL,,11,9.35,3.1526,11,Aetna,Commercial,10.12,92,,percent of total billed charges,,
LEVALBUTEROL HCL 0.63 MG/3 ML INHL NEBU,,3153,LOCAL,Facility,Outpatient,3 mL,mL,,34,28.9,9.7444,34,Aetna,Medicare Advantage,16.66,49,,percent of total billed charges,,
LEVALBUTEROL HCL 0.63 MG/3 ML INHL NEBU,,3153,LOCAL,Facility,Outpatient,3 mL,mL,,11,9.35,3.1526,11,Aetna,Medicare Advantage,5.39,49,,percent of total billed charges,,
LEVALBUTEROL HCL 0.63 MG/3 ML INHL NEBU,,3153,LOCAL,Facility,Outpatient,3 mL,mL,,11,9.35,3.1526,11,Aetna,Medicare Advantage,5.39,49,,percent of total billed charges,,
LEVALBUTEROL HCL 0.63 MG/3 ML INHL NEBU,,3153,LOCAL,Facility,Inpatient,3 mL,mL,,34,28.9,9.7444,34,Aetna,Medicare Advantage,,,,,Included in per diem rate,
LEVALBUTEROL HCL 0.63 MG/3 ML INHL NEBU,,3153,LOCAL,Facility,Inpatient,3 mL,mL,,11,9.35,3.1526,11,Aetna,Medicare Advantage,,,,,Included in per diem rate,
LEVALBUTEROL HCL 0.63 MG/3 ML INHL NEBU,,3153,LOCAL,Facility,Inpatient,3 mL,mL,,11,9.35,3.1526,11,Aetna,Medicare Advantage,,,,,Included in per diem rate,
LEVALBUTEROL HCL 0.63 MG/3 ML INHL NEBU,,3153,LOCAL,Facility,Both,3 mL,mL,,34,28.9,9.7444,34,Aetna,PPO,31.62,93,,percent of total billed charges,,
LEVALBUTEROL HCL 0.63 MG/3 ML INHL NEBU,,3153,LOCAL,Facility,Both,3 mL,mL,,11,9.35,3.1526,11,Aetna,PPO,10.23,93,,percent of total billed charges,,
LEVALBUTEROL HCL 0.63 MG/3 ML INHL NEBU,,3153,LOCAL,Facility,Both,3 mL,mL,,11,9.35,3.1526,11,Aetna,PPO,10.23,93,,percent of total billed charges,,
LEVALBUTEROL HCL 0.63 MG/3 ML INHL NEBU,,3153,LOCAL,Facility,Both,3 mL,mL,,34,28.9,9.7444,34,America's PPO,America's PPO,32.6502,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
LEVALBUTEROL HCL 0.63 MG/3 ML INHL NEBU,,3153,LOCAL,Facility,Both,3 mL,mL,,11,9.35,3.1526,11,America's PPO,America's PPO,10.5633,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
LEVALBUTEROL HCL 0.63 MG/3 ML INHL NEBU,,3153,LOCAL,Facility,Both,3 mL,mL,,11,9.35,3.1526,11,America's PPO,America's PPO,10.5633,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
LEVALBUTEROL HCL 0.63 MG/3 ML INHL NEBU,,3153,LOCAL,Facility,Both,3 mL,mL,,34,28.9,9.7444,34,BlueCross BlueShield Minnesota, Federal Employee Program,33.456,98.4,,percent of total billed charges,,
LEVALBUTEROL HCL 0.63 MG/3 ML INHL NEBU,,3153,LOCAL,Facility,Both,3 mL,mL,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota, Federal Employee Program,10.824,98.4,,percent of total billed charges,,
LEVALBUTEROL HCL 0.63 MG/3 ML INHL NEBU,,3153,LOCAL,Facility,Both,3 mL,mL,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota, Federal Employee Program,10.824,98.4,,percent of total billed charges,,
LEVALBUTEROL HCL 0.63 MG/3 ML INHL NEBU,,3153,LOCAL,Facility,Both,3 mL,mL,,34,28.9,9.7444,34,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,34,100,,percent of total billed charges,,
LEVALBUTEROL HCL 0.63 MG/3 ML INHL NEBU,,3153,LOCAL,Facility,Both,3 mL,mL,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,11,100,,percent of total billed charges,,
LEVALBUTEROL HCL 0.63 MG/3 ML INHL NEBU,,3153,LOCAL,Facility,Both,3 mL,mL,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,11,100,,percent of total billed charges,,
LEVALBUTEROL HCL 0.63 MG/3 ML INHL NEBU,,3153,LOCAL,Facility,Both,3 mL,mL,,34,28.9,9.7444,34,BlueCross BlueShield Minnesota,High Value Network Plan,30.6,90,,percent of total billed charges,,
LEVALBUTEROL HCL 0.63 MG/3 ML INHL NEBU,,3153,LOCAL,Facility,Both,3 mL,mL,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,High Value Network Plan,9.9,90,,percent of total billed charges,,
LEVALBUTEROL HCL 0.63 MG/3 ML INHL NEBU,,3153,LOCAL,Facility,Both,3 mL,mL,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,High Value Network Plan,9.9,90,,percent of total billed charges,,
LEVALBUTEROL HCL 0.63 MG/3 ML INHL NEBU,,3153,LOCAL,Facility,Outpatient,3 mL,mL,,34,28.9,9.7444,34,BlueCross BlueShield Minnesota,Medicare Advantage,16.66,49,,percent of total billed charges,,
LEVALBUTEROL HCL 0.63 MG/3 ML INHL NEBU,,3153,LOCAL,Facility,Outpatient,3 mL,mL,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,Medicare Advantage,5.39,49,,percent of total billed charges,,
LEVALBUTEROL HCL 0.63 MG/3 ML INHL NEBU,,3153,LOCAL,Facility,Outpatient,3 mL,mL,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,Medicare Advantage,5.39,49,,percent of total billed charges,,
LEVALBUTEROL HCL 0.63 MG/3 ML INHL NEBU,,3153,LOCAL,Facility,Inpatient,3 mL,mL,,34,28.9,9.7444,34,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
LEVALBUTEROL HCL 0.63 MG/3 ML INHL NEBU,,3153,LOCAL,Facility,Inpatient,3 mL,mL,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
LEVALBUTEROL HCL 0.63 MG/3 ML INHL NEBU,,3153,LOCAL,Facility,Inpatient,3 mL,mL,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
LEVALBUTEROL HCL 0.63 MG/3 ML INHL NEBU,,3153,LOCAL,Facility,Both,3 mL,mL,,34,28.9,9.7444,34,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,30.1138,88.57,,percent of total billed charges,,
LEVALBUTEROL HCL 0.63 MG/3 ML INHL NEBU,,3153,LOCAL,Facility,Both,3 mL,mL,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,9.7427,88.57,,percent of total billed charges,,
LEVALBUTEROL HCL 0.63 MG/3 ML INHL NEBU,,3153,LOCAL,Facility,Both,3 mL,mL,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,9.7427,88.57,,percent of total billed charges,,
LEVALBUTEROL HCL 0.63 MG/3 ML INHL NEBU,,3153,LOCAL,Facility,Both,3 mL,mL,,34,28.9,9.7444,34,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,9.7444,28.66,,percent of total billed charges,,
LEVALBUTEROL HCL 0.63 MG/3 ML INHL NEBU,,3153,LOCAL,Facility,Both,3 mL,mL,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,3.1526,28.66,,percent of total billed charges,,
LEVALBUTEROL HCL 0.63 MG/3 ML INHL NEBU,,3153,LOCAL,Facility,Both,3 mL,mL,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,3.1526,28.66,,percent of total billed charges,,
LEVALBUTEROL HCL 0.63 MG/3 ML INHL NEBU,,3153,LOCAL,Facility,Outpatient,3 mL,mL,,34,28.9,9.7444,34,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),16.66,49,,percent of total billed charges,,
LEVALBUTEROL HCL 0.63 MG/3 ML INHL NEBU,,3153,LOCAL,Facility,Outpatient,3 mL,mL,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),5.39,49,,percent of total billed charges,,
LEVALBUTEROL HCL 0.63 MG/3 ML INHL NEBU,,3153,LOCAL,Facility,Outpatient,3 mL,mL,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),5.39,49,,percent of total billed charges,,
LEVALBUTEROL HCL 0.63 MG/3 ML INHL NEBU,,3153,LOCAL,Facility,Inpatient,3 mL,mL,,34,28.9,9.7444,34,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
LEVALBUTEROL HCL 0.63 MG/3 ML INHL NEBU,,3153,LOCAL,Facility,Inpatient,3 mL,mL,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
LEVALBUTEROL HCL 0.63 MG/3 ML INHL NEBU,,3153,LOCAL,Facility,Inpatient,3 mL,mL,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
LEVALBUTEROL HCL 0.63 MG/3 ML INHL NEBU,,3153,LOCAL,Facility,Both,3 mL,mL,,34,28.9,9.7444,34,CorVel,Worker's Compensation,34,100,,percent of total billed charges,,
LEVALBUTEROL HCL 0.63 MG/3 ML INHL NEBU,,3153,LOCAL,Facility,Both,3 mL,mL,,11,9.35,3.1526,11,CorVel,Worker's Compensation,11,100,,percent of total billed charges,,
LEVALBUTEROL HCL 0.63 MG/3 ML INHL NEBU,,3153,LOCAL,Facility,Both,3 mL,mL,,11,9.35,3.1526,11,CorVel,Worker's Compensation,11,100,,percent of total billed charges,,
LEVALBUTEROL HCL 0.63 MG/3 ML INHL NEBU,,3153,LOCAL,Facility,Both,3 mL,mL,,34,28.9,9.7444,34,First Health Group Corporation,First Health Network,32.98,97,,percent of total billed charges,,
LEVALBUTEROL HCL 0.63 MG/3 ML INHL NEBU,,3153,LOCAL,Facility,Both,3 mL,mL,,11,9.35,3.1526,11,First Health Group Corporation,First Health Network,10.67,97,,percent of total billed charges,,
LEVALBUTEROL HCL 0.63 MG/3 ML INHL NEBU,,3153,LOCAL,Facility,Both,3 mL,mL,,11,9.35,3.1526,11,First Health Group Corporation,First Health Network,10.67,97,,percent of total billed charges,,
LEVALBUTEROL HCL 0.63 MG/3 ML INHL NEBU,,3153,LOCAL,Facility,Both,3 mL,mL,,34,28.9,9.7444,34,"Health Partners, Inc.",Commercial,32.164,94.6,,percent of total billed charges,,
LEVALBUTEROL HCL 0.63 MG/3 ML INHL NEBU,,3153,LOCAL,Facility,Both,3 mL,mL,,11,9.35,3.1526,11,"Health Partners, Inc.",Commercial,10.406,94.6,,percent of total billed charges,,
LEVALBUTEROL HCL 0.63 MG/3 ML INHL NEBU,,3153,LOCAL,Facility,Both,3 mL,mL,,11,9.35,3.1526,11,"Health Partners, Inc.",Commercial,10.406,94.6,,percent of total billed charges,,
LEVALBUTEROL HCL 0.63 MG/3 ML INHL NEBU,,3153,LOCAL,Facility,Outpatient,3 mL,mL,,34,28.9,9.7444,34,"Health Partners, Inc.",Medicare Advantage,16.66,49,,percent of total billed charges,,
LEVALBUTEROL HCL 0.63 MG/3 ML INHL NEBU,,3153,LOCAL,Facility,Outpatient,3 mL,mL,,11,9.35,3.1526,11,"Health Partners, Inc.",Medicare Advantage,5.39,49,,percent of total billed charges,,
LEVALBUTEROL HCL 0.63 MG/3 ML INHL NEBU,,3153,LOCAL,Facility,Outpatient,3 mL,mL,,11,9.35,3.1526,11,"Health Partners, Inc.",Medicare Advantage,5.39,49,,percent of total billed charges,,
LEVALBUTEROL HCL 0.63 MG/3 ML INHL NEBU,,3153,LOCAL,Facility,Inpatient,3 mL,mL,,34,28.9,9.7444,34,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LEVALBUTEROL HCL 0.63 MG/3 ML INHL NEBU,,3153,LOCAL,Facility,Inpatient,3 mL,mL,,11,9.35,3.1526,11,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LEVALBUTEROL HCL 0.63 MG/3 ML INHL NEBU,,3153,LOCAL,Facility,Inpatient,3 mL,mL,,11,9.35,3.1526,11,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LEVALBUTEROL HCL 0.63 MG/3 ML INHL NEBU,,3153,LOCAL,Facility,Both,3 mL,mL,,34,28.9,9.7444,34,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),20.4,60,,percent of total billed charges,,
LEVALBUTEROL HCL 0.63 MG/3 ML INHL NEBU,,3153,LOCAL,Facility,Both,3 mL,mL,,11,9.35,3.1526,11,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),6.6,60,,percent of total billed charges,,
LEVALBUTEROL HCL 0.63 MG/3 ML INHL NEBU,,3153,LOCAL,Facility,Both,3 mL,mL,,11,9.35,3.1526,11,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),6.6,60,,percent of total billed charges,,
LEVALBUTEROL HCL 0.63 MG/3 ML INHL NEBU,,3153,LOCAL,Facility,Both,3 mL,mL,,34,28.9,9.7444,34,"Health Partners, Inc.",State of Minnesota Advantage Program,27.71,81.5,,percent of total billed charges,,
LEVALBUTEROL HCL 0.63 MG/3 ML INHL NEBU,,3153,LOCAL,Facility,Both,3 mL,mL,,11,9.35,3.1526,11,"Health Partners, Inc.",State of Minnesota Advantage Program,8.965,81.5,,percent of total billed charges,,
LEVALBUTEROL HCL 0.63 MG/3 ML INHL NEBU,,3153,LOCAL,Facility,Both,3 mL,mL,,11,9.35,3.1526,11,"Health Partners, Inc.",State of Minnesota Advantage Program,8.965,81.5,,percent of total billed charges,,
LEVALBUTEROL HCL 0.63 MG/3 ML INHL NEBU,,3153,LOCAL,Facility,Both,3 mL,mL,,34,28.9,9.7444,34,"Health Partners, Inc.",State Public Programs,17,50,,percent of total billed charges,,
LEVALBUTEROL HCL 0.63 MG/3 ML INHL NEBU,,3153,LOCAL,Facility,Both,3 mL,mL,,11,9.35,3.1526,11,"Health Partners, Inc.",State Public Programs,5.5,50,,percent of total billed charges,,
LEVALBUTEROL HCL 0.63 MG/3 ML INHL NEBU,,3153,LOCAL,Facility,Both,3 mL,mL,,11,9.35,3.1526,11,"Health Partners, Inc.",State Public Programs,5.5,50,,percent of total billed charges,,
LEVALBUTEROL HCL 0.63 MG/3 ML INHL NEBU,,3153,LOCAL,Facility,Both,3 mL,mL,,34,28.9,9.7444,34,Humana Insurance Company,Commercial PPO,32.3,95,,percent of total billed charges,,
LEVALBUTEROL HCL 0.63 MG/3 ML INHL NEBU,,3153,LOCAL,Facility,Both,3 mL,mL,,11,9.35,3.1526,11,Humana Insurance Company,Commercial PPO,10.45,95,,percent of total billed charges,,
LEVALBUTEROL HCL 0.63 MG/3 ML INHL NEBU,,3153,LOCAL,Facility,Both,3 mL,mL,,11,9.35,3.1526,11,Humana Insurance Company,Commercial PPO,10.45,95,,percent of total billed charges,,
LEVALBUTEROL HCL 0.63 MG/3 ML INHL NEBU,,3153,LOCAL,Facility,Outpatient,3 mL,mL,,34,28.9,9.7444,34,Humana Insurance Company,Medicare PPO,16.66,49,,percent of total billed charges,,
LEVALBUTEROL HCL 0.63 MG/3 ML INHL NEBU,,3153,LOCAL,Facility,Outpatient,3 mL,mL,,11,9.35,3.1526,11,Humana Insurance Company,Medicare PPO,5.39,49,,percent of total billed charges,,
LEVALBUTEROL HCL 0.63 MG/3 ML INHL NEBU,,3153,LOCAL,Facility,Outpatient,3 mL,mL,,11,9.35,3.1526,11,Humana Insurance Company,Medicare PPO,5.39,49,,percent of total billed charges,,
LEVALBUTEROL HCL 0.63 MG/3 ML INHL NEBU,,3153,LOCAL,Facility,Inpatient,3 mL,mL,,34,28.9,9.7444,34,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
LEVALBUTEROL HCL 0.63 MG/3 ML INHL NEBU,,3153,LOCAL,Facility,Inpatient,3 mL,mL,,11,9.35,3.1526,11,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
LEVALBUTEROL HCL 0.63 MG/3 ML INHL NEBU,,3153,LOCAL,Facility,Inpatient,3 mL,mL,,11,9.35,3.1526,11,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
LEVALBUTEROL HCL 0.63 MG/3 ML INHL NEBU,,3153,LOCAL,Facility,Both,3 mL,mL,,34,28.9,9.7444,34,Medica,Individual & Family,33.694,99.1,,percent of total billed charges,,
LEVALBUTEROL HCL 0.63 MG/3 ML INHL NEBU,,3153,LOCAL,Facility,Both,3 mL,mL,,11,9.35,3.1526,11,Medica,Individual & Family,10.901,99.1,,percent of total billed charges,,
LEVALBUTEROL HCL 0.63 MG/3 ML INHL NEBU,,3153,LOCAL,Facility,Both,3 mL,mL,,11,9.35,3.1526,11,Medica,Individual & Family,10.901,99.1,,percent of total billed charges,,
LEVALBUTEROL HCL 0.63 MG/3 ML INHL NEBU,,3153,LOCAL,Facility,Outpatient,3 mL,mL,,34,28.9,9.7444,34,Medica,Medica Advantage Solution,16.932,49.8,,percent of total billed charges,,
LEVALBUTEROL HCL 0.63 MG/3 ML INHL NEBU,,3153,LOCAL,Facility,Outpatient,3 mL,mL,,11,9.35,3.1526,11,Medica,Medica Advantage Solution,5.478,49.8,,percent of total billed charges,,
LEVALBUTEROL HCL 0.63 MG/3 ML INHL NEBU,,3153,LOCAL,Facility,Outpatient,3 mL,mL,,11,9.35,3.1526,11,Medica,Medica Advantage Solution,5.478,49.8,,percent of total billed charges,,
LEVALBUTEROL HCL 0.63 MG/3 ML INHL NEBU,,3153,LOCAL,Facility,Inpatient,3 mL,mL,,34,28.9,9.7444,34,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
LEVALBUTEROL HCL 0.63 MG/3 ML INHL NEBU,,3153,LOCAL,Facility,Inpatient,3 mL,mL,,11,9.35,3.1526,11,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
LEVALBUTEROL HCL 0.63 MG/3 ML INHL NEBU,,3153,LOCAL,Facility,Inpatient,3 mL,mL,,11,9.35,3.1526,11,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
LEVALBUTEROL HCL 0.63 MG/3 ML INHL NEBU,,3153,LOCAL,Facility,Outpatient,3 mL,mL,,34,28.9,9.7444,34,Medica,Medical Assistance,15.164,44.6,,percent of total billed charges,,
LEVALBUTEROL HCL 0.63 MG/3 ML INHL NEBU,,3153,LOCAL,Facility,Outpatient,3 mL,mL,,11,9.35,3.1526,11,Medica,Medical Assistance,4.906,44.6,,percent of total billed charges,,
LEVALBUTEROL HCL 0.63 MG/3 ML INHL NEBU,,3153,LOCAL,Facility,Outpatient,3 mL,mL,,11,9.35,3.1526,11,Medica,Medical Assistance,4.906,44.6,,percent of total billed charges,,
LEVALBUTEROL HCL 0.63 MG/3 ML INHL NEBU,,3153,LOCAL,Facility,Inpatient,3 mL,mL,,34,28.9,9.7444,34,Medica,Medical Assistance,,,,,Included in per diem rate,
LEVALBUTEROL HCL 0.63 MG/3 ML INHL NEBU,,3153,LOCAL,Facility,Inpatient,3 mL,mL,,11,9.35,3.1526,11,Medica,Medical Assistance,,,,,Included in per diem rate,
LEVALBUTEROL HCL 0.63 MG/3 ML INHL NEBU,,3153,LOCAL,Facility,Inpatient,3 mL,mL,,11,9.35,3.1526,11,Medica,Medical Assistance,,,,,Included in per diem rate,
LEVALBUTEROL HCL 0.63 MG/3 ML INHL NEBU,,3153,LOCAL,Facility,Outpatient,3 mL,mL,,34,28.9,9.7444,34,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,16.932,49.8,,percent of total billed charges,,
LEVALBUTEROL HCL 0.63 MG/3 ML INHL NEBU,,3153,LOCAL,Facility,Outpatient,3 mL,mL,,11,9.35,3.1526,11,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,5.478,49.8,,percent of total billed charges,,
LEVALBUTEROL HCL 0.63 MG/3 ML INHL NEBU,,3153,LOCAL,Facility,Outpatient,3 mL,mL,,11,9.35,3.1526,11,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,5.478,49.8,,percent of total billed charges,,
LEVALBUTEROL HCL 0.63 MG/3 ML INHL NEBU,,3153,LOCAL,Facility,Inpatient,3 mL,mL,,34,28.9,9.7444,34,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
LEVALBUTEROL HCL 0.63 MG/3 ML INHL NEBU,,3153,LOCAL,Facility,Inpatient,3 mL,mL,,11,9.35,3.1526,11,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
LEVALBUTEROL HCL 0.63 MG/3 ML INHL NEBU,,3153,LOCAL,Facility,Inpatient,3 mL,mL,,11,9.35,3.1526,11,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
LEVALBUTEROL HCL 0.63 MG/3 ML INHL NEBU,,3153,LOCAL,Facility,Both,3 mL,mL,,34,28.9,9.7444,34,"Multiplan, Inc.","Multiplan, Inc.",31.96,94,,percent of total billed charges,,
LEVALBUTEROL HCL 0.63 MG/3 ML INHL NEBU,,3153,LOCAL,Facility,Both,3 mL,mL,,11,9.35,3.1526,11,"Multiplan, Inc.","Multiplan, Inc.",10.34,94,,percent of total billed charges,,
LEVALBUTEROL HCL 0.63 MG/3 ML INHL NEBU,,3153,LOCAL,Facility,Both,3 mL,mL,,11,9.35,3.1526,11,"Multiplan, Inc.","Multiplan, Inc.",10.34,94,,percent of total billed charges,,
LEVALBUTEROL HCL 0.63 MG/3 ML INHL NEBU,,3153,LOCAL,Facility,Outpatient,3 mL,mL,,34,28.9,9.7444,34,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,30.634,90.1,,percent of total billed charges,,
LEVALBUTEROL HCL 0.63 MG/3 ML INHL NEBU,,3153,LOCAL,Facility,Outpatient,3 mL,mL,,11,9.35,3.1526,11,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,9.911,90.1,,percent of total billed charges,,
LEVALBUTEROL HCL 0.63 MG/3 ML INHL NEBU,,3153,LOCAL,Facility,Outpatient,3 mL,mL,,11,9.35,3.1526,11,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,9.911,90.1,,percent of total billed charges,,
LEVALBUTEROL HCL 0.63 MG/3 ML INHL NEBU,,3153,LOCAL,Facility,Inpatient,3 mL,mL,,34,28.9,9.7444,34,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
LEVALBUTEROL HCL 0.63 MG/3 ML INHL NEBU,,3153,LOCAL,Facility,Inpatient,3 mL,mL,,11,9.35,3.1526,11,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
LEVALBUTEROL HCL 0.63 MG/3 ML INHL NEBU,,3153,LOCAL,Facility,Inpatient,3 mL,mL,,11,9.35,3.1526,11,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
LEVALBUTEROL HCL 0.63 MG/3 ML INHL NEBU,,3153,LOCAL,Facility,Both,3 mL,mL,,34,28.9,9.7444,34,"Preferred One Administrative Services, INC.",PPO,33.524,98.6,,percent of total billed charges,,
LEVALBUTEROL HCL 0.63 MG/3 ML INHL NEBU,,3153,LOCAL,Facility,Both,3 mL,mL,,11,9.35,3.1526,11,"Preferred One Administrative Services, INC.",PPO,10.846,98.6,,percent of total billed charges,,
LEVALBUTEROL HCL 0.63 MG/3 ML INHL NEBU,,3153,LOCAL,Facility,Both,3 mL,mL,,11,9.35,3.1526,11,"Preferred One Administrative Services, INC.",PPO,10.846,98.6,,percent of total billed charges,,
LEVALBUTEROL HCL 0.63 MG/3 ML INHL NEBU,,3153,LOCAL,Facility,Outpatient,3 mL,mL,,34,28.9,9.7444,34,PrimeWest Health,Minnesota Senior Health Options (MSHO),17.493,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
LEVALBUTEROL HCL 0.63 MG/3 ML INHL NEBU,,3153,LOCAL,Facility,Outpatient,3 mL,mL,,11,9.35,3.1526,11,PrimeWest Health,Minnesota Senior Health Options (MSHO),5.6595,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
LEVALBUTEROL HCL 0.63 MG/3 ML INHL NEBU,,3153,LOCAL,Facility,Outpatient,3 mL,mL,,11,9.35,3.1526,11,PrimeWest Health,Minnesota Senior Health Options (MSHO),5.6595,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
LEVALBUTEROL HCL 0.63 MG/3 ML INHL NEBU,,3153,LOCAL,Facility,Inpatient,3 mL,mL,,34,28.9,9.7444,34,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LEVALBUTEROL HCL 0.63 MG/3 ML INHL NEBU,,3153,LOCAL,Facility,Inpatient,3 mL,mL,,11,9.35,3.1526,11,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LEVALBUTEROL HCL 0.63 MG/3 ML INHL NEBU,,3153,LOCAL,Facility,Inpatient,3 mL,mL,,11,9.35,3.1526,11,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LEVALBUTEROL HCL 0.63 MG/3 ML INHL NEBU,,3153,LOCAL,Facility,Outpatient,3 mL,mL,,34,28.9,9.7444,34,PrimeWest Health,MinnesotaCare,17.4624,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
LEVALBUTEROL HCL 0.63 MG/3 ML INHL NEBU,,3153,LOCAL,Facility,Outpatient,3 mL,mL,,11,9.35,3.1526,11,PrimeWest Health,MinnesotaCare,5.6496,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
LEVALBUTEROL HCL 0.63 MG/3 ML INHL NEBU,,3153,LOCAL,Facility,Outpatient,3 mL,mL,,11,9.35,3.1526,11,PrimeWest Health,MinnesotaCare,5.6496,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
LEVALBUTEROL HCL 0.63 MG/3 ML INHL NEBU,,3153,LOCAL,Facility,Inpatient,3 mL,mL,,34,28.9,9.7444,34,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
LEVALBUTEROL HCL 0.63 MG/3 ML INHL NEBU,,3153,LOCAL,Facility,Inpatient,3 mL,mL,,11,9.35,3.1526,11,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
LEVALBUTEROL HCL 0.63 MG/3 ML INHL NEBU,,3153,LOCAL,Facility,Inpatient,3 mL,mL,,11,9.35,3.1526,11,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
LEVALBUTEROL HCL 0.63 MG/3 ML INHL NEBU,,3153,LOCAL,Facility,Both,3 mL,mL,,34,28.9,9.7444,34,Sanford Health Plan,Sanford Health Plan,31.28,92,,percent of total billed charges,,
LEVALBUTEROL HCL 0.63 MG/3 ML INHL NEBU,,3153,LOCAL,Facility,Both,3 mL,mL,,11,9.35,3.1526,11,Sanford Health Plan,Sanford Health Plan,10.12,92,,percent of total billed charges,,
LEVALBUTEROL HCL 0.63 MG/3 ML INHL NEBU,,3153,LOCAL,Facility,Both,3 mL,mL,,11,9.35,3.1526,11,Sanford Health Plan,Sanford Health Plan,10.12,92,,percent of total billed charges,,
LEVALBUTEROL HCL 0.63 MG/3 ML INHL NEBU,,3153,LOCAL,Facility,Outpatient,3 mL,mL,,34,28.9,9.7444,34,"UCare Health, Inc.",Individual & Family Plan,19.159,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
LEVALBUTEROL HCL 0.63 MG/3 ML INHL NEBU,,3153,LOCAL,Facility,Outpatient,3 mL,mL,,11,9.35,3.1526,11,"UCare Health, Inc.",Individual & Family Plan,6.1985,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
LEVALBUTEROL HCL 0.63 MG/3 ML INHL NEBU,,3153,LOCAL,Facility,Outpatient,3 mL,mL,,11,9.35,3.1526,11,"UCare Health, Inc.",Individual & Family Plan,6.1985,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
LEVALBUTEROL HCL 0.63 MG/3 ML INHL NEBU,,3153,LOCAL,Facility,Inpatient,3 mL,mL,,34,28.9,9.7444,34,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
LEVALBUTEROL HCL 0.63 MG/3 ML INHL NEBU,,3153,LOCAL,Facility,Inpatient,3 mL,mL,,11,9.35,3.1526,11,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
LEVALBUTEROL HCL 0.63 MG/3 ML INHL NEBU,,3153,LOCAL,Facility,Inpatient,3 mL,mL,,11,9.35,3.1526,11,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
LEVALBUTEROL HCL 0.63 MG/3 ML INHL NEBU,,3153,LOCAL,Facility,Outpatient,3 mL,mL,,34,28.9,9.7444,34,"UCare Health, Inc.",Medical Assistance,17.1598,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LEVALBUTEROL HCL 0.63 MG/3 ML INHL NEBU,,3153,LOCAL,Facility,Outpatient,3 mL,mL,,11,9.35,3.1526,11,"UCare Health, Inc.",Medical Assistance,5.5517,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LEVALBUTEROL HCL 0.63 MG/3 ML INHL NEBU,,3153,LOCAL,Facility,Outpatient,3 mL,mL,,11,9.35,3.1526,11,"UCare Health, Inc.",Medical Assistance,5.5517,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LEVALBUTEROL HCL 0.63 MG/3 ML INHL NEBU,,3153,LOCAL,Facility,Inpatient,3 mL,mL,,34,28.9,9.7444,34,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
LEVALBUTEROL HCL 0.63 MG/3 ML INHL NEBU,,3153,LOCAL,Facility,Inpatient,3 mL,mL,,11,9.35,3.1526,11,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
LEVALBUTEROL HCL 0.63 MG/3 ML INHL NEBU,,3153,LOCAL,Facility,Inpatient,3 mL,mL,,11,9.35,3.1526,11,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
LEVALBUTEROL HCL 0.63 MG/3 ML INHL NEBU,,3153,LOCAL,Facility,Outpatient,3 mL,mL,,34,28.9,9.7444,34,"UCare Health, Inc.",Medicare Advantage,17.1598,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LEVALBUTEROL HCL 0.63 MG/3 ML INHL NEBU,,3153,LOCAL,Facility,Outpatient,3 mL,mL,,11,9.35,3.1526,11,"UCare Health, Inc.",Medicare Advantage,5.5517,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LEVALBUTEROL HCL 0.63 MG/3 ML INHL NEBU,,3153,LOCAL,Facility,Outpatient,3 mL,mL,,11,9.35,3.1526,11,"UCare Health, Inc.",Medicare Advantage,5.5517,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LEVALBUTEROL HCL 0.63 MG/3 ML INHL NEBU,,3153,LOCAL,Facility,Inpatient,3 mL,mL,,34,28.9,9.7444,34,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LEVALBUTEROL HCL 0.63 MG/3 ML INHL NEBU,,3153,LOCAL,Facility,Inpatient,3 mL,mL,,11,9.35,3.1526,11,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LEVALBUTEROL HCL 0.63 MG/3 ML INHL NEBU,,3153,LOCAL,Facility,Inpatient,3 mL,mL,,11,9.35,3.1526,11,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LEVALBUTEROL HCL 0.63 MG/3 ML INHL NEBU,,3153,LOCAL,Facility,Outpatient,3 mL,mL,,34,28.9,9.7444,34,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),17.1598,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LEVALBUTEROL HCL 0.63 MG/3 ML INHL NEBU,,3153,LOCAL,Facility,Outpatient,3 mL,mL,,11,9.35,3.1526,11,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),5.5517,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LEVALBUTEROL HCL 0.63 MG/3 ML INHL NEBU,,3153,LOCAL,Facility,Outpatient,3 mL,mL,,11,9.35,3.1526,11,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),5.5517,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LEVALBUTEROL HCL 0.63 MG/3 ML INHL NEBU,,3153,LOCAL,Facility,Inpatient,3 mL,mL,,34,28.9,9.7444,34,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LEVALBUTEROL HCL 0.63 MG/3 ML INHL NEBU,,3153,LOCAL,Facility,Inpatient,3 mL,mL,,11,9.35,3.1526,11,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LEVALBUTEROL HCL 0.63 MG/3 ML INHL NEBU,,3153,LOCAL,Facility,Inpatient,3 mL,mL,,11,9.35,3.1526,11,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LEVALBUTEROL HCL 0.63 MG/3 ML INHL NEBU,,3153,LOCAL,Facility,Both,3 mL,mL,,34,28.9,9.7444,34,UnitedHealthcare,Individual & Family,31.96,94,,percent of total billed charges,,
LEVALBUTEROL HCL 0.63 MG/3 ML INHL NEBU,,3153,LOCAL,Facility,Both,3 mL,mL,,11,9.35,3.1526,11,UnitedHealthcare,Individual & Family,10.34,94,,percent of total billed charges,,
LEVALBUTEROL HCL 0.63 MG/3 ML INHL NEBU,,3153,LOCAL,Facility,Both,3 mL,mL,,11,9.35,3.1526,11,UnitedHealthcare,Individual & Family,10.34,94,,percent of total billed charges,,
LEVALBUTEROL HCL 0.63 MG/3 ML INHL NEBU,,3153,LOCAL,Facility,Outpatient,3 mL,mL,,34,28.9,9.7444,34,UnitedHealthcare,Medicare Advantage,16.66,49,,percent of total billed charges,,
LEVALBUTEROL HCL 0.63 MG/3 ML INHL NEBU,,3153,LOCAL,Facility,Outpatient,3 mL,mL,,11,9.35,3.1526,11,UnitedHealthcare,Medicare Advantage,5.39,49,,percent of total billed charges,,
LEVALBUTEROL HCL 0.63 MG/3 ML INHL NEBU,,3153,LOCAL,Facility,Outpatient,3 mL,mL,,11,9.35,3.1526,11,UnitedHealthcare,Medicare Advantage,5.39,49,,percent of total billed charges,,
LEVALBUTEROL HCL 0.63 MG/3 ML INHL NEBU,,3153,LOCAL,Facility,Inpatient,3 mL,mL,,34,28.9,9.7444,34,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
LEVALBUTEROL HCL 0.63 MG/3 ML INHL NEBU,,3153,LOCAL,Facility,Inpatient,3 mL,mL,,11,9.35,3.1526,11,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
LEVALBUTEROL HCL 0.63 MG/3 ML INHL NEBU,,3153,LOCAL,Facility,Inpatient,3 mL,mL,,11,9.35,3.1526,11,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
LEVALBUTEROL HCL 0.63 MG/3 ML INHL NEBU,,3153,LOCAL,Facility,Outpatient,3 mL,mL,,34,28.9,9.7444,34,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,16.32,48,,percent of total billed charges,,100% of DHS outpatient percentage
LEVALBUTEROL HCL 0.63 MG/3 ML INHL NEBU,,3153,LOCAL,Facility,Outpatient,3 mL,mL,,11,9.35,3.1526,11,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,5.28,48,,percent of total billed charges,,100% of DHS outpatient percentage
LEVALBUTEROL HCL 0.63 MG/3 ML INHL NEBU,,3153,LOCAL,Facility,Outpatient,3 mL,mL,,11,9.35,3.1526,11,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,5.28,48,,percent of total billed charges,,100% of DHS outpatient percentage
LEVALBUTEROL HCL 0.63 MG/3 ML INHL NEBU,,3153,LOCAL,Facility,Inpatient,3 mL,mL,,34,28.9,9.7444,34,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
LEVALBUTEROL HCL 0.63 MG/3 ML INHL NEBU,,3153,LOCAL,Facility,Inpatient,3 mL,mL,,11,9.35,3.1526,11,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
LEVALBUTEROL HCL 0.63 MG/3 ML INHL NEBU,,3153,LOCAL,Facility,Inpatient,3 mL,mL,,11,9.35,3.1526,11,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
LEVALBUTEROL HCL 1.25 MG/3 ML INHL NEBU,,16935,LOCAL,Facility,Both,3 mL,mL,,11,9.35,3.1526,11,Aetna,Commercial,10.12,92,,percent of total billed charges,,
LEVALBUTEROL HCL 1.25 MG/3 ML INHL NEBU,,16935,LOCAL,Facility,Outpatient,3 mL,mL,,11,9.35,3.1526,11,Aetna,Medicare Advantage,5.39,49,,percent of total billed charges,,
LEVALBUTEROL HCL 1.25 MG/3 ML INHL NEBU,,16935,LOCAL,Facility,Inpatient,3 mL,mL,,11,9.35,3.1526,11,Aetna,Medicare Advantage,,,,,Included in per diem rate,
LEVALBUTEROL HCL 1.25 MG/3 ML INHL NEBU,,16935,LOCAL,Facility,Both,3 mL,mL,,11,9.35,3.1526,11,Aetna,PPO,10.23,93,,percent of total billed charges,,
LEVALBUTEROL HCL 1.25 MG/3 ML INHL NEBU,,16935,LOCAL,Facility,Both,3 mL,mL,,11,9.35,3.1526,11,America's PPO,America's PPO,10.5633,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
LEVALBUTEROL HCL 1.25 MG/3 ML INHL NEBU,,16935,LOCAL,Facility,Both,3 mL,mL,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota, Federal Employee Program,10.824,98.4,,percent of total billed charges,,
LEVALBUTEROL HCL 1.25 MG/3 ML INHL NEBU,,16935,LOCAL,Facility,Both,3 mL,mL,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,11,100,,percent of total billed charges,,
LEVALBUTEROL HCL 1.25 MG/3 ML INHL NEBU,,16935,LOCAL,Facility,Both,3 mL,mL,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,High Value Network Plan,9.9,90,,percent of total billed charges,,
LEVALBUTEROL HCL 1.25 MG/3 ML INHL NEBU,,16935,LOCAL,Facility,Outpatient,3 mL,mL,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,Medicare Advantage,5.39,49,,percent of total billed charges,,
LEVALBUTEROL HCL 1.25 MG/3 ML INHL NEBU,,16935,LOCAL,Facility,Inpatient,3 mL,mL,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
LEVALBUTEROL HCL 1.25 MG/3 ML INHL NEBU,,16935,LOCAL,Facility,Both,3 mL,mL,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,9.7427,88.57,,percent of total billed charges,,
LEVALBUTEROL HCL 1.25 MG/3 ML INHL NEBU,,16935,LOCAL,Facility,Both,3 mL,mL,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,3.1526,28.66,,percent of total billed charges,,
LEVALBUTEROL HCL 1.25 MG/3 ML INHL NEBU,,16935,LOCAL,Facility,Outpatient,3 mL,mL,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),5.39,49,,percent of total billed charges,,
LEVALBUTEROL HCL 1.25 MG/3 ML INHL NEBU,,16935,LOCAL,Facility,Inpatient,3 mL,mL,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
LEVALBUTEROL HCL 1.25 MG/3 ML INHL NEBU,,16935,LOCAL,Facility,Both,3 mL,mL,,11,9.35,3.1526,11,CorVel,Worker's Compensation,11,100,,percent of total billed charges,,
LEVALBUTEROL HCL 1.25 MG/3 ML INHL NEBU,,16935,LOCAL,Facility,Both,3 mL,mL,,11,9.35,3.1526,11,First Health Group Corporation,First Health Network,10.67,97,,percent of total billed charges,,
LEVALBUTEROL HCL 1.25 MG/3 ML INHL NEBU,,16935,LOCAL,Facility,Both,3 mL,mL,,11,9.35,3.1526,11,"Health Partners, Inc.",Commercial,10.406,94.6,,percent of total billed charges,,
LEVALBUTEROL HCL 1.25 MG/3 ML INHL NEBU,,16935,LOCAL,Facility,Outpatient,3 mL,mL,,11,9.35,3.1526,11,"Health Partners, Inc.",Medicare Advantage,5.39,49,,percent of total billed charges,,
LEVALBUTEROL HCL 1.25 MG/3 ML INHL NEBU,,16935,LOCAL,Facility,Inpatient,3 mL,mL,,11,9.35,3.1526,11,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LEVALBUTEROL HCL 1.25 MG/3 ML INHL NEBU,,16935,LOCAL,Facility,Both,3 mL,mL,,11,9.35,3.1526,11,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),6.6,60,,percent of total billed charges,,
LEVALBUTEROL HCL 1.25 MG/3 ML INHL NEBU,,16935,LOCAL,Facility,Both,3 mL,mL,,11,9.35,3.1526,11,"Health Partners, Inc.",State of Minnesota Advantage Program,8.965,81.5,,percent of total billed charges,,
LEVALBUTEROL HCL 1.25 MG/3 ML INHL NEBU,,16935,LOCAL,Facility,Both,3 mL,mL,,11,9.35,3.1526,11,"Health Partners, Inc.",State Public Programs,5.5,50,,percent of total billed charges,,
LEVALBUTEROL HCL 1.25 MG/3 ML INHL NEBU,,16935,LOCAL,Facility,Both,3 mL,mL,,11,9.35,3.1526,11,Humana Insurance Company,Commercial PPO,10.45,95,,percent of total billed charges,,
LEVALBUTEROL HCL 1.25 MG/3 ML INHL NEBU,,16935,LOCAL,Facility,Outpatient,3 mL,mL,,11,9.35,3.1526,11,Humana Insurance Company,Medicare PPO,5.39,49,,percent of total billed charges,,
LEVALBUTEROL HCL 1.25 MG/3 ML INHL NEBU,,16935,LOCAL,Facility,Inpatient,3 mL,mL,,11,9.35,3.1526,11,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
LEVALBUTEROL HCL 1.25 MG/3 ML INHL NEBU,,16935,LOCAL,Facility,Both,3 mL,mL,,11,9.35,3.1526,11,Medica,Individual & Family,10.901,99.1,,percent of total billed charges,,
LEVALBUTEROL HCL 1.25 MG/3 ML INHL NEBU,,16935,LOCAL,Facility,Outpatient,3 mL,mL,,11,9.35,3.1526,11,Medica,Medica Advantage Solution,5.478,49.8,,percent of total billed charges,,
LEVALBUTEROL HCL 1.25 MG/3 ML INHL NEBU,,16935,LOCAL,Facility,Inpatient,3 mL,mL,,11,9.35,3.1526,11,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
LEVALBUTEROL HCL 1.25 MG/3 ML INHL NEBU,,16935,LOCAL,Facility,Outpatient,3 mL,mL,,11,9.35,3.1526,11,Medica,Medical Assistance,4.906,44.6,,percent of total billed charges,,
LEVALBUTEROL HCL 1.25 MG/3 ML INHL NEBU,,16935,LOCAL,Facility,Inpatient,3 mL,mL,,11,9.35,3.1526,11,Medica,Medical Assistance,,,,,Included in per diem rate,
LEVALBUTEROL HCL 1.25 MG/3 ML INHL NEBU,,16935,LOCAL,Facility,Outpatient,3 mL,mL,,11,9.35,3.1526,11,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,5.478,49.8,,percent of total billed charges,,
LEVALBUTEROL HCL 1.25 MG/3 ML INHL NEBU,,16935,LOCAL,Facility,Inpatient,3 mL,mL,,11,9.35,3.1526,11,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
LEVALBUTEROL HCL 1.25 MG/3 ML INHL NEBU,,16935,LOCAL,Facility,Both,3 mL,mL,,11,9.35,3.1526,11,"Multiplan, Inc.","Multiplan, Inc.",10.34,94,,percent of total billed charges,,
LEVALBUTEROL HCL 1.25 MG/3 ML INHL NEBU,,16935,LOCAL,Facility,Outpatient,3 mL,mL,,11,9.35,3.1526,11,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,9.911,90.1,,percent of total billed charges,,
LEVALBUTEROL HCL 1.25 MG/3 ML INHL NEBU,,16935,LOCAL,Facility,Inpatient,3 mL,mL,,11,9.35,3.1526,11,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
LEVALBUTEROL HCL 1.25 MG/3 ML INHL NEBU,,16935,LOCAL,Facility,Both,3 mL,mL,,11,9.35,3.1526,11,"Preferred One Administrative Services, INC.",PPO,10.846,98.6,,percent of total billed charges,,
LEVALBUTEROL HCL 1.25 MG/3 ML INHL NEBU,,16935,LOCAL,Facility,Outpatient,3 mL,mL,,11,9.35,3.1526,11,PrimeWest Health,Minnesota Senior Health Options (MSHO),5.6595,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
LEVALBUTEROL HCL 1.25 MG/3 ML INHL NEBU,,16935,LOCAL,Facility,Inpatient,3 mL,mL,,11,9.35,3.1526,11,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LEVALBUTEROL HCL 1.25 MG/3 ML INHL NEBU,,16935,LOCAL,Facility,Outpatient,3 mL,mL,,11,9.35,3.1526,11,PrimeWest Health,MinnesotaCare,5.6496,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
LEVALBUTEROL HCL 1.25 MG/3 ML INHL NEBU,,16935,LOCAL,Facility,Inpatient,3 mL,mL,,11,9.35,3.1526,11,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
LEVALBUTEROL HCL 1.25 MG/3 ML INHL NEBU,,16935,LOCAL,Facility,Both,3 mL,mL,,11,9.35,3.1526,11,Sanford Health Plan,Sanford Health Plan,10.12,92,,percent of total billed charges,,
LEVALBUTEROL HCL 1.25 MG/3 ML INHL NEBU,,16935,LOCAL,Facility,Outpatient,3 mL,mL,,11,9.35,3.1526,11,"UCare Health, Inc.",Individual & Family Plan,6.1985,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
LEVALBUTEROL HCL 1.25 MG/3 ML INHL NEBU,,16935,LOCAL,Facility,Inpatient,3 mL,mL,,11,9.35,3.1526,11,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
LEVALBUTEROL HCL 1.25 MG/3 ML INHL NEBU,,16935,LOCAL,Facility,Outpatient,3 mL,mL,,11,9.35,3.1526,11,"UCare Health, Inc.",Medical Assistance,5.5517,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LEVALBUTEROL HCL 1.25 MG/3 ML INHL NEBU,,16935,LOCAL,Facility,Inpatient,3 mL,mL,,11,9.35,3.1526,11,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
LEVALBUTEROL HCL 1.25 MG/3 ML INHL NEBU,,16935,LOCAL,Facility,Outpatient,3 mL,mL,,11,9.35,3.1526,11,"UCare Health, Inc.",Medicare Advantage,5.5517,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LEVALBUTEROL HCL 1.25 MG/3 ML INHL NEBU,,16935,LOCAL,Facility,Inpatient,3 mL,mL,,11,9.35,3.1526,11,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LEVALBUTEROL HCL 1.25 MG/3 ML INHL NEBU,,16935,LOCAL,Facility,Outpatient,3 mL,mL,,11,9.35,3.1526,11,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),5.5517,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LEVALBUTEROL HCL 1.25 MG/3 ML INHL NEBU,,16935,LOCAL,Facility,Inpatient,3 mL,mL,,11,9.35,3.1526,11,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LEVALBUTEROL HCL 1.25 MG/3 ML INHL NEBU,,16935,LOCAL,Facility,Both,3 mL,mL,,11,9.35,3.1526,11,UnitedHealthcare,Individual & Family,10.34,94,,percent of total billed charges,,
LEVALBUTEROL HCL 1.25 MG/3 ML INHL NEBU,,16935,LOCAL,Facility,Outpatient,3 mL,mL,,11,9.35,3.1526,11,UnitedHealthcare,Medicare Advantage,5.39,49,,percent of total billed charges,,
LEVALBUTEROL HCL 1.25 MG/3 ML INHL NEBU,,16935,LOCAL,Facility,Inpatient,3 mL,mL,,11,9.35,3.1526,11,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
LEVALBUTEROL HCL 1.25 MG/3 ML INHL NEBU,,16935,LOCAL,Facility,Outpatient,3 mL,mL,,11,9.35,3.1526,11,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,5.28,48,,percent of total billed charges,,100% of DHS outpatient percentage
LEVALBUTEROL HCL 1.25 MG/3 ML INHL NEBU,,16935,LOCAL,Facility,Inpatient,3 mL,mL,,11,9.35,3.1526,11,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
SODIUM CHLORIDE 0.9 % INHL NEBU,,18550,LOCAL,Facility,Both,3 mL,mL,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % INHL NEBU,,18550,LOCAL,Facility,Outpatient,3 mL,mL,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % INHL NEBU,,18550,LOCAL,Facility,Inpatient,3 mL,mL,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
SODIUM CHLORIDE 0.9 % INHL NEBU,,18550,LOCAL,Facility,Both,3 mL,mL,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % INHL NEBU,,18550,LOCAL,Facility,Both,3 mL,mL,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SODIUM CHLORIDE 0.9 % INHL NEBU,,18550,LOCAL,Facility,Both,3 mL,mL,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % INHL NEBU,,18550,LOCAL,Facility,Both,3 mL,mL,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % INHL NEBU,,18550,LOCAL,Facility,Both,3 mL,mL,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % INHL NEBU,,18550,LOCAL,Facility,Outpatient,3 mL,mL,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % INHL NEBU,,18550,LOCAL,Facility,Inpatient,3 mL,mL,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
SODIUM CHLORIDE 0.9 % INHL NEBU,,18550,LOCAL,Facility,Both,3 mL,mL,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % INHL NEBU,,18550,LOCAL,Facility,Both,3 mL,mL,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % INHL NEBU,,18550,LOCAL,Facility,Outpatient,3 mL,mL,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % INHL NEBU,,18550,LOCAL,Facility,Inpatient,3 mL,mL,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
SODIUM CHLORIDE 0.9 % INHL NEBU,,18550,LOCAL,Facility,Both,3 mL,mL,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % INHL NEBU,,18550,LOCAL,Facility,Both,3 mL,mL,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % INHL NEBU,,18550,LOCAL,Facility,Both,3 mL,mL,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % INHL NEBU,,18550,LOCAL,Facility,Outpatient,3 mL,mL,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % INHL NEBU,,18550,LOCAL,Facility,Inpatient,3 mL,mL,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SODIUM CHLORIDE 0.9 % INHL NEBU,,18550,LOCAL,Facility,Both,3 mL,mL,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % INHL NEBU,,18550,LOCAL,Facility,Both,3 mL,mL,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % INHL NEBU,,18550,LOCAL,Facility,Both,3 mL,mL,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % INHL NEBU,,18550,LOCAL,Facility,Both,3 mL,mL,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % INHL NEBU,,18550,LOCAL,Facility,Outpatient,3 mL,mL,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % INHL NEBU,,18550,LOCAL,Facility,Inpatient,3 mL,mL,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
SODIUM CHLORIDE 0.9 % INHL NEBU,,18550,LOCAL,Facility,Both,3 mL,mL,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % INHL NEBU,,18550,LOCAL,Facility,Outpatient,3 mL,mL,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % INHL NEBU,,18550,LOCAL,Facility,Inpatient,3 mL,mL,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
SODIUM CHLORIDE 0.9 % INHL NEBU,,18550,LOCAL,Facility,Outpatient,3 mL,mL,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % INHL NEBU,,18550,LOCAL,Facility,Inpatient,3 mL,mL,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
SODIUM CHLORIDE 0.9 % INHL NEBU,,18550,LOCAL,Facility,Outpatient,3 mL,mL,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % INHL NEBU,,18550,LOCAL,Facility,Inpatient,3 mL,mL,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
SODIUM CHLORIDE 0.9 % INHL NEBU,,18550,LOCAL,Facility,Both,3 mL,mL,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % INHL NEBU,,18550,LOCAL,Facility,Outpatient,3 mL,mL,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % INHL NEBU,,18550,LOCAL,Facility,Inpatient,3 mL,mL,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
SODIUM CHLORIDE 0.9 % INHL NEBU,,18550,LOCAL,Facility,Both,3 mL,mL,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % INHL NEBU,,18550,LOCAL,Facility,Outpatient,3 mL,mL,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
SODIUM CHLORIDE 0.9 % INHL NEBU,,18550,LOCAL,Facility,Inpatient,3 mL,mL,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SODIUM CHLORIDE 0.9 % INHL NEBU,,18550,LOCAL,Facility,Outpatient,3 mL,mL,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
SODIUM CHLORIDE 0.9 % INHL NEBU,,18550,LOCAL,Facility,Inpatient,3 mL,mL,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
SODIUM CHLORIDE 0.9 % INHL NEBU,,18550,LOCAL,Facility,Both,3 mL,mL,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % INHL NEBU,,18550,LOCAL,Facility,Outpatient,3 mL,mL,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
SODIUM CHLORIDE 0.9 % INHL NEBU,,18550,LOCAL,Facility,Inpatient,3 mL,mL,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
SODIUM CHLORIDE 0.9 % INHL NEBU,,18550,LOCAL,Facility,Outpatient,3 mL,mL,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SODIUM CHLORIDE 0.9 % INHL NEBU,,18550,LOCAL,Facility,Inpatient,3 mL,mL,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
SODIUM CHLORIDE 0.9 % INHL NEBU,,18550,LOCAL,Facility,Outpatient,3 mL,mL,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SODIUM CHLORIDE 0.9 % INHL NEBU,,18550,LOCAL,Facility,Inpatient,3 mL,mL,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SODIUM CHLORIDE 0.9 % INHL NEBU,,18550,LOCAL,Facility,Outpatient,3 mL,mL,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SODIUM CHLORIDE 0.9 % INHL NEBU,,18550,LOCAL,Facility,Inpatient,3 mL,mL,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SODIUM CHLORIDE 0.9 % INHL NEBU,,18550,LOCAL,Facility,Both,3 mL,mL,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % INHL NEBU,,18550,LOCAL,Facility,Outpatient,3 mL,mL,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % INHL NEBU,,18550,LOCAL,Facility,Inpatient,3 mL,mL,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
SODIUM CHLORIDE 0.9 % INHL NEBU,,18550,LOCAL,Facility,Outpatient,3 mL,mL,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
SODIUM CHLORIDE 0.9 % INHL NEBU,,18550,LOCAL,Facility,Inpatient,3 mL,mL,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
MOXIFLOXACIN 0.5 % OPHT DROP,,27954,LOCAL,Facility,Both,3 mL,mL,,653,555.05,187.1498,653,Aetna,Commercial,600.76,92,,percent of total billed charges,,
MOXIFLOXACIN 0.5 % OPHT DROP,,27954,LOCAL,Facility,Outpatient,3 mL,mL,,653,555.05,187.1498,653,Aetna,Medicare Advantage,319.97,49,,percent of total billed charges,,
MOXIFLOXACIN 0.5 % OPHT DROP,,27954,LOCAL,Facility,Inpatient,3 mL,mL,,653,555.05,187.1498,653,Aetna,Medicare Advantage,,,,,Included in per diem rate,
MOXIFLOXACIN 0.5 % OPHT DROP,,27954,LOCAL,Facility,Both,3 mL,mL,,653,555.05,187.1498,653,Aetna,PPO,607.29,93,,percent of total billed charges,,
MOXIFLOXACIN 0.5 % OPHT DROP,,27954,LOCAL,Facility,Both,3 mL,mL,,653,555.05,187.1498,653,America's PPO,America's PPO,627.0759,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
MOXIFLOXACIN 0.5 % OPHT DROP,,27954,LOCAL,Facility,Both,3 mL,mL,,653,555.05,187.1498,653,BlueCross BlueShield Minnesota, Federal Employee Program,642.552,98.4,,percent of total billed charges,,
MOXIFLOXACIN 0.5 % OPHT DROP,,27954,LOCAL,Facility,Both,3 mL,mL,,653,555.05,187.1498,653,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,653,100,,percent of total billed charges,,
MOXIFLOXACIN 0.5 % OPHT DROP,,27954,LOCAL,Facility,Both,3 mL,mL,,653,555.05,187.1498,653,BlueCross BlueShield Minnesota,High Value Network Plan,587.7,90,,percent of total billed charges,,
MOXIFLOXACIN 0.5 % OPHT DROP,,27954,LOCAL,Facility,Outpatient,3 mL,mL,,653,555.05,187.1498,653,BlueCross BlueShield Minnesota,Medicare Advantage,319.97,49,,percent of total billed charges,,
MOXIFLOXACIN 0.5 % OPHT DROP,,27954,LOCAL,Facility,Inpatient,3 mL,mL,,653,555.05,187.1498,653,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
MOXIFLOXACIN 0.5 % OPHT DROP,,27954,LOCAL,Facility,Both,3 mL,mL,,653,555.05,187.1498,653,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,578.3621,88.57,,percent of total billed charges,,
MOXIFLOXACIN 0.5 % OPHT DROP,,27954,LOCAL,Facility,Both,3 mL,mL,,653,555.05,187.1498,653,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,187.1498,28.66,,percent of total billed charges,,
MOXIFLOXACIN 0.5 % OPHT DROP,,27954,LOCAL,Facility,Outpatient,3 mL,mL,,653,555.05,187.1498,653,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),319.97,49,,percent of total billed charges,,
MOXIFLOXACIN 0.5 % OPHT DROP,,27954,LOCAL,Facility,Inpatient,3 mL,mL,,653,555.05,187.1498,653,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
MOXIFLOXACIN 0.5 % OPHT DROP,,27954,LOCAL,Facility,Both,3 mL,mL,,653,555.05,187.1498,653,CorVel,Worker's Compensation,653,100,,percent of total billed charges,,
MOXIFLOXACIN 0.5 % OPHT DROP,,27954,LOCAL,Facility,Both,3 mL,mL,,653,555.05,187.1498,653,First Health Group Corporation,First Health Network,633.41,97,,percent of total billed charges,,
MOXIFLOXACIN 0.5 % OPHT DROP,,27954,LOCAL,Facility,Both,3 mL,mL,,653,555.05,187.1498,653,"Health Partners, Inc.",Commercial,617.738,94.6,,percent of total billed charges,,
MOXIFLOXACIN 0.5 % OPHT DROP,,27954,LOCAL,Facility,Outpatient,3 mL,mL,,653,555.05,187.1498,653,"Health Partners, Inc.",Medicare Advantage,319.97,49,,percent of total billed charges,,
MOXIFLOXACIN 0.5 % OPHT DROP,,27954,LOCAL,Facility,Inpatient,3 mL,mL,,653,555.05,187.1498,653,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
MOXIFLOXACIN 0.5 % OPHT DROP,,27954,LOCAL,Facility,Both,3 mL,mL,,653,555.05,187.1498,653,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),391.8,60,,percent of total billed charges,,
MOXIFLOXACIN 0.5 % OPHT DROP,,27954,LOCAL,Facility,Both,3 mL,mL,,653,555.05,187.1498,653,"Health Partners, Inc.",State of Minnesota Advantage Program,532.195,81.5,,percent of total billed charges,,
MOXIFLOXACIN 0.5 % OPHT DROP,,27954,LOCAL,Facility,Both,3 mL,mL,,653,555.05,187.1498,653,"Health Partners, Inc.",State Public Programs,326.5,50,,percent of total billed charges,,
MOXIFLOXACIN 0.5 % OPHT DROP,,27954,LOCAL,Facility,Both,3 mL,mL,,653,555.05,187.1498,653,Humana Insurance Company,Commercial PPO,620.35,95,,percent of total billed charges,,
MOXIFLOXACIN 0.5 % OPHT DROP,,27954,LOCAL,Facility,Outpatient,3 mL,mL,,653,555.05,187.1498,653,Humana Insurance Company,Medicare PPO,319.97,49,,percent of total billed charges,,
MOXIFLOXACIN 0.5 % OPHT DROP,,27954,LOCAL,Facility,Inpatient,3 mL,mL,,653,555.05,187.1498,653,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
MOXIFLOXACIN 0.5 % OPHT DROP,,27954,LOCAL,Facility,Both,3 mL,mL,,653,555.05,187.1498,653,Medica,Individual & Family,647.123,99.1,,percent of total billed charges,,
MOXIFLOXACIN 0.5 % OPHT DROP,,27954,LOCAL,Facility,Outpatient,3 mL,mL,,653,555.05,187.1498,653,Medica,Medica Advantage Solution,325.194,49.8,,percent of total billed charges,,
MOXIFLOXACIN 0.5 % OPHT DROP,,27954,LOCAL,Facility,Inpatient,3 mL,mL,,653,555.05,187.1498,653,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
MOXIFLOXACIN 0.5 % OPHT DROP,,27954,LOCAL,Facility,Outpatient,3 mL,mL,,653,555.05,187.1498,653,Medica,Medical Assistance,291.238,44.6,,percent of total billed charges,,
MOXIFLOXACIN 0.5 % OPHT DROP,,27954,LOCAL,Facility,Inpatient,3 mL,mL,,653,555.05,187.1498,653,Medica,Medical Assistance,,,,,Included in per diem rate,
MOXIFLOXACIN 0.5 % OPHT DROP,,27954,LOCAL,Facility,Outpatient,3 mL,mL,,653,555.05,187.1498,653,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,325.194,49.8,,percent of total billed charges,,
MOXIFLOXACIN 0.5 % OPHT DROP,,27954,LOCAL,Facility,Inpatient,3 mL,mL,,653,555.05,187.1498,653,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
MOXIFLOXACIN 0.5 % OPHT DROP,,27954,LOCAL,Facility,Both,3 mL,mL,,653,555.05,187.1498,653,"Multiplan, Inc.","Multiplan, Inc.",613.82,94,,percent of total billed charges,,
MOXIFLOXACIN 0.5 % OPHT DROP,,27954,LOCAL,Facility,Outpatient,3 mL,mL,,653,555.05,187.1498,653,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,588.353,90.1,,percent of total billed charges,,
MOXIFLOXACIN 0.5 % OPHT DROP,,27954,LOCAL,Facility,Inpatient,3 mL,mL,,653,555.05,187.1498,653,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
MOXIFLOXACIN 0.5 % OPHT DROP,,27954,LOCAL,Facility,Both,3 mL,mL,,653,555.05,187.1498,653,"Preferred One Administrative Services, INC.",PPO,643.858,98.6,,percent of total billed charges,,
MOXIFLOXACIN 0.5 % OPHT DROP,,27954,LOCAL,Facility,Outpatient,3 mL,mL,,653,555.05,187.1498,653,PrimeWest Health,Minnesota Senior Health Options (MSHO),335.9685,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
MOXIFLOXACIN 0.5 % OPHT DROP,,27954,LOCAL,Facility,Inpatient,3 mL,mL,,653,555.05,187.1498,653,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
MOXIFLOXACIN 0.5 % OPHT DROP,,27954,LOCAL,Facility,Outpatient,3 mL,mL,,653,555.05,187.1498,653,PrimeWest Health,MinnesotaCare,335.3808,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
MOXIFLOXACIN 0.5 % OPHT DROP,,27954,LOCAL,Facility,Inpatient,3 mL,mL,,653,555.05,187.1498,653,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
MOXIFLOXACIN 0.5 % OPHT DROP,,27954,LOCAL,Facility,Both,3 mL,mL,,653,555.05,187.1498,653,Sanford Health Plan,Sanford Health Plan,600.76,92,,percent of total billed charges,,
MOXIFLOXACIN 0.5 % OPHT DROP,,27954,LOCAL,Facility,Outpatient,3 mL,mL,,653,555.05,187.1498,653,"UCare Health, Inc.",Individual & Family Plan,367.9655,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
MOXIFLOXACIN 0.5 % OPHT DROP,,27954,LOCAL,Facility,Inpatient,3 mL,mL,,653,555.05,187.1498,653,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
MOXIFLOXACIN 0.5 % OPHT DROP,,27954,LOCAL,Facility,Outpatient,3 mL,mL,,653,555.05,187.1498,653,"UCare Health, Inc.",Medical Assistance,329.5691,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MOXIFLOXACIN 0.5 % OPHT DROP,,27954,LOCAL,Facility,Inpatient,3 mL,mL,,653,555.05,187.1498,653,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
MOXIFLOXACIN 0.5 % OPHT DROP,,27954,LOCAL,Facility,Outpatient,3 mL,mL,,653,555.05,187.1498,653,"UCare Health, Inc.",Medicare Advantage,329.5691,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MOXIFLOXACIN 0.5 % OPHT DROP,,27954,LOCAL,Facility,Inpatient,3 mL,mL,,653,555.05,187.1498,653,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
MOXIFLOXACIN 0.5 % OPHT DROP,,27954,LOCAL,Facility,Outpatient,3 mL,mL,,653,555.05,187.1498,653,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),329.5691,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MOXIFLOXACIN 0.5 % OPHT DROP,,27954,LOCAL,Facility,Inpatient,3 mL,mL,,653,555.05,187.1498,653,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
MOXIFLOXACIN 0.5 % OPHT DROP,,27954,LOCAL,Facility,Both,3 mL,mL,,653,555.05,187.1498,653,UnitedHealthcare,Individual & Family,613.82,94,,percent of total billed charges,,
MOXIFLOXACIN 0.5 % OPHT DROP,,27954,LOCAL,Facility,Outpatient,3 mL,mL,,653,555.05,187.1498,653,UnitedHealthcare,Medicare Advantage,319.97,49,,percent of total billed charges,,
MOXIFLOXACIN 0.5 % OPHT DROP,,27954,LOCAL,Facility,Inpatient,3 mL,mL,,653,555.05,187.1498,653,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
MOXIFLOXACIN 0.5 % OPHT DROP,,27954,LOCAL,Facility,Outpatient,3 mL,mL,,653,555.05,187.1498,653,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,313.44,48,,percent of total billed charges,,100% of DHS outpatient percentage
MOXIFLOXACIN 0.5 % OPHT DROP,,27954,LOCAL,Facility,Inpatient,3 mL,mL,,653,555.05,187.1498,653,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
L.E.T. GEL,,420306,LOCAL,Facility,Both,3 mL,mL,,72,61.2,20.6352,72,Aetna,Commercial,66.24,92,,percent of total billed charges,,
L.E.T. GEL,,420306,LOCAL,Facility,Outpatient,3 mL,mL,,72,61.2,20.6352,72,Aetna,Medicare Advantage,35.28,49,,percent of total billed charges,,
L.E.T. GEL,,420306,LOCAL,Facility,Inpatient,3 mL,mL,,72,61.2,20.6352,72,Aetna,Medicare Advantage,,,,,Included in per diem rate,
L.E.T. GEL,,420306,LOCAL,Facility,Both,3 mL,mL,,72,61.2,20.6352,72,Aetna,PPO,66.96,93,,percent of total billed charges,,
L.E.T. GEL,,420306,LOCAL,Facility,Both,3 mL,mL,,72,61.2,20.6352,72,America's PPO,America's PPO,69.1416,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
L.E.T. GEL,,420306,LOCAL,Facility,Both,3 mL,mL,,72,61.2,20.6352,72,BlueCross BlueShield Minnesota, Federal Employee Program,70.848,98.4,,percent of total billed charges,,
L.E.T. GEL,,420306,LOCAL,Facility,Both,3 mL,mL,,72,61.2,20.6352,72,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,72,100,,percent of total billed charges,,
L.E.T. GEL,,420306,LOCAL,Facility,Both,3 mL,mL,,72,61.2,20.6352,72,BlueCross BlueShield Minnesota,High Value Network Plan,64.8,90,,percent of total billed charges,,
L.E.T. GEL,,420306,LOCAL,Facility,Outpatient,3 mL,mL,,72,61.2,20.6352,72,BlueCross BlueShield Minnesota,Medicare Advantage,35.28,49,,percent of total billed charges,,
L.E.T. GEL,,420306,LOCAL,Facility,Inpatient,3 mL,mL,,72,61.2,20.6352,72,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
L.E.T. GEL,,420306,LOCAL,Facility,Both,3 mL,mL,,72,61.2,20.6352,72,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,63.7704,88.57,,percent of total billed charges,,
L.E.T. GEL,,420306,LOCAL,Facility,Both,3 mL,mL,,72,61.2,20.6352,72,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,20.6352,28.66,,percent of total billed charges,,
L.E.T. GEL,,420306,LOCAL,Facility,Outpatient,3 mL,mL,,72,61.2,20.6352,72,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),35.28,49,,percent of total billed charges,,
L.E.T. GEL,,420306,LOCAL,Facility,Inpatient,3 mL,mL,,72,61.2,20.6352,72,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
L.E.T. GEL,,420306,LOCAL,Facility,Both,3 mL,mL,,72,61.2,20.6352,72,CorVel,Worker's Compensation,72,100,,percent of total billed charges,,
L.E.T. GEL,,420306,LOCAL,Facility,Both,3 mL,mL,,72,61.2,20.6352,72,First Health Group Corporation,First Health Network,69.84,97,,percent of total billed charges,,
L.E.T. GEL,,420306,LOCAL,Facility,Both,3 mL,mL,,72,61.2,20.6352,72,"Health Partners, Inc.",Commercial,68.112,94.6,,percent of total billed charges,,
L.E.T. GEL,,420306,LOCAL,Facility,Outpatient,3 mL,mL,,72,61.2,20.6352,72,"Health Partners, Inc.",Medicare Advantage,35.28,49,,percent of total billed charges,,
L.E.T. GEL,,420306,LOCAL,Facility,Inpatient,3 mL,mL,,72,61.2,20.6352,72,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
L.E.T. GEL,,420306,LOCAL,Facility,Both,3 mL,mL,,72,61.2,20.6352,72,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),43.2,60,,percent of total billed charges,,
L.E.T. GEL,,420306,LOCAL,Facility,Both,3 mL,mL,,72,61.2,20.6352,72,"Health Partners, Inc.",State of Minnesota Advantage Program,58.68,81.5,,percent of total billed charges,,
L.E.T. GEL,,420306,LOCAL,Facility,Both,3 mL,mL,,72,61.2,20.6352,72,"Health Partners, Inc.",State Public Programs,36,50,,percent of total billed charges,,
L.E.T. GEL,,420306,LOCAL,Facility,Both,3 mL,mL,,72,61.2,20.6352,72,Humana Insurance Company,Commercial PPO,68.4,95,,percent of total billed charges,,
L.E.T. GEL,,420306,LOCAL,Facility,Outpatient,3 mL,mL,,72,61.2,20.6352,72,Humana Insurance Company,Medicare PPO,35.28,49,,percent of total billed charges,,
L.E.T. GEL,,420306,LOCAL,Facility,Inpatient,3 mL,mL,,72,61.2,20.6352,72,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
L.E.T. GEL,,420306,LOCAL,Facility,Both,3 mL,mL,,72,61.2,20.6352,72,Medica,Individual & Family,71.352,99.1,,percent of total billed charges,,
L.E.T. GEL,,420306,LOCAL,Facility,Outpatient,3 mL,mL,,72,61.2,20.6352,72,Medica,Medica Advantage Solution,35.856,49.8,,percent of total billed charges,,
L.E.T. GEL,,420306,LOCAL,Facility,Inpatient,3 mL,mL,,72,61.2,20.6352,72,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
L.E.T. GEL,,420306,LOCAL,Facility,Outpatient,3 mL,mL,,72,61.2,20.6352,72,Medica,Medical Assistance,32.112,44.6,,percent of total billed charges,,
L.E.T. GEL,,420306,LOCAL,Facility,Inpatient,3 mL,mL,,72,61.2,20.6352,72,Medica,Medical Assistance,,,,,Included in per diem rate,
L.E.T. GEL,,420306,LOCAL,Facility,Outpatient,3 mL,mL,,72,61.2,20.6352,72,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,35.856,49.8,,percent of total billed charges,,
L.E.T. GEL,,420306,LOCAL,Facility,Inpatient,3 mL,mL,,72,61.2,20.6352,72,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
L.E.T. GEL,,420306,LOCAL,Facility,Both,3 mL,mL,,72,61.2,20.6352,72,"Multiplan, Inc.","Multiplan, Inc.",67.68,94,,percent of total billed charges,,
L.E.T. GEL,,420306,LOCAL,Facility,Outpatient,3 mL,mL,,72,61.2,20.6352,72,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,64.872,90.1,,percent of total billed charges,,
L.E.T. GEL,,420306,LOCAL,Facility,Inpatient,3 mL,mL,,72,61.2,20.6352,72,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
L.E.T. GEL,,420306,LOCAL,Facility,Both,3 mL,mL,,72,61.2,20.6352,72,"Preferred One Administrative Services, INC.",PPO,70.992,98.6,,percent of total billed charges,,
L.E.T. GEL,,420306,LOCAL,Facility,Outpatient,3 mL,mL,,72,61.2,20.6352,72,PrimeWest Health,Minnesota Senior Health Options (MSHO),37.044,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
L.E.T. GEL,,420306,LOCAL,Facility,Inpatient,3 mL,mL,,72,61.2,20.6352,72,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
L.E.T. GEL,,420306,LOCAL,Facility,Outpatient,3 mL,mL,,72,61.2,20.6352,72,PrimeWest Health,MinnesotaCare,36.9792,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
L.E.T. GEL,,420306,LOCAL,Facility,Inpatient,3 mL,mL,,72,61.2,20.6352,72,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
L.E.T. GEL,,420306,LOCAL,Facility,Both,3 mL,mL,,72,61.2,20.6352,72,Sanford Health Plan,Sanford Health Plan,66.24,92,,percent of total billed charges,,
L.E.T. GEL,,420306,LOCAL,Facility,Outpatient,3 mL,mL,,72,61.2,20.6352,72,"UCare Health, Inc.",Individual & Family Plan,40.572,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
L.E.T. GEL,,420306,LOCAL,Facility,Inpatient,3 mL,mL,,72,61.2,20.6352,72,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
L.E.T. GEL,,420306,LOCAL,Facility,Outpatient,3 mL,mL,,72,61.2,20.6352,72,"UCare Health, Inc.",Medical Assistance,36.3384,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
L.E.T. GEL,,420306,LOCAL,Facility,Inpatient,3 mL,mL,,72,61.2,20.6352,72,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
L.E.T. GEL,,420306,LOCAL,Facility,Outpatient,3 mL,mL,,72,61.2,20.6352,72,"UCare Health, Inc.",Medicare Advantage,36.3384,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
L.E.T. GEL,,420306,LOCAL,Facility,Inpatient,3 mL,mL,,72,61.2,20.6352,72,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
L.E.T. GEL,,420306,LOCAL,Facility,Outpatient,3 mL,mL,,72,61.2,20.6352,72,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),36.3384,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
L.E.T. GEL,,420306,LOCAL,Facility,Inpatient,3 mL,mL,,72,61.2,20.6352,72,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
L.E.T. GEL,,420306,LOCAL,Facility,Both,3 mL,mL,,72,61.2,20.6352,72,UnitedHealthcare,Individual & Family,67.68,94,,percent of total billed charges,,
L.E.T. GEL,,420306,LOCAL,Facility,Outpatient,3 mL,mL,,72,61.2,20.6352,72,UnitedHealthcare,Medicare Advantage,35.28,49,,percent of total billed charges,,
L.E.T. GEL,,420306,LOCAL,Facility,Inpatient,3 mL,mL,,72,61.2,20.6352,72,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
L.E.T. GEL,,420306,LOCAL,Facility,Outpatient,3 mL,mL,,72,61.2,20.6352,72,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,34.56,48,,percent of total billed charges,,100% of DHS outpatient percentage
L.E.T. GEL,,420306,LOCAL,Facility,Inpatient,3 mL,mL,,72,61.2,20.6352,72,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
INSULIN GLARGINE 100 UNIT/ML (3 ML) SUBQ INPN WRAPPER,,900690,LOCAL,Facility,Both,3 mL,mL,,411,349.35,117.7926,411,Aetna,Commercial,378.12,92,,percent of total billed charges,,
INSULIN GLARGINE 100 UNIT/ML (3 ML) SUBQ INPN WRAPPER,,900690,LOCAL,Facility,Outpatient,3 mL,mL,,411,349.35,117.7926,411,Aetna,Medicare Advantage,201.39,49,,percent of total billed charges,,
INSULIN GLARGINE 100 UNIT/ML (3 ML) SUBQ INPN WRAPPER,,900690,LOCAL,Facility,Inpatient,3 mL,mL,,411,349.35,117.7926,411,Aetna,Medicare Advantage,,,,,Included in per diem rate,
INSULIN GLARGINE 100 UNIT/ML (3 ML) SUBQ INPN WRAPPER,,900690,LOCAL,Facility,Both,3 mL,mL,,411,349.35,117.7926,411,Aetna,PPO,382.23,93,,percent of total billed charges,,
INSULIN GLARGINE 100 UNIT/ML (3 ML) SUBQ INPN WRAPPER,,900690,LOCAL,Facility,Both,3 mL,mL,,411,349.35,117.7926,411,America's PPO,America's PPO,394.6833,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
INSULIN GLARGINE 100 UNIT/ML (3 ML) SUBQ INPN WRAPPER,,900690,LOCAL,Facility,Both,3 mL,mL,,411,349.35,117.7926,411,BlueCross BlueShield Minnesota, Federal Employee Program,404.424,98.4,,percent of total billed charges,,
INSULIN GLARGINE 100 UNIT/ML (3 ML) SUBQ INPN WRAPPER,,900690,LOCAL,Facility,Both,3 mL,mL,,411,349.35,117.7926,411,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,411,100,,percent of total billed charges,,
INSULIN GLARGINE 100 UNIT/ML (3 ML) SUBQ INPN WRAPPER,,900690,LOCAL,Facility,Both,3 mL,mL,,411,349.35,117.7926,411,BlueCross BlueShield Minnesota,High Value Network Plan,369.9,90,,percent of total billed charges,,
INSULIN GLARGINE 100 UNIT/ML (3 ML) SUBQ INPN WRAPPER,,900690,LOCAL,Facility,Outpatient,3 mL,mL,,411,349.35,117.7926,411,BlueCross BlueShield Minnesota,Medicare Advantage,201.39,49,,percent of total billed charges,,
INSULIN GLARGINE 100 UNIT/ML (3 ML) SUBQ INPN WRAPPER,,900690,LOCAL,Facility,Inpatient,3 mL,mL,,411,349.35,117.7926,411,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
INSULIN GLARGINE 100 UNIT/ML (3 ML) SUBQ INPN WRAPPER,,900690,LOCAL,Facility,Both,3 mL,mL,,411,349.35,117.7926,411,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,364.0227,88.57,,percent of total billed charges,,
INSULIN GLARGINE 100 UNIT/ML (3 ML) SUBQ INPN WRAPPER,,900690,LOCAL,Facility,Both,3 mL,mL,,411,349.35,117.7926,411,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,117.7926,28.66,,percent of total billed charges,,
INSULIN GLARGINE 100 UNIT/ML (3 ML) SUBQ INPN WRAPPER,,900690,LOCAL,Facility,Outpatient,3 mL,mL,,411,349.35,117.7926,411,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),201.39,49,,percent of total billed charges,,
INSULIN GLARGINE 100 UNIT/ML (3 ML) SUBQ INPN WRAPPER,,900690,LOCAL,Facility,Inpatient,3 mL,mL,,411,349.35,117.7926,411,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
INSULIN GLARGINE 100 UNIT/ML (3 ML) SUBQ INPN WRAPPER,,900690,LOCAL,Facility,Both,3 mL,mL,,411,349.35,117.7926,411,CorVel,Worker's Compensation,411,100,,percent of total billed charges,,
INSULIN GLARGINE 100 UNIT/ML (3 ML) SUBQ INPN WRAPPER,,900690,LOCAL,Facility,Both,3 mL,mL,,411,349.35,117.7926,411,First Health Group Corporation,First Health Network,398.67,97,,percent of total billed charges,,
INSULIN GLARGINE 100 UNIT/ML (3 ML) SUBQ INPN WRAPPER,,900690,LOCAL,Facility,Both,3 mL,mL,,411,349.35,117.7926,411,"Health Partners, Inc.",Commercial,388.806,94.6,,percent of total billed charges,,
INSULIN GLARGINE 100 UNIT/ML (3 ML) SUBQ INPN WRAPPER,,900690,LOCAL,Facility,Outpatient,3 mL,mL,,411,349.35,117.7926,411,"Health Partners, Inc.",Medicare Advantage,201.39,49,,percent of total billed charges,,
INSULIN GLARGINE 100 UNIT/ML (3 ML) SUBQ INPN WRAPPER,,900690,LOCAL,Facility,Inpatient,3 mL,mL,,411,349.35,117.7926,411,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
INSULIN GLARGINE 100 UNIT/ML (3 ML) SUBQ INPN WRAPPER,,900690,LOCAL,Facility,Both,3 mL,mL,,411,349.35,117.7926,411,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),246.6,60,,percent of total billed charges,,
INSULIN GLARGINE 100 UNIT/ML (3 ML) SUBQ INPN WRAPPER,,900690,LOCAL,Facility,Both,3 mL,mL,,411,349.35,117.7926,411,"Health Partners, Inc.",State of Minnesota Advantage Program,334.965,81.5,,percent of total billed charges,,
INSULIN GLARGINE 100 UNIT/ML (3 ML) SUBQ INPN WRAPPER,,900690,LOCAL,Facility,Both,3 mL,mL,,411,349.35,117.7926,411,"Health Partners, Inc.",State Public Programs,205.5,50,,percent of total billed charges,,
INSULIN GLARGINE 100 UNIT/ML (3 ML) SUBQ INPN WRAPPER,,900690,LOCAL,Facility,Both,3 mL,mL,,411,349.35,117.7926,411,Humana Insurance Company,Commercial PPO,390.45,95,,percent of total billed charges,,
INSULIN GLARGINE 100 UNIT/ML (3 ML) SUBQ INPN WRAPPER,,900690,LOCAL,Facility,Outpatient,3 mL,mL,,411,349.35,117.7926,411,Humana Insurance Company,Medicare PPO,201.39,49,,percent of total billed charges,,
INSULIN GLARGINE 100 UNIT/ML (3 ML) SUBQ INPN WRAPPER,,900690,LOCAL,Facility,Inpatient,3 mL,mL,,411,349.35,117.7926,411,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
INSULIN GLARGINE 100 UNIT/ML (3 ML) SUBQ INPN WRAPPER,,900690,LOCAL,Facility,Both,3 mL,mL,,411,349.35,117.7926,411,Medica,Individual & Family,407.301,99.1,,percent of total billed charges,,
INSULIN GLARGINE 100 UNIT/ML (3 ML) SUBQ INPN WRAPPER,,900690,LOCAL,Facility,Outpatient,3 mL,mL,,411,349.35,117.7926,411,Medica,Medica Advantage Solution,204.678,49.8,,percent of total billed charges,,
INSULIN GLARGINE 100 UNIT/ML (3 ML) SUBQ INPN WRAPPER,,900690,LOCAL,Facility,Inpatient,3 mL,mL,,411,349.35,117.7926,411,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
INSULIN GLARGINE 100 UNIT/ML (3 ML) SUBQ INPN WRAPPER,,900690,LOCAL,Facility,Outpatient,3 mL,mL,,411,349.35,117.7926,411,Medica,Medical Assistance,183.306,44.6,,percent of total billed charges,,
INSULIN GLARGINE 100 UNIT/ML (3 ML) SUBQ INPN WRAPPER,,900690,LOCAL,Facility,Inpatient,3 mL,mL,,411,349.35,117.7926,411,Medica,Medical Assistance,,,,,Included in per diem rate,
INSULIN GLARGINE 100 UNIT/ML (3 ML) SUBQ INPN WRAPPER,,900690,LOCAL,Facility,Outpatient,3 mL,mL,,411,349.35,117.7926,411,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,204.678,49.8,,percent of total billed charges,,
INSULIN GLARGINE 100 UNIT/ML (3 ML) SUBQ INPN WRAPPER,,900690,LOCAL,Facility,Inpatient,3 mL,mL,,411,349.35,117.7926,411,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
INSULIN GLARGINE 100 UNIT/ML (3 ML) SUBQ INPN WRAPPER,,900690,LOCAL,Facility,Both,3 mL,mL,,411,349.35,117.7926,411,"Multiplan, Inc.","Multiplan, Inc.",386.34,94,,percent of total billed charges,,
INSULIN GLARGINE 100 UNIT/ML (3 ML) SUBQ INPN WRAPPER,,900690,LOCAL,Facility,Outpatient,3 mL,mL,,411,349.35,117.7926,411,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,370.311,90.1,,percent of total billed charges,,
INSULIN GLARGINE 100 UNIT/ML (3 ML) SUBQ INPN WRAPPER,,900690,LOCAL,Facility,Inpatient,3 mL,mL,,411,349.35,117.7926,411,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
INSULIN GLARGINE 100 UNIT/ML (3 ML) SUBQ INPN WRAPPER,,900690,LOCAL,Facility,Both,3 mL,mL,,411,349.35,117.7926,411,"Preferred One Administrative Services, INC.",PPO,405.246,98.6,,percent of total billed charges,,
INSULIN GLARGINE 100 UNIT/ML (3 ML) SUBQ INPN WRAPPER,,900690,LOCAL,Facility,Outpatient,3 mL,mL,,411,349.35,117.7926,411,PrimeWest Health,Minnesota Senior Health Options (MSHO),211.4595,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
INSULIN GLARGINE 100 UNIT/ML (3 ML) SUBQ INPN WRAPPER,,900690,LOCAL,Facility,Inpatient,3 mL,mL,,411,349.35,117.7926,411,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
INSULIN GLARGINE 100 UNIT/ML (3 ML) SUBQ INPN WRAPPER,,900690,LOCAL,Facility,Outpatient,3 mL,mL,,411,349.35,117.7926,411,PrimeWest Health,MinnesotaCare,211.0896,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
INSULIN GLARGINE 100 UNIT/ML (3 ML) SUBQ INPN WRAPPER,,900690,LOCAL,Facility,Inpatient,3 mL,mL,,411,349.35,117.7926,411,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
INSULIN GLARGINE 100 UNIT/ML (3 ML) SUBQ INPN WRAPPER,,900690,LOCAL,Facility,Both,3 mL,mL,,411,349.35,117.7926,411,Sanford Health Plan,Sanford Health Plan,378.12,92,,percent of total billed charges,,
INSULIN GLARGINE 100 UNIT/ML (3 ML) SUBQ INPN WRAPPER,,900690,LOCAL,Facility,Outpatient,3 mL,mL,,411,349.35,117.7926,411,"UCare Health, Inc.",Individual & Family Plan,231.5985,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
INSULIN GLARGINE 100 UNIT/ML (3 ML) SUBQ INPN WRAPPER,,900690,LOCAL,Facility,Inpatient,3 mL,mL,,411,349.35,117.7926,411,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
INSULIN GLARGINE 100 UNIT/ML (3 ML) SUBQ INPN WRAPPER,,900690,LOCAL,Facility,Outpatient,3 mL,mL,,411,349.35,117.7926,411,"UCare Health, Inc.",Medical Assistance,207.4317,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
INSULIN GLARGINE 100 UNIT/ML (3 ML) SUBQ INPN WRAPPER,,900690,LOCAL,Facility,Inpatient,3 mL,mL,,411,349.35,117.7926,411,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
INSULIN GLARGINE 100 UNIT/ML (3 ML) SUBQ INPN WRAPPER,,900690,LOCAL,Facility,Outpatient,3 mL,mL,,411,349.35,117.7926,411,"UCare Health, Inc.",Medicare Advantage,207.4317,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
INSULIN GLARGINE 100 UNIT/ML (3 ML) SUBQ INPN WRAPPER,,900690,LOCAL,Facility,Inpatient,3 mL,mL,,411,349.35,117.7926,411,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
INSULIN GLARGINE 100 UNIT/ML (3 ML) SUBQ INPN WRAPPER,,900690,LOCAL,Facility,Outpatient,3 mL,mL,,411,349.35,117.7926,411,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),207.4317,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
INSULIN GLARGINE 100 UNIT/ML (3 ML) SUBQ INPN WRAPPER,,900690,LOCAL,Facility,Inpatient,3 mL,mL,,411,349.35,117.7926,411,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
INSULIN GLARGINE 100 UNIT/ML (3 ML) SUBQ INPN WRAPPER,,900690,LOCAL,Facility,Both,3 mL,mL,,411,349.35,117.7926,411,UnitedHealthcare,Individual & Family,386.34,94,,percent of total billed charges,,
INSULIN GLARGINE 100 UNIT/ML (3 ML) SUBQ INPN WRAPPER,,900690,LOCAL,Facility,Outpatient,3 mL,mL,,411,349.35,117.7926,411,UnitedHealthcare,Medicare Advantage,201.39,49,,percent of total billed charges,,
INSULIN GLARGINE 100 UNIT/ML (3 ML) SUBQ INPN WRAPPER,,900690,LOCAL,Facility,Inpatient,3 mL,mL,,411,349.35,117.7926,411,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
INSULIN GLARGINE 100 UNIT/ML (3 ML) SUBQ INPN WRAPPER,,900690,LOCAL,Facility,Outpatient,3 mL,mL,,411,349.35,117.7926,411,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,197.28,48,,percent of total billed charges,,100% of DHS outpatient percentage
INSULIN GLARGINE 100 UNIT/ML (3 ML) SUBQ INPN WRAPPER,,900690,LOCAL,Facility,Inpatient,3 mL,mL,,411,349.35,117.7926,411,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
AMIODARONE 50 MG/ML IV SOLN,,J0282,HCPCS,Facility,Both,3 mL,mL,,11,9.35,3.1526,11,Aetna,Commercial,10.12,92,,percent of total billed charges,,
AMIODARONE 50 MG/ML IV SOLN,,J0282,HCPCS,Facility,Outpatient,3 mL,mL,,11,9.35,3.1526,11,Aetna,Medicare Advantage,5.39,49,,percent of total billed charges,,
AMIODARONE 50 MG/ML IV SOLN,,J0282,HCPCS,Facility,Inpatient,3 mL,mL,,11,9.35,3.1526,11,Aetna,Medicare Advantage,,,,,Included in per diem rate,
AMIODARONE 50 MG/ML IV SOLN,,J0282,HCPCS,Facility,Both,3 mL,mL,,11,9.35,3.1526,11,Aetna,PPO,10.23,93,,percent of total billed charges,,
AMIODARONE 50 MG/ML IV SOLN,,J0282,HCPCS,Facility,Both,3 mL,mL,,11,9.35,3.1526,11,America's PPO,America's PPO,10.5633,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
AMIODARONE 50 MG/ML IV SOLN,,J0282,HCPCS,Facility,Both,3 mL,mL,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota, Federal Employee Program,10.824,98.4,,percent of total billed charges,,
AMIODARONE 50 MG/ML IV SOLN,,J0282,HCPCS,Facility,Both,3 mL,mL,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,11,100,,percent of total billed charges,,
AMIODARONE 50 MG/ML IV SOLN,,J0282,HCPCS,Facility,Both,3 mL,mL,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,High Value Network Plan,9.9,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
AMIODARONE 50 MG/ML IV SOLN,,J0282,HCPCS,Facility,Outpatient,3 mL,mL,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,Medicare Advantage,5.39,49,,percent of total billed charges,,
AMIODARONE 50 MG/ML IV SOLN,,J0282,HCPCS,Facility,Inpatient,3 mL,mL,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
AMIODARONE 50 MG/ML IV SOLN,,J0282,HCPCS,Facility,Both,3 mL,mL,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,9.7427,88.57,,percent of total billed charges,,
AMIODARONE 50 MG/ML IV SOLN,,J0282,HCPCS,Facility,Both,3 mL,mL,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,3.1526,28.66,,percent of total billed charges,,
AMIODARONE 50 MG/ML IV SOLN,,J0282,HCPCS,Facility,Outpatient,3 mL,mL,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),5.39,49,,percent of total billed charges,,
AMIODARONE 50 MG/ML IV SOLN,,J0282,HCPCS,Facility,Inpatient,3 mL,mL,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
AMIODARONE 50 MG/ML IV SOLN,,J0282,HCPCS,Facility,Both,3 mL,mL,,11,9.35,3.1526,11,CorVel,Worker's Compensation,11,100,,percent of total billed charges,,
AMIODARONE 50 MG/ML IV SOLN,,J0282,HCPCS,Facility,Both,3 mL,mL,,11,9.35,3.1526,11,First Health Group Corporation,First Health Network,10.67,97,,percent of total billed charges,,
AMIODARONE 50 MG/ML IV SOLN,,J0282,HCPCS,Facility,Both,3 mL,mL,,11,9.35,3.1526,11,"Health Partners, Inc.",Commercial,10.406,94.6,,percent of total billed charges,,
AMIODARONE 50 MG/ML IV SOLN,,J0282,HCPCS,Facility,Outpatient,3 mL,mL,,11,9.35,3.1526,11,"Health Partners, Inc.",Medicare Advantage,5.39,49,,percent of total billed charges,,
AMIODARONE 50 MG/ML IV SOLN,,J0282,HCPCS,Facility,Inpatient,3 mL,mL,,11,9.35,3.1526,11,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
AMIODARONE 50 MG/ML IV SOLN,,J0282,HCPCS,Facility,Both,3 mL,mL,,11,9.35,3.1526,11,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),6.6,60,,percent of total billed charges,,
AMIODARONE 50 MG/ML IV SOLN,,J0282,HCPCS,Facility,Both,3 mL,mL,,11,9.35,3.1526,11,"Health Partners, Inc.",State of Minnesota Advantage Program,8.965,81.5,,percent of total billed charges,,
AMIODARONE 50 MG/ML IV SOLN,,J0282,HCPCS,Facility,Both,3 mL,mL,,11,9.35,3.1526,11,"Health Partners, Inc.",State Public Programs,5.5,50,,percent of total billed charges,,
AMIODARONE 50 MG/ML IV SOLN,,J0282,HCPCS,Facility,Both,3 mL,mL,,11,9.35,3.1526,11,Humana Insurance Company,Commercial PPO,10.45,95,,percent of total billed charges,,
AMIODARONE 50 MG/ML IV SOLN,,J0282,HCPCS,Facility,Outpatient,3 mL,mL,,11,9.35,3.1526,11,Humana Insurance Company,Medicare PPO,5.39,49,,percent of total billed charges,,
AMIODARONE 50 MG/ML IV SOLN,,J0282,HCPCS,Facility,Inpatient,3 mL,mL,,11,9.35,3.1526,11,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
AMIODARONE 50 MG/ML IV SOLN,,J0282,HCPCS,Facility,Both,3 mL,mL,,11,9.35,3.1526,11,Medica,Individual & Family,10.901,99.1,,percent of total billed charges,,
AMIODARONE 50 MG/ML IV SOLN,,J0282,HCPCS,Facility,Outpatient,3 mL,mL,,11,9.35,3.1526,11,Medica,Medica Advantage Solution,5.478,49.8,,percent of total billed charges,,
AMIODARONE 50 MG/ML IV SOLN,,J0282,HCPCS,Facility,Inpatient,3 mL,mL,,11,9.35,3.1526,11,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
AMIODARONE 50 MG/ML IV SOLN,,J0282,HCPCS,Facility,Outpatient,3 mL,mL,,11,9.35,3.1526,11,Medica,Medical Assistance,4.906,44.6,,percent of total billed charges,,
AMIODARONE 50 MG/ML IV SOLN,,J0282,HCPCS,Facility,Inpatient,3 mL,mL,,11,9.35,3.1526,11,Medica,Medical Assistance,,,,,Included in per diem rate,
AMIODARONE 50 MG/ML IV SOLN,,J0282,HCPCS,Facility,Outpatient,3 mL,mL,,11,9.35,3.1526,11,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,5.478,49.8,,percent of total billed charges,,
AMIODARONE 50 MG/ML IV SOLN,,J0282,HCPCS,Facility,Inpatient,3 mL,mL,,11,9.35,3.1526,11,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
AMIODARONE 50 MG/ML IV SOLN,,J0282,HCPCS,Facility,Both,3 mL,mL,,11,9.35,3.1526,11,"Multiplan, Inc.","Multiplan, Inc.",10.34,94,,percent of total billed charges,,
AMIODARONE 50 MG/ML IV SOLN,,J0282,HCPCS,Facility,Outpatient,3 mL,mL,,11,9.35,3.1526,11,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,9.911,90.1,,percent of total billed charges,,
AMIODARONE 50 MG/ML IV SOLN,,J0282,HCPCS,Facility,Inpatient,3 mL,mL,,11,9.35,3.1526,11,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
AMIODARONE 50 MG/ML IV SOLN,,J0282,HCPCS,Facility,Both,3 mL,mL,,11,9.35,3.1526,11,"Preferred One Administrative Services, INC.",PPO,10.846,98.6,,percent of total billed charges,,
AMIODARONE 50 MG/ML IV SOLN,,J0282,HCPCS,Facility,Outpatient,3 mL,mL,,11,9.35,3.1526,11,PrimeWest Health,Minnesota Senior Health Options (MSHO),5.6595,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
AMIODARONE 50 MG/ML IV SOLN,,J0282,HCPCS,Facility,Inpatient,3 mL,mL,,11,9.35,3.1526,11,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
AMIODARONE 50 MG/ML IV SOLN,,J0282,HCPCS,Facility,Outpatient,3 mL,mL,,11,9.35,3.1526,11,PrimeWest Health,MinnesotaCare,5.6496,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
AMIODARONE 50 MG/ML IV SOLN,,J0282,HCPCS,Facility,Inpatient,3 mL,mL,,11,9.35,3.1526,11,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
AMIODARONE 50 MG/ML IV SOLN,,J0282,HCPCS,Facility,Both,3 mL,mL,,11,9.35,3.1526,11,Sanford Health Plan,Sanford Health Plan,10.12,92,,percent of total billed charges,,
AMIODARONE 50 MG/ML IV SOLN,,J0282,HCPCS,Facility,Outpatient,3 mL,mL,,11,9.35,3.1526,11,"UCare Health, Inc.",Individual & Family Plan,6.1985,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
AMIODARONE 50 MG/ML IV SOLN,,J0282,HCPCS,Facility,Inpatient,3 mL,mL,,11,9.35,3.1526,11,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
AMIODARONE 50 MG/ML IV SOLN,,J0282,HCPCS,Facility,Outpatient,3 mL,mL,,11,9.35,3.1526,11,"UCare Health, Inc.",Medical Assistance,5.5517,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
AMIODARONE 50 MG/ML IV SOLN,,J0282,HCPCS,Facility,Inpatient,3 mL,mL,,11,9.35,3.1526,11,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
AMIODARONE 50 MG/ML IV SOLN,,J0282,HCPCS,Facility,Outpatient,3 mL,mL,,11,9.35,3.1526,11,"UCare Health, Inc.",Medicare Advantage,5.5517,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
AMIODARONE 50 MG/ML IV SOLN,,J0282,HCPCS,Facility,Inpatient,3 mL,mL,,11,9.35,3.1526,11,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
AMIODARONE 50 MG/ML IV SOLN,,J0282,HCPCS,Facility,Outpatient,3 mL,mL,,11,9.35,3.1526,11,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),5.5517,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
AMIODARONE 50 MG/ML IV SOLN,,J0282,HCPCS,Facility,Inpatient,3 mL,mL,,11,9.35,3.1526,11,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
AMIODARONE 50 MG/ML IV SOLN,,J0282,HCPCS,Facility,Both,3 mL,mL,,11,9.35,3.1526,11,UnitedHealthcare,Individual & Family,10.34,94,,percent of total billed charges,,
AMIODARONE 50 MG/ML IV SOLN,,J0282,HCPCS,Facility,Outpatient,3 mL,mL,,11,9.35,3.1526,11,UnitedHealthcare,Medicare Advantage,5.39,49,,percent of total billed charges,,
AMIODARONE 50 MG/ML IV SOLN,,J0282,HCPCS,Facility,Inpatient,3 mL,mL,,11,9.35,3.1526,11,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
AMIODARONE 50 MG/ML IV SOLN,,J0282,HCPCS,Facility,Outpatient,3 mL,mL,,11,9.35,3.1526,11,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,5.28,48,,percent of total billed charges,,100% of DHS outpatient percentage
AMIODARONE 50 MG/ML IV SOLN,,J0282,HCPCS,Facility,Inpatient,3 mL,mL,,11,9.35,3.1526,11,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
AMIODARONE 50 MG/ML IV SOLN (PEDS 300 MG MAX),,J0282,HCPCS,Facility,Both,3 mL,mL,,15,12.75,4.299,15,Aetna,Commercial,13.8,92,,percent of total billed charges,,
AMIODARONE 50 MG/ML IV SOLN (PEDS 300 MG MAX),,J0282,HCPCS,Facility,Outpatient,3 mL,mL,,15,12.75,4.299,15,Aetna,Medicare Advantage,7.35,49,,percent of total billed charges,,
AMIODARONE 50 MG/ML IV SOLN (PEDS 300 MG MAX),,J0282,HCPCS,Facility,Inpatient,3 mL,mL,,15,12.75,4.299,15,Aetna,Medicare Advantage,,,,,Included in per diem rate,
AMIODARONE 50 MG/ML IV SOLN (PEDS 300 MG MAX),,J0282,HCPCS,Facility,Both,3 mL,mL,,15,12.75,4.299,15,Aetna,PPO,13.95,93,,percent of total billed charges,,
AMIODARONE 50 MG/ML IV SOLN (PEDS 300 MG MAX),,J0282,HCPCS,Facility,Both,3 mL,mL,,15,12.75,4.299,15,America's PPO,America's PPO,14.4045,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
AMIODARONE 50 MG/ML IV SOLN (PEDS 300 MG MAX),,J0282,HCPCS,Facility,Both,3 mL,mL,,15,12.75,4.299,15,BlueCross BlueShield Minnesota, Federal Employee Program,14.76,98.4,,percent of total billed charges,,
AMIODARONE 50 MG/ML IV SOLN (PEDS 300 MG MAX),,J0282,HCPCS,Facility,Both,3 mL,mL,,15,12.75,4.299,15,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,15,100,,percent of total billed charges,,
AMIODARONE 50 MG/ML IV SOLN (PEDS 300 MG MAX),,J0282,HCPCS,Facility,Both,3 mL,mL,,15,12.75,4.299,15,BlueCross BlueShield Minnesota,High Value Network Plan,13.5,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
AMIODARONE 50 MG/ML IV SOLN (PEDS 300 MG MAX),,J0282,HCPCS,Facility,Outpatient,3 mL,mL,,15,12.75,4.299,15,BlueCross BlueShield Minnesota,Medicare Advantage,7.35,49,,percent of total billed charges,,
AMIODARONE 50 MG/ML IV SOLN (PEDS 300 MG MAX),,J0282,HCPCS,Facility,Inpatient,3 mL,mL,,15,12.75,4.299,15,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
AMIODARONE 50 MG/ML IV SOLN (PEDS 300 MG MAX),,J0282,HCPCS,Facility,Both,3 mL,mL,,15,12.75,4.299,15,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,13.2855,88.57,,percent of total billed charges,,
AMIODARONE 50 MG/ML IV SOLN (PEDS 300 MG MAX),,J0282,HCPCS,Facility,Both,3 mL,mL,,15,12.75,4.299,15,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,4.299,28.66,,percent of total billed charges,,
AMIODARONE 50 MG/ML IV SOLN (PEDS 300 MG MAX),,J0282,HCPCS,Facility,Outpatient,3 mL,mL,,15,12.75,4.299,15,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),7.35,49,,percent of total billed charges,,
AMIODARONE 50 MG/ML IV SOLN (PEDS 300 MG MAX),,J0282,HCPCS,Facility,Inpatient,3 mL,mL,,15,12.75,4.299,15,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
AMIODARONE 50 MG/ML IV SOLN (PEDS 300 MG MAX),,J0282,HCPCS,Facility,Both,3 mL,mL,,15,12.75,4.299,15,CorVel,Worker's Compensation,15,100,,percent of total billed charges,,
AMIODARONE 50 MG/ML IV SOLN (PEDS 300 MG MAX),,J0282,HCPCS,Facility,Both,3 mL,mL,,15,12.75,4.299,15,First Health Group Corporation,First Health Network,14.55,97,,percent of total billed charges,,
AMIODARONE 50 MG/ML IV SOLN (PEDS 300 MG MAX),,J0282,HCPCS,Facility,Both,3 mL,mL,,15,12.75,4.299,15,"Health Partners, Inc.",Commercial,14.19,94.6,,percent of total billed charges,,
AMIODARONE 50 MG/ML IV SOLN (PEDS 300 MG MAX),,J0282,HCPCS,Facility,Outpatient,3 mL,mL,,15,12.75,4.299,15,"Health Partners, Inc.",Medicare Advantage,7.35,49,,percent of total billed charges,,
AMIODARONE 50 MG/ML IV SOLN (PEDS 300 MG MAX),,J0282,HCPCS,Facility,Inpatient,3 mL,mL,,15,12.75,4.299,15,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
AMIODARONE 50 MG/ML IV SOLN (PEDS 300 MG MAX),,J0282,HCPCS,Facility,Both,3 mL,mL,,15,12.75,4.299,15,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),9,60,,percent of total billed charges,,
AMIODARONE 50 MG/ML IV SOLN (PEDS 300 MG MAX),,J0282,HCPCS,Facility,Both,3 mL,mL,,15,12.75,4.299,15,"Health Partners, Inc.",State of Minnesota Advantage Program,12.225,81.5,,percent of total billed charges,,
AMIODARONE 50 MG/ML IV SOLN (PEDS 300 MG MAX),,J0282,HCPCS,Facility,Both,3 mL,mL,,15,12.75,4.299,15,"Health Partners, Inc.",State Public Programs,7.5,50,,percent of total billed charges,,
AMIODARONE 50 MG/ML IV SOLN (PEDS 300 MG MAX),,J0282,HCPCS,Facility,Both,3 mL,mL,,15,12.75,4.299,15,Humana Insurance Company,Commercial PPO,14.25,95,,percent of total billed charges,,
AMIODARONE 50 MG/ML IV SOLN (PEDS 300 MG MAX),,J0282,HCPCS,Facility,Outpatient,3 mL,mL,,15,12.75,4.299,15,Humana Insurance Company,Medicare PPO,7.35,49,,percent of total billed charges,,
AMIODARONE 50 MG/ML IV SOLN (PEDS 300 MG MAX),,J0282,HCPCS,Facility,Inpatient,3 mL,mL,,15,12.75,4.299,15,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
AMIODARONE 50 MG/ML IV SOLN (PEDS 300 MG MAX),,J0282,HCPCS,Facility,Both,3 mL,mL,,15,12.75,4.299,15,Medica,Individual & Family,14.865,99.1,,percent of total billed charges,,
AMIODARONE 50 MG/ML IV SOLN (PEDS 300 MG MAX),,J0282,HCPCS,Facility,Outpatient,3 mL,mL,,15,12.75,4.299,15,Medica,Medica Advantage Solution,7.47,49.8,,percent of total billed charges,,
AMIODARONE 50 MG/ML IV SOLN (PEDS 300 MG MAX),,J0282,HCPCS,Facility,Inpatient,3 mL,mL,,15,12.75,4.299,15,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
AMIODARONE 50 MG/ML IV SOLN (PEDS 300 MG MAX),,J0282,HCPCS,Facility,Outpatient,3 mL,mL,,15,12.75,4.299,15,Medica,Medical Assistance,6.69,44.6,,percent of total billed charges,,
AMIODARONE 50 MG/ML IV SOLN (PEDS 300 MG MAX),,J0282,HCPCS,Facility,Inpatient,3 mL,mL,,15,12.75,4.299,15,Medica,Medical Assistance,,,,,Included in per diem rate,
AMIODARONE 50 MG/ML IV SOLN (PEDS 300 MG MAX),,J0282,HCPCS,Facility,Outpatient,3 mL,mL,,15,12.75,4.299,15,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,7.47,49.8,,percent of total billed charges,,
AMIODARONE 50 MG/ML IV SOLN (PEDS 300 MG MAX),,J0282,HCPCS,Facility,Inpatient,3 mL,mL,,15,12.75,4.299,15,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
AMIODARONE 50 MG/ML IV SOLN (PEDS 300 MG MAX),,J0282,HCPCS,Facility,Both,3 mL,mL,,15,12.75,4.299,15,"Multiplan, Inc.","Multiplan, Inc.",14.1,94,,percent of total billed charges,,
AMIODARONE 50 MG/ML IV SOLN (PEDS 300 MG MAX),,J0282,HCPCS,Facility,Outpatient,3 mL,mL,,15,12.75,4.299,15,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,13.515,90.1,,percent of total billed charges,,
AMIODARONE 50 MG/ML IV SOLN (PEDS 300 MG MAX),,J0282,HCPCS,Facility,Inpatient,3 mL,mL,,15,12.75,4.299,15,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
AMIODARONE 50 MG/ML IV SOLN (PEDS 300 MG MAX),,J0282,HCPCS,Facility,Both,3 mL,mL,,15,12.75,4.299,15,"Preferred One Administrative Services, INC.",PPO,14.79,98.6,,percent of total billed charges,,
AMIODARONE 50 MG/ML IV SOLN (PEDS 300 MG MAX),,J0282,HCPCS,Facility,Outpatient,3 mL,mL,,15,12.75,4.299,15,PrimeWest Health,Minnesota Senior Health Options (MSHO),7.7175,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
AMIODARONE 50 MG/ML IV SOLN (PEDS 300 MG MAX),,J0282,HCPCS,Facility,Inpatient,3 mL,mL,,15,12.75,4.299,15,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
AMIODARONE 50 MG/ML IV SOLN (PEDS 300 MG MAX),,J0282,HCPCS,Facility,Outpatient,3 mL,mL,,15,12.75,4.299,15,PrimeWest Health,MinnesotaCare,7.704,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
AMIODARONE 50 MG/ML IV SOLN (PEDS 300 MG MAX),,J0282,HCPCS,Facility,Inpatient,3 mL,mL,,15,12.75,4.299,15,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
AMIODARONE 50 MG/ML IV SOLN (PEDS 300 MG MAX),,J0282,HCPCS,Facility,Both,3 mL,mL,,15,12.75,4.299,15,Sanford Health Plan,Sanford Health Plan,13.8,92,,percent of total billed charges,,
AMIODARONE 50 MG/ML IV SOLN (PEDS 300 MG MAX),,J0282,HCPCS,Facility,Outpatient,3 mL,mL,,15,12.75,4.299,15,"UCare Health, Inc.",Individual & Family Plan,8.4525,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
AMIODARONE 50 MG/ML IV SOLN (PEDS 300 MG MAX),,J0282,HCPCS,Facility,Inpatient,3 mL,mL,,15,12.75,4.299,15,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
AMIODARONE 50 MG/ML IV SOLN (PEDS 300 MG MAX),,J0282,HCPCS,Facility,Outpatient,3 mL,mL,,15,12.75,4.299,15,"UCare Health, Inc.",Medical Assistance,7.5705,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
AMIODARONE 50 MG/ML IV SOLN (PEDS 300 MG MAX),,J0282,HCPCS,Facility,Inpatient,3 mL,mL,,15,12.75,4.299,15,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
AMIODARONE 50 MG/ML IV SOLN (PEDS 300 MG MAX),,J0282,HCPCS,Facility,Outpatient,3 mL,mL,,15,12.75,4.299,15,"UCare Health, Inc.",Medicare Advantage,7.5705,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
AMIODARONE 50 MG/ML IV SOLN (PEDS 300 MG MAX),,J0282,HCPCS,Facility,Inpatient,3 mL,mL,,15,12.75,4.299,15,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
AMIODARONE 50 MG/ML IV SOLN (PEDS 300 MG MAX),,J0282,HCPCS,Facility,Outpatient,3 mL,mL,,15,12.75,4.299,15,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),7.5705,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
AMIODARONE 50 MG/ML IV SOLN (PEDS 300 MG MAX),,J0282,HCPCS,Facility,Inpatient,3 mL,mL,,15,12.75,4.299,15,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
AMIODARONE 50 MG/ML IV SOLN (PEDS 300 MG MAX),,J0282,HCPCS,Facility,Both,3 mL,mL,,15,12.75,4.299,15,UnitedHealthcare,Individual & Family,14.1,94,,percent of total billed charges,,
AMIODARONE 50 MG/ML IV SOLN (PEDS 300 MG MAX),,J0282,HCPCS,Facility,Outpatient,3 mL,mL,,15,12.75,4.299,15,UnitedHealthcare,Medicare Advantage,7.35,49,,percent of total billed charges,,
AMIODARONE 50 MG/ML IV SOLN (PEDS 300 MG MAX),,J0282,HCPCS,Facility,Inpatient,3 mL,mL,,15,12.75,4.299,15,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
AMIODARONE 50 MG/ML IV SOLN (PEDS 300 MG MAX),,J0282,HCPCS,Facility,Outpatient,3 mL,mL,,15,12.75,4.299,15,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,7.2,48,,percent of total billed charges,,100% of DHS outpatient percentage
AMIODARONE 50 MG/ML IV SOLN (PEDS 300 MG MAX),,J0282,HCPCS,Facility,Inpatient,3 mL,mL,,15,12.75,4.299,15,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
IBANDRONATE 3 MG/3 ML IV SYRG,,J1740,HCPCS,Facility,Both,3 mL,mL,,1668,1417.8,478.0488,1668,Aetna,Commercial,1534.56,92,,percent of total billed charges,,
IBANDRONATE 3 MG/3 ML IV SYRG,,J1740,HCPCS,Facility,Outpatient,3 mL,mL,,1668,1417.8,478.0488,1668,Aetna,Medicare Advantage,817.32,49,,percent of total billed charges,,
IBANDRONATE 3 MG/3 ML IV SYRG,,J1740,HCPCS,Facility,Inpatient,3 mL,mL,,1668,1417.8,478.0488,1668,Aetna,Medicare Advantage,,,,,Included in per diem rate,
IBANDRONATE 3 MG/3 ML IV SYRG,,J1740,HCPCS,Facility,Both,3 mL,mL,,1668,1417.8,478.0488,1668,Aetna,PPO,1551.24,93,,percent of total billed charges,,
IBANDRONATE 3 MG/3 ML IV SYRG,,J1740,HCPCS,Facility,Both,3 mL,mL,,1668,1417.8,478.0488,1668,America's PPO,America's PPO,1601.7804,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
IBANDRONATE 3 MG/3 ML IV SYRG,,J1740,HCPCS,Facility,Both,3 mL,mL,,1668,1417.8,478.0488,1668,BlueCross BlueShield Minnesota, Federal Employee Program,1641.312,98.4,,percent of total billed charges,,
IBANDRONATE 3 MG/3 ML IV SYRG,,J1740,HCPCS,Facility,Both,3 mL,mL,,1668,1417.8,478.0488,1668,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1668,100,,percent of total billed charges,,
IBANDRONATE 3 MG/3 ML IV SYRG,,J1740,HCPCS,Facility,Both,3 mL,mL,,1668,1417.8,478.0488,1668,BlueCross BlueShield Minnesota,High Value Network Plan,1501.2,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
IBANDRONATE 3 MG/3 ML IV SYRG,,J1740,HCPCS,Facility,Outpatient,3 mL,mL,,1668,1417.8,478.0488,1668,BlueCross BlueShield Minnesota,Medicare Advantage,817.32,49,,percent of total billed charges,,
IBANDRONATE 3 MG/3 ML IV SYRG,,J1740,HCPCS,Facility,Inpatient,3 mL,mL,,1668,1417.8,478.0488,1668,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
IBANDRONATE 3 MG/3 ML IV SYRG,,J1740,HCPCS,Facility,Both,3 mL,mL,,1668,1417.8,478.0488,1668,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1477.3476,88.57,,percent of total billed charges,,
IBANDRONATE 3 MG/3 ML IV SYRG,,J1740,HCPCS,Facility,Both,3 mL,mL,,1668,1417.8,478.0488,1668,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,478.0488,28.66,,percent of total billed charges,,
IBANDRONATE 3 MG/3 ML IV SYRG,,J1740,HCPCS,Facility,Outpatient,3 mL,mL,,1668,1417.8,478.0488,1668,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),817.32,49,,percent of total billed charges,,
IBANDRONATE 3 MG/3 ML IV SYRG,,J1740,HCPCS,Facility,Inpatient,3 mL,mL,,1668,1417.8,478.0488,1668,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
IBANDRONATE 3 MG/3 ML IV SYRG,,J1740,HCPCS,Facility,Both,3 mL,mL,,1668,1417.8,478.0488,1668,CorVel,Worker's Compensation,1668,100,,percent of total billed charges,,
IBANDRONATE 3 MG/3 ML IV SYRG,,J1740,HCPCS,Facility,Both,3 mL,mL,,1668,1417.8,478.0488,1668,First Health Group Corporation,First Health Network,1617.96,97,,percent of total billed charges,,
IBANDRONATE 3 MG/3 ML IV SYRG,,J1740,HCPCS,Facility,Both,3 mL,mL,,1668,1417.8,478.0488,1668,"Health Partners, Inc.",Commercial,1577.928,94.6,,percent of total billed charges,,
IBANDRONATE 3 MG/3 ML IV SYRG,,J1740,HCPCS,Facility,Outpatient,3 mL,mL,,1668,1417.8,478.0488,1668,"Health Partners, Inc.",Medicare Advantage,817.32,49,,percent of total billed charges,,
IBANDRONATE 3 MG/3 ML IV SYRG,,J1740,HCPCS,Facility,Inpatient,3 mL,mL,,1668,1417.8,478.0488,1668,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
IBANDRONATE 3 MG/3 ML IV SYRG,,J1740,HCPCS,Facility,Both,3 mL,mL,,1668,1417.8,478.0488,1668,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1000.8,60,,percent of total billed charges,,
IBANDRONATE 3 MG/3 ML IV SYRG,,J1740,HCPCS,Facility,Both,3 mL,mL,,1668,1417.8,478.0488,1668,"Health Partners, Inc.",State of Minnesota Advantage Program,1359.42,81.5,,percent of total billed charges,,
IBANDRONATE 3 MG/3 ML IV SYRG,,J1740,HCPCS,Facility,Both,3 mL,mL,,1668,1417.8,478.0488,1668,"Health Partners, Inc.",State Public Programs,834,50,,percent of total billed charges,,
IBANDRONATE 3 MG/3 ML IV SYRG,,J1740,HCPCS,Facility,Both,3 mL,mL,,1668,1417.8,478.0488,1668,Humana Insurance Company,Commercial PPO,1584.6,95,,percent of total billed charges,,
IBANDRONATE 3 MG/3 ML IV SYRG,,J1740,HCPCS,Facility,Outpatient,3 mL,mL,,1668,1417.8,478.0488,1668,Humana Insurance Company,Medicare PPO,817.32,49,,percent of total billed charges,,
IBANDRONATE 3 MG/3 ML IV SYRG,,J1740,HCPCS,Facility,Inpatient,3 mL,mL,,1668,1417.8,478.0488,1668,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
IBANDRONATE 3 MG/3 ML IV SYRG,,J1740,HCPCS,Facility,Both,3 mL,mL,,1668,1417.8,478.0488,1668,Medica,Individual & Family,1652.988,99.1,,percent of total billed charges,,
IBANDRONATE 3 MG/3 ML IV SYRG,,J1740,HCPCS,Facility,Outpatient,3 mL,mL,,1668,1417.8,478.0488,1668,Medica,Medica Advantage Solution,830.664,49.8,,percent of total billed charges,,
IBANDRONATE 3 MG/3 ML IV SYRG,,J1740,HCPCS,Facility,Inpatient,3 mL,mL,,1668,1417.8,478.0488,1668,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
IBANDRONATE 3 MG/3 ML IV SYRG,,J1740,HCPCS,Facility,Outpatient,3 mL,mL,,1668,1417.8,478.0488,1668,Medica,Medical Assistance,743.928,44.6,,percent of total billed charges,,
IBANDRONATE 3 MG/3 ML IV SYRG,,J1740,HCPCS,Facility,Inpatient,3 mL,mL,,1668,1417.8,478.0488,1668,Medica,Medical Assistance,,,,,Included in per diem rate,
IBANDRONATE 3 MG/3 ML IV SYRG,,J1740,HCPCS,Facility,Outpatient,3 mL,mL,,1668,1417.8,478.0488,1668,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,830.664,49.8,,percent of total billed charges,,
IBANDRONATE 3 MG/3 ML IV SYRG,,J1740,HCPCS,Facility,Inpatient,3 mL,mL,,1668,1417.8,478.0488,1668,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
IBANDRONATE 3 MG/3 ML IV SYRG,,J1740,HCPCS,Facility,Both,3 mL,mL,,1668,1417.8,478.0488,1668,"Multiplan, Inc.","Multiplan, Inc.",1567.92,94,,percent of total billed charges,,
IBANDRONATE 3 MG/3 ML IV SYRG,,J1740,HCPCS,Facility,Outpatient,3 mL,mL,,1668,1417.8,478.0488,1668,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1502.868,90.1,,percent of total billed charges,,
IBANDRONATE 3 MG/3 ML IV SYRG,,J1740,HCPCS,Facility,Inpatient,3 mL,mL,,1668,1417.8,478.0488,1668,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
IBANDRONATE 3 MG/3 ML IV SYRG,,J1740,HCPCS,Facility,Both,3 mL,mL,,1668,1417.8,478.0488,1668,"Preferred One Administrative Services, INC.",PPO,1644.648,98.6,,percent of total billed charges,,
IBANDRONATE 3 MG/3 ML IV SYRG,,J1740,HCPCS,Facility,Outpatient,3 mL,mL,,1668,1417.8,478.0488,1668,PrimeWest Health,Minnesota Senior Health Options (MSHO),858.186,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
IBANDRONATE 3 MG/3 ML IV SYRG,,J1740,HCPCS,Facility,Inpatient,3 mL,mL,,1668,1417.8,478.0488,1668,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
IBANDRONATE 3 MG/3 ML IV SYRG,,J1740,HCPCS,Facility,Outpatient,3 mL,mL,,1668,1417.8,478.0488,1668,PrimeWest Health,MinnesotaCare,856.6848,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
IBANDRONATE 3 MG/3 ML IV SYRG,,J1740,HCPCS,Facility,Inpatient,3 mL,mL,,1668,1417.8,478.0488,1668,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
IBANDRONATE 3 MG/3 ML IV SYRG,,J1740,HCPCS,Facility,Both,3 mL,mL,,1668,1417.8,478.0488,1668,Sanford Health Plan,Sanford Health Plan,1534.56,92,,percent of total billed charges,,
IBANDRONATE 3 MG/3 ML IV SYRG,,J1740,HCPCS,Facility,Outpatient,3 mL,mL,,1668,1417.8,478.0488,1668,"UCare Health, Inc.",Individual & Family Plan,939.918,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
IBANDRONATE 3 MG/3 ML IV SYRG,,J1740,HCPCS,Facility,Inpatient,3 mL,mL,,1668,1417.8,478.0488,1668,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
IBANDRONATE 3 MG/3 ML IV SYRG,,J1740,HCPCS,Facility,Outpatient,3 mL,mL,,1668,1417.8,478.0488,1668,"UCare Health, Inc.",Medical Assistance,841.8396,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
IBANDRONATE 3 MG/3 ML IV SYRG,,J1740,HCPCS,Facility,Inpatient,3 mL,mL,,1668,1417.8,478.0488,1668,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
IBANDRONATE 3 MG/3 ML IV SYRG,,J1740,HCPCS,Facility,Outpatient,3 mL,mL,,1668,1417.8,478.0488,1668,"UCare Health, Inc.",Medicare Advantage,841.8396,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
IBANDRONATE 3 MG/3 ML IV SYRG,,J1740,HCPCS,Facility,Inpatient,3 mL,mL,,1668,1417.8,478.0488,1668,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
IBANDRONATE 3 MG/3 ML IV SYRG,,J1740,HCPCS,Facility,Outpatient,3 mL,mL,,1668,1417.8,478.0488,1668,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),841.8396,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
IBANDRONATE 3 MG/3 ML IV SYRG,,J1740,HCPCS,Facility,Inpatient,3 mL,mL,,1668,1417.8,478.0488,1668,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
IBANDRONATE 3 MG/3 ML IV SYRG,,J1740,HCPCS,Facility,Both,3 mL,mL,,1668,1417.8,478.0488,1668,UnitedHealthcare,Individual & Family,1567.92,94,,percent of total billed charges,,
IBANDRONATE 3 MG/3 ML IV SYRG,,J1740,HCPCS,Facility,Outpatient,3 mL,mL,,1668,1417.8,478.0488,1668,UnitedHealthcare,Medicare Advantage,817.32,49,,percent of total billed charges,,
IBANDRONATE 3 MG/3 ML IV SYRG,,J1740,HCPCS,Facility,Inpatient,3 mL,mL,,1668,1417.8,478.0488,1668,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
IBANDRONATE 3 MG/3 ML IV SYRG,,J1740,HCPCS,Facility,Outpatient,3 mL,mL,,1668,1417.8,478.0488,1668,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,800.64,48,,percent of total billed charges,,100% of DHS outpatient percentage
IBANDRONATE 3 MG/3 ML IV SYRG,,J1740,HCPCS,Facility,Inpatient,3 mL,mL,,1668,1417.8,478.0488,1668,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
INSULIN ASPART U-100 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Both,3 mL,mL,,524,445.4,150.1784,524,Aetna,Commercial,482.08,92,,percent of total billed charges,,
INSULIN ASPART U-100 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Outpatient,3 mL,mL,,524,445.4,150.1784,524,Aetna,Medicare Advantage,256.76,49,,percent of total billed charges,,
INSULIN ASPART U-100 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Inpatient,3 mL,mL,,524,445.4,150.1784,524,Aetna,Medicare Advantage,,,,,Included in per diem rate,
INSULIN ASPART U-100 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Both,3 mL,mL,,524,445.4,150.1784,524,Aetna,PPO,487.32,93,,percent of total billed charges,,
INSULIN ASPART U-100 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Both,3 mL,mL,,524,445.4,150.1784,524,America's PPO,America's PPO,503.1972,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
INSULIN ASPART U-100 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Both,3 mL,mL,,524,445.4,150.1784,524,BlueCross BlueShield Minnesota, Federal Employee Program,515.616,98.4,,percent of total billed charges,,
INSULIN ASPART U-100 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Both,3 mL,mL,,524,445.4,150.1784,524,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,524,100,,percent of total billed charges,,
INSULIN ASPART U-100 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Both,3 mL,mL,,524,445.4,150.1784,524,BlueCross BlueShield Minnesota,High Value Network Plan,471.6,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
INSULIN ASPART U-100 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Outpatient,3 mL,mL,,524,445.4,150.1784,524,BlueCross BlueShield Minnesota,Medicare Advantage,256.76,49,,percent of total billed charges,,
INSULIN ASPART U-100 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Inpatient,3 mL,mL,,524,445.4,150.1784,524,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
INSULIN ASPART U-100 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Both,3 mL,mL,,524,445.4,150.1784,524,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,464.1068,88.57,,percent of total billed charges,,
INSULIN ASPART U-100 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Both,3 mL,mL,,524,445.4,150.1784,524,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,150.1784,28.66,,percent of total billed charges,,
INSULIN ASPART U-100 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Outpatient,3 mL,mL,,524,445.4,150.1784,524,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),256.76,49,,percent of total billed charges,,
INSULIN ASPART U-100 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Inpatient,3 mL,mL,,524,445.4,150.1784,524,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
INSULIN ASPART U-100 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Both,3 mL,mL,,524,445.4,150.1784,524,CorVel,Worker's Compensation,524,100,,percent of total billed charges,,
INSULIN ASPART U-100 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Both,3 mL,mL,,524,445.4,150.1784,524,First Health Group Corporation,First Health Network,508.28,97,,percent of total billed charges,,
INSULIN ASPART U-100 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Both,3 mL,mL,,524,445.4,150.1784,524,"Health Partners, Inc.",Commercial,495.704,94.6,,percent of total billed charges,,
INSULIN ASPART U-100 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Outpatient,3 mL,mL,,524,445.4,150.1784,524,"Health Partners, Inc.",Medicare Advantage,256.76,49,,percent of total billed charges,,
INSULIN ASPART U-100 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Inpatient,3 mL,mL,,524,445.4,150.1784,524,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
INSULIN ASPART U-100 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Both,3 mL,mL,,524,445.4,150.1784,524,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),314.4,60,,percent of total billed charges,,
INSULIN ASPART U-100 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Both,3 mL,mL,,524,445.4,150.1784,524,"Health Partners, Inc.",State of Minnesota Advantage Program,427.06,81.5,,percent of total billed charges,,
INSULIN ASPART U-100 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Both,3 mL,mL,,524,445.4,150.1784,524,"Health Partners, Inc.",State Public Programs,262,50,,percent of total billed charges,,
INSULIN ASPART U-100 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Both,3 mL,mL,,524,445.4,150.1784,524,Humana Insurance Company,Commercial PPO,497.8,95,,percent of total billed charges,,
INSULIN ASPART U-100 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Outpatient,3 mL,mL,,524,445.4,150.1784,524,Humana Insurance Company,Medicare PPO,256.76,49,,percent of total billed charges,,
INSULIN ASPART U-100 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Inpatient,3 mL,mL,,524,445.4,150.1784,524,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
INSULIN ASPART U-100 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Both,3 mL,mL,,524,445.4,150.1784,524,Medica,Individual & Family,519.284,99.1,,percent of total billed charges,,
INSULIN ASPART U-100 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Outpatient,3 mL,mL,,524,445.4,150.1784,524,Medica,Medica Advantage Solution,260.952,49.8,,percent of total billed charges,,
INSULIN ASPART U-100 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Inpatient,3 mL,mL,,524,445.4,150.1784,524,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
INSULIN ASPART U-100 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Outpatient,3 mL,mL,,524,445.4,150.1784,524,Medica,Medical Assistance,233.704,44.6,,percent of total billed charges,,
INSULIN ASPART U-100 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Inpatient,3 mL,mL,,524,445.4,150.1784,524,Medica,Medical Assistance,,,,,Included in per diem rate,
INSULIN ASPART U-100 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Outpatient,3 mL,mL,,524,445.4,150.1784,524,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,260.952,49.8,,percent of total billed charges,,
INSULIN ASPART U-100 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Inpatient,3 mL,mL,,524,445.4,150.1784,524,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
INSULIN ASPART U-100 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Both,3 mL,mL,,524,445.4,150.1784,524,"Multiplan, Inc.","Multiplan, Inc.",492.56,94,,percent of total billed charges,,
INSULIN ASPART U-100 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Outpatient,3 mL,mL,,524,445.4,150.1784,524,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,472.124,90.1,,percent of total billed charges,,
INSULIN ASPART U-100 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Inpatient,3 mL,mL,,524,445.4,150.1784,524,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
INSULIN ASPART U-100 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Both,3 mL,mL,,524,445.4,150.1784,524,"Preferred One Administrative Services, INC.",PPO,516.664,98.6,,percent of total billed charges,,
INSULIN ASPART U-100 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Outpatient,3 mL,mL,,524,445.4,150.1784,524,PrimeWest Health,Minnesota Senior Health Options (MSHO),269.598,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
INSULIN ASPART U-100 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Inpatient,3 mL,mL,,524,445.4,150.1784,524,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
INSULIN ASPART U-100 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Outpatient,3 mL,mL,,524,445.4,150.1784,524,PrimeWest Health,MinnesotaCare,269.1264,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
INSULIN ASPART U-100 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Inpatient,3 mL,mL,,524,445.4,150.1784,524,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
INSULIN ASPART U-100 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Both,3 mL,mL,,524,445.4,150.1784,524,Sanford Health Plan,Sanford Health Plan,482.08,92,,percent of total billed charges,,
INSULIN ASPART U-100 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Outpatient,3 mL,mL,,524,445.4,150.1784,524,"UCare Health, Inc.",Individual & Family Plan,295.274,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
INSULIN ASPART U-100 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Inpatient,3 mL,mL,,524,445.4,150.1784,524,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
INSULIN ASPART U-100 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Outpatient,3 mL,mL,,524,445.4,150.1784,524,"UCare Health, Inc.",Medical Assistance,264.4628,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
INSULIN ASPART U-100 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Inpatient,3 mL,mL,,524,445.4,150.1784,524,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
INSULIN ASPART U-100 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Outpatient,3 mL,mL,,524,445.4,150.1784,524,"UCare Health, Inc.",Medicare Advantage,264.4628,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
INSULIN ASPART U-100 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Inpatient,3 mL,mL,,524,445.4,150.1784,524,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
INSULIN ASPART U-100 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Outpatient,3 mL,mL,,524,445.4,150.1784,524,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),264.4628,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
INSULIN ASPART U-100 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Inpatient,3 mL,mL,,524,445.4,150.1784,524,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
INSULIN ASPART U-100 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Both,3 mL,mL,,524,445.4,150.1784,524,UnitedHealthcare,Individual & Family,492.56,94,,percent of total billed charges,,
INSULIN ASPART U-100 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Outpatient,3 mL,mL,,524,445.4,150.1784,524,UnitedHealthcare,Medicare Advantage,256.76,49,,percent of total billed charges,,
INSULIN ASPART U-100 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Inpatient,3 mL,mL,,524,445.4,150.1784,524,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
INSULIN ASPART U-100 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Outpatient,3 mL,mL,,524,445.4,150.1784,524,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,251.52,48,,percent of total billed charges,,100% of DHS outpatient percentage
INSULIN ASPART U-100 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Inpatient,3 mL,mL,,524,445.4,150.1784,524,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
INSULIN DEGLUDEC 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Both,3 mL,mL,,476,404.6,136.4216,476,Aetna,Commercial,437.92,92,,percent of total billed charges,,
INSULIN DEGLUDEC 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Outpatient,3 mL,mL,,476,404.6,136.4216,476,Aetna,Medicare Advantage,233.24,49,,percent of total billed charges,,
INSULIN DEGLUDEC 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Inpatient,3 mL,mL,,476,404.6,136.4216,476,Aetna,Medicare Advantage,,,,,Included in per diem rate,
INSULIN DEGLUDEC 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Both,3 mL,mL,,476,404.6,136.4216,476,Aetna,PPO,442.68,93,,percent of total billed charges,,
INSULIN DEGLUDEC 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Both,3 mL,mL,,476,404.6,136.4216,476,America's PPO,America's PPO,457.1028,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
INSULIN DEGLUDEC 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Both,3 mL,mL,,476,404.6,136.4216,476,BlueCross BlueShield Minnesota, Federal Employee Program,468.384,98.4,,percent of total billed charges,,
INSULIN DEGLUDEC 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Both,3 mL,mL,,476,404.6,136.4216,476,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,476,100,,percent of total billed charges,,
INSULIN DEGLUDEC 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Both,3 mL,mL,,476,404.6,136.4216,476,BlueCross BlueShield Minnesota,High Value Network Plan,428.4,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
INSULIN DEGLUDEC 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Outpatient,3 mL,mL,,476,404.6,136.4216,476,BlueCross BlueShield Minnesota,Medicare Advantage,233.24,49,,percent of total billed charges,,
INSULIN DEGLUDEC 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Inpatient,3 mL,mL,,476,404.6,136.4216,476,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
INSULIN DEGLUDEC 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Both,3 mL,mL,,476,404.6,136.4216,476,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,421.5932,88.57,,percent of total billed charges,,
INSULIN DEGLUDEC 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Both,3 mL,mL,,476,404.6,136.4216,476,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,136.4216,28.66,,percent of total billed charges,,
INSULIN DEGLUDEC 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Outpatient,3 mL,mL,,476,404.6,136.4216,476,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),233.24,49,,percent of total billed charges,,
INSULIN DEGLUDEC 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Inpatient,3 mL,mL,,476,404.6,136.4216,476,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
INSULIN DEGLUDEC 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Both,3 mL,mL,,476,404.6,136.4216,476,CorVel,Worker's Compensation,476,100,,percent of total billed charges,,
INSULIN DEGLUDEC 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Both,3 mL,mL,,476,404.6,136.4216,476,First Health Group Corporation,First Health Network,461.72,97,,percent of total billed charges,,
INSULIN DEGLUDEC 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Both,3 mL,mL,,476,404.6,136.4216,476,"Health Partners, Inc.",Commercial,450.296,94.6,,percent of total billed charges,,
INSULIN DEGLUDEC 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Outpatient,3 mL,mL,,476,404.6,136.4216,476,"Health Partners, Inc.",Medicare Advantage,233.24,49,,percent of total billed charges,,
INSULIN DEGLUDEC 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Inpatient,3 mL,mL,,476,404.6,136.4216,476,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
INSULIN DEGLUDEC 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Both,3 mL,mL,,476,404.6,136.4216,476,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),285.6,60,,percent of total billed charges,,
INSULIN DEGLUDEC 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Both,3 mL,mL,,476,404.6,136.4216,476,"Health Partners, Inc.",State of Minnesota Advantage Program,387.94,81.5,,percent of total billed charges,,
INSULIN DEGLUDEC 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Both,3 mL,mL,,476,404.6,136.4216,476,"Health Partners, Inc.",State Public Programs,238,50,,percent of total billed charges,,
INSULIN DEGLUDEC 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Both,3 mL,mL,,476,404.6,136.4216,476,Humana Insurance Company,Commercial PPO,452.2,95,,percent of total billed charges,,
INSULIN DEGLUDEC 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Outpatient,3 mL,mL,,476,404.6,136.4216,476,Humana Insurance Company,Medicare PPO,233.24,49,,percent of total billed charges,,
INSULIN DEGLUDEC 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Inpatient,3 mL,mL,,476,404.6,136.4216,476,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
INSULIN DEGLUDEC 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Both,3 mL,mL,,476,404.6,136.4216,476,Medica,Individual & Family,471.716,99.1,,percent of total billed charges,,
INSULIN DEGLUDEC 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Outpatient,3 mL,mL,,476,404.6,136.4216,476,Medica,Medica Advantage Solution,237.048,49.8,,percent of total billed charges,,
INSULIN DEGLUDEC 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Inpatient,3 mL,mL,,476,404.6,136.4216,476,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
INSULIN DEGLUDEC 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Outpatient,3 mL,mL,,476,404.6,136.4216,476,Medica,Medical Assistance,212.296,44.6,,percent of total billed charges,,
INSULIN DEGLUDEC 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Inpatient,3 mL,mL,,476,404.6,136.4216,476,Medica,Medical Assistance,,,,,Included in per diem rate,
INSULIN DEGLUDEC 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Outpatient,3 mL,mL,,476,404.6,136.4216,476,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,237.048,49.8,,percent of total billed charges,,
INSULIN DEGLUDEC 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Inpatient,3 mL,mL,,476,404.6,136.4216,476,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
INSULIN DEGLUDEC 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Both,3 mL,mL,,476,404.6,136.4216,476,"Multiplan, Inc.","Multiplan, Inc.",447.44,94,,percent of total billed charges,,
INSULIN DEGLUDEC 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Outpatient,3 mL,mL,,476,404.6,136.4216,476,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,428.876,90.1,,percent of total billed charges,,
INSULIN DEGLUDEC 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Inpatient,3 mL,mL,,476,404.6,136.4216,476,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
INSULIN DEGLUDEC 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Both,3 mL,mL,,476,404.6,136.4216,476,"Preferred One Administrative Services, INC.",PPO,469.336,98.6,,percent of total billed charges,,
INSULIN DEGLUDEC 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Outpatient,3 mL,mL,,476,404.6,136.4216,476,PrimeWest Health,Minnesota Senior Health Options (MSHO),244.902,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
INSULIN DEGLUDEC 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Inpatient,3 mL,mL,,476,404.6,136.4216,476,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
INSULIN DEGLUDEC 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Outpatient,3 mL,mL,,476,404.6,136.4216,476,PrimeWest Health,MinnesotaCare,244.4736,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
INSULIN DEGLUDEC 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Inpatient,3 mL,mL,,476,404.6,136.4216,476,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
INSULIN DEGLUDEC 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Both,3 mL,mL,,476,404.6,136.4216,476,Sanford Health Plan,Sanford Health Plan,437.92,92,,percent of total billed charges,,
INSULIN DEGLUDEC 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Outpatient,3 mL,mL,,476,404.6,136.4216,476,"UCare Health, Inc.",Individual & Family Plan,268.226,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
INSULIN DEGLUDEC 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Inpatient,3 mL,mL,,476,404.6,136.4216,476,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
INSULIN DEGLUDEC 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Outpatient,3 mL,mL,,476,404.6,136.4216,476,"UCare Health, Inc.",Medical Assistance,240.2372,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
INSULIN DEGLUDEC 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Inpatient,3 mL,mL,,476,404.6,136.4216,476,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
INSULIN DEGLUDEC 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Outpatient,3 mL,mL,,476,404.6,136.4216,476,"UCare Health, Inc.",Medicare Advantage,240.2372,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
INSULIN DEGLUDEC 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Inpatient,3 mL,mL,,476,404.6,136.4216,476,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
INSULIN DEGLUDEC 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Outpatient,3 mL,mL,,476,404.6,136.4216,476,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),240.2372,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
INSULIN DEGLUDEC 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Inpatient,3 mL,mL,,476,404.6,136.4216,476,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
INSULIN DEGLUDEC 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Both,3 mL,mL,,476,404.6,136.4216,476,UnitedHealthcare,Individual & Family,447.44,94,,percent of total billed charges,,
INSULIN DEGLUDEC 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Outpatient,3 mL,mL,,476,404.6,136.4216,476,UnitedHealthcare,Medicare Advantage,233.24,49,,percent of total billed charges,,
INSULIN DEGLUDEC 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Inpatient,3 mL,mL,,476,404.6,136.4216,476,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
INSULIN DEGLUDEC 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Outpatient,3 mL,mL,,476,404.6,136.4216,476,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,228.48,48,,percent of total billed charges,,100% of DHS outpatient percentage
INSULIN DEGLUDEC 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Inpatient,3 mL,mL,,476,404.6,136.4216,476,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
INSULIN DETEMIR U-100 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Both,3 mL,mL,,433,368.05,124.0978,433,Aetna,Commercial,398.36,92,,percent of total billed charges,,
INSULIN DETEMIR U-100 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Outpatient,3 mL,mL,,433,368.05,124.0978,433,Aetna,Medicare Advantage,212.17,49,,percent of total billed charges,,
INSULIN DETEMIR U-100 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Inpatient,3 mL,mL,,433,368.05,124.0978,433,Aetna,Medicare Advantage,,,,,Included in per diem rate,
INSULIN DETEMIR U-100 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Both,3 mL,mL,,433,368.05,124.0978,433,Aetna,PPO,402.69,93,,percent of total billed charges,,
INSULIN DETEMIR U-100 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Both,3 mL,mL,,433,368.05,124.0978,433,America's PPO,America's PPO,415.8099,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
INSULIN DETEMIR U-100 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Both,3 mL,mL,,433,368.05,124.0978,433,BlueCross BlueShield Minnesota, Federal Employee Program,426.072,98.4,,percent of total billed charges,,
INSULIN DETEMIR U-100 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Both,3 mL,mL,,433,368.05,124.0978,433,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,433,100,,percent of total billed charges,,
INSULIN DETEMIR U-100 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Both,3 mL,mL,,433,368.05,124.0978,433,BlueCross BlueShield Minnesota,High Value Network Plan,389.7,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
INSULIN DETEMIR U-100 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Outpatient,3 mL,mL,,433,368.05,124.0978,433,BlueCross BlueShield Minnesota,Medicare Advantage,212.17,49,,percent of total billed charges,,
INSULIN DETEMIR U-100 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Inpatient,3 mL,mL,,433,368.05,124.0978,433,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
INSULIN DETEMIR U-100 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Both,3 mL,mL,,433,368.05,124.0978,433,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,383.5081,88.57,,percent of total billed charges,,
INSULIN DETEMIR U-100 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Both,3 mL,mL,,433,368.05,124.0978,433,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,124.0978,28.66,,percent of total billed charges,,
INSULIN DETEMIR U-100 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Outpatient,3 mL,mL,,433,368.05,124.0978,433,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),212.17,49,,percent of total billed charges,,
INSULIN DETEMIR U-100 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Inpatient,3 mL,mL,,433,368.05,124.0978,433,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
INSULIN DETEMIR U-100 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Both,3 mL,mL,,433,368.05,124.0978,433,CorVel,Worker's Compensation,433,100,,percent of total billed charges,,
INSULIN DETEMIR U-100 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Both,3 mL,mL,,433,368.05,124.0978,433,First Health Group Corporation,First Health Network,420.01,97,,percent of total billed charges,,
INSULIN DETEMIR U-100 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Both,3 mL,mL,,433,368.05,124.0978,433,"Health Partners, Inc.",Commercial,409.618,94.6,,percent of total billed charges,,
INSULIN DETEMIR U-100 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Outpatient,3 mL,mL,,433,368.05,124.0978,433,"Health Partners, Inc.",Medicare Advantage,212.17,49,,percent of total billed charges,,
INSULIN DETEMIR U-100 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Inpatient,3 mL,mL,,433,368.05,124.0978,433,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
INSULIN DETEMIR U-100 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Both,3 mL,mL,,433,368.05,124.0978,433,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),259.8,60,,percent of total billed charges,,
INSULIN DETEMIR U-100 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Both,3 mL,mL,,433,368.05,124.0978,433,"Health Partners, Inc.",State of Minnesota Advantage Program,352.895,81.5,,percent of total billed charges,,
INSULIN DETEMIR U-100 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Both,3 mL,mL,,433,368.05,124.0978,433,"Health Partners, Inc.",State Public Programs,216.5,50,,percent of total billed charges,,
INSULIN DETEMIR U-100 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Both,3 mL,mL,,433,368.05,124.0978,433,Humana Insurance Company,Commercial PPO,411.35,95,,percent of total billed charges,,
INSULIN DETEMIR U-100 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Outpatient,3 mL,mL,,433,368.05,124.0978,433,Humana Insurance Company,Medicare PPO,212.17,49,,percent of total billed charges,,
INSULIN DETEMIR U-100 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Inpatient,3 mL,mL,,433,368.05,124.0978,433,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
INSULIN DETEMIR U-100 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Both,3 mL,mL,,433,368.05,124.0978,433,Medica,Individual & Family,429.103,99.1,,percent of total billed charges,,
INSULIN DETEMIR U-100 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Outpatient,3 mL,mL,,433,368.05,124.0978,433,Medica,Medica Advantage Solution,215.634,49.8,,percent of total billed charges,,
INSULIN DETEMIR U-100 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Inpatient,3 mL,mL,,433,368.05,124.0978,433,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
INSULIN DETEMIR U-100 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Outpatient,3 mL,mL,,433,368.05,124.0978,433,Medica,Medical Assistance,193.118,44.6,,percent of total billed charges,,
INSULIN DETEMIR U-100 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Inpatient,3 mL,mL,,433,368.05,124.0978,433,Medica,Medical Assistance,,,,,Included in per diem rate,
INSULIN DETEMIR U-100 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Outpatient,3 mL,mL,,433,368.05,124.0978,433,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,215.634,49.8,,percent of total billed charges,,
INSULIN DETEMIR U-100 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Inpatient,3 mL,mL,,433,368.05,124.0978,433,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
INSULIN DETEMIR U-100 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Both,3 mL,mL,,433,368.05,124.0978,433,"Multiplan, Inc.","Multiplan, Inc.",407.02,94,,percent of total billed charges,,
INSULIN DETEMIR U-100 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Outpatient,3 mL,mL,,433,368.05,124.0978,433,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,390.133,90.1,,percent of total billed charges,,
INSULIN DETEMIR U-100 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Inpatient,3 mL,mL,,433,368.05,124.0978,433,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
INSULIN DETEMIR U-100 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Both,3 mL,mL,,433,368.05,124.0978,433,"Preferred One Administrative Services, INC.",PPO,426.938,98.6,,percent of total billed charges,,
INSULIN DETEMIR U-100 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Outpatient,3 mL,mL,,433,368.05,124.0978,433,PrimeWest Health,Minnesota Senior Health Options (MSHO),222.7785,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
INSULIN DETEMIR U-100 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Inpatient,3 mL,mL,,433,368.05,124.0978,433,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
INSULIN DETEMIR U-100 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Outpatient,3 mL,mL,,433,368.05,124.0978,433,PrimeWest Health,MinnesotaCare,222.3888,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
INSULIN DETEMIR U-100 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Inpatient,3 mL,mL,,433,368.05,124.0978,433,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
INSULIN DETEMIR U-100 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Both,3 mL,mL,,433,368.05,124.0978,433,Sanford Health Plan,Sanford Health Plan,398.36,92,,percent of total billed charges,,
INSULIN DETEMIR U-100 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Outpatient,3 mL,mL,,433,368.05,124.0978,433,"UCare Health, Inc.",Individual & Family Plan,243.9955,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
INSULIN DETEMIR U-100 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Inpatient,3 mL,mL,,433,368.05,124.0978,433,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
INSULIN DETEMIR U-100 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Outpatient,3 mL,mL,,433,368.05,124.0978,433,"UCare Health, Inc.",Medical Assistance,218.5351,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
INSULIN DETEMIR U-100 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Inpatient,3 mL,mL,,433,368.05,124.0978,433,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
INSULIN DETEMIR U-100 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Outpatient,3 mL,mL,,433,368.05,124.0978,433,"UCare Health, Inc.",Medicare Advantage,218.5351,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
INSULIN DETEMIR U-100 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Inpatient,3 mL,mL,,433,368.05,124.0978,433,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
INSULIN DETEMIR U-100 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Outpatient,3 mL,mL,,433,368.05,124.0978,433,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),218.5351,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
INSULIN DETEMIR U-100 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Inpatient,3 mL,mL,,433,368.05,124.0978,433,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
INSULIN DETEMIR U-100 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Both,3 mL,mL,,433,368.05,124.0978,433,UnitedHealthcare,Individual & Family,407.02,94,,percent of total billed charges,,
INSULIN DETEMIR U-100 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Outpatient,3 mL,mL,,433,368.05,124.0978,433,UnitedHealthcare,Medicare Advantage,212.17,49,,percent of total billed charges,,
INSULIN DETEMIR U-100 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Inpatient,3 mL,mL,,433,368.05,124.0978,433,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
INSULIN DETEMIR U-100 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Outpatient,3 mL,mL,,433,368.05,124.0978,433,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,207.84,48,,percent of total billed charges,,100% of DHS outpatient percentage
INSULIN DETEMIR U-100 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Inpatient,3 mL,mL,,433,368.05,124.0978,433,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
INSULIN GLARGINE 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Both,3 mL,mL,,411,349.35,117.7926,411,Aetna,Commercial,378.12,92,,percent of total billed charges,,
INSULIN GLARGINE 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Outpatient,3 mL,mL,,411,349.35,117.7926,411,Aetna,Medicare Advantage,201.39,49,,percent of total billed charges,,
INSULIN GLARGINE 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Inpatient,3 mL,mL,,411,349.35,117.7926,411,Aetna,Medicare Advantage,,,,,Included in per diem rate,
INSULIN GLARGINE 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Both,3 mL,mL,,411,349.35,117.7926,411,Aetna,PPO,382.23,93,,percent of total billed charges,,
INSULIN GLARGINE 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Both,3 mL,mL,,411,349.35,117.7926,411,America's PPO,America's PPO,394.6833,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
INSULIN GLARGINE 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Both,3 mL,mL,,411,349.35,117.7926,411,BlueCross BlueShield Minnesota, Federal Employee Program,404.424,98.4,,percent of total billed charges,,
INSULIN GLARGINE 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Both,3 mL,mL,,411,349.35,117.7926,411,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,411,100,,percent of total billed charges,,
INSULIN GLARGINE 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Both,3 mL,mL,,411,349.35,117.7926,411,BlueCross BlueShield Minnesota,High Value Network Plan,369.9,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
INSULIN GLARGINE 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Outpatient,3 mL,mL,,411,349.35,117.7926,411,BlueCross BlueShield Minnesota,Medicare Advantage,201.39,49,,percent of total billed charges,,
INSULIN GLARGINE 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Inpatient,3 mL,mL,,411,349.35,117.7926,411,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
INSULIN GLARGINE 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Both,3 mL,mL,,411,349.35,117.7926,411,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,364.0227,88.57,,percent of total billed charges,,
INSULIN GLARGINE 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Both,3 mL,mL,,411,349.35,117.7926,411,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,117.7926,28.66,,percent of total billed charges,,
INSULIN GLARGINE 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Outpatient,3 mL,mL,,411,349.35,117.7926,411,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),201.39,49,,percent of total billed charges,,
INSULIN GLARGINE 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Inpatient,3 mL,mL,,411,349.35,117.7926,411,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
INSULIN GLARGINE 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Both,3 mL,mL,,411,349.35,117.7926,411,CorVel,Worker's Compensation,411,100,,percent of total billed charges,,
INSULIN GLARGINE 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Both,3 mL,mL,,411,349.35,117.7926,411,First Health Group Corporation,First Health Network,398.67,97,,percent of total billed charges,,
INSULIN GLARGINE 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Both,3 mL,mL,,411,349.35,117.7926,411,"Health Partners, Inc.",Commercial,388.806,94.6,,percent of total billed charges,,
INSULIN GLARGINE 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Outpatient,3 mL,mL,,411,349.35,117.7926,411,"Health Partners, Inc.",Medicare Advantage,201.39,49,,percent of total billed charges,,
INSULIN GLARGINE 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Inpatient,3 mL,mL,,411,349.35,117.7926,411,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
INSULIN GLARGINE 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Both,3 mL,mL,,411,349.35,117.7926,411,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),246.6,60,,percent of total billed charges,,
INSULIN GLARGINE 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Both,3 mL,mL,,411,349.35,117.7926,411,"Health Partners, Inc.",State of Minnesota Advantage Program,334.965,81.5,,percent of total billed charges,,
INSULIN GLARGINE 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Both,3 mL,mL,,411,349.35,117.7926,411,"Health Partners, Inc.",State Public Programs,205.5,50,,percent of total billed charges,,
INSULIN GLARGINE 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Both,3 mL,mL,,411,349.35,117.7926,411,Humana Insurance Company,Commercial PPO,390.45,95,,percent of total billed charges,,
INSULIN GLARGINE 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Outpatient,3 mL,mL,,411,349.35,117.7926,411,Humana Insurance Company,Medicare PPO,201.39,49,,percent of total billed charges,,
INSULIN GLARGINE 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Inpatient,3 mL,mL,,411,349.35,117.7926,411,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
INSULIN GLARGINE 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Both,3 mL,mL,,411,349.35,117.7926,411,Medica,Individual & Family,407.301,99.1,,percent of total billed charges,,
INSULIN GLARGINE 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Outpatient,3 mL,mL,,411,349.35,117.7926,411,Medica,Medica Advantage Solution,204.678,49.8,,percent of total billed charges,,
INSULIN GLARGINE 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Inpatient,3 mL,mL,,411,349.35,117.7926,411,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
INSULIN GLARGINE 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Outpatient,3 mL,mL,,411,349.35,117.7926,411,Medica,Medical Assistance,183.306,44.6,,percent of total billed charges,,
INSULIN GLARGINE 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Inpatient,3 mL,mL,,411,349.35,117.7926,411,Medica,Medical Assistance,,,,,Included in per diem rate,
INSULIN GLARGINE 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Outpatient,3 mL,mL,,411,349.35,117.7926,411,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,204.678,49.8,,percent of total billed charges,,
INSULIN GLARGINE 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Inpatient,3 mL,mL,,411,349.35,117.7926,411,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
INSULIN GLARGINE 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Both,3 mL,mL,,411,349.35,117.7926,411,"Multiplan, Inc.","Multiplan, Inc.",386.34,94,,percent of total billed charges,,
INSULIN GLARGINE 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Outpatient,3 mL,mL,,411,349.35,117.7926,411,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,370.311,90.1,,percent of total billed charges,,
INSULIN GLARGINE 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Inpatient,3 mL,mL,,411,349.35,117.7926,411,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
INSULIN GLARGINE 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Both,3 mL,mL,,411,349.35,117.7926,411,"Preferred One Administrative Services, INC.",PPO,405.246,98.6,,percent of total billed charges,,
INSULIN GLARGINE 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Outpatient,3 mL,mL,,411,349.35,117.7926,411,PrimeWest Health,Minnesota Senior Health Options (MSHO),211.4595,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
INSULIN GLARGINE 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Inpatient,3 mL,mL,,411,349.35,117.7926,411,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
INSULIN GLARGINE 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Outpatient,3 mL,mL,,411,349.35,117.7926,411,PrimeWest Health,MinnesotaCare,211.0896,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
INSULIN GLARGINE 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Inpatient,3 mL,mL,,411,349.35,117.7926,411,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
INSULIN GLARGINE 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Both,3 mL,mL,,411,349.35,117.7926,411,Sanford Health Plan,Sanford Health Plan,378.12,92,,percent of total billed charges,,
INSULIN GLARGINE 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Outpatient,3 mL,mL,,411,349.35,117.7926,411,"UCare Health, Inc.",Individual & Family Plan,231.5985,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
INSULIN GLARGINE 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Inpatient,3 mL,mL,,411,349.35,117.7926,411,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
INSULIN GLARGINE 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Outpatient,3 mL,mL,,411,349.35,117.7926,411,"UCare Health, Inc.",Medical Assistance,207.4317,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
INSULIN GLARGINE 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Inpatient,3 mL,mL,,411,349.35,117.7926,411,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
INSULIN GLARGINE 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Outpatient,3 mL,mL,,411,349.35,117.7926,411,"UCare Health, Inc.",Medicare Advantage,207.4317,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
INSULIN GLARGINE 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Inpatient,3 mL,mL,,411,349.35,117.7926,411,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
INSULIN GLARGINE 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Outpatient,3 mL,mL,,411,349.35,117.7926,411,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),207.4317,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
INSULIN GLARGINE 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Inpatient,3 mL,mL,,411,349.35,117.7926,411,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
INSULIN GLARGINE 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Both,3 mL,mL,,411,349.35,117.7926,411,UnitedHealthcare,Individual & Family,386.34,94,,percent of total billed charges,,
INSULIN GLARGINE 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Outpatient,3 mL,mL,,411,349.35,117.7926,411,UnitedHealthcare,Medicare Advantage,201.39,49,,percent of total billed charges,,
INSULIN GLARGINE 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Inpatient,3 mL,mL,,411,349.35,117.7926,411,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
INSULIN GLARGINE 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Outpatient,3 mL,mL,,411,349.35,117.7926,411,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,197.28,48,,percent of total billed charges,,100% of DHS outpatient percentage
INSULIN GLARGINE 100 UNIT/ML (3 ML) SUBQ INPN,,J1815,HCPCS,Facility,Inpatient,3 mL,mL,,411,349.35,117.7926,411,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
INSULIN NPH AND REGULAR HUMAN 100 UNIT/ML (70-30) SUBQ SUSP,,J1815,HCPCS,Facility,Both,3 mL,mL,,225,191.25,64.485,225,Aetna,Commercial,207,92,,percent of total billed charges,,
INSULIN NPH AND REGULAR HUMAN 100 UNIT/ML (70-30) SUBQ SUSP,,J1815,HCPCS,Facility,Outpatient,3 mL,mL,,225,191.25,64.485,225,Aetna,Medicare Advantage,110.25,49,,percent of total billed charges,,
INSULIN NPH AND REGULAR HUMAN 100 UNIT/ML (70-30) SUBQ SUSP,,J1815,HCPCS,Facility,Inpatient,3 mL,mL,,225,191.25,64.485,225,Aetna,Medicare Advantage,,,,,Included in per diem rate,
INSULIN NPH AND REGULAR HUMAN 100 UNIT/ML (70-30) SUBQ SUSP,,J1815,HCPCS,Facility,Both,3 mL,mL,,225,191.25,64.485,225,Aetna,PPO,209.25,93,,percent of total billed charges,,
INSULIN NPH AND REGULAR HUMAN 100 UNIT/ML (70-30) SUBQ SUSP,,J1815,HCPCS,Facility,Both,3 mL,mL,,225,191.25,64.485,225,America's PPO,America's PPO,216.0675,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
INSULIN NPH AND REGULAR HUMAN 100 UNIT/ML (70-30) SUBQ SUSP,,J1815,HCPCS,Facility,Both,3 mL,mL,,225,191.25,64.485,225,BlueCross BlueShield Minnesota, Federal Employee Program,221.4,98.4,,percent of total billed charges,,
INSULIN NPH AND REGULAR HUMAN 100 UNIT/ML (70-30) SUBQ SUSP,,J1815,HCPCS,Facility,Both,3 mL,mL,,225,191.25,64.485,225,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,225,100,,percent of total billed charges,,
INSULIN NPH AND REGULAR HUMAN 100 UNIT/ML (70-30) SUBQ SUSP,,J1815,HCPCS,Facility,Both,3 mL,mL,,225,191.25,64.485,225,BlueCross BlueShield Minnesota,High Value Network Plan,202.5,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
INSULIN NPH AND REGULAR HUMAN 100 UNIT/ML (70-30) SUBQ SUSP,,J1815,HCPCS,Facility,Outpatient,3 mL,mL,,225,191.25,64.485,225,BlueCross BlueShield Minnesota,Medicare Advantage,110.25,49,,percent of total billed charges,,
INSULIN NPH AND REGULAR HUMAN 100 UNIT/ML (70-30) SUBQ SUSP,,J1815,HCPCS,Facility,Inpatient,3 mL,mL,,225,191.25,64.485,225,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
INSULIN NPH AND REGULAR HUMAN 100 UNIT/ML (70-30) SUBQ SUSP,,J1815,HCPCS,Facility,Both,3 mL,mL,,225,191.25,64.485,225,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,199.2825,88.57,,percent of total billed charges,,
INSULIN NPH AND REGULAR HUMAN 100 UNIT/ML (70-30) SUBQ SUSP,,J1815,HCPCS,Facility,Both,3 mL,mL,,225,191.25,64.485,225,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,64.485,28.66,,percent of total billed charges,,
INSULIN NPH AND REGULAR HUMAN 100 UNIT/ML (70-30) SUBQ SUSP,,J1815,HCPCS,Facility,Outpatient,3 mL,mL,,225,191.25,64.485,225,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),110.25,49,,percent of total billed charges,,
INSULIN NPH AND REGULAR HUMAN 100 UNIT/ML (70-30) SUBQ SUSP,,J1815,HCPCS,Facility,Inpatient,3 mL,mL,,225,191.25,64.485,225,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
INSULIN NPH AND REGULAR HUMAN 100 UNIT/ML (70-30) SUBQ SUSP,,J1815,HCPCS,Facility,Both,3 mL,mL,,225,191.25,64.485,225,CorVel,Worker's Compensation,225,100,,percent of total billed charges,,
INSULIN NPH AND REGULAR HUMAN 100 UNIT/ML (70-30) SUBQ SUSP,,J1815,HCPCS,Facility,Both,3 mL,mL,,225,191.25,64.485,225,First Health Group Corporation,First Health Network,218.25,97,,percent of total billed charges,,
INSULIN NPH AND REGULAR HUMAN 100 UNIT/ML (70-30) SUBQ SUSP,,J1815,HCPCS,Facility,Both,3 mL,mL,,225,191.25,64.485,225,"Health Partners, Inc.",Commercial,212.85,94.6,,percent of total billed charges,,
INSULIN NPH AND REGULAR HUMAN 100 UNIT/ML (70-30) SUBQ SUSP,,J1815,HCPCS,Facility,Outpatient,3 mL,mL,,225,191.25,64.485,225,"Health Partners, Inc.",Medicare Advantage,110.25,49,,percent of total billed charges,,
INSULIN NPH AND REGULAR HUMAN 100 UNIT/ML (70-30) SUBQ SUSP,,J1815,HCPCS,Facility,Inpatient,3 mL,mL,,225,191.25,64.485,225,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
INSULIN NPH AND REGULAR HUMAN 100 UNIT/ML (70-30) SUBQ SUSP,,J1815,HCPCS,Facility,Both,3 mL,mL,,225,191.25,64.485,225,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),135,60,,percent of total billed charges,,
INSULIN NPH AND REGULAR HUMAN 100 UNIT/ML (70-30) SUBQ SUSP,,J1815,HCPCS,Facility,Both,3 mL,mL,,225,191.25,64.485,225,"Health Partners, Inc.",State of Minnesota Advantage Program,183.375,81.5,,percent of total billed charges,,
INSULIN NPH AND REGULAR HUMAN 100 UNIT/ML (70-30) SUBQ SUSP,,J1815,HCPCS,Facility,Both,3 mL,mL,,225,191.25,64.485,225,"Health Partners, Inc.",State Public Programs,112.5,50,,percent of total billed charges,,
INSULIN NPH AND REGULAR HUMAN 100 UNIT/ML (70-30) SUBQ SUSP,,J1815,HCPCS,Facility,Both,3 mL,mL,,225,191.25,64.485,225,Humana Insurance Company,Commercial PPO,213.75,95,,percent of total billed charges,,
INSULIN NPH AND REGULAR HUMAN 100 UNIT/ML (70-30) SUBQ SUSP,,J1815,HCPCS,Facility,Outpatient,3 mL,mL,,225,191.25,64.485,225,Humana Insurance Company,Medicare PPO,110.25,49,,percent of total billed charges,,
INSULIN NPH AND REGULAR HUMAN 100 UNIT/ML (70-30) SUBQ SUSP,,J1815,HCPCS,Facility,Inpatient,3 mL,mL,,225,191.25,64.485,225,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
INSULIN NPH AND REGULAR HUMAN 100 UNIT/ML (70-30) SUBQ SUSP,,J1815,HCPCS,Facility,Both,3 mL,mL,,225,191.25,64.485,225,Medica,Individual & Family,222.975,99.1,,percent of total billed charges,,
INSULIN NPH AND REGULAR HUMAN 100 UNIT/ML (70-30) SUBQ SUSP,,J1815,HCPCS,Facility,Outpatient,3 mL,mL,,225,191.25,64.485,225,Medica,Medica Advantage Solution,112.05,49.8,,percent of total billed charges,,
INSULIN NPH AND REGULAR HUMAN 100 UNIT/ML (70-30) SUBQ SUSP,,J1815,HCPCS,Facility,Inpatient,3 mL,mL,,225,191.25,64.485,225,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
INSULIN NPH AND REGULAR HUMAN 100 UNIT/ML (70-30) SUBQ SUSP,,J1815,HCPCS,Facility,Outpatient,3 mL,mL,,225,191.25,64.485,225,Medica,Medical Assistance,100.35,44.6,,percent of total billed charges,,
INSULIN NPH AND REGULAR HUMAN 100 UNIT/ML (70-30) SUBQ SUSP,,J1815,HCPCS,Facility,Inpatient,3 mL,mL,,225,191.25,64.485,225,Medica,Medical Assistance,,,,,Included in per diem rate,
INSULIN NPH AND REGULAR HUMAN 100 UNIT/ML (70-30) SUBQ SUSP,,J1815,HCPCS,Facility,Outpatient,3 mL,mL,,225,191.25,64.485,225,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,112.05,49.8,,percent of total billed charges,,
INSULIN NPH AND REGULAR HUMAN 100 UNIT/ML (70-30) SUBQ SUSP,,J1815,HCPCS,Facility,Inpatient,3 mL,mL,,225,191.25,64.485,225,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
INSULIN NPH AND REGULAR HUMAN 100 UNIT/ML (70-30) SUBQ SUSP,,J1815,HCPCS,Facility,Both,3 mL,mL,,225,191.25,64.485,225,"Multiplan, Inc.","Multiplan, Inc.",211.5,94,,percent of total billed charges,,
INSULIN NPH AND REGULAR HUMAN 100 UNIT/ML (70-30) SUBQ SUSP,,J1815,HCPCS,Facility,Outpatient,3 mL,mL,,225,191.25,64.485,225,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,202.725,90.1,,percent of total billed charges,,
INSULIN NPH AND REGULAR HUMAN 100 UNIT/ML (70-30) SUBQ SUSP,,J1815,HCPCS,Facility,Inpatient,3 mL,mL,,225,191.25,64.485,225,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
INSULIN NPH AND REGULAR HUMAN 100 UNIT/ML (70-30) SUBQ SUSP,,J1815,HCPCS,Facility,Both,3 mL,mL,,225,191.25,64.485,225,"Preferred One Administrative Services, INC.",PPO,221.85,98.6,,percent of total billed charges,,
INSULIN NPH AND REGULAR HUMAN 100 UNIT/ML (70-30) SUBQ SUSP,,J1815,HCPCS,Facility,Outpatient,3 mL,mL,,225,191.25,64.485,225,PrimeWest Health,Minnesota Senior Health Options (MSHO),115.7625,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
INSULIN NPH AND REGULAR HUMAN 100 UNIT/ML (70-30) SUBQ SUSP,,J1815,HCPCS,Facility,Inpatient,3 mL,mL,,225,191.25,64.485,225,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
INSULIN NPH AND REGULAR HUMAN 100 UNIT/ML (70-30) SUBQ SUSP,,J1815,HCPCS,Facility,Outpatient,3 mL,mL,,225,191.25,64.485,225,PrimeWest Health,MinnesotaCare,115.56,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
INSULIN NPH AND REGULAR HUMAN 100 UNIT/ML (70-30) SUBQ SUSP,,J1815,HCPCS,Facility,Inpatient,3 mL,mL,,225,191.25,64.485,225,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
INSULIN NPH AND REGULAR HUMAN 100 UNIT/ML (70-30) SUBQ SUSP,,J1815,HCPCS,Facility,Both,3 mL,mL,,225,191.25,64.485,225,Sanford Health Plan,Sanford Health Plan,207,92,,percent of total billed charges,,
INSULIN NPH AND REGULAR HUMAN 100 UNIT/ML (70-30) SUBQ SUSP,,J1815,HCPCS,Facility,Outpatient,3 mL,mL,,225,191.25,64.485,225,"UCare Health, Inc.",Individual & Family Plan,126.7875,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
INSULIN NPH AND REGULAR HUMAN 100 UNIT/ML (70-30) SUBQ SUSP,,J1815,HCPCS,Facility,Inpatient,3 mL,mL,,225,191.25,64.485,225,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
INSULIN NPH AND REGULAR HUMAN 100 UNIT/ML (70-30) SUBQ SUSP,,J1815,HCPCS,Facility,Outpatient,3 mL,mL,,225,191.25,64.485,225,"UCare Health, Inc.",Medical Assistance,113.5575,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
INSULIN NPH AND REGULAR HUMAN 100 UNIT/ML (70-30) SUBQ SUSP,,J1815,HCPCS,Facility,Inpatient,3 mL,mL,,225,191.25,64.485,225,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
INSULIN NPH AND REGULAR HUMAN 100 UNIT/ML (70-30) SUBQ SUSP,,J1815,HCPCS,Facility,Outpatient,3 mL,mL,,225,191.25,64.485,225,"UCare Health, Inc.",Medicare Advantage,113.5575,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
INSULIN NPH AND REGULAR HUMAN 100 UNIT/ML (70-30) SUBQ SUSP,,J1815,HCPCS,Facility,Inpatient,3 mL,mL,,225,191.25,64.485,225,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
INSULIN NPH AND REGULAR HUMAN 100 UNIT/ML (70-30) SUBQ SUSP,,J1815,HCPCS,Facility,Outpatient,3 mL,mL,,225,191.25,64.485,225,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),113.5575,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
INSULIN NPH AND REGULAR HUMAN 100 UNIT/ML (70-30) SUBQ SUSP,,J1815,HCPCS,Facility,Inpatient,3 mL,mL,,225,191.25,64.485,225,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
INSULIN NPH AND REGULAR HUMAN 100 UNIT/ML (70-30) SUBQ SUSP,,J1815,HCPCS,Facility,Both,3 mL,mL,,225,191.25,64.485,225,UnitedHealthcare,Individual & Family,211.5,94,,percent of total billed charges,,
INSULIN NPH AND REGULAR HUMAN 100 UNIT/ML (70-30) SUBQ SUSP,,J1815,HCPCS,Facility,Outpatient,3 mL,mL,,225,191.25,64.485,225,UnitedHealthcare,Medicare Advantage,110.25,49,,percent of total billed charges,,
INSULIN NPH AND REGULAR HUMAN 100 UNIT/ML (70-30) SUBQ SUSP,,J1815,HCPCS,Facility,Inpatient,3 mL,mL,,225,191.25,64.485,225,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
INSULIN NPH AND REGULAR HUMAN 100 UNIT/ML (70-30) SUBQ SUSP,,J1815,HCPCS,Facility,Outpatient,3 mL,mL,,225,191.25,64.485,225,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,108,48,,percent of total billed charges,,100% of DHS outpatient percentage
INSULIN NPH AND REGULAR HUMAN 100 UNIT/ML (70-30) SUBQ SUSP,,J1815,HCPCS,Facility,Inpatient,3 mL,mL,,225,191.25,64.485,225,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
INSULIN NPH ISOPH U-100 HUMAN 100 UNIT/ML SUBQ SUSP,,J1815,HCPCS,Facility,Both,3 mL,mL,,225,191.25,64.485,225,Aetna,Commercial,207,92,,percent of total billed charges,,
INSULIN NPH ISOPH U-100 HUMAN 100 UNIT/ML SUBQ SUSP,,J1815,HCPCS,Facility,Outpatient,3 mL,mL,,225,191.25,64.485,225,Aetna,Medicare Advantage,110.25,49,,percent of total billed charges,,
INSULIN NPH ISOPH U-100 HUMAN 100 UNIT/ML SUBQ SUSP,,J1815,HCPCS,Facility,Inpatient,3 mL,mL,,225,191.25,64.485,225,Aetna,Medicare Advantage,,,,,Included in per diem rate,
INSULIN NPH ISOPH U-100 HUMAN 100 UNIT/ML SUBQ SUSP,,J1815,HCPCS,Facility,Both,3 mL,mL,,225,191.25,64.485,225,Aetna,PPO,209.25,93,,percent of total billed charges,,
INSULIN NPH ISOPH U-100 HUMAN 100 UNIT/ML SUBQ SUSP,,J1815,HCPCS,Facility,Both,3 mL,mL,,225,191.25,64.485,225,America's PPO,America's PPO,216.0675,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
INSULIN NPH ISOPH U-100 HUMAN 100 UNIT/ML SUBQ SUSP,,J1815,HCPCS,Facility,Both,3 mL,mL,,225,191.25,64.485,225,BlueCross BlueShield Minnesota, Federal Employee Program,221.4,98.4,,percent of total billed charges,,
INSULIN NPH ISOPH U-100 HUMAN 100 UNIT/ML SUBQ SUSP,,J1815,HCPCS,Facility,Both,3 mL,mL,,225,191.25,64.485,225,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,225,100,,percent of total billed charges,,
INSULIN NPH ISOPH U-100 HUMAN 100 UNIT/ML SUBQ SUSP,,J1815,HCPCS,Facility,Both,3 mL,mL,,225,191.25,64.485,225,BlueCross BlueShield Minnesota,High Value Network Plan,202.5,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
INSULIN NPH ISOPH U-100 HUMAN 100 UNIT/ML SUBQ SUSP,,J1815,HCPCS,Facility,Outpatient,3 mL,mL,,225,191.25,64.485,225,BlueCross BlueShield Minnesota,Medicare Advantage,110.25,49,,percent of total billed charges,,
INSULIN NPH ISOPH U-100 HUMAN 100 UNIT/ML SUBQ SUSP,,J1815,HCPCS,Facility,Inpatient,3 mL,mL,,225,191.25,64.485,225,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
INSULIN NPH ISOPH U-100 HUMAN 100 UNIT/ML SUBQ SUSP,,J1815,HCPCS,Facility,Both,3 mL,mL,,225,191.25,64.485,225,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,199.2825,88.57,,percent of total billed charges,,
INSULIN NPH ISOPH U-100 HUMAN 100 UNIT/ML SUBQ SUSP,,J1815,HCPCS,Facility,Both,3 mL,mL,,225,191.25,64.485,225,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,64.485,28.66,,percent of total billed charges,,
INSULIN NPH ISOPH U-100 HUMAN 100 UNIT/ML SUBQ SUSP,,J1815,HCPCS,Facility,Outpatient,3 mL,mL,,225,191.25,64.485,225,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),110.25,49,,percent of total billed charges,,
INSULIN NPH ISOPH U-100 HUMAN 100 UNIT/ML SUBQ SUSP,,J1815,HCPCS,Facility,Inpatient,3 mL,mL,,225,191.25,64.485,225,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
INSULIN NPH ISOPH U-100 HUMAN 100 UNIT/ML SUBQ SUSP,,J1815,HCPCS,Facility,Both,3 mL,mL,,225,191.25,64.485,225,CorVel,Worker's Compensation,225,100,,percent of total billed charges,,
INSULIN NPH ISOPH U-100 HUMAN 100 UNIT/ML SUBQ SUSP,,J1815,HCPCS,Facility,Both,3 mL,mL,,225,191.25,64.485,225,First Health Group Corporation,First Health Network,218.25,97,,percent of total billed charges,,
INSULIN NPH ISOPH U-100 HUMAN 100 UNIT/ML SUBQ SUSP,,J1815,HCPCS,Facility,Both,3 mL,mL,,225,191.25,64.485,225,"Health Partners, Inc.",Commercial,212.85,94.6,,percent of total billed charges,,
INSULIN NPH ISOPH U-100 HUMAN 100 UNIT/ML SUBQ SUSP,,J1815,HCPCS,Facility,Outpatient,3 mL,mL,,225,191.25,64.485,225,"Health Partners, Inc.",Medicare Advantage,110.25,49,,percent of total billed charges,,
INSULIN NPH ISOPH U-100 HUMAN 100 UNIT/ML SUBQ SUSP,,J1815,HCPCS,Facility,Inpatient,3 mL,mL,,225,191.25,64.485,225,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
INSULIN NPH ISOPH U-100 HUMAN 100 UNIT/ML SUBQ SUSP,,J1815,HCPCS,Facility,Both,3 mL,mL,,225,191.25,64.485,225,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),135,60,,percent of total billed charges,,
INSULIN NPH ISOPH U-100 HUMAN 100 UNIT/ML SUBQ SUSP,,J1815,HCPCS,Facility,Both,3 mL,mL,,225,191.25,64.485,225,"Health Partners, Inc.",State of Minnesota Advantage Program,183.375,81.5,,percent of total billed charges,,
INSULIN NPH ISOPH U-100 HUMAN 100 UNIT/ML SUBQ SUSP,,J1815,HCPCS,Facility,Both,3 mL,mL,,225,191.25,64.485,225,"Health Partners, Inc.",State Public Programs,112.5,50,,percent of total billed charges,,
INSULIN NPH ISOPH U-100 HUMAN 100 UNIT/ML SUBQ SUSP,,J1815,HCPCS,Facility,Both,3 mL,mL,,225,191.25,64.485,225,Humana Insurance Company,Commercial PPO,213.75,95,,percent of total billed charges,,
INSULIN NPH ISOPH U-100 HUMAN 100 UNIT/ML SUBQ SUSP,,J1815,HCPCS,Facility,Outpatient,3 mL,mL,,225,191.25,64.485,225,Humana Insurance Company,Medicare PPO,110.25,49,,percent of total billed charges,,
INSULIN NPH ISOPH U-100 HUMAN 100 UNIT/ML SUBQ SUSP,,J1815,HCPCS,Facility,Inpatient,3 mL,mL,,225,191.25,64.485,225,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
INSULIN NPH ISOPH U-100 HUMAN 100 UNIT/ML SUBQ SUSP,,J1815,HCPCS,Facility,Both,3 mL,mL,,225,191.25,64.485,225,Medica,Individual & Family,222.975,99.1,,percent of total billed charges,,
INSULIN NPH ISOPH U-100 HUMAN 100 UNIT/ML SUBQ SUSP,,J1815,HCPCS,Facility,Outpatient,3 mL,mL,,225,191.25,64.485,225,Medica,Medica Advantage Solution,112.05,49.8,,percent of total billed charges,,
INSULIN NPH ISOPH U-100 HUMAN 100 UNIT/ML SUBQ SUSP,,J1815,HCPCS,Facility,Inpatient,3 mL,mL,,225,191.25,64.485,225,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
INSULIN NPH ISOPH U-100 HUMAN 100 UNIT/ML SUBQ SUSP,,J1815,HCPCS,Facility,Outpatient,3 mL,mL,,225,191.25,64.485,225,Medica,Medical Assistance,100.35,44.6,,percent of total billed charges,,
INSULIN NPH ISOPH U-100 HUMAN 100 UNIT/ML SUBQ SUSP,,J1815,HCPCS,Facility,Inpatient,3 mL,mL,,225,191.25,64.485,225,Medica,Medical Assistance,,,,,Included in per diem rate,
INSULIN NPH ISOPH U-100 HUMAN 100 UNIT/ML SUBQ SUSP,,J1815,HCPCS,Facility,Outpatient,3 mL,mL,,225,191.25,64.485,225,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,112.05,49.8,,percent of total billed charges,,
INSULIN NPH ISOPH U-100 HUMAN 100 UNIT/ML SUBQ SUSP,,J1815,HCPCS,Facility,Inpatient,3 mL,mL,,225,191.25,64.485,225,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
INSULIN NPH ISOPH U-100 HUMAN 100 UNIT/ML SUBQ SUSP,,J1815,HCPCS,Facility,Both,3 mL,mL,,225,191.25,64.485,225,"Multiplan, Inc.","Multiplan, Inc.",211.5,94,,percent of total billed charges,,
INSULIN NPH ISOPH U-100 HUMAN 100 UNIT/ML SUBQ SUSP,,J1815,HCPCS,Facility,Outpatient,3 mL,mL,,225,191.25,64.485,225,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,202.725,90.1,,percent of total billed charges,,
INSULIN NPH ISOPH U-100 HUMAN 100 UNIT/ML SUBQ SUSP,,J1815,HCPCS,Facility,Inpatient,3 mL,mL,,225,191.25,64.485,225,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
INSULIN NPH ISOPH U-100 HUMAN 100 UNIT/ML SUBQ SUSP,,J1815,HCPCS,Facility,Both,3 mL,mL,,225,191.25,64.485,225,"Preferred One Administrative Services, INC.",PPO,221.85,98.6,,percent of total billed charges,,
INSULIN NPH ISOPH U-100 HUMAN 100 UNIT/ML SUBQ SUSP,,J1815,HCPCS,Facility,Outpatient,3 mL,mL,,225,191.25,64.485,225,PrimeWest Health,Minnesota Senior Health Options (MSHO),115.7625,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
INSULIN NPH ISOPH U-100 HUMAN 100 UNIT/ML SUBQ SUSP,,J1815,HCPCS,Facility,Inpatient,3 mL,mL,,225,191.25,64.485,225,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
INSULIN NPH ISOPH U-100 HUMAN 100 UNIT/ML SUBQ SUSP,,J1815,HCPCS,Facility,Outpatient,3 mL,mL,,225,191.25,64.485,225,PrimeWest Health,MinnesotaCare,115.56,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
INSULIN NPH ISOPH U-100 HUMAN 100 UNIT/ML SUBQ SUSP,,J1815,HCPCS,Facility,Inpatient,3 mL,mL,,225,191.25,64.485,225,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
INSULIN NPH ISOPH U-100 HUMAN 100 UNIT/ML SUBQ SUSP,,J1815,HCPCS,Facility,Both,3 mL,mL,,225,191.25,64.485,225,Sanford Health Plan,Sanford Health Plan,207,92,,percent of total billed charges,,
INSULIN NPH ISOPH U-100 HUMAN 100 UNIT/ML SUBQ SUSP,,J1815,HCPCS,Facility,Outpatient,3 mL,mL,,225,191.25,64.485,225,"UCare Health, Inc.",Individual & Family Plan,126.7875,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
INSULIN NPH ISOPH U-100 HUMAN 100 UNIT/ML SUBQ SUSP,,J1815,HCPCS,Facility,Inpatient,3 mL,mL,,225,191.25,64.485,225,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
INSULIN NPH ISOPH U-100 HUMAN 100 UNIT/ML SUBQ SUSP,,J1815,HCPCS,Facility,Outpatient,3 mL,mL,,225,191.25,64.485,225,"UCare Health, Inc.",Medical Assistance,113.5575,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
INSULIN NPH ISOPH U-100 HUMAN 100 UNIT/ML SUBQ SUSP,,J1815,HCPCS,Facility,Inpatient,3 mL,mL,,225,191.25,64.485,225,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
INSULIN NPH ISOPH U-100 HUMAN 100 UNIT/ML SUBQ SUSP,,J1815,HCPCS,Facility,Outpatient,3 mL,mL,,225,191.25,64.485,225,"UCare Health, Inc.",Medicare Advantage,113.5575,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
INSULIN NPH ISOPH U-100 HUMAN 100 UNIT/ML SUBQ SUSP,,J1815,HCPCS,Facility,Inpatient,3 mL,mL,,225,191.25,64.485,225,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
INSULIN NPH ISOPH U-100 HUMAN 100 UNIT/ML SUBQ SUSP,,J1815,HCPCS,Facility,Outpatient,3 mL,mL,,225,191.25,64.485,225,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),113.5575,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
INSULIN NPH ISOPH U-100 HUMAN 100 UNIT/ML SUBQ SUSP,,J1815,HCPCS,Facility,Inpatient,3 mL,mL,,225,191.25,64.485,225,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
INSULIN NPH ISOPH U-100 HUMAN 100 UNIT/ML SUBQ SUSP,,J1815,HCPCS,Facility,Both,3 mL,mL,,225,191.25,64.485,225,UnitedHealthcare,Individual & Family,211.5,94,,percent of total billed charges,,
INSULIN NPH ISOPH U-100 HUMAN 100 UNIT/ML SUBQ SUSP,,J1815,HCPCS,Facility,Outpatient,3 mL,mL,,225,191.25,64.485,225,UnitedHealthcare,Medicare Advantage,110.25,49,,percent of total billed charges,,
INSULIN NPH ISOPH U-100 HUMAN 100 UNIT/ML SUBQ SUSP,,J1815,HCPCS,Facility,Inpatient,3 mL,mL,,225,191.25,64.485,225,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
INSULIN NPH ISOPH U-100 HUMAN 100 UNIT/ML SUBQ SUSP,,J1815,HCPCS,Facility,Outpatient,3 mL,mL,,225,191.25,64.485,225,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,108,48,,percent of total billed charges,,100% of DHS outpatient percentage
INSULIN NPH ISOPH U-100 HUMAN 100 UNIT/ML SUBQ SUSP,,J1815,HCPCS,Facility,Inpatient,3 mL,mL,,225,191.25,64.485,225,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
INSULIN REGULAR HUMAN 100 UNIT/ML INJ SOLN,,J1815,HCPCS,Facility,Both,3 mL,mL,,225,191.25,64.485,225,Aetna,Commercial,207,92,,percent of total billed charges,,
INSULIN REGULAR HUMAN 100 UNIT/ML INJ SOLN,,J1815,HCPCS,Facility,Outpatient,3 mL,mL,,225,191.25,64.485,225,Aetna,Medicare Advantage,110.25,49,,percent of total billed charges,,
INSULIN REGULAR HUMAN 100 UNIT/ML INJ SOLN,,J1815,HCPCS,Facility,Inpatient,3 mL,mL,,225,191.25,64.485,225,Aetna,Medicare Advantage,,,,,Included in per diem rate,
INSULIN REGULAR HUMAN 100 UNIT/ML INJ SOLN,,J1815,HCPCS,Facility,Both,3 mL,mL,,225,191.25,64.485,225,Aetna,PPO,209.25,93,,percent of total billed charges,,
INSULIN REGULAR HUMAN 100 UNIT/ML INJ SOLN,,J1815,HCPCS,Facility,Both,3 mL,mL,,225,191.25,64.485,225,America's PPO,America's PPO,216.0675,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
INSULIN REGULAR HUMAN 100 UNIT/ML INJ SOLN,,J1815,HCPCS,Facility,Both,3 mL,mL,,225,191.25,64.485,225,BlueCross BlueShield Minnesota, Federal Employee Program,221.4,98.4,,percent of total billed charges,,
INSULIN REGULAR HUMAN 100 UNIT/ML INJ SOLN,,J1815,HCPCS,Facility,Both,3 mL,mL,,225,191.25,64.485,225,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,225,100,,percent of total billed charges,,
INSULIN REGULAR HUMAN 100 UNIT/ML INJ SOLN,,J1815,HCPCS,Facility,Both,3 mL,mL,,225,191.25,64.485,225,BlueCross BlueShield Minnesota,High Value Network Plan,202.5,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
INSULIN REGULAR HUMAN 100 UNIT/ML INJ SOLN,,J1815,HCPCS,Facility,Outpatient,3 mL,mL,,225,191.25,64.485,225,BlueCross BlueShield Minnesota,Medicare Advantage,110.25,49,,percent of total billed charges,,
INSULIN REGULAR HUMAN 100 UNIT/ML INJ SOLN,,J1815,HCPCS,Facility,Inpatient,3 mL,mL,,225,191.25,64.485,225,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
INSULIN REGULAR HUMAN 100 UNIT/ML INJ SOLN,,J1815,HCPCS,Facility,Both,3 mL,mL,,225,191.25,64.485,225,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,199.2825,88.57,,percent of total billed charges,,
INSULIN REGULAR HUMAN 100 UNIT/ML INJ SOLN,,J1815,HCPCS,Facility,Both,3 mL,mL,,225,191.25,64.485,225,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,64.485,28.66,,percent of total billed charges,,
INSULIN REGULAR HUMAN 100 UNIT/ML INJ SOLN,,J1815,HCPCS,Facility,Outpatient,3 mL,mL,,225,191.25,64.485,225,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),110.25,49,,percent of total billed charges,,
INSULIN REGULAR HUMAN 100 UNIT/ML INJ SOLN,,J1815,HCPCS,Facility,Inpatient,3 mL,mL,,225,191.25,64.485,225,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
INSULIN REGULAR HUMAN 100 UNIT/ML INJ SOLN,,J1815,HCPCS,Facility,Both,3 mL,mL,,225,191.25,64.485,225,CorVel,Worker's Compensation,225,100,,percent of total billed charges,,
INSULIN REGULAR HUMAN 100 UNIT/ML INJ SOLN,,J1815,HCPCS,Facility,Both,3 mL,mL,,225,191.25,64.485,225,First Health Group Corporation,First Health Network,218.25,97,,percent of total billed charges,,
INSULIN REGULAR HUMAN 100 UNIT/ML INJ SOLN,,J1815,HCPCS,Facility,Both,3 mL,mL,,225,191.25,64.485,225,"Health Partners, Inc.",Commercial,212.85,94.6,,percent of total billed charges,,
INSULIN REGULAR HUMAN 100 UNIT/ML INJ SOLN,,J1815,HCPCS,Facility,Outpatient,3 mL,mL,,225,191.25,64.485,225,"Health Partners, Inc.",Medicare Advantage,110.25,49,,percent of total billed charges,,
INSULIN REGULAR HUMAN 100 UNIT/ML INJ SOLN,,J1815,HCPCS,Facility,Inpatient,3 mL,mL,,225,191.25,64.485,225,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
INSULIN REGULAR HUMAN 100 UNIT/ML INJ SOLN,,J1815,HCPCS,Facility,Both,3 mL,mL,,225,191.25,64.485,225,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),135,60,,percent of total billed charges,,
INSULIN REGULAR HUMAN 100 UNIT/ML INJ SOLN,,J1815,HCPCS,Facility,Both,3 mL,mL,,225,191.25,64.485,225,"Health Partners, Inc.",State of Minnesota Advantage Program,183.375,81.5,,percent of total billed charges,,
INSULIN REGULAR HUMAN 100 UNIT/ML INJ SOLN,,J1815,HCPCS,Facility,Both,3 mL,mL,,225,191.25,64.485,225,"Health Partners, Inc.",State Public Programs,112.5,50,,percent of total billed charges,,
INSULIN REGULAR HUMAN 100 UNIT/ML INJ SOLN,,J1815,HCPCS,Facility,Both,3 mL,mL,,225,191.25,64.485,225,Humana Insurance Company,Commercial PPO,213.75,95,,percent of total billed charges,,
INSULIN REGULAR HUMAN 100 UNIT/ML INJ SOLN,,J1815,HCPCS,Facility,Outpatient,3 mL,mL,,225,191.25,64.485,225,Humana Insurance Company,Medicare PPO,110.25,49,,percent of total billed charges,,
INSULIN REGULAR HUMAN 100 UNIT/ML INJ SOLN,,J1815,HCPCS,Facility,Inpatient,3 mL,mL,,225,191.25,64.485,225,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
INSULIN REGULAR HUMAN 100 UNIT/ML INJ SOLN,,J1815,HCPCS,Facility,Both,3 mL,mL,,225,191.25,64.485,225,Medica,Individual & Family,222.975,99.1,,percent of total billed charges,,
INSULIN REGULAR HUMAN 100 UNIT/ML INJ SOLN,,J1815,HCPCS,Facility,Outpatient,3 mL,mL,,225,191.25,64.485,225,Medica,Medica Advantage Solution,112.05,49.8,,percent of total billed charges,,
INSULIN REGULAR HUMAN 100 UNIT/ML INJ SOLN,,J1815,HCPCS,Facility,Inpatient,3 mL,mL,,225,191.25,64.485,225,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
INSULIN REGULAR HUMAN 100 UNIT/ML INJ SOLN,,J1815,HCPCS,Facility,Outpatient,3 mL,mL,,225,191.25,64.485,225,Medica,Medical Assistance,100.35,44.6,,percent of total billed charges,,
INSULIN REGULAR HUMAN 100 UNIT/ML INJ SOLN,,J1815,HCPCS,Facility,Inpatient,3 mL,mL,,225,191.25,64.485,225,Medica,Medical Assistance,,,,,Included in per diem rate,
INSULIN REGULAR HUMAN 100 UNIT/ML INJ SOLN,,J1815,HCPCS,Facility,Outpatient,3 mL,mL,,225,191.25,64.485,225,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,112.05,49.8,,percent of total billed charges,,
INSULIN REGULAR HUMAN 100 UNIT/ML INJ SOLN,,J1815,HCPCS,Facility,Inpatient,3 mL,mL,,225,191.25,64.485,225,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
INSULIN REGULAR HUMAN 100 UNIT/ML INJ SOLN,,J1815,HCPCS,Facility,Both,3 mL,mL,,225,191.25,64.485,225,"Multiplan, Inc.","Multiplan, Inc.",211.5,94,,percent of total billed charges,,
INSULIN REGULAR HUMAN 100 UNIT/ML INJ SOLN,,J1815,HCPCS,Facility,Outpatient,3 mL,mL,,225,191.25,64.485,225,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,202.725,90.1,,percent of total billed charges,,
INSULIN REGULAR HUMAN 100 UNIT/ML INJ SOLN,,J1815,HCPCS,Facility,Inpatient,3 mL,mL,,225,191.25,64.485,225,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
INSULIN REGULAR HUMAN 100 UNIT/ML INJ SOLN,,J1815,HCPCS,Facility,Both,3 mL,mL,,225,191.25,64.485,225,"Preferred One Administrative Services, INC.",PPO,221.85,98.6,,percent of total billed charges,,
INSULIN REGULAR HUMAN 100 UNIT/ML INJ SOLN,,J1815,HCPCS,Facility,Outpatient,3 mL,mL,,225,191.25,64.485,225,PrimeWest Health,Minnesota Senior Health Options (MSHO),115.7625,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
INSULIN REGULAR HUMAN 100 UNIT/ML INJ SOLN,,J1815,HCPCS,Facility,Inpatient,3 mL,mL,,225,191.25,64.485,225,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
INSULIN REGULAR HUMAN 100 UNIT/ML INJ SOLN,,J1815,HCPCS,Facility,Outpatient,3 mL,mL,,225,191.25,64.485,225,PrimeWest Health,MinnesotaCare,115.56,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
INSULIN REGULAR HUMAN 100 UNIT/ML INJ SOLN,,J1815,HCPCS,Facility,Inpatient,3 mL,mL,,225,191.25,64.485,225,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
INSULIN REGULAR HUMAN 100 UNIT/ML INJ SOLN,,J1815,HCPCS,Facility,Both,3 mL,mL,,225,191.25,64.485,225,Sanford Health Plan,Sanford Health Plan,207,92,,percent of total billed charges,,
INSULIN REGULAR HUMAN 100 UNIT/ML INJ SOLN,,J1815,HCPCS,Facility,Outpatient,3 mL,mL,,225,191.25,64.485,225,"UCare Health, Inc.",Individual & Family Plan,126.7875,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
INSULIN REGULAR HUMAN 100 UNIT/ML INJ SOLN,,J1815,HCPCS,Facility,Inpatient,3 mL,mL,,225,191.25,64.485,225,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
INSULIN REGULAR HUMAN 100 UNIT/ML INJ SOLN,,J1815,HCPCS,Facility,Outpatient,3 mL,mL,,225,191.25,64.485,225,"UCare Health, Inc.",Medical Assistance,113.5575,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
INSULIN REGULAR HUMAN 100 UNIT/ML INJ SOLN,,J1815,HCPCS,Facility,Inpatient,3 mL,mL,,225,191.25,64.485,225,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
INSULIN REGULAR HUMAN 100 UNIT/ML INJ SOLN,,J1815,HCPCS,Facility,Outpatient,3 mL,mL,,225,191.25,64.485,225,"UCare Health, Inc.",Medicare Advantage,113.5575,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
INSULIN REGULAR HUMAN 100 UNIT/ML INJ SOLN,,J1815,HCPCS,Facility,Inpatient,3 mL,mL,,225,191.25,64.485,225,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
INSULIN REGULAR HUMAN 100 UNIT/ML INJ SOLN,,J1815,HCPCS,Facility,Outpatient,3 mL,mL,,225,191.25,64.485,225,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),113.5575,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
INSULIN REGULAR HUMAN 100 UNIT/ML INJ SOLN,,J1815,HCPCS,Facility,Inpatient,3 mL,mL,,225,191.25,64.485,225,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
INSULIN REGULAR HUMAN 100 UNIT/ML INJ SOLN,,J1815,HCPCS,Facility,Both,3 mL,mL,,225,191.25,64.485,225,UnitedHealthcare,Individual & Family,211.5,94,,percent of total billed charges,,
INSULIN REGULAR HUMAN 100 UNIT/ML INJ SOLN,,J1815,HCPCS,Facility,Outpatient,3 mL,mL,,225,191.25,64.485,225,UnitedHealthcare,Medicare Advantage,110.25,49,,percent of total billed charges,,
INSULIN REGULAR HUMAN 100 UNIT/ML INJ SOLN,,J1815,HCPCS,Facility,Inpatient,3 mL,mL,,225,191.25,64.485,225,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
INSULIN REGULAR HUMAN 100 UNIT/ML INJ SOLN,,J1815,HCPCS,Facility,Outpatient,3 mL,mL,,225,191.25,64.485,225,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,108,48,,percent of total billed charges,,100% of DHS outpatient percentage
INSULIN REGULAR HUMAN 100 UNIT/ML INJ SOLN,,J1815,HCPCS,Facility,Inpatient,3 mL,mL,,225,191.25,64.485,225,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
ALBUTEROL SULFATE 1.25 MG/3 ML INHL NEBU,,J7613,HCPCS,Facility,Both,3 mL,mL,,9,7.65,2.5794,9,Aetna,Commercial,8.28,92,,percent of total billed charges,,
ALBUTEROL SULFATE 1.25 MG/3 ML INHL NEBU,,J7613,HCPCS,Facility,Outpatient,3 mL,mL,,9,7.65,2.5794,9,Aetna,Medicare Advantage,4.41,49,,percent of total billed charges,,
ALBUTEROL SULFATE 1.25 MG/3 ML INHL NEBU,,J7613,HCPCS,Facility,Inpatient,3 mL,mL,,9,7.65,2.5794,9,Aetna,Medicare Advantage,,,,,Included in per diem rate,
ALBUTEROL SULFATE 1.25 MG/3 ML INHL NEBU,,J7613,HCPCS,Facility,Both,3 mL,mL,,9,7.65,2.5794,9,Aetna,PPO,8.37,93,,percent of total billed charges,,
ALBUTEROL SULFATE 1.25 MG/3 ML INHL NEBU,,J7613,HCPCS,Facility,Both,3 mL,mL,,9,7.65,2.5794,9,America's PPO,America's PPO,8.6427,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
ALBUTEROL SULFATE 1.25 MG/3 ML INHL NEBU,,J7613,HCPCS,Facility,Both,3 mL,mL,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota, Federal Employee Program,8.856,98.4,,percent of total billed charges,,
ALBUTEROL SULFATE 1.25 MG/3 ML INHL NEBU,,J7613,HCPCS,Facility,Both,3 mL,mL,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,9,100,,percent of total billed charges,,
ALBUTEROL SULFATE 1.25 MG/3 ML INHL NEBU,,J7613,HCPCS,Facility,Both,3 mL,mL,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota,High Value Network Plan,8.1,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
ALBUTEROL SULFATE 1.25 MG/3 ML INHL NEBU,,J7613,HCPCS,Facility,Outpatient,3 mL,mL,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota,Medicare Advantage,4.41,49,,percent of total billed charges,,
ALBUTEROL SULFATE 1.25 MG/3 ML INHL NEBU,,J7613,HCPCS,Facility,Inpatient,3 mL,mL,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
ALBUTEROL SULFATE 1.25 MG/3 ML INHL NEBU,,J7613,HCPCS,Facility,Both,3 mL,mL,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,7.9713,88.57,,percent of total billed charges,,
ALBUTEROL SULFATE 1.25 MG/3 ML INHL NEBU,,J7613,HCPCS,Facility,Both,3 mL,mL,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,2.5794,28.66,,percent of total billed charges,,
ALBUTEROL SULFATE 1.25 MG/3 ML INHL NEBU,,J7613,HCPCS,Facility,Outpatient,3 mL,mL,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),4.41,49,,percent of total billed charges,,
ALBUTEROL SULFATE 1.25 MG/3 ML INHL NEBU,,J7613,HCPCS,Facility,Inpatient,3 mL,mL,,9,7.65,2.5794,9,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
ALBUTEROL SULFATE 1.25 MG/3 ML INHL NEBU,,J7613,HCPCS,Facility,Both,3 mL,mL,,9,7.65,2.5794,9,CorVel,Worker's Compensation,9,100,,percent of total billed charges,,
ALBUTEROL SULFATE 1.25 MG/3 ML INHL NEBU,,J7613,HCPCS,Facility,Both,3 mL,mL,,9,7.65,2.5794,9,First Health Group Corporation,First Health Network,8.73,97,,percent of total billed charges,,
ALBUTEROL SULFATE 1.25 MG/3 ML INHL NEBU,,J7613,HCPCS,Facility,Both,3 mL,mL,,9,7.65,2.5794,9,"Health Partners, Inc.",Commercial,8.514,94.6,,percent of total billed charges,,
ALBUTEROL SULFATE 1.25 MG/3 ML INHL NEBU,,J7613,HCPCS,Facility,Outpatient,3 mL,mL,,9,7.65,2.5794,9,"Health Partners, Inc.",Medicare Advantage,4.41,49,,percent of total billed charges,,
ALBUTEROL SULFATE 1.25 MG/3 ML INHL NEBU,,J7613,HCPCS,Facility,Inpatient,3 mL,mL,,9,7.65,2.5794,9,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ALBUTEROL SULFATE 1.25 MG/3 ML INHL NEBU,,J7613,HCPCS,Facility,Both,3 mL,mL,,9,7.65,2.5794,9,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),5.4,60,,percent of total billed charges,,
ALBUTEROL SULFATE 1.25 MG/3 ML INHL NEBU,,J7613,HCPCS,Facility,Both,3 mL,mL,,9,7.65,2.5794,9,"Health Partners, Inc.",State of Minnesota Advantage Program,7.335,81.5,,percent of total billed charges,,
ALBUTEROL SULFATE 1.25 MG/3 ML INHL NEBU,,J7613,HCPCS,Facility,Both,3 mL,mL,,9,7.65,2.5794,9,"Health Partners, Inc.",State Public Programs,4.5,50,,percent of total billed charges,,
ALBUTEROL SULFATE 1.25 MG/3 ML INHL NEBU,,J7613,HCPCS,Facility,Both,3 mL,mL,,9,7.65,2.5794,9,Humana Insurance Company,Commercial PPO,8.55,95,,percent of total billed charges,,
ALBUTEROL SULFATE 1.25 MG/3 ML INHL NEBU,,J7613,HCPCS,Facility,Outpatient,3 mL,mL,,9,7.65,2.5794,9,Humana Insurance Company,Medicare PPO,4.41,49,,percent of total billed charges,,
ALBUTEROL SULFATE 1.25 MG/3 ML INHL NEBU,,J7613,HCPCS,Facility,Inpatient,3 mL,mL,,9,7.65,2.5794,9,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
ALBUTEROL SULFATE 1.25 MG/3 ML INHL NEBU,,J7613,HCPCS,Facility,Both,3 mL,mL,,9,7.65,2.5794,9,Medica,Individual & Family,8.919,99.1,,percent of total billed charges,,
ALBUTEROL SULFATE 1.25 MG/3 ML INHL NEBU,,J7613,HCPCS,Facility,Outpatient,3 mL,mL,,9,7.65,2.5794,9,Medica,Medica Advantage Solution,4.482,49.8,,percent of total billed charges,,
ALBUTEROL SULFATE 1.25 MG/3 ML INHL NEBU,,J7613,HCPCS,Facility,Inpatient,3 mL,mL,,9,7.65,2.5794,9,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
ALBUTEROL SULFATE 1.25 MG/3 ML INHL NEBU,,J7613,HCPCS,Facility,Outpatient,3 mL,mL,,9,7.65,2.5794,9,Medica,Medical Assistance,4.014,44.6,,percent of total billed charges,,
ALBUTEROL SULFATE 1.25 MG/3 ML INHL NEBU,,J7613,HCPCS,Facility,Inpatient,3 mL,mL,,9,7.65,2.5794,9,Medica,Medical Assistance,,,,,Included in per diem rate,
ALBUTEROL SULFATE 1.25 MG/3 ML INHL NEBU,,J7613,HCPCS,Facility,Outpatient,3 mL,mL,,9,7.65,2.5794,9,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,4.482,49.8,,percent of total billed charges,,
ALBUTEROL SULFATE 1.25 MG/3 ML INHL NEBU,,J7613,HCPCS,Facility,Inpatient,3 mL,mL,,9,7.65,2.5794,9,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
ALBUTEROL SULFATE 1.25 MG/3 ML INHL NEBU,,J7613,HCPCS,Facility,Both,3 mL,mL,,9,7.65,2.5794,9,"Multiplan, Inc.","Multiplan, Inc.",8.46,94,,percent of total billed charges,,
ALBUTEROL SULFATE 1.25 MG/3 ML INHL NEBU,,J7613,HCPCS,Facility,Outpatient,3 mL,mL,,9,7.65,2.5794,9,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,8.109,90.1,,percent of total billed charges,,
ALBUTEROL SULFATE 1.25 MG/3 ML INHL NEBU,,J7613,HCPCS,Facility,Inpatient,3 mL,mL,,9,7.65,2.5794,9,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
ALBUTEROL SULFATE 1.25 MG/3 ML INHL NEBU,,J7613,HCPCS,Facility,Both,3 mL,mL,,9,7.65,2.5794,9,"Preferred One Administrative Services, INC.",PPO,8.874,98.6,,percent of total billed charges,,
ALBUTEROL SULFATE 1.25 MG/3 ML INHL NEBU,,J7613,HCPCS,Facility,Outpatient,3 mL,mL,,9,7.65,2.5794,9,PrimeWest Health,Minnesota Senior Health Options (MSHO),4.6305,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
ALBUTEROL SULFATE 1.25 MG/3 ML INHL NEBU,,J7613,HCPCS,Facility,Inpatient,3 mL,mL,,9,7.65,2.5794,9,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ALBUTEROL SULFATE 1.25 MG/3 ML INHL NEBU,,J7613,HCPCS,Facility,Outpatient,3 mL,mL,,9,7.65,2.5794,9,PrimeWest Health,MinnesotaCare,4.6224,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
ALBUTEROL SULFATE 1.25 MG/3 ML INHL NEBU,,J7613,HCPCS,Facility,Inpatient,3 mL,mL,,9,7.65,2.5794,9,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
ALBUTEROL SULFATE 1.25 MG/3 ML INHL NEBU,,J7613,HCPCS,Facility,Both,3 mL,mL,,9,7.65,2.5794,9,Sanford Health Plan,Sanford Health Plan,8.28,92,,percent of total billed charges,,
ALBUTEROL SULFATE 1.25 MG/3 ML INHL NEBU,,J7613,HCPCS,Facility,Outpatient,3 mL,mL,,9,7.65,2.5794,9,"UCare Health, Inc.",Individual & Family Plan,5.0715,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
ALBUTEROL SULFATE 1.25 MG/3 ML INHL NEBU,,J7613,HCPCS,Facility,Inpatient,3 mL,mL,,9,7.65,2.5794,9,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
ALBUTEROL SULFATE 1.25 MG/3 ML INHL NEBU,,J7613,HCPCS,Facility,Outpatient,3 mL,mL,,9,7.65,2.5794,9,"UCare Health, Inc.",Medical Assistance,4.5423,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ALBUTEROL SULFATE 1.25 MG/3 ML INHL NEBU,,J7613,HCPCS,Facility,Inpatient,3 mL,mL,,9,7.65,2.5794,9,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
ALBUTEROL SULFATE 1.25 MG/3 ML INHL NEBU,,J7613,HCPCS,Facility,Outpatient,3 mL,mL,,9,7.65,2.5794,9,"UCare Health, Inc.",Medicare Advantage,4.5423,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ALBUTEROL SULFATE 1.25 MG/3 ML INHL NEBU,,J7613,HCPCS,Facility,Inpatient,3 mL,mL,,9,7.65,2.5794,9,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ALBUTEROL SULFATE 1.25 MG/3 ML INHL NEBU,,J7613,HCPCS,Facility,Outpatient,3 mL,mL,,9,7.65,2.5794,9,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),4.5423,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ALBUTEROL SULFATE 1.25 MG/3 ML INHL NEBU,,J7613,HCPCS,Facility,Inpatient,3 mL,mL,,9,7.65,2.5794,9,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ALBUTEROL SULFATE 1.25 MG/3 ML INHL NEBU,,J7613,HCPCS,Facility,Both,3 mL,mL,,9,7.65,2.5794,9,UnitedHealthcare,Individual & Family,8.46,94,,percent of total billed charges,,
ALBUTEROL SULFATE 1.25 MG/3 ML INHL NEBU,,J7613,HCPCS,Facility,Outpatient,3 mL,mL,,9,7.65,2.5794,9,UnitedHealthcare,Medicare Advantage,4.41,49,,percent of total billed charges,,
ALBUTEROL SULFATE 1.25 MG/3 ML INHL NEBU,,J7613,HCPCS,Facility,Inpatient,3 mL,mL,,9,7.65,2.5794,9,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
ALBUTEROL SULFATE 1.25 MG/3 ML INHL NEBU,,J7613,HCPCS,Facility,Outpatient,3 mL,mL,,9,7.65,2.5794,9,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,4.32,48,,percent of total billed charges,,100% of DHS outpatient percentage
ALBUTEROL SULFATE 1.25 MG/3 ML INHL NEBU,,J7613,HCPCS,Facility,Inpatient,3 mL,mL,,9,7.65,2.5794,9,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
ALBUTEROL SULFATE 2.5 MG /3 ML (0.083 %) INHL NEBU,,J7613,HCPCS,Facility,Both,3 mL,mL,,7,5.95,2.0062,7,Aetna,Commercial,6.44,92,,percent of total billed charges,,
ALBUTEROL SULFATE 2.5 MG /3 ML (0.083 %) INHL NEBU,,J7613,HCPCS,Facility,Outpatient,3 mL,mL,,7,5.95,2.0062,7,Aetna,Medicare Advantage,3.43,49,,percent of total billed charges,,
ALBUTEROL SULFATE 2.5 MG /3 ML (0.083 %) INHL NEBU,,J7613,HCPCS,Facility,Inpatient,3 mL,mL,,7,5.95,2.0062,7,Aetna,Medicare Advantage,,,,,Included in per diem rate,
ALBUTEROL SULFATE 2.5 MG /3 ML (0.083 %) INHL NEBU,,J7613,HCPCS,Facility,Both,3 mL,mL,,7,5.95,2.0062,7,Aetna,PPO,6.51,93,,percent of total billed charges,,
ALBUTEROL SULFATE 2.5 MG /3 ML (0.083 %) INHL NEBU,,J7613,HCPCS,Facility,Both,3 mL,mL,,7,5.95,2.0062,7,America's PPO,America's PPO,6.7221,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
ALBUTEROL SULFATE 2.5 MG /3 ML (0.083 %) INHL NEBU,,J7613,HCPCS,Facility,Both,3 mL,mL,,7,5.95,2.0062,7,BlueCross BlueShield Minnesota, Federal Employee Program,6.888,98.4,,percent of total billed charges,,
ALBUTEROL SULFATE 2.5 MG /3 ML (0.083 %) INHL NEBU,,J7613,HCPCS,Facility,Both,3 mL,mL,,7,5.95,2.0062,7,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,7,100,,percent of total billed charges,,
ALBUTEROL SULFATE 2.5 MG /3 ML (0.083 %) INHL NEBU,,J7613,HCPCS,Facility,Both,3 mL,mL,,7,5.95,2.0062,7,BlueCross BlueShield Minnesota,High Value Network Plan,6.3,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
ALBUTEROL SULFATE 2.5 MG /3 ML (0.083 %) INHL NEBU,,J7613,HCPCS,Facility,Outpatient,3 mL,mL,,7,5.95,2.0062,7,BlueCross BlueShield Minnesota,Medicare Advantage,3.43,49,,percent of total billed charges,,
ALBUTEROL SULFATE 2.5 MG /3 ML (0.083 %) INHL NEBU,,J7613,HCPCS,Facility,Inpatient,3 mL,mL,,7,5.95,2.0062,7,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
ALBUTEROL SULFATE 2.5 MG /3 ML (0.083 %) INHL NEBU,,J7613,HCPCS,Facility,Both,3 mL,mL,,7,5.95,2.0062,7,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,6.1999,88.57,,percent of total billed charges,,
ALBUTEROL SULFATE 2.5 MG /3 ML (0.083 %) INHL NEBU,,J7613,HCPCS,Facility,Both,3 mL,mL,,7,5.95,2.0062,7,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,2.0062,28.66,,percent of total billed charges,,
ALBUTEROL SULFATE 2.5 MG /3 ML (0.083 %) INHL NEBU,,J7613,HCPCS,Facility,Outpatient,3 mL,mL,,7,5.95,2.0062,7,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),3.43,49,,percent of total billed charges,,
ALBUTEROL SULFATE 2.5 MG /3 ML (0.083 %) INHL NEBU,,J7613,HCPCS,Facility,Inpatient,3 mL,mL,,7,5.95,2.0062,7,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
ALBUTEROL SULFATE 2.5 MG /3 ML (0.083 %) INHL NEBU,,J7613,HCPCS,Facility,Both,3 mL,mL,,7,5.95,2.0062,7,CorVel,Worker's Compensation,7,100,,percent of total billed charges,,
ALBUTEROL SULFATE 2.5 MG /3 ML (0.083 %) INHL NEBU,,J7613,HCPCS,Facility,Both,3 mL,mL,,7,5.95,2.0062,7,First Health Group Corporation,First Health Network,6.79,97,,percent of total billed charges,,
ALBUTEROL SULFATE 2.5 MG /3 ML (0.083 %) INHL NEBU,,J7613,HCPCS,Facility,Both,3 mL,mL,,7,5.95,2.0062,7,"Health Partners, Inc.",Commercial,6.622,94.6,,percent of total billed charges,,
ALBUTEROL SULFATE 2.5 MG /3 ML (0.083 %) INHL NEBU,,J7613,HCPCS,Facility,Outpatient,3 mL,mL,,7,5.95,2.0062,7,"Health Partners, Inc.",Medicare Advantage,3.43,49,,percent of total billed charges,,
ALBUTEROL SULFATE 2.5 MG /3 ML (0.083 %) INHL NEBU,,J7613,HCPCS,Facility,Inpatient,3 mL,mL,,7,5.95,2.0062,7,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ALBUTEROL SULFATE 2.5 MG /3 ML (0.083 %) INHL NEBU,,J7613,HCPCS,Facility,Both,3 mL,mL,,7,5.95,2.0062,7,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),4.2,60,,percent of total billed charges,,
ALBUTEROL SULFATE 2.5 MG /3 ML (0.083 %) INHL NEBU,,J7613,HCPCS,Facility,Both,3 mL,mL,,7,5.95,2.0062,7,"Health Partners, Inc.",State of Minnesota Advantage Program,5.705,81.5,,percent of total billed charges,,
ALBUTEROL SULFATE 2.5 MG /3 ML (0.083 %) INHL NEBU,,J7613,HCPCS,Facility,Both,3 mL,mL,,7,5.95,2.0062,7,"Health Partners, Inc.",State Public Programs,3.5,50,,percent of total billed charges,,
ALBUTEROL SULFATE 2.5 MG /3 ML (0.083 %) INHL NEBU,,J7613,HCPCS,Facility,Both,3 mL,mL,,7,5.95,2.0062,7,Humana Insurance Company,Commercial PPO,6.65,95,,percent of total billed charges,,
ALBUTEROL SULFATE 2.5 MG /3 ML (0.083 %) INHL NEBU,,J7613,HCPCS,Facility,Outpatient,3 mL,mL,,7,5.95,2.0062,7,Humana Insurance Company,Medicare PPO,3.43,49,,percent of total billed charges,,
ALBUTEROL SULFATE 2.5 MG /3 ML (0.083 %) INHL NEBU,,J7613,HCPCS,Facility,Inpatient,3 mL,mL,,7,5.95,2.0062,7,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
ALBUTEROL SULFATE 2.5 MG /3 ML (0.083 %) INHL NEBU,,J7613,HCPCS,Facility,Both,3 mL,mL,,7,5.95,2.0062,7,Medica,Individual & Family,6.937,99.1,,percent of total billed charges,,
ALBUTEROL SULFATE 2.5 MG /3 ML (0.083 %) INHL NEBU,,J7613,HCPCS,Facility,Outpatient,3 mL,mL,,7,5.95,2.0062,7,Medica,Medica Advantage Solution,3.486,49.8,,percent of total billed charges,,
ALBUTEROL SULFATE 2.5 MG /3 ML (0.083 %) INHL NEBU,,J7613,HCPCS,Facility,Inpatient,3 mL,mL,,7,5.95,2.0062,7,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
ALBUTEROL SULFATE 2.5 MG /3 ML (0.083 %) INHL NEBU,,J7613,HCPCS,Facility,Outpatient,3 mL,mL,,7,5.95,2.0062,7,Medica,Medical Assistance,3.122,44.6,,percent of total billed charges,,
ALBUTEROL SULFATE 2.5 MG /3 ML (0.083 %) INHL NEBU,,J7613,HCPCS,Facility,Inpatient,3 mL,mL,,7,5.95,2.0062,7,Medica,Medical Assistance,,,,,Included in per diem rate,
ALBUTEROL SULFATE 2.5 MG /3 ML (0.083 %) INHL NEBU,,J7613,HCPCS,Facility,Outpatient,3 mL,mL,,7,5.95,2.0062,7,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,3.486,49.8,,percent of total billed charges,,
ALBUTEROL SULFATE 2.5 MG /3 ML (0.083 %) INHL NEBU,,J7613,HCPCS,Facility,Inpatient,3 mL,mL,,7,5.95,2.0062,7,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
ALBUTEROL SULFATE 2.5 MG /3 ML (0.083 %) INHL NEBU,,J7613,HCPCS,Facility,Both,3 mL,mL,,7,5.95,2.0062,7,"Multiplan, Inc.","Multiplan, Inc.",6.58,94,,percent of total billed charges,,
ALBUTEROL SULFATE 2.5 MG /3 ML (0.083 %) INHL NEBU,,J7613,HCPCS,Facility,Outpatient,3 mL,mL,,7,5.95,2.0062,7,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,6.307,90.1,,percent of total billed charges,,
ALBUTEROL SULFATE 2.5 MG /3 ML (0.083 %) INHL NEBU,,J7613,HCPCS,Facility,Inpatient,3 mL,mL,,7,5.95,2.0062,7,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
ALBUTEROL SULFATE 2.5 MG /3 ML (0.083 %) INHL NEBU,,J7613,HCPCS,Facility,Both,3 mL,mL,,7,5.95,2.0062,7,"Preferred One Administrative Services, INC.",PPO,6.902,98.6,,percent of total billed charges,,
ALBUTEROL SULFATE 2.5 MG /3 ML (0.083 %) INHL NEBU,,J7613,HCPCS,Facility,Outpatient,3 mL,mL,,7,5.95,2.0062,7,PrimeWest Health,Minnesota Senior Health Options (MSHO),3.6015,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
ALBUTEROL SULFATE 2.5 MG /3 ML (0.083 %) INHL NEBU,,J7613,HCPCS,Facility,Inpatient,3 mL,mL,,7,5.95,2.0062,7,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ALBUTEROL SULFATE 2.5 MG /3 ML (0.083 %) INHL NEBU,,J7613,HCPCS,Facility,Outpatient,3 mL,mL,,7,5.95,2.0062,7,PrimeWest Health,MinnesotaCare,3.5952,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
ALBUTEROL SULFATE 2.5 MG /3 ML (0.083 %) INHL NEBU,,J7613,HCPCS,Facility,Inpatient,3 mL,mL,,7,5.95,2.0062,7,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
ALBUTEROL SULFATE 2.5 MG /3 ML (0.083 %) INHL NEBU,,J7613,HCPCS,Facility,Both,3 mL,mL,,7,5.95,2.0062,7,Sanford Health Plan,Sanford Health Plan,6.44,92,,percent of total billed charges,,
ALBUTEROL SULFATE 2.5 MG /3 ML (0.083 %) INHL NEBU,,J7613,HCPCS,Facility,Outpatient,3 mL,mL,,7,5.95,2.0062,7,"UCare Health, Inc.",Individual & Family Plan,3.9445,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
ALBUTEROL SULFATE 2.5 MG /3 ML (0.083 %) INHL NEBU,,J7613,HCPCS,Facility,Inpatient,3 mL,mL,,7,5.95,2.0062,7,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
ALBUTEROL SULFATE 2.5 MG /3 ML (0.083 %) INHL NEBU,,J7613,HCPCS,Facility,Outpatient,3 mL,mL,,7,5.95,2.0062,7,"UCare Health, Inc.",Medical Assistance,3.5329,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ALBUTEROL SULFATE 2.5 MG /3 ML (0.083 %) INHL NEBU,,J7613,HCPCS,Facility,Inpatient,3 mL,mL,,7,5.95,2.0062,7,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
ALBUTEROL SULFATE 2.5 MG /3 ML (0.083 %) INHL NEBU,,J7613,HCPCS,Facility,Outpatient,3 mL,mL,,7,5.95,2.0062,7,"UCare Health, Inc.",Medicare Advantage,3.5329,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ALBUTEROL SULFATE 2.5 MG /3 ML (0.083 %) INHL NEBU,,J7613,HCPCS,Facility,Inpatient,3 mL,mL,,7,5.95,2.0062,7,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ALBUTEROL SULFATE 2.5 MG /3 ML (0.083 %) INHL NEBU,,J7613,HCPCS,Facility,Outpatient,3 mL,mL,,7,5.95,2.0062,7,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),3.5329,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ALBUTEROL SULFATE 2.5 MG /3 ML (0.083 %) INHL NEBU,,J7613,HCPCS,Facility,Inpatient,3 mL,mL,,7,5.95,2.0062,7,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ALBUTEROL SULFATE 2.5 MG /3 ML (0.083 %) INHL NEBU,,J7613,HCPCS,Facility,Both,3 mL,mL,,7,5.95,2.0062,7,UnitedHealthcare,Individual & Family,6.58,94,,percent of total billed charges,,
ALBUTEROL SULFATE 2.5 MG /3 ML (0.083 %) INHL NEBU,,J7613,HCPCS,Facility,Outpatient,3 mL,mL,,7,5.95,2.0062,7,UnitedHealthcare,Medicare Advantage,3.43,49,,percent of total billed charges,,
ALBUTEROL SULFATE 2.5 MG /3 ML (0.083 %) INHL NEBU,,J7613,HCPCS,Facility,Inpatient,3 mL,mL,,7,5.95,2.0062,7,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
ALBUTEROL SULFATE 2.5 MG /3 ML (0.083 %) INHL NEBU,,J7613,HCPCS,Facility,Outpatient,3 mL,mL,,7,5.95,2.0062,7,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,3.36,48,,percent of total billed charges,,100% of DHS outpatient percentage
ALBUTEROL SULFATE 2.5 MG /3 ML (0.083 %) INHL NEBU,,J7613,HCPCS,Facility,Inpatient,3 mL,mL,,7,5.95,2.0062,7,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
IPRATROPIUM-ALBUTEROL 0.5 MG-3 MG(2.5 MG BASE)/3 ML INHL NEBU,,J7620,HCPCS,Facility,Both,3 mL,mL,,12,10.2,3.4392,12,Aetna,Commercial,11.04,92,,percent of total billed charges,,
IPRATROPIUM-ALBUTEROL 0.5 MG-3 MG(2.5 MG BASE)/3 ML INHL NEBU,,J7620,HCPCS,Facility,Outpatient,3 mL,mL,,12,10.2,3.4392,12,Aetna,Medicare Advantage,5.88,49,,percent of total billed charges,,
IPRATROPIUM-ALBUTEROL 0.5 MG-3 MG(2.5 MG BASE)/3 ML INHL NEBU,,J7620,HCPCS,Facility,Inpatient,3 mL,mL,,12,10.2,3.4392,12,Aetna,Medicare Advantage,,,,,Included in per diem rate,
IPRATROPIUM-ALBUTEROL 0.5 MG-3 MG(2.5 MG BASE)/3 ML INHL NEBU,,J7620,HCPCS,Facility,Both,3 mL,mL,,12,10.2,3.4392,12,Aetna,PPO,11.16,93,,percent of total billed charges,,
IPRATROPIUM-ALBUTEROL 0.5 MG-3 MG(2.5 MG BASE)/3 ML INHL NEBU,,J7620,HCPCS,Facility,Both,3 mL,mL,,12,10.2,3.4392,12,America's PPO,America's PPO,11.5236,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
IPRATROPIUM-ALBUTEROL 0.5 MG-3 MG(2.5 MG BASE)/3 ML INHL NEBU,,J7620,HCPCS,Facility,Both,3 mL,mL,,12,10.2,3.4392,12,BlueCross BlueShield Minnesota, Federal Employee Program,11.808,98.4,,percent of total billed charges,,
IPRATROPIUM-ALBUTEROL 0.5 MG-3 MG(2.5 MG BASE)/3 ML INHL NEBU,,J7620,HCPCS,Facility,Both,3 mL,mL,,12,10.2,3.4392,12,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,12,100,,percent of total billed charges,,
IPRATROPIUM-ALBUTEROL 0.5 MG-3 MG(2.5 MG BASE)/3 ML INHL NEBU,,J7620,HCPCS,Facility,Both,3 mL,mL,,12,10.2,3.4392,12,BlueCross BlueShield Minnesota,High Value Network Plan,10.8,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
IPRATROPIUM-ALBUTEROL 0.5 MG-3 MG(2.5 MG BASE)/3 ML INHL NEBU,,J7620,HCPCS,Facility,Outpatient,3 mL,mL,,12,10.2,3.4392,12,BlueCross BlueShield Minnesota,Medicare Advantage,5.88,49,,percent of total billed charges,,
IPRATROPIUM-ALBUTEROL 0.5 MG-3 MG(2.5 MG BASE)/3 ML INHL NEBU,,J7620,HCPCS,Facility,Inpatient,3 mL,mL,,12,10.2,3.4392,12,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
IPRATROPIUM-ALBUTEROL 0.5 MG-3 MG(2.5 MG BASE)/3 ML INHL NEBU,,J7620,HCPCS,Facility,Both,3 mL,mL,,12,10.2,3.4392,12,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,10.6284,88.57,,percent of total billed charges,,
IPRATROPIUM-ALBUTEROL 0.5 MG-3 MG(2.5 MG BASE)/3 ML INHL NEBU,,J7620,HCPCS,Facility,Both,3 mL,mL,,12,10.2,3.4392,12,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,3.4392,28.66,,percent of total billed charges,,
IPRATROPIUM-ALBUTEROL 0.5 MG-3 MG(2.5 MG BASE)/3 ML INHL NEBU,,J7620,HCPCS,Facility,Outpatient,3 mL,mL,,12,10.2,3.4392,12,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),5.88,49,,percent of total billed charges,,
IPRATROPIUM-ALBUTEROL 0.5 MG-3 MG(2.5 MG BASE)/3 ML INHL NEBU,,J7620,HCPCS,Facility,Inpatient,3 mL,mL,,12,10.2,3.4392,12,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
IPRATROPIUM-ALBUTEROL 0.5 MG-3 MG(2.5 MG BASE)/3 ML INHL NEBU,,J7620,HCPCS,Facility,Both,3 mL,mL,,12,10.2,3.4392,12,CorVel,Worker's Compensation,12,100,,percent of total billed charges,,
IPRATROPIUM-ALBUTEROL 0.5 MG-3 MG(2.5 MG BASE)/3 ML INHL NEBU,,J7620,HCPCS,Facility,Both,3 mL,mL,,12,10.2,3.4392,12,First Health Group Corporation,First Health Network,11.64,97,,percent of total billed charges,,
IPRATROPIUM-ALBUTEROL 0.5 MG-3 MG(2.5 MG BASE)/3 ML INHL NEBU,,J7620,HCPCS,Facility,Both,3 mL,mL,,12,10.2,3.4392,12,"Health Partners, Inc.",Commercial,11.352,94.6,,percent of total billed charges,,
IPRATROPIUM-ALBUTEROL 0.5 MG-3 MG(2.5 MG BASE)/3 ML INHL NEBU,,J7620,HCPCS,Facility,Outpatient,3 mL,mL,,12,10.2,3.4392,12,"Health Partners, Inc.",Medicare Advantage,5.88,49,,percent of total billed charges,,
IPRATROPIUM-ALBUTEROL 0.5 MG-3 MG(2.5 MG BASE)/3 ML INHL NEBU,,J7620,HCPCS,Facility,Inpatient,3 mL,mL,,12,10.2,3.4392,12,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
IPRATROPIUM-ALBUTEROL 0.5 MG-3 MG(2.5 MG BASE)/3 ML INHL NEBU,,J7620,HCPCS,Facility,Both,3 mL,mL,,12,10.2,3.4392,12,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),7.2,60,,percent of total billed charges,,
IPRATROPIUM-ALBUTEROL 0.5 MG-3 MG(2.5 MG BASE)/3 ML INHL NEBU,,J7620,HCPCS,Facility,Both,3 mL,mL,,12,10.2,3.4392,12,"Health Partners, Inc.",State of Minnesota Advantage Program,9.78,81.5,,percent of total billed charges,,
IPRATROPIUM-ALBUTEROL 0.5 MG-3 MG(2.5 MG BASE)/3 ML INHL NEBU,,J7620,HCPCS,Facility,Both,3 mL,mL,,12,10.2,3.4392,12,"Health Partners, Inc.",State Public Programs,6,50,,percent of total billed charges,,
IPRATROPIUM-ALBUTEROL 0.5 MG-3 MG(2.5 MG BASE)/3 ML INHL NEBU,,J7620,HCPCS,Facility,Both,3 mL,mL,,12,10.2,3.4392,12,Humana Insurance Company,Commercial PPO,11.4,95,,percent of total billed charges,,
IPRATROPIUM-ALBUTEROL 0.5 MG-3 MG(2.5 MG BASE)/3 ML INHL NEBU,,J7620,HCPCS,Facility,Outpatient,3 mL,mL,,12,10.2,3.4392,12,Humana Insurance Company,Medicare PPO,5.88,49,,percent of total billed charges,,
IPRATROPIUM-ALBUTEROL 0.5 MG-3 MG(2.5 MG BASE)/3 ML INHL NEBU,,J7620,HCPCS,Facility,Inpatient,3 mL,mL,,12,10.2,3.4392,12,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
IPRATROPIUM-ALBUTEROL 0.5 MG-3 MG(2.5 MG BASE)/3 ML INHL NEBU,,J7620,HCPCS,Facility,Both,3 mL,mL,,12,10.2,3.4392,12,Medica,Individual & Family,11.892,99.1,,percent of total billed charges,,
IPRATROPIUM-ALBUTEROL 0.5 MG-3 MG(2.5 MG BASE)/3 ML INHL NEBU,,J7620,HCPCS,Facility,Outpatient,3 mL,mL,,12,10.2,3.4392,12,Medica,Medica Advantage Solution,5.976,49.8,,percent of total billed charges,,
IPRATROPIUM-ALBUTEROL 0.5 MG-3 MG(2.5 MG BASE)/3 ML INHL NEBU,,J7620,HCPCS,Facility,Inpatient,3 mL,mL,,12,10.2,3.4392,12,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
IPRATROPIUM-ALBUTEROL 0.5 MG-3 MG(2.5 MG BASE)/3 ML INHL NEBU,,J7620,HCPCS,Facility,Outpatient,3 mL,mL,,12,10.2,3.4392,12,Medica,Medical Assistance,5.352,44.6,,percent of total billed charges,,
IPRATROPIUM-ALBUTEROL 0.5 MG-3 MG(2.5 MG BASE)/3 ML INHL NEBU,,J7620,HCPCS,Facility,Inpatient,3 mL,mL,,12,10.2,3.4392,12,Medica,Medical Assistance,,,,,Included in per diem rate,
IPRATROPIUM-ALBUTEROL 0.5 MG-3 MG(2.5 MG BASE)/3 ML INHL NEBU,,J7620,HCPCS,Facility,Outpatient,3 mL,mL,,12,10.2,3.4392,12,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,5.976,49.8,,percent of total billed charges,,
IPRATROPIUM-ALBUTEROL 0.5 MG-3 MG(2.5 MG BASE)/3 ML INHL NEBU,,J7620,HCPCS,Facility,Inpatient,3 mL,mL,,12,10.2,3.4392,12,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
IPRATROPIUM-ALBUTEROL 0.5 MG-3 MG(2.5 MG BASE)/3 ML INHL NEBU,,J7620,HCPCS,Facility,Both,3 mL,mL,,12,10.2,3.4392,12,"Multiplan, Inc.","Multiplan, Inc.",11.28,94,,percent of total billed charges,,
IPRATROPIUM-ALBUTEROL 0.5 MG-3 MG(2.5 MG BASE)/3 ML INHL NEBU,,J7620,HCPCS,Facility,Outpatient,3 mL,mL,,12,10.2,3.4392,12,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,10.812,90.1,,percent of total billed charges,,
IPRATROPIUM-ALBUTEROL 0.5 MG-3 MG(2.5 MG BASE)/3 ML INHL NEBU,,J7620,HCPCS,Facility,Inpatient,3 mL,mL,,12,10.2,3.4392,12,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
IPRATROPIUM-ALBUTEROL 0.5 MG-3 MG(2.5 MG BASE)/3 ML INHL NEBU,,J7620,HCPCS,Facility,Both,3 mL,mL,,12,10.2,3.4392,12,"Preferred One Administrative Services, INC.",PPO,11.832,98.6,,percent of total billed charges,,
IPRATROPIUM-ALBUTEROL 0.5 MG-3 MG(2.5 MG BASE)/3 ML INHL NEBU,,J7620,HCPCS,Facility,Outpatient,3 mL,mL,,12,10.2,3.4392,12,PrimeWest Health,Minnesota Senior Health Options (MSHO),6.174,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
IPRATROPIUM-ALBUTEROL 0.5 MG-3 MG(2.5 MG BASE)/3 ML INHL NEBU,,J7620,HCPCS,Facility,Inpatient,3 mL,mL,,12,10.2,3.4392,12,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
IPRATROPIUM-ALBUTEROL 0.5 MG-3 MG(2.5 MG BASE)/3 ML INHL NEBU,,J7620,HCPCS,Facility,Outpatient,3 mL,mL,,12,10.2,3.4392,12,PrimeWest Health,MinnesotaCare,6.1632,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
IPRATROPIUM-ALBUTEROL 0.5 MG-3 MG(2.5 MG BASE)/3 ML INHL NEBU,,J7620,HCPCS,Facility,Inpatient,3 mL,mL,,12,10.2,3.4392,12,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
IPRATROPIUM-ALBUTEROL 0.5 MG-3 MG(2.5 MG BASE)/3 ML INHL NEBU,,J7620,HCPCS,Facility,Both,3 mL,mL,,12,10.2,3.4392,12,Sanford Health Plan,Sanford Health Plan,11.04,92,,percent of total billed charges,,
IPRATROPIUM-ALBUTEROL 0.5 MG-3 MG(2.5 MG BASE)/3 ML INHL NEBU,,J7620,HCPCS,Facility,Outpatient,3 mL,mL,,12,10.2,3.4392,12,"UCare Health, Inc.",Individual & Family Plan,6.762,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
IPRATROPIUM-ALBUTEROL 0.5 MG-3 MG(2.5 MG BASE)/3 ML INHL NEBU,,J7620,HCPCS,Facility,Inpatient,3 mL,mL,,12,10.2,3.4392,12,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
IPRATROPIUM-ALBUTEROL 0.5 MG-3 MG(2.5 MG BASE)/3 ML INHL NEBU,,J7620,HCPCS,Facility,Outpatient,3 mL,mL,,12,10.2,3.4392,12,"UCare Health, Inc.",Medical Assistance,6.0564,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
IPRATROPIUM-ALBUTEROL 0.5 MG-3 MG(2.5 MG BASE)/3 ML INHL NEBU,,J7620,HCPCS,Facility,Inpatient,3 mL,mL,,12,10.2,3.4392,12,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
IPRATROPIUM-ALBUTEROL 0.5 MG-3 MG(2.5 MG BASE)/3 ML INHL NEBU,,J7620,HCPCS,Facility,Outpatient,3 mL,mL,,12,10.2,3.4392,12,"UCare Health, Inc.",Medicare Advantage,6.0564,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
IPRATROPIUM-ALBUTEROL 0.5 MG-3 MG(2.5 MG BASE)/3 ML INHL NEBU,,J7620,HCPCS,Facility,Inpatient,3 mL,mL,,12,10.2,3.4392,12,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
IPRATROPIUM-ALBUTEROL 0.5 MG-3 MG(2.5 MG BASE)/3 ML INHL NEBU,,J7620,HCPCS,Facility,Outpatient,3 mL,mL,,12,10.2,3.4392,12,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),6.0564,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
IPRATROPIUM-ALBUTEROL 0.5 MG-3 MG(2.5 MG BASE)/3 ML INHL NEBU,,J7620,HCPCS,Facility,Inpatient,3 mL,mL,,12,10.2,3.4392,12,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
IPRATROPIUM-ALBUTEROL 0.5 MG-3 MG(2.5 MG BASE)/3 ML INHL NEBU,,J7620,HCPCS,Facility,Both,3 mL,mL,,12,10.2,3.4392,12,UnitedHealthcare,Individual & Family,11.28,94,,percent of total billed charges,,
IPRATROPIUM-ALBUTEROL 0.5 MG-3 MG(2.5 MG BASE)/3 ML INHL NEBU,,J7620,HCPCS,Facility,Outpatient,3 mL,mL,,12,10.2,3.4392,12,UnitedHealthcare,Medicare Advantage,5.88,49,,percent of total billed charges,,
IPRATROPIUM-ALBUTEROL 0.5 MG-3 MG(2.5 MG BASE)/3 ML INHL NEBU,,J7620,HCPCS,Facility,Inpatient,3 mL,mL,,12,10.2,3.4392,12,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
IPRATROPIUM-ALBUTEROL 0.5 MG-3 MG(2.5 MG BASE)/3 ML INHL NEBU,,J7620,HCPCS,Facility,Outpatient,3 mL,mL,,12,10.2,3.4392,12,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,5.76,48,,percent of total billed charges,,100% of DHS outpatient percentage
IPRATROPIUM-ALBUTEROL 0.5 MG-3 MG(2.5 MG BASE)/3 ML INHL NEBU,,J7620,HCPCS,Facility,Inpatient,3 mL,mL,,12,10.2,3.4392,12,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
PERFLUTREN PROTEIN-A MICROSPHR 0.22 MG/ML IV SUSP,,Q9956,HCPCS,Facility,Both,3 mL,mL,,658,559.3,188.5828,658,Aetna,Commercial,605.36,92,,percent of total billed charges,,
PERFLUTREN PROTEIN-A MICROSPHR 0.22 MG/ML IV SUSP,,Q9956,HCPCS,Facility,Outpatient,3 mL,mL,,658,559.3,188.5828,658,Aetna,Medicare Advantage,322.42,49,,percent of total billed charges,,
PERFLUTREN PROTEIN-A MICROSPHR 0.22 MG/ML IV SUSP,,Q9956,HCPCS,Facility,Inpatient,3 mL,mL,,658,559.3,188.5828,658,Aetna,Medicare Advantage,,,,,Included in per diem rate,
PERFLUTREN PROTEIN-A MICROSPHR 0.22 MG/ML IV SUSP,,Q9956,HCPCS,Facility,Both,3 mL,mL,,658,559.3,188.5828,658,Aetna,PPO,611.94,93,,percent of total billed charges,,
PERFLUTREN PROTEIN-A MICROSPHR 0.22 MG/ML IV SUSP,,Q9956,HCPCS,Facility,Both,3 mL,mL,,658,559.3,188.5828,658,America's PPO,America's PPO,631.8774,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
PERFLUTREN PROTEIN-A MICROSPHR 0.22 MG/ML IV SUSP,,Q9956,HCPCS,Facility,Both,3 mL,mL,,658,559.3,188.5828,658,BlueCross BlueShield Minnesota, Federal Employee Program,647.472,98.4,,percent of total billed charges,,
PERFLUTREN PROTEIN-A MICROSPHR 0.22 MG/ML IV SUSP,,Q9956,HCPCS,Facility,Both,3 mL,mL,,658,559.3,188.5828,658,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,658,100,,percent of total billed charges,,
PERFLUTREN PROTEIN-A MICROSPHR 0.22 MG/ML IV SUSP,,Q9956,HCPCS,Facility,Both,3 mL,mL,,658,559.3,188.5828,658,BlueCross BlueShield Minnesota,High Value Network Plan,592.2,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
PERFLUTREN PROTEIN-A MICROSPHR 0.22 MG/ML IV SUSP,,Q9956,HCPCS,Facility,Outpatient,3 mL,mL,,658,559.3,188.5828,658,BlueCross BlueShield Minnesota,Medicare Advantage,322.42,49,,percent of total billed charges,,
PERFLUTREN PROTEIN-A MICROSPHR 0.22 MG/ML IV SUSP,,Q9956,HCPCS,Facility,Inpatient,3 mL,mL,,658,559.3,188.5828,658,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
PERFLUTREN PROTEIN-A MICROSPHR 0.22 MG/ML IV SUSP,,Q9956,HCPCS,Facility,Both,3 mL,mL,,658,559.3,188.5828,658,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,582.7906,88.57,,percent of total billed charges,,
PERFLUTREN PROTEIN-A MICROSPHR 0.22 MG/ML IV SUSP,,Q9956,HCPCS,Facility,Both,3 mL,mL,,658,559.3,188.5828,658,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,188.5828,28.66,,percent of total billed charges,,
PERFLUTREN PROTEIN-A MICROSPHR 0.22 MG/ML IV SUSP,,Q9956,HCPCS,Facility,Outpatient,3 mL,mL,,658,559.3,188.5828,658,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),322.42,49,,percent of total billed charges,,
PERFLUTREN PROTEIN-A MICROSPHR 0.22 MG/ML IV SUSP,,Q9956,HCPCS,Facility,Inpatient,3 mL,mL,,658,559.3,188.5828,658,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
PERFLUTREN PROTEIN-A MICROSPHR 0.22 MG/ML IV SUSP,,Q9956,HCPCS,Facility,Both,3 mL,mL,,658,559.3,188.5828,658,CorVel,Worker's Compensation,658,100,,percent of total billed charges,,
PERFLUTREN PROTEIN-A MICROSPHR 0.22 MG/ML IV SUSP,,Q9956,HCPCS,Facility,Both,3 mL,mL,,658,559.3,188.5828,658,First Health Group Corporation,First Health Network,638.26,97,,percent of total billed charges,,
PERFLUTREN PROTEIN-A MICROSPHR 0.22 MG/ML IV SUSP,,Q9956,HCPCS,Facility,Both,3 mL,mL,,658,559.3,188.5828,658,"Health Partners, Inc.",Commercial,622.468,94.6,,percent of total billed charges,,
PERFLUTREN PROTEIN-A MICROSPHR 0.22 MG/ML IV SUSP,,Q9956,HCPCS,Facility,Outpatient,3 mL,mL,,658,559.3,188.5828,658,"Health Partners, Inc.",Medicare Advantage,322.42,49,,percent of total billed charges,,
PERFLUTREN PROTEIN-A MICROSPHR 0.22 MG/ML IV SUSP,,Q9956,HCPCS,Facility,Inpatient,3 mL,mL,,658,559.3,188.5828,658,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PERFLUTREN PROTEIN-A MICROSPHR 0.22 MG/ML IV SUSP,,Q9956,HCPCS,Facility,Both,3 mL,mL,,658,559.3,188.5828,658,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),394.8,60,,percent of total billed charges,,
PERFLUTREN PROTEIN-A MICROSPHR 0.22 MG/ML IV SUSP,,Q9956,HCPCS,Facility,Both,3 mL,mL,,658,559.3,188.5828,658,"Health Partners, Inc.",State of Minnesota Advantage Program,536.27,81.5,,percent of total billed charges,,
PERFLUTREN PROTEIN-A MICROSPHR 0.22 MG/ML IV SUSP,,Q9956,HCPCS,Facility,Both,3 mL,mL,,658,559.3,188.5828,658,"Health Partners, Inc.",State Public Programs,329,50,,percent of total billed charges,,
PERFLUTREN PROTEIN-A MICROSPHR 0.22 MG/ML IV SUSP,,Q9956,HCPCS,Facility,Both,3 mL,mL,,658,559.3,188.5828,658,Humana Insurance Company,Commercial PPO,625.1,95,,percent of total billed charges,,
PERFLUTREN PROTEIN-A MICROSPHR 0.22 MG/ML IV SUSP,,Q9956,HCPCS,Facility,Outpatient,3 mL,mL,,658,559.3,188.5828,658,Humana Insurance Company,Medicare PPO,322.42,49,,percent of total billed charges,,
PERFLUTREN PROTEIN-A MICROSPHR 0.22 MG/ML IV SUSP,,Q9956,HCPCS,Facility,Inpatient,3 mL,mL,,658,559.3,188.5828,658,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
PERFLUTREN PROTEIN-A MICROSPHR 0.22 MG/ML IV SUSP,,Q9956,HCPCS,Facility,Both,3 mL,mL,,658,559.3,188.5828,658,Medica,Individual & Family,652.078,99.1,,percent of total billed charges,,
PERFLUTREN PROTEIN-A MICROSPHR 0.22 MG/ML IV SUSP,,Q9956,HCPCS,Facility,Outpatient,3 mL,mL,,658,559.3,188.5828,658,Medica,Medica Advantage Solution,327.684,49.8,,percent of total billed charges,,
PERFLUTREN PROTEIN-A MICROSPHR 0.22 MG/ML IV SUSP,,Q9956,HCPCS,Facility,Inpatient,3 mL,mL,,658,559.3,188.5828,658,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
PERFLUTREN PROTEIN-A MICROSPHR 0.22 MG/ML IV SUSP,,Q9956,HCPCS,Facility,Outpatient,3 mL,mL,,658,559.3,188.5828,658,Medica,Medical Assistance,293.468,44.6,,percent of total billed charges,,
PERFLUTREN PROTEIN-A MICROSPHR 0.22 MG/ML IV SUSP,,Q9956,HCPCS,Facility,Inpatient,3 mL,mL,,658,559.3,188.5828,658,Medica,Medical Assistance,,,,,Included in per diem rate,
PERFLUTREN PROTEIN-A MICROSPHR 0.22 MG/ML IV SUSP,,Q9956,HCPCS,Facility,Outpatient,3 mL,mL,,658,559.3,188.5828,658,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,327.684,49.8,,percent of total billed charges,,
PERFLUTREN PROTEIN-A MICROSPHR 0.22 MG/ML IV SUSP,,Q9956,HCPCS,Facility,Inpatient,3 mL,mL,,658,559.3,188.5828,658,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
PERFLUTREN PROTEIN-A MICROSPHR 0.22 MG/ML IV SUSP,,Q9956,HCPCS,Facility,Both,3 mL,mL,,658,559.3,188.5828,658,"Multiplan, Inc.","Multiplan, Inc.",618.52,94,,percent of total billed charges,,
PERFLUTREN PROTEIN-A MICROSPHR 0.22 MG/ML IV SUSP,,Q9956,HCPCS,Facility,Outpatient,3 mL,mL,,658,559.3,188.5828,658,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,592.858,90.1,,percent of total billed charges,,
PERFLUTREN PROTEIN-A MICROSPHR 0.22 MG/ML IV SUSP,,Q9956,HCPCS,Facility,Inpatient,3 mL,mL,,658,559.3,188.5828,658,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
PERFLUTREN PROTEIN-A MICROSPHR 0.22 MG/ML IV SUSP,,Q9956,HCPCS,Facility,Both,3 mL,mL,,658,559.3,188.5828,658,"Preferred One Administrative Services, INC.",PPO,648.788,98.6,,percent of total billed charges,,
PERFLUTREN PROTEIN-A MICROSPHR 0.22 MG/ML IV SUSP,,Q9956,HCPCS,Facility,Outpatient,3 mL,mL,,658,559.3,188.5828,658,PrimeWest Health,Minnesota Senior Health Options (MSHO),338.541,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
PERFLUTREN PROTEIN-A MICROSPHR 0.22 MG/ML IV SUSP,,Q9956,HCPCS,Facility,Inpatient,3 mL,mL,,658,559.3,188.5828,658,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PERFLUTREN PROTEIN-A MICROSPHR 0.22 MG/ML IV SUSP,,Q9956,HCPCS,Facility,Outpatient,3 mL,mL,,658,559.3,188.5828,658,PrimeWest Health,MinnesotaCare,337.9488,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
PERFLUTREN PROTEIN-A MICROSPHR 0.22 MG/ML IV SUSP,,Q9956,HCPCS,Facility,Inpatient,3 mL,mL,,658,559.3,188.5828,658,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
PERFLUTREN PROTEIN-A MICROSPHR 0.22 MG/ML IV SUSP,,Q9956,HCPCS,Facility,Both,3 mL,mL,,658,559.3,188.5828,658,Sanford Health Plan,Sanford Health Plan,605.36,92,,percent of total billed charges,,
PERFLUTREN PROTEIN-A MICROSPHR 0.22 MG/ML IV SUSP,,Q9956,HCPCS,Facility,Outpatient,3 mL,mL,,658,559.3,188.5828,658,"UCare Health, Inc.",Individual & Family Plan,370.783,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
PERFLUTREN PROTEIN-A MICROSPHR 0.22 MG/ML IV SUSP,,Q9956,HCPCS,Facility,Inpatient,3 mL,mL,,658,559.3,188.5828,658,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
PERFLUTREN PROTEIN-A MICROSPHR 0.22 MG/ML IV SUSP,,Q9956,HCPCS,Facility,Outpatient,3 mL,mL,,658,559.3,188.5828,658,"UCare Health, Inc.",Medical Assistance,332.0926,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PERFLUTREN PROTEIN-A MICROSPHR 0.22 MG/ML IV SUSP,,Q9956,HCPCS,Facility,Inpatient,3 mL,mL,,658,559.3,188.5828,658,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
PERFLUTREN PROTEIN-A MICROSPHR 0.22 MG/ML IV SUSP,,Q9956,HCPCS,Facility,Outpatient,3 mL,mL,,658,559.3,188.5828,658,"UCare Health, Inc.",Medicare Advantage,332.0926,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PERFLUTREN PROTEIN-A MICROSPHR 0.22 MG/ML IV SUSP,,Q9956,HCPCS,Facility,Inpatient,3 mL,mL,,658,559.3,188.5828,658,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PERFLUTREN PROTEIN-A MICROSPHR 0.22 MG/ML IV SUSP,,Q9956,HCPCS,Facility,Outpatient,3 mL,mL,,658,559.3,188.5828,658,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),332.0926,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PERFLUTREN PROTEIN-A MICROSPHR 0.22 MG/ML IV SUSP,,Q9956,HCPCS,Facility,Inpatient,3 mL,mL,,658,559.3,188.5828,658,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PERFLUTREN PROTEIN-A MICROSPHR 0.22 MG/ML IV SUSP,,Q9956,HCPCS,Facility,Both,3 mL,mL,,658,559.3,188.5828,658,UnitedHealthcare,Individual & Family,618.52,94,,percent of total billed charges,,
PERFLUTREN PROTEIN-A MICROSPHR 0.22 MG/ML IV SUSP,,Q9956,HCPCS,Facility,Outpatient,3 mL,mL,,658,559.3,188.5828,658,UnitedHealthcare,Medicare Advantage,322.42,49,,percent of total billed charges,,
PERFLUTREN PROTEIN-A MICROSPHR 0.22 MG/ML IV SUSP,,Q9956,HCPCS,Facility,Inpatient,3 mL,mL,,658,559.3,188.5828,658,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
PERFLUTREN PROTEIN-A MICROSPHR 0.22 MG/ML IV SUSP,,Q9956,HCPCS,Facility,Outpatient,3 mL,mL,,658,559.3,188.5828,658,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,315.84,48,,percent of total billed charges,,100% of DHS outpatient percentage
PERFLUTREN PROTEIN-A MICROSPHR 0.22 MG/ML IV SUSP,,Q9956,HCPCS,Facility,Inpatient,3 mL,mL,,658,559.3,188.5828,658,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT OINT,,6400,LOCAL,Facility,Both,3.5 g,g,,1138,967.3,326.1508,1138,Aetna,Commercial,1046.96,92,,percent of total billed charges,,
TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT OINT,,6400,LOCAL,Facility,Outpatient,3.5 g,g,,1138,967.3,326.1508,1138,Aetna,Medicare Advantage,557.62,49,,percent of total billed charges,,
TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT OINT,,6400,LOCAL,Facility,Inpatient,3.5 g,g,,1138,967.3,326.1508,1138,Aetna,Medicare Advantage,,,,,Included in per diem rate,
TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT OINT,,6400,LOCAL,Facility,Both,3.5 g,g,,1138,967.3,326.1508,1138,Aetna,PPO,1058.34,93,,percent of total billed charges,,
TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT OINT,,6400,LOCAL,Facility,Both,3.5 g,g,,1138,967.3,326.1508,1138,America's PPO,America's PPO,1092.8214,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT OINT,,6400,LOCAL,Facility,Both,3.5 g,g,,1138,967.3,326.1508,1138,BlueCross BlueShield Minnesota, Federal Employee Program,1119.792,98.4,,percent of total billed charges,,
TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT OINT,,6400,LOCAL,Facility,Both,3.5 g,g,,1138,967.3,326.1508,1138,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1138,100,,percent of total billed charges,,
TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT OINT,,6400,LOCAL,Facility,Both,3.5 g,g,,1138,967.3,326.1508,1138,BlueCross BlueShield Minnesota,High Value Network Plan,1024.2,90,,percent of total billed charges,,
TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT OINT,,6400,LOCAL,Facility,Outpatient,3.5 g,g,,1138,967.3,326.1508,1138,BlueCross BlueShield Minnesota,Medicare Advantage,557.62,49,,percent of total billed charges,,
TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT OINT,,6400,LOCAL,Facility,Inpatient,3.5 g,g,,1138,967.3,326.1508,1138,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT OINT,,6400,LOCAL,Facility,Both,3.5 g,g,,1138,967.3,326.1508,1138,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1007.9266,88.57,,percent of total billed charges,,
TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT OINT,,6400,LOCAL,Facility,Both,3.5 g,g,,1138,967.3,326.1508,1138,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,326.1508,28.66,,percent of total billed charges,,
TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT OINT,,6400,LOCAL,Facility,Outpatient,3.5 g,g,,1138,967.3,326.1508,1138,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),557.62,49,,percent of total billed charges,,
TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT OINT,,6400,LOCAL,Facility,Inpatient,3.5 g,g,,1138,967.3,326.1508,1138,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT OINT,,6400,LOCAL,Facility,Both,3.5 g,g,,1138,967.3,326.1508,1138,CorVel,Worker's Compensation,1138,100,,percent of total billed charges,,
TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT OINT,,6400,LOCAL,Facility,Both,3.5 g,g,,1138,967.3,326.1508,1138,First Health Group Corporation,First Health Network,1103.86,97,,percent of total billed charges,,
TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT OINT,,6400,LOCAL,Facility,Both,3.5 g,g,,1138,967.3,326.1508,1138,"Health Partners, Inc.",Commercial,1076.548,94.6,,percent of total billed charges,,
TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT OINT,,6400,LOCAL,Facility,Outpatient,3.5 g,g,,1138,967.3,326.1508,1138,"Health Partners, Inc.",Medicare Advantage,557.62,49,,percent of total billed charges,,
TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT OINT,,6400,LOCAL,Facility,Inpatient,3.5 g,g,,1138,967.3,326.1508,1138,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT OINT,,6400,LOCAL,Facility,Both,3.5 g,g,,1138,967.3,326.1508,1138,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),682.8,60,,percent of total billed charges,,
TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT OINT,,6400,LOCAL,Facility,Both,3.5 g,g,,1138,967.3,326.1508,1138,"Health Partners, Inc.",State of Minnesota Advantage Program,927.47,81.5,,percent of total billed charges,,
TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT OINT,,6400,LOCAL,Facility,Both,3.5 g,g,,1138,967.3,326.1508,1138,"Health Partners, Inc.",State Public Programs,569,50,,percent of total billed charges,,
TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT OINT,,6400,LOCAL,Facility,Both,3.5 g,g,,1138,967.3,326.1508,1138,Humana Insurance Company,Commercial PPO,1081.1,95,,percent of total billed charges,,
TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT OINT,,6400,LOCAL,Facility,Outpatient,3.5 g,g,,1138,967.3,326.1508,1138,Humana Insurance Company,Medicare PPO,557.62,49,,percent of total billed charges,,
TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT OINT,,6400,LOCAL,Facility,Inpatient,3.5 g,g,,1138,967.3,326.1508,1138,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT OINT,,6400,LOCAL,Facility,Both,3.5 g,g,,1138,967.3,326.1508,1138,Medica,Individual & Family,1127.758,99.1,,percent of total billed charges,,
TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT OINT,,6400,LOCAL,Facility,Outpatient,3.5 g,g,,1138,967.3,326.1508,1138,Medica,Medica Advantage Solution,566.724,49.8,,percent of total billed charges,,
TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT OINT,,6400,LOCAL,Facility,Inpatient,3.5 g,g,,1138,967.3,326.1508,1138,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT OINT,,6400,LOCAL,Facility,Outpatient,3.5 g,g,,1138,967.3,326.1508,1138,Medica,Medical Assistance,507.548,44.6,,percent of total billed charges,,
TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT OINT,,6400,LOCAL,Facility,Inpatient,3.5 g,g,,1138,967.3,326.1508,1138,Medica,Medical Assistance,,,,,Included in per diem rate,
TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT OINT,,6400,LOCAL,Facility,Outpatient,3.5 g,g,,1138,967.3,326.1508,1138,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,566.724,49.8,,percent of total billed charges,,
TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT OINT,,6400,LOCAL,Facility,Inpatient,3.5 g,g,,1138,967.3,326.1508,1138,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT OINT,,6400,LOCAL,Facility,Both,3.5 g,g,,1138,967.3,326.1508,1138,"Multiplan, Inc.","Multiplan, Inc.",1069.72,94,,percent of total billed charges,,
TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT OINT,,6400,LOCAL,Facility,Outpatient,3.5 g,g,,1138,967.3,326.1508,1138,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1025.338,90.1,,percent of total billed charges,,
TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT OINT,,6400,LOCAL,Facility,Inpatient,3.5 g,g,,1138,967.3,326.1508,1138,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT OINT,,6400,LOCAL,Facility,Both,3.5 g,g,,1138,967.3,326.1508,1138,"Preferred One Administrative Services, INC.",PPO,1122.068,98.6,,percent of total billed charges,,
TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT OINT,,6400,LOCAL,Facility,Outpatient,3.5 g,g,,1138,967.3,326.1508,1138,PrimeWest Health,Minnesota Senior Health Options (MSHO),585.501,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT OINT,,6400,LOCAL,Facility,Inpatient,3.5 g,g,,1138,967.3,326.1508,1138,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT OINT,,6400,LOCAL,Facility,Outpatient,3.5 g,g,,1138,967.3,326.1508,1138,PrimeWest Health,MinnesotaCare,584.4768,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT OINT,,6400,LOCAL,Facility,Inpatient,3.5 g,g,,1138,967.3,326.1508,1138,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT OINT,,6400,LOCAL,Facility,Both,3.5 g,g,,1138,967.3,326.1508,1138,Sanford Health Plan,Sanford Health Plan,1046.96,92,,percent of total billed charges,,
TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT OINT,,6400,LOCAL,Facility,Outpatient,3.5 g,g,,1138,967.3,326.1508,1138,"UCare Health, Inc.",Individual & Family Plan,641.263,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT OINT,,6400,LOCAL,Facility,Inpatient,3.5 g,g,,1138,967.3,326.1508,1138,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT OINT,,6400,LOCAL,Facility,Outpatient,3.5 g,g,,1138,967.3,326.1508,1138,"UCare Health, Inc.",Medical Assistance,574.3486,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT OINT,,6400,LOCAL,Facility,Inpatient,3.5 g,g,,1138,967.3,326.1508,1138,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT OINT,,6400,LOCAL,Facility,Outpatient,3.5 g,g,,1138,967.3,326.1508,1138,"UCare Health, Inc.",Medicare Advantage,574.3486,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT OINT,,6400,LOCAL,Facility,Inpatient,3.5 g,g,,1138,967.3,326.1508,1138,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT OINT,,6400,LOCAL,Facility,Outpatient,3.5 g,g,,1138,967.3,326.1508,1138,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),574.3486,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT OINT,,6400,LOCAL,Facility,Inpatient,3.5 g,g,,1138,967.3,326.1508,1138,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT OINT,,6400,LOCAL,Facility,Both,3.5 g,g,,1138,967.3,326.1508,1138,UnitedHealthcare,Individual & Family,1069.72,94,,percent of total billed charges,,
TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT OINT,,6400,LOCAL,Facility,Outpatient,3.5 g,g,,1138,967.3,326.1508,1138,UnitedHealthcare,Medicare Advantage,557.62,49,,percent of total billed charges,,
TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT OINT,,6400,LOCAL,Facility,Inpatient,3.5 g,g,,1138,967.3,326.1508,1138,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT OINT,,6400,LOCAL,Facility,Outpatient,3.5 g,g,,1138,967.3,326.1508,1138,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,546.24,48,,percent of total billed charges,,100% of DHS outpatient percentage
TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT OINT,,6400,LOCAL,Facility,Inpatient,3.5 g,g,,1138,967.3,326.1508,1138,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
SODIUM CHLORIDE 5 % OPHT OINT,,9844,LOCAL,Facility,Both,3.5 g,g,,59,50.15,16.9094,59,Aetna,Commercial,54.28,92,,percent of total billed charges,,
SODIUM CHLORIDE 5 % OPHT OINT,,9844,LOCAL,Facility,Outpatient,3.5 g,g,,59,50.15,16.9094,59,Aetna,Medicare Advantage,28.91,49,,percent of total billed charges,,
SODIUM CHLORIDE 5 % OPHT OINT,,9844,LOCAL,Facility,Inpatient,3.5 g,g,,59,50.15,16.9094,59,Aetna,Medicare Advantage,,,,,Included in per diem rate,
SODIUM CHLORIDE 5 % OPHT OINT,,9844,LOCAL,Facility,Both,3.5 g,g,,59,50.15,16.9094,59,Aetna,PPO,54.87,93,,percent of total billed charges,,
SODIUM CHLORIDE 5 % OPHT OINT,,9844,LOCAL,Facility,Both,3.5 g,g,,59,50.15,16.9094,59,America's PPO,America's PPO,56.6577,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SODIUM CHLORIDE 5 % OPHT OINT,,9844,LOCAL,Facility,Both,3.5 g,g,,59,50.15,16.9094,59,BlueCross BlueShield Minnesota, Federal Employee Program,58.056,98.4,,percent of total billed charges,,
SODIUM CHLORIDE 5 % OPHT OINT,,9844,LOCAL,Facility,Both,3.5 g,g,,59,50.15,16.9094,59,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,59,100,,percent of total billed charges,,
SODIUM CHLORIDE 5 % OPHT OINT,,9844,LOCAL,Facility,Both,3.5 g,g,,59,50.15,16.9094,59,BlueCross BlueShield Minnesota,High Value Network Plan,53.1,90,,percent of total billed charges,,
SODIUM CHLORIDE 5 % OPHT OINT,,9844,LOCAL,Facility,Outpatient,3.5 g,g,,59,50.15,16.9094,59,BlueCross BlueShield Minnesota,Medicare Advantage,28.91,49,,percent of total billed charges,,
SODIUM CHLORIDE 5 % OPHT OINT,,9844,LOCAL,Facility,Inpatient,3.5 g,g,,59,50.15,16.9094,59,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
SODIUM CHLORIDE 5 % OPHT OINT,,9844,LOCAL,Facility,Both,3.5 g,g,,59,50.15,16.9094,59,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,52.2563,88.57,,percent of total billed charges,,
SODIUM CHLORIDE 5 % OPHT OINT,,9844,LOCAL,Facility,Both,3.5 g,g,,59,50.15,16.9094,59,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,16.9094,28.66,,percent of total billed charges,,
SODIUM CHLORIDE 5 % OPHT OINT,,9844,LOCAL,Facility,Outpatient,3.5 g,g,,59,50.15,16.9094,59,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),28.91,49,,percent of total billed charges,,
SODIUM CHLORIDE 5 % OPHT OINT,,9844,LOCAL,Facility,Inpatient,3.5 g,g,,59,50.15,16.9094,59,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
SODIUM CHLORIDE 5 % OPHT OINT,,9844,LOCAL,Facility,Both,3.5 g,g,,59,50.15,16.9094,59,CorVel,Worker's Compensation,59,100,,percent of total billed charges,,
SODIUM CHLORIDE 5 % OPHT OINT,,9844,LOCAL,Facility,Both,3.5 g,g,,59,50.15,16.9094,59,First Health Group Corporation,First Health Network,57.23,97,,percent of total billed charges,,
SODIUM CHLORIDE 5 % OPHT OINT,,9844,LOCAL,Facility,Both,3.5 g,g,,59,50.15,16.9094,59,"Health Partners, Inc.",Commercial,55.814,94.6,,percent of total billed charges,,
SODIUM CHLORIDE 5 % OPHT OINT,,9844,LOCAL,Facility,Outpatient,3.5 g,g,,59,50.15,16.9094,59,"Health Partners, Inc.",Medicare Advantage,28.91,49,,percent of total billed charges,,
SODIUM CHLORIDE 5 % OPHT OINT,,9844,LOCAL,Facility,Inpatient,3.5 g,g,,59,50.15,16.9094,59,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SODIUM CHLORIDE 5 % OPHT OINT,,9844,LOCAL,Facility,Both,3.5 g,g,,59,50.15,16.9094,59,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),35.4,60,,percent of total billed charges,,
SODIUM CHLORIDE 5 % OPHT OINT,,9844,LOCAL,Facility,Both,3.5 g,g,,59,50.15,16.9094,59,"Health Partners, Inc.",State of Minnesota Advantage Program,48.085,81.5,,percent of total billed charges,,
SODIUM CHLORIDE 5 % OPHT OINT,,9844,LOCAL,Facility,Both,3.5 g,g,,59,50.15,16.9094,59,"Health Partners, Inc.",State Public Programs,29.5,50,,percent of total billed charges,,
SODIUM CHLORIDE 5 % OPHT OINT,,9844,LOCAL,Facility,Both,3.5 g,g,,59,50.15,16.9094,59,Humana Insurance Company,Commercial PPO,56.05,95,,percent of total billed charges,,
SODIUM CHLORIDE 5 % OPHT OINT,,9844,LOCAL,Facility,Outpatient,3.5 g,g,,59,50.15,16.9094,59,Humana Insurance Company,Medicare PPO,28.91,49,,percent of total billed charges,,
SODIUM CHLORIDE 5 % OPHT OINT,,9844,LOCAL,Facility,Inpatient,3.5 g,g,,59,50.15,16.9094,59,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
SODIUM CHLORIDE 5 % OPHT OINT,,9844,LOCAL,Facility,Both,3.5 g,g,,59,50.15,16.9094,59,Medica,Individual & Family,58.469,99.1,,percent of total billed charges,,
SODIUM CHLORIDE 5 % OPHT OINT,,9844,LOCAL,Facility,Outpatient,3.5 g,g,,59,50.15,16.9094,59,Medica,Medica Advantage Solution,29.382,49.8,,percent of total billed charges,,
SODIUM CHLORIDE 5 % OPHT OINT,,9844,LOCAL,Facility,Inpatient,3.5 g,g,,59,50.15,16.9094,59,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
SODIUM CHLORIDE 5 % OPHT OINT,,9844,LOCAL,Facility,Outpatient,3.5 g,g,,59,50.15,16.9094,59,Medica,Medical Assistance,26.314,44.6,,percent of total billed charges,,
SODIUM CHLORIDE 5 % OPHT OINT,,9844,LOCAL,Facility,Inpatient,3.5 g,g,,59,50.15,16.9094,59,Medica,Medical Assistance,,,,,Included in per diem rate,
SODIUM CHLORIDE 5 % OPHT OINT,,9844,LOCAL,Facility,Outpatient,3.5 g,g,,59,50.15,16.9094,59,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,29.382,49.8,,percent of total billed charges,,
SODIUM CHLORIDE 5 % OPHT OINT,,9844,LOCAL,Facility,Inpatient,3.5 g,g,,59,50.15,16.9094,59,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
SODIUM CHLORIDE 5 % OPHT OINT,,9844,LOCAL,Facility,Both,3.5 g,g,,59,50.15,16.9094,59,"Multiplan, Inc.","Multiplan, Inc.",55.46,94,,percent of total billed charges,,
SODIUM CHLORIDE 5 % OPHT OINT,,9844,LOCAL,Facility,Outpatient,3.5 g,g,,59,50.15,16.9094,59,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,53.159,90.1,,percent of total billed charges,,
SODIUM CHLORIDE 5 % OPHT OINT,,9844,LOCAL,Facility,Inpatient,3.5 g,g,,59,50.15,16.9094,59,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
SODIUM CHLORIDE 5 % OPHT OINT,,9844,LOCAL,Facility,Both,3.5 g,g,,59,50.15,16.9094,59,"Preferred One Administrative Services, INC.",PPO,58.174,98.6,,percent of total billed charges,,
SODIUM CHLORIDE 5 % OPHT OINT,,9844,LOCAL,Facility,Outpatient,3.5 g,g,,59,50.15,16.9094,59,PrimeWest Health,Minnesota Senior Health Options (MSHO),30.3555,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
SODIUM CHLORIDE 5 % OPHT OINT,,9844,LOCAL,Facility,Inpatient,3.5 g,g,,59,50.15,16.9094,59,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SODIUM CHLORIDE 5 % OPHT OINT,,9844,LOCAL,Facility,Outpatient,3.5 g,g,,59,50.15,16.9094,59,PrimeWest Health,MinnesotaCare,30.3024,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
SODIUM CHLORIDE 5 % OPHT OINT,,9844,LOCAL,Facility,Inpatient,3.5 g,g,,59,50.15,16.9094,59,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
SODIUM CHLORIDE 5 % OPHT OINT,,9844,LOCAL,Facility,Both,3.5 g,g,,59,50.15,16.9094,59,Sanford Health Plan,Sanford Health Plan,54.28,92,,percent of total billed charges,,
SODIUM CHLORIDE 5 % OPHT OINT,,9844,LOCAL,Facility,Outpatient,3.5 g,g,,59,50.15,16.9094,59,"UCare Health, Inc.",Individual & Family Plan,33.2465,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
SODIUM CHLORIDE 5 % OPHT OINT,,9844,LOCAL,Facility,Inpatient,3.5 g,g,,59,50.15,16.9094,59,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
SODIUM CHLORIDE 5 % OPHT OINT,,9844,LOCAL,Facility,Outpatient,3.5 g,g,,59,50.15,16.9094,59,"UCare Health, Inc.",Medical Assistance,29.7773,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SODIUM CHLORIDE 5 % OPHT OINT,,9844,LOCAL,Facility,Inpatient,3.5 g,g,,59,50.15,16.9094,59,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
SODIUM CHLORIDE 5 % OPHT OINT,,9844,LOCAL,Facility,Outpatient,3.5 g,g,,59,50.15,16.9094,59,"UCare Health, Inc.",Medicare Advantage,29.7773,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SODIUM CHLORIDE 5 % OPHT OINT,,9844,LOCAL,Facility,Inpatient,3.5 g,g,,59,50.15,16.9094,59,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SODIUM CHLORIDE 5 % OPHT OINT,,9844,LOCAL,Facility,Outpatient,3.5 g,g,,59,50.15,16.9094,59,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),29.7773,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SODIUM CHLORIDE 5 % OPHT OINT,,9844,LOCAL,Facility,Inpatient,3.5 g,g,,59,50.15,16.9094,59,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SODIUM CHLORIDE 5 % OPHT OINT,,9844,LOCAL,Facility,Both,3.5 g,g,,59,50.15,16.9094,59,UnitedHealthcare,Individual & Family,55.46,94,,percent of total billed charges,,
SODIUM CHLORIDE 5 % OPHT OINT,,9844,LOCAL,Facility,Outpatient,3.5 g,g,,59,50.15,16.9094,59,UnitedHealthcare,Medicare Advantage,28.91,49,,percent of total billed charges,,
SODIUM CHLORIDE 5 % OPHT OINT,,9844,LOCAL,Facility,Inpatient,3.5 g,g,,59,50.15,16.9094,59,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
SODIUM CHLORIDE 5 % OPHT OINT,,9844,LOCAL,Facility,Outpatient,3.5 g,g,,59,50.15,16.9094,59,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,28.32,48,,percent of total billed charges,,100% of DHS outpatient percentage
SODIUM CHLORIDE 5 % OPHT OINT,,9844,LOCAL,Facility,Inpatient,3.5 g,g,,59,50.15,16.9094,59,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINT,,12105,LOCAL,Facility,Both,3.5 g,g,,92,78.2,26.3672,92,Aetna,Commercial,84.64,92,,percent of total billed charges,,
ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINT,,12105,LOCAL,Facility,Both,3.5 g,g,,87,73.95,24.9342,87,Aetna,Commercial,80.04,92,,percent of total billed charges,,
ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINT,,12105,LOCAL,Facility,Both,3.5 g,g,,90,76.5,25.794,90,Aetna,Commercial,82.8,92,,percent of total billed charges,,
ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINT,,12105,LOCAL,Facility,Outpatient,3.5 g,g,,92,78.2,26.3672,92,Aetna,Medicare Advantage,45.08,49,,percent of total billed charges,,
ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINT,,12105,LOCAL,Facility,Outpatient,3.5 g,g,,87,73.95,24.9342,87,Aetna,Medicare Advantage,42.63,49,,percent of total billed charges,,
ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINT,,12105,LOCAL,Facility,Outpatient,3.5 g,g,,90,76.5,25.794,90,Aetna,Medicare Advantage,44.1,49,,percent of total billed charges,,
ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINT,,12105,LOCAL,Facility,Inpatient,3.5 g,g,,92,78.2,26.3672,92,Aetna,Medicare Advantage,,,,,Included in per diem rate,
ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINT,,12105,LOCAL,Facility,Inpatient,3.5 g,g,,87,73.95,24.9342,87,Aetna,Medicare Advantage,,,,,Included in per diem rate,
ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINT,,12105,LOCAL,Facility,Inpatient,3.5 g,g,,90,76.5,25.794,90,Aetna,Medicare Advantage,,,,,Included in per diem rate,
ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINT,,12105,LOCAL,Facility,Both,3.5 g,g,,92,78.2,26.3672,92,Aetna,PPO,85.56,93,,percent of total billed charges,,
ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINT,,12105,LOCAL,Facility,Both,3.5 g,g,,87,73.95,24.9342,87,Aetna,PPO,80.91,93,,percent of total billed charges,,
ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINT,,12105,LOCAL,Facility,Both,3.5 g,g,,90,76.5,25.794,90,Aetna,PPO,83.7,93,,percent of total billed charges,,
ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINT,,12105,LOCAL,Facility,Both,3.5 g,g,,92,78.2,26.3672,92,America's PPO,America's PPO,88.3476,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINT,,12105,LOCAL,Facility,Both,3.5 g,g,,87,73.95,24.9342,87,America's PPO,America's PPO,83.5461,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINT,,12105,LOCAL,Facility,Both,3.5 g,g,,90,76.5,25.794,90,America's PPO,America's PPO,86.427,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINT,,12105,LOCAL,Facility,Both,3.5 g,g,,92,78.2,26.3672,92,BlueCross BlueShield Minnesota, Federal Employee Program,90.528,98.4,,percent of total billed charges,,
ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINT,,12105,LOCAL,Facility,Both,3.5 g,g,,87,73.95,24.9342,87,BlueCross BlueShield Minnesota, Federal Employee Program,85.608,98.4,,percent of total billed charges,,
ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINT,,12105,LOCAL,Facility,Both,3.5 g,g,,90,76.5,25.794,90,BlueCross BlueShield Minnesota, Federal Employee Program,88.56,98.4,,percent of total billed charges,,
ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINT,,12105,LOCAL,Facility,Both,3.5 g,g,,92,78.2,26.3672,92,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,92,100,,percent of total billed charges,,
ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINT,,12105,LOCAL,Facility,Both,3.5 g,g,,87,73.95,24.9342,87,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,87,100,,percent of total billed charges,,
ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINT,,12105,LOCAL,Facility,Both,3.5 g,g,,90,76.5,25.794,90,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,90,100,,percent of total billed charges,,
ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINT,,12105,LOCAL,Facility,Both,3.5 g,g,,92,78.2,26.3672,92,BlueCross BlueShield Minnesota,High Value Network Plan,82.8,90,,percent of total billed charges,,
ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINT,,12105,LOCAL,Facility,Both,3.5 g,g,,87,73.95,24.9342,87,BlueCross BlueShield Minnesota,High Value Network Plan,78.3,90,,percent of total billed charges,,
ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINT,,12105,LOCAL,Facility,Both,3.5 g,g,,90,76.5,25.794,90,BlueCross BlueShield Minnesota,High Value Network Plan,81,90,,percent of total billed charges,,
ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINT,,12105,LOCAL,Facility,Outpatient,3.5 g,g,,92,78.2,26.3672,92,BlueCross BlueShield Minnesota,Medicare Advantage,45.08,49,,percent of total billed charges,,
ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINT,,12105,LOCAL,Facility,Outpatient,3.5 g,g,,87,73.95,24.9342,87,BlueCross BlueShield Minnesota,Medicare Advantage,42.63,49,,percent of total billed charges,,
ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINT,,12105,LOCAL,Facility,Outpatient,3.5 g,g,,90,76.5,25.794,90,BlueCross BlueShield Minnesota,Medicare Advantage,44.1,49,,percent of total billed charges,,
ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINT,,12105,LOCAL,Facility,Inpatient,3.5 g,g,,92,78.2,26.3672,92,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINT,,12105,LOCAL,Facility,Inpatient,3.5 g,g,,87,73.95,24.9342,87,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINT,,12105,LOCAL,Facility,Inpatient,3.5 g,g,,90,76.5,25.794,90,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINT,,12105,LOCAL,Facility,Both,3.5 g,g,,92,78.2,26.3672,92,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,81.4844,88.57,,percent of total billed charges,,
ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINT,,12105,LOCAL,Facility,Both,3.5 g,g,,87,73.95,24.9342,87,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,77.0559,88.57,,percent of total billed charges,,
ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINT,,12105,LOCAL,Facility,Both,3.5 g,g,,90,76.5,25.794,90,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,79.713,88.57,,percent of total billed charges,,
ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINT,,12105,LOCAL,Facility,Both,3.5 g,g,,92,78.2,26.3672,92,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,26.3672,28.66,,percent of total billed charges,,
ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINT,,12105,LOCAL,Facility,Both,3.5 g,g,,87,73.95,24.9342,87,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,24.9342,28.66,,percent of total billed charges,,
ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINT,,12105,LOCAL,Facility,Both,3.5 g,g,,90,76.5,25.794,90,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,25.794,28.66,,percent of total billed charges,,
ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINT,,12105,LOCAL,Facility,Outpatient,3.5 g,g,,92,78.2,26.3672,92,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),45.08,49,,percent of total billed charges,,
ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINT,,12105,LOCAL,Facility,Outpatient,3.5 g,g,,87,73.95,24.9342,87,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),42.63,49,,percent of total billed charges,,
ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINT,,12105,LOCAL,Facility,Outpatient,3.5 g,g,,90,76.5,25.794,90,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),44.1,49,,percent of total billed charges,,
ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINT,,12105,LOCAL,Facility,Inpatient,3.5 g,g,,92,78.2,26.3672,92,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINT,,12105,LOCAL,Facility,Inpatient,3.5 g,g,,87,73.95,24.9342,87,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINT,,12105,LOCAL,Facility,Inpatient,3.5 g,g,,90,76.5,25.794,90,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINT,,12105,LOCAL,Facility,Both,3.5 g,g,,92,78.2,26.3672,92,CorVel,Worker's Compensation,92,100,,percent of total billed charges,,
ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINT,,12105,LOCAL,Facility,Both,3.5 g,g,,87,73.95,24.9342,87,CorVel,Worker's Compensation,87,100,,percent of total billed charges,,
ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINT,,12105,LOCAL,Facility,Both,3.5 g,g,,90,76.5,25.794,90,CorVel,Worker's Compensation,90,100,,percent of total billed charges,,
ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINT,,12105,LOCAL,Facility,Both,3.5 g,g,,92,78.2,26.3672,92,First Health Group Corporation,First Health Network,89.24,97,,percent of total billed charges,,
ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINT,,12105,LOCAL,Facility,Both,3.5 g,g,,87,73.95,24.9342,87,First Health Group Corporation,First Health Network,84.39,97,,percent of total billed charges,,
ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINT,,12105,LOCAL,Facility,Both,3.5 g,g,,90,76.5,25.794,90,First Health Group Corporation,First Health Network,87.3,97,,percent of total billed charges,,
ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINT,,12105,LOCAL,Facility,Both,3.5 g,g,,92,78.2,26.3672,92,"Health Partners, Inc.",Commercial,87.032,94.6,,percent of total billed charges,,
ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINT,,12105,LOCAL,Facility,Both,3.5 g,g,,87,73.95,24.9342,87,"Health Partners, Inc.",Commercial,82.302,94.6,,percent of total billed charges,,
ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINT,,12105,LOCAL,Facility,Both,3.5 g,g,,90,76.5,25.794,90,"Health Partners, Inc.",Commercial,85.14,94.6,,percent of total billed charges,,
ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINT,,12105,LOCAL,Facility,Outpatient,3.5 g,g,,92,78.2,26.3672,92,"Health Partners, Inc.",Medicare Advantage,45.08,49,,percent of total billed charges,,
ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINT,,12105,LOCAL,Facility,Outpatient,3.5 g,g,,87,73.95,24.9342,87,"Health Partners, Inc.",Medicare Advantage,42.63,49,,percent of total billed charges,,
ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINT,,12105,LOCAL,Facility,Outpatient,3.5 g,g,,90,76.5,25.794,90,"Health Partners, Inc.",Medicare Advantage,44.1,49,,percent of total billed charges,,
ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINT,,12105,LOCAL,Facility,Inpatient,3.5 g,g,,92,78.2,26.3672,92,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINT,,12105,LOCAL,Facility,Inpatient,3.5 g,g,,87,73.95,24.9342,87,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINT,,12105,LOCAL,Facility,Inpatient,3.5 g,g,,90,76.5,25.794,90,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINT,,12105,LOCAL,Facility,Both,3.5 g,g,,92,78.2,26.3672,92,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),55.2,60,,percent of total billed charges,,
ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINT,,12105,LOCAL,Facility,Both,3.5 g,g,,87,73.95,24.9342,87,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),52.2,60,,percent of total billed charges,,
ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINT,,12105,LOCAL,Facility,Both,3.5 g,g,,90,76.5,25.794,90,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),54,60,,percent of total billed charges,,
ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINT,,12105,LOCAL,Facility,Both,3.5 g,g,,92,78.2,26.3672,92,"Health Partners, Inc.",State of Minnesota Advantage Program,74.98,81.5,,percent of total billed charges,,
ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINT,,12105,LOCAL,Facility,Both,3.5 g,g,,87,73.95,24.9342,87,"Health Partners, Inc.",State of Minnesota Advantage Program,70.905,81.5,,percent of total billed charges,,
ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINT,,12105,LOCAL,Facility,Both,3.5 g,g,,90,76.5,25.794,90,"Health Partners, Inc.",State of Minnesota Advantage Program,73.35,81.5,,percent of total billed charges,,
ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINT,,12105,LOCAL,Facility,Both,3.5 g,g,,92,78.2,26.3672,92,"Health Partners, Inc.",State Public Programs,46,50,,percent of total billed charges,,
ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINT,,12105,LOCAL,Facility,Both,3.5 g,g,,87,73.95,24.9342,87,"Health Partners, Inc.",State Public Programs,43.5,50,,percent of total billed charges,,
ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINT,,12105,LOCAL,Facility,Both,3.5 g,g,,90,76.5,25.794,90,"Health Partners, Inc.",State Public Programs,45,50,,percent of total billed charges,,
ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINT,,12105,LOCAL,Facility,Both,3.5 g,g,,92,78.2,26.3672,92,Humana Insurance Company,Commercial PPO,87.4,95,,percent of total billed charges,,
ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINT,,12105,LOCAL,Facility,Both,3.5 g,g,,87,73.95,24.9342,87,Humana Insurance Company,Commercial PPO,82.65,95,,percent of total billed charges,,
ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINT,,12105,LOCAL,Facility,Both,3.5 g,g,,90,76.5,25.794,90,Humana Insurance Company,Commercial PPO,85.5,95,,percent of total billed charges,,
ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINT,,12105,LOCAL,Facility,Outpatient,3.5 g,g,,92,78.2,26.3672,92,Humana Insurance Company,Medicare PPO,45.08,49,,percent of total billed charges,,
ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINT,,12105,LOCAL,Facility,Outpatient,3.5 g,g,,87,73.95,24.9342,87,Humana Insurance Company,Medicare PPO,42.63,49,,percent of total billed charges,,
ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINT,,12105,LOCAL,Facility,Outpatient,3.5 g,g,,90,76.5,25.794,90,Humana Insurance Company,Medicare PPO,44.1,49,,percent of total billed charges,,
ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINT,,12105,LOCAL,Facility,Inpatient,3.5 g,g,,92,78.2,26.3672,92,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINT,,12105,LOCAL,Facility,Inpatient,3.5 g,g,,87,73.95,24.9342,87,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINT,,12105,LOCAL,Facility,Inpatient,3.5 g,g,,90,76.5,25.794,90,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINT,,12105,LOCAL,Facility,Both,3.5 g,g,,92,78.2,26.3672,92,Medica,Individual & Family,91.172,99.1,,percent of total billed charges,,
ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINT,,12105,LOCAL,Facility,Both,3.5 g,g,,87,73.95,24.9342,87,Medica,Individual & Family,86.217,99.1,,percent of total billed charges,,
ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINT,,12105,LOCAL,Facility,Both,3.5 g,g,,90,76.5,25.794,90,Medica,Individual & Family,89.19,99.1,,percent of total billed charges,,
ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINT,,12105,LOCAL,Facility,Outpatient,3.5 g,g,,92,78.2,26.3672,92,Medica,Medica Advantage Solution,45.816,49.8,,percent of total billed charges,,
ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINT,,12105,LOCAL,Facility,Outpatient,3.5 g,g,,87,73.95,24.9342,87,Medica,Medica Advantage Solution,43.326,49.8,,percent of total billed charges,,
ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINT,,12105,LOCAL,Facility,Outpatient,3.5 g,g,,90,76.5,25.794,90,Medica,Medica Advantage Solution,44.82,49.8,,percent of total billed charges,,
ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINT,,12105,LOCAL,Facility,Inpatient,3.5 g,g,,92,78.2,26.3672,92,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINT,,12105,LOCAL,Facility,Inpatient,3.5 g,g,,87,73.95,24.9342,87,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINT,,12105,LOCAL,Facility,Inpatient,3.5 g,g,,90,76.5,25.794,90,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINT,,12105,LOCAL,Facility,Outpatient,3.5 g,g,,92,78.2,26.3672,92,Medica,Medical Assistance,41.032,44.6,,percent of total billed charges,,
ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINT,,12105,LOCAL,Facility,Outpatient,3.5 g,g,,87,73.95,24.9342,87,Medica,Medical Assistance,38.802,44.6,,percent of total billed charges,,
ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINT,,12105,LOCAL,Facility,Outpatient,3.5 g,g,,90,76.5,25.794,90,Medica,Medical Assistance,40.14,44.6,,percent of total billed charges,,
ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINT,,12105,LOCAL,Facility,Inpatient,3.5 g,g,,92,78.2,26.3672,92,Medica,Medical Assistance,,,,,Included in per diem rate,
ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINT,,12105,LOCAL,Facility,Inpatient,3.5 g,g,,87,73.95,24.9342,87,Medica,Medical Assistance,,,,,Included in per diem rate,
ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINT,,12105,LOCAL,Facility,Inpatient,3.5 g,g,,90,76.5,25.794,90,Medica,Medical Assistance,,,,,Included in per diem rate,
ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINT,,12105,LOCAL,Facility,Outpatient,3.5 g,g,,92,78.2,26.3672,92,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,45.816,49.8,,percent of total billed charges,,
ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINT,,12105,LOCAL,Facility,Outpatient,3.5 g,g,,87,73.95,24.9342,87,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,43.326,49.8,,percent of total billed charges,,
ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINT,,12105,LOCAL,Facility,Outpatient,3.5 g,g,,90,76.5,25.794,90,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,44.82,49.8,,percent of total billed charges,,
ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINT,,12105,LOCAL,Facility,Inpatient,3.5 g,g,,92,78.2,26.3672,92,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINT,,12105,LOCAL,Facility,Inpatient,3.5 g,g,,87,73.95,24.9342,87,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINT,,12105,LOCAL,Facility,Inpatient,3.5 g,g,,90,76.5,25.794,90,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINT,,12105,LOCAL,Facility,Both,3.5 g,g,,92,78.2,26.3672,92,"Multiplan, Inc.","Multiplan, Inc.",86.48,94,,percent of total billed charges,,
ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINT,,12105,LOCAL,Facility,Both,3.5 g,g,,87,73.95,24.9342,87,"Multiplan, Inc.","Multiplan, Inc.",81.78,94,,percent of total billed charges,,
ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINT,,12105,LOCAL,Facility,Both,3.5 g,g,,90,76.5,25.794,90,"Multiplan, Inc.","Multiplan, Inc.",84.6,94,,percent of total billed charges,,
ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINT,,12105,LOCAL,Facility,Outpatient,3.5 g,g,,92,78.2,26.3672,92,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,82.892,90.1,,percent of total billed charges,,
ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINT,,12105,LOCAL,Facility,Outpatient,3.5 g,g,,87,73.95,24.9342,87,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,78.387,90.1,,percent of total billed charges,,
ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINT,,12105,LOCAL,Facility,Outpatient,3.5 g,g,,90,76.5,25.794,90,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,81.09,90.1,,percent of total billed charges,,
ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINT,,12105,LOCAL,Facility,Inpatient,3.5 g,g,,92,78.2,26.3672,92,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINT,,12105,LOCAL,Facility,Inpatient,3.5 g,g,,87,73.95,24.9342,87,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINT,,12105,LOCAL,Facility,Inpatient,3.5 g,g,,90,76.5,25.794,90,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINT,,12105,LOCAL,Facility,Both,3.5 g,g,,92,78.2,26.3672,92,"Preferred One Administrative Services, INC.",PPO,90.712,98.6,,percent of total billed charges,,
ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINT,,12105,LOCAL,Facility,Both,3.5 g,g,,87,73.95,24.9342,87,"Preferred One Administrative Services, INC.",PPO,85.782,98.6,,percent of total billed charges,,
ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINT,,12105,LOCAL,Facility,Both,3.5 g,g,,90,76.5,25.794,90,"Preferred One Administrative Services, INC.",PPO,88.74,98.6,,percent of total billed charges,,
ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINT,,12105,LOCAL,Facility,Outpatient,3.5 g,g,,92,78.2,26.3672,92,PrimeWest Health,Minnesota Senior Health Options (MSHO),47.334,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINT,,12105,LOCAL,Facility,Outpatient,3.5 g,g,,87,73.95,24.9342,87,PrimeWest Health,Minnesota Senior Health Options (MSHO),44.7615,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINT,,12105,LOCAL,Facility,Outpatient,3.5 g,g,,90,76.5,25.794,90,PrimeWest Health,Minnesota Senior Health Options (MSHO),46.305,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINT,,12105,LOCAL,Facility,Inpatient,3.5 g,g,,92,78.2,26.3672,92,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINT,,12105,LOCAL,Facility,Inpatient,3.5 g,g,,87,73.95,24.9342,87,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINT,,12105,LOCAL,Facility,Inpatient,3.5 g,g,,90,76.5,25.794,90,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINT,,12105,LOCAL,Facility,Outpatient,3.5 g,g,,92,78.2,26.3672,92,PrimeWest Health,MinnesotaCare,47.2512,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINT,,12105,LOCAL,Facility,Outpatient,3.5 g,g,,87,73.95,24.9342,87,PrimeWest Health,MinnesotaCare,44.6832,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINT,,12105,LOCAL,Facility,Outpatient,3.5 g,g,,90,76.5,25.794,90,PrimeWest Health,MinnesotaCare,46.224,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINT,,12105,LOCAL,Facility,Inpatient,3.5 g,g,,92,78.2,26.3672,92,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINT,,12105,LOCAL,Facility,Inpatient,3.5 g,g,,87,73.95,24.9342,87,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINT,,12105,LOCAL,Facility,Inpatient,3.5 g,g,,90,76.5,25.794,90,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINT,,12105,LOCAL,Facility,Both,3.5 g,g,,92,78.2,26.3672,92,Sanford Health Plan,Sanford Health Plan,84.64,92,,percent of total billed charges,,
ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINT,,12105,LOCAL,Facility,Both,3.5 g,g,,87,73.95,24.9342,87,Sanford Health Plan,Sanford Health Plan,80.04,92,,percent of total billed charges,,
ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINT,,12105,LOCAL,Facility,Both,3.5 g,g,,90,76.5,25.794,90,Sanford Health Plan,Sanford Health Plan,82.8,92,,percent of total billed charges,,
ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINT,,12105,LOCAL,Facility,Outpatient,3.5 g,g,,92,78.2,26.3672,92,"UCare Health, Inc.",Individual & Family Plan,51.842,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINT,,12105,LOCAL,Facility,Outpatient,3.5 g,g,,87,73.95,24.9342,87,"UCare Health, Inc.",Individual & Family Plan,49.0245,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINT,,12105,LOCAL,Facility,Outpatient,3.5 g,g,,90,76.5,25.794,90,"UCare Health, Inc.",Individual & Family Plan,50.715,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINT,,12105,LOCAL,Facility,Inpatient,3.5 g,g,,92,78.2,26.3672,92,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINT,,12105,LOCAL,Facility,Inpatient,3.5 g,g,,87,73.95,24.9342,87,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINT,,12105,LOCAL,Facility,Inpatient,3.5 g,g,,90,76.5,25.794,90,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINT,,12105,LOCAL,Facility,Outpatient,3.5 g,g,,92,78.2,26.3672,92,"UCare Health, Inc.",Medical Assistance,46.4324,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINT,,12105,LOCAL,Facility,Outpatient,3.5 g,g,,87,73.95,24.9342,87,"UCare Health, Inc.",Medical Assistance,43.9089,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINT,,12105,LOCAL,Facility,Outpatient,3.5 g,g,,90,76.5,25.794,90,"UCare Health, Inc.",Medical Assistance,45.423,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINT,,12105,LOCAL,Facility,Inpatient,3.5 g,g,,92,78.2,26.3672,92,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINT,,12105,LOCAL,Facility,Inpatient,3.5 g,g,,87,73.95,24.9342,87,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINT,,12105,LOCAL,Facility,Inpatient,3.5 g,g,,90,76.5,25.794,90,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINT,,12105,LOCAL,Facility,Outpatient,3.5 g,g,,92,78.2,26.3672,92,"UCare Health, Inc.",Medicare Advantage,46.4324,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINT,,12105,LOCAL,Facility,Outpatient,3.5 g,g,,87,73.95,24.9342,87,"UCare Health, Inc.",Medicare Advantage,43.9089,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINT,,12105,LOCAL,Facility,Outpatient,3.5 g,g,,90,76.5,25.794,90,"UCare Health, Inc.",Medicare Advantage,45.423,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINT,,12105,LOCAL,Facility,Inpatient,3.5 g,g,,92,78.2,26.3672,92,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINT,,12105,LOCAL,Facility,Inpatient,3.5 g,g,,87,73.95,24.9342,87,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINT,,12105,LOCAL,Facility,Inpatient,3.5 g,g,,90,76.5,25.794,90,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINT,,12105,LOCAL,Facility,Outpatient,3.5 g,g,,92,78.2,26.3672,92,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),46.4324,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINT,,12105,LOCAL,Facility,Outpatient,3.5 g,g,,87,73.95,24.9342,87,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),43.9089,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINT,,12105,LOCAL,Facility,Outpatient,3.5 g,g,,90,76.5,25.794,90,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),45.423,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINT,,12105,LOCAL,Facility,Inpatient,3.5 g,g,,92,78.2,26.3672,92,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINT,,12105,LOCAL,Facility,Inpatient,3.5 g,g,,87,73.95,24.9342,87,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINT,,12105,LOCAL,Facility,Inpatient,3.5 g,g,,90,76.5,25.794,90,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINT,,12105,LOCAL,Facility,Both,3.5 g,g,,92,78.2,26.3672,92,UnitedHealthcare,Individual & Family,86.48,94,,percent of total billed charges,,
ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINT,,12105,LOCAL,Facility,Both,3.5 g,g,,87,73.95,24.9342,87,UnitedHealthcare,Individual & Family,81.78,94,,percent of total billed charges,,
ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINT,,12105,LOCAL,Facility,Both,3.5 g,g,,90,76.5,25.794,90,UnitedHealthcare,Individual & Family,84.6,94,,percent of total billed charges,,
ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINT,,12105,LOCAL,Facility,Outpatient,3.5 g,g,,92,78.2,26.3672,92,UnitedHealthcare,Medicare Advantage,45.08,49,,percent of total billed charges,,
ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINT,,12105,LOCAL,Facility,Outpatient,3.5 g,g,,87,73.95,24.9342,87,UnitedHealthcare,Medicare Advantage,42.63,49,,percent of total billed charges,,
ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINT,,12105,LOCAL,Facility,Outpatient,3.5 g,g,,90,76.5,25.794,90,UnitedHealthcare,Medicare Advantage,44.1,49,,percent of total billed charges,,
ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINT,,12105,LOCAL,Facility,Inpatient,3.5 g,g,,92,78.2,26.3672,92,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINT,,12105,LOCAL,Facility,Inpatient,3.5 g,g,,87,73.95,24.9342,87,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINT,,12105,LOCAL,Facility,Inpatient,3.5 g,g,,90,76.5,25.794,90,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINT,,12105,LOCAL,Facility,Outpatient,3.5 g,g,,92,78.2,26.3672,92,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,44.16,48,,percent of total billed charges,,100% of DHS outpatient percentage
ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINT,,12105,LOCAL,Facility,Outpatient,3.5 g,g,,87,73.95,24.9342,87,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,41.76,48,,percent of total billed charges,,100% of DHS outpatient percentage
ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINT,,12105,LOCAL,Facility,Outpatient,3.5 g,g,,90,76.5,25.794,90,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,43.2,48,,percent of total billed charges,,100% of DHS outpatient percentage
ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINT,,12105,LOCAL,Facility,Inpatient,3.5 g,g,,92,78.2,26.3672,92,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINT,,12105,LOCAL,Facility,Inpatient,3.5 g,g,,87,73.95,24.9342,87,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINT,,12105,LOCAL,Facility,Inpatient,3.5 g,g,,90,76.5,25.794,90,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
GENTAMICIN 0.3 % (3 MG/GRAM) OPHT OINT,,17735,LOCAL,Facility,Both,3.5 g,g,,176,149.6,50.4416,176,Aetna,Commercial,161.92,92,,percent of total billed charges,,
GENTAMICIN 0.3 % (3 MG/GRAM) OPHT OINT,,17735,LOCAL,Facility,Outpatient,3.5 g,g,,176,149.6,50.4416,176,Aetna,Medicare Advantage,86.24,49,,percent of total billed charges,,
GENTAMICIN 0.3 % (3 MG/GRAM) OPHT OINT,,17735,LOCAL,Facility,Inpatient,3.5 g,g,,176,149.6,50.4416,176,Aetna,Medicare Advantage,,,,,Included in per diem rate,
GENTAMICIN 0.3 % (3 MG/GRAM) OPHT OINT,,17735,LOCAL,Facility,Both,3.5 g,g,,176,149.6,50.4416,176,Aetna,PPO,163.68,93,,percent of total billed charges,,
GENTAMICIN 0.3 % (3 MG/GRAM) OPHT OINT,,17735,LOCAL,Facility,Both,3.5 g,g,,176,149.6,50.4416,176,America's PPO,America's PPO,169.0128,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
GENTAMICIN 0.3 % (3 MG/GRAM) OPHT OINT,,17735,LOCAL,Facility,Both,3.5 g,g,,176,149.6,50.4416,176,BlueCross BlueShield Minnesota, Federal Employee Program,173.184,98.4,,percent of total billed charges,,
GENTAMICIN 0.3 % (3 MG/GRAM) OPHT OINT,,17735,LOCAL,Facility,Both,3.5 g,g,,176,149.6,50.4416,176,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,176,100,,percent of total billed charges,,
GENTAMICIN 0.3 % (3 MG/GRAM) OPHT OINT,,17735,LOCAL,Facility,Both,3.5 g,g,,176,149.6,50.4416,176,BlueCross BlueShield Minnesota,High Value Network Plan,158.4,90,,percent of total billed charges,,
GENTAMICIN 0.3 % (3 MG/GRAM) OPHT OINT,,17735,LOCAL,Facility,Outpatient,3.5 g,g,,176,149.6,50.4416,176,BlueCross BlueShield Minnesota,Medicare Advantage,86.24,49,,percent of total billed charges,,
GENTAMICIN 0.3 % (3 MG/GRAM) OPHT OINT,,17735,LOCAL,Facility,Inpatient,3.5 g,g,,176,149.6,50.4416,176,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
GENTAMICIN 0.3 % (3 MG/GRAM) OPHT OINT,,17735,LOCAL,Facility,Both,3.5 g,g,,176,149.6,50.4416,176,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,155.8832,88.57,,percent of total billed charges,,
GENTAMICIN 0.3 % (3 MG/GRAM) OPHT OINT,,17735,LOCAL,Facility,Both,3.5 g,g,,176,149.6,50.4416,176,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,50.4416,28.66,,percent of total billed charges,,
GENTAMICIN 0.3 % (3 MG/GRAM) OPHT OINT,,17735,LOCAL,Facility,Outpatient,3.5 g,g,,176,149.6,50.4416,176,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),86.24,49,,percent of total billed charges,,
GENTAMICIN 0.3 % (3 MG/GRAM) OPHT OINT,,17735,LOCAL,Facility,Inpatient,3.5 g,g,,176,149.6,50.4416,176,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
GENTAMICIN 0.3 % (3 MG/GRAM) OPHT OINT,,17735,LOCAL,Facility,Both,3.5 g,g,,176,149.6,50.4416,176,CorVel,Worker's Compensation,176,100,,percent of total billed charges,,
GENTAMICIN 0.3 % (3 MG/GRAM) OPHT OINT,,17735,LOCAL,Facility,Both,3.5 g,g,,176,149.6,50.4416,176,First Health Group Corporation,First Health Network,170.72,97,,percent of total billed charges,,
GENTAMICIN 0.3 % (3 MG/GRAM) OPHT OINT,,17735,LOCAL,Facility,Both,3.5 g,g,,176,149.6,50.4416,176,"Health Partners, Inc.",Commercial,166.496,94.6,,percent of total billed charges,,
GENTAMICIN 0.3 % (3 MG/GRAM) OPHT OINT,,17735,LOCAL,Facility,Outpatient,3.5 g,g,,176,149.6,50.4416,176,"Health Partners, Inc.",Medicare Advantage,86.24,49,,percent of total billed charges,,
GENTAMICIN 0.3 % (3 MG/GRAM) OPHT OINT,,17735,LOCAL,Facility,Inpatient,3.5 g,g,,176,149.6,50.4416,176,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
GENTAMICIN 0.3 % (3 MG/GRAM) OPHT OINT,,17735,LOCAL,Facility,Both,3.5 g,g,,176,149.6,50.4416,176,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),105.6,60,,percent of total billed charges,,
GENTAMICIN 0.3 % (3 MG/GRAM) OPHT OINT,,17735,LOCAL,Facility,Both,3.5 g,g,,176,149.6,50.4416,176,"Health Partners, Inc.",State of Minnesota Advantage Program,143.44,81.5,,percent of total billed charges,,
GENTAMICIN 0.3 % (3 MG/GRAM) OPHT OINT,,17735,LOCAL,Facility,Both,3.5 g,g,,176,149.6,50.4416,176,"Health Partners, Inc.",State Public Programs,88,50,,percent of total billed charges,,
GENTAMICIN 0.3 % (3 MG/GRAM) OPHT OINT,,17735,LOCAL,Facility,Both,3.5 g,g,,176,149.6,50.4416,176,Humana Insurance Company,Commercial PPO,167.2,95,,percent of total billed charges,,
GENTAMICIN 0.3 % (3 MG/GRAM) OPHT OINT,,17735,LOCAL,Facility,Outpatient,3.5 g,g,,176,149.6,50.4416,176,Humana Insurance Company,Medicare PPO,86.24,49,,percent of total billed charges,,
GENTAMICIN 0.3 % (3 MG/GRAM) OPHT OINT,,17735,LOCAL,Facility,Inpatient,3.5 g,g,,176,149.6,50.4416,176,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
GENTAMICIN 0.3 % (3 MG/GRAM) OPHT OINT,,17735,LOCAL,Facility,Both,3.5 g,g,,176,149.6,50.4416,176,Medica,Individual & Family,174.416,99.1,,percent of total billed charges,,
GENTAMICIN 0.3 % (3 MG/GRAM) OPHT OINT,,17735,LOCAL,Facility,Outpatient,3.5 g,g,,176,149.6,50.4416,176,Medica,Medica Advantage Solution,87.648,49.8,,percent of total billed charges,,
GENTAMICIN 0.3 % (3 MG/GRAM) OPHT OINT,,17735,LOCAL,Facility,Inpatient,3.5 g,g,,176,149.6,50.4416,176,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
GENTAMICIN 0.3 % (3 MG/GRAM) OPHT OINT,,17735,LOCAL,Facility,Outpatient,3.5 g,g,,176,149.6,50.4416,176,Medica,Medical Assistance,78.496,44.6,,percent of total billed charges,,
GENTAMICIN 0.3 % (3 MG/GRAM) OPHT OINT,,17735,LOCAL,Facility,Inpatient,3.5 g,g,,176,149.6,50.4416,176,Medica,Medical Assistance,,,,,Included in per diem rate,
GENTAMICIN 0.3 % (3 MG/GRAM) OPHT OINT,,17735,LOCAL,Facility,Outpatient,3.5 g,g,,176,149.6,50.4416,176,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,87.648,49.8,,percent of total billed charges,,
GENTAMICIN 0.3 % (3 MG/GRAM) OPHT OINT,,17735,LOCAL,Facility,Inpatient,3.5 g,g,,176,149.6,50.4416,176,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
GENTAMICIN 0.3 % (3 MG/GRAM) OPHT OINT,,17735,LOCAL,Facility,Both,3.5 g,g,,176,149.6,50.4416,176,"Multiplan, Inc.","Multiplan, Inc.",165.44,94,,percent of total billed charges,,
GENTAMICIN 0.3 % (3 MG/GRAM) OPHT OINT,,17735,LOCAL,Facility,Outpatient,3.5 g,g,,176,149.6,50.4416,176,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,158.576,90.1,,percent of total billed charges,,
GENTAMICIN 0.3 % (3 MG/GRAM) OPHT OINT,,17735,LOCAL,Facility,Inpatient,3.5 g,g,,176,149.6,50.4416,176,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
GENTAMICIN 0.3 % (3 MG/GRAM) OPHT OINT,,17735,LOCAL,Facility,Both,3.5 g,g,,176,149.6,50.4416,176,"Preferred One Administrative Services, INC.",PPO,173.536,98.6,,percent of total billed charges,,
GENTAMICIN 0.3 % (3 MG/GRAM) OPHT OINT,,17735,LOCAL,Facility,Outpatient,3.5 g,g,,176,149.6,50.4416,176,PrimeWest Health,Minnesota Senior Health Options (MSHO),90.552,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
GENTAMICIN 0.3 % (3 MG/GRAM) OPHT OINT,,17735,LOCAL,Facility,Inpatient,3.5 g,g,,176,149.6,50.4416,176,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
GENTAMICIN 0.3 % (3 MG/GRAM) OPHT OINT,,17735,LOCAL,Facility,Outpatient,3.5 g,g,,176,149.6,50.4416,176,PrimeWest Health,MinnesotaCare,90.3936,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
GENTAMICIN 0.3 % (3 MG/GRAM) OPHT OINT,,17735,LOCAL,Facility,Inpatient,3.5 g,g,,176,149.6,50.4416,176,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
GENTAMICIN 0.3 % (3 MG/GRAM) OPHT OINT,,17735,LOCAL,Facility,Both,3.5 g,g,,176,149.6,50.4416,176,Sanford Health Plan,Sanford Health Plan,161.92,92,,percent of total billed charges,,
GENTAMICIN 0.3 % (3 MG/GRAM) OPHT OINT,,17735,LOCAL,Facility,Outpatient,3.5 g,g,,176,149.6,50.4416,176,"UCare Health, Inc.",Individual & Family Plan,99.176,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
GENTAMICIN 0.3 % (3 MG/GRAM) OPHT OINT,,17735,LOCAL,Facility,Inpatient,3.5 g,g,,176,149.6,50.4416,176,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
GENTAMICIN 0.3 % (3 MG/GRAM) OPHT OINT,,17735,LOCAL,Facility,Outpatient,3.5 g,g,,176,149.6,50.4416,176,"UCare Health, Inc.",Medical Assistance,88.8272,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
GENTAMICIN 0.3 % (3 MG/GRAM) OPHT OINT,,17735,LOCAL,Facility,Inpatient,3.5 g,g,,176,149.6,50.4416,176,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
GENTAMICIN 0.3 % (3 MG/GRAM) OPHT OINT,,17735,LOCAL,Facility,Outpatient,3.5 g,g,,176,149.6,50.4416,176,"UCare Health, Inc.",Medicare Advantage,88.8272,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
GENTAMICIN 0.3 % (3 MG/GRAM) OPHT OINT,,17735,LOCAL,Facility,Inpatient,3.5 g,g,,176,149.6,50.4416,176,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
GENTAMICIN 0.3 % (3 MG/GRAM) OPHT OINT,,17735,LOCAL,Facility,Outpatient,3.5 g,g,,176,149.6,50.4416,176,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),88.8272,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
GENTAMICIN 0.3 % (3 MG/GRAM) OPHT OINT,,17735,LOCAL,Facility,Inpatient,3.5 g,g,,176,149.6,50.4416,176,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
GENTAMICIN 0.3 % (3 MG/GRAM) OPHT OINT,,17735,LOCAL,Facility,Both,3.5 g,g,,176,149.6,50.4416,176,UnitedHealthcare,Individual & Family,165.44,94,,percent of total billed charges,,
GENTAMICIN 0.3 % (3 MG/GRAM) OPHT OINT,,17735,LOCAL,Facility,Outpatient,3.5 g,g,,176,149.6,50.4416,176,UnitedHealthcare,Medicare Advantage,86.24,49,,percent of total billed charges,,
GENTAMICIN 0.3 % (3 MG/GRAM) OPHT OINT,,17735,LOCAL,Facility,Inpatient,3.5 g,g,,176,149.6,50.4416,176,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
GENTAMICIN 0.3 % (3 MG/GRAM) OPHT OINT,,17735,LOCAL,Facility,Outpatient,3.5 g,g,,176,149.6,50.4416,176,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,84.48,48,,percent of total billed charges,,100% of DHS outpatient percentage
GENTAMICIN 0.3 % (3 MG/GRAM) OPHT OINT,,17735,LOCAL,Facility,Inpatient,3.5 g,g,,176,149.6,50.4416,176,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"NEOMYCIN-POLYMYXIN B-DEXAMETH 3.5 MG/G-10,000 UNIT/G-0.1 % OPHT OINT",,20563,LOCAL,Facility,Both,3.5 g,g,,96,81.6,27.5136,96,Aetna,Commercial,88.32,92,,percent of total billed charges,,
"NEOMYCIN-POLYMYXIN B-DEXAMETH 3.5 MG/G-10,000 UNIT/G-0.1 % OPHT OINT",,20563,LOCAL,Facility,Outpatient,3.5 g,g,,96,81.6,27.5136,96,Aetna,Medicare Advantage,47.04,49,,percent of total billed charges,,
"NEOMYCIN-POLYMYXIN B-DEXAMETH 3.5 MG/G-10,000 UNIT/G-0.1 % OPHT OINT",,20563,LOCAL,Facility,Inpatient,3.5 g,g,,96,81.6,27.5136,96,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"NEOMYCIN-POLYMYXIN B-DEXAMETH 3.5 MG/G-10,000 UNIT/G-0.1 % OPHT OINT",,20563,LOCAL,Facility,Both,3.5 g,g,,96,81.6,27.5136,96,Aetna,PPO,89.28,93,,percent of total billed charges,,
"NEOMYCIN-POLYMYXIN B-DEXAMETH 3.5 MG/G-10,000 UNIT/G-0.1 % OPHT OINT",,20563,LOCAL,Facility,Both,3.5 g,g,,96,81.6,27.5136,96,America's PPO,America's PPO,92.1888,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"NEOMYCIN-POLYMYXIN B-DEXAMETH 3.5 MG/G-10,000 UNIT/G-0.1 % OPHT OINT",,20563,LOCAL,Facility,Both,3.5 g,g,,96,81.6,27.5136,96,BlueCross BlueShield Minnesota, Federal Employee Program,94.464,98.4,,percent of total billed charges,,
"NEOMYCIN-POLYMYXIN B-DEXAMETH 3.5 MG/G-10,000 UNIT/G-0.1 % OPHT OINT",,20563,LOCAL,Facility,Both,3.5 g,g,,96,81.6,27.5136,96,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,96,100,,percent of total billed charges,,
"NEOMYCIN-POLYMYXIN B-DEXAMETH 3.5 MG/G-10,000 UNIT/G-0.1 % OPHT OINT",,20563,LOCAL,Facility,Both,3.5 g,g,,96,81.6,27.5136,96,BlueCross BlueShield Minnesota,High Value Network Plan,86.4,90,,percent of total billed charges,,
"NEOMYCIN-POLYMYXIN B-DEXAMETH 3.5 MG/G-10,000 UNIT/G-0.1 % OPHT OINT",,20563,LOCAL,Facility,Outpatient,3.5 g,g,,96,81.6,27.5136,96,BlueCross BlueShield Minnesota,Medicare Advantage,47.04,49,,percent of total billed charges,,
"NEOMYCIN-POLYMYXIN B-DEXAMETH 3.5 MG/G-10,000 UNIT/G-0.1 % OPHT OINT",,20563,LOCAL,Facility,Inpatient,3.5 g,g,,96,81.6,27.5136,96,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"NEOMYCIN-POLYMYXIN B-DEXAMETH 3.5 MG/G-10,000 UNIT/G-0.1 % OPHT OINT",,20563,LOCAL,Facility,Both,3.5 g,g,,96,81.6,27.5136,96,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,85.0272,88.57,,percent of total billed charges,,
"NEOMYCIN-POLYMYXIN B-DEXAMETH 3.5 MG/G-10,000 UNIT/G-0.1 % OPHT OINT",,20563,LOCAL,Facility,Both,3.5 g,g,,96,81.6,27.5136,96,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,27.5136,28.66,,percent of total billed charges,,
"NEOMYCIN-POLYMYXIN B-DEXAMETH 3.5 MG/G-10,000 UNIT/G-0.1 % OPHT OINT",,20563,LOCAL,Facility,Outpatient,3.5 g,g,,96,81.6,27.5136,96,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),47.04,49,,percent of total billed charges,,
"NEOMYCIN-POLYMYXIN B-DEXAMETH 3.5 MG/G-10,000 UNIT/G-0.1 % OPHT OINT",,20563,LOCAL,Facility,Inpatient,3.5 g,g,,96,81.6,27.5136,96,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"NEOMYCIN-POLYMYXIN B-DEXAMETH 3.5 MG/G-10,000 UNIT/G-0.1 % OPHT OINT",,20563,LOCAL,Facility,Both,3.5 g,g,,96,81.6,27.5136,96,CorVel,Worker's Compensation,96,100,,percent of total billed charges,,
"NEOMYCIN-POLYMYXIN B-DEXAMETH 3.5 MG/G-10,000 UNIT/G-0.1 % OPHT OINT",,20563,LOCAL,Facility,Both,3.5 g,g,,96,81.6,27.5136,96,First Health Group Corporation,First Health Network,93.12,97,,percent of total billed charges,,
"NEOMYCIN-POLYMYXIN B-DEXAMETH 3.5 MG/G-10,000 UNIT/G-0.1 % OPHT OINT",,20563,LOCAL,Facility,Both,3.5 g,g,,96,81.6,27.5136,96,"Health Partners, Inc.",Commercial,90.816,94.6,,percent of total billed charges,,
"NEOMYCIN-POLYMYXIN B-DEXAMETH 3.5 MG/G-10,000 UNIT/G-0.1 % OPHT OINT",,20563,LOCAL,Facility,Outpatient,3.5 g,g,,96,81.6,27.5136,96,"Health Partners, Inc.",Medicare Advantage,47.04,49,,percent of total billed charges,,
"NEOMYCIN-POLYMYXIN B-DEXAMETH 3.5 MG/G-10,000 UNIT/G-0.1 % OPHT OINT",,20563,LOCAL,Facility,Inpatient,3.5 g,g,,96,81.6,27.5136,96,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"NEOMYCIN-POLYMYXIN B-DEXAMETH 3.5 MG/G-10,000 UNIT/G-0.1 % OPHT OINT",,20563,LOCAL,Facility,Both,3.5 g,g,,96,81.6,27.5136,96,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),57.6,60,,percent of total billed charges,,
"NEOMYCIN-POLYMYXIN B-DEXAMETH 3.5 MG/G-10,000 UNIT/G-0.1 % OPHT OINT",,20563,LOCAL,Facility,Both,3.5 g,g,,96,81.6,27.5136,96,"Health Partners, Inc.",State of Minnesota Advantage Program,78.24,81.5,,percent of total billed charges,,
"NEOMYCIN-POLYMYXIN B-DEXAMETH 3.5 MG/G-10,000 UNIT/G-0.1 % OPHT OINT",,20563,LOCAL,Facility,Both,3.5 g,g,,96,81.6,27.5136,96,"Health Partners, Inc.",State Public Programs,48,50,,percent of total billed charges,,
"NEOMYCIN-POLYMYXIN B-DEXAMETH 3.5 MG/G-10,000 UNIT/G-0.1 % OPHT OINT",,20563,LOCAL,Facility,Both,3.5 g,g,,96,81.6,27.5136,96,Humana Insurance Company,Commercial PPO,91.2,95,,percent of total billed charges,,
"NEOMYCIN-POLYMYXIN B-DEXAMETH 3.5 MG/G-10,000 UNIT/G-0.1 % OPHT OINT",,20563,LOCAL,Facility,Outpatient,3.5 g,g,,96,81.6,27.5136,96,Humana Insurance Company,Medicare PPO,47.04,49,,percent of total billed charges,,
"NEOMYCIN-POLYMYXIN B-DEXAMETH 3.5 MG/G-10,000 UNIT/G-0.1 % OPHT OINT",,20563,LOCAL,Facility,Inpatient,3.5 g,g,,96,81.6,27.5136,96,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"NEOMYCIN-POLYMYXIN B-DEXAMETH 3.5 MG/G-10,000 UNIT/G-0.1 % OPHT OINT",,20563,LOCAL,Facility,Both,3.5 g,g,,96,81.6,27.5136,96,Medica,Individual & Family,95.136,99.1,,percent of total billed charges,,
"NEOMYCIN-POLYMYXIN B-DEXAMETH 3.5 MG/G-10,000 UNIT/G-0.1 % OPHT OINT",,20563,LOCAL,Facility,Outpatient,3.5 g,g,,96,81.6,27.5136,96,Medica,Medica Advantage Solution,47.808,49.8,,percent of total billed charges,,
"NEOMYCIN-POLYMYXIN B-DEXAMETH 3.5 MG/G-10,000 UNIT/G-0.1 % OPHT OINT",,20563,LOCAL,Facility,Inpatient,3.5 g,g,,96,81.6,27.5136,96,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"NEOMYCIN-POLYMYXIN B-DEXAMETH 3.5 MG/G-10,000 UNIT/G-0.1 % OPHT OINT",,20563,LOCAL,Facility,Outpatient,3.5 g,g,,96,81.6,27.5136,96,Medica,Medical Assistance,42.816,44.6,,percent of total billed charges,,
"NEOMYCIN-POLYMYXIN B-DEXAMETH 3.5 MG/G-10,000 UNIT/G-0.1 % OPHT OINT",,20563,LOCAL,Facility,Inpatient,3.5 g,g,,96,81.6,27.5136,96,Medica,Medical Assistance,,,,,Included in per diem rate,
"NEOMYCIN-POLYMYXIN B-DEXAMETH 3.5 MG/G-10,000 UNIT/G-0.1 % OPHT OINT",,20563,LOCAL,Facility,Outpatient,3.5 g,g,,96,81.6,27.5136,96,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,47.808,49.8,,percent of total billed charges,,
"NEOMYCIN-POLYMYXIN B-DEXAMETH 3.5 MG/G-10,000 UNIT/G-0.1 % OPHT OINT",,20563,LOCAL,Facility,Inpatient,3.5 g,g,,96,81.6,27.5136,96,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"NEOMYCIN-POLYMYXIN B-DEXAMETH 3.5 MG/G-10,000 UNIT/G-0.1 % OPHT OINT",,20563,LOCAL,Facility,Both,3.5 g,g,,96,81.6,27.5136,96,"Multiplan, Inc.","Multiplan, Inc.",90.24,94,,percent of total billed charges,,
"NEOMYCIN-POLYMYXIN B-DEXAMETH 3.5 MG/G-10,000 UNIT/G-0.1 % OPHT OINT",,20563,LOCAL,Facility,Outpatient,3.5 g,g,,96,81.6,27.5136,96,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,86.496,90.1,,percent of total billed charges,,
"NEOMYCIN-POLYMYXIN B-DEXAMETH 3.5 MG/G-10,000 UNIT/G-0.1 % OPHT OINT",,20563,LOCAL,Facility,Inpatient,3.5 g,g,,96,81.6,27.5136,96,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"NEOMYCIN-POLYMYXIN B-DEXAMETH 3.5 MG/G-10,000 UNIT/G-0.1 % OPHT OINT",,20563,LOCAL,Facility,Both,3.5 g,g,,96,81.6,27.5136,96,"Preferred One Administrative Services, INC.",PPO,94.656,98.6,,percent of total billed charges,,
"NEOMYCIN-POLYMYXIN B-DEXAMETH 3.5 MG/G-10,000 UNIT/G-0.1 % OPHT OINT",,20563,LOCAL,Facility,Outpatient,3.5 g,g,,96,81.6,27.5136,96,PrimeWest Health,Minnesota Senior Health Options (MSHO),49.392,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"NEOMYCIN-POLYMYXIN B-DEXAMETH 3.5 MG/G-10,000 UNIT/G-0.1 % OPHT OINT",,20563,LOCAL,Facility,Inpatient,3.5 g,g,,96,81.6,27.5136,96,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"NEOMYCIN-POLYMYXIN B-DEXAMETH 3.5 MG/G-10,000 UNIT/G-0.1 % OPHT OINT",,20563,LOCAL,Facility,Outpatient,3.5 g,g,,96,81.6,27.5136,96,PrimeWest Health,MinnesotaCare,49.3056,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"NEOMYCIN-POLYMYXIN B-DEXAMETH 3.5 MG/G-10,000 UNIT/G-0.1 % OPHT OINT",,20563,LOCAL,Facility,Inpatient,3.5 g,g,,96,81.6,27.5136,96,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"NEOMYCIN-POLYMYXIN B-DEXAMETH 3.5 MG/G-10,000 UNIT/G-0.1 % OPHT OINT",,20563,LOCAL,Facility,Both,3.5 g,g,,96,81.6,27.5136,96,Sanford Health Plan,Sanford Health Plan,88.32,92,,percent of total billed charges,,
"NEOMYCIN-POLYMYXIN B-DEXAMETH 3.5 MG/G-10,000 UNIT/G-0.1 % OPHT OINT",,20563,LOCAL,Facility,Outpatient,3.5 g,g,,96,81.6,27.5136,96,"UCare Health, Inc.",Individual & Family Plan,54.096,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"NEOMYCIN-POLYMYXIN B-DEXAMETH 3.5 MG/G-10,000 UNIT/G-0.1 % OPHT OINT",,20563,LOCAL,Facility,Inpatient,3.5 g,g,,96,81.6,27.5136,96,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"NEOMYCIN-POLYMYXIN B-DEXAMETH 3.5 MG/G-10,000 UNIT/G-0.1 % OPHT OINT",,20563,LOCAL,Facility,Outpatient,3.5 g,g,,96,81.6,27.5136,96,"UCare Health, Inc.",Medical Assistance,48.4512,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"NEOMYCIN-POLYMYXIN B-DEXAMETH 3.5 MG/G-10,000 UNIT/G-0.1 % OPHT OINT",,20563,LOCAL,Facility,Inpatient,3.5 g,g,,96,81.6,27.5136,96,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"NEOMYCIN-POLYMYXIN B-DEXAMETH 3.5 MG/G-10,000 UNIT/G-0.1 % OPHT OINT",,20563,LOCAL,Facility,Outpatient,3.5 g,g,,96,81.6,27.5136,96,"UCare Health, Inc.",Medicare Advantage,48.4512,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"NEOMYCIN-POLYMYXIN B-DEXAMETH 3.5 MG/G-10,000 UNIT/G-0.1 % OPHT OINT",,20563,LOCAL,Facility,Inpatient,3.5 g,g,,96,81.6,27.5136,96,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"NEOMYCIN-POLYMYXIN B-DEXAMETH 3.5 MG/G-10,000 UNIT/G-0.1 % OPHT OINT",,20563,LOCAL,Facility,Outpatient,3.5 g,g,,96,81.6,27.5136,96,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),48.4512,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"NEOMYCIN-POLYMYXIN B-DEXAMETH 3.5 MG/G-10,000 UNIT/G-0.1 % OPHT OINT",,20563,LOCAL,Facility,Inpatient,3.5 g,g,,96,81.6,27.5136,96,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"NEOMYCIN-POLYMYXIN B-DEXAMETH 3.5 MG/G-10,000 UNIT/G-0.1 % OPHT OINT",,20563,LOCAL,Facility,Both,3.5 g,g,,96,81.6,27.5136,96,UnitedHealthcare,Individual & Family,90.24,94,,percent of total billed charges,,
"NEOMYCIN-POLYMYXIN B-DEXAMETH 3.5 MG/G-10,000 UNIT/G-0.1 % OPHT OINT",,20563,LOCAL,Facility,Outpatient,3.5 g,g,,96,81.6,27.5136,96,UnitedHealthcare,Medicare Advantage,47.04,49,,percent of total billed charges,,
"NEOMYCIN-POLYMYXIN B-DEXAMETH 3.5 MG/G-10,000 UNIT/G-0.1 % OPHT OINT",,20563,LOCAL,Facility,Inpatient,3.5 g,g,,96,81.6,27.5136,96,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"NEOMYCIN-POLYMYXIN B-DEXAMETH 3.5 MG/G-10,000 UNIT/G-0.1 % OPHT OINT",,20563,LOCAL,Facility,Outpatient,3.5 g,g,,96,81.6,27.5136,96,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,46.08,48,,percent of total billed charges,,100% of DHS outpatient percentage
"NEOMYCIN-POLYMYXIN B-DEXAMETH 3.5 MG/G-10,000 UNIT/G-0.1 % OPHT OINT",,20563,LOCAL,Facility,Inpatient,3.5 g,g,,96,81.6,27.5136,96,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
ARTIFICIAL TEARS OINTMENT WRAPPER,,900707,LOCAL,Facility,Both,3.5 g,g,,57,48.45,16.3362,57,Aetna,Commercial,52.44,92,,percent of total billed charges,,
ARTIFICIAL TEARS OINTMENT WRAPPER,,900707,LOCAL,Facility,Outpatient,3.5 g,g,,57,48.45,16.3362,57,Aetna,Medicare Advantage,27.93,49,,percent of total billed charges,,
ARTIFICIAL TEARS OINTMENT WRAPPER,,900707,LOCAL,Facility,Inpatient,3.5 g,g,,57,48.45,16.3362,57,Aetna,Medicare Advantage,,,,,Included in per diem rate,
ARTIFICIAL TEARS OINTMENT WRAPPER,,900707,LOCAL,Facility,Both,3.5 g,g,,57,48.45,16.3362,57,Aetna,PPO,53.01,93,,percent of total billed charges,,
ARTIFICIAL TEARS OINTMENT WRAPPER,,900707,LOCAL,Facility,Both,3.5 g,g,,57,48.45,16.3362,57,America's PPO,America's PPO,54.7371,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
ARTIFICIAL TEARS OINTMENT WRAPPER,,900707,LOCAL,Facility,Both,3.5 g,g,,57,48.45,16.3362,57,BlueCross BlueShield Minnesota, Federal Employee Program,56.088,98.4,,percent of total billed charges,,
ARTIFICIAL TEARS OINTMENT WRAPPER,,900707,LOCAL,Facility,Both,3.5 g,g,,57,48.45,16.3362,57,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,57,100,,percent of total billed charges,,
ARTIFICIAL TEARS OINTMENT WRAPPER,,900707,LOCAL,Facility,Both,3.5 g,g,,57,48.45,16.3362,57,BlueCross BlueShield Minnesota,High Value Network Plan,51.3,90,,percent of total billed charges,,
ARTIFICIAL TEARS OINTMENT WRAPPER,,900707,LOCAL,Facility,Outpatient,3.5 g,g,,57,48.45,16.3362,57,BlueCross BlueShield Minnesota,Medicare Advantage,27.93,49,,percent of total billed charges,,
ARTIFICIAL TEARS OINTMENT WRAPPER,,900707,LOCAL,Facility,Inpatient,3.5 g,g,,57,48.45,16.3362,57,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
ARTIFICIAL TEARS OINTMENT WRAPPER,,900707,LOCAL,Facility,Both,3.5 g,g,,57,48.45,16.3362,57,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,50.4849,88.57,,percent of total billed charges,,
ARTIFICIAL TEARS OINTMENT WRAPPER,,900707,LOCAL,Facility,Both,3.5 g,g,,57,48.45,16.3362,57,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,16.3362,28.66,,percent of total billed charges,,
ARTIFICIAL TEARS OINTMENT WRAPPER,,900707,LOCAL,Facility,Outpatient,3.5 g,g,,57,48.45,16.3362,57,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),27.93,49,,percent of total billed charges,,
ARTIFICIAL TEARS OINTMENT WRAPPER,,900707,LOCAL,Facility,Inpatient,3.5 g,g,,57,48.45,16.3362,57,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
ARTIFICIAL TEARS OINTMENT WRAPPER,,900707,LOCAL,Facility,Both,3.5 g,g,,57,48.45,16.3362,57,CorVel,Worker's Compensation,57,100,,percent of total billed charges,,
ARTIFICIAL TEARS OINTMENT WRAPPER,,900707,LOCAL,Facility,Both,3.5 g,g,,57,48.45,16.3362,57,First Health Group Corporation,First Health Network,55.29,97,,percent of total billed charges,,
ARTIFICIAL TEARS OINTMENT WRAPPER,,900707,LOCAL,Facility,Both,3.5 g,g,,57,48.45,16.3362,57,"Health Partners, Inc.",Commercial,53.922,94.6,,percent of total billed charges,,
ARTIFICIAL TEARS OINTMENT WRAPPER,,900707,LOCAL,Facility,Outpatient,3.5 g,g,,57,48.45,16.3362,57,"Health Partners, Inc.",Medicare Advantage,27.93,49,,percent of total billed charges,,
ARTIFICIAL TEARS OINTMENT WRAPPER,,900707,LOCAL,Facility,Inpatient,3.5 g,g,,57,48.45,16.3362,57,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ARTIFICIAL TEARS OINTMENT WRAPPER,,900707,LOCAL,Facility,Both,3.5 g,g,,57,48.45,16.3362,57,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),34.2,60,,percent of total billed charges,,
ARTIFICIAL TEARS OINTMENT WRAPPER,,900707,LOCAL,Facility,Both,3.5 g,g,,57,48.45,16.3362,57,"Health Partners, Inc.",State of Minnesota Advantage Program,46.455,81.5,,percent of total billed charges,,
ARTIFICIAL TEARS OINTMENT WRAPPER,,900707,LOCAL,Facility,Both,3.5 g,g,,57,48.45,16.3362,57,"Health Partners, Inc.",State Public Programs,28.5,50,,percent of total billed charges,,
ARTIFICIAL TEARS OINTMENT WRAPPER,,900707,LOCAL,Facility,Both,3.5 g,g,,57,48.45,16.3362,57,Humana Insurance Company,Commercial PPO,54.15,95,,percent of total billed charges,,
ARTIFICIAL TEARS OINTMENT WRAPPER,,900707,LOCAL,Facility,Outpatient,3.5 g,g,,57,48.45,16.3362,57,Humana Insurance Company,Medicare PPO,27.93,49,,percent of total billed charges,,
ARTIFICIAL TEARS OINTMENT WRAPPER,,900707,LOCAL,Facility,Inpatient,3.5 g,g,,57,48.45,16.3362,57,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
ARTIFICIAL TEARS OINTMENT WRAPPER,,900707,LOCAL,Facility,Both,3.5 g,g,,57,48.45,16.3362,57,Medica,Individual & Family,56.487,99.1,,percent of total billed charges,,
ARTIFICIAL TEARS OINTMENT WRAPPER,,900707,LOCAL,Facility,Outpatient,3.5 g,g,,57,48.45,16.3362,57,Medica,Medica Advantage Solution,28.386,49.8,,percent of total billed charges,,
ARTIFICIAL TEARS OINTMENT WRAPPER,,900707,LOCAL,Facility,Inpatient,3.5 g,g,,57,48.45,16.3362,57,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
ARTIFICIAL TEARS OINTMENT WRAPPER,,900707,LOCAL,Facility,Outpatient,3.5 g,g,,57,48.45,16.3362,57,Medica,Medical Assistance,25.422,44.6,,percent of total billed charges,,
ARTIFICIAL TEARS OINTMENT WRAPPER,,900707,LOCAL,Facility,Inpatient,3.5 g,g,,57,48.45,16.3362,57,Medica,Medical Assistance,,,,,Included in per diem rate,
ARTIFICIAL TEARS OINTMENT WRAPPER,,900707,LOCAL,Facility,Outpatient,3.5 g,g,,57,48.45,16.3362,57,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,28.386,49.8,,percent of total billed charges,,
ARTIFICIAL TEARS OINTMENT WRAPPER,,900707,LOCAL,Facility,Inpatient,3.5 g,g,,57,48.45,16.3362,57,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
ARTIFICIAL TEARS OINTMENT WRAPPER,,900707,LOCAL,Facility,Both,3.5 g,g,,57,48.45,16.3362,57,"Multiplan, Inc.","Multiplan, Inc.",53.58,94,,percent of total billed charges,,
ARTIFICIAL TEARS OINTMENT WRAPPER,,900707,LOCAL,Facility,Outpatient,3.5 g,g,,57,48.45,16.3362,57,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,51.357,90.1,,percent of total billed charges,,
ARTIFICIAL TEARS OINTMENT WRAPPER,,900707,LOCAL,Facility,Inpatient,3.5 g,g,,57,48.45,16.3362,57,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
ARTIFICIAL TEARS OINTMENT WRAPPER,,900707,LOCAL,Facility,Both,3.5 g,g,,57,48.45,16.3362,57,"Preferred One Administrative Services, INC.",PPO,56.202,98.6,,percent of total billed charges,,
ARTIFICIAL TEARS OINTMENT WRAPPER,,900707,LOCAL,Facility,Outpatient,3.5 g,g,,57,48.45,16.3362,57,PrimeWest Health,Minnesota Senior Health Options (MSHO),29.3265,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
ARTIFICIAL TEARS OINTMENT WRAPPER,,900707,LOCAL,Facility,Inpatient,3.5 g,g,,57,48.45,16.3362,57,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ARTIFICIAL TEARS OINTMENT WRAPPER,,900707,LOCAL,Facility,Outpatient,3.5 g,g,,57,48.45,16.3362,57,PrimeWest Health,MinnesotaCare,29.2752,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
ARTIFICIAL TEARS OINTMENT WRAPPER,,900707,LOCAL,Facility,Inpatient,3.5 g,g,,57,48.45,16.3362,57,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
ARTIFICIAL TEARS OINTMENT WRAPPER,,900707,LOCAL,Facility,Both,3.5 g,g,,57,48.45,16.3362,57,Sanford Health Plan,Sanford Health Plan,52.44,92,,percent of total billed charges,,
ARTIFICIAL TEARS OINTMENT WRAPPER,,900707,LOCAL,Facility,Outpatient,3.5 g,g,,57,48.45,16.3362,57,"UCare Health, Inc.",Individual & Family Plan,32.1195,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
ARTIFICIAL TEARS OINTMENT WRAPPER,,900707,LOCAL,Facility,Inpatient,3.5 g,g,,57,48.45,16.3362,57,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
ARTIFICIAL TEARS OINTMENT WRAPPER,,900707,LOCAL,Facility,Outpatient,3.5 g,g,,57,48.45,16.3362,57,"UCare Health, Inc.",Medical Assistance,28.7679,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ARTIFICIAL TEARS OINTMENT WRAPPER,,900707,LOCAL,Facility,Inpatient,3.5 g,g,,57,48.45,16.3362,57,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
ARTIFICIAL TEARS OINTMENT WRAPPER,,900707,LOCAL,Facility,Outpatient,3.5 g,g,,57,48.45,16.3362,57,"UCare Health, Inc.",Medicare Advantage,28.7679,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ARTIFICIAL TEARS OINTMENT WRAPPER,,900707,LOCAL,Facility,Inpatient,3.5 g,g,,57,48.45,16.3362,57,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ARTIFICIAL TEARS OINTMENT WRAPPER,,900707,LOCAL,Facility,Outpatient,3.5 g,g,,57,48.45,16.3362,57,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),28.7679,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ARTIFICIAL TEARS OINTMENT WRAPPER,,900707,LOCAL,Facility,Inpatient,3.5 g,g,,57,48.45,16.3362,57,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ARTIFICIAL TEARS OINTMENT WRAPPER,,900707,LOCAL,Facility,Both,3.5 g,g,,57,48.45,16.3362,57,UnitedHealthcare,Individual & Family,53.58,94,,percent of total billed charges,,
ARTIFICIAL TEARS OINTMENT WRAPPER,,900707,LOCAL,Facility,Outpatient,3.5 g,g,,57,48.45,16.3362,57,UnitedHealthcare,Medicare Advantage,27.93,49,,percent of total billed charges,,
ARTIFICIAL TEARS OINTMENT WRAPPER,,900707,LOCAL,Facility,Inpatient,3.5 g,g,,57,48.45,16.3362,57,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
ARTIFICIAL TEARS OINTMENT WRAPPER,,900707,LOCAL,Facility,Outpatient,3.5 g,g,,57,48.45,16.3362,57,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,27.36,48,,percent of total billed charges,,100% of DHS outpatient percentage
ARTIFICIAL TEARS OINTMENT WRAPPER,,900707,LOCAL,Facility,Inpatient,3.5 g,g,,57,48.45,16.3362,57,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
CALCITONIN (SALMON) 200 UNIT/ACTUATION NASL SPRY,,11297,LOCAL,Facility,Both,3.7 mL,mL,,463,393.55,132.6958,463,Aetna,Commercial,425.96,92,,percent of total billed charges,,
CALCITONIN (SALMON) 200 UNIT/ACTUATION NASL SPRY,,11297,LOCAL,Facility,Outpatient,3.7 mL,mL,,463,393.55,132.6958,463,Aetna,Medicare Advantage,226.87,49,,percent of total billed charges,,
CALCITONIN (SALMON) 200 UNIT/ACTUATION NASL SPRY,,11297,LOCAL,Facility,Inpatient,3.7 mL,mL,,463,393.55,132.6958,463,Aetna,Medicare Advantage,,,,,Included in per diem rate,
CALCITONIN (SALMON) 200 UNIT/ACTUATION NASL SPRY,,11297,LOCAL,Facility,Both,3.7 mL,mL,,463,393.55,132.6958,463,Aetna,PPO,430.59,93,,percent of total billed charges,,
CALCITONIN (SALMON) 200 UNIT/ACTUATION NASL SPRY,,11297,LOCAL,Facility,Both,3.7 mL,mL,,463,393.55,132.6958,463,America's PPO,America's PPO,444.6189,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
CALCITONIN (SALMON) 200 UNIT/ACTUATION NASL SPRY,,11297,LOCAL,Facility,Both,3.7 mL,mL,,463,393.55,132.6958,463,BlueCross BlueShield Minnesota, Federal Employee Program,455.592,98.4,,percent of total billed charges,,
CALCITONIN (SALMON) 200 UNIT/ACTUATION NASL SPRY,,11297,LOCAL,Facility,Both,3.7 mL,mL,,463,393.55,132.6958,463,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,463,100,,percent of total billed charges,,
CALCITONIN (SALMON) 200 UNIT/ACTUATION NASL SPRY,,11297,LOCAL,Facility,Both,3.7 mL,mL,,463,393.55,132.6958,463,BlueCross BlueShield Minnesota,High Value Network Plan,416.7,90,,percent of total billed charges,,
CALCITONIN (SALMON) 200 UNIT/ACTUATION NASL SPRY,,11297,LOCAL,Facility,Outpatient,3.7 mL,mL,,463,393.55,132.6958,463,BlueCross BlueShield Minnesota,Medicare Advantage,226.87,49,,percent of total billed charges,,
CALCITONIN (SALMON) 200 UNIT/ACTUATION NASL SPRY,,11297,LOCAL,Facility,Inpatient,3.7 mL,mL,,463,393.55,132.6958,463,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
CALCITONIN (SALMON) 200 UNIT/ACTUATION NASL SPRY,,11297,LOCAL,Facility,Both,3.7 mL,mL,,463,393.55,132.6958,463,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,410.0791,88.57,,percent of total billed charges,,
CALCITONIN (SALMON) 200 UNIT/ACTUATION NASL SPRY,,11297,LOCAL,Facility,Both,3.7 mL,mL,,463,393.55,132.6958,463,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,132.6958,28.66,,percent of total billed charges,,
CALCITONIN (SALMON) 200 UNIT/ACTUATION NASL SPRY,,11297,LOCAL,Facility,Outpatient,3.7 mL,mL,,463,393.55,132.6958,463,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),226.87,49,,percent of total billed charges,,
CALCITONIN (SALMON) 200 UNIT/ACTUATION NASL SPRY,,11297,LOCAL,Facility,Inpatient,3.7 mL,mL,,463,393.55,132.6958,463,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
CALCITONIN (SALMON) 200 UNIT/ACTUATION NASL SPRY,,11297,LOCAL,Facility,Both,3.7 mL,mL,,463,393.55,132.6958,463,CorVel,Worker's Compensation,463,100,,percent of total billed charges,,
CALCITONIN (SALMON) 200 UNIT/ACTUATION NASL SPRY,,11297,LOCAL,Facility,Both,3.7 mL,mL,,463,393.55,132.6958,463,First Health Group Corporation,First Health Network,449.11,97,,percent of total billed charges,,
CALCITONIN (SALMON) 200 UNIT/ACTUATION NASL SPRY,,11297,LOCAL,Facility,Both,3.7 mL,mL,,463,393.55,132.6958,463,"Health Partners, Inc.",Commercial,437.998,94.6,,percent of total billed charges,,
CALCITONIN (SALMON) 200 UNIT/ACTUATION NASL SPRY,,11297,LOCAL,Facility,Outpatient,3.7 mL,mL,,463,393.55,132.6958,463,"Health Partners, Inc.",Medicare Advantage,226.87,49,,percent of total billed charges,,
CALCITONIN (SALMON) 200 UNIT/ACTUATION NASL SPRY,,11297,LOCAL,Facility,Inpatient,3.7 mL,mL,,463,393.55,132.6958,463,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CALCITONIN (SALMON) 200 UNIT/ACTUATION NASL SPRY,,11297,LOCAL,Facility,Both,3.7 mL,mL,,463,393.55,132.6958,463,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),277.8,60,,percent of total billed charges,,
CALCITONIN (SALMON) 200 UNIT/ACTUATION NASL SPRY,,11297,LOCAL,Facility,Both,3.7 mL,mL,,463,393.55,132.6958,463,"Health Partners, Inc.",State of Minnesota Advantage Program,377.345,81.5,,percent of total billed charges,,
CALCITONIN (SALMON) 200 UNIT/ACTUATION NASL SPRY,,11297,LOCAL,Facility,Both,3.7 mL,mL,,463,393.55,132.6958,463,"Health Partners, Inc.",State Public Programs,231.5,50,,percent of total billed charges,,
CALCITONIN (SALMON) 200 UNIT/ACTUATION NASL SPRY,,11297,LOCAL,Facility,Both,3.7 mL,mL,,463,393.55,132.6958,463,Humana Insurance Company,Commercial PPO,439.85,95,,percent of total billed charges,,
CALCITONIN (SALMON) 200 UNIT/ACTUATION NASL SPRY,,11297,LOCAL,Facility,Outpatient,3.7 mL,mL,,463,393.55,132.6958,463,Humana Insurance Company,Medicare PPO,226.87,49,,percent of total billed charges,,
CALCITONIN (SALMON) 200 UNIT/ACTUATION NASL SPRY,,11297,LOCAL,Facility,Inpatient,3.7 mL,mL,,463,393.55,132.6958,463,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
CALCITONIN (SALMON) 200 UNIT/ACTUATION NASL SPRY,,11297,LOCAL,Facility,Both,3.7 mL,mL,,463,393.55,132.6958,463,Medica,Individual & Family,458.833,99.1,,percent of total billed charges,,
CALCITONIN (SALMON) 200 UNIT/ACTUATION NASL SPRY,,11297,LOCAL,Facility,Outpatient,3.7 mL,mL,,463,393.55,132.6958,463,Medica,Medica Advantage Solution,230.574,49.8,,percent of total billed charges,,
CALCITONIN (SALMON) 200 UNIT/ACTUATION NASL SPRY,,11297,LOCAL,Facility,Inpatient,3.7 mL,mL,,463,393.55,132.6958,463,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
CALCITONIN (SALMON) 200 UNIT/ACTUATION NASL SPRY,,11297,LOCAL,Facility,Outpatient,3.7 mL,mL,,463,393.55,132.6958,463,Medica,Medical Assistance,206.498,44.6,,percent of total billed charges,,
CALCITONIN (SALMON) 200 UNIT/ACTUATION NASL SPRY,,11297,LOCAL,Facility,Inpatient,3.7 mL,mL,,463,393.55,132.6958,463,Medica,Medical Assistance,,,,,Included in per diem rate,
CALCITONIN (SALMON) 200 UNIT/ACTUATION NASL SPRY,,11297,LOCAL,Facility,Outpatient,3.7 mL,mL,,463,393.55,132.6958,463,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,230.574,49.8,,percent of total billed charges,,
CALCITONIN (SALMON) 200 UNIT/ACTUATION NASL SPRY,,11297,LOCAL,Facility,Inpatient,3.7 mL,mL,,463,393.55,132.6958,463,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
CALCITONIN (SALMON) 200 UNIT/ACTUATION NASL SPRY,,11297,LOCAL,Facility,Both,3.7 mL,mL,,463,393.55,132.6958,463,"Multiplan, Inc.","Multiplan, Inc.",435.22,94,,percent of total billed charges,,
CALCITONIN (SALMON) 200 UNIT/ACTUATION NASL SPRY,,11297,LOCAL,Facility,Outpatient,3.7 mL,mL,,463,393.55,132.6958,463,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,417.163,90.1,,percent of total billed charges,,
CALCITONIN (SALMON) 200 UNIT/ACTUATION NASL SPRY,,11297,LOCAL,Facility,Inpatient,3.7 mL,mL,,463,393.55,132.6958,463,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
CALCITONIN (SALMON) 200 UNIT/ACTUATION NASL SPRY,,11297,LOCAL,Facility,Both,3.7 mL,mL,,463,393.55,132.6958,463,"Preferred One Administrative Services, INC.",PPO,456.518,98.6,,percent of total billed charges,,
CALCITONIN (SALMON) 200 UNIT/ACTUATION NASL SPRY,,11297,LOCAL,Facility,Outpatient,3.7 mL,mL,,463,393.55,132.6958,463,PrimeWest Health,Minnesota Senior Health Options (MSHO),238.2135,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
CALCITONIN (SALMON) 200 UNIT/ACTUATION NASL SPRY,,11297,LOCAL,Facility,Inpatient,3.7 mL,mL,,463,393.55,132.6958,463,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CALCITONIN (SALMON) 200 UNIT/ACTUATION NASL SPRY,,11297,LOCAL,Facility,Outpatient,3.7 mL,mL,,463,393.55,132.6958,463,PrimeWest Health,MinnesotaCare,237.7968,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
CALCITONIN (SALMON) 200 UNIT/ACTUATION NASL SPRY,,11297,LOCAL,Facility,Inpatient,3.7 mL,mL,,463,393.55,132.6958,463,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
CALCITONIN (SALMON) 200 UNIT/ACTUATION NASL SPRY,,11297,LOCAL,Facility,Both,3.7 mL,mL,,463,393.55,132.6958,463,Sanford Health Plan,Sanford Health Plan,425.96,92,,percent of total billed charges,,
CALCITONIN (SALMON) 200 UNIT/ACTUATION NASL SPRY,,11297,LOCAL,Facility,Outpatient,3.7 mL,mL,,463,393.55,132.6958,463,"UCare Health, Inc.",Individual & Family Plan,260.9005,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
CALCITONIN (SALMON) 200 UNIT/ACTUATION NASL SPRY,,11297,LOCAL,Facility,Inpatient,3.7 mL,mL,,463,393.55,132.6958,463,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
CALCITONIN (SALMON) 200 UNIT/ACTUATION NASL SPRY,,11297,LOCAL,Facility,Outpatient,3.7 mL,mL,,463,393.55,132.6958,463,"UCare Health, Inc.",Medical Assistance,233.6761,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CALCITONIN (SALMON) 200 UNIT/ACTUATION NASL SPRY,,11297,LOCAL,Facility,Inpatient,3.7 mL,mL,,463,393.55,132.6958,463,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
CALCITONIN (SALMON) 200 UNIT/ACTUATION NASL SPRY,,11297,LOCAL,Facility,Outpatient,3.7 mL,mL,,463,393.55,132.6958,463,"UCare Health, Inc.",Medicare Advantage,233.6761,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CALCITONIN (SALMON) 200 UNIT/ACTUATION NASL SPRY,,11297,LOCAL,Facility,Inpatient,3.7 mL,mL,,463,393.55,132.6958,463,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CALCITONIN (SALMON) 200 UNIT/ACTUATION NASL SPRY,,11297,LOCAL,Facility,Outpatient,3.7 mL,mL,,463,393.55,132.6958,463,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),233.6761,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CALCITONIN (SALMON) 200 UNIT/ACTUATION NASL SPRY,,11297,LOCAL,Facility,Inpatient,3.7 mL,mL,,463,393.55,132.6958,463,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CALCITONIN (SALMON) 200 UNIT/ACTUATION NASL SPRY,,11297,LOCAL,Facility,Both,3.7 mL,mL,,463,393.55,132.6958,463,UnitedHealthcare,Individual & Family,435.22,94,,percent of total billed charges,,
CALCITONIN (SALMON) 200 UNIT/ACTUATION NASL SPRY,,11297,LOCAL,Facility,Outpatient,3.7 mL,mL,,463,393.55,132.6958,463,UnitedHealthcare,Medicare Advantage,226.87,49,,percent of total billed charges,,
CALCITONIN (SALMON) 200 UNIT/ACTUATION NASL SPRY,,11297,LOCAL,Facility,Inpatient,3.7 mL,mL,,463,393.55,132.6958,463,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
CALCITONIN (SALMON) 200 UNIT/ACTUATION NASL SPRY,,11297,LOCAL,Facility,Outpatient,3.7 mL,mL,,463,393.55,132.6958,463,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,222.24,48,,percent of total billed charges,,100% of DHS outpatient percentage
CALCITONIN (SALMON) 200 UNIT/ACTUATION NASL SPRY,,11297,LOCAL,Facility,Inpatient,3.7 mL,mL,,463,393.55,132.6958,463,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
HYDROCORTISONE 2.5 % TOP CRPE,,9501,LOCAL,Facility,Both,30 g,TUBE,,63,53.55,18.0558,63,Aetna,Commercial,57.96,92,,percent of total billed charges,,
HYDROCORTISONE 2.5 % TOP CRPE,,9501,LOCAL,Facility,Outpatient,30 g,TUBE,,63,53.55,18.0558,63,Aetna,Medicare Advantage,30.87,49,,percent of total billed charges,,
HYDROCORTISONE 2.5 % TOP CRPE,,9501,LOCAL,Facility,Inpatient,30 g,TUBE,,63,53.55,18.0558,63,Aetna,Medicare Advantage,,,,,Included in per diem rate,
HYDROCORTISONE 2.5 % TOP CRPE,,9501,LOCAL,Facility,Both,30 g,TUBE,,63,53.55,18.0558,63,Aetna,PPO,58.59,93,,percent of total billed charges,,
HYDROCORTISONE 2.5 % TOP CRPE,,9501,LOCAL,Facility,Both,30 g,TUBE,,63,53.55,18.0558,63,America's PPO,America's PPO,60.4989,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
HYDROCORTISONE 2.5 % TOP CRPE,,9501,LOCAL,Facility,Both,30 g,TUBE,,63,53.55,18.0558,63,BlueCross BlueShield Minnesota, Federal Employee Program,61.992,98.4,,percent of total billed charges,,
HYDROCORTISONE 2.5 % TOP CRPE,,9501,LOCAL,Facility,Both,30 g,TUBE,,63,53.55,18.0558,63,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,63,100,,percent of total billed charges,,
HYDROCORTISONE 2.5 % TOP CRPE,,9501,LOCAL,Facility,Both,30 g,TUBE,,63,53.55,18.0558,63,BlueCross BlueShield Minnesota,High Value Network Plan,56.7,90,,percent of total billed charges,,
HYDROCORTISONE 2.5 % TOP CRPE,,9501,LOCAL,Facility,Outpatient,30 g,TUBE,,63,53.55,18.0558,63,BlueCross BlueShield Minnesota,Medicare Advantage,30.87,49,,percent of total billed charges,,
HYDROCORTISONE 2.5 % TOP CRPE,,9501,LOCAL,Facility,Inpatient,30 g,TUBE,,63,53.55,18.0558,63,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
HYDROCORTISONE 2.5 % TOP CRPE,,9501,LOCAL,Facility,Both,30 g,TUBE,,63,53.55,18.0558,63,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,55.7991,88.57,,percent of total billed charges,,
HYDROCORTISONE 2.5 % TOP CRPE,,9501,LOCAL,Facility,Both,30 g,TUBE,,63,53.55,18.0558,63,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,18.0558,28.66,,percent of total billed charges,,
HYDROCORTISONE 2.5 % TOP CRPE,,9501,LOCAL,Facility,Outpatient,30 g,TUBE,,63,53.55,18.0558,63,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),30.87,49,,percent of total billed charges,,
HYDROCORTISONE 2.5 % TOP CRPE,,9501,LOCAL,Facility,Inpatient,30 g,TUBE,,63,53.55,18.0558,63,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
HYDROCORTISONE 2.5 % TOP CRPE,,9501,LOCAL,Facility,Both,30 g,TUBE,,63,53.55,18.0558,63,CorVel,Worker's Compensation,63,100,,percent of total billed charges,,
HYDROCORTISONE 2.5 % TOP CRPE,,9501,LOCAL,Facility,Both,30 g,TUBE,,63,53.55,18.0558,63,First Health Group Corporation,First Health Network,61.11,97,,percent of total billed charges,,
HYDROCORTISONE 2.5 % TOP CRPE,,9501,LOCAL,Facility,Both,30 g,TUBE,,63,53.55,18.0558,63,"Health Partners, Inc.",Commercial,59.598,94.6,,percent of total billed charges,,
HYDROCORTISONE 2.5 % TOP CRPE,,9501,LOCAL,Facility,Outpatient,30 g,TUBE,,63,53.55,18.0558,63,"Health Partners, Inc.",Medicare Advantage,30.87,49,,percent of total billed charges,,
HYDROCORTISONE 2.5 % TOP CRPE,,9501,LOCAL,Facility,Inpatient,30 g,TUBE,,63,53.55,18.0558,63,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
HYDROCORTISONE 2.5 % TOP CRPE,,9501,LOCAL,Facility,Both,30 g,TUBE,,63,53.55,18.0558,63,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),37.8,60,,percent of total billed charges,,
HYDROCORTISONE 2.5 % TOP CRPE,,9501,LOCAL,Facility,Both,30 g,TUBE,,63,53.55,18.0558,63,"Health Partners, Inc.",State of Minnesota Advantage Program,51.345,81.5,,percent of total billed charges,,
HYDROCORTISONE 2.5 % TOP CRPE,,9501,LOCAL,Facility,Both,30 g,TUBE,,63,53.55,18.0558,63,"Health Partners, Inc.",State Public Programs,31.5,50,,percent of total billed charges,,
HYDROCORTISONE 2.5 % TOP CRPE,,9501,LOCAL,Facility,Both,30 g,TUBE,,63,53.55,18.0558,63,Humana Insurance Company,Commercial PPO,59.85,95,,percent of total billed charges,,
HYDROCORTISONE 2.5 % TOP CRPE,,9501,LOCAL,Facility,Outpatient,30 g,TUBE,,63,53.55,18.0558,63,Humana Insurance Company,Medicare PPO,30.87,49,,percent of total billed charges,,
HYDROCORTISONE 2.5 % TOP CRPE,,9501,LOCAL,Facility,Inpatient,30 g,TUBE,,63,53.55,18.0558,63,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
HYDROCORTISONE 2.5 % TOP CRPE,,9501,LOCAL,Facility,Both,30 g,TUBE,,63,53.55,18.0558,63,Medica,Individual & Family,62.433,99.1,,percent of total billed charges,,
HYDROCORTISONE 2.5 % TOP CRPE,,9501,LOCAL,Facility,Outpatient,30 g,TUBE,,63,53.55,18.0558,63,Medica,Medica Advantage Solution,31.374,49.8,,percent of total billed charges,,
HYDROCORTISONE 2.5 % TOP CRPE,,9501,LOCAL,Facility,Inpatient,30 g,TUBE,,63,53.55,18.0558,63,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
HYDROCORTISONE 2.5 % TOP CRPE,,9501,LOCAL,Facility,Outpatient,30 g,TUBE,,63,53.55,18.0558,63,Medica,Medical Assistance,28.098,44.6,,percent of total billed charges,,
HYDROCORTISONE 2.5 % TOP CRPE,,9501,LOCAL,Facility,Inpatient,30 g,TUBE,,63,53.55,18.0558,63,Medica,Medical Assistance,,,,,Included in per diem rate,
HYDROCORTISONE 2.5 % TOP CRPE,,9501,LOCAL,Facility,Outpatient,30 g,TUBE,,63,53.55,18.0558,63,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,31.374,49.8,,percent of total billed charges,,
HYDROCORTISONE 2.5 % TOP CRPE,,9501,LOCAL,Facility,Inpatient,30 g,TUBE,,63,53.55,18.0558,63,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
HYDROCORTISONE 2.5 % TOP CRPE,,9501,LOCAL,Facility,Both,30 g,TUBE,,63,53.55,18.0558,63,"Multiplan, Inc.","Multiplan, Inc.",59.22,94,,percent of total billed charges,,
HYDROCORTISONE 2.5 % TOP CRPE,,9501,LOCAL,Facility,Outpatient,30 g,TUBE,,63,53.55,18.0558,63,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,56.763,90.1,,percent of total billed charges,,
HYDROCORTISONE 2.5 % TOP CRPE,,9501,LOCAL,Facility,Inpatient,30 g,TUBE,,63,53.55,18.0558,63,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
HYDROCORTISONE 2.5 % TOP CRPE,,9501,LOCAL,Facility,Both,30 g,TUBE,,63,53.55,18.0558,63,"Preferred One Administrative Services, INC.",PPO,62.118,98.6,,percent of total billed charges,,
HYDROCORTISONE 2.5 % TOP CRPE,,9501,LOCAL,Facility,Outpatient,30 g,TUBE,,63,53.55,18.0558,63,PrimeWest Health,Minnesota Senior Health Options (MSHO),32.4135,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
HYDROCORTISONE 2.5 % TOP CRPE,,9501,LOCAL,Facility,Inpatient,30 g,TUBE,,63,53.55,18.0558,63,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
HYDROCORTISONE 2.5 % TOP CRPE,,9501,LOCAL,Facility,Outpatient,30 g,TUBE,,63,53.55,18.0558,63,PrimeWest Health,MinnesotaCare,32.3568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
HYDROCORTISONE 2.5 % TOP CRPE,,9501,LOCAL,Facility,Inpatient,30 g,TUBE,,63,53.55,18.0558,63,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
HYDROCORTISONE 2.5 % TOP CRPE,,9501,LOCAL,Facility,Both,30 g,TUBE,,63,53.55,18.0558,63,Sanford Health Plan,Sanford Health Plan,57.96,92,,percent of total billed charges,,
HYDROCORTISONE 2.5 % TOP CRPE,,9501,LOCAL,Facility,Outpatient,30 g,TUBE,,63,53.55,18.0558,63,"UCare Health, Inc.",Individual & Family Plan,35.5005,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
HYDROCORTISONE 2.5 % TOP CRPE,,9501,LOCAL,Facility,Inpatient,30 g,TUBE,,63,53.55,18.0558,63,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
HYDROCORTISONE 2.5 % TOP CRPE,,9501,LOCAL,Facility,Outpatient,30 g,TUBE,,63,53.55,18.0558,63,"UCare Health, Inc.",Medical Assistance,31.7961,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
HYDROCORTISONE 2.5 % TOP CRPE,,9501,LOCAL,Facility,Inpatient,30 g,TUBE,,63,53.55,18.0558,63,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
HYDROCORTISONE 2.5 % TOP CRPE,,9501,LOCAL,Facility,Outpatient,30 g,TUBE,,63,53.55,18.0558,63,"UCare Health, Inc.",Medicare Advantage,31.7961,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
HYDROCORTISONE 2.5 % TOP CRPE,,9501,LOCAL,Facility,Inpatient,30 g,TUBE,,63,53.55,18.0558,63,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
HYDROCORTISONE 2.5 % TOP CRPE,,9501,LOCAL,Facility,Outpatient,30 g,TUBE,,63,53.55,18.0558,63,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),31.7961,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
HYDROCORTISONE 2.5 % TOP CRPE,,9501,LOCAL,Facility,Inpatient,30 g,TUBE,,63,53.55,18.0558,63,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
HYDROCORTISONE 2.5 % TOP CRPE,,9501,LOCAL,Facility,Both,30 g,TUBE,,63,53.55,18.0558,63,UnitedHealthcare,Individual & Family,59.22,94,,percent of total billed charges,,
HYDROCORTISONE 2.5 % TOP CRPE,,9501,LOCAL,Facility,Outpatient,30 g,TUBE,,63,53.55,18.0558,63,UnitedHealthcare,Medicare Advantage,30.87,49,,percent of total billed charges,,
HYDROCORTISONE 2.5 % TOP CRPE,,9501,LOCAL,Facility,Inpatient,30 g,TUBE,,63,53.55,18.0558,63,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
HYDROCORTISONE 2.5 % TOP CRPE,,9501,LOCAL,Facility,Outpatient,30 g,TUBE,,63,53.55,18.0558,63,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,30.24,48,,percent of total billed charges,,100% of DHS outpatient percentage
HYDROCORTISONE 2.5 % TOP CRPE,,9501,LOCAL,Facility,Inpatient,30 g,TUBE,,63,53.55,18.0558,63,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
CONJUGATED ESTROGENS 0.625 MG/GRAM VAGL CREAM,,12411,LOCAL,Facility,Both,30 g,g,,1731,1471.35,496.1046,1731,Aetna,Commercial,1592.52,92,,percent of total billed charges,,
CONJUGATED ESTROGENS 0.625 MG/GRAM VAGL CREAM,,12411,LOCAL,Facility,Outpatient,30 g,g,,1731,1471.35,496.1046,1731,Aetna,Medicare Advantage,848.19,49,,percent of total billed charges,,
CONJUGATED ESTROGENS 0.625 MG/GRAM VAGL CREAM,,12411,LOCAL,Facility,Inpatient,30 g,g,,1731,1471.35,496.1046,1731,Aetna,Medicare Advantage,,,,,Included in per diem rate,
CONJUGATED ESTROGENS 0.625 MG/GRAM VAGL CREAM,,12411,LOCAL,Facility,Both,30 g,g,,1731,1471.35,496.1046,1731,Aetna,PPO,1609.83,93,,percent of total billed charges,,
CONJUGATED ESTROGENS 0.625 MG/GRAM VAGL CREAM,,12411,LOCAL,Facility,Both,30 g,g,,1731,1471.35,496.1046,1731,America's PPO,America's PPO,1662.2793,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
CONJUGATED ESTROGENS 0.625 MG/GRAM VAGL CREAM,,12411,LOCAL,Facility,Both,30 g,g,,1731,1471.35,496.1046,1731,BlueCross BlueShield Minnesota, Federal Employee Program,1703.304,98.4,,percent of total billed charges,,
CONJUGATED ESTROGENS 0.625 MG/GRAM VAGL CREAM,,12411,LOCAL,Facility,Both,30 g,g,,1731,1471.35,496.1046,1731,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1731,100,,percent of total billed charges,,
CONJUGATED ESTROGENS 0.625 MG/GRAM VAGL CREAM,,12411,LOCAL,Facility,Both,30 g,g,,1731,1471.35,496.1046,1731,BlueCross BlueShield Minnesota,High Value Network Plan,1557.9,90,,percent of total billed charges,,
CONJUGATED ESTROGENS 0.625 MG/GRAM VAGL CREAM,,12411,LOCAL,Facility,Outpatient,30 g,g,,1731,1471.35,496.1046,1731,BlueCross BlueShield Minnesota,Medicare Advantage,848.19,49,,percent of total billed charges,,
CONJUGATED ESTROGENS 0.625 MG/GRAM VAGL CREAM,,12411,LOCAL,Facility,Inpatient,30 g,g,,1731,1471.35,496.1046,1731,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
CONJUGATED ESTROGENS 0.625 MG/GRAM VAGL CREAM,,12411,LOCAL,Facility,Both,30 g,g,,1731,1471.35,496.1046,1731,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1533.1467,88.57,,percent of total billed charges,,
CONJUGATED ESTROGENS 0.625 MG/GRAM VAGL CREAM,,12411,LOCAL,Facility,Both,30 g,g,,1731,1471.35,496.1046,1731,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,496.1046,28.66,,percent of total billed charges,,
CONJUGATED ESTROGENS 0.625 MG/GRAM VAGL CREAM,,12411,LOCAL,Facility,Outpatient,30 g,g,,1731,1471.35,496.1046,1731,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),848.19,49,,percent of total billed charges,,
CONJUGATED ESTROGENS 0.625 MG/GRAM VAGL CREAM,,12411,LOCAL,Facility,Inpatient,30 g,g,,1731,1471.35,496.1046,1731,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
CONJUGATED ESTROGENS 0.625 MG/GRAM VAGL CREAM,,12411,LOCAL,Facility,Both,30 g,g,,1731,1471.35,496.1046,1731,CorVel,Worker's Compensation,1731,100,,percent of total billed charges,,
CONJUGATED ESTROGENS 0.625 MG/GRAM VAGL CREAM,,12411,LOCAL,Facility,Both,30 g,g,,1731,1471.35,496.1046,1731,First Health Group Corporation,First Health Network,1679.07,97,,percent of total billed charges,,
CONJUGATED ESTROGENS 0.625 MG/GRAM VAGL CREAM,,12411,LOCAL,Facility,Both,30 g,g,,1731,1471.35,496.1046,1731,"Health Partners, Inc.",Commercial,1637.526,94.6,,percent of total billed charges,,
CONJUGATED ESTROGENS 0.625 MG/GRAM VAGL CREAM,,12411,LOCAL,Facility,Outpatient,30 g,g,,1731,1471.35,496.1046,1731,"Health Partners, Inc.",Medicare Advantage,848.19,49,,percent of total billed charges,,
CONJUGATED ESTROGENS 0.625 MG/GRAM VAGL CREAM,,12411,LOCAL,Facility,Inpatient,30 g,g,,1731,1471.35,496.1046,1731,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CONJUGATED ESTROGENS 0.625 MG/GRAM VAGL CREAM,,12411,LOCAL,Facility,Both,30 g,g,,1731,1471.35,496.1046,1731,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1038.6,60,,percent of total billed charges,,
CONJUGATED ESTROGENS 0.625 MG/GRAM VAGL CREAM,,12411,LOCAL,Facility,Both,30 g,g,,1731,1471.35,496.1046,1731,"Health Partners, Inc.",State of Minnesota Advantage Program,1410.765,81.5,,percent of total billed charges,,
CONJUGATED ESTROGENS 0.625 MG/GRAM VAGL CREAM,,12411,LOCAL,Facility,Both,30 g,g,,1731,1471.35,496.1046,1731,"Health Partners, Inc.",State Public Programs,865.5,50,,percent of total billed charges,,
CONJUGATED ESTROGENS 0.625 MG/GRAM VAGL CREAM,,12411,LOCAL,Facility,Both,30 g,g,,1731,1471.35,496.1046,1731,Humana Insurance Company,Commercial PPO,1644.45,95,,percent of total billed charges,,
CONJUGATED ESTROGENS 0.625 MG/GRAM VAGL CREAM,,12411,LOCAL,Facility,Outpatient,30 g,g,,1731,1471.35,496.1046,1731,Humana Insurance Company,Medicare PPO,848.19,49,,percent of total billed charges,,
CONJUGATED ESTROGENS 0.625 MG/GRAM VAGL CREAM,,12411,LOCAL,Facility,Inpatient,30 g,g,,1731,1471.35,496.1046,1731,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
CONJUGATED ESTROGENS 0.625 MG/GRAM VAGL CREAM,,12411,LOCAL,Facility,Both,30 g,g,,1731,1471.35,496.1046,1731,Medica,Individual & Family,1715.421,99.1,,percent of total billed charges,,
CONJUGATED ESTROGENS 0.625 MG/GRAM VAGL CREAM,,12411,LOCAL,Facility,Outpatient,30 g,g,,1731,1471.35,496.1046,1731,Medica,Medica Advantage Solution,862.038,49.8,,percent of total billed charges,,
CONJUGATED ESTROGENS 0.625 MG/GRAM VAGL CREAM,,12411,LOCAL,Facility,Inpatient,30 g,g,,1731,1471.35,496.1046,1731,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
CONJUGATED ESTROGENS 0.625 MG/GRAM VAGL CREAM,,12411,LOCAL,Facility,Outpatient,30 g,g,,1731,1471.35,496.1046,1731,Medica,Medical Assistance,772.026,44.6,,percent of total billed charges,,
CONJUGATED ESTROGENS 0.625 MG/GRAM VAGL CREAM,,12411,LOCAL,Facility,Inpatient,30 g,g,,1731,1471.35,496.1046,1731,Medica,Medical Assistance,,,,,Included in per diem rate,
CONJUGATED ESTROGENS 0.625 MG/GRAM VAGL CREAM,,12411,LOCAL,Facility,Outpatient,30 g,g,,1731,1471.35,496.1046,1731,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,862.038,49.8,,percent of total billed charges,,
CONJUGATED ESTROGENS 0.625 MG/GRAM VAGL CREAM,,12411,LOCAL,Facility,Inpatient,30 g,g,,1731,1471.35,496.1046,1731,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
CONJUGATED ESTROGENS 0.625 MG/GRAM VAGL CREAM,,12411,LOCAL,Facility,Both,30 g,g,,1731,1471.35,496.1046,1731,"Multiplan, Inc.","Multiplan, Inc.",1627.14,94,,percent of total billed charges,,
CONJUGATED ESTROGENS 0.625 MG/GRAM VAGL CREAM,,12411,LOCAL,Facility,Outpatient,30 g,g,,1731,1471.35,496.1046,1731,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1559.631,90.1,,percent of total billed charges,,
CONJUGATED ESTROGENS 0.625 MG/GRAM VAGL CREAM,,12411,LOCAL,Facility,Inpatient,30 g,g,,1731,1471.35,496.1046,1731,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
CONJUGATED ESTROGENS 0.625 MG/GRAM VAGL CREAM,,12411,LOCAL,Facility,Both,30 g,g,,1731,1471.35,496.1046,1731,"Preferred One Administrative Services, INC.",PPO,1706.766,98.6,,percent of total billed charges,,
CONJUGATED ESTROGENS 0.625 MG/GRAM VAGL CREAM,,12411,LOCAL,Facility,Outpatient,30 g,g,,1731,1471.35,496.1046,1731,PrimeWest Health,Minnesota Senior Health Options (MSHO),890.5995,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
CONJUGATED ESTROGENS 0.625 MG/GRAM VAGL CREAM,,12411,LOCAL,Facility,Inpatient,30 g,g,,1731,1471.35,496.1046,1731,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CONJUGATED ESTROGENS 0.625 MG/GRAM VAGL CREAM,,12411,LOCAL,Facility,Outpatient,30 g,g,,1731,1471.35,496.1046,1731,PrimeWest Health,MinnesotaCare,889.0416,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
CONJUGATED ESTROGENS 0.625 MG/GRAM VAGL CREAM,,12411,LOCAL,Facility,Inpatient,30 g,g,,1731,1471.35,496.1046,1731,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
CONJUGATED ESTROGENS 0.625 MG/GRAM VAGL CREAM,,12411,LOCAL,Facility,Both,30 g,g,,1731,1471.35,496.1046,1731,Sanford Health Plan,Sanford Health Plan,1592.52,92,,percent of total billed charges,,
CONJUGATED ESTROGENS 0.625 MG/GRAM VAGL CREAM,,12411,LOCAL,Facility,Outpatient,30 g,g,,1731,1471.35,496.1046,1731,"UCare Health, Inc.",Individual & Family Plan,975.4185,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
CONJUGATED ESTROGENS 0.625 MG/GRAM VAGL CREAM,,12411,LOCAL,Facility,Inpatient,30 g,g,,1731,1471.35,496.1046,1731,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
CONJUGATED ESTROGENS 0.625 MG/GRAM VAGL CREAM,,12411,LOCAL,Facility,Outpatient,30 g,g,,1731,1471.35,496.1046,1731,"UCare Health, Inc.",Medical Assistance,873.6357,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CONJUGATED ESTROGENS 0.625 MG/GRAM VAGL CREAM,,12411,LOCAL,Facility,Inpatient,30 g,g,,1731,1471.35,496.1046,1731,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
CONJUGATED ESTROGENS 0.625 MG/GRAM VAGL CREAM,,12411,LOCAL,Facility,Outpatient,30 g,g,,1731,1471.35,496.1046,1731,"UCare Health, Inc.",Medicare Advantage,873.6357,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CONJUGATED ESTROGENS 0.625 MG/GRAM VAGL CREAM,,12411,LOCAL,Facility,Inpatient,30 g,g,,1731,1471.35,496.1046,1731,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CONJUGATED ESTROGENS 0.625 MG/GRAM VAGL CREAM,,12411,LOCAL,Facility,Outpatient,30 g,g,,1731,1471.35,496.1046,1731,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),873.6357,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CONJUGATED ESTROGENS 0.625 MG/GRAM VAGL CREAM,,12411,LOCAL,Facility,Inpatient,30 g,g,,1731,1471.35,496.1046,1731,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CONJUGATED ESTROGENS 0.625 MG/GRAM VAGL CREAM,,12411,LOCAL,Facility,Both,30 g,g,,1731,1471.35,496.1046,1731,UnitedHealthcare,Individual & Family,1627.14,94,,percent of total billed charges,,
CONJUGATED ESTROGENS 0.625 MG/GRAM VAGL CREAM,,12411,LOCAL,Facility,Outpatient,30 g,g,,1731,1471.35,496.1046,1731,UnitedHealthcare,Medicare Advantage,848.19,49,,percent of total billed charges,,
CONJUGATED ESTROGENS 0.625 MG/GRAM VAGL CREAM,,12411,LOCAL,Facility,Inpatient,30 g,g,,1731,1471.35,496.1046,1731,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
CONJUGATED ESTROGENS 0.625 MG/GRAM VAGL CREAM,,12411,LOCAL,Facility,Outpatient,30 g,g,,1731,1471.35,496.1046,1731,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,830.88,48,,percent of total billed charges,,100% of DHS outpatient percentage
CONJUGATED ESTROGENS 0.625 MG/GRAM VAGL CREAM,,12411,LOCAL,Facility,Inpatient,30 g,g,,1731,1471.35,496.1046,1731,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"NYSTATIN 100,000 UNIT/GRAM TOP CREAM",,12671,LOCAL,Facility,Both,30 g,g,,114,96.9,32.6724,114,Aetna,Commercial,104.88,92,,percent of total billed charges,,
"NYSTATIN 100,000 UNIT/GRAM TOP CREAM",,12671,LOCAL,Facility,Outpatient,30 g,g,,114,96.9,32.6724,114,Aetna,Medicare Advantage,55.86,49,,percent of total billed charges,,
"NYSTATIN 100,000 UNIT/GRAM TOP CREAM",,12671,LOCAL,Facility,Inpatient,30 g,g,,114,96.9,32.6724,114,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"NYSTATIN 100,000 UNIT/GRAM TOP CREAM",,12671,LOCAL,Facility,Both,30 g,g,,114,96.9,32.6724,114,Aetna,PPO,106.02,93,,percent of total billed charges,,
"NYSTATIN 100,000 UNIT/GRAM TOP CREAM",,12671,LOCAL,Facility,Both,30 g,g,,114,96.9,32.6724,114,America's PPO,America's PPO,109.4742,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"NYSTATIN 100,000 UNIT/GRAM TOP CREAM",,12671,LOCAL,Facility,Both,30 g,g,,114,96.9,32.6724,114,BlueCross BlueShield Minnesota, Federal Employee Program,112.176,98.4,,percent of total billed charges,,
"NYSTATIN 100,000 UNIT/GRAM TOP CREAM",,12671,LOCAL,Facility,Both,30 g,g,,114,96.9,32.6724,114,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,114,100,,percent of total billed charges,,
"NYSTATIN 100,000 UNIT/GRAM TOP CREAM",,12671,LOCAL,Facility,Both,30 g,g,,114,96.9,32.6724,114,BlueCross BlueShield Minnesota,High Value Network Plan,102.6,90,,percent of total billed charges,,
"NYSTATIN 100,000 UNIT/GRAM TOP CREAM",,12671,LOCAL,Facility,Outpatient,30 g,g,,114,96.9,32.6724,114,BlueCross BlueShield Minnesota,Medicare Advantage,55.86,49,,percent of total billed charges,,
"NYSTATIN 100,000 UNIT/GRAM TOP CREAM",,12671,LOCAL,Facility,Inpatient,30 g,g,,114,96.9,32.6724,114,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"NYSTATIN 100,000 UNIT/GRAM TOP CREAM",,12671,LOCAL,Facility,Both,30 g,g,,114,96.9,32.6724,114,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,100.9698,88.57,,percent of total billed charges,,
"NYSTATIN 100,000 UNIT/GRAM TOP CREAM",,12671,LOCAL,Facility,Both,30 g,g,,114,96.9,32.6724,114,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,32.6724,28.66,,percent of total billed charges,,
"NYSTATIN 100,000 UNIT/GRAM TOP CREAM",,12671,LOCAL,Facility,Outpatient,30 g,g,,114,96.9,32.6724,114,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),55.86,49,,percent of total billed charges,,
"NYSTATIN 100,000 UNIT/GRAM TOP CREAM",,12671,LOCAL,Facility,Inpatient,30 g,g,,114,96.9,32.6724,114,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"NYSTATIN 100,000 UNIT/GRAM TOP CREAM",,12671,LOCAL,Facility,Both,30 g,g,,114,96.9,32.6724,114,CorVel,Worker's Compensation,114,100,,percent of total billed charges,,
"NYSTATIN 100,000 UNIT/GRAM TOP CREAM",,12671,LOCAL,Facility,Both,30 g,g,,114,96.9,32.6724,114,First Health Group Corporation,First Health Network,110.58,97,,percent of total billed charges,,
"NYSTATIN 100,000 UNIT/GRAM TOP CREAM",,12671,LOCAL,Facility,Both,30 g,g,,114,96.9,32.6724,114,"Health Partners, Inc.",Commercial,107.844,94.6,,percent of total billed charges,,
"NYSTATIN 100,000 UNIT/GRAM TOP CREAM",,12671,LOCAL,Facility,Outpatient,30 g,g,,114,96.9,32.6724,114,"Health Partners, Inc.",Medicare Advantage,55.86,49,,percent of total billed charges,,
"NYSTATIN 100,000 UNIT/GRAM TOP CREAM",,12671,LOCAL,Facility,Inpatient,30 g,g,,114,96.9,32.6724,114,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"NYSTATIN 100,000 UNIT/GRAM TOP CREAM",,12671,LOCAL,Facility,Both,30 g,g,,114,96.9,32.6724,114,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),68.4,60,,percent of total billed charges,,
"NYSTATIN 100,000 UNIT/GRAM TOP CREAM",,12671,LOCAL,Facility,Both,30 g,g,,114,96.9,32.6724,114,"Health Partners, Inc.",State of Minnesota Advantage Program,92.91,81.5,,percent of total billed charges,,
"NYSTATIN 100,000 UNIT/GRAM TOP CREAM",,12671,LOCAL,Facility,Both,30 g,g,,114,96.9,32.6724,114,"Health Partners, Inc.",State Public Programs,57,50,,percent of total billed charges,,
"NYSTATIN 100,000 UNIT/GRAM TOP CREAM",,12671,LOCAL,Facility,Both,30 g,g,,114,96.9,32.6724,114,Humana Insurance Company,Commercial PPO,108.3,95,,percent of total billed charges,,
"NYSTATIN 100,000 UNIT/GRAM TOP CREAM",,12671,LOCAL,Facility,Outpatient,30 g,g,,114,96.9,32.6724,114,Humana Insurance Company,Medicare PPO,55.86,49,,percent of total billed charges,,
"NYSTATIN 100,000 UNIT/GRAM TOP CREAM",,12671,LOCAL,Facility,Inpatient,30 g,g,,114,96.9,32.6724,114,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"NYSTATIN 100,000 UNIT/GRAM TOP CREAM",,12671,LOCAL,Facility,Both,30 g,g,,114,96.9,32.6724,114,Medica,Individual & Family,112.974,99.1,,percent of total billed charges,,
"NYSTATIN 100,000 UNIT/GRAM TOP CREAM",,12671,LOCAL,Facility,Outpatient,30 g,g,,114,96.9,32.6724,114,Medica,Medica Advantage Solution,56.772,49.8,,percent of total billed charges,,
"NYSTATIN 100,000 UNIT/GRAM TOP CREAM",,12671,LOCAL,Facility,Inpatient,30 g,g,,114,96.9,32.6724,114,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"NYSTATIN 100,000 UNIT/GRAM TOP CREAM",,12671,LOCAL,Facility,Outpatient,30 g,g,,114,96.9,32.6724,114,Medica,Medical Assistance,50.844,44.6,,percent of total billed charges,,
"NYSTATIN 100,000 UNIT/GRAM TOP CREAM",,12671,LOCAL,Facility,Inpatient,30 g,g,,114,96.9,32.6724,114,Medica,Medical Assistance,,,,,Included in per diem rate,
"NYSTATIN 100,000 UNIT/GRAM TOP CREAM",,12671,LOCAL,Facility,Outpatient,30 g,g,,114,96.9,32.6724,114,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,56.772,49.8,,percent of total billed charges,,
"NYSTATIN 100,000 UNIT/GRAM TOP CREAM",,12671,LOCAL,Facility,Inpatient,30 g,g,,114,96.9,32.6724,114,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"NYSTATIN 100,000 UNIT/GRAM TOP CREAM",,12671,LOCAL,Facility,Both,30 g,g,,114,96.9,32.6724,114,"Multiplan, Inc.","Multiplan, Inc.",107.16,94,,percent of total billed charges,,
"NYSTATIN 100,000 UNIT/GRAM TOP CREAM",,12671,LOCAL,Facility,Outpatient,30 g,g,,114,96.9,32.6724,114,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,102.714,90.1,,percent of total billed charges,,
"NYSTATIN 100,000 UNIT/GRAM TOP CREAM",,12671,LOCAL,Facility,Inpatient,30 g,g,,114,96.9,32.6724,114,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"NYSTATIN 100,000 UNIT/GRAM TOP CREAM",,12671,LOCAL,Facility,Both,30 g,g,,114,96.9,32.6724,114,"Preferred One Administrative Services, INC.",PPO,112.404,98.6,,percent of total billed charges,,
"NYSTATIN 100,000 UNIT/GRAM TOP CREAM",,12671,LOCAL,Facility,Outpatient,30 g,g,,114,96.9,32.6724,114,PrimeWest Health,Minnesota Senior Health Options (MSHO),58.653,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"NYSTATIN 100,000 UNIT/GRAM TOP CREAM",,12671,LOCAL,Facility,Inpatient,30 g,g,,114,96.9,32.6724,114,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"NYSTATIN 100,000 UNIT/GRAM TOP CREAM",,12671,LOCAL,Facility,Outpatient,30 g,g,,114,96.9,32.6724,114,PrimeWest Health,MinnesotaCare,58.5504,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"NYSTATIN 100,000 UNIT/GRAM TOP CREAM",,12671,LOCAL,Facility,Inpatient,30 g,g,,114,96.9,32.6724,114,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"NYSTATIN 100,000 UNIT/GRAM TOP CREAM",,12671,LOCAL,Facility,Both,30 g,g,,114,96.9,32.6724,114,Sanford Health Plan,Sanford Health Plan,104.88,92,,percent of total billed charges,,
"NYSTATIN 100,000 UNIT/GRAM TOP CREAM",,12671,LOCAL,Facility,Outpatient,30 g,g,,114,96.9,32.6724,114,"UCare Health, Inc.",Individual & Family Plan,64.239,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"NYSTATIN 100,000 UNIT/GRAM TOP CREAM",,12671,LOCAL,Facility,Inpatient,30 g,g,,114,96.9,32.6724,114,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"NYSTATIN 100,000 UNIT/GRAM TOP CREAM",,12671,LOCAL,Facility,Outpatient,30 g,g,,114,96.9,32.6724,114,"UCare Health, Inc.",Medical Assistance,57.5358,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"NYSTATIN 100,000 UNIT/GRAM TOP CREAM",,12671,LOCAL,Facility,Inpatient,30 g,g,,114,96.9,32.6724,114,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"NYSTATIN 100,000 UNIT/GRAM TOP CREAM",,12671,LOCAL,Facility,Outpatient,30 g,g,,114,96.9,32.6724,114,"UCare Health, Inc.",Medicare Advantage,57.5358,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"NYSTATIN 100,000 UNIT/GRAM TOP CREAM",,12671,LOCAL,Facility,Inpatient,30 g,g,,114,96.9,32.6724,114,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"NYSTATIN 100,000 UNIT/GRAM TOP CREAM",,12671,LOCAL,Facility,Outpatient,30 g,g,,114,96.9,32.6724,114,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),57.5358,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"NYSTATIN 100,000 UNIT/GRAM TOP CREAM",,12671,LOCAL,Facility,Inpatient,30 g,g,,114,96.9,32.6724,114,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"NYSTATIN 100,000 UNIT/GRAM TOP CREAM",,12671,LOCAL,Facility,Both,30 g,g,,114,96.9,32.6724,114,UnitedHealthcare,Individual & Family,107.16,94,,percent of total billed charges,,
"NYSTATIN 100,000 UNIT/GRAM TOP CREAM",,12671,LOCAL,Facility,Outpatient,30 g,g,,114,96.9,32.6724,114,UnitedHealthcare,Medicare Advantage,55.86,49,,percent of total billed charges,,
"NYSTATIN 100,000 UNIT/GRAM TOP CREAM",,12671,LOCAL,Facility,Inpatient,30 g,g,,114,96.9,32.6724,114,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"NYSTATIN 100,000 UNIT/GRAM TOP CREAM",,12671,LOCAL,Facility,Outpatient,30 g,g,,114,96.9,32.6724,114,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,54.72,48,,percent of total billed charges,,100% of DHS outpatient percentage
"NYSTATIN 100,000 UNIT/GRAM TOP CREAM",,12671,LOCAL,Facility,Inpatient,30 g,g,,114,96.9,32.6724,114,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
KETOCONAZOLE 2 % TOP CREAM,,18136,LOCAL,Facility,Both,30 g,g,,219,186.15,62.7654,219,Aetna,Commercial,201.48,92,,percent of total billed charges,,
KETOCONAZOLE 2 % TOP CREAM,,18136,LOCAL,Facility,Outpatient,30 g,g,,219,186.15,62.7654,219,Aetna,Medicare Advantage,107.31,49,,percent of total billed charges,,
KETOCONAZOLE 2 % TOP CREAM,,18136,LOCAL,Facility,Inpatient,30 g,g,,219,186.15,62.7654,219,Aetna,Medicare Advantage,,,,,Included in per diem rate,
KETOCONAZOLE 2 % TOP CREAM,,18136,LOCAL,Facility,Both,30 g,g,,219,186.15,62.7654,219,Aetna,PPO,203.67,93,,percent of total billed charges,,
KETOCONAZOLE 2 % TOP CREAM,,18136,LOCAL,Facility,Both,30 g,g,,219,186.15,62.7654,219,America's PPO,America's PPO,210.3057,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
KETOCONAZOLE 2 % TOP CREAM,,18136,LOCAL,Facility,Both,30 g,g,,219,186.15,62.7654,219,BlueCross BlueShield Minnesota, Federal Employee Program,215.496,98.4,,percent of total billed charges,,
KETOCONAZOLE 2 % TOP CREAM,,18136,LOCAL,Facility,Both,30 g,g,,219,186.15,62.7654,219,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,219,100,,percent of total billed charges,,
KETOCONAZOLE 2 % TOP CREAM,,18136,LOCAL,Facility,Both,30 g,g,,219,186.15,62.7654,219,BlueCross BlueShield Minnesota,High Value Network Plan,197.1,90,,percent of total billed charges,,
KETOCONAZOLE 2 % TOP CREAM,,18136,LOCAL,Facility,Outpatient,30 g,g,,219,186.15,62.7654,219,BlueCross BlueShield Minnesota,Medicare Advantage,107.31,49,,percent of total billed charges,,
KETOCONAZOLE 2 % TOP CREAM,,18136,LOCAL,Facility,Inpatient,30 g,g,,219,186.15,62.7654,219,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
KETOCONAZOLE 2 % TOP CREAM,,18136,LOCAL,Facility,Both,30 g,g,,219,186.15,62.7654,219,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,193.9683,88.57,,percent of total billed charges,,
KETOCONAZOLE 2 % TOP CREAM,,18136,LOCAL,Facility,Both,30 g,g,,219,186.15,62.7654,219,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,62.7654,28.66,,percent of total billed charges,,
KETOCONAZOLE 2 % TOP CREAM,,18136,LOCAL,Facility,Outpatient,30 g,g,,219,186.15,62.7654,219,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),107.31,49,,percent of total billed charges,,
KETOCONAZOLE 2 % TOP CREAM,,18136,LOCAL,Facility,Inpatient,30 g,g,,219,186.15,62.7654,219,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
KETOCONAZOLE 2 % TOP CREAM,,18136,LOCAL,Facility,Both,30 g,g,,219,186.15,62.7654,219,CorVel,Worker's Compensation,219,100,,percent of total billed charges,,
KETOCONAZOLE 2 % TOP CREAM,,18136,LOCAL,Facility,Both,30 g,g,,219,186.15,62.7654,219,First Health Group Corporation,First Health Network,212.43,97,,percent of total billed charges,,
KETOCONAZOLE 2 % TOP CREAM,,18136,LOCAL,Facility,Both,30 g,g,,219,186.15,62.7654,219,"Health Partners, Inc.",Commercial,207.174,94.6,,percent of total billed charges,,
KETOCONAZOLE 2 % TOP CREAM,,18136,LOCAL,Facility,Outpatient,30 g,g,,219,186.15,62.7654,219,"Health Partners, Inc.",Medicare Advantage,107.31,49,,percent of total billed charges,,
KETOCONAZOLE 2 % TOP CREAM,,18136,LOCAL,Facility,Inpatient,30 g,g,,219,186.15,62.7654,219,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
KETOCONAZOLE 2 % TOP CREAM,,18136,LOCAL,Facility,Both,30 g,g,,219,186.15,62.7654,219,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),131.4,60,,percent of total billed charges,,
KETOCONAZOLE 2 % TOP CREAM,,18136,LOCAL,Facility,Both,30 g,g,,219,186.15,62.7654,219,"Health Partners, Inc.",State of Minnesota Advantage Program,178.485,81.5,,percent of total billed charges,,
KETOCONAZOLE 2 % TOP CREAM,,18136,LOCAL,Facility,Both,30 g,g,,219,186.15,62.7654,219,"Health Partners, Inc.",State Public Programs,109.5,50,,percent of total billed charges,,
KETOCONAZOLE 2 % TOP CREAM,,18136,LOCAL,Facility,Both,30 g,g,,219,186.15,62.7654,219,Humana Insurance Company,Commercial PPO,208.05,95,,percent of total billed charges,,
KETOCONAZOLE 2 % TOP CREAM,,18136,LOCAL,Facility,Outpatient,30 g,g,,219,186.15,62.7654,219,Humana Insurance Company,Medicare PPO,107.31,49,,percent of total billed charges,,
KETOCONAZOLE 2 % TOP CREAM,,18136,LOCAL,Facility,Inpatient,30 g,g,,219,186.15,62.7654,219,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
KETOCONAZOLE 2 % TOP CREAM,,18136,LOCAL,Facility,Both,30 g,g,,219,186.15,62.7654,219,Medica,Individual & Family,217.029,99.1,,percent of total billed charges,,
KETOCONAZOLE 2 % TOP CREAM,,18136,LOCAL,Facility,Outpatient,30 g,g,,219,186.15,62.7654,219,Medica,Medica Advantage Solution,109.062,49.8,,percent of total billed charges,,
KETOCONAZOLE 2 % TOP CREAM,,18136,LOCAL,Facility,Inpatient,30 g,g,,219,186.15,62.7654,219,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
KETOCONAZOLE 2 % TOP CREAM,,18136,LOCAL,Facility,Outpatient,30 g,g,,219,186.15,62.7654,219,Medica,Medical Assistance,97.674,44.6,,percent of total billed charges,,
KETOCONAZOLE 2 % TOP CREAM,,18136,LOCAL,Facility,Inpatient,30 g,g,,219,186.15,62.7654,219,Medica,Medical Assistance,,,,,Included in per diem rate,
KETOCONAZOLE 2 % TOP CREAM,,18136,LOCAL,Facility,Outpatient,30 g,g,,219,186.15,62.7654,219,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,109.062,49.8,,percent of total billed charges,,
KETOCONAZOLE 2 % TOP CREAM,,18136,LOCAL,Facility,Inpatient,30 g,g,,219,186.15,62.7654,219,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
KETOCONAZOLE 2 % TOP CREAM,,18136,LOCAL,Facility,Both,30 g,g,,219,186.15,62.7654,219,"Multiplan, Inc.","Multiplan, Inc.",205.86,94,,percent of total billed charges,,
KETOCONAZOLE 2 % TOP CREAM,,18136,LOCAL,Facility,Outpatient,30 g,g,,219,186.15,62.7654,219,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,197.319,90.1,,percent of total billed charges,,
KETOCONAZOLE 2 % TOP CREAM,,18136,LOCAL,Facility,Inpatient,30 g,g,,219,186.15,62.7654,219,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
KETOCONAZOLE 2 % TOP CREAM,,18136,LOCAL,Facility,Both,30 g,g,,219,186.15,62.7654,219,"Preferred One Administrative Services, INC.",PPO,215.934,98.6,,percent of total billed charges,,
KETOCONAZOLE 2 % TOP CREAM,,18136,LOCAL,Facility,Outpatient,30 g,g,,219,186.15,62.7654,219,PrimeWest Health,Minnesota Senior Health Options (MSHO),112.6755,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
KETOCONAZOLE 2 % TOP CREAM,,18136,LOCAL,Facility,Inpatient,30 g,g,,219,186.15,62.7654,219,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
KETOCONAZOLE 2 % TOP CREAM,,18136,LOCAL,Facility,Outpatient,30 g,g,,219,186.15,62.7654,219,PrimeWest Health,MinnesotaCare,112.4784,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
KETOCONAZOLE 2 % TOP CREAM,,18136,LOCAL,Facility,Inpatient,30 g,g,,219,186.15,62.7654,219,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
KETOCONAZOLE 2 % TOP CREAM,,18136,LOCAL,Facility,Both,30 g,g,,219,186.15,62.7654,219,Sanford Health Plan,Sanford Health Plan,201.48,92,,percent of total billed charges,,
KETOCONAZOLE 2 % TOP CREAM,,18136,LOCAL,Facility,Outpatient,30 g,g,,219,186.15,62.7654,219,"UCare Health, Inc.",Individual & Family Plan,123.4065,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
KETOCONAZOLE 2 % TOP CREAM,,18136,LOCAL,Facility,Inpatient,30 g,g,,219,186.15,62.7654,219,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
KETOCONAZOLE 2 % TOP CREAM,,18136,LOCAL,Facility,Outpatient,30 g,g,,219,186.15,62.7654,219,"UCare Health, Inc.",Medical Assistance,110.5293,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
KETOCONAZOLE 2 % TOP CREAM,,18136,LOCAL,Facility,Inpatient,30 g,g,,219,186.15,62.7654,219,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
KETOCONAZOLE 2 % TOP CREAM,,18136,LOCAL,Facility,Outpatient,30 g,g,,219,186.15,62.7654,219,"UCare Health, Inc.",Medicare Advantage,110.5293,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
KETOCONAZOLE 2 % TOP CREAM,,18136,LOCAL,Facility,Inpatient,30 g,g,,219,186.15,62.7654,219,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
KETOCONAZOLE 2 % TOP CREAM,,18136,LOCAL,Facility,Outpatient,30 g,g,,219,186.15,62.7654,219,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),110.5293,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
KETOCONAZOLE 2 % TOP CREAM,,18136,LOCAL,Facility,Inpatient,30 g,g,,219,186.15,62.7654,219,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
KETOCONAZOLE 2 % TOP CREAM,,18136,LOCAL,Facility,Both,30 g,g,,219,186.15,62.7654,219,UnitedHealthcare,Individual & Family,205.86,94,,percent of total billed charges,,
KETOCONAZOLE 2 % TOP CREAM,,18136,LOCAL,Facility,Outpatient,30 g,g,,219,186.15,62.7654,219,UnitedHealthcare,Medicare Advantage,107.31,49,,percent of total billed charges,,
KETOCONAZOLE 2 % TOP CREAM,,18136,LOCAL,Facility,Inpatient,30 g,g,,219,186.15,62.7654,219,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
KETOCONAZOLE 2 % TOP CREAM,,18136,LOCAL,Facility,Outpatient,30 g,g,,219,186.15,62.7654,219,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,105.12,48,,percent of total billed charges,,100% of DHS outpatient percentage
KETOCONAZOLE 2 % TOP CREAM,,18136,LOCAL,Facility,Inpatient,30 g,g,,219,186.15,62.7654,219,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
MORPHINE CONCENTRATE 100 MG/5 ML (20 MG/ML) ORAL SOLN,,3032,LOCAL,Facility,Both,30 mL,mL,,114,96.9,32.6724,114,Aetna,Commercial,104.88,92,,percent of total billed charges,,
MORPHINE CONCENTRATE 100 MG/5 ML (20 MG/ML) ORAL SOLN,,3032,LOCAL,Facility,Outpatient,30 mL,mL,,114,96.9,32.6724,114,Aetna,Medicare Advantage,55.86,49,,percent of total billed charges,,
MORPHINE CONCENTRATE 100 MG/5 ML (20 MG/ML) ORAL SOLN,,3032,LOCAL,Facility,Inpatient,30 mL,mL,,114,96.9,32.6724,114,Aetna,Medicare Advantage,,,,,Included in per diem rate,
MORPHINE CONCENTRATE 100 MG/5 ML (20 MG/ML) ORAL SOLN,,3032,LOCAL,Facility,Both,30 mL,mL,,114,96.9,32.6724,114,Aetna,PPO,106.02,93,,percent of total billed charges,,
MORPHINE CONCENTRATE 100 MG/5 ML (20 MG/ML) ORAL SOLN,,3032,LOCAL,Facility,Both,30 mL,mL,,114,96.9,32.6724,114,America's PPO,America's PPO,109.4742,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
MORPHINE CONCENTRATE 100 MG/5 ML (20 MG/ML) ORAL SOLN,,3032,LOCAL,Facility,Both,30 mL,mL,,114,96.9,32.6724,114,BlueCross BlueShield Minnesota, Federal Employee Program,112.176,98.4,,percent of total billed charges,,
MORPHINE CONCENTRATE 100 MG/5 ML (20 MG/ML) ORAL SOLN,,3032,LOCAL,Facility,Both,30 mL,mL,,114,96.9,32.6724,114,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,114,100,,percent of total billed charges,,
MORPHINE CONCENTRATE 100 MG/5 ML (20 MG/ML) ORAL SOLN,,3032,LOCAL,Facility,Both,30 mL,mL,,114,96.9,32.6724,114,BlueCross BlueShield Minnesota,High Value Network Plan,102.6,90,,percent of total billed charges,,
MORPHINE CONCENTRATE 100 MG/5 ML (20 MG/ML) ORAL SOLN,,3032,LOCAL,Facility,Outpatient,30 mL,mL,,114,96.9,32.6724,114,BlueCross BlueShield Minnesota,Medicare Advantage,55.86,49,,percent of total billed charges,,
MORPHINE CONCENTRATE 100 MG/5 ML (20 MG/ML) ORAL SOLN,,3032,LOCAL,Facility,Inpatient,30 mL,mL,,114,96.9,32.6724,114,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
MORPHINE CONCENTRATE 100 MG/5 ML (20 MG/ML) ORAL SOLN,,3032,LOCAL,Facility,Both,30 mL,mL,,114,96.9,32.6724,114,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,100.9698,88.57,,percent of total billed charges,,
MORPHINE CONCENTRATE 100 MG/5 ML (20 MG/ML) ORAL SOLN,,3032,LOCAL,Facility,Both,30 mL,mL,,114,96.9,32.6724,114,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,32.6724,28.66,,percent of total billed charges,,
MORPHINE CONCENTRATE 100 MG/5 ML (20 MG/ML) ORAL SOLN,,3032,LOCAL,Facility,Outpatient,30 mL,mL,,114,96.9,32.6724,114,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),55.86,49,,percent of total billed charges,,
MORPHINE CONCENTRATE 100 MG/5 ML (20 MG/ML) ORAL SOLN,,3032,LOCAL,Facility,Inpatient,30 mL,mL,,114,96.9,32.6724,114,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
MORPHINE CONCENTRATE 100 MG/5 ML (20 MG/ML) ORAL SOLN,,3032,LOCAL,Facility,Both,30 mL,mL,,114,96.9,32.6724,114,CorVel,Worker's Compensation,114,100,,percent of total billed charges,,
MORPHINE CONCENTRATE 100 MG/5 ML (20 MG/ML) ORAL SOLN,,3032,LOCAL,Facility,Both,30 mL,mL,,114,96.9,32.6724,114,First Health Group Corporation,First Health Network,110.58,97,,percent of total billed charges,,
MORPHINE CONCENTRATE 100 MG/5 ML (20 MG/ML) ORAL SOLN,,3032,LOCAL,Facility,Both,30 mL,mL,,114,96.9,32.6724,114,"Health Partners, Inc.",Commercial,107.844,94.6,,percent of total billed charges,,
MORPHINE CONCENTRATE 100 MG/5 ML (20 MG/ML) ORAL SOLN,,3032,LOCAL,Facility,Outpatient,30 mL,mL,,114,96.9,32.6724,114,"Health Partners, Inc.",Medicare Advantage,55.86,49,,percent of total billed charges,,
MORPHINE CONCENTRATE 100 MG/5 ML (20 MG/ML) ORAL SOLN,,3032,LOCAL,Facility,Inpatient,30 mL,mL,,114,96.9,32.6724,114,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
MORPHINE CONCENTRATE 100 MG/5 ML (20 MG/ML) ORAL SOLN,,3032,LOCAL,Facility,Both,30 mL,mL,,114,96.9,32.6724,114,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),68.4,60,,percent of total billed charges,,
MORPHINE CONCENTRATE 100 MG/5 ML (20 MG/ML) ORAL SOLN,,3032,LOCAL,Facility,Both,30 mL,mL,,114,96.9,32.6724,114,"Health Partners, Inc.",State of Minnesota Advantage Program,92.91,81.5,,percent of total billed charges,,
MORPHINE CONCENTRATE 100 MG/5 ML (20 MG/ML) ORAL SOLN,,3032,LOCAL,Facility,Both,30 mL,mL,,114,96.9,32.6724,114,"Health Partners, Inc.",State Public Programs,57,50,,percent of total billed charges,,
MORPHINE CONCENTRATE 100 MG/5 ML (20 MG/ML) ORAL SOLN,,3032,LOCAL,Facility,Both,30 mL,mL,,114,96.9,32.6724,114,Humana Insurance Company,Commercial PPO,108.3,95,,percent of total billed charges,,
MORPHINE CONCENTRATE 100 MG/5 ML (20 MG/ML) ORAL SOLN,,3032,LOCAL,Facility,Outpatient,30 mL,mL,,114,96.9,32.6724,114,Humana Insurance Company,Medicare PPO,55.86,49,,percent of total billed charges,,
MORPHINE CONCENTRATE 100 MG/5 ML (20 MG/ML) ORAL SOLN,,3032,LOCAL,Facility,Inpatient,30 mL,mL,,114,96.9,32.6724,114,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
MORPHINE CONCENTRATE 100 MG/5 ML (20 MG/ML) ORAL SOLN,,3032,LOCAL,Facility,Both,30 mL,mL,,114,96.9,32.6724,114,Medica,Individual & Family,112.974,99.1,,percent of total billed charges,,
MORPHINE CONCENTRATE 100 MG/5 ML (20 MG/ML) ORAL SOLN,,3032,LOCAL,Facility,Outpatient,30 mL,mL,,114,96.9,32.6724,114,Medica,Medica Advantage Solution,56.772,49.8,,percent of total billed charges,,
MORPHINE CONCENTRATE 100 MG/5 ML (20 MG/ML) ORAL SOLN,,3032,LOCAL,Facility,Inpatient,30 mL,mL,,114,96.9,32.6724,114,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
MORPHINE CONCENTRATE 100 MG/5 ML (20 MG/ML) ORAL SOLN,,3032,LOCAL,Facility,Outpatient,30 mL,mL,,114,96.9,32.6724,114,Medica,Medical Assistance,50.844,44.6,,percent of total billed charges,,
MORPHINE CONCENTRATE 100 MG/5 ML (20 MG/ML) ORAL SOLN,,3032,LOCAL,Facility,Inpatient,30 mL,mL,,114,96.9,32.6724,114,Medica,Medical Assistance,,,,,Included in per diem rate,
MORPHINE CONCENTRATE 100 MG/5 ML (20 MG/ML) ORAL SOLN,,3032,LOCAL,Facility,Outpatient,30 mL,mL,,114,96.9,32.6724,114,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,56.772,49.8,,percent of total billed charges,,
MORPHINE CONCENTRATE 100 MG/5 ML (20 MG/ML) ORAL SOLN,,3032,LOCAL,Facility,Inpatient,30 mL,mL,,114,96.9,32.6724,114,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
MORPHINE CONCENTRATE 100 MG/5 ML (20 MG/ML) ORAL SOLN,,3032,LOCAL,Facility,Both,30 mL,mL,,114,96.9,32.6724,114,"Multiplan, Inc.","Multiplan, Inc.",107.16,94,,percent of total billed charges,,
MORPHINE CONCENTRATE 100 MG/5 ML (20 MG/ML) ORAL SOLN,,3032,LOCAL,Facility,Outpatient,30 mL,mL,,114,96.9,32.6724,114,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,102.714,90.1,,percent of total billed charges,,
MORPHINE CONCENTRATE 100 MG/5 ML (20 MG/ML) ORAL SOLN,,3032,LOCAL,Facility,Inpatient,30 mL,mL,,114,96.9,32.6724,114,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
MORPHINE CONCENTRATE 100 MG/5 ML (20 MG/ML) ORAL SOLN,,3032,LOCAL,Facility,Both,30 mL,mL,,114,96.9,32.6724,114,"Preferred One Administrative Services, INC.",PPO,112.404,98.6,,percent of total billed charges,,
MORPHINE CONCENTRATE 100 MG/5 ML (20 MG/ML) ORAL SOLN,,3032,LOCAL,Facility,Outpatient,30 mL,mL,,114,96.9,32.6724,114,PrimeWest Health,Minnesota Senior Health Options (MSHO),58.653,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
MORPHINE CONCENTRATE 100 MG/5 ML (20 MG/ML) ORAL SOLN,,3032,LOCAL,Facility,Inpatient,30 mL,mL,,114,96.9,32.6724,114,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
MORPHINE CONCENTRATE 100 MG/5 ML (20 MG/ML) ORAL SOLN,,3032,LOCAL,Facility,Outpatient,30 mL,mL,,114,96.9,32.6724,114,PrimeWest Health,MinnesotaCare,58.5504,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
MORPHINE CONCENTRATE 100 MG/5 ML (20 MG/ML) ORAL SOLN,,3032,LOCAL,Facility,Inpatient,30 mL,mL,,114,96.9,32.6724,114,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
MORPHINE CONCENTRATE 100 MG/5 ML (20 MG/ML) ORAL SOLN,,3032,LOCAL,Facility,Both,30 mL,mL,,114,96.9,32.6724,114,Sanford Health Plan,Sanford Health Plan,104.88,92,,percent of total billed charges,,
MORPHINE CONCENTRATE 100 MG/5 ML (20 MG/ML) ORAL SOLN,,3032,LOCAL,Facility,Outpatient,30 mL,mL,,114,96.9,32.6724,114,"UCare Health, Inc.",Individual & Family Plan,64.239,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
MORPHINE CONCENTRATE 100 MG/5 ML (20 MG/ML) ORAL SOLN,,3032,LOCAL,Facility,Inpatient,30 mL,mL,,114,96.9,32.6724,114,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
MORPHINE CONCENTRATE 100 MG/5 ML (20 MG/ML) ORAL SOLN,,3032,LOCAL,Facility,Outpatient,30 mL,mL,,114,96.9,32.6724,114,"UCare Health, Inc.",Medical Assistance,57.5358,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MORPHINE CONCENTRATE 100 MG/5 ML (20 MG/ML) ORAL SOLN,,3032,LOCAL,Facility,Inpatient,30 mL,mL,,114,96.9,32.6724,114,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
MORPHINE CONCENTRATE 100 MG/5 ML (20 MG/ML) ORAL SOLN,,3032,LOCAL,Facility,Outpatient,30 mL,mL,,114,96.9,32.6724,114,"UCare Health, Inc.",Medicare Advantage,57.5358,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MORPHINE CONCENTRATE 100 MG/5 ML (20 MG/ML) ORAL SOLN,,3032,LOCAL,Facility,Inpatient,30 mL,mL,,114,96.9,32.6724,114,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
MORPHINE CONCENTRATE 100 MG/5 ML (20 MG/ML) ORAL SOLN,,3032,LOCAL,Facility,Outpatient,30 mL,mL,,114,96.9,32.6724,114,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),57.5358,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MORPHINE CONCENTRATE 100 MG/5 ML (20 MG/ML) ORAL SOLN,,3032,LOCAL,Facility,Inpatient,30 mL,mL,,114,96.9,32.6724,114,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
MORPHINE CONCENTRATE 100 MG/5 ML (20 MG/ML) ORAL SOLN,,3032,LOCAL,Facility,Both,30 mL,mL,,114,96.9,32.6724,114,UnitedHealthcare,Individual & Family,107.16,94,,percent of total billed charges,,
MORPHINE CONCENTRATE 100 MG/5 ML (20 MG/ML) ORAL SOLN,,3032,LOCAL,Facility,Outpatient,30 mL,mL,,114,96.9,32.6724,114,UnitedHealthcare,Medicare Advantage,55.86,49,,percent of total billed charges,,
MORPHINE CONCENTRATE 100 MG/5 ML (20 MG/ML) ORAL SOLN,,3032,LOCAL,Facility,Inpatient,30 mL,mL,,114,96.9,32.6724,114,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
MORPHINE CONCENTRATE 100 MG/5 ML (20 MG/ML) ORAL SOLN,,3032,LOCAL,Facility,Outpatient,30 mL,mL,,114,96.9,32.6724,114,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,54.72,48,,percent of total billed charges,,100% of DHS outpatient percentage
MORPHINE CONCENTRATE 100 MG/5 ML (20 MG/ML) ORAL SOLN,,3032,LOCAL,Facility,Inpatient,30 mL,mL,,114,96.9,32.6724,114,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
LIDOCAINE HCL 2 % MM JELL,,6821,LOCAL,Facility,Both,30 mL,mL,,501,425.85,143.5866,501,Aetna,Commercial,460.92,92,,percent of total billed charges,,
LIDOCAINE HCL 2 % MM JELL,,6821,LOCAL,Facility,Outpatient,30 mL,mL,,501,425.85,143.5866,501,Aetna,Medicare Advantage,245.49,49,,percent of total billed charges,,
LIDOCAINE HCL 2 % MM JELL,,6821,LOCAL,Facility,Inpatient,30 mL,mL,,501,425.85,143.5866,501,Aetna,Medicare Advantage,,,,,Included in per diem rate,
LIDOCAINE HCL 2 % MM JELL,,6821,LOCAL,Facility,Both,30 mL,mL,,501,425.85,143.5866,501,Aetna,PPO,465.93,93,,percent of total billed charges,,
LIDOCAINE HCL 2 % MM JELL,,6821,LOCAL,Facility,Both,30 mL,mL,,501,425.85,143.5866,501,America's PPO,America's PPO,481.1103,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
LIDOCAINE HCL 2 % MM JELL,,6821,LOCAL,Facility,Both,30 mL,mL,,501,425.85,143.5866,501,BlueCross BlueShield Minnesota, Federal Employee Program,492.984,98.4,,percent of total billed charges,,
LIDOCAINE HCL 2 % MM JELL,,6821,LOCAL,Facility,Both,30 mL,mL,,501,425.85,143.5866,501,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,501,100,,percent of total billed charges,,
LIDOCAINE HCL 2 % MM JELL,,6821,LOCAL,Facility,Both,30 mL,mL,,501,425.85,143.5866,501,BlueCross BlueShield Minnesota,High Value Network Plan,450.9,90,,percent of total billed charges,,
LIDOCAINE HCL 2 % MM JELL,,6821,LOCAL,Facility,Outpatient,30 mL,mL,,501,425.85,143.5866,501,BlueCross BlueShield Minnesota,Medicare Advantage,245.49,49,,percent of total billed charges,,
LIDOCAINE HCL 2 % MM JELL,,6821,LOCAL,Facility,Inpatient,30 mL,mL,,501,425.85,143.5866,501,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
LIDOCAINE HCL 2 % MM JELL,,6821,LOCAL,Facility,Both,30 mL,mL,,501,425.85,143.5866,501,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,443.7357,88.57,,percent of total billed charges,,
LIDOCAINE HCL 2 % MM JELL,,6821,LOCAL,Facility,Both,30 mL,mL,,501,425.85,143.5866,501,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,143.5866,28.66,,percent of total billed charges,,
LIDOCAINE HCL 2 % MM JELL,,6821,LOCAL,Facility,Outpatient,30 mL,mL,,501,425.85,143.5866,501,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),245.49,49,,percent of total billed charges,,
LIDOCAINE HCL 2 % MM JELL,,6821,LOCAL,Facility,Inpatient,30 mL,mL,,501,425.85,143.5866,501,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
LIDOCAINE HCL 2 % MM JELL,,6821,LOCAL,Facility,Both,30 mL,mL,,501,425.85,143.5866,501,CorVel,Worker's Compensation,501,100,,percent of total billed charges,,
LIDOCAINE HCL 2 % MM JELL,,6821,LOCAL,Facility,Both,30 mL,mL,,501,425.85,143.5866,501,First Health Group Corporation,First Health Network,485.97,97,,percent of total billed charges,,
LIDOCAINE HCL 2 % MM JELL,,6821,LOCAL,Facility,Both,30 mL,mL,,501,425.85,143.5866,501,"Health Partners, Inc.",Commercial,473.946,94.6,,percent of total billed charges,,
LIDOCAINE HCL 2 % MM JELL,,6821,LOCAL,Facility,Outpatient,30 mL,mL,,501,425.85,143.5866,501,"Health Partners, Inc.",Medicare Advantage,245.49,49,,percent of total billed charges,,
LIDOCAINE HCL 2 % MM JELL,,6821,LOCAL,Facility,Inpatient,30 mL,mL,,501,425.85,143.5866,501,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LIDOCAINE HCL 2 % MM JELL,,6821,LOCAL,Facility,Both,30 mL,mL,,501,425.85,143.5866,501,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),300.6,60,,percent of total billed charges,,
LIDOCAINE HCL 2 % MM JELL,,6821,LOCAL,Facility,Both,30 mL,mL,,501,425.85,143.5866,501,"Health Partners, Inc.",State of Minnesota Advantage Program,408.315,81.5,,percent of total billed charges,,
LIDOCAINE HCL 2 % MM JELL,,6821,LOCAL,Facility,Both,30 mL,mL,,501,425.85,143.5866,501,"Health Partners, Inc.",State Public Programs,250.5,50,,percent of total billed charges,,
LIDOCAINE HCL 2 % MM JELL,,6821,LOCAL,Facility,Both,30 mL,mL,,501,425.85,143.5866,501,Humana Insurance Company,Commercial PPO,475.95,95,,percent of total billed charges,,
LIDOCAINE HCL 2 % MM JELL,,6821,LOCAL,Facility,Outpatient,30 mL,mL,,501,425.85,143.5866,501,Humana Insurance Company,Medicare PPO,245.49,49,,percent of total billed charges,,
LIDOCAINE HCL 2 % MM JELL,,6821,LOCAL,Facility,Inpatient,30 mL,mL,,501,425.85,143.5866,501,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
LIDOCAINE HCL 2 % MM JELL,,6821,LOCAL,Facility,Both,30 mL,mL,,501,425.85,143.5866,501,Medica,Individual & Family,496.491,99.1,,percent of total billed charges,,
LIDOCAINE HCL 2 % MM JELL,,6821,LOCAL,Facility,Outpatient,30 mL,mL,,501,425.85,143.5866,501,Medica,Medica Advantage Solution,249.498,49.8,,percent of total billed charges,,
LIDOCAINE HCL 2 % MM JELL,,6821,LOCAL,Facility,Inpatient,30 mL,mL,,501,425.85,143.5866,501,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
LIDOCAINE HCL 2 % MM JELL,,6821,LOCAL,Facility,Outpatient,30 mL,mL,,501,425.85,143.5866,501,Medica,Medical Assistance,223.446,44.6,,percent of total billed charges,,
LIDOCAINE HCL 2 % MM JELL,,6821,LOCAL,Facility,Inpatient,30 mL,mL,,501,425.85,143.5866,501,Medica,Medical Assistance,,,,,Included in per diem rate,
LIDOCAINE HCL 2 % MM JELL,,6821,LOCAL,Facility,Outpatient,30 mL,mL,,501,425.85,143.5866,501,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,249.498,49.8,,percent of total billed charges,,
LIDOCAINE HCL 2 % MM JELL,,6821,LOCAL,Facility,Inpatient,30 mL,mL,,501,425.85,143.5866,501,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
LIDOCAINE HCL 2 % MM JELL,,6821,LOCAL,Facility,Both,30 mL,mL,,501,425.85,143.5866,501,"Multiplan, Inc.","Multiplan, Inc.",470.94,94,,percent of total billed charges,,
LIDOCAINE HCL 2 % MM JELL,,6821,LOCAL,Facility,Outpatient,30 mL,mL,,501,425.85,143.5866,501,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,451.401,90.1,,percent of total billed charges,,
LIDOCAINE HCL 2 % MM JELL,,6821,LOCAL,Facility,Inpatient,30 mL,mL,,501,425.85,143.5866,501,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
LIDOCAINE HCL 2 % MM JELL,,6821,LOCAL,Facility,Both,30 mL,mL,,501,425.85,143.5866,501,"Preferred One Administrative Services, INC.",PPO,493.986,98.6,,percent of total billed charges,,
LIDOCAINE HCL 2 % MM JELL,,6821,LOCAL,Facility,Outpatient,30 mL,mL,,501,425.85,143.5866,501,PrimeWest Health,Minnesota Senior Health Options (MSHO),257.7645,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
LIDOCAINE HCL 2 % MM JELL,,6821,LOCAL,Facility,Inpatient,30 mL,mL,,501,425.85,143.5866,501,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LIDOCAINE HCL 2 % MM JELL,,6821,LOCAL,Facility,Outpatient,30 mL,mL,,501,425.85,143.5866,501,PrimeWest Health,MinnesotaCare,257.3136,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
LIDOCAINE HCL 2 % MM JELL,,6821,LOCAL,Facility,Inpatient,30 mL,mL,,501,425.85,143.5866,501,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
LIDOCAINE HCL 2 % MM JELL,,6821,LOCAL,Facility,Both,30 mL,mL,,501,425.85,143.5866,501,Sanford Health Plan,Sanford Health Plan,460.92,92,,percent of total billed charges,,
LIDOCAINE HCL 2 % MM JELL,,6821,LOCAL,Facility,Outpatient,30 mL,mL,,501,425.85,143.5866,501,"UCare Health, Inc.",Individual & Family Plan,282.3135,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
LIDOCAINE HCL 2 % MM JELL,,6821,LOCAL,Facility,Inpatient,30 mL,mL,,501,425.85,143.5866,501,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
LIDOCAINE HCL 2 % MM JELL,,6821,LOCAL,Facility,Outpatient,30 mL,mL,,501,425.85,143.5866,501,"UCare Health, Inc.",Medical Assistance,252.8547,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LIDOCAINE HCL 2 % MM JELL,,6821,LOCAL,Facility,Inpatient,30 mL,mL,,501,425.85,143.5866,501,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
LIDOCAINE HCL 2 % MM JELL,,6821,LOCAL,Facility,Outpatient,30 mL,mL,,501,425.85,143.5866,501,"UCare Health, Inc.",Medicare Advantage,252.8547,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LIDOCAINE HCL 2 % MM JELL,,6821,LOCAL,Facility,Inpatient,30 mL,mL,,501,425.85,143.5866,501,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LIDOCAINE HCL 2 % MM JELL,,6821,LOCAL,Facility,Outpatient,30 mL,mL,,501,425.85,143.5866,501,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),252.8547,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LIDOCAINE HCL 2 % MM JELL,,6821,LOCAL,Facility,Inpatient,30 mL,mL,,501,425.85,143.5866,501,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LIDOCAINE HCL 2 % MM JELL,,6821,LOCAL,Facility,Both,30 mL,mL,,501,425.85,143.5866,501,UnitedHealthcare,Individual & Family,470.94,94,,percent of total billed charges,,
LIDOCAINE HCL 2 % MM JELL,,6821,LOCAL,Facility,Outpatient,30 mL,mL,,501,425.85,143.5866,501,UnitedHealthcare,Medicare Advantage,245.49,49,,percent of total billed charges,,
LIDOCAINE HCL 2 % MM JELL,,6821,LOCAL,Facility,Inpatient,30 mL,mL,,501,425.85,143.5866,501,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
LIDOCAINE HCL 2 % MM JELL,,6821,LOCAL,Facility,Outpatient,30 mL,mL,,501,425.85,143.5866,501,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,240.48,48,,percent of total billed charges,,100% of DHS outpatient percentage
LIDOCAINE HCL 2 % MM JELL,,6821,LOCAL,Facility,Inpatient,30 mL,mL,,501,425.85,143.5866,501,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSP,,10441,LOCAL,Facility,Both,30 mL,mL,,12,10.2,3.4392,12,Aetna,Commercial,11.04,92,,percent of total billed charges,,
MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSP,,10441,LOCAL,Facility,Outpatient,30 mL,mL,,12,10.2,3.4392,12,Aetna,Medicare Advantage,5.88,49,,percent of total billed charges,,
MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSP,,10441,LOCAL,Facility,Inpatient,30 mL,mL,,12,10.2,3.4392,12,Aetna,Medicare Advantage,,,,,Included in per diem rate,
MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSP,,10441,LOCAL,Facility,Both,30 mL,mL,,12,10.2,3.4392,12,Aetna,PPO,11.16,93,,percent of total billed charges,,
MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSP,,10441,LOCAL,Facility,Both,30 mL,mL,,12,10.2,3.4392,12,America's PPO,America's PPO,11.5236,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSP,,10441,LOCAL,Facility,Both,30 mL,mL,,12,10.2,3.4392,12,BlueCross BlueShield Minnesota, Federal Employee Program,11.808,98.4,,percent of total billed charges,,
MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSP,,10441,LOCAL,Facility,Both,30 mL,mL,,12,10.2,3.4392,12,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,12,100,,percent of total billed charges,,
MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSP,,10441,LOCAL,Facility,Both,30 mL,mL,,12,10.2,3.4392,12,BlueCross BlueShield Minnesota,High Value Network Plan,10.8,90,,percent of total billed charges,,
MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSP,,10441,LOCAL,Facility,Outpatient,30 mL,mL,,12,10.2,3.4392,12,BlueCross BlueShield Minnesota,Medicare Advantage,5.88,49,,percent of total billed charges,,
MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSP,,10441,LOCAL,Facility,Inpatient,30 mL,mL,,12,10.2,3.4392,12,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSP,,10441,LOCAL,Facility,Both,30 mL,mL,,12,10.2,3.4392,12,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,10.6284,88.57,,percent of total billed charges,,
MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSP,,10441,LOCAL,Facility,Both,30 mL,mL,,12,10.2,3.4392,12,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,3.4392,28.66,,percent of total billed charges,,
MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSP,,10441,LOCAL,Facility,Outpatient,30 mL,mL,,12,10.2,3.4392,12,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),5.88,49,,percent of total billed charges,,
MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSP,,10441,LOCAL,Facility,Inpatient,30 mL,mL,,12,10.2,3.4392,12,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSP,,10441,LOCAL,Facility,Both,30 mL,mL,,12,10.2,3.4392,12,CorVel,Worker's Compensation,12,100,,percent of total billed charges,,
MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSP,,10441,LOCAL,Facility,Both,30 mL,mL,,12,10.2,3.4392,12,First Health Group Corporation,First Health Network,11.64,97,,percent of total billed charges,,
MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSP,,10441,LOCAL,Facility,Both,30 mL,mL,,12,10.2,3.4392,12,"Health Partners, Inc.",Commercial,11.352,94.6,,percent of total billed charges,,
MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSP,,10441,LOCAL,Facility,Outpatient,30 mL,mL,,12,10.2,3.4392,12,"Health Partners, Inc.",Medicare Advantage,5.88,49,,percent of total billed charges,,
MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSP,,10441,LOCAL,Facility,Inpatient,30 mL,mL,,12,10.2,3.4392,12,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSP,,10441,LOCAL,Facility,Both,30 mL,mL,,12,10.2,3.4392,12,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),7.2,60,,percent of total billed charges,,
MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSP,,10441,LOCAL,Facility,Both,30 mL,mL,,12,10.2,3.4392,12,"Health Partners, Inc.",State of Minnesota Advantage Program,9.78,81.5,,percent of total billed charges,,
MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSP,,10441,LOCAL,Facility,Both,30 mL,mL,,12,10.2,3.4392,12,"Health Partners, Inc.",State Public Programs,6,50,,percent of total billed charges,,
MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSP,,10441,LOCAL,Facility,Both,30 mL,mL,,12,10.2,3.4392,12,Humana Insurance Company,Commercial PPO,11.4,95,,percent of total billed charges,,
MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSP,,10441,LOCAL,Facility,Outpatient,30 mL,mL,,12,10.2,3.4392,12,Humana Insurance Company,Medicare PPO,5.88,49,,percent of total billed charges,,
MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSP,,10441,LOCAL,Facility,Inpatient,30 mL,mL,,12,10.2,3.4392,12,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSP,,10441,LOCAL,Facility,Both,30 mL,mL,,12,10.2,3.4392,12,Medica,Individual & Family,11.892,99.1,,percent of total billed charges,,
MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSP,,10441,LOCAL,Facility,Outpatient,30 mL,mL,,12,10.2,3.4392,12,Medica,Medica Advantage Solution,5.976,49.8,,percent of total billed charges,,
MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSP,,10441,LOCAL,Facility,Inpatient,30 mL,mL,,12,10.2,3.4392,12,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSP,,10441,LOCAL,Facility,Outpatient,30 mL,mL,,12,10.2,3.4392,12,Medica,Medical Assistance,5.352,44.6,,percent of total billed charges,,
MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSP,,10441,LOCAL,Facility,Inpatient,30 mL,mL,,12,10.2,3.4392,12,Medica,Medical Assistance,,,,,Included in per diem rate,
MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSP,,10441,LOCAL,Facility,Outpatient,30 mL,mL,,12,10.2,3.4392,12,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,5.976,49.8,,percent of total billed charges,,
MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSP,,10441,LOCAL,Facility,Inpatient,30 mL,mL,,12,10.2,3.4392,12,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSP,,10441,LOCAL,Facility,Both,30 mL,mL,,12,10.2,3.4392,12,"Multiplan, Inc.","Multiplan, Inc.",11.28,94,,percent of total billed charges,,
MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSP,,10441,LOCAL,Facility,Outpatient,30 mL,mL,,12,10.2,3.4392,12,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,10.812,90.1,,percent of total billed charges,,
MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSP,,10441,LOCAL,Facility,Inpatient,30 mL,mL,,12,10.2,3.4392,12,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSP,,10441,LOCAL,Facility,Both,30 mL,mL,,12,10.2,3.4392,12,"Preferred One Administrative Services, INC.",PPO,11.832,98.6,,percent of total billed charges,,
MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSP,,10441,LOCAL,Facility,Outpatient,30 mL,mL,,12,10.2,3.4392,12,PrimeWest Health,Minnesota Senior Health Options (MSHO),6.174,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSP,,10441,LOCAL,Facility,Inpatient,30 mL,mL,,12,10.2,3.4392,12,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSP,,10441,LOCAL,Facility,Outpatient,30 mL,mL,,12,10.2,3.4392,12,PrimeWest Health,MinnesotaCare,6.1632,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSP,,10441,LOCAL,Facility,Inpatient,30 mL,mL,,12,10.2,3.4392,12,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSP,,10441,LOCAL,Facility,Both,30 mL,mL,,12,10.2,3.4392,12,Sanford Health Plan,Sanford Health Plan,11.04,92,,percent of total billed charges,,
MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSP,,10441,LOCAL,Facility,Outpatient,30 mL,mL,,12,10.2,3.4392,12,"UCare Health, Inc.",Individual & Family Plan,6.762,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSP,,10441,LOCAL,Facility,Inpatient,30 mL,mL,,12,10.2,3.4392,12,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSP,,10441,LOCAL,Facility,Outpatient,30 mL,mL,,12,10.2,3.4392,12,"UCare Health, Inc.",Medical Assistance,6.0564,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSP,,10441,LOCAL,Facility,Inpatient,30 mL,mL,,12,10.2,3.4392,12,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSP,,10441,LOCAL,Facility,Outpatient,30 mL,mL,,12,10.2,3.4392,12,"UCare Health, Inc.",Medicare Advantage,6.0564,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSP,,10441,LOCAL,Facility,Inpatient,30 mL,mL,,12,10.2,3.4392,12,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSP,,10441,LOCAL,Facility,Outpatient,30 mL,mL,,12,10.2,3.4392,12,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),6.0564,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSP,,10441,LOCAL,Facility,Inpatient,30 mL,mL,,12,10.2,3.4392,12,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSP,,10441,LOCAL,Facility,Both,30 mL,mL,,12,10.2,3.4392,12,UnitedHealthcare,Individual & Family,11.28,94,,percent of total billed charges,,
MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSP,,10441,LOCAL,Facility,Outpatient,30 mL,mL,,12,10.2,3.4392,12,UnitedHealthcare,Medicare Advantage,5.88,49,,percent of total billed charges,,
MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSP,,10441,LOCAL,Facility,Inpatient,30 mL,mL,,12,10.2,3.4392,12,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSP,,10441,LOCAL,Facility,Outpatient,30 mL,mL,,12,10.2,3.4392,12,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,5.76,48,,percent of total billed charges,,100% of DHS outpatient percentage
MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSP,,10441,LOCAL,Facility,Inpatient,30 mL,mL,,12,10.2,3.4392,12,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
POVIDONE-IODINE 5 % OPHT SOLN,,13252,LOCAL,Facility,Both,30 mL,mL,,93,79.05,26.6538,93,Aetna,Commercial,85.56,92,,percent of total billed charges,,
POVIDONE-IODINE 5 % OPHT SOLN,,13252,LOCAL,Facility,Outpatient,30 mL,mL,,93,79.05,26.6538,93,Aetna,Medicare Advantage,45.57,49,,percent of total billed charges,,
POVIDONE-IODINE 5 % OPHT SOLN,,13252,LOCAL,Facility,Inpatient,30 mL,mL,,93,79.05,26.6538,93,Aetna,Medicare Advantage,,,,,Included in per diem rate,
POVIDONE-IODINE 5 % OPHT SOLN,,13252,LOCAL,Facility,Both,30 mL,mL,,93,79.05,26.6538,93,Aetna,PPO,86.49,93,,percent of total billed charges,,
POVIDONE-IODINE 5 % OPHT SOLN,,13252,LOCAL,Facility,Both,30 mL,mL,,93,79.05,26.6538,93,America's PPO,America's PPO,89.3079,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
POVIDONE-IODINE 5 % OPHT SOLN,,13252,LOCAL,Facility,Both,30 mL,mL,,93,79.05,26.6538,93,BlueCross BlueShield Minnesota, Federal Employee Program,91.512,98.4,,percent of total billed charges,,
POVIDONE-IODINE 5 % OPHT SOLN,,13252,LOCAL,Facility,Both,30 mL,mL,,93,79.05,26.6538,93,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,93,100,,percent of total billed charges,,
POVIDONE-IODINE 5 % OPHT SOLN,,13252,LOCAL,Facility,Both,30 mL,mL,,93,79.05,26.6538,93,BlueCross BlueShield Minnesota,High Value Network Plan,83.7,90,,percent of total billed charges,,
POVIDONE-IODINE 5 % OPHT SOLN,,13252,LOCAL,Facility,Outpatient,30 mL,mL,,93,79.05,26.6538,93,BlueCross BlueShield Minnesota,Medicare Advantage,45.57,49,,percent of total billed charges,,
POVIDONE-IODINE 5 % OPHT SOLN,,13252,LOCAL,Facility,Inpatient,30 mL,mL,,93,79.05,26.6538,93,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
POVIDONE-IODINE 5 % OPHT SOLN,,13252,LOCAL,Facility,Both,30 mL,mL,,93,79.05,26.6538,93,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,82.3701,88.57,,percent of total billed charges,,
POVIDONE-IODINE 5 % OPHT SOLN,,13252,LOCAL,Facility,Both,30 mL,mL,,93,79.05,26.6538,93,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,26.6538,28.66,,percent of total billed charges,,
POVIDONE-IODINE 5 % OPHT SOLN,,13252,LOCAL,Facility,Outpatient,30 mL,mL,,93,79.05,26.6538,93,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),45.57,49,,percent of total billed charges,,
POVIDONE-IODINE 5 % OPHT SOLN,,13252,LOCAL,Facility,Inpatient,30 mL,mL,,93,79.05,26.6538,93,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
POVIDONE-IODINE 5 % OPHT SOLN,,13252,LOCAL,Facility,Both,30 mL,mL,,93,79.05,26.6538,93,CorVel,Worker's Compensation,93,100,,percent of total billed charges,,
POVIDONE-IODINE 5 % OPHT SOLN,,13252,LOCAL,Facility,Both,30 mL,mL,,93,79.05,26.6538,93,First Health Group Corporation,First Health Network,90.21,97,,percent of total billed charges,,
POVIDONE-IODINE 5 % OPHT SOLN,,13252,LOCAL,Facility,Both,30 mL,mL,,93,79.05,26.6538,93,"Health Partners, Inc.",Commercial,87.978,94.6,,percent of total billed charges,,
POVIDONE-IODINE 5 % OPHT SOLN,,13252,LOCAL,Facility,Outpatient,30 mL,mL,,93,79.05,26.6538,93,"Health Partners, Inc.",Medicare Advantage,45.57,49,,percent of total billed charges,,
POVIDONE-IODINE 5 % OPHT SOLN,,13252,LOCAL,Facility,Inpatient,30 mL,mL,,93,79.05,26.6538,93,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
POVIDONE-IODINE 5 % OPHT SOLN,,13252,LOCAL,Facility,Both,30 mL,mL,,93,79.05,26.6538,93,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),55.8,60,,percent of total billed charges,,
POVIDONE-IODINE 5 % OPHT SOLN,,13252,LOCAL,Facility,Both,30 mL,mL,,93,79.05,26.6538,93,"Health Partners, Inc.",State of Minnesota Advantage Program,75.795,81.5,,percent of total billed charges,,
POVIDONE-IODINE 5 % OPHT SOLN,,13252,LOCAL,Facility,Both,30 mL,mL,,93,79.05,26.6538,93,"Health Partners, Inc.",State Public Programs,46.5,50,,percent of total billed charges,,
POVIDONE-IODINE 5 % OPHT SOLN,,13252,LOCAL,Facility,Both,30 mL,mL,,93,79.05,26.6538,93,Humana Insurance Company,Commercial PPO,88.35,95,,percent of total billed charges,,
POVIDONE-IODINE 5 % OPHT SOLN,,13252,LOCAL,Facility,Outpatient,30 mL,mL,,93,79.05,26.6538,93,Humana Insurance Company,Medicare PPO,45.57,49,,percent of total billed charges,,
POVIDONE-IODINE 5 % OPHT SOLN,,13252,LOCAL,Facility,Inpatient,30 mL,mL,,93,79.05,26.6538,93,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
POVIDONE-IODINE 5 % OPHT SOLN,,13252,LOCAL,Facility,Both,30 mL,mL,,93,79.05,26.6538,93,Medica,Individual & Family,92.163,99.1,,percent of total billed charges,,
POVIDONE-IODINE 5 % OPHT SOLN,,13252,LOCAL,Facility,Outpatient,30 mL,mL,,93,79.05,26.6538,93,Medica,Medica Advantage Solution,46.314,49.8,,percent of total billed charges,,
POVIDONE-IODINE 5 % OPHT SOLN,,13252,LOCAL,Facility,Inpatient,30 mL,mL,,93,79.05,26.6538,93,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
POVIDONE-IODINE 5 % OPHT SOLN,,13252,LOCAL,Facility,Outpatient,30 mL,mL,,93,79.05,26.6538,93,Medica,Medical Assistance,41.478,44.6,,percent of total billed charges,,
POVIDONE-IODINE 5 % OPHT SOLN,,13252,LOCAL,Facility,Inpatient,30 mL,mL,,93,79.05,26.6538,93,Medica,Medical Assistance,,,,,Included in per diem rate,
POVIDONE-IODINE 5 % OPHT SOLN,,13252,LOCAL,Facility,Outpatient,30 mL,mL,,93,79.05,26.6538,93,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,46.314,49.8,,percent of total billed charges,,
POVIDONE-IODINE 5 % OPHT SOLN,,13252,LOCAL,Facility,Inpatient,30 mL,mL,,93,79.05,26.6538,93,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
POVIDONE-IODINE 5 % OPHT SOLN,,13252,LOCAL,Facility,Both,30 mL,mL,,93,79.05,26.6538,93,"Multiplan, Inc.","Multiplan, Inc.",87.42,94,,percent of total billed charges,,
POVIDONE-IODINE 5 % OPHT SOLN,,13252,LOCAL,Facility,Outpatient,30 mL,mL,,93,79.05,26.6538,93,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,83.793,90.1,,percent of total billed charges,,
POVIDONE-IODINE 5 % OPHT SOLN,,13252,LOCAL,Facility,Inpatient,30 mL,mL,,93,79.05,26.6538,93,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
POVIDONE-IODINE 5 % OPHT SOLN,,13252,LOCAL,Facility,Both,30 mL,mL,,93,79.05,26.6538,93,"Preferred One Administrative Services, INC.",PPO,91.698,98.6,,percent of total billed charges,,
POVIDONE-IODINE 5 % OPHT SOLN,,13252,LOCAL,Facility,Outpatient,30 mL,mL,,93,79.05,26.6538,93,PrimeWest Health,Minnesota Senior Health Options (MSHO),47.8485,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
POVIDONE-IODINE 5 % OPHT SOLN,,13252,LOCAL,Facility,Inpatient,30 mL,mL,,93,79.05,26.6538,93,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
POVIDONE-IODINE 5 % OPHT SOLN,,13252,LOCAL,Facility,Outpatient,30 mL,mL,,93,79.05,26.6538,93,PrimeWest Health,MinnesotaCare,47.7648,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
POVIDONE-IODINE 5 % OPHT SOLN,,13252,LOCAL,Facility,Inpatient,30 mL,mL,,93,79.05,26.6538,93,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
POVIDONE-IODINE 5 % OPHT SOLN,,13252,LOCAL,Facility,Both,30 mL,mL,,93,79.05,26.6538,93,Sanford Health Plan,Sanford Health Plan,85.56,92,,percent of total billed charges,,
POVIDONE-IODINE 5 % OPHT SOLN,,13252,LOCAL,Facility,Outpatient,30 mL,mL,,93,79.05,26.6538,93,"UCare Health, Inc.",Individual & Family Plan,52.4055,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
POVIDONE-IODINE 5 % OPHT SOLN,,13252,LOCAL,Facility,Inpatient,30 mL,mL,,93,79.05,26.6538,93,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
POVIDONE-IODINE 5 % OPHT SOLN,,13252,LOCAL,Facility,Outpatient,30 mL,mL,,93,79.05,26.6538,93,"UCare Health, Inc.",Medical Assistance,46.9371,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
POVIDONE-IODINE 5 % OPHT SOLN,,13252,LOCAL,Facility,Inpatient,30 mL,mL,,93,79.05,26.6538,93,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
POVIDONE-IODINE 5 % OPHT SOLN,,13252,LOCAL,Facility,Outpatient,30 mL,mL,,93,79.05,26.6538,93,"UCare Health, Inc.",Medicare Advantage,46.9371,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
POVIDONE-IODINE 5 % OPHT SOLN,,13252,LOCAL,Facility,Inpatient,30 mL,mL,,93,79.05,26.6538,93,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
POVIDONE-IODINE 5 % OPHT SOLN,,13252,LOCAL,Facility,Outpatient,30 mL,mL,,93,79.05,26.6538,93,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),46.9371,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
POVIDONE-IODINE 5 % OPHT SOLN,,13252,LOCAL,Facility,Inpatient,30 mL,mL,,93,79.05,26.6538,93,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
POVIDONE-IODINE 5 % OPHT SOLN,,13252,LOCAL,Facility,Both,30 mL,mL,,93,79.05,26.6538,93,UnitedHealthcare,Individual & Family,87.42,94,,percent of total billed charges,,
POVIDONE-IODINE 5 % OPHT SOLN,,13252,LOCAL,Facility,Outpatient,30 mL,mL,,93,79.05,26.6538,93,UnitedHealthcare,Medicare Advantage,45.57,49,,percent of total billed charges,,
POVIDONE-IODINE 5 % OPHT SOLN,,13252,LOCAL,Facility,Inpatient,30 mL,mL,,93,79.05,26.6538,93,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
POVIDONE-IODINE 5 % OPHT SOLN,,13252,LOCAL,Facility,Outpatient,30 mL,mL,,93,79.05,26.6538,93,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,44.64,48,,percent of total billed charges,,100% of DHS outpatient percentage
POVIDONE-IODINE 5 % OPHT SOLN,,13252,LOCAL,Facility,Inpatient,30 mL,mL,,93,79.05,26.6538,93,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
ALUM-MAG HYDROXIDE-SIMETH 200-200-20 MG/5 ML ORAL SUSP,,16790,LOCAL,Facility,Both,30 mL,mL,,19,16.15,5.4454,19,Aetna,Commercial,17.48,92,,percent of total billed charges,,
ALUM-MAG HYDROXIDE-SIMETH 200-200-20 MG/5 ML ORAL SUSP,,16790,LOCAL,Facility,Outpatient,30 mL,mL,,19,16.15,5.4454,19,Aetna,Medicare Advantage,9.31,49,,percent of total billed charges,,
ALUM-MAG HYDROXIDE-SIMETH 200-200-20 MG/5 ML ORAL SUSP,,16790,LOCAL,Facility,Inpatient,30 mL,mL,,19,16.15,5.4454,19,Aetna,Medicare Advantage,,,,,Included in per diem rate,
ALUM-MAG HYDROXIDE-SIMETH 200-200-20 MG/5 ML ORAL SUSP,,16790,LOCAL,Facility,Both,30 mL,mL,,19,16.15,5.4454,19,Aetna,PPO,17.67,93,,percent of total billed charges,,
ALUM-MAG HYDROXIDE-SIMETH 200-200-20 MG/5 ML ORAL SUSP,,16790,LOCAL,Facility,Both,30 mL,mL,,19,16.15,5.4454,19,America's PPO,America's PPO,18.2457,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
ALUM-MAG HYDROXIDE-SIMETH 200-200-20 MG/5 ML ORAL SUSP,,16790,LOCAL,Facility,Both,30 mL,mL,,19,16.15,5.4454,19,BlueCross BlueShield Minnesota, Federal Employee Program,18.696,98.4,,percent of total billed charges,,
ALUM-MAG HYDROXIDE-SIMETH 200-200-20 MG/5 ML ORAL SUSP,,16790,LOCAL,Facility,Both,30 mL,mL,,19,16.15,5.4454,19,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,19,100,,percent of total billed charges,,
ALUM-MAG HYDROXIDE-SIMETH 200-200-20 MG/5 ML ORAL SUSP,,16790,LOCAL,Facility,Both,30 mL,mL,,19,16.15,5.4454,19,BlueCross BlueShield Minnesota,High Value Network Plan,17.1,90,,percent of total billed charges,,
ALUM-MAG HYDROXIDE-SIMETH 200-200-20 MG/5 ML ORAL SUSP,,16790,LOCAL,Facility,Outpatient,30 mL,mL,,19,16.15,5.4454,19,BlueCross BlueShield Minnesota,Medicare Advantage,9.31,49,,percent of total billed charges,,
ALUM-MAG HYDROXIDE-SIMETH 200-200-20 MG/5 ML ORAL SUSP,,16790,LOCAL,Facility,Inpatient,30 mL,mL,,19,16.15,5.4454,19,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
ALUM-MAG HYDROXIDE-SIMETH 200-200-20 MG/5 ML ORAL SUSP,,16790,LOCAL,Facility,Both,30 mL,mL,,19,16.15,5.4454,19,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,16.8283,88.57,,percent of total billed charges,,
ALUM-MAG HYDROXIDE-SIMETH 200-200-20 MG/5 ML ORAL SUSP,,16790,LOCAL,Facility,Both,30 mL,mL,,19,16.15,5.4454,19,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,5.4454,28.66,,percent of total billed charges,,
ALUM-MAG HYDROXIDE-SIMETH 200-200-20 MG/5 ML ORAL SUSP,,16790,LOCAL,Facility,Outpatient,30 mL,mL,,19,16.15,5.4454,19,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),9.31,49,,percent of total billed charges,,
ALUM-MAG HYDROXIDE-SIMETH 200-200-20 MG/5 ML ORAL SUSP,,16790,LOCAL,Facility,Inpatient,30 mL,mL,,19,16.15,5.4454,19,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
ALUM-MAG HYDROXIDE-SIMETH 200-200-20 MG/5 ML ORAL SUSP,,16790,LOCAL,Facility,Both,30 mL,mL,,19,16.15,5.4454,19,CorVel,Worker's Compensation,19,100,,percent of total billed charges,,
ALUM-MAG HYDROXIDE-SIMETH 200-200-20 MG/5 ML ORAL SUSP,,16790,LOCAL,Facility,Both,30 mL,mL,,19,16.15,5.4454,19,First Health Group Corporation,First Health Network,18.43,97,,percent of total billed charges,,
ALUM-MAG HYDROXIDE-SIMETH 200-200-20 MG/5 ML ORAL SUSP,,16790,LOCAL,Facility,Both,30 mL,mL,,19,16.15,5.4454,19,"Health Partners, Inc.",Commercial,17.974,94.6,,percent of total billed charges,,
ALUM-MAG HYDROXIDE-SIMETH 200-200-20 MG/5 ML ORAL SUSP,,16790,LOCAL,Facility,Outpatient,30 mL,mL,,19,16.15,5.4454,19,"Health Partners, Inc.",Medicare Advantage,9.31,49,,percent of total billed charges,,
ALUM-MAG HYDROXIDE-SIMETH 200-200-20 MG/5 ML ORAL SUSP,,16790,LOCAL,Facility,Inpatient,30 mL,mL,,19,16.15,5.4454,19,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ALUM-MAG HYDROXIDE-SIMETH 200-200-20 MG/5 ML ORAL SUSP,,16790,LOCAL,Facility,Both,30 mL,mL,,19,16.15,5.4454,19,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),11.4,60,,percent of total billed charges,,
ALUM-MAG HYDROXIDE-SIMETH 200-200-20 MG/5 ML ORAL SUSP,,16790,LOCAL,Facility,Both,30 mL,mL,,19,16.15,5.4454,19,"Health Partners, Inc.",State of Minnesota Advantage Program,15.485,81.5,,percent of total billed charges,,
ALUM-MAG HYDROXIDE-SIMETH 200-200-20 MG/5 ML ORAL SUSP,,16790,LOCAL,Facility,Both,30 mL,mL,,19,16.15,5.4454,19,"Health Partners, Inc.",State Public Programs,9.5,50,,percent of total billed charges,,
ALUM-MAG HYDROXIDE-SIMETH 200-200-20 MG/5 ML ORAL SUSP,,16790,LOCAL,Facility,Both,30 mL,mL,,19,16.15,5.4454,19,Humana Insurance Company,Commercial PPO,18.05,95,,percent of total billed charges,,
ALUM-MAG HYDROXIDE-SIMETH 200-200-20 MG/5 ML ORAL SUSP,,16790,LOCAL,Facility,Outpatient,30 mL,mL,,19,16.15,5.4454,19,Humana Insurance Company,Medicare PPO,9.31,49,,percent of total billed charges,,
ALUM-MAG HYDROXIDE-SIMETH 200-200-20 MG/5 ML ORAL SUSP,,16790,LOCAL,Facility,Inpatient,30 mL,mL,,19,16.15,5.4454,19,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
ALUM-MAG HYDROXIDE-SIMETH 200-200-20 MG/5 ML ORAL SUSP,,16790,LOCAL,Facility,Both,30 mL,mL,,19,16.15,5.4454,19,Medica,Individual & Family,18.829,99.1,,percent of total billed charges,,
ALUM-MAG HYDROXIDE-SIMETH 200-200-20 MG/5 ML ORAL SUSP,,16790,LOCAL,Facility,Outpatient,30 mL,mL,,19,16.15,5.4454,19,Medica,Medica Advantage Solution,9.462,49.8,,percent of total billed charges,,
ALUM-MAG HYDROXIDE-SIMETH 200-200-20 MG/5 ML ORAL SUSP,,16790,LOCAL,Facility,Inpatient,30 mL,mL,,19,16.15,5.4454,19,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
ALUM-MAG HYDROXIDE-SIMETH 200-200-20 MG/5 ML ORAL SUSP,,16790,LOCAL,Facility,Outpatient,30 mL,mL,,19,16.15,5.4454,19,Medica,Medical Assistance,8.474,44.6,,percent of total billed charges,,
ALUM-MAG HYDROXIDE-SIMETH 200-200-20 MG/5 ML ORAL SUSP,,16790,LOCAL,Facility,Inpatient,30 mL,mL,,19,16.15,5.4454,19,Medica,Medical Assistance,,,,,Included in per diem rate,
ALUM-MAG HYDROXIDE-SIMETH 200-200-20 MG/5 ML ORAL SUSP,,16790,LOCAL,Facility,Outpatient,30 mL,mL,,19,16.15,5.4454,19,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,9.462,49.8,,percent of total billed charges,,
ALUM-MAG HYDROXIDE-SIMETH 200-200-20 MG/5 ML ORAL SUSP,,16790,LOCAL,Facility,Inpatient,30 mL,mL,,19,16.15,5.4454,19,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
ALUM-MAG HYDROXIDE-SIMETH 200-200-20 MG/5 ML ORAL SUSP,,16790,LOCAL,Facility,Both,30 mL,mL,,19,16.15,5.4454,19,"Multiplan, Inc.","Multiplan, Inc.",17.86,94,,percent of total billed charges,,
ALUM-MAG HYDROXIDE-SIMETH 200-200-20 MG/5 ML ORAL SUSP,,16790,LOCAL,Facility,Outpatient,30 mL,mL,,19,16.15,5.4454,19,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,17.119,90.1,,percent of total billed charges,,
ALUM-MAG HYDROXIDE-SIMETH 200-200-20 MG/5 ML ORAL SUSP,,16790,LOCAL,Facility,Inpatient,30 mL,mL,,19,16.15,5.4454,19,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
ALUM-MAG HYDROXIDE-SIMETH 200-200-20 MG/5 ML ORAL SUSP,,16790,LOCAL,Facility,Both,30 mL,mL,,19,16.15,5.4454,19,"Preferred One Administrative Services, INC.",PPO,18.734,98.6,,percent of total billed charges,,
ALUM-MAG HYDROXIDE-SIMETH 200-200-20 MG/5 ML ORAL SUSP,,16790,LOCAL,Facility,Outpatient,30 mL,mL,,19,16.15,5.4454,19,PrimeWest Health,Minnesota Senior Health Options (MSHO),9.7755,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
ALUM-MAG HYDROXIDE-SIMETH 200-200-20 MG/5 ML ORAL SUSP,,16790,LOCAL,Facility,Inpatient,30 mL,mL,,19,16.15,5.4454,19,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ALUM-MAG HYDROXIDE-SIMETH 200-200-20 MG/5 ML ORAL SUSP,,16790,LOCAL,Facility,Outpatient,30 mL,mL,,19,16.15,5.4454,19,PrimeWest Health,MinnesotaCare,9.7584,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
ALUM-MAG HYDROXIDE-SIMETH 200-200-20 MG/5 ML ORAL SUSP,,16790,LOCAL,Facility,Inpatient,30 mL,mL,,19,16.15,5.4454,19,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
ALUM-MAG HYDROXIDE-SIMETH 200-200-20 MG/5 ML ORAL SUSP,,16790,LOCAL,Facility,Both,30 mL,mL,,19,16.15,5.4454,19,Sanford Health Plan,Sanford Health Plan,17.48,92,,percent of total billed charges,,
ALUM-MAG HYDROXIDE-SIMETH 200-200-20 MG/5 ML ORAL SUSP,,16790,LOCAL,Facility,Outpatient,30 mL,mL,,19,16.15,5.4454,19,"UCare Health, Inc.",Individual & Family Plan,10.7065,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
ALUM-MAG HYDROXIDE-SIMETH 200-200-20 MG/5 ML ORAL SUSP,,16790,LOCAL,Facility,Inpatient,30 mL,mL,,19,16.15,5.4454,19,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
ALUM-MAG HYDROXIDE-SIMETH 200-200-20 MG/5 ML ORAL SUSP,,16790,LOCAL,Facility,Outpatient,30 mL,mL,,19,16.15,5.4454,19,"UCare Health, Inc.",Medical Assistance,9.5893,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ALUM-MAG HYDROXIDE-SIMETH 200-200-20 MG/5 ML ORAL SUSP,,16790,LOCAL,Facility,Inpatient,30 mL,mL,,19,16.15,5.4454,19,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
ALUM-MAG HYDROXIDE-SIMETH 200-200-20 MG/5 ML ORAL SUSP,,16790,LOCAL,Facility,Outpatient,30 mL,mL,,19,16.15,5.4454,19,"UCare Health, Inc.",Medicare Advantage,9.5893,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ALUM-MAG HYDROXIDE-SIMETH 200-200-20 MG/5 ML ORAL SUSP,,16790,LOCAL,Facility,Inpatient,30 mL,mL,,19,16.15,5.4454,19,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ALUM-MAG HYDROXIDE-SIMETH 200-200-20 MG/5 ML ORAL SUSP,,16790,LOCAL,Facility,Outpatient,30 mL,mL,,19,16.15,5.4454,19,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),9.5893,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ALUM-MAG HYDROXIDE-SIMETH 200-200-20 MG/5 ML ORAL SUSP,,16790,LOCAL,Facility,Inpatient,30 mL,mL,,19,16.15,5.4454,19,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ALUM-MAG HYDROXIDE-SIMETH 200-200-20 MG/5 ML ORAL SUSP,,16790,LOCAL,Facility,Both,30 mL,mL,,19,16.15,5.4454,19,UnitedHealthcare,Individual & Family,17.86,94,,percent of total billed charges,,
ALUM-MAG HYDROXIDE-SIMETH 200-200-20 MG/5 ML ORAL SUSP,,16790,LOCAL,Facility,Outpatient,30 mL,mL,,19,16.15,5.4454,19,UnitedHealthcare,Medicare Advantage,9.31,49,,percent of total billed charges,,
ALUM-MAG HYDROXIDE-SIMETH 200-200-20 MG/5 ML ORAL SUSP,,16790,LOCAL,Facility,Inpatient,30 mL,mL,,19,16.15,5.4454,19,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
ALUM-MAG HYDROXIDE-SIMETH 200-200-20 MG/5 ML ORAL SUSP,,16790,LOCAL,Facility,Outpatient,30 mL,mL,,19,16.15,5.4454,19,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,9.12,48,,percent of total billed charges,,100% of DHS outpatient percentage
ALUM-MAG HYDROXIDE-SIMETH 200-200-20 MG/5 ML ORAL SUSP,,16790,LOCAL,Facility,Inpatient,30 mL,mL,,19,16.15,5.4454,19,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
AZELASTINE 137 MCG (0.1 %) NASL SPRA,,17050,LOCAL,Facility,Both,30 mL,mL,,411,349.35,117.7926,411,Aetna,Commercial,378.12,92,,percent of total billed charges,,
AZELASTINE 137 MCG (0.1 %) NASL SPRA,,17050,LOCAL,Facility,Outpatient,30 mL,mL,,411,349.35,117.7926,411,Aetna,Medicare Advantage,201.39,49,,percent of total billed charges,,
AZELASTINE 137 MCG (0.1 %) NASL SPRA,,17050,LOCAL,Facility,Inpatient,30 mL,mL,,411,349.35,117.7926,411,Aetna,Medicare Advantage,,,,,Included in per diem rate,
AZELASTINE 137 MCG (0.1 %) NASL SPRA,,17050,LOCAL,Facility,Both,30 mL,mL,,411,349.35,117.7926,411,Aetna,PPO,382.23,93,,percent of total billed charges,,
AZELASTINE 137 MCG (0.1 %) NASL SPRA,,17050,LOCAL,Facility,Both,30 mL,mL,,411,349.35,117.7926,411,America's PPO,America's PPO,394.6833,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
AZELASTINE 137 MCG (0.1 %) NASL SPRA,,17050,LOCAL,Facility,Both,30 mL,mL,,411,349.35,117.7926,411,BlueCross BlueShield Minnesota, Federal Employee Program,404.424,98.4,,percent of total billed charges,,
AZELASTINE 137 MCG (0.1 %) NASL SPRA,,17050,LOCAL,Facility,Both,30 mL,mL,,411,349.35,117.7926,411,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,411,100,,percent of total billed charges,,
AZELASTINE 137 MCG (0.1 %) NASL SPRA,,17050,LOCAL,Facility,Both,30 mL,mL,,411,349.35,117.7926,411,BlueCross BlueShield Minnesota,High Value Network Plan,369.9,90,,percent of total billed charges,,
AZELASTINE 137 MCG (0.1 %) NASL SPRA,,17050,LOCAL,Facility,Outpatient,30 mL,mL,,411,349.35,117.7926,411,BlueCross BlueShield Minnesota,Medicare Advantage,201.39,49,,percent of total billed charges,,
AZELASTINE 137 MCG (0.1 %) NASL SPRA,,17050,LOCAL,Facility,Inpatient,30 mL,mL,,411,349.35,117.7926,411,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
AZELASTINE 137 MCG (0.1 %) NASL SPRA,,17050,LOCAL,Facility,Both,30 mL,mL,,411,349.35,117.7926,411,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,364.0227,88.57,,percent of total billed charges,,
AZELASTINE 137 MCG (0.1 %) NASL SPRA,,17050,LOCAL,Facility,Both,30 mL,mL,,411,349.35,117.7926,411,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,117.7926,28.66,,percent of total billed charges,,
AZELASTINE 137 MCG (0.1 %) NASL SPRA,,17050,LOCAL,Facility,Outpatient,30 mL,mL,,411,349.35,117.7926,411,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),201.39,49,,percent of total billed charges,,
AZELASTINE 137 MCG (0.1 %) NASL SPRA,,17050,LOCAL,Facility,Inpatient,30 mL,mL,,411,349.35,117.7926,411,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
AZELASTINE 137 MCG (0.1 %) NASL SPRA,,17050,LOCAL,Facility,Both,30 mL,mL,,411,349.35,117.7926,411,CorVel,Worker's Compensation,411,100,,percent of total billed charges,,
AZELASTINE 137 MCG (0.1 %) NASL SPRA,,17050,LOCAL,Facility,Both,30 mL,mL,,411,349.35,117.7926,411,First Health Group Corporation,First Health Network,398.67,97,,percent of total billed charges,,
AZELASTINE 137 MCG (0.1 %) NASL SPRA,,17050,LOCAL,Facility,Both,30 mL,mL,,411,349.35,117.7926,411,"Health Partners, Inc.",Commercial,388.806,94.6,,percent of total billed charges,,
AZELASTINE 137 MCG (0.1 %) NASL SPRA,,17050,LOCAL,Facility,Outpatient,30 mL,mL,,411,349.35,117.7926,411,"Health Partners, Inc.",Medicare Advantage,201.39,49,,percent of total billed charges,,
AZELASTINE 137 MCG (0.1 %) NASL SPRA,,17050,LOCAL,Facility,Inpatient,30 mL,mL,,411,349.35,117.7926,411,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
AZELASTINE 137 MCG (0.1 %) NASL SPRA,,17050,LOCAL,Facility,Both,30 mL,mL,,411,349.35,117.7926,411,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),246.6,60,,percent of total billed charges,,
AZELASTINE 137 MCG (0.1 %) NASL SPRA,,17050,LOCAL,Facility,Both,30 mL,mL,,411,349.35,117.7926,411,"Health Partners, Inc.",State of Minnesota Advantage Program,334.965,81.5,,percent of total billed charges,,
AZELASTINE 137 MCG (0.1 %) NASL SPRA,,17050,LOCAL,Facility,Both,30 mL,mL,,411,349.35,117.7926,411,"Health Partners, Inc.",State Public Programs,205.5,50,,percent of total billed charges,,
AZELASTINE 137 MCG (0.1 %) NASL SPRA,,17050,LOCAL,Facility,Both,30 mL,mL,,411,349.35,117.7926,411,Humana Insurance Company,Commercial PPO,390.45,95,,percent of total billed charges,,
AZELASTINE 137 MCG (0.1 %) NASL SPRA,,17050,LOCAL,Facility,Outpatient,30 mL,mL,,411,349.35,117.7926,411,Humana Insurance Company,Medicare PPO,201.39,49,,percent of total billed charges,,
AZELASTINE 137 MCG (0.1 %) NASL SPRA,,17050,LOCAL,Facility,Inpatient,30 mL,mL,,411,349.35,117.7926,411,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
AZELASTINE 137 MCG (0.1 %) NASL SPRA,,17050,LOCAL,Facility,Both,30 mL,mL,,411,349.35,117.7926,411,Medica,Individual & Family,407.301,99.1,,percent of total billed charges,,
AZELASTINE 137 MCG (0.1 %) NASL SPRA,,17050,LOCAL,Facility,Outpatient,30 mL,mL,,411,349.35,117.7926,411,Medica,Medica Advantage Solution,204.678,49.8,,percent of total billed charges,,
AZELASTINE 137 MCG (0.1 %) NASL SPRA,,17050,LOCAL,Facility,Inpatient,30 mL,mL,,411,349.35,117.7926,411,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
AZELASTINE 137 MCG (0.1 %) NASL SPRA,,17050,LOCAL,Facility,Outpatient,30 mL,mL,,411,349.35,117.7926,411,Medica,Medical Assistance,183.306,44.6,,percent of total billed charges,,
AZELASTINE 137 MCG (0.1 %) NASL SPRA,,17050,LOCAL,Facility,Inpatient,30 mL,mL,,411,349.35,117.7926,411,Medica,Medical Assistance,,,,,Included in per diem rate,
AZELASTINE 137 MCG (0.1 %) NASL SPRA,,17050,LOCAL,Facility,Outpatient,30 mL,mL,,411,349.35,117.7926,411,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,204.678,49.8,,percent of total billed charges,,
AZELASTINE 137 MCG (0.1 %) NASL SPRA,,17050,LOCAL,Facility,Inpatient,30 mL,mL,,411,349.35,117.7926,411,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
AZELASTINE 137 MCG (0.1 %) NASL SPRA,,17050,LOCAL,Facility,Both,30 mL,mL,,411,349.35,117.7926,411,"Multiplan, Inc.","Multiplan, Inc.",386.34,94,,percent of total billed charges,,
AZELASTINE 137 MCG (0.1 %) NASL SPRA,,17050,LOCAL,Facility,Outpatient,30 mL,mL,,411,349.35,117.7926,411,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,370.311,90.1,,percent of total billed charges,,
AZELASTINE 137 MCG (0.1 %) NASL SPRA,,17050,LOCAL,Facility,Inpatient,30 mL,mL,,411,349.35,117.7926,411,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
AZELASTINE 137 MCG (0.1 %) NASL SPRA,,17050,LOCAL,Facility,Both,30 mL,mL,,411,349.35,117.7926,411,"Preferred One Administrative Services, INC.",PPO,405.246,98.6,,percent of total billed charges,,
AZELASTINE 137 MCG (0.1 %) NASL SPRA,,17050,LOCAL,Facility,Outpatient,30 mL,mL,,411,349.35,117.7926,411,PrimeWest Health,Minnesota Senior Health Options (MSHO),211.4595,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
AZELASTINE 137 MCG (0.1 %) NASL SPRA,,17050,LOCAL,Facility,Inpatient,30 mL,mL,,411,349.35,117.7926,411,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
AZELASTINE 137 MCG (0.1 %) NASL SPRA,,17050,LOCAL,Facility,Outpatient,30 mL,mL,,411,349.35,117.7926,411,PrimeWest Health,MinnesotaCare,211.0896,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
AZELASTINE 137 MCG (0.1 %) NASL SPRA,,17050,LOCAL,Facility,Inpatient,30 mL,mL,,411,349.35,117.7926,411,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
AZELASTINE 137 MCG (0.1 %) NASL SPRA,,17050,LOCAL,Facility,Both,30 mL,mL,,411,349.35,117.7926,411,Sanford Health Plan,Sanford Health Plan,378.12,92,,percent of total billed charges,,
AZELASTINE 137 MCG (0.1 %) NASL SPRA,,17050,LOCAL,Facility,Outpatient,30 mL,mL,,411,349.35,117.7926,411,"UCare Health, Inc.",Individual & Family Plan,231.5985,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
AZELASTINE 137 MCG (0.1 %) NASL SPRA,,17050,LOCAL,Facility,Inpatient,30 mL,mL,,411,349.35,117.7926,411,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
AZELASTINE 137 MCG (0.1 %) NASL SPRA,,17050,LOCAL,Facility,Outpatient,30 mL,mL,,411,349.35,117.7926,411,"UCare Health, Inc.",Medical Assistance,207.4317,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
AZELASTINE 137 MCG (0.1 %) NASL SPRA,,17050,LOCAL,Facility,Inpatient,30 mL,mL,,411,349.35,117.7926,411,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
AZELASTINE 137 MCG (0.1 %) NASL SPRA,,17050,LOCAL,Facility,Outpatient,30 mL,mL,,411,349.35,117.7926,411,"UCare Health, Inc.",Medicare Advantage,207.4317,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
AZELASTINE 137 MCG (0.1 %) NASL SPRA,,17050,LOCAL,Facility,Inpatient,30 mL,mL,,411,349.35,117.7926,411,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
AZELASTINE 137 MCG (0.1 %) NASL SPRA,,17050,LOCAL,Facility,Outpatient,30 mL,mL,,411,349.35,117.7926,411,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),207.4317,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
AZELASTINE 137 MCG (0.1 %) NASL SPRA,,17050,LOCAL,Facility,Inpatient,30 mL,mL,,411,349.35,117.7926,411,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
AZELASTINE 137 MCG (0.1 %) NASL SPRA,,17050,LOCAL,Facility,Both,30 mL,mL,,411,349.35,117.7926,411,UnitedHealthcare,Individual & Family,386.34,94,,percent of total billed charges,,
AZELASTINE 137 MCG (0.1 %) NASL SPRA,,17050,LOCAL,Facility,Outpatient,30 mL,mL,,411,349.35,117.7926,411,UnitedHealthcare,Medicare Advantage,201.39,49,,percent of total billed charges,,
AZELASTINE 137 MCG (0.1 %) NASL SPRA,,17050,LOCAL,Facility,Inpatient,30 mL,mL,,411,349.35,117.7926,411,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
AZELASTINE 137 MCG (0.1 %) NASL SPRA,,17050,LOCAL,Facility,Outpatient,30 mL,mL,,411,349.35,117.7926,411,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,197.28,48,,percent of total billed charges,,100% of DHS outpatient percentage
AZELASTINE 137 MCG (0.1 %) NASL SPRA,,17050,LOCAL,Facility,Inpatient,30 mL,mL,,411,349.35,117.7926,411,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
AZITHROMYCIN 200 MG/5 ML ORAL SUSR,,17399,LOCAL,Facility,Both,30 mL,mL,,158,134.3,45.2828,158,Aetna,Commercial,145.36,92,,percent of total billed charges,,
AZITHROMYCIN 200 MG/5 ML ORAL SUSR,,17399,LOCAL,Facility,Outpatient,30 mL,mL,,158,134.3,45.2828,158,Aetna,Medicare Advantage,77.42,49,,percent of total billed charges,,
AZITHROMYCIN 200 MG/5 ML ORAL SUSR,,17399,LOCAL,Facility,Inpatient,30 mL,mL,,158,134.3,45.2828,158,Aetna,Medicare Advantage,,,,,Included in per diem rate,
AZITHROMYCIN 200 MG/5 ML ORAL SUSR,,17399,LOCAL,Facility,Both,30 mL,mL,,158,134.3,45.2828,158,Aetna,PPO,146.94,93,,percent of total billed charges,,
AZITHROMYCIN 200 MG/5 ML ORAL SUSR,,17399,LOCAL,Facility,Both,30 mL,mL,,158,134.3,45.2828,158,America's PPO,America's PPO,151.7274,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
AZITHROMYCIN 200 MG/5 ML ORAL SUSR,,17399,LOCAL,Facility,Both,30 mL,mL,,158,134.3,45.2828,158,BlueCross BlueShield Minnesota, Federal Employee Program,155.472,98.4,,percent of total billed charges,,
AZITHROMYCIN 200 MG/5 ML ORAL SUSR,,17399,LOCAL,Facility,Both,30 mL,mL,,158,134.3,45.2828,158,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,158,100,,percent of total billed charges,,
AZITHROMYCIN 200 MG/5 ML ORAL SUSR,,17399,LOCAL,Facility,Both,30 mL,mL,,158,134.3,45.2828,158,BlueCross BlueShield Minnesota,High Value Network Plan,142.2,90,,percent of total billed charges,,
AZITHROMYCIN 200 MG/5 ML ORAL SUSR,,17399,LOCAL,Facility,Outpatient,30 mL,mL,,158,134.3,45.2828,158,BlueCross BlueShield Minnesota,Medicare Advantage,77.42,49,,percent of total billed charges,,
AZITHROMYCIN 200 MG/5 ML ORAL SUSR,,17399,LOCAL,Facility,Inpatient,30 mL,mL,,158,134.3,45.2828,158,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
AZITHROMYCIN 200 MG/5 ML ORAL SUSR,,17399,LOCAL,Facility,Both,30 mL,mL,,158,134.3,45.2828,158,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,139.9406,88.57,,percent of total billed charges,,
AZITHROMYCIN 200 MG/5 ML ORAL SUSR,,17399,LOCAL,Facility,Both,30 mL,mL,,158,134.3,45.2828,158,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,45.2828,28.66,,percent of total billed charges,,
AZITHROMYCIN 200 MG/5 ML ORAL SUSR,,17399,LOCAL,Facility,Outpatient,30 mL,mL,,158,134.3,45.2828,158,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),77.42,49,,percent of total billed charges,,
AZITHROMYCIN 200 MG/5 ML ORAL SUSR,,17399,LOCAL,Facility,Inpatient,30 mL,mL,,158,134.3,45.2828,158,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
AZITHROMYCIN 200 MG/5 ML ORAL SUSR,,17399,LOCAL,Facility,Both,30 mL,mL,,158,134.3,45.2828,158,CorVel,Worker's Compensation,158,100,,percent of total billed charges,,
AZITHROMYCIN 200 MG/5 ML ORAL SUSR,,17399,LOCAL,Facility,Both,30 mL,mL,,158,134.3,45.2828,158,First Health Group Corporation,First Health Network,153.26,97,,percent of total billed charges,,
AZITHROMYCIN 200 MG/5 ML ORAL SUSR,,17399,LOCAL,Facility,Both,30 mL,mL,,158,134.3,45.2828,158,"Health Partners, Inc.",Commercial,149.468,94.6,,percent of total billed charges,,
AZITHROMYCIN 200 MG/5 ML ORAL SUSR,,17399,LOCAL,Facility,Outpatient,30 mL,mL,,158,134.3,45.2828,158,"Health Partners, Inc.",Medicare Advantage,77.42,49,,percent of total billed charges,,
AZITHROMYCIN 200 MG/5 ML ORAL SUSR,,17399,LOCAL,Facility,Inpatient,30 mL,mL,,158,134.3,45.2828,158,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
AZITHROMYCIN 200 MG/5 ML ORAL SUSR,,17399,LOCAL,Facility,Both,30 mL,mL,,158,134.3,45.2828,158,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),94.8,60,,percent of total billed charges,,
AZITHROMYCIN 200 MG/5 ML ORAL SUSR,,17399,LOCAL,Facility,Both,30 mL,mL,,158,134.3,45.2828,158,"Health Partners, Inc.",State of Minnesota Advantage Program,128.77,81.5,,percent of total billed charges,,
AZITHROMYCIN 200 MG/5 ML ORAL SUSR,,17399,LOCAL,Facility,Both,30 mL,mL,,158,134.3,45.2828,158,"Health Partners, Inc.",State Public Programs,79,50,,percent of total billed charges,,
AZITHROMYCIN 200 MG/5 ML ORAL SUSR,,17399,LOCAL,Facility,Both,30 mL,mL,,158,134.3,45.2828,158,Humana Insurance Company,Commercial PPO,150.1,95,,percent of total billed charges,,
AZITHROMYCIN 200 MG/5 ML ORAL SUSR,,17399,LOCAL,Facility,Outpatient,30 mL,mL,,158,134.3,45.2828,158,Humana Insurance Company,Medicare PPO,77.42,49,,percent of total billed charges,,
AZITHROMYCIN 200 MG/5 ML ORAL SUSR,,17399,LOCAL,Facility,Inpatient,30 mL,mL,,158,134.3,45.2828,158,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
AZITHROMYCIN 200 MG/5 ML ORAL SUSR,,17399,LOCAL,Facility,Both,30 mL,mL,,158,134.3,45.2828,158,Medica,Individual & Family,156.578,99.1,,percent of total billed charges,,
AZITHROMYCIN 200 MG/5 ML ORAL SUSR,,17399,LOCAL,Facility,Outpatient,30 mL,mL,,158,134.3,45.2828,158,Medica,Medica Advantage Solution,78.684,49.8,,percent of total billed charges,,
AZITHROMYCIN 200 MG/5 ML ORAL SUSR,,17399,LOCAL,Facility,Inpatient,30 mL,mL,,158,134.3,45.2828,158,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
AZITHROMYCIN 200 MG/5 ML ORAL SUSR,,17399,LOCAL,Facility,Outpatient,30 mL,mL,,158,134.3,45.2828,158,Medica,Medical Assistance,70.468,44.6,,percent of total billed charges,,
AZITHROMYCIN 200 MG/5 ML ORAL SUSR,,17399,LOCAL,Facility,Inpatient,30 mL,mL,,158,134.3,45.2828,158,Medica,Medical Assistance,,,,,Included in per diem rate,
AZITHROMYCIN 200 MG/5 ML ORAL SUSR,,17399,LOCAL,Facility,Outpatient,30 mL,mL,,158,134.3,45.2828,158,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,78.684,49.8,,percent of total billed charges,,
AZITHROMYCIN 200 MG/5 ML ORAL SUSR,,17399,LOCAL,Facility,Inpatient,30 mL,mL,,158,134.3,45.2828,158,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
AZITHROMYCIN 200 MG/5 ML ORAL SUSR,,17399,LOCAL,Facility,Both,30 mL,mL,,158,134.3,45.2828,158,"Multiplan, Inc.","Multiplan, Inc.",148.52,94,,percent of total billed charges,,
AZITHROMYCIN 200 MG/5 ML ORAL SUSR,,17399,LOCAL,Facility,Outpatient,30 mL,mL,,158,134.3,45.2828,158,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,142.358,90.1,,percent of total billed charges,,
AZITHROMYCIN 200 MG/5 ML ORAL SUSR,,17399,LOCAL,Facility,Inpatient,30 mL,mL,,158,134.3,45.2828,158,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
AZITHROMYCIN 200 MG/5 ML ORAL SUSR,,17399,LOCAL,Facility,Both,30 mL,mL,,158,134.3,45.2828,158,"Preferred One Administrative Services, INC.",PPO,155.788,98.6,,percent of total billed charges,,
AZITHROMYCIN 200 MG/5 ML ORAL SUSR,,17399,LOCAL,Facility,Outpatient,30 mL,mL,,158,134.3,45.2828,158,PrimeWest Health,Minnesota Senior Health Options (MSHO),81.291,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
AZITHROMYCIN 200 MG/5 ML ORAL SUSR,,17399,LOCAL,Facility,Inpatient,30 mL,mL,,158,134.3,45.2828,158,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
AZITHROMYCIN 200 MG/5 ML ORAL SUSR,,17399,LOCAL,Facility,Outpatient,30 mL,mL,,158,134.3,45.2828,158,PrimeWest Health,MinnesotaCare,81.1488,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
AZITHROMYCIN 200 MG/5 ML ORAL SUSR,,17399,LOCAL,Facility,Inpatient,30 mL,mL,,158,134.3,45.2828,158,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
AZITHROMYCIN 200 MG/5 ML ORAL SUSR,,17399,LOCAL,Facility,Both,30 mL,mL,,158,134.3,45.2828,158,Sanford Health Plan,Sanford Health Plan,145.36,92,,percent of total billed charges,,
AZITHROMYCIN 200 MG/5 ML ORAL SUSR,,17399,LOCAL,Facility,Outpatient,30 mL,mL,,158,134.3,45.2828,158,"UCare Health, Inc.",Individual & Family Plan,89.033,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
AZITHROMYCIN 200 MG/5 ML ORAL SUSR,,17399,LOCAL,Facility,Inpatient,30 mL,mL,,158,134.3,45.2828,158,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
AZITHROMYCIN 200 MG/5 ML ORAL SUSR,,17399,LOCAL,Facility,Outpatient,30 mL,mL,,158,134.3,45.2828,158,"UCare Health, Inc.",Medical Assistance,79.7426,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
AZITHROMYCIN 200 MG/5 ML ORAL SUSR,,17399,LOCAL,Facility,Inpatient,30 mL,mL,,158,134.3,45.2828,158,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
AZITHROMYCIN 200 MG/5 ML ORAL SUSR,,17399,LOCAL,Facility,Outpatient,30 mL,mL,,158,134.3,45.2828,158,"UCare Health, Inc.",Medicare Advantage,79.7426,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
AZITHROMYCIN 200 MG/5 ML ORAL SUSR,,17399,LOCAL,Facility,Inpatient,30 mL,mL,,158,134.3,45.2828,158,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
AZITHROMYCIN 200 MG/5 ML ORAL SUSR,,17399,LOCAL,Facility,Outpatient,30 mL,mL,,158,134.3,45.2828,158,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),79.7426,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
AZITHROMYCIN 200 MG/5 ML ORAL SUSR,,17399,LOCAL,Facility,Inpatient,30 mL,mL,,158,134.3,45.2828,158,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
AZITHROMYCIN 200 MG/5 ML ORAL SUSR,,17399,LOCAL,Facility,Both,30 mL,mL,,158,134.3,45.2828,158,UnitedHealthcare,Individual & Family,148.52,94,,percent of total billed charges,,
AZITHROMYCIN 200 MG/5 ML ORAL SUSR,,17399,LOCAL,Facility,Outpatient,30 mL,mL,,158,134.3,45.2828,158,UnitedHealthcare,Medicare Advantage,77.42,49,,percent of total billed charges,,
AZITHROMYCIN 200 MG/5 ML ORAL SUSR,,17399,LOCAL,Facility,Inpatient,30 mL,mL,,158,134.3,45.2828,158,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
AZITHROMYCIN 200 MG/5 ML ORAL SUSR,,17399,LOCAL,Facility,Outpatient,30 mL,mL,,158,134.3,45.2828,158,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,75.84,48,,percent of total billed charges,,100% of DHS outpatient percentage
AZITHROMYCIN 200 MG/5 ML ORAL SUSR,,17399,LOCAL,Facility,Inpatient,30 mL,mL,,158,134.3,45.2828,158,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
LORAZEPAM 2 MG/ML ORAL CONC,,19091,LOCAL,Facility,Both,30 mL,mL,,180,153,51.588,180,Aetna,Commercial,165.6,92,,percent of total billed charges,,
LORAZEPAM 2 MG/ML ORAL CONC,,19091,LOCAL,Facility,Outpatient,30 mL,mL,,180,153,51.588,180,Aetna,Medicare Advantage,88.2,49,,percent of total billed charges,,
LORAZEPAM 2 MG/ML ORAL CONC,,19091,LOCAL,Facility,Inpatient,30 mL,mL,,180,153,51.588,180,Aetna,Medicare Advantage,,,,,Included in per diem rate,
LORAZEPAM 2 MG/ML ORAL CONC,,19091,LOCAL,Facility,Both,30 mL,mL,,180,153,51.588,180,Aetna,PPO,167.4,93,,percent of total billed charges,,
LORAZEPAM 2 MG/ML ORAL CONC,,19091,LOCAL,Facility,Both,30 mL,mL,,180,153,51.588,180,America's PPO,America's PPO,172.854,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
LORAZEPAM 2 MG/ML ORAL CONC,,19091,LOCAL,Facility,Both,30 mL,mL,,180,153,51.588,180,BlueCross BlueShield Minnesota, Federal Employee Program,177.12,98.4,,percent of total billed charges,,
LORAZEPAM 2 MG/ML ORAL CONC,,19091,LOCAL,Facility,Both,30 mL,mL,,180,153,51.588,180,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,180,100,,percent of total billed charges,,
LORAZEPAM 2 MG/ML ORAL CONC,,19091,LOCAL,Facility,Both,30 mL,mL,,180,153,51.588,180,BlueCross BlueShield Minnesota,High Value Network Plan,162,90,,percent of total billed charges,,
LORAZEPAM 2 MG/ML ORAL CONC,,19091,LOCAL,Facility,Outpatient,30 mL,mL,,180,153,51.588,180,BlueCross BlueShield Minnesota,Medicare Advantage,88.2,49,,percent of total billed charges,,
LORAZEPAM 2 MG/ML ORAL CONC,,19091,LOCAL,Facility,Inpatient,30 mL,mL,,180,153,51.588,180,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
LORAZEPAM 2 MG/ML ORAL CONC,,19091,LOCAL,Facility,Both,30 mL,mL,,180,153,51.588,180,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,159.426,88.57,,percent of total billed charges,,
LORAZEPAM 2 MG/ML ORAL CONC,,19091,LOCAL,Facility,Both,30 mL,mL,,180,153,51.588,180,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,51.588,28.66,,percent of total billed charges,,
LORAZEPAM 2 MG/ML ORAL CONC,,19091,LOCAL,Facility,Outpatient,30 mL,mL,,180,153,51.588,180,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),88.2,49,,percent of total billed charges,,
LORAZEPAM 2 MG/ML ORAL CONC,,19091,LOCAL,Facility,Inpatient,30 mL,mL,,180,153,51.588,180,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
LORAZEPAM 2 MG/ML ORAL CONC,,19091,LOCAL,Facility,Both,30 mL,mL,,180,153,51.588,180,CorVel,Worker's Compensation,180,100,,percent of total billed charges,,
LORAZEPAM 2 MG/ML ORAL CONC,,19091,LOCAL,Facility,Both,30 mL,mL,,180,153,51.588,180,First Health Group Corporation,First Health Network,174.6,97,,percent of total billed charges,,
LORAZEPAM 2 MG/ML ORAL CONC,,19091,LOCAL,Facility,Both,30 mL,mL,,180,153,51.588,180,"Health Partners, Inc.",Commercial,170.28,94.6,,percent of total billed charges,,
LORAZEPAM 2 MG/ML ORAL CONC,,19091,LOCAL,Facility,Outpatient,30 mL,mL,,180,153,51.588,180,"Health Partners, Inc.",Medicare Advantage,88.2,49,,percent of total billed charges,,
LORAZEPAM 2 MG/ML ORAL CONC,,19091,LOCAL,Facility,Inpatient,30 mL,mL,,180,153,51.588,180,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LORAZEPAM 2 MG/ML ORAL CONC,,19091,LOCAL,Facility,Both,30 mL,mL,,180,153,51.588,180,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),108,60,,percent of total billed charges,,
LORAZEPAM 2 MG/ML ORAL CONC,,19091,LOCAL,Facility,Both,30 mL,mL,,180,153,51.588,180,"Health Partners, Inc.",State of Minnesota Advantage Program,146.7,81.5,,percent of total billed charges,,
LORAZEPAM 2 MG/ML ORAL CONC,,19091,LOCAL,Facility,Both,30 mL,mL,,180,153,51.588,180,"Health Partners, Inc.",State Public Programs,90,50,,percent of total billed charges,,
LORAZEPAM 2 MG/ML ORAL CONC,,19091,LOCAL,Facility,Both,30 mL,mL,,180,153,51.588,180,Humana Insurance Company,Commercial PPO,171,95,,percent of total billed charges,,
LORAZEPAM 2 MG/ML ORAL CONC,,19091,LOCAL,Facility,Outpatient,30 mL,mL,,180,153,51.588,180,Humana Insurance Company,Medicare PPO,88.2,49,,percent of total billed charges,,
LORAZEPAM 2 MG/ML ORAL CONC,,19091,LOCAL,Facility,Inpatient,30 mL,mL,,180,153,51.588,180,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
LORAZEPAM 2 MG/ML ORAL CONC,,19091,LOCAL,Facility,Both,30 mL,mL,,180,153,51.588,180,Medica,Individual & Family,178.38,99.1,,percent of total billed charges,,
LORAZEPAM 2 MG/ML ORAL CONC,,19091,LOCAL,Facility,Outpatient,30 mL,mL,,180,153,51.588,180,Medica,Medica Advantage Solution,89.64,49.8,,percent of total billed charges,,
LORAZEPAM 2 MG/ML ORAL CONC,,19091,LOCAL,Facility,Inpatient,30 mL,mL,,180,153,51.588,180,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
LORAZEPAM 2 MG/ML ORAL CONC,,19091,LOCAL,Facility,Outpatient,30 mL,mL,,180,153,51.588,180,Medica,Medical Assistance,80.28,44.6,,percent of total billed charges,,
LORAZEPAM 2 MG/ML ORAL CONC,,19091,LOCAL,Facility,Inpatient,30 mL,mL,,180,153,51.588,180,Medica,Medical Assistance,,,,,Included in per diem rate,
LORAZEPAM 2 MG/ML ORAL CONC,,19091,LOCAL,Facility,Outpatient,30 mL,mL,,180,153,51.588,180,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,89.64,49.8,,percent of total billed charges,,
LORAZEPAM 2 MG/ML ORAL CONC,,19091,LOCAL,Facility,Inpatient,30 mL,mL,,180,153,51.588,180,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
LORAZEPAM 2 MG/ML ORAL CONC,,19091,LOCAL,Facility,Both,30 mL,mL,,180,153,51.588,180,"Multiplan, Inc.","Multiplan, Inc.",169.2,94,,percent of total billed charges,,
LORAZEPAM 2 MG/ML ORAL CONC,,19091,LOCAL,Facility,Outpatient,30 mL,mL,,180,153,51.588,180,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,162.18,90.1,,percent of total billed charges,,
LORAZEPAM 2 MG/ML ORAL CONC,,19091,LOCAL,Facility,Inpatient,30 mL,mL,,180,153,51.588,180,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
LORAZEPAM 2 MG/ML ORAL CONC,,19091,LOCAL,Facility,Both,30 mL,mL,,180,153,51.588,180,"Preferred One Administrative Services, INC.",PPO,177.48,98.6,,percent of total billed charges,,
LORAZEPAM 2 MG/ML ORAL CONC,,19091,LOCAL,Facility,Outpatient,30 mL,mL,,180,153,51.588,180,PrimeWest Health,Minnesota Senior Health Options (MSHO),92.61,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
LORAZEPAM 2 MG/ML ORAL CONC,,19091,LOCAL,Facility,Inpatient,30 mL,mL,,180,153,51.588,180,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LORAZEPAM 2 MG/ML ORAL CONC,,19091,LOCAL,Facility,Outpatient,30 mL,mL,,180,153,51.588,180,PrimeWest Health,MinnesotaCare,92.448,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
LORAZEPAM 2 MG/ML ORAL CONC,,19091,LOCAL,Facility,Inpatient,30 mL,mL,,180,153,51.588,180,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
LORAZEPAM 2 MG/ML ORAL CONC,,19091,LOCAL,Facility,Both,30 mL,mL,,180,153,51.588,180,Sanford Health Plan,Sanford Health Plan,165.6,92,,percent of total billed charges,,
LORAZEPAM 2 MG/ML ORAL CONC,,19091,LOCAL,Facility,Outpatient,30 mL,mL,,180,153,51.588,180,"UCare Health, Inc.",Individual & Family Plan,101.43,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
LORAZEPAM 2 MG/ML ORAL CONC,,19091,LOCAL,Facility,Inpatient,30 mL,mL,,180,153,51.588,180,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
LORAZEPAM 2 MG/ML ORAL CONC,,19091,LOCAL,Facility,Outpatient,30 mL,mL,,180,153,51.588,180,"UCare Health, Inc.",Medical Assistance,90.846,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LORAZEPAM 2 MG/ML ORAL CONC,,19091,LOCAL,Facility,Inpatient,30 mL,mL,,180,153,51.588,180,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
LORAZEPAM 2 MG/ML ORAL CONC,,19091,LOCAL,Facility,Outpatient,30 mL,mL,,180,153,51.588,180,"UCare Health, Inc.",Medicare Advantage,90.846,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LORAZEPAM 2 MG/ML ORAL CONC,,19091,LOCAL,Facility,Inpatient,30 mL,mL,,180,153,51.588,180,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LORAZEPAM 2 MG/ML ORAL CONC,,19091,LOCAL,Facility,Outpatient,30 mL,mL,,180,153,51.588,180,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),90.846,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LORAZEPAM 2 MG/ML ORAL CONC,,19091,LOCAL,Facility,Inpatient,30 mL,mL,,180,153,51.588,180,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LORAZEPAM 2 MG/ML ORAL CONC,,19091,LOCAL,Facility,Both,30 mL,mL,,180,153,51.588,180,UnitedHealthcare,Individual & Family,169.2,94,,percent of total billed charges,,
LORAZEPAM 2 MG/ML ORAL CONC,,19091,LOCAL,Facility,Outpatient,30 mL,mL,,180,153,51.588,180,UnitedHealthcare,Medicare Advantage,88.2,49,,percent of total billed charges,,
LORAZEPAM 2 MG/ML ORAL CONC,,19091,LOCAL,Facility,Inpatient,30 mL,mL,,180,153,51.588,180,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
LORAZEPAM 2 MG/ML ORAL CONC,,19091,LOCAL,Facility,Outpatient,30 mL,mL,,180,153,51.588,180,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,86.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
LORAZEPAM 2 MG/ML ORAL CONC,,19091,LOCAL,Facility,Inpatient,30 mL,mL,,180,153,51.588,180,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJ SOLN",,28217,LOCAL,Facility,Both,30 mL,mL,,33,28.05,9.4578,33,Aetna,Commercial,30.36,92,,percent of total billed charges,,
"BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJ SOLN",,28217,LOCAL,Facility,Both,30 mL,mL,,33,28.05,9.4578,33,Aetna,Commercial,30.36,92,,percent of total billed charges,,
"BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJ SOLN",,28217,LOCAL,Facility,Outpatient,30 mL,mL,,33,28.05,9.4578,33,Aetna,Medicare Advantage,16.17,49,,percent of total billed charges,,
"BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJ SOLN",,28217,LOCAL,Facility,Outpatient,30 mL,mL,,33,28.05,9.4578,33,Aetna,Medicare Advantage,16.17,49,,percent of total billed charges,,
"BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJ SOLN",,28217,LOCAL,Facility,Inpatient,30 mL,mL,,33,28.05,9.4578,33,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJ SOLN",,28217,LOCAL,Facility,Inpatient,30 mL,mL,,33,28.05,9.4578,33,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJ SOLN",,28217,LOCAL,Facility,Both,30 mL,mL,,33,28.05,9.4578,33,Aetna,PPO,30.69,93,,percent of total billed charges,,
"BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJ SOLN",,28217,LOCAL,Facility,Both,30 mL,mL,,33,28.05,9.4578,33,Aetna,PPO,30.69,93,,percent of total billed charges,,
"BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJ SOLN",,28217,LOCAL,Facility,Both,30 mL,mL,,33,28.05,9.4578,33,America's PPO,America's PPO,31.6899,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJ SOLN",,28217,LOCAL,Facility,Both,30 mL,mL,,33,28.05,9.4578,33,America's PPO,America's PPO,31.6899,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJ SOLN",,28217,LOCAL,Facility,Both,30 mL,mL,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota, Federal Employee Program,32.472,98.4,,percent of total billed charges,,
"BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJ SOLN",,28217,LOCAL,Facility,Both,30 mL,mL,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota, Federal Employee Program,32.472,98.4,,percent of total billed charges,,
"BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJ SOLN",,28217,LOCAL,Facility,Both,30 mL,mL,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,33,100,,percent of total billed charges,,
"BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJ SOLN",,28217,LOCAL,Facility,Both,30 mL,mL,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,33,100,,percent of total billed charges,,
"BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJ SOLN",,28217,LOCAL,Facility,Both,30 mL,mL,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota,High Value Network Plan,29.7,90,,percent of total billed charges,,
"BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJ SOLN",,28217,LOCAL,Facility,Both,30 mL,mL,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota,High Value Network Plan,29.7,90,,percent of total billed charges,,
"BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJ SOLN",,28217,LOCAL,Facility,Outpatient,30 mL,mL,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota,Medicare Advantage,16.17,49,,percent of total billed charges,,
"BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJ SOLN",,28217,LOCAL,Facility,Outpatient,30 mL,mL,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota,Medicare Advantage,16.17,49,,percent of total billed charges,,
"BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJ SOLN",,28217,LOCAL,Facility,Inpatient,30 mL,mL,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJ SOLN",,28217,LOCAL,Facility,Inpatient,30 mL,mL,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJ SOLN",,28217,LOCAL,Facility,Both,30 mL,mL,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,29.2281,88.57,,percent of total billed charges,,
"BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJ SOLN",,28217,LOCAL,Facility,Both,30 mL,mL,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,29.2281,88.57,,percent of total billed charges,,
"BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJ SOLN",,28217,LOCAL,Facility,Both,30 mL,mL,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,9.4578,28.66,,percent of total billed charges,,
"BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJ SOLN",,28217,LOCAL,Facility,Both,30 mL,mL,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,9.4578,28.66,,percent of total billed charges,,
"BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJ SOLN",,28217,LOCAL,Facility,Outpatient,30 mL,mL,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),16.17,49,,percent of total billed charges,,
"BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJ SOLN",,28217,LOCAL,Facility,Outpatient,30 mL,mL,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),16.17,49,,percent of total billed charges,,
"BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJ SOLN",,28217,LOCAL,Facility,Inpatient,30 mL,mL,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJ SOLN",,28217,LOCAL,Facility,Inpatient,30 mL,mL,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJ SOLN",,28217,LOCAL,Facility,Both,30 mL,mL,,33,28.05,9.4578,33,CorVel,Worker's Compensation,33,100,,percent of total billed charges,,
"BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJ SOLN",,28217,LOCAL,Facility,Both,30 mL,mL,,33,28.05,9.4578,33,CorVel,Worker's Compensation,33,100,,percent of total billed charges,,
"BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJ SOLN",,28217,LOCAL,Facility,Both,30 mL,mL,,33,28.05,9.4578,33,First Health Group Corporation,First Health Network,32.01,97,,percent of total billed charges,,
"BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJ SOLN",,28217,LOCAL,Facility,Both,30 mL,mL,,33,28.05,9.4578,33,First Health Group Corporation,First Health Network,32.01,97,,percent of total billed charges,,
"BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJ SOLN",,28217,LOCAL,Facility,Both,30 mL,mL,,33,28.05,9.4578,33,"Health Partners, Inc.",Commercial,31.218,94.6,,percent of total billed charges,,
"BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJ SOLN",,28217,LOCAL,Facility,Both,30 mL,mL,,33,28.05,9.4578,33,"Health Partners, Inc.",Commercial,31.218,94.6,,percent of total billed charges,,
"BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJ SOLN",,28217,LOCAL,Facility,Outpatient,30 mL,mL,,33,28.05,9.4578,33,"Health Partners, Inc.",Medicare Advantage,16.17,49,,percent of total billed charges,,
"BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJ SOLN",,28217,LOCAL,Facility,Outpatient,30 mL,mL,,33,28.05,9.4578,33,"Health Partners, Inc.",Medicare Advantage,16.17,49,,percent of total billed charges,,
"BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJ SOLN",,28217,LOCAL,Facility,Inpatient,30 mL,mL,,33,28.05,9.4578,33,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJ SOLN",,28217,LOCAL,Facility,Inpatient,30 mL,mL,,33,28.05,9.4578,33,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJ SOLN",,28217,LOCAL,Facility,Both,30 mL,mL,,33,28.05,9.4578,33,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),19.8,60,,percent of total billed charges,,
"BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJ SOLN",,28217,LOCAL,Facility,Both,30 mL,mL,,33,28.05,9.4578,33,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),19.8,60,,percent of total billed charges,,
"BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJ SOLN",,28217,LOCAL,Facility,Both,30 mL,mL,,33,28.05,9.4578,33,"Health Partners, Inc.",State of Minnesota Advantage Program,26.895,81.5,,percent of total billed charges,,
"BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJ SOLN",,28217,LOCAL,Facility,Both,30 mL,mL,,33,28.05,9.4578,33,"Health Partners, Inc.",State of Minnesota Advantage Program,26.895,81.5,,percent of total billed charges,,
"BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJ SOLN",,28217,LOCAL,Facility,Both,30 mL,mL,,33,28.05,9.4578,33,"Health Partners, Inc.",State Public Programs,16.5,50,,percent of total billed charges,,
"BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJ SOLN",,28217,LOCAL,Facility,Both,30 mL,mL,,33,28.05,9.4578,33,"Health Partners, Inc.",State Public Programs,16.5,50,,percent of total billed charges,,
"BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJ SOLN",,28217,LOCAL,Facility,Both,30 mL,mL,,33,28.05,9.4578,33,Humana Insurance Company,Commercial PPO,31.35,95,,percent of total billed charges,,
"BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJ SOLN",,28217,LOCAL,Facility,Both,30 mL,mL,,33,28.05,9.4578,33,Humana Insurance Company,Commercial PPO,31.35,95,,percent of total billed charges,,
"BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJ SOLN",,28217,LOCAL,Facility,Outpatient,30 mL,mL,,33,28.05,9.4578,33,Humana Insurance Company,Medicare PPO,16.17,49,,percent of total billed charges,,
"BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJ SOLN",,28217,LOCAL,Facility,Outpatient,30 mL,mL,,33,28.05,9.4578,33,Humana Insurance Company,Medicare PPO,16.17,49,,percent of total billed charges,,
"BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJ SOLN",,28217,LOCAL,Facility,Inpatient,30 mL,mL,,33,28.05,9.4578,33,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJ SOLN",,28217,LOCAL,Facility,Inpatient,30 mL,mL,,33,28.05,9.4578,33,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJ SOLN",,28217,LOCAL,Facility,Both,30 mL,mL,,33,28.05,9.4578,33,Medica,Individual & Family,32.703,99.1,,percent of total billed charges,,
"BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJ SOLN",,28217,LOCAL,Facility,Both,30 mL,mL,,33,28.05,9.4578,33,Medica,Individual & Family,32.703,99.1,,percent of total billed charges,,
"BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJ SOLN",,28217,LOCAL,Facility,Outpatient,30 mL,mL,,33,28.05,9.4578,33,Medica,Medica Advantage Solution,16.434,49.8,,percent of total billed charges,,
"BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJ SOLN",,28217,LOCAL,Facility,Outpatient,30 mL,mL,,33,28.05,9.4578,33,Medica,Medica Advantage Solution,16.434,49.8,,percent of total billed charges,,
"BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJ SOLN",,28217,LOCAL,Facility,Inpatient,30 mL,mL,,33,28.05,9.4578,33,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJ SOLN",,28217,LOCAL,Facility,Inpatient,30 mL,mL,,33,28.05,9.4578,33,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJ SOLN",,28217,LOCAL,Facility,Outpatient,30 mL,mL,,33,28.05,9.4578,33,Medica,Medical Assistance,14.718,44.6,,percent of total billed charges,,
"BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJ SOLN",,28217,LOCAL,Facility,Outpatient,30 mL,mL,,33,28.05,9.4578,33,Medica,Medical Assistance,14.718,44.6,,percent of total billed charges,,
"BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJ SOLN",,28217,LOCAL,Facility,Inpatient,30 mL,mL,,33,28.05,9.4578,33,Medica,Medical Assistance,,,,,Included in per diem rate,
"BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJ SOLN",,28217,LOCAL,Facility,Inpatient,30 mL,mL,,33,28.05,9.4578,33,Medica,Medical Assistance,,,,,Included in per diem rate,
"BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJ SOLN",,28217,LOCAL,Facility,Outpatient,30 mL,mL,,33,28.05,9.4578,33,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,16.434,49.8,,percent of total billed charges,,
"BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJ SOLN",,28217,LOCAL,Facility,Outpatient,30 mL,mL,,33,28.05,9.4578,33,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,16.434,49.8,,percent of total billed charges,,
"BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJ SOLN",,28217,LOCAL,Facility,Inpatient,30 mL,mL,,33,28.05,9.4578,33,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJ SOLN",,28217,LOCAL,Facility,Inpatient,30 mL,mL,,33,28.05,9.4578,33,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJ SOLN",,28217,LOCAL,Facility,Both,30 mL,mL,,33,28.05,9.4578,33,"Multiplan, Inc.","Multiplan, Inc.",31.02,94,,percent of total billed charges,,
"BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJ SOLN",,28217,LOCAL,Facility,Both,30 mL,mL,,33,28.05,9.4578,33,"Multiplan, Inc.","Multiplan, Inc.",31.02,94,,percent of total billed charges,,
"BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJ SOLN",,28217,LOCAL,Facility,Outpatient,30 mL,mL,,33,28.05,9.4578,33,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,29.733,90.1,,percent of total billed charges,,
"BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJ SOLN",,28217,LOCAL,Facility,Outpatient,30 mL,mL,,33,28.05,9.4578,33,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,29.733,90.1,,percent of total billed charges,,
"BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJ SOLN",,28217,LOCAL,Facility,Inpatient,30 mL,mL,,33,28.05,9.4578,33,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJ SOLN",,28217,LOCAL,Facility,Inpatient,30 mL,mL,,33,28.05,9.4578,33,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJ SOLN",,28217,LOCAL,Facility,Both,30 mL,mL,,33,28.05,9.4578,33,"Preferred One Administrative Services, INC.",PPO,32.538,98.6,,percent of total billed charges,,
"BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJ SOLN",,28217,LOCAL,Facility,Both,30 mL,mL,,33,28.05,9.4578,33,"Preferred One Administrative Services, INC.",PPO,32.538,98.6,,percent of total billed charges,,
"BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJ SOLN",,28217,LOCAL,Facility,Outpatient,30 mL,mL,,33,28.05,9.4578,33,PrimeWest Health,Minnesota Senior Health Options (MSHO),16.9785,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJ SOLN",,28217,LOCAL,Facility,Outpatient,30 mL,mL,,33,28.05,9.4578,33,PrimeWest Health,Minnesota Senior Health Options (MSHO),16.9785,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJ SOLN",,28217,LOCAL,Facility,Inpatient,30 mL,mL,,33,28.05,9.4578,33,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJ SOLN",,28217,LOCAL,Facility,Inpatient,30 mL,mL,,33,28.05,9.4578,33,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJ SOLN",,28217,LOCAL,Facility,Outpatient,30 mL,mL,,33,28.05,9.4578,33,PrimeWest Health,MinnesotaCare,16.9488,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJ SOLN",,28217,LOCAL,Facility,Outpatient,30 mL,mL,,33,28.05,9.4578,33,PrimeWest Health,MinnesotaCare,16.9488,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJ SOLN",,28217,LOCAL,Facility,Inpatient,30 mL,mL,,33,28.05,9.4578,33,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJ SOLN",,28217,LOCAL,Facility,Inpatient,30 mL,mL,,33,28.05,9.4578,33,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJ SOLN",,28217,LOCAL,Facility,Both,30 mL,mL,,33,28.05,9.4578,33,Sanford Health Plan,Sanford Health Plan,30.36,92,,percent of total billed charges,,
"BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJ SOLN",,28217,LOCAL,Facility,Both,30 mL,mL,,33,28.05,9.4578,33,Sanford Health Plan,Sanford Health Plan,30.36,92,,percent of total billed charges,,
"BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJ SOLN",,28217,LOCAL,Facility,Outpatient,30 mL,mL,,33,28.05,9.4578,33,"UCare Health, Inc.",Individual & Family Plan,18.5955,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJ SOLN",,28217,LOCAL,Facility,Outpatient,30 mL,mL,,33,28.05,9.4578,33,"UCare Health, Inc.",Individual & Family Plan,18.5955,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJ SOLN",,28217,LOCAL,Facility,Inpatient,30 mL,mL,,33,28.05,9.4578,33,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJ SOLN",,28217,LOCAL,Facility,Inpatient,30 mL,mL,,33,28.05,9.4578,33,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJ SOLN",,28217,LOCAL,Facility,Outpatient,30 mL,mL,,33,28.05,9.4578,33,"UCare Health, Inc.",Medical Assistance,16.6551,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJ SOLN",,28217,LOCAL,Facility,Outpatient,30 mL,mL,,33,28.05,9.4578,33,"UCare Health, Inc.",Medical Assistance,16.6551,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJ SOLN",,28217,LOCAL,Facility,Inpatient,30 mL,mL,,33,28.05,9.4578,33,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJ SOLN",,28217,LOCAL,Facility,Inpatient,30 mL,mL,,33,28.05,9.4578,33,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJ SOLN",,28217,LOCAL,Facility,Outpatient,30 mL,mL,,33,28.05,9.4578,33,"UCare Health, Inc.",Medicare Advantage,16.6551,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJ SOLN",,28217,LOCAL,Facility,Outpatient,30 mL,mL,,33,28.05,9.4578,33,"UCare Health, Inc.",Medicare Advantage,16.6551,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJ SOLN",,28217,LOCAL,Facility,Inpatient,30 mL,mL,,33,28.05,9.4578,33,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJ SOLN",,28217,LOCAL,Facility,Inpatient,30 mL,mL,,33,28.05,9.4578,33,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJ SOLN",,28217,LOCAL,Facility,Outpatient,30 mL,mL,,33,28.05,9.4578,33,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),16.6551,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJ SOLN",,28217,LOCAL,Facility,Outpatient,30 mL,mL,,33,28.05,9.4578,33,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),16.6551,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJ SOLN",,28217,LOCAL,Facility,Inpatient,30 mL,mL,,33,28.05,9.4578,33,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJ SOLN",,28217,LOCAL,Facility,Inpatient,30 mL,mL,,33,28.05,9.4578,33,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJ SOLN",,28217,LOCAL,Facility,Both,30 mL,mL,,33,28.05,9.4578,33,UnitedHealthcare,Individual & Family,31.02,94,,percent of total billed charges,,
"BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJ SOLN",,28217,LOCAL,Facility,Both,30 mL,mL,,33,28.05,9.4578,33,UnitedHealthcare,Individual & Family,31.02,94,,percent of total billed charges,,
"BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJ SOLN",,28217,LOCAL,Facility,Outpatient,30 mL,mL,,33,28.05,9.4578,33,UnitedHealthcare,Medicare Advantage,16.17,49,,percent of total billed charges,,
"BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJ SOLN",,28217,LOCAL,Facility,Outpatient,30 mL,mL,,33,28.05,9.4578,33,UnitedHealthcare,Medicare Advantage,16.17,49,,percent of total billed charges,,
"BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJ SOLN",,28217,LOCAL,Facility,Inpatient,30 mL,mL,,33,28.05,9.4578,33,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJ SOLN",,28217,LOCAL,Facility,Inpatient,30 mL,mL,,33,28.05,9.4578,33,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJ SOLN",,28217,LOCAL,Facility,Outpatient,30 mL,mL,,33,28.05,9.4578,33,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,15.84,48,,percent of total billed charges,,100% of DHS outpatient percentage
"BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJ SOLN",,28217,LOCAL,Facility,Outpatient,30 mL,mL,,33,28.05,9.4578,33,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,15.84,48,,percent of total billed charges,,100% of DHS outpatient percentage
"BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJ SOLN",,28217,LOCAL,Facility,Inpatient,30 mL,mL,,33,28.05,9.4578,33,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJ SOLN",,28217,LOCAL,Facility,Inpatient,30 mL,mL,,33,28.05,9.4578,33,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
OXYMETAZOLINE 0.05 % NASL SPRY,,28372,LOCAL,Facility,Both,30 mL,mL,,13,11.05,3.7258,13,Aetna,Commercial,11.96,92,,percent of total billed charges,,
OXYMETAZOLINE 0.05 % NASL SPRY,,28372,LOCAL,Facility,Outpatient,30 mL,mL,,13,11.05,3.7258,13,Aetna,Medicare Advantage,6.37,49,,percent of total billed charges,,
OXYMETAZOLINE 0.05 % NASL SPRY,,28372,LOCAL,Facility,Inpatient,30 mL,mL,,13,11.05,3.7258,13,Aetna,Medicare Advantage,,,,,Included in per diem rate,
OXYMETAZOLINE 0.05 % NASL SPRY,,28372,LOCAL,Facility,Both,30 mL,mL,,13,11.05,3.7258,13,Aetna,PPO,12.09,93,,percent of total billed charges,,
OXYMETAZOLINE 0.05 % NASL SPRY,,28372,LOCAL,Facility,Both,30 mL,mL,,13,11.05,3.7258,13,America's PPO,America's PPO,12.4839,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
OXYMETAZOLINE 0.05 % NASL SPRY,,28372,LOCAL,Facility,Both,30 mL,mL,,13,11.05,3.7258,13,BlueCross BlueShield Minnesota, Federal Employee Program,12.792,98.4,,percent of total billed charges,,
OXYMETAZOLINE 0.05 % NASL SPRY,,28372,LOCAL,Facility,Both,30 mL,mL,,13,11.05,3.7258,13,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,13,100,,percent of total billed charges,,
OXYMETAZOLINE 0.05 % NASL SPRY,,28372,LOCAL,Facility,Both,30 mL,mL,,13,11.05,3.7258,13,BlueCross BlueShield Minnesota,High Value Network Plan,11.7,90,,percent of total billed charges,,
OXYMETAZOLINE 0.05 % NASL SPRY,,28372,LOCAL,Facility,Outpatient,30 mL,mL,,13,11.05,3.7258,13,BlueCross BlueShield Minnesota,Medicare Advantage,6.37,49,,percent of total billed charges,,
OXYMETAZOLINE 0.05 % NASL SPRY,,28372,LOCAL,Facility,Inpatient,30 mL,mL,,13,11.05,3.7258,13,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
OXYMETAZOLINE 0.05 % NASL SPRY,,28372,LOCAL,Facility,Both,30 mL,mL,,13,11.05,3.7258,13,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,11.5141,88.57,,percent of total billed charges,,
OXYMETAZOLINE 0.05 % NASL SPRY,,28372,LOCAL,Facility,Both,30 mL,mL,,13,11.05,3.7258,13,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,3.7258,28.66,,percent of total billed charges,,
OXYMETAZOLINE 0.05 % NASL SPRY,,28372,LOCAL,Facility,Outpatient,30 mL,mL,,13,11.05,3.7258,13,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),6.37,49,,percent of total billed charges,,
OXYMETAZOLINE 0.05 % NASL SPRY,,28372,LOCAL,Facility,Inpatient,30 mL,mL,,13,11.05,3.7258,13,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
OXYMETAZOLINE 0.05 % NASL SPRY,,28372,LOCAL,Facility,Both,30 mL,mL,,13,11.05,3.7258,13,CorVel,Worker's Compensation,13,100,,percent of total billed charges,,
OXYMETAZOLINE 0.05 % NASL SPRY,,28372,LOCAL,Facility,Both,30 mL,mL,,13,11.05,3.7258,13,First Health Group Corporation,First Health Network,12.61,97,,percent of total billed charges,,
OXYMETAZOLINE 0.05 % NASL SPRY,,28372,LOCAL,Facility,Both,30 mL,mL,,13,11.05,3.7258,13,"Health Partners, Inc.",Commercial,12.298,94.6,,percent of total billed charges,,
OXYMETAZOLINE 0.05 % NASL SPRY,,28372,LOCAL,Facility,Outpatient,30 mL,mL,,13,11.05,3.7258,13,"Health Partners, Inc.",Medicare Advantage,6.37,49,,percent of total billed charges,,
OXYMETAZOLINE 0.05 % NASL SPRY,,28372,LOCAL,Facility,Inpatient,30 mL,mL,,13,11.05,3.7258,13,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
OXYMETAZOLINE 0.05 % NASL SPRY,,28372,LOCAL,Facility,Both,30 mL,mL,,13,11.05,3.7258,13,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),7.8,60,,percent of total billed charges,,
OXYMETAZOLINE 0.05 % NASL SPRY,,28372,LOCAL,Facility,Both,30 mL,mL,,13,11.05,3.7258,13,"Health Partners, Inc.",State of Minnesota Advantage Program,10.595,81.5,,percent of total billed charges,,
OXYMETAZOLINE 0.05 % NASL SPRY,,28372,LOCAL,Facility,Both,30 mL,mL,,13,11.05,3.7258,13,"Health Partners, Inc.",State Public Programs,6.5,50,,percent of total billed charges,,
OXYMETAZOLINE 0.05 % NASL SPRY,,28372,LOCAL,Facility,Both,30 mL,mL,,13,11.05,3.7258,13,Humana Insurance Company,Commercial PPO,12.35,95,,percent of total billed charges,,
OXYMETAZOLINE 0.05 % NASL SPRY,,28372,LOCAL,Facility,Outpatient,30 mL,mL,,13,11.05,3.7258,13,Humana Insurance Company,Medicare PPO,6.37,49,,percent of total billed charges,,
OXYMETAZOLINE 0.05 % NASL SPRY,,28372,LOCAL,Facility,Inpatient,30 mL,mL,,13,11.05,3.7258,13,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
OXYMETAZOLINE 0.05 % NASL SPRY,,28372,LOCAL,Facility,Both,30 mL,mL,,13,11.05,3.7258,13,Medica,Individual & Family,12.883,99.1,,percent of total billed charges,,
OXYMETAZOLINE 0.05 % NASL SPRY,,28372,LOCAL,Facility,Outpatient,30 mL,mL,,13,11.05,3.7258,13,Medica,Medica Advantage Solution,6.474,49.8,,percent of total billed charges,,
OXYMETAZOLINE 0.05 % NASL SPRY,,28372,LOCAL,Facility,Inpatient,30 mL,mL,,13,11.05,3.7258,13,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
OXYMETAZOLINE 0.05 % NASL SPRY,,28372,LOCAL,Facility,Outpatient,30 mL,mL,,13,11.05,3.7258,13,Medica,Medical Assistance,5.798,44.6,,percent of total billed charges,,
OXYMETAZOLINE 0.05 % NASL SPRY,,28372,LOCAL,Facility,Inpatient,30 mL,mL,,13,11.05,3.7258,13,Medica,Medical Assistance,,,,,Included in per diem rate,
OXYMETAZOLINE 0.05 % NASL SPRY,,28372,LOCAL,Facility,Outpatient,30 mL,mL,,13,11.05,3.7258,13,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,6.474,49.8,,percent of total billed charges,,
OXYMETAZOLINE 0.05 % NASL SPRY,,28372,LOCAL,Facility,Inpatient,30 mL,mL,,13,11.05,3.7258,13,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
OXYMETAZOLINE 0.05 % NASL SPRY,,28372,LOCAL,Facility,Both,30 mL,mL,,13,11.05,3.7258,13,"Multiplan, Inc.","Multiplan, Inc.",12.22,94,,percent of total billed charges,,
OXYMETAZOLINE 0.05 % NASL SPRY,,28372,LOCAL,Facility,Outpatient,30 mL,mL,,13,11.05,3.7258,13,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,11.713,90.1,,percent of total billed charges,,
OXYMETAZOLINE 0.05 % NASL SPRY,,28372,LOCAL,Facility,Inpatient,30 mL,mL,,13,11.05,3.7258,13,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
OXYMETAZOLINE 0.05 % NASL SPRY,,28372,LOCAL,Facility,Both,30 mL,mL,,13,11.05,3.7258,13,"Preferred One Administrative Services, INC.",PPO,12.818,98.6,,percent of total billed charges,,
OXYMETAZOLINE 0.05 % NASL SPRY,,28372,LOCAL,Facility,Outpatient,30 mL,mL,,13,11.05,3.7258,13,PrimeWest Health,Minnesota Senior Health Options (MSHO),6.6885,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
OXYMETAZOLINE 0.05 % NASL SPRY,,28372,LOCAL,Facility,Inpatient,30 mL,mL,,13,11.05,3.7258,13,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
OXYMETAZOLINE 0.05 % NASL SPRY,,28372,LOCAL,Facility,Outpatient,30 mL,mL,,13,11.05,3.7258,13,PrimeWest Health,MinnesotaCare,6.6768,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
OXYMETAZOLINE 0.05 % NASL SPRY,,28372,LOCAL,Facility,Inpatient,30 mL,mL,,13,11.05,3.7258,13,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
OXYMETAZOLINE 0.05 % NASL SPRY,,28372,LOCAL,Facility,Both,30 mL,mL,,13,11.05,3.7258,13,Sanford Health Plan,Sanford Health Plan,11.96,92,,percent of total billed charges,,
OXYMETAZOLINE 0.05 % NASL SPRY,,28372,LOCAL,Facility,Outpatient,30 mL,mL,,13,11.05,3.7258,13,"UCare Health, Inc.",Individual & Family Plan,7.3255,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
OXYMETAZOLINE 0.05 % NASL SPRY,,28372,LOCAL,Facility,Inpatient,30 mL,mL,,13,11.05,3.7258,13,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
OXYMETAZOLINE 0.05 % NASL SPRY,,28372,LOCAL,Facility,Outpatient,30 mL,mL,,13,11.05,3.7258,13,"UCare Health, Inc.",Medical Assistance,6.5611,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
OXYMETAZOLINE 0.05 % NASL SPRY,,28372,LOCAL,Facility,Inpatient,30 mL,mL,,13,11.05,3.7258,13,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
OXYMETAZOLINE 0.05 % NASL SPRY,,28372,LOCAL,Facility,Outpatient,30 mL,mL,,13,11.05,3.7258,13,"UCare Health, Inc.",Medicare Advantage,6.5611,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
OXYMETAZOLINE 0.05 % NASL SPRY,,28372,LOCAL,Facility,Inpatient,30 mL,mL,,13,11.05,3.7258,13,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
OXYMETAZOLINE 0.05 % NASL SPRY,,28372,LOCAL,Facility,Outpatient,30 mL,mL,,13,11.05,3.7258,13,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),6.5611,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
OXYMETAZOLINE 0.05 % NASL SPRY,,28372,LOCAL,Facility,Inpatient,30 mL,mL,,13,11.05,3.7258,13,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
OXYMETAZOLINE 0.05 % NASL SPRY,,28372,LOCAL,Facility,Both,30 mL,mL,,13,11.05,3.7258,13,UnitedHealthcare,Individual & Family,12.22,94,,percent of total billed charges,,
OXYMETAZOLINE 0.05 % NASL SPRY,,28372,LOCAL,Facility,Outpatient,30 mL,mL,,13,11.05,3.7258,13,UnitedHealthcare,Medicare Advantage,6.37,49,,percent of total billed charges,,
OXYMETAZOLINE 0.05 % NASL SPRY,,28372,LOCAL,Facility,Inpatient,30 mL,mL,,13,11.05,3.7258,13,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
OXYMETAZOLINE 0.05 % NASL SPRY,,28372,LOCAL,Facility,Outpatient,30 mL,mL,,13,11.05,3.7258,13,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,6.24,48,,percent of total billed charges,,100% of DHS outpatient percentage
OXYMETAZOLINE 0.05 % NASL SPRY,,28372,LOCAL,Facility,Inpatient,30 mL,mL,,13,11.05,3.7258,13,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
BALANCED SALT SOLN NON-SURG 3 OPHT SOLN,,34941,LOCAL,Facility,Both,30 mL,mL,,108,91.8,30.9528,108,Aetna,Commercial,99.36,92,,percent of total billed charges,,
BALANCED SALT SOLN NON-SURG 3 OPHT SOLN,,34941,LOCAL,Facility,Outpatient,30 mL,mL,,108,91.8,30.9528,108,Aetna,Medicare Advantage,52.92,49,,percent of total billed charges,,
BALANCED SALT SOLN NON-SURG 3 OPHT SOLN,,34941,LOCAL,Facility,Inpatient,30 mL,mL,,108,91.8,30.9528,108,Aetna,Medicare Advantage,,,,,Included in per diem rate,
BALANCED SALT SOLN NON-SURG 3 OPHT SOLN,,34941,LOCAL,Facility,Both,30 mL,mL,,108,91.8,30.9528,108,Aetna,PPO,100.44,93,,percent of total billed charges,,
BALANCED SALT SOLN NON-SURG 3 OPHT SOLN,,34941,LOCAL,Facility,Both,30 mL,mL,,108,91.8,30.9528,108,America's PPO,America's PPO,103.7124,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
BALANCED SALT SOLN NON-SURG 3 OPHT SOLN,,34941,LOCAL,Facility,Both,30 mL,mL,,108,91.8,30.9528,108,BlueCross BlueShield Minnesota, Federal Employee Program,106.272,98.4,,percent of total billed charges,,
BALANCED SALT SOLN NON-SURG 3 OPHT SOLN,,34941,LOCAL,Facility,Both,30 mL,mL,,108,91.8,30.9528,108,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,108,100,,percent of total billed charges,,
BALANCED SALT SOLN NON-SURG 3 OPHT SOLN,,34941,LOCAL,Facility,Both,30 mL,mL,,108,91.8,30.9528,108,BlueCross BlueShield Minnesota,High Value Network Plan,97.2,90,,percent of total billed charges,,
BALANCED SALT SOLN NON-SURG 3 OPHT SOLN,,34941,LOCAL,Facility,Outpatient,30 mL,mL,,108,91.8,30.9528,108,BlueCross BlueShield Minnesota,Medicare Advantage,52.92,49,,percent of total billed charges,,
BALANCED SALT SOLN NON-SURG 3 OPHT SOLN,,34941,LOCAL,Facility,Inpatient,30 mL,mL,,108,91.8,30.9528,108,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
BALANCED SALT SOLN NON-SURG 3 OPHT SOLN,,34941,LOCAL,Facility,Both,30 mL,mL,,108,91.8,30.9528,108,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,95.6556,88.57,,percent of total billed charges,,
BALANCED SALT SOLN NON-SURG 3 OPHT SOLN,,34941,LOCAL,Facility,Both,30 mL,mL,,108,91.8,30.9528,108,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,30.9528,28.66,,percent of total billed charges,,
BALANCED SALT SOLN NON-SURG 3 OPHT SOLN,,34941,LOCAL,Facility,Outpatient,30 mL,mL,,108,91.8,30.9528,108,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),52.92,49,,percent of total billed charges,,
BALANCED SALT SOLN NON-SURG 3 OPHT SOLN,,34941,LOCAL,Facility,Inpatient,30 mL,mL,,108,91.8,30.9528,108,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
BALANCED SALT SOLN NON-SURG 3 OPHT SOLN,,34941,LOCAL,Facility,Both,30 mL,mL,,108,91.8,30.9528,108,CorVel,Worker's Compensation,108,100,,percent of total billed charges,,
BALANCED SALT SOLN NON-SURG 3 OPHT SOLN,,34941,LOCAL,Facility,Both,30 mL,mL,,108,91.8,30.9528,108,First Health Group Corporation,First Health Network,104.76,97,,percent of total billed charges,,
BALANCED SALT SOLN NON-SURG 3 OPHT SOLN,,34941,LOCAL,Facility,Both,30 mL,mL,,108,91.8,30.9528,108,"Health Partners, Inc.",Commercial,102.168,94.6,,percent of total billed charges,,
BALANCED SALT SOLN NON-SURG 3 OPHT SOLN,,34941,LOCAL,Facility,Outpatient,30 mL,mL,,108,91.8,30.9528,108,"Health Partners, Inc.",Medicare Advantage,52.92,49,,percent of total billed charges,,
BALANCED SALT SOLN NON-SURG 3 OPHT SOLN,,34941,LOCAL,Facility,Inpatient,30 mL,mL,,108,91.8,30.9528,108,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
BALANCED SALT SOLN NON-SURG 3 OPHT SOLN,,34941,LOCAL,Facility,Both,30 mL,mL,,108,91.8,30.9528,108,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),64.8,60,,percent of total billed charges,,
BALANCED SALT SOLN NON-SURG 3 OPHT SOLN,,34941,LOCAL,Facility,Both,30 mL,mL,,108,91.8,30.9528,108,"Health Partners, Inc.",State of Minnesota Advantage Program,88.02,81.5,,percent of total billed charges,,
BALANCED SALT SOLN NON-SURG 3 OPHT SOLN,,34941,LOCAL,Facility,Both,30 mL,mL,,108,91.8,30.9528,108,"Health Partners, Inc.",State Public Programs,54,50,,percent of total billed charges,,
BALANCED SALT SOLN NON-SURG 3 OPHT SOLN,,34941,LOCAL,Facility,Both,30 mL,mL,,108,91.8,30.9528,108,Humana Insurance Company,Commercial PPO,102.6,95,,percent of total billed charges,,
BALANCED SALT SOLN NON-SURG 3 OPHT SOLN,,34941,LOCAL,Facility,Outpatient,30 mL,mL,,108,91.8,30.9528,108,Humana Insurance Company,Medicare PPO,52.92,49,,percent of total billed charges,,
BALANCED SALT SOLN NON-SURG 3 OPHT SOLN,,34941,LOCAL,Facility,Inpatient,30 mL,mL,,108,91.8,30.9528,108,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
BALANCED SALT SOLN NON-SURG 3 OPHT SOLN,,34941,LOCAL,Facility,Both,30 mL,mL,,108,91.8,30.9528,108,Medica,Individual & Family,107.028,99.1,,percent of total billed charges,,
BALANCED SALT SOLN NON-SURG 3 OPHT SOLN,,34941,LOCAL,Facility,Outpatient,30 mL,mL,,108,91.8,30.9528,108,Medica,Medica Advantage Solution,53.784,49.8,,percent of total billed charges,,
BALANCED SALT SOLN NON-SURG 3 OPHT SOLN,,34941,LOCAL,Facility,Inpatient,30 mL,mL,,108,91.8,30.9528,108,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
BALANCED SALT SOLN NON-SURG 3 OPHT SOLN,,34941,LOCAL,Facility,Outpatient,30 mL,mL,,108,91.8,30.9528,108,Medica,Medical Assistance,48.168,44.6,,percent of total billed charges,,
BALANCED SALT SOLN NON-SURG 3 OPHT SOLN,,34941,LOCAL,Facility,Inpatient,30 mL,mL,,108,91.8,30.9528,108,Medica,Medical Assistance,,,,,Included in per diem rate,
BALANCED SALT SOLN NON-SURG 3 OPHT SOLN,,34941,LOCAL,Facility,Outpatient,30 mL,mL,,108,91.8,30.9528,108,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,53.784,49.8,,percent of total billed charges,,
BALANCED SALT SOLN NON-SURG 3 OPHT SOLN,,34941,LOCAL,Facility,Inpatient,30 mL,mL,,108,91.8,30.9528,108,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
BALANCED SALT SOLN NON-SURG 3 OPHT SOLN,,34941,LOCAL,Facility,Both,30 mL,mL,,108,91.8,30.9528,108,"Multiplan, Inc.","Multiplan, Inc.",101.52,94,,percent of total billed charges,,
BALANCED SALT SOLN NON-SURG 3 OPHT SOLN,,34941,LOCAL,Facility,Outpatient,30 mL,mL,,108,91.8,30.9528,108,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,97.308,90.1,,percent of total billed charges,,
BALANCED SALT SOLN NON-SURG 3 OPHT SOLN,,34941,LOCAL,Facility,Inpatient,30 mL,mL,,108,91.8,30.9528,108,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
BALANCED SALT SOLN NON-SURG 3 OPHT SOLN,,34941,LOCAL,Facility,Both,30 mL,mL,,108,91.8,30.9528,108,"Preferred One Administrative Services, INC.",PPO,106.488,98.6,,percent of total billed charges,,
BALANCED SALT SOLN NON-SURG 3 OPHT SOLN,,34941,LOCAL,Facility,Outpatient,30 mL,mL,,108,91.8,30.9528,108,PrimeWest Health,Minnesota Senior Health Options (MSHO),55.566,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
BALANCED SALT SOLN NON-SURG 3 OPHT SOLN,,34941,LOCAL,Facility,Inpatient,30 mL,mL,,108,91.8,30.9528,108,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
BALANCED SALT SOLN NON-SURG 3 OPHT SOLN,,34941,LOCAL,Facility,Outpatient,30 mL,mL,,108,91.8,30.9528,108,PrimeWest Health,MinnesotaCare,55.4688,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
BALANCED SALT SOLN NON-SURG 3 OPHT SOLN,,34941,LOCAL,Facility,Inpatient,30 mL,mL,,108,91.8,30.9528,108,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
BALANCED SALT SOLN NON-SURG 3 OPHT SOLN,,34941,LOCAL,Facility,Both,30 mL,mL,,108,91.8,30.9528,108,Sanford Health Plan,Sanford Health Plan,99.36,92,,percent of total billed charges,,
BALANCED SALT SOLN NON-SURG 3 OPHT SOLN,,34941,LOCAL,Facility,Outpatient,30 mL,mL,,108,91.8,30.9528,108,"UCare Health, Inc.",Individual & Family Plan,60.858,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
BALANCED SALT SOLN NON-SURG 3 OPHT SOLN,,34941,LOCAL,Facility,Inpatient,30 mL,mL,,108,91.8,30.9528,108,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
BALANCED SALT SOLN NON-SURG 3 OPHT SOLN,,34941,LOCAL,Facility,Outpatient,30 mL,mL,,108,91.8,30.9528,108,"UCare Health, Inc.",Medical Assistance,54.5076,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BALANCED SALT SOLN NON-SURG 3 OPHT SOLN,,34941,LOCAL,Facility,Inpatient,30 mL,mL,,108,91.8,30.9528,108,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
BALANCED SALT SOLN NON-SURG 3 OPHT SOLN,,34941,LOCAL,Facility,Outpatient,30 mL,mL,,108,91.8,30.9528,108,"UCare Health, Inc.",Medicare Advantage,54.5076,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BALANCED SALT SOLN NON-SURG 3 OPHT SOLN,,34941,LOCAL,Facility,Inpatient,30 mL,mL,,108,91.8,30.9528,108,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
BALANCED SALT SOLN NON-SURG 3 OPHT SOLN,,34941,LOCAL,Facility,Outpatient,30 mL,mL,,108,91.8,30.9528,108,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),54.5076,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BALANCED SALT SOLN NON-SURG 3 OPHT SOLN,,34941,LOCAL,Facility,Inpatient,30 mL,mL,,108,91.8,30.9528,108,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
BALANCED SALT SOLN NON-SURG 3 OPHT SOLN,,34941,LOCAL,Facility,Both,30 mL,mL,,108,91.8,30.9528,108,UnitedHealthcare,Individual & Family,101.52,94,,percent of total billed charges,,
BALANCED SALT SOLN NON-SURG 3 OPHT SOLN,,34941,LOCAL,Facility,Outpatient,30 mL,mL,,108,91.8,30.9528,108,UnitedHealthcare,Medicare Advantage,52.92,49,,percent of total billed charges,,
BALANCED SALT SOLN NON-SURG 3 OPHT SOLN,,34941,LOCAL,Facility,Inpatient,30 mL,mL,,108,91.8,30.9528,108,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
BALANCED SALT SOLN NON-SURG 3 OPHT SOLN,,34941,LOCAL,Facility,Outpatient,30 mL,mL,,108,91.8,30.9528,108,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,51.84,48,,percent of total billed charges,,100% of DHS outpatient percentage
BALANCED SALT SOLN NON-SURG 3 OPHT SOLN,,34941,LOCAL,Facility,Inpatient,30 mL,mL,,108,91.8,30.9528,108,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Both,30 mL,mL,,22,18.7,6.3052,22,Aetna,Commercial,20.24,92,,percent of total billed charges,,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Outpatient,30 mL,mL,,22,18.7,6.3052,22,Aetna,Medicare Advantage,10.78,49,,percent of total billed charges,,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Inpatient,30 mL,mL,,22,18.7,6.3052,22,Aetna,Medicare Advantage,,,,,Included in per diem rate,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Both,30 mL,mL,,22,18.7,6.3052,22,Aetna,PPO,20.46,93,,percent of total billed charges,,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Both,30 mL,mL,,22,18.7,6.3052,22,America's PPO,America's PPO,21.1266,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Both,30 mL,mL,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota, Federal Employee Program,21.648,98.4,,percent of total billed charges,,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Both,30 mL,mL,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,22,100,,percent of total billed charges,,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Both,30 mL,mL,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota,High Value Network Plan,19.8,90,,percent of total billed charges,,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Outpatient,30 mL,mL,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota,Medicare Advantage,10.78,49,,percent of total billed charges,,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Inpatient,30 mL,mL,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Both,30 mL,mL,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,19.4854,88.57,,percent of total billed charges,,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Both,30 mL,mL,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,6.3052,28.66,,percent of total billed charges,,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Outpatient,30 mL,mL,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),10.78,49,,percent of total billed charges,,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Inpatient,30 mL,mL,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Both,30 mL,mL,,22,18.7,6.3052,22,CorVel,Worker's Compensation,22,100,,percent of total billed charges,,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Both,30 mL,mL,,22,18.7,6.3052,22,First Health Group Corporation,First Health Network,21.34,97,,percent of total billed charges,,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Both,30 mL,mL,,22,18.7,6.3052,22,"Health Partners, Inc.",Commercial,20.812,94.6,,percent of total billed charges,,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Outpatient,30 mL,mL,,22,18.7,6.3052,22,"Health Partners, Inc.",Medicare Advantage,10.78,49,,percent of total billed charges,,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Inpatient,30 mL,mL,,22,18.7,6.3052,22,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Both,30 mL,mL,,22,18.7,6.3052,22,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),13.2,60,,percent of total billed charges,,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Both,30 mL,mL,,22,18.7,6.3052,22,"Health Partners, Inc.",State of Minnesota Advantage Program,17.93,81.5,,percent of total billed charges,,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Both,30 mL,mL,,22,18.7,6.3052,22,"Health Partners, Inc.",State Public Programs,11,50,,percent of total billed charges,,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Both,30 mL,mL,,22,18.7,6.3052,22,Humana Insurance Company,Commercial PPO,20.9,95,,percent of total billed charges,,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Outpatient,30 mL,mL,,22,18.7,6.3052,22,Humana Insurance Company,Medicare PPO,10.78,49,,percent of total billed charges,,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Inpatient,30 mL,mL,,22,18.7,6.3052,22,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Both,30 mL,mL,,22,18.7,6.3052,22,Medica,Individual & Family,21.802,99.1,,percent of total billed charges,,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Outpatient,30 mL,mL,,22,18.7,6.3052,22,Medica,Medica Advantage Solution,10.956,49.8,,percent of total billed charges,,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Inpatient,30 mL,mL,,22,18.7,6.3052,22,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Outpatient,30 mL,mL,,22,18.7,6.3052,22,Medica,Medical Assistance,9.812,44.6,,percent of total billed charges,,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Inpatient,30 mL,mL,,22,18.7,6.3052,22,Medica,Medical Assistance,,,,,Included in per diem rate,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Outpatient,30 mL,mL,,22,18.7,6.3052,22,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,10.956,49.8,,percent of total billed charges,,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Inpatient,30 mL,mL,,22,18.7,6.3052,22,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Both,30 mL,mL,,22,18.7,6.3052,22,"Multiplan, Inc.","Multiplan, Inc.",20.68,94,,percent of total billed charges,,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Outpatient,30 mL,mL,,22,18.7,6.3052,22,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,19.822,90.1,,percent of total billed charges,,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Inpatient,30 mL,mL,,22,18.7,6.3052,22,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Both,30 mL,mL,,22,18.7,6.3052,22,"Preferred One Administrative Services, INC.",PPO,21.692,98.6,,percent of total billed charges,,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Outpatient,30 mL,mL,,22,18.7,6.3052,22,PrimeWest Health,Minnesota Senior Health Options (MSHO),11.319,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Inpatient,30 mL,mL,,22,18.7,6.3052,22,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Outpatient,30 mL,mL,,22,18.7,6.3052,22,PrimeWest Health,MinnesotaCare,11.2992,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Inpatient,30 mL,mL,,22,18.7,6.3052,22,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Both,30 mL,mL,,22,18.7,6.3052,22,Sanford Health Plan,Sanford Health Plan,20.24,92,,percent of total billed charges,,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Outpatient,30 mL,mL,,22,18.7,6.3052,22,"UCare Health, Inc.",Individual & Family Plan,12.397,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Inpatient,30 mL,mL,,22,18.7,6.3052,22,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Outpatient,30 mL,mL,,22,18.7,6.3052,22,"UCare Health, Inc.",Medical Assistance,11.1034,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Inpatient,30 mL,mL,,22,18.7,6.3052,22,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Outpatient,30 mL,mL,,22,18.7,6.3052,22,"UCare Health, Inc.",Medicare Advantage,11.1034,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Inpatient,30 mL,mL,,22,18.7,6.3052,22,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Outpatient,30 mL,mL,,22,18.7,6.3052,22,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),11.1034,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Inpatient,30 mL,mL,,22,18.7,6.3052,22,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Both,30 mL,mL,,22,18.7,6.3052,22,UnitedHealthcare,Individual & Family,20.68,94,,percent of total billed charges,,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Outpatient,30 mL,mL,,22,18.7,6.3052,22,UnitedHealthcare,Medicare Advantage,10.78,49,,percent of total billed charges,,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Inpatient,30 mL,mL,,22,18.7,6.3052,22,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Outpatient,30 mL,mL,,22,18.7,6.3052,22,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,10.56,48,,percent of total billed charges,,100% of DHS outpatient percentage
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Inpatient,30 mL,mL,,22,18.7,6.3052,22,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
MORPHINE 30 MG/30 ML (1 MG/ML) IV SPCA,,88277,LOCAL,Facility,Both,30 mL,mL,,70,59.5,20.062,70,Aetna,Commercial,64.4,92,,percent of total billed charges,,
MORPHINE 30 MG/30 ML (1 MG/ML) IV SPCA,,88277,LOCAL,Facility,Outpatient,30 mL,mL,,70,59.5,20.062,70,Aetna,Medicare Advantage,34.3,49,,percent of total billed charges,,
MORPHINE 30 MG/30 ML (1 MG/ML) IV SPCA,,88277,LOCAL,Facility,Inpatient,30 mL,mL,,70,59.5,20.062,70,Aetna,Medicare Advantage,,,,,Included in per diem rate,
MORPHINE 30 MG/30 ML (1 MG/ML) IV SPCA,,88277,LOCAL,Facility,Both,30 mL,mL,,70,59.5,20.062,70,Aetna,PPO,65.1,93,,percent of total billed charges,,
MORPHINE 30 MG/30 ML (1 MG/ML) IV SPCA,,88277,LOCAL,Facility,Both,30 mL,mL,,70,59.5,20.062,70,America's PPO,America's PPO,67.221,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
MORPHINE 30 MG/30 ML (1 MG/ML) IV SPCA,,88277,LOCAL,Facility,Both,30 mL,mL,,70,59.5,20.062,70,BlueCross BlueShield Minnesota, Federal Employee Program,68.88,98.4,,percent of total billed charges,,
MORPHINE 30 MG/30 ML (1 MG/ML) IV SPCA,,88277,LOCAL,Facility,Both,30 mL,mL,,70,59.5,20.062,70,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,70,100,,percent of total billed charges,,
MORPHINE 30 MG/30 ML (1 MG/ML) IV SPCA,,88277,LOCAL,Facility,Both,30 mL,mL,,70,59.5,20.062,70,BlueCross BlueShield Minnesota,High Value Network Plan,63,90,,percent of total billed charges,,
MORPHINE 30 MG/30 ML (1 MG/ML) IV SPCA,,88277,LOCAL,Facility,Outpatient,30 mL,mL,,70,59.5,20.062,70,BlueCross BlueShield Minnesota,Medicare Advantage,34.3,49,,percent of total billed charges,,
MORPHINE 30 MG/30 ML (1 MG/ML) IV SPCA,,88277,LOCAL,Facility,Inpatient,30 mL,mL,,70,59.5,20.062,70,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
MORPHINE 30 MG/30 ML (1 MG/ML) IV SPCA,,88277,LOCAL,Facility,Both,30 mL,mL,,70,59.5,20.062,70,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,61.999,88.57,,percent of total billed charges,,
MORPHINE 30 MG/30 ML (1 MG/ML) IV SPCA,,88277,LOCAL,Facility,Both,30 mL,mL,,70,59.5,20.062,70,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,20.062,28.66,,percent of total billed charges,,
MORPHINE 30 MG/30 ML (1 MG/ML) IV SPCA,,88277,LOCAL,Facility,Outpatient,30 mL,mL,,70,59.5,20.062,70,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),34.3,49,,percent of total billed charges,,
MORPHINE 30 MG/30 ML (1 MG/ML) IV SPCA,,88277,LOCAL,Facility,Inpatient,30 mL,mL,,70,59.5,20.062,70,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
MORPHINE 30 MG/30 ML (1 MG/ML) IV SPCA,,88277,LOCAL,Facility,Both,30 mL,mL,,70,59.5,20.062,70,CorVel,Worker's Compensation,70,100,,percent of total billed charges,,
MORPHINE 30 MG/30 ML (1 MG/ML) IV SPCA,,88277,LOCAL,Facility,Both,30 mL,mL,,70,59.5,20.062,70,First Health Group Corporation,First Health Network,67.9,97,,percent of total billed charges,,
MORPHINE 30 MG/30 ML (1 MG/ML) IV SPCA,,88277,LOCAL,Facility,Both,30 mL,mL,,70,59.5,20.062,70,"Health Partners, Inc.",Commercial,66.22,94.6,,percent of total billed charges,,
MORPHINE 30 MG/30 ML (1 MG/ML) IV SPCA,,88277,LOCAL,Facility,Outpatient,30 mL,mL,,70,59.5,20.062,70,"Health Partners, Inc.",Medicare Advantage,34.3,49,,percent of total billed charges,,
MORPHINE 30 MG/30 ML (1 MG/ML) IV SPCA,,88277,LOCAL,Facility,Inpatient,30 mL,mL,,70,59.5,20.062,70,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
MORPHINE 30 MG/30 ML (1 MG/ML) IV SPCA,,88277,LOCAL,Facility,Both,30 mL,mL,,70,59.5,20.062,70,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),42,60,,percent of total billed charges,,
MORPHINE 30 MG/30 ML (1 MG/ML) IV SPCA,,88277,LOCAL,Facility,Both,30 mL,mL,,70,59.5,20.062,70,"Health Partners, Inc.",State of Minnesota Advantage Program,57.05,81.5,,percent of total billed charges,,
MORPHINE 30 MG/30 ML (1 MG/ML) IV SPCA,,88277,LOCAL,Facility,Both,30 mL,mL,,70,59.5,20.062,70,"Health Partners, Inc.",State Public Programs,35,50,,percent of total billed charges,,
MORPHINE 30 MG/30 ML (1 MG/ML) IV SPCA,,88277,LOCAL,Facility,Both,30 mL,mL,,70,59.5,20.062,70,Humana Insurance Company,Commercial PPO,66.5,95,,percent of total billed charges,,
MORPHINE 30 MG/30 ML (1 MG/ML) IV SPCA,,88277,LOCAL,Facility,Outpatient,30 mL,mL,,70,59.5,20.062,70,Humana Insurance Company,Medicare PPO,34.3,49,,percent of total billed charges,,
MORPHINE 30 MG/30 ML (1 MG/ML) IV SPCA,,88277,LOCAL,Facility,Inpatient,30 mL,mL,,70,59.5,20.062,70,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
MORPHINE 30 MG/30 ML (1 MG/ML) IV SPCA,,88277,LOCAL,Facility,Both,30 mL,mL,,70,59.5,20.062,70,Medica,Individual & Family,69.37,99.1,,percent of total billed charges,,
MORPHINE 30 MG/30 ML (1 MG/ML) IV SPCA,,88277,LOCAL,Facility,Outpatient,30 mL,mL,,70,59.5,20.062,70,Medica,Medica Advantage Solution,34.86,49.8,,percent of total billed charges,,
MORPHINE 30 MG/30 ML (1 MG/ML) IV SPCA,,88277,LOCAL,Facility,Inpatient,30 mL,mL,,70,59.5,20.062,70,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
MORPHINE 30 MG/30 ML (1 MG/ML) IV SPCA,,88277,LOCAL,Facility,Outpatient,30 mL,mL,,70,59.5,20.062,70,Medica,Medical Assistance,31.22,44.6,,percent of total billed charges,,
MORPHINE 30 MG/30 ML (1 MG/ML) IV SPCA,,88277,LOCAL,Facility,Inpatient,30 mL,mL,,70,59.5,20.062,70,Medica,Medical Assistance,,,,,Included in per diem rate,
MORPHINE 30 MG/30 ML (1 MG/ML) IV SPCA,,88277,LOCAL,Facility,Outpatient,30 mL,mL,,70,59.5,20.062,70,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,34.86,49.8,,percent of total billed charges,,
MORPHINE 30 MG/30 ML (1 MG/ML) IV SPCA,,88277,LOCAL,Facility,Inpatient,30 mL,mL,,70,59.5,20.062,70,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
MORPHINE 30 MG/30 ML (1 MG/ML) IV SPCA,,88277,LOCAL,Facility,Both,30 mL,mL,,70,59.5,20.062,70,"Multiplan, Inc.","Multiplan, Inc.",65.8,94,,percent of total billed charges,,
MORPHINE 30 MG/30 ML (1 MG/ML) IV SPCA,,88277,LOCAL,Facility,Outpatient,30 mL,mL,,70,59.5,20.062,70,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,63.07,90.1,,percent of total billed charges,,
MORPHINE 30 MG/30 ML (1 MG/ML) IV SPCA,,88277,LOCAL,Facility,Inpatient,30 mL,mL,,70,59.5,20.062,70,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
MORPHINE 30 MG/30 ML (1 MG/ML) IV SPCA,,88277,LOCAL,Facility,Both,30 mL,mL,,70,59.5,20.062,70,"Preferred One Administrative Services, INC.",PPO,69.02,98.6,,percent of total billed charges,,
MORPHINE 30 MG/30 ML (1 MG/ML) IV SPCA,,88277,LOCAL,Facility,Outpatient,30 mL,mL,,70,59.5,20.062,70,PrimeWest Health,Minnesota Senior Health Options (MSHO),36.015,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
MORPHINE 30 MG/30 ML (1 MG/ML) IV SPCA,,88277,LOCAL,Facility,Inpatient,30 mL,mL,,70,59.5,20.062,70,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
MORPHINE 30 MG/30 ML (1 MG/ML) IV SPCA,,88277,LOCAL,Facility,Outpatient,30 mL,mL,,70,59.5,20.062,70,PrimeWest Health,MinnesotaCare,35.952,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
MORPHINE 30 MG/30 ML (1 MG/ML) IV SPCA,,88277,LOCAL,Facility,Inpatient,30 mL,mL,,70,59.5,20.062,70,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
MORPHINE 30 MG/30 ML (1 MG/ML) IV SPCA,,88277,LOCAL,Facility,Both,30 mL,mL,,70,59.5,20.062,70,Sanford Health Plan,Sanford Health Plan,64.4,92,,percent of total billed charges,,
MORPHINE 30 MG/30 ML (1 MG/ML) IV SPCA,,88277,LOCAL,Facility,Outpatient,30 mL,mL,,70,59.5,20.062,70,"UCare Health, Inc.",Individual & Family Plan,39.445,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
MORPHINE 30 MG/30 ML (1 MG/ML) IV SPCA,,88277,LOCAL,Facility,Inpatient,30 mL,mL,,70,59.5,20.062,70,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
MORPHINE 30 MG/30 ML (1 MG/ML) IV SPCA,,88277,LOCAL,Facility,Outpatient,30 mL,mL,,70,59.5,20.062,70,"UCare Health, Inc.",Medical Assistance,35.329,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MORPHINE 30 MG/30 ML (1 MG/ML) IV SPCA,,88277,LOCAL,Facility,Inpatient,30 mL,mL,,70,59.5,20.062,70,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
MORPHINE 30 MG/30 ML (1 MG/ML) IV SPCA,,88277,LOCAL,Facility,Outpatient,30 mL,mL,,70,59.5,20.062,70,"UCare Health, Inc.",Medicare Advantage,35.329,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MORPHINE 30 MG/30 ML (1 MG/ML) IV SPCA,,88277,LOCAL,Facility,Inpatient,30 mL,mL,,70,59.5,20.062,70,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
MORPHINE 30 MG/30 ML (1 MG/ML) IV SPCA,,88277,LOCAL,Facility,Outpatient,30 mL,mL,,70,59.5,20.062,70,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),35.329,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MORPHINE 30 MG/30 ML (1 MG/ML) IV SPCA,,88277,LOCAL,Facility,Inpatient,30 mL,mL,,70,59.5,20.062,70,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
MORPHINE 30 MG/30 ML (1 MG/ML) IV SPCA,,88277,LOCAL,Facility,Both,30 mL,mL,,70,59.5,20.062,70,UnitedHealthcare,Individual & Family,65.8,94,,percent of total billed charges,,
MORPHINE 30 MG/30 ML (1 MG/ML) IV SPCA,,88277,LOCAL,Facility,Outpatient,30 mL,mL,,70,59.5,20.062,70,UnitedHealthcare,Medicare Advantage,34.3,49,,percent of total billed charges,,
MORPHINE 30 MG/30 ML (1 MG/ML) IV SPCA,,88277,LOCAL,Facility,Inpatient,30 mL,mL,,70,59.5,20.062,70,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
MORPHINE 30 MG/30 ML (1 MG/ML) IV SPCA,,88277,LOCAL,Facility,Outpatient,30 mL,mL,,70,59.5,20.062,70,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,33.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
MORPHINE 30 MG/30 ML (1 MG/ML) IV SPCA,,88277,LOCAL,Facility,Inpatient,30 mL,mL,,70,59.5,20.062,70,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
SODIUM CHLORIDE 0.9 % TOP SOLN,,91634,LOCAL,Facility,Both,30 mL,mL,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % TOP SOLN,,91634,LOCAL,Facility,Outpatient,30 mL,mL,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % TOP SOLN,,91634,LOCAL,Facility,Inpatient,30 mL,mL,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
SODIUM CHLORIDE 0.9 % TOP SOLN,,91634,LOCAL,Facility,Both,30 mL,mL,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % TOP SOLN,,91634,LOCAL,Facility,Both,30 mL,mL,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SODIUM CHLORIDE 0.9 % TOP SOLN,,91634,LOCAL,Facility,Both,30 mL,mL,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % TOP SOLN,,91634,LOCAL,Facility,Both,30 mL,mL,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % TOP SOLN,,91634,LOCAL,Facility,Both,30 mL,mL,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % TOP SOLN,,91634,LOCAL,Facility,Outpatient,30 mL,mL,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % TOP SOLN,,91634,LOCAL,Facility,Inpatient,30 mL,mL,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
SODIUM CHLORIDE 0.9 % TOP SOLN,,91634,LOCAL,Facility,Both,30 mL,mL,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % TOP SOLN,,91634,LOCAL,Facility,Both,30 mL,mL,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % TOP SOLN,,91634,LOCAL,Facility,Outpatient,30 mL,mL,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % TOP SOLN,,91634,LOCAL,Facility,Inpatient,30 mL,mL,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
SODIUM CHLORIDE 0.9 % TOP SOLN,,91634,LOCAL,Facility,Both,30 mL,mL,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % TOP SOLN,,91634,LOCAL,Facility,Both,30 mL,mL,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % TOP SOLN,,91634,LOCAL,Facility,Both,30 mL,mL,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % TOP SOLN,,91634,LOCAL,Facility,Outpatient,30 mL,mL,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % TOP SOLN,,91634,LOCAL,Facility,Inpatient,30 mL,mL,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SODIUM CHLORIDE 0.9 % TOP SOLN,,91634,LOCAL,Facility,Both,30 mL,mL,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % TOP SOLN,,91634,LOCAL,Facility,Both,30 mL,mL,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % TOP SOLN,,91634,LOCAL,Facility,Both,30 mL,mL,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % TOP SOLN,,91634,LOCAL,Facility,Both,30 mL,mL,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % TOP SOLN,,91634,LOCAL,Facility,Outpatient,30 mL,mL,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % TOP SOLN,,91634,LOCAL,Facility,Inpatient,30 mL,mL,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
SODIUM CHLORIDE 0.9 % TOP SOLN,,91634,LOCAL,Facility,Both,30 mL,mL,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % TOP SOLN,,91634,LOCAL,Facility,Outpatient,30 mL,mL,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % TOP SOLN,,91634,LOCAL,Facility,Inpatient,30 mL,mL,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
SODIUM CHLORIDE 0.9 % TOP SOLN,,91634,LOCAL,Facility,Outpatient,30 mL,mL,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % TOP SOLN,,91634,LOCAL,Facility,Inpatient,30 mL,mL,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
SODIUM CHLORIDE 0.9 % TOP SOLN,,91634,LOCAL,Facility,Outpatient,30 mL,mL,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % TOP SOLN,,91634,LOCAL,Facility,Inpatient,30 mL,mL,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
SODIUM CHLORIDE 0.9 % TOP SOLN,,91634,LOCAL,Facility,Both,30 mL,mL,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % TOP SOLN,,91634,LOCAL,Facility,Outpatient,30 mL,mL,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % TOP SOLN,,91634,LOCAL,Facility,Inpatient,30 mL,mL,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
SODIUM CHLORIDE 0.9 % TOP SOLN,,91634,LOCAL,Facility,Both,30 mL,mL,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % TOP SOLN,,91634,LOCAL,Facility,Outpatient,30 mL,mL,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
SODIUM CHLORIDE 0.9 % TOP SOLN,,91634,LOCAL,Facility,Inpatient,30 mL,mL,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SODIUM CHLORIDE 0.9 % TOP SOLN,,91634,LOCAL,Facility,Outpatient,30 mL,mL,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
SODIUM CHLORIDE 0.9 % TOP SOLN,,91634,LOCAL,Facility,Inpatient,30 mL,mL,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
SODIUM CHLORIDE 0.9 % TOP SOLN,,91634,LOCAL,Facility,Both,30 mL,mL,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % TOP SOLN,,91634,LOCAL,Facility,Outpatient,30 mL,mL,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
SODIUM CHLORIDE 0.9 % TOP SOLN,,91634,LOCAL,Facility,Inpatient,30 mL,mL,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
SODIUM CHLORIDE 0.9 % TOP SOLN,,91634,LOCAL,Facility,Outpatient,30 mL,mL,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SODIUM CHLORIDE 0.9 % TOP SOLN,,91634,LOCAL,Facility,Inpatient,30 mL,mL,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
SODIUM CHLORIDE 0.9 % TOP SOLN,,91634,LOCAL,Facility,Outpatient,30 mL,mL,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SODIUM CHLORIDE 0.9 % TOP SOLN,,91634,LOCAL,Facility,Inpatient,30 mL,mL,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SODIUM CHLORIDE 0.9 % TOP SOLN,,91634,LOCAL,Facility,Outpatient,30 mL,mL,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SODIUM CHLORIDE 0.9 % TOP SOLN,,91634,LOCAL,Facility,Inpatient,30 mL,mL,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SODIUM CHLORIDE 0.9 % TOP SOLN,,91634,LOCAL,Facility,Both,30 mL,mL,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % TOP SOLN,,91634,LOCAL,Facility,Outpatient,30 mL,mL,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % TOP SOLN,,91634,LOCAL,Facility,Inpatient,30 mL,mL,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
SODIUM CHLORIDE 0.9 % TOP SOLN,,91634,LOCAL,Facility,Outpatient,30 mL,mL,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
SODIUM CHLORIDE 0.9 % TOP SOLN,,91634,LOCAL,Facility,Inpatient,30 mL,mL,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"FENTANYL CITRATE (PF) 1,500 MCG/30 ML (50 MCG/ML) IV PCAS",,93178,LOCAL,Facility,Both,30 mL,mL,,147,124.95,42.1302,147,Aetna,Commercial,135.24,92,,percent of total billed charges,,
"FENTANYL CITRATE (PF) 1,500 MCG/30 ML (50 MCG/ML) IV PCAS",,93178,LOCAL,Facility,Outpatient,30 mL,mL,,147,124.95,42.1302,147,Aetna,Medicare Advantage,72.03,49,,percent of total billed charges,,
"FENTANYL CITRATE (PF) 1,500 MCG/30 ML (50 MCG/ML) IV PCAS",,93178,LOCAL,Facility,Inpatient,30 mL,mL,,147,124.95,42.1302,147,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"FENTANYL CITRATE (PF) 1,500 MCG/30 ML (50 MCG/ML) IV PCAS",,93178,LOCAL,Facility,Both,30 mL,mL,,147,124.95,42.1302,147,Aetna,PPO,136.71,93,,percent of total billed charges,,
"FENTANYL CITRATE (PF) 1,500 MCG/30 ML (50 MCG/ML) IV PCAS",,93178,LOCAL,Facility,Both,30 mL,mL,,147,124.95,42.1302,147,America's PPO,America's PPO,141.1641,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"FENTANYL CITRATE (PF) 1,500 MCG/30 ML (50 MCG/ML) IV PCAS",,93178,LOCAL,Facility,Both,30 mL,mL,,147,124.95,42.1302,147,BlueCross BlueShield Minnesota, Federal Employee Program,144.648,98.4,,percent of total billed charges,,
"FENTANYL CITRATE (PF) 1,500 MCG/30 ML (50 MCG/ML) IV PCAS",,93178,LOCAL,Facility,Both,30 mL,mL,,147,124.95,42.1302,147,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,147,100,,percent of total billed charges,,
"FENTANYL CITRATE (PF) 1,500 MCG/30 ML (50 MCG/ML) IV PCAS",,93178,LOCAL,Facility,Both,30 mL,mL,,147,124.95,42.1302,147,BlueCross BlueShield Minnesota,High Value Network Plan,132.3,90,,percent of total billed charges,,
"FENTANYL CITRATE (PF) 1,500 MCG/30 ML (50 MCG/ML) IV PCAS",,93178,LOCAL,Facility,Outpatient,30 mL,mL,,147,124.95,42.1302,147,BlueCross BlueShield Minnesota,Medicare Advantage,72.03,49,,percent of total billed charges,,
"FENTANYL CITRATE (PF) 1,500 MCG/30 ML (50 MCG/ML) IV PCAS",,93178,LOCAL,Facility,Inpatient,30 mL,mL,,147,124.95,42.1302,147,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"FENTANYL CITRATE (PF) 1,500 MCG/30 ML (50 MCG/ML) IV PCAS",,93178,LOCAL,Facility,Both,30 mL,mL,,147,124.95,42.1302,147,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,130.1979,88.57,,percent of total billed charges,,
"FENTANYL CITRATE (PF) 1,500 MCG/30 ML (50 MCG/ML) IV PCAS",,93178,LOCAL,Facility,Both,30 mL,mL,,147,124.95,42.1302,147,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,42.1302,28.66,,percent of total billed charges,,
"FENTANYL CITRATE (PF) 1,500 MCG/30 ML (50 MCG/ML) IV PCAS",,93178,LOCAL,Facility,Outpatient,30 mL,mL,,147,124.95,42.1302,147,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),72.03,49,,percent of total billed charges,,
"FENTANYL CITRATE (PF) 1,500 MCG/30 ML (50 MCG/ML) IV PCAS",,93178,LOCAL,Facility,Inpatient,30 mL,mL,,147,124.95,42.1302,147,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"FENTANYL CITRATE (PF) 1,500 MCG/30 ML (50 MCG/ML) IV PCAS",,93178,LOCAL,Facility,Both,30 mL,mL,,147,124.95,42.1302,147,CorVel,Worker's Compensation,147,100,,percent of total billed charges,,
"FENTANYL CITRATE (PF) 1,500 MCG/30 ML (50 MCG/ML) IV PCAS",,93178,LOCAL,Facility,Both,30 mL,mL,,147,124.95,42.1302,147,First Health Group Corporation,First Health Network,142.59,97,,percent of total billed charges,,
"FENTANYL CITRATE (PF) 1,500 MCG/30 ML (50 MCG/ML) IV PCAS",,93178,LOCAL,Facility,Both,30 mL,mL,,147,124.95,42.1302,147,"Health Partners, Inc.",Commercial,139.062,94.6,,percent of total billed charges,,
"FENTANYL CITRATE (PF) 1,500 MCG/30 ML (50 MCG/ML) IV PCAS",,93178,LOCAL,Facility,Outpatient,30 mL,mL,,147,124.95,42.1302,147,"Health Partners, Inc.",Medicare Advantage,72.03,49,,percent of total billed charges,,
"FENTANYL CITRATE (PF) 1,500 MCG/30 ML (50 MCG/ML) IV PCAS",,93178,LOCAL,Facility,Inpatient,30 mL,mL,,147,124.95,42.1302,147,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"FENTANYL CITRATE (PF) 1,500 MCG/30 ML (50 MCG/ML) IV PCAS",,93178,LOCAL,Facility,Both,30 mL,mL,,147,124.95,42.1302,147,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),88.2,60,,percent of total billed charges,,
"FENTANYL CITRATE (PF) 1,500 MCG/30 ML (50 MCG/ML) IV PCAS",,93178,LOCAL,Facility,Both,30 mL,mL,,147,124.95,42.1302,147,"Health Partners, Inc.",State of Minnesota Advantage Program,119.805,81.5,,percent of total billed charges,,
"FENTANYL CITRATE (PF) 1,500 MCG/30 ML (50 MCG/ML) IV PCAS",,93178,LOCAL,Facility,Both,30 mL,mL,,147,124.95,42.1302,147,"Health Partners, Inc.",State Public Programs,73.5,50,,percent of total billed charges,,
"FENTANYL CITRATE (PF) 1,500 MCG/30 ML (50 MCG/ML) IV PCAS",,93178,LOCAL,Facility,Both,30 mL,mL,,147,124.95,42.1302,147,Humana Insurance Company,Commercial PPO,139.65,95,,percent of total billed charges,,
"FENTANYL CITRATE (PF) 1,500 MCG/30 ML (50 MCG/ML) IV PCAS",,93178,LOCAL,Facility,Outpatient,30 mL,mL,,147,124.95,42.1302,147,Humana Insurance Company,Medicare PPO,72.03,49,,percent of total billed charges,,
"FENTANYL CITRATE (PF) 1,500 MCG/30 ML (50 MCG/ML) IV PCAS",,93178,LOCAL,Facility,Inpatient,30 mL,mL,,147,124.95,42.1302,147,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"FENTANYL CITRATE (PF) 1,500 MCG/30 ML (50 MCG/ML) IV PCAS",,93178,LOCAL,Facility,Both,30 mL,mL,,147,124.95,42.1302,147,Medica,Individual & Family,145.677,99.1,,percent of total billed charges,,
"FENTANYL CITRATE (PF) 1,500 MCG/30 ML (50 MCG/ML) IV PCAS",,93178,LOCAL,Facility,Outpatient,30 mL,mL,,147,124.95,42.1302,147,Medica,Medica Advantage Solution,73.206,49.8,,percent of total billed charges,,
"FENTANYL CITRATE (PF) 1,500 MCG/30 ML (50 MCG/ML) IV PCAS",,93178,LOCAL,Facility,Inpatient,30 mL,mL,,147,124.95,42.1302,147,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"FENTANYL CITRATE (PF) 1,500 MCG/30 ML (50 MCG/ML) IV PCAS",,93178,LOCAL,Facility,Outpatient,30 mL,mL,,147,124.95,42.1302,147,Medica,Medical Assistance,65.562,44.6,,percent of total billed charges,,
"FENTANYL CITRATE (PF) 1,500 MCG/30 ML (50 MCG/ML) IV PCAS",,93178,LOCAL,Facility,Inpatient,30 mL,mL,,147,124.95,42.1302,147,Medica,Medical Assistance,,,,,Included in per diem rate,
"FENTANYL CITRATE (PF) 1,500 MCG/30 ML (50 MCG/ML) IV PCAS",,93178,LOCAL,Facility,Outpatient,30 mL,mL,,147,124.95,42.1302,147,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,73.206,49.8,,percent of total billed charges,,
"FENTANYL CITRATE (PF) 1,500 MCG/30 ML (50 MCG/ML) IV PCAS",,93178,LOCAL,Facility,Inpatient,30 mL,mL,,147,124.95,42.1302,147,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"FENTANYL CITRATE (PF) 1,500 MCG/30 ML (50 MCG/ML) IV PCAS",,93178,LOCAL,Facility,Both,30 mL,mL,,147,124.95,42.1302,147,"Multiplan, Inc.","Multiplan, Inc.",138.18,94,,percent of total billed charges,,
"FENTANYL CITRATE (PF) 1,500 MCG/30 ML (50 MCG/ML) IV PCAS",,93178,LOCAL,Facility,Outpatient,30 mL,mL,,147,124.95,42.1302,147,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,132.447,90.1,,percent of total billed charges,,
"FENTANYL CITRATE (PF) 1,500 MCG/30 ML (50 MCG/ML) IV PCAS",,93178,LOCAL,Facility,Inpatient,30 mL,mL,,147,124.95,42.1302,147,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"FENTANYL CITRATE (PF) 1,500 MCG/30 ML (50 MCG/ML) IV PCAS",,93178,LOCAL,Facility,Both,30 mL,mL,,147,124.95,42.1302,147,"Preferred One Administrative Services, INC.",PPO,144.942,98.6,,percent of total billed charges,,
"FENTANYL CITRATE (PF) 1,500 MCG/30 ML (50 MCG/ML) IV PCAS",,93178,LOCAL,Facility,Outpatient,30 mL,mL,,147,124.95,42.1302,147,PrimeWest Health,Minnesota Senior Health Options (MSHO),75.6315,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"FENTANYL CITRATE (PF) 1,500 MCG/30 ML (50 MCG/ML) IV PCAS",,93178,LOCAL,Facility,Inpatient,30 mL,mL,,147,124.95,42.1302,147,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"FENTANYL CITRATE (PF) 1,500 MCG/30 ML (50 MCG/ML) IV PCAS",,93178,LOCAL,Facility,Outpatient,30 mL,mL,,147,124.95,42.1302,147,PrimeWest Health,MinnesotaCare,75.4992,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"FENTANYL CITRATE (PF) 1,500 MCG/30 ML (50 MCG/ML) IV PCAS",,93178,LOCAL,Facility,Inpatient,30 mL,mL,,147,124.95,42.1302,147,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"FENTANYL CITRATE (PF) 1,500 MCG/30 ML (50 MCG/ML) IV PCAS",,93178,LOCAL,Facility,Both,30 mL,mL,,147,124.95,42.1302,147,Sanford Health Plan,Sanford Health Plan,135.24,92,,percent of total billed charges,,
"FENTANYL CITRATE (PF) 1,500 MCG/30 ML (50 MCG/ML) IV PCAS",,93178,LOCAL,Facility,Outpatient,30 mL,mL,,147,124.95,42.1302,147,"UCare Health, Inc.",Individual & Family Plan,82.8345,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"FENTANYL CITRATE (PF) 1,500 MCG/30 ML (50 MCG/ML) IV PCAS",,93178,LOCAL,Facility,Inpatient,30 mL,mL,,147,124.95,42.1302,147,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"FENTANYL CITRATE (PF) 1,500 MCG/30 ML (50 MCG/ML) IV PCAS",,93178,LOCAL,Facility,Outpatient,30 mL,mL,,147,124.95,42.1302,147,"UCare Health, Inc.",Medical Assistance,74.1909,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"FENTANYL CITRATE (PF) 1,500 MCG/30 ML (50 MCG/ML) IV PCAS",,93178,LOCAL,Facility,Inpatient,30 mL,mL,,147,124.95,42.1302,147,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"FENTANYL CITRATE (PF) 1,500 MCG/30 ML (50 MCG/ML) IV PCAS",,93178,LOCAL,Facility,Outpatient,30 mL,mL,,147,124.95,42.1302,147,"UCare Health, Inc.",Medicare Advantage,74.1909,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"FENTANYL CITRATE (PF) 1,500 MCG/30 ML (50 MCG/ML) IV PCAS",,93178,LOCAL,Facility,Inpatient,30 mL,mL,,147,124.95,42.1302,147,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"FENTANYL CITRATE (PF) 1,500 MCG/30 ML (50 MCG/ML) IV PCAS",,93178,LOCAL,Facility,Outpatient,30 mL,mL,,147,124.95,42.1302,147,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),74.1909,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"FENTANYL CITRATE (PF) 1,500 MCG/30 ML (50 MCG/ML) IV PCAS",,93178,LOCAL,Facility,Inpatient,30 mL,mL,,147,124.95,42.1302,147,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"FENTANYL CITRATE (PF) 1,500 MCG/30 ML (50 MCG/ML) IV PCAS",,93178,LOCAL,Facility,Both,30 mL,mL,,147,124.95,42.1302,147,UnitedHealthcare,Individual & Family,138.18,94,,percent of total billed charges,,
"FENTANYL CITRATE (PF) 1,500 MCG/30 ML (50 MCG/ML) IV PCAS",,93178,LOCAL,Facility,Outpatient,30 mL,mL,,147,124.95,42.1302,147,UnitedHealthcare,Medicare Advantage,72.03,49,,percent of total billed charges,,
"FENTANYL CITRATE (PF) 1,500 MCG/30 ML (50 MCG/ML) IV PCAS",,93178,LOCAL,Facility,Inpatient,30 mL,mL,,147,124.95,42.1302,147,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"FENTANYL CITRATE (PF) 1,500 MCG/30 ML (50 MCG/ML) IV PCAS",,93178,LOCAL,Facility,Outpatient,30 mL,mL,,147,124.95,42.1302,147,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,70.56,48,,percent of total billed charges,,100% of DHS outpatient percentage
"FENTANYL CITRATE (PF) 1,500 MCG/30 ML (50 MCG/ML) IV PCAS",,93178,LOCAL,Facility,Inpatient,30 mL,mL,,147,124.95,42.1302,147,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
LACTULOSE 20 GRAM/30 ML ORAL SOLN,,99350,LOCAL,Facility,Both,30 mL,mL,,8,6.8,2.2928,8,Aetna,Commercial,7.36,92,,percent of total billed charges,,
LACTULOSE 20 GRAM/30 ML ORAL SOLN,,99350,LOCAL,Facility,Outpatient,30 mL,mL,,8,6.8,2.2928,8,Aetna,Medicare Advantage,3.92,49,,percent of total billed charges,,
LACTULOSE 20 GRAM/30 ML ORAL SOLN,,99350,LOCAL,Facility,Inpatient,30 mL,mL,,8,6.8,2.2928,8,Aetna,Medicare Advantage,,,,,Included in per diem rate,
LACTULOSE 20 GRAM/30 ML ORAL SOLN,,99350,LOCAL,Facility,Both,30 mL,mL,,8,6.8,2.2928,8,Aetna,PPO,7.44,93,,percent of total billed charges,,
LACTULOSE 20 GRAM/30 ML ORAL SOLN,,99350,LOCAL,Facility,Both,30 mL,mL,,8,6.8,2.2928,8,America's PPO,America's PPO,7.6824,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
LACTULOSE 20 GRAM/30 ML ORAL SOLN,,99350,LOCAL,Facility,Both,30 mL,mL,,8,6.8,2.2928,8,BlueCross BlueShield Minnesota, Federal Employee Program,7.872,98.4,,percent of total billed charges,,
LACTULOSE 20 GRAM/30 ML ORAL SOLN,,99350,LOCAL,Facility,Both,30 mL,mL,,8,6.8,2.2928,8,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,8,100,,percent of total billed charges,,
LACTULOSE 20 GRAM/30 ML ORAL SOLN,,99350,LOCAL,Facility,Both,30 mL,mL,,8,6.8,2.2928,8,BlueCross BlueShield Minnesota,High Value Network Plan,7.2,90,,percent of total billed charges,,
LACTULOSE 20 GRAM/30 ML ORAL SOLN,,99350,LOCAL,Facility,Outpatient,30 mL,mL,,8,6.8,2.2928,8,BlueCross BlueShield Minnesota,Medicare Advantage,3.92,49,,percent of total billed charges,,
LACTULOSE 20 GRAM/30 ML ORAL SOLN,,99350,LOCAL,Facility,Inpatient,30 mL,mL,,8,6.8,2.2928,8,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
LACTULOSE 20 GRAM/30 ML ORAL SOLN,,99350,LOCAL,Facility,Both,30 mL,mL,,8,6.8,2.2928,8,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,7.0856,88.57,,percent of total billed charges,,
LACTULOSE 20 GRAM/30 ML ORAL SOLN,,99350,LOCAL,Facility,Both,30 mL,mL,,8,6.8,2.2928,8,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,2.2928,28.66,,percent of total billed charges,,
LACTULOSE 20 GRAM/30 ML ORAL SOLN,,99350,LOCAL,Facility,Outpatient,30 mL,mL,,8,6.8,2.2928,8,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),3.92,49,,percent of total billed charges,,
LACTULOSE 20 GRAM/30 ML ORAL SOLN,,99350,LOCAL,Facility,Inpatient,30 mL,mL,,8,6.8,2.2928,8,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
LACTULOSE 20 GRAM/30 ML ORAL SOLN,,99350,LOCAL,Facility,Both,30 mL,mL,,8,6.8,2.2928,8,CorVel,Worker's Compensation,8,100,,percent of total billed charges,,
LACTULOSE 20 GRAM/30 ML ORAL SOLN,,99350,LOCAL,Facility,Both,30 mL,mL,,8,6.8,2.2928,8,First Health Group Corporation,First Health Network,7.76,97,,percent of total billed charges,,
LACTULOSE 20 GRAM/30 ML ORAL SOLN,,99350,LOCAL,Facility,Both,30 mL,mL,,8,6.8,2.2928,8,"Health Partners, Inc.",Commercial,7.568,94.6,,percent of total billed charges,,
LACTULOSE 20 GRAM/30 ML ORAL SOLN,,99350,LOCAL,Facility,Outpatient,30 mL,mL,,8,6.8,2.2928,8,"Health Partners, Inc.",Medicare Advantage,3.92,49,,percent of total billed charges,,
LACTULOSE 20 GRAM/30 ML ORAL SOLN,,99350,LOCAL,Facility,Inpatient,30 mL,mL,,8,6.8,2.2928,8,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LACTULOSE 20 GRAM/30 ML ORAL SOLN,,99350,LOCAL,Facility,Both,30 mL,mL,,8,6.8,2.2928,8,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),4.8,60,,percent of total billed charges,,
LACTULOSE 20 GRAM/30 ML ORAL SOLN,,99350,LOCAL,Facility,Both,30 mL,mL,,8,6.8,2.2928,8,"Health Partners, Inc.",State of Minnesota Advantage Program,6.52,81.5,,percent of total billed charges,,
LACTULOSE 20 GRAM/30 ML ORAL SOLN,,99350,LOCAL,Facility,Both,30 mL,mL,,8,6.8,2.2928,8,"Health Partners, Inc.",State Public Programs,4,50,,percent of total billed charges,,
LACTULOSE 20 GRAM/30 ML ORAL SOLN,,99350,LOCAL,Facility,Both,30 mL,mL,,8,6.8,2.2928,8,Humana Insurance Company,Commercial PPO,7.6,95,,percent of total billed charges,,
LACTULOSE 20 GRAM/30 ML ORAL SOLN,,99350,LOCAL,Facility,Outpatient,30 mL,mL,,8,6.8,2.2928,8,Humana Insurance Company,Medicare PPO,3.92,49,,percent of total billed charges,,
LACTULOSE 20 GRAM/30 ML ORAL SOLN,,99350,LOCAL,Facility,Inpatient,30 mL,mL,,8,6.8,2.2928,8,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
LACTULOSE 20 GRAM/30 ML ORAL SOLN,,99350,LOCAL,Facility,Both,30 mL,mL,,8,6.8,2.2928,8,Medica,Individual & Family,7.928,99.1,,percent of total billed charges,,
LACTULOSE 20 GRAM/30 ML ORAL SOLN,,99350,LOCAL,Facility,Outpatient,30 mL,mL,,8,6.8,2.2928,8,Medica,Medica Advantage Solution,3.984,49.8,,percent of total billed charges,,
LACTULOSE 20 GRAM/30 ML ORAL SOLN,,99350,LOCAL,Facility,Inpatient,30 mL,mL,,8,6.8,2.2928,8,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
LACTULOSE 20 GRAM/30 ML ORAL SOLN,,99350,LOCAL,Facility,Outpatient,30 mL,mL,,8,6.8,2.2928,8,Medica,Medical Assistance,3.568,44.6,,percent of total billed charges,,
LACTULOSE 20 GRAM/30 ML ORAL SOLN,,99350,LOCAL,Facility,Inpatient,30 mL,mL,,8,6.8,2.2928,8,Medica,Medical Assistance,,,,,Included in per diem rate,
LACTULOSE 20 GRAM/30 ML ORAL SOLN,,99350,LOCAL,Facility,Outpatient,30 mL,mL,,8,6.8,2.2928,8,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,3.984,49.8,,percent of total billed charges,,
LACTULOSE 20 GRAM/30 ML ORAL SOLN,,99350,LOCAL,Facility,Inpatient,30 mL,mL,,8,6.8,2.2928,8,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
LACTULOSE 20 GRAM/30 ML ORAL SOLN,,99350,LOCAL,Facility,Both,30 mL,mL,,8,6.8,2.2928,8,"Multiplan, Inc.","Multiplan, Inc.",7.52,94,,percent of total billed charges,,
LACTULOSE 20 GRAM/30 ML ORAL SOLN,,99350,LOCAL,Facility,Outpatient,30 mL,mL,,8,6.8,2.2928,8,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,7.208,90.1,,percent of total billed charges,,
LACTULOSE 20 GRAM/30 ML ORAL SOLN,,99350,LOCAL,Facility,Inpatient,30 mL,mL,,8,6.8,2.2928,8,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
LACTULOSE 20 GRAM/30 ML ORAL SOLN,,99350,LOCAL,Facility,Both,30 mL,mL,,8,6.8,2.2928,8,"Preferred One Administrative Services, INC.",PPO,7.888,98.6,,percent of total billed charges,,
LACTULOSE 20 GRAM/30 ML ORAL SOLN,,99350,LOCAL,Facility,Outpatient,30 mL,mL,,8,6.8,2.2928,8,PrimeWest Health,Minnesota Senior Health Options (MSHO),4.116,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
LACTULOSE 20 GRAM/30 ML ORAL SOLN,,99350,LOCAL,Facility,Inpatient,30 mL,mL,,8,6.8,2.2928,8,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LACTULOSE 20 GRAM/30 ML ORAL SOLN,,99350,LOCAL,Facility,Outpatient,30 mL,mL,,8,6.8,2.2928,8,PrimeWest Health,MinnesotaCare,4.1088,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
LACTULOSE 20 GRAM/30 ML ORAL SOLN,,99350,LOCAL,Facility,Inpatient,30 mL,mL,,8,6.8,2.2928,8,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
LACTULOSE 20 GRAM/30 ML ORAL SOLN,,99350,LOCAL,Facility,Both,30 mL,mL,,8,6.8,2.2928,8,Sanford Health Plan,Sanford Health Plan,7.36,92,,percent of total billed charges,,
LACTULOSE 20 GRAM/30 ML ORAL SOLN,,99350,LOCAL,Facility,Outpatient,30 mL,mL,,8,6.8,2.2928,8,"UCare Health, Inc.",Individual & Family Plan,4.508,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
LACTULOSE 20 GRAM/30 ML ORAL SOLN,,99350,LOCAL,Facility,Inpatient,30 mL,mL,,8,6.8,2.2928,8,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
LACTULOSE 20 GRAM/30 ML ORAL SOLN,,99350,LOCAL,Facility,Outpatient,30 mL,mL,,8,6.8,2.2928,8,"UCare Health, Inc.",Medical Assistance,4.0376,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LACTULOSE 20 GRAM/30 ML ORAL SOLN,,99350,LOCAL,Facility,Inpatient,30 mL,mL,,8,6.8,2.2928,8,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
LACTULOSE 20 GRAM/30 ML ORAL SOLN,,99350,LOCAL,Facility,Outpatient,30 mL,mL,,8,6.8,2.2928,8,"UCare Health, Inc.",Medicare Advantage,4.0376,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LACTULOSE 20 GRAM/30 ML ORAL SOLN,,99350,LOCAL,Facility,Inpatient,30 mL,mL,,8,6.8,2.2928,8,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LACTULOSE 20 GRAM/30 ML ORAL SOLN,,99350,LOCAL,Facility,Outpatient,30 mL,mL,,8,6.8,2.2928,8,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),4.0376,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LACTULOSE 20 GRAM/30 ML ORAL SOLN,,99350,LOCAL,Facility,Inpatient,30 mL,mL,,8,6.8,2.2928,8,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LACTULOSE 20 GRAM/30 ML ORAL SOLN,,99350,LOCAL,Facility,Both,30 mL,mL,,8,6.8,2.2928,8,UnitedHealthcare,Individual & Family,7.52,94,,percent of total billed charges,,
LACTULOSE 20 GRAM/30 ML ORAL SOLN,,99350,LOCAL,Facility,Outpatient,30 mL,mL,,8,6.8,2.2928,8,UnitedHealthcare,Medicare Advantage,3.92,49,,percent of total billed charges,,
LACTULOSE 20 GRAM/30 ML ORAL SOLN,,99350,LOCAL,Facility,Inpatient,30 mL,mL,,8,6.8,2.2928,8,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
LACTULOSE 20 GRAM/30 ML ORAL SOLN,,99350,LOCAL,Facility,Outpatient,30 mL,mL,,8,6.8,2.2928,8,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,3.84,48,,percent of total billed charges,,100% of DHS outpatient percentage
LACTULOSE 20 GRAM/30 ML ORAL SOLN,,99350,LOCAL,Facility,Inpatient,30 mL,mL,,8,6.8,2.2928,8,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
ACETYLCYSTEINE 20 % (200 MG/ML) IV SOLN,,J0132,HCPCS,Facility,Both,30 mL,mL,,1261,1071.85,361.4026,1261,Aetna,Commercial,1160.12,92,,percent of total billed charges,,
ACETYLCYSTEINE 20 % (200 MG/ML) IV SOLN,,J0132,HCPCS,Facility,Outpatient,30 mL,mL,,1261,1071.85,361.4026,1261,Aetna,Medicare Advantage,617.89,49,,percent of total billed charges,,
ACETYLCYSTEINE 20 % (200 MG/ML) IV SOLN,,J0132,HCPCS,Facility,Inpatient,30 mL,mL,,1261,1071.85,361.4026,1261,Aetna,Medicare Advantage,,,,,Included in per diem rate,
ACETYLCYSTEINE 20 % (200 MG/ML) IV SOLN,,J0132,HCPCS,Facility,Both,30 mL,mL,,1261,1071.85,361.4026,1261,Aetna,PPO,1172.73,93,,percent of total billed charges,,
ACETYLCYSTEINE 20 % (200 MG/ML) IV SOLN,,J0132,HCPCS,Facility,Both,30 mL,mL,,1261,1071.85,361.4026,1261,America's PPO,America's PPO,1210.9383,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
ACETYLCYSTEINE 20 % (200 MG/ML) IV SOLN,,J0132,HCPCS,Facility,Both,30 mL,mL,,1261,1071.85,361.4026,1261,BlueCross BlueShield Minnesota, Federal Employee Program,1240.824,98.4,,percent of total billed charges,,
ACETYLCYSTEINE 20 % (200 MG/ML) IV SOLN,,J0132,HCPCS,Facility,Both,30 mL,mL,,1261,1071.85,361.4026,1261,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1261,100,,percent of total billed charges,,
ACETYLCYSTEINE 20 % (200 MG/ML) IV SOLN,,J0132,HCPCS,Facility,Both,30 mL,mL,,1261,1071.85,361.4026,1261,BlueCross BlueShield Minnesota,High Value Network Plan,1134.9,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
ACETYLCYSTEINE 20 % (200 MG/ML) IV SOLN,,J0132,HCPCS,Facility,Outpatient,30 mL,mL,,1261,1071.85,361.4026,1261,BlueCross BlueShield Minnesota,Medicare Advantage,617.89,49,,percent of total billed charges,,
ACETYLCYSTEINE 20 % (200 MG/ML) IV SOLN,,J0132,HCPCS,Facility,Inpatient,30 mL,mL,,1261,1071.85,361.4026,1261,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
ACETYLCYSTEINE 20 % (200 MG/ML) IV SOLN,,J0132,HCPCS,Facility,Both,30 mL,mL,,1261,1071.85,361.4026,1261,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1116.8677,88.57,,percent of total billed charges,,
ACETYLCYSTEINE 20 % (200 MG/ML) IV SOLN,,J0132,HCPCS,Facility,Both,30 mL,mL,,1261,1071.85,361.4026,1261,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,361.4026,28.66,,percent of total billed charges,,
ACETYLCYSTEINE 20 % (200 MG/ML) IV SOLN,,J0132,HCPCS,Facility,Outpatient,30 mL,mL,,1261,1071.85,361.4026,1261,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),617.89,49,,percent of total billed charges,,
ACETYLCYSTEINE 20 % (200 MG/ML) IV SOLN,,J0132,HCPCS,Facility,Inpatient,30 mL,mL,,1261,1071.85,361.4026,1261,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
ACETYLCYSTEINE 20 % (200 MG/ML) IV SOLN,,J0132,HCPCS,Facility,Both,30 mL,mL,,1261,1071.85,361.4026,1261,CorVel,Worker's Compensation,1261,100,,percent of total billed charges,,
ACETYLCYSTEINE 20 % (200 MG/ML) IV SOLN,,J0132,HCPCS,Facility,Both,30 mL,mL,,1261,1071.85,361.4026,1261,First Health Group Corporation,First Health Network,1223.17,97,,percent of total billed charges,,
ACETYLCYSTEINE 20 % (200 MG/ML) IV SOLN,,J0132,HCPCS,Facility,Both,30 mL,mL,,1261,1071.85,361.4026,1261,"Health Partners, Inc.",Commercial,1192.906,94.6,,percent of total billed charges,,
ACETYLCYSTEINE 20 % (200 MG/ML) IV SOLN,,J0132,HCPCS,Facility,Outpatient,30 mL,mL,,1261,1071.85,361.4026,1261,"Health Partners, Inc.",Medicare Advantage,617.89,49,,percent of total billed charges,,
ACETYLCYSTEINE 20 % (200 MG/ML) IV SOLN,,J0132,HCPCS,Facility,Inpatient,30 mL,mL,,1261,1071.85,361.4026,1261,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ACETYLCYSTEINE 20 % (200 MG/ML) IV SOLN,,J0132,HCPCS,Facility,Both,30 mL,mL,,1261,1071.85,361.4026,1261,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),756.6,60,,percent of total billed charges,,
ACETYLCYSTEINE 20 % (200 MG/ML) IV SOLN,,J0132,HCPCS,Facility,Both,30 mL,mL,,1261,1071.85,361.4026,1261,"Health Partners, Inc.",State of Minnesota Advantage Program,1027.715,81.5,,percent of total billed charges,,
ACETYLCYSTEINE 20 % (200 MG/ML) IV SOLN,,J0132,HCPCS,Facility,Both,30 mL,mL,,1261,1071.85,361.4026,1261,"Health Partners, Inc.",State Public Programs,630.5,50,,percent of total billed charges,,
ACETYLCYSTEINE 20 % (200 MG/ML) IV SOLN,,J0132,HCPCS,Facility,Both,30 mL,mL,,1261,1071.85,361.4026,1261,Humana Insurance Company,Commercial PPO,1197.95,95,,percent of total billed charges,,
ACETYLCYSTEINE 20 % (200 MG/ML) IV SOLN,,J0132,HCPCS,Facility,Outpatient,30 mL,mL,,1261,1071.85,361.4026,1261,Humana Insurance Company,Medicare PPO,617.89,49,,percent of total billed charges,,
ACETYLCYSTEINE 20 % (200 MG/ML) IV SOLN,,J0132,HCPCS,Facility,Inpatient,30 mL,mL,,1261,1071.85,361.4026,1261,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
ACETYLCYSTEINE 20 % (200 MG/ML) IV SOLN,,J0132,HCPCS,Facility,Both,30 mL,mL,,1261,1071.85,361.4026,1261,Medica,Individual & Family,1249.651,99.1,,percent of total billed charges,,
ACETYLCYSTEINE 20 % (200 MG/ML) IV SOLN,,J0132,HCPCS,Facility,Outpatient,30 mL,mL,,1261,1071.85,361.4026,1261,Medica,Medica Advantage Solution,627.978,49.8,,percent of total billed charges,,
ACETYLCYSTEINE 20 % (200 MG/ML) IV SOLN,,J0132,HCPCS,Facility,Inpatient,30 mL,mL,,1261,1071.85,361.4026,1261,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
ACETYLCYSTEINE 20 % (200 MG/ML) IV SOLN,,J0132,HCPCS,Facility,Outpatient,30 mL,mL,,1261,1071.85,361.4026,1261,Medica,Medical Assistance,562.406,44.6,,percent of total billed charges,,
ACETYLCYSTEINE 20 % (200 MG/ML) IV SOLN,,J0132,HCPCS,Facility,Inpatient,30 mL,mL,,1261,1071.85,361.4026,1261,Medica,Medical Assistance,,,,,Included in per diem rate,
ACETYLCYSTEINE 20 % (200 MG/ML) IV SOLN,,J0132,HCPCS,Facility,Outpatient,30 mL,mL,,1261,1071.85,361.4026,1261,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,627.978,49.8,,percent of total billed charges,,
ACETYLCYSTEINE 20 % (200 MG/ML) IV SOLN,,J0132,HCPCS,Facility,Inpatient,30 mL,mL,,1261,1071.85,361.4026,1261,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
ACETYLCYSTEINE 20 % (200 MG/ML) IV SOLN,,J0132,HCPCS,Facility,Both,30 mL,mL,,1261,1071.85,361.4026,1261,"Multiplan, Inc.","Multiplan, Inc.",1185.34,94,,percent of total billed charges,,
ACETYLCYSTEINE 20 % (200 MG/ML) IV SOLN,,J0132,HCPCS,Facility,Outpatient,30 mL,mL,,1261,1071.85,361.4026,1261,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1136.161,90.1,,percent of total billed charges,,
ACETYLCYSTEINE 20 % (200 MG/ML) IV SOLN,,J0132,HCPCS,Facility,Inpatient,30 mL,mL,,1261,1071.85,361.4026,1261,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
ACETYLCYSTEINE 20 % (200 MG/ML) IV SOLN,,J0132,HCPCS,Facility,Both,30 mL,mL,,1261,1071.85,361.4026,1261,"Preferred One Administrative Services, INC.",PPO,1243.346,98.6,,percent of total billed charges,,
ACETYLCYSTEINE 20 % (200 MG/ML) IV SOLN,,J0132,HCPCS,Facility,Outpatient,30 mL,mL,,1261,1071.85,361.4026,1261,PrimeWest Health,Minnesota Senior Health Options (MSHO),648.7845,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
ACETYLCYSTEINE 20 % (200 MG/ML) IV SOLN,,J0132,HCPCS,Facility,Inpatient,30 mL,mL,,1261,1071.85,361.4026,1261,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ACETYLCYSTEINE 20 % (200 MG/ML) IV SOLN,,J0132,HCPCS,Facility,Outpatient,30 mL,mL,,1261,1071.85,361.4026,1261,PrimeWest Health,MinnesotaCare,647.6496,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
ACETYLCYSTEINE 20 % (200 MG/ML) IV SOLN,,J0132,HCPCS,Facility,Inpatient,30 mL,mL,,1261,1071.85,361.4026,1261,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
ACETYLCYSTEINE 20 % (200 MG/ML) IV SOLN,,J0132,HCPCS,Facility,Both,30 mL,mL,,1261,1071.85,361.4026,1261,Sanford Health Plan,Sanford Health Plan,1160.12,92,,percent of total billed charges,,
ACETYLCYSTEINE 20 % (200 MG/ML) IV SOLN,,J0132,HCPCS,Facility,Outpatient,30 mL,mL,,1261,1071.85,361.4026,1261,"UCare Health, Inc.",Individual & Family Plan,710.5735,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
ACETYLCYSTEINE 20 % (200 MG/ML) IV SOLN,,J0132,HCPCS,Facility,Inpatient,30 mL,mL,,1261,1071.85,361.4026,1261,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
ACETYLCYSTEINE 20 % (200 MG/ML) IV SOLN,,J0132,HCPCS,Facility,Outpatient,30 mL,mL,,1261,1071.85,361.4026,1261,"UCare Health, Inc.",Medical Assistance,636.4267,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ACETYLCYSTEINE 20 % (200 MG/ML) IV SOLN,,J0132,HCPCS,Facility,Inpatient,30 mL,mL,,1261,1071.85,361.4026,1261,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
ACETYLCYSTEINE 20 % (200 MG/ML) IV SOLN,,J0132,HCPCS,Facility,Outpatient,30 mL,mL,,1261,1071.85,361.4026,1261,"UCare Health, Inc.",Medicare Advantage,636.4267,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ACETYLCYSTEINE 20 % (200 MG/ML) IV SOLN,,J0132,HCPCS,Facility,Inpatient,30 mL,mL,,1261,1071.85,361.4026,1261,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ACETYLCYSTEINE 20 % (200 MG/ML) IV SOLN,,J0132,HCPCS,Facility,Outpatient,30 mL,mL,,1261,1071.85,361.4026,1261,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),636.4267,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ACETYLCYSTEINE 20 % (200 MG/ML) IV SOLN,,J0132,HCPCS,Facility,Inpatient,30 mL,mL,,1261,1071.85,361.4026,1261,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ACETYLCYSTEINE 20 % (200 MG/ML) IV SOLN,,J0132,HCPCS,Facility,Both,30 mL,mL,,1261,1071.85,361.4026,1261,UnitedHealthcare,Individual & Family,1185.34,94,,percent of total billed charges,,
ACETYLCYSTEINE 20 % (200 MG/ML) IV SOLN,,J0132,HCPCS,Facility,Outpatient,30 mL,mL,,1261,1071.85,361.4026,1261,UnitedHealthcare,Medicare Advantage,617.89,49,,percent of total billed charges,,
ACETYLCYSTEINE 20 % (200 MG/ML) IV SOLN,,J0132,HCPCS,Facility,Inpatient,30 mL,mL,,1261,1071.85,361.4026,1261,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
ACETYLCYSTEINE 20 % (200 MG/ML) IV SOLN,,J0132,HCPCS,Facility,Outpatient,30 mL,mL,,1261,1071.85,361.4026,1261,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,605.28,48,,percent of total billed charges,,100% of DHS outpatient percentage
ACETYLCYSTEINE 20 % (200 MG/ML) IV SOLN,,J0132,HCPCS,Facility,Inpatient,30 mL,mL,,1261,1071.85,361.4026,1261,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
EPINEPHRINE 1 MG/ML FOR ETT (PEDS),,J0171,HCPCS,Facility,Both,30 mL,mL,,1083,920.55,310.3878,1083,Aetna,Commercial,996.36,92,,percent of total billed charges,,
EPINEPHRINE 1 MG/ML FOR ETT (PEDS),,J0171,HCPCS,Facility,Outpatient,30 mL,mL,,1083,920.55,310.3878,1083,Aetna,Medicare Advantage,530.67,49,,percent of total billed charges,,
EPINEPHRINE 1 MG/ML FOR ETT (PEDS),,J0171,HCPCS,Facility,Inpatient,30 mL,mL,,1083,920.55,310.3878,1083,Aetna,Medicare Advantage,,,,,Included in per diem rate,
EPINEPHRINE 1 MG/ML FOR ETT (PEDS),,J0171,HCPCS,Facility,Both,30 mL,mL,,1083,920.55,310.3878,1083,Aetna,PPO,1007.19,93,,percent of total billed charges,,
EPINEPHRINE 1 MG/ML FOR ETT (PEDS),,J0171,HCPCS,Facility,Both,30 mL,mL,,1083,920.55,310.3878,1083,America's PPO,America's PPO,1040.0049,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
EPINEPHRINE 1 MG/ML FOR ETT (PEDS),,J0171,HCPCS,Facility,Both,30 mL,mL,,1083,920.55,310.3878,1083,BlueCross BlueShield Minnesota, Federal Employee Program,1065.672,98.4,,percent of total billed charges,,
EPINEPHRINE 1 MG/ML FOR ETT (PEDS),,J0171,HCPCS,Facility,Both,30 mL,mL,,1083,920.55,310.3878,1083,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1083,100,,percent of total billed charges,,
EPINEPHRINE 1 MG/ML FOR ETT (PEDS),,J0171,HCPCS,Facility,Both,30 mL,mL,,1083,920.55,310.3878,1083,BlueCross BlueShield Minnesota,High Value Network Plan,974.7,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
EPINEPHRINE 1 MG/ML FOR ETT (PEDS),,J0171,HCPCS,Facility,Outpatient,30 mL,mL,,1083,920.55,310.3878,1083,BlueCross BlueShield Minnesota,Medicare Advantage,530.67,49,,percent of total billed charges,,
EPINEPHRINE 1 MG/ML FOR ETT (PEDS),,J0171,HCPCS,Facility,Inpatient,30 mL,mL,,1083,920.55,310.3878,1083,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
EPINEPHRINE 1 MG/ML FOR ETT (PEDS),,J0171,HCPCS,Facility,Both,30 mL,mL,,1083,920.55,310.3878,1083,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,959.2131,88.57,,percent of total billed charges,,
EPINEPHRINE 1 MG/ML FOR ETT (PEDS),,J0171,HCPCS,Facility,Both,30 mL,mL,,1083,920.55,310.3878,1083,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,310.3878,28.66,,percent of total billed charges,,
EPINEPHRINE 1 MG/ML FOR ETT (PEDS),,J0171,HCPCS,Facility,Outpatient,30 mL,mL,,1083,920.55,310.3878,1083,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),530.67,49,,percent of total billed charges,,
EPINEPHRINE 1 MG/ML FOR ETT (PEDS),,J0171,HCPCS,Facility,Inpatient,30 mL,mL,,1083,920.55,310.3878,1083,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
EPINEPHRINE 1 MG/ML FOR ETT (PEDS),,J0171,HCPCS,Facility,Both,30 mL,mL,,1083,920.55,310.3878,1083,CorVel,Worker's Compensation,1083,100,,percent of total billed charges,,
EPINEPHRINE 1 MG/ML FOR ETT (PEDS),,J0171,HCPCS,Facility,Both,30 mL,mL,,1083,920.55,310.3878,1083,First Health Group Corporation,First Health Network,1050.51,97,,percent of total billed charges,,
EPINEPHRINE 1 MG/ML FOR ETT (PEDS),,J0171,HCPCS,Facility,Both,30 mL,mL,,1083,920.55,310.3878,1083,"Health Partners, Inc.",Commercial,1024.518,94.6,,percent of total billed charges,,
EPINEPHRINE 1 MG/ML FOR ETT (PEDS),,J0171,HCPCS,Facility,Outpatient,30 mL,mL,,1083,920.55,310.3878,1083,"Health Partners, Inc.",Medicare Advantage,530.67,49,,percent of total billed charges,,
EPINEPHRINE 1 MG/ML FOR ETT (PEDS),,J0171,HCPCS,Facility,Inpatient,30 mL,mL,,1083,920.55,310.3878,1083,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
EPINEPHRINE 1 MG/ML FOR ETT (PEDS),,J0171,HCPCS,Facility,Both,30 mL,mL,,1083,920.55,310.3878,1083,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),649.8,60,,percent of total billed charges,,
EPINEPHRINE 1 MG/ML FOR ETT (PEDS),,J0171,HCPCS,Facility,Both,30 mL,mL,,1083,920.55,310.3878,1083,"Health Partners, Inc.",State of Minnesota Advantage Program,882.645,81.5,,percent of total billed charges,,
EPINEPHRINE 1 MG/ML FOR ETT (PEDS),,J0171,HCPCS,Facility,Both,30 mL,mL,,1083,920.55,310.3878,1083,"Health Partners, Inc.",State Public Programs,541.5,50,,percent of total billed charges,,
EPINEPHRINE 1 MG/ML FOR ETT (PEDS),,J0171,HCPCS,Facility,Both,30 mL,mL,,1083,920.55,310.3878,1083,Humana Insurance Company,Commercial PPO,1028.85,95,,percent of total billed charges,,
EPINEPHRINE 1 MG/ML FOR ETT (PEDS),,J0171,HCPCS,Facility,Outpatient,30 mL,mL,,1083,920.55,310.3878,1083,Humana Insurance Company,Medicare PPO,530.67,49,,percent of total billed charges,,
EPINEPHRINE 1 MG/ML FOR ETT (PEDS),,J0171,HCPCS,Facility,Inpatient,30 mL,mL,,1083,920.55,310.3878,1083,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
EPINEPHRINE 1 MG/ML FOR ETT (PEDS),,J0171,HCPCS,Facility,Both,30 mL,mL,,1083,920.55,310.3878,1083,Medica,Individual & Family,1073.253,99.1,,percent of total billed charges,,
EPINEPHRINE 1 MG/ML FOR ETT (PEDS),,J0171,HCPCS,Facility,Outpatient,30 mL,mL,,1083,920.55,310.3878,1083,Medica,Medica Advantage Solution,539.334,49.8,,percent of total billed charges,,
EPINEPHRINE 1 MG/ML FOR ETT (PEDS),,J0171,HCPCS,Facility,Inpatient,30 mL,mL,,1083,920.55,310.3878,1083,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
EPINEPHRINE 1 MG/ML FOR ETT (PEDS),,J0171,HCPCS,Facility,Outpatient,30 mL,mL,,1083,920.55,310.3878,1083,Medica,Medical Assistance,483.018,44.6,,percent of total billed charges,,
EPINEPHRINE 1 MG/ML FOR ETT (PEDS),,J0171,HCPCS,Facility,Inpatient,30 mL,mL,,1083,920.55,310.3878,1083,Medica,Medical Assistance,,,,,Included in per diem rate,
EPINEPHRINE 1 MG/ML FOR ETT (PEDS),,J0171,HCPCS,Facility,Outpatient,30 mL,mL,,1083,920.55,310.3878,1083,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,539.334,49.8,,percent of total billed charges,,
EPINEPHRINE 1 MG/ML FOR ETT (PEDS),,J0171,HCPCS,Facility,Inpatient,30 mL,mL,,1083,920.55,310.3878,1083,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
EPINEPHRINE 1 MG/ML FOR ETT (PEDS),,J0171,HCPCS,Facility,Both,30 mL,mL,,1083,920.55,310.3878,1083,"Multiplan, Inc.","Multiplan, Inc.",1018.02,94,,percent of total billed charges,,
EPINEPHRINE 1 MG/ML FOR ETT (PEDS),,J0171,HCPCS,Facility,Outpatient,30 mL,mL,,1083,920.55,310.3878,1083,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,975.783,90.1,,percent of total billed charges,,
EPINEPHRINE 1 MG/ML FOR ETT (PEDS),,J0171,HCPCS,Facility,Inpatient,30 mL,mL,,1083,920.55,310.3878,1083,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
EPINEPHRINE 1 MG/ML FOR ETT (PEDS),,J0171,HCPCS,Facility,Both,30 mL,mL,,1083,920.55,310.3878,1083,"Preferred One Administrative Services, INC.",PPO,1067.838,98.6,,percent of total billed charges,,
EPINEPHRINE 1 MG/ML FOR ETT (PEDS),,J0171,HCPCS,Facility,Outpatient,30 mL,mL,,1083,920.55,310.3878,1083,PrimeWest Health,Minnesota Senior Health Options (MSHO),557.2035,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
EPINEPHRINE 1 MG/ML FOR ETT (PEDS),,J0171,HCPCS,Facility,Inpatient,30 mL,mL,,1083,920.55,310.3878,1083,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
EPINEPHRINE 1 MG/ML FOR ETT (PEDS),,J0171,HCPCS,Facility,Outpatient,30 mL,mL,,1083,920.55,310.3878,1083,PrimeWest Health,MinnesotaCare,556.2288,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
EPINEPHRINE 1 MG/ML FOR ETT (PEDS),,J0171,HCPCS,Facility,Inpatient,30 mL,mL,,1083,920.55,310.3878,1083,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
EPINEPHRINE 1 MG/ML FOR ETT (PEDS),,J0171,HCPCS,Facility,Both,30 mL,mL,,1083,920.55,310.3878,1083,Sanford Health Plan,Sanford Health Plan,996.36,92,,percent of total billed charges,,
EPINEPHRINE 1 MG/ML FOR ETT (PEDS),,J0171,HCPCS,Facility,Outpatient,30 mL,mL,,1083,920.55,310.3878,1083,"UCare Health, Inc.",Individual & Family Plan,610.2705,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
EPINEPHRINE 1 MG/ML FOR ETT (PEDS),,J0171,HCPCS,Facility,Inpatient,30 mL,mL,,1083,920.55,310.3878,1083,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
EPINEPHRINE 1 MG/ML FOR ETT (PEDS),,J0171,HCPCS,Facility,Outpatient,30 mL,mL,,1083,920.55,310.3878,1083,"UCare Health, Inc.",Medical Assistance,546.5901,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
EPINEPHRINE 1 MG/ML FOR ETT (PEDS),,J0171,HCPCS,Facility,Inpatient,30 mL,mL,,1083,920.55,310.3878,1083,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
EPINEPHRINE 1 MG/ML FOR ETT (PEDS),,J0171,HCPCS,Facility,Outpatient,30 mL,mL,,1083,920.55,310.3878,1083,"UCare Health, Inc.",Medicare Advantage,546.5901,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
EPINEPHRINE 1 MG/ML FOR ETT (PEDS),,J0171,HCPCS,Facility,Inpatient,30 mL,mL,,1083,920.55,310.3878,1083,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
EPINEPHRINE 1 MG/ML FOR ETT (PEDS),,J0171,HCPCS,Facility,Outpatient,30 mL,mL,,1083,920.55,310.3878,1083,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),546.5901,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
EPINEPHRINE 1 MG/ML FOR ETT (PEDS),,J0171,HCPCS,Facility,Inpatient,30 mL,mL,,1083,920.55,310.3878,1083,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
EPINEPHRINE 1 MG/ML FOR ETT (PEDS),,J0171,HCPCS,Facility,Both,30 mL,mL,,1083,920.55,310.3878,1083,UnitedHealthcare,Individual & Family,1018.02,94,,percent of total billed charges,,
EPINEPHRINE 1 MG/ML FOR ETT (PEDS),,J0171,HCPCS,Facility,Outpatient,30 mL,mL,,1083,920.55,310.3878,1083,UnitedHealthcare,Medicare Advantage,530.67,49,,percent of total billed charges,,
EPINEPHRINE 1 MG/ML FOR ETT (PEDS),,J0171,HCPCS,Facility,Inpatient,30 mL,mL,,1083,920.55,310.3878,1083,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
EPINEPHRINE 1 MG/ML FOR ETT (PEDS),,J0171,HCPCS,Facility,Outpatient,30 mL,mL,,1083,920.55,310.3878,1083,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,519.84,48,,percent of total billed charges,,100% of DHS outpatient percentage
EPINEPHRINE 1 MG/ML FOR ETT (PEDS),,J0171,HCPCS,Facility,Inpatient,30 mL,mL,,1083,920.55,310.3878,1083,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
EPINEPHRINE 1 MG/ML INJ SOLN,,J0171,HCPCS,Facility,Both,30 mL,mL,,1083,920.55,310.3878,1083,Aetna,Commercial,996.36,92,,percent of total billed charges,,
EPINEPHRINE 1 MG/ML INJ SOLN,,J0171,HCPCS,Facility,Outpatient,30 mL,mL,,1083,920.55,310.3878,1083,Aetna,Medicare Advantage,530.67,49,,percent of total billed charges,,
EPINEPHRINE 1 MG/ML INJ SOLN,,J0171,HCPCS,Facility,Inpatient,30 mL,mL,,1083,920.55,310.3878,1083,Aetna,Medicare Advantage,,,,,Included in per diem rate,
EPINEPHRINE 1 MG/ML INJ SOLN,,J0171,HCPCS,Facility,Both,30 mL,mL,,1083,920.55,310.3878,1083,Aetna,PPO,1007.19,93,,percent of total billed charges,,
EPINEPHRINE 1 MG/ML INJ SOLN,,J0171,HCPCS,Facility,Both,30 mL,mL,,1083,920.55,310.3878,1083,America's PPO,America's PPO,1040.0049,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
EPINEPHRINE 1 MG/ML INJ SOLN,,J0171,HCPCS,Facility,Both,30 mL,mL,,1083,920.55,310.3878,1083,BlueCross BlueShield Minnesota, Federal Employee Program,1065.672,98.4,,percent of total billed charges,,
EPINEPHRINE 1 MG/ML INJ SOLN,,J0171,HCPCS,Facility,Both,30 mL,mL,,1083,920.55,310.3878,1083,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1083,100,,percent of total billed charges,,
EPINEPHRINE 1 MG/ML INJ SOLN,,J0171,HCPCS,Facility,Both,30 mL,mL,,1083,920.55,310.3878,1083,BlueCross BlueShield Minnesota,High Value Network Plan,974.7,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
EPINEPHRINE 1 MG/ML INJ SOLN,,J0171,HCPCS,Facility,Outpatient,30 mL,mL,,1083,920.55,310.3878,1083,BlueCross BlueShield Minnesota,Medicare Advantage,530.67,49,,percent of total billed charges,,
EPINEPHRINE 1 MG/ML INJ SOLN,,J0171,HCPCS,Facility,Inpatient,30 mL,mL,,1083,920.55,310.3878,1083,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
EPINEPHRINE 1 MG/ML INJ SOLN,,J0171,HCPCS,Facility,Both,30 mL,mL,,1083,920.55,310.3878,1083,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,959.2131,88.57,,percent of total billed charges,,
EPINEPHRINE 1 MG/ML INJ SOLN,,J0171,HCPCS,Facility,Both,30 mL,mL,,1083,920.55,310.3878,1083,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,310.3878,28.66,,percent of total billed charges,,
EPINEPHRINE 1 MG/ML INJ SOLN,,J0171,HCPCS,Facility,Outpatient,30 mL,mL,,1083,920.55,310.3878,1083,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),530.67,49,,percent of total billed charges,,
EPINEPHRINE 1 MG/ML INJ SOLN,,J0171,HCPCS,Facility,Inpatient,30 mL,mL,,1083,920.55,310.3878,1083,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
EPINEPHRINE 1 MG/ML INJ SOLN,,J0171,HCPCS,Facility,Both,30 mL,mL,,1083,920.55,310.3878,1083,CorVel,Worker's Compensation,1083,100,,percent of total billed charges,,
EPINEPHRINE 1 MG/ML INJ SOLN,,J0171,HCPCS,Facility,Both,30 mL,mL,,1083,920.55,310.3878,1083,First Health Group Corporation,First Health Network,1050.51,97,,percent of total billed charges,,
EPINEPHRINE 1 MG/ML INJ SOLN,,J0171,HCPCS,Facility,Both,30 mL,mL,,1083,920.55,310.3878,1083,"Health Partners, Inc.",Commercial,1024.518,94.6,,percent of total billed charges,,
EPINEPHRINE 1 MG/ML INJ SOLN,,J0171,HCPCS,Facility,Outpatient,30 mL,mL,,1083,920.55,310.3878,1083,"Health Partners, Inc.",Medicare Advantage,530.67,49,,percent of total billed charges,,
EPINEPHRINE 1 MG/ML INJ SOLN,,J0171,HCPCS,Facility,Inpatient,30 mL,mL,,1083,920.55,310.3878,1083,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
EPINEPHRINE 1 MG/ML INJ SOLN,,J0171,HCPCS,Facility,Both,30 mL,mL,,1083,920.55,310.3878,1083,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),649.8,60,,percent of total billed charges,,
EPINEPHRINE 1 MG/ML INJ SOLN,,J0171,HCPCS,Facility,Both,30 mL,mL,,1083,920.55,310.3878,1083,"Health Partners, Inc.",State of Minnesota Advantage Program,882.645,81.5,,percent of total billed charges,,
EPINEPHRINE 1 MG/ML INJ SOLN,,J0171,HCPCS,Facility,Both,30 mL,mL,,1083,920.55,310.3878,1083,"Health Partners, Inc.",State Public Programs,541.5,50,,percent of total billed charges,,
EPINEPHRINE 1 MG/ML INJ SOLN,,J0171,HCPCS,Facility,Both,30 mL,mL,,1083,920.55,310.3878,1083,Humana Insurance Company,Commercial PPO,1028.85,95,,percent of total billed charges,,
EPINEPHRINE 1 MG/ML INJ SOLN,,J0171,HCPCS,Facility,Outpatient,30 mL,mL,,1083,920.55,310.3878,1083,Humana Insurance Company,Medicare PPO,530.67,49,,percent of total billed charges,,
EPINEPHRINE 1 MG/ML INJ SOLN,,J0171,HCPCS,Facility,Inpatient,30 mL,mL,,1083,920.55,310.3878,1083,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
EPINEPHRINE 1 MG/ML INJ SOLN,,J0171,HCPCS,Facility,Both,30 mL,mL,,1083,920.55,310.3878,1083,Medica,Individual & Family,1073.253,99.1,,percent of total billed charges,,
EPINEPHRINE 1 MG/ML INJ SOLN,,J0171,HCPCS,Facility,Outpatient,30 mL,mL,,1083,920.55,310.3878,1083,Medica,Medica Advantage Solution,539.334,49.8,,percent of total billed charges,,
EPINEPHRINE 1 MG/ML INJ SOLN,,J0171,HCPCS,Facility,Inpatient,30 mL,mL,,1083,920.55,310.3878,1083,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
EPINEPHRINE 1 MG/ML INJ SOLN,,J0171,HCPCS,Facility,Outpatient,30 mL,mL,,1083,920.55,310.3878,1083,Medica,Medical Assistance,483.018,44.6,,percent of total billed charges,,
EPINEPHRINE 1 MG/ML INJ SOLN,,J0171,HCPCS,Facility,Inpatient,30 mL,mL,,1083,920.55,310.3878,1083,Medica,Medical Assistance,,,,,Included in per diem rate,
EPINEPHRINE 1 MG/ML INJ SOLN,,J0171,HCPCS,Facility,Outpatient,30 mL,mL,,1083,920.55,310.3878,1083,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,539.334,49.8,,percent of total billed charges,,
EPINEPHRINE 1 MG/ML INJ SOLN,,J0171,HCPCS,Facility,Inpatient,30 mL,mL,,1083,920.55,310.3878,1083,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
EPINEPHRINE 1 MG/ML INJ SOLN,,J0171,HCPCS,Facility,Both,30 mL,mL,,1083,920.55,310.3878,1083,"Multiplan, Inc.","Multiplan, Inc.",1018.02,94,,percent of total billed charges,,
EPINEPHRINE 1 MG/ML INJ SOLN,,J0171,HCPCS,Facility,Outpatient,30 mL,mL,,1083,920.55,310.3878,1083,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,975.783,90.1,,percent of total billed charges,,
EPINEPHRINE 1 MG/ML INJ SOLN,,J0171,HCPCS,Facility,Inpatient,30 mL,mL,,1083,920.55,310.3878,1083,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
EPINEPHRINE 1 MG/ML INJ SOLN,,J0171,HCPCS,Facility,Both,30 mL,mL,,1083,920.55,310.3878,1083,"Preferred One Administrative Services, INC.",PPO,1067.838,98.6,,percent of total billed charges,,
EPINEPHRINE 1 MG/ML INJ SOLN,,J0171,HCPCS,Facility,Outpatient,30 mL,mL,,1083,920.55,310.3878,1083,PrimeWest Health,Minnesota Senior Health Options (MSHO),557.2035,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
EPINEPHRINE 1 MG/ML INJ SOLN,,J0171,HCPCS,Facility,Inpatient,30 mL,mL,,1083,920.55,310.3878,1083,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
EPINEPHRINE 1 MG/ML INJ SOLN,,J0171,HCPCS,Facility,Outpatient,30 mL,mL,,1083,920.55,310.3878,1083,PrimeWest Health,MinnesotaCare,556.2288,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
EPINEPHRINE 1 MG/ML INJ SOLN,,J0171,HCPCS,Facility,Inpatient,30 mL,mL,,1083,920.55,310.3878,1083,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
EPINEPHRINE 1 MG/ML INJ SOLN,,J0171,HCPCS,Facility,Both,30 mL,mL,,1083,920.55,310.3878,1083,Sanford Health Plan,Sanford Health Plan,996.36,92,,percent of total billed charges,,
EPINEPHRINE 1 MG/ML INJ SOLN,,J0171,HCPCS,Facility,Outpatient,30 mL,mL,,1083,920.55,310.3878,1083,"UCare Health, Inc.",Individual & Family Plan,610.2705,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
EPINEPHRINE 1 MG/ML INJ SOLN,,J0171,HCPCS,Facility,Inpatient,30 mL,mL,,1083,920.55,310.3878,1083,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
EPINEPHRINE 1 MG/ML INJ SOLN,,J0171,HCPCS,Facility,Outpatient,30 mL,mL,,1083,920.55,310.3878,1083,"UCare Health, Inc.",Medical Assistance,546.5901,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
EPINEPHRINE 1 MG/ML INJ SOLN,,J0171,HCPCS,Facility,Inpatient,30 mL,mL,,1083,920.55,310.3878,1083,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
EPINEPHRINE 1 MG/ML INJ SOLN,,J0171,HCPCS,Facility,Outpatient,30 mL,mL,,1083,920.55,310.3878,1083,"UCare Health, Inc.",Medicare Advantage,546.5901,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
EPINEPHRINE 1 MG/ML INJ SOLN,,J0171,HCPCS,Facility,Inpatient,30 mL,mL,,1083,920.55,310.3878,1083,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
EPINEPHRINE 1 MG/ML INJ SOLN,,J0171,HCPCS,Facility,Outpatient,30 mL,mL,,1083,920.55,310.3878,1083,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),546.5901,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
EPINEPHRINE 1 MG/ML INJ SOLN,,J0171,HCPCS,Facility,Inpatient,30 mL,mL,,1083,920.55,310.3878,1083,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
EPINEPHRINE 1 MG/ML INJ SOLN,,J0171,HCPCS,Facility,Both,30 mL,mL,,1083,920.55,310.3878,1083,UnitedHealthcare,Individual & Family,1018.02,94,,percent of total billed charges,,
EPINEPHRINE 1 MG/ML INJ SOLN,,J0171,HCPCS,Facility,Outpatient,30 mL,mL,,1083,920.55,310.3878,1083,UnitedHealthcare,Medicare Advantage,530.67,49,,percent of total billed charges,,
EPINEPHRINE 1 MG/ML INJ SOLN,,J0171,HCPCS,Facility,Inpatient,30 mL,mL,,1083,920.55,310.3878,1083,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
EPINEPHRINE 1 MG/ML INJ SOLN,,J0171,HCPCS,Facility,Outpatient,30 mL,mL,,1083,920.55,310.3878,1083,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,519.84,48,,percent of total billed charges,,100% of DHS outpatient percentage
EPINEPHRINE 1 MG/ML INJ SOLN,,J0171,HCPCS,Facility,Inpatient,30 mL,mL,,1083,920.55,310.3878,1083,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Both,30 mL,mL,,17,14.45,4.8722,17,Aetna,Commercial,15.64,92,,percent of total billed charges,,
BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Outpatient,30 mL,mL,,17,14.45,4.8722,17,Aetna,Medicare Advantage,8.33,49,,percent of total billed charges,,
BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Inpatient,30 mL,mL,,17,14.45,4.8722,17,Aetna,Medicare Advantage,,,,,Included in per diem rate,
BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Both,30 mL,mL,,17,14.45,4.8722,17,Aetna,PPO,15.81,93,,percent of total billed charges,,
BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Both,30 mL,mL,,17,14.45,4.8722,17,America's PPO,America's PPO,16.3251,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Both,30 mL,mL,,17,14.45,4.8722,17,BlueCross BlueShield Minnesota, Federal Employee Program,16.728,98.4,,percent of total billed charges,,
BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Both,30 mL,mL,,17,14.45,4.8722,17,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,17,100,,percent of total billed charges,,
BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Both,30 mL,mL,,17,14.45,4.8722,17,BlueCross BlueShield Minnesota,High Value Network Plan,15.3,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Outpatient,30 mL,mL,,17,14.45,4.8722,17,BlueCross BlueShield Minnesota,Medicare Advantage,8.33,49,,percent of total billed charges,,
BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Inpatient,30 mL,mL,,17,14.45,4.8722,17,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Both,30 mL,mL,,17,14.45,4.8722,17,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,15.0569,88.57,,percent of total billed charges,,
BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Both,30 mL,mL,,17,14.45,4.8722,17,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,4.8722,28.66,,percent of total billed charges,,
BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Outpatient,30 mL,mL,,17,14.45,4.8722,17,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),8.33,49,,percent of total billed charges,,
BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Inpatient,30 mL,mL,,17,14.45,4.8722,17,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Both,30 mL,mL,,17,14.45,4.8722,17,CorVel,Worker's Compensation,17,100,,percent of total billed charges,,
BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Both,30 mL,mL,,17,14.45,4.8722,17,First Health Group Corporation,First Health Network,16.49,97,,percent of total billed charges,,
BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Both,30 mL,mL,,17,14.45,4.8722,17,"Health Partners, Inc.",Commercial,16.082,94.6,,percent of total billed charges,,
BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Outpatient,30 mL,mL,,17,14.45,4.8722,17,"Health Partners, Inc.",Medicare Advantage,8.33,49,,percent of total billed charges,,
BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Inpatient,30 mL,mL,,17,14.45,4.8722,17,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Both,30 mL,mL,,17,14.45,4.8722,17,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),10.2,60,,percent of total billed charges,,
BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Both,30 mL,mL,,17,14.45,4.8722,17,"Health Partners, Inc.",State of Minnesota Advantage Program,13.855,81.5,,percent of total billed charges,,
BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Both,30 mL,mL,,17,14.45,4.8722,17,"Health Partners, Inc.",State Public Programs,8.5,50,,percent of total billed charges,,
BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Both,30 mL,mL,,17,14.45,4.8722,17,Humana Insurance Company,Commercial PPO,16.15,95,,percent of total billed charges,,
BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Outpatient,30 mL,mL,,17,14.45,4.8722,17,Humana Insurance Company,Medicare PPO,8.33,49,,percent of total billed charges,,
BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Inpatient,30 mL,mL,,17,14.45,4.8722,17,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Both,30 mL,mL,,17,14.45,4.8722,17,Medica,Individual & Family,16.847,99.1,,percent of total billed charges,,
BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Outpatient,30 mL,mL,,17,14.45,4.8722,17,Medica,Medica Advantage Solution,8.466,49.8,,percent of total billed charges,,
BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Inpatient,30 mL,mL,,17,14.45,4.8722,17,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Outpatient,30 mL,mL,,17,14.45,4.8722,17,Medica,Medical Assistance,7.582,44.6,,percent of total billed charges,,
BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Inpatient,30 mL,mL,,17,14.45,4.8722,17,Medica,Medical Assistance,,,,,Included in per diem rate,
BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Outpatient,30 mL,mL,,17,14.45,4.8722,17,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,8.466,49.8,,percent of total billed charges,,
BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Inpatient,30 mL,mL,,17,14.45,4.8722,17,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Both,30 mL,mL,,17,14.45,4.8722,17,"Multiplan, Inc.","Multiplan, Inc.",15.98,94,,percent of total billed charges,,
BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Outpatient,30 mL,mL,,17,14.45,4.8722,17,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,15.317,90.1,,percent of total billed charges,,
BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Inpatient,30 mL,mL,,17,14.45,4.8722,17,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Both,30 mL,mL,,17,14.45,4.8722,17,"Preferred One Administrative Services, INC.",PPO,16.762,98.6,,percent of total billed charges,,
BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Outpatient,30 mL,mL,,17,14.45,4.8722,17,PrimeWest Health,Minnesota Senior Health Options (MSHO),8.7465,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Inpatient,30 mL,mL,,17,14.45,4.8722,17,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Outpatient,30 mL,mL,,17,14.45,4.8722,17,PrimeWest Health,MinnesotaCare,8.7312,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Inpatient,30 mL,mL,,17,14.45,4.8722,17,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Both,30 mL,mL,,17,14.45,4.8722,17,Sanford Health Plan,Sanford Health Plan,15.64,92,,percent of total billed charges,,
BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Outpatient,30 mL,mL,,17,14.45,4.8722,17,"UCare Health, Inc.",Individual & Family Plan,9.5795,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Inpatient,30 mL,mL,,17,14.45,4.8722,17,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Outpatient,30 mL,mL,,17,14.45,4.8722,17,"UCare Health, Inc.",Medical Assistance,8.5799,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Inpatient,30 mL,mL,,17,14.45,4.8722,17,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Outpatient,30 mL,mL,,17,14.45,4.8722,17,"UCare Health, Inc.",Medicare Advantage,8.5799,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Inpatient,30 mL,mL,,17,14.45,4.8722,17,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Outpatient,30 mL,mL,,17,14.45,4.8722,17,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),8.5799,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Inpatient,30 mL,mL,,17,14.45,4.8722,17,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Both,30 mL,mL,,17,14.45,4.8722,17,UnitedHealthcare,Individual & Family,15.98,94,,percent of total billed charges,,
BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Outpatient,30 mL,mL,,17,14.45,4.8722,17,UnitedHealthcare,Medicare Advantage,8.33,49,,percent of total billed charges,,
BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Inpatient,30 mL,mL,,17,14.45,4.8722,17,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Outpatient,30 mL,mL,,17,14.45,4.8722,17,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,8.16,48,,percent of total billed charges,,100% of DHS outpatient percentage
BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Inpatient,30 mL,mL,,17,14.45,4.8722,17,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Both,30 mL,mL,,18,15.3,5.1588,18,Aetna,Commercial,16.56,92,,percent of total billed charges,,
BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Outpatient,30 mL,mL,,18,15.3,5.1588,18,Aetna,Medicare Advantage,8.82,49,,percent of total billed charges,,
BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Inpatient,30 mL,mL,,18,15.3,5.1588,18,Aetna,Medicare Advantage,,,,,Included in per diem rate,
BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Both,30 mL,mL,,18,15.3,5.1588,18,Aetna,PPO,16.74,93,,percent of total billed charges,,
BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Both,30 mL,mL,,18,15.3,5.1588,18,America's PPO,America's PPO,17.2854,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Both,30 mL,mL,,18,15.3,5.1588,18,BlueCross BlueShield Minnesota, Federal Employee Program,17.712,98.4,,percent of total billed charges,,
BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Both,30 mL,mL,,18,15.3,5.1588,18,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,18,100,,percent of total billed charges,,
BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Both,30 mL,mL,,18,15.3,5.1588,18,BlueCross BlueShield Minnesota,High Value Network Plan,16.2,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Outpatient,30 mL,mL,,18,15.3,5.1588,18,BlueCross BlueShield Minnesota,Medicare Advantage,8.82,49,,percent of total billed charges,,
BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Inpatient,30 mL,mL,,18,15.3,5.1588,18,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Both,30 mL,mL,,18,15.3,5.1588,18,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,15.9426,88.57,,percent of total billed charges,,
BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Both,30 mL,mL,,18,15.3,5.1588,18,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,5.1588,28.66,,percent of total billed charges,,
BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Outpatient,30 mL,mL,,18,15.3,5.1588,18,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),8.82,49,,percent of total billed charges,,
BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Inpatient,30 mL,mL,,18,15.3,5.1588,18,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Both,30 mL,mL,,18,15.3,5.1588,18,CorVel,Worker's Compensation,18,100,,percent of total billed charges,,
BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Both,30 mL,mL,,18,15.3,5.1588,18,First Health Group Corporation,First Health Network,17.46,97,,percent of total billed charges,,
BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Both,30 mL,mL,,18,15.3,5.1588,18,"Health Partners, Inc.",Commercial,17.028,94.6,,percent of total billed charges,,
BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Outpatient,30 mL,mL,,18,15.3,5.1588,18,"Health Partners, Inc.",Medicare Advantage,8.82,49,,percent of total billed charges,,
BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Inpatient,30 mL,mL,,18,15.3,5.1588,18,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Both,30 mL,mL,,18,15.3,5.1588,18,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),10.8,60,,percent of total billed charges,,
BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Both,30 mL,mL,,18,15.3,5.1588,18,"Health Partners, Inc.",State of Minnesota Advantage Program,14.67,81.5,,percent of total billed charges,,
BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Both,30 mL,mL,,18,15.3,5.1588,18,"Health Partners, Inc.",State Public Programs,9,50,,percent of total billed charges,,
BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Both,30 mL,mL,,18,15.3,5.1588,18,Humana Insurance Company,Commercial PPO,17.1,95,,percent of total billed charges,,
BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Outpatient,30 mL,mL,,18,15.3,5.1588,18,Humana Insurance Company,Medicare PPO,8.82,49,,percent of total billed charges,,
BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Inpatient,30 mL,mL,,18,15.3,5.1588,18,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Both,30 mL,mL,,18,15.3,5.1588,18,Medica,Individual & Family,17.838,99.1,,percent of total billed charges,,
BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Outpatient,30 mL,mL,,18,15.3,5.1588,18,Medica,Medica Advantage Solution,8.964,49.8,,percent of total billed charges,,
BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Inpatient,30 mL,mL,,18,15.3,5.1588,18,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Outpatient,30 mL,mL,,18,15.3,5.1588,18,Medica,Medical Assistance,8.028,44.6,,percent of total billed charges,,
BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Inpatient,30 mL,mL,,18,15.3,5.1588,18,Medica,Medical Assistance,,,,,Included in per diem rate,
BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Outpatient,30 mL,mL,,18,15.3,5.1588,18,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,8.964,49.8,,percent of total billed charges,,
BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Inpatient,30 mL,mL,,18,15.3,5.1588,18,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Both,30 mL,mL,,18,15.3,5.1588,18,"Multiplan, Inc.","Multiplan, Inc.",16.92,94,,percent of total billed charges,,
BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Outpatient,30 mL,mL,,18,15.3,5.1588,18,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,16.218,90.1,,percent of total billed charges,,
BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Inpatient,30 mL,mL,,18,15.3,5.1588,18,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Both,30 mL,mL,,18,15.3,5.1588,18,"Preferred One Administrative Services, INC.",PPO,17.748,98.6,,percent of total billed charges,,
BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Outpatient,30 mL,mL,,18,15.3,5.1588,18,PrimeWest Health,Minnesota Senior Health Options (MSHO),9.261,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Inpatient,30 mL,mL,,18,15.3,5.1588,18,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Outpatient,30 mL,mL,,18,15.3,5.1588,18,PrimeWest Health,MinnesotaCare,9.2448,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Inpatient,30 mL,mL,,18,15.3,5.1588,18,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Both,30 mL,mL,,18,15.3,5.1588,18,Sanford Health Plan,Sanford Health Plan,16.56,92,,percent of total billed charges,,
BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Outpatient,30 mL,mL,,18,15.3,5.1588,18,"UCare Health, Inc.",Individual & Family Plan,10.143,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Inpatient,30 mL,mL,,18,15.3,5.1588,18,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Outpatient,30 mL,mL,,18,15.3,5.1588,18,"UCare Health, Inc.",Medical Assistance,9.0846,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Inpatient,30 mL,mL,,18,15.3,5.1588,18,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Outpatient,30 mL,mL,,18,15.3,5.1588,18,"UCare Health, Inc.",Medicare Advantage,9.0846,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Inpatient,30 mL,mL,,18,15.3,5.1588,18,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Outpatient,30 mL,mL,,18,15.3,5.1588,18,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),9.0846,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Inpatient,30 mL,mL,,18,15.3,5.1588,18,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Both,30 mL,mL,,18,15.3,5.1588,18,UnitedHealthcare,Individual & Family,16.92,94,,percent of total billed charges,,
BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Outpatient,30 mL,mL,,18,15.3,5.1588,18,UnitedHealthcare,Medicare Advantage,8.82,49,,percent of total billed charges,,
BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Inpatient,30 mL,mL,,18,15.3,5.1588,18,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Outpatient,30 mL,mL,,18,15.3,5.1588,18,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,8.64,48,,percent of total billed charges,,100% of DHS outpatient percentage
BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Inpatient,30 mL,mL,,18,15.3,5.1588,18,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Both,30 mL,mL,,220,187,63.052,220,Aetna,Commercial,202.4,92,,percent of total billed charges,,
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Outpatient,30 mL,mL,,220,187,63.052,220,Aetna,Medicare Advantage,107.8,49,,percent of total billed charges,,
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Inpatient,30 mL,mL,,220,187,63.052,220,Aetna,Medicare Advantage,,,,,Included in per diem rate,
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Both,30 mL,mL,,220,187,63.052,220,Aetna,PPO,204.6,93,,percent of total billed charges,,
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Both,30 mL,mL,,220,187,63.052,220,America's PPO,America's PPO,211.266,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Both,30 mL,mL,,220,187,63.052,220,BlueCross BlueShield Minnesota, Federal Employee Program,216.48,98.4,,percent of total billed charges,,
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Both,30 mL,mL,,220,187,63.052,220,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,220,100,,percent of total billed charges,,
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Both,30 mL,mL,,220,187,63.052,220,BlueCross BlueShield Minnesota,High Value Network Plan,198,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Outpatient,30 mL,mL,,220,187,63.052,220,BlueCross BlueShield Minnesota,Medicare Advantage,107.8,49,,percent of total billed charges,,
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Inpatient,30 mL,mL,,220,187,63.052,220,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Both,30 mL,mL,,220,187,63.052,220,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,194.854,88.57,,percent of total billed charges,,
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Both,30 mL,mL,,220,187,63.052,220,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,63.052,28.66,,percent of total billed charges,,
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Outpatient,30 mL,mL,,220,187,63.052,220,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),107.8,49,,percent of total billed charges,,
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Inpatient,30 mL,mL,,220,187,63.052,220,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Both,30 mL,mL,,220,187,63.052,220,CorVel,Worker's Compensation,220,100,,percent of total billed charges,,
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Both,30 mL,mL,,220,187,63.052,220,First Health Group Corporation,First Health Network,213.4,97,,percent of total billed charges,,
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Both,30 mL,mL,,220,187,63.052,220,"Health Partners, Inc.",Commercial,208.12,94.6,,percent of total billed charges,,
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Outpatient,30 mL,mL,,220,187,63.052,220,"Health Partners, Inc.",Medicare Advantage,107.8,49,,percent of total billed charges,,
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Inpatient,30 mL,mL,,220,187,63.052,220,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Both,30 mL,mL,,220,187,63.052,220,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),132,60,,percent of total billed charges,,
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Both,30 mL,mL,,220,187,63.052,220,"Health Partners, Inc.",State of Minnesota Advantage Program,179.3,81.5,,percent of total billed charges,,
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Both,30 mL,mL,,220,187,63.052,220,"Health Partners, Inc.",State Public Programs,110,50,,percent of total billed charges,,
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Both,30 mL,mL,,220,187,63.052,220,Humana Insurance Company,Commercial PPO,209,95,,percent of total billed charges,,
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Outpatient,30 mL,mL,,220,187,63.052,220,Humana Insurance Company,Medicare PPO,107.8,49,,percent of total billed charges,,
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Inpatient,30 mL,mL,,220,187,63.052,220,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Both,30 mL,mL,,220,187,63.052,220,Medica,Individual & Family,218.02,99.1,,percent of total billed charges,,
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Outpatient,30 mL,mL,,220,187,63.052,220,Medica,Medica Advantage Solution,109.56,49.8,,percent of total billed charges,,
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Inpatient,30 mL,mL,,220,187,63.052,220,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Outpatient,30 mL,mL,,220,187,63.052,220,Medica,Medical Assistance,98.12,44.6,,percent of total billed charges,,
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Inpatient,30 mL,mL,,220,187,63.052,220,Medica,Medical Assistance,,,,,Included in per diem rate,
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Outpatient,30 mL,mL,,220,187,63.052,220,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,109.56,49.8,,percent of total billed charges,,
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Inpatient,30 mL,mL,,220,187,63.052,220,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Both,30 mL,mL,,220,187,63.052,220,"Multiplan, Inc.","Multiplan, Inc.",206.8,94,,percent of total billed charges,,
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Outpatient,30 mL,mL,,220,187,63.052,220,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,198.22,90.1,,percent of total billed charges,,
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Inpatient,30 mL,mL,,220,187,63.052,220,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Both,30 mL,mL,,220,187,63.052,220,"Preferred One Administrative Services, INC.",PPO,216.92,98.6,,percent of total billed charges,,
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Outpatient,30 mL,mL,,220,187,63.052,220,PrimeWest Health,Minnesota Senior Health Options (MSHO),113.19,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Inpatient,30 mL,mL,,220,187,63.052,220,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Outpatient,30 mL,mL,,220,187,63.052,220,PrimeWest Health,MinnesotaCare,112.992,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Inpatient,30 mL,mL,,220,187,63.052,220,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Both,30 mL,mL,,220,187,63.052,220,Sanford Health Plan,Sanford Health Plan,202.4,92,,percent of total billed charges,,
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Outpatient,30 mL,mL,,220,187,63.052,220,"UCare Health, Inc.",Individual & Family Plan,123.97,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Inpatient,30 mL,mL,,220,187,63.052,220,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Outpatient,30 mL,mL,,220,187,63.052,220,"UCare Health, Inc.",Medical Assistance,111.034,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Inpatient,30 mL,mL,,220,187,63.052,220,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Outpatient,30 mL,mL,,220,187,63.052,220,"UCare Health, Inc.",Medicare Advantage,111.034,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Inpatient,30 mL,mL,,220,187,63.052,220,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Outpatient,30 mL,mL,,220,187,63.052,220,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),111.034,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Inpatient,30 mL,mL,,220,187,63.052,220,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Both,30 mL,mL,,220,187,63.052,220,UnitedHealthcare,Individual & Family,206.8,94,,percent of total billed charges,,
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Outpatient,30 mL,mL,,220,187,63.052,220,UnitedHealthcare,Medicare Advantage,107.8,49,,percent of total billed charges,,
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Inpatient,30 mL,mL,,220,187,63.052,220,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Outpatient,30 mL,mL,,220,187,63.052,220,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,105.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Inpatient,30 mL,mL,,220,187,63.052,220,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
TOBRAMYCIN SULFATE 40 MG/ML INJ SOLN,,J3260,HCPCS,Facility,Both,30 mL,mL,,119,101.15,34.1054,119,Aetna,Commercial,109.48,92,,percent of total billed charges,,
TOBRAMYCIN SULFATE 40 MG/ML INJ SOLN,,J3260,HCPCS,Facility,Outpatient,30 mL,mL,,119,101.15,34.1054,119,Aetna,Medicare Advantage,58.31,49,,percent of total billed charges,,
TOBRAMYCIN SULFATE 40 MG/ML INJ SOLN,,J3260,HCPCS,Facility,Inpatient,30 mL,mL,,119,101.15,34.1054,119,Aetna,Medicare Advantage,,,,,Included in per diem rate,
TOBRAMYCIN SULFATE 40 MG/ML INJ SOLN,,J3260,HCPCS,Facility,Both,30 mL,mL,,119,101.15,34.1054,119,Aetna,PPO,110.67,93,,percent of total billed charges,,
TOBRAMYCIN SULFATE 40 MG/ML INJ SOLN,,J3260,HCPCS,Facility,Both,30 mL,mL,,119,101.15,34.1054,119,America's PPO,America's PPO,114.2757,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
TOBRAMYCIN SULFATE 40 MG/ML INJ SOLN,,J3260,HCPCS,Facility,Both,30 mL,mL,,119,101.15,34.1054,119,BlueCross BlueShield Minnesota, Federal Employee Program,117.096,98.4,,percent of total billed charges,,
TOBRAMYCIN SULFATE 40 MG/ML INJ SOLN,,J3260,HCPCS,Facility,Both,30 mL,mL,,119,101.15,34.1054,119,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,119,100,,percent of total billed charges,,
TOBRAMYCIN SULFATE 40 MG/ML INJ SOLN,,J3260,HCPCS,Facility,Both,30 mL,mL,,119,101.15,34.1054,119,BlueCross BlueShield Minnesota,High Value Network Plan,107.1,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
TOBRAMYCIN SULFATE 40 MG/ML INJ SOLN,,J3260,HCPCS,Facility,Outpatient,30 mL,mL,,119,101.15,34.1054,119,BlueCross BlueShield Minnesota,Medicare Advantage,58.31,49,,percent of total billed charges,,
TOBRAMYCIN SULFATE 40 MG/ML INJ SOLN,,J3260,HCPCS,Facility,Inpatient,30 mL,mL,,119,101.15,34.1054,119,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
TOBRAMYCIN SULFATE 40 MG/ML INJ SOLN,,J3260,HCPCS,Facility,Both,30 mL,mL,,119,101.15,34.1054,119,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,105.3983,88.57,,percent of total billed charges,,
TOBRAMYCIN SULFATE 40 MG/ML INJ SOLN,,J3260,HCPCS,Facility,Both,30 mL,mL,,119,101.15,34.1054,119,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,34.1054,28.66,,percent of total billed charges,,
TOBRAMYCIN SULFATE 40 MG/ML INJ SOLN,,J3260,HCPCS,Facility,Outpatient,30 mL,mL,,119,101.15,34.1054,119,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),58.31,49,,percent of total billed charges,,
TOBRAMYCIN SULFATE 40 MG/ML INJ SOLN,,J3260,HCPCS,Facility,Inpatient,30 mL,mL,,119,101.15,34.1054,119,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
TOBRAMYCIN SULFATE 40 MG/ML INJ SOLN,,J3260,HCPCS,Facility,Both,30 mL,mL,,119,101.15,34.1054,119,CorVel,Worker's Compensation,119,100,,percent of total billed charges,,
TOBRAMYCIN SULFATE 40 MG/ML INJ SOLN,,J3260,HCPCS,Facility,Both,30 mL,mL,,119,101.15,34.1054,119,First Health Group Corporation,First Health Network,115.43,97,,percent of total billed charges,,
TOBRAMYCIN SULFATE 40 MG/ML INJ SOLN,,J3260,HCPCS,Facility,Both,30 mL,mL,,119,101.15,34.1054,119,"Health Partners, Inc.",Commercial,112.574,94.6,,percent of total billed charges,,
TOBRAMYCIN SULFATE 40 MG/ML INJ SOLN,,J3260,HCPCS,Facility,Outpatient,30 mL,mL,,119,101.15,34.1054,119,"Health Partners, Inc.",Medicare Advantage,58.31,49,,percent of total billed charges,,
TOBRAMYCIN SULFATE 40 MG/ML INJ SOLN,,J3260,HCPCS,Facility,Inpatient,30 mL,mL,,119,101.15,34.1054,119,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
TOBRAMYCIN SULFATE 40 MG/ML INJ SOLN,,J3260,HCPCS,Facility,Both,30 mL,mL,,119,101.15,34.1054,119,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),71.4,60,,percent of total billed charges,,
TOBRAMYCIN SULFATE 40 MG/ML INJ SOLN,,J3260,HCPCS,Facility,Both,30 mL,mL,,119,101.15,34.1054,119,"Health Partners, Inc.",State of Minnesota Advantage Program,96.985,81.5,,percent of total billed charges,,
TOBRAMYCIN SULFATE 40 MG/ML INJ SOLN,,J3260,HCPCS,Facility,Both,30 mL,mL,,119,101.15,34.1054,119,"Health Partners, Inc.",State Public Programs,59.5,50,,percent of total billed charges,,
TOBRAMYCIN SULFATE 40 MG/ML INJ SOLN,,J3260,HCPCS,Facility,Both,30 mL,mL,,119,101.15,34.1054,119,Humana Insurance Company,Commercial PPO,113.05,95,,percent of total billed charges,,
TOBRAMYCIN SULFATE 40 MG/ML INJ SOLN,,J3260,HCPCS,Facility,Outpatient,30 mL,mL,,119,101.15,34.1054,119,Humana Insurance Company,Medicare PPO,58.31,49,,percent of total billed charges,,
TOBRAMYCIN SULFATE 40 MG/ML INJ SOLN,,J3260,HCPCS,Facility,Inpatient,30 mL,mL,,119,101.15,34.1054,119,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
TOBRAMYCIN SULFATE 40 MG/ML INJ SOLN,,J3260,HCPCS,Facility,Both,30 mL,mL,,119,101.15,34.1054,119,Medica,Individual & Family,117.929,99.1,,percent of total billed charges,,
TOBRAMYCIN SULFATE 40 MG/ML INJ SOLN,,J3260,HCPCS,Facility,Outpatient,30 mL,mL,,119,101.15,34.1054,119,Medica,Medica Advantage Solution,59.262,49.8,,percent of total billed charges,,
TOBRAMYCIN SULFATE 40 MG/ML INJ SOLN,,J3260,HCPCS,Facility,Inpatient,30 mL,mL,,119,101.15,34.1054,119,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
TOBRAMYCIN SULFATE 40 MG/ML INJ SOLN,,J3260,HCPCS,Facility,Outpatient,30 mL,mL,,119,101.15,34.1054,119,Medica,Medical Assistance,53.074,44.6,,percent of total billed charges,,
TOBRAMYCIN SULFATE 40 MG/ML INJ SOLN,,J3260,HCPCS,Facility,Inpatient,30 mL,mL,,119,101.15,34.1054,119,Medica,Medical Assistance,,,,,Included in per diem rate,
TOBRAMYCIN SULFATE 40 MG/ML INJ SOLN,,J3260,HCPCS,Facility,Outpatient,30 mL,mL,,119,101.15,34.1054,119,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,59.262,49.8,,percent of total billed charges,,
TOBRAMYCIN SULFATE 40 MG/ML INJ SOLN,,J3260,HCPCS,Facility,Inpatient,30 mL,mL,,119,101.15,34.1054,119,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
TOBRAMYCIN SULFATE 40 MG/ML INJ SOLN,,J3260,HCPCS,Facility,Both,30 mL,mL,,119,101.15,34.1054,119,"Multiplan, Inc.","Multiplan, Inc.",111.86,94,,percent of total billed charges,,
TOBRAMYCIN SULFATE 40 MG/ML INJ SOLN,,J3260,HCPCS,Facility,Outpatient,30 mL,mL,,119,101.15,34.1054,119,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,107.219,90.1,,percent of total billed charges,,
TOBRAMYCIN SULFATE 40 MG/ML INJ SOLN,,J3260,HCPCS,Facility,Inpatient,30 mL,mL,,119,101.15,34.1054,119,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
TOBRAMYCIN SULFATE 40 MG/ML INJ SOLN,,J3260,HCPCS,Facility,Both,30 mL,mL,,119,101.15,34.1054,119,"Preferred One Administrative Services, INC.",PPO,117.334,98.6,,percent of total billed charges,,
TOBRAMYCIN SULFATE 40 MG/ML INJ SOLN,,J3260,HCPCS,Facility,Outpatient,30 mL,mL,,119,101.15,34.1054,119,PrimeWest Health,Minnesota Senior Health Options (MSHO),61.2255,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
TOBRAMYCIN SULFATE 40 MG/ML INJ SOLN,,J3260,HCPCS,Facility,Inpatient,30 mL,mL,,119,101.15,34.1054,119,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
TOBRAMYCIN SULFATE 40 MG/ML INJ SOLN,,J3260,HCPCS,Facility,Outpatient,30 mL,mL,,119,101.15,34.1054,119,PrimeWest Health,MinnesotaCare,61.1184,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
TOBRAMYCIN SULFATE 40 MG/ML INJ SOLN,,J3260,HCPCS,Facility,Inpatient,30 mL,mL,,119,101.15,34.1054,119,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
TOBRAMYCIN SULFATE 40 MG/ML INJ SOLN,,J3260,HCPCS,Facility,Both,30 mL,mL,,119,101.15,34.1054,119,Sanford Health Plan,Sanford Health Plan,109.48,92,,percent of total billed charges,,
TOBRAMYCIN SULFATE 40 MG/ML INJ SOLN,,J3260,HCPCS,Facility,Outpatient,30 mL,mL,,119,101.15,34.1054,119,"UCare Health, Inc.",Individual & Family Plan,67.0565,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
TOBRAMYCIN SULFATE 40 MG/ML INJ SOLN,,J3260,HCPCS,Facility,Inpatient,30 mL,mL,,119,101.15,34.1054,119,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
TOBRAMYCIN SULFATE 40 MG/ML INJ SOLN,,J3260,HCPCS,Facility,Outpatient,30 mL,mL,,119,101.15,34.1054,119,"UCare Health, Inc.",Medical Assistance,60.0593,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TOBRAMYCIN SULFATE 40 MG/ML INJ SOLN,,J3260,HCPCS,Facility,Inpatient,30 mL,mL,,119,101.15,34.1054,119,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
TOBRAMYCIN SULFATE 40 MG/ML INJ SOLN,,J3260,HCPCS,Facility,Outpatient,30 mL,mL,,119,101.15,34.1054,119,"UCare Health, Inc.",Medicare Advantage,60.0593,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TOBRAMYCIN SULFATE 40 MG/ML INJ SOLN,,J3260,HCPCS,Facility,Inpatient,30 mL,mL,,119,101.15,34.1054,119,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
TOBRAMYCIN SULFATE 40 MG/ML INJ SOLN,,J3260,HCPCS,Facility,Outpatient,30 mL,mL,,119,101.15,34.1054,119,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),60.0593,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TOBRAMYCIN SULFATE 40 MG/ML INJ SOLN,,J3260,HCPCS,Facility,Inpatient,30 mL,mL,,119,101.15,34.1054,119,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
TOBRAMYCIN SULFATE 40 MG/ML INJ SOLN,,J3260,HCPCS,Facility,Both,30 mL,mL,,119,101.15,34.1054,119,UnitedHealthcare,Individual & Family,111.86,94,,percent of total billed charges,,
TOBRAMYCIN SULFATE 40 MG/ML INJ SOLN,,J3260,HCPCS,Facility,Outpatient,30 mL,mL,,119,101.15,34.1054,119,UnitedHealthcare,Medicare Advantage,58.31,49,,percent of total billed charges,,
TOBRAMYCIN SULFATE 40 MG/ML INJ SOLN,,J3260,HCPCS,Facility,Inpatient,30 mL,mL,,119,101.15,34.1054,119,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
TOBRAMYCIN SULFATE 40 MG/ML INJ SOLN,,J3260,HCPCS,Facility,Outpatient,30 mL,mL,,119,101.15,34.1054,119,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,57.12,48,,percent of total billed charges,,100% of DHS outpatient percentage
TOBRAMYCIN SULFATE 40 MG/ML INJ SOLN,,J3260,HCPCS,Facility,Inpatient,30 mL,mL,,119,101.15,34.1054,119,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
DEXAMETHASONE 1 MG/ML ORAL DROP,,J8540,HCPCS,Facility,Both,30 mL,mL,,145,123.25,41.557,145,Aetna,Commercial,133.4,92,,percent of total billed charges,,
DEXAMETHASONE 1 MG/ML ORAL DROP,,J8540,HCPCS,Facility,Outpatient,30 mL,mL,,145,123.25,41.557,145,Aetna,Medicare Advantage,71.05,49,,percent of total billed charges,,
DEXAMETHASONE 1 MG/ML ORAL DROP,,J8540,HCPCS,Facility,Inpatient,30 mL,mL,,145,123.25,41.557,145,Aetna,Medicare Advantage,,,,,Included in per diem rate,
DEXAMETHASONE 1 MG/ML ORAL DROP,,J8540,HCPCS,Facility,Both,30 mL,mL,,145,123.25,41.557,145,Aetna,PPO,134.85,93,,percent of total billed charges,,
DEXAMETHASONE 1 MG/ML ORAL DROP,,J8540,HCPCS,Facility,Both,30 mL,mL,,145,123.25,41.557,145,America's PPO,America's PPO,139.2435,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
DEXAMETHASONE 1 MG/ML ORAL DROP,,J8540,HCPCS,Facility,Both,30 mL,mL,,145,123.25,41.557,145,BlueCross BlueShield Minnesota, Federal Employee Program,142.68,98.4,,percent of total billed charges,,
DEXAMETHASONE 1 MG/ML ORAL DROP,,J8540,HCPCS,Facility,Both,30 mL,mL,,145,123.25,41.557,145,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,145,100,,percent of total billed charges,,
DEXAMETHASONE 1 MG/ML ORAL DROP,,J8540,HCPCS,Facility,Both,30 mL,mL,,145,123.25,41.557,145,BlueCross BlueShield Minnesota,High Value Network Plan,130.5,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
DEXAMETHASONE 1 MG/ML ORAL DROP,,J8540,HCPCS,Facility,Outpatient,30 mL,mL,,145,123.25,41.557,145,BlueCross BlueShield Minnesota,Medicare Advantage,71.05,49,,percent of total billed charges,,
DEXAMETHASONE 1 MG/ML ORAL DROP,,J8540,HCPCS,Facility,Inpatient,30 mL,mL,,145,123.25,41.557,145,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
DEXAMETHASONE 1 MG/ML ORAL DROP,,J8540,HCPCS,Facility,Both,30 mL,mL,,145,123.25,41.557,145,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,128.4265,88.57,,percent of total billed charges,,
DEXAMETHASONE 1 MG/ML ORAL DROP,,J8540,HCPCS,Facility,Both,30 mL,mL,,145,123.25,41.557,145,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,41.557,28.66,,percent of total billed charges,,
DEXAMETHASONE 1 MG/ML ORAL DROP,,J8540,HCPCS,Facility,Outpatient,30 mL,mL,,145,123.25,41.557,145,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),71.05,49,,percent of total billed charges,,
DEXAMETHASONE 1 MG/ML ORAL DROP,,J8540,HCPCS,Facility,Inpatient,30 mL,mL,,145,123.25,41.557,145,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
DEXAMETHASONE 1 MG/ML ORAL DROP,,J8540,HCPCS,Facility,Both,30 mL,mL,,145,123.25,41.557,145,CorVel,Worker's Compensation,145,100,,percent of total billed charges,,
DEXAMETHASONE 1 MG/ML ORAL DROP,,J8540,HCPCS,Facility,Both,30 mL,mL,,145,123.25,41.557,145,First Health Group Corporation,First Health Network,140.65,97,,percent of total billed charges,,
DEXAMETHASONE 1 MG/ML ORAL DROP,,J8540,HCPCS,Facility,Both,30 mL,mL,,145,123.25,41.557,145,"Health Partners, Inc.",Commercial,137.17,94.6,,percent of total billed charges,,
DEXAMETHASONE 1 MG/ML ORAL DROP,,J8540,HCPCS,Facility,Outpatient,30 mL,mL,,145,123.25,41.557,145,"Health Partners, Inc.",Medicare Advantage,71.05,49,,percent of total billed charges,,
DEXAMETHASONE 1 MG/ML ORAL DROP,,J8540,HCPCS,Facility,Inpatient,30 mL,mL,,145,123.25,41.557,145,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DEXAMETHASONE 1 MG/ML ORAL DROP,,J8540,HCPCS,Facility,Both,30 mL,mL,,145,123.25,41.557,145,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),87,60,,percent of total billed charges,,
DEXAMETHASONE 1 MG/ML ORAL DROP,,J8540,HCPCS,Facility,Both,30 mL,mL,,145,123.25,41.557,145,"Health Partners, Inc.",State of Minnesota Advantage Program,118.175,81.5,,percent of total billed charges,,
DEXAMETHASONE 1 MG/ML ORAL DROP,,J8540,HCPCS,Facility,Both,30 mL,mL,,145,123.25,41.557,145,"Health Partners, Inc.",State Public Programs,72.5,50,,percent of total billed charges,,
DEXAMETHASONE 1 MG/ML ORAL DROP,,J8540,HCPCS,Facility,Both,30 mL,mL,,145,123.25,41.557,145,Humana Insurance Company,Commercial PPO,137.75,95,,percent of total billed charges,,
DEXAMETHASONE 1 MG/ML ORAL DROP,,J8540,HCPCS,Facility,Outpatient,30 mL,mL,,145,123.25,41.557,145,Humana Insurance Company,Medicare PPO,71.05,49,,percent of total billed charges,,
DEXAMETHASONE 1 MG/ML ORAL DROP,,J8540,HCPCS,Facility,Inpatient,30 mL,mL,,145,123.25,41.557,145,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
DEXAMETHASONE 1 MG/ML ORAL DROP,,J8540,HCPCS,Facility,Both,30 mL,mL,,145,123.25,41.557,145,Medica,Individual & Family,143.695,99.1,,percent of total billed charges,,
DEXAMETHASONE 1 MG/ML ORAL DROP,,J8540,HCPCS,Facility,Outpatient,30 mL,mL,,145,123.25,41.557,145,Medica,Medica Advantage Solution,72.21,49.8,,percent of total billed charges,,
DEXAMETHASONE 1 MG/ML ORAL DROP,,J8540,HCPCS,Facility,Inpatient,30 mL,mL,,145,123.25,41.557,145,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
DEXAMETHASONE 1 MG/ML ORAL DROP,,J8540,HCPCS,Facility,Outpatient,30 mL,mL,,145,123.25,41.557,145,Medica,Medical Assistance,64.67,44.6,,percent of total billed charges,,
DEXAMETHASONE 1 MG/ML ORAL DROP,,J8540,HCPCS,Facility,Inpatient,30 mL,mL,,145,123.25,41.557,145,Medica,Medical Assistance,,,,,Included in per diem rate,
DEXAMETHASONE 1 MG/ML ORAL DROP,,J8540,HCPCS,Facility,Outpatient,30 mL,mL,,145,123.25,41.557,145,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,72.21,49.8,,percent of total billed charges,,
DEXAMETHASONE 1 MG/ML ORAL DROP,,J8540,HCPCS,Facility,Inpatient,30 mL,mL,,145,123.25,41.557,145,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
DEXAMETHASONE 1 MG/ML ORAL DROP,,J8540,HCPCS,Facility,Both,30 mL,mL,,145,123.25,41.557,145,"Multiplan, Inc.","Multiplan, Inc.",136.3,94,,percent of total billed charges,,
DEXAMETHASONE 1 MG/ML ORAL DROP,,J8540,HCPCS,Facility,Outpatient,30 mL,mL,,145,123.25,41.557,145,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,130.645,90.1,,percent of total billed charges,,
DEXAMETHASONE 1 MG/ML ORAL DROP,,J8540,HCPCS,Facility,Inpatient,30 mL,mL,,145,123.25,41.557,145,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
DEXAMETHASONE 1 MG/ML ORAL DROP,,J8540,HCPCS,Facility,Both,30 mL,mL,,145,123.25,41.557,145,"Preferred One Administrative Services, INC.",PPO,142.97,98.6,,percent of total billed charges,,
DEXAMETHASONE 1 MG/ML ORAL DROP,,J8540,HCPCS,Facility,Outpatient,30 mL,mL,,145,123.25,41.557,145,PrimeWest Health,Minnesota Senior Health Options (MSHO),74.6025,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
DEXAMETHASONE 1 MG/ML ORAL DROP,,J8540,HCPCS,Facility,Inpatient,30 mL,mL,,145,123.25,41.557,145,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DEXAMETHASONE 1 MG/ML ORAL DROP,,J8540,HCPCS,Facility,Outpatient,30 mL,mL,,145,123.25,41.557,145,PrimeWest Health,MinnesotaCare,74.472,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
DEXAMETHASONE 1 MG/ML ORAL DROP,,J8540,HCPCS,Facility,Inpatient,30 mL,mL,,145,123.25,41.557,145,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
DEXAMETHASONE 1 MG/ML ORAL DROP,,J8540,HCPCS,Facility,Both,30 mL,mL,,145,123.25,41.557,145,Sanford Health Plan,Sanford Health Plan,133.4,92,,percent of total billed charges,,
DEXAMETHASONE 1 MG/ML ORAL DROP,,J8540,HCPCS,Facility,Outpatient,30 mL,mL,,145,123.25,41.557,145,"UCare Health, Inc.",Individual & Family Plan,81.7075,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
DEXAMETHASONE 1 MG/ML ORAL DROP,,J8540,HCPCS,Facility,Inpatient,30 mL,mL,,145,123.25,41.557,145,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
DEXAMETHASONE 1 MG/ML ORAL DROP,,J8540,HCPCS,Facility,Outpatient,30 mL,mL,,145,123.25,41.557,145,"UCare Health, Inc.",Medical Assistance,73.1815,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DEXAMETHASONE 1 MG/ML ORAL DROP,,J8540,HCPCS,Facility,Inpatient,30 mL,mL,,145,123.25,41.557,145,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
DEXAMETHASONE 1 MG/ML ORAL DROP,,J8540,HCPCS,Facility,Outpatient,30 mL,mL,,145,123.25,41.557,145,"UCare Health, Inc.",Medicare Advantage,73.1815,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DEXAMETHASONE 1 MG/ML ORAL DROP,,J8540,HCPCS,Facility,Inpatient,30 mL,mL,,145,123.25,41.557,145,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DEXAMETHASONE 1 MG/ML ORAL DROP,,J8540,HCPCS,Facility,Outpatient,30 mL,mL,,145,123.25,41.557,145,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),73.1815,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DEXAMETHASONE 1 MG/ML ORAL DROP,,J8540,HCPCS,Facility,Inpatient,30 mL,mL,,145,123.25,41.557,145,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DEXAMETHASONE 1 MG/ML ORAL DROP,,J8540,HCPCS,Facility,Both,30 mL,mL,,145,123.25,41.557,145,UnitedHealthcare,Individual & Family,136.3,94,,percent of total billed charges,,
DEXAMETHASONE 1 MG/ML ORAL DROP,,J8540,HCPCS,Facility,Outpatient,30 mL,mL,,145,123.25,41.557,145,UnitedHealthcare,Medicare Advantage,71.05,49,,percent of total billed charges,,
DEXAMETHASONE 1 MG/ML ORAL DROP,,J8540,HCPCS,Facility,Inpatient,30 mL,mL,,145,123.25,41.557,145,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
DEXAMETHASONE 1 MG/ML ORAL DROP,,J8540,HCPCS,Facility,Outpatient,30 mL,mL,,145,123.25,41.557,145,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,69.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
DEXAMETHASONE 1 MG/ML ORAL DROP,,J8540,HCPCS,Facility,Inpatient,30 mL,mL,,145,123.25,41.557,145,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
LINEZOLID IN DEXTROSE 5% 600 MG/300 ML IV PGBK,,J2020,HCPCS,Facility,Both,300 mL,mL,,242,205.7,69.3572,242,Aetna,Commercial,222.64,92,,percent of total billed charges,,
LINEZOLID IN DEXTROSE 5% 600 MG/300 ML IV PGBK,,J2020,HCPCS,Facility,Outpatient,300 mL,mL,,242,205.7,69.3572,242,Aetna,Medicare Advantage,118.58,49,,percent of total billed charges,,
LINEZOLID IN DEXTROSE 5% 600 MG/300 ML IV PGBK,,J2020,HCPCS,Facility,Inpatient,300 mL,mL,,242,205.7,69.3572,242,Aetna,Medicare Advantage,,,,,Included in per diem rate,
LINEZOLID IN DEXTROSE 5% 600 MG/300 ML IV PGBK,,J2020,HCPCS,Facility,Both,300 mL,mL,,242,205.7,69.3572,242,Aetna,PPO,225.06,93,,percent of total billed charges,,
LINEZOLID IN DEXTROSE 5% 600 MG/300 ML IV PGBK,,J2020,HCPCS,Facility,Both,300 mL,mL,,242,205.7,69.3572,242,America's PPO,America's PPO,232.3926,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
LINEZOLID IN DEXTROSE 5% 600 MG/300 ML IV PGBK,,J2020,HCPCS,Facility,Both,300 mL,mL,,242,205.7,69.3572,242,BlueCross BlueShield Minnesota, Federal Employee Program,238.128,98.4,,percent of total billed charges,,
LINEZOLID IN DEXTROSE 5% 600 MG/300 ML IV PGBK,,J2020,HCPCS,Facility,Both,300 mL,mL,,242,205.7,69.3572,242,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,242,100,,percent of total billed charges,,
LINEZOLID IN DEXTROSE 5% 600 MG/300 ML IV PGBK,,J2020,HCPCS,Facility,Both,300 mL,mL,,242,205.7,69.3572,242,BlueCross BlueShield Minnesota,High Value Network Plan,217.8,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
LINEZOLID IN DEXTROSE 5% 600 MG/300 ML IV PGBK,,J2020,HCPCS,Facility,Outpatient,300 mL,mL,,242,205.7,69.3572,242,BlueCross BlueShield Minnesota,Medicare Advantage,118.58,49,,percent of total billed charges,,
LINEZOLID IN DEXTROSE 5% 600 MG/300 ML IV PGBK,,J2020,HCPCS,Facility,Inpatient,300 mL,mL,,242,205.7,69.3572,242,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
LINEZOLID IN DEXTROSE 5% 600 MG/300 ML IV PGBK,,J2020,HCPCS,Facility,Both,300 mL,mL,,242,205.7,69.3572,242,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,214.3394,88.57,,percent of total billed charges,,
LINEZOLID IN DEXTROSE 5% 600 MG/300 ML IV PGBK,,J2020,HCPCS,Facility,Both,300 mL,mL,,242,205.7,69.3572,242,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,69.3572,28.66,,percent of total billed charges,,
LINEZOLID IN DEXTROSE 5% 600 MG/300 ML IV PGBK,,J2020,HCPCS,Facility,Outpatient,300 mL,mL,,242,205.7,69.3572,242,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),118.58,49,,percent of total billed charges,,
LINEZOLID IN DEXTROSE 5% 600 MG/300 ML IV PGBK,,J2020,HCPCS,Facility,Inpatient,300 mL,mL,,242,205.7,69.3572,242,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
LINEZOLID IN DEXTROSE 5% 600 MG/300 ML IV PGBK,,J2020,HCPCS,Facility,Both,300 mL,mL,,242,205.7,69.3572,242,CorVel,Worker's Compensation,242,100,,percent of total billed charges,,
LINEZOLID IN DEXTROSE 5% 600 MG/300 ML IV PGBK,,J2020,HCPCS,Facility,Both,300 mL,mL,,242,205.7,69.3572,242,First Health Group Corporation,First Health Network,234.74,97,,percent of total billed charges,,
LINEZOLID IN DEXTROSE 5% 600 MG/300 ML IV PGBK,,J2020,HCPCS,Facility,Both,300 mL,mL,,242,205.7,69.3572,242,"Health Partners, Inc.",Commercial,228.932,94.6,,percent of total billed charges,,
LINEZOLID IN DEXTROSE 5% 600 MG/300 ML IV PGBK,,J2020,HCPCS,Facility,Outpatient,300 mL,mL,,242,205.7,69.3572,242,"Health Partners, Inc.",Medicare Advantage,118.58,49,,percent of total billed charges,,
LINEZOLID IN DEXTROSE 5% 600 MG/300 ML IV PGBK,,J2020,HCPCS,Facility,Inpatient,300 mL,mL,,242,205.7,69.3572,242,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LINEZOLID IN DEXTROSE 5% 600 MG/300 ML IV PGBK,,J2020,HCPCS,Facility,Both,300 mL,mL,,242,205.7,69.3572,242,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),145.2,60,,percent of total billed charges,,
LINEZOLID IN DEXTROSE 5% 600 MG/300 ML IV PGBK,,J2020,HCPCS,Facility,Both,300 mL,mL,,242,205.7,69.3572,242,"Health Partners, Inc.",State of Minnesota Advantage Program,197.23,81.5,,percent of total billed charges,,
LINEZOLID IN DEXTROSE 5% 600 MG/300 ML IV PGBK,,J2020,HCPCS,Facility,Both,300 mL,mL,,242,205.7,69.3572,242,"Health Partners, Inc.",State Public Programs,121,50,,percent of total billed charges,,
LINEZOLID IN DEXTROSE 5% 600 MG/300 ML IV PGBK,,J2020,HCPCS,Facility,Both,300 mL,mL,,242,205.7,69.3572,242,Humana Insurance Company,Commercial PPO,229.9,95,,percent of total billed charges,,
LINEZOLID IN DEXTROSE 5% 600 MG/300 ML IV PGBK,,J2020,HCPCS,Facility,Outpatient,300 mL,mL,,242,205.7,69.3572,242,Humana Insurance Company,Medicare PPO,118.58,49,,percent of total billed charges,,
LINEZOLID IN DEXTROSE 5% 600 MG/300 ML IV PGBK,,J2020,HCPCS,Facility,Inpatient,300 mL,mL,,242,205.7,69.3572,242,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
LINEZOLID IN DEXTROSE 5% 600 MG/300 ML IV PGBK,,J2020,HCPCS,Facility,Both,300 mL,mL,,242,205.7,69.3572,242,Medica,Individual & Family,239.822,99.1,,percent of total billed charges,,
LINEZOLID IN DEXTROSE 5% 600 MG/300 ML IV PGBK,,J2020,HCPCS,Facility,Outpatient,300 mL,mL,,242,205.7,69.3572,242,Medica,Medica Advantage Solution,120.516,49.8,,percent of total billed charges,,
LINEZOLID IN DEXTROSE 5% 600 MG/300 ML IV PGBK,,J2020,HCPCS,Facility,Inpatient,300 mL,mL,,242,205.7,69.3572,242,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
LINEZOLID IN DEXTROSE 5% 600 MG/300 ML IV PGBK,,J2020,HCPCS,Facility,Outpatient,300 mL,mL,,242,205.7,69.3572,242,Medica,Medical Assistance,107.932,44.6,,percent of total billed charges,,
LINEZOLID IN DEXTROSE 5% 600 MG/300 ML IV PGBK,,J2020,HCPCS,Facility,Inpatient,300 mL,mL,,242,205.7,69.3572,242,Medica,Medical Assistance,,,,,Included in per diem rate,
LINEZOLID IN DEXTROSE 5% 600 MG/300 ML IV PGBK,,J2020,HCPCS,Facility,Outpatient,300 mL,mL,,242,205.7,69.3572,242,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,120.516,49.8,,percent of total billed charges,,
LINEZOLID IN DEXTROSE 5% 600 MG/300 ML IV PGBK,,J2020,HCPCS,Facility,Inpatient,300 mL,mL,,242,205.7,69.3572,242,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
LINEZOLID IN DEXTROSE 5% 600 MG/300 ML IV PGBK,,J2020,HCPCS,Facility,Both,300 mL,mL,,242,205.7,69.3572,242,"Multiplan, Inc.","Multiplan, Inc.",227.48,94,,percent of total billed charges,,
LINEZOLID IN DEXTROSE 5% 600 MG/300 ML IV PGBK,,J2020,HCPCS,Facility,Outpatient,300 mL,mL,,242,205.7,69.3572,242,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,218.042,90.1,,percent of total billed charges,,
LINEZOLID IN DEXTROSE 5% 600 MG/300 ML IV PGBK,,J2020,HCPCS,Facility,Inpatient,300 mL,mL,,242,205.7,69.3572,242,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
LINEZOLID IN DEXTROSE 5% 600 MG/300 ML IV PGBK,,J2020,HCPCS,Facility,Both,300 mL,mL,,242,205.7,69.3572,242,"Preferred One Administrative Services, INC.",PPO,238.612,98.6,,percent of total billed charges,,
LINEZOLID IN DEXTROSE 5% 600 MG/300 ML IV PGBK,,J2020,HCPCS,Facility,Outpatient,300 mL,mL,,242,205.7,69.3572,242,PrimeWest Health,Minnesota Senior Health Options (MSHO),124.509,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
LINEZOLID IN DEXTROSE 5% 600 MG/300 ML IV PGBK,,J2020,HCPCS,Facility,Inpatient,300 mL,mL,,242,205.7,69.3572,242,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LINEZOLID IN DEXTROSE 5% 600 MG/300 ML IV PGBK,,J2020,HCPCS,Facility,Outpatient,300 mL,mL,,242,205.7,69.3572,242,PrimeWest Health,MinnesotaCare,124.2912,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
LINEZOLID IN DEXTROSE 5% 600 MG/300 ML IV PGBK,,J2020,HCPCS,Facility,Inpatient,300 mL,mL,,242,205.7,69.3572,242,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
LINEZOLID IN DEXTROSE 5% 600 MG/300 ML IV PGBK,,J2020,HCPCS,Facility,Both,300 mL,mL,,242,205.7,69.3572,242,Sanford Health Plan,Sanford Health Plan,222.64,92,,percent of total billed charges,,
LINEZOLID IN DEXTROSE 5% 600 MG/300 ML IV PGBK,,J2020,HCPCS,Facility,Outpatient,300 mL,mL,,242,205.7,69.3572,242,"UCare Health, Inc.",Individual & Family Plan,136.367,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
LINEZOLID IN DEXTROSE 5% 600 MG/300 ML IV PGBK,,J2020,HCPCS,Facility,Inpatient,300 mL,mL,,242,205.7,69.3572,242,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
LINEZOLID IN DEXTROSE 5% 600 MG/300 ML IV PGBK,,J2020,HCPCS,Facility,Outpatient,300 mL,mL,,242,205.7,69.3572,242,"UCare Health, Inc.",Medical Assistance,122.1374,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LINEZOLID IN DEXTROSE 5% 600 MG/300 ML IV PGBK,,J2020,HCPCS,Facility,Inpatient,300 mL,mL,,242,205.7,69.3572,242,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
LINEZOLID IN DEXTROSE 5% 600 MG/300 ML IV PGBK,,J2020,HCPCS,Facility,Outpatient,300 mL,mL,,242,205.7,69.3572,242,"UCare Health, Inc.",Medicare Advantage,122.1374,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LINEZOLID IN DEXTROSE 5% 600 MG/300 ML IV PGBK,,J2020,HCPCS,Facility,Inpatient,300 mL,mL,,242,205.7,69.3572,242,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LINEZOLID IN DEXTROSE 5% 600 MG/300 ML IV PGBK,,J2020,HCPCS,Facility,Outpatient,300 mL,mL,,242,205.7,69.3572,242,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),122.1374,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LINEZOLID IN DEXTROSE 5% 600 MG/300 ML IV PGBK,,J2020,HCPCS,Facility,Inpatient,300 mL,mL,,242,205.7,69.3572,242,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LINEZOLID IN DEXTROSE 5% 600 MG/300 ML IV PGBK,,J2020,HCPCS,Facility,Both,300 mL,mL,,242,205.7,69.3572,242,UnitedHealthcare,Individual & Family,227.48,94,,percent of total billed charges,,
LINEZOLID IN DEXTROSE 5% 600 MG/300 ML IV PGBK,,J2020,HCPCS,Facility,Outpatient,300 mL,mL,,242,205.7,69.3572,242,UnitedHealthcare,Medicare Advantage,118.58,49,,percent of total billed charges,,
LINEZOLID IN DEXTROSE 5% 600 MG/300 ML IV PGBK,,J2020,HCPCS,Facility,Inpatient,300 mL,mL,,242,205.7,69.3572,242,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
LINEZOLID IN DEXTROSE 5% 600 MG/300 ML IV PGBK,,J2020,HCPCS,Facility,Outpatient,300 mL,mL,,242,205.7,69.3572,242,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,116.16,48,,percent of total billed charges,,100% of DHS outpatient percentage
LINEZOLID IN DEXTROSE 5% 600 MG/300 ML IV PGBK,,J2020,HCPCS,Facility,Inpatient,300 mL,mL,,242,205.7,69.3572,242,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 1.5 GRAM/300 ML IV PGBK,,J3372,HCPCS,Facility,Both,300 mL,mL,,125,106.25,35.825,125,Aetna,Commercial,115,92,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.5 GRAM/300 ML IV PGBK,,J3372,HCPCS,Facility,Both,300 mL,mL,,125,106.25,35.825,125,Aetna,Commercial,115,92,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.5 GRAM/300 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,300 mL,mL,,125,106.25,35.825,125,Aetna,Medicare Advantage,61.25,49,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.5 GRAM/300 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,300 mL,mL,,125,106.25,35.825,125,Aetna,Medicare Advantage,61.25,49,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.5 GRAM/300 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,300 mL,mL,,125,106.25,35.825,125,Aetna,Medicare Advantage,,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 1.5 GRAM/300 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,300 mL,mL,,125,106.25,35.825,125,Aetna,Medicare Advantage,,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 1.5 GRAM/300 ML IV PGBK,,J3372,HCPCS,Facility,Both,300 mL,mL,,125,106.25,35.825,125,Aetna,PPO,116.25,93,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.5 GRAM/300 ML IV PGBK,,J3372,HCPCS,Facility,Both,300 mL,mL,,125,106.25,35.825,125,Aetna,PPO,116.25,93,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.5 GRAM/300 ML IV PGBK,,J3372,HCPCS,Facility,Both,300 mL,mL,,125,106.25,35.825,125,America's PPO,America's PPO,120.0375,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
VANCOMYCIN-DILUENT COMBO NO.1 1.5 GRAM/300 ML IV PGBK,,J3372,HCPCS,Facility,Both,300 mL,mL,,125,106.25,35.825,125,America's PPO,America's PPO,120.0375,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
VANCOMYCIN-DILUENT COMBO NO.1 1.5 GRAM/300 ML IV PGBK,,J3372,HCPCS,Facility,Both,300 mL,mL,,125,106.25,35.825,125,BlueCross BlueShield Minnesota, Federal Employee Program,123,98.4,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.5 GRAM/300 ML IV PGBK,,J3372,HCPCS,Facility,Both,300 mL,mL,,125,106.25,35.825,125,BlueCross BlueShield Minnesota, Federal Employee Program,123,98.4,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.5 GRAM/300 ML IV PGBK,,J3372,HCPCS,Facility,Both,300 mL,mL,,125,106.25,35.825,125,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,125,100,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.5 GRAM/300 ML IV PGBK,,J3372,HCPCS,Facility,Both,300 mL,mL,,125,106.25,35.825,125,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,125,100,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.5 GRAM/300 ML IV PGBK,,J3372,HCPCS,Facility,Both,300 mL,mL,,125,106.25,35.825,125,BlueCross BlueShield Minnesota,High Value Network Plan,112.5,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
VANCOMYCIN-DILUENT COMBO NO.1 1.5 GRAM/300 ML IV PGBK,,J3372,HCPCS,Facility,Both,300 mL,mL,,125,106.25,35.825,125,BlueCross BlueShield Minnesota,High Value Network Plan,112.5,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
VANCOMYCIN-DILUENT COMBO NO.1 1.5 GRAM/300 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,300 mL,mL,,125,106.25,35.825,125,BlueCross BlueShield Minnesota,Medicare Advantage,61.25,49,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.5 GRAM/300 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,300 mL,mL,,125,106.25,35.825,125,BlueCross BlueShield Minnesota,Medicare Advantage,61.25,49,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.5 GRAM/300 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,300 mL,mL,,125,106.25,35.825,125,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 1.5 GRAM/300 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,300 mL,mL,,125,106.25,35.825,125,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 1.5 GRAM/300 ML IV PGBK,,J3372,HCPCS,Facility,Both,300 mL,mL,,125,106.25,35.825,125,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,110.7125,88.57,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.5 GRAM/300 ML IV PGBK,,J3372,HCPCS,Facility,Both,300 mL,mL,,125,106.25,35.825,125,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,110.7125,88.57,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.5 GRAM/300 ML IV PGBK,,J3372,HCPCS,Facility,Both,300 mL,mL,,125,106.25,35.825,125,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,35.825,28.66,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.5 GRAM/300 ML IV PGBK,,J3372,HCPCS,Facility,Both,300 mL,mL,,125,106.25,35.825,125,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,35.825,28.66,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.5 GRAM/300 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,300 mL,mL,,125,106.25,35.825,125,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),61.25,49,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.5 GRAM/300 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,300 mL,mL,,125,106.25,35.825,125,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),61.25,49,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.5 GRAM/300 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,300 mL,mL,,125,106.25,35.825,125,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 1.5 GRAM/300 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,300 mL,mL,,125,106.25,35.825,125,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 1.5 GRAM/300 ML IV PGBK,,J3372,HCPCS,Facility,Both,300 mL,mL,,125,106.25,35.825,125,CorVel,Worker's Compensation,125,100,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.5 GRAM/300 ML IV PGBK,,J3372,HCPCS,Facility,Both,300 mL,mL,,125,106.25,35.825,125,CorVel,Worker's Compensation,125,100,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.5 GRAM/300 ML IV PGBK,,J3372,HCPCS,Facility,Both,300 mL,mL,,125,106.25,35.825,125,First Health Group Corporation,First Health Network,121.25,97,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.5 GRAM/300 ML IV PGBK,,J3372,HCPCS,Facility,Both,300 mL,mL,,125,106.25,35.825,125,First Health Group Corporation,First Health Network,121.25,97,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.5 GRAM/300 ML IV PGBK,,J3372,HCPCS,Facility,Both,300 mL,mL,,125,106.25,35.825,125,"Health Partners, Inc.",Commercial,118.25,94.6,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.5 GRAM/300 ML IV PGBK,,J3372,HCPCS,Facility,Both,300 mL,mL,,125,106.25,35.825,125,"Health Partners, Inc.",Commercial,118.25,94.6,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.5 GRAM/300 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,300 mL,mL,,125,106.25,35.825,125,"Health Partners, Inc.",Medicare Advantage,61.25,49,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.5 GRAM/300 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,300 mL,mL,,125,106.25,35.825,125,"Health Partners, Inc.",Medicare Advantage,61.25,49,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.5 GRAM/300 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,300 mL,mL,,125,106.25,35.825,125,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 1.5 GRAM/300 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,300 mL,mL,,125,106.25,35.825,125,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 1.5 GRAM/300 ML IV PGBK,,J3372,HCPCS,Facility,Both,300 mL,mL,,125,106.25,35.825,125,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),75,60,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.5 GRAM/300 ML IV PGBK,,J3372,HCPCS,Facility,Both,300 mL,mL,,125,106.25,35.825,125,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),75,60,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.5 GRAM/300 ML IV PGBK,,J3372,HCPCS,Facility,Both,300 mL,mL,,125,106.25,35.825,125,"Health Partners, Inc.",State of Minnesota Advantage Program,101.875,81.5,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.5 GRAM/300 ML IV PGBK,,J3372,HCPCS,Facility,Both,300 mL,mL,,125,106.25,35.825,125,"Health Partners, Inc.",State of Minnesota Advantage Program,101.875,81.5,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.5 GRAM/300 ML IV PGBK,,J3372,HCPCS,Facility,Both,300 mL,mL,,125,106.25,35.825,125,"Health Partners, Inc.",State Public Programs,62.5,50,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.5 GRAM/300 ML IV PGBK,,J3372,HCPCS,Facility,Both,300 mL,mL,,125,106.25,35.825,125,"Health Partners, Inc.",State Public Programs,62.5,50,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.5 GRAM/300 ML IV PGBK,,J3372,HCPCS,Facility,Both,300 mL,mL,,125,106.25,35.825,125,Humana Insurance Company,Commercial PPO,118.75,95,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.5 GRAM/300 ML IV PGBK,,J3372,HCPCS,Facility,Both,300 mL,mL,,125,106.25,35.825,125,Humana Insurance Company,Commercial PPO,118.75,95,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.5 GRAM/300 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,300 mL,mL,,125,106.25,35.825,125,Humana Insurance Company,Medicare PPO,61.25,49,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.5 GRAM/300 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,300 mL,mL,,125,106.25,35.825,125,Humana Insurance Company,Medicare PPO,61.25,49,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.5 GRAM/300 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,300 mL,mL,,125,106.25,35.825,125,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 1.5 GRAM/300 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,300 mL,mL,,125,106.25,35.825,125,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 1.5 GRAM/300 ML IV PGBK,,J3372,HCPCS,Facility,Both,300 mL,mL,,125,106.25,35.825,125,Medica,Individual & Family,123.875,99.1,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.5 GRAM/300 ML IV PGBK,,J3372,HCPCS,Facility,Both,300 mL,mL,,125,106.25,35.825,125,Medica,Individual & Family,123.875,99.1,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.5 GRAM/300 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,300 mL,mL,,125,106.25,35.825,125,Medica,Medica Advantage Solution,62.25,49.8,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.5 GRAM/300 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,300 mL,mL,,125,106.25,35.825,125,Medica,Medica Advantage Solution,62.25,49.8,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.5 GRAM/300 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,300 mL,mL,,125,106.25,35.825,125,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 1.5 GRAM/300 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,300 mL,mL,,125,106.25,35.825,125,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 1.5 GRAM/300 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,300 mL,mL,,125,106.25,35.825,125,Medica,Medical Assistance,55.75,44.6,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.5 GRAM/300 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,300 mL,mL,,125,106.25,35.825,125,Medica,Medical Assistance,55.75,44.6,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.5 GRAM/300 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,300 mL,mL,,125,106.25,35.825,125,Medica,Medical Assistance,,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 1.5 GRAM/300 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,300 mL,mL,,125,106.25,35.825,125,Medica,Medical Assistance,,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 1.5 GRAM/300 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,300 mL,mL,,125,106.25,35.825,125,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,62.25,49.8,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.5 GRAM/300 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,300 mL,mL,,125,106.25,35.825,125,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,62.25,49.8,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.5 GRAM/300 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,300 mL,mL,,125,106.25,35.825,125,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 1.5 GRAM/300 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,300 mL,mL,,125,106.25,35.825,125,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 1.5 GRAM/300 ML IV PGBK,,J3372,HCPCS,Facility,Both,300 mL,mL,,125,106.25,35.825,125,"Multiplan, Inc.","Multiplan, Inc.",117.5,94,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.5 GRAM/300 ML IV PGBK,,J3372,HCPCS,Facility,Both,300 mL,mL,,125,106.25,35.825,125,"Multiplan, Inc.","Multiplan, Inc.",117.5,94,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.5 GRAM/300 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,300 mL,mL,,125,106.25,35.825,125,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,112.625,90.1,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.5 GRAM/300 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,300 mL,mL,,125,106.25,35.825,125,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,112.625,90.1,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.5 GRAM/300 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,300 mL,mL,,125,106.25,35.825,125,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
VANCOMYCIN-DILUENT COMBO NO.1 1.5 GRAM/300 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,300 mL,mL,,125,106.25,35.825,125,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
VANCOMYCIN-DILUENT COMBO NO.1 1.5 GRAM/300 ML IV PGBK,,J3372,HCPCS,Facility,Both,300 mL,mL,,125,106.25,35.825,125,"Preferred One Administrative Services, INC.",PPO,123.25,98.6,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.5 GRAM/300 ML IV PGBK,,J3372,HCPCS,Facility,Both,300 mL,mL,,125,106.25,35.825,125,"Preferred One Administrative Services, INC.",PPO,123.25,98.6,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.5 GRAM/300 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,300 mL,mL,,125,106.25,35.825,125,PrimeWest Health,Minnesota Senior Health Options (MSHO),64.3125,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
VANCOMYCIN-DILUENT COMBO NO.1 1.5 GRAM/300 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,300 mL,mL,,125,106.25,35.825,125,PrimeWest Health,Minnesota Senior Health Options (MSHO),64.3125,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
VANCOMYCIN-DILUENT COMBO NO.1 1.5 GRAM/300 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,300 mL,mL,,125,106.25,35.825,125,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 1.5 GRAM/300 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,300 mL,mL,,125,106.25,35.825,125,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 1.5 GRAM/300 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,300 mL,mL,,125,106.25,35.825,125,PrimeWest Health,MinnesotaCare,64.2,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
VANCOMYCIN-DILUENT COMBO NO.1 1.5 GRAM/300 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,300 mL,mL,,125,106.25,35.825,125,PrimeWest Health,MinnesotaCare,64.2,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
VANCOMYCIN-DILUENT COMBO NO.1 1.5 GRAM/300 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,300 mL,mL,,125,106.25,35.825,125,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 1.5 GRAM/300 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,300 mL,mL,,125,106.25,35.825,125,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 1.5 GRAM/300 ML IV PGBK,,J3372,HCPCS,Facility,Both,300 mL,mL,,125,106.25,35.825,125,Sanford Health Plan,Sanford Health Plan,115,92,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.5 GRAM/300 ML IV PGBK,,J3372,HCPCS,Facility,Both,300 mL,mL,,125,106.25,35.825,125,Sanford Health Plan,Sanford Health Plan,115,92,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.5 GRAM/300 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,300 mL,mL,,125,106.25,35.825,125,"UCare Health, Inc.",Individual & Family Plan,70.4375,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
VANCOMYCIN-DILUENT COMBO NO.1 1.5 GRAM/300 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,300 mL,mL,,125,106.25,35.825,125,"UCare Health, Inc.",Individual & Family Plan,70.4375,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
VANCOMYCIN-DILUENT COMBO NO.1 1.5 GRAM/300 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,300 mL,mL,,125,106.25,35.825,125,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 1.5 GRAM/300 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,300 mL,mL,,125,106.25,35.825,125,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 1.5 GRAM/300 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,300 mL,mL,,125,106.25,35.825,125,"UCare Health, Inc.",Medical Assistance,63.0875,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
VANCOMYCIN-DILUENT COMBO NO.1 1.5 GRAM/300 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,300 mL,mL,,125,106.25,35.825,125,"UCare Health, Inc.",Medical Assistance,63.0875,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
VANCOMYCIN-DILUENT COMBO NO.1 1.5 GRAM/300 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,300 mL,mL,,125,106.25,35.825,125,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 1.5 GRAM/300 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,300 mL,mL,,125,106.25,35.825,125,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 1.5 GRAM/300 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,300 mL,mL,,125,106.25,35.825,125,"UCare Health, Inc.",Medicare Advantage,63.0875,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
VANCOMYCIN-DILUENT COMBO NO.1 1.5 GRAM/300 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,300 mL,mL,,125,106.25,35.825,125,"UCare Health, Inc.",Medicare Advantage,63.0875,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
VANCOMYCIN-DILUENT COMBO NO.1 1.5 GRAM/300 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,300 mL,mL,,125,106.25,35.825,125,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 1.5 GRAM/300 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,300 mL,mL,,125,106.25,35.825,125,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 1.5 GRAM/300 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,300 mL,mL,,125,106.25,35.825,125,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),63.0875,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
VANCOMYCIN-DILUENT COMBO NO.1 1.5 GRAM/300 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,300 mL,mL,,125,106.25,35.825,125,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),63.0875,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
VANCOMYCIN-DILUENT COMBO NO.1 1.5 GRAM/300 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,300 mL,mL,,125,106.25,35.825,125,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 1.5 GRAM/300 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,300 mL,mL,,125,106.25,35.825,125,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 1.5 GRAM/300 ML IV PGBK,,J3372,HCPCS,Facility,Both,300 mL,mL,,125,106.25,35.825,125,UnitedHealthcare,Individual & Family,117.5,94,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.5 GRAM/300 ML IV PGBK,,J3372,HCPCS,Facility,Both,300 mL,mL,,125,106.25,35.825,125,UnitedHealthcare,Individual & Family,117.5,94,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.5 GRAM/300 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,300 mL,mL,,125,106.25,35.825,125,UnitedHealthcare,Medicare Advantage,61.25,49,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.5 GRAM/300 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,300 mL,mL,,125,106.25,35.825,125,UnitedHealthcare,Medicare Advantage,61.25,49,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.5 GRAM/300 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,300 mL,mL,,125,106.25,35.825,125,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 1.5 GRAM/300 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,300 mL,mL,,125,106.25,35.825,125,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 1.5 GRAM/300 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,300 mL,mL,,125,106.25,35.825,125,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,60,48,,percent of total billed charges,,100% of DHS outpatient percentage
VANCOMYCIN-DILUENT COMBO NO.1 1.5 GRAM/300 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,300 mL,mL,,125,106.25,35.825,125,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,60,48,,percent of total billed charges,,100% of DHS outpatient percentage
VANCOMYCIN-DILUENT COMBO NO.1 1.5 GRAM/300 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,300 mL,mL,,125,106.25,35.825,125,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 1.5 GRAM/300 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,300 mL,mL,,125,106.25,35.825,125,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Both,3000 mL,mL,,95,80.75,27.227,95,Aetna,Commercial,87.4,92,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Outpatient,3000 mL,mL,,95,80.75,27.227,95,Aetna,Medicare Advantage,46.55,49,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Inpatient,3000 mL,mL,,95,80.75,27.227,95,Aetna,Medicare Advantage,,,,,Included in per diem rate,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Both,3000 mL,mL,,95,80.75,27.227,95,Aetna,PPO,88.35,93,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Both,3000 mL,mL,,95,80.75,27.227,95,America's PPO,America's PPO,91.2285,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Both,3000 mL,mL,,95,80.75,27.227,95,BlueCross BlueShield Minnesota, Federal Employee Program,93.48,98.4,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Both,3000 mL,mL,,95,80.75,27.227,95,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,95,100,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Both,3000 mL,mL,,95,80.75,27.227,95,BlueCross BlueShield Minnesota,High Value Network Plan,85.5,90,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Outpatient,3000 mL,mL,,95,80.75,27.227,95,BlueCross BlueShield Minnesota,Medicare Advantage,46.55,49,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Inpatient,3000 mL,mL,,95,80.75,27.227,95,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Both,3000 mL,mL,,95,80.75,27.227,95,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,84.1415,88.57,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Both,3000 mL,mL,,95,80.75,27.227,95,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,27.227,28.66,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Outpatient,3000 mL,mL,,95,80.75,27.227,95,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),46.55,49,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Inpatient,3000 mL,mL,,95,80.75,27.227,95,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Both,3000 mL,mL,,95,80.75,27.227,95,CorVel,Worker's Compensation,95,100,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Both,3000 mL,mL,,95,80.75,27.227,95,First Health Group Corporation,First Health Network,92.15,97,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Both,3000 mL,mL,,95,80.75,27.227,95,"Health Partners, Inc.",Commercial,89.87,94.6,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Outpatient,3000 mL,mL,,95,80.75,27.227,95,"Health Partners, Inc.",Medicare Advantage,46.55,49,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Inpatient,3000 mL,mL,,95,80.75,27.227,95,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Both,3000 mL,mL,,95,80.75,27.227,95,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),57,60,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Both,3000 mL,mL,,95,80.75,27.227,95,"Health Partners, Inc.",State of Minnesota Advantage Program,77.425,81.5,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Both,3000 mL,mL,,95,80.75,27.227,95,"Health Partners, Inc.",State Public Programs,47.5,50,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Both,3000 mL,mL,,95,80.75,27.227,95,Humana Insurance Company,Commercial PPO,90.25,95,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Outpatient,3000 mL,mL,,95,80.75,27.227,95,Humana Insurance Company,Medicare PPO,46.55,49,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Inpatient,3000 mL,mL,,95,80.75,27.227,95,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Both,3000 mL,mL,,95,80.75,27.227,95,Medica,Individual & Family,94.145,99.1,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Outpatient,3000 mL,mL,,95,80.75,27.227,95,Medica,Medica Advantage Solution,47.31,49.8,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Inpatient,3000 mL,mL,,95,80.75,27.227,95,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Outpatient,3000 mL,mL,,95,80.75,27.227,95,Medica,Medical Assistance,42.37,44.6,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Inpatient,3000 mL,mL,,95,80.75,27.227,95,Medica,Medical Assistance,,,,,Included in per diem rate,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Outpatient,3000 mL,mL,,95,80.75,27.227,95,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,47.31,49.8,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Inpatient,3000 mL,mL,,95,80.75,27.227,95,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Both,3000 mL,mL,,95,80.75,27.227,95,"Multiplan, Inc.","Multiplan, Inc.",89.3,94,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Outpatient,3000 mL,mL,,95,80.75,27.227,95,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,85.595,90.1,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Inpatient,3000 mL,mL,,95,80.75,27.227,95,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Both,3000 mL,mL,,95,80.75,27.227,95,"Preferred One Administrative Services, INC.",PPO,93.67,98.6,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Outpatient,3000 mL,mL,,95,80.75,27.227,95,PrimeWest Health,Minnesota Senior Health Options (MSHO),48.8775,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Inpatient,3000 mL,mL,,95,80.75,27.227,95,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Outpatient,3000 mL,mL,,95,80.75,27.227,95,PrimeWest Health,MinnesotaCare,48.792,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Inpatient,3000 mL,mL,,95,80.75,27.227,95,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Both,3000 mL,mL,,95,80.75,27.227,95,Sanford Health Plan,Sanford Health Plan,87.4,92,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Outpatient,3000 mL,mL,,95,80.75,27.227,95,"UCare Health, Inc.",Individual & Family Plan,53.5325,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Inpatient,3000 mL,mL,,95,80.75,27.227,95,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Outpatient,3000 mL,mL,,95,80.75,27.227,95,"UCare Health, Inc.",Medical Assistance,47.9465,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Inpatient,3000 mL,mL,,95,80.75,27.227,95,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Outpatient,3000 mL,mL,,95,80.75,27.227,95,"UCare Health, Inc.",Medicare Advantage,47.9465,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Inpatient,3000 mL,mL,,95,80.75,27.227,95,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Outpatient,3000 mL,mL,,95,80.75,27.227,95,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),47.9465,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Inpatient,3000 mL,mL,,95,80.75,27.227,95,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Both,3000 mL,mL,,95,80.75,27.227,95,UnitedHealthcare,Individual & Family,89.3,94,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Outpatient,3000 mL,mL,,95,80.75,27.227,95,UnitedHealthcare,Medicare Advantage,46.55,49,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Inpatient,3000 mL,mL,,95,80.75,27.227,95,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Outpatient,3000 mL,mL,,95,80.75,27.227,95,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,45.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Inpatient,3000 mL,mL,,95,80.75,27.227,95,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Both,3000 mL,mL,,72,61.2,20.6352,72,Aetna,Commercial,66.24,92,,percent of total billed charges,,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Outpatient,3000 mL,mL,,72,61.2,20.6352,72,Aetna,Medicare Advantage,35.28,49,,percent of total billed charges,,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Inpatient,3000 mL,mL,,72,61.2,20.6352,72,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Both,3000 mL,mL,,72,61.2,20.6352,72,Aetna,PPO,66.96,93,,percent of total billed charges,,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Both,3000 mL,mL,,72,61.2,20.6352,72,America's PPO,America's PPO,69.1416,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Both,3000 mL,mL,,72,61.2,20.6352,72,BlueCross BlueShield Minnesota, Federal Employee Program,70.848,98.4,,percent of total billed charges,,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Both,3000 mL,mL,,72,61.2,20.6352,72,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,72,100,,percent of total billed charges,,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Both,3000 mL,mL,,72,61.2,20.6352,72,BlueCross BlueShield Minnesota,High Value Network Plan,64.8,90,,percent of total billed charges,,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Outpatient,3000 mL,mL,,72,61.2,20.6352,72,BlueCross BlueShield Minnesota,Medicare Advantage,35.28,49,,percent of total billed charges,,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Inpatient,3000 mL,mL,,72,61.2,20.6352,72,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Both,3000 mL,mL,,72,61.2,20.6352,72,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,63.7704,88.57,,percent of total billed charges,,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Both,3000 mL,mL,,72,61.2,20.6352,72,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,20.6352,28.66,,percent of total billed charges,,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Outpatient,3000 mL,mL,,72,61.2,20.6352,72,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),35.28,49,,percent of total billed charges,,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Inpatient,3000 mL,mL,,72,61.2,20.6352,72,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Both,3000 mL,mL,,72,61.2,20.6352,72,CorVel,Worker's Compensation,72,100,,percent of total billed charges,,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Both,3000 mL,mL,,72,61.2,20.6352,72,First Health Group Corporation,First Health Network,69.84,97,,percent of total billed charges,,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Both,3000 mL,mL,,72,61.2,20.6352,72,"Health Partners, Inc.",Commercial,68.112,94.6,,percent of total billed charges,,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Outpatient,3000 mL,mL,,72,61.2,20.6352,72,"Health Partners, Inc.",Medicare Advantage,35.28,49,,percent of total billed charges,,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Inpatient,3000 mL,mL,,72,61.2,20.6352,72,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Both,3000 mL,mL,,72,61.2,20.6352,72,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),43.2,60,,percent of total billed charges,,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Both,3000 mL,mL,,72,61.2,20.6352,72,"Health Partners, Inc.",State of Minnesota Advantage Program,58.68,81.5,,percent of total billed charges,,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Both,3000 mL,mL,,72,61.2,20.6352,72,"Health Partners, Inc.",State Public Programs,36,50,,percent of total billed charges,,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Both,3000 mL,mL,,72,61.2,20.6352,72,Humana Insurance Company,Commercial PPO,68.4,95,,percent of total billed charges,,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Outpatient,3000 mL,mL,,72,61.2,20.6352,72,Humana Insurance Company,Medicare PPO,35.28,49,,percent of total billed charges,,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Inpatient,3000 mL,mL,,72,61.2,20.6352,72,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Both,3000 mL,mL,,72,61.2,20.6352,72,Medica,Individual & Family,71.352,99.1,,percent of total billed charges,,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Outpatient,3000 mL,mL,,72,61.2,20.6352,72,Medica,Medica Advantage Solution,35.856,49.8,,percent of total billed charges,,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Inpatient,3000 mL,mL,,72,61.2,20.6352,72,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Outpatient,3000 mL,mL,,72,61.2,20.6352,72,Medica,Medical Assistance,32.112,44.6,,percent of total billed charges,,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Inpatient,3000 mL,mL,,72,61.2,20.6352,72,Medica,Medical Assistance,,,,,Included in per diem rate,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Outpatient,3000 mL,mL,,72,61.2,20.6352,72,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,35.856,49.8,,percent of total billed charges,,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Inpatient,3000 mL,mL,,72,61.2,20.6352,72,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Both,3000 mL,mL,,72,61.2,20.6352,72,"Multiplan, Inc.","Multiplan, Inc.",67.68,94,,percent of total billed charges,,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Outpatient,3000 mL,mL,,72,61.2,20.6352,72,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,64.872,90.1,,percent of total billed charges,,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Inpatient,3000 mL,mL,,72,61.2,20.6352,72,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Both,3000 mL,mL,,72,61.2,20.6352,72,"Preferred One Administrative Services, INC.",PPO,70.992,98.6,,percent of total billed charges,,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Outpatient,3000 mL,mL,,72,61.2,20.6352,72,PrimeWest Health,Minnesota Senior Health Options (MSHO),37.044,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Inpatient,3000 mL,mL,,72,61.2,20.6352,72,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Outpatient,3000 mL,mL,,72,61.2,20.6352,72,PrimeWest Health,MinnesotaCare,36.9792,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Inpatient,3000 mL,mL,,72,61.2,20.6352,72,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Both,3000 mL,mL,,72,61.2,20.6352,72,Sanford Health Plan,Sanford Health Plan,66.24,92,,percent of total billed charges,,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Outpatient,3000 mL,mL,,72,61.2,20.6352,72,"UCare Health, Inc.",Individual & Family Plan,40.572,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Inpatient,3000 mL,mL,,72,61.2,20.6352,72,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Outpatient,3000 mL,mL,,72,61.2,20.6352,72,"UCare Health, Inc.",Medical Assistance,36.3384,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Inpatient,3000 mL,mL,,72,61.2,20.6352,72,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Outpatient,3000 mL,mL,,72,61.2,20.6352,72,"UCare Health, Inc.",Medicare Advantage,36.3384,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Inpatient,3000 mL,mL,,72,61.2,20.6352,72,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Outpatient,3000 mL,mL,,72,61.2,20.6352,72,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),36.3384,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Inpatient,3000 mL,mL,,72,61.2,20.6352,72,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Both,3000 mL,mL,,72,61.2,20.6352,72,UnitedHealthcare,Individual & Family,67.68,94,,percent of total billed charges,,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Outpatient,3000 mL,mL,,72,61.2,20.6352,72,UnitedHealthcare,Medicare Advantage,35.28,49,,percent of total billed charges,,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Inpatient,3000 mL,mL,,72,61.2,20.6352,72,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Outpatient,3000 mL,mL,,72,61.2,20.6352,72,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,34.56,48,,percent of total billed charges,,100% of DHS outpatient percentage
"WATER FOR IRRIGATION, STERILE IR SOLN",,9730,LOCAL,Facility,Inpatient,3000 mL,mL,,72,61.2,20.6352,72,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
ALUMINUM CHLORIDE 20 % TOP SOLN,,5786,LOCAL,Facility,Both,35 mL,mL,,49,41.65,14.0434,49,Aetna,Commercial,45.08,92,,percent of total billed charges,,
ALUMINUM CHLORIDE 20 % TOP SOLN,,5786,LOCAL,Facility,Outpatient,35 mL,mL,,49,41.65,14.0434,49,Aetna,Medicare Advantage,24.01,49,,percent of total billed charges,,
ALUMINUM CHLORIDE 20 % TOP SOLN,,5786,LOCAL,Facility,Inpatient,35 mL,mL,,49,41.65,14.0434,49,Aetna,Medicare Advantage,,,,,Included in per diem rate,
ALUMINUM CHLORIDE 20 % TOP SOLN,,5786,LOCAL,Facility,Both,35 mL,mL,,49,41.65,14.0434,49,Aetna,PPO,45.57,93,,percent of total billed charges,,
ALUMINUM CHLORIDE 20 % TOP SOLN,,5786,LOCAL,Facility,Both,35 mL,mL,,49,41.65,14.0434,49,America's PPO,America's PPO,47.0547,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
ALUMINUM CHLORIDE 20 % TOP SOLN,,5786,LOCAL,Facility,Both,35 mL,mL,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota, Federal Employee Program,48.216,98.4,,percent of total billed charges,,
ALUMINUM CHLORIDE 20 % TOP SOLN,,5786,LOCAL,Facility,Both,35 mL,mL,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,49,100,,percent of total billed charges,,
ALUMINUM CHLORIDE 20 % TOP SOLN,,5786,LOCAL,Facility,Both,35 mL,mL,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,High Value Network Plan,44.1,90,,percent of total billed charges,,
ALUMINUM CHLORIDE 20 % TOP SOLN,,5786,LOCAL,Facility,Outpatient,35 mL,mL,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Medicare Advantage,24.01,49,,percent of total billed charges,,
ALUMINUM CHLORIDE 20 % TOP SOLN,,5786,LOCAL,Facility,Inpatient,35 mL,mL,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
ALUMINUM CHLORIDE 20 % TOP SOLN,,5786,LOCAL,Facility,Both,35 mL,mL,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,43.3993,88.57,,percent of total billed charges,,
ALUMINUM CHLORIDE 20 % TOP SOLN,,5786,LOCAL,Facility,Both,35 mL,mL,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,14.0434,28.66,,percent of total billed charges,,
ALUMINUM CHLORIDE 20 % TOP SOLN,,5786,LOCAL,Facility,Outpatient,35 mL,mL,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),24.01,49,,percent of total billed charges,,
ALUMINUM CHLORIDE 20 % TOP SOLN,,5786,LOCAL,Facility,Inpatient,35 mL,mL,,49,41.65,14.0434,49,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
ALUMINUM CHLORIDE 20 % TOP SOLN,,5786,LOCAL,Facility,Both,35 mL,mL,,49,41.65,14.0434,49,CorVel,Worker's Compensation,49,100,,percent of total billed charges,,
ALUMINUM CHLORIDE 20 % TOP SOLN,,5786,LOCAL,Facility,Both,35 mL,mL,,49,41.65,14.0434,49,First Health Group Corporation,First Health Network,47.53,97,,percent of total billed charges,,
ALUMINUM CHLORIDE 20 % TOP SOLN,,5786,LOCAL,Facility,Both,35 mL,mL,,49,41.65,14.0434,49,"Health Partners, Inc.",Commercial,46.354,94.6,,percent of total billed charges,,
ALUMINUM CHLORIDE 20 % TOP SOLN,,5786,LOCAL,Facility,Outpatient,35 mL,mL,,49,41.65,14.0434,49,"Health Partners, Inc.",Medicare Advantage,24.01,49,,percent of total billed charges,,
ALUMINUM CHLORIDE 20 % TOP SOLN,,5786,LOCAL,Facility,Inpatient,35 mL,mL,,49,41.65,14.0434,49,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ALUMINUM CHLORIDE 20 % TOP SOLN,,5786,LOCAL,Facility,Both,35 mL,mL,,49,41.65,14.0434,49,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),29.4,60,,percent of total billed charges,,
ALUMINUM CHLORIDE 20 % TOP SOLN,,5786,LOCAL,Facility,Both,35 mL,mL,,49,41.65,14.0434,49,"Health Partners, Inc.",State of Minnesota Advantage Program,39.935,81.5,,percent of total billed charges,,
ALUMINUM CHLORIDE 20 % TOP SOLN,,5786,LOCAL,Facility,Both,35 mL,mL,,49,41.65,14.0434,49,"Health Partners, Inc.",State Public Programs,24.5,50,,percent of total billed charges,,
ALUMINUM CHLORIDE 20 % TOP SOLN,,5786,LOCAL,Facility,Both,35 mL,mL,,49,41.65,14.0434,49,Humana Insurance Company,Commercial PPO,46.55,95,,percent of total billed charges,,
ALUMINUM CHLORIDE 20 % TOP SOLN,,5786,LOCAL,Facility,Outpatient,35 mL,mL,,49,41.65,14.0434,49,Humana Insurance Company,Medicare PPO,24.01,49,,percent of total billed charges,,
ALUMINUM CHLORIDE 20 % TOP SOLN,,5786,LOCAL,Facility,Inpatient,35 mL,mL,,49,41.65,14.0434,49,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
ALUMINUM CHLORIDE 20 % TOP SOLN,,5786,LOCAL,Facility,Both,35 mL,mL,,49,41.65,14.0434,49,Medica,Individual & Family,48.559,99.1,,percent of total billed charges,,
ALUMINUM CHLORIDE 20 % TOP SOLN,,5786,LOCAL,Facility,Outpatient,35 mL,mL,,49,41.65,14.0434,49,Medica,Medica Advantage Solution,24.402,49.8,,percent of total billed charges,,
ALUMINUM CHLORIDE 20 % TOP SOLN,,5786,LOCAL,Facility,Inpatient,35 mL,mL,,49,41.65,14.0434,49,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
ALUMINUM CHLORIDE 20 % TOP SOLN,,5786,LOCAL,Facility,Outpatient,35 mL,mL,,49,41.65,14.0434,49,Medica,Medical Assistance,21.854,44.6,,percent of total billed charges,,
ALUMINUM CHLORIDE 20 % TOP SOLN,,5786,LOCAL,Facility,Inpatient,35 mL,mL,,49,41.65,14.0434,49,Medica,Medical Assistance,,,,,Included in per diem rate,
ALUMINUM CHLORIDE 20 % TOP SOLN,,5786,LOCAL,Facility,Outpatient,35 mL,mL,,49,41.65,14.0434,49,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,24.402,49.8,,percent of total billed charges,,
ALUMINUM CHLORIDE 20 % TOP SOLN,,5786,LOCAL,Facility,Inpatient,35 mL,mL,,49,41.65,14.0434,49,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
ALUMINUM CHLORIDE 20 % TOP SOLN,,5786,LOCAL,Facility,Both,35 mL,mL,,49,41.65,14.0434,49,"Multiplan, Inc.","Multiplan, Inc.",46.06,94,,percent of total billed charges,,
ALUMINUM CHLORIDE 20 % TOP SOLN,,5786,LOCAL,Facility,Outpatient,35 mL,mL,,49,41.65,14.0434,49,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,44.149,90.1,,percent of total billed charges,,
ALUMINUM CHLORIDE 20 % TOP SOLN,,5786,LOCAL,Facility,Inpatient,35 mL,mL,,49,41.65,14.0434,49,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
ALUMINUM CHLORIDE 20 % TOP SOLN,,5786,LOCAL,Facility,Both,35 mL,mL,,49,41.65,14.0434,49,"Preferred One Administrative Services, INC.",PPO,48.314,98.6,,percent of total billed charges,,
ALUMINUM CHLORIDE 20 % TOP SOLN,,5786,LOCAL,Facility,Outpatient,35 mL,mL,,49,41.65,14.0434,49,PrimeWest Health,Minnesota Senior Health Options (MSHO),25.2105,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
ALUMINUM CHLORIDE 20 % TOP SOLN,,5786,LOCAL,Facility,Inpatient,35 mL,mL,,49,41.65,14.0434,49,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ALUMINUM CHLORIDE 20 % TOP SOLN,,5786,LOCAL,Facility,Outpatient,35 mL,mL,,49,41.65,14.0434,49,PrimeWest Health,MinnesotaCare,25.1664,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
ALUMINUM CHLORIDE 20 % TOP SOLN,,5786,LOCAL,Facility,Inpatient,35 mL,mL,,49,41.65,14.0434,49,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
ALUMINUM CHLORIDE 20 % TOP SOLN,,5786,LOCAL,Facility,Both,35 mL,mL,,49,41.65,14.0434,49,Sanford Health Plan,Sanford Health Plan,45.08,92,,percent of total billed charges,,
ALUMINUM CHLORIDE 20 % TOP SOLN,,5786,LOCAL,Facility,Outpatient,35 mL,mL,,49,41.65,14.0434,49,"UCare Health, Inc.",Individual & Family Plan,27.6115,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
ALUMINUM CHLORIDE 20 % TOP SOLN,,5786,LOCAL,Facility,Inpatient,35 mL,mL,,49,41.65,14.0434,49,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
ALUMINUM CHLORIDE 20 % TOP SOLN,,5786,LOCAL,Facility,Outpatient,35 mL,mL,,49,41.65,14.0434,49,"UCare Health, Inc.",Medical Assistance,24.7303,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ALUMINUM CHLORIDE 20 % TOP SOLN,,5786,LOCAL,Facility,Inpatient,35 mL,mL,,49,41.65,14.0434,49,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
ALUMINUM CHLORIDE 20 % TOP SOLN,,5786,LOCAL,Facility,Outpatient,35 mL,mL,,49,41.65,14.0434,49,"UCare Health, Inc.",Medicare Advantage,24.7303,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ALUMINUM CHLORIDE 20 % TOP SOLN,,5786,LOCAL,Facility,Inpatient,35 mL,mL,,49,41.65,14.0434,49,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ALUMINUM CHLORIDE 20 % TOP SOLN,,5786,LOCAL,Facility,Outpatient,35 mL,mL,,49,41.65,14.0434,49,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),24.7303,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ALUMINUM CHLORIDE 20 % TOP SOLN,,5786,LOCAL,Facility,Inpatient,35 mL,mL,,49,41.65,14.0434,49,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ALUMINUM CHLORIDE 20 % TOP SOLN,,5786,LOCAL,Facility,Both,35 mL,mL,,49,41.65,14.0434,49,UnitedHealthcare,Individual & Family,46.06,94,,percent of total billed charges,,
ALUMINUM CHLORIDE 20 % TOP SOLN,,5786,LOCAL,Facility,Outpatient,35 mL,mL,,49,41.65,14.0434,49,UnitedHealthcare,Medicare Advantage,24.01,49,,percent of total billed charges,,
ALUMINUM CHLORIDE 20 % TOP SOLN,,5786,LOCAL,Facility,Inpatient,35 mL,mL,,49,41.65,14.0434,49,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
ALUMINUM CHLORIDE 20 % TOP SOLN,,5786,LOCAL,Facility,Outpatient,35 mL,mL,,49,41.65,14.0434,49,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,23.52,48,,percent of total billed charges,,100% of DHS outpatient percentage
ALUMINUM CHLORIDE 20 % TOP SOLN,,5786,LOCAL,Facility,Inpatient,35 mL,mL,,49,41.65,14.0434,49,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
FLUCONAZOLE 10 MG/ML ORAL SUSR,,11331,LOCAL,Facility,Both,35 mL,mL,,162,137.7,46.4292,162,Aetna,Commercial,149.04,92,,percent of total billed charges,,
FLUCONAZOLE 10 MG/ML ORAL SUSR,,11331,LOCAL,Facility,Both,35 mL,mL,,162,137.7,46.4292,162,Aetna,Commercial,149.04,92,,percent of total billed charges,,
FLUCONAZOLE 10 MG/ML ORAL SUSR,,11331,LOCAL,Facility,Outpatient,35 mL,mL,,162,137.7,46.4292,162,Aetna,Medicare Advantage,79.38,49,,percent of total billed charges,,
FLUCONAZOLE 10 MG/ML ORAL SUSR,,11331,LOCAL,Facility,Outpatient,35 mL,mL,,162,137.7,46.4292,162,Aetna,Medicare Advantage,79.38,49,,percent of total billed charges,,
FLUCONAZOLE 10 MG/ML ORAL SUSR,,11331,LOCAL,Facility,Inpatient,35 mL,mL,,162,137.7,46.4292,162,Aetna,Medicare Advantage,,,,,Included in per diem rate,
FLUCONAZOLE 10 MG/ML ORAL SUSR,,11331,LOCAL,Facility,Inpatient,35 mL,mL,,162,137.7,46.4292,162,Aetna,Medicare Advantage,,,,,Included in per diem rate,
FLUCONAZOLE 10 MG/ML ORAL SUSR,,11331,LOCAL,Facility,Both,35 mL,mL,,162,137.7,46.4292,162,Aetna,PPO,150.66,93,,percent of total billed charges,,
FLUCONAZOLE 10 MG/ML ORAL SUSR,,11331,LOCAL,Facility,Both,35 mL,mL,,162,137.7,46.4292,162,Aetna,PPO,150.66,93,,percent of total billed charges,,
FLUCONAZOLE 10 MG/ML ORAL SUSR,,11331,LOCAL,Facility,Both,35 mL,mL,,162,137.7,46.4292,162,America's PPO,America's PPO,155.5686,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
FLUCONAZOLE 10 MG/ML ORAL SUSR,,11331,LOCAL,Facility,Both,35 mL,mL,,162,137.7,46.4292,162,America's PPO,America's PPO,155.5686,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
FLUCONAZOLE 10 MG/ML ORAL SUSR,,11331,LOCAL,Facility,Both,35 mL,mL,,162,137.7,46.4292,162,BlueCross BlueShield Minnesota, Federal Employee Program,159.408,98.4,,percent of total billed charges,,
FLUCONAZOLE 10 MG/ML ORAL SUSR,,11331,LOCAL,Facility,Both,35 mL,mL,,162,137.7,46.4292,162,BlueCross BlueShield Minnesota, Federal Employee Program,159.408,98.4,,percent of total billed charges,,
FLUCONAZOLE 10 MG/ML ORAL SUSR,,11331,LOCAL,Facility,Both,35 mL,mL,,162,137.7,46.4292,162,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,162,100,,percent of total billed charges,,
FLUCONAZOLE 10 MG/ML ORAL SUSR,,11331,LOCAL,Facility,Both,35 mL,mL,,162,137.7,46.4292,162,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,162,100,,percent of total billed charges,,
FLUCONAZOLE 10 MG/ML ORAL SUSR,,11331,LOCAL,Facility,Both,35 mL,mL,,162,137.7,46.4292,162,BlueCross BlueShield Minnesota,High Value Network Plan,145.8,90,,percent of total billed charges,,
FLUCONAZOLE 10 MG/ML ORAL SUSR,,11331,LOCAL,Facility,Both,35 mL,mL,,162,137.7,46.4292,162,BlueCross BlueShield Minnesota,High Value Network Plan,145.8,90,,percent of total billed charges,,
FLUCONAZOLE 10 MG/ML ORAL SUSR,,11331,LOCAL,Facility,Outpatient,35 mL,mL,,162,137.7,46.4292,162,BlueCross BlueShield Minnesota,Medicare Advantage,79.38,49,,percent of total billed charges,,
FLUCONAZOLE 10 MG/ML ORAL SUSR,,11331,LOCAL,Facility,Outpatient,35 mL,mL,,162,137.7,46.4292,162,BlueCross BlueShield Minnesota,Medicare Advantage,79.38,49,,percent of total billed charges,,
FLUCONAZOLE 10 MG/ML ORAL SUSR,,11331,LOCAL,Facility,Inpatient,35 mL,mL,,162,137.7,46.4292,162,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
FLUCONAZOLE 10 MG/ML ORAL SUSR,,11331,LOCAL,Facility,Inpatient,35 mL,mL,,162,137.7,46.4292,162,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
FLUCONAZOLE 10 MG/ML ORAL SUSR,,11331,LOCAL,Facility,Both,35 mL,mL,,162,137.7,46.4292,162,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,143.4834,88.57,,percent of total billed charges,,
FLUCONAZOLE 10 MG/ML ORAL SUSR,,11331,LOCAL,Facility,Both,35 mL,mL,,162,137.7,46.4292,162,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,143.4834,88.57,,percent of total billed charges,,
FLUCONAZOLE 10 MG/ML ORAL SUSR,,11331,LOCAL,Facility,Both,35 mL,mL,,162,137.7,46.4292,162,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,46.4292,28.66,,percent of total billed charges,,
FLUCONAZOLE 10 MG/ML ORAL SUSR,,11331,LOCAL,Facility,Both,35 mL,mL,,162,137.7,46.4292,162,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,46.4292,28.66,,percent of total billed charges,,
FLUCONAZOLE 10 MG/ML ORAL SUSR,,11331,LOCAL,Facility,Outpatient,35 mL,mL,,162,137.7,46.4292,162,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),79.38,49,,percent of total billed charges,,
FLUCONAZOLE 10 MG/ML ORAL SUSR,,11331,LOCAL,Facility,Outpatient,35 mL,mL,,162,137.7,46.4292,162,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),79.38,49,,percent of total billed charges,,
FLUCONAZOLE 10 MG/ML ORAL SUSR,,11331,LOCAL,Facility,Inpatient,35 mL,mL,,162,137.7,46.4292,162,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
FLUCONAZOLE 10 MG/ML ORAL SUSR,,11331,LOCAL,Facility,Inpatient,35 mL,mL,,162,137.7,46.4292,162,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
FLUCONAZOLE 10 MG/ML ORAL SUSR,,11331,LOCAL,Facility,Both,35 mL,mL,,162,137.7,46.4292,162,CorVel,Worker's Compensation,162,100,,percent of total billed charges,,
FLUCONAZOLE 10 MG/ML ORAL SUSR,,11331,LOCAL,Facility,Both,35 mL,mL,,162,137.7,46.4292,162,CorVel,Worker's Compensation,162,100,,percent of total billed charges,,
FLUCONAZOLE 10 MG/ML ORAL SUSR,,11331,LOCAL,Facility,Both,35 mL,mL,,162,137.7,46.4292,162,First Health Group Corporation,First Health Network,157.14,97,,percent of total billed charges,,
FLUCONAZOLE 10 MG/ML ORAL SUSR,,11331,LOCAL,Facility,Both,35 mL,mL,,162,137.7,46.4292,162,First Health Group Corporation,First Health Network,157.14,97,,percent of total billed charges,,
FLUCONAZOLE 10 MG/ML ORAL SUSR,,11331,LOCAL,Facility,Both,35 mL,mL,,162,137.7,46.4292,162,"Health Partners, Inc.",Commercial,153.252,94.6,,percent of total billed charges,,
FLUCONAZOLE 10 MG/ML ORAL SUSR,,11331,LOCAL,Facility,Both,35 mL,mL,,162,137.7,46.4292,162,"Health Partners, Inc.",Commercial,153.252,94.6,,percent of total billed charges,,
FLUCONAZOLE 10 MG/ML ORAL SUSR,,11331,LOCAL,Facility,Outpatient,35 mL,mL,,162,137.7,46.4292,162,"Health Partners, Inc.",Medicare Advantage,79.38,49,,percent of total billed charges,,
FLUCONAZOLE 10 MG/ML ORAL SUSR,,11331,LOCAL,Facility,Outpatient,35 mL,mL,,162,137.7,46.4292,162,"Health Partners, Inc.",Medicare Advantage,79.38,49,,percent of total billed charges,,
FLUCONAZOLE 10 MG/ML ORAL SUSR,,11331,LOCAL,Facility,Inpatient,35 mL,mL,,162,137.7,46.4292,162,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
FLUCONAZOLE 10 MG/ML ORAL SUSR,,11331,LOCAL,Facility,Inpatient,35 mL,mL,,162,137.7,46.4292,162,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
FLUCONAZOLE 10 MG/ML ORAL SUSR,,11331,LOCAL,Facility,Both,35 mL,mL,,162,137.7,46.4292,162,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),97.2,60,,percent of total billed charges,,
FLUCONAZOLE 10 MG/ML ORAL SUSR,,11331,LOCAL,Facility,Both,35 mL,mL,,162,137.7,46.4292,162,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),97.2,60,,percent of total billed charges,,
FLUCONAZOLE 10 MG/ML ORAL SUSR,,11331,LOCAL,Facility,Both,35 mL,mL,,162,137.7,46.4292,162,"Health Partners, Inc.",State of Minnesota Advantage Program,132.03,81.5,,percent of total billed charges,,
FLUCONAZOLE 10 MG/ML ORAL SUSR,,11331,LOCAL,Facility,Both,35 mL,mL,,162,137.7,46.4292,162,"Health Partners, Inc.",State of Minnesota Advantage Program,132.03,81.5,,percent of total billed charges,,
FLUCONAZOLE 10 MG/ML ORAL SUSR,,11331,LOCAL,Facility,Both,35 mL,mL,,162,137.7,46.4292,162,"Health Partners, Inc.",State Public Programs,81,50,,percent of total billed charges,,
FLUCONAZOLE 10 MG/ML ORAL SUSR,,11331,LOCAL,Facility,Both,35 mL,mL,,162,137.7,46.4292,162,"Health Partners, Inc.",State Public Programs,81,50,,percent of total billed charges,,
FLUCONAZOLE 10 MG/ML ORAL SUSR,,11331,LOCAL,Facility,Both,35 mL,mL,,162,137.7,46.4292,162,Humana Insurance Company,Commercial PPO,153.9,95,,percent of total billed charges,,
FLUCONAZOLE 10 MG/ML ORAL SUSR,,11331,LOCAL,Facility,Both,35 mL,mL,,162,137.7,46.4292,162,Humana Insurance Company,Commercial PPO,153.9,95,,percent of total billed charges,,
FLUCONAZOLE 10 MG/ML ORAL SUSR,,11331,LOCAL,Facility,Outpatient,35 mL,mL,,162,137.7,46.4292,162,Humana Insurance Company,Medicare PPO,79.38,49,,percent of total billed charges,,
FLUCONAZOLE 10 MG/ML ORAL SUSR,,11331,LOCAL,Facility,Outpatient,35 mL,mL,,162,137.7,46.4292,162,Humana Insurance Company,Medicare PPO,79.38,49,,percent of total billed charges,,
FLUCONAZOLE 10 MG/ML ORAL SUSR,,11331,LOCAL,Facility,Inpatient,35 mL,mL,,162,137.7,46.4292,162,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
FLUCONAZOLE 10 MG/ML ORAL SUSR,,11331,LOCAL,Facility,Inpatient,35 mL,mL,,162,137.7,46.4292,162,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
FLUCONAZOLE 10 MG/ML ORAL SUSR,,11331,LOCAL,Facility,Both,35 mL,mL,,162,137.7,46.4292,162,Medica,Individual & Family,160.542,99.1,,percent of total billed charges,,
FLUCONAZOLE 10 MG/ML ORAL SUSR,,11331,LOCAL,Facility,Both,35 mL,mL,,162,137.7,46.4292,162,Medica,Individual & Family,160.542,99.1,,percent of total billed charges,,
FLUCONAZOLE 10 MG/ML ORAL SUSR,,11331,LOCAL,Facility,Outpatient,35 mL,mL,,162,137.7,46.4292,162,Medica,Medica Advantage Solution,80.676,49.8,,percent of total billed charges,,
FLUCONAZOLE 10 MG/ML ORAL SUSR,,11331,LOCAL,Facility,Outpatient,35 mL,mL,,162,137.7,46.4292,162,Medica,Medica Advantage Solution,80.676,49.8,,percent of total billed charges,,
FLUCONAZOLE 10 MG/ML ORAL SUSR,,11331,LOCAL,Facility,Inpatient,35 mL,mL,,162,137.7,46.4292,162,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
FLUCONAZOLE 10 MG/ML ORAL SUSR,,11331,LOCAL,Facility,Inpatient,35 mL,mL,,162,137.7,46.4292,162,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
FLUCONAZOLE 10 MG/ML ORAL SUSR,,11331,LOCAL,Facility,Outpatient,35 mL,mL,,162,137.7,46.4292,162,Medica,Medical Assistance,72.252,44.6,,percent of total billed charges,,
FLUCONAZOLE 10 MG/ML ORAL SUSR,,11331,LOCAL,Facility,Outpatient,35 mL,mL,,162,137.7,46.4292,162,Medica,Medical Assistance,72.252,44.6,,percent of total billed charges,,
FLUCONAZOLE 10 MG/ML ORAL SUSR,,11331,LOCAL,Facility,Inpatient,35 mL,mL,,162,137.7,46.4292,162,Medica,Medical Assistance,,,,,Included in per diem rate,
FLUCONAZOLE 10 MG/ML ORAL SUSR,,11331,LOCAL,Facility,Inpatient,35 mL,mL,,162,137.7,46.4292,162,Medica,Medical Assistance,,,,,Included in per diem rate,
FLUCONAZOLE 10 MG/ML ORAL SUSR,,11331,LOCAL,Facility,Outpatient,35 mL,mL,,162,137.7,46.4292,162,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,80.676,49.8,,percent of total billed charges,,
FLUCONAZOLE 10 MG/ML ORAL SUSR,,11331,LOCAL,Facility,Outpatient,35 mL,mL,,162,137.7,46.4292,162,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,80.676,49.8,,percent of total billed charges,,
FLUCONAZOLE 10 MG/ML ORAL SUSR,,11331,LOCAL,Facility,Inpatient,35 mL,mL,,162,137.7,46.4292,162,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
FLUCONAZOLE 10 MG/ML ORAL SUSR,,11331,LOCAL,Facility,Inpatient,35 mL,mL,,162,137.7,46.4292,162,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
FLUCONAZOLE 10 MG/ML ORAL SUSR,,11331,LOCAL,Facility,Both,35 mL,mL,,162,137.7,46.4292,162,"Multiplan, Inc.","Multiplan, Inc.",152.28,94,,percent of total billed charges,,
FLUCONAZOLE 10 MG/ML ORAL SUSR,,11331,LOCAL,Facility,Both,35 mL,mL,,162,137.7,46.4292,162,"Multiplan, Inc.","Multiplan, Inc.",152.28,94,,percent of total billed charges,,
FLUCONAZOLE 10 MG/ML ORAL SUSR,,11331,LOCAL,Facility,Outpatient,35 mL,mL,,162,137.7,46.4292,162,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,145.962,90.1,,percent of total billed charges,,
FLUCONAZOLE 10 MG/ML ORAL SUSR,,11331,LOCAL,Facility,Outpatient,35 mL,mL,,162,137.7,46.4292,162,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,145.962,90.1,,percent of total billed charges,,
FLUCONAZOLE 10 MG/ML ORAL SUSR,,11331,LOCAL,Facility,Inpatient,35 mL,mL,,162,137.7,46.4292,162,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
FLUCONAZOLE 10 MG/ML ORAL SUSR,,11331,LOCAL,Facility,Inpatient,35 mL,mL,,162,137.7,46.4292,162,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
FLUCONAZOLE 10 MG/ML ORAL SUSR,,11331,LOCAL,Facility,Both,35 mL,mL,,162,137.7,46.4292,162,"Preferred One Administrative Services, INC.",PPO,159.732,98.6,,percent of total billed charges,,
FLUCONAZOLE 10 MG/ML ORAL SUSR,,11331,LOCAL,Facility,Both,35 mL,mL,,162,137.7,46.4292,162,"Preferred One Administrative Services, INC.",PPO,159.732,98.6,,percent of total billed charges,,
FLUCONAZOLE 10 MG/ML ORAL SUSR,,11331,LOCAL,Facility,Outpatient,35 mL,mL,,162,137.7,46.4292,162,PrimeWest Health,Minnesota Senior Health Options (MSHO),83.349,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
FLUCONAZOLE 10 MG/ML ORAL SUSR,,11331,LOCAL,Facility,Outpatient,35 mL,mL,,162,137.7,46.4292,162,PrimeWest Health,Minnesota Senior Health Options (MSHO),83.349,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
FLUCONAZOLE 10 MG/ML ORAL SUSR,,11331,LOCAL,Facility,Inpatient,35 mL,mL,,162,137.7,46.4292,162,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
FLUCONAZOLE 10 MG/ML ORAL SUSR,,11331,LOCAL,Facility,Inpatient,35 mL,mL,,162,137.7,46.4292,162,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
FLUCONAZOLE 10 MG/ML ORAL SUSR,,11331,LOCAL,Facility,Outpatient,35 mL,mL,,162,137.7,46.4292,162,PrimeWest Health,MinnesotaCare,83.2032,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
FLUCONAZOLE 10 MG/ML ORAL SUSR,,11331,LOCAL,Facility,Outpatient,35 mL,mL,,162,137.7,46.4292,162,PrimeWest Health,MinnesotaCare,83.2032,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
FLUCONAZOLE 10 MG/ML ORAL SUSR,,11331,LOCAL,Facility,Inpatient,35 mL,mL,,162,137.7,46.4292,162,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
FLUCONAZOLE 10 MG/ML ORAL SUSR,,11331,LOCAL,Facility,Inpatient,35 mL,mL,,162,137.7,46.4292,162,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
FLUCONAZOLE 10 MG/ML ORAL SUSR,,11331,LOCAL,Facility,Both,35 mL,mL,,162,137.7,46.4292,162,Sanford Health Plan,Sanford Health Plan,149.04,92,,percent of total billed charges,,
FLUCONAZOLE 10 MG/ML ORAL SUSR,,11331,LOCAL,Facility,Both,35 mL,mL,,162,137.7,46.4292,162,Sanford Health Plan,Sanford Health Plan,149.04,92,,percent of total billed charges,,
FLUCONAZOLE 10 MG/ML ORAL SUSR,,11331,LOCAL,Facility,Outpatient,35 mL,mL,,162,137.7,46.4292,162,"UCare Health, Inc.",Individual & Family Plan,91.287,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
FLUCONAZOLE 10 MG/ML ORAL SUSR,,11331,LOCAL,Facility,Outpatient,35 mL,mL,,162,137.7,46.4292,162,"UCare Health, Inc.",Individual & Family Plan,91.287,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
FLUCONAZOLE 10 MG/ML ORAL SUSR,,11331,LOCAL,Facility,Inpatient,35 mL,mL,,162,137.7,46.4292,162,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
FLUCONAZOLE 10 MG/ML ORAL SUSR,,11331,LOCAL,Facility,Inpatient,35 mL,mL,,162,137.7,46.4292,162,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
FLUCONAZOLE 10 MG/ML ORAL SUSR,,11331,LOCAL,Facility,Outpatient,35 mL,mL,,162,137.7,46.4292,162,"UCare Health, Inc.",Medical Assistance,81.7614,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FLUCONAZOLE 10 MG/ML ORAL SUSR,,11331,LOCAL,Facility,Outpatient,35 mL,mL,,162,137.7,46.4292,162,"UCare Health, Inc.",Medical Assistance,81.7614,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FLUCONAZOLE 10 MG/ML ORAL SUSR,,11331,LOCAL,Facility,Inpatient,35 mL,mL,,162,137.7,46.4292,162,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
FLUCONAZOLE 10 MG/ML ORAL SUSR,,11331,LOCAL,Facility,Inpatient,35 mL,mL,,162,137.7,46.4292,162,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
FLUCONAZOLE 10 MG/ML ORAL SUSR,,11331,LOCAL,Facility,Outpatient,35 mL,mL,,162,137.7,46.4292,162,"UCare Health, Inc.",Medicare Advantage,81.7614,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FLUCONAZOLE 10 MG/ML ORAL SUSR,,11331,LOCAL,Facility,Outpatient,35 mL,mL,,162,137.7,46.4292,162,"UCare Health, Inc.",Medicare Advantage,81.7614,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FLUCONAZOLE 10 MG/ML ORAL SUSR,,11331,LOCAL,Facility,Inpatient,35 mL,mL,,162,137.7,46.4292,162,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
FLUCONAZOLE 10 MG/ML ORAL SUSR,,11331,LOCAL,Facility,Inpatient,35 mL,mL,,162,137.7,46.4292,162,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
FLUCONAZOLE 10 MG/ML ORAL SUSR,,11331,LOCAL,Facility,Outpatient,35 mL,mL,,162,137.7,46.4292,162,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),81.7614,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FLUCONAZOLE 10 MG/ML ORAL SUSR,,11331,LOCAL,Facility,Outpatient,35 mL,mL,,162,137.7,46.4292,162,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),81.7614,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FLUCONAZOLE 10 MG/ML ORAL SUSR,,11331,LOCAL,Facility,Inpatient,35 mL,mL,,162,137.7,46.4292,162,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
FLUCONAZOLE 10 MG/ML ORAL SUSR,,11331,LOCAL,Facility,Inpatient,35 mL,mL,,162,137.7,46.4292,162,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
FLUCONAZOLE 10 MG/ML ORAL SUSR,,11331,LOCAL,Facility,Both,35 mL,mL,,162,137.7,46.4292,162,UnitedHealthcare,Individual & Family,152.28,94,,percent of total billed charges,,
FLUCONAZOLE 10 MG/ML ORAL SUSR,,11331,LOCAL,Facility,Both,35 mL,mL,,162,137.7,46.4292,162,UnitedHealthcare,Individual & Family,152.28,94,,percent of total billed charges,,
FLUCONAZOLE 10 MG/ML ORAL SUSR,,11331,LOCAL,Facility,Outpatient,35 mL,mL,,162,137.7,46.4292,162,UnitedHealthcare,Medicare Advantage,79.38,49,,percent of total billed charges,,
FLUCONAZOLE 10 MG/ML ORAL SUSR,,11331,LOCAL,Facility,Outpatient,35 mL,mL,,162,137.7,46.4292,162,UnitedHealthcare,Medicare Advantage,79.38,49,,percent of total billed charges,,
FLUCONAZOLE 10 MG/ML ORAL SUSR,,11331,LOCAL,Facility,Inpatient,35 mL,mL,,162,137.7,46.4292,162,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
FLUCONAZOLE 10 MG/ML ORAL SUSR,,11331,LOCAL,Facility,Inpatient,35 mL,mL,,162,137.7,46.4292,162,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
FLUCONAZOLE 10 MG/ML ORAL SUSR,,11331,LOCAL,Facility,Outpatient,35 mL,mL,,162,137.7,46.4292,162,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,77.76,48,,percent of total billed charges,,100% of DHS outpatient percentage
FLUCONAZOLE 10 MG/ML ORAL SUSR,,11331,LOCAL,Facility,Outpatient,35 mL,mL,,162,137.7,46.4292,162,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,77.76,48,,percent of total billed charges,,100% of DHS outpatient percentage
FLUCONAZOLE 10 MG/ML ORAL SUSR,,11331,LOCAL,Facility,Inpatient,35 mL,mL,,162,137.7,46.4292,162,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
FLUCONAZOLE 10 MG/ML ORAL SUSR,,11331,LOCAL,Facility,Inpatient,35 mL,mL,,162,137.7,46.4292,162,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
FLUCONAZOLE 40 MG/ML ORAL SUSR,,18498,LOCAL,Facility,Both,35 mL,mL,,509,432.65,145.8794,509,Aetna,Commercial,468.28,92,,percent of total billed charges,,
FLUCONAZOLE 40 MG/ML ORAL SUSR,,18498,LOCAL,Facility,Outpatient,35 mL,mL,,509,432.65,145.8794,509,Aetna,Medicare Advantage,249.41,49,,percent of total billed charges,,
FLUCONAZOLE 40 MG/ML ORAL SUSR,,18498,LOCAL,Facility,Inpatient,35 mL,mL,,509,432.65,145.8794,509,Aetna,Medicare Advantage,,,,,Included in per diem rate,
FLUCONAZOLE 40 MG/ML ORAL SUSR,,18498,LOCAL,Facility,Both,35 mL,mL,,509,432.65,145.8794,509,Aetna,PPO,473.37,93,,percent of total billed charges,,
FLUCONAZOLE 40 MG/ML ORAL SUSR,,18498,LOCAL,Facility,Both,35 mL,mL,,509,432.65,145.8794,509,America's PPO,America's PPO,488.7927,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
FLUCONAZOLE 40 MG/ML ORAL SUSR,,18498,LOCAL,Facility,Both,35 mL,mL,,509,432.65,145.8794,509,BlueCross BlueShield Minnesota, Federal Employee Program,500.856,98.4,,percent of total billed charges,,
FLUCONAZOLE 40 MG/ML ORAL SUSR,,18498,LOCAL,Facility,Both,35 mL,mL,,509,432.65,145.8794,509,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,509,100,,percent of total billed charges,,
FLUCONAZOLE 40 MG/ML ORAL SUSR,,18498,LOCAL,Facility,Both,35 mL,mL,,509,432.65,145.8794,509,BlueCross BlueShield Minnesota,High Value Network Plan,458.1,90,,percent of total billed charges,,
FLUCONAZOLE 40 MG/ML ORAL SUSR,,18498,LOCAL,Facility,Outpatient,35 mL,mL,,509,432.65,145.8794,509,BlueCross BlueShield Minnesota,Medicare Advantage,249.41,49,,percent of total billed charges,,
FLUCONAZOLE 40 MG/ML ORAL SUSR,,18498,LOCAL,Facility,Inpatient,35 mL,mL,,509,432.65,145.8794,509,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
FLUCONAZOLE 40 MG/ML ORAL SUSR,,18498,LOCAL,Facility,Both,35 mL,mL,,509,432.65,145.8794,509,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,450.8213,88.57,,percent of total billed charges,,
FLUCONAZOLE 40 MG/ML ORAL SUSR,,18498,LOCAL,Facility,Both,35 mL,mL,,509,432.65,145.8794,509,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,145.8794,28.66,,percent of total billed charges,,
FLUCONAZOLE 40 MG/ML ORAL SUSR,,18498,LOCAL,Facility,Outpatient,35 mL,mL,,509,432.65,145.8794,509,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),249.41,49,,percent of total billed charges,,
FLUCONAZOLE 40 MG/ML ORAL SUSR,,18498,LOCAL,Facility,Inpatient,35 mL,mL,,509,432.65,145.8794,509,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
FLUCONAZOLE 40 MG/ML ORAL SUSR,,18498,LOCAL,Facility,Both,35 mL,mL,,509,432.65,145.8794,509,CorVel,Worker's Compensation,509,100,,percent of total billed charges,,
FLUCONAZOLE 40 MG/ML ORAL SUSR,,18498,LOCAL,Facility,Both,35 mL,mL,,509,432.65,145.8794,509,First Health Group Corporation,First Health Network,493.73,97,,percent of total billed charges,,
FLUCONAZOLE 40 MG/ML ORAL SUSR,,18498,LOCAL,Facility,Both,35 mL,mL,,509,432.65,145.8794,509,"Health Partners, Inc.",Commercial,481.514,94.6,,percent of total billed charges,,
FLUCONAZOLE 40 MG/ML ORAL SUSR,,18498,LOCAL,Facility,Outpatient,35 mL,mL,,509,432.65,145.8794,509,"Health Partners, Inc.",Medicare Advantage,249.41,49,,percent of total billed charges,,
FLUCONAZOLE 40 MG/ML ORAL SUSR,,18498,LOCAL,Facility,Inpatient,35 mL,mL,,509,432.65,145.8794,509,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
FLUCONAZOLE 40 MG/ML ORAL SUSR,,18498,LOCAL,Facility,Both,35 mL,mL,,509,432.65,145.8794,509,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),305.4,60,,percent of total billed charges,,
FLUCONAZOLE 40 MG/ML ORAL SUSR,,18498,LOCAL,Facility,Both,35 mL,mL,,509,432.65,145.8794,509,"Health Partners, Inc.",State of Minnesota Advantage Program,414.835,81.5,,percent of total billed charges,,
FLUCONAZOLE 40 MG/ML ORAL SUSR,,18498,LOCAL,Facility,Both,35 mL,mL,,509,432.65,145.8794,509,"Health Partners, Inc.",State Public Programs,254.5,50,,percent of total billed charges,,
FLUCONAZOLE 40 MG/ML ORAL SUSR,,18498,LOCAL,Facility,Both,35 mL,mL,,509,432.65,145.8794,509,Humana Insurance Company,Commercial PPO,483.55,95,,percent of total billed charges,,
FLUCONAZOLE 40 MG/ML ORAL SUSR,,18498,LOCAL,Facility,Outpatient,35 mL,mL,,509,432.65,145.8794,509,Humana Insurance Company,Medicare PPO,249.41,49,,percent of total billed charges,,
FLUCONAZOLE 40 MG/ML ORAL SUSR,,18498,LOCAL,Facility,Inpatient,35 mL,mL,,509,432.65,145.8794,509,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
FLUCONAZOLE 40 MG/ML ORAL SUSR,,18498,LOCAL,Facility,Both,35 mL,mL,,509,432.65,145.8794,509,Medica,Individual & Family,504.419,99.1,,percent of total billed charges,,
FLUCONAZOLE 40 MG/ML ORAL SUSR,,18498,LOCAL,Facility,Outpatient,35 mL,mL,,509,432.65,145.8794,509,Medica,Medica Advantage Solution,253.482,49.8,,percent of total billed charges,,
FLUCONAZOLE 40 MG/ML ORAL SUSR,,18498,LOCAL,Facility,Inpatient,35 mL,mL,,509,432.65,145.8794,509,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
FLUCONAZOLE 40 MG/ML ORAL SUSR,,18498,LOCAL,Facility,Outpatient,35 mL,mL,,509,432.65,145.8794,509,Medica,Medical Assistance,227.014,44.6,,percent of total billed charges,,
FLUCONAZOLE 40 MG/ML ORAL SUSR,,18498,LOCAL,Facility,Inpatient,35 mL,mL,,509,432.65,145.8794,509,Medica,Medical Assistance,,,,,Included in per diem rate,
FLUCONAZOLE 40 MG/ML ORAL SUSR,,18498,LOCAL,Facility,Outpatient,35 mL,mL,,509,432.65,145.8794,509,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,253.482,49.8,,percent of total billed charges,,
FLUCONAZOLE 40 MG/ML ORAL SUSR,,18498,LOCAL,Facility,Inpatient,35 mL,mL,,509,432.65,145.8794,509,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
FLUCONAZOLE 40 MG/ML ORAL SUSR,,18498,LOCAL,Facility,Both,35 mL,mL,,509,432.65,145.8794,509,"Multiplan, Inc.","Multiplan, Inc.",478.46,94,,percent of total billed charges,,
FLUCONAZOLE 40 MG/ML ORAL SUSR,,18498,LOCAL,Facility,Outpatient,35 mL,mL,,509,432.65,145.8794,509,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,458.609,90.1,,percent of total billed charges,,
FLUCONAZOLE 40 MG/ML ORAL SUSR,,18498,LOCAL,Facility,Inpatient,35 mL,mL,,509,432.65,145.8794,509,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
FLUCONAZOLE 40 MG/ML ORAL SUSR,,18498,LOCAL,Facility,Both,35 mL,mL,,509,432.65,145.8794,509,"Preferred One Administrative Services, INC.",PPO,501.874,98.6,,percent of total billed charges,,
FLUCONAZOLE 40 MG/ML ORAL SUSR,,18498,LOCAL,Facility,Outpatient,35 mL,mL,,509,432.65,145.8794,509,PrimeWest Health,Minnesota Senior Health Options (MSHO),261.8805,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
FLUCONAZOLE 40 MG/ML ORAL SUSR,,18498,LOCAL,Facility,Inpatient,35 mL,mL,,509,432.65,145.8794,509,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
FLUCONAZOLE 40 MG/ML ORAL SUSR,,18498,LOCAL,Facility,Outpatient,35 mL,mL,,509,432.65,145.8794,509,PrimeWest Health,MinnesotaCare,261.4224,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
FLUCONAZOLE 40 MG/ML ORAL SUSR,,18498,LOCAL,Facility,Inpatient,35 mL,mL,,509,432.65,145.8794,509,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
FLUCONAZOLE 40 MG/ML ORAL SUSR,,18498,LOCAL,Facility,Both,35 mL,mL,,509,432.65,145.8794,509,Sanford Health Plan,Sanford Health Plan,468.28,92,,percent of total billed charges,,
FLUCONAZOLE 40 MG/ML ORAL SUSR,,18498,LOCAL,Facility,Outpatient,35 mL,mL,,509,432.65,145.8794,509,"UCare Health, Inc.",Individual & Family Plan,286.8215,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
FLUCONAZOLE 40 MG/ML ORAL SUSR,,18498,LOCAL,Facility,Inpatient,35 mL,mL,,509,432.65,145.8794,509,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
FLUCONAZOLE 40 MG/ML ORAL SUSR,,18498,LOCAL,Facility,Outpatient,35 mL,mL,,509,432.65,145.8794,509,"UCare Health, Inc.",Medical Assistance,256.8923,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FLUCONAZOLE 40 MG/ML ORAL SUSR,,18498,LOCAL,Facility,Inpatient,35 mL,mL,,509,432.65,145.8794,509,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
FLUCONAZOLE 40 MG/ML ORAL SUSR,,18498,LOCAL,Facility,Outpatient,35 mL,mL,,509,432.65,145.8794,509,"UCare Health, Inc.",Medicare Advantage,256.8923,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FLUCONAZOLE 40 MG/ML ORAL SUSR,,18498,LOCAL,Facility,Inpatient,35 mL,mL,,509,432.65,145.8794,509,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
FLUCONAZOLE 40 MG/ML ORAL SUSR,,18498,LOCAL,Facility,Outpatient,35 mL,mL,,509,432.65,145.8794,509,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),256.8923,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FLUCONAZOLE 40 MG/ML ORAL SUSR,,18498,LOCAL,Facility,Inpatient,35 mL,mL,,509,432.65,145.8794,509,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
FLUCONAZOLE 40 MG/ML ORAL SUSR,,18498,LOCAL,Facility,Both,35 mL,mL,,509,432.65,145.8794,509,UnitedHealthcare,Individual & Family,478.46,94,,percent of total billed charges,,
FLUCONAZOLE 40 MG/ML ORAL SUSR,,18498,LOCAL,Facility,Outpatient,35 mL,mL,,509,432.65,145.8794,509,UnitedHealthcare,Medicare Advantage,249.41,49,,percent of total billed charges,,
FLUCONAZOLE 40 MG/ML ORAL SUSR,,18498,LOCAL,Facility,Inpatient,35 mL,mL,,509,432.65,145.8794,509,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
FLUCONAZOLE 40 MG/ML ORAL SUSR,,18498,LOCAL,Facility,Outpatient,35 mL,mL,,509,432.65,145.8794,509,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,244.32,48,,percent of total billed charges,,100% of DHS outpatient percentage
FLUCONAZOLE 40 MG/ML ORAL SUSR,,18498,LOCAL,Facility,Inpatient,35 mL,mL,,509,432.65,145.8794,509,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
LIDOCAINE 5 % TOP OINT,,100878,LOCAL,Facility,Both,35.44 g,g,,1140,969,326.724,1140,Aetna,Commercial,1048.8,92,,percent of total billed charges,,
LIDOCAINE 5 % TOP OINT,,100878,LOCAL,Facility,Outpatient,35.44 g,g,,1140,969,326.724,1140,Aetna,Medicare Advantage,558.6,49,,percent of total billed charges,,
LIDOCAINE 5 % TOP OINT,,100878,LOCAL,Facility,Inpatient,35.44 g,g,,1140,969,326.724,1140,Aetna,Medicare Advantage,,,,,Included in per diem rate,
LIDOCAINE 5 % TOP OINT,,100878,LOCAL,Facility,Both,35.44 g,g,,1140,969,326.724,1140,Aetna,PPO,1060.2,93,,percent of total billed charges,,
LIDOCAINE 5 % TOP OINT,,100878,LOCAL,Facility,Both,35.44 g,g,,1140,969,326.724,1140,America's PPO,America's PPO,1094.742,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
LIDOCAINE 5 % TOP OINT,,100878,LOCAL,Facility,Both,35.44 g,g,,1140,969,326.724,1140,BlueCross BlueShield Minnesota, Federal Employee Program,1121.76,98.4,,percent of total billed charges,,
LIDOCAINE 5 % TOP OINT,,100878,LOCAL,Facility,Both,35.44 g,g,,1140,969,326.724,1140,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1140,100,,percent of total billed charges,,
LIDOCAINE 5 % TOP OINT,,100878,LOCAL,Facility,Both,35.44 g,g,,1140,969,326.724,1140,BlueCross BlueShield Minnesota,High Value Network Plan,1026,90,,percent of total billed charges,,
LIDOCAINE 5 % TOP OINT,,100878,LOCAL,Facility,Outpatient,35.44 g,g,,1140,969,326.724,1140,BlueCross BlueShield Minnesota,Medicare Advantage,558.6,49,,percent of total billed charges,,
LIDOCAINE 5 % TOP OINT,,100878,LOCAL,Facility,Inpatient,35.44 g,g,,1140,969,326.724,1140,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
LIDOCAINE 5 % TOP OINT,,100878,LOCAL,Facility,Both,35.44 g,g,,1140,969,326.724,1140,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1009.698,88.57,,percent of total billed charges,,
LIDOCAINE 5 % TOP OINT,,100878,LOCAL,Facility,Both,35.44 g,g,,1140,969,326.724,1140,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,326.724,28.66,,percent of total billed charges,,
LIDOCAINE 5 % TOP OINT,,100878,LOCAL,Facility,Outpatient,35.44 g,g,,1140,969,326.724,1140,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),558.6,49,,percent of total billed charges,,
LIDOCAINE 5 % TOP OINT,,100878,LOCAL,Facility,Inpatient,35.44 g,g,,1140,969,326.724,1140,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
LIDOCAINE 5 % TOP OINT,,100878,LOCAL,Facility,Both,35.44 g,g,,1140,969,326.724,1140,CorVel,Worker's Compensation,1140,100,,percent of total billed charges,,
LIDOCAINE 5 % TOP OINT,,100878,LOCAL,Facility,Both,35.44 g,g,,1140,969,326.724,1140,First Health Group Corporation,First Health Network,1105.8,97,,percent of total billed charges,,
LIDOCAINE 5 % TOP OINT,,100878,LOCAL,Facility,Both,35.44 g,g,,1140,969,326.724,1140,"Health Partners, Inc.",Commercial,1078.44,94.6,,percent of total billed charges,,
LIDOCAINE 5 % TOP OINT,,100878,LOCAL,Facility,Outpatient,35.44 g,g,,1140,969,326.724,1140,"Health Partners, Inc.",Medicare Advantage,558.6,49,,percent of total billed charges,,
LIDOCAINE 5 % TOP OINT,,100878,LOCAL,Facility,Inpatient,35.44 g,g,,1140,969,326.724,1140,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LIDOCAINE 5 % TOP OINT,,100878,LOCAL,Facility,Both,35.44 g,g,,1140,969,326.724,1140,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),684,60,,percent of total billed charges,,
LIDOCAINE 5 % TOP OINT,,100878,LOCAL,Facility,Both,35.44 g,g,,1140,969,326.724,1140,"Health Partners, Inc.",State of Minnesota Advantage Program,929.1,81.5,,percent of total billed charges,,
LIDOCAINE 5 % TOP OINT,,100878,LOCAL,Facility,Both,35.44 g,g,,1140,969,326.724,1140,"Health Partners, Inc.",State Public Programs,570,50,,percent of total billed charges,,
LIDOCAINE 5 % TOP OINT,,100878,LOCAL,Facility,Both,35.44 g,g,,1140,969,326.724,1140,Humana Insurance Company,Commercial PPO,1083,95,,percent of total billed charges,,
LIDOCAINE 5 % TOP OINT,,100878,LOCAL,Facility,Outpatient,35.44 g,g,,1140,969,326.724,1140,Humana Insurance Company,Medicare PPO,558.6,49,,percent of total billed charges,,
LIDOCAINE 5 % TOP OINT,,100878,LOCAL,Facility,Inpatient,35.44 g,g,,1140,969,326.724,1140,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
LIDOCAINE 5 % TOP OINT,,100878,LOCAL,Facility,Both,35.44 g,g,,1140,969,326.724,1140,Medica,Individual & Family,1129.74,99.1,,percent of total billed charges,,
LIDOCAINE 5 % TOP OINT,,100878,LOCAL,Facility,Outpatient,35.44 g,g,,1140,969,326.724,1140,Medica,Medica Advantage Solution,567.72,49.8,,percent of total billed charges,,
LIDOCAINE 5 % TOP OINT,,100878,LOCAL,Facility,Inpatient,35.44 g,g,,1140,969,326.724,1140,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
LIDOCAINE 5 % TOP OINT,,100878,LOCAL,Facility,Outpatient,35.44 g,g,,1140,969,326.724,1140,Medica,Medical Assistance,508.44,44.6,,percent of total billed charges,,
LIDOCAINE 5 % TOP OINT,,100878,LOCAL,Facility,Inpatient,35.44 g,g,,1140,969,326.724,1140,Medica,Medical Assistance,,,,,Included in per diem rate,
LIDOCAINE 5 % TOP OINT,,100878,LOCAL,Facility,Outpatient,35.44 g,g,,1140,969,326.724,1140,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,567.72,49.8,,percent of total billed charges,,
LIDOCAINE 5 % TOP OINT,,100878,LOCAL,Facility,Inpatient,35.44 g,g,,1140,969,326.724,1140,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
LIDOCAINE 5 % TOP OINT,,100878,LOCAL,Facility,Both,35.44 g,g,,1140,969,326.724,1140,"Multiplan, Inc.","Multiplan, Inc.",1071.6,94,,percent of total billed charges,,
LIDOCAINE 5 % TOP OINT,,100878,LOCAL,Facility,Outpatient,35.44 g,g,,1140,969,326.724,1140,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1027.14,90.1,,percent of total billed charges,,
LIDOCAINE 5 % TOP OINT,,100878,LOCAL,Facility,Inpatient,35.44 g,g,,1140,969,326.724,1140,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
LIDOCAINE 5 % TOP OINT,,100878,LOCAL,Facility,Both,35.44 g,g,,1140,969,326.724,1140,"Preferred One Administrative Services, INC.",PPO,1124.04,98.6,,percent of total billed charges,,
LIDOCAINE 5 % TOP OINT,,100878,LOCAL,Facility,Outpatient,35.44 g,g,,1140,969,326.724,1140,PrimeWest Health,Minnesota Senior Health Options (MSHO),586.53,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
LIDOCAINE 5 % TOP OINT,,100878,LOCAL,Facility,Inpatient,35.44 g,g,,1140,969,326.724,1140,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LIDOCAINE 5 % TOP OINT,,100878,LOCAL,Facility,Outpatient,35.44 g,g,,1140,969,326.724,1140,PrimeWest Health,MinnesotaCare,585.504,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
LIDOCAINE 5 % TOP OINT,,100878,LOCAL,Facility,Inpatient,35.44 g,g,,1140,969,326.724,1140,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
LIDOCAINE 5 % TOP OINT,,100878,LOCAL,Facility,Both,35.44 g,g,,1140,969,326.724,1140,Sanford Health Plan,Sanford Health Plan,1048.8,92,,percent of total billed charges,,
LIDOCAINE 5 % TOP OINT,,100878,LOCAL,Facility,Outpatient,35.44 g,g,,1140,969,326.724,1140,"UCare Health, Inc.",Individual & Family Plan,642.39,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
LIDOCAINE 5 % TOP OINT,,100878,LOCAL,Facility,Inpatient,35.44 g,g,,1140,969,326.724,1140,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
LIDOCAINE 5 % TOP OINT,,100878,LOCAL,Facility,Outpatient,35.44 g,g,,1140,969,326.724,1140,"UCare Health, Inc.",Medical Assistance,575.358,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LIDOCAINE 5 % TOP OINT,,100878,LOCAL,Facility,Inpatient,35.44 g,g,,1140,969,326.724,1140,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
LIDOCAINE 5 % TOP OINT,,100878,LOCAL,Facility,Outpatient,35.44 g,g,,1140,969,326.724,1140,"UCare Health, Inc.",Medicare Advantage,575.358,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LIDOCAINE 5 % TOP OINT,,100878,LOCAL,Facility,Inpatient,35.44 g,g,,1140,969,326.724,1140,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LIDOCAINE 5 % TOP OINT,,100878,LOCAL,Facility,Outpatient,35.44 g,g,,1140,969,326.724,1140,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),575.358,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LIDOCAINE 5 % TOP OINT,,100878,LOCAL,Facility,Inpatient,35.44 g,g,,1140,969,326.724,1140,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LIDOCAINE 5 % TOP OINT,,100878,LOCAL,Facility,Both,35.44 g,g,,1140,969,326.724,1140,UnitedHealthcare,Individual & Family,1071.6,94,,percent of total billed charges,,
LIDOCAINE 5 % TOP OINT,,100878,LOCAL,Facility,Outpatient,35.44 g,g,,1140,969,326.724,1140,UnitedHealthcare,Medicare Advantage,558.6,49,,percent of total billed charges,,
LIDOCAINE 5 % TOP OINT,,100878,LOCAL,Facility,Inpatient,35.44 g,g,,1140,969,326.724,1140,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
LIDOCAINE 5 % TOP OINT,,100878,LOCAL,Facility,Outpatient,35.44 g,g,,1140,969,326.724,1140,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,547.2,48,,percent of total billed charges,,100% of DHS outpatient percentage
LIDOCAINE 5 % TOP OINT,,100878,LOCAL,Facility,Inpatient,35.44 g,g,,1140,969,326.724,1140,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 1.75 GRAM/350 ML IV PGBK,,J3372,HCPCS,Facility,Both,350 mL,mL,,141,119.85,40.4106,141,Aetna,Commercial,129.72,92,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.75 GRAM/350 ML IV PGBK,,J3372,HCPCS,Facility,Both,350 mL,mL,,141,119.85,40.4106,141,Aetna,Commercial,129.72,92,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.75 GRAM/350 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,350 mL,mL,,141,119.85,40.4106,141,Aetna,Medicare Advantage,69.09,49,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.75 GRAM/350 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,350 mL,mL,,141,119.85,40.4106,141,Aetna,Medicare Advantage,69.09,49,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.75 GRAM/350 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,350 mL,mL,,141,119.85,40.4106,141,Aetna,Medicare Advantage,,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 1.75 GRAM/350 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,350 mL,mL,,141,119.85,40.4106,141,Aetna,Medicare Advantage,,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 1.75 GRAM/350 ML IV PGBK,,J3372,HCPCS,Facility,Both,350 mL,mL,,141,119.85,40.4106,141,Aetna,PPO,131.13,93,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.75 GRAM/350 ML IV PGBK,,J3372,HCPCS,Facility,Both,350 mL,mL,,141,119.85,40.4106,141,Aetna,PPO,131.13,93,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.75 GRAM/350 ML IV PGBK,,J3372,HCPCS,Facility,Both,350 mL,mL,,141,119.85,40.4106,141,America's PPO,America's PPO,135.4023,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
VANCOMYCIN-DILUENT COMBO NO.1 1.75 GRAM/350 ML IV PGBK,,J3372,HCPCS,Facility,Both,350 mL,mL,,141,119.85,40.4106,141,America's PPO,America's PPO,135.4023,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
VANCOMYCIN-DILUENT COMBO NO.1 1.75 GRAM/350 ML IV PGBK,,J3372,HCPCS,Facility,Both,350 mL,mL,,141,119.85,40.4106,141,BlueCross BlueShield Minnesota, Federal Employee Program,138.744,98.4,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.75 GRAM/350 ML IV PGBK,,J3372,HCPCS,Facility,Both,350 mL,mL,,141,119.85,40.4106,141,BlueCross BlueShield Minnesota, Federal Employee Program,138.744,98.4,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.75 GRAM/350 ML IV PGBK,,J3372,HCPCS,Facility,Both,350 mL,mL,,141,119.85,40.4106,141,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,141,100,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.75 GRAM/350 ML IV PGBK,,J3372,HCPCS,Facility,Both,350 mL,mL,,141,119.85,40.4106,141,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,141,100,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.75 GRAM/350 ML IV PGBK,,J3372,HCPCS,Facility,Both,350 mL,mL,,141,119.85,40.4106,141,BlueCross BlueShield Minnesota,High Value Network Plan,126.9,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
VANCOMYCIN-DILUENT COMBO NO.1 1.75 GRAM/350 ML IV PGBK,,J3372,HCPCS,Facility,Both,350 mL,mL,,141,119.85,40.4106,141,BlueCross BlueShield Minnesota,High Value Network Plan,126.9,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
VANCOMYCIN-DILUENT COMBO NO.1 1.75 GRAM/350 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,350 mL,mL,,141,119.85,40.4106,141,BlueCross BlueShield Minnesota,Medicare Advantage,69.09,49,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.75 GRAM/350 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,350 mL,mL,,141,119.85,40.4106,141,BlueCross BlueShield Minnesota,Medicare Advantage,69.09,49,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.75 GRAM/350 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,350 mL,mL,,141,119.85,40.4106,141,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 1.75 GRAM/350 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,350 mL,mL,,141,119.85,40.4106,141,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 1.75 GRAM/350 ML IV PGBK,,J3372,HCPCS,Facility,Both,350 mL,mL,,141,119.85,40.4106,141,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,124.8837,88.57,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.75 GRAM/350 ML IV PGBK,,J3372,HCPCS,Facility,Both,350 mL,mL,,141,119.85,40.4106,141,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,124.8837,88.57,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.75 GRAM/350 ML IV PGBK,,J3372,HCPCS,Facility,Both,350 mL,mL,,141,119.85,40.4106,141,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,40.4106,28.66,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.75 GRAM/350 ML IV PGBK,,J3372,HCPCS,Facility,Both,350 mL,mL,,141,119.85,40.4106,141,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,40.4106,28.66,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.75 GRAM/350 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,350 mL,mL,,141,119.85,40.4106,141,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),69.09,49,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.75 GRAM/350 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,350 mL,mL,,141,119.85,40.4106,141,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),69.09,49,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.75 GRAM/350 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,350 mL,mL,,141,119.85,40.4106,141,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 1.75 GRAM/350 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,350 mL,mL,,141,119.85,40.4106,141,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 1.75 GRAM/350 ML IV PGBK,,J3372,HCPCS,Facility,Both,350 mL,mL,,141,119.85,40.4106,141,CorVel,Worker's Compensation,141,100,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.75 GRAM/350 ML IV PGBK,,J3372,HCPCS,Facility,Both,350 mL,mL,,141,119.85,40.4106,141,CorVel,Worker's Compensation,141,100,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.75 GRAM/350 ML IV PGBK,,J3372,HCPCS,Facility,Both,350 mL,mL,,141,119.85,40.4106,141,First Health Group Corporation,First Health Network,136.77,97,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.75 GRAM/350 ML IV PGBK,,J3372,HCPCS,Facility,Both,350 mL,mL,,141,119.85,40.4106,141,First Health Group Corporation,First Health Network,136.77,97,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.75 GRAM/350 ML IV PGBK,,J3372,HCPCS,Facility,Both,350 mL,mL,,141,119.85,40.4106,141,"Health Partners, Inc.",Commercial,133.386,94.6,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.75 GRAM/350 ML IV PGBK,,J3372,HCPCS,Facility,Both,350 mL,mL,,141,119.85,40.4106,141,"Health Partners, Inc.",Commercial,133.386,94.6,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.75 GRAM/350 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,350 mL,mL,,141,119.85,40.4106,141,"Health Partners, Inc.",Medicare Advantage,69.09,49,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.75 GRAM/350 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,350 mL,mL,,141,119.85,40.4106,141,"Health Partners, Inc.",Medicare Advantage,69.09,49,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.75 GRAM/350 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,350 mL,mL,,141,119.85,40.4106,141,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 1.75 GRAM/350 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,350 mL,mL,,141,119.85,40.4106,141,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 1.75 GRAM/350 ML IV PGBK,,J3372,HCPCS,Facility,Both,350 mL,mL,,141,119.85,40.4106,141,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),84.6,60,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.75 GRAM/350 ML IV PGBK,,J3372,HCPCS,Facility,Both,350 mL,mL,,141,119.85,40.4106,141,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),84.6,60,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.75 GRAM/350 ML IV PGBK,,J3372,HCPCS,Facility,Both,350 mL,mL,,141,119.85,40.4106,141,"Health Partners, Inc.",State of Minnesota Advantage Program,114.915,81.5,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.75 GRAM/350 ML IV PGBK,,J3372,HCPCS,Facility,Both,350 mL,mL,,141,119.85,40.4106,141,"Health Partners, Inc.",State of Minnesota Advantage Program,114.915,81.5,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.75 GRAM/350 ML IV PGBK,,J3372,HCPCS,Facility,Both,350 mL,mL,,141,119.85,40.4106,141,"Health Partners, Inc.",State Public Programs,70.5,50,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.75 GRAM/350 ML IV PGBK,,J3372,HCPCS,Facility,Both,350 mL,mL,,141,119.85,40.4106,141,"Health Partners, Inc.",State Public Programs,70.5,50,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.75 GRAM/350 ML IV PGBK,,J3372,HCPCS,Facility,Both,350 mL,mL,,141,119.85,40.4106,141,Humana Insurance Company,Commercial PPO,133.95,95,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.75 GRAM/350 ML IV PGBK,,J3372,HCPCS,Facility,Both,350 mL,mL,,141,119.85,40.4106,141,Humana Insurance Company,Commercial PPO,133.95,95,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.75 GRAM/350 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,350 mL,mL,,141,119.85,40.4106,141,Humana Insurance Company,Medicare PPO,69.09,49,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.75 GRAM/350 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,350 mL,mL,,141,119.85,40.4106,141,Humana Insurance Company,Medicare PPO,69.09,49,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.75 GRAM/350 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,350 mL,mL,,141,119.85,40.4106,141,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 1.75 GRAM/350 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,350 mL,mL,,141,119.85,40.4106,141,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 1.75 GRAM/350 ML IV PGBK,,J3372,HCPCS,Facility,Both,350 mL,mL,,141,119.85,40.4106,141,Medica,Individual & Family,139.731,99.1,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.75 GRAM/350 ML IV PGBK,,J3372,HCPCS,Facility,Both,350 mL,mL,,141,119.85,40.4106,141,Medica,Individual & Family,139.731,99.1,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.75 GRAM/350 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,350 mL,mL,,141,119.85,40.4106,141,Medica,Medica Advantage Solution,70.218,49.8,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.75 GRAM/350 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,350 mL,mL,,141,119.85,40.4106,141,Medica,Medica Advantage Solution,70.218,49.8,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.75 GRAM/350 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,350 mL,mL,,141,119.85,40.4106,141,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 1.75 GRAM/350 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,350 mL,mL,,141,119.85,40.4106,141,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 1.75 GRAM/350 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,350 mL,mL,,141,119.85,40.4106,141,Medica,Medical Assistance,62.886,44.6,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.75 GRAM/350 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,350 mL,mL,,141,119.85,40.4106,141,Medica,Medical Assistance,62.886,44.6,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.75 GRAM/350 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,350 mL,mL,,141,119.85,40.4106,141,Medica,Medical Assistance,,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 1.75 GRAM/350 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,350 mL,mL,,141,119.85,40.4106,141,Medica,Medical Assistance,,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 1.75 GRAM/350 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,350 mL,mL,,141,119.85,40.4106,141,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,70.218,49.8,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.75 GRAM/350 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,350 mL,mL,,141,119.85,40.4106,141,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,70.218,49.8,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.75 GRAM/350 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,350 mL,mL,,141,119.85,40.4106,141,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 1.75 GRAM/350 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,350 mL,mL,,141,119.85,40.4106,141,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 1.75 GRAM/350 ML IV PGBK,,J3372,HCPCS,Facility,Both,350 mL,mL,,141,119.85,40.4106,141,"Multiplan, Inc.","Multiplan, Inc.",132.54,94,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.75 GRAM/350 ML IV PGBK,,J3372,HCPCS,Facility,Both,350 mL,mL,,141,119.85,40.4106,141,"Multiplan, Inc.","Multiplan, Inc.",132.54,94,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.75 GRAM/350 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,350 mL,mL,,141,119.85,40.4106,141,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,127.041,90.1,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.75 GRAM/350 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,350 mL,mL,,141,119.85,40.4106,141,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,127.041,90.1,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.75 GRAM/350 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,350 mL,mL,,141,119.85,40.4106,141,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
VANCOMYCIN-DILUENT COMBO NO.1 1.75 GRAM/350 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,350 mL,mL,,141,119.85,40.4106,141,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
VANCOMYCIN-DILUENT COMBO NO.1 1.75 GRAM/350 ML IV PGBK,,J3372,HCPCS,Facility,Both,350 mL,mL,,141,119.85,40.4106,141,"Preferred One Administrative Services, INC.",PPO,139.026,98.6,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.75 GRAM/350 ML IV PGBK,,J3372,HCPCS,Facility,Both,350 mL,mL,,141,119.85,40.4106,141,"Preferred One Administrative Services, INC.",PPO,139.026,98.6,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.75 GRAM/350 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,350 mL,mL,,141,119.85,40.4106,141,PrimeWest Health,Minnesota Senior Health Options (MSHO),72.5445,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
VANCOMYCIN-DILUENT COMBO NO.1 1.75 GRAM/350 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,350 mL,mL,,141,119.85,40.4106,141,PrimeWest Health,Minnesota Senior Health Options (MSHO),72.5445,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
VANCOMYCIN-DILUENT COMBO NO.1 1.75 GRAM/350 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,350 mL,mL,,141,119.85,40.4106,141,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 1.75 GRAM/350 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,350 mL,mL,,141,119.85,40.4106,141,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 1.75 GRAM/350 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,350 mL,mL,,141,119.85,40.4106,141,PrimeWest Health,MinnesotaCare,72.4176,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
VANCOMYCIN-DILUENT COMBO NO.1 1.75 GRAM/350 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,350 mL,mL,,141,119.85,40.4106,141,PrimeWest Health,MinnesotaCare,72.4176,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
VANCOMYCIN-DILUENT COMBO NO.1 1.75 GRAM/350 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,350 mL,mL,,141,119.85,40.4106,141,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 1.75 GRAM/350 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,350 mL,mL,,141,119.85,40.4106,141,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 1.75 GRAM/350 ML IV PGBK,,J3372,HCPCS,Facility,Both,350 mL,mL,,141,119.85,40.4106,141,Sanford Health Plan,Sanford Health Plan,129.72,92,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.75 GRAM/350 ML IV PGBK,,J3372,HCPCS,Facility,Both,350 mL,mL,,141,119.85,40.4106,141,Sanford Health Plan,Sanford Health Plan,129.72,92,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.75 GRAM/350 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,350 mL,mL,,141,119.85,40.4106,141,"UCare Health, Inc.",Individual & Family Plan,79.4535,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
VANCOMYCIN-DILUENT COMBO NO.1 1.75 GRAM/350 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,350 mL,mL,,141,119.85,40.4106,141,"UCare Health, Inc.",Individual & Family Plan,79.4535,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
VANCOMYCIN-DILUENT COMBO NO.1 1.75 GRAM/350 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,350 mL,mL,,141,119.85,40.4106,141,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 1.75 GRAM/350 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,350 mL,mL,,141,119.85,40.4106,141,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 1.75 GRAM/350 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,350 mL,mL,,141,119.85,40.4106,141,"UCare Health, Inc.",Medical Assistance,71.1627,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
VANCOMYCIN-DILUENT COMBO NO.1 1.75 GRAM/350 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,350 mL,mL,,141,119.85,40.4106,141,"UCare Health, Inc.",Medical Assistance,71.1627,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
VANCOMYCIN-DILUENT COMBO NO.1 1.75 GRAM/350 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,350 mL,mL,,141,119.85,40.4106,141,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 1.75 GRAM/350 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,350 mL,mL,,141,119.85,40.4106,141,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 1.75 GRAM/350 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,350 mL,mL,,141,119.85,40.4106,141,"UCare Health, Inc.",Medicare Advantage,71.1627,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
VANCOMYCIN-DILUENT COMBO NO.1 1.75 GRAM/350 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,350 mL,mL,,141,119.85,40.4106,141,"UCare Health, Inc.",Medicare Advantage,71.1627,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
VANCOMYCIN-DILUENT COMBO NO.1 1.75 GRAM/350 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,350 mL,mL,,141,119.85,40.4106,141,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 1.75 GRAM/350 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,350 mL,mL,,141,119.85,40.4106,141,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 1.75 GRAM/350 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,350 mL,mL,,141,119.85,40.4106,141,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),71.1627,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
VANCOMYCIN-DILUENT COMBO NO.1 1.75 GRAM/350 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,350 mL,mL,,141,119.85,40.4106,141,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),71.1627,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
VANCOMYCIN-DILUENT COMBO NO.1 1.75 GRAM/350 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,350 mL,mL,,141,119.85,40.4106,141,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 1.75 GRAM/350 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,350 mL,mL,,141,119.85,40.4106,141,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 1.75 GRAM/350 ML IV PGBK,,J3372,HCPCS,Facility,Both,350 mL,mL,,141,119.85,40.4106,141,UnitedHealthcare,Individual & Family,132.54,94,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.75 GRAM/350 ML IV PGBK,,J3372,HCPCS,Facility,Both,350 mL,mL,,141,119.85,40.4106,141,UnitedHealthcare,Individual & Family,132.54,94,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.75 GRAM/350 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,350 mL,mL,,141,119.85,40.4106,141,UnitedHealthcare,Medicare Advantage,69.09,49,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.75 GRAM/350 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,350 mL,mL,,141,119.85,40.4106,141,UnitedHealthcare,Medicare Advantage,69.09,49,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 1.75 GRAM/350 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,350 mL,mL,,141,119.85,40.4106,141,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 1.75 GRAM/350 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,350 mL,mL,,141,119.85,40.4106,141,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 1.75 GRAM/350 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,350 mL,mL,,141,119.85,40.4106,141,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,67.68,48,,percent of total billed charges,,100% of DHS outpatient percentage
VANCOMYCIN-DILUENT COMBO NO.1 1.75 GRAM/350 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,350 mL,mL,,141,119.85,40.4106,141,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,67.68,48,,percent of total billed charges,,100% of DHS outpatient percentage
VANCOMYCIN-DILUENT COMBO NO.1 1.75 GRAM/350 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,350 mL,mL,,141,119.85,40.4106,141,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 1.75 GRAM/350 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,350 mL,mL,,141,119.85,40.4106,141,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
PSYLLIUM HUSK (WITH SUGAR) 3 GRAM/7 GRAM ORAL POWD,,133525,LOCAL,Facility,Both,369 g,g,,41,34.85,11.7506,41,Aetna,Commercial,37.72,92,,percent of total billed charges,,
PSYLLIUM HUSK (WITH SUGAR) 3 GRAM/7 GRAM ORAL POWD,,133525,LOCAL,Facility,Outpatient,369 g,g,,41,34.85,11.7506,41,Aetna,Medicare Advantage,20.09,49,,percent of total billed charges,,
PSYLLIUM HUSK (WITH SUGAR) 3 GRAM/7 GRAM ORAL POWD,,133525,LOCAL,Facility,Inpatient,369 g,g,,41,34.85,11.7506,41,Aetna,Medicare Advantage,,,,,Included in per diem rate,
PSYLLIUM HUSK (WITH SUGAR) 3 GRAM/7 GRAM ORAL POWD,,133525,LOCAL,Facility,Both,369 g,g,,41,34.85,11.7506,41,Aetna,PPO,38.13,93,,percent of total billed charges,,
PSYLLIUM HUSK (WITH SUGAR) 3 GRAM/7 GRAM ORAL POWD,,133525,LOCAL,Facility,Both,369 g,g,,41,34.85,11.7506,41,America's PPO,America's PPO,39.3723,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
PSYLLIUM HUSK (WITH SUGAR) 3 GRAM/7 GRAM ORAL POWD,,133525,LOCAL,Facility,Both,369 g,g,,41,34.85,11.7506,41,BlueCross BlueShield Minnesota, Federal Employee Program,40.344,98.4,,percent of total billed charges,,
PSYLLIUM HUSK (WITH SUGAR) 3 GRAM/7 GRAM ORAL POWD,,133525,LOCAL,Facility,Both,369 g,g,,41,34.85,11.7506,41,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,41,100,,percent of total billed charges,,
PSYLLIUM HUSK (WITH SUGAR) 3 GRAM/7 GRAM ORAL POWD,,133525,LOCAL,Facility,Both,369 g,g,,41,34.85,11.7506,41,BlueCross BlueShield Minnesota,High Value Network Plan,36.9,90,,percent of total billed charges,,
PSYLLIUM HUSK (WITH SUGAR) 3 GRAM/7 GRAM ORAL POWD,,133525,LOCAL,Facility,Outpatient,369 g,g,,41,34.85,11.7506,41,BlueCross BlueShield Minnesota,Medicare Advantage,20.09,49,,percent of total billed charges,,
PSYLLIUM HUSK (WITH SUGAR) 3 GRAM/7 GRAM ORAL POWD,,133525,LOCAL,Facility,Inpatient,369 g,g,,41,34.85,11.7506,41,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
PSYLLIUM HUSK (WITH SUGAR) 3 GRAM/7 GRAM ORAL POWD,,133525,LOCAL,Facility,Both,369 g,g,,41,34.85,11.7506,41,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,36.3137,88.57,,percent of total billed charges,,
PSYLLIUM HUSK (WITH SUGAR) 3 GRAM/7 GRAM ORAL POWD,,133525,LOCAL,Facility,Both,369 g,g,,41,34.85,11.7506,41,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,11.7506,28.66,,percent of total billed charges,,
PSYLLIUM HUSK (WITH SUGAR) 3 GRAM/7 GRAM ORAL POWD,,133525,LOCAL,Facility,Outpatient,369 g,g,,41,34.85,11.7506,41,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),20.09,49,,percent of total billed charges,,
PSYLLIUM HUSK (WITH SUGAR) 3 GRAM/7 GRAM ORAL POWD,,133525,LOCAL,Facility,Inpatient,369 g,g,,41,34.85,11.7506,41,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
PSYLLIUM HUSK (WITH SUGAR) 3 GRAM/7 GRAM ORAL POWD,,133525,LOCAL,Facility,Both,369 g,g,,41,34.85,11.7506,41,CorVel,Worker's Compensation,41,100,,percent of total billed charges,,
PSYLLIUM HUSK (WITH SUGAR) 3 GRAM/7 GRAM ORAL POWD,,133525,LOCAL,Facility,Both,369 g,g,,41,34.85,11.7506,41,First Health Group Corporation,First Health Network,39.77,97,,percent of total billed charges,,
PSYLLIUM HUSK (WITH SUGAR) 3 GRAM/7 GRAM ORAL POWD,,133525,LOCAL,Facility,Both,369 g,g,,41,34.85,11.7506,41,"Health Partners, Inc.",Commercial,38.786,94.6,,percent of total billed charges,,
PSYLLIUM HUSK (WITH SUGAR) 3 GRAM/7 GRAM ORAL POWD,,133525,LOCAL,Facility,Outpatient,369 g,g,,41,34.85,11.7506,41,"Health Partners, Inc.",Medicare Advantage,20.09,49,,percent of total billed charges,,
PSYLLIUM HUSK (WITH SUGAR) 3 GRAM/7 GRAM ORAL POWD,,133525,LOCAL,Facility,Inpatient,369 g,g,,41,34.85,11.7506,41,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PSYLLIUM HUSK (WITH SUGAR) 3 GRAM/7 GRAM ORAL POWD,,133525,LOCAL,Facility,Both,369 g,g,,41,34.85,11.7506,41,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),24.6,60,,percent of total billed charges,,
PSYLLIUM HUSK (WITH SUGAR) 3 GRAM/7 GRAM ORAL POWD,,133525,LOCAL,Facility,Both,369 g,g,,41,34.85,11.7506,41,"Health Partners, Inc.",State of Minnesota Advantage Program,33.415,81.5,,percent of total billed charges,,
PSYLLIUM HUSK (WITH SUGAR) 3 GRAM/7 GRAM ORAL POWD,,133525,LOCAL,Facility,Both,369 g,g,,41,34.85,11.7506,41,"Health Partners, Inc.",State Public Programs,20.5,50,,percent of total billed charges,,
PSYLLIUM HUSK (WITH SUGAR) 3 GRAM/7 GRAM ORAL POWD,,133525,LOCAL,Facility,Both,369 g,g,,41,34.85,11.7506,41,Humana Insurance Company,Commercial PPO,38.95,95,,percent of total billed charges,,
PSYLLIUM HUSK (WITH SUGAR) 3 GRAM/7 GRAM ORAL POWD,,133525,LOCAL,Facility,Outpatient,369 g,g,,41,34.85,11.7506,41,Humana Insurance Company,Medicare PPO,20.09,49,,percent of total billed charges,,
PSYLLIUM HUSK (WITH SUGAR) 3 GRAM/7 GRAM ORAL POWD,,133525,LOCAL,Facility,Inpatient,369 g,g,,41,34.85,11.7506,41,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
PSYLLIUM HUSK (WITH SUGAR) 3 GRAM/7 GRAM ORAL POWD,,133525,LOCAL,Facility,Both,369 g,g,,41,34.85,11.7506,41,Medica,Individual & Family,40.631,99.1,,percent of total billed charges,,
PSYLLIUM HUSK (WITH SUGAR) 3 GRAM/7 GRAM ORAL POWD,,133525,LOCAL,Facility,Outpatient,369 g,g,,41,34.85,11.7506,41,Medica,Medica Advantage Solution,20.418,49.8,,percent of total billed charges,,
PSYLLIUM HUSK (WITH SUGAR) 3 GRAM/7 GRAM ORAL POWD,,133525,LOCAL,Facility,Inpatient,369 g,g,,41,34.85,11.7506,41,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
PSYLLIUM HUSK (WITH SUGAR) 3 GRAM/7 GRAM ORAL POWD,,133525,LOCAL,Facility,Outpatient,369 g,g,,41,34.85,11.7506,41,Medica,Medical Assistance,18.286,44.6,,percent of total billed charges,,
PSYLLIUM HUSK (WITH SUGAR) 3 GRAM/7 GRAM ORAL POWD,,133525,LOCAL,Facility,Inpatient,369 g,g,,41,34.85,11.7506,41,Medica,Medical Assistance,,,,,Included in per diem rate,
PSYLLIUM HUSK (WITH SUGAR) 3 GRAM/7 GRAM ORAL POWD,,133525,LOCAL,Facility,Outpatient,369 g,g,,41,34.85,11.7506,41,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,20.418,49.8,,percent of total billed charges,,
PSYLLIUM HUSK (WITH SUGAR) 3 GRAM/7 GRAM ORAL POWD,,133525,LOCAL,Facility,Inpatient,369 g,g,,41,34.85,11.7506,41,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
PSYLLIUM HUSK (WITH SUGAR) 3 GRAM/7 GRAM ORAL POWD,,133525,LOCAL,Facility,Both,369 g,g,,41,34.85,11.7506,41,"Multiplan, Inc.","Multiplan, Inc.",38.54,94,,percent of total billed charges,,
PSYLLIUM HUSK (WITH SUGAR) 3 GRAM/7 GRAM ORAL POWD,,133525,LOCAL,Facility,Outpatient,369 g,g,,41,34.85,11.7506,41,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,36.941,90.1,,percent of total billed charges,,
PSYLLIUM HUSK (WITH SUGAR) 3 GRAM/7 GRAM ORAL POWD,,133525,LOCAL,Facility,Inpatient,369 g,g,,41,34.85,11.7506,41,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
PSYLLIUM HUSK (WITH SUGAR) 3 GRAM/7 GRAM ORAL POWD,,133525,LOCAL,Facility,Both,369 g,g,,41,34.85,11.7506,41,"Preferred One Administrative Services, INC.",PPO,40.426,98.6,,percent of total billed charges,,
PSYLLIUM HUSK (WITH SUGAR) 3 GRAM/7 GRAM ORAL POWD,,133525,LOCAL,Facility,Outpatient,369 g,g,,41,34.85,11.7506,41,PrimeWest Health,Minnesota Senior Health Options (MSHO),21.0945,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
PSYLLIUM HUSK (WITH SUGAR) 3 GRAM/7 GRAM ORAL POWD,,133525,LOCAL,Facility,Inpatient,369 g,g,,41,34.85,11.7506,41,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PSYLLIUM HUSK (WITH SUGAR) 3 GRAM/7 GRAM ORAL POWD,,133525,LOCAL,Facility,Outpatient,369 g,g,,41,34.85,11.7506,41,PrimeWest Health,MinnesotaCare,21.0576,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
PSYLLIUM HUSK (WITH SUGAR) 3 GRAM/7 GRAM ORAL POWD,,133525,LOCAL,Facility,Inpatient,369 g,g,,41,34.85,11.7506,41,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
PSYLLIUM HUSK (WITH SUGAR) 3 GRAM/7 GRAM ORAL POWD,,133525,LOCAL,Facility,Both,369 g,g,,41,34.85,11.7506,41,Sanford Health Plan,Sanford Health Plan,37.72,92,,percent of total billed charges,,
PSYLLIUM HUSK (WITH SUGAR) 3 GRAM/7 GRAM ORAL POWD,,133525,LOCAL,Facility,Outpatient,369 g,g,,41,34.85,11.7506,41,"UCare Health, Inc.",Individual & Family Plan,23.1035,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
PSYLLIUM HUSK (WITH SUGAR) 3 GRAM/7 GRAM ORAL POWD,,133525,LOCAL,Facility,Inpatient,369 g,g,,41,34.85,11.7506,41,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
PSYLLIUM HUSK (WITH SUGAR) 3 GRAM/7 GRAM ORAL POWD,,133525,LOCAL,Facility,Outpatient,369 g,g,,41,34.85,11.7506,41,"UCare Health, Inc.",Medical Assistance,20.6927,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PSYLLIUM HUSK (WITH SUGAR) 3 GRAM/7 GRAM ORAL POWD,,133525,LOCAL,Facility,Inpatient,369 g,g,,41,34.85,11.7506,41,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
PSYLLIUM HUSK (WITH SUGAR) 3 GRAM/7 GRAM ORAL POWD,,133525,LOCAL,Facility,Outpatient,369 g,g,,41,34.85,11.7506,41,"UCare Health, Inc.",Medicare Advantage,20.6927,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PSYLLIUM HUSK (WITH SUGAR) 3 GRAM/7 GRAM ORAL POWD,,133525,LOCAL,Facility,Inpatient,369 g,g,,41,34.85,11.7506,41,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PSYLLIUM HUSK (WITH SUGAR) 3 GRAM/7 GRAM ORAL POWD,,133525,LOCAL,Facility,Outpatient,369 g,g,,41,34.85,11.7506,41,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),20.6927,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PSYLLIUM HUSK (WITH SUGAR) 3 GRAM/7 GRAM ORAL POWD,,133525,LOCAL,Facility,Inpatient,369 g,g,,41,34.85,11.7506,41,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PSYLLIUM HUSK (WITH SUGAR) 3 GRAM/7 GRAM ORAL POWD,,133525,LOCAL,Facility,Both,369 g,g,,41,34.85,11.7506,41,UnitedHealthcare,Individual & Family,38.54,94,,percent of total billed charges,,
PSYLLIUM HUSK (WITH SUGAR) 3 GRAM/7 GRAM ORAL POWD,,133525,LOCAL,Facility,Outpatient,369 g,g,,41,34.85,11.7506,41,UnitedHealthcare,Medicare Advantage,20.09,49,,percent of total billed charges,,
PSYLLIUM HUSK (WITH SUGAR) 3 GRAM/7 GRAM ORAL POWD,,133525,LOCAL,Facility,Inpatient,369 g,g,,41,34.85,11.7506,41,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
PSYLLIUM HUSK (WITH SUGAR) 3 GRAM/7 GRAM ORAL POWD,,133525,LOCAL,Facility,Outpatient,369 g,g,,41,34.85,11.7506,41,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,19.68,48,,percent of total billed charges,,100% of DHS outpatient percentage
PSYLLIUM HUSK (WITH SUGAR) 3 GRAM/7 GRAM ORAL POWD,,133525,LOCAL,Facility,Inpatient,369 g,g,,41,34.85,11.7506,41,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
DEXTROSE 40 % ORAL GEL,,5132,LOCAL,Facility,Both,37.5 g,g,,19,16.15,5.4454,19,Aetna,Commercial,17.48,92,,percent of total billed charges,,
DEXTROSE 40 % ORAL GEL,,5132,LOCAL,Facility,Outpatient,37.5 g,g,,19,16.15,5.4454,19,Aetna,Medicare Advantage,9.31,49,,percent of total billed charges,,
DEXTROSE 40 % ORAL GEL,,5132,LOCAL,Facility,Inpatient,37.5 g,g,,19,16.15,5.4454,19,Aetna,Medicare Advantage,,,,,Included in per diem rate,
DEXTROSE 40 % ORAL GEL,,5132,LOCAL,Facility,Both,37.5 g,g,,19,16.15,5.4454,19,Aetna,PPO,17.67,93,,percent of total billed charges,,
DEXTROSE 40 % ORAL GEL,,5132,LOCAL,Facility,Both,37.5 g,g,,19,16.15,5.4454,19,America's PPO,America's PPO,18.2457,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
DEXTROSE 40 % ORAL GEL,,5132,LOCAL,Facility,Both,37.5 g,g,,19,16.15,5.4454,19,BlueCross BlueShield Minnesota, Federal Employee Program,18.696,98.4,,percent of total billed charges,,
DEXTROSE 40 % ORAL GEL,,5132,LOCAL,Facility,Both,37.5 g,g,,19,16.15,5.4454,19,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,19,100,,percent of total billed charges,,
DEXTROSE 40 % ORAL GEL,,5132,LOCAL,Facility,Both,37.5 g,g,,19,16.15,5.4454,19,BlueCross BlueShield Minnesota,High Value Network Plan,17.1,90,,percent of total billed charges,,
DEXTROSE 40 % ORAL GEL,,5132,LOCAL,Facility,Outpatient,37.5 g,g,,19,16.15,5.4454,19,BlueCross BlueShield Minnesota,Medicare Advantage,9.31,49,,percent of total billed charges,,
DEXTROSE 40 % ORAL GEL,,5132,LOCAL,Facility,Inpatient,37.5 g,g,,19,16.15,5.4454,19,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
DEXTROSE 40 % ORAL GEL,,5132,LOCAL,Facility,Both,37.5 g,g,,19,16.15,5.4454,19,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,16.8283,88.57,,percent of total billed charges,,
DEXTROSE 40 % ORAL GEL,,5132,LOCAL,Facility,Both,37.5 g,g,,19,16.15,5.4454,19,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,5.4454,28.66,,percent of total billed charges,,
DEXTROSE 40 % ORAL GEL,,5132,LOCAL,Facility,Outpatient,37.5 g,g,,19,16.15,5.4454,19,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),9.31,49,,percent of total billed charges,,
DEXTROSE 40 % ORAL GEL,,5132,LOCAL,Facility,Inpatient,37.5 g,g,,19,16.15,5.4454,19,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
DEXTROSE 40 % ORAL GEL,,5132,LOCAL,Facility,Both,37.5 g,g,,19,16.15,5.4454,19,CorVel,Worker's Compensation,19,100,,percent of total billed charges,,
DEXTROSE 40 % ORAL GEL,,5132,LOCAL,Facility,Both,37.5 g,g,,19,16.15,5.4454,19,First Health Group Corporation,First Health Network,18.43,97,,percent of total billed charges,,
DEXTROSE 40 % ORAL GEL,,5132,LOCAL,Facility,Both,37.5 g,g,,19,16.15,5.4454,19,"Health Partners, Inc.",Commercial,17.974,94.6,,percent of total billed charges,,
DEXTROSE 40 % ORAL GEL,,5132,LOCAL,Facility,Outpatient,37.5 g,g,,19,16.15,5.4454,19,"Health Partners, Inc.",Medicare Advantage,9.31,49,,percent of total billed charges,,
DEXTROSE 40 % ORAL GEL,,5132,LOCAL,Facility,Inpatient,37.5 g,g,,19,16.15,5.4454,19,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DEXTROSE 40 % ORAL GEL,,5132,LOCAL,Facility,Both,37.5 g,g,,19,16.15,5.4454,19,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),11.4,60,,percent of total billed charges,,
DEXTROSE 40 % ORAL GEL,,5132,LOCAL,Facility,Both,37.5 g,g,,19,16.15,5.4454,19,"Health Partners, Inc.",State of Minnesota Advantage Program,15.485,81.5,,percent of total billed charges,,
DEXTROSE 40 % ORAL GEL,,5132,LOCAL,Facility,Both,37.5 g,g,,19,16.15,5.4454,19,"Health Partners, Inc.",State Public Programs,9.5,50,,percent of total billed charges,,
DEXTROSE 40 % ORAL GEL,,5132,LOCAL,Facility,Both,37.5 g,g,,19,16.15,5.4454,19,Humana Insurance Company,Commercial PPO,18.05,95,,percent of total billed charges,,
DEXTROSE 40 % ORAL GEL,,5132,LOCAL,Facility,Outpatient,37.5 g,g,,19,16.15,5.4454,19,Humana Insurance Company,Medicare PPO,9.31,49,,percent of total billed charges,,
DEXTROSE 40 % ORAL GEL,,5132,LOCAL,Facility,Inpatient,37.5 g,g,,19,16.15,5.4454,19,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
DEXTROSE 40 % ORAL GEL,,5132,LOCAL,Facility,Both,37.5 g,g,,19,16.15,5.4454,19,Medica,Individual & Family,18.829,99.1,,percent of total billed charges,,
DEXTROSE 40 % ORAL GEL,,5132,LOCAL,Facility,Outpatient,37.5 g,g,,19,16.15,5.4454,19,Medica,Medica Advantage Solution,9.462,49.8,,percent of total billed charges,,
DEXTROSE 40 % ORAL GEL,,5132,LOCAL,Facility,Inpatient,37.5 g,g,,19,16.15,5.4454,19,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
DEXTROSE 40 % ORAL GEL,,5132,LOCAL,Facility,Outpatient,37.5 g,g,,19,16.15,5.4454,19,Medica,Medical Assistance,8.474,44.6,,percent of total billed charges,,
DEXTROSE 40 % ORAL GEL,,5132,LOCAL,Facility,Inpatient,37.5 g,g,,19,16.15,5.4454,19,Medica,Medical Assistance,,,,,Included in per diem rate,
DEXTROSE 40 % ORAL GEL,,5132,LOCAL,Facility,Outpatient,37.5 g,g,,19,16.15,5.4454,19,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,9.462,49.8,,percent of total billed charges,,
DEXTROSE 40 % ORAL GEL,,5132,LOCAL,Facility,Inpatient,37.5 g,g,,19,16.15,5.4454,19,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
DEXTROSE 40 % ORAL GEL,,5132,LOCAL,Facility,Both,37.5 g,g,,19,16.15,5.4454,19,"Multiplan, Inc.","Multiplan, Inc.",17.86,94,,percent of total billed charges,,
DEXTROSE 40 % ORAL GEL,,5132,LOCAL,Facility,Outpatient,37.5 g,g,,19,16.15,5.4454,19,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,17.119,90.1,,percent of total billed charges,,
DEXTROSE 40 % ORAL GEL,,5132,LOCAL,Facility,Inpatient,37.5 g,g,,19,16.15,5.4454,19,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
DEXTROSE 40 % ORAL GEL,,5132,LOCAL,Facility,Both,37.5 g,g,,19,16.15,5.4454,19,"Preferred One Administrative Services, INC.",PPO,18.734,98.6,,percent of total billed charges,,
DEXTROSE 40 % ORAL GEL,,5132,LOCAL,Facility,Outpatient,37.5 g,g,,19,16.15,5.4454,19,PrimeWest Health,Minnesota Senior Health Options (MSHO),9.7755,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
DEXTROSE 40 % ORAL GEL,,5132,LOCAL,Facility,Inpatient,37.5 g,g,,19,16.15,5.4454,19,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DEXTROSE 40 % ORAL GEL,,5132,LOCAL,Facility,Outpatient,37.5 g,g,,19,16.15,5.4454,19,PrimeWest Health,MinnesotaCare,9.7584,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
DEXTROSE 40 % ORAL GEL,,5132,LOCAL,Facility,Inpatient,37.5 g,g,,19,16.15,5.4454,19,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
DEXTROSE 40 % ORAL GEL,,5132,LOCAL,Facility,Both,37.5 g,g,,19,16.15,5.4454,19,Sanford Health Plan,Sanford Health Plan,17.48,92,,percent of total billed charges,,
DEXTROSE 40 % ORAL GEL,,5132,LOCAL,Facility,Outpatient,37.5 g,g,,19,16.15,5.4454,19,"UCare Health, Inc.",Individual & Family Plan,10.7065,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
DEXTROSE 40 % ORAL GEL,,5132,LOCAL,Facility,Inpatient,37.5 g,g,,19,16.15,5.4454,19,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
DEXTROSE 40 % ORAL GEL,,5132,LOCAL,Facility,Outpatient,37.5 g,g,,19,16.15,5.4454,19,"UCare Health, Inc.",Medical Assistance,9.5893,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DEXTROSE 40 % ORAL GEL,,5132,LOCAL,Facility,Inpatient,37.5 g,g,,19,16.15,5.4454,19,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
DEXTROSE 40 % ORAL GEL,,5132,LOCAL,Facility,Outpatient,37.5 g,g,,19,16.15,5.4454,19,"UCare Health, Inc.",Medicare Advantage,9.5893,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DEXTROSE 40 % ORAL GEL,,5132,LOCAL,Facility,Inpatient,37.5 g,g,,19,16.15,5.4454,19,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DEXTROSE 40 % ORAL GEL,,5132,LOCAL,Facility,Outpatient,37.5 g,g,,19,16.15,5.4454,19,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),9.5893,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DEXTROSE 40 % ORAL GEL,,5132,LOCAL,Facility,Inpatient,37.5 g,g,,19,16.15,5.4454,19,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DEXTROSE 40 % ORAL GEL,,5132,LOCAL,Facility,Both,37.5 g,g,,19,16.15,5.4454,19,UnitedHealthcare,Individual & Family,17.86,94,,percent of total billed charges,,
DEXTROSE 40 % ORAL GEL,,5132,LOCAL,Facility,Outpatient,37.5 g,g,,19,16.15,5.4454,19,UnitedHealthcare,Medicare Advantage,9.31,49,,percent of total billed charges,,
DEXTROSE 40 % ORAL GEL,,5132,LOCAL,Facility,Inpatient,37.5 g,g,,19,16.15,5.4454,19,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
DEXTROSE 40 % ORAL GEL,,5132,LOCAL,Facility,Outpatient,37.5 g,g,,19,16.15,5.4454,19,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,9.12,48,,percent of total billed charges,,100% of DHS outpatient percentage
DEXTROSE 40 % ORAL GEL,,5132,LOCAL,Facility,Inpatient,37.5 g,g,,19,16.15,5.4454,19,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
ALUMINUM CHLORIDE 20 % TOP SOLN,,5786,LOCAL,Facility,Both,37.5 mL,mL,,47,39.95,13.4702,47,Aetna,Commercial,43.24,92,,percent of total billed charges,,
ALUMINUM CHLORIDE 20 % TOP SOLN,,5786,LOCAL,Facility,Outpatient,37.5 mL,mL,,47,39.95,13.4702,47,Aetna,Medicare Advantage,23.03,49,,percent of total billed charges,,
ALUMINUM CHLORIDE 20 % TOP SOLN,,5786,LOCAL,Facility,Inpatient,37.5 mL,mL,,47,39.95,13.4702,47,Aetna,Medicare Advantage,,,,,Included in per diem rate,
ALUMINUM CHLORIDE 20 % TOP SOLN,,5786,LOCAL,Facility,Both,37.5 mL,mL,,47,39.95,13.4702,47,Aetna,PPO,43.71,93,,percent of total billed charges,,
ALUMINUM CHLORIDE 20 % TOP SOLN,,5786,LOCAL,Facility,Both,37.5 mL,mL,,47,39.95,13.4702,47,America's PPO,America's PPO,45.1341,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
ALUMINUM CHLORIDE 20 % TOP SOLN,,5786,LOCAL,Facility,Both,37.5 mL,mL,,47,39.95,13.4702,47,BlueCross BlueShield Minnesota, Federal Employee Program,46.248,98.4,,percent of total billed charges,,
ALUMINUM CHLORIDE 20 % TOP SOLN,,5786,LOCAL,Facility,Both,37.5 mL,mL,,47,39.95,13.4702,47,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,47,100,,percent of total billed charges,,
ALUMINUM CHLORIDE 20 % TOP SOLN,,5786,LOCAL,Facility,Both,37.5 mL,mL,,47,39.95,13.4702,47,BlueCross BlueShield Minnesota,High Value Network Plan,42.3,90,,percent of total billed charges,,
ALUMINUM CHLORIDE 20 % TOP SOLN,,5786,LOCAL,Facility,Outpatient,37.5 mL,mL,,47,39.95,13.4702,47,BlueCross BlueShield Minnesota,Medicare Advantage,23.03,49,,percent of total billed charges,,
ALUMINUM CHLORIDE 20 % TOP SOLN,,5786,LOCAL,Facility,Inpatient,37.5 mL,mL,,47,39.95,13.4702,47,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
ALUMINUM CHLORIDE 20 % TOP SOLN,,5786,LOCAL,Facility,Both,37.5 mL,mL,,47,39.95,13.4702,47,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,41.6279,88.57,,percent of total billed charges,,
ALUMINUM CHLORIDE 20 % TOP SOLN,,5786,LOCAL,Facility,Both,37.5 mL,mL,,47,39.95,13.4702,47,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,13.4702,28.66,,percent of total billed charges,,
ALUMINUM CHLORIDE 20 % TOP SOLN,,5786,LOCAL,Facility,Outpatient,37.5 mL,mL,,47,39.95,13.4702,47,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),23.03,49,,percent of total billed charges,,
ALUMINUM CHLORIDE 20 % TOP SOLN,,5786,LOCAL,Facility,Inpatient,37.5 mL,mL,,47,39.95,13.4702,47,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
ALUMINUM CHLORIDE 20 % TOP SOLN,,5786,LOCAL,Facility,Both,37.5 mL,mL,,47,39.95,13.4702,47,CorVel,Worker's Compensation,47,100,,percent of total billed charges,,
ALUMINUM CHLORIDE 20 % TOP SOLN,,5786,LOCAL,Facility,Both,37.5 mL,mL,,47,39.95,13.4702,47,First Health Group Corporation,First Health Network,45.59,97,,percent of total billed charges,,
ALUMINUM CHLORIDE 20 % TOP SOLN,,5786,LOCAL,Facility,Both,37.5 mL,mL,,47,39.95,13.4702,47,"Health Partners, Inc.",Commercial,44.462,94.6,,percent of total billed charges,,
ALUMINUM CHLORIDE 20 % TOP SOLN,,5786,LOCAL,Facility,Outpatient,37.5 mL,mL,,47,39.95,13.4702,47,"Health Partners, Inc.",Medicare Advantage,23.03,49,,percent of total billed charges,,
ALUMINUM CHLORIDE 20 % TOP SOLN,,5786,LOCAL,Facility,Inpatient,37.5 mL,mL,,47,39.95,13.4702,47,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ALUMINUM CHLORIDE 20 % TOP SOLN,,5786,LOCAL,Facility,Both,37.5 mL,mL,,47,39.95,13.4702,47,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),28.2,60,,percent of total billed charges,,
ALUMINUM CHLORIDE 20 % TOP SOLN,,5786,LOCAL,Facility,Both,37.5 mL,mL,,47,39.95,13.4702,47,"Health Partners, Inc.",State of Minnesota Advantage Program,38.305,81.5,,percent of total billed charges,,
ALUMINUM CHLORIDE 20 % TOP SOLN,,5786,LOCAL,Facility,Both,37.5 mL,mL,,47,39.95,13.4702,47,"Health Partners, Inc.",State Public Programs,23.5,50,,percent of total billed charges,,
ALUMINUM CHLORIDE 20 % TOP SOLN,,5786,LOCAL,Facility,Both,37.5 mL,mL,,47,39.95,13.4702,47,Humana Insurance Company,Commercial PPO,44.65,95,,percent of total billed charges,,
ALUMINUM CHLORIDE 20 % TOP SOLN,,5786,LOCAL,Facility,Outpatient,37.5 mL,mL,,47,39.95,13.4702,47,Humana Insurance Company,Medicare PPO,23.03,49,,percent of total billed charges,,
ALUMINUM CHLORIDE 20 % TOP SOLN,,5786,LOCAL,Facility,Inpatient,37.5 mL,mL,,47,39.95,13.4702,47,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
ALUMINUM CHLORIDE 20 % TOP SOLN,,5786,LOCAL,Facility,Both,37.5 mL,mL,,47,39.95,13.4702,47,Medica,Individual & Family,46.577,99.1,,percent of total billed charges,,
ALUMINUM CHLORIDE 20 % TOP SOLN,,5786,LOCAL,Facility,Outpatient,37.5 mL,mL,,47,39.95,13.4702,47,Medica,Medica Advantage Solution,23.406,49.8,,percent of total billed charges,,
ALUMINUM CHLORIDE 20 % TOP SOLN,,5786,LOCAL,Facility,Inpatient,37.5 mL,mL,,47,39.95,13.4702,47,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
ALUMINUM CHLORIDE 20 % TOP SOLN,,5786,LOCAL,Facility,Outpatient,37.5 mL,mL,,47,39.95,13.4702,47,Medica,Medical Assistance,20.962,44.6,,percent of total billed charges,,
ALUMINUM CHLORIDE 20 % TOP SOLN,,5786,LOCAL,Facility,Inpatient,37.5 mL,mL,,47,39.95,13.4702,47,Medica,Medical Assistance,,,,,Included in per diem rate,
ALUMINUM CHLORIDE 20 % TOP SOLN,,5786,LOCAL,Facility,Outpatient,37.5 mL,mL,,47,39.95,13.4702,47,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,23.406,49.8,,percent of total billed charges,,
ALUMINUM CHLORIDE 20 % TOP SOLN,,5786,LOCAL,Facility,Inpatient,37.5 mL,mL,,47,39.95,13.4702,47,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
ALUMINUM CHLORIDE 20 % TOP SOLN,,5786,LOCAL,Facility,Both,37.5 mL,mL,,47,39.95,13.4702,47,"Multiplan, Inc.","Multiplan, Inc.",44.18,94,,percent of total billed charges,,
ALUMINUM CHLORIDE 20 % TOP SOLN,,5786,LOCAL,Facility,Outpatient,37.5 mL,mL,,47,39.95,13.4702,47,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,42.347,90.1,,percent of total billed charges,,
ALUMINUM CHLORIDE 20 % TOP SOLN,,5786,LOCAL,Facility,Inpatient,37.5 mL,mL,,47,39.95,13.4702,47,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
ALUMINUM CHLORIDE 20 % TOP SOLN,,5786,LOCAL,Facility,Both,37.5 mL,mL,,47,39.95,13.4702,47,"Preferred One Administrative Services, INC.",PPO,46.342,98.6,,percent of total billed charges,,
ALUMINUM CHLORIDE 20 % TOP SOLN,,5786,LOCAL,Facility,Outpatient,37.5 mL,mL,,47,39.95,13.4702,47,PrimeWest Health,Minnesota Senior Health Options (MSHO),24.1815,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
ALUMINUM CHLORIDE 20 % TOP SOLN,,5786,LOCAL,Facility,Inpatient,37.5 mL,mL,,47,39.95,13.4702,47,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ALUMINUM CHLORIDE 20 % TOP SOLN,,5786,LOCAL,Facility,Outpatient,37.5 mL,mL,,47,39.95,13.4702,47,PrimeWest Health,MinnesotaCare,24.1392,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
ALUMINUM CHLORIDE 20 % TOP SOLN,,5786,LOCAL,Facility,Inpatient,37.5 mL,mL,,47,39.95,13.4702,47,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
ALUMINUM CHLORIDE 20 % TOP SOLN,,5786,LOCAL,Facility,Both,37.5 mL,mL,,47,39.95,13.4702,47,Sanford Health Plan,Sanford Health Plan,43.24,92,,percent of total billed charges,,
ALUMINUM CHLORIDE 20 % TOP SOLN,,5786,LOCAL,Facility,Outpatient,37.5 mL,mL,,47,39.95,13.4702,47,"UCare Health, Inc.",Individual & Family Plan,26.4845,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
ALUMINUM CHLORIDE 20 % TOP SOLN,,5786,LOCAL,Facility,Inpatient,37.5 mL,mL,,47,39.95,13.4702,47,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
ALUMINUM CHLORIDE 20 % TOP SOLN,,5786,LOCAL,Facility,Outpatient,37.5 mL,mL,,47,39.95,13.4702,47,"UCare Health, Inc.",Medical Assistance,23.7209,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ALUMINUM CHLORIDE 20 % TOP SOLN,,5786,LOCAL,Facility,Inpatient,37.5 mL,mL,,47,39.95,13.4702,47,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
ALUMINUM CHLORIDE 20 % TOP SOLN,,5786,LOCAL,Facility,Outpatient,37.5 mL,mL,,47,39.95,13.4702,47,"UCare Health, Inc.",Medicare Advantage,23.7209,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ALUMINUM CHLORIDE 20 % TOP SOLN,,5786,LOCAL,Facility,Inpatient,37.5 mL,mL,,47,39.95,13.4702,47,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ALUMINUM CHLORIDE 20 % TOP SOLN,,5786,LOCAL,Facility,Outpatient,37.5 mL,mL,,47,39.95,13.4702,47,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),23.7209,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ALUMINUM CHLORIDE 20 % TOP SOLN,,5786,LOCAL,Facility,Inpatient,37.5 mL,mL,,47,39.95,13.4702,47,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ALUMINUM CHLORIDE 20 % TOP SOLN,,5786,LOCAL,Facility,Both,37.5 mL,mL,,47,39.95,13.4702,47,UnitedHealthcare,Individual & Family,44.18,94,,percent of total billed charges,,
ALUMINUM CHLORIDE 20 % TOP SOLN,,5786,LOCAL,Facility,Outpatient,37.5 mL,mL,,47,39.95,13.4702,47,UnitedHealthcare,Medicare Advantage,23.03,49,,percent of total billed charges,,
ALUMINUM CHLORIDE 20 % TOP SOLN,,5786,LOCAL,Facility,Inpatient,37.5 mL,mL,,47,39.95,13.4702,47,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
ALUMINUM CHLORIDE 20 % TOP SOLN,,5786,LOCAL,Facility,Outpatient,37.5 mL,mL,,47,39.95,13.4702,47,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,22.56,48,,percent of total billed charges,,100% of DHS outpatient percentage
ALUMINUM CHLORIDE 20 % TOP SOLN,,5786,LOCAL,Facility,Inpatient,37.5 mL,mL,,47,39.95,13.4702,47,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
PSYLLIUM HUSK (WITH DEXTROSE) 3.4 GRAM/ 6.5 GRAM ORAL POWD,,112283,LOCAL,Facility,Both,397 g,g,,63,53.55,18.0558,63,Aetna,Commercial,57.96,92,,percent of total billed charges,,
PSYLLIUM HUSK (WITH DEXTROSE) 3.4 GRAM/ 6.5 GRAM ORAL POWD,,112283,LOCAL,Facility,Outpatient,397 g,g,,63,53.55,18.0558,63,Aetna,Medicare Advantage,30.87,49,,percent of total billed charges,,
PSYLLIUM HUSK (WITH DEXTROSE) 3.4 GRAM/ 6.5 GRAM ORAL POWD,,112283,LOCAL,Facility,Inpatient,397 g,g,,63,53.55,18.0558,63,Aetna,Medicare Advantage,,,,,Included in per diem rate,
PSYLLIUM HUSK (WITH DEXTROSE) 3.4 GRAM/ 6.5 GRAM ORAL POWD,,112283,LOCAL,Facility,Both,397 g,g,,63,53.55,18.0558,63,Aetna,PPO,58.59,93,,percent of total billed charges,,
PSYLLIUM HUSK (WITH DEXTROSE) 3.4 GRAM/ 6.5 GRAM ORAL POWD,,112283,LOCAL,Facility,Both,397 g,g,,63,53.55,18.0558,63,America's PPO,America's PPO,60.4989,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
PSYLLIUM HUSK (WITH DEXTROSE) 3.4 GRAM/ 6.5 GRAM ORAL POWD,,112283,LOCAL,Facility,Both,397 g,g,,63,53.55,18.0558,63,BlueCross BlueShield Minnesota, Federal Employee Program,61.992,98.4,,percent of total billed charges,,
PSYLLIUM HUSK (WITH DEXTROSE) 3.4 GRAM/ 6.5 GRAM ORAL POWD,,112283,LOCAL,Facility,Both,397 g,g,,63,53.55,18.0558,63,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,63,100,,percent of total billed charges,,
PSYLLIUM HUSK (WITH DEXTROSE) 3.4 GRAM/ 6.5 GRAM ORAL POWD,,112283,LOCAL,Facility,Both,397 g,g,,63,53.55,18.0558,63,BlueCross BlueShield Minnesota,High Value Network Plan,56.7,90,,percent of total billed charges,,
PSYLLIUM HUSK (WITH DEXTROSE) 3.4 GRAM/ 6.5 GRAM ORAL POWD,,112283,LOCAL,Facility,Outpatient,397 g,g,,63,53.55,18.0558,63,BlueCross BlueShield Minnesota,Medicare Advantage,30.87,49,,percent of total billed charges,,
PSYLLIUM HUSK (WITH DEXTROSE) 3.4 GRAM/ 6.5 GRAM ORAL POWD,,112283,LOCAL,Facility,Inpatient,397 g,g,,63,53.55,18.0558,63,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
PSYLLIUM HUSK (WITH DEXTROSE) 3.4 GRAM/ 6.5 GRAM ORAL POWD,,112283,LOCAL,Facility,Both,397 g,g,,63,53.55,18.0558,63,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,55.7991,88.57,,percent of total billed charges,,
PSYLLIUM HUSK (WITH DEXTROSE) 3.4 GRAM/ 6.5 GRAM ORAL POWD,,112283,LOCAL,Facility,Both,397 g,g,,63,53.55,18.0558,63,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,18.0558,28.66,,percent of total billed charges,,
PSYLLIUM HUSK (WITH DEXTROSE) 3.4 GRAM/ 6.5 GRAM ORAL POWD,,112283,LOCAL,Facility,Outpatient,397 g,g,,63,53.55,18.0558,63,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),30.87,49,,percent of total billed charges,,
PSYLLIUM HUSK (WITH DEXTROSE) 3.4 GRAM/ 6.5 GRAM ORAL POWD,,112283,LOCAL,Facility,Inpatient,397 g,g,,63,53.55,18.0558,63,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
PSYLLIUM HUSK (WITH DEXTROSE) 3.4 GRAM/ 6.5 GRAM ORAL POWD,,112283,LOCAL,Facility,Both,397 g,g,,63,53.55,18.0558,63,CorVel,Worker's Compensation,63,100,,percent of total billed charges,,
PSYLLIUM HUSK (WITH DEXTROSE) 3.4 GRAM/ 6.5 GRAM ORAL POWD,,112283,LOCAL,Facility,Both,397 g,g,,63,53.55,18.0558,63,First Health Group Corporation,First Health Network,61.11,97,,percent of total billed charges,,
PSYLLIUM HUSK (WITH DEXTROSE) 3.4 GRAM/ 6.5 GRAM ORAL POWD,,112283,LOCAL,Facility,Both,397 g,g,,63,53.55,18.0558,63,"Health Partners, Inc.",Commercial,59.598,94.6,,percent of total billed charges,,
PSYLLIUM HUSK (WITH DEXTROSE) 3.4 GRAM/ 6.5 GRAM ORAL POWD,,112283,LOCAL,Facility,Outpatient,397 g,g,,63,53.55,18.0558,63,"Health Partners, Inc.",Medicare Advantage,30.87,49,,percent of total billed charges,,
PSYLLIUM HUSK (WITH DEXTROSE) 3.4 GRAM/ 6.5 GRAM ORAL POWD,,112283,LOCAL,Facility,Inpatient,397 g,g,,63,53.55,18.0558,63,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PSYLLIUM HUSK (WITH DEXTROSE) 3.4 GRAM/ 6.5 GRAM ORAL POWD,,112283,LOCAL,Facility,Both,397 g,g,,63,53.55,18.0558,63,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),37.8,60,,percent of total billed charges,,
PSYLLIUM HUSK (WITH DEXTROSE) 3.4 GRAM/ 6.5 GRAM ORAL POWD,,112283,LOCAL,Facility,Both,397 g,g,,63,53.55,18.0558,63,"Health Partners, Inc.",State of Minnesota Advantage Program,51.345,81.5,,percent of total billed charges,,
PSYLLIUM HUSK (WITH DEXTROSE) 3.4 GRAM/ 6.5 GRAM ORAL POWD,,112283,LOCAL,Facility,Both,397 g,g,,63,53.55,18.0558,63,"Health Partners, Inc.",State Public Programs,31.5,50,,percent of total billed charges,,
PSYLLIUM HUSK (WITH DEXTROSE) 3.4 GRAM/ 6.5 GRAM ORAL POWD,,112283,LOCAL,Facility,Both,397 g,g,,63,53.55,18.0558,63,Humana Insurance Company,Commercial PPO,59.85,95,,percent of total billed charges,,
PSYLLIUM HUSK (WITH DEXTROSE) 3.4 GRAM/ 6.5 GRAM ORAL POWD,,112283,LOCAL,Facility,Outpatient,397 g,g,,63,53.55,18.0558,63,Humana Insurance Company,Medicare PPO,30.87,49,,percent of total billed charges,,
PSYLLIUM HUSK (WITH DEXTROSE) 3.4 GRAM/ 6.5 GRAM ORAL POWD,,112283,LOCAL,Facility,Inpatient,397 g,g,,63,53.55,18.0558,63,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
PSYLLIUM HUSK (WITH DEXTROSE) 3.4 GRAM/ 6.5 GRAM ORAL POWD,,112283,LOCAL,Facility,Both,397 g,g,,63,53.55,18.0558,63,Medica,Individual & Family,62.433,99.1,,percent of total billed charges,,
PSYLLIUM HUSK (WITH DEXTROSE) 3.4 GRAM/ 6.5 GRAM ORAL POWD,,112283,LOCAL,Facility,Outpatient,397 g,g,,63,53.55,18.0558,63,Medica,Medica Advantage Solution,31.374,49.8,,percent of total billed charges,,
PSYLLIUM HUSK (WITH DEXTROSE) 3.4 GRAM/ 6.5 GRAM ORAL POWD,,112283,LOCAL,Facility,Inpatient,397 g,g,,63,53.55,18.0558,63,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
PSYLLIUM HUSK (WITH DEXTROSE) 3.4 GRAM/ 6.5 GRAM ORAL POWD,,112283,LOCAL,Facility,Outpatient,397 g,g,,63,53.55,18.0558,63,Medica,Medical Assistance,28.098,44.6,,percent of total billed charges,,
PSYLLIUM HUSK (WITH DEXTROSE) 3.4 GRAM/ 6.5 GRAM ORAL POWD,,112283,LOCAL,Facility,Inpatient,397 g,g,,63,53.55,18.0558,63,Medica,Medical Assistance,,,,,Included in per diem rate,
PSYLLIUM HUSK (WITH DEXTROSE) 3.4 GRAM/ 6.5 GRAM ORAL POWD,,112283,LOCAL,Facility,Outpatient,397 g,g,,63,53.55,18.0558,63,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,31.374,49.8,,percent of total billed charges,,
PSYLLIUM HUSK (WITH DEXTROSE) 3.4 GRAM/ 6.5 GRAM ORAL POWD,,112283,LOCAL,Facility,Inpatient,397 g,g,,63,53.55,18.0558,63,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
PSYLLIUM HUSK (WITH DEXTROSE) 3.4 GRAM/ 6.5 GRAM ORAL POWD,,112283,LOCAL,Facility,Both,397 g,g,,63,53.55,18.0558,63,"Multiplan, Inc.","Multiplan, Inc.",59.22,94,,percent of total billed charges,,
PSYLLIUM HUSK (WITH DEXTROSE) 3.4 GRAM/ 6.5 GRAM ORAL POWD,,112283,LOCAL,Facility,Outpatient,397 g,g,,63,53.55,18.0558,63,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,56.763,90.1,,percent of total billed charges,,
PSYLLIUM HUSK (WITH DEXTROSE) 3.4 GRAM/ 6.5 GRAM ORAL POWD,,112283,LOCAL,Facility,Inpatient,397 g,g,,63,53.55,18.0558,63,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
PSYLLIUM HUSK (WITH DEXTROSE) 3.4 GRAM/ 6.5 GRAM ORAL POWD,,112283,LOCAL,Facility,Both,397 g,g,,63,53.55,18.0558,63,"Preferred One Administrative Services, INC.",PPO,62.118,98.6,,percent of total billed charges,,
PSYLLIUM HUSK (WITH DEXTROSE) 3.4 GRAM/ 6.5 GRAM ORAL POWD,,112283,LOCAL,Facility,Outpatient,397 g,g,,63,53.55,18.0558,63,PrimeWest Health,Minnesota Senior Health Options (MSHO),32.4135,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
PSYLLIUM HUSK (WITH DEXTROSE) 3.4 GRAM/ 6.5 GRAM ORAL POWD,,112283,LOCAL,Facility,Inpatient,397 g,g,,63,53.55,18.0558,63,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PSYLLIUM HUSK (WITH DEXTROSE) 3.4 GRAM/ 6.5 GRAM ORAL POWD,,112283,LOCAL,Facility,Outpatient,397 g,g,,63,53.55,18.0558,63,PrimeWest Health,MinnesotaCare,32.3568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
PSYLLIUM HUSK (WITH DEXTROSE) 3.4 GRAM/ 6.5 GRAM ORAL POWD,,112283,LOCAL,Facility,Inpatient,397 g,g,,63,53.55,18.0558,63,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
PSYLLIUM HUSK (WITH DEXTROSE) 3.4 GRAM/ 6.5 GRAM ORAL POWD,,112283,LOCAL,Facility,Both,397 g,g,,63,53.55,18.0558,63,Sanford Health Plan,Sanford Health Plan,57.96,92,,percent of total billed charges,,
PSYLLIUM HUSK (WITH DEXTROSE) 3.4 GRAM/ 6.5 GRAM ORAL POWD,,112283,LOCAL,Facility,Outpatient,397 g,g,,63,53.55,18.0558,63,"UCare Health, Inc.",Individual & Family Plan,35.5005,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
PSYLLIUM HUSK (WITH DEXTROSE) 3.4 GRAM/ 6.5 GRAM ORAL POWD,,112283,LOCAL,Facility,Inpatient,397 g,g,,63,53.55,18.0558,63,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
PSYLLIUM HUSK (WITH DEXTROSE) 3.4 GRAM/ 6.5 GRAM ORAL POWD,,112283,LOCAL,Facility,Outpatient,397 g,g,,63,53.55,18.0558,63,"UCare Health, Inc.",Medical Assistance,31.7961,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PSYLLIUM HUSK (WITH DEXTROSE) 3.4 GRAM/ 6.5 GRAM ORAL POWD,,112283,LOCAL,Facility,Inpatient,397 g,g,,63,53.55,18.0558,63,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
PSYLLIUM HUSK (WITH DEXTROSE) 3.4 GRAM/ 6.5 GRAM ORAL POWD,,112283,LOCAL,Facility,Outpatient,397 g,g,,63,53.55,18.0558,63,"UCare Health, Inc.",Medicare Advantage,31.7961,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PSYLLIUM HUSK (WITH DEXTROSE) 3.4 GRAM/ 6.5 GRAM ORAL POWD,,112283,LOCAL,Facility,Inpatient,397 g,g,,63,53.55,18.0558,63,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PSYLLIUM HUSK (WITH DEXTROSE) 3.4 GRAM/ 6.5 GRAM ORAL POWD,,112283,LOCAL,Facility,Outpatient,397 g,g,,63,53.55,18.0558,63,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),31.7961,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PSYLLIUM HUSK (WITH DEXTROSE) 3.4 GRAM/ 6.5 GRAM ORAL POWD,,112283,LOCAL,Facility,Inpatient,397 g,g,,63,53.55,18.0558,63,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PSYLLIUM HUSK (WITH DEXTROSE) 3.4 GRAM/ 6.5 GRAM ORAL POWD,,112283,LOCAL,Facility,Both,397 g,g,,63,53.55,18.0558,63,UnitedHealthcare,Individual & Family,59.22,94,,percent of total billed charges,,
PSYLLIUM HUSK (WITH DEXTROSE) 3.4 GRAM/ 6.5 GRAM ORAL POWD,,112283,LOCAL,Facility,Outpatient,397 g,g,,63,53.55,18.0558,63,UnitedHealthcare,Medicare Advantage,30.87,49,,percent of total billed charges,,
PSYLLIUM HUSK (WITH DEXTROSE) 3.4 GRAM/ 6.5 GRAM ORAL POWD,,112283,LOCAL,Facility,Inpatient,397 g,g,,63,53.55,18.0558,63,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
PSYLLIUM HUSK (WITH DEXTROSE) 3.4 GRAM/ 6.5 GRAM ORAL POWD,,112283,LOCAL,Facility,Outpatient,397 g,g,,63,53.55,18.0558,63,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,30.24,48,,percent of total billed charges,,100% of DHS outpatient percentage
PSYLLIUM HUSK (WITH DEXTROSE) 3.4 GRAM/ 6.5 GRAM ORAL POWD,,112283,LOCAL,Facility,Inpatient,397 g,g,,63,53.55,18.0558,63,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
TIOTROPIUM BROMIDE 2.5 MCG/ACTUATION INHL MIST,,113112,LOCAL,Facility,Both,4 g,g,,378,321.3,108.3348,378,Aetna,Commercial,347.76,92,,percent of total billed charges,,
TIOTROPIUM BROMIDE 2.5 MCG/ACTUATION INHL MIST,,113112,LOCAL,Facility,Outpatient,4 g,g,,378,321.3,108.3348,378,Aetna,Medicare Advantage,185.22,49,,percent of total billed charges,,
TIOTROPIUM BROMIDE 2.5 MCG/ACTUATION INHL MIST,,113112,LOCAL,Facility,Inpatient,4 g,g,,378,321.3,108.3348,378,Aetna,Medicare Advantage,,,,,Included in per diem rate,
TIOTROPIUM BROMIDE 2.5 MCG/ACTUATION INHL MIST,,113112,LOCAL,Facility,Both,4 g,g,,378,321.3,108.3348,378,Aetna,PPO,351.54,93,,percent of total billed charges,,
TIOTROPIUM BROMIDE 2.5 MCG/ACTUATION INHL MIST,,113112,LOCAL,Facility,Both,4 g,g,,378,321.3,108.3348,378,America's PPO,America's PPO,362.9934,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
TIOTROPIUM BROMIDE 2.5 MCG/ACTUATION INHL MIST,,113112,LOCAL,Facility,Both,4 g,g,,378,321.3,108.3348,378,BlueCross BlueShield Minnesota, Federal Employee Program,371.952,98.4,,percent of total billed charges,,
TIOTROPIUM BROMIDE 2.5 MCG/ACTUATION INHL MIST,,113112,LOCAL,Facility,Both,4 g,g,,378,321.3,108.3348,378,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,378,100,,percent of total billed charges,,
TIOTROPIUM BROMIDE 2.5 MCG/ACTUATION INHL MIST,,113112,LOCAL,Facility,Both,4 g,g,,378,321.3,108.3348,378,BlueCross BlueShield Minnesota,High Value Network Plan,340.2,90,,percent of total billed charges,,
TIOTROPIUM BROMIDE 2.5 MCG/ACTUATION INHL MIST,,113112,LOCAL,Facility,Outpatient,4 g,g,,378,321.3,108.3348,378,BlueCross BlueShield Minnesota,Medicare Advantage,185.22,49,,percent of total billed charges,,
TIOTROPIUM BROMIDE 2.5 MCG/ACTUATION INHL MIST,,113112,LOCAL,Facility,Inpatient,4 g,g,,378,321.3,108.3348,378,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
TIOTROPIUM BROMIDE 2.5 MCG/ACTUATION INHL MIST,,113112,LOCAL,Facility,Both,4 g,g,,378,321.3,108.3348,378,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,334.7946,88.57,,percent of total billed charges,,
TIOTROPIUM BROMIDE 2.5 MCG/ACTUATION INHL MIST,,113112,LOCAL,Facility,Both,4 g,g,,378,321.3,108.3348,378,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,108.3348,28.66,,percent of total billed charges,,
TIOTROPIUM BROMIDE 2.5 MCG/ACTUATION INHL MIST,,113112,LOCAL,Facility,Outpatient,4 g,g,,378,321.3,108.3348,378,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),185.22,49,,percent of total billed charges,,
TIOTROPIUM BROMIDE 2.5 MCG/ACTUATION INHL MIST,,113112,LOCAL,Facility,Inpatient,4 g,g,,378,321.3,108.3348,378,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
TIOTROPIUM BROMIDE 2.5 MCG/ACTUATION INHL MIST,,113112,LOCAL,Facility,Both,4 g,g,,378,321.3,108.3348,378,CorVel,Worker's Compensation,378,100,,percent of total billed charges,,
TIOTROPIUM BROMIDE 2.5 MCG/ACTUATION INHL MIST,,113112,LOCAL,Facility,Both,4 g,g,,378,321.3,108.3348,378,First Health Group Corporation,First Health Network,366.66,97,,percent of total billed charges,,
TIOTROPIUM BROMIDE 2.5 MCG/ACTUATION INHL MIST,,113112,LOCAL,Facility,Both,4 g,g,,378,321.3,108.3348,378,"Health Partners, Inc.",Commercial,357.588,94.6,,percent of total billed charges,,
TIOTROPIUM BROMIDE 2.5 MCG/ACTUATION INHL MIST,,113112,LOCAL,Facility,Outpatient,4 g,g,,378,321.3,108.3348,378,"Health Partners, Inc.",Medicare Advantage,185.22,49,,percent of total billed charges,,
TIOTROPIUM BROMIDE 2.5 MCG/ACTUATION INHL MIST,,113112,LOCAL,Facility,Inpatient,4 g,g,,378,321.3,108.3348,378,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
TIOTROPIUM BROMIDE 2.5 MCG/ACTUATION INHL MIST,,113112,LOCAL,Facility,Both,4 g,g,,378,321.3,108.3348,378,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),226.8,60,,percent of total billed charges,,
TIOTROPIUM BROMIDE 2.5 MCG/ACTUATION INHL MIST,,113112,LOCAL,Facility,Both,4 g,g,,378,321.3,108.3348,378,"Health Partners, Inc.",State of Minnesota Advantage Program,308.07,81.5,,percent of total billed charges,,
TIOTROPIUM BROMIDE 2.5 MCG/ACTUATION INHL MIST,,113112,LOCAL,Facility,Both,4 g,g,,378,321.3,108.3348,378,"Health Partners, Inc.",State Public Programs,189,50,,percent of total billed charges,,
TIOTROPIUM BROMIDE 2.5 MCG/ACTUATION INHL MIST,,113112,LOCAL,Facility,Both,4 g,g,,378,321.3,108.3348,378,Humana Insurance Company,Commercial PPO,359.1,95,,percent of total billed charges,,
TIOTROPIUM BROMIDE 2.5 MCG/ACTUATION INHL MIST,,113112,LOCAL,Facility,Outpatient,4 g,g,,378,321.3,108.3348,378,Humana Insurance Company,Medicare PPO,185.22,49,,percent of total billed charges,,
TIOTROPIUM BROMIDE 2.5 MCG/ACTUATION INHL MIST,,113112,LOCAL,Facility,Inpatient,4 g,g,,378,321.3,108.3348,378,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
TIOTROPIUM BROMIDE 2.5 MCG/ACTUATION INHL MIST,,113112,LOCAL,Facility,Both,4 g,g,,378,321.3,108.3348,378,Medica,Individual & Family,374.598,99.1,,percent of total billed charges,,
TIOTROPIUM BROMIDE 2.5 MCG/ACTUATION INHL MIST,,113112,LOCAL,Facility,Outpatient,4 g,g,,378,321.3,108.3348,378,Medica,Medica Advantage Solution,188.244,49.8,,percent of total billed charges,,
TIOTROPIUM BROMIDE 2.5 MCG/ACTUATION INHL MIST,,113112,LOCAL,Facility,Inpatient,4 g,g,,378,321.3,108.3348,378,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
TIOTROPIUM BROMIDE 2.5 MCG/ACTUATION INHL MIST,,113112,LOCAL,Facility,Outpatient,4 g,g,,378,321.3,108.3348,378,Medica,Medical Assistance,168.588,44.6,,percent of total billed charges,,
TIOTROPIUM BROMIDE 2.5 MCG/ACTUATION INHL MIST,,113112,LOCAL,Facility,Inpatient,4 g,g,,378,321.3,108.3348,378,Medica,Medical Assistance,,,,,Included in per diem rate,
TIOTROPIUM BROMIDE 2.5 MCG/ACTUATION INHL MIST,,113112,LOCAL,Facility,Outpatient,4 g,g,,378,321.3,108.3348,378,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,188.244,49.8,,percent of total billed charges,,
TIOTROPIUM BROMIDE 2.5 MCG/ACTUATION INHL MIST,,113112,LOCAL,Facility,Inpatient,4 g,g,,378,321.3,108.3348,378,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
TIOTROPIUM BROMIDE 2.5 MCG/ACTUATION INHL MIST,,113112,LOCAL,Facility,Both,4 g,g,,378,321.3,108.3348,378,"Multiplan, Inc.","Multiplan, Inc.",355.32,94,,percent of total billed charges,,
TIOTROPIUM BROMIDE 2.5 MCG/ACTUATION INHL MIST,,113112,LOCAL,Facility,Outpatient,4 g,g,,378,321.3,108.3348,378,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,340.578,90.1,,percent of total billed charges,,
TIOTROPIUM BROMIDE 2.5 MCG/ACTUATION INHL MIST,,113112,LOCAL,Facility,Inpatient,4 g,g,,378,321.3,108.3348,378,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
TIOTROPIUM BROMIDE 2.5 MCG/ACTUATION INHL MIST,,113112,LOCAL,Facility,Both,4 g,g,,378,321.3,108.3348,378,"Preferred One Administrative Services, INC.",PPO,372.708,98.6,,percent of total billed charges,,
TIOTROPIUM BROMIDE 2.5 MCG/ACTUATION INHL MIST,,113112,LOCAL,Facility,Outpatient,4 g,g,,378,321.3,108.3348,378,PrimeWest Health,Minnesota Senior Health Options (MSHO),194.481,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
TIOTROPIUM BROMIDE 2.5 MCG/ACTUATION INHL MIST,,113112,LOCAL,Facility,Inpatient,4 g,g,,378,321.3,108.3348,378,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
TIOTROPIUM BROMIDE 2.5 MCG/ACTUATION INHL MIST,,113112,LOCAL,Facility,Outpatient,4 g,g,,378,321.3,108.3348,378,PrimeWest Health,MinnesotaCare,194.1408,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
TIOTROPIUM BROMIDE 2.5 MCG/ACTUATION INHL MIST,,113112,LOCAL,Facility,Inpatient,4 g,g,,378,321.3,108.3348,378,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
TIOTROPIUM BROMIDE 2.5 MCG/ACTUATION INHL MIST,,113112,LOCAL,Facility,Both,4 g,g,,378,321.3,108.3348,378,Sanford Health Plan,Sanford Health Plan,347.76,92,,percent of total billed charges,,
TIOTROPIUM BROMIDE 2.5 MCG/ACTUATION INHL MIST,,113112,LOCAL,Facility,Outpatient,4 g,g,,378,321.3,108.3348,378,"UCare Health, Inc.",Individual & Family Plan,213.003,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
TIOTROPIUM BROMIDE 2.5 MCG/ACTUATION INHL MIST,,113112,LOCAL,Facility,Inpatient,4 g,g,,378,321.3,108.3348,378,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
TIOTROPIUM BROMIDE 2.5 MCG/ACTUATION INHL MIST,,113112,LOCAL,Facility,Outpatient,4 g,g,,378,321.3,108.3348,378,"UCare Health, Inc.",Medical Assistance,190.7766,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TIOTROPIUM BROMIDE 2.5 MCG/ACTUATION INHL MIST,,113112,LOCAL,Facility,Inpatient,4 g,g,,378,321.3,108.3348,378,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
TIOTROPIUM BROMIDE 2.5 MCG/ACTUATION INHL MIST,,113112,LOCAL,Facility,Outpatient,4 g,g,,378,321.3,108.3348,378,"UCare Health, Inc.",Medicare Advantage,190.7766,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TIOTROPIUM BROMIDE 2.5 MCG/ACTUATION INHL MIST,,113112,LOCAL,Facility,Inpatient,4 g,g,,378,321.3,108.3348,378,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
TIOTROPIUM BROMIDE 2.5 MCG/ACTUATION INHL MIST,,113112,LOCAL,Facility,Outpatient,4 g,g,,378,321.3,108.3348,378,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),190.7766,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TIOTROPIUM BROMIDE 2.5 MCG/ACTUATION INHL MIST,,113112,LOCAL,Facility,Inpatient,4 g,g,,378,321.3,108.3348,378,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
TIOTROPIUM BROMIDE 2.5 MCG/ACTUATION INHL MIST,,113112,LOCAL,Facility,Both,4 g,g,,378,321.3,108.3348,378,UnitedHealthcare,Individual & Family,355.32,94,,percent of total billed charges,,
TIOTROPIUM BROMIDE 2.5 MCG/ACTUATION INHL MIST,,113112,LOCAL,Facility,Outpatient,4 g,g,,378,321.3,108.3348,378,UnitedHealthcare,Medicare Advantage,185.22,49,,percent of total billed charges,,
TIOTROPIUM BROMIDE 2.5 MCG/ACTUATION INHL MIST,,113112,LOCAL,Facility,Inpatient,4 g,g,,378,321.3,108.3348,378,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
TIOTROPIUM BROMIDE 2.5 MCG/ACTUATION INHL MIST,,113112,LOCAL,Facility,Outpatient,4 g,g,,378,321.3,108.3348,378,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,181.44,48,,percent of total billed charges,,100% of DHS outpatient percentage
TIOTROPIUM BROMIDE 2.5 MCG/ACTUATION INHL MIST,,113112,LOCAL,Facility,Inpatient,4 g,g,,378,321.3,108.3348,378,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
IPRATROPIUM-ALBUTEROL 20-100 MCG/ACTUATION INHL MIST,,113240,LOCAL,Facility,Both,4 g,g,,1882,1599.7,539.3812,1882,Aetna,Commercial,1731.44,92,,percent of total billed charges,,
IPRATROPIUM-ALBUTEROL 20-100 MCG/ACTUATION INHL MIST,,113240,LOCAL,Facility,Outpatient,4 g,g,,1882,1599.7,539.3812,1882,Aetna,Medicare Advantage,922.18,49,,percent of total billed charges,,
IPRATROPIUM-ALBUTEROL 20-100 MCG/ACTUATION INHL MIST,,113240,LOCAL,Facility,Inpatient,4 g,g,,1882,1599.7,539.3812,1882,Aetna,Medicare Advantage,,,,,Included in per diem rate,
IPRATROPIUM-ALBUTEROL 20-100 MCG/ACTUATION INHL MIST,,113240,LOCAL,Facility,Both,4 g,g,,1882,1599.7,539.3812,1882,Aetna,PPO,1750.26,93,,percent of total billed charges,,
IPRATROPIUM-ALBUTEROL 20-100 MCG/ACTUATION INHL MIST,,113240,LOCAL,Facility,Both,4 g,g,,1882,1599.7,539.3812,1882,America's PPO,America's PPO,1807.2846,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
IPRATROPIUM-ALBUTEROL 20-100 MCG/ACTUATION INHL MIST,,113240,LOCAL,Facility,Both,4 g,g,,1882,1599.7,539.3812,1882,BlueCross BlueShield Minnesota, Federal Employee Program,1851.888,98.4,,percent of total billed charges,,
IPRATROPIUM-ALBUTEROL 20-100 MCG/ACTUATION INHL MIST,,113240,LOCAL,Facility,Both,4 g,g,,1882,1599.7,539.3812,1882,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1882,100,,percent of total billed charges,,
IPRATROPIUM-ALBUTEROL 20-100 MCG/ACTUATION INHL MIST,,113240,LOCAL,Facility,Both,4 g,g,,1882,1599.7,539.3812,1882,BlueCross BlueShield Minnesota,High Value Network Plan,1693.8,90,,percent of total billed charges,,
IPRATROPIUM-ALBUTEROL 20-100 MCG/ACTUATION INHL MIST,,113240,LOCAL,Facility,Outpatient,4 g,g,,1882,1599.7,539.3812,1882,BlueCross BlueShield Minnesota,Medicare Advantage,922.18,49,,percent of total billed charges,,
IPRATROPIUM-ALBUTEROL 20-100 MCG/ACTUATION INHL MIST,,113240,LOCAL,Facility,Inpatient,4 g,g,,1882,1599.7,539.3812,1882,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
IPRATROPIUM-ALBUTEROL 20-100 MCG/ACTUATION INHL MIST,,113240,LOCAL,Facility,Both,4 g,g,,1882,1599.7,539.3812,1882,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1666.8874,88.57,,percent of total billed charges,,
IPRATROPIUM-ALBUTEROL 20-100 MCG/ACTUATION INHL MIST,,113240,LOCAL,Facility,Both,4 g,g,,1882,1599.7,539.3812,1882,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,539.3812,28.66,,percent of total billed charges,,
IPRATROPIUM-ALBUTEROL 20-100 MCG/ACTUATION INHL MIST,,113240,LOCAL,Facility,Outpatient,4 g,g,,1882,1599.7,539.3812,1882,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),922.18,49,,percent of total billed charges,,
IPRATROPIUM-ALBUTEROL 20-100 MCG/ACTUATION INHL MIST,,113240,LOCAL,Facility,Inpatient,4 g,g,,1882,1599.7,539.3812,1882,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
IPRATROPIUM-ALBUTEROL 20-100 MCG/ACTUATION INHL MIST,,113240,LOCAL,Facility,Both,4 g,g,,1882,1599.7,539.3812,1882,CorVel,Worker's Compensation,1882,100,,percent of total billed charges,,
IPRATROPIUM-ALBUTEROL 20-100 MCG/ACTUATION INHL MIST,,113240,LOCAL,Facility,Both,4 g,g,,1882,1599.7,539.3812,1882,First Health Group Corporation,First Health Network,1825.54,97,,percent of total billed charges,,
IPRATROPIUM-ALBUTEROL 20-100 MCG/ACTUATION INHL MIST,,113240,LOCAL,Facility,Both,4 g,g,,1882,1599.7,539.3812,1882,"Health Partners, Inc.",Commercial,1780.372,94.6,,percent of total billed charges,,
IPRATROPIUM-ALBUTEROL 20-100 MCG/ACTUATION INHL MIST,,113240,LOCAL,Facility,Outpatient,4 g,g,,1882,1599.7,539.3812,1882,"Health Partners, Inc.",Medicare Advantage,922.18,49,,percent of total billed charges,,
IPRATROPIUM-ALBUTEROL 20-100 MCG/ACTUATION INHL MIST,,113240,LOCAL,Facility,Inpatient,4 g,g,,1882,1599.7,539.3812,1882,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
IPRATROPIUM-ALBUTEROL 20-100 MCG/ACTUATION INHL MIST,,113240,LOCAL,Facility,Both,4 g,g,,1882,1599.7,539.3812,1882,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1129.2,60,,percent of total billed charges,,
IPRATROPIUM-ALBUTEROL 20-100 MCG/ACTUATION INHL MIST,,113240,LOCAL,Facility,Both,4 g,g,,1882,1599.7,539.3812,1882,"Health Partners, Inc.",State of Minnesota Advantage Program,1533.83,81.5,,percent of total billed charges,,
IPRATROPIUM-ALBUTEROL 20-100 MCG/ACTUATION INHL MIST,,113240,LOCAL,Facility,Both,4 g,g,,1882,1599.7,539.3812,1882,"Health Partners, Inc.",State Public Programs,941,50,,percent of total billed charges,,
IPRATROPIUM-ALBUTEROL 20-100 MCG/ACTUATION INHL MIST,,113240,LOCAL,Facility,Both,4 g,g,,1882,1599.7,539.3812,1882,Humana Insurance Company,Commercial PPO,1787.9,95,,percent of total billed charges,,
IPRATROPIUM-ALBUTEROL 20-100 MCG/ACTUATION INHL MIST,,113240,LOCAL,Facility,Outpatient,4 g,g,,1882,1599.7,539.3812,1882,Humana Insurance Company,Medicare PPO,922.18,49,,percent of total billed charges,,
IPRATROPIUM-ALBUTEROL 20-100 MCG/ACTUATION INHL MIST,,113240,LOCAL,Facility,Inpatient,4 g,g,,1882,1599.7,539.3812,1882,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
IPRATROPIUM-ALBUTEROL 20-100 MCG/ACTUATION INHL MIST,,113240,LOCAL,Facility,Both,4 g,g,,1882,1599.7,539.3812,1882,Medica,Individual & Family,1865.062,99.1,,percent of total billed charges,,
IPRATROPIUM-ALBUTEROL 20-100 MCG/ACTUATION INHL MIST,,113240,LOCAL,Facility,Outpatient,4 g,g,,1882,1599.7,539.3812,1882,Medica,Medica Advantage Solution,937.236,49.8,,percent of total billed charges,,
IPRATROPIUM-ALBUTEROL 20-100 MCG/ACTUATION INHL MIST,,113240,LOCAL,Facility,Inpatient,4 g,g,,1882,1599.7,539.3812,1882,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
IPRATROPIUM-ALBUTEROL 20-100 MCG/ACTUATION INHL MIST,,113240,LOCAL,Facility,Outpatient,4 g,g,,1882,1599.7,539.3812,1882,Medica,Medical Assistance,839.372,44.6,,percent of total billed charges,,
IPRATROPIUM-ALBUTEROL 20-100 MCG/ACTUATION INHL MIST,,113240,LOCAL,Facility,Inpatient,4 g,g,,1882,1599.7,539.3812,1882,Medica,Medical Assistance,,,,,Included in per diem rate,
IPRATROPIUM-ALBUTEROL 20-100 MCG/ACTUATION INHL MIST,,113240,LOCAL,Facility,Outpatient,4 g,g,,1882,1599.7,539.3812,1882,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,937.236,49.8,,percent of total billed charges,,
IPRATROPIUM-ALBUTEROL 20-100 MCG/ACTUATION INHL MIST,,113240,LOCAL,Facility,Inpatient,4 g,g,,1882,1599.7,539.3812,1882,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
IPRATROPIUM-ALBUTEROL 20-100 MCG/ACTUATION INHL MIST,,113240,LOCAL,Facility,Both,4 g,g,,1882,1599.7,539.3812,1882,"Multiplan, Inc.","Multiplan, Inc.",1769.08,94,,percent of total billed charges,,
IPRATROPIUM-ALBUTEROL 20-100 MCG/ACTUATION INHL MIST,,113240,LOCAL,Facility,Outpatient,4 g,g,,1882,1599.7,539.3812,1882,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1695.682,90.1,,percent of total billed charges,,
IPRATROPIUM-ALBUTEROL 20-100 MCG/ACTUATION INHL MIST,,113240,LOCAL,Facility,Inpatient,4 g,g,,1882,1599.7,539.3812,1882,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
IPRATROPIUM-ALBUTEROL 20-100 MCG/ACTUATION INHL MIST,,113240,LOCAL,Facility,Both,4 g,g,,1882,1599.7,539.3812,1882,"Preferred One Administrative Services, INC.",PPO,1855.652,98.6,,percent of total billed charges,,
IPRATROPIUM-ALBUTEROL 20-100 MCG/ACTUATION INHL MIST,,113240,LOCAL,Facility,Outpatient,4 g,g,,1882,1599.7,539.3812,1882,PrimeWest Health,Minnesota Senior Health Options (MSHO),968.289,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
IPRATROPIUM-ALBUTEROL 20-100 MCG/ACTUATION INHL MIST,,113240,LOCAL,Facility,Inpatient,4 g,g,,1882,1599.7,539.3812,1882,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
IPRATROPIUM-ALBUTEROL 20-100 MCG/ACTUATION INHL MIST,,113240,LOCAL,Facility,Outpatient,4 g,g,,1882,1599.7,539.3812,1882,PrimeWest Health,MinnesotaCare,966.5952,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
IPRATROPIUM-ALBUTEROL 20-100 MCG/ACTUATION INHL MIST,,113240,LOCAL,Facility,Inpatient,4 g,g,,1882,1599.7,539.3812,1882,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
IPRATROPIUM-ALBUTEROL 20-100 MCG/ACTUATION INHL MIST,,113240,LOCAL,Facility,Both,4 g,g,,1882,1599.7,539.3812,1882,Sanford Health Plan,Sanford Health Plan,1731.44,92,,percent of total billed charges,,
IPRATROPIUM-ALBUTEROL 20-100 MCG/ACTUATION INHL MIST,,113240,LOCAL,Facility,Outpatient,4 g,g,,1882,1599.7,539.3812,1882,"UCare Health, Inc.",Individual & Family Plan,1060.507,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
IPRATROPIUM-ALBUTEROL 20-100 MCG/ACTUATION INHL MIST,,113240,LOCAL,Facility,Inpatient,4 g,g,,1882,1599.7,539.3812,1882,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
IPRATROPIUM-ALBUTEROL 20-100 MCG/ACTUATION INHL MIST,,113240,LOCAL,Facility,Outpatient,4 g,g,,1882,1599.7,539.3812,1882,"UCare Health, Inc.",Medical Assistance,949.8454,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
IPRATROPIUM-ALBUTEROL 20-100 MCG/ACTUATION INHL MIST,,113240,LOCAL,Facility,Inpatient,4 g,g,,1882,1599.7,539.3812,1882,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
IPRATROPIUM-ALBUTEROL 20-100 MCG/ACTUATION INHL MIST,,113240,LOCAL,Facility,Outpatient,4 g,g,,1882,1599.7,539.3812,1882,"UCare Health, Inc.",Medicare Advantage,949.8454,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
IPRATROPIUM-ALBUTEROL 20-100 MCG/ACTUATION INHL MIST,,113240,LOCAL,Facility,Inpatient,4 g,g,,1882,1599.7,539.3812,1882,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
IPRATROPIUM-ALBUTEROL 20-100 MCG/ACTUATION INHL MIST,,113240,LOCAL,Facility,Outpatient,4 g,g,,1882,1599.7,539.3812,1882,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),949.8454,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
IPRATROPIUM-ALBUTEROL 20-100 MCG/ACTUATION INHL MIST,,113240,LOCAL,Facility,Inpatient,4 g,g,,1882,1599.7,539.3812,1882,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
IPRATROPIUM-ALBUTEROL 20-100 MCG/ACTUATION INHL MIST,,113240,LOCAL,Facility,Both,4 g,g,,1882,1599.7,539.3812,1882,UnitedHealthcare,Individual & Family,1769.08,94,,percent of total billed charges,,
IPRATROPIUM-ALBUTEROL 20-100 MCG/ACTUATION INHL MIST,,113240,LOCAL,Facility,Outpatient,4 g,g,,1882,1599.7,539.3812,1882,UnitedHealthcare,Medicare Advantage,922.18,49,,percent of total billed charges,,
IPRATROPIUM-ALBUTEROL 20-100 MCG/ACTUATION INHL MIST,,113240,LOCAL,Facility,Inpatient,4 g,g,,1882,1599.7,539.3812,1882,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
IPRATROPIUM-ALBUTEROL 20-100 MCG/ACTUATION INHL MIST,,113240,LOCAL,Facility,Outpatient,4 g,g,,1882,1599.7,539.3812,1882,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,903.36,48,,percent of total billed charges,,100% of DHS outpatient percentage
IPRATROPIUM-ALBUTEROL 20-100 MCG/ACTUATION INHL MIST,,113240,LOCAL,Facility,Inpatient,4 g,g,,1882,1599.7,539.3812,1882,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
TIOTROPIUM BROMIDE 1.25 MCG/ACTUATION INHL MIST,,118828,LOCAL,Facility,Both,4 g,g,,2028,1723.8,581.2248,2028,Aetna,Commercial,1865.76,92,,percent of total billed charges,,
TIOTROPIUM BROMIDE 1.25 MCG/ACTUATION INHL MIST,,118828,LOCAL,Facility,Outpatient,4 g,g,,2028,1723.8,581.2248,2028,Aetna,Medicare Advantage,993.72,49,,percent of total billed charges,,
TIOTROPIUM BROMIDE 1.25 MCG/ACTUATION INHL MIST,,118828,LOCAL,Facility,Inpatient,4 g,g,,2028,1723.8,581.2248,2028,Aetna,Medicare Advantage,,,,,Included in per diem rate,
TIOTROPIUM BROMIDE 1.25 MCG/ACTUATION INHL MIST,,118828,LOCAL,Facility,Both,4 g,g,,2028,1723.8,581.2248,2028,Aetna,PPO,1886.04,93,,percent of total billed charges,,
TIOTROPIUM BROMIDE 1.25 MCG/ACTUATION INHL MIST,,118828,LOCAL,Facility,Both,4 g,g,,2028,1723.8,581.2248,2028,America's PPO,America's PPO,1947.4884,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
TIOTROPIUM BROMIDE 1.25 MCG/ACTUATION INHL MIST,,118828,LOCAL,Facility,Both,4 g,g,,2028,1723.8,581.2248,2028,BlueCross BlueShield Minnesota, Federal Employee Program,1995.552,98.4,,percent of total billed charges,,
TIOTROPIUM BROMIDE 1.25 MCG/ACTUATION INHL MIST,,118828,LOCAL,Facility,Both,4 g,g,,2028,1723.8,581.2248,2028,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,2028,100,,percent of total billed charges,,
TIOTROPIUM BROMIDE 1.25 MCG/ACTUATION INHL MIST,,118828,LOCAL,Facility,Both,4 g,g,,2028,1723.8,581.2248,2028,BlueCross BlueShield Minnesota,High Value Network Plan,1825.2,90,,percent of total billed charges,,
TIOTROPIUM BROMIDE 1.25 MCG/ACTUATION INHL MIST,,118828,LOCAL,Facility,Outpatient,4 g,g,,2028,1723.8,581.2248,2028,BlueCross BlueShield Minnesota,Medicare Advantage,993.72,49,,percent of total billed charges,,
TIOTROPIUM BROMIDE 1.25 MCG/ACTUATION INHL MIST,,118828,LOCAL,Facility,Inpatient,4 g,g,,2028,1723.8,581.2248,2028,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
TIOTROPIUM BROMIDE 1.25 MCG/ACTUATION INHL MIST,,118828,LOCAL,Facility,Both,4 g,g,,2028,1723.8,581.2248,2028,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1796.1996,88.57,,percent of total billed charges,,
TIOTROPIUM BROMIDE 1.25 MCG/ACTUATION INHL MIST,,118828,LOCAL,Facility,Both,4 g,g,,2028,1723.8,581.2248,2028,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,581.2248,28.66,,percent of total billed charges,,
TIOTROPIUM BROMIDE 1.25 MCG/ACTUATION INHL MIST,,118828,LOCAL,Facility,Outpatient,4 g,g,,2028,1723.8,581.2248,2028,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),993.72,49,,percent of total billed charges,,
TIOTROPIUM BROMIDE 1.25 MCG/ACTUATION INHL MIST,,118828,LOCAL,Facility,Inpatient,4 g,g,,2028,1723.8,581.2248,2028,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
TIOTROPIUM BROMIDE 1.25 MCG/ACTUATION INHL MIST,,118828,LOCAL,Facility,Both,4 g,g,,2028,1723.8,581.2248,2028,CorVel,Worker's Compensation,2028,100,,percent of total billed charges,,
TIOTROPIUM BROMIDE 1.25 MCG/ACTUATION INHL MIST,,118828,LOCAL,Facility,Both,4 g,g,,2028,1723.8,581.2248,2028,First Health Group Corporation,First Health Network,1967.16,97,,percent of total billed charges,,
TIOTROPIUM BROMIDE 1.25 MCG/ACTUATION INHL MIST,,118828,LOCAL,Facility,Both,4 g,g,,2028,1723.8,581.2248,2028,"Health Partners, Inc.",Commercial,1918.488,94.6,,percent of total billed charges,,
TIOTROPIUM BROMIDE 1.25 MCG/ACTUATION INHL MIST,,118828,LOCAL,Facility,Outpatient,4 g,g,,2028,1723.8,581.2248,2028,"Health Partners, Inc.",Medicare Advantage,993.72,49,,percent of total billed charges,,
TIOTROPIUM BROMIDE 1.25 MCG/ACTUATION INHL MIST,,118828,LOCAL,Facility,Inpatient,4 g,g,,2028,1723.8,581.2248,2028,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
TIOTROPIUM BROMIDE 1.25 MCG/ACTUATION INHL MIST,,118828,LOCAL,Facility,Both,4 g,g,,2028,1723.8,581.2248,2028,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1216.8,60,,percent of total billed charges,,
TIOTROPIUM BROMIDE 1.25 MCG/ACTUATION INHL MIST,,118828,LOCAL,Facility,Both,4 g,g,,2028,1723.8,581.2248,2028,"Health Partners, Inc.",State of Minnesota Advantage Program,1652.82,81.5,,percent of total billed charges,,
TIOTROPIUM BROMIDE 1.25 MCG/ACTUATION INHL MIST,,118828,LOCAL,Facility,Both,4 g,g,,2028,1723.8,581.2248,2028,"Health Partners, Inc.",State Public Programs,1014,50,,percent of total billed charges,,
TIOTROPIUM BROMIDE 1.25 MCG/ACTUATION INHL MIST,,118828,LOCAL,Facility,Both,4 g,g,,2028,1723.8,581.2248,2028,Humana Insurance Company,Commercial PPO,1926.6,95,,percent of total billed charges,,
TIOTROPIUM BROMIDE 1.25 MCG/ACTUATION INHL MIST,,118828,LOCAL,Facility,Outpatient,4 g,g,,2028,1723.8,581.2248,2028,Humana Insurance Company,Medicare PPO,993.72,49,,percent of total billed charges,,
TIOTROPIUM BROMIDE 1.25 MCG/ACTUATION INHL MIST,,118828,LOCAL,Facility,Inpatient,4 g,g,,2028,1723.8,581.2248,2028,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
TIOTROPIUM BROMIDE 1.25 MCG/ACTUATION INHL MIST,,118828,LOCAL,Facility,Both,4 g,g,,2028,1723.8,581.2248,2028,Medica,Individual & Family,2009.748,99.1,,percent of total billed charges,,
TIOTROPIUM BROMIDE 1.25 MCG/ACTUATION INHL MIST,,118828,LOCAL,Facility,Outpatient,4 g,g,,2028,1723.8,581.2248,2028,Medica,Medica Advantage Solution,1009.944,49.8,,percent of total billed charges,,
TIOTROPIUM BROMIDE 1.25 MCG/ACTUATION INHL MIST,,118828,LOCAL,Facility,Inpatient,4 g,g,,2028,1723.8,581.2248,2028,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
TIOTROPIUM BROMIDE 1.25 MCG/ACTUATION INHL MIST,,118828,LOCAL,Facility,Outpatient,4 g,g,,2028,1723.8,581.2248,2028,Medica,Medical Assistance,904.488,44.6,,percent of total billed charges,,
TIOTROPIUM BROMIDE 1.25 MCG/ACTUATION INHL MIST,,118828,LOCAL,Facility,Inpatient,4 g,g,,2028,1723.8,581.2248,2028,Medica,Medical Assistance,,,,,Included in per diem rate,
TIOTROPIUM BROMIDE 1.25 MCG/ACTUATION INHL MIST,,118828,LOCAL,Facility,Outpatient,4 g,g,,2028,1723.8,581.2248,2028,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1009.944,49.8,,percent of total billed charges,,
TIOTROPIUM BROMIDE 1.25 MCG/ACTUATION INHL MIST,,118828,LOCAL,Facility,Inpatient,4 g,g,,2028,1723.8,581.2248,2028,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
TIOTROPIUM BROMIDE 1.25 MCG/ACTUATION INHL MIST,,118828,LOCAL,Facility,Both,4 g,g,,2028,1723.8,581.2248,2028,"Multiplan, Inc.","Multiplan, Inc.",1906.32,94,,percent of total billed charges,,
TIOTROPIUM BROMIDE 1.25 MCG/ACTUATION INHL MIST,,118828,LOCAL,Facility,Outpatient,4 g,g,,2028,1723.8,581.2248,2028,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1827.228,90.1,,percent of total billed charges,,
TIOTROPIUM BROMIDE 1.25 MCG/ACTUATION INHL MIST,,118828,LOCAL,Facility,Inpatient,4 g,g,,2028,1723.8,581.2248,2028,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
TIOTROPIUM BROMIDE 1.25 MCG/ACTUATION INHL MIST,,118828,LOCAL,Facility,Both,4 g,g,,2028,1723.8,581.2248,2028,"Preferred One Administrative Services, INC.",PPO,1999.608,98.6,,percent of total billed charges,,
TIOTROPIUM BROMIDE 1.25 MCG/ACTUATION INHL MIST,,118828,LOCAL,Facility,Outpatient,4 g,g,,2028,1723.8,581.2248,2028,PrimeWest Health,Minnesota Senior Health Options (MSHO),1043.406,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
TIOTROPIUM BROMIDE 1.25 MCG/ACTUATION INHL MIST,,118828,LOCAL,Facility,Inpatient,4 g,g,,2028,1723.8,581.2248,2028,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
TIOTROPIUM BROMIDE 1.25 MCG/ACTUATION INHL MIST,,118828,LOCAL,Facility,Outpatient,4 g,g,,2028,1723.8,581.2248,2028,PrimeWest Health,MinnesotaCare,1041.5808,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
TIOTROPIUM BROMIDE 1.25 MCG/ACTUATION INHL MIST,,118828,LOCAL,Facility,Inpatient,4 g,g,,2028,1723.8,581.2248,2028,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
TIOTROPIUM BROMIDE 1.25 MCG/ACTUATION INHL MIST,,118828,LOCAL,Facility,Both,4 g,g,,2028,1723.8,581.2248,2028,Sanford Health Plan,Sanford Health Plan,1865.76,92,,percent of total billed charges,,
TIOTROPIUM BROMIDE 1.25 MCG/ACTUATION INHL MIST,,118828,LOCAL,Facility,Outpatient,4 g,g,,2028,1723.8,581.2248,2028,"UCare Health, Inc.",Individual & Family Plan,1142.778,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
TIOTROPIUM BROMIDE 1.25 MCG/ACTUATION INHL MIST,,118828,LOCAL,Facility,Inpatient,4 g,g,,2028,1723.8,581.2248,2028,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
TIOTROPIUM BROMIDE 1.25 MCG/ACTUATION INHL MIST,,118828,LOCAL,Facility,Outpatient,4 g,g,,2028,1723.8,581.2248,2028,"UCare Health, Inc.",Medical Assistance,1023.5316,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TIOTROPIUM BROMIDE 1.25 MCG/ACTUATION INHL MIST,,118828,LOCAL,Facility,Inpatient,4 g,g,,2028,1723.8,581.2248,2028,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
TIOTROPIUM BROMIDE 1.25 MCG/ACTUATION INHL MIST,,118828,LOCAL,Facility,Outpatient,4 g,g,,2028,1723.8,581.2248,2028,"UCare Health, Inc.",Medicare Advantage,1023.5316,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TIOTROPIUM BROMIDE 1.25 MCG/ACTUATION INHL MIST,,118828,LOCAL,Facility,Inpatient,4 g,g,,2028,1723.8,581.2248,2028,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
TIOTROPIUM BROMIDE 1.25 MCG/ACTUATION INHL MIST,,118828,LOCAL,Facility,Outpatient,4 g,g,,2028,1723.8,581.2248,2028,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1023.5316,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TIOTROPIUM BROMIDE 1.25 MCG/ACTUATION INHL MIST,,118828,LOCAL,Facility,Inpatient,4 g,g,,2028,1723.8,581.2248,2028,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
TIOTROPIUM BROMIDE 1.25 MCG/ACTUATION INHL MIST,,118828,LOCAL,Facility,Both,4 g,g,,2028,1723.8,581.2248,2028,UnitedHealthcare,Individual & Family,1906.32,94,,percent of total billed charges,,
TIOTROPIUM BROMIDE 1.25 MCG/ACTUATION INHL MIST,,118828,LOCAL,Facility,Outpatient,4 g,g,,2028,1723.8,581.2248,2028,UnitedHealthcare,Medicare Advantage,993.72,49,,percent of total billed charges,,
TIOTROPIUM BROMIDE 1.25 MCG/ACTUATION INHL MIST,,118828,LOCAL,Facility,Inpatient,4 g,g,,2028,1723.8,581.2248,2028,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
TIOTROPIUM BROMIDE 1.25 MCG/ACTUATION INHL MIST,,118828,LOCAL,Facility,Outpatient,4 g,g,,2028,1723.8,581.2248,2028,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,973.44,48,,percent of total billed charges,,100% of DHS outpatient percentage
TIOTROPIUM BROMIDE 1.25 MCG/ACTUATION INHL MIST,,118828,LOCAL,Facility,Inpatient,4 g,g,,2028,1723.8,581.2248,2028,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
VERAPAMIL 2.5 MG/ML IV SOLN,,15518,LOCAL,Facility,Both,4 mL,mL,,98,83.3,28.0868,98,Aetna,Commercial,90.16,92,,percent of total billed charges,,
VERAPAMIL 2.5 MG/ML IV SOLN,,15518,LOCAL,Facility,Outpatient,4 mL,mL,,98,83.3,28.0868,98,Aetna,Medicare Advantage,48.02,49,,percent of total billed charges,,
VERAPAMIL 2.5 MG/ML IV SOLN,,15518,LOCAL,Facility,Inpatient,4 mL,mL,,98,83.3,28.0868,98,Aetna,Medicare Advantage,,,,,Included in per diem rate,
VERAPAMIL 2.5 MG/ML IV SOLN,,15518,LOCAL,Facility,Both,4 mL,mL,,98,83.3,28.0868,98,Aetna,PPO,91.14,93,,percent of total billed charges,,
VERAPAMIL 2.5 MG/ML IV SOLN,,15518,LOCAL,Facility,Both,4 mL,mL,,98,83.3,28.0868,98,America's PPO,America's PPO,94.1094,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
VERAPAMIL 2.5 MG/ML IV SOLN,,15518,LOCAL,Facility,Both,4 mL,mL,,98,83.3,28.0868,98,BlueCross BlueShield Minnesota, Federal Employee Program,96.432,98.4,,percent of total billed charges,,
VERAPAMIL 2.5 MG/ML IV SOLN,,15518,LOCAL,Facility,Both,4 mL,mL,,98,83.3,28.0868,98,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,98,100,,percent of total billed charges,,
VERAPAMIL 2.5 MG/ML IV SOLN,,15518,LOCAL,Facility,Both,4 mL,mL,,98,83.3,28.0868,98,BlueCross BlueShield Minnesota,High Value Network Plan,88.2,90,,percent of total billed charges,,
VERAPAMIL 2.5 MG/ML IV SOLN,,15518,LOCAL,Facility,Outpatient,4 mL,mL,,98,83.3,28.0868,98,BlueCross BlueShield Minnesota,Medicare Advantage,48.02,49,,percent of total billed charges,,
VERAPAMIL 2.5 MG/ML IV SOLN,,15518,LOCAL,Facility,Inpatient,4 mL,mL,,98,83.3,28.0868,98,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
VERAPAMIL 2.5 MG/ML IV SOLN,,15518,LOCAL,Facility,Both,4 mL,mL,,98,83.3,28.0868,98,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,86.7986,88.57,,percent of total billed charges,,
VERAPAMIL 2.5 MG/ML IV SOLN,,15518,LOCAL,Facility,Both,4 mL,mL,,98,83.3,28.0868,98,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,28.0868,28.66,,percent of total billed charges,,
VERAPAMIL 2.5 MG/ML IV SOLN,,15518,LOCAL,Facility,Outpatient,4 mL,mL,,98,83.3,28.0868,98,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),48.02,49,,percent of total billed charges,,
VERAPAMIL 2.5 MG/ML IV SOLN,,15518,LOCAL,Facility,Inpatient,4 mL,mL,,98,83.3,28.0868,98,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
VERAPAMIL 2.5 MG/ML IV SOLN,,15518,LOCAL,Facility,Both,4 mL,mL,,98,83.3,28.0868,98,CorVel,Worker's Compensation,98,100,,percent of total billed charges,,
VERAPAMIL 2.5 MG/ML IV SOLN,,15518,LOCAL,Facility,Both,4 mL,mL,,98,83.3,28.0868,98,First Health Group Corporation,First Health Network,95.06,97,,percent of total billed charges,,
VERAPAMIL 2.5 MG/ML IV SOLN,,15518,LOCAL,Facility,Both,4 mL,mL,,98,83.3,28.0868,98,"Health Partners, Inc.",Commercial,92.708,94.6,,percent of total billed charges,,
VERAPAMIL 2.5 MG/ML IV SOLN,,15518,LOCAL,Facility,Outpatient,4 mL,mL,,98,83.3,28.0868,98,"Health Partners, Inc.",Medicare Advantage,48.02,49,,percent of total billed charges,,
VERAPAMIL 2.5 MG/ML IV SOLN,,15518,LOCAL,Facility,Inpatient,4 mL,mL,,98,83.3,28.0868,98,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
VERAPAMIL 2.5 MG/ML IV SOLN,,15518,LOCAL,Facility,Both,4 mL,mL,,98,83.3,28.0868,98,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),58.8,60,,percent of total billed charges,,
VERAPAMIL 2.5 MG/ML IV SOLN,,15518,LOCAL,Facility,Both,4 mL,mL,,98,83.3,28.0868,98,"Health Partners, Inc.",State of Minnesota Advantage Program,79.87,81.5,,percent of total billed charges,,
VERAPAMIL 2.5 MG/ML IV SOLN,,15518,LOCAL,Facility,Both,4 mL,mL,,98,83.3,28.0868,98,"Health Partners, Inc.",State Public Programs,49,50,,percent of total billed charges,,
VERAPAMIL 2.5 MG/ML IV SOLN,,15518,LOCAL,Facility,Both,4 mL,mL,,98,83.3,28.0868,98,Humana Insurance Company,Commercial PPO,93.1,95,,percent of total billed charges,,
VERAPAMIL 2.5 MG/ML IV SOLN,,15518,LOCAL,Facility,Outpatient,4 mL,mL,,98,83.3,28.0868,98,Humana Insurance Company,Medicare PPO,48.02,49,,percent of total billed charges,,
VERAPAMIL 2.5 MG/ML IV SOLN,,15518,LOCAL,Facility,Inpatient,4 mL,mL,,98,83.3,28.0868,98,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
VERAPAMIL 2.5 MG/ML IV SOLN,,15518,LOCAL,Facility,Both,4 mL,mL,,98,83.3,28.0868,98,Medica,Individual & Family,97.118,99.1,,percent of total billed charges,,
VERAPAMIL 2.5 MG/ML IV SOLN,,15518,LOCAL,Facility,Outpatient,4 mL,mL,,98,83.3,28.0868,98,Medica,Medica Advantage Solution,48.804,49.8,,percent of total billed charges,,
VERAPAMIL 2.5 MG/ML IV SOLN,,15518,LOCAL,Facility,Inpatient,4 mL,mL,,98,83.3,28.0868,98,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
VERAPAMIL 2.5 MG/ML IV SOLN,,15518,LOCAL,Facility,Outpatient,4 mL,mL,,98,83.3,28.0868,98,Medica,Medical Assistance,43.708,44.6,,percent of total billed charges,,
VERAPAMIL 2.5 MG/ML IV SOLN,,15518,LOCAL,Facility,Inpatient,4 mL,mL,,98,83.3,28.0868,98,Medica,Medical Assistance,,,,,Included in per diem rate,
VERAPAMIL 2.5 MG/ML IV SOLN,,15518,LOCAL,Facility,Outpatient,4 mL,mL,,98,83.3,28.0868,98,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,48.804,49.8,,percent of total billed charges,,
VERAPAMIL 2.5 MG/ML IV SOLN,,15518,LOCAL,Facility,Inpatient,4 mL,mL,,98,83.3,28.0868,98,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
VERAPAMIL 2.5 MG/ML IV SOLN,,15518,LOCAL,Facility,Both,4 mL,mL,,98,83.3,28.0868,98,"Multiplan, Inc.","Multiplan, Inc.",92.12,94,,percent of total billed charges,,
VERAPAMIL 2.5 MG/ML IV SOLN,,15518,LOCAL,Facility,Outpatient,4 mL,mL,,98,83.3,28.0868,98,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,88.298,90.1,,percent of total billed charges,,
VERAPAMIL 2.5 MG/ML IV SOLN,,15518,LOCAL,Facility,Inpatient,4 mL,mL,,98,83.3,28.0868,98,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
VERAPAMIL 2.5 MG/ML IV SOLN,,15518,LOCAL,Facility,Both,4 mL,mL,,98,83.3,28.0868,98,"Preferred One Administrative Services, INC.",PPO,96.628,98.6,,percent of total billed charges,,
VERAPAMIL 2.5 MG/ML IV SOLN,,15518,LOCAL,Facility,Outpatient,4 mL,mL,,98,83.3,28.0868,98,PrimeWest Health,Minnesota Senior Health Options (MSHO),50.421,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
VERAPAMIL 2.5 MG/ML IV SOLN,,15518,LOCAL,Facility,Inpatient,4 mL,mL,,98,83.3,28.0868,98,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
VERAPAMIL 2.5 MG/ML IV SOLN,,15518,LOCAL,Facility,Outpatient,4 mL,mL,,98,83.3,28.0868,98,PrimeWest Health,MinnesotaCare,50.3328,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
VERAPAMIL 2.5 MG/ML IV SOLN,,15518,LOCAL,Facility,Inpatient,4 mL,mL,,98,83.3,28.0868,98,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
VERAPAMIL 2.5 MG/ML IV SOLN,,15518,LOCAL,Facility,Both,4 mL,mL,,98,83.3,28.0868,98,Sanford Health Plan,Sanford Health Plan,90.16,92,,percent of total billed charges,,
VERAPAMIL 2.5 MG/ML IV SOLN,,15518,LOCAL,Facility,Outpatient,4 mL,mL,,98,83.3,28.0868,98,"UCare Health, Inc.",Individual & Family Plan,55.223,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
VERAPAMIL 2.5 MG/ML IV SOLN,,15518,LOCAL,Facility,Inpatient,4 mL,mL,,98,83.3,28.0868,98,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
VERAPAMIL 2.5 MG/ML IV SOLN,,15518,LOCAL,Facility,Outpatient,4 mL,mL,,98,83.3,28.0868,98,"UCare Health, Inc.",Medical Assistance,49.4606,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
VERAPAMIL 2.5 MG/ML IV SOLN,,15518,LOCAL,Facility,Inpatient,4 mL,mL,,98,83.3,28.0868,98,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
VERAPAMIL 2.5 MG/ML IV SOLN,,15518,LOCAL,Facility,Outpatient,4 mL,mL,,98,83.3,28.0868,98,"UCare Health, Inc.",Medicare Advantage,49.4606,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
VERAPAMIL 2.5 MG/ML IV SOLN,,15518,LOCAL,Facility,Inpatient,4 mL,mL,,98,83.3,28.0868,98,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
VERAPAMIL 2.5 MG/ML IV SOLN,,15518,LOCAL,Facility,Outpatient,4 mL,mL,,98,83.3,28.0868,98,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),49.4606,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
VERAPAMIL 2.5 MG/ML IV SOLN,,15518,LOCAL,Facility,Inpatient,4 mL,mL,,98,83.3,28.0868,98,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
VERAPAMIL 2.5 MG/ML IV SOLN,,15518,LOCAL,Facility,Both,4 mL,mL,,98,83.3,28.0868,98,UnitedHealthcare,Individual & Family,92.12,94,,percent of total billed charges,,
VERAPAMIL 2.5 MG/ML IV SOLN,,15518,LOCAL,Facility,Outpatient,4 mL,mL,,98,83.3,28.0868,98,UnitedHealthcare,Medicare Advantage,48.02,49,,percent of total billed charges,,
VERAPAMIL 2.5 MG/ML IV SOLN,,15518,LOCAL,Facility,Inpatient,4 mL,mL,,98,83.3,28.0868,98,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
VERAPAMIL 2.5 MG/ML IV SOLN,,15518,LOCAL,Facility,Outpatient,4 mL,mL,,98,83.3,28.0868,98,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,47.04,48,,percent of total billed charges,,100% of DHS outpatient percentage
VERAPAMIL 2.5 MG/ML IV SOLN,,15518,LOCAL,Facility,Inpatient,4 mL,mL,,98,83.3,28.0868,98,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
NOREPINEPHRINE BITARTRATE 1 MG/ML IV SOLN,,19474,LOCAL,Facility,Both,4 mL,mL,,51,43.35,14.6166,51,Aetna,Commercial,46.92,92,,percent of total billed charges,,
NOREPINEPHRINE BITARTRATE 1 MG/ML IV SOLN,,19474,LOCAL,Facility,Outpatient,4 mL,mL,,51,43.35,14.6166,51,Aetna,Medicare Advantage,24.99,49,,percent of total billed charges,,
NOREPINEPHRINE BITARTRATE 1 MG/ML IV SOLN,,19474,LOCAL,Facility,Inpatient,4 mL,mL,,51,43.35,14.6166,51,Aetna,Medicare Advantage,,,,,Included in per diem rate,
NOREPINEPHRINE BITARTRATE 1 MG/ML IV SOLN,,19474,LOCAL,Facility,Both,4 mL,mL,,51,43.35,14.6166,51,Aetna,PPO,47.43,93,,percent of total billed charges,,
NOREPINEPHRINE BITARTRATE 1 MG/ML IV SOLN,,19474,LOCAL,Facility,Both,4 mL,mL,,51,43.35,14.6166,51,America's PPO,America's PPO,48.9753,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
NOREPINEPHRINE BITARTRATE 1 MG/ML IV SOLN,,19474,LOCAL,Facility,Both,4 mL,mL,,51,43.35,14.6166,51,BlueCross BlueShield Minnesota, Federal Employee Program,50.184,98.4,,percent of total billed charges,,
NOREPINEPHRINE BITARTRATE 1 MG/ML IV SOLN,,19474,LOCAL,Facility,Both,4 mL,mL,,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,51,100,,percent of total billed charges,,
NOREPINEPHRINE BITARTRATE 1 MG/ML IV SOLN,,19474,LOCAL,Facility,Both,4 mL,mL,,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,High Value Network Plan,45.9,90,,percent of total billed charges,,
NOREPINEPHRINE BITARTRATE 1 MG/ML IV SOLN,,19474,LOCAL,Facility,Outpatient,4 mL,mL,,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,Medicare Advantage,24.99,49,,percent of total billed charges,,
NOREPINEPHRINE BITARTRATE 1 MG/ML IV SOLN,,19474,LOCAL,Facility,Inpatient,4 mL,mL,,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
NOREPINEPHRINE BITARTRATE 1 MG/ML IV SOLN,,19474,LOCAL,Facility,Both,4 mL,mL,,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,45.1707,88.57,,percent of total billed charges,,
NOREPINEPHRINE BITARTRATE 1 MG/ML IV SOLN,,19474,LOCAL,Facility,Both,4 mL,mL,,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,14.6166,28.66,,percent of total billed charges,,
NOREPINEPHRINE BITARTRATE 1 MG/ML IV SOLN,,19474,LOCAL,Facility,Outpatient,4 mL,mL,,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),24.99,49,,percent of total billed charges,,
NOREPINEPHRINE BITARTRATE 1 MG/ML IV SOLN,,19474,LOCAL,Facility,Inpatient,4 mL,mL,,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
NOREPINEPHRINE BITARTRATE 1 MG/ML IV SOLN,,19474,LOCAL,Facility,Both,4 mL,mL,,51,43.35,14.6166,51,CorVel,Worker's Compensation,51,100,,percent of total billed charges,,
NOREPINEPHRINE BITARTRATE 1 MG/ML IV SOLN,,19474,LOCAL,Facility,Both,4 mL,mL,,51,43.35,14.6166,51,First Health Group Corporation,First Health Network,49.47,97,,percent of total billed charges,,
NOREPINEPHRINE BITARTRATE 1 MG/ML IV SOLN,,19474,LOCAL,Facility,Both,4 mL,mL,,51,43.35,14.6166,51,"Health Partners, Inc.",Commercial,48.246,94.6,,percent of total billed charges,,
NOREPINEPHRINE BITARTRATE 1 MG/ML IV SOLN,,19474,LOCAL,Facility,Outpatient,4 mL,mL,,51,43.35,14.6166,51,"Health Partners, Inc.",Medicare Advantage,24.99,49,,percent of total billed charges,,
NOREPINEPHRINE BITARTRATE 1 MG/ML IV SOLN,,19474,LOCAL,Facility,Inpatient,4 mL,mL,,51,43.35,14.6166,51,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
NOREPINEPHRINE BITARTRATE 1 MG/ML IV SOLN,,19474,LOCAL,Facility,Both,4 mL,mL,,51,43.35,14.6166,51,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),30.6,60,,percent of total billed charges,,
NOREPINEPHRINE BITARTRATE 1 MG/ML IV SOLN,,19474,LOCAL,Facility,Both,4 mL,mL,,51,43.35,14.6166,51,"Health Partners, Inc.",State of Minnesota Advantage Program,41.565,81.5,,percent of total billed charges,,
NOREPINEPHRINE BITARTRATE 1 MG/ML IV SOLN,,19474,LOCAL,Facility,Both,4 mL,mL,,51,43.35,14.6166,51,"Health Partners, Inc.",State Public Programs,25.5,50,,percent of total billed charges,,
NOREPINEPHRINE BITARTRATE 1 MG/ML IV SOLN,,19474,LOCAL,Facility,Both,4 mL,mL,,51,43.35,14.6166,51,Humana Insurance Company,Commercial PPO,48.45,95,,percent of total billed charges,,
NOREPINEPHRINE BITARTRATE 1 MG/ML IV SOLN,,19474,LOCAL,Facility,Outpatient,4 mL,mL,,51,43.35,14.6166,51,Humana Insurance Company,Medicare PPO,24.99,49,,percent of total billed charges,,
NOREPINEPHRINE BITARTRATE 1 MG/ML IV SOLN,,19474,LOCAL,Facility,Inpatient,4 mL,mL,,51,43.35,14.6166,51,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
NOREPINEPHRINE BITARTRATE 1 MG/ML IV SOLN,,19474,LOCAL,Facility,Both,4 mL,mL,,51,43.35,14.6166,51,Medica,Individual & Family,50.541,99.1,,percent of total billed charges,,
NOREPINEPHRINE BITARTRATE 1 MG/ML IV SOLN,,19474,LOCAL,Facility,Outpatient,4 mL,mL,,51,43.35,14.6166,51,Medica,Medica Advantage Solution,25.398,49.8,,percent of total billed charges,,
NOREPINEPHRINE BITARTRATE 1 MG/ML IV SOLN,,19474,LOCAL,Facility,Inpatient,4 mL,mL,,51,43.35,14.6166,51,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
NOREPINEPHRINE BITARTRATE 1 MG/ML IV SOLN,,19474,LOCAL,Facility,Outpatient,4 mL,mL,,51,43.35,14.6166,51,Medica,Medical Assistance,22.746,44.6,,percent of total billed charges,,
NOREPINEPHRINE BITARTRATE 1 MG/ML IV SOLN,,19474,LOCAL,Facility,Inpatient,4 mL,mL,,51,43.35,14.6166,51,Medica,Medical Assistance,,,,,Included in per diem rate,
NOREPINEPHRINE BITARTRATE 1 MG/ML IV SOLN,,19474,LOCAL,Facility,Outpatient,4 mL,mL,,51,43.35,14.6166,51,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,25.398,49.8,,percent of total billed charges,,
NOREPINEPHRINE BITARTRATE 1 MG/ML IV SOLN,,19474,LOCAL,Facility,Inpatient,4 mL,mL,,51,43.35,14.6166,51,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
NOREPINEPHRINE BITARTRATE 1 MG/ML IV SOLN,,19474,LOCAL,Facility,Both,4 mL,mL,,51,43.35,14.6166,51,"Multiplan, Inc.","Multiplan, Inc.",47.94,94,,percent of total billed charges,,
NOREPINEPHRINE BITARTRATE 1 MG/ML IV SOLN,,19474,LOCAL,Facility,Outpatient,4 mL,mL,,51,43.35,14.6166,51,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,45.951,90.1,,percent of total billed charges,,
NOREPINEPHRINE BITARTRATE 1 MG/ML IV SOLN,,19474,LOCAL,Facility,Inpatient,4 mL,mL,,51,43.35,14.6166,51,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
NOREPINEPHRINE BITARTRATE 1 MG/ML IV SOLN,,19474,LOCAL,Facility,Both,4 mL,mL,,51,43.35,14.6166,51,"Preferred One Administrative Services, INC.",PPO,50.286,98.6,,percent of total billed charges,,
NOREPINEPHRINE BITARTRATE 1 MG/ML IV SOLN,,19474,LOCAL,Facility,Outpatient,4 mL,mL,,51,43.35,14.6166,51,PrimeWest Health,Minnesota Senior Health Options (MSHO),26.2395,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
NOREPINEPHRINE BITARTRATE 1 MG/ML IV SOLN,,19474,LOCAL,Facility,Inpatient,4 mL,mL,,51,43.35,14.6166,51,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
NOREPINEPHRINE BITARTRATE 1 MG/ML IV SOLN,,19474,LOCAL,Facility,Outpatient,4 mL,mL,,51,43.35,14.6166,51,PrimeWest Health,MinnesotaCare,26.1936,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
NOREPINEPHRINE BITARTRATE 1 MG/ML IV SOLN,,19474,LOCAL,Facility,Inpatient,4 mL,mL,,51,43.35,14.6166,51,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
NOREPINEPHRINE BITARTRATE 1 MG/ML IV SOLN,,19474,LOCAL,Facility,Both,4 mL,mL,,51,43.35,14.6166,51,Sanford Health Plan,Sanford Health Plan,46.92,92,,percent of total billed charges,,
NOREPINEPHRINE BITARTRATE 1 MG/ML IV SOLN,,19474,LOCAL,Facility,Outpatient,4 mL,mL,,51,43.35,14.6166,51,"UCare Health, Inc.",Individual & Family Plan,28.7385,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
NOREPINEPHRINE BITARTRATE 1 MG/ML IV SOLN,,19474,LOCAL,Facility,Inpatient,4 mL,mL,,51,43.35,14.6166,51,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
NOREPINEPHRINE BITARTRATE 1 MG/ML IV SOLN,,19474,LOCAL,Facility,Outpatient,4 mL,mL,,51,43.35,14.6166,51,"UCare Health, Inc.",Medical Assistance,25.7397,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
NOREPINEPHRINE BITARTRATE 1 MG/ML IV SOLN,,19474,LOCAL,Facility,Inpatient,4 mL,mL,,51,43.35,14.6166,51,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
NOREPINEPHRINE BITARTRATE 1 MG/ML IV SOLN,,19474,LOCAL,Facility,Outpatient,4 mL,mL,,51,43.35,14.6166,51,"UCare Health, Inc.",Medicare Advantage,25.7397,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
NOREPINEPHRINE BITARTRATE 1 MG/ML IV SOLN,,19474,LOCAL,Facility,Inpatient,4 mL,mL,,51,43.35,14.6166,51,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
NOREPINEPHRINE BITARTRATE 1 MG/ML IV SOLN,,19474,LOCAL,Facility,Outpatient,4 mL,mL,,51,43.35,14.6166,51,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),25.7397,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
NOREPINEPHRINE BITARTRATE 1 MG/ML IV SOLN,,19474,LOCAL,Facility,Inpatient,4 mL,mL,,51,43.35,14.6166,51,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
NOREPINEPHRINE BITARTRATE 1 MG/ML IV SOLN,,19474,LOCAL,Facility,Both,4 mL,mL,,51,43.35,14.6166,51,UnitedHealthcare,Individual & Family,47.94,94,,percent of total billed charges,,
NOREPINEPHRINE BITARTRATE 1 MG/ML IV SOLN,,19474,LOCAL,Facility,Outpatient,4 mL,mL,,51,43.35,14.6166,51,UnitedHealthcare,Medicare Advantage,24.99,49,,percent of total billed charges,,
NOREPINEPHRINE BITARTRATE 1 MG/ML IV SOLN,,19474,LOCAL,Facility,Inpatient,4 mL,mL,,51,43.35,14.6166,51,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
NOREPINEPHRINE BITARTRATE 1 MG/ML IV SOLN,,19474,LOCAL,Facility,Outpatient,4 mL,mL,,51,43.35,14.6166,51,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,24.48,48,,percent of total billed charges,,100% of DHS outpatient percentage
NOREPINEPHRINE BITARTRATE 1 MG/ML IV SOLN,,19474,LOCAL,Facility,Inpatient,4 mL,mL,,51,43.35,14.6166,51,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"AMIKACIN 1,000 MG/4 ML INJ SOLN",,92699,LOCAL,Facility,Both,4 mL,mL,,133,113.05,38.1178,133,Aetna,Commercial,122.36,92,,percent of total billed charges,,
"AMIKACIN 1,000 MG/4 ML INJ SOLN",,92699,LOCAL,Facility,Outpatient,4 mL,mL,,133,113.05,38.1178,133,Aetna,Medicare Advantage,65.17,49,,percent of total billed charges,,
"AMIKACIN 1,000 MG/4 ML INJ SOLN",,92699,LOCAL,Facility,Inpatient,4 mL,mL,,133,113.05,38.1178,133,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"AMIKACIN 1,000 MG/4 ML INJ SOLN",,92699,LOCAL,Facility,Both,4 mL,mL,,133,113.05,38.1178,133,Aetna,PPO,123.69,93,,percent of total billed charges,,
"AMIKACIN 1,000 MG/4 ML INJ SOLN",,92699,LOCAL,Facility,Both,4 mL,mL,,133,113.05,38.1178,133,America's PPO,America's PPO,127.7199,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"AMIKACIN 1,000 MG/4 ML INJ SOLN",,92699,LOCAL,Facility,Both,4 mL,mL,,133,113.05,38.1178,133,BlueCross BlueShield Minnesota, Federal Employee Program,130.872,98.4,,percent of total billed charges,,
"AMIKACIN 1,000 MG/4 ML INJ SOLN",,92699,LOCAL,Facility,Both,4 mL,mL,,133,113.05,38.1178,133,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,133,100,,percent of total billed charges,,
"AMIKACIN 1,000 MG/4 ML INJ SOLN",,92699,LOCAL,Facility,Both,4 mL,mL,,133,113.05,38.1178,133,BlueCross BlueShield Minnesota,High Value Network Plan,119.7,90,,percent of total billed charges,,
"AMIKACIN 1,000 MG/4 ML INJ SOLN",,92699,LOCAL,Facility,Outpatient,4 mL,mL,,133,113.05,38.1178,133,BlueCross BlueShield Minnesota,Medicare Advantage,65.17,49,,percent of total billed charges,,
"AMIKACIN 1,000 MG/4 ML INJ SOLN",,92699,LOCAL,Facility,Inpatient,4 mL,mL,,133,113.05,38.1178,133,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"AMIKACIN 1,000 MG/4 ML INJ SOLN",,92699,LOCAL,Facility,Both,4 mL,mL,,133,113.05,38.1178,133,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,117.7981,88.57,,percent of total billed charges,,
"AMIKACIN 1,000 MG/4 ML INJ SOLN",,92699,LOCAL,Facility,Both,4 mL,mL,,133,113.05,38.1178,133,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,38.1178,28.66,,percent of total billed charges,,
"AMIKACIN 1,000 MG/4 ML INJ SOLN",,92699,LOCAL,Facility,Outpatient,4 mL,mL,,133,113.05,38.1178,133,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),65.17,49,,percent of total billed charges,,
"AMIKACIN 1,000 MG/4 ML INJ SOLN",,92699,LOCAL,Facility,Inpatient,4 mL,mL,,133,113.05,38.1178,133,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"AMIKACIN 1,000 MG/4 ML INJ SOLN",,92699,LOCAL,Facility,Both,4 mL,mL,,133,113.05,38.1178,133,CorVel,Worker's Compensation,133,100,,percent of total billed charges,,
"AMIKACIN 1,000 MG/4 ML INJ SOLN",,92699,LOCAL,Facility,Both,4 mL,mL,,133,113.05,38.1178,133,First Health Group Corporation,First Health Network,129.01,97,,percent of total billed charges,,
"AMIKACIN 1,000 MG/4 ML INJ SOLN",,92699,LOCAL,Facility,Both,4 mL,mL,,133,113.05,38.1178,133,"Health Partners, Inc.",Commercial,125.818,94.6,,percent of total billed charges,,
"AMIKACIN 1,000 MG/4 ML INJ SOLN",,92699,LOCAL,Facility,Outpatient,4 mL,mL,,133,113.05,38.1178,133,"Health Partners, Inc.",Medicare Advantage,65.17,49,,percent of total billed charges,,
"AMIKACIN 1,000 MG/4 ML INJ SOLN",,92699,LOCAL,Facility,Inpatient,4 mL,mL,,133,113.05,38.1178,133,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"AMIKACIN 1,000 MG/4 ML INJ SOLN",,92699,LOCAL,Facility,Both,4 mL,mL,,133,113.05,38.1178,133,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),79.8,60,,percent of total billed charges,,
"AMIKACIN 1,000 MG/4 ML INJ SOLN",,92699,LOCAL,Facility,Both,4 mL,mL,,133,113.05,38.1178,133,"Health Partners, Inc.",State of Minnesota Advantage Program,108.395,81.5,,percent of total billed charges,,
"AMIKACIN 1,000 MG/4 ML INJ SOLN",,92699,LOCAL,Facility,Both,4 mL,mL,,133,113.05,38.1178,133,"Health Partners, Inc.",State Public Programs,66.5,50,,percent of total billed charges,,
"AMIKACIN 1,000 MG/4 ML INJ SOLN",,92699,LOCAL,Facility,Both,4 mL,mL,,133,113.05,38.1178,133,Humana Insurance Company,Commercial PPO,126.35,95,,percent of total billed charges,,
"AMIKACIN 1,000 MG/4 ML INJ SOLN",,92699,LOCAL,Facility,Outpatient,4 mL,mL,,133,113.05,38.1178,133,Humana Insurance Company,Medicare PPO,65.17,49,,percent of total billed charges,,
"AMIKACIN 1,000 MG/4 ML INJ SOLN",,92699,LOCAL,Facility,Inpatient,4 mL,mL,,133,113.05,38.1178,133,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"AMIKACIN 1,000 MG/4 ML INJ SOLN",,92699,LOCAL,Facility,Both,4 mL,mL,,133,113.05,38.1178,133,Medica,Individual & Family,131.803,99.1,,percent of total billed charges,,
"AMIKACIN 1,000 MG/4 ML INJ SOLN",,92699,LOCAL,Facility,Outpatient,4 mL,mL,,133,113.05,38.1178,133,Medica,Medica Advantage Solution,66.234,49.8,,percent of total billed charges,,
"AMIKACIN 1,000 MG/4 ML INJ SOLN",,92699,LOCAL,Facility,Inpatient,4 mL,mL,,133,113.05,38.1178,133,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"AMIKACIN 1,000 MG/4 ML INJ SOLN",,92699,LOCAL,Facility,Outpatient,4 mL,mL,,133,113.05,38.1178,133,Medica,Medical Assistance,59.318,44.6,,percent of total billed charges,,
"AMIKACIN 1,000 MG/4 ML INJ SOLN",,92699,LOCAL,Facility,Inpatient,4 mL,mL,,133,113.05,38.1178,133,Medica,Medical Assistance,,,,,Included in per diem rate,
"AMIKACIN 1,000 MG/4 ML INJ SOLN",,92699,LOCAL,Facility,Outpatient,4 mL,mL,,133,113.05,38.1178,133,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,66.234,49.8,,percent of total billed charges,,
"AMIKACIN 1,000 MG/4 ML INJ SOLN",,92699,LOCAL,Facility,Inpatient,4 mL,mL,,133,113.05,38.1178,133,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"AMIKACIN 1,000 MG/4 ML INJ SOLN",,92699,LOCAL,Facility,Both,4 mL,mL,,133,113.05,38.1178,133,"Multiplan, Inc.","Multiplan, Inc.",125.02,94,,percent of total billed charges,,
"AMIKACIN 1,000 MG/4 ML INJ SOLN",,92699,LOCAL,Facility,Outpatient,4 mL,mL,,133,113.05,38.1178,133,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,119.833,90.1,,percent of total billed charges,,
"AMIKACIN 1,000 MG/4 ML INJ SOLN",,92699,LOCAL,Facility,Inpatient,4 mL,mL,,133,113.05,38.1178,133,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"AMIKACIN 1,000 MG/4 ML INJ SOLN",,92699,LOCAL,Facility,Both,4 mL,mL,,133,113.05,38.1178,133,"Preferred One Administrative Services, INC.",PPO,131.138,98.6,,percent of total billed charges,,
"AMIKACIN 1,000 MG/4 ML INJ SOLN",,92699,LOCAL,Facility,Outpatient,4 mL,mL,,133,113.05,38.1178,133,PrimeWest Health,Minnesota Senior Health Options (MSHO),68.4285,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"AMIKACIN 1,000 MG/4 ML INJ SOLN",,92699,LOCAL,Facility,Inpatient,4 mL,mL,,133,113.05,38.1178,133,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"AMIKACIN 1,000 MG/4 ML INJ SOLN",,92699,LOCAL,Facility,Outpatient,4 mL,mL,,133,113.05,38.1178,133,PrimeWest Health,MinnesotaCare,68.3088,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"AMIKACIN 1,000 MG/4 ML INJ SOLN",,92699,LOCAL,Facility,Inpatient,4 mL,mL,,133,113.05,38.1178,133,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"AMIKACIN 1,000 MG/4 ML INJ SOLN",,92699,LOCAL,Facility,Both,4 mL,mL,,133,113.05,38.1178,133,Sanford Health Plan,Sanford Health Plan,122.36,92,,percent of total billed charges,,
"AMIKACIN 1,000 MG/4 ML INJ SOLN",,92699,LOCAL,Facility,Outpatient,4 mL,mL,,133,113.05,38.1178,133,"UCare Health, Inc.",Individual & Family Plan,74.9455,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"AMIKACIN 1,000 MG/4 ML INJ SOLN",,92699,LOCAL,Facility,Inpatient,4 mL,mL,,133,113.05,38.1178,133,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"AMIKACIN 1,000 MG/4 ML INJ SOLN",,92699,LOCAL,Facility,Outpatient,4 mL,mL,,133,113.05,38.1178,133,"UCare Health, Inc.",Medical Assistance,67.1251,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"AMIKACIN 1,000 MG/4 ML INJ SOLN",,92699,LOCAL,Facility,Inpatient,4 mL,mL,,133,113.05,38.1178,133,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"AMIKACIN 1,000 MG/4 ML INJ SOLN",,92699,LOCAL,Facility,Outpatient,4 mL,mL,,133,113.05,38.1178,133,"UCare Health, Inc.",Medicare Advantage,67.1251,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"AMIKACIN 1,000 MG/4 ML INJ SOLN",,92699,LOCAL,Facility,Inpatient,4 mL,mL,,133,113.05,38.1178,133,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"AMIKACIN 1,000 MG/4 ML INJ SOLN",,92699,LOCAL,Facility,Outpatient,4 mL,mL,,133,113.05,38.1178,133,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),67.1251,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"AMIKACIN 1,000 MG/4 ML INJ SOLN",,92699,LOCAL,Facility,Inpatient,4 mL,mL,,133,113.05,38.1178,133,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"AMIKACIN 1,000 MG/4 ML INJ SOLN",,92699,LOCAL,Facility,Both,4 mL,mL,,133,113.05,38.1178,133,UnitedHealthcare,Individual & Family,125.02,94,,percent of total billed charges,,
"AMIKACIN 1,000 MG/4 ML INJ SOLN",,92699,LOCAL,Facility,Outpatient,4 mL,mL,,133,113.05,38.1178,133,UnitedHealthcare,Medicare Advantage,65.17,49,,percent of total billed charges,,
"AMIKACIN 1,000 MG/4 ML INJ SOLN",,92699,LOCAL,Facility,Inpatient,4 mL,mL,,133,113.05,38.1178,133,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"AMIKACIN 1,000 MG/4 ML INJ SOLN",,92699,LOCAL,Facility,Outpatient,4 mL,mL,,133,113.05,38.1178,133,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,63.84,48,,percent of total billed charges,,100% of DHS outpatient percentage
"AMIKACIN 1,000 MG/4 ML INJ SOLN",,92699,LOCAL,Facility,Inpatient,4 mL,mL,,133,113.05,38.1178,133,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
COCAINE 4 % NASL SOLN,,C9046,HCPCS,Facility,Both,4 mL,mL,,1032,877.2,295.7712,1032,Aetna,Commercial,949.44,92,,percent of total billed charges,,
COCAINE 4 % NASL SOLN,,C9046,HCPCS,Facility,Outpatient,4 mL,mL,,1032,877.2,295.7712,1032,Aetna,Medicare Advantage,505.68,49,,percent of total billed charges,,
COCAINE 4 % NASL SOLN,,C9046,HCPCS,Facility,Inpatient,4 mL,mL,,1032,877.2,295.7712,1032,Aetna,Medicare Advantage,,,,,Included in per diem rate,
COCAINE 4 % NASL SOLN,,C9046,HCPCS,Facility,Both,4 mL,mL,,1032,877.2,295.7712,1032,Aetna,PPO,959.76,93,,percent of total billed charges,,
COCAINE 4 % NASL SOLN,,C9046,HCPCS,Facility,Both,4 mL,mL,,1032,877.2,295.7712,1032,America's PPO,America's PPO,991.0296,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
COCAINE 4 % NASL SOLN,,C9046,HCPCS,Facility,Both,4 mL,mL,,1032,877.2,295.7712,1032,BlueCross BlueShield Minnesota, Federal Employee Program,1015.488,98.4,,percent of total billed charges,,
COCAINE 4 % NASL SOLN,,C9046,HCPCS,Facility,Both,4 mL,mL,,1032,877.2,295.7712,1032,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1032,100,,percent of total billed charges,,
COCAINE 4 % NASL SOLN,,C9046,HCPCS,Facility,Both,4 mL,mL,,1032,877.2,295.7712,1032,BlueCross BlueShield Minnesota,High Value Network Plan,928.8,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
COCAINE 4 % NASL SOLN,,C9046,HCPCS,Facility,Outpatient,4 mL,mL,,1032,877.2,295.7712,1032,BlueCross BlueShield Minnesota,Medicare Advantage,505.68,49,,percent of total billed charges,,
COCAINE 4 % NASL SOLN,,C9046,HCPCS,Facility,Inpatient,4 mL,mL,,1032,877.2,295.7712,1032,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
COCAINE 4 % NASL SOLN,,C9046,HCPCS,Facility,Both,4 mL,mL,,1032,877.2,295.7712,1032,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,914.0424,88.57,,percent of total billed charges,,
COCAINE 4 % NASL SOLN,,C9046,HCPCS,Facility,Both,4 mL,mL,,1032,877.2,295.7712,1032,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,295.7712,28.66,,percent of total billed charges,,
COCAINE 4 % NASL SOLN,,C9046,HCPCS,Facility,Outpatient,4 mL,mL,,1032,877.2,295.7712,1032,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),505.68,49,,percent of total billed charges,,
COCAINE 4 % NASL SOLN,,C9046,HCPCS,Facility,Inpatient,4 mL,mL,,1032,877.2,295.7712,1032,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
COCAINE 4 % NASL SOLN,,C9046,HCPCS,Facility,Both,4 mL,mL,,1032,877.2,295.7712,1032,CorVel,Worker's Compensation,1032,100,,percent of total billed charges,,
COCAINE 4 % NASL SOLN,,C9046,HCPCS,Facility,Both,4 mL,mL,,1032,877.2,295.7712,1032,First Health Group Corporation,First Health Network,1001.04,97,,percent of total billed charges,,
COCAINE 4 % NASL SOLN,,C9046,HCPCS,Facility,Both,4 mL,mL,,1032,877.2,295.7712,1032,"Health Partners, Inc.",Commercial,976.272,94.6,,percent of total billed charges,,
COCAINE 4 % NASL SOLN,,C9046,HCPCS,Facility,Outpatient,4 mL,mL,,1032,877.2,295.7712,1032,"Health Partners, Inc.",Medicare Advantage,505.68,49,,percent of total billed charges,,
COCAINE 4 % NASL SOLN,,C9046,HCPCS,Facility,Inpatient,4 mL,mL,,1032,877.2,295.7712,1032,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
COCAINE 4 % NASL SOLN,,C9046,HCPCS,Facility,Both,4 mL,mL,,1032,877.2,295.7712,1032,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),619.2,60,,percent of total billed charges,,
COCAINE 4 % NASL SOLN,,C9046,HCPCS,Facility,Both,4 mL,mL,,1032,877.2,295.7712,1032,"Health Partners, Inc.",State of Minnesota Advantage Program,841.08,81.5,,percent of total billed charges,,
COCAINE 4 % NASL SOLN,,C9046,HCPCS,Facility,Both,4 mL,mL,,1032,877.2,295.7712,1032,"Health Partners, Inc.",State Public Programs,516,50,,percent of total billed charges,,
COCAINE 4 % NASL SOLN,,C9046,HCPCS,Facility,Both,4 mL,mL,,1032,877.2,295.7712,1032,Humana Insurance Company,Commercial PPO,980.4,95,,percent of total billed charges,,
COCAINE 4 % NASL SOLN,,C9046,HCPCS,Facility,Outpatient,4 mL,mL,,1032,877.2,295.7712,1032,Humana Insurance Company,Medicare PPO,505.68,49,,percent of total billed charges,,
COCAINE 4 % NASL SOLN,,C9046,HCPCS,Facility,Inpatient,4 mL,mL,,1032,877.2,295.7712,1032,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
COCAINE 4 % NASL SOLN,,C9046,HCPCS,Facility,Both,4 mL,mL,,1032,877.2,295.7712,1032,Medica,Individual & Family,1022.712,99.1,,percent of total billed charges,,
COCAINE 4 % NASL SOLN,,C9046,HCPCS,Facility,Outpatient,4 mL,mL,,1032,877.2,295.7712,1032,Medica,Medica Advantage Solution,513.936,49.8,,percent of total billed charges,,
COCAINE 4 % NASL SOLN,,C9046,HCPCS,Facility,Inpatient,4 mL,mL,,1032,877.2,295.7712,1032,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
COCAINE 4 % NASL SOLN,,C9046,HCPCS,Facility,Outpatient,4 mL,mL,,1032,877.2,295.7712,1032,Medica,Medical Assistance,460.272,44.6,,percent of total billed charges,,
COCAINE 4 % NASL SOLN,,C9046,HCPCS,Facility,Inpatient,4 mL,mL,,1032,877.2,295.7712,1032,Medica,Medical Assistance,,,,,Included in per diem rate,
COCAINE 4 % NASL SOLN,,C9046,HCPCS,Facility,Outpatient,4 mL,mL,,1032,877.2,295.7712,1032,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,513.936,49.8,,percent of total billed charges,,
COCAINE 4 % NASL SOLN,,C9046,HCPCS,Facility,Inpatient,4 mL,mL,,1032,877.2,295.7712,1032,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
COCAINE 4 % NASL SOLN,,C9046,HCPCS,Facility,Both,4 mL,mL,,1032,877.2,295.7712,1032,"Multiplan, Inc.","Multiplan, Inc.",970.08,94,,percent of total billed charges,,
COCAINE 4 % NASL SOLN,,C9046,HCPCS,Facility,Outpatient,4 mL,mL,,1032,877.2,295.7712,1032,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,929.832,90.1,,percent of total billed charges,,
COCAINE 4 % NASL SOLN,,C9046,HCPCS,Facility,Inpatient,4 mL,mL,,1032,877.2,295.7712,1032,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
COCAINE 4 % NASL SOLN,,C9046,HCPCS,Facility,Both,4 mL,mL,,1032,877.2,295.7712,1032,"Preferred One Administrative Services, INC.",PPO,1017.552,98.6,,percent of total billed charges,,
COCAINE 4 % NASL SOLN,,C9046,HCPCS,Facility,Outpatient,4 mL,mL,,1032,877.2,295.7712,1032,PrimeWest Health,Minnesota Senior Health Options (MSHO),530.964,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
COCAINE 4 % NASL SOLN,,C9046,HCPCS,Facility,Inpatient,4 mL,mL,,1032,877.2,295.7712,1032,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
COCAINE 4 % NASL SOLN,,C9046,HCPCS,Facility,Outpatient,4 mL,mL,,1032,877.2,295.7712,1032,PrimeWest Health,MinnesotaCare,530.0352,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
COCAINE 4 % NASL SOLN,,C9046,HCPCS,Facility,Inpatient,4 mL,mL,,1032,877.2,295.7712,1032,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
COCAINE 4 % NASL SOLN,,C9046,HCPCS,Facility,Both,4 mL,mL,,1032,877.2,295.7712,1032,Sanford Health Plan,Sanford Health Plan,949.44,92,,percent of total billed charges,,
COCAINE 4 % NASL SOLN,,C9046,HCPCS,Facility,Outpatient,4 mL,mL,,1032,877.2,295.7712,1032,"UCare Health, Inc.",Individual & Family Plan,581.532,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
COCAINE 4 % NASL SOLN,,C9046,HCPCS,Facility,Inpatient,4 mL,mL,,1032,877.2,295.7712,1032,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
COCAINE 4 % NASL SOLN,,C9046,HCPCS,Facility,Outpatient,4 mL,mL,,1032,877.2,295.7712,1032,"UCare Health, Inc.",Medical Assistance,520.8504,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
COCAINE 4 % NASL SOLN,,C9046,HCPCS,Facility,Inpatient,4 mL,mL,,1032,877.2,295.7712,1032,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
COCAINE 4 % NASL SOLN,,C9046,HCPCS,Facility,Outpatient,4 mL,mL,,1032,877.2,295.7712,1032,"UCare Health, Inc.",Medicare Advantage,520.8504,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
COCAINE 4 % NASL SOLN,,C9046,HCPCS,Facility,Inpatient,4 mL,mL,,1032,877.2,295.7712,1032,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
COCAINE 4 % NASL SOLN,,C9046,HCPCS,Facility,Outpatient,4 mL,mL,,1032,877.2,295.7712,1032,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),520.8504,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
COCAINE 4 % NASL SOLN,,C9046,HCPCS,Facility,Inpatient,4 mL,mL,,1032,877.2,295.7712,1032,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
COCAINE 4 % NASL SOLN,,C9046,HCPCS,Facility,Both,4 mL,mL,,1032,877.2,295.7712,1032,UnitedHealthcare,Individual & Family,970.08,94,,percent of total billed charges,,
COCAINE 4 % NASL SOLN,,C9046,HCPCS,Facility,Outpatient,4 mL,mL,,1032,877.2,295.7712,1032,UnitedHealthcare,Medicare Advantage,505.68,49,,percent of total billed charges,,
COCAINE 4 % NASL SOLN,,C9046,HCPCS,Facility,Inpatient,4 mL,mL,,1032,877.2,295.7712,1032,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
COCAINE 4 % NASL SOLN,,C9046,HCPCS,Facility,Outpatient,4 mL,mL,,1032,877.2,295.7712,1032,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,495.36,48,,percent of total billed charges,,100% of DHS outpatient percentage
COCAINE 4 % NASL SOLN,,C9046,HCPCS,Facility,Inpatient,4 mL,mL,,1032,877.2,295.7712,1032,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
FUROSEMIDE 10 MG/ML INJ SOLN,,J1940,HCPCS,Facility,Both,4 mL,mL,,18,15.3,5.1588,18,Aetna,Commercial,16.56,92,,percent of total billed charges,,
FUROSEMIDE 10 MG/ML INJ SOLN,,J1940,HCPCS,Facility,Outpatient,4 mL,mL,,18,15.3,5.1588,18,Aetna,Medicare Advantage,8.82,49,,percent of total billed charges,,
FUROSEMIDE 10 MG/ML INJ SOLN,,J1940,HCPCS,Facility,Inpatient,4 mL,mL,,18,15.3,5.1588,18,Aetna,Medicare Advantage,,,,,Included in per diem rate,
FUROSEMIDE 10 MG/ML INJ SOLN,,J1940,HCPCS,Facility,Both,4 mL,mL,,18,15.3,5.1588,18,Aetna,PPO,16.74,93,,percent of total billed charges,,
FUROSEMIDE 10 MG/ML INJ SOLN,,J1940,HCPCS,Facility,Both,4 mL,mL,,18,15.3,5.1588,18,America's PPO,America's PPO,17.2854,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
FUROSEMIDE 10 MG/ML INJ SOLN,,J1940,HCPCS,Facility,Both,4 mL,mL,,18,15.3,5.1588,18,BlueCross BlueShield Minnesota, Federal Employee Program,17.712,98.4,,percent of total billed charges,,
FUROSEMIDE 10 MG/ML INJ SOLN,,J1940,HCPCS,Facility,Both,4 mL,mL,,18,15.3,5.1588,18,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,18,100,,percent of total billed charges,,
FUROSEMIDE 10 MG/ML INJ SOLN,,J1940,HCPCS,Facility,Both,4 mL,mL,,18,15.3,5.1588,18,BlueCross BlueShield Minnesota,High Value Network Plan,16.2,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
FUROSEMIDE 10 MG/ML INJ SOLN,,J1940,HCPCS,Facility,Outpatient,4 mL,mL,,18,15.3,5.1588,18,BlueCross BlueShield Minnesota,Medicare Advantage,8.82,49,,percent of total billed charges,,
FUROSEMIDE 10 MG/ML INJ SOLN,,J1940,HCPCS,Facility,Inpatient,4 mL,mL,,18,15.3,5.1588,18,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
FUROSEMIDE 10 MG/ML INJ SOLN,,J1940,HCPCS,Facility,Both,4 mL,mL,,18,15.3,5.1588,18,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,15.9426,88.57,,percent of total billed charges,,
FUROSEMIDE 10 MG/ML INJ SOLN,,J1940,HCPCS,Facility,Both,4 mL,mL,,18,15.3,5.1588,18,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,5.1588,28.66,,percent of total billed charges,,
FUROSEMIDE 10 MG/ML INJ SOLN,,J1940,HCPCS,Facility,Outpatient,4 mL,mL,,18,15.3,5.1588,18,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),8.82,49,,percent of total billed charges,,
FUROSEMIDE 10 MG/ML INJ SOLN,,J1940,HCPCS,Facility,Inpatient,4 mL,mL,,18,15.3,5.1588,18,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
FUROSEMIDE 10 MG/ML INJ SOLN,,J1940,HCPCS,Facility,Both,4 mL,mL,,18,15.3,5.1588,18,CorVel,Worker's Compensation,18,100,,percent of total billed charges,,
FUROSEMIDE 10 MG/ML INJ SOLN,,J1940,HCPCS,Facility,Both,4 mL,mL,,18,15.3,5.1588,18,First Health Group Corporation,First Health Network,17.46,97,,percent of total billed charges,,
FUROSEMIDE 10 MG/ML INJ SOLN,,J1940,HCPCS,Facility,Both,4 mL,mL,,18,15.3,5.1588,18,"Health Partners, Inc.",Commercial,17.028,94.6,,percent of total billed charges,,
FUROSEMIDE 10 MG/ML INJ SOLN,,J1940,HCPCS,Facility,Outpatient,4 mL,mL,,18,15.3,5.1588,18,"Health Partners, Inc.",Medicare Advantage,8.82,49,,percent of total billed charges,,
FUROSEMIDE 10 MG/ML INJ SOLN,,J1940,HCPCS,Facility,Inpatient,4 mL,mL,,18,15.3,5.1588,18,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
FUROSEMIDE 10 MG/ML INJ SOLN,,J1940,HCPCS,Facility,Both,4 mL,mL,,18,15.3,5.1588,18,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),10.8,60,,percent of total billed charges,,
FUROSEMIDE 10 MG/ML INJ SOLN,,J1940,HCPCS,Facility,Both,4 mL,mL,,18,15.3,5.1588,18,"Health Partners, Inc.",State of Minnesota Advantage Program,14.67,81.5,,percent of total billed charges,,
FUROSEMIDE 10 MG/ML INJ SOLN,,J1940,HCPCS,Facility,Both,4 mL,mL,,18,15.3,5.1588,18,"Health Partners, Inc.",State Public Programs,9,50,,percent of total billed charges,,
FUROSEMIDE 10 MG/ML INJ SOLN,,J1940,HCPCS,Facility,Both,4 mL,mL,,18,15.3,5.1588,18,Humana Insurance Company,Commercial PPO,17.1,95,,percent of total billed charges,,
FUROSEMIDE 10 MG/ML INJ SOLN,,J1940,HCPCS,Facility,Outpatient,4 mL,mL,,18,15.3,5.1588,18,Humana Insurance Company,Medicare PPO,8.82,49,,percent of total billed charges,,
FUROSEMIDE 10 MG/ML INJ SOLN,,J1940,HCPCS,Facility,Inpatient,4 mL,mL,,18,15.3,5.1588,18,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
FUROSEMIDE 10 MG/ML INJ SOLN,,J1940,HCPCS,Facility,Both,4 mL,mL,,18,15.3,5.1588,18,Medica,Individual & Family,17.838,99.1,,percent of total billed charges,,
FUROSEMIDE 10 MG/ML INJ SOLN,,J1940,HCPCS,Facility,Outpatient,4 mL,mL,,18,15.3,5.1588,18,Medica,Medica Advantage Solution,8.964,49.8,,percent of total billed charges,,
FUROSEMIDE 10 MG/ML INJ SOLN,,J1940,HCPCS,Facility,Inpatient,4 mL,mL,,18,15.3,5.1588,18,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
FUROSEMIDE 10 MG/ML INJ SOLN,,J1940,HCPCS,Facility,Outpatient,4 mL,mL,,18,15.3,5.1588,18,Medica,Medical Assistance,8.028,44.6,,percent of total billed charges,,
FUROSEMIDE 10 MG/ML INJ SOLN,,J1940,HCPCS,Facility,Inpatient,4 mL,mL,,18,15.3,5.1588,18,Medica,Medical Assistance,,,,,Included in per diem rate,
FUROSEMIDE 10 MG/ML INJ SOLN,,J1940,HCPCS,Facility,Outpatient,4 mL,mL,,18,15.3,5.1588,18,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,8.964,49.8,,percent of total billed charges,,
FUROSEMIDE 10 MG/ML INJ SOLN,,J1940,HCPCS,Facility,Inpatient,4 mL,mL,,18,15.3,5.1588,18,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
FUROSEMIDE 10 MG/ML INJ SOLN,,J1940,HCPCS,Facility,Both,4 mL,mL,,18,15.3,5.1588,18,"Multiplan, Inc.","Multiplan, Inc.",16.92,94,,percent of total billed charges,,
FUROSEMIDE 10 MG/ML INJ SOLN,,J1940,HCPCS,Facility,Outpatient,4 mL,mL,,18,15.3,5.1588,18,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,16.218,90.1,,percent of total billed charges,,
FUROSEMIDE 10 MG/ML INJ SOLN,,J1940,HCPCS,Facility,Inpatient,4 mL,mL,,18,15.3,5.1588,18,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
FUROSEMIDE 10 MG/ML INJ SOLN,,J1940,HCPCS,Facility,Both,4 mL,mL,,18,15.3,5.1588,18,"Preferred One Administrative Services, INC.",PPO,17.748,98.6,,percent of total billed charges,,
FUROSEMIDE 10 MG/ML INJ SOLN,,J1940,HCPCS,Facility,Outpatient,4 mL,mL,,18,15.3,5.1588,18,PrimeWest Health,Minnesota Senior Health Options (MSHO),9.261,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
FUROSEMIDE 10 MG/ML INJ SOLN,,J1940,HCPCS,Facility,Inpatient,4 mL,mL,,18,15.3,5.1588,18,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
FUROSEMIDE 10 MG/ML INJ SOLN,,J1940,HCPCS,Facility,Outpatient,4 mL,mL,,18,15.3,5.1588,18,PrimeWest Health,MinnesotaCare,9.2448,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
FUROSEMIDE 10 MG/ML INJ SOLN,,J1940,HCPCS,Facility,Inpatient,4 mL,mL,,18,15.3,5.1588,18,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
FUROSEMIDE 10 MG/ML INJ SOLN,,J1940,HCPCS,Facility,Both,4 mL,mL,,18,15.3,5.1588,18,Sanford Health Plan,Sanford Health Plan,16.56,92,,percent of total billed charges,,
FUROSEMIDE 10 MG/ML INJ SOLN,,J1940,HCPCS,Facility,Outpatient,4 mL,mL,,18,15.3,5.1588,18,"UCare Health, Inc.",Individual & Family Plan,10.143,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
FUROSEMIDE 10 MG/ML INJ SOLN,,J1940,HCPCS,Facility,Inpatient,4 mL,mL,,18,15.3,5.1588,18,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
FUROSEMIDE 10 MG/ML INJ SOLN,,J1940,HCPCS,Facility,Outpatient,4 mL,mL,,18,15.3,5.1588,18,"UCare Health, Inc.",Medical Assistance,9.0846,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FUROSEMIDE 10 MG/ML INJ SOLN,,J1940,HCPCS,Facility,Inpatient,4 mL,mL,,18,15.3,5.1588,18,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
FUROSEMIDE 10 MG/ML INJ SOLN,,J1940,HCPCS,Facility,Outpatient,4 mL,mL,,18,15.3,5.1588,18,"UCare Health, Inc.",Medicare Advantage,9.0846,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FUROSEMIDE 10 MG/ML INJ SOLN,,J1940,HCPCS,Facility,Inpatient,4 mL,mL,,18,15.3,5.1588,18,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
FUROSEMIDE 10 MG/ML INJ SOLN,,J1940,HCPCS,Facility,Outpatient,4 mL,mL,,18,15.3,5.1588,18,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),9.0846,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FUROSEMIDE 10 MG/ML INJ SOLN,,J1940,HCPCS,Facility,Inpatient,4 mL,mL,,18,15.3,5.1588,18,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
FUROSEMIDE 10 MG/ML INJ SOLN,,J1940,HCPCS,Facility,Both,4 mL,mL,,18,15.3,5.1588,18,UnitedHealthcare,Individual & Family,16.92,94,,percent of total billed charges,,
FUROSEMIDE 10 MG/ML INJ SOLN,,J1940,HCPCS,Facility,Outpatient,4 mL,mL,,18,15.3,5.1588,18,UnitedHealthcare,Medicare Advantage,8.82,49,,percent of total billed charges,,
FUROSEMIDE 10 MG/ML INJ SOLN,,J1940,HCPCS,Facility,Inpatient,4 mL,mL,,18,15.3,5.1588,18,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
FUROSEMIDE 10 MG/ML INJ SOLN,,J1940,HCPCS,Facility,Outpatient,4 mL,mL,,18,15.3,5.1588,18,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,8.64,48,,percent of total billed charges,,100% of DHS outpatient percentage
FUROSEMIDE 10 MG/ML INJ SOLN,,J1940,HCPCS,Facility,Inpatient,4 mL,mL,,18,15.3,5.1588,18,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
BUMETANIDE 0.25 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Both,4 mL,mL,,14,11.9,4.0124,14,Aetna,Commercial,12.88,92,,percent of total billed charges,,
BUMETANIDE 0.25 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Outpatient,4 mL,mL,,14,11.9,4.0124,14,Aetna,Medicare Advantage,6.86,49,,percent of total billed charges,,
BUMETANIDE 0.25 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Inpatient,4 mL,mL,,14,11.9,4.0124,14,Aetna,Medicare Advantage,,,,,Included in per diem rate,
BUMETANIDE 0.25 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Both,4 mL,mL,,14,11.9,4.0124,14,Aetna,PPO,13.02,93,,percent of total billed charges,,
BUMETANIDE 0.25 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Both,4 mL,mL,,14,11.9,4.0124,14,America's PPO,America's PPO,13.4442,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
BUMETANIDE 0.25 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Both,4 mL,mL,,14,11.9,4.0124,14,BlueCross BlueShield Minnesota, Federal Employee Program,13.776,98.4,,percent of total billed charges,,
BUMETANIDE 0.25 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Both,4 mL,mL,,14,11.9,4.0124,14,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,14,100,,percent of total billed charges,,
BUMETANIDE 0.25 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Both,4 mL,mL,,14,11.9,4.0124,14,BlueCross BlueShield Minnesota,High Value Network Plan,12.6,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
BUMETANIDE 0.25 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Outpatient,4 mL,mL,,14,11.9,4.0124,14,BlueCross BlueShield Minnesota,Medicare Advantage,6.86,49,,percent of total billed charges,,
BUMETANIDE 0.25 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Inpatient,4 mL,mL,,14,11.9,4.0124,14,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
BUMETANIDE 0.25 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Both,4 mL,mL,,14,11.9,4.0124,14,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,12.3998,88.57,,percent of total billed charges,,
BUMETANIDE 0.25 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Both,4 mL,mL,,14,11.9,4.0124,14,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,4.0124,28.66,,percent of total billed charges,,
BUMETANIDE 0.25 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Outpatient,4 mL,mL,,14,11.9,4.0124,14,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),6.86,49,,percent of total billed charges,,
BUMETANIDE 0.25 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Inpatient,4 mL,mL,,14,11.9,4.0124,14,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
BUMETANIDE 0.25 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Both,4 mL,mL,,14,11.9,4.0124,14,CorVel,Worker's Compensation,14,100,,percent of total billed charges,,
BUMETANIDE 0.25 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Both,4 mL,mL,,14,11.9,4.0124,14,First Health Group Corporation,First Health Network,13.58,97,,percent of total billed charges,,
BUMETANIDE 0.25 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Both,4 mL,mL,,14,11.9,4.0124,14,"Health Partners, Inc.",Commercial,13.244,94.6,,percent of total billed charges,,
BUMETANIDE 0.25 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Outpatient,4 mL,mL,,14,11.9,4.0124,14,"Health Partners, Inc.",Medicare Advantage,6.86,49,,percent of total billed charges,,
BUMETANIDE 0.25 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Inpatient,4 mL,mL,,14,11.9,4.0124,14,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
BUMETANIDE 0.25 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Both,4 mL,mL,,14,11.9,4.0124,14,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),8.4,60,,percent of total billed charges,,
BUMETANIDE 0.25 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Both,4 mL,mL,,14,11.9,4.0124,14,"Health Partners, Inc.",State of Minnesota Advantage Program,11.41,81.5,,percent of total billed charges,,
BUMETANIDE 0.25 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Both,4 mL,mL,,14,11.9,4.0124,14,"Health Partners, Inc.",State Public Programs,7,50,,percent of total billed charges,,
BUMETANIDE 0.25 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Both,4 mL,mL,,14,11.9,4.0124,14,Humana Insurance Company,Commercial PPO,13.3,95,,percent of total billed charges,,
BUMETANIDE 0.25 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Outpatient,4 mL,mL,,14,11.9,4.0124,14,Humana Insurance Company,Medicare PPO,6.86,49,,percent of total billed charges,,
BUMETANIDE 0.25 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Inpatient,4 mL,mL,,14,11.9,4.0124,14,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
BUMETANIDE 0.25 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Both,4 mL,mL,,14,11.9,4.0124,14,Medica,Individual & Family,13.874,99.1,,percent of total billed charges,,
BUMETANIDE 0.25 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Outpatient,4 mL,mL,,14,11.9,4.0124,14,Medica,Medica Advantage Solution,6.972,49.8,,percent of total billed charges,,
BUMETANIDE 0.25 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Inpatient,4 mL,mL,,14,11.9,4.0124,14,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
BUMETANIDE 0.25 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Outpatient,4 mL,mL,,14,11.9,4.0124,14,Medica,Medical Assistance,6.244,44.6,,percent of total billed charges,,
BUMETANIDE 0.25 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Inpatient,4 mL,mL,,14,11.9,4.0124,14,Medica,Medical Assistance,,,,,Included in per diem rate,
BUMETANIDE 0.25 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Outpatient,4 mL,mL,,14,11.9,4.0124,14,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,6.972,49.8,,percent of total billed charges,,
BUMETANIDE 0.25 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Inpatient,4 mL,mL,,14,11.9,4.0124,14,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
BUMETANIDE 0.25 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Both,4 mL,mL,,14,11.9,4.0124,14,"Multiplan, Inc.","Multiplan, Inc.",13.16,94,,percent of total billed charges,,
BUMETANIDE 0.25 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Outpatient,4 mL,mL,,14,11.9,4.0124,14,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,12.614,90.1,,percent of total billed charges,,
BUMETANIDE 0.25 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Inpatient,4 mL,mL,,14,11.9,4.0124,14,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
BUMETANIDE 0.25 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Both,4 mL,mL,,14,11.9,4.0124,14,"Preferred One Administrative Services, INC.",PPO,13.804,98.6,,percent of total billed charges,,
BUMETANIDE 0.25 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Outpatient,4 mL,mL,,14,11.9,4.0124,14,PrimeWest Health,Minnesota Senior Health Options (MSHO),7.203,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
BUMETANIDE 0.25 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Inpatient,4 mL,mL,,14,11.9,4.0124,14,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
BUMETANIDE 0.25 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Outpatient,4 mL,mL,,14,11.9,4.0124,14,PrimeWest Health,MinnesotaCare,7.1904,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
BUMETANIDE 0.25 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Inpatient,4 mL,mL,,14,11.9,4.0124,14,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
BUMETANIDE 0.25 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Both,4 mL,mL,,14,11.9,4.0124,14,Sanford Health Plan,Sanford Health Plan,12.88,92,,percent of total billed charges,,
BUMETANIDE 0.25 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Outpatient,4 mL,mL,,14,11.9,4.0124,14,"UCare Health, Inc.",Individual & Family Plan,7.889,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
BUMETANIDE 0.25 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Inpatient,4 mL,mL,,14,11.9,4.0124,14,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
BUMETANIDE 0.25 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Outpatient,4 mL,mL,,14,11.9,4.0124,14,"UCare Health, Inc.",Medical Assistance,7.0658,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BUMETANIDE 0.25 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Inpatient,4 mL,mL,,14,11.9,4.0124,14,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
BUMETANIDE 0.25 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Outpatient,4 mL,mL,,14,11.9,4.0124,14,"UCare Health, Inc.",Medicare Advantage,7.0658,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BUMETANIDE 0.25 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Inpatient,4 mL,mL,,14,11.9,4.0124,14,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
BUMETANIDE 0.25 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Outpatient,4 mL,mL,,14,11.9,4.0124,14,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),7.0658,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BUMETANIDE 0.25 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Inpatient,4 mL,mL,,14,11.9,4.0124,14,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
BUMETANIDE 0.25 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Both,4 mL,mL,,14,11.9,4.0124,14,UnitedHealthcare,Individual & Family,13.16,94,,percent of total billed charges,,
BUMETANIDE 0.25 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Outpatient,4 mL,mL,,14,11.9,4.0124,14,UnitedHealthcare,Medicare Advantage,6.86,49,,percent of total billed charges,,
BUMETANIDE 0.25 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Inpatient,4 mL,mL,,14,11.9,4.0124,14,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
BUMETANIDE 0.25 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Outpatient,4 mL,mL,,14,11.9,4.0124,14,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,6.72,48,,percent of total billed charges,,100% of DHS outpatient percentage
BUMETANIDE 0.25 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Inpatient,4 mL,mL,,14,11.9,4.0124,14,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
FAMOTIDINE 10 MG/ML IV SOLN,,J3490,HCPCS,Facility,Both,4 mL,mL,,11,9.35,3.1526,11,Aetna,Commercial,10.12,92,,percent of total billed charges,,
FAMOTIDINE 10 MG/ML IV SOLN,,J3490,HCPCS,Facility,Outpatient,4 mL,mL,,11,9.35,3.1526,11,Aetna,Medicare Advantage,5.39,49,,percent of total billed charges,,
FAMOTIDINE 10 MG/ML IV SOLN,,J3490,HCPCS,Facility,Inpatient,4 mL,mL,,11,9.35,3.1526,11,Aetna,Medicare Advantage,,,,,Included in per diem rate,
FAMOTIDINE 10 MG/ML IV SOLN,,J3490,HCPCS,Facility,Both,4 mL,mL,,11,9.35,3.1526,11,Aetna,PPO,10.23,93,,percent of total billed charges,,
FAMOTIDINE 10 MG/ML IV SOLN,,J3490,HCPCS,Facility,Both,4 mL,mL,,11,9.35,3.1526,11,America's PPO,America's PPO,10.5633,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
FAMOTIDINE 10 MG/ML IV SOLN,,J3490,HCPCS,Facility,Both,4 mL,mL,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota, Federal Employee Program,10.824,98.4,,percent of total billed charges,,
FAMOTIDINE 10 MG/ML IV SOLN,,J3490,HCPCS,Facility,Both,4 mL,mL,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,11,100,,percent of total billed charges,,
FAMOTIDINE 10 MG/ML IV SOLN,,J3490,HCPCS,Facility,Both,4 mL,mL,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,High Value Network Plan,9.9,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
FAMOTIDINE 10 MG/ML IV SOLN,,J3490,HCPCS,Facility,Outpatient,4 mL,mL,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,Medicare Advantage,5.39,49,,percent of total billed charges,,
FAMOTIDINE 10 MG/ML IV SOLN,,J3490,HCPCS,Facility,Inpatient,4 mL,mL,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
FAMOTIDINE 10 MG/ML IV SOLN,,J3490,HCPCS,Facility,Both,4 mL,mL,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,9.7427,88.57,,percent of total billed charges,,
FAMOTIDINE 10 MG/ML IV SOLN,,J3490,HCPCS,Facility,Both,4 mL,mL,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,3.1526,28.66,,percent of total billed charges,,
FAMOTIDINE 10 MG/ML IV SOLN,,J3490,HCPCS,Facility,Outpatient,4 mL,mL,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),5.39,49,,percent of total billed charges,,
FAMOTIDINE 10 MG/ML IV SOLN,,J3490,HCPCS,Facility,Inpatient,4 mL,mL,,11,9.35,3.1526,11,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
FAMOTIDINE 10 MG/ML IV SOLN,,J3490,HCPCS,Facility,Both,4 mL,mL,,11,9.35,3.1526,11,CorVel,Worker's Compensation,11,100,,percent of total billed charges,,
FAMOTIDINE 10 MG/ML IV SOLN,,J3490,HCPCS,Facility,Both,4 mL,mL,,11,9.35,3.1526,11,First Health Group Corporation,First Health Network,10.67,97,,percent of total billed charges,,
FAMOTIDINE 10 MG/ML IV SOLN,,J3490,HCPCS,Facility,Both,4 mL,mL,,11,9.35,3.1526,11,"Health Partners, Inc.",Commercial,10.406,94.6,,percent of total billed charges,,
FAMOTIDINE 10 MG/ML IV SOLN,,J3490,HCPCS,Facility,Outpatient,4 mL,mL,,11,9.35,3.1526,11,"Health Partners, Inc.",Medicare Advantage,5.39,49,,percent of total billed charges,,
FAMOTIDINE 10 MG/ML IV SOLN,,J3490,HCPCS,Facility,Inpatient,4 mL,mL,,11,9.35,3.1526,11,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
FAMOTIDINE 10 MG/ML IV SOLN,,J3490,HCPCS,Facility,Both,4 mL,mL,,11,9.35,3.1526,11,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),6.6,60,,percent of total billed charges,,
FAMOTIDINE 10 MG/ML IV SOLN,,J3490,HCPCS,Facility,Both,4 mL,mL,,11,9.35,3.1526,11,"Health Partners, Inc.",State of Minnesota Advantage Program,8.965,81.5,,percent of total billed charges,,
FAMOTIDINE 10 MG/ML IV SOLN,,J3490,HCPCS,Facility,Both,4 mL,mL,,11,9.35,3.1526,11,"Health Partners, Inc.",State Public Programs,5.5,50,,percent of total billed charges,,
FAMOTIDINE 10 MG/ML IV SOLN,,J3490,HCPCS,Facility,Both,4 mL,mL,,11,9.35,3.1526,11,Humana Insurance Company,Commercial PPO,10.45,95,,percent of total billed charges,,
FAMOTIDINE 10 MG/ML IV SOLN,,J3490,HCPCS,Facility,Outpatient,4 mL,mL,,11,9.35,3.1526,11,Humana Insurance Company,Medicare PPO,5.39,49,,percent of total billed charges,,
FAMOTIDINE 10 MG/ML IV SOLN,,J3490,HCPCS,Facility,Inpatient,4 mL,mL,,11,9.35,3.1526,11,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
FAMOTIDINE 10 MG/ML IV SOLN,,J3490,HCPCS,Facility,Both,4 mL,mL,,11,9.35,3.1526,11,Medica,Individual & Family,10.901,99.1,,percent of total billed charges,,
FAMOTIDINE 10 MG/ML IV SOLN,,J3490,HCPCS,Facility,Outpatient,4 mL,mL,,11,9.35,3.1526,11,Medica,Medica Advantage Solution,5.478,49.8,,percent of total billed charges,,
FAMOTIDINE 10 MG/ML IV SOLN,,J3490,HCPCS,Facility,Inpatient,4 mL,mL,,11,9.35,3.1526,11,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
FAMOTIDINE 10 MG/ML IV SOLN,,J3490,HCPCS,Facility,Outpatient,4 mL,mL,,11,9.35,3.1526,11,Medica,Medical Assistance,4.906,44.6,,percent of total billed charges,,
FAMOTIDINE 10 MG/ML IV SOLN,,J3490,HCPCS,Facility,Inpatient,4 mL,mL,,11,9.35,3.1526,11,Medica,Medical Assistance,,,,,Included in per diem rate,
FAMOTIDINE 10 MG/ML IV SOLN,,J3490,HCPCS,Facility,Outpatient,4 mL,mL,,11,9.35,3.1526,11,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,5.478,49.8,,percent of total billed charges,,
FAMOTIDINE 10 MG/ML IV SOLN,,J3490,HCPCS,Facility,Inpatient,4 mL,mL,,11,9.35,3.1526,11,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
FAMOTIDINE 10 MG/ML IV SOLN,,J3490,HCPCS,Facility,Both,4 mL,mL,,11,9.35,3.1526,11,"Multiplan, Inc.","Multiplan, Inc.",10.34,94,,percent of total billed charges,,
FAMOTIDINE 10 MG/ML IV SOLN,,J3490,HCPCS,Facility,Outpatient,4 mL,mL,,11,9.35,3.1526,11,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,9.911,90.1,,percent of total billed charges,,
FAMOTIDINE 10 MG/ML IV SOLN,,J3490,HCPCS,Facility,Inpatient,4 mL,mL,,11,9.35,3.1526,11,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
FAMOTIDINE 10 MG/ML IV SOLN,,J3490,HCPCS,Facility,Both,4 mL,mL,,11,9.35,3.1526,11,"Preferred One Administrative Services, INC.",PPO,10.846,98.6,,percent of total billed charges,,
FAMOTIDINE 10 MG/ML IV SOLN,,J3490,HCPCS,Facility,Outpatient,4 mL,mL,,11,9.35,3.1526,11,PrimeWest Health,Minnesota Senior Health Options (MSHO),5.6595,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
FAMOTIDINE 10 MG/ML IV SOLN,,J3490,HCPCS,Facility,Inpatient,4 mL,mL,,11,9.35,3.1526,11,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
FAMOTIDINE 10 MG/ML IV SOLN,,J3490,HCPCS,Facility,Outpatient,4 mL,mL,,11,9.35,3.1526,11,PrimeWest Health,MinnesotaCare,5.6496,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
FAMOTIDINE 10 MG/ML IV SOLN,,J3490,HCPCS,Facility,Inpatient,4 mL,mL,,11,9.35,3.1526,11,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
FAMOTIDINE 10 MG/ML IV SOLN,,J3490,HCPCS,Facility,Both,4 mL,mL,,11,9.35,3.1526,11,Sanford Health Plan,Sanford Health Plan,10.12,92,,percent of total billed charges,,
FAMOTIDINE 10 MG/ML IV SOLN,,J3490,HCPCS,Facility,Outpatient,4 mL,mL,,11,9.35,3.1526,11,"UCare Health, Inc.",Individual & Family Plan,6.1985,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
FAMOTIDINE 10 MG/ML IV SOLN,,J3490,HCPCS,Facility,Inpatient,4 mL,mL,,11,9.35,3.1526,11,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
FAMOTIDINE 10 MG/ML IV SOLN,,J3490,HCPCS,Facility,Outpatient,4 mL,mL,,11,9.35,3.1526,11,"UCare Health, Inc.",Medical Assistance,5.5517,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FAMOTIDINE 10 MG/ML IV SOLN,,J3490,HCPCS,Facility,Inpatient,4 mL,mL,,11,9.35,3.1526,11,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
FAMOTIDINE 10 MG/ML IV SOLN,,J3490,HCPCS,Facility,Outpatient,4 mL,mL,,11,9.35,3.1526,11,"UCare Health, Inc.",Medicare Advantage,5.5517,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FAMOTIDINE 10 MG/ML IV SOLN,,J3490,HCPCS,Facility,Inpatient,4 mL,mL,,11,9.35,3.1526,11,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
FAMOTIDINE 10 MG/ML IV SOLN,,J3490,HCPCS,Facility,Outpatient,4 mL,mL,,11,9.35,3.1526,11,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),5.5517,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FAMOTIDINE 10 MG/ML IV SOLN,,J3490,HCPCS,Facility,Inpatient,4 mL,mL,,11,9.35,3.1526,11,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
FAMOTIDINE 10 MG/ML IV SOLN,,J3490,HCPCS,Facility,Both,4 mL,mL,,11,9.35,3.1526,11,UnitedHealthcare,Individual & Family,10.34,94,,percent of total billed charges,,
FAMOTIDINE 10 MG/ML IV SOLN,,J3490,HCPCS,Facility,Outpatient,4 mL,mL,,11,9.35,3.1526,11,UnitedHealthcare,Medicare Advantage,5.39,49,,percent of total billed charges,,
FAMOTIDINE 10 MG/ML IV SOLN,,J3490,HCPCS,Facility,Inpatient,4 mL,mL,,11,9.35,3.1526,11,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
FAMOTIDINE 10 MG/ML IV SOLN,,J3490,HCPCS,Facility,Outpatient,4 mL,mL,,11,9.35,3.1526,11,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,5.28,48,,percent of total billed charges,,100% of DHS outpatient percentage
FAMOTIDINE 10 MG/ML IV SOLN,,J3490,HCPCS,Facility,Inpatient,4 mL,mL,,11,9.35,3.1526,11,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
LABETALOL 5 MG/ML IV SOLN,,J1920,HCPCS,Facility,Both,40 mL,mL,,36,30.6,10.3176,36,Aetna,Commercial,33.12,92,,percent of total billed charges,,
LABETALOL 5 MG/ML IV SOLN,,J1920,HCPCS,Facility,Outpatient,40 mL,mL,,36,30.6,10.3176,36,Aetna,Medicare Advantage,17.64,49,,percent of total billed charges,,
LABETALOL 5 MG/ML IV SOLN,,J1920,HCPCS,Facility,Inpatient,40 mL,mL,,36,30.6,10.3176,36,Aetna,Medicare Advantage,,,,,Included in per diem rate,
LABETALOL 5 MG/ML IV SOLN,,J1920,HCPCS,Facility,Both,40 mL,mL,,36,30.6,10.3176,36,Aetna,PPO,33.48,93,,percent of total billed charges,,
LABETALOL 5 MG/ML IV SOLN,,J1920,HCPCS,Facility,Both,40 mL,mL,,36,30.6,10.3176,36,America's PPO,America's PPO,34.5708,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
LABETALOL 5 MG/ML IV SOLN,,J1920,HCPCS,Facility,Both,40 mL,mL,,36,30.6,10.3176,36,BlueCross BlueShield Minnesota, Federal Employee Program,35.424,98.4,,percent of total billed charges,,
LABETALOL 5 MG/ML IV SOLN,,J1920,HCPCS,Facility,Both,40 mL,mL,,36,30.6,10.3176,36,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,36,100,,percent of total billed charges,,
LABETALOL 5 MG/ML IV SOLN,,J1920,HCPCS,Facility,Both,40 mL,mL,,36,30.6,10.3176,36,BlueCross BlueShield Minnesota,High Value Network Plan,32.4,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
LABETALOL 5 MG/ML IV SOLN,,J1920,HCPCS,Facility,Outpatient,40 mL,mL,,36,30.6,10.3176,36,BlueCross BlueShield Minnesota,Medicare Advantage,17.64,49,,percent of total billed charges,,
LABETALOL 5 MG/ML IV SOLN,,J1920,HCPCS,Facility,Inpatient,40 mL,mL,,36,30.6,10.3176,36,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
LABETALOL 5 MG/ML IV SOLN,,J1920,HCPCS,Facility,Both,40 mL,mL,,36,30.6,10.3176,36,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,31.8852,88.57,,percent of total billed charges,,
LABETALOL 5 MG/ML IV SOLN,,J1920,HCPCS,Facility,Both,40 mL,mL,,36,30.6,10.3176,36,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,10.3176,28.66,,percent of total billed charges,,
LABETALOL 5 MG/ML IV SOLN,,J1920,HCPCS,Facility,Outpatient,40 mL,mL,,36,30.6,10.3176,36,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),17.64,49,,percent of total billed charges,,
LABETALOL 5 MG/ML IV SOLN,,J1920,HCPCS,Facility,Inpatient,40 mL,mL,,36,30.6,10.3176,36,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
LABETALOL 5 MG/ML IV SOLN,,J1920,HCPCS,Facility,Both,40 mL,mL,,36,30.6,10.3176,36,CorVel,Worker's Compensation,36,100,,percent of total billed charges,,
LABETALOL 5 MG/ML IV SOLN,,J1920,HCPCS,Facility,Both,40 mL,mL,,36,30.6,10.3176,36,First Health Group Corporation,First Health Network,34.92,97,,percent of total billed charges,,
LABETALOL 5 MG/ML IV SOLN,,J1920,HCPCS,Facility,Both,40 mL,mL,,36,30.6,10.3176,36,"Health Partners, Inc.",Commercial,34.056,94.6,,percent of total billed charges,,
LABETALOL 5 MG/ML IV SOLN,,J1920,HCPCS,Facility,Outpatient,40 mL,mL,,36,30.6,10.3176,36,"Health Partners, Inc.",Medicare Advantage,17.64,49,,percent of total billed charges,,
LABETALOL 5 MG/ML IV SOLN,,J1920,HCPCS,Facility,Inpatient,40 mL,mL,,36,30.6,10.3176,36,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LABETALOL 5 MG/ML IV SOLN,,J1920,HCPCS,Facility,Both,40 mL,mL,,36,30.6,10.3176,36,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),21.6,60,,percent of total billed charges,,
LABETALOL 5 MG/ML IV SOLN,,J1920,HCPCS,Facility,Both,40 mL,mL,,36,30.6,10.3176,36,"Health Partners, Inc.",State of Minnesota Advantage Program,29.34,81.5,,percent of total billed charges,,
LABETALOL 5 MG/ML IV SOLN,,J1920,HCPCS,Facility,Both,40 mL,mL,,36,30.6,10.3176,36,"Health Partners, Inc.",State Public Programs,18,50,,percent of total billed charges,,
LABETALOL 5 MG/ML IV SOLN,,J1920,HCPCS,Facility,Both,40 mL,mL,,36,30.6,10.3176,36,Humana Insurance Company,Commercial PPO,34.2,95,,percent of total billed charges,,
LABETALOL 5 MG/ML IV SOLN,,J1920,HCPCS,Facility,Outpatient,40 mL,mL,,36,30.6,10.3176,36,Humana Insurance Company,Medicare PPO,17.64,49,,percent of total billed charges,,
LABETALOL 5 MG/ML IV SOLN,,J1920,HCPCS,Facility,Inpatient,40 mL,mL,,36,30.6,10.3176,36,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
LABETALOL 5 MG/ML IV SOLN,,J1920,HCPCS,Facility,Both,40 mL,mL,,36,30.6,10.3176,36,Medica,Individual & Family,35.676,99.1,,percent of total billed charges,,
LABETALOL 5 MG/ML IV SOLN,,J1920,HCPCS,Facility,Outpatient,40 mL,mL,,36,30.6,10.3176,36,Medica,Medica Advantage Solution,17.928,49.8,,percent of total billed charges,,
LABETALOL 5 MG/ML IV SOLN,,J1920,HCPCS,Facility,Inpatient,40 mL,mL,,36,30.6,10.3176,36,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
LABETALOL 5 MG/ML IV SOLN,,J1920,HCPCS,Facility,Outpatient,40 mL,mL,,36,30.6,10.3176,36,Medica,Medical Assistance,16.056,44.6,,percent of total billed charges,,
LABETALOL 5 MG/ML IV SOLN,,J1920,HCPCS,Facility,Inpatient,40 mL,mL,,36,30.6,10.3176,36,Medica,Medical Assistance,,,,,Included in per diem rate,
LABETALOL 5 MG/ML IV SOLN,,J1920,HCPCS,Facility,Outpatient,40 mL,mL,,36,30.6,10.3176,36,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,17.928,49.8,,percent of total billed charges,,
LABETALOL 5 MG/ML IV SOLN,,J1920,HCPCS,Facility,Inpatient,40 mL,mL,,36,30.6,10.3176,36,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
LABETALOL 5 MG/ML IV SOLN,,J1920,HCPCS,Facility,Both,40 mL,mL,,36,30.6,10.3176,36,"Multiplan, Inc.","Multiplan, Inc.",33.84,94,,percent of total billed charges,,
LABETALOL 5 MG/ML IV SOLN,,J1920,HCPCS,Facility,Outpatient,40 mL,mL,,36,30.6,10.3176,36,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,32.436,90.1,,percent of total billed charges,,
LABETALOL 5 MG/ML IV SOLN,,J1920,HCPCS,Facility,Inpatient,40 mL,mL,,36,30.6,10.3176,36,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
LABETALOL 5 MG/ML IV SOLN,,J1920,HCPCS,Facility,Both,40 mL,mL,,36,30.6,10.3176,36,"Preferred One Administrative Services, INC.",PPO,35.496,98.6,,percent of total billed charges,,
LABETALOL 5 MG/ML IV SOLN,,J1920,HCPCS,Facility,Outpatient,40 mL,mL,,36,30.6,10.3176,36,PrimeWest Health,Minnesota Senior Health Options (MSHO),18.522,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
LABETALOL 5 MG/ML IV SOLN,,J1920,HCPCS,Facility,Inpatient,40 mL,mL,,36,30.6,10.3176,36,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LABETALOL 5 MG/ML IV SOLN,,J1920,HCPCS,Facility,Outpatient,40 mL,mL,,36,30.6,10.3176,36,PrimeWest Health,MinnesotaCare,18.4896,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
LABETALOL 5 MG/ML IV SOLN,,J1920,HCPCS,Facility,Inpatient,40 mL,mL,,36,30.6,10.3176,36,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
LABETALOL 5 MG/ML IV SOLN,,J1920,HCPCS,Facility,Both,40 mL,mL,,36,30.6,10.3176,36,Sanford Health Plan,Sanford Health Plan,33.12,92,,percent of total billed charges,,
LABETALOL 5 MG/ML IV SOLN,,J1920,HCPCS,Facility,Outpatient,40 mL,mL,,36,30.6,10.3176,36,"UCare Health, Inc.",Individual & Family Plan,20.286,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
LABETALOL 5 MG/ML IV SOLN,,J1920,HCPCS,Facility,Inpatient,40 mL,mL,,36,30.6,10.3176,36,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
LABETALOL 5 MG/ML IV SOLN,,J1920,HCPCS,Facility,Outpatient,40 mL,mL,,36,30.6,10.3176,36,"UCare Health, Inc.",Medical Assistance,18.1692,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LABETALOL 5 MG/ML IV SOLN,,J1920,HCPCS,Facility,Inpatient,40 mL,mL,,36,30.6,10.3176,36,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
LABETALOL 5 MG/ML IV SOLN,,J1920,HCPCS,Facility,Outpatient,40 mL,mL,,36,30.6,10.3176,36,"UCare Health, Inc.",Medicare Advantage,18.1692,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LABETALOL 5 MG/ML IV SOLN,,J1920,HCPCS,Facility,Inpatient,40 mL,mL,,36,30.6,10.3176,36,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LABETALOL 5 MG/ML IV SOLN,,J1920,HCPCS,Facility,Outpatient,40 mL,mL,,36,30.6,10.3176,36,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),18.1692,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LABETALOL 5 MG/ML IV SOLN,,J1920,HCPCS,Facility,Inpatient,40 mL,mL,,36,30.6,10.3176,36,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LABETALOL 5 MG/ML IV SOLN,,J1920,HCPCS,Facility,Both,40 mL,mL,,36,30.6,10.3176,36,UnitedHealthcare,Individual & Family,33.84,94,,percent of total billed charges,,
LABETALOL 5 MG/ML IV SOLN,,J1920,HCPCS,Facility,Outpatient,40 mL,mL,,36,30.6,10.3176,36,UnitedHealthcare,Medicare Advantage,17.64,49,,percent of total billed charges,,
LABETALOL 5 MG/ML IV SOLN,,J1920,HCPCS,Facility,Inpatient,40 mL,mL,,36,30.6,10.3176,36,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
LABETALOL 5 MG/ML IV SOLN,,J1920,HCPCS,Facility,Outpatient,40 mL,mL,,36,30.6,10.3176,36,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,17.28,48,,percent of total billed charges,,100% of DHS outpatient percentage
LABETALOL 5 MG/ML IV SOLN,,J1920,HCPCS,Facility,Inpatient,40 mL,mL,,36,30.6,10.3176,36,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 2 GRAM/400 ML IV PGBK,,J3372,HCPCS,Facility,Both,400 mL,mL,,152,129.2,43.5632,152,Aetna,Commercial,139.84,92,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 2 GRAM/400 ML IV PGBK,,J3372,HCPCS,Facility,Both,400 mL,mL,,152,129.2,43.5632,152,Aetna,Commercial,139.84,92,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 2 GRAM/400 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,400 mL,mL,,152,129.2,43.5632,152,Aetna,Medicare Advantage,74.48,49,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 2 GRAM/400 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,400 mL,mL,,152,129.2,43.5632,152,Aetna,Medicare Advantage,74.48,49,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 2 GRAM/400 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,400 mL,mL,,152,129.2,43.5632,152,Aetna,Medicare Advantage,,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 2 GRAM/400 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,400 mL,mL,,152,129.2,43.5632,152,Aetna,Medicare Advantage,,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 2 GRAM/400 ML IV PGBK,,J3372,HCPCS,Facility,Both,400 mL,mL,,152,129.2,43.5632,152,Aetna,PPO,141.36,93,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 2 GRAM/400 ML IV PGBK,,J3372,HCPCS,Facility,Both,400 mL,mL,,152,129.2,43.5632,152,Aetna,PPO,141.36,93,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 2 GRAM/400 ML IV PGBK,,J3372,HCPCS,Facility,Both,400 mL,mL,,152,129.2,43.5632,152,America's PPO,America's PPO,145.9656,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
VANCOMYCIN-DILUENT COMBO NO.1 2 GRAM/400 ML IV PGBK,,J3372,HCPCS,Facility,Both,400 mL,mL,,152,129.2,43.5632,152,America's PPO,America's PPO,145.9656,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
VANCOMYCIN-DILUENT COMBO NO.1 2 GRAM/400 ML IV PGBK,,J3372,HCPCS,Facility,Both,400 mL,mL,,152,129.2,43.5632,152,BlueCross BlueShield Minnesota, Federal Employee Program,149.568,98.4,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 2 GRAM/400 ML IV PGBK,,J3372,HCPCS,Facility,Both,400 mL,mL,,152,129.2,43.5632,152,BlueCross BlueShield Minnesota, Federal Employee Program,149.568,98.4,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 2 GRAM/400 ML IV PGBK,,J3372,HCPCS,Facility,Both,400 mL,mL,,152,129.2,43.5632,152,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,152,100,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 2 GRAM/400 ML IV PGBK,,J3372,HCPCS,Facility,Both,400 mL,mL,,152,129.2,43.5632,152,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,152,100,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 2 GRAM/400 ML IV PGBK,,J3372,HCPCS,Facility,Both,400 mL,mL,,152,129.2,43.5632,152,BlueCross BlueShield Minnesota,High Value Network Plan,136.8,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
VANCOMYCIN-DILUENT COMBO NO.1 2 GRAM/400 ML IV PGBK,,J3372,HCPCS,Facility,Both,400 mL,mL,,152,129.2,43.5632,152,BlueCross BlueShield Minnesota,High Value Network Plan,136.8,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
VANCOMYCIN-DILUENT COMBO NO.1 2 GRAM/400 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,400 mL,mL,,152,129.2,43.5632,152,BlueCross BlueShield Minnesota,Medicare Advantage,74.48,49,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 2 GRAM/400 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,400 mL,mL,,152,129.2,43.5632,152,BlueCross BlueShield Minnesota,Medicare Advantage,74.48,49,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 2 GRAM/400 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,400 mL,mL,,152,129.2,43.5632,152,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 2 GRAM/400 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,400 mL,mL,,152,129.2,43.5632,152,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 2 GRAM/400 ML IV PGBK,,J3372,HCPCS,Facility,Both,400 mL,mL,,152,129.2,43.5632,152,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,134.6264,88.57,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 2 GRAM/400 ML IV PGBK,,J3372,HCPCS,Facility,Both,400 mL,mL,,152,129.2,43.5632,152,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,134.6264,88.57,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 2 GRAM/400 ML IV PGBK,,J3372,HCPCS,Facility,Both,400 mL,mL,,152,129.2,43.5632,152,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,43.5632,28.66,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 2 GRAM/400 ML IV PGBK,,J3372,HCPCS,Facility,Both,400 mL,mL,,152,129.2,43.5632,152,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,43.5632,28.66,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 2 GRAM/400 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,400 mL,mL,,152,129.2,43.5632,152,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),74.48,49,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 2 GRAM/400 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,400 mL,mL,,152,129.2,43.5632,152,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),74.48,49,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 2 GRAM/400 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,400 mL,mL,,152,129.2,43.5632,152,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 2 GRAM/400 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,400 mL,mL,,152,129.2,43.5632,152,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 2 GRAM/400 ML IV PGBK,,J3372,HCPCS,Facility,Both,400 mL,mL,,152,129.2,43.5632,152,CorVel,Worker's Compensation,152,100,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 2 GRAM/400 ML IV PGBK,,J3372,HCPCS,Facility,Both,400 mL,mL,,152,129.2,43.5632,152,CorVel,Worker's Compensation,152,100,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 2 GRAM/400 ML IV PGBK,,J3372,HCPCS,Facility,Both,400 mL,mL,,152,129.2,43.5632,152,First Health Group Corporation,First Health Network,147.44,97,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 2 GRAM/400 ML IV PGBK,,J3372,HCPCS,Facility,Both,400 mL,mL,,152,129.2,43.5632,152,First Health Group Corporation,First Health Network,147.44,97,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 2 GRAM/400 ML IV PGBK,,J3372,HCPCS,Facility,Both,400 mL,mL,,152,129.2,43.5632,152,"Health Partners, Inc.",Commercial,143.792,94.6,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 2 GRAM/400 ML IV PGBK,,J3372,HCPCS,Facility,Both,400 mL,mL,,152,129.2,43.5632,152,"Health Partners, Inc.",Commercial,143.792,94.6,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 2 GRAM/400 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,400 mL,mL,,152,129.2,43.5632,152,"Health Partners, Inc.",Medicare Advantage,74.48,49,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 2 GRAM/400 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,400 mL,mL,,152,129.2,43.5632,152,"Health Partners, Inc.",Medicare Advantage,74.48,49,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 2 GRAM/400 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,400 mL,mL,,152,129.2,43.5632,152,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 2 GRAM/400 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,400 mL,mL,,152,129.2,43.5632,152,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 2 GRAM/400 ML IV PGBK,,J3372,HCPCS,Facility,Both,400 mL,mL,,152,129.2,43.5632,152,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),91.2,60,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 2 GRAM/400 ML IV PGBK,,J3372,HCPCS,Facility,Both,400 mL,mL,,152,129.2,43.5632,152,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),91.2,60,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 2 GRAM/400 ML IV PGBK,,J3372,HCPCS,Facility,Both,400 mL,mL,,152,129.2,43.5632,152,"Health Partners, Inc.",State of Minnesota Advantage Program,123.88,81.5,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 2 GRAM/400 ML IV PGBK,,J3372,HCPCS,Facility,Both,400 mL,mL,,152,129.2,43.5632,152,"Health Partners, Inc.",State of Minnesota Advantage Program,123.88,81.5,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 2 GRAM/400 ML IV PGBK,,J3372,HCPCS,Facility,Both,400 mL,mL,,152,129.2,43.5632,152,"Health Partners, Inc.",State Public Programs,76,50,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 2 GRAM/400 ML IV PGBK,,J3372,HCPCS,Facility,Both,400 mL,mL,,152,129.2,43.5632,152,"Health Partners, Inc.",State Public Programs,76,50,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 2 GRAM/400 ML IV PGBK,,J3372,HCPCS,Facility,Both,400 mL,mL,,152,129.2,43.5632,152,Humana Insurance Company,Commercial PPO,144.4,95,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 2 GRAM/400 ML IV PGBK,,J3372,HCPCS,Facility,Both,400 mL,mL,,152,129.2,43.5632,152,Humana Insurance Company,Commercial PPO,144.4,95,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 2 GRAM/400 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,400 mL,mL,,152,129.2,43.5632,152,Humana Insurance Company,Medicare PPO,74.48,49,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 2 GRAM/400 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,400 mL,mL,,152,129.2,43.5632,152,Humana Insurance Company,Medicare PPO,74.48,49,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 2 GRAM/400 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,400 mL,mL,,152,129.2,43.5632,152,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 2 GRAM/400 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,400 mL,mL,,152,129.2,43.5632,152,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 2 GRAM/400 ML IV PGBK,,J3372,HCPCS,Facility,Both,400 mL,mL,,152,129.2,43.5632,152,Medica,Individual & Family,150.632,99.1,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 2 GRAM/400 ML IV PGBK,,J3372,HCPCS,Facility,Both,400 mL,mL,,152,129.2,43.5632,152,Medica,Individual & Family,150.632,99.1,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 2 GRAM/400 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,400 mL,mL,,152,129.2,43.5632,152,Medica,Medica Advantage Solution,75.696,49.8,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 2 GRAM/400 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,400 mL,mL,,152,129.2,43.5632,152,Medica,Medica Advantage Solution,75.696,49.8,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 2 GRAM/400 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,400 mL,mL,,152,129.2,43.5632,152,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 2 GRAM/400 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,400 mL,mL,,152,129.2,43.5632,152,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 2 GRAM/400 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,400 mL,mL,,152,129.2,43.5632,152,Medica,Medical Assistance,67.792,44.6,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 2 GRAM/400 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,400 mL,mL,,152,129.2,43.5632,152,Medica,Medical Assistance,67.792,44.6,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 2 GRAM/400 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,400 mL,mL,,152,129.2,43.5632,152,Medica,Medical Assistance,,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 2 GRAM/400 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,400 mL,mL,,152,129.2,43.5632,152,Medica,Medical Assistance,,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 2 GRAM/400 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,400 mL,mL,,152,129.2,43.5632,152,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,75.696,49.8,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 2 GRAM/400 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,400 mL,mL,,152,129.2,43.5632,152,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,75.696,49.8,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 2 GRAM/400 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,400 mL,mL,,152,129.2,43.5632,152,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 2 GRAM/400 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,400 mL,mL,,152,129.2,43.5632,152,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 2 GRAM/400 ML IV PGBK,,J3372,HCPCS,Facility,Both,400 mL,mL,,152,129.2,43.5632,152,"Multiplan, Inc.","Multiplan, Inc.",142.88,94,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 2 GRAM/400 ML IV PGBK,,J3372,HCPCS,Facility,Both,400 mL,mL,,152,129.2,43.5632,152,"Multiplan, Inc.","Multiplan, Inc.",142.88,94,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 2 GRAM/400 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,400 mL,mL,,152,129.2,43.5632,152,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,136.952,90.1,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 2 GRAM/400 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,400 mL,mL,,152,129.2,43.5632,152,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,136.952,90.1,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 2 GRAM/400 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,400 mL,mL,,152,129.2,43.5632,152,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
VANCOMYCIN-DILUENT COMBO NO.1 2 GRAM/400 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,400 mL,mL,,152,129.2,43.5632,152,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
VANCOMYCIN-DILUENT COMBO NO.1 2 GRAM/400 ML IV PGBK,,J3372,HCPCS,Facility,Both,400 mL,mL,,152,129.2,43.5632,152,"Preferred One Administrative Services, INC.",PPO,149.872,98.6,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 2 GRAM/400 ML IV PGBK,,J3372,HCPCS,Facility,Both,400 mL,mL,,152,129.2,43.5632,152,"Preferred One Administrative Services, INC.",PPO,149.872,98.6,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 2 GRAM/400 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,400 mL,mL,,152,129.2,43.5632,152,PrimeWest Health,Minnesota Senior Health Options (MSHO),78.204,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
VANCOMYCIN-DILUENT COMBO NO.1 2 GRAM/400 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,400 mL,mL,,152,129.2,43.5632,152,PrimeWest Health,Minnesota Senior Health Options (MSHO),78.204,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
VANCOMYCIN-DILUENT COMBO NO.1 2 GRAM/400 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,400 mL,mL,,152,129.2,43.5632,152,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 2 GRAM/400 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,400 mL,mL,,152,129.2,43.5632,152,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 2 GRAM/400 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,400 mL,mL,,152,129.2,43.5632,152,PrimeWest Health,MinnesotaCare,78.0672,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
VANCOMYCIN-DILUENT COMBO NO.1 2 GRAM/400 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,400 mL,mL,,152,129.2,43.5632,152,PrimeWest Health,MinnesotaCare,78.0672,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
VANCOMYCIN-DILUENT COMBO NO.1 2 GRAM/400 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,400 mL,mL,,152,129.2,43.5632,152,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 2 GRAM/400 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,400 mL,mL,,152,129.2,43.5632,152,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 2 GRAM/400 ML IV PGBK,,J3372,HCPCS,Facility,Both,400 mL,mL,,152,129.2,43.5632,152,Sanford Health Plan,Sanford Health Plan,139.84,92,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 2 GRAM/400 ML IV PGBK,,J3372,HCPCS,Facility,Both,400 mL,mL,,152,129.2,43.5632,152,Sanford Health Plan,Sanford Health Plan,139.84,92,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 2 GRAM/400 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,400 mL,mL,,152,129.2,43.5632,152,"UCare Health, Inc.",Individual & Family Plan,85.652,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
VANCOMYCIN-DILUENT COMBO NO.1 2 GRAM/400 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,400 mL,mL,,152,129.2,43.5632,152,"UCare Health, Inc.",Individual & Family Plan,85.652,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
VANCOMYCIN-DILUENT COMBO NO.1 2 GRAM/400 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,400 mL,mL,,152,129.2,43.5632,152,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 2 GRAM/400 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,400 mL,mL,,152,129.2,43.5632,152,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 2 GRAM/400 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,400 mL,mL,,152,129.2,43.5632,152,"UCare Health, Inc.",Medical Assistance,76.7144,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
VANCOMYCIN-DILUENT COMBO NO.1 2 GRAM/400 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,400 mL,mL,,152,129.2,43.5632,152,"UCare Health, Inc.",Medical Assistance,76.7144,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
VANCOMYCIN-DILUENT COMBO NO.1 2 GRAM/400 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,400 mL,mL,,152,129.2,43.5632,152,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 2 GRAM/400 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,400 mL,mL,,152,129.2,43.5632,152,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 2 GRAM/400 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,400 mL,mL,,152,129.2,43.5632,152,"UCare Health, Inc.",Medicare Advantage,76.7144,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
VANCOMYCIN-DILUENT COMBO NO.1 2 GRAM/400 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,400 mL,mL,,152,129.2,43.5632,152,"UCare Health, Inc.",Medicare Advantage,76.7144,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
VANCOMYCIN-DILUENT COMBO NO.1 2 GRAM/400 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,400 mL,mL,,152,129.2,43.5632,152,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 2 GRAM/400 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,400 mL,mL,,152,129.2,43.5632,152,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 2 GRAM/400 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,400 mL,mL,,152,129.2,43.5632,152,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),76.7144,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
VANCOMYCIN-DILUENT COMBO NO.1 2 GRAM/400 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,400 mL,mL,,152,129.2,43.5632,152,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),76.7144,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
VANCOMYCIN-DILUENT COMBO NO.1 2 GRAM/400 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,400 mL,mL,,152,129.2,43.5632,152,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 2 GRAM/400 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,400 mL,mL,,152,129.2,43.5632,152,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 2 GRAM/400 ML IV PGBK,,J3372,HCPCS,Facility,Both,400 mL,mL,,152,129.2,43.5632,152,UnitedHealthcare,Individual & Family,142.88,94,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 2 GRAM/400 ML IV PGBK,,J3372,HCPCS,Facility,Both,400 mL,mL,,152,129.2,43.5632,152,UnitedHealthcare,Individual & Family,142.88,94,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 2 GRAM/400 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,400 mL,mL,,152,129.2,43.5632,152,UnitedHealthcare,Medicare Advantage,74.48,49,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 2 GRAM/400 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,400 mL,mL,,152,129.2,43.5632,152,UnitedHealthcare,Medicare Advantage,74.48,49,,percent of total billed charges,,
VANCOMYCIN-DILUENT COMBO NO.1 2 GRAM/400 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,400 mL,mL,,152,129.2,43.5632,152,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 2 GRAM/400 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,400 mL,mL,,152,129.2,43.5632,152,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 2 GRAM/400 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,400 mL,mL,,152,129.2,43.5632,152,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,72.96,48,,percent of total billed charges,,100% of DHS outpatient percentage
VANCOMYCIN-DILUENT COMBO NO.1 2 GRAM/400 ML IV PGBK,,J3372,HCPCS,Facility,Outpatient,400 mL,mL,,152,129.2,43.5632,152,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,72.96,48,,percent of total billed charges,,100% of DHS outpatient percentage
VANCOMYCIN-DILUENT COMBO NO.1 2 GRAM/400 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,400 mL,mL,,152,129.2,43.5632,152,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
VANCOMYCIN-DILUENT COMBO NO.1 2 GRAM/400 ML IV PGBK,,J3372,HCPCS,Facility,Inpatient,400 mL,mL,,152,129.2,43.5632,152,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
VITS A AND D-WHITE PET-LANOLIN TOP OINT,,85848,LOCAL,Facility,Both,42.5 g,g,,14,11.9,4.0124,14,Aetna,Commercial,12.88,92,,percent of total billed charges,,
VITS A AND D-WHITE PET-LANOLIN TOP OINT,,85848,LOCAL,Facility,Outpatient,42.5 g,g,,14,11.9,4.0124,14,Aetna,Medicare Advantage,6.86,49,,percent of total billed charges,,
VITS A AND D-WHITE PET-LANOLIN TOP OINT,,85848,LOCAL,Facility,Inpatient,42.5 g,g,,14,11.9,4.0124,14,Aetna,Medicare Advantage,,,,,Included in per diem rate,
VITS A AND D-WHITE PET-LANOLIN TOP OINT,,85848,LOCAL,Facility,Both,42.5 g,g,,14,11.9,4.0124,14,Aetna,PPO,13.02,93,,percent of total billed charges,,
VITS A AND D-WHITE PET-LANOLIN TOP OINT,,85848,LOCAL,Facility,Both,42.5 g,g,,14,11.9,4.0124,14,America's PPO,America's PPO,13.4442,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
VITS A AND D-WHITE PET-LANOLIN TOP OINT,,85848,LOCAL,Facility,Both,42.5 g,g,,14,11.9,4.0124,14,BlueCross BlueShield Minnesota, Federal Employee Program,13.776,98.4,,percent of total billed charges,,
VITS A AND D-WHITE PET-LANOLIN TOP OINT,,85848,LOCAL,Facility,Both,42.5 g,g,,14,11.9,4.0124,14,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,14,100,,percent of total billed charges,,
VITS A AND D-WHITE PET-LANOLIN TOP OINT,,85848,LOCAL,Facility,Both,42.5 g,g,,14,11.9,4.0124,14,BlueCross BlueShield Minnesota,High Value Network Plan,12.6,90,,percent of total billed charges,,
VITS A AND D-WHITE PET-LANOLIN TOP OINT,,85848,LOCAL,Facility,Outpatient,42.5 g,g,,14,11.9,4.0124,14,BlueCross BlueShield Minnesota,Medicare Advantage,6.86,49,,percent of total billed charges,,
VITS A AND D-WHITE PET-LANOLIN TOP OINT,,85848,LOCAL,Facility,Inpatient,42.5 g,g,,14,11.9,4.0124,14,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
VITS A AND D-WHITE PET-LANOLIN TOP OINT,,85848,LOCAL,Facility,Both,42.5 g,g,,14,11.9,4.0124,14,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,12.3998,88.57,,percent of total billed charges,,
VITS A AND D-WHITE PET-LANOLIN TOP OINT,,85848,LOCAL,Facility,Both,42.5 g,g,,14,11.9,4.0124,14,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,4.0124,28.66,,percent of total billed charges,,
VITS A AND D-WHITE PET-LANOLIN TOP OINT,,85848,LOCAL,Facility,Outpatient,42.5 g,g,,14,11.9,4.0124,14,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),6.86,49,,percent of total billed charges,,
VITS A AND D-WHITE PET-LANOLIN TOP OINT,,85848,LOCAL,Facility,Inpatient,42.5 g,g,,14,11.9,4.0124,14,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
VITS A AND D-WHITE PET-LANOLIN TOP OINT,,85848,LOCAL,Facility,Both,42.5 g,g,,14,11.9,4.0124,14,CorVel,Worker's Compensation,14,100,,percent of total billed charges,,
VITS A AND D-WHITE PET-LANOLIN TOP OINT,,85848,LOCAL,Facility,Both,42.5 g,g,,14,11.9,4.0124,14,First Health Group Corporation,First Health Network,13.58,97,,percent of total billed charges,,
VITS A AND D-WHITE PET-LANOLIN TOP OINT,,85848,LOCAL,Facility,Both,42.5 g,g,,14,11.9,4.0124,14,"Health Partners, Inc.",Commercial,13.244,94.6,,percent of total billed charges,,
VITS A AND D-WHITE PET-LANOLIN TOP OINT,,85848,LOCAL,Facility,Outpatient,42.5 g,g,,14,11.9,4.0124,14,"Health Partners, Inc.",Medicare Advantage,6.86,49,,percent of total billed charges,,
VITS A AND D-WHITE PET-LANOLIN TOP OINT,,85848,LOCAL,Facility,Inpatient,42.5 g,g,,14,11.9,4.0124,14,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
VITS A AND D-WHITE PET-LANOLIN TOP OINT,,85848,LOCAL,Facility,Both,42.5 g,g,,14,11.9,4.0124,14,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),8.4,60,,percent of total billed charges,,
VITS A AND D-WHITE PET-LANOLIN TOP OINT,,85848,LOCAL,Facility,Both,42.5 g,g,,14,11.9,4.0124,14,"Health Partners, Inc.",State of Minnesota Advantage Program,11.41,81.5,,percent of total billed charges,,
VITS A AND D-WHITE PET-LANOLIN TOP OINT,,85848,LOCAL,Facility,Both,42.5 g,g,,14,11.9,4.0124,14,"Health Partners, Inc.",State Public Programs,7,50,,percent of total billed charges,,
VITS A AND D-WHITE PET-LANOLIN TOP OINT,,85848,LOCAL,Facility,Both,42.5 g,g,,14,11.9,4.0124,14,Humana Insurance Company,Commercial PPO,13.3,95,,percent of total billed charges,,
VITS A AND D-WHITE PET-LANOLIN TOP OINT,,85848,LOCAL,Facility,Outpatient,42.5 g,g,,14,11.9,4.0124,14,Humana Insurance Company,Medicare PPO,6.86,49,,percent of total billed charges,,
VITS A AND D-WHITE PET-LANOLIN TOP OINT,,85848,LOCAL,Facility,Inpatient,42.5 g,g,,14,11.9,4.0124,14,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
VITS A AND D-WHITE PET-LANOLIN TOP OINT,,85848,LOCAL,Facility,Both,42.5 g,g,,14,11.9,4.0124,14,Medica,Individual & Family,13.874,99.1,,percent of total billed charges,,
VITS A AND D-WHITE PET-LANOLIN TOP OINT,,85848,LOCAL,Facility,Outpatient,42.5 g,g,,14,11.9,4.0124,14,Medica,Medica Advantage Solution,6.972,49.8,,percent of total billed charges,,
VITS A AND D-WHITE PET-LANOLIN TOP OINT,,85848,LOCAL,Facility,Inpatient,42.5 g,g,,14,11.9,4.0124,14,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
VITS A AND D-WHITE PET-LANOLIN TOP OINT,,85848,LOCAL,Facility,Outpatient,42.5 g,g,,14,11.9,4.0124,14,Medica,Medical Assistance,6.244,44.6,,percent of total billed charges,,
VITS A AND D-WHITE PET-LANOLIN TOP OINT,,85848,LOCAL,Facility,Inpatient,42.5 g,g,,14,11.9,4.0124,14,Medica,Medical Assistance,,,,,Included in per diem rate,
VITS A AND D-WHITE PET-LANOLIN TOP OINT,,85848,LOCAL,Facility,Outpatient,42.5 g,g,,14,11.9,4.0124,14,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,6.972,49.8,,percent of total billed charges,,
VITS A AND D-WHITE PET-LANOLIN TOP OINT,,85848,LOCAL,Facility,Inpatient,42.5 g,g,,14,11.9,4.0124,14,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
VITS A AND D-WHITE PET-LANOLIN TOP OINT,,85848,LOCAL,Facility,Both,42.5 g,g,,14,11.9,4.0124,14,"Multiplan, Inc.","Multiplan, Inc.",13.16,94,,percent of total billed charges,,
VITS A AND D-WHITE PET-LANOLIN TOP OINT,,85848,LOCAL,Facility,Outpatient,42.5 g,g,,14,11.9,4.0124,14,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,12.614,90.1,,percent of total billed charges,,
VITS A AND D-WHITE PET-LANOLIN TOP OINT,,85848,LOCAL,Facility,Inpatient,42.5 g,g,,14,11.9,4.0124,14,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
VITS A AND D-WHITE PET-LANOLIN TOP OINT,,85848,LOCAL,Facility,Both,42.5 g,g,,14,11.9,4.0124,14,"Preferred One Administrative Services, INC.",PPO,13.804,98.6,,percent of total billed charges,,
VITS A AND D-WHITE PET-LANOLIN TOP OINT,,85848,LOCAL,Facility,Outpatient,42.5 g,g,,14,11.9,4.0124,14,PrimeWest Health,Minnesota Senior Health Options (MSHO),7.203,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
VITS A AND D-WHITE PET-LANOLIN TOP OINT,,85848,LOCAL,Facility,Inpatient,42.5 g,g,,14,11.9,4.0124,14,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
VITS A AND D-WHITE PET-LANOLIN TOP OINT,,85848,LOCAL,Facility,Outpatient,42.5 g,g,,14,11.9,4.0124,14,PrimeWest Health,MinnesotaCare,7.1904,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
VITS A AND D-WHITE PET-LANOLIN TOP OINT,,85848,LOCAL,Facility,Inpatient,42.5 g,g,,14,11.9,4.0124,14,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
VITS A AND D-WHITE PET-LANOLIN TOP OINT,,85848,LOCAL,Facility,Both,42.5 g,g,,14,11.9,4.0124,14,Sanford Health Plan,Sanford Health Plan,12.88,92,,percent of total billed charges,,
VITS A AND D-WHITE PET-LANOLIN TOP OINT,,85848,LOCAL,Facility,Outpatient,42.5 g,g,,14,11.9,4.0124,14,"UCare Health, Inc.",Individual & Family Plan,7.889,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
VITS A AND D-WHITE PET-LANOLIN TOP OINT,,85848,LOCAL,Facility,Inpatient,42.5 g,g,,14,11.9,4.0124,14,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
VITS A AND D-WHITE PET-LANOLIN TOP OINT,,85848,LOCAL,Facility,Outpatient,42.5 g,g,,14,11.9,4.0124,14,"UCare Health, Inc.",Medical Assistance,7.0658,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
VITS A AND D-WHITE PET-LANOLIN TOP OINT,,85848,LOCAL,Facility,Inpatient,42.5 g,g,,14,11.9,4.0124,14,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
VITS A AND D-WHITE PET-LANOLIN TOP OINT,,85848,LOCAL,Facility,Outpatient,42.5 g,g,,14,11.9,4.0124,14,"UCare Health, Inc.",Medicare Advantage,7.0658,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
VITS A AND D-WHITE PET-LANOLIN TOP OINT,,85848,LOCAL,Facility,Inpatient,42.5 g,g,,14,11.9,4.0124,14,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
VITS A AND D-WHITE PET-LANOLIN TOP OINT,,85848,LOCAL,Facility,Outpatient,42.5 g,g,,14,11.9,4.0124,14,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),7.0658,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
VITS A AND D-WHITE PET-LANOLIN TOP OINT,,85848,LOCAL,Facility,Inpatient,42.5 g,g,,14,11.9,4.0124,14,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
VITS A AND D-WHITE PET-LANOLIN TOP OINT,,85848,LOCAL,Facility,Both,42.5 g,g,,14,11.9,4.0124,14,UnitedHealthcare,Individual & Family,13.16,94,,percent of total billed charges,,
VITS A AND D-WHITE PET-LANOLIN TOP OINT,,85848,LOCAL,Facility,Outpatient,42.5 g,g,,14,11.9,4.0124,14,UnitedHealthcare,Medicare Advantage,6.86,49,,percent of total billed charges,,
VITS A AND D-WHITE PET-LANOLIN TOP OINT,,85848,LOCAL,Facility,Inpatient,42.5 g,g,,14,11.9,4.0124,14,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
VITS A AND D-WHITE PET-LANOLIN TOP OINT,,85848,LOCAL,Facility,Outpatient,42.5 g,g,,14,11.9,4.0124,14,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,6.72,48,,percent of total billed charges,,100% of DHS outpatient percentage
VITS A AND D-WHITE PET-LANOLIN TOP OINT,,85848,LOCAL,Facility,Inpatient,42.5 g,g,,14,11.9,4.0124,14,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
SODIUM CHLORIDE 0.65 % NASL SPRA,,28463,LOCAL,Facility,Both,44 mL,mL,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
SODIUM CHLORIDE 0.65 % NASL SPRA,,28463,LOCAL,Facility,Outpatient,44 mL,mL,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
SODIUM CHLORIDE 0.65 % NASL SPRA,,28463,LOCAL,Facility,Inpatient,44 mL,mL,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
SODIUM CHLORIDE 0.65 % NASL SPRA,,28463,LOCAL,Facility,Both,44 mL,mL,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
SODIUM CHLORIDE 0.65 % NASL SPRA,,28463,LOCAL,Facility,Both,44 mL,mL,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SODIUM CHLORIDE 0.65 % NASL SPRA,,28463,LOCAL,Facility,Both,44 mL,mL,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
SODIUM CHLORIDE 0.65 % NASL SPRA,,28463,LOCAL,Facility,Both,44 mL,mL,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
SODIUM CHLORIDE 0.65 % NASL SPRA,,28463,LOCAL,Facility,Both,44 mL,mL,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,
SODIUM CHLORIDE 0.65 % NASL SPRA,,28463,LOCAL,Facility,Outpatient,44 mL,mL,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
SODIUM CHLORIDE 0.65 % NASL SPRA,,28463,LOCAL,Facility,Inpatient,44 mL,mL,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
SODIUM CHLORIDE 0.65 % NASL SPRA,,28463,LOCAL,Facility,Both,44 mL,mL,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
SODIUM CHLORIDE 0.65 % NASL SPRA,,28463,LOCAL,Facility,Both,44 mL,mL,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
SODIUM CHLORIDE 0.65 % NASL SPRA,,28463,LOCAL,Facility,Outpatient,44 mL,mL,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
SODIUM CHLORIDE 0.65 % NASL SPRA,,28463,LOCAL,Facility,Inpatient,44 mL,mL,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
SODIUM CHLORIDE 0.65 % NASL SPRA,,28463,LOCAL,Facility,Both,44 mL,mL,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
SODIUM CHLORIDE 0.65 % NASL SPRA,,28463,LOCAL,Facility,Both,44 mL,mL,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
SODIUM CHLORIDE 0.65 % NASL SPRA,,28463,LOCAL,Facility,Both,44 mL,mL,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
SODIUM CHLORIDE 0.65 % NASL SPRA,,28463,LOCAL,Facility,Outpatient,44 mL,mL,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
SODIUM CHLORIDE 0.65 % NASL SPRA,,28463,LOCAL,Facility,Inpatient,44 mL,mL,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SODIUM CHLORIDE 0.65 % NASL SPRA,,28463,LOCAL,Facility,Both,44 mL,mL,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
SODIUM CHLORIDE 0.65 % NASL SPRA,,28463,LOCAL,Facility,Both,44 mL,mL,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
SODIUM CHLORIDE 0.65 % NASL SPRA,,28463,LOCAL,Facility,Both,44 mL,mL,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
SODIUM CHLORIDE 0.65 % NASL SPRA,,28463,LOCAL,Facility,Both,44 mL,mL,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
SODIUM CHLORIDE 0.65 % NASL SPRA,,28463,LOCAL,Facility,Outpatient,44 mL,mL,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
SODIUM CHLORIDE 0.65 % NASL SPRA,,28463,LOCAL,Facility,Inpatient,44 mL,mL,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
SODIUM CHLORIDE 0.65 % NASL SPRA,,28463,LOCAL,Facility,Both,44 mL,mL,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
SODIUM CHLORIDE 0.65 % NASL SPRA,,28463,LOCAL,Facility,Outpatient,44 mL,mL,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
SODIUM CHLORIDE 0.65 % NASL SPRA,,28463,LOCAL,Facility,Inpatient,44 mL,mL,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
SODIUM CHLORIDE 0.65 % NASL SPRA,,28463,LOCAL,Facility,Outpatient,44 mL,mL,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
SODIUM CHLORIDE 0.65 % NASL SPRA,,28463,LOCAL,Facility,Inpatient,44 mL,mL,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
SODIUM CHLORIDE 0.65 % NASL SPRA,,28463,LOCAL,Facility,Outpatient,44 mL,mL,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
SODIUM CHLORIDE 0.65 % NASL SPRA,,28463,LOCAL,Facility,Inpatient,44 mL,mL,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
SODIUM CHLORIDE 0.65 % NASL SPRA,,28463,LOCAL,Facility,Both,44 mL,mL,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
SODIUM CHLORIDE 0.65 % NASL SPRA,,28463,LOCAL,Facility,Outpatient,44 mL,mL,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
SODIUM CHLORIDE 0.65 % NASL SPRA,,28463,LOCAL,Facility,Inpatient,44 mL,mL,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
SODIUM CHLORIDE 0.65 % NASL SPRA,,28463,LOCAL,Facility,Both,44 mL,mL,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
SODIUM CHLORIDE 0.65 % NASL SPRA,,28463,LOCAL,Facility,Outpatient,44 mL,mL,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
SODIUM CHLORIDE 0.65 % NASL SPRA,,28463,LOCAL,Facility,Inpatient,44 mL,mL,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SODIUM CHLORIDE 0.65 % NASL SPRA,,28463,LOCAL,Facility,Outpatient,44 mL,mL,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
SODIUM CHLORIDE 0.65 % NASL SPRA,,28463,LOCAL,Facility,Inpatient,44 mL,mL,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
SODIUM CHLORIDE 0.65 % NASL SPRA,,28463,LOCAL,Facility,Both,44 mL,mL,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
SODIUM CHLORIDE 0.65 % NASL SPRA,,28463,LOCAL,Facility,Outpatient,44 mL,mL,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
SODIUM CHLORIDE 0.65 % NASL SPRA,,28463,LOCAL,Facility,Inpatient,44 mL,mL,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
SODIUM CHLORIDE 0.65 % NASL SPRA,,28463,LOCAL,Facility,Outpatient,44 mL,mL,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SODIUM CHLORIDE 0.65 % NASL SPRA,,28463,LOCAL,Facility,Inpatient,44 mL,mL,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
SODIUM CHLORIDE 0.65 % NASL SPRA,,28463,LOCAL,Facility,Outpatient,44 mL,mL,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SODIUM CHLORIDE 0.65 % NASL SPRA,,28463,LOCAL,Facility,Inpatient,44 mL,mL,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SODIUM CHLORIDE 0.65 % NASL SPRA,,28463,LOCAL,Facility,Outpatient,44 mL,mL,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SODIUM CHLORIDE 0.65 % NASL SPRA,,28463,LOCAL,Facility,Inpatient,44 mL,mL,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SODIUM CHLORIDE 0.65 % NASL SPRA,,28463,LOCAL,Facility,Both,44 mL,mL,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
SODIUM CHLORIDE 0.65 % NASL SPRA,,28463,LOCAL,Facility,Outpatient,44 mL,mL,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
SODIUM CHLORIDE 0.65 % NASL SPRA,,28463,LOCAL,Facility,Inpatient,44 mL,mL,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
SODIUM CHLORIDE 0.65 % NASL SPRA,,28463,LOCAL,Facility,Outpatient,44 mL,mL,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
SODIUM CHLORIDE 0.65 % NASL SPRA,,28463,LOCAL,Facility,Inpatient,44 mL,mL,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
MICONAZOLE NITRATE 2 % VAGL CREAM,,5445,LOCAL,Facility,Both,45 g,g,,55,46.75,15.763,55,Aetna,Commercial,50.6,92,,percent of total billed charges,,
MICONAZOLE NITRATE 2 % VAGL CREAM,,5445,LOCAL,Facility,Outpatient,45 g,g,,55,46.75,15.763,55,Aetna,Medicare Advantage,26.95,49,,percent of total billed charges,,
MICONAZOLE NITRATE 2 % VAGL CREAM,,5445,LOCAL,Facility,Inpatient,45 g,g,,55,46.75,15.763,55,Aetna,Medicare Advantage,,,,,Included in per diem rate,
MICONAZOLE NITRATE 2 % VAGL CREAM,,5445,LOCAL,Facility,Both,45 g,g,,55,46.75,15.763,55,Aetna,PPO,51.15,93,,percent of total billed charges,,
MICONAZOLE NITRATE 2 % VAGL CREAM,,5445,LOCAL,Facility,Both,45 g,g,,55,46.75,15.763,55,America's PPO,America's PPO,52.8165,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
MICONAZOLE NITRATE 2 % VAGL CREAM,,5445,LOCAL,Facility,Both,45 g,g,,55,46.75,15.763,55,BlueCross BlueShield Minnesota, Federal Employee Program,54.12,98.4,,percent of total billed charges,,
MICONAZOLE NITRATE 2 % VAGL CREAM,,5445,LOCAL,Facility,Both,45 g,g,,55,46.75,15.763,55,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,55,100,,percent of total billed charges,,
MICONAZOLE NITRATE 2 % VAGL CREAM,,5445,LOCAL,Facility,Both,45 g,g,,55,46.75,15.763,55,BlueCross BlueShield Minnesota,High Value Network Plan,49.5,90,,percent of total billed charges,,
MICONAZOLE NITRATE 2 % VAGL CREAM,,5445,LOCAL,Facility,Outpatient,45 g,g,,55,46.75,15.763,55,BlueCross BlueShield Minnesota,Medicare Advantage,26.95,49,,percent of total billed charges,,
MICONAZOLE NITRATE 2 % VAGL CREAM,,5445,LOCAL,Facility,Inpatient,45 g,g,,55,46.75,15.763,55,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
MICONAZOLE NITRATE 2 % VAGL CREAM,,5445,LOCAL,Facility,Both,45 g,g,,55,46.75,15.763,55,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,48.7135,88.57,,percent of total billed charges,,
MICONAZOLE NITRATE 2 % VAGL CREAM,,5445,LOCAL,Facility,Both,45 g,g,,55,46.75,15.763,55,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,15.763,28.66,,percent of total billed charges,,
MICONAZOLE NITRATE 2 % VAGL CREAM,,5445,LOCAL,Facility,Outpatient,45 g,g,,55,46.75,15.763,55,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),26.95,49,,percent of total billed charges,,
MICONAZOLE NITRATE 2 % VAGL CREAM,,5445,LOCAL,Facility,Inpatient,45 g,g,,55,46.75,15.763,55,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
MICONAZOLE NITRATE 2 % VAGL CREAM,,5445,LOCAL,Facility,Both,45 g,g,,55,46.75,15.763,55,CorVel,Worker's Compensation,55,100,,percent of total billed charges,,
MICONAZOLE NITRATE 2 % VAGL CREAM,,5445,LOCAL,Facility,Both,45 g,g,,55,46.75,15.763,55,First Health Group Corporation,First Health Network,53.35,97,,percent of total billed charges,,
MICONAZOLE NITRATE 2 % VAGL CREAM,,5445,LOCAL,Facility,Both,45 g,g,,55,46.75,15.763,55,"Health Partners, Inc.",Commercial,52.03,94.6,,percent of total billed charges,,
MICONAZOLE NITRATE 2 % VAGL CREAM,,5445,LOCAL,Facility,Outpatient,45 g,g,,55,46.75,15.763,55,"Health Partners, Inc.",Medicare Advantage,26.95,49,,percent of total billed charges,,
MICONAZOLE NITRATE 2 % VAGL CREAM,,5445,LOCAL,Facility,Inpatient,45 g,g,,55,46.75,15.763,55,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
MICONAZOLE NITRATE 2 % VAGL CREAM,,5445,LOCAL,Facility,Both,45 g,g,,55,46.75,15.763,55,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),33,60,,percent of total billed charges,,
MICONAZOLE NITRATE 2 % VAGL CREAM,,5445,LOCAL,Facility,Both,45 g,g,,55,46.75,15.763,55,"Health Partners, Inc.",State of Minnesota Advantage Program,44.825,81.5,,percent of total billed charges,,
MICONAZOLE NITRATE 2 % VAGL CREAM,,5445,LOCAL,Facility,Both,45 g,g,,55,46.75,15.763,55,"Health Partners, Inc.",State Public Programs,27.5,50,,percent of total billed charges,,
MICONAZOLE NITRATE 2 % VAGL CREAM,,5445,LOCAL,Facility,Both,45 g,g,,55,46.75,15.763,55,Humana Insurance Company,Commercial PPO,52.25,95,,percent of total billed charges,,
MICONAZOLE NITRATE 2 % VAGL CREAM,,5445,LOCAL,Facility,Outpatient,45 g,g,,55,46.75,15.763,55,Humana Insurance Company,Medicare PPO,26.95,49,,percent of total billed charges,,
MICONAZOLE NITRATE 2 % VAGL CREAM,,5445,LOCAL,Facility,Inpatient,45 g,g,,55,46.75,15.763,55,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
MICONAZOLE NITRATE 2 % VAGL CREAM,,5445,LOCAL,Facility,Both,45 g,g,,55,46.75,15.763,55,Medica,Individual & Family,54.505,99.1,,percent of total billed charges,,
MICONAZOLE NITRATE 2 % VAGL CREAM,,5445,LOCAL,Facility,Outpatient,45 g,g,,55,46.75,15.763,55,Medica,Medica Advantage Solution,27.39,49.8,,percent of total billed charges,,
MICONAZOLE NITRATE 2 % VAGL CREAM,,5445,LOCAL,Facility,Inpatient,45 g,g,,55,46.75,15.763,55,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
MICONAZOLE NITRATE 2 % VAGL CREAM,,5445,LOCAL,Facility,Outpatient,45 g,g,,55,46.75,15.763,55,Medica,Medical Assistance,24.53,44.6,,percent of total billed charges,,
MICONAZOLE NITRATE 2 % VAGL CREAM,,5445,LOCAL,Facility,Inpatient,45 g,g,,55,46.75,15.763,55,Medica,Medical Assistance,,,,,Included in per diem rate,
MICONAZOLE NITRATE 2 % VAGL CREAM,,5445,LOCAL,Facility,Outpatient,45 g,g,,55,46.75,15.763,55,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,27.39,49.8,,percent of total billed charges,,
MICONAZOLE NITRATE 2 % VAGL CREAM,,5445,LOCAL,Facility,Inpatient,45 g,g,,55,46.75,15.763,55,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
MICONAZOLE NITRATE 2 % VAGL CREAM,,5445,LOCAL,Facility,Both,45 g,g,,55,46.75,15.763,55,"Multiplan, Inc.","Multiplan, Inc.",51.7,94,,percent of total billed charges,,
MICONAZOLE NITRATE 2 % VAGL CREAM,,5445,LOCAL,Facility,Outpatient,45 g,g,,55,46.75,15.763,55,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,49.555,90.1,,percent of total billed charges,,
MICONAZOLE NITRATE 2 % VAGL CREAM,,5445,LOCAL,Facility,Inpatient,45 g,g,,55,46.75,15.763,55,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
MICONAZOLE NITRATE 2 % VAGL CREAM,,5445,LOCAL,Facility,Both,45 g,g,,55,46.75,15.763,55,"Preferred One Administrative Services, INC.",PPO,54.23,98.6,,percent of total billed charges,,
MICONAZOLE NITRATE 2 % VAGL CREAM,,5445,LOCAL,Facility,Outpatient,45 g,g,,55,46.75,15.763,55,PrimeWest Health,Minnesota Senior Health Options (MSHO),28.2975,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
MICONAZOLE NITRATE 2 % VAGL CREAM,,5445,LOCAL,Facility,Inpatient,45 g,g,,55,46.75,15.763,55,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
MICONAZOLE NITRATE 2 % VAGL CREAM,,5445,LOCAL,Facility,Outpatient,45 g,g,,55,46.75,15.763,55,PrimeWest Health,MinnesotaCare,28.248,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
MICONAZOLE NITRATE 2 % VAGL CREAM,,5445,LOCAL,Facility,Inpatient,45 g,g,,55,46.75,15.763,55,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
MICONAZOLE NITRATE 2 % VAGL CREAM,,5445,LOCAL,Facility,Both,45 g,g,,55,46.75,15.763,55,Sanford Health Plan,Sanford Health Plan,50.6,92,,percent of total billed charges,,
MICONAZOLE NITRATE 2 % VAGL CREAM,,5445,LOCAL,Facility,Outpatient,45 g,g,,55,46.75,15.763,55,"UCare Health, Inc.",Individual & Family Plan,30.9925,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
MICONAZOLE NITRATE 2 % VAGL CREAM,,5445,LOCAL,Facility,Inpatient,45 g,g,,55,46.75,15.763,55,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
MICONAZOLE NITRATE 2 % VAGL CREAM,,5445,LOCAL,Facility,Outpatient,45 g,g,,55,46.75,15.763,55,"UCare Health, Inc.",Medical Assistance,27.7585,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MICONAZOLE NITRATE 2 % VAGL CREAM,,5445,LOCAL,Facility,Inpatient,45 g,g,,55,46.75,15.763,55,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
MICONAZOLE NITRATE 2 % VAGL CREAM,,5445,LOCAL,Facility,Outpatient,45 g,g,,55,46.75,15.763,55,"UCare Health, Inc.",Medicare Advantage,27.7585,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MICONAZOLE NITRATE 2 % VAGL CREAM,,5445,LOCAL,Facility,Inpatient,45 g,g,,55,46.75,15.763,55,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
MICONAZOLE NITRATE 2 % VAGL CREAM,,5445,LOCAL,Facility,Outpatient,45 g,g,,55,46.75,15.763,55,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),27.7585,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MICONAZOLE NITRATE 2 % VAGL CREAM,,5445,LOCAL,Facility,Inpatient,45 g,g,,55,46.75,15.763,55,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
MICONAZOLE NITRATE 2 % VAGL CREAM,,5445,LOCAL,Facility,Both,45 g,g,,55,46.75,15.763,55,UnitedHealthcare,Individual & Family,51.7,94,,percent of total billed charges,,
MICONAZOLE NITRATE 2 % VAGL CREAM,,5445,LOCAL,Facility,Outpatient,45 g,g,,55,46.75,15.763,55,UnitedHealthcare,Medicare Advantage,26.95,49,,percent of total billed charges,,
MICONAZOLE NITRATE 2 % VAGL CREAM,,5445,LOCAL,Facility,Inpatient,45 g,g,,55,46.75,15.763,55,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
MICONAZOLE NITRATE 2 % VAGL CREAM,,5445,LOCAL,Facility,Outpatient,45 g,g,,55,46.75,15.763,55,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,26.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
MICONAZOLE NITRATE 2 % VAGL CREAM,,5445,LOCAL,Facility,Inpatient,45 g,g,,55,46.75,15.763,55,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
CLOTRIMAZOLE 1 % VAGL CREAM,,6451,LOCAL,Facility,Both,45 g,g,,41,34.85,11.7506,41,Aetna,Commercial,37.72,92,,percent of total billed charges,,
CLOTRIMAZOLE 1 % VAGL CREAM,,6451,LOCAL,Facility,Outpatient,45 g,g,,41,34.85,11.7506,41,Aetna,Medicare Advantage,20.09,49,,percent of total billed charges,,
CLOTRIMAZOLE 1 % VAGL CREAM,,6451,LOCAL,Facility,Inpatient,45 g,g,,41,34.85,11.7506,41,Aetna,Medicare Advantage,,,,,Included in per diem rate,
CLOTRIMAZOLE 1 % VAGL CREAM,,6451,LOCAL,Facility,Both,45 g,g,,41,34.85,11.7506,41,Aetna,PPO,38.13,93,,percent of total billed charges,,
CLOTRIMAZOLE 1 % VAGL CREAM,,6451,LOCAL,Facility,Both,45 g,g,,41,34.85,11.7506,41,America's PPO,America's PPO,39.3723,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
CLOTRIMAZOLE 1 % VAGL CREAM,,6451,LOCAL,Facility,Both,45 g,g,,41,34.85,11.7506,41,BlueCross BlueShield Minnesota, Federal Employee Program,40.344,98.4,,percent of total billed charges,,
CLOTRIMAZOLE 1 % VAGL CREAM,,6451,LOCAL,Facility,Both,45 g,g,,41,34.85,11.7506,41,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,41,100,,percent of total billed charges,,
CLOTRIMAZOLE 1 % VAGL CREAM,,6451,LOCAL,Facility,Both,45 g,g,,41,34.85,11.7506,41,BlueCross BlueShield Minnesota,High Value Network Plan,36.9,90,,percent of total billed charges,,
CLOTRIMAZOLE 1 % VAGL CREAM,,6451,LOCAL,Facility,Outpatient,45 g,g,,41,34.85,11.7506,41,BlueCross BlueShield Minnesota,Medicare Advantage,20.09,49,,percent of total billed charges,,
CLOTRIMAZOLE 1 % VAGL CREAM,,6451,LOCAL,Facility,Inpatient,45 g,g,,41,34.85,11.7506,41,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
CLOTRIMAZOLE 1 % VAGL CREAM,,6451,LOCAL,Facility,Both,45 g,g,,41,34.85,11.7506,41,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,36.3137,88.57,,percent of total billed charges,,
CLOTRIMAZOLE 1 % VAGL CREAM,,6451,LOCAL,Facility,Both,45 g,g,,41,34.85,11.7506,41,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,11.7506,28.66,,percent of total billed charges,,
CLOTRIMAZOLE 1 % VAGL CREAM,,6451,LOCAL,Facility,Outpatient,45 g,g,,41,34.85,11.7506,41,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),20.09,49,,percent of total billed charges,,
CLOTRIMAZOLE 1 % VAGL CREAM,,6451,LOCAL,Facility,Inpatient,45 g,g,,41,34.85,11.7506,41,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
CLOTRIMAZOLE 1 % VAGL CREAM,,6451,LOCAL,Facility,Both,45 g,g,,41,34.85,11.7506,41,CorVel,Worker's Compensation,41,100,,percent of total billed charges,,
CLOTRIMAZOLE 1 % VAGL CREAM,,6451,LOCAL,Facility,Both,45 g,g,,41,34.85,11.7506,41,First Health Group Corporation,First Health Network,39.77,97,,percent of total billed charges,,
CLOTRIMAZOLE 1 % VAGL CREAM,,6451,LOCAL,Facility,Both,45 g,g,,41,34.85,11.7506,41,"Health Partners, Inc.",Commercial,38.786,94.6,,percent of total billed charges,,
CLOTRIMAZOLE 1 % VAGL CREAM,,6451,LOCAL,Facility,Outpatient,45 g,g,,41,34.85,11.7506,41,"Health Partners, Inc.",Medicare Advantage,20.09,49,,percent of total billed charges,,
CLOTRIMAZOLE 1 % VAGL CREAM,,6451,LOCAL,Facility,Inpatient,45 g,g,,41,34.85,11.7506,41,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CLOTRIMAZOLE 1 % VAGL CREAM,,6451,LOCAL,Facility,Both,45 g,g,,41,34.85,11.7506,41,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),24.6,60,,percent of total billed charges,,
CLOTRIMAZOLE 1 % VAGL CREAM,,6451,LOCAL,Facility,Both,45 g,g,,41,34.85,11.7506,41,"Health Partners, Inc.",State of Minnesota Advantage Program,33.415,81.5,,percent of total billed charges,,
CLOTRIMAZOLE 1 % VAGL CREAM,,6451,LOCAL,Facility,Both,45 g,g,,41,34.85,11.7506,41,"Health Partners, Inc.",State Public Programs,20.5,50,,percent of total billed charges,,
CLOTRIMAZOLE 1 % VAGL CREAM,,6451,LOCAL,Facility,Both,45 g,g,,41,34.85,11.7506,41,Humana Insurance Company,Commercial PPO,38.95,95,,percent of total billed charges,,
CLOTRIMAZOLE 1 % VAGL CREAM,,6451,LOCAL,Facility,Outpatient,45 g,g,,41,34.85,11.7506,41,Humana Insurance Company,Medicare PPO,20.09,49,,percent of total billed charges,,
CLOTRIMAZOLE 1 % VAGL CREAM,,6451,LOCAL,Facility,Inpatient,45 g,g,,41,34.85,11.7506,41,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
CLOTRIMAZOLE 1 % VAGL CREAM,,6451,LOCAL,Facility,Both,45 g,g,,41,34.85,11.7506,41,Medica,Individual & Family,40.631,99.1,,percent of total billed charges,,
CLOTRIMAZOLE 1 % VAGL CREAM,,6451,LOCAL,Facility,Outpatient,45 g,g,,41,34.85,11.7506,41,Medica,Medica Advantage Solution,20.418,49.8,,percent of total billed charges,,
CLOTRIMAZOLE 1 % VAGL CREAM,,6451,LOCAL,Facility,Inpatient,45 g,g,,41,34.85,11.7506,41,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
CLOTRIMAZOLE 1 % VAGL CREAM,,6451,LOCAL,Facility,Outpatient,45 g,g,,41,34.85,11.7506,41,Medica,Medical Assistance,18.286,44.6,,percent of total billed charges,,
CLOTRIMAZOLE 1 % VAGL CREAM,,6451,LOCAL,Facility,Inpatient,45 g,g,,41,34.85,11.7506,41,Medica,Medical Assistance,,,,,Included in per diem rate,
CLOTRIMAZOLE 1 % VAGL CREAM,,6451,LOCAL,Facility,Outpatient,45 g,g,,41,34.85,11.7506,41,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,20.418,49.8,,percent of total billed charges,,
CLOTRIMAZOLE 1 % VAGL CREAM,,6451,LOCAL,Facility,Inpatient,45 g,g,,41,34.85,11.7506,41,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
CLOTRIMAZOLE 1 % VAGL CREAM,,6451,LOCAL,Facility,Both,45 g,g,,41,34.85,11.7506,41,"Multiplan, Inc.","Multiplan, Inc.",38.54,94,,percent of total billed charges,,
CLOTRIMAZOLE 1 % VAGL CREAM,,6451,LOCAL,Facility,Outpatient,45 g,g,,41,34.85,11.7506,41,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,36.941,90.1,,percent of total billed charges,,
CLOTRIMAZOLE 1 % VAGL CREAM,,6451,LOCAL,Facility,Inpatient,45 g,g,,41,34.85,11.7506,41,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
CLOTRIMAZOLE 1 % VAGL CREAM,,6451,LOCAL,Facility,Both,45 g,g,,41,34.85,11.7506,41,"Preferred One Administrative Services, INC.",PPO,40.426,98.6,,percent of total billed charges,,
CLOTRIMAZOLE 1 % VAGL CREAM,,6451,LOCAL,Facility,Outpatient,45 g,g,,41,34.85,11.7506,41,PrimeWest Health,Minnesota Senior Health Options (MSHO),21.0945,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
CLOTRIMAZOLE 1 % VAGL CREAM,,6451,LOCAL,Facility,Inpatient,45 g,g,,41,34.85,11.7506,41,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CLOTRIMAZOLE 1 % VAGL CREAM,,6451,LOCAL,Facility,Outpatient,45 g,g,,41,34.85,11.7506,41,PrimeWest Health,MinnesotaCare,21.0576,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
CLOTRIMAZOLE 1 % VAGL CREAM,,6451,LOCAL,Facility,Inpatient,45 g,g,,41,34.85,11.7506,41,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
CLOTRIMAZOLE 1 % VAGL CREAM,,6451,LOCAL,Facility,Both,45 g,g,,41,34.85,11.7506,41,Sanford Health Plan,Sanford Health Plan,37.72,92,,percent of total billed charges,,
CLOTRIMAZOLE 1 % VAGL CREAM,,6451,LOCAL,Facility,Outpatient,45 g,g,,41,34.85,11.7506,41,"UCare Health, Inc.",Individual & Family Plan,23.1035,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
CLOTRIMAZOLE 1 % VAGL CREAM,,6451,LOCAL,Facility,Inpatient,45 g,g,,41,34.85,11.7506,41,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
CLOTRIMAZOLE 1 % VAGL CREAM,,6451,LOCAL,Facility,Outpatient,45 g,g,,41,34.85,11.7506,41,"UCare Health, Inc.",Medical Assistance,20.6927,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CLOTRIMAZOLE 1 % VAGL CREAM,,6451,LOCAL,Facility,Inpatient,45 g,g,,41,34.85,11.7506,41,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
CLOTRIMAZOLE 1 % VAGL CREAM,,6451,LOCAL,Facility,Outpatient,45 g,g,,41,34.85,11.7506,41,"UCare Health, Inc.",Medicare Advantage,20.6927,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CLOTRIMAZOLE 1 % VAGL CREAM,,6451,LOCAL,Facility,Inpatient,45 g,g,,41,34.85,11.7506,41,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CLOTRIMAZOLE 1 % VAGL CREAM,,6451,LOCAL,Facility,Outpatient,45 g,g,,41,34.85,11.7506,41,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),20.6927,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CLOTRIMAZOLE 1 % VAGL CREAM,,6451,LOCAL,Facility,Inpatient,45 g,g,,41,34.85,11.7506,41,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CLOTRIMAZOLE 1 % VAGL CREAM,,6451,LOCAL,Facility,Both,45 g,g,,41,34.85,11.7506,41,UnitedHealthcare,Individual & Family,38.54,94,,percent of total billed charges,,
CLOTRIMAZOLE 1 % VAGL CREAM,,6451,LOCAL,Facility,Outpatient,45 g,g,,41,34.85,11.7506,41,UnitedHealthcare,Medicare Advantage,20.09,49,,percent of total billed charges,,
CLOTRIMAZOLE 1 % VAGL CREAM,,6451,LOCAL,Facility,Inpatient,45 g,g,,41,34.85,11.7506,41,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
CLOTRIMAZOLE 1 % VAGL CREAM,,6451,LOCAL,Facility,Outpatient,45 g,g,,41,34.85,11.7506,41,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,19.68,48,,percent of total billed charges,,100% of DHS outpatient percentage
CLOTRIMAZOLE 1 % VAGL CREAM,,6451,LOCAL,Facility,Inpatient,45 g,g,,41,34.85,11.7506,41,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"BARIUM SULFATE 2.1 % (W/V), 2.0 % (W/W) ORAL SUSP",,21103,LOCAL,Facility,Both,450 mL,mL,,34,28.9,9.7444,34,Aetna,Commercial,31.28,92,,percent of total billed charges,,
"BARIUM SULFATE 2.1 % (W/V), 2.0 % (W/W) ORAL SUSP",,21103,LOCAL,Facility,Both,450 mL,mL,,34,28.9,9.7444,34,Aetna,Commercial,31.28,92,,percent of total billed charges,,
"BARIUM SULFATE 2.1 % (W/V), 2.0 % (W/W) ORAL SUSP",,21103,LOCAL,Facility,Outpatient,450 mL,mL,,34,28.9,9.7444,34,Aetna,Medicare Advantage,16.66,49,,percent of total billed charges,,
"BARIUM SULFATE 2.1 % (W/V), 2.0 % (W/W) ORAL SUSP",,21103,LOCAL,Facility,Outpatient,450 mL,mL,,34,28.9,9.7444,34,Aetna,Medicare Advantage,16.66,49,,percent of total billed charges,,
"BARIUM SULFATE 2.1 % (W/V), 2.0 % (W/W) ORAL SUSP",,21103,LOCAL,Facility,Inpatient,450 mL,mL,,34,28.9,9.7444,34,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"BARIUM SULFATE 2.1 % (W/V), 2.0 % (W/W) ORAL SUSP",,21103,LOCAL,Facility,Inpatient,450 mL,mL,,34,28.9,9.7444,34,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"BARIUM SULFATE 2.1 % (W/V), 2.0 % (W/W) ORAL SUSP",,21103,LOCAL,Facility,Both,450 mL,mL,,34,28.9,9.7444,34,Aetna,PPO,31.62,93,,percent of total billed charges,,
"BARIUM SULFATE 2.1 % (W/V), 2.0 % (W/W) ORAL SUSP",,21103,LOCAL,Facility,Both,450 mL,mL,,34,28.9,9.7444,34,Aetna,PPO,31.62,93,,percent of total billed charges,,
"BARIUM SULFATE 2.1 % (W/V), 2.0 % (W/W) ORAL SUSP",,21103,LOCAL,Facility,Both,450 mL,mL,,34,28.9,9.7444,34,America's PPO,America's PPO,32.6502,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"BARIUM SULFATE 2.1 % (W/V), 2.0 % (W/W) ORAL SUSP",,21103,LOCAL,Facility,Both,450 mL,mL,,34,28.9,9.7444,34,America's PPO,America's PPO,32.6502,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"BARIUM SULFATE 2.1 % (W/V), 2.0 % (W/W) ORAL SUSP",,21103,LOCAL,Facility,Both,450 mL,mL,,34,28.9,9.7444,34,BlueCross BlueShield Minnesota, Federal Employee Program,33.456,98.4,,percent of total billed charges,,
"BARIUM SULFATE 2.1 % (W/V), 2.0 % (W/W) ORAL SUSP",,21103,LOCAL,Facility,Both,450 mL,mL,,34,28.9,9.7444,34,BlueCross BlueShield Minnesota, Federal Employee Program,33.456,98.4,,percent of total billed charges,,
"BARIUM SULFATE 2.1 % (W/V), 2.0 % (W/W) ORAL SUSP",,21103,LOCAL,Facility,Both,450 mL,mL,,34,28.9,9.7444,34,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,34,100,,percent of total billed charges,,
"BARIUM SULFATE 2.1 % (W/V), 2.0 % (W/W) ORAL SUSP",,21103,LOCAL,Facility,Both,450 mL,mL,,34,28.9,9.7444,34,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,34,100,,percent of total billed charges,,
"BARIUM SULFATE 2.1 % (W/V), 2.0 % (W/W) ORAL SUSP",,21103,LOCAL,Facility,Both,450 mL,mL,,34,28.9,9.7444,34,BlueCross BlueShield Minnesota,High Value Network Plan,30.6,90,,percent of total billed charges,,
"BARIUM SULFATE 2.1 % (W/V), 2.0 % (W/W) ORAL SUSP",,21103,LOCAL,Facility,Both,450 mL,mL,,34,28.9,9.7444,34,BlueCross BlueShield Minnesota,High Value Network Plan,30.6,90,,percent of total billed charges,,
"BARIUM SULFATE 2.1 % (W/V), 2.0 % (W/W) ORAL SUSP",,21103,LOCAL,Facility,Outpatient,450 mL,mL,,34,28.9,9.7444,34,BlueCross BlueShield Minnesota,Medicare Advantage,16.66,49,,percent of total billed charges,,
"BARIUM SULFATE 2.1 % (W/V), 2.0 % (W/W) ORAL SUSP",,21103,LOCAL,Facility,Outpatient,450 mL,mL,,34,28.9,9.7444,34,BlueCross BlueShield Minnesota,Medicare Advantage,16.66,49,,percent of total billed charges,,
"BARIUM SULFATE 2.1 % (W/V), 2.0 % (W/W) ORAL SUSP",,21103,LOCAL,Facility,Inpatient,450 mL,mL,,34,28.9,9.7444,34,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"BARIUM SULFATE 2.1 % (W/V), 2.0 % (W/W) ORAL SUSP",,21103,LOCAL,Facility,Inpatient,450 mL,mL,,34,28.9,9.7444,34,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"BARIUM SULFATE 2.1 % (W/V), 2.0 % (W/W) ORAL SUSP",,21103,LOCAL,Facility,Both,450 mL,mL,,34,28.9,9.7444,34,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,30.1138,88.57,,percent of total billed charges,,
"BARIUM SULFATE 2.1 % (W/V), 2.0 % (W/W) ORAL SUSP",,21103,LOCAL,Facility,Both,450 mL,mL,,34,28.9,9.7444,34,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,30.1138,88.57,,percent of total billed charges,,
"BARIUM SULFATE 2.1 % (W/V), 2.0 % (W/W) ORAL SUSP",,21103,LOCAL,Facility,Both,450 mL,mL,,34,28.9,9.7444,34,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,9.7444,28.66,,percent of total billed charges,,
"BARIUM SULFATE 2.1 % (W/V), 2.0 % (W/W) ORAL SUSP",,21103,LOCAL,Facility,Both,450 mL,mL,,34,28.9,9.7444,34,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,9.7444,28.66,,percent of total billed charges,,
"BARIUM SULFATE 2.1 % (W/V), 2.0 % (W/W) ORAL SUSP",,21103,LOCAL,Facility,Outpatient,450 mL,mL,,34,28.9,9.7444,34,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),16.66,49,,percent of total billed charges,,
"BARIUM SULFATE 2.1 % (W/V), 2.0 % (W/W) ORAL SUSP",,21103,LOCAL,Facility,Outpatient,450 mL,mL,,34,28.9,9.7444,34,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),16.66,49,,percent of total billed charges,,
"BARIUM SULFATE 2.1 % (W/V), 2.0 % (W/W) ORAL SUSP",,21103,LOCAL,Facility,Inpatient,450 mL,mL,,34,28.9,9.7444,34,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"BARIUM SULFATE 2.1 % (W/V), 2.0 % (W/W) ORAL SUSP",,21103,LOCAL,Facility,Inpatient,450 mL,mL,,34,28.9,9.7444,34,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"BARIUM SULFATE 2.1 % (W/V), 2.0 % (W/W) ORAL SUSP",,21103,LOCAL,Facility,Both,450 mL,mL,,34,28.9,9.7444,34,CorVel,Worker's Compensation,34,100,,percent of total billed charges,,
"BARIUM SULFATE 2.1 % (W/V), 2.0 % (W/W) ORAL SUSP",,21103,LOCAL,Facility,Both,450 mL,mL,,34,28.9,9.7444,34,CorVel,Worker's Compensation,34,100,,percent of total billed charges,,
"BARIUM SULFATE 2.1 % (W/V), 2.0 % (W/W) ORAL SUSP",,21103,LOCAL,Facility,Both,450 mL,mL,,34,28.9,9.7444,34,First Health Group Corporation,First Health Network,32.98,97,,percent of total billed charges,,
"BARIUM SULFATE 2.1 % (W/V), 2.0 % (W/W) ORAL SUSP",,21103,LOCAL,Facility,Both,450 mL,mL,,34,28.9,9.7444,34,First Health Group Corporation,First Health Network,32.98,97,,percent of total billed charges,,
"BARIUM SULFATE 2.1 % (W/V), 2.0 % (W/W) ORAL SUSP",,21103,LOCAL,Facility,Both,450 mL,mL,,34,28.9,9.7444,34,"Health Partners, Inc.",Commercial,32.164,94.6,,percent of total billed charges,,
"BARIUM SULFATE 2.1 % (W/V), 2.0 % (W/W) ORAL SUSP",,21103,LOCAL,Facility,Both,450 mL,mL,,34,28.9,9.7444,34,"Health Partners, Inc.",Commercial,32.164,94.6,,percent of total billed charges,,
"BARIUM SULFATE 2.1 % (W/V), 2.0 % (W/W) ORAL SUSP",,21103,LOCAL,Facility,Outpatient,450 mL,mL,,34,28.9,9.7444,34,"Health Partners, Inc.",Medicare Advantage,16.66,49,,percent of total billed charges,,
"BARIUM SULFATE 2.1 % (W/V), 2.0 % (W/W) ORAL SUSP",,21103,LOCAL,Facility,Outpatient,450 mL,mL,,34,28.9,9.7444,34,"Health Partners, Inc.",Medicare Advantage,16.66,49,,percent of total billed charges,,
"BARIUM SULFATE 2.1 % (W/V), 2.0 % (W/W) ORAL SUSP",,21103,LOCAL,Facility,Inpatient,450 mL,mL,,34,28.9,9.7444,34,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"BARIUM SULFATE 2.1 % (W/V), 2.0 % (W/W) ORAL SUSP",,21103,LOCAL,Facility,Inpatient,450 mL,mL,,34,28.9,9.7444,34,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"BARIUM SULFATE 2.1 % (W/V), 2.0 % (W/W) ORAL SUSP",,21103,LOCAL,Facility,Both,450 mL,mL,,34,28.9,9.7444,34,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),20.4,60,,percent of total billed charges,,
"BARIUM SULFATE 2.1 % (W/V), 2.0 % (W/W) ORAL SUSP",,21103,LOCAL,Facility,Both,450 mL,mL,,34,28.9,9.7444,34,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),20.4,60,,percent of total billed charges,,
"BARIUM SULFATE 2.1 % (W/V), 2.0 % (W/W) ORAL SUSP",,21103,LOCAL,Facility,Both,450 mL,mL,,34,28.9,9.7444,34,"Health Partners, Inc.",State of Minnesota Advantage Program,27.71,81.5,,percent of total billed charges,,
"BARIUM SULFATE 2.1 % (W/V), 2.0 % (W/W) ORAL SUSP",,21103,LOCAL,Facility,Both,450 mL,mL,,34,28.9,9.7444,34,"Health Partners, Inc.",State of Minnesota Advantage Program,27.71,81.5,,percent of total billed charges,,
"BARIUM SULFATE 2.1 % (W/V), 2.0 % (W/W) ORAL SUSP",,21103,LOCAL,Facility,Both,450 mL,mL,,34,28.9,9.7444,34,"Health Partners, Inc.",State Public Programs,17,50,,percent of total billed charges,,
"BARIUM SULFATE 2.1 % (W/V), 2.0 % (W/W) ORAL SUSP",,21103,LOCAL,Facility,Both,450 mL,mL,,34,28.9,9.7444,34,"Health Partners, Inc.",State Public Programs,17,50,,percent of total billed charges,,
"BARIUM SULFATE 2.1 % (W/V), 2.0 % (W/W) ORAL SUSP",,21103,LOCAL,Facility,Both,450 mL,mL,,34,28.9,9.7444,34,Humana Insurance Company,Commercial PPO,32.3,95,,percent of total billed charges,,
"BARIUM SULFATE 2.1 % (W/V), 2.0 % (W/W) ORAL SUSP",,21103,LOCAL,Facility,Both,450 mL,mL,,34,28.9,9.7444,34,Humana Insurance Company,Commercial PPO,32.3,95,,percent of total billed charges,,
"BARIUM SULFATE 2.1 % (W/V), 2.0 % (W/W) ORAL SUSP",,21103,LOCAL,Facility,Outpatient,450 mL,mL,,34,28.9,9.7444,34,Humana Insurance Company,Medicare PPO,16.66,49,,percent of total billed charges,,
"BARIUM SULFATE 2.1 % (W/V), 2.0 % (W/W) ORAL SUSP",,21103,LOCAL,Facility,Outpatient,450 mL,mL,,34,28.9,9.7444,34,Humana Insurance Company,Medicare PPO,16.66,49,,percent of total billed charges,,
"BARIUM SULFATE 2.1 % (W/V), 2.0 % (W/W) ORAL SUSP",,21103,LOCAL,Facility,Inpatient,450 mL,mL,,34,28.9,9.7444,34,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"BARIUM SULFATE 2.1 % (W/V), 2.0 % (W/W) ORAL SUSP",,21103,LOCAL,Facility,Inpatient,450 mL,mL,,34,28.9,9.7444,34,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"BARIUM SULFATE 2.1 % (W/V), 2.0 % (W/W) ORAL SUSP",,21103,LOCAL,Facility,Both,450 mL,mL,,34,28.9,9.7444,34,Medica,Individual & Family,33.694,99.1,,percent of total billed charges,,
"BARIUM SULFATE 2.1 % (W/V), 2.0 % (W/W) ORAL SUSP",,21103,LOCAL,Facility,Both,450 mL,mL,,34,28.9,9.7444,34,Medica,Individual & Family,33.694,99.1,,percent of total billed charges,,
"BARIUM SULFATE 2.1 % (W/V), 2.0 % (W/W) ORAL SUSP",,21103,LOCAL,Facility,Outpatient,450 mL,mL,,34,28.9,9.7444,34,Medica,Medica Advantage Solution,16.932,49.8,,percent of total billed charges,,
"BARIUM SULFATE 2.1 % (W/V), 2.0 % (W/W) ORAL SUSP",,21103,LOCAL,Facility,Outpatient,450 mL,mL,,34,28.9,9.7444,34,Medica,Medica Advantage Solution,16.932,49.8,,percent of total billed charges,,
"BARIUM SULFATE 2.1 % (W/V), 2.0 % (W/W) ORAL SUSP",,21103,LOCAL,Facility,Inpatient,450 mL,mL,,34,28.9,9.7444,34,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"BARIUM SULFATE 2.1 % (W/V), 2.0 % (W/W) ORAL SUSP",,21103,LOCAL,Facility,Inpatient,450 mL,mL,,34,28.9,9.7444,34,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"BARIUM SULFATE 2.1 % (W/V), 2.0 % (W/W) ORAL SUSP",,21103,LOCAL,Facility,Outpatient,450 mL,mL,,34,28.9,9.7444,34,Medica,Medical Assistance,15.164,44.6,,percent of total billed charges,,
"BARIUM SULFATE 2.1 % (W/V), 2.0 % (W/W) ORAL SUSP",,21103,LOCAL,Facility,Outpatient,450 mL,mL,,34,28.9,9.7444,34,Medica,Medical Assistance,15.164,44.6,,percent of total billed charges,,
"BARIUM SULFATE 2.1 % (W/V), 2.0 % (W/W) ORAL SUSP",,21103,LOCAL,Facility,Inpatient,450 mL,mL,,34,28.9,9.7444,34,Medica,Medical Assistance,,,,,Included in per diem rate,
"BARIUM SULFATE 2.1 % (W/V), 2.0 % (W/W) ORAL SUSP",,21103,LOCAL,Facility,Inpatient,450 mL,mL,,34,28.9,9.7444,34,Medica,Medical Assistance,,,,,Included in per diem rate,
"BARIUM SULFATE 2.1 % (W/V), 2.0 % (W/W) ORAL SUSP",,21103,LOCAL,Facility,Outpatient,450 mL,mL,,34,28.9,9.7444,34,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,16.932,49.8,,percent of total billed charges,,
"BARIUM SULFATE 2.1 % (W/V), 2.0 % (W/W) ORAL SUSP",,21103,LOCAL,Facility,Outpatient,450 mL,mL,,34,28.9,9.7444,34,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,16.932,49.8,,percent of total billed charges,,
"BARIUM SULFATE 2.1 % (W/V), 2.0 % (W/W) ORAL SUSP",,21103,LOCAL,Facility,Inpatient,450 mL,mL,,34,28.9,9.7444,34,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"BARIUM SULFATE 2.1 % (W/V), 2.0 % (W/W) ORAL SUSP",,21103,LOCAL,Facility,Inpatient,450 mL,mL,,34,28.9,9.7444,34,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"BARIUM SULFATE 2.1 % (W/V), 2.0 % (W/W) ORAL SUSP",,21103,LOCAL,Facility,Both,450 mL,mL,,34,28.9,9.7444,34,"Multiplan, Inc.","Multiplan, Inc.",31.96,94,,percent of total billed charges,,
"BARIUM SULFATE 2.1 % (W/V), 2.0 % (W/W) ORAL SUSP",,21103,LOCAL,Facility,Both,450 mL,mL,,34,28.9,9.7444,34,"Multiplan, Inc.","Multiplan, Inc.",31.96,94,,percent of total billed charges,,
"BARIUM SULFATE 2.1 % (W/V), 2.0 % (W/W) ORAL SUSP",,21103,LOCAL,Facility,Outpatient,450 mL,mL,,34,28.9,9.7444,34,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,30.634,90.1,,percent of total billed charges,,
"BARIUM SULFATE 2.1 % (W/V), 2.0 % (W/W) ORAL SUSP",,21103,LOCAL,Facility,Outpatient,450 mL,mL,,34,28.9,9.7444,34,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,30.634,90.1,,percent of total billed charges,,
"BARIUM SULFATE 2.1 % (W/V), 2.0 % (W/W) ORAL SUSP",,21103,LOCAL,Facility,Inpatient,450 mL,mL,,34,28.9,9.7444,34,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"BARIUM SULFATE 2.1 % (W/V), 2.0 % (W/W) ORAL SUSP",,21103,LOCAL,Facility,Inpatient,450 mL,mL,,34,28.9,9.7444,34,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"BARIUM SULFATE 2.1 % (W/V), 2.0 % (W/W) ORAL SUSP",,21103,LOCAL,Facility,Both,450 mL,mL,,34,28.9,9.7444,34,"Preferred One Administrative Services, INC.",PPO,33.524,98.6,,percent of total billed charges,,
"BARIUM SULFATE 2.1 % (W/V), 2.0 % (W/W) ORAL SUSP",,21103,LOCAL,Facility,Both,450 mL,mL,,34,28.9,9.7444,34,"Preferred One Administrative Services, INC.",PPO,33.524,98.6,,percent of total billed charges,,
"BARIUM SULFATE 2.1 % (W/V), 2.0 % (W/W) ORAL SUSP",,21103,LOCAL,Facility,Outpatient,450 mL,mL,,34,28.9,9.7444,34,PrimeWest Health,Minnesota Senior Health Options (MSHO),17.493,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"BARIUM SULFATE 2.1 % (W/V), 2.0 % (W/W) ORAL SUSP",,21103,LOCAL,Facility,Outpatient,450 mL,mL,,34,28.9,9.7444,34,PrimeWest Health,Minnesota Senior Health Options (MSHO),17.493,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"BARIUM SULFATE 2.1 % (W/V), 2.0 % (W/W) ORAL SUSP",,21103,LOCAL,Facility,Inpatient,450 mL,mL,,34,28.9,9.7444,34,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"BARIUM SULFATE 2.1 % (W/V), 2.0 % (W/W) ORAL SUSP",,21103,LOCAL,Facility,Inpatient,450 mL,mL,,34,28.9,9.7444,34,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"BARIUM SULFATE 2.1 % (W/V), 2.0 % (W/W) ORAL SUSP",,21103,LOCAL,Facility,Outpatient,450 mL,mL,,34,28.9,9.7444,34,PrimeWest Health,MinnesotaCare,17.4624,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"BARIUM SULFATE 2.1 % (W/V), 2.0 % (W/W) ORAL SUSP",,21103,LOCAL,Facility,Outpatient,450 mL,mL,,34,28.9,9.7444,34,PrimeWest Health,MinnesotaCare,17.4624,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"BARIUM SULFATE 2.1 % (W/V), 2.0 % (W/W) ORAL SUSP",,21103,LOCAL,Facility,Inpatient,450 mL,mL,,34,28.9,9.7444,34,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"BARIUM SULFATE 2.1 % (W/V), 2.0 % (W/W) ORAL SUSP",,21103,LOCAL,Facility,Inpatient,450 mL,mL,,34,28.9,9.7444,34,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"BARIUM SULFATE 2.1 % (W/V), 2.0 % (W/W) ORAL SUSP",,21103,LOCAL,Facility,Both,450 mL,mL,,34,28.9,9.7444,34,Sanford Health Plan,Sanford Health Plan,31.28,92,,percent of total billed charges,,
"BARIUM SULFATE 2.1 % (W/V), 2.0 % (W/W) ORAL SUSP",,21103,LOCAL,Facility,Both,450 mL,mL,,34,28.9,9.7444,34,Sanford Health Plan,Sanford Health Plan,31.28,92,,percent of total billed charges,,
"BARIUM SULFATE 2.1 % (W/V), 2.0 % (W/W) ORAL SUSP",,21103,LOCAL,Facility,Outpatient,450 mL,mL,,34,28.9,9.7444,34,"UCare Health, Inc.",Individual & Family Plan,19.159,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"BARIUM SULFATE 2.1 % (W/V), 2.0 % (W/W) ORAL SUSP",,21103,LOCAL,Facility,Outpatient,450 mL,mL,,34,28.9,9.7444,34,"UCare Health, Inc.",Individual & Family Plan,19.159,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"BARIUM SULFATE 2.1 % (W/V), 2.0 % (W/W) ORAL SUSP",,21103,LOCAL,Facility,Inpatient,450 mL,mL,,34,28.9,9.7444,34,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"BARIUM SULFATE 2.1 % (W/V), 2.0 % (W/W) ORAL SUSP",,21103,LOCAL,Facility,Inpatient,450 mL,mL,,34,28.9,9.7444,34,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"BARIUM SULFATE 2.1 % (W/V), 2.0 % (W/W) ORAL SUSP",,21103,LOCAL,Facility,Outpatient,450 mL,mL,,34,28.9,9.7444,34,"UCare Health, Inc.",Medical Assistance,17.1598,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"BARIUM SULFATE 2.1 % (W/V), 2.0 % (W/W) ORAL SUSP",,21103,LOCAL,Facility,Outpatient,450 mL,mL,,34,28.9,9.7444,34,"UCare Health, Inc.",Medical Assistance,17.1598,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"BARIUM SULFATE 2.1 % (W/V), 2.0 % (W/W) ORAL SUSP",,21103,LOCAL,Facility,Inpatient,450 mL,mL,,34,28.9,9.7444,34,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"BARIUM SULFATE 2.1 % (W/V), 2.0 % (W/W) ORAL SUSP",,21103,LOCAL,Facility,Inpatient,450 mL,mL,,34,28.9,9.7444,34,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"BARIUM SULFATE 2.1 % (W/V), 2.0 % (W/W) ORAL SUSP",,21103,LOCAL,Facility,Outpatient,450 mL,mL,,34,28.9,9.7444,34,"UCare Health, Inc.",Medicare Advantage,17.1598,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"BARIUM SULFATE 2.1 % (W/V), 2.0 % (W/W) ORAL SUSP",,21103,LOCAL,Facility,Outpatient,450 mL,mL,,34,28.9,9.7444,34,"UCare Health, Inc.",Medicare Advantage,17.1598,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"BARIUM SULFATE 2.1 % (W/V), 2.0 % (W/W) ORAL SUSP",,21103,LOCAL,Facility,Inpatient,450 mL,mL,,34,28.9,9.7444,34,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"BARIUM SULFATE 2.1 % (W/V), 2.0 % (W/W) ORAL SUSP",,21103,LOCAL,Facility,Inpatient,450 mL,mL,,34,28.9,9.7444,34,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"BARIUM SULFATE 2.1 % (W/V), 2.0 % (W/W) ORAL SUSP",,21103,LOCAL,Facility,Outpatient,450 mL,mL,,34,28.9,9.7444,34,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),17.1598,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"BARIUM SULFATE 2.1 % (W/V), 2.0 % (W/W) ORAL SUSP",,21103,LOCAL,Facility,Outpatient,450 mL,mL,,34,28.9,9.7444,34,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),17.1598,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"BARIUM SULFATE 2.1 % (W/V), 2.0 % (W/W) ORAL SUSP",,21103,LOCAL,Facility,Inpatient,450 mL,mL,,34,28.9,9.7444,34,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"BARIUM SULFATE 2.1 % (W/V), 2.0 % (W/W) ORAL SUSP",,21103,LOCAL,Facility,Inpatient,450 mL,mL,,34,28.9,9.7444,34,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"BARIUM SULFATE 2.1 % (W/V), 2.0 % (W/W) ORAL SUSP",,21103,LOCAL,Facility,Both,450 mL,mL,,34,28.9,9.7444,34,UnitedHealthcare,Individual & Family,31.96,94,,percent of total billed charges,,
"BARIUM SULFATE 2.1 % (W/V), 2.0 % (W/W) ORAL SUSP",,21103,LOCAL,Facility,Both,450 mL,mL,,34,28.9,9.7444,34,UnitedHealthcare,Individual & Family,31.96,94,,percent of total billed charges,,
"BARIUM SULFATE 2.1 % (W/V), 2.0 % (W/W) ORAL SUSP",,21103,LOCAL,Facility,Outpatient,450 mL,mL,,34,28.9,9.7444,34,UnitedHealthcare,Medicare Advantage,16.66,49,,percent of total billed charges,,
"BARIUM SULFATE 2.1 % (W/V), 2.0 % (W/W) ORAL SUSP",,21103,LOCAL,Facility,Outpatient,450 mL,mL,,34,28.9,9.7444,34,UnitedHealthcare,Medicare Advantage,16.66,49,,percent of total billed charges,,
"BARIUM SULFATE 2.1 % (W/V), 2.0 % (W/W) ORAL SUSP",,21103,LOCAL,Facility,Inpatient,450 mL,mL,,34,28.9,9.7444,34,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"BARIUM SULFATE 2.1 % (W/V), 2.0 % (W/W) ORAL SUSP",,21103,LOCAL,Facility,Inpatient,450 mL,mL,,34,28.9,9.7444,34,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"BARIUM SULFATE 2.1 % (W/V), 2.0 % (W/W) ORAL SUSP",,21103,LOCAL,Facility,Outpatient,450 mL,mL,,34,28.9,9.7444,34,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,16.32,48,,percent of total billed charges,,100% of DHS outpatient percentage
"BARIUM SULFATE 2.1 % (W/V), 2.0 % (W/W) ORAL SUSP",,21103,LOCAL,Facility,Outpatient,450 mL,mL,,34,28.9,9.7444,34,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,16.32,48,,percent of total billed charges,,100% of DHS outpatient percentage
"BARIUM SULFATE 2.1 % (W/V), 2.0 % (W/W) ORAL SUSP",,21103,LOCAL,Facility,Inpatient,450 mL,mL,,34,28.9,9.7444,34,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"BARIUM SULFATE 2.1 % (W/V), 2.0 % (W/W) ORAL SUSP",,21103,LOCAL,Facility,Inpatient,450 mL,mL,,34,28.9,9.7444,34,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
MINERAL OIL-HYDROPHIL PETROLAT TOP OINT,,7157,LOCAL,Facility,Both,454 g,g,,125,106.25,35.825,125,Aetna,Commercial,115,92,,percent of total billed charges,,
MINERAL OIL-HYDROPHIL PETROLAT TOP OINT,,7157,LOCAL,Facility,Outpatient,454 g,g,,125,106.25,35.825,125,Aetna,Medicare Advantage,61.25,49,,percent of total billed charges,,
MINERAL OIL-HYDROPHIL PETROLAT TOP OINT,,7157,LOCAL,Facility,Inpatient,454 g,g,,125,106.25,35.825,125,Aetna,Medicare Advantage,,,,,Included in per diem rate,
MINERAL OIL-HYDROPHIL PETROLAT TOP OINT,,7157,LOCAL,Facility,Both,454 g,g,,125,106.25,35.825,125,Aetna,PPO,116.25,93,,percent of total billed charges,,
MINERAL OIL-HYDROPHIL PETROLAT TOP OINT,,7157,LOCAL,Facility,Both,454 g,g,,125,106.25,35.825,125,America's PPO,America's PPO,120.0375,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
MINERAL OIL-HYDROPHIL PETROLAT TOP OINT,,7157,LOCAL,Facility,Both,454 g,g,,125,106.25,35.825,125,BlueCross BlueShield Minnesota, Federal Employee Program,123,98.4,,percent of total billed charges,,
MINERAL OIL-HYDROPHIL PETROLAT TOP OINT,,7157,LOCAL,Facility,Both,454 g,g,,125,106.25,35.825,125,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,125,100,,percent of total billed charges,,
MINERAL OIL-HYDROPHIL PETROLAT TOP OINT,,7157,LOCAL,Facility,Both,454 g,g,,125,106.25,35.825,125,BlueCross BlueShield Minnesota,High Value Network Plan,112.5,90,,percent of total billed charges,,
MINERAL OIL-HYDROPHIL PETROLAT TOP OINT,,7157,LOCAL,Facility,Outpatient,454 g,g,,125,106.25,35.825,125,BlueCross BlueShield Minnesota,Medicare Advantage,61.25,49,,percent of total billed charges,,
MINERAL OIL-HYDROPHIL PETROLAT TOP OINT,,7157,LOCAL,Facility,Inpatient,454 g,g,,125,106.25,35.825,125,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
MINERAL OIL-HYDROPHIL PETROLAT TOP OINT,,7157,LOCAL,Facility,Both,454 g,g,,125,106.25,35.825,125,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,110.7125,88.57,,percent of total billed charges,,
MINERAL OIL-HYDROPHIL PETROLAT TOP OINT,,7157,LOCAL,Facility,Both,454 g,g,,125,106.25,35.825,125,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,35.825,28.66,,percent of total billed charges,,
MINERAL OIL-HYDROPHIL PETROLAT TOP OINT,,7157,LOCAL,Facility,Outpatient,454 g,g,,125,106.25,35.825,125,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),61.25,49,,percent of total billed charges,,
MINERAL OIL-HYDROPHIL PETROLAT TOP OINT,,7157,LOCAL,Facility,Inpatient,454 g,g,,125,106.25,35.825,125,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
MINERAL OIL-HYDROPHIL PETROLAT TOP OINT,,7157,LOCAL,Facility,Both,454 g,g,,125,106.25,35.825,125,CorVel,Worker's Compensation,125,100,,percent of total billed charges,,
MINERAL OIL-HYDROPHIL PETROLAT TOP OINT,,7157,LOCAL,Facility,Both,454 g,g,,125,106.25,35.825,125,First Health Group Corporation,First Health Network,121.25,97,,percent of total billed charges,,
MINERAL OIL-HYDROPHIL PETROLAT TOP OINT,,7157,LOCAL,Facility,Both,454 g,g,,125,106.25,35.825,125,"Health Partners, Inc.",Commercial,118.25,94.6,,percent of total billed charges,,
MINERAL OIL-HYDROPHIL PETROLAT TOP OINT,,7157,LOCAL,Facility,Outpatient,454 g,g,,125,106.25,35.825,125,"Health Partners, Inc.",Medicare Advantage,61.25,49,,percent of total billed charges,,
MINERAL OIL-HYDROPHIL PETROLAT TOP OINT,,7157,LOCAL,Facility,Inpatient,454 g,g,,125,106.25,35.825,125,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
MINERAL OIL-HYDROPHIL PETROLAT TOP OINT,,7157,LOCAL,Facility,Both,454 g,g,,125,106.25,35.825,125,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),75,60,,percent of total billed charges,,
MINERAL OIL-HYDROPHIL PETROLAT TOP OINT,,7157,LOCAL,Facility,Both,454 g,g,,125,106.25,35.825,125,"Health Partners, Inc.",State of Minnesota Advantage Program,101.875,81.5,,percent of total billed charges,,
MINERAL OIL-HYDROPHIL PETROLAT TOP OINT,,7157,LOCAL,Facility,Both,454 g,g,,125,106.25,35.825,125,"Health Partners, Inc.",State Public Programs,62.5,50,,percent of total billed charges,,
MINERAL OIL-HYDROPHIL PETROLAT TOP OINT,,7157,LOCAL,Facility,Both,454 g,g,,125,106.25,35.825,125,Humana Insurance Company,Commercial PPO,118.75,95,,percent of total billed charges,,
MINERAL OIL-HYDROPHIL PETROLAT TOP OINT,,7157,LOCAL,Facility,Outpatient,454 g,g,,125,106.25,35.825,125,Humana Insurance Company,Medicare PPO,61.25,49,,percent of total billed charges,,
MINERAL OIL-HYDROPHIL PETROLAT TOP OINT,,7157,LOCAL,Facility,Inpatient,454 g,g,,125,106.25,35.825,125,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
MINERAL OIL-HYDROPHIL PETROLAT TOP OINT,,7157,LOCAL,Facility,Both,454 g,g,,125,106.25,35.825,125,Medica,Individual & Family,123.875,99.1,,percent of total billed charges,,
MINERAL OIL-HYDROPHIL PETROLAT TOP OINT,,7157,LOCAL,Facility,Outpatient,454 g,g,,125,106.25,35.825,125,Medica,Medica Advantage Solution,62.25,49.8,,percent of total billed charges,,
MINERAL OIL-HYDROPHIL PETROLAT TOP OINT,,7157,LOCAL,Facility,Inpatient,454 g,g,,125,106.25,35.825,125,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
MINERAL OIL-HYDROPHIL PETROLAT TOP OINT,,7157,LOCAL,Facility,Outpatient,454 g,g,,125,106.25,35.825,125,Medica,Medical Assistance,55.75,44.6,,percent of total billed charges,,
MINERAL OIL-HYDROPHIL PETROLAT TOP OINT,,7157,LOCAL,Facility,Inpatient,454 g,g,,125,106.25,35.825,125,Medica,Medical Assistance,,,,,Included in per diem rate,
MINERAL OIL-HYDROPHIL PETROLAT TOP OINT,,7157,LOCAL,Facility,Outpatient,454 g,g,,125,106.25,35.825,125,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,62.25,49.8,,percent of total billed charges,,
MINERAL OIL-HYDROPHIL PETROLAT TOP OINT,,7157,LOCAL,Facility,Inpatient,454 g,g,,125,106.25,35.825,125,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
MINERAL OIL-HYDROPHIL PETROLAT TOP OINT,,7157,LOCAL,Facility,Both,454 g,g,,125,106.25,35.825,125,"Multiplan, Inc.","Multiplan, Inc.",117.5,94,,percent of total billed charges,,
MINERAL OIL-HYDROPHIL PETROLAT TOP OINT,,7157,LOCAL,Facility,Outpatient,454 g,g,,125,106.25,35.825,125,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,112.625,90.1,,percent of total billed charges,,
MINERAL OIL-HYDROPHIL PETROLAT TOP OINT,,7157,LOCAL,Facility,Inpatient,454 g,g,,125,106.25,35.825,125,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
MINERAL OIL-HYDROPHIL PETROLAT TOP OINT,,7157,LOCAL,Facility,Both,454 g,g,,125,106.25,35.825,125,"Preferred One Administrative Services, INC.",PPO,123.25,98.6,,percent of total billed charges,,
MINERAL OIL-HYDROPHIL PETROLAT TOP OINT,,7157,LOCAL,Facility,Outpatient,454 g,g,,125,106.25,35.825,125,PrimeWest Health,Minnesota Senior Health Options (MSHO),64.3125,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
MINERAL OIL-HYDROPHIL PETROLAT TOP OINT,,7157,LOCAL,Facility,Inpatient,454 g,g,,125,106.25,35.825,125,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
MINERAL OIL-HYDROPHIL PETROLAT TOP OINT,,7157,LOCAL,Facility,Outpatient,454 g,g,,125,106.25,35.825,125,PrimeWest Health,MinnesotaCare,64.2,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
MINERAL OIL-HYDROPHIL PETROLAT TOP OINT,,7157,LOCAL,Facility,Inpatient,454 g,g,,125,106.25,35.825,125,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
MINERAL OIL-HYDROPHIL PETROLAT TOP OINT,,7157,LOCAL,Facility,Both,454 g,g,,125,106.25,35.825,125,Sanford Health Plan,Sanford Health Plan,115,92,,percent of total billed charges,,
MINERAL OIL-HYDROPHIL PETROLAT TOP OINT,,7157,LOCAL,Facility,Outpatient,454 g,g,,125,106.25,35.825,125,"UCare Health, Inc.",Individual & Family Plan,70.4375,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
MINERAL OIL-HYDROPHIL PETROLAT TOP OINT,,7157,LOCAL,Facility,Inpatient,454 g,g,,125,106.25,35.825,125,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
MINERAL OIL-HYDROPHIL PETROLAT TOP OINT,,7157,LOCAL,Facility,Outpatient,454 g,g,,125,106.25,35.825,125,"UCare Health, Inc.",Medical Assistance,63.0875,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MINERAL OIL-HYDROPHIL PETROLAT TOP OINT,,7157,LOCAL,Facility,Inpatient,454 g,g,,125,106.25,35.825,125,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
MINERAL OIL-HYDROPHIL PETROLAT TOP OINT,,7157,LOCAL,Facility,Outpatient,454 g,g,,125,106.25,35.825,125,"UCare Health, Inc.",Medicare Advantage,63.0875,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MINERAL OIL-HYDROPHIL PETROLAT TOP OINT,,7157,LOCAL,Facility,Inpatient,454 g,g,,125,106.25,35.825,125,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
MINERAL OIL-HYDROPHIL PETROLAT TOP OINT,,7157,LOCAL,Facility,Outpatient,454 g,g,,125,106.25,35.825,125,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),63.0875,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MINERAL OIL-HYDROPHIL PETROLAT TOP OINT,,7157,LOCAL,Facility,Inpatient,454 g,g,,125,106.25,35.825,125,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
MINERAL OIL-HYDROPHIL PETROLAT TOP OINT,,7157,LOCAL,Facility,Both,454 g,g,,125,106.25,35.825,125,UnitedHealthcare,Individual & Family,117.5,94,,percent of total billed charges,,
MINERAL OIL-HYDROPHIL PETROLAT TOP OINT,,7157,LOCAL,Facility,Outpatient,454 g,g,,125,106.25,35.825,125,UnitedHealthcare,Medicare Advantage,61.25,49,,percent of total billed charges,,
MINERAL OIL-HYDROPHIL PETROLAT TOP OINT,,7157,LOCAL,Facility,Inpatient,454 g,g,,125,106.25,35.825,125,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
MINERAL OIL-HYDROPHIL PETROLAT TOP OINT,,7157,LOCAL,Facility,Outpatient,454 g,g,,125,106.25,35.825,125,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,60,48,,percent of total billed charges,,100% of DHS outpatient percentage
MINERAL OIL-HYDROPHIL PETROLAT TOP OINT,,7157,LOCAL,Facility,Inpatient,454 g,g,,125,106.25,35.825,125,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Sup Lexiscan (Regadenoson) Per 0.1Mg,,J2785,HCPCS,Facility,Both,,,,246,209.1,70.5036,246,Aetna,Commercial,226.32,92,,percent of total billed charges,,
Sup Lexiscan (Regadenoson) Per 0.1Mg,,J2785,HCPCS,Facility,Outpatient,,,,246,209.1,70.5036,246,Aetna,Medicare Advantage,120.54,49,,percent of total billed charges,,
Sup Lexiscan (Regadenoson) Per 0.1Mg,,J2785,HCPCS,Facility,Inpatient,,,,246,209.1,70.5036,246,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Sup Lexiscan (Regadenoson) Per 0.1Mg,,J2785,HCPCS,Facility,Both,,,,246,209.1,70.5036,246,Aetna,PPO,228.78,93,,percent of total billed charges,,
Sup Lexiscan (Regadenoson) Per 0.1Mg,,J2785,HCPCS,Facility,Both,,,,246,209.1,70.5036,246,America's PPO,America's PPO,236.2338,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Sup Lexiscan (Regadenoson) Per 0.1Mg,,J2785,HCPCS,Facility,Both,,,,246,209.1,70.5036,246,BlueCross BlueShield Minnesota, Federal Employee Program,242.064,98.4,,percent of total billed charges,,
Sup Lexiscan (Regadenoson) Per 0.1Mg,,J2785,HCPCS,Facility,Both,,,,246,209.1,70.5036,246,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,246,100,,percent of total billed charges,,
Sup Lexiscan (Regadenoson) Per 0.1Mg,,J2785,HCPCS,Facility,Both,,,,246,209.1,70.5036,246,BlueCross BlueShield Minnesota,High Value Network Plan,221.4,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
Sup Lexiscan (Regadenoson) Per 0.1Mg,,J2785,HCPCS,Facility,Outpatient,,,,246,209.1,70.5036,246,BlueCross BlueShield Minnesota,Medicare Advantage,120.54,49,,percent of total billed charges,,
Sup Lexiscan (Regadenoson) Per 0.1Mg,,J2785,HCPCS,Facility,Inpatient,,,,246,209.1,70.5036,246,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Sup Lexiscan (Regadenoson) Per 0.1Mg,,J2785,HCPCS,Facility,Both,,,,246,209.1,70.5036,246,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,217.8822,88.57,,percent of total billed charges,,
Sup Lexiscan (Regadenoson) Per 0.1Mg,,J2785,HCPCS,Facility,Both,,,,246,209.1,70.5036,246,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,70.5036,28.66,,percent of total billed charges,,
Sup Lexiscan (Regadenoson) Per 0.1Mg,,J2785,HCPCS,Facility,Outpatient,,,,246,209.1,70.5036,246,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),120.54,49,,percent of total billed charges,,
Sup Lexiscan (Regadenoson) Per 0.1Mg,,J2785,HCPCS,Facility,Inpatient,,,,246,209.1,70.5036,246,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Sup Lexiscan (Regadenoson) Per 0.1Mg,,J2785,HCPCS,Facility,Both,,,,246,209.1,70.5036,246,CorVel,Worker's Compensation,246,100,,percent of total billed charges,,
Sup Lexiscan (Regadenoson) Per 0.1Mg,,J2785,HCPCS,Facility,Both,,,,246,209.1,70.5036,246,First Health Group Corporation,First Health Network,238.62,97,,percent of total billed charges,,
Sup Lexiscan (Regadenoson) Per 0.1Mg,,J2785,HCPCS,Facility,Both,,,,246,209.1,70.5036,246,"Health Partners, Inc.",Commercial,232.716,94.6,,percent of total billed charges,,
Sup Lexiscan (Regadenoson) Per 0.1Mg,,J2785,HCPCS,Facility,Outpatient,,,,246,209.1,70.5036,246,"Health Partners, Inc.",Medicare Advantage,120.54,49,,percent of total billed charges,,
Sup Lexiscan (Regadenoson) Per 0.1Mg,,J2785,HCPCS,Facility,Inpatient,,,,246,209.1,70.5036,246,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Lexiscan (Regadenoson) Per 0.1Mg,,J2785,HCPCS,Facility,Both,,,,246,209.1,70.5036,246,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),147.6,60,,percent of total billed charges,,
Sup Lexiscan (Regadenoson) Per 0.1Mg,,J2785,HCPCS,Facility,Both,,,,246,209.1,70.5036,246,"Health Partners, Inc.",State of Minnesota Advantage Program,200.49,81.5,,percent of total billed charges,,
Sup Lexiscan (Regadenoson) Per 0.1Mg,,J2785,HCPCS,Facility,Both,,,,246,209.1,70.5036,246,"Health Partners, Inc.",State Public Programs,123,50,,percent of total billed charges,,
Sup Lexiscan (Regadenoson) Per 0.1Mg,,J2785,HCPCS,Facility,Both,,,,246,209.1,70.5036,246,Humana Insurance Company,Commercial PPO,233.7,95,,percent of total billed charges,,
Sup Lexiscan (Regadenoson) Per 0.1Mg,,J2785,HCPCS,Facility,Outpatient,,,,246,209.1,70.5036,246,Humana Insurance Company,Medicare PPO,120.54,49,,percent of total billed charges,,
Sup Lexiscan (Regadenoson) Per 0.1Mg,,J2785,HCPCS,Facility,Inpatient,,,,246,209.1,70.5036,246,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Sup Lexiscan (Regadenoson) Per 0.1Mg,,J2785,HCPCS,Facility,Both,,,,246,209.1,70.5036,246,Medica,Individual & Family,243.786,99.1,,percent of total billed charges,,
Sup Lexiscan (Regadenoson) Per 0.1Mg,,J2785,HCPCS,Facility,Outpatient,,,,246,209.1,70.5036,246,Medica,Medica Advantage Solution,122.508,49.8,,percent of total billed charges,,
Sup Lexiscan (Regadenoson) Per 0.1Mg,,J2785,HCPCS,Facility,Inpatient,,,,246,209.1,70.5036,246,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Sup Lexiscan (Regadenoson) Per 0.1Mg,,J2785,HCPCS,Facility,Outpatient,,,,246,209.1,70.5036,246,Medica,Medical Assistance,109.716,44.6,,percent of total billed charges,,
Sup Lexiscan (Regadenoson) Per 0.1Mg,,J2785,HCPCS,Facility,Inpatient,,,,246,209.1,70.5036,246,Medica,Medical Assistance,,,,,Included in per diem rate,
Sup Lexiscan (Regadenoson) Per 0.1Mg,,J2785,HCPCS,Facility,Outpatient,,,,246,209.1,70.5036,246,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,122.508,49.8,,percent of total billed charges,,
Sup Lexiscan (Regadenoson) Per 0.1Mg,,J2785,HCPCS,Facility,Inpatient,,,,246,209.1,70.5036,246,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Sup Lexiscan (Regadenoson) Per 0.1Mg,,J2785,HCPCS,Facility,Both,,,,246,209.1,70.5036,246,"Multiplan, Inc.","Multiplan, Inc.",231.24,94,,percent of total billed charges,,
Sup Lexiscan (Regadenoson) Per 0.1Mg,,J2785,HCPCS,Facility,Outpatient,,,,246,209.1,70.5036,246,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,221.646,90.1,,percent of total billed charges,,
Sup Lexiscan (Regadenoson) Per 0.1Mg,,J2785,HCPCS,Facility,Inpatient,,,,246,209.1,70.5036,246,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Sup Lexiscan (Regadenoson) Per 0.1Mg,,J2785,HCPCS,Facility,Both,,,,246,209.1,70.5036,246,"Preferred One Administrative Services, INC.",PPO,242.556,98.6,,percent of total billed charges,,
Sup Lexiscan (Regadenoson) Per 0.1Mg,,J2785,HCPCS,Facility,Outpatient,,,,246,209.1,70.5036,246,PrimeWest Health,Minnesota Senior Health Options (MSHO),126.567,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Sup Lexiscan (Regadenoson) Per 0.1Mg,,J2785,HCPCS,Facility,Inpatient,,,,246,209.1,70.5036,246,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Lexiscan (Regadenoson) Per 0.1Mg,,J2785,HCPCS,Facility,Outpatient,,,,246,209.1,70.5036,246,PrimeWest Health,MinnesotaCare,126.3456,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Sup Lexiscan (Regadenoson) Per 0.1Mg,,J2785,HCPCS,Facility,Inpatient,,,,246,209.1,70.5036,246,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Sup Lexiscan (Regadenoson) Per 0.1Mg,,J2785,HCPCS,Facility,Both,,,,246,209.1,70.5036,246,Sanford Health Plan,Sanford Health Plan,226.32,92,,percent of total billed charges,,
Sup Lexiscan (Regadenoson) Per 0.1Mg,,J2785,HCPCS,Facility,Outpatient,,,,246,209.1,70.5036,246,"UCare Health, Inc.",Individual & Family Plan,138.621,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Sup Lexiscan (Regadenoson) Per 0.1Mg,,J2785,HCPCS,Facility,Inpatient,,,,246,209.1,70.5036,246,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Sup Lexiscan (Regadenoson) Per 0.1Mg,,J2785,HCPCS,Facility,Outpatient,,,,246,209.1,70.5036,246,"UCare Health, Inc.",Medical Assistance,124.1562,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Lexiscan (Regadenoson) Per 0.1Mg,,J2785,HCPCS,Facility,Inpatient,,,,246,209.1,70.5036,246,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Sup Lexiscan (Regadenoson) Per 0.1Mg,,J2785,HCPCS,Facility,Outpatient,,,,246,209.1,70.5036,246,"UCare Health, Inc.",Medicare Advantage,124.1562,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Lexiscan (Regadenoson) Per 0.1Mg,,J2785,HCPCS,Facility,Inpatient,,,,246,209.1,70.5036,246,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Lexiscan (Regadenoson) Per 0.1Mg,,J2785,HCPCS,Facility,Outpatient,,,,246,209.1,70.5036,246,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),124.1562,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Lexiscan (Regadenoson) Per 0.1Mg,,J2785,HCPCS,Facility,Inpatient,,,,246,209.1,70.5036,246,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Lexiscan (Regadenoson) Per 0.1Mg,,J2785,HCPCS,Facility,Both,,,,246,209.1,70.5036,246,UnitedHealthcare,Individual & Family,231.24,94,,percent of total billed charges,,
Sup Lexiscan (Regadenoson) Per 0.1Mg,,J2785,HCPCS,Facility,Outpatient,,,,246,209.1,70.5036,246,UnitedHealthcare,Medicare Advantage,120.54,49,,percent of total billed charges,,
Sup Lexiscan (Regadenoson) Per 0.1Mg,,J2785,HCPCS,Facility,Inpatient,,,,246,209.1,70.5036,246,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Sup Lexiscan (Regadenoson) Per 0.1Mg,,J2785,HCPCS,Facility,Outpatient,,,,246,209.1,70.5036,246,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,118.08,48,,percent of total billed charges,,100% of DHS outpatient percentage
Sup Lexiscan (Regadenoson) Per 0.1Mg,,J2785,HCPCS,Facility,Inpatient,,,,246,209.1,70.5036,246,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Rhogam - Product Only (Bb),,J2790,HCPCS,Facility,Both,,,,275,233.75,78.815,275,Aetna,Commercial,253,92,,percent of total billed charges,,
Rhogam - Product Only (Bb),,J2790,HCPCS,Facility,Outpatient,,,,275,233.75,78.815,275,Aetna,Medicare Advantage,134.75,49,,percent of total billed charges,,
Rhogam - Product Only (Bb),,J2790,HCPCS,Facility,Inpatient,,,,275,233.75,78.815,275,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Rhogam - Product Only (Bb),,J2790,HCPCS,Facility,Both,,,,275,233.75,78.815,275,Aetna,PPO,255.75,93,,percent of total billed charges,,
Rhogam - Product Only (Bb),,J2790,HCPCS,Facility,Both,,,,275,233.75,78.815,275,America's PPO,America's PPO,264.0825,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Rhogam - Product Only (Bb),,J2790,HCPCS,Facility,Both,,,,275,233.75,78.815,275,BlueCross BlueShield Minnesota, Federal Employee Program,270.6,98.4,,percent of total billed charges,,
Rhogam - Product Only (Bb),,J2790,HCPCS,Facility,Both,,,,275,233.75,78.815,275,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,275,100,,percent of total billed charges,,
Rhogam - Product Only (Bb),,J2790,HCPCS,Facility,Both,,,,275,233.75,78.815,275,BlueCross BlueShield Minnesota,High Value Network Plan,247.5,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
Rhogam - Product Only (Bb),,J2790,HCPCS,Facility,Outpatient,,,,275,233.75,78.815,275,BlueCross BlueShield Minnesota,Medicare Advantage,134.75,49,,percent of total billed charges,,
Rhogam - Product Only (Bb),,J2790,HCPCS,Facility,Inpatient,,,,275,233.75,78.815,275,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Rhogam - Product Only (Bb),,J2790,HCPCS,Facility,Both,,,,275,233.75,78.815,275,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,243.5675,88.57,,percent of total billed charges,,
Rhogam - Product Only (Bb),,J2790,HCPCS,Facility,Both,,,,275,233.75,78.815,275,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,78.815,28.66,,percent of total billed charges,,
Rhogam - Product Only (Bb),,J2790,HCPCS,Facility,Outpatient,,,,275,233.75,78.815,275,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),134.75,49,,percent of total billed charges,,
Rhogam - Product Only (Bb),,J2790,HCPCS,Facility,Inpatient,,,,275,233.75,78.815,275,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Rhogam - Product Only (Bb),,J2790,HCPCS,Facility,Both,,,,275,233.75,78.815,275,CorVel,Worker's Compensation,275,100,,percent of total billed charges,,
Rhogam - Product Only (Bb),,J2790,HCPCS,Facility,Both,,,,275,233.75,78.815,275,First Health Group Corporation,First Health Network,266.75,97,,percent of total billed charges,,
Rhogam - Product Only (Bb),,J2790,HCPCS,Facility,Both,,,,275,233.75,78.815,275,"Health Partners, Inc.",Commercial,260.15,94.6,,percent of total billed charges,,
Rhogam - Product Only (Bb),,J2790,HCPCS,Facility,Outpatient,,,,275,233.75,78.815,275,"Health Partners, Inc.",Medicare Advantage,134.75,49,,percent of total billed charges,,
Rhogam - Product Only (Bb),,J2790,HCPCS,Facility,Inpatient,,,,275,233.75,78.815,275,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Rhogam - Product Only (Bb),,J2790,HCPCS,Facility,Both,,,,275,233.75,78.815,275,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),165,60,,percent of total billed charges,,
Rhogam - Product Only (Bb),,J2790,HCPCS,Facility,Both,,,,275,233.75,78.815,275,"Health Partners, Inc.",State of Minnesota Advantage Program,224.125,81.5,,percent of total billed charges,,
Rhogam - Product Only (Bb),,J2790,HCPCS,Facility,Both,,,,275,233.75,78.815,275,"Health Partners, Inc.",State Public Programs,137.5,50,,percent of total billed charges,,
Rhogam - Product Only (Bb),,J2790,HCPCS,Facility,Both,,,,275,233.75,78.815,275,Humana Insurance Company,Commercial PPO,261.25,95,,percent of total billed charges,,
Rhogam - Product Only (Bb),,J2790,HCPCS,Facility,Outpatient,,,,275,233.75,78.815,275,Humana Insurance Company,Medicare PPO,134.75,49,,percent of total billed charges,,
Rhogam - Product Only (Bb),,J2790,HCPCS,Facility,Inpatient,,,,275,233.75,78.815,275,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Rhogam - Product Only (Bb),,J2790,HCPCS,Facility,Both,,,,275,233.75,78.815,275,Medica,Individual & Family,272.525,99.1,,percent of total billed charges,,
Rhogam - Product Only (Bb),,J2790,HCPCS,Facility,Outpatient,,,,275,233.75,78.815,275,Medica,Medica Advantage Solution,136.95,49.8,,percent of total billed charges,,
Rhogam - Product Only (Bb),,J2790,HCPCS,Facility,Inpatient,,,,275,233.75,78.815,275,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Rhogam - Product Only (Bb),,J2790,HCPCS,Facility,Outpatient,,,,275,233.75,78.815,275,Medica,Medical Assistance,122.65,44.6,,percent of total billed charges,,
Rhogam - Product Only (Bb),,J2790,HCPCS,Facility,Inpatient,,,,275,233.75,78.815,275,Medica,Medical Assistance,,,,,Included in per diem rate,
Rhogam - Product Only (Bb),,J2790,HCPCS,Facility,Outpatient,,,,275,233.75,78.815,275,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,136.95,49.8,,percent of total billed charges,,
Rhogam - Product Only (Bb),,J2790,HCPCS,Facility,Inpatient,,,,275,233.75,78.815,275,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Rhogam - Product Only (Bb),,J2790,HCPCS,Facility,Both,,,,275,233.75,78.815,275,"Multiplan, Inc.","Multiplan, Inc.",258.5,94,,percent of total billed charges,,
Rhogam - Product Only (Bb),,J2790,HCPCS,Facility,Outpatient,,,,275,233.75,78.815,275,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,247.775,90.1,,percent of total billed charges,,
Rhogam - Product Only (Bb),,J2790,HCPCS,Facility,Inpatient,,,,275,233.75,78.815,275,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Rhogam - Product Only (Bb),,J2790,HCPCS,Facility,Both,,,,275,233.75,78.815,275,"Preferred One Administrative Services, INC.",PPO,271.15,98.6,,percent of total billed charges,,
Rhogam - Product Only (Bb),,J2790,HCPCS,Facility,Outpatient,,,,275,233.75,78.815,275,PrimeWest Health,Minnesota Senior Health Options (MSHO),141.4875,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Rhogam - Product Only (Bb),,J2790,HCPCS,Facility,Inpatient,,,,275,233.75,78.815,275,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Rhogam - Product Only (Bb),,J2790,HCPCS,Facility,Outpatient,,,,275,233.75,78.815,275,PrimeWest Health,MinnesotaCare,141.24,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Rhogam - Product Only (Bb),,J2790,HCPCS,Facility,Inpatient,,,,275,233.75,78.815,275,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Rhogam - Product Only (Bb),,J2790,HCPCS,Facility,Both,,,,275,233.75,78.815,275,Sanford Health Plan,Sanford Health Plan,253,92,,percent of total billed charges,,
Rhogam - Product Only (Bb),,J2790,HCPCS,Facility,Outpatient,,,,275,233.75,78.815,275,"UCare Health, Inc.",Individual & Family Plan,154.9625,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Rhogam - Product Only (Bb),,J2790,HCPCS,Facility,Inpatient,,,,275,233.75,78.815,275,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Rhogam - Product Only (Bb),,J2790,HCPCS,Facility,Outpatient,,,,275,233.75,78.815,275,"UCare Health, Inc.",Medical Assistance,138.7925,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Rhogam - Product Only (Bb),,J2790,HCPCS,Facility,Inpatient,,,,275,233.75,78.815,275,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Rhogam - Product Only (Bb),,J2790,HCPCS,Facility,Outpatient,,,,275,233.75,78.815,275,"UCare Health, Inc.",Medicare Advantage,138.7925,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Rhogam - Product Only (Bb),,J2790,HCPCS,Facility,Inpatient,,,,275,233.75,78.815,275,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Rhogam - Product Only (Bb),,J2790,HCPCS,Facility,Outpatient,,,,275,233.75,78.815,275,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),138.7925,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Rhogam - Product Only (Bb),,J2790,HCPCS,Facility,Inpatient,,,,275,233.75,78.815,275,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Rhogam - Product Only (Bb),,J2790,HCPCS,Facility,Both,,,,275,233.75,78.815,275,UnitedHealthcare,Individual & Family,258.5,94,,percent of total billed charges,,
Rhogam - Product Only (Bb),,J2790,HCPCS,Facility,Outpatient,,,,275,233.75,78.815,275,UnitedHealthcare,Medicare Advantage,134.75,49,,percent of total billed charges,,
Rhogam - Product Only (Bb),,J2790,HCPCS,Facility,Inpatient,,,,275,233.75,78.815,275,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Rhogam - Product Only (Bb),,J2790,HCPCS,Facility,Outpatient,,,,275,233.75,78.815,275,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,132,48,,percent of total billed charges,,100% of DHS outpatient percentage
Rhogam - Product Only (Bb),,J2790,HCPCS,Facility,Inpatient,,,,275,233.75,78.815,275,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
HYDROCORTISONE 1 % TOP CREAM,,11781,LOCAL,Facility,Both,454 g,g,,217,184.45,62.1922,217,Aetna,Commercial,199.64,92,,percent of total billed charges,,
HYDROCORTISONE 1 % TOP CREAM,,11781,LOCAL,Facility,Outpatient,454 g,g,,217,184.45,62.1922,217,Aetna,Medicare Advantage,106.33,49,,percent of total billed charges,,
HYDROCORTISONE 1 % TOP CREAM,,11781,LOCAL,Facility,Inpatient,454 g,g,,217,184.45,62.1922,217,Aetna,Medicare Advantage,,,,,Included in per diem rate,
HYDROCORTISONE 1 % TOP CREAM,,11781,LOCAL,Facility,Both,454 g,g,,217,184.45,62.1922,217,Aetna,PPO,201.81,93,,percent of total billed charges,,
HYDROCORTISONE 1 % TOP CREAM,,11781,LOCAL,Facility,Both,454 g,g,,217,184.45,62.1922,217,America's PPO,America's PPO,208.3851,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
HYDROCORTISONE 1 % TOP CREAM,,11781,LOCAL,Facility,Both,454 g,g,,217,184.45,62.1922,217,BlueCross BlueShield Minnesota, Federal Employee Program,213.528,98.4,,percent of total billed charges,,
HYDROCORTISONE 1 % TOP CREAM,,11781,LOCAL,Facility,Both,454 g,g,,217,184.45,62.1922,217,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,217,100,,percent of total billed charges,,
HYDROCORTISONE 1 % TOP CREAM,,11781,LOCAL,Facility,Both,454 g,g,,217,184.45,62.1922,217,BlueCross BlueShield Minnesota,High Value Network Plan,195.3,90,,percent of total billed charges,,
HYDROCORTISONE 1 % TOP CREAM,,11781,LOCAL,Facility,Outpatient,454 g,g,,217,184.45,62.1922,217,BlueCross BlueShield Minnesota,Medicare Advantage,106.33,49,,percent of total billed charges,,
HYDROCORTISONE 1 % TOP CREAM,,11781,LOCAL,Facility,Inpatient,454 g,g,,217,184.45,62.1922,217,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
HYDROCORTISONE 1 % TOP CREAM,,11781,LOCAL,Facility,Both,454 g,g,,217,184.45,62.1922,217,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,192.1969,88.57,,percent of total billed charges,,
HYDROCORTISONE 1 % TOP CREAM,,11781,LOCAL,Facility,Both,454 g,g,,217,184.45,62.1922,217,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,62.1922,28.66,,percent of total billed charges,,
HYDROCORTISONE 1 % TOP CREAM,,11781,LOCAL,Facility,Outpatient,454 g,g,,217,184.45,62.1922,217,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),106.33,49,,percent of total billed charges,,
HYDROCORTISONE 1 % TOP CREAM,,11781,LOCAL,Facility,Inpatient,454 g,g,,217,184.45,62.1922,217,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
HYDROCORTISONE 1 % TOP CREAM,,11781,LOCAL,Facility,Both,454 g,g,,217,184.45,62.1922,217,CorVel,Worker's Compensation,217,100,,percent of total billed charges,,
HYDROCORTISONE 1 % TOP CREAM,,11781,LOCAL,Facility,Both,454 g,g,,217,184.45,62.1922,217,First Health Group Corporation,First Health Network,210.49,97,,percent of total billed charges,,
HYDROCORTISONE 1 % TOP CREAM,,11781,LOCAL,Facility,Both,454 g,g,,217,184.45,62.1922,217,"Health Partners, Inc.",Commercial,205.282,94.6,,percent of total billed charges,,
HYDROCORTISONE 1 % TOP CREAM,,11781,LOCAL,Facility,Outpatient,454 g,g,,217,184.45,62.1922,217,"Health Partners, Inc.",Medicare Advantage,106.33,49,,percent of total billed charges,,
HYDROCORTISONE 1 % TOP CREAM,,11781,LOCAL,Facility,Inpatient,454 g,g,,217,184.45,62.1922,217,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
HYDROCORTISONE 1 % TOP CREAM,,11781,LOCAL,Facility,Both,454 g,g,,217,184.45,62.1922,217,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),130.2,60,,percent of total billed charges,,
HYDROCORTISONE 1 % TOP CREAM,,11781,LOCAL,Facility,Both,454 g,g,,217,184.45,62.1922,217,"Health Partners, Inc.",State of Minnesota Advantage Program,176.855,81.5,,percent of total billed charges,,
HYDROCORTISONE 1 % TOP CREAM,,11781,LOCAL,Facility,Both,454 g,g,,217,184.45,62.1922,217,"Health Partners, Inc.",State Public Programs,108.5,50,,percent of total billed charges,,
HYDROCORTISONE 1 % TOP CREAM,,11781,LOCAL,Facility,Both,454 g,g,,217,184.45,62.1922,217,Humana Insurance Company,Commercial PPO,206.15,95,,percent of total billed charges,,
HYDROCORTISONE 1 % TOP CREAM,,11781,LOCAL,Facility,Outpatient,454 g,g,,217,184.45,62.1922,217,Humana Insurance Company,Medicare PPO,106.33,49,,percent of total billed charges,,
HYDROCORTISONE 1 % TOP CREAM,,11781,LOCAL,Facility,Inpatient,454 g,g,,217,184.45,62.1922,217,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
HYDROCORTISONE 1 % TOP CREAM,,11781,LOCAL,Facility,Both,454 g,g,,217,184.45,62.1922,217,Medica,Individual & Family,215.047,99.1,,percent of total billed charges,,
HYDROCORTISONE 1 % TOP CREAM,,11781,LOCAL,Facility,Outpatient,454 g,g,,217,184.45,62.1922,217,Medica,Medica Advantage Solution,108.066,49.8,,percent of total billed charges,,
HYDROCORTISONE 1 % TOP CREAM,,11781,LOCAL,Facility,Inpatient,454 g,g,,217,184.45,62.1922,217,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
HYDROCORTISONE 1 % TOP CREAM,,11781,LOCAL,Facility,Outpatient,454 g,g,,217,184.45,62.1922,217,Medica,Medical Assistance,96.782,44.6,,percent of total billed charges,,
HYDROCORTISONE 1 % TOP CREAM,,11781,LOCAL,Facility,Inpatient,454 g,g,,217,184.45,62.1922,217,Medica,Medical Assistance,,,,,Included in per diem rate,
HYDROCORTISONE 1 % TOP CREAM,,11781,LOCAL,Facility,Outpatient,454 g,g,,217,184.45,62.1922,217,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,108.066,49.8,,percent of total billed charges,,
HYDROCORTISONE 1 % TOP CREAM,,11781,LOCAL,Facility,Inpatient,454 g,g,,217,184.45,62.1922,217,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
HYDROCORTISONE 1 % TOP CREAM,,11781,LOCAL,Facility,Both,454 g,g,,217,184.45,62.1922,217,"Multiplan, Inc.","Multiplan, Inc.",203.98,94,,percent of total billed charges,,
HYDROCORTISONE 1 % TOP CREAM,,11781,LOCAL,Facility,Outpatient,454 g,g,,217,184.45,62.1922,217,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,195.517,90.1,,percent of total billed charges,,
HYDROCORTISONE 1 % TOP CREAM,,11781,LOCAL,Facility,Inpatient,454 g,g,,217,184.45,62.1922,217,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
HYDROCORTISONE 1 % TOP CREAM,,11781,LOCAL,Facility,Both,454 g,g,,217,184.45,62.1922,217,"Preferred One Administrative Services, INC.",PPO,213.962,98.6,,percent of total billed charges,,
HYDROCORTISONE 1 % TOP CREAM,,11781,LOCAL,Facility,Outpatient,454 g,g,,217,184.45,62.1922,217,PrimeWest Health,Minnesota Senior Health Options (MSHO),111.6465,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
HYDROCORTISONE 1 % TOP CREAM,,11781,LOCAL,Facility,Inpatient,454 g,g,,217,184.45,62.1922,217,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
HYDROCORTISONE 1 % TOP CREAM,,11781,LOCAL,Facility,Outpatient,454 g,g,,217,184.45,62.1922,217,PrimeWest Health,MinnesotaCare,111.4512,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
HYDROCORTISONE 1 % TOP CREAM,,11781,LOCAL,Facility,Inpatient,454 g,g,,217,184.45,62.1922,217,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
HYDROCORTISONE 1 % TOP CREAM,,11781,LOCAL,Facility,Both,454 g,g,,217,184.45,62.1922,217,Sanford Health Plan,Sanford Health Plan,199.64,92,,percent of total billed charges,,
HYDROCORTISONE 1 % TOP CREAM,,11781,LOCAL,Facility,Outpatient,454 g,g,,217,184.45,62.1922,217,"UCare Health, Inc.",Individual & Family Plan,122.2795,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
HYDROCORTISONE 1 % TOP CREAM,,11781,LOCAL,Facility,Inpatient,454 g,g,,217,184.45,62.1922,217,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
HYDROCORTISONE 1 % TOP CREAM,,11781,LOCAL,Facility,Outpatient,454 g,g,,217,184.45,62.1922,217,"UCare Health, Inc.",Medical Assistance,109.5199,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
HYDROCORTISONE 1 % TOP CREAM,,11781,LOCAL,Facility,Inpatient,454 g,g,,217,184.45,62.1922,217,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
HYDROCORTISONE 1 % TOP CREAM,,11781,LOCAL,Facility,Outpatient,454 g,g,,217,184.45,62.1922,217,"UCare Health, Inc.",Medicare Advantage,109.5199,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
HYDROCORTISONE 1 % TOP CREAM,,11781,LOCAL,Facility,Inpatient,454 g,g,,217,184.45,62.1922,217,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
HYDROCORTISONE 1 % TOP CREAM,,11781,LOCAL,Facility,Outpatient,454 g,g,,217,184.45,62.1922,217,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),109.5199,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
HYDROCORTISONE 1 % TOP CREAM,,11781,LOCAL,Facility,Inpatient,454 g,g,,217,184.45,62.1922,217,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
HYDROCORTISONE 1 % TOP CREAM,,11781,LOCAL,Facility,Both,454 g,g,,217,184.45,62.1922,217,UnitedHealthcare,Individual & Family,203.98,94,,percent of total billed charges,,
HYDROCORTISONE 1 % TOP CREAM,,11781,LOCAL,Facility,Outpatient,454 g,g,,217,184.45,62.1922,217,UnitedHealthcare,Medicare Advantage,106.33,49,,percent of total billed charges,,
HYDROCORTISONE 1 % TOP CREAM,,11781,LOCAL,Facility,Inpatient,454 g,g,,217,184.45,62.1922,217,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
HYDROCORTISONE 1 % TOP CREAM,,11781,LOCAL,Facility,Outpatient,454 g,g,,217,184.45,62.1922,217,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,104.16,48,,percent of total billed charges,,100% of DHS outpatient percentage
HYDROCORTISONE 1 % TOP CREAM,,11781,LOCAL,Facility,Inpatient,454 g,g,,217,184.45,62.1922,217,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
PHENOBARBITAL 20 MG/5 ML (4 MG/ML) ORAL ELIXIR,,3028,LOCAL,Facility,Both,473 mL,mL,,406,345.1,116.3596,406,Aetna,Commercial,373.52,92,,percent of total billed charges,,
PHENOBARBITAL 20 MG/5 ML (4 MG/ML) ORAL ELIXIR,,3028,LOCAL,Facility,Outpatient,473 mL,mL,,406,345.1,116.3596,406,Aetna,Medicare Advantage,198.94,49,,percent of total billed charges,,
PHENOBARBITAL 20 MG/5 ML (4 MG/ML) ORAL ELIXIR,,3028,LOCAL,Facility,Inpatient,473 mL,mL,,406,345.1,116.3596,406,Aetna,Medicare Advantage,,,,,Included in per diem rate,
PHENOBARBITAL 20 MG/5 ML (4 MG/ML) ORAL ELIXIR,,3028,LOCAL,Facility,Both,473 mL,mL,,406,345.1,116.3596,406,Aetna,PPO,377.58,93,,percent of total billed charges,,
PHENOBARBITAL 20 MG/5 ML (4 MG/ML) ORAL ELIXIR,,3028,LOCAL,Facility,Both,473 mL,mL,,406,345.1,116.3596,406,America's PPO,America's PPO,389.8818,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
PHENOBARBITAL 20 MG/5 ML (4 MG/ML) ORAL ELIXIR,,3028,LOCAL,Facility,Both,473 mL,mL,,406,345.1,116.3596,406,BlueCross BlueShield Minnesota, Federal Employee Program,399.504,98.4,,percent of total billed charges,,
PHENOBARBITAL 20 MG/5 ML (4 MG/ML) ORAL ELIXIR,,3028,LOCAL,Facility,Both,473 mL,mL,,406,345.1,116.3596,406,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,406,100,,percent of total billed charges,,
PHENOBARBITAL 20 MG/5 ML (4 MG/ML) ORAL ELIXIR,,3028,LOCAL,Facility,Both,473 mL,mL,,406,345.1,116.3596,406,BlueCross BlueShield Minnesota,High Value Network Plan,365.4,90,,percent of total billed charges,,
PHENOBARBITAL 20 MG/5 ML (4 MG/ML) ORAL ELIXIR,,3028,LOCAL,Facility,Outpatient,473 mL,mL,,406,345.1,116.3596,406,BlueCross BlueShield Minnesota,Medicare Advantage,198.94,49,,percent of total billed charges,,
PHENOBARBITAL 20 MG/5 ML (4 MG/ML) ORAL ELIXIR,,3028,LOCAL,Facility,Inpatient,473 mL,mL,,406,345.1,116.3596,406,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
PHENOBARBITAL 20 MG/5 ML (4 MG/ML) ORAL ELIXIR,,3028,LOCAL,Facility,Both,473 mL,mL,,406,345.1,116.3596,406,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,359.5942,88.57,,percent of total billed charges,,
PHENOBARBITAL 20 MG/5 ML (4 MG/ML) ORAL ELIXIR,,3028,LOCAL,Facility,Both,473 mL,mL,,406,345.1,116.3596,406,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,116.3596,28.66,,percent of total billed charges,,
PHENOBARBITAL 20 MG/5 ML (4 MG/ML) ORAL ELIXIR,,3028,LOCAL,Facility,Outpatient,473 mL,mL,,406,345.1,116.3596,406,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),198.94,49,,percent of total billed charges,,
PHENOBARBITAL 20 MG/5 ML (4 MG/ML) ORAL ELIXIR,,3028,LOCAL,Facility,Inpatient,473 mL,mL,,406,345.1,116.3596,406,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
PHENOBARBITAL 20 MG/5 ML (4 MG/ML) ORAL ELIXIR,,3028,LOCAL,Facility,Both,473 mL,mL,,406,345.1,116.3596,406,CorVel,Worker's Compensation,406,100,,percent of total billed charges,,
PHENOBARBITAL 20 MG/5 ML (4 MG/ML) ORAL ELIXIR,,3028,LOCAL,Facility,Both,473 mL,mL,,406,345.1,116.3596,406,First Health Group Corporation,First Health Network,393.82,97,,percent of total billed charges,,
PHENOBARBITAL 20 MG/5 ML (4 MG/ML) ORAL ELIXIR,,3028,LOCAL,Facility,Both,473 mL,mL,,406,345.1,116.3596,406,"Health Partners, Inc.",Commercial,384.076,94.6,,percent of total billed charges,,
PHENOBARBITAL 20 MG/5 ML (4 MG/ML) ORAL ELIXIR,,3028,LOCAL,Facility,Outpatient,473 mL,mL,,406,345.1,116.3596,406,"Health Partners, Inc.",Medicare Advantage,198.94,49,,percent of total billed charges,,
PHENOBARBITAL 20 MG/5 ML (4 MG/ML) ORAL ELIXIR,,3028,LOCAL,Facility,Inpatient,473 mL,mL,,406,345.1,116.3596,406,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PHENOBARBITAL 20 MG/5 ML (4 MG/ML) ORAL ELIXIR,,3028,LOCAL,Facility,Both,473 mL,mL,,406,345.1,116.3596,406,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),243.6,60,,percent of total billed charges,,
PHENOBARBITAL 20 MG/5 ML (4 MG/ML) ORAL ELIXIR,,3028,LOCAL,Facility,Both,473 mL,mL,,406,345.1,116.3596,406,"Health Partners, Inc.",State of Minnesota Advantage Program,330.89,81.5,,percent of total billed charges,,
PHENOBARBITAL 20 MG/5 ML (4 MG/ML) ORAL ELIXIR,,3028,LOCAL,Facility,Both,473 mL,mL,,406,345.1,116.3596,406,"Health Partners, Inc.",State Public Programs,203,50,,percent of total billed charges,,
PHENOBARBITAL 20 MG/5 ML (4 MG/ML) ORAL ELIXIR,,3028,LOCAL,Facility,Both,473 mL,mL,,406,345.1,116.3596,406,Humana Insurance Company,Commercial PPO,385.7,95,,percent of total billed charges,,
PHENOBARBITAL 20 MG/5 ML (4 MG/ML) ORAL ELIXIR,,3028,LOCAL,Facility,Outpatient,473 mL,mL,,406,345.1,116.3596,406,Humana Insurance Company,Medicare PPO,198.94,49,,percent of total billed charges,,
PHENOBARBITAL 20 MG/5 ML (4 MG/ML) ORAL ELIXIR,,3028,LOCAL,Facility,Inpatient,473 mL,mL,,406,345.1,116.3596,406,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
PHENOBARBITAL 20 MG/5 ML (4 MG/ML) ORAL ELIXIR,,3028,LOCAL,Facility,Both,473 mL,mL,,406,345.1,116.3596,406,Medica,Individual & Family,402.346,99.1,,percent of total billed charges,,
PHENOBARBITAL 20 MG/5 ML (4 MG/ML) ORAL ELIXIR,,3028,LOCAL,Facility,Outpatient,473 mL,mL,,406,345.1,116.3596,406,Medica,Medica Advantage Solution,202.188,49.8,,percent of total billed charges,,
PHENOBARBITAL 20 MG/5 ML (4 MG/ML) ORAL ELIXIR,,3028,LOCAL,Facility,Inpatient,473 mL,mL,,406,345.1,116.3596,406,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
PHENOBARBITAL 20 MG/5 ML (4 MG/ML) ORAL ELIXIR,,3028,LOCAL,Facility,Outpatient,473 mL,mL,,406,345.1,116.3596,406,Medica,Medical Assistance,181.076,44.6,,percent of total billed charges,,
PHENOBARBITAL 20 MG/5 ML (4 MG/ML) ORAL ELIXIR,,3028,LOCAL,Facility,Inpatient,473 mL,mL,,406,345.1,116.3596,406,Medica,Medical Assistance,,,,,Included in per diem rate,
PHENOBARBITAL 20 MG/5 ML (4 MG/ML) ORAL ELIXIR,,3028,LOCAL,Facility,Outpatient,473 mL,mL,,406,345.1,116.3596,406,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,202.188,49.8,,percent of total billed charges,,
PHENOBARBITAL 20 MG/5 ML (4 MG/ML) ORAL ELIXIR,,3028,LOCAL,Facility,Inpatient,473 mL,mL,,406,345.1,116.3596,406,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
PHENOBARBITAL 20 MG/5 ML (4 MG/ML) ORAL ELIXIR,,3028,LOCAL,Facility,Both,473 mL,mL,,406,345.1,116.3596,406,"Multiplan, Inc.","Multiplan, Inc.",381.64,94,,percent of total billed charges,,
PHENOBARBITAL 20 MG/5 ML (4 MG/ML) ORAL ELIXIR,,3028,LOCAL,Facility,Outpatient,473 mL,mL,,406,345.1,116.3596,406,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,365.806,90.1,,percent of total billed charges,,
PHENOBARBITAL 20 MG/5 ML (4 MG/ML) ORAL ELIXIR,,3028,LOCAL,Facility,Inpatient,473 mL,mL,,406,345.1,116.3596,406,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
PHENOBARBITAL 20 MG/5 ML (4 MG/ML) ORAL ELIXIR,,3028,LOCAL,Facility,Both,473 mL,mL,,406,345.1,116.3596,406,"Preferred One Administrative Services, INC.",PPO,400.316,98.6,,percent of total billed charges,,
PHENOBARBITAL 20 MG/5 ML (4 MG/ML) ORAL ELIXIR,,3028,LOCAL,Facility,Outpatient,473 mL,mL,,406,345.1,116.3596,406,PrimeWest Health,Minnesota Senior Health Options (MSHO),208.887,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
PHENOBARBITAL 20 MG/5 ML (4 MG/ML) ORAL ELIXIR,,3028,LOCAL,Facility,Inpatient,473 mL,mL,,406,345.1,116.3596,406,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PHENOBARBITAL 20 MG/5 ML (4 MG/ML) ORAL ELIXIR,,3028,LOCAL,Facility,Outpatient,473 mL,mL,,406,345.1,116.3596,406,PrimeWest Health,MinnesotaCare,208.5216,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
PHENOBARBITAL 20 MG/5 ML (4 MG/ML) ORAL ELIXIR,,3028,LOCAL,Facility,Inpatient,473 mL,mL,,406,345.1,116.3596,406,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
PHENOBARBITAL 20 MG/5 ML (4 MG/ML) ORAL ELIXIR,,3028,LOCAL,Facility,Both,473 mL,mL,,406,345.1,116.3596,406,Sanford Health Plan,Sanford Health Plan,373.52,92,,percent of total billed charges,,
PHENOBARBITAL 20 MG/5 ML (4 MG/ML) ORAL ELIXIR,,3028,LOCAL,Facility,Outpatient,473 mL,mL,,406,345.1,116.3596,406,"UCare Health, Inc.",Individual & Family Plan,228.781,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
PHENOBARBITAL 20 MG/5 ML (4 MG/ML) ORAL ELIXIR,,3028,LOCAL,Facility,Inpatient,473 mL,mL,,406,345.1,116.3596,406,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
PHENOBARBITAL 20 MG/5 ML (4 MG/ML) ORAL ELIXIR,,3028,LOCAL,Facility,Outpatient,473 mL,mL,,406,345.1,116.3596,406,"UCare Health, Inc.",Medical Assistance,204.9082,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PHENOBARBITAL 20 MG/5 ML (4 MG/ML) ORAL ELIXIR,,3028,LOCAL,Facility,Inpatient,473 mL,mL,,406,345.1,116.3596,406,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
PHENOBARBITAL 20 MG/5 ML (4 MG/ML) ORAL ELIXIR,,3028,LOCAL,Facility,Outpatient,473 mL,mL,,406,345.1,116.3596,406,"UCare Health, Inc.",Medicare Advantage,204.9082,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PHENOBARBITAL 20 MG/5 ML (4 MG/ML) ORAL ELIXIR,,3028,LOCAL,Facility,Inpatient,473 mL,mL,,406,345.1,116.3596,406,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PHENOBARBITAL 20 MG/5 ML (4 MG/ML) ORAL ELIXIR,,3028,LOCAL,Facility,Outpatient,473 mL,mL,,406,345.1,116.3596,406,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),204.9082,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PHENOBARBITAL 20 MG/5 ML (4 MG/ML) ORAL ELIXIR,,3028,LOCAL,Facility,Inpatient,473 mL,mL,,406,345.1,116.3596,406,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PHENOBARBITAL 20 MG/5 ML (4 MG/ML) ORAL ELIXIR,,3028,LOCAL,Facility,Both,473 mL,mL,,406,345.1,116.3596,406,UnitedHealthcare,Individual & Family,381.64,94,,percent of total billed charges,,
PHENOBARBITAL 20 MG/5 ML (4 MG/ML) ORAL ELIXIR,,3028,LOCAL,Facility,Outpatient,473 mL,mL,,406,345.1,116.3596,406,UnitedHealthcare,Medicare Advantage,198.94,49,,percent of total billed charges,,
PHENOBARBITAL 20 MG/5 ML (4 MG/ML) ORAL ELIXIR,,3028,LOCAL,Facility,Inpatient,473 mL,mL,,406,345.1,116.3596,406,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
PHENOBARBITAL 20 MG/5 ML (4 MG/ML) ORAL ELIXIR,,3028,LOCAL,Facility,Outpatient,473 mL,mL,,406,345.1,116.3596,406,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,194.88,48,,percent of total billed charges,,100% of DHS outpatient percentage
PHENOBARBITAL 20 MG/5 ML (4 MG/ML) ORAL ELIXIR,,3028,LOCAL,Facility,Inpatient,473 mL,mL,,406,345.1,116.3596,406,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
HYDROGEN PEROXIDE 3 % MISC SOLN,,3495,LOCAL,Facility,Both,473 mL,mL,,10,8.5,2.866,10,Aetna,Commercial,9.2,92,,percent of total billed charges,,
HYDROGEN PEROXIDE 3 % MISC SOLN,,3495,LOCAL,Facility,Outpatient,473 mL,mL,,10,8.5,2.866,10,Aetna,Medicare Advantage,4.9,49,,percent of total billed charges,,
HYDROGEN PEROXIDE 3 % MISC SOLN,,3495,LOCAL,Facility,Inpatient,473 mL,mL,,10,8.5,2.866,10,Aetna,Medicare Advantage,,,,,Included in per diem rate,
HYDROGEN PEROXIDE 3 % MISC SOLN,,3495,LOCAL,Facility,Both,473 mL,mL,,10,8.5,2.866,10,Aetna,PPO,9.3,93,,percent of total billed charges,,
HYDROGEN PEROXIDE 3 % MISC SOLN,,3495,LOCAL,Facility,Both,473 mL,mL,,10,8.5,2.866,10,America's PPO,America's PPO,9.603,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
HYDROGEN PEROXIDE 3 % MISC SOLN,,3495,LOCAL,Facility,Both,473 mL,mL,,10,8.5,2.866,10,BlueCross BlueShield Minnesota, Federal Employee Program,9.84,98.4,,percent of total billed charges,,
HYDROGEN PEROXIDE 3 % MISC SOLN,,3495,LOCAL,Facility,Both,473 mL,mL,,10,8.5,2.866,10,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,10,100,,percent of total billed charges,,
HYDROGEN PEROXIDE 3 % MISC SOLN,,3495,LOCAL,Facility,Both,473 mL,mL,,10,8.5,2.866,10,BlueCross BlueShield Minnesota,High Value Network Plan,9,90,,percent of total billed charges,,
HYDROGEN PEROXIDE 3 % MISC SOLN,,3495,LOCAL,Facility,Outpatient,473 mL,mL,,10,8.5,2.866,10,BlueCross BlueShield Minnesota,Medicare Advantage,4.9,49,,percent of total billed charges,,
HYDROGEN PEROXIDE 3 % MISC SOLN,,3495,LOCAL,Facility,Inpatient,473 mL,mL,,10,8.5,2.866,10,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
HYDROGEN PEROXIDE 3 % MISC SOLN,,3495,LOCAL,Facility,Both,473 mL,mL,,10,8.5,2.866,10,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,8.857,88.57,,percent of total billed charges,,
HYDROGEN PEROXIDE 3 % MISC SOLN,,3495,LOCAL,Facility,Both,473 mL,mL,,10,8.5,2.866,10,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,2.866,28.66,,percent of total billed charges,,
HYDROGEN PEROXIDE 3 % MISC SOLN,,3495,LOCAL,Facility,Outpatient,473 mL,mL,,10,8.5,2.866,10,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),4.9,49,,percent of total billed charges,,
HYDROGEN PEROXIDE 3 % MISC SOLN,,3495,LOCAL,Facility,Inpatient,473 mL,mL,,10,8.5,2.866,10,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
HYDROGEN PEROXIDE 3 % MISC SOLN,,3495,LOCAL,Facility,Both,473 mL,mL,,10,8.5,2.866,10,CorVel,Worker's Compensation,10,100,,percent of total billed charges,,
HYDROGEN PEROXIDE 3 % MISC SOLN,,3495,LOCAL,Facility,Both,473 mL,mL,,10,8.5,2.866,10,First Health Group Corporation,First Health Network,9.7,97,,percent of total billed charges,,
HYDROGEN PEROXIDE 3 % MISC SOLN,,3495,LOCAL,Facility,Both,473 mL,mL,,10,8.5,2.866,10,"Health Partners, Inc.",Commercial,9.46,94.6,,percent of total billed charges,,
HYDROGEN PEROXIDE 3 % MISC SOLN,,3495,LOCAL,Facility,Outpatient,473 mL,mL,,10,8.5,2.866,10,"Health Partners, Inc.",Medicare Advantage,4.9,49,,percent of total billed charges,,
HYDROGEN PEROXIDE 3 % MISC SOLN,,3495,LOCAL,Facility,Inpatient,473 mL,mL,,10,8.5,2.866,10,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
HYDROGEN PEROXIDE 3 % MISC SOLN,,3495,LOCAL,Facility,Both,473 mL,mL,,10,8.5,2.866,10,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),6,60,,percent of total billed charges,,
HYDROGEN PEROXIDE 3 % MISC SOLN,,3495,LOCAL,Facility,Both,473 mL,mL,,10,8.5,2.866,10,"Health Partners, Inc.",State of Minnesota Advantage Program,8.15,81.5,,percent of total billed charges,,
HYDROGEN PEROXIDE 3 % MISC SOLN,,3495,LOCAL,Facility,Both,473 mL,mL,,10,8.5,2.866,10,"Health Partners, Inc.",State Public Programs,5,50,,percent of total billed charges,,
HYDROGEN PEROXIDE 3 % MISC SOLN,,3495,LOCAL,Facility,Both,473 mL,mL,,10,8.5,2.866,10,Humana Insurance Company,Commercial PPO,9.5,95,,percent of total billed charges,,
HYDROGEN PEROXIDE 3 % MISC SOLN,,3495,LOCAL,Facility,Outpatient,473 mL,mL,,10,8.5,2.866,10,Humana Insurance Company,Medicare PPO,4.9,49,,percent of total billed charges,,
HYDROGEN PEROXIDE 3 % MISC SOLN,,3495,LOCAL,Facility,Inpatient,473 mL,mL,,10,8.5,2.866,10,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
HYDROGEN PEROXIDE 3 % MISC SOLN,,3495,LOCAL,Facility,Both,473 mL,mL,,10,8.5,2.866,10,Medica,Individual & Family,9.91,99.1,,percent of total billed charges,,
HYDROGEN PEROXIDE 3 % MISC SOLN,,3495,LOCAL,Facility,Outpatient,473 mL,mL,,10,8.5,2.866,10,Medica,Medica Advantage Solution,4.98,49.8,,percent of total billed charges,,
HYDROGEN PEROXIDE 3 % MISC SOLN,,3495,LOCAL,Facility,Inpatient,473 mL,mL,,10,8.5,2.866,10,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
HYDROGEN PEROXIDE 3 % MISC SOLN,,3495,LOCAL,Facility,Outpatient,473 mL,mL,,10,8.5,2.866,10,Medica,Medical Assistance,4.46,44.6,,percent of total billed charges,,
HYDROGEN PEROXIDE 3 % MISC SOLN,,3495,LOCAL,Facility,Inpatient,473 mL,mL,,10,8.5,2.866,10,Medica,Medical Assistance,,,,,Included in per diem rate,
HYDROGEN PEROXIDE 3 % MISC SOLN,,3495,LOCAL,Facility,Outpatient,473 mL,mL,,10,8.5,2.866,10,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,4.98,49.8,,percent of total billed charges,,
HYDROGEN PEROXIDE 3 % MISC SOLN,,3495,LOCAL,Facility,Inpatient,473 mL,mL,,10,8.5,2.866,10,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
HYDROGEN PEROXIDE 3 % MISC SOLN,,3495,LOCAL,Facility,Both,473 mL,mL,,10,8.5,2.866,10,"Multiplan, Inc.","Multiplan, Inc.",9.4,94,,percent of total billed charges,,
HYDROGEN PEROXIDE 3 % MISC SOLN,,3495,LOCAL,Facility,Outpatient,473 mL,mL,,10,8.5,2.866,10,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,9.01,90.1,,percent of total billed charges,,
HYDROGEN PEROXIDE 3 % MISC SOLN,,3495,LOCAL,Facility,Inpatient,473 mL,mL,,10,8.5,2.866,10,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
HYDROGEN PEROXIDE 3 % MISC SOLN,,3495,LOCAL,Facility,Both,473 mL,mL,,10,8.5,2.866,10,"Preferred One Administrative Services, INC.",PPO,9.86,98.6,,percent of total billed charges,,
HYDROGEN PEROXIDE 3 % MISC SOLN,,3495,LOCAL,Facility,Outpatient,473 mL,mL,,10,8.5,2.866,10,PrimeWest Health,Minnesota Senior Health Options (MSHO),5.145,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
HYDROGEN PEROXIDE 3 % MISC SOLN,,3495,LOCAL,Facility,Inpatient,473 mL,mL,,10,8.5,2.866,10,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
HYDROGEN PEROXIDE 3 % MISC SOLN,,3495,LOCAL,Facility,Outpatient,473 mL,mL,,10,8.5,2.866,10,PrimeWest Health,MinnesotaCare,5.136,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
HYDROGEN PEROXIDE 3 % MISC SOLN,,3495,LOCAL,Facility,Inpatient,473 mL,mL,,10,8.5,2.866,10,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
HYDROGEN PEROXIDE 3 % MISC SOLN,,3495,LOCAL,Facility,Both,473 mL,mL,,10,8.5,2.866,10,Sanford Health Plan,Sanford Health Plan,9.2,92,,percent of total billed charges,,
HYDROGEN PEROXIDE 3 % MISC SOLN,,3495,LOCAL,Facility,Outpatient,473 mL,mL,,10,8.5,2.866,10,"UCare Health, Inc.",Individual & Family Plan,5.635,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
HYDROGEN PEROXIDE 3 % MISC SOLN,,3495,LOCAL,Facility,Inpatient,473 mL,mL,,10,8.5,2.866,10,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
HYDROGEN PEROXIDE 3 % MISC SOLN,,3495,LOCAL,Facility,Outpatient,473 mL,mL,,10,8.5,2.866,10,"UCare Health, Inc.",Medical Assistance,5.047,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
HYDROGEN PEROXIDE 3 % MISC SOLN,,3495,LOCAL,Facility,Inpatient,473 mL,mL,,10,8.5,2.866,10,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
HYDROGEN PEROXIDE 3 % MISC SOLN,,3495,LOCAL,Facility,Outpatient,473 mL,mL,,10,8.5,2.866,10,"UCare Health, Inc.",Medicare Advantage,5.047,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
HYDROGEN PEROXIDE 3 % MISC SOLN,,3495,LOCAL,Facility,Inpatient,473 mL,mL,,10,8.5,2.866,10,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
HYDROGEN PEROXIDE 3 % MISC SOLN,,3495,LOCAL,Facility,Outpatient,473 mL,mL,,10,8.5,2.866,10,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),5.047,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
HYDROGEN PEROXIDE 3 % MISC SOLN,,3495,LOCAL,Facility,Inpatient,473 mL,mL,,10,8.5,2.866,10,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
HYDROGEN PEROXIDE 3 % MISC SOLN,,3495,LOCAL,Facility,Both,473 mL,mL,,10,8.5,2.866,10,UnitedHealthcare,Individual & Family,9.4,94,,percent of total billed charges,,
HYDROGEN PEROXIDE 3 % MISC SOLN,,3495,LOCAL,Facility,Outpatient,473 mL,mL,,10,8.5,2.866,10,UnitedHealthcare,Medicare Advantage,4.9,49,,percent of total billed charges,,
HYDROGEN PEROXIDE 3 % MISC SOLN,,3495,LOCAL,Facility,Inpatient,473 mL,mL,,10,8.5,2.866,10,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
HYDROGEN PEROXIDE 3 % MISC SOLN,,3495,LOCAL,Facility,Outpatient,473 mL,mL,,10,8.5,2.866,10,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,4.8,48,,percent of total billed charges,,100% of DHS outpatient percentage
HYDROGEN PEROXIDE 3 % MISC SOLN,,3495,LOCAL,Facility,Inpatient,473 mL,mL,,10,8.5,2.866,10,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
ACETAMINOPHEN-CODEINE 120-12 MG/5 ML ORAL SOLN,,3522,LOCAL,Facility,Both,473 mL,mL,,87,73.95,24.9342,87,Aetna,Commercial,80.04,92,,percent of total billed charges,,
ACETAMINOPHEN-CODEINE 120-12 MG/5 ML ORAL SOLN,,3522,LOCAL,Facility,Outpatient,473 mL,mL,,87,73.95,24.9342,87,Aetna,Medicare Advantage,42.63,49,,percent of total billed charges,,
ACETAMINOPHEN-CODEINE 120-12 MG/5 ML ORAL SOLN,,3522,LOCAL,Facility,Inpatient,473 mL,mL,,87,73.95,24.9342,87,Aetna,Medicare Advantage,,,,,Included in per diem rate,
ACETAMINOPHEN-CODEINE 120-12 MG/5 ML ORAL SOLN,,3522,LOCAL,Facility,Both,473 mL,mL,,87,73.95,24.9342,87,Aetna,PPO,80.91,93,,percent of total billed charges,,
ACETAMINOPHEN-CODEINE 120-12 MG/5 ML ORAL SOLN,,3522,LOCAL,Facility,Both,473 mL,mL,,87,73.95,24.9342,87,America's PPO,America's PPO,83.5461,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
ACETAMINOPHEN-CODEINE 120-12 MG/5 ML ORAL SOLN,,3522,LOCAL,Facility,Both,473 mL,mL,,87,73.95,24.9342,87,BlueCross BlueShield Minnesota, Federal Employee Program,85.608,98.4,,percent of total billed charges,,
ACETAMINOPHEN-CODEINE 120-12 MG/5 ML ORAL SOLN,,3522,LOCAL,Facility,Both,473 mL,mL,,87,73.95,24.9342,87,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,87,100,,percent of total billed charges,,
ACETAMINOPHEN-CODEINE 120-12 MG/5 ML ORAL SOLN,,3522,LOCAL,Facility,Both,473 mL,mL,,87,73.95,24.9342,87,BlueCross BlueShield Minnesota,High Value Network Plan,78.3,90,,percent of total billed charges,,
ACETAMINOPHEN-CODEINE 120-12 MG/5 ML ORAL SOLN,,3522,LOCAL,Facility,Outpatient,473 mL,mL,,87,73.95,24.9342,87,BlueCross BlueShield Minnesota,Medicare Advantage,42.63,49,,percent of total billed charges,,
ACETAMINOPHEN-CODEINE 120-12 MG/5 ML ORAL SOLN,,3522,LOCAL,Facility,Inpatient,473 mL,mL,,87,73.95,24.9342,87,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
ACETAMINOPHEN-CODEINE 120-12 MG/5 ML ORAL SOLN,,3522,LOCAL,Facility,Both,473 mL,mL,,87,73.95,24.9342,87,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,77.0559,88.57,,percent of total billed charges,,
ACETAMINOPHEN-CODEINE 120-12 MG/5 ML ORAL SOLN,,3522,LOCAL,Facility,Both,473 mL,mL,,87,73.95,24.9342,87,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,24.9342,28.66,,percent of total billed charges,,
ACETAMINOPHEN-CODEINE 120-12 MG/5 ML ORAL SOLN,,3522,LOCAL,Facility,Outpatient,473 mL,mL,,87,73.95,24.9342,87,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),42.63,49,,percent of total billed charges,,
ACETAMINOPHEN-CODEINE 120-12 MG/5 ML ORAL SOLN,,3522,LOCAL,Facility,Inpatient,473 mL,mL,,87,73.95,24.9342,87,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
ACETAMINOPHEN-CODEINE 120-12 MG/5 ML ORAL SOLN,,3522,LOCAL,Facility,Both,473 mL,mL,,87,73.95,24.9342,87,CorVel,Worker's Compensation,87,100,,percent of total billed charges,,
ACETAMINOPHEN-CODEINE 120-12 MG/5 ML ORAL SOLN,,3522,LOCAL,Facility,Both,473 mL,mL,,87,73.95,24.9342,87,First Health Group Corporation,First Health Network,84.39,97,,percent of total billed charges,,
ACETAMINOPHEN-CODEINE 120-12 MG/5 ML ORAL SOLN,,3522,LOCAL,Facility,Both,473 mL,mL,,87,73.95,24.9342,87,"Health Partners, Inc.",Commercial,82.302,94.6,,percent of total billed charges,,
ACETAMINOPHEN-CODEINE 120-12 MG/5 ML ORAL SOLN,,3522,LOCAL,Facility,Outpatient,473 mL,mL,,87,73.95,24.9342,87,"Health Partners, Inc.",Medicare Advantage,42.63,49,,percent of total billed charges,,
ACETAMINOPHEN-CODEINE 120-12 MG/5 ML ORAL SOLN,,3522,LOCAL,Facility,Inpatient,473 mL,mL,,87,73.95,24.9342,87,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ACETAMINOPHEN-CODEINE 120-12 MG/5 ML ORAL SOLN,,3522,LOCAL,Facility,Both,473 mL,mL,,87,73.95,24.9342,87,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),52.2,60,,percent of total billed charges,,
ACETAMINOPHEN-CODEINE 120-12 MG/5 ML ORAL SOLN,,3522,LOCAL,Facility,Both,473 mL,mL,,87,73.95,24.9342,87,"Health Partners, Inc.",State of Minnesota Advantage Program,70.905,81.5,,percent of total billed charges,,
ACETAMINOPHEN-CODEINE 120-12 MG/5 ML ORAL SOLN,,3522,LOCAL,Facility,Both,473 mL,mL,,87,73.95,24.9342,87,"Health Partners, Inc.",State Public Programs,43.5,50,,percent of total billed charges,,
ACETAMINOPHEN-CODEINE 120-12 MG/5 ML ORAL SOLN,,3522,LOCAL,Facility,Both,473 mL,mL,,87,73.95,24.9342,87,Humana Insurance Company,Commercial PPO,82.65,95,,percent of total billed charges,,
ACETAMINOPHEN-CODEINE 120-12 MG/5 ML ORAL SOLN,,3522,LOCAL,Facility,Outpatient,473 mL,mL,,87,73.95,24.9342,87,Humana Insurance Company,Medicare PPO,42.63,49,,percent of total billed charges,,
ACETAMINOPHEN-CODEINE 120-12 MG/5 ML ORAL SOLN,,3522,LOCAL,Facility,Inpatient,473 mL,mL,,87,73.95,24.9342,87,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
ACETAMINOPHEN-CODEINE 120-12 MG/5 ML ORAL SOLN,,3522,LOCAL,Facility,Both,473 mL,mL,,87,73.95,24.9342,87,Medica,Individual & Family,86.217,99.1,,percent of total billed charges,,
ACETAMINOPHEN-CODEINE 120-12 MG/5 ML ORAL SOLN,,3522,LOCAL,Facility,Outpatient,473 mL,mL,,87,73.95,24.9342,87,Medica,Medica Advantage Solution,43.326,49.8,,percent of total billed charges,,
ACETAMINOPHEN-CODEINE 120-12 MG/5 ML ORAL SOLN,,3522,LOCAL,Facility,Inpatient,473 mL,mL,,87,73.95,24.9342,87,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
ACETAMINOPHEN-CODEINE 120-12 MG/5 ML ORAL SOLN,,3522,LOCAL,Facility,Outpatient,473 mL,mL,,87,73.95,24.9342,87,Medica,Medical Assistance,38.802,44.6,,percent of total billed charges,,
ACETAMINOPHEN-CODEINE 120-12 MG/5 ML ORAL SOLN,,3522,LOCAL,Facility,Inpatient,473 mL,mL,,87,73.95,24.9342,87,Medica,Medical Assistance,,,,,Included in per diem rate,
ACETAMINOPHEN-CODEINE 120-12 MG/5 ML ORAL SOLN,,3522,LOCAL,Facility,Outpatient,473 mL,mL,,87,73.95,24.9342,87,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,43.326,49.8,,percent of total billed charges,,
ACETAMINOPHEN-CODEINE 120-12 MG/5 ML ORAL SOLN,,3522,LOCAL,Facility,Inpatient,473 mL,mL,,87,73.95,24.9342,87,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
ACETAMINOPHEN-CODEINE 120-12 MG/5 ML ORAL SOLN,,3522,LOCAL,Facility,Both,473 mL,mL,,87,73.95,24.9342,87,"Multiplan, Inc.","Multiplan, Inc.",81.78,94,,percent of total billed charges,,
ACETAMINOPHEN-CODEINE 120-12 MG/5 ML ORAL SOLN,,3522,LOCAL,Facility,Outpatient,473 mL,mL,,87,73.95,24.9342,87,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,78.387,90.1,,percent of total billed charges,,
ACETAMINOPHEN-CODEINE 120-12 MG/5 ML ORAL SOLN,,3522,LOCAL,Facility,Inpatient,473 mL,mL,,87,73.95,24.9342,87,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
ACETAMINOPHEN-CODEINE 120-12 MG/5 ML ORAL SOLN,,3522,LOCAL,Facility,Both,473 mL,mL,,87,73.95,24.9342,87,"Preferred One Administrative Services, INC.",PPO,85.782,98.6,,percent of total billed charges,,
ACETAMINOPHEN-CODEINE 120-12 MG/5 ML ORAL SOLN,,3522,LOCAL,Facility,Outpatient,473 mL,mL,,87,73.95,24.9342,87,PrimeWest Health,Minnesota Senior Health Options (MSHO),44.7615,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
ACETAMINOPHEN-CODEINE 120-12 MG/5 ML ORAL SOLN,,3522,LOCAL,Facility,Inpatient,473 mL,mL,,87,73.95,24.9342,87,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ACETAMINOPHEN-CODEINE 120-12 MG/5 ML ORAL SOLN,,3522,LOCAL,Facility,Outpatient,473 mL,mL,,87,73.95,24.9342,87,PrimeWest Health,MinnesotaCare,44.6832,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
ACETAMINOPHEN-CODEINE 120-12 MG/5 ML ORAL SOLN,,3522,LOCAL,Facility,Inpatient,473 mL,mL,,87,73.95,24.9342,87,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
ACETAMINOPHEN-CODEINE 120-12 MG/5 ML ORAL SOLN,,3522,LOCAL,Facility,Both,473 mL,mL,,87,73.95,24.9342,87,Sanford Health Plan,Sanford Health Plan,80.04,92,,percent of total billed charges,,
ACETAMINOPHEN-CODEINE 120-12 MG/5 ML ORAL SOLN,,3522,LOCAL,Facility,Outpatient,473 mL,mL,,87,73.95,24.9342,87,"UCare Health, Inc.",Individual & Family Plan,49.0245,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
ACETAMINOPHEN-CODEINE 120-12 MG/5 ML ORAL SOLN,,3522,LOCAL,Facility,Inpatient,473 mL,mL,,87,73.95,24.9342,87,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
ACETAMINOPHEN-CODEINE 120-12 MG/5 ML ORAL SOLN,,3522,LOCAL,Facility,Outpatient,473 mL,mL,,87,73.95,24.9342,87,"UCare Health, Inc.",Medical Assistance,43.9089,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ACETAMINOPHEN-CODEINE 120-12 MG/5 ML ORAL SOLN,,3522,LOCAL,Facility,Inpatient,473 mL,mL,,87,73.95,24.9342,87,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
ACETAMINOPHEN-CODEINE 120-12 MG/5 ML ORAL SOLN,,3522,LOCAL,Facility,Outpatient,473 mL,mL,,87,73.95,24.9342,87,"UCare Health, Inc.",Medicare Advantage,43.9089,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ACETAMINOPHEN-CODEINE 120-12 MG/5 ML ORAL SOLN,,3522,LOCAL,Facility,Inpatient,473 mL,mL,,87,73.95,24.9342,87,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ACETAMINOPHEN-CODEINE 120-12 MG/5 ML ORAL SOLN,,3522,LOCAL,Facility,Outpatient,473 mL,mL,,87,73.95,24.9342,87,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),43.9089,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ACETAMINOPHEN-CODEINE 120-12 MG/5 ML ORAL SOLN,,3522,LOCAL,Facility,Inpatient,473 mL,mL,,87,73.95,24.9342,87,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ACETAMINOPHEN-CODEINE 120-12 MG/5 ML ORAL SOLN,,3522,LOCAL,Facility,Both,473 mL,mL,,87,73.95,24.9342,87,UnitedHealthcare,Individual & Family,81.78,94,,percent of total billed charges,,
ACETAMINOPHEN-CODEINE 120-12 MG/5 ML ORAL SOLN,,3522,LOCAL,Facility,Outpatient,473 mL,mL,,87,73.95,24.9342,87,UnitedHealthcare,Medicare Advantage,42.63,49,,percent of total billed charges,,
ACETAMINOPHEN-CODEINE 120-12 MG/5 ML ORAL SOLN,,3522,LOCAL,Facility,Inpatient,473 mL,mL,,87,73.95,24.9342,87,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
ACETAMINOPHEN-CODEINE 120-12 MG/5 ML ORAL SOLN,,3522,LOCAL,Facility,Outpatient,473 mL,mL,,87,73.95,24.9342,87,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,41.76,48,,percent of total billed charges,,100% of DHS outpatient percentage
ACETAMINOPHEN-CODEINE 120-12 MG/5 ML ORAL SOLN,,3522,LOCAL,Facility,Inpatient,473 mL,mL,,87,73.95,24.9342,87,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
SODIUM CITRATE-CITRIC ACID 500-334 MG/5 ML ORAL SOLN,,11239,LOCAL,Facility,Both,473 mL,mL,,194,164.9,55.6004,194,Aetna,Commercial,178.48,92,,percent of total billed charges,,
SODIUM CITRATE-CITRIC ACID 500-334 MG/5 ML ORAL SOLN,,11239,LOCAL,Facility,Outpatient,473 mL,mL,,194,164.9,55.6004,194,Aetna,Medicare Advantage,95.06,49,,percent of total billed charges,,
SODIUM CITRATE-CITRIC ACID 500-334 MG/5 ML ORAL SOLN,,11239,LOCAL,Facility,Inpatient,473 mL,mL,,194,164.9,55.6004,194,Aetna,Medicare Advantage,,,,,Included in per diem rate,
SODIUM CITRATE-CITRIC ACID 500-334 MG/5 ML ORAL SOLN,,11239,LOCAL,Facility,Both,473 mL,mL,,194,164.9,55.6004,194,Aetna,PPO,180.42,93,,percent of total billed charges,,
SODIUM CITRATE-CITRIC ACID 500-334 MG/5 ML ORAL SOLN,,11239,LOCAL,Facility,Both,473 mL,mL,,194,164.9,55.6004,194,America's PPO,America's PPO,186.2982,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SODIUM CITRATE-CITRIC ACID 500-334 MG/5 ML ORAL SOLN,,11239,LOCAL,Facility,Both,473 mL,mL,,194,164.9,55.6004,194,BlueCross BlueShield Minnesota, Federal Employee Program,190.896,98.4,,percent of total billed charges,,
SODIUM CITRATE-CITRIC ACID 500-334 MG/5 ML ORAL SOLN,,11239,LOCAL,Facility,Both,473 mL,mL,,194,164.9,55.6004,194,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,194,100,,percent of total billed charges,,
SODIUM CITRATE-CITRIC ACID 500-334 MG/5 ML ORAL SOLN,,11239,LOCAL,Facility,Both,473 mL,mL,,194,164.9,55.6004,194,BlueCross BlueShield Minnesota,High Value Network Plan,174.6,90,,percent of total billed charges,,
SODIUM CITRATE-CITRIC ACID 500-334 MG/5 ML ORAL SOLN,,11239,LOCAL,Facility,Outpatient,473 mL,mL,,194,164.9,55.6004,194,BlueCross BlueShield Minnesota,Medicare Advantage,95.06,49,,percent of total billed charges,,
SODIUM CITRATE-CITRIC ACID 500-334 MG/5 ML ORAL SOLN,,11239,LOCAL,Facility,Inpatient,473 mL,mL,,194,164.9,55.6004,194,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
SODIUM CITRATE-CITRIC ACID 500-334 MG/5 ML ORAL SOLN,,11239,LOCAL,Facility,Both,473 mL,mL,,194,164.9,55.6004,194,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,171.8258,88.57,,percent of total billed charges,,
SODIUM CITRATE-CITRIC ACID 500-334 MG/5 ML ORAL SOLN,,11239,LOCAL,Facility,Both,473 mL,mL,,194,164.9,55.6004,194,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,55.6004,28.66,,percent of total billed charges,,
SODIUM CITRATE-CITRIC ACID 500-334 MG/5 ML ORAL SOLN,,11239,LOCAL,Facility,Outpatient,473 mL,mL,,194,164.9,55.6004,194,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),95.06,49,,percent of total billed charges,,
SODIUM CITRATE-CITRIC ACID 500-334 MG/5 ML ORAL SOLN,,11239,LOCAL,Facility,Inpatient,473 mL,mL,,194,164.9,55.6004,194,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
SODIUM CITRATE-CITRIC ACID 500-334 MG/5 ML ORAL SOLN,,11239,LOCAL,Facility,Both,473 mL,mL,,194,164.9,55.6004,194,CorVel,Worker's Compensation,194,100,,percent of total billed charges,,
SODIUM CITRATE-CITRIC ACID 500-334 MG/5 ML ORAL SOLN,,11239,LOCAL,Facility,Both,473 mL,mL,,194,164.9,55.6004,194,First Health Group Corporation,First Health Network,188.18,97,,percent of total billed charges,,
SODIUM CITRATE-CITRIC ACID 500-334 MG/5 ML ORAL SOLN,,11239,LOCAL,Facility,Both,473 mL,mL,,194,164.9,55.6004,194,"Health Partners, Inc.",Commercial,183.524,94.6,,percent of total billed charges,,
SODIUM CITRATE-CITRIC ACID 500-334 MG/5 ML ORAL SOLN,,11239,LOCAL,Facility,Outpatient,473 mL,mL,,194,164.9,55.6004,194,"Health Partners, Inc.",Medicare Advantage,95.06,49,,percent of total billed charges,,
SODIUM CITRATE-CITRIC ACID 500-334 MG/5 ML ORAL SOLN,,11239,LOCAL,Facility,Inpatient,473 mL,mL,,194,164.9,55.6004,194,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SODIUM CITRATE-CITRIC ACID 500-334 MG/5 ML ORAL SOLN,,11239,LOCAL,Facility,Both,473 mL,mL,,194,164.9,55.6004,194,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),116.4,60,,percent of total billed charges,,
SODIUM CITRATE-CITRIC ACID 500-334 MG/5 ML ORAL SOLN,,11239,LOCAL,Facility,Both,473 mL,mL,,194,164.9,55.6004,194,"Health Partners, Inc.",State of Minnesota Advantage Program,158.11,81.5,,percent of total billed charges,,
SODIUM CITRATE-CITRIC ACID 500-334 MG/5 ML ORAL SOLN,,11239,LOCAL,Facility,Both,473 mL,mL,,194,164.9,55.6004,194,"Health Partners, Inc.",State Public Programs,97,50,,percent of total billed charges,,
SODIUM CITRATE-CITRIC ACID 500-334 MG/5 ML ORAL SOLN,,11239,LOCAL,Facility,Both,473 mL,mL,,194,164.9,55.6004,194,Humana Insurance Company,Commercial PPO,184.3,95,,percent of total billed charges,,
SODIUM CITRATE-CITRIC ACID 500-334 MG/5 ML ORAL SOLN,,11239,LOCAL,Facility,Outpatient,473 mL,mL,,194,164.9,55.6004,194,Humana Insurance Company,Medicare PPO,95.06,49,,percent of total billed charges,,
SODIUM CITRATE-CITRIC ACID 500-334 MG/5 ML ORAL SOLN,,11239,LOCAL,Facility,Inpatient,473 mL,mL,,194,164.9,55.6004,194,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
SODIUM CITRATE-CITRIC ACID 500-334 MG/5 ML ORAL SOLN,,11239,LOCAL,Facility,Both,473 mL,mL,,194,164.9,55.6004,194,Medica,Individual & Family,192.254,99.1,,percent of total billed charges,,
SODIUM CITRATE-CITRIC ACID 500-334 MG/5 ML ORAL SOLN,,11239,LOCAL,Facility,Outpatient,473 mL,mL,,194,164.9,55.6004,194,Medica,Medica Advantage Solution,96.612,49.8,,percent of total billed charges,,
SODIUM CITRATE-CITRIC ACID 500-334 MG/5 ML ORAL SOLN,,11239,LOCAL,Facility,Inpatient,473 mL,mL,,194,164.9,55.6004,194,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
SODIUM CITRATE-CITRIC ACID 500-334 MG/5 ML ORAL SOLN,,11239,LOCAL,Facility,Outpatient,473 mL,mL,,194,164.9,55.6004,194,Medica,Medical Assistance,86.524,44.6,,percent of total billed charges,,
SODIUM CITRATE-CITRIC ACID 500-334 MG/5 ML ORAL SOLN,,11239,LOCAL,Facility,Inpatient,473 mL,mL,,194,164.9,55.6004,194,Medica,Medical Assistance,,,,,Included in per diem rate,
SODIUM CITRATE-CITRIC ACID 500-334 MG/5 ML ORAL SOLN,,11239,LOCAL,Facility,Outpatient,473 mL,mL,,194,164.9,55.6004,194,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,96.612,49.8,,percent of total billed charges,,
SODIUM CITRATE-CITRIC ACID 500-334 MG/5 ML ORAL SOLN,,11239,LOCAL,Facility,Inpatient,473 mL,mL,,194,164.9,55.6004,194,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
SODIUM CITRATE-CITRIC ACID 500-334 MG/5 ML ORAL SOLN,,11239,LOCAL,Facility,Both,473 mL,mL,,194,164.9,55.6004,194,"Multiplan, Inc.","Multiplan, Inc.",182.36,94,,percent of total billed charges,,
SODIUM CITRATE-CITRIC ACID 500-334 MG/5 ML ORAL SOLN,,11239,LOCAL,Facility,Outpatient,473 mL,mL,,194,164.9,55.6004,194,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,174.794,90.1,,percent of total billed charges,,
SODIUM CITRATE-CITRIC ACID 500-334 MG/5 ML ORAL SOLN,,11239,LOCAL,Facility,Inpatient,473 mL,mL,,194,164.9,55.6004,194,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
SODIUM CITRATE-CITRIC ACID 500-334 MG/5 ML ORAL SOLN,,11239,LOCAL,Facility,Both,473 mL,mL,,194,164.9,55.6004,194,"Preferred One Administrative Services, INC.",PPO,191.284,98.6,,percent of total billed charges,,
SODIUM CITRATE-CITRIC ACID 500-334 MG/5 ML ORAL SOLN,,11239,LOCAL,Facility,Outpatient,473 mL,mL,,194,164.9,55.6004,194,PrimeWest Health,Minnesota Senior Health Options (MSHO),99.813,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
SODIUM CITRATE-CITRIC ACID 500-334 MG/5 ML ORAL SOLN,,11239,LOCAL,Facility,Inpatient,473 mL,mL,,194,164.9,55.6004,194,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SODIUM CITRATE-CITRIC ACID 500-334 MG/5 ML ORAL SOLN,,11239,LOCAL,Facility,Outpatient,473 mL,mL,,194,164.9,55.6004,194,PrimeWest Health,MinnesotaCare,99.6384,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
SODIUM CITRATE-CITRIC ACID 500-334 MG/5 ML ORAL SOLN,,11239,LOCAL,Facility,Inpatient,473 mL,mL,,194,164.9,55.6004,194,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
SODIUM CITRATE-CITRIC ACID 500-334 MG/5 ML ORAL SOLN,,11239,LOCAL,Facility,Both,473 mL,mL,,194,164.9,55.6004,194,Sanford Health Plan,Sanford Health Plan,178.48,92,,percent of total billed charges,,
SODIUM CITRATE-CITRIC ACID 500-334 MG/5 ML ORAL SOLN,,11239,LOCAL,Facility,Outpatient,473 mL,mL,,194,164.9,55.6004,194,"UCare Health, Inc.",Individual & Family Plan,109.319,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
SODIUM CITRATE-CITRIC ACID 500-334 MG/5 ML ORAL SOLN,,11239,LOCAL,Facility,Inpatient,473 mL,mL,,194,164.9,55.6004,194,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
SODIUM CITRATE-CITRIC ACID 500-334 MG/5 ML ORAL SOLN,,11239,LOCAL,Facility,Outpatient,473 mL,mL,,194,164.9,55.6004,194,"UCare Health, Inc.",Medical Assistance,97.9118,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SODIUM CITRATE-CITRIC ACID 500-334 MG/5 ML ORAL SOLN,,11239,LOCAL,Facility,Inpatient,473 mL,mL,,194,164.9,55.6004,194,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
SODIUM CITRATE-CITRIC ACID 500-334 MG/5 ML ORAL SOLN,,11239,LOCAL,Facility,Outpatient,473 mL,mL,,194,164.9,55.6004,194,"UCare Health, Inc.",Medicare Advantage,97.9118,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SODIUM CITRATE-CITRIC ACID 500-334 MG/5 ML ORAL SOLN,,11239,LOCAL,Facility,Inpatient,473 mL,mL,,194,164.9,55.6004,194,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SODIUM CITRATE-CITRIC ACID 500-334 MG/5 ML ORAL SOLN,,11239,LOCAL,Facility,Outpatient,473 mL,mL,,194,164.9,55.6004,194,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),97.9118,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SODIUM CITRATE-CITRIC ACID 500-334 MG/5 ML ORAL SOLN,,11239,LOCAL,Facility,Inpatient,473 mL,mL,,194,164.9,55.6004,194,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SODIUM CITRATE-CITRIC ACID 500-334 MG/5 ML ORAL SOLN,,11239,LOCAL,Facility,Both,473 mL,mL,,194,164.9,55.6004,194,UnitedHealthcare,Individual & Family,182.36,94,,percent of total billed charges,,
SODIUM CITRATE-CITRIC ACID 500-334 MG/5 ML ORAL SOLN,,11239,LOCAL,Facility,Outpatient,473 mL,mL,,194,164.9,55.6004,194,UnitedHealthcare,Medicare Advantage,95.06,49,,percent of total billed charges,,
SODIUM CITRATE-CITRIC ACID 500-334 MG/5 ML ORAL SOLN,,11239,LOCAL,Facility,Inpatient,473 mL,mL,,194,164.9,55.6004,194,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
SODIUM CITRATE-CITRIC ACID 500-334 MG/5 ML ORAL SOLN,,11239,LOCAL,Facility,Outpatient,473 mL,mL,,194,164.9,55.6004,194,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,93.12,48,,percent of total billed charges,,100% of DHS outpatient percentage
SODIUM CITRATE-CITRIC ACID 500-334 MG/5 ML ORAL SOLN,,11239,LOCAL,Facility,Inpatient,473 mL,mL,,194,164.9,55.6004,194,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
SULFAMETHOXAZOLE-TRIMETHOPRIM 200-40 MG/5 ML ORAL SUSP,,14715,LOCAL,Facility,Both,473 mL,mL,,840,714,240.744,840,Aetna,Commercial,772.8,92,,percent of total billed charges,,
SULFAMETHOXAZOLE-TRIMETHOPRIM 200-40 MG/5 ML ORAL SUSP,,14715,LOCAL,Facility,Outpatient,473 mL,mL,,840,714,240.744,840,Aetna,Medicare Advantage,411.6,49,,percent of total billed charges,,
SULFAMETHOXAZOLE-TRIMETHOPRIM 200-40 MG/5 ML ORAL SUSP,,14715,LOCAL,Facility,Inpatient,473 mL,mL,,840,714,240.744,840,Aetna,Medicare Advantage,,,,,Included in per diem rate,
SULFAMETHOXAZOLE-TRIMETHOPRIM 200-40 MG/5 ML ORAL SUSP,,14715,LOCAL,Facility,Both,473 mL,mL,,840,714,240.744,840,Aetna,PPO,781.2,93,,percent of total billed charges,,
SULFAMETHOXAZOLE-TRIMETHOPRIM 200-40 MG/5 ML ORAL SUSP,,14715,LOCAL,Facility,Both,473 mL,mL,,840,714,240.744,840,America's PPO,America's PPO,806.652,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SULFAMETHOXAZOLE-TRIMETHOPRIM 200-40 MG/5 ML ORAL SUSP,,14715,LOCAL,Facility,Both,473 mL,mL,,840,714,240.744,840,BlueCross BlueShield Minnesota, Federal Employee Program,826.56,98.4,,percent of total billed charges,,
SULFAMETHOXAZOLE-TRIMETHOPRIM 200-40 MG/5 ML ORAL SUSP,,14715,LOCAL,Facility,Both,473 mL,mL,,840,714,240.744,840,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,840,100,,percent of total billed charges,,
SULFAMETHOXAZOLE-TRIMETHOPRIM 200-40 MG/5 ML ORAL SUSP,,14715,LOCAL,Facility,Both,473 mL,mL,,840,714,240.744,840,BlueCross BlueShield Minnesota,High Value Network Plan,756,90,,percent of total billed charges,,
SULFAMETHOXAZOLE-TRIMETHOPRIM 200-40 MG/5 ML ORAL SUSP,,14715,LOCAL,Facility,Outpatient,473 mL,mL,,840,714,240.744,840,BlueCross BlueShield Minnesota,Medicare Advantage,411.6,49,,percent of total billed charges,,
SULFAMETHOXAZOLE-TRIMETHOPRIM 200-40 MG/5 ML ORAL SUSP,,14715,LOCAL,Facility,Inpatient,473 mL,mL,,840,714,240.744,840,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
SULFAMETHOXAZOLE-TRIMETHOPRIM 200-40 MG/5 ML ORAL SUSP,,14715,LOCAL,Facility,Both,473 mL,mL,,840,714,240.744,840,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,743.988,88.57,,percent of total billed charges,,
SULFAMETHOXAZOLE-TRIMETHOPRIM 200-40 MG/5 ML ORAL SUSP,,14715,LOCAL,Facility,Both,473 mL,mL,,840,714,240.744,840,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,240.744,28.66,,percent of total billed charges,,
SULFAMETHOXAZOLE-TRIMETHOPRIM 200-40 MG/5 ML ORAL SUSP,,14715,LOCAL,Facility,Outpatient,473 mL,mL,,840,714,240.744,840,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),411.6,49,,percent of total billed charges,,
SULFAMETHOXAZOLE-TRIMETHOPRIM 200-40 MG/5 ML ORAL SUSP,,14715,LOCAL,Facility,Inpatient,473 mL,mL,,840,714,240.744,840,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
SULFAMETHOXAZOLE-TRIMETHOPRIM 200-40 MG/5 ML ORAL SUSP,,14715,LOCAL,Facility,Both,473 mL,mL,,840,714,240.744,840,CorVel,Worker's Compensation,840,100,,percent of total billed charges,,
SULFAMETHOXAZOLE-TRIMETHOPRIM 200-40 MG/5 ML ORAL SUSP,,14715,LOCAL,Facility,Both,473 mL,mL,,840,714,240.744,840,First Health Group Corporation,First Health Network,814.8,97,,percent of total billed charges,,
SULFAMETHOXAZOLE-TRIMETHOPRIM 200-40 MG/5 ML ORAL SUSP,,14715,LOCAL,Facility,Both,473 mL,mL,,840,714,240.744,840,"Health Partners, Inc.",Commercial,794.64,94.6,,percent of total billed charges,,
SULFAMETHOXAZOLE-TRIMETHOPRIM 200-40 MG/5 ML ORAL SUSP,,14715,LOCAL,Facility,Outpatient,473 mL,mL,,840,714,240.744,840,"Health Partners, Inc.",Medicare Advantage,411.6,49,,percent of total billed charges,,
SULFAMETHOXAZOLE-TRIMETHOPRIM 200-40 MG/5 ML ORAL SUSP,,14715,LOCAL,Facility,Inpatient,473 mL,mL,,840,714,240.744,840,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SULFAMETHOXAZOLE-TRIMETHOPRIM 200-40 MG/5 ML ORAL SUSP,,14715,LOCAL,Facility,Both,473 mL,mL,,840,714,240.744,840,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),504,60,,percent of total billed charges,,
SULFAMETHOXAZOLE-TRIMETHOPRIM 200-40 MG/5 ML ORAL SUSP,,14715,LOCAL,Facility,Both,473 mL,mL,,840,714,240.744,840,"Health Partners, Inc.",State of Minnesota Advantage Program,684.6,81.5,,percent of total billed charges,,
SULFAMETHOXAZOLE-TRIMETHOPRIM 200-40 MG/5 ML ORAL SUSP,,14715,LOCAL,Facility,Both,473 mL,mL,,840,714,240.744,840,"Health Partners, Inc.",State Public Programs,420,50,,percent of total billed charges,,
SULFAMETHOXAZOLE-TRIMETHOPRIM 200-40 MG/5 ML ORAL SUSP,,14715,LOCAL,Facility,Both,473 mL,mL,,840,714,240.744,840,Humana Insurance Company,Commercial PPO,798,95,,percent of total billed charges,,
SULFAMETHOXAZOLE-TRIMETHOPRIM 200-40 MG/5 ML ORAL SUSP,,14715,LOCAL,Facility,Outpatient,473 mL,mL,,840,714,240.744,840,Humana Insurance Company,Medicare PPO,411.6,49,,percent of total billed charges,,
SULFAMETHOXAZOLE-TRIMETHOPRIM 200-40 MG/5 ML ORAL SUSP,,14715,LOCAL,Facility,Inpatient,473 mL,mL,,840,714,240.744,840,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
SULFAMETHOXAZOLE-TRIMETHOPRIM 200-40 MG/5 ML ORAL SUSP,,14715,LOCAL,Facility,Both,473 mL,mL,,840,714,240.744,840,Medica,Individual & Family,832.44,99.1,,percent of total billed charges,,
SULFAMETHOXAZOLE-TRIMETHOPRIM 200-40 MG/5 ML ORAL SUSP,,14715,LOCAL,Facility,Outpatient,473 mL,mL,,840,714,240.744,840,Medica,Medica Advantage Solution,418.32,49.8,,percent of total billed charges,,
SULFAMETHOXAZOLE-TRIMETHOPRIM 200-40 MG/5 ML ORAL SUSP,,14715,LOCAL,Facility,Inpatient,473 mL,mL,,840,714,240.744,840,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
SULFAMETHOXAZOLE-TRIMETHOPRIM 200-40 MG/5 ML ORAL SUSP,,14715,LOCAL,Facility,Outpatient,473 mL,mL,,840,714,240.744,840,Medica,Medical Assistance,374.64,44.6,,percent of total billed charges,,
SULFAMETHOXAZOLE-TRIMETHOPRIM 200-40 MG/5 ML ORAL SUSP,,14715,LOCAL,Facility,Inpatient,473 mL,mL,,840,714,240.744,840,Medica,Medical Assistance,,,,,Included in per diem rate,
SULFAMETHOXAZOLE-TRIMETHOPRIM 200-40 MG/5 ML ORAL SUSP,,14715,LOCAL,Facility,Outpatient,473 mL,mL,,840,714,240.744,840,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,418.32,49.8,,percent of total billed charges,,
SULFAMETHOXAZOLE-TRIMETHOPRIM 200-40 MG/5 ML ORAL SUSP,,14715,LOCAL,Facility,Inpatient,473 mL,mL,,840,714,240.744,840,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
SULFAMETHOXAZOLE-TRIMETHOPRIM 200-40 MG/5 ML ORAL SUSP,,14715,LOCAL,Facility,Both,473 mL,mL,,840,714,240.744,840,"Multiplan, Inc.","Multiplan, Inc.",789.6,94,,percent of total billed charges,,
SULFAMETHOXAZOLE-TRIMETHOPRIM 200-40 MG/5 ML ORAL SUSP,,14715,LOCAL,Facility,Outpatient,473 mL,mL,,840,714,240.744,840,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,756.84,90.1,,percent of total billed charges,,
SULFAMETHOXAZOLE-TRIMETHOPRIM 200-40 MG/5 ML ORAL SUSP,,14715,LOCAL,Facility,Inpatient,473 mL,mL,,840,714,240.744,840,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
SULFAMETHOXAZOLE-TRIMETHOPRIM 200-40 MG/5 ML ORAL SUSP,,14715,LOCAL,Facility,Both,473 mL,mL,,840,714,240.744,840,"Preferred One Administrative Services, INC.",PPO,828.24,98.6,,percent of total billed charges,,
SULFAMETHOXAZOLE-TRIMETHOPRIM 200-40 MG/5 ML ORAL SUSP,,14715,LOCAL,Facility,Outpatient,473 mL,mL,,840,714,240.744,840,PrimeWest Health,Minnesota Senior Health Options (MSHO),432.18,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
SULFAMETHOXAZOLE-TRIMETHOPRIM 200-40 MG/5 ML ORAL SUSP,,14715,LOCAL,Facility,Inpatient,473 mL,mL,,840,714,240.744,840,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SULFAMETHOXAZOLE-TRIMETHOPRIM 200-40 MG/5 ML ORAL SUSP,,14715,LOCAL,Facility,Outpatient,473 mL,mL,,840,714,240.744,840,PrimeWest Health,MinnesotaCare,431.424,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
SULFAMETHOXAZOLE-TRIMETHOPRIM 200-40 MG/5 ML ORAL SUSP,,14715,LOCAL,Facility,Inpatient,473 mL,mL,,840,714,240.744,840,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
SULFAMETHOXAZOLE-TRIMETHOPRIM 200-40 MG/5 ML ORAL SUSP,,14715,LOCAL,Facility,Both,473 mL,mL,,840,714,240.744,840,Sanford Health Plan,Sanford Health Plan,772.8,92,,percent of total billed charges,,
SULFAMETHOXAZOLE-TRIMETHOPRIM 200-40 MG/5 ML ORAL SUSP,,14715,LOCAL,Facility,Outpatient,473 mL,mL,,840,714,240.744,840,"UCare Health, Inc.",Individual & Family Plan,473.34,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
SULFAMETHOXAZOLE-TRIMETHOPRIM 200-40 MG/5 ML ORAL SUSP,,14715,LOCAL,Facility,Inpatient,473 mL,mL,,840,714,240.744,840,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
SULFAMETHOXAZOLE-TRIMETHOPRIM 200-40 MG/5 ML ORAL SUSP,,14715,LOCAL,Facility,Outpatient,473 mL,mL,,840,714,240.744,840,"UCare Health, Inc.",Medical Assistance,423.948,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SULFAMETHOXAZOLE-TRIMETHOPRIM 200-40 MG/5 ML ORAL SUSP,,14715,LOCAL,Facility,Inpatient,473 mL,mL,,840,714,240.744,840,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
SULFAMETHOXAZOLE-TRIMETHOPRIM 200-40 MG/5 ML ORAL SUSP,,14715,LOCAL,Facility,Outpatient,473 mL,mL,,840,714,240.744,840,"UCare Health, Inc.",Medicare Advantage,423.948,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SULFAMETHOXAZOLE-TRIMETHOPRIM 200-40 MG/5 ML ORAL SUSP,,14715,LOCAL,Facility,Inpatient,473 mL,mL,,840,714,240.744,840,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SULFAMETHOXAZOLE-TRIMETHOPRIM 200-40 MG/5 ML ORAL SUSP,,14715,LOCAL,Facility,Outpatient,473 mL,mL,,840,714,240.744,840,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),423.948,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SULFAMETHOXAZOLE-TRIMETHOPRIM 200-40 MG/5 ML ORAL SUSP,,14715,LOCAL,Facility,Inpatient,473 mL,mL,,840,714,240.744,840,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SULFAMETHOXAZOLE-TRIMETHOPRIM 200-40 MG/5 ML ORAL SUSP,,14715,LOCAL,Facility,Both,473 mL,mL,,840,714,240.744,840,UnitedHealthcare,Individual & Family,789.6,94,,percent of total billed charges,,
SULFAMETHOXAZOLE-TRIMETHOPRIM 200-40 MG/5 ML ORAL SUSP,,14715,LOCAL,Facility,Outpatient,473 mL,mL,,840,714,240.744,840,UnitedHealthcare,Medicare Advantage,411.6,49,,percent of total billed charges,,
SULFAMETHOXAZOLE-TRIMETHOPRIM 200-40 MG/5 ML ORAL SUSP,,14715,LOCAL,Facility,Inpatient,473 mL,mL,,840,714,240.744,840,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
SULFAMETHOXAZOLE-TRIMETHOPRIM 200-40 MG/5 ML ORAL SUSP,,14715,LOCAL,Facility,Outpatient,473 mL,mL,,840,714,240.744,840,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,403.2,48,,percent of total billed charges,,100% of DHS outpatient percentage
SULFAMETHOXAZOLE-TRIMETHOPRIM 200-40 MG/5 ML ORAL SUSP,,14715,LOCAL,Facility,Inpatient,473 mL,mL,,840,714,240.744,840,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
SORBITOL 70 % MISC SOLN,,18852,LOCAL,Facility,Both,473 mL,mL,,53,45.05,15.1898,53,Aetna,Commercial,48.76,92,,percent of total billed charges,,
SORBITOL 70 % MISC SOLN,,18852,LOCAL,Facility,Outpatient,473 mL,mL,,53,45.05,15.1898,53,Aetna,Medicare Advantage,25.97,49,,percent of total billed charges,,
SORBITOL 70 % MISC SOLN,,18852,LOCAL,Facility,Inpatient,473 mL,mL,,53,45.05,15.1898,53,Aetna,Medicare Advantage,,,,,Included in per diem rate,
SORBITOL 70 % MISC SOLN,,18852,LOCAL,Facility,Both,473 mL,mL,,53,45.05,15.1898,53,Aetna,PPO,49.29,93,,percent of total billed charges,,
SORBITOL 70 % MISC SOLN,,18852,LOCAL,Facility,Both,473 mL,mL,,53,45.05,15.1898,53,America's PPO,America's PPO,50.8959,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SORBITOL 70 % MISC SOLN,,18852,LOCAL,Facility,Both,473 mL,mL,,53,45.05,15.1898,53,BlueCross BlueShield Minnesota, Federal Employee Program,52.152,98.4,,percent of total billed charges,,
SORBITOL 70 % MISC SOLN,,18852,LOCAL,Facility,Both,473 mL,mL,,53,45.05,15.1898,53,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,53,100,,percent of total billed charges,,
SORBITOL 70 % MISC SOLN,,18852,LOCAL,Facility,Both,473 mL,mL,,53,45.05,15.1898,53,BlueCross BlueShield Minnesota,High Value Network Plan,47.7,90,,percent of total billed charges,,
SORBITOL 70 % MISC SOLN,,18852,LOCAL,Facility,Outpatient,473 mL,mL,,53,45.05,15.1898,53,BlueCross BlueShield Minnesota,Medicare Advantage,25.97,49,,percent of total billed charges,,
SORBITOL 70 % MISC SOLN,,18852,LOCAL,Facility,Inpatient,473 mL,mL,,53,45.05,15.1898,53,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
SORBITOL 70 % MISC SOLN,,18852,LOCAL,Facility,Both,473 mL,mL,,53,45.05,15.1898,53,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,46.9421,88.57,,percent of total billed charges,,
SORBITOL 70 % MISC SOLN,,18852,LOCAL,Facility,Both,473 mL,mL,,53,45.05,15.1898,53,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,15.1898,28.66,,percent of total billed charges,,
SORBITOL 70 % MISC SOLN,,18852,LOCAL,Facility,Outpatient,473 mL,mL,,53,45.05,15.1898,53,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),25.97,49,,percent of total billed charges,,
SORBITOL 70 % MISC SOLN,,18852,LOCAL,Facility,Inpatient,473 mL,mL,,53,45.05,15.1898,53,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
SORBITOL 70 % MISC SOLN,,18852,LOCAL,Facility,Both,473 mL,mL,,53,45.05,15.1898,53,CorVel,Worker's Compensation,53,100,,percent of total billed charges,,
SORBITOL 70 % MISC SOLN,,18852,LOCAL,Facility,Both,473 mL,mL,,53,45.05,15.1898,53,First Health Group Corporation,First Health Network,51.41,97,,percent of total billed charges,,
SORBITOL 70 % MISC SOLN,,18852,LOCAL,Facility,Both,473 mL,mL,,53,45.05,15.1898,53,"Health Partners, Inc.",Commercial,50.138,94.6,,percent of total billed charges,,
SORBITOL 70 % MISC SOLN,,18852,LOCAL,Facility,Outpatient,473 mL,mL,,53,45.05,15.1898,53,"Health Partners, Inc.",Medicare Advantage,25.97,49,,percent of total billed charges,,
SORBITOL 70 % MISC SOLN,,18852,LOCAL,Facility,Inpatient,473 mL,mL,,53,45.05,15.1898,53,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SORBITOL 70 % MISC SOLN,,18852,LOCAL,Facility,Both,473 mL,mL,,53,45.05,15.1898,53,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),31.8,60,,percent of total billed charges,,
SORBITOL 70 % MISC SOLN,,18852,LOCAL,Facility,Both,473 mL,mL,,53,45.05,15.1898,53,"Health Partners, Inc.",State of Minnesota Advantage Program,43.195,81.5,,percent of total billed charges,,
SORBITOL 70 % MISC SOLN,,18852,LOCAL,Facility,Both,473 mL,mL,,53,45.05,15.1898,53,"Health Partners, Inc.",State Public Programs,26.5,50,,percent of total billed charges,,
SORBITOL 70 % MISC SOLN,,18852,LOCAL,Facility,Both,473 mL,mL,,53,45.05,15.1898,53,Humana Insurance Company,Commercial PPO,50.35,95,,percent of total billed charges,,
SORBITOL 70 % MISC SOLN,,18852,LOCAL,Facility,Outpatient,473 mL,mL,,53,45.05,15.1898,53,Humana Insurance Company,Medicare PPO,25.97,49,,percent of total billed charges,,
SORBITOL 70 % MISC SOLN,,18852,LOCAL,Facility,Inpatient,473 mL,mL,,53,45.05,15.1898,53,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
SORBITOL 70 % MISC SOLN,,18852,LOCAL,Facility,Both,473 mL,mL,,53,45.05,15.1898,53,Medica,Individual & Family,52.523,99.1,,percent of total billed charges,,
SORBITOL 70 % MISC SOLN,,18852,LOCAL,Facility,Outpatient,473 mL,mL,,53,45.05,15.1898,53,Medica,Medica Advantage Solution,26.394,49.8,,percent of total billed charges,,
SORBITOL 70 % MISC SOLN,,18852,LOCAL,Facility,Inpatient,473 mL,mL,,53,45.05,15.1898,53,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
SORBITOL 70 % MISC SOLN,,18852,LOCAL,Facility,Outpatient,473 mL,mL,,53,45.05,15.1898,53,Medica,Medical Assistance,23.638,44.6,,percent of total billed charges,,
SORBITOL 70 % MISC SOLN,,18852,LOCAL,Facility,Inpatient,473 mL,mL,,53,45.05,15.1898,53,Medica,Medical Assistance,,,,,Included in per diem rate,
SORBITOL 70 % MISC SOLN,,18852,LOCAL,Facility,Outpatient,473 mL,mL,,53,45.05,15.1898,53,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,26.394,49.8,,percent of total billed charges,,
SORBITOL 70 % MISC SOLN,,18852,LOCAL,Facility,Inpatient,473 mL,mL,,53,45.05,15.1898,53,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
SORBITOL 70 % MISC SOLN,,18852,LOCAL,Facility,Both,473 mL,mL,,53,45.05,15.1898,53,"Multiplan, Inc.","Multiplan, Inc.",49.82,94,,percent of total billed charges,,
SORBITOL 70 % MISC SOLN,,18852,LOCAL,Facility,Outpatient,473 mL,mL,,53,45.05,15.1898,53,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,47.753,90.1,,percent of total billed charges,,
SORBITOL 70 % MISC SOLN,,18852,LOCAL,Facility,Inpatient,473 mL,mL,,53,45.05,15.1898,53,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
SORBITOL 70 % MISC SOLN,,18852,LOCAL,Facility,Both,473 mL,mL,,53,45.05,15.1898,53,"Preferred One Administrative Services, INC.",PPO,52.258,98.6,,percent of total billed charges,,
SORBITOL 70 % MISC SOLN,,18852,LOCAL,Facility,Outpatient,473 mL,mL,,53,45.05,15.1898,53,PrimeWest Health,Minnesota Senior Health Options (MSHO),27.2685,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
SORBITOL 70 % MISC SOLN,,18852,LOCAL,Facility,Inpatient,473 mL,mL,,53,45.05,15.1898,53,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SORBITOL 70 % MISC SOLN,,18852,LOCAL,Facility,Outpatient,473 mL,mL,,53,45.05,15.1898,53,PrimeWest Health,MinnesotaCare,27.2208,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
SORBITOL 70 % MISC SOLN,,18852,LOCAL,Facility,Inpatient,473 mL,mL,,53,45.05,15.1898,53,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
SORBITOL 70 % MISC SOLN,,18852,LOCAL,Facility,Both,473 mL,mL,,53,45.05,15.1898,53,Sanford Health Plan,Sanford Health Plan,48.76,92,,percent of total billed charges,,
SORBITOL 70 % MISC SOLN,,18852,LOCAL,Facility,Outpatient,473 mL,mL,,53,45.05,15.1898,53,"UCare Health, Inc.",Individual & Family Plan,29.8655,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
SORBITOL 70 % MISC SOLN,,18852,LOCAL,Facility,Inpatient,473 mL,mL,,53,45.05,15.1898,53,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
SORBITOL 70 % MISC SOLN,,18852,LOCAL,Facility,Outpatient,473 mL,mL,,53,45.05,15.1898,53,"UCare Health, Inc.",Medical Assistance,26.7491,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SORBITOL 70 % MISC SOLN,,18852,LOCAL,Facility,Inpatient,473 mL,mL,,53,45.05,15.1898,53,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
SORBITOL 70 % MISC SOLN,,18852,LOCAL,Facility,Outpatient,473 mL,mL,,53,45.05,15.1898,53,"UCare Health, Inc.",Medicare Advantage,26.7491,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SORBITOL 70 % MISC SOLN,,18852,LOCAL,Facility,Inpatient,473 mL,mL,,53,45.05,15.1898,53,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SORBITOL 70 % MISC SOLN,,18852,LOCAL,Facility,Outpatient,473 mL,mL,,53,45.05,15.1898,53,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),26.7491,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SORBITOL 70 % MISC SOLN,,18852,LOCAL,Facility,Inpatient,473 mL,mL,,53,45.05,15.1898,53,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SORBITOL 70 % MISC SOLN,,18852,LOCAL,Facility,Both,473 mL,mL,,53,45.05,15.1898,53,UnitedHealthcare,Individual & Family,49.82,94,,percent of total billed charges,,
SORBITOL 70 % MISC SOLN,,18852,LOCAL,Facility,Outpatient,473 mL,mL,,53,45.05,15.1898,53,UnitedHealthcare,Medicare Advantage,25.97,49,,percent of total billed charges,,
SORBITOL 70 % MISC SOLN,,18852,LOCAL,Facility,Inpatient,473 mL,mL,,53,45.05,15.1898,53,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
SORBITOL 70 % MISC SOLN,,18852,LOCAL,Facility,Outpatient,473 mL,mL,,53,45.05,15.1898,53,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,25.44,48,,percent of total billed charges,,100% of DHS outpatient percentage
SORBITOL 70 % MISC SOLN,,18852,LOCAL,Facility,Inpatient,473 mL,mL,,53,45.05,15.1898,53,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
SODIUM HYPOCHLORITE 0.25 % MISC SOLN,,21181,LOCAL,Facility,Both,473 mL,mL,,66,56.1,18.9156,66,Aetna,Commercial,60.72,92,,percent of total billed charges,,
SODIUM HYPOCHLORITE 0.25 % MISC SOLN,,21181,LOCAL,Facility,Outpatient,473 mL,mL,,66,56.1,18.9156,66,Aetna,Medicare Advantage,32.34,49,,percent of total billed charges,,
SODIUM HYPOCHLORITE 0.25 % MISC SOLN,,21181,LOCAL,Facility,Inpatient,473 mL,mL,,66,56.1,18.9156,66,Aetna,Medicare Advantage,,,,,Included in per diem rate,
SODIUM HYPOCHLORITE 0.25 % MISC SOLN,,21181,LOCAL,Facility,Both,473 mL,mL,,66,56.1,18.9156,66,Aetna,PPO,61.38,93,,percent of total billed charges,,
SODIUM HYPOCHLORITE 0.25 % MISC SOLN,,21181,LOCAL,Facility,Both,473 mL,mL,,66,56.1,18.9156,66,America's PPO,America's PPO,63.3798,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SODIUM HYPOCHLORITE 0.25 % MISC SOLN,,21181,LOCAL,Facility,Both,473 mL,mL,,66,56.1,18.9156,66,BlueCross BlueShield Minnesota, Federal Employee Program,64.944,98.4,,percent of total billed charges,,
SODIUM HYPOCHLORITE 0.25 % MISC SOLN,,21181,LOCAL,Facility,Both,473 mL,mL,,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,66,100,,percent of total billed charges,,
SODIUM HYPOCHLORITE 0.25 % MISC SOLN,,21181,LOCAL,Facility,Both,473 mL,mL,,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,High Value Network Plan,59.4,90,,percent of total billed charges,,
SODIUM HYPOCHLORITE 0.25 % MISC SOLN,,21181,LOCAL,Facility,Outpatient,473 mL,mL,,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,Medicare Advantage,32.34,49,,percent of total billed charges,,
SODIUM HYPOCHLORITE 0.25 % MISC SOLN,,21181,LOCAL,Facility,Inpatient,473 mL,mL,,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
SODIUM HYPOCHLORITE 0.25 % MISC SOLN,,21181,LOCAL,Facility,Both,473 mL,mL,,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,58.4562,88.57,,percent of total billed charges,,
SODIUM HYPOCHLORITE 0.25 % MISC SOLN,,21181,LOCAL,Facility,Both,473 mL,mL,,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,18.9156,28.66,,percent of total billed charges,,
SODIUM HYPOCHLORITE 0.25 % MISC SOLN,,21181,LOCAL,Facility,Outpatient,473 mL,mL,,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),32.34,49,,percent of total billed charges,,
SODIUM HYPOCHLORITE 0.25 % MISC SOLN,,21181,LOCAL,Facility,Inpatient,473 mL,mL,,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
SODIUM HYPOCHLORITE 0.25 % MISC SOLN,,21181,LOCAL,Facility,Both,473 mL,mL,,66,56.1,18.9156,66,CorVel,Worker's Compensation,66,100,,percent of total billed charges,,
SODIUM HYPOCHLORITE 0.25 % MISC SOLN,,21181,LOCAL,Facility,Both,473 mL,mL,,66,56.1,18.9156,66,First Health Group Corporation,First Health Network,64.02,97,,percent of total billed charges,,
SODIUM HYPOCHLORITE 0.25 % MISC SOLN,,21181,LOCAL,Facility,Both,473 mL,mL,,66,56.1,18.9156,66,"Health Partners, Inc.",Commercial,62.436,94.6,,percent of total billed charges,,
SODIUM HYPOCHLORITE 0.25 % MISC SOLN,,21181,LOCAL,Facility,Outpatient,473 mL,mL,,66,56.1,18.9156,66,"Health Partners, Inc.",Medicare Advantage,32.34,49,,percent of total billed charges,,
SODIUM HYPOCHLORITE 0.25 % MISC SOLN,,21181,LOCAL,Facility,Inpatient,473 mL,mL,,66,56.1,18.9156,66,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SODIUM HYPOCHLORITE 0.25 % MISC SOLN,,21181,LOCAL,Facility,Both,473 mL,mL,,66,56.1,18.9156,66,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),39.6,60,,percent of total billed charges,,
SODIUM HYPOCHLORITE 0.25 % MISC SOLN,,21181,LOCAL,Facility,Both,473 mL,mL,,66,56.1,18.9156,66,"Health Partners, Inc.",State of Minnesota Advantage Program,53.79,81.5,,percent of total billed charges,,
SODIUM HYPOCHLORITE 0.25 % MISC SOLN,,21181,LOCAL,Facility,Both,473 mL,mL,,66,56.1,18.9156,66,"Health Partners, Inc.",State Public Programs,33,50,,percent of total billed charges,,
SODIUM HYPOCHLORITE 0.25 % MISC SOLN,,21181,LOCAL,Facility,Both,473 mL,mL,,66,56.1,18.9156,66,Humana Insurance Company,Commercial PPO,62.7,95,,percent of total billed charges,,
SODIUM HYPOCHLORITE 0.25 % MISC SOLN,,21181,LOCAL,Facility,Outpatient,473 mL,mL,,66,56.1,18.9156,66,Humana Insurance Company,Medicare PPO,32.34,49,,percent of total billed charges,,
SODIUM HYPOCHLORITE 0.25 % MISC SOLN,,21181,LOCAL,Facility,Inpatient,473 mL,mL,,66,56.1,18.9156,66,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
SODIUM HYPOCHLORITE 0.25 % MISC SOLN,,21181,LOCAL,Facility,Both,473 mL,mL,,66,56.1,18.9156,66,Medica,Individual & Family,65.406,99.1,,percent of total billed charges,,
SODIUM HYPOCHLORITE 0.25 % MISC SOLN,,21181,LOCAL,Facility,Outpatient,473 mL,mL,,66,56.1,18.9156,66,Medica,Medica Advantage Solution,32.868,49.8,,percent of total billed charges,,
SODIUM HYPOCHLORITE 0.25 % MISC SOLN,,21181,LOCAL,Facility,Inpatient,473 mL,mL,,66,56.1,18.9156,66,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
SODIUM HYPOCHLORITE 0.25 % MISC SOLN,,21181,LOCAL,Facility,Outpatient,473 mL,mL,,66,56.1,18.9156,66,Medica,Medical Assistance,29.436,44.6,,percent of total billed charges,,
SODIUM HYPOCHLORITE 0.25 % MISC SOLN,,21181,LOCAL,Facility,Inpatient,473 mL,mL,,66,56.1,18.9156,66,Medica,Medical Assistance,,,,,Included in per diem rate,
SODIUM HYPOCHLORITE 0.25 % MISC SOLN,,21181,LOCAL,Facility,Outpatient,473 mL,mL,,66,56.1,18.9156,66,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,32.868,49.8,,percent of total billed charges,,
SODIUM HYPOCHLORITE 0.25 % MISC SOLN,,21181,LOCAL,Facility,Inpatient,473 mL,mL,,66,56.1,18.9156,66,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
SODIUM HYPOCHLORITE 0.25 % MISC SOLN,,21181,LOCAL,Facility,Both,473 mL,mL,,66,56.1,18.9156,66,"Multiplan, Inc.","Multiplan, Inc.",62.04,94,,percent of total billed charges,,
SODIUM HYPOCHLORITE 0.25 % MISC SOLN,,21181,LOCAL,Facility,Outpatient,473 mL,mL,,66,56.1,18.9156,66,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,59.466,90.1,,percent of total billed charges,,
SODIUM HYPOCHLORITE 0.25 % MISC SOLN,,21181,LOCAL,Facility,Inpatient,473 mL,mL,,66,56.1,18.9156,66,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
SODIUM HYPOCHLORITE 0.25 % MISC SOLN,,21181,LOCAL,Facility,Both,473 mL,mL,,66,56.1,18.9156,66,"Preferred One Administrative Services, INC.",PPO,65.076,98.6,,percent of total billed charges,,
SODIUM HYPOCHLORITE 0.25 % MISC SOLN,,21181,LOCAL,Facility,Outpatient,473 mL,mL,,66,56.1,18.9156,66,PrimeWest Health,Minnesota Senior Health Options (MSHO),33.957,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
SODIUM HYPOCHLORITE 0.25 % MISC SOLN,,21181,LOCAL,Facility,Inpatient,473 mL,mL,,66,56.1,18.9156,66,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SODIUM HYPOCHLORITE 0.25 % MISC SOLN,,21181,LOCAL,Facility,Outpatient,473 mL,mL,,66,56.1,18.9156,66,PrimeWest Health,MinnesotaCare,33.8976,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
SODIUM HYPOCHLORITE 0.25 % MISC SOLN,,21181,LOCAL,Facility,Inpatient,473 mL,mL,,66,56.1,18.9156,66,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
SODIUM HYPOCHLORITE 0.25 % MISC SOLN,,21181,LOCAL,Facility,Both,473 mL,mL,,66,56.1,18.9156,66,Sanford Health Plan,Sanford Health Plan,60.72,92,,percent of total billed charges,,
SODIUM HYPOCHLORITE 0.25 % MISC SOLN,,21181,LOCAL,Facility,Outpatient,473 mL,mL,,66,56.1,18.9156,66,"UCare Health, Inc.",Individual & Family Plan,37.191,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
SODIUM HYPOCHLORITE 0.25 % MISC SOLN,,21181,LOCAL,Facility,Inpatient,473 mL,mL,,66,56.1,18.9156,66,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
SODIUM HYPOCHLORITE 0.25 % MISC SOLN,,21181,LOCAL,Facility,Outpatient,473 mL,mL,,66,56.1,18.9156,66,"UCare Health, Inc.",Medical Assistance,33.3102,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SODIUM HYPOCHLORITE 0.25 % MISC SOLN,,21181,LOCAL,Facility,Inpatient,473 mL,mL,,66,56.1,18.9156,66,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
SODIUM HYPOCHLORITE 0.25 % MISC SOLN,,21181,LOCAL,Facility,Outpatient,473 mL,mL,,66,56.1,18.9156,66,"UCare Health, Inc.",Medicare Advantage,33.3102,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SODIUM HYPOCHLORITE 0.25 % MISC SOLN,,21181,LOCAL,Facility,Inpatient,473 mL,mL,,66,56.1,18.9156,66,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SODIUM HYPOCHLORITE 0.25 % MISC SOLN,,21181,LOCAL,Facility,Outpatient,473 mL,mL,,66,56.1,18.9156,66,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),33.3102,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SODIUM HYPOCHLORITE 0.25 % MISC SOLN,,21181,LOCAL,Facility,Inpatient,473 mL,mL,,66,56.1,18.9156,66,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SODIUM HYPOCHLORITE 0.25 % MISC SOLN,,21181,LOCAL,Facility,Both,473 mL,mL,,66,56.1,18.9156,66,UnitedHealthcare,Individual & Family,62.04,94,,percent of total billed charges,,
SODIUM HYPOCHLORITE 0.25 % MISC SOLN,,21181,LOCAL,Facility,Outpatient,473 mL,mL,,66,56.1,18.9156,66,UnitedHealthcare,Medicare Advantage,32.34,49,,percent of total billed charges,,
SODIUM HYPOCHLORITE 0.25 % MISC SOLN,,21181,LOCAL,Facility,Inpatient,473 mL,mL,,66,56.1,18.9156,66,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
SODIUM HYPOCHLORITE 0.25 % MISC SOLN,,21181,LOCAL,Facility,Outpatient,473 mL,mL,,66,56.1,18.9156,66,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,31.68,48,,percent of total billed charges,,100% of DHS outpatient percentage
SODIUM HYPOCHLORITE 0.25 % MISC SOLN,,21181,LOCAL,Facility,Inpatient,473 mL,mL,,66,56.1,18.9156,66,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
LACTULOSE 10 GRAM/15 ML ORAL SOLN,,37092,LOCAL,Facility,Both,473 mL,mL,,164,139.4,47.0024,164,Aetna,Commercial,150.88,92,,percent of total billed charges,,
LACTULOSE 10 GRAM/15 ML ORAL SOLN,,37092,LOCAL,Facility,Outpatient,473 mL,mL,,164,139.4,47.0024,164,Aetna,Medicare Advantage,80.36,49,,percent of total billed charges,,
LACTULOSE 10 GRAM/15 ML ORAL SOLN,,37092,LOCAL,Facility,Inpatient,473 mL,mL,,164,139.4,47.0024,164,Aetna,Medicare Advantage,,,,,Included in per diem rate,
LACTULOSE 10 GRAM/15 ML ORAL SOLN,,37092,LOCAL,Facility,Both,473 mL,mL,,164,139.4,47.0024,164,Aetna,PPO,152.52,93,,percent of total billed charges,,
LACTULOSE 10 GRAM/15 ML ORAL SOLN,,37092,LOCAL,Facility,Both,473 mL,mL,,164,139.4,47.0024,164,America's PPO,America's PPO,157.4892,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
LACTULOSE 10 GRAM/15 ML ORAL SOLN,,37092,LOCAL,Facility,Both,473 mL,mL,,164,139.4,47.0024,164,BlueCross BlueShield Minnesota, Federal Employee Program,161.376,98.4,,percent of total billed charges,,
LACTULOSE 10 GRAM/15 ML ORAL SOLN,,37092,LOCAL,Facility,Both,473 mL,mL,,164,139.4,47.0024,164,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,164,100,,percent of total billed charges,,
LACTULOSE 10 GRAM/15 ML ORAL SOLN,,37092,LOCAL,Facility,Both,473 mL,mL,,164,139.4,47.0024,164,BlueCross BlueShield Minnesota,High Value Network Plan,147.6,90,,percent of total billed charges,,
LACTULOSE 10 GRAM/15 ML ORAL SOLN,,37092,LOCAL,Facility,Outpatient,473 mL,mL,,164,139.4,47.0024,164,BlueCross BlueShield Minnesota,Medicare Advantage,80.36,49,,percent of total billed charges,,
LACTULOSE 10 GRAM/15 ML ORAL SOLN,,37092,LOCAL,Facility,Inpatient,473 mL,mL,,164,139.4,47.0024,164,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
LACTULOSE 10 GRAM/15 ML ORAL SOLN,,37092,LOCAL,Facility,Both,473 mL,mL,,164,139.4,47.0024,164,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,145.2548,88.57,,percent of total billed charges,,
LACTULOSE 10 GRAM/15 ML ORAL SOLN,,37092,LOCAL,Facility,Both,473 mL,mL,,164,139.4,47.0024,164,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,47.0024,28.66,,percent of total billed charges,,
LACTULOSE 10 GRAM/15 ML ORAL SOLN,,37092,LOCAL,Facility,Outpatient,473 mL,mL,,164,139.4,47.0024,164,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),80.36,49,,percent of total billed charges,,
LACTULOSE 10 GRAM/15 ML ORAL SOLN,,37092,LOCAL,Facility,Inpatient,473 mL,mL,,164,139.4,47.0024,164,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
LACTULOSE 10 GRAM/15 ML ORAL SOLN,,37092,LOCAL,Facility,Both,473 mL,mL,,164,139.4,47.0024,164,CorVel,Worker's Compensation,164,100,,percent of total billed charges,,
LACTULOSE 10 GRAM/15 ML ORAL SOLN,,37092,LOCAL,Facility,Both,473 mL,mL,,164,139.4,47.0024,164,First Health Group Corporation,First Health Network,159.08,97,,percent of total billed charges,,
LACTULOSE 10 GRAM/15 ML ORAL SOLN,,37092,LOCAL,Facility,Both,473 mL,mL,,164,139.4,47.0024,164,"Health Partners, Inc.",Commercial,155.144,94.6,,percent of total billed charges,,
LACTULOSE 10 GRAM/15 ML ORAL SOLN,,37092,LOCAL,Facility,Outpatient,473 mL,mL,,164,139.4,47.0024,164,"Health Partners, Inc.",Medicare Advantage,80.36,49,,percent of total billed charges,,
LACTULOSE 10 GRAM/15 ML ORAL SOLN,,37092,LOCAL,Facility,Inpatient,473 mL,mL,,164,139.4,47.0024,164,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LACTULOSE 10 GRAM/15 ML ORAL SOLN,,37092,LOCAL,Facility,Both,473 mL,mL,,164,139.4,47.0024,164,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),98.4,60,,percent of total billed charges,,
LACTULOSE 10 GRAM/15 ML ORAL SOLN,,37092,LOCAL,Facility,Both,473 mL,mL,,164,139.4,47.0024,164,"Health Partners, Inc.",State of Minnesota Advantage Program,133.66,81.5,,percent of total billed charges,,
LACTULOSE 10 GRAM/15 ML ORAL SOLN,,37092,LOCAL,Facility,Both,473 mL,mL,,164,139.4,47.0024,164,"Health Partners, Inc.",State Public Programs,82,50,,percent of total billed charges,,
LACTULOSE 10 GRAM/15 ML ORAL SOLN,,37092,LOCAL,Facility,Both,473 mL,mL,,164,139.4,47.0024,164,Humana Insurance Company,Commercial PPO,155.8,95,,percent of total billed charges,,
LACTULOSE 10 GRAM/15 ML ORAL SOLN,,37092,LOCAL,Facility,Outpatient,473 mL,mL,,164,139.4,47.0024,164,Humana Insurance Company,Medicare PPO,80.36,49,,percent of total billed charges,,
LACTULOSE 10 GRAM/15 ML ORAL SOLN,,37092,LOCAL,Facility,Inpatient,473 mL,mL,,164,139.4,47.0024,164,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
LACTULOSE 10 GRAM/15 ML ORAL SOLN,,37092,LOCAL,Facility,Both,473 mL,mL,,164,139.4,47.0024,164,Medica,Individual & Family,162.524,99.1,,percent of total billed charges,,
LACTULOSE 10 GRAM/15 ML ORAL SOLN,,37092,LOCAL,Facility,Outpatient,473 mL,mL,,164,139.4,47.0024,164,Medica,Medica Advantage Solution,81.672,49.8,,percent of total billed charges,,
LACTULOSE 10 GRAM/15 ML ORAL SOLN,,37092,LOCAL,Facility,Inpatient,473 mL,mL,,164,139.4,47.0024,164,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
LACTULOSE 10 GRAM/15 ML ORAL SOLN,,37092,LOCAL,Facility,Outpatient,473 mL,mL,,164,139.4,47.0024,164,Medica,Medical Assistance,73.144,44.6,,percent of total billed charges,,
LACTULOSE 10 GRAM/15 ML ORAL SOLN,,37092,LOCAL,Facility,Inpatient,473 mL,mL,,164,139.4,47.0024,164,Medica,Medical Assistance,,,,,Included in per diem rate,
LACTULOSE 10 GRAM/15 ML ORAL SOLN,,37092,LOCAL,Facility,Outpatient,473 mL,mL,,164,139.4,47.0024,164,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,81.672,49.8,,percent of total billed charges,,
LACTULOSE 10 GRAM/15 ML ORAL SOLN,,37092,LOCAL,Facility,Inpatient,473 mL,mL,,164,139.4,47.0024,164,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
LACTULOSE 10 GRAM/15 ML ORAL SOLN,,37092,LOCAL,Facility,Both,473 mL,mL,,164,139.4,47.0024,164,"Multiplan, Inc.","Multiplan, Inc.",154.16,94,,percent of total billed charges,,
LACTULOSE 10 GRAM/15 ML ORAL SOLN,,37092,LOCAL,Facility,Outpatient,473 mL,mL,,164,139.4,47.0024,164,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,147.764,90.1,,percent of total billed charges,,
LACTULOSE 10 GRAM/15 ML ORAL SOLN,,37092,LOCAL,Facility,Inpatient,473 mL,mL,,164,139.4,47.0024,164,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
LACTULOSE 10 GRAM/15 ML ORAL SOLN,,37092,LOCAL,Facility,Both,473 mL,mL,,164,139.4,47.0024,164,"Preferred One Administrative Services, INC.",PPO,161.704,98.6,,percent of total billed charges,,
LACTULOSE 10 GRAM/15 ML ORAL SOLN,,37092,LOCAL,Facility,Outpatient,473 mL,mL,,164,139.4,47.0024,164,PrimeWest Health,Minnesota Senior Health Options (MSHO),84.378,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
LACTULOSE 10 GRAM/15 ML ORAL SOLN,,37092,LOCAL,Facility,Inpatient,473 mL,mL,,164,139.4,47.0024,164,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LACTULOSE 10 GRAM/15 ML ORAL SOLN,,37092,LOCAL,Facility,Outpatient,473 mL,mL,,164,139.4,47.0024,164,PrimeWest Health,MinnesotaCare,84.2304,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
LACTULOSE 10 GRAM/15 ML ORAL SOLN,,37092,LOCAL,Facility,Inpatient,473 mL,mL,,164,139.4,47.0024,164,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
LACTULOSE 10 GRAM/15 ML ORAL SOLN,,37092,LOCAL,Facility,Both,473 mL,mL,,164,139.4,47.0024,164,Sanford Health Plan,Sanford Health Plan,150.88,92,,percent of total billed charges,,
LACTULOSE 10 GRAM/15 ML ORAL SOLN,,37092,LOCAL,Facility,Outpatient,473 mL,mL,,164,139.4,47.0024,164,"UCare Health, Inc.",Individual & Family Plan,92.414,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
LACTULOSE 10 GRAM/15 ML ORAL SOLN,,37092,LOCAL,Facility,Inpatient,473 mL,mL,,164,139.4,47.0024,164,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
LACTULOSE 10 GRAM/15 ML ORAL SOLN,,37092,LOCAL,Facility,Outpatient,473 mL,mL,,164,139.4,47.0024,164,"UCare Health, Inc.",Medical Assistance,82.7708,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LACTULOSE 10 GRAM/15 ML ORAL SOLN,,37092,LOCAL,Facility,Inpatient,473 mL,mL,,164,139.4,47.0024,164,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
LACTULOSE 10 GRAM/15 ML ORAL SOLN,,37092,LOCAL,Facility,Outpatient,473 mL,mL,,164,139.4,47.0024,164,"UCare Health, Inc.",Medicare Advantage,82.7708,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LACTULOSE 10 GRAM/15 ML ORAL SOLN,,37092,LOCAL,Facility,Inpatient,473 mL,mL,,164,139.4,47.0024,164,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LACTULOSE 10 GRAM/15 ML ORAL SOLN,,37092,LOCAL,Facility,Outpatient,473 mL,mL,,164,139.4,47.0024,164,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),82.7708,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LACTULOSE 10 GRAM/15 ML ORAL SOLN,,37092,LOCAL,Facility,Inpatient,473 mL,mL,,164,139.4,47.0024,164,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LACTULOSE 10 GRAM/15 ML ORAL SOLN,,37092,LOCAL,Facility,Both,473 mL,mL,,164,139.4,47.0024,164,UnitedHealthcare,Individual & Family,154.16,94,,percent of total billed charges,,
LACTULOSE 10 GRAM/15 ML ORAL SOLN,,37092,LOCAL,Facility,Outpatient,473 mL,mL,,164,139.4,47.0024,164,UnitedHealthcare,Medicare Advantage,80.36,49,,percent of total billed charges,,
LACTULOSE 10 GRAM/15 ML ORAL SOLN,,37092,LOCAL,Facility,Inpatient,473 mL,mL,,164,139.4,47.0024,164,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
LACTULOSE 10 GRAM/15 ML ORAL SOLN,,37092,LOCAL,Facility,Outpatient,473 mL,mL,,164,139.4,47.0024,164,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,78.72,48,,percent of total billed charges,,100% of DHS outpatient percentage
LACTULOSE 10 GRAM/15 ML ORAL SOLN,,37092,LOCAL,Facility,Inpatient,473 mL,mL,,164,139.4,47.0024,164,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
SODIUM HYPOCHLORITE 0.125 % MISC SOLN,,68035,LOCAL,Facility,Both,473 mL,mL,,66,56.1,18.9156,66,Aetna,Commercial,60.72,92,,percent of total billed charges,,
SODIUM HYPOCHLORITE 0.125 % MISC SOLN,,68035,LOCAL,Facility,Outpatient,473 mL,mL,,66,56.1,18.9156,66,Aetna,Medicare Advantage,32.34,49,,percent of total billed charges,,
SODIUM HYPOCHLORITE 0.125 % MISC SOLN,,68035,LOCAL,Facility,Inpatient,473 mL,mL,,66,56.1,18.9156,66,Aetna,Medicare Advantage,,,,,Included in per diem rate,
SODIUM HYPOCHLORITE 0.125 % MISC SOLN,,68035,LOCAL,Facility,Both,473 mL,mL,,66,56.1,18.9156,66,Aetna,PPO,61.38,93,,percent of total billed charges,,
SODIUM HYPOCHLORITE 0.125 % MISC SOLN,,68035,LOCAL,Facility,Both,473 mL,mL,,66,56.1,18.9156,66,America's PPO,America's PPO,63.3798,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SODIUM HYPOCHLORITE 0.125 % MISC SOLN,,68035,LOCAL,Facility,Both,473 mL,mL,,66,56.1,18.9156,66,BlueCross BlueShield Minnesota, Federal Employee Program,64.944,98.4,,percent of total billed charges,,
SODIUM HYPOCHLORITE 0.125 % MISC SOLN,,68035,LOCAL,Facility,Both,473 mL,mL,,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,66,100,,percent of total billed charges,,
SODIUM HYPOCHLORITE 0.125 % MISC SOLN,,68035,LOCAL,Facility,Both,473 mL,mL,,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,High Value Network Plan,59.4,90,,percent of total billed charges,,
SODIUM HYPOCHLORITE 0.125 % MISC SOLN,,68035,LOCAL,Facility,Outpatient,473 mL,mL,,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,Medicare Advantage,32.34,49,,percent of total billed charges,,
SODIUM HYPOCHLORITE 0.125 % MISC SOLN,,68035,LOCAL,Facility,Inpatient,473 mL,mL,,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
SODIUM HYPOCHLORITE 0.125 % MISC SOLN,,68035,LOCAL,Facility,Both,473 mL,mL,,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,58.4562,88.57,,percent of total billed charges,,
SODIUM HYPOCHLORITE 0.125 % MISC SOLN,,68035,LOCAL,Facility,Both,473 mL,mL,,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,18.9156,28.66,,percent of total billed charges,,
SODIUM HYPOCHLORITE 0.125 % MISC SOLN,,68035,LOCAL,Facility,Outpatient,473 mL,mL,,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),32.34,49,,percent of total billed charges,,
SODIUM HYPOCHLORITE 0.125 % MISC SOLN,,68035,LOCAL,Facility,Inpatient,473 mL,mL,,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
SODIUM HYPOCHLORITE 0.125 % MISC SOLN,,68035,LOCAL,Facility,Both,473 mL,mL,,66,56.1,18.9156,66,CorVel,Worker's Compensation,66,100,,percent of total billed charges,,
SODIUM HYPOCHLORITE 0.125 % MISC SOLN,,68035,LOCAL,Facility,Both,473 mL,mL,,66,56.1,18.9156,66,First Health Group Corporation,First Health Network,64.02,97,,percent of total billed charges,,
SODIUM HYPOCHLORITE 0.125 % MISC SOLN,,68035,LOCAL,Facility,Both,473 mL,mL,,66,56.1,18.9156,66,"Health Partners, Inc.",Commercial,62.436,94.6,,percent of total billed charges,,
SODIUM HYPOCHLORITE 0.125 % MISC SOLN,,68035,LOCAL,Facility,Outpatient,473 mL,mL,,66,56.1,18.9156,66,"Health Partners, Inc.",Medicare Advantage,32.34,49,,percent of total billed charges,,
SODIUM HYPOCHLORITE 0.125 % MISC SOLN,,68035,LOCAL,Facility,Inpatient,473 mL,mL,,66,56.1,18.9156,66,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SODIUM HYPOCHLORITE 0.125 % MISC SOLN,,68035,LOCAL,Facility,Both,473 mL,mL,,66,56.1,18.9156,66,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),39.6,60,,percent of total billed charges,,
SODIUM HYPOCHLORITE 0.125 % MISC SOLN,,68035,LOCAL,Facility,Both,473 mL,mL,,66,56.1,18.9156,66,"Health Partners, Inc.",State of Minnesota Advantage Program,53.79,81.5,,percent of total billed charges,,
SODIUM HYPOCHLORITE 0.125 % MISC SOLN,,68035,LOCAL,Facility,Both,473 mL,mL,,66,56.1,18.9156,66,"Health Partners, Inc.",State Public Programs,33,50,,percent of total billed charges,,
SODIUM HYPOCHLORITE 0.125 % MISC SOLN,,68035,LOCAL,Facility,Both,473 mL,mL,,66,56.1,18.9156,66,Humana Insurance Company,Commercial PPO,62.7,95,,percent of total billed charges,,
SODIUM HYPOCHLORITE 0.125 % MISC SOLN,,68035,LOCAL,Facility,Outpatient,473 mL,mL,,66,56.1,18.9156,66,Humana Insurance Company,Medicare PPO,32.34,49,,percent of total billed charges,,
SODIUM HYPOCHLORITE 0.125 % MISC SOLN,,68035,LOCAL,Facility,Inpatient,473 mL,mL,,66,56.1,18.9156,66,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
SODIUM HYPOCHLORITE 0.125 % MISC SOLN,,68035,LOCAL,Facility,Both,473 mL,mL,,66,56.1,18.9156,66,Medica,Individual & Family,65.406,99.1,,percent of total billed charges,,
SODIUM HYPOCHLORITE 0.125 % MISC SOLN,,68035,LOCAL,Facility,Outpatient,473 mL,mL,,66,56.1,18.9156,66,Medica,Medica Advantage Solution,32.868,49.8,,percent of total billed charges,,
SODIUM HYPOCHLORITE 0.125 % MISC SOLN,,68035,LOCAL,Facility,Inpatient,473 mL,mL,,66,56.1,18.9156,66,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
SODIUM HYPOCHLORITE 0.125 % MISC SOLN,,68035,LOCAL,Facility,Outpatient,473 mL,mL,,66,56.1,18.9156,66,Medica,Medical Assistance,29.436,44.6,,percent of total billed charges,,
SODIUM HYPOCHLORITE 0.125 % MISC SOLN,,68035,LOCAL,Facility,Inpatient,473 mL,mL,,66,56.1,18.9156,66,Medica,Medical Assistance,,,,,Included in per diem rate,
SODIUM HYPOCHLORITE 0.125 % MISC SOLN,,68035,LOCAL,Facility,Outpatient,473 mL,mL,,66,56.1,18.9156,66,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,32.868,49.8,,percent of total billed charges,,
SODIUM HYPOCHLORITE 0.125 % MISC SOLN,,68035,LOCAL,Facility,Inpatient,473 mL,mL,,66,56.1,18.9156,66,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
SODIUM HYPOCHLORITE 0.125 % MISC SOLN,,68035,LOCAL,Facility,Both,473 mL,mL,,66,56.1,18.9156,66,"Multiplan, Inc.","Multiplan, Inc.",62.04,94,,percent of total billed charges,,
SODIUM HYPOCHLORITE 0.125 % MISC SOLN,,68035,LOCAL,Facility,Outpatient,473 mL,mL,,66,56.1,18.9156,66,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,59.466,90.1,,percent of total billed charges,,
SODIUM HYPOCHLORITE 0.125 % MISC SOLN,,68035,LOCAL,Facility,Inpatient,473 mL,mL,,66,56.1,18.9156,66,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
SODIUM HYPOCHLORITE 0.125 % MISC SOLN,,68035,LOCAL,Facility,Both,473 mL,mL,,66,56.1,18.9156,66,"Preferred One Administrative Services, INC.",PPO,65.076,98.6,,percent of total billed charges,,
SODIUM HYPOCHLORITE 0.125 % MISC SOLN,,68035,LOCAL,Facility,Outpatient,473 mL,mL,,66,56.1,18.9156,66,PrimeWest Health,Minnesota Senior Health Options (MSHO),33.957,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
SODIUM HYPOCHLORITE 0.125 % MISC SOLN,,68035,LOCAL,Facility,Inpatient,473 mL,mL,,66,56.1,18.9156,66,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SODIUM HYPOCHLORITE 0.125 % MISC SOLN,,68035,LOCAL,Facility,Outpatient,473 mL,mL,,66,56.1,18.9156,66,PrimeWest Health,MinnesotaCare,33.8976,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
SODIUM HYPOCHLORITE 0.125 % MISC SOLN,,68035,LOCAL,Facility,Inpatient,473 mL,mL,,66,56.1,18.9156,66,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
SODIUM HYPOCHLORITE 0.125 % MISC SOLN,,68035,LOCAL,Facility,Both,473 mL,mL,,66,56.1,18.9156,66,Sanford Health Plan,Sanford Health Plan,60.72,92,,percent of total billed charges,,
SODIUM HYPOCHLORITE 0.125 % MISC SOLN,,68035,LOCAL,Facility,Outpatient,473 mL,mL,,66,56.1,18.9156,66,"UCare Health, Inc.",Individual & Family Plan,37.191,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
SODIUM HYPOCHLORITE 0.125 % MISC SOLN,,68035,LOCAL,Facility,Inpatient,473 mL,mL,,66,56.1,18.9156,66,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
SODIUM HYPOCHLORITE 0.125 % MISC SOLN,,68035,LOCAL,Facility,Outpatient,473 mL,mL,,66,56.1,18.9156,66,"UCare Health, Inc.",Medical Assistance,33.3102,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SODIUM HYPOCHLORITE 0.125 % MISC SOLN,,68035,LOCAL,Facility,Inpatient,473 mL,mL,,66,56.1,18.9156,66,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
SODIUM HYPOCHLORITE 0.125 % MISC SOLN,,68035,LOCAL,Facility,Outpatient,473 mL,mL,,66,56.1,18.9156,66,"UCare Health, Inc.",Medicare Advantage,33.3102,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SODIUM HYPOCHLORITE 0.125 % MISC SOLN,,68035,LOCAL,Facility,Inpatient,473 mL,mL,,66,56.1,18.9156,66,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SODIUM HYPOCHLORITE 0.125 % MISC SOLN,,68035,LOCAL,Facility,Outpatient,473 mL,mL,,66,56.1,18.9156,66,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),33.3102,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SODIUM HYPOCHLORITE 0.125 % MISC SOLN,,68035,LOCAL,Facility,Inpatient,473 mL,mL,,66,56.1,18.9156,66,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SODIUM HYPOCHLORITE 0.125 % MISC SOLN,,68035,LOCAL,Facility,Both,473 mL,mL,,66,56.1,18.9156,66,UnitedHealthcare,Individual & Family,62.04,94,,percent of total billed charges,,
SODIUM HYPOCHLORITE 0.125 % MISC SOLN,,68035,LOCAL,Facility,Outpatient,473 mL,mL,,66,56.1,18.9156,66,UnitedHealthcare,Medicare Advantage,32.34,49,,percent of total billed charges,,
SODIUM HYPOCHLORITE 0.125 % MISC SOLN,,68035,LOCAL,Facility,Inpatient,473 mL,mL,,66,56.1,18.9156,66,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
SODIUM HYPOCHLORITE 0.125 % MISC SOLN,,68035,LOCAL,Facility,Outpatient,473 mL,mL,,66,56.1,18.9156,66,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,31.68,48,,percent of total billed charges,,100% of DHS outpatient percentage
SODIUM HYPOCHLORITE 0.125 % MISC SOLN,,68035,LOCAL,Facility,Inpatient,473 mL,mL,,66,56.1,18.9156,66,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
COMPOUND VEHICLE SUSP SF NO.20 ORAL SUSP,,119478,LOCAL,Facility,Both,473 mL,mL,,96,81.6,27.5136,96,Aetna,Commercial,88.32,92,,percent of total billed charges,,
COMPOUND VEHICLE SUSP SF NO.20 ORAL SUSP,,119478,LOCAL,Facility,Outpatient,473 mL,mL,,96,81.6,27.5136,96,Aetna,Medicare Advantage,47.04,49,,percent of total billed charges,,
COMPOUND VEHICLE SUSP SF NO.20 ORAL SUSP,,119478,LOCAL,Facility,Inpatient,473 mL,mL,,96,81.6,27.5136,96,Aetna,Medicare Advantage,,,,,Included in per diem rate,
COMPOUND VEHICLE SUSP SF NO.20 ORAL SUSP,,119478,LOCAL,Facility,Both,473 mL,mL,,96,81.6,27.5136,96,Aetna,PPO,89.28,93,,percent of total billed charges,,
COMPOUND VEHICLE SUSP SF NO.20 ORAL SUSP,,119478,LOCAL,Facility,Both,473 mL,mL,,96,81.6,27.5136,96,America's PPO,America's PPO,92.1888,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
COMPOUND VEHICLE SUSP SF NO.20 ORAL SUSP,,119478,LOCAL,Facility,Both,473 mL,mL,,96,81.6,27.5136,96,BlueCross BlueShield Minnesota, Federal Employee Program,94.464,98.4,,percent of total billed charges,,
COMPOUND VEHICLE SUSP SF NO.20 ORAL SUSP,,119478,LOCAL,Facility,Both,473 mL,mL,,96,81.6,27.5136,96,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,96,100,,percent of total billed charges,,
COMPOUND VEHICLE SUSP SF NO.20 ORAL SUSP,,119478,LOCAL,Facility,Both,473 mL,mL,,96,81.6,27.5136,96,BlueCross BlueShield Minnesota,High Value Network Plan,86.4,90,,percent of total billed charges,,
COMPOUND VEHICLE SUSP SF NO.20 ORAL SUSP,,119478,LOCAL,Facility,Outpatient,473 mL,mL,,96,81.6,27.5136,96,BlueCross BlueShield Minnesota,Medicare Advantage,47.04,49,,percent of total billed charges,,
COMPOUND VEHICLE SUSP SF NO.20 ORAL SUSP,,119478,LOCAL,Facility,Inpatient,473 mL,mL,,96,81.6,27.5136,96,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
COMPOUND VEHICLE SUSP SF NO.20 ORAL SUSP,,119478,LOCAL,Facility,Both,473 mL,mL,,96,81.6,27.5136,96,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,85.0272,88.57,,percent of total billed charges,,
COMPOUND VEHICLE SUSP SF NO.20 ORAL SUSP,,119478,LOCAL,Facility,Both,473 mL,mL,,96,81.6,27.5136,96,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,27.5136,28.66,,percent of total billed charges,,
COMPOUND VEHICLE SUSP SF NO.20 ORAL SUSP,,119478,LOCAL,Facility,Outpatient,473 mL,mL,,96,81.6,27.5136,96,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),47.04,49,,percent of total billed charges,,
COMPOUND VEHICLE SUSP SF NO.20 ORAL SUSP,,119478,LOCAL,Facility,Inpatient,473 mL,mL,,96,81.6,27.5136,96,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
COMPOUND VEHICLE SUSP SF NO.20 ORAL SUSP,,119478,LOCAL,Facility,Both,473 mL,mL,,96,81.6,27.5136,96,CorVel,Worker's Compensation,96,100,,percent of total billed charges,,
COMPOUND VEHICLE SUSP SF NO.20 ORAL SUSP,,119478,LOCAL,Facility,Both,473 mL,mL,,96,81.6,27.5136,96,First Health Group Corporation,First Health Network,93.12,97,,percent of total billed charges,,
COMPOUND VEHICLE SUSP SF NO.20 ORAL SUSP,,119478,LOCAL,Facility,Both,473 mL,mL,,96,81.6,27.5136,96,"Health Partners, Inc.",Commercial,90.816,94.6,,percent of total billed charges,,
COMPOUND VEHICLE SUSP SF NO.20 ORAL SUSP,,119478,LOCAL,Facility,Outpatient,473 mL,mL,,96,81.6,27.5136,96,"Health Partners, Inc.",Medicare Advantage,47.04,49,,percent of total billed charges,,
COMPOUND VEHICLE SUSP SF NO.20 ORAL SUSP,,119478,LOCAL,Facility,Inpatient,473 mL,mL,,96,81.6,27.5136,96,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
COMPOUND VEHICLE SUSP SF NO.20 ORAL SUSP,,119478,LOCAL,Facility,Both,473 mL,mL,,96,81.6,27.5136,96,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),57.6,60,,percent of total billed charges,,
COMPOUND VEHICLE SUSP SF NO.20 ORAL SUSP,,119478,LOCAL,Facility,Both,473 mL,mL,,96,81.6,27.5136,96,"Health Partners, Inc.",State of Minnesota Advantage Program,78.24,81.5,,percent of total billed charges,,
COMPOUND VEHICLE SUSP SF NO.20 ORAL SUSP,,119478,LOCAL,Facility,Both,473 mL,mL,,96,81.6,27.5136,96,"Health Partners, Inc.",State Public Programs,48,50,,percent of total billed charges,,
COMPOUND VEHICLE SUSP SF NO.20 ORAL SUSP,,119478,LOCAL,Facility,Both,473 mL,mL,,96,81.6,27.5136,96,Humana Insurance Company,Commercial PPO,91.2,95,,percent of total billed charges,,
COMPOUND VEHICLE SUSP SF NO.20 ORAL SUSP,,119478,LOCAL,Facility,Outpatient,473 mL,mL,,96,81.6,27.5136,96,Humana Insurance Company,Medicare PPO,47.04,49,,percent of total billed charges,,
COMPOUND VEHICLE SUSP SF NO.20 ORAL SUSP,,119478,LOCAL,Facility,Inpatient,473 mL,mL,,96,81.6,27.5136,96,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
COMPOUND VEHICLE SUSP SF NO.20 ORAL SUSP,,119478,LOCAL,Facility,Both,473 mL,mL,,96,81.6,27.5136,96,Medica,Individual & Family,95.136,99.1,,percent of total billed charges,,
COMPOUND VEHICLE SUSP SF NO.20 ORAL SUSP,,119478,LOCAL,Facility,Outpatient,473 mL,mL,,96,81.6,27.5136,96,Medica,Medica Advantage Solution,47.808,49.8,,percent of total billed charges,,
COMPOUND VEHICLE SUSP SF NO.20 ORAL SUSP,,119478,LOCAL,Facility,Inpatient,473 mL,mL,,96,81.6,27.5136,96,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
COMPOUND VEHICLE SUSP SF NO.20 ORAL SUSP,,119478,LOCAL,Facility,Outpatient,473 mL,mL,,96,81.6,27.5136,96,Medica,Medical Assistance,42.816,44.6,,percent of total billed charges,,
COMPOUND VEHICLE SUSP SF NO.20 ORAL SUSP,,119478,LOCAL,Facility,Inpatient,473 mL,mL,,96,81.6,27.5136,96,Medica,Medical Assistance,,,,,Included in per diem rate,
COMPOUND VEHICLE SUSP SF NO.20 ORAL SUSP,,119478,LOCAL,Facility,Outpatient,473 mL,mL,,96,81.6,27.5136,96,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,47.808,49.8,,percent of total billed charges,,
COMPOUND VEHICLE SUSP SF NO.20 ORAL SUSP,,119478,LOCAL,Facility,Inpatient,473 mL,mL,,96,81.6,27.5136,96,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
COMPOUND VEHICLE SUSP SF NO.20 ORAL SUSP,,119478,LOCAL,Facility,Both,473 mL,mL,,96,81.6,27.5136,96,"Multiplan, Inc.","Multiplan, Inc.",90.24,94,,percent of total billed charges,,
COMPOUND VEHICLE SUSP SF NO.20 ORAL SUSP,,119478,LOCAL,Facility,Outpatient,473 mL,mL,,96,81.6,27.5136,96,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,86.496,90.1,,percent of total billed charges,,
COMPOUND VEHICLE SUSP SF NO.20 ORAL SUSP,,119478,LOCAL,Facility,Inpatient,473 mL,mL,,96,81.6,27.5136,96,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
COMPOUND VEHICLE SUSP SF NO.20 ORAL SUSP,,119478,LOCAL,Facility,Both,473 mL,mL,,96,81.6,27.5136,96,"Preferred One Administrative Services, INC.",PPO,94.656,98.6,,percent of total billed charges,,
COMPOUND VEHICLE SUSP SF NO.20 ORAL SUSP,,119478,LOCAL,Facility,Outpatient,473 mL,mL,,96,81.6,27.5136,96,PrimeWest Health,Minnesota Senior Health Options (MSHO),49.392,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
COMPOUND VEHICLE SUSP SF NO.20 ORAL SUSP,,119478,LOCAL,Facility,Inpatient,473 mL,mL,,96,81.6,27.5136,96,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
COMPOUND VEHICLE SUSP SF NO.20 ORAL SUSP,,119478,LOCAL,Facility,Outpatient,473 mL,mL,,96,81.6,27.5136,96,PrimeWest Health,MinnesotaCare,49.3056,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
COMPOUND VEHICLE SUSP SF NO.20 ORAL SUSP,,119478,LOCAL,Facility,Inpatient,473 mL,mL,,96,81.6,27.5136,96,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
COMPOUND VEHICLE SUSP SF NO.20 ORAL SUSP,,119478,LOCAL,Facility,Both,473 mL,mL,,96,81.6,27.5136,96,Sanford Health Plan,Sanford Health Plan,88.32,92,,percent of total billed charges,,
COMPOUND VEHICLE SUSP SF NO.20 ORAL SUSP,,119478,LOCAL,Facility,Outpatient,473 mL,mL,,96,81.6,27.5136,96,"UCare Health, Inc.",Individual & Family Plan,54.096,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
COMPOUND VEHICLE SUSP SF NO.20 ORAL SUSP,,119478,LOCAL,Facility,Inpatient,473 mL,mL,,96,81.6,27.5136,96,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
COMPOUND VEHICLE SUSP SF NO.20 ORAL SUSP,,119478,LOCAL,Facility,Outpatient,473 mL,mL,,96,81.6,27.5136,96,"UCare Health, Inc.",Medical Assistance,48.4512,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
COMPOUND VEHICLE SUSP SF NO.20 ORAL SUSP,,119478,LOCAL,Facility,Inpatient,473 mL,mL,,96,81.6,27.5136,96,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
COMPOUND VEHICLE SUSP SF NO.20 ORAL SUSP,,119478,LOCAL,Facility,Outpatient,473 mL,mL,,96,81.6,27.5136,96,"UCare Health, Inc.",Medicare Advantage,48.4512,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
COMPOUND VEHICLE SUSP SF NO.20 ORAL SUSP,,119478,LOCAL,Facility,Inpatient,473 mL,mL,,96,81.6,27.5136,96,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
COMPOUND VEHICLE SUSP SF NO.20 ORAL SUSP,,119478,LOCAL,Facility,Outpatient,473 mL,mL,,96,81.6,27.5136,96,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),48.4512,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
COMPOUND VEHICLE SUSP SF NO.20 ORAL SUSP,,119478,LOCAL,Facility,Inpatient,473 mL,mL,,96,81.6,27.5136,96,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
COMPOUND VEHICLE SUSP SF NO.20 ORAL SUSP,,119478,LOCAL,Facility,Both,473 mL,mL,,96,81.6,27.5136,96,UnitedHealthcare,Individual & Family,90.24,94,,percent of total billed charges,,
COMPOUND VEHICLE SUSP SF NO.20 ORAL SUSP,,119478,LOCAL,Facility,Outpatient,473 mL,mL,,96,81.6,27.5136,96,UnitedHealthcare,Medicare Advantage,47.04,49,,percent of total billed charges,,
COMPOUND VEHICLE SUSP SF NO.20 ORAL SUSP,,119478,LOCAL,Facility,Inpatient,473 mL,mL,,96,81.6,27.5136,96,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
COMPOUND VEHICLE SUSP SF NO.20 ORAL SUSP,,119478,LOCAL,Facility,Outpatient,473 mL,mL,,96,81.6,27.5136,96,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,46.08,48,,percent of total billed charges,,100% of DHS outpatient percentage
COMPOUND VEHICLE SUSP SF NO.20 ORAL SUSP,,119478,LOCAL,Facility,Inpatient,473 mL,mL,,96,81.6,27.5136,96,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
WHEAT DEXTRIN 3 GRAM/3.8 GRAM ORAL POWD,,109075,LOCAL,Facility,Both,475 g,g,,87,73.95,24.9342,87,Aetna,Commercial,80.04,92,,percent of total billed charges,,
WHEAT DEXTRIN 3 GRAM/3.8 GRAM ORAL POWD,,109075,LOCAL,Facility,Outpatient,475 g,g,,87,73.95,24.9342,87,Aetna,Medicare Advantage,42.63,49,,percent of total billed charges,,
WHEAT DEXTRIN 3 GRAM/3.8 GRAM ORAL POWD,,109075,LOCAL,Facility,Inpatient,475 g,g,,87,73.95,24.9342,87,Aetna,Medicare Advantage,,,,,Included in per diem rate,
WHEAT DEXTRIN 3 GRAM/3.8 GRAM ORAL POWD,,109075,LOCAL,Facility,Both,475 g,g,,87,73.95,24.9342,87,Aetna,PPO,80.91,93,,percent of total billed charges,,
WHEAT DEXTRIN 3 GRAM/3.8 GRAM ORAL POWD,,109075,LOCAL,Facility,Both,475 g,g,,87,73.95,24.9342,87,America's PPO,America's PPO,83.5461,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
WHEAT DEXTRIN 3 GRAM/3.8 GRAM ORAL POWD,,109075,LOCAL,Facility,Both,475 g,g,,87,73.95,24.9342,87,BlueCross BlueShield Minnesota, Federal Employee Program,85.608,98.4,,percent of total billed charges,,
WHEAT DEXTRIN 3 GRAM/3.8 GRAM ORAL POWD,,109075,LOCAL,Facility,Both,475 g,g,,87,73.95,24.9342,87,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,87,100,,percent of total billed charges,,
WHEAT DEXTRIN 3 GRAM/3.8 GRAM ORAL POWD,,109075,LOCAL,Facility,Both,475 g,g,,87,73.95,24.9342,87,BlueCross BlueShield Minnesota,High Value Network Plan,78.3,90,,percent of total billed charges,,
WHEAT DEXTRIN 3 GRAM/3.8 GRAM ORAL POWD,,109075,LOCAL,Facility,Outpatient,475 g,g,,87,73.95,24.9342,87,BlueCross BlueShield Minnesota,Medicare Advantage,42.63,49,,percent of total billed charges,,
WHEAT DEXTRIN 3 GRAM/3.8 GRAM ORAL POWD,,109075,LOCAL,Facility,Inpatient,475 g,g,,87,73.95,24.9342,87,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
WHEAT DEXTRIN 3 GRAM/3.8 GRAM ORAL POWD,,109075,LOCAL,Facility,Both,475 g,g,,87,73.95,24.9342,87,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,77.0559,88.57,,percent of total billed charges,,
WHEAT DEXTRIN 3 GRAM/3.8 GRAM ORAL POWD,,109075,LOCAL,Facility,Both,475 g,g,,87,73.95,24.9342,87,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,24.9342,28.66,,percent of total billed charges,,
WHEAT DEXTRIN 3 GRAM/3.8 GRAM ORAL POWD,,109075,LOCAL,Facility,Outpatient,475 g,g,,87,73.95,24.9342,87,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),42.63,49,,percent of total billed charges,,
WHEAT DEXTRIN 3 GRAM/3.8 GRAM ORAL POWD,,109075,LOCAL,Facility,Inpatient,475 g,g,,87,73.95,24.9342,87,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
WHEAT DEXTRIN 3 GRAM/3.8 GRAM ORAL POWD,,109075,LOCAL,Facility,Both,475 g,g,,87,73.95,24.9342,87,CorVel,Worker's Compensation,87,100,,percent of total billed charges,,
WHEAT DEXTRIN 3 GRAM/3.8 GRAM ORAL POWD,,109075,LOCAL,Facility,Both,475 g,g,,87,73.95,24.9342,87,First Health Group Corporation,First Health Network,84.39,97,,percent of total billed charges,,
WHEAT DEXTRIN 3 GRAM/3.8 GRAM ORAL POWD,,109075,LOCAL,Facility,Both,475 g,g,,87,73.95,24.9342,87,"Health Partners, Inc.",Commercial,82.302,94.6,,percent of total billed charges,,
WHEAT DEXTRIN 3 GRAM/3.8 GRAM ORAL POWD,,109075,LOCAL,Facility,Outpatient,475 g,g,,87,73.95,24.9342,87,"Health Partners, Inc.",Medicare Advantage,42.63,49,,percent of total billed charges,,
WHEAT DEXTRIN 3 GRAM/3.8 GRAM ORAL POWD,,109075,LOCAL,Facility,Inpatient,475 g,g,,87,73.95,24.9342,87,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
WHEAT DEXTRIN 3 GRAM/3.8 GRAM ORAL POWD,,109075,LOCAL,Facility,Both,475 g,g,,87,73.95,24.9342,87,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),52.2,60,,percent of total billed charges,,
WHEAT DEXTRIN 3 GRAM/3.8 GRAM ORAL POWD,,109075,LOCAL,Facility,Both,475 g,g,,87,73.95,24.9342,87,"Health Partners, Inc.",State of Minnesota Advantage Program,70.905,81.5,,percent of total billed charges,,
WHEAT DEXTRIN 3 GRAM/3.8 GRAM ORAL POWD,,109075,LOCAL,Facility,Both,475 g,g,,87,73.95,24.9342,87,"Health Partners, Inc.",State Public Programs,43.5,50,,percent of total billed charges,,
WHEAT DEXTRIN 3 GRAM/3.8 GRAM ORAL POWD,,109075,LOCAL,Facility,Both,475 g,g,,87,73.95,24.9342,87,Humana Insurance Company,Commercial PPO,82.65,95,,percent of total billed charges,,
WHEAT DEXTRIN 3 GRAM/3.8 GRAM ORAL POWD,,109075,LOCAL,Facility,Outpatient,475 g,g,,87,73.95,24.9342,87,Humana Insurance Company,Medicare PPO,42.63,49,,percent of total billed charges,,
WHEAT DEXTRIN 3 GRAM/3.8 GRAM ORAL POWD,,109075,LOCAL,Facility,Inpatient,475 g,g,,87,73.95,24.9342,87,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
WHEAT DEXTRIN 3 GRAM/3.8 GRAM ORAL POWD,,109075,LOCAL,Facility,Both,475 g,g,,87,73.95,24.9342,87,Medica,Individual & Family,86.217,99.1,,percent of total billed charges,,
WHEAT DEXTRIN 3 GRAM/3.8 GRAM ORAL POWD,,109075,LOCAL,Facility,Outpatient,475 g,g,,87,73.95,24.9342,87,Medica,Medica Advantage Solution,43.326,49.8,,percent of total billed charges,,
WHEAT DEXTRIN 3 GRAM/3.8 GRAM ORAL POWD,,109075,LOCAL,Facility,Inpatient,475 g,g,,87,73.95,24.9342,87,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
WHEAT DEXTRIN 3 GRAM/3.8 GRAM ORAL POWD,,109075,LOCAL,Facility,Outpatient,475 g,g,,87,73.95,24.9342,87,Medica,Medical Assistance,38.802,44.6,,percent of total billed charges,,
WHEAT DEXTRIN 3 GRAM/3.8 GRAM ORAL POWD,,109075,LOCAL,Facility,Inpatient,475 g,g,,87,73.95,24.9342,87,Medica,Medical Assistance,,,,,Included in per diem rate,
WHEAT DEXTRIN 3 GRAM/3.8 GRAM ORAL POWD,,109075,LOCAL,Facility,Outpatient,475 g,g,,87,73.95,24.9342,87,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,43.326,49.8,,percent of total billed charges,,
WHEAT DEXTRIN 3 GRAM/3.8 GRAM ORAL POWD,,109075,LOCAL,Facility,Inpatient,475 g,g,,87,73.95,24.9342,87,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
WHEAT DEXTRIN 3 GRAM/3.8 GRAM ORAL POWD,,109075,LOCAL,Facility,Both,475 g,g,,87,73.95,24.9342,87,"Multiplan, Inc.","Multiplan, Inc.",81.78,94,,percent of total billed charges,,
WHEAT DEXTRIN 3 GRAM/3.8 GRAM ORAL POWD,,109075,LOCAL,Facility,Outpatient,475 g,g,,87,73.95,24.9342,87,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,78.387,90.1,,percent of total billed charges,,
WHEAT DEXTRIN 3 GRAM/3.8 GRAM ORAL POWD,,109075,LOCAL,Facility,Inpatient,475 g,g,,87,73.95,24.9342,87,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
WHEAT DEXTRIN 3 GRAM/3.8 GRAM ORAL POWD,,109075,LOCAL,Facility,Both,475 g,g,,87,73.95,24.9342,87,"Preferred One Administrative Services, INC.",PPO,85.782,98.6,,percent of total billed charges,,
WHEAT DEXTRIN 3 GRAM/3.8 GRAM ORAL POWD,,109075,LOCAL,Facility,Outpatient,475 g,g,,87,73.95,24.9342,87,PrimeWest Health,Minnesota Senior Health Options (MSHO),44.7615,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
WHEAT DEXTRIN 3 GRAM/3.8 GRAM ORAL POWD,,109075,LOCAL,Facility,Inpatient,475 g,g,,87,73.95,24.9342,87,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
WHEAT DEXTRIN 3 GRAM/3.8 GRAM ORAL POWD,,109075,LOCAL,Facility,Outpatient,475 g,g,,87,73.95,24.9342,87,PrimeWest Health,MinnesotaCare,44.6832,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
WHEAT DEXTRIN 3 GRAM/3.8 GRAM ORAL POWD,,109075,LOCAL,Facility,Inpatient,475 g,g,,87,73.95,24.9342,87,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
WHEAT DEXTRIN 3 GRAM/3.8 GRAM ORAL POWD,,109075,LOCAL,Facility,Both,475 g,g,,87,73.95,24.9342,87,Sanford Health Plan,Sanford Health Plan,80.04,92,,percent of total billed charges,,
WHEAT DEXTRIN 3 GRAM/3.8 GRAM ORAL POWD,,109075,LOCAL,Facility,Outpatient,475 g,g,,87,73.95,24.9342,87,"UCare Health, Inc.",Individual & Family Plan,49.0245,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
WHEAT DEXTRIN 3 GRAM/3.8 GRAM ORAL POWD,,109075,LOCAL,Facility,Inpatient,475 g,g,,87,73.95,24.9342,87,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
WHEAT DEXTRIN 3 GRAM/3.8 GRAM ORAL POWD,,109075,LOCAL,Facility,Outpatient,475 g,g,,87,73.95,24.9342,87,"UCare Health, Inc.",Medical Assistance,43.9089,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
WHEAT DEXTRIN 3 GRAM/3.8 GRAM ORAL POWD,,109075,LOCAL,Facility,Inpatient,475 g,g,,87,73.95,24.9342,87,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
WHEAT DEXTRIN 3 GRAM/3.8 GRAM ORAL POWD,,109075,LOCAL,Facility,Outpatient,475 g,g,,87,73.95,24.9342,87,"UCare Health, Inc.",Medicare Advantage,43.9089,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
WHEAT DEXTRIN 3 GRAM/3.8 GRAM ORAL POWD,,109075,LOCAL,Facility,Inpatient,475 g,g,,87,73.95,24.9342,87,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
WHEAT DEXTRIN 3 GRAM/3.8 GRAM ORAL POWD,,109075,LOCAL,Facility,Outpatient,475 g,g,,87,73.95,24.9342,87,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),43.9089,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
WHEAT DEXTRIN 3 GRAM/3.8 GRAM ORAL POWD,,109075,LOCAL,Facility,Inpatient,475 g,g,,87,73.95,24.9342,87,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
WHEAT DEXTRIN 3 GRAM/3.8 GRAM ORAL POWD,,109075,LOCAL,Facility,Both,475 g,g,,87,73.95,24.9342,87,UnitedHealthcare,Individual & Family,81.78,94,,percent of total billed charges,,
WHEAT DEXTRIN 3 GRAM/3.8 GRAM ORAL POWD,,109075,LOCAL,Facility,Outpatient,475 g,g,,87,73.95,24.9342,87,UnitedHealthcare,Medicare Advantage,42.63,49,,percent of total billed charges,,
WHEAT DEXTRIN 3 GRAM/3.8 GRAM ORAL POWD,,109075,LOCAL,Facility,Inpatient,475 g,g,,87,73.95,24.9342,87,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
WHEAT DEXTRIN 3 GRAM/3.8 GRAM ORAL POWD,,109075,LOCAL,Facility,Outpatient,475 g,g,,87,73.95,24.9342,87,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,41.76,48,,percent of total billed charges,,100% of DHS outpatient percentage
WHEAT DEXTRIN 3 GRAM/3.8 GRAM ORAL POWD,,109075,LOCAL,Facility,Inpatient,475 g,g,,87,73.95,24.9342,87,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
PREDNISOLONE 15 MG/5 ML ORAL SOLN,,J7510,HCPCS,Facility,Both,480 mL,mL,,721,612.85,206.6386,721,Aetna,Commercial,663.32,92,,percent of total billed charges,,
PREDNISOLONE 15 MG/5 ML ORAL SOLN,,J7510,HCPCS,Facility,Outpatient,480 mL,mL,,721,612.85,206.6386,721,Aetna,Medicare Advantage,353.29,49,,percent of total billed charges,,
PREDNISOLONE 15 MG/5 ML ORAL SOLN,,J7510,HCPCS,Facility,Inpatient,480 mL,mL,,721,612.85,206.6386,721,Aetna,Medicare Advantage,,,,,Included in per diem rate,
PREDNISOLONE 15 MG/5 ML ORAL SOLN,,J7510,HCPCS,Facility,Both,480 mL,mL,,721,612.85,206.6386,721,Aetna,PPO,670.53,93,,percent of total billed charges,,
PREDNISOLONE 15 MG/5 ML ORAL SOLN,,J7510,HCPCS,Facility,Both,480 mL,mL,,721,612.85,206.6386,721,America's PPO,America's PPO,692.3763,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
PREDNISOLONE 15 MG/5 ML ORAL SOLN,,J7510,HCPCS,Facility,Both,480 mL,mL,,721,612.85,206.6386,721,BlueCross BlueShield Minnesota, Federal Employee Program,709.464,98.4,,percent of total billed charges,,
PREDNISOLONE 15 MG/5 ML ORAL SOLN,,J7510,HCPCS,Facility,Both,480 mL,mL,,721,612.85,206.6386,721,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,721,100,,percent of total billed charges,,
PREDNISOLONE 15 MG/5 ML ORAL SOLN,,J7510,HCPCS,Facility,Both,480 mL,mL,,721,612.85,206.6386,721,BlueCross BlueShield Minnesota,High Value Network Plan,648.9,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
PREDNISOLONE 15 MG/5 ML ORAL SOLN,,J7510,HCPCS,Facility,Outpatient,480 mL,mL,,721,612.85,206.6386,721,BlueCross BlueShield Minnesota,Medicare Advantage,353.29,49,,percent of total billed charges,,
PREDNISOLONE 15 MG/5 ML ORAL SOLN,,J7510,HCPCS,Facility,Inpatient,480 mL,mL,,721,612.85,206.6386,721,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
PREDNISOLONE 15 MG/5 ML ORAL SOLN,,J7510,HCPCS,Facility,Both,480 mL,mL,,721,612.85,206.6386,721,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,638.5897,88.57,,percent of total billed charges,,
PREDNISOLONE 15 MG/5 ML ORAL SOLN,,J7510,HCPCS,Facility,Both,480 mL,mL,,721,612.85,206.6386,721,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,206.6386,28.66,,percent of total billed charges,,
PREDNISOLONE 15 MG/5 ML ORAL SOLN,,J7510,HCPCS,Facility,Outpatient,480 mL,mL,,721,612.85,206.6386,721,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),353.29,49,,percent of total billed charges,,
PREDNISOLONE 15 MG/5 ML ORAL SOLN,,J7510,HCPCS,Facility,Inpatient,480 mL,mL,,721,612.85,206.6386,721,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
PREDNISOLONE 15 MG/5 ML ORAL SOLN,,J7510,HCPCS,Facility,Both,480 mL,mL,,721,612.85,206.6386,721,CorVel,Worker's Compensation,721,100,,percent of total billed charges,,
PREDNISOLONE 15 MG/5 ML ORAL SOLN,,J7510,HCPCS,Facility,Both,480 mL,mL,,721,612.85,206.6386,721,First Health Group Corporation,First Health Network,699.37,97,,percent of total billed charges,,
PREDNISOLONE 15 MG/5 ML ORAL SOLN,,J7510,HCPCS,Facility,Both,480 mL,mL,,721,612.85,206.6386,721,"Health Partners, Inc.",Commercial,682.066,94.6,,percent of total billed charges,,
PREDNISOLONE 15 MG/5 ML ORAL SOLN,,J7510,HCPCS,Facility,Outpatient,480 mL,mL,,721,612.85,206.6386,721,"Health Partners, Inc.",Medicare Advantage,353.29,49,,percent of total billed charges,,
PREDNISOLONE 15 MG/5 ML ORAL SOLN,,J7510,HCPCS,Facility,Inpatient,480 mL,mL,,721,612.85,206.6386,721,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PREDNISOLONE 15 MG/5 ML ORAL SOLN,,J7510,HCPCS,Facility,Both,480 mL,mL,,721,612.85,206.6386,721,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),432.6,60,,percent of total billed charges,,
PREDNISOLONE 15 MG/5 ML ORAL SOLN,,J7510,HCPCS,Facility,Both,480 mL,mL,,721,612.85,206.6386,721,"Health Partners, Inc.",State of Minnesota Advantage Program,587.615,81.5,,percent of total billed charges,,
PREDNISOLONE 15 MG/5 ML ORAL SOLN,,J7510,HCPCS,Facility,Both,480 mL,mL,,721,612.85,206.6386,721,"Health Partners, Inc.",State Public Programs,360.5,50,,percent of total billed charges,,
PREDNISOLONE 15 MG/5 ML ORAL SOLN,,J7510,HCPCS,Facility,Both,480 mL,mL,,721,612.85,206.6386,721,Humana Insurance Company,Commercial PPO,684.95,95,,percent of total billed charges,,
PREDNISOLONE 15 MG/5 ML ORAL SOLN,,J7510,HCPCS,Facility,Outpatient,480 mL,mL,,721,612.85,206.6386,721,Humana Insurance Company,Medicare PPO,353.29,49,,percent of total billed charges,,
PREDNISOLONE 15 MG/5 ML ORAL SOLN,,J7510,HCPCS,Facility,Inpatient,480 mL,mL,,721,612.85,206.6386,721,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
PREDNISOLONE 15 MG/5 ML ORAL SOLN,,J7510,HCPCS,Facility,Both,480 mL,mL,,721,612.85,206.6386,721,Medica,Individual & Family,714.511,99.1,,percent of total billed charges,,
PREDNISOLONE 15 MG/5 ML ORAL SOLN,,J7510,HCPCS,Facility,Outpatient,480 mL,mL,,721,612.85,206.6386,721,Medica,Medica Advantage Solution,359.058,49.8,,percent of total billed charges,,
PREDNISOLONE 15 MG/5 ML ORAL SOLN,,J7510,HCPCS,Facility,Inpatient,480 mL,mL,,721,612.85,206.6386,721,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
PREDNISOLONE 15 MG/5 ML ORAL SOLN,,J7510,HCPCS,Facility,Outpatient,480 mL,mL,,721,612.85,206.6386,721,Medica,Medical Assistance,321.566,44.6,,percent of total billed charges,,
PREDNISOLONE 15 MG/5 ML ORAL SOLN,,J7510,HCPCS,Facility,Inpatient,480 mL,mL,,721,612.85,206.6386,721,Medica,Medical Assistance,,,,,Included in per diem rate,
PREDNISOLONE 15 MG/5 ML ORAL SOLN,,J7510,HCPCS,Facility,Outpatient,480 mL,mL,,721,612.85,206.6386,721,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,359.058,49.8,,percent of total billed charges,,
PREDNISOLONE 15 MG/5 ML ORAL SOLN,,J7510,HCPCS,Facility,Inpatient,480 mL,mL,,721,612.85,206.6386,721,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
PREDNISOLONE 15 MG/5 ML ORAL SOLN,,J7510,HCPCS,Facility,Both,480 mL,mL,,721,612.85,206.6386,721,"Multiplan, Inc.","Multiplan, Inc.",677.74,94,,percent of total billed charges,,
PREDNISOLONE 15 MG/5 ML ORAL SOLN,,J7510,HCPCS,Facility,Outpatient,480 mL,mL,,721,612.85,206.6386,721,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,649.621,90.1,,percent of total billed charges,,
PREDNISOLONE 15 MG/5 ML ORAL SOLN,,J7510,HCPCS,Facility,Inpatient,480 mL,mL,,721,612.85,206.6386,721,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
PREDNISOLONE 15 MG/5 ML ORAL SOLN,,J7510,HCPCS,Facility,Both,480 mL,mL,,721,612.85,206.6386,721,"Preferred One Administrative Services, INC.",PPO,710.906,98.6,,percent of total billed charges,,
PREDNISOLONE 15 MG/5 ML ORAL SOLN,,J7510,HCPCS,Facility,Outpatient,480 mL,mL,,721,612.85,206.6386,721,PrimeWest Health,Minnesota Senior Health Options (MSHO),370.9545,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
PREDNISOLONE 15 MG/5 ML ORAL SOLN,,J7510,HCPCS,Facility,Inpatient,480 mL,mL,,721,612.85,206.6386,721,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PREDNISOLONE 15 MG/5 ML ORAL SOLN,,J7510,HCPCS,Facility,Outpatient,480 mL,mL,,721,612.85,206.6386,721,PrimeWest Health,MinnesotaCare,370.3056,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
PREDNISOLONE 15 MG/5 ML ORAL SOLN,,J7510,HCPCS,Facility,Inpatient,480 mL,mL,,721,612.85,206.6386,721,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
PREDNISOLONE 15 MG/5 ML ORAL SOLN,,J7510,HCPCS,Facility,Both,480 mL,mL,,721,612.85,206.6386,721,Sanford Health Plan,Sanford Health Plan,663.32,92,,percent of total billed charges,,
PREDNISOLONE 15 MG/5 ML ORAL SOLN,,J7510,HCPCS,Facility,Outpatient,480 mL,mL,,721,612.85,206.6386,721,"UCare Health, Inc.",Individual & Family Plan,406.2835,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
PREDNISOLONE 15 MG/5 ML ORAL SOLN,,J7510,HCPCS,Facility,Inpatient,480 mL,mL,,721,612.85,206.6386,721,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
PREDNISOLONE 15 MG/5 ML ORAL SOLN,,J7510,HCPCS,Facility,Outpatient,480 mL,mL,,721,612.85,206.6386,721,"UCare Health, Inc.",Medical Assistance,363.8887,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PREDNISOLONE 15 MG/5 ML ORAL SOLN,,J7510,HCPCS,Facility,Inpatient,480 mL,mL,,721,612.85,206.6386,721,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
PREDNISOLONE 15 MG/5 ML ORAL SOLN,,J7510,HCPCS,Facility,Outpatient,480 mL,mL,,721,612.85,206.6386,721,"UCare Health, Inc.",Medicare Advantage,363.8887,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PREDNISOLONE 15 MG/5 ML ORAL SOLN,,J7510,HCPCS,Facility,Inpatient,480 mL,mL,,721,612.85,206.6386,721,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PREDNISOLONE 15 MG/5 ML ORAL SOLN,,J7510,HCPCS,Facility,Outpatient,480 mL,mL,,721,612.85,206.6386,721,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),363.8887,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PREDNISOLONE 15 MG/5 ML ORAL SOLN,,J7510,HCPCS,Facility,Inpatient,480 mL,mL,,721,612.85,206.6386,721,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PREDNISOLONE 15 MG/5 ML ORAL SOLN,,J7510,HCPCS,Facility,Both,480 mL,mL,,721,612.85,206.6386,721,UnitedHealthcare,Individual & Family,677.74,94,,percent of total billed charges,,
PREDNISOLONE 15 MG/5 ML ORAL SOLN,,J7510,HCPCS,Facility,Outpatient,480 mL,mL,,721,612.85,206.6386,721,UnitedHealthcare,Medicare Advantage,353.29,49,,percent of total billed charges,,
PREDNISOLONE 15 MG/5 ML ORAL SOLN,,J7510,HCPCS,Facility,Inpatient,480 mL,mL,,721,612.85,206.6386,721,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
PREDNISOLONE 15 MG/5 ML ORAL SOLN,,J7510,HCPCS,Facility,Outpatient,480 mL,mL,,721,612.85,206.6386,721,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,346.08,48,,percent of total billed charges,,100% of DHS outpatient percentage
PREDNISOLONE 15 MG/5 ML ORAL SOLN,,J7510,HCPCS,Facility,Inpatient,480 mL,mL,,721,612.85,206.6386,721,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
LIDOCAINE-PRILOCAINE 2.5-2.5 % TOP CREAM,,8273,LOCAL,Facility,Both,5 g,g,,50,42.5,14.33,50,Aetna,Commercial,46,92,,percent of total billed charges,,
LIDOCAINE-PRILOCAINE 2.5-2.5 % TOP CREAM,,8273,LOCAL,Facility,Both,5 g,g,,41,34.85,11.7506,41,Aetna,Commercial,37.72,92,,percent of total billed charges,,
LIDOCAINE-PRILOCAINE 2.5-2.5 % TOP CREAM,,8273,LOCAL,Facility,Outpatient,5 g,g,,50,42.5,14.33,50,Aetna,Medicare Advantage,24.5,49,,percent of total billed charges,,
LIDOCAINE-PRILOCAINE 2.5-2.5 % TOP CREAM,,8273,LOCAL,Facility,Outpatient,5 g,g,,41,34.85,11.7506,41,Aetna,Medicare Advantage,20.09,49,,percent of total billed charges,,
LIDOCAINE-PRILOCAINE 2.5-2.5 % TOP CREAM,,8273,LOCAL,Facility,Inpatient,5 g,g,,50,42.5,14.33,50,Aetna,Medicare Advantage,,,,,Included in per diem rate,
LIDOCAINE-PRILOCAINE 2.5-2.5 % TOP CREAM,,8273,LOCAL,Facility,Inpatient,5 g,g,,41,34.85,11.7506,41,Aetna,Medicare Advantage,,,,,Included in per diem rate,
LIDOCAINE-PRILOCAINE 2.5-2.5 % TOP CREAM,,8273,LOCAL,Facility,Both,5 g,g,,50,42.5,14.33,50,Aetna,PPO,46.5,93,,percent of total billed charges,,
LIDOCAINE-PRILOCAINE 2.5-2.5 % TOP CREAM,,8273,LOCAL,Facility,Both,5 g,g,,41,34.85,11.7506,41,Aetna,PPO,38.13,93,,percent of total billed charges,,
LIDOCAINE-PRILOCAINE 2.5-2.5 % TOP CREAM,,8273,LOCAL,Facility,Both,5 g,g,,50,42.5,14.33,50,America's PPO,America's PPO,48.015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
LIDOCAINE-PRILOCAINE 2.5-2.5 % TOP CREAM,,8273,LOCAL,Facility,Both,5 g,g,,41,34.85,11.7506,41,America's PPO,America's PPO,39.3723,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
LIDOCAINE-PRILOCAINE 2.5-2.5 % TOP CREAM,,8273,LOCAL,Facility,Both,5 g,g,,50,42.5,14.33,50,BlueCross BlueShield Minnesota, Federal Employee Program,49.2,98.4,,percent of total billed charges,,
LIDOCAINE-PRILOCAINE 2.5-2.5 % TOP CREAM,,8273,LOCAL,Facility,Both,5 g,g,,41,34.85,11.7506,41,BlueCross BlueShield Minnesota, Federal Employee Program,40.344,98.4,,percent of total billed charges,,
LIDOCAINE-PRILOCAINE 2.5-2.5 % TOP CREAM,,8273,LOCAL,Facility,Both,5 g,g,,50,42.5,14.33,50,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,50,100,,percent of total billed charges,,
LIDOCAINE-PRILOCAINE 2.5-2.5 % TOP CREAM,,8273,LOCAL,Facility,Both,5 g,g,,41,34.85,11.7506,41,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,41,100,,percent of total billed charges,,
LIDOCAINE-PRILOCAINE 2.5-2.5 % TOP CREAM,,8273,LOCAL,Facility,Both,5 g,g,,50,42.5,14.33,50,BlueCross BlueShield Minnesota,High Value Network Plan,45,90,,percent of total billed charges,,
LIDOCAINE-PRILOCAINE 2.5-2.5 % TOP CREAM,,8273,LOCAL,Facility,Both,5 g,g,,41,34.85,11.7506,41,BlueCross BlueShield Minnesota,High Value Network Plan,36.9,90,,percent of total billed charges,,
LIDOCAINE-PRILOCAINE 2.5-2.5 % TOP CREAM,,8273,LOCAL,Facility,Outpatient,5 g,g,,50,42.5,14.33,50,BlueCross BlueShield Minnesota,Medicare Advantage,24.5,49,,percent of total billed charges,,
LIDOCAINE-PRILOCAINE 2.5-2.5 % TOP CREAM,,8273,LOCAL,Facility,Outpatient,5 g,g,,41,34.85,11.7506,41,BlueCross BlueShield Minnesota,Medicare Advantage,20.09,49,,percent of total billed charges,,
LIDOCAINE-PRILOCAINE 2.5-2.5 % TOP CREAM,,8273,LOCAL,Facility,Inpatient,5 g,g,,50,42.5,14.33,50,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
LIDOCAINE-PRILOCAINE 2.5-2.5 % TOP CREAM,,8273,LOCAL,Facility,Inpatient,5 g,g,,41,34.85,11.7506,41,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
LIDOCAINE-PRILOCAINE 2.5-2.5 % TOP CREAM,,8273,LOCAL,Facility,Both,5 g,g,,50,42.5,14.33,50,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,44.285,88.57,,percent of total billed charges,,
LIDOCAINE-PRILOCAINE 2.5-2.5 % TOP CREAM,,8273,LOCAL,Facility,Both,5 g,g,,41,34.85,11.7506,41,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,36.3137,88.57,,percent of total billed charges,,
LIDOCAINE-PRILOCAINE 2.5-2.5 % TOP CREAM,,8273,LOCAL,Facility,Both,5 g,g,,50,42.5,14.33,50,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,14.33,28.66,,percent of total billed charges,,
LIDOCAINE-PRILOCAINE 2.5-2.5 % TOP CREAM,,8273,LOCAL,Facility,Both,5 g,g,,41,34.85,11.7506,41,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,11.7506,28.66,,percent of total billed charges,,
LIDOCAINE-PRILOCAINE 2.5-2.5 % TOP CREAM,,8273,LOCAL,Facility,Outpatient,5 g,g,,50,42.5,14.33,50,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),24.5,49,,percent of total billed charges,,
LIDOCAINE-PRILOCAINE 2.5-2.5 % TOP CREAM,,8273,LOCAL,Facility,Outpatient,5 g,g,,41,34.85,11.7506,41,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),20.09,49,,percent of total billed charges,,
LIDOCAINE-PRILOCAINE 2.5-2.5 % TOP CREAM,,8273,LOCAL,Facility,Inpatient,5 g,g,,50,42.5,14.33,50,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
LIDOCAINE-PRILOCAINE 2.5-2.5 % TOP CREAM,,8273,LOCAL,Facility,Inpatient,5 g,g,,41,34.85,11.7506,41,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
LIDOCAINE-PRILOCAINE 2.5-2.5 % TOP CREAM,,8273,LOCAL,Facility,Both,5 g,g,,50,42.5,14.33,50,CorVel,Worker's Compensation,50,100,,percent of total billed charges,,
LIDOCAINE-PRILOCAINE 2.5-2.5 % TOP CREAM,,8273,LOCAL,Facility,Both,5 g,g,,41,34.85,11.7506,41,CorVel,Worker's Compensation,41,100,,percent of total billed charges,,
LIDOCAINE-PRILOCAINE 2.5-2.5 % TOP CREAM,,8273,LOCAL,Facility,Both,5 g,g,,50,42.5,14.33,50,First Health Group Corporation,First Health Network,48.5,97,,percent of total billed charges,,
LIDOCAINE-PRILOCAINE 2.5-2.5 % TOP CREAM,,8273,LOCAL,Facility,Both,5 g,g,,41,34.85,11.7506,41,First Health Group Corporation,First Health Network,39.77,97,,percent of total billed charges,,
LIDOCAINE-PRILOCAINE 2.5-2.5 % TOP CREAM,,8273,LOCAL,Facility,Both,5 g,g,,50,42.5,14.33,50,"Health Partners, Inc.",Commercial,47.3,94.6,,percent of total billed charges,,
LIDOCAINE-PRILOCAINE 2.5-2.5 % TOP CREAM,,8273,LOCAL,Facility,Both,5 g,g,,41,34.85,11.7506,41,"Health Partners, Inc.",Commercial,38.786,94.6,,percent of total billed charges,,
LIDOCAINE-PRILOCAINE 2.5-2.5 % TOP CREAM,,8273,LOCAL,Facility,Outpatient,5 g,g,,50,42.5,14.33,50,"Health Partners, Inc.",Medicare Advantage,24.5,49,,percent of total billed charges,,
LIDOCAINE-PRILOCAINE 2.5-2.5 % TOP CREAM,,8273,LOCAL,Facility,Outpatient,5 g,g,,41,34.85,11.7506,41,"Health Partners, Inc.",Medicare Advantage,20.09,49,,percent of total billed charges,,
LIDOCAINE-PRILOCAINE 2.5-2.5 % TOP CREAM,,8273,LOCAL,Facility,Inpatient,5 g,g,,50,42.5,14.33,50,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LIDOCAINE-PRILOCAINE 2.5-2.5 % TOP CREAM,,8273,LOCAL,Facility,Inpatient,5 g,g,,41,34.85,11.7506,41,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LIDOCAINE-PRILOCAINE 2.5-2.5 % TOP CREAM,,8273,LOCAL,Facility,Both,5 g,g,,50,42.5,14.33,50,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),30,60,,percent of total billed charges,,
LIDOCAINE-PRILOCAINE 2.5-2.5 % TOP CREAM,,8273,LOCAL,Facility,Both,5 g,g,,41,34.85,11.7506,41,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),24.6,60,,percent of total billed charges,,
LIDOCAINE-PRILOCAINE 2.5-2.5 % TOP CREAM,,8273,LOCAL,Facility,Both,5 g,g,,50,42.5,14.33,50,"Health Partners, Inc.",State of Minnesota Advantage Program,40.75,81.5,,percent of total billed charges,,
LIDOCAINE-PRILOCAINE 2.5-2.5 % TOP CREAM,,8273,LOCAL,Facility,Both,5 g,g,,41,34.85,11.7506,41,"Health Partners, Inc.",State of Minnesota Advantage Program,33.415,81.5,,percent of total billed charges,,
LIDOCAINE-PRILOCAINE 2.5-2.5 % TOP CREAM,,8273,LOCAL,Facility,Both,5 g,g,,50,42.5,14.33,50,"Health Partners, Inc.",State Public Programs,25,50,,percent of total billed charges,,
LIDOCAINE-PRILOCAINE 2.5-2.5 % TOP CREAM,,8273,LOCAL,Facility,Both,5 g,g,,41,34.85,11.7506,41,"Health Partners, Inc.",State Public Programs,20.5,50,,percent of total billed charges,,
LIDOCAINE-PRILOCAINE 2.5-2.5 % TOP CREAM,,8273,LOCAL,Facility,Both,5 g,g,,50,42.5,14.33,50,Humana Insurance Company,Commercial PPO,47.5,95,,percent of total billed charges,,
LIDOCAINE-PRILOCAINE 2.5-2.5 % TOP CREAM,,8273,LOCAL,Facility,Both,5 g,g,,41,34.85,11.7506,41,Humana Insurance Company,Commercial PPO,38.95,95,,percent of total billed charges,,
LIDOCAINE-PRILOCAINE 2.5-2.5 % TOP CREAM,,8273,LOCAL,Facility,Outpatient,5 g,g,,50,42.5,14.33,50,Humana Insurance Company,Medicare PPO,24.5,49,,percent of total billed charges,,
LIDOCAINE-PRILOCAINE 2.5-2.5 % TOP CREAM,,8273,LOCAL,Facility,Outpatient,5 g,g,,41,34.85,11.7506,41,Humana Insurance Company,Medicare PPO,20.09,49,,percent of total billed charges,,
LIDOCAINE-PRILOCAINE 2.5-2.5 % TOP CREAM,,8273,LOCAL,Facility,Inpatient,5 g,g,,50,42.5,14.33,50,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
LIDOCAINE-PRILOCAINE 2.5-2.5 % TOP CREAM,,8273,LOCAL,Facility,Inpatient,5 g,g,,41,34.85,11.7506,41,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
LIDOCAINE-PRILOCAINE 2.5-2.5 % TOP CREAM,,8273,LOCAL,Facility,Both,5 g,g,,50,42.5,14.33,50,Medica,Individual & Family,49.55,99.1,,percent of total billed charges,,
LIDOCAINE-PRILOCAINE 2.5-2.5 % TOP CREAM,,8273,LOCAL,Facility,Both,5 g,g,,41,34.85,11.7506,41,Medica,Individual & Family,40.631,99.1,,percent of total billed charges,,
LIDOCAINE-PRILOCAINE 2.5-2.5 % TOP CREAM,,8273,LOCAL,Facility,Outpatient,5 g,g,,50,42.5,14.33,50,Medica,Medica Advantage Solution,24.9,49.8,,percent of total billed charges,,
LIDOCAINE-PRILOCAINE 2.5-2.5 % TOP CREAM,,8273,LOCAL,Facility,Outpatient,5 g,g,,41,34.85,11.7506,41,Medica,Medica Advantage Solution,20.418,49.8,,percent of total billed charges,,
LIDOCAINE-PRILOCAINE 2.5-2.5 % TOP CREAM,,8273,LOCAL,Facility,Inpatient,5 g,g,,50,42.5,14.33,50,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
LIDOCAINE-PRILOCAINE 2.5-2.5 % TOP CREAM,,8273,LOCAL,Facility,Inpatient,5 g,g,,41,34.85,11.7506,41,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
LIDOCAINE-PRILOCAINE 2.5-2.5 % TOP CREAM,,8273,LOCAL,Facility,Outpatient,5 g,g,,50,42.5,14.33,50,Medica,Medical Assistance,22.3,44.6,,percent of total billed charges,,
LIDOCAINE-PRILOCAINE 2.5-2.5 % TOP CREAM,,8273,LOCAL,Facility,Outpatient,5 g,g,,41,34.85,11.7506,41,Medica,Medical Assistance,18.286,44.6,,percent of total billed charges,,
LIDOCAINE-PRILOCAINE 2.5-2.5 % TOP CREAM,,8273,LOCAL,Facility,Inpatient,5 g,g,,50,42.5,14.33,50,Medica,Medical Assistance,,,,,Included in per diem rate,
LIDOCAINE-PRILOCAINE 2.5-2.5 % TOP CREAM,,8273,LOCAL,Facility,Inpatient,5 g,g,,41,34.85,11.7506,41,Medica,Medical Assistance,,,,,Included in per diem rate,
LIDOCAINE-PRILOCAINE 2.5-2.5 % TOP CREAM,,8273,LOCAL,Facility,Outpatient,5 g,g,,50,42.5,14.33,50,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,24.9,49.8,,percent of total billed charges,,
LIDOCAINE-PRILOCAINE 2.5-2.5 % TOP CREAM,,8273,LOCAL,Facility,Outpatient,5 g,g,,41,34.85,11.7506,41,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,20.418,49.8,,percent of total billed charges,,
LIDOCAINE-PRILOCAINE 2.5-2.5 % TOP CREAM,,8273,LOCAL,Facility,Inpatient,5 g,g,,50,42.5,14.33,50,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
LIDOCAINE-PRILOCAINE 2.5-2.5 % TOP CREAM,,8273,LOCAL,Facility,Inpatient,5 g,g,,41,34.85,11.7506,41,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
LIDOCAINE-PRILOCAINE 2.5-2.5 % TOP CREAM,,8273,LOCAL,Facility,Both,5 g,g,,50,42.5,14.33,50,"Multiplan, Inc.","Multiplan, Inc.",47,94,,percent of total billed charges,,
LIDOCAINE-PRILOCAINE 2.5-2.5 % TOP CREAM,,8273,LOCAL,Facility,Both,5 g,g,,41,34.85,11.7506,41,"Multiplan, Inc.","Multiplan, Inc.",38.54,94,,percent of total billed charges,,
LIDOCAINE-PRILOCAINE 2.5-2.5 % TOP CREAM,,8273,LOCAL,Facility,Outpatient,5 g,g,,50,42.5,14.33,50,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,45.05,90.1,,percent of total billed charges,,
LIDOCAINE-PRILOCAINE 2.5-2.5 % TOP CREAM,,8273,LOCAL,Facility,Outpatient,5 g,g,,41,34.85,11.7506,41,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,36.941,90.1,,percent of total billed charges,,
LIDOCAINE-PRILOCAINE 2.5-2.5 % TOP CREAM,,8273,LOCAL,Facility,Inpatient,5 g,g,,50,42.5,14.33,50,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
LIDOCAINE-PRILOCAINE 2.5-2.5 % TOP CREAM,,8273,LOCAL,Facility,Inpatient,5 g,g,,41,34.85,11.7506,41,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
LIDOCAINE-PRILOCAINE 2.5-2.5 % TOP CREAM,,8273,LOCAL,Facility,Both,5 g,g,,50,42.5,14.33,50,"Preferred One Administrative Services, INC.",PPO,49.3,98.6,,percent of total billed charges,,
LIDOCAINE-PRILOCAINE 2.5-2.5 % TOP CREAM,,8273,LOCAL,Facility,Both,5 g,g,,41,34.85,11.7506,41,"Preferred One Administrative Services, INC.",PPO,40.426,98.6,,percent of total billed charges,,
LIDOCAINE-PRILOCAINE 2.5-2.5 % TOP CREAM,,8273,LOCAL,Facility,Outpatient,5 g,g,,50,42.5,14.33,50,PrimeWest Health,Minnesota Senior Health Options (MSHO),25.725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
LIDOCAINE-PRILOCAINE 2.5-2.5 % TOP CREAM,,8273,LOCAL,Facility,Outpatient,5 g,g,,41,34.85,11.7506,41,PrimeWest Health,Minnesota Senior Health Options (MSHO),21.0945,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
LIDOCAINE-PRILOCAINE 2.5-2.5 % TOP CREAM,,8273,LOCAL,Facility,Inpatient,5 g,g,,50,42.5,14.33,50,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LIDOCAINE-PRILOCAINE 2.5-2.5 % TOP CREAM,,8273,LOCAL,Facility,Inpatient,5 g,g,,41,34.85,11.7506,41,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LIDOCAINE-PRILOCAINE 2.5-2.5 % TOP CREAM,,8273,LOCAL,Facility,Outpatient,5 g,g,,50,42.5,14.33,50,PrimeWest Health,MinnesotaCare,25.68,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
LIDOCAINE-PRILOCAINE 2.5-2.5 % TOP CREAM,,8273,LOCAL,Facility,Outpatient,5 g,g,,41,34.85,11.7506,41,PrimeWest Health,MinnesotaCare,21.0576,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
LIDOCAINE-PRILOCAINE 2.5-2.5 % TOP CREAM,,8273,LOCAL,Facility,Inpatient,5 g,g,,50,42.5,14.33,50,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
LIDOCAINE-PRILOCAINE 2.5-2.5 % TOP CREAM,,8273,LOCAL,Facility,Inpatient,5 g,g,,41,34.85,11.7506,41,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
LIDOCAINE-PRILOCAINE 2.5-2.5 % TOP CREAM,,8273,LOCAL,Facility,Both,5 g,g,,50,42.5,14.33,50,Sanford Health Plan,Sanford Health Plan,46,92,,percent of total billed charges,,
LIDOCAINE-PRILOCAINE 2.5-2.5 % TOP CREAM,,8273,LOCAL,Facility,Both,5 g,g,,41,34.85,11.7506,41,Sanford Health Plan,Sanford Health Plan,37.72,92,,percent of total billed charges,,
LIDOCAINE-PRILOCAINE 2.5-2.5 % TOP CREAM,,8273,LOCAL,Facility,Outpatient,5 g,g,,50,42.5,14.33,50,"UCare Health, Inc.",Individual & Family Plan,28.175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
LIDOCAINE-PRILOCAINE 2.5-2.5 % TOP CREAM,,8273,LOCAL,Facility,Outpatient,5 g,g,,41,34.85,11.7506,41,"UCare Health, Inc.",Individual & Family Plan,23.1035,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
LIDOCAINE-PRILOCAINE 2.5-2.5 % TOP CREAM,,8273,LOCAL,Facility,Inpatient,5 g,g,,50,42.5,14.33,50,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
LIDOCAINE-PRILOCAINE 2.5-2.5 % TOP CREAM,,8273,LOCAL,Facility,Inpatient,5 g,g,,41,34.85,11.7506,41,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
LIDOCAINE-PRILOCAINE 2.5-2.5 % TOP CREAM,,8273,LOCAL,Facility,Outpatient,5 g,g,,50,42.5,14.33,50,"UCare Health, Inc.",Medical Assistance,25.235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LIDOCAINE-PRILOCAINE 2.5-2.5 % TOP CREAM,,8273,LOCAL,Facility,Outpatient,5 g,g,,41,34.85,11.7506,41,"UCare Health, Inc.",Medical Assistance,20.6927,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LIDOCAINE-PRILOCAINE 2.5-2.5 % TOP CREAM,,8273,LOCAL,Facility,Inpatient,5 g,g,,50,42.5,14.33,50,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
LIDOCAINE-PRILOCAINE 2.5-2.5 % TOP CREAM,,8273,LOCAL,Facility,Inpatient,5 g,g,,41,34.85,11.7506,41,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
LIDOCAINE-PRILOCAINE 2.5-2.5 % TOP CREAM,,8273,LOCAL,Facility,Outpatient,5 g,g,,50,42.5,14.33,50,"UCare Health, Inc.",Medicare Advantage,25.235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LIDOCAINE-PRILOCAINE 2.5-2.5 % TOP CREAM,,8273,LOCAL,Facility,Outpatient,5 g,g,,41,34.85,11.7506,41,"UCare Health, Inc.",Medicare Advantage,20.6927,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LIDOCAINE-PRILOCAINE 2.5-2.5 % TOP CREAM,,8273,LOCAL,Facility,Inpatient,5 g,g,,50,42.5,14.33,50,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LIDOCAINE-PRILOCAINE 2.5-2.5 % TOP CREAM,,8273,LOCAL,Facility,Inpatient,5 g,g,,41,34.85,11.7506,41,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LIDOCAINE-PRILOCAINE 2.5-2.5 % TOP CREAM,,8273,LOCAL,Facility,Outpatient,5 g,g,,50,42.5,14.33,50,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),25.235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LIDOCAINE-PRILOCAINE 2.5-2.5 % TOP CREAM,,8273,LOCAL,Facility,Outpatient,5 g,g,,41,34.85,11.7506,41,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),20.6927,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LIDOCAINE-PRILOCAINE 2.5-2.5 % TOP CREAM,,8273,LOCAL,Facility,Inpatient,5 g,g,,50,42.5,14.33,50,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LIDOCAINE-PRILOCAINE 2.5-2.5 % TOP CREAM,,8273,LOCAL,Facility,Inpatient,5 g,g,,41,34.85,11.7506,41,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LIDOCAINE-PRILOCAINE 2.5-2.5 % TOP CREAM,,8273,LOCAL,Facility,Both,5 g,g,,50,42.5,14.33,50,UnitedHealthcare,Individual & Family,47,94,,percent of total billed charges,,
LIDOCAINE-PRILOCAINE 2.5-2.5 % TOP CREAM,,8273,LOCAL,Facility,Both,5 g,g,,41,34.85,11.7506,41,UnitedHealthcare,Individual & Family,38.54,94,,percent of total billed charges,,
LIDOCAINE-PRILOCAINE 2.5-2.5 % TOP CREAM,,8273,LOCAL,Facility,Outpatient,5 g,g,,50,42.5,14.33,50,UnitedHealthcare,Medicare Advantage,24.5,49,,percent of total billed charges,,
LIDOCAINE-PRILOCAINE 2.5-2.5 % TOP CREAM,,8273,LOCAL,Facility,Outpatient,5 g,g,,41,34.85,11.7506,41,UnitedHealthcare,Medicare Advantage,20.09,49,,percent of total billed charges,,
LIDOCAINE-PRILOCAINE 2.5-2.5 % TOP CREAM,,8273,LOCAL,Facility,Inpatient,5 g,g,,50,42.5,14.33,50,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
LIDOCAINE-PRILOCAINE 2.5-2.5 % TOP CREAM,,8273,LOCAL,Facility,Inpatient,5 g,g,,41,34.85,11.7506,41,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
LIDOCAINE-PRILOCAINE 2.5-2.5 % TOP CREAM,,8273,LOCAL,Facility,Outpatient,5 g,g,,50,42.5,14.33,50,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,24,48,,percent of total billed charges,,100% of DHS outpatient percentage
LIDOCAINE-PRILOCAINE 2.5-2.5 % TOP CREAM,,8273,LOCAL,Facility,Outpatient,5 g,g,,41,34.85,11.7506,41,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,19.68,48,,percent of total billed charges,,100% of DHS outpatient percentage
LIDOCAINE-PRILOCAINE 2.5-2.5 % TOP CREAM,,8273,LOCAL,Facility,Inpatient,5 g,g,,50,42.5,14.33,50,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
LIDOCAINE-PRILOCAINE 2.5-2.5 % TOP CREAM,,8273,LOCAL,Facility,Inpatient,5 g,g,,41,34.85,11.7506,41,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
TRIAMCINOLONE ACETONIDE 0.1 % DENT PSTE,,10418,LOCAL,Facility,Both,5 g,g,,349,296.65,100.0234,349,Aetna,Commercial,321.08,92,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.1 % DENT PSTE,,10418,LOCAL,Facility,Outpatient,5 g,g,,349,296.65,100.0234,349,Aetna,Medicare Advantage,171.01,49,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.1 % DENT PSTE,,10418,LOCAL,Facility,Inpatient,5 g,g,,349,296.65,100.0234,349,Aetna,Medicare Advantage,,,,,Included in per diem rate,
TRIAMCINOLONE ACETONIDE 0.1 % DENT PSTE,,10418,LOCAL,Facility,Both,5 g,g,,349,296.65,100.0234,349,Aetna,PPO,324.57,93,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.1 % DENT PSTE,,10418,LOCAL,Facility,Both,5 g,g,,349,296.65,100.0234,349,America's PPO,America's PPO,335.1447,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
TRIAMCINOLONE ACETONIDE 0.1 % DENT PSTE,,10418,LOCAL,Facility,Both,5 g,g,,349,296.65,100.0234,349,BlueCross BlueShield Minnesota, Federal Employee Program,343.416,98.4,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.1 % DENT PSTE,,10418,LOCAL,Facility,Both,5 g,g,,349,296.65,100.0234,349,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,349,100,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.1 % DENT PSTE,,10418,LOCAL,Facility,Both,5 g,g,,349,296.65,100.0234,349,BlueCross BlueShield Minnesota,High Value Network Plan,314.1,90,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.1 % DENT PSTE,,10418,LOCAL,Facility,Outpatient,5 g,g,,349,296.65,100.0234,349,BlueCross BlueShield Minnesota,Medicare Advantage,171.01,49,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.1 % DENT PSTE,,10418,LOCAL,Facility,Inpatient,5 g,g,,349,296.65,100.0234,349,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
TRIAMCINOLONE ACETONIDE 0.1 % DENT PSTE,,10418,LOCAL,Facility,Both,5 g,g,,349,296.65,100.0234,349,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,309.1093,88.57,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.1 % DENT PSTE,,10418,LOCAL,Facility,Both,5 g,g,,349,296.65,100.0234,349,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,100.0234,28.66,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.1 % DENT PSTE,,10418,LOCAL,Facility,Outpatient,5 g,g,,349,296.65,100.0234,349,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),171.01,49,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.1 % DENT PSTE,,10418,LOCAL,Facility,Inpatient,5 g,g,,349,296.65,100.0234,349,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
TRIAMCINOLONE ACETONIDE 0.1 % DENT PSTE,,10418,LOCAL,Facility,Both,5 g,g,,349,296.65,100.0234,349,CorVel,Worker's Compensation,349,100,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.1 % DENT PSTE,,10418,LOCAL,Facility,Both,5 g,g,,349,296.65,100.0234,349,First Health Group Corporation,First Health Network,338.53,97,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.1 % DENT PSTE,,10418,LOCAL,Facility,Both,5 g,g,,349,296.65,100.0234,349,"Health Partners, Inc.",Commercial,330.154,94.6,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.1 % DENT PSTE,,10418,LOCAL,Facility,Outpatient,5 g,g,,349,296.65,100.0234,349,"Health Partners, Inc.",Medicare Advantage,171.01,49,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.1 % DENT PSTE,,10418,LOCAL,Facility,Inpatient,5 g,g,,349,296.65,100.0234,349,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
TRIAMCINOLONE ACETONIDE 0.1 % DENT PSTE,,10418,LOCAL,Facility,Both,5 g,g,,349,296.65,100.0234,349,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),209.4,60,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.1 % DENT PSTE,,10418,LOCAL,Facility,Both,5 g,g,,349,296.65,100.0234,349,"Health Partners, Inc.",State of Minnesota Advantage Program,284.435,81.5,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.1 % DENT PSTE,,10418,LOCAL,Facility,Both,5 g,g,,349,296.65,100.0234,349,"Health Partners, Inc.",State Public Programs,174.5,50,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.1 % DENT PSTE,,10418,LOCAL,Facility,Both,5 g,g,,349,296.65,100.0234,349,Humana Insurance Company,Commercial PPO,331.55,95,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.1 % DENT PSTE,,10418,LOCAL,Facility,Outpatient,5 g,g,,349,296.65,100.0234,349,Humana Insurance Company,Medicare PPO,171.01,49,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.1 % DENT PSTE,,10418,LOCAL,Facility,Inpatient,5 g,g,,349,296.65,100.0234,349,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
TRIAMCINOLONE ACETONIDE 0.1 % DENT PSTE,,10418,LOCAL,Facility,Both,5 g,g,,349,296.65,100.0234,349,Medica,Individual & Family,345.859,99.1,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.1 % DENT PSTE,,10418,LOCAL,Facility,Outpatient,5 g,g,,349,296.65,100.0234,349,Medica,Medica Advantage Solution,173.802,49.8,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.1 % DENT PSTE,,10418,LOCAL,Facility,Inpatient,5 g,g,,349,296.65,100.0234,349,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
TRIAMCINOLONE ACETONIDE 0.1 % DENT PSTE,,10418,LOCAL,Facility,Outpatient,5 g,g,,349,296.65,100.0234,349,Medica,Medical Assistance,155.654,44.6,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.1 % DENT PSTE,,10418,LOCAL,Facility,Inpatient,5 g,g,,349,296.65,100.0234,349,Medica,Medical Assistance,,,,,Included in per diem rate,
TRIAMCINOLONE ACETONIDE 0.1 % DENT PSTE,,10418,LOCAL,Facility,Outpatient,5 g,g,,349,296.65,100.0234,349,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,173.802,49.8,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.1 % DENT PSTE,,10418,LOCAL,Facility,Inpatient,5 g,g,,349,296.65,100.0234,349,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
TRIAMCINOLONE ACETONIDE 0.1 % DENT PSTE,,10418,LOCAL,Facility,Both,5 g,g,,349,296.65,100.0234,349,"Multiplan, Inc.","Multiplan, Inc.",328.06,94,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.1 % DENT PSTE,,10418,LOCAL,Facility,Outpatient,5 g,g,,349,296.65,100.0234,349,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,314.449,90.1,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.1 % DENT PSTE,,10418,LOCAL,Facility,Inpatient,5 g,g,,349,296.65,100.0234,349,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
TRIAMCINOLONE ACETONIDE 0.1 % DENT PSTE,,10418,LOCAL,Facility,Both,5 g,g,,349,296.65,100.0234,349,"Preferred One Administrative Services, INC.",PPO,344.114,98.6,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.1 % DENT PSTE,,10418,LOCAL,Facility,Outpatient,5 g,g,,349,296.65,100.0234,349,PrimeWest Health,Minnesota Senior Health Options (MSHO),179.5605,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
TRIAMCINOLONE ACETONIDE 0.1 % DENT PSTE,,10418,LOCAL,Facility,Inpatient,5 g,g,,349,296.65,100.0234,349,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
TRIAMCINOLONE ACETONIDE 0.1 % DENT PSTE,,10418,LOCAL,Facility,Outpatient,5 g,g,,349,296.65,100.0234,349,PrimeWest Health,MinnesotaCare,179.2464,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
TRIAMCINOLONE ACETONIDE 0.1 % DENT PSTE,,10418,LOCAL,Facility,Inpatient,5 g,g,,349,296.65,100.0234,349,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
TRIAMCINOLONE ACETONIDE 0.1 % DENT PSTE,,10418,LOCAL,Facility,Both,5 g,g,,349,296.65,100.0234,349,Sanford Health Plan,Sanford Health Plan,321.08,92,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.1 % DENT PSTE,,10418,LOCAL,Facility,Outpatient,5 g,g,,349,296.65,100.0234,349,"UCare Health, Inc.",Individual & Family Plan,196.6615,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
TRIAMCINOLONE ACETONIDE 0.1 % DENT PSTE,,10418,LOCAL,Facility,Inpatient,5 g,g,,349,296.65,100.0234,349,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
TRIAMCINOLONE ACETONIDE 0.1 % DENT PSTE,,10418,LOCAL,Facility,Outpatient,5 g,g,,349,296.65,100.0234,349,"UCare Health, Inc.",Medical Assistance,176.1403,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TRIAMCINOLONE ACETONIDE 0.1 % DENT PSTE,,10418,LOCAL,Facility,Inpatient,5 g,g,,349,296.65,100.0234,349,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
TRIAMCINOLONE ACETONIDE 0.1 % DENT PSTE,,10418,LOCAL,Facility,Outpatient,5 g,g,,349,296.65,100.0234,349,"UCare Health, Inc.",Medicare Advantage,176.1403,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TRIAMCINOLONE ACETONIDE 0.1 % DENT PSTE,,10418,LOCAL,Facility,Inpatient,5 g,g,,349,296.65,100.0234,349,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
TRIAMCINOLONE ACETONIDE 0.1 % DENT PSTE,,10418,LOCAL,Facility,Outpatient,5 g,g,,349,296.65,100.0234,349,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),176.1403,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TRIAMCINOLONE ACETONIDE 0.1 % DENT PSTE,,10418,LOCAL,Facility,Inpatient,5 g,g,,349,296.65,100.0234,349,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
TRIAMCINOLONE ACETONIDE 0.1 % DENT PSTE,,10418,LOCAL,Facility,Both,5 g,g,,349,296.65,100.0234,349,UnitedHealthcare,Individual & Family,328.06,94,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.1 % DENT PSTE,,10418,LOCAL,Facility,Outpatient,5 g,g,,349,296.65,100.0234,349,UnitedHealthcare,Medicare Advantage,171.01,49,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.1 % DENT PSTE,,10418,LOCAL,Facility,Inpatient,5 g,g,,349,296.65,100.0234,349,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
TRIAMCINOLONE ACETONIDE 0.1 % DENT PSTE,,10418,LOCAL,Facility,Outpatient,5 g,g,,349,296.65,100.0234,349,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,167.52,48,,percent of total billed charges,,100% of DHS outpatient percentage
TRIAMCINOLONE ACETONIDE 0.1 % DENT PSTE,,10418,LOCAL,Facility,Inpatient,5 g,g,,349,296.65,100.0234,349,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
PREDNISOLONE SODIUM PHOSPHATE 15 MG/5 ML (3 MG/ML) ORAL SOLN,,J7510,HCPCS,Facility,Both,5 mg,mL,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
PREDNISOLONE SODIUM PHOSPHATE 15 MG/5 ML (3 MG/ML) ORAL SOLN,,J7510,HCPCS,Facility,Outpatient,5 mg,mL,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
PREDNISOLONE SODIUM PHOSPHATE 15 MG/5 ML (3 MG/ML) ORAL SOLN,,J7510,HCPCS,Facility,Inpatient,5 mg,mL,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
PREDNISOLONE SODIUM PHOSPHATE 15 MG/5 ML (3 MG/ML) ORAL SOLN,,J7510,HCPCS,Facility,Both,5 mg,mL,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
PREDNISOLONE SODIUM PHOSPHATE 15 MG/5 ML (3 MG/ML) ORAL SOLN,,J7510,HCPCS,Facility,Both,5 mg,mL,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
PREDNISOLONE SODIUM PHOSPHATE 15 MG/5 ML (3 MG/ML) ORAL SOLN,,J7510,HCPCS,Facility,Both,5 mg,mL,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
PREDNISOLONE SODIUM PHOSPHATE 15 MG/5 ML (3 MG/ML) ORAL SOLN,,J7510,HCPCS,Facility,Both,5 mg,mL,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
PREDNISOLONE SODIUM PHOSPHATE 15 MG/5 ML (3 MG/ML) ORAL SOLN,,J7510,HCPCS,Facility,Both,5 mg,mL,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
PREDNISOLONE SODIUM PHOSPHATE 15 MG/5 ML (3 MG/ML) ORAL SOLN,,J7510,HCPCS,Facility,Outpatient,5 mg,mL,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
PREDNISOLONE SODIUM PHOSPHATE 15 MG/5 ML (3 MG/ML) ORAL SOLN,,J7510,HCPCS,Facility,Inpatient,5 mg,mL,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
PREDNISOLONE SODIUM PHOSPHATE 15 MG/5 ML (3 MG/ML) ORAL SOLN,,J7510,HCPCS,Facility,Both,5 mg,mL,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
PREDNISOLONE SODIUM PHOSPHATE 15 MG/5 ML (3 MG/ML) ORAL SOLN,,J7510,HCPCS,Facility,Both,5 mg,mL,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
PREDNISOLONE SODIUM PHOSPHATE 15 MG/5 ML (3 MG/ML) ORAL SOLN,,J7510,HCPCS,Facility,Outpatient,5 mg,mL,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
PREDNISOLONE SODIUM PHOSPHATE 15 MG/5 ML (3 MG/ML) ORAL SOLN,,J7510,HCPCS,Facility,Inpatient,5 mg,mL,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
PREDNISOLONE SODIUM PHOSPHATE 15 MG/5 ML (3 MG/ML) ORAL SOLN,,J7510,HCPCS,Facility,Both,5 mg,mL,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
PREDNISOLONE SODIUM PHOSPHATE 15 MG/5 ML (3 MG/ML) ORAL SOLN,,J7510,HCPCS,Facility,Both,5 mg,mL,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
PREDNISOLONE SODIUM PHOSPHATE 15 MG/5 ML (3 MG/ML) ORAL SOLN,,J7510,HCPCS,Facility,Both,5 mg,mL,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
PREDNISOLONE SODIUM PHOSPHATE 15 MG/5 ML (3 MG/ML) ORAL SOLN,,J7510,HCPCS,Facility,Outpatient,5 mg,mL,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
PREDNISOLONE SODIUM PHOSPHATE 15 MG/5 ML (3 MG/ML) ORAL SOLN,,J7510,HCPCS,Facility,Inpatient,5 mg,mL,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PREDNISOLONE SODIUM PHOSPHATE 15 MG/5 ML (3 MG/ML) ORAL SOLN,,J7510,HCPCS,Facility,Both,5 mg,mL,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
PREDNISOLONE SODIUM PHOSPHATE 15 MG/5 ML (3 MG/ML) ORAL SOLN,,J7510,HCPCS,Facility,Both,5 mg,mL,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
PREDNISOLONE SODIUM PHOSPHATE 15 MG/5 ML (3 MG/ML) ORAL SOLN,,J7510,HCPCS,Facility,Both,5 mg,mL,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
PREDNISOLONE SODIUM PHOSPHATE 15 MG/5 ML (3 MG/ML) ORAL SOLN,,J7510,HCPCS,Facility,Both,5 mg,mL,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
PREDNISOLONE SODIUM PHOSPHATE 15 MG/5 ML (3 MG/ML) ORAL SOLN,,J7510,HCPCS,Facility,Outpatient,5 mg,mL,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
PREDNISOLONE SODIUM PHOSPHATE 15 MG/5 ML (3 MG/ML) ORAL SOLN,,J7510,HCPCS,Facility,Inpatient,5 mg,mL,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
PREDNISOLONE SODIUM PHOSPHATE 15 MG/5 ML (3 MG/ML) ORAL SOLN,,J7510,HCPCS,Facility,Both,5 mg,mL,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
PREDNISOLONE SODIUM PHOSPHATE 15 MG/5 ML (3 MG/ML) ORAL SOLN,,J7510,HCPCS,Facility,Outpatient,5 mg,mL,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
PREDNISOLONE SODIUM PHOSPHATE 15 MG/5 ML (3 MG/ML) ORAL SOLN,,J7510,HCPCS,Facility,Inpatient,5 mg,mL,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
PREDNISOLONE SODIUM PHOSPHATE 15 MG/5 ML (3 MG/ML) ORAL SOLN,,J7510,HCPCS,Facility,Outpatient,5 mg,mL,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
PREDNISOLONE SODIUM PHOSPHATE 15 MG/5 ML (3 MG/ML) ORAL SOLN,,J7510,HCPCS,Facility,Inpatient,5 mg,mL,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
PREDNISOLONE SODIUM PHOSPHATE 15 MG/5 ML (3 MG/ML) ORAL SOLN,,J7510,HCPCS,Facility,Outpatient,5 mg,mL,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
PREDNISOLONE SODIUM PHOSPHATE 15 MG/5 ML (3 MG/ML) ORAL SOLN,,J7510,HCPCS,Facility,Inpatient,5 mg,mL,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
PREDNISOLONE SODIUM PHOSPHATE 15 MG/5 ML (3 MG/ML) ORAL SOLN,,J7510,HCPCS,Facility,Both,5 mg,mL,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
PREDNISOLONE SODIUM PHOSPHATE 15 MG/5 ML (3 MG/ML) ORAL SOLN,,J7510,HCPCS,Facility,Outpatient,5 mg,mL,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
PREDNISOLONE SODIUM PHOSPHATE 15 MG/5 ML (3 MG/ML) ORAL SOLN,,J7510,HCPCS,Facility,Inpatient,5 mg,mL,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
PREDNISOLONE SODIUM PHOSPHATE 15 MG/5 ML (3 MG/ML) ORAL SOLN,,J7510,HCPCS,Facility,Both,5 mg,mL,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
PREDNISOLONE SODIUM PHOSPHATE 15 MG/5 ML (3 MG/ML) ORAL SOLN,,J7510,HCPCS,Facility,Outpatient,5 mg,mL,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
PREDNISOLONE SODIUM PHOSPHATE 15 MG/5 ML (3 MG/ML) ORAL SOLN,,J7510,HCPCS,Facility,Inpatient,5 mg,mL,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PREDNISOLONE SODIUM PHOSPHATE 15 MG/5 ML (3 MG/ML) ORAL SOLN,,J7510,HCPCS,Facility,Outpatient,5 mg,mL,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
PREDNISOLONE SODIUM PHOSPHATE 15 MG/5 ML (3 MG/ML) ORAL SOLN,,J7510,HCPCS,Facility,Inpatient,5 mg,mL,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
PREDNISOLONE SODIUM PHOSPHATE 15 MG/5 ML (3 MG/ML) ORAL SOLN,,J7510,HCPCS,Facility,Both,5 mg,mL,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
PREDNISOLONE SODIUM PHOSPHATE 15 MG/5 ML (3 MG/ML) ORAL SOLN,,J7510,HCPCS,Facility,Outpatient,5 mg,mL,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
PREDNISOLONE SODIUM PHOSPHATE 15 MG/5 ML (3 MG/ML) ORAL SOLN,,J7510,HCPCS,Facility,Inpatient,5 mg,mL,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
PREDNISOLONE SODIUM PHOSPHATE 15 MG/5 ML (3 MG/ML) ORAL SOLN,,J7510,HCPCS,Facility,Outpatient,5 mg,mL,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PREDNISOLONE SODIUM PHOSPHATE 15 MG/5 ML (3 MG/ML) ORAL SOLN,,J7510,HCPCS,Facility,Inpatient,5 mg,mL,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
PREDNISOLONE SODIUM PHOSPHATE 15 MG/5 ML (3 MG/ML) ORAL SOLN,,J7510,HCPCS,Facility,Outpatient,5 mg,mL,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PREDNISOLONE SODIUM PHOSPHATE 15 MG/5 ML (3 MG/ML) ORAL SOLN,,J7510,HCPCS,Facility,Inpatient,5 mg,mL,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PREDNISOLONE SODIUM PHOSPHATE 15 MG/5 ML (3 MG/ML) ORAL SOLN,,J7510,HCPCS,Facility,Outpatient,5 mg,mL,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PREDNISOLONE SODIUM PHOSPHATE 15 MG/5 ML (3 MG/ML) ORAL SOLN,,J7510,HCPCS,Facility,Inpatient,5 mg,mL,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PREDNISOLONE SODIUM PHOSPHATE 15 MG/5 ML (3 MG/ML) ORAL SOLN,,J7510,HCPCS,Facility,Both,5 mg,mL,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
PREDNISOLONE SODIUM PHOSPHATE 15 MG/5 ML (3 MG/ML) ORAL SOLN,,J7510,HCPCS,Facility,Outpatient,5 mg,mL,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
PREDNISOLONE SODIUM PHOSPHATE 15 MG/5 ML (3 MG/ML) ORAL SOLN,,J7510,HCPCS,Facility,Inpatient,5 mg,mL,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
PREDNISOLONE SODIUM PHOSPHATE 15 MG/5 ML (3 MG/ML) ORAL SOLN,,J7510,HCPCS,Facility,Outpatient,5 mg,mL,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
PREDNISOLONE SODIUM PHOSPHATE 15 MG/5 ML (3 MG/ML) ORAL SOLN,,J7510,HCPCS,Facility,Inpatient,5 mg,mL,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
APRACLONIDINE 0.5 % OPHT DROP,,2670,LOCAL,Facility,Both,5 mL,mL,,365,310.25,104.609,365,Aetna,Commercial,335.8,92,,percent of total billed charges,,
APRACLONIDINE 0.5 % OPHT DROP,,2670,LOCAL,Facility,Outpatient,5 mL,mL,,365,310.25,104.609,365,Aetna,Medicare Advantage,178.85,49,,percent of total billed charges,,
APRACLONIDINE 0.5 % OPHT DROP,,2670,LOCAL,Facility,Inpatient,5 mL,mL,,365,310.25,104.609,365,Aetna,Medicare Advantage,,,,,Included in per diem rate,
APRACLONIDINE 0.5 % OPHT DROP,,2670,LOCAL,Facility,Both,5 mL,mL,,365,310.25,104.609,365,Aetna,PPO,339.45,93,,percent of total billed charges,,
APRACLONIDINE 0.5 % OPHT DROP,,2670,LOCAL,Facility,Both,5 mL,mL,,365,310.25,104.609,365,America's PPO,America's PPO,350.5095,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
APRACLONIDINE 0.5 % OPHT DROP,,2670,LOCAL,Facility,Both,5 mL,mL,,365,310.25,104.609,365,BlueCross BlueShield Minnesota, Federal Employee Program,359.16,98.4,,percent of total billed charges,,
APRACLONIDINE 0.5 % OPHT DROP,,2670,LOCAL,Facility,Both,5 mL,mL,,365,310.25,104.609,365,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,365,100,,percent of total billed charges,,
APRACLONIDINE 0.5 % OPHT DROP,,2670,LOCAL,Facility,Both,5 mL,mL,,365,310.25,104.609,365,BlueCross BlueShield Minnesota,High Value Network Plan,328.5,90,,percent of total billed charges,,
APRACLONIDINE 0.5 % OPHT DROP,,2670,LOCAL,Facility,Outpatient,5 mL,mL,,365,310.25,104.609,365,BlueCross BlueShield Minnesota,Medicare Advantage,178.85,49,,percent of total billed charges,,
APRACLONIDINE 0.5 % OPHT DROP,,2670,LOCAL,Facility,Inpatient,5 mL,mL,,365,310.25,104.609,365,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
APRACLONIDINE 0.5 % OPHT DROP,,2670,LOCAL,Facility,Both,5 mL,mL,,365,310.25,104.609,365,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,323.2805,88.57,,percent of total billed charges,,
APRACLONIDINE 0.5 % OPHT DROP,,2670,LOCAL,Facility,Both,5 mL,mL,,365,310.25,104.609,365,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,104.609,28.66,,percent of total billed charges,,
APRACLONIDINE 0.5 % OPHT DROP,,2670,LOCAL,Facility,Outpatient,5 mL,mL,,365,310.25,104.609,365,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),178.85,49,,percent of total billed charges,,
APRACLONIDINE 0.5 % OPHT DROP,,2670,LOCAL,Facility,Inpatient,5 mL,mL,,365,310.25,104.609,365,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
APRACLONIDINE 0.5 % OPHT DROP,,2670,LOCAL,Facility,Both,5 mL,mL,,365,310.25,104.609,365,CorVel,Worker's Compensation,365,100,,percent of total billed charges,,
APRACLONIDINE 0.5 % OPHT DROP,,2670,LOCAL,Facility,Both,5 mL,mL,,365,310.25,104.609,365,First Health Group Corporation,First Health Network,354.05,97,,percent of total billed charges,,
APRACLONIDINE 0.5 % OPHT DROP,,2670,LOCAL,Facility,Both,5 mL,mL,,365,310.25,104.609,365,"Health Partners, Inc.",Commercial,345.29,94.6,,percent of total billed charges,,
APRACLONIDINE 0.5 % OPHT DROP,,2670,LOCAL,Facility,Outpatient,5 mL,mL,,365,310.25,104.609,365,"Health Partners, Inc.",Medicare Advantage,178.85,49,,percent of total billed charges,,
APRACLONIDINE 0.5 % OPHT DROP,,2670,LOCAL,Facility,Inpatient,5 mL,mL,,365,310.25,104.609,365,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
APRACLONIDINE 0.5 % OPHT DROP,,2670,LOCAL,Facility,Both,5 mL,mL,,365,310.25,104.609,365,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),219,60,,percent of total billed charges,,
APRACLONIDINE 0.5 % OPHT DROP,,2670,LOCAL,Facility,Both,5 mL,mL,,365,310.25,104.609,365,"Health Partners, Inc.",State of Minnesota Advantage Program,297.475,81.5,,percent of total billed charges,,
APRACLONIDINE 0.5 % OPHT DROP,,2670,LOCAL,Facility,Both,5 mL,mL,,365,310.25,104.609,365,"Health Partners, Inc.",State Public Programs,182.5,50,,percent of total billed charges,,
APRACLONIDINE 0.5 % OPHT DROP,,2670,LOCAL,Facility,Both,5 mL,mL,,365,310.25,104.609,365,Humana Insurance Company,Commercial PPO,346.75,95,,percent of total billed charges,,
APRACLONIDINE 0.5 % OPHT DROP,,2670,LOCAL,Facility,Outpatient,5 mL,mL,,365,310.25,104.609,365,Humana Insurance Company,Medicare PPO,178.85,49,,percent of total billed charges,,
APRACLONIDINE 0.5 % OPHT DROP,,2670,LOCAL,Facility,Inpatient,5 mL,mL,,365,310.25,104.609,365,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
APRACLONIDINE 0.5 % OPHT DROP,,2670,LOCAL,Facility,Both,5 mL,mL,,365,310.25,104.609,365,Medica,Individual & Family,361.715,99.1,,percent of total billed charges,,
APRACLONIDINE 0.5 % OPHT DROP,,2670,LOCAL,Facility,Outpatient,5 mL,mL,,365,310.25,104.609,365,Medica,Medica Advantage Solution,181.77,49.8,,percent of total billed charges,,
APRACLONIDINE 0.5 % OPHT DROP,,2670,LOCAL,Facility,Inpatient,5 mL,mL,,365,310.25,104.609,365,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
APRACLONIDINE 0.5 % OPHT DROP,,2670,LOCAL,Facility,Outpatient,5 mL,mL,,365,310.25,104.609,365,Medica,Medical Assistance,162.79,44.6,,percent of total billed charges,,
APRACLONIDINE 0.5 % OPHT DROP,,2670,LOCAL,Facility,Inpatient,5 mL,mL,,365,310.25,104.609,365,Medica,Medical Assistance,,,,,Included in per diem rate,
APRACLONIDINE 0.5 % OPHT DROP,,2670,LOCAL,Facility,Outpatient,5 mL,mL,,365,310.25,104.609,365,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,181.77,49.8,,percent of total billed charges,,
APRACLONIDINE 0.5 % OPHT DROP,,2670,LOCAL,Facility,Inpatient,5 mL,mL,,365,310.25,104.609,365,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
APRACLONIDINE 0.5 % OPHT DROP,,2670,LOCAL,Facility,Both,5 mL,mL,,365,310.25,104.609,365,"Multiplan, Inc.","Multiplan, Inc.",343.1,94,,percent of total billed charges,,
APRACLONIDINE 0.5 % OPHT DROP,,2670,LOCAL,Facility,Outpatient,5 mL,mL,,365,310.25,104.609,365,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,328.865,90.1,,percent of total billed charges,,
APRACLONIDINE 0.5 % OPHT DROP,,2670,LOCAL,Facility,Inpatient,5 mL,mL,,365,310.25,104.609,365,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
APRACLONIDINE 0.5 % OPHT DROP,,2670,LOCAL,Facility,Both,5 mL,mL,,365,310.25,104.609,365,"Preferred One Administrative Services, INC.",PPO,359.89,98.6,,percent of total billed charges,,
APRACLONIDINE 0.5 % OPHT DROP,,2670,LOCAL,Facility,Outpatient,5 mL,mL,,365,310.25,104.609,365,PrimeWest Health,Minnesota Senior Health Options (MSHO),187.7925,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
APRACLONIDINE 0.5 % OPHT DROP,,2670,LOCAL,Facility,Inpatient,5 mL,mL,,365,310.25,104.609,365,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
APRACLONIDINE 0.5 % OPHT DROP,,2670,LOCAL,Facility,Outpatient,5 mL,mL,,365,310.25,104.609,365,PrimeWest Health,MinnesotaCare,187.464,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
APRACLONIDINE 0.5 % OPHT DROP,,2670,LOCAL,Facility,Inpatient,5 mL,mL,,365,310.25,104.609,365,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
APRACLONIDINE 0.5 % OPHT DROP,,2670,LOCAL,Facility,Both,5 mL,mL,,365,310.25,104.609,365,Sanford Health Plan,Sanford Health Plan,335.8,92,,percent of total billed charges,,
APRACLONIDINE 0.5 % OPHT DROP,,2670,LOCAL,Facility,Outpatient,5 mL,mL,,365,310.25,104.609,365,"UCare Health, Inc.",Individual & Family Plan,205.6775,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
APRACLONIDINE 0.5 % OPHT DROP,,2670,LOCAL,Facility,Inpatient,5 mL,mL,,365,310.25,104.609,365,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
APRACLONIDINE 0.5 % OPHT DROP,,2670,LOCAL,Facility,Outpatient,5 mL,mL,,365,310.25,104.609,365,"UCare Health, Inc.",Medical Assistance,184.2155,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
APRACLONIDINE 0.5 % OPHT DROP,,2670,LOCAL,Facility,Inpatient,5 mL,mL,,365,310.25,104.609,365,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
APRACLONIDINE 0.5 % OPHT DROP,,2670,LOCAL,Facility,Outpatient,5 mL,mL,,365,310.25,104.609,365,"UCare Health, Inc.",Medicare Advantage,184.2155,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
APRACLONIDINE 0.5 % OPHT DROP,,2670,LOCAL,Facility,Inpatient,5 mL,mL,,365,310.25,104.609,365,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
APRACLONIDINE 0.5 % OPHT DROP,,2670,LOCAL,Facility,Outpatient,5 mL,mL,,365,310.25,104.609,365,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),184.2155,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
APRACLONIDINE 0.5 % OPHT DROP,,2670,LOCAL,Facility,Inpatient,5 mL,mL,,365,310.25,104.609,365,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
APRACLONIDINE 0.5 % OPHT DROP,,2670,LOCAL,Facility,Both,5 mL,mL,,365,310.25,104.609,365,UnitedHealthcare,Individual & Family,343.1,94,,percent of total billed charges,,
APRACLONIDINE 0.5 % OPHT DROP,,2670,LOCAL,Facility,Outpatient,5 mL,mL,,365,310.25,104.609,365,UnitedHealthcare,Medicare Advantage,178.85,49,,percent of total billed charges,,
APRACLONIDINE 0.5 % OPHT DROP,,2670,LOCAL,Facility,Inpatient,5 mL,mL,,365,310.25,104.609,365,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
APRACLONIDINE 0.5 % OPHT DROP,,2670,LOCAL,Facility,Outpatient,5 mL,mL,,365,310.25,104.609,365,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,175.2,48,,percent of total billed charges,,100% of DHS outpatient percentage
APRACLONIDINE 0.5 % OPHT DROP,,2670,LOCAL,Facility,Inpatient,5 mL,mL,,365,310.25,104.609,365,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
OFLOXACIN 0.3 % OPHT DROP,,3368,LOCAL,Facility,Both,5 mL,mL,,296,251.6,84.8336,296,Aetna,Commercial,272.32,92,,percent of total billed charges,,
OFLOXACIN 0.3 % OPHT DROP,,3368,LOCAL,Facility,Outpatient,5 mL,mL,,296,251.6,84.8336,296,Aetna,Medicare Advantage,145.04,49,,percent of total billed charges,,
OFLOXACIN 0.3 % OPHT DROP,,3368,LOCAL,Facility,Inpatient,5 mL,mL,,296,251.6,84.8336,296,Aetna,Medicare Advantage,,,,,Included in per diem rate,
OFLOXACIN 0.3 % OPHT DROP,,3368,LOCAL,Facility,Both,5 mL,mL,,296,251.6,84.8336,296,Aetna,PPO,275.28,93,,percent of total billed charges,,
OFLOXACIN 0.3 % OPHT DROP,,3368,LOCAL,Facility,Both,5 mL,mL,,296,251.6,84.8336,296,America's PPO,America's PPO,284.2488,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
OFLOXACIN 0.3 % OPHT DROP,,3368,LOCAL,Facility,Both,5 mL,mL,,296,251.6,84.8336,296,BlueCross BlueShield Minnesota, Federal Employee Program,291.264,98.4,,percent of total billed charges,,
OFLOXACIN 0.3 % OPHT DROP,,3368,LOCAL,Facility,Both,5 mL,mL,,296,251.6,84.8336,296,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,296,100,,percent of total billed charges,,
OFLOXACIN 0.3 % OPHT DROP,,3368,LOCAL,Facility,Both,5 mL,mL,,296,251.6,84.8336,296,BlueCross BlueShield Minnesota,High Value Network Plan,266.4,90,,percent of total billed charges,,
OFLOXACIN 0.3 % OPHT DROP,,3368,LOCAL,Facility,Outpatient,5 mL,mL,,296,251.6,84.8336,296,BlueCross BlueShield Minnesota,Medicare Advantage,145.04,49,,percent of total billed charges,,
OFLOXACIN 0.3 % OPHT DROP,,3368,LOCAL,Facility,Inpatient,5 mL,mL,,296,251.6,84.8336,296,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
OFLOXACIN 0.3 % OPHT DROP,,3368,LOCAL,Facility,Both,5 mL,mL,,296,251.6,84.8336,296,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,262.1672,88.57,,percent of total billed charges,,
OFLOXACIN 0.3 % OPHT DROP,,3368,LOCAL,Facility,Both,5 mL,mL,,296,251.6,84.8336,296,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,84.8336,28.66,,percent of total billed charges,,
OFLOXACIN 0.3 % OPHT DROP,,3368,LOCAL,Facility,Outpatient,5 mL,mL,,296,251.6,84.8336,296,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),145.04,49,,percent of total billed charges,,
OFLOXACIN 0.3 % OPHT DROP,,3368,LOCAL,Facility,Inpatient,5 mL,mL,,296,251.6,84.8336,296,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
OFLOXACIN 0.3 % OPHT DROP,,3368,LOCAL,Facility,Both,5 mL,mL,,296,251.6,84.8336,296,CorVel,Worker's Compensation,296,100,,percent of total billed charges,,
OFLOXACIN 0.3 % OPHT DROP,,3368,LOCAL,Facility,Both,5 mL,mL,,296,251.6,84.8336,296,First Health Group Corporation,First Health Network,287.12,97,,percent of total billed charges,,
OFLOXACIN 0.3 % OPHT DROP,,3368,LOCAL,Facility,Both,5 mL,mL,,296,251.6,84.8336,296,"Health Partners, Inc.",Commercial,280.016,94.6,,percent of total billed charges,,
OFLOXACIN 0.3 % OPHT DROP,,3368,LOCAL,Facility,Outpatient,5 mL,mL,,296,251.6,84.8336,296,"Health Partners, Inc.",Medicare Advantage,145.04,49,,percent of total billed charges,,
OFLOXACIN 0.3 % OPHT DROP,,3368,LOCAL,Facility,Inpatient,5 mL,mL,,296,251.6,84.8336,296,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
OFLOXACIN 0.3 % OPHT DROP,,3368,LOCAL,Facility,Both,5 mL,mL,,296,251.6,84.8336,296,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),177.6,60,,percent of total billed charges,,
OFLOXACIN 0.3 % OPHT DROP,,3368,LOCAL,Facility,Both,5 mL,mL,,296,251.6,84.8336,296,"Health Partners, Inc.",State of Minnesota Advantage Program,241.24,81.5,,percent of total billed charges,,
OFLOXACIN 0.3 % OPHT DROP,,3368,LOCAL,Facility,Both,5 mL,mL,,296,251.6,84.8336,296,"Health Partners, Inc.",State Public Programs,148,50,,percent of total billed charges,,
OFLOXACIN 0.3 % OPHT DROP,,3368,LOCAL,Facility,Both,5 mL,mL,,296,251.6,84.8336,296,Humana Insurance Company,Commercial PPO,281.2,95,,percent of total billed charges,,
OFLOXACIN 0.3 % OPHT DROP,,3368,LOCAL,Facility,Outpatient,5 mL,mL,,296,251.6,84.8336,296,Humana Insurance Company,Medicare PPO,145.04,49,,percent of total billed charges,,
OFLOXACIN 0.3 % OPHT DROP,,3368,LOCAL,Facility,Inpatient,5 mL,mL,,296,251.6,84.8336,296,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
OFLOXACIN 0.3 % OPHT DROP,,3368,LOCAL,Facility,Both,5 mL,mL,,296,251.6,84.8336,296,Medica,Individual & Family,293.336,99.1,,percent of total billed charges,,
OFLOXACIN 0.3 % OPHT DROP,,3368,LOCAL,Facility,Outpatient,5 mL,mL,,296,251.6,84.8336,296,Medica,Medica Advantage Solution,147.408,49.8,,percent of total billed charges,,
OFLOXACIN 0.3 % OPHT DROP,,3368,LOCAL,Facility,Inpatient,5 mL,mL,,296,251.6,84.8336,296,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
OFLOXACIN 0.3 % OPHT DROP,,3368,LOCAL,Facility,Outpatient,5 mL,mL,,296,251.6,84.8336,296,Medica,Medical Assistance,132.016,44.6,,percent of total billed charges,,
OFLOXACIN 0.3 % OPHT DROP,,3368,LOCAL,Facility,Inpatient,5 mL,mL,,296,251.6,84.8336,296,Medica,Medical Assistance,,,,,Included in per diem rate,
OFLOXACIN 0.3 % OPHT DROP,,3368,LOCAL,Facility,Outpatient,5 mL,mL,,296,251.6,84.8336,296,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,147.408,49.8,,percent of total billed charges,,
OFLOXACIN 0.3 % OPHT DROP,,3368,LOCAL,Facility,Inpatient,5 mL,mL,,296,251.6,84.8336,296,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
OFLOXACIN 0.3 % OPHT DROP,,3368,LOCAL,Facility,Both,5 mL,mL,,296,251.6,84.8336,296,"Multiplan, Inc.","Multiplan, Inc.",278.24,94,,percent of total billed charges,,
OFLOXACIN 0.3 % OPHT DROP,,3368,LOCAL,Facility,Outpatient,5 mL,mL,,296,251.6,84.8336,296,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,266.696,90.1,,percent of total billed charges,,
OFLOXACIN 0.3 % OPHT DROP,,3368,LOCAL,Facility,Inpatient,5 mL,mL,,296,251.6,84.8336,296,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
OFLOXACIN 0.3 % OPHT DROP,,3368,LOCAL,Facility,Both,5 mL,mL,,296,251.6,84.8336,296,"Preferred One Administrative Services, INC.",PPO,291.856,98.6,,percent of total billed charges,,
OFLOXACIN 0.3 % OPHT DROP,,3368,LOCAL,Facility,Outpatient,5 mL,mL,,296,251.6,84.8336,296,PrimeWest Health,Minnesota Senior Health Options (MSHO),152.292,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
OFLOXACIN 0.3 % OPHT DROP,,3368,LOCAL,Facility,Inpatient,5 mL,mL,,296,251.6,84.8336,296,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
OFLOXACIN 0.3 % OPHT DROP,,3368,LOCAL,Facility,Outpatient,5 mL,mL,,296,251.6,84.8336,296,PrimeWest Health,MinnesotaCare,152.0256,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
OFLOXACIN 0.3 % OPHT DROP,,3368,LOCAL,Facility,Inpatient,5 mL,mL,,296,251.6,84.8336,296,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
OFLOXACIN 0.3 % OPHT DROP,,3368,LOCAL,Facility,Both,5 mL,mL,,296,251.6,84.8336,296,Sanford Health Plan,Sanford Health Plan,272.32,92,,percent of total billed charges,,
OFLOXACIN 0.3 % OPHT DROP,,3368,LOCAL,Facility,Outpatient,5 mL,mL,,296,251.6,84.8336,296,"UCare Health, Inc.",Individual & Family Plan,166.796,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
OFLOXACIN 0.3 % OPHT DROP,,3368,LOCAL,Facility,Inpatient,5 mL,mL,,296,251.6,84.8336,296,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
OFLOXACIN 0.3 % OPHT DROP,,3368,LOCAL,Facility,Outpatient,5 mL,mL,,296,251.6,84.8336,296,"UCare Health, Inc.",Medical Assistance,149.3912,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
OFLOXACIN 0.3 % OPHT DROP,,3368,LOCAL,Facility,Inpatient,5 mL,mL,,296,251.6,84.8336,296,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
OFLOXACIN 0.3 % OPHT DROP,,3368,LOCAL,Facility,Outpatient,5 mL,mL,,296,251.6,84.8336,296,"UCare Health, Inc.",Medicare Advantage,149.3912,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
OFLOXACIN 0.3 % OPHT DROP,,3368,LOCAL,Facility,Inpatient,5 mL,mL,,296,251.6,84.8336,296,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
OFLOXACIN 0.3 % OPHT DROP,,3368,LOCAL,Facility,Outpatient,5 mL,mL,,296,251.6,84.8336,296,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),149.3912,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
OFLOXACIN 0.3 % OPHT DROP,,3368,LOCAL,Facility,Inpatient,5 mL,mL,,296,251.6,84.8336,296,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
OFLOXACIN 0.3 % OPHT DROP,,3368,LOCAL,Facility,Both,5 mL,mL,,296,251.6,84.8336,296,UnitedHealthcare,Individual & Family,278.24,94,,percent of total billed charges,,
OFLOXACIN 0.3 % OPHT DROP,,3368,LOCAL,Facility,Outpatient,5 mL,mL,,296,251.6,84.8336,296,UnitedHealthcare,Medicare Advantage,145.04,49,,percent of total billed charges,,
OFLOXACIN 0.3 % OPHT DROP,,3368,LOCAL,Facility,Inpatient,5 mL,mL,,296,251.6,84.8336,296,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
OFLOXACIN 0.3 % OPHT DROP,,3368,LOCAL,Facility,Outpatient,5 mL,mL,,296,251.6,84.8336,296,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,142.08,48,,percent of total billed charges,,100% of DHS outpatient percentage
OFLOXACIN 0.3 % OPHT DROP,,3368,LOCAL,Facility,Inpatient,5 mL,mL,,296,251.6,84.8336,296,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
KETOTIFEN FUMARATE 0.025 % (0.035 %) OPHT DROP,,3697,LOCAL,Facility,Both,5 mL,mL,,55,46.75,15.763,55,Aetna,Commercial,50.6,92,,percent of total billed charges,,
KETOTIFEN FUMARATE 0.025 % (0.035 %) OPHT DROP,,3697,LOCAL,Facility,Outpatient,5 mL,mL,,55,46.75,15.763,55,Aetna,Medicare Advantage,26.95,49,,percent of total billed charges,,
KETOTIFEN FUMARATE 0.025 % (0.035 %) OPHT DROP,,3697,LOCAL,Facility,Inpatient,5 mL,mL,,55,46.75,15.763,55,Aetna,Medicare Advantage,,,,,Included in per diem rate,
KETOTIFEN FUMARATE 0.025 % (0.035 %) OPHT DROP,,3697,LOCAL,Facility,Both,5 mL,mL,,55,46.75,15.763,55,Aetna,PPO,51.15,93,,percent of total billed charges,,
KETOTIFEN FUMARATE 0.025 % (0.035 %) OPHT DROP,,3697,LOCAL,Facility,Both,5 mL,mL,,55,46.75,15.763,55,America's PPO,America's PPO,52.8165,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
KETOTIFEN FUMARATE 0.025 % (0.035 %) OPHT DROP,,3697,LOCAL,Facility,Both,5 mL,mL,,55,46.75,15.763,55,BlueCross BlueShield Minnesota, Federal Employee Program,54.12,98.4,,percent of total billed charges,,
KETOTIFEN FUMARATE 0.025 % (0.035 %) OPHT DROP,,3697,LOCAL,Facility,Both,5 mL,mL,,55,46.75,15.763,55,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,55,100,,percent of total billed charges,,
KETOTIFEN FUMARATE 0.025 % (0.035 %) OPHT DROP,,3697,LOCAL,Facility,Both,5 mL,mL,,55,46.75,15.763,55,BlueCross BlueShield Minnesota,High Value Network Plan,49.5,90,,percent of total billed charges,,
KETOTIFEN FUMARATE 0.025 % (0.035 %) OPHT DROP,,3697,LOCAL,Facility,Outpatient,5 mL,mL,,55,46.75,15.763,55,BlueCross BlueShield Minnesota,Medicare Advantage,26.95,49,,percent of total billed charges,,
KETOTIFEN FUMARATE 0.025 % (0.035 %) OPHT DROP,,3697,LOCAL,Facility,Inpatient,5 mL,mL,,55,46.75,15.763,55,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
KETOTIFEN FUMARATE 0.025 % (0.035 %) OPHT DROP,,3697,LOCAL,Facility,Both,5 mL,mL,,55,46.75,15.763,55,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,48.7135,88.57,,percent of total billed charges,,
KETOTIFEN FUMARATE 0.025 % (0.035 %) OPHT DROP,,3697,LOCAL,Facility,Both,5 mL,mL,,55,46.75,15.763,55,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,15.763,28.66,,percent of total billed charges,,
KETOTIFEN FUMARATE 0.025 % (0.035 %) OPHT DROP,,3697,LOCAL,Facility,Outpatient,5 mL,mL,,55,46.75,15.763,55,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),26.95,49,,percent of total billed charges,,
KETOTIFEN FUMARATE 0.025 % (0.035 %) OPHT DROP,,3697,LOCAL,Facility,Inpatient,5 mL,mL,,55,46.75,15.763,55,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
KETOTIFEN FUMARATE 0.025 % (0.035 %) OPHT DROP,,3697,LOCAL,Facility,Both,5 mL,mL,,55,46.75,15.763,55,CorVel,Worker's Compensation,55,100,,percent of total billed charges,,
KETOTIFEN FUMARATE 0.025 % (0.035 %) OPHT DROP,,3697,LOCAL,Facility,Both,5 mL,mL,,55,46.75,15.763,55,First Health Group Corporation,First Health Network,53.35,97,,percent of total billed charges,,
KETOTIFEN FUMARATE 0.025 % (0.035 %) OPHT DROP,,3697,LOCAL,Facility,Both,5 mL,mL,,55,46.75,15.763,55,"Health Partners, Inc.",Commercial,52.03,94.6,,percent of total billed charges,,
KETOTIFEN FUMARATE 0.025 % (0.035 %) OPHT DROP,,3697,LOCAL,Facility,Outpatient,5 mL,mL,,55,46.75,15.763,55,"Health Partners, Inc.",Medicare Advantage,26.95,49,,percent of total billed charges,,
KETOTIFEN FUMARATE 0.025 % (0.035 %) OPHT DROP,,3697,LOCAL,Facility,Inpatient,5 mL,mL,,55,46.75,15.763,55,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
KETOTIFEN FUMARATE 0.025 % (0.035 %) OPHT DROP,,3697,LOCAL,Facility,Both,5 mL,mL,,55,46.75,15.763,55,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),33,60,,percent of total billed charges,,
KETOTIFEN FUMARATE 0.025 % (0.035 %) OPHT DROP,,3697,LOCAL,Facility,Both,5 mL,mL,,55,46.75,15.763,55,"Health Partners, Inc.",State of Minnesota Advantage Program,44.825,81.5,,percent of total billed charges,,
KETOTIFEN FUMARATE 0.025 % (0.035 %) OPHT DROP,,3697,LOCAL,Facility,Both,5 mL,mL,,55,46.75,15.763,55,"Health Partners, Inc.",State Public Programs,27.5,50,,percent of total billed charges,,
KETOTIFEN FUMARATE 0.025 % (0.035 %) OPHT DROP,,3697,LOCAL,Facility,Both,5 mL,mL,,55,46.75,15.763,55,Humana Insurance Company,Commercial PPO,52.25,95,,percent of total billed charges,,
KETOTIFEN FUMARATE 0.025 % (0.035 %) OPHT DROP,,3697,LOCAL,Facility,Outpatient,5 mL,mL,,55,46.75,15.763,55,Humana Insurance Company,Medicare PPO,26.95,49,,percent of total billed charges,,
KETOTIFEN FUMARATE 0.025 % (0.035 %) OPHT DROP,,3697,LOCAL,Facility,Inpatient,5 mL,mL,,55,46.75,15.763,55,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
KETOTIFEN FUMARATE 0.025 % (0.035 %) OPHT DROP,,3697,LOCAL,Facility,Both,5 mL,mL,,55,46.75,15.763,55,Medica,Individual & Family,54.505,99.1,,percent of total billed charges,,
KETOTIFEN FUMARATE 0.025 % (0.035 %) OPHT DROP,,3697,LOCAL,Facility,Outpatient,5 mL,mL,,55,46.75,15.763,55,Medica,Medica Advantage Solution,27.39,49.8,,percent of total billed charges,,
KETOTIFEN FUMARATE 0.025 % (0.035 %) OPHT DROP,,3697,LOCAL,Facility,Inpatient,5 mL,mL,,55,46.75,15.763,55,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
KETOTIFEN FUMARATE 0.025 % (0.035 %) OPHT DROP,,3697,LOCAL,Facility,Outpatient,5 mL,mL,,55,46.75,15.763,55,Medica,Medical Assistance,24.53,44.6,,percent of total billed charges,,
KETOTIFEN FUMARATE 0.025 % (0.035 %) OPHT DROP,,3697,LOCAL,Facility,Inpatient,5 mL,mL,,55,46.75,15.763,55,Medica,Medical Assistance,,,,,Included in per diem rate,
KETOTIFEN FUMARATE 0.025 % (0.035 %) OPHT DROP,,3697,LOCAL,Facility,Outpatient,5 mL,mL,,55,46.75,15.763,55,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,27.39,49.8,,percent of total billed charges,,
KETOTIFEN FUMARATE 0.025 % (0.035 %) OPHT DROP,,3697,LOCAL,Facility,Inpatient,5 mL,mL,,55,46.75,15.763,55,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
KETOTIFEN FUMARATE 0.025 % (0.035 %) OPHT DROP,,3697,LOCAL,Facility,Both,5 mL,mL,,55,46.75,15.763,55,"Multiplan, Inc.","Multiplan, Inc.",51.7,94,,percent of total billed charges,,
KETOTIFEN FUMARATE 0.025 % (0.035 %) OPHT DROP,,3697,LOCAL,Facility,Outpatient,5 mL,mL,,55,46.75,15.763,55,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,49.555,90.1,,percent of total billed charges,,
KETOTIFEN FUMARATE 0.025 % (0.035 %) OPHT DROP,,3697,LOCAL,Facility,Inpatient,5 mL,mL,,55,46.75,15.763,55,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
KETOTIFEN FUMARATE 0.025 % (0.035 %) OPHT DROP,,3697,LOCAL,Facility,Both,5 mL,mL,,55,46.75,15.763,55,"Preferred One Administrative Services, INC.",PPO,54.23,98.6,,percent of total billed charges,,
KETOTIFEN FUMARATE 0.025 % (0.035 %) OPHT DROP,,3697,LOCAL,Facility,Outpatient,5 mL,mL,,55,46.75,15.763,55,PrimeWest Health,Minnesota Senior Health Options (MSHO),28.2975,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
KETOTIFEN FUMARATE 0.025 % (0.035 %) OPHT DROP,,3697,LOCAL,Facility,Inpatient,5 mL,mL,,55,46.75,15.763,55,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
KETOTIFEN FUMARATE 0.025 % (0.035 %) OPHT DROP,,3697,LOCAL,Facility,Outpatient,5 mL,mL,,55,46.75,15.763,55,PrimeWest Health,MinnesotaCare,28.248,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
KETOTIFEN FUMARATE 0.025 % (0.035 %) OPHT DROP,,3697,LOCAL,Facility,Inpatient,5 mL,mL,,55,46.75,15.763,55,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
KETOTIFEN FUMARATE 0.025 % (0.035 %) OPHT DROP,,3697,LOCAL,Facility,Both,5 mL,mL,,55,46.75,15.763,55,Sanford Health Plan,Sanford Health Plan,50.6,92,,percent of total billed charges,,
KETOTIFEN FUMARATE 0.025 % (0.035 %) OPHT DROP,,3697,LOCAL,Facility,Outpatient,5 mL,mL,,55,46.75,15.763,55,"UCare Health, Inc.",Individual & Family Plan,30.9925,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
KETOTIFEN FUMARATE 0.025 % (0.035 %) OPHT DROP,,3697,LOCAL,Facility,Inpatient,5 mL,mL,,55,46.75,15.763,55,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
KETOTIFEN FUMARATE 0.025 % (0.035 %) OPHT DROP,,3697,LOCAL,Facility,Outpatient,5 mL,mL,,55,46.75,15.763,55,"UCare Health, Inc.",Medical Assistance,27.7585,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
KETOTIFEN FUMARATE 0.025 % (0.035 %) OPHT DROP,,3697,LOCAL,Facility,Inpatient,5 mL,mL,,55,46.75,15.763,55,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
KETOTIFEN FUMARATE 0.025 % (0.035 %) OPHT DROP,,3697,LOCAL,Facility,Outpatient,5 mL,mL,,55,46.75,15.763,55,"UCare Health, Inc.",Medicare Advantage,27.7585,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
KETOTIFEN FUMARATE 0.025 % (0.035 %) OPHT DROP,,3697,LOCAL,Facility,Inpatient,5 mL,mL,,55,46.75,15.763,55,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
KETOTIFEN FUMARATE 0.025 % (0.035 %) OPHT DROP,,3697,LOCAL,Facility,Outpatient,5 mL,mL,,55,46.75,15.763,55,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),27.7585,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
KETOTIFEN FUMARATE 0.025 % (0.035 %) OPHT DROP,,3697,LOCAL,Facility,Inpatient,5 mL,mL,,55,46.75,15.763,55,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
KETOTIFEN FUMARATE 0.025 % (0.035 %) OPHT DROP,,3697,LOCAL,Facility,Both,5 mL,mL,,55,46.75,15.763,55,UnitedHealthcare,Individual & Family,51.7,94,,percent of total billed charges,,
KETOTIFEN FUMARATE 0.025 % (0.035 %) OPHT DROP,,3697,LOCAL,Facility,Outpatient,5 mL,mL,,55,46.75,15.763,55,UnitedHealthcare,Medicare Advantage,26.95,49,,percent of total billed charges,,
KETOTIFEN FUMARATE 0.025 % (0.035 %) OPHT DROP,,3697,LOCAL,Facility,Inpatient,5 mL,mL,,55,46.75,15.763,55,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
KETOTIFEN FUMARATE 0.025 % (0.035 %) OPHT DROP,,3697,LOCAL,Facility,Outpatient,5 mL,mL,,55,46.75,15.763,55,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,26.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
KETOTIFEN FUMARATE 0.025 % (0.035 %) OPHT DROP,,3697,LOCAL,Facility,Inpatient,5 mL,mL,,55,46.75,15.763,55,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
TETRACAINE HCL 0.5 % OPHT DROP,,4680,LOCAL,Facility,Both,5 mL,mL,,162,137.7,46.4292,162,Aetna,Commercial,149.04,92,,percent of total billed charges,,
TETRACAINE HCL 0.5 % OPHT DROP,,4680,LOCAL,Facility,Outpatient,5 mL,mL,,162,137.7,46.4292,162,Aetna,Medicare Advantage,79.38,49,,percent of total billed charges,,
TETRACAINE HCL 0.5 % OPHT DROP,,4680,LOCAL,Facility,Inpatient,5 mL,mL,,162,137.7,46.4292,162,Aetna,Medicare Advantage,,,,,Included in per diem rate,
TETRACAINE HCL 0.5 % OPHT DROP,,4680,LOCAL,Facility,Both,5 mL,mL,,162,137.7,46.4292,162,Aetna,PPO,150.66,93,,percent of total billed charges,,
TETRACAINE HCL 0.5 % OPHT DROP,,4680,LOCAL,Facility,Both,5 mL,mL,,162,137.7,46.4292,162,America's PPO,America's PPO,155.5686,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
TETRACAINE HCL 0.5 % OPHT DROP,,4680,LOCAL,Facility,Both,5 mL,mL,,162,137.7,46.4292,162,BlueCross BlueShield Minnesota, Federal Employee Program,159.408,98.4,,percent of total billed charges,,
TETRACAINE HCL 0.5 % OPHT DROP,,4680,LOCAL,Facility,Both,5 mL,mL,,162,137.7,46.4292,162,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,162,100,,percent of total billed charges,,
TETRACAINE HCL 0.5 % OPHT DROP,,4680,LOCAL,Facility,Both,5 mL,mL,,162,137.7,46.4292,162,BlueCross BlueShield Minnesota,High Value Network Plan,145.8,90,,percent of total billed charges,,
TETRACAINE HCL 0.5 % OPHT DROP,,4680,LOCAL,Facility,Outpatient,5 mL,mL,,162,137.7,46.4292,162,BlueCross BlueShield Minnesota,Medicare Advantage,79.38,49,,percent of total billed charges,,
TETRACAINE HCL 0.5 % OPHT DROP,,4680,LOCAL,Facility,Inpatient,5 mL,mL,,162,137.7,46.4292,162,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
TETRACAINE HCL 0.5 % OPHT DROP,,4680,LOCAL,Facility,Both,5 mL,mL,,162,137.7,46.4292,162,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,143.4834,88.57,,percent of total billed charges,,
TETRACAINE HCL 0.5 % OPHT DROP,,4680,LOCAL,Facility,Both,5 mL,mL,,162,137.7,46.4292,162,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,46.4292,28.66,,percent of total billed charges,,
TETRACAINE HCL 0.5 % OPHT DROP,,4680,LOCAL,Facility,Outpatient,5 mL,mL,,162,137.7,46.4292,162,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),79.38,49,,percent of total billed charges,,
TETRACAINE HCL 0.5 % OPHT DROP,,4680,LOCAL,Facility,Inpatient,5 mL,mL,,162,137.7,46.4292,162,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
TETRACAINE HCL 0.5 % OPHT DROP,,4680,LOCAL,Facility,Both,5 mL,mL,,162,137.7,46.4292,162,CorVel,Worker's Compensation,162,100,,percent of total billed charges,,
TETRACAINE HCL 0.5 % OPHT DROP,,4680,LOCAL,Facility,Both,5 mL,mL,,162,137.7,46.4292,162,First Health Group Corporation,First Health Network,157.14,97,,percent of total billed charges,,
TETRACAINE HCL 0.5 % OPHT DROP,,4680,LOCAL,Facility,Both,5 mL,mL,,162,137.7,46.4292,162,"Health Partners, Inc.",Commercial,153.252,94.6,,percent of total billed charges,,
TETRACAINE HCL 0.5 % OPHT DROP,,4680,LOCAL,Facility,Outpatient,5 mL,mL,,162,137.7,46.4292,162,"Health Partners, Inc.",Medicare Advantage,79.38,49,,percent of total billed charges,,
TETRACAINE HCL 0.5 % OPHT DROP,,4680,LOCAL,Facility,Inpatient,5 mL,mL,,162,137.7,46.4292,162,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
TETRACAINE HCL 0.5 % OPHT DROP,,4680,LOCAL,Facility,Both,5 mL,mL,,162,137.7,46.4292,162,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),97.2,60,,percent of total billed charges,,
TETRACAINE HCL 0.5 % OPHT DROP,,4680,LOCAL,Facility,Both,5 mL,mL,,162,137.7,46.4292,162,"Health Partners, Inc.",State of Minnesota Advantage Program,132.03,81.5,,percent of total billed charges,,
TETRACAINE HCL 0.5 % OPHT DROP,,4680,LOCAL,Facility,Both,5 mL,mL,,162,137.7,46.4292,162,"Health Partners, Inc.",State Public Programs,81,50,,percent of total billed charges,,
TETRACAINE HCL 0.5 % OPHT DROP,,4680,LOCAL,Facility,Both,5 mL,mL,,162,137.7,46.4292,162,Humana Insurance Company,Commercial PPO,153.9,95,,percent of total billed charges,,
TETRACAINE HCL 0.5 % OPHT DROP,,4680,LOCAL,Facility,Outpatient,5 mL,mL,,162,137.7,46.4292,162,Humana Insurance Company,Medicare PPO,79.38,49,,percent of total billed charges,,
TETRACAINE HCL 0.5 % OPHT DROP,,4680,LOCAL,Facility,Inpatient,5 mL,mL,,162,137.7,46.4292,162,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
TETRACAINE HCL 0.5 % OPHT DROP,,4680,LOCAL,Facility,Both,5 mL,mL,,162,137.7,46.4292,162,Medica,Individual & Family,160.542,99.1,,percent of total billed charges,,
TETRACAINE HCL 0.5 % OPHT DROP,,4680,LOCAL,Facility,Outpatient,5 mL,mL,,162,137.7,46.4292,162,Medica,Medica Advantage Solution,80.676,49.8,,percent of total billed charges,,
TETRACAINE HCL 0.5 % OPHT DROP,,4680,LOCAL,Facility,Inpatient,5 mL,mL,,162,137.7,46.4292,162,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
TETRACAINE HCL 0.5 % OPHT DROP,,4680,LOCAL,Facility,Outpatient,5 mL,mL,,162,137.7,46.4292,162,Medica,Medical Assistance,72.252,44.6,,percent of total billed charges,,
TETRACAINE HCL 0.5 % OPHT DROP,,4680,LOCAL,Facility,Inpatient,5 mL,mL,,162,137.7,46.4292,162,Medica,Medical Assistance,,,,,Included in per diem rate,
TETRACAINE HCL 0.5 % OPHT DROP,,4680,LOCAL,Facility,Outpatient,5 mL,mL,,162,137.7,46.4292,162,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,80.676,49.8,,percent of total billed charges,,
TETRACAINE HCL 0.5 % OPHT DROP,,4680,LOCAL,Facility,Inpatient,5 mL,mL,,162,137.7,46.4292,162,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
TETRACAINE HCL 0.5 % OPHT DROP,,4680,LOCAL,Facility,Both,5 mL,mL,,162,137.7,46.4292,162,"Multiplan, Inc.","Multiplan, Inc.",152.28,94,,percent of total billed charges,,
TETRACAINE HCL 0.5 % OPHT DROP,,4680,LOCAL,Facility,Outpatient,5 mL,mL,,162,137.7,46.4292,162,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,145.962,90.1,,percent of total billed charges,,
TETRACAINE HCL 0.5 % OPHT DROP,,4680,LOCAL,Facility,Inpatient,5 mL,mL,,162,137.7,46.4292,162,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
TETRACAINE HCL 0.5 % OPHT DROP,,4680,LOCAL,Facility,Both,5 mL,mL,,162,137.7,46.4292,162,"Preferred One Administrative Services, INC.",PPO,159.732,98.6,,percent of total billed charges,,
TETRACAINE HCL 0.5 % OPHT DROP,,4680,LOCAL,Facility,Outpatient,5 mL,mL,,162,137.7,46.4292,162,PrimeWest Health,Minnesota Senior Health Options (MSHO),83.349,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
TETRACAINE HCL 0.5 % OPHT DROP,,4680,LOCAL,Facility,Inpatient,5 mL,mL,,162,137.7,46.4292,162,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
TETRACAINE HCL 0.5 % OPHT DROP,,4680,LOCAL,Facility,Outpatient,5 mL,mL,,162,137.7,46.4292,162,PrimeWest Health,MinnesotaCare,83.2032,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
TETRACAINE HCL 0.5 % OPHT DROP,,4680,LOCAL,Facility,Inpatient,5 mL,mL,,162,137.7,46.4292,162,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
TETRACAINE HCL 0.5 % OPHT DROP,,4680,LOCAL,Facility,Both,5 mL,mL,,162,137.7,46.4292,162,Sanford Health Plan,Sanford Health Plan,149.04,92,,percent of total billed charges,,
TETRACAINE HCL 0.5 % OPHT DROP,,4680,LOCAL,Facility,Outpatient,5 mL,mL,,162,137.7,46.4292,162,"UCare Health, Inc.",Individual & Family Plan,91.287,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
TETRACAINE HCL 0.5 % OPHT DROP,,4680,LOCAL,Facility,Inpatient,5 mL,mL,,162,137.7,46.4292,162,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
TETRACAINE HCL 0.5 % OPHT DROP,,4680,LOCAL,Facility,Outpatient,5 mL,mL,,162,137.7,46.4292,162,"UCare Health, Inc.",Medical Assistance,81.7614,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TETRACAINE HCL 0.5 % OPHT DROP,,4680,LOCAL,Facility,Inpatient,5 mL,mL,,162,137.7,46.4292,162,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
TETRACAINE HCL 0.5 % OPHT DROP,,4680,LOCAL,Facility,Outpatient,5 mL,mL,,162,137.7,46.4292,162,"UCare Health, Inc.",Medicare Advantage,81.7614,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TETRACAINE HCL 0.5 % OPHT DROP,,4680,LOCAL,Facility,Inpatient,5 mL,mL,,162,137.7,46.4292,162,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
TETRACAINE HCL 0.5 % OPHT DROP,,4680,LOCAL,Facility,Outpatient,5 mL,mL,,162,137.7,46.4292,162,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),81.7614,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TETRACAINE HCL 0.5 % OPHT DROP,,4680,LOCAL,Facility,Inpatient,5 mL,mL,,162,137.7,46.4292,162,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
TETRACAINE HCL 0.5 % OPHT DROP,,4680,LOCAL,Facility,Both,5 mL,mL,,162,137.7,46.4292,162,UnitedHealthcare,Individual & Family,152.28,94,,percent of total billed charges,,
TETRACAINE HCL 0.5 % OPHT DROP,,4680,LOCAL,Facility,Outpatient,5 mL,mL,,162,137.7,46.4292,162,UnitedHealthcare,Medicare Advantage,79.38,49,,percent of total billed charges,,
TETRACAINE HCL 0.5 % OPHT DROP,,4680,LOCAL,Facility,Inpatient,5 mL,mL,,162,137.7,46.4292,162,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
TETRACAINE HCL 0.5 % OPHT DROP,,4680,LOCAL,Facility,Outpatient,5 mL,mL,,162,137.7,46.4292,162,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,77.76,48,,percent of total billed charges,,100% of DHS outpatient percentage
TETRACAINE HCL 0.5 % OPHT DROP,,4680,LOCAL,Facility,Inpatient,5 mL,mL,,162,137.7,46.4292,162,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
DEXTROMETHORPHAN-GUAIFENESIN 10-100 MG/5 ML ORAL SYRP,,7112,LOCAL,Facility,Both,5 mL,mL,,13,11.05,3.7258,13,Aetna,Commercial,11.96,92,,percent of total billed charges,,
DEXTROMETHORPHAN-GUAIFENESIN 10-100 MG/5 ML ORAL SYRP,,7112,LOCAL,Facility,Outpatient,5 mL,mL,,13,11.05,3.7258,13,Aetna,Medicare Advantage,6.37,49,,percent of total billed charges,,
DEXTROMETHORPHAN-GUAIFENESIN 10-100 MG/5 ML ORAL SYRP,,7112,LOCAL,Facility,Inpatient,5 mL,mL,,13,11.05,3.7258,13,Aetna,Medicare Advantage,,,,,Included in per diem rate,
DEXTROMETHORPHAN-GUAIFENESIN 10-100 MG/5 ML ORAL SYRP,,7112,LOCAL,Facility,Both,5 mL,mL,,13,11.05,3.7258,13,Aetna,PPO,12.09,93,,percent of total billed charges,,
DEXTROMETHORPHAN-GUAIFENESIN 10-100 MG/5 ML ORAL SYRP,,7112,LOCAL,Facility,Both,5 mL,mL,,13,11.05,3.7258,13,America's PPO,America's PPO,12.4839,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
DEXTROMETHORPHAN-GUAIFENESIN 10-100 MG/5 ML ORAL SYRP,,7112,LOCAL,Facility,Both,5 mL,mL,,13,11.05,3.7258,13,BlueCross BlueShield Minnesota, Federal Employee Program,12.792,98.4,,percent of total billed charges,,
DEXTROMETHORPHAN-GUAIFENESIN 10-100 MG/5 ML ORAL SYRP,,7112,LOCAL,Facility,Both,5 mL,mL,,13,11.05,3.7258,13,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,13,100,,percent of total billed charges,,
DEXTROMETHORPHAN-GUAIFENESIN 10-100 MG/5 ML ORAL SYRP,,7112,LOCAL,Facility,Both,5 mL,mL,,13,11.05,3.7258,13,BlueCross BlueShield Minnesota,High Value Network Plan,11.7,90,,percent of total billed charges,,
DEXTROMETHORPHAN-GUAIFENESIN 10-100 MG/5 ML ORAL SYRP,,7112,LOCAL,Facility,Outpatient,5 mL,mL,,13,11.05,3.7258,13,BlueCross BlueShield Minnesota,Medicare Advantage,6.37,49,,percent of total billed charges,,
DEXTROMETHORPHAN-GUAIFENESIN 10-100 MG/5 ML ORAL SYRP,,7112,LOCAL,Facility,Inpatient,5 mL,mL,,13,11.05,3.7258,13,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
DEXTROMETHORPHAN-GUAIFENESIN 10-100 MG/5 ML ORAL SYRP,,7112,LOCAL,Facility,Both,5 mL,mL,,13,11.05,3.7258,13,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,11.5141,88.57,,percent of total billed charges,,
DEXTROMETHORPHAN-GUAIFENESIN 10-100 MG/5 ML ORAL SYRP,,7112,LOCAL,Facility,Both,5 mL,mL,,13,11.05,3.7258,13,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,3.7258,28.66,,percent of total billed charges,,
DEXTROMETHORPHAN-GUAIFENESIN 10-100 MG/5 ML ORAL SYRP,,7112,LOCAL,Facility,Outpatient,5 mL,mL,,13,11.05,3.7258,13,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),6.37,49,,percent of total billed charges,,
DEXTROMETHORPHAN-GUAIFENESIN 10-100 MG/5 ML ORAL SYRP,,7112,LOCAL,Facility,Inpatient,5 mL,mL,,13,11.05,3.7258,13,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
DEXTROMETHORPHAN-GUAIFENESIN 10-100 MG/5 ML ORAL SYRP,,7112,LOCAL,Facility,Both,5 mL,mL,,13,11.05,3.7258,13,CorVel,Worker's Compensation,13,100,,percent of total billed charges,,
DEXTROMETHORPHAN-GUAIFENESIN 10-100 MG/5 ML ORAL SYRP,,7112,LOCAL,Facility,Both,5 mL,mL,,13,11.05,3.7258,13,First Health Group Corporation,First Health Network,12.61,97,,percent of total billed charges,,
DEXTROMETHORPHAN-GUAIFENESIN 10-100 MG/5 ML ORAL SYRP,,7112,LOCAL,Facility,Both,5 mL,mL,,13,11.05,3.7258,13,"Health Partners, Inc.",Commercial,12.298,94.6,,percent of total billed charges,,
DEXTROMETHORPHAN-GUAIFENESIN 10-100 MG/5 ML ORAL SYRP,,7112,LOCAL,Facility,Outpatient,5 mL,mL,,13,11.05,3.7258,13,"Health Partners, Inc.",Medicare Advantage,6.37,49,,percent of total billed charges,,
DEXTROMETHORPHAN-GUAIFENESIN 10-100 MG/5 ML ORAL SYRP,,7112,LOCAL,Facility,Inpatient,5 mL,mL,,13,11.05,3.7258,13,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DEXTROMETHORPHAN-GUAIFENESIN 10-100 MG/5 ML ORAL SYRP,,7112,LOCAL,Facility,Both,5 mL,mL,,13,11.05,3.7258,13,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),7.8,60,,percent of total billed charges,,
DEXTROMETHORPHAN-GUAIFENESIN 10-100 MG/5 ML ORAL SYRP,,7112,LOCAL,Facility,Both,5 mL,mL,,13,11.05,3.7258,13,"Health Partners, Inc.",State of Minnesota Advantage Program,10.595,81.5,,percent of total billed charges,,
DEXTROMETHORPHAN-GUAIFENESIN 10-100 MG/5 ML ORAL SYRP,,7112,LOCAL,Facility,Both,5 mL,mL,,13,11.05,3.7258,13,"Health Partners, Inc.",State Public Programs,6.5,50,,percent of total billed charges,,
DEXTROMETHORPHAN-GUAIFENESIN 10-100 MG/5 ML ORAL SYRP,,7112,LOCAL,Facility,Both,5 mL,mL,,13,11.05,3.7258,13,Humana Insurance Company,Commercial PPO,12.35,95,,percent of total billed charges,,
DEXTROMETHORPHAN-GUAIFENESIN 10-100 MG/5 ML ORAL SYRP,,7112,LOCAL,Facility,Outpatient,5 mL,mL,,13,11.05,3.7258,13,Humana Insurance Company,Medicare PPO,6.37,49,,percent of total billed charges,,
DEXTROMETHORPHAN-GUAIFENESIN 10-100 MG/5 ML ORAL SYRP,,7112,LOCAL,Facility,Inpatient,5 mL,mL,,13,11.05,3.7258,13,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
DEXTROMETHORPHAN-GUAIFENESIN 10-100 MG/5 ML ORAL SYRP,,7112,LOCAL,Facility,Both,5 mL,mL,,13,11.05,3.7258,13,Medica,Individual & Family,12.883,99.1,,percent of total billed charges,,
DEXTROMETHORPHAN-GUAIFENESIN 10-100 MG/5 ML ORAL SYRP,,7112,LOCAL,Facility,Outpatient,5 mL,mL,,13,11.05,3.7258,13,Medica,Medica Advantage Solution,6.474,49.8,,percent of total billed charges,,
DEXTROMETHORPHAN-GUAIFENESIN 10-100 MG/5 ML ORAL SYRP,,7112,LOCAL,Facility,Inpatient,5 mL,mL,,13,11.05,3.7258,13,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
DEXTROMETHORPHAN-GUAIFENESIN 10-100 MG/5 ML ORAL SYRP,,7112,LOCAL,Facility,Outpatient,5 mL,mL,,13,11.05,3.7258,13,Medica,Medical Assistance,5.798,44.6,,percent of total billed charges,,
DEXTROMETHORPHAN-GUAIFENESIN 10-100 MG/5 ML ORAL SYRP,,7112,LOCAL,Facility,Inpatient,5 mL,mL,,13,11.05,3.7258,13,Medica,Medical Assistance,,,,,Included in per diem rate,
DEXTROMETHORPHAN-GUAIFENESIN 10-100 MG/5 ML ORAL SYRP,,7112,LOCAL,Facility,Outpatient,5 mL,mL,,13,11.05,3.7258,13,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,6.474,49.8,,percent of total billed charges,,
DEXTROMETHORPHAN-GUAIFENESIN 10-100 MG/5 ML ORAL SYRP,,7112,LOCAL,Facility,Inpatient,5 mL,mL,,13,11.05,3.7258,13,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
DEXTROMETHORPHAN-GUAIFENESIN 10-100 MG/5 ML ORAL SYRP,,7112,LOCAL,Facility,Both,5 mL,mL,,13,11.05,3.7258,13,"Multiplan, Inc.","Multiplan, Inc.",12.22,94,,percent of total billed charges,,
DEXTROMETHORPHAN-GUAIFENESIN 10-100 MG/5 ML ORAL SYRP,,7112,LOCAL,Facility,Outpatient,5 mL,mL,,13,11.05,3.7258,13,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,11.713,90.1,,percent of total billed charges,,
DEXTROMETHORPHAN-GUAIFENESIN 10-100 MG/5 ML ORAL SYRP,,7112,LOCAL,Facility,Inpatient,5 mL,mL,,13,11.05,3.7258,13,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
DEXTROMETHORPHAN-GUAIFENESIN 10-100 MG/5 ML ORAL SYRP,,7112,LOCAL,Facility,Both,5 mL,mL,,13,11.05,3.7258,13,"Preferred One Administrative Services, INC.",PPO,12.818,98.6,,percent of total billed charges,,
DEXTROMETHORPHAN-GUAIFENESIN 10-100 MG/5 ML ORAL SYRP,,7112,LOCAL,Facility,Outpatient,5 mL,mL,,13,11.05,3.7258,13,PrimeWest Health,Minnesota Senior Health Options (MSHO),6.6885,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
DEXTROMETHORPHAN-GUAIFENESIN 10-100 MG/5 ML ORAL SYRP,,7112,LOCAL,Facility,Inpatient,5 mL,mL,,13,11.05,3.7258,13,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DEXTROMETHORPHAN-GUAIFENESIN 10-100 MG/5 ML ORAL SYRP,,7112,LOCAL,Facility,Outpatient,5 mL,mL,,13,11.05,3.7258,13,PrimeWest Health,MinnesotaCare,6.6768,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
DEXTROMETHORPHAN-GUAIFENESIN 10-100 MG/5 ML ORAL SYRP,,7112,LOCAL,Facility,Inpatient,5 mL,mL,,13,11.05,3.7258,13,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
DEXTROMETHORPHAN-GUAIFENESIN 10-100 MG/5 ML ORAL SYRP,,7112,LOCAL,Facility,Both,5 mL,mL,,13,11.05,3.7258,13,Sanford Health Plan,Sanford Health Plan,11.96,92,,percent of total billed charges,,
DEXTROMETHORPHAN-GUAIFENESIN 10-100 MG/5 ML ORAL SYRP,,7112,LOCAL,Facility,Outpatient,5 mL,mL,,13,11.05,3.7258,13,"UCare Health, Inc.",Individual & Family Plan,7.3255,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
DEXTROMETHORPHAN-GUAIFENESIN 10-100 MG/5 ML ORAL SYRP,,7112,LOCAL,Facility,Inpatient,5 mL,mL,,13,11.05,3.7258,13,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
DEXTROMETHORPHAN-GUAIFENESIN 10-100 MG/5 ML ORAL SYRP,,7112,LOCAL,Facility,Outpatient,5 mL,mL,,13,11.05,3.7258,13,"UCare Health, Inc.",Medical Assistance,6.5611,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DEXTROMETHORPHAN-GUAIFENESIN 10-100 MG/5 ML ORAL SYRP,,7112,LOCAL,Facility,Inpatient,5 mL,mL,,13,11.05,3.7258,13,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
DEXTROMETHORPHAN-GUAIFENESIN 10-100 MG/5 ML ORAL SYRP,,7112,LOCAL,Facility,Outpatient,5 mL,mL,,13,11.05,3.7258,13,"UCare Health, Inc.",Medicare Advantage,6.5611,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DEXTROMETHORPHAN-GUAIFENESIN 10-100 MG/5 ML ORAL SYRP,,7112,LOCAL,Facility,Inpatient,5 mL,mL,,13,11.05,3.7258,13,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DEXTROMETHORPHAN-GUAIFENESIN 10-100 MG/5 ML ORAL SYRP,,7112,LOCAL,Facility,Outpatient,5 mL,mL,,13,11.05,3.7258,13,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),6.5611,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DEXTROMETHORPHAN-GUAIFENESIN 10-100 MG/5 ML ORAL SYRP,,7112,LOCAL,Facility,Inpatient,5 mL,mL,,13,11.05,3.7258,13,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DEXTROMETHORPHAN-GUAIFENESIN 10-100 MG/5 ML ORAL SYRP,,7112,LOCAL,Facility,Both,5 mL,mL,,13,11.05,3.7258,13,UnitedHealthcare,Individual & Family,12.22,94,,percent of total billed charges,,
DEXTROMETHORPHAN-GUAIFENESIN 10-100 MG/5 ML ORAL SYRP,,7112,LOCAL,Facility,Outpatient,5 mL,mL,,13,11.05,3.7258,13,UnitedHealthcare,Medicare Advantage,6.37,49,,percent of total billed charges,,
DEXTROMETHORPHAN-GUAIFENESIN 10-100 MG/5 ML ORAL SYRP,,7112,LOCAL,Facility,Inpatient,5 mL,mL,,13,11.05,3.7258,13,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
DEXTROMETHORPHAN-GUAIFENESIN 10-100 MG/5 ML ORAL SYRP,,7112,LOCAL,Facility,Outpatient,5 mL,mL,,13,11.05,3.7258,13,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,6.24,48,,percent of total billed charges,,100% of DHS outpatient percentage
DEXTROMETHORPHAN-GUAIFENESIN 10-100 MG/5 ML ORAL SYRP,,7112,LOCAL,Facility,Inpatient,5 mL,mL,,13,11.05,3.7258,13,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJ SOLN,,7635,LOCAL,Facility,Both,5 mL,mL,,882,749.7,252.7812,882,Aetna,Commercial,811.44,92,,percent of total billed charges,,
INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJ SOLN,,7635,LOCAL,Facility,Outpatient,5 mL,mL,,882,749.7,252.7812,882,Aetna,Medicare Advantage,432.18,49,,percent of total billed charges,,
INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJ SOLN,,7635,LOCAL,Facility,Inpatient,5 mL,mL,,882,749.7,252.7812,882,Aetna,Medicare Advantage,,,,,Included in per diem rate,
INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJ SOLN,,7635,LOCAL,Facility,Both,5 mL,mL,,882,749.7,252.7812,882,Aetna,PPO,820.26,93,,percent of total billed charges,,
INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJ SOLN,,7635,LOCAL,Facility,Both,5 mL,mL,,882,749.7,252.7812,882,America's PPO,America's PPO,846.9846,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJ SOLN,,7635,LOCAL,Facility,Both,5 mL,mL,,882,749.7,252.7812,882,BlueCross BlueShield Minnesota, Federal Employee Program,867.888,98.4,,percent of total billed charges,,
INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJ SOLN,,7635,LOCAL,Facility,Both,5 mL,mL,,882,749.7,252.7812,882,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,882,100,,percent of total billed charges,,
INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJ SOLN,,7635,LOCAL,Facility,Both,5 mL,mL,,882,749.7,252.7812,882,BlueCross BlueShield Minnesota,High Value Network Plan,793.8,90,,percent of total billed charges,,
INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJ SOLN,,7635,LOCAL,Facility,Outpatient,5 mL,mL,,882,749.7,252.7812,882,BlueCross BlueShield Minnesota,Medicare Advantage,432.18,49,,percent of total billed charges,,
INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJ SOLN,,7635,LOCAL,Facility,Inpatient,5 mL,mL,,882,749.7,252.7812,882,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJ SOLN,,7635,LOCAL,Facility,Both,5 mL,mL,,882,749.7,252.7812,882,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,781.1874,88.57,,percent of total billed charges,,
INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJ SOLN,,7635,LOCAL,Facility,Both,5 mL,mL,,882,749.7,252.7812,882,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,252.7812,28.66,,percent of total billed charges,,
INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJ SOLN,,7635,LOCAL,Facility,Outpatient,5 mL,mL,,882,749.7,252.7812,882,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),432.18,49,,percent of total billed charges,,
INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJ SOLN,,7635,LOCAL,Facility,Inpatient,5 mL,mL,,882,749.7,252.7812,882,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJ SOLN,,7635,LOCAL,Facility,Both,5 mL,mL,,882,749.7,252.7812,882,CorVel,Worker's Compensation,882,100,,percent of total billed charges,,
INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJ SOLN,,7635,LOCAL,Facility,Both,5 mL,mL,,882,749.7,252.7812,882,First Health Group Corporation,First Health Network,855.54,97,,percent of total billed charges,,
INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJ SOLN,,7635,LOCAL,Facility,Both,5 mL,mL,,882,749.7,252.7812,882,"Health Partners, Inc.",Commercial,834.372,94.6,,percent of total billed charges,,
INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJ SOLN,,7635,LOCAL,Facility,Outpatient,5 mL,mL,,882,749.7,252.7812,882,"Health Partners, Inc.",Medicare Advantage,432.18,49,,percent of total billed charges,,
INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJ SOLN,,7635,LOCAL,Facility,Inpatient,5 mL,mL,,882,749.7,252.7812,882,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJ SOLN,,7635,LOCAL,Facility,Both,5 mL,mL,,882,749.7,252.7812,882,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),529.2,60,,percent of total billed charges,,
INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJ SOLN,,7635,LOCAL,Facility,Both,5 mL,mL,,882,749.7,252.7812,882,"Health Partners, Inc.",State of Minnesota Advantage Program,718.83,81.5,,percent of total billed charges,,
INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJ SOLN,,7635,LOCAL,Facility,Both,5 mL,mL,,882,749.7,252.7812,882,"Health Partners, Inc.",State Public Programs,441,50,,percent of total billed charges,,
INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJ SOLN,,7635,LOCAL,Facility,Both,5 mL,mL,,882,749.7,252.7812,882,Humana Insurance Company,Commercial PPO,837.9,95,,percent of total billed charges,,
INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJ SOLN,,7635,LOCAL,Facility,Outpatient,5 mL,mL,,882,749.7,252.7812,882,Humana Insurance Company,Medicare PPO,432.18,49,,percent of total billed charges,,
INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJ SOLN,,7635,LOCAL,Facility,Inpatient,5 mL,mL,,882,749.7,252.7812,882,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJ SOLN,,7635,LOCAL,Facility,Both,5 mL,mL,,882,749.7,252.7812,882,Medica,Individual & Family,874.062,99.1,,percent of total billed charges,,
INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJ SOLN,,7635,LOCAL,Facility,Outpatient,5 mL,mL,,882,749.7,252.7812,882,Medica,Medica Advantage Solution,439.236,49.8,,percent of total billed charges,,
INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJ SOLN,,7635,LOCAL,Facility,Inpatient,5 mL,mL,,882,749.7,252.7812,882,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJ SOLN,,7635,LOCAL,Facility,Outpatient,5 mL,mL,,882,749.7,252.7812,882,Medica,Medical Assistance,393.372,44.6,,percent of total billed charges,,
INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJ SOLN,,7635,LOCAL,Facility,Inpatient,5 mL,mL,,882,749.7,252.7812,882,Medica,Medical Assistance,,,,,Included in per diem rate,
INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJ SOLN,,7635,LOCAL,Facility,Outpatient,5 mL,mL,,882,749.7,252.7812,882,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,439.236,49.8,,percent of total billed charges,,
INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJ SOLN,,7635,LOCAL,Facility,Inpatient,5 mL,mL,,882,749.7,252.7812,882,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJ SOLN,,7635,LOCAL,Facility,Both,5 mL,mL,,882,749.7,252.7812,882,"Multiplan, Inc.","Multiplan, Inc.",829.08,94,,percent of total billed charges,,
INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJ SOLN,,7635,LOCAL,Facility,Outpatient,5 mL,mL,,882,749.7,252.7812,882,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,794.682,90.1,,percent of total billed charges,,
INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJ SOLN,,7635,LOCAL,Facility,Inpatient,5 mL,mL,,882,749.7,252.7812,882,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJ SOLN,,7635,LOCAL,Facility,Both,5 mL,mL,,882,749.7,252.7812,882,"Preferred One Administrative Services, INC.",PPO,869.652,98.6,,percent of total billed charges,,
INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJ SOLN,,7635,LOCAL,Facility,Outpatient,5 mL,mL,,882,749.7,252.7812,882,PrimeWest Health,Minnesota Senior Health Options (MSHO),453.789,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJ SOLN,,7635,LOCAL,Facility,Inpatient,5 mL,mL,,882,749.7,252.7812,882,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJ SOLN,,7635,LOCAL,Facility,Outpatient,5 mL,mL,,882,749.7,252.7812,882,PrimeWest Health,MinnesotaCare,452.9952,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJ SOLN,,7635,LOCAL,Facility,Inpatient,5 mL,mL,,882,749.7,252.7812,882,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJ SOLN,,7635,LOCAL,Facility,Both,5 mL,mL,,882,749.7,252.7812,882,Sanford Health Plan,Sanford Health Plan,811.44,92,,percent of total billed charges,,
INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJ SOLN,,7635,LOCAL,Facility,Outpatient,5 mL,mL,,882,749.7,252.7812,882,"UCare Health, Inc.",Individual & Family Plan,497.007,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJ SOLN,,7635,LOCAL,Facility,Inpatient,5 mL,mL,,882,749.7,252.7812,882,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJ SOLN,,7635,LOCAL,Facility,Outpatient,5 mL,mL,,882,749.7,252.7812,882,"UCare Health, Inc.",Medical Assistance,445.1454,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJ SOLN,,7635,LOCAL,Facility,Inpatient,5 mL,mL,,882,749.7,252.7812,882,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJ SOLN,,7635,LOCAL,Facility,Outpatient,5 mL,mL,,882,749.7,252.7812,882,"UCare Health, Inc.",Medicare Advantage,445.1454,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJ SOLN,,7635,LOCAL,Facility,Inpatient,5 mL,mL,,882,749.7,252.7812,882,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJ SOLN,,7635,LOCAL,Facility,Outpatient,5 mL,mL,,882,749.7,252.7812,882,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),445.1454,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJ SOLN,,7635,LOCAL,Facility,Inpatient,5 mL,mL,,882,749.7,252.7812,882,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJ SOLN,,7635,LOCAL,Facility,Both,5 mL,mL,,882,749.7,252.7812,882,UnitedHealthcare,Individual & Family,829.08,94,,percent of total billed charges,,
INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJ SOLN,,7635,LOCAL,Facility,Outpatient,5 mL,mL,,882,749.7,252.7812,882,UnitedHealthcare,Medicare Advantage,432.18,49,,percent of total billed charges,,
INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJ SOLN,,7635,LOCAL,Facility,Inpatient,5 mL,mL,,882,749.7,252.7812,882,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJ SOLN,,7635,LOCAL,Facility,Outpatient,5 mL,mL,,882,749.7,252.7812,882,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,423.36,48,,percent of total billed charges,,100% of DHS outpatient percentage
INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJ SOLN,,7635,LOCAL,Facility,Inpatient,5 mL,mL,,882,749.7,252.7812,882,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
KETOROLAC 0.5 % OPHT DROP,,8761,LOCAL,Facility,Both,5 mL,mL,,414,351.9,118.6524,414,Aetna,Commercial,380.88,92,,percent of total billed charges,,
KETOROLAC 0.5 % OPHT DROP,,8761,LOCAL,Facility,Outpatient,5 mL,mL,,414,351.9,118.6524,414,Aetna,Medicare Advantage,202.86,49,,percent of total billed charges,,
KETOROLAC 0.5 % OPHT DROP,,8761,LOCAL,Facility,Inpatient,5 mL,mL,,414,351.9,118.6524,414,Aetna,Medicare Advantage,,,,,Included in per diem rate,
KETOROLAC 0.5 % OPHT DROP,,8761,LOCAL,Facility,Both,5 mL,mL,,414,351.9,118.6524,414,Aetna,PPO,385.02,93,,percent of total billed charges,,
KETOROLAC 0.5 % OPHT DROP,,8761,LOCAL,Facility,Both,5 mL,mL,,414,351.9,118.6524,414,America's PPO,America's PPO,397.5642,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
KETOROLAC 0.5 % OPHT DROP,,8761,LOCAL,Facility,Both,5 mL,mL,,414,351.9,118.6524,414,BlueCross BlueShield Minnesota, Federal Employee Program,407.376,98.4,,percent of total billed charges,,
KETOROLAC 0.5 % OPHT DROP,,8761,LOCAL,Facility,Both,5 mL,mL,,414,351.9,118.6524,414,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,414,100,,percent of total billed charges,,
KETOROLAC 0.5 % OPHT DROP,,8761,LOCAL,Facility,Both,5 mL,mL,,414,351.9,118.6524,414,BlueCross BlueShield Minnesota,High Value Network Plan,372.6,90,,percent of total billed charges,,
KETOROLAC 0.5 % OPHT DROP,,8761,LOCAL,Facility,Outpatient,5 mL,mL,,414,351.9,118.6524,414,BlueCross BlueShield Minnesota,Medicare Advantage,202.86,49,,percent of total billed charges,,
KETOROLAC 0.5 % OPHT DROP,,8761,LOCAL,Facility,Inpatient,5 mL,mL,,414,351.9,118.6524,414,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
KETOROLAC 0.5 % OPHT DROP,,8761,LOCAL,Facility,Both,5 mL,mL,,414,351.9,118.6524,414,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,366.6798,88.57,,percent of total billed charges,,
KETOROLAC 0.5 % OPHT DROP,,8761,LOCAL,Facility,Both,5 mL,mL,,414,351.9,118.6524,414,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,118.6524,28.66,,percent of total billed charges,,
KETOROLAC 0.5 % OPHT DROP,,8761,LOCAL,Facility,Outpatient,5 mL,mL,,414,351.9,118.6524,414,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),202.86,49,,percent of total billed charges,,
KETOROLAC 0.5 % OPHT DROP,,8761,LOCAL,Facility,Inpatient,5 mL,mL,,414,351.9,118.6524,414,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
KETOROLAC 0.5 % OPHT DROP,,8761,LOCAL,Facility,Both,5 mL,mL,,414,351.9,118.6524,414,CorVel,Worker's Compensation,414,100,,percent of total billed charges,,
KETOROLAC 0.5 % OPHT DROP,,8761,LOCAL,Facility,Both,5 mL,mL,,414,351.9,118.6524,414,First Health Group Corporation,First Health Network,401.58,97,,percent of total billed charges,,
KETOROLAC 0.5 % OPHT DROP,,8761,LOCAL,Facility,Both,5 mL,mL,,414,351.9,118.6524,414,"Health Partners, Inc.",Commercial,391.644,94.6,,percent of total billed charges,,
KETOROLAC 0.5 % OPHT DROP,,8761,LOCAL,Facility,Outpatient,5 mL,mL,,414,351.9,118.6524,414,"Health Partners, Inc.",Medicare Advantage,202.86,49,,percent of total billed charges,,
KETOROLAC 0.5 % OPHT DROP,,8761,LOCAL,Facility,Inpatient,5 mL,mL,,414,351.9,118.6524,414,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
KETOROLAC 0.5 % OPHT DROP,,8761,LOCAL,Facility,Both,5 mL,mL,,414,351.9,118.6524,414,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),248.4,60,,percent of total billed charges,,
KETOROLAC 0.5 % OPHT DROP,,8761,LOCAL,Facility,Both,5 mL,mL,,414,351.9,118.6524,414,"Health Partners, Inc.",State of Minnesota Advantage Program,337.41,81.5,,percent of total billed charges,,
KETOROLAC 0.5 % OPHT DROP,,8761,LOCAL,Facility,Both,5 mL,mL,,414,351.9,118.6524,414,"Health Partners, Inc.",State Public Programs,207,50,,percent of total billed charges,,
KETOROLAC 0.5 % OPHT DROP,,8761,LOCAL,Facility,Both,5 mL,mL,,414,351.9,118.6524,414,Humana Insurance Company,Commercial PPO,393.3,95,,percent of total billed charges,,
KETOROLAC 0.5 % OPHT DROP,,8761,LOCAL,Facility,Outpatient,5 mL,mL,,414,351.9,118.6524,414,Humana Insurance Company,Medicare PPO,202.86,49,,percent of total billed charges,,
KETOROLAC 0.5 % OPHT DROP,,8761,LOCAL,Facility,Inpatient,5 mL,mL,,414,351.9,118.6524,414,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
KETOROLAC 0.5 % OPHT DROP,,8761,LOCAL,Facility,Both,5 mL,mL,,414,351.9,118.6524,414,Medica,Individual & Family,410.274,99.1,,percent of total billed charges,,
KETOROLAC 0.5 % OPHT DROP,,8761,LOCAL,Facility,Outpatient,5 mL,mL,,414,351.9,118.6524,414,Medica,Medica Advantage Solution,206.172,49.8,,percent of total billed charges,,
KETOROLAC 0.5 % OPHT DROP,,8761,LOCAL,Facility,Inpatient,5 mL,mL,,414,351.9,118.6524,414,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
KETOROLAC 0.5 % OPHT DROP,,8761,LOCAL,Facility,Outpatient,5 mL,mL,,414,351.9,118.6524,414,Medica,Medical Assistance,184.644,44.6,,percent of total billed charges,,
KETOROLAC 0.5 % OPHT DROP,,8761,LOCAL,Facility,Inpatient,5 mL,mL,,414,351.9,118.6524,414,Medica,Medical Assistance,,,,,Included in per diem rate,
KETOROLAC 0.5 % OPHT DROP,,8761,LOCAL,Facility,Outpatient,5 mL,mL,,414,351.9,118.6524,414,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,206.172,49.8,,percent of total billed charges,,
KETOROLAC 0.5 % OPHT DROP,,8761,LOCAL,Facility,Inpatient,5 mL,mL,,414,351.9,118.6524,414,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
KETOROLAC 0.5 % OPHT DROP,,8761,LOCAL,Facility,Both,5 mL,mL,,414,351.9,118.6524,414,"Multiplan, Inc.","Multiplan, Inc.",389.16,94,,percent of total billed charges,,
KETOROLAC 0.5 % OPHT DROP,,8761,LOCAL,Facility,Outpatient,5 mL,mL,,414,351.9,118.6524,414,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,373.014,90.1,,percent of total billed charges,,
KETOROLAC 0.5 % OPHT DROP,,8761,LOCAL,Facility,Inpatient,5 mL,mL,,414,351.9,118.6524,414,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
KETOROLAC 0.5 % OPHT DROP,,8761,LOCAL,Facility,Both,5 mL,mL,,414,351.9,118.6524,414,"Preferred One Administrative Services, INC.",PPO,408.204,98.6,,percent of total billed charges,,
KETOROLAC 0.5 % OPHT DROP,,8761,LOCAL,Facility,Outpatient,5 mL,mL,,414,351.9,118.6524,414,PrimeWest Health,Minnesota Senior Health Options (MSHO),213.003,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
KETOROLAC 0.5 % OPHT DROP,,8761,LOCAL,Facility,Inpatient,5 mL,mL,,414,351.9,118.6524,414,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
KETOROLAC 0.5 % OPHT DROP,,8761,LOCAL,Facility,Outpatient,5 mL,mL,,414,351.9,118.6524,414,PrimeWest Health,MinnesotaCare,212.6304,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
KETOROLAC 0.5 % OPHT DROP,,8761,LOCAL,Facility,Inpatient,5 mL,mL,,414,351.9,118.6524,414,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
KETOROLAC 0.5 % OPHT DROP,,8761,LOCAL,Facility,Both,5 mL,mL,,414,351.9,118.6524,414,Sanford Health Plan,Sanford Health Plan,380.88,92,,percent of total billed charges,,
KETOROLAC 0.5 % OPHT DROP,,8761,LOCAL,Facility,Outpatient,5 mL,mL,,414,351.9,118.6524,414,"UCare Health, Inc.",Individual & Family Plan,233.289,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
KETOROLAC 0.5 % OPHT DROP,,8761,LOCAL,Facility,Inpatient,5 mL,mL,,414,351.9,118.6524,414,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
KETOROLAC 0.5 % OPHT DROP,,8761,LOCAL,Facility,Outpatient,5 mL,mL,,414,351.9,118.6524,414,"UCare Health, Inc.",Medical Assistance,208.9458,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
KETOROLAC 0.5 % OPHT DROP,,8761,LOCAL,Facility,Inpatient,5 mL,mL,,414,351.9,118.6524,414,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
KETOROLAC 0.5 % OPHT DROP,,8761,LOCAL,Facility,Outpatient,5 mL,mL,,414,351.9,118.6524,414,"UCare Health, Inc.",Medicare Advantage,208.9458,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
KETOROLAC 0.5 % OPHT DROP,,8761,LOCAL,Facility,Inpatient,5 mL,mL,,414,351.9,118.6524,414,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
KETOROLAC 0.5 % OPHT DROP,,8761,LOCAL,Facility,Outpatient,5 mL,mL,,414,351.9,118.6524,414,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),208.9458,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
KETOROLAC 0.5 % OPHT DROP,,8761,LOCAL,Facility,Inpatient,5 mL,mL,,414,351.9,118.6524,414,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
KETOROLAC 0.5 % OPHT DROP,,8761,LOCAL,Facility,Both,5 mL,mL,,414,351.9,118.6524,414,UnitedHealthcare,Individual & Family,389.16,94,,percent of total billed charges,,
KETOROLAC 0.5 % OPHT DROP,,8761,LOCAL,Facility,Outpatient,5 mL,mL,,414,351.9,118.6524,414,UnitedHealthcare,Medicare Advantage,202.86,49,,percent of total billed charges,,
KETOROLAC 0.5 % OPHT DROP,,8761,LOCAL,Facility,Inpatient,5 mL,mL,,414,351.9,118.6524,414,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
KETOROLAC 0.5 % OPHT DROP,,8761,LOCAL,Facility,Outpatient,5 mL,mL,,414,351.9,118.6524,414,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,198.72,48,,percent of total billed charges,,100% of DHS outpatient percentage
KETOROLAC 0.5 % OPHT DROP,,8761,LOCAL,Facility,Inpatient,5 mL,mL,,414,351.9,118.6524,414,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
PREDNISOLONE ACETATE 1 % OPHT DRPS,,10176,LOCAL,Facility,Both,5 mL,mL,,233,198.05,66.7778,233,Aetna,Commercial,214.36,92,,percent of total billed charges,,
PREDNISOLONE ACETATE 1 % OPHT DRPS,,10176,LOCAL,Facility,Outpatient,5 mL,mL,,233,198.05,66.7778,233,Aetna,Medicare Advantage,114.17,49,,percent of total billed charges,,
PREDNISOLONE ACETATE 1 % OPHT DRPS,,10176,LOCAL,Facility,Inpatient,5 mL,mL,,233,198.05,66.7778,233,Aetna,Medicare Advantage,,,,,Included in per diem rate,
PREDNISOLONE ACETATE 1 % OPHT DRPS,,10176,LOCAL,Facility,Both,5 mL,mL,,233,198.05,66.7778,233,Aetna,PPO,216.69,93,,percent of total billed charges,,
PREDNISOLONE ACETATE 1 % OPHT DRPS,,10176,LOCAL,Facility,Both,5 mL,mL,,233,198.05,66.7778,233,America's PPO,America's PPO,223.7499,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
PREDNISOLONE ACETATE 1 % OPHT DRPS,,10176,LOCAL,Facility,Both,5 mL,mL,,233,198.05,66.7778,233,BlueCross BlueShield Minnesota, Federal Employee Program,229.272,98.4,,percent of total billed charges,,
PREDNISOLONE ACETATE 1 % OPHT DRPS,,10176,LOCAL,Facility,Both,5 mL,mL,,233,198.05,66.7778,233,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,233,100,,percent of total billed charges,,
PREDNISOLONE ACETATE 1 % OPHT DRPS,,10176,LOCAL,Facility,Both,5 mL,mL,,233,198.05,66.7778,233,BlueCross BlueShield Minnesota,High Value Network Plan,209.7,90,,percent of total billed charges,,
PREDNISOLONE ACETATE 1 % OPHT DRPS,,10176,LOCAL,Facility,Outpatient,5 mL,mL,,233,198.05,66.7778,233,BlueCross BlueShield Minnesota,Medicare Advantage,114.17,49,,percent of total billed charges,,
PREDNISOLONE ACETATE 1 % OPHT DRPS,,10176,LOCAL,Facility,Inpatient,5 mL,mL,,233,198.05,66.7778,233,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
PREDNISOLONE ACETATE 1 % OPHT DRPS,,10176,LOCAL,Facility,Both,5 mL,mL,,233,198.05,66.7778,233,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,206.3681,88.57,,percent of total billed charges,,
PREDNISOLONE ACETATE 1 % OPHT DRPS,,10176,LOCAL,Facility,Both,5 mL,mL,,233,198.05,66.7778,233,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,66.7778,28.66,,percent of total billed charges,,
PREDNISOLONE ACETATE 1 % OPHT DRPS,,10176,LOCAL,Facility,Outpatient,5 mL,mL,,233,198.05,66.7778,233,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),114.17,49,,percent of total billed charges,,
PREDNISOLONE ACETATE 1 % OPHT DRPS,,10176,LOCAL,Facility,Inpatient,5 mL,mL,,233,198.05,66.7778,233,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
PREDNISOLONE ACETATE 1 % OPHT DRPS,,10176,LOCAL,Facility,Both,5 mL,mL,,233,198.05,66.7778,233,CorVel,Worker's Compensation,233,100,,percent of total billed charges,,
PREDNISOLONE ACETATE 1 % OPHT DRPS,,10176,LOCAL,Facility,Both,5 mL,mL,,233,198.05,66.7778,233,First Health Group Corporation,First Health Network,226.01,97,,percent of total billed charges,,
PREDNISOLONE ACETATE 1 % OPHT DRPS,,10176,LOCAL,Facility,Both,5 mL,mL,,233,198.05,66.7778,233,"Health Partners, Inc.",Commercial,220.418,94.6,,percent of total billed charges,,
PREDNISOLONE ACETATE 1 % OPHT DRPS,,10176,LOCAL,Facility,Outpatient,5 mL,mL,,233,198.05,66.7778,233,"Health Partners, Inc.",Medicare Advantage,114.17,49,,percent of total billed charges,,
PREDNISOLONE ACETATE 1 % OPHT DRPS,,10176,LOCAL,Facility,Inpatient,5 mL,mL,,233,198.05,66.7778,233,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PREDNISOLONE ACETATE 1 % OPHT DRPS,,10176,LOCAL,Facility,Both,5 mL,mL,,233,198.05,66.7778,233,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),139.8,60,,percent of total billed charges,,
PREDNISOLONE ACETATE 1 % OPHT DRPS,,10176,LOCAL,Facility,Both,5 mL,mL,,233,198.05,66.7778,233,"Health Partners, Inc.",State of Minnesota Advantage Program,189.895,81.5,,percent of total billed charges,,
PREDNISOLONE ACETATE 1 % OPHT DRPS,,10176,LOCAL,Facility,Both,5 mL,mL,,233,198.05,66.7778,233,"Health Partners, Inc.",State Public Programs,116.5,50,,percent of total billed charges,,
PREDNISOLONE ACETATE 1 % OPHT DRPS,,10176,LOCAL,Facility,Both,5 mL,mL,,233,198.05,66.7778,233,Humana Insurance Company,Commercial PPO,221.35,95,,percent of total billed charges,,
PREDNISOLONE ACETATE 1 % OPHT DRPS,,10176,LOCAL,Facility,Outpatient,5 mL,mL,,233,198.05,66.7778,233,Humana Insurance Company,Medicare PPO,114.17,49,,percent of total billed charges,,
PREDNISOLONE ACETATE 1 % OPHT DRPS,,10176,LOCAL,Facility,Inpatient,5 mL,mL,,233,198.05,66.7778,233,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
PREDNISOLONE ACETATE 1 % OPHT DRPS,,10176,LOCAL,Facility,Both,5 mL,mL,,233,198.05,66.7778,233,Medica,Individual & Family,230.903,99.1,,percent of total billed charges,,
PREDNISOLONE ACETATE 1 % OPHT DRPS,,10176,LOCAL,Facility,Outpatient,5 mL,mL,,233,198.05,66.7778,233,Medica,Medica Advantage Solution,116.034,49.8,,percent of total billed charges,,
PREDNISOLONE ACETATE 1 % OPHT DRPS,,10176,LOCAL,Facility,Inpatient,5 mL,mL,,233,198.05,66.7778,233,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
PREDNISOLONE ACETATE 1 % OPHT DRPS,,10176,LOCAL,Facility,Outpatient,5 mL,mL,,233,198.05,66.7778,233,Medica,Medical Assistance,103.918,44.6,,percent of total billed charges,,
PREDNISOLONE ACETATE 1 % OPHT DRPS,,10176,LOCAL,Facility,Inpatient,5 mL,mL,,233,198.05,66.7778,233,Medica,Medical Assistance,,,,,Included in per diem rate,
PREDNISOLONE ACETATE 1 % OPHT DRPS,,10176,LOCAL,Facility,Outpatient,5 mL,mL,,233,198.05,66.7778,233,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,116.034,49.8,,percent of total billed charges,,
PREDNISOLONE ACETATE 1 % OPHT DRPS,,10176,LOCAL,Facility,Inpatient,5 mL,mL,,233,198.05,66.7778,233,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
PREDNISOLONE ACETATE 1 % OPHT DRPS,,10176,LOCAL,Facility,Both,5 mL,mL,,233,198.05,66.7778,233,"Multiplan, Inc.","Multiplan, Inc.",219.02,94,,percent of total billed charges,,
PREDNISOLONE ACETATE 1 % OPHT DRPS,,10176,LOCAL,Facility,Outpatient,5 mL,mL,,233,198.05,66.7778,233,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,209.933,90.1,,percent of total billed charges,,
PREDNISOLONE ACETATE 1 % OPHT DRPS,,10176,LOCAL,Facility,Inpatient,5 mL,mL,,233,198.05,66.7778,233,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
PREDNISOLONE ACETATE 1 % OPHT DRPS,,10176,LOCAL,Facility,Both,5 mL,mL,,233,198.05,66.7778,233,"Preferred One Administrative Services, INC.",PPO,229.738,98.6,,percent of total billed charges,,
PREDNISOLONE ACETATE 1 % OPHT DRPS,,10176,LOCAL,Facility,Outpatient,5 mL,mL,,233,198.05,66.7778,233,PrimeWest Health,Minnesota Senior Health Options (MSHO),119.8785,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
PREDNISOLONE ACETATE 1 % OPHT DRPS,,10176,LOCAL,Facility,Inpatient,5 mL,mL,,233,198.05,66.7778,233,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PREDNISOLONE ACETATE 1 % OPHT DRPS,,10176,LOCAL,Facility,Outpatient,5 mL,mL,,233,198.05,66.7778,233,PrimeWest Health,MinnesotaCare,119.6688,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
PREDNISOLONE ACETATE 1 % OPHT DRPS,,10176,LOCAL,Facility,Inpatient,5 mL,mL,,233,198.05,66.7778,233,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
PREDNISOLONE ACETATE 1 % OPHT DRPS,,10176,LOCAL,Facility,Both,5 mL,mL,,233,198.05,66.7778,233,Sanford Health Plan,Sanford Health Plan,214.36,92,,percent of total billed charges,,
PREDNISOLONE ACETATE 1 % OPHT DRPS,,10176,LOCAL,Facility,Outpatient,5 mL,mL,,233,198.05,66.7778,233,"UCare Health, Inc.",Individual & Family Plan,131.2955,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
PREDNISOLONE ACETATE 1 % OPHT DRPS,,10176,LOCAL,Facility,Inpatient,5 mL,mL,,233,198.05,66.7778,233,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
PREDNISOLONE ACETATE 1 % OPHT DRPS,,10176,LOCAL,Facility,Outpatient,5 mL,mL,,233,198.05,66.7778,233,"UCare Health, Inc.",Medical Assistance,117.5951,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PREDNISOLONE ACETATE 1 % OPHT DRPS,,10176,LOCAL,Facility,Inpatient,5 mL,mL,,233,198.05,66.7778,233,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
PREDNISOLONE ACETATE 1 % OPHT DRPS,,10176,LOCAL,Facility,Outpatient,5 mL,mL,,233,198.05,66.7778,233,"UCare Health, Inc.",Medicare Advantage,117.5951,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PREDNISOLONE ACETATE 1 % OPHT DRPS,,10176,LOCAL,Facility,Inpatient,5 mL,mL,,233,198.05,66.7778,233,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PREDNISOLONE ACETATE 1 % OPHT DRPS,,10176,LOCAL,Facility,Outpatient,5 mL,mL,,233,198.05,66.7778,233,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),117.5951,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PREDNISOLONE ACETATE 1 % OPHT DRPS,,10176,LOCAL,Facility,Inpatient,5 mL,mL,,233,198.05,66.7778,233,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PREDNISOLONE ACETATE 1 % OPHT DRPS,,10176,LOCAL,Facility,Both,5 mL,mL,,233,198.05,66.7778,233,UnitedHealthcare,Individual & Family,219.02,94,,percent of total billed charges,,
PREDNISOLONE ACETATE 1 % OPHT DRPS,,10176,LOCAL,Facility,Outpatient,5 mL,mL,,233,198.05,66.7778,233,UnitedHealthcare,Medicare Advantage,114.17,49,,percent of total billed charges,,
PREDNISOLONE ACETATE 1 % OPHT DRPS,,10176,LOCAL,Facility,Inpatient,5 mL,mL,,233,198.05,66.7778,233,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
PREDNISOLONE ACETATE 1 % OPHT DRPS,,10176,LOCAL,Facility,Outpatient,5 mL,mL,,233,198.05,66.7778,233,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,111.84,48,,percent of total billed charges,,100% of DHS outpatient percentage
PREDNISOLONE ACETATE 1 % OPHT DRPS,,10176,LOCAL,Facility,Inpatient,5 mL,mL,,233,198.05,66.7778,233,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
LEVOFLOXACIN 0.5 % OPHT DROP,,10358,LOCAL,Facility,Both,5 mL,mL,,538,457.3,154.1908,538,Aetna,Commercial,494.96,92,,percent of total billed charges,,
LEVOFLOXACIN 0.5 % OPHT DROP,,10358,LOCAL,Facility,Outpatient,5 mL,mL,,538,457.3,154.1908,538,Aetna,Medicare Advantage,263.62,49,,percent of total billed charges,,
LEVOFLOXACIN 0.5 % OPHT DROP,,10358,LOCAL,Facility,Inpatient,5 mL,mL,,538,457.3,154.1908,538,Aetna,Medicare Advantage,,,,,Included in per diem rate,
LEVOFLOXACIN 0.5 % OPHT DROP,,10358,LOCAL,Facility,Both,5 mL,mL,,538,457.3,154.1908,538,Aetna,PPO,500.34,93,,percent of total billed charges,,
LEVOFLOXACIN 0.5 % OPHT DROP,,10358,LOCAL,Facility,Both,5 mL,mL,,538,457.3,154.1908,538,America's PPO,America's PPO,516.6414,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
LEVOFLOXACIN 0.5 % OPHT DROP,,10358,LOCAL,Facility,Both,5 mL,mL,,538,457.3,154.1908,538,BlueCross BlueShield Minnesota, Federal Employee Program,529.392,98.4,,percent of total billed charges,,
LEVOFLOXACIN 0.5 % OPHT DROP,,10358,LOCAL,Facility,Both,5 mL,mL,,538,457.3,154.1908,538,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,538,100,,percent of total billed charges,,
LEVOFLOXACIN 0.5 % OPHT DROP,,10358,LOCAL,Facility,Both,5 mL,mL,,538,457.3,154.1908,538,BlueCross BlueShield Minnesota,High Value Network Plan,484.2,90,,percent of total billed charges,,
LEVOFLOXACIN 0.5 % OPHT DROP,,10358,LOCAL,Facility,Outpatient,5 mL,mL,,538,457.3,154.1908,538,BlueCross BlueShield Minnesota,Medicare Advantage,263.62,49,,percent of total billed charges,,
LEVOFLOXACIN 0.5 % OPHT DROP,,10358,LOCAL,Facility,Inpatient,5 mL,mL,,538,457.3,154.1908,538,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
LEVOFLOXACIN 0.5 % OPHT DROP,,10358,LOCAL,Facility,Both,5 mL,mL,,538,457.3,154.1908,538,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,476.5066,88.57,,percent of total billed charges,,
LEVOFLOXACIN 0.5 % OPHT DROP,,10358,LOCAL,Facility,Both,5 mL,mL,,538,457.3,154.1908,538,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,154.1908,28.66,,percent of total billed charges,,
LEVOFLOXACIN 0.5 % OPHT DROP,,10358,LOCAL,Facility,Outpatient,5 mL,mL,,538,457.3,154.1908,538,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),263.62,49,,percent of total billed charges,,
LEVOFLOXACIN 0.5 % OPHT DROP,,10358,LOCAL,Facility,Inpatient,5 mL,mL,,538,457.3,154.1908,538,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
LEVOFLOXACIN 0.5 % OPHT DROP,,10358,LOCAL,Facility,Both,5 mL,mL,,538,457.3,154.1908,538,CorVel,Worker's Compensation,538,100,,percent of total billed charges,,
LEVOFLOXACIN 0.5 % OPHT DROP,,10358,LOCAL,Facility,Both,5 mL,mL,,538,457.3,154.1908,538,First Health Group Corporation,First Health Network,521.86,97,,percent of total billed charges,,
LEVOFLOXACIN 0.5 % OPHT DROP,,10358,LOCAL,Facility,Both,5 mL,mL,,538,457.3,154.1908,538,"Health Partners, Inc.",Commercial,508.948,94.6,,percent of total billed charges,,
LEVOFLOXACIN 0.5 % OPHT DROP,,10358,LOCAL,Facility,Outpatient,5 mL,mL,,538,457.3,154.1908,538,"Health Partners, Inc.",Medicare Advantage,263.62,49,,percent of total billed charges,,
LEVOFLOXACIN 0.5 % OPHT DROP,,10358,LOCAL,Facility,Inpatient,5 mL,mL,,538,457.3,154.1908,538,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LEVOFLOXACIN 0.5 % OPHT DROP,,10358,LOCAL,Facility,Both,5 mL,mL,,538,457.3,154.1908,538,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),322.8,60,,percent of total billed charges,,
LEVOFLOXACIN 0.5 % OPHT DROP,,10358,LOCAL,Facility,Both,5 mL,mL,,538,457.3,154.1908,538,"Health Partners, Inc.",State of Minnesota Advantage Program,438.47,81.5,,percent of total billed charges,,
LEVOFLOXACIN 0.5 % OPHT DROP,,10358,LOCAL,Facility,Both,5 mL,mL,,538,457.3,154.1908,538,"Health Partners, Inc.",State Public Programs,269,50,,percent of total billed charges,,
LEVOFLOXACIN 0.5 % OPHT DROP,,10358,LOCAL,Facility,Both,5 mL,mL,,538,457.3,154.1908,538,Humana Insurance Company,Commercial PPO,511.1,95,,percent of total billed charges,,
LEVOFLOXACIN 0.5 % OPHT DROP,,10358,LOCAL,Facility,Outpatient,5 mL,mL,,538,457.3,154.1908,538,Humana Insurance Company,Medicare PPO,263.62,49,,percent of total billed charges,,
LEVOFLOXACIN 0.5 % OPHT DROP,,10358,LOCAL,Facility,Inpatient,5 mL,mL,,538,457.3,154.1908,538,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
LEVOFLOXACIN 0.5 % OPHT DROP,,10358,LOCAL,Facility,Both,5 mL,mL,,538,457.3,154.1908,538,Medica,Individual & Family,533.158,99.1,,percent of total billed charges,,
LEVOFLOXACIN 0.5 % OPHT DROP,,10358,LOCAL,Facility,Outpatient,5 mL,mL,,538,457.3,154.1908,538,Medica,Medica Advantage Solution,267.924,49.8,,percent of total billed charges,,
LEVOFLOXACIN 0.5 % OPHT DROP,,10358,LOCAL,Facility,Inpatient,5 mL,mL,,538,457.3,154.1908,538,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
LEVOFLOXACIN 0.5 % OPHT DROP,,10358,LOCAL,Facility,Outpatient,5 mL,mL,,538,457.3,154.1908,538,Medica,Medical Assistance,239.948,44.6,,percent of total billed charges,,
LEVOFLOXACIN 0.5 % OPHT DROP,,10358,LOCAL,Facility,Inpatient,5 mL,mL,,538,457.3,154.1908,538,Medica,Medical Assistance,,,,,Included in per diem rate,
LEVOFLOXACIN 0.5 % OPHT DROP,,10358,LOCAL,Facility,Outpatient,5 mL,mL,,538,457.3,154.1908,538,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,267.924,49.8,,percent of total billed charges,,
LEVOFLOXACIN 0.5 % OPHT DROP,,10358,LOCAL,Facility,Inpatient,5 mL,mL,,538,457.3,154.1908,538,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
LEVOFLOXACIN 0.5 % OPHT DROP,,10358,LOCAL,Facility,Both,5 mL,mL,,538,457.3,154.1908,538,"Multiplan, Inc.","Multiplan, Inc.",505.72,94,,percent of total billed charges,,
LEVOFLOXACIN 0.5 % OPHT DROP,,10358,LOCAL,Facility,Outpatient,5 mL,mL,,538,457.3,154.1908,538,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,484.738,90.1,,percent of total billed charges,,
LEVOFLOXACIN 0.5 % OPHT DROP,,10358,LOCAL,Facility,Inpatient,5 mL,mL,,538,457.3,154.1908,538,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
LEVOFLOXACIN 0.5 % OPHT DROP,,10358,LOCAL,Facility,Both,5 mL,mL,,538,457.3,154.1908,538,"Preferred One Administrative Services, INC.",PPO,530.468,98.6,,percent of total billed charges,,
LEVOFLOXACIN 0.5 % OPHT DROP,,10358,LOCAL,Facility,Outpatient,5 mL,mL,,538,457.3,154.1908,538,PrimeWest Health,Minnesota Senior Health Options (MSHO),276.801,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
LEVOFLOXACIN 0.5 % OPHT DROP,,10358,LOCAL,Facility,Inpatient,5 mL,mL,,538,457.3,154.1908,538,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LEVOFLOXACIN 0.5 % OPHT DROP,,10358,LOCAL,Facility,Outpatient,5 mL,mL,,538,457.3,154.1908,538,PrimeWest Health,MinnesotaCare,276.3168,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
LEVOFLOXACIN 0.5 % OPHT DROP,,10358,LOCAL,Facility,Inpatient,5 mL,mL,,538,457.3,154.1908,538,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
LEVOFLOXACIN 0.5 % OPHT DROP,,10358,LOCAL,Facility,Both,5 mL,mL,,538,457.3,154.1908,538,Sanford Health Plan,Sanford Health Plan,494.96,92,,percent of total billed charges,,
LEVOFLOXACIN 0.5 % OPHT DROP,,10358,LOCAL,Facility,Outpatient,5 mL,mL,,538,457.3,154.1908,538,"UCare Health, Inc.",Individual & Family Plan,303.163,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
LEVOFLOXACIN 0.5 % OPHT DROP,,10358,LOCAL,Facility,Inpatient,5 mL,mL,,538,457.3,154.1908,538,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
LEVOFLOXACIN 0.5 % OPHT DROP,,10358,LOCAL,Facility,Outpatient,5 mL,mL,,538,457.3,154.1908,538,"UCare Health, Inc.",Medical Assistance,271.5286,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LEVOFLOXACIN 0.5 % OPHT DROP,,10358,LOCAL,Facility,Inpatient,5 mL,mL,,538,457.3,154.1908,538,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
LEVOFLOXACIN 0.5 % OPHT DROP,,10358,LOCAL,Facility,Outpatient,5 mL,mL,,538,457.3,154.1908,538,"UCare Health, Inc.",Medicare Advantage,271.5286,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LEVOFLOXACIN 0.5 % OPHT DROP,,10358,LOCAL,Facility,Inpatient,5 mL,mL,,538,457.3,154.1908,538,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LEVOFLOXACIN 0.5 % OPHT DROP,,10358,LOCAL,Facility,Outpatient,5 mL,mL,,538,457.3,154.1908,538,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),271.5286,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LEVOFLOXACIN 0.5 % OPHT DROP,,10358,LOCAL,Facility,Inpatient,5 mL,mL,,538,457.3,154.1908,538,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LEVOFLOXACIN 0.5 % OPHT DROP,,10358,LOCAL,Facility,Both,5 mL,mL,,538,457.3,154.1908,538,UnitedHealthcare,Individual & Family,505.72,94,,percent of total billed charges,,
LEVOFLOXACIN 0.5 % OPHT DROP,,10358,LOCAL,Facility,Outpatient,5 mL,mL,,538,457.3,154.1908,538,UnitedHealthcare,Medicare Advantage,263.62,49,,percent of total billed charges,,
LEVOFLOXACIN 0.5 % OPHT DROP,,10358,LOCAL,Facility,Inpatient,5 mL,mL,,538,457.3,154.1908,538,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
LEVOFLOXACIN 0.5 % OPHT DROP,,10358,LOCAL,Facility,Outpatient,5 mL,mL,,538,457.3,154.1908,538,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,258.24,48,,percent of total billed charges,,100% of DHS outpatient percentage
LEVOFLOXACIN 0.5 % OPHT DROP,,10358,LOCAL,Facility,Inpatient,5 mL,mL,,538,457.3,154.1908,538,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
GENTAMICIN 0.3 % OPHT DROP,,10830,LOCAL,Facility,Both,5 mL,mL,,98,83.3,28.0868,98,Aetna,Commercial,90.16,92,,percent of total billed charges,,
GENTAMICIN 0.3 % OPHT DROP,,10830,LOCAL,Facility,Outpatient,5 mL,mL,,98,83.3,28.0868,98,Aetna,Medicare Advantage,48.02,49,,percent of total billed charges,,
GENTAMICIN 0.3 % OPHT DROP,,10830,LOCAL,Facility,Inpatient,5 mL,mL,,98,83.3,28.0868,98,Aetna,Medicare Advantage,,,,,Included in per diem rate,
GENTAMICIN 0.3 % OPHT DROP,,10830,LOCAL,Facility,Both,5 mL,mL,,98,83.3,28.0868,98,Aetna,PPO,91.14,93,,percent of total billed charges,,
GENTAMICIN 0.3 % OPHT DROP,,10830,LOCAL,Facility,Both,5 mL,mL,,98,83.3,28.0868,98,America's PPO,America's PPO,94.1094,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
GENTAMICIN 0.3 % OPHT DROP,,10830,LOCAL,Facility,Both,5 mL,mL,,98,83.3,28.0868,98,BlueCross BlueShield Minnesota, Federal Employee Program,96.432,98.4,,percent of total billed charges,,
GENTAMICIN 0.3 % OPHT DROP,,10830,LOCAL,Facility,Both,5 mL,mL,,98,83.3,28.0868,98,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,98,100,,percent of total billed charges,,
GENTAMICIN 0.3 % OPHT DROP,,10830,LOCAL,Facility,Both,5 mL,mL,,98,83.3,28.0868,98,BlueCross BlueShield Minnesota,High Value Network Plan,88.2,90,,percent of total billed charges,,
GENTAMICIN 0.3 % OPHT DROP,,10830,LOCAL,Facility,Outpatient,5 mL,mL,,98,83.3,28.0868,98,BlueCross BlueShield Minnesota,Medicare Advantage,48.02,49,,percent of total billed charges,,
GENTAMICIN 0.3 % OPHT DROP,,10830,LOCAL,Facility,Inpatient,5 mL,mL,,98,83.3,28.0868,98,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
GENTAMICIN 0.3 % OPHT DROP,,10830,LOCAL,Facility,Both,5 mL,mL,,98,83.3,28.0868,98,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,86.7986,88.57,,percent of total billed charges,,
GENTAMICIN 0.3 % OPHT DROP,,10830,LOCAL,Facility,Both,5 mL,mL,,98,83.3,28.0868,98,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,28.0868,28.66,,percent of total billed charges,,
GENTAMICIN 0.3 % OPHT DROP,,10830,LOCAL,Facility,Outpatient,5 mL,mL,,98,83.3,28.0868,98,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),48.02,49,,percent of total billed charges,,
GENTAMICIN 0.3 % OPHT DROP,,10830,LOCAL,Facility,Inpatient,5 mL,mL,,98,83.3,28.0868,98,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
GENTAMICIN 0.3 % OPHT DROP,,10830,LOCAL,Facility,Both,5 mL,mL,,98,83.3,28.0868,98,CorVel,Worker's Compensation,98,100,,percent of total billed charges,,
GENTAMICIN 0.3 % OPHT DROP,,10830,LOCAL,Facility,Both,5 mL,mL,,98,83.3,28.0868,98,First Health Group Corporation,First Health Network,95.06,97,,percent of total billed charges,,
GENTAMICIN 0.3 % OPHT DROP,,10830,LOCAL,Facility,Both,5 mL,mL,,98,83.3,28.0868,98,"Health Partners, Inc.",Commercial,92.708,94.6,,percent of total billed charges,,
GENTAMICIN 0.3 % OPHT DROP,,10830,LOCAL,Facility,Outpatient,5 mL,mL,,98,83.3,28.0868,98,"Health Partners, Inc.",Medicare Advantage,48.02,49,,percent of total billed charges,,
GENTAMICIN 0.3 % OPHT DROP,,10830,LOCAL,Facility,Inpatient,5 mL,mL,,98,83.3,28.0868,98,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
GENTAMICIN 0.3 % OPHT DROP,,10830,LOCAL,Facility,Both,5 mL,mL,,98,83.3,28.0868,98,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),58.8,60,,percent of total billed charges,,
GENTAMICIN 0.3 % OPHT DROP,,10830,LOCAL,Facility,Both,5 mL,mL,,98,83.3,28.0868,98,"Health Partners, Inc.",State of Minnesota Advantage Program,79.87,81.5,,percent of total billed charges,,
GENTAMICIN 0.3 % OPHT DROP,,10830,LOCAL,Facility,Both,5 mL,mL,,98,83.3,28.0868,98,"Health Partners, Inc.",State Public Programs,49,50,,percent of total billed charges,,
GENTAMICIN 0.3 % OPHT DROP,,10830,LOCAL,Facility,Both,5 mL,mL,,98,83.3,28.0868,98,Humana Insurance Company,Commercial PPO,93.1,95,,percent of total billed charges,,
GENTAMICIN 0.3 % OPHT DROP,,10830,LOCAL,Facility,Outpatient,5 mL,mL,,98,83.3,28.0868,98,Humana Insurance Company,Medicare PPO,48.02,49,,percent of total billed charges,,
GENTAMICIN 0.3 % OPHT DROP,,10830,LOCAL,Facility,Inpatient,5 mL,mL,,98,83.3,28.0868,98,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
GENTAMICIN 0.3 % OPHT DROP,,10830,LOCAL,Facility,Both,5 mL,mL,,98,83.3,28.0868,98,Medica,Individual & Family,97.118,99.1,,percent of total billed charges,,
GENTAMICIN 0.3 % OPHT DROP,,10830,LOCAL,Facility,Outpatient,5 mL,mL,,98,83.3,28.0868,98,Medica,Medica Advantage Solution,48.804,49.8,,percent of total billed charges,,
GENTAMICIN 0.3 % OPHT DROP,,10830,LOCAL,Facility,Inpatient,5 mL,mL,,98,83.3,28.0868,98,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
GENTAMICIN 0.3 % OPHT DROP,,10830,LOCAL,Facility,Outpatient,5 mL,mL,,98,83.3,28.0868,98,Medica,Medical Assistance,43.708,44.6,,percent of total billed charges,,
GENTAMICIN 0.3 % OPHT DROP,,10830,LOCAL,Facility,Inpatient,5 mL,mL,,98,83.3,28.0868,98,Medica,Medical Assistance,,,,,Included in per diem rate,
GENTAMICIN 0.3 % OPHT DROP,,10830,LOCAL,Facility,Outpatient,5 mL,mL,,98,83.3,28.0868,98,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,48.804,49.8,,percent of total billed charges,,
GENTAMICIN 0.3 % OPHT DROP,,10830,LOCAL,Facility,Inpatient,5 mL,mL,,98,83.3,28.0868,98,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
GENTAMICIN 0.3 % OPHT DROP,,10830,LOCAL,Facility,Both,5 mL,mL,,98,83.3,28.0868,98,"Multiplan, Inc.","Multiplan, Inc.",92.12,94,,percent of total billed charges,,
GENTAMICIN 0.3 % OPHT DROP,,10830,LOCAL,Facility,Outpatient,5 mL,mL,,98,83.3,28.0868,98,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,88.298,90.1,,percent of total billed charges,,
GENTAMICIN 0.3 % OPHT DROP,,10830,LOCAL,Facility,Inpatient,5 mL,mL,,98,83.3,28.0868,98,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
GENTAMICIN 0.3 % OPHT DROP,,10830,LOCAL,Facility,Both,5 mL,mL,,98,83.3,28.0868,98,"Preferred One Administrative Services, INC.",PPO,96.628,98.6,,percent of total billed charges,,
GENTAMICIN 0.3 % OPHT DROP,,10830,LOCAL,Facility,Outpatient,5 mL,mL,,98,83.3,28.0868,98,PrimeWest Health,Minnesota Senior Health Options (MSHO),50.421,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
GENTAMICIN 0.3 % OPHT DROP,,10830,LOCAL,Facility,Inpatient,5 mL,mL,,98,83.3,28.0868,98,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
GENTAMICIN 0.3 % OPHT DROP,,10830,LOCAL,Facility,Outpatient,5 mL,mL,,98,83.3,28.0868,98,PrimeWest Health,MinnesotaCare,50.3328,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
GENTAMICIN 0.3 % OPHT DROP,,10830,LOCAL,Facility,Inpatient,5 mL,mL,,98,83.3,28.0868,98,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
GENTAMICIN 0.3 % OPHT DROP,,10830,LOCAL,Facility,Both,5 mL,mL,,98,83.3,28.0868,98,Sanford Health Plan,Sanford Health Plan,90.16,92,,percent of total billed charges,,
GENTAMICIN 0.3 % OPHT DROP,,10830,LOCAL,Facility,Outpatient,5 mL,mL,,98,83.3,28.0868,98,"UCare Health, Inc.",Individual & Family Plan,55.223,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
GENTAMICIN 0.3 % OPHT DROP,,10830,LOCAL,Facility,Inpatient,5 mL,mL,,98,83.3,28.0868,98,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
GENTAMICIN 0.3 % OPHT DROP,,10830,LOCAL,Facility,Outpatient,5 mL,mL,,98,83.3,28.0868,98,"UCare Health, Inc.",Medical Assistance,49.4606,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
GENTAMICIN 0.3 % OPHT DROP,,10830,LOCAL,Facility,Inpatient,5 mL,mL,,98,83.3,28.0868,98,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
GENTAMICIN 0.3 % OPHT DROP,,10830,LOCAL,Facility,Outpatient,5 mL,mL,,98,83.3,28.0868,98,"UCare Health, Inc.",Medicare Advantage,49.4606,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
GENTAMICIN 0.3 % OPHT DROP,,10830,LOCAL,Facility,Inpatient,5 mL,mL,,98,83.3,28.0868,98,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
GENTAMICIN 0.3 % OPHT DROP,,10830,LOCAL,Facility,Outpatient,5 mL,mL,,98,83.3,28.0868,98,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),49.4606,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
GENTAMICIN 0.3 % OPHT DROP,,10830,LOCAL,Facility,Inpatient,5 mL,mL,,98,83.3,28.0868,98,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
GENTAMICIN 0.3 % OPHT DROP,,10830,LOCAL,Facility,Both,5 mL,mL,,98,83.3,28.0868,98,UnitedHealthcare,Individual & Family,92.12,94,,percent of total billed charges,,
GENTAMICIN 0.3 % OPHT DROP,,10830,LOCAL,Facility,Outpatient,5 mL,mL,,98,83.3,28.0868,98,UnitedHealthcare,Medicare Advantage,48.02,49,,percent of total billed charges,,
GENTAMICIN 0.3 % OPHT DROP,,10830,LOCAL,Facility,Inpatient,5 mL,mL,,98,83.3,28.0868,98,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
GENTAMICIN 0.3 % OPHT DROP,,10830,LOCAL,Facility,Outpatient,5 mL,mL,,98,83.3,28.0868,98,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,47.04,48,,percent of total billed charges,,100% of DHS outpatient percentage
GENTAMICIN 0.3 % OPHT DROP,,10830,LOCAL,Facility,Inpatient,5 mL,mL,,98,83.3,28.0868,98,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
TIMOLOL MALEATE 0.25 % OPHT DROP,,11726,LOCAL,Facility,Both,5 mL,mL,,72,61.2,20.6352,72,Aetna,Commercial,66.24,92,,percent of total billed charges,,
TIMOLOL MALEATE 0.25 % OPHT DROP,,11726,LOCAL,Facility,Outpatient,5 mL,mL,,72,61.2,20.6352,72,Aetna,Medicare Advantage,35.28,49,,percent of total billed charges,,
TIMOLOL MALEATE 0.25 % OPHT DROP,,11726,LOCAL,Facility,Inpatient,5 mL,mL,,72,61.2,20.6352,72,Aetna,Medicare Advantage,,,,,Included in per diem rate,
TIMOLOL MALEATE 0.25 % OPHT DROP,,11726,LOCAL,Facility,Both,5 mL,mL,,72,61.2,20.6352,72,Aetna,PPO,66.96,93,,percent of total billed charges,,
TIMOLOL MALEATE 0.25 % OPHT DROP,,11726,LOCAL,Facility,Both,5 mL,mL,,72,61.2,20.6352,72,America's PPO,America's PPO,69.1416,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
TIMOLOL MALEATE 0.25 % OPHT DROP,,11726,LOCAL,Facility,Both,5 mL,mL,,72,61.2,20.6352,72,BlueCross BlueShield Minnesota, Federal Employee Program,70.848,98.4,,percent of total billed charges,,
TIMOLOL MALEATE 0.25 % OPHT DROP,,11726,LOCAL,Facility,Both,5 mL,mL,,72,61.2,20.6352,72,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,72,100,,percent of total billed charges,,
TIMOLOL MALEATE 0.25 % OPHT DROP,,11726,LOCAL,Facility,Both,5 mL,mL,,72,61.2,20.6352,72,BlueCross BlueShield Minnesota,High Value Network Plan,64.8,90,,percent of total billed charges,,
TIMOLOL MALEATE 0.25 % OPHT DROP,,11726,LOCAL,Facility,Outpatient,5 mL,mL,,72,61.2,20.6352,72,BlueCross BlueShield Minnesota,Medicare Advantage,35.28,49,,percent of total billed charges,,
TIMOLOL MALEATE 0.25 % OPHT DROP,,11726,LOCAL,Facility,Inpatient,5 mL,mL,,72,61.2,20.6352,72,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
TIMOLOL MALEATE 0.25 % OPHT DROP,,11726,LOCAL,Facility,Both,5 mL,mL,,72,61.2,20.6352,72,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,63.7704,88.57,,percent of total billed charges,,
TIMOLOL MALEATE 0.25 % OPHT DROP,,11726,LOCAL,Facility,Both,5 mL,mL,,72,61.2,20.6352,72,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,20.6352,28.66,,percent of total billed charges,,
TIMOLOL MALEATE 0.25 % OPHT DROP,,11726,LOCAL,Facility,Outpatient,5 mL,mL,,72,61.2,20.6352,72,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),35.28,49,,percent of total billed charges,,
TIMOLOL MALEATE 0.25 % OPHT DROP,,11726,LOCAL,Facility,Inpatient,5 mL,mL,,72,61.2,20.6352,72,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
TIMOLOL MALEATE 0.25 % OPHT DROP,,11726,LOCAL,Facility,Both,5 mL,mL,,72,61.2,20.6352,72,CorVel,Worker's Compensation,72,100,,percent of total billed charges,,
TIMOLOL MALEATE 0.25 % OPHT DROP,,11726,LOCAL,Facility,Both,5 mL,mL,,72,61.2,20.6352,72,First Health Group Corporation,First Health Network,69.84,97,,percent of total billed charges,,
TIMOLOL MALEATE 0.25 % OPHT DROP,,11726,LOCAL,Facility,Both,5 mL,mL,,72,61.2,20.6352,72,"Health Partners, Inc.",Commercial,68.112,94.6,,percent of total billed charges,,
TIMOLOL MALEATE 0.25 % OPHT DROP,,11726,LOCAL,Facility,Outpatient,5 mL,mL,,72,61.2,20.6352,72,"Health Partners, Inc.",Medicare Advantage,35.28,49,,percent of total billed charges,,
TIMOLOL MALEATE 0.25 % OPHT DROP,,11726,LOCAL,Facility,Inpatient,5 mL,mL,,72,61.2,20.6352,72,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
TIMOLOL MALEATE 0.25 % OPHT DROP,,11726,LOCAL,Facility,Both,5 mL,mL,,72,61.2,20.6352,72,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),43.2,60,,percent of total billed charges,,
TIMOLOL MALEATE 0.25 % OPHT DROP,,11726,LOCAL,Facility,Both,5 mL,mL,,72,61.2,20.6352,72,"Health Partners, Inc.",State of Minnesota Advantage Program,58.68,81.5,,percent of total billed charges,,
TIMOLOL MALEATE 0.25 % OPHT DROP,,11726,LOCAL,Facility,Both,5 mL,mL,,72,61.2,20.6352,72,"Health Partners, Inc.",State Public Programs,36,50,,percent of total billed charges,,
TIMOLOL MALEATE 0.25 % OPHT DROP,,11726,LOCAL,Facility,Both,5 mL,mL,,72,61.2,20.6352,72,Humana Insurance Company,Commercial PPO,68.4,95,,percent of total billed charges,,
TIMOLOL MALEATE 0.25 % OPHT DROP,,11726,LOCAL,Facility,Outpatient,5 mL,mL,,72,61.2,20.6352,72,Humana Insurance Company,Medicare PPO,35.28,49,,percent of total billed charges,,
TIMOLOL MALEATE 0.25 % OPHT DROP,,11726,LOCAL,Facility,Inpatient,5 mL,mL,,72,61.2,20.6352,72,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
TIMOLOL MALEATE 0.25 % OPHT DROP,,11726,LOCAL,Facility,Both,5 mL,mL,,72,61.2,20.6352,72,Medica,Individual & Family,71.352,99.1,,percent of total billed charges,,
TIMOLOL MALEATE 0.25 % OPHT DROP,,11726,LOCAL,Facility,Outpatient,5 mL,mL,,72,61.2,20.6352,72,Medica,Medica Advantage Solution,35.856,49.8,,percent of total billed charges,,
TIMOLOL MALEATE 0.25 % OPHT DROP,,11726,LOCAL,Facility,Inpatient,5 mL,mL,,72,61.2,20.6352,72,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
TIMOLOL MALEATE 0.25 % OPHT DROP,,11726,LOCAL,Facility,Outpatient,5 mL,mL,,72,61.2,20.6352,72,Medica,Medical Assistance,32.112,44.6,,percent of total billed charges,,
TIMOLOL MALEATE 0.25 % OPHT DROP,,11726,LOCAL,Facility,Inpatient,5 mL,mL,,72,61.2,20.6352,72,Medica,Medical Assistance,,,,,Included in per diem rate,
TIMOLOL MALEATE 0.25 % OPHT DROP,,11726,LOCAL,Facility,Outpatient,5 mL,mL,,72,61.2,20.6352,72,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,35.856,49.8,,percent of total billed charges,,
TIMOLOL MALEATE 0.25 % OPHT DROP,,11726,LOCAL,Facility,Inpatient,5 mL,mL,,72,61.2,20.6352,72,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
TIMOLOL MALEATE 0.25 % OPHT DROP,,11726,LOCAL,Facility,Both,5 mL,mL,,72,61.2,20.6352,72,"Multiplan, Inc.","Multiplan, Inc.",67.68,94,,percent of total billed charges,,
TIMOLOL MALEATE 0.25 % OPHT DROP,,11726,LOCAL,Facility,Outpatient,5 mL,mL,,72,61.2,20.6352,72,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,64.872,90.1,,percent of total billed charges,,
TIMOLOL MALEATE 0.25 % OPHT DROP,,11726,LOCAL,Facility,Inpatient,5 mL,mL,,72,61.2,20.6352,72,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
TIMOLOL MALEATE 0.25 % OPHT DROP,,11726,LOCAL,Facility,Both,5 mL,mL,,72,61.2,20.6352,72,"Preferred One Administrative Services, INC.",PPO,70.992,98.6,,percent of total billed charges,,
TIMOLOL MALEATE 0.25 % OPHT DROP,,11726,LOCAL,Facility,Outpatient,5 mL,mL,,72,61.2,20.6352,72,PrimeWest Health,Minnesota Senior Health Options (MSHO),37.044,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
TIMOLOL MALEATE 0.25 % OPHT DROP,,11726,LOCAL,Facility,Inpatient,5 mL,mL,,72,61.2,20.6352,72,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
TIMOLOL MALEATE 0.25 % OPHT DROP,,11726,LOCAL,Facility,Outpatient,5 mL,mL,,72,61.2,20.6352,72,PrimeWest Health,MinnesotaCare,36.9792,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
TIMOLOL MALEATE 0.25 % OPHT DROP,,11726,LOCAL,Facility,Inpatient,5 mL,mL,,72,61.2,20.6352,72,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
TIMOLOL MALEATE 0.25 % OPHT DROP,,11726,LOCAL,Facility,Both,5 mL,mL,,72,61.2,20.6352,72,Sanford Health Plan,Sanford Health Plan,66.24,92,,percent of total billed charges,,
TIMOLOL MALEATE 0.25 % OPHT DROP,,11726,LOCAL,Facility,Outpatient,5 mL,mL,,72,61.2,20.6352,72,"UCare Health, Inc.",Individual & Family Plan,40.572,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
TIMOLOL MALEATE 0.25 % OPHT DROP,,11726,LOCAL,Facility,Inpatient,5 mL,mL,,72,61.2,20.6352,72,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
TIMOLOL MALEATE 0.25 % OPHT DROP,,11726,LOCAL,Facility,Outpatient,5 mL,mL,,72,61.2,20.6352,72,"UCare Health, Inc.",Medical Assistance,36.3384,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TIMOLOL MALEATE 0.25 % OPHT DROP,,11726,LOCAL,Facility,Inpatient,5 mL,mL,,72,61.2,20.6352,72,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
TIMOLOL MALEATE 0.25 % OPHT DROP,,11726,LOCAL,Facility,Outpatient,5 mL,mL,,72,61.2,20.6352,72,"UCare Health, Inc.",Medicare Advantage,36.3384,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TIMOLOL MALEATE 0.25 % OPHT DROP,,11726,LOCAL,Facility,Inpatient,5 mL,mL,,72,61.2,20.6352,72,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
TIMOLOL MALEATE 0.25 % OPHT DROP,,11726,LOCAL,Facility,Outpatient,5 mL,mL,,72,61.2,20.6352,72,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),36.3384,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TIMOLOL MALEATE 0.25 % OPHT DROP,,11726,LOCAL,Facility,Inpatient,5 mL,mL,,72,61.2,20.6352,72,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
TIMOLOL MALEATE 0.25 % OPHT DROP,,11726,LOCAL,Facility,Both,5 mL,mL,,72,61.2,20.6352,72,UnitedHealthcare,Individual & Family,67.68,94,,percent of total billed charges,,
TIMOLOL MALEATE 0.25 % OPHT DROP,,11726,LOCAL,Facility,Outpatient,5 mL,mL,,72,61.2,20.6352,72,UnitedHealthcare,Medicare Advantage,35.28,49,,percent of total billed charges,,
TIMOLOL MALEATE 0.25 % OPHT DROP,,11726,LOCAL,Facility,Inpatient,5 mL,mL,,72,61.2,20.6352,72,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
TIMOLOL MALEATE 0.25 % OPHT DROP,,11726,LOCAL,Facility,Outpatient,5 mL,mL,,72,61.2,20.6352,72,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,34.56,48,,percent of total billed charges,,100% of DHS outpatient percentage
TIMOLOL MALEATE 0.25 % OPHT DROP,,11726,LOCAL,Facility,Inpatient,5 mL,mL,,72,61.2,20.6352,72,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
TOBRAMYCIN 0.3 % OPHT DROP,,12626,LOCAL,Facility,Both,5 mL,mL,,70,59.5,20.062,70,Aetna,Commercial,64.4,92,,percent of total billed charges,,
TOBRAMYCIN 0.3 % OPHT DROP,,12626,LOCAL,Facility,Outpatient,5 mL,mL,,70,59.5,20.062,70,Aetna,Medicare Advantage,34.3,49,,percent of total billed charges,,
TOBRAMYCIN 0.3 % OPHT DROP,,12626,LOCAL,Facility,Inpatient,5 mL,mL,,70,59.5,20.062,70,Aetna,Medicare Advantage,,,,,Included in per diem rate,
TOBRAMYCIN 0.3 % OPHT DROP,,12626,LOCAL,Facility,Both,5 mL,mL,,70,59.5,20.062,70,Aetna,PPO,65.1,93,,percent of total billed charges,,
TOBRAMYCIN 0.3 % OPHT DROP,,12626,LOCAL,Facility,Both,5 mL,mL,,70,59.5,20.062,70,America's PPO,America's PPO,67.221,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
TOBRAMYCIN 0.3 % OPHT DROP,,12626,LOCAL,Facility,Both,5 mL,mL,,70,59.5,20.062,70,BlueCross BlueShield Minnesota, Federal Employee Program,68.88,98.4,,percent of total billed charges,,
TOBRAMYCIN 0.3 % OPHT DROP,,12626,LOCAL,Facility,Both,5 mL,mL,,70,59.5,20.062,70,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,70,100,,percent of total billed charges,,
TOBRAMYCIN 0.3 % OPHT DROP,,12626,LOCAL,Facility,Both,5 mL,mL,,70,59.5,20.062,70,BlueCross BlueShield Minnesota,High Value Network Plan,63,90,,percent of total billed charges,,
TOBRAMYCIN 0.3 % OPHT DROP,,12626,LOCAL,Facility,Outpatient,5 mL,mL,,70,59.5,20.062,70,BlueCross BlueShield Minnesota,Medicare Advantage,34.3,49,,percent of total billed charges,,
TOBRAMYCIN 0.3 % OPHT DROP,,12626,LOCAL,Facility,Inpatient,5 mL,mL,,70,59.5,20.062,70,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
TOBRAMYCIN 0.3 % OPHT DROP,,12626,LOCAL,Facility,Both,5 mL,mL,,70,59.5,20.062,70,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,61.999,88.57,,percent of total billed charges,,
TOBRAMYCIN 0.3 % OPHT DROP,,12626,LOCAL,Facility,Both,5 mL,mL,,70,59.5,20.062,70,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,20.062,28.66,,percent of total billed charges,,
TOBRAMYCIN 0.3 % OPHT DROP,,12626,LOCAL,Facility,Outpatient,5 mL,mL,,70,59.5,20.062,70,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),34.3,49,,percent of total billed charges,,
TOBRAMYCIN 0.3 % OPHT DROP,,12626,LOCAL,Facility,Inpatient,5 mL,mL,,70,59.5,20.062,70,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
TOBRAMYCIN 0.3 % OPHT DROP,,12626,LOCAL,Facility,Both,5 mL,mL,,70,59.5,20.062,70,CorVel,Worker's Compensation,70,100,,percent of total billed charges,,
TOBRAMYCIN 0.3 % OPHT DROP,,12626,LOCAL,Facility,Both,5 mL,mL,,70,59.5,20.062,70,First Health Group Corporation,First Health Network,67.9,97,,percent of total billed charges,,
TOBRAMYCIN 0.3 % OPHT DROP,,12626,LOCAL,Facility,Both,5 mL,mL,,70,59.5,20.062,70,"Health Partners, Inc.",Commercial,66.22,94.6,,percent of total billed charges,,
TOBRAMYCIN 0.3 % OPHT DROP,,12626,LOCAL,Facility,Outpatient,5 mL,mL,,70,59.5,20.062,70,"Health Partners, Inc.",Medicare Advantage,34.3,49,,percent of total billed charges,,
TOBRAMYCIN 0.3 % OPHT DROP,,12626,LOCAL,Facility,Inpatient,5 mL,mL,,70,59.5,20.062,70,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
TOBRAMYCIN 0.3 % OPHT DROP,,12626,LOCAL,Facility,Both,5 mL,mL,,70,59.5,20.062,70,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),42,60,,percent of total billed charges,,
TOBRAMYCIN 0.3 % OPHT DROP,,12626,LOCAL,Facility,Both,5 mL,mL,,70,59.5,20.062,70,"Health Partners, Inc.",State of Minnesota Advantage Program,57.05,81.5,,percent of total billed charges,,
TOBRAMYCIN 0.3 % OPHT DROP,,12626,LOCAL,Facility,Both,5 mL,mL,,70,59.5,20.062,70,"Health Partners, Inc.",State Public Programs,35,50,,percent of total billed charges,,
TOBRAMYCIN 0.3 % OPHT DROP,,12626,LOCAL,Facility,Both,5 mL,mL,,70,59.5,20.062,70,Humana Insurance Company,Commercial PPO,66.5,95,,percent of total billed charges,,
TOBRAMYCIN 0.3 % OPHT DROP,,12626,LOCAL,Facility,Outpatient,5 mL,mL,,70,59.5,20.062,70,Humana Insurance Company,Medicare PPO,34.3,49,,percent of total billed charges,,
TOBRAMYCIN 0.3 % OPHT DROP,,12626,LOCAL,Facility,Inpatient,5 mL,mL,,70,59.5,20.062,70,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
TOBRAMYCIN 0.3 % OPHT DROP,,12626,LOCAL,Facility,Both,5 mL,mL,,70,59.5,20.062,70,Medica,Individual & Family,69.37,99.1,,percent of total billed charges,,
TOBRAMYCIN 0.3 % OPHT DROP,,12626,LOCAL,Facility,Outpatient,5 mL,mL,,70,59.5,20.062,70,Medica,Medica Advantage Solution,34.86,49.8,,percent of total billed charges,,
TOBRAMYCIN 0.3 % OPHT DROP,,12626,LOCAL,Facility,Inpatient,5 mL,mL,,70,59.5,20.062,70,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
TOBRAMYCIN 0.3 % OPHT DROP,,12626,LOCAL,Facility,Outpatient,5 mL,mL,,70,59.5,20.062,70,Medica,Medical Assistance,31.22,44.6,,percent of total billed charges,,
TOBRAMYCIN 0.3 % OPHT DROP,,12626,LOCAL,Facility,Inpatient,5 mL,mL,,70,59.5,20.062,70,Medica,Medical Assistance,,,,,Included in per diem rate,
TOBRAMYCIN 0.3 % OPHT DROP,,12626,LOCAL,Facility,Outpatient,5 mL,mL,,70,59.5,20.062,70,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,34.86,49.8,,percent of total billed charges,,
TOBRAMYCIN 0.3 % OPHT DROP,,12626,LOCAL,Facility,Inpatient,5 mL,mL,,70,59.5,20.062,70,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
TOBRAMYCIN 0.3 % OPHT DROP,,12626,LOCAL,Facility,Both,5 mL,mL,,70,59.5,20.062,70,"Multiplan, Inc.","Multiplan, Inc.",65.8,94,,percent of total billed charges,,
TOBRAMYCIN 0.3 % OPHT DROP,,12626,LOCAL,Facility,Outpatient,5 mL,mL,,70,59.5,20.062,70,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,63.07,90.1,,percent of total billed charges,,
TOBRAMYCIN 0.3 % OPHT DROP,,12626,LOCAL,Facility,Inpatient,5 mL,mL,,70,59.5,20.062,70,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
TOBRAMYCIN 0.3 % OPHT DROP,,12626,LOCAL,Facility,Both,5 mL,mL,,70,59.5,20.062,70,"Preferred One Administrative Services, INC.",PPO,69.02,98.6,,percent of total billed charges,,
TOBRAMYCIN 0.3 % OPHT DROP,,12626,LOCAL,Facility,Outpatient,5 mL,mL,,70,59.5,20.062,70,PrimeWest Health,Minnesota Senior Health Options (MSHO),36.015,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
TOBRAMYCIN 0.3 % OPHT DROP,,12626,LOCAL,Facility,Inpatient,5 mL,mL,,70,59.5,20.062,70,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
TOBRAMYCIN 0.3 % OPHT DROP,,12626,LOCAL,Facility,Outpatient,5 mL,mL,,70,59.5,20.062,70,PrimeWest Health,MinnesotaCare,35.952,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
TOBRAMYCIN 0.3 % OPHT DROP,,12626,LOCAL,Facility,Inpatient,5 mL,mL,,70,59.5,20.062,70,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
TOBRAMYCIN 0.3 % OPHT DROP,,12626,LOCAL,Facility,Both,5 mL,mL,,70,59.5,20.062,70,Sanford Health Plan,Sanford Health Plan,64.4,92,,percent of total billed charges,,
TOBRAMYCIN 0.3 % OPHT DROP,,12626,LOCAL,Facility,Outpatient,5 mL,mL,,70,59.5,20.062,70,"UCare Health, Inc.",Individual & Family Plan,39.445,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
TOBRAMYCIN 0.3 % OPHT DROP,,12626,LOCAL,Facility,Inpatient,5 mL,mL,,70,59.5,20.062,70,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
TOBRAMYCIN 0.3 % OPHT DROP,,12626,LOCAL,Facility,Outpatient,5 mL,mL,,70,59.5,20.062,70,"UCare Health, Inc.",Medical Assistance,35.329,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TOBRAMYCIN 0.3 % OPHT DROP,,12626,LOCAL,Facility,Inpatient,5 mL,mL,,70,59.5,20.062,70,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
TOBRAMYCIN 0.3 % OPHT DROP,,12626,LOCAL,Facility,Outpatient,5 mL,mL,,70,59.5,20.062,70,"UCare Health, Inc.",Medicare Advantage,35.329,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TOBRAMYCIN 0.3 % OPHT DROP,,12626,LOCAL,Facility,Inpatient,5 mL,mL,,70,59.5,20.062,70,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
TOBRAMYCIN 0.3 % OPHT DROP,,12626,LOCAL,Facility,Outpatient,5 mL,mL,,70,59.5,20.062,70,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),35.329,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TOBRAMYCIN 0.3 % OPHT DROP,,12626,LOCAL,Facility,Inpatient,5 mL,mL,,70,59.5,20.062,70,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
TOBRAMYCIN 0.3 % OPHT DROP,,12626,LOCAL,Facility,Both,5 mL,mL,,70,59.5,20.062,70,UnitedHealthcare,Individual & Family,65.8,94,,percent of total billed charges,,
TOBRAMYCIN 0.3 % OPHT DROP,,12626,LOCAL,Facility,Outpatient,5 mL,mL,,70,59.5,20.062,70,UnitedHealthcare,Medicare Advantage,34.3,49,,percent of total billed charges,,
TOBRAMYCIN 0.3 % OPHT DROP,,12626,LOCAL,Facility,Inpatient,5 mL,mL,,70,59.5,20.062,70,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
TOBRAMYCIN 0.3 % OPHT DROP,,12626,LOCAL,Facility,Outpatient,5 mL,mL,,70,59.5,20.062,70,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,33.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
TOBRAMYCIN 0.3 % OPHT DROP,,12626,LOCAL,Facility,Inpatient,5 mL,mL,,70,59.5,20.062,70,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
BRIMONIDINE 0.2 % OPHT DROP,,13627,LOCAL,Facility,Both,5 mL,mL,,147,124.95,42.1302,147,Aetna,Commercial,135.24,92,,percent of total billed charges,,
BRIMONIDINE 0.2 % OPHT DROP,,13627,LOCAL,Facility,Outpatient,5 mL,mL,,147,124.95,42.1302,147,Aetna,Medicare Advantage,72.03,49,,percent of total billed charges,,
BRIMONIDINE 0.2 % OPHT DROP,,13627,LOCAL,Facility,Inpatient,5 mL,mL,,147,124.95,42.1302,147,Aetna,Medicare Advantage,,,,,Included in per diem rate,
BRIMONIDINE 0.2 % OPHT DROP,,13627,LOCAL,Facility,Both,5 mL,mL,,147,124.95,42.1302,147,Aetna,PPO,136.71,93,,percent of total billed charges,,
BRIMONIDINE 0.2 % OPHT DROP,,13627,LOCAL,Facility,Both,5 mL,mL,,147,124.95,42.1302,147,America's PPO,America's PPO,141.1641,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
BRIMONIDINE 0.2 % OPHT DROP,,13627,LOCAL,Facility,Both,5 mL,mL,,147,124.95,42.1302,147,BlueCross BlueShield Minnesota, Federal Employee Program,144.648,98.4,,percent of total billed charges,,
BRIMONIDINE 0.2 % OPHT DROP,,13627,LOCAL,Facility,Both,5 mL,mL,,147,124.95,42.1302,147,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,147,100,,percent of total billed charges,,
BRIMONIDINE 0.2 % OPHT DROP,,13627,LOCAL,Facility,Both,5 mL,mL,,147,124.95,42.1302,147,BlueCross BlueShield Minnesota,High Value Network Plan,132.3,90,,percent of total billed charges,,
BRIMONIDINE 0.2 % OPHT DROP,,13627,LOCAL,Facility,Outpatient,5 mL,mL,,147,124.95,42.1302,147,BlueCross BlueShield Minnesota,Medicare Advantage,72.03,49,,percent of total billed charges,,
BRIMONIDINE 0.2 % OPHT DROP,,13627,LOCAL,Facility,Inpatient,5 mL,mL,,147,124.95,42.1302,147,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
BRIMONIDINE 0.2 % OPHT DROP,,13627,LOCAL,Facility,Both,5 mL,mL,,147,124.95,42.1302,147,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,130.1979,88.57,,percent of total billed charges,,
BRIMONIDINE 0.2 % OPHT DROP,,13627,LOCAL,Facility,Both,5 mL,mL,,147,124.95,42.1302,147,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,42.1302,28.66,,percent of total billed charges,,
BRIMONIDINE 0.2 % OPHT DROP,,13627,LOCAL,Facility,Outpatient,5 mL,mL,,147,124.95,42.1302,147,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),72.03,49,,percent of total billed charges,,
BRIMONIDINE 0.2 % OPHT DROP,,13627,LOCAL,Facility,Inpatient,5 mL,mL,,147,124.95,42.1302,147,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
BRIMONIDINE 0.2 % OPHT DROP,,13627,LOCAL,Facility,Both,5 mL,mL,,147,124.95,42.1302,147,CorVel,Worker's Compensation,147,100,,percent of total billed charges,,
BRIMONIDINE 0.2 % OPHT DROP,,13627,LOCAL,Facility,Both,5 mL,mL,,147,124.95,42.1302,147,First Health Group Corporation,First Health Network,142.59,97,,percent of total billed charges,,
BRIMONIDINE 0.2 % OPHT DROP,,13627,LOCAL,Facility,Both,5 mL,mL,,147,124.95,42.1302,147,"Health Partners, Inc.",Commercial,139.062,94.6,,percent of total billed charges,,
BRIMONIDINE 0.2 % OPHT DROP,,13627,LOCAL,Facility,Outpatient,5 mL,mL,,147,124.95,42.1302,147,"Health Partners, Inc.",Medicare Advantage,72.03,49,,percent of total billed charges,,
BRIMONIDINE 0.2 % OPHT DROP,,13627,LOCAL,Facility,Inpatient,5 mL,mL,,147,124.95,42.1302,147,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
BRIMONIDINE 0.2 % OPHT DROP,,13627,LOCAL,Facility,Both,5 mL,mL,,147,124.95,42.1302,147,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),88.2,60,,percent of total billed charges,,
BRIMONIDINE 0.2 % OPHT DROP,,13627,LOCAL,Facility,Both,5 mL,mL,,147,124.95,42.1302,147,"Health Partners, Inc.",State of Minnesota Advantage Program,119.805,81.5,,percent of total billed charges,,
BRIMONIDINE 0.2 % OPHT DROP,,13627,LOCAL,Facility,Both,5 mL,mL,,147,124.95,42.1302,147,"Health Partners, Inc.",State Public Programs,73.5,50,,percent of total billed charges,,
BRIMONIDINE 0.2 % OPHT DROP,,13627,LOCAL,Facility,Both,5 mL,mL,,147,124.95,42.1302,147,Humana Insurance Company,Commercial PPO,139.65,95,,percent of total billed charges,,
BRIMONIDINE 0.2 % OPHT DROP,,13627,LOCAL,Facility,Outpatient,5 mL,mL,,147,124.95,42.1302,147,Humana Insurance Company,Medicare PPO,72.03,49,,percent of total billed charges,,
BRIMONIDINE 0.2 % OPHT DROP,,13627,LOCAL,Facility,Inpatient,5 mL,mL,,147,124.95,42.1302,147,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
BRIMONIDINE 0.2 % OPHT DROP,,13627,LOCAL,Facility,Both,5 mL,mL,,147,124.95,42.1302,147,Medica,Individual & Family,145.677,99.1,,percent of total billed charges,,
BRIMONIDINE 0.2 % OPHT DROP,,13627,LOCAL,Facility,Outpatient,5 mL,mL,,147,124.95,42.1302,147,Medica,Medica Advantage Solution,73.206,49.8,,percent of total billed charges,,
BRIMONIDINE 0.2 % OPHT DROP,,13627,LOCAL,Facility,Inpatient,5 mL,mL,,147,124.95,42.1302,147,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
BRIMONIDINE 0.2 % OPHT DROP,,13627,LOCAL,Facility,Outpatient,5 mL,mL,,147,124.95,42.1302,147,Medica,Medical Assistance,65.562,44.6,,percent of total billed charges,,
BRIMONIDINE 0.2 % OPHT DROP,,13627,LOCAL,Facility,Inpatient,5 mL,mL,,147,124.95,42.1302,147,Medica,Medical Assistance,,,,,Included in per diem rate,
BRIMONIDINE 0.2 % OPHT DROP,,13627,LOCAL,Facility,Outpatient,5 mL,mL,,147,124.95,42.1302,147,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,73.206,49.8,,percent of total billed charges,,
BRIMONIDINE 0.2 % OPHT DROP,,13627,LOCAL,Facility,Inpatient,5 mL,mL,,147,124.95,42.1302,147,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
BRIMONIDINE 0.2 % OPHT DROP,,13627,LOCAL,Facility,Both,5 mL,mL,,147,124.95,42.1302,147,"Multiplan, Inc.","Multiplan, Inc.",138.18,94,,percent of total billed charges,,
BRIMONIDINE 0.2 % OPHT DROP,,13627,LOCAL,Facility,Outpatient,5 mL,mL,,147,124.95,42.1302,147,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,132.447,90.1,,percent of total billed charges,,
BRIMONIDINE 0.2 % OPHT DROP,,13627,LOCAL,Facility,Inpatient,5 mL,mL,,147,124.95,42.1302,147,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
BRIMONIDINE 0.2 % OPHT DROP,,13627,LOCAL,Facility,Both,5 mL,mL,,147,124.95,42.1302,147,"Preferred One Administrative Services, INC.",PPO,144.942,98.6,,percent of total billed charges,,
BRIMONIDINE 0.2 % OPHT DROP,,13627,LOCAL,Facility,Outpatient,5 mL,mL,,147,124.95,42.1302,147,PrimeWest Health,Minnesota Senior Health Options (MSHO),75.6315,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
BRIMONIDINE 0.2 % OPHT DROP,,13627,LOCAL,Facility,Inpatient,5 mL,mL,,147,124.95,42.1302,147,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
BRIMONIDINE 0.2 % OPHT DROP,,13627,LOCAL,Facility,Outpatient,5 mL,mL,,147,124.95,42.1302,147,PrimeWest Health,MinnesotaCare,75.4992,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
BRIMONIDINE 0.2 % OPHT DROP,,13627,LOCAL,Facility,Inpatient,5 mL,mL,,147,124.95,42.1302,147,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
BRIMONIDINE 0.2 % OPHT DROP,,13627,LOCAL,Facility,Both,5 mL,mL,,147,124.95,42.1302,147,Sanford Health Plan,Sanford Health Plan,135.24,92,,percent of total billed charges,,
BRIMONIDINE 0.2 % OPHT DROP,,13627,LOCAL,Facility,Outpatient,5 mL,mL,,147,124.95,42.1302,147,"UCare Health, Inc.",Individual & Family Plan,82.8345,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
BRIMONIDINE 0.2 % OPHT DROP,,13627,LOCAL,Facility,Inpatient,5 mL,mL,,147,124.95,42.1302,147,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
BRIMONIDINE 0.2 % OPHT DROP,,13627,LOCAL,Facility,Outpatient,5 mL,mL,,147,124.95,42.1302,147,"UCare Health, Inc.",Medical Assistance,74.1909,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BRIMONIDINE 0.2 % OPHT DROP,,13627,LOCAL,Facility,Inpatient,5 mL,mL,,147,124.95,42.1302,147,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
BRIMONIDINE 0.2 % OPHT DROP,,13627,LOCAL,Facility,Outpatient,5 mL,mL,,147,124.95,42.1302,147,"UCare Health, Inc.",Medicare Advantage,74.1909,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BRIMONIDINE 0.2 % OPHT DROP,,13627,LOCAL,Facility,Inpatient,5 mL,mL,,147,124.95,42.1302,147,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
BRIMONIDINE 0.2 % OPHT DROP,,13627,LOCAL,Facility,Outpatient,5 mL,mL,,147,124.95,42.1302,147,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),74.1909,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BRIMONIDINE 0.2 % OPHT DROP,,13627,LOCAL,Facility,Inpatient,5 mL,mL,,147,124.95,42.1302,147,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
BRIMONIDINE 0.2 % OPHT DROP,,13627,LOCAL,Facility,Both,5 mL,mL,,147,124.95,42.1302,147,UnitedHealthcare,Individual & Family,138.18,94,,percent of total billed charges,,
BRIMONIDINE 0.2 % OPHT DROP,,13627,LOCAL,Facility,Outpatient,5 mL,mL,,147,124.95,42.1302,147,UnitedHealthcare,Medicare Advantage,72.03,49,,percent of total billed charges,,
BRIMONIDINE 0.2 % OPHT DROP,,13627,LOCAL,Facility,Inpatient,5 mL,mL,,147,124.95,42.1302,147,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
BRIMONIDINE 0.2 % OPHT DROP,,13627,LOCAL,Facility,Outpatient,5 mL,mL,,147,124.95,42.1302,147,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,70.56,48,,percent of total billed charges,,100% of DHS outpatient percentage
BRIMONIDINE 0.2 % OPHT DROP,,13627,LOCAL,Facility,Inpatient,5 mL,mL,,147,124.95,42.1302,147,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) IV SOLN,,13725,LOCAL,Facility,Both,5 mL,mL,,15,12.75,4.299,15,Aetna,Commercial,13.8,92,,percent of total billed charges,,
VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) IV SOLN,,13725,LOCAL,Facility,Both,5 mL,mL,,15,12.75,4.299,15,Aetna,Commercial,13.8,92,,percent of total billed charges,,
VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) IV SOLN,,13725,LOCAL,Facility,Outpatient,5 mL,mL,,15,12.75,4.299,15,Aetna,Medicare Advantage,7.35,49,,percent of total billed charges,,
VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) IV SOLN,,13725,LOCAL,Facility,Outpatient,5 mL,mL,,15,12.75,4.299,15,Aetna,Medicare Advantage,7.35,49,,percent of total billed charges,,
VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) IV SOLN,,13725,LOCAL,Facility,Inpatient,5 mL,mL,,15,12.75,4.299,15,Aetna,Medicare Advantage,,,,,Included in per diem rate,
VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) IV SOLN,,13725,LOCAL,Facility,Inpatient,5 mL,mL,,15,12.75,4.299,15,Aetna,Medicare Advantage,,,,,Included in per diem rate,
VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) IV SOLN,,13725,LOCAL,Facility,Both,5 mL,mL,,15,12.75,4.299,15,Aetna,PPO,13.95,93,,percent of total billed charges,,
VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) IV SOLN,,13725,LOCAL,Facility,Both,5 mL,mL,,15,12.75,4.299,15,Aetna,PPO,13.95,93,,percent of total billed charges,,
VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) IV SOLN,,13725,LOCAL,Facility,Both,5 mL,mL,,15,12.75,4.299,15,America's PPO,America's PPO,14.4045,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) IV SOLN,,13725,LOCAL,Facility,Both,5 mL,mL,,15,12.75,4.299,15,America's PPO,America's PPO,14.4045,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) IV SOLN,,13725,LOCAL,Facility,Both,5 mL,mL,,15,12.75,4.299,15,BlueCross BlueShield Minnesota, Federal Employee Program,14.76,98.4,,percent of total billed charges,,
VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) IV SOLN,,13725,LOCAL,Facility,Both,5 mL,mL,,15,12.75,4.299,15,BlueCross BlueShield Minnesota, Federal Employee Program,14.76,98.4,,percent of total billed charges,,
VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) IV SOLN,,13725,LOCAL,Facility,Both,5 mL,mL,,15,12.75,4.299,15,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,15,100,,percent of total billed charges,,
VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) IV SOLN,,13725,LOCAL,Facility,Both,5 mL,mL,,15,12.75,4.299,15,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,15,100,,percent of total billed charges,,
VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) IV SOLN,,13725,LOCAL,Facility,Both,5 mL,mL,,15,12.75,4.299,15,BlueCross BlueShield Minnesota,High Value Network Plan,13.5,90,,percent of total billed charges,,
VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) IV SOLN,,13725,LOCAL,Facility,Both,5 mL,mL,,15,12.75,4.299,15,BlueCross BlueShield Minnesota,High Value Network Plan,13.5,90,,percent of total billed charges,,
VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) IV SOLN,,13725,LOCAL,Facility,Outpatient,5 mL,mL,,15,12.75,4.299,15,BlueCross BlueShield Minnesota,Medicare Advantage,7.35,49,,percent of total billed charges,,
VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) IV SOLN,,13725,LOCAL,Facility,Outpatient,5 mL,mL,,15,12.75,4.299,15,BlueCross BlueShield Minnesota,Medicare Advantage,7.35,49,,percent of total billed charges,,
VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) IV SOLN,,13725,LOCAL,Facility,Inpatient,5 mL,mL,,15,12.75,4.299,15,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) IV SOLN,,13725,LOCAL,Facility,Inpatient,5 mL,mL,,15,12.75,4.299,15,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) IV SOLN,,13725,LOCAL,Facility,Both,5 mL,mL,,15,12.75,4.299,15,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,13.2855,88.57,,percent of total billed charges,,
VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) IV SOLN,,13725,LOCAL,Facility,Both,5 mL,mL,,15,12.75,4.299,15,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,13.2855,88.57,,percent of total billed charges,,
VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) IV SOLN,,13725,LOCAL,Facility,Both,5 mL,mL,,15,12.75,4.299,15,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,4.299,28.66,,percent of total billed charges,,
VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) IV SOLN,,13725,LOCAL,Facility,Both,5 mL,mL,,15,12.75,4.299,15,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,4.299,28.66,,percent of total billed charges,,
VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) IV SOLN,,13725,LOCAL,Facility,Outpatient,5 mL,mL,,15,12.75,4.299,15,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),7.35,49,,percent of total billed charges,,
VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) IV SOLN,,13725,LOCAL,Facility,Outpatient,5 mL,mL,,15,12.75,4.299,15,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),7.35,49,,percent of total billed charges,,
VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) IV SOLN,,13725,LOCAL,Facility,Inpatient,5 mL,mL,,15,12.75,4.299,15,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) IV SOLN,,13725,LOCAL,Facility,Inpatient,5 mL,mL,,15,12.75,4.299,15,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) IV SOLN,,13725,LOCAL,Facility,Both,5 mL,mL,,15,12.75,4.299,15,CorVel,Worker's Compensation,15,100,,percent of total billed charges,,
VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) IV SOLN,,13725,LOCAL,Facility,Both,5 mL,mL,,15,12.75,4.299,15,CorVel,Worker's Compensation,15,100,,percent of total billed charges,,
VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) IV SOLN,,13725,LOCAL,Facility,Both,5 mL,mL,,15,12.75,4.299,15,First Health Group Corporation,First Health Network,14.55,97,,percent of total billed charges,,
VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) IV SOLN,,13725,LOCAL,Facility,Both,5 mL,mL,,15,12.75,4.299,15,First Health Group Corporation,First Health Network,14.55,97,,percent of total billed charges,,
VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) IV SOLN,,13725,LOCAL,Facility,Both,5 mL,mL,,15,12.75,4.299,15,"Health Partners, Inc.",Commercial,14.19,94.6,,percent of total billed charges,,
VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) IV SOLN,,13725,LOCAL,Facility,Both,5 mL,mL,,15,12.75,4.299,15,"Health Partners, Inc.",Commercial,14.19,94.6,,percent of total billed charges,,
VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) IV SOLN,,13725,LOCAL,Facility,Outpatient,5 mL,mL,,15,12.75,4.299,15,"Health Partners, Inc.",Medicare Advantage,7.35,49,,percent of total billed charges,,
VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) IV SOLN,,13725,LOCAL,Facility,Outpatient,5 mL,mL,,15,12.75,4.299,15,"Health Partners, Inc.",Medicare Advantage,7.35,49,,percent of total billed charges,,
VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) IV SOLN,,13725,LOCAL,Facility,Inpatient,5 mL,mL,,15,12.75,4.299,15,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) IV SOLN,,13725,LOCAL,Facility,Inpatient,5 mL,mL,,15,12.75,4.299,15,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) IV SOLN,,13725,LOCAL,Facility,Both,5 mL,mL,,15,12.75,4.299,15,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),9,60,,percent of total billed charges,,
VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) IV SOLN,,13725,LOCAL,Facility,Both,5 mL,mL,,15,12.75,4.299,15,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),9,60,,percent of total billed charges,,
VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) IV SOLN,,13725,LOCAL,Facility,Both,5 mL,mL,,15,12.75,4.299,15,"Health Partners, Inc.",State of Minnesota Advantage Program,12.225,81.5,,percent of total billed charges,,
VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) IV SOLN,,13725,LOCAL,Facility,Both,5 mL,mL,,15,12.75,4.299,15,"Health Partners, Inc.",State of Minnesota Advantage Program,12.225,81.5,,percent of total billed charges,,
VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) IV SOLN,,13725,LOCAL,Facility,Both,5 mL,mL,,15,12.75,4.299,15,"Health Partners, Inc.",State Public Programs,7.5,50,,percent of total billed charges,,
VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) IV SOLN,,13725,LOCAL,Facility,Both,5 mL,mL,,15,12.75,4.299,15,"Health Partners, Inc.",State Public Programs,7.5,50,,percent of total billed charges,,
VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) IV SOLN,,13725,LOCAL,Facility,Both,5 mL,mL,,15,12.75,4.299,15,Humana Insurance Company,Commercial PPO,14.25,95,,percent of total billed charges,,
VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) IV SOLN,,13725,LOCAL,Facility,Both,5 mL,mL,,15,12.75,4.299,15,Humana Insurance Company,Commercial PPO,14.25,95,,percent of total billed charges,,
VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) IV SOLN,,13725,LOCAL,Facility,Outpatient,5 mL,mL,,15,12.75,4.299,15,Humana Insurance Company,Medicare PPO,7.35,49,,percent of total billed charges,,
VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) IV SOLN,,13725,LOCAL,Facility,Outpatient,5 mL,mL,,15,12.75,4.299,15,Humana Insurance Company,Medicare PPO,7.35,49,,percent of total billed charges,,
VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) IV SOLN,,13725,LOCAL,Facility,Inpatient,5 mL,mL,,15,12.75,4.299,15,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) IV SOLN,,13725,LOCAL,Facility,Inpatient,5 mL,mL,,15,12.75,4.299,15,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) IV SOLN,,13725,LOCAL,Facility,Both,5 mL,mL,,15,12.75,4.299,15,Medica,Individual & Family,14.865,99.1,,percent of total billed charges,,
VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) IV SOLN,,13725,LOCAL,Facility,Both,5 mL,mL,,15,12.75,4.299,15,Medica,Individual & Family,14.865,99.1,,percent of total billed charges,,
VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) IV SOLN,,13725,LOCAL,Facility,Outpatient,5 mL,mL,,15,12.75,4.299,15,Medica,Medica Advantage Solution,7.47,49.8,,percent of total billed charges,,
VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) IV SOLN,,13725,LOCAL,Facility,Outpatient,5 mL,mL,,15,12.75,4.299,15,Medica,Medica Advantage Solution,7.47,49.8,,percent of total billed charges,,
VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) IV SOLN,,13725,LOCAL,Facility,Inpatient,5 mL,mL,,15,12.75,4.299,15,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) IV SOLN,,13725,LOCAL,Facility,Inpatient,5 mL,mL,,15,12.75,4.299,15,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) IV SOLN,,13725,LOCAL,Facility,Outpatient,5 mL,mL,,15,12.75,4.299,15,Medica,Medical Assistance,6.69,44.6,,percent of total billed charges,,
VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) IV SOLN,,13725,LOCAL,Facility,Outpatient,5 mL,mL,,15,12.75,4.299,15,Medica,Medical Assistance,6.69,44.6,,percent of total billed charges,,
VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) IV SOLN,,13725,LOCAL,Facility,Inpatient,5 mL,mL,,15,12.75,4.299,15,Medica,Medical Assistance,,,,,Included in per diem rate,
VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) IV SOLN,,13725,LOCAL,Facility,Inpatient,5 mL,mL,,15,12.75,4.299,15,Medica,Medical Assistance,,,,,Included in per diem rate,
VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) IV SOLN,,13725,LOCAL,Facility,Outpatient,5 mL,mL,,15,12.75,4.299,15,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,7.47,49.8,,percent of total billed charges,,
VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) IV SOLN,,13725,LOCAL,Facility,Outpatient,5 mL,mL,,15,12.75,4.299,15,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,7.47,49.8,,percent of total billed charges,,
VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) IV SOLN,,13725,LOCAL,Facility,Inpatient,5 mL,mL,,15,12.75,4.299,15,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) IV SOLN,,13725,LOCAL,Facility,Inpatient,5 mL,mL,,15,12.75,4.299,15,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) IV SOLN,,13725,LOCAL,Facility,Both,5 mL,mL,,15,12.75,4.299,15,"Multiplan, Inc.","Multiplan, Inc.",14.1,94,,percent of total billed charges,,
VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) IV SOLN,,13725,LOCAL,Facility,Both,5 mL,mL,,15,12.75,4.299,15,"Multiplan, Inc.","Multiplan, Inc.",14.1,94,,percent of total billed charges,,
VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) IV SOLN,,13725,LOCAL,Facility,Outpatient,5 mL,mL,,15,12.75,4.299,15,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,13.515,90.1,,percent of total billed charges,,
VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) IV SOLN,,13725,LOCAL,Facility,Outpatient,5 mL,mL,,15,12.75,4.299,15,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,13.515,90.1,,percent of total billed charges,,
VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) IV SOLN,,13725,LOCAL,Facility,Inpatient,5 mL,mL,,15,12.75,4.299,15,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) IV SOLN,,13725,LOCAL,Facility,Inpatient,5 mL,mL,,15,12.75,4.299,15,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) IV SOLN,,13725,LOCAL,Facility,Both,5 mL,mL,,15,12.75,4.299,15,"Preferred One Administrative Services, INC.",PPO,14.79,98.6,,percent of total billed charges,,
VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) IV SOLN,,13725,LOCAL,Facility,Both,5 mL,mL,,15,12.75,4.299,15,"Preferred One Administrative Services, INC.",PPO,14.79,98.6,,percent of total billed charges,,
VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) IV SOLN,,13725,LOCAL,Facility,Outpatient,5 mL,mL,,15,12.75,4.299,15,PrimeWest Health,Minnesota Senior Health Options (MSHO),7.7175,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) IV SOLN,,13725,LOCAL,Facility,Outpatient,5 mL,mL,,15,12.75,4.299,15,PrimeWest Health,Minnesota Senior Health Options (MSHO),7.7175,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) IV SOLN,,13725,LOCAL,Facility,Inpatient,5 mL,mL,,15,12.75,4.299,15,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) IV SOLN,,13725,LOCAL,Facility,Inpatient,5 mL,mL,,15,12.75,4.299,15,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) IV SOLN,,13725,LOCAL,Facility,Outpatient,5 mL,mL,,15,12.75,4.299,15,PrimeWest Health,MinnesotaCare,7.704,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) IV SOLN,,13725,LOCAL,Facility,Outpatient,5 mL,mL,,15,12.75,4.299,15,PrimeWest Health,MinnesotaCare,7.704,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) IV SOLN,,13725,LOCAL,Facility,Inpatient,5 mL,mL,,15,12.75,4.299,15,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) IV SOLN,,13725,LOCAL,Facility,Inpatient,5 mL,mL,,15,12.75,4.299,15,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) IV SOLN,,13725,LOCAL,Facility,Both,5 mL,mL,,15,12.75,4.299,15,Sanford Health Plan,Sanford Health Plan,13.8,92,,percent of total billed charges,,
VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) IV SOLN,,13725,LOCAL,Facility,Both,5 mL,mL,,15,12.75,4.299,15,Sanford Health Plan,Sanford Health Plan,13.8,92,,percent of total billed charges,,
VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) IV SOLN,,13725,LOCAL,Facility,Outpatient,5 mL,mL,,15,12.75,4.299,15,"UCare Health, Inc.",Individual & Family Plan,8.4525,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) IV SOLN,,13725,LOCAL,Facility,Outpatient,5 mL,mL,,15,12.75,4.299,15,"UCare Health, Inc.",Individual & Family Plan,8.4525,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) IV SOLN,,13725,LOCAL,Facility,Inpatient,5 mL,mL,,15,12.75,4.299,15,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) IV SOLN,,13725,LOCAL,Facility,Inpatient,5 mL,mL,,15,12.75,4.299,15,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) IV SOLN,,13725,LOCAL,Facility,Outpatient,5 mL,mL,,15,12.75,4.299,15,"UCare Health, Inc.",Medical Assistance,7.5705,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) IV SOLN,,13725,LOCAL,Facility,Outpatient,5 mL,mL,,15,12.75,4.299,15,"UCare Health, Inc.",Medical Assistance,7.5705,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) IV SOLN,,13725,LOCAL,Facility,Inpatient,5 mL,mL,,15,12.75,4.299,15,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) IV SOLN,,13725,LOCAL,Facility,Inpatient,5 mL,mL,,15,12.75,4.299,15,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) IV SOLN,,13725,LOCAL,Facility,Outpatient,5 mL,mL,,15,12.75,4.299,15,"UCare Health, Inc.",Medicare Advantage,7.5705,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) IV SOLN,,13725,LOCAL,Facility,Outpatient,5 mL,mL,,15,12.75,4.299,15,"UCare Health, Inc.",Medicare Advantage,7.5705,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) IV SOLN,,13725,LOCAL,Facility,Inpatient,5 mL,mL,,15,12.75,4.299,15,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) IV SOLN,,13725,LOCAL,Facility,Inpatient,5 mL,mL,,15,12.75,4.299,15,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) IV SOLN,,13725,LOCAL,Facility,Outpatient,5 mL,mL,,15,12.75,4.299,15,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),7.5705,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) IV SOLN,,13725,LOCAL,Facility,Outpatient,5 mL,mL,,15,12.75,4.299,15,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),7.5705,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) IV SOLN,,13725,LOCAL,Facility,Inpatient,5 mL,mL,,15,12.75,4.299,15,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) IV SOLN,,13725,LOCAL,Facility,Inpatient,5 mL,mL,,15,12.75,4.299,15,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) IV SOLN,,13725,LOCAL,Facility,Both,5 mL,mL,,15,12.75,4.299,15,UnitedHealthcare,Individual & Family,14.1,94,,percent of total billed charges,,
VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) IV SOLN,,13725,LOCAL,Facility,Both,5 mL,mL,,15,12.75,4.299,15,UnitedHealthcare,Individual & Family,14.1,94,,percent of total billed charges,,
VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) IV SOLN,,13725,LOCAL,Facility,Outpatient,5 mL,mL,,15,12.75,4.299,15,UnitedHealthcare,Medicare Advantage,7.35,49,,percent of total billed charges,,
VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) IV SOLN,,13725,LOCAL,Facility,Outpatient,5 mL,mL,,15,12.75,4.299,15,UnitedHealthcare,Medicare Advantage,7.35,49,,percent of total billed charges,,
VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) IV SOLN,,13725,LOCAL,Facility,Inpatient,5 mL,mL,,15,12.75,4.299,15,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) IV SOLN,,13725,LOCAL,Facility,Inpatient,5 mL,mL,,15,12.75,4.299,15,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) IV SOLN,,13725,LOCAL,Facility,Outpatient,5 mL,mL,,15,12.75,4.299,15,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,7.2,48,,percent of total billed charges,,100% of DHS outpatient percentage
VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) IV SOLN,,13725,LOCAL,Facility,Outpatient,5 mL,mL,,15,12.75,4.299,15,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,7.2,48,,percent of total billed charges,,100% of DHS outpatient percentage
VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) IV SOLN,,13725,LOCAL,Facility,Inpatient,5 mL,mL,,15,12.75,4.299,15,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) IV SOLN,,13725,LOCAL,Facility,Inpatient,5 mL,mL,,15,12.75,4.299,15,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
FLUORESCEIN-BENOXINATE 0.25-0.4 % OPHT DROP,,13879,LOCAL,Facility,Both,5 mL,mL,,203,172.55,58.1798,203,Aetna,Commercial,186.76,92,,percent of total billed charges,,
FLUORESCEIN-BENOXINATE 0.25-0.4 % OPHT DROP,,13879,LOCAL,Facility,Outpatient,5 mL,mL,,203,172.55,58.1798,203,Aetna,Medicare Advantage,99.47,49,,percent of total billed charges,,
FLUORESCEIN-BENOXINATE 0.25-0.4 % OPHT DROP,,13879,LOCAL,Facility,Inpatient,5 mL,mL,,203,172.55,58.1798,203,Aetna,Medicare Advantage,,,,,Included in per diem rate,
FLUORESCEIN-BENOXINATE 0.25-0.4 % OPHT DROP,,13879,LOCAL,Facility,Both,5 mL,mL,,203,172.55,58.1798,203,Aetna,PPO,188.79,93,,percent of total billed charges,,
FLUORESCEIN-BENOXINATE 0.25-0.4 % OPHT DROP,,13879,LOCAL,Facility,Both,5 mL,mL,,203,172.55,58.1798,203,America's PPO,America's PPO,194.9409,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
FLUORESCEIN-BENOXINATE 0.25-0.4 % OPHT DROP,,13879,LOCAL,Facility,Both,5 mL,mL,,203,172.55,58.1798,203,BlueCross BlueShield Minnesota, Federal Employee Program,199.752,98.4,,percent of total billed charges,,
FLUORESCEIN-BENOXINATE 0.25-0.4 % OPHT DROP,,13879,LOCAL,Facility,Both,5 mL,mL,,203,172.55,58.1798,203,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,203,100,,percent of total billed charges,,
FLUORESCEIN-BENOXINATE 0.25-0.4 % OPHT DROP,,13879,LOCAL,Facility,Both,5 mL,mL,,203,172.55,58.1798,203,BlueCross BlueShield Minnesota,High Value Network Plan,182.7,90,,percent of total billed charges,,
FLUORESCEIN-BENOXINATE 0.25-0.4 % OPHT DROP,,13879,LOCAL,Facility,Outpatient,5 mL,mL,,203,172.55,58.1798,203,BlueCross BlueShield Minnesota,Medicare Advantage,99.47,49,,percent of total billed charges,,
FLUORESCEIN-BENOXINATE 0.25-0.4 % OPHT DROP,,13879,LOCAL,Facility,Inpatient,5 mL,mL,,203,172.55,58.1798,203,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
FLUORESCEIN-BENOXINATE 0.25-0.4 % OPHT DROP,,13879,LOCAL,Facility,Both,5 mL,mL,,203,172.55,58.1798,203,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,179.7971,88.57,,percent of total billed charges,,
FLUORESCEIN-BENOXINATE 0.25-0.4 % OPHT DROP,,13879,LOCAL,Facility,Both,5 mL,mL,,203,172.55,58.1798,203,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,58.1798,28.66,,percent of total billed charges,,
FLUORESCEIN-BENOXINATE 0.25-0.4 % OPHT DROP,,13879,LOCAL,Facility,Outpatient,5 mL,mL,,203,172.55,58.1798,203,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),99.47,49,,percent of total billed charges,,
FLUORESCEIN-BENOXINATE 0.25-0.4 % OPHT DROP,,13879,LOCAL,Facility,Inpatient,5 mL,mL,,203,172.55,58.1798,203,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
FLUORESCEIN-BENOXINATE 0.25-0.4 % OPHT DROP,,13879,LOCAL,Facility,Both,5 mL,mL,,203,172.55,58.1798,203,CorVel,Worker's Compensation,203,100,,percent of total billed charges,,
FLUORESCEIN-BENOXINATE 0.25-0.4 % OPHT DROP,,13879,LOCAL,Facility,Both,5 mL,mL,,203,172.55,58.1798,203,First Health Group Corporation,First Health Network,196.91,97,,percent of total billed charges,,
FLUORESCEIN-BENOXINATE 0.25-0.4 % OPHT DROP,,13879,LOCAL,Facility,Both,5 mL,mL,,203,172.55,58.1798,203,"Health Partners, Inc.",Commercial,192.038,94.6,,percent of total billed charges,,
FLUORESCEIN-BENOXINATE 0.25-0.4 % OPHT DROP,,13879,LOCAL,Facility,Outpatient,5 mL,mL,,203,172.55,58.1798,203,"Health Partners, Inc.",Medicare Advantage,99.47,49,,percent of total billed charges,,
FLUORESCEIN-BENOXINATE 0.25-0.4 % OPHT DROP,,13879,LOCAL,Facility,Inpatient,5 mL,mL,,203,172.55,58.1798,203,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
FLUORESCEIN-BENOXINATE 0.25-0.4 % OPHT DROP,,13879,LOCAL,Facility,Both,5 mL,mL,,203,172.55,58.1798,203,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),121.8,60,,percent of total billed charges,,
FLUORESCEIN-BENOXINATE 0.25-0.4 % OPHT DROP,,13879,LOCAL,Facility,Both,5 mL,mL,,203,172.55,58.1798,203,"Health Partners, Inc.",State of Minnesota Advantage Program,165.445,81.5,,percent of total billed charges,,
FLUORESCEIN-BENOXINATE 0.25-0.4 % OPHT DROP,,13879,LOCAL,Facility,Both,5 mL,mL,,203,172.55,58.1798,203,"Health Partners, Inc.",State Public Programs,101.5,50,,percent of total billed charges,,
FLUORESCEIN-BENOXINATE 0.25-0.4 % OPHT DROP,,13879,LOCAL,Facility,Both,5 mL,mL,,203,172.55,58.1798,203,Humana Insurance Company,Commercial PPO,192.85,95,,percent of total billed charges,,
FLUORESCEIN-BENOXINATE 0.25-0.4 % OPHT DROP,,13879,LOCAL,Facility,Outpatient,5 mL,mL,,203,172.55,58.1798,203,Humana Insurance Company,Medicare PPO,99.47,49,,percent of total billed charges,,
FLUORESCEIN-BENOXINATE 0.25-0.4 % OPHT DROP,,13879,LOCAL,Facility,Inpatient,5 mL,mL,,203,172.55,58.1798,203,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
FLUORESCEIN-BENOXINATE 0.25-0.4 % OPHT DROP,,13879,LOCAL,Facility,Both,5 mL,mL,,203,172.55,58.1798,203,Medica,Individual & Family,201.173,99.1,,percent of total billed charges,,
FLUORESCEIN-BENOXINATE 0.25-0.4 % OPHT DROP,,13879,LOCAL,Facility,Outpatient,5 mL,mL,,203,172.55,58.1798,203,Medica,Medica Advantage Solution,101.094,49.8,,percent of total billed charges,,
FLUORESCEIN-BENOXINATE 0.25-0.4 % OPHT DROP,,13879,LOCAL,Facility,Inpatient,5 mL,mL,,203,172.55,58.1798,203,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
FLUORESCEIN-BENOXINATE 0.25-0.4 % OPHT DROP,,13879,LOCAL,Facility,Outpatient,5 mL,mL,,203,172.55,58.1798,203,Medica,Medical Assistance,90.538,44.6,,percent of total billed charges,,
FLUORESCEIN-BENOXINATE 0.25-0.4 % OPHT DROP,,13879,LOCAL,Facility,Inpatient,5 mL,mL,,203,172.55,58.1798,203,Medica,Medical Assistance,,,,,Included in per diem rate,
FLUORESCEIN-BENOXINATE 0.25-0.4 % OPHT DROP,,13879,LOCAL,Facility,Outpatient,5 mL,mL,,203,172.55,58.1798,203,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,101.094,49.8,,percent of total billed charges,,
FLUORESCEIN-BENOXINATE 0.25-0.4 % OPHT DROP,,13879,LOCAL,Facility,Inpatient,5 mL,mL,,203,172.55,58.1798,203,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
FLUORESCEIN-BENOXINATE 0.25-0.4 % OPHT DROP,,13879,LOCAL,Facility,Both,5 mL,mL,,203,172.55,58.1798,203,"Multiplan, Inc.","Multiplan, Inc.",190.82,94,,percent of total billed charges,,
FLUORESCEIN-BENOXINATE 0.25-0.4 % OPHT DROP,,13879,LOCAL,Facility,Outpatient,5 mL,mL,,203,172.55,58.1798,203,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,182.903,90.1,,percent of total billed charges,,
FLUORESCEIN-BENOXINATE 0.25-0.4 % OPHT DROP,,13879,LOCAL,Facility,Inpatient,5 mL,mL,,203,172.55,58.1798,203,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
FLUORESCEIN-BENOXINATE 0.25-0.4 % OPHT DROP,,13879,LOCAL,Facility,Both,5 mL,mL,,203,172.55,58.1798,203,"Preferred One Administrative Services, INC.",PPO,200.158,98.6,,percent of total billed charges,,
FLUORESCEIN-BENOXINATE 0.25-0.4 % OPHT DROP,,13879,LOCAL,Facility,Outpatient,5 mL,mL,,203,172.55,58.1798,203,PrimeWest Health,Minnesota Senior Health Options (MSHO),104.4435,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
FLUORESCEIN-BENOXINATE 0.25-0.4 % OPHT DROP,,13879,LOCAL,Facility,Inpatient,5 mL,mL,,203,172.55,58.1798,203,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
FLUORESCEIN-BENOXINATE 0.25-0.4 % OPHT DROP,,13879,LOCAL,Facility,Outpatient,5 mL,mL,,203,172.55,58.1798,203,PrimeWest Health,MinnesotaCare,104.2608,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
FLUORESCEIN-BENOXINATE 0.25-0.4 % OPHT DROP,,13879,LOCAL,Facility,Inpatient,5 mL,mL,,203,172.55,58.1798,203,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
FLUORESCEIN-BENOXINATE 0.25-0.4 % OPHT DROP,,13879,LOCAL,Facility,Both,5 mL,mL,,203,172.55,58.1798,203,Sanford Health Plan,Sanford Health Plan,186.76,92,,percent of total billed charges,,
FLUORESCEIN-BENOXINATE 0.25-0.4 % OPHT DROP,,13879,LOCAL,Facility,Outpatient,5 mL,mL,,203,172.55,58.1798,203,"UCare Health, Inc.",Individual & Family Plan,114.3905,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
FLUORESCEIN-BENOXINATE 0.25-0.4 % OPHT DROP,,13879,LOCAL,Facility,Inpatient,5 mL,mL,,203,172.55,58.1798,203,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
FLUORESCEIN-BENOXINATE 0.25-0.4 % OPHT DROP,,13879,LOCAL,Facility,Outpatient,5 mL,mL,,203,172.55,58.1798,203,"UCare Health, Inc.",Medical Assistance,102.4541,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FLUORESCEIN-BENOXINATE 0.25-0.4 % OPHT DROP,,13879,LOCAL,Facility,Inpatient,5 mL,mL,,203,172.55,58.1798,203,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
FLUORESCEIN-BENOXINATE 0.25-0.4 % OPHT DROP,,13879,LOCAL,Facility,Outpatient,5 mL,mL,,203,172.55,58.1798,203,"UCare Health, Inc.",Medicare Advantage,102.4541,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FLUORESCEIN-BENOXINATE 0.25-0.4 % OPHT DROP,,13879,LOCAL,Facility,Inpatient,5 mL,mL,,203,172.55,58.1798,203,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
FLUORESCEIN-BENOXINATE 0.25-0.4 % OPHT DROP,,13879,LOCAL,Facility,Outpatient,5 mL,mL,,203,172.55,58.1798,203,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),102.4541,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FLUORESCEIN-BENOXINATE 0.25-0.4 % OPHT DROP,,13879,LOCAL,Facility,Inpatient,5 mL,mL,,203,172.55,58.1798,203,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
FLUORESCEIN-BENOXINATE 0.25-0.4 % OPHT DROP,,13879,LOCAL,Facility,Both,5 mL,mL,,203,172.55,58.1798,203,UnitedHealthcare,Individual & Family,190.82,94,,percent of total billed charges,,
FLUORESCEIN-BENOXINATE 0.25-0.4 % OPHT DROP,,13879,LOCAL,Facility,Outpatient,5 mL,mL,,203,172.55,58.1798,203,UnitedHealthcare,Medicare Advantage,99.47,49,,percent of total billed charges,,
FLUORESCEIN-BENOXINATE 0.25-0.4 % OPHT DROP,,13879,LOCAL,Facility,Inpatient,5 mL,mL,,203,172.55,58.1798,203,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
FLUORESCEIN-BENOXINATE 0.25-0.4 % OPHT DROP,,13879,LOCAL,Facility,Outpatient,5 mL,mL,,203,172.55,58.1798,203,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,97.44,48,,percent of total billed charges,,100% of DHS outpatient percentage
FLUORESCEIN-BENOXINATE 0.25-0.4 % OPHT DROP,,13879,LOCAL,Facility,Inpatient,5 mL,mL,,203,172.55,58.1798,203,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
ATROPINE 1 % OPHT DROP,,18497,LOCAL,Facility,Both,5 mL,mL,,274,232.9,78.5284,274,Aetna,Commercial,252.08,92,,percent of total billed charges,,
ATROPINE 1 % OPHT DROP,,18497,LOCAL,Facility,Outpatient,5 mL,mL,,274,232.9,78.5284,274,Aetna,Medicare Advantage,134.26,49,,percent of total billed charges,,
ATROPINE 1 % OPHT DROP,,18497,LOCAL,Facility,Inpatient,5 mL,mL,,274,232.9,78.5284,274,Aetna,Medicare Advantage,,,,,Included in per diem rate,
ATROPINE 1 % OPHT DROP,,18497,LOCAL,Facility,Both,5 mL,mL,,274,232.9,78.5284,274,Aetna,PPO,254.82,93,,percent of total billed charges,,
ATROPINE 1 % OPHT DROP,,18497,LOCAL,Facility,Both,5 mL,mL,,274,232.9,78.5284,274,America's PPO,America's PPO,263.1222,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
ATROPINE 1 % OPHT DROP,,18497,LOCAL,Facility,Both,5 mL,mL,,274,232.9,78.5284,274,BlueCross BlueShield Minnesota, Federal Employee Program,269.616,98.4,,percent of total billed charges,,
ATROPINE 1 % OPHT DROP,,18497,LOCAL,Facility,Both,5 mL,mL,,274,232.9,78.5284,274,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,274,100,,percent of total billed charges,,
ATROPINE 1 % OPHT DROP,,18497,LOCAL,Facility,Both,5 mL,mL,,274,232.9,78.5284,274,BlueCross BlueShield Minnesota,High Value Network Plan,246.6,90,,percent of total billed charges,,
ATROPINE 1 % OPHT DROP,,18497,LOCAL,Facility,Outpatient,5 mL,mL,,274,232.9,78.5284,274,BlueCross BlueShield Minnesota,Medicare Advantage,134.26,49,,percent of total billed charges,,
ATROPINE 1 % OPHT DROP,,18497,LOCAL,Facility,Inpatient,5 mL,mL,,274,232.9,78.5284,274,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
ATROPINE 1 % OPHT DROP,,18497,LOCAL,Facility,Both,5 mL,mL,,274,232.9,78.5284,274,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,242.6818,88.57,,percent of total billed charges,,
ATROPINE 1 % OPHT DROP,,18497,LOCAL,Facility,Both,5 mL,mL,,274,232.9,78.5284,274,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,78.5284,28.66,,percent of total billed charges,,
ATROPINE 1 % OPHT DROP,,18497,LOCAL,Facility,Outpatient,5 mL,mL,,274,232.9,78.5284,274,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),134.26,49,,percent of total billed charges,,
ATROPINE 1 % OPHT DROP,,18497,LOCAL,Facility,Inpatient,5 mL,mL,,274,232.9,78.5284,274,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
ATROPINE 1 % OPHT DROP,,18497,LOCAL,Facility,Both,5 mL,mL,,274,232.9,78.5284,274,CorVel,Worker's Compensation,274,100,,percent of total billed charges,,
ATROPINE 1 % OPHT DROP,,18497,LOCAL,Facility,Both,5 mL,mL,,274,232.9,78.5284,274,First Health Group Corporation,First Health Network,265.78,97,,percent of total billed charges,,
ATROPINE 1 % OPHT DROP,,18497,LOCAL,Facility,Both,5 mL,mL,,274,232.9,78.5284,274,"Health Partners, Inc.",Commercial,259.204,94.6,,percent of total billed charges,,
ATROPINE 1 % OPHT DROP,,18497,LOCAL,Facility,Outpatient,5 mL,mL,,274,232.9,78.5284,274,"Health Partners, Inc.",Medicare Advantage,134.26,49,,percent of total billed charges,,
ATROPINE 1 % OPHT DROP,,18497,LOCAL,Facility,Inpatient,5 mL,mL,,274,232.9,78.5284,274,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ATROPINE 1 % OPHT DROP,,18497,LOCAL,Facility,Both,5 mL,mL,,274,232.9,78.5284,274,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),164.4,60,,percent of total billed charges,,
ATROPINE 1 % OPHT DROP,,18497,LOCAL,Facility,Both,5 mL,mL,,274,232.9,78.5284,274,"Health Partners, Inc.",State of Minnesota Advantage Program,223.31,81.5,,percent of total billed charges,,
ATROPINE 1 % OPHT DROP,,18497,LOCAL,Facility,Both,5 mL,mL,,274,232.9,78.5284,274,"Health Partners, Inc.",State Public Programs,137,50,,percent of total billed charges,,
ATROPINE 1 % OPHT DROP,,18497,LOCAL,Facility,Both,5 mL,mL,,274,232.9,78.5284,274,Humana Insurance Company,Commercial PPO,260.3,95,,percent of total billed charges,,
ATROPINE 1 % OPHT DROP,,18497,LOCAL,Facility,Outpatient,5 mL,mL,,274,232.9,78.5284,274,Humana Insurance Company,Medicare PPO,134.26,49,,percent of total billed charges,,
ATROPINE 1 % OPHT DROP,,18497,LOCAL,Facility,Inpatient,5 mL,mL,,274,232.9,78.5284,274,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
ATROPINE 1 % OPHT DROP,,18497,LOCAL,Facility,Both,5 mL,mL,,274,232.9,78.5284,274,Medica,Individual & Family,271.534,99.1,,percent of total billed charges,,
ATROPINE 1 % OPHT DROP,,18497,LOCAL,Facility,Outpatient,5 mL,mL,,274,232.9,78.5284,274,Medica,Medica Advantage Solution,136.452,49.8,,percent of total billed charges,,
ATROPINE 1 % OPHT DROP,,18497,LOCAL,Facility,Inpatient,5 mL,mL,,274,232.9,78.5284,274,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
ATROPINE 1 % OPHT DROP,,18497,LOCAL,Facility,Outpatient,5 mL,mL,,274,232.9,78.5284,274,Medica,Medical Assistance,122.204,44.6,,percent of total billed charges,,
ATROPINE 1 % OPHT DROP,,18497,LOCAL,Facility,Inpatient,5 mL,mL,,274,232.9,78.5284,274,Medica,Medical Assistance,,,,,Included in per diem rate,
ATROPINE 1 % OPHT DROP,,18497,LOCAL,Facility,Outpatient,5 mL,mL,,274,232.9,78.5284,274,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,136.452,49.8,,percent of total billed charges,,
ATROPINE 1 % OPHT DROP,,18497,LOCAL,Facility,Inpatient,5 mL,mL,,274,232.9,78.5284,274,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
ATROPINE 1 % OPHT DROP,,18497,LOCAL,Facility,Both,5 mL,mL,,274,232.9,78.5284,274,"Multiplan, Inc.","Multiplan, Inc.",257.56,94,,percent of total billed charges,,
ATROPINE 1 % OPHT DROP,,18497,LOCAL,Facility,Outpatient,5 mL,mL,,274,232.9,78.5284,274,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,246.874,90.1,,percent of total billed charges,,
ATROPINE 1 % OPHT DROP,,18497,LOCAL,Facility,Inpatient,5 mL,mL,,274,232.9,78.5284,274,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
ATROPINE 1 % OPHT DROP,,18497,LOCAL,Facility,Both,5 mL,mL,,274,232.9,78.5284,274,"Preferred One Administrative Services, INC.",PPO,270.164,98.6,,percent of total billed charges,,
ATROPINE 1 % OPHT DROP,,18497,LOCAL,Facility,Outpatient,5 mL,mL,,274,232.9,78.5284,274,PrimeWest Health,Minnesota Senior Health Options (MSHO),140.973,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
ATROPINE 1 % OPHT DROP,,18497,LOCAL,Facility,Inpatient,5 mL,mL,,274,232.9,78.5284,274,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ATROPINE 1 % OPHT DROP,,18497,LOCAL,Facility,Outpatient,5 mL,mL,,274,232.9,78.5284,274,PrimeWest Health,MinnesotaCare,140.7264,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
ATROPINE 1 % OPHT DROP,,18497,LOCAL,Facility,Inpatient,5 mL,mL,,274,232.9,78.5284,274,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
ATROPINE 1 % OPHT DROP,,18497,LOCAL,Facility,Both,5 mL,mL,,274,232.9,78.5284,274,Sanford Health Plan,Sanford Health Plan,252.08,92,,percent of total billed charges,,
ATROPINE 1 % OPHT DROP,,18497,LOCAL,Facility,Outpatient,5 mL,mL,,274,232.9,78.5284,274,"UCare Health, Inc.",Individual & Family Plan,154.399,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
ATROPINE 1 % OPHT DROP,,18497,LOCAL,Facility,Inpatient,5 mL,mL,,274,232.9,78.5284,274,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
ATROPINE 1 % OPHT DROP,,18497,LOCAL,Facility,Outpatient,5 mL,mL,,274,232.9,78.5284,274,"UCare Health, Inc.",Medical Assistance,138.2878,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ATROPINE 1 % OPHT DROP,,18497,LOCAL,Facility,Inpatient,5 mL,mL,,274,232.9,78.5284,274,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
ATROPINE 1 % OPHT DROP,,18497,LOCAL,Facility,Outpatient,5 mL,mL,,274,232.9,78.5284,274,"UCare Health, Inc.",Medicare Advantage,138.2878,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ATROPINE 1 % OPHT DROP,,18497,LOCAL,Facility,Inpatient,5 mL,mL,,274,232.9,78.5284,274,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ATROPINE 1 % OPHT DROP,,18497,LOCAL,Facility,Outpatient,5 mL,mL,,274,232.9,78.5284,274,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),138.2878,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ATROPINE 1 % OPHT DROP,,18497,LOCAL,Facility,Inpatient,5 mL,mL,,274,232.9,78.5284,274,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ATROPINE 1 % OPHT DROP,,18497,LOCAL,Facility,Both,5 mL,mL,,274,232.9,78.5284,274,UnitedHealthcare,Individual & Family,257.56,94,,percent of total billed charges,,
ATROPINE 1 % OPHT DROP,,18497,LOCAL,Facility,Outpatient,5 mL,mL,,274,232.9,78.5284,274,UnitedHealthcare,Medicare Advantage,134.26,49,,percent of total billed charges,,
ATROPINE 1 % OPHT DROP,,18497,LOCAL,Facility,Inpatient,5 mL,mL,,274,232.9,78.5284,274,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
ATROPINE 1 % OPHT DROP,,18497,LOCAL,Facility,Outpatient,5 mL,mL,,274,232.9,78.5284,274,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,131.52,48,,percent of total billed charges,,100% of DHS outpatient percentage
ATROPINE 1 % OPHT DROP,,18497,LOCAL,Facility,Inpatient,5 mL,mL,,274,232.9,78.5284,274,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
BRIMONIDINE 0.15 % OPHT DROP,,19433,LOCAL,Facility,Both,5 mL,mL,,748,635.8,214.3768,748,Aetna,Commercial,688.16,92,,percent of total billed charges,,
BRIMONIDINE 0.15 % OPHT DROP,,19433,LOCAL,Facility,Outpatient,5 mL,mL,,748,635.8,214.3768,748,Aetna,Medicare Advantage,366.52,49,,percent of total billed charges,,
BRIMONIDINE 0.15 % OPHT DROP,,19433,LOCAL,Facility,Inpatient,5 mL,mL,,748,635.8,214.3768,748,Aetna,Medicare Advantage,,,,,Included in per diem rate,
BRIMONIDINE 0.15 % OPHT DROP,,19433,LOCAL,Facility,Both,5 mL,mL,,748,635.8,214.3768,748,Aetna,PPO,695.64,93,,percent of total billed charges,,
BRIMONIDINE 0.15 % OPHT DROP,,19433,LOCAL,Facility,Both,5 mL,mL,,748,635.8,214.3768,748,America's PPO,America's PPO,718.3044,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
BRIMONIDINE 0.15 % OPHT DROP,,19433,LOCAL,Facility,Both,5 mL,mL,,748,635.8,214.3768,748,BlueCross BlueShield Minnesota, Federal Employee Program,736.032,98.4,,percent of total billed charges,,
BRIMONIDINE 0.15 % OPHT DROP,,19433,LOCAL,Facility,Both,5 mL,mL,,748,635.8,214.3768,748,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,748,100,,percent of total billed charges,,
BRIMONIDINE 0.15 % OPHT DROP,,19433,LOCAL,Facility,Both,5 mL,mL,,748,635.8,214.3768,748,BlueCross BlueShield Minnesota,High Value Network Plan,673.2,90,,percent of total billed charges,,
BRIMONIDINE 0.15 % OPHT DROP,,19433,LOCAL,Facility,Outpatient,5 mL,mL,,748,635.8,214.3768,748,BlueCross BlueShield Minnesota,Medicare Advantage,366.52,49,,percent of total billed charges,,
BRIMONIDINE 0.15 % OPHT DROP,,19433,LOCAL,Facility,Inpatient,5 mL,mL,,748,635.8,214.3768,748,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
BRIMONIDINE 0.15 % OPHT DROP,,19433,LOCAL,Facility,Both,5 mL,mL,,748,635.8,214.3768,748,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,662.5036,88.57,,percent of total billed charges,,
BRIMONIDINE 0.15 % OPHT DROP,,19433,LOCAL,Facility,Both,5 mL,mL,,748,635.8,214.3768,748,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,214.3768,28.66,,percent of total billed charges,,
BRIMONIDINE 0.15 % OPHT DROP,,19433,LOCAL,Facility,Outpatient,5 mL,mL,,748,635.8,214.3768,748,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),366.52,49,,percent of total billed charges,,
BRIMONIDINE 0.15 % OPHT DROP,,19433,LOCAL,Facility,Inpatient,5 mL,mL,,748,635.8,214.3768,748,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
BRIMONIDINE 0.15 % OPHT DROP,,19433,LOCAL,Facility,Both,5 mL,mL,,748,635.8,214.3768,748,CorVel,Worker's Compensation,748,100,,percent of total billed charges,,
BRIMONIDINE 0.15 % OPHT DROP,,19433,LOCAL,Facility,Both,5 mL,mL,,748,635.8,214.3768,748,First Health Group Corporation,First Health Network,725.56,97,,percent of total billed charges,,
BRIMONIDINE 0.15 % OPHT DROP,,19433,LOCAL,Facility,Both,5 mL,mL,,748,635.8,214.3768,748,"Health Partners, Inc.",Commercial,707.608,94.6,,percent of total billed charges,,
BRIMONIDINE 0.15 % OPHT DROP,,19433,LOCAL,Facility,Outpatient,5 mL,mL,,748,635.8,214.3768,748,"Health Partners, Inc.",Medicare Advantage,366.52,49,,percent of total billed charges,,
BRIMONIDINE 0.15 % OPHT DROP,,19433,LOCAL,Facility,Inpatient,5 mL,mL,,748,635.8,214.3768,748,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
BRIMONIDINE 0.15 % OPHT DROP,,19433,LOCAL,Facility,Both,5 mL,mL,,748,635.8,214.3768,748,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),448.8,60,,percent of total billed charges,,
BRIMONIDINE 0.15 % OPHT DROP,,19433,LOCAL,Facility,Both,5 mL,mL,,748,635.8,214.3768,748,"Health Partners, Inc.",State of Minnesota Advantage Program,609.62,81.5,,percent of total billed charges,,
BRIMONIDINE 0.15 % OPHT DROP,,19433,LOCAL,Facility,Both,5 mL,mL,,748,635.8,214.3768,748,"Health Partners, Inc.",State Public Programs,374,50,,percent of total billed charges,,
BRIMONIDINE 0.15 % OPHT DROP,,19433,LOCAL,Facility,Both,5 mL,mL,,748,635.8,214.3768,748,Humana Insurance Company,Commercial PPO,710.6,95,,percent of total billed charges,,
BRIMONIDINE 0.15 % OPHT DROP,,19433,LOCAL,Facility,Outpatient,5 mL,mL,,748,635.8,214.3768,748,Humana Insurance Company,Medicare PPO,366.52,49,,percent of total billed charges,,
BRIMONIDINE 0.15 % OPHT DROP,,19433,LOCAL,Facility,Inpatient,5 mL,mL,,748,635.8,214.3768,748,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
BRIMONIDINE 0.15 % OPHT DROP,,19433,LOCAL,Facility,Both,5 mL,mL,,748,635.8,214.3768,748,Medica,Individual & Family,741.268,99.1,,percent of total billed charges,,
BRIMONIDINE 0.15 % OPHT DROP,,19433,LOCAL,Facility,Outpatient,5 mL,mL,,748,635.8,214.3768,748,Medica,Medica Advantage Solution,372.504,49.8,,percent of total billed charges,,
BRIMONIDINE 0.15 % OPHT DROP,,19433,LOCAL,Facility,Inpatient,5 mL,mL,,748,635.8,214.3768,748,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
BRIMONIDINE 0.15 % OPHT DROP,,19433,LOCAL,Facility,Outpatient,5 mL,mL,,748,635.8,214.3768,748,Medica,Medical Assistance,333.608,44.6,,percent of total billed charges,,
BRIMONIDINE 0.15 % OPHT DROP,,19433,LOCAL,Facility,Inpatient,5 mL,mL,,748,635.8,214.3768,748,Medica,Medical Assistance,,,,,Included in per diem rate,
BRIMONIDINE 0.15 % OPHT DROP,,19433,LOCAL,Facility,Outpatient,5 mL,mL,,748,635.8,214.3768,748,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,372.504,49.8,,percent of total billed charges,,
BRIMONIDINE 0.15 % OPHT DROP,,19433,LOCAL,Facility,Inpatient,5 mL,mL,,748,635.8,214.3768,748,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
BRIMONIDINE 0.15 % OPHT DROP,,19433,LOCAL,Facility,Both,5 mL,mL,,748,635.8,214.3768,748,"Multiplan, Inc.","Multiplan, Inc.",703.12,94,,percent of total billed charges,,
BRIMONIDINE 0.15 % OPHT DROP,,19433,LOCAL,Facility,Outpatient,5 mL,mL,,748,635.8,214.3768,748,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,673.948,90.1,,percent of total billed charges,,
BRIMONIDINE 0.15 % OPHT DROP,,19433,LOCAL,Facility,Inpatient,5 mL,mL,,748,635.8,214.3768,748,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
BRIMONIDINE 0.15 % OPHT DROP,,19433,LOCAL,Facility,Both,5 mL,mL,,748,635.8,214.3768,748,"Preferred One Administrative Services, INC.",PPO,737.528,98.6,,percent of total billed charges,,
BRIMONIDINE 0.15 % OPHT DROP,,19433,LOCAL,Facility,Outpatient,5 mL,mL,,748,635.8,214.3768,748,PrimeWest Health,Minnesota Senior Health Options (MSHO),384.846,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
BRIMONIDINE 0.15 % OPHT DROP,,19433,LOCAL,Facility,Inpatient,5 mL,mL,,748,635.8,214.3768,748,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
BRIMONIDINE 0.15 % OPHT DROP,,19433,LOCAL,Facility,Outpatient,5 mL,mL,,748,635.8,214.3768,748,PrimeWest Health,MinnesotaCare,384.1728,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
BRIMONIDINE 0.15 % OPHT DROP,,19433,LOCAL,Facility,Inpatient,5 mL,mL,,748,635.8,214.3768,748,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
BRIMONIDINE 0.15 % OPHT DROP,,19433,LOCAL,Facility,Both,5 mL,mL,,748,635.8,214.3768,748,Sanford Health Plan,Sanford Health Plan,688.16,92,,percent of total billed charges,,
BRIMONIDINE 0.15 % OPHT DROP,,19433,LOCAL,Facility,Outpatient,5 mL,mL,,748,635.8,214.3768,748,"UCare Health, Inc.",Individual & Family Plan,421.498,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
BRIMONIDINE 0.15 % OPHT DROP,,19433,LOCAL,Facility,Inpatient,5 mL,mL,,748,635.8,214.3768,748,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
BRIMONIDINE 0.15 % OPHT DROP,,19433,LOCAL,Facility,Outpatient,5 mL,mL,,748,635.8,214.3768,748,"UCare Health, Inc.",Medical Assistance,377.5156,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BRIMONIDINE 0.15 % OPHT DROP,,19433,LOCAL,Facility,Inpatient,5 mL,mL,,748,635.8,214.3768,748,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
BRIMONIDINE 0.15 % OPHT DROP,,19433,LOCAL,Facility,Outpatient,5 mL,mL,,748,635.8,214.3768,748,"UCare Health, Inc.",Medicare Advantage,377.5156,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BRIMONIDINE 0.15 % OPHT DROP,,19433,LOCAL,Facility,Inpatient,5 mL,mL,,748,635.8,214.3768,748,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
BRIMONIDINE 0.15 % OPHT DROP,,19433,LOCAL,Facility,Outpatient,5 mL,mL,,748,635.8,214.3768,748,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),377.5156,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BRIMONIDINE 0.15 % OPHT DROP,,19433,LOCAL,Facility,Inpatient,5 mL,mL,,748,635.8,214.3768,748,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
BRIMONIDINE 0.15 % OPHT DROP,,19433,LOCAL,Facility,Both,5 mL,mL,,748,635.8,214.3768,748,UnitedHealthcare,Individual & Family,703.12,94,,percent of total billed charges,,
BRIMONIDINE 0.15 % OPHT DROP,,19433,LOCAL,Facility,Outpatient,5 mL,mL,,748,635.8,214.3768,748,UnitedHealthcare,Medicare Advantage,366.52,49,,percent of total billed charges,,
BRIMONIDINE 0.15 % OPHT DROP,,19433,LOCAL,Facility,Inpatient,5 mL,mL,,748,635.8,214.3768,748,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
BRIMONIDINE 0.15 % OPHT DROP,,19433,LOCAL,Facility,Outpatient,5 mL,mL,,748,635.8,214.3768,748,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,359.04,48,,percent of total billed charges,,100% of DHS outpatient percentage
BRIMONIDINE 0.15 % OPHT DROP,,19433,LOCAL,Facility,Inpatient,5 mL,mL,,748,635.8,214.3768,748,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
ETHANOL (ETHYL ALCOHOL) 98 % INJ SOLN,,22556,LOCAL,Facility,Both,5 mL,mL,,1843,1566.55,528.2038,1843,Aetna,Commercial,1695.56,92,,percent of total billed charges,,
ETHANOL (ETHYL ALCOHOL) 98 % INJ SOLN,,22556,LOCAL,Facility,Outpatient,5 mL,mL,,1843,1566.55,528.2038,1843,Aetna,Medicare Advantage,903.07,49,,percent of total billed charges,,
ETHANOL (ETHYL ALCOHOL) 98 % INJ SOLN,,22556,LOCAL,Facility,Inpatient,5 mL,mL,,1843,1566.55,528.2038,1843,Aetna,Medicare Advantage,,,,,Included in per diem rate,
ETHANOL (ETHYL ALCOHOL) 98 % INJ SOLN,,22556,LOCAL,Facility,Both,5 mL,mL,,1843,1566.55,528.2038,1843,Aetna,PPO,1713.99,93,,percent of total billed charges,,
ETHANOL (ETHYL ALCOHOL) 98 % INJ SOLN,,22556,LOCAL,Facility,Both,5 mL,mL,,1843,1566.55,528.2038,1843,America's PPO,America's PPO,1769.8329,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
ETHANOL (ETHYL ALCOHOL) 98 % INJ SOLN,,22556,LOCAL,Facility,Both,5 mL,mL,,1843,1566.55,528.2038,1843,BlueCross BlueShield Minnesota, Federal Employee Program,1813.512,98.4,,percent of total billed charges,,
ETHANOL (ETHYL ALCOHOL) 98 % INJ SOLN,,22556,LOCAL,Facility,Both,5 mL,mL,,1843,1566.55,528.2038,1843,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1843,100,,percent of total billed charges,,
ETHANOL (ETHYL ALCOHOL) 98 % INJ SOLN,,22556,LOCAL,Facility,Both,5 mL,mL,,1843,1566.55,528.2038,1843,BlueCross BlueShield Minnesota,High Value Network Plan,1658.7,90,,percent of total billed charges,,
ETHANOL (ETHYL ALCOHOL) 98 % INJ SOLN,,22556,LOCAL,Facility,Outpatient,5 mL,mL,,1843,1566.55,528.2038,1843,BlueCross BlueShield Minnesota,Medicare Advantage,903.07,49,,percent of total billed charges,,
ETHANOL (ETHYL ALCOHOL) 98 % INJ SOLN,,22556,LOCAL,Facility,Inpatient,5 mL,mL,,1843,1566.55,528.2038,1843,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
ETHANOL (ETHYL ALCOHOL) 98 % INJ SOLN,,22556,LOCAL,Facility,Both,5 mL,mL,,1843,1566.55,528.2038,1843,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1632.3451,88.57,,percent of total billed charges,,
ETHANOL (ETHYL ALCOHOL) 98 % INJ SOLN,,22556,LOCAL,Facility,Both,5 mL,mL,,1843,1566.55,528.2038,1843,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,528.2038,28.66,,percent of total billed charges,,
ETHANOL (ETHYL ALCOHOL) 98 % INJ SOLN,,22556,LOCAL,Facility,Outpatient,5 mL,mL,,1843,1566.55,528.2038,1843,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),903.07,49,,percent of total billed charges,,
ETHANOL (ETHYL ALCOHOL) 98 % INJ SOLN,,22556,LOCAL,Facility,Inpatient,5 mL,mL,,1843,1566.55,528.2038,1843,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
ETHANOL (ETHYL ALCOHOL) 98 % INJ SOLN,,22556,LOCAL,Facility,Both,5 mL,mL,,1843,1566.55,528.2038,1843,CorVel,Worker's Compensation,1843,100,,percent of total billed charges,,
ETHANOL (ETHYL ALCOHOL) 98 % INJ SOLN,,22556,LOCAL,Facility,Both,5 mL,mL,,1843,1566.55,528.2038,1843,First Health Group Corporation,First Health Network,1787.71,97,,percent of total billed charges,,
ETHANOL (ETHYL ALCOHOL) 98 % INJ SOLN,,22556,LOCAL,Facility,Both,5 mL,mL,,1843,1566.55,528.2038,1843,"Health Partners, Inc.",Commercial,1743.478,94.6,,percent of total billed charges,,
ETHANOL (ETHYL ALCOHOL) 98 % INJ SOLN,,22556,LOCAL,Facility,Outpatient,5 mL,mL,,1843,1566.55,528.2038,1843,"Health Partners, Inc.",Medicare Advantage,903.07,49,,percent of total billed charges,,
ETHANOL (ETHYL ALCOHOL) 98 % INJ SOLN,,22556,LOCAL,Facility,Inpatient,5 mL,mL,,1843,1566.55,528.2038,1843,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ETHANOL (ETHYL ALCOHOL) 98 % INJ SOLN,,22556,LOCAL,Facility,Both,5 mL,mL,,1843,1566.55,528.2038,1843,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1105.8,60,,percent of total billed charges,,
ETHANOL (ETHYL ALCOHOL) 98 % INJ SOLN,,22556,LOCAL,Facility,Both,5 mL,mL,,1843,1566.55,528.2038,1843,"Health Partners, Inc.",State of Minnesota Advantage Program,1502.045,81.5,,percent of total billed charges,,
ETHANOL (ETHYL ALCOHOL) 98 % INJ SOLN,,22556,LOCAL,Facility,Both,5 mL,mL,,1843,1566.55,528.2038,1843,"Health Partners, Inc.",State Public Programs,921.5,50,,percent of total billed charges,,
ETHANOL (ETHYL ALCOHOL) 98 % INJ SOLN,,22556,LOCAL,Facility,Both,5 mL,mL,,1843,1566.55,528.2038,1843,Humana Insurance Company,Commercial PPO,1750.85,95,,percent of total billed charges,,
ETHANOL (ETHYL ALCOHOL) 98 % INJ SOLN,,22556,LOCAL,Facility,Outpatient,5 mL,mL,,1843,1566.55,528.2038,1843,Humana Insurance Company,Medicare PPO,903.07,49,,percent of total billed charges,,
ETHANOL (ETHYL ALCOHOL) 98 % INJ SOLN,,22556,LOCAL,Facility,Inpatient,5 mL,mL,,1843,1566.55,528.2038,1843,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
ETHANOL (ETHYL ALCOHOL) 98 % INJ SOLN,,22556,LOCAL,Facility,Both,5 mL,mL,,1843,1566.55,528.2038,1843,Medica,Individual & Family,1826.413,99.1,,percent of total billed charges,,
ETHANOL (ETHYL ALCOHOL) 98 % INJ SOLN,,22556,LOCAL,Facility,Outpatient,5 mL,mL,,1843,1566.55,528.2038,1843,Medica,Medica Advantage Solution,917.814,49.8,,percent of total billed charges,,
ETHANOL (ETHYL ALCOHOL) 98 % INJ SOLN,,22556,LOCAL,Facility,Inpatient,5 mL,mL,,1843,1566.55,528.2038,1843,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
ETHANOL (ETHYL ALCOHOL) 98 % INJ SOLN,,22556,LOCAL,Facility,Outpatient,5 mL,mL,,1843,1566.55,528.2038,1843,Medica,Medical Assistance,821.978,44.6,,percent of total billed charges,,
ETHANOL (ETHYL ALCOHOL) 98 % INJ SOLN,,22556,LOCAL,Facility,Inpatient,5 mL,mL,,1843,1566.55,528.2038,1843,Medica,Medical Assistance,,,,,Included in per diem rate,
ETHANOL (ETHYL ALCOHOL) 98 % INJ SOLN,,22556,LOCAL,Facility,Outpatient,5 mL,mL,,1843,1566.55,528.2038,1843,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,917.814,49.8,,percent of total billed charges,,
ETHANOL (ETHYL ALCOHOL) 98 % INJ SOLN,,22556,LOCAL,Facility,Inpatient,5 mL,mL,,1843,1566.55,528.2038,1843,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
ETHANOL (ETHYL ALCOHOL) 98 % INJ SOLN,,22556,LOCAL,Facility,Both,5 mL,mL,,1843,1566.55,528.2038,1843,"Multiplan, Inc.","Multiplan, Inc.",1732.42,94,,percent of total billed charges,,
ETHANOL (ETHYL ALCOHOL) 98 % INJ SOLN,,22556,LOCAL,Facility,Outpatient,5 mL,mL,,1843,1566.55,528.2038,1843,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1660.543,90.1,,percent of total billed charges,,
ETHANOL (ETHYL ALCOHOL) 98 % INJ SOLN,,22556,LOCAL,Facility,Inpatient,5 mL,mL,,1843,1566.55,528.2038,1843,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
ETHANOL (ETHYL ALCOHOL) 98 % INJ SOLN,,22556,LOCAL,Facility,Both,5 mL,mL,,1843,1566.55,528.2038,1843,"Preferred One Administrative Services, INC.",PPO,1817.198,98.6,,percent of total billed charges,,
ETHANOL (ETHYL ALCOHOL) 98 % INJ SOLN,,22556,LOCAL,Facility,Outpatient,5 mL,mL,,1843,1566.55,528.2038,1843,PrimeWest Health,Minnesota Senior Health Options (MSHO),948.2235,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
ETHANOL (ETHYL ALCOHOL) 98 % INJ SOLN,,22556,LOCAL,Facility,Inpatient,5 mL,mL,,1843,1566.55,528.2038,1843,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ETHANOL (ETHYL ALCOHOL) 98 % INJ SOLN,,22556,LOCAL,Facility,Outpatient,5 mL,mL,,1843,1566.55,528.2038,1843,PrimeWest Health,MinnesotaCare,946.5648,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
ETHANOL (ETHYL ALCOHOL) 98 % INJ SOLN,,22556,LOCAL,Facility,Inpatient,5 mL,mL,,1843,1566.55,528.2038,1843,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
ETHANOL (ETHYL ALCOHOL) 98 % INJ SOLN,,22556,LOCAL,Facility,Both,5 mL,mL,,1843,1566.55,528.2038,1843,Sanford Health Plan,Sanford Health Plan,1695.56,92,,percent of total billed charges,,
ETHANOL (ETHYL ALCOHOL) 98 % INJ SOLN,,22556,LOCAL,Facility,Outpatient,5 mL,mL,,1843,1566.55,528.2038,1843,"UCare Health, Inc.",Individual & Family Plan,1038.5305,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
ETHANOL (ETHYL ALCOHOL) 98 % INJ SOLN,,22556,LOCAL,Facility,Inpatient,5 mL,mL,,1843,1566.55,528.2038,1843,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
ETHANOL (ETHYL ALCOHOL) 98 % INJ SOLN,,22556,LOCAL,Facility,Outpatient,5 mL,mL,,1843,1566.55,528.2038,1843,"UCare Health, Inc.",Medical Assistance,930.1621,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ETHANOL (ETHYL ALCOHOL) 98 % INJ SOLN,,22556,LOCAL,Facility,Inpatient,5 mL,mL,,1843,1566.55,528.2038,1843,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
ETHANOL (ETHYL ALCOHOL) 98 % INJ SOLN,,22556,LOCAL,Facility,Outpatient,5 mL,mL,,1843,1566.55,528.2038,1843,"UCare Health, Inc.",Medicare Advantage,930.1621,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ETHANOL (ETHYL ALCOHOL) 98 % INJ SOLN,,22556,LOCAL,Facility,Inpatient,5 mL,mL,,1843,1566.55,528.2038,1843,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ETHANOL (ETHYL ALCOHOL) 98 % INJ SOLN,,22556,LOCAL,Facility,Outpatient,5 mL,mL,,1843,1566.55,528.2038,1843,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),930.1621,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ETHANOL (ETHYL ALCOHOL) 98 % INJ SOLN,,22556,LOCAL,Facility,Inpatient,5 mL,mL,,1843,1566.55,528.2038,1843,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ETHANOL (ETHYL ALCOHOL) 98 % INJ SOLN,,22556,LOCAL,Facility,Both,5 mL,mL,,1843,1566.55,528.2038,1843,UnitedHealthcare,Individual & Family,1732.42,94,,percent of total billed charges,,
ETHANOL (ETHYL ALCOHOL) 98 % INJ SOLN,,22556,LOCAL,Facility,Outpatient,5 mL,mL,,1843,1566.55,528.2038,1843,UnitedHealthcare,Medicare Advantage,903.07,49,,percent of total billed charges,,
ETHANOL (ETHYL ALCOHOL) 98 % INJ SOLN,,22556,LOCAL,Facility,Inpatient,5 mL,mL,,1843,1566.55,528.2038,1843,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
ETHANOL (ETHYL ALCOHOL) 98 % INJ SOLN,,22556,LOCAL,Facility,Outpatient,5 mL,mL,,1843,1566.55,528.2038,1843,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,884.64,48,,percent of total billed charges,,100% of DHS outpatient percentage
ETHANOL (ETHYL ALCOHOL) 98 % INJ SOLN,,22556,LOCAL,Facility,Inpatient,5 mL,mL,,1843,1566.55,528.2038,1843,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
BRIMONIDINE 0.1 % OPHT DROP,,64508,LOCAL,Facility,Both,5 mL,mL,,910,773.5,260.806,910,Aetna,Commercial,837.2,92,,percent of total billed charges,,
BRIMONIDINE 0.1 % OPHT DROP,,64508,LOCAL,Facility,Outpatient,5 mL,mL,,910,773.5,260.806,910,Aetna,Medicare Advantage,445.9,49,,percent of total billed charges,,
BRIMONIDINE 0.1 % OPHT DROP,,64508,LOCAL,Facility,Inpatient,5 mL,mL,,910,773.5,260.806,910,Aetna,Medicare Advantage,,,,,Included in per diem rate,
BRIMONIDINE 0.1 % OPHT DROP,,64508,LOCAL,Facility,Both,5 mL,mL,,910,773.5,260.806,910,Aetna,PPO,846.3,93,,percent of total billed charges,,
BRIMONIDINE 0.1 % OPHT DROP,,64508,LOCAL,Facility,Both,5 mL,mL,,910,773.5,260.806,910,America's PPO,America's PPO,873.873,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
BRIMONIDINE 0.1 % OPHT DROP,,64508,LOCAL,Facility,Both,5 mL,mL,,910,773.5,260.806,910,BlueCross BlueShield Minnesota, Federal Employee Program,895.44,98.4,,percent of total billed charges,,
BRIMONIDINE 0.1 % OPHT DROP,,64508,LOCAL,Facility,Both,5 mL,mL,,910,773.5,260.806,910,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,910,100,,percent of total billed charges,,
BRIMONIDINE 0.1 % OPHT DROP,,64508,LOCAL,Facility,Both,5 mL,mL,,910,773.5,260.806,910,BlueCross BlueShield Minnesota,High Value Network Plan,819,90,,percent of total billed charges,,
BRIMONIDINE 0.1 % OPHT DROP,,64508,LOCAL,Facility,Outpatient,5 mL,mL,,910,773.5,260.806,910,BlueCross BlueShield Minnesota,Medicare Advantage,445.9,49,,percent of total billed charges,,
BRIMONIDINE 0.1 % OPHT DROP,,64508,LOCAL,Facility,Inpatient,5 mL,mL,,910,773.5,260.806,910,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
BRIMONIDINE 0.1 % OPHT DROP,,64508,LOCAL,Facility,Both,5 mL,mL,,910,773.5,260.806,910,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,805.987,88.57,,percent of total billed charges,,
BRIMONIDINE 0.1 % OPHT DROP,,64508,LOCAL,Facility,Both,5 mL,mL,,910,773.5,260.806,910,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,260.806,28.66,,percent of total billed charges,,
BRIMONIDINE 0.1 % OPHT DROP,,64508,LOCAL,Facility,Outpatient,5 mL,mL,,910,773.5,260.806,910,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),445.9,49,,percent of total billed charges,,
BRIMONIDINE 0.1 % OPHT DROP,,64508,LOCAL,Facility,Inpatient,5 mL,mL,,910,773.5,260.806,910,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
BRIMONIDINE 0.1 % OPHT DROP,,64508,LOCAL,Facility,Both,5 mL,mL,,910,773.5,260.806,910,CorVel,Worker's Compensation,910,100,,percent of total billed charges,,
BRIMONIDINE 0.1 % OPHT DROP,,64508,LOCAL,Facility,Both,5 mL,mL,,910,773.5,260.806,910,First Health Group Corporation,First Health Network,882.7,97,,percent of total billed charges,,
BRIMONIDINE 0.1 % OPHT DROP,,64508,LOCAL,Facility,Both,5 mL,mL,,910,773.5,260.806,910,"Health Partners, Inc.",Commercial,860.86,94.6,,percent of total billed charges,,
BRIMONIDINE 0.1 % OPHT DROP,,64508,LOCAL,Facility,Outpatient,5 mL,mL,,910,773.5,260.806,910,"Health Partners, Inc.",Medicare Advantage,445.9,49,,percent of total billed charges,,
BRIMONIDINE 0.1 % OPHT DROP,,64508,LOCAL,Facility,Inpatient,5 mL,mL,,910,773.5,260.806,910,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
BRIMONIDINE 0.1 % OPHT DROP,,64508,LOCAL,Facility,Both,5 mL,mL,,910,773.5,260.806,910,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),546,60,,percent of total billed charges,,
BRIMONIDINE 0.1 % OPHT DROP,,64508,LOCAL,Facility,Both,5 mL,mL,,910,773.5,260.806,910,"Health Partners, Inc.",State of Minnesota Advantage Program,741.65,81.5,,percent of total billed charges,,
BRIMONIDINE 0.1 % OPHT DROP,,64508,LOCAL,Facility,Both,5 mL,mL,,910,773.5,260.806,910,"Health Partners, Inc.",State Public Programs,455,50,,percent of total billed charges,,
BRIMONIDINE 0.1 % OPHT DROP,,64508,LOCAL,Facility,Both,5 mL,mL,,910,773.5,260.806,910,Humana Insurance Company,Commercial PPO,864.5,95,,percent of total billed charges,,
BRIMONIDINE 0.1 % OPHT DROP,,64508,LOCAL,Facility,Outpatient,5 mL,mL,,910,773.5,260.806,910,Humana Insurance Company,Medicare PPO,445.9,49,,percent of total billed charges,,
BRIMONIDINE 0.1 % OPHT DROP,,64508,LOCAL,Facility,Inpatient,5 mL,mL,,910,773.5,260.806,910,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
BRIMONIDINE 0.1 % OPHT DROP,,64508,LOCAL,Facility,Both,5 mL,mL,,910,773.5,260.806,910,Medica,Individual & Family,901.81,99.1,,percent of total billed charges,,
BRIMONIDINE 0.1 % OPHT DROP,,64508,LOCAL,Facility,Outpatient,5 mL,mL,,910,773.5,260.806,910,Medica,Medica Advantage Solution,453.18,49.8,,percent of total billed charges,,
BRIMONIDINE 0.1 % OPHT DROP,,64508,LOCAL,Facility,Inpatient,5 mL,mL,,910,773.5,260.806,910,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
BRIMONIDINE 0.1 % OPHT DROP,,64508,LOCAL,Facility,Outpatient,5 mL,mL,,910,773.5,260.806,910,Medica,Medical Assistance,405.86,44.6,,percent of total billed charges,,
BRIMONIDINE 0.1 % OPHT DROP,,64508,LOCAL,Facility,Inpatient,5 mL,mL,,910,773.5,260.806,910,Medica,Medical Assistance,,,,,Included in per diem rate,
BRIMONIDINE 0.1 % OPHT DROP,,64508,LOCAL,Facility,Outpatient,5 mL,mL,,910,773.5,260.806,910,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,453.18,49.8,,percent of total billed charges,,
BRIMONIDINE 0.1 % OPHT DROP,,64508,LOCAL,Facility,Inpatient,5 mL,mL,,910,773.5,260.806,910,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
BRIMONIDINE 0.1 % OPHT DROP,,64508,LOCAL,Facility,Both,5 mL,mL,,910,773.5,260.806,910,"Multiplan, Inc.","Multiplan, Inc.",855.4,94,,percent of total billed charges,,
BRIMONIDINE 0.1 % OPHT DROP,,64508,LOCAL,Facility,Outpatient,5 mL,mL,,910,773.5,260.806,910,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,819.91,90.1,,percent of total billed charges,,
BRIMONIDINE 0.1 % OPHT DROP,,64508,LOCAL,Facility,Inpatient,5 mL,mL,,910,773.5,260.806,910,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
BRIMONIDINE 0.1 % OPHT DROP,,64508,LOCAL,Facility,Both,5 mL,mL,,910,773.5,260.806,910,"Preferred One Administrative Services, INC.",PPO,897.26,98.6,,percent of total billed charges,,
BRIMONIDINE 0.1 % OPHT DROP,,64508,LOCAL,Facility,Outpatient,5 mL,mL,,910,773.5,260.806,910,PrimeWest Health,Minnesota Senior Health Options (MSHO),468.195,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
BRIMONIDINE 0.1 % OPHT DROP,,64508,LOCAL,Facility,Inpatient,5 mL,mL,,910,773.5,260.806,910,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
BRIMONIDINE 0.1 % OPHT DROP,,64508,LOCAL,Facility,Outpatient,5 mL,mL,,910,773.5,260.806,910,PrimeWest Health,MinnesotaCare,467.376,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
BRIMONIDINE 0.1 % OPHT DROP,,64508,LOCAL,Facility,Inpatient,5 mL,mL,,910,773.5,260.806,910,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
BRIMONIDINE 0.1 % OPHT DROP,,64508,LOCAL,Facility,Both,5 mL,mL,,910,773.5,260.806,910,Sanford Health Plan,Sanford Health Plan,837.2,92,,percent of total billed charges,,
BRIMONIDINE 0.1 % OPHT DROP,,64508,LOCAL,Facility,Outpatient,5 mL,mL,,910,773.5,260.806,910,"UCare Health, Inc.",Individual & Family Plan,512.785,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
BRIMONIDINE 0.1 % OPHT DROP,,64508,LOCAL,Facility,Inpatient,5 mL,mL,,910,773.5,260.806,910,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
BRIMONIDINE 0.1 % OPHT DROP,,64508,LOCAL,Facility,Outpatient,5 mL,mL,,910,773.5,260.806,910,"UCare Health, Inc.",Medical Assistance,459.277,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BRIMONIDINE 0.1 % OPHT DROP,,64508,LOCAL,Facility,Inpatient,5 mL,mL,,910,773.5,260.806,910,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
BRIMONIDINE 0.1 % OPHT DROP,,64508,LOCAL,Facility,Outpatient,5 mL,mL,,910,773.5,260.806,910,"UCare Health, Inc.",Medicare Advantage,459.277,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BRIMONIDINE 0.1 % OPHT DROP,,64508,LOCAL,Facility,Inpatient,5 mL,mL,,910,773.5,260.806,910,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
BRIMONIDINE 0.1 % OPHT DROP,,64508,LOCAL,Facility,Outpatient,5 mL,mL,,910,773.5,260.806,910,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),459.277,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BRIMONIDINE 0.1 % OPHT DROP,,64508,LOCAL,Facility,Inpatient,5 mL,mL,,910,773.5,260.806,910,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
BRIMONIDINE 0.1 % OPHT DROP,,64508,LOCAL,Facility,Both,5 mL,mL,,910,773.5,260.806,910,UnitedHealthcare,Individual & Family,855.4,94,,percent of total billed charges,,
BRIMONIDINE 0.1 % OPHT DROP,,64508,LOCAL,Facility,Outpatient,5 mL,mL,,910,773.5,260.806,910,UnitedHealthcare,Medicare Advantage,445.9,49,,percent of total billed charges,,
BRIMONIDINE 0.1 % OPHT DROP,,64508,LOCAL,Facility,Inpatient,5 mL,mL,,910,773.5,260.806,910,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
BRIMONIDINE 0.1 % OPHT DROP,,64508,LOCAL,Facility,Outpatient,5 mL,mL,,910,773.5,260.806,910,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,436.8,48,,percent of total billed charges,,100% of DHS outpatient percentage
BRIMONIDINE 0.1 % OPHT DROP,,64508,LOCAL,Facility,Inpatient,5 mL,mL,,910,773.5,260.806,910,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Both,5 mL,mL,,13,11.05,3.7258,13,Aetna,Commercial,11.96,92,,percent of total billed charges,,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Both,5 mL,mL,,21,17.85,6.0186,21,Aetna,Commercial,19.32,92,,percent of total billed charges,,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Both,5 mL,mL,,24,20.4,6.8784,24,Aetna,Commercial,22.08,92,,percent of total billed charges,,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Outpatient,5 mL,mL,,13,11.05,3.7258,13,Aetna,Medicare Advantage,6.37,49,,percent of total billed charges,,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Outpatient,5 mL,mL,,21,17.85,6.0186,21,Aetna,Medicare Advantage,10.29,49,,percent of total billed charges,,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Outpatient,5 mL,mL,,24,20.4,6.8784,24,Aetna,Medicare Advantage,11.76,49,,percent of total billed charges,,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Inpatient,5 mL,mL,,13,11.05,3.7258,13,Aetna,Medicare Advantage,,,,,Included in per diem rate,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Inpatient,5 mL,mL,,21,17.85,6.0186,21,Aetna,Medicare Advantage,,,,,Included in per diem rate,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Inpatient,5 mL,mL,,24,20.4,6.8784,24,Aetna,Medicare Advantage,,,,,Included in per diem rate,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Both,5 mL,mL,,13,11.05,3.7258,13,Aetna,PPO,12.09,93,,percent of total billed charges,,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Both,5 mL,mL,,21,17.85,6.0186,21,Aetna,PPO,19.53,93,,percent of total billed charges,,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Both,5 mL,mL,,24,20.4,6.8784,24,Aetna,PPO,22.32,93,,percent of total billed charges,,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Both,5 mL,mL,,13,11.05,3.7258,13,America's PPO,America's PPO,12.4839,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Both,5 mL,mL,,21,17.85,6.0186,21,America's PPO,America's PPO,20.1663,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Both,5 mL,mL,,24,20.4,6.8784,24,America's PPO,America's PPO,23.0472,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Both,5 mL,mL,,13,11.05,3.7258,13,BlueCross BlueShield Minnesota, Federal Employee Program,12.792,98.4,,percent of total billed charges,,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Both,5 mL,mL,,21,17.85,6.0186,21,BlueCross BlueShield Minnesota, Federal Employee Program,20.664,98.4,,percent of total billed charges,,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Both,5 mL,mL,,24,20.4,6.8784,24,BlueCross BlueShield Minnesota, Federal Employee Program,23.616,98.4,,percent of total billed charges,,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Both,5 mL,mL,,13,11.05,3.7258,13,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,13,100,,percent of total billed charges,,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Both,5 mL,mL,,21,17.85,6.0186,21,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,21,100,,percent of total billed charges,,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Both,5 mL,mL,,24,20.4,6.8784,24,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,24,100,,percent of total billed charges,,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Both,5 mL,mL,,13,11.05,3.7258,13,BlueCross BlueShield Minnesota,High Value Network Plan,11.7,90,,percent of total billed charges,,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Both,5 mL,mL,,21,17.85,6.0186,21,BlueCross BlueShield Minnesota,High Value Network Plan,18.9,90,,percent of total billed charges,,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Both,5 mL,mL,,24,20.4,6.8784,24,BlueCross BlueShield Minnesota,High Value Network Plan,21.6,90,,percent of total billed charges,,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Outpatient,5 mL,mL,,13,11.05,3.7258,13,BlueCross BlueShield Minnesota,Medicare Advantage,6.37,49,,percent of total billed charges,,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Outpatient,5 mL,mL,,21,17.85,6.0186,21,BlueCross BlueShield Minnesota,Medicare Advantage,10.29,49,,percent of total billed charges,,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Outpatient,5 mL,mL,,24,20.4,6.8784,24,BlueCross BlueShield Minnesota,Medicare Advantage,11.76,49,,percent of total billed charges,,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Inpatient,5 mL,mL,,13,11.05,3.7258,13,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Inpatient,5 mL,mL,,21,17.85,6.0186,21,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Inpatient,5 mL,mL,,24,20.4,6.8784,24,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Both,5 mL,mL,,13,11.05,3.7258,13,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,11.5141,88.57,,percent of total billed charges,,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Both,5 mL,mL,,21,17.85,6.0186,21,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,18.5997,88.57,,percent of total billed charges,,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Both,5 mL,mL,,24,20.4,6.8784,24,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,21.2568,88.57,,percent of total billed charges,,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Both,5 mL,mL,,13,11.05,3.7258,13,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,3.7258,28.66,,percent of total billed charges,,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Both,5 mL,mL,,21,17.85,6.0186,21,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,6.0186,28.66,,percent of total billed charges,,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Both,5 mL,mL,,24,20.4,6.8784,24,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,6.8784,28.66,,percent of total billed charges,,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Outpatient,5 mL,mL,,13,11.05,3.7258,13,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),6.37,49,,percent of total billed charges,,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Outpatient,5 mL,mL,,21,17.85,6.0186,21,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),10.29,49,,percent of total billed charges,,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Outpatient,5 mL,mL,,24,20.4,6.8784,24,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),11.76,49,,percent of total billed charges,,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Inpatient,5 mL,mL,,13,11.05,3.7258,13,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Inpatient,5 mL,mL,,21,17.85,6.0186,21,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Inpatient,5 mL,mL,,24,20.4,6.8784,24,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Both,5 mL,mL,,13,11.05,3.7258,13,CorVel,Worker's Compensation,13,100,,percent of total billed charges,,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Both,5 mL,mL,,21,17.85,6.0186,21,CorVel,Worker's Compensation,21,100,,percent of total billed charges,,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Both,5 mL,mL,,24,20.4,6.8784,24,CorVel,Worker's Compensation,24,100,,percent of total billed charges,,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Both,5 mL,mL,,13,11.05,3.7258,13,First Health Group Corporation,First Health Network,12.61,97,,percent of total billed charges,,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Both,5 mL,mL,,21,17.85,6.0186,21,First Health Group Corporation,First Health Network,20.37,97,,percent of total billed charges,,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Both,5 mL,mL,,24,20.4,6.8784,24,First Health Group Corporation,First Health Network,23.28,97,,percent of total billed charges,,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Both,5 mL,mL,,13,11.05,3.7258,13,"Health Partners, Inc.",Commercial,12.298,94.6,,percent of total billed charges,,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Both,5 mL,mL,,21,17.85,6.0186,21,"Health Partners, Inc.",Commercial,19.866,94.6,,percent of total billed charges,,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Both,5 mL,mL,,24,20.4,6.8784,24,"Health Partners, Inc.",Commercial,22.704,94.6,,percent of total billed charges,,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Outpatient,5 mL,mL,,13,11.05,3.7258,13,"Health Partners, Inc.",Medicare Advantage,6.37,49,,percent of total billed charges,,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Outpatient,5 mL,mL,,21,17.85,6.0186,21,"Health Partners, Inc.",Medicare Advantage,10.29,49,,percent of total billed charges,,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Outpatient,5 mL,mL,,24,20.4,6.8784,24,"Health Partners, Inc.",Medicare Advantage,11.76,49,,percent of total billed charges,,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Inpatient,5 mL,mL,,13,11.05,3.7258,13,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Inpatient,5 mL,mL,,21,17.85,6.0186,21,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Inpatient,5 mL,mL,,24,20.4,6.8784,24,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Both,5 mL,mL,,13,11.05,3.7258,13,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),7.8,60,,percent of total billed charges,,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Both,5 mL,mL,,21,17.85,6.0186,21,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),12.6,60,,percent of total billed charges,,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Both,5 mL,mL,,24,20.4,6.8784,24,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),14.4,60,,percent of total billed charges,,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Both,5 mL,mL,,13,11.05,3.7258,13,"Health Partners, Inc.",State of Minnesota Advantage Program,10.595,81.5,,percent of total billed charges,,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Both,5 mL,mL,,21,17.85,6.0186,21,"Health Partners, Inc.",State of Minnesota Advantage Program,17.115,81.5,,percent of total billed charges,,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Both,5 mL,mL,,24,20.4,6.8784,24,"Health Partners, Inc.",State of Minnesota Advantage Program,19.56,81.5,,percent of total billed charges,,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Both,5 mL,mL,,13,11.05,3.7258,13,"Health Partners, Inc.",State Public Programs,6.5,50,,percent of total billed charges,,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Both,5 mL,mL,,21,17.85,6.0186,21,"Health Partners, Inc.",State Public Programs,10.5,50,,percent of total billed charges,,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Both,5 mL,mL,,24,20.4,6.8784,24,"Health Partners, Inc.",State Public Programs,12,50,,percent of total billed charges,,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Both,5 mL,mL,,13,11.05,3.7258,13,Humana Insurance Company,Commercial PPO,12.35,95,,percent of total billed charges,,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Both,5 mL,mL,,21,17.85,6.0186,21,Humana Insurance Company,Commercial PPO,19.95,95,,percent of total billed charges,,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Both,5 mL,mL,,24,20.4,6.8784,24,Humana Insurance Company,Commercial PPO,22.8,95,,percent of total billed charges,,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Outpatient,5 mL,mL,,13,11.05,3.7258,13,Humana Insurance Company,Medicare PPO,6.37,49,,percent of total billed charges,,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Outpatient,5 mL,mL,,21,17.85,6.0186,21,Humana Insurance Company,Medicare PPO,10.29,49,,percent of total billed charges,,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Outpatient,5 mL,mL,,24,20.4,6.8784,24,Humana Insurance Company,Medicare PPO,11.76,49,,percent of total billed charges,,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Inpatient,5 mL,mL,,13,11.05,3.7258,13,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Inpatient,5 mL,mL,,21,17.85,6.0186,21,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Inpatient,5 mL,mL,,24,20.4,6.8784,24,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Both,5 mL,mL,,13,11.05,3.7258,13,Medica,Individual & Family,12.883,99.1,,percent of total billed charges,,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Both,5 mL,mL,,21,17.85,6.0186,21,Medica,Individual & Family,20.811,99.1,,percent of total billed charges,,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Both,5 mL,mL,,24,20.4,6.8784,24,Medica,Individual & Family,23.784,99.1,,percent of total billed charges,,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Outpatient,5 mL,mL,,13,11.05,3.7258,13,Medica,Medica Advantage Solution,6.474,49.8,,percent of total billed charges,,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Outpatient,5 mL,mL,,21,17.85,6.0186,21,Medica,Medica Advantage Solution,10.458,49.8,,percent of total billed charges,,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Outpatient,5 mL,mL,,24,20.4,6.8784,24,Medica,Medica Advantage Solution,11.952,49.8,,percent of total billed charges,,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Inpatient,5 mL,mL,,13,11.05,3.7258,13,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Inpatient,5 mL,mL,,21,17.85,6.0186,21,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Inpatient,5 mL,mL,,24,20.4,6.8784,24,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Outpatient,5 mL,mL,,13,11.05,3.7258,13,Medica,Medical Assistance,5.798,44.6,,percent of total billed charges,,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Outpatient,5 mL,mL,,21,17.85,6.0186,21,Medica,Medical Assistance,9.366,44.6,,percent of total billed charges,,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Outpatient,5 mL,mL,,24,20.4,6.8784,24,Medica,Medical Assistance,10.704,44.6,,percent of total billed charges,,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Inpatient,5 mL,mL,,13,11.05,3.7258,13,Medica,Medical Assistance,,,,,Included in per diem rate,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Inpatient,5 mL,mL,,21,17.85,6.0186,21,Medica,Medical Assistance,,,,,Included in per diem rate,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Inpatient,5 mL,mL,,24,20.4,6.8784,24,Medica,Medical Assistance,,,,,Included in per diem rate,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Outpatient,5 mL,mL,,13,11.05,3.7258,13,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,6.474,49.8,,percent of total billed charges,,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Outpatient,5 mL,mL,,21,17.85,6.0186,21,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,10.458,49.8,,percent of total billed charges,,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Outpatient,5 mL,mL,,24,20.4,6.8784,24,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,11.952,49.8,,percent of total billed charges,,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Inpatient,5 mL,mL,,13,11.05,3.7258,13,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Inpatient,5 mL,mL,,21,17.85,6.0186,21,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Inpatient,5 mL,mL,,24,20.4,6.8784,24,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Both,5 mL,mL,,13,11.05,3.7258,13,"Multiplan, Inc.","Multiplan, Inc.",12.22,94,,percent of total billed charges,,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Both,5 mL,mL,,21,17.85,6.0186,21,"Multiplan, Inc.","Multiplan, Inc.",19.74,94,,percent of total billed charges,,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Both,5 mL,mL,,24,20.4,6.8784,24,"Multiplan, Inc.","Multiplan, Inc.",22.56,94,,percent of total billed charges,,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Outpatient,5 mL,mL,,13,11.05,3.7258,13,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,11.713,90.1,,percent of total billed charges,,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Outpatient,5 mL,mL,,21,17.85,6.0186,21,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,18.921,90.1,,percent of total billed charges,,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Outpatient,5 mL,mL,,24,20.4,6.8784,24,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,21.624,90.1,,percent of total billed charges,,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Inpatient,5 mL,mL,,13,11.05,3.7258,13,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Inpatient,5 mL,mL,,21,17.85,6.0186,21,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Inpatient,5 mL,mL,,24,20.4,6.8784,24,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Both,5 mL,mL,,13,11.05,3.7258,13,"Preferred One Administrative Services, INC.",PPO,12.818,98.6,,percent of total billed charges,,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Both,5 mL,mL,,21,17.85,6.0186,21,"Preferred One Administrative Services, INC.",PPO,20.706,98.6,,percent of total billed charges,,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Both,5 mL,mL,,24,20.4,6.8784,24,"Preferred One Administrative Services, INC.",PPO,23.664,98.6,,percent of total billed charges,,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Outpatient,5 mL,mL,,13,11.05,3.7258,13,PrimeWest Health,Minnesota Senior Health Options (MSHO),6.6885,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Outpatient,5 mL,mL,,21,17.85,6.0186,21,PrimeWest Health,Minnesota Senior Health Options (MSHO),10.8045,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Outpatient,5 mL,mL,,24,20.4,6.8784,24,PrimeWest Health,Minnesota Senior Health Options (MSHO),12.348,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Inpatient,5 mL,mL,,13,11.05,3.7258,13,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Inpatient,5 mL,mL,,21,17.85,6.0186,21,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Inpatient,5 mL,mL,,24,20.4,6.8784,24,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Outpatient,5 mL,mL,,13,11.05,3.7258,13,PrimeWest Health,MinnesotaCare,6.6768,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Outpatient,5 mL,mL,,21,17.85,6.0186,21,PrimeWest Health,MinnesotaCare,10.7856,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Outpatient,5 mL,mL,,24,20.4,6.8784,24,PrimeWest Health,MinnesotaCare,12.3264,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Inpatient,5 mL,mL,,13,11.05,3.7258,13,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Inpatient,5 mL,mL,,21,17.85,6.0186,21,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Inpatient,5 mL,mL,,24,20.4,6.8784,24,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Both,5 mL,mL,,13,11.05,3.7258,13,Sanford Health Plan,Sanford Health Plan,11.96,92,,percent of total billed charges,,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Both,5 mL,mL,,21,17.85,6.0186,21,Sanford Health Plan,Sanford Health Plan,19.32,92,,percent of total billed charges,,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Both,5 mL,mL,,24,20.4,6.8784,24,Sanford Health Plan,Sanford Health Plan,22.08,92,,percent of total billed charges,,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Outpatient,5 mL,mL,,13,11.05,3.7258,13,"UCare Health, Inc.",Individual & Family Plan,7.3255,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Outpatient,5 mL,mL,,21,17.85,6.0186,21,"UCare Health, Inc.",Individual & Family Plan,11.8335,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Outpatient,5 mL,mL,,24,20.4,6.8784,24,"UCare Health, Inc.",Individual & Family Plan,13.524,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Inpatient,5 mL,mL,,13,11.05,3.7258,13,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Inpatient,5 mL,mL,,21,17.85,6.0186,21,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Inpatient,5 mL,mL,,24,20.4,6.8784,24,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Outpatient,5 mL,mL,,13,11.05,3.7258,13,"UCare Health, Inc.",Medical Assistance,6.5611,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Outpatient,5 mL,mL,,21,17.85,6.0186,21,"UCare Health, Inc.",Medical Assistance,10.5987,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Outpatient,5 mL,mL,,24,20.4,6.8784,24,"UCare Health, Inc.",Medical Assistance,12.1128,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Inpatient,5 mL,mL,,13,11.05,3.7258,13,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Inpatient,5 mL,mL,,21,17.85,6.0186,21,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Inpatient,5 mL,mL,,24,20.4,6.8784,24,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Outpatient,5 mL,mL,,13,11.05,3.7258,13,"UCare Health, Inc.",Medicare Advantage,6.5611,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Outpatient,5 mL,mL,,21,17.85,6.0186,21,"UCare Health, Inc.",Medicare Advantage,10.5987,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Outpatient,5 mL,mL,,24,20.4,6.8784,24,"UCare Health, Inc.",Medicare Advantage,12.1128,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Inpatient,5 mL,mL,,13,11.05,3.7258,13,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Inpatient,5 mL,mL,,21,17.85,6.0186,21,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Inpatient,5 mL,mL,,24,20.4,6.8784,24,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Outpatient,5 mL,mL,,13,11.05,3.7258,13,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),6.5611,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Outpatient,5 mL,mL,,21,17.85,6.0186,21,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),10.5987,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Outpatient,5 mL,mL,,24,20.4,6.8784,24,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),12.1128,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Inpatient,5 mL,mL,,13,11.05,3.7258,13,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Inpatient,5 mL,mL,,21,17.85,6.0186,21,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Inpatient,5 mL,mL,,24,20.4,6.8784,24,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Both,5 mL,mL,,13,11.05,3.7258,13,UnitedHealthcare,Individual & Family,12.22,94,,percent of total billed charges,,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Both,5 mL,mL,,21,17.85,6.0186,21,UnitedHealthcare,Individual & Family,19.74,94,,percent of total billed charges,,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Both,5 mL,mL,,24,20.4,6.8784,24,UnitedHealthcare,Individual & Family,22.56,94,,percent of total billed charges,,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Outpatient,5 mL,mL,,13,11.05,3.7258,13,UnitedHealthcare,Medicare Advantage,6.37,49,,percent of total billed charges,,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Outpatient,5 mL,mL,,21,17.85,6.0186,21,UnitedHealthcare,Medicare Advantage,10.29,49,,percent of total billed charges,,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Outpatient,5 mL,mL,,24,20.4,6.8784,24,UnitedHealthcare,Medicare Advantage,11.76,49,,percent of total billed charges,,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Inpatient,5 mL,mL,,13,11.05,3.7258,13,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Inpatient,5 mL,mL,,21,17.85,6.0186,21,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Inpatient,5 mL,mL,,24,20.4,6.8784,24,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Outpatient,5 mL,mL,,13,11.05,3.7258,13,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,6.24,48,,percent of total billed charges,,100% of DHS outpatient percentage
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Outpatient,5 mL,mL,,21,17.85,6.0186,21,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,10.08,48,,percent of total billed charges,,100% of DHS outpatient percentage
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Outpatient,5 mL,mL,,24,20.4,6.8784,24,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,11.52,48,,percent of total billed charges,,100% of DHS outpatient percentage
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Inpatient,5 mL,mL,,13,11.05,3.7258,13,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Inpatient,5 mL,mL,,21,17.85,6.0186,21,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN,,66150,LOCAL,Facility,Inpatient,5 mL,mL,,24,20.4,6.8784,24,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Both,5 mL,mL,,22,18.7,6.3052,22,Aetna,Commercial,20.24,92,,percent of total billed charges,,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Both,5 mL,mL,,22,18.7,6.3052,22,Aetna,Commercial,20.24,92,,percent of total billed charges,,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Outpatient,5 mL,mL,,22,18.7,6.3052,22,Aetna,Medicare Advantage,10.78,49,,percent of total billed charges,,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Outpatient,5 mL,mL,,22,18.7,6.3052,22,Aetna,Medicare Advantage,10.78,49,,percent of total billed charges,,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Inpatient,5 mL,mL,,22,18.7,6.3052,22,Aetna,Medicare Advantage,,,,,Included in per diem rate,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Inpatient,5 mL,mL,,22,18.7,6.3052,22,Aetna,Medicare Advantage,,,,,Included in per diem rate,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Both,5 mL,mL,,22,18.7,6.3052,22,Aetna,PPO,20.46,93,,percent of total billed charges,,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Both,5 mL,mL,,22,18.7,6.3052,22,Aetna,PPO,20.46,93,,percent of total billed charges,,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Both,5 mL,mL,,22,18.7,6.3052,22,America's PPO,America's PPO,21.1266,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Both,5 mL,mL,,22,18.7,6.3052,22,America's PPO,America's PPO,21.1266,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Both,5 mL,mL,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota, Federal Employee Program,21.648,98.4,,percent of total billed charges,,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Both,5 mL,mL,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota, Federal Employee Program,21.648,98.4,,percent of total billed charges,,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Both,5 mL,mL,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,22,100,,percent of total billed charges,,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Both,5 mL,mL,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,22,100,,percent of total billed charges,,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Both,5 mL,mL,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota,High Value Network Plan,19.8,90,,percent of total billed charges,,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Both,5 mL,mL,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota,High Value Network Plan,19.8,90,,percent of total billed charges,,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Outpatient,5 mL,mL,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota,Medicare Advantage,10.78,49,,percent of total billed charges,,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Outpatient,5 mL,mL,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota,Medicare Advantage,10.78,49,,percent of total billed charges,,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Inpatient,5 mL,mL,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Inpatient,5 mL,mL,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Both,5 mL,mL,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,19.4854,88.57,,percent of total billed charges,,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Both,5 mL,mL,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,19.4854,88.57,,percent of total billed charges,,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Both,5 mL,mL,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,6.3052,28.66,,percent of total billed charges,,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Both,5 mL,mL,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,6.3052,28.66,,percent of total billed charges,,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Outpatient,5 mL,mL,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),10.78,49,,percent of total billed charges,,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Outpatient,5 mL,mL,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),10.78,49,,percent of total billed charges,,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Inpatient,5 mL,mL,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Inpatient,5 mL,mL,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Both,5 mL,mL,,22,18.7,6.3052,22,CorVel,Worker's Compensation,22,100,,percent of total billed charges,,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Both,5 mL,mL,,22,18.7,6.3052,22,CorVel,Worker's Compensation,22,100,,percent of total billed charges,,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Both,5 mL,mL,,22,18.7,6.3052,22,First Health Group Corporation,First Health Network,21.34,97,,percent of total billed charges,,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Both,5 mL,mL,,22,18.7,6.3052,22,First Health Group Corporation,First Health Network,21.34,97,,percent of total billed charges,,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Both,5 mL,mL,,22,18.7,6.3052,22,"Health Partners, Inc.",Commercial,20.812,94.6,,percent of total billed charges,,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Both,5 mL,mL,,22,18.7,6.3052,22,"Health Partners, Inc.",Commercial,20.812,94.6,,percent of total billed charges,,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Outpatient,5 mL,mL,,22,18.7,6.3052,22,"Health Partners, Inc.",Medicare Advantage,10.78,49,,percent of total billed charges,,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Outpatient,5 mL,mL,,22,18.7,6.3052,22,"Health Partners, Inc.",Medicare Advantage,10.78,49,,percent of total billed charges,,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Inpatient,5 mL,mL,,22,18.7,6.3052,22,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Inpatient,5 mL,mL,,22,18.7,6.3052,22,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Both,5 mL,mL,,22,18.7,6.3052,22,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),13.2,60,,percent of total billed charges,,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Both,5 mL,mL,,22,18.7,6.3052,22,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),13.2,60,,percent of total billed charges,,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Both,5 mL,mL,,22,18.7,6.3052,22,"Health Partners, Inc.",State of Minnesota Advantage Program,17.93,81.5,,percent of total billed charges,,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Both,5 mL,mL,,22,18.7,6.3052,22,"Health Partners, Inc.",State of Minnesota Advantage Program,17.93,81.5,,percent of total billed charges,,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Both,5 mL,mL,,22,18.7,6.3052,22,"Health Partners, Inc.",State Public Programs,11,50,,percent of total billed charges,,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Both,5 mL,mL,,22,18.7,6.3052,22,"Health Partners, Inc.",State Public Programs,11,50,,percent of total billed charges,,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Both,5 mL,mL,,22,18.7,6.3052,22,Humana Insurance Company,Commercial PPO,20.9,95,,percent of total billed charges,,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Both,5 mL,mL,,22,18.7,6.3052,22,Humana Insurance Company,Commercial PPO,20.9,95,,percent of total billed charges,,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Outpatient,5 mL,mL,,22,18.7,6.3052,22,Humana Insurance Company,Medicare PPO,10.78,49,,percent of total billed charges,,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Outpatient,5 mL,mL,,22,18.7,6.3052,22,Humana Insurance Company,Medicare PPO,10.78,49,,percent of total billed charges,,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Inpatient,5 mL,mL,,22,18.7,6.3052,22,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Inpatient,5 mL,mL,,22,18.7,6.3052,22,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Both,5 mL,mL,,22,18.7,6.3052,22,Medica,Individual & Family,21.802,99.1,,percent of total billed charges,,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Both,5 mL,mL,,22,18.7,6.3052,22,Medica,Individual & Family,21.802,99.1,,percent of total billed charges,,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Outpatient,5 mL,mL,,22,18.7,6.3052,22,Medica,Medica Advantage Solution,10.956,49.8,,percent of total billed charges,,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Outpatient,5 mL,mL,,22,18.7,6.3052,22,Medica,Medica Advantage Solution,10.956,49.8,,percent of total billed charges,,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Inpatient,5 mL,mL,,22,18.7,6.3052,22,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Inpatient,5 mL,mL,,22,18.7,6.3052,22,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Outpatient,5 mL,mL,,22,18.7,6.3052,22,Medica,Medical Assistance,9.812,44.6,,percent of total billed charges,,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Outpatient,5 mL,mL,,22,18.7,6.3052,22,Medica,Medical Assistance,9.812,44.6,,percent of total billed charges,,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Inpatient,5 mL,mL,,22,18.7,6.3052,22,Medica,Medical Assistance,,,,,Included in per diem rate,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Inpatient,5 mL,mL,,22,18.7,6.3052,22,Medica,Medical Assistance,,,,,Included in per diem rate,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Outpatient,5 mL,mL,,22,18.7,6.3052,22,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,10.956,49.8,,percent of total billed charges,,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Outpatient,5 mL,mL,,22,18.7,6.3052,22,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,10.956,49.8,,percent of total billed charges,,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Inpatient,5 mL,mL,,22,18.7,6.3052,22,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Inpatient,5 mL,mL,,22,18.7,6.3052,22,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Both,5 mL,mL,,22,18.7,6.3052,22,"Multiplan, Inc.","Multiplan, Inc.",20.68,94,,percent of total billed charges,,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Both,5 mL,mL,,22,18.7,6.3052,22,"Multiplan, Inc.","Multiplan, Inc.",20.68,94,,percent of total billed charges,,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Outpatient,5 mL,mL,,22,18.7,6.3052,22,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,19.822,90.1,,percent of total billed charges,,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Outpatient,5 mL,mL,,22,18.7,6.3052,22,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,19.822,90.1,,percent of total billed charges,,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Inpatient,5 mL,mL,,22,18.7,6.3052,22,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Inpatient,5 mL,mL,,22,18.7,6.3052,22,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Both,5 mL,mL,,22,18.7,6.3052,22,"Preferred One Administrative Services, INC.",PPO,21.692,98.6,,percent of total billed charges,,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Both,5 mL,mL,,22,18.7,6.3052,22,"Preferred One Administrative Services, INC.",PPO,21.692,98.6,,percent of total billed charges,,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Outpatient,5 mL,mL,,22,18.7,6.3052,22,PrimeWest Health,Minnesota Senior Health Options (MSHO),11.319,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Outpatient,5 mL,mL,,22,18.7,6.3052,22,PrimeWest Health,Minnesota Senior Health Options (MSHO),11.319,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Inpatient,5 mL,mL,,22,18.7,6.3052,22,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Inpatient,5 mL,mL,,22,18.7,6.3052,22,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Outpatient,5 mL,mL,,22,18.7,6.3052,22,PrimeWest Health,MinnesotaCare,11.2992,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Outpatient,5 mL,mL,,22,18.7,6.3052,22,PrimeWest Health,MinnesotaCare,11.2992,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Inpatient,5 mL,mL,,22,18.7,6.3052,22,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Inpatient,5 mL,mL,,22,18.7,6.3052,22,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Both,5 mL,mL,,22,18.7,6.3052,22,Sanford Health Plan,Sanford Health Plan,20.24,92,,percent of total billed charges,,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Both,5 mL,mL,,22,18.7,6.3052,22,Sanford Health Plan,Sanford Health Plan,20.24,92,,percent of total billed charges,,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Outpatient,5 mL,mL,,22,18.7,6.3052,22,"UCare Health, Inc.",Individual & Family Plan,12.397,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Outpatient,5 mL,mL,,22,18.7,6.3052,22,"UCare Health, Inc.",Individual & Family Plan,12.397,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Inpatient,5 mL,mL,,22,18.7,6.3052,22,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Inpatient,5 mL,mL,,22,18.7,6.3052,22,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Outpatient,5 mL,mL,,22,18.7,6.3052,22,"UCare Health, Inc.",Medical Assistance,11.1034,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Outpatient,5 mL,mL,,22,18.7,6.3052,22,"UCare Health, Inc.",Medical Assistance,11.1034,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Inpatient,5 mL,mL,,22,18.7,6.3052,22,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Inpatient,5 mL,mL,,22,18.7,6.3052,22,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Outpatient,5 mL,mL,,22,18.7,6.3052,22,"UCare Health, Inc.",Medicare Advantage,11.1034,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Outpatient,5 mL,mL,,22,18.7,6.3052,22,"UCare Health, Inc.",Medicare Advantage,11.1034,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Inpatient,5 mL,mL,,22,18.7,6.3052,22,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Inpatient,5 mL,mL,,22,18.7,6.3052,22,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Outpatient,5 mL,mL,,22,18.7,6.3052,22,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),11.1034,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Outpatient,5 mL,mL,,22,18.7,6.3052,22,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),11.1034,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Inpatient,5 mL,mL,,22,18.7,6.3052,22,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Inpatient,5 mL,mL,,22,18.7,6.3052,22,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Both,5 mL,mL,,22,18.7,6.3052,22,UnitedHealthcare,Individual & Family,20.68,94,,percent of total billed charges,,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Both,5 mL,mL,,22,18.7,6.3052,22,UnitedHealthcare,Individual & Family,20.68,94,,percent of total billed charges,,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Outpatient,5 mL,mL,,22,18.7,6.3052,22,UnitedHealthcare,Medicare Advantage,10.78,49,,percent of total billed charges,,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Outpatient,5 mL,mL,,22,18.7,6.3052,22,UnitedHealthcare,Medicare Advantage,10.78,49,,percent of total billed charges,,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Inpatient,5 mL,mL,,22,18.7,6.3052,22,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Inpatient,5 mL,mL,,22,18.7,6.3052,22,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Outpatient,5 mL,mL,,22,18.7,6.3052,22,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,10.56,48,,percent of total billed charges,,100% of DHS outpatient percentage
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Outpatient,5 mL,mL,,22,18.7,6.3052,22,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,10.56,48,,percent of total billed charges,,100% of DHS outpatient percentage
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Inpatient,5 mL,mL,,22,18.7,6.3052,22,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN,,66151,LOCAL,Facility,Inpatient,5 mL,mL,,22,18.7,6.3052,22,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
LIDOCAINE (PF) 100 MG/5 ML (2 %) IV SYRG,,66155,LOCAL,Facility,Both,5 mL,mL,,32,27.2,9.1712,32,Aetna,Commercial,29.44,92,,percent of total billed charges,,
LIDOCAINE (PF) 100 MG/5 ML (2 %) IV SYRG,,66155,LOCAL,Facility,Outpatient,5 mL,mL,,32,27.2,9.1712,32,Aetna,Medicare Advantage,15.68,49,,percent of total billed charges,,
LIDOCAINE (PF) 100 MG/5 ML (2 %) IV SYRG,,66155,LOCAL,Facility,Inpatient,5 mL,mL,,32,27.2,9.1712,32,Aetna,Medicare Advantage,,,,,Included in per diem rate,
LIDOCAINE (PF) 100 MG/5 ML (2 %) IV SYRG,,66155,LOCAL,Facility,Both,5 mL,mL,,32,27.2,9.1712,32,Aetna,PPO,29.76,93,,percent of total billed charges,,
LIDOCAINE (PF) 100 MG/5 ML (2 %) IV SYRG,,66155,LOCAL,Facility,Both,5 mL,mL,,32,27.2,9.1712,32,America's PPO,America's PPO,30.7296,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
LIDOCAINE (PF) 100 MG/5 ML (2 %) IV SYRG,,66155,LOCAL,Facility,Both,5 mL,mL,,32,27.2,9.1712,32,BlueCross BlueShield Minnesota, Federal Employee Program,31.488,98.4,,percent of total billed charges,,
LIDOCAINE (PF) 100 MG/5 ML (2 %) IV SYRG,,66155,LOCAL,Facility,Both,5 mL,mL,,32,27.2,9.1712,32,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,32,100,,percent of total billed charges,,
LIDOCAINE (PF) 100 MG/5 ML (2 %) IV SYRG,,66155,LOCAL,Facility,Both,5 mL,mL,,32,27.2,9.1712,32,BlueCross BlueShield Minnesota,High Value Network Plan,28.8,90,,percent of total billed charges,,
LIDOCAINE (PF) 100 MG/5 ML (2 %) IV SYRG,,66155,LOCAL,Facility,Outpatient,5 mL,mL,,32,27.2,9.1712,32,BlueCross BlueShield Minnesota,Medicare Advantage,15.68,49,,percent of total billed charges,,
LIDOCAINE (PF) 100 MG/5 ML (2 %) IV SYRG,,66155,LOCAL,Facility,Inpatient,5 mL,mL,,32,27.2,9.1712,32,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
LIDOCAINE (PF) 100 MG/5 ML (2 %) IV SYRG,,66155,LOCAL,Facility,Both,5 mL,mL,,32,27.2,9.1712,32,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,28.3424,88.57,,percent of total billed charges,,
LIDOCAINE (PF) 100 MG/5 ML (2 %) IV SYRG,,66155,LOCAL,Facility,Both,5 mL,mL,,32,27.2,9.1712,32,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,9.1712,28.66,,percent of total billed charges,,
LIDOCAINE (PF) 100 MG/5 ML (2 %) IV SYRG,,66155,LOCAL,Facility,Outpatient,5 mL,mL,,32,27.2,9.1712,32,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),15.68,49,,percent of total billed charges,,
LIDOCAINE (PF) 100 MG/5 ML (2 %) IV SYRG,,66155,LOCAL,Facility,Inpatient,5 mL,mL,,32,27.2,9.1712,32,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
LIDOCAINE (PF) 100 MG/5 ML (2 %) IV SYRG,,66155,LOCAL,Facility,Both,5 mL,mL,,32,27.2,9.1712,32,CorVel,Worker's Compensation,32,100,,percent of total billed charges,,
LIDOCAINE (PF) 100 MG/5 ML (2 %) IV SYRG,,66155,LOCAL,Facility,Both,5 mL,mL,,32,27.2,9.1712,32,First Health Group Corporation,First Health Network,31.04,97,,percent of total billed charges,,
LIDOCAINE (PF) 100 MG/5 ML (2 %) IV SYRG,,66155,LOCAL,Facility,Both,5 mL,mL,,32,27.2,9.1712,32,"Health Partners, Inc.",Commercial,30.272,94.6,,percent of total billed charges,,
LIDOCAINE (PF) 100 MG/5 ML (2 %) IV SYRG,,66155,LOCAL,Facility,Outpatient,5 mL,mL,,32,27.2,9.1712,32,"Health Partners, Inc.",Medicare Advantage,15.68,49,,percent of total billed charges,,
LIDOCAINE (PF) 100 MG/5 ML (2 %) IV SYRG,,66155,LOCAL,Facility,Inpatient,5 mL,mL,,32,27.2,9.1712,32,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LIDOCAINE (PF) 100 MG/5 ML (2 %) IV SYRG,,66155,LOCAL,Facility,Both,5 mL,mL,,32,27.2,9.1712,32,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),19.2,60,,percent of total billed charges,,
LIDOCAINE (PF) 100 MG/5 ML (2 %) IV SYRG,,66155,LOCAL,Facility,Both,5 mL,mL,,32,27.2,9.1712,32,"Health Partners, Inc.",State of Minnesota Advantage Program,26.08,81.5,,percent of total billed charges,,
LIDOCAINE (PF) 100 MG/5 ML (2 %) IV SYRG,,66155,LOCAL,Facility,Both,5 mL,mL,,32,27.2,9.1712,32,"Health Partners, Inc.",State Public Programs,16,50,,percent of total billed charges,,
LIDOCAINE (PF) 100 MG/5 ML (2 %) IV SYRG,,66155,LOCAL,Facility,Both,5 mL,mL,,32,27.2,9.1712,32,Humana Insurance Company,Commercial PPO,30.4,95,,percent of total billed charges,,
LIDOCAINE (PF) 100 MG/5 ML (2 %) IV SYRG,,66155,LOCAL,Facility,Outpatient,5 mL,mL,,32,27.2,9.1712,32,Humana Insurance Company,Medicare PPO,15.68,49,,percent of total billed charges,,
LIDOCAINE (PF) 100 MG/5 ML (2 %) IV SYRG,,66155,LOCAL,Facility,Inpatient,5 mL,mL,,32,27.2,9.1712,32,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
LIDOCAINE (PF) 100 MG/5 ML (2 %) IV SYRG,,66155,LOCAL,Facility,Both,5 mL,mL,,32,27.2,9.1712,32,Medica,Individual & Family,31.712,99.1,,percent of total billed charges,,
LIDOCAINE (PF) 100 MG/5 ML (2 %) IV SYRG,,66155,LOCAL,Facility,Outpatient,5 mL,mL,,32,27.2,9.1712,32,Medica,Medica Advantage Solution,15.936,49.8,,percent of total billed charges,,
LIDOCAINE (PF) 100 MG/5 ML (2 %) IV SYRG,,66155,LOCAL,Facility,Inpatient,5 mL,mL,,32,27.2,9.1712,32,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
LIDOCAINE (PF) 100 MG/5 ML (2 %) IV SYRG,,66155,LOCAL,Facility,Outpatient,5 mL,mL,,32,27.2,9.1712,32,Medica,Medical Assistance,14.272,44.6,,percent of total billed charges,,
LIDOCAINE (PF) 100 MG/5 ML (2 %) IV SYRG,,66155,LOCAL,Facility,Inpatient,5 mL,mL,,32,27.2,9.1712,32,Medica,Medical Assistance,,,,,Included in per diem rate,
LIDOCAINE (PF) 100 MG/5 ML (2 %) IV SYRG,,66155,LOCAL,Facility,Outpatient,5 mL,mL,,32,27.2,9.1712,32,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,15.936,49.8,,percent of total billed charges,,
LIDOCAINE (PF) 100 MG/5 ML (2 %) IV SYRG,,66155,LOCAL,Facility,Inpatient,5 mL,mL,,32,27.2,9.1712,32,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
LIDOCAINE (PF) 100 MG/5 ML (2 %) IV SYRG,,66155,LOCAL,Facility,Both,5 mL,mL,,32,27.2,9.1712,32,"Multiplan, Inc.","Multiplan, Inc.",30.08,94,,percent of total billed charges,,
LIDOCAINE (PF) 100 MG/5 ML (2 %) IV SYRG,,66155,LOCAL,Facility,Outpatient,5 mL,mL,,32,27.2,9.1712,32,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,28.832,90.1,,percent of total billed charges,,
LIDOCAINE (PF) 100 MG/5 ML (2 %) IV SYRG,,66155,LOCAL,Facility,Inpatient,5 mL,mL,,32,27.2,9.1712,32,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
LIDOCAINE (PF) 100 MG/5 ML (2 %) IV SYRG,,66155,LOCAL,Facility,Both,5 mL,mL,,32,27.2,9.1712,32,"Preferred One Administrative Services, INC.",PPO,31.552,98.6,,percent of total billed charges,,
LIDOCAINE (PF) 100 MG/5 ML (2 %) IV SYRG,,66155,LOCAL,Facility,Outpatient,5 mL,mL,,32,27.2,9.1712,32,PrimeWest Health,Minnesota Senior Health Options (MSHO),16.464,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
LIDOCAINE (PF) 100 MG/5 ML (2 %) IV SYRG,,66155,LOCAL,Facility,Inpatient,5 mL,mL,,32,27.2,9.1712,32,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LIDOCAINE (PF) 100 MG/5 ML (2 %) IV SYRG,,66155,LOCAL,Facility,Outpatient,5 mL,mL,,32,27.2,9.1712,32,PrimeWest Health,MinnesotaCare,16.4352,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
LIDOCAINE (PF) 100 MG/5 ML (2 %) IV SYRG,,66155,LOCAL,Facility,Inpatient,5 mL,mL,,32,27.2,9.1712,32,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
LIDOCAINE (PF) 100 MG/5 ML (2 %) IV SYRG,,66155,LOCAL,Facility,Both,5 mL,mL,,32,27.2,9.1712,32,Sanford Health Plan,Sanford Health Plan,29.44,92,,percent of total billed charges,,
LIDOCAINE (PF) 100 MG/5 ML (2 %) IV SYRG,,66155,LOCAL,Facility,Outpatient,5 mL,mL,,32,27.2,9.1712,32,"UCare Health, Inc.",Individual & Family Plan,18.032,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
LIDOCAINE (PF) 100 MG/5 ML (2 %) IV SYRG,,66155,LOCAL,Facility,Inpatient,5 mL,mL,,32,27.2,9.1712,32,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
LIDOCAINE (PF) 100 MG/5 ML (2 %) IV SYRG,,66155,LOCAL,Facility,Outpatient,5 mL,mL,,32,27.2,9.1712,32,"UCare Health, Inc.",Medical Assistance,16.1504,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LIDOCAINE (PF) 100 MG/5 ML (2 %) IV SYRG,,66155,LOCAL,Facility,Inpatient,5 mL,mL,,32,27.2,9.1712,32,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
LIDOCAINE (PF) 100 MG/5 ML (2 %) IV SYRG,,66155,LOCAL,Facility,Outpatient,5 mL,mL,,32,27.2,9.1712,32,"UCare Health, Inc.",Medicare Advantage,16.1504,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LIDOCAINE (PF) 100 MG/5 ML (2 %) IV SYRG,,66155,LOCAL,Facility,Inpatient,5 mL,mL,,32,27.2,9.1712,32,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LIDOCAINE (PF) 100 MG/5 ML (2 %) IV SYRG,,66155,LOCAL,Facility,Outpatient,5 mL,mL,,32,27.2,9.1712,32,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),16.1504,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LIDOCAINE (PF) 100 MG/5 ML (2 %) IV SYRG,,66155,LOCAL,Facility,Inpatient,5 mL,mL,,32,27.2,9.1712,32,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LIDOCAINE (PF) 100 MG/5 ML (2 %) IV SYRG,,66155,LOCAL,Facility,Both,5 mL,mL,,32,27.2,9.1712,32,UnitedHealthcare,Individual & Family,30.08,94,,percent of total billed charges,,
LIDOCAINE (PF) 100 MG/5 ML (2 %) IV SYRG,,66155,LOCAL,Facility,Outpatient,5 mL,mL,,32,27.2,9.1712,32,UnitedHealthcare,Medicare Advantage,15.68,49,,percent of total billed charges,,
LIDOCAINE (PF) 100 MG/5 ML (2 %) IV SYRG,,66155,LOCAL,Facility,Inpatient,5 mL,mL,,32,27.2,9.1712,32,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
LIDOCAINE (PF) 100 MG/5 ML (2 %) IV SYRG,,66155,LOCAL,Facility,Outpatient,5 mL,mL,,32,27.2,9.1712,32,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,15.36,48,,percent of total billed charges,,100% of DHS outpatient percentage
LIDOCAINE (PF) 100 MG/5 ML (2 %) IV SYRG,,66155,LOCAL,Facility,Inpatient,5 mL,mL,,32,27.2,9.1712,32,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
LIDOCAINE (PF) 50 MG/5 ML (1 %) IV SYRG,,66156,LOCAL,Facility,Both,5 mL,mL,,59,50.15,16.9094,59,Aetna,Commercial,54.28,92,,percent of total billed charges,,
LIDOCAINE (PF) 50 MG/5 ML (1 %) IV SYRG,,66156,LOCAL,Facility,Outpatient,5 mL,mL,,59,50.15,16.9094,59,Aetna,Medicare Advantage,28.91,49,,percent of total billed charges,,
LIDOCAINE (PF) 50 MG/5 ML (1 %) IV SYRG,,66156,LOCAL,Facility,Inpatient,5 mL,mL,,59,50.15,16.9094,59,Aetna,Medicare Advantage,,,,,Included in per diem rate,
LIDOCAINE (PF) 50 MG/5 ML (1 %) IV SYRG,,66156,LOCAL,Facility,Both,5 mL,mL,,59,50.15,16.9094,59,Aetna,PPO,54.87,93,,percent of total billed charges,,
LIDOCAINE (PF) 50 MG/5 ML (1 %) IV SYRG,,66156,LOCAL,Facility,Both,5 mL,mL,,59,50.15,16.9094,59,America's PPO,America's PPO,56.6577,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
LIDOCAINE (PF) 50 MG/5 ML (1 %) IV SYRG,,66156,LOCAL,Facility,Both,5 mL,mL,,59,50.15,16.9094,59,BlueCross BlueShield Minnesota, Federal Employee Program,58.056,98.4,,percent of total billed charges,,
LIDOCAINE (PF) 50 MG/5 ML (1 %) IV SYRG,,66156,LOCAL,Facility,Both,5 mL,mL,,59,50.15,16.9094,59,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,59,100,,percent of total billed charges,,
LIDOCAINE (PF) 50 MG/5 ML (1 %) IV SYRG,,66156,LOCAL,Facility,Both,5 mL,mL,,59,50.15,16.9094,59,BlueCross BlueShield Minnesota,High Value Network Plan,53.1,90,,percent of total billed charges,,
LIDOCAINE (PF) 50 MG/5 ML (1 %) IV SYRG,,66156,LOCAL,Facility,Outpatient,5 mL,mL,,59,50.15,16.9094,59,BlueCross BlueShield Minnesota,Medicare Advantage,28.91,49,,percent of total billed charges,,
LIDOCAINE (PF) 50 MG/5 ML (1 %) IV SYRG,,66156,LOCAL,Facility,Inpatient,5 mL,mL,,59,50.15,16.9094,59,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
LIDOCAINE (PF) 50 MG/5 ML (1 %) IV SYRG,,66156,LOCAL,Facility,Both,5 mL,mL,,59,50.15,16.9094,59,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,52.2563,88.57,,percent of total billed charges,,
LIDOCAINE (PF) 50 MG/5 ML (1 %) IV SYRG,,66156,LOCAL,Facility,Both,5 mL,mL,,59,50.15,16.9094,59,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,16.9094,28.66,,percent of total billed charges,,
LIDOCAINE (PF) 50 MG/5 ML (1 %) IV SYRG,,66156,LOCAL,Facility,Outpatient,5 mL,mL,,59,50.15,16.9094,59,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),28.91,49,,percent of total billed charges,,
LIDOCAINE (PF) 50 MG/5 ML (1 %) IV SYRG,,66156,LOCAL,Facility,Inpatient,5 mL,mL,,59,50.15,16.9094,59,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
LIDOCAINE (PF) 50 MG/5 ML (1 %) IV SYRG,,66156,LOCAL,Facility,Both,5 mL,mL,,59,50.15,16.9094,59,CorVel,Worker's Compensation,59,100,,percent of total billed charges,,
LIDOCAINE (PF) 50 MG/5 ML (1 %) IV SYRG,,66156,LOCAL,Facility,Both,5 mL,mL,,59,50.15,16.9094,59,First Health Group Corporation,First Health Network,57.23,97,,percent of total billed charges,,
LIDOCAINE (PF) 50 MG/5 ML (1 %) IV SYRG,,66156,LOCAL,Facility,Both,5 mL,mL,,59,50.15,16.9094,59,"Health Partners, Inc.",Commercial,55.814,94.6,,percent of total billed charges,,
LIDOCAINE (PF) 50 MG/5 ML (1 %) IV SYRG,,66156,LOCAL,Facility,Outpatient,5 mL,mL,,59,50.15,16.9094,59,"Health Partners, Inc.",Medicare Advantage,28.91,49,,percent of total billed charges,,
LIDOCAINE (PF) 50 MG/5 ML (1 %) IV SYRG,,66156,LOCAL,Facility,Inpatient,5 mL,mL,,59,50.15,16.9094,59,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LIDOCAINE (PF) 50 MG/5 ML (1 %) IV SYRG,,66156,LOCAL,Facility,Both,5 mL,mL,,59,50.15,16.9094,59,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),35.4,60,,percent of total billed charges,,
LIDOCAINE (PF) 50 MG/5 ML (1 %) IV SYRG,,66156,LOCAL,Facility,Both,5 mL,mL,,59,50.15,16.9094,59,"Health Partners, Inc.",State of Minnesota Advantage Program,48.085,81.5,,percent of total billed charges,,
LIDOCAINE (PF) 50 MG/5 ML (1 %) IV SYRG,,66156,LOCAL,Facility,Both,5 mL,mL,,59,50.15,16.9094,59,"Health Partners, Inc.",State Public Programs,29.5,50,,percent of total billed charges,,
LIDOCAINE (PF) 50 MG/5 ML (1 %) IV SYRG,,66156,LOCAL,Facility,Both,5 mL,mL,,59,50.15,16.9094,59,Humana Insurance Company,Commercial PPO,56.05,95,,percent of total billed charges,,
LIDOCAINE (PF) 50 MG/5 ML (1 %) IV SYRG,,66156,LOCAL,Facility,Outpatient,5 mL,mL,,59,50.15,16.9094,59,Humana Insurance Company,Medicare PPO,28.91,49,,percent of total billed charges,,
LIDOCAINE (PF) 50 MG/5 ML (1 %) IV SYRG,,66156,LOCAL,Facility,Inpatient,5 mL,mL,,59,50.15,16.9094,59,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
LIDOCAINE (PF) 50 MG/5 ML (1 %) IV SYRG,,66156,LOCAL,Facility,Both,5 mL,mL,,59,50.15,16.9094,59,Medica,Individual & Family,58.469,99.1,,percent of total billed charges,,
LIDOCAINE (PF) 50 MG/5 ML (1 %) IV SYRG,,66156,LOCAL,Facility,Outpatient,5 mL,mL,,59,50.15,16.9094,59,Medica,Medica Advantage Solution,29.382,49.8,,percent of total billed charges,,
LIDOCAINE (PF) 50 MG/5 ML (1 %) IV SYRG,,66156,LOCAL,Facility,Inpatient,5 mL,mL,,59,50.15,16.9094,59,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
LIDOCAINE (PF) 50 MG/5 ML (1 %) IV SYRG,,66156,LOCAL,Facility,Outpatient,5 mL,mL,,59,50.15,16.9094,59,Medica,Medical Assistance,26.314,44.6,,percent of total billed charges,,
LIDOCAINE (PF) 50 MG/5 ML (1 %) IV SYRG,,66156,LOCAL,Facility,Inpatient,5 mL,mL,,59,50.15,16.9094,59,Medica,Medical Assistance,,,,,Included in per diem rate,
LIDOCAINE (PF) 50 MG/5 ML (1 %) IV SYRG,,66156,LOCAL,Facility,Outpatient,5 mL,mL,,59,50.15,16.9094,59,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,29.382,49.8,,percent of total billed charges,,
LIDOCAINE (PF) 50 MG/5 ML (1 %) IV SYRG,,66156,LOCAL,Facility,Inpatient,5 mL,mL,,59,50.15,16.9094,59,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
LIDOCAINE (PF) 50 MG/5 ML (1 %) IV SYRG,,66156,LOCAL,Facility,Both,5 mL,mL,,59,50.15,16.9094,59,"Multiplan, Inc.","Multiplan, Inc.",55.46,94,,percent of total billed charges,,
LIDOCAINE (PF) 50 MG/5 ML (1 %) IV SYRG,,66156,LOCAL,Facility,Outpatient,5 mL,mL,,59,50.15,16.9094,59,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,53.159,90.1,,percent of total billed charges,,
LIDOCAINE (PF) 50 MG/5 ML (1 %) IV SYRG,,66156,LOCAL,Facility,Inpatient,5 mL,mL,,59,50.15,16.9094,59,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
LIDOCAINE (PF) 50 MG/5 ML (1 %) IV SYRG,,66156,LOCAL,Facility,Both,5 mL,mL,,59,50.15,16.9094,59,"Preferred One Administrative Services, INC.",PPO,58.174,98.6,,percent of total billed charges,,
LIDOCAINE (PF) 50 MG/5 ML (1 %) IV SYRG,,66156,LOCAL,Facility,Outpatient,5 mL,mL,,59,50.15,16.9094,59,PrimeWest Health,Minnesota Senior Health Options (MSHO),30.3555,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
LIDOCAINE (PF) 50 MG/5 ML (1 %) IV SYRG,,66156,LOCAL,Facility,Inpatient,5 mL,mL,,59,50.15,16.9094,59,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LIDOCAINE (PF) 50 MG/5 ML (1 %) IV SYRG,,66156,LOCAL,Facility,Outpatient,5 mL,mL,,59,50.15,16.9094,59,PrimeWest Health,MinnesotaCare,30.3024,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
LIDOCAINE (PF) 50 MG/5 ML (1 %) IV SYRG,,66156,LOCAL,Facility,Inpatient,5 mL,mL,,59,50.15,16.9094,59,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
LIDOCAINE (PF) 50 MG/5 ML (1 %) IV SYRG,,66156,LOCAL,Facility,Both,5 mL,mL,,59,50.15,16.9094,59,Sanford Health Plan,Sanford Health Plan,54.28,92,,percent of total billed charges,,
LIDOCAINE (PF) 50 MG/5 ML (1 %) IV SYRG,,66156,LOCAL,Facility,Outpatient,5 mL,mL,,59,50.15,16.9094,59,"UCare Health, Inc.",Individual & Family Plan,33.2465,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
LIDOCAINE (PF) 50 MG/5 ML (1 %) IV SYRG,,66156,LOCAL,Facility,Inpatient,5 mL,mL,,59,50.15,16.9094,59,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
LIDOCAINE (PF) 50 MG/5 ML (1 %) IV SYRG,,66156,LOCAL,Facility,Outpatient,5 mL,mL,,59,50.15,16.9094,59,"UCare Health, Inc.",Medical Assistance,29.7773,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LIDOCAINE (PF) 50 MG/5 ML (1 %) IV SYRG,,66156,LOCAL,Facility,Inpatient,5 mL,mL,,59,50.15,16.9094,59,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
LIDOCAINE (PF) 50 MG/5 ML (1 %) IV SYRG,,66156,LOCAL,Facility,Outpatient,5 mL,mL,,59,50.15,16.9094,59,"UCare Health, Inc.",Medicare Advantage,29.7773,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LIDOCAINE (PF) 50 MG/5 ML (1 %) IV SYRG,,66156,LOCAL,Facility,Inpatient,5 mL,mL,,59,50.15,16.9094,59,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LIDOCAINE (PF) 50 MG/5 ML (1 %) IV SYRG,,66156,LOCAL,Facility,Outpatient,5 mL,mL,,59,50.15,16.9094,59,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),29.7773,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LIDOCAINE (PF) 50 MG/5 ML (1 %) IV SYRG,,66156,LOCAL,Facility,Inpatient,5 mL,mL,,59,50.15,16.9094,59,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LIDOCAINE (PF) 50 MG/5 ML (1 %) IV SYRG,,66156,LOCAL,Facility,Both,5 mL,mL,,59,50.15,16.9094,59,UnitedHealthcare,Individual & Family,55.46,94,,percent of total billed charges,,
LIDOCAINE (PF) 50 MG/5 ML (1 %) IV SYRG,,66156,LOCAL,Facility,Outpatient,5 mL,mL,,59,50.15,16.9094,59,UnitedHealthcare,Medicare Advantage,28.91,49,,percent of total billed charges,,
LIDOCAINE (PF) 50 MG/5 ML (1 %) IV SYRG,,66156,LOCAL,Facility,Inpatient,5 mL,mL,,59,50.15,16.9094,59,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
LIDOCAINE (PF) 50 MG/5 ML (1 %) IV SYRG,,66156,LOCAL,Facility,Outpatient,5 mL,mL,,59,50.15,16.9094,59,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,28.32,48,,percent of total billed charges,,100% of DHS outpatient percentage
LIDOCAINE (PF) 50 MG/5 ML (1 %) IV SYRG,,66156,LOCAL,Facility,Inpatient,5 mL,mL,,59,50.15,16.9094,59,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
BRIMONIDINE-TIMOLOL 0.2-0.5 % OPHT DROP,,79514,LOCAL,Facility,Both,5 mL,mL,,956,812.6,273.9896,956,Aetna,Commercial,879.52,92,,percent of total billed charges,,
BRIMONIDINE-TIMOLOL 0.2-0.5 % OPHT DROP,,79514,LOCAL,Facility,Outpatient,5 mL,mL,,956,812.6,273.9896,956,Aetna,Medicare Advantage,468.44,49,,percent of total billed charges,,
BRIMONIDINE-TIMOLOL 0.2-0.5 % OPHT DROP,,79514,LOCAL,Facility,Inpatient,5 mL,mL,,956,812.6,273.9896,956,Aetna,Medicare Advantage,,,,,Included in per diem rate,
BRIMONIDINE-TIMOLOL 0.2-0.5 % OPHT DROP,,79514,LOCAL,Facility,Both,5 mL,mL,,956,812.6,273.9896,956,Aetna,PPO,889.08,93,,percent of total billed charges,,
BRIMONIDINE-TIMOLOL 0.2-0.5 % OPHT DROP,,79514,LOCAL,Facility,Both,5 mL,mL,,956,812.6,273.9896,956,America's PPO,America's PPO,918.0468,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
BRIMONIDINE-TIMOLOL 0.2-0.5 % OPHT DROP,,79514,LOCAL,Facility,Both,5 mL,mL,,956,812.6,273.9896,956,BlueCross BlueShield Minnesota, Federal Employee Program,940.704,98.4,,percent of total billed charges,,
BRIMONIDINE-TIMOLOL 0.2-0.5 % OPHT DROP,,79514,LOCAL,Facility,Both,5 mL,mL,,956,812.6,273.9896,956,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,956,100,,percent of total billed charges,,
BRIMONIDINE-TIMOLOL 0.2-0.5 % OPHT DROP,,79514,LOCAL,Facility,Both,5 mL,mL,,956,812.6,273.9896,956,BlueCross BlueShield Minnesota,High Value Network Plan,860.4,90,,percent of total billed charges,,
BRIMONIDINE-TIMOLOL 0.2-0.5 % OPHT DROP,,79514,LOCAL,Facility,Outpatient,5 mL,mL,,956,812.6,273.9896,956,BlueCross BlueShield Minnesota,Medicare Advantage,468.44,49,,percent of total billed charges,,
BRIMONIDINE-TIMOLOL 0.2-0.5 % OPHT DROP,,79514,LOCAL,Facility,Inpatient,5 mL,mL,,956,812.6,273.9896,956,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
BRIMONIDINE-TIMOLOL 0.2-0.5 % OPHT DROP,,79514,LOCAL,Facility,Both,5 mL,mL,,956,812.6,273.9896,956,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,846.7292,88.57,,percent of total billed charges,,
BRIMONIDINE-TIMOLOL 0.2-0.5 % OPHT DROP,,79514,LOCAL,Facility,Both,5 mL,mL,,956,812.6,273.9896,956,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,273.9896,28.66,,percent of total billed charges,,
BRIMONIDINE-TIMOLOL 0.2-0.5 % OPHT DROP,,79514,LOCAL,Facility,Outpatient,5 mL,mL,,956,812.6,273.9896,956,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),468.44,49,,percent of total billed charges,,
BRIMONIDINE-TIMOLOL 0.2-0.5 % OPHT DROP,,79514,LOCAL,Facility,Inpatient,5 mL,mL,,956,812.6,273.9896,956,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
BRIMONIDINE-TIMOLOL 0.2-0.5 % OPHT DROP,,79514,LOCAL,Facility,Both,5 mL,mL,,956,812.6,273.9896,956,CorVel,Worker's Compensation,956,100,,percent of total billed charges,,
BRIMONIDINE-TIMOLOL 0.2-0.5 % OPHT DROP,,79514,LOCAL,Facility,Both,5 mL,mL,,956,812.6,273.9896,956,First Health Group Corporation,First Health Network,927.32,97,,percent of total billed charges,,
BRIMONIDINE-TIMOLOL 0.2-0.5 % OPHT DROP,,79514,LOCAL,Facility,Both,5 mL,mL,,956,812.6,273.9896,956,"Health Partners, Inc.",Commercial,904.376,94.6,,percent of total billed charges,,
BRIMONIDINE-TIMOLOL 0.2-0.5 % OPHT DROP,,79514,LOCAL,Facility,Outpatient,5 mL,mL,,956,812.6,273.9896,956,"Health Partners, Inc.",Medicare Advantage,468.44,49,,percent of total billed charges,,
BRIMONIDINE-TIMOLOL 0.2-0.5 % OPHT DROP,,79514,LOCAL,Facility,Inpatient,5 mL,mL,,956,812.6,273.9896,956,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
BRIMONIDINE-TIMOLOL 0.2-0.5 % OPHT DROP,,79514,LOCAL,Facility,Both,5 mL,mL,,956,812.6,273.9896,956,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),573.6,60,,percent of total billed charges,,
BRIMONIDINE-TIMOLOL 0.2-0.5 % OPHT DROP,,79514,LOCAL,Facility,Both,5 mL,mL,,956,812.6,273.9896,956,"Health Partners, Inc.",State of Minnesota Advantage Program,779.14,81.5,,percent of total billed charges,,
BRIMONIDINE-TIMOLOL 0.2-0.5 % OPHT DROP,,79514,LOCAL,Facility,Both,5 mL,mL,,956,812.6,273.9896,956,"Health Partners, Inc.",State Public Programs,478,50,,percent of total billed charges,,
BRIMONIDINE-TIMOLOL 0.2-0.5 % OPHT DROP,,79514,LOCAL,Facility,Both,5 mL,mL,,956,812.6,273.9896,956,Humana Insurance Company,Commercial PPO,908.2,95,,percent of total billed charges,,
BRIMONIDINE-TIMOLOL 0.2-0.5 % OPHT DROP,,79514,LOCAL,Facility,Outpatient,5 mL,mL,,956,812.6,273.9896,956,Humana Insurance Company,Medicare PPO,468.44,49,,percent of total billed charges,,
BRIMONIDINE-TIMOLOL 0.2-0.5 % OPHT DROP,,79514,LOCAL,Facility,Inpatient,5 mL,mL,,956,812.6,273.9896,956,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
BRIMONIDINE-TIMOLOL 0.2-0.5 % OPHT DROP,,79514,LOCAL,Facility,Both,5 mL,mL,,956,812.6,273.9896,956,Medica,Individual & Family,947.396,99.1,,percent of total billed charges,,
BRIMONIDINE-TIMOLOL 0.2-0.5 % OPHT DROP,,79514,LOCAL,Facility,Outpatient,5 mL,mL,,956,812.6,273.9896,956,Medica,Medica Advantage Solution,476.088,49.8,,percent of total billed charges,,
BRIMONIDINE-TIMOLOL 0.2-0.5 % OPHT DROP,,79514,LOCAL,Facility,Inpatient,5 mL,mL,,956,812.6,273.9896,956,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
BRIMONIDINE-TIMOLOL 0.2-0.5 % OPHT DROP,,79514,LOCAL,Facility,Outpatient,5 mL,mL,,956,812.6,273.9896,956,Medica,Medical Assistance,426.376,44.6,,percent of total billed charges,,
BRIMONIDINE-TIMOLOL 0.2-0.5 % OPHT DROP,,79514,LOCAL,Facility,Inpatient,5 mL,mL,,956,812.6,273.9896,956,Medica,Medical Assistance,,,,,Included in per diem rate,
BRIMONIDINE-TIMOLOL 0.2-0.5 % OPHT DROP,,79514,LOCAL,Facility,Outpatient,5 mL,mL,,956,812.6,273.9896,956,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,476.088,49.8,,percent of total billed charges,,
BRIMONIDINE-TIMOLOL 0.2-0.5 % OPHT DROP,,79514,LOCAL,Facility,Inpatient,5 mL,mL,,956,812.6,273.9896,956,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
BRIMONIDINE-TIMOLOL 0.2-0.5 % OPHT DROP,,79514,LOCAL,Facility,Both,5 mL,mL,,956,812.6,273.9896,956,"Multiplan, Inc.","Multiplan, Inc.",898.64,94,,percent of total billed charges,,
BRIMONIDINE-TIMOLOL 0.2-0.5 % OPHT DROP,,79514,LOCAL,Facility,Outpatient,5 mL,mL,,956,812.6,273.9896,956,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,861.356,90.1,,percent of total billed charges,,
BRIMONIDINE-TIMOLOL 0.2-0.5 % OPHT DROP,,79514,LOCAL,Facility,Inpatient,5 mL,mL,,956,812.6,273.9896,956,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
BRIMONIDINE-TIMOLOL 0.2-0.5 % OPHT DROP,,79514,LOCAL,Facility,Both,5 mL,mL,,956,812.6,273.9896,956,"Preferred One Administrative Services, INC.",PPO,942.616,98.6,,percent of total billed charges,,
BRIMONIDINE-TIMOLOL 0.2-0.5 % OPHT DROP,,79514,LOCAL,Facility,Outpatient,5 mL,mL,,956,812.6,273.9896,956,PrimeWest Health,Minnesota Senior Health Options (MSHO),491.862,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
BRIMONIDINE-TIMOLOL 0.2-0.5 % OPHT DROP,,79514,LOCAL,Facility,Inpatient,5 mL,mL,,956,812.6,273.9896,956,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
BRIMONIDINE-TIMOLOL 0.2-0.5 % OPHT DROP,,79514,LOCAL,Facility,Outpatient,5 mL,mL,,956,812.6,273.9896,956,PrimeWest Health,MinnesotaCare,491.0016,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
BRIMONIDINE-TIMOLOL 0.2-0.5 % OPHT DROP,,79514,LOCAL,Facility,Inpatient,5 mL,mL,,956,812.6,273.9896,956,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
BRIMONIDINE-TIMOLOL 0.2-0.5 % OPHT DROP,,79514,LOCAL,Facility,Both,5 mL,mL,,956,812.6,273.9896,956,Sanford Health Plan,Sanford Health Plan,879.52,92,,percent of total billed charges,,
BRIMONIDINE-TIMOLOL 0.2-0.5 % OPHT DROP,,79514,LOCAL,Facility,Outpatient,5 mL,mL,,956,812.6,273.9896,956,"UCare Health, Inc.",Individual & Family Plan,538.706,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
BRIMONIDINE-TIMOLOL 0.2-0.5 % OPHT DROP,,79514,LOCAL,Facility,Inpatient,5 mL,mL,,956,812.6,273.9896,956,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
BRIMONIDINE-TIMOLOL 0.2-0.5 % OPHT DROP,,79514,LOCAL,Facility,Outpatient,5 mL,mL,,956,812.6,273.9896,956,"UCare Health, Inc.",Medical Assistance,482.4932,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BRIMONIDINE-TIMOLOL 0.2-0.5 % OPHT DROP,,79514,LOCAL,Facility,Inpatient,5 mL,mL,,956,812.6,273.9896,956,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
BRIMONIDINE-TIMOLOL 0.2-0.5 % OPHT DROP,,79514,LOCAL,Facility,Outpatient,5 mL,mL,,956,812.6,273.9896,956,"UCare Health, Inc.",Medicare Advantage,482.4932,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BRIMONIDINE-TIMOLOL 0.2-0.5 % OPHT DROP,,79514,LOCAL,Facility,Inpatient,5 mL,mL,,956,812.6,273.9896,956,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
BRIMONIDINE-TIMOLOL 0.2-0.5 % OPHT DROP,,79514,LOCAL,Facility,Outpatient,5 mL,mL,,956,812.6,273.9896,956,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),482.4932,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BRIMONIDINE-TIMOLOL 0.2-0.5 % OPHT DROP,,79514,LOCAL,Facility,Inpatient,5 mL,mL,,956,812.6,273.9896,956,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
BRIMONIDINE-TIMOLOL 0.2-0.5 % OPHT DROP,,79514,LOCAL,Facility,Both,5 mL,mL,,956,812.6,273.9896,956,UnitedHealthcare,Individual & Family,898.64,94,,percent of total billed charges,,
BRIMONIDINE-TIMOLOL 0.2-0.5 % OPHT DROP,,79514,LOCAL,Facility,Outpatient,5 mL,mL,,956,812.6,273.9896,956,UnitedHealthcare,Medicare Advantage,468.44,49,,percent of total billed charges,,
BRIMONIDINE-TIMOLOL 0.2-0.5 % OPHT DROP,,79514,LOCAL,Facility,Inpatient,5 mL,mL,,956,812.6,273.9896,956,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
BRIMONIDINE-TIMOLOL 0.2-0.5 % OPHT DROP,,79514,LOCAL,Facility,Outpatient,5 mL,mL,,956,812.6,273.9896,956,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,458.88,48,,percent of total billed charges,,100% of DHS outpatient percentage
BRIMONIDINE-TIMOLOL 0.2-0.5 % OPHT DROP,,79514,LOCAL,Facility,Inpatient,5 mL,mL,,956,812.6,273.9896,956,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
DIFLUPREDNATE 0.05 % OPHT DROP,,84196,LOCAL,Facility,Both,5 mL,mL,,1021,867.85,292.6186,1021,Aetna,Commercial,939.32,92,,percent of total billed charges,,
DIFLUPREDNATE 0.05 % OPHT DROP,,84196,LOCAL,Facility,Outpatient,5 mL,mL,,1021,867.85,292.6186,1021,Aetna,Medicare Advantage,500.29,49,,percent of total billed charges,,
DIFLUPREDNATE 0.05 % OPHT DROP,,84196,LOCAL,Facility,Inpatient,5 mL,mL,,1021,867.85,292.6186,1021,Aetna,Medicare Advantage,,,,,Included in per diem rate,
DIFLUPREDNATE 0.05 % OPHT DROP,,84196,LOCAL,Facility,Both,5 mL,mL,,1021,867.85,292.6186,1021,Aetna,PPO,949.53,93,,percent of total billed charges,,
DIFLUPREDNATE 0.05 % OPHT DROP,,84196,LOCAL,Facility,Both,5 mL,mL,,1021,867.85,292.6186,1021,America's PPO,America's PPO,980.4663,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
DIFLUPREDNATE 0.05 % OPHT DROP,,84196,LOCAL,Facility,Both,5 mL,mL,,1021,867.85,292.6186,1021,BlueCross BlueShield Minnesota, Federal Employee Program,1004.664,98.4,,percent of total billed charges,,
DIFLUPREDNATE 0.05 % OPHT DROP,,84196,LOCAL,Facility,Both,5 mL,mL,,1021,867.85,292.6186,1021,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1021,100,,percent of total billed charges,,
DIFLUPREDNATE 0.05 % OPHT DROP,,84196,LOCAL,Facility,Both,5 mL,mL,,1021,867.85,292.6186,1021,BlueCross BlueShield Minnesota,High Value Network Plan,918.9,90,,percent of total billed charges,,
DIFLUPREDNATE 0.05 % OPHT DROP,,84196,LOCAL,Facility,Outpatient,5 mL,mL,,1021,867.85,292.6186,1021,BlueCross BlueShield Minnesota,Medicare Advantage,500.29,49,,percent of total billed charges,,
DIFLUPREDNATE 0.05 % OPHT DROP,,84196,LOCAL,Facility,Inpatient,5 mL,mL,,1021,867.85,292.6186,1021,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
DIFLUPREDNATE 0.05 % OPHT DROP,,84196,LOCAL,Facility,Both,5 mL,mL,,1021,867.85,292.6186,1021,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,904.2997,88.57,,percent of total billed charges,,
DIFLUPREDNATE 0.05 % OPHT DROP,,84196,LOCAL,Facility,Both,5 mL,mL,,1021,867.85,292.6186,1021,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,292.6186,28.66,,percent of total billed charges,,
DIFLUPREDNATE 0.05 % OPHT DROP,,84196,LOCAL,Facility,Outpatient,5 mL,mL,,1021,867.85,292.6186,1021,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),500.29,49,,percent of total billed charges,,
DIFLUPREDNATE 0.05 % OPHT DROP,,84196,LOCAL,Facility,Inpatient,5 mL,mL,,1021,867.85,292.6186,1021,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
DIFLUPREDNATE 0.05 % OPHT DROP,,84196,LOCAL,Facility,Both,5 mL,mL,,1021,867.85,292.6186,1021,CorVel,Worker's Compensation,1021,100,,percent of total billed charges,,
DIFLUPREDNATE 0.05 % OPHT DROP,,84196,LOCAL,Facility,Both,5 mL,mL,,1021,867.85,292.6186,1021,First Health Group Corporation,First Health Network,990.37,97,,percent of total billed charges,,
DIFLUPREDNATE 0.05 % OPHT DROP,,84196,LOCAL,Facility,Both,5 mL,mL,,1021,867.85,292.6186,1021,"Health Partners, Inc.",Commercial,965.866,94.6,,percent of total billed charges,,
DIFLUPREDNATE 0.05 % OPHT DROP,,84196,LOCAL,Facility,Outpatient,5 mL,mL,,1021,867.85,292.6186,1021,"Health Partners, Inc.",Medicare Advantage,500.29,49,,percent of total billed charges,,
DIFLUPREDNATE 0.05 % OPHT DROP,,84196,LOCAL,Facility,Inpatient,5 mL,mL,,1021,867.85,292.6186,1021,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DIFLUPREDNATE 0.05 % OPHT DROP,,84196,LOCAL,Facility,Both,5 mL,mL,,1021,867.85,292.6186,1021,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),612.6,60,,percent of total billed charges,,
DIFLUPREDNATE 0.05 % OPHT DROP,,84196,LOCAL,Facility,Both,5 mL,mL,,1021,867.85,292.6186,1021,"Health Partners, Inc.",State of Minnesota Advantage Program,832.115,81.5,,percent of total billed charges,,
DIFLUPREDNATE 0.05 % OPHT DROP,,84196,LOCAL,Facility,Both,5 mL,mL,,1021,867.85,292.6186,1021,"Health Partners, Inc.",State Public Programs,510.5,50,,percent of total billed charges,,
DIFLUPREDNATE 0.05 % OPHT DROP,,84196,LOCAL,Facility,Both,5 mL,mL,,1021,867.85,292.6186,1021,Humana Insurance Company,Commercial PPO,969.95,95,,percent of total billed charges,,
DIFLUPREDNATE 0.05 % OPHT DROP,,84196,LOCAL,Facility,Outpatient,5 mL,mL,,1021,867.85,292.6186,1021,Humana Insurance Company,Medicare PPO,500.29,49,,percent of total billed charges,,
DIFLUPREDNATE 0.05 % OPHT DROP,,84196,LOCAL,Facility,Inpatient,5 mL,mL,,1021,867.85,292.6186,1021,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
DIFLUPREDNATE 0.05 % OPHT DROP,,84196,LOCAL,Facility,Both,5 mL,mL,,1021,867.85,292.6186,1021,Medica,Individual & Family,1011.811,99.1,,percent of total billed charges,,
DIFLUPREDNATE 0.05 % OPHT DROP,,84196,LOCAL,Facility,Outpatient,5 mL,mL,,1021,867.85,292.6186,1021,Medica,Medica Advantage Solution,508.458,49.8,,percent of total billed charges,,
DIFLUPREDNATE 0.05 % OPHT DROP,,84196,LOCAL,Facility,Inpatient,5 mL,mL,,1021,867.85,292.6186,1021,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
DIFLUPREDNATE 0.05 % OPHT DROP,,84196,LOCAL,Facility,Outpatient,5 mL,mL,,1021,867.85,292.6186,1021,Medica,Medical Assistance,455.366,44.6,,percent of total billed charges,,
DIFLUPREDNATE 0.05 % OPHT DROP,,84196,LOCAL,Facility,Inpatient,5 mL,mL,,1021,867.85,292.6186,1021,Medica,Medical Assistance,,,,,Included in per diem rate,
DIFLUPREDNATE 0.05 % OPHT DROP,,84196,LOCAL,Facility,Outpatient,5 mL,mL,,1021,867.85,292.6186,1021,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,508.458,49.8,,percent of total billed charges,,
DIFLUPREDNATE 0.05 % OPHT DROP,,84196,LOCAL,Facility,Inpatient,5 mL,mL,,1021,867.85,292.6186,1021,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
DIFLUPREDNATE 0.05 % OPHT DROP,,84196,LOCAL,Facility,Both,5 mL,mL,,1021,867.85,292.6186,1021,"Multiplan, Inc.","Multiplan, Inc.",959.74,94,,percent of total billed charges,,
DIFLUPREDNATE 0.05 % OPHT DROP,,84196,LOCAL,Facility,Outpatient,5 mL,mL,,1021,867.85,292.6186,1021,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,919.921,90.1,,percent of total billed charges,,
DIFLUPREDNATE 0.05 % OPHT DROP,,84196,LOCAL,Facility,Inpatient,5 mL,mL,,1021,867.85,292.6186,1021,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
DIFLUPREDNATE 0.05 % OPHT DROP,,84196,LOCAL,Facility,Both,5 mL,mL,,1021,867.85,292.6186,1021,"Preferred One Administrative Services, INC.",PPO,1006.706,98.6,,percent of total billed charges,,
DIFLUPREDNATE 0.05 % OPHT DROP,,84196,LOCAL,Facility,Outpatient,5 mL,mL,,1021,867.85,292.6186,1021,PrimeWest Health,Minnesota Senior Health Options (MSHO),525.3045,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
DIFLUPREDNATE 0.05 % OPHT DROP,,84196,LOCAL,Facility,Inpatient,5 mL,mL,,1021,867.85,292.6186,1021,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DIFLUPREDNATE 0.05 % OPHT DROP,,84196,LOCAL,Facility,Outpatient,5 mL,mL,,1021,867.85,292.6186,1021,PrimeWest Health,MinnesotaCare,524.3856,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
DIFLUPREDNATE 0.05 % OPHT DROP,,84196,LOCAL,Facility,Inpatient,5 mL,mL,,1021,867.85,292.6186,1021,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
DIFLUPREDNATE 0.05 % OPHT DROP,,84196,LOCAL,Facility,Both,5 mL,mL,,1021,867.85,292.6186,1021,Sanford Health Plan,Sanford Health Plan,939.32,92,,percent of total billed charges,,
DIFLUPREDNATE 0.05 % OPHT DROP,,84196,LOCAL,Facility,Outpatient,5 mL,mL,,1021,867.85,292.6186,1021,"UCare Health, Inc.",Individual & Family Plan,575.3335,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
DIFLUPREDNATE 0.05 % OPHT DROP,,84196,LOCAL,Facility,Inpatient,5 mL,mL,,1021,867.85,292.6186,1021,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
DIFLUPREDNATE 0.05 % OPHT DROP,,84196,LOCAL,Facility,Outpatient,5 mL,mL,,1021,867.85,292.6186,1021,"UCare Health, Inc.",Medical Assistance,515.2987,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DIFLUPREDNATE 0.05 % OPHT DROP,,84196,LOCAL,Facility,Inpatient,5 mL,mL,,1021,867.85,292.6186,1021,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
DIFLUPREDNATE 0.05 % OPHT DROP,,84196,LOCAL,Facility,Outpatient,5 mL,mL,,1021,867.85,292.6186,1021,"UCare Health, Inc.",Medicare Advantage,515.2987,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DIFLUPREDNATE 0.05 % OPHT DROP,,84196,LOCAL,Facility,Inpatient,5 mL,mL,,1021,867.85,292.6186,1021,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DIFLUPREDNATE 0.05 % OPHT DROP,,84196,LOCAL,Facility,Outpatient,5 mL,mL,,1021,867.85,292.6186,1021,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),515.2987,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DIFLUPREDNATE 0.05 % OPHT DROP,,84196,LOCAL,Facility,Inpatient,5 mL,mL,,1021,867.85,292.6186,1021,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DIFLUPREDNATE 0.05 % OPHT DROP,,84196,LOCAL,Facility,Both,5 mL,mL,,1021,867.85,292.6186,1021,UnitedHealthcare,Individual & Family,959.74,94,,percent of total billed charges,,
DIFLUPREDNATE 0.05 % OPHT DROP,,84196,LOCAL,Facility,Outpatient,5 mL,mL,,1021,867.85,292.6186,1021,UnitedHealthcare,Medicare Advantage,500.29,49,,percent of total billed charges,,
DIFLUPREDNATE 0.05 % OPHT DROP,,84196,LOCAL,Facility,Inpatient,5 mL,mL,,1021,867.85,292.6186,1021,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
DIFLUPREDNATE 0.05 % OPHT DROP,,84196,LOCAL,Facility,Outpatient,5 mL,mL,,1021,867.85,292.6186,1021,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,490.08,48,,percent of total billed charges,,100% of DHS outpatient percentage
DIFLUPREDNATE 0.05 % OPHT DROP,,84196,LOCAL,Facility,Inpatient,5 mL,mL,,1021,867.85,292.6186,1021,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
POLIOVIRUS VACCINE 40-8-32 UNIT/0.5 ML INJ SUSP,,90713,CPT,Facility,Both,5 mL,mL,,1724,1465.4,494.0984,1724,Aetna,Commercial,1586.08,92,,percent of total billed charges,,
POLIOVIRUS VACCINE 40-8-32 UNIT/0.5 ML INJ SUSP,,90713,CPT,Facility,Outpatient,5 mL,mL,,1724,1465.4,494.0984,1724,Aetna,Medicare Advantage,844.76,49,,percent of total billed charges,,
POLIOVIRUS VACCINE 40-8-32 UNIT/0.5 ML INJ SUSP,,90713,CPT,Facility,Inpatient,5 mL,mL,,1724,1465.4,494.0984,1724,Aetna,Medicare Advantage,,,,,Included in per diem rate,
POLIOVIRUS VACCINE 40-8-32 UNIT/0.5 ML INJ SUSP,,90713,CPT,Facility,Both,5 mL,mL,,1724,1465.4,494.0984,1724,Aetna,PPO,1603.32,93,,percent of total billed charges,,
POLIOVIRUS VACCINE 40-8-32 UNIT/0.5 ML INJ SUSP,,90713,CPT,Facility,Both,5 mL,mL,,1724,1465.4,494.0984,1724,America's PPO,America's PPO,1655.5572,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
POLIOVIRUS VACCINE 40-8-32 UNIT/0.5 ML INJ SUSP,,90713,CPT,Facility,Both,5 mL,mL,,1724,1465.4,494.0984,1724,BlueCross BlueShield Minnesota, Federal Employee Program,1696.416,98.4,,percent of total billed charges,,
POLIOVIRUS VACCINE 40-8-32 UNIT/0.5 ML INJ SUSP,,90713,CPT,Facility,Both,5 mL,mL,,1724,1465.4,494.0984,1724,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1724,100,,percent of total billed charges,,
POLIOVIRUS VACCINE 40-8-32 UNIT/0.5 ML INJ SUSP,,90713,CPT,Facility,Both,5 mL,mL,,1724,1465.4,494.0984,1724,BlueCross BlueShield Minnesota,High Value Network Plan,1551.6,90,,percent of total billed charges,,
POLIOVIRUS VACCINE 40-8-32 UNIT/0.5 ML INJ SUSP,,90713,CPT,Facility,Outpatient,5 mL,mL,,1724,1465.4,494.0984,1724,BlueCross BlueShield Minnesota,Medicare Advantage,844.76,49,,percent of total billed charges,,
POLIOVIRUS VACCINE 40-8-32 UNIT/0.5 ML INJ SUSP,,90713,CPT,Facility,Inpatient,5 mL,mL,,1724,1465.4,494.0984,1724,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
POLIOVIRUS VACCINE 40-8-32 UNIT/0.5 ML INJ SUSP,,90713,CPT,Facility,Both,5 mL,mL,,1724,1465.4,494.0984,1724,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1526.9468,88.57,,percent of total billed charges,,
POLIOVIRUS VACCINE 40-8-32 UNIT/0.5 ML INJ SUSP,,90713,CPT,Facility,Both,5 mL,mL,,1724,1465.4,494.0984,1724,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,494.0984,28.66,,percent of total billed charges,,
POLIOVIRUS VACCINE 40-8-32 UNIT/0.5 ML INJ SUSP,,90713,CPT,Facility,Outpatient,5 mL,mL,,1724,1465.4,494.0984,1724,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),844.76,49,,percent of total billed charges,,
POLIOVIRUS VACCINE 40-8-32 UNIT/0.5 ML INJ SUSP,,90713,CPT,Facility,Inpatient,5 mL,mL,,1724,1465.4,494.0984,1724,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
POLIOVIRUS VACCINE 40-8-32 UNIT/0.5 ML INJ SUSP,,90713,CPT,Facility,Both,5 mL,mL,,1724,1465.4,494.0984,1724,CorVel,Worker's Compensation,1724,100,,percent of total billed charges,,
POLIOVIRUS VACCINE 40-8-32 UNIT/0.5 ML INJ SUSP,,90713,CPT,Facility,Both,5 mL,mL,,1724,1465.4,494.0984,1724,First Health Group Corporation,First Health Network,1672.28,97,,percent of total billed charges,,
POLIOVIRUS VACCINE 40-8-32 UNIT/0.5 ML INJ SUSP,,90713,CPT,Facility,Both,5 mL,mL,,1724,1465.4,494.0984,1724,"Health Partners, Inc.",Commercial,1630.904,94.6,,percent of total billed charges,,
POLIOVIRUS VACCINE 40-8-32 UNIT/0.5 ML INJ SUSP,,90713,CPT,Facility,Outpatient,5 mL,mL,,1724,1465.4,494.0984,1724,"Health Partners, Inc.",Medicare Advantage,844.76,49,,percent of total billed charges,,
POLIOVIRUS VACCINE 40-8-32 UNIT/0.5 ML INJ SUSP,,90713,CPT,Facility,Inpatient,5 mL,mL,,1724,1465.4,494.0984,1724,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
POLIOVIRUS VACCINE 40-8-32 UNIT/0.5 ML INJ SUSP,,90713,CPT,Facility,Both,5 mL,mL,,1724,1465.4,494.0984,1724,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1034.4,60,,percent of total billed charges,,
POLIOVIRUS VACCINE 40-8-32 UNIT/0.5 ML INJ SUSP,,90713,CPT,Facility,Both,5 mL,mL,,1724,1465.4,494.0984,1724,"Health Partners, Inc.",State of Minnesota Advantage Program,1405.06,81.5,,percent of total billed charges,,
POLIOVIRUS VACCINE 40-8-32 UNIT/0.5 ML INJ SUSP,,90713,CPT,Facility,Both,5 mL,mL,,1724,1465.4,494.0984,1724,"Health Partners, Inc.",State Public Programs,862,50,,percent of total billed charges,,
POLIOVIRUS VACCINE 40-8-32 UNIT/0.5 ML INJ SUSP,,90713,CPT,Facility,Both,5 mL,mL,,1724,1465.4,494.0984,1724,Humana Insurance Company,Commercial PPO,1637.8,95,,percent of total billed charges,,
POLIOVIRUS VACCINE 40-8-32 UNIT/0.5 ML INJ SUSP,,90713,CPT,Facility,Outpatient,5 mL,mL,,1724,1465.4,494.0984,1724,Humana Insurance Company,Medicare PPO,844.76,49,,percent of total billed charges,,
POLIOVIRUS VACCINE 40-8-32 UNIT/0.5 ML INJ SUSP,,90713,CPT,Facility,Inpatient,5 mL,mL,,1724,1465.4,494.0984,1724,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
POLIOVIRUS VACCINE 40-8-32 UNIT/0.5 ML INJ SUSP,,90713,CPT,Facility,Both,5 mL,mL,,1724,1465.4,494.0984,1724,Medica,Individual & Family,1708.484,99.1,,percent of total billed charges,,
POLIOVIRUS VACCINE 40-8-32 UNIT/0.5 ML INJ SUSP,,90713,CPT,Facility,Outpatient,5 mL,mL,,1724,1465.4,494.0984,1724,Medica,Medica Advantage Solution,858.552,49.8,,percent of total billed charges,,
POLIOVIRUS VACCINE 40-8-32 UNIT/0.5 ML INJ SUSP,,90713,CPT,Facility,Inpatient,5 mL,mL,,1724,1465.4,494.0984,1724,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
POLIOVIRUS VACCINE 40-8-32 UNIT/0.5 ML INJ SUSP,,90713,CPT,Facility,Outpatient,5 mL,mL,,1724,1465.4,494.0984,1724,Medica,Medical Assistance,768.904,44.6,,percent of total billed charges,,
POLIOVIRUS VACCINE 40-8-32 UNIT/0.5 ML INJ SUSP,,90713,CPT,Facility,Inpatient,5 mL,mL,,1724,1465.4,494.0984,1724,Medica,Medical Assistance,,,,,Included in per diem rate,
POLIOVIRUS VACCINE 40-8-32 UNIT/0.5 ML INJ SUSP,,90713,CPT,Facility,Outpatient,5 mL,mL,,1724,1465.4,494.0984,1724,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,858.552,49.8,,percent of total billed charges,,
POLIOVIRUS VACCINE 40-8-32 UNIT/0.5 ML INJ SUSP,,90713,CPT,Facility,Inpatient,5 mL,mL,,1724,1465.4,494.0984,1724,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
POLIOVIRUS VACCINE 40-8-32 UNIT/0.5 ML INJ SUSP,,90713,CPT,Facility,Both,5 mL,mL,,1724,1465.4,494.0984,1724,"Multiplan, Inc.","Multiplan, Inc.",1620.56,94,,percent of total billed charges,,
POLIOVIRUS VACCINE 40-8-32 UNIT/0.5 ML INJ SUSP,,90713,CPT,Facility,Outpatient,5 mL,mL,,1724,1465.4,494.0984,1724,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1553.324,90.1,,percent of total billed charges,,
POLIOVIRUS VACCINE 40-8-32 UNIT/0.5 ML INJ SUSP,,90713,CPT,Facility,Inpatient,5 mL,mL,,1724,1465.4,494.0984,1724,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
POLIOVIRUS VACCINE 40-8-32 UNIT/0.5 ML INJ SUSP,,90713,CPT,Facility,Both,5 mL,mL,,1724,1465.4,494.0984,1724,"Preferred One Administrative Services, INC.",PPO,1699.864,98.6,,percent of total billed charges,,
POLIOVIRUS VACCINE 40-8-32 UNIT/0.5 ML INJ SUSP,,90713,CPT,Facility,Outpatient,5 mL,mL,,1724,1465.4,494.0984,1724,PrimeWest Health,Minnesota Senior Health Options (MSHO),886.998,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
POLIOVIRUS VACCINE 40-8-32 UNIT/0.5 ML INJ SUSP,,90713,CPT,Facility,Inpatient,5 mL,mL,,1724,1465.4,494.0984,1724,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
POLIOVIRUS VACCINE 40-8-32 UNIT/0.5 ML INJ SUSP,,90713,CPT,Facility,Outpatient,5 mL,mL,,1724,1465.4,494.0984,1724,PrimeWest Health,MinnesotaCare,885.4464,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
POLIOVIRUS VACCINE 40-8-32 UNIT/0.5 ML INJ SUSP,,90713,CPT,Facility,Inpatient,5 mL,mL,,1724,1465.4,494.0984,1724,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
POLIOVIRUS VACCINE 40-8-32 UNIT/0.5 ML INJ SUSP,,90713,CPT,Facility,Both,5 mL,mL,,1724,1465.4,494.0984,1724,Sanford Health Plan,Sanford Health Plan,1586.08,92,,percent of total billed charges,,
POLIOVIRUS VACCINE 40-8-32 UNIT/0.5 ML INJ SUSP,,90713,CPT,Facility,Outpatient,5 mL,mL,,1724,1465.4,494.0984,1724,"UCare Health, Inc.",Individual & Family Plan,971.474,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
POLIOVIRUS VACCINE 40-8-32 UNIT/0.5 ML INJ SUSP,,90713,CPT,Facility,Inpatient,5 mL,mL,,1724,1465.4,494.0984,1724,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
POLIOVIRUS VACCINE 40-8-32 UNIT/0.5 ML INJ SUSP,,90713,CPT,Facility,Outpatient,5 mL,mL,,1724,1465.4,494.0984,1724,"UCare Health, Inc.",Medical Assistance,870.1028,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
POLIOVIRUS VACCINE 40-8-32 UNIT/0.5 ML INJ SUSP,,90713,CPT,Facility,Inpatient,5 mL,mL,,1724,1465.4,494.0984,1724,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
POLIOVIRUS VACCINE 40-8-32 UNIT/0.5 ML INJ SUSP,,90713,CPT,Facility,Outpatient,5 mL,mL,,1724,1465.4,494.0984,1724,"UCare Health, Inc.",Medicare Advantage,870.1028,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
POLIOVIRUS VACCINE 40-8-32 UNIT/0.5 ML INJ SUSP,,90713,CPT,Facility,Inpatient,5 mL,mL,,1724,1465.4,494.0984,1724,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
POLIOVIRUS VACCINE 40-8-32 UNIT/0.5 ML INJ SUSP,,90713,CPT,Facility,Outpatient,5 mL,mL,,1724,1465.4,494.0984,1724,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),870.1028,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
POLIOVIRUS VACCINE 40-8-32 UNIT/0.5 ML INJ SUSP,,90713,CPT,Facility,Inpatient,5 mL,mL,,1724,1465.4,494.0984,1724,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
POLIOVIRUS VACCINE 40-8-32 UNIT/0.5 ML INJ SUSP,,90713,CPT,Facility,Both,5 mL,mL,,1724,1465.4,494.0984,1724,UnitedHealthcare,Individual & Family,1620.56,94,,percent of total billed charges,,
POLIOVIRUS VACCINE 40-8-32 UNIT/0.5 ML INJ SUSP,,90713,CPT,Facility,Outpatient,5 mL,mL,,1724,1465.4,494.0984,1724,UnitedHealthcare,Medicare Advantage,844.76,49,,percent of total billed charges,,
POLIOVIRUS VACCINE 40-8-32 UNIT/0.5 ML INJ SUSP,,90713,CPT,Facility,Inpatient,5 mL,mL,,1724,1465.4,494.0984,1724,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
POLIOVIRUS VACCINE 40-8-32 UNIT/0.5 ML INJ SUSP,,90713,CPT,Facility,Outpatient,5 mL,mL,,1724,1465.4,494.0984,1724,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,827.52,48,,percent of total billed charges,,100% of DHS outpatient percentage
POLIOVIRUS VACCINE 40-8-32 UNIT/0.5 ML INJ SUSP,,90713,CPT,Facility,Inpatient,5 mL,mL,,1724,1465.4,494.0984,1724,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"DIAZEPAM 5 MG/5 ML (1 MG/ML, 5 ML) ORAL SOLN",,100892,LOCAL,Facility,Both,5 mL,mL,,23,19.55,6.5918,23,Aetna,Commercial,21.16,92,,percent of total billed charges,,
"DIAZEPAM 5 MG/5 ML (1 MG/ML, 5 ML) ORAL SOLN",,100892,LOCAL,Facility,Outpatient,5 mL,mL,,23,19.55,6.5918,23,Aetna,Medicare Advantage,11.27,49,,percent of total billed charges,,
"DIAZEPAM 5 MG/5 ML (1 MG/ML, 5 ML) ORAL SOLN",,100892,LOCAL,Facility,Inpatient,5 mL,mL,,23,19.55,6.5918,23,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"DIAZEPAM 5 MG/5 ML (1 MG/ML, 5 ML) ORAL SOLN",,100892,LOCAL,Facility,Both,5 mL,mL,,23,19.55,6.5918,23,Aetna,PPO,21.39,93,,percent of total billed charges,,
"DIAZEPAM 5 MG/5 ML (1 MG/ML, 5 ML) ORAL SOLN",,100892,LOCAL,Facility,Both,5 mL,mL,,23,19.55,6.5918,23,America's PPO,America's PPO,22.0869,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"DIAZEPAM 5 MG/5 ML (1 MG/ML, 5 ML) ORAL SOLN",,100892,LOCAL,Facility,Both,5 mL,mL,,23,19.55,6.5918,23,BlueCross BlueShield Minnesota, Federal Employee Program,22.632,98.4,,percent of total billed charges,,
"DIAZEPAM 5 MG/5 ML (1 MG/ML, 5 ML) ORAL SOLN",,100892,LOCAL,Facility,Both,5 mL,mL,,23,19.55,6.5918,23,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,23,100,,percent of total billed charges,,
"DIAZEPAM 5 MG/5 ML (1 MG/ML, 5 ML) ORAL SOLN",,100892,LOCAL,Facility,Both,5 mL,mL,,23,19.55,6.5918,23,BlueCross BlueShield Minnesota,High Value Network Plan,20.7,90,,percent of total billed charges,,
"DIAZEPAM 5 MG/5 ML (1 MG/ML, 5 ML) ORAL SOLN",,100892,LOCAL,Facility,Outpatient,5 mL,mL,,23,19.55,6.5918,23,BlueCross BlueShield Minnesota,Medicare Advantage,11.27,49,,percent of total billed charges,,
"DIAZEPAM 5 MG/5 ML (1 MG/ML, 5 ML) ORAL SOLN",,100892,LOCAL,Facility,Inpatient,5 mL,mL,,23,19.55,6.5918,23,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"DIAZEPAM 5 MG/5 ML (1 MG/ML, 5 ML) ORAL SOLN",,100892,LOCAL,Facility,Both,5 mL,mL,,23,19.55,6.5918,23,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,20.3711,88.57,,percent of total billed charges,,
"DIAZEPAM 5 MG/5 ML (1 MG/ML, 5 ML) ORAL SOLN",,100892,LOCAL,Facility,Both,5 mL,mL,,23,19.55,6.5918,23,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,6.5918,28.66,,percent of total billed charges,,
"DIAZEPAM 5 MG/5 ML (1 MG/ML, 5 ML) ORAL SOLN",,100892,LOCAL,Facility,Outpatient,5 mL,mL,,23,19.55,6.5918,23,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),11.27,49,,percent of total billed charges,,
"DIAZEPAM 5 MG/5 ML (1 MG/ML, 5 ML) ORAL SOLN",,100892,LOCAL,Facility,Inpatient,5 mL,mL,,23,19.55,6.5918,23,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"DIAZEPAM 5 MG/5 ML (1 MG/ML, 5 ML) ORAL SOLN",,100892,LOCAL,Facility,Both,5 mL,mL,,23,19.55,6.5918,23,CorVel,Worker's Compensation,23,100,,percent of total billed charges,,
"DIAZEPAM 5 MG/5 ML (1 MG/ML, 5 ML) ORAL SOLN",,100892,LOCAL,Facility,Both,5 mL,mL,,23,19.55,6.5918,23,First Health Group Corporation,First Health Network,22.31,97,,percent of total billed charges,,
"DIAZEPAM 5 MG/5 ML (1 MG/ML, 5 ML) ORAL SOLN",,100892,LOCAL,Facility,Both,5 mL,mL,,23,19.55,6.5918,23,"Health Partners, Inc.",Commercial,21.758,94.6,,percent of total billed charges,,
"DIAZEPAM 5 MG/5 ML (1 MG/ML, 5 ML) ORAL SOLN",,100892,LOCAL,Facility,Outpatient,5 mL,mL,,23,19.55,6.5918,23,"Health Partners, Inc.",Medicare Advantage,11.27,49,,percent of total billed charges,,
"DIAZEPAM 5 MG/5 ML (1 MG/ML, 5 ML) ORAL SOLN",,100892,LOCAL,Facility,Inpatient,5 mL,mL,,23,19.55,6.5918,23,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"DIAZEPAM 5 MG/5 ML (1 MG/ML, 5 ML) ORAL SOLN",,100892,LOCAL,Facility,Both,5 mL,mL,,23,19.55,6.5918,23,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),13.8,60,,percent of total billed charges,,
"DIAZEPAM 5 MG/5 ML (1 MG/ML, 5 ML) ORAL SOLN",,100892,LOCAL,Facility,Both,5 mL,mL,,23,19.55,6.5918,23,"Health Partners, Inc.",State of Minnesota Advantage Program,18.745,81.5,,percent of total billed charges,,
"DIAZEPAM 5 MG/5 ML (1 MG/ML, 5 ML) ORAL SOLN",,100892,LOCAL,Facility,Both,5 mL,mL,,23,19.55,6.5918,23,"Health Partners, Inc.",State Public Programs,11.5,50,,percent of total billed charges,,
"DIAZEPAM 5 MG/5 ML (1 MG/ML, 5 ML) ORAL SOLN",,100892,LOCAL,Facility,Both,5 mL,mL,,23,19.55,6.5918,23,Humana Insurance Company,Commercial PPO,21.85,95,,percent of total billed charges,,
"DIAZEPAM 5 MG/5 ML (1 MG/ML, 5 ML) ORAL SOLN",,100892,LOCAL,Facility,Outpatient,5 mL,mL,,23,19.55,6.5918,23,Humana Insurance Company,Medicare PPO,11.27,49,,percent of total billed charges,,
"DIAZEPAM 5 MG/5 ML (1 MG/ML, 5 ML) ORAL SOLN",,100892,LOCAL,Facility,Inpatient,5 mL,mL,,23,19.55,6.5918,23,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"DIAZEPAM 5 MG/5 ML (1 MG/ML, 5 ML) ORAL SOLN",,100892,LOCAL,Facility,Both,5 mL,mL,,23,19.55,6.5918,23,Medica,Individual & Family,22.793,99.1,,percent of total billed charges,,
"DIAZEPAM 5 MG/5 ML (1 MG/ML, 5 ML) ORAL SOLN",,100892,LOCAL,Facility,Outpatient,5 mL,mL,,23,19.55,6.5918,23,Medica,Medica Advantage Solution,11.454,49.8,,percent of total billed charges,,
"DIAZEPAM 5 MG/5 ML (1 MG/ML, 5 ML) ORAL SOLN",,100892,LOCAL,Facility,Inpatient,5 mL,mL,,23,19.55,6.5918,23,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"DIAZEPAM 5 MG/5 ML (1 MG/ML, 5 ML) ORAL SOLN",,100892,LOCAL,Facility,Outpatient,5 mL,mL,,23,19.55,6.5918,23,Medica,Medical Assistance,10.258,44.6,,percent of total billed charges,,
"DIAZEPAM 5 MG/5 ML (1 MG/ML, 5 ML) ORAL SOLN",,100892,LOCAL,Facility,Inpatient,5 mL,mL,,23,19.55,6.5918,23,Medica,Medical Assistance,,,,,Included in per diem rate,
"DIAZEPAM 5 MG/5 ML (1 MG/ML, 5 ML) ORAL SOLN",,100892,LOCAL,Facility,Outpatient,5 mL,mL,,23,19.55,6.5918,23,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,11.454,49.8,,percent of total billed charges,,
"DIAZEPAM 5 MG/5 ML (1 MG/ML, 5 ML) ORAL SOLN",,100892,LOCAL,Facility,Inpatient,5 mL,mL,,23,19.55,6.5918,23,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"DIAZEPAM 5 MG/5 ML (1 MG/ML, 5 ML) ORAL SOLN",,100892,LOCAL,Facility,Both,5 mL,mL,,23,19.55,6.5918,23,"Multiplan, Inc.","Multiplan, Inc.",21.62,94,,percent of total billed charges,,
"DIAZEPAM 5 MG/5 ML (1 MG/ML, 5 ML) ORAL SOLN",,100892,LOCAL,Facility,Outpatient,5 mL,mL,,23,19.55,6.5918,23,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,20.723,90.1,,percent of total billed charges,,
"DIAZEPAM 5 MG/5 ML (1 MG/ML, 5 ML) ORAL SOLN",,100892,LOCAL,Facility,Inpatient,5 mL,mL,,23,19.55,6.5918,23,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"DIAZEPAM 5 MG/5 ML (1 MG/ML, 5 ML) ORAL SOLN",,100892,LOCAL,Facility,Both,5 mL,mL,,23,19.55,6.5918,23,"Preferred One Administrative Services, INC.",PPO,22.678,98.6,,percent of total billed charges,,
"DIAZEPAM 5 MG/5 ML (1 MG/ML, 5 ML) ORAL SOLN",,100892,LOCAL,Facility,Outpatient,5 mL,mL,,23,19.55,6.5918,23,PrimeWest Health,Minnesota Senior Health Options (MSHO),11.8335,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"DIAZEPAM 5 MG/5 ML (1 MG/ML, 5 ML) ORAL SOLN",,100892,LOCAL,Facility,Inpatient,5 mL,mL,,23,19.55,6.5918,23,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"DIAZEPAM 5 MG/5 ML (1 MG/ML, 5 ML) ORAL SOLN",,100892,LOCAL,Facility,Outpatient,5 mL,mL,,23,19.55,6.5918,23,PrimeWest Health,MinnesotaCare,11.8128,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"DIAZEPAM 5 MG/5 ML (1 MG/ML, 5 ML) ORAL SOLN",,100892,LOCAL,Facility,Inpatient,5 mL,mL,,23,19.55,6.5918,23,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"DIAZEPAM 5 MG/5 ML (1 MG/ML, 5 ML) ORAL SOLN",,100892,LOCAL,Facility,Both,5 mL,mL,,23,19.55,6.5918,23,Sanford Health Plan,Sanford Health Plan,21.16,92,,percent of total billed charges,,
"DIAZEPAM 5 MG/5 ML (1 MG/ML, 5 ML) ORAL SOLN",,100892,LOCAL,Facility,Outpatient,5 mL,mL,,23,19.55,6.5918,23,"UCare Health, Inc.",Individual & Family Plan,12.9605,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"DIAZEPAM 5 MG/5 ML (1 MG/ML, 5 ML) ORAL SOLN",,100892,LOCAL,Facility,Inpatient,5 mL,mL,,23,19.55,6.5918,23,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"DIAZEPAM 5 MG/5 ML (1 MG/ML, 5 ML) ORAL SOLN",,100892,LOCAL,Facility,Outpatient,5 mL,mL,,23,19.55,6.5918,23,"UCare Health, Inc.",Medical Assistance,11.6081,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"DIAZEPAM 5 MG/5 ML (1 MG/ML, 5 ML) ORAL SOLN",,100892,LOCAL,Facility,Inpatient,5 mL,mL,,23,19.55,6.5918,23,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"DIAZEPAM 5 MG/5 ML (1 MG/ML, 5 ML) ORAL SOLN",,100892,LOCAL,Facility,Outpatient,5 mL,mL,,23,19.55,6.5918,23,"UCare Health, Inc.",Medicare Advantage,11.6081,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"DIAZEPAM 5 MG/5 ML (1 MG/ML, 5 ML) ORAL SOLN",,100892,LOCAL,Facility,Inpatient,5 mL,mL,,23,19.55,6.5918,23,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"DIAZEPAM 5 MG/5 ML (1 MG/ML, 5 ML) ORAL SOLN",,100892,LOCAL,Facility,Outpatient,5 mL,mL,,23,19.55,6.5918,23,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),11.6081,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"DIAZEPAM 5 MG/5 ML (1 MG/ML, 5 ML) ORAL SOLN",,100892,LOCAL,Facility,Inpatient,5 mL,mL,,23,19.55,6.5918,23,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"DIAZEPAM 5 MG/5 ML (1 MG/ML, 5 ML) ORAL SOLN",,100892,LOCAL,Facility,Both,5 mL,mL,,23,19.55,6.5918,23,UnitedHealthcare,Individual & Family,21.62,94,,percent of total billed charges,,
"DIAZEPAM 5 MG/5 ML (1 MG/ML, 5 ML) ORAL SOLN",,100892,LOCAL,Facility,Outpatient,5 mL,mL,,23,19.55,6.5918,23,UnitedHealthcare,Medicare Advantage,11.27,49,,percent of total billed charges,,
"DIAZEPAM 5 MG/5 ML (1 MG/ML, 5 ML) ORAL SOLN",,100892,LOCAL,Facility,Inpatient,5 mL,mL,,23,19.55,6.5918,23,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"DIAZEPAM 5 MG/5 ML (1 MG/ML, 5 ML) ORAL SOLN",,100892,LOCAL,Facility,Outpatient,5 mL,mL,,23,19.55,6.5918,23,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,11.04,48,,percent of total billed charges,,100% of DHS outpatient percentage
"DIAZEPAM 5 MG/5 ML (1 MG/ML, 5 ML) ORAL SOLN",,100892,LOCAL,Facility,Inpatient,5 mL,mL,,23,19.55,6.5918,23,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"MVI, ADULT NO.4 WITH VIT K 3,300 UNIT- 150 MCG/10 ML IV SOLN",,104237,LOCAL,Facility,Both,5 mL,mL,,78,66.3,22.3548,78,Aetna,Commercial,71.76,92,,percent of total billed charges,,
"MVI, ADULT NO.4 WITH VIT K 3,300 UNIT- 150 MCG/10 ML IV SOLN",,104237,LOCAL,Facility,Outpatient,5 mL,mL,,78,66.3,22.3548,78,Aetna,Medicare Advantage,38.22,49,,percent of total billed charges,,
"MVI, ADULT NO.4 WITH VIT K 3,300 UNIT- 150 MCG/10 ML IV SOLN",,104237,LOCAL,Facility,Inpatient,5 mL,mL,,78,66.3,22.3548,78,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"MVI, ADULT NO.4 WITH VIT K 3,300 UNIT- 150 MCG/10 ML IV SOLN",,104237,LOCAL,Facility,Both,5 mL,mL,,78,66.3,22.3548,78,Aetna,PPO,72.54,93,,percent of total billed charges,,
"MVI, ADULT NO.4 WITH VIT K 3,300 UNIT- 150 MCG/10 ML IV SOLN",,104237,LOCAL,Facility,Both,5 mL,mL,,78,66.3,22.3548,78,America's PPO,America's PPO,74.9034,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"MVI, ADULT NO.4 WITH VIT K 3,300 UNIT- 150 MCG/10 ML IV SOLN",,104237,LOCAL,Facility,Both,5 mL,mL,,78,66.3,22.3548,78,BlueCross BlueShield Minnesota, Federal Employee Program,76.752,98.4,,percent of total billed charges,,
"MVI, ADULT NO.4 WITH VIT K 3,300 UNIT- 150 MCG/10 ML IV SOLN",,104237,LOCAL,Facility,Both,5 mL,mL,,78,66.3,22.3548,78,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,78,100,,percent of total billed charges,,
"MVI, ADULT NO.4 WITH VIT K 3,300 UNIT- 150 MCG/10 ML IV SOLN",,104237,LOCAL,Facility,Both,5 mL,mL,,78,66.3,22.3548,78,BlueCross BlueShield Minnesota,High Value Network Plan,70.2,90,,percent of total billed charges,,
"MVI, ADULT NO.4 WITH VIT K 3,300 UNIT- 150 MCG/10 ML IV SOLN",,104237,LOCAL,Facility,Outpatient,5 mL,mL,,78,66.3,22.3548,78,BlueCross BlueShield Minnesota,Medicare Advantage,38.22,49,,percent of total billed charges,,
"MVI, ADULT NO.4 WITH VIT K 3,300 UNIT- 150 MCG/10 ML IV SOLN",,104237,LOCAL,Facility,Inpatient,5 mL,mL,,78,66.3,22.3548,78,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"MVI, ADULT NO.4 WITH VIT K 3,300 UNIT- 150 MCG/10 ML IV SOLN",,104237,LOCAL,Facility,Both,5 mL,mL,,78,66.3,22.3548,78,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,69.0846,88.57,,percent of total billed charges,,
"MVI, ADULT NO.4 WITH VIT K 3,300 UNIT- 150 MCG/10 ML IV SOLN",,104237,LOCAL,Facility,Both,5 mL,mL,,78,66.3,22.3548,78,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,22.3548,28.66,,percent of total billed charges,,
"MVI, ADULT NO.4 WITH VIT K 3,300 UNIT- 150 MCG/10 ML IV SOLN",,104237,LOCAL,Facility,Outpatient,5 mL,mL,,78,66.3,22.3548,78,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),38.22,49,,percent of total billed charges,,
"MVI, ADULT NO.4 WITH VIT K 3,300 UNIT- 150 MCG/10 ML IV SOLN",,104237,LOCAL,Facility,Inpatient,5 mL,mL,,78,66.3,22.3548,78,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"MVI, ADULT NO.4 WITH VIT K 3,300 UNIT- 150 MCG/10 ML IV SOLN",,104237,LOCAL,Facility,Both,5 mL,mL,,78,66.3,22.3548,78,CorVel,Worker's Compensation,78,100,,percent of total billed charges,,
"MVI, ADULT NO.4 WITH VIT K 3,300 UNIT- 150 MCG/10 ML IV SOLN",,104237,LOCAL,Facility,Both,5 mL,mL,,78,66.3,22.3548,78,First Health Group Corporation,First Health Network,75.66,97,,percent of total billed charges,,
"MVI, ADULT NO.4 WITH VIT K 3,300 UNIT- 150 MCG/10 ML IV SOLN",,104237,LOCAL,Facility,Both,5 mL,mL,,78,66.3,22.3548,78,"Health Partners, Inc.",Commercial,73.788,94.6,,percent of total billed charges,,
"MVI, ADULT NO.4 WITH VIT K 3,300 UNIT- 150 MCG/10 ML IV SOLN",,104237,LOCAL,Facility,Outpatient,5 mL,mL,,78,66.3,22.3548,78,"Health Partners, Inc.",Medicare Advantage,38.22,49,,percent of total billed charges,,
"MVI, ADULT NO.4 WITH VIT K 3,300 UNIT- 150 MCG/10 ML IV SOLN",,104237,LOCAL,Facility,Inpatient,5 mL,mL,,78,66.3,22.3548,78,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"MVI, ADULT NO.4 WITH VIT K 3,300 UNIT- 150 MCG/10 ML IV SOLN",,104237,LOCAL,Facility,Both,5 mL,mL,,78,66.3,22.3548,78,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),46.8,60,,percent of total billed charges,,
"MVI, ADULT NO.4 WITH VIT K 3,300 UNIT- 150 MCG/10 ML IV SOLN",,104237,LOCAL,Facility,Both,5 mL,mL,,78,66.3,22.3548,78,"Health Partners, Inc.",State of Minnesota Advantage Program,63.57,81.5,,percent of total billed charges,,
"MVI, ADULT NO.4 WITH VIT K 3,300 UNIT- 150 MCG/10 ML IV SOLN",,104237,LOCAL,Facility,Both,5 mL,mL,,78,66.3,22.3548,78,"Health Partners, Inc.",State Public Programs,39,50,,percent of total billed charges,,
"MVI, ADULT NO.4 WITH VIT K 3,300 UNIT- 150 MCG/10 ML IV SOLN",,104237,LOCAL,Facility,Both,5 mL,mL,,78,66.3,22.3548,78,Humana Insurance Company,Commercial PPO,74.1,95,,percent of total billed charges,,
"MVI, ADULT NO.4 WITH VIT K 3,300 UNIT- 150 MCG/10 ML IV SOLN",,104237,LOCAL,Facility,Outpatient,5 mL,mL,,78,66.3,22.3548,78,Humana Insurance Company,Medicare PPO,38.22,49,,percent of total billed charges,,
"MVI, ADULT NO.4 WITH VIT K 3,300 UNIT- 150 MCG/10 ML IV SOLN",,104237,LOCAL,Facility,Inpatient,5 mL,mL,,78,66.3,22.3548,78,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"MVI, ADULT NO.4 WITH VIT K 3,300 UNIT- 150 MCG/10 ML IV SOLN",,104237,LOCAL,Facility,Both,5 mL,mL,,78,66.3,22.3548,78,Medica,Individual & Family,77.298,99.1,,percent of total billed charges,,
"MVI, ADULT NO.4 WITH VIT K 3,300 UNIT- 150 MCG/10 ML IV SOLN",,104237,LOCAL,Facility,Outpatient,5 mL,mL,,78,66.3,22.3548,78,Medica,Medica Advantage Solution,38.844,49.8,,percent of total billed charges,,
"MVI, ADULT NO.4 WITH VIT K 3,300 UNIT- 150 MCG/10 ML IV SOLN",,104237,LOCAL,Facility,Inpatient,5 mL,mL,,78,66.3,22.3548,78,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"MVI, ADULT NO.4 WITH VIT K 3,300 UNIT- 150 MCG/10 ML IV SOLN",,104237,LOCAL,Facility,Outpatient,5 mL,mL,,78,66.3,22.3548,78,Medica,Medical Assistance,34.788,44.6,,percent of total billed charges,,
"MVI, ADULT NO.4 WITH VIT K 3,300 UNIT- 150 MCG/10 ML IV SOLN",,104237,LOCAL,Facility,Inpatient,5 mL,mL,,78,66.3,22.3548,78,Medica,Medical Assistance,,,,,Included in per diem rate,
"MVI, ADULT NO.4 WITH VIT K 3,300 UNIT- 150 MCG/10 ML IV SOLN",,104237,LOCAL,Facility,Outpatient,5 mL,mL,,78,66.3,22.3548,78,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,38.844,49.8,,percent of total billed charges,,
"MVI, ADULT NO.4 WITH VIT K 3,300 UNIT- 150 MCG/10 ML IV SOLN",,104237,LOCAL,Facility,Inpatient,5 mL,mL,,78,66.3,22.3548,78,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"MVI, ADULT NO.4 WITH VIT K 3,300 UNIT- 150 MCG/10 ML IV SOLN",,104237,LOCAL,Facility,Both,5 mL,mL,,78,66.3,22.3548,78,"Multiplan, Inc.","Multiplan, Inc.",73.32,94,,percent of total billed charges,,
"MVI, ADULT NO.4 WITH VIT K 3,300 UNIT- 150 MCG/10 ML IV SOLN",,104237,LOCAL,Facility,Outpatient,5 mL,mL,,78,66.3,22.3548,78,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,70.278,90.1,,percent of total billed charges,,
"MVI, ADULT NO.4 WITH VIT K 3,300 UNIT- 150 MCG/10 ML IV SOLN",,104237,LOCAL,Facility,Inpatient,5 mL,mL,,78,66.3,22.3548,78,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"MVI, ADULT NO.4 WITH VIT K 3,300 UNIT- 150 MCG/10 ML IV SOLN",,104237,LOCAL,Facility,Both,5 mL,mL,,78,66.3,22.3548,78,"Preferred One Administrative Services, INC.",PPO,76.908,98.6,,percent of total billed charges,,
"MVI, ADULT NO.4 WITH VIT K 3,300 UNIT- 150 MCG/10 ML IV SOLN",,104237,LOCAL,Facility,Outpatient,5 mL,mL,,78,66.3,22.3548,78,PrimeWest Health,Minnesota Senior Health Options (MSHO),40.131,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"MVI, ADULT NO.4 WITH VIT K 3,300 UNIT- 150 MCG/10 ML IV SOLN",,104237,LOCAL,Facility,Inpatient,5 mL,mL,,78,66.3,22.3548,78,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"MVI, ADULT NO.4 WITH VIT K 3,300 UNIT- 150 MCG/10 ML IV SOLN",,104237,LOCAL,Facility,Outpatient,5 mL,mL,,78,66.3,22.3548,78,PrimeWest Health,MinnesotaCare,40.0608,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"MVI, ADULT NO.4 WITH VIT K 3,300 UNIT- 150 MCG/10 ML IV SOLN",,104237,LOCAL,Facility,Inpatient,5 mL,mL,,78,66.3,22.3548,78,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"MVI, ADULT NO.4 WITH VIT K 3,300 UNIT- 150 MCG/10 ML IV SOLN",,104237,LOCAL,Facility,Both,5 mL,mL,,78,66.3,22.3548,78,Sanford Health Plan,Sanford Health Plan,71.76,92,,percent of total billed charges,,
"MVI, ADULT NO.4 WITH VIT K 3,300 UNIT- 150 MCG/10 ML IV SOLN",,104237,LOCAL,Facility,Outpatient,5 mL,mL,,78,66.3,22.3548,78,"UCare Health, Inc.",Individual & Family Plan,43.953,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"MVI, ADULT NO.4 WITH VIT K 3,300 UNIT- 150 MCG/10 ML IV SOLN",,104237,LOCAL,Facility,Inpatient,5 mL,mL,,78,66.3,22.3548,78,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"MVI, ADULT NO.4 WITH VIT K 3,300 UNIT- 150 MCG/10 ML IV SOLN",,104237,LOCAL,Facility,Outpatient,5 mL,mL,,78,66.3,22.3548,78,"UCare Health, Inc.",Medical Assistance,39.3666,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"MVI, ADULT NO.4 WITH VIT K 3,300 UNIT- 150 MCG/10 ML IV SOLN",,104237,LOCAL,Facility,Inpatient,5 mL,mL,,78,66.3,22.3548,78,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"MVI, ADULT NO.4 WITH VIT K 3,300 UNIT- 150 MCG/10 ML IV SOLN",,104237,LOCAL,Facility,Outpatient,5 mL,mL,,78,66.3,22.3548,78,"UCare Health, Inc.",Medicare Advantage,39.3666,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"MVI, ADULT NO.4 WITH VIT K 3,300 UNIT- 150 MCG/10 ML IV SOLN",,104237,LOCAL,Facility,Inpatient,5 mL,mL,,78,66.3,22.3548,78,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"MVI, ADULT NO.4 WITH VIT K 3,300 UNIT- 150 MCG/10 ML IV SOLN",,104237,LOCAL,Facility,Outpatient,5 mL,mL,,78,66.3,22.3548,78,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),39.3666,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"MVI, ADULT NO.4 WITH VIT K 3,300 UNIT- 150 MCG/10 ML IV SOLN",,104237,LOCAL,Facility,Inpatient,5 mL,mL,,78,66.3,22.3548,78,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"MVI, ADULT NO.4 WITH VIT K 3,300 UNIT- 150 MCG/10 ML IV SOLN",,104237,LOCAL,Facility,Both,5 mL,mL,,78,66.3,22.3548,78,UnitedHealthcare,Individual & Family,73.32,94,,percent of total billed charges,,
"MVI, ADULT NO.4 WITH VIT K 3,300 UNIT- 150 MCG/10 ML IV SOLN",,104237,LOCAL,Facility,Outpatient,5 mL,mL,,78,66.3,22.3548,78,UnitedHealthcare,Medicare Advantage,38.22,49,,percent of total billed charges,,
"MVI, ADULT NO.4 WITH VIT K 3,300 UNIT- 150 MCG/10 ML IV SOLN",,104237,LOCAL,Facility,Inpatient,5 mL,mL,,78,66.3,22.3548,78,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"MVI, ADULT NO.4 WITH VIT K 3,300 UNIT- 150 MCG/10 ML IV SOLN",,104237,LOCAL,Facility,Outpatient,5 mL,mL,,78,66.3,22.3548,78,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,37.44,48,,percent of total billed charges,,100% of DHS outpatient percentage
"MVI, ADULT NO.4 WITH VIT K 3,300 UNIT- 150 MCG/10 ML IV SOLN",,104237,LOCAL,Facility,Inpatient,5 mL,mL,,78,66.3,22.3548,78,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
LIDOCAINE (CONC: 100 MG/5 ML) FOR ETT (ADULT),,414102,LOCAL,Facility,Both,5 mL,mL,,30,25.5,8.598,30,Aetna,Commercial,27.6,92,,percent of total billed charges,,
LIDOCAINE (CONC: 100 MG/5 ML) FOR ETT (ADULT),,414102,LOCAL,Facility,Outpatient,5 mL,mL,,30,25.5,8.598,30,Aetna,Medicare Advantage,14.7,49,,percent of total billed charges,,
LIDOCAINE (CONC: 100 MG/5 ML) FOR ETT (ADULT),,414102,LOCAL,Facility,Inpatient,5 mL,mL,,30,25.5,8.598,30,Aetna,Medicare Advantage,,,,,Included in per diem rate,
LIDOCAINE (CONC: 100 MG/5 ML) FOR ETT (ADULT),,414102,LOCAL,Facility,Both,5 mL,mL,,30,25.5,8.598,30,Aetna,PPO,27.9,93,,percent of total billed charges,,
LIDOCAINE (CONC: 100 MG/5 ML) FOR ETT (ADULT),,414102,LOCAL,Facility,Both,5 mL,mL,,30,25.5,8.598,30,America's PPO,America's PPO,28.809,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
LIDOCAINE (CONC: 100 MG/5 ML) FOR ETT (ADULT),,414102,LOCAL,Facility,Both,5 mL,mL,,30,25.5,8.598,30,BlueCross BlueShield Minnesota, Federal Employee Program,29.52,98.4,,percent of total billed charges,,
LIDOCAINE (CONC: 100 MG/5 ML) FOR ETT (ADULT),,414102,LOCAL,Facility,Both,5 mL,mL,,30,25.5,8.598,30,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,30,100,,percent of total billed charges,,
LIDOCAINE (CONC: 100 MG/5 ML) FOR ETT (ADULT),,414102,LOCAL,Facility,Both,5 mL,mL,,30,25.5,8.598,30,BlueCross BlueShield Minnesota,High Value Network Plan,27,90,,percent of total billed charges,,
LIDOCAINE (CONC: 100 MG/5 ML) FOR ETT (ADULT),,414102,LOCAL,Facility,Outpatient,5 mL,mL,,30,25.5,8.598,30,BlueCross BlueShield Minnesota,Medicare Advantage,14.7,49,,percent of total billed charges,,
LIDOCAINE (CONC: 100 MG/5 ML) FOR ETT (ADULT),,414102,LOCAL,Facility,Inpatient,5 mL,mL,,30,25.5,8.598,30,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
LIDOCAINE (CONC: 100 MG/5 ML) FOR ETT (ADULT),,414102,LOCAL,Facility,Both,5 mL,mL,,30,25.5,8.598,30,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,26.571,88.57,,percent of total billed charges,,
LIDOCAINE (CONC: 100 MG/5 ML) FOR ETT (ADULT),,414102,LOCAL,Facility,Both,5 mL,mL,,30,25.5,8.598,30,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,8.598,28.66,,percent of total billed charges,,
LIDOCAINE (CONC: 100 MG/5 ML) FOR ETT (ADULT),,414102,LOCAL,Facility,Outpatient,5 mL,mL,,30,25.5,8.598,30,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),14.7,49,,percent of total billed charges,,
LIDOCAINE (CONC: 100 MG/5 ML) FOR ETT (ADULT),,414102,LOCAL,Facility,Inpatient,5 mL,mL,,30,25.5,8.598,30,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
LIDOCAINE (CONC: 100 MG/5 ML) FOR ETT (ADULT),,414102,LOCAL,Facility,Both,5 mL,mL,,30,25.5,8.598,30,CorVel,Worker's Compensation,30,100,,percent of total billed charges,,
LIDOCAINE (CONC: 100 MG/5 ML) FOR ETT (ADULT),,414102,LOCAL,Facility,Both,5 mL,mL,,30,25.5,8.598,30,First Health Group Corporation,First Health Network,29.1,97,,percent of total billed charges,,
LIDOCAINE (CONC: 100 MG/5 ML) FOR ETT (ADULT),,414102,LOCAL,Facility,Both,5 mL,mL,,30,25.5,8.598,30,"Health Partners, Inc.",Commercial,28.38,94.6,,percent of total billed charges,,
LIDOCAINE (CONC: 100 MG/5 ML) FOR ETT (ADULT),,414102,LOCAL,Facility,Outpatient,5 mL,mL,,30,25.5,8.598,30,"Health Partners, Inc.",Medicare Advantage,14.7,49,,percent of total billed charges,,
LIDOCAINE (CONC: 100 MG/5 ML) FOR ETT (ADULT),,414102,LOCAL,Facility,Inpatient,5 mL,mL,,30,25.5,8.598,30,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LIDOCAINE (CONC: 100 MG/5 ML) FOR ETT (ADULT),,414102,LOCAL,Facility,Both,5 mL,mL,,30,25.5,8.598,30,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),18,60,,percent of total billed charges,,
LIDOCAINE (CONC: 100 MG/5 ML) FOR ETT (ADULT),,414102,LOCAL,Facility,Both,5 mL,mL,,30,25.5,8.598,30,"Health Partners, Inc.",State of Minnesota Advantage Program,24.45,81.5,,percent of total billed charges,,
LIDOCAINE (CONC: 100 MG/5 ML) FOR ETT (ADULT),,414102,LOCAL,Facility,Both,5 mL,mL,,30,25.5,8.598,30,"Health Partners, Inc.",State Public Programs,15,50,,percent of total billed charges,,
LIDOCAINE (CONC: 100 MG/5 ML) FOR ETT (ADULT),,414102,LOCAL,Facility,Both,5 mL,mL,,30,25.5,8.598,30,Humana Insurance Company,Commercial PPO,28.5,95,,percent of total billed charges,,
LIDOCAINE (CONC: 100 MG/5 ML) FOR ETT (ADULT),,414102,LOCAL,Facility,Outpatient,5 mL,mL,,30,25.5,8.598,30,Humana Insurance Company,Medicare PPO,14.7,49,,percent of total billed charges,,
LIDOCAINE (CONC: 100 MG/5 ML) FOR ETT (ADULT),,414102,LOCAL,Facility,Inpatient,5 mL,mL,,30,25.5,8.598,30,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
LIDOCAINE (CONC: 100 MG/5 ML) FOR ETT (ADULT),,414102,LOCAL,Facility,Both,5 mL,mL,,30,25.5,8.598,30,Medica,Individual & Family,29.73,99.1,,percent of total billed charges,,
LIDOCAINE (CONC: 100 MG/5 ML) FOR ETT (ADULT),,414102,LOCAL,Facility,Outpatient,5 mL,mL,,30,25.5,8.598,30,Medica,Medica Advantage Solution,14.94,49.8,,percent of total billed charges,,
LIDOCAINE (CONC: 100 MG/5 ML) FOR ETT (ADULT),,414102,LOCAL,Facility,Inpatient,5 mL,mL,,30,25.5,8.598,30,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
LIDOCAINE (CONC: 100 MG/5 ML) FOR ETT (ADULT),,414102,LOCAL,Facility,Outpatient,5 mL,mL,,30,25.5,8.598,30,Medica,Medical Assistance,13.38,44.6,,percent of total billed charges,,
LIDOCAINE (CONC: 100 MG/5 ML) FOR ETT (ADULT),,414102,LOCAL,Facility,Inpatient,5 mL,mL,,30,25.5,8.598,30,Medica,Medical Assistance,,,,,Included in per diem rate,
LIDOCAINE (CONC: 100 MG/5 ML) FOR ETT (ADULT),,414102,LOCAL,Facility,Outpatient,5 mL,mL,,30,25.5,8.598,30,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,14.94,49.8,,percent of total billed charges,,
LIDOCAINE (CONC: 100 MG/5 ML) FOR ETT (ADULT),,414102,LOCAL,Facility,Inpatient,5 mL,mL,,30,25.5,8.598,30,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
LIDOCAINE (CONC: 100 MG/5 ML) FOR ETT (ADULT),,414102,LOCAL,Facility,Both,5 mL,mL,,30,25.5,8.598,30,"Multiplan, Inc.","Multiplan, Inc.",28.2,94,,percent of total billed charges,,
LIDOCAINE (CONC: 100 MG/5 ML) FOR ETT (ADULT),,414102,LOCAL,Facility,Outpatient,5 mL,mL,,30,25.5,8.598,30,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,27.03,90.1,,percent of total billed charges,,
LIDOCAINE (CONC: 100 MG/5 ML) FOR ETT (ADULT),,414102,LOCAL,Facility,Inpatient,5 mL,mL,,30,25.5,8.598,30,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
LIDOCAINE (CONC: 100 MG/5 ML) FOR ETT (ADULT),,414102,LOCAL,Facility,Both,5 mL,mL,,30,25.5,8.598,30,"Preferred One Administrative Services, INC.",PPO,29.58,98.6,,percent of total billed charges,,
LIDOCAINE (CONC: 100 MG/5 ML) FOR ETT (ADULT),,414102,LOCAL,Facility,Outpatient,5 mL,mL,,30,25.5,8.598,30,PrimeWest Health,Minnesota Senior Health Options (MSHO),15.435,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
LIDOCAINE (CONC: 100 MG/5 ML) FOR ETT (ADULT),,414102,LOCAL,Facility,Inpatient,5 mL,mL,,30,25.5,8.598,30,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LIDOCAINE (CONC: 100 MG/5 ML) FOR ETT (ADULT),,414102,LOCAL,Facility,Outpatient,5 mL,mL,,30,25.5,8.598,30,PrimeWest Health,MinnesotaCare,15.408,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
LIDOCAINE (CONC: 100 MG/5 ML) FOR ETT (ADULT),,414102,LOCAL,Facility,Inpatient,5 mL,mL,,30,25.5,8.598,30,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
LIDOCAINE (CONC: 100 MG/5 ML) FOR ETT (ADULT),,414102,LOCAL,Facility,Both,5 mL,mL,,30,25.5,8.598,30,Sanford Health Plan,Sanford Health Plan,27.6,92,,percent of total billed charges,,
LIDOCAINE (CONC: 100 MG/5 ML) FOR ETT (ADULT),,414102,LOCAL,Facility,Outpatient,5 mL,mL,,30,25.5,8.598,30,"UCare Health, Inc.",Individual & Family Plan,16.905,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
LIDOCAINE (CONC: 100 MG/5 ML) FOR ETT (ADULT),,414102,LOCAL,Facility,Inpatient,5 mL,mL,,30,25.5,8.598,30,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
LIDOCAINE (CONC: 100 MG/5 ML) FOR ETT (ADULT),,414102,LOCAL,Facility,Outpatient,5 mL,mL,,30,25.5,8.598,30,"UCare Health, Inc.",Medical Assistance,15.141,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LIDOCAINE (CONC: 100 MG/5 ML) FOR ETT (ADULT),,414102,LOCAL,Facility,Inpatient,5 mL,mL,,30,25.5,8.598,30,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
LIDOCAINE (CONC: 100 MG/5 ML) FOR ETT (ADULT),,414102,LOCAL,Facility,Outpatient,5 mL,mL,,30,25.5,8.598,30,"UCare Health, Inc.",Medicare Advantage,15.141,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LIDOCAINE (CONC: 100 MG/5 ML) FOR ETT (ADULT),,414102,LOCAL,Facility,Inpatient,5 mL,mL,,30,25.5,8.598,30,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LIDOCAINE (CONC: 100 MG/5 ML) FOR ETT (ADULT),,414102,LOCAL,Facility,Outpatient,5 mL,mL,,30,25.5,8.598,30,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),15.141,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LIDOCAINE (CONC: 100 MG/5 ML) FOR ETT (ADULT),,414102,LOCAL,Facility,Inpatient,5 mL,mL,,30,25.5,8.598,30,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LIDOCAINE (CONC: 100 MG/5 ML) FOR ETT (ADULT),,414102,LOCAL,Facility,Both,5 mL,mL,,30,25.5,8.598,30,UnitedHealthcare,Individual & Family,28.2,94,,percent of total billed charges,,
LIDOCAINE (CONC: 100 MG/5 ML) FOR ETT (ADULT),,414102,LOCAL,Facility,Outpatient,5 mL,mL,,30,25.5,8.598,30,UnitedHealthcare,Medicare Advantage,14.7,49,,percent of total billed charges,,
LIDOCAINE (CONC: 100 MG/5 ML) FOR ETT (ADULT),,414102,LOCAL,Facility,Inpatient,5 mL,mL,,30,25.5,8.598,30,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
LIDOCAINE (CONC: 100 MG/5 ML) FOR ETT (ADULT),,414102,LOCAL,Facility,Outpatient,5 mL,mL,,30,25.5,8.598,30,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,14.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
LIDOCAINE (CONC: 100 MG/5 ML) FOR ETT (ADULT),,414102,LOCAL,Facility,Inpatient,5 mL,mL,,30,25.5,8.598,30,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
LIDOCAINE (PF) 100 MG/5 ML (2 %) IV SYRG (PEDS 100 MG MAX),,414131,LOCAL,Facility,Both,5 mL,mL,,32,27.2,9.1712,32,Aetna,Commercial,29.44,92,,percent of total billed charges,,
LIDOCAINE (PF) 100 MG/5 ML (2 %) IV SYRG (PEDS 100 MG MAX),,414131,LOCAL,Facility,Outpatient,5 mL,mL,,32,27.2,9.1712,32,Aetna,Medicare Advantage,15.68,49,,percent of total billed charges,,
LIDOCAINE (PF) 100 MG/5 ML (2 %) IV SYRG (PEDS 100 MG MAX),,414131,LOCAL,Facility,Inpatient,5 mL,mL,,32,27.2,9.1712,32,Aetna,Medicare Advantage,,,,,Included in per diem rate,
LIDOCAINE (PF) 100 MG/5 ML (2 %) IV SYRG (PEDS 100 MG MAX),,414131,LOCAL,Facility,Both,5 mL,mL,,32,27.2,9.1712,32,Aetna,PPO,29.76,93,,percent of total billed charges,,
LIDOCAINE (PF) 100 MG/5 ML (2 %) IV SYRG (PEDS 100 MG MAX),,414131,LOCAL,Facility,Both,5 mL,mL,,32,27.2,9.1712,32,America's PPO,America's PPO,30.7296,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
LIDOCAINE (PF) 100 MG/5 ML (2 %) IV SYRG (PEDS 100 MG MAX),,414131,LOCAL,Facility,Both,5 mL,mL,,32,27.2,9.1712,32,BlueCross BlueShield Minnesota, Federal Employee Program,31.488,98.4,,percent of total billed charges,,
LIDOCAINE (PF) 100 MG/5 ML (2 %) IV SYRG (PEDS 100 MG MAX),,414131,LOCAL,Facility,Both,5 mL,mL,,32,27.2,9.1712,32,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,32,100,,percent of total billed charges,,
LIDOCAINE (PF) 100 MG/5 ML (2 %) IV SYRG (PEDS 100 MG MAX),,414131,LOCAL,Facility,Both,5 mL,mL,,32,27.2,9.1712,32,BlueCross BlueShield Minnesota,High Value Network Plan,28.8,90,,percent of total billed charges,,
LIDOCAINE (PF) 100 MG/5 ML (2 %) IV SYRG (PEDS 100 MG MAX),,414131,LOCAL,Facility,Outpatient,5 mL,mL,,32,27.2,9.1712,32,BlueCross BlueShield Minnesota,Medicare Advantage,15.68,49,,percent of total billed charges,,
LIDOCAINE (PF) 100 MG/5 ML (2 %) IV SYRG (PEDS 100 MG MAX),,414131,LOCAL,Facility,Inpatient,5 mL,mL,,32,27.2,9.1712,32,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
LIDOCAINE (PF) 100 MG/5 ML (2 %) IV SYRG (PEDS 100 MG MAX),,414131,LOCAL,Facility,Both,5 mL,mL,,32,27.2,9.1712,32,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,28.3424,88.57,,percent of total billed charges,,
LIDOCAINE (PF) 100 MG/5 ML (2 %) IV SYRG (PEDS 100 MG MAX),,414131,LOCAL,Facility,Both,5 mL,mL,,32,27.2,9.1712,32,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,9.1712,28.66,,percent of total billed charges,,
LIDOCAINE (PF) 100 MG/5 ML (2 %) IV SYRG (PEDS 100 MG MAX),,414131,LOCAL,Facility,Outpatient,5 mL,mL,,32,27.2,9.1712,32,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),15.68,49,,percent of total billed charges,,
LIDOCAINE (PF) 100 MG/5 ML (2 %) IV SYRG (PEDS 100 MG MAX),,414131,LOCAL,Facility,Inpatient,5 mL,mL,,32,27.2,9.1712,32,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
LIDOCAINE (PF) 100 MG/5 ML (2 %) IV SYRG (PEDS 100 MG MAX),,414131,LOCAL,Facility,Both,5 mL,mL,,32,27.2,9.1712,32,CorVel,Worker's Compensation,32,100,,percent of total billed charges,,
LIDOCAINE (PF) 100 MG/5 ML (2 %) IV SYRG (PEDS 100 MG MAX),,414131,LOCAL,Facility,Both,5 mL,mL,,32,27.2,9.1712,32,First Health Group Corporation,First Health Network,31.04,97,,percent of total billed charges,,
LIDOCAINE (PF) 100 MG/5 ML (2 %) IV SYRG (PEDS 100 MG MAX),,414131,LOCAL,Facility,Both,5 mL,mL,,32,27.2,9.1712,32,"Health Partners, Inc.",Commercial,30.272,94.6,,percent of total billed charges,,
LIDOCAINE (PF) 100 MG/5 ML (2 %) IV SYRG (PEDS 100 MG MAX),,414131,LOCAL,Facility,Outpatient,5 mL,mL,,32,27.2,9.1712,32,"Health Partners, Inc.",Medicare Advantage,15.68,49,,percent of total billed charges,,
LIDOCAINE (PF) 100 MG/5 ML (2 %) IV SYRG (PEDS 100 MG MAX),,414131,LOCAL,Facility,Inpatient,5 mL,mL,,32,27.2,9.1712,32,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LIDOCAINE (PF) 100 MG/5 ML (2 %) IV SYRG (PEDS 100 MG MAX),,414131,LOCAL,Facility,Both,5 mL,mL,,32,27.2,9.1712,32,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),19.2,60,,percent of total billed charges,,
LIDOCAINE (PF) 100 MG/5 ML (2 %) IV SYRG (PEDS 100 MG MAX),,414131,LOCAL,Facility,Both,5 mL,mL,,32,27.2,9.1712,32,"Health Partners, Inc.",State of Minnesota Advantage Program,26.08,81.5,,percent of total billed charges,,
LIDOCAINE (PF) 100 MG/5 ML (2 %) IV SYRG (PEDS 100 MG MAX),,414131,LOCAL,Facility,Both,5 mL,mL,,32,27.2,9.1712,32,"Health Partners, Inc.",State Public Programs,16,50,,percent of total billed charges,,
LIDOCAINE (PF) 100 MG/5 ML (2 %) IV SYRG (PEDS 100 MG MAX),,414131,LOCAL,Facility,Both,5 mL,mL,,32,27.2,9.1712,32,Humana Insurance Company,Commercial PPO,30.4,95,,percent of total billed charges,,
LIDOCAINE (PF) 100 MG/5 ML (2 %) IV SYRG (PEDS 100 MG MAX),,414131,LOCAL,Facility,Outpatient,5 mL,mL,,32,27.2,9.1712,32,Humana Insurance Company,Medicare PPO,15.68,49,,percent of total billed charges,,
LIDOCAINE (PF) 100 MG/5 ML (2 %) IV SYRG (PEDS 100 MG MAX),,414131,LOCAL,Facility,Inpatient,5 mL,mL,,32,27.2,9.1712,32,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
LIDOCAINE (PF) 100 MG/5 ML (2 %) IV SYRG (PEDS 100 MG MAX),,414131,LOCAL,Facility,Both,5 mL,mL,,32,27.2,9.1712,32,Medica,Individual & Family,31.712,99.1,,percent of total billed charges,,
LIDOCAINE (PF) 100 MG/5 ML (2 %) IV SYRG (PEDS 100 MG MAX),,414131,LOCAL,Facility,Outpatient,5 mL,mL,,32,27.2,9.1712,32,Medica,Medica Advantage Solution,15.936,49.8,,percent of total billed charges,,
LIDOCAINE (PF) 100 MG/5 ML (2 %) IV SYRG (PEDS 100 MG MAX),,414131,LOCAL,Facility,Inpatient,5 mL,mL,,32,27.2,9.1712,32,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
LIDOCAINE (PF) 100 MG/5 ML (2 %) IV SYRG (PEDS 100 MG MAX),,414131,LOCAL,Facility,Outpatient,5 mL,mL,,32,27.2,9.1712,32,Medica,Medical Assistance,14.272,44.6,,percent of total billed charges,,
LIDOCAINE (PF) 100 MG/5 ML (2 %) IV SYRG (PEDS 100 MG MAX),,414131,LOCAL,Facility,Inpatient,5 mL,mL,,32,27.2,9.1712,32,Medica,Medical Assistance,,,,,Included in per diem rate,
LIDOCAINE (PF) 100 MG/5 ML (2 %) IV SYRG (PEDS 100 MG MAX),,414131,LOCAL,Facility,Outpatient,5 mL,mL,,32,27.2,9.1712,32,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,15.936,49.8,,percent of total billed charges,,
LIDOCAINE (PF) 100 MG/5 ML (2 %) IV SYRG (PEDS 100 MG MAX),,414131,LOCAL,Facility,Inpatient,5 mL,mL,,32,27.2,9.1712,32,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
LIDOCAINE (PF) 100 MG/5 ML (2 %) IV SYRG (PEDS 100 MG MAX),,414131,LOCAL,Facility,Both,5 mL,mL,,32,27.2,9.1712,32,"Multiplan, Inc.","Multiplan, Inc.",30.08,94,,percent of total billed charges,,
LIDOCAINE (PF) 100 MG/5 ML (2 %) IV SYRG (PEDS 100 MG MAX),,414131,LOCAL,Facility,Outpatient,5 mL,mL,,32,27.2,9.1712,32,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,28.832,90.1,,percent of total billed charges,,
LIDOCAINE (PF) 100 MG/5 ML (2 %) IV SYRG (PEDS 100 MG MAX),,414131,LOCAL,Facility,Inpatient,5 mL,mL,,32,27.2,9.1712,32,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
LIDOCAINE (PF) 100 MG/5 ML (2 %) IV SYRG (PEDS 100 MG MAX),,414131,LOCAL,Facility,Both,5 mL,mL,,32,27.2,9.1712,32,"Preferred One Administrative Services, INC.",PPO,31.552,98.6,,percent of total billed charges,,
LIDOCAINE (PF) 100 MG/5 ML (2 %) IV SYRG (PEDS 100 MG MAX),,414131,LOCAL,Facility,Outpatient,5 mL,mL,,32,27.2,9.1712,32,PrimeWest Health,Minnesota Senior Health Options (MSHO),16.464,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
LIDOCAINE (PF) 100 MG/5 ML (2 %) IV SYRG (PEDS 100 MG MAX),,414131,LOCAL,Facility,Inpatient,5 mL,mL,,32,27.2,9.1712,32,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LIDOCAINE (PF) 100 MG/5 ML (2 %) IV SYRG (PEDS 100 MG MAX),,414131,LOCAL,Facility,Outpatient,5 mL,mL,,32,27.2,9.1712,32,PrimeWest Health,MinnesotaCare,16.4352,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
LIDOCAINE (PF) 100 MG/5 ML (2 %) IV SYRG (PEDS 100 MG MAX),,414131,LOCAL,Facility,Inpatient,5 mL,mL,,32,27.2,9.1712,32,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
LIDOCAINE (PF) 100 MG/5 ML (2 %) IV SYRG (PEDS 100 MG MAX),,414131,LOCAL,Facility,Both,5 mL,mL,,32,27.2,9.1712,32,Sanford Health Plan,Sanford Health Plan,29.44,92,,percent of total billed charges,,
LIDOCAINE (PF) 100 MG/5 ML (2 %) IV SYRG (PEDS 100 MG MAX),,414131,LOCAL,Facility,Outpatient,5 mL,mL,,32,27.2,9.1712,32,"UCare Health, Inc.",Individual & Family Plan,18.032,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
LIDOCAINE (PF) 100 MG/5 ML (2 %) IV SYRG (PEDS 100 MG MAX),,414131,LOCAL,Facility,Inpatient,5 mL,mL,,32,27.2,9.1712,32,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
LIDOCAINE (PF) 100 MG/5 ML (2 %) IV SYRG (PEDS 100 MG MAX),,414131,LOCAL,Facility,Outpatient,5 mL,mL,,32,27.2,9.1712,32,"UCare Health, Inc.",Medical Assistance,16.1504,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LIDOCAINE (PF) 100 MG/5 ML (2 %) IV SYRG (PEDS 100 MG MAX),,414131,LOCAL,Facility,Inpatient,5 mL,mL,,32,27.2,9.1712,32,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
LIDOCAINE (PF) 100 MG/5 ML (2 %) IV SYRG (PEDS 100 MG MAX),,414131,LOCAL,Facility,Outpatient,5 mL,mL,,32,27.2,9.1712,32,"UCare Health, Inc.",Medicare Advantage,16.1504,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LIDOCAINE (PF) 100 MG/5 ML (2 %) IV SYRG (PEDS 100 MG MAX),,414131,LOCAL,Facility,Inpatient,5 mL,mL,,32,27.2,9.1712,32,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LIDOCAINE (PF) 100 MG/5 ML (2 %) IV SYRG (PEDS 100 MG MAX),,414131,LOCAL,Facility,Outpatient,5 mL,mL,,32,27.2,9.1712,32,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),16.1504,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LIDOCAINE (PF) 100 MG/5 ML (2 %) IV SYRG (PEDS 100 MG MAX),,414131,LOCAL,Facility,Inpatient,5 mL,mL,,32,27.2,9.1712,32,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LIDOCAINE (PF) 100 MG/5 ML (2 %) IV SYRG (PEDS 100 MG MAX),,414131,LOCAL,Facility,Both,5 mL,mL,,32,27.2,9.1712,32,UnitedHealthcare,Individual & Family,30.08,94,,percent of total billed charges,,
LIDOCAINE (PF) 100 MG/5 ML (2 %) IV SYRG (PEDS 100 MG MAX),,414131,LOCAL,Facility,Outpatient,5 mL,mL,,32,27.2,9.1712,32,UnitedHealthcare,Medicare Advantage,15.68,49,,percent of total billed charges,,
LIDOCAINE (PF) 100 MG/5 ML (2 %) IV SYRG (PEDS 100 MG MAX),,414131,LOCAL,Facility,Inpatient,5 mL,mL,,32,27.2,9.1712,32,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
LIDOCAINE (PF) 100 MG/5 ML (2 %) IV SYRG (PEDS 100 MG MAX),,414131,LOCAL,Facility,Outpatient,5 mL,mL,,32,27.2,9.1712,32,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,15.36,48,,percent of total billed charges,,100% of DHS outpatient percentage
LIDOCAINE (PF) 100 MG/5 ML (2 %) IV SYRG (PEDS 100 MG MAX),,414131,LOCAL,Facility,Inpatient,5 mL,mL,,32,27.2,9.1712,32,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
LIDOCAINE (PF) 100 MG/5 ML (2 %) FOR ETT (PEDS),,414132,LOCAL,Facility,Both,5 mL,mL,,32,27.2,9.1712,32,Aetna,Commercial,29.44,92,,percent of total billed charges,,
LIDOCAINE (PF) 100 MG/5 ML (2 %) FOR ETT (PEDS),,414132,LOCAL,Facility,Outpatient,5 mL,mL,,32,27.2,9.1712,32,Aetna,Medicare Advantage,15.68,49,,percent of total billed charges,,
LIDOCAINE (PF) 100 MG/5 ML (2 %) FOR ETT (PEDS),,414132,LOCAL,Facility,Inpatient,5 mL,mL,,32,27.2,9.1712,32,Aetna,Medicare Advantage,,,,,Included in per diem rate,
LIDOCAINE (PF) 100 MG/5 ML (2 %) FOR ETT (PEDS),,414132,LOCAL,Facility,Both,5 mL,mL,,32,27.2,9.1712,32,Aetna,PPO,29.76,93,,percent of total billed charges,,
LIDOCAINE (PF) 100 MG/5 ML (2 %) FOR ETT (PEDS),,414132,LOCAL,Facility,Both,5 mL,mL,,32,27.2,9.1712,32,America's PPO,America's PPO,30.7296,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
LIDOCAINE (PF) 100 MG/5 ML (2 %) FOR ETT (PEDS),,414132,LOCAL,Facility,Both,5 mL,mL,,32,27.2,9.1712,32,BlueCross BlueShield Minnesota, Federal Employee Program,31.488,98.4,,percent of total billed charges,,
LIDOCAINE (PF) 100 MG/5 ML (2 %) FOR ETT (PEDS),,414132,LOCAL,Facility,Both,5 mL,mL,,32,27.2,9.1712,32,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,32,100,,percent of total billed charges,,
LIDOCAINE (PF) 100 MG/5 ML (2 %) FOR ETT (PEDS),,414132,LOCAL,Facility,Both,5 mL,mL,,32,27.2,9.1712,32,BlueCross BlueShield Minnesota,High Value Network Plan,28.8,90,,percent of total billed charges,,
LIDOCAINE (PF) 100 MG/5 ML (2 %) FOR ETT (PEDS),,414132,LOCAL,Facility,Outpatient,5 mL,mL,,32,27.2,9.1712,32,BlueCross BlueShield Minnesota,Medicare Advantage,15.68,49,,percent of total billed charges,,
LIDOCAINE (PF) 100 MG/5 ML (2 %) FOR ETT (PEDS),,414132,LOCAL,Facility,Inpatient,5 mL,mL,,32,27.2,9.1712,32,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
LIDOCAINE (PF) 100 MG/5 ML (2 %) FOR ETT (PEDS),,414132,LOCAL,Facility,Both,5 mL,mL,,32,27.2,9.1712,32,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,28.3424,88.57,,percent of total billed charges,,
LIDOCAINE (PF) 100 MG/5 ML (2 %) FOR ETT (PEDS),,414132,LOCAL,Facility,Both,5 mL,mL,,32,27.2,9.1712,32,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,9.1712,28.66,,percent of total billed charges,,
LIDOCAINE (PF) 100 MG/5 ML (2 %) FOR ETT (PEDS),,414132,LOCAL,Facility,Outpatient,5 mL,mL,,32,27.2,9.1712,32,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),15.68,49,,percent of total billed charges,,
LIDOCAINE (PF) 100 MG/5 ML (2 %) FOR ETT (PEDS),,414132,LOCAL,Facility,Inpatient,5 mL,mL,,32,27.2,9.1712,32,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
LIDOCAINE (PF) 100 MG/5 ML (2 %) FOR ETT (PEDS),,414132,LOCAL,Facility,Both,5 mL,mL,,32,27.2,9.1712,32,CorVel,Worker's Compensation,32,100,,percent of total billed charges,,
LIDOCAINE (PF) 100 MG/5 ML (2 %) FOR ETT (PEDS),,414132,LOCAL,Facility,Both,5 mL,mL,,32,27.2,9.1712,32,First Health Group Corporation,First Health Network,31.04,97,,percent of total billed charges,,
LIDOCAINE (PF) 100 MG/5 ML (2 %) FOR ETT (PEDS),,414132,LOCAL,Facility,Both,5 mL,mL,,32,27.2,9.1712,32,"Health Partners, Inc.",Commercial,30.272,94.6,,percent of total billed charges,,
LIDOCAINE (PF) 100 MG/5 ML (2 %) FOR ETT (PEDS),,414132,LOCAL,Facility,Outpatient,5 mL,mL,,32,27.2,9.1712,32,"Health Partners, Inc.",Medicare Advantage,15.68,49,,percent of total billed charges,,
LIDOCAINE (PF) 100 MG/5 ML (2 %) FOR ETT (PEDS),,414132,LOCAL,Facility,Inpatient,5 mL,mL,,32,27.2,9.1712,32,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LIDOCAINE (PF) 100 MG/5 ML (2 %) FOR ETT (PEDS),,414132,LOCAL,Facility,Both,5 mL,mL,,32,27.2,9.1712,32,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),19.2,60,,percent of total billed charges,,
LIDOCAINE (PF) 100 MG/5 ML (2 %) FOR ETT (PEDS),,414132,LOCAL,Facility,Both,5 mL,mL,,32,27.2,9.1712,32,"Health Partners, Inc.",State of Minnesota Advantage Program,26.08,81.5,,percent of total billed charges,,
LIDOCAINE (PF) 100 MG/5 ML (2 %) FOR ETT (PEDS),,414132,LOCAL,Facility,Both,5 mL,mL,,32,27.2,9.1712,32,"Health Partners, Inc.",State Public Programs,16,50,,percent of total billed charges,,
LIDOCAINE (PF) 100 MG/5 ML (2 %) FOR ETT (PEDS),,414132,LOCAL,Facility,Both,5 mL,mL,,32,27.2,9.1712,32,Humana Insurance Company,Commercial PPO,30.4,95,,percent of total billed charges,,
LIDOCAINE (PF) 100 MG/5 ML (2 %) FOR ETT (PEDS),,414132,LOCAL,Facility,Outpatient,5 mL,mL,,32,27.2,9.1712,32,Humana Insurance Company,Medicare PPO,15.68,49,,percent of total billed charges,,
LIDOCAINE (PF) 100 MG/5 ML (2 %) FOR ETT (PEDS),,414132,LOCAL,Facility,Inpatient,5 mL,mL,,32,27.2,9.1712,32,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
LIDOCAINE (PF) 100 MG/5 ML (2 %) FOR ETT (PEDS),,414132,LOCAL,Facility,Both,5 mL,mL,,32,27.2,9.1712,32,Medica,Individual & Family,31.712,99.1,,percent of total billed charges,,
LIDOCAINE (PF) 100 MG/5 ML (2 %) FOR ETT (PEDS),,414132,LOCAL,Facility,Outpatient,5 mL,mL,,32,27.2,9.1712,32,Medica,Medica Advantage Solution,15.936,49.8,,percent of total billed charges,,
LIDOCAINE (PF) 100 MG/5 ML (2 %) FOR ETT (PEDS),,414132,LOCAL,Facility,Inpatient,5 mL,mL,,32,27.2,9.1712,32,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
LIDOCAINE (PF) 100 MG/5 ML (2 %) FOR ETT (PEDS),,414132,LOCAL,Facility,Outpatient,5 mL,mL,,32,27.2,9.1712,32,Medica,Medical Assistance,14.272,44.6,,percent of total billed charges,,
LIDOCAINE (PF) 100 MG/5 ML (2 %) FOR ETT (PEDS),,414132,LOCAL,Facility,Inpatient,5 mL,mL,,32,27.2,9.1712,32,Medica,Medical Assistance,,,,,Included in per diem rate,
LIDOCAINE (PF) 100 MG/5 ML (2 %) FOR ETT (PEDS),,414132,LOCAL,Facility,Outpatient,5 mL,mL,,32,27.2,9.1712,32,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,15.936,49.8,,percent of total billed charges,,
LIDOCAINE (PF) 100 MG/5 ML (2 %) FOR ETT (PEDS),,414132,LOCAL,Facility,Inpatient,5 mL,mL,,32,27.2,9.1712,32,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
LIDOCAINE (PF) 100 MG/5 ML (2 %) FOR ETT (PEDS),,414132,LOCAL,Facility,Both,5 mL,mL,,32,27.2,9.1712,32,"Multiplan, Inc.","Multiplan, Inc.",30.08,94,,percent of total billed charges,,
LIDOCAINE (PF) 100 MG/5 ML (2 %) FOR ETT (PEDS),,414132,LOCAL,Facility,Outpatient,5 mL,mL,,32,27.2,9.1712,32,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,28.832,90.1,,percent of total billed charges,,
LIDOCAINE (PF) 100 MG/5 ML (2 %) FOR ETT (PEDS),,414132,LOCAL,Facility,Inpatient,5 mL,mL,,32,27.2,9.1712,32,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
LIDOCAINE (PF) 100 MG/5 ML (2 %) FOR ETT (PEDS),,414132,LOCAL,Facility,Both,5 mL,mL,,32,27.2,9.1712,32,"Preferred One Administrative Services, INC.",PPO,31.552,98.6,,percent of total billed charges,,
LIDOCAINE (PF) 100 MG/5 ML (2 %) FOR ETT (PEDS),,414132,LOCAL,Facility,Outpatient,5 mL,mL,,32,27.2,9.1712,32,PrimeWest Health,Minnesota Senior Health Options (MSHO),16.464,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
LIDOCAINE (PF) 100 MG/5 ML (2 %) FOR ETT (PEDS),,414132,LOCAL,Facility,Inpatient,5 mL,mL,,32,27.2,9.1712,32,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LIDOCAINE (PF) 100 MG/5 ML (2 %) FOR ETT (PEDS),,414132,LOCAL,Facility,Outpatient,5 mL,mL,,32,27.2,9.1712,32,PrimeWest Health,MinnesotaCare,16.4352,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
LIDOCAINE (PF) 100 MG/5 ML (2 %) FOR ETT (PEDS),,414132,LOCAL,Facility,Inpatient,5 mL,mL,,32,27.2,9.1712,32,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
LIDOCAINE (PF) 100 MG/5 ML (2 %) FOR ETT (PEDS),,414132,LOCAL,Facility,Both,5 mL,mL,,32,27.2,9.1712,32,Sanford Health Plan,Sanford Health Plan,29.44,92,,percent of total billed charges,,
LIDOCAINE (PF) 100 MG/5 ML (2 %) FOR ETT (PEDS),,414132,LOCAL,Facility,Outpatient,5 mL,mL,,32,27.2,9.1712,32,"UCare Health, Inc.",Individual & Family Plan,18.032,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
LIDOCAINE (PF) 100 MG/5 ML (2 %) FOR ETT (PEDS),,414132,LOCAL,Facility,Inpatient,5 mL,mL,,32,27.2,9.1712,32,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
LIDOCAINE (PF) 100 MG/5 ML (2 %) FOR ETT (PEDS),,414132,LOCAL,Facility,Outpatient,5 mL,mL,,32,27.2,9.1712,32,"UCare Health, Inc.",Medical Assistance,16.1504,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LIDOCAINE (PF) 100 MG/5 ML (2 %) FOR ETT (PEDS),,414132,LOCAL,Facility,Inpatient,5 mL,mL,,32,27.2,9.1712,32,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
LIDOCAINE (PF) 100 MG/5 ML (2 %) FOR ETT (PEDS),,414132,LOCAL,Facility,Outpatient,5 mL,mL,,32,27.2,9.1712,32,"UCare Health, Inc.",Medicare Advantage,16.1504,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LIDOCAINE (PF) 100 MG/5 ML (2 %) FOR ETT (PEDS),,414132,LOCAL,Facility,Inpatient,5 mL,mL,,32,27.2,9.1712,32,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LIDOCAINE (PF) 100 MG/5 ML (2 %) FOR ETT (PEDS),,414132,LOCAL,Facility,Outpatient,5 mL,mL,,32,27.2,9.1712,32,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),16.1504,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LIDOCAINE (PF) 100 MG/5 ML (2 %) FOR ETT (PEDS),,414132,LOCAL,Facility,Inpatient,5 mL,mL,,32,27.2,9.1712,32,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LIDOCAINE (PF) 100 MG/5 ML (2 %) FOR ETT (PEDS),,414132,LOCAL,Facility,Both,5 mL,mL,,32,27.2,9.1712,32,UnitedHealthcare,Individual & Family,30.08,94,,percent of total billed charges,,
LIDOCAINE (PF) 100 MG/5 ML (2 %) FOR ETT (PEDS),,414132,LOCAL,Facility,Outpatient,5 mL,mL,,32,27.2,9.1712,32,UnitedHealthcare,Medicare Advantage,15.68,49,,percent of total billed charges,,
LIDOCAINE (PF) 100 MG/5 ML (2 %) FOR ETT (PEDS),,414132,LOCAL,Facility,Inpatient,5 mL,mL,,32,27.2,9.1712,32,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
LIDOCAINE (PF) 100 MG/5 ML (2 %) FOR ETT (PEDS),,414132,LOCAL,Facility,Outpatient,5 mL,mL,,32,27.2,9.1712,32,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,15.36,48,,percent of total billed charges,,100% of DHS outpatient percentage
LIDOCAINE (PF) 100 MG/5 ML (2 %) FOR ETT (PEDS),,414132,LOCAL,Facility,Inpatient,5 mL,mL,,32,27.2,9.1712,32,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"BETAMETHASONE ACET,SOD PHOS 6 MG/ML INJ SUSP",,J0702,HCPCS,Facility,Both,5 mL,mL,,278,236.3,79.6748,278,Aetna,Commercial,255.76,92,,percent of total billed charges,,
"BETAMETHASONE ACET,SOD PHOS 6 MG/ML INJ SUSP",,J0702,HCPCS,Facility,Outpatient,5 mL,mL,,278,236.3,79.6748,278,Aetna,Medicare Advantage,136.22,49,,percent of total billed charges,,
"BETAMETHASONE ACET,SOD PHOS 6 MG/ML INJ SUSP",,J0702,HCPCS,Facility,Inpatient,5 mL,mL,,278,236.3,79.6748,278,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"BETAMETHASONE ACET,SOD PHOS 6 MG/ML INJ SUSP",,J0702,HCPCS,Facility,Both,5 mL,mL,,278,236.3,79.6748,278,Aetna,PPO,258.54,93,,percent of total billed charges,,
"BETAMETHASONE ACET,SOD PHOS 6 MG/ML INJ SUSP",,J0702,HCPCS,Facility,Both,5 mL,mL,,278,236.3,79.6748,278,America's PPO,America's PPO,266.9634,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"BETAMETHASONE ACET,SOD PHOS 6 MG/ML INJ SUSP",,J0702,HCPCS,Facility,Both,5 mL,mL,,278,236.3,79.6748,278,BlueCross BlueShield Minnesota, Federal Employee Program,273.552,98.4,,percent of total billed charges,,
"BETAMETHASONE ACET,SOD PHOS 6 MG/ML INJ SUSP",,J0702,HCPCS,Facility,Both,5 mL,mL,,278,236.3,79.6748,278,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,278,100,,percent of total billed charges,,
"BETAMETHASONE ACET,SOD PHOS 6 MG/ML INJ SUSP",,J0702,HCPCS,Facility,Both,5 mL,mL,,278,236.3,79.6748,278,BlueCross BlueShield Minnesota,High Value Network Plan,250.2,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
"BETAMETHASONE ACET,SOD PHOS 6 MG/ML INJ SUSP",,J0702,HCPCS,Facility,Outpatient,5 mL,mL,,278,236.3,79.6748,278,BlueCross BlueShield Minnesota,Medicare Advantage,136.22,49,,percent of total billed charges,,
"BETAMETHASONE ACET,SOD PHOS 6 MG/ML INJ SUSP",,J0702,HCPCS,Facility,Inpatient,5 mL,mL,,278,236.3,79.6748,278,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"BETAMETHASONE ACET,SOD PHOS 6 MG/ML INJ SUSP",,J0702,HCPCS,Facility,Both,5 mL,mL,,278,236.3,79.6748,278,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,246.2246,88.57,,percent of total billed charges,,
"BETAMETHASONE ACET,SOD PHOS 6 MG/ML INJ SUSP",,J0702,HCPCS,Facility,Both,5 mL,mL,,278,236.3,79.6748,278,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,79.6748,28.66,,percent of total billed charges,,
"BETAMETHASONE ACET,SOD PHOS 6 MG/ML INJ SUSP",,J0702,HCPCS,Facility,Outpatient,5 mL,mL,,278,236.3,79.6748,278,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),136.22,49,,percent of total billed charges,,
"BETAMETHASONE ACET,SOD PHOS 6 MG/ML INJ SUSP",,J0702,HCPCS,Facility,Inpatient,5 mL,mL,,278,236.3,79.6748,278,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"BETAMETHASONE ACET,SOD PHOS 6 MG/ML INJ SUSP",,J0702,HCPCS,Facility,Both,5 mL,mL,,278,236.3,79.6748,278,CorVel,Worker's Compensation,278,100,,percent of total billed charges,,
"BETAMETHASONE ACET,SOD PHOS 6 MG/ML INJ SUSP",,J0702,HCPCS,Facility,Both,5 mL,mL,,278,236.3,79.6748,278,First Health Group Corporation,First Health Network,269.66,97,,percent of total billed charges,,
"BETAMETHASONE ACET,SOD PHOS 6 MG/ML INJ SUSP",,J0702,HCPCS,Facility,Both,5 mL,mL,,278,236.3,79.6748,278,"Health Partners, Inc.",Commercial,262.988,94.6,,percent of total billed charges,,
"BETAMETHASONE ACET,SOD PHOS 6 MG/ML INJ SUSP",,J0702,HCPCS,Facility,Outpatient,5 mL,mL,,278,236.3,79.6748,278,"Health Partners, Inc.",Medicare Advantage,136.22,49,,percent of total billed charges,,
"BETAMETHASONE ACET,SOD PHOS 6 MG/ML INJ SUSP",,J0702,HCPCS,Facility,Inpatient,5 mL,mL,,278,236.3,79.6748,278,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"BETAMETHASONE ACET,SOD PHOS 6 MG/ML INJ SUSP",,J0702,HCPCS,Facility,Both,5 mL,mL,,278,236.3,79.6748,278,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),166.8,60,,percent of total billed charges,,
"BETAMETHASONE ACET,SOD PHOS 6 MG/ML INJ SUSP",,J0702,HCPCS,Facility,Both,5 mL,mL,,278,236.3,79.6748,278,"Health Partners, Inc.",State of Minnesota Advantage Program,226.57,81.5,,percent of total billed charges,,
"BETAMETHASONE ACET,SOD PHOS 6 MG/ML INJ SUSP",,J0702,HCPCS,Facility,Both,5 mL,mL,,278,236.3,79.6748,278,"Health Partners, Inc.",State Public Programs,139,50,,percent of total billed charges,,
"BETAMETHASONE ACET,SOD PHOS 6 MG/ML INJ SUSP",,J0702,HCPCS,Facility,Both,5 mL,mL,,278,236.3,79.6748,278,Humana Insurance Company,Commercial PPO,264.1,95,,percent of total billed charges,,
"BETAMETHASONE ACET,SOD PHOS 6 MG/ML INJ SUSP",,J0702,HCPCS,Facility,Outpatient,5 mL,mL,,278,236.3,79.6748,278,Humana Insurance Company,Medicare PPO,136.22,49,,percent of total billed charges,,
"BETAMETHASONE ACET,SOD PHOS 6 MG/ML INJ SUSP",,J0702,HCPCS,Facility,Inpatient,5 mL,mL,,278,236.3,79.6748,278,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"BETAMETHASONE ACET,SOD PHOS 6 MG/ML INJ SUSP",,J0702,HCPCS,Facility,Both,5 mL,mL,,278,236.3,79.6748,278,Medica,Individual & Family,275.498,99.1,,percent of total billed charges,,
"BETAMETHASONE ACET,SOD PHOS 6 MG/ML INJ SUSP",,J0702,HCPCS,Facility,Outpatient,5 mL,mL,,278,236.3,79.6748,278,Medica,Medica Advantage Solution,138.444,49.8,,percent of total billed charges,,
"BETAMETHASONE ACET,SOD PHOS 6 MG/ML INJ SUSP",,J0702,HCPCS,Facility,Inpatient,5 mL,mL,,278,236.3,79.6748,278,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"BETAMETHASONE ACET,SOD PHOS 6 MG/ML INJ SUSP",,J0702,HCPCS,Facility,Outpatient,5 mL,mL,,278,236.3,79.6748,278,Medica,Medical Assistance,123.988,44.6,,percent of total billed charges,,
"BETAMETHASONE ACET,SOD PHOS 6 MG/ML INJ SUSP",,J0702,HCPCS,Facility,Inpatient,5 mL,mL,,278,236.3,79.6748,278,Medica,Medical Assistance,,,,,Included in per diem rate,
"BETAMETHASONE ACET,SOD PHOS 6 MG/ML INJ SUSP",,J0702,HCPCS,Facility,Outpatient,5 mL,mL,,278,236.3,79.6748,278,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,138.444,49.8,,percent of total billed charges,,
"BETAMETHASONE ACET,SOD PHOS 6 MG/ML INJ SUSP",,J0702,HCPCS,Facility,Inpatient,5 mL,mL,,278,236.3,79.6748,278,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"BETAMETHASONE ACET,SOD PHOS 6 MG/ML INJ SUSP",,J0702,HCPCS,Facility,Both,5 mL,mL,,278,236.3,79.6748,278,"Multiplan, Inc.","Multiplan, Inc.",261.32,94,,percent of total billed charges,,
"BETAMETHASONE ACET,SOD PHOS 6 MG/ML INJ SUSP",,J0702,HCPCS,Facility,Outpatient,5 mL,mL,,278,236.3,79.6748,278,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,250.478,90.1,,percent of total billed charges,,
"BETAMETHASONE ACET,SOD PHOS 6 MG/ML INJ SUSP",,J0702,HCPCS,Facility,Inpatient,5 mL,mL,,278,236.3,79.6748,278,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"BETAMETHASONE ACET,SOD PHOS 6 MG/ML INJ SUSP",,J0702,HCPCS,Facility,Both,5 mL,mL,,278,236.3,79.6748,278,"Preferred One Administrative Services, INC.",PPO,274.108,98.6,,percent of total billed charges,,
"BETAMETHASONE ACET,SOD PHOS 6 MG/ML INJ SUSP",,J0702,HCPCS,Facility,Outpatient,5 mL,mL,,278,236.3,79.6748,278,PrimeWest Health,Minnesota Senior Health Options (MSHO),143.031,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"BETAMETHASONE ACET,SOD PHOS 6 MG/ML INJ SUSP",,J0702,HCPCS,Facility,Inpatient,5 mL,mL,,278,236.3,79.6748,278,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"BETAMETHASONE ACET,SOD PHOS 6 MG/ML INJ SUSP",,J0702,HCPCS,Facility,Outpatient,5 mL,mL,,278,236.3,79.6748,278,PrimeWest Health,MinnesotaCare,142.7808,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"BETAMETHASONE ACET,SOD PHOS 6 MG/ML INJ SUSP",,J0702,HCPCS,Facility,Inpatient,5 mL,mL,,278,236.3,79.6748,278,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"BETAMETHASONE ACET,SOD PHOS 6 MG/ML INJ SUSP",,J0702,HCPCS,Facility,Both,5 mL,mL,,278,236.3,79.6748,278,Sanford Health Plan,Sanford Health Plan,255.76,92,,percent of total billed charges,,
"BETAMETHASONE ACET,SOD PHOS 6 MG/ML INJ SUSP",,J0702,HCPCS,Facility,Outpatient,5 mL,mL,,278,236.3,79.6748,278,"UCare Health, Inc.",Individual & Family Plan,156.653,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"BETAMETHASONE ACET,SOD PHOS 6 MG/ML INJ SUSP",,J0702,HCPCS,Facility,Inpatient,5 mL,mL,,278,236.3,79.6748,278,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"BETAMETHASONE ACET,SOD PHOS 6 MG/ML INJ SUSP",,J0702,HCPCS,Facility,Outpatient,5 mL,mL,,278,236.3,79.6748,278,"UCare Health, Inc.",Medical Assistance,140.3066,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"BETAMETHASONE ACET,SOD PHOS 6 MG/ML INJ SUSP",,J0702,HCPCS,Facility,Inpatient,5 mL,mL,,278,236.3,79.6748,278,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"BETAMETHASONE ACET,SOD PHOS 6 MG/ML INJ SUSP",,J0702,HCPCS,Facility,Outpatient,5 mL,mL,,278,236.3,79.6748,278,"UCare Health, Inc.",Medicare Advantage,140.3066,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"BETAMETHASONE ACET,SOD PHOS 6 MG/ML INJ SUSP",,J0702,HCPCS,Facility,Inpatient,5 mL,mL,,278,236.3,79.6748,278,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"BETAMETHASONE ACET,SOD PHOS 6 MG/ML INJ SUSP",,J0702,HCPCS,Facility,Outpatient,5 mL,mL,,278,236.3,79.6748,278,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),140.3066,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"BETAMETHASONE ACET,SOD PHOS 6 MG/ML INJ SUSP",,J0702,HCPCS,Facility,Inpatient,5 mL,mL,,278,236.3,79.6748,278,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"BETAMETHASONE ACET,SOD PHOS 6 MG/ML INJ SUSP",,J0702,HCPCS,Facility,Both,5 mL,mL,,278,236.3,79.6748,278,UnitedHealthcare,Individual & Family,261.32,94,,percent of total billed charges,,
"BETAMETHASONE ACET,SOD PHOS 6 MG/ML INJ SUSP",,J0702,HCPCS,Facility,Outpatient,5 mL,mL,,278,236.3,79.6748,278,UnitedHealthcare,Medicare Advantage,136.22,49,,percent of total billed charges,,
"BETAMETHASONE ACET,SOD PHOS 6 MG/ML INJ SUSP",,J0702,HCPCS,Facility,Inpatient,5 mL,mL,,278,236.3,79.6748,278,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"BETAMETHASONE ACET,SOD PHOS 6 MG/ML INJ SUSP",,J0702,HCPCS,Facility,Outpatient,5 mL,mL,,278,236.3,79.6748,278,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,133.44,48,,percent of total billed charges,,100% of DHS outpatient percentage
"BETAMETHASONE ACET,SOD PHOS 6 MG/ML INJ SUSP",,J0702,HCPCS,Facility,Inpatient,5 mL,mL,,278,236.3,79.6748,278,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Both,5 mL,mL,,7,5.95,2.0062,7,Aetna,Commercial,6.44,92,,percent of total billed charges,,
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Outpatient,5 mL,mL,,7,5.95,2.0062,7,Aetna,Medicare Advantage,3.43,49,,percent of total billed charges,,
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Inpatient,5 mL,mL,,7,5.95,2.0062,7,Aetna,Medicare Advantage,,,,,Included in per diem rate,
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Both,5 mL,mL,,7,5.95,2.0062,7,Aetna,PPO,6.51,93,,percent of total billed charges,,
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Both,5 mL,mL,,7,5.95,2.0062,7,America's PPO,America's PPO,6.7221,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Both,5 mL,mL,,7,5.95,2.0062,7,BlueCross BlueShield Minnesota, Federal Employee Program,6.888,98.4,,percent of total billed charges,,
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Both,5 mL,mL,,7,5.95,2.0062,7,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,7,100,,percent of total billed charges,,
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Both,5 mL,mL,,7,5.95,2.0062,7,BlueCross BlueShield Minnesota,High Value Network Plan,6.3,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Outpatient,5 mL,mL,,7,5.95,2.0062,7,BlueCross BlueShield Minnesota,Medicare Advantage,3.43,49,,percent of total billed charges,,
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Inpatient,5 mL,mL,,7,5.95,2.0062,7,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Both,5 mL,mL,,7,5.95,2.0062,7,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,6.1999,88.57,,percent of total billed charges,,
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Both,5 mL,mL,,7,5.95,2.0062,7,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,2.0062,28.66,,percent of total billed charges,,
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Outpatient,5 mL,mL,,7,5.95,2.0062,7,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),3.43,49,,percent of total billed charges,,
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Inpatient,5 mL,mL,,7,5.95,2.0062,7,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Both,5 mL,mL,,7,5.95,2.0062,7,CorVel,Worker's Compensation,7,100,,percent of total billed charges,,
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Both,5 mL,mL,,7,5.95,2.0062,7,First Health Group Corporation,First Health Network,6.79,97,,percent of total billed charges,,
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Both,5 mL,mL,,7,5.95,2.0062,7,"Health Partners, Inc.",Commercial,6.622,94.6,,percent of total billed charges,,
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Outpatient,5 mL,mL,,7,5.95,2.0062,7,"Health Partners, Inc.",Medicare Advantage,3.43,49,,percent of total billed charges,,
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Inpatient,5 mL,mL,,7,5.95,2.0062,7,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Both,5 mL,mL,,7,5.95,2.0062,7,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),4.2,60,,percent of total billed charges,,
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Both,5 mL,mL,,7,5.95,2.0062,7,"Health Partners, Inc.",State of Minnesota Advantage Program,5.705,81.5,,percent of total billed charges,,
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Both,5 mL,mL,,7,5.95,2.0062,7,"Health Partners, Inc.",State Public Programs,3.5,50,,percent of total billed charges,,
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Both,5 mL,mL,,7,5.95,2.0062,7,Humana Insurance Company,Commercial PPO,6.65,95,,percent of total billed charges,,
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Outpatient,5 mL,mL,,7,5.95,2.0062,7,Humana Insurance Company,Medicare PPO,3.43,49,,percent of total billed charges,,
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Inpatient,5 mL,mL,,7,5.95,2.0062,7,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Both,5 mL,mL,,7,5.95,2.0062,7,Medica,Individual & Family,6.937,99.1,,percent of total billed charges,,
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Outpatient,5 mL,mL,,7,5.95,2.0062,7,Medica,Medica Advantage Solution,3.486,49.8,,percent of total billed charges,,
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Inpatient,5 mL,mL,,7,5.95,2.0062,7,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Outpatient,5 mL,mL,,7,5.95,2.0062,7,Medica,Medical Assistance,3.122,44.6,,percent of total billed charges,,
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Inpatient,5 mL,mL,,7,5.95,2.0062,7,Medica,Medical Assistance,,,,,Included in per diem rate,
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Outpatient,5 mL,mL,,7,5.95,2.0062,7,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,3.486,49.8,,percent of total billed charges,,
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Inpatient,5 mL,mL,,7,5.95,2.0062,7,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Both,5 mL,mL,,7,5.95,2.0062,7,"Multiplan, Inc.","Multiplan, Inc.",6.58,94,,percent of total billed charges,,
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Outpatient,5 mL,mL,,7,5.95,2.0062,7,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,6.307,90.1,,percent of total billed charges,,
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Inpatient,5 mL,mL,,7,5.95,2.0062,7,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Both,5 mL,mL,,7,5.95,2.0062,7,"Preferred One Administrative Services, INC.",PPO,6.902,98.6,,percent of total billed charges,,
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Outpatient,5 mL,mL,,7,5.95,2.0062,7,PrimeWest Health,Minnesota Senior Health Options (MSHO),3.6015,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Inpatient,5 mL,mL,,7,5.95,2.0062,7,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Outpatient,5 mL,mL,,7,5.95,2.0062,7,PrimeWest Health,MinnesotaCare,3.5952,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Inpatient,5 mL,mL,,7,5.95,2.0062,7,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Both,5 mL,mL,,7,5.95,2.0062,7,Sanford Health Plan,Sanford Health Plan,6.44,92,,percent of total billed charges,,
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Outpatient,5 mL,mL,,7,5.95,2.0062,7,"UCare Health, Inc.",Individual & Family Plan,3.9445,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Inpatient,5 mL,mL,,7,5.95,2.0062,7,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Outpatient,5 mL,mL,,7,5.95,2.0062,7,"UCare Health, Inc.",Medical Assistance,3.5329,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Inpatient,5 mL,mL,,7,5.95,2.0062,7,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Outpatient,5 mL,mL,,7,5.95,2.0062,7,"UCare Health, Inc.",Medicare Advantage,3.5329,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Inpatient,5 mL,mL,,7,5.95,2.0062,7,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Outpatient,5 mL,mL,,7,5.95,2.0062,7,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),3.5329,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Inpatient,5 mL,mL,,7,5.95,2.0062,7,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Both,5 mL,mL,,7,5.95,2.0062,7,UnitedHealthcare,Individual & Family,6.58,94,,percent of total billed charges,,
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Outpatient,5 mL,mL,,7,5.95,2.0062,7,UnitedHealthcare,Medicare Advantage,3.43,49,,percent of total billed charges,,
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Inpatient,5 mL,mL,,7,5.95,2.0062,7,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Outpatient,5 mL,mL,,7,5.95,2.0062,7,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,3.36,48,,percent of total billed charges,,100% of DHS outpatient percentage
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJ SOLN,,J1100,HCPCS,Facility,Inpatient,5 mL,mL,,7,5.95,2.0062,7,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"HEPARIN, PORCINE (PF) 100 UNIT/ML IV SYRG",,J1642,HCPCS,Facility,Both,5 mL,mL,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
"HEPARIN, PORCINE (PF) 100 UNIT/ML IV SYRG",,J1642,HCPCS,Facility,Outpatient,5 mL,mL,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
"HEPARIN, PORCINE (PF) 100 UNIT/ML IV SYRG",,J1642,HCPCS,Facility,Inpatient,5 mL,mL,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"HEPARIN, PORCINE (PF) 100 UNIT/ML IV SYRG",,J1642,HCPCS,Facility,Both,5 mL,mL,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
"HEPARIN, PORCINE (PF) 100 UNIT/ML IV SYRG",,J1642,HCPCS,Facility,Both,5 mL,mL,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"HEPARIN, PORCINE (PF) 100 UNIT/ML IV SYRG",,J1642,HCPCS,Facility,Both,5 mL,mL,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
"HEPARIN, PORCINE (PF) 100 UNIT/ML IV SYRG",,J1642,HCPCS,Facility,Both,5 mL,mL,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
"HEPARIN, PORCINE (PF) 100 UNIT/ML IV SYRG",,J1642,HCPCS,Facility,Both,5 mL,mL,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
"HEPARIN, PORCINE (PF) 100 UNIT/ML IV SYRG",,J1642,HCPCS,Facility,Outpatient,5 mL,mL,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
"HEPARIN, PORCINE (PF) 100 UNIT/ML IV SYRG",,J1642,HCPCS,Facility,Inpatient,5 mL,mL,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"HEPARIN, PORCINE (PF) 100 UNIT/ML IV SYRG",,J1642,HCPCS,Facility,Both,5 mL,mL,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
"HEPARIN, PORCINE (PF) 100 UNIT/ML IV SYRG",,J1642,HCPCS,Facility,Both,5 mL,mL,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
"HEPARIN, PORCINE (PF) 100 UNIT/ML IV SYRG",,J1642,HCPCS,Facility,Outpatient,5 mL,mL,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
"HEPARIN, PORCINE (PF) 100 UNIT/ML IV SYRG",,J1642,HCPCS,Facility,Inpatient,5 mL,mL,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"HEPARIN, PORCINE (PF) 100 UNIT/ML IV SYRG",,J1642,HCPCS,Facility,Both,5 mL,mL,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
"HEPARIN, PORCINE (PF) 100 UNIT/ML IV SYRG",,J1642,HCPCS,Facility,Both,5 mL,mL,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
"HEPARIN, PORCINE (PF) 100 UNIT/ML IV SYRG",,J1642,HCPCS,Facility,Both,5 mL,mL,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
"HEPARIN, PORCINE (PF) 100 UNIT/ML IV SYRG",,J1642,HCPCS,Facility,Outpatient,5 mL,mL,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
"HEPARIN, PORCINE (PF) 100 UNIT/ML IV SYRG",,J1642,HCPCS,Facility,Inpatient,5 mL,mL,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"HEPARIN, PORCINE (PF) 100 UNIT/ML IV SYRG",,J1642,HCPCS,Facility,Both,5 mL,mL,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
"HEPARIN, PORCINE (PF) 100 UNIT/ML IV SYRG",,J1642,HCPCS,Facility,Both,5 mL,mL,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
"HEPARIN, PORCINE (PF) 100 UNIT/ML IV SYRG",,J1642,HCPCS,Facility,Both,5 mL,mL,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
"HEPARIN, PORCINE (PF) 100 UNIT/ML IV SYRG",,J1642,HCPCS,Facility,Both,5 mL,mL,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
"HEPARIN, PORCINE (PF) 100 UNIT/ML IV SYRG",,J1642,HCPCS,Facility,Outpatient,5 mL,mL,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
"HEPARIN, PORCINE (PF) 100 UNIT/ML IV SYRG",,J1642,HCPCS,Facility,Inpatient,5 mL,mL,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"HEPARIN, PORCINE (PF) 100 UNIT/ML IV SYRG",,J1642,HCPCS,Facility,Both,5 mL,mL,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
"HEPARIN, PORCINE (PF) 100 UNIT/ML IV SYRG",,J1642,HCPCS,Facility,Outpatient,5 mL,mL,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
"HEPARIN, PORCINE (PF) 100 UNIT/ML IV SYRG",,J1642,HCPCS,Facility,Inpatient,5 mL,mL,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"HEPARIN, PORCINE (PF) 100 UNIT/ML IV SYRG",,J1642,HCPCS,Facility,Outpatient,5 mL,mL,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
"HEPARIN, PORCINE (PF) 100 UNIT/ML IV SYRG",,J1642,HCPCS,Facility,Inpatient,5 mL,mL,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
"HEPARIN, PORCINE (PF) 100 UNIT/ML IV SYRG",,J1642,HCPCS,Facility,Outpatient,5 mL,mL,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
"HEPARIN, PORCINE (PF) 100 UNIT/ML IV SYRG",,J1642,HCPCS,Facility,Inpatient,5 mL,mL,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"HEPARIN, PORCINE (PF) 100 UNIT/ML IV SYRG",,J1642,HCPCS,Facility,Both,5 mL,mL,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
"HEPARIN, PORCINE (PF) 100 UNIT/ML IV SYRG",,J1642,HCPCS,Facility,Outpatient,5 mL,mL,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
"HEPARIN, PORCINE (PF) 100 UNIT/ML IV SYRG",,J1642,HCPCS,Facility,Inpatient,5 mL,mL,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"HEPARIN, PORCINE (PF) 100 UNIT/ML IV SYRG",,J1642,HCPCS,Facility,Both,5 mL,mL,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
"HEPARIN, PORCINE (PF) 100 UNIT/ML IV SYRG",,J1642,HCPCS,Facility,Outpatient,5 mL,mL,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"HEPARIN, PORCINE (PF) 100 UNIT/ML IV SYRG",,J1642,HCPCS,Facility,Inpatient,5 mL,mL,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"HEPARIN, PORCINE (PF) 100 UNIT/ML IV SYRG",,J1642,HCPCS,Facility,Outpatient,5 mL,mL,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"HEPARIN, PORCINE (PF) 100 UNIT/ML IV SYRG",,J1642,HCPCS,Facility,Inpatient,5 mL,mL,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"HEPARIN, PORCINE (PF) 100 UNIT/ML IV SYRG",,J1642,HCPCS,Facility,Both,5 mL,mL,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
"HEPARIN, PORCINE (PF) 100 UNIT/ML IV SYRG",,J1642,HCPCS,Facility,Outpatient,5 mL,mL,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"HEPARIN, PORCINE (PF) 100 UNIT/ML IV SYRG",,J1642,HCPCS,Facility,Inpatient,5 mL,mL,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"HEPARIN, PORCINE (PF) 100 UNIT/ML IV SYRG",,J1642,HCPCS,Facility,Outpatient,5 mL,mL,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"HEPARIN, PORCINE (PF) 100 UNIT/ML IV SYRG",,J1642,HCPCS,Facility,Inpatient,5 mL,mL,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"HEPARIN, PORCINE (PF) 100 UNIT/ML IV SYRG",,J1642,HCPCS,Facility,Outpatient,5 mL,mL,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"HEPARIN, PORCINE (PF) 100 UNIT/ML IV SYRG",,J1642,HCPCS,Facility,Inpatient,5 mL,mL,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"HEPARIN, PORCINE (PF) 100 UNIT/ML IV SYRG",,J1642,HCPCS,Facility,Outpatient,5 mL,mL,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"HEPARIN, PORCINE (PF) 100 UNIT/ML IV SYRG",,J1642,HCPCS,Facility,Inpatient,5 mL,mL,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"HEPARIN, PORCINE (PF) 100 UNIT/ML IV SYRG",,J1642,HCPCS,Facility,Both,5 mL,mL,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
"HEPARIN, PORCINE (PF) 100 UNIT/ML IV SYRG",,J1642,HCPCS,Facility,Outpatient,5 mL,mL,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
"HEPARIN, PORCINE (PF) 100 UNIT/ML IV SYRG",,J1642,HCPCS,Facility,Inpatient,5 mL,mL,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"HEPARIN, PORCINE (PF) 100 UNIT/ML IV SYRG",,J1642,HCPCS,Facility,Outpatient,5 mL,mL,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
"HEPARIN, PORCINE (PF) 100 UNIT/ML IV SYRG",,J1642,HCPCS,Facility,Inpatient,5 mL,mL,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
LEVETIRACETAM 500 MG/5 ML IV SOLN,,J1953,HCPCS,Facility,Both,5 mL,mL,,33,28.05,9.4578,33,Aetna,Commercial,30.36,92,,percent of total billed charges,,
LEVETIRACETAM 500 MG/5 ML IV SOLN,,J1953,HCPCS,Facility,Outpatient,5 mL,mL,,33,28.05,9.4578,33,Aetna,Medicare Advantage,16.17,49,,percent of total billed charges,,
LEVETIRACETAM 500 MG/5 ML IV SOLN,,J1953,HCPCS,Facility,Inpatient,5 mL,mL,,33,28.05,9.4578,33,Aetna,Medicare Advantage,,,,,Included in per diem rate,
LEVETIRACETAM 500 MG/5 ML IV SOLN,,J1953,HCPCS,Facility,Both,5 mL,mL,,33,28.05,9.4578,33,Aetna,PPO,30.69,93,,percent of total billed charges,,
LEVETIRACETAM 500 MG/5 ML IV SOLN,,J1953,HCPCS,Facility,Both,5 mL,mL,,33,28.05,9.4578,33,America's PPO,America's PPO,31.6899,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
LEVETIRACETAM 500 MG/5 ML IV SOLN,,J1953,HCPCS,Facility,Both,5 mL,mL,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota, Federal Employee Program,32.472,98.4,,percent of total billed charges,,
LEVETIRACETAM 500 MG/5 ML IV SOLN,,J1953,HCPCS,Facility,Both,5 mL,mL,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,33,100,,percent of total billed charges,,
LEVETIRACETAM 500 MG/5 ML IV SOLN,,J1953,HCPCS,Facility,Both,5 mL,mL,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota,High Value Network Plan,29.7,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
LEVETIRACETAM 500 MG/5 ML IV SOLN,,J1953,HCPCS,Facility,Outpatient,5 mL,mL,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota,Medicare Advantage,16.17,49,,percent of total billed charges,,
LEVETIRACETAM 500 MG/5 ML IV SOLN,,J1953,HCPCS,Facility,Inpatient,5 mL,mL,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
LEVETIRACETAM 500 MG/5 ML IV SOLN,,J1953,HCPCS,Facility,Both,5 mL,mL,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,29.2281,88.57,,percent of total billed charges,,
LEVETIRACETAM 500 MG/5 ML IV SOLN,,J1953,HCPCS,Facility,Both,5 mL,mL,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,9.4578,28.66,,percent of total billed charges,,
LEVETIRACETAM 500 MG/5 ML IV SOLN,,J1953,HCPCS,Facility,Outpatient,5 mL,mL,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),16.17,49,,percent of total billed charges,,
LEVETIRACETAM 500 MG/5 ML IV SOLN,,J1953,HCPCS,Facility,Inpatient,5 mL,mL,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
LEVETIRACETAM 500 MG/5 ML IV SOLN,,J1953,HCPCS,Facility,Both,5 mL,mL,,33,28.05,9.4578,33,CorVel,Worker's Compensation,33,100,,percent of total billed charges,,
LEVETIRACETAM 500 MG/5 ML IV SOLN,,J1953,HCPCS,Facility,Both,5 mL,mL,,33,28.05,9.4578,33,First Health Group Corporation,First Health Network,32.01,97,,percent of total billed charges,,
LEVETIRACETAM 500 MG/5 ML IV SOLN,,J1953,HCPCS,Facility,Both,5 mL,mL,,33,28.05,9.4578,33,"Health Partners, Inc.",Commercial,31.218,94.6,,percent of total billed charges,,
LEVETIRACETAM 500 MG/5 ML IV SOLN,,J1953,HCPCS,Facility,Outpatient,5 mL,mL,,33,28.05,9.4578,33,"Health Partners, Inc.",Medicare Advantage,16.17,49,,percent of total billed charges,,
LEVETIRACETAM 500 MG/5 ML IV SOLN,,J1953,HCPCS,Facility,Inpatient,5 mL,mL,,33,28.05,9.4578,33,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LEVETIRACETAM 500 MG/5 ML IV SOLN,,J1953,HCPCS,Facility,Both,5 mL,mL,,33,28.05,9.4578,33,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),19.8,60,,percent of total billed charges,,
LEVETIRACETAM 500 MG/5 ML IV SOLN,,J1953,HCPCS,Facility,Both,5 mL,mL,,33,28.05,9.4578,33,"Health Partners, Inc.",State of Minnesota Advantage Program,26.895,81.5,,percent of total billed charges,,
LEVETIRACETAM 500 MG/5 ML IV SOLN,,J1953,HCPCS,Facility,Both,5 mL,mL,,33,28.05,9.4578,33,"Health Partners, Inc.",State Public Programs,16.5,50,,percent of total billed charges,,
LEVETIRACETAM 500 MG/5 ML IV SOLN,,J1953,HCPCS,Facility,Both,5 mL,mL,,33,28.05,9.4578,33,Humana Insurance Company,Commercial PPO,31.35,95,,percent of total billed charges,,
LEVETIRACETAM 500 MG/5 ML IV SOLN,,J1953,HCPCS,Facility,Outpatient,5 mL,mL,,33,28.05,9.4578,33,Humana Insurance Company,Medicare PPO,16.17,49,,percent of total billed charges,,
LEVETIRACETAM 500 MG/5 ML IV SOLN,,J1953,HCPCS,Facility,Inpatient,5 mL,mL,,33,28.05,9.4578,33,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
LEVETIRACETAM 500 MG/5 ML IV SOLN,,J1953,HCPCS,Facility,Both,5 mL,mL,,33,28.05,9.4578,33,Medica,Individual & Family,32.703,99.1,,percent of total billed charges,,
LEVETIRACETAM 500 MG/5 ML IV SOLN,,J1953,HCPCS,Facility,Outpatient,5 mL,mL,,33,28.05,9.4578,33,Medica,Medica Advantage Solution,16.434,49.8,,percent of total billed charges,,
LEVETIRACETAM 500 MG/5 ML IV SOLN,,J1953,HCPCS,Facility,Inpatient,5 mL,mL,,33,28.05,9.4578,33,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
LEVETIRACETAM 500 MG/5 ML IV SOLN,,J1953,HCPCS,Facility,Outpatient,5 mL,mL,,33,28.05,9.4578,33,Medica,Medical Assistance,14.718,44.6,,percent of total billed charges,,
LEVETIRACETAM 500 MG/5 ML IV SOLN,,J1953,HCPCS,Facility,Inpatient,5 mL,mL,,33,28.05,9.4578,33,Medica,Medical Assistance,,,,,Included in per diem rate,
LEVETIRACETAM 500 MG/5 ML IV SOLN,,J1953,HCPCS,Facility,Outpatient,5 mL,mL,,33,28.05,9.4578,33,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,16.434,49.8,,percent of total billed charges,,
LEVETIRACETAM 500 MG/5 ML IV SOLN,,J1953,HCPCS,Facility,Inpatient,5 mL,mL,,33,28.05,9.4578,33,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
LEVETIRACETAM 500 MG/5 ML IV SOLN,,J1953,HCPCS,Facility,Both,5 mL,mL,,33,28.05,9.4578,33,"Multiplan, Inc.","Multiplan, Inc.",31.02,94,,percent of total billed charges,,
LEVETIRACETAM 500 MG/5 ML IV SOLN,,J1953,HCPCS,Facility,Outpatient,5 mL,mL,,33,28.05,9.4578,33,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,29.733,90.1,,percent of total billed charges,,
LEVETIRACETAM 500 MG/5 ML IV SOLN,,J1953,HCPCS,Facility,Inpatient,5 mL,mL,,33,28.05,9.4578,33,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
LEVETIRACETAM 500 MG/5 ML IV SOLN,,J1953,HCPCS,Facility,Both,5 mL,mL,,33,28.05,9.4578,33,"Preferred One Administrative Services, INC.",PPO,32.538,98.6,,percent of total billed charges,,
LEVETIRACETAM 500 MG/5 ML IV SOLN,,J1953,HCPCS,Facility,Outpatient,5 mL,mL,,33,28.05,9.4578,33,PrimeWest Health,Minnesota Senior Health Options (MSHO),16.9785,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
LEVETIRACETAM 500 MG/5 ML IV SOLN,,J1953,HCPCS,Facility,Inpatient,5 mL,mL,,33,28.05,9.4578,33,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LEVETIRACETAM 500 MG/5 ML IV SOLN,,J1953,HCPCS,Facility,Outpatient,5 mL,mL,,33,28.05,9.4578,33,PrimeWest Health,MinnesotaCare,16.9488,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
LEVETIRACETAM 500 MG/5 ML IV SOLN,,J1953,HCPCS,Facility,Inpatient,5 mL,mL,,33,28.05,9.4578,33,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
LEVETIRACETAM 500 MG/5 ML IV SOLN,,J1953,HCPCS,Facility,Both,5 mL,mL,,33,28.05,9.4578,33,Sanford Health Plan,Sanford Health Plan,30.36,92,,percent of total billed charges,,
LEVETIRACETAM 500 MG/5 ML IV SOLN,,J1953,HCPCS,Facility,Outpatient,5 mL,mL,,33,28.05,9.4578,33,"UCare Health, Inc.",Individual & Family Plan,18.5955,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
LEVETIRACETAM 500 MG/5 ML IV SOLN,,J1953,HCPCS,Facility,Inpatient,5 mL,mL,,33,28.05,9.4578,33,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
LEVETIRACETAM 500 MG/5 ML IV SOLN,,J1953,HCPCS,Facility,Outpatient,5 mL,mL,,33,28.05,9.4578,33,"UCare Health, Inc.",Medical Assistance,16.6551,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LEVETIRACETAM 500 MG/5 ML IV SOLN,,J1953,HCPCS,Facility,Inpatient,5 mL,mL,,33,28.05,9.4578,33,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
LEVETIRACETAM 500 MG/5 ML IV SOLN,,J1953,HCPCS,Facility,Outpatient,5 mL,mL,,33,28.05,9.4578,33,"UCare Health, Inc.",Medicare Advantage,16.6551,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LEVETIRACETAM 500 MG/5 ML IV SOLN,,J1953,HCPCS,Facility,Inpatient,5 mL,mL,,33,28.05,9.4578,33,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LEVETIRACETAM 500 MG/5 ML IV SOLN,,J1953,HCPCS,Facility,Outpatient,5 mL,mL,,33,28.05,9.4578,33,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),16.6551,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LEVETIRACETAM 500 MG/5 ML IV SOLN,,J1953,HCPCS,Facility,Inpatient,5 mL,mL,,33,28.05,9.4578,33,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LEVETIRACETAM 500 MG/5 ML IV SOLN,,J1953,HCPCS,Facility,Both,5 mL,mL,,33,28.05,9.4578,33,UnitedHealthcare,Individual & Family,31.02,94,,percent of total billed charges,,
LEVETIRACETAM 500 MG/5 ML IV SOLN,,J1953,HCPCS,Facility,Outpatient,5 mL,mL,,33,28.05,9.4578,33,UnitedHealthcare,Medicare Advantage,16.17,49,,percent of total billed charges,,
LEVETIRACETAM 500 MG/5 ML IV SOLN,,J1953,HCPCS,Facility,Inpatient,5 mL,mL,,33,28.05,9.4578,33,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
LEVETIRACETAM 500 MG/5 ML IV SOLN,,J1953,HCPCS,Facility,Outpatient,5 mL,mL,,33,28.05,9.4578,33,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,15.84,48,,percent of total billed charges,,100% of DHS outpatient percentage
LEVETIRACETAM 500 MG/5 ML IV SOLN,,J1953,HCPCS,Facility,Inpatient,5 mL,mL,,33,28.05,9.4578,33,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
OCTREOTIDE ACETATE 200 MCG/ML INJ SOLN,,J2354,HCPCS,Facility,Both,5 mL,mL,,343,291.55,98.3038,343,Aetna,Commercial,315.56,92,,percent of total billed charges,,
OCTREOTIDE ACETATE 200 MCG/ML INJ SOLN,,J2354,HCPCS,Facility,Outpatient,5 mL,mL,,343,291.55,98.3038,343,Aetna,Medicare Advantage,168.07,49,,percent of total billed charges,,
OCTREOTIDE ACETATE 200 MCG/ML INJ SOLN,,J2354,HCPCS,Facility,Inpatient,5 mL,mL,,343,291.55,98.3038,343,Aetna,Medicare Advantage,,,,,Included in per diem rate,
OCTREOTIDE ACETATE 200 MCG/ML INJ SOLN,,J2354,HCPCS,Facility,Both,5 mL,mL,,343,291.55,98.3038,343,Aetna,PPO,318.99,93,,percent of total billed charges,,
OCTREOTIDE ACETATE 200 MCG/ML INJ SOLN,,J2354,HCPCS,Facility,Both,5 mL,mL,,343,291.55,98.3038,343,America's PPO,America's PPO,329.3829,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
OCTREOTIDE ACETATE 200 MCG/ML INJ SOLN,,J2354,HCPCS,Facility,Both,5 mL,mL,,343,291.55,98.3038,343,BlueCross BlueShield Minnesota, Federal Employee Program,337.512,98.4,,percent of total billed charges,,
OCTREOTIDE ACETATE 200 MCG/ML INJ SOLN,,J2354,HCPCS,Facility,Both,5 mL,mL,,343,291.55,98.3038,343,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,343,100,,percent of total billed charges,,
OCTREOTIDE ACETATE 200 MCG/ML INJ SOLN,,J2354,HCPCS,Facility,Both,5 mL,mL,,343,291.55,98.3038,343,BlueCross BlueShield Minnesota,High Value Network Plan,308.7,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
OCTREOTIDE ACETATE 200 MCG/ML INJ SOLN,,J2354,HCPCS,Facility,Outpatient,5 mL,mL,,343,291.55,98.3038,343,BlueCross BlueShield Minnesota,Medicare Advantage,168.07,49,,percent of total billed charges,,
OCTREOTIDE ACETATE 200 MCG/ML INJ SOLN,,J2354,HCPCS,Facility,Inpatient,5 mL,mL,,343,291.55,98.3038,343,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
OCTREOTIDE ACETATE 200 MCG/ML INJ SOLN,,J2354,HCPCS,Facility,Both,5 mL,mL,,343,291.55,98.3038,343,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,303.7951,88.57,,percent of total billed charges,,
OCTREOTIDE ACETATE 200 MCG/ML INJ SOLN,,J2354,HCPCS,Facility,Both,5 mL,mL,,343,291.55,98.3038,343,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,98.3038,28.66,,percent of total billed charges,,
OCTREOTIDE ACETATE 200 MCG/ML INJ SOLN,,J2354,HCPCS,Facility,Outpatient,5 mL,mL,,343,291.55,98.3038,343,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),168.07,49,,percent of total billed charges,,
OCTREOTIDE ACETATE 200 MCG/ML INJ SOLN,,J2354,HCPCS,Facility,Inpatient,5 mL,mL,,343,291.55,98.3038,343,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
OCTREOTIDE ACETATE 200 MCG/ML INJ SOLN,,J2354,HCPCS,Facility,Both,5 mL,mL,,343,291.55,98.3038,343,CorVel,Worker's Compensation,343,100,,percent of total billed charges,,
OCTREOTIDE ACETATE 200 MCG/ML INJ SOLN,,J2354,HCPCS,Facility,Both,5 mL,mL,,343,291.55,98.3038,343,First Health Group Corporation,First Health Network,332.71,97,,percent of total billed charges,,
OCTREOTIDE ACETATE 200 MCG/ML INJ SOLN,,J2354,HCPCS,Facility,Both,5 mL,mL,,343,291.55,98.3038,343,"Health Partners, Inc.",Commercial,324.478,94.6,,percent of total billed charges,,
OCTREOTIDE ACETATE 200 MCG/ML INJ SOLN,,J2354,HCPCS,Facility,Outpatient,5 mL,mL,,343,291.55,98.3038,343,"Health Partners, Inc.",Medicare Advantage,168.07,49,,percent of total billed charges,,
OCTREOTIDE ACETATE 200 MCG/ML INJ SOLN,,J2354,HCPCS,Facility,Inpatient,5 mL,mL,,343,291.55,98.3038,343,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
OCTREOTIDE ACETATE 200 MCG/ML INJ SOLN,,J2354,HCPCS,Facility,Both,5 mL,mL,,343,291.55,98.3038,343,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),205.8,60,,percent of total billed charges,,
OCTREOTIDE ACETATE 200 MCG/ML INJ SOLN,,J2354,HCPCS,Facility,Both,5 mL,mL,,343,291.55,98.3038,343,"Health Partners, Inc.",State of Minnesota Advantage Program,279.545,81.5,,percent of total billed charges,,
OCTREOTIDE ACETATE 200 MCG/ML INJ SOLN,,J2354,HCPCS,Facility,Both,5 mL,mL,,343,291.55,98.3038,343,"Health Partners, Inc.",State Public Programs,171.5,50,,percent of total billed charges,,
OCTREOTIDE ACETATE 200 MCG/ML INJ SOLN,,J2354,HCPCS,Facility,Both,5 mL,mL,,343,291.55,98.3038,343,Humana Insurance Company,Commercial PPO,325.85,95,,percent of total billed charges,,
OCTREOTIDE ACETATE 200 MCG/ML INJ SOLN,,J2354,HCPCS,Facility,Outpatient,5 mL,mL,,343,291.55,98.3038,343,Humana Insurance Company,Medicare PPO,168.07,49,,percent of total billed charges,,
OCTREOTIDE ACETATE 200 MCG/ML INJ SOLN,,J2354,HCPCS,Facility,Inpatient,5 mL,mL,,343,291.55,98.3038,343,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
OCTREOTIDE ACETATE 200 MCG/ML INJ SOLN,,J2354,HCPCS,Facility,Both,5 mL,mL,,343,291.55,98.3038,343,Medica,Individual & Family,339.913,99.1,,percent of total billed charges,,
OCTREOTIDE ACETATE 200 MCG/ML INJ SOLN,,J2354,HCPCS,Facility,Outpatient,5 mL,mL,,343,291.55,98.3038,343,Medica,Medica Advantage Solution,170.814,49.8,,percent of total billed charges,,
OCTREOTIDE ACETATE 200 MCG/ML INJ SOLN,,J2354,HCPCS,Facility,Inpatient,5 mL,mL,,343,291.55,98.3038,343,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
OCTREOTIDE ACETATE 200 MCG/ML INJ SOLN,,J2354,HCPCS,Facility,Outpatient,5 mL,mL,,343,291.55,98.3038,343,Medica,Medical Assistance,152.978,44.6,,percent of total billed charges,,
OCTREOTIDE ACETATE 200 MCG/ML INJ SOLN,,J2354,HCPCS,Facility,Inpatient,5 mL,mL,,343,291.55,98.3038,343,Medica,Medical Assistance,,,,,Included in per diem rate,
OCTREOTIDE ACETATE 200 MCG/ML INJ SOLN,,J2354,HCPCS,Facility,Outpatient,5 mL,mL,,343,291.55,98.3038,343,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,170.814,49.8,,percent of total billed charges,,
OCTREOTIDE ACETATE 200 MCG/ML INJ SOLN,,J2354,HCPCS,Facility,Inpatient,5 mL,mL,,343,291.55,98.3038,343,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
OCTREOTIDE ACETATE 200 MCG/ML INJ SOLN,,J2354,HCPCS,Facility,Both,5 mL,mL,,343,291.55,98.3038,343,"Multiplan, Inc.","Multiplan, Inc.",322.42,94,,percent of total billed charges,,
OCTREOTIDE ACETATE 200 MCG/ML INJ SOLN,,J2354,HCPCS,Facility,Outpatient,5 mL,mL,,343,291.55,98.3038,343,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,309.043,90.1,,percent of total billed charges,,
OCTREOTIDE ACETATE 200 MCG/ML INJ SOLN,,J2354,HCPCS,Facility,Inpatient,5 mL,mL,,343,291.55,98.3038,343,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
OCTREOTIDE ACETATE 200 MCG/ML INJ SOLN,,J2354,HCPCS,Facility,Both,5 mL,mL,,343,291.55,98.3038,343,"Preferred One Administrative Services, INC.",PPO,338.198,98.6,,percent of total billed charges,,
OCTREOTIDE ACETATE 200 MCG/ML INJ SOLN,,J2354,HCPCS,Facility,Outpatient,5 mL,mL,,343,291.55,98.3038,343,PrimeWest Health,Minnesota Senior Health Options (MSHO),176.4735,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
OCTREOTIDE ACETATE 200 MCG/ML INJ SOLN,,J2354,HCPCS,Facility,Inpatient,5 mL,mL,,343,291.55,98.3038,343,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
OCTREOTIDE ACETATE 200 MCG/ML INJ SOLN,,J2354,HCPCS,Facility,Outpatient,5 mL,mL,,343,291.55,98.3038,343,PrimeWest Health,MinnesotaCare,176.1648,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
OCTREOTIDE ACETATE 200 MCG/ML INJ SOLN,,J2354,HCPCS,Facility,Inpatient,5 mL,mL,,343,291.55,98.3038,343,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
OCTREOTIDE ACETATE 200 MCG/ML INJ SOLN,,J2354,HCPCS,Facility,Both,5 mL,mL,,343,291.55,98.3038,343,Sanford Health Plan,Sanford Health Plan,315.56,92,,percent of total billed charges,,
OCTREOTIDE ACETATE 200 MCG/ML INJ SOLN,,J2354,HCPCS,Facility,Outpatient,5 mL,mL,,343,291.55,98.3038,343,"UCare Health, Inc.",Individual & Family Plan,193.2805,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
OCTREOTIDE ACETATE 200 MCG/ML INJ SOLN,,J2354,HCPCS,Facility,Inpatient,5 mL,mL,,343,291.55,98.3038,343,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
OCTREOTIDE ACETATE 200 MCG/ML INJ SOLN,,J2354,HCPCS,Facility,Outpatient,5 mL,mL,,343,291.55,98.3038,343,"UCare Health, Inc.",Medical Assistance,173.1121,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
OCTREOTIDE ACETATE 200 MCG/ML INJ SOLN,,J2354,HCPCS,Facility,Inpatient,5 mL,mL,,343,291.55,98.3038,343,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
OCTREOTIDE ACETATE 200 MCG/ML INJ SOLN,,J2354,HCPCS,Facility,Outpatient,5 mL,mL,,343,291.55,98.3038,343,"UCare Health, Inc.",Medicare Advantage,173.1121,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
OCTREOTIDE ACETATE 200 MCG/ML INJ SOLN,,J2354,HCPCS,Facility,Inpatient,5 mL,mL,,343,291.55,98.3038,343,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
OCTREOTIDE ACETATE 200 MCG/ML INJ SOLN,,J2354,HCPCS,Facility,Outpatient,5 mL,mL,,343,291.55,98.3038,343,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),173.1121,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
OCTREOTIDE ACETATE 200 MCG/ML INJ SOLN,,J2354,HCPCS,Facility,Inpatient,5 mL,mL,,343,291.55,98.3038,343,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
OCTREOTIDE ACETATE 200 MCG/ML INJ SOLN,,J2354,HCPCS,Facility,Both,5 mL,mL,,343,291.55,98.3038,343,UnitedHealthcare,Individual & Family,322.42,94,,percent of total billed charges,,
OCTREOTIDE ACETATE 200 MCG/ML INJ SOLN,,J2354,HCPCS,Facility,Outpatient,5 mL,mL,,343,291.55,98.3038,343,UnitedHealthcare,Medicare Advantage,168.07,49,,percent of total billed charges,,
OCTREOTIDE ACETATE 200 MCG/ML INJ SOLN,,J2354,HCPCS,Facility,Inpatient,5 mL,mL,,343,291.55,98.3038,343,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
OCTREOTIDE ACETATE 200 MCG/ML INJ SOLN,,J2354,HCPCS,Facility,Outpatient,5 mL,mL,,343,291.55,98.3038,343,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,164.64,48,,percent of total billed charges,,100% of DHS outpatient percentage
OCTREOTIDE ACETATE 200 MCG/ML INJ SOLN,,J2354,HCPCS,Facility,Inpatient,5 mL,mL,,343,291.55,98.3038,343,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
REGADENOSON 0.4 MG/5 ML IV SYRG,,J2785,HCPCS,Facility,Both,5 mL,mL,,1114,946.9,319.2724,1114,Aetna,Commercial,1024.88,92,,percent of total billed charges,,
REGADENOSON 0.4 MG/5 ML IV SYRG,,J2785,HCPCS,Facility,Outpatient,5 mL,mL,,1114,946.9,319.2724,1114,Aetna,Medicare Advantage,545.86,49,,percent of total billed charges,,
REGADENOSON 0.4 MG/5 ML IV SYRG,,J2785,HCPCS,Facility,Inpatient,5 mL,mL,,1114,946.9,319.2724,1114,Aetna,Medicare Advantage,,,,,Included in per diem rate,
REGADENOSON 0.4 MG/5 ML IV SYRG,,J2785,HCPCS,Facility,Both,5 mL,mL,,1114,946.9,319.2724,1114,Aetna,PPO,1036.02,93,,percent of total billed charges,,
REGADENOSON 0.4 MG/5 ML IV SYRG,,J2785,HCPCS,Facility,Both,5 mL,mL,,1114,946.9,319.2724,1114,America's PPO,America's PPO,1069.7742,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
REGADENOSON 0.4 MG/5 ML IV SYRG,,J2785,HCPCS,Facility,Both,5 mL,mL,,1114,946.9,319.2724,1114,BlueCross BlueShield Minnesota, Federal Employee Program,1096.176,98.4,,percent of total billed charges,,
REGADENOSON 0.4 MG/5 ML IV SYRG,,J2785,HCPCS,Facility,Both,5 mL,mL,,1114,946.9,319.2724,1114,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1114,100,,percent of total billed charges,,
REGADENOSON 0.4 MG/5 ML IV SYRG,,J2785,HCPCS,Facility,Both,5 mL,mL,,1114,946.9,319.2724,1114,BlueCross BlueShield Minnesota,High Value Network Plan,1002.6,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
REGADENOSON 0.4 MG/5 ML IV SYRG,,J2785,HCPCS,Facility,Outpatient,5 mL,mL,,1114,946.9,319.2724,1114,BlueCross BlueShield Minnesota,Medicare Advantage,545.86,49,,percent of total billed charges,,
REGADENOSON 0.4 MG/5 ML IV SYRG,,J2785,HCPCS,Facility,Inpatient,5 mL,mL,,1114,946.9,319.2724,1114,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
REGADENOSON 0.4 MG/5 ML IV SYRG,,J2785,HCPCS,Facility,Both,5 mL,mL,,1114,946.9,319.2724,1114,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,986.6698,88.57,,percent of total billed charges,,
REGADENOSON 0.4 MG/5 ML IV SYRG,,J2785,HCPCS,Facility,Both,5 mL,mL,,1114,946.9,319.2724,1114,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,319.2724,28.66,,percent of total billed charges,,
REGADENOSON 0.4 MG/5 ML IV SYRG,,J2785,HCPCS,Facility,Outpatient,5 mL,mL,,1114,946.9,319.2724,1114,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),545.86,49,,percent of total billed charges,,
REGADENOSON 0.4 MG/5 ML IV SYRG,,J2785,HCPCS,Facility,Inpatient,5 mL,mL,,1114,946.9,319.2724,1114,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
REGADENOSON 0.4 MG/5 ML IV SYRG,,J2785,HCPCS,Facility,Both,5 mL,mL,,1114,946.9,319.2724,1114,CorVel,Worker's Compensation,1114,100,,percent of total billed charges,,
REGADENOSON 0.4 MG/5 ML IV SYRG,,J2785,HCPCS,Facility,Both,5 mL,mL,,1114,946.9,319.2724,1114,First Health Group Corporation,First Health Network,1080.58,97,,percent of total billed charges,,
REGADENOSON 0.4 MG/5 ML IV SYRG,,J2785,HCPCS,Facility,Both,5 mL,mL,,1114,946.9,319.2724,1114,"Health Partners, Inc.",Commercial,1053.844,94.6,,percent of total billed charges,,
REGADENOSON 0.4 MG/5 ML IV SYRG,,J2785,HCPCS,Facility,Outpatient,5 mL,mL,,1114,946.9,319.2724,1114,"Health Partners, Inc.",Medicare Advantage,545.86,49,,percent of total billed charges,,
REGADENOSON 0.4 MG/5 ML IV SYRG,,J2785,HCPCS,Facility,Inpatient,5 mL,mL,,1114,946.9,319.2724,1114,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
REGADENOSON 0.4 MG/5 ML IV SYRG,,J2785,HCPCS,Facility,Both,5 mL,mL,,1114,946.9,319.2724,1114,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),668.4,60,,percent of total billed charges,,
REGADENOSON 0.4 MG/5 ML IV SYRG,,J2785,HCPCS,Facility,Both,5 mL,mL,,1114,946.9,319.2724,1114,"Health Partners, Inc.",State of Minnesota Advantage Program,907.91,81.5,,percent of total billed charges,,
REGADENOSON 0.4 MG/5 ML IV SYRG,,J2785,HCPCS,Facility,Both,5 mL,mL,,1114,946.9,319.2724,1114,"Health Partners, Inc.",State Public Programs,557,50,,percent of total billed charges,,
REGADENOSON 0.4 MG/5 ML IV SYRG,,J2785,HCPCS,Facility,Both,5 mL,mL,,1114,946.9,319.2724,1114,Humana Insurance Company,Commercial PPO,1058.3,95,,percent of total billed charges,,
REGADENOSON 0.4 MG/5 ML IV SYRG,,J2785,HCPCS,Facility,Outpatient,5 mL,mL,,1114,946.9,319.2724,1114,Humana Insurance Company,Medicare PPO,545.86,49,,percent of total billed charges,,
REGADENOSON 0.4 MG/5 ML IV SYRG,,J2785,HCPCS,Facility,Inpatient,5 mL,mL,,1114,946.9,319.2724,1114,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
REGADENOSON 0.4 MG/5 ML IV SYRG,,J2785,HCPCS,Facility,Both,5 mL,mL,,1114,946.9,319.2724,1114,Medica,Individual & Family,1103.974,99.1,,percent of total billed charges,,
REGADENOSON 0.4 MG/5 ML IV SYRG,,J2785,HCPCS,Facility,Outpatient,5 mL,mL,,1114,946.9,319.2724,1114,Medica,Medica Advantage Solution,554.772,49.8,,percent of total billed charges,,
REGADENOSON 0.4 MG/5 ML IV SYRG,,J2785,HCPCS,Facility,Inpatient,5 mL,mL,,1114,946.9,319.2724,1114,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
REGADENOSON 0.4 MG/5 ML IV SYRG,,J2785,HCPCS,Facility,Outpatient,5 mL,mL,,1114,946.9,319.2724,1114,Medica,Medical Assistance,496.844,44.6,,percent of total billed charges,,
REGADENOSON 0.4 MG/5 ML IV SYRG,,J2785,HCPCS,Facility,Inpatient,5 mL,mL,,1114,946.9,319.2724,1114,Medica,Medical Assistance,,,,,Included in per diem rate,
REGADENOSON 0.4 MG/5 ML IV SYRG,,J2785,HCPCS,Facility,Outpatient,5 mL,mL,,1114,946.9,319.2724,1114,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,554.772,49.8,,percent of total billed charges,,
REGADENOSON 0.4 MG/5 ML IV SYRG,,J2785,HCPCS,Facility,Inpatient,5 mL,mL,,1114,946.9,319.2724,1114,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
REGADENOSON 0.4 MG/5 ML IV SYRG,,J2785,HCPCS,Facility,Both,5 mL,mL,,1114,946.9,319.2724,1114,"Multiplan, Inc.","Multiplan, Inc.",1047.16,94,,percent of total billed charges,,
REGADENOSON 0.4 MG/5 ML IV SYRG,,J2785,HCPCS,Facility,Outpatient,5 mL,mL,,1114,946.9,319.2724,1114,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1003.714,90.1,,percent of total billed charges,,
REGADENOSON 0.4 MG/5 ML IV SYRG,,J2785,HCPCS,Facility,Inpatient,5 mL,mL,,1114,946.9,319.2724,1114,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
REGADENOSON 0.4 MG/5 ML IV SYRG,,J2785,HCPCS,Facility,Both,5 mL,mL,,1114,946.9,319.2724,1114,"Preferred One Administrative Services, INC.",PPO,1098.404,98.6,,percent of total billed charges,,
REGADENOSON 0.4 MG/5 ML IV SYRG,,J2785,HCPCS,Facility,Outpatient,5 mL,mL,,1114,946.9,319.2724,1114,PrimeWest Health,Minnesota Senior Health Options (MSHO),573.153,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
REGADENOSON 0.4 MG/5 ML IV SYRG,,J2785,HCPCS,Facility,Inpatient,5 mL,mL,,1114,946.9,319.2724,1114,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
REGADENOSON 0.4 MG/5 ML IV SYRG,,J2785,HCPCS,Facility,Outpatient,5 mL,mL,,1114,946.9,319.2724,1114,PrimeWest Health,MinnesotaCare,572.1504,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
REGADENOSON 0.4 MG/5 ML IV SYRG,,J2785,HCPCS,Facility,Inpatient,5 mL,mL,,1114,946.9,319.2724,1114,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
REGADENOSON 0.4 MG/5 ML IV SYRG,,J2785,HCPCS,Facility,Both,5 mL,mL,,1114,946.9,319.2724,1114,Sanford Health Plan,Sanford Health Plan,1024.88,92,,percent of total billed charges,,
REGADENOSON 0.4 MG/5 ML IV SYRG,,J2785,HCPCS,Facility,Outpatient,5 mL,mL,,1114,946.9,319.2724,1114,"UCare Health, Inc.",Individual & Family Plan,627.739,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
REGADENOSON 0.4 MG/5 ML IV SYRG,,J2785,HCPCS,Facility,Inpatient,5 mL,mL,,1114,946.9,319.2724,1114,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
REGADENOSON 0.4 MG/5 ML IV SYRG,,J2785,HCPCS,Facility,Outpatient,5 mL,mL,,1114,946.9,319.2724,1114,"UCare Health, Inc.",Medical Assistance,562.2358,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
REGADENOSON 0.4 MG/5 ML IV SYRG,,J2785,HCPCS,Facility,Inpatient,5 mL,mL,,1114,946.9,319.2724,1114,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
REGADENOSON 0.4 MG/5 ML IV SYRG,,J2785,HCPCS,Facility,Outpatient,5 mL,mL,,1114,946.9,319.2724,1114,"UCare Health, Inc.",Medicare Advantage,562.2358,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
REGADENOSON 0.4 MG/5 ML IV SYRG,,J2785,HCPCS,Facility,Inpatient,5 mL,mL,,1114,946.9,319.2724,1114,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
REGADENOSON 0.4 MG/5 ML IV SYRG,,J2785,HCPCS,Facility,Outpatient,5 mL,mL,,1114,946.9,319.2724,1114,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),562.2358,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
REGADENOSON 0.4 MG/5 ML IV SYRG,,J2785,HCPCS,Facility,Inpatient,5 mL,mL,,1114,946.9,319.2724,1114,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
REGADENOSON 0.4 MG/5 ML IV SYRG,,J2785,HCPCS,Facility,Both,5 mL,mL,,1114,946.9,319.2724,1114,UnitedHealthcare,Individual & Family,1047.16,94,,percent of total billed charges,,
REGADENOSON 0.4 MG/5 ML IV SYRG,,J2785,HCPCS,Facility,Outpatient,5 mL,mL,,1114,946.9,319.2724,1114,UnitedHealthcare,Medicare Advantage,545.86,49,,percent of total billed charges,,
REGADENOSON 0.4 MG/5 ML IV SYRG,,J2785,HCPCS,Facility,Inpatient,5 mL,mL,,1114,946.9,319.2724,1114,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
REGADENOSON 0.4 MG/5 ML IV SYRG,,J2785,HCPCS,Facility,Outpatient,5 mL,mL,,1114,946.9,319.2724,1114,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,534.72,48,,percent of total billed charges,,100% of DHS outpatient percentage
REGADENOSON 0.4 MG/5 ML IV SYRG,,J2785,HCPCS,Facility,Inpatient,5 mL,mL,,1114,946.9,319.2724,1114,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
TRIAMCINOLONE ACETONIDE 10 MG/ML INJ SUSP,,J3301,HCPCS,Facility,Both,5 mL,mL,,70,59.5,20.062,70,Aetna,Commercial,64.4,92,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 10 MG/ML INJ SUSP,,J3301,HCPCS,Facility,Outpatient,5 mL,mL,,70,59.5,20.062,70,Aetna,Medicare Advantage,34.3,49,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 10 MG/ML INJ SUSP,,J3301,HCPCS,Facility,Inpatient,5 mL,mL,,70,59.5,20.062,70,Aetna,Medicare Advantage,,,,,Included in per diem rate,
TRIAMCINOLONE ACETONIDE 10 MG/ML INJ SUSP,,J3301,HCPCS,Facility,Both,5 mL,mL,,70,59.5,20.062,70,Aetna,PPO,65.1,93,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 10 MG/ML INJ SUSP,,J3301,HCPCS,Facility,Both,5 mL,mL,,70,59.5,20.062,70,America's PPO,America's PPO,67.221,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
TRIAMCINOLONE ACETONIDE 10 MG/ML INJ SUSP,,J3301,HCPCS,Facility,Both,5 mL,mL,,70,59.5,20.062,70,BlueCross BlueShield Minnesota, Federal Employee Program,68.88,98.4,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 10 MG/ML INJ SUSP,,J3301,HCPCS,Facility,Both,5 mL,mL,,70,59.5,20.062,70,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,70,100,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 10 MG/ML INJ SUSP,,J3301,HCPCS,Facility,Both,5 mL,mL,,70,59.5,20.062,70,BlueCross BlueShield Minnesota,High Value Network Plan,63,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
TRIAMCINOLONE ACETONIDE 10 MG/ML INJ SUSP,,J3301,HCPCS,Facility,Outpatient,5 mL,mL,,70,59.5,20.062,70,BlueCross BlueShield Minnesota,Medicare Advantage,34.3,49,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 10 MG/ML INJ SUSP,,J3301,HCPCS,Facility,Inpatient,5 mL,mL,,70,59.5,20.062,70,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
TRIAMCINOLONE ACETONIDE 10 MG/ML INJ SUSP,,J3301,HCPCS,Facility,Both,5 mL,mL,,70,59.5,20.062,70,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,61.999,88.57,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 10 MG/ML INJ SUSP,,J3301,HCPCS,Facility,Both,5 mL,mL,,70,59.5,20.062,70,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,20.062,28.66,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 10 MG/ML INJ SUSP,,J3301,HCPCS,Facility,Outpatient,5 mL,mL,,70,59.5,20.062,70,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),34.3,49,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 10 MG/ML INJ SUSP,,J3301,HCPCS,Facility,Inpatient,5 mL,mL,,70,59.5,20.062,70,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
TRIAMCINOLONE ACETONIDE 10 MG/ML INJ SUSP,,J3301,HCPCS,Facility,Both,5 mL,mL,,70,59.5,20.062,70,CorVel,Worker's Compensation,70,100,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 10 MG/ML INJ SUSP,,J3301,HCPCS,Facility,Both,5 mL,mL,,70,59.5,20.062,70,First Health Group Corporation,First Health Network,67.9,97,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 10 MG/ML INJ SUSP,,J3301,HCPCS,Facility,Both,5 mL,mL,,70,59.5,20.062,70,"Health Partners, Inc.",Commercial,66.22,94.6,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 10 MG/ML INJ SUSP,,J3301,HCPCS,Facility,Outpatient,5 mL,mL,,70,59.5,20.062,70,"Health Partners, Inc.",Medicare Advantage,34.3,49,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 10 MG/ML INJ SUSP,,J3301,HCPCS,Facility,Inpatient,5 mL,mL,,70,59.5,20.062,70,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
TRIAMCINOLONE ACETONIDE 10 MG/ML INJ SUSP,,J3301,HCPCS,Facility,Both,5 mL,mL,,70,59.5,20.062,70,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),42,60,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 10 MG/ML INJ SUSP,,J3301,HCPCS,Facility,Both,5 mL,mL,,70,59.5,20.062,70,"Health Partners, Inc.",State of Minnesota Advantage Program,57.05,81.5,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 10 MG/ML INJ SUSP,,J3301,HCPCS,Facility,Both,5 mL,mL,,70,59.5,20.062,70,"Health Partners, Inc.",State Public Programs,35,50,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 10 MG/ML INJ SUSP,,J3301,HCPCS,Facility,Both,5 mL,mL,,70,59.5,20.062,70,Humana Insurance Company,Commercial PPO,66.5,95,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 10 MG/ML INJ SUSP,,J3301,HCPCS,Facility,Outpatient,5 mL,mL,,70,59.5,20.062,70,Humana Insurance Company,Medicare PPO,34.3,49,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 10 MG/ML INJ SUSP,,J3301,HCPCS,Facility,Inpatient,5 mL,mL,,70,59.5,20.062,70,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
TRIAMCINOLONE ACETONIDE 10 MG/ML INJ SUSP,,J3301,HCPCS,Facility,Both,5 mL,mL,,70,59.5,20.062,70,Medica,Individual & Family,69.37,99.1,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 10 MG/ML INJ SUSP,,J3301,HCPCS,Facility,Outpatient,5 mL,mL,,70,59.5,20.062,70,Medica,Medica Advantage Solution,34.86,49.8,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 10 MG/ML INJ SUSP,,J3301,HCPCS,Facility,Inpatient,5 mL,mL,,70,59.5,20.062,70,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
TRIAMCINOLONE ACETONIDE 10 MG/ML INJ SUSP,,J3301,HCPCS,Facility,Outpatient,5 mL,mL,,70,59.5,20.062,70,Medica,Medical Assistance,31.22,44.6,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 10 MG/ML INJ SUSP,,J3301,HCPCS,Facility,Inpatient,5 mL,mL,,70,59.5,20.062,70,Medica,Medical Assistance,,,,,Included in per diem rate,
TRIAMCINOLONE ACETONIDE 10 MG/ML INJ SUSP,,J3301,HCPCS,Facility,Outpatient,5 mL,mL,,70,59.5,20.062,70,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,34.86,49.8,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 10 MG/ML INJ SUSP,,J3301,HCPCS,Facility,Inpatient,5 mL,mL,,70,59.5,20.062,70,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
TRIAMCINOLONE ACETONIDE 10 MG/ML INJ SUSP,,J3301,HCPCS,Facility,Both,5 mL,mL,,70,59.5,20.062,70,"Multiplan, Inc.","Multiplan, Inc.",65.8,94,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 10 MG/ML INJ SUSP,,J3301,HCPCS,Facility,Outpatient,5 mL,mL,,70,59.5,20.062,70,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,63.07,90.1,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 10 MG/ML INJ SUSP,,J3301,HCPCS,Facility,Inpatient,5 mL,mL,,70,59.5,20.062,70,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
TRIAMCINOLONE ACETONIDE 10 MG/ML INJ SUSP,,J3301,HCPCS,Facility,Both,5 mL,mL,,70,59.5,20.062,70,"Preferred One Administrative Services, INC.",PPO,69.02,98.6,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 10 MG/ML INJ SUSP,,J3301,HCPCS,Facility,Outpatient,5 mL,mL,,70,59.5,20.062,70,PrimeWest Health,Minnesota Senior Health Options (MSHO),36.015,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
TRIAMCINOLONE ACETONIDE 10 MG/ML INJ SUSP,,J3301,HCPCS,Facility,Inpatient,5 mL,mL,,70,59.5,20.062,70,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
TRIAMCINOLONE ACETONIDE 10 MG/ML INJ SUSP,,J3301,HCPCS,Facility,Outpatient,5 mL,mL,,70,59.5,20.062,70,PrimeWest Health,MinnesotaCare,35.952,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
TRIAMCINOLONE ACETONIDE 10 MG/ML INJ SUSP,,J3301,HCPCS,Facility,Inpatient,5 mL,mL,,70,59.5,20.062,70,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
TRIAMCINOLONE ACETONIDE 10 MG/ML INJ SUSP,,J3301,HCPCS,Facility,Both,5 mL,mL,,70,59.5,20.062,70,Sanford Health Plan,Sanford Health Plan,64.4,92,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 10 MG/ML INJ SUSP,,J3301,HCPCS,Facility,Outpatient,5 mL,mL,,70,59.5,20.062,70,"UCare Health, Inc.",Individual & Family Plan,39.445,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
TRIAMCINOLONE ACETONIDE 10 MG/ML INJ SUSP,,J3301,HCPCS,Facility,Inpatient,5 mL,mL,,70,59.5,20.062,70,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
TRIAMCINOLONE ACETONIDE 10 MG/ML INJ SUSP,,J3301,HCPCS,Facility,Outpatient,5 mL,mL,,70,59.5,20.062,70,"UCare Health, Inc.",Medical Assistance,35.329,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TRIAMCINOLONE ACETONIDE 10 MG/ML INJ SUSP,,J3301,HCPCS,Facility,Inpatient,5 mL,mL,,70,59.5,20.062,70,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
TRIAMCINOLONE ACETONIDE 10 MG/ML INJ SUSP,,J3301,HCPCS,Facility,Outpatient,5 mL,mL,,70,59.5,20.062,70,"UCare Health, Inc.",Medicare Advantage,35.329,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TRIAMCINOLONE ACETONIDE 10 MG/ML INJ SUSP,,J3301,HCPCS,Facility,Inpatient,5 mL,mL,,70,59.5,20.062,70,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
TRIAMCINOLONE ACETONIDE 10 MG/ML INJ SUSP,,J3301,HCPCS,Facility,Outpatient,5 mL,mL,,70,59.5,20.062,70,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),35.329,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TRIAMCINOLONE ACETONIDE 10 MG/ML INJ SUSP,,J3301,HCPCS,Facility,Inpatient,5 mL,mL,,70,59.5,20.062,70,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
TRIAMCINOLONE ACETONIDE 10 MG/ML INJ SUSP,,J3301,HCPCS,Facility,Both,5 mL,mL,,70,59.5,20.062,70,UnitedHealthcare,Individual & Family,65.8,94,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 10 MG/ML INJ SUSP,,J3301,HCPCS,Facility,Outpatient,5 mL,mL,,70,59.5,20.062,70,UnitedHealthcare,Medicare Advantage,34.3,49,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 10 MG/ML INJ SUSP,,J3301,HCPCS,Facility,Inpatient,5 mL,mL,,70,59.5,20.062,70,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
TRIAMCINOLONE ACETONIDE 10 MG/ML INJ SUSP,,J3301,HCPCS,Facility,Outpatient,5 mL,mL,,70,59.5,20.062,70,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,33.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
TRIAMCINOLONE ACETONIDE 10 MG/ML INJ SUSP,,J3301,HCPCS,Facility,Inpatient,5 mL,mL,,70,59.5,20.062,70,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
ALFENTANIL 500 MCG/ML INJ SOLN,,J3490,HCPCS,Facility,Both,5 mL,mL,,91,77.35,26.0806,91,Aetna,Commercial,83.72,92,,percent of total billed charges,,
ALFENTANIL 500 MCG/ML INJ SOLN,,J3490,HCPCS,Facility,Outpatient,5 mL,mL,,91,77.35,26.0806,91,Aetna,Medicare Advantage,44.59,49,,percent of total billed charges,,
ALFENTANIL 500 MCG/ML INJ SOLN,,J3490,HCPCS,Facility,Inpatient,5 mL,mL,,91,77.35,26.0806,91,Aetna,Medicare Advantage,,,,,Included in per diem rate,
ALFENTANIL 500 MCG/ML INJ SOLN,,J3490,HCPCS,Facility,Both,5 mL,mL,,91,77.35,26.0806,91,Aetna,PPO,84.63,93,,percent of total billed charges,,
ALFENTANIL 500 MCG/ML INJ SOLN,,J3490,HCPCS,Facility,Both,5 mL,mL,,91,77.35,26.0806,91,America's PPO,America's PPO,87.3873,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
ALFENTANIL 500 MCG/ML INJ SOLN,,J3490,HCPCS,Facility,Both,5 mL,mL,,91,77.35,26.0806,91,BlueCross BlueShield Minnesota, Federal Employee Program,89.544,98.4,,percent of total billed charges,,
ALFENTANIL 500 MCG/ML INJ SOLN,,J3490,HCPCS,Facility,Both,5 mL,mL,,91,77.35,26.0806,91,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,91,100,,percent of total billed charges,,
ALFENTANIL 500 MCG/ML INJ SOLN,,J3490,HCPCS,Facility,Both,5 mL,mL,,91,77.35,26.0806,91,BlueCross BlueShield Minnesota,High Value Network Plan,81.9,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
ALFENTANIL 500 MCG/ML INJ SOLN,,J3490,HCPCS,Facility,Outpatient,5 mL,mL,,91,77.35,26.0806,91,BlueCross BlueShield Minnesota,Medicare Advantage,44.59,49,,percent of total billed charges,,
ALFENTANIL 500 MCG/ML INJ SOLN,,J3490,HCPCS,Facility,Inpatient,5 mL,mL,,91,77.35,26.0806,91,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
ALFENTANIL 500 MCG/ML INJ SOLN,,J3490,HCPCS,Facility,Both,5 mL,mL,,91,77.35,26.0806,91,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,80.5987,88.57,,percent of total billed charges,,
ALFENTANIL 500 MCG/ML INJ SOLN,,J3490,HCPCS,Facility,Both,5 mL,mL,,91,77.35,26.0806,91,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,26.0806,28.66,,percent of total billed charges,,
ALFENTANIL 500 MCG/ML INJ SOLN,,J3490,HCPCS,Facility,Outpatient,5 mL,mL,,91,77.35,26.0806,91,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),44.59,49,,percent of total billed charges,,
ALFENTANIL 500 MCG/ML INJ SOLN,,J3490,HCPCS,Facility,Inpatient,5 mL,mL,,91,77.35,26.0806,91,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
ALFENTANIL 500 MCG/ML INJ SOLN,,J3490,HCPCS,Facility,Both,5 mL,mL,,91,77.35,26.0806,91,CorVel,Worker's Compensation,91,100,,percent of total billed charges,,
ALFENTANIL 500 MCG/ML INJ SOLN,,J3490,HCPCS,Facility,Both,5 mL,mL,,91,77.35,26.0806,91,First Health Group Corporation,First Health Network,88.27,97,,percent of total billed charges,,
ALFENTANIL 500 MCG/ML INJ SOLN,,J3490,HCPCS,Facility,Both,5 mL,mL,,91,77.35,26.0806,91,"Health Partners, Inc.",Commercial,86.086,94.6,,percent of total billed charges,,
ALFENTANIL 500 MCG/ML INJ SOLN,,J3490,HCPCS,Facility,Outpatient,5 mL,mL,,91,77.35,26.0806,91,"Health Partners, Inc.",Medicare Advantage,44.59,49,,percent of total billed charges,,
ALFENTANIL 500 MCG/ML INJ SOLN,,J3490,HCPCS,Facility,Inpatient,5 mL,mL,,91,77.35,26.0806,91,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ALFENTANIL 500 MCG/ML INJ SOLN,,J3490,HCPCS,Facility,Both,5 mL,mL,,91,77.35,26.0806,91,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),54.6,60,,percent of total billed charges,,
ALFENTANIL 500 MCG/ML INJ SOLN,,J3490,HCPCS,Facility,Both,5 mL,mL,,91,77.35,26.0806,91,"Health Partners, Inc.",State of Minnesota Advantage Program,74.165,81.5,,percent of total billed charges,,
ALFENTANIL 500 MCG/ML INJ SOLN,,J3490,HCPCS,Facility,Both,5 mL,mL,,91,77.35,26.0806,91,"Health Partners, Inc.",State Public Programs,45.5,50,,percent of total billed charges,,
ALFENTANIL 500 MCG/ML INJ SOLN,,J3490,HCPCS,Facility,Both,5 mL,mL,,91,77.35,26.0806,91,Humana Insurance Company,Commercial PPO,86.45,95,,percent of total billed charges,,
ALFENTANIL 500 MCG/ML INJ SOLN,,J3490,HCPCS,Facility,Outpatient,5 mL,mL,,91,77.35,26.0806,91,Humana Insurance Company,Medicare PPO,44.59,49,,percent of total billed charges,,
ALFENTANIL 500 MCG/ML INJ SOLN,,J3490,HCPCS,Facility,Inpatient,5 mL,mL,,91,77.35,26.0806,91,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
ALFENTANIL 500 MCG/ML INJ SOLN,,J3490,HCPCS,Facility,Both,5 mL,mL,,91,77.35,26.0806,91,Medica,Individual & Family,90.181,99.1,,percent of total billed charges,,
ALFENTANIL 500 MCG/ML INJ SOLN,,J3490,HCPCS,Facility,Outpatient,5 mL,mL,,91,77.35,26.0806,91,Medica,Medica Advantage Solution,45.318,49.8,,percent of total billed charges,,
ALFENTANIL 500 MCG/ML INJ SOLN,,J3490,HCPCS,Facility,Inpatient,5 mL,mL,,91,77.35,26.0806,91,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
ALFENTANIL 500 MCG/ML INJ SOLN,,J3490,HCPCS,Facility,Outpatient,5 mL,mL,,91,77.35,26.0806,91,Medica,Medical Assistance,40.586,44.6,,percent of total billed charges,,
ALFENTANIL 500 MCG/ML INJ SOLN,,J3490,HCPCS,Facility,Inpatient,5 mL,mL,,91,77.35,26.0806,91,Medica,Medical Assistance,,,,,Included in per diem rate,
ALFENTANIL 500 MCG/ML INJ SOLN,,J3490,HCPCS,Facility,Outpatient,5 mL,mL,,91,77.35,26.0806,91,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,45.318,49.8,,percent of total billed charges,,
ALFENTANIL 500 MCG/ML INJ SOLN,,J3490,HCPCS,Facility,Inpatient,5 mL,mL,,91,77.35,26.0806,91,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
ALFENTANIL 500 MCG/ML INJ SOLN,,J3490,HCPCS,Facility,Both,5 mL,mL,,91,77.35,26.0806,91,"Multiplan, Inc.","Multiplan, Inc.",85.54,94,,percent of total billed charges,,
ALFENTANIL 500 MCG/ML INJ SOLN,,J3490,HCPCS,Facility,Outpatient,5 mL,mL,,91,77.35,26.0806,91,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,81.991,90.1,,percent of total billed charges,,
ALFENTANIL 500 MCG/ML INJ SOLN,,J3490,HCPCS,Facility,Inpatient,5 mL,mL,,91,77.35,26.0806,91,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
ALFENTANIL 500 MCG/ML INJ SOLN,,J3490,HCPCS,Facility,Both,5 mL,mL,,91,77.35,26.0806,91,"Preferred One Administrative Services, INC.",PPO,89.726,98.6,,percent of total billed charges,,
ALFENTANIL 500 MCG/ML INJ SOLN,,J3490,HCPCS,Facility,Outpatient,5 mL,mL,,91,77.35,26.0806,91,PrimeWest Health,Minnesota Senior Health Options (MSHO),46.8195,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
ALFENTANIL 500 MCG/ML INJ SOLN,,J3490,HCPCS,Facility,Inpatient,5 mL,mL,,91,77.35,26.0806,91,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ALFENTANIL 500 MCG/ML INJ SOLN,,J3490,HCPCS,Facility,Outpatient,5 mL,mL,,91,77.35,26.0806,91,PrimeWest Health,MinnesotaCare,46.7376,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
ALFENTANIL 500 MCG/ML INJ SOLN,,J3490,HCPCS,Facility,Inpatient,5 mL,mL,,91,77.35,26.0806,91,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
ALFENTANIL 500 MCG/ML INJ SOLN,,J3490,HCPCS,Facility,Both,5 mL,mL,,91,77.35,26.0806,91,Sanford Health Plan,Sanford Health Plan,83.72,92,,percent of total billed charges,,
ALFENTANIL 500 MCG/ML INJ SOLN,,J3490,HCPCS,Facility,Outpatient,5 mL,mL,,91,77.35,26.0806,91,"UCare Health, Inc.",Individual & Family Plan,51.2785,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
ALFENTANIL 500 MCG/ML INJ SOLN,,J3490,HCPCS,Facility,Inpatient,5 mL,mL,,91,77.35,26.0806,91,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
ALFENTANIL 500 MCG/ML INJ SOLN,,J3490,HCPCS,Facility,Outpatient,5 mL,mL,,91,77.35,26.0806,91,"UCare Health, Inc.",Medical Assistance,45.9277,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ALFENTANIL 500 MCG/ML INJ SOLN,,J3490,HCPCS,Facility,Inpatient,5 mL,mL,,91,77.35,26.0806,91,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
ALFENTANIL 500 MCG/ML INJ SOLN,,J3490,HCPCS,Facility,Outpatient,5 mL,mL,,91,77.35,26.0806,91,"UCare Health, Inc.",Medicare Advantage,45.9277,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ALFENTANIL 500 MCG/ML INJ SOLN,,J3490,HCPCS,Facility,Inpatient,5 mL,mL,,91,77.35,26.0806,91,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ALFENTANIL 500 MCG/ML INJ SOLN,,J3490,HCPCS,Facility,Outpatient,5 mL,mL,,91,77.35,26.0806,91,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),45.9277,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ALFENTANIL 500 MCG/ML INJ SOLN,,J3490,HCPCS,Facility,Inpatient,5 mL,mL,,91,77.35,26.0806,91,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ALFENTANIL 500 MCG/ML INJ SOLN,,J3490,HCPCS,Facility,Both,5 mL,mL,,91,77.35,26.0806,91,UnitedHealthcare,Individual & Family,85.54,94,,percent of total billed charges,,
ALFENTANIL 500 MCG/ML INJ SOLN,,J3490,HCPCS,Facility,Outpatient,5 mL,mL,,91,77.35,26.0806,91,UnitedHealthcare,Medicare Advantage,44.59,49,,percent of total billed charges,,
ALFENTANIL 500 MCG/ML INJ SOLN,,J3490,HCPCS,Facility,Inpatient,5 mL,mL,,91,77.35,26.0806,91,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
ALFENTANIL 500 MCG/ML INJ SOLN,,J3490,HCPCS,Facility,Outpatient,5 mL,mL,,91,77.35,26.0806,91,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,43.68,48,,percent of total billed charges,,100% of DHS outpatient percentage
ALFENTANIL 500 MCG/ML INJ SOLN,,J3490,HCPCS,Facility,Inpatient,5 mL,mL,,91,77.35,26.0806,91,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
DILTIAZEM HCL 5 MG/ML IV SOLN,,J3490,HCPCS,Facility,Both,5 mL,mL,,14,11.9,4.0124,14,Aetna,Commercial,12.88,92,,percent of total billed charges,,
DILTIAZEM HCL 5 MG/ML IV SOLN,,J3490,HCPCS,Facility,Outpatient,5 mL,mL,,14,11.9,4.0124,14,Aetna,Medicare Advantage,6.86,49,,percent of total billed charges,,
DILTIAZEM HCL 5 MG/ML IV SOLN,,J3490,HCPCS,Facility,Inpatient,5 mL,mL,,14,11.9,4.0124,14,Aetna,Medicare Advantage,,,,,Included in per diem rate,
DILTIAZEM HCL 5 MG/ML IV SOLN,,J3490,HCPCS,Facility,Both,5 mL,mL,,14,11.9,4.0124,14,Aetna,PPO,13.02,93,,percent of total billed charges,,
DILTIAZEM HCL 5 MG/ML IV SOLN,,J3490,HCPCS,Facility,Both,5 mL,mL,,14,11.9,4.0124,14,America's PPO,America's PPO,13.4442,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
DILTIAZEM HCL 5 MG/ML IV SOLN,,J3490,HCPCS,Facility,Both,5 mL,mL,,14,11.9,4.0124,14,BlueCross BlueShield Minnesota, Federal Employee Program,13.776,98.4,,percent of total billed charges,,
DILTIAZEM HCL 5 MG/ML IV SOLN,,J3490,HCPCS,Facility,Both,5 mL,mL,,14,11.9,4.0124,14,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,14,100,,percent of total billed charges,,
DILTIAZEM HCL 5 MG/ML IV SOLN,,J3490,HCPCS,Facility,Both,5 mL,mL,,14,11.9,4.0124,14,BlueCross BlueShield Minnesota,High Value Network Plan,12.6,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
DILTIAZEM HCL 5 MG/ML IV SOLN,,J3490,HCPCS,Facility,Outpatient,5 mL,mL,,14,11.9,4.0124,14,BlueCross BlueShield Minnesota,Medicare Advantage,6.86,49,,percent of total billed charges,,
DILTIAZEM HCL 5 MG/ML IV SOLN,,J3490,HCPCS,Facility,Inpatient,5 mL,mL,,14,11.9,4.0124,14,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
DILTIAZEM HCL 5 MG/ML IV SOLN,,J3490,HCPCS,Facility,Both,5 mL,mL,,14,11.9,4.0124,14,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,12.3998,88.57,,percent of total billed charges,,
DILTIAZEM HCL 5 MG/ML IV SOLN,,J3490,HCPCS,Facility,Both,5 mL,mL,,14,11.9,4.0124,14,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,4.0124,28.66,,percent of total billed charges,,
DILTIAZEM HCL 5 MG/ML IV SOLN,,J3490,HCPCS,Facility,Outpatient,5 mL,mL,,14,11.9,4.0124,14,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),6.86,49,,percent of total billed charges,,
DILTIAZEM HCL 5 MG/ML IV SOLN,,J3490,HCPCS,Facility,Inpatient,5 mL,mL,,14,11.9,4.0124,14,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
DILTIAZEM HCL 5 MG/ML IV SOLN,,J3490,HCPCS,Facility,Both,5 mL,mL,,14,11.9,4.0124,14,CorVel,Worker's Compensation,14,100,,percent of total billed charges,,
DILTIAZEM HCL 5 MG/ML IV SOLN,,J3490,HCPCS,Facility,Both,5 mL,mL,,14,11.9,4.0124,14,First Health Group Corporation,First Health Network,13.58,97,,percent of total billed charges,,
DILTIAZEM HCL 5 MG/ML IV SOLN,,J3490,HCPCS,Facility,Both,5 mL,mL,,14,11.9,4.0124,14,"Health Partners, Inc.",Commercial,13.244,94.6,,percent of total billed charges,,
DILTIAZEM HCL 5 MG/ML IV SOLN,,J3490,HCPCS,Facility,Outpatient,5 mL,mL,,14,11.9,4.0124,14,"Health Partners, Inc.",Medicare Advantage,6.86,49,,percent of total billed charges,,
DILTIAZEM HCL 5 MG/ML IV SOLN,,J3490,HCPCS,Facility,Inpatient,5 mL,mL,,14,11.9,4.0124,14,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DILTIAZEM HCL 5 MG/ML IV SOLN,,J3490,HCPCS,Facility,Both,5 mL,mL,,14,11.9,4.0124,14,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),8.4,60,,percent of total billed charges,,
DILTIAZEM HCL 5 MG/ML IV SOLN,,J3490,HCPCS,Facility,Both,5 mL,mL,,14,11.9,4.0124,14,"Health Partners, Inc.",State of Minnesota Advantage Program,11.41,81.5,,percent of total billed charges,,
DILTIAZEM HCL 5 MG/ML IV SOLN,,J3490,HCPCS,Facility,Both,5 mL,mL,,14,11.9,4.0124,14,"Health Partners, Inc.",State Public Programs,7,50,,percent of total billed charges,,
DILTIAZEM HCL 5 MG/ML IV SOLN,,J3490,HCPCS,Facility,Both,5 mL,mL,,14,11.9,4.0124,14,Humana Insurance Company,Commercial PPO,13.3,95,,percent of total billed charges,,
DILTIAZEM HCL 5 MG/ML IV SOLN,,J3490,HCPCS,Facility,Outpatient,5 mL,mL,,14,11.9,4.0124,14,Humana Insurance Company,Medicare PPO,6.86,49,,percent of total billed charges,,
DILTIAZEM HCL 5 MG/ML IV SOLN,,J3490,HCPCS,Facility,Inpatient,5 mL,mL,,14,11.9,4.0124,14,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
DILTIAZEM HCL 5 MG/ML IV SOLN,,J3490,HCPCS,Facility,Both,5 mL,mL,,14,11.9,4.0124,14,Medica,Individual & Family,13.874,99.1,,percent of total billed charges,,
DILTIAZEM HCL 5 MG/ML IV SOLN,,J3490,HCPCS,Facility,Outpatient,5 mL,mL,,14,11.9,4.0124,14,Medica,Medica Advantage Solution,6.972,49.8,,percent of total billed charges,,
DILTIAZEM HCL 5 MG/ML IV SOLN,,J3490,HCPCS,Facility,Inpatient,5 mL,mL,,14,11.9,4.0124,14,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
DILTIAZEM HCL 5 MG/ML IV SOLN,,J3490,HCPCS,Facility,Outpatient,5 mL,mL,,14,11.9,4.0124,14,Medica,Medical Assistance,6.244,44.6,,percent of total billed charges,,
DILTIAZEM HCL 5 MG/ML IV SOLN,,J3490,HCPCS,Facility,Inpatient,5 mL,mL,,14,11.9,4.0124,14,Medica,Medical Assistance,,,,,Included in per diem rate,
DILTIAZEM HCL 5 MG/ML IV SOLN,,J3490,HCPCS,Facility,Outpatient,5 mL,mL,,14,11.9,4.0124,14,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,6.972,49.8,,percent of total billed charges,,
DILTIAZEM HCL 5 MG/ML IV SOLN,,J3490,HCPCS,Facility,Inpatient,5 mL,mL,,14,11.9,4.0124,14,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
DILTIAZEM HCL 5 MG/ML IV SOLN,,J3490,HCPCS,Facility,Both,5 mL,mL,,14,11.9,4.0124,14,"Multiplan, Inc.","Multiplan, Inc.",13.16,94,,percent of total billed charges,,
DILTIAZEM HCL 5 MG/ML IV SOLN,,J3490,HCPCS,Facility,Outpatient,5 mL,mL,,14,11.9,4.0124,14,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,12.614,90.1,,percent of total billed charges,,
DILTIAZEM HCL 5 MG/ML IV SOLN,,J3490,HCPCS,Facility,Inpatient,5 mL,mL,,14,11.9,4.0124,14,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
DILTIAZEM HCL 5 MG/ML IV SOLN,,J3490,HCPCS,Facility,Both,5 mL,mL,,14,11.9,4.0124,14,"Preferred One Administrative Services, INC.",PPO,13.804,98.6,,percent of total billed charges,,
DILTIAZEM HCL 5 MG/ML IV SOLN,,J3490,HCPCS,Facility,Outpatient,5 mL,mL,,14,11.9,4.0124,14,PrimeWest Health,Minnesota Senior Health Options (MSHO),7.203,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
DILTIAZEM HCL 5 MG/ML IV SOLN,,J3490,HCPCS,Facility,Inpatient,5 mL,mL,,14,11.9,4.0124,14,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DILTIAZEM HCL 5 MG/ML IV SOLN,,J3490,HCPCS,Facility,Outpatient,5 mL,mL,,14,11.9,4.0124,14,PrimeWest Health,MinnesotaCare,7.1904,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
DILTIAZEM HCL 5 MG/ML IV SOLN,,J3490,HCPCS,Facility,Inpatient,5 mL,mL,,14,11.9,4.0124,14,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
DILTIAZEM HCL 5 MG/ML IV SOLN,,J3490,HCPCS,Facility,Both,5 mL,mL,,14,11.9,4.0124,14,Sanford Health Plan,Sanford Health Plan,12.88,92,,percent of total billed charges,,
DILTIAZEM HCL 5 MG/ML IV SOLN,,J3490,HCPCS,Facility,Outpatient,5 mL,mL,,14,11.9,4.0124,14,"UCare Health, Inc.",Individual & Family Plan,7.889,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
DILTIAZEM HCL 5 MG/ML IV SOLN,,J3490,HCPCS,Facility,Inpatient,5 mL,mL,,14,11.9,4.0124,14,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
DILTIAZEM HCL 5 MG/ML IV SOLN,,J3490,HCPCS,Facility,Outpatient,5 mL,mL,,14,11.9,4.0124,14,"UCare Health, Inc.",Medical Assistance,7.0658,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DILTIAZEM HCL 5 MG/ML IV SOLN,,J3490,HCPCS,Facility,Inpatient,5 mL,mL,,14,11.9,4.0124,14,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
DILTIAZEM HCL 5 MG/ML IV SOLN,,J3490,HCPCS,Facility,Outpatient,5 mL,mL,,14,11.9,4.0124,14,"UCare Health, Inc.",Medicare Advantage,7.0658,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DILTIAZEM HCL 5 MG/ML IV SOLN,,J3490,HCPCS,Facility,Inpatient,5 mL,mL,,14,11.9,4.0124,14,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DILTIAZEM HCL 5 MG/ML IV SOLN,,J3490,HCPCS,Facility,Outpatient,5 mL,mL,,14,11.9,4.0124,14,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),7.0658,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DILTIAZEM HCL 5 MG/ML IV SOLN,,J3490,HCPCS,Facility,Inpatient,5 mL,mL,,14,11.9,4.0124,14,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DILTIAZEM HCL 5 MG/ML IV SOLN,,J3490,HCPCS,Facility,Both,5 mL,mL,,14,11.9,4.0124,14,UnitedHealthcare,Individual & Family,13.16,94,,percent of total billed charges,,
DILTIAZEM HCL 5 MG/ML IV SOLN,,J3490,HCPCS,Facility,Outpatient,5 mL,mL,,14,11.9,4.0124,14,UnitedHealthcare,Medicare Advantage,6.86,49,,percent of total billed charges,,
DILTIAZEM HCL 5 MG/ML IV SOLN,,J3490,HCPCS,Facility,Inpatient,5 mL,mL,,14,11.9,4.0124,14,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
DILTIAZEM HCL 5 MG/ML IV SOLN,,J3490,HCPCS,Facility,Outpatient,5 mL,mL,,14,11.9,4.0124,14,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,6.72,48,,percent of total billed charges,,100% of DHS outpatient percentage
DILTIAZEM HCL 5 MG/ML IV SOLN,,J3490,HCPCS,Facility,Inpatient,5 mL,mL,,14,11.9,4.0124,14,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
FLUMAZENIL 0.1 MG/ML IV SOLN,,J3490,HCPCS,Facility,Both,5 mL,mL,,39,33.15,11.1774,39,Aetna,Commercial,35.88,92,,percent of total billed charges,,
FLUMAZENIL 0.1 MG/ML IV SOLN,,J3490,HCPCS,Facility,Outpatient,5 mL,mL,,39,33.15,11.1774,39,Aetna,Medicare Advantage,19.11,49,,percent of total billed charges,,
FLUMAZENIL 0.1 MG/ML IV SOLN,,J3490,HCPCS,Facility,Inpatient,5 mL,mL,,39,33.15,11.1774,39,Aetna,Medicare Advantage,,,,,Included in per diem rate,
FLUMAZENIL 0.1 MG/ML IV SOLN,,J3490,HCPCS,Facility,Both,5 mL,mL,,39,33.15,11.1774,39,Aetna,PPO,36.27,93,,percent of total billed charges,,
FLUMAZENIL 0.1 MG/ML IV SOLN,,J3490,HCPCS,Facility,Both,5 mL,mL,,39,33.15,11.1774,39,America's PPO,America's PPO,37.4517,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
FLUMAZENIL 0.1 MG/ML IV SOLN,,J3490,HCPCS,Facility,Both,5 mL,mL,,39,33.15,11.1774,39,BlueCross BlueShield Minnesota, Federal Employee Program,38.376,98.4,,percent of total billed charges,,
FLUMAZENIL 0.1 MG/ML IV SOLN,,J3490,HCPCS,Facility,Both,5 mL,mL,,39,33.15,11.1774,39,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,39,100,,percent of total billed charges,,
FLUMAZENIL 0.1 MG/ML IV SOLN,,J3490,HCPCS,Facility,Both,5 mL,mL,,39,33.15,11.1774,39,BlueCross BlueShield Minnesota,High Value Network Plan,35.1,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
FLUMAZENIL 0.1 MG/ML IV SOLN,,J3490,HCPCS,Facility,Outpatient,5 mL,mL,,39,33.15,11.1774,39,BlueCross BlueShield Minnesota,Medicare Advantage,19.11,49,,percent of total billed charges,,
FLUMAZENIL 0.1 MG/ML IV SOLN,,J3490,HCPCS,Facility,Inpatient,5 mL,mL,,39,33.15,11.1774,39,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
FLUMAZENIL 0.1 MG/ML IV SOLN,,J3490,HCPCS,Facility,Both,5 mL,mL,,39,33.15,11.1774,39,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,34.5423,88.57,,percent of total billed charges,,
FLUMAZENIL 0.1 MG/ML IV SOLN,,J3490,HCPCS,Facility,Both,5 mL,mL,,39,33.15,11.1774,39,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,11.1774,28.66,,percent of total billed charges,,
FLUMAZENIL 0.1 MG/ML IV SOLN,,J3490,HCPCS,Facility,Outpatient,5 mL,mL,,39,33.15,11.1774,39,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),19.11,49,,percent of total billed charges,,
FLUMAZENIL 0.1 MG/ML IV SOLN,,J3490,HCPCS,Facility,Inpatient,5 mL,mL,,39,33.15,11.1774,39,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
FLUMAZENIL 0.1 MG/ML IV SOLN,,J3490,HCPCS,Facility,Both,5 mL,mL,,39,33.15,11.1774,39,CorVel,Worker's Compensation,39,100,,percent of total billed charges,,
FLUMAZENIL 0.1 MG/ML IV SOLN,,J3490,HCPCS,Facility,Both,5 mL,mL,,39,33.15,11.1774,39,First Health Group Corporation,First Health Network,37.83,97,,percent of total billed charges,,
FLUMAZENIL 0.1 MG/ML IV SOLN,,J3490,HCPCS,Facility,Both,5 mL,mL,,39,33.15,11.1774,39,"Health Partners, Inc.",Commercial,36.894,94.6,,percent of total billed charges,,
FLUMAZENIL 0.1 MG/ML IV SOLN,,J3490,HCPCS,Facility,Outpatient,5 mL,mL,,39,33.15,11.1774,39,"Health Partners, Inc.",Medicare Advantage,19.11,49,,percent of total billed charges,,
FLUMAZENIL 0.1 MG/ML IV SOLN,,J3490,HCPCS,Facility,Inpatient,5 mL,mL,,39,33.15,11.1774,39,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
FLUMAZENIL 0.1 MG/ML IV SOLN,,J3490,HCPCS,Facility,Both,5 mL,mL,,39,33.15,11.1774,39,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),23.4,60,,percent of total billed charges,,
FLUMAZENIL 0.1 MG/ML IV SOLN,,J3490,HCPCS,Facility,Both,5 mL,mL,,39,33.15,11.1774,39,"Health Partners, Inc.",State of Minnesota Advantage Program,31.785,81.5,,percent of total billed charges,,
FLUMAZENIL 0.1 MG/ML IV SOLN,,J3490,HCPCS,Facility,Both,5 mL,mL,,39,33.15,11.1774,39,"Health Partners, Inc.",State Public Programs,19.5,50,,percent of total billed charges,,
FLUMAZENIL 0.1 MG/ML IV SOLN,,J3490,HCPCS,Facility,Both,5 mL,mL,,39,33.15,11.1774,39,Humana Insurance Company,Commercial PPO,37.05,95,,percent of total billed charges,,
FLUMAZENIL 0.1 MG/ML IV SOLN,,J3490,HCPCS,Facility,Outpatient,5 mL,mL,,39,33.15,11.1774,39,Humana Insurance Company,Medicare PPO,19.11,49,,percent of total billed charges,,
FLUMAZENIL 0.1 MG/ML IV SOLN,,J3490,HCPCS,Facility,Inpatient,5 mL,mL,,39,33.15,11.1774,39,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
FLUMAZENIL 0.1 MG/ML IV SOLN,,J3490,HCPCS,Facility,Both,5 mL,mL,,39,33.15,11.1774,39,Medica,Individual & Family,38.649,99.1,,percent of total billed charges,,
FLUMAZENIL 0.1 MG/ML IV SOLN,,J3490,HCPCS,Facility,Outpatient,5 mL,mL,,39,33.15,11.1774,39,Medica,Medica Advantage Solution,19.422,49.8,,percent of total billed charges,,
FLUMAZENIL 0.1 MG/ML IV SOLN,,J3490,HCPCS,Facility,Inpatient,5 mL,mL,,39,33.15,11.1774,39,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
FLUMAZENIL 0.1 MG/ML IV SOLN,,J3490,HCPCS,Facility,Outpatient,5 mL,mL,,39,33.15,11.1774,39,Medica,Medical Assistance,17.394,44.6,,percent of total billed charges,,
FLUMAZENIL 0.1 MG/ML IV SOLN,,J3490,HCPCS,Facility,Inpatient,5 mL,mL,,39,33.15,11.1774,39,Medica,Medical Assistance,,,,,Included in per diem rate,
FLUMAZENIL 0.1 MG/ML IV SOLN,,J3490,HCPCS,Facility,Outpatient,5 mL,mL,,39,33.15,11.1774,39,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,19.422,49.8,,percent of total billed charges,,
FLUMAZENIL 0.1 MG/ML IV SOLN,,J3490,HCPCS,Facility,Inpatient,5 mL,mL,,39,33.15,11.1774,39,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
FLUMAZENIL 0.1 MG/ML IV SOLN,,J3490,HCPCS,Facility,Both,5 mL,mL,,39,33.15,11.1774,39,"Multiplan, Inc.","Multiplan, Inc.",36.66,94,,percent of total billed charges,,
FLUMAZENIL 0.1 MG/ML IV SOLN,,J3490,HCPCS,Facility,Outpatient,5 mL,mL,,39,33.15,11.1774,39,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,35.139,90.1,,percent of total billed charges,,
FLUMAZENIL 0.1 MG/ML IV SOLN,,J3490,HCPCS,Facility,Inpatient,5 mL,mL,,39,33.15,11.1774,39,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
FLUMAZENIL 0.1 MG/ML IV SOLN,,J3490,HCPCS,Facility,Both,5 mL,mL,,39,33.15,11.1774,39,"Preferred One Administrative Services, INC.",PPO,38.454,98.6,,percent of total billed charges,,
FLUMAZENIL 0.1 MG/ML IV SOLN,,J3490,HCPCS,Facility,Outpatient,5 mL,mL,,39,33.15,11.1774,39,PrimeWest Health,Minnesota Senior Health Options (MSHO),20.0655,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
FLUMAZENIL 0.1 MG/ML IV SOLN,,J3490,HCPCS,Facility,Inpatient,5 mL,mL,,39,33.15,11.1774,39,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
FLUMAZENIL 0.1 MG/ML IV SOLN,,J3490,HCPCS,Facility,Outpatient,5 mL,mL,,39,33.15,11.1774,39,PrimeWest Health,MinnesotaCare,20.0304,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
FLUMAZENIL 0.1 MG/ML IV SOLN,,J3490,HCPCS,Facility,Inpatient,5 mL,mL,,39,33.15,11.1774,39,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
FLUMAZENIL 0.1 MG/ML IV SOLN,,J3490,HCPCS,Facility,Both,5 mL,mL,,39,33.15,11.1774,39,Sanford Health Plan,Sanford Health Plan,35.88,92,,percent of total billed charges,,
FLUMAZENIL 0.1 MG/ML IV SOLN,,J3490,HCPCS,Facility,Outpatient,5 mL,mL,,39,33.15,11.1774,39,"UCare Health, Inc.",Individual & Family Plan,21.9765,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
FLUMAZENIL 0.1 MG/ML IV SOLN,,J3490,HCPCS,Facility,Inpatient,5 mL,mL,,39,33.15,11.1774,39,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
FLUMAZENIL 0.1 MG/ML IV SOLN,,J3490,HCPCS,Facility,Outpatient,5 mL,mL,,39,33.15,11.1774,39,"UCare Health, Inc.",Medical Assistance,19.6833,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FLUMAZENIL 0.1 MG/ML IV SOLN,,J3490,HCPCS,Facility,Inpatient,5 mL,mL,,39,33.15,11.1774,39,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
FLUMAZENIL 0.1 MG/ML IV SOLN,,J3490,HCPCS,Facility,Outpatient,5 mL,mL,,39,33.15,11.1774,39,"UCare Health, Inc.",Medicare Advantage,19.6833,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FLUMAZENIL 0.1 MG/ML IV SOLN,,J3490,HCPCS,Facility,Inpatient,5 mL,mL,,39,33.15,11.1774,39,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
FLUMAZENIL 0.1 MG/ML IV SOLN,,J3490,HCPCS,Facility,Outpatient,5 mL,mL,,39,33.15,11.1774,39,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),19.6833,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FLUMAZENIL 0.1 MG/ML IV SOLN,,J3490,HCPCS,Facility,Inpatient,5 mL,mL,,39,33.15,11.1774,39,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
FLUMAZENIL 0.1 MG/ML IV SOLN,,J3490,HCPCS,Facility,Both,5 mL,mL,,39,33.15,11.1774,39,UnitedHealthcare,Individual & Family,36.66,94,,percent of total billed charges,,
FLUMAZENIL 0.1 MG/ML IV SOLN,,J3490,HCPCS,Facility,Outpatient,5 mL,mL,,39,33.15,11.1774,39,UnitedHealthcare,Medicare Advantage,19.11,49,,percent of total billed charges,,
FLUMAZENIL 0.1 MG/ML IV SOLN,,J3490,HCPCS,Facility,Inpatient,5 mL,mL,,39,33.15,11.1774,39,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
FLUMAZENIL 0.1 MG/ML IV SOLN,,J3490,HCPCS,Facility,Outpatient,5 mL,mL,,39,33.15,11.1774,39,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,18.72,48,,percent of total billed charges,,100% of DHS outpatient percentage
FLUMAZENIL 0.1 MG/ML IV SOLN,,J3490,HCPCS,Facility,Inpatient,5 mL,mL,,39,33.15,11.1774,39,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
GLYCOPYRROLATE 0.2 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Both,5 mL,mL,,66,56.1,18.9156,66,Aetna,Commercial,60.72,92,,percent of total billed charges,,
GLYCOPYRROLATE 0.2 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Outpatient,5 mL,mL,,66,56.1,18.9156,66,Aetna,Medicare Advantage,32.34,49,,percent of total billed charges,,
GLYCOPYRROLATE 0.2 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Inpatient,5 mL,mL,,66,56.1,18.9156,66,Aetna,Medicare Advantage,,,,,Included in per diem rate,
GLYCOPYRROLATE 0.2 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Both,5 mL,mL,,66,56.1,18.9156,66,Aetna,PPO,61.38,93,,percent of total billed charges,,
GLYCOPYRROLATE 0.2 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Both,5 mL,mL,,66,56.1,18.9156,66,America's PPO,America's PPO,63.3798,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
GLYCOPYRROLATE 0.2 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Both,5 mL,mL,,66,56.1,18.9156,66,BlueCross BlueShield Minnesota, Federal Employee Program,64.944,98.4,,percent of total billed charges,,
GLYCOPYRROLATE 0.2 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Both,5 mL,mL,,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,66,100,,percent of total billed charges,,
GLYCOPYRROLATE 0.2 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Both,5 mL,mL,,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,High Value Network Plan,59.4,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
GLYCOPYRROLATE 0.2 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Outpatient,5 mL,mL,,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,Medicare Advantage,32.34,49,,percent of total billed charges,,
GLYCOPYRROLATE 0.2 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Inpatient,5 mL,mL,,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
GLYCOPYRROLATE 0.2 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Both,5 mL,mL,,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,58.4562,88.57,,percent of total billed charges,,
GLYCOPYRROLATE 0.2 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Both,5 mL,mL,,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,18.9156,28.66,,percent of total billed charges,,
GLYCOPYRROLATE 0.2 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Outpatient,5 mL,mL,,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),32.34,49,,percent of total billed charges,,
GLYCOPYRROLATE 0.2 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Inpatient,5 mL,mL,,66,56.1,18.9156,66,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
GLYCOPYRROLATE 0.2 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Both,5 mL,mL,,66,56.1,18.9156,66,CorVel,Worker's Compensation,66,100,,percent of total billed charges,,
GLYCOPYRROLATE 0.2 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Both,5 mL,mL,,66,56.1,18.9156,66,First Health Group Corporation,First Health Network,64.02,97,,percent of total billed charges,,
GLYCOPYRROLATE 0.2 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Both,5 mL,mL,,66,56.1,18.9156,66,"Health Partners, Inc.",Commercial,62.436,94.6,,percent of total billed charges,,
GLYCOPYRROLATE 0.2 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Outpatient,5 mL,mL,,66,56.1,18.9156,66,"Health Partners, Inc.",Medicare Advantage,32.34,49,,percent of total billed charges,,
GLYCOPYRROLATE 0.2 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Inpatient,5 mL,mL,,66,56.1,18.9156,66,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
GLYCOPYRROLATE 0.2 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Both,5 mL,mL,,66,56.1,18.9156,66,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),39.6,60,,percent of total billed charges,,
GLYCOPYRROLATE 0.2 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Both,5 mL,mL,,66,56.1,18.9156,66,"Health Partners, Inc.",State of Minnesota Advantage Program,53.79,81.5,,percent of total billed charges,,
GLYCOPYRROLATE 0.2 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Both,5 mL,mL,,66,56.1,18.9156,66,"Health Partners, Inc.",State Public Programs,33,50,,percent of total billed charges,,
GLYCOPYRROLATE 0.2 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Both,5 mL,mL,,66,56.1,18.9156,66,Humana Insurance Company,Commercial PPO,62.7,95,,percent of total billed charges,,
GLYCOPYRROLATE 0.2 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Outpatient,5 mL,mL,,66,56.1,18.9156,66,Humana Insurance Company,Medicare PPO,32.34,49,,percent of total billed charges,,
GLYCOPYRROLATE 0.2 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Inpatient,5 mL,mL,,66,56.1,18.9156,66,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
GLYCOPYRROLATE 0.2 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Both,5 mL,mL,,66,56.1,18.9156,66,Medica,Individual & Family,65.406,99.1,,percent of total billed charges,,
GLYCOPYRROLATE 0.2 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Outpatient,5 mL,mL,,66,56.1,18.9156,66,Medica,Medica Advantage Solution,32.868,49.8,,percent of total billed charges,,
GLYCOPYRROLATE 0.2 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Inpatient,5 mL,mL,,66,56.1,18.9156,66,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
GLYCOPYRROLATE 0.2 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Outpatient,5 mL,mL,,66,56.1,18.9156,66,Medica,Medical Assistance,29.436,44.6,,percent of total billed charges,,
GLYCOPYRROLATE 0.2 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Inpatient,5 mL,mL,,66,56.1,18.9156,66,Medica,Medical Assistance,,,,,Included in per diem rate,
GLYCOPYRROLATE 0.2 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Outpatient,5 mL,mL,,66,56.1,18.9156,66,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,32.868,49.8,,percent of total billed charges,,
GLYCOPYRROLATE 0.2 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Inpatient,5 mL,mL,,66,56.1,18.9156,66,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
GLYCOPYRROLATE 0.2 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Both,5 mL,mL,,66,56.1,18.9156,66,"Multiplan, Inc.","Multiplan, Inc.",62.04,94,,percent of total billed charges,,
GLYCOPYRROLATE 0.2 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Outpatient,5 mL,mL,,66,56.1,18.9156,66,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,59.466,90.1,,percent of total billed charges,,
GLYCOPYRROLATE 0.2 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Inpatient,5 mL,mL,,66,56.1,18.9156,66,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
GLYCOPYRROLATE 0.2 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Both,5 mL,mL,,66,56.1,18.9156,66,"Preferred One Administrative Services, INC.",PPO,65.076,98.6,,percent of total billed charges,,
GLYCOPYRROLATE 0.2 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Outpatient,5 mL,mL,,66,56.1,18.9156,66,PrimeWest Health,Minnesota Senior Health Options (MSHO),33.957,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
GLYCOPYRROLATE 0.2 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Inpatient,5 mL,mL,,66,56.1,18.9156,66,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
GLYCOPYRROLATE 0.2 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Outpatient,5 mL,mL,,66,56.1,18.9156,66,PrimeWest Health,MinnesotaCare,33.8976,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
GLYCOPYRROLATE 0.2 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Inpatient,5 mL,mL,,66,56.1,18.9156,66,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
GLYCOPYRROLATE 0.2 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Both,5 mL,mL,,66,56.1,18.9156,66,Sanford Health Plan,Sanford Health Plan,60.72,92,,percent of total billed charges,,
GLYCOPYRROLATE 0.2 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Outpatient,5 mL,mL,,66,56.1,18.9156,66,"UCare Health, Inc.",Individual & Family Plan,37.191,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
GLYCOPYRROLATE 0.2 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Inpatient,5 mL,mL,,66,56.1,18.9156,66,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
GLYCOPYRROLATE 0.2 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Outpatient,5 mL,mL,,66,56.1,18.9156,66,"UCare Health, Inc.",Medical Assistance,33.3102,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
GLYCOPYRROLATE 0.2 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Inpatient,5 mL,mL,,66,56.1,18.9156,66,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
GLYCOPYRROLATE 0.2 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Outpatient,5 mL,mL,,66,56.1,18.9156,66,"UCare Health, Inc.",Medicare Advantage,33.3102,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
GLYCOPYRROLATE 0.2 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Inpatient,5 mL,mL,,66,56.1,18.9156,66,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
GLYCOPYRROLATE 0.2 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Outpatient,5 mL,mL,,66,56.1,18.9156,66,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),33.3102,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
GLYCOPYRROLATE 0.2 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Inpatient,5 mL,mL,,66,56.1,18.9156,66,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
GLYCOPYRROLATE 0.2 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Both,5 mL,mL,,66,56.1,18.9156,66,UnitedHealthcare,Individual & Family,62.04,94,,percent of total billed charges,,
GLYCOPYRROLATE 0.2 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Outpatient,5 mL,mL,,66,56.1,18.9156,66,UnitedHealthcare,Medicare Advantage,32.34,49,,percent of total billed charges,,
GLYCOPYRROLATE 0.2 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Inpatient,5 mL,mL,,66,56.1,18.9156,66,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
GLYCOPYRROLATE 0.2 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Outpatient,5 mL,mL,,66,56.1,18.9156,66,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,31.68,48,,percent of total billed charges,,100% of DHS outpatient percentage
GLYCOPYRROLATE 0.2 MG/ML INJ SOLN,,J3490,HCPCS,Facility,Inpatient,5 mL,mL,,66,56.1,18.9156,66,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
METOPROLOL TARTRATE 5 MG/5 ML IV SOLN,,J3490,HCPCS,Facility,Both,5 mL,mL,,8,6.8,2.2928,8,Aetna,Commercial,7.36,92,,percent of total billed charges,,
METOPROLOL TARTRATE 5 MG/5 ML IV SOLN,,J3490,HCPCS,Facility,Outpatient,5 mL,mL,,8,6.8,2.2928,8,Aetna,Medicare Advantage,3.92,49,,percent of total billed charges,,
METOPROLOL TARTRATE 5 MG/5 ML IV SOLN,,J3490,HCPCS,Facility,Inpatient,5 mL,mL,,8,6.8,2.2928,8,Aetna,Medicare Advantage,,,,,Included in per diem rate,
METOPROLOL TARTRATE 5 MG/5 ML IV SOLN,,J3490,HCPCS,Facility,Both,5 mL,mL,,8,6.8,2.2928,8,Aetna,PPO,7.44,93,,percent of total billed charges,,
METOPROLOL TARTRATE 5 MG/5 ML IV SOLN,,J3490,HCPCS,Facility,Both,5 mL,mL,,8,6.8,2.2928,8,America's PPO,America's PPO,7.6824,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
METOPROLOL TARTRATE 5 MG/5 ML IV SOLN,,J3490,HCPCS,Facility,Both,5 mL,mL,,8,6.8,2.2928,8,BlueCross BlueShield Minnesota, Federal Employee Program,7.872,98.4,,percent of total billed charges,,
METOPROLOL TARTRATE 5 MG/5 ML IV SOLN,,J3490,HCPCS,Facility,Both,5 mL,mL,,8,6.8,2.2928,8,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,8,100,,percent of total billed charges,,
METOPROLOL TARTRATE 5 MG/5 ML IV SOLN,,J3490,HCPCS,Facility,Both,5 mL,mL,,8,6.8,2.2928,8,BlueCross BlueShield Minnesota,High Value Network Plan,7.2,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
METOPROLOL TARTRATE 5 MG/5 ML IV SOLN,,J3490,HCPCS,Facility,Outpatient,5 mL,mL,,8,6.8,2.2928,8,BlueCross BlueShield Minnesota,Medicare Advantage,3.92,49,,percent of total billed charges,,
METOPROLOL TARTRATE 5 MG/5 ML IV SOLN,,J3490,HCPCS,Facility,Inpatient,5 mL,mL,,8,6.8,2.2928,8,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
METOPROLOL TARTRATE 5 MG/5 ML IV SOLN,,J3490,HCPCS,Facility,Both,5 mL,mL,,8,6.8,2.2928,8,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,7.0856,88.57,,percent of total billed charges,,
METOPROLOL TARTRATE 5 MG/5 ML IV SOLN,,J3490,HCPCS,Facility,Both,5 mL,mL,,8,6.8,2.2928,8,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,2.2928,28.66,,percent of total billed charges,,
METOPROLOL TARTRATE 5 MG/5 ML IV SOLN,,J3490,HCPCS,Facility,Outpatient,5 mL,mL,,8,6.8,2.2928,8,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),3.92,49,,percent of total billed charges,,
METOPROLOL TARTRATE 5 MG/5 ML IV SOLN,,J3490,HCPCS,Facility,Inpatient,5 mL,mL,,8,6.8,2.2928,8,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
METOPROLOL TARTRATE 5 MG/5 ML IV SOLN,,J3490,HCPCS,Facility,Both,5 mL,mL,,8,6.8,2.2928,8,CorVel,Worker's Compensation,8,100,,percent of total billed charges,,
METOPROLOL TARTRATE 5 MG/5 ML IV SOLN,,J3490,HCPCS,Facility,Both,5 mL,mL,,8,6.8,2.2928,8,First Health Group Corporation,First Health Network,7.76,97,,percent of total billed charges,,
METOPROLOL TARTRATE 5 MG/5 ML IV SOLN,,J3490,HCPCS,Facility,Both,5 mL,mL,,8,6.8,2.2928,8,"Health Partners, Inc.",Commercial,7.568,94.6,,percent of total billed charges,,
METOPROLOL TARTRATE 5 MG/5 ML IV SOLN,,J3490,HCPCS,Facility,Outpatient,5 mL,mL,,8,6.8,2.2928,8,"Health Partners, Inc.",Medicare Advantage,3.92,49,,percent of total billed charges,,
METOPROLOL TARTRATE 5 MG/5 ML IV SOLN,,J3490,HCPCS,Facility,Inpatient,5 mL,mL,,8,6.8,2.2928,8,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
METOPROLOL TARTRATE 5 MG/5 ML IV SOLN,,J3490,HCPCS,Facility,Both,5 mL,mL,,8,6.8,2.2928,8,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),4.8,60,,percent of total billed charges,,
METOPROLOL TARTRATE 5 MG/5 ML IV SOLN,,J3490,HCPCS,Facility,Both,5 mL,mL,,8,6.8,2.2928,8,"Health Partners, Inc.",State of Minnesota Advantage Program,6.52,81.5,,percent of total billed charges,,
METOPROLOL TARTRATE 5 MG/5 ML IV SOLN,,J3490,HCPCS,Facility,Both,5 mL,mL,,8,6.8,2.2928,8,"Health Partners, Inc.",State Public Programs,4,50,,percent of total billed charges,,
METOPROLOL TARTRATE 5 MG/5 ML IV SOLN,,J3490,HCPCS,Facility,Both,5 mL,mL,,8,6.8,2.2928,8,Humana Insurance Company,Commercial PPO,7.6,95,,percent of total billed charges,,
METOPROLOL TARTRATE 5 MG/5 ML IV SOLN,,J3490,HCPCS,Facility,Outpatient,5 mL,mL,,8,6.8,2.2928,8,Humana Insurance Company,Medicare PPO,3.92,49,,percent of total billed charges,,
METOPROLOL TARTRATE 5 MG/5 ML IV SOLN,,J3490,HCPCS,Facility,Inpatient,5 mL,mL,,8,6.8,2.2928,8,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
METOPROLOL TARTRATE 5 MG/5 ML IV SOLN,,J3490,HCPCS,Facility,Both,5 mL,mL,,8,6.8,2.2928,8,Medica,Individual & Family,7.928,99.1,,percent of total billed charges,,
METOPROLOL TARTRATE 5 MG/5 ML IV SOLN,,J3490,HCPCS,Facility,Outpatient,5 mL,mL,,8,6.8,2.2928,8,Medica,Medica Advantage Solution,3.984,49.8,,percent of total billed charges,,
METOPROLOL TARTRATE 5 MG/5 ML IV SOLN,,J3490,HCPCS,Facility,Inpatient,5 mL,mL,,8,6.8,2.2928,8,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
METOPROLOL TARTRATE 5 MG/5 ML IV SOLN,,J3490,HCPCS,Facility,Outpatient,5 mL,mL,,8,6.8,2.2928,8,Medica,Medical Assistance,3.568,44.6,,percent of total billed charges,,
METOPROLOL TARTRATE 5 MG/5 ML IV SOLN,,J3490,HCPCS,Facility,Inpatient,5 mL,mL,,8,6.8,2.2928,8,Medica,Medical Assistance,,,,,Included in per diem rate,
METOPROLOL TARTRATE 5 MG/5 ML IV SOLN,,J3490,HCPCS,Facility,Outpatient,5 mL,mL,,8,6.8,2.2928,8,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,3.984,49.8,,percent of total billed charges,,
METOPROLOL TARTRATE 5 MG/5 ML IV SOLN,,J3490,HCPCS,Facility,Inpatient,5 mL,mL,,8,6.8,2.2928,8,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
METOPROLOL TARTRATE 5 MG/5 ML IV SOLN,,J3490,HCPCS,Facility,Both,5 mL,mL,,8,6.8,2.2928,8,"Multiplan, Inc.","Multiplan, Inc.",7.52,94,,percent of total billed charges,,
METOPROLOL TARTRATE 5 MG/5 ML IV SOLN,,J3490,HCPCS,Facility,Outpatient,5 mL,mL,,8,6.8,2.2928,8,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,7.208,90.1,,percent of total billed charges,,
METOPROLOL TARTRATE 5 MG/5 ML IV SOLN,,J3490,HCPCS,Facility,Inpatient,5 mL,mL,,8,6.8,2.2928,8,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
METOPROLOL TARTRATE 5 MG/5 ML IV SOLN,,J3490,HCPCS,Facility,Both,5 mL,mL,,8,6.8,2.2928,8,"Preferred One Administrative Services, INC.",PPO,7.888,98.6,,percent of total billed charges,,
METOPROLOL TARTRATE 5 MG/5 ML IV SOLN,,J3490,HCPCS,Facility,Outpatient,5 mL,mL,,8,6.8,2.2928,8,PrimeWest Health,Minnesota Senior Health Options (MSHO),4.116,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
METOPROLOL TARTRATE 5 MG/5 ML IV SOLN,,J3490,HCPCS,Facility,Inpatient,5 mL,mL,,8,6.8,2.2928,8,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
METOPROLOL TARTRATE 5 MG/5 ML IV SOLN,,J3490,HCPCS,Facility,Outpatient,5 mL,mL,,8,6.8,2.2928,8,PrimeWest Health,MinnesotaCare,4.1088,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
METOPROLOL TARTRATE 5 MG/5 ML IV SOLN,,J3490,HCPCS,Facility,Inpatient,5 mL,mL,,8,6.8,2.2928,8,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
METOPROLOL TARTRATE 5 MG/5 ML IV SOLN,,J3490,HCPCS,Facility,Both,5 mL,mL,,8,6.8,2.2928,8,Sanford Health Plan,Sanford Health Plan,7.36,92,,percent of total billed charges,,
METOPROLOL TARTRATE 5 MG/5 ML IV SOLN,,J3490,HCPCS,Facility,Outpatient,5 mL,mL,,8,6.8,2.2928,8,"UCare Health, Inc.",Individual & Family Plan,4.508,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
METOPROLOL TARTRATE 5 MG/5 ML IV SOLN,,J3490,HCPCS,Facility,Inpatient,5 mL,mL,,8,6.8,2.2928,8,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
METOPROLOL TARTRATE 5 MG/5 ML IV SOLN,,J3490,HCPCS,Facility,Outpatient,5 mL,mL,,8,6.8,2.2928,8,"UCare Health, Inc.",Medical Assistance,4.0376,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
METOPROLOL TARTRATE 5 MG/5 ML IV SOLN,,J3490,HCPCS,Facility,Inpatient,5 mL,mL,,8,6.8,2.2928,8,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
METOPROLOL TARTRATE 5 MG/5 ML IV SOLN,,J3490,HCPCS,Facility,Outpatient,5 mL,mL,,8,6.8,2.2928,8,"UCare Health, Inc.",Medicare Advantage,4.0376,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
METOPROLOL TARTRATE 5 MG/5 ML IV SOLN,,J3490,HCPCS,Facility,Inpatient,5 mL,mL,,8,6.8,2.2928,8,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
METOPROLOL TARTRATE 5 MG/5 ML IV SOLN,,J3490,HCPCS,Facility,Outpatient,5 mL,mL,,8,6.8,2.2928,8,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),4.0376,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
METOPROLOL TARTRATE 5 MG/5 ML IV SOLN,,J3490,HCPCS,Facility,Inpatient,5 mL,mL,,8,6.8,2.2928,8,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
METOPROLOL TARTRATE 5 MG/5 ML IV SOLN,,J3490,HCPCS,Facility,Both,5 mL,mL,,8,6.8,2.2928,8,UnitedHealthcare,Individual & Family,7.52,94,,percent of total billed charges,,
METOPROLOL TARTRATE 5 MG/5 ML IV SOLN,,J3490,HCPCS,Facility,Outpatient,5 mL,mL,,8,6.8,2.2928,8,UnitedHealthcare,Medicare Advantage,3.92,49,,percent of total billed charges,,
METOPROLOL TARTRATE 5 MG/5 ML IV SOLN,,J3490,HCPCS,Facility,Inpatient,5 mL,mL,,8,6.8,2.2928,8,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
METOPROLOL TARTRATE 5 MG/5 ML IV SOLN,,J3490,HCPCS,Facility,Outpatient,5 mL,mL,,8,6.8,2.2928,8,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,3.84,48,,percent of total billed charges,,100% of DHS outpatient percentage
METOPROLOL TARTRATE 5 MG/5 ML IV SOLN,,J3490,HCPCS,Facility,Inpatient,5 mL,mL,,8,6.8,2.2928,8,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
WHITE PETROLATUM 41 % TOP OINT,,29868,LOCAL,Facility,Both,50 g,g,,43,36.55,12.3238,43,Aetna,Commercial,39.56,92,,percent of total billed charges,,
WHITE PETROLATUM 41 % TOP OINT,,29868,LOCAL,Facility,Outpatient,50 g,g,,43,36.55,12.3238,43,Aetna,Medicare Advantage,21.07,49,,percent of total billed charges,,
WHITE PETROLATUM 41 % TOP OINT,,29868,LOCAL,Facility,Inpatient,50 g,g,,43,36.55,12.3238,43,Aetna,Medicare Advantage,,,,,Included in per diem rate,
WHITE PETROLATUM 41 % TOP OINT,,29868,LOCAL,Facility,Both,50 g,g,,43,36.55,12.3238,43,Aetna,PPO,39.99,93,,percent of total billed charges,,
WHITE PETROLATUM 41 % TOP OINT,,29868,LOCAL,Facility,Both,50 g,g,,43,36.55,12.3238,43,America's PPO,America's PPO,41.2929,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
WHITE PETROLATUM 41 % TOP OINT,,29868,LOCAL,Facility,Both,50 g,g,,43,36.55,12.3238,43,BlueCross BlueShield Minnesota, Federal Employee Program,42.312,98.4,,percent of total billed charges,,
WHITE PETROLATUM 41 % TOP OINT,,29868,LOCAL,Facility,Both,50 g,g,,43,36.55,12.3238,43,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,43,100,,percent of total billed charges,,
WHITE PETROLATUM 41 % TOP OINT,,29868,LOCAL,Facility,Both,50 g,g,,43,36.55,12.3238,43,BlueCross BlueShield Minnesota,High Value Network Plan,38.7,90,,percent of total billed charges,,
WHITE PETROLATUM 41 % TOP OINT,,29868,LOCAL,Facility,Outpatient,50 g,g,,43,36.55,12.3238,43,BlueCross BlueShield Minnesota,Medicare Advantage,21.07,49,,percent of total billed charges,,
WHITE PETROLATUM 41 % TOP OINT,,29868,LOCAL,Facility,Inpatient,50 g,g,,43,36.55,12.3238,43,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
WHITE PETROLATUM 41 % TOP OINT,,29868,LOCAL,Facility,Both,50 g,g,,43,36.55,12.3238,43,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,38.0851,88.57,,percent of total billed charges,,
WHITE PETROLATUM 41 % TOP OINT,,29868,LOCAL,Facility,Both,50 g,g,,43,36.55,12.3238,43,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,12.3238,28.66,,percent of total billed charges,,
WHITE PETROLATUM 41 % TOP OINT,,29868,LOCAL,Facility,Outpatient,50 g,g,,43,36.55,12.3238,43,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),21.07,49,,percent of total billed charges,,
WHITE PETROLATUM 41 % TOP OINT,,29868,LOCAL,Facility,Inpatient,50 g,g,,43,36.55,12.3238,43,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
WHITE PETROLATUM 41 % TOP OINT,,29868,LOCAL,Facility,Both,50 g,g,,43,36.55,12.3238,43,CorVel,Worker's Compensation,43,100,,percent of total billed charges,,
WHITE PETROLATUM 41 % TOP OINT,,29868,LOCAL,Facility,Both,50 g,g,,43,36.55,12.3238,43,First Health Group Corporation,First Health Network,41.71,97,,percent of total billed charges,,
WHITE PETROLATUM 41 % TOP OINT,,29868,LOCAL,Facility,Both,50 g,g,,43,36.55,12.3238,43,"Health Partners, Inc.",Commercial,40.678,94.6,,percent of total billed charges,,
WHITE PETROLATUM 41 % TOP OINT,,29868,LOCAL,Facility,Outpatient,50 g,g,,43,36.55,12.3238,43,"Health Partners, Inc.",Medicare Advantage,21.07,49,,percent of total billed charges,,
WHITE PETROLATUM 41 % TOP OINT,,29868,LOCAL,Facility,Inpatient,50 g,g,,43,36.55,12.3238,43,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
WHITE PETROLATUM 41 % TOP OINT,,29868,LOCAL,Facility,Both,50 g,g,,43,36.55,12.3238,43,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),25.8,60,,percent of total billed charges,,
WHITE PETROLATUM 41 % TOP OINT,,29868,LOCAL,Facility,Both,50 g,g,,43,36.55,12.3238,43,"Health Partners, Inc.",State of Minnesota Advantage Program,35.045,81.5,,percent of total billed charges,,
WHITE PETROLATUM 41 % TOP OINT,,29868,LOCAL,Facility,Both,50 g,g,,43,36.55,12.3238,43,"Health Partners, Inc.",State Public Programs,21.5,50,,percent of total billed charges,,
WHITE PETROLATUM 41 % TOP OINT,,29868,LOCAL,Facility,Both,50 g,g,,43,36.55,12.3238,43,Humana Insurance Company,Commercial PPO,40.85,95,,percent of total billed charges,,
WHITE PETROLATUM 41 % TOP OINT,,29868,LOCAL,Facility,Outpatient,50 g,g,,43,36.55,12.3238,43,Humana Insurance Company,Medicare PPO,21.07,49,,percent of total billed charges,,
WHITE PETROLATUM 41 % TOP OINT,,29868,LOCAL,Facility,Inpatient,50 g,g,,43,36.55,12.3238,43,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
WHITE PETROLATUM 41 % TOP OINT,,29868,LOCAL,Facility,Both,50 g,g,,43,36.55,12.3238,43,Medica,Individual & Family,42.613,99.1,,percent of total billed charges,,
WHITE PETROLATUM 41 % TOP OINT,,29868,LOCAL,Facility,Outpatient,50 g,g,,43,36.55,12.3238,43,Medica,Medica Advantage Solution,21.414,49.8,,percent of total billed charges,,
WHITE PETROLATUM 41 % TOP OINT,,29868,LOCAL,Facility,Inpatient,50 g,g,,43,36.55,12.3238,43,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
WHITE PETROLATUM 41 % TOP OINT,,29868,LOCAL,Facility,Outpatient,50 g,g,,43,36.55,12.3238,43,Medica,Medical Assistance,19.178,44.6,,percent of total billed charges,,
WHITE PETROLATUM 41 % TOP OINT,,29868,LOCAL,Facility,Inpatient,50 g,g,,43,36.55,12.3238,43,Medica,Medical Assistance,,,,,Included in per diem rate,
WHITE PETROLATUM 41 % TOP OINT,,29868,LOCAL,Facility,Outpatient,50 g,g,,43,36.55,12.3238,43,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,21.414,49.8,,percent of total billed charges,,
WHITE PETROLATUM 41 % TOP OINT,,29868,LOCAL,Facility,Inpatient,50 g,g,,43,36.55,12.3238,43,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
WHITE PETROLATUM 41 % TOP OINT,,29868,LOCAL,Facility,Both,50 g,g,,43,36.55,12.3238,43,"Multiplan, Inc.","Multiplan, Inc.",40.42,94,,percent of total billed charges,,
WHITE PETROLATUM 41 % TOP OINT,,29868,LOCAL,Facility,Outpatient,50 g,g,,43,36.55,12.3238,43,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,38.743,90.1,,percent of total billed charges,,
WHITE PETROLATUM 41 % TOP OINT,,29868,LOCAL,Facility,Inpatient,50 g,g,,43,36.55,12.3238,43,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
WHITE PETROLATUM 41 % TOP OINT,,29868,LOCAL,Facility,Both,50 g,g,,43,36.55,12.3238,43,"Preferred One Administrative Services, INC.",PPO,42.398,98.6,,percent of total billed charges,,
WHITE PETROLATUM 41 % TOP OINT,,29868,LOCAL,Facility,Outpatient,50 g,g,,43,36.55,12.3238,43,PrimeWest Health,Minnesota Senior Health Options (MSHO),22.1235,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
WHITE PETROLATUM 41 % TOP OINT,,29868,LOCAL,Facility,Inpatient,50 g,g,,43,36.55,12.3238,43,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
WHITE PETROLATUM 41 % TOP OINT,,29868,LOCAL,Facility,Outpatient,50 g,g,,43,36.55,12.3238,43,PrimeWest Health,MinnesotaCare,22.0848,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
WHITE PETROLATUM 41 % TOP OINT,,29868,LOCAL,Facility,Inpatient,50 g,g,,43,36.55,12.3238,43,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
WHITE PETROLATUM 41 % TOP OINT,,29868,LOCAL,Facility,Both,50 g,g,,43,36.55,12.3238,43,Sanford Health Plan,Sanford Health Plan,39.56,92,,percent of total billed charges,,
WHITE PETROLATUM 41 % TOP OINT,,29868,LOCAL,Facility,Outpatient,50 g,g,,43,36.55,12.3238,43,"UCare Health, Inc.",Individual & Family Plan,24.2305,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
WHITE PETROLATUM 41 % TOP OINT,,29868,LOCAL,Facility,Inpatient,50 g,g,,43,36.55,12.3238,43,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
WHITE PETROLATUM 41 % TOP OINT,,29868,LOCAL,Facility,Outpatient,50 g,g,,43,36.55,12.3238,43,"UCare Health, Inc.",Medical Assistance,21.7021,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
WHITE PETROLATUM 41 % TOP OINT,,29868,LOCAL,Facility,Inpatient,50 g,g,,43,36.55,12.3238,43,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
WHITE PETROLATUM 41 % TOP OINT,,29868,LOCAL,Facility,Outpatient,50 g,g,,43,36.55,12.3238,43,"UCare Health, Inc.",Medicare Advantage,21.7021,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
WHITE PETROLATUM 41 % TOP OINT,,29868,LOCAL,Facility,Inpatient,50 g,g,,43,36.55,12.3238,43,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
WHITE PETROLATUM 41 % TOP OINT,,29868,LOCAL,Facility,Outpatient,50 g,g,,43,36.55,12.3238,43,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),21.7021,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
WHITE PETROLATUM 41 % TOP OINT,,29868,LOCAL,Facility,Inpatient,50 g,g,,43,36.55,12.3238,43,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
WHITE PETROLATUM 41 % TOP OINT,,29868,LOCAL,Facility,Both,50 g,g,,43,36.55,12.3238,43,UnitedHealthcare,Individual & Family,40.42,94,,percent of total billed charges,,
WHITE PETROLATUM 41 % TOP OINT,,29868,LOCAL,Facility,Outpatient,50 g,g,,43,36.55,12.3238,43,UnitedHealthcare,Medicare Advantage,21.07,49,,percent of total billed charges,,
WHITE PETROLATUM 41 % TOP OINT,,29868,LOCAL,Facility,Inpatient,50 g,g,,43,36.55,12.3238,43,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
WHITE PETROLATUM 41 % TOP OINT,,29868,LOCAL,Facility,Outpatient,50 g,g,,43,36.55,12.3238,43,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,20.64,48,,percent of total billed charges,,100% of DHS outpatient percentage
WHITE PETROLATUM 41 % TOP OINT,,29868,LOCAL,Facility,Inpatient,50 g,g,,43,36.55,12.3238,43,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Both,50 mL,mL,,35,29.75,10.031,35,Aetna,Commercial,32.2,92,,percent of total billed charges,,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Both,50 mL,mL,,19,16.15,5.4454,19,Aetna,Commercial,17.48,92,,percent of total billed charges,,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Outpatient,50 mL,mL,,35,29.75,10.031,35,Aetna,Medicare Advantage,17.15,49,,percent of total billed charges,,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Outpatient,50 mL,mL,,19,16.15,5.4454,19,Aetna,Medicare Advantage,9.31,49,,percent of total billed charges,,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Inpatient,50 mL,mL,,35,29.75,10.031,35,Aetna,Medicare Advantage,,,,,Included in per diem rate,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Inpatient,50 mL,mL,,19,16.15,5.4454,19,Aetna,Medicare Advantage,,,,,Included in per diem rate,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Both,50 mL,mL,,35,29.75,10.031,35,Aetna,PPO,32.55,93,,percent of total billed charges,,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Both,50 mL,mL,,19,16.15,5.4454,19,Aetna,PPO,17.67,93,,percent of total billed charges,,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Both,50 mL,mL,,35,29.75,10.031,35,America's PPO,America's PPO,33.6105,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Both,50 mL,mL,,19,16.15,5.4454,19,America's PPO,America's PPO,18.2457,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Both,50 mL,mL,,35,29.75,10.031,35,BlueCross BlueShield Minnesota, Federal Employee Program,34.44,98.4,,percent of total billed charges,,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Both,50 mL,mL,,19,16.15,5.4454,19,BlueCross BlueShield Minnesota, Federal Employee Program,18.696,98.4,,percent of total billed charges,,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Both,50 mL,mL,,35,29.75,10.031,35,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,35,100,,percent of total billed charges,,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Both,50 mL,mL,,19,16.15,5.4454,19,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,19,100,,percent of total billed charges,,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Both,50 mL,mL,,35,29.75,10.031,35,BlueCross BlueShield Minnesota,High Value Network Plan,31.5,90,,percent of total billed charges,,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Both,50 mL,mL,,19,16.15,5.4454,19,BlueCross BlueShield Minnesota,High Value Network Plan,17.1,90,,percent of total billed charges,,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Outpatient,50 mL,mL,,35,29.75,10.031,35,BlueCross BlueShield Minnesota,Medicare Advantage,17.15,49,,percent of total billed charges,,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Outpatient,50 mL,mL,,19,16.15,5.4454,19,BlueCross BlueShield Minnesota,Medicare Advantage,9.31,49,,percent of total billed charges,,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Inpatient,50 mL,mL,,35,29.75,10.031,35,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Inpatient,50 mL,mL,,19,16.15,5.4454,19,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Both,50 mL,mL,,35,29.75,10.031,35,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,30.9995,88.57,,percent of total billed charges,,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Both,50 mL,mL,,19,16.15,5.4454,19,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,16.8283,88.57,,percent of total billed charges,,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Both,50 mL,mL,,35,29.75,10.031,35,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,10.031,28.66,,percent of total billed charges,,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Both,50 mL,mL,,19,16.15,5.4454,19,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,5.4454,28.66,,percent of total billed charges,,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Outpatient,50 mL,mL,,35,29.75,10.031,35,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),17.15,49,,percent of total billed charges,,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Outpatient,50 mL,mL,,19,16.15,5.4454,19,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),9.31,49,,percent of total billed charges,,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Inpatient,50 mL,mL,,35,29.75,10.031,35,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Inpatient,50 mL,mL,,19,16.15,5.4454,19,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Both,50 mL,mL,,35,29.75,10.031,35,CorVel,Worker's Compensation,35,100,,percent of total billed charges,,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Both,50 mL,mL,,19,16.15,5.4454,19,CorVel,Worker's Compensation,19,100,,percent of total billed charges,,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Both,50 mL,mL,,35,29.75,10.031,35,First Health Group Corporation,First Health Network,33.95,97,,percent of total billed charges,,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Both,50 mL,mL,,19,16.15,5.4454,19,First Health Group Corporation,First Health Network,18.43,97,,percent of total billed charges,,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Both,50 mL,mL,,35,29.75,10.031,35,"Health Partners, Inc.",Commercial,33.11,94.6,,percent of total billed charges,,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Both,50 mL,mL,,19,16.15,5.4454,19,"Health Partners, Inc.",Commercial,17.974,94.6,,percent of total billed charges,,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Outpatient,50 mL,mL,,35,29.75,10.031,35,"Health Partners, Inc.",Medicare Advantage,17.15,49,,percent of total billed charges,,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Outpatient,50 mL,mL,,19,16.15,5.4454,19,"Health Partners, Inc.",Medicare Advantage,9.31,49,,percent of total billed charges,,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Inpatient,50 mL,mL,,35,29.75,10.031,35,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Inpatient,50 mL,mL,,19,16.15,5.4454,19,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Both,50 mL,mL,,35,29.75,10.031,35,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),21,60,,percent of total billed charges,,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Both,50 mL,mL,,19,16.15,5.4454,19,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),11.4,60,,percent of total billed charges,,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Both,50 mL,mL,,35,29.75,10.031,35,"Health Partners, Inc.",State of Minnesota Advantage Program,28.525,81.5,,percent of total billed charges,,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Both,50 mL,mL,,19,16.15,5.4454,19,"Health Partners, Inc.",State of Minnesota Advantage Program,15.485,81.5,,percent of total billed charges,,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Both,50 mL,mL,,35,29.75,10.031,35,"Health Partners, Inc.",State Public Programs,17.5,50,,percent of total billed charges,,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Both,50 mL,mL,,19,16.15,5.4454,19,"Health Partners, Inc.",State Public Programs,9.5,50,,percent of total billed charges,,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Both,50 mL,mL,,35,29.75,10.031,35,Humana Insurance Company,Commercial PPO,33.25,95,,percent of total billed charges,,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Both,50 mL,mL,,19,16.15,5.4454,19,Humana Insurance Company,Commercial PPO,18.05,95,,percent of total billed charges,,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Outpatient,50 mL,mL,,35,29.75,10.031,35,Humana Insurance Company,Medicare PPO,17.15,49,,percent of total billed charges,,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Outpatient,50 mL,mL,,19,16.15,5.4454,19,Humana Insurance Company,Medicare PPO,9.31,49,,percent of total billed charges,,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Inpatient,50 mL,mL,,35,29.75,10.031,35,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Inpatient,50 mL,mL,,19,16.15,5.4454,19,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Both,50 mL,mL,,35,29.75,10.031,35,Medica,Individual & Family,34.685,99.1,,percent of total billed charges,,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Both,50 mL,mL,,19,16.15,5.4454,19,Medica,Individual & Family,18.829,99.1,,percent of total billed charges,,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Outpatient,50 mL,mL,,35,29.75,10.031,35,Medica,Medica Advantage Solution,17.43,49.8,,percent of total billed charges,,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Outpatient,50 mL,mL,,19,16.15,5.4454,19,Medica,Medica Advantage Solution,9.462,49.8,,percent of total billed charges,,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Inpatient,50 mL,mL,,35,29.75,10.031,35,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Inpatient,50 mL,mL,,19,16.15,5.4454,19,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Outpatient,50 mL,mL,,35,29.75,10.031,35,Medica,Medical Assistance,15.61,44.6,,percent of total billed charges,,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Outpatient,50 mL,mL,,19,16.15,5.4454,19,Medica,Medical Assistance,8.474,44.6,,percent of total billed charges,,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Inpatient,50 mL,mL,,35,29.75,10.031,35,Medica,Medical Assistance,,,,,Included in per diem rate,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Inpatient,50 mL,mL,,19,16.15,5.4454,19,Medica,Medical Assistance,,,,,Included in per diem rate,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Outpatient,50 mL,mL,,35,29.75,10.031,35,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,17.43,49.8,,percent of total billed charges,,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Outpatient,50 mL,mL,,19,16.15,5.4454,19,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,9.462,49.8,,percent of total billed charges,,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Inpatient,50 mL,mL,,35,29.75,10.031,35,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Inpatient,50 mL,mL,,19,16.15,5.4454,19,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Both,50 mL,mL,,35,29.75,10.031,35,"Multiplan, Inc.","Multiplan, Inc.",32.9,94,,percent of total billed charges,,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Both,50 mL,mL,,19,16.15,5.4454,19,"Multiplan, Inc.","Multiplan, Inc.",17.86,94,,percent of total billed charges,,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Outpatient,50 mL,mL,,35,29.75,10.031,35,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,31.535,90.1,,percent of total billed charges,,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Outpatient,50 mL,mL,,19,16.15,5.4454,19,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,17.119,90.1,,percent of total billed charges,,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Inpatient,50 mL,mL,,35,29.75,10.031,35,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Inpatient,50 mL,mL,,19,16.15,5.4454,19,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Both,50 mL,mL,,35,29.75,10.031,35,"Preferred One Administrative Services, INC.",PPO,34.51,98.6,,percent of total billed charges,,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Both,50 mL,mL,,19,16.15,5.4454,19,"Preferred One Administrative Services, INC.",PPO,18.734,98.6,,percent of total billed charges,,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Outpatient,50 mL,mL,,35,29.75,10.031,35,PrimeWest Health,Minnesota Senior Health Options (MSHO),18.0075,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Outpatient,50 mL,mL,,19,16.15,5.4454,19,PrimeWest Health,Minnesota Senior Health Options (MSHO),9.7755,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Inpatient,50 mL,mL,,35,29.75,10.031,35,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Inpatient,50 mL,mL,,19,16.15,5.4454,19,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Outpatient,50 mL,mL,,35,29.75,10.031,35,PrimeWest Health,MinnesotaCare,17.976,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Outpatient,50 mL,mL,,19,16.15,5.4454,19,PrimeWest Health,MinnesotaCare,9.7584,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Inpatient,50 mL,mL,,35,29.75,10.031,35,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Inpatient,50 mL,mL,,19,16.15,5.4454,19,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Both,50 mL,mL,,35,29.75,10.031,35,Sanford Health Plan,Sanford Health Plan,32.2,92,,percent of total billed charges,,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Both,50 mL,mL,,19,16.15,5.4454,19,Sanford Health Plan,Sanford Health Plan,17.48,92,,percent of total billed charges,,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Outpatient,50 mL,mL,,35,29.75,10.031,35,"UCare Health, Inc.",Individual & Family Plan,19.7225,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Outpatient,50 mL,mL,,19,16.15,5.4454,19,"UCare Health, Inc.",Individual & Family Plan,10.7065,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Inpatient,50 mL,mL,,35,29.75,10.031,35,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Inpatient,50 mL,mL,,19,16.15,5.4454,19,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Outpatient,50 mL,mL,,35,29.75,10.031,35,"UCare Health, Inc.",Medical Assistance,17.6645,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Outpatient,50 mL,mL,,19,16.15,5.4454,19,"UCare Health, Inc.",Medical Assistance,9.5893,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Inpatient,50 mL,mL,,35,29.75,10.031,35,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Inpatient,50 mL,mL,,19,16.15,5.4454,19,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Outpatient,50 mL,mL,,35,29.75,10.031,35,"UCare Health, Inc.",Medicare Advantage,17.6645,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Outpatient,50 mL,mL,,19,16.15,5.4454,19,"UCare Health, Inc.",Medicare Advantage,9.5893,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Inpatient,50 mL,mL,,35,29.75,10.031,35,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Inpatient,50 mL,mL,,19,16.15,5.4454,19,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Outpatient,50 mL,mL,,35,29.75,10.031,35,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),17.6645,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Outpatient,50 mL,mL,,19,16.15,5.4454,19,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),9.5893,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Inpatient,50 mL,mL,,35,29.75,10.031,35,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Inpatient,50 mL,mL,,19,16.15,5.4454,19,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Both,50 mL,mL,,35,29.75,10.031,35,UnitedHealthcare,Individual & Family,32.9,94,,percent of total billed charges,,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Both,50 mL,mL,,19,16.15,5.4454,19,UnitedHealthcare,Individual & Family,17.86,94,,percent of total billed charges,,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Outpatient,50 mL,mL,,35,29.75,10.031,35,UnitedHealthcare,Medicare Advantage,17.15,49,,percent of total billed charges,,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Outpatient,50 mL,mL,,19,16.15,5.4454,19,UnitedHealthcare,Medicare Advantage,9.31,49,,percent of total billed charges,,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Inpatient,50 mL,mL,,35,29.75,10.031,35,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Inpatient,50 mL,mL,,19,16.15,5.4454,19,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Outpatient,50 mL,mL,,35,29.75,10.031,35,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,16.8,48,,percent of total billed charges,,100% of DHS outpatient percentage
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Outpatient,50 mL,mL,,19,16.15,5.4454,19,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,9.12,48,,percent of total billed charges,,100% of DHS outpatient percentage
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Inpatient,50 mL,mL,,35,29.75,10.031,35,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN,,1056,LOCAL,Facility,Inpatient,50 mL,mL,,19,16.15,5.4454,19,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
SODIUM BICARBONATE 1 MEQ/ML (8.4 %) IV SOLN,,8752,LOCAL,Facility,Both,50 mL,mL,,57,48.45,16.3362,57,Aetna,Commercial,52.44,92,,percent of total billed charges,,
SODIUM BICARBONATE 1 MEQ/ML (8.4 %) IV SOLN,,8752,LOCAL,Facility,Outpatient,50 mL,mL,,57,48.45,16.3362,57,Aetna,Medicare Advantage,27.93,49,,percent of total billed charges,,
SODIUM BICARBONATE 1 MEQ/ML (8.4 %) IV SOLN,,8752,LOCAL,Facility,Inpatient,50 mL,mL,,57,48.45,16.3362,57,Aetna,Medicare Advantage,,,,,Included in per diem rate,
SODIUM BICARBONATE 1 MEQ/ML (8.4 %) IV SOLN,,8752,LOCAL,Facility,Both,50 mL,mL,,57,48.45,16.3362,57,Aetna,PPO,53.01,93,,percent of total billed charges,,
SODIUM BICARBONATE 1 MEQ/ML (8.4 %) IV SOLN,,8752,LOCAL,Facility,Both,50 mL,mL,,57,48.45,16.3362,57,America's PPO,America's PPO,54.7371,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SODIUM BICARBONATE 1 MEQ/ML (8.4 %) IV SOLN,,8752,LOCAL,Facility,Both,50 mL,mL,,57,48.45,16.3362,57,BlueCross BlueShield Minnesota, Federal Employee Program,56.088,98.4,,percent of total billed charges,,
SODIUM BICARBONATE 1 MEQ/ML (8.4 %) IV SOLN,,8752,LOCAL,Facility,Both,50 mL,mL,,57,48.45,16.3362,57,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,57,100,,percent of total billed charges,,
SODIUM BICARBONATE 1 MEQ/ML (8.4 %) IV SOLN,,8752,LOCAL,Facility,Both,50 mL,mL,,57,48.45,16.3362,57,BlueCross BlueShield Minnesota,High Value Network Plan,51.3,90,,percent of total billed charges,,
SODIUM BICARBONATE 1 MEQ/ML (8.4 %) IV SOLN,,8752,LOCAL,Facility,Outpatient,50 mL,mL,,57,48.45,16.3362,57,BlueCross BlueShield Minnesota,Medicare Advantage,27.93,49,,percent of total billed charges,,
SODIUM BICARBONATE 1 MEQ/ML (8.4 %) IV SOLN,,8752,LOCAL,Facility,Inpatient,50 mL,mL,,57,48.45,16.3362,57,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
SODIUM BICARBONATE 1 MEQ/ML (8.4 %) IV SOLN,,8752,LOCAL,Facility,Both,50 mL,mL,,57,48.45,16.3362,57,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,50.4849,88.57,,percent of total billed charges,,
SODIUM BICARBONATE 1 MEQ/ML (8.4 %) IV SOLN,,8752,LOCAL,Facility,Both,50 mL,mL,,57,48.45,16.3362,57,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,16.3362,28.66,,percent of total billed charges,,
SODIUM BICARBONATE 1 MEQ/ML (8.4 %) IV SOLN,,8752,LOCAL,Facility,Outpatient,50 mL,mL,,57,48.45,16.3362,57,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),27.93,49,,percent of total billed charges,,
SODIUM BICARBONATE 1 MEQ/ML (8.4 %) IV SOLN,,8752,LOCAL,Facility,Inpatient,50 mL,mL,,57,48.45,16.3362,57,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
SODIUM BICARBONATE 1 MEQ/ML (8.4 %) IV SOLN,,8752,LOCAL,Facility,Both,50 mL,mL,,57,48.45,16.3362,57,CorVel,Worker's Compensation,57,100,,percent of total billed charges,,
SODIUM BICARBONATE 1 MEQ/ML (8.4 %) IV SOLN,,8752,LOCAL,Facility,Both,50 mL,mL,,57,48.45,16.3362,57,First Health Group Corporation,First Health Network,55.29,97,,percent of total billed charges,,
SODIUM BICARBONATE 1 MEQ/ML (8.4 %) IV SOLN,,8752,LOCAL,Facility,Both,50 mL,mL,,57,48.45,16.3362,57,"Health Partners, Inc.",Commercial,53.922,94.6,,percent of total billed charges,,
SODIUM BICARBONATE 1 MEQ/ML (8.4 %) IV SOLN,,8752,LOCAL,Facility,Outpatient,50 mL,mL,,57,48.45,16.3362,57,"Health Partners, Inc.",Medicare Advantage,27.93,49,,percent of total billed charges,,
SODIUM BICARBONATE 1 MEQ/ML (8.4 %) IV SOLN,,8752,LOCAL,Facility,Inpatient,50 mL,mL,,57,48.45,16.3362,57,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SODIUM BICARBONATE 1 MEQ/ML (8.4 %) IV SOLN,,8752,LOCAL,Facility,Both,50 mL,mL,,57,48.45,16.3362,57,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),34.2,60,,percent of total billed charges,,
SODIUM BICARBONATE 1 MEQ/ML (8.4 %) IV SOLN,,8752,LOCAL,Facility,Both,50 mL,mL,,57,48.45,16.3362,57,"Health Partners, Inc.",State of Minnesota Advantage Program,46.455,81.5,,percent of total billed charges,,
SODIUM BICARBONATE 1 MEQ/ML (8.4 %) IV SOLN,,8752,LOCAL,Facility,Both,50 mL,mL,,57,48.45,16.3362,57,"Health Partners, Inc.",State Public Programs,28.5,50,,percent of total billed charges,,
SODIUM BICARBONATE 1 MEQ/ML (8.4 %) IV SOLN,,8752,LOCAL,Facility,Both,50 mL,mL,,57,48.45,16.3362,57,Humana Insurance Company,Commercial PPO,54.15,95,,percent of total billed charges,,
SODIUM BICARBONATE 1 MEQ/ML (8.4 %) IV SOLN,,8752,LOCAL,Facility,Outpatient,50 mL,mL,,57,48.45,16.3362,57,Humana Insurance Company,Medicare PPO,27.93,49,,percent of total billed charges,,
SODIUM BICARBONATE 1 MEQ/ML (8.4 %) IV SOLN,,8752,LOCAL,Facility,Inpatient,50 mL,mL,,57,48.45,16.3362,57,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
SODIUM BICARBONATE 1 MEQ/ML (8.4 %) IV SOLN,,8752,LOCAL,Facility,Both,50 mL,mL,,57,48.45,16.3362,57,Medica,Individual & Family,56.487,99.1,,percent of total billed charges,,
SODIUM BICARBONATE 1 MEQ/ML (8.4 %) IV SOLN,,8752,LOCAL,Facility,Outpatient,50 mL,mL,,57,48.45,16.3362,57,Medica,Medica Advantage Solution,28.386,49.8,,percent of total billed charges,,
SODIUM BICARBONATE 1 MEQ/ML (8.4 %) IV SOLN,,8752,LOCAL,Facility,Inpatient,50 mL,mL,,57,48.45,16.3362,57,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
SODIUM BICARBONATE 1 MEQ/ML (8.4 %) IV SOLN,,8752,LOCAL,Facility,Outpatient,50 mL,mL,,57,48.45,16.3362,57,Medica,Medical Assistance,25.422,44.6,,percent of total billed charges,,
SODIUM BICARBONATE 1 MEQ/ML (8.4 %) IV SOLN,,8752,LOCAL,Facility,Inpatient,50 mL,mL,,57,48.45,16.3362,57,Medica,Medical Assistance,,,,,Included in per diem rate,
SODIUM BICARBONATE 1 MEQ/ML (8.4 %) IV SOLN,,8752,LOCAL,Facility,Outpatient,50 mL,mL,,57,48.45,16.3362,57,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,28.386,49.8,,percent of total billed charges,,
SODIUM BICARBONATE 1 MEQ/ML (8.4 %) IV SOLN,,8752,LOCAL,Facility,Inpatient,50 mL,mL,,57,48.45,16.3362,57,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
SODIUM BICARBONATE 1 MEQ/ML (8.4 %) IV SOLN,,8752,LOCAL,Facility,Both,50 mL,mL,,57,48.45,16.3362,57,"Multiplan, Inc.","Multiplan, Inc.",53.58,94,,percent of total billed charges,,
SODIUM BICARBONATE 1 MEQ/ML (8.4 %) IV SOLN,,8752,LOCAL,Facility,Outpatient,50 mL,mL,,57,48.45,16.3362,57,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,51.357,90.1,,percent of total billed charges,,
SODIUM BICARBONATE 1 MEQ/ML (8.4 %) IV SOLN,,8752,LOCAL,Facility,Inpatient,50 mL,mL,,57,48.45,16.3362,57,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
SODIUM BICARBONATE 1 MEQ/ML (8.4 %) IV SOLN,,8752,LOCAL,Facility,Both,50 mL,mL,,57,48.45,16.3362,57,"Preferred One Administrative Services, INC.",PPO,56.202,98.6,,percent of total billed charges,,
SODIUM BICARBONATE 1 MEQ/ML (8.4 %) IV SOLN,,8752,LOCAL,Facility,Outpatient,50 mL,mL,,57,48.45,16.3362,57,PrimeWest Health,Minnesota Senior Health Options (MSHO),29.3265,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
SODIUM BICARBONATE 1 MEQ/ML (8.4 %) IV SOLN,,8752,LOCAL,Facility,Inpatient,50 mL,mL,,57,48.45,16.3362,57,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SODIUM BICARBONATE 1 MEQ/ML (8.4 %) IV SOLN,,8752,LOCAL,Facility,Outpatient,50 mL,mL,,57,48.45,16.3362,57,PrimeWest Health,MinnesotaCare,29.2752,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
SODIUM BICARBONATE 1 MEQ/ML (8.4 %) IV SOLN,,8752,LOCAL,Facility,Inpatient,50 mL,mL,,57,48.45,16.3362,57,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
SODIUM BICARBONATE 1 MEQ/ML (8.4 %) IV SOLN,,8752,LOCAL,Facility,Both,50 mL,mL,,57,48.45,16.3362,57,Sanford Health Plan,Sanford Health Plan,52.44,92,,percent of total billed charges,,
SODIUM BICARBONATE 1 MEQ/ML (8.4 %) IV SOLN,,8752,LOCAL,Facility,Outpatient,50 mL,mL,,57,48.45,16.3362,57,"UCare Health, Inc.",Individual & Family Plan,32.1195,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
SODIUM BICARBONATE 1 MEQ/ML (8.4 %) IV SOLN,,8752,LOCAL,Facility,Inpatient,50 mL,mL,,57,48.45,16.3362,57,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
SODIUM BICARBONATE 1 MEQ/ML (8.4 %) IV SOLN,,8752,LOCAL,Facility,Outpatient,50 mL,mL,,57,48.45,16.3362,57,"UCare Health, Inc.",Medical Assistance,28.7679,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SODIUM BICARBONATE 1 MEQ/ML (8.4 %) IV SOLN,,8752,LOCAL,Facility,Inpatient,50 mL,mL,,57,48.45,16.3362,57,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
SODIUM BICARBONATE 1 MEQ/ML (8.4 %) IV SOLN,,8752,LOCAL,Facility,Outpatient,50 mL,mL,,57,48.45,16.3362,57,"UCare Health, Inc.",Medicare Advantage,28.7679,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SODIUM BICARBONATE 1 MEQ/ML (8.4 %) IV SOLN,,8752,LOCAL,Facility,Inpatient,50 mL,mL,,57,48.45,16.3362,57,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SODIUM BICARBONATE 1 MEQ/ML (8.4 %) IV SOLN,,8752,LOCAL,Facility,Outpatient,50 mL,mL,,57,48.45,16.3362,57,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),28.7679,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SODIUM BICARBONATE 1 MEQ/ML (8.4 %) IV SOLN,,8752,LOCAL,Facility,Inpatient,50 mL,mL,,57,48.45,16.3362,57,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SODIUM BICARBONATE 1 MEQ/ML (8.4 %) IV SOLN,,8752,LOCAL,Facility,Both,50 mL,mL,,57,48.45,16.3362,57,UnitedHealthcare,Individual & Family,53.58,94,,percent of total billed charges,,
SODIUM BICARBONATE 1 MEQ/ML (8.4 %) IV SOLN,,8752,LOCAL,Facility,Outpatient,50 mL,mL,,57,48.45,16.3362,57,UnitedHealthcare,Medicare Advantage,27.93,49,,percent of total billed charges,,
SODIUM BICARBONATE 1 MEQ/ML (8.4 %) IV SOLN,,8752,LOCAL,Facility,Inpatient,50 mL,mL,,57,48.45,16.3362,57,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
SODIUM BICARBONATE 1 MEQ/ML (8.4 %) IV SOLN,,8752,LOCAL,Facility,Outpatient,50 mL,mL,,57,48.45,16.3362,57,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,27.36,48,,percent of total billed charges,,100% of DHS outpatient percentage
SODIUM BICARBONATE 1 MEQ/ML (8.4 %) IV SOLN,,8752,LOCAL,Facility,Inpatient,50 mL,mL,,57,48.45,16.3362,57,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
AMOXICILLIN-POT CLAVULANATE 400-57 MG/5 ML ORAL SUSR,,8914,LOCAL,Facility,Both,50 mL,mL,,159,135.15,45.5694,159,Aetna,Commercial,146.28,92,,percent of total billed charges,,
AMOXICILLIN-POT CLAVULANATE 400-57 MG/5 ML ORAL SUSR,,8914,LOCAL,Facility,Outpatient,50 mL,mL,,159,135.15,45.5694,159,Aetna,Medicare Advantage,77.91,49,,percent of total billed charges,,
AMOXICILLIN-POT CLAVULANATE 400-57 MG/5 ML ORAL SUSR,,8914,LOCAL,Facility,Inpatient,50 mL,mL,,159,135.15,45.5694,159,Aetna,Medicare Advantage,,,,,Included in per diem rate,
AMOXICILLIN-POT CLAVULANATE 400-57 MG/5 ML ORAL SUSR,,8914,LOCAL,Facility,Both,50 mL,mL,,159,135.15,45.5694,159,Aetna,PPO,147.87,93,,percent of total billed charges,,
AMOXICILLIN-POT CLAVULANATE 400-57 MG/5 ML ORAL SUSR,,8914,LOCAL,Facility,Both,50 mL,mL,,159,135.15,45.5694,159,America's PPO,America's PPO,152.6877,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
AMOXICILLIN-POT CLAVULANATE 400-57 MG/5 ML ORAL SUSR,,8914,LOCAL,Facility,Both,50 mL,mL,,159,135.15,45.5694,159,BlueCross BlueShield Minnesota, Federal Employee Program,156.456,98.4,,percent of total billed charges,,
AMOXICILLIN-POT CLAVULANATE 400-57 MG/5 ML ORAL SUSR,,8914,LOCAL,Facility,Both,50 mL,mL,,159,135.15,45.5694,159,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,159,100,,percent of total billed charges,,
AMOXICILLIN-POT CLAVULANATE 400-57 MG/5 ML ORAL SUSR,,8914,LOCAL,Facility,Both,50 mL,mL,,159,135.15,45.5694,159,BlueCross BlueShield Minnesota,High Value Network Plan,143.1,90,,percent of total billed charges,,
AMOXICILLIN-POT CLAVULANATE 400-57 MG/5 ML ORAL SUSR,,8914,LOCAL,Facility,Outpatient,50 mL,mL,,159,135.15,45.5694,159,BlueCross BlueShield Minnesota,Medicare Advantage,77.91,49,,percent of total billed charges,,
AMOXICILLIN-POT CLAVULANATE 400-57 MG/5 ML ORAL SUSR,,8914,LOCAL,Facility,Inpatient,50 mL,mL,,159,135.15,45.5694,159,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
AMOXICILLIN-POT CLAVULANATE 400-57 MG/5 ML ORAL SUSR,,8914,LOCAL,Facility,Both,50 mL,mL,,159,135.15,45.5694,159,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,140.8263,88.57,,percent of total billed charges,,
AMOXICILLIN-POT CLAVULANATE 400-57 MG/5 ML ORAL SUSR,,8914,LOCAL,Facility,Both,50 mL,mL,,159,135.15,45.5694,159,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,45.5694,28.66,,percent of total billed charges,,
AMOXICILLIN-POT CLAVULANATE 400-57 MG/5 ML ORAL SUSR,,8914,LOCAL,Facility,Outpatient,50 mL,mL,,159,135.15,45.5694,159,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),77.91,49,,percent of total billed charges,,
AMOXICILLIN-POT CLAVULANATE 400-57 MG/5 ML ORAL SUSR,,8914,LOCAL,Facility,Inpatient,50 mL,mL,,159,135.15,45.5694,159,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
AMOXICILLIN-POT CLAVULANATE 400-57 MG/5 ML ORAL SUSR,,8914,LOCAL,Facility,Both,50 mL,mL,,159,135.15,45.5694,159,CorVel,Worker's Compensation,159,100,,percent of total billed charges,,
AMOXICILLIN-POT CLAVULANATE 400-57 MG/5 ML ORAL SUSR,,8914,LOCAL,Facility,Both,50 mL,mL,,159,135.15,45.5694,159,First Health Group Corporation,First Health Network,154.23,97,,percent of total billed charges,,
AMOXICILLIN-POT CLAVULANATE 400-57 MG/5 ML ORAL SUSR,,8914,LOCAL,Facility,Both,50 mL,mL,,159,135.15,45.5694,159,"Health Partners, Inc.",Commercial,150.414,94.6,,percent of total billed charges,,
AMOXICILLIN-POT CLAVULANATE 400-57 MG/5 ML ORAL SUSR,,8914,LOCAL,Facility,Outpatient,50 mL,mL,,159,135.15,45.5694,159,"Health Partners, Inc.",Medicare Advantage,77.91,49,,percent of total billed charges,,
AMOXICILLIN-POT CLAVULANATE 400-57 MG/5 ML ORAL SUSR,,8914,LOCAL,Facility,Inpatient,50 mL,mL,,159,135.15,45.5694,159,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
AMOXICILLIN-POT CLAVULANATE 400-57 MG/5 ML ORAL SUSR,,8914,LOCAL,Facility,Both,50 mL,mL,,159,135.15,45.5694,159,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),95.4,60,,percent of total billed charges,,
AMOXICILLIN-POT CLAVULANATE 400-57 MG/5 ML ORAL SUSR,,8914,LOCAL,Facility,Both,50 mL,mL,,159,135.15,45.5694,159,"Health Partners, Inc.",State of Minnesota Advantage Program,129.585,81.5,,percent of total billed charges,,
AMOXICILLIN-POT CLAVULANATE 400-57 MG/5 ML ORAL SUSR,,8914,LOCAL,Facility,Both,50 mL,mL,,159,135.15,45.5694,159,"Health Partners, Inc.",State Public Programs,79.5,50,,percent of total billed charges,,
AMOXICILLIN-POT CLAVULANATE 400-57 MG/5 ML ORAL SUSR,,8914,LOCAL,Facility,Both,50 mL,mL,,159,135.15,45.5694,159,Humana Insurance Company,Commercial PPO,151.05,95,,percent of total billed charges,,
AMOXICILLIN-POT CLAVULANATE 400-57 MG/5 ML ORAL SUSR,,8914,LOCAL,Facility,Outpatient,50 mL,mL,,159,135.15,45.5694,159,Humana Insurance Company,Medicare PPO,77.91,49,,percent of total billed charges,,
AMOXICILLIN-POT CLAVULANATE 400-57 MG/5 ML ORAL SUSR,,8914,LOCAL,Facility,Inpatient,50 mL,mL,,159,135.15,45.5694,159,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
AMOXICILLIN-POT CLAVULANATE 400-57 MG/5 ML ORAL SUSR,,8914,LOCAL,Facility,Both,50 mL,mL,,159,135.15,45.5694,159,Medica,Individual & Family,157.569,99.1,,percent of total billed charges,,
AMOXICILLIN-POT CLAVULANATE 400-57 MG/5 ML ORAL SUSR,,8914,LOCAL,Facility,Outpatient,50 mL,mL,,159,135.15,45.5694,159,Medica,Medica Advantage Solution,79.182,49.8,,percent of total billed charges,,
AMOXICILLIN-POT CLAVULANATE 400-57 MG/5 ML ORAL SUSR,,8914,LOCAL,Facility,Inpatient,50 mL,mL,,159,135.15,45.5694,159,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
AMOXICILLIN-POT CLAVULANATE 400-57 MG/5 ML ORAL SUSR,,8914,LOCAL,Facility,Outpatient,50 mL,mL,,159,135.15,45.5694,159,Medica,Medical Assistance,70.914,44.6,,percent of total billed charges,,
AMOXICILLIN-POT CLAVULANATE 400-57 MG/5 ML ORAL SUSR,,8914,LOCAL,Facility,Inpatient,50 mL,mL,,159,135.15,45.5694,159,Medica,Medical Assistance,,,,,Included in per diem rate,
AMOXICILLIN-POT CLAVULANATE 400-57 MG/5 ML ORAL SUSR,,8914,LOCAL,Facility,Outpatient,50 mL,mL,,159,135.15,45.5694,159,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,79.182,49.8,,percent of total billed charges,,
AMOXICILLIN-POT CLAVULANATE 400-57 MG/5 ML ORAL SUSR,,8914,LOCAL,Facility,Inpatient,50 mL,mL,,159,135.15,45.5694,159,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
AMOXICILLIN-POT CLAVULANATE 400-57 MG/5 ML ORAL SUSR,,8914,LOCAL,Facility,Both,50 mL,mL,,159,135.15,45.5694,159,"Multiplan, Inc.","Multiplan, Inc.",149.46,94,,percent of total billed charges,,
AMOXICILLIN-POT CLAVULANATE 400-57 MG/5 ML ORAL SUSR,,8914,LOCAL,Facility,Outpatient,50 mL,mL,,159,135.15,45.5694,159,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,143.259,90.1,,percent of total billed charges,,
AMOXICILLIN-POT CLAVULANATE 400-57 MG/5 ML ORAL SUSR,,8914,LOCAL,Facility,Inpatient,50 mL,mL,,159,135.15,45.5694,159,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
AMOXICILLIN-POT CLAVULANATE 400-57 MG/5 ML ORAL SUSR,,8914,LOCAL,Facility,Both,50 mL,mL,,159,135.15,45.5694,159,"Preferred One Administrative Services, INC.",PPO,156.774,98.6,,percent of total billed charges,,
AMOXICILLIN-POT CLAVULANATE 400-57 MG/5 ML ORAL SUSR,,8914,LOCAL,Facility,Outpatient,50 mL,mL,,159,135.15,45.5694,159,PrimeWest Health,Minnesota Senior Health Options (MSHO),81.8055,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
AMOXICILLIN-POT CLAVULANATE 400-57 MG/5 ML ORAL SUSR,,8914,LOCAL,Facility,Inpatient,50 mL,mL,,159,135.15,45.5694,159,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
AMOXICILLIN-POT CLAVULANATE 400-57 MG/5 ML ORAL SUSR,,8914,LOCAL,Facility,Outpatient,50 mL,mL,,159,135.15,45.5694,159,PrimeWest Health,MinnesotaCare,81.6624,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
AMOXICILLIN-POT CLAVULANATE 400-57 MG/5 ML ORAL SUSR,,8914,LOCAL,Facility,Inpatient,50 mL,mL,,159,135.15,45.5694,159,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
AMOXICILLIN-POT CLAVULANATE 400-57 MG/5 ML ORAL SUSR,,8914,LOCAL,Facility,Both,50 mL,mL,,159,135.15,45.5694,159,Sanford Health Plan,Sanford Health Plan,146.28,92,,percent of total billed charges,,
AMOXICILLIN-POT CLAVULANATE 400-57 MG/5 ML ORAL SUSR,,8914,LOCAL,Facility,Outpatient,50 mL,mL,,159,135.15,45.5694,159,"UCare Health, Inc.",Individual & Family Plan,89.5965,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
AMOXICILLIN-POT CLAVULANATE 400-57 MG/5 ML ORAL SUSR,,8914,LOCAL,Facility,Inpatient,50 mL,mL,,159,135.15,45.5694,159,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
AMOXICILLIN-POT CLAVULANATE 400-57 MG/5 ML ORAL SUSR,,8914,LOCAL,Facility,Outpatient,50 mL,mL,,159,135.15,45.5694,159,"UCare Health, Inc.",Medical Assistance,80.2473,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
AMOXICILLIN-POT CLAVULANATE 400-57 MG/5 ML ORAL SUSR,,8914,LOCAL,Facility,Inpatient,50 mL,mL,,159,135.15,45.5694,159,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
AMOXICILLIN-POT CLAVULANATE 400-57 MG/5 ML ORAL SUSR,,8914,LOCAL,Facility,Outpatient,50 mL,mL,,159,135.15,45.5694,159,"UCare Health, Inc.",Medicare Advantage,80.2473,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
AMOXICILLIN-POT CLAVULANATE 400-57 MG/5 ML ORAL SUSR,,8914,LOCAL,Facility,Inpatient,50 mL,mL,,159,135.15,45.5694,159,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
AMOXICILLIN-POT CLAVULANATE 400-57 MG/5 ML ORAL SUSR,,8914,LOCAL,Facility,Outpatient,50 mL,mL,,159,135.15,45.5694,159,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),80.2473,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
AMOXICILLIN-POT CLAVULANATE 400-57 MG/5 ML ORAL SUSR,,8914,LOCAL,Facility,Inpatient,50 mL,mL,,159,135.15,45.5694,159,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
AMOXICILLIN-POT CLAVULANATE 400-57 MG/5 ML ORAL SUSR,,8914,LOCAL,Facility,Both,50 mL,mL,,159,135.15,45.5694,159,UnitedHealthcare,Individual & Family,149.46,94,,percent of total billed charges,,
AMOXICILLIN-POT CLAVULANATE 400-57 MG/5 ML ORAL SUSR,,8914,LOCAL,Facility,Outpatient,50 mL,mL,,159,135.15,45.5694,159,UnitedHealthcare,Medicare Advantage,77.91,49,,percent of total billed charges,,
AMOXICILLIN-POT CLAVULANATE 400-57 MG/5 ML ORAL SUSR,,8914,LOCAL,Facility,Inpatient,50 mL,mL,,159,135.15,45.5694,159,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
AMOXICILLIN-POT CLAVULANATE 400-57 MG/5 ML ORAL SUSR,,8914,LOCAL,Facility,Outpatient,50 mL,mL,,159,135.15,45.5694,159,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,76.32,48,,percent of total billed charges,,100% of DHS outpatient percentage
AMOXICILLIN-POT CLAVULANATE 400-57 MG/5 ML ORAL SUSR,,8914,LOCAL,Facility,Inpatient,50 mL,mL,,159,135.15,45.5694,159,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"LIDOCAINE-EPINEPHRINE 1 %-1:100,000 INJ SOLN",,9559,LOCAL,Facility,Both,50 mL,mL,,24,20.4,6.8784,24,Aetna,Commercial,22.08,92,,percent of total billed charges,,
"LIDOCAINE-EPINEPHRINE 1 %-1:100,000 INJ SOLN",,9559,LOCAL,Facility,Outpatient,50 mL,mL,,24,20.4,6.8784,24,Aetna,Medicare Advantage,11.76,49,,percent of total billed charges,,
"LIDOCAINE-EPINEPHRINE 1 %-1:100,000 INJ SOLN",,9559,LOCAL,Facility,Inpatient,50 mL,mL,,24,20.4,6.8784,24,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"LIDOCAINE-EPINEPHRINE 1 %-1:100,000 INJ SOLN",,9559,LOCAL,Facility,Both,50 mL,mL,,24,20.4,6.8784,24,Aetna,PPO,22.32,93,,percent of total billed charges,,
"LIDOCAINE-EPINEPHRINE 1 %-1:100,000 INJ SOLN",,9559,LOCAL,Facility,Both,50 mL,mL,,24,20.4,6.8784,24,America's PPO,America's PPO,23.0472,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"LIDOCAINE-EPINEPHRINE 1 %-1:100,000 INJ SOLN",,9559,LOCAL,Facility,Both,50 mL,mL,,24,20.4,6.8784,24,BlueCross BlueShield Minnesota, Federal Employee Program,23.616,98.4,,percent of total billed charges,,
"LIDOCAINE-EPINEPHRINE 1 %-1:100,000 INJ SOLN",,9559,LOCAL,Facility,Both,50 mL,mL,,24,20.4,6.8784,24,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,24,100,,percent of total billed charges,,
"LIDOCAINE-EPINEPHRINE 1 %-1:100,000 INJ SOLN",,9559,LOCAL,Facility,Both,50 mL,mL,,24,20.4,6.8784,24,BlueCross BlueShield Minnesota,High Value Network Plan,21.6,90,,percent of total billed charges,,
"LIDOCAINE-EPINEPHRINE 1 %-1:100,000 INJ SOLN",,9559,LOCAL,Facility,Outpatient,50 mL,mL,,24,20.4,6.8784,24,BlueCross BlueShield Minnesota,Medicare Advantage,11.76,49,,percent of total billed charges,,
"LIDOCAINE-EPINEPHRINE 1 %-1:100,000 INJ SOLN",,9559,LOCAL,Facility,Inpatient,50 mL,mL,,24,20.4,6.8784,24,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"LIDOCAINE-EPINEPHRINE 1 %-1:100,000 INJ SOLN",,9559,LOCAL,Facility,Both,50 mL,mL,,24,20.4,6.8784,24,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,21.2568,88.57,,percent of total billed charges,,
"LIDOCAINE-EPINEPHRINE 1 %-1:100,000 INJ SOLN",,9559,LOCAL,Facility,Both,50 mL,mL,,24,20.4,6.8784,24,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,6.8784,28.66,,percent of total billed charges,,
"LIDOCAINE-EPINEPHRINE 1 %-1:100,000 INJ SOLN",,9559,LOCAL,Facility,Outpatient,50 mL,mL,,24,20.4,6.8784,24,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),11.76,49,,percent of total billed charges,,
"LIDOCAINE-EPINEPHRINE 1 %-1:100,000 INJ SOLN",,9559,LOCAL,Facility,Inpatient,50 mL,mL,,24,20.4,6.8784,24,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"LIDOCAINE-EPINEPHRINE 1 %-1:100,000 INJ SOLN",,9559,LOCAL,Facility,Both,50 mL,mL,,24,20.4,6.8784,24,CorVel,Worker's Compensation,24,100,,percent of total billed charges,,
"LIDOCAINE-EPINEPHRINE 1 %-1:100,000 INJ SOLN",,9559,LOCAL,Facility,Both,50 mL,mL,,24,20.4,6.8784,24,First Health Group Corporation,First Health Network,23.28,97,,percent of total billed charges,,
"LIDOCAINE-EPINEPHRINE 1 %-1:100,000 INJ SOLN",,9559,LOCAL,Facility,Both,50 mL,mL,,24,20.4,6.8784,24,"Health Partners, Inc.",Commercial,22.704,94.6,,percent of total billed charges,,
"LIDOCAINE-EPINEPHRINE 1 %-1:100,000 INJ SOLN",,9559,LOCAL,Facility,Outpatient,50 mL,mL,,24,20.4,6.8784,24,"Health Partners, Inc.",Medicare Advantage,11.76,49,,percent of total billed charges,,
"LIDOCAINE-EPINEPHRINE 1 %-1:100,000 INJ SOLN",,9559,LOCAL,Facility,Inpatient,50 mL,mL,,24,20.4,6.8784,24,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"LIDOCAINE-EPINEPHRINE 1 %-1:100,000 INJ SOLN",,9559,LOCAL,Facility,Both,50 mL,mL,,24,20.4,6.8784,24,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),14.4,60,,percent of total billed charges,,
"LIDOCAINE-EPINEPHRINE 1 %-1:100,000 INJ SOLN",,9559,LOCAL,Facility,Both,50 mL,mL,,24,20.4,6.8784,24,"Health Partners, Inc.",State of Minnesota Advantage Program,19.56,81.5,,percent of total billed charges,,
"LIDOCAINE-EPINEPHRINE 1 %-1:100,000 INJ SOLN",,9559,LOCAL,Facility,Both,50 mL,mL,,24,20.4,6.8784,24,"Health Partners, Inc.",State Public Programs,12,50,,percent of total billed charges,,
"LIDOCAINE-EPINEPHRINE 1 %-1:100,000 INJ SOLN",,9559,LOCAL,Facility,Both,50 mL,mL,,24,20.4,6.8784,24,Humana Insurance Company,Commercial PPO,22.8,95,,percent of total billed charges,,
"LIDOCAINE-EPINEPHRINE 1 %-1:100,000 INJ SOLN",,9559,LOCAL,Facility,Outpatient,50 mL,mL,,24,20.4,6.8784,24,Humana Insurance Company,Medicare PPO,11.76,49,,percent of total billed charges,,
"LIDOCAINE-EPINEPHRINE 1 %-1:100,000 INJ SOLN",,9559,LOCAL,Facility,Inpatient,50 mL,mL,,24,20.4,6.8784,24,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"LIDOCAINE-EPINEPHRINE 1 %-1:100,000 INJ SOLN",,9559,LOCAL,Facility,Both,50 mL,mL,,24,20.4,6.8784,24,Medica,Individual & Family,23.784,99.1,,percent of total billed charges,,
"LIDOCAINE-EPINEPHRINE 1 %-1:100,000 INJ SOLN",,9559,LOCAL,Facility,Outpatient,50 mL,mL,,24,20.4,6.8784,24,Medica,Medica Advantage Solution,11.952,49.8,,percent of total billed charges,,
"LIDOCAINE-EPINEPHRINE 1 %-1:100,000 INJ SOLN",,9559,LOCAL,Facility,Inpatient,50 mL,mL,,24,20.4,6.8784,24,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"LIDOCAINE-EPINEPHRINE 1 %-1:100,000 INJ SOLN",,9559,LOCAL,Facility,Outpatient,50 mL,mL,,24,20.4,6.8784,24,Medica,Medical Assistance,10.704,44.6,,percent of total billed charges,,
"LIDOCAINE-EPINEPHRINE 1 %-1:100,000 INJ SOLN",,9559,LOCAL,Facility,Inpatient,50 mL,mL,,24,20.4,6.8784,24,Medica,Medical Assistance,,,,,Included in per diem rate,
"LIDOCAINE-EPINEPHRINE 1 %-1:100,000 INJ SOLN",,9559,LOCAL,Facility,Outpatient,50 mL,mL,,24,20.4,6.8784,24,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,11.952,49.8,,percent of total billed charges,,
"LIDOCAINE-EPINEPHRINE 1 %-1:100,000 INJ SOLN",,9559,LOCAL,Facility,Inpatient,50 mL,mL,,24,20.4,6.8784,24,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"LIDOCAINE-EPINEPHRINE 1 %-1:100,000 INJ SOLN",,9559,LOCAL,Facility,Both,50 mL,mL,,24,20.4,6.8784,24,"Multiplan, Inc.","Multiplan, Inc.",22.56,94,,percent of total billed charges,,
"LIDOCAINE-EPINEPHRINE 1 %-1:100,000 INJ SOLN",,9559,LOCAL,Facility,Outpatient,50 mL,mL,,24,20.4,6.8784,24,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,21.624,90.1,,percent of total billed charges,,
"LIDOCAINE-EPINEPHRINE 1 %-1:100,000 INJ SOLN",,9559,LOCAL,Facility,Inpatient,50 mL,mL,,24,20.4,6.8784,24,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"LIDOCAINE-EPINEPHRINE 1 %-1:100,000 INJ SOLN",,9559,LOCAL,Facility,Both,50 mL,mL,,24,20.4,6.8784,24,"Preferred One Administrative Services, INC.",PPO,23.664,98.6,,percent of total billed charges,,
"LIDOCAINE-EPINEPHRINE 1 %-1:100,000 INJ SOLN",,9559,LOCAL,Facility,Outpatient,50 mL,mL,,24,20.4,6.8784,24,PrimeWest Health,Minnesota Senior Health Options (MSHO),12.348,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"LIDOCAINE-EPINEPHRINE 1 %-1:100,000 INJ SOLN",,9559,LOCAL,Facility,Inpatient,50 mL,mL,,24,20.4,6.8784,24,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"LIDOCAINE-EPINEPHRINE 1 %-1:100,000 INJ SOLN",,9559,LOCAL,Facility,Outpatient,50 mL,mL,,24,20.4,6.8784,24,PrimeWest Health,MinnesotaCare,12.3264,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"LIDOCAINE-EPINEPHRINE 1 %-1:100,000 INJ SOLN",,9559,LOCAL,Facility,Inpatient,50 mL,mL,,24,20.4,6.8784,24,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"LIDOCAINE-EPINEPHRINE 1 %-1:100,000 INJ SOLN",,9559,LOCAL,Facility,Both,50 mL,mL,,24,20.4,6.8784,24,Sanford Health Plan,Sanford Health Plan,22.08,92,,percent of total billed charges,,
"LIDOCAINE-EPINEPHRINE 1 %-1:100,000 INJ SOLN",,9559,LOCAL,Facility,Outpatient,50 mL,mL,,24,20.4,6.8784,24,"UCare Health, Inc.",Individual & Family Plan,13.524,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"LIDOCAINE-EPINEPHRINE 1 %-1:100,000 INJ SOLN",,9559,LOCAL,Facility,Inpatient,50 mL,mL,,24,20.4,6.8784,24,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"LIDOCAINE-EPINEPHRINE 1 %-1:100,000 INJ SOLN",,9559,LOCAL,Facility,Outpatient,50 mL,mL,,24,20.4,6.8784,24,"UCare Health, Inc.",Medical Assistance,12.1128,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"LIDOCAINE-EPINEPHRINE 1 %-1:100,000 INJ SOLN",,9559,LOCAL,Facility,Inpatient,50 mL,mL,,24,20.4,6.8784,24,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"LIDOCAINE-EPINEPHRINE 1 %-1:100,000 INJ SOLN",,9559,LOCAL,Facility,Outpatient,50 mL,mL,,24,20.4,6.8784,24,"UCare Health, Inc.",Medicare Advantage,12.1128,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"LIDOCAINE-EPINEPHRINE 1 %-1:100,000 INJ SOLN",,9559,LOCAL,Facility,Inpatient,50 mL,mL,,24,20.4,6.8784,24,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"LIDOCAINE-EPINEPHRINE 1 %-1:100,000 INJ SOLN",,9559,LOCAL,Facility,Outpatient,50 mL,mL,,24,20.4,6.8784,24,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),12.1128,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"LIDOCAINE-EPINEPHRINE 1 %-1:100,000 INJ SOLN",,9559,LOCAL,Facility,Inpatient,50 mL,mL,,24,20.4,6.8784,24,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"LIDOCAINE-EPINEPHRINE 1 %-1:100,000 INJ SOLN",,9559,LOCAL,Facility,Both,50 mL,mL,,24,20.4,6.8784,24,UnitedHealthcare,Individual & Family,22.56,94,,percent of total billed charges,,
"LIDOCAINE-EPINEPHRINE 1 %-1:100,000 INJ SOLN",,9559,LOCAL,Facility,Outpatient,50 mL,mL,,24,20.4,6.8784,24,UnitedHealthcare,Medicare Advantage,11.76,49,,percent of total billed charges,,
"LIDOCAINE-EPINEPHRINE 1 %-1:100,000 INJ SOLN",,9559,LOCAL,Facility,Inpatient,50 mL,mL,,24,20.4,6.8784,24,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"LIDOCAINE-EPINEPHRINE 1 %-1:100,000 INJ SOLN",,9559,LOCAL,Facility,Outpatient,50 mL,mL,,24,20.4,6.8784,24,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,11.52,48,,percent of total billed charges,,100% of DHS outpatient percentage
"LIDOCAINE-EPINEPHRINE 1 %-1:100,000 INJ SOLN",,9559,LOCAL,Facility,Inpatient,50 mL,mL,,24,20.4,6.8784,24,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
ONDANSETRON HCL 4 MG/5 ML ORAL SOLN,,10288,LOCAL,Facility,Both,50 mL,mL,,936,795.6,268.2576,936,Aetna,Commercial,861.12,92,,percent of total billed charges,,
ONDANSETRON HCL 4 MG/5 ML ORAL SOLN,,10288,LOCAL,Facility,Outpatient,50 mL,mL,,936,795.6,268.2576,936,Aetna,Medicare Advantage,458.64,49,,percent of total billed charges,,
ONDANSETRON HCL 4 MG/5 ML ORAL SOLN,,10288,LOCAL,Facility,Inpatient,50 mL,mL,,936,795.6,268.2576,936,Aetna,Medicare Advantage,,,,,Included in per diem rate,
ONDANSETRON HCL 4 MG/5 ML ORAL SOLN,,10288,LOCAL,Facility,Both,50 mL,mL,,936,795.6,268.2576,936,Aetna,PPO,870.48,93,,percent of total billed charges,,
ONDANSETRON HCL 4 MG/5 ML ORAL SOLN,,10288,LOCAL,Facility,Both,50 mL,mL,,936,795.6,268.2576,936,America's PPO,America's PPO,898.8408,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
ONDANSETRON HCL 4 MG/5 ML ORAL SOLN,,10288,LOCAL,Facility,Both,50 mL,mL,,936,795.6,268.2576,936,BlueCross BlueShield Minnesota, Federal Employee Program,921.024,98.4,,percent of total billed charges,,
ONDANSETRON HCL 4 MG/5 ML ORAL SOLN,,10288,LOCAL,Facility,Both,50 mL,mL,,936,795.6,268.2576,936,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,936,100,,percent of total billed charges,,
ONDANSETRON HCL 4 MG/5 ML ORAL SOLN,,10288,LOCAL,Facility,Both,50 mL,mL,,936,795.6,268.2576,936,BlueCross BlueShield Minnesota,High Value Network Plan,842.4,90,,percent of total billed charges,,
ONDANSETRON HCL 4 MG/5 ML ORAL SOLN,,10288,LOCAL,Facility,Outpatient,50 mL,mL,,936,795.6,268.2576,936,BlueCross BlueShield Minnesota,Medicare Advantage,458.64,49,,percent of total billed charges,,
ONDANSETRON HCL 4 MG/5 ML ORAL SOLN,,10288,LOCAL,Facility,Inpatient,50 mL,mL,,936,795.6,268.2576,936,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
ONDANSETRON HCL 4 MG/5 ML ORAL SOLN,,10288,LOCAL,Facility,Both,50 mL,mL,,936,795.6,268.2576,936,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,829.0152,88.57,,percent of total billed charges,,
ONDANSETRON HCL 4 MG/5 ML ORAL SOLN,,10288,LOCAL,Facility,Both,50 mL,mL,,936,795.6,268.2576,936,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,268.2576,28.66,,percent of total billed charges,,
ONDANSETRON HCL 4 MG/5 ML ORAL SOLN,,10288,LOCAL,Facility,Outpatient,50 mL,mL,,936,795.6,268.2576,936,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),458.64,49,,percent of total billed charges,,
ONDANSETRON HCL 4 MG/5 ML ORAL SOLN,,10288,LOCAL,Facility,Inpatient,50 mL,mL,,936,795.6,268.2576,936,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
ONDANSETRON HCL 4 MG/5 ML ORAL SOLN,,10288,LOCAL,Facility,Both,50 mL,mL,,936,795.6,268.2576,936,CorVel,Worker's Compensation,936,100,,percent of total billed charges,,
ONDANSETRON HCL 4 MG/5 ML ORAL SOLN,,10288,LOCAL,Facility,Both,50 mL,mL,,936,795.6,268.2576,936,First Health Group Corporation,First Health Network,907.92,97,,percent of total billed charges,,
ONDANSETRON HCL 4 MG/5 ML ORAL SOLN,,10288,LOCAL,Facility,Both,50 mL,mL,,936,795.6,268.2576,936,"Health Partners, Inc.",Commercial,885.456,94.6,,percent of total billed charges,,
ONDANSETRON HCL 4 MG/5 ML ORAL SOLN,,10288,LOCAL,Facility,Outpatient,50 mL,mL,,936,795.6,268.2576,936,"Health Partners, Inc.",Medicare Advantage,458.64,49,,percent of total billed charges,,
ONDANSETRON HCL 4 MG/5 ML ORAL SOLN,,10288,LOCAL,Facility,Inpatient,50 mL,mL,,936,795.6,268.2576,936,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ONDANSETRON HCL 4 MG/5 ML ORAL SOLN,,10288,LOCAL,Facility,Both,50 mL,mL,,936,795.6,268.2576,936,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),561.6,60,,percent of total billed charges,,
ONDANSETRON HCL 4 MG/5 ML ORAL SOLN,,10288,LOCAL,Facility,Both,50 mL,mL,,936,795.6,268.2576,936,"Health Partners, Inc.",State of Minnesota Advantage Program,762.84,81.5,,percent of total billed charges,,
ONDANSETRON HCL 4 MG/5 ML ORAL SOLN,,10288,LOCAL,Facility,Both,50 mL,mL,,936,795.6,268.2576,936,"Health Partners, Inc.",State Public Programs,468,50,,percent of total billed charges,,
ONDANSETRON HCL 4 MG/5 ML ORAL SOLN,,10288,LOCAL,Facility,Both,50 mL,mL,,936,795.6,268.2576,936,Humana Insurance Company,Commercial PPO,889.2,95,,percent of total billed charges,,
ONDANSETRON HCL 4 MG/5 ML ORAL SOLN,,10288,LOCAL,Facility,Outpatient,50 mL,mL,,936,795.6,268.2576,936,Humana Insurance Company,Medicare PPO,458.64,49,,percent of total billed charges,,
ONDANSETRON HCL 4 MG/5 ML ORAL SOLN,,10288,LOCAL,Facility,Inpatient,50 mL,mL,,936,795.6,268.2576,936,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
ONDANSETRON HCL 4 MG/5 ML ORAL SOLN,,10288,LOCAL,Facility,Both,50 mL,mL,,936,795.6,268.2576,936,Medica,Individual & Family,927.576,99.1,,percent of total billed charges,,
ONDANSETRON HCL 4 MG/5 ML ORAL SOLN,,10288,LOCAL,Facility,Outpatient,50 mL,mL,,936,795.6,268.2576,936,Medica,Medica Advantage Solution,466.128,49.8,,percent of total billed charges,,
ONDANSETRON HCL 4 MG/5 ML ORAL SOLN,,10288,LOCAL,Facility,Inpatient,50 mL,mL,,936,795.6,268.2576,936,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
ONDANSETRON HCL 4 MG/5 ML ORAL SOLN,,10288,LOCAL,Facility,Outpatient,50 mL,mL,,936,795.6,268.2576,936,Medica,Medical Assistance,417.456,44.6,,percent of total billed charges,,
ONDANSETRON HCL 4 MG/5 ML ORAL SOLN,,10288,LOCAL,Facility,Inpatient,50 mL,mL,,936,795.6,268.2576,936,Medica,Medical Assistance,,,,,Included in per diem rate,
ONDANSETRON HCL 4 MG/5 ML ORAL SOLN,,10288,LOCAL,Facility,Outpatient,50 mL,mL,,936,795.6,268.2576,936,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,466.128,49.8,,percent of total billed charges,,
ONDANSETRON HCL 4 MG/5 ML ORAL SOLN,,10288,LOCAL,Facility,Inpatient,50 mL,mL,,936,795.6,268.2576,936,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
ONDANSETRON HCL 4 MG/5 ML ORAL SOLN,,10288,LOCAL,Facility,Both,50 mL,mL,,936,795.6,268.2576,936,"Multiplan, Inc.","Multiplan, Inc.",879.84,94,,percent of total billed charges,,
ONDANSETRON HCL 4 MG/5 ML ORAL SOLN,,10288,LOCAL,Facility,Outpatient,50 mL,mL,,936,795.6,268.2576,936,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,843.336,90.1,,percent of total billed charges,,
ONDANSETRON HCL 4 MG/5 ML ORAL SOLN,,10288,LOCAL,Facility,Inpatient,50 mL,mL,,936,795.6,268.2576,936,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
ONDANSETRON HCL 4 MG/5 ML ORAL SOLN,,10288,LOCAL,Facility,Both,50 mL,mL,,936,795.6,268.2576,936,"Preferred One Administrative Services, INC.",PPO,922.896,98.6,,percent of total billed charges,,
ONDANSETRON HCL 4 MG/5 ML ORAL SOLN,,10288,LOCAL,Facility,Outpatient,50 mL,mL,,936,795.6,268.2576,936,PrimeWest Health,Minnesota Senior Health Options (MSHO),481.572,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
ONDANSETRON HCL 4 MG/5 ML ORAL SOLN,,10288,LOCAL,Facility,Inpatient,50 mL,mL,,936,795.6,268.2576,936,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ONDANSETRON HCL 4 MG/5 ML ORAL SOLN,,10288,LOCAL,Facility,Outpatient,50 mL,mL,,936,795.6,268.2576,936,PrimeWest Health,MinnesotaCare,480.7296,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
ONDANSETRON HCL 4 MG/5 ML ORAL SOLN,,10288,LOCAL,Facility,Inpatient,50 mL,mL,,936,795.6,268.2576,936,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
ONDANSETRON HCL 4 MG/5 ML ORAL SOLN,,10288,LOCAL,Facility,Both,50 mL,mL,,936,795.6,268.2576,936,Sanford Health Plan,Sanford Health Plan,861.12,92,,percent of total billed charges,,
ONDANSETRON HCL 4 MG/5 ML ORAL SOLN,,10288,LOCAL,Facility,Outpatient,50 mL,mL,,936,795.6,268.2576,936,"UCare Health, Inc.",Individual & Family Plan,527.436,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
ONDANSETRON HCL 4 MG/5 ML ORAL SOLN,,10288,LOCAL,Facility,Inpatient,50 mL,mL,,936,795.6,268.2576,936,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
ONDANSETRON HCL 4 MG/5 ML ORAL SOLN,,10288,LOCAL,Facility,Outpatient,50 mL,mL,,936,795.6,268.2576,936,"UCare Health, Inc.",Medical Assistance,472.3992,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ONDANSETRON HCL 4 MG/5 ML ORAL SOLN,,10288,LOCAL,Facility,Inpatient,50 mL,mL,,936,795.6,268.2576,936,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
ONDANSETRON HCL 4 MG/5 ML ORAL SOLN,,10288,LOCAL,Facility,Outpatient,50 mL,mL,,936,795.6,268.2576,936,"UCare Health, Inc.",Medicare Advantage,472.3992,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ONDANSETRON HCL 4 MG/5 ML ORAL SOLN,,10288,LOCAL,Facility,Inpatient,50 mL,mL,,936,795.6,268.2576,936,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ONDANSETRON HCL 4 MG/5 ML ORAL SOLN,,10288,LOCAL,Facility,Outpatient,50 mL,mL,,936,795.6,268.2576,936,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),472.3992,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ONDANSETRON HCL 4 MG/5 ML ORAL SOLN,,10288,LOCAL,Facility,Inpatient,50 mL,mL,,936,795.6,268.2576,936,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ONDANSETRON HCL 4 MG/5 ML ORAL SOLN,,10288,LOCAL,Facility,Both,50 mL,mL,,936,795.6,268.2576,936,UnitedHealthcare,Individual & Family,879.84,94,,percent of total billed charges,,
ONDANSETRON HCL 4 MG/5 ML ORAL SOLN,,10288,LOCAL,Facility,Outpatient,50 mL,mL,,936,795.6,268.2576,936,UnitedHealthcare,Medicare Advantage,458.64,49,,percent of total billed charges,,
ONDANSETRON HCL 4 MG/5 ML ORAL SOLN,,10288,LOCAL,Facility,Inpatient,50 mL,mL,,936,795.6,268.2576,936,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
ONDANSETRON HCL 4 MG/5 ML ORAL SOLN,,10288,LOCAL,Facility,Outpatient,50 mL,mL,,936,795.6,268.2576,936,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,449.28,48,,percent of total billed charges,,100% of DHS outpatient percentage
ONDANSETRON HCL 4 MG/5 ML ORAL SOLN,,10288,LOCAL,Facility,Inpatient,50 mL,mL,,936,795.6,268.2576,936,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
LIDOCAINE HCL 4 % (40 MG/ML) MM SOLN,,10710,LOCAL,Facility,Both,50 mL,mL,,272,231.2,77.9552,272,Aetna,Commercial,250.24,92,,percent of total billed charges,,
LIDOCAINE HCL 4 % (40 MG/ML) MM SOLN,,10710,LOCAL,Facility,Outpatient,50 mL,mL,,272,231.2,77.9552,272,Aetna,Medicare Advantage,133.28,49,,percent of total billed charges,,
LIDOCAINE HCL 4 % (40 MG/ML) MM SOLN,,10710,LOCAL,Facility,Inpatient,50 mL,mL,,272,231.2,77.9552,272,Aetna,Medicare Advantage,,,,,Included in per diem rate,
LIDOCAINE HCL 4 % (40 MG/ML) MM SOLN,,10710,LOCAL,Facility,Both,50 mL,mL,,272,231.2,77.9552,272,Aetna,PPO,252.96,93,,percent of total billed charges,,
LIDOCAINE HCL 4 % (40 MG/ML) MM SOLN,,10710,LOCAL,Facility,Both,50 mL,mL,,272,231.2,77.9552,272,America's PPO,America's PPO,261.2016,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
LIDOCAINE HCL 4 % (40 MG/ML) MM SOLN,,10710,LOCAL,Facility,Both,50 mL,mL,,272,231.2,77.9552,272,BlueCross BlueShield Minnesota, Federal Employee Program,267.648,98.4,,percent of total billed charges,,
LIDOCAINE HCL 4 % (40 MG/ML) MM SOLN,,10710,LOCAL,Facility,Both,50 mL,mL,,272,231.2,77.9552,272,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,272,100,,percent of total billed charges,,
LIDOCAINE HCL 4 % (40 MG/ML) MM SOLN,,10710,LOCAL,Facility,Both,50 mL,mL,,272,231.2,77.9552,272,BlueCross BlueShield Minnesota,High Value Network Plan,244.8,90,,percent of total billed charges,,
LIDOCAINE HCL 4 % (40 MG/ML) MM SOLN,,10710,LOCAL,Facility,Outpatient,50 mL,mL,,272,231.2,77.9552,272,BlueCross BlueShield Minnesota,Medicare Advantage,133.28,49,,percent of total billed charges,,
LIDOCAINE HCL 4 % (40 MG/ML) MM SOLN,,10710,LOCAL,Facility,Inpatient,50 mL,mL,,272,231.2,77.9552,272,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
LIDOCAINE HCL 4 % (40 MG/ML) MM SOLN,,10710,LOCAL,Facility,Both,50 mL,mL,,272,231.2,77.9552,272,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,240.9104,88.57,,percent of total billed charges,,
LIDOCAINE HCL 4 % (40 MG/ML) MM SOLN,,10710,LOCAL,Facility,Both,50 mL,mL,,272,231.2,77.9552,272,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,77.9552,28.66,,percent of total billed charges,,
LIDOCAINE HCL 4 % (40 MG/ML) MM SOLN,,10710,LOCAL,Facility,Outpatient,50 mL,mL,,272,231.2,77.9552,272,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),133.28,49,,percent of total billed charges,,
LIDOCAINE HCL 4 % (40 MG/ML) MM SOLN,,10710,LOCAL,Facility,Inpatient,50 mL,mL,,272,231.2,77.9552,272,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
LIDOCAINE HCL 4 % (40 MG/ML) MM SOLN,,10710,LOCAL,Facility,Both,50 mL,mL,,272,231.2,77.9552,272,CorVel,Worker's Compensation,272,100,,percent of total billed charges,,
LIDOCAINE HCL 4 % (40 MG/ML) MM SOLN,,10710,LOCAL,Facility,Both,50 mL,mL,,272,231.2,77.9552,272,First Health Group Corporation,First Health Network,263.84,97,,percent of total billed charges,,
LIDOCAINE HCL 4 % (40 MG/ML) MM SOLN,,10710,LOCAL,Facility,Both,50 mL,mL,,272,231.2,77.9552,272,"Health Partners, Inc.",Commercial,257.312,94.6,,percent of total billed charges,,
LIDOCAINE HCL 4 % (40 MG/ML) MM SOLN,,10710,LOCAL,Facility,Outpatient,50 mL,mL,,272,231.2,77.9552,272,"Health Partners, Inc.",Medicare Advantage,133.28,49,,percent of total billed charges,,
LIDOCAINE HCL 4 % (40 MG/ML) MM SOLN,,10710,LOCAL,Facility,Inpatient,50 mL,mL,,272,231.2,77.9552,272,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LIDOCAINE HCL 4 % (40 MG/ML) MM SOLN,,10710,LOCAL,Facility,Both,50 mL,mL,,272,231.2,77.9552,272,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),163.2,60,,percent of total billed charges,,
LIDOCAINE HCL 4 % (40 MG/ML) MM SOLN,,10710,LOCAL,Facility,Both,50 mL,mL,,272,231.2,77.9552,272,"Health Partners, Inc.",State of Minnesota Advantage Program,221.68,81.5,,percent of total billed charges,,
LIDOCAINE HCL 4 % (40 MG/ML) MM SOLN,,10710,LOCAL,Facility,Both,50 mL,mL,,272,231.2,77.9552,272,"Health Partners, Inc.",State Public Programs,136,50,,percent of total billed charges,,
LIDOCAINE HCL 4 % (40 MG/ML) MM SOLN,,10710,LOCAL,Facility,Both,50 mL,mL,,272,231.2,77.9552,272,Humana Insurance Company,Commercial PPO,258.4,95,,percent of total billed charges,,
LIDOCAINE HCL 4 % (40 MG/ML) MM SOLN,,10710,LOCAL,Facility,Outpatient,50 mL,mL,,272,231.2,77.9552,272,Humana Insurance Company,Medicare PPO,133.28,49,,percent of total billed charges,,
LIDOCAINE HCL 4 % (40 MG/ML) MM SOLN,,10710,LOCAL,Facility,Inpatient,50 mL,mL,,272,231.2,77.9552,272,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
LIDOCAINE HCL 4 % (40 MG/ML) MM SOLN,,10710,LOCAL,Facility,Both,50 mL,mL,,272,231.2,77.9552,272,Medica,Individual & Family,269.552,99.1,,percent of total billed charges,,
LIDOCAINE HCL 4 % (40 MG/ML) MM SOLN,,10710,LOCAL,Facility,Outpatient,50 mL,mL,,272,231.2,77.9552,272,Medica,Medica Advantage Solution,135.456,49.8,,percent of total billed charges,,
LIDOCAINE HCL 4 % (40 MG/ML) MM SOLN,,10710,LOCAL,Facility,Inpatient,50 mL,mL,,272,231.2,77.9552,272,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
LIDOCAINE HCL 4 % (40 MG/ML) MM SOLN,,10710,LOCAL,Facility,Outpatient,50 mL,mL,,272,231.2,77.9552,272,Medica,Medical Assistance,121.312,44.6,,percent of total billed charges,,
LIDOCAINE HCL 4 % (40 MG/ML) MM SOLN,,10710,LOCAL,Facility,Inpatient,50 mL,mL,,272,231.2,77.9552,272,Medica,Medical Assistance,,,,,Included in per diem rate,
LIDOCAINE HCL 4 % (40 MG/ML) MM SOLN,,10710,LOCAL,Facility,Outpatient,50 mL,mL,,272,231.2,77.9552,272,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,135.456,49.8,,percent of total billed charges,,
LIDOCAINE HCL 4 % (40 MG/ML) MM SOLN,,10710,LOCAL,Facility,Inpatient,50 mL,mL,,272,231.2,77.9552,272,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
LIDOCAINE HCL 4 % (40 MG/ML) MM SOLN,,10710,LOCAL,Facility,Both,50 mL,mL,,272,231.2,77.9552,272,"Multiplan, Inc.","Multiplan, Inc.",255.68,94,,percent of total billed charges,,
LIDOCAINE HCL 4 % (40 MG/ML) MM SOLN,,10710,LOCAL,Facility,Outpatient,50 mL,mL,,272,231.2,77.9552,272,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,245.072,90.1,,percent of total billed charges,,
LIDOCAINE HCL 4 % (40 MG/ML) MM SOLN,,10710,LOCAL,Facility,Inpatient,50 mL,mL,,272,231.2,77.9552,272,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
LIDOCAINE HCL 4 % (40 MG/ML) MM SOLN,,10710,LOCAL,Facility,Both,50 mL,mL,,272,231.2,77.9552,272,"Preferred One Administrative Services, INC.",PPO,268.192,98.6,,percent of total billed charges,,
LIDOCAINE HCL 4 % (40 MG/ML) MM SOLN,,10710,LOCAL,Facility,Outpatient,50 mL,mL,,272,231.2,77.9552,272,PrimeWest Health,Minnesota Senior Health Options (MSHO),139.944,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
LIDOCAINE HCL 4 % (40 MG/ML) MM SOLN,,10710,LOCAL,Facility,Inpatient,50 mL,mL,,272,231.2,77.9552,272,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LIDOCAINE HCL 4 % (40 MG/ML) MM SOLN,,10710,LOCAL,Facility,Outpatient,50 mL,mL,,272,231.2,77.9552,272,PrimeWest Health,MinnesotaCare,139.6992,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
LIDOCAINE HCL 4 % (40 MG/ML) MM SOLN,,10710,LOCAL,Facility,Inpatient,50 mL,mL,,272,231.2,77.9552,272,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
LIDOCAINE HCL 4 % (40 MG/ML) MM SOLN,,10710,LOCAL,Facility,Both,50 mL,mL,,272,231.2,77.9552,272,Sanford Health Plan,Sanford Health Plan,250.24,92,,percent of total billed charges,,
LIDOCAINE HCL 4 % (40 MG/ML) MM SOLN,,10710,LOCAL,Facility,Outpatient,50 mL,mL,,272,231.2,77.9552,272,"UCare Health, Inc.",Individual & Family Plan,153.272,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
LIDOCAINE HCL 4 % (40 MG/ML) MM SOLN,,10710,LOCAL,Facility,Inpatient,50 mL,mL,,272,231.2,77.9552,272,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
LIDOCAINE HCL 4 % (40 MG/ML) MM SOLN,,10710,LOCAL,Facility,Outpatient,50 mL,mL,,272,231.2,77.9552,272,"UCare Health, Inc.",Medical Assistance,137.2784,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LIDOCAINE HCL 4 % (40 MG/ML) MM SOLN,,10710,LOCAL,Facility,Inpatient,50 mL,mL,,272,231.2,77.9552,272,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
LIDOCAINE HCL 4 % (40 MG/ML) MM SOLN,,10710,LOCAL,Facility,Outpatient,50 mL,mL,,272,231.2,77.9552,272,"UCare Health, Inc.",Medicare Advantage,137.2784,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LIDOCAINE HCL 4 % (40 MG/ML) MM SOLN,,10710,LOCAL,Facility,Inpatient,50 mL,mL,,272,231.2,77.9552,272,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LIDOCAINE HCL 4 % (40 MG/ML) MM SOLN,,10710,LOCAL,Facility,Outpatient,50 mL,mL,,272,231.2,77.9552,272,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),137.2784,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LIDOCAINE HCL 4 % (40 MG/ML) MM SOLN,,10710,LOCAL,Facility,Inpatient,50 mL,mL,,272,231.2,77.9552,272,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LIDOCAINE HCL 4 % (40 MG/ML) MM SOLN,,10710,LOCAL,Facility,Both,50 mL,mL,,272,231.2,77.9552,272,UnitedHealthcare,Individual & Family,255.68,94,,percent of total billed charges,,
LIDOCAINE HCL 4 % (40 MG/ML) MM SOLN,,10710,LOCAL,Facility,Outpatient,50 mL,mL,,272,231.2,77.9552,272,UnitedHealthcare,Medicare Advantage,133.28,49,,percent of total billed charges,,
LIDOCAINE HCL 4 % (40 MG/ML) MM SOLN,,10710,LOCAL,Facility,Inpatient,50 mL,mL,,272,231.2,77.9552,272,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
LIDOCAINE HCL 4 % (40 MG/ML) MM SOLN,,10710,LOCAL,Facility,Outpatient,50 mL,mL,,272,231.2,77.9552,272,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,130.56,48,,percent of total billed charges,,100% of DHS outpatient percentage
LIDOCAINE HCL 4 % (40 MG/ML) MM SOLN,,10710,LOCAL,Facility,Inpatient,50 mL,mL,,272,231.2,77.9552,272,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
DEXTROSE 50 % IN WATER (D50W) IV SYRG,,25171,LOCAL,Facility,Both,50 mL,mL,,91,77.35,26.0806,91,Aetna,Commercial,83.72,92,,percent of total billed charges,,
DEXTROSE 50 % IN WATER (D50W) IV SYRG,,25171,LOCAL,Facility,Outpatient,50 mL,mL,,91,77.35,26.0806,91,Aetna,Medicare Advantage,44.59,49,,percent of total billed charges,,
DEXTROSE 50 % IN WATER (D50W) IV SYRG,,25171,LOCAL,Facility,Inpatient,50 mL,mL,,91,77.35,26.0806,91,Aetna,Medicare Advantage,,,,,Included in per diem rate,
DEXTROSE 50 % IN WATER (D50W) IV SYRG,,25171,LOCAL,Facility,Both,50 mL,mL,,91,77.35,26.0806,91,Aetna,PPO,84.63,93,,percent of total billed charges,,
DEXTROSE 50 % IN WATER (D50W) IV SYRG,,25171,LOCAL,Facility,Both,50 mL,mL,,91,77.35,26.0806,91,America's PPO,America's PPO,87.3873,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
DEXTROSE 50 % IN WATER (D50W) IV SYRG,,25171,LOCAL,Facility,Both,50 mL,mL,,91,77.35,26.0806,91,BlueCross BlueShield Minnesota, Federal Employee Program,89.544,98.4,,percent of total billed charges,,
DEXTROSE 50 % IN WATER (D50W) IV SYRG,,25171,LOCAL,Facility,Both,50 mL,mL,,91,77.35,26.0806,91,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,91,100,,percent of total billed charges,,
DEXTROSE 50 % IN WATER (D50W) IV SYRG,,25171,LOCAL,Facility,Both,50 mL,mL,,91,77.35,26.0806,91,BlueCross BlueShield Minnesota,High Value Network Plan,81.9,90,,percent of total billed charges,,
DEXTROSE 50 % IN WATER (D50W) IV SYRG,,25171,LOCAL,Facility,Outpatient,50 mL,mL,,91,77.35,26.0806,91,BlueCross BlueShield Minnesota,Medicare Advantage,44.59,49,,percent of total billed charges,,
DEXTROSE 50 % IN WATER (D50W) IV SYRG,,25171,LOCAL,Facility,Inpatient,50 mL,mL,,91,77.35,26.0806,91,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
DEXTROSE 50 % IN WATER (D50W) IV SYRG,,25171,LOCAL,Facility,Both,50 mL,mL,,91,77.35,26.0806,91,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,80.5987,88.57,,percent of total billed charges,,
DEXTROSE 50 % IN WATER (D50W) IV SYRG,,25171,LOCAL,Facility,Both,50 mL,mL,,91,77.35,26.0806,91,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,26.0806,28.66,,percent of total billed charges,,
DEXTROSE 50 % IN WATER (D50W) IV SYRG,,25171,LOCAL,Facility,Outpatient,50 mL,mL,,91,77.35,26.0806,91,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),44.59,49,,percent of total billed charges,,
DEXTROSE 50 % IN WATER (D50W) IV SYRG,,25171,LOCAL,Facility,Inpatient,50 mL,mL,,91,77.35,26.0806,91,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
DEXTROSE 50 % IN WATER (D50W) IV SYRG,,25171,LOCAL,Facility,Both,50 mL,mL,,91,77.35,26.0806,91,CorVel,Worker's Compensation,91,100,,percent of total billed charges,,
DEXTROSE 50 % IN WATER (D50W) IV SYRG,,25171,LOCAL,Facility,Both,50 mL,mL,,91,77.35,26.0806,91,First Health Group Corporation,First Health Network,88.27,97,,percent of total billed charges,,
DEXTROSE 50 % IN WATER (D50W) IV SYRG,,25171,LOCAL,Facility,Both,50 mL,mL,,91,77.35,26.0806,91,"Health Partners, Inc.",Commercial,86.086,94.6,,percent of total billed charges,,
DEXTROSE 50 % IN WATER (D50W) IV SYRG,,25171,LOCAL,Facility,Outpatient,50 mL,mL,,91,77.35,26.0806,91,"Health Partners, Inc.",Medicare Advantage,44.59,49,,percent of total billed charges,,
DEXTROSE 50 % IN WATER (D50W) IV SYRG,,25171,LOCAL,Facility,Inpatient,50 mL,mL,,91,77.35,26.0806,91,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DEXTROSE 50 % IN WATER (D50W) IV SYRG,,25171,LOCAL,Facility,Both,50 mL,mL,,91,77.35,26.0806,91,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),54.6,60,,percent of total billed charges,,
DEXTROSE 50 % IN WATER (D50W) IV SYRG,,25171,LOCAL,Facility,Both,50 mL,mL,,91,77.35,26.0806,91,"Health Partners, Inc.",State of Minnesota Advantage Program,74.165,81.5,,percent of total billed charges,,
DEXTROSE 50 % IN WATER (D50W) IV SYRG,,25171,LOCAL,Facility,Both,50 mL,mL,,91,77.35,26.0806,91,"Health Partners, Inc.",State Public Programs,45.5,50,,percent of total billed charges,,
DEXTROSE 50 % IN WATER (D50W) IV SYRG,,25171,LOCAL,Facility,Both,50 mL,mL,,91,77.35,26.0806,91,Humana Insurance Company,Commercial PPO,86.45,95,,percent of total billed charges,,
DEXTROSE 50 % IN WATER (D50W) IV SYRG,,25171,LOCAL,Facility,Outpatient,50 mL,mL,,91,77.35,26.0806,91,Humana Insurance Company,Medicare PPO,44.59,49,,percent of total billed charges,,
DEXTROSE 50 % IN WATER (D50W) IV SYRG,,25171,LOCAL,Facility,Inpatient,50 mL,mL,,91,77.35,26.0806,91,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
DEXTROSE 50 % IN WATER (D50W) IV SYRG,,25171,LOCAL,Facility,Both,50 mL,mL,,91,77.35,26.0806,91,Medica,Individual & Family,90.181,99.1,,percent of total billed charges,,
DEXTROSE 50 % IN WATER (D50W) IV SYRG,,25171,LOCAL,Facility,Outpatient,50 mL,mL,,91,77.35,26.0806,91,Medica,Medica Advantage Solution,45.318,49.8,,percent of total billed charges,,
DEXTROSE 50 % IN WATER (D50W) IV SYRG,,25171,LOCAL,Facility,Inpatient,50 mL,mL,,91,77.35,26.0806,91,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
DEXTROSE 50 % IN WATER (D50W) IV SYRG,,25171,LOCAL,Facility,Outpatient,50 mL,mL,,91,77.35,26.0806,91,Medica,Medical Assistance,40.586,44.6,,percent of total billed charges,,
DEXTROSE 50 % IN WATER (D50W) IV SYRG,,25171,LOCAL,Facility,Inpatient,50 mL,mL,,91,77.35,26.0806,91,Medica,Medical Assistance,,,,,Included in per diem rate,
DEXTROSE 50 % IN WATER (D50W) IV SYRG,,25171,LOCAL,Facility,Outpatient,50 mL,mL,,91,77.35,26.0806,91,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,45.318,49.8,,percent of total billed charges,,
DEXTROSE 50 % IN WATER (D50W) IV SYRG,,25171,LOCAL,Facility,Inpatient,50 mL,mL,,91,77.35,26.0806,91,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
DEXTROSE 50 % IN WATER (D50W) IV SYRG,,25171,LOCAL,Facility,Both,50 mL,mL,,91,77.35,26.0806,91,"Multiplan, Inc.","Multiplan, Inc.",85.54,94,,percent of total billed charges,,
DEXTROSE 50 % IN WATER (D50W) IV SYRG,,25171,LOCAL,Facility,Outpatient,50 mL,mL,,91,77.35,26.0806,91,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,81.991,90.1,,percent of total billed charges,,
DEXTROSE 50 % IN WATER (D50W) IV SYRG,,25171,LOCAL,Facility,Inpatient,50 mL,mL,,91,77.35,26.0806,91,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
DEXTROSE 50 % IN WATER (D50W) IV SYRG,,25171,LOCAL,Facility,Both,50 mL,mL,,91,77.35,26.0806,91,"Preferred One Administrative Services, INC.",PPO,89.726,98.6,,percent of total billed charges,,
DEXTROSE 50 % IN WATER (D50W) IV SYRG,,25171,LOCAL,Facility,Outpatient,50 mL,mL,,91,77.35,26.0806,91,PrimeWest Health,Minnesota Senior Health Options (MSHO),46.8195,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
DEXTROSE 50 % IN WATER (D50W) IV SYRG,,25171,LOCAL,Facility,Inpatient,50 mL,mL,,91,77.35,26.0806,91,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DEXTROSE 50 % IN WATER (D50W) IV SYRG,,25171,LOCAL,Facility,Outpatient,50 mL,mL,,91,77.35,26.0806,91,PrimeWest Health,MinnesotaCare,46.7376,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
DEXTROSE 50 % IN WATER (D50W) IV SYRG,,25171,LOCAL,Facility,Inpatient,50 mL,mL,,91,77.35,26.0806,91,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
DEXTROSE 50 % IN WATER (D50W) IV SYRG,,25171,LOCAL,Facility,Both,50 mL,mL,,91,77.35,26.0806,91,Sanford Health Plan,Sanford Health Plan,83.72,92,,percent of total billed charges,,
DEXTROSE 50 % IN WATER (D50W) IV SYRG,,25171,LOCAL,Facility,Outpatient,50 mL,mL,,91,77.35,26.0806,91,"UCare Health, Inc.",Individual & Family Plan,51.2785,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
DEXTROSE 50 % IN WATER (D50W) IV SYRG,,25171,LOCAL,Facility,Inpatient,50 mL,mL,,91,77.35,26.0806,91,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
DEXTROSE 50 % IN WATER (D50W) IV SYRG,,25171,LOCAL,Facility,Outpatient,50 mL,mL,,91,77.35,26.0806,91,"UCare Health, Inc.",Medical Assistance,45.9277,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DEXTROSE 50 % IN WATER (D50W) IV SYRG,,25171,LOCAL,Facility,Inpatient,50 mL,mL,,91,77.35,26.0806,91,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
DEXTROSE 50 % IN WATER (D50W) IV SYRG,,25171,LOCAL,Facility,Outpatient,50 mL,mL,,91,77.35,26.0806,91,"UCare Health, Inc.",Medicare Advantage,45.9277,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DEXTROSE 50 % IN WATER (D50W) IV SYRG,,25171,LOCAL,Facility,Inpatient,50 mL,mL,,91,77.35,26.0806,91,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DEXTROSE 50 % IN WATER (D50W) IV SYRG,,25171,LOCAL,Facility,Outpatient,50 mL,mL,,91,77.35,26.0806,91,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),45.9277,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DEXTROSE 50 % IN WATER (D50W) IV SYRG,,25171,LOCAL,Facility,Inpatient,50 mL,mL,,91,77.35,26.0806,91,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DEXTROSE 50 % IN WATER (D50W) IV SYRG,,25171,LOCAL,Facility,Both,50 mL,mL,,91,77.35,26.0806,91,UnitedHealthcare,Individual & Family,85.54,94,,percent of total billed charges,,
DEXTROSE 50 % IN WATER (D50W) IV SYRG,,25171,LOCAL,Facility,Outpatient,50 mL,mL,,91,77.35,26.0806,91,UnitedHealthcare,Medicare Advantage,44.59,49,,percent of total billed charges,,
DEXTROSE 50 % IN WATER (D50W) IV SYRG,,25171,LOCAL,Facility,Inpatient,50 mL,mL,,91,77.35,26.0806,91,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
DEXTROSE 50 % IN WATER (D50W) IV SYRG,,25171,LOCAL,Facility,Outpatient,50 mL,mL,,91,77.35,26.0806,91,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,43.68,48,,percent of total billed charges,,100% of DHS outpatient percentage
DEXTROSE 50 % IN WATER (D50W) IV SYRG,,25171,LOCAL,Facility,Inpatient,50 mL,mL,,91,77.35,26.0806,91,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
SODIUM BICARBONATE 8.4 % (1 MEQ/ML) IV SYRG,,25452,LOCAL,Facility,Both,50 mL,mL,,92,78.2,26.3672,92,Aetna,Commercial,84.64,92,,percent of total billed charges,,
SODIUM BICARBONATE 8.4 % (1 MEQ/ML) IV SYRG,,25452,LOCAL,Facility,Outpatient,50 mL,mL,,92,78.2,26.3672,92,Aetna,Medicare Advantage,45.08,49,,percent of total billed charges,,
SODIUM BICARBONATE 8.4 % (1 MEQ/ML) IV SYRG,,25452,LOCAL,Facility,Inpatient,50 mL,mL,,92,78.2,26.3672,92,Aetna,Medicare Advantage,,,,,Included in per diem rate,
SODIUM BICARBONATE 8.4 % (1 MEQ/ML) IV SYRG,,25452,LOCAL,Facility,Both,50 mL,mL,,92,78.2,26.3672,92,Aetna,PPO,85.56,93,,percent of total billed charges,,
SODIUM BICARBONATE 8.4 % (1 MEQ/ML) IV SYRG,,25452,LOCAL,Facility,Both,50 mL,mL,,92,78.2,26.3672,92,America's PPO,America's PPO,88.3476,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SODIUM BICARBONATE 8.4 % (1 MEQ/ML) IV SYRG,,25452,LOCAL,Facility,Both,50 mL,mL,,92,78.2,26.3672,92,BlueCross BlueShield Minnesota, Federal Employee Program,90.528,98.4,,percent of total billed charges,,
SODIUM BICARBONATE 8.4 % (1 MEQ/ML) IV SYRG,,25452,LOCAL,Facility,Both,50 mL,mL,,92,78.2,26.3672,92,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,92,100,,percent of total billed charges,,
SODIUM BICARBONATE 8.4 % (1 MEQ/ML) IV SYRG,,25452,LOCAL,Facility,Both,50 mL,mL,,92,78.2,26.3672,92,BlueCross BlueShield Minnesota,High Value Network Plan,82.8,90,,percent of total billed charges,,
SODIUM BICARBONATE 8.4 % (1 MEQ/ML) IV SYRG,,25452,LOCAL,Facility,Outpatient,50 mL,mL,,92,78.2,26.3672,92,BlueCross BlueShield Minnesota,Medicare Advantage,45.08,49,,percent of total billed charges,,
SODIUM BICARBONATE 8.4 % (1 MEQ/ML) IV SYRG,,25452,LOCAL,Facility,Inpatient,50 mL,mL,,92,78.2,26.3672,92,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
SODIUM BICARBONATE 8.4 % (1 MEQ/ML) IV SYRG,,25452,LOCAL,Facility,Both,50 mL,mL,,92,78.2,26.3672,92,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,81.4844,88.57,,percent of total billed charges,,
SODIUM BICARBONATE 8.4 % (1 MEQ/ML) IV SYRG,,25452,LOCAL,Facility,Both,50 mL,mL,,92,78.2,26.3672,92,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,26.3672,28.66,,percent of total billed charges,,
SODIUM BICARBONATE 8.4 % (1 MEQ/ML) IV SYRG,,25452,LOCAL,Facility,Outpatient,50 mL,mL,,92,78.2,26.3672,92,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),45.08,49,,percent of total billed charges,,
SODIUM BICARBONATE 8.4 % (1 MEQ/ML) IV SYRG,,25452,LOCAL,Facility,Inpatient,50 mL,mL,,92,78.2,26.3672,92,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
SODIUM BICARBONATE 8.4 % (1 MEQ/ML) IV SYRG,,25452,LOCAL,Facility,Both,50 mL,mL,,92,78.2,26.3672,92,CorVel,Worker's Compensation,92,100,,percent of total billed charges,,
SODIUM BICARBONATE 8.4 % (1 MEQ/ML) IV SYRG,,25452,LOCAL,Facility,Both,50 mL,mL,,92,78.2,26.3672,92,First Health Group Corporation,First Health Network,89.24,97,,percent of total billed charges,,
SODIUM BICARBONATE 8.4 % (1 MEQ/ML) IV SYRG,,25452,LOCAL,Facility,Both,50 mL,mL,,92,78.2,26.3672,92,"Health Partners, Inc.",Commercial,87.032,94.6,,percent of total billed charges,,
SODIUM BICARBONATE 8.4 % (1 MEQ/ML) IV SYRG,,25452,LOCAL,Facility,Outpatient,50 mL,mL,,92,78.2,26.3672,92,"Health Partners, Inc.",Medicare Advantage,45.08,49,,percent of total billed charges,,
SODIUM BICARBONATE 8.4 % (1 MEQ/ML) IV SYRG,,25452,LOCAL,Facility,Inpatient,50 mL,mL,,92,78.2,26.3672,92,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SODIUM BICARBONATE 8.4 % (1 MEQ/ML) IV SYRG,,25452,LOCAL,Facility,Both,50 mL,mL,,92,78.2,26.3672,92,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),55.2,60,,percent of total billed charges,,
SODIUM BICARBONATE 8.4 % (1 MEQ/ML) IV SYRG,,25452,LOCAL,Facility,Both,50 mL,mL,,92,78.2,26.3672,92,"Health Partners, Inc.",State of Minnesota Advantage Program,74.98,81.5,,percent of total billed charges,,
SODIUM BICARBONATE 8.4 % (1 MEQ/ML) IV SYRG,,25452,LOCAL,Facility,Both,50 mL,mL,,92,78.2,26.3672,92,"Health Partners, Inc.",State Public Programs,46,50,,percent of total billed charges,,
SODIUM BICARBONATE 8.4 % (1 MEQ/ML) IV SYRG,,25452,LOCAL,Facility,Both,50 mL,mL,,92,78.2,26.3672,92,Humana Insurance Company,Commercial PPO,87.4,95,,percent of total billed charges,,
SODIUM BICARBONATE 8.4 % (1 MEQ/ML) IV SYRG,,25452,LOCAL,Facility,Outpatient,50 mL,mL,,92,78.2,26.3672,92,Humana Insurance Company,Medicare PPO,45.08,49,,percent of total billed charges,,
SODIUM BICARBONATE 8.4 % (1 MEQ/ML) IV SYRG,,25452,LOCAL,Facility,Inpatient,50 mL,mL,,92,78.2,26.3672,92,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
SODIUM BICARBONATE 8.4 % (1 MEQ/ML) IV SYRG,,25452,LOCAL,Facility,Both,50 mL,mL,,92,78.2,26.3672,92,Medica,Individual & Family,91.172,99.1,,percent of total billed charges,,
SODIUM BICARBONATE 8.4 % (1 MEQ/ML) IV SYRG,,25452,LOCAL,Facility,Outpatient,50 mL,mL,,92,78.2,26.3672,92,Medica,Medica Advantage Solution,45.816,49.8,,percent of total billed charges,,
SODIUM BICARBONATE 8.4 % (1 MEQ/ML) IV SYRG,,25452,LOCAL,Facility,Inpatient,50 mL,mL,,92,78.2,26.3672,92,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
SODIUM BICARBONATE 8.4 % (1 MEQ/ML) IV SYRG,,25452,LOCAL,Facility,Outpatient,50 mL,mL,,92,78.2,26.3672,92,Medica,Medical Assistance,41.032,44.6,,percent of total billed charges,,
SODIUM BICARBONATE 8.4 % (1 MEQ/ML) IV SYRG,,25452,LOCAL,Facility,Inpatient,50 mL,mL,,92,78.2,26.3672,92,Medica,Medical Assistance,,,,,Included in per diem rate,
SODIUM BICARBONATE 8.4 % (1 MEQ/ML) IV SYRG,,25452,LOCAL,Facility,Outpatient,50 mL,mL,,92,78.2,26.3672,92,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,45.816,49.8,,percent of total billed charges,,
SODIUM BICARBONATE 8.4 % (1 MEQ/ML) IV SYRG,,25452,LOCAL,Facility,Inpatient,50 mL,mL,,92,78.2,26.3672,92,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
SODIUM BICARBONATE 8.4 % (1 MEQ/ML) IV SYRG,,25452,LOCAL,Facility,Both,50 mL,mL,,92,78.2,26.3672,92,"Multiplan, Inc.","Multiplan, Inc.",86.48,94,,percent of total billed charges,,
SODIUM BICARBONATE 8.4 % (1 MEQ/ML) IV SYRG,,25452,LOCAL,Facility,Outpatient,50 mL,mL,,92,78.2,26.3672,92,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,82.892,90.1,,percent of total billed charges,,
SODIUM BICARBONATE 8.4 % (1 MEQ/ML) IV SYRG,,25452,LOCAL,Facility,Inpatient,50 mL,mL,,92,78.2,26.3672,92,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
SODIUM BICARBONATE 8.4 % (1 MEQ/ML) IV SYRG,,25452,LOCAL,Facility,Both,50 mL,mL,,92,78.2,26.3672,92,"Preferred One Administrative Services, INC.",PPO,90.712,98.6,,percent of total billed charges,,
SODIUM BICARBONATE 8.4 % (1 MEQ/ML) IV SYRG,,25452,LOCAL,Facility,Outpatient,50 mL,mL,,92,78.2,26.3672,92,PrimeWest Health,Minnesota Senior Health Options (MSHO),47.334,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
SODIUM BICARBONATE 8.4 % (1 MEQ/ML) IV SYRG,,25452,LOCAL,Facility,Inpatient,50 mL,mL,,92,78.2,26.3672,92,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SODIUM BICARBONATE 8.4 % (1 MEQ/ML) IV SYRG,,25452,LOCAL,Facility,Outpatient,50 mL,mL,,92,78.2,26.3672,92,PrimeWest Health,MinnesotaCare,47.2512,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
SODIUM BICARBONATE 8.4 % (1 MEQ/ML) IV SYRG,,25452,LOCAL,Facility,Inpatient,50 mL,mL,,92,78.2,26.3672,92,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
SODIUM BICARBONATE 8.4 % (1 MEQ/ML) IV SYRG,,25452,LOCAL,Facility,Both,50 mL,mL,,92,78.2,26.3672,92,Sanford Health Plan,Sanford Health Plan,84.64,92,,percent of total billed charges,,
SODIUM BICARBONATE 8.4 % (1 MEQ/ML) IV SYRG,,25452,LOCAL,Facility,Outpatient,50 mL,mL,,92,78.2,26.3672,92,"UCare Health, Inc.",Individual & Family Plan,51.842,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
SODIUM BICARBONATE 8.4 % (1 MEQ/ML) IV SYRG,,25452,LOCAL,Facility,Inpatient,50 mL,mL,,92,78.2,26.3672,92,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
SODIUM BICARBONATE 8.4 % (1 MEQ/ML) IV SYRG,,25452,LOCAL,Facility,Outpatient,50 mL,mL,,92,78.2,26.3672,92,"UCare Health, Inc.",Medical Assistance,46.4324,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SODIUM BICARBONATE 8.4 % (1 MEQ/ML) IV SYRG,,25452,LOCAL,Facility,Inpatient,50 mL,mL,,92,78.2,26.3672,92,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
SODIUM BICARBONATE 8.4 % (1 MEQ/ML) IV SYRG,,25452,LOCAL,Facility,Outpatient,50 mL,mL,,92,78.2,26.3672,92,"UCare Health, Inc.",Medicare Advantage,46.4324,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SODIUM BICARBONATE 8.4 % (1 MEQ/ML) IV SYRG,,25452,LOCAL,Facility,Inpatient,50 mL,mL,,92,78.2,26.3672,92,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SODIUM BICARBONATE 8.4 % (1 MEQ/ML) IV SYRG,,25452,LOCAL,Facility,Outpatient,50 mL,mL,,92,78.2,26.3672,92,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),46.4324,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SODIUM BICARBONATE 8.4 % (1 MEQ/ML) IV SYRG,,25452,LOCAL,Facility,Inpatient,50 mL,mL,,92,78.2,26.3672,92,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SODIUM BICARBONATE 8.4 % (1 MEQ/ML) IV SYRG,,25452,LOCAL,Facility,Both,50 mL,mL,,92,78.2,26.3672,92,UnitedHealthcare,Individual & Family,86.48,94,,percent of total billed charges,,
SODIUM BICARBONATE 8.4 % (1 MEQ/ML) IV SYRG,,25452,LOCAL,Facility,Outpatient,50 mL,mL,,92,78.2,26.3672,92,UnitedHealthcare,Medicare Advantage,45.08,49,,percent of total billed charges,,
SODIUM BICARBONATE 8.4 % (1 MEQ/ML) IV SYRG,,25452,LOCAL,Facility,Inpatient,50 mL,mL,,92,78.2,26.3672,92,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
SODIUM BICARBONATE 8.4 % (1 MEQ/ML) IV SYRG,,25452,LOCAL,Facility,Outpatient,50 mL,mL,,92,78.2,26.3672,92,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,44.16,48,,percent of total billed charges,,100% of DHS outpatient percentage
SODIUM BICARBONATE 8.4 % (1 MEQ/ML) IV SYRG,,25452,LOCAL,Facility,Inpatient,50 mL,mL,,92,78.2,26.3672,92,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
LIDOCAINE (PF) 5 MG/ML (0.5 %) INJ SOLN,,66153,LOCAL,Facility,Both,50 mL,mL,,26,22.1,7.4516,26,Aetna,Commercial,23.92,92,,percent of total billed charges,,
LIDOCAINE (PF) 5 MG/ML (0.5 %) INJ SOLN,,66153,LOCAL,Facility,Outpatient,50 mL,mL,,26,22.1,7.4516,26,Aetna,Medicare Advantage,12.74,49,,percent of total billed charges,,
LIDOCAINE (PF) 5 MG/ML (0.5 %) INJ SOLN,,66153,LOCAL,Facility,Inpatient,50 mL,mL,,26,22.1,7.4516,26,Aetna,Medicare Advantage,,,,,Included in per diem rate,
LIDOCAINE (PF) 5 MG/ML (0.5 %) INJ SOLN,,66153,LOCAL,Facility,Both,50 mL,mL,,26,22.1,7.4516,26,Aetna,PPO,24.18,93,,percent of total billed charges,,
LIDOCAINE (PF) 5 MG/ML (0.5 %) INJ SOLN,,66153,LOCAL,Facility,Both,50 mL,mL,,26,22.1,7.4516,26,America's PPO,America's PPO,24.9678,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
LIDOCAINE (PF) 5 MG/ML (0.5 %) INJ SOLN,,66153,LOCAL,Facility,Both,50 mL,mL,,26,22.1,7.4516,26,BlueCross BlueShield Minnesota, Federal Employee Program,25.584,98.4,,percent of total billed charges,,
LIDOCAINE (PF) 5 MG/ML (0.5 %) INJ SOLN,,66153,LOCAL,Facility,Both,50 mL,mL,,26,22.1,7.4516,26,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,26,100,,percent of total billed charges,,
LIDOCAINE (PF) 5 MG/ML (0.5 %) INJ SOLN,,66153,LOCAL,Facility,Both,50 mL,mL,,26,22.1,7.4516,26,BlueCross BlueShield Minnesota,High Value Network Plan,23.4,90,,percent of total billed charges,,
LIDOCAINE (PF) 5 MG/ML (0.5 %) INJ SOLN,,66153,LOCAL,Facility,Outpatient,50 mL,mL,,26,22.1,7.4516,26,BlueCross BlueShield Minnesota,Medicare Advantage,12.74,49,,percent of total billed charges,,
LIDOCAINE (PF) 5 MG/ML (0.5 %) INJ SOLN,,66153,LOCAL,Facility,Inpatient,50 mL,mL,,26,22.1,7.4516,26,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
LIDOCAINE (PF) 5 MG/ML (0.5 %) INJ SOLN,,66153,LOCAL,Facility,Both,50 mL,mL,,26,22.1,7.4516,26,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,23.0282,88.57,,percent of total billed charges,,
LIDOCAINE (PF) 5 MG/ML (0.5 %) INJ SOLN,,66153,LOCAL,Facility,Both,50 mL,mL,,26,22.1,7.4516,26,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,7.4516,28.66,,percent of total billed charges,,
LIDOCAINE (PF) 5 MG/ML (0.5 %) INJ SOLN,,66153,LOCAL,Facility,Outpatient,50 mL,mL,,26,22.1,7.4516,26,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),12.74,49,,percent of total billed charges,,
LIDOCAINE (PF) 5 MG/ML (0.5 %) INJ SOLN,,66153,LOCAL,Facility,Inpatient,50 mL,mL,,26,22.1,7.4516,26,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
LIDOCAINE (PF) 5 MG/ML (0.5 %) INJ SOLN,,66153,LOCAL,Facility,Both,50 mL,mL,,26,22.1,7.4516,26,CorVel,Worker's Compensation,26,100,,percent of total billed charges,,
LIDOCAINE (PF) 5 MG/ML (0.5 %) INJ SOLN,,66153,LOCAL,Facility,Both,50 mL,mL,,26,22.1,7.4516,26,First Health Group Corporation,First Health Network,25.22,97,,percent of total billed charges,,
LIDOCAINE (PF) 5 MG/ML (0.5 %) INJ SOLN,,66153,LOCAL,Facility,Both,50 mL,mL,,26,22.1,7.4516,26,"Health Partners, Inc.",Commercial,24.596,94.6,,percent of total billed charges,,
LIDOCAINE (PF) 5 MG/ML (0.5 %) INJ SOLN,,66153,LOCAL,Facility,Outpatient,50 mL,mL,,26,22.1,7.4516,26,"Health Partners, Inc.",Medicare Advantage,12.74,49,,percent of total billed charges,,
LIDOCAINE (PF) 5 MG/ML (0.5 %) INJ SOLN,,66153,LOCAL,Facility,Inpatient,50 mL,mL,,26,22.1,7.4516,26,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LIDOCAINE (PF) 5 MG/ML (0.5 %) INJ SOLN,,66153,LOCAL,Facility,Both,50 mL,mL,,26,22.1,7.4516,26,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),15.6,60,,percent of total billed charges,,
LIDOCAINE (PF) 5 MG/ML (0.5 %) INJ SOLN,,66153,LOCAL,Facility,Both,50 mL,mL,,26,22.1,7.4516,26,"Health Partners, Inc.",State of Minnesota Advantage Program,21.19,81.5,,percent of total billed charges,,
LIDOCAINE (PF) 5 MG/ML (0.5 %) INJ SOLN,,66153,LOCAL,Facility,Both,50 mL,mL,,26,22.1,7.4516,26,"Health Partners, Inc.",State Public Programs,13,50,,percent of total billed charges,,
LIDOCAINE (PF) 5 MG/ML (0.5 %) INJ SOLN,,66153,LOCAL,Facility,Both,50 mL,mL,,26,22.1,7.4516,26,Humana Insurance Company,Commercial PPO,24.7,95,,percent of total billed charges,,
LIDOCAINE (PF) 5 MG/ML (0.5 %) INJ SOLN,,66153,LOCAL,Facility,Outpatient,50 mL,mL,,26,22.1,7.4516,26,Humana Insurance Company,Medicare PPO,12.74,49,,percent of total billed charges,,
LIDOCAINE (PF) 5 MG/ML (0.5 %) INJ SOLN,,66153,LOCAL,Facility,Inpatient,50 mL,mL,,26,22.1,7.4516,26,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
LIDOCAINE (PF) 5 MG/ML (0.5 %) INJ SOLN,,66153,LOCAL,Facility,Both,50 mL,mL,,26,22.1,7.4516,26,Medica,Individual & Family,25.766,99.1,,percent of total billed charges,,
LIDOCAINE (PF) 5 MG/ML (0.5 %) INJ SOLN,,66153,LOCAL,Facility,Outpatient,50 mL,mL,,26,22.1,7.4516,26,Medica,Medica Advantage Solution,12.948,49.8,,percent of total billed charges,,
LIDOCAINE (PF) 5 MG/ML (0.5 %) INJ SOLN,,66153,LOCAL,Facility,Inpatient,50 mL,mL,,26,22.1,7.4516,26,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
LIDOCAINE (PF) 5 MG/ML (0.5 %) INJ SOLN,,66153,LOCAL,Facility,Outpatient,50 mL,mL,,26,22.1,7.4516,26,Medica,Medical Assistance,11.596,44.6,,percent of total billed charges,,
LIDOCAINE (PF) 5 MG/ML (0.5 %) INJ SOLN,,66153,LOCAL,Facility,Inpatient,50 mL,mL,,26,22.1,7.4516,26,Medica,Medical Assistance,,,,,Included in per diem rate,
LIDOCAINE (PF) 5 MG/ML (0.5 %) INJ SOLN,,66153,LOCAL,Facility,Outpatient,50 mL,mL,,26,22.1,7.4516,26,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,12.948,49.8,,percent of total billed charges,,
LIDOCAINE (PF) 5 MG/ML (0.5 %) INJ SOLN,,66153,LOCAL,Facility,Inpatient,50 mL,mL,,26,22.1,7.4516,26,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
LIDOCAINE (PF) 5 MG/ML (0.5 %) INJ SOLN,,66153,LOCAL,Facility,Both,50 mL,mL,,26,22.1,7.4516,26,"Multiplan, Inc.","Multiplan, Inc.",24.44,94,,percent of total billed charges,,
LIDOCAINE (PF) 5 MG/ML (0.5 %) INJ SOLN,,66153,LOCAL,Facility,Outpatient,50 mL,mL,,26,22.1,7.4516,26,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,23.426,90.1,,percent of total billed charges,,
LIDOCAINE (PF) 5 MG/ML (0.5 %) INJ SOLN,,66153,LOCAL,Facility,Inpatient,50 mL,mL,,26,22.1,7.4516,26,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
LIDOCAINE (PF) 5 MG/ML (0.5 %) INJ SOLN,,66153,LOCAL,Facility,Both,50 mL,mL,,26,22.1,7.4516,26,"Preferred One Administrative Services, INC.",PPO,25.636,98.6,,percent of total billed charges,,
LIDOCAINE (PF) 5 MG/ML (0.5 %) INJ SOLN,,66153,LOCAL,Facility,Outpatient,50 mL,mL,,26,22.1,7.4516,26,PrimeWest Health,Minnesota Senior Health Options (MSHO),13.377,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
LIDOCAINE (PF) 5 MG/ML (0.5 %) INJ SOLN,,66153,LOCAL,Facility,Inpatient,50 mL,mL,,26,22.1,7.4516,26,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LIDOCAINE (PF) 5 MG/ML (0.5 %) INJ SOLN,,66153,LOCAL,Facility,Outpatient,50 mL,mL,,26,22.1,7.4516,26,PrimeWest Health,MinnesotaCare,13.3536,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
LIDOCAINE (PF) 5 MG/ML (0.5 %) INJ SOLN,,66153,LOCAL,Facility,Inpatient,50 mL,mL,,26,22.1,7.4516,26,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
LIDOCAINE (PF) 5 MG/ML (0.5 %) INJ SOLN,,66153,LOCAL,Facility,Both,50 mL,mL,,26,22.1,7.4516,26,Sanford Health Plan,Sanford Health Plan,23.92,92,,percent of total billed charges,,
LIDOCAINE (PF) 5 MG/ML (0.5 %) INJ SOLN,,66153,LOCAL,Facility,Outpatient,50 mL,mL,,26,22.1,7.4516,26,"UCare Health, Inc.",Individual & Family Plan,14.651,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
LIDOCAINE (PF) 5 MG/ML (0.5 %) INJ SOLN,,66153,LOCAL,Facility,Inpatient,50 mL,mL,,26,22.1,7.4516,26,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
LIDOCAINE (PF) 5 MG/ML (0.5 %) INJ SOLN,,66153,LOCAL,Facility,Outpatient,50 mL,mL,,26,22.1,7.4516,26,"UCare Health, Inc.",Medical Assistance,13.1222,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LIDOCAINE (PF) 5 MG/ML (0.5 %) INJ SOLN,,66153,LOCAL,Facility,Inpatient,50 mL,mL,,26,22.1,7.4516,26,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
LIDOCAINE (PF) 5 MG/ML (0.5 %) INJ SOLN,,66153,LOCAL,Facility,Outpatient,50 mL,mL,,26,22.1,7.4516,26,"UCare Health, Inc.",Medicare Advantage,13.1222,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LIDOCAINE (PF) 5 MG/ML (0.5 %) INJ SOLN,,66153,LOCAL,Facility,Inpatient,50 mL,mL,,26,22.1,7.4516,26,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LIDOCAINE (PF) 5 MG/ML (0.5 %) INJ SOLN,,66153,LOCAL,Facility,Outpatient,50 mL,mL,,26,22.1,7.4516,26,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),13.1222,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LIDOCAINE (PF) 5 MG/ML (0.5 %) INJ SOLN,,66153,LOCAL,Facility,Inpatient,50 mL,mL,,26,22.1,7.4516,26,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LIDOCAINE (PF) 5 MG/ML (0.5 %) INJ SOLN,,66153,LOCAL,Facility,Both,50 mL,mL,,26,22.1,7.4516,26,UnitedHealthcare,Individual & Family,24.44,94,,percent of total billed charges,,
LIDOCAINE (PF) 5 MG/ML (0.5 %) INJ SOLN,,66153,LOCAL,Facility,Outpatient,50 mL,mL,,26,22.1,7.4516,26,UnitedHealthcare,Medicare Advantage,12.74,49,,percent of total billed charges,,
LIDOCAINE (PF) 5 MG/ML (0.5 %) INJ SOLN,,66153,LOCAL,Facility,Inpatient,50 mL,mL,,26,22.1,7.4516,26,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
LIDOCAINE (PF) 5 MG/ML (0.5 %) INJ SOLN,,66153,LOCAL,Facility,Outpatient,50 mL,mL,,26,22.1,7.4516,26,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,12.48,48,,percent of total billed charges,,100% of DHS outpatient percentage
LIDOCAINE (PF) 5 MG/ML (0.5 %) INJ SOLN,,66153,LOCAL,Facility,Inpatient,50 mL,mL,,26,22.1,7.4516,26,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
BUFFERED LIDOCAINE 1% - MHS,,480083,LOCAL,Facility,Both,50 mL,mL,,35,29.75,10.031,35,Aetna,Commercial,32.2,92,,percent of total billed charges,,
BUFFERED LIDOCAINE 1% - MHS,,480083,LOCAL,Facility,Outpatient,50 mL,mL,,35,29.75,10.031,35,Aetna,Medicare Advantage,17.15,49,,percent of total billed charges,,
BUFFERED LIDOCAINE 1% - MHS,,480083,LOCAL,Facility,Inpatient,50 mL,mL,,35,29.75,10.031,35,Aetna,Medicare Advantage,,,,,Included in per diem rate,
BUFFERED LIDOCAINE 1% - MHS,,480083,LOCAL,Facility,Both,50 mL,mL,,35,29.75,10.031,35,Aetna,PPO,32.55,93,,percent of total billed charges,,
BUFFERED LIDOCAINE 1% - MHS,,480083,LOCAL,Facility,Both,50 mL,mL,,35,29.75,10.031,35,America's PPO,America's PPO,33.6105,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
BUFFERED LIDOCAINE 1% - MHS,,480083,LOCAL,Facility,Both,50 mL,mL,,35,29.75,10.031,35,BlueCross BlueShield Minnesota, Federal Employee Program,34.44,98.4,,percent of total billed charges,,
BUFFERED LIDOCAINE 1% - MHS,,480083,LOCAL,Facility,Both,50 mL,mL,,35,29.75,10.031,35,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,35,100,,percent of total billed charges,,
BUFFERED LIDOCAINE 1% - MHS,,480083,LOCAL,Facility,Both,50 mL,mL,,35,29.75,10.031,35,BlueCross BlueShield Minnesota,High Value Network Plan,31.5,90,,percent of total billed charges,,
BUFFERED LIDOCAINE 1% - MHS,,480083,LOCAL,Facility,Outpatient,50 mL,mL,,35,29.75,10.031,35,BlueCross BlueShield Minnesota,Medicare Advantage,17.15,49,,percent of total billed charges,,
BUFFERED LIDOCAINE 1% - MHS,,480083,LOCAL,Facility,Inpatient,50 mL,mL,,35,29.75,10.031,35,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
BUFFERED LIDOCAINE 1% - MHS,,480083,LOCAL,Facility,Both,50 mL,mL,,35,29.75,10.031,35,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,30.9995,88.57,,percent of total billed charges,,
BUFFERED LIDOCAINE 1% - MHS,,480083,LOCAL,Facility,Both,50 mL,mL,,35,29.75,10.031,35,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,10.031,28.66,,percent of total billed charges,,
BUFFERED LIDOCAINE 1% - MHS,,480083,LOCAL,Facility,Outpatient,50 mL,mL,,35,29.75,10.031,35,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),17.15,49,,percent of total billed charges,,
BUFFERED LIDOCAINE 1% - MHS,,480083,LOCAL,Facility,Inpatient,50 mL,mL,,35,29.75,10.031,35,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
BUFFERED LIDOCAINE 1% - MHS,,480083,LOCAL,Facility,Both,50 mL,mL,,35,29.75,10.031,35,CorVel,Worker's Compensation,35,100,,percent of total billed charges,,
BUFFERED LIDOCAINE 1% - MHS,,480083,LOCAL,Facility,Both,50 mL,mL,,35,29.75,10.031,35,First Health Group Corporation,First Health Network,33.95,97,,percent of total billed charges,,
BUFFERED LIDOCAINE 1% - MHS,,480083,LOCAL,Facility,Both,50 mL,mL,,35,29.75,10.031,35,"Health Partners, Inc.",Commercial,33.11,94.6,,percent of total billed charges,,
BUFFERED LIDOCAINE 1% - MHS,,480083,LOCAL,Facility,Outpatient,50 mL,mL,,35,29.75,10.031,35,"Health Partners, Inc.",Medicare Advantage,17.15,49,,percent of total billed charges,,
BUFFERED LIDOCAINE 1% - MHS,,480083,LOCAL,Facility,Inpatient,50 mL,mL,,35,29.75,10.031,35,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
BUFFERED LIDOCAINE 1% - MHS,,480083,LOCAL,Facility,Both,50 mL,mL,,35,29.75,10.031,35,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),21,60,,percent of total billed charges,,
BUFFERED LIDOCAINE 1% - MHS,,480083,LOCAL,Facility,Both,50 mL,mL,,35,29.75,10.031,35,"Health Partners, Inc.",State of Minnesota Advantage Program,28.525,81.5,,percent of total billed charges,,
BUFFERED LIDOCAINE 1% - MHS,,480083,LOCAL,Facility,Both,50 mL,mL,,35,29.75,10.031,35,"Health Partners, Inc.",State Public Programs,17.5,50,,percent of total billed charges,,
BUFFERED LIDOCAINE 1% - MHS,,480083,LOCAL,Facility,Both,50 mL,mL,,35,29.75,10.031,35,Humana Insurance Company,Commercial PPO,33.25,95,,percent of total billed charges,,
BUFFERED LIDOCAINE 1% - MHS,,480083,LOCAL,Facility,Outpatient,50 mL,mL,,35,29.75,10.031,35,Humana Insurance Company,Medicare PPO,17.15,49,,percent of total billed charges,,
BUFFERED LIDOCAINE 1% - MHS,,480083,LOCAL,Facility,Inpatient,50 mL,mL,,35,29.75,10.031,35,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
BUFFERED LIDOCAINE 1% - MHS,,480083,LOCAL,Facility,Both,50 mL,mL,,35,29.75,10.031,35,Medica,Individual & Family,34.685,99.1,,percent of total billed charges,,
BUFFERED LIDOCAINE 1% - MHS,,480083,LOCAL,Facility,Outpatient,50 mL,mL,,35,29.75,10.031,35,Medica,Medica Advantage Solution,17.43,49.8,,percent of total billed charges,,
BUFFERED LIDOCAINE 1% - MHS,,480083,LOCAL,Facility,Inpatient,50 mL,mL,,35,29.75,10.031,35,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
BUFFERED LIDOCAINE 1% - MHS,,480083,LOCAL,Facility,Outpatient,50 mL,mL,,35,29.75,10.031,35,Medica,Medical Assistance,15.61,44.6,,percent of total billed charges,,
BUFFERED LIDOCAINE 1% - MHS,,480083,LOCAL,Facility,Inpatient,50 mL,mL,,35,29.75,10.031,35,Medica,Medical Assistance,,,,,Included in per diem rate,
BUFFERED LIDOCAINE 1% - MHS,,480083,LOCAL,Facility,Outpatient,50 mL,mL,,35,29.75,10.031,35,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,17.43,49.8,,percent of total billed charges,,
BUFFERED LIDOCAINE 1% - MHS,,480083,LOCAL,Facility,Inpatient,50 mL,mL,,35,29.75,10.031,35,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
BUFFERED LIDOCAINE 1% - MHS,,480083,LOCAL,Facility,Both,50 mL,mL,,35,29.75,10.031,35,"Multiplan, Inc.","Multiplan, Inc.",32.9,94,,percent of total billed charges,,
BUFFERED LIDOCAINE 1% - MHS,,480083,LOCAL,Facility,Outpatient,50 mL,mL,,35,29.75,10.031,35,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,31.535,90.1,,percent of total billed charges,,
BUFFERED LIDOCAINE 1% - MHS,,480083,LOCAL,Facility,Inpatient,50 mL,mL,,35,29.75,10.031,35,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
BUFFERED LIDOCAINE 1% - MHS,,480083,LOCAL,Facility,Both,50 mL,mL,,35,29.75,10.031,35,"Preferred One Administrative Services, INC.",PPO,34.51,98.6,,percent of total billed charges,,
BUFFERED LIDOCAINE 1% - MHS,,480083,LOCAL,Facility,Outpatient,50 mL,mL,,35,29.75,10.031,35,PrimeWest Health,Minnesota Senior Health Options (MSHO),18.0075,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
BUFFERED LIDOCAINE 1% - MHS,,480083,LOCAL,Facility,Inpatient,50 mL,mL,,35,29.75,10.031,35,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
BUFFERED LIDOCAINE 1% - MHS,,480083,LOCAL,Facility,Outpatient,50 mL,mL,,35,29.75,10.031,35,PrimeWest Health,MinnesotaCare,17.976,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
BUFFERED LIDOCAINE 1% - MHS,,480083,LOCAL,Facility,Inpatient,50 mL,mL,,35,29.75,10.031,35,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
BUFFERED LIDOCAINE 1% - MHS,,480083,LOCAL,Facility,Both,50 mL,mL,,35,29.75,10.031,35,Sanford Health Plan,Sanford Health Plan,32.2,92,,percent of total billed charges,,
BUFFERED LIDOCAINE 1% - MHS,,480083,LOCAL,Facility,Outpatient,50 mL,mL,,35,29.75,10.031,35,"UCare Health, Inc.",Individual & Family Plan,19.7225,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
BUFFERED LIDOCAINE 1% - MHS,,480083,LOCAL,Facility,Inpatient,50 mL,mL,,35,29.75,10.031,35,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
BUFFERED LIDOCAINE 1% - MHS,,480083,LOCAL,Facility,Outpatient,50 mL,mL,,35,29.75,10.031,35,"UCare Health, Inc.",Medical Assistance,17.6645,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BUFFERED LIDOCAINE 1% - MHS,,480083,LOCAL,Facility,Inpatient,50 mL,mL,,35,29.75,10.031,35,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
BUFFERED LIDOCAINE 1% - MHS,,480083,LOCAL,Facility,Outpatient,50 mL,mL,,35,29.75,10.031,35,"UCare Health, Inc.",Medicare Advantage,17.6645,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BUFFERED LIDOCAINE 1% - MHS,,480083,LOCAL,Facility,Inpatient,50 mL,mL,,35,29.75,10.031,35,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
BUFFERED LIDOCAINE 1% - MHS,,480083,LOCAL,Facility,Outpatient,50 mL,mL,,35,29.75,10.031,35,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),17.6645,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BUFFERED LIDOCAINE 1% - MHS,,480083,LOCAL,Facility,Inpatient,50 mL,mL,,35,29.75,10.031,35,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
BUFFERED LIDOCAINE 1% - MHS,,480083,LOCAL,Facility,Both,50 mL,mL,,35,29.75,10.031,35,UnitedHealthcare,Individual & Family,32.9,94,,percent of total billed charges,,
BUFFERED LIDOCAINE 1% - MHS,,480083,LOCAL,Facility,Outpatient,50 mL,mL,,35,29.75,10.031,35,UnitedHealthcare,Medicare Advantage,17.15,49,,percent of total billed charges,,
BUFFERED LIDOCAINE 1% - MHS,,480083,LOCAL,Facility,Inpatient,50 mL,mL,,35,29.75,10.031,35,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
BUFFERED LIDOCAINE 1% - MHS,,480083,LOCAL,Facility,Outpatient,50 mL,mL,,35,29.75,10.031,35,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,16.8,48,,percent of total billed charges,,100% of DHS outpatient percentage
BUFFERED LIDOCAINE 1% - MHS,,480083,LOCAL,Facility,Inpatient,50 mL,mL,,35,29.75,10.031,35,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
BUPIVACAINE HCL 0.25 % (2.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Both,50 mL,mL,,39,33.15,11.1774,39,Aetna,Commercial,35.88,92,,percent of total billed charges,,
BUPIVACAINE HCL 0.25 % (2.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Outpatient,50 mL,mL,,39,33.15,11.1774,39,Aetna,Medicare Advantage,19.11,49,,percent of total billed charges,,
BUPIVACAINE HCL 0.25 % (2.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Inpatient,50 mL,mL,,39,33.15,11.1774,39,Aetna,Medicare Advantage,,,,,Included in per diem rate,
BUPIVACAINE HCL 0.25 % (2.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Both,50 mL,mL,,39,33.15,11.1774,39,Aetna,PPO,36.27,93,,percent of total billed charges,,
BUPIVACAINE HCL 0.25 % (2.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Both,50 mL,mL,,39,33.15,11.1774,39,America's PPO,America's PPO,37.4517,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
BUPIVACAINE HCL 0.25 % (2.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Both,50 mL,mL,,39,33.15,11.1774,39,BlueCross BlueShield Minnesota, Federal Employee Program,38.376,98.4,,percent of total billed charges,,
BUPIVACAINE HCL 0.25 % (2.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Both,50 mL,mL,,39,33.15,11.1774,39,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,39,100,,percent of total billed charges,,
BUPIVACAINE HCL 0.25 % (2.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Both,50 mL,mL,,39,33.15,11.1774,39,BlueCross BlueShield Minnesota,High Value Network Plan,35.1,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
BUPIVACAINE HCL 0.25 % (2.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Outpatient,50 mL,mL,,39,33.15,11.1774,39,BlueCross BlueShield Minnesota,Medicare Advantage,19.11,49,,percent of total billed charges,,
BUPIVACAINE HCL 0.25 % (2.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Inpatient,50 mL,mL,,39,33.15,11.1774,39,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
BUPIVACAINE HCL 0.25 % (2.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Both,50 mL,mL,,39,33.15,11.1774,39,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,34.5423,88.57,,percent of total billed charges,,
BUPIVACAINE HCL 0.25 % (2.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Both,50 mL,mL,,39,33.15,11.1774,39,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,11.1774,28.66,,percent of total billed charges,,
BUPIVACAINE HCL 0.25 % (2.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Outpatient,50 mL,mL,,39,33.15,11.1774,39,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),19.11,49,,percent of total billed charges,,
BUPIVACAINE HCL 0.25 % (2.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Inpatient,50 mL,mL,,39,33.15,11.1774,39,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
BUPIVACAINE HCL 0.25 % (2.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Both,50 mL,mL,,39,33.15,11.1774,39,CorVel,Worker's Compensation,39,100,,percent of total billed charges,,
BUPIVACAINE HCL 0.25 % (2.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Both,50 mL,mL,,39,33.15,11.1774,39,First Health Group Corporation,First Health Network,37.83,97,,percent of total billed charges,,
BUPIVACAINE HCL 0.25 % (2.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Both,50 mL,mL,,39,33.15,11.1774,39,"Health Partners, Inc.",Commercial,36.894,94.6,,percent of total billed charges,,
BUPIVACAINE HCL 0.25 % (2.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Outpatient,50 mL,mL,,39,33.15,11.1774,39,"Health Partners, Inc.",Medicare Advantage,19.11,49,,percent of total billed charges,,
BUPIVACAINE HCL 0.25 % (2.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Inpatient,50 mL,mL,,39,33.15,11.1774,39,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
BUPIVACAINE HCL 0.25 % (2.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Both,50 mL,mL,,39,33.15,11.1774,39,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),23.4,60,,percent of total billed charges,,
BUPIVACAINE HCL 0.25 % (2.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Both,50 mL,mL,,39,33.15,11.1774,39,"Health Partners, Inc.",State of Minnesota Advantage Program,31.785,81.5,,percent of total billed charges,,
BUPIVACAINE HCL 0.25 % (2.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Both,50 mL,mL,,39,33.15,11.1774,39,"Health Partners, Inc.",State Public Programs,19.5,50,,percent of total billed charges,,
BUPIVACAINE HCL 0.25 % (2.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Both,50 mL,mL,,39,33.15,11.1774,39,Humana Insurance Company,Commercial PPO,37.05,95,,percent of total billed charges,,
BUPIVACAINE HCL 0.25 % (2.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Outpatient,50 mL,mL,,39,33.15,11.1774,39,Humana Insurance Company,Medicare PPO,19.11,49,,percent of total billed charges,,
BUPIVACAINE HCL 0.25 % (2.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Inpatient,50 mL,mL,,39,33.15,11.1774,39,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
BUPIVACAINE HCL 0.25 % (2.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Both,50 mL,mL,,39,33.15,11.1774,39,Medica,Individual & Family,38.649,99.1,,percent of total billed charges,,
BUPIVACAINE HCL 0.25 % (2.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Outpatient,50 mL,mL,,39,33.15,11.1774,39,Medica,Medica Advantage Solution,19.422,49.8,,percent of total billed charges,,
BUPIVACAINE HCL 0.25 % (2.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Inpatient,50 mL,mL,,39,33.15,11.1774,39,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
BUPIVACAINE HCL 0.25 % (2.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Outpatient,50 mL,mL,,39,33.15,11.1774,39,Medica,Medical Assistance,17.394,44.6,,percent of total billed charges,,
BUPIVACAINE HCL 0.25 % (2.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Inpatient,50 mL,mL,,39,33.15,11.1774,39,Medica,Medical Assistance,,,,,Included in per diem rate,
BUPIVACAINE HCL 0.25 % (2.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Outpatient,50 mL,mL,,39,33.15,11.1774,39,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,19.422,49.8,,percent of total billed charges,,
BUPIVACAINE HCL 0.25 % (2.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Inpatient,50 mL,mL,,39,33.15,11.1774,39,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
BUPIVACAINE HCL 0.25 % (2.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Both,50 mL,mL,,39,33.15,11.1774,39,"Multiplan, Inc.","Multiplan, Inc.",36.66,94,,percent of total billed charges,,
BUPIVACAINE HCL 0.25 % (2.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Outpatient,50 mL,mL,,39,33.15,11.1774,39,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,35.139,90.1,,percent of total billed charges,,
BUPIVACAINE HCL 0.25 % (2.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Inpatient,50 mL,mL,,39,33.15,11.1774,39,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
BUPIVACAINE HCL 0.25 % (2.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Both,50 mL,mL,,39,33.15,11.1774,39,"Preferred One Administrative Services, INC.",PPO,38.454,98.6,,percent of total billed charges,,
BUPIVACAINE HCL 0.25 % (2.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Outpatient,50 mL,mL,,39,33.15,11.1774,39,PrimeWest Health,Minnesota Senior Health Options (MSHO),20.0655,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
BUPIVACAINE HCL 0.25 % (2.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Inpatient,50 mL,mL,,39,33.15,11.1774,39,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
BUPIVACAINE HCL 0.25 % (2.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Outpatient,50 mL,mL,,39,33.15,11.1774,39,PrimeWest Health,MinnesotaCare,20.0304,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
BUPIVACAINE HCL 0.25 % (2.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Inpatient,50 mL,mL,,39,33.15,11.1774,39,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
BUPIVACAINE HCL 0.25 % (2.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Both,50 mL,mL,,39,33.15,11.1774,39,Sanford Health Plan,Sanford Health Plan,35.88,92,,percent of total billed charges,,
BUPIVACAINE HCL 0.25 % (2.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Outpatient,50 mL,mL,,39,33.15,11.1774,39,"UCare Health, Inc.",Individual & Family Plan,21.9765,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
BUPIVACAINE HCL 0.25 % (2.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Inpatient,50 mL,mL,,39,33.15,11.1774,39,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
BUPIVACAINE HCL 0.25 % (2.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Outpatient,50 mL,mL,,39,33.15,11.1774,39,"UCare Health, Inc.",Medical Assistance,19.6833,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BUPIVACAINE HCL 0.25 % (2.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Inpatient,50 mL,mL,,39,33.15,11.1774,39,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
BUPIVACAINE HCL 0.25 % (2.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Outpatient,50 mL,mL,,39,33.15,11.1774,39,"UCare Health, Inc.",Medicare Advantage,19.6833,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BUPIVACAINE HCL 0.25 % (2.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Inpatient,50 mL,mL,,39,33.15,11.1774,39,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
BUPIVACAINE HCL 0.25 % (2.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Outpatient,50 mL,mL,,39,33.15,11.1774,39,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),19.6833,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BUPIVACAINE HCL 0.25 % (2.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Inpatient,50 mL,mL,,39,33.15,11.1774,39,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
BUPIVACAINE HCL 0.25 % (2.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Both,50 mL,mL,,39,33.15,11.1774,39,UnitedHealthcare,Individual & Family,36.66,94,,percent of total billed charges,,
BUPIVACAINE HCL 0.25 % (2.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Outpatient,50 mL,mL,,39,33.15,11.1774,39,UnitedHealthcare,Medicare Advantage,19.11,49,,percent of total billed charges,,
BUPIVACAINE HCL 0.25 % (2.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Inpatient,50 mL,mL,,39,33.15,11.1774,39,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
BUPIVACAINE HCL 0.25 % (2.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Outpatient,50 mL,mL,,39,33.15,11.1774,39,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,18.72,48,,percent of total billed charges,,100% of DHS outpatient percentage
BUPIVACAINE HCL 0.25 % (2.5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Inpatient,50 mL,mL,,39,33.15,11.1774,39,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
BUPIVACAINE HCL 0.5 % (5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Both,50 mL,mL,,34,28.9,9.7444,34,Aetna,Commercial,31.28,92,,percent of total billed charges,,
BUPIVACAINE HCL 0.5 % (5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Outpatient,50 mL,mL,,34,28.9,9.7444,34,Aetna,Medicare Advantage,16.66,49,,percent of total billed charges,,
BUPIVACAINE HCL 0.5 % (5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Inpatient,50 mL,mL,,34,28.9,9.7444,34,Aetna,Medicare Advantage,,,,,Included in per diem rate,
BUPIVACAINE HCL 0.5 % (5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Both,50 mL,mL,,34,28.9,9.7444,34,Aetna,PPO,31.62,93,,percent of total billed charges,,
BUPIVACAINE HCL 0.5 % (5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Both,50 mL,mL,,34,28.9,9.7444,34,America's PPO,America's PPO,32.6502,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
BUPIVACAINE HCL 0.5 % (5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Both,50 mL,mL,,34,28.9,9.7444,34,BlueCross BlueShield Minnesota, Federal Employee Program,33.456,98.4,,percent of total billed charges,,
BUPIVACAINE HCL 0.5 % (5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Both,50 mL,mL,,34,28.9,9.7444,34,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,34,100,,percent of total billed charges,,
BUPIVACAINE HCL 0.5 % (5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Both,50 mL,mL,,34,28.9,9.7444,34,BlueCross BlueShield Minnesota,High Value Network Plan,30.6,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
BUPIVACAINE HCL 0.5 % (5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Outpatient,50 mL,mL,,34,28.9,9.7444,34,BlueCross BlueShield Minnesota,Medicare Advantage,16.66,49,,percent of total billed charges,,
BUPIVACAINE HCL 0.5 % (5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Inpatient,50 mL,mL,,34,28.9,9.7444,34,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
BUPIVACAINE HCL 0.5 % (5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Both,50 mL,mL,,34,28.9,9.7444,34,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,30.1138,88.57,,percent of total billed charges,,
BUPIVACAINE HCL 0.5 % (5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Both,50 mL,mL,,34,28.9,9.7444,34,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,9.7444,28.66,,percent of total billed charges,,
BUPIVACAINE HCL 0.5 % (5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Outpatient,50 mL,mL,,34,28.9,9.7444,34,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),16.66,49,,percent of total billed charges,,
BUPIVACAINE HCL 0.5 % (5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Inpatient,50 mL,mL,,34,28.9,9.7444,34,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
BUPIVACAINE HCL 0.5 % (5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Both,50 mL,mL,,34,28.9,9.7444,34,CorVel,Worker's Compensation,34,100,,percent of total billed charges,,
BUPIVACAINE HCL 0.5 % (5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Both,50 mL,mL,,34,28.9,9.7444,34,First Health Group Corporation,First Health Network,32.98,97,,percent of total billed charges,,
BUPIVACAINE HCL 0.5 % (5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Both,50 mL,mL,,34,28.9,9.7444,34,"Health Partners, Inc.",Commercial,32.164,94.6,,percent of total billed charges,,
BUPIVACAINE HCL 0.5 % (5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Outpatient,50 mL,mL,,34,28.9,9.7444,34,"Health Partners, Inc.",Medicare Advantage,16.66,49,,percent of total billed charges,,
BUPIVACAINE HCL 0.5 % (5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Inpatient,50 mL,mL,,34,28.9,9.7444,34,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
BUPIVACAINE HCL 0.5 % (5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Both,50 mL,mL,,34,28.9,9.7444,34,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),20.4,60,,percent of total billed charges,,
BUPIVACAINE HCL 0.5 % (5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Both,50 mL,mL,,34,28.9,9.7444,34,"Health Partners, Inc.",State of Minnesota Advantage Program,27.71,81.5,,percent of total billed charges,,
BUPIVACAINE HCL 0.5 % (5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Both,50 mL,mL,,34,28.9,9.7444,34,"Health Partners, Inc.",State Public Programs,17,50,,percent of total billed charges,,
BUPIVACAINE HCL 0.5 % (5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Both,50 mL,mL,,34,28.9,9.7444,34,Humana Insurance Company,Commercial PPO,32.3,95,,percent of total billed charges,,
BUPIVACAINE HCL 0.5 % (5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Outpatient,50 mL,mL,,34,28.9,9.7444,34,Humana Insurance Company,Medicare PPO,16.66,49,,percent of total billed charges,,
BUPIVACAINE HCL 0.5 % (5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Inpatient,50 mL,mL,,34,28.9,9.7444,34,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
BUPIVACAINE HCL 0.5 % (5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Both,50 mL,mL,,34,28.9,9.7444,34,Medica,Individual & Family,33.694,99.1,,percent of total billed charges,,
BUPIVACAINE HCL 0.5 % (5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Outpatient,50 mL,mL,,34,28.9,9.7444,34,Medica,Medica Advantage Solution,16.932,49.8,,percent of total billed charges,,
BUPIVACAINE HCL 0.5 % (5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Inpatient,50 mL,mL,,34,28.9,9.7444,34,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
BUPIVACAINE HCL 0.5 % (5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Outpatient,50 mL,mL,,34,28.9,9.7444,34,Medica,Medical Assistance,15.164,44.6,,percent of total billed charges,,
BUPIVACAINE HCL 0.5 % (5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Inpatient,50 mL,mL,,34,28.9,9.7444,34,Medica,Medical Assistance,,,,,Included in per diem rate,
BUPIVACAINE HCL 0.5 % (5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Outpatient,50 mL,mL,,34,28.9,9.7444,34,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,16.932,49.8,,percent of total billed charges,,
BUPIVACAINE HCL 0.5 % (5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Inpatient,50 mL,mL,,34,28.9,9.7444,34,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
BUPIVACAINE HCL 0.5 % (5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Both,50 mL,mL,,34,28.9,9.7444,34,"Multiplan, Inc.","Multiplan, Inc.",31.96,94,,percent of total billed charges,,
BUPIVACAINE HCL 0.5 % (5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Outpatient,50 mL,mL,,34,28.9,9.7444,34,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,30.634,90.1,,percent of total billed charges,,
BUPIVACAINE HCL 0.5 % (5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Inpatient,50 mL,mL,,34,28.9,9.7444,34,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
BUPIVACAINE HCL 0.5 % (5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Both,50 mL,mL,,34,28.9,9.7444,34,"Preferred One Administrative Services, INC.",PPO,33.524,98.6,,percent of total billed charges,,
BUPIVACAINE HCL 0.5 % (5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Outpatient,50 mL,mL,,34,28.9,9.7444,34,PrimeWest Health,Minnesota Senior Health Options (MSHO),17.493,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
BUPIVACAINE HCL 0.5 % (5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Inpatient,50 mL,mL,,34,28.9,9.7444,34,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
BUPIVACAINE HCL 0.5 % (5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Outpatient,50 mL,mL,,34,28.9,9.7444,34,PrimeWest Health,MinnesotaCare,17.4624,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
BUPIVACAINE HCL 0.5 % (5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Inpatient,50 mL,mL,,34,28.9,9.7444,34,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
BUPIVACAINE HCL 0.5 % (5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Both,50 mL,mL,,34,28.9,9.7444,34,Sanford Health Plan,Sanford Health Plan,31.28,92,,percent of total billed charges,,
BUPIVACAINE HCL 0.5 % (5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Outpatient,50 mL,mL,,34,28.9,9.7444,34,"UCare Health, Inc.",Individual & Family Plan,19.159,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
BUPIVACAINE HCL 0.5 % (5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Inpatient,50 mL,mL,,34,28.9,9.7444,34,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
BUPIVACAINE HCL 0.5 % (5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Outpatient,50 mL,mL,,34,28.9,9.7444,34,"UCare Health, Inc.",Medical Assistance,17.1598,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BUPIVACAINE HCL 0.5 % (5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Inpatient,50 mL,mL,,34,28.9,9.7444,34,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
BUPIVACAINE HCL 0.5 % (5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Outpatient,50 mL,mL,,34,28.9,9.7444,34,"UCare Health, Inc.",Medicare Advantage,17.1598,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BUPIVACAINE HCL 0.5 % (5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Inpatient,50 mL,mL,,34,28.9,9.7444,34,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
BUPIVACAINE HCL 0.5 % (5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Outpatient,50 mL,mL,,34,28.9,9.7444,34,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),17.1598,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BUPIVACAINE HCL 0.5 % (5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Inpatient,50 mL,mL,,34,28.9,9.7444,34,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
BUPIVACAINE HCL 0.5 % (5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Both,50 mL,mL,,34,28.9,9.7444,34,UnitedHealthcare,Individual & Family,31.96,94,,percent of total billed charges,,
BUPIVACAINE HCL 0.5 % (5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Outpatient,50 mL,mL,,34,28.9,9.7444,34,UnitedHealthcare,Medicare Advantage,16.66,49,,percent of total billed charges,,
BUPIVACAINE HCL 0.5 % (5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Inpatient,50 mL,mL,,34,28.9,9.7444,34,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
BUPIVACAINE HCL 0.5 % (5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Outpatient,50 mL,mL,,34,28.9,9.7444,34,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,16.32,48,,percent of total billed charges,,100% of DHS outpatient percentage
BUPIVACAINE HCL 0.5 % (5 MG/ML) INJ SOLN,,J0665,HCPCS,Facility,Inpatient,50 mL,mL,,34,28.9,9.7444,34,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
CLINDAMYCIN IN 5 % DEXTROSE 300 MG/50 ML IV PGBK,,J0736,HCPCS,Facility,Both,50 mL,mL,,50,42.5,14.33,50,Aetna,Commercial,46,92,,percent of total billed charges,,
CLINDAMYCIN IN 5 % DEXTROSE 300 MG/50 ML IV PGBK,,J0736,HCPCS,Facility,Both,50 mL,mL,,50,42.5,14.33,50,Aetna,Commercial,46,92,,percent of total billed charges,,
CLINDAMYCIN IN 5 % DEXTROSE 300 MG/50 ML IV PGBK,,J0736,HCPCS,Facility,Outpatient,50 mL,mL,,50,42.5,14.33,50,Aetna,Medicare Advantage,24.5,49,,percent of total billed charges,,
CLINDAMYCIN IN 5 % DEXTROSE 300 MG/50 ML IV PGBK,,J0736,HCPCS,Facility,Outpatient,50 mL,mL,,50,42.5,14.33,50,Aetna,Medicare Advantage,24.5,49,,percent of total billed charges,,
CLINDAMYCIN IN 5 % DEXTROSE 300 MG/50 ML IV PGBK,,J0736,HCPCS,Facility,Inpatient,50 mL,mL,,50,42.5,14.33,50,Aetna,Medicare Advantage,,,,,Included in per diem rate,
CLINDAMYCIN IN 5 % DEXTROSE 300 MG/50 ML IV PGBK,,J0736,HCPCS,Facility,Inpatient,50 mL,mL,,50,42.5,14.33,50,Aetna,Medicare Advantage,,,,,Included in per diem rate,
CLINDAMYCIN IN 5 % DEXTROSE 300 MG/50 ML IV PGBK,,J0736,HCPCS,Facility,Both,50 mL,mL,,50,42.5,14.33,50,Aetna,PPO,46.5,93,,percent of total billed charges,,
CLINDAMYCIN IN 5 % DEXTROSE 300 MG/50 ML IV PGBK,,J0736,HCPCS,Facility,Both,50 mL,mL,,50,42.5,14.33,50,Aetna,PPO,46.5,93,,percent of total billed charges,,
CLINDAMYCIN IN 5 % DEXTROSE 300 MG/50 ML IV PGBK,,J0736,HCPCS,Facility,Both,50 mL,mL,,50,42.5,14.33,50,America's PPO,America's PPO,48.015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
CLINDAMYCIN IN 5 % DEXTROSE 300 MG/50 ML IV PGBK,,J0736,HCPCS,Facility,Both,50 mL,mL,,50,42.5,14.33,50,America's PPO,America's PPO,48.015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
CLINDAMYCIN IN 5 % DEXTROSE 300 MG/50 ML IV PGBK,,J0736,HCPCS,Facility,Both,50 mL,mL,,50,42.5,14.33,50,BlueCross BlueShield Minnesota, Federal Employee Program,49.2,98.4,,percent of total billed charges,,
CLINDAMYCIN IN 5 % DEXTROSE 300 MG/50 ML IV PGBK,,J0736,HCPCS,Facility,Both,50 mL,mL,,50,42.5,14.33,50,BlueCross BlueShield Minnesota, Federal Employee Program,49.2,98.4,,percent of total billed charges,,
CLINDAMYCIN IN 5 % DEXTROSE 300 MG/50 ML IV PGBK,,J0736,HCPCS,Facility,Both,50 mL,mL,,50,42.5,14.33,50,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,50,100,,percent of total billed charges,,
CLINDAMYCIN IN 5 % DEXTROSE 300 MG/50 ML IV PGBK,,J0736,HCPCS,Facility,Both,50 mL,mL,,50,42.5,14.33,50,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,50,100,,percent of total billed charges,,
CLINDAMYCIN IN 5 % DEXTROSE 300 MG/50 ML IV PGBK,,J0736,HCPCS,Facility,Both,50 mL,mL,,50,42.5,14.33,50,BlueCross BlueShield Minnesota,High Value Network Plan,45,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
CLINDAMYCIN IN 5 % DEXTROSE 300 MG/50 ML IV PGBK,,J0736,HCPCS,Facility,Both,50 mL,mL,,50,42.5,14.33,50,BlueCross BlueShield Minnesota,High Value Network Plan,45,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
CLINDAMYCIN IN 5 % DEXTROSE 300 MG/50 ML IV PGBK,,J0736,HCPCS,Facility,Outpatient,50 mL,mL,,50,42.5,14.33,50,BlueCross BlueShield Minnesota,Medicare Advantage,24.5,49,,percent of total billed charges,,
CLINDAMYCIN IN 5 % DEXTROSE 300 MG/50 ML IV PGBK,,J0736,HCPCS,Facility,Outpatient,50 mL,mL,,50,42.5,14.33,50,BlueCross BlueShield Minnesota,Medicare Advantage,24.5,49,,percent of total billed charges,,
CLINDAMYCIN IN 5 % DEXTROSE 300 MG/50 ML IV PGBK,,J0736,HCPCS,Facility,Inpatient,50 mL,mL,,50,42.5,14.33,50,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
CLINDAMYCIN IN 5 % DEXTROSE 300 MG/50 ML IV PGBK,,J0736,HCPCS,Facility,Inpatient,50 mL,mL,,50,42.5,14.33,50,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
CLINDAMYCIN IN 5 % DEXTROSE 300 MG/50 ML IV PGBK,,J0736,HCPCS,Facility,Both,50 mL,mL,,50,42.5,14.33,50,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,44.285,88.57,,percent of total billed charges,,
CLINDAMYCIN IN 5 % DEXTROSE 300 MG/50 ML IV PGBK,,J0736,HCPCS,Facility,Both,50 mL,mL,,50,42.5,14.33,50,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,44.285,88.57,,percent of total billed charges,,
CLINDAMYCIN IN 5 % DEXTROSE 300 MG/50 ML IV PGBK,,J0736,HCPCS,Facility,Both,50 mL,mL,,50,42.5,14.33,50,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,14.33,28.66,,percent of total billed charges,,
CLINDAMYCIN IN 5 % DEXTROSE 300 MG/50 ML IV PGBK,,J0736,HCPCS,Facility,Both,50 mL,mL,,50,42.5,14.33,50,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,14.33,28.66,,percent of total billed charges,,
CLINDAMYCIN IN 5 % DEXTROSE 300 MG/50 ML IV PGBK,,J0736,HCPCS,Facility,Outpatient,50 mL,mL,,50,42.5,14.33,50,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),24.5,49,,percent of total billed charges,,
CLINDAMYCIN IN 5 % DEXTROSE 300 MG/50 ML IV PGBK,,J0736,HCPCS,Facility,Outpatient,50 mL,mL,,50,42.5,14.33,50,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),24.5,49,,percent of total billed charges,,
CLINDAMYCIN IN 5 % DEXTROSE 300 MG/50 ML IV PGBK,,J0736,HCPCS,Facility,Inpatient,50 mL,mL,,50,42.5,14.33,50,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
CLINDAMYCIN IN 5 % DEXTROSE 300 MG/50 ML IV PGBK,,J0736,HCPCS,Facility,Inpatient,50 mL,mL,,50,42.5,14.33,50,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
CLINDAMYCIN IN 5 % DEXTROSE 300 MG/50 ML IV PGBK,,J0736,HCPCS,Facility,Both,50 mL,mL,,50,42.5,14.33,50,CorVel,Worker's Compensation,50,100,,percent of total billed charges,,
CLINDAMYCIN IN 5 % DEXTROSE 300 MG/50 ML IV PGBK,,J0736,HCPCS,Facility,Both,50 mL,mL,,50,42.5,14.33,50,CorVel,Worker's Compensation,50,100,,percent of total billed charges,,
CLINDAMYCIN IN 5 % DEXTROSE 300 MG/50 ML IV PGBK,,J0736,HCPCS,Facility,Both,50 mL,mL,,50,42.5,14.33,50,First Health Group Corporation,First Health Network,48.5,97,,percent of total billed charges,,
CLINDAMYCIN IN 5 % DEXTROSE 300 MG/50 ML IV PGBK,,J0736,HCPCS,Facility,Both,50 mL,mL,,50,42.5,14.33,50,First Health Group Corporation,First Health Network,48.5,97,,percent of total billed charges,,
CLINDAMYCIN IN 5 % DEXTROSE 300 MG/50 ML IV PGBK,,J0736,HCPCS,Facility,Both,50 mL,mL,,50,42.5,14.33,50,"Health Partners, Inc.",Commercial,47.3,94.6,,percent of total billed charges,,
CLINDAMYCIN IN 5 % DEXTROSE 300 MG/50 ML IV PGBK,,J0736,HCPCS,Facility,Both,50 mL,mL,,50,42.5,14.33,50,"Health Partners, Inc.",Commercial,47.3,94.6,,percent of total billed charges,,
CLINDAMYCIN IN 5 % DEXTROSE 300 MG/50 ML IV PGBK,,J0736,HCPCS,Facility,Outpatient,50 mL,mL,,50,42.5,14.33,50,"Health Partners, Inc.",Medicare Advantage,24.5,49,,percent of total billed charges,,
CLINDAMYCIN IN 5 % DEXTROSE 300 MG/50 ML IV PGBK,,J0736,HCPCS,Facility,Outpatient,50 mL,mL,,50,42.5,14.33,50,"Health Partners, Inc.",Medicare Advantage,24.5,49,,percent of total billed charges,,
CLINDAMYCIN IN 5 % DEXTROSE 300 MG/50 ML IV PGBK,,J0736,HCPCS,Facility,Inpatient,50 mL,mL,,50,42.5,14.33,50,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CLINDAMYCIN IN 5 % DEXTROSE 300 MG/50 ML IV PGBK,,J0736,HCPCS,Facility,Inpatient,50 mL,mL,,50,42.5,14.33,50,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CLINDAMYCIN IN 5 % DEXTROSE 300 MG/50 ML IV PGBK,,J0736,HCPCS,Facility,Both,50 mL,mL,,50,42.5,14.33,50,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),30,60,,percent of total billed charges,,
CLINDAMYCIN IN 5 % DEXTROSE 300 MG/50 ML IV PGBK,,J0736,HCPCS,Facility,Both,50 mL,mL,,50,42.5,14.33,50,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),30,60,,percent of total billed charges,,
CLINDAMYCIN IN 5 % DEXTROSE 300 MG/50 ML IV PGBK,,J0736,HCPCS,Facility,Both,50 mL,mL,,50,42.5,14.33,50,"Health Partners, Inc.",State of Minnesota Advantage Program,40.75,81.5,,percent of total billed charges,,
CLINDAMYCIN IN 5 % DEXTROSE 300 MG/50 ML IV PGBK,,J0736,HCPCS,Facility,Both,50 mL,mL,,50,42.5,14.33,50,"Health Partners, Inc.",State of Minnesota Advantage Program,40.75,81.5,,percent of total billed charges,,
CLINDAMYCIN IN 5 % DEXTROSE 300 MG/50 ML IV PGBK,,J0736,HCPCS,Facility,Both,50 mL,mL,,50,42.5,14.33,50,"Health Partners, Inc.",State Public Programs,25,50,,percent of total billed charges,,
CLINDAMYCIN IN 5 % DEXTROSE 300 MG/50 ML IV PGBK,,J0736,HCPCS,Facility,Both,50 mL,mL,,50,42.5,14.33,50,"Health Partners, Inc.",State Public Programs,25,50,,percent of total billed charges,,
CLINDAMYCIN IN 5 % DEXTROSE 300 MG/50 ML IV PGBK,,J0736,HCPCS,Facility,Both,50 mL,mL,,50,42.5,14.33,50,Humana Insurance Company,Commercial PPO,47.5,95,,percent of total billed charges,,
CLINDAMYCIN IN 5 % DEXTROSE 300 MG/50 ML IV PGBK,,J0736,HCPCS,Facility,Both,50 mL,mL,,50,42.5,14.33,50,Humana Insurance Company,Commercial PPO,47.5,95,,percent of total billed charges,,
CLINDAMYCIN IN 5 % DEXTROSE 300 MG/50 ML IV PGBK,,J0736,HCPCS,Facility,Outpatient,50 mL,mL,,50,42.5,14.33,50,Humana Insurance Company,Medicare PPO,24.5,49,,percent of total billed charges,,
CLINDAMYCIN IN 5 % DEXTROSE 300 MG/50 ML IV PGBK,,J0736,HCPCS,Facility,Outpatient,50 mL,mL,,50,42.5,14.33,50,Humana Insurance Company,Medicare PPO,24.5,49,,percent of total billed charges,,
CLINDAMYCIN IN 5 % DEXTROSE 300 MG/50 ML IV PGBK,,J0736,HCPCS,Facility,Inpatient,50 mL,mL,,50,42.5,14.33,50,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
CLINDAMYCIN IN 5 % DEXTROSE 300 MG/50 ML IV PGBK,,J0736,HCPCS,Facility,Inpatient,50 mL,mL,,50,42.5,14.33,50,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
CLINDAMYCIN IN 5 % DEXTROSE 300 MG/50 ML IV PGBK,,J0736,HCPCS,Facility,Both,50 mL,mL,,50,42.5,14.33,50,Medica,Individual & Family,49.55,99.1,,percent of total billed charges,,
CLINDAMYCIN IN 5 % DEXTROSE 300 MG/50 ML IV PGBK,,J0736,HCPCS,Facility,Both,50 mL,mL,,50,42.5,14.33,50,Medica,Individual & Family,49.55,99.1,,percent of total billed charges,,
CLINDAMYCIN IN 5 % DEXTROSE 300 MG/50 ML IV PGBK,,J0736,HCPCS,Facility,Outpatient,50 mL,mL,,50,42.5,14.33,50,Medica,Medica Advantage Solution,24.9,49.8,,percent of total billed charges,,
CLINDAMYCIN IN 5 % DEXTROSE 300 MG/50 ML IV PGBK,,J0736,HCPCS,Facility,Outpatient,50 mL,mL,,50,42.5,14.33,50,Medica,Medica Advantage Solution,24.9,49.8,,percent of total billed charges,,
CLINDAMYCIN IN 5 % DEXTROSE 300 MG/50 ML IV PGBK,,J0736,HCPCS,Facility,Inpatient,50 mL,mL,,50,42.5,14.33,50,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
CLINDAMYCIN IN 5 % DEXTROSE 300 MG/50 ML IV PGBK,,J0736,HCPCS,Facility,Inpatient,50 mL,mL,,50,42.5,14.33,50,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
CLINDAMYCIN IN 5 % DEXTROSE 300 MG/50 ML IV PGBK,,J0736,HCPCS,Facility,Outpatient,50 mL,mL,,50,42.5,14.33,50,Medica,Medical Assistance,22.3,44.6,,percent of total billed charges,,
CLINDAMYCIN IN 5 % DEXTROSE 300 MG/50 ML IV PGBK,,J0736,HCPCS,Facility,Outpatient,50 mL,mL,,50,42.5,14.33,50,Medica,Medical Assistance,22.3,44.6,,percent of total billed charges,,
CLINDAMYCIN IN 5 % DEXTROSE 300 MG/50 ML IV PGBK,,J0736,HCPCS,Facility,Inpatient,50 mL,mL,,50,42.5,14.33,50,Medica,Medical Assistance,,,,,Included in per diem rate,
CLINDAMYCIN IN 5 % DEXTROSE 300 MG/50 ML IV PGBK,,J0736,HCPCS,Facility,Inpatient,50 mL,mL,,50,42.5,14.33,50,Medica,Medical Assistance,,,,,Included in per diem rate,
CLINDAMYCIN IN 5 % DEXTROSE 300 MG/50 ML IV PGBK,,J0736,HCPCS,Facility,Outpatient,50 mL,mL,,50,42.5,14.33,50,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,24.9,49.8,,percent of total billed charges,,
CLINDAMYCIN IN 5 % DEXTROSE 300 MG/50 ML IV PGBK,,J0736,HCPCS,Facility,Outpatient,50 mL,mL,,50,42.5,14.33,50,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,24.9,49.8,,percent of total billed charges,,
CLINDAMYCIN IN 5 % DEXTROSE 300 MG/50 ML IV PGBK,,J0736,HCPCS,Facility,Inpatient,50 mL,mL,,50,42.5,14.33,50,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
CLINDAMYCIN IN 5 % DEXTROSE 300 MG/50 ML IV PGBK,,J0736,HCPCS,Facility,Inpatient,50 mL,mL,,50,42.5,14.33,50,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
CLINDAMYCIN IN 5 % DEXTROSE 300 MG/50 ML IV PGBK,,J0736,HCPCS,Facility,Both,50 mL,mL,,50,42.5,14.33,50,"Multiplan, Inc.","Multiplan, Inc.",47,94,,percent of total billed charges,,
CLINDAMYCIN IN 5 % DEXTROSE 300 MG/50 ML IV PGBK,,J0736,HCPCS,Facility,Both,50 mL,mL,,50,42.5,14.33,50,"Multiplan, Inc.","Multiplan, Inc.",47,94,,percent of total billed charges,,
CLINDAMYCIN IN 5 % DEXTROSE 300 MG/50 ML IV PGBK,,J0736,HCPCS,Facility,Outpatient,50 mL,mL,,50,42.5,14.33,50,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,45.05,90.1,,percent of total billed charges,,
CLINDAMYCIN IN 5 % DEXTROSE 300 MG/50 ML IV PGBK,,J0736,HCPCS,Facility,Outpatient,50 mL,mL,,50,42.5,14.33,50,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,45.05,90.1,,percent of total billed charges,,
CLINDAMYCIN IN 5 % DEXTROSE 300 MG/50 ML IV PGBK,,J0736,HCPCS,Facility,Inpatient,50 mL,mL,,50,42.5,14.33,50,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
CLINDAMYCIN IN 5 % DEXTROSE 300 MG/50 ML IV PGBK,,J0736,HCPCS,Facility,Inpatient,50 mL,mL,,50,42.5,14.33,50,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
CLINDAMYCIN IN 5 % DEXTROSE 300 MG/50 ML IV PGBK,,J0736,HCPCS,Facility,Both,50 mL,mL,,50,42.5,14.33,50,"Preferred One Administrative Services, INC.",PPO,49.3,98.6,,percent of total billed charges,,
CLINDAMYCIN IN 5 % DEXTROSE 300 MG/50 ML IV PGBK,,J0736,HCPCS,Facility,Both,50 mL,mL,,50,42.5,14.33,50,"Preferred One Administrative Services, INC.",PPO,49.3,98.6,,percent of total billed charges,,
CLINDAMYCIN IN 5 % DEXTROSE 300 MG/50 ML IV PGBK,,J0736,HCPCS,Facility,Outpatient,50 mL,mL,,50,42.5,14.33,50,PrimeWest Health,Minnesota Senior Health Options (MSHO),25.725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
CLINDAMYCIN IN 5 % DEXTROSE 300 MG/50 ML IV PGBK,,J0736,HCPCS,Facility,Outpatient,50 mL,mL,,50,42.5,14.33,50,PrimeWest Health,Minnesota Senior Health Options (MSHO),25.725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
CLINDAMYCIN IN 5 % DEXTROSE 300 MG/50 ML IV PGBK,,J0736,HCPCS,Facility,Inpatient,50 mL,mL,,50,42.5,14.33,50,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CLINDAMYCIN IN 5 % DEXTROSE 300 MG/50 ML IV PGBK,,J0736,HCPCS,Facility,Inpatient,50 mL,mL,,50,42.5,14.33,50,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CLINDAMYCIN IN 5 % DEXTROSE 300 MG/50 ML IV PGBK,,J0736,HCPCS,Facility,Outpatient,50 mL,mL,,50,42.5,14.33,50,PrimeWest Health,MinnesotaCare,25.68,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
CLINDAMYCIN IN 5 % DEXTROSE 300 MG/50 ML IV PGBK,,J0736,HCPCS,Facility,Outpatient,50 mL,mL,,50,42.5,14.33,50,PrimeWest Health,MinnesotaCare,25.68,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
CLINDAMYCIN IN 5 % DEXTROSE 300 MG/50 ML IV PGBK,,J0736,HCPCS,Facility,Inpatient,50 mL,mL,,50,42.5,14.33,50,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
CLINDAMYCIN IN 5 % DEXTROSE 300 MG/50 ML IV PGBK,,J0736,HCPCS,Facility,Inpatient,50 mL,mL,,50,42.5,14.33,50,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
CLINDAMYCIN IN 5 % DEXTROSE 300 MG/50 ML IV PGBK,,J0736,HCPCS,Facility,Both,50 mL,mL,,50,42.5,14.33,50,Sanford Health Plan,Sanford Health Plan,46,92,,percent of total billed charges,,
CLINDAMYCIN IN 5 % DEXTROSE 300 MG/50 ML IV PGBK,,J0736,HCPCS,Facility,Both,50 mL,mL,,50,42.5,14.33,50,Sanford Health Plan,Sanford Health Plan,46,92,,percent of total billed charges,,
CLINDAMYCIN IN 5 % DEXTROSE 300 MG/50 ML IV PGBK,,J0736,HCPCS,Facility,Outpatient,50 mL,mL,,50,42.5,14.33,50,"UCare Health, Inc.",Individual & Family Plan,28.175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
CLINDAMYCIN IN 5 % DEXTROSE 300 MG/50 ML IV PGBK,,J0736,HCPCS,Facility,Outpatient,50 mL,mL,,50,42.5,14.33,50,"UCare Health, Inc.",Individual & Family Plan,28.175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
CLINDAMYCIN IN 5 % DEXTROSE 300 MG/50 ML IV PGBK,,J0736,HCPCS,Facility,Inpatient,50 mL,mL,,50,42.5,14.33,50,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
CLINDAMYCIN IN 5 % DEXTROSE 300 MG/50 ML IV PGBK,,J0736,HCPCS,Facility,Inpatient,50 mL,mL,,50,42.5,14.33,50,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
CLINDAMYCIN IN 5 % DEXTROSE 300 MG/50 ML IV PGBK,,J0736,HCPCS,Facility,Outpatient,50 mL,mL,,50,42.5,14.33,50,"UCare Health, Inc.",Medical Assistance,25.235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CLINDAMYCIN IN 5 % DEXTROSE 300 MG/50 ML IV PGBK,,J0736,HCPCS,Facility,Outpatient,50 mL,mL,,50,42.5,14.33,50,"UCare Health, Inc.",Medical Assistance,25.235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CLINDAMYCIN IN 5 % DEXTROSE 300 MG/50 ML IV PGBK,,J0736,HCPCS,Facility,Inpatient,50 mL,mL,,50,42.5,14.33,50,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
CLINDAMYCIN IN 5 % DEXTROSE 300 MG/50 ML IV PGBK,,J0736,HCPCS,Facility,Inpatient,50 mL,mL,,50,42.5,14.33,50,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
CLINDAMYCIN IN 5 % DEXTROSE 300 MG/50 ML IV PGBK,,J0736,HCPCS,Facility,Outpatient,50 mL,mL,,50,42.5,14.33,50,"UCare Health, Inc.",Medicare Advantage,25.235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CLINDAMYCIN IN 5 % DEXTROSE 300 MG/50 ML IV PGBK,,J0736,HCPCS,Facility,Outpatient,50 mL,mL,,50,42.5,14.33,50,"UCare Health, Inc.",Medicare Advantage,25.235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CLINDAMYCIN IN 5 % DEXTROSE 300 MG/50 ML IV PGBK,,J0736,HCPCS,Facility,Inpatient,50 mL,mL,,50,42.5,14.33,50,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CLINDAMYCIN IN 5 % DEXTROSE 300 MG/50 ML IV PGBK,,J0736,HCPCS,Facility,Inpatient,50 mL,mL,,50,42.5,14.33,50,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CLINDAMYCIN IN 5 % DEXTROSE 300 MG/50 ML IV PGBK,,J0736,HCPCS,Facility,Outpatient,50 mL,mL,,50,42.5,14.33,50,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),25.235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CLINDAMYCIN IN 5 % DEXTROSE 300 MG/50 ML IV PGBK,,J0736,HCPCS,Facility,Outpatient,50 mL,mL,,50,42.5,14.33,50,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),25.235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CLINDAMYCIN IN 5 % DEXTROSE 300 MG/50 ML IV PGBK,,J0736,HCPCS,Facility,Inpatient,50 mL,mL,,50,42.5,14.33,50,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CLINDAMYCIN IN 5 % DEXTROSE 300 MG/50 ML IV PGBK,,J0736,HCPCS,Facility,Inpatient,50 mL,mL,,50,42.5,14.33,50,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CLINDAMYCIN IN 5 % DEXTROSE 300 MG/50 ML IV PGBK,,J0736,HCPCS,Facility,Both,50 mL,mL,,50,42.5,14.33,50,UnitedHealthcare,Individual & Family,47,94,,percent of total billed charges,,
CLINDAMYCIN IN 5 % DEXTROSE 300 MG/50 ML IV PGBK,,J0736,HCPCS,Facility,Both,50 mL,mL,,50,42.5,14.33,50,UnitedHealthcare,Individual & Family,47,94,,percent of total billed charges,,
CLINDAMYCIN IN 5 % DEXTROSE 300 MG/50 ML IV PGBK,,J0736,HCPCS,Facility,Outpatient,50 mL,mL,,50,42.5,14.33,50,UnitedHealthcare,Medicare Advantage,24.5,49,,percent of total billed charges,,
CLINDAMYCIN IN 5 % DEXTROSE 300 MG/50 ML IV PGBK,,J0736,HCPCS,Facility,Outpatient,50 mL,mL,,50,42.5,14.33,50,UnitedHealthcare,Medicare Advantage,24.5,49,,percent of total billed charges,,
CLINDAMYCIN IN 5 % DEXTROSE 300 MG/50 ML IV PGBK,,J0736,HCPCS,Facility,Inpatient,50 mL,mL,,50,42.5,14.33,50,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
CLINDAMYCIN IN 5 % DEXTROSE 300 MG/50 ML IV PGBK,,J0736,HCPCS,Facility,Inpatient,50 mL,mL,,50,42.5,14.33,50,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
CLINDAMYCIN IN 5 % DEXTROSE 300 MG/50 ML IV PGBK,,J0736,HCPCS,Facility,Outpatient,50 mL,mL,,50,42.5,14.33,50,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,24,48,,percent of total billed charges,,100% of DHS outpatient percentage
CLINDAMYCIN IN 5 % DEXTROSE 300 MG/50 ML IV PGBK,,J0736,HCPCS,Facility,Outpatient,50 mL,mL,,50,42.5,14.33,50,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,24,48,,percent of total billed charges,,100% of DHS outpatient percentage
CLINDAMYCIN IN 5 % DEXTROSE 300 MG/50 ML IV PGBK,,J0736,HCPCS,Facility,Inpatient,50 mL,mL,,50,42.5,14.33,50,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
CLINDAMYCIN IN 5 % DEXTROSE 300 MG/50 ML IV PGBK,,J0736,HCPCS,Facility,Inpatient,50 mL,mL,,50,42.5,14.33,50,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
LEVOFLOXACIN IN D5W 250 MG/50 ML IV PGBK,,J1956,HCPCS,Facility,Both,50 mL,mL,,24,20.4,6.8784,24,Aetna,Commercial,22.08,92,,percent of total billed charges,,
LEVOFLOXACIN IN D5W 250 MG/50 ML IV PGBK,,J1956,HCPCS,Facility,Outpatient,50 mL,mL,,24,20.4,6.8784,24,Aetna,Medicare Advantage,11.76,49,,percent of total billed charges,,
LEVOFLOXACIN IN D5W 250 MG/50 ML IV PGBK,,J1956,HCPCS,Facility,Inpatient,50 mL,mL,,24,20.4,6.8784,24,Aetna,Medicare Advantage,,,,,Included in per diem rate,
LEVOFLOXACIN IN D5W 250 MG/50 ML IV PGBK,,J1956,HCPCS,Facility,Both,50 mL,mL,,24,20.4,6.8784,24,Aetna,PPO,22.32,93,,percent of total billed charges,,
LEVOFLOXACIN IN D5W 250 MG/50 ML IV PGBK,,J1956,HCPCS,Facility,Both,50 mL,mL,,24,20.4,6.8784,24,America's PPO,America's PPO,23.0472,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
LEVOFLOXACIN IN D5W 250 MG/50 ML IV PGBK,,J1956,HCPCS,Facility,Both,50 mL,mL,,24,20.4,6.8784,24,BlueCross BlueShield Minnesota, Federal Employee Program,23.616,98.4,,percent of total billed charges,,
LEVOFLOXACIN IN D5W 250 MG/50 ML IV PGBK,,J1956,HCPCS,Facility,Both,50 mL,mL,,24,20.4,6.8784,24,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,24,100,,percent of total billed charges,,
LEVOFLOXACIN IN D5W 250 MG/50 ML IV PGBK,,J1956,HCPCS,Facility,Both,50 mL,mL,,24,20.4,6.8784,24,BlueCross BlueShield Minnesota,High Value Network Plan,21.6,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
LEVOFLOXACIN IN D5W 250 MG/50 ML IV PGBK,,J1956,HCPCS,Facility,Outpatient,50 mL,mL,,24,20.4,6.8784,24,BlueCross BlueShield Minnesota,Medicare Advantage,11.76,49,,percent of total billed charges,,
LEVOFLOXACIN IN D5W 250 MG/50 ML IV PGBK,,J1956,HCPCS,Facility,Inpatient,50 mL,mL,,24,20.4,6.8784,24,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
LEVOFLOXACIN IN D5W 250 MG/50 ML IV PGBK,,J1956,HCPCS,Facility,Both,50 mL,mL,,24,20.4,6.8784,24,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,21.2568,88.57,,percent of total billed charges,,
LEVOFLOXACIN IN D5W 250 MG/50 ML IV PGBK,,J1956,HCPCS,Facility,Both,50 mL,mL,,24,20.4,6.8784,24,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,6.8784,28.66,,percent of total billed charges,,
LEVOFLOXACIN IN D5W 250 MG/50 ML IV PGBK,,J1956,HCPCS,Facility,Outpatient,50 mL,mL,,24,20.4,6.8784,24,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),11.76,49,,percent of total billed charges,,
LEVOFLOXACIN IN D5W 250 MG/50 ML IV PGBK,,J1956,HCPCS,Facility,Inpatient,50 mL,mL,,24,20.4,6.8784,24,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
LEVOFLOXACIN IN D5W 250 MG/50 ML IV PGBK,,J1956,HCPCS,Facility,Both,50 mL,mL,,24,20.4,6.8784,24,CorVel,Worker's Compensation,24,100,,percent of total billed charges,,
LEVOFLOXACIN IN D5W 250 MG/50 ML IV PGBK,,J1956,HCPCS,Facility,Both,50 mL,mL,,24,20.4,6.8784,24,First Health Group Corporation,First Health Network,23.28,97,,percent of total billed charges,,
LEVOFLOXACIN IN D5W 250 MG/50 ML IV PGBK,,J1956,HCPCS,Facility,Both,50 mL,mL,,24,20.4,6.8784,24,"Health Partners, Inc.",Commercial,22.704,94.6,,percent of total billed charges,,
LEVOFLOXACIN IN D5W 250 MG/50 ML IV PGBK,,J1956,HCPCS,Facility,Outpatient,50 mL,mL,,24,20.4,6.8784,24,"Health Partners, Inc.",Medicare Advantage,11.76,49,,percent of total billed charges,,
LEVOFLOXACIN IN D5W 250 MG/50 ML IV PGBK,,J1956,HCPCS,Facility,Inpatient,50 mL,mL,,24,20.4,6.8784,24,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LEVOFLOXACIN IN D5W 250 MG/50 ML IV PGBK,,J1956,HCPCS,Facility,Both,50 mL,mL,,24,20.4,6.8784,24,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),14.4,60,,percent of total billed charges,,
LEVOFLOXACIN IN D5W 250 MG/50 ML IV PGBK,,J1956,HCPCS,Facility,Both,50 mL,mL,,24,20.4,6.8784,24,"Health Partners, Inc.",State of Minnesota Advantage Program,19.56,81.5,,percent of total billed charges,,
LEVOFLOXACIN IN D5W 250 MG/50 ML IV PGBK,,J1956,HCPCS,Facility,Both,50 mL,mL,,24,20.4,6.8784,24,"Health Partners, Inc.",State Public Programs,12,50,,percent of total billed charges,,
LEVOFLOXACIN IN D5W 250 MG/50 ML IV PGBK,,J1956,HCPCS,Facility,Both,50 mL,mL,,24,20.4,6.8784,24,Humana Insurance Company,Commercial PPO,22.8,95,,percent of total billed charges,,
LEVOFLOXACIN IN D5W 250 MG/50 ML IV PGBK,,J1956,HCPCS,Facility,Outpatient,50 mL,mL,,24,20.4,6.8784,24,Humana Insurance Company,Medicare PPO,11.76,49,,percent of total billed charges,,
LEVOFLOXACIN IN D5W 250 MG/50 ML IV PGBK,,J1956,HCPCS,Facility,Inpatient,50 mL,mL,,24,20.4,6.8784,24,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
LEVOFLOXACIN IN D5W 250 MG/50 ML IV PGBK,,J1956,HCPCS,Facility,Both,50 mL,mL,,24,20.4,6.8784,24,Medica,Individual & Family,23.784,99.1,,percent of total billed charges,,
LEVOFLOXACIN IN D5W 250 MG/50 ML IV PGBK,,J1956,HCPCS,Facility,Outpatient,50 mL,mL,,24,20.4,6.8784,24,Medica,Medica Advantage Solution,11.952,49.8,,percent of total billed charges,,
LEVOFLOXACIN IN D5W 250 MG/50 ML IV PGBK,,J1956,HCPCS,Facility,Inpatient,50 mL,mL,,24,20.4,6.8784,24,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
LEVOFLOXACIN IN D5W 250 MG/50 ML IV PGBK,,J1956,HCPCS,Facility,Outpatient,50 mL,mL,,24,20.4,6.8784,24,Medica,Medical Assistance,10.704,44.6,,percent of total billed charges,,
LEVOFLOXACIN IN D5W 250 MG/50 ML IV PGBK,,J1956,HCPCS,Facility,Inpatient,50 mL,mL,,24,20.4,6.8784,24,Medica,Medical Assistance,,,,,Included in per diem rate,
LEVOFLOXACIN IN D5W 250 MG/50 ML IV PGBK,,J1956,HCPCS,Facility,Outpatient,50 mL,mL,,24,20.4,6.8784,24,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,11.952,49.8,,percent of total billed charges,,
LEVOFLOXACIN IN D5W 250 MG/50 ML IV PGBK,,J1956,HCPCS,Facility,Inpatient,50 mL,mL,,24,20.4,6.8784,24,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
LEVOFLOXACIN IN D5W 250 MG/50 ML IV PGBK,,J1956,HCPCS,Facility,Both,50 mL,mL,,24,20.4,6.8784,24,"Multiplan, Inc.","Multiplan, Inc.",22.56,94,,percent of total billed charges,,
LEVOFLOXACIN IN D5W 250 MG/50 ML IV PGBK,,J1956,HCPCS,Facility,Outpatient,50 mL,mL,,24,20.4,6.8784,24,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,21.624,90.1,,percent of total billed charges,,
LEVOFLOXACIN IN D5W 250 MG/50 ML IV PGBK,,J1956,HCPCS,Facility,Inpatient,50 mL,mL,,24,20.4,6.8784,24,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
LEVOFLOXACIN IN D5W 250 MG/50 ML IV PGBK,,J1956,HCPCS,Facility,Both,50 mL,mL,,24,20.4,6.8784,24,"Preferred One Administrative Services, INC.",PPO,23.664,98.6,,percent of total billed charges,,
LEVOFLOXACIN IN D5W 250 MG/50 ML IV PGBK,,J1956,HCPCS,Facility,Outpatient,50 mL,mL,,24,20.4,6.8784,24,PrimeWest Health,Minnesota Senior Health Options (MSHO),12.348,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
LEVOFLOXACIN IN D5W 250 MG/50 ML IV PGBK,,J1956,HCPCS,Facility,Inpatient,50 mL,mL,,24,20.4,6.8784,24,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LEVOFLOXACIN IN D5W 250 MG/50 ML IV PGBK,,J1956,HCPCS,Facility,Outpatient,50 mL,mL,,24,20.4,6.8784,24,PrimeWest Health,MinnesotaCare,12.3264,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
LEVOFLOXACIN IN D5W 250 MG/50 ML IV PGBK,,J1956,HCPCS,Facility,Inpatient,50 mL,mL,,24,20.4,6.8784,24,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
LEVOFLOXACIN IN D5W 250 MG/50 ML IV PGBK,,J1956,HCPCS,Facility,Both,50 mL,mL,,24,20.4,6.8784,24,Sanford Health Plan,Sanford Health Plan,22.08,92,,percent of total billed charges,,
LEVOFLOXACIN IN D5W 250 MG/50 ML IV PGBK,,J1956,HCPCS,Facility,Outpatient,50 mL,mL,,24,20.4,6.8784,24,"UCare Health, Inc.",Individual & Family Plan,13.524,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
LEVOFLOXACIN IN D5W 250 MG/50 ML IV PGBK,,J1956,HCPCS,Facility,Inpatient,50 mL,mL,,24,20.4,6.8784,24,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
LEVOFLOXACIN IN D5W 250 MG/50 ML IV PGBK,,J1956,HCPCS,Facility,Outpatient,50 mL,mL,,24,20.4,6.8784,24,"UCare Health, Inc.",Medical Assistance,12.1128,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LEVOFLOXACIN IN D5W 250 MG/50 ML IV PGBK,,J1956,HCPCS,Facility,Inpatient,50 mL,mL,,24,20.4,6.8784,24,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
LEVOFLOXACIN IN D5W 250 MG/50 ML IV PGBK,,J1956,HCPCS,Facility,Outpatient,50 mL,mL,,24,20.4,6.8784,24,"UCare Health, Inc.",Medicare Advantage,12.1128,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LEVOFLOXACIN IN D5W 250 MG/50 ML IV PGBK,,J1956,HCPCS,Facility,Inpatient,50 mL,mL,,24,20.4,6.8784,24,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LEVOFLOXACIN IN D5W 250 MG/50 ML IV PGBK,,J1956,HCPCS,Facility,Outpatient,50 mL,mL,,24,20.4,6.8784,24,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),12.1128,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LEVOFLOXACIN IN D5W 250 MG/50 ML IV PGBK,,J1956,HCPCS,Facility,Inpatient,50 mL,mL,,24,20.4,6.8784,24,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LEVOFLOXACIN IN D5W 250 MG/50 ML IV PGBK,,J1956,HCPCS,Facility,Both,50 mL,mL,,24,20.4,6.8784,24,UnitedHealthcare,Individual & Family,22.56,94,,percent of total billed charges,,
LEVOFLOXACIN IN D5W 250 MG/50 ML IV PGBK,,J1956,HCPCS,Facility,Outpatient,50 mL,mL,,24,20.4,6.8784,24,UnitedHealthcare,Medicare Advantage,11.76,49,,percent of total billed charges,,
LEVOFLOXACIN IN D5W 250 MG/50 ML IV PGBK,,J1956,HCPCS,Facility,Inpatient,50 mL,mL,,24,20.4,6.8784,24,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
LEVOFLOXACIN IN D5W 250 MG/50 ML IV PGBK,,J1956,HCPCS,Facility,Outpatient,50 mL,mL,,24,20.4,6.8784,24,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,11.52,48,,percent of total billed charges,,100% of DHS outpatient percentage
LEVOFLOXACIN IN D5W 250 MG/50 ML IV PGBK,,J1956,HCPCS,Facility,Inpatient,50 mL,mL,,24,20.4,6.8784,24,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
PROPOFOL 10 MG/ML IV BOLUS,,J2704,HCPCS,Facility,Both,50 mL,mL,,63,53.55,18.0558,63,Aetna,Commercial,57.96,92,,percent of total billed charges,,
PROPOFOL 10 MG/ML IV BOLUS,,J2704,HCPCS,Facility,Outpatient,50 mL,mL,,63,53.55,18.0558,63,Aetna,Medicare Advantage,30.87,49,,percent of total billed charges,,
PROPOFOL 10 MG/ML IV BOLUS,,J2704,HCPCS,Facility,Inpatient,50 mL,mL,,63,53.55,18.0558,63,Aetna,Medicare Advantage,,,,,Included in per diem rate,
PROPOFOL 10 MG/ML IV BOLUS,,J2704,HCPCS,Facility,Both,50 mL,mL,,63,53.55,18.0558,63,Aetna,PPO,58.59,93,,percent of total billed charges,,
PROPOFOL 10 MG/ML IV BOLUS,,J2704,HCPCS,Facility,Both,50 mL,mL,,63,53.55,18.0558,63,America's PPO,America's PPO,60.4989,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
PROPOFOL 10 MG/ML IV BOLUS,,J2704,HCPCS,Facility,Both,50 mL,mL,,63,53.55,18.0558,63,BlueCross BlueShield Minnesota, Federal Employee Program,61.992,98.4,,percent of total billed charges,,
PROPOFOL 10 MG/ML IV BOLUS,,J2704,HCPCS,Facility,Both,50 mL,mL,,63,53.55,18.0558,63,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,63,100,,percent of total billed charges,,
PROPOFOL 10 MG/ML IV BOLUS,,J2704,HCPCS,Facility,Both,50 mL,mL,,63,53.55,18.0558,63,BlueCross BlueShield Minnesota,High Value Network Plan,56.7,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
PROPOFOL 10 MG/ML IV BOLUS,,J2704,HCPCS,Facility,Outpatient,50 mL,mL,,63,53.55,18.0558,63,BlueCross BlueShield Minnesota,Medicare Advantage,30.87,49,,percent of total billed charges,,
PROPOFOL 10 MG/ML IV BOLUS,,J2704,HCPCS,Facility,Inpatient,50 mL,mL,,63,53.55,18.0558,63,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
PROPOFOL 10 MG/ML IV BOLUS,,J2704,HCPCS,Facility,Both,50 mL,mL,,63,53.55,18.0558,63,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,55.7991,88.57,,percent of total billed charges,,
PROPOFOL 10 MG/ML IV BOLUS,,J2704,HCPCS,Facility,Both,50 mL,mL,,63,53.55,18.0558,63,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,18.0558,28.66,,percent of total billed charges,,
PROPOFOL 10 MG/ML IV BOLUS,,J2704,HCPCS,Facility,Outpatient,50 mL,mL,,63,53.55,18.0558,63,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),30.87,49,,percent of total billed charges,,
PROPOFOL 10 MG/ML IV BOLUS,,J2704,HCPCS,Facility,Inpatient,50 mL,mL,,63,53.55,18.0558,63,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
PROPOFOL 10 MG/ML IV BOLUS,,J2704,HCPCS,Facility,Both,50 mL,mL,,63,53.55,18.0558,63,CorVel,Worker's Compensation,63,100,,percent of total billed charges,,
PROPOFOL 10 MG/ML IV BOLUS,,J2704,HCPCS,Facility,Both,50 mL,mL,,63,53.55,18.0558,63,First Health Group Corporation,First Health Network,61.11,97,,percent of total billed charges,,
PROPOFOL 10 MG/ML IV BOLUS,,J2704,HCPCS,Facility,Both,50 mL,mL,,63,53.55,18.0558,63,"Health Partners, Inc.",Commercial,59.598,94.6,,percent of total billed charges,,
PROPOFOL 10 MG/ML IV BOLUS,,J2704,HCPCS,Facility,Outpatient,50 mL,mL,,63,53.55,18.0558,63,"Health Partners, Inc.",Medicare Advantage,30.87,49,,percent of total billed charges,,
PROPOFOL 10 MG/ML IV BOLUS,,J2704,HCPCS,Facility,Inpatient,50 mL,mL,,63,53.55,18.0558,63,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PROPOFOL 10 MG/ML IV BOLUS,,J2704,HCPCS,Facility,Both,50 mL,mL,,63,53.55,18.0558,63,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),37.8,60,,percent of total billed charges,,
PROPOFOL 10 MG/ML IV BOLUS,,J2704,HCPCS,Facility,Both,50 mL,mL,,63,53.55,18.0558,63,"Health Partners, Inc.",State of Minnesota Advantage Program,51.345,81.5,,percent of total billed charges,,
PROPOFOL 10 MG/ML IV BOLUS,,J2704,HCPCS,Facility,Both,50 mL,mL,,63,53.55,18.0558,63,"Health Partners, Inc.",State Public Programs,31.5,50,,percent of total billed charges,,
PROPOFOL 10 MG/ML IV BOLUS,,J2704,HCPCS,Facility,Both,50 mL,mL,,63,53.55,18.0558,63,Humana Insurance Company,Commercial PPO,59.85,95,,percent of total billed charges,,
PROPOFOL 10 MG/ML IV BOLUS,,J2704,HCPCS,Facility,Outpatient,50 mL,mL,,63,53.55,18.0558,63,Humana Insurance Company,Medicare PPO,30.87,49,,percent of total billed charges,,
PROPOFOL 10 MG/ML IV BOLUS,,J2704,HCPCS,Facility,Inpatient,50 mL,mL,,63,53.55,18.0558,63,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
PROPOFOL 10 MG/ML IV BOLUS,,J2704,HCPCS,Facility,Both,50 mL,mL,,63,53.55,18.0558,63,Medica,Individual & Family,62.433,99.1,,percent of total billed charges,,
PROPOFOL 10 MG/ML IV BOLUS,,J2704,HCPCS,Facility,Outpatient,50 mL,mL,,63,53.55,18.0558,63,Medica,Medica Advantage Solution,31.374,49.8,,percent of total billed charges,,
PROPOFOL 10 MG/ML IV BOLUS,,J2704,HCPCS,Facility,Inpatient,50 mL,mL,,63,53.55,18.0558,63,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
PROPOFOL 10 MG/ML IV BOLUS,,J2704,HCPCS,Facility,Outpatient,50 mL,mL,,63,53.55,18.0558,63,Medica,Medical Assistance,28.098,44.6,,percent of total billed charges,,
PROPOFOL 10 MG/ML IV BOLUS,,J2704,HCPCS,Facility,Inpatient,50 mL,mL,,63,53.55,18.0558,63,Medica,Medical Assistance,,,,,Included in per diem rate,
PROPOFOL 10 MG/ML IV BOLUS,,J2704,HCPCS,Facility,Outpatient,50 mL,mL,,63,53.55,18.0558,63,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,31.374,49.8,,percent of total billed charges,,
PROPOFOL 10 MG/ML IV BOLUS,,J2704,HCPCS,Facility,Inpatient,50 mL,mL,,63,53.55,18.0558,63,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
PROPOFOL 10 MG/ML IV BOLUS,,J2704,HCPCS,Facility,Both,50 mL,mL,,63,53.55,18.0558,63,"Multiplan, Inc.","Multiplan, Inc.",59.22,94,,percent of total billed charges,,
PROPOFOL 10 MG/ML IV BOLUS,,J2704,HCPCS,Facility,Outpatient,50 mL,mL,,63,53.55,18.0558,63,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,56.763,90.1,,percent of total billed charges,,
PROPOFOL 10 MG/ML IV BOLUS,,J2704,HCPCS,Facility,Inpatient,50 mL,mL,,63,53.55,18.0558,63,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
PROPOFOL 10 MG/ML IV BOLUS,,J2704,HCPCS,Facility,Both,50 mL,mL,,63,53.55,18.0558,63,"Preferred One Administrative Services, INC.",PPO,62.118,98.6,,percent of total billed charges,,
PROPOFOL 10 MG/ML IV BOLUS,,J2704,HCPCS,Facility,Outpatient,50 mL,mL,,63,53.55,18.0558,63,PrimeWest Health,Minnesota Senior Health Options (MSHO),32.4135,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
PROPOFOL 10 MG/ML IV BOLUS,,J2704,HCPCS,Facility,Inpatient,50 mL,mL,,63,53.55,18.0558,63,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PROPOFOL 10 MG/ML IV BOLUS,,J2704,HCPCS,Facility,Outpatient,50 mL,mL,,63,53.55,18.0558,63,PrimeWest Health,MinnesotaCare,32.3568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
PROPOFOL 10 MG/ML IV BOLUS,,J2704,HCPCS,Facility,Inpatient,50 mL,mL,,63,53.55,18.0558,63,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
PROPOFOL 10 MG/ML IV BOLUS,,J2704,HCPCS,Facility,Both,50 mL,mL,,63,53.55,18.0558,63,Sanford Health Plan,Sanford Health Plan,57.96,92,,percent of total billed charges,,
PROPOFOL 10 MG/ML IV BOLUS,,J2704,HCPCS,Facility,Outpatient,50 mL,mL,,63,53.55,18.0558,63,"UCare Health, Inc.",Individual & Family Plan,35.5005,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
PROPOFOL 10 MG/ML IV BOLUS,,J2704,HCPCS,Facility,Inpatient,50 mL,mL,,63,53.55,18.0558,63,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
PROPOFOL 10 MG/ML IV BOLUS,,J2704,HCPCS,Facility,Outpatient,50 mL,mL,,63,53.55,18.0558,63,"UCare Health, Inc.",Medical Assistance,31.7961,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PROPOFOL 10 MG/ML IV BOLUS,,J2704,HCPCS,Facility,Inpatient,50 mL,mL,,63,53.55,18.0558,63,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
PROPOFOL 10 MG/ML IV BOLUS,,J2704,HCPCS,Facility,Outpatient,50 mL,mL,,63,53.55,18.0558,63,"UCare Health, Inc.",Medicare Advantage,31.7961,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PROPOFOL 10 MG/ML IV BOLUS,,J2704,HCPCS,Facility,Inpatient,50 mL,mL,,63,53.55,18.0558,63,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PROPOFOL 10 MG/ML IV BOLUS,,J2704,HCPCS,Facility,Outpatient,50 mL,mL,,63,53.55,18.0558,63,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),31.7961,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PROPOFOL 10 MG/ML IV BOLUS,,J2704,HCPCS,Facility,Inpatient,50 mL,mL,,63,53.55,18.0558,63,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PROPOFOL 10 MG/ML IV BOLUS,,J2704,HCPCS,Facility,Both,50 mL,mL,,63,53.55,18.0558,63,UnitedHealthcare,Individual & Family,59.22,94,,percent of total billed charges,,
PROPOFOL 10 MG/ML IV BOLUS,,J2704,HCPCS,Facility,Outpatient,50 mL,mL,,63,53.55,18.0558,63,UnitedHealthcare,Medicare Advantage,30.87,49,,percent of total billed charges,,
PROPOFOL 10 MG/ML IV BOLUS,,J2704,HCPCS,Facility,Inpatient,50 mL,mL,,63,53.55,18.0558,63,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
PROPOFOL 10 MG/ML IV BOLUS,,J2704,HCPCS,Facility,Outpatient,50 mL,mL,,63,53.55,18.0558,63,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,30.24,48,,percent of total billed charges,,100% of DHS outpatient percentage
PROPOFOL 10 MG/ML IV BOLUS,,J2704,HCPCS,Facility,Inpatient,50 mL,mL,,63,53.55,18.0558,63,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
PROPOFOL 10 MG/ML IV EMUL,,J2704,HCPCS,Facility,Both,50 mL,mL,,81,68.85,23.2146,81,Aetna,Commercial,74.52,92,,percent of total billed charges,,
PROPOFOL 10 MG/ML IV EMUL,,J2704,HCPCS,Facility,Outpatient,50 mL,mL,,81,68.85,23.2146,81,Aetna,Medicare Advantage,39.69,49,,percent of total billed charges,,
PROPOFOL 10 MG/ML IV EMUL,,J2704,HCPCS,Facility,Inpatient,50 mL,mL,,81,68.85,23.2146,81,Aetna,Medicare Advantage,,,,,Included in per diem rate,
PROPOFOL 10 MG/ML IV EMUL,,J2704,HCPCS,Facility,Both,50 mL,mL,,81,68.85,23.2146,81,Aetna,PPO,75.33,93,,percent of total billed charges,,
PROPOFOL 10 MG/ML IV EMUL,,J2704,HCPCS,Facility,Both,50 mL,mL,,81,68.85,23.2146,81,America's PPO,America's PPO,77.7843,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
PROPOFOL 10 MG/ML IV EMUL,,J2704,HCPCS,Facility,Both,50 mL,mL,,81,68.85,23.2146,81,BlueCross BlueShield Minnesota, Federal Employee Program,79.704,98.4,,percent of total billed charges,,
PROPOFOL 10 MG/ML IV EMUL,,J2704,HCPCS,Facility,Both,50 mL,mL,,81,68.85,23.2146,81,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,81,100,,percent of total billed charges,,
PROPOFOL 10 MG/ML IV EMUL,,J2704,HCPCS,Facility,Both,50 mL,mL,,81,68.85,23.2146,81,BlueCross BlueShield Minnesota,High Value Network Plan,72.9,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
PROPOFOL 10 MG/ML IV EMUL,,J2704,HCPCS,Facility,Outpatient,50 mL,mL,,81,68.85,23.2146,81,BlueCross BlueShield Minnesota,Medicare Advantage,39.69,49,,percent of total billed charges,,
PROPOFOL 10 MG/ML IV EMUL,,J2704,HCPCS,Facility,Inpatient,50 mL,mL,,81,68.85,23.2146,81,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
PROPOFOL 10 MG/ML IV EMUL,,J2704,HCPCS,Facility,Both,50 mL,mL,,81,68.85,23.2146,81,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,71.7417,88.57,,percent of total billed charges,,
PROPOFOL 10 MG/ML IV EMUL,,J2704,HCPCS,Facility,Both,50 mL,mL,,81,68.85,23.2146,81,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,23.2146,28.66,,percent of total billed charges,,
PROPOFOL 10 MG/ML IV EMUL,,J2704,HCPCS,Facility,Outpatient,50 mL,mL,,81,68.85,23.2146,81,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),39.69,49,,percent of total billed charges,,
PROPOFOL 10 MG/ML IV EMUL,,J2704,HCPCS,Facility,Inpatient,50 mL,mL,,81,68.85,23.2146,81,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
PROPOFOL 10 MG/ML IV EMUL,,J2704,HCPCS,Facility,Both,50 mL,mL,,81,68.85,23.2146,81,CorVel,Worker's Compensation,81,100,,percent of total billed charges,,
PROPOFOL 10 MG/ML IV EMUL,,J2704,HCPCS,Facility,Both,50 mL,mL,,81,68.85,23.2146,81,First Health Group Corporation,First Health Network,78.57,97,,percent of total billed charges,,
PROPOFOL 10 MG/ML IV EMUL,,J2704,HCPCS,Facility,Both,50 mL,mL,,81,68.85,23.2146,81,"Health Partners, Inc.",Commercial,76.626,94.6,,percent of total billed charges,,
PROPOFOL 10 MG/ML IV EMUL,,J2704,HCPCS,Facility,Outpatient,50 mL,mL,,81,68.85,23.2146,81,"Health Partners, Inc.",Medicare Advantage,39.69,49,,percent of total billed charges,,
PROPOFOL 10 MG/ML IV EMUL,,J2704,HCPCS,Facility,Inpatient,50 mL,mL,,81,68.85,23.2146,81,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PROPOFOL 10 MG/ML IV EMUL,,J2704,HCPCS,Facility,Both,50 mL,mL,,81,68.85,23.2146,81,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),48.6,60,,percent of total billed charges,,
PROPOFOL 10 MG/ML IV EMUL,,J2704,HCPCS,Facility,Both,50 mL,mL,,81,68.85,23.2146,81,"Health Partners, Inc.",State of Minnesota Advantage Program,66.015,81.5,,percent of total billed charges,,
PROPOFOL 10 MG/ML IV EMUL,,J2704,HCPCS,Facility,Both,50 mL,mL,,81,68.85,23.2146,81,"Health Partners, Inc.",State Public Programs,40.5,50,,percent of total billed charges,,
PROPOFOL 10 MG/ML IV EMUL,,J2704,HCPCS,Facility,Both,50 mL,mL,,81,68.85,23.2146,81,Humana Insurance Company,Commercial PPO,76.95,95,,percent of total billed charges,,
PROPOFOL 10 MG/ML IV EMUL,,J2704,HCPCS,Facility,Outpatient,50 mL,mL,,81,68.85,23.2146,81,Humana Insurance Company,Medicare PPO,39.69,49,,percent of total billed charges,,
PROPOFOL 10 MG/ML IV EMUL,,J2704,HCPCS,Facility,Inpatient,50 mL,mL,,81,68.85,23.2146,81,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
PROPOFOL 10 MG/ML IV EMUL,,J2704,HCPCS,Facility,Both,50 mL,mL,,81,68.85,23.2146,81,Medica,Individual & Family,80.271,99.1,,percent of total billed charges,,
PROPOFOL 10 MG/ML IV EMUL,,J2704,HCPCS,Facility,Outpatient,50 mL,mL,,81,68.85,23.2146,81,Medica,Medica Advantage Solution,40.338,49.8,,percent of total billed charges,,
PROPOFOL 10 MG/ML IV EMUL,,J2704,HCPCS,Facility,Inpatient,50 mL,mL,,81,68.85,23.2146,81,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
PROPOFOL 10 MG/ML IV EMUL,,J2704,HCPCS,Facility,Outpatient,50 mL,mL,,81,68.85,23.2146,81,Medica,Medical Assistance,36.126,44.6,,percent of total billed charges,,
PROPOFOL 10 MG/ML IV EMUL,,J2704,HCPCS,Facility,Inpatient,50 mL,mL,,81,68.85,23.2146,81,Medica,Medical Assistance,,,,,Included in per diem rate,
PROPOFOL 10 MG/ML IV EMUL,,J2704,HCPCS,Facility,Outpatient,50 mL,mL,,81,68.85,23.2146,81,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,40.338,49.8,,percent of total billed charges,,
PROPOFOL 10 MG/ML IV EMUL,,J2704,HCPCS,Facility,Inpatient,50 mL,mL,,81,68.85,23.2146,81,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
PROPOFOL 10 MG/ML IV EMUL,,J2704,HCPCS,Facility,Both,50 mL,mL,,81,68.85,23.2146,81,"Multiplan, Inc.","Multiplan, Inc.",76.14,94,,percent of total billed charges,,
PROPOFOL 10 MG/ML IV EMUL,,J2704,HCPCS,Facility,Outpatient,50 mL,mL,,81,68.85,23.2146,81,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,72.981,90.1,,percent of total billed charges,,
PROPOFOL 10 MG/ML IV EMUL,,J2704,HCPCS,Facility,Inpatient,50 mL,mL,,81,68.85,23.2146,81,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
PROPOFOL 10 MG/ML IV EMUL,,J2704,HCPCS,Facility,Both,50 mL,mL,,81,68.85,23.2146,81,"Preferred One Administrative Services, INC.",PPO,79.866,98.6,,percent of total billed charges,,
PROPOFOL 10 MG/ML IV EMUL,,J2704,HCPCS,Facility,Outpatient,50 mL,mL,,81,68.85,23.2146,81,PrimeWest Health,Minnesota Senior Health Options (MSHO),41.6745,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
PROPOFOL 10 MG/ML IV EMUL,,J2704,HCPCS,Facility,Inpatient,50 mL,mL,,81,68.85,23.2146,81,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PROPOFOL 10 MG/ML IV EMUL,,J2704,HCPCS,Facility,Outpatient,50 mL,mL,,81,68.85,23.2146,81,PrimeWest Health,MinnesotaCare,41.6016,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
PROPOFOL 10 MG/ML IV EMUL,,J2704,HCPCS,Facility,Inpatient,50 mL,mL,,81,68.85,23.2146,81,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
PROPOFOL 10 MG/ML IV EMUL,,J2704,HCPCS,Facility,Both,50 mL,mL,,81,68.85,23.2146,81,Sanford Health Plan,Sanford Health Plan,74.52,92,,percent of total billed charges,,
PROPOFOL 10 MG/ML IV EMUL,,J2704,HCPCS,Facility,Outpatient,50 mL,mL,,81,68.85,23.2146,81,"UCare Health, Inc.",Individual & Family Plan,45.6435,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
PROPOFOL 10 MG/ML IV EMUL,,J2704,HCPCS,Facility,Inpatient,50 mL,mL,,81,68.85,23.2146,81,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
PROPOFOL 10 MG/ML IV EMUL,,J2704,HCPCS,Facility,Outpatient,50 mL,mL,,81,68.85,23.2146,81,"UCare Health, Inc.",Medical Assistance,40.8807,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PROPOFOL 10 MG/ML IV EMUL,,J2704,HCPCS,Facility,Inpatient,50 mL,mL,,81,68.85,23.2146,81,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
PROPOFOL 10 MG/ML IV EMUL,,J2704,HCPCS,Facility,Outpatient,50 mL,mL,,81,68.85,23.2146,81,"UCare Health, Inc.",Medicare Advantage,40.8807,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PROPOFOL 10 MG/ML IV EMUL,,J2704,HCPCS,Facility,Inpatient,50 mL,mL,,81,68.85,23.2146,81,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
PROPOFOL 10 MG/ML IV EMUL,,J2704,HCPCS,Facility,Outpatient,50 mL,mL,,81,68.85,23.2146,81,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),40.8807,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
PROPOFOL 10 MG/ML IV EMUL,,J2704,HCPCS,Facility,Inpatient,50 mL,mL,,81,68.85,23.2146,81,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
PROPOFOL 10 MG/ML IV EMUL,,J2704,HCPCS,Facility,Both,50 mL,mL,,81,68.85,23.2146,81,UnitedHealthcare,Individual & Family,76.14,94,,percent of total billed charges,,
PROPOFOL 10 MG/ML IV EMUL,,J2704,HCPCS,Facility,Outpatient,50 mL,mL,,81,68.85,23.2146,81,UnitedHealthcare,Medicare Advantage,39.69,49,,percent of total billed charges,,
PROPOFOL 10 MG/ML IV EMUL,,J2704,HCPCS,Facility,Inpatient,50 mL,mL,,81,68.85,23.2146,81,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
PROPOFOL 10 MG/ML IV EMUL,,J2704,HCPCS,Facility,Outpatient,50 mL,mL,,81,68.85,23.2146,81,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,38.88,48,,percent of total billed charges,,100% of DHS outpatient percentage
PROPOFOL 10 MG/ML IV EMUL,,J2704,HCPCS,Facility,Inpatient,50 mL,mL,,81,68.85,23.2146,81,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"ALBUMIN, HUMAN 25 % IV SOLP (50 ML)",,P9047,HCPCS,Facility,Both,50 mL,mL,,422,358.7,120.9452,422,Aetna,Commercial,388.24,92,,percent of total billed charges,,
"ALBUMIN, HUMAN 25 % IV SOLP (50 ML)",,P9047,HCPCS,Facility,Outpatient,50 mL,mL,,422,358.7,120.9452,422,Aetna,Medicare Advantage,206.78,49,,percent of total billed charges,,
"ALBUMIN, HUMAN 25 % IV SOLP (50 ML)",,P9047,HCPCS,Facility,Inpatient,50 mL,mL,,422,358.7,120.9452,422,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"ALBUMIN, HUMAN 25 % IV SOLP (50 ML)",,P9047,HCPCS,Facility,Both,50 mL,mL,,422,358.7,120.9452,422,Aetna,PPO,392.46,93,,percent of total billed charges,,
"ALBUMIN, HUMAN 25 % IV SOLP (50 ML)",,P9047,HCPCS,Facility,Both,50 mL,mL,,422,358.7,120.9452,422,America's PPO,America's PPO,405.2466,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"ALBUMIN, HUMAN 25 % IV SOLP (50 ML)",,P9047,HCPCS,Facility,Both,50 mL,mL,,422,358.7,120.9452,422,BlueCross BlueShield Minnesota, Federal Employee Program,415.248,98.4,,percent of total billed charges,,
"ALBUMIN, HUMAN 25 % IV SOLP (50 ML)",,P9047,HCPCS,Facility,Both,50 mL,mL,,422,358.7,120.9452,422,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,422,100,,percent of total billed charges,,
"ALBUMIN, HUMAN 25 % IV SOLP (50 ML)",,P9047,HCPCS,Facility,Both,50 mL,mL,,422,358.7,120.9452,422,BlueCross BlueShield Minnesota,High Value Network Plan,379.8,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
"ALBUMIN, HUMAN 25 % IV SOLP (50 ML)",,P9047,HCPCS,Facility,Outpatient,50 mL,mL,,422,358.7,120.9452,422,BlueCross BlueShield Minnesota,Medicare Advantage,206.78,49,,percent of total billed charges,,
"ALBUMIN, HUMAN 25 % IV SOLP (50 ML)",,P9047,HCPCS,Facility,Inpatient,50 mL,mL,,422,358.7,120.9452,422,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"ALBUMIN, HUMAN 25 % IV SOLP (50 ML)",,P9047,HCPCS,Facility,Both,50 mL,mL,,422,358.7,120.9452,422,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,373.7654,88.57,,percent of total billed charges,,
"ALBUMIN, HUMAN 25 % IV SOLP (50 ML)",,P9047,HCPCS,Facility,Both,50 mL,mL,,422,358.7,120.9452,422,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,120.9452,28.66,,percent of total billed charges,,
"ALBUMIN, HUMAN 25 % IV SOLP (50 ML)",,P9047,HCPCS,Facility,Outpatient,50 mL,mL,,422,358.7,120.9452,422,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),206.78,49,,percent of total billed charges,,
"ALBUMIN, HUMAN 25 % IV SOLP (50 ML)",,P9047,HCPCS,Facility,Inpatient,50 mL,mL,,422,358.7,120.9452,422,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"ALBUMIN, HUMAN 25 % IV SOLP (50 ML)",,P9047,HCPCS,Facility,Both,50 mL,mL,,422,358.7,120.9452,422,CorVel,Worker's Compensation,422,100,,percent of total billed charges,,
"ALBUMIN, HUMAN 25 % IV SOLP (50 ML)",,P9047,HCPCS,Facility,Both,50 mL,mL,,422,358.7,120.9452,422,First Health Group Corporation,First Health Network,409.34,97,,percent of total billed charges,,
"ALBUMIN, HUMAN 25 % IV SOLP (50 ML)",,P9047,HCPCS,Facility,Both,50 mL,mL,,422,358.7,120.9452,422,"Health Partners, Inc.",Commercial,399.212,94.6,,percent of total billed charges,,
"ALBUMIN, HUMAN 25 % IV SOLP (50 ML)",,P9047,HCPCS,Facility,Outpatient,50 mL,mL,,422,358.7,120.9452,422,"Health Partners, Inc.",Medicare Advantage,206.78,49,,percent of total billed charges,,
"ALBUMIN, HUMAN 25 % IV SOLP (50 ML)",,P9047,HCPCS,Facility,Inpatient,50 mL,mL,,422,358.7,120.9452,422,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"ALBUMIN, HUMAN 25 % IV SOLP (50 ML)",,P9047,HCPCS,Facility,Both,50 mL,mL,,422,358.7,120.9452,422,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),253.2,60,,percent of total billed charges,,
"ALBUMIN, HUMAN 25 % IV SOLP (50 ML)",,P9047,HCPCS,Facility,Both,50 mL,mL,,422,358.7,120.9452,422,"Health Partners, Inc.",State of Minnesota Advantage Program,343.93,81.5,,percent of total billed charges,,
"ALBUMIN, HUMAN 25 % IV SOLP (50 ML)",,P9047,HCPCS,Facility,Both,50 mL,mL,,422,358.7,120.9452,422,"Health Partners, Inc.",State Public Programs,211,50,,percent of total billed charges,,
"ALBUMIN, HUMAN 25 % IV SOLP (50 ML)",,P9047,HCPCS,Facility,Both,50 mL,mL,,422,358.7,120.9452,422,Humana Insurance Company,Commercial PPO,400.9,95,,percent of total billed charges,,
"ALBUMIN, HUMAN 25 % IV SOLP (50 ML)",,P9047,HCPCS,Facility,Outpatient,50 mL,mL,,422,358.7,120.9452,422,Humana Insurance Company,Medicare PPO,206.78,49,,percent of total billed charges,,
"ALBUMIN, HUMAN 25 % IV SOLP (50 ML)",,P9047,HCPCS,Facility,Inpatient,50 mL,mL,,422,358.7,120.9452,422,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"ALBUMIN, HUMAN 25 % IV SOLP (50 ML)",,P9047,HCPCS,Facility,Both,50 mL,mL,,422,358.7,120.9452,422,Medica,Individual & Family,418.202,99.1,,percent of total billed charges,,
"ALBUMIN, HUMAN 25 % IV SOLP (50 ML)",,P9047,HCPCS,Facility,Outpatient,50 mL,mL,,422,358.7,120.9452,422,Medica,Medica Advantage Solution,210.156,49.8,,percent of total billed charges,,
"ALBUMIN, HUMAN 25 % IV SOLP (50 ML)",,P9047,HCPCS,Facility,Inpatient,50 mL,mL,,422,358.7,120.9452,422,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"ALBUMIN, HUMAN 25 % IV SOLP (50 ML)",,P9047,HCPCS,Facility,Outpatient,50 mL,mL,,422,358.7,120.9452,422,Medica,Medical Assistance,188.212,44.6,,percent of total billed charges,,
"ALBUMIN, HUMAN 25 % IV SOLP (50 ML)",,P9047,HCPCS,Facility,Inpatient,50 mL,mL,,422,358.7,120.9452,422,Medica,Medical Assistance,,,,,Included in per diem rate,
"ALBUMIN, HUMAN 25 % IV SOLP (50 ML)",,P9047,HCPCS,Facility,Outpatient,50 mL,mL,,422,358.7,120.9452,422,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,210.156,49.8,,percent of total billed charges,,
"ALBUMIN, HUMAN 25 % IV SOLP (50 ML)",,P9047,HCPCS,Facility,Inpatient,50 mL,mL,,422,358.7,120.9452,422,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"ALBUMIN, HUMAN 25 % IV SOLP (50 ML)",,P9047,HCPCS,Facility,Both,50 mL,mL,,422,358.7,120.9452,422,"Multiplan, Inc.","Multiplan, Inc.",396.68,94,,percent of total billed charges,,
"ALBUMIN, HUMAN 25 % IV SOLP (50 ML)",,P9047,HCPCS,Facility,Outpatient,50 mL,mL,,422,358.7,120.9452,422,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,380.222,90.1,,percent of total billed charges,,
"ALBUMIN, HUMAN 25 % IV SOLP (50 ML)",,P9047,HCPCS,Facility,Inpatient,50 mL,mL,,422,358.7,120.9452,422,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"ALBUMIN, HUMAN 25 % IV SOLP (50 ML)",,P9047,HCPCS,Facility,Both,50 mL,mL,,422,358.7,120.9452,422,"Preferred One Administrative Services, INC.",PPO,416.092,98.6,,percent of total billed charges,,
"ALBUMIN, HUMAN 25 % IV SOLP (50 ML)",,P9047,HCPCS,Facility,Outpatient,50 mL,mL,,422,358.7,120.9452,422,PrimeWest Health,Minnesota Senior Health Options (MSHO),217.119,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"ALBUMIN, HUMAN 25 % IV SOLP (50 ML)",,P9047,HCPCS,Facility,Inpatient,50 mL,mL,,422,358.7,120.9452,422,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"ALBUMIN, HUMAN 25 % IV SOLP (50 ML)",,P9047,HCPCS,Facility,Outpatient,50 mL,mL,,422,358.7,120.9452,422,PrimeWest Health,MinnesotaCare,216.7392,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"ALBUMIN, HUMAN 25 % IV SOLP (50 ML)",,P9047,HCPCS,Facility,Inpatient,50 mL,mL,,422,358.7,120.9452,422,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"ALBUMIN, HUMAN 25 % IV SOLP (50 ML)",,P9047,HCPCS,Facility,Both,50 mL,mL,,422,358.7,120.9452,422,Sanford Health Plan,Sanford Health Plan,388.24,92,,percent of total billed charges,,
"ALBUMIN, HUMAN 25 % IV SOLP (50 ML)",,P9047,HCPCS,Facility,Outpatient,50 mL,mL,,422,358.7,120.9452,422,"UCare Health, Inc.",Individual & Family Plan,237.797,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"ALBUMIN, HUMAN 25 % IV SOLP (50 ML)",,P9047,HCPCS,Facility,Inpatient,50 mL,mL,,422,358.7,120.9452,422,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"ALBUMIN, HUMAN 25 % IV SOLP (50 ML)",,P9047,HCPCS,Facility,Outpatient,50 mL,mL,,422,358.7,120.9452,422,"UCare Health, Inc.",Medical Assistance,212.9834,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"ALBUMIN, HUMAN 25 % IV SOLP (50 ML)",,P9047,HCPCS,Facility,Inpatient,50 mL,mL,,422,358.7,120.9452,422,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"ALBUMIN, HUMAN 25 % IV SOLP (50 ML)",,P9047,HCPCS,Facility,Outpatient,50 mL,mL,,422,358.7,120.9452,422,"UCare Health, Inc.",Medicare Advantage,212.9834,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"ALBUMIN, HUMAN 25 % IV SOLP (50 ML)",,P9047,HCPCS,Facility,Inpatient,50 mL,mL,,422,358.7,120.9452,422,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"ALBUMIN, HUMAN 25 % IV SOLP (50 ML)",,P9047,HCPCS,Facility,Outpatient,50 mL,mL,,422,358.7,120.9452,422,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),212.9834,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"ALBUMIN, HUMAN 25 % IV SOLP (50 ML)",,P9047,HCPCS,Facility,Inpatient,50 mL,mL,,422,358.7,120.9452,422,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"ALBUMIN, HUMAN 25 % IV SOLP (50 ML)",,P9047,HCPCS,Facility,Both,50 mL,mL,,422,358.7,120.9452,422,UnitedHealthcare,Individual & Family,396.68,94,,percent of total billed charges,,
"ALBUMIN, HUMAN 25 % IV SOLP (50 ML)",,P9047,HCPCS,Facility,Outpatient,50 mL,mL,,422,358.7,120.9452,422,UnitedHealthcare,Medicare Advantage,206.78,49,,percent of total billed charges,,
"ALBUMIN, HUMAN 25 % IV SOLP (50 ML)",,P9047,HCPCS,Facility,Inpatient,50 mL,mL,,422,358.7,120.9452,422,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"ALBUMIN, HUMAN 25 % IV SOLP (50 ML)",,P9047,HCPCS,Facility,Outpatient,50 mL,mL,,422,358.7,120.9452,422,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,202.56,48,,percent of total billed charges,,100% of DHS outpatient percentage
"ALBUMIN, HUMAN 25 % IV SOLP (50 ML)",,P9047,HCPCS,Facility,Inpatient,50 mL,mL,,422,358.7,120.9452,422,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Both,50 mL,mL,,58,49.3,16.6228,58,Aetna,Commercial,53.36,92,,percent of total billed charges,,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Outpatient,50 mL,mL,,58,49.3,16.6228,58,Aetna,Medicare Advantage,28.42,49,,percent of total billed charges,,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Inpatient,50 mL,mL,,58,49.3,16.6228,58,Aetna,Medicare Advantage,,,,,Included in per diem rate,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Both,50 mL,mL,,58,49.3,16.6228,58,Aetna,PPO,53.94,93,,percent of total billed charges,,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Both,50 mL,mL,,58,49.3,16.6228,58,America's PPO,America's PPO,55.6974,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Both,50 mL,mL,,58,49.3,16.6228,58,BlueCross BlueShield Minnesota, Federal Employee Program,57.072,98.4,,percent of total billed charges,,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Both,50 mL,mL,,58,49.3,16.6228,58,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,58,100,,percent of total billed charges,,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Both,50 mL,mL,,58,49.3,16.6228,58,BlueCross BlueShield Minnesota,High Value Network Plan,52.2,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Outpatient,50 mL,mL,,58,49.3,16.6228,58,BlueCross BlueShield Minnesota,Medicare Advantage,28.42,49,,percent of total billed charges,,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Inpatient,50 mL,mL,,58,49.3,16.6228,58,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Both,50 mL,mL,,58,49.3,16.6228,58,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,51.3706,88.57,,percent of total billed charges,,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Both,50 mL,mL,,58,49.3,16.6228,58,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,16.6228,28.66,,percent of total billed charges,,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Outpatient,50 mL,mL,,58,49.3,16.6228,58,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),28.42,49,,percent of total billed charges,,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Inpatient,50 mL,mL,,58,49.3,16.6228,58,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Both,50 mL,mL,,58,49.3,16.6228,58,CorVel,Worker's Compensation,58,100,,percent of total billed charges,,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Both,50 mL,mL,,58,49.3,16.6228,58,First Health Group Corporation,First Health Network,56.26,97,,percent of total billed charges,,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Both,50 mL,mL,,58,49.3,16.6228,58,"Health Partners, Inc.",Commercial,54.868,94.6,,percent of total billed charges,,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Outpatient,50 mL,mL,,58,49.3,16.6228,58,"Health Partners, Inc.",Medicare Advantage,28.42,49,,percent of total billed charges,,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Inpatient,50 mL,mL,,58,49.3,16.6228,58,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Both,50 mL,mL,,58,49.3,16.6228,58,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),34.8,60,,percent of total billed charges,,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Both,50 mL,mL,,58,49.3,16.6228,58,"Health Partners, Inc.",State of Minnesota Advantage Program,47.27,81.5,,percent of total billed charges,,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Both,50 mL,mL,,58,49.3,16.6228,58,"Health Partners, Inc.",State Public Programs,29,50,,percent of total billed charges,,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Both,50 mL,mL,,58,49.3,16.6228,58,Humana Insurance Company,Commercial PPO,55.1,95,,percent of total billed charges,,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Outpatient,50 mL,mL,,58,49.3,16.6228,58,Humana Insurance Company,Medicare PPO,28.42,49,,percent of total billed charges,,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Inpatient,50 mL,mL,,58,49.3,16.6228,58,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Both,50 mL,mL,,58,49.3,16.6228,58,Medica,Individual & Family,57.478,99.1,,percent of total billed charges,,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Outpatient,50 mL,mL,,58,49.3,16.6228,58,Medica,Medica Advantage Solution,28.884,49.8,,percent of total billed charges,,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Inpatient,50 mL,mL,,58,49.3,16.6228,58,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Outpatient,50 mL,mL,,58,49.3,16.6228,58,Medica,Medical Assistance,25.868,44.6,,percent of total billed charges,,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Inpatient,50 mL,mL,,58,49.3,16.6228,58,Medica,Medical Assistance,,,,,Included in per diem rate,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Outpatient,50 mL,mL,,58,49.3,16.6228,58,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,28.884,49.8,,percent of total billed charges,,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Inpatient,50 mL,mL,,58,49.3,16.6228,58,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Both,50 mL,mL,,58,49.3,16.6228,58,"Multiplan, Inc.","Multiplan, Inc.",54.52,94,,percent of total billed charges,,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Outpatient,50 mL,mL,,58,49.3,16.6228,58,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,52.258,90.1,,percent of total billed charges,,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Inpatient,50 mL,mL,,58,49.3,16.6228,58,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Both,50 mL,mL,,58,49.3,16.6228,58,"Preferred One Administrative Services, INC.",PPO,57.188,98.6,,percent of total billed charges,,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Outpatient,50 mL,mL,,58,49.3,16.6228,58,PrimeWest Health,Minnesota Senior Health Options (MSHO),29.841,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Inpatient,50 mL,mL,,58,49.3,16.6228,58,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Outpatient,50 mL,mL,,58,49.3,16.6228,58,PrimeWest Health,MinnesotaCare,29.7888,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Inpatient,50 mL,mL,,58,49.3,16.6228,58,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Both,50 mL,mL,,58,49.3,16.6228,58,Sanford Health Plan,Sanford Health Plan,53.36,92,,percent of total billed charges,,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Outpatient,50 mL,mL,,58,49.3,16.6228,58,"UCare Health, Inc.",Individual & Family Plan,32.683,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Inpatient,50 mL,mL,,58,49.3,16.6228,58,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Outpatient,50 mL,mL,,58,49.3,16.6228,58,"UCare Health, Inc.",Medical Assistance,29.2726,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Inpatient,50 mL,mL,,58,49.3,16.6228,58,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Outpatient,50 mL,mL,,58,49.3,16.6228,58,"UCare Health, Inc.",Medicare Advantage,29.2726,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Inpatient,50 mL,mL,,58,49.3,16.6228,58,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Outpatient,50 mL,mL,,58,49.3,16.6228,58,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),29.2726,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Inpatient,50 mL,mL,,58,49.3,16.6228,58,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Both,50 mL,mL,,58,49.3,16.6228,58,UnitedHealthcare,Individual & Family,54.52,94,,percent of total billed charges,,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Outpatient,50 mL,mL,,58,49.3,16.6228,58,UnitedHealthcare,Medicare Advantage,28.42,49,,percent of total billed charges,,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Inpatient,50 mL,mL,,58,49.3,16.6228,58,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Outpatient,50 mL,mL,,58,49.3,16.6228,58,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,27.84,48,,percent of total billed charges,,100% of DHS outpatient percentage
IOHEXOL 300 MG IODINE/ML IV SOLN,,Q9967,HCPCS,Facility,Inpatient,50 mL,mL,,58,49.3,16.6228,58,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
HETASTARCH 6 % IN 0.9 % NACL 6 % IV SOLN,,6900,LOCAL,Facility,Both,500 mL,mL,,142,120.7,40.6972,142,Aetna,Commercial,130.64,92,,percent of total billed charges,,
HETASTARCH 6 % IN 0.9 % NACL 6 % IV SOLN,,6900,LOCAL,Facility,Outpatient,500 mL,mL,,142,120.7,40.6972,142,Aetna,Medicare Advantage,69.58,49,,percent of total billed charges,,
HETASTARCH 6 % IN 0.9 % NACL 6 % IV SOLN,,6900,LOCAL,Facility,Inpatient,500 mL,mL,,142,120.7,40.6972,142,Aetna,Medicare Advantage,,,,,Included in per diem rate,
HETASTARCH 6 % IN 0.9 % NACL 6 % IV SOLN,,6900,LOCAL,Facility,Both,500 mL,mL,,142,120.7,40.6972,142,Aetna,PPO,132.06,93,,percent of total billed charges,,
HETASTARCH 6 % IN 0.9 % NACL 6 % IV SOLN,,6900,LOCAL,Facility,Both,500 mL,mL,,142,120.7,40.6972,142,America's PPO,America's PPO,136.3626,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
HETASTARCH 6 % IN 0.9 % NACL 6 % IV SOLN,,6900,LOCAL,Facility,Both,500 mL,mL,,142,120.7,40.6972,142,BlueCross BlueShield Minnesota, Federal Employee Program,139.728,98.4,,percent of total billed charges,,
HETASTARCH 6 % IN 0.9 % NACL 6 % IV SOLN,,6900,LOCAL,Facility,Both,500 mL,mL,,142,120.7,40.6972,142,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,142,100,,percent of total billed charges,,
HETASTARCH 6 % IN 0.9 % NACL 6 % IV SOLN,,6900,LOCAL,Facility,Both,500 mL,mL,,142,120.7,40.6972,142,BlueCross BlueShield Minnesota,High Value Network Plan,127.8,90,,percent of total billed charges,,
HETASTARCH 6 % IN 0.9 % NACL 6 % IV SOLN,,6900,LOCAL,Facility,Outpatient,500 mL,mL,,142,120.7,40.6972,142,BlueCross BlueShield Minnesota,Medicare Advantage,69.58,49,,percent of total billed charges,,
HETASTARCH 6 % IN 0.9 % NACL 6 % IV SOLN,,6900,LOCAL,Facility,Inpatient,500 mL,mL,,142,120.7,40.6972,142,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
HETASTARCH 6 % IN 0.9 % NACL 6 % IV SOLN,,6900,LOCAL,Facility,Both,500 mL,mL,,142,120.7,40.6972,142,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,125.7694,88.57,,percent of total billed charges,,
HETASTARCH 6 % IN 0.9 % NACL 6 % IV SOLN,,6900,LOCAL,Facility,Both,500 mL,mL,,142,120.7,40.6972,142,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,40.6972,28.66,,percent of total billed charges,,
HETASTARCH 6 % IN 0.9 % NACL 6 % IV SOLN,,6900,LOCAL,Facility,Outpatient,500 mL,mL,,142,120.7,40.6972,142,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),69.58,49,,percent of total billed charges,,
HETASTARCH 6 % IN 0.9 % NACL 6 % IV SOLN,,6900,LOCAL,Facility,Inpatient,500 mL,mL,,142,120.7,40.6972,142,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
HETASTARCH 6 % IN 0.9 % NACL 6 % IV SOLN,,6900,LOCAL,Facility,Both,500 mL,mL,,142,120.7,40.6972,142,CorVel,Worker's Compensation,142,100,,percent of total billed charges,,
HETASTARCH 6 % IN 0.9 % NACL 6 % IV SOLN,,6900,LOCAL,Facility,Both,500 mL,mL,,142,120.7,40.6972,142,First Health Group Corporation,First Health Network,137.74,97,,percent of total billed charges,,
HETASTARCH 6 % IN 0.9 % NACL 6 % IV SOLN,,6900,LOCAL,Facility,Both,500 mL,mL,,142,120.7,40.6972,142,"Health Partners, Inc.",Commercial,134.332,94.6,,percent of total billed charges,,
HETASTARCH 6 % IN 0.9 % NACL 6 % IV SOLN,,6900,LOCAL,Facility,Outpatient,500 mL,mL,,142,120.7,40.6972,142,"Health Partners, Inc.",Medicare Advantage,69.58,49,,percent of total billed charges,,
HETASTARCH 6 % IN 0.9 % NACL 6 % IV SOLN,,6900,LOCAL,Facility,Inpatient,500 mL,mL,,142,120.7,40.6972,142,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
HETASTARCH 6 % IN 0.9 % NACL 6 % IV SOLN,,6900,LOCAL,Facility,Both,500 mL,mL,,142,120.7,40.6972,142,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),85.2,60,,percent of total billed charges,,
HETASTARCH 6 % IN 0.9 % NACL 6 % IV SOLN,,6900,LOCAL,Facility,Both,500 mL,mL,,142,120.7,40.6972,142,"Health Partners, Inc.",State of Minnesota Advantage Program,115.73,81.5,,percent of total billed charges,,
HETASTARCH 6 % IN 0.9 % NACL 6 % IV SOLN,,6900,LOCAL,Facility,Both,500 mL,mL,,142,120.7,40.6972,142,"Health Partners, Inc.",State Public Programs,71,50,,percent of total billed charges,,
HETASTARCH 6 % IN 0.9 % NACL 6 % IV SOLN,,6900,LOCAL,Facility,Both,500 mL,mL,,142,120.7,40.6972,142,Humana Insurance Company,Commercial PPO,134.9,95,,percent of total billed charges,,
HETASTARCH 6 % IN 0.9 % NACL 6 % IV SOLN,,6900,LOCAL,Facility,Outpatient,500 mL,mL,,142,120.7,40.6972,142,Humana Insurance Company,Medicare PPO,69.58,49,,percent of total billed charges,,
HETASTARCH 6 % IN 0.9 % NACL 6 % IV SOLN,,6900,LOCAL,Facility,Inpatient,500 mL,mL,,142,120.7,40.6972,142,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
HETASTARCH 6 % IN 0.9 % NACL 6 % IV SOLN,,6900,LOCAL,Facility,Both,500 mL,mL,,142,120.7,40.6972,142,Medica,Individual & Family,140.722,99.1,,percent of total billed charges,,
HETASTARCH 6 % IN 0.9 % NACL 6 % IV SOLN,,6900,LOCAL,Facility,Outpatient,500 mL,mL,,142,120.7,40.6972,142,Medica,Medica Advantage Solution,70.716,49.8,,percent of total billed charges,,
HETASTARCH 6 % IN 0.9 % NACL 6 % IV SOLN,,6900,LOCAL,Facility,Inpatient,500 mL,mL,,142,120.7,40.6972,142,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
HETASTARCH 6 % IN 0.9 % NACL 6 % IV SOLN,,6900,LOCAL,Facility,Outpatient,500 mL,mL,,142,120.7,40.6972,142,Medica,Medical Assistance,63.332,44.6,,percent of total billed charges,,
HETASTARCH 6 % IN 0.9 % NACL 6 % IV SOLN,,6900,LOCAL,Facility,Inpatient,500 mL,mL,,142,120.7,40.6972,142,Medica,Medical Assistance,,,,,Included in per diem rate,
HETASTARCH 6 % IN 0.9 % NACL 6 % IV SOLN,,6900,LOCAL,Facility,Outpatient,500 mL,mL,,142,120.7,40.6972,142,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,70.716,49.8,,percent of total billed charges,,
HETASTARCH 6 % IN 0.9 % NACL 6 % IV SOLN,,6900,LOCAL,Facility,Inpatient,500 mL,mL,,142,120.7,40.6972,142,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
HETASTARCH 6 % IN 0.9 % NACL 6 % IV SOLN,,6900,LOCAL,Facility,Both,500 mL,mL,,142,120.7,40.6972,142,"Multiplan, Inc.","Multiplan, Inc.",133.48,94,,percent of total billed charges,,
HETASTARCH 6 % IN 0.9 % NACL 6 % IV SOLN,,6900,LOCAL,Facility,Outpatient,500 mL,mL,,142,120.7,40.6972,142,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,127.942,90.1,,percent of total billed charges,,
HETASTARCH 6 % IN 0.9 % NACL 6 % IV SOLN,,6900,LOCAL,Facility,Inpatient,500 mL,mL,,142,120.7,40.6972,142,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
HETASTARCH 6 % IN 0.9 % NACL 6 % IV SOLN,,6900,LOCAL,Facility,Both,500 mL,mL,,142,120.7,40.6972,142,"Preferred One Administrative Services, INC.",PPO,140.012,98.6,,percent of total billed charges,,
HETASTARCH 6 % IN 0.9 % NACL 6 % IV SOLN,,6900,LOCAL,Facility,Outpatient,500 mL,mL,,142,120.7,40.6972,142,PrimeWest Health,Minnesota Senior Health Options (MSHO),73.059,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
HETASTARCH 6 % IN 0.9 % NACL 6 % IV SOLN,,6900,LOCAL,Facility,Inpatient,500 mL,mL,,142,120.7,40.6972,142,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
HETASTARCH 6 % IN 0.9 % NACL 6 % IV SOLN,,6900,LOCAL,Facility,Outpatient,500 mL,mL,,142,120.7,40.6972,142,PrimeWest Health,MinnesotaCare,72.9312,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
HETASTARCH 6 % IN 0.9 % NACL 6 % IV SOLN,,6900,LOCAL,Facility,Inpatient,500 mL,mL,,142,120.7,40.6972,142,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
HETASTARCH 6 % IN 0.9 % NACL 6 % IV SOLN,,6900,LOCAL,Facility,Both,500 mL,mL,,142,120.7,40.6972,142,Sanford Health Plan,Sanford Health Plan,130.64,92,,percent of total billed charges,,
HETASTARCH 6 % IN 0.9 % NACL 6 % IV SOLN,,6900,LOCAL,Facility,Outpatient,500 mL,mL,,142,120.7,40.6972,142,"UCare Health, Inc.",Individual & Family Plan,80.017,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
HETASTARCH 6 % IN 0.9 % NACL 6 % IV SOLN,,6900,LOCAL,Facility,Inpatient,500 mL,mL,,142,120.7,40.6972,142,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
HETASTARCH 6 % IN 0.9 % NACL 6 % IV SOLN,,6900,LOCAL,Facility,Outpatient,500 mL,mL,,142,120.7,40.6972,142,"UCare Health, Inc.",Medical Assistance,71.6674,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
HETASTARCH 6 % IN 0.9 % NACL 6 % IV SOLN,,6900,LOCAL,Facility,Inpatient,500 mL,mL,,142,120.7,40.6972,142,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
HETASTARCH 6 % IN 0.9 % NACL 6 % IV SOLN,,6900,LOCAL,Facility,Outpatient,500 mL,mL,,142,120.7,40.6972,142,"UCare Health, Inc.",Medicare Advantage,71.6674,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
HETASTARCH 6 % IN 0.9 % NACL 6 % IV SOLN,,6900,LOCAL,Facility,Inpatient,500 mL,mL,,142,120.7,40.6972,142,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
HETASTARCH 6 % IN 0.9 % NACL 6 % IV SOLN,,6900,LOCAL,Facility,Outpatient,500 mL,mL,,142,120.7,40.6972,142,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),71.6674,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
HETASTARCH 6 % IN 0.9 % NACL 6 % IV SOLN,,6900,LOCAL,Facility,Inpatient,500 mL,mL,,142,120.7,40.6972,142,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
HETASTARCH 6 % IN 0.9 % NACL 6 % IV SOLN,,6900,LOCAL,Facility,Both,500 mL,mL,,142,120.7,40.6972,142,UnitedHealthcare,Individual & Family,133.48,94,,percent of total billed charges,,
HETASTARCH 6 % IN 0.9 % NACL 6 % IV SOLN,,6900,LOCAL,Facility,Outpatient,500 mL,mL,,142,120.7,40.6972,142,UnitedHealthcare,Medicare Advantage,69.58,49,,percent of total billed charges,,
HETASTARCH 6 % IN 0.9 % NACL 6 % IV SOLN,,6900,LOCAL,Facility,Inpatient,500 mL,mL,,142,120.7,40.6972,142,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
HETASTARCH 6 % IN 0.9 % NACL 6 % IV SOLN,,6900,LOCAL,Facility,Outpatient,500 mL,mL,,142,120.7,40.6972,142,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,68.16,48,,percent of total billed charges,,100% of DHS outpatient percentage
HETASTARCH 6 % IN 0.9 % NACL 6 % IV SOLN,,6900,LOCAL,Facility,Inpatient,500 mL,mL,,142,120.7,40.6972,142,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
DIAZEPAM 5 MG/5 ML (1 MG/ML) ORAL SOLN,,8137,LOCAL,Facility,Both,500 mL,mL,,328,278.8,94.0048,328,Aetna,Commercial,301.76,92,,percent of total billed charges,,
DIAZEPAM 5 MG/5 ML (1 MG/ML) ORAL SOLN,,8137,LOCAL,Facility,Outpatient,500 mL,mL,,328,278.8,94.0048,328,Aetna,Medicare Advantage,160.72,49,,percent of total billed charges,,
DIAZEPAM 5 MG/5 ML (1 MG/ML) ORAL SOLN,,8137,LOCAL,Facility,Inpatient,500 mL,mL,,328,278.8,94.0048,328,Aetna,Medicare Advantage,,,,,Included in per diem rate,
DIAZEPAM 5 MG/5 ML (1 MG/ML) ORAL SOLN,,8137,LOCAL,Facility,Both,500 mL,mL,,328,278.8,94.0048,328,Aetna,PPO,305.04,93,,percent of total billed charges,,
DIAZEPAM 5 MG/5 ML (1 MG/ML) ORAL SOLN,,8137,LOCAL,Facility,Both,500 mL,mL,,328,278.8,94.0048,328,America's PPO,America's PPO,314.9784,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
DIAZEPAM 5 MG/5 ML (1 MG/ML) ORAL SOLN,,8137,LOCAL,Facility,Both,500 mL,mL,,328,278.8,94.0048,328,BlueCross BlueShield Minnesota, Federal Employee Program,322.752,98.4,,percent of total billed charges,,
DIAZEPAM 5 MG/5 ML (1 MG/ML) ORAL SOLN,,8137,LOCAL,Facility,Both,500 mL,mL,,328,278.8,94.0048,328,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,328,100,,percent of total billed charges,,
DIAZEPAM 5 MG/5 ML (1 MG/ML) ORAL SOLN,,8137,LOCAL,Facility,Both,500 mL,mL,,328,278.8,94.0048,328,BlueCross BlueShield Minnesota,High Value Network Plan,295.2,90,,percent of total billed charges,,
DIAZEPAM 5 MG/5 ML (1 MG/ML) ORAL SOLN,,8137,LOCAL,Facility,Outpatient,500 mL,mL,,328,278.8,94.0048,328,BlueCross BlueShield Minnesota,Medicare Advantage,160.72,49,,percent of total billed charges,,
DIAZEPAM 5 MG/5 ML (1 MG/ML) ORAL SOLN,,8137,LOCAL,Facility,Inpatient,500 mL,mL,,328,278.8,94.0048,328,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
DIAZEPAM 5 MG/5 ML (1 MG/ML) ORAL SOLN,,8137,LOCAL,Facility,Both,500 mL,mL,,328,278.8,94.0048,328,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,290.5096,88.57,,percent of total billed charges,,
DIAZEPAM 5 MG/5 ML (1 MG/ML) ORAL SOLN,,8137,LOCAL,Facility,Both,500 mL,mL,,328,278.8,94.0048,328,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,94.0048,28.66,,percent of total billed charges,,
DIAZEPAM 5 MG/5 ML (1 MG/ML) ORAL SOLN,,8137,LOCAL,Facility,Outpatient,500 mL,mL,,328,278.8,94.0048,328,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),160.72,49,,percent of total billed charges,,
DIAZEPAM 5 MG/5 ML (1 MG/ML) ORAL SOLN,,8137,LOCAL,Facility,Inpatient,500 mL,mL,,328,278.8,94.0048,328,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
DIAZEPAM 5 MG/5 ML (1 MG/ML) ORAL SOLN,,8137,LOCAL,Facility,Both,500 mL,mL,,328,278.8,94.0048,328,CorVel,Worker's Compensation,328,100,,percent of total billed charges,,
DIAZEPAM 5 MG/5 ML (1 MG/ML) ORAL SOLN,,8137,LOCAL,Facility,Both,500 mL,mL,,328,278.8,94.0048,328,First Health Group Corporation,First Health Network,318.16,97,,percent of total billed charges,,
DIAZEPAM 5 MG/5 ML (1 MG/ML) ORAL SOLN,,8137,LOCAL,Facility,Both,500 mL,mL,,328,278.8,94.0048,328,"Health Partners, Inc.",Commercial,310.288,94.6,,percent of total billed charges,,
DIAZEPAM 5 MG/5 ML (1 MG/ML) ORAL SOLN,,8137,LOCAL,Facility,Outpatient,500 mL,mL,,328,278.8,94.0048,328,"Health Partners, Inc.",Medicare Advantage,160.72,49,,percent of total billed charges,,
DIAZEPAM 5 MG/5 ML (1 MG/ML) ORAL SOLN,,8137,LOCAL,Facility,Inpatient,500 mL,mL,,328,278.8,94.0048,328,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DIAZEPAM 5 MG/5 ML (1 MG/ML) ORAL SOLN,,8137,LOCAL,Facility,Both,500 mL,mL,,328,278.8,94.0048,328,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),196.8,60,,percent of total billed charges,,
DIAZEPAM 5 MG/5 ML (1 MG/ML) ORAL SOLN,,8137,LOCAL,Facility,Both,500 mL,mL,,328,278.8,94.0048,328,"Health Partners, Inc.",State of Minnesota Advantage Program,267.32,81.5,,percent of total billed charges,,
DIAZEPAM 5 MG/5 ML (1 MG/ML) ORAL SOLN,,8137,LOCAL,Facility,Both,500 mL,mL,,328,278.8,94.0048,328,"Health Partners, Inc.",State Public Programs,164,50,,percent of total billed charges,,
DIAZEPAM 5 MG/5 ML (1 MG/ML) ORAL SOLN,,8137,LOCAL,Facility,Both,500 mL,mL,,328,278.8,94.0048,328,Humana Insurance Company,Commercial PPO,311.6,95,,percent of total billed charges,,
DIAZEPAM 5 MG/5 ML (1 MG/ML) ORAL SOLN,,8137,LOCAL,Facility,Outpatient,500 mL,mL,,328,278.8,94.0048,328,Humana Insurance Company,Medicare PPO,160.72,49,,percent of total billed charges,,
DIAZEPAM 5 MG/5 ML (1 MG/ML) ORAL SOLN,,8137,LOCAL,Facility,Inpatient,500 mL,mL,,328,278.8,94.0048,328,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
DIAZEPAM 5 MG/5 ML (1 MG/ML) ORAL SOLN,,8137,LOCAL,Facility,Both,500 mL,mL,,328,278.8,94.0048,328,Medica,Individual & Family,325.048,99.1,,percent of total billed charges,,
DIAZEPAM 5 MG/5 ML (1 MG/ML) ORAL SOLN,,8137,LOCAL,Facility,Outpatient,500 mL,mL,,328,278.8,94.0048,328,Medica,Medica Advantage Solution,163.344,49.8,,percent of total billed charges,,
DIAZEPAM 5 MG/5 ML (1 MG/ML) ORAL SOLN,,8137,LOCAL,Facility,Inpatient,500 mL,mL,,328,278.8,94.0048,328,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
DIAZEPAM 5 MG/5 ML (1 MG/ML) ORAL SOLN,,8137,LOCAL,Facility,Outpatient,500 mL,mL,,328,278.8,94.0048,328,Medica,Medical Assistance,146.288,44.6,,percent of total billed charges,,
DIAZEPAM 5 MG/5 ML (1 MG/ML) ORAL SOLN,,8137,LOCAL,Facility,Inpatient,500 mL,mL,,328,278.8,94.0048,328,Medica,Medical Assistance,,,,,Included in per diem rate,
DIAZEPAM 5 MG/5 ML (1 MG/ML) ORAL SOLN,,8137,LOCAL,Facility,Outpatient,500 mL,mL,,328,278.8,94.0048,328,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,163.344,49.8,,percent of total billed charges,,
DIAZEPAM 5 MG/5 ML (1 MG/ML) ORAL SOLN,,8137,LOCAL,Facility,Inpatient,500 mL,mL,,328,278.8,94.0048,328,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
DIAZEPAM 5 MG/5 ML (1 MG/ML) ORAL SOLN,,8137,LOCAL,Facility,Both,500 mL,mL,,328,278.8,94.0048,328,"Multiplan, Inc.","Multiplan, Inc.",308.32,94,,percent of total billed charges,,
DIAZEPAM 5 MG/5 ML (1 MG/ML) ORAL SOLN,,8137,LOCAL,Facility,Outpatient,500 mL,mL,,328,278.8,94.0048,328,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,295.528,90.1,,percent of total billed charges,,
DIAZEPAM 5 MG/5 ML (1 MG/ML) ORAL SOLN,,8137,LOCAL,Facility,Inpatient,500 mL,mL,,328,278.8,94.0048,328,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
DIAZEPAM 5 MG/5 ML (1 MG/ML) ORAL SOLN,,8137,LOCAL,Facility,Both,500 mL,mL,,328,278.8,94.0048,328,"Preferred One Administrative Services, INC.",PPO,323.408,98.6,,percent of total billed charges,,
DIAZEPAM 5 MG/5 ML (1 MG/ML) ORAL SOLN,,8137,LOCAL,Facility,Outpatient,500 mL,mL,,328,278.8,94.0048,328,PrimeWest Health,Minnesota Senior Health Options (MSHO),168.756,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
DIAZEPAM 5 MG/5 ML (1 MG/ML) ORAL SOLN,,8137,LOCAL,Facility,Inpatient,500 mL,mL,,328,278.8,94.0048,328,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DIAZEPAM 5 MG/5 ML (1 MG/ML) ORAL SOLN,,8137,LOCAL,Facility,Outpatient,500 mL,mL,,328,278.8,94.0048,328,PrimeWest Health,MinnesotaCare,168.4608,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
DIAZEPAM 5 MG/5 ML (1 MG/ML) ORAL SOLN,,8137,LOCAL,Facility,Inpatient,500 mL,mL,,328,278.8,94.0048,328,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
DIAZEPAM 5 MG/5 ML (1 MG/ML) ORAL SOLN,,8137,LOCAL,Facility,Both,500 mL,mL,,328,278.8,94.0048,328,Sanford Health Plan,Sanford Health Plan,301.76,92,,percent of total billed charges,,
DIAZEPAM 5 MG/5 ML (1 MG/ML) ORAL SOLN,,8137,LOCAL,Facility,Outpatient,500 mL,mL,,328,278.8,94.0048,328,"UCare Health, Inc.",Individual & Family Plan,184.828,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
DIAZEPAM 5 MG/5 ML (1 MG/ML) ORAL SOLN,,8137,LOCAL,Facility,Inpatient,500 mL,mL,,328,278.8,94.0048,328,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
DIAZEPAM 5 MG/5 ML (1 MG/ML) ORAL SOLN,,8137,LOCAL,Facility,Outpatient,500 mL,mL,,328,278.8,94.0048,328,"UCare Health, Inc.",Medical Assistance,165.5416,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DIAZEPAM 5 MG/5 ML (1 MG/ML) ORAL SOLN,,8137,LOCAL,Facility,Inpatient,500 mL,mL,,328,278.8,94.0048,328,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
DIAZEPAM 5 MG/5 ML (1 MG/ML) ORAL SOLN,,8137,LOCAL,Facility,Outpatient,500 mL,mL,,328,278.8,94.0048,328,"UCare Health, Inc.",Medicare Advantage,165.5416,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DIAZEPAM 5 MG/5 ML (1 MG/ML) ORAL SOLN,,8137,LOCAL,Facility,Inpatient,500 mL,mL,,328,278.8,94.0048,328,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DIAZEPAM 5 MG/5 ML (1 MG/ML) ORAL SOLN,,8137,LOCAL,Facility,Outpatient,500 mL,mL,,328,278.8,94.0048,328,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),165.5416,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DIAZEPAM 5 MG/5 ML (1 MG/ML) ORAL SOLN,,8137,LOCAL,Facility,Inpatient,500 mL,mL,,328,278.8,94.0048,328,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DIAZEPAM 5 MG/5 ML (1 MG/ML) ORAL SOLN,,8137,LOCAL,Facility,Both,500 mL,mL,,328,278.8,94.0048,328,UnitedHealthcare,Individual & Family,308.32,94,,percent of total billed charges,,
DIAZEPAM 5 MG/5 ML (1 MG/ML) ORAL SOLN,,8137,LOCAL,Facility,Outpatient,500 mL,mL,,328,278.8,94.0048,328,UnitedHealthcare,Medicare Advantage,160.72,49,,percent of total billed charges,,
DIAZEPAM 5 MG/5 ML (1 MG/ML) ORAL SOLN,,8137,LOCAL,Facility,Inpatient,500 mL,mL,,328,278.8,94.0048,328,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
DIAZEPAM 5 MG/5 ML (1 MG/ML) ORAL SOLN,,8137,LOCAL,Facility,Outpatient,500 mL,mL,,328,278.8,94.0048,328,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,157.44,48,,percent of total billed charges,,100% of DHS outpatient percentage
DIAZEPAM 5 MG/5 ML (1 MG/ML) ORAL SOLN,,8137,LOCAL,Facility,Inpatient,500 mL,mL,,328,278.8,94.0048,328,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Both,500 mL,mL,,20,17,5.732,20,Aetna,Commercial,18.4,92,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Outpatient,500 mL,mL,,20,17,5.732,20,Aetna,Medicare Advantage,9.8,49,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Inpatient,500 mL,mL,,20,17,5.732,20,Aetna,Medicare Advantage,,,,,Included in per diem rate,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Both,500 mL,mL,,20,17,5.732,20,Aetna,PPO,18.6,93,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Both,500 mL,mL,,20,17,5.732,20,America's PPO,America's PPO,19.206,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Both,500 mL,mL,,20,17,5.732,20,BlueCross BlueShield Minnesota, Federal Employee Program,19.68,98.4,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Both,500 mL,mL,,20,17,5.732,20,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,20,100,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Both,500 mL,mL,,20,17,5.732,20,BlueCross BlueShield Minnesota,High Value Network Plan,18,90,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Outpatient,500 mL,mL,,20,17,5.732,20,BlueCross BlueShield Minnesota,Medicare Advantage,9.8,49,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Inpatient,500 mL,mL,,20,17,5.732,20,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Both,500 mL,mL,,20,17,5.732,20,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,17.714,88.57,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Both,500 mL,mL,,20,17,5.732,20,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,5.732,28.66,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Outpatient,500 mL,mL,,20,17,5.732,20,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),9.8,49,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Inpatient,500 mL,mL,,20,17,5.732,20,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Both,500 mL,mL,,20,17,5.732,20,CorVel,Worker's Compensation,20,100,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Both,500 mL,mL,,20,17,5.732,20,First Health Group Corporation,First Health Network,19.4,97,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Both,500 mL,mL,,20,17,5.732,20,"Health Partners, Inc.",Commercial,18.92,94.6,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Outpatient,500 mL,mL,,20,17,5.732,20,"Health Partners, Inc.",Medicare Advantage,9.8,49,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Inpatient,500 mL,mL,,20,17,5.732,20,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Both,500 mL,mL,,20,17,5.732,20,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),12,60,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Both,500 mL,mL,,20,17,5.732,20,"Health Partners, Inc.",State of Minnesota Advantage Program,16.3,81.5,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Both,500 mL,mL,,20,17,5.732,20,"Health Partners, Inc.",State Public Programs,10,50,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Both,500 mL,mL,,20,17,5.732,20,Humana Insurance Company,Commercial PPO,19,95,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Outpatient,500 mL,mL,,20,17,5.732,20,Humana Insurance Company,Medicare PPO,9.8,49,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Inpatient,500 mL,mL,,20,17,5.732,20,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Both,500 mL,mL,,20,17,5.732,20,Medica,Individual & Family,19.82,99.1,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Outpatient,500 mL,mL,,20,17,5.732,20,Medica,Medica Advantage Solution,9.96,49.8,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Inpatient,500 mL,mL,,20,17,5.732,20,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Outpatient,500 mL,mL,,20,17,5.732,20,Medica,Medical Assistance,8.92,44.6,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Inpatient,500 mL,mL,,20,17,5.732,20,Medica,Medical Assistance,,,,,Included in per diem rate,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Outpatient,500 mL,mL,,20,17,5.732,20,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,9.96,49.8,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Inpatient,500 mL,mL,,20,17,5.732,20,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Both,500 mL,mL,,20,17,5.732,20,"Multiplan, Inc.","Multiplan, Inc.",18.8,94,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Outpatient,500 mL,mL,,20,17,5.732,20,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,18.02,90.1,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Inpatient,500 mL,mL,,20,17,5.732,20,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Both,500 mL,mL,,20,17,5.732,20,"Preferred One Administrative Services, INC.",PPO,19.72,98.6,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Outpatient,500 mL,mL,,20,17,5.732,20,PrimeWest Health,Minnesota Senior Health Options (MSHO),10.29,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Inpatient,500 mL,mL,,20,17,5.732,20,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Outpatient,500 mL,mL,,20,17,5.732,20,PrimeWest Health,MinnesotaCare,10.272,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Inpatient,500 mL,mL,,20,17,5.732,20,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Both,500 mL,mL,,20,17,5.732,20,Sanford Health Plan,Sanford Health Plan,18.4,92,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Outpatient,500 mL,mL,,20,17,5.732,20,"UCare Health, Inc.",Individual & Family Plan,11.27,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Inpatient,500 mL,mL,,20,17,5.732,20,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Outpatient,500 mL,mL,,20,17,5.732,20,"UCare Health, Inc.",Medical Assistance,10.094,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Inpatient,500 mL,mL,,20,17,5.732,20,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Outpatient,500 mL,mL,,20,17,5.732,20,"UCare Health, Inc.",Medicare Advantage,10.094,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Inpatient,500 mL,mL,,20,17,5.732,20,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Outpatient,500 mL,mL,,20,17,5.732,20,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),10.094,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Inpatient,500 mL,mL,,20,17,5.732,20,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Both,500 mL,mL,,20,17,5.732,20,UnitedHealthcare,Individual & Family,18.8,94,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Outpatient,500 mL,mL,,20,17,5.732,20,UnitedHealthcare,Medicare Advantage,9.8,49,,percent of total billed charges,,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Inpatient,500 mL,mL,,20,17,5.732,20,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Outpatient,500 mL,mL,,20,17,5.732,20,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,9.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
SODIUM CHLORIDE 0.9 % IR SOLN,,9333,LOCAL,Facility,Inpatient,500 mL,mL,,20,17,5.732,20,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
MANNITOL 20 % 20 % IV SOLP,,17240,LOCAL,Facility,Both,500 mL,mL,,104,88.4,29.8064,104,Aetna,Commercial,95.68,92,,percent of total billed charges,,
MANNITOL 20 % 20 % IV SOLP,,17240,LOCAL,Facility,Outpatient,500 mL,mL,,104,88.4,29.8064,104,Aetna,Medicare Advantage,50.96,49,,percent of total billed charges,,
MANNITOL 20 % 20 % IV SOLP,,17240,LOCAL,Facility,Inpatient,500 mL,mL,,104,88.4,29.8064,104,Aetna,Medicare Advantage,,,,,Included in per diem rate,
MANNITOL 20 % 20 % IV SOLP,,17240,LOCAL,Facility,Both,500 mL,mL,,104,88.4,29.8064,104,Aetna,PPO,96.72,93,,percent of total billed charges,,
MANNITOL 20 % 20 % IV SOLP,,17240,LOCAL,Facility,Both,500 mL,mL,,104,88.4,29.8064,104,America's PPO,America's PPO,99.8712,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
MANNITOL 20 % 20 % IV SOLP,,17240,LOCAL,Facility,Both,500 mL,mL,,104,88.4,29.8064,104,BlueCross BlueShield Minnesota, Federal Employee Program,102.336,98.4,,percent of total billed charges,,
MANNITOL 20 % 20 % IV SOLP,,17240,LOCAL,Facility,Both,500 mL,mL,,104,88.4,29.8064,104,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,104,100,,percent of total billed charges,,
MANNITOL 20 % 20 % IV SOLP,,17240,LOCAL,Facility,Both,500 mL,mL,,104,88.4,29.8064,104,BlueCross BlueShield Minnesota,High Value Network Plan,93.6,90,,percent of total billed charges,,
MANNITOL 20 % 20 % IV SOLP,,17240,LOCAL,Facility,Outpatient,500 mL,mL,,104,88.4,29.8064,104,BlueCross BlueShield Minnesota,Medicare Advantage,50.96,49,,percent of total billed charges,,
MANNITOL 20 % 20 % IV SOLP,,17240,LOCAL,Facility,Inpatient,500 mL,mL,,104,88.4,29.8064,104,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
MANNITOL 20 % 20 % IV SOLP,,17240,LOCAL,Facility,Both,500 mL,mL,,104,88.4,29.8064,104,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,92.1128,88.57,,percent of total billed charges,,
MANNITOL 20 % 20 % IV SOLP,,17240,LOCAL,Facility,Both,500 mL,mL,,104,88.4,29.8064,104,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,29.8064,28.66,,percent of total billed charges,,
MANNITOL 20 % 20 % IV SOLP,,17240,LOCAL,Facility,Outpatient,500 mL,mL,,104,88.4,29.8064,104,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),50.96,49,,percent of total billed charges,,
MANNITOL 20 % 20 % IV SOLP,,17240,LOCAL,Facility,Inpatient,500 mL,mL,,104,88.4,29.8064,104,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
MANNITOL 20 % 20 % IV SOLP,,17240,LOCAL,Facility,Both,500 mL,mL,,104,88.4,29.8064,104,CorVel,Worker's Compensation,104,100,,percent of total billed charges,,
MANNITOL 20 % 20 % IV SOLP,,17240,LOCAL,Facility,Both,500 mL,mL,,104,88.4,29.8064,104,First Health Group Corporation,First Health Network,100.88,97,,percent of total billed charges,,
MANNITOL 20 % 20 % IV SOLP,,17240,LOCAL,Facility,Both,500 mL,mL,,104,88.4,29.8064,104,"Health Partners, Inc.",Commercial,98.384,94.6,,percent of total billed charges,,
MANNITOL 20 % 20 % IV SOLP,,17240,LOCAL,Facility,Outpatient,500 mL,mL,,104,88.4,29.8064,104,"Health Partners, Inc.",Medicare Advantage,50.96,49,,percent of total billed charges,,
MANNITOL 20 % 20 % IV SOLP,,17240,LOCAL,Facility,Inpatient,500 mL,mL,,104,88.4,29.8064,104,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
MANNITOL 20 % 20 % IV SOLP,,17240,LOCAL,Facility,Both,500 mL,mL,,104,88.4,29.8064,104,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),62.4,60,,percent of total billed charges,,
MANNITOL 20 % 20 % IV SOLP,,17240,LOCAL,Facility,Both,500 mL,mL,,104,88.4,29.8064,104,"Health Partners, Inc.",State of Minnesota Advantage Program,84.76,81.5,,percent of total billed charges,,
MANNITOL 20 % 20 % IV SOLP,,17240,LOCAL,Facility,Both,500 mL,mL,,104,88.4,29.8064,104,"Health Partners, Inc.",State Public Programs,52,50,,percent of total billed charges,,
MANNITOL 20 % 20 % IV SOLP,,17240,LOCAL,Facility,Both,500 mL,mL,,104,88.4,29.8064,104,Humana Insurance Company,Commercial PPO,98.8,95,,percent of total billed charges,,
MANNITOL 20 % 20 % IV SOLP,,17240,LOCAL,Facility,Outpatient,500 mL,mL,,104,88.4,29.8064,104,Humana Insurance Company,Medicare PPO,50.96,49,,percent of total billed charges,,
MANNITOL 20 % 20 % IV SOLP,,17240,LOCAL,Facility,Inpatient,500 mL,mL,,104,88.4,29.8064,104,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
MANNITOL 20 % 20 % IV SOLP,,17240,LOCAL,Facility,Both,500 mL,mL,,104,88.4,29.8064,104,Medica,Individual & Family,103.064,99.1,,percent of total billed charges,,
MANNITOL 20 % 20 % IV SOLP,,17240,LOCAL,Facility,Outpatient,500 mL,mL,,104,88.4,29.8064,104,Medica,Medica Advantage Solution,51.792,49.8,,percent of total billed charges,,
MANNITOL 20 % 20 % IV SOLP,,17240,LOCAL,Facility,Inpatient,500 mL,mL,,104,88.4,29.8064,104,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
MANNITOL 20 % 20 % IV SOLP,,17240,LOCAL,Facility,Outpatient,500 mL,mL,,104,88.4,29.8064,104,Medica,Medical Assistance,46.384,44.6,,percent of total billed charges,,
MANNITOL 20 % 20 % IV SOLP,,17240,LOCAL,Facility,Inpatient,500 mL,mL,,104,88.4,29.8064,104,Medica,Medical Assistance,,,,,Included in per diem rate,
MANNITOL 20 % 20 % IV SOLP,,17240,LOCAL,Facility,Outpatient,500 mL,mL,,104,88.4,29.8064,104,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,51.792,49.8,,percent of total billed charges,,
MANNITOL 20 % 20 % IV SOLP,,17240,LOCAL,Facility,Inpatient,500 mL,mL,,104,88.4,29.8064,104,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
MANNITOL 20 % 20 % IV SOLP,,17240,LOCAL,Facility,Both,500 mL,mL,,104,88.4,29.8064,104,"Multiplan, Inc.","Multiplan, Inc.",97.76,94,,percent of total billed charges,,
MANNITOL 20 % 20 % IV SOLP,,17240,LOCAL,Facility,Outpatient,500 mL,mL,,104,88.4,29.8064,104,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,93.704,90.1,,percent of total billed charges,,
MANNITOL 20 % 20 % IV SOLP,,17240,LOCAL,Facility,Inpatient,500 mL,mL,,104,88.4,29.8064,104,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
MANNITOL 20 % 20 % IV SOLP,,17240,LOCAL,Facility,Both,500 mL,mL,,104,88.4,29.8064,104,"Preferred One Administrative Services, INC.",PPO,102.544,98.6,,percent of total billed charges,,
MANNITOL 20 % 20 % IV SOLP,,17240,LOCAL,Facility,Outpatient,500 mL,mL,,104,88.4,29.8064,104,PrimeWest Health,Minnesota Senior Health Options (MSHO),53.508,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
MANNITOL 20 % 20 % IV SOLP,,17240,LOCAL,Facility,Inpatient,500 mL,mL,,104,88.4,29.8064,104,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
MANNITOL 20 % 20 % IV SOLP,,17240,LOCAL,Facility,Outpatient,500 mL,mL,,104,88.4,29.8064,104,PrimeWest Health,MinnesotaCare,53.4144,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
MANNITOL 20 % 20 % IV SOLP,,17240,LOCAL,Facility,Inpatient,500 mL,mL,,104,88.4,29.8064,104,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
MANNITOL 20 % 20 % IV SOLP,,17240,LOCAL,Facility,Both,500 mL,mL,,104,88.4,29.8064,104,Sanford Health Plan,Sanford Health Plan,95.68,92,,percent of total billed charges,,
MANNITOL 20 % 20 % IV SOLP,,17240,LOCAL,Facility,Outpatient,500 mL,mL,,104,88.4,29.8064,104,"UCare Health, Inc.",Individual & Family Plan,58.604,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
MANNITOL 20 % 20 % IV SOLP,,17240,LOCAL,Facility,Inpatient,500 mL,mL,,104,88.4,29.8064,104,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
MANNITOL 20 % 20 % IV SOLP,,17240,LOCAL,Facility,Outpatient,500 mL,mL,,104,88.4,29.8064,104,"UCare Health, Inc.",Medical Assistance,52.4888,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MANNITOL 20 % 20 % IV SOLP,,17240,LOCAL,Facility,Inpatient,500 mL,mL,,104,88.4,29.8064,104,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
MANNITOL 20 % 20 % IV SOLP,,17240,LOCAL,Facility,Outpatient,500 mL,mL,,104,88.4,29.8064,104,"UCare Health, Inc.",Medicare Advantage,52.4888,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MANNITOL 20 % 20 % IV SOLP,,17240,LOCAL,Facility,Inpatient,500 mL,mL,,104,88.4,29.8064,104,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
MANNITOL 20 % 20 % IV SOLP,,17240,LOCAL,Facility,Outpatient,500 mL,mL,,104,88.4,29.8064,104,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),52.4888,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MANNITOL 20 % 20 % IV SOLP,,17240,LOCAL,Facility,Inpatient,500 mL,mL,,104,88.4,29.8064,104,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
MANNITOL 20 % 20 % IV SOLP,,17240,LOCAL,Facility,Both,500 mL,mL,,104,88.4,29.8064,104,UnitedHealthcare,Individual & Family,97.76,94,,percent of total billed charges,,
MANNITOL 20 % 20 % IV SOLP,,17240,LOCAL,Facility,Outpatient,500 mL,mL,,104,88.4,29.8064,104,UnitedHealthcare,Medicare Advantage,50.96,49,,percent of total billed charges,,
MANNITOL 20 % 20 % IV SOLP,,17240,LOCAL,Facility,Inpatient,500 mL,mL,,104,88.4,29.8064,104,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
MANNITOL 20 % 20 % IV SOLP,,17240,LOCAL,Facility,Outpatient,500 mL,mL,,104,88.4,29.8064,104,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,49.92,48,,percent of total billed charges,,100% of DHS outpatient percentage
MANNITOL 20 % 20 % IV SOLP,,17240,LOCAL,Facility,Inpatient,500 mL,mL,,104,88.4,29.8064,104,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
SODIUM CHLORIDE 3 % HYPERTONIC 3 % IV SOLP,,J7131,HCPCS,Facility,Both,500 mL,mL,,33,28.05,9.4578,33,Aetna,Commercial,30.36,92,,percent of total billed charges,,
SODIUM CHLORIDE 3 % HYPERTONIC 3 % IV SOLP,,J7131,HCPCS,Facility,Outpatient,500 mL,mL,,33,28.05,9.4578,33,Aetna,Medicare Advantage,16.17,49,,percent of total billed charges,,
SODIUM CHLORIDE 3 % HYPERTONIC 3 % IV SOLP,,J7131,HCPCS,Facility,Inpatient,500 mL,mL,,33,28.05,9.4578,33,Aetna,Medicare Advantage,,,,,Included in per diem rate,
SODIUM CHLORIDE 3 % HYPERTONIC 3 % IV SOLP,,J7131,HCPCS,Facility,Both,500 mL,mL,,33,28.05,9.4578,33,Aetna,PPO,30.69,93,,percent of total billed charges,,
SODIUM CHLORIDE 3 % HYPERTONIC 3 % IV SOLP,,J7131,HCPCS,Facility,Both,500 mL,mL,,33,28.05,9.4578,33,America's PPO,America's PPO,31.6899,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SODIUM CHLORIDE 3 % HYPERTONIC 3 % IV SOLP,,J7131,HCPCS,Facility,Both,500 mL,mL,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota, Federal Employee Program,32.472,98.4,,percent of total billed charges,,
SODIUM CHLORIDE 3 % HYPERTONIC 3 % IV SOLP,,J7131,HCPCS,Facility,Both,500 mL,mL,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,33,100,,percent of total billed charges,,
SODIUM CHLORIDE 3 % HYPERTONIC 3 % IV SOLP,,J7131,HCPCS,Facility,Both,500 mL,mL,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota,High Value Network Plan,29.7,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
SODIUM CHLORIDE 3 % HYPERTONIC 3 % IV SOLP,,J7131,HCPCS,Facility,Outpatient,500 mL,mL,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota,Medicare Advantage,16.17,49,,percent of total billed charges,,
SODIUM CHLORIDE 3 % HYPERTONIC 3 % IV SOLP,,J7131,HCPCS,Facility,Inpatient,500 mL,mL,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
SODIUM CHLORIDE 3 % HYPERTONIC 3 % IV SOLP,,J7131,HCPCS,Facility,Both,500 mL,mL,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,29.2281,88.57,,percent of total billed charges,,
SODIUM CHLORIDE 3 % HYPERTONIC 3 % IV SOLP,,J7131,HCPCS,Facility,Both,500 mL,mL,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,9.4578,28.66,,percent of total billed charges,,
SODIUM CHLORIDE 3 % HYPERTONIC 3 % IV SOLP,,J7131,HCPCS,Facility,Outpatient,500 mL,mL,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),16.17,49,,percent of total billed charges,,
SODIUM CHLORIDE 3 % HYPERTONIC 3 % IV SOLP,,J7131,HCPCS,Facility,Inpatient,500 mL,mL,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
SODIUM CHLORIDE 3 % HYPERTONIC 3 % IV SOLP,,J7131,HCPCS,Facility,Both,500 mL,mL,,33,28.05,9.4578,33,CorVel,Worker's Compensation,33,100,,percent of total billed charges,,
SODIUM CHLORIDE 3 % HYPERTONIC 3 % IV SOLP,,J7131,HCPCS,Facility,Both,500 mL,mL,,33,28.05,9.4578,33,First Health Group Corporation,First Health Network,32.01,97,,percent of total billed charges,,
SODIUM CHLORIDE 3 % HYPERTONIC 3 % IV SOLP,,J7131,HCPCS,Facility,Both,500 mL,mL,,33,28.05,9.4578,33,"Health Partners, Inc.",Commercial,31.218,94.6,,percent of total billed charges,,
SODIUM CHLORIDE 3 % HYPERTONIC 3 % IV SOLP,,J7131,HCPCS,Facility,Outpatient,500 mL,mL,,33,28.05,9.4578,33,"Health Partners, Inc.",Medicare Advantage,16.17,49,,percent of total billed charges,,
SODIUM CHLORIDE 3 % HYPERTONIC 3 % IV SOLP,,J7131,HCPCS,Facility,Inpatient,500 mL,mL,,33,28.05,9.4578,33,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SODIUM CHLORIDE 3 % HYPERTONIC 3 % IV SOLP,,J7131,HCPCS,Facility,Both,500 mL,mL,,33,28.05,9.4578,33,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),19.8,60,,percent of total billed charges,,
SODIUM CHLORIDE 3 % HYPERTONIC 3 % IV SOLP,,J7131,HCPCS,Facility,Both,500 mL,mL,,33,28.05,9.4578,33,"Health Partners, Inc.",State of Minnesota Advantage Program,26.895,81.5,,percent of total billed charges,,
SODIUM CHLORIDE 3 % HYPERTONIC 3 % IV SOLP,,J7131,HCPCS,Facility,Both,500 mL,mL,,33,28.05,9.4578,33,"Health Partners, Inc.",State Public Programs,16.5,50,,percent of total billed charges,,
SODIUM CHLORIDE 3 % HYPERTONIC 3 % IV SOLP,,J7131,HCPCS,Facility,Both,500 mL,mL,,33,28.05,9.4578,33,Humana Insurance Company,Commercial PPO,31.35,95,,percent of total billed charges,,
SODIUM CHLORIDE 3 % HYPERTONIC 3 % IV SOLP,,J7131,HCPCS,Facility,Outpatient,500 mL,mL,,33,28.05,9.4578,33,Humana Insurance Company,Medicare PPO,16.17,49,,percent of total billed charges,,
SODIUM CHLORIDE 3 % HYPERTONIC 3 % IV SOLP,,J7131,HCPCS,Facility,Inpatient,500 mL,mL,,33,28.05,9.4578,33,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
SODIUM CHLORIDE 3 % HYPERTONIC 3 % IV SOLP,,J7131,HCPCS,Facility,Both,500 mL,mL,,33,28.05,9.4578,33,Medica,Individual & Family,32.703,99.1,,percent of total billed charges,,
SODIUM CHLORIDE 3 % HYPERTONIC 3 % IV SOLP,,J7131,HCPCS,Facility,Outpatient,500 mL,mL,,33,28.05,9.4578,33,Medica,Medica Advantage Solution,16.434,49.8,,percent of total billed charges,,
SODIUM CHLORIDE 3 % HYPERTONIC 3 % IV SOLP,,J7131,HCPCS,Facility,Inpatient,500 mL,mL,,33,28.05,9.4578,33,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
SODIUM CHLORIDE 3 % HYPERTONIC 3 % IV SOLP,,J7131,HCPCS,Facility,Outpatient,500 mL,mL,,33,28.05,9.4578,33,Medica,Medical Assistance,14.718,44.6,,percent of total billed charges,,
SODIUM CHLORIDE 3 % HYPERTONIC 3 % IV SOLP,,J7131,HCPCS,Facility,Inpatient,500 mL,mL,,33,28.05,9.4578,33,Medica,Medical Assistance,,,,,Included in per diem rate,
SODIUM CHLORIDE 3 % HYPERTONIC 3 % IV SOLP,,J7131,HCPCS,Facility,Outpatient,500 mL,mL,,33,28.05,9.4578,33,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,16.434,49.8,,percent of total billed charges,,
SODIUM CHLORIDE 3 % HYPERTONIC 3 % IV SOLP,,J7131,HCPCS,Facility,Inpatient,500 mL,mL,,33,28.05,9.4578,33,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
SODIUM CHLORIDE 3 % HYPERTONIC 3 % IV SOLP,,J7131,HCPCS,Facility,Both,500 mL,mL,,33,28.05,9.4578,33,"Multiplan, Inc.","Multiplan, Inc.",31.02,94,,percent of total billed charges,,
SODIUM CHLORIDE 3 % HYPERTONIC 3 % IV SOLP,,J7131,HCPCS,Facility,Outpatient,500 mL,mL,,33,28.05,9.4578,33,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,29.733,90.1,,percent of total billed charges,,
SODIUM CHLORIDE 3 % HYPERTONIC 3 % IV SOLP,,J7131,HCPCS,Facility,Inpatient,500 mL,mL,,33,28.05,9.4578,33,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
SODIUM CHLORIDE 3 % HYPERTONIC 3 % IV SOLP,,J7131,HCPCS,Facility,Both,500 mL,mL,,33,28.05,9.4578,33,"Preferred One Administrative Services, INC.",PPO,32.538,98.6,,percent of total billed charges,,
SODIUM CHLORIDE 3 % HYPERTONIC 3 % IV SOLP,,J7131,HCPCS,Facility,Outpatient,500 mL,mL,,33,28.05,9.4578,33,PrimeWest Health,Minnesota Senior Health Options (MSHO),16.9785,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
SODIUM CHLORIDE 3 % HYPERTONIC 3 % IV SOLP,,J7131,HCPCS,Facility,Inpatient,500 mL,mL,,33,28.05,9.4578,33,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SODIUM CHLORIDE 3 % HYPERTONIC 3 % IV SOLP,,J7131,HCPCS,Facility,Outpatient,500 mL,mL,,33,28.05,9.4578,33,PrimeWest Health,MinnesotaCare,16.9488,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
SODIUM CHLORIDE 3 % HYPERTONIC 3 % IV SOLP,,J7131,HCPCS,Facility,Inpatient,500 mL,mL,,33,28.05,9.4578,33,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
SODIUM CHLORIDE 3 % HYPERTONIC 3 % IV SOLP,,J7131,HCPCS,Facility,Both,500 mL,mL,,33,28.05,9.4578,33,Sanford Health Plan,Sanford Health Plan,30.36,92,,percent of total billed charges,,
SODIUM CHLORIDE 3 % HYPERTONIC 3 % IV SOLP,,J7131,HCPCS,Facility,Outpatient,500 mL,mL,,33,28.05,9.4578,33,"UCare Health, Inc.",Individual & Family Plan,18.5955,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
SODIUM CHLORIDE 3 % HYPERTONIC 3 % IV SOLP,,J7131,HCPCS,Facility,Inpatient,500 mL,mL,,33,28.05,9.4578,33,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
SODIUM CHLORIDE 3 % HYPERTONIC 3 % IV SOLP,,J7131,HCPCS,Facility,Outpatient,500 mL,mL,,33,28.05,9.4578,33,"UCare Health, Inc.",Medical Assistance,16.6551,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SODIUM CHLORIDE 3 % HYPERTONIC 3 % IV SOLP,,J7131,HCPCS,Facility,Inpatient,500 mL,mL,,33,28.05,9.4578,33,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
SODIUM CHLORIDE 3 % HYPERTONIC 3 % IV SOLP,,J7131,HCPCS,Facility,Outpatient,500 mL,mL,,33,28.05,9.4578,33,"UCare Health, Inc.",Medicare Advantage,16.6551,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SODIUM CHLORIDE 3 % HYPERTONIC 3 % IV SOLP,,J7131,HCPCS,Facility,Inpatient,500 mL,mL,,33,28.05,9.4578,33,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SODIUM CHLORIDE 3 % HYPERTONIC 3 % IV SOLP,,J7131,HCPCS,Facility,Outpatient,500 mL,mL,,33,28.05,9.4578,33,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),16.6551,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SODIUM CHLORIDE 3 % HYPERTONIC 3 % IV SOLP,,J7131,HCPCS,Facility,Inpatient,500 mL,mL,,33,28.05,9.4578,33,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SODIUM CHLORIDE 3 % HYPERTONIC 3 % IV SOLP,,J7131,HCPCS,Facility,Both,500 mL,mL,,33,28.05,9.4578,33,UnitedHealthcare,Individual & Family,31.02,94,,percent of total billed charges,,
SODIUM CHLORIDE 3 % HYPERTONIC 3 % IV SOLP,,J7131,HCPCS,Facility,Outpatient,500 mL,mL,,33,28.05,9.4578,33,UnitedHealthcare,Medicare Advantage,16.17,49,,percent of total billed charges,,
SODIUM CHLORIDE 3 % HYPERTONIC 3 % IV SOLP,,J7131,HCPCS,Facility,Inpatient,500 mL,mL,,33,28.05,9.4578,33,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
SODIUM CHLORIDE 3 % HYPERTONIC 3 % IV SOLP,,J7131,HCPCS,Facility,Outpatient,500 mL,mL,,33,28.05,9.4578,33,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,15.84,48,,percent of total billed charges,,100% of DHS outpatient percentage
SODIUM CHLORIDE 3 % HYPERTONIC 3 % IV SOLP,,J7131,HCPCS,Facility,Inpatient,500 mL,mL,,33,28.05,9.4578,33,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
SODIUM CHLORIDE 3 % HYPERTONIC 3 % IV SOLP - INTERMITTENT DOSE,,J7131,HCPCS,Facility,Both,500 mL,mL,,33,28.05,9.4578,33,Aetna,Commercial,30.36,92,,percent of total billed charges,,
SODIUM CHLORIDE 3 % HYPERTONIC 3 % IV SOLP - INTERMITTENT DOSE,,J7131,HCPCS,Facility,Outpatient,500 mL,mL,,33,28.05,9.4578,33,Aetna,Medicare Advantage,16.17,49,,percent of total billed charges,,
SODIUM CHLORIDE 3 % HYPERTONIC 3 % IV SOLP - INTERMITTENT DOSE,,J7131,HCPCS,Facility,Inpatient,500 mL,mL,,33,28.05,9.4578,33,Aetna,Medicare Advantage,,,,,Included in per diem rate,
SODIUM CHLORIDE 3 % HYPERTONIC 3 % IV SOLP - INTERMITTENT DOSE,,J7131,HCPCS,Facility,Both,500 mL,mL,,33,28.05,9.4578,33,Aetna,PPO,30.69,93,,percent of total billed charges,,
SODIUM CHLORIDE 3 % HYPERTONIC 3 % IV SOLP - INTERMITTENT DOSE,,J7131,HCPCS,Facility,Both,500 mL,mL,,33,28.05,9.4578,33,America's PPO,America's PPO,31.6899,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SODIUM CHLORIDE 3 % HYPERTONIC 3 % IV SOLP - INTERMITTENT DOSE,,J7131,HCPCS,Facility,Both,500 mL,mL,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota, Federal Employee Program,32.472,98.4,,percent of total billed charges,,
SODIUM CHLORIDE 3 % HYPERTONIC 3 % IV SOLP - INTERMITTENT DOSE,,J7131,HCPCS,Facility,Both,500 mL,mL,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,33,100,,percent of total billed charges,,
SODIUM CHLORIDE 3 % HYPERTONIC 3 % IV SOLP - INTERMITTENT DOSE,,J7131,HCPCS,Facility,Both,500 mL,mL,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota,High Value Network Plan,29.7,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
SODIUM CHLORIDE 3 % HYPERTONIC 3 % IV SOLP - INTERMITTENT DOSE,,J7131,HCPCS,Facility,Outpatient,500 mL,mL,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota,Medicare Advantage,16.17,49,,percent of total billed charges,,
SODIUM CHLORIDE 3 % HYPERTONIC 3 % IV SOLP - INTERMITTENT DOSE,,J7131,HCPCS,Facility,Inpatient,500 mL,mL,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
SODIUM CHLORIDE 3 % HYPERTONIC 3 % IV SOLP - INTERMITTENT DOSE,,J7131,HCPCS,Facility,Both,500 mL,mL,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,29.2281,88.57,,percent of total billed charges,,
SODIUM CHLORIDE 3 % HYPERTONIC 3 % IV SOLP - INTERMITTENT DOSE,,J7131,HCPCS,Facility,Both,500 mL,mL,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,9.4578,28.66,,percent of total billed charges,,
SODIUM CHLORIDE 3 % HYPERTONIC 3 % IV SOLP - INTERMITTENT DOSE,,J7131,HCPCS,Facility,Outpatient,500 mL,mL,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),16.17,49,,percent of total billed charges,,
SODIUM CHLORIDE 3 % HYPERTONIC 3 % IV SOLP - INTERMITTENT DOSE,,J7131,HCPCS,Facility,Inpatient,500 mL,mL,,33,28.05,9.4578,33,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
SODIUM CHLORIDE 3 % HYPERTONIC 3 % IV SOLP - INTERMITTENT DOSE,,J7131,HCPCS,Facility,Both,500 mL,mL,,33,28.05,9.4578,33,CorVel,Worker's Compensation,33,100,,percent of total billed charges,,
SODIUM CHLORIDE 3 % HYPERTONIC 3 % IV SOLP - INTERMITTENT DOSE,,J7131,HCPCS,Facility,Both,500 mL,mL,,33,28.05,9.4578,33,First Health Group Corporation,First Health Network,32.01,97,,percent of total billed charges,,
SODIUM CHLORIDE 3 % HYPERTONIC 3 % IV SOLP - INTERMITTENT DOSE,,J7131,HCPCS,Facility,Both,500 mL,mL,,33,28.05,9.4578,33,"Health Partners, Inc.",Commercial,31.218,94.6,,percent of total billed charges,,
SODIUM CHLORIDE 3 % HYPERTONIC 3 % IV SOLP - INTERMITTENT DOSE,,J7131,HCPCS,Facility,Outpatient,500 mL,mL,,33,28.05,9.4578,33,"Health Partners, Inc.",Medicare Advantage,16.17,49,,percent of total billed charges,,
SODIUM CHLORIDE 3 % HYPERTONIC 3 % IV SOLP - INTERMITTENT DOSE,,J7131,HCPCS,Facility,Inpatient,500 mL,mL,,33,28.05,9.4578,33,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SODIUM CHLORIDE 3 % HYPERTONIC 3 % IV SOLP - INTERMITTENT DOSE,,J7131,HCPCS,Facility,Both,500 mL,mL,,33,28.05,9.4578,33,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),19.8,60,,percent of total billed charges,,
SODIUM CHLORIDE 3 % HYPERTONIC 3 % IV SOLP - INTERMITTENT DOSE,,J7131,HCPCS,Facility,Both,500 mL,mL,,33,28.05,9.4578,33,"Health Partners, Inc.",State of Minnesota Advantage Program,26.895,81.5,,percent of total billed charges,,
SODIUM CHLORIDE 3 % HYPERTONIC 3 % IV SOLP - INTERMITTENT DOSE,,J7131,HCPCS,Facility,Both,500 mL,mL,,33,28.05,9.4578,33,"Health Partners, Inc.",State Public Programs,16.5,50,,percent of total billed charges,,
SODIUM CHLORIDE 3 % HYPERTONIC 3 % IV SOLP - INTERMITTENT DOSE,,J7131,HCPCS,Facility,Both,500 mL,mL,,33,28.05,9.4578,33,Humana Insurance Company,Commercial PPO,31.35,95,,percent of total billed charges,,
SODIUM CHLORIDE 3 % HYPERTONIC 3 % IV SOLP - INTERMITTENT DOSE,,J7131,HCPCS,Facility,Outpatient,500 mL,mL,,33,28.05,9.4578,33,Humana Insurance Company,Medicare PPO,16.17,49,,percent of total billed charges,,
SODIUM CHLORIDE 3 % HYPERTONIC 3 % IV SOLP - INTERMITTENT DOSE,,J7131,HCPCS,Facility,Inpatient,500 mL,mL,,33,28.05,9.4578,33,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
SODIUM CHLORIDE 3 % HYPERTONIC 3 % IV SOLP - INTERMITTENT DOSE,,J7131,HCPCS,Facility,Both,500 mL,mL,,33,28.05,9.4578,33,Medica,Individual & Family,32.703,99.1,,percent of total billed charges,,
SODIUM CHLORIDE 3 % HYPERTONIC 3 % IV SOLP - INTERMITTENT DOSE,,J7131,HCPCS,Facility,Outpatient,500 mL,mL,,33,28.05,9.4578,33,Medica,Medica Advantage Solution,16.434,49.8,,percent of total billed charges,,
SODIUM CHLORIDE 3 % HYPERTONIC 3 % IV SOLP - INTERMITTENT DOSE,,J7131,HCPCS,Facility,Inpatient,500 mL,mL,,33,28.05,9.4578,33,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
SODIUM CHLORIDE 3 % HYPERTONIC 3 % IV SOLP - INTERMITTENT DOSE,,J7131,HCPCS,Facility,Outpatient,500 mL,mL,,33,28.05,9.4578,33,Medica,Medical Assistance,14.718,44.6,,percent of total billed charges,,
SODIUM CHLORIDE 3 % HYPERTONIC 3 % IV SOLP - INTERMITTENT DOSE,,J7131,HCPCS,Facility,Inpatient,500 mL,mL,,33,28.05,9.4578,33,Medica,Medical Assistance,,,,,Included in per diem rate,
SODIUM CHLORIDE 3 % HYPERTONIC 3 % IV SOLP - INTERMITTENT DOSE,,J7131,HCPCS,Facility,Outpatient,500 mL,mL,,33,28.05,9.4578,33,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,16.434,49.8,,percent of total billed charges,,
SODIUM CHLORIDE 3 % HYPERTONIC 3 % IV SOLP - INTERMITTENT DOSE,,J7131,HCPCS,Facility,Inpatient,500 mL,mL,,33,28.05,9.4578,33,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
SODIUM CHLORIDE 3 % HYPERTONIC 3 % IV SOLP - INTERMITTENT DOSE,,J7131,HCPCS,Facility,Both,500 mL,mL,,33,28.05,9.4578,33,"Multiplan, Inc.","Multiplan, Inc.",31.02,94,,percent of total billed charges,,
SODIUM CHLORIDE 3 % HYPERTONIC 3 % IV SOLP - INTERMITTENT DOSE,,J7131,HCPCS,Facility,Outpatient,500 mL,mL,,33,28.05,9.4578,33,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,29.733,90.1,,percent of total billed charges,,
SODIUM CHLORIDE 3 % HYPERTONIC 3 % IV SOLP - INTERMITTENT DOSE,,J7131,HCPCS,Facility,Inpatient,500 mL,mL,,33,28.05,9.4578,33,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
SODIUM CHLORIDE 3 % HYPERTONIC 3 % IV SOLP - INTERMITTENT DOSE,,J7131,HCPCS,Facility,Both,500 mL,mL,,33,28.05,9.4578,33,"Preferred One Administrative Services, INC.",PPO,32.538,98.6,,percent of total billed charges,,
SODIUM CHLORIDE 3 % HYPERTONIC 3 % IV SOLP - INTERMITTENT DOSE,,J7131,HCPCS,Facility,Outpatient,500 mL,mL,,33,28.05,9.4578,33,PrimeWest Health,Minnesota Senior Health Options (MSHO),16.9785,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
SODIUM CHLORIDE 3 % HYPERTONIC 3 % IV SOLP - INTERMITTENT DOSE,,J7131,HCPCS,Facility,Inpatient,500 mL,mL,,33,28.05,9.4578,33,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SODIUM CHLORIDE 3 % HYPERTONIC 3 % IV SOLP - INTERMITTENT DOSE,,J7131,HCPCS,Facility,Outpatient,500 mL,mL,,33,28.05,9.4578,33,PrimeWest Health,MinnesotaCare,16.9488,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
SODIUM CHLORIDE 3 % HYPERTONIC 3 % IV SOLP - INTERMITTENT DOSE,,J7131,HCPCS,Facility,Inpatient,500 mL,mL,,33,28.05,9.4578,33,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
SODIUM CHLORIDE 3 % HYPERTONIC 3 % IV SOLP - INTERMITTENT DOSE,,J7131,HCPCS,Facility,Both,500 mL,mL,,33,28.05,9.4578,33,Sanford Health Plan,Sanford Health Plan,30.36,92,,percent of total billed charges,,
SODIUM CHLORIDE 3 % HYPERTONIC 3 % IV SOLP - INTERMITTENT DOSE,,J7131,HCPCS,Facility,Outpatient,500 mL,mL,,33,28.05,9.4578,33,"UCare Health, Inc.",Individual & Family Plan,18.5955,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
SODIUM CHLORIDE 3 % HYPERTONIC 3 % IV SOLP - INTERMITTENT DOSE,,J7131,HCPCS,Facility,Inpatient,500 mL,mL,,33,28.05,9.4578,33,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
SODIUM CHLORIDE 3 % HYPERTONIC 3 % IV SOLP - INTERMITTENT DOSE,,J7131,HCPCS,Facility,Outpatient,500 mL,mL,,33,28.05,9.4578,33,"UCare Health, Inc.",Medical Assistance,16.6551,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SODIUM CHLORIDE 3 % HYPERTONIC 3 % IV SOLP - INTERMITTENT DOSE,,J7131,HCPCS,Facility,Inpatient,500 mL,mL,,33,28.05,9.4578,33,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
SODIUM CHLORIDE 3 % HYPERTONIC 3 % IV SOLP - INTERMITTENT DOSE,,J7131,HCPCS,Facility,Outpatient,500 mL,mL,,33,28.05,9.4578,33,"UCare Health, Inc.",Medicare Advantage,16.6551,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SODIUM CHLORIDE 3 % HYPERTONIC 3 % IV SOLP - INTERMITTENT DOSE,,J7131,HCPCS,Facility,Inpatient,500 mL,mL,,33,28.05,9.4578,33,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SODIUM CHLORIDE 3 % HYPERTONIC 3 % IV SOLP - INTERMITTENT DOSE,,J7131,HCPCS,Facility,Outpatient,500 mL,mL,,33,28.05,9.4578,33,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),16.6551,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SODIUM CHLORIDE 3 % HYPERTONIC 3 % IV SOLP - INTERMITTENT DOSE,,J7131,HCPCS,Facility,Inpatient,500 mL,mL,,33,28.05,9.4578,33,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SODIUM CHLORIDE 3 % HYPERTONIC 3 % IV SOLP - INTERMITTENT DOSE,,J7131,HCPCS,Facility,Both,500 mL,mL,,33,28.05,9.4578,33,UnitedHealthcare,Individual & Family,31.02,94,,percent of total billed charges,,
SODIUM CHLORIDE 3 % HYPERTONIC 3 % IV SOLP - INTERMITTENT DOSE,,J7131,HCPCS,Facility,Outpatient,500 mL,mL,,33,28.05,9.4578,33,UnitedHealthcare,Medicare Advantage,16.17,49,,percent of total billed charges,,
SODIUM CHLORIDE 3 % HYPERTONIC 3 % IV SOLP - INTERMITTENT DOSE,,J7131,HCPCS,Facility,Inpatient,500 mL,mL,,33,28.05,9.4578,33,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
SODIUM CHLORIDE 3 % HYPERTONIC 3 % IV SOLP - INTERMITTENT DOSE,,J7131,HCPCS,Facility,Outpatient,500 mL,mL,,33,28.05,9.4578,33,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,15.84,48,,percent of total billed charges,,100% of DHS outpatient percentage
SODIUM CHLORIDE 3 % HYPERTONIC 3 % IV SOLP - INTERMITTENT DOSE,,J7131,HCPCS,Facility,Inpatient,500 mL,mL,,33,28.05,9.4578,33,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
HUM PROTHROMBIN CPLX(PCC)4FACT 500 UNIT (400-620 UNIT) IV SOLR,,J7168,HCPCS,Facility,Both,500 Units,Units,,5364,4559.4,1537.3224,5364,Aetna,Commercial,4934.88,92,,percent of total billed charges,,
HUM PROTHROMBIN CPLX(PCC)4FACT 500 UNIT (400-620 UNIT) IV SOLR,,J7168,HCPCS,Facility,Outpatient,500 Units,Units,,5364,4559.4,1537.3224,5364,Aetna,Medicare Advantage,2628.36,49,,percent of total billed charges,,
HUM PROTHROMBIN CPLX(PCC)4FACT 500 UNIT (400-620 UNIT) IV SOLR,,J7168,HCPCS,Facility,Inpatient,500 Units,Units,,5364,4559.4,1537.3224,5364,Aetna,Medicare Advantage,,,,,Included in per diem rate,
HUM PROTHROMBIN CPLX(PCC)4FACT 500 UNIT (400-620 UNIT) IV SOLR,,J7168,HCPCS,Facility,Both,500 Units,Units,,5364,4559.4,1537.3224,5364,Aetna,PPO,4988.52,93,,percent of total billed charges,,
HUM PROTHROMBIN CPLX(PCC)4FACT 500 UNIT (400-620 UNIT) IV SOLR,,J7168,HCPCS,Facility,Both,500 Units,Units,,5364,4559.4,1537.3224,5364,America's PPO,America's PPO,5151.0492,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
HUM PROTHROMBIN CPLX(PCC)4FACT 500 UNIT (400-620 UNIT) IV SOLR,,J7168,HCPCS,Facility,Both,500 Units,Units,,5364,4559.4,1537.3224,5364,BlueCross BlueShield Minnesota, Federal Employee Program,5278.176,98.4,,percent of total billed charges,,
HUM PROTHROMBIN CPLX(PCC)4FACT 500 UNIT (400-620 UNIT) IV SOLR,,J7168,HCPCS,Facility,Both,500 Units,Units,,5364,4559.4,1537.3224,5364,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5364,100,,percent of total billed charges,,
HUM PROTHROMBIN CPLX(PCC)4FACT 500 UNIT (400-620 UNIT) IV SOLR,,J7168,HCPCS,Facility,Both,500 Units,Units,,5364,4559.4,1537.3224,5364,BlueCross BlueShield Minnesota,High Value Network Plan,4827.6,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
HUM PROTHROMBIN CPLX(PCC)4FACT 500 UNIT (400-620 UNIT) IV SOLR,,J7168,HCPCS,Facility,Outpatient,500 Units,Units,,5364,4559.4,1537.3224,5364,BlueCross BlueShield Minnesota,Medicare Advantage,2628.36,49,,percent of total billed charges,,
HUM PROTHROMBIN CPLX(PCC)4FACT 500 UNIT (400-620 UNIT) IV SOLR,,J7168,HCPCS,Facility,Inpatient,500 Units,Units,,5364,4559.4,1537.3224,5364,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
HUM PROTHROMBIN CPLX(PCC)4FACT 500 UNIT (400-620 UNIT) IV SOLR,,J7168,HCPCS,Facility,Both,500 Units,Units,,5364,4559.4,1537.3224,5364,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4750.8948,88.57,,percent of total billed charges,,
HUM PROTHROMBIN CPLX(PCC)4FACT 500 UNIT (400-620 UNIT) IV SOLR,,J7168,HCPCS,Facility,Both,500 Units,Units,,5364,4559.4,1537.3224,5364,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1537.3224,28.66,,percent of total billed charges,,
HUM PROTHROMBIN CPLX(PCC)4FACT 500 UNIT (400-620 UNIT) IV SOLR,,J7168,HCPCS,Facility,Outpatient,500 Units,Units,,5364,4559.4,1537.3224,5364,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2628.36,49,,percent of total billed charges,,
HUM PROTHROMBIN CPLX(PCC)4FACT 500 UNIT (400-620 UNIT) IV SOLR,,J7168,HCPCS,Facility,Inpatient,500 Units,Units,,5364,4559.4,1537.3224,5364,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
HUM PROTHROMBIN CPLX(PCC)4FACT 500 UNIT (400-620 UNIT) IV SOLR,,J7168,HCPCS,Facility,Both,500 Units,Units,,5364,4559.4,1537.3224,5364,CorVel,Worker's Compensation,5364,100,,percent of total billed charges,,
HUM PROTHROMBIN CPLX(PCC)4FACT 500 UNIT (400-620 UNIT) IV SOLR,,J7168,HCPCS,Facility,Both,500 Units,Units,,5364,4559.4,1537.3224,5364,First Health Group Corporation,First Health Network,5203.08,97,,percent of total billed charges,,
HUM PROTHROMBIN CPLX(PCC)4FACT 500 UNIT (400-620 UNIT) IV SOLR,,J7168,HCPCS,Facility,Both,500 Units,Units,,5364,4559.4,1537.3224,5364,"Health Partners, Inc.",Commercial,5074.344,94.6,,percent of total billed charges,,
HUM PROTHROMBIN CPLX(PCC)4FACT 500 UNIT (400-620 UNIT) IV SOLR,,J7168,HCPCS,Facility,Outpatient,500 Units,Units,,5364,4559.4,1537.3224,5364,"Health Partners, Inc.",Medicare Advantage,2628.36,49,,percent of total billed charges,,
HUM PROTHROMBIN CPLX(PCC)4FACT 500 UNIT (400-620 UNIT) IV SOLR,,J7168,HCPCS,Facility,Inpatient,500 Units,Units,,5364,4559.4,1537.3224,5364,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
HUM PROTHROMBIN CPLX(PCC)4FACT 500 UNIT (400-620 UNIT) IV SOLR,,J7168,HCPCS,Facility,Both,500 Units,Units,,5364,4559.4,1537.3224,5364,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3218.4,60,,percent of total billed charges,,
HUM PROTHROMBIN CPLX(PCC)4FACT 500 UNIT (400-620 UNIT) IV SOLR,,J7168,HCPCS,Facility,Both,500 Units,Units,,5364,4559.4,1537.3224,5364,"Health Partners, Inc.",State of Minnesota Advantage Program,4371.66,81.5,,percent of total billed charges,,
HUM PROTHROMBIN CPLX(PCC)4FACT 500 UNIT (400-620 UNIT) IV SOLR,,J7168,HCPCS,Facility,Both,500 Units,Units,,5364,4559.4,1537.3224,5364,"Health Partners, Inc.",State Public Programs,2682,50,,percent of total billed charges,,
HUM PROTHROMBIN CPLX(PCC)4FACT 500 UNIT (400-620 UNIT) IV SOLR,,J7168,HCPCS,Facility,Both,500 Units,Units,,5364,4559.4,1537.3224,5364,Humana Insurance Company,Commercial PPO,5095.8,95,,percent of total billed charges,,
HUM PROTHROMBIN CPLX(PCC)4FACT 500 UNIT (400-620 UNIT) IV SOLR,,J7168,HCPCS,Facility,Outpatient,500 Units,Units,,5364,4559.4,1537.3224,5364,Humana Insurance Company,Medicare PPO,2628.36,49,,percent of total billed charges,,
HUM PROTHROMBIN CPLX(PCC)4FACT 500 UNIT (400-620 UNIT) IV SOLR,,J7168,HCPCS,Facility,Inpatient,500 Units,Units,,5364,4559.4,1537.3224,5364,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
HUM PROTHROMBIN CPLX(PCC)4FACT 500 UNIT (400-620 UNIT) IV SOLR,,J7168,HCPCS,Facility,Both,500 Units,Units,,5364,4559.4,1537.3224,5364,Medica,Individual & Family,5315.724,99.1,,percent of total billed charges,,
HUM PROTHROMBIN CPLX(PCC)4FACT 500 UNIT (400-620 UNIT) IV SOLR,,J7168,HCPCS,Facility,Outpatient,500 Units,Units,,5364,4559.4,1537.3224,5364,Medica,Medica Advantage Solution,2671.272,49.8,,percent of total billed charges,,
HUM PROTHROMBIN CPLX(PCC)4FACT 500 UNIT (400-620 UNIT) IV SOLR,,J7168,HCPCS,Facility,Inpatient,500 Units,Units,,5364,4559.4,1537.3224,5364,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
HUM PROTHROMBIN CPLX(PCC)4FACT 500 UNIT (400-620 UNIT) IV SOLR,,J7168,HCPCS,Facility,Outpatient,500 Units,Units,,5364,4559.4,1537.3224,5364,Medica,Medical Assistance,2392.344,44.6,,percent of total billed charges,,
HUM PROTHROMBIN CPLX(PCC)4FACT 500 UNIT (400-620 UNIT) IV SOLR,,J7168,HCPCS,Facility,Inpatient,500 Units,Units,,5364,4559.4,1537.3224,5364,Medica,Medical Assistance,,,,,Included in per diem rate,
HUM PROTHROMBIN CPLX(PCC)4FACT 500 UNIT (400-620 UNIT) IV SOLR,,J7168,HCPCS,Facility,Outpatient,500 Units,Units,,5364,4559.4,1537.3224,5364,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2671.272,49.8,,percent of total billed charges,,
HUM PROTHROMBIN CPLX(PCC)4FACT 500 UNIT (400-620 UNIT) IV SOLR,,J7168,HCPCS,Facility,Inpatient,500 Units,Units,,5364,4559.4,1537.3224,5364,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
HUM PROTHROMBIN CPLX(PCC)4FACT 500 UNIT (400-620 UNIT) IV SOLR,,J7168,HCPCS,Facility,Both,500 Units,Units,,5364,4559.4,1537.3224,5364,"Multiplan, Inc.","Multiplan, Inc.",5042.16,94,,percent of total billed charges,,
HUM PROTHROMBIN CPLX(PCC)4FACT 500 UNIT (400-620 UNIT) IV SOLR,,J7168,HCPCS,Facility,Outpatient,500 Units,Units,,5364,4559.4,1537.3224,5364,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4832.964,90.1,,percent of total billed charges,,
HUM PROTHROMBIN CPLX(PCC)4FACT 500 UNIT (400-620 UNIT) IV SOLR,,J7168,HCPCS,Facility,Inpatient,500 Units,Units,,5364,4559.4,1537.3224,5364,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
HUM PROTHROMBIN CPLX(PCC)4FACT 500 UNIT (400-620 UNIT) IV SOLR,,J7168,HCPCS,Facility,Both,500 Units,Units,,5364,4559.4,1537.3224,5364,"Preferred One Administrative Services, INC.",PPO,5288.904,98.6,,percent of total billed charges,,
HUM PROTHROMBIN CPLX(PCC)4FACT 500 UNIT (400-620 UNIT) IV SOLR,,J7168,HCPCS,Facility,Outpatient,500 Units,Units,,5364,4559.4,1537.3224,5364,PrimeWest Health,Minnesota Senior Health Options (MSHO),2759.778,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
HUM PROTHROMBIN CPLX(PCC)4FACT 500 UNIT (400-620 UNIT) IV SOLR,,J7168,HCPCS,Facility,Inpatient,500 Units,Units,,5364,4559.4,1537.3224,5364,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
HUM PROTHROMBIN CPLX(PCC)4FACT 500 UNIT (400-620 UNIT) IV SOLR,,J7168,HCPCS,Facility,Outpatient,500 Units,Units,,5364,4559.4,1537.3224,5364,PrimeWest Health,MinnesotaCare,2754.9504,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
HUM PROTHROMBIN CPLX(PCC)4FACT 500 UNIT (400-620 UNIT) IV SOLR,,J7168,HCPCS,Facility,Inpatient,500 Units,Units,,5364,4559.4,1537.3224,5364,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
HUM PROTHROMBIN CPLX(PCC)4FACT 500 UNIT (400-620 UNIT) IV SOLR,,J7168,HCPCS,Facility,Both,500 Units,Units,,5364,4559.4,1537.3224,5364,Sanford Health Plan,Sanford Health Plan,4934.88,92,,percent of total billed charges,,
HUM PROTHROMBIN CPLX(PCC)4FACT 500 UNIT (400-620 UNIT) IV SOLR,,J7168,HCPCS,Facility,Outpatient,500 Units,Units,,5364,4559.4,1537.3224,5364,"UCare Health, Inc.",Individual & Family Plan,3022.614,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
HUM PROTHROMBIN CPLX(PCC)4FACT 500 UNIT (400-620 UNIT) IV SOLR,,J7168,HCPCS,Facility,Inpatient,500 Units,Units,,5364,4559.4,1537.3224,5364,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
HUM PROTHROMBIN CPLX(PCC)4FACT 500 UNIT (400-620 UNIT) IV SOLR,,J7168,HCPCS,Facility,Outpatient,500 Units,Units,,5364,4559.4,1537.3224,5364,"UCare Health, Inc.",Medical Assistance,2707.2108,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
HUM PROTHROMBIN CPLX(PCC)4FACT 500 UNIT (400-620 UNIT) IV SOLR,,J7168,HCPCS,Facility,Inpatient,500 Units,Units,,5364,4559.4,1537.3224,5364,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
HUM PROTHROMBIN CPLX(PCC)4FACT 500 UNIT (400-620 UNIT) IV SOLR,,J7168,HCPCS,Facility,Outpatient,500 Units,Units,,5364,4559.4,1537.3224,5364,"UCare Health, Inc.",Medicare Advantage,2707.2108,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
HUM PROTHROMBIN CPLX(PCC)4FACT 500 UNIT (400-620 UNIT) IV SOLR,,J7168,HCPCS,Facility,Inpatient,500 Units,Units,,5364,4559.4,1537.3224,5364,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
HUM PROTHROMBIN CPLX(PCC)4FACT 500 UNIT (400-620 UNIT) IV SOLR,,J7168,HCPCS,Facility,Outpatient,500 Units,Units,,5364,4559.4,1537.3224,5364,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2707.2108,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
HUM PROTHROMBIN CPLX(PCC)4FACT 500 UNIT (400-620 UNIT) IV SOLR,,J7168,HCPCS,Facility,Inpatient,500 Units,Units,,5364,4559.4,1537.3224,5364,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
HUM PROTHROMBIN CPLX(PCC)4FACT 500 UNIT (400-620 UNIT) IV SOLR,,J7168,HCPCS,Facility,Both,500 Units,Units,,5364,4559.4,1537.3224,5364,UnitedHealthcare,Individual & Family,5042.16,94,,percent of total billed charges,,
HUM PROTHROMBIN CPLX(PCC)4FACT 500 UNIT (400-620 UNIT) IV SOLR,,J7168,HCPCS,Facility,Outpatient,500 Units,Units,,5364,4559.4,1537.3224,5364,UnitedHealthcare,Medicare Advantage,2628.36,49,,percent of total billed charges,,
HUM PROTHROMBIN CPLX(PCC)4FACT 500 UNIT (400-620 UNIT) IV SOLR,,J7168,HCPCS,Facility,Inpatient,500 Units,Units,,5364,4559.4,1537.3224,5364,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
HUM PROTHROMBIN CPLX(PCC)4FACT 500 UNIT (400-620 UNIT) IV SOLR,,J7168,HCPCS,Facility,Outpatient,500 Units,Units,,5364,4559.4,1537.3224,5364,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2574.72,48,,percent of total billed charges,,100% of DHS outpatient percentage
HUM PROTHROMBIN CPLX(PCC)4FACT 500 UNIT (400-620 UNIT) IV SOLR,,J7168,HCPCS,Facility,Inpatient,500 Units,Units,,5364,4559.4,1537.3224,5364,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
HYLAN G-F 20 48 MG/6 ML IATC SYRG,,J7325,HCPCS,Facility,Both,6 mL,mL,,4931,4191.35,1413.2246,4931,Aetna,Commercial,4536.52,92,,percent of total billed charges,,
HYLAN G-F 20 48 MG/6 ML IATC SYRG,,J7325,HCPCS,Facility,Outpatient,6 mL,mL,,4931,4191.35,1413.2246,4931,Aetna,Medicare Advantage,2416.19,49,,percent of total billed charges,,
HYLAN G-F 20 48 MG/6 ML IATC SYRG,,J7325,HCPCS,Facility,Inpatient,6 mL,mL,,4931,4191.35,1413.2246,4931,Aetna,Medicare Advantage,,,,,Included in per diem rate,
HYLAN G-F 20 48 MG/6 ML IATC SYRG,,J7325,HCPCS,Facility,Both,6 mL,mL,,4931,4191.35,1413.2246,4931,Aetna,PPO,4585.83,93,,percent of total billed charges,,
HYLAN G-F 20 48 MG/6 ML IATC SYRG,,J7325,HCPCS,Facility,Both,6 mL,mL,,4931,4191.35,1413.2246,4931,America's PPO,America's PPO,4735.2393,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
HYLAN G-F 20 48 MG/6 ML IATC SYRG,,J7325,HCPCS,Facility,Both,6 mL,mL,,4931,4191.35,1413.2246,4931,BlueCross BlueShield Minnesota, Federal Employee Program,4852.104,98.4,,percent of total billed charges,,
HYLAN G-F 20 48 MG/6 ML IATC SYRG,,J7325,HCPCS,Facility,Both,6 mL,mL,,4931,4191.35,1413.2246,4931,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,4931,100,,percent of total billed charges,,
HYLAN G-F 20 48 MG/6 ML IATC SYRG,,J7325,HCPCS,Facility,Both,6 mL,mL,,4931,4191.35,1413.2246,4931,BlueCross BlueShield Minnesota,High Value Network Plan,4437.9,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
HYLAN G-F 20 48 MG/6 ML IATC SYRG,,J7325,HCPCS,Facility,Outpatient,6 mL,mL,,4931,4191.35,1413.2246,4931,BlueCross BlueShield Minnesota,Medicare Advantage,2416.19,49,,percent of total billed charges,,
HYLAN G-F 20 48 MG/6 ML IATC SYRG,,J7325,HCPCS,Facility,Inpatient,6 mL,mL,,4931,4191.35,1413.2246,4931,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
HYLAN G-F 20 48 MG/6 ML IATC SYRG,,J7325,HCPCS,Facility,Both,6 mL,mL,,4931,4191.35,1413.2246,4931,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4367.3867,88.57,,percent of total billed charges,,
HYLAN G-F 20 48 MG/6 ML IATC SYRG,,J7325,HCPCS,Facility,Both,6 mL,mL,,4931,4191.35,1413.2246,4931,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1413.2246,28.66,,percent of total billed charges,,
HYLAN G-F 20 48 MG/6 ML IATC SYRG,,J7325,HCPCS,Facility,Outpatient,6 mL,mL,,4931,4191.35,1413.2246,4931,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2416.19,49,,percent of total billed charges,,
HYLAN G-F 20 48 MG/6 ML IATC SYRG,,J7325,HCPCS,Facility,Inpatient,6 mL,mL,,4931,4191.35,1413.2246,4931,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
HYLAN G-F 20 48 MG/6 ML IATC SYRG,,J7325,HCPCS,Facility,Both,6 mL,mL,,4931,4191.35,1413.2246,4931,CorVel,Worker's Compensation,4931,100,,percent of total billed charges,,
HYLAN G-F 20 48 MG/6 ML IATC SYRG,,J7325,HCPCS,Facility,Both,6 mL,mL,,4931,4191.35,1413.2246,4931,First Health Group Corporation,First Health Network,4783.07,97,,percent of total billed charges,,
HYLAN G-F 20 48 MG/6 ML IATC SYRG,,J7325,HCPCS,Facility,Both,6 mL,mL,,4931,4191.35,1413.2246,4931,"Health Partners, Inc.",Commercial,4664.726,94.6,,percent of total billed charges,,
HYLAN G-F 20 48 MG/6 ML IATC SYRG,,J7325,HCPCS,Facility,Outpatient,6 mL,mL,,4931,4191.35,1413.2246,4931,"Health Partners, Inc.",Medicare Advantage,2416.19,49,,percent of total billed charges,,
HYLAN G-F 20 48 MG/6 ML IATC SYRG,,J7325,HCPCS,Facility,Inpatient,6 mL,mL,,4931,4191.35,1413.2246,4931,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
HYLAN G-F 20 48 MG/6 ML IATC SYRG,,J7325,HCPCS,Facility,Both,6 mL,mL,,4931,4191.35,1413.2246,4931,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),2958.6,60,,percent of total billed charges,,
HYLAN G-F 20 48 MG/6 ML IATC SYRG,,J7325,HCPCS,Facility,Both,6 mL,mL,,4931,4191.35,1413.2246,4931,"Health Partners, Inc.",State of Minnesota Advantage Program,4018.765,81.5,,percent of total billed charges,,
HYLAN G-F 20 48 MG/6 ML IATC SYRG,,J7325,HCPCS,Facility,Both,6 mL,mL,,4931,4191.35,1413.2246,4931,"Health Partners, Inc.",State Public Programs,2465.5,50,,percent of total billed charges,,
HYLAN G-F 20 48 MG/6 ML IATC SYRG,,J7325,HCPCS,Facility,Both,6 mL,mL,,4931,4191.35,1413.2246,4931,Humana Insurance Company,Commercial PPO,4684.45,95,,percent of total billed charges,,
HYLAN G-F 20 48 MG/6 ML IATC SYRG,,J7325,HCPCS,Facility,Outpatient,6 mL,mL,,4931,4191.35,1413.2246,4931,Humana Insurance Company,Medicare PPO,2416.19,49,,percent of total billed charges,,
HYLAN G-F 20 48 MG/6 ML IATC SYRG,,J7325,HCPCS,Facility,Inpatient,6 mL,mL,,4931,4191.35,1413.2246,4931,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
HYLAN G-F 20 48 MG/6 ML IATC SYRG,,J7325,HCPCS,Facility,Both,6 mL,mL,,4931,4191.35,1413.2246,4931,Medica,Individual & Family,4886.621,99.1,,percent of total billed charges,,
HYLAN G-F 20 48 MG/6 ML IATC SYRG,,J7325,HCPCS,Facility,Outpatient,6 mL,mL,,4931,4191.35,1413.2246,4931,Medica,Medica Advantage Solution,2455.638,49.8,,percent of total billed charges,,
HYLAN G-F 20 48 MG/6 ML IATC SYRG,,J7325,HCPCS,Facility,Inpatient,6 mL,mL,,4931,4191.35,1413.2246,4931,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
HYLAN G-F 20 48 MG/6 ML IATC SYRG,,J7325,HCPCS,Facility,Outpatient,6 mL,mL,,4931,4191.35,1413.2246,4931,Medica,Medical Assistance,2199.226,44.6,,percent of total billed charges,,
HYLAN G-F 20 48 MG/6 ML IATC SYRG,,J7325,HCPCS,Facility,Inpatient,6 mL,mL,,4931,4191.35,1413.2246,4931,Medica,Medical Assistance,,,,,Included in per diem rate,
HYLAN G-F 20 48 MG/6 ML IATC SYRG,,J7325,HCPCS,Facility,Outpatient,6 mL,mL,,4931,4191.35,1413.2246,4931,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2455.638,49.8,,percent of total billed charges,,
HYLAN G-F 20 48 MG/6 ML IATC SYRG,,J7325,HCPCS,Facility,Inpatient,6 mL,mL,,4931,4191.35,1413.2246,4931,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
HYLAN G-F 20 48 MG/6 ML IATC SYRG,,J7325,HCPCS,Facility,Both,6 mL,mL,,4931,4191.35,1413.2246,4931,"Multiplan, Inc.","Multiplan, Inc.",4635.14,94,,percent of total billed charges,,
HYLAN G-F 20 48 MG/6 ML IATC SYRG,,J7325,HCPCS,Facility,Outpatient,6 mL,mL,,4931,4191.35,1413.2246,4931,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4442.831,90.1,,percent of total billed charges,,
HYLAN G-F 20 48 MG/6 ML IATC SYRG,,J7325,HCPCS,Facility,Inpatient,6 mL,mL,,4931,4191.35,1413.2246,4931,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
HYLAN G-F 20 48 MG/6 ML IATC SYRG,,J7325,HCPCS,Facility,Both,6 mL,mL,,4931,4191.35,1413.2246,4931,"Preferred One Administrative Services, INC.",PPO,4861.966,98.6,,percent of total billed charges,,
HYLAN G-F 20 48 MG/6 ML IATC SYRG,,J7325,HCPCS,Facility,Outpatient,6 mL,mL,,4931,4191.35,1413.2246,4931,PrimeWest Health,Minnesota Senior Health Options (MSHO),2536.9995,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
HYLAN G-F 20 48 MG/6 ML IATC SYRG,,J7325,HCPCS,Facility,Inpatient,6 mL,mL,,4931,4191.35,1413.2246,4931,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
HYLAN G-F 20 48 MG/6 ML IATC SYRG,,J7325,HCPCS,Facility,Outpatient,6 mL,mL,,4931,4191.35,1413.2246,4931,PrimeWest Health,MinnesotaCare,2532.5616,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
HYLAN G-F 20 48 MG/6 ML IATC SYRG,,J7325,HCPCS,Facility,Inpatient,6 mL,mL,,4931,4191.35,1413.2246,4931,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
HYLAN G-F 20 48 MG/6 ML IATC SYRG,,J7325,HCPCS,Facility,Both,6 mL,mL,,4931,4191.35,1413.2246,4931,Sanford Health Plan,Sanford Health Plan,4536.52,92,,percent of total billed charges,,
HYLAN G-F 20 48 MG/6 ML IATC SYRG,,J7325,HCPCS,Facility,Outpatient,6 mL,mL,,4931,4191.35,1413.2246,4931,"UCare Health, Inc.",Individual & Family Plan,2778.6185,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
HYLAN G-F 20 48 MG/6 ML IATC SYRG,,J7325,HCPCS,Facility,Inpatient,6 mL,mL,,4931,4191.35,1413.2246,4931,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
HYLAN G-F 20 48 MG/6 ML IATC SYRG,,J7325,HCPCS,Facility,Outpatient,6 mL,mL,,4931,4191.35,1413.2246,4931,"UCare Health, Inc.",Medical Assistance,2488.6757,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
HYLAN G-F 20 48 MG/6 ML IATC SYRG,,J7325,HCPCS,Facility,Inpatient,6 mL,mL,,4931,4191.35,1413.2246,4931,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
HYLAN G-F 20 48 MG/6 ML IATC SYRG,,J7325,HCPCS,Facility,Outpatient,6 mL,mL,,4931,4191.35,1413.2246,4931,"UCare Health, Inc.",Medicare Advantage,2488.6757,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
HYLAN G-F 20 48 MG/6 ML IATC SYRG,,J7325,HCPCS,Facility,Inpatient,6 mL,mL,,4931,4191.35,1413.2246,4931,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
HYLAN G-F 20 48 MG/6 ML IATC SYRG,,J7325,HCPCS,Facility,Outpatient,6 mL,mL,,4931,4191.35,1413.2246,4931,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2488.6757,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
HYLAN G-F 20 48 MG/6 ML IATC SYRG,,J7325,HCPCS,Facility,Inpatient,6 mL,mL,,4931,4191.35,1413.2246,4931,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
HYLAN G-F 20 48 MG/6 ML IATC SYRG,,J7325,HCPCS,Facility,Both,6 mL,mL,,4931,4191.35,1413.2246,4931,UnitedHealthcare,Individual & Family,4635.14,94,,percent of total billed charges,,
HYLAN G-F 20 48 MG/6 ML IATC SYRG,,J7325,HCPCS,Facility,Outpatient,6 mL,mL,,4931,4191.35,1413.2246,4931,UnitedHealthcare,Medicare Advantage,2416.19,49,,percent of total billed charges,,
HYLAN G-F 20 48 MG/6 ML IATC SYRG,,J7325,HCPCS,Facility,Inpatient,6 mL,mL,,4931,4191.35,1413.2246,4931,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
HYLAN G-F 20 48 MG/6 ML IATC SYRG,,J7325,HCPCS,Facility,Outpatient,6 mL,mL,,4931,4191.35,1413.2246,4931,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2366.88,48,,percent of total billed charges,,100% of DHS outpatient percentage
HYLAN G-F 20 48 MG/6 ML IATC SYRG,,J7325,HCPCS,Facility,Inpatient,6 mL,mL,,4931,4191.35,1413.2246,4931,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
BUDESONIDE-FORMOTEROL 80-4.5 MCG/ACTUATION INHL HFAA,,76244,LOCAL,Facility,Both,6.9 g,g,,1080,918,309.528,1080,Aetna,Commercial,993.6,92,,percent of total billed charges,,
BUDESONIDE-FORMOTEROL 80-4.5 MCG/ACTUATION INHL HFAA,,76244,LOCAL,Facility,Outpatient,6.9 g,g,,1080,918,309.528,1080,Aetna,Medicare Advantage,529.2,49,,percent of total billed charges,,
BUDESONIDE-FORMOTEROL 80-4.5 MCG/ACTUATION INHL HFAA,,76244,LOCAL,Facility,Inpatient,6.9 g,g,,1080,918,309.528,1080,Aetna,Medicare Advantage,,,,,Included in per diem rate,
BUDESONIDE-FORMOTEROL 80-4.5 MCG/ACTUATION INHL HFAA,,76244,LOCAL,Facility,Both,6.9 g,g,,1080,918,309.528,1080,Aetna,PPO,1004.4,93,,percent of total billed charges,,
BUDESONIDE-FORMOTEROL 80-4.5 MCG/ACTUATION INHL HFAA,,76244,LOCAL,Facility,Both,6.9 g,g,,1080,918,309.528,1080,America's PPO,America's PPO,1037.124,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
BUDESONIDE-FORMOTEROL 80-4.5 MCG/ACTUATION INHL HFAA,,76244,LOCAL,Facility,Both,6.9 g,g,,1080,918,309.528,1080,BlueCross BlueShield Minnesota, Federal Employee Program,1062.72,98.4,,percent of total billed charges,,
BUDESONIDE-FORMOTEROL 80-4.5 MCG/ACTUATION INHL HFAA,,76244,LOCAL,Facility,Both,6.9 g,g,,1080,918,309.528,1080,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1080,100,,percent of total billed charges,,
BUDESONIDE-FORMOTEROL 80-4.5 MCG/ACTUATION INHL HFAA,,76244,LOCAL,Facility,Both,6.9 g,g,,1080,918,309.528,1080,BlueCross BlueShield Minnesota,High Value Network Plan,972,90,,percent of total billed charges,,
BUDESONIDE-FORMOTEROL 80-4.5 MCG/ACTUATION INHL HFAA,,76244,LOCAL,Facility,Outpatient,6.9 g,g,,1080,918,309.528,1080,BlueCross BlueShield Minnesota,Medicare Advantage,529.2,49,,percent of total billed charges,,
BUDESONIDE-FORMOTEROL 80-4.5 MCG/ACTUATION INHL HFAA,,76244,LOCAL,Facility,Inpatient,6.9 g,g,,1080,918,309.528,1080,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
BUDESONIDE-FORMOTEROL 80-4.5 MCG/ACTUATION INHL HFAA,,76244,LOCAL,Facility,Both,6.9 g,g,,1080,918,309.528,1080,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,956.556,88.57,,percent of total billed charges,,
BUDESONIDE-FORMOTEROL 80-4.5 MCG/ACTUATION INHL HFAA,,76244,LOCAL,Facility,Both,6.9 g,g,,1080,918,309.528,1080,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,309.528,28.66,,percent of total billed charges,,
BUDESONIDE-FORMOTEROL 80-4.5 MCG/ACTUATION INHL HFAA,,76244,LOCAL,Facility,Outpatient,6.9 g,g,,1080,918,309.528,1080,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),529.2,49,,percent of total billed charges,,
BUDESONIDE-FORMOTEROL 80-4.5 MCG/ACTUATION INHL HFAA,,76244,LOCAL,Facility,Inpatient,6.9 g,g,,1080,918,309.528,1080,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
BUDESONIDE-FORMOTEROL 80-4.5 MCG/ACTUATION INHL HFAA,,76244,LOCAL,Facility,Both,6.9 g,g,,1080,918,309.528,1080,CorVel,Worker's Compensation,1080,100,,percent of total billed charges,,
BUDESONIDE-FORMOTEROL 80-4.5 MCG/ACTUATION INHL HFAA,,76244,LOCAL,Facility,Both,6.9 g,g,,1080,918,309.528,1080,First Health Group Corporation,First Health Network,1047.6,97,,percent of total billed charges,,
BUDESONIDE-FORMOTEROL 80-4.5 MCG/ACTUATION INHL HFAA,,76244,LOCAL,Facility,Both,6.9 g,g,,1080,918,309.528,1080,"Health Partners, Inc.",Commercial,1021.68,94.6,,percent of total billed charges,,
BUDESONIDE-FORMOTEROL 80-4.5 MCG/ACTUATION INHL HFAA,,76244,LOCAL,Facility,Outpatient,6.9 g,g,,1080,918,309.528,1080,"Health Partners, Inc.",Medicare Advantage,529.2,49,,percent of total billed charges,,
BUDESONIDE-FORMOTEROL 80-4.5 MCG/ACTUATION INHL HFAA,,76244,LOCAL,Facility,Inpatient,6.9 g,g,,1080,918,309.528,1080,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
BUDESONIDE-FORMOTEROL 80-4.5 MCG/ACTUATION INHL HFAA,,76244,LOCAL,Facility,Both,6.9 g,g,,1080,918,309.528,1080,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),648,60,,percent of total billed charges,,
BUDESONIDE-FORMOTEROL 80-4.5 MCG/ACTUATION INHL HFAA,,76244,LOCAL,Facility,Both,6.9 g,g,,1080,918,309.528,1080,"Health Partners, Inc.",State of Minnesota Advantage Program,880.2,81.5,,percent of total billed charges,,
BUDESONIDE-FORMOTEROL 80-4.5 MCG/ACTUATION INHL HFAA,,76244,LOCAL,Facility,Both,6.9 g,g,,1080,918,309.528,1080,"Health Partners, Inc.",State Public Programs,540,50,,percent of total billed charges,,
BUDESONIDE-FORMOTEROL 80-4.5 MCG/ACTUATION INHL HFAA,,76244,LOCAL,Facility,Both,6.9 g,g,,1080,918,309.528,1080,Humana Insurance Company,Commercial PPO,1026,95,,percent of total billed charges,,
BUDESONIDE-FORMOTEROL 80-4.5 MCG/ACTUATION INHL HFAA,,76244,LOCAL,Facility,Outpatient,6.9 g,g,,1080,918,309.528,1080,Humana Insurance Company,Medicare PPO,529.2,49,,percent of total billed charges,,
BUDESONIDE-FORMOTEROL 80-4.5 MCG/ACTUATION INHL HFAA,,76244,LOCAL,Facility,Inpatient,6.9 g,g,,1080,918,309.528,1080,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
BUDESONIDE-FORMOTEROL 80-4.5 MCG/ACTUATION INHL HFAA,,76244,LOCAL,Facility,Both,6.9 g,g,,1080,918,309.528,1080,Medica,Individual & Family,1070.28,99.1,,percent of total billed charges,,
BUDESONIDE-FORMOTEROL 80-4.5 MCG/ACTUATION INHL HFAA,,76244,LOCAL,Facility,Outpatient,6.9 g,g,,1080,918,309.528,1080,Medica,Medica Advantage Solution,537.84,49.8,,percent of total billed charges,,
BUDESONIDE-FORMOTEROL 80-4.5 MCG/ACTUATION INHL HFAA,,76244,LOCAL,Facility,Inpatient,6.9 g,g,,1080,918,309.528,1080,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
BUDESONIDE-FORMOTEROL 80-4.5 MCG/ACTUATION INHL HFAA,,76244,LOCAL,Facility,Outpatient,6.9 g,g,,1080,918,309.528,1080,Medica,Medical Assistance,481.68,44.6,,percent of total billed charges,,
BUDESONIDE-FORMOTEROL 80-4.5 MCG/ACTUATION INHL HFAA,,76244,LOCAL,Facility,Inpatient,6.9 g,g,,1080,918,309.528,1080,Medica,Medical Assistance,,,,,Included in per diem rate,
BUDESONIDE-FORMOTEROL 80-4.5 MCG/ACTUATION INHL HFAA,,76244,LOCAL,Facility,Outpatient,6.9 g,g,,1080,918,309.528,1080,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,537.84,49.8,,percent of total billed charges,,
BUDESONIDE-FORMOTEROL 80-4.5 MCG/ACTUATION INHL HFAA,,76244,LOCAL,Facility,Inpatient,6.9 g,g,,1080,918,309.528,1080,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
BUDESONIDE-FORMOTEROL 80-4.5 MCG/ACTUATION INHL HFAA,,76244,LOCAL,Facility,Both,6.9 g,g,,1080,918,309.528,1080,"Multiplan, Inc.","Multiplan, Inc.",1015.2,94,,percent of total billed charges,,
BUDESONIDE-FORMOTEROL 80-4.5 MCG/ACTUATION INHL HFAA,,76244,LOCAL,Facility,Outpatient,6.9 g,g,,1080,918,309.528,1080,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,973.08,90.1,,percent of total billed charges,,
BUDESONIDE-FORMOTEROL 80-4.5 MCG/ACTUATION INHL HFAA,,76244,LOCAL,Facility,Inpatient,6.9 g,g,,1080,918,309.528,1080,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
BUDESONIDE-FORMOTEROL 80-4.5 MCG/ACTUATION INHL HFAA,,76244,LOCAL,Facility,Both,6.9 g,g,,1080,918,309.528,1080,"Preferred One Administrative Services, INC.",PPO,1064.88,98.6,,percent of total billed charges,,
BUDESONIDE-FORMOTEROL 80-4.5 MCG/ACTUATION INHL HFAA,,76244,LOCAL,Facility,Outpatient,6.9 g,g,,1080,918,309.528,1080,PrimeWest Health,Minnesota Senior Health Options (MSHO),555.66,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
BUDESONIDE-FORMOTEROL 80-4.5 MCG/ACTUATION INHL HFAA,,76244,LOCAL,Facility,Inpatient,6.9 g,g,,1080,918,309.528,1080,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
BUDESONIDE-FORMOTEROL 80-4.5 MCG/ACTUATION INHL HFAA,,76244,LOCAL,Facility,Outpatient,6.9 g,g,,1080,918,309.528,1080,PrimeWest Health,MinnesotaCare,554.688,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
BUDESONIDE-FORMOTEROL 80-4.5 MCG/ACTUATION INHL HFAA,,76244,LOCAL,Facility,Inpatient,6.9 g,g,,1080,918,309.528,1080,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
BUDESONIDE-FORMOTEROL 80-4.5 MCG/ACTUATION INHL HFAA,,76244,LOCAL,Facility,Both,6.9 g,g,,1080,918,309.528,1080,Sanford Health Plan,Sanford Health Plan,993.6,92,,percent of total billed charges,,
BUDESONIDE-FORMOTEROL 80-4.5 MCG/ACTUATION INHL HFAA,,76244,LOCAL,Facility,Outpatient,6.9 g,g,,1080,918,309.528,1080,"UCare Health, Inc.",Individual & Family Plan,608.58,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
BUDESONIDE-FORMOTEROL 80-4.5 MCG/ACTUATION INHL HFAA,,76244,LOCAL,Facility,Inpatient,6.9 g,g,,1080,918,309.528,1080,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
BUDESONIDE-FORMOTEROL 80-4.5 MCG/ACTUATION INHL HFAA,,76244,LOCAL,Facility,Outpatient,6.9 g,g,,1080,918,309.528,1080,"UCare Health, Inc.",Medical Assistance,545.076,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BUDESONIDE-FORMOTEROL 80-4.5 MCG/ACTUATION INHL HFAA,,76244,LOCAL,Facility,Inpatient,6.9 g,g,,1080,918,309.528,1080,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
BUDESONIDE-FORMOTEROL 80-4.5 MCG/ACTUATION INHL HFAA,,76244,LOCAL,Facility,Outpatient,6.9 g,g,,1080,918,309.528,1080,"UCare Health, Inc.",Medicare Advantage,545.076,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BUDESONIDE-FORMOTEROL 80-4.5 MCG/ACTUATION INHL HFAA,,76244,LOCAL,Facility,Inpatient,6.9 g,g,,1080,918,309.528,1080,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
BUDESONIDE-FORMOTEROL 80-4.5 MCG/ACTUATION INHL HFAA,,76244,LOCAL,Facility,Outpatient,6.9 g,g,,1080,918,309.528,1080,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),545.076,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BUDESONIDE-FORMOTEROL 80-4.5 MCG/ACTUATION INHL HFAA,,76244,LOCAL,Facility,Inpatient,6.9 g,g,,1080,918,309.528,1080,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
BUDESONIDE-FORMOTEROL 80-4.5 MCG/ACTUATION INHL HFAA,,76244,LOCAL,Facility,Both,6.9 g,g,,1080,918,309.528,1080,UnitedHealthcare,Individual & Family,1015.2,94,,percent of total billed charges,,
BUDESONIDE-FORMOTEROL 80-4.5 MCG/ACTUATION INHL HFAA,,76244,LOCAL,Facility,Outpatient,6.9 g,g,,1080,918,309.528,1080,UnitedHealthcare,Medicare Advantage,529.2,49,,percent of total billed charges,,
BUDESONIDE-FORMOTEROL 80-4.5 MCG/ACTUATION INHL HFAA,,76244,LOCAL,Facility,Inpatient,6.9 g,g,,1080,918,309.528,1080,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
BUDESONIDE-FORMOTEROL 80-4.5 MCG/ACTUATION INHL HFAA,,76244,LOCAL,Facility,Outpatient,6.9 g,g,,1080,918,309.528,1080,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,518.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
BUDESONIDE-FORMOTEROL 80-4.5 MCG/ACTUATION INHL HFAA,,76244,LOCAL,Facility,Inpatient,6.9 g,g,,1080,918,309.528,1080,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"NYSTATIN 100,000 UNIT/ML ORAL SUSP",,1301,LOCAL,Facility,Both,60 mL,mL,,70,59.5,20.062,70,Aetna,Commercial,64.4,92,,percent of total billed charges,,
"NYSTATIN 100,000 UNIT/ML ORAL SUSP",,1301,LOCAL,Facility,Outpatient,60 mL,mL,,70,59.5,20.062,70,Aetna,Medicare Advantage,34.3,49,,percent of total billed charges,,
"NYSTATIN 100,000 UNIT/ML ORAL SUSP",,1301,LOCAL,Facility,Inpatient,60 mL,mL,,70,59.5,20.062,70,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"NYSTATIN 100,000 UNIT/ML ORAL SUSP",,1301,LOCAL,Facility,Both,60 mL,mL,,70,59.5,20.062,70,Aetna,PPO,65.1,93,,percent of total billed charges,,
"NYSTATIN 100,000 UNIT/ML ORAL SUSP",,1301,LOCAL,Facility,Both,60 mL,mL,,70,59.5,20.062,70,America's PPO,America's PPO,67.221,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"NYSTATIN 100,000 UNIT/ML ORAL SUSP",,1301,LOCAL,Facility,Both,60 mL,mL,,70,59.5,20.062,70,BlueCross BlueShield Minnesota, Federal Employee Program,68.88,98.4,,percent of total billed charges,,
"NYSTATIN 100,000 UNIT/ML ORAL SUSP",,1301,LOCAL,Facility,Both,60 mL,mL,,70,59.5,20.062,70,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,70,100,,percent of total billed charges,,
"NYSTATIN 100,000 UNIT/ML ORAL SUSP",,1301,LOCAL,Facility,Both,60 mL,mL,,70,59.5,20.062,70,BlueCross BlueShield Minnesota,High Value Network Plan,63,90,,percent of total billed charges,,
"NYSTATIN 100,000 UNIT/ML ORAL SUSP",,1301,LOCAL,Facility,Outpatient,60 mL,mL,,70,59.5,20.062,70,BlueCross BlueShield Minnesota,Medicare Advantage,34.3,49,,percent of total billed charges,,
"NYSTATIN 100,000 UNIT/ML ORAL SUSP",,1301,LOCAL,Facility,Inpatient,60 mL,mL,,70,59.5,20.062,70,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"NYSTATIN 100,000 UNIT/ML ORAL SUSP",,1301,LOCAL,Facility,Both,60 mL,mL,,70,59.5,20.062,70,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,61.999,88.57,,percent of total billed charges,,
"NYSTATIN 100,000 UNIT/ML ORAL SUSP",,1301,LOCAL,Facility,Both,60 mL,mL,,70,59.5,20.062,70,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,20.062,28.66,,percent of total billed charges,,
"NYSTATIN 100,000 UNIT/ML ORAL SUSP",,1301,LOCAL,Facility,Outpatient,60 mL,mL,,70,59.5,20.062,70,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),34.3,49,,percent of total billed charges,,
"NYSTATIN 100,000 UNIT/ML ORAL SUSP",,1301,LOCAL,Facility,Inpatient,60 mL,mL,,70,59.5,20.062,70,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"NYSTATIN 100,000 UNIT/ML ORAL SUSP",,1301,LOCAL,Facility,Both,60 mL,mL,,70,59.5,20.062,70,CorVel,Worker's Compensation,70,100,,percent of total billed charges,,
"NYSTATIN 100,000 UNIT/ML ORAL SUSP",,1301,LOCAL,Facility,Both,60 mL,mL,,70,59.5,20.062,70,First Health Group Corporation,First Health Network,67.9,97,,percent of total billed charges,,
"NYSTATIN 100,000 UNIT/ML ORAL SUSP",,1301,LOCAL,Facility,Both,60 mL,mL,,70,59.5,20.062,70,"Health Partners, Inc.",Commercial,66.22,94.6,,percent of total billed charges,,
"NYSTATIN 100,000 UNIT/ML ORAL SUSP",,1301,LOCAL,Facility,Outpatient,60 mL,mL,,70,59.5,20.062,70,"Health Partners, Inc.",Medicare Advantage,34.3,49,,percent of total billed charges,,
"NYSTATIN 100,000 UNIT/ML ORAL SUSP",,1301,LOCAL,Facility,Inpatient,60 mL,mL,,70,59.5,20.062,70,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"NYSTATIN 100,000 UNIT/ML ORAL SUSP",,1301,LOCAL,Facility,Both,60 mL,mL,,70,59.5,20.062,70,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),42,60,,percent of total billed charges,,
"NYSTATIN 100,000 UNIT/ML ORAL SUSP",,1301,LOCAL,Facility,Both,60 mL,mL,,70,59.5,20.062,70,"Health Partners, Inc.",State of Minnesota Advantage Program,57.05,81.5,,percent of total billed charges,,
"NYSTATIN 100,000 UNIT/ML ORAL SUSP",,1301,LOCAL,Facility,Both,60 mL,mL,,70,59.5,20.062,70,"Health Partners, Inc.",State Public Programs,35,50,,percent of total billed charges,,
"NYSTATIN 100,000 UNIT/ML ORAL SUSP",,1301,LOCAL,Facility,Both,60 mL,mL,,70,59.5,20.062,70,Humana Insurance Company,Commercial PPO,66.5,95,,percent of total billed charges,,
"NYSTATIN 100,000 UNIT/ML ORAL SUSP",,1301,LOCAL,Facility,Outpatient,60 mL,mL,,70,59.5,20.062,70,Humana Insurance Company,Medicare PPO,34.3,49,,percent of total billed charges,,
"NYSTATIN 100,000 UNIT/ML ORAL SUSP",,1301,LOCAL,Facility,Inpatient,60 mL,mL,,70,59.5,20.062,70,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"NYSTATIN 100,000 UNIT/ML ORAL SUSP",,1301,LOCAL,Facility,Both,60 mL,mL,,70,59.5,20.062,70,Medica,Individual & Family,69.37,99.1,,percent of total billed charges,,
"NYSTATIN 100,000 UNIT/ML ORAL SUSP",,1301,LOCAL,Facility,Outpatient,60 mL,mL,,70,59.5,20.062,70,Medica,Medica Advantage Solution,34.86,49.8,,percent of total billed charges,,
"NYSTATIN 100,000 UNIT/ML ORAL SUSP",,1301,LOCAL,Facility,Inpatient,60 mL,mL,,70,59.5,20.062,70,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"NYSTATIN 100,000 UNIT/ML ORAL SUSP",,1301,LOCAL,Facility,Outpatient,60 mL,mL,,70,59.5,20.062,70,Medica,Medical Assistance,31.22,44.6,,percent of total billed charges,,
"NYSTATIN 100,000 UNIT/ML ORAL SUSP",,1301,LOCAL,Facility,Inpatient,60 mL,mL,,70,59.5,20.062,70,Medica,Medical Assistance,,,,,Included in per diem rate,
"NYSTATIN 100,000 UNIT/ML ORAL SUSP",,1301,LOCAL,Facility,Outpatient,60 mL,mL,,70,59.5,20.062,70,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,34.86,49.8,,percent of total billed charges,,
"NYSTATIN 100,000 UNIT/ML ORAL SUSP",,1301,LOCAL,Facility,Inpatient,60 mL,mL,,70,59.5,20.062,70,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"NYSTATIN 100,000 UNIT/ML ORAL SUSP",,1301,LOCAL,Facility,Both,60 mL,mL,,70,59.5,20.062,70,"Multiplan, Inc.","Multiplan, Inc.",65.8,94,,percent of total billed charges,,
"NYSTATIN 100,000 UNIT/ML ORAL SUSP",,1301,LOCAL,Facility,Outpatient,60 mL,mL,,70,59.5,20.062,70,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,63.07,90.1,,percent of total billed charges,,
"NYSTATIN 100,000 UNIT/ML ORAL SUSP",,1301,LOCAL,Facility,Inpatient,60 mL,mL,,70,59.5,20.062,70,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"NYSTATIN 100,000 UNIT/ML ORAL SUSP",,1301,LOCAL,Facility,Both,60 mL,mL,,70,59.5,20.062,70,"Preferred One Administrative Services, INC.",PPO,69.02,98.6,,percent of total billed charges,,
"NYSTATIN 100,000 UNIT/ML ORAL SUSP",,1301,LOCAL,Facility,Outpatient,60 mL,mL,,70,59.5,20.062,70,PrimeWest Health,Minnesota Senior Health Options (MSHO),36.015,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"NYSTATIN 100,000 UNIT/ML ORAL SUSP",,1301,LOCAL,Facility,Inpatient,60 mL,mL,,70,59.5,20.062,70,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"NYSTATIN 100,000 UNIT/ML ORAL SUSP",,1301,LOCAL,Facility,Outpatient,60 mL,mL,,70,59.5,20.062,70,PrimeWest Health,MinnesotaCare,35.952,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"NYSTATIN 100,000 UNIT/ML ORAL SUSP",,1301,LOCAL,Facility,Inpatient,60 mL,mL,,70,59.5,20.062,70,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"NYSTATIN 100,000 UNIT/ML ORAL SUSP",,1301,LOCAL,Facility,Both,60 mL,mL,,70,59.5,20.062,70,Sanford Health Plan,Sanford Health Plan,64.4,92,,percent of total billed charges,,
"NYSTATIN 100,000 UNIT/ML ORAL SUSP",,1301,LOCAL,Facility,Outpatient,60 mL,mL,,70,59.5,20.062,70,"UCare Health, Inc.",Individual & Family Plan,39.445,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"NYSTATIN 100,000 UNIT/ML ORAL SUSP",,1301,LOCAL,Facility,Inpatient,60 mL,mL,,70,59.5,20.062,70,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"NYSTATIN 100,000 UNIT/ML ORAL SUSP",,1301,LOCAL,Facility,Outpatient,60 mL,mL,,70,59.5,20.062,70,"UCare Health, Inc.",Medical Assistance,35.329,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"NYSTATIN 100,000 UNIT/ML ORAL SUSP",,1301,LOCAL,Facility,Inpatient,60 mL,mL,,70,59.5,20.062,70,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"NYSTATIN 100,000 UNIT/ML ORAL SUSP",,1301,LOCAL,Facility,Outpatient,60 mL,mL,,70,59.5,20.062,70,"UCare Health, Inc.",Medicare Advantage,35.329,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"NYSTATIN 100,000 UNIT/ML ORAL SUSP",,1301,LOCAL,Facility,Inpatient,60 mL,mL,,70,59.5,20.062,70,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"NYSTATIN 100,000 UNIT/ML ORAL SUSP",,1301,LOCAL,Facility,Outpatient,60 mL,mL,,70,59.5,20.062,70,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),35.329,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"NYSTATIN 100,000 UNIT/ML ORAL SUSP",,1301,LOCAL,Facility,Inpatient,60 mL,mL,,70,59.5,20.062,70,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"NYSTATIN 100,000 UNIT/ML ORAL SUSP",,1301,LOCAL,Facility,Both,60 mL,mL,,70,59.5,20.062,70,UnitedHealthcare,Individual & Family,65.8,94,,percent of total billed charges,,
"NYSTATIN 100,000 UNIT/ML ORAL SUSP",,1301,LOCAL,Facility,Outpatient,60 mL,mL,,70,59.5,20.062,70,UnitedHealthcare,Medicare Advantage,34.3,49,,percent of total billed charges,,
"NYSTATIN 100,000 UNIT/ML ORAL SUSP",,1301,LOCAL,Facility,Inpatient,60 mL,mL,,70,59.5,20.062,70,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"NYSTATIN 100,000 UNIT/ML ORAL SUSP",,1301,LOCAL,Facility,Outpatient,60 mL,mL,,70,59.5,20.062,70,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,33.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
"NYSTATIN 100,000 UNIT/ML ORAL SUSP",,1301,LOCAL,Facility,Inpatient,60 mL,mL,,70,59.5,20.062,70,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
FUROSEMIDE 10 MG/ML ORAL SOLN,,2836,LOCAL,Facility,Both,60 mL,mL,,50,42.5,14.33,50,Aetna,Commercial,46,92,,percent of total billed charges,,
FUROSEMIDE 10 MG/ML ORAL SOLN,,2836,LOCAL,Facility,Outpatient,60 mL,mL,,50,42.5,14.33,50,Aetna,Medicare Advantage,24.5,49,,percent of total billed charges,,
FUROSEMIDE 10 MG/ML ORAL SOLN,,2836,LOCAL,Facility,Inpatient,60 mL,mL,,50,42.5,14.33,50,Aetna,Medicare Advantage,,,,,Included in per diem rate,
FUROSEMIDE 10 MG/ML ORAL SOLN,,2836,LOCAL,Facility,Both,60 mL,mL,,50,42.5,14.33,50,Aetna,PPO,46.5,93,,percent of total billed charges,,
FUROSEMIDE 10 MG/ML ORAL SOLN,,2836,LOCAL,Facility,Both,60 mL,mL,,50,42.5,14.33,50,America's PPO,America's PPO,48.015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
FUROSEMIDE 10 MG/ML ORAL SOLN,,2836,LOCAL,Facility,Both,60 mL,mL,,50,42.5,14.33,50,BlueCross BlueShield Minnesota, Federal Employee Program,49.2,98.4,,percent of total billed charges,,
FUROSEMIDE 10 MG/ML ORAL SOLN,,2836,LOCAL,Facility,Both,60 mL,mL,,50,42.5,14.33,50,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,50,100,,percent of total billed charges,,
FUROSEMIDE 10 MG/ML ORAL SOLN,,2836,LOCAL,Facility,Both,60 mL,mL,,50,42.5,14.33,50,BlueCross BlueShield Minnesota,High Value Network Plan,45,90,,percent of total billed charges,,
FUROSEMIDE 10 MG/ML ORAL SOLN,,2836,LOCAL,Facility,Outpatient,60 mL,mL,,50,42.5,14.33,50,BlueCross BlueShield Minnesota,Medicare Advantage,24.5,49,,percent of total billed charges,,
FUROSEMIDE 10 MG/ML ORAL SOLN,,2836,LOCAL,Facility,Inpatient,60 mL,mL,,50,42.5,14.33,50,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
FUROSEMIDE 10 MG/ML ORAL SOLN,,2836,LOCAL,Facility,Both,60 mL,mL,,50,42.5,14.33,50,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,44.285,88.57,,percent of total billed charges,,
FUROSEMIDE 10 MG/ML ORAL SOLN,,2836,LOCAL,Facility,Both,60 mL,mL,,50,42.5,14.33,50,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,14.33,28.66,,percent of total billed charges,,
FUROSEMIDE 10 MG/ML ORAL SOLN,,2836,LOCAL,Facility,Outpatient,60 mL,mL,,50,42.5,14.33,50,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),24.5,49,,percent of total billed charges,,
FUROSEMIDE 10 MG/ML ORAL SOLN,,2836,LOCAL,Facility,Inpatient,60 mL,mL,,50,42.5,14.33,50,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
FUROSEMIDE 10 MG/ML ORAL SOLN,,2836,LOCAL,Facility,Both,60 mL,mL,,50,42.5,14.33,50,CorVel,Worker's Compensation,50,100,,percent of total billed charges,,
FUROSEMIDE 10 MG/ML ORAL SOLN,,2836,LOCAL,Facility,Both,60 mL,mL,,50,42.5,14.33,50,First Health Group Corporation,First Health Network,48.5,97,,percent of total billed charges,,
FUROSEMIDE 10 MG/ML ORAL SOLN,,2836,LOCAL,Facility,Both,60 mL,mL,,50,42.5,14.33,50,"Health Partners, Inc.",Commercial,47.3,94.6,,percent of total billed charges,,
FUROSEMIDE 10 MG/ML ORAL SOLN,,2836,LOCAL,Facility,Outpatient,60 mL,mL,,50,42.5,14.33,50,"Health Partners, Inc.",Medicare Advantage,24.5,49,,percent of total billed charges,,
FUROSEMIDE 10 MG/ML ORAL SOLN,,2836,LOCAL,Facility,Inpatient,60 mL,mL,,50,42.5,14.33,50,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
FUROSEMIDE 10 MG/ML ORAL SOLN,,2836,LOCAL,Facility,Both,60 mL,mL,,50,42.5,14.33,50,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),30,60,,percent of total billed charges,,
FUROSEMIDE 10 MG/ML ORAL SOLN,,2836,LOCAL,Facility,Both,60 mL,mL,,50,42.5,14.33,50,"Health Partners, Inc.",State of Minnesota Advantage Program,40.75,81.5,,percent of total billed charges,,
FUROSEMIDE 10 MG/ML ORAL SOLN,,2836,LOCAL,Facility,Both,60 mL,mL,,50,42.5,14.33,50,"Health Partners, Inc.",State Public Programs,25,50,,percent of total billed charges,,
FUROSEMIDE 10 MG/ML ORAL SOLN,,2836,LOCAL,Facility,Both,60 mL,mL,,50,42.5,14.33,50,Humana Insurance Company,Commercial PPO,47.5,95,,percent of total billed charges,,
FUROSEMIDE 10 MG/ML ORAL SOLN,,2836,LOCAL,Facility,Outpatient,60 mL,mL,,50,42.5,14.33,50,Humana Insurance Company,Medicare PPO,24.5,49,,percent of total billed charges,,
FUROSEMIDE 10 MG/ML ORAL SOLN,,2836,LOCAL,Facility,Inpatient,60 mL,mL,,50,42.5,14.33,50,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
FUROSEMIDE 10 MG/ML ORAL SOLN,,2836,LOCAL,Facility,Both,60 mL,mL,,50,42.5,14.33,50,Medica,Individual & Family,49.55,99.1,,percent of total billed charges,,
FUROSEMIDE 10 MG/ML ORAL SOLN,,2836,LOCAL,Facility,Outpatient,60 mL,mL,,50,42.5,14.33,50,Medica,Medica Advantage Solution,24.9,49.8,,percent of total billed charges,,
FUROSEMIDE 10 MG/ML ORAL SOLN,,2836,LOCAL,Facility,Inpatient,60 mL,mL,,50,42.5,14.33,50,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
FUROSEMIDE 10 MG/ML ORAL SOLN,,2836,LOCAL,Facility,Outpatient,60 mL,mL,,50,42.5,14.33,50,Medica,Medical Assistance,22.3,44.6,,percent of total billed charges,,
FUROSEMIDE 10 MG/ML ORAL SOLN,,2836,LOCAL,Facility,Inpatient,60 mL,mL,,50,42.5,14.33,50,Medica,Medical Assistance,,,,,Included in per diem rate,
FUROSEMIDE 10 MG/ML ORAL SOLN,,2836,LOCAL,Facility,Outpatient,60 mL,mL,,50,42.5,14.33,50,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,24.9,49.8,,percent of total billed charges,,
FUROSEMIDE 10 MG/ML ORAL SOLN,,2836,LOCAL,Facility,Inpatient,60 mL,mL,,50,42.5,14.33,50,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
FUROSEMIDE 10 MG/ML ORAL SOLN,,2836,LOCAL,Facility,Both,60 mL,mL,,50,42.5,14.33,50,"Multiplan, Inc.","Multiplan, Inc.",47,94,,percent of total billed charges,,
FUROSEMIDE 10 MG/ML ORAL SOLN,,2836,LOCAL,Facility,Outpatient,60 mL,mL,,50,42.5,14.33,50,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,45.05,90.1,,percent of total billed charges,,
FUROSEMIDE 10 MG/ML ORAL SOLN,,2836,LOCAL,Facility,Inpatient,60 mL,mL,,50,42.5,14.33,50,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
FUROSEMIDE 10 MG/ML ORAL SOLN,,2836,LOCAL,Facility,Both,60 mL,mL,,50,42.5,14.33,50,"Preferred One Administrative Services, INC.",PPO,49.3,98.6,,percent of total billed charges,,
FUROSEMIDE 10 MG/ML ORAL SOLN,,2836,LOCAL,Facility,Outpatient,60 mL,mL,,50,42.5,14.33,50,PrimeWest Health,Minnesota Senior Health Options (MSHO),25.725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
FUROSEMIDE 10 MG/ML ORAL SOLN,,2836,LOCAL,Facility,Inpatient,60 mL,mL,,50,42.5,14.33,50,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
FUROSEMIDE 10 MG/ML ORAL SOLN,,2836,LOCAL,Facility,Outpatient,60 mL,mL,,50,42.5,14.33,50,PrimeWest Health,MinnesotaCare,25.68,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
FUROSEMIDE 10 MG/ML ORAL SOLN,,2836,LOCAL,Facility,Inpatient,60 mL,mL,,50,42.5,14.33,50,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
FUROSEMIDE 10 MG/ML ORAL SOLN,,2836,LOCAL,Facility,Both,60 mL,mL,,50,42.5,14.33,50,Sanford Health Plan,Sanford Health Plan,46,92,,percent of total billed charges,,
FUROSEMIDE 10 MG/ML ORAL SOLN,,2836,LOCAL,Facility,Outpatient,60 mL,mL,,50,42.5,14.33,50,"UCare Health, Inc.",Individual & Family Plan,28.175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
FUROSEMIDE 10 MG/ML ORAL SOLN,,2836,LOCAL,Facility,Inpatient,60 mL,mL,,50,42.5,14.33,50,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
FUROSEMIDE 10 MG/ML ORAL SOLN,,2836,LOCAL,Facility,Outpatient,60 mL,mL,,50,42.5,14.33,50,"UCare Health, Inc.",Medical Assistance,25.235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FUROSEMIDE 10 MG/ML ORAL SOLN,,2836,LOCAL,Facility,Inpatient,60 mL,mL,,50,42.5,14.33,50,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
FUROSEMIDE 10 MG/ML ORAL SOLN,,2836,LOCAL,Facility,Outpatient,60 mL,mL,,50,42.5,14.33,50,"UCare Health, Inc.",Medicare Advantage,25.235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FUROSEMIDE 10 MG/ML ORAL SOLN,,2836,LOCAL,Facility,Inpatient,60 mL,mL,,50,42.5,14.33,50,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
FUROSEMIDE 10 MG/ML ORAL SOLN,,2836,LOCAL,Facility,Outpatient,60 mL,mL,,50,42.5,14.33,50,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),25.235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FUROSEMIDE 10 MG/ML ORAL SOLN,,2836,LOCAL,Facility,Inpatient,60 mL,mL,,50,42.5,14.33,50,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
FUROSEMIDE 10 MG/ML ORAL SOLN,,2836,LOCAL,Facility,Both,60 mL,mL,,50,42.5,14.33,50,UnitedHealthcare,Individual & Family,47,94,,percent of total billed charges,,
FUROSEMIDE 10 MG/ML ORAL SOLN,,2836,LOCAL,Facility,Outpatient,60 mL,mL,,50,42.5,14.33,50,UnitedHealthcare,Medicare Advantage,24.5,49,,percent of total billed charges,,
FUROSEMIDE 10 MG/ML ORAL SOLN,,2836,LOCAL,Facility,Inpatient,60 mL,mL,,50,42.5,14.33,50,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
FUROSEMIDE 10 MG/ML ORAL SOLN,,2836,LOCAL,Facility,Outpatient,60 mL,mL,,50,42.5,14.33,50,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,24,48,,percent of total billed charges,,100% of DHS outpatient percentage
FUROSEMIDE 10 MG/ML ORAL SOLN,,2836,LOCAL,Facility,Inpatient,60 mL,mL,,50,42.5,14.33,50,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
HYDROCORTISONE 100 MG/60 ML RECT ENEMA,,13583,LOCAL,Facility,Both,60 mL,mL,,116,98.6,33.2456,116,Aetna,Commercial,106.72,92,,percent of total billed charges,,
HYDROCORTISONE 100 MG/60 ML RECT ENEMA,,13583,LOCAL,Facility,Outpatient,60 mL,mL,,116,98.6,33.2456,116,Aetna,Medicare Advantage,56.84,49,,percent of total billed charges,,
HYDROCORTISONE 100 MG/60 ML RECT ENEMA,,13583,LOCAL,Facility,Inpatient,60 mL,mL,,116,98.6,33.2456,116,Aetna,Medicare Advantage,,,,,Included in per diem rate,
HYDROCORTISONE 100 MG/60 ML RECT ENEMA,,13583,LOCAL,Facility,Both,60 mL,mL,,116,98.6,33.2456,116,Aetna,PPO,107.88,93,,percent of total billed charges,,
HYDROCORTISONE 100 MG/60 ML RECT ENEMA,,13583,LOCAL,Facility,Both,60 mL,mL,,116,98.6,33.2456,116,America's PPO,America's PPO,111.3948,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
HYDROCORTISONE 100 MG/60 ML RECT ENEMA,,13583,LOCAL,Facility,Both,60 mL,mL,,116,98.6,33.2456,116,BlueCross BlueShield Minnesota, Federal Employee Program,114.144,98.4,,percent of total billed charges,,
HYDROCORTISONE 100 MG/60 ML RECT ENEMA,,13583,LOCAL,Facility,Both,60 mL,mL,,116,98.6,33.2456,116,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,116,100,,percent of total billed charges,,
HYDROCORTISONE 100 MG/60 ML RECT ENEMA,,13583,LOCAL,Facility,Both,60 mL,mL,,116,98.6,33.2456,116,BlueCross BlueShield Minnesota,High Value Network Plan,104.4,90,,percent of total billed charges,,
HYDROCORTISONE 100 MG/60 ML RECT ENEMA,,13583,LOCAL,Facility,Outpatient,60 mL,mL,,116,98.6,33.2456,116,BlueCross BlueShield Minnesota,Medicare Advantage,56.84,49,,percent of total billed charges,,
HYDROCORTISONE 100 MG/60 ML RECT ENEMA,,13583,LOCAL,Facility,Inpatient,60 mL,mL,,116,98.6,33.2456,116,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
HYDROCORTISONE 100 MG/60 ML RECT ENEMA,,13583,LOCAL,Facility,Both,60 mL,mL,,116,98.6,33.2456,116,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,102.7412,88.57,,percent of total billed charges,,
HYDROCORTISONE 100 MG/60 ML RECT ENEMA,,13583,LOCAL,Facility,Both,60 mL,mL,,116,98.6,33.2456,116,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,33.2456,28.66,,percent of total billed charges,,
HYDROCORTISONE 100 MG/60 ML RECT ENEMA,,13583,LOCAL,Facility,Outpatient,60 mL,mL,,116,98.6,33.2456,116,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),56.84,49,,percent of total billed charges,,
HYDROCORTISONE 100 MG/60 ML RECT ENEMA,,13583,LOCAL,Facility,Inpatient,60 mL,mL,,116,98.6,33.2456,116,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
HYDROCORTISONE 100 MG/60 ML RECT ENEMA,,13583,LOCAL,Facility,Both,60 mL,mL,,116,98.6,33.2456,116,CorVel,Worker's Compensation,116,100,,percent of total billed charges,,
HYDROCORTISONE 100 MG/60 ML RECT ENEMA,,13583,LOCAL,Facility,Both,60 mL,mL,,116,98.6,33.2456,116,First Health Group Corporation,First Health Network,112.52,97,,percent of total billed charges,,
HYDROCORTISONE 100 MG/60 ML RECT ENEMA,,13583,LOCAL,Facility,Both,60 mL,mL,,116,98.6,33.2456,116,"Health Partners, Inc.",Commercial,109.736,94.6,,percent of total billed charges,,
HYDROCORTISONE 100 MG/60 ML RECT ENEMA,,13583,LOCAL,Facility,Outpatient,60 mL,mL,,116,98.6,33.2456,116,"Health Partners, Inc.",Medicare Advantage,56.84,49,,percent of total billed charges,,
HYDROCORTISONE 100 MG/60 ML RECT ENEMA,,13583,LOCAL,Facility,Inpatient,60 mL,mL,,116,98.6,33.2456,116,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
HYDROCORTISONE 100 MG/60 ML RECT ENEMA,,13583,LOCAL,Facility,Both,60 mL,mL,,116,98.6,33.2456,116,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),69.6,60,,percent of total billed charges,,
HYDROCORTISONE 100 MG/60 ML RECT ENEMA,,13583,LOCAL,Facility,Both,60 mL,mL,,116,98.6,33.2456,116,"Health Partners, Inc.",State of Minnesota Advantage Program,94.54,81.5,,percent of total billed charges,,
HYDROCORTISONE 100 MG/60 ML RECT ENEMA,,13583,LOCAL,Facility,Both,60 mL,mL,,116,98.6,33.2456,116,"Health Partners, Inc.",State Public Programs,58,50,,percent of total billed charges,,
HYDROCORTISONE 100 MG/60 ML RECT ENEMA,,13583,LOCAL,Facility,Both,60 mL,mL,,116,98.6,33.2456,116,Humana Insurance Company,Commercial PPO,110.2,95,,percent of total billed charges,,
HYDROCORTISONE 100 MG/60 ML RECT ENEMA,,13583,LOCAL,Facility,Outpatient,60 mL,mL,,116,98.6,33.2456,116,Humana Insurance Company,Medicare PPO,56.84,49,,percent of total billed charges,,
HYDROCORTISONE 100 MG/60 ML RECT ENEMA,,13583,LOCAL,Facility,Inpatient,60 mL,mL,,116,98.6,33.2456,116,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
HYDROCORTISONE 100 MG/60 ML RECT ENEMA,,13583,LOCAL,Facility,Both,60 mL,mL,,116,98.6,33.2456,116,Medica,Individual & Family,114.956,99.1,,percent of total billed charges,,
HYDROCORTISONE 100 MG/60 ML RECT ENEMA,,13583,LOCAL,Facility,Outpatient,60 mL,mL,,116,98.6,33.2456,116,Medica,Medica Advantage Solution,57.768,49.8,,percent of total billed charges,,
HYDROCORTISONE 100 MG/60 ML RECT ENEMA,,13583,LOCAL,Facility,Inpatient,60 mL,mL,,116,98.6,33.2456,116,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
HYDROCORTISONE 100 MG/60 ML RECT ENEMA,,13583,LOCAL,Facility,Outpatient,60 mL,mL,,116,98.6,33.2456,116,Medica,Medical Assistance,51.736,44.6,,percent of total billed charges,,
HYDROCORTISONE 100 MG/60 ML RECT ENEMA,,13583,LOCAL,Facility,Inpatient,60 mL,mL,,116,98.6,33.2456,116,Medica,Medical Assistance,,,,,Included in per diem rate,
HYDROCORTISONE 100 MG/60 ML RECT ENEMA,,13583,LOCAL,Facility,Outpatient,60 mL,mL,,116,98.6,33.2456,116,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,57.768,49.8,,percent of total billed charges,,
HYDROCORTISONE 100 MG/60 ML RECT ENEMA,,13583,LOCAL,Facility,Inpatient,60 mL,mL,,116,98.6,33.2456,116,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
HYDROCORTISONE 100 MG/60 ML RECT ENEMA,,13583,LOCAL,Facility,Both,60 mL,mL,,116,98.6,33.2456,116,"Multiplan, Inc.","Multiplan, Inc.",109.04,94,,percent of total billed charges,,
HYDROCORTISONE 100 MG/60 ML RECT ENEMA,,13583,LOCAL,Facility,Outpatient,60 mL,mL,,116,98.6,33.2456,116,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,104.516,90.1,,percent of total billed charges,,
HYDROCORTISONE 100 MG/60 ML RECT ENEMA,,13583,LOCAL,Facility,Inpatient,60 mL,mL,,116,98.6,33.2456,116,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
HYDROCORTISONE 100 MG/60 ML RECT ENEMA,,13583,LOCAL,Facility,Both,60 mL,mL,,116,98.6,33.2456,116,"Preferred One Administrative Services, INC.",PPO,114.376,98.6,,percent of total billed charges,,
HYDROCORTISONE 100 MG/60 ML RECT ENEMA,,13583,LOCAL,Facility,Outpatient,60 mL,mL,,116,98.6,33.2456,116,PrimeWest Health,Minnesota Senior Health Options (MSHO),59.682,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
HYDROCORTISONE 100 MG/60 ML RECT ENEMA,,13583,LOCAL,Facility,Inpatient,60 mL,mL,,116,98.6,33.2456,116,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
HYDROCORTISONE 100 MG/60 ML RECT ENEMA,,13583,LOCAL,Facility,Outpatient,60 mL,mL,,116,98.6,33.2456,116,PrimeWest Health,MinnesotaCare,59.5776,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
HYDROCORTISONE 100 MG/60 ML RECT ENEMA,,13583,LOCAL,Facility,Inpatient,60 mL,mL,,116,98.6,33.2456,116,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
HYDROCORTISONE 100 MG/60 ML RECT ENEMA,,13583,LOCAL,Facility,Both,60 mL,mL,,116,98.6,33.2456,116,Sanford Health Plan,Sanford Health Plan,106.72,92,,percent of total billed charges,,
HYDROCORTISONE 100 MG/60 ML RECT ENEMA,,13583,LOCAL,Facility,Outpatient,60 mL,mL,,116,98.6,33.2456,116,"UCare Health, Inc.",Individual & Family Plan,65.366,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
HYDROCORTISONE 100 MG/60 ML RECT ENEMA,,13583,LOCAL,Facility,Inpatient,60 mL,mL,,116,98.6,33.2456,116,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
HYDROCORTISONE 100 MG/60 ML RECT ENEMA,,13583,LOCAL,Facility,Outpatient,60 mL,mL,,116,98.6,33.2456,116,"UCare Health, Inc.",Medical Assistance,58.5452,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
HYDROCORTISONE 100 MG/60 ML RECT ENEMA,,13583,LOCAL,Facility,Inpatient,60 mL,mL,,116,98.6,33.2456,116,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
HYDROCORTISONE 100 MG/60 ML RECT ENEMA,,13583,LOCAL,Facility,Outpatient,60 mL,mL,,116,98.6,33.2456,116,"UCare Health, Inc.",Medicare Advantage,58.5452,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
HYDROCORTISONE 100 MG/60 ML RECT ENEMA,,13583,LOCAL,Facility,Inpatient,60 mL,mL,,116,98.6,33.2456,116,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
HYDROCORTISONE 100 MG/60 ML RECT ENEMA,,13583,LOCAL,Facility,Outpatient,60 mL,mL,,116,98.6,33.2456,116,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),58.5452,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
HYDROCORTISONE 100 MG/60 ML RECT ENEMA,,13583,LOCAL,Facility,Inpatient,60 mL,mL,,116,98.6,33.2456,116,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
HYDROCORTISONE 100 MG/60 ML RECT ENEMA,,13583,LOCAL,Facility,Both,60 mL,mL,,116,98.6,33.2456,116,UnitedHealthcare,Individual & Family,109.04,94,,percent of total billed charges,,
HYDROCORTISONE 100 MG/60 ML RECT ENEMA,,13583,LOCAL,Facility,Outpatient,60 mL,mL,,116,98.6,33.2456,116,UnitedHealthcare,Medicare Advantage,56.84,49,,percent of total billed charges,,
HYDROCORTISONE 100 MG/60 ML RECT ENEMA,,13583,LOCAL,Facility,Inpatient,60 mL,mL,,116,98.6,33.2456,116,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
HYDROCORTISONE 100 MG/60 ML RECT ENEMA,,13583,LOCAL,Facility,Outpatient,60 mL,mL,,116,98.6,33.2456,116,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,55.68,48,,percent of total billed charges,,100% of DHS outpatient percentage
HYDROCORTISONE 100 MG/60 ML RECT ENEMA,,13583,LOCAL,Facility,Inpatient,60 mL,mL,,116,98.6,33.2456,116,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
CEFDINIR 250 MG/5 ML ORAL SUSR,,36534,LOCAL,Facility,Both,60 mL,mL,,418,355.3,119.7988,418,Aetna,Commercial,384.56,92,,percent of total billed charges,,
CEFDINIR 250 MG/5 ML ORAL SUSR,,36534,LOCAL,Facility,Outpatient,60 mL,mL,,418,355.3,119.7988,418,Aetna,Medicare Advantage,204.82,49,,percent of total billed charges,,
CEFDINIR 250 MG/5 ML ORAL SUSR,,36534,LOCAL,Facility,Inpatient,60 mL,mL,,418,355.3,119.7988,418,Aetna,Medicare Advantage,,,,,Included in per diem rate,
CEFDINIR 250 MG/5 ML ORAL SUSR,,36534,LOCAL,Facility,Both,60 mL,mL,,418,355.3,119.7988,418,Aetna,PPO,388.74,93,,percent of total billed charges,,
CEFDINIR 250 MG/5 ML ORAL SUSR,,36534,LOCAL,Facility,Both,60 mL,mL,,418,355.3,119.7988,418,America's PPO,America's PPO,401.4054,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
CEFDINIR 250 MG/5 ML ORAL SUSR,,36534,LOCAL,Facility,Both,60 mL,mL,,418,355.3,119.7988,418,BlueCross BlueShield Minnesota, Federal Employee Program,411.312,98.4,,percent of total billed charges,,
CEFDINIR 250 MG/5 ML ORAL SUSR,,36534,LOCAL,Facility,Both,60 mL,mL,,418,355.3,119.7988,418,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,418,100,,percent of total billed charges,,
CEFDINIR 250 MG/5 ML ORAL SUSR,,36534,LOCAL,Facility,Both,60 mL,mL,,418,355.3,119.7988,418,BlueCross BlueShield Minnesota,High Value Network Plan,376.2,90,,percent of total billed charges,,
CEFDINIR 250 MG/5 ML ORAL SUSR,,36534,LOCAL,Facility,Outpatient,60 mL,mL,,418,355.3,119.7988,418,BlueCross BlueShield Minnesota,Medicare Advantage,204.82,49,,percent of total billed charges,,
CEFDINIR 250 MG/5 ML ORAL SUSR,,36534,LOCAL,Facility,Inpatient,60 mL,mL,,418,355.3,119.7988,418,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
CEFDINIR 250 MG/5 ML ORAL SUSR,,36534,LOCAL,Facility,Both,60 mL,mL,,418,355.3,119.7988,418,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,370.2226,88.57,,percent of total billed charges,,
CEFDINIR 250 MG/5 ML ORAL SUSR,,36534,LOCAL,Facility,Both,60 mL,mL,,418,355.3,119.7988,418,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,119.7988,28.66,,percent of total billed charges,,
CEFDINIR 250 MG/5 ML ORAL SUSR,,36534,LOCAL,Facility,Outpatient,60 mL,mL,,418,355.3,119.7988,418,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),204.82,49,,percent of total billed charges,,
CEFDINIR 250 MG/5 ML ORAL SUSR,,36534,LOCAL,Facility,Inpatient,60 mL,mL,,418,355.3,119.7988,418,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
CEFDINIR 250 MG/5 ML ORAL SUSR,,36534,LOCAL,Facility,Both,60 mL,mL,,418,355.3,119.7988,418,CorVel,Worker's Compensation,418,100,,percent of total billed charges,,
CEFDINIR 250 MG/5 ML ORAL SUSR,,36534,LOCAL,Facility,Both,60 mL,mL,,418,355.3,119.7988,418,First Health Group Corporation,First Health Network,405.46,97,,percent of total billed charges,,
CEFDINIR 250 MG/5 ML ORAL SUSR,,36534,LOCAL,Facility,Both,60 mL,mL,,418,355.3,119.7988,418,"Health Partners, Inc.",Commercial,395.428,94.6,,percent of total billed charges,,
CEFDINIR 250 MG/5 ML ORAL SUSR,,36534,LOCAL,Facility,Outpatient,60 mL,mL,,418,355.3,119.7988,418,"Health Partners, Inc.",Medicare Advantage,204.82,49,,percent of total billed charges,,
CEFDINIR 250 MG/5 ML ORAL SUSR,,36534,LOCAL,Facility,Inpatient,60 mL,mL,,418,355.3,119.7988,418,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CEFDINIR 250 MG/5 ML ORAL SUSR,,36534,LOCAL,Facility,Both,60 mL,mL,,418,355.3,119.7988,418,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),250.8,60,,percent of total billed charges,,
CEFDINIR 250 MG/5 ML ORAL SUSR,,36534,LOCAL,Facility,Both,60 mL,mL,,418,355.3,119.7988,418,"Health Partners, Inc.",State of Minnesota Advantage Program,340.67,81.5,,percent of total billed charges,,
CEFDINIR 250 MG/5 ML ORAL SUSR,,36534,LOCAL,Facility,Both,60 mL,mL,,418,355.3,119.7988,418,"Health Partners, Inc.",State Public Programs,209,50,,percent of total billed charges,,
CEFDINIR 250 MG/5 ML ORAL SUSR,,36534,LOCAL,Facility,Both,60 mL,mL,,418,355.3,119.7988,418,Humana Insurance Company,Commercial PPO,397.1,95,,percent of total billed charges,,
CEFDINIR 250 MG/5 ML ORAL SUSR,,36534,LOCAL,Facility,Outpatient,60 mL,mL,,418,355.3,119.7988,418,Humana Insurance Company,Medicare PPO,204.82,49,,percent of total billed charges,,
CEFDINIR 250 MG/5 ML ORAL SUSR,,36534,LOCAL,Facility,Inpatient,60 mL,mL,,418,355.3,119.7988,418,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
CEFDINIR 250 MG/5 ML ORAL SUSR,,36534,LOCAL,Facility,Both,60 mL,mL,,418,355.3,119.7988,418,Medica,Individual & Family,414.238,99.1,,percent of total billed charges,,
CEFDINIR 250 MG/5 ML ORAL SUSR,,36534,LOCAL,Facility,Outpatient,60 mL,mL,,418,355.3,119.7988,418,Medica,Medica Advantage Solution,208.164,49.8,,percent of total billed charges,,
CEFDINIR 250 MG/5 ML ORAL SUSR,,36534,LOCAL,Facility,Inpatient,60 mL,mL,,418,355.3,119.7988,418,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
CEFDINIR 250 MG/5 ML ORAL SUSR,,36534,LOCAL,Facility,Outpatient,60 mL,mL,,418,355.3,119.7988,418,Medica,Medical Assistance,186.428,44.6,,percent of total billed charges,,
CEFDINIR 250 MG/5 ML ORAL SUSR,,36534,LOCAL,Facility,Inpatient,60 mL,mL,,418,355.3,119.7988,418,Medica,Medical Assistance,,,,,Included in per diem rate,
CEFDINIR 250 MG/5 ML ORAL SUSR,,36534,LOCAL,Facility,Outpatient,60 mL,mL,,418,355.3,119.7988,418,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,208.164,49.8,,percent of total billed charges,,
CEFDINIR 250 MG/5 ML ORAL SUSR,,36534,LOCAL,Facility,Inpatient,60 mL,mL,,418,355.3,119.7988,418,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
CEFDINIR 250 MG/5 ML ORAL SUSR,,36534,LOCAL,Facility,Both,60 mL,mL,,418,355.3,119.7988,418,"Multiplan, Inc.","Multiplan, Inc.",392.92,94,,percent of total billed charges,,
CEFDINIR 250 MG/5 ML ORAL SUSR,,36534,LOCAL,Facility,Outpatient,60 mL,mL,,418,355.3,119.7988,418,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,376.618,90.1,,percent of total billed charges,,
CEFDINIR 250 MG/5 ML ORAL SUSR,,36534,LOCAL,Facility,Inpatient,60 mL,mL,,418,355.3,119.7988,418,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
CEFDINIR 250 MG/5 ML ORAL SUSR,,36534,LOCAL,Facility,Both,60 mL,mL,,418,355.3,119.7988,418,"Preferred One Administrative Services, INC.",PPO,412.148,98.6,,percent of total billed charges,,
CEFDINIR 250 MG/5 ML ORAL SUSR,,36534,LOCAL,Facility,Outpatient,60 mL,mL,,418,355.3,119.7988,418,PrimeWest Health,Minnesota Senior Health Options (MSHO),215.061,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
CEFDINIR 250 MG/5 ML ORAL SUSR,,36534,LOCAL,Facility,Inpatient,60 mL,mL,,418,355.3,119.7988,418,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CEFDINIR 250 MG/5 ML ORAL SUSR,,36534,LOCAL,Facility,Outpatient,60 mL,mL,,418,355.3,119.7988,418,PrimeWest Health,MinnesotaCare,214.6848,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
CEFDINIR 250 MG/5 ML ORAL SUSR,,36534,LOCAL,Facility,Inpatient,60 mL,mL,,418,355.3,119.7988,418,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
CEFDINIR 250 MG/5 ML ORAL SUSR,,36534,LOCAL,Facility,Both,60 mL,mL,,418,355.3,119.7988,418,Sanford Health Plan,Sanford Health Plan,384.56,92,,percent of total billed charges,,
CEFDINIR 250 MG/5 ML ORAL SUSR,,36534,LOCAL,Facility,Outpatient,60 mL,mL,,418,355.3,119.7988,418,"UCare Health, Inc.",Individual & Family Plan,235.543,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
CEFDINIR 250 MG/5 ML ORAL SUSR,,36534,LOCAL,Facility,Inpatient,60 mL,mL,,418,355.3,119.7988,418,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
CEFDINIR 250 MG/5 ML ORAL SUSR,,36534,LOCAL,Facility,Outpatient,60 mL,mL,,418,355.3,119.7988,418,"UCare Health, Inc.",Medical Assistance,210.9646,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CEFDINIR 250 MG/5 ML ORAL SUSR,,36534,LOCAL,Facility,Inpatient,60 mL,mL,,418,355.3,119.7988,418,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
CEFDINIR 250 MG/5 ML ORAL SUSR,,36534,LOCAL,Facility,Outpatient,60 mL,mL,,418,355.3,119.7988,418,"UCare Health, Inc.",Medicare Advantage,210.9646,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CEFDINIR 250 MG/5 ML ORAL SUSR,,36534,LOCAL,Facility,Inpatient,60 mL,mL,,418,355.3,119.7988,418,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CEFDINIR 250 MG/5 ML ORAL SUSR,,36534,LOCAL,Facility,Outpatient,60 mL,mL,,418,355.3,119.7988,418,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),210.9646,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CEFDINIR 250 MG/5 ML ORAL SUSR,,36534,LOCAL,Facility,Inpatient,60 mL,mL,,418,355.3,119.7988,418,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CEFDINIR 250 MG/5 ML ORAL SUSR,,36534,LOCAL,Facility,Both,60 mL,mL,,418,355.3,119.7988,418,UnitedHealthcare,Individual & Family,392.92,94,,percent of total billed charges,,
CEFDINIR 250 MG/5 ML ORAL SUSR,,36534,LOCAL,Facility,Outpatient,60 mL,mL,,418,355.3,119.7988,418,UnitedHealthcare,Medicare Advantage,204.82,49,,percent of total billed charges,,
CEFDINIR 250 MG/5 ML ORAL SUSR,,36534,LOCAL,Facility,Inpatient,60 mL,mL,,418,355.3,119.7988,418,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
CEFDINIR 250 MG/5 ML ORAL SUSR,,36534,LOCAL,Facility,Outpatient,60 mL,mL,,418,355.3,119.7988,418,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,200.64,48,,percent of total billed charges,,100% of DHS outpatient percentage
CEFDINIR 250 MG/5 ML ORAL SUSR,,36534,LOCAL,Facility,Inpatient,60 mL,mL,,418,355.3,119.7988,418,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
OSELTAMIVIR 6 MG/ML ORAL SUSR,,97047,LOCAL,Facility,Both,60 mL,mL,,639,543.15,183.1374,639,Aetna,Commercial,587.88,92,,percent of total billed charges,,
OSELTAMIVIR 6 MG/ML ORAL SUSR,,97047,LOCAL,Facility,Outpatient,60 mL,mL,,639,543.15,183.1374,639,Aetna,Medicare Advantage,313.11,49,,percent of total billed charges,,
OSELTAMIVIR 6 MG/ML ORAL SUSR,,97047,LOCAL,Facility,Inpatient,60 mL,mL,,639,543.15,183.1374,639,Aetna,Medicare Advantage,,,,,Included in per diem rate,
OSELTAMIVIR 6 MG/ML ORAL SUSR,,97047,LOCAL,Facility,Both,60 mL,mL,,639,543.15,183.1374,639,Aetna,PPO,594.27,93,,percent of total billed charges,,
OSELTAMIVIR 6 MG/ML ORAL SUSR,,97047,LOCAL,Facility,Both,60 mL,mL,,639,543.15,183.1374,639,America's PPO,America's PPO,613.6317,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
OSELTAMIVIR 6 MG/ML ORAL SUSR,,97047,LOCAL,Facility,Both,60 mL,mL,,639,543.15,183.1374,639,BlueCross BlueShield Minnesota, Federal Employee Program,628.776,98.4,,percent of total billed charges,,
OSELTAMIVIR 6 MG/ML ORAL SUSR,,97047,LOCAL,Facility,Both,60 mL,mL,,639,543.15,183.1374,639,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,639,100,,percent of total billed charges,,
OSELTAMIVIR 6 MG/ML ORAL SUSR,,97047,LOCAL,Facility,Both,60 mL,mL,,639,543.15,183.1374,639,BlueCross BlueShield Minnesota,High Value Network Plan,575.1,90,,percent of total billed charges,,
OSELTAMIVIR 6 MG/ML ORAL SUSR,,97047,LOCAL,Facility,Outpatient,60 mL,mL,,639,543.15,183.1374,639,BlueCross BlueShield Minnesota,Medicare Advantage,313.11,49,,percent of total billed charges,,
OSELTAMIVIR 6 MG/ML ORAL SUSR,,97047,LOCAL,Facility,Inpatient,60 mL,mL,,639,543.15,183.1374,639,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
OSELTAMIVIR 6 MG/ML ORAL SUSR,,97047,LOCAL,Facility,Both,60 mL,mL,,639,543.15,183.1374,639,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,565.9623,88.57,,percent of total billed charges,,
OSELTAMIVIR 6 MG/ML ORAL SUSR,,97047,LOCAL,Facility,Both,60 mL,mL,,639,543.15,183.1374,639,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,183.1374,28.66,,percent of total billed charges,,
OSELTAMIVIR 6 MG/ML ORAL SUSR,,97047,LOCAL,Facility,Outpatient,60 mL,mL,,639,543.15,183.1374,639,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),313.11,49,,percent of total billed charges,,
OSELTAMIVIR 6 MG/ML ORAL SUSR,,97047,LOCAL,Facility,Inpatient,60 mL,mL,,639,543.15,183.1374,639,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
OSELTAMIVIR 6 MG/ML ORAL SUSR,,97047,LOCAL,Facility,Both,60 mL,mL,,639,543.15,183.1374,639,CorVel,Worker's Compensation,639,100,,percent of total billed charges,,
OSELTAMIVIR 6 MG/ML ORAL SUSR,,97047,LOCAL,Facility,Both,60 mL,mL,,639,543.15,183.1374,639,First Health Group Corporation,First Health Network,619.83,97,,percent of total billed charges,,
OSELTAMIVIR 6 MG/ML ORAL SUSR,,97047,LOCAL,Facility,Both,60 mL,mL,,639,543.15,183.1374,639,"Health Partners, Inc.",Commercial,604.494,94.6,,percent of total billed charges,,
OSELTAMIVIR 6 MG/ML ORAL SUSR,,97047,LOCAL,Facility,Outpatient,60 mL,mL,,639,543.15,183.1374,639,"Health Partners, Inc.",Medicare Advantage,313.11,49,,percent of total billed charges,,
OSELTAMIVIR 6 MG/ML ORAL SUSR,,97047,LOCAL,Facility,Inpatient,60 mL,mL,,639,543.15,183.1374,639,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
OSELTAMIVIR 6 MG/ML ORAL SUSR,,97047,LOCAL,Facility,Both,60 mL,mL,,639,543.15,183.1374,639,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),383.4,60,,percent of total billed charges,,
OSELTAMIVIR 6 MG/ML ORAL SUSR,,97047,LOCAL,Facility,Both,60 mL,mL,,639,543.15,183.1374,639,"Health Partners, Inc.",State of Minnesota Advantage Program,520.785,81.5,,percent of total billed charges,,
OSELTAMIVIR 6 MG/ML ORAL SUSR,,97047,LOCAL,Facility,Both,60 mL,mL,,639,543.15,183.1374,639,"Health Partners, Inc.",State Public Programs,319.5,50,,percent of total billed charges,,
OSELTAMIVIR 6 MG/ML ORAL SUSR,,97047,LOCAL,Facility,Both,60 mL,mL,,639,543.15,183.1374,639,Humana Insurance Company,Commercial PPO,607.05,95,,percent of total billed charges,,
OSELTAMIVIR 6 MG/ML ORAL SUSR,,97047,LOCAL,Facility,Outpatient,60 mL,mL,,639,543.15,183.1374,639,Humana Insurance Company,Medicare PPO,313.11,49,,percent of total billed charges,,
OSELTAMIVIR 6 MG/ML ORAL SUSR,,97047,LOCAL,Facility,Inpatient,60 mL,mL,,639,543.15,183.1374,639,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
OSELTAMIVIR 6 MG/ML ORAL SUSR,,97047,LOCAL,Facility,Both,60 mL,mL,,639,543.15,183.1374,639,Medica,Individual & Family,633.249,99.1,,percent of total billed charges,,
OSELTAMIVIR 6 MG/ML ORAL SUSR,,97047,LOCAL,Facility,Outpatient,60 mL,mL,,639,543.15,183.1374,639,Medica,Medica Advantage Solution,318.222,49.8,,percent of total billed charges,,
OSELTAMIVIR 6 MG/ML ORAL SUSR,,97047,LOCAL,Facility,Inpatient,60 mL,mL,,639,543.15,183.1374,639,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
OSELTAMIVIR 6 MG/ML ORAL SUSR,,97047,LOCAL,Facility,Outpatient,60 mL,mL,,639,543.15,183.1374,639,Medica,Medical Assistance,284.994,44.6,,percent of total billed charges,,
OSELTAMIVIR 6 MG/ML ORAL SUSR,,97047,LOCAL,Facility,Inpatient,60 mL,mL,,639,543.15,183.1374,639,Medica,Medical Assistance,,,,,Included in per diem rate,
OSELTAMIVIR 6 MG/ML ORAL SUSR,,97047,LOCAL,Facility,Outpatient,60 mL,mL,,639,543.15,183.1374,639,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,318.222,49.8,,percent of total billed charges,,
OSELTAMIVIR 6 MG/ML ORAL SUSR,,97047,LOCAL,Facility,Inpatient,60 mL,mL,,639,543.15,183.1374,639,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
OSELTAMIVIR 6 MG/ML ORAL SUSR,,97047,LOCAL,Facility,Both,60 mL,mL,,639,543.15,183.1374,639,"Multiplan, Inc.","Multiplan, Inc.",600.66,94,,percent of total billed charges,,
OSELTAMIVIR 6 MG/ML ORAL SUSR,,97047,LOCAL,Facility,Outpatient,60 mL,mL,,639,543.15,183.1374,639,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,575.739,90.1,,percent of total billed charges,,
OSELTAMIVIR 6 MG/ML ORAL SUSR,,97047,LOCAL,Facility,Inpatient,60 mL,mL,,639,543.15,183.1374,639,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
OSELTAMIVIR 6 MG/ML ORAL SUSR,,97047,LOCAL,Facility,Both,60 mL,mL,,639,543.15,183.1374,639,"Preferred One Administrative Services, INC.",PPO,630.054,98.6,,percent of total billed charges,,
OSELTAMIVIR 6 MG/ML ORAL SUSR,,97047,LOCAL,Facility,Outpatient,60 mL,mL,,639,543.15,183.1374,639,PrimeWest Health,Minnesota Senior Health Options (MSHO),328.7655,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
OSELTAMIVIR 6 MG/ML ORAL SUSR,,97047,LOCAL,Facility,Inpatient,60 mL,mL,,639,543.15,183.1374,639,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
OSELTAMIVIR 6 MG/ML ORAL SUSR,,97047,LOCAL,Facility,Outpatient,60 mL,mL,,639,543.15,183.1374,639,PrimeWest Health,MinnesotaCare,328.1904,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
OSELTAMIVIR 6 MG/ML ORAL SUSR,,97047,LOCAL,Facility,Inpatient,60 mL,mL,,639,543.15,183.1374,639,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
OSELTAMIVIR 6 MG/ML ORAL SUSR,,97047,LOCAL,Facility,Both,60 mL,mL,,639,543.15,183.1374,639,Sanford Health Plan,Sanford Health Plan,587.88,92,,percent of total billed charges,,
OSELTAMIVIR 6 MG/ML ORAL SUSR,,97047,LOCAL,Facility,Outpatient,60 mL,mL,,639,543.15,183.1374,639,"UCare Health, Inc.",Individual & Family Plan,360.0765,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
OSELTAMIVIR 6 MG/ML ORAL SUSR,,97047,LOCAL,Facility,Inpatient,60 mL,mL,,639,543.15,183.1374,639,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
OSELTAMIVIR 6 MG/ML ORAL SUSR,,97047,LOCAL,Facility,Outpatient,60 mL,mL,,639,543.15,183.1374,639,"UCare Health, Inc.",Medical Assistance,322.5033,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
OSELTAMIVIR 6 MG/ML ORAL SUSR,,97047,LOCAL,Facility,Inpatient,60 mL,mL,,639,543.15,183.1374,639,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
OSELTAMIVIR 6 MG/ML ORAL SUSR,,97047,LOCAL,Facility,Outpatient,60 mL,mL,,639,543.15,183.1374,639,"UCare Health, Inc.",Medicare Advantage,322.5033,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
OSELTAMIVIR 6 MG/ML ORAL SUSR,,97047,LOCAL,Facility,Inpatient,60 mL,mL,,639,543.15,183.1374,639,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
OSELTAMIVIR 6 MG/ML ORAL SUSR,,97047,LOCAL,Facility,Outpatient,60 mL,mL,,639,543.15,183.1374,639,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),322.5033,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
OSELTAMIVIR 6 MG/ML ORAL SUSR,,97047,LOCAL,Facility,Inpatient,60 mL,mL,,639,543.15,183.1374,639,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
OSELTAMIVIR 6 MG/ML ORAL SUSR,,97047,LOCAL,Facility,Both,60 mL,mL,,639,543.15,183.1374,639,UnitedHealthcare,Individual & Family,600.66,94,,percent of total billed charges,,
OSELTAMIVIR 6 MG/ML ORAL SUSR,,97047,LOCAL,Facility,Outpatient,60 mL,mL,,639,543.15,183.1374,639,UnitedHealthcare,Medicare Advantage,313.11,49,,percent of total billed charges,,
OSELTAMIVIR 6 MG/ML ORAL SUSR,,97047,LOCAL,Facility,Inpatient,60 mL,mL,,639,543.15,183.1374,639,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
OSELTAMIVIR 6 MG/ML ORAL SUSR,,97047,LOCAL,Facility,Outpatient,60 mL,mL,,639,543.15,183.1374,639,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,306.72,48,,percent of total billed charges,,100% of DHS outpatient percentage
OSELTAMIVIR 6 MG/ML ORAL SUSR,,97047,LOCAL,Facility,Inpatient,60 mL,mL,,639,543.15,183.1374,639,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
SODIUM POLYSTYRENE SULF-SORBTL 15-20 GRAM/60 ML ORAL SUSP,,123154,LOCAL,Facility,Both,60 mL,mL,,137,116.45,39.2642,137,Aetna,Commercial,126.04,92,,percent of total billed charges,,
SODIUM POLYSTYRENE SULF-SORBTL 15-20 GRAM/60 ML ORAL SUSP,,123154,LOCAL,Facility,Outpatient,60 mL,mL,,137,116.45,39.2642,137,Aetna,Medicare Advantage,67.13,49,,percent of total billed charges,,
SODIUM POLYSTYRENE SULF-SORBTL 15-20 GRAM/60 ML ORAL SUSP,,123154,LOCAL,Facility,Inpatient,60 mL,mL,,137,116.45,39.2642,137,Aetna,Medicare Advantage,,,,,Included in per diem rate,
SODIUM POLYSTYRENE SULF-SORBTL 15-20 GRAM/60 ML ORAL SUSP,,123154,LOCAL,Facility,Both,60 mL,mL,,137,116.45,39.2642,137,Aetna,PPO,127.41,93,,percent of total billed charges,,
SODIUM POLYSTYRENE SULF-SORBTL 15-20 GRAM/60 ML ORAL SUSP,,123154,LOCAL,Facility,Both,60 mL,mL,,137,116.45,39.2642,137,America's PPO,America's PPO,131.5611,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
SODIUM POLYSTYRENE SULF-SORBTL 15-20 GRAM/60 ML ORAL SUSP,,123154,LOCAL,Facility,Both,60 mL,mL,,137,116.45,39.2642,137,BlueCross BlueShield Minnesota, Federal Employee Program,134.808,98.4,,percent of total billed charges,,
SODIUM POLYSTYRENE SULF-SORBTL 15-20 GRAM/60 ML ORAL SUSP,,123154,LOCAL,Facility,Both,60 mL,mL,,137,116.45,39.2642,137,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,137,100,,percent of total billed charges,,
SODIUM POLYSTYRENE SULF-SORBTL 15-20 GRAM/60 ML ORAL SUSP,,123154,LOCAL,Facility,Both,60 mL,mL,,137,116.45,39.2642,137,BlueCross BlueShield Minnesota,High Value Network Plan,123.3,90,,percent of total billed charges,,
SODIUM POLYSTYRENE SULF-SORBTL 15-20 GRAM/60 ML ORAL SUSP,,123154,LOCAL,Facility,Outpatient,60 mL,mL,,137,116.45,39.2642,137,BlueCross BlueShield Minnesota,Medicare Advantage,67.13,49,,percent of total billed charges,,
SODIUM POLYSTYRENE SULF-SORBTL 15-20 GRAM/60 ML ORAL SUSP,,123154,LOCAL,Facility,Inpatient,60 mL,mL,,137,116.45,39.2642,137,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
SODIUM POLYSTYRENE SULF-SORBTL 15-20 GRAM/60 ML ORAL SUSP,,123154,LOCAL,Facility,Both,60 mL,mL,,137,116.45,39.2642,137,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,121.3409,88.57,,percent of total billed charges,,
SODIUM POLYSTYRENE SULF-SORBTL 15-20 GRAM/60 ML ORAL SUSP,,123154,LOCAL,Facility,Both,60 mL,mL,,137,116.45,39.2642,137,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,39.2642,28.66,,percent of total billed charges,,
SODIUM POLYSTYRENE SULF-SORBTL 15-20 GRAM/60 ML ORAL SUSP,,123154,LOCAL,Facility,Outpatient,60 mL,mL,,137,116.45,39.2642,137,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),67.13,49,,percent of total billed charges,,
SODIUM POLYSTYRENE SULF-SORBTL 15-20 GRAM/60 ML ORAL SUSP,,123154,LOCAL,Facility,Inpatient,60 mL,mL,,137,116.45,39.2642,137,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
SODIUM POLYSTYRENE SULF-SORBTL 15-20 GRAM/60 ML ORAL SUSP,,123154,LOCAL,Facility,Both,60 mL,mL,,137,116.45,39.2642,137,CorVel,Worker's Compensation,137,100,,percent of total billed charges,,
SODIUM POLYSTYRENE SULF-SORBTL 15-20 GRAM/60 ML ORAL SUSP,,123154,LOCAL,Facility,Both,60 mL,mL,,137,116.45,39.2642,137,First Health Group Corporation,First Health Network,132.89,97,,percent of total billed charges,,
SODIUM POLYSTYRENE SULF-SORBTL 15-20 GRAM/60 ML ORAL SUSP,,123154,LOCAL,Facility,Both,60 mL,mL,,137,116.45,39.2642,137,"Health Partners, Inc.",Commercial,129.602,94.6,,percent of total billed charges,,
SODIUM POLYSTYRENE SULF-SORBTL 15-20 GRAM/60 ML ORAL SUSP,,123154,LOCAL,Facility,Outpatient,60 mL,mL,,137,116.45,39.2642,137,"Health Partners, Inc.",Medicare Advantage,67.13,49,,percent of total billed charges,,
SODIUM POLYSTYRENE SULF-SORBTL 15-20 GRAM/60 ML ORAL SUSP,,123154,LOCAL,Facility,Inpatient,60 mL,mL,,137,116.45,39.2642,137,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SODIUM POLYSTYRENE SULF-SORBTL 15-20 GRAM/60 ML ORAL SUSP,,123154,LOCAL,Facility,Both,60 mL,mL,,137,116.45,39.2642,137,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),82.2,60,,percent of total billed charges,,
SODIUM POLYSTYRENE SULF-SORBTL 15-20 GRAM/60 ML ORAL SUSP,,123154,LOCAL,Facility,Both,60 mL,mL,,137,116.45,39.2642,137,"Health Partners, Inc.",State of Minnesota Advantage Program,111.655,81.5,,percent of total billed charges,,
SODIUM POLYSTYRENE SULF-SORBTL 15-20 GRAM/60 ML ORAL SUSP,,123154,LOCAL,Facility,Both,60 mL,mL,,137,116.45,39.2642,137,"Health Partners, Inc.",State Public Programs,68.5,50,,percent of total billed charges,,
SODIUM POLYSTYRENE SULF-SORBTL 15-20 GRAM/60 ML ORAL SUSP,,123154,LOCAL,Facility,Both,60 mL,mL,,137,116.45,39.2642,137,Humana Insurance Company,Commercial PPO,130.15,95,,percent of total billed charges,,
SODIUM POLYSTYRENE SULF-SORBTL 15-20 GRAM/60 ML ORAL SUSP,,123154,LOCAL,Facility,Outpatient,60 mL,mL,,137,116.45,39.2642,137,Humana Insurance Company,Medicare PPO,67.13,49,,percent of total billed charges,,
SODIUM POLYSTYRENE SULF-SORBTL 15-20 GRAM/60 ML ORAL SUSP,,123154,LOCAL,Facility,Inpatient,60 mL,mL,,137,116.45,39.2642,137,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
SODIUM POLYSTYRENE SULF-SORBTL 15-20 GRAM/60 ML ORAL SUSP,,123154,LOCAL,Facility,Both,60 mL,mL,,137,116.45,39.2642,137,Medica,Individual & Family,135.767,99.1,,percent of total billed charges,,
SODIUM POLYSTYRENE SULF-SORBTL 15-20 GRAM/60 ML ORAL SUSP,,123154,LOCAL,Facility,Outpatient,60 mL,mL,,137,116.45,39.2642,137,Medica,Medica Advantage Solution,68.226,49.8,,percent of total billed charges,,
SODIUM POLYSTYRENE SULF-SORBTL 15-20 GRAM/60 ML ORAL SUSP,,123154,LOCAL,Facility,Inpatient,60 mL,mL,,137,116.45,39.2642,137,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
SODIUM POLYSTYRENE SULF-SORBTL 15-20 GRAM/60 ML ORAL SUSP,,123154,LOCAL,Facility,Outpatient,60 mL,mL,,137,116.45,39.2642,137,Medica,Medical Assistance,61.102,44.6,,percent of total billed charges,,
SODIUM POLYSTYRENE SULF-SORBTL 15-20 GRAM/60 ML ORAL SUSP,,123154,LOCAL,Facility,Inpatient,60 mL,mL,,137,116.45,39.2642,137,Medica,Medical Assistance,,,,,Included in per diem rate,
SODIUM POLYSTYRENE SULF-SORBTL 15-20 GRAM/60 ML ORAL SUSP,,123154,LOCAL,Facility,Outpatient,60 mL,mL,,137,116.45,39.2642,137,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,68.226,49.8,,percent of total billed charges,,
SODIUM POLYSTYRENE SULF-SORBTL 15-20 GRAM/60 ML ORAL SUSP,,123154,LOCAL,Facility,Inpatient,60 mL,mL,,137,116.45,39.2642,137,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
SODIUM POLYSTYRENE SULF-SORBTL 15-20 GRAM/60 ML ORAL SUSP,,123154,LOCAL,Facility,Both,60 mL,mL,,137,116.45,39.2642,137,"Multiplan, Inc.","Multiplan, Inc.",128.78,94,,percent of total billed charges,,
SODIUM POLYSTYRENE SULF-SORBTL 15-20 GRAM/60 ML ORAL SUSP,,123154,LOCAL,Facility,Outpatient,60 mL,mL,,137,116.45,39.2642,137,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,123.437,90.1,,percent of total billed charges,,
SODIUM POLYSTYRENE SULF-SORBTL 15-20 GRAM/60 ML ORAL SUSP,,123154,LOCAL,Facility,Inpatient,60 mL,mL,,137,116.45,39.2642,137,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
SODIUM POLYSTYRENE SULF-SORBTL 15-20 GRAM/60 ML ORAL SUSP,,123154,LOCAL,Facility,Both,60 mL,mL,,137,116.45,39.2642,137,"Preferred One Administrative Services, INC.",PPO,135.082,98.6,,percent of total billed charges,,
SODIUM POLYSTYRENE SULF-SORBTL 15-20 GRAM/60 ML ORAL SUSP,,123154,LOCAL,Facility,Outpatient,60 mL,mL,,137,116.45,39.2642,137,PrimeWest Health,Minnesota Senior Health Options (MSHO),70.4865,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
SODIUM POLYSTYRENE SULF-SORBTL 15-20 GRAM/60 ML ORAL SUSP,,123154,LOCAL,Facility,Inpatient,60 mL,mL,,137,116.45,39.2642,137,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SODIUM POLYSTYRENE SULF-SORBTL 15-20 GRAM/60 ML ORAL SUSP,,123154,LOCAL,Facility,Outpatient,60 mL,mL,,137,116.45,39.2642,137,PrimeWest Health,MinnesotaCare,70.3632,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
SODIUM POLYSTYRENE SULF-SORBTL 15-20 GRAM/60 ML ORAL SUSP,,123154,LOCAL,Facility,Inpatient,60 mL,mL,,137,116.45,39.2642,137,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
SODIUM POLYSTYRENE SULF-SORBTL 15-20 GRAM/60 ML ORAL SUSP,,123154,LOCAL,Facility,Both,60 mL,mL,,137,116.45,39.2642,137,Sanford Health Plan,Sanford Health Plan,126.04,92,,percent of total billed charges,,
SODIUM POLYSTYRENE SULF-SORBTL 15-20 GRAM/60 ML ORAL SUSP,,123154,LOCAL,Facility,Outpatient,60 mL,mL,,137,116.45,39.2642,137,"UCare Health, Inc.",Individual & Family Plan,77.1995,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
SODIUM POLYSTYRENE SULF-SORBTL 15-20 GRAM/60 ML ORAL SUSP,,123154,LOCAL,Facility,Inpatient,60 mL,mL,,137,116.45,39.2642,137,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
SODIUM POLYSTYRENE SULF-SORBTL 15-20 GRAM/60 ML ORAL SUSP,,123154,LOCAL,Facility,Outpatient,60 mL,mL,,137,116.45,39.2642,137,"UCare Health, Inc.",Medical Assistance,69.1439,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SODIUM POLYSTYRENE SULF-SORBTL 15-20 GRAM/60 ML ORAL SUSP,,123154,LOCAL,Facility,Inpatient,60 mL,mL,,137,116.45,39.2642,137,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
SODIUM POLYSTYRENE SULF-SORBTL 15-20 GRAM/60 ML ORAL SUSP,,123154,LOCAL,Facility,Outpatient,60 mL,mL,,137,116.45,39.2642,137,"UCare Health, Inc.",Medicare Advantage,69.1439,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SODIUM POLYSTYRENE SULF-SORBTL 15-20 GRAM/60 ML ORAL SUSP,,123154,LOCAL,Facility,Inpatient,60 mL,mL,,137,116.45,39.2642,137,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
SODIUM POLYSTYRENE SULF-SORBTL 15-20 GRAM/60 ML ORAL SUSP,,123154,LOCAL,Facility,Outpatient,60 mL,mL,,137,116.45,39.2642,137,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),69.1439,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
SODIUM POLYSTYRENE SULF-SORBTL 15-20 GRAM/60 ML ORAL SUSP,,123154,LOCAL,Facility,Inpatient,60 mL,mL,,137,116.45,39.2642,137,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
SODIUM POLYSTYRENE SULF-SORBTL 15-20 GRAM/60 ML ORAL SUSP,,123154,LOCAL,Facility,Both,60 mL,mL,,137,116.45,39.2642,137,UnitedHealthcare,Individual & Family,128.78,94,,percent of total billed charges,,
SODIUM POLYSTYRENE SULF-SORBTL 15-20 GRAM/60 ML ORAL SUSP,,123154,LOCAL,Facility,Outpatient,60 mL,mL,,137,116.45,39.2642,137,UnitedHealthcare,Medicare Advantage,67.13,49,,percent of total billed charges,,
SODIUM POLYSTYRENE SULF-SORBTL 15-20 GRAM/60 ML ORAL SUSP,,123154,LOCAL,Facility,Inpatient,60 mL,mL,,137,116.45,39.2642,137,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
SODIUM POLYSTYRENE SULF-SORBTL 15-20 GRAM/60 ML ORAL SUSP,,123154,LOCAL,Facility,Outpatient,60 mL,mL,,137,116.45,39.2642,137,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,65.76,48,,percent of total billed charges,,100% of DHS outpatient percentage
SODIUM POLYSTYRENE SULF-SORBTL 15-20 GRAM/60 ML ORAL SUSP,,123154,LOCAL,Facility,Inpatient,60 mL,mL,,137,116.45,39.2642,137,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
CIPROFLOXACIN-DEXAMETHASONE 0.3-0.1 % OTIC DRPS,,29173,LOCAL,Facility,Both,7.5 mL,mL,,1050,892.5,300.93,1050,Aetna,Commercial,966,92,,percent of total billed charges,,
CIPROFLOXACIN-DEXAMETHASONE 0.3-0.1 % OTIC DRPS,,29173,LOCAL,Facility,Outpatient,7.5 mL,mL,,1050,892.5,300.93,1050,Aetna,Medicare Advantage,514.5,49,,percent of total billed charges,,
CIPROFLOXACIN-DEXAMETHASONE 0.3-0.1 % OTIC DRPS,,29173,LOCAL,Facility,Inpatient,7.5 mL,mL,,1050,892.5,300.93,1050,Aetna,Medicare Advantage,,,,,Included in per diem rate,
CIPROFLOXACIN-DEXAMETHASONE 0.3-0.1 % OTIC DRPS,,29173,LOCAL,Facility,Both,7.5 mL,mL,,1050,892.5,300.93,1050,Aetna,PPO,976.5,93,,percent of total billed charges,,
CIPROFLOXACIN-DEXAMETHASONE 0.3-0.1 % OTIC DRPS,,29173,LOCAL,Facility,Both,7.5 mL,mL,,1050,892.5,300.93,1050,America's PPO,America's PPO,1008.315,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
CIPROFLOXACIN-DEXAMETHASONE 0.3-0.1 % OTIC DRPS,,29173,LOCAL,Facility,Both,7.5 mL,mL,,1050,892.5,300.93,1050,BlueCross BlueShield Minnesota, Federal Employee Program,1033.2,98.4,,percent of total billed charges,,
CIPROFLOXACIN-DEXAMETHASONE 0.3-0.1 % OTIC DRPS,,29173,LOCAL,Facility,Both,7.5 mL,mL,,1050,892.5,300.93,1050,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1050,100,,percent of total billed charges,,
CIPROFLOXACIN-DEXAMETHASONE 0.3-0.1 % OTIC DRPS,,29173,LOCAL,Facility,Both,7.5 mL,mL,,1050,892.5,300.93,1050,BlueCross BlueShield Minnesota,High Value Network Plan,945,90,,percent of total billed charges,,
CIPROFLOXACIN-DEXAMETHASONE 0.3-0.1 % OTIC DRPS,,29173,LOCAL,Facility,Outpatient,7.5 mL,mL,,1050,892.5,300.93,1050,BlueCross BlueShield Minnesota,Medicare Advantage,514.5,49,,percent of total billed charges,,
CIPROFLOXACIN-DEXAMETHASONE 0.3-0.1 % OTIC DRPS,,29173,LOCAL,Facility,Inpatient,7.5 mL,mL,,1050,892.5,300.93,1050,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
CIPROFLOXACIN-DEXAMETHASONE 0.3-0.1 % OTIC DRPS,,29173,LOCAL,Facility,Both,7.5 mL,mL,,1050,892.5,300.93,1050,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,929.985,88.57,,percent of total billed charges,,
CIPROFLOXACIN-DEXAMETHASONE 0.3-0.1 % OTIC DRPS,,29173,LOCAL,Facility,Both,7.5 mL,mL,,1050,892.5,300.93,1050,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,300.93,28.66,,percent of total billed charges,,
CIPROFLOXACIN-DEXAMETHASONE 0.3-0.1 % OTIC DRPS,,29173,LOCAL,Facility,Outpatient,7.5 mL,mL,,1050,892.5,300.93,1050,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),514.5,49,,percent of total billed charges,,
CIPROFLOXACIN-DEXAMETHASONE 0.3-0.1 % OTIC DRPS,,29173,LOCAL,Facility,Inpatient,7.5 mL,mL,,1050,892.5,300.93,1050,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
CIPROFLOXACIN-DEXAMETHASONE 0.3-0.1 % OTIC DRPS,,29173,LOCAL,Facility,Both,7.5 mL,mL,,1050,892.5,300.93,1050,CorVel,Worker's Compensation,1050,100,,percent of total billed charges,,
CIPROFLOXACIN-DEXAMETHASONE 0.3-0.1 % OTIC DRPS,,29173,LOCAL,Facility,Both,7.5 mL,mL,,1050,892.5,300.93,1050,First Health Group Corporation,First Health Network,1018.5,97,,percent of total billed charges,,
CIPROFLOXACIN-DEXAMETHASONE 0.3-0.1 % OTIC DRPS,,29173,LOCAL,Facility,Both,7.5 mL,mL,,1050,892.5,300.93,1050,"Health Partners, Inc.",Commercial,993.3,94.6,,percent of total billed charges,,
CIPROFLOXACIN-DEXAMETHASONE 0.3-0.1 % OTIC DRPS,,29173,LOCAL,Facility,Outpatient,7.5 mL,mL,,1050,892.5,300.93,1050,"Health Partners, Inc.",Medicare Advantage,514.5,49,,percent of total billed charges,,
CIPROFLOXACIN-DEXAMETHASONE 0.3-0.1 % OTIC DRPS,,29173,LOCAL,Facility,Inpatient,7.5 mL,mL,,1050,892.5,300.93,1050,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CIPROFLOXACIN-DEXAMETHASONE 0.3-0.1 % OTIC DRPS,,29173,LOCAL,Facility,Both,7.5 mL,mL,,1050,892.5,300.93,1050,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),630,60,,percent of total billed charges,,
CIPROFLOXACIN-DEXAMETHASONE 0.3-0.1 % OTIC DRPS,,29173,LOCAL,Facility,Both,7.5 mL,mL,,1050,892.5,300.93,1050,"Health Partners, Inc.",State of Minnesota Advantage Program,855.75,81.5,,percent of total billed charges,,
CIPROFLOXACIN-DEXAMETHASONE 0.3-0.1 % OTIC DRPS,,29173,LOCAL,Facility,Both,7.5 mL,mL,,1050,892.5,300.93,1050,"Health Partners, Inc.",State Public Programs,525,50,,percent of total billed charges,,
CIPROFLOXACIN-DEXAMETHASONE 0.3-0.1 % OTIC DRPS,,29173,LOCAL,Facility,Both,7.5 mL,mL,,1050,892.5,300.93,1050,Humana Insurance Company,Commercial PPO,997.5,95,,percent of total billed charges,,
CIPROFLOXACIN-DEXAMETHASONE 0.3-0.1 % OTIC DRPS,,29173,LOCAL,Facility,Outpatient,7.5 mL,mL,,1050,892.5,300.93,1050,Humana Insurance Company,Medicare PPO,514.5,49,,percent of total billed charges,,
CIPROFLOXACIN-DEXAMETHASONE 0.3-0.1 % OTIC DRPS,,29173,LOCAL,Facility,Inpatient,7.5 mL,mL,,1050,892.5,300.93,1050,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
CIPROFLOXACIN-DEXAMETHASONE 0.3-0.1 % OTIC DRPS,,29173,LOCAL,Facility,Both,7.5 mL,mL,,1050,892.5,300.93,1050,Medica,Individual & Family,1040.55,99.1,,percent of total billed charges,,
CIPROFLOXACIN-DEXAMETHASONE 0.3-0.1 % OTIC DRPS,,29173,LOCAL,Facility,Outpatient,7.5 mL,mL,,1050,892.5,300.93,1050,Medica,Medica Advantage Solution,522.9,49.8,,percent of total billed charges,,
CIPROFLOXACIN-DEXAMETHASONE 0.3-0.1 % OTIC DRPS,,29173,LOCAL,Facility,Inpatient,7.5 mL,mL,,1050,892.5,300.93,1050,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
CIPROFLOXACIN-DEXAMETHASONE 0.3-0.1 % OTIC DRPS,,29173,LOCAL,Facility,Outpatient,7.5 mL,mL,,1050,892.5,300.93,1050,Medica,Medical Assistance,468.3,44.6,,percent of total billed charges,,
CIPROFLOXACIN-DEXAMETHASONE 0.3-0.1 % OTIC DRPS,,29173,LOCAL,Facility,Inpatient,7.5 mL,mL,,1050,892.5,300.93,1050,Medica,Medical Assistance,,,,,Included in per diem rate,
CIPROFLOXACIN-DEXAMETHASONE 0.3-0.1 % OTIC DRPS,,29173,LOCAL,Facility,Outpatient,7.5 mL,mL,,1050,892.5,300.93,1050,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,522.9,49.8,,percent of total billed charges,,
CIPROFLOXACIN-DEXAMETHASONE 0.3-0.1 % OTIC DRPS,,29173,LOCAL,Facility,Inpatient,7.5 mL,mL,,1050,892.5,300.93,1050,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
CIPROFLOXACIN-DEXAMETHASONE 0.3-0.1 % OTIC DRPS,,29173,LOCAL,Facility,Both,7.5 mL,mL,,1050,892.5,300.93,1050,"Multiplan, Inc.","Multiplan, Inc.",987,94,,percent of total billed charges,,
CIPROFLOXACIN-DEXAMETHASONE 0.3-0.1 % OTIC DRPS,,29173,LOCAL,Facility,Outpatient,7.5 mL,mL,,1050,892.5,300.93,1050,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,946.05,90.1,,percent of total billed charges,,
CIPROFLOXACIN-DEXAMETHASONE 0.3-0.1 % OTIC DRPS,,29173,LOCAL,Facility,Inpatient,7.5 mL,mL,,1050,892.5,300.93,1050,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
CIPROFLOXACIN-DEXAMETHASONE 0.3-0.1 % OTIC DRPS,,29173,LOCAL,Facility,Both,7.5 mL,mL,,1050,892.5,300.93,1050,"Preferred One Administrative Services, INC.",PPO,1035.3,98.6,,percent of total billed charges,,
CIPROFLOXACIN-DEXAMETHASONE 0.3-0.1 % OTIC DRPS,,29173,LOCAL,Facility,Outpatient,7.5 mL,mL,,1050,892.5,300.93,1050,PrimeWest Health,Minnesota Senior Health Options (MSHO),540.225,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
CIPROFLOXACIN-DEXAMETHASONE 0.3-0.1 % OTIC DRPS,,29173,LOCAL,Facility,Inpatient,7.5 mL,mL,,1050,892.5,300.93,1050,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CIPROFLOXACIN-DEXAMETHASONE 0.3-0.1 % OTIC DRPS,,29173,LOCAL,Facility,Outpatient,7.5 mL,mL,,1050,892.5,300.93,1050,PrimeWest Health,MinnesotaCare,539.28,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
CIPROFLOXACIN-DEXAMETHASONE 0.3-0.1 % OTIC DRPS,,29173,LOCAL,Facility,Inpatient,7.5 mL,mL,,1050,892.5,300.93,1050,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
CIPROFLOXACIN-DEXAMETHASONE 0.3-0.1 % OTIC DRPS,,29173,LOCAL,Facility,Both,7.5 mL,mL,,1050,892.5,300.93,1050,Sanford Health Plan,Sanford Health Plan,966,92,,percent of total billed charges,,
CIPROFLOXACIN-DEXAMETHASONE 0.3-0.1 % OTIC DRPS,,29173,LOCAL,Facility,Outpatient,7.5 mL,mL,,1050,892.5,300.93,1050,"UCare Health, Inc.",Individual & Family Plan,591.675,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
CIPROFLOXACIN-DEXAMETHASONE 0.3-0.1 % OTIC DRPS,,29173,LOCAL,Facility,Inpatient,7.5 mL,mL,,1050,892.5,300.93,1050,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
CIPROFLOXACIN-DEXAMETHASONE 0.3-0.1 % OTIC DRPS,,29173,LOCAL,Facility,Outpatient,7.5 mL,mL,,1050,892.5,300.93,1050,"UCare Health, Inc.",Medical Assistance,529.935,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CIPROFLOXACIN-DEXAMETHASONE 0.3-0.1 % OTIC DRPS,,29173,LOCAL,Facility,Inpatient,7.5 mL,mL,,1050,892.5,300.93,1050,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
CIPROFLOXACIN-DEXAMETHASONE 0.3-0.1 % OTIC DRPS,,29173,LOCAL,Facility,Outpatient,7.5 mL,mL,,1050,892.5,300.93,1050,"UCare Health, Inc.",Medicare Advantage,529.935,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CIPROFLOXACIN-DEXAMETHASONE 0.3-0.1 % OTIC DRPS,,29173,LOCAL,Facility,Inpatient,7.5 mL,mL,,1050,892.5,300.93,1050,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CIPROFLOXACIN-DEXAMETHASONE 0.3-0.1 % OTIC DRPS,,29173,LOCAL,Facility,Outpatient,7.5 mL,mL,,1050,892.5,300.93,1050,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),529.935,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CIPROFLOXACIN-DEXAMETHASONE 0.3-0.1 % OTIC DRPS,,29173,LOCAL,Facility,Inpatient,7.5 mL,mL,,1050,892.5,300.93,1050,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CIPROFLOXACIN-DEXAMETHASONE 0.3-0.1 % OTIC DRPS,,29173,LOCAL,Facility,Both,7.5 mL,mL,,1050,892.5,300.93,1050,UnitedHealthcare,Individual & Family,987,94,,percent of total billed charges,,
CIPROFLOXACIN-DEXAMETHASONE 0.3-0.1 % OTIC DRPS,,29173,LOCAL,Facility,Outpatient,7.5 mL,mL,,1050,892.5,300.93,1050,UnitedHealthcare,Medicare Advantage,514.5,49,,percent of total billed charges,,
CIPROFLOXACIN-DEXAMETHASONE 0.3-0.1 % OTIC DRPS,,29173,LOCAL,Facility,Inpatient,7.5 mL,mL,,1050,892.5,300.93,1050,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
CIPROFLOXACIN-DEXAMETHASONE 0.3-0.1 % OTIC DRPS,,29173,LOCAL,Facility,Outpatient,7.5 mL,mL,,1050,892.5,300.93,1050,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,504,48,,percent of total billed charges,,100% of DHS outpatient percentage
CIPROFLOXACIN-DEXAMETHASONE 0.3-0.1 % OTIC DRPS,,29173,LOCAL,Facility,Inpatient,7.5 mL,mL,,1050,892.5,300.93,1050,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
METRONIDAZOLE 0.75 % (37.5MG/5 GRAM) VAGL GEL,,4584,LOCAL,Facility,Both,70 g,g,,596,506.6,170.8136,596,Aetna,Commercial,548.32,92,,percent of total billed charges,,
METRONIDAZOLE 0.75 % (37.5MG/5 GRAM) VAGL GEL,,4584,LOCAL,Facility,Outpatient,70 g,g,,596,506.6,170.8136,596,Aetna,Medicare Advantage,292.04,49,,percent of total billed charges,,
METRONIDAZOLE 0.75 % (37.5MG/5 GRAM) VAGL GEL,,4584,LOCAL,Facility,Inpatient,70 g,g,,596,506.6,170.8136,596,Aetna,Medicare Advantage,,,,,Included in per diem rate,
METRONIDAZOLE 0.75 % (37.5MG/5 GRAM) VAGL GEL,,4584,LOCAL,Facility,Both,70 g,g,,596,506.6,170.8136,596,Aetna,PPO,554.28,93,,percent of total billed charges,,
METRONIDAZOLE 0.75 % (37.5MG/5 GRAM) VAGL GEL,,4584,LOCAL,Facility,Both,70 g,g,,596,506.6,170.8136,596,America's PPO,America's PPO,572.3388,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
METRONIDAZOLE 0.75 % (37.5MG/5 GRAM) VAGL GEL,,4584,LOCAL,Facility,Both,70 g,g,,596,506.6,170.8136,596,BlueCross BlueShield Minnesota, Federal Employee Program,586.464,98.4,,percent of total billed charges,,
METRONIDAZOLE 0.75 % (37.5MG/5 GRAM) VAGL GEL,,4584,LOCAL,Facility,Both,70 g,g,,596,506.6,170.8136,596,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,596,100,,percent of total billed charges,,
METRONIDAZOLE 0.75 % (37.5MG/5 GRAM) VAGL GEL,,4584,LOCAL,Facility,Both,70 g,g,,596,506.6,170.8136,596,BlueCross BlueShield Minnesota,High Value Network Plan,536.4,90,,percent of total billed charges,,
METRONIDAZOLE 0.75 % (37.5MG/5 GRAM) VAGL GEL,,4584,LOCAL,Facility,Outpatient,70 g,g,,596,506.6,170.8136,596,BlueCross BlueShield Minnesota,Medicare Advantage,292.04,49,,percent of total billed charges,,
METRONIDAZOLE 0.75 % (37.5MG/5 GRAM) VAGL GEL,,4584,LOCAL,Facility,Inpatient,70 g,g,,596,506.6,170.8136,596,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
METRONIDAZOLE 0.75 % (37.5MG/5 GRAM) VAGL GEL,,4584,LOCAL,Facility,Both,70 g,g,,596,506.6,170.8136,596,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,527.8772,88.57,,percent of total billed charges,,
METRONIDAZOLE 0.75 % (37.5MG/5 GRAM) VAGL GEL,,4584,LOCAL,Facility,Both,70 g,g,,596,506.6,170.8136,596,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,170.8136,28.66,,percent of total billed charges,,
METRONIDAZOLE 0.75 % (37.5MG/5 GRAM) VAGL GEL,,4584,LOCAL,Facility,Outpatient,70 g,g,,596,506.6,170.8136,596,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),292.04,49,,percent of total billed charges,,
METRONIDAZOLE 0.75 % (37.5MG/5 GRAM) VAGL GEL,,4584,LOCAL,Facility,Inpatient,70 g,g,,596,506.6,170.8136,596,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
METRONIDAZOLE 0.75 % (37.5MG/5 GRAM) VAGL GEL,,4584,LOCAL,Facility,Both,70 g,g,,596,506.6,170.8136,596,CorVel,Worker's Compensation,596,100,,percent of total billed charges,,
METRONIDAZOLE 0.75 % (37.5MG/5 GRAM) VAGL GEL,,4584,LOCAL,Facility,Both,70 g,g,,596,506.6,170.8136,596,First Health Group Corporation,First Health Network,578.12,97,,percent of total billed charges,,
METRONIDAZOLE 0.75 % (37.5MG/5 GRAM) VAGL GEL,,4584,LOCAL,Facility,Both,70 g,g,,596,506.6,170.8136,596,"Health Partners, Inc.",Commercial,563.816,94.6,,percent of total billed charges,,
METRONIDAZOLE 0.75 % (37.5MG/5 GRAM) VAGL GEL,,4584,LOCAL,Facility,Outpatient,70 g,g,,596,506.6,170.8136,596,"Health Partners, Inc.",Medicare Advantage,292.04,49,,percent of total billed charges,,
METRONIDAZOLE 0.75 % (37.5MG/5 GRAM) VAGL GEL,,4584,LOCAL,Facility,Inpatient,70 g,g,,596,506.6,170.8136,596,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
METRONIDAZOLE 0.75 % (37.5MG/5 GRAM) VAGL GEL,,4584,LOCAL,Facility,Both,70 g,g,,596,506.6,170.8136,596,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),357.6,60,,percent of total billed charges,,
METRONIDAZOLE 0.75 % (37.5MG/5 GRAM) VAGL GEL,,4584,LOCAL,Facility,Both,70 g,g,,596,506.6,170.8136,596,"Health Partners, Inc.",State of Minnesota Advantage Program,485.74,81.5,,percent of total billed charges,,
METRONIDAZOLE 0.75 % (37.5MG/5 GRAM) VAGL GEL,,4584,LOCAL,Facility,Both,70 g,g,,596,506.6,170.8136,596,"Health Partners, Inc.",State Public Programs,298,50,,percent of total billed charges,,
METRONIDAZOLE 0.75 % (37.5MG/5 GRAM) VAGL GEL,,4584,LOCAL,Facility,Both,70 g,g,,596,506.6,170.8136,596,Humana Insurance Company,Commercial PPO,566.2,95,,percent of total billed charges,,
METRONIDAZOLE 0.75 % (37.5MG/5 GRAM) VAGL GEL,,4584,LOCAL,Facility,Outpatient,70 g,g,,596,506.6,170.8136,596,Humana Insurance Company,Medicare PPO,292.04,49,,percent of total billed charges,,
METRONIDAZOLE 0.75 % (37.5MG/5 GRAM) VAGL GEL,,4584,LOCAL,Facility,Inpatient,70 g,g,,596,506.6,170.8136,596,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
METRONIDAZOLE 0.75 % (37.5MG/5 GRAM) VAGL GEL,,4584,LOCAL,Facility,Both,70 g,g,,596,506.6,170.8136,596,Medica,Individual & Family,590.636,99.1,,percent of total billed charges,,
METRONIDAZOLE 0.75 % (37.5MG/5 GRAM) VAGL GEL,,4584,LOCAL,Facility,Outpatient,70 g,g,,596,506.6,170.8136,596,Medica,Medica Advantage Solution,296.808,49.8,,percent of total billed charges,,
METRONIDAZOLE 0.75 % (37.5MG/5 GRAM) VAGL GEL,,4584,LOCAL,Facility,Inpatient,70 g,g,,596,506.6,170.8136,596,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
METRONIDAZOLE 0.75 % (37.5MG/5 GRAM) VAGL GEL,,4584,LOCAL,Facility,Outpatient,70 g,g,,596,506.6,170.8136,596,Medica,Medical Assistance,265.816,44.6,,percent of total billed charges,,
METRONIDAZOLE 0.75 % (37.5MG/5 GRAM) VAGL GEL,,4584,LOCAL,Facility,Inpatient,70 g,g,,596,506.6,170.8136,596,Medica,Medical Assistance,,,,,Included in per diem rate,
METRONIDAZOLE 0.75 % (37.5MG/5 GRAM) VAGL GEL,,4584,LOCAL,Facility,Outpatient,70 g,g,,596,506.6,170.8136,596,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,296.808,49.8,,percent of total billed charges,,
METRONIDAZOLE 0.75 % (37.5MG/5 GRAM) VAGL GEL,,4584,LOCAL,Facility,Inpatient,70 g,g,,596,506.6,170.8136,596,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
METRONIDAZOLE 0.75 % (37.5MG/5 GRAM) VAGL GEL,,4584,LOCAL,Facility,Both,70 g,g,,596,506.6,170.8136,596,"Multiplan, Inc.","Multiplan, Inc.",560.24,94,,percent of total billed charges,,
METRONIDAZOLE 0.75 % (37.5MG/5 GRAM) VAGL GEL,,4584,LOCAL,Facility,Outpatient,70 g,g,,596,506.6,170.8136,596,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,536.996,90.1,,percent of total billed charges,,
METRONIDAZOLE 0.75 % (37.5MG/5 GRAM) VAGL GEL,,4584,LOCAL,Facility,Inpatient,70 g,g,,596,506.6,170.8136,596,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
METRONIDAZOLE 0.75 % (37.5MG/5 GRAM) VAGL GEL,,4584,LOCAL,Facility,Both,70 g,g,,596,506.6,170.8136,596,"Preferred One Administrative Services, INC.",PPO,587.656,98.6,,percent of total billed charges,,
METRONIDAZOLE 0.75 % (37.5MG/5 GRAM) VAGL GEL,,4584,LOCAL,Facility,Outpatient,70 g,g,,596,506.6,170.8136,596,PrimeWest Health,Minnesota Senior Health Options (MSHO),306.642,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
METRONIDAZOLE 0.75 % (37.5MG/5 GRAM) VAGL GEL,,4584,LOCAL,Facility,Inpatient,70 g,g,,596,506.6,170.8136,596,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
METRONIDAZOLE 0.75 % (37.5MG/5 GRAM) VAGL GEL,,4584,LOCAL,Facility,Outpatient,70 g,g,,596,506.6,170.8136,596,PrimeWest Health,MinnesotaCare,306.1056,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
METRONIDAZOLE 0.75 % (37.5MG/5 GRAM) VAGL GEL,,4584,LOCAL,Facility,Inpatient,70 g,g,,596,506.6,170.8136,596,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
METRONIDAZOLE 0.75 % (37.5MG/5 GRAM) VAGL GEL,,4584,LOCAL,Facility,Both,70 g,g,,596,506.6,170.8136,596,Sanford Health Plan,Sanford Health Plan,548.32,92,,percent of total billed charges,,
METRONIDAZOLE 0.75 % (37.5MG/5 GRAM) VAGL GEL,,4584,LOCAL,Facility,Outpatient,70 g,g,,596,506.6,170.8136,596,"UCare Health, Inc.",Individual & Family Plan,335.846,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
METRONIDAZOLE 0.75 % (37.5MG/5 GRAM) VAGL GEL,,4584,LOCAL,Facility,Inpatient,70 g,g,,596,506.6,170.8136,596,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
METRONIDAZOLE 0.75 % (37.5MG/5 GRAM) VAGL GEL,,4584,LOCAL,Facility,Outpatient,70 g,g,,596,506.6,170.8136,596,"UCare Health, Inc.",Medical Assistance,300.8012,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
METRONIDAZOLE 0.75 % (37.5MG/5 GRAM) VAGL GEL,,4584,LOCAL,Facility,Inpatient,70 g,g,,596,506.6,170.8136,596,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
METRONIDAZOLE 0.75 % (37.5MG/5 GRAM) VAGL GEL,,4584,LOCAL,Facility,Outpatient,70 g,g,,596,506.6,170.8136,596,"UCare Health, Inc.",Medicare Advantage,300.8012,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
METRONIDAZOLE 0.75 % (37.5MG/5 GRAM) VAGL GEL,,4584,LOCAL,Facility,Inpatient,70 g,g,,596,506.6,170.8136,596,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
METRONIDAZOLE 0.75 % (37.5MG/5 GRAM) VAGL GEL,,4584,LOCAL,Facility,Outpatient,70 g,g,,596,506.6,170.8136,596,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),300.8012,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
METRONIDAZOLE 0.75 % (37.5MG/5 GRAM) VAGL GEL,,4584,LOCAL,Facility,Inpatient,70 g,g,,596,506.6,170.8136,596,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
METRONIDAZOLE 0.75 % (37.5MG/5 GRAM) VAGL GEL,,4584,LOCAL,Facility,Both,70 g,g,,596,506.6,170.8136,596,UnitedHealthcare,Individual & Family,560.24,94,,percent of total billed charges,,
METRONIDAZOLE 0.75 % (37.5MG/5 GRAM) VAGL GEL,,4584,LOCAL,Facility,Outpatient,70 g,g,,596,506.6,170.8136,596,UnitedHealthcare,Medicare Advantage,292.04,49,,percent of total billed charges,,
METRONIDAZOLE 0.75 % (37.5MG/5 GRAM) VAGL GEL,,4584,LOCAL,Facility,Inpatient,70 g,g,,596,506.6,170.8136,596,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
METRONIDAZOLE 0.75 % (37.5MG/5 GRAM) VAGL GEL,,4584,LOCAL,Facility,Outpatient,70 g,g,,596,506.6,170.8136,596,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,286.08,48,,percent of total billed charges,,100% of DHS outpatient percentage
METRONIDAZOLE 0.75 % (37.5MG/5 GRAM) VAGL GEL,,4584,LOCAL,Facility,Inpatient,70 g,g,,596,506.6,170.8136,596,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Sup Cervical Collar Foam,,L0120,HCPCS,Facility,Both,,,,59,50.15,16.9094,59,Aetna,Commercial,54.28,92,,percent of total billed charges,,
Sup Cervical Collar Foam,,L0120,HCPCS,Facility,Outpatient,,,,59,50.15,16.9094,59,Aetna,Medicare Advantage,28.91,49,,percent of total billed charges,,
Sup Cervical Collar Foam,,L0120,HCPCS,Facility,Inpatient,,,,59,50.15,16.9094,59,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Sup Cervical Collar Foam,,L0120,HCPCS,Facility,Both,,,,59,50.15,16.9094,59,Aetna,PPO,54.87,93,,percent of total billed charges,,
Sup Cervical Collar Foam,,L0120,HCPCS,Facility,Both,,,,59,50.15,16.9094,59,America's PPO,America's PPO,56.6577,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Sup Cervical Collar Foam,,L0120,HCPCS,Facility,Both,,,,59,50.15,16.9094,59,BlueCross BlueShield Minnesota, Federal Employee Program,58.056,98.4,,percent of total billed charges,,
Sup Cervical Collar Foam,,L0120,HCPCS,Facility,Both,,,,59,50.15,16.9094,59,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,59,100,,percent of total billed charges,,
Sup Cervical Collar Foam,,L0120,HCPCS,Facility,Both,,,,59,50.15,16.9094,59,BlueCross BlueShield Minnesota,High Value Network Plan,53.1,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
Sup Cervical Collar Foam,,L0120,HCPCS,Facility,Outpatient,,,,59,50.15,16.9094,59,BlueCross BlueShield Minnesota,Medicare Advantage,28.91,49,,percent of total billed charges,,
Sup Cervical Collar Foam,,L0120,HCPCS,Facility,Inpatient,,,,59,50.15,16.9094,59,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Sup Cervical Collar Foam,,L0120,HCPCS,Facility,Both,,,,59,50.15,16.9094,59,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,52.2563,88.57,,percent of total billed charges,,
Sup Cervical Collar Foam,,L0120,HCPCS,Facility,Both,,,,59,50.15,16.9094,59,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,16.9094,28.66,,percent of total billed charges,,
Sup Cervical Collar Foam,,L0120,HCPCS,Facility,Outpatient,,,,59,50.15,16.9094,59,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),28.91,49,,percent of total billed charges,,
Sup Cervical Collar Foam,,L0120,HCPCS,Facility,Inpatient,,,,59,50.15,16.9094,59,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Sup Cervical Collar Foam,,L0120,HCPCS,Facility,Both,,,,59,50.15,16.9094,59,CorVel,Worker's Compensation,59,100,,percent of total billed charges,,
Sup Cervical Collar Foam,,L0120,HCPCS,Facility,Both,,,,59,50.15,16.9094,59,First Health Group Corporation,First Health Network,57.23,97,,percent of total billed charges,,
Sup Cervical Collar Foam,,L0120,HCPCS,Facility,Both,,,,59,50.15,16.9094,59,"Health Partners, Inc.",Commercial,55.814,94.6,,percent of total billed charges,,
Sup Cervical Collar Foam,,L0120,HCPCS,Facility,Outpatient,,,,59,50.15,16.9094,59,"Health Partners, Inc.",Medicare Advantage,28.91,49,,percent of total billed charges,,
Sup Cervical Collar Foam,,L0120,HCPCS,Facility,Inpatient,,,,59,50.15,16.9094,59,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Cervical Collar Foam,,L0120,HCPCS,Facility,Both,,,,59,50.15,16.9094,59,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),35.4,60,,percent of total billed charges,,
Sup Cervical Collar Foam,,L0120,HCPCS,Facility,Both,,,,59,50.15,16.9094,59,"Health Partners, Inc.",State of Minnesota Advantage Program,48.085,81.5,,percent of total billed charges,,
Sup Cervical Collar Foam,,L0120,HCPCS,Facility,Both,,,,59,50.15,16.9094,59,"Health Partners, Inc.",State Public Programs,29.5,50,,percent of total billed charges,,
Sup Cervical Collar Foam,,L0120,HCPCS,Facility,Both,,,,59,50.15,16.9094,59,Humana Insurance Company,Commercial PPO,56.05,95,,percent of total billed charges,,
Sup Cervical Collar Foam,,L0120,HCPCS,Facility,Outpatient,,,,59,50.15,16.9094,59,Humana Insurance Company,Medicare PPO,28.91,49,,percent of total billed charges,,
Sup Cervical Collar Foam,,L0120,HCPCS,Facility,Inpatient,,,,59,50.15,16.9094,59,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Sup Cervical Collar Foam,,L0120,HCPCS,Facility,Both,,,,59,50.15,16.9094,59,Medica,Individual & Family,58.469,99.1,,percent of total billed charges,,
Sup Cervical Collar Foam,,L0120,HCPCS,Facility,Outpatient,,,,59,50.15,16.9094,59,Medica,Medica Advantage Solution,29.382,49.8,,percent of total billed charges,,
Sup Cervical Collar Foam,,L0120,HCPCS,Facility,Inpatient,,,,59,50.15,16.9094,59,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Sup Cervical Collar Foam,,L0120,HCPCS,Facility,Outpatient,,,,59,50.15,16.9094,59,Medica,Medical Assistance,26.314,44.6,,percent of total billed charges,,
Sup Cervical Collar Foam,,L0120,HCPCS,Facility,Inpatient,,,,59,50.15,16.9094,59,Medica,Medical Assistance,,,,,Included in per diem rate,
Sup Cervical Collar Foam,,L0120,HCPCS,Facility,Outpatient,,,,59,50.15,16.9094,59,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,29.382,49.8,,percent of total billed charges,,
Sup Cervical Collar Foam,,L0120,HCPCS,Facility,Inpatient,,,,59,50.15,16.9094,59,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Sup Cervical Collar Foam,,L0120,HCPCS,Facility,Both,,,,59,50.15,16.9094,59,"Multiplan, Inc.","Multiplan, Inc.",55.46,94,,percent of total billed charges,,
Sup Cervical Collar Foam,,L0120,HCPCS,Facility,Outpatient,,,,59,50.15,16.9094,59,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,53.159,90.1,,percent of total billed charges,,
Sup Cervical Collar Foam,,L0120,HCPCS,Facility,Inpatient,,,,59,50.15,16.9094,59,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Sup Cervical Collar Foam,,L0120,HCPCS,Facility,Both,,,,59,50.15,16.9094,59,"Preferred One Administrative Services, INC.",PPO,58.174,98.6,,percent of total billed charges,,
Sup Cervical Collar Foam,,L0120,HCPCS,Facility,Outpatient,,,,59,50.15,16.9094,59,PrimeWest Health,Minnesota Senior Health Options (MSHO),30.3555,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Sup Cervical Collar Foam,,L0120,HCPCS,Facility,Inpatient,,,,59,50.15,16.9094,59,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Cervical Collar Foam,,L0120,HCPCS,Facility,Outpatient,,,,59,50.15,16.9094,59,PrimeWest Health,MinnesotaCare,30.3024,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Sup Cervical Collar Foam,,L0120,HCPCS,Facility,Inpatient,,,,59,50.15,16.9094,59,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Sup Cervical Collar Foam,,L0120,HCPCS,Facility,Both,,,,59,50.15,16.9094,59,Sanford Health Plan,Sanford Health Plan,54.28,92,,percent of total billed charges,,
Sup Cervical Collar Foam,,L0120,HCPCS,Facility,Outpatient,,,,59,50.15,16.9094,59,"UCare Health, Inc.",Individual & Family Plan,33.2465,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Sup Cervical Collar Foam,,L0120,HCPCS,Facility,Inpatient,,,,59,50.15,16.9094,59,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Sup Cervical Collar Foam,,L0120,HCPCS,Facility,Outpatient,,,,59,50.15,16.9094,59,"UCare Health, Inc.",Medical Assistance,29.7773,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Cervical Collar Foam,,L0120,HCPCS,Facility,Inpatient,,,,59,50.15,16.9094,59,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Sup Cervical Collar Foam,,L0120,HCPCS,Facility,Outpatient,,,,59,50.15,16.9094,59,"UCare Health, Inc.",Medicare Advantage,29.7773,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Cervical Collar Foam,,L0120,HCPCS,Facility,Inpatient,,,,59,50.15,16.9094,59,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Cervical Collar Foam,,L0120,HCPCS,Facility,Outpatient,,,,59,50.15,16.9094,59,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),29.7773,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Cervical Collar Foam,,L0120,HCPCS,Facility,Inpatient,,,,59,50.15,16.9094,59,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Cervical Collar Foam,,L0120,HCPCS,Facility,Both,,,,59,50.15,16.9094,59,UnitedHealthcare,Individual & Family,55.46,94,,percent of total billed charges,,
Sup Cervical Collar Foam,,L0120,HCPCS,Facility,Outpatient,,,,59,50.15,16.9094,59,UnitedHealthcare,Medicare Advantage,28.91,49,,percent of total billed charges,,
Sup Cervical Collar Foam,,L0120,HCPCS,Facility,Inpatient,,,,59,50.15,16.9094,59,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Sup Cervical Collar Foam,,L0120,HCPCS,Facility,Outpatient,,,,59,50.15,16.9094,59,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,28.32,48,,percent of total billed charges,,100% of DHS outpatient percentage
Sup Cervical Collar Foam,,L0120,HCPCS,Facility,Inpatient,,,,59,50.15,16.9094,59,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Sup Stiff Neck Cervical Collar,,L0150,HCPCS,Facility,Both,,,,95,80.75,27.227,95,Aetna,Commercial,87.4,92,,percent of total billed charges,,
Sup Stiff Neck Cervical Collar,,L0150,HCPCS,Facility,Outpatient,,,,95,80.75,27.227,95,Aetna,Medicare Advantage,46.55,49,,percent of total billed charges,,
Sup Stiff Neck Cervical Collar,,L0150,HCPCS,Facility,Inpatient,,,,95,80.75,27.227,95,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Sup Stiff Neck Cervical Collar,,L0150,HCPCS,Facility,Both,,,,95,80.75,27.227,95,Aetna,PPO,88.35,93,,percent of total billed charges,,
Sup Stiff Neck Cervical Collar,,L0150,HCPCS,Facility,Both,,,,95,80.75,27.227,95,America's PPO,America's PPO,91.2285,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Sup Stiff Neck Cervical Collar,,L0150,HCPCS,Facility,Both,,,,95,80.75,27.227,95,BlueCross BlueShield Minnesota, Federal Employee Program,93.48,98.4,,percent of total billed charges,,
Sup Stiff Neck Cervical Collar,,L0150,HCPCS,Facility,Both,,,,95,80.75,27.227,95,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,95,100,,percent of total billed charges,,
Sup Stiff Neck Cervical Collar,,L0150,HCPCS,Facility,Both,,,,95,80.75,27.227,95,BlueCross BlueShield Minnesota,High Value Network Plan,85.5,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
Sup Stiff Neck Cervical Collar,,L0150,HCPCS,Facility,Outpatient,,,,95,80.75,27.227,95,BlueCross BlueShield Minnesota,Medicare Advantage,46.55,49,,percent of total billed charges,,
Sup Stiff Neck Cervical Collar,,L0150,HCPCS,Facility,Inpatient,,,,95,80.75,27.227,95,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Sup Stiff Neck Cervical Collar,,L0150,HCPCS,Facility,Both,,,,95,80.75,27.227,95,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,84.1415,88.57,,percent of total billed charges,,
Sup Stiff Neck Cervical Collar,,L0150,HCPCS,Facility,Both,,,,95,80.75,27.227,95,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,27.227,28.66,,percent of total billed charges,,
Sup Stiff Neck Cervical Collar,,L0150,HCPCS,Facility,Outpatient,,,,95,80.75,27.227,95,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),46.55,49,,percent of total billed charges,,
Sup Stiff Neck Cervical Collar,,L0150,HCPCS,Facility,Inpatient,,,,95,80.75,27.227,95,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Sup Stiff Neck Cervical Collar,,L0150,HCPCS,Facility,Both,,,,95,80.75,27.227,95,CorVel,Worker's Compensation,95,100,,percent of total billed charges,,
Sup Stiff Neck Cervical Collar,,L0150,HCPCS,Facility,Both,,,,95,80.75,27.227,95,First Health Group Corporation,First Health Network,92.15,97,,percent of total billed charges,,
Sup Stiff Neck Cervical Collar,,L0150,HCPCS,Facility,Both,,,,95,80.75,27.227,95,"Health Partners, Inc.",Commercial,89.87,94.6,,percent of total billed charges,,
Sup Stiff Neck Cervical Collar,,L0150,HCPCS,Facility,Outpatient,,,,95,80.75,27.227,95,"Health Partners, Inc.",Medicare Advantage,46.55,49,,percent of total billed charges,,
Sup Stiff Neck Cervical Collar,,L0150,HCPCS,Facility,Inpatient,,,,95,80.75,27.227,95,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Stiff Neck Cervical Collar,,L0150,HCPCS,Facility,Both,,,,95,80.75,27.227,95,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),57,60,,percent of total billed charges,,
Sup Stiff Neck Cervical Collar,,L0150,HCPCS,Facility,Both,,,,95,80.75,27.227,95,"Health Partners, Inc.",State of Minnesota Advantage Program,77.425,81.5,,percent of total billed charges,,
Sup Stiff Neck Cervical Collar,,L0150,HCPCS,Facility,Both,,,,95,80.75,27.227,95,"Health Partners, Inc.",State Public Programs,47.5,50,,percent of total billed charges,,
Sup Stiff Neck Cervical Collar,,L0150,HCPCS,Facility,Both,,,,95,80.75,27.227,95,Humana Insurance Company,Commercial PPO,90.25,95,,percent of total billed charges,,
Sup Stiff Neck Cervical Collar,,L0150,HCPCS,Facility,Outpatient,,,,95,80.75,27.227,95,Humana Insurance Company,Medicare PPO,46.55,49,,percent of total billed charges,,
Sup Stiff Neck Cervical Collar,,L0150,HCPCS,Facility,Inpatient,,,,95,80.75,27.227,95,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Sup Stiff Neck Cervical Collar,,L0150,HCPCS,Facility,Both,,,,95,80.75,27.227,95,Medica,Individual & Family,94.145,99.1,,percent of total billed charges,,
Sup Stiff Neck Cervical Collar,,L0150,HCPCS,Facility,Outpatient,,,,95,80.75,27.227,95,Medica,Medica Advantage Solution,47.31,49.8,,percent of total billed charges,,
Sup Stiff Neck Cervical Collar,,L0150,HCPCS,Facility,Inpatient,,,,95,80.75,27.227,95,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Sup Stiff Neck Cervical Collar,,L0150,HCPCS,Facility,Outpatient,,,,95,80.75,27.227,95,Medica,Medical Assistance,42.37,44.6,,percent of total billed charges,,
Sup Stiff Neck Cervical Collar,,L0150,HCPCS,Facility,Inpatient,,,,95,80.75,27.227,95,Medica,Medical Assistance,,,,,Included in per diem rate,
Sup Stiff Neck Cervical Collar,,L0150,HCPCS,Facility,Outpatient,,,,95,80.75,27.227,95,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,47.31,49.8,,percent of total billed charges,,
Sup Stiff Neck Cervical Collar,,L0150,HCPCS,Facility,Inpatient,,,,95,80.75,27.227,95,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Sup Stiff Neck Cervical Collar,,L0150,HCPCS,Facility,Both,,,,95,80.75,27.227,95,"Multiplan, Inc.","Multiplan, Inc.",89.3,94,,percent of total billed charges,,
Sup Stiff Neck Cervical Collar,,L0150,HCPCS,Facility,Outpatient,,,,95,80.75,27.227,95,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,85.595,90.1,,percent of total billed charges,,
Sup Stiff Neck Cervical Collar,,L0150,HCPCS,Facility,Inpatient,,,,95,80.75,27.227,95,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Sup Stiff Neck Cervical Collar,,L0150,HCPCS,Facility,Both,,,,95,80.75,27.227,95,"Preferred One Administrative Services, INC.",PPO,93.67,98.6,,percent of total billed charges,,
Sup Stiff Neck Cervical Collar,,L0150,HCPCS,Facility,Outpatient,,,,95,80.75,27.227,95,PrimeWest Health,Minnesota Senior Health Options (MSHO),48.8775,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Sup Stiff Neck Cervical Collar,,L0150,HCPCS,Facility,Inpatient,,,,95,80.75,27.227,95,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Stiff Neck Cervical Collar,,L0150,HCPCS,Facility,Outpatient,,,,95,80.75,27.227,95,PrimeWest Health,MinnesotaCare,48.792,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Sup Stiff Neck Cervical Collar,,L0150,HCPCS,Facility,Inpatient,,,,95,80.75,27.227,95,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Sup Stiff Neck Cervical Collar,,L0150,HCPCS,Facility,Both,,,,95,80.75,27.227,95,Sanford Health Plan,Sanford Health Plan,87.4,92,,percent of total billed charges,,
Sup Stiff Neck Cervical Collar,,L0150,HCPCS,Facility,Outpatient,,,,95,80.75,27.227,95,"UCare Health, Inc.",Individual & Family Plan,53.5325,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Sup Stiff Neck Cervical Collar,,L0150,HCPCS,Facility,Inpatient,,,,95,80.75,27.227,95,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Sup Stiff Neck Cervical Collar,,L0150,HCPCS,Facility,Outpatient,,,,95,80.75,27.227,95,"UCare Health, Inc.",Medical Assistance,47.9465,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Stiff Neck Cervical Collar,,L0150,HCPCS,Facility,Inpatient,,,,95,80.75,27.227,95,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Sup Stiff Neck Cervical Collar,,L0150,HCPCS,Facility,Outpatient,,,,95,80.75,27.227,95,"UCare Health, Inc.",Medicare Advantage,47.9465,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Stiff Neck Cervical Collar,,L0150,HCPCS,Facility,Inpatient,,,,95,80.75,27.227,95,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Stiff Neck Cervical Collar,,L0150,HCPCS,Facility,Outpatient,,,,95,80.75,27.227,95,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),47.9465,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Stiff Neck Cervical Collar,,L0150,HCPCS,Facility,Inpatient,,,,95,80.75,27.227,95,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Stiff Neck Cervical Collar,,L0150,HCPCS,Facility,Both,,,,95,80.75,27.227,95,UnitedHealthcare,Individual & Family,89.3,94,,percent of total billed charges,,
Sup Stiff Neck Cervical Collar,,L0150,HCPCS,Facility,Outpatient,,,,95,80.75,27.227,95,UnitedHealthcare,Medicare Advantage,46.55,49,,percent of total billed charges,,
Sup Stiff Neck Cervical Collar,,L0150,HCPCS,Facility,Inpatient,,,,95,80.75,27.227,95,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Sup Stiff Neck Cervical Collar,,L0150,HCPCS,Facility,Outpatient,,,,95,80.75,27.227,95,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,45.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
Sup Stiff Neck Cervical Collar,,L0150,HCPCS,Facility,Inpatient,,,,95,80.75,27.227,95,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Sup Anterior Closure Hinged Knee Support,,L1812,HCPCS,Facility,Both,,,,117,99.45,33.5322,117,Aetna,Commercial,107.64,92,,percent of total billed charges,,
Sup Anterior Closure Hinged Knee Support,,L1812,HCPCS,Facility,Outpatient,,,,117,99.45,33.5322,117,Aetna,Medicare Advantage,57.33,49,,percent of total billed charges,,
Sup Anterior Closure Hinged Knee Support,,L1812,HCPCS,Facility,Inpatient,,,,117,99.45,33.5322,117,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Sup Anterior Closure Hinged Knee Support,,L1812,HCPCS,Facility,Both,,,,117,99.45,33.5322,117,Aetna,PPO,108.81,93,,percent of total billed charges,,
Sup Anterior Closure Hinged Knee Support,,L1812,HCPCS,Facility,Both,,,,117,99.45,33.5322,117,America's PPO,America's PPO,112.3551,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Sup Anterior Closure Hinged Knee Support,,L1812,HCPCS,Facility,Both,,,,117,99.45,33.5322,117,BlueCross BlueShield Minnesota, Federal Employee Program,115.128,98.4,,percent of total billed charges,,
Sup Anterior Closure Hinged Knee Support,,L1812,HCPCS,Facility,Both,,,,117,99.45,33.5322,117,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,117,100,,percent of total billed charges,,
Sup Anterior Closure Hinged Knee Support,,L1812,HCPCS,Facility,Both,,,,117,99.45,33.5322,117,BlueCross BlueShield Minnesota,High Value Network Plan,105.3,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
Sup Anterior Closure Hinged Knee Support,,L1812,HCPCS,Facility,Outpatient,,,,117,99.45,33.5322,117,BlueCross BlueShield Minnesota,Medicare Advantage,57.33,49,,percent of total billed charges,,
Sup Anterior Closure Hinged Knee Support,,L1812,HCPCS,Facility,Inpatient,,,,117,99.45,33.5322,117,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Sup Anterior Closure Hinged Knee Support,,L1812,HCPCS,Facility,Both,,,,117,99.45,33.5322,117,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,103.6269,88.57,,percent of total billed charges,,
Sup Anterior Closure Hinged Knee Support,,L1812,HCPCS,Facility,Both,,,,117,99.45,33.5322,117,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,33.5322,28.66,,percent of total billed charges,,
Sup Anterior Closure Hinged Knee Support,,L1812,HCPCS,Facility,Outpatient,,,,117,99.45,33.5322,117,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),57.33,49,,percent of total billed charges,,
Sup Anterior Closure Hinged Knee Support,,L1812,HCPCS,Facility,Inpatient,,,,117,99.45,33.5322,117,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Sup Anterior Closure Hinged Knee Support,,L1812,HCPCS,Facility,Both,,,,117,99.45,33.5322,117,CorVel,Worker's Compensation,117,100,,percent of total billed charges,,
Sup Anterior Closure Hinged Knee Support,,L1812,HCPCS,Facility,Both,,,,117,99.45,33.5322,117,First Health Group Corporation,First Health Network,113.49,97,,percent of total billed charges,,
Sup Anterior Closure Hinged Knee Support,,L1812,HCPCS,Facility,Both,,,,117,99.45,33.5322,117,"Health Partners, Inc.",Commercial,110.682,94.6,,percent of total billed charges,,
Sup Anterior Closure Hinged Knee Support,,L1812,HCPCS,Facility,Outpatient,,,,117,99.45,33.5322,117,"Health Partners, Inc.",Medicare Advantage,57.33,49,,percent of total billed charges,,
Sup Anterior Closure Hinged Knee Support,,L1812,HCPCS,Facility,Inpatient,,,,117,99.45,33.5322,117,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Anterior Closure Hinged Knee Support,,L1812,HCPCS,Facility,Both,,,,117,99.45,33.5322,117,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),70.2,60,,percent of total billed charges,,
Sup Anterior Closure Hinged Knee Support,,L1812,HCPCS,Facility,Both,,,,117,99.45,33.5322,117,"Health Partners, Inc.",State of Minnesota Advantage Program,95.355,81.5,,percent of total billed charges,,
Sup Anterior Closure Hinged Knee Support,,L1812,HCPCS,Facility,Both,,,,117,99.45,33.5322,117,"Health Partners, Inc.",State Public Programs,58.5,50,,percent of total billed charges,,
Sup Anterior Closure Hinged Knee Support,,L1812,HCPCS,Facility,Both,,,,117,99.45,33.5322,117,Humana Insurance Company,Commercial PPO,111.15,95,,percent of total billed charges,,
Sup Anterior Closure Hinged Knee Support,,L1812,HCPCS,Facility,Outpatient,,,,117,99.45,33.5322,117,Humana Insurance Company,Medicare PPO,57.33,49,,percent of total billed charges,,
Sup Anterior Closure Hinged Knee Support,,L1812,HCPCS,Facility,Inpatient,,,,117,99.45,33.5322,117,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Sup Anterior Closure Hinged Knee Support,,L1812,HCPCS,Facility,Both,,,,117,99.45,33.5322,117,Medica,Individual & Family,115.947,99.1,,percent of total billed charges,,
Sup Anterior Closure Hinged Knee Support,,L1812,HCPCS,Facility,Outpatient,,,,117,99.45,33.5322,117,Medica,Medica Advantage Solution,58.266,49.8,,percent of total billed charges,,
Sup Anterior Closure Hinged Knee Support,,L1812,HCPCS,Facility,Inpatient,,,,117,99.45,33.5322,117,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Sup Anterior Closure Hinged Knee Support,,L1812,HCPCS,Facility,Outpatient,,,,117,99.45,33.5322,117,Medica,Medical Assistance,52.182,44.6,,percent of total billed charges,,
Sup Anterior Closure Hinged Knee Support,,L1812,HCPCS,Facility,Inpatient,,,,117,99.45,33.5322,117,Medica,Medical Assistance,,,,,Included in per diem rate,
Sup Anterior Closure Hinged Knee Support,,L1812,HCPCS,Facility,Outpatient,,,,117,99.45,33.5322,117,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,58.266,49.8,,percent of total billed charges,,
Sup Anterior Closure Hinged Knee Support,,L1812,HCPCS,Facility,Inpatient,,,,117,99.45,33.5322,117,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Sup Anterior Closure Hinged Knee Support,,L1812,HCPCS,Facility,Both,,,,117,99.45,33.5322,117,"Multiplan, Inc.","Multiplan, Inc.",109.98,94,,percent of total billed charges,,
Sup Anterior Closure Hinged Knee Support,,L1812,HCPCS,Facility,Outpatient,,,,117,99.45,33.5322,117,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,105.417,90.1,,percent of total billed charges,,
Sup Anterior Closure Hinged Knee Support,,L1812,HCPCS,Facility,Inpatient,,,,117,99.45,33.5322,117,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Sup Anterior Closure Hinged Knee Support,,L1812,HCPCS,Facility,Both,,,,117,99.45,33.5322,117,"Preferred One Administrative Services, INC.",PPO,115.362,98.6,,percent of total billed charges,,
Sup Anterior Closure Hinged Knee Support,,L1812,HCPCS,Facility,Outpatient,,,,117,99.45,33.5322,117,PrimeWest Health,Minnesota Senior Health Options (MSHO),60.1965,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Sup Anterior Closure Hinged Knee Support,,L1812,HCPCS,Facility,Inpatient,,,,117,99.45,33.5322,117,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Anterior Closure Hinged Knee Support,,L1812,HCPCS,Facility,Outpatient,,,,117,99.45,33.5322,117,PrimeWest Health,MinnesotaCare,60.0912,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Sup Anterior Closure Hinged Knee Support,,L1812,HCPCS,Facility,Inpatient,,,,117,99.45,33.5322,117,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Sup Anterior Closure Hinged Knee Support,,L1812,HCPCS,Facility,Both,,,,117,99.45,33.5322,117,Sanford Health Plan,Sanford Health Plan,107.64,92,,percent of total billed charges,,
Sup Anterior Closure Hinged Knee Support,,L1812,HCPCS,Facility,Outpatient,,,,117,99.45,33.5322,117,"UCare Health, Inc.",Individual & Family Plan,65.9295,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Sup Anterior Closure Hinged Knee Support,,L1812,HCPCS,Facility,Inpatient,,,,117,99.45,33.5322,117,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Sup Anterior Closure Hinged Knee Support,,L1812,HCPCS,Facility,Outpatient,,,,117,99.45,33.5322,117,"UCare Health, Inc.",Medical Assistance,59.0499,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Anterior Closure Hinged Knee Support,,L1812,HCPCS,Facility,Inpatient,,,,117,99.45,33.5322,117,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Sup Anterior Closure Hinged Knee Support,,L1812,HCPCS,Facility,Outpatient,,,,117,99.45,33.5322,117,"UCare Health, Inc.",Medicare Advantage,59.0499,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Anterior Closure Hinged Knee Support,,L1812,HCPCS,Facility,Inpatient,,,,117,99.45,33.5322,117,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Anterior Closure Hinged Knee Support,,L1812,HCPCS,Facility,Outpatient,,,,117,99.45,33.5322,117,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),59.0499,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Anterior Closure Hinged Knee Support,,L1812,HCPCS,Facility,Inpatient,,,,117,99.45,33.5322,117,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Anterior Closure Hinged Knee Support,,L1812,HCPCS,Facility,Both,,,,117,99.45,33.5322,117,UnitedHealthcare,Individual & Family,109.98,94,,percent of total billed charges,,
Sup Anterior Closure Hinged Knee Support,,L1812,HCPCS,Facility,Outpatient,,,,117,99.45,33.5322,117,UnitedHealthcare,Medicare Advantage,57.33,49,,percent of total billed charges,,
Sup Anterior Closure Hinged Knee Support,,L1812,HCPCS,Facility,Inpatient,,,,117,99.45,33.5322,117,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Sup Anterior Closure Hinged Knee Support,,L1812,HCPCS,Facility,Outpatient,,,,117,99.45,33.5322,117,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,56.16,48,,percent of total billed charges,,100% of DHS outpatient percentage
Sup Anterior Closure Hinged Knee Support,,L1812,HCPCS,Facility,Inpatient,,,,117,99.45,33.5322,117,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Sup Knee Immobilizer,,L1830,HCPCS,Facility,Both,,,,89,75.65,25.5074,89,Aetna,Commercial,81.88,92,,percent of total billed charges,,
Sup Knee Immobilizer,,L1830,HCPCS,Facility,Outpatient,,,,89,75.65,25.5074,89,Aetna,Medicare Advantage,43.61,49,,percent of total billed charges,,
Sup Knee Immobilizer,,L1830,HCPCS,Facility,Inpatient,,,,89,75.65,25.5074,89,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Sup Knee Immobilizer,,L1830,HCPCS,Facility,Both,,,,89,75.65,25.5074,89,Aetna,PPO,82.77,93,,percent of total billed charges,,
Sup Knee Immobilizer,,L1830,HCPCS,Facility,Both,,,,89,75.65,25.5074,89,America's PPO,America's PPO,85.4667,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Sup Knee Immobilizer,,L1830,HCPCS,Facility,Both,,,,89,75.65,25.5074,89,BlueCross BlueShield Minnesota, Federal Employee Program,87.576,98.4,,percent of total billed charges,,
Sup Knee Immobilizer,,L1830,HCPCS,Facility,Both,,,,89,75.65,25.5074,89,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,89,100,,percent of total billed charges,,
Sup Knee Immobilizer,,L1830,HCPCS,Facility,Both,,,,89,75.65,25.5074,89,BlueCross BlueShield Minnesota,High Value Network Plan,80.1,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
Sup Knee Immobilizer,,L1830,HCPCS,Facility,Outpatient,,,,89,75.65,25.5074,89,BlueCross BlueShield Minnesota,Medicare Advantage,43.61,49,,percent of total billed charges,,
Sup Knee Immobilizer,,L1830,HCPCS,Facility,Inpatient,,,,89,75.65,25.5074,89,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Sup Knee Immobilizer,,L1830,HCPCS,Facility,Both,,,,89,75.65,25.5074,89,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,78.8273,88.57,,percent of total billed charges,,
Sup Knee Immobilizer,,L1830,HCPCS,Facility,Both,,,,89,75.65,25.5074,89,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,25.5074,28.66,,percent of total billed charges,,
Sup Knee Immobilizer,,L1830,HCPCS,Facility,Outpatient,,,,89,75.65,25.5074,89,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),43.61,49,,percent of total billed charges,,
Sup Knee Immobilizer,,L1830,HCPCS,Facility,Inpatient,,,,89,75.65,25.5074,89,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Sup Knee Immobilizer,,L1830,HCPCS,Facility,Both,,,,89,75.65,25.5074,89,CorVel,Worker's Compensation,89,100,,percent of total billed charges,,
Sup Knee Immobilizer,,L1830,HCPCS,Facility,Both,,,,89,75.65,25.5074,89,First Health Group Corporation,First Health Network,86.33,97,,percent of total billed charges,,
Sup Knee Immobilizer,,L1830,HCPCS,Facility,Both,,,,89,75.65,25.5074,89,"Health Partners, Inc.",Commercial,84.194,94.6,,percent of total billed charges,,
Sup Knee Immobilizer,,L1830,HCPCS,Facility,Outpatient,,,,89,75.65,25.5074,89,"Health Partners, Inc.",Medicare Advantage,43.61,49,,percent of total billed charges,,
Sup Knee Immobilizer,,L1830,HCPCS,Facility,Inpatient,,,,89,75.65,25.5074,89,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Knee Immobilizer,,L1830,HCPCS,Facility,Both,,,,89,75.65,25.5074,89,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),53.4,60,,percent of total billed charges,,
Sup Knee Immobilizer,,L1830,HCPCS,Facility,Both,,,,89,75.65,25.5074,89,"Health Partners, Inc.",State of Minnesota Advantage Program,72.535,81.5,,percent of total billed charges,,
Sup Knee Immobilizer,,L1830,HCPCS,Facility,Both,,,,89,75.65,25.5074,89,"Health Partners, Inc.",State Public Programs,44.5,50,,percent of total billed charges,,
Sup Knee Immobilizer,,L1830,HCPCS,Facility,Both,,,,89,75.65,25.5074,89,Humana Insurance Company,Commercial PPO,84.55,95,,percent of total billed charges,,
Sup Knee Immobilizer,,L1830,HCPCS,Facility,Outpatient,,,,89,75.65,25.5074,89,Humana Insurance Company,Medicare PPO,43.61,49,,percent of total billed charges,,
Sup Knee Immobilizer,,L1830,HCPCS,Facility,Inpatient,,,,89,75.65,25.5074,89,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Sup Knee Immobilizer,,L1830,HCPCS,Facility,Both,,,,89,75.65,25.5074,89,Medica,Individual & Family,88.199,99.1,,percent of total billed charges,,
Sup Knee Immobilizer,,L1830,HCPCS,Facility,Outpatient,,,,89,75.65,25.5074,89,Medica,Medica Advantage Solution,44.322,49.8,,percent of total billed charges,,
Sup Knee Immobilizer,,L1830,HCPCS,Facility,Inpatient,,,,89,75.65,25.5074,89,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Sup Knee Immobilizer,,L1830,HCPCS,Facility,Outpatient,,,,89,75.65,25.5074,89,Medica,Medical Assistance,39.694,44.6,,percent of total billed charges,,
Sup Knee Immobilizer,,L1830,HCPCS,Facility,Inpatient,,,,89,75.65,25.5074,89,Medica,Medical Assistance,,,,,Included in per diem rate,
Sup Knee Immobilizer,,L1830,HCPCS,Facility,Outpatient,,,,89,75.65,25.5074,89,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,44.322,49.8,,percent of total billed charges,,
Sup Knee Immobilizer,,L1830,HCPCS,Facility,Inpatient,,,,89,75.65,25.5074,89,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Sup Knee Immobilizer,,L1830,HCPCS,Facility,Both,,,,89,75.65,25.5074,89,"Multiplan, Inc.","Multiplan, Inc.",83.66,94,,percent of total billed charges,,
Sup Knee Immobilizer,,L1830,HCPCS,Facility,Outpatient,,,,89,75.65,25.5074,89,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,80.189,90.1,,percent of total billed charges,,
Sup Knee Immobilizer,,L1830,HCPCS,Facility,Inpatient,,,,89,75.65,25.5074,89,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Sup Knee Immobilizer,,L1830,HCPCS,Facility,Both,,,,89,75.65,25.5074,89,"Preferred One Administrative Services, INC.",PPO,87.754,98.6,,percent of total billed charges,,
Sup Knee Immobilizer,,L1830,HCPCS,Facility,Outpatient,,,,89,75.65,25.5074,89,PrimeWest Health,Minnesota Senior Health Options (MSHO),45.7905,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Sup Knee Immobilizer,,L1830,HCPCS,Facility,Inpatient,,,,89,75.65,25.5074,89,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Knee Immobilizer,,L1830,HCPCS,Facility,Outpatient,,,,89,75.65,25.5074,89,PrimeWest Health,MinnesotaCare,45.7104,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Sup Knee Immobilizer,,L1830,HCPCS,Facility,Inpatient,,,,89,75.65,25.5074,89,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Sup Knee Immobilizer,,L1830,HCPCS,Facility,Both,,,,89,75.65,25.5074,89,Sanford Health Plan,Sanford Health Plan,81.88,92,,percent of total billed charges,,
Sup Knee Immobilizer,,L1830,HCPCS,Facility,Outpatient,,,,89,75.65,25.5074,89,"UCare Health, Inc.",Individual & Family Plan,50.1515,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Sup Knee Immobilizer,,L1830,HCPCS,Facility,Inpatient,,,,89,75.65,25.5074,89,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Sup Knee Immobilizer,,L1830,HCPCS,Facility,Outpatient,,,,89,75.65,25.5074,89,"UCare Health, Inc.",Medical Assistance,44.9183,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Knee Immobilizer,,L1830,HCPCS,Facility,Inpatient,,,,89,75.65,25.5074,89,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Sup Knee Immobilizer,,L1830,HCPCS,Facility,Outpatient,,,,89,75.65,25.5074,89,"UCare Health, Inc.",Medicare Advantage,44.9183,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Knee Immobilizer,,L1830,HCPCS,Facility,Inpatient,,,,89,75.65,25.5074,89,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Knee Immobilizer,,L1830,HCPCS,Facility,Outpatient,,,,89,75.65,25.5074,89,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),44.9183,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Knee Immobilizer,,L1830,HCPCS,Facility,Inpatient,,,,89,75.65,25.5074,89,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Knee Immobilizer,,L1830,HCPCS,Facility,Both,,,,89,75.65,25.5074,89,UnitedHealthcare,Individual & Family,83.66,94,,percent of total billed charges,,
Sup Knee Immobilizer,,L1830,HCPCS,Facility,Outpatient,,,,89,75.65,25.5074,89,UnitedHealthcare,Medicare Advantage,43.61,49,,percent of total billed charges,,
Sup Knee Immobilizer,,L1830,HCPCS,Facility,Inpatient,,,,89,75.65,25.5074,89,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Sup Knee Immobilizer,,L1830,HCPCS,Facility,Outpatient,,,,89,75.65,25.5074,89,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,42.72,48,,percent of total billed charges,,100% of DHS outpatient percentage
Sup Knee Immobilizer,,L1830,HCPCS,Facility,Inpatient,,,,89,75.65,25.5074,89,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Sup Neoprene Knee Sleeve,,L2999,HCPCS,Facility,Both,,,,50,42.5,14.33,50,Aetna,Commercial,46,92,,percent of total billed charges,,
Sup Neoprene Knee Sleeve,,L2999,HCPCS,Facility,Outpatient,,,,50,42.5,14.33,50,Aetna,Medicare Advantage,24.5,49,,percent of total billed charges,,
Sup Neoprene Knee Sleeve,,L2999,HCPCS,Facility,Inpatient,,,,50,42.5,14.33,50,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Sup Neoprene Knee Sleeve,,L2999,HCPCS,Facility,Both,,,,50,42.5,14.33,50,Aetna,PPO,46.5,93,,percent of total billed charges,,
Sup Neoprene Knee Sleeve,,L2999,HCPCS,Facility,Both,,,,50,42.5,14.33,50,America's PPO,America's PPO,48.015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Sup Neoprene Knee Sleeve,,L2999,HCPCS,Facility,Both,,,,50,42.5,14.33,50,BlueCross BlueShield Minnesota, Federal Employee Program,49.2,98.4,,percent of total billed charges,,
Sup Neoprene Knee Sleeve,,L2999,HCPCS,Facility,Both,,,,50,42.5,14.33,50,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,50,100,,percent of total billed charges,,
Sup Neoprene Knee Sleeve,,L2999,HCPCS,Facility,Both,,,,50,42.5,14.33,50,BlueCross BlueShield Minnesota,High Value Network Plan,45,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
Sup Neoprene Knee Sleeve,,L2999,HCPCS,Facility,Outpatient,,,,50,42.5,14.33,50,BlueCross BlueShield Minnesota,Medicare Advantage,24.5,49,,percent of total billed charges,,
Sup Neoprene Knee Sleeve,,L2999,HCPCS,Facility,Inpatient,,,,50,42.5,14.33,50,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Sup Neoprene Knee Sleeve,,L2999,HCPCS,Facility,Both,,,,50,42.5,14.33,50,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,44.285,88.57,,percent of total billed charges,,
Sup Neoprene Knee Sleeve,,L2999,HCPCS,Facility,Both,,,,50,42.5,14.33,50,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,14.33,28.66,,percent of total billed charges,,
Sup Neoprene Knee Sleeve,,L2999,HCPCS,Facility,Outpatient,,,,50,42.5,14.33,50,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),24.5,49,,percent of total billed charges,,
Sup Neoprene Knee Sleeve,,L2999,HCPCS,Facility,Inpatient,,,,50,42.5,14.33,50,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Sup Neoprene Knee Sleeve,,L2999,HCPCS,Facility,Both,,,,50,42.5,14.33,50,CorVel,Worker's Compensation,50,100,,percent of total billed charges,,
Sup Neoprene Knee Sleeve,,L2999,HCPCS,Facility,Both,,,,50,42.5,14.33,50,First Health Group Corporation,First Health Network,48.5,97,,percent of total billed charges,,
Sup Neoprene Knee Sleeve,,L2999,HCPCS,Facility,Both,,,,50,42.5,14.33,50,"Health Partners, Inc.",Commercial,47.3,94.6,,percent of total billed charges,,
Sup Neoprene Knee Sleeve,,L2999,HCPCS,Facility,Outpatient,,,,50,42.5,14.33,50,"Health Partners, Inc.",Medicare Advantage,24.5,49,,percent of total billed charges,,
Sup Neoprene Knee Sleeve,,L2999,HCPCS,Facility,Inpatient,,,,50,42.5,14.33,50,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Neoprene Knee Sleeve,,L2999,HCPCS,Facility,Both,,,,50,42.5,14.33,50,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),30,60,,percent of total billed charges,,
Sup Neoprene Knee Sleeve,,L2999,HCPCS,Facility,Both,,,,50,42.5,14.33,50,"Health Partners, Inc.",State of Minnesota Advantage Program,40.75,81.5,,percent of total billed charges,,
Sup Neoprene Knee Sleeve,,L2999,HCPCS,Facility,Both,,,,50,42.5,14.33,50,"Health Partners, Inc.",State Public Programs,25,50,,percent of total billed charges,,
Sup Neoprene Knee Sleeve,,L2999,HCPCS,Facility,Both,,,,50,42.5,14.33,50,Humana Insurance Company,Commercial PPO,47.5,95,,percent of total billed charges,,
Sup Neoprene Knee Sleeve,,L2999,HCPCS,Facility,Outpatient,,,,50,42.5,14.33,50,Humana Insurance Company,Medicare PPO,24.5,49,,percent of total billed charges,,
Sup Neoprene Knee Sleeve,,L2999,HCPCS,Facility,Inpatient,,,,50,42.5,14.33,50,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Sup Neoprene Knee Sleeve,,L2999,HCPCS,Facility,Both,,,,50,42.5,14.33,50,Medica,Individual & Family,49.55,99.1,,percent of total billed charges,,
Sup Neoprene Knee Sleeve,,L2999,HCPCS,Facility,Outpatient,,,,50,42.5,14.33,50,Medica,Medica Advantage Solution,24.9,49.8,,percent of total billed charges,,
Sup Neoprene Knee Sleeve,,L2999,HCPCS,Facility,Inpatient,,,,50,42.5,14.33,50,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Sup Neoprene Knee Sleeve,,L2999,HCPCS,Facility,Outpatient,,,,50,42.5,14.33,50,Medica,Medical Assistance,22.3,44.6,,percent of total billed charges,,
Sup Neoprene Knee Sleeve,,L2999,HCPCS,Facility,Inpatient,,,,50,42.5,14.33,50,Medica,Medical Assistance,,,,,Included in per diem rate,
Sup Neoprene Knee Sleeve,,L2999,HCPCS,Facility,Outpatient,,,,50,42.5,14.33,50,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,24.9,49.8,,percent of total billed charges,,
Sup Neoprene Knee Sleeve,,L2999,HCPCS,Facility,Inpatient,,,,50,42.5,14.33,50,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Sup Neoprene Knee Sleeve,,L2999,HCPCS,Facility,Both,,,,50,42.5,14.33,50,"Multiplan, Inc.","Multiplan, Inc.",47,94,,percent of total billed charges,,
Sup Neoprene Knee Sleeve,,L2999,HCPCS,Facility,Outpatient,,,,50,42.5,14.33,50,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,45.05,90.1,,percent of total billed charges,,
Sup Neoprene Knee Sleeve,,L2999,HCPCS,Facility,Inpatient,,,,50,42.5,14.33,50,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Sup Neoprene Knee Sleeve,,L2999,HCPCS,Facility,Both,,,,50,42.5,14.33,50,"Preferred One Administrative Services, INC.",PPO,49.3,98.6,,percent of total billed charges,,
Sup Neoprene Knee Sleeve,,L2999,HCPCS,Facility,Outpatient,,,,50,42.5,14.33,50,PrimeWest Health,Minnesota Senior Health Options (MSHO),25.725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Sup Neoprene Knee Sleeve,,L2999,HCPCS,Facility,Inpatient,,,,50,42.5,14.33,50,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Neoprene Knee Sleeve,,L2999,HCPCS,Facility,Outpatient,,,,50,42.5,14.33,50,PrimeWest Health,MinnesotaCare,25.68,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Sup Neoprene Knee Sleeve,,L2999,HCPCS,Facility,Inpatient,,,,50,42.5,14.33,50,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Sup Neoprene Knee Sleeve,,L2999,HCPCS,Facility,Both,,,,50,42.5,14.33,50,Sanford Health Plan,Sanford Health Plan,46,92,,percent of total billed charges,,
Sup Neoprene Knee Sleeve,,L2999,HCPCS,Facility,Outpatient,,,,50,42.5,14.33,50,"UCare Health, Inc.",Individual & Family Plan,28.175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Sup Neoprene Knee Sleeve,,L2999,HCPCS,Facility,Inpatient,,,,50,42.5,14.33,50,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Sup Neoprene Knee Sleeve,,L2999,HCPCS,Facility,Outpatient,,,,50,42.5,14.33,50,"UCare Health, Inc.",Medical Assistance,25.235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Neoprene Knee Sleeve,,L2999,HCPCS,Facility,Inpatient,,,,50,42.5,14.33,50,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Sup Neoprene Knee Sleeve,,L2999,HCPCS,Facility,Outpatient,,,,50,42.5,14.33,50,"UCare Health, Inc.",Medicare Advantage,25.235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Neoprene Knee Sleeve,,L2999,HCPCS,Facility,Inpatient,,,,50,42.5,14.33,50,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Neoprene Knee Sleeve,,L2999,HCPCS,Facility,Outpatient,,,,50,42.5,14.33,50,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),25.235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Neoprene Knee Sleeve,,L2999,HCPCS,Facility,Inpatient,,,,50,42.5,14.33,50,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Neoprene Knee Sleeve,,L2999,HCPCS,Facility,Both,,,,50,42.5,14.33,50,UnitedHealthcare,Individual & Family,47,94,,percent of total billed charges,,
Sup Neoprene Knee Sleeve,,L2999,HCPCS,Facility,Outpatient,,,,50,42.5,14.33,50,UnitedHealthcare,Medicare Advantage,24.5,49,,percent of total billed charges,,
Sup Neoprene Knee Sleeve,,L2999,HCPCS,Facility,Inpatient,,,,50,42.5,14.33,50,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Sup Neoprene Knee Sleeve,,L2999,HCPCS,Facility,Outpatient,,,,50,42.5,14.33,50,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,24,48,,percent of total billed charges,,100% of DHS outpatient percentage
Sup Neoprene Knee Sleeve,,L2999,HCPCS,Facility,Inpatient,,,,50,42.5,14.33,50,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Sup Postop Shoe,,L3260,HCPCS,Facility,Both,,,,36,30.6,10.3176,36,Aetna,Commercial,33.12,92,,percent of total billed charges,,
Sup Postop Shoe,,L3260,HCPCS,Facility,Outpatient,,,,36,30.6,10.3176,36,Aetna,Medicare Advantage,17.64,49,,percent of total billed charges,,
Sup Postop Shoe,,L3260,HCPCS,Facility,Inpatient,,,,36,30.6,10.3176,36,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Sup Postop Shoe,,L3260,HCPCS,Facility,Both,,,,36,30.6,10.3176,36,Aetna,PPO,33.48,93,,percent of total billed charges,,
Sup Postop Shoe,,L3260,HCPCS,Facility,Both,,,,36,30.6,10.3176,36,America's PPO,America's PPO,34.5708,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Sup Postop Shoe,,L3260,HCPCS,Facility,Both,,,,36,30.6,10.3176,36,BlueCross BlueShield Minnesota, Federal Employee Program,35.424,98.4,,percent of total billed charges,,
Sup Postop Shoe,,L3260,HCPCS,Facility,Both,,,,36,30.6,10.3176,36,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,36,100,,percent of total billed charges,,
Sup Postop Shoe,,L3260,HCPCS,Facility,Both,,,,36,30.6,10.3176,36,BlueCross BlueShield Minnesota,High Value Network Plan,32.4,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
Sup Postop Shoe,,L3260,HCPCS,Facility,Outpatient,,,,36,30.6,10.3176,36,BlueCross BlueShield Minnesota,Medicare Advantage,17.64,49,,percent of total billed charges,,
Sup Postop Shoe,,L3260,HCPCS,Facility,Inpatient,,,,36,30.6,10.3176,36,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Sup Postop Shoe,,L3260,HCPCS,Facility,Both,,,,36,30.6,10.3176,36,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,31.8852,88.57,,percent of total billed charges,,
Sup Postop Shoe,,L3260,HCPCS,Facility,Both,,,,36,30.6,10.3176,36,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,10.3176,28.66,,percent of total billed charges,,
Sup Postop Shoe,,L3260,HCPCS,Facility,Outpatient,,,,36,30.6,10.3176,36,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),17.64,49,,percent of total billed charges,,
Sup Postop Shoe,,L3260,HCPCS,Facility,Inpatient,,,,36,30.6,10.3176,36,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Sup Postop Shoe,,L3260,HCPCS,Facility,Both,,,,36,30.6,10.3176,36,CorVel,Worker's Compensation,36,100,,percent of total billed charges,,
Sup Postop Shoe,,L3260,HCPCS,Facility,Both,,,,36,30.6,10.3176,36,First Health Group Corporation,First Health Network,34.92,97,,percent of total billed charges,,
Sup Postop Shoe,,L3260,HCPCS,Facility,Both,,,,36,30.6,10.3176,36,"Health Partners, Inc.",Commercial,34.056,94.6,,percent of total billed charges,,
Sup Postop Shoe,,L3260,HCPCS,Facility,Outpatient,,,,36,30.6,10.3176,36,"Health Partners, Inc.",Medicare Advantage,17.64,49,,percent of total billed charges,,
Sup Postop Shoe,,L3260,HCPCS,Facility,Inpatient,,,,36,30.6,10.3176,36,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Postop Shoe,,L3260,HCPCS,Facility,Both,,,,36,30.6,10.3176,36,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),21.6,60,,percent of total billed charges,,
Sup Postop Shoe,,L3260,HCPCS,Facility,Both,,,,36,30.6,10.3176,36,"Health Partners, Inc.",State of Minnesota Advantage Program,29.34,81.5,,percent of total billed charges,,
Sup Postop Shoe,,L3260,HCPCS,Facility,Both,,,,36,30.6,10.3176,36,"Health Partners, Inc.",State Public Programs,18,50,,percent of total billed charges,,
Sup Postop Shoe,,L3260,HCPCS,Facility,Both,,,,36,30.6,10.3176,36,Humana Insurance Company,Commercial PPO,34.2,95,,percent of total billed charges,,
Sup Postop Shoe,,L3260,HCPCS,Facility,Outpatient,,,,36,30.6,10.3176,36,Humana Insurance Company,Medicare PPO,17.64,49,,percent of total billed charges,,
Sup Postop Shoe,,L3260,HCPCS,Facility,Inpatient,,,,36,30.6,10.3176,36,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Sup Postop Shoe,,L3260,HCPCS,Facility,Both,,,,36,30.6,10.3176,36,Medica,Individual & Family,35.676,99.1,,percent of total billed charges,,
Sup Postop Shoe,,L3260,HCPCS,Facility,Outpatient,,,,36,30.6,10.3176,36,Medica,Medica Advantage Solution,17.928,49.8,,percent of total billed charges,,
Sup Postop Shoe,,L3260,HCPCS,Facility,Inpatient,,,,36,30.6,10.3176,36,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Sup Postop Shoe,,L3260,HCPCS,Facility,Outpatient,,,,36,30.6,10.3176,36,Medica,Medical Assistance,16.056,44.6,,percent of total billed charges,,
Sup Postop Shoe,,L3260,HCPCS,Facility,Inpatient,,,,36,30.6,10.3176,36,Medica,Medical Assistance,,,,,Included in per diem rate,
Sup Postop Shoe,,L3260,HCPCS,Facility,Outpatient,,,,36,30.6,10.3176,36,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,17.928,49.8,,percent of total billed charges,,
Sup Postop Shoe,,L3260,HCPCS,Facility,Inpatient,,,,36,30.6,10.3176,36,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Sup Postop Shoe,,L3260,HCPCS,Facility,Both,,,,36,30.6,10.3176,36,"Multiplan, Inc.","Multiplan, Inc.",33.84,94,,percent of total billed charges,,
Sup Postop Shoe,,L3260,HCPCS,Facility,Outpatient,,,,36,30.6,10.3176,36,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,32.436,90.1,,percent of total billed charges,,
Sup Postop Shoe,,L3260,HCPCS,Facility,Inpatient,,,,36,30.6,10.3176,36,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Sup Postop Shoe,,L3260,HCPCS,Facility,Both,,,,36,30.6,10.3176,36,"Preferred One Administrative Services, INC.",PPO,35.496,98.6,,percent of total billed charges,,
Sup Postop Shoe,,L3260,HCPCS,Facility,Outpatient,,,,36,30.6,10.3176,36,PrimeWest Health,Minnesota Senior Health Options (MSHO),18.522,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Sup Postop Shoe,,L3260,HCPCS,Facility,Inpatient,,,,36,30.6,10.3176,36,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Postop Shoe,,L3260,HCPCS,Facility,Outpatient,,,,36,30.6,10.3176,36,PrimeWest Health,MinnesotaCare,18.4896,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Sup Postop Shoe,,L3260,HCPCS,Facility,Inpatient,,,,36,30.6,10.3176,36,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Sup Postop Shoe,,L3260,HCPCS,Facility,Both,,,,36,30.6,10.3176,36,Sanford Health Plan,Sanford Health Plan,33.12,92,,percent of total billed charges,,
Sup Postop Shoe,,L3260,HCPCS,Facility,Outpatient,,,,36,30.6,10.3176,36,"UCare Health, Inc.",Individual & Family Plan,20.286,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Sup Postop Shoe,,L3260,HCPCS,Facility,Inpatient,,,,36,30.6,10.3176,36,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Sup Postop Shoe,,L3260,HCPCS,Facility,Outpatient,,,,36,30.6,10.3176,36,"UCare Health, Inc.",Medical Assistance,18.1692,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Postop Shoe,,L3260,HCPCS,Facility,Inpatient,,,,36,30.6,10.3176,36,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Sup Postop Shoe,,L3260,HCPCS,Facility,Outpatient,,,,36,30.6,10.3176,36,"UCare Health, Inc.",Medicare Advantage,18.1692,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Postop Shoe,,L3260,HCPCS,Facility,Inpatient,,,,36,30.6,10.3176,36,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Postop Shoe,,L3260,HCPCS,Facility,Outpatient,,,,36,30.6,10.3176,36,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),18.1692,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Postop Shoe,,L3260,HCPCS,Facility,Inpatient,,,,36,30.6,10.3176,36,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Postop Shoe,,L3260,HCPCS,Facility,Both,,,,36,30.6,10.3176,36,UnitedHealthcare,Individual & Family,33.84,94,,percent of total billed charges,,
Sup Postop Shoe,,L3260,HCPCS,Facility,Outpatient,,,,36,30.6,10.3176,36,UnitedHealthcare,Medicare Advantage,17.64,49,,percent of total billed charges,,
Sup Postop Shoe,,L3260,HCPCS,Facility,Inpatient,,,,36,30.6,10.3176,36,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Sup Postop Shoe,,L3260,HCPCS,Facility,Outpatient,,,,36,30.6,10.3176,36,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,17.28,48,,percent of total billed charges,,100% of DHS outpatient percentage
Sup Postop Shoe,,L3260,HCPCS,Facility,Inpatient,,,,36,30.6,10.3176,36,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Sup Immobilizer Shoulder,,L3650,HCPCS,Facility,Both,,,,173,147.05,49.5818,173,Aetna,Commercial,159.16,92,,percent of total billed charges,,
Sup Immobilizer Shoulder,,L3650,HCPCS,Facility,Outpatient,,,,173,147.05,49.5818,173,Aetna,Medicare Advantage,84.77,49,,percent of total billed charges,,
Sup Immobilizer Shoulder,,L3650,HCPCS,Facility,Inpatient,,,,173,147.05,49.5818,173,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Sup Immobilizer Shoulder,,L3650,HCPCS,Facility,Both,,,,173,147.05,49.5818,173,Aetna,PPO,160.89,93,,percent of total billed charges,,
Sup Immobilizer Shoulder,,L3650,HCPCS,Facility,Both,,,,173,147.05,49.5818,173,America's PPO,America's PPO,166.1319,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Sup Immobilizer Shoulder,,L3650,HCPCS,Facility,Both,,,,173,147.05,49.5818,173,BlueCross BlueShield Minnesota, Federal Employee Program,170.232,98.4,,percent of total billed charges,,
Sup Immobilizer Shoulder,,L3650,HCPCS,Facility,Both,,,,173,147.05,49.5818,173,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,173,100,,percent of total billed charges,,
Sup Immobilizer Shoulder,,L3650,HCPCS,Facility,Both,,,,173,147.05,49.5818,173,BlueCross BlueShield Minnesota,High Value Network Plan,155.7,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
Sup Immobilizer Shoulder,,L3650,HCPCS,Facility,Outpatient,,,,173,147.05,49.5818,173,BlueCross BlueShield Minnesota,Medicare Advantage,84.77,49,,percent of total billed charges,,
Sup Immobilizer Shoulder,,L3650,HCPCS,Facility,Inpatient,,,,173,147.05,49.5818,173,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Sup Immobilizer Shoulder,,L3650,HCPCS,Facility,Both,,,,173,147.05,49.5818,173,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,153.2261,88.57,,percent of total billed charges,,
Sup Immobilizer Shoulder,,L3650,HCPCS,Facility,Both,,,,173,147.05,49.5818,173,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,49.5818,28.66,,percent of total billed charges,,
Sup Immobilizer Shoulder,,L3650,HCPCS,Facility,Outpatient,,,,173,147.05,49.5818,173,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),84.77,49,,percent of total billed charges,,
Sup Immobilizer Shoulder,,L3650,HCPCS,Facility,Inpatient,,,,173,147.05,49.5818,173,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Sup Immobilizer Shoulder,,L3650,HCPCS,Facility,Both,,,,173,147.05,49.5818,173,CorVel,Worker's Compensation,173,100,,percent of total billed charges,,
Sup Immobilizer Shoulder,,L3650,HCPCS,Facility,Both,,,,173,147.05,49.5818,173,First Health Group Corporation,First Health Network,167.81,97,,percent of total billed charges,,
Sup Immobilizer Shoulder,,L3650,HCPCS,Facility,Both,,,,173,147.05,49.5818,173,"Health Partners, Inc.",Commercial,163.658,94.6,,percent of total billed charges,,
Sup Immobilizer Shoulder,,L3650,HCPCS,Facility,Outpatient,,,,173,147.05,49.5818,173,"Health Partners, Inc.",Medicare Advantage,84.77,49,,percent of total billed charges,,
Sup Immobilizer Shoulder,,L3650,HCPCS,Facility,Inpatient,,,,173,147.05,49.5818,173,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Immobilizer Shoulder,,L3650,HCPCS,Facility,Both,,,,173,147.05,49.5818,173,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),103.8,60,,percent of total billed charges,,
Sup Immobilizer Shoulder,,L3650,HCPCS,Facility,Both,,,,173,147.05,49.5818,173,"Health Partners, Inc.",State of Minnesota Advantage Program,140.995,81.5,,percent of total billed charges,,
Sup Immobilizer Shoulder,,L3650,HCPCS,Facility,Both,,,,173,147.05,49.5818,173,"Health Partners, Inc.",State Public Programs,86.5,50,,percent of total billed charges,,
Sup Immobilizer Shoulder,,L3650,HCPCS,Facility,Both,,,,173,147.05,49.5818,173,Humana Insurance Company,Commercial PPO,164.35,95,,percent of total billed charges,,
Sup Immobilizer Shoulder,,L3650,HCPCS,Facility,Outpatient,,,,173,147.05,49.5818,173,Humana Insurance Company,Medicare PPO,84.77,49,,percent of total billed charges,,
Sup Immobilizer Shoulder,,L3650,HCPCS,Facility,Inpatient,,,,173,147.05,49.5818,173,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Sup Immobilizer Shoulder,,L3650,HCPCS,Facility,Both,,,,173,147.05,49.5818,173,Medica,Individual & Family,171.443,99.1,,percent of total billed charges,,
Sup Immobilizer Shoulder,,L3650,HCPCS,Facility,Outpatient,,,,173,147.05,49.5818,173,Medica,Medica Advantage Solution,86.154,49.8,,percent of total billed charges,,
Sup Immobilizer Shoulder,,L3650,HCPCS,Facility,Inpatient,,,,173,147.05,49.5818,173,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Sup Immobilizer Shoulder,,L3650,HCPCS,Facility,Outpatient,,,,173,147.05,49.5818,173,Medica,Medical Assistance,77.158,44.6,,percent of total billed charges,,
Sup Immobilizer Shoulder,,L3650,HCPCS,Facility,Inpatient,,,,173,147.05,49.5818,173,Medica,Medical Assistance,,,,,Included in per diem rate,
Sup Immobilizer Shoulder,,L3650,HCPCS,Facility,Outpatient,,,,173,147.05,49.5818,173,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,86.154,49.8,,percent of total billed charges,,
Sup Immobilizer Shoulder,,L3650,HCPCS,Facility,Inpatient,,,,173,147.05,49.5818,173,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Sup Immobilizer Shoulder,,L3650,HCPCS,Facility,Both,,,,173,147.05,49.5818,173,"Multiplan, Inc.","Multiplan, Inc.",162.62,94,,percent of total billed charges,,
Sup Immobilizer Shoulder,,L3650,HCPCS,Facility,Outpatient,,,,173,147.05,49.5818,173,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,155.873,90.1,,percent of total billed charges,,
Sup Immobilizer Shoulder,,L3650,HCPCS,Facility,Inpatient,,,,173,147.05,49.5818,173,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Sup Immobilizer Shoulder,,L3650,HCPCS,Facility,Both,,,,173,147.05,49.5818,173,"Preferred One Administrative Services, INC.",PPO,170.578,98.6,,percent of total billed charges,,
Sup Immobilizer Shoulder,,L3650,HCPCS,Facility,Outpatient,,,,173,147.05,49.5818,173,PrimeWest Health,Minnesota Senior Health Options (MSHO),89.0085,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Sup Immobilizer Shoulder,,L3650,HCPCS,Facility,Inpatient,,,,173,147.05,49.5818,173,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Immobilizer Shoulder,,L3650,HCPCS,Facility,Outpatient,,,,173,147.05,49.5818,173,PrimeWest Health,MinnesotaCare,88.8528,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Sup Immobilizer Shoulder,,L3650,HCPCS,Facility,Inpatient,,,,173,147.05,49.5818,173,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Sup Immobilizer Shoulder,,L3650,HCPCS,Facility,Both,,,,173,147.05,49.5818,173,Sanford Health Plan,Sanford Health Plan,159.16,92,,percent of total billed charges,,
Sup Immobilizer Shoulder,,L3650,HCPCS,Facility,Outpatient,,,,173,147.05,49.5818,173,"UCare Health, Inc.",Individual & Family Plan,97.4855,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Sup Immobilizer Shoulder,,L3650,HCPCS,Facility,Inpatient,,,,173,147.05,49.5818,173,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Sup Immobilizer Shoulder,,L3650,HCPCS,Facility,Outpatient,,,,173,147.05,49.5818,173,"UCare Health, Inc.",Medical Assistance,87.3131,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Immobilizer Shoulder,,L3650,HCPCS,Facility,Inpatient,,,,173,147.05,49.5818,173,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Sup Immobilizer Shoulder,,L3650,HCPCS,Facility,Outpatient,,,,173,147.05,49.5818,173,"UCare Health, Inc.",Medicare Advantage,87.3131,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Immobilizer Shoulder,,L3650,HCPCS,Facility,Inpatient,,,,173,147.05,49.5818,173,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Immobilizer Shoulder,,L3650,HCPCS,Facility,Outpatient,,,,173,147.05,49.5818,173,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),87.3131,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Immobilizer Shoulder,,L3650,HCPCS,Facility,Inpatient,,,,173,147.05,49.5818,173,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Immobilizer Shoulder,,L3650,HCPCS,Facility,Both,,,,173,147.05,49.5818,173,UnitedHealthcare,Individual & Family,162.62,94,,percent of total billed charges,,
Sup Immobilizer Shoulder,,L3650,HCPCS,Facility,Outpatient,,,,173,147.05,49.5818,173,UnitedHealthcare,Medicare Advantage,84.77,49,,percent of total billed charges,,
Sup Immobilizer Shoulder,,L3650,HCPCS,Facility,Inpatient,,,,173,147.05,49.5818,173,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Sup Immobilizer Shoulder,,L3650,HCPCS,Facility,Outpatient,,,,173,147.05,49.5818,173,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,83.04,48,,percent of total billed charges,,100% of DHS outpatient percentage
Sup Immobilizer Shoulder,,L3650,HCPCS,Facility,Inpatient,,,,173,147.05,49.5818,173,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Sup Splint Wrist,,L3908,HCPCS,Facility,Both,,,,37,31.45,10.6042,37,Aetna,Commercial,34.04,92,,percent of total billed charges,,
Sup Splint Wrist,,L3908,HCPCS,Facility,Outpatient,,,,37,31.45,10.6042,37,Aetna,Medicare Advantage,18.13,49,,percent of total billed charges,,
Sup Splint Wrist,,L3908,HCPCS,Facility,Inpatient,,,,37,31.45,10.6042,37,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Sup Splint Wrist,,L3908,HCPCS,Facility,Both,,,,37,31.45,10.6042,37,Aetna,PPO,34.41,93,,percent of total billed charges,,
Sup Splint Wrist,,L3908,HCPCS,Facility,Both,,,,37,31.45,10.6042,37,America's PPO,America's PPO,35.5311,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Sup Splint Wrist,,L3908,HCPCS,Facility,Both,,,,37,31.45,10.6042,37,BlueCross BlueShield Minnesota, Federal Employee Program,36.408,98.4,,percent of total billed charges,,
Sup Splint Wrist,,L3908,HCPCS,Facility,Both,,,,37,31.45,10.6042,37,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,37,100,,percent of total billed charges,,
Sup Splint Wrist,,L3908,HCPCS,Facility,Both,,,,37,31.45,10.6042,37,BlueCross BlueShield Minnesota,High Value Network Plan,33.3,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
Sup Splint Wrist,,L3908,HCPCS,Facility,Outpatient,,,,37,31.45,10.6042,37,BlueCross BlueShield Minnesota,Medicare Advantage,18.13,49,,percent of total billed charges,,
Sup Splint Wrist,,L3908,HCPCS,Facility,Inpatient,,,,37,31.45,10.6042,37,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Sup Splint Wrist,,L3908,HCPCS,Facility,Both,,,,37,31.45,10.6042,37,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,32.7709,88.57,,percent of total billed charges,,
Sup Splint Wrist,,L3908,HCPCS,Facility,Both,,,,37,31.45,10.6042,37,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,10.6042,28.66,,percent of total billed charges,,
Sup Splint Wrist,,L3908,HCPCS,Facility,Outpatient,,,,37,31.45,10.6042,37,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),18.13,49,,percent of total billed charges,,
Sup Splint Wrist,,L3908,HCPCS,Facility,Inpatient,,,,37,31.45,10.6042,37,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Sup Splint Wrist,,L3908,HCPCS,Facility,Both,,,,37,31.45,10.6042,37,CorVel,Worker's Compensation,37,100,,percent of total billed charges,,
Sup Splint Wrist,,L3908,HCPCS,Facility,Both,,,,37,31.45,10.6042,37,First Health Group Corporation,First Health Network,35.89,97,,percent of total billed charges,,
Sup Splint Wrist,,L3908,HCPCS,Facility,Both,,,,37,31.45,10.6042,37,"Health Partners, Inc.",Commercial,35.002,94.6,,percent of total billed charges,,
Sup Splint Wrist,,L3908,HCPCS,Facility,Outpatient,,,,37,31.45,10.6042,37,"Health Partners, Inc.",Medicare Advantage,18.13,49,,percent of total billed charges,,
Sup Splint Wrist,,L3908,HCPCS,Facility,Inpatient,,,,37,31.45,10.6042,37,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Splint Wrist,,L3908,HCPCS,Facility,Both,,,,37,31.45,10.6042,37,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),22.2,60,,percent of total billed charges,,
Sup Splint Wrist,,L3908,HCPCS,Facility,Both,,,,37,31.45,10.6042,37,"Health Partners, Inc.",State of Minnesota Advantage Program,30.155,81.5,,percent of total billed charges,,
Sup Splint Wrist,,L3908,HCPCS,Facility,Both,,,,37,31.45,10.6042,37,"Health Partners, Inc.",State Public Programs,18.5,50,,percent of total billed charges,,
Sup Splint Wrist,,L3908,HCPCS,Facility,Both,,,,37,31.45,10.6042,37,Humana Insurance Company,Commercial PPO,35.15,95,,percent of total billed charges,,
Sup Splint Wrist,,L3908,HCPCS,Facility,Outpatient,,,,37,31.45,10.6042,37,Humana Insurance Company,Medicare PPO,18.13,49,,percent of total billed charges,,
Sup Splint Wrist,,L3908,HCPCS,Facility,Inpatient,,,,37,31.45,10.6042,37,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Sup Splint Wrist,,L3908,HCPCS,Facility,Both,,,,37,31.45,10.6042,37,Medica,Individual & Family,36.667,99.1,,percent of total billed charges,,
Sup Splint Wrist,,L3908,HCPCS,Facility,Outpatient,,,,37,31.45,10.6042,37,Medica,Medica Advantage Solution,18.426,49.8,,percent of total billed charges,,
Sup Splint Wrist,,L3908,HCPCS,Facility,Inpatient,,,,37,31.45,10.6042,37,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Sup Splint Wrist,,L3908,HCPCS,Facility,Outpatient,,,,37,31.45,10.6042,37,Medica,Medical Assistance,16.502,44.6,,percent of total billed charges,,
Sup Splint Wrist,,L3908,HCPCS,Facility,Inpatient,,,,37,31.45,10.6042,37,Medica,Medical Assistance,,,,,Included in per diem rate,
Sup Splint Wrist,,L3908,HCPCS,Facility,Outpatient,,,,37,31.45,10.6042,37,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,18.426,49.8,,percent of total billed charges,,
Sup Splint Wrist,,L3908,HCPCS,Facility,Inpatient,,,,37,31.45,10.6042,37,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Sup Splint Wrist,,L3908,HCPCS,Facility,Both,,,,37,31.45,10.6042,37,"Multiplan, Inc.","Multiplan, Inc.",34.78,94,,percent of total billed charges,,
Sup Splint Wrist,,L3908,HCPCS,Facility,Outpatient,,,,37,31.45,10.6042,37,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,33.337,90.1,,percent of total billed charges,,
Sup Splint Wrist,,L3908,HCPCS,Facility,Inpatient,,,,37,31.45,10.6042,37,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Sup Splint Wrist,,L3908,HCPCS,Facility,Both,,,,37,31.45,10.6042,37,"Preferred One Administrative Services, INC.",PPO,36.482,98.6,,percent of total billed charges,,
Sup Splint Wrist,,L3908,HCPCS,Facility,Outpatient,,,,37,31.45,10.6042,37,PrimeWest Health,Minnesota Senior Health Options (MSHO),19.0365,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Sup Splint Wrist,,L3908,HCPCS,Facility,Inpatient,,,,37,31.45,10.6042,37,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Splint Wrist,,L3908,HCPCS,Facility,Outpatient,,,,37,31.45,10.6042,37,PrimeWest Health,MinnesotaCare,19.0032,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Sup Splint Wrist,,L3908,HCPCS,Facility,Inpatient,,,,37,31.45,10.6042,37,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Sup Splint Wrist,,L3908,HCPCS,Facility,Both,,,,37,31.45,10.6042,37,Sanford Health Plan,Sanford Health Plan,34.04,92,,percent of total billed charges,,
Sup Splint Wrist,,L3908,HCPCS,Facility,Outpatient,,,,37,31.45,10.6042,37,"UCare Health, Inc.",Individual & Family Plan,20.8495,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Sup Splint Wrist,,L3908,HCPCS,Facility,Inpatient,,,,37,31.45,10.6042,37,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Sup Splint Wrist,,L3908,HCPCS,Facility,Outpatient,,,,37,31.45,10.6042,37,"UCare Health, Inc.",Medical Assistance,18.6739,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Splint Wrist,,L3908,HCPCS,Facility,Inpatient,,,,37,31.45,10.6042,37,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Sup Splint Wrist,,L3908,HCPCS,Facility,Outpatient,,,,37,31.45,10.6042,37,"UCare Health, Inc.",Medicare Advantage,18.6739,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Splint Wrist,,L3908,HCPCS,Facility,Inpatient,,,,37,31.45,10.6042,37,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Splint Wrist,,L3908,HCPCS,Facility,Outpatient,,,,37,31.45,10.6042,37,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),18.6739,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Splint Wrist,,L3908,HCPCS,Facility,Inpatient,,,,37,31.45,10.6042,37,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Splint Wrist,,L3908,HCPCS,Facility,Both,,,,37,31.45,10.6042,37,UnitedHealthcare,Individual & Family,34.78,94,,percent of total billed charges,,
Sup Splint Wrist,,L3908,HCPCS,Facility,Outpatient,,,,37,31.45,10.6042,37,UnitedHealthcare,Medicare Advantage,18.13,49,,percent of total billed charges,,
Sup Splint Wrist,,L3908,HCPCS,Facility,Inpatient,,,,37,31.45,10.6042,37,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Sup Splint Wrist,,L3908,HCPCS,Facility,Outpatient,,,,37,31.45,10.6042,37,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,17.76,48,,percent of total billed charges,,100% of DHS outpatient percentage
Sup Splint Wrist,,L3908,HCPCS,Facility,Inpatient,,,,37,31.45,10.6042,37,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Sup Tennis Elbow Splint,,L3999,HCPCS,Facility,Both,,,,12,10.2,3.4392,12,Aetna,Commercial,11.04,92,,percent of total billed charges,,
Sup Tennis Elbow Splint,,L3999,HCPCS,Facility,Outpatient,,,,12,10.2,3.4392,12,Aetna,Medicare Advantage,5.88,49,,percent of total billed charges,,
Sup Tennis Elbow Splint,,L3999,HCPCS,Facility,Inpatient,,,,12,10.2,3.4392,12,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Sup Tennis Elbow Splint,,L3999,HCPCS,Facility,Both,,,,12,10.2,3.4392,12,Aetna,PPO,11.16,93,,percent of total billed charges,,
Sup Tennis Elbow Splint,,L3999,HCPCS,Facility,Both,,,,12,10.2,3.4392,12,America's PPO,America's PPO,11.5236,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Sup Tennis Elbow Splint,,L3999,HCPCS,Facility,Both,,,,12,10.2,3.4392,12,BlueCross BlueShield Minnesota, Federal Employee Program,11.808,98.4,,percent of total billed charges,,
Sup Tennis Elbow Splint,,L3999,HCPCS,Facility,Both,,,,12,10.2,3.4392,12,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,12,100,,percent of total billed charges,,
Sup Tennis Elbow Splint,,L3999,HCPCS,Facility,Both,,,,12,10.2,3.4392,12,BlueCross BlueShield Minnesota,High Value Network Plan,10.8,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
Sup Tennis Elbow Splint,,L3999,HCPCS,Facility,Outpatient,,,,12,10.2,3.4392,12,BlueCross BlueShield Minnesota,Medicare Advantage,5.88,49,,percent of total billed charges,,
Sup Tennis Elbow Splint,,L3999,HCPCS,Facility,Inpatient,,,,12,10.2,3.4392,12,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Sup Tennis Elbow Splint,,L3999,HCPCS,Facility,Both,,,,12,10.2,3.4392,12,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,10.6284,88.57,,percent of total billed charges,,
Sup Tennis Elbow Splint,,L3999,HCPCS,Facility,Both,,,,12,10.2,3.4392,12,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,3.4392,28.66,,percent of total billed charges,,
Sup Tennis Elbow Splint,,L3999,HCPCS,Facility,Outpatient,,,,12,10.2,3.4392,12,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),5.88,49,,percent of total billed charges,,
Sup Tennis Elbow Splint,,L3999,HCPCS,Facility,Inpatient,,,,12,10.2,3.4392,12,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Sup Tennis Elbow Splint,,L3999,HCPCS,Facility,Both,,,,12,10.2,3.4392,12,CorVel,Worker's Compensation,12,100,,percent of total billed charges,,
Sup Tennis Elbow Splint,,L3999,HCPCS,Facility,Both,,,,12,10.2,3.4392,12,First Health Group Corporation,First Health Network,11.64,97,,percent of total billed charges,,
Sup Tennis Elbow Splint,,L3999,HCPCS,Facility,Both,,,,12,10.2,3.4392,12,"Health Partners, Inc.",Commercial,11.352,94.6,,percent of total billed charges,,
Sup Tennis Elbow Splint,,L3999,HCPCS,Facility,Outpatient,,,,12,10.2,3.4392,12,"Health Partners, Inc.",Medicare Advantage,5.88,49,,percent of total billed charges,,
Sup Tennis Elbow Splint,,L3999,HCPCS,Facility,Inpatient,,,,12,10.2,3.4392,12,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Tennis Elbow Splint,,L3999,HCPCS,Facility,Both,,,,12,10.2,3.4392,12,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),7.2,60,,percent of total billed charges,,
Sup Tennis Elbow Splint,,L3999,HCPCS,Facility,Both,,,,12,10.2,3.4392,12,"Health Partners, Inc.",State of Minnesota Advantage Program,9.78,81.5,,percent of total billed charges,,
Sup Tennis Elbow Splint,,L3999,HCPCS,Facility,Both,,,,12,10.2,3.4392,12,"Health Partners, Inc.",State Public Programs,6,50,,percent of total billed charges,,
Sup Tennis Elbow Splint,,L3999,HCPCS,Facility,Both,,,,12,10.2,3.4392,12,Humana Insurance Company,Commercial PPO,11.4,95,,percent of total billed charges,,
Sup Tennis Elbow Splint,,L3999,HCPCS,Facility,Outpatient,,,,12,10.2,3.4392,12,Humana Insurance Company,Medicare PPO,5.88,49,,percent of total billed charges,,
Sup Tennis Elbow Splint,,L3999,HCPCS,Facility,Inpatient,,,,12,10.2,3.4392,12,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Sup Tennis Elbow Splint,,L3999,HCPCS,Facility,Both,,,,12,10.2,3.4392,12,Medica,Individual & Family,11.892,99.1,,percent of total billed charges,,
Sup Tennis Elbow Splint,,L3999,HCPCS,Facility,Outpatient,,,,12,10.2,3.4392,12,Medica,Medica Advantage Solution,5.976,49.8,,percent of total billed charges,,
Sup Tennis Elbow Splint,,L3999,HCPCS,Facility,Inpatient,,,,12,10.2,3.4392,12,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Sup Tennis Elbow Splint,,L3999,HCPCS,Facility,Outpatient,,,,12,10.2,3.4392,12,Medica,Medical Assistance,5.352,44.6,,percent of total billed charges,,
Sup Tennis Elbow Splint,,L3999,HCPCS,Facility,Inpatient,,,,12,10.2,3.4392,12,Medica,Medical Assistance,,,,,Included in per diem rate,
Sup Tennis Elbow Splint,,L3999,HCPCS,Facility,Outpatient,,,,12,10.2,3.4392,12,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,5.976,49.8,,percent of total billed charges,,
Sup Tennis Elbow Splint,,L3999,HCPCS,Facility,Inpatient,,,,12,10.2,3.4392,12,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Sup Tennis Elbow Splint,,L3999,HCPCS,Facility,Both,,,,12,10.2,3.4392,12,"Multiplan, Inc.","Multiplan, Inc.",11.28,94,,percent of total billed charges,,
Sup Tennis Elbow Splint,,L3999,HCPCS,Facility,Outpatient,,,,12,10.2,3.4392,12,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,10.812,90.1,,percent of total billed charges,,
Sup Tennis Elbow Splint,,L3999,HCPCS,Facility,Inpatient,,,,12,10.2,3.4392,12,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Sup Tennis Elbow Splint,,L3999,HCPCS,Facility,Both,,,,12,10.2,3.4392,12,"Preferred One Administrative Services, INC.",PPO,11.832,98.6,,percent of total billed charges,,
Sup Tennis Elbow Splint,,L3999,HCPCS,Facility,Outpatient,,,,12,10.2,3.4392,12,PrimeWest Health,Minnesota Senior Health Options (MSHO),6.174,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Sup Tennis Elbow Splint,,L3999,HCPCS,Facility,Inpatient,,,,12,10.2,3.4392,12,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Tennis Elbow Splint,,L3999,HCPCS,Facility,Outpatient,,,,12,10.2,3.4392,12,PrimeWest Health,MinnesotaCare,6.1632,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Sup Tennis Elbow Splint,,L3999,HCPCS,Facility,Inpatient,,,,12,10.2,3.4392,12,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Sup Tennis Elbow Splint,,L3999,HCPCS,Facility,Both,,,,12,10.2,3.4392,12,Sanford Health Plan,Sanford Health Plan,11.04,92,,percent of total billed charges,,
Sup Tennis Elbow Splint,,L3999,HCPCS,Facility,Outpatient,,,,12,10.2,3.4392,12,"UCare Health, Inc.",Individual & Family Plan,6.762,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Sup Tennis Elbow Splint,,L3999,HCPCS,Facility,Inpatient,,,,12,10.2,3.4392,12,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Sup Tennis Elbow Splint,,L3999,HCPCS,Facility,Outpatient,,,,12,10.2,3.4392,12,"UCare Health, Inc.",Medical Assistance,6.0564,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Tennis Elbow Splint,,L3999,HCPCS,Facility,Inpatient,,,,12,10.2,3.4392,12,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Sup Tennis Elbow Splint,,L3999,HCPCS,Facility,Outpatient,,,,12,10.2,3.4392,12,"UCare Health, Inc.",Medicare Advantage,6.0564,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Tennis Elbow Splint,,L3999,HCPCS,Facility,Inpatient,,,,12,10.2,3.4392,12,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Tennis Elbow Splint,,L3999,HCPCS,Facility,Outpatient,,,,12,10.2,3.4392,12,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),6.0564,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Tennis Elbow Splint,,L3999,HCPCS,Facility,Inpatient,,,,12,10.2,3.4392,12,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Tennis Elbow Splint,,L3999,HCPCS,Facility,Both,,,,12,10.2,3.4392,12,UnitedHealthcare,Individual & Family,11.28,94,,percent of total billed charges,,
Sup Tennis Elbow Splint,,L3999,HCPCS,Facility,Outpatient,,,,12,10.2,3.4392,12,UnitedHealthcare,Medicare Advantage,5.88,49,,percent of total billed charges,,
Sup Tennis Elbow Splint,,L3999,HCPCS,Facility,Inpatient,,,,12,10.2,3.4392,12,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Sup Tennis Elbow Splint,,L3999,HCPCS,Facility,Outpatient,,,,12,10.2,3.4392,12,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,5.76,48,,percent of total billed charges,,100% of DHS outpatient percentage
Sup Tennis Elbow Splint,,L3999,HCPCS,Facility,Inpatient,,,,12,10.2,3.4392,12,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Sup Air Cast Splint,,L4350,HCPCS,Facility,Both,,,,59,50.15,16.9094,59,Aetna,Commercial,54.28,92,,percent of total billed charges,,
Sup Air Cast Splint,,L4350,HCPCS,Facility,Outpatient,,,,59,50.15,16.9094,59,Aetna,Medicare Advantage,28.91,49,,percent of total billed charges,,
Sup Air Cast Splint,,L4350,HCPCS,Facility,Inpatient,,,,59,50.15,16.9094,59,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Sup Air Cast Splint,,L4350,HCPCS,Facility,Both,,,,59,50.15,16.9094,59,Aetna,PPO,54.87,93,,percent of total billed charges,,
Sup Air Cast Splint,,L4350,HCPCS,Facility,Both,,,,59,50.15,16.9094,59,America's PPO,America's PPO,56.6577,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Sup Air Cast Splint,,L4350,HCPCS,Facility,Both,,,,59,50.15,16.9094,59,BlueCross BlueShield Minnesota, Federal Employee Program,58.056,98.4,,percent of total billed charges,,
Sup Air Cast Splint,,L4350,HCPCS,Facility,Both,,,,59,50.15,16.9094,59,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,59,100,,percent of total billed charges,,
Sup Air Cast Splint,,L4350,HCPCS,Facility,Both,,,,59,50.15,16.9094,59,BlueCross BlueShield Minnesota,High Value Network Plan,53.1,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
Sup Air Cast Splint,,L4350,HCPCS,Facility,Outpatient,,,,59,50.15,16.9094,59,BlueCross BlueShield Minnesota,Medicare Advantage,28.91,49,,percent of total billed charges,,
Sup Air Cast Splint,,L4350,HCPCS,Facility,Inpatient,,,,59,50.15,16.9094,59,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Sup Air Cast Splint,,L4350,HCPCS,Facility,Both,,,,59,50.15,16.9094,59,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,52.2563,88.57,,percent of total billed charges,,
Sup Air Cast Splint,,L4350,HCPCS,Facility,Both,,,,59,50.15,16.9094,59,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,16.9094,28.66,,percent of total billed charges,,
Sup Air Cast Splint,,L4350,HCPCS,Facility,Outpatient,,,,59,50.15,16.9094,59,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),28.91,49,,percent of total billed charges,,
Sup Air Cast Splint,,L4350,HCPCS,Facility,Inpatient,,,,59,50.15,16.9094,59,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Sup Air Cast Splint,,L4350,HCPCS,Facility,Both,,,,59,50.15,16.9094,59,CorVel,Worker's Compensation,59,100,,percent of total billed charges,,
Sup Air Cast Splint,,L4350,HCPCS,Facility,Both,,,,59,50.15,16.9094,59,First Health Group Corporation,First Health Network,57.23,97,,percent of total billed charges,,
Sup Air Cast Splint,,L4350,HCPCS,Facility,Both,,,,59,50.15,16.9094,59,"Health Partners, Inc.",Commercial,55.814,94.6,,percent of total billed charges,,
Sup Air Cast Splint,,L4350,HCPCS,Facility,Outpatient,,,,59,50.15,16.9094,59,"Health Partners, Inc.",Medicare Advantage,28.91,49,,percent of total billed charges,,
Sup Air Cast Splint,,L4350,HCPCS,Facility,Inpatient,,,,59,50.15,16.9094,59,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Air Cast Splint,,L4350,HCPCS,Facility,Both,,,,59,50.15,16.9094,59,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),35.4,60,,percent of total billed charges,,
Sup Air Cast Splint,,L4350,HCPCS,Facility,Both,,,,59,50.15,16.9094,59,"Health Partners, Inc.",State of Minnesota Advantage Program,48.085,81.5,,percent of total billed charges,,
Sup Air Cast Splint,,L4350,HCPCS,Facility,Both,,,,59,50.15,16.9094,59,"Health Partners, Inc.",State Public Programs,29.5,50,,percent of total billed charges,,
Sup Air Cast Splint,,L4350,HCPCS,Facility,Both,,,,59,50.15,16.9094,59,Humana Insurance Company,Commercial PPO,56.05,95,,percent of total billed charges,,
Sup Air Cast Splint,,L4350,HCPCS,Facility,Outpatient,,,,59,50.15,16.9094,59,Humana Insurance Company,Medicare PPO,28.91,49,,percent of total billed charges,,
Sup Air Cast Splint,,L4350,HCPCS,Facility,Inpatient,,,,59,50.15,16.9094,59,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Sup Air Cast Splint,,L4350,HCPCS,Facility,Both,,,,59,50.15,16.9094,59,Medica,Individual & Family,58.469,99.1,,percent of total billed charges,,
Sup Air Cast Splint,,L4350,HCPCS,Facility,Outpatient,,,,59,50.15,16.9094,59,Medica,Medica Advantage Solution,29.382,49.8,,percent of total billed charges,,
Sup Air Cast Splint,,L4350,HCPCS,Facility,Inpatient,,,,59,50.15,16.9094,59,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Sup Air Cast Splint,,L4350,HCPCS,Facility,Outpatient,,,,59,50.15,16.9094,59,Medica,Medical Assistance,26.314,44.6,,percent of total billed charges,,
Sup Air Cast Splint,,L4350,HCPCS,Facility,Inpatient,,,,59,50.15,16.9094,59,Medica,Medical Assistance,,,,,Included in per diem rate,
Sup Air Cast Splint,,L4350,HCPCS,Facility,Outpatient,,,,59,50.15,16.9094,59,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,29.382,49.8,,percent of total billed charges,,
Sup Air Cast Splint,,L4350,HCPCS,Facility,Inpatient,,,,59,50.15,16.9094,59,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Sup Air Cast Splint,,L4350,HCPCS,Facility,Both,,,,59,50.15,16.9094,59,"Multiplan, Inc.","Multiplan, Inc.",55.46,94,,percent of total billed charges,,
Sup Air Cast Splint,,L4350,HCPCS,Facility,Outpatient,,,,59,50.15,16.9094,59,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,53.159,90.1,,percent of total billed charges,,
Sup Air Cast Splint,,L4350,HCPCS,Facility,Inpatient,,,,59,50.15,16.9094,59,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Sup Air Cast Splint,,L4350,HCPCS,Facility,Both,,,,59,50.15,16.9094,59,"Preferred One Administrative Services, INC.",PPO,58.174,98.6,,percent of total billed charges,,
Sup Air Cast Splint,,L4350,HCPCS,Facility,Outpatient,,,,59,50.15,16.9094,59,PrimeWest Health,Minnesota Senior Health Options (MSHO),30.3555,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Sup Air Cast Splint,,L4350,HCPCS,Facility,Inpatient,,,,59,50.15,16.9094,59,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Air Cast Splint,,L4350,HCPCS,Facility,Outpatient,,,,59,50.15,16.9094,59,PrimeWest Health,MinnesotaCare,30.3024,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Sup Air Cast Splint,,L4350,HCPCS,Facility,Inpatient,,,,59,50.15,16.9094,59,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Sup Air Cast Splint,,L4350,HCPCS,Facility,Both,,,,59,50.15,16.9094,59,Sanford Health Plan,Sanford Health Plan,54.28,92,,percent of total billed charges,,
Sup Air Cast Splint,,L4350,HCPCS,Facility,Outpatient,,,,59,50.15,16.9094,59,"UCare Health, Inc.",Individual & Family Plan,33.2465,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Sup Air Cast Splint,,L4350,HCPCS,Facility,Inpatient,,,,59,50.15,16.9094,59,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Sup Air Cast Splint,,L4350,HCPCS,Facility,Outpatient,,,,59,50.15,16.9094,59,"UCare Health, Inc.",Medical Assistance,29.7773,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Air Cast Splint,,L4350,HCPCS,Facility,Inpatient,,,,59,50.15,16.9094,59,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Sup Air Cast Splint,,L4350,HCPCS,Facility,Outpatient,,,,59,50.15,16.9094,59,"UCare Health, Inc.",Medicare Advantage,29.7773,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Air Cast Splint,,L4350,HCPCS,Facility,Inpatient,,,,59,50.15,16.9094,59,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Air Cast Splint,,L4350,HCPCS,Facility,Outpatient,,,,59,50.15,16.9094,59,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),29.7773,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Air Cast Splint,,L4350,HCPCS,Facility,Inpatient,,,,59,50.15,16.9094,59,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Air Cast Splint,,L4350,HCPCS,Facility,Both,,,,59,50.15,16.9094,59,UnitedHealthcare,Individual & Family,55.46,94,,percent of total billed charges,,
Sup Air Cast Splint,,L4350,HCPCS,Facility,Outpatient,,,,59,50.15,16.9094,59,UnitedHealthcare,Medicare Advantage,28.91,49,,percent of total billed charges,,
Sup Air Cast Splint,,L4350,HCPCS,Facility,Inpatient,,,,59,50.15,16.9094,59,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Sup Air Cast Splint,,L4350,HCPCS,Facility,Outpatient,,,,59,50.15,16.9094,59,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,28.32,48,,percent of total billed charges,,100% of DHS outpatient percentage
Sup Air Cast Splint,,L4350,HCPCS,Facility,Inpatient,,,,59,50.15,16.9094,59,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Sup Walking Boot, Pneumatic/Vac Pre Fab Ots",,L4361,HCPCS,Facility,Both,,,,98,83.3,28.0868,98,Aetna,Commercial,90.16,92,,percent of total billed charges,,
"Sup Walking Boot, Pneumatic/Vac Pre Fab Ots",,L4361,HCPCS,Facility,Outpatient,,,,98,83.3,28.0868,98,Aetna,Medicare Advantage,48.02,49,,percent of total billed charges,,
"Sup Walking Boot, Pneumatic/Vac Pre Fab Ots",,L4361,HCPCS,Facility,Inpatient,,,,98,83.3,28.0868,98,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Sup Walking Boot, Pneumatic/Vac Pre Fab Ots",,L4361,HCPCS,Facility,Both,,,,98,83.3,28.0868,98,Aetna,PPO,91.14,93,,percent of total billed charges,,
"Sup Walking Boot, Pneumatic/Vac Pre Fab Ots",,L4361,HCPCS,Facility,Both,,,,98,83.3,28.0868,98,America's PPO,America's PPO,94.1094,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Sup Walking Boot, Pneumatic/Vac Pre Fab Ots",,L4361,HCPCS,Facility,Both,,,,98,83.3,28.0868,98,BlueCross BlueShield Minnesota, Federal Employee Program,96.432,98.4,,percent of total billed charges,,
"Sup Walking Boot, Pneumatic/Vac Pre Fab Ots",,L4361,HCPCS,Facility,Both,,,,98,83.3,28.0868,98,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,98,100,,percent of total billed charges,,
"Sup Walking Boot, Pneumatic/Vac Pre Fab Ots",,L4361,HCPCS,Facility,Both,,,,98,83.3,28.0868,98,BlueCross BlueShield Minnesota,High Value Network Plan,88.2,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
"Sup Walking Boot, Pneumatic/Vac Pre Fab Ots",,L4361,HCPCS,Facility,Outpatient,,,,98,83.3,28.0868,98,BlueCross BlueShield Minnesota,Medicare Advantage,48.02,49,,percent of total billed charges,,
"Sup Walking Boot, Pneumatic/Vac Pre Fab Ots",,L4361,HCPCS,Facility,Inpatient,,,,98,83.3,28.0868,98,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Sup Walking Boot, Pneumatic/Vac Pre Fab Ots",,L4361,HCPCS,Facility,Both,,,,98,83.3,28.0868,98,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,86.7986,88.57,,percent of total billed charges,,
"Sup Walking Boot, Pneumatic/Vac Pre Fab Ots",,L4361,HCPCS,Facility,Both,,,,98,83.3,28.0868,98,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,28.0868,28.66,,percent of total billed charges,,
"Sup Walking Boot, Pneumatic/Vac Pre Fab Ots",,L4361,HCPCS,Facility,Outpatient,,,,98,83.3,28.0868,98,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),48.02,49,,percent of total billed charges,,
"Sup Walking Boot, Pneumatic/Vac Pre Fab Ots",,L4361,HCPCS,Facility,Inpatient,,,,98,83.3,28.0868,98,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Sup Walking Boot, Pneumatic/Vac Pre Fab Ots",,L4361,HCPCS,Facility,Both,,,,98,83.3,28.0868,98,CorVel,Worker's Compensation,98,100,,percent of total billed charges,,
"Sup Walking Boot, Pneumatic/Vac Pre Fab Ots",,L4361,HCPCS,Facility,Both,,,,98,83.3,28.0868,98,First Health Group Corporation,First Health Network,95.06,97,,percent of total billed charges,,
"Sup Walking Boot, Pneumatic/Vac Pre Fab Ots",,L4361,HCPCS,Facility,Both,,,,98,83.3,28.0868,98,"Health Partners, Inc.",Commercial,92.708,94.6,,percent of total billed charges,,
"Sup Walking Boot, Pneumatic/Vac Pre Fab Ots",,L4361,HCPCS,Facility,Outpatient,,,,98,83.3,28.0868,98,"Health Partners, Inc.",Medicare Advantage,48.02,49,,percent of total billed charges,,
"Sup Walking Boot, Pneumatic/Vac Pre Fab Ots",,L4361,HCPCS,Facility,Inpatient,,,,98,83.3,28.0868,98,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Sup Walking Boot, Pneumatic/Vac Pre Fab Ots",,L4361,HCPCS,Facility,Both,,,,98,83.3,28.0868,98,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),58.8,60,,percent of total billed charges,,
"Sup Walking Boot, Pneumatic/Vac Pre Fab Ots",,L4361,HCPCS,Facility,Both,,,,98,83.3,28.0868,98,"Health Partners, Inc.",State of Minnesota Advantage Program,79.87,81.5,,percent of total billed charges,,
"Sup Walking Boot, Pneumatic/Vac Pre Fab Ots",,L4361,HCPCS,Facility,Both,,,,98,83.3,28.0868,98,"Health Partners, Inc.",State Public Programs,49,50,,percent of total billed charges,,
"Sup Walking Boot, Pneumatic/Vac Pre Fab Ots",,L4361,HCPCS,Facility,Both,,,,98,83.3,28.0868,98,Humana Insurance Company,Commercial PPO,93.1,95,,percent of total billed charges,,
"Sup Walking Boot, Pneumatic/Vac Pre Fab Ots",,L4361,HCPCS,Facility,Outpatient,,,,98,83.3,28.0868,98,Humana Insurance Company,Medicare PPO,48.02,49,,percent of total billed charges,,
"Sup Walking Boot, Pneumatic/Vac Pre Fab Ots",,L4361,HCPCS,Facility,Inpatient,,,,98,83.3,28.0868,98,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Sup Walking Boot, Pneumatic/Vac Pre Fab Ots",,L4361,HCPCS,Facility,Both,,,,98,83.3,28.0868,98,Medica,Individual & Family,97.118,99.1,,percent of total billed charges,,
"Sup Walking Boot, Pneumatic/Vac Pre Fab Ots",,L4361,HCPCS,Facility,Outpatient,,,,98,83.3,28.0868,98,Medica,Medica Advantage Solution,48.804,49.8,,percent of total billed charges,,
"Sup Walking Boot, Pneumatic/Vac Pre Fab Ots",,L4361,HCPCS,Facility,Inpatient,,,,98,83.3,28.0868,98,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Sup Walking Boot, Pneumatic/Vac Pre Fab Ots",,L4361,HCPCS,Facility,Outpatient,,,,98,83.3,28.0868,98,Medica,Medical Assistance,43.708,44.6,,percent of total billed charges,,
"Sup Walking Boot, Pneumatic/Vac Pre Fab Ots",,L4361,HCPCS,Facility,Inpatient,,,,98,83.3,28.0868,98,Medica,Medical Assistance,,,,,Included in per diem rate,
"Sup Walking Boot, Pneumatic/Vac Pre Fab Ots",,L4361,HCPCS,Facility,Outpatient,,,,98,83.3,28.0868,98,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,48.804,49.8,,percent of total billed charges,,
"Sup Walking Boot, Pneumatic/Vac Pre Fab Ots",,L4361,HCPCS,Facility,Inpatient,,,,98,83.3,28.0868,98,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Sup Walking Boot, Pneumatic/Vac Pre Fab Ots",,L4361,HCPCS,Facility,Both,,,,98,83.3,28.0868,98,"Multiplan, Inc.","Multiplan, Inc.",92.12,94,,percent of total billed charges,,
"Sup Walking Boot, Pneumatic/Vac Pre Fab Ots",,L4361,HCPCS,Facility,Outpatient,,,,98,83.3,28.0868,98,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,88.298,90.1,,percent of total billed charges,,
"Sup Walking Boot, Pneumatic/Vac Pre Fab Ots",,L4361,HCPCS,Facility,Inpatient,,,,98,83.3,28.0868,98,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Sup Walking Boot, Pneumatic/Vac Pre Fab Ots",,L4361,HCPCS,Facility,Both,,,,98,83.3,28.0868,98,"Preferred One Administrative Services, INC.",PPO,96.628,98.6,,percent of total billed charges,,
"Sup Walking Boot, Pneumatic/Vac Pre Fab Ots",,L4361,HCPCS,Facility,Outpatient,,,,98,83.3,28.0868,98,PrimeWest Health,Minnesota Senior Health Options (MSHO),50.421,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Sup Walking Boot, Pneumatic/Vac Pre Fab Ots",,L4361,HCPCS,Facility,Inpatient,,,,98,83.3,28.0868,98,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Sup Walking Boot, Pneumatic/Vac Pre Fab Ots",,L4361,HCPCS,Facility,Outpatient,,,,98,83.3,28.0868,98,PrimeWest Health,MinnesotaCare,50.3328,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Sup Walking Boot, Pneumatic/Vac Pre Fab Ots",,L4361,HCPCS,Facility,Inpatient,,,,98,83.3,28.0868,98,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Sup Walking Boot, Pneumatic/Vac Pre Fab Ots",,L4361,HCPCS,Facility,Both,,,,98,83.3,28.0868,98,Sanford Health Plan,Sanford Health Plan,90.16,92,,percent of total billed charges,,
"Sup Walking Boot, Pneumatic/Vac Pre Fab Ots",,L4361,HCPCS,Facility,Outpatient,,,,98,83.3,28.0868,98,"UCare Health, Inc.",Individual & Family Plan,55.223,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Sup Walking Boot, Pneumatic/Vac Pre Fab Ots",,L4361,HCPCS,Facility,Inpatient,,,,98,83.3,28.0868,98,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Sup Walking Boot, Pneumatic/Vac Pre Fab Ots",,L4361,HCPCS,Facility,Outpatient,,,,98,83.3,28.0868,98,"UCare Health, Inc.",Medical Assistance,49.4606,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Sup Walking Boot, Pneumatic/Vac Pre Fab Ots",,L4361,HCPCS,Facility,Inpatient,,,,98,83.3,28.0868,98,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Sup Walking Boot, Pneumatic/Vac Pre Fab Ots",,L4361,HCPCS,Facility,Outpatient,,,,98,83.3,28.0868,98,"UCare Health, Inc.",Medicare Advantage,49.4606,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Sup Walking Boot, Pneumatic/Vac Pre Fab Ots",,L4361,HCPCS,Facility,Inpatient,,,,98,83.3,28.0868,98,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Sup Walking Boot, Pneumatic/Vac Pre Fab Ots",,L4361,HCPCS,Facility,Outpatient,,,,98,83.3,28.0868,98,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),49.4606,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Sup Walking Boot, Pneumatic/Vac Pre Fab Ots",,L4361,HCPCS,Facility,Inpatient,,,,98,83.3,28.0868,98,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Sup Walking Boot, Pneumatic/Vac Pre Fab Ots",,L4361,HCPCS,Facility,Both,,,,98,83.3,28.0868,98,UnitedHealthcare,Individual & Family,92.12,94,,percent of total billed charges,,
"Sup Walking Boot, Pneumatic/Vac Pre Fab Ots",,L4361,HCPCS,Facility,Outpatient,,,,98,83.3,28.0868,98,UnitedHealthcare,Medicare Advantage,48.02,49,,percent of total billed charges,,
"Sup Walking Boot, Pneumatic/Vac Pre Fab Ots",,L4361,HCPCS,Facility,Inpatient,,,,98,83.3,28.0868,98,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Sup Walking Boot, Pneumatic/Vac Pre Fab Ots",,L4361,HCPCS,Facility,Outpatient,,,,98,83.3,28.0868,98,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,47.04,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Sup Walking Boot, Pneumatic/Vac Pre Fab Ots",,L4361,HCPCS,Facility,Inpatient,,,,98,83.3,28.0868,98,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Sup Cl Walking Boot, Nonpneum, W/W/O Jnts, W/W/O Interface Material, Prefab, Ots",,L4387,HCPCS,Facility,Both,,,,98,83.3,28.0868,98,Aetna,Commercial,90.16,92,,percent of total billed charges,,
"Sup Cl Walking Boot, Nonpneum, W/W/O Jnts, W/W/O Interface Material, Prefab, Ots",,L4387,HCPCS,Facility,Outpatient,,,,98,83.3,28.0868,98,Aetna,Medicare Advantage,48.02,49,,percent of total billed charges,,
"Sup Cl Walking Boot, Nonpneum, W/W/O Jnts, W/W/O Interface Material, Prefab, Ots",,L4387,HCPCS,Facility,Inpatient,,,,98,83.3,28.0868,98,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Sup Cl Walking Boot, Nonpneum, W/W/O Jnts, W/W/O Interface Material, Prefab, Ots",,L4387,HCPCS,Facility,Both,,,,98,83.3,28.0868,98,Aetna,PPO,91.14,93,,percent of total billed charges,,
"Sup Cl Walking Boot, Nonpneum, W/W/O Jnts, W/W/O Interface Material, Prefab, Ots",,L4387,HCPCS,Facility,Both,,,,98,83.3,28.0868,98,America's PPO,America's PPO,94.1094,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Sup Cl Walking Boot, Nonpneum, W/W/O Jnts, W/W/O Interface Material, Prefab, Ots",,L4387,HCPCS,Facility,Both,,,,98,83.3,28.0868,98,BlueCross BlueShield Minnesota, Federal Employee Program,96.432,98.4,,percent of total billed charges,,
"Sup Cl Walking Boot, Nonpneum, W/W/O Jnts, W/W/O Interface Material, Prefab, Ots",,L4387,HCPCS,Facility,Both,,,,98,83.3,28.0868,98,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,98,100,,percent of total billed charges,,
"Sup Cl Walking Boot, Nonpneum, W/W/O Jnts, W/W/O Interface Material, Prefab, Ots",,L4387,HCPCS,Facility,Both,,,,98,83.3,28.0868,98,BlueCross BlueShield Minnesota,High Value Network Plan,88.2,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
"Sup Cl Walking Boot, Nonpneum, W/W/O Jnts, W/W/O Interface Material, Prefab, Ots",,L4387,HCPCS,Facility,Outpatient,,,,98,83.3,28.0868,98,BlueCross BlueShield Minnesota,Medicare Advantage,48.02,49,,percent of total billed charges,,
"Sup Cl Walking Boot, Nonpneum, W/W/O Jnts, W/W/O Interface Material, Prefab, Ots",,L4387,HCPCS,Facility,Inpatient,,,,98,83.3,28.0868,98,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Sup Cl Walking Boot, Nonpneum, W/W/O Jnts, W/W/O Interface Material, Prefab, Ots",,L4387,HCPCS,Facility,Both,,,,98,83.3,28.0868,98,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,86.7986,88.57,,percent of total billed charges,,
"Sup Cl Walking Boot, Nonpneum, W/W/O Jnts, W/W/O Interface Material, Prefab, Ots",,L4387,HCPCS,Facility,Both,,,,98,83.3,28.0868,98,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,28.0868,28.66,,percent of total billed charges,,
"Sup Cl Walking Boot, Nonpneum, W/W/O Jnts, W/W/O Interface Material, Prefab, Ots",,L4387,HCPCS,Facility,Outpatient,,,,98,83.3,28.0868,98,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),48.02,49,,percent of total billed charges,,
"Sup Cl Walking Boot, Nonpneum, W/W/O Jnts, W/W/O Interface Material, Prefab, Ots",,L4387,HCPCS,Facility,Inpatient,,,,98,83.3,28.0868,98,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Sup Cl Walking Boot, Nonpneum, W/W/O Jnts, W/W/O Interface Material, Prefab, Ots",,L4387,HCPCS,Facility,Both,,,,98,83.3,28.0868,98,CorVel,Worker's Compensation,98,100,,percent of total billed charges,,
"Sup Cl Walking Boot, Nonpneum, W/W/O Jnts, W/W/O Interface Material, Prefab, Ots",,L4387,HCPCS,Facility,Both,,,,98,83.3,28.0868,98,First Health Group Corporation,First Health Network,95.06,97,,percent of total billed charges,,
"Sup Cl Walking Boot, Nonpneum, W/W/O Jnts, W/W/O Interface Material, Prefab, Ots",,L4387,HCPCS,Facility,Both,,,,98,83.3,28.0868,98,"Health Partners, Inc.",Commercial,92.708,94.6,,percent of total billed charges,,
"Sup Cl Walking Boot, Nonpneum, W/W/O Jnts, W/W/O Interface Material, Prefab, Ots",,L4387,HCPCS,Facility,Outpatient,,,,98,83.3,28.0868,98,"Health Partners, Inc.",Medicare Advantage,48.02,49,,percent of total billed charges,,
"Sup Cl Walking Boot, Nonpneum, W/W/O Jnts, W/W/O Interface Material, Prefab, Ots",,L4387,HCPCS,Facility,Inpatient,,,,98,83.3,28.0868,98,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Sup Cl Walking Boot, Nonpneum, W/W/O Jnts, W/W/O Interface Material, Prefab, Ots",,L4387,HCPCS,Facility,Both,,,,98,83.3,28.0868,98,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),58.8,60,,percent of total billed charges,,
"Sup Cl Walking Boot, Nonpneum, W/W/O Jnts, W/W/O Interface Material, Prefab, Ots",,L4387,HCPCS,Facility,Both,,,,98,83.3,28.0868,98,"Health Partners, Inc.",State of Minnesota Advantage Program,79.87,81.5,,percent of total billed charges,,
"Sup Cl Walking Boot, Nonpneum, W/W/O Jnts, W/W/O Interface Material, Prefab, Ots",,L4387,HCPCS,Facility,Both,,,,98,83.3,28.0868,98,"Health Partners, Inc.",State Public Programs,49,50,,percent of total billed charges,,
"Sup Cl Walking Boot, Nonpneum, W/W/O Jnts, W/W/O Interface Material, Prefab, Ots",,L4387,HCPCS,Facility,Both,,,,98,83.3,28.0868,98,Humana Insurance Company,Commercial PPO,93.1,95,,percent of total billed charges,,
"Sup Cl Walking Boot, Nonpneum, W/W/O Jnts, W/W/O Interface Material, Prefab, Ots",,L4387,HCPCS,Facility,Outpatient,,,,98,83.3,28.0868,98,Humana Insurance Company,Medicare PPO,48.02,49,,percent of total billed charges,,
"Sup Cl Walking Boot, Nonpneum, W/W/O Jnts, W/W/O Interface Material, Prefab, Ots",,L4387,HCPCS,Facility,Inpatient,,,,98,83.3,28.0868,98,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Sup Cl Walking Boot, Nonpneum, W/W/O Jnts, W/W/O Interface Material, Prefab, Ots",,L4387,HCPCS,Facility,Both,,,,98,83.3,28.0868,98,Medica,Individual & Family,97.118,99.1,,percent of total billed charges,,
"Sup Cl Walking Boot, Nonpneum, W/W/O Jnts, W/W/O Interface Material, Prefab, Ots",,L4387,HCPCS,Facility,Outpatient,,,,98,83.3,28.0868,98,Medica,Medica Advantage Solution,48.804,49.8,,percent of total billed charges,,
"Sup Cl Walking Boot, Nonpneum, W/W/O Jnts, W/W/O Interface Material, Prefab, Ots",,L4387,HCPCS,Facility,Inpatient,,,,98,83.3,28.0868,98,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Sup Cl Walking Boot, Nonpneum, W/W/O Jnts, W/W/O Interface Material, Prefab, Ots",,L4387,HCPCS,Facility,Outpatient,,,,98,83.3,28.0868,98,Medica,Medical Assistance,43.708,44.6,,percent of total billed charges,,
"Sup Cl Walking Boot, Nonpneum, W/W/O Jnts, W/W/O Interface Material, Prefab, Ots",,L4387,HCPCS,Facility,Inpatient,,,,98,83.3,28.0868,98,Medica,Medical Assistance,,,,,Included in per diem rate,
"Sup Cl Walking Boot, Nonpneum, W/W/O Jnts, W/W/O Interface Material, Prefab, Ots",,L4387,HCPCS,Facility,Outpatient,,,,98,83.3,28.0868,98,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,48.804,49.8,,percent of total billed charges,,
"Sup Cl Walking Boot, Nonpneum, W/W/O Jnts, W/W/O Interface Material, Prefab, Ots",,L4387,HCPCS,Facility,Inpatient,,,,98,83.3,28.0868,98,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Sup Cl Walking Boot, Nonpneum, W/W/O Jnts, W/W/O Interface Material, Prefab, Ots",,L4387,HCPCS,Facility,Both,,,,98,83.3,28.0868,98,"Multiplan, Inc.","Multiplan, Inc.",92.12,94,,percent of total billed charges,,
"Sup Cl Walking Boot, Nonpneum, W/W/O Jnts, W/W/O Interface Material, Prefab, Ots",,L4387,HCPCS,Facility,Outpatient,,,,98,83.3,28.0868,98,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,88.298,90.1,,percent of total billed charges,,
"Sup Cl Walking Boot, Nonpneum, W/W/O Jnts, W/W/O Interface Material, Prefab, Ots",,L4387,HCPCS,Facility,Inpatient,,,,98,83.3,28.0868,98,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Sup Cl Walking Boot, Nonpneum, W/W/O Jnts, W/W/O Interface Material, Prefab, Ots",,L4387,HCPCS,Facility,Both,,,,98,83.3,28.0868,98,"Preferred One Administrative Services, INC.",PPO,96.628,98.6,,percent of total billed charges,,
"Sup Cl Walking Boot, Nonpneum, W/W/O Jnts, W/W/O Interface Material, Prefab, Ots",,L4387,HCPCS,Facility,Outpatient,,,,98,83.3,28.0868,98,PrimeWest Health,Minnesota Senior Health Options (MSHO),50.421,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Sup Cl Walking Boot, Nonpneum, W/W/O Jnts, W/W/O Interface Material, Prefab, Ots",,L4387,HCPCS,Facility,Inpatient,,,,98,83.3,28.0868,98,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Sup Cl Walking Boot, Nonpneum, W/W/O Jnts, W/W/O Interface Material, Prefab, Ots",,L4387,HCPCS,Facility,Outpatient,,,,98,83.3,28.0868,98,PrimeWest Health,MinnesotaCare,50.3328,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Sup Cl Walking Boot, Nonpneum, W/W/O Jnts, W/W/O Interface Material, Prefab, Ots",,L4387,HCPCS,Facility,Inpatient,,,,98,83.3,28.0868,98,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Sup Cl Walking Boot, Nonpneum, W/W/O Jnts, W/W/O Interface Material, Prefab, Ots",,L4387,HCPCS,Facility,Both,,,,98,83.3,28.0868,98,Sanford Health Plan,Sanford Health Plan,90.16,92,,percent of total billed charges,,
"Sup Cl Walking Boot, Nonpneum, W/W/O Jnts, W/W/O Interface Material, Prefab, Ots",,L4387,HCPCS,Facility,Outpatient,,,,98,83.3,28.0868,98,"UCare Health, Inc.",Individual & Family Plan,55.223,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Sup Cl Walking Boot, Nonpneum, W/W/O Jnts, W/W/O Interface Material, Prefab, Ots",,L4387,HCPCS,Facility,Inpatient,,,,98,83.3,28.0868,98,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Sup Cl Walking Boot, Nonpneum, W/W/O Jnts, W/W/O Interface Material, Prefab, Ots",,L4387,HCPCS,Facility,Outpatient,,,,98,83.3,28.0868,98,"UCare Health, Inc.",Medical Assistance,49.4606,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Sup Cl Walking Boot, Nonpneum, W/W/O Jnts, W/W/O Interface Material, Prefab, Ots",,L4387,HCPCS,Facility,Inpatient,,,,98,83.3,28.0868,98,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Sup Cl Walking Boot, Nonpneum, W/W/O Jnts, W/W/O Interface Material, Prefab, Ots",,L4387,HCPCS,Facility,Outpatient,,,,98,83.3,28.0868,98,"UCare Health, Inc.",Medicare Advantage,49.4606,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Sup Cl Walking Boot, Nonpneum, W/W/O Jnts, W/W/O Interface Material, Prefab, Ots",,L4387,HCPCS,Facility,Inpatient,,,,98,83.3,28.0868,98,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Sup Cl Walking Boot, Nonpneum, W/W/O Jnts, W/W/O Interface Material, Prefab, Ots",,L4387,HCPCS,Facility,Outpatient,,,,98,83.3,28.0868,98,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),49.4606,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Sup Cl Walking Boot, Nonpneum, W/W/O Jnts, W/W/O Interface Material, Prefab, Ots",,L4387,HCPCS,Facility,Inpatient,,,,98,83.3,28.0868,98,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Sup Cl Walking Boot, Nonpneum, W/W/O Jnts, W/W/O Interface Material, Prefab, Ots",,L4387,HCPCS,Facility,Both,,,,98,83.3,28.0868,98,UnitedHealthcare,Individual & Family,92.12,94,,percent of total billed charges,,
"Sup Cl Walking Boot, Nonpneum, W/W/O Jnts, W/W/O Interface Material, Prefab, Ots",,L4387,HCPCS,Facility,Outpatient,,,,98,83.3,28.0868,98,UnitedHealthcare,Medicare Advantage,48.02,49,,percent of total billed charges,,
"Sup Cl Walking Boot, Nonpneum, W/W/O Jnts, W/W/O Interface Material, Prefab, Ots",,L4387,HCPCS,Facility,Inpatient,,,,98,83.3,28.0868,98,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Sup Cl Walking Boot, Nonpneum, W/W/O Jnts, W/W/O Interface Material, Prefab, Ots",,L4387,HCPCS,Facility,Outpatient,,,,98,83.3,28.0868,98,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,47.04,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Sup Cl Walking Boot, Nonpneum, W/W/O Jnts, W/W/O Interface Material, Prefab, Ots",,L4387,HCPCS,Facility,Inpatient,,,,98,83.3,28.0868,98,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
BETADINE 5% STERILE OPHTHALMIC PREP SOLUTION 30ML,,L8606,HCPCS,Facility,Both,,,,38.75,32.9375,11.10575,38.75,Aetna,Commercial,35.65,92,,percent of total billed charges,,
BETADINE 5% STERILE OPHTHALMIC PREP SOLUTION 30ML,,L8606,HCPCS,Facility,Outpatient,,,,38.75,32.9375,11.10575,38.75,Aetna,Medicare Advantage,18.9875,49,,percent of total billed charges,,
BETADINE 5% STERILE OPHTHALMIC PREP SOLUTION 30ML,,L8606,HCPCS,Facility,Inpatient,,,,38.75,32.9375,11.10575,38.75,Aetna,Medicare Advantage,,,,,Included in per diem rate,
BETADINE 5% STERILE OPHTHALMIC PREP SOLUTION 30ML,,L8606,HCPCS,Facility,Both,,,,38.75,32.9375,11.10575,38.75,Aetna,PPO,36.0375,93,,percent of total billed charges,,
BETADINE 5% STERILE OPHTHALMIC PREP SOLUTION 30ML,,L8606,HCPCS,Facility,Both,,,,38.75,32.9375,11.10575,38.75,America's PPO,America's PPO,37.211625,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
BETADINE 5% STERILE OPHTHALMIC PREP SOLUTION 30ML,,L8606,HCPCS,Facility,Both,,,,38.75,32.9375,11.10575,38.75,BlueCross BlueShield Minnesota, Federal Employee Program,38.13,98.4,,percent of total billed charges,,
BETADINE 5% STERILE OPHTHALMIC PREP SOLUTION 30ML,,L8606,HCPCS,Facility,Both,,,,38.75,32.9375,11.10575,38.75,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,38.75,100,,percent of total billed charges,,
BETADINE 5% STERILE OPHTHALMIC PREP SOLUTION 30ML,,L8606,HCPCS,Facility,Both,,,,38.75,32.9375,11.10575,38.75,BlueCross BlueShield Minnesota,High Value Network Plan,34.875,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
BETADINE 5% STERILE OPHTHALMIC PREP SOLUTION 30ML,,L8606,HCPCS,Facility,Outpatient,,,,38.75,32.9375,11.10575,38.75,BlueCross BlueShield Minnesota,Medicare Advantage,18.9875,49,,percent of total billed charges,,
BETADINE 5% STERILE OPHTHALMIC PREP SOLUTION 30ML,,L8606,HCPCS,Facility,Inpatient,,,,38.75,32.9375,11.10575,38.75,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
BETADINE 5% STERILE OPHTHALMIC PREP SOLUTION 30ML,,L8606,HCPCS,Facility,Both,,,,38.75,32.9375,11.10575,38.75,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,34.320875,88.57,,percent of total billed charges,,
BETADINE 5% STERILE OPHTHALMIC PREP SOLUTION 30ML,,L8606,HCPCS,Facility,Both,,,,38.75,32.9375,11.10575,38.75,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,11.10575,28.66,,percent of total billed charges,,
BETADINE 5% STERILE OPHTHALMIC PREP SOLUTION 30ML,,L8606,HCPCS,Facility,Outpatient,,,,38.75,32.9375,11.10575,38.75,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),18.9875,49,,percent of total billed charges,,
BETADINE 5% STERILE OPHTHALMIC PREP SOLUTION 30ML,,L8606,HCPCS,Facility,Inpatient,,,,38.75,32.9375,11.10575,38.75,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
BETADINE 5% STERILE OPHTHALMIC PREP SOLUTION 30ML,,L8606,HCPCS,Facility,Both,,,,38.75,32.9375,11.10575,38.75,CorVel,Worker's Compensation,38.75,100,,percent of total billed charges,,
BETADINE 5% STERILE OPHTHALMIC PREP SOLUTION 30ML,,L8606,HCPCS,Facility,Both,,,,38.75,32.9375,11.10575,38.75,First Health Group Corporation,First Health Network,37.5875,97,,percent of total billed charges,,
BETADINE 5% STERILE OPHTHALMIC PREP SOLUTION 30ML,,L8606,HCPCS,Facility,Both,,,,38.75,32.9375,11.10575,38.75,"Health Partners, Inc.",Commercial,36.6575,94.6,,percent of total billed charges,,
BETADINE 5% STERILE OPHTHALMIC PREP SOLUTION 30ML,,L8606,HCPCS,Facility,Outpatient,,,,38.75,32.9375,11.10575,38.75,"Health Partners, Inc.",Medicare Advantage,18.9875,49,,percent of total billed charges,,
BETADINE 5% STERILE OPHTHALMIC PREP SOLUTION 30ML,,L8606,HCPCS,Facility,Inpatient,,,,38.75,32.9375,11.10575,38.75,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
BETADINE 5% STERILE OPHTHALMIC PREP SOLUTION 30ML,,L8606,HCPCS,Facility,Both,,,,38.75,32.9375,11.10575,38.75,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),23.25,60,,percent of total billed charges,,
BETADINE 5% STERILE OPHTHALMIC PREP SOLUTION 30ML,,L8606,HCPCS,Facility,Both,,,,38.75,32.9375,11.10575,38.75,"Health Partners, Inc.",State of Minnesota Advantage Program,31.58125,81.5,,percent of total billed charges,,
BETADINE 5% STERILE OPHTHALMIC PREP SOLUTION 30ML,,L8606,HCPCS,Facility,Both,,,,38.75,32.9375,11.10575,38.75,"Health Partners, Inc.",State Public Programs,19.375,50,,percent of total billed charges,,
BETADINE 5% STERILE OPHTHALMIC PREP SOLUTION 30ML,,L8606,HCPCS,Facility,Both,,,,38.75,32.9375,11.10575,38.75,Humana Insurance Company,Commercial PPO,36.8125,95,,percent of total billed charges,,
BETADINE 5% STERILE OPHTHALMIC PREP SOLUTION 30ML,,L8606,HCPCS,Facility,Outpatient,,,,38.75,32.9375,11.10575,38.75,Humana Insurance Company,Medicare PPO,18.9875,49,,percent of total billed charges,,
BETADINE 5% STERILE OPHTHALMIC PREP SOLUTION 30ML,,L8606,HCPCS,Facility,Inpatient,,,,38.75,32.9375,11.10575,38.75,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
BETADINE 5% STERILE OPHTHALMIC PREP SOLUTION 30ML,,L8606,HCPCS,Facility,Both,,,,38.75,32.9375,11.10575,38.75,Medica,Individual & Family,38.40125,99.1,,percent of total billed charges,,
BETADINE 5% STERILE OPHTHALMIC PREP SOLUTION 30ML,,L8606,HCPCS,Facility,Outpatient,,,,38.75,32.9375,11.10575,38.75,Medica,Medica Advantage Solution,19.2975,49.8,,percent of total billed charges,,
BETADINE 5% STERILE OPHTHALMIC PREP SOLUTION 30ML,,L8606,HCPCS,Facility,Inpatient,,,,38.75,32.9375,11.10575,38.75,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
BETADINE 5% STERILE OPHTHALMIC PREP SOLUTION 30ML,,L8606,HCPCS,Facility,Outpatient,,,,38.75,32.9375,11.10575,38.75,Medica,Medical Assistance,17.2825,44.6,,percent of total billed charges,,
BETADINE 5% STERILE OPHTHALMIC PREP SOLUTION 30ML,,L8606,HCPCS,Facility,Inpatient,,,,38.75,32.9375,11.10575,38.75,Medica,Medical Assistance,,,,,Included in per diem rate,
BETADINE 5% STERILE OPHTHALMIC PREP SOLUTION 30ML,,L8606,HCPCS,Facility,Outpatient,,,,38.75,32.9375,11.10575,38.75,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,19.2975,49.8,,percent of total billed charges,,
BETADINE 5% STERILE OPHTHALMIC PREP SOLUTION 30ML,,L8606,HCPCS,Facility,Inpatient,,,,38.75,32.9375,11.10575,38.75,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
BETADINE 5% STERILE OPHTHALMIC PREP SOLUTION 30ML,,L8606,HCPCS,Facility,Both,,,,38.75,32.9375,11.10575,38.75,"Multiplan, Inc.","Multiplan, Inc.",36.425,94,,percent of total billed charges,,
BETADINE 5% STERILE OPHTHALMIC PREP SOLUTION 30ML,,L8606,HCPCS,Facility,Outpatient,,,,38.75,32.9375,11.10575,38.75,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,34.91375,90.1,,percent of total billed charges,,
BETADINE 5% STERILE OPHTHALMIC PREP SOLUTION 30ML,,L8606,HCPCS,Facility,Inpatient,,,,38.75,32.9375,11.10575,38.75,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
BETADINE 5% STERILE OPHTHALMIC PREP SOLUTION 30ML,,L8606,HCPCS,Facility,Both,,,,38.75,32.9375,11.10575,38.75,"Preferred One Administrative Services, INC.",PPO,38.2075,98.6,,percent of total billed charges,,
BETADINE 5% STERILE OPHTHALMIC PREP SOLUTION 30ML,,L8606,HCPCS,Facility,Outpatient,,,,38.75,32.9375,11.10575,38.75,PrimeWest Health,Minnesota Senior Health Options (MSHO),19.936875,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
BETADINE 5% STERILE OPHTHALMIC PREP SOLUTION 30ML,,L8606,HCPCS,Facility,Inpatient,,,,38.75,32.9375,11.10575,38.75,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
BETADINE 5% STERILE OPHTHALMIC PREP SOLUTION 30ML,,L8606,HCPCS,Facility,Outpatient,,,,38.75,32.9375,11.10575,38.75,PrimeWest Health,MinnesotaCare,19.902,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
BETADINE 5% STERILE OPHTHALMIC PREP SOLUTION 30ML,,L8606,HCPCS,Facility,Inpatient,,,,38.75,32.9375,11.10575,38.75,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
BETADINE 5% STERILE OPHTHALMIC PREP SOLUTION 30ML,,L8606,HCPCS,Facility,Both,,,,38.75,32.9375,11.10575,38.75,Sanford Health Plan,Sanford Health Plan,35.65,92,,percent of total billed charges,,
BETADINE 5% STERILE OPHTHALMIC PREP SOLUTION 30ML,,L8606,HCPCS,Facility,Outpatient,,,,38.75,32.9375,11.10575,38.75,"UCare Health, Inc.",Individual & Family Plan,21.835625,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
BETADINE 5% STERILE OPHTHALMIC PREP SOLUTION 30ML,,L8606,HCPCS,Facility,Inpatient,,,,38.75,32.9375,11.10575,38.75,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
BETADINE 5% STERILE OPHTHALMIC PREP SOLUTION 30ML,,L8606,HCPCS,Facility,Outpatient,,,,38.75,32.9375,11.10575,38.75,"UCare Health, Inc.",Medical Assistance,19.557125,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BETADINE 5% STERILE OPHTHALMIC PREP SOLUTION 30ML,,L8606,HCPCS,Facility,Inpatient,,,,38.75,32.9375,11.10575,38.75,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
BETADINE 5% STERILE OPHTHALMIC PREP SOLUTION 30ML,,L8606,HCPCS,Facility,Outpatient,,,,38.75,32.9375,11.10575,38.75,"UCare Health, Inc.",Medicare Advantage,19.557125,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BETADINE 5% STERILE OPHTHALMIC PREP SOLUTION 30ML,,L8606,HCPCS,Facility,Inpatient,,,,38.75,32.9375,11.10575,38.75,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
BETADINE 5% STERILE OPHTHALMIC PREP SOLUTION 30ML,,L8606,HCPCS,Facility,Outpatient,,,,38.75,32.9375,11.10575,38.75,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),19.557125,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BETADINE 5% STERILE OPHTHALMIC PREP SOLUTION 30ML,,L8606,HCPCS,Facility,Inpatient,,,,38.75,32.9375,11.10575,38.75,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
BETADINE 5% STERILE OPHTHALMIC PREP SOLUTION 30ML,,L8606,HCPCS,Facility,Both,,,,38.75,32.9375,11.10575,38.75,UnitedHealthcare,Individual & Family,36.425,94,,percent of total billed charges,,
BETADINE 5% STERILE OPHTHALMIC PREP SOLUTION 30ML,,L8606,HCPCS,Facility,Outpatient,,,,38.75,32.9375,11.10575,38.75,UnitedHealthcare,Medicare Advantage,18.9875,49,,percent of total billed charges,,
BETADINE 5% STERILE OPHTHALMIC PREP SOLUTION 30ML,,L8606,HCPCS,Facility,Inpatient,,,,38.75,32.9375,11.10575,38.75,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
BETADINE 5% STERILE OPHTHALMIC PREP SOLUTION 30ML,,L8606,HCPCS,Facility,Outpatient,,,,38.75,32.9375,11.10575,38.75,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,18.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
BETADINE 5% STERILE OPHTHALMIC PREP SOLUTION 30ML,,L8606,HCPCS,Facility,Inpatient,,,,38.75,32.9375,11.10575,38.75,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
MACROPLASTIQUE URETHRAL BULKING AGENT IMPLANT 2.5ML   MPQ-2.5,,L8606,HCPCS,Facility,Both,,,,1237.5,1051.875,354.6675,1237.5,Aetna,Commercial,1138.5,92,,percent of total billed charges,,
MACROPLASTIQUE URETHRAL BULKING AGENT IMPLANT 2.5ML   MPQ-2.5,,L8606,HCPCS,Facility,Outpatient,,,,1237.5,1051.875,354.6675,1237.5,Aetna,Medicare Advantage,606.375,49,,percent of total billed charges,,
MACROPLASTIQUE URETHRAL BULKING AGENT IMPLANT 2.5ML   MPQ-2.5,,L8606,HCPCS,Facility,Inpatient,,,,1237.5,1051.875,354.6675,1237.5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
MACROPLASTIQUE URETHRAL BULKING AGENT IMPLANT 2.5ML   MPQ-2.5,,L8606,HCPCS,Facility,Both,,,,1237.5,1051.875,354.6675,1237.5,Aetna,PPO,1150.875,93,,percent of total billed charges,,
MACROPLASTIQUE URETHRAL BULKING AGENT IMPLANT 2.5ML   MPQ-2.5,,L8606,HCPCS,Facility,Both,,,,1237.5,1051.875,354.6675,1237.5,America's PPO,America's PPO,1188.37125,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
MACROPLASTIQUE URETHRAL BULKING AGENT IMPLANT 2.5ML   MPQ-2.5,,L8606,HCPCS,Facility,Both,,,,1237.5,1051.875,354.6675,1237.5,BlueCross BlueShield Minnesota, Federal Employee Program,1217.7,98.4,,percent of total billed charges,,
MACROPLASTIQUE URETHRAL BULKING AGENT IMPLANT 2.5ML   MPQ-2.5,,L8606,HCPCS,Facility,Both,,,,1237.5,1051.875,354.6675,1237.5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1237.5,100,,percent of total billed charges,,
MACROPLASTIQUE URETHRAL BULKING AGENT IMPLANT 2.5ML   MPQ-2.5,,L8606,HCPCS,Facility,Both,,,,1237.5,1051.875,354.6675,1237.5,BlueCross BlueShield Minnesota,High Value Network Plan,1113.75,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
MACROPLASTIQUE URETHRAL BULKING AGENT IMPLANT 2.5ML   MPQ-2.5,,L8606,HCPCS,Facility,Outpatient,,,,1237.5,1051.875,354.6675,1237.5,BlueCross BlueShield Minnesota,Medicare Advantage,606.375,49,,percent of total billed charges,,
MACROPLASTIQUE URETHRAL BULKING AGENT IMPLANT 2.5ML   MPQ-2.5,,L8606,HCPCS,Facility,Inpatient,,,,1237.5,1051.875,354.6675,1237.5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
MACROPLASTIQUE URETHRAL BULKING AGENT IMPLANT 2.5ML   MPQ-2.5,,L8606,HCPCS,Facility,Both,,,,1237.5,1051.875,354.6675,1237.5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1096.05375,88.57,,percent of total billed charges,,
MACROPLASTIQUE URETHRAL BULKING AGENT IMPLANT 2.5ML   MPQ-2.5,,L8606,HCPCS,Facility,Both,,,,1237.5,1051.875,354.6675,1237.5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,354.6675,28.66,,percent of total billed charges,,
MACROPLASTIQUE URETHRAL BULKING AGENT IMPLANT 2.5ML   MPQ-2.5,,L8606,HCPCS,Facility,Outpatient,,,,1237.5,1051.875,354.6675,1237.5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),606.375,49,,percent of total billed charges,,
MACROPLASTIQUE URETHRAL BULKING AGENT IMPLANT 2.5ML   MPQ-2.5,,L8606,HCPCS,Facility,Inpatient,,,,1237.5,1051.875,354.6675,1237.5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
MACROPLASTIQUE URETHRAL BULKING AGENT IMPLANT 2.5ML   MPQ-2.5,,L8606,HCPCS,Facility,Both,,,,1237.5,1051.875,354.6675,1237.5,CorVel,Worker's Compensation,1237.5,100,,percent of total billed charges,,
MACROPLASTIQUE URETHRAL BULKING AGENT IMPLANT 2.5ML   MPQ-2.5,,L8606,HCPCS,Facility,Both,,,,1237.5,1051.875,354.6675,1237.5,First Health Group Corporation,First Health Network,1200.375,97,,percent of total billed charges,,
MACROPLASTIQUE URETHRAL BULKING AGENT IMPLANT 2.5ML   MPQ-2.5,,L8606,HCPCS,Facility,Both,,,,1237.5,1051.875,354.6675,1237.5,"Health Partners, Inc.",Commercial,1170.675,94.6,,percent of total billed charges,,
MACROPLASTIQUE URETHRAL BULKING AGENT IMPLANT 2.5ML   MPQ-2.5,,L8606,HCPCS,Facility,Outpatient,,,,1237.5,1051.875,354.6675,1237.5,"Health Partners, Inc.",Medicare Advantage,606.375,49,,percent of total billed charges,,
MACROPLASTIQUE URETHRAL BULKING AGENT IMPLANT 2.5ML   MPQ-2.5,,L8606,HCPCS,Facility,Inpatient,,,,1237.5,1051.875,354.6675,1237.5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
MACROPLASTIQUE URETHRAL BULKING AGENT IMPLANT 2.5ML   MPQ-2.5,,L8606,HCPCS,Facility,Both,,,,1237.5,1051.875,354.6675,1237.5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),742.5,60,,percent of total billed charges,,
MACROPLASTIQUE URETHRAL BULKING AGENT IMPLANT 2.5ML   MPQ-2.5,,L8606,HCPCS,Facility,Both,,,,1237.5,1051.875,354.6675,1237.5,"Health Partners, Inc.",State of Minnesota Advantage Program,1008.5625,81.5,,percent of total billed charges,,
MACROPLASTIQUE URETHRAL BULKING AGENT IMPLANT 2.5ML   MPQ-2.5,,L8606,HCPCS,Facility,Both,,,,1237.5,1051.875,354.6675,1237.5,"Health Partners, Inc.",State Public Programs,618.75,50,,percent of total billed charges,,
MACROPLASTIQUE URETHRAL BULKING AGENT IMPLANT 2.5ML   MPQ-2.5,,L8606,HCPCS,Facility,Both,,,,1237.5,1051.875,354.6675,1237.5,Humana Insurance Company,Commercial PPO,1175.625,95,,percent of total billed charges,,
MACROPLASTIQUE URETHRAL BULKING AGENT IMPLANT 2.5ML   MPQ-2.5,,L8606,HCPCS,Facility,Outpatient,,,,1237.5,1051.875,354.6675,1237.5,Humana Insurance Company,Medicare PPO,606.375,49,,percent of total billed charges,,
MACROPLASTIQUE URETHRAL BULKING AGENT IMPLANT 2.5ML   MPQ-2.5,,L8606,HCPCS,Facility,Inpatient,,,,1237.5,1051.875,354.6675,1237.5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
MACROPLASTIQUE URETHRAL BULKING AGENT IMPLANT 2.5ML   MPQ-2.5,,L8606,HCPCS,Facility,Both,,,,1237.5,1051.875,354.6675,1237.5,Medica,Individual & Family,1226.3625,99.1,,percent of total billed charges,,
MACROPLASTIQUE URETHRAL BULKING AGENT IMPLANT 2.5ML   MPQ-2.5,,L8606,HCPCS,Facility,Outpatient,,,,1237.5,1051.875,354.6675,1237.5,Medica,Medica Advantage Solution,616.275,49.8,,percent of total billed charges,,
MACROPLASTIQUE URETHRAL BULKING AGENT IMPLANT 2.5ML   MPQ-2.5,,L8606,HCPCS,Facility,Inpatient,,,,1237.5,1051.875,354.6675,1237.5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
MACROPLASTIQUE URETHRAL BULKING AGENT IMPLANT 2.5ML   MPQ-2.5,,L8606,HCPCS,Facility,Outpatient,,,,1237.5,1051.875,354.6675,1237.5,Medica,Medical Assistance,551.925,44.6,,percent of total billed charges,,
MACROPLASTIQUE URETHRAL BULKING AGENT IMPLANT 2.5ML   MPQ-2.5,,L8606,HCPCS,Facility,Inpatient,,,,1237.5,1051.875,354.6675,1237.5,Medica,Medical Assistance,,,,,Included in per diem rate,
MACROPLASTIQUE URETHRAL BULKING AGENT IMPLANT 2.5ML   MPQ-2.5,,L8606,HCPCS,Facility,Outpatient,,,,1237.5,1051.875,354.6675,1237.5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,616.275,49.8,,percent of total billed charges,,
MACROPLASTIQUE URETHRAL BULKING AGENT IMPLANT 2.5ML   MPQ-2.5,,L8606,HCPCS,Facility,Inpatient,,,,1237.5,1051.875,354.6675,1237.5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
MACROPLASTIQUE URETHRAL BULKING AGENT IMPLANT 2.5ML   MPQ-2.5,,L8606,HCPCS,Facility,Both,,,,1237.5,1051.875,354.6675,1237.5,"Multiplan, Inc.","Multiplan, Inc.",1163.25,94,,percent of total billed charges,,
MACROPLASTIQUE URETHRAL BULKING AGENT IMPLANT 2.5ML   MPQ-2.5,,L8606,HCPCS,Facility,Outpatient,,,,1237.5,1051.875,354.6675,1237.5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1114.9875,90.1,,percent of total billed charges,,
MACROPLASTIQUE URETHRAL BULKING AGENT IMPLANT 2.5ML   MPQ-2.5,,L8606,HCPCS,Facility,Inpatient,,,,1237.5,1051.875,354.6675,1237.5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
MACROPLASTIQUE URETHRAL BULKING AGENT IMPLANT 2.5ML   MPQ-2.5,,L8606,HCPCS,Facility,Both,,,,1237.5,1051.875,354.6675,1237.5,"Preferred One Administrative Services, INC.",PPO,1220.175,98.6,,percent of total billed charges,,
MACROPLASTIQUE URETHRAL BULKING AGENT IMPLANT 2.5ML   MPQ-2.5,,L8606,HCPCS,Facility,Outpatient,,,,1237.5,1051.875,354.6675,1237.5,PrimeWest Health,Minnesota Senior Health Options (MSHO),636.69375,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
MACROPLASTIQUE URETHRAL BULKING AGENT IMPLANT 2.5ML   MPQ-2.5,,L8606,HCPCS,Facility,Inpatient,,,,1237.5,1051.875,354.6675,1237.5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
MACROPLASTIQUE URETHRAL BULKING AGENT IMPLANT 2.5ML   MPQ-2.5,,L8606,HCPCS,Facility,Outpatient,,,,1237.5,1051.875,354.6675,1237.5,PrimeWest Health,MinnesotaCare,635.58,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
MACROPLASTIQUE URETHRAL BULKING AGENT IMPLANT 2.5ML   MPQ-2.5,,L8606,HCPCS,Facility,Inpatient,,,,1237.5,1051.875,354.6675,1237.5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
MACROPLASTIQUE URETHRAL BULKING AGENT IMPLANT 2.5ML   MPQ-2.5,,L8606,HCPCS,Facility,Both,,,,1237.5,1051.875,354.6675,1237.5,Sanford Health Plan,Sanford Health Plan,1138.5,92,,percent of total billed charges,,
MACROPLASTIQUE URETHRAL BULKING AGENT IMPLANT 2.5ML   MPQ-2.5,,L8606,HCPCS,Facility,Outpatient,,,,1237.5,1051.875,354.6675,1237.5,"UCare Health, Inc.",Individual & Family Plan,697.33125,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
MACROPLASTIQUE URETHRAL BULKING AGENT IMPLANT 2.5ML   MPQ-2.5,,L8606,HCPCS,Facility,Inpatient,,,,1237.5,1051.875,354.6675,1237.5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
MACROPLASTIQUE URETHRAL BULKING AGENT IMPLANT 2.5ML   MPQ-2.5,,L8606,HCPCS,Facility,Outpatient,,,,1237.5,1051.875,354.6675,1237.5,"UCare Health, Inc.",Medical Assistance,624.56625,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MACROPLASTIQUE URETHRAL BULKING AGENT IMPLANT 2.5ML   MPQ-2.5,,L8606,HCPCS,Facility,Inpatient,,,,1237.5,1051.875,354.6675,1237.5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
MACROPLASTIQUE URETHRAL BULKING AGENT IMPLANT 2.5ML   MPQ-2.5,,L8606,HCPCS,Facility,Outpatient,,,,1237.5,1051.875,354.6675,1237.5,"UCare Health, Inc.",Medicare Advantage,624.56625,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MACROPLASTIQUE URETHRAL BULKING AGENT IMPLANT 2.5ML   MPQ-2.5,,L8606,HCPCS,Facility,Inpatient,,,,1237.5,1051.875,354.6675,1237.5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
MACROPLASTIQUE URETHRAL BULKING AGENT IMPLANT 2.5ML   MPQ-2.5,,L8606,HCPCS,Facility,Outpatient,,,,1237.5,1051.875,354.6675,1237.5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),624.56625,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MACROPLASTIQUE URETHRAL BULKING AGENT IMPLANT 2.5ML   MPQ-2.5,,L8606,HCPCS,Facility,Inpatient,,,,1237.5,1051.875,354.6675,1237.5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
MACROPLASTIQUE URETHRAL BULKING AGENT IMPLANT 2.5ML   MPQ-2.5,,L8606,HCPCS,Facility,Both,,,,1237.5,1051.875,354.6675,1237.5,UnitedHealthcare,Individual & Family,1163.25,94,,percent of total billed charges,,
MACROPLASTIQUE URETHRAL BULKING AGENT IMPLANT 2.5ML   MPQ-2.5,,L8606,HCPCS,Facility,Outpatient,,,,1237.5,1051.875,354.6675,1237.5,UnitedHealthcare,Medicare Advantage,606.375,49,,percent of total billed charges,,
MACROPLASTIQUE URETHRAL BULKING AGENT IMPLANT 2.5ML   MPQ-2.5,,L8606,HCPCS,Facility,Inpatient,,,,1237.5,1051.875,354.6675,1237.5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
MACROPLASTIQUE URETHRAL BULKING AGENT IMPLANT 2.5ML   MPQ-2.5,,L8606,HCPCS,Facility,Outpatient,,,,1237.5,1051.875,354.6675,1237.5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,594,48,,percent of total billed charges,,100% of DHS outpatient percentage
MACROPLASTIQUE URETHRAL BULKING AGENT IMPLANT 2.5ML   MPQ-2.5,,L8606,HCPCS,Facility,Inpatient,,,,1237.5,1051.875,354.6675,1237.5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
DBM PUTTY W/CHIPS 2.5CC TENSIX,,L8699,HCPCS,Facility,Both,,,,3173.9,2697.815,909.63974,3173.9,Aetna,Commercial,2919.988,92,,percent of total billed charges,,
DBM PUTTY W/CHIPS 2.5CC TENSIX,,L8699,HCPCS,Facility,Outpatient,,,,3173.9,2697.815,909.63974,3173.9,Aetna,Medicare Advantage,1555.211,49,,percent of total billed charges,,
DBM PUTTY W/CHIPS 2.5CC TENSIX,,L8699,HCPCS,Facility,Inpatient,,,,3173.9,2697.815,909.63974,3173.9,Aetna,Medicare Advantage,,,,,Included in per diem rate,
DBM PUTTY W/CHIPS 2.5CC TENSIX,,L8699,HCPCS,Facility,Both,,,,3173.9,2697.815,909.63974,3173.9,Aetna,PPO,2951.727,93,,percent of total billed charges,,
DBM PUTTY W/CHIPS 2.5CC TENSIX,,L8699,HCPCS,Facility,Both,,,,3173.9,2697.815,909.63974,3173.9,America's PPO,America's PPO,3047.89617,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
DBM PUTTY W/CHIPS 2.5CC TENSIX,,L8699,HCPCS,Facility,Both,,,,3173.9,2697.815,909.63974,3173.9,BlueCross BlueShield Minnesota, Federal Employee Program,3123.1176,98.4,,percent of total billed charges,,
DBM PUTTY W/CHIPS 2.5CC TENSIX,,L8699,HCPCS,Facility,Both,,,,3173.9,2697.815,909.63974,3173.9,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,3173.9,100,,percent of total billed charges,,
DBM PUTTY W/CHIPS 2.5CC TENSIX,,L8699,HCPCS,Facility,Both,,,,3173.9,2697.815,909.63974,3173.9,BlueCross BlueShield Minnesota,High Value Network Plan,2856.51,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
DBM PUTTY W/CHIPS 2.5CC TENSIX,,L8699,HCPCS,Facility,Outpatient,,,,3173.9,2697.815,909.63974,3173.9,BlueCross BlueShield Minnesota,Medicare Advantage,1555.211,49,,percent of total billed charges,,
DBM PUTTY W/CHIPS 2.5CC TENSIX,,L8699,HCPCS,Facility,Inpatient,,,,3173.9,2697.815,909.63974,3173.9,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
DBM PUTTY W/CHIPS 2.5CC TENSIX,,L8699,HCPCS,Facility,Both,,,,3173.9,2697.815,909.63974,3173.9,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,2811.12323,88.57,,percent of total billed charges,,
DBM PUTTY W/CHIPS 2.5CC TENSIX,,L8699,HCPCS,Facility,Both,,,,3173.9,2697.815,909.63974,3173.9,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,909.63974,28.66,,percent of total billed charges,,
DBM PUTTY W/CHIPS 2.5CC TENSIX,,L8699,HCPCS,Facility,Outpatient,,,,3173.9,2697.815,909.63974,3173.9,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1555.211,49,,percent of total billed charges,,
DBM PUTTY W/CHIPS 2.5CC TENSIX,,L8699,HCPCS,Facility,Inpatient,,,,3173.9,2697.815,909.63974,3173.9,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
DBM PUTTY W/CHIPS 2.5CC TENSIX,,L8699,HCPCS,Facility,Both,,,,3173.9,2697.815,909.63974,3173.9,CorVel,Worker's Compensation,3173.9,100,,percent of total billed charges,,
DBM PUTTY W/CHIPS 2.5CC TENSIX,,L8699,HCPCS,Facility,Both,,,,3173.9,2697.815,909.63974,3173.9,First Health Group Corporation,First Health Network,3078.683,97,,percent of total billed charges,,
DBM PUTTY W/CHIPS 2.5CC TENSIX,,L8699,HCPCS,Facility,Both,,,,3173.9,2697.815,909.63974,3173.9,"Health Partners, Inc.",Commercial,3002.5094,94.6,,percent of total billed charges,,
DBM PUTTY W/CHIPS 2.5CC TENSIX,,L8699,HCPCS,Facility,Outpatient,,,,3173.9,2697.815,909.63974,3173.9,"Health Partners, Inc.",Medicare Advantage,1555.211,49,,percent of total billed charges,,
DBM PUTTY W/CHIPS 2.5CC TENSIX,,L8699,HCPCS,Facility,Inpatient,,,,3173.9,2697.815,909.63974,3173.9,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DBM PUTTY W/CHIPS 2.5CC TENSIX,,L8699,HCPCS,Facility,Both,,,,3173.9,2697.815,909.63974,3173.9,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1904.34,60,,percent of total billed charges,,
DBM PUTTY W/CHIPS 2.5CC TENSIX,,L8699,HCPCS,Facility,Both,,,,3173.9,2697.815,909.63974,3173.9,"Health Partners, Inc.",State of Minnesota Advantage Program,2586.7285,81.5,,percent of total billed charges,,
DBM PUTTY W/CHIPS 2.5CC TENSIX,,L8699,HCPCS,Facility,Both,,,,3173.9,2697.815,909.63974,3173.9,"Health Partners, Inc.",State Public Programs,1586.95,50,,percent of total billed charges,,
DBM PUTTY W/CHIPS 2.5CC TENSIX,,L8699,HCPCS,Facility,Both,,,,3173.9,2697.815,909.63974,3173.9,Humana Insurance Company,Commercial PPO,3015.205,95,,percent of total billed charges,,
DBM PUTTY W/CHIPS 2.5CC TENSIX,,L8699,HCPCS,Facility,Outpatient,,,,3173.9,2697.815,909.63974,3173.9,Humana Insurance Company,Medicare PPO,1555.211,49,,percent of total billed charges,,
DBM PUTTY W/CHIPS 2.5CC TENSIX,,L8699,HCPCS,Facility,Inpatient,,,,3173.9,2697.815,909.63974,3173.9,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
DBM PUTTY W/CHIPS 2.5CC TENSIX,,L8699,HCPCS,Facility,Both,,,,3173.9,2697.815,909.63974,3173.9,Medica,Individual & Family,3145.3349,99.1,,percent of total billed charges,,
DBM PUTTY W/CHIPS 2.5CC TENSIX,,L8699,HCPCS,Facility,Outpatient,,,,3173.9,2697.815,909.63974,3173.9,Medica,Medica Advantage Solution,1580.6022,49.8,,percent of total billed charges,,
DBM PUTTY W/CHIPS 2.5CC TENSIX,,L8699,HCPCS,Facility,Inpatient,,,,3173.9,2697.815,909.63974,3173.9,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
DBM PUTTY W/CHIPS 2.5CC TENSIX,,L8699,HCPCS,Facility,Outpatient,,,,3173.9,2697.815,909.63974,3173.9,Medica,Medical Assistance,1415.5594,44.6,,percent of total billed charges,,
DBM PUTTY W/CHIPS 2.5CC TENSIX,,L8699,HCPCS,Facility,Inpatient,,,,3173.9,2697.815,909.63974,3173.9,Medica,Medical Assistance,,,,,Included in per diem rate,
DBM PUTTY W/CHIPS 2.5CC TENSIX,,L8699,HCPCS,Facility,Outpatient,,,,3173.9,2697.815,909.63974,3173.9,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1580.6022,49.8,,percent of total billed charges,,
DBM PUTTY W/CHIPS 2.5CC TENSIX,,L8699,HCPCS,Facility,Inpatient,,,,3173.9,2697.815,909.63974,3173.9,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
DBM PUTTY W/CHIPS 2.5CC TENSIX,,L8699,HCPCS,Facility,Both,,,,3173.9,2697.815,909.63974,3173.9,"Multiplan, Inc.","Multiplan, Inc.",2983.466,94,,percent of total billed charges,,
DBM PUTTY W/CHIPS 2.5CC TENSIX,,L8699,HCPCS,Facility,Outpatient,,,,3173.9,2697.815,909.63974,3173.9,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,2859.6839,90.1,,percent of total billed charges,,
DBM PUTTY W/CHIPS 2.5CC TENSIX,,L8699,HCPCS,Facility,Inpatient,,,,3173.9,2697.815,909.63974,3173.9,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
DBM PUTTY W/CHIPS 2.5CC TENSIX,,L8699,HCPCS,Facility,Both,,,,3173.9,2697.815,909.63974,3173.9,"Preferred One Administrative Services, INC.",PPO,3129.4654,98.6,,percent of total billed charges,,
DBM PUTTY W/CHIPS 2.5CC TENSIX,,L8699,HCPCS,Facility,Outpatient,,,,3173.9,2697.815,909.63974,3173.9,PrimeWest Health,Minnesota Senior Health Options (MSHO),1632.97155,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
DBM PUTTY W/CHIPS 2.5CC TENSIX,,L8699,HCPCS,Facility,Inpatient,,,,3173.9,2697.815,909.63974,3173.9,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DBM PUTTY W/CHIPS 2.5CC TENSIX,,L8699,HCPCS,Facility,Outpatient,,,,3173.9,2697.815,909.63974,3173.9,PrimeWest Health,MinnesotaCare,1630.11504,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
DBM PUTTY W/CHIPS 2.5CC TENSIX,,L8699,HCPCS,Facility,Inpatient,,,,3173.9,2697.815,909.63974,3173.9,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
DBM PUTTY W/CHIPS 2.5CC TENSIX,,L8699,HCPCS,Facility,Both,,,,3173.9,2697.815,909.63974,3173.9,Sanford Health Plan,Sanford Health Plan,2919.988,92,,percent of total billed charges,,
DBM PUTTY W/CHIPS 2.5CC TENSIX,,L8699,HCPCS,Facility,Outpatient,,,,3173.9,2697.815,909.63974,3173.9,"UCare Health, Inc.",Individual & Family Plan,1788.49265,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
DBM PUTTY W/CHIPS 2.5CC TENSIX,,L8699,HCPCS,Facility,Inpatient,,,,3173.9,2697.815,909.63974,3173.9,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
DBM PUTTY W/CHIPS 2.5CC TENSIX,,L8699,HCPCS,Facility,Outpatient,,,,3173.9,2697.815,909.63974,3173.9,"UCare Health, Inc.",Medical Assistance,1601.86733,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DBM PUTTY W/CHIPS 2.5CC TENSIX,,L8699,HCPCS,Facility,Inpatient,,,,3173.9,2697.815,909.63974,3173.9,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
DBM PUTTY W/CHIPS 2.5CC TENSIX,,L8699,HCPCS,Facility,Outpatient,,,,3173.9,2697.815,909.63974,3173.9,"UCare Health, Inc.",Medicare Advantage,1601.86733,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DBM PUTTY W/CHIPS 2.5CC TENSIX,,L8699,HCPCS,Facility,Inpatient,,,,3173.9,2697.815,909.63974,3173.9,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
DBM PUTTY W/CHIPS 2.5CC TENSIX,,L8699,HCPCS,Facility,Outpatient,,,,3173.9,2697.815,909.63974,3173.9,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1601.86733,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
DBM PUTTY W/CHIPS 2.5CC TENSIX,,L8699,HCPCS,Facility,Inpatient,,,,3173.9,2697.815,909.63974,3173.9,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
DBM PUTTY W/CHIPS 2.5CC TENSIX,,L8699,HCPCS,Facility,Both,,,,3173.9,2697.815,909.63974,3173.9,UnitedHealthcare,Individual & Family,2983.466,94,,percent of total billed charges,,
DBM PUTTY W/CHIPS 2.5CC TENSIX,,L8699,HCPCS,Facility,Outpatient,,,,3173.9,2697.815,909.63974,3173.9,UnitedHealthcare,Medicare Advantage,1555.211,49,,percent of total billed charges,,
DBM PUTTY W/CHIPS 2.5CC TENSIX,,L8699,HCPCS,Facility,Inpatient,,,,3173.9,2697.815,909.63974,3173.9,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
DBM PUTTY W/CHIPS 2.5CC TENSIX,,L8699,HCPCS,Facility,Outpatient,,,,3173.9,2697.815,909.63974,3173.9,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1523.472,48,,percent of total billed charges,,100% of DHS outpatient percentage
DBM PUTTY W/CHIPS 2.5CC TENSIX,,L8699,HCPCS,Facility,Inpatient,,,,3173.9,2697.815,909.63974,3173.9,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
HEX SCREW PERSONA PKS 2.5X25MM FEMALE  ZIMMER 42-5099-025-25,,L8699,HCPCS,Facility,Both,,,,427.5,363.375,122.5215,427.5,Aetna,Commercial,393.3,92,,percent of total billed charges,,
HEX SCREW PERSONA PKS 2.5X25MM FEMALE  ZIMMER 42-5099-025-25,,L8699,HCPCS,Facility,Outpatient,,,,427.5,363.375,122.5215,427.5,Aetna,Medicare Advantage,209.475,49,,percent of total billed charges,,
HEX SCREW PERSONA PKS 2.5X25MM FEMALE  ZIMMER 42-5099-025-25,,L8699,HCPCS,Facility,Inpatient,,,,427.5,363.375,122.5215,427.5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
HEX SCREW PERSONA PKS 2.5X25MM FEMALE  ZIMMER 42-5099-025-25,,L8699,HCPCS,Facility,Both,,,,427.5,363.375,122.5215,427.5,Aetna,PPO,397.575,93,,percent of total billed charges,,
HEX SCREW PERSONA PKS 2.5X25MM FEMALE  ZIMMER 42-5099-025-25,,L8699,HCPCS,Facility,Both,,,,427.5,363.375,122.5215,427.5,America's PPO,America's PPO,410.52825,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
HEX SCREW PERSONA PKS 2.5X25MM FEMALE  ZIMMER 42-5099-025-25,,L8699,HCPCS,Facility,Both,,,,427.5,363.375,122.5215,427.5,BlueCross BlueShield Minnesota, Federal Employee Program,420.66,98.4,,percent of total billed charges,,
HEX SCREW PERSONA PKS 2.5X25MM FEMALE  ZIMMER 42-5099-025-25,,L8699,HCPCS,Facility,Both,,,,427.5,363.375,122.5215,427.5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,427.5,100,,percent of total billed charges,,
HEX SCREW PERSONA PKS 2.5X25MM FEMALE  ZIMMER 42-5099-025-25,,L8699,HCPCS,Facility,Both,,,,427.5,363.375,122.5215,427.5,BlueCross BlueShield Minnesota,High Value Network Plan,384.75,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
HEX SCREW PERSONA PKS 2.5X25MM FEMALE  ZIMMER 42-5099-025-25,,L8699,HCPCS,Facility,Outpatient,,,,427.5,363.375,122.5215,427.5,BlueCross BlueShield Minnesota,Medicare Advantage,209.475,49,,percent of total billed charges,,
HEX SCREW PERSONA PKS 2.5X25MM FEMALE  ZIMMER 42-5099-025-25,,L8699,HCPCS,Facility,Inpatient,,,,427.5,363.375,122.5215,427.5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
HEX SCREW PERSONA PKS 2.5X25MM FEMALE  ZIMMER 42-5099-025-25,,L8699,HCPCS,Facility,Both,,,,427.5,363.375,122.5215,427.5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,378.63675,88.57,,percent of total billed charges,,
HEX SCREW PERSONA PKS 2.5X25MM FEMALE  ZIMMER 42-5099-025-25,,L8699,HCPCS,Facility,Both,,,,427.5,363.375,122.5215,427.5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,122.5215,28.66,,percent of total billed charges,,
HEX SCREW PERSONA PKS 2.5X25MM FEMALE  ZIMMER 42-5099-025-25,,L8699,HCPCS,Facility,Outpatient,,,,427.5,363.375,122.5215,427.5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),209.475,49,,percent of total billed charges,,
HEX SCREW PERSONA PKS 2.5X25MM FEMALE  ZIMMER 42-5099-025-25,,L8699,HCPCS,Facility,Inpatient,,,,427.5,363.375,122.5215,427.5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
HEX SCREW PERSONA PKS 2.5X25MM FEMALE  ZIMMER 42-5099-025-25,,L8699,HCPCS,Facility,Both,,,,427.5,363.375,122.5215,427.5,CorVel,Worker's Compensation,427.5,100,,percent of total billed charges,,
HEX SCREW PERSONA PKS 2.5X25MM FEMALE  ZIMMER 42-5099-025-25,,L8699,HCPCS,Facility,Both,,,,427.5,363.375,122.5215,427.5,First Health Group Corporation,First Health Network,414.675,97,,percent of total billed charges,,
HEX SCREW PERSONA PKS 2.5X25MM FEMALE  ZIMMER 42-5099-025-25,,L8699,HCPCS,Facility,Both,,,,427.5,363.375,122.5215,427.5,"Health Partners, Inc.",Commercial,404.415,94.6,,percent of total billed charges,,
HEX SCREW PERSONA PKS 2.5X25MM FEMALE  ZIMMER 42-5099-025-25,,L8699,HCPCS,Facility,Outpatient,,,,427.5,363.375,122.5215,427.5,"Health Partners, Inc.",Medicare Advantage,209.475,49,,percent of total billed charges,,
HEX SCREW PERSONA PKS 2.5X25MM FEMALE  ZIMMER 42-5099-025-25,,L8699,HCPCS,Facility,Inpatient,,,,427.5,363.375,122.5215,427.5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
HEX SCREW PERSONA PKS 2.5X25MM FEMALE  ZIMMER 42-5099-025-25,,L8699,HCPCS,Facility,Both,,,,427.5,363.375,122.5215,427.5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),256.5,60,,percent of total billed charges,,
HEX SCREW PERSONA PKS 2.5X25MM FEMALE  ZIMMER 42-5099-025-25,,L8699,HCPCS,Facility,Both,,,,427.5,363.375,122.5215,427.5,"Health Partners, Inc.",State of Minnesota Advantage Program,348.4125,81.5,,percent of total billed charges,,
HEX SCREW PERSONA PKS 2.5X25MM FEMALE  ZIMMER 42-5099-025-25,,L8699,HCPCS,Facility,Both,,,,427.5,363.375,122.5215,427.5,"Health Partners, Inc.",State Public Programs,213.75,50,,percent of total billed charges,,
HEX SCREW PERSONA PKS 2.5X25MM FEMALE  ZIMMER 42-5099-025-25,,L8699,HCPCS,Facility,Both,,,,427.5,363.375,122.5215,427.5,Humana Insurance Company,Commercial PPO,406.125,95,,percent of total billed charges,,
HEX SCREW PERSONA PKS 2.5X25MM FEMALE  ZIMMER 42-5099-025-25,,L8699,HCPCS,Facility,Outpatient,,,,427.5,363.375,122.5215,427.5,Humana Insurance Company,Medicare PPO,209.475,49,,percent of total billed charges,,
HEX SCREW PERSONA PKS 2.5X25MM FEMALE  ZIMMER 42-5099-025-25,,L8699,HCPCS,Facility,Inpatient,,,,427.5,363.375,122.5215,427.5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
HEX SCREW PERSONA PKS 2.5X25MM FEMALE  ZIMMER 42-5099-025-25,,L8699,HCPCS,Facility,Both,,,,427.5,363.375,122.5215,427.5,Medica,Individual & Family,423.6525,99.1,,percent of total billed charges,,
HEX SCREW PERSONA PKS 2.5X25MM FEMALE  ZIMMER 42-5099-025-25,,L8699,HCPCS,Facility,Outpatient,,,,427.5,363.375,122.5215,427.5,Medica,Medica Advantage Solution,212.895,49.8,,percent of total billed charges,,
HEX SCREW PERSONA PKS 2.5X25MM FEMALE  ZIMMER 42-5099-025-25,,L8699,HCPCS,Facility,Inpatient,,,,427.5,363.375,122.5215,427.5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
HEX SCREW PERSONA PKS 2.5X25MM FEMALE  ZIMMER 42-5099-025-25,,L8699,HCPCS,Facility,Outpatient,,,,427.5,363.375,122.5215,427.5,Medica,Medical Assistance,190.665,44.6,,percent of total billed charges,,
HEX SCREW PERSONA PKS 2.5X25MM FEMALE  ZIMMER 42-5099-025-25,,L8699,HCPCS,Facility,Inpatient,,,,427.5,363.375,122.5215,427.5,Medica,Medical Assistance,,,,,Included in per diem rate,
HEX SCREW PERSONA PKS 2.5X25MM FEMALE  ZIMMER 42-5099-025-25,,L8699,HCPCS,Facility,Outpatient,,,,427.5,363.375,122.5215,427.5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,212.895,49.8,,percent of total billed charges,,
HEX SCREW PERSONA PKS 2.5X25MM FEMALE  ZIMMER 42-5099-025-25,,L8699,HCPCS,Facility,Inpatient,,,,427.5,363.375,122.5215,427.5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
HEX SCREW PERSONA PKS 2.5X25MM FEMALE  ZIMMER 42-5099-025-25,,L8699,HCPCS,Facility,Both,,,,427.5,363.375,122.5215,427.5,"Multiplan, Inc.","Multiplan, Inc.",401.85,94,,percent of total billed charges,,
HEX SCREW PERSONA PKS 2.5X25MM FEMALE  ZIMMER 42-5099-025-25,,L8699,HCPCS,Facility,Outpatient,,,,427.5,363.375,122.5215,427.5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,385.1775,90.1,,percent of total billed charges,,
HEX SCREW PERSONA PKS 2.5X25MM FEMALE  ZIMMER 42-5099-025-25,,L8699,HCPCS,Facility,Inpatient,,,,427.5,363.375,122.5215,427.5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
HEX SCREW PERSONA PKS 2.5X25MM FEMALE  ZIMMER 42-5099-025-25,,L8699,HCPCS,Facility,Both,,,,427.5,363.375,122.5215,427.5,"Preferred One Administrative Services, INC.",PPO,421.515,98.6,,percent of total billed charges,,
HEX SCREW PERSONA PKS 2.5X25MM FEMALE  ZIMMER 42-5099-025-25,,L8699,HCPCS,Facility,Outpatient,,,,427.5,363.375,122.5215,427.5,PrimeWest Health,Minnesota Senior Health Options (MSHO),219.94875,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
HEX SCREW PERSONA PKS 2.5X25MM FEMALE  ZIMMER 42-5099-025-25,,L8699,HCPCS,Facility,Inpatient,,,,427.5,363.375,122.5215,427.5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
HEX SCREW PERSONA PKS 2.5X25MM FEMALE  ZIMMER 42-5099-025-25,,L8699,HCPCS,Facility,Outpatient,,,,427.5,363.375,122.5215,427.5,PrimeWest Health,MinnesotaCare,219.564,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
HEX SCREW PERSONA PKS 2.5X25MM FEMALE  ZIMMER 42-5099-025-25,,L8699,HCPCS,Facility,Inpatient,,,,427.5,363.375,122.5215,427.5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
HEX SCREW PERSONA PKS 2.5X25MM FEMALE  ZIMMER 42-5099-025-25,,L8699,HCPCS,Facility,Both,,,,427.5,363.375,122.5215,427.5,Sanford Health Plan,Sanford Health Plan,393.3,92,,percent of total billed charges,,
HEX SCREW PERSONA PKS 2.5X25MM FEMALE  ZIMMER 42-5099-025-25,,L8699,HCPCS,Facility,Outpatient,,,,427.5,363.375,122.5215,427.5,"UCare Health, Inc.",Individual & Family Plan,240.89625,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
HEX SCREW PERSONA PKS 2.5X25MM FEMALE  ZIMMER 42-5099-025-25,,L8699,HCPCS,Facility,Inpatient,,,,427.5,363.375,122.5215,427.5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
HEX SCREW PERSONA PKS 2.5X25MM FEMALE  ZIMMER 42-5099-025-25,,L8699,HCPCS,Facility,Outpatient,,,,427.5,363.375,122.5215,427.5,"UCare Health, Inc.",Medical Assistance,215.75925,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
HEX SCREW PERSONA PKS 2.5X25MM FEMALE  ZIMMER 42-5099-025-25,,L8699,HCPCS,Facility,Inpatient,,,,427.5,363.375,122.5215,427.5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
HEX SCREW PERSONA PKS 2.5X25MM FEMALE  ZIMMER 42-5099-025-25,,L8699,HCPCS,Facility,Outpatient,,,,427.5,363.375,122.5215,427.5,"UCare Health, Inc.",Medicare Advantage,215.75925,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
HEX SCREW PERSONA PKS 2.5X25MM FEMALE  ZIMMER 42-5099-025-25,,L8699,HCPCS,Facility,Inpatient,,,,427.5,363.375,122.5215,427.5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
HEX SCREW PERSONA PKS 2.5X25MM FEMALE  ZIMMER 42-5099-025-25,,L8699,HCPCS,Facility,Outpatient,,,,427.5,363.375,122.5215,427.5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),215.75925,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
HEX SCREW PERSONA PKS 2.5X25MM FEMALE  ZIMMER 42-5099-025-25,,L8699,HCPCS,Facility,Inpatient,,,,427.5,363.375,122.5215,427.5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
HEX SCREW PERSONA PKS 2.5X25MM FEMALE  ZIMMER 42-5099-025-25,,L8699,HCPCS,Facility,Both,,,,427.5,363.375,122.5215,427.5,UnitedHealthcare,Individual & Family,401.85,94,,percent of total billed charges,,
HEX SCREW PERSONA PKS 2.5X25MM FEMALE  ZIMMER 42-5099-025-25,,L8699,HCPCS,Facility,Outpatient,,,,427.5,363.375,122.5215,427.5,UnitedHealthcare,Medicare Advantage,209.475,49,,percent of total billed charges,,
HEX SCREW PERSONA PKS 2.5X25MM FEMALE  ZIMMER 42-5099-025-25,,L8699,HCPCS,Facility,Inpatient,,,,427.5,363.375,122.5215,427.5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
HEX SCREW PERSONA PKS 2.5X25MM FEMALE  ZIMMER 42-5099-025-25,,L8699,HCPCS,Facility,Outpatient,,,,427.5,363.375,122.5215,427.5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,205.2,48,,percent of total billed charges,,100% of DHS outpatient percentage
HEX SCREW PERSONA PKS 2.5X25MM FEMALE  ZIMMER 42-5099-025-25,,L8699,HCPCS,Facility,Inpatient,,,,427.5,363.375,122.5215,427.5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Intravenous Infusion Or Subq, Casirivimab And Imdevimab Inc Infusion And Post Admin Monitoring",,M0243,HCPCS,Facility,Both,,,,357,303.45,159.222,915.416,Aetna,Commercial,328.44,92,,percent of total billed charges,,
"Intravenous Infusion Or Subq, Casirivimab And Imdevimab Inc Infusion And Post Admin Monitoring",,M0243,HCPCS,Facility,Outpatient,,,,357,303.45,159.222,915.416,Aetna,Medicare Advantage,174.93,49,,percent of total billed charges,,
"Intravenous Infusion Or Subq, Casirivimab And Imdevimab Inc Infusion And Post Admin Monitoring",,M0243,HCPCS,Facility,Inpatient,,,,357,303.45,159.222,915.416,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Intravenous Infusion Or Subq, Casirivimab And Imdevimab Inc Infusion And Post Admin Monitoring",,M0243,HCPCS,Facility,Both,,,,357,303.45,159.222,915.416,Aetna,PPO,332.01,93,,percent of total billed charges,,
"Intravenous Infusion Or Subq, Casirivimab And Imdevimab Inc Infusion And Post Admin Monitoring",,M0243,HCPCS,Facility,Both,,,,357,303.45,159.222,915.416,America's PPO,America's PPO,342.8271,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Intravenous Infusion Or Subq, Casirivimab And Imdevimab Inc Infusion And Post Admin Monitoring",,M0243,HCPCS,Facility,Both,,,,357,303.45,159.222,915.416,BlueCross BlueShield Minnesota, Federal Employee Program,901,,,Fee schedule,,100% of BCBS commercial commodity fee schedule
"Intravenous Infusion Or Subq, Casirivimab And Imdevimab Inc Infusion And Post Admin Monitoring",,M0243,HCPCS,Facility,Both,,,,357,303.45,159.222,915.416,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,915.416,,,Fee schedule,,"100% of BCBS commercial commodity fee schedule, plus MN Care tax"
"Intravenous Infusion Or Subq, Casirivimab And Imdevimab Inc Infusion And Post Admin Monitoring",,M0243,HCPCS,Facility,Both,,,,357,303.45,159.222,915.416,BlueCross BlueShield Minnesota,High Value Network Plan,321.3,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
"Intravenous Infusion Or Subq, Casirivimab And Imdevimab Inc Infusion And Post Admin Monitoring",,M0243,HCPCS,Facility,Outpatient,,,,357,303.45,159.222,915.416,BlueCross BlueShield Minnesota,Medicare Advantage,174.93,49,,percent of total billed charges,,
"Intravenous Infusion Or Subq, Casirivimab And Imdevimab Inc Infusion And Post Admin Monitoring",,M0243,HCPCS,Facility,Inpatient,,,,357,303.45,159.222,915.416,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Intravenous Infusion Or Subq, Casirivimab And Imdevimab Inc Infusion And Post Admin Monitoring",,M0243,HCPCS,Facility,Both,,,,357,303.45,159.222,915.416,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,810.7839512,,,Fee schedule,,"88.57% of BCBS commercial commodity fee schedule, plus MN Care tax"
"Intravenous Infusion Or Subq, Casirivimab And Imdevimab Inc Infusion And Post Admin Monitoring",,M0243,HCPCS,Facility,Both,,,,357,303.45,159.222,915.416,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,457.708,,,Fee schedule,,"100% of BCBS Medicaid commodity fee schedule, plus MN Care tax"
"Intravenous Infusion Or Subq, Casirivimab And Imdevimab Inc Infusion And Post Admin Monitoring",,M0243,HCPCS,Facility,Outpatient,,,,357,303.45,159.222,915.416,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),174.93,49,,percent of total billed charges,,
"Intravenous Infusion Or Subq, Casirivimab And Imdevimab Inc Infusion And Post Admin Monitoring",,M0243,HCPCS,Facility,Inpatient,,,,357,303.45,159.222,915.416,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Intravenous Infusion Or Subq, Casirivimab And Imdevimab Inc Infusion And Post Admin Monitoring",,M0243,HCPCS,Facility,Both,,,,357,303.45,159.222,915.416,CorVel,Worker's Compensation,357,100,,percent of total billed charges,,
"Intravenous Infusion Or Subq, Casirivimab And Imdevimab Inc Infusion And Post Admin Monitoring",,M0243,HCPCS,Facility,Both,,,,357,303.45,159.222,915.416,First Health Group Corporation,First Health Network,346.29,97,,percent of total billed charges,,
"Intravenous Infusion Or Subq, Casirivimab And Imdevimab Inc Infusion And Post Admin Monitoring",,M0243,HCPCS,Facility,Both,,,,357,303.45,159.222,915.416,"Health Partners, Inc.",Commercial,337.722,94.6,,percent of total billed charges,,
"Intravenous Infusion Or Subq, Casirivimab And Imdevimab Inc Infusion And Post Admin Monitoring",,M0243,HCPCS,Facility,Outpatient,,,,357,303.45,159.222,915.416,"Health Partners, Inc.",Medicare Advantage,174.93,49,,percent of total billed charges,,
"Intravenous Infusion Or Subq, Casirivimab And Imdevimab Inc Infusion And Post Admin Monitoring",,M0243,HCPCS,Facility,Inpatient,,,,357,303.45,159.222,915.416,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Intravenous Infusion Or Subq, Casirivimab And Imdevimab Inc Infusion And Post Admin Monitoring",,M0243,HCPCS,Facility,Both,,,,357,303.45,159.222,915.416,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),214.2,60,,percent of total billed charges,,
"Intravenous Infusion Or Subq, Casirivimab And Imdevimab Inc Infusion And Post Admin Monitoring",,M0243,HCPCS,Facility,Both,,,,357,303.45,159.222,915.416,"Health Partners, Inc.",State of Minnesota Advantage Program,290.955,81.5,,percent of total billed charges,,
"Intravenous Infusion Or Subq, Casirivimab And Imdevimab Inc Infusion And Post Admin Monitoring",,M0243,HCPCS,Facility,Both,,,,357,303.45,159.222,915.416,"Health Partners, Inc.",State Public Programs,178.5,50,,percent of total billed charges,,
"Intravenous Infusion Or Subq, Casirivimab And Imdevimab Inc Infusion And Post Admin Monitoring",,M0243,HCPCS,Facility,Both,,,,357,303.45,159.222,915.416,Humana Insurance Company,Commercial PPO,339.15,95,,percent of total billed charges,,
"Intravenous Infusion Or Subq, Casirivimab And Imdevimab Inc Infusion And Post Admin Monitoring",,M0243,HCPCS,Facility,Outpatient,,,,357,303.45,159.222,915.416,Humana Insurance Company,Medicare PPO,174.93,49,,percent of total billed charges,,
"Intravenous Infusion Or Subq, Casirivimab And Imdevimab Inc Infusion And Post Admin Monitoring",,M0243,HCPCS,Facility,Inpatient,,,,357,303.45,159.222,915.416,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Intravenous Infusion Or Subq, Casirivimab And Imdevimab Inc Infusion And Post Admin Monitoring",,M0243,HCPCS,Facility,Both,,,,357,303.45,159.222,915.416,Medica,Individual & Family,353.787,99.1,,percent of total billed charges,,
"Intravenous Infusion Or Subq, Casirivimab And Imdevimab Inc Infusion And Post Admin Monitoring",,M0243,HCPCS,Facility,Outpatient,,,,357,303.45,159.222,915.416,Medica,Medica Advantage Solution,177.786,49.8,,percent of total billed charges,,
"Intravenous Infusion Or Subq, Casirivimab And Imdevimab Inc Infusion And Post Admin Monitoring",,M0243,HCPCS,Facility,Inpatient,,,,357,303.45,159.222,915.416,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Intravenous Infusion Or Subq, Casirivimab And Imdevimab Inc Infusion And Post Admin Monitoring",,M0243,HCPCS,Facility,Outpatient,,,,357,303.45,159.222,915.416,Medica,Medical Assistance,159.222,44.6,,percent of total billed charges,,
"Intravenous Infusion Or Subq, Casirivimab And Imdevimab Inc Infusion And Post Admin Monitoring",,M0243,HCPCS,Facility,Inpatient,,,,357,303.45,159.222,915.416,Medica,Medical Assistance,,,,,Included in per diem rate,
"Intravenous Infusion Or Subq, Casirivimab And Imdevimab Inc Infusion And Post Admin Monitoring",,M0243,HCPCS,Facility,Outpatient,,,,357,303.45,159.222,915.416,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,177.786,49.8,,percent of total billed charges,,
"Intravenous Infusion Or Subq, Casirivimab And Imdevimab Inc Infusion And Post Admin Monitoring",,M0243,HCPCS,Facility,Inpatient,,,,357,303.45,159.222,915.416,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Intravenous Infusion Or Subq, Casirivimab And Imdevimab Inc Infusion And Post Admin Monitoring",,M0243,HCPCS,Facility,Both,,,,357,303.45,159.222,915.416,"Multiplan, Inc.","Multiplan, Inc.",335.58,94,,percent of total billed charges,,
"Intravenous Infusion Or Subq, Casirivimab And Imdevimab Inc Infusion And Post Admin Monitoring",,M0243,HCPCS,Facility,Outpatient,,,,357,303.45,159.222,915.416,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,321.657,90.1,,percent of total billed charges,,
"Intravenous Infusion Or Subq, Casirivimab And Imdevimab Inc Infusion And Post Admin Monitoring",,M0243,HCPCS,Facility,Inpatient,,,,357,303.45,159.222,915.416,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Intravenous Infusion Or Subq, Casirivimab And Imdevimab Inc Infusion And Post Admin Monitoring",,M0243,HCPCS,Facility,Both,,,,357,303.45,159.222,915.416,"Preferred One Administrative Services, INC.",PPO,352.002,98.6,,percent of total billed charges,,
"Intravenous Infusion Or Subq, Casirivimab And Imdevimab Inc Infusion And Post Admin Monitoring",,M0243,HCPCS,Facility,Outpatient,,,,357,303.45,159.222,915.416,PrimeWest Health,Minnesota Senior Health Options (MSHO),183.6765,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Intravenous Infusion Or Subq, Casirivimab And Imdevimab Inc Infusion And Post Admin Monitoring",,M0243,HCPCS,Facility,Inpatient,,,,357,303.45,159.222,915.416,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Intravenous Infusion Or Subq, Casirivimab And Imdevimab Inc Infusion And Post Admin Monitoring",,M0243,HCPCS,Facility,Outpatient,,,,357,303.45,159.222,915.416,PrimeWest Health,MinnesotaCare,183.3552,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Intravenous Infusion Or Subq, Casirivimab And Imdevimab Inc Infusion And Post Admin Monitoring",,M0243,HCPCS,Facility,Inpatient,,,,357,303.45,159.222,915.416,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Intravenous Infusion Or Subq, Casirivimab And Imdevimab Inc Infusion And Post Admin Monitoring",,M0243,HCPCS,Facility,Both,,,,357,303.45,159.222,915.416,Sanford Health Plan,Sanford Health Plan,328.44,92,,percent of total billed charges,,
"Intravenous Infusion Or Subq, Casirivimab And Imdevimab Inc Infusion And Post Admin Monitoring",,M0243,HCPCS,Facility,Outpatient,,,,357,303.45,159.222,915.416,"UCare Health, Inc.",Individual & Family Plan,201.1695,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Intravenous Infusion Or Subq, Casirivimab And Imdevimab Inc Infusion And Post Admin Monitoring",,M0243,HCPCS,Facility,Inpatient,,,,357,303.45,159.222,915.416,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Intravenous Infusion Or Subq, Casirivimab And Imdevimab Inc Infusion And Post Admin Monitoring",,M0243,HCPCS,Facility,Outpatient,,,,357,303.45,159.222,915.416,"UCare Health, Inc.",Medical Assistance,180.1779,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Intravenous Infusion Or Subq, Casirivimab And Imdevimab Inc Infusion And Post Admin Monitoring",,M0243,HCPCS,Facility,Inpatient,,,,357,303.45,159.222,915.416,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Intravenous Infusion Or Subq, Casirivimab And Imdevimab Inc Infusion And Post Admin Monitoring",,M0243,HCPCS,Facility,Outpatient,,,,357,303.45,159.222,915.416,"UCare Health, Inc.",Medicare Advantage,180.1779,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Intravenous Infusion Or Subq, Casirivimab And Imdevimab Inc Infusion And Post Admin Monitoring",,M0243,HCPCS,Facility,Inpatient,,,,357,303.45,159.222,915.416,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Intravenous Infusion Or Subq, Casirivimab And Imdevimab Inc Infusion And Post Admin Monitoring",,M0243,HCPCS,Facility,Outpatient,,,,357,303.45,159.222,915.416,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),180.1779,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Intravenous Infusion Or Subq, Casirivimab And Imdevimab Inc Infusion And Post Admin Monitoring",,M0243,HCPCS,Facility,Inpatient,,,,357,303.45,159.222,915.416,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Intravenous Infusion Or Subq, Casirivimab And Imdevimab Inc Infusion And Post Admin Monitoring",,M0243,HCPCS,Facility,Both,,,,357,303.45,159.222,915.416,UnitedHealthcare,Individual & Family,335.58,94,,percent of total billed charges,,
"Intravenous Infusion Or Subq, Casirivimab And Imdevimab Inc Infusion And Post Admin Monitoring",,M0243,HCPCS,Facility,Outpatient,,,,357,303.45,159.222,915.416,UnitedHealthcare,Medicare Advantage,174.93,49,,percent of total billed charges,,
"Intravenous Infusion Or Subq, Casirivimab And Imdevimab Inc Infusion And Post Admin Monitoring",,M0243,HCPCS,Facility,Inpatient,,,,357,303.45,159.222,915.416,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Intravenous Infusion Or Subq, Casirivimab And Imdevimab Inc Infusion And Post Admin Monitoring",,M0243,HCPCS,Facility,Outpatient,,,,357,303.45,159.222,915.416,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,171.36,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Intravenous Infusion Or Subq, Casirivimab And Imdevimab Inc Infusion And Post Admin Monitoring",,M0243,HCPCS,Facility,Inpatient,,,,357,303.45,159.222,915.416,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Intravenous Infusion, Bamlanivimab And Etesevimab, Includes Infusion And Post Administration Monitoring",,M0245,HCPCS,Facility,Both,,,,357,303.45,102.3162,357,Aetna,Commercial,328.44,92,,percent of total billed charges,,
"Intravenous Infusion, Bamlanivimab And Etesevimab, Includes Infusion And Post Administration Monitoring",,M0245,HCPCS,Facility,Outpatient,,,,357,303.45,102.3162,357,Aetna,Medicare Advantage,174.93,49,,percent of total billed charges,,
"Intravenous Infusion, Bamlanivimab And Etesevimab, Includes Infusion And Post Administration Monitoring",,M0245,HCPCS,Facility,Inpatient,,,,357,303.45,102.3162,357,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Intravenous Infusion, Bamlanivimab And Etesevimab, Includes Infusion And Post Administration Monitoring",,M0245,HCPCS,Facility,Both,,,,357,303.45,102.3162,357,Aetna,PPO,332.01,93,,percent of total billed charges,,
"Intravenous Infusion, Bamlanivimab And Etesevimab, Includes Infusion And Post Administration Monitoring",,M0245,HCPCS,Facility,Both,,,,357,303.45,102.3162,357,America's PPO,America's PPO,342.8271,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Intravenous Infusion, Bamlanivimab And Etesevimab, Includes Infusion And Post Administration Monitoring",,M0245,HCPCS,Facility,Both,,,,357,303.45,102.3162,357,BlueCross BlueShield Minnesota, Federal Employee Program,351.288,98.4,,percent of total billed charges,,
"Intravenous Infusion, Bamlanivimab And Etesevimab, Includes Infusion And Post Administration Monitoring",,M0245,HCPCS,Facility,Both,,,,357,303.45,102.3162,357,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,357,100,,percent of total billed charges,,
"Intravenous Infusion, Bamlanivimab And Etesevimab, Includes Infusion And Post Administration Monitoring",,M0245,HCPCS,Facility,Both,,,,357,303.45,102.3162,357,BlueCross BlueShield Minnesota,High Value Network Plan,321.3,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
"Intravenous Infusion, Bamlanivimab And Etesevimab, Includes Infusion And Post Administration Monitoring",,M0245,HCPCS,Facility,Outpatient,,,,357,303.45,102.3162,357,BlueCross BlueShield Minnesota,Medicare Advantage,174.93,49,,percent of total billed charges,,
"Intravenous Infusion, Bamlanivimab And Etesevimab, Includes Infusion And Post Administration Monitoring",,M0245,HCPCS,Facility,Inpatient,,,,357,303.45,102.3162,357,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Intravenous Infusion, Bamlanivimab And Etesevimab, Includes Infusion And Post Administration Monitoring",,M0245,HCPCS,Facility,Both,,,,357,303.45,102.3162,357,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,316.1949,88.57,,percent of total billed charges,,
"Intravenous Infusion, Bamlanivimab And Etesevimab, Includes Infusion And Post Administration Monitoring",,M0245,HCPCS,Facility,Both,,,,357,303.45,102.3162,357,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,102.3162,28.66,,percent of total billed charges,,
"Intravenous Infusion, Bamlanivimab And Etesevimab, Includes Infusion And Post Administration Monitoring",,M0245,HCPCS,Facility,Outpatient,,,,357,303.45,102.3162,357,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),174.93,49,,percent of total billed charges,,
"Intravenous Infusion, Bamlanivimab And Etesevimab, Includes Infusion And Post Administration Monitoring",,M0245,HCPCS,Facility,Inpatient,,,,357,303.45,102.3162,357,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Intravenous Infusion, Bamlanivimab And Etesevimab, Includes Infusion And Post Administration Monitoring",,M0245,HCPCS,Facility,Both,,,,357,303.45,102.3162,357,CorVel,Worker's Compensation,357,100,,percent of total billed charges,,
"Intravenous Infusion, Bamlanivimab And Etesevimab, Includes Infusion And Post Administration Monitoring",,M0245,HCPCS,Facility,Both,,,,357,303.45,102.3162,357,First Health Group Corporation,First Health Network,346.29,97,,percent of total billed charges,,
"Intravenous Infusion, Bamlanivimab And Etesevimab, Includes Infusion And Post Administration Monitoring",,M0245,HCPCS,Facility,Both,,,,357,303.45,102.3162,357,"Health Partners, Inc.",Commercial,337.722,94.6,,percent of total billed charges,,
"Intravenous Infusion, Bamlanivimab And Etesevimab, Includes Infusion And Post Administration Monitoring",,M0245,HCPCS,Facility,Outpatient,,,,357,303.45,102.3162,357,"Health Partners, Inc.",Medicare Advantage,174.93,49,,percent of total billed charges,,
"Intravenous Infusion, Bamlanivimab And Etesevimab, Includes Infusion And Post Administration Monitoring",,M0245,HCPCS,Facility,Inpatient,,,,357,303.45,102.3162,357,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Intravenous Infusion, Bamlanivimab And Etesevimab, Includes Infusion And Post Administration Monitoring",,M0245,HCPCS,Facility,Both,,,,357,303.45,102.3162,357,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),214.2,60,,percent of total billed charges,,
"Intravenous Infusion, Bamlanivimab And Etesevimab, Includes Infusion And Post Administration Monitoring",,M0245,HCPCS,Facility,Both,,,,357,303.45,102.3162,357,"Health Partners, Inc.",State of Minnesota Advantage Program,290.955,81.5,,percent of total billed charges,,
"Intravenous Infusion, Bamlanivimab And Etesevimab, Includes Infusion And Post Administration Monitoring",,M0245,HCPCS,Facility,Both,,,,357,303.45,102.3162,357,"Health Partners, Inc.",State Public Programs,178.5,50,,percent of total billed charges,,
"Intravenous Infusion, Bamlanivimab And Etesevimab, Includes Infusion And Post Administration Monitoring",,M0245,HCPCS,Facility,Both,,,,357,303.45,102.3162,357,Humana Insurance Company,Commercial PPO,339.15,95,,percent of total billed charges,,
"Intravenous Infusion, Bamlanivimab And Etesevimab, Includes Infusion And Post Administration Monitoring",,M0245,HCPCS,Facility,Outpatient,,,,357,303.45,102.3162,357,Humana Insurance Company,Medicare PPO,174.93,49,,percent of total billed charges,,
"Intravenous Infusion, Bamlanivimab And Etesevimab, Includes Infusion And Post Administration Monitoring",,M0245,HCPCS,Facility,Inpatient,,,,357,303.45,102.3162,357,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Intravenous Infusion, Bamlanivimab And Etesevimab, Includes Infusion And Post Administration Monitoring",,M0245,HCPCS,Facility,Both,,,,357,303.45,102.3162,357,Medica,Individual & Family,353.787,99.1,,percent of total billed charges,,
"Intravenous Infusion, Bamlanivimab And Etesevimab, Includes Infusion And Post Administration Monitoring",,M0245,HCPCS,Facility,Outpatient,,,,357,303.45,102.3162,357,Medica,Medica Advantage Solution,177.786,49.8,,percent of total billed charges,,
"Intravenous Infusion, Bamlanivimab And Etesevimab, Includes Infusion And Post Administration Monitoring",,M0245,HCPCS,Facility,Inpatient,,,,357,303.45,102.3162,357,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Intravenous Infusion, Bamlanivimab And Etesevimab, Includes Infusion And Post Administration Monitoring",,M0245,HCPCS,Facility,Outpatient,,,,357,303.45,102.3162,357,Medica,Medical Assistance,159.222,44.6,,percent of total billed charges,,
"Intravenous Infusion, Bamlanivimab And Etesevimab, Includes Infusion And Post Administration Monitoring",,M0245,HCPCS,Facility,Inpatient,,,,357,303.45,102.3162,357,Medica,Medical Assistance,,,,,Included in per diem rate,
"Intravenous Infusion, Bamlanivimab And Etesevimab, Includes Infusion And Post Administration Monitoring",,M0245,HCPCS,Facility,Outpatient,,,,357,303.45,102.3162,357,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,177.786,49.8,,percent of total billed charges,,
"Intravenous Infusion, Bamlanivimab And Etesevimab, Includes Infusion And Post Administration Monitoring",,M0245,HCPCS,Facility,Inpatient,,,,357,303.45,102.3162,357,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Intravenous Infusion, Bamlanivimab And Etesevimab, Includes Infusion And Post Administration Monitoring",,M0245,HCPCS,Facility,Both,,,,357,303.45,102.3162,357,"Multiplan, Inc.","Multiplan, Inc.",335.58,94,,percent of total billed charges,,
"Intravenous Infusion, Bamlanivimab And Etesevimab, Includes Infusion And Post Administration Monitoring",,M0245,HCPCS,Facility,Outpatient,,,,357,303.45,102.3162,357,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,321.657,90.1,,percent of total billed charges,,
"Intravenous Infusion, Bamlanivimab And Etesevimab, Includes Infusion And Post Administration Monitoring",,M0245,HCPCS,Facility,Inpatient,,,,357,303.45,102.3162,357,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Intravenous Infusion, Bamlanivimab And Etesevimab, Includes Infusion And Post Administration Monitoring",,M0245,HCPCS,Facility,Both,,,,357,303.45,102.3162,357,"Preferred One Administrative Services, INC.",PPO,352.002,98.6,,percent of total billed charges,,
"Intravenous Infusion, Bamlanivimab And Etesevimab, Includes Infusion And Post Administration Monitoring",,M0245,HCPCS,Facility,Outpatient,,,,357,303.45,102.3162,357,PrimeWest Health,Minnesota Senior Health Options (MSHO),183.6765,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Intravenous Infusion, Bamlanivimab And Etesevimab, Includes Infusion And Post Administration Monitoring",,M0245,HCPCS,Facility,Inpatient,,,,357,303.45,102.3162,357,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Intravenous Infusion, Bamlanivimab And Etesevimab, Includes Infusion And Post Administration Monitoring",,M0245,HCPCS,Facility,Outpatient,,,,357,303.45,102.3162,357,PrimeWest Health,MinnesotaCare,183.3552,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Intravenous Infusion, Bamlanivimab And Etesevimab, Includes Infusion And Post Administration Monitoring",,M0245,HCPCS,Facility,Inpatient,,,,357,303.45,102.3162,357,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Intravenous Infusion, Bamlanivimab And Etesevimab, Includes Infusion And Post Administration Monitoring",,M0245,HCPCS,Facility,Both,,,,357,303.45,102.3162,357,Sanford Health Plan,Sanford Health Plan,328.44,92,,percent of total billed charges,,
"Intravenous Infusion, Bamlanivimab And Etesevimab, Includes Infusion And Post Administration Monitoring",,M0245,HCPCS,Facility,Outpatient,,,,357,303.45,102.3162,357,"UCare Health, Inc.",Individual & Family Plan,201.1695,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Intravenous Infusion, Bamlanivimab And Etesevimab, Includes Infusion And Post Administration Monitoring",,M0245,HCPCS,Facility,Inpatient,,,,357,303.45,102.3162,357,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Intravenous Infusion, Bamlanivimab And Etesevimab, Includes Infusion And Post Administration Monitoring",,M0245,HCPCS,Facility,Outpatient,,,,357,303.45,102.3162,357,"UCare Health, Inc.",Medical Assistance,180.1779,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Intravenous Infusion, Bamlanivimab And Etesevimab, Includes Infusion And Post Administration Monitoring",,M0245,HCPCS,Facility,Inpatient,,,,357,303.45,102.3162,357,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Intravenous Infusion, Bamlanivimab And Etesevimab, Includes Infusion And Post Administration Monitoring",,M0245,HCPCS,Facility,Outpatient,,,,357,303.45,102.3162,357,"UCare Health, Inc.",Medicare Advantage,180.1779,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Intravenous Infusion, Bamlanivimab And Etesevimab, Includes Infusion And Post Administration Monitoring",,M0245,HCPCS,Facility,Inpatient,,,,357,303.45,102.3162,357,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Intravenous Infusion, Bamlanivimab And Etesevimab, Includes Infusion And Post Administration Monitoring",,M0245,HCPCS,Facility,Outpatient,,,,357,303.45,102.3162,357,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),180.1779,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Intravenous Infusion, Bamlanivimab And Etesevimab, Includes Infusion And Post Administration Monitoring",,M0245,HCPCS,Facility,Inpatient,,,,357,303.45,102.3162,357,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Intravenous Infusion, Bamlanivimab And Etesevimab, Includes Infusion And Post Administration Monitoring",,M0245,HCPCS,Facility,Both,,,,357,303.45,102.3162,357,UnitedHealthcare,Individual & Family,335.58,94,,percent of total billed charges,,
"Intravenous Infusion, Bamlanivimab And Etesevimab, Includes Infusion And Post Administration Monitoring",,M0245,HCPCS,Facility,Outpatient,,,,357,303.45,102.3162,357,UnitedHealthcare,Medicare Advantage,174.93,49,,percent of total billed charges,,
"Intravenous Infusion, Bamlanivimab And Etesevimab, Includes Infusion And Post Administration Monitoring",,M0245,HCPCS,Facility,Inpatient,,,,357,303.45,102.3162,357,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Intravenous Infusion, Bamlanivimab And Etesevimab, Includes Infusion And Post Administration Monitoring",,M0245,HCPCS,Facility,Outpatient,,,,357,303.45,102.3162,357,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,171.36,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Intravenous Infusion, Bamlanivimab And Etesevimab, Includes Infusion And Post Administration Monitoring",,M0245,HCPCS,Facility,Inpatient,,,,357,303.45,102.3162,357,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Cryoprecipitate, Each Unit (Bb)",,P9012,HCPCS,Facility,Both,,,,459,390.15,131.5494,459,Aetna,Commercial,422.28,92,,percent of total billed charges,,
"Cryoprecipitate, Each Unit (Bb)",,P9012,HCPCS,Facility,Outpatient,,,,459,390.15,131.5494,459,Aetna,Medicare Advantage,224.91,49,,percent of total billed charges,,
"Cryoprecipitate, Each Unit (Bb)",,P9012,HCPCS,Facility,Inpatient,,,,459,390.15,131.5494,459,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Cryoprecipitate, Each Unit (Bb)",,P9012,HCPCS,Facility,Both,,,,459,390.15,131.5494,459,Aetna,PPO,426.87,93,,percent of total billed charges,,
"Cryoprecipitate, Each Unit (Bb)",,P9012,HCPCS,Facility,Both,,,,459,390.15,131.5494,459,America's PPO,America's PPO,440.7777,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Cryoprecipitate, Each Unit (Bb)",,P9012,HCPCS,Facility,Both,,,,459,390.15,131.5494,459,BlueCross BlueShield Minnesota, Federal Employee Program,451.656,98.4,,percent of total billed charges,,
"Cryoprecipitate, Each Unit (Bb)",,P9012,HCPCS,Facility,Both,,,,459,390.15,131.5494,459,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,459,100,,percent of total billed charges,,
"Cryoprecipitate, Each Unit (Bb)",,P9012,HCPCS,Facility,Both,,,,459,390.15,131.5494,459,BlueCross BlueShield Minnesota,High Value Network Plan,413.1,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
"Cryoprecipitate, Each Unit (Bb)",,P9012,HCPCS,Facility,Outpatient,,,,459,390.15,131.5494,459,BlueCross BlueShield Minnesota,Medicare Advantage,224.91,49,,percent of total billed charges,,
"Cryoprecipitate, Each Unit (Bb)",,P9012,HCPCS,Facility,Inpatient,,,,459,390.15,131.5494,459,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Cryoprecipitate, Each Unit (Bb)",,P9012,HCPCS,Facility,Both,,,,459,390.15,131.5494,459,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,406.5363,88.57,,percent of total billed charges,,
"Cryoprecipitate, Each Unit (Bb)",,P9012,HCPCS,Facility,Both,,,,459,390.15,131.5494,459,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,131.5494,28.66,,percent of total billed charges,,
"Cryoprecipitate, Each Unit (Bb)",,P9012,HCPCS,Facility,Outpatient,,,,459,390.15,131.5494,459,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),224.91,49,,percent of total billed charges,,
"Cryoprecipitate, Each Unit (Bb)",,P9012,HCPCS,Facility,Inpatient,,,,459,390.15,131.5494,459,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Cryoprecipitate, Each Unit (Bb)",,P9012,HCPCS,Facility,Both,,,,459,390.15,131.5494,459,CorVel,Worker's Compensation,459,100,,percent of total billed charges,,
"Cryoprecipitate, Each Unit (Bb)",,P9012,HCPCS,Facility,Both,,,,459,390.15,131.5494,459,First Health Group Corporation,First Health Network,445.23,97,,percent of total billed charges,,
"Cryoprecipitate, Each Unit (Bb)",,P9012,HCPCS,Facility,Both,,,,459,390.15,131.5494,459,"Health Partners, Inc.",Commercial,434.214,94.6,,percent of total billed charges,,
"Cryoprecipitate, Each Unit (Bb)",,P9012,HCPCS,Facility,Outpatient,,,,459,390.15,131.5494,459,"Health Partners, Inc.",Medicare Advantage,224.91,49,,percent of total billed charges,,
"Cryoprecipitate, Each Unit (Bb)",,P9012,HCPCS,Facility,Inpatient,,,,459,390.15,131.5494,459,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Cryoprecipitate, Each Unit (Bb)",,P9012,HCPCS,Facility,Both,,,,459,390.15,131.5494,459,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),275.4,60,,percent of total billed charges,,
"Cryoprecipitate, Each Unit (Bb)",,P9012,HCPCS,Facility,Both,,,,459,390.15,131.5494,459,"Health Partners, Inc.",State of Minnesota Advantage Program,374.085,81.5,,percent of total billed charges,,
"Cryoprecipitate, Each Unit (Bb)",,P9012,HCPCS,Facility,Both,,,,459,390.15,131.5494,459,"Health Partners, Inc.",State Public Programs,229.5,50,,percent of total billed charges,,
"Cryoprecipitate, Each Unit (Bb)",,P9012,HCPCS,Facility,Both,,,,459,390.15,131.5494,459,Humana Insurance Company,Commercial PPO,436.05,95,,percent of total billed charges,,
"Cryoprecipitate, Each Unit (Bb)",,P9012,HCPCS,Facility,Outpatient,,,,459,390.15,131.5494,459,Humana Insurance Company,Medicare PPO,224.91,49,,percent of total billed charges,,
"Cryoprecipitate, Each Unit (Bb)",,P9012,HCPCS,Facility,Inpatient,,,,459,390.15,131.5494,459,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Cryoprecipitate, Each Unit (Bb)",,P9012,HCPCS,Facility,Both,,,,459,390.15,131.5494,459,Medica,Individual & Family,454.869,99.1,,percent of total billed charges,,
"Cryoprecipitate, Each Unit (Bb)",,P9012,HCPCS,Facility,Outpatient,,,,459,390.15,131.5494,459,Medica,Medica Advantage Solution,228.582,49.8,,percent of total billed charges,,
"Cryoprecipitate, Each Unit (Bb)",,P9012,HCPCS,Facility,Inpatient,,,,459,390.15,131.5494,459,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Cryoprecipitate, Each Unit (Bb)",,P9012,HCPCS,Facility,Outpatient,,,,459,390.15,131.5494,459,Medica,Medical Assistance,204.714,44.6,,percent of total billed charges,,
"Cryoprecipitate, Each Unit (Bb)",,P9012,HCPCS,Facility,Inpatient,,,,459,390.15,131.5494,459,Medica,Medical Assistance,,,,,Included in per diem rate,
"Cryoprecipitate, Each Unit (Bb)",,P9012,HCPCS,Facility,Outpatient,,,,459,390.15,131.5494,459,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,228.582,49.8,,percent of total billed charges,,
"Cryoprecipitate, Each Unit (Bb)",,P9012,HCPCS,Facility,Inpatient,,,,459,390.15,131.5494,459,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Cryoprecipitate, Each Unit (Bb)",,P9012,HCPCS,Facility,Both,,,,459,390.15,131.5494,459,"Multiplan, Inc.","Multiplan, Inc.",431.46,94,,percent of total billed charges,,
"Cryoprecipitate, Each Unit (Bb)",,P9012,HCPCS,Facility,Outpatient,,,,459,390.15,131.5494,459,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,413.559,90.1,,percent of total billed charges,,
"Cryoprecipitate, Each Unit (Bb)",,P9012,HCPCS,Facility,Inpatient,,,,459,390.15,131.5494,459,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Cryoprecipitate, Each Unit (Bb)",,P9012,HCPCS,Facility,Both,,,,459,390.15,131.5494,459,"Preferred One Administrative Services, INC.",PPO,452.574,98.6,,percent of total billed charges,,
"Cryoprecipitate, Each Unit (Bb)",,P9012,HCPCS,Facility,Outpatient,,,,459,390.15,131.5494,459,PrimeWest Health,Minnesota Senior Health Options (MSHO),236.1555,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Cryoprecipitate, Each Unit (Bb)",,P9012,HCPCS,Facility,Inpatient,,,,459,390.15,131.5494,459,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Cryoprecipitate, Each Unit (Bb)",,P9012,HCPCS,Facility,Outpatient,,,,459,390.15,131.5494,459,PrimeWest Health,MinnesotaCare,235.7424,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Cryoprecipitate, Each Unit (Bb)",,P9012,HCPCS,Facility,Inpatient,,,,459,390.15,131.5494,459,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Cryoprecipitate, Each Unit (Bb)",,P9012,HCPCS,Facility,Both,,,,459,390.15,131.5494,459,Sanford Health Plan,Sanford Health Plan,422.28,92,,percent of total billed charges,,
"Cryoprecipitate, Each Unit (Bb)",,P9012,HCPCS,Facility,Outpatient,,,,459,390.15,131.5494,459,"UCare Health, Inc.",Individual & Family Plan,258.6465,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Cryoprecipitate, Each Unit (Bb)",,P9012,HCPCS,Facility,Inpatient,,,,459,390.15,131.5494,459,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Cryoprecipitate, Each Unit (Bb)",,P9012,HCPCS,Facility,Outpatient,,,,459,390.15,131.5494,459,"UCare Health, Inc.",Medical Assistance,231.6573,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Cryoprecipitate, Each Unit (Bb)",,P9012,HCPCS,Facility,Inpatient,,,,459,390.15,131.5494,459,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Cryoprecipitate, Each Unit (Bb)",,P9012,HCPCS,Facility,Outpatient,,,,459,390.15,131.5494,459,"UCare Health, Inc.",Medicare Advantage,231.6573,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Cryoprecipitate, Each Unit (Bb)",,P9012,HCPCS,Facility,Inpatient,,,,459,390.15,131.5494,459,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Cryoprecipitate, Each Unit (Bb)",,P9012,HCPCS,Facility,Outpatient,,,,459,390.15,131.5494,459,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),231.6573,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Cryoprecipitate, Each Unit (Bb)",,P9012,HCPCS,Facility,Inpatient,,,,459,390.15,131.5494,459,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Cryoprecipitate, Each Unit (Bb)",,P9012,HCPCS,Facility,Both,,,,459,390.15,131.5494,459,UnitedHealthcare,Individual & Family,431.46,94,,percent of total billed charges,,
"Cryoprecipitate, Each Unit (Bb)",,P9012,HCPCS,Facility,Outpatient,,,,459,390.15,131.5494,459,UnitedHealthcare,Medicare Advantage,224.91,49,,percent of total billed charges,,
"Cryoprecipitate, Each Unit (Bb)",,P9012,HCPCS,Facility,Inpatient,,,,459,390.15,131.5494,459,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Cryoprecipitate, Each Unit (Bb)",,P9012,HCPCS,Facility,Outpatient,,,,459,390.15,131.5494,459,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,220.32,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Cryoprecipitate, Each Unit (Bb)",,P9012,HCPCS,Facility,Inpatient,,,,459,390.15,131.5494,459,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Red Blood Cells, Leukocytes Reduced, Each Unit (Adult) (Bb)",,P9016,HCPCS,Facility,Both,,,,532,452.2,152.4712,532,Aetna,Commercial,489.44,92,,percent of total billed charges,,
"Red Blood Cells, Leukocytes Reduced, Each Unit (Adult) (Bb)",,P9016,HCPCS,Facility,Outpatient,,,,532,452.2,152.4712,532,Aetna,Medicare Advantage,260.68,49,,percent of total billed charges,,
"Red Blood Cells, Leukocytes Reduced, Each Unit (Adult) (Bb)",,P9016,HCPCS,Facility,Inpatient,,,,532,452.2,152.4712,532,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Red Blood Cells, Leukocytes Reduced, Each Unit (Adult) (Bb)",,P9016,HCPCS,Facility,Both,,,,532,452.2,152.4712,532,Aetna,PPO,494.76,93,,percent of total billed charges,,
"Red Blood Cells, Leukocytes Reduced, Each Unit (Adult) (Bb)",,P9016,HCPCS,Facility,Both,,,,532,452.2,152.4712,532,America's PPO,America's PPO,510.8796,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Red Blood Cells, Leukocytes Reduced, Each Unit (Adult) (Bb)",,P9016,HCPCS,Facility,Both,,,,532,452.2,152.4712,532,BlueCross BlueShield Minnesota, Federal Employee Program,523.488,98.4,,percent of total billed charges,,
"Red Blood Cells, Leukocytes Reduced, Each Unit (Adult) (Bb)",,P9016,HCPCS,Facility,Both,,,,532,452.2,152.4712,532,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,532,100,,percent of total billed charges,,
"Red Blood Cells, Leukocytes Reduced, Each Unit (Adult) (Bb)",,P9016,HCPCS,Facility,Both,,,,532,452.2,152.4712,532,BlueCross BlueShield Minnesota,High Value Network Plan,478.8,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
"Red Blood Cells, Leukocytes Reduced, Each Unit (Adult) (Bb)",,P9016,HCPCS,Facility,Outpatient,,,,532,452.2,152.4712,532,BlueCross BlueShield Minnesota,Medicare Advantage,260.68,49,,percent of total billed charges,,
"Red Blood Cells, Leukocytes Reduced, Each Unit (Adult) (Bb)",,P9016,HCPCS,Facility,Inpatient,,,,532,452.2,152.4712,532,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Red Blood Cells, Leukocytes Reduced, Each Unit (Adult) (Bb)",,P9016,HCPCS,Facility,Both,,,,532,452.2,152.4712,532,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,471.1924,88.57,,percent of total billed charges,,
"Red Blood Cells, Leukocytes Reduced, Each Unit (Adult) (Bb)",,P9016,HCPCS,Facility,Both,,,,532,452.2,152.4712,532,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,152.4712,28.66,,percent of total billed charges,,
"Red Blood Cells, Leukocytes Reduced, Each Unit (Adult) (Bb)",,P9016,HCPCS,Facility,Outpatient,,,,532,452.2,152.4712,532,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),260.68,49,,percent of total billed charges,,
"Red Blood Cells, Leukocytes Reduced, Each Unit (Adult) (Bb)",,P9016,HCPCS,Facility,Inpatient,,,,532,452.2,152.4712,532,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Red Blood Cells, Leukocytes Reduced, Each Unit (Adult) (Bb)",,P9016,HCPCS,Facility,Both,,,,532,452.2,152.4712,532,CorVel,Worker's Compensation,532,100,,percent of total billed charges,,
"Red Blood Cells, Leukocytes Reduced, Each Unit (Adult) (Bb)",,P9016,HCPCS,Facility,Both,,,,532,452.2,152.4712,532,First Health Group Corporation,First Health Network,516.04,97,,percent of total billed charges,,
"Red Blood Cells, Leukocytes Reduced, Each Unit (Adult) (Bb)",,P9016,HCPCS,Facility,Both,,,,532,452.2,152.4712,532,"Health Partners, Inc.",Commercial,503.272,94.6,,percent of total billed charges,,
"Red Blood Cells, Leukocytes Reduced, Each Unit (Adult) (Bb)",,P9016,HCPCS,Facility,Outpatient,,,,532,452.2,152.4712,532,"Health Partners, Inc.",Medicare Advantage,260.68,49,,percent of total billed charges,,
"Red Blood Cells, Leukocytes Reduced, Each Unit (Adult) (Bb)",,P9016,HCPCS,Facility,Inpatient,,,,532,452.2,152.4712,532,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Red Blood Cells, Leukocytes Reduced, Each Unit (Adult) (Bb)",,P9016,HCPCS,Facility,Both,,,,532,452.2,152.4712,532,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),319.2,60,,percent of total billed charges,,
"Red Blood Cells, Leukocytes Reduced, Each Unit (Adult) (Bb)",,P9016,HCPCS,Facility,Both,,,,532,452.2,152.4712,532,"Health Partners, Inc.",State of Minnesota Advantage Program,433.58,81.5,,percent of total billed charges,,
"Red Blood Cells, Leukocytes Reduced, Each Unit (Adult) (Bb)",,P9016,HCPCS,Facility,Both,,,,532,452.2,152.4712,532,"Health Partners, Inc.",State Public Programs,266,50,,percent of total billed charges,,
"Red Blood Cells, Leukocytes Reduced, Each Unit (Adult) (Bb)",,P9016,HCPCS,Facility,Both,,,,532,452.2,152.4712,532,Humana Insurance Company,Commercial PPO,505.4,95,,percent of total billed charges,,
"Red Blood Cells, Leukocytes Reduced, Each Unit (Adult) (Bb)",,P9016,HCPCS,Facility,Outpatient,,,,532,452.2,152.4712,532,Humana Insurance Company,Medicare PPO,260.68,49,,percent of total billed charges,,
"Red Blood Cells, Leukocytes Reduced, Each Unit (Adult) (Bb)",,P9016,HCPCS,Facility,Inpatient,,,,532,452.2,152.4712,532,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Red Blood Cells, Leukocytes Reduced, Each Unit (Adult) (Bb)",,P9016,HCPCS,Facility,Both,,,,532,452.2,152.4712,532,Medica,Individual & Family,527.212,99.1,,percent of total billed charges,,
"Red Blood Cells, Leukocytes Reduced, Each Unit (Adult) (Bb)",,P9016,HCPCS,Facility,Outpatient,,,,532,452.2,152.4712,532,Medica,Medica Advantage Solution,264.936,49.8,,percent of total billed charges,,
"Red Blood Cells, Leukocytes Reduced, Each Unit (Adult) (Bb)",,P9016,HCPCS,Facility,Inpatient,,,,532,452.2,152.4712,532,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Red Blood Cells, Leukocytes Reduced, Each Unit (Adult) (Bb)",,P9016,HCPCS,Facility,Outpatient,,,,532,452.2,152.4712,532,Medica,Medical Assistance,237.272,44.6,,percent of total billed charges,,
"Red Blood Cells, Leukocytes Reduced, Each Unit (Adult) (Bb)",,P9016,HCPCS,Facility,Inpatient,,,,532,452.2,152.4712,532,Medica,Medical Assistance,,,,,Included in per diem rate,
"Red Blood Cells, Leukocytes Reduced, Each Unit (Adult) (Bb)",,P9016,HCPCS,Facility,Outpatient,,,,532,452.2,152.4712,532,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,264.936,49.8,,percent of total billed charges,,
"Red Blood Cells, Leukocytes Reduced, Each Unit (Adult) (Bb)",,P9016,HCPCS,Facility,Inpatient,,,,532,452.2,152.4712,532,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Red Blood Cells, Leukocytes Reduced, Each Unit (Adult) (Bb)",,P9016,HCPCS,Facility,Both,,,,532,452.2,152.4712,532,"Multiplan, Inc.","Multiplan, Inc.",500.08,94,,percent of total billed charges,,
"Red Blood Cells, Leukocytes Reduced, Each Unit (Adult) (Bb)",,P9016,HCPCS,Facility,Outpatient,,,,532,452.2,152.4712,532,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,479.332,90.1,,percent of total billed charges,,
"Red Blood Cells, Leukocytes Reduced, Each Unit (Adult) (Bb)",,P9016,HCPCS,Facility,Inpatient,,,,532,452.2,152.4712,532,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Red Blood Cells, Leukocytes Reduced, Each Unit (Adult) (Bb)",,P9016,HCPCS,Facility,Both,,,,532,452.2,152.4712,532,"Preferred One Administrative Services, INC.",PPO,524.552,98.6,,percent of total billed charges,,
"Red Blood Cells, Leukocytes Reduced, Each Unit (Adult) (Bb)",,P9016,HCPCS,Facility,Outpatient,,,,532,452.2,152.4712,532,PrimeWest Health,Minnesota Senior Health Options (MSHO),273.714,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Red Blood Cells, Leukocytes Reduced, Each Unit (Adult) (Bb)",,P9016,HCPCS,Facility,Inpatient,,,,532,452.2,152.4712,532,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Red Blood Cells, Leukocytes Reduced, Each Unit (Adult) (Bb)",,P9016,HCPCS,Facility,Outpatient,,,,532,452.2,152.4712,532,PrimeWest Health,MinnesotaCare,273.2352,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Red Blood Cells, Leukocytes Reduced, Each Unit (Adult) (Bb)",,P9016,HCPCS,Facility,Inpatient,,,,532,452.2,152.4712,532,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Red Blood Cells, Leukocytes Reduced, Each Unit (Adult) (Bb)",,P9016,HCPCS,Facility,Both,,,,532,452.2,152.4712,532,Sanford Health Plan,Sanford Health Plan,489.44,92,,percent of total billed charges,,
"Red Blood Cells, Leukocytes Reduced, Each Unit (Adult) (Bb)",,P9016,HCPCS,Facility,Outpatient,,,,532,452.2,152.4712,532,"UCare Health, Inc.",Individual & Family Plan,299.782,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Red Blood Cells, Leukocytes Reduced, Each Unit (Adult) (Bb)",,P9016,HCPCS,Facility,Inpatient,,,,532,452.2,152.4712,532,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Red Blood Cells, Leukocytes Reduced, Each Unit (Adult) (Bb)",,P9016,HCPCS,Facility,Outpatient,,,,532,452.2,152.4712,532,"UCare Health, Inc.",Medical Assistance,268.5004,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Red Blood Cells, Leukocytes Reduced, Each Unit (Adult) (Bb)",,P9016,HCPCS,Facility,Inpatient,,,,532,452.2,152.4712,532,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Red Blood Cells, Leukocytes Reduced, Each Unit (Adult) (Bb)",,P9016,HCPCS,Facility,Outpatient,,,,532,452.2,152.4712,532,"UCare Health, Inc.",Medicare Advantage,268.5004,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Red Blood Cells, Leukocytes Reduced, Each Unit (Adult) (Bb)",,P9016,HCPCS,Facility,Inpatient,,,,532,452.2,152.4712,532,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Red Blood Cells, Leukocytes Reduced, Each Unit (Adult) (Bb)",,P9016,HCPCS,Facility,Outpatient,,,,532,452.2,152.4712,532,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),268.5004,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Red Blood Cells, Leukocytes Reduced, Each Unit (Adult) (Bb)",,P9016,HCPCS,Facility,Inpatient,,,,532,452.2,152.4712,532,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Red Blood Cells, Leukocytes Reduced, Each Unit (Adult) (Bb)",,P9016,HCPCS,Facility,Both,,,,532,452.2,152.4712,532,UnitedHealthcare,Individual & Family,500.08,94,,percent of total billed charges,,
"Red Blood Cells, Leukocytes Reduced, Each Unit (Adult) (Bb)",,P9016,HCPCS,Facility,Outpatient,,,,532,452.2,152.4712,532,UnitedHealthcare,Medicare Advantage,260.68,49,,percent of total billed charges,,
"Red Blood Cells, Leukocytes Reduced, Each Unit (Adult) (Bb)",,P9016,HCPCS,Facility,Inpatient,,,,532,452.2,152.4712,532,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Red Blood Cells, Leukocytes Reduced, Each Unit (Adult) (Bb)",,P9016,HCPCS,Facility,Outpatient,,,,532,452.2,152.4712,532,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,255.36,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Red Blood Cells, Leukocytes Reduced, Each Unit (Adult) (Bb)",,P9016,HCPCS,Facility,Inpatient,,,,532,452.2,152.4712,532,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Platelets, Pheresis, Leukocytes Reduced, Each Unit (Bb)",,P9035,HCPCS,Facility,Both,,,,1214,1031.9,347.9324,1214,Aetna,Commercial,1116.88,92,,percent of total billed charges,,
"Platelets, Pheresis, Leukocytes Reduced, Each Unit (Bb)",,P9035,HCPCS,Facility,Outpatient,,,,1214,1031.9,347.9324,1214,Aetna,Medicare Advantage,594.86,49,,percent of total billed charges,,
"Platelets, Pheresis, Leukocytes Reduced, Each Unit (Bb)",,P9035,HCPCS,Facility,Inpatient,,,,1214,1031.9,347.9324,1214,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Platelets, Pheresis, Leukocytes Reduced, Each Unit (Bb)",,P9035,HCPCS,Facility,Both,,,,1214,1031.9,347.9324,1214,Aetna,PPO,1129.02,93,,percent of total billed charges,,
"Platelets, Pheresis, Leukocytes Reduced, Each Unit (Bb)",,P9035,HCPCS,Facility,Both,,,,1214,1031.9,347.9324,1214,America's PPO,America's PPO,1165.8042,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Platelets, Pheresis, Leukocytes Reduced, Each Unit (Bb)",,P9035,HCPCS,Facility,Both,,,,1214,1031.9,347.9324,1214,BlueCross BlueShield Minnesota, Federal Employee Program,1194.576,98.4,,percent of total billed charges,,
"Platelets, Pheresis, Leukocytes Reduced, Each Unit (Bb)",,P9035,HCPCS,Facility,Both,,,,1214,1031.9,347.9324,1214,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1214,100,,percent of total billed charges,,
"Platelets, Pheresis, Leukocytes Reduced, Each Unit (Bb)",,P9035,HCPCS,Facility,Both,,,,1214,1031.9,347.9324,1214,BlueCross BlueShield Minnesota,High Value Network Plan,1092.6,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
"Platelets, Pheresis, Leukocytes Reduced, Each Unit (Bb)",,P9035,HCPCS,Facility,Outpatient,,,,1214,1031.9,347.9324,1214,BlueCross BlueShield Minnesota,Medicare Advantage,594.86,49,,percent of total billed charges,,
"Platelets, Pheresis, Leukocytes Reduced, Each Unit (Bb)",,P9035,HCPCS,Facility,Inpatient,,,,1214,1031.9,347.9324,1214,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Platelets, Pheresis, Leukocytes Reduced, Each Unit (Bb)",,P9035,HCPCS,Facility,Both,,,,1214,1031.9,347.9324,1214,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1075.2398,88.57,,percent of total billed charges,,
"Platelets, Pheresis, Leukocytes Reduced, Each Unit (Bb)",,P9035,HCPCS,Facility,Both,,,,1214,1031.9,347.9324,1214,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,347.9324,28.66,,percent of total billed charges,,
"Platelets, Pheresis, Leukocytes Reduced, Each Unit (Bb)",,P9035,HCPCS,Facility,Outpatient,,,,1214,1031.9,347.9324,1214,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),594.86,49,,percent of total billed charges,,
"Platelets, Pheresis, Leukocytes Reduced, Each Unit (Bb)",,P9035,HCPCS,Facility,Inpatient,,,,1214,1031.9,347.9324,1214,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Platelets, Pheresis, Leukocytes Reduced, Each Unit (Bb)",,P9035,HCPCS,Facility,Both,,,,1214,1031.9,347.9324,1214,CorVel,Worker's Compensation,1214,100,,percent of total billed charges,,
"Platelets, Pheresis, Leukocytes Reduced, Each Unit (Bb)",,P9035,HCPCS,Facility,Both,,,,1214,1031.9,347.9324,1214,First Health Group Corporation,First Health Network,1177.58,97,,percent of total billed charges,,
"Platelets, Pheresis, Leukocytes Reduced, Each Unit (Bb)",,P9035,HCPCS,Facility,Both,,,,1214,1031.9,347.9324,1214,"Health Partners, Inc.",Commercial,1148.444,94.6,,percent of total billed charges,,
"Platelets, Pheresis, Leukocytes Reduced, Each Unit (Bb)",,P9035,HCPCS,Facility,Outpatient,,,,1214,1031.9,347.9324,1214,"Health Partners, Inc.",Medicare Advantage,594.86,49,,percent of total billed charges,,
"Platelets, Pheresis, Leukocytes Reduced, Each Unit (Bb)",,P9035,HCPCS,Facility,Inpatient,,,,1214,1031.9,347.9324,1214,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Platelets, Pheresis, Leukocytes Reduced, Each Unit (Bb)",,P9035,HCPCS,Facility,Both,,,,1214,1031.9,347.9324,1214,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),728.4,60,,percent of total billed charges,,
"Platelets, Pheresis, Leukocytes Reduced, Each Unit (Bb)",,P9035,HCPCS,Facility,Both,,,,1214,1031.9,347.9324,1214,"Health Partners, Inc.",State of Minnesota Advantage Program,989.41,81.5,,percent of total billed charges,,
"Platelets, Pheresis, Leukocytes Reduced, Each Unit (Bb)",,P9035,HCPCS,Facility,Both,,,,1214,1031.9,347.9324,1214,"Health Partners, Inc.",State Public Programs,607,50,,percent of total billed charges,,
"Platelets, Pheresis, Leukocytes Reduced, Each Unit (Bb)",,P9035,HCPCS,Facility,Both,,,,1214,1031.9,347.9324,1214,Humana Insurance Company,Commercial PPO,1153.3,95,,percent of total billed charges,,
"Platelets, Pheresis, Leukocytes Reduced, Each Unit (Bb)",,P9035,HCPCS,Facility,Outpatient,,,,1214,1031.9,347.9324,1214,Humana Insurance Company,Medicare PPO,594.86,49,,percent of total billed charges,,
"Platelets, Pheresis, Leukocytes Reduced, Each Unit (Bb)",,P9035,HCPCS,Facility,Inpatient,,,,1214,1031.9,347.9324,1214,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Platelets, Pheresis, Leukocytes Reduced, Each Unit (Bb)",,P9035,HCPCS,Facility,Both,,,,1214,1031.9,347.9324,1214,Medica,Individual & Family,1203.074,99.1,,percent of total billed charges,,
"Platelets, Pheresis, Leukocytes Reduced, Each Unit (Bb)",,P9035,HCPCS,Facility,Outpatient,,,,1214,1031.9,347.9324,1214,Medica,Medica Advantage Solution,604.572,49.8,,percent of total billed charges,,
"Platelets, Pheresis, Leukocytes Reduced, Each Unit (Bb)",,P9035,HCPCS,Facility,Inpatient,,,,1214,1031.9,347.9324,1214,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Platelets, Pheresis, Leukocytes Reduced, Each Unit (Bb)",,P9035,HCPCS,Facility,Outpatient,,,,1214,1031.9,347.9324,1214,Medica,Medical Assistance,541.444,44.6,,percent of total billed charges,,
"Platelets, Pheresis, Leukocytes Reduced, Each Unit (Bb)",,P9035,HCPCS,Facility,Inpatient,,,,1214,1031.9,347.9324,1214,Medica,Medical Assistance,,,,,Included in per diem rate,
"Platelets, Pheresis, Leukocytes Reduced, Each Unit (Bb)",,P9035,HCPCS,Facility,Outpatient,,,,1214,1031.9,347.9324,1214,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,604.572,49.8,,percent of total billed charges,,
"Platelets, Pheresis, Leukocytes Reduced, Each Unit (Bb)",,P9035,HCPCS,Facility,Inpatient,,,,1214,1031.9,347.9324,1214,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Platelets, Pheresis, Leukocytes Reduced, Each Unit (Bb)",,P9035,HCPCS,Facility,Both,,,,1214,1031.9,347.9324,1214,"Multiplan, Inc.","Multiplan, Inc.",1141.16,94,,percent of total billed charges,,
"Platelets, Pheresis, Leukocytes Reduced, Each Unit (Bb)",,P9035,HCPCS,Facility,Outpatient,,,,1214,1031.9,347.9324,1214,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1093.814,90.1,,percent of total billed charges,,
"Platelets, Pheresis, Leukocytes Reduced, Each Unit (Bb)",,P9035,HCPCS,Facility,Inpatient,,,,1214,1031.9,347.9324,1214,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Platelets, Pheresis, Leukocytes Reduced, Each Unit (Bb)",,P9035,HCPCS,Facility,Both,,,,1214,1031.9,347.9324,1214,"Preferred One Administrative Services, INC.",PPO,1197.004,98.6,,percent of total billed charges,,
"Platelets, Pheresis, Leukocytes Reduced, Each Unit (Bb)",,P9035,HCPCS,Facility,Outpatient,,,,1214,1031.9,347.9324,1214,PrimeWest Health,Minnesota Senior Health Options (MSHO),624.603,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Platelets, Pheresis, Leukocytes Reduced, Each Unit (Bb)",,P9035,HCPCS,Facility,Inpatient,,,,1214,1031.9,347.9324,1214,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Platelets, Pheresis, Leukocytes Reduced, Each Unit (Bb)",,P9035,HCPCS,Facility,Outpatient,,,,1214,1031.9,347.9324,1214,PrimeWest Health,MinnesotaCare,623.5104,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Platelets, Pheresis, Leukocytes Reduced, Each Unit (Bb)",,P9035,HCPCS,Facility,Inpatient,,,,1214,1031.9,347.9324,1214,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Platelets, Pheresis, Leukocytes Reduced, Each Unit (Bb)",,P9035,HCPCS,Facility,Both,,,,1214,1031.9,347.9324,1214,Sanford Health Plan,Sanford Health Plan,1116.88,92,,percent of total billed charges,,
"Platelets, Pheresis, Leukocytes Reduced, Each Unit (Bb)",,P9035,HCPCS,Facility,Outpatient,,,,1214,1031.9,347.9324,1214,"UCare Health, Inc.",Individual & Family Plan,684.089,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Platelets, Pheresis, Leukocytes Reduced, Each Unit (Bb)",,P9035,HCPCS,Facility,Inpatient,,,,1214,1031.9,347.9324,1214,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Platelets, Pheresis, Leukocytes Reduced, Each Unit (Bb)",,P9035,HCPCS,Facility,Outpatient,,,,1214,1031.9,347.9324,1214,"UCare Health, Inc.",Medical Assistance,612.7058,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Platelets, Pheresis, Leukocytes Reduced, Each Unit (Bb)",,P9035,HCPCS,Facility,Inpatient,,,,1214,1031.9,347.9324,1214,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Platelets, Pheresis, Leukocytes Reduced, Each Unit (Bb)",,P9035,HCPCS,Facility,Outpatient,,,,1214,1031.9,347.9324,1214,"UCare Health, Inc.",Medicare Advantage,612.7058,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Platelets, Pheresis, Leukocytes Reduced, Each Unit (Bb)",,P9035,HCPCS,Facility,Inpatient,,,,1214,1031.9,347.9324,1214,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Platelets, Pheresis, Leukocytes Reduced, Each Unit (Bb)",,P9035,HCPCS,Facility,Outpatient,,,,1214,1031.9,347.9324,1214,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),612.7058,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Platelets, Pheresis, Leukocytes Reduced, Each Unit (Bb)",,P9035,HCPCS,Facility,Inpatient,,,,1214,1031.9,347.9324,1214,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Platelets, Pheresis, Leukocytes Reduced, Each Unit (Bb)",,P9035,HCPCS,Facility,Both,,,,1214,1031.9,347.9324,1214,UnitedHealthcare,Individual & Family,1141.16,94,,percent of total billed charges,,
"Platelets, Pheresis, Leukocytes Reduced, Each Unit (Bb)",,P9035,HCPCS,Facility,Outpatient,,,,1214,1031.9,347.9324,1214,UnitedHealthcare,Medicare Advantage,594.86,49,,percent of total billed charges,,
"Platelets, Pheresis, Leukocytes Reduced, Each Unit (Bb)",,P9035,HCPCS,Facility,Inpatient,,,,1214,1031.9,347.9324,1214,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Platelets, Pheresis, Leukocytes Reduced, Each Unit (Bb)",,P9035,HCPCS,Facility,Outpatient,,,,1214,1031.9,347.9324,1214,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,582.72,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Platelets, Pheresis, Leukocytes Reduced, Each Unit (Bb)",,P9035,HCPCS,Facility,Inpatient,,,,1214,1031.9,347.9324,1214,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
MENTHOL-ZINC OXIDE 0.44-20.6 % TOP OINT,,89502,LOCAL,Facility,Both,71 g,g,,36,30.6,10.3176,36,Aetna,Commercial,33.12,92,,percent of total billed charges,,
MENTHOL-ZINC OXIDE 0.44-20.6 % TOP OINT,,89502,LOCAL,Facility,Outpatient,71 g,g,,36,30.6,10.3176,36,Aetna,Medicare Advantage,17.64,49,,percent of total billed charges,,
MENTHOL-ZINC OXIDE 0.44-20.6 % TOP OINT,,89502,LOCAL,Facility,Inpatient,71 g,g,,36,30.6,10.3176,36,Aetna,Medicare Advantage,,,,,Included in per diem rate,
MENTHOL-ZINC OXIDE 0.44-20.6 % TOP OINT,,89502,LOCAL,Facility,Both,71 g,g,,36,30.6,10.3176,36,Aetna,PPO,33.48,93,,percent of total billed charges,,
MENTHOL-ZINC OXIDE 0.44-20.6 % TOP OINT,,89502,LOCAL,Facility,Both,71 g,g,,36,30.6,10.3176,36,America's PPO,America's PPO,34.5708,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
MENTHOL-ZINC OXIDE 0.44-20.6 % TOP OINT,,89502,LOCAL,Facility,Both,71 g,g,,36,30.6,10.3176,36,BlueCross BlueShield Minnesota, Federal Employee Program,35.424,98.4,,percent of total billed charges,,
MENTHOL-ZINC OXIDE 0.44-20.6 % TOP OINT,,89502,LOCAL,Facility,Both,71 g,g,,36,30.6,10.3176,36,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,36,100,,percent of total billed charges,,
MENTHOL-ZINC OXIDE 0.44-20.6 % TOP OINT,,89502,LOCAL,Facility,Both,71 g,g,,36,30.6,10.3176,36,BlueCross BlueShield Minnesota,High Value Network Plan,32.4,90,,percent of total billed charges,,
MENTHOL-ZINC OXIDE 0.44-20.6 % TOP OINT,,89502,LOCAL,Facility,Outpatient,71 g,g,,36,30.6,10.3176,36,BlueCross BlueShield Minnesota,Medicare Advantage,17.64,49,,percent of total billed charges,,
MENTHOL-ZINC OXIDE 0.44-20.6 % TOP OINT,,89502,LOCAL,Facility,Inpatient,71 g,g,,36,30.6,10.3176,36,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
MENTHOL-ZINC OXIDE 0.44-20.6 % TOP OINT,,89502,LOCAL,Facility,Both,71 g,g,,36,30.6,10.3176,36,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,31.8852,88.57,,percent of total billed charges,,
MENTHOL-ZINC OXIDE 0.44-20.6 % TOP OINT,,89502,LOCAL,Facility,Both,71 g,g,,36,30.6,10.3176,36,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,10.3176,28.66,,percent of total billed charges,,
MENTHOL-ZINC OXIDE 0.44-20.6 % TOP OINT,,89502,LOCAL,Facility,Outpatient,71 g,g,,36,30.6,10.3176,36,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),17.64,49,,percent of total billed charges,,
MENTHOL-ZINC OXIDE 0.44-20.6 % TOP OINT,,89502,LOCAL,Facility,Inpatient,71 g,g,,36,30.6,10.3176,36,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
MENTHOL-ZINC OXIDE 0.44-20.6 % TOP OINT,,89502,LOCAL,Facility,Both,71 g,g,,36,30.6,10.3176,36,CorVel,Worker's Compensation,36,100,,percent of total billed charges,,
MENTHOL-ZINC OXIDE 0.44-20.6 % TOP OINT,,89502,LOCAL,Facility,Both,71 g,g,,36,30.6,10.3176,36,First Health Group Corporation,First Health Network,34.92,97,,percent of total billed charges,,
MENTHOL-ZINC OXIDE 0.44-20.6 % TOP OINT,,89502,LOCAL,Facility,Both,71 g,g,,36,30.6,10.3176,36,"Health Partners, Inc.",Commercial,34.056,94.6,,percent of total billed charges,,
MENTHOL-ZINC OXIDE 0.44-20.6 % TOP OINT,,89502,LOCAL,Facility,Outpatient,71 g,g,,36,30.6,10.3176,36,"Health Partners, Inc.",Medicare Advantage,17.64,49,,percent of total billed charges,,
MENTHOL-ZINC OXIDE 0.44-20.6 % TOP OINT,,89502,LOCAL,Facility,Inpatient,71 g,g,,36,30.6,10.3176,36,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
MENTHOL-ZINC OXIDE 0.44-20.6 % TOP OINT,,89502,LOCAL,Facility,Both,71 g,g,,36,30.6,10.3176,36,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),21.6,60,,percent of total billed charges,,
MENTHOL-ZINC OXIDE 0.44-20.6 % TOP OINT,,89502,LOCAL,Facility,Both,71 g,g,,36,30.6,10.3176,36,"Health Partners, Inc.",State of Minnesota Advantage Program,29.34,81.5,,percent of total billed charges,,
MENTHOL-ZINC OXIDE 0.44-20.6 % TOP OINT,,89502,LOCAL,Facility,Both,71 g,g,,36,30.6,10.3176,36,"Health Partners, Inc.",State Public Programs,18,50,,percent of total billed charges,,
MENTHOL-ZINC OXIDE 0.44-20.6 % TOP OINT,,89502,LOCAL,Facility,Both,71 g,g,,36,30.6,10.3176,36,Humana Insurance Company,Commercial PPO,34.2,95,,percent of total billed charges,,
MENTHOL-ZINC OXIDE 0.44-20.6 % TOP OINT,,89502,LOCAL,Facility,Outpatient,71 g,g,,36,30.6,10.3176,36,Humana Insurance Company,Medicare PPO,17.64,49,,percent of total billed charges,,
MENTHOL-ZINC OXIDE 0.44-20.6 % TOP OINT,,89502,LOCAL,Facility,Inpatient,71 g,g,,36,30.6,10.3176,36,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
MENTHOL-ZINC OXIDE 0.44-20.6 % TOP OINT,,89502,LOCAL,Facility,Both,71 g,g,,36,30.6,10.3176,36,Medica,Individual & Family,35.676,99.1,,percent of total billed charges,,
MENTHOL-ZINC OXIDE 0.44-20.6 % TOP OINT,,89502,LOCAL,Facility,Outpatient,71 g,g,,36,30.6,10.3176,36,Medica,Medica Advantage Solution,17.928,49.8,,percent of total billed charges,,
MENTHOL-ZINC OXIDE 0.44-20.6 % TOP OINT,,89502,LOCAL,Facility,Inpatient,71 g,g,,36,30.6,10.3176,36,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
MENTHOL-ZINC OXIDE 0.44-20.6 % TOP OINT,,89502,LOCAL,Facility,Outpatient,71 g,g,,36,30.6,10.3176,36,Medica,Medical Assistance,16.056,44.6,,percent of total billed charges,,
MENTHOL-ZINC OXIDE 0.44-20.6 % TOP OINT,,89502,LOCAL,Facility,Inpatient,71 g,g,,36,30.6,10.3176,36,Medica,Medical Assistance,,,,,Included in per diem rate,
MENTHOL-ZINC OXIDE 0.44-20.6 % TOP OINT,,89502,LOCAL,Facility,Outpatient,71 g,g,,36,30.6,10.3176,36,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,17.928,49.8,,percent of total billed charges,,
MENTHOL-ZINC OXIDE 0.44-20.6 % TOP OINT,,89502,LOCAL,Facility,Inpatient,71 g,g,,36,30.6,10.3176,36,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
MENTHOL-ZINC OXIDE 0.44-20.6 % TOP OINT,,89502,LOCAL,Facility,Both,71 g,g,,36,30.6,10.3176,36,"Multiplan, Inc.","Multiplan, Inc.",33.84,94,,percent of total billed charges,,
MENTHOL-ZINC OXIDE 0.44-20.6 % TOP OINT,,89502,LOCAL,Facility,Outpatient,71 g,g,,36,30.6,10.3176,36,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,32.436,90.1,,percent of total billed charges,,
MENTHOL-ZINC OXIDE 0.44-20.6 % TOP OINT,,89502,LOCAL,Facility,Inpatient,71 g,g,,36,30.6,10.3176,36,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
MENTHOL-ZINC OXIDE 0.44-20.6 % TOP OINT,,89502,LOCAL,Facility,Both,71 g,g,,36,30.6,10.3176,36,"Preferred One Administrative Services, INC.",PPO,35.496,98.6,,percent of total billed charges,,
MENTHOL-ZINC OXIDE 0.44-20.6 % TOP OINT,,89502,LOCAL,Facility,Outpatient,71 g,g,,36,30.6,10.3176,36,PrimeWest Health,Minnesota Senior Health Options (MSHO),18.522,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
MENTHOL-ZINC OXIDE 0.44-20.6 % TOP OINT,,89502,LOCAL,Facility,Inpatient,71 g,g,,36,30.6,10.3176,36,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
MENTHOL-ZINC OXIDE 0.44-20.6 % TOP OINT,,89502,LOCAL,Facility,Outpatient,71 g,g,,36,30.6,10.3176,36,PrimeWest Health,MinnesotaCare,18.4896,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
MENTHOL-ZINC OXIDE 0.44-20.6 % TOP OINT,,89502,LOCAL,Facility,Inpatient,71 g,g,,36,30.6,10.3176,36,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
MENTHOL-ZINC OXIDE 0.44-20.6 % TOP OINT,,89502,LOCAL,Facility,Both,71 g,g,,36,30.6,10.3176,36,Sanford Health Plan,Sanford Health Plan,33.12,92,,percent of total billed charges,,
MENTHOL-ZINC OXIDE 0.44-20.6 % TOP OINT,,89502,LOCAL,Facility,Outpatient,71 g,g,,36,30.6,10.3176,36,"UCare Health, Inc.",Individual & Family Plan,20.286,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
MENTHOL-ZINC OXIDE 0.44-20.6 % TOP OINT,,89502,LOCAL,Facility,Inpatient,71 g,g,,36,30.6,10.3176,36,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
MENTHOL-ZINC OXIDE 0.44-20.6 % TOP OINT,,89502,LOCAL,Facility,Outpatient,71 g,g,,36,30.6,10.3176,36,"UCare Health, Inc.",Medical Assistance,18.1692,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MENTHOL-ZINC OXIDE 0.44-20.6 % TOP OINT,,89502,LOCAL,Facility,Inpatient,71 g,g,,36,30.6,10.3176,36,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
MENTHOL-ZINC OXIDE 0.44-20.6 % TOP OINT,,89502,LOCAL,Facility,Outpatient,71 g,g,,36,30.6,10.3176,36,"UCare Health, Inc.",Medicare Advantage,18.1692,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MENTHOL-ZINC OXIDE 0.44-20.6 % TOP OINT,,89502,LOCAL,Facility,Inpatient,71 g,g,,36,30.6,10.3176,36,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
MENTHOL-ZINC OXIDE 0.44-20.6 % TOP OINT,,89502,LOCAL,Facility,Outpatient,71 g,g,,36,30.6,10.3176,36,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),18.1692,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MENTHOL-ZINC OXIDE 0.44-20.6 % TOP OINT,,89502,LOCAL,Facility,Inpatient,71 g,g,,36,30.6,10.3176,36,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
MENTHOL-ZINC OXIDE 0.44-20.6 % TOP OINT,,89502,LOCAL,Facility,Both,71 g,g,,36,30.6,10.3176,36,UnitedHealthcare,Individual & Family,33.84,94,,percent of total billed charges,,
MENTHOL-ZINC OXIDE 0.44-20.6 % TOP OINT,,89502,LOCAL,Facility,Outpatient,71 g,g,,36,30.6,10.3176,36,UnitedHealthcare,Medicare Advantage,17.64,49,,percent of total billed charges,,
MENTHOL-ZINC OXIDE 0.44-20.6 % TOP OINT,,89502,LOCAL,Facility,Inpatient,71 g,g,,36,30.6,10.3176,36,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
MENTHOL-ZINC OXIDE 0.44-20.6 % TOP OINT,,89502,LOCAL,Facility,Outpatient,71 g,g,,36,30.6,10.3176,36,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,17.28,48,,percent of total billed charges,,100% of DHS outpatient percentage
MENTHOL-ZINC OXIDE 0.44-20.6 % TOP OINT,,89502,LOCAL,Facility,Inpatient,71 g,g,,36,30.6,10.3176,36,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Fresh Frozen Plasma Between 8-24 Hours Of Collection, Each Unit (Bb)",,P9059,HCPCS,Facility,Both,,,,204,173.4,58.4664,204,Aetna,Commercial,187.68,92,,percent of total billed charges,,
"Fresh Frozen Plasma Between 8-24 Hours Of Collection, Each Unit (Bb)",,P9059,HCPCS,Facility,Outpatient,,,,204,173.4,58.4664,204,Aetna,Medicare Advantage,99.96,49,,percent of total billed charges,,
"Fresh Frozen Plasma Between 8-24 Hours Of Collection, Each Unit (Bb)",,P9059,HCPCS,Facility,Inpatient,,,,204,173.4,58.4664,204,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Fresh Frozen Plasma Between 8-24 Hours Of Collection, Each Unit (Bb)",,P9059,HCPCS,Facility,Both,,,,204,173.4,58.4664,204,Aetna,PPO,189.72,93,,percent of total billed charges,,
"Fresh Frozen Plasma Between 8-24 Hours Of Collection, Each Unit (Bb)",,P9059,HCPCS,Facility,Both,,,,204,173.4,58.4664,204,America's PPO,America's PPO,195.9012,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Fresh Frozen Plasma Between 8-24 Hours Of Collection, Each Unit (Bb)",,P9059,HCPCS,Facility,Both,,,,204,173.4,58.4664,204,BlueCross BlueShield Minnesota, Federal Employee Program,200.736,98.4,,percent of total billed charges,,
"Fresh Frozen Plasma Between 8-24 Hours Of Collection, Each Unit (Bb)",,P9059,HCPCS,Facility,Both,,,,204,173.4,58.4664,204,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,204,100,,percent of total billed charges,,
"Fresh Frozen Plasma Between 8-24 Hours Of Collection, Each Unit (Bb)",,P9059,HCPCS,Facility,Both,,,,204,173.4,58.4664,204,BlueCross BlueShield Minnesota,High Value Network Plan,183.6,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
"Fresh Frozen Plasma Between 8-24 Hours Of Collection, Each Unit (Bb)",,P9059,HCPCS,Facility,Outpatient,,,,204,173.4,58.4664,204,BlueCross BlueShield Minnesota,Medicare Advantage,99.96,49,,percent of total billed charges,,
"Fresh Frozen Plasma Between 8-24 Hours Of Collection, Each Unit (Bb)",,P9059,HCPCS,Facility,Inpatient,,,,204,173.4,58.4664,204,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Fresh Frozen Plasma Between 8-24 Hours Of Collection, Each Unit (Bb)",,P9059,HCPCS,Facility,Both,,,,204,173.4,58.4664,204,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,180.6828,88.57,,percent of total billed charges,,
"Fresh Frozen Plasma Between 8-24 Hours Of Collection, Each Unit (Bb)",,P9059,HCPCS,Facility,Both,,,,204,173.4,58.4664,204,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,58.4664,28.66,,percent of total billed charges,,
"Fresh Frozen Plasma Between 8-24 Hours Of Collection, Each Unit (Bb)",,P9059,HCPCS,Facility,Outpatient,,,,204,173.4,58.4664,204,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),99.96,49,,percent of total billed charges,,
"Fresh Frozen Plasma Between 8-24 Hours Of Collection, Each Unit (Bb)",,P9059,HCPCS,Facility,Inpatient,,,,204,173.4,58.4664,204,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Fresh Frozen Plasma Between 8-24 Hours Of Collection, Each Unit (Bb)",,P9059,HCPCS,Facility,Both,,,,204,173.4,58.4664,204,CorVel,Worker's Compensation,204,100,,percent of total billed charges,,
"Fresh Frozen Plasma Between 8-24 Hours Of Collection, Each Unit (Bb)",,P9059,HCPCS,Facility,Both,,,,204,173.4,58.4664,204,First Health Group Corporation,First Health Network,197.88,97,,percent of total billed charges,,
"Fresh Frozen Plasma Between 8-24 Hours Of Collection, Each Unit (Bb)",,P9059,HCPCS,Facility,Both,,,,204,173.4,58.4664,204,"Health Partners, Inc.",Commercial,192.984,94.6,,percent of total billed charges,,
"Fresh Frozen Plasma Between 8-24 Hours Of Collection, Each Unit (Bb)",,P9059,HCPCS,Facility,Outpatient,,,,204,173.4,58.4664,204,"Health Partners, Inc.",Medicare Advantage,99.96,49,,percent of total billed charges,,
"Fresh Frozen Plasma Between 8-24 Hours Of Collection, Each Unit (Bb)",,P9059,HCPCS,Facility,Inpatient,,,,204,173.4,58.4664,204,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Fresh Frozen Plasma Between 8-24 Hours Of Collection, Each Unit (Bb)",,P9059,HCPCS,Facility,Both,,,,204,173.4,58.4664,204,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),122.4,60,,percent of total billed charges,,
"Fresh Frozen Plasma Between 8-24 Hours Of Collection, Each Unit (Bb)",,P9059,HCPCS,Facility,Both,,,,204,173.4,58.4664,204,"Health Partners, Inc.",State of Minnesota Advantage Program,166.26,81.5,,percent of total billed charges,,
"Fresh Frozen Plasma Between 8-24 Hours Of Collection, Each Unit (Bb)",,P9059,HCPCS,Facility,Both,,,,204,173.4,58.4664,204,"Health Partners, Inc.",State Public Programs,102,50,,percent of total billed charges,,
"Fresh Frozen Plasma Between 8-24 Hours Of Collection, Each Unit (Bb)",,P9059,HCPCS,Facility,Both,,,,204,173.4,58.4664,204,Humana Insurance Company,Commercial PPO,193.8,95,,percent of total billed charges,,
"Fresh Frozen Plasma Between 8-24 Hours Of Collection, Each Unit (Bb)",,P9059,HCPCS,Facility,Outpatient,,,,204,173.4,58.4664,204,Humana Insurance Company,Medicare PPO,99.96,49,,percent of total billed charges,,
"Fresh Frozen Plasma Between 8-24 Hours Of Collection, Each Unit (Bb)",,P9059,HCPCS,Facility,Inpatient,,,,204,173.4,58.4664,204,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Fresh Frozen Plasma Between 8-24 Hours Of Collection, Each Unit (Bb)",,P9059,HCPCS,Facility,Both,,,,204,173.4,58.4664,204,Medica,Individual & Family,202.164,99.1,,percent of total billed charges,,
"Fresh Frozen Plasma Between 8-24 Hours Of Collection, Each Unit (Bb)",,P9059,HCPCS,Facility,Outpatient,,,,204,173.4,58.4664,204,Medica,Medica Advantage Solution,101.592,49.8,,percent of total billed charges,,
"Fresh Frozen Plasma Between 8-24 Hours Of Collection, Each Unit (Bb)",,P9059,HCPCS,Facility,Inpatient,,,,204,173.4,58.4664,204,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Fresh Frozen Plasma Between 8-24 Hours Of Collection, Each Unit (Bb)",,P9059,HCPCS,Facility,Outpatient,,,,204,173.4,58.4664,204,Medica,Medical Assistance,90.984,44.6,,percent of total billed charges,,
"Fresh Frozen Plasma Between 8-24 Hours Of Collection, Each Unit (Bb)",,P9059,HCPCS,Facility,Inpatient,,,,204,173.4,58.4664,204,Medica,Medical Assistance,,,,,Included in per diem rate,
"Fresh Frozen Plasma Between 8-24 Hours Of Collection, Each Unit (Bb)",,P9059,HCPCS,Facility,Outpatient,,,,204,173.4,58.4664,204,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,101.592,49.8,,percent of total billed charges,,
"Fresh Frozen Plasma Between 8-24 Hours Of Collection, Each Unit (Bb)",,P9059,HCPCS,Facility,Inpatient,,,,204,173.4,58.4664,204,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Fresh Frozen Plasma Between 8-24 Hours Of Collection, Each Unit (Bb)",,P9059,HCPCS,Facility,Both,,,,204,173.4,58.4664,204,"Multiplan, Inc.","Multiplan, Inc.",191.76,94,,percent of total billed charges,,
"Fresh Frozen Plasma Between 8-24 Hours Of Collection, Each Unit (Bb)",,P9059,HCPCS,Facility,Outpatient,,,,204,173.4,58.4664,204,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,183.804,90.1,,percent of total billed charges,,
"Fresh Frozen Plasma Between 8-24 Hours Of Collection, Each Unit (Bb)",,P9059,HCPCS,Facility,Inpatient,,,,204,173.4,58.4664,204,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Fresh Frozen Plasma Between 8-24 Hours Of Collection, Each Unit (Bb)",,P9059,HCPCS,Facility,Both,,,,204,173.4,58.4664,204,"Preferred One Administrative Services, INC.",PPO,201.144,98.6,,percent of total billed charges,,
"Fresh Frozen Plasma Between 8-24 Hours Of Collection, Each Unit (Bb)",,P9059,HCPCS,Facility,Outpatient,,,,204,173.4,58.4664,204,PrimeWest Health,Minnesota Senior Health Options (MSHO),104.958,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Fresh Frozen Plasma Between 8-24 Hours Of Collection, Each Unit (Bb)",,P9059,HCPCS,Facility,Inpatient,,,,204,173.4,58.4664,204,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Fresh Frozen Plasma Between 8-24 Hours Of Collection, Each Unit (Bb)",,P9059,HCPCS,Facility,Outpatient,,,,204,173.4,58.4664,204,PrimeWest Health,MinnesotaCare,104.7744,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Fresh Frozen Plasma Between 8-24 Hours Of Collection, Each Unit (Bb)",,P9059,HCPCS,Facility,Inpatient,,,,204,173.4,58.4664,204,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Fresh Frozen Plasma Between 8-24 Hours Of Collection, Each Unit (Bb)",,P9059,HCPCS,Facility,Both,,,,204,173.4,58.4664,204,Sanford Health Plan,Sanford Health Plan,187.68,92,,percent of total billed charges,,
"Fresh Frozen Plasma Between 8-24 Hours Of Collection, Each Unit (Bb)",,P9059,HCPCS,Facility,Outpatient,,,,204,173.4,58.4664,204,"UCare Health, Inc.",Individual & Family Plan,114.954,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Fresh Frozen Plasma Between 8-24 Hours Of Collection, Each Unit (Bb)",,P9059,HCPCS,Facility,Inpatient,,,,204,173.4,58.4664,204,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Fresh Frozen Plasma Between 8-24 Hours Of Collection, Each Unit (Bb)",,P9059,HCPCS,Facility,Outpatient,,,,204,173.4,58.4664,204,"UCare Health, Inc.",Medical Assistance,102.9588,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Fresh Frozen Plasma Between 8-24 Hours Of Collection, Each Unit (Bb)",,P9059,HCPCS,Facility,Inpatient,,,,204,173.4,58.4664,204,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Fresh Frozen Plasma Between 8-24 Hours Of Collection, Each Unit (Bb)",,P9059,HCPCS,Facility,Outpatient,,,,204,173.4,58.4664,204,"UCare Health, Inc.",Medicare Advantage,102.9588,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Fresh Frozen Plasma Between 8-24 Hours Of Collection, Each Unit (Bb)",,P9059,HCPCS,Facility,Inpatient,,,,204,173.4,58.4664,204,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Fresh Frozen Plasma Between 8-24 Hours Of Collection, Each Unit (Bb)",,P9059,HCPCS,Facility,Outpatient,,,,204,173.4,58.4664,204,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),102.9588,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Fresh Frozen Plasma Between 8-24 Hours Of Collection, Each Unit (Bb)",,P9059,HCPCS,Facility,Inpatient,,,,204,173.4,58.4664,204,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Fresh Frozen Plasma Between 8-24 Hours Of Collection, Each Unit (Bb)",,P9059,HCPCS,Facility,Both,,,,204,173.4,58.4664,204,UnitedHealthcare,Individual & Family,191.76,94,,percent of total billed charges,,
"Fresh Frozen Plasma Between 8-24 Hours Of Collection, Each Unit (Bb)",,P9059,HCPCS,Facility,Outpatient,,,,204,173.4,58.4664,204,UnitedHealthcare,Medicare Advantage,99.96,49,,percent of total billed charges,,
"Fresh Frozen Plasma Between 8-24 Hours Of Collection, Each Unit (Bb)",,P9059,HCPCS,Facility,Inpatient,,,,204,173.4,58.4664,204,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Fresh Frozen Plasma Between 8-24 Hours Of Collection, Each Unit (Bb)",,P9059,HCPCS,Facility,Outpatient,,,,204,173.4,58.4664,204,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,97.92,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Fresh Frozen Plasma Between 8-24 Hours Of Collection, Each Unit (Bb)",,P9059,HCPCS,Facility,Inpatient,,,,204,173.4,58.4664,204,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Travel, Flat-Rate Trip",,P9604,HCPCS,Facility,Both,,,,26,22.1,7.4516,26,Aetna,Commercial,23.92,92,,percent of total billed charges,,
"Travel, Flat-Rate Trip",,P9604,HCPCS,Facility,Outpatient,,,,26,22.1,7.4516,26,Aetna,Medicare Advantage,12.74,49,,percent of total billed charges,,
"Travel, Flat-Rate Trip",,P9604,HCPCS,Facility,Inpatient,,,,26,22.1,7.4516,26,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Travel, Flat-Rate Trip",,P9604,HCPCS,Facility,Both,,,,26,22.1,7.4516,26,Aetna,PPO,24.18,93,,percent of total billed charges,,
"Travel, Flat-Rate Trip",,P9604,HCPCS,Facility,Both,,,,26,22.1,7.4516,26,America's PPO,America's PPO,24.9678,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Travel, Flat-Rate Trip",,P9604,HCPCS,Facility,Both,,,,26,22.1,7.4516,26,BlueCross BlueShield Minnesota, Federal Employee Program,25.584,98.4,,percent of total billed charges,,
"Travel, Flat-Rate Trip",,P9604,HCPCS,Facility,Both,,,,26,22.1,7.4516,26,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,26,100,,percent of total billed charges,,
"Travel, Flat-Rate Trip",,P9604,HCPCS,Facility,Both,,,,26,22.1,7.4516,26,BlueCross BlueShield Minnesota,High Value Network Plan,23.4,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
"Travel, Flat-Rate Trip",,P9604,HCPCS,Facility,Outpatient,,,,26,22.1,7.4516,26,BlueCross BlueShield Minnesota,Medicare Advantage,12.74,49,,percent of total billed charges,,
"Travel, Flat-Rate Trip",,P9604,HCPCS,Facility,Inpatient,,,,26,22.1,7.4516,26,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Travel, Flat-Rate Trip",,P9604,HCPCS,Facility,Both,,,,26,22.1,7.4516,26,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,23.0282,88.57,,percent of total billed charges,,
"Travel, Flat-Rate Trip",,P9604,HCPCS,Facility,Both,,,,26,22.1,7.4516,26,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,7.4516,28.66,,percent of total billed charges,,
"Travel, Flat-Rate Trip",,P9604,HCPCS,Facility,Outpatient,,,,26,22.1,7.4516,26,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),12.74,49,,percent of total billed charges,,
"Travel, Flat-Rate Trip",,P9604,HCPCS,Facility,Inpatient,,,,26,22.1,7.4516,26,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Travel, Flat-Rate Trip",,P9604,HCPCS,Facility,Both,,,,26,22.1,7.4516,26,CorVel,Worker's Compensation,26,100,,percent of total billed charges,,
"Travel, Flat-Rate Trip",,P9604,HCPCS,Facility,Both,,,,26,22.1,7.4516,26,First Health Group Corporation,First Health Network,25.22,97,,percent of total billed charges,,
"Travel, Flat-Rate Trip",,P9604,HCPCS,Facility,Both,,,,26,22.1,7.4516,26,"Health Partners, Inc.",Commercial,24.596,94.6,,percent of total billed charges,,
"Travel, Flat-Rate Trip",,P9604,HCPCS,Facility,Outpatient,,,,26,22.1,7.4516,26,"Health Partners, Inc.",Medicare Advantage,12.74,49,,percent of total billed charges,,
"Travel, Flat-Rate Trip",,P9604,HCPCS,Facility,Inpatient,,,,26,22.1,7.4516,26,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Travel, Flat-Rate Trip",,P9604,HCPCS,Facility,Both,,,,26,22.1,7.4516,26,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),15.6,60,,percent of total billed charges,,
"Travel, Flat-Rate Trip",,P9604,HCPCS,Facility,Both,,,,26,22.1,7.4516,26,"Health Partners, Inc.",State of Minnesota Advantage Program,21.19,81.5,,percent of total billed charges,,
"Travel, Flat-Rate Trip",,P9604,HCPCS,Facility,Both,,,,26,22.1,7.4516,26,"Health Partners, Inc.",State Public Programs,13,50,,percent of total billed charges,,
"Travel, Flat-Rate Trip",,P9604,HCPCS,Facility,Both,,,,26,22.1,7.4516,26,Humana Insurance Company,Commercial PPO,24.7,95,,percent of total billed charges,,
"Travel, Flat-Rate Trip",,P9604,HCPCS,Facility,Outpatient,,,,26,22.1,7.4516,26,Humana Insurance Company,Medicare PPO,12.74,49,,percent of total billed charges,,
"Travel, Flat-Rate Trip",,P9604,HCPCS,Facility,Inpatient,,,,26,22.1,7.4516,26,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Travel, Flat-Rate Trip",,P9604,HCPCS,Facility,Both,,,,26,22.1,7.4516,26,Medica,Individual & Family,25.766,99.1,,percent of total billed charges,,
"Travel, Flat-Rate Trip",,P9604,HCPCS,Facility,Outpatient,,,,26,22.1,7.4516,26,Medica,Medica Advantage Solution,12.948,49.8,,percent of total billed charges,,
"Travel, Flat-Rate Trip",,P9604,HCPCS,Facility,Inpatient,,,,26,22.1,7.4516,26,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Travel, Flat-Rate Trip",,P9604,HCPCS,Facility,Outpatient,,,,26,22.1,7.4516,26,Medica,Medical Assistance,11.596,44.6,,percent of total billed charges,,
"Travel, Flat-Rate Trip",,P9604,HCPCS,Facility,Inpatient,,,,26,22.1,7.4516,26,Medica,Medical Assistance,,,,,Included in per diem rate,
"Travel, Flat-Rate Trip",,P9604,HCPCS,Facility,Outpatient,,,,26,22.1,7.4516,26,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,12.948,49.8,,percent of total billed charges,,
"Travel, Flat-Rate Trip",,P9604,HCPCS,Facility,Inpatient,,,,26,22.1,7.4516,26,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Travel, Flat-Rate Trip",,P9604,HCPCS,Facility,Both,,,,26,22.1,7.4516,26,"Multiplan, Inc.","Multiplan, Inc.",24.44,94,,percent of total billed charges,,
"Travel, Flat-Rate Trip",,P9604,HCPCS,Facility,Outpatient,,,,26,22.1,7.4516,26,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,22.464,86.4,,percent of total billed charges,,
"Travel, Flat-Rate Trip",,P9604,HCPCS,Facility,Inpatient,,,,26,22.1,7.4516,26,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Travel, Flat-Rate Trip",,P9604,HCPCS,Facility,Both,,,,26,22.1,7.4516,26,"Preferred One Administrative Services, INC.",PPO,25.636,98.6,,percent of total billed charges,,
"Travel, Flat-Rate Trip",,P9604,HCPCS,Facility,Outpatient,,,,26,22.1,7.4516,26,PrimeWest Health,Minnesota Senior Health Options (MSHO),13.377,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Travel, Flat-Rate Trip",,P9604,HCPCS,Facility,Inpatient,,,,26,22.1,7.4516,26,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Travel, Flat-Rate Trip",,P9604,HCPCS,Facility,Outpatient,,,,26,22.1,7.4516,26,PrimeWest Health,MinnesotaCare,13.3536,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Travel, Flat-Rate Trip",,P9604,HCPCS,Facility,Inpatient,,,,26,22.1,7.4516,26,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Travel, Flat-Rate Trip",,P9604,HCPCS,Facility,Both,,,,26,22.1,7.4516,26,Sanford Health Plan,Sanford Health Plan,23.92,92,,percent of total billed charges,,
"Travel, Flat-Rate Trip",,P9604,HCPCS,Facility,Outpatient,,,,26,22.1,7.4516,26,"UCare Health, Inc.",Individual & Family Plan,14.651,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Travel, Flat-Rate Trip",,P9604,HCPCS,Facility,Inpatient,,,,26,22.1,7.4516,26,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Travel, Flat-Rate Trip",,P9604,HCPCS,Facility,Outpatient,,,,26,22.1,7.4516,26,"UCare Health, Inc.",Medical Assistance,13.1222,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Travel, Flat-Rate Trip",,P9604,HCPCS,Facility,Inpatient,,,,26,22.1,7.4516,26,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Travel, Flat-Rate Trip",,P9604,HCPCS,Facility,Outpatient,,,,26,22.1,7.4516,26,"UCare Health, Inc.",Medicare Advantage,13.1222,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Travel, Flat-Rate Trip",,P9604,HCPCS,Facility,Inpatient,,,,26,22.1,7.4516,26,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Travel, Flat-Rate Trip",,P9604,HCPCS,Facility,Outpatient,,,,26,22.1,7.4516,26,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),13.1222,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Travel, Flat-Rate Trip",,P9604,HCPCS,Facility,Inpatient,,,,26,22.1,7.4516,26,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Travel, Flat-Rate Trip",,P9604,HCPCS,Facility,Both,,,,26,22.1,7.4516,26,UnitedHealthcare,Individual & Family,24.44,94,,percent of total billed charges,,
"Travel, Flat-Rate Trip",,P9604,HCPCS,Facility,Outpatient,,,,26,22.1,7.4516,26,UnitedHealthcare,Medicare Advantage,12.74,49,,percent of total billed charges,,
"Travel, Flat-Rate Trip",,P9604,HCPCS,Facility,Inpatient,,,,26,22.1,7.4516,26,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Travel, Flat-Rate Trip",,P9604,HCPCS,Facility,Outpatient,,,,26,22.1,7.4516,26,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,12.48,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Travel, Flat-Rate Trip",,P9604,HCPCS,Facility,Inpatient,,,,26,22.1,7.4516,26,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
AMOXICILLIN-POT CLAVULANATE 600-42.9 MG/5 ML ORAL SUSR,,3752,LOCAL,Facility,Both,75 mL,mL,,218,185.3,62.4788,218,Aetna,Commercial,200.56,92,,percent of total billed charges,,
AMOXICILLIN-POT CLAVULANATE 600-42.9 MG/5 ML ORAL SUSR,,3752,LOCAL,Facility,Outpatient,75 mL,mL,,218,185.3,62.4788,218,Aetna,Medicare Advantage,106.82,49,,percent of total billed charges,,
AMOXICILLIN-POT CLAVULANATE 600-42.9 MG/5 ML ORAL SUSR,,3752,LOCAL,Facility,Inpatient,75 mL,mL,,218,185.3,62.4788,218,Aetna,Medicare Advantage,,,,,Included in per diem rate,
AMOXICILLIN-POT CLAVULANATE 600-42.9 MG/5 ML ORAL SUSR,,3752,LOCAL,Facility,Both,75 mL,mL,,218,185.3,62.4788,218,Aetna,PPO,202.74,93,,percent of total billed charges,,
AMOXICILLIN-POT CLAVULANATE 600-42.9 MG/5 ML ORAL SUSR,,3752,LOCAL,Facility,Both,75 mL,mL,,218,185.3,62.4788,218,America's PPO,America's PPO,209.3454,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
AMOXICILLIN-POT CLAVULANATE 600-42.9 MG/5 ML ORAL SUSR,,3752,LOCAL,Facility,Both,75 mL,mL,,218,185.3,62.4788,218,BlueCross BlueShield Minnesota, Federal Employee Program,214.512,98.4,,percent of total billed charges,,
AMOXICILLIN-POT CLAVULANATE 600-42.9 MG/5 ML ORAL SUSR,,3752,LOCAL,Facility,Both,75 mL,mL,,218,185.3,62.4788,218,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,218,100,,percent of total billed charges,,
AMOXICILLIN-POT CLAVULANATE 600-42.9 MG/5 ML ORAL SUSR,,3752,LOCAL,Facility,Both,75 mL,mL,,218,185.3,62.4788,218,BlueCross BlueShield Minnesota,High Value Network Plan,196.2,90,,percent of total billed charges,,
AMOXICILLIN-POT CLAVULANATE 600-42.9 MG/5 ML ORAL SUSR,,3752,LOCAL,Facility,Outpatient,75 mL,mL,,218,185.3,62.4788,218,BlueCross BlueShield Minnesota,Medicare Advantage,106.82,49,,percent of total billed charges,,
AMOXICILLIN-POT CLAVULANATE 600-42.9 MG/5 ML ORAL SUSR,,3752,LOCAL,Facility,Inpatient,75 mL,mL,,218,185.3,62.4788,218,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
AMOXICILLIN-POT CLAVULANATE 600-42.9 MG/5 ML ORAL SUSR,,3752,LOCAL,Facility,Both,75 mL,mL,,218,185.3,62.4788,218,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,193.0826,88.57,,percent of total billed charges,,
AMOXICILLIN-POT CLAVULANATE 600-42.9 MG/5 ML ORAL SUSR,,3752,LOCAL,Facility,Both,75 mL,mL,,218,185.3,62.4788,218,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,62.4788,28.66,,percent of total billed charges,,
AMOXICILLIN-POT CLAVULANATE 600-42.9 MG/5 ML ORAL SUSR,,3752,LOCAL,Facility,Outpatient,75 mL,mL,,218,185.3,62.4788,218,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),106.82,49,,percent of total billed charges,,
AMOXICILLIN-POT CLAVULANATE 600-42.9 MG/5 ML ORAL SUSR,,3752,LOCAL,Facility,Inpatient,75 mL,mL,,218,185.3,62.4788,218,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
AMOXICILLIN-POT CLAVULANATE 600-42.9 MG/5 ML ORAL SUSR,,3752,LOCAL,Facility,Both,75 mL,mL,,218,185.3,62.4788,218,CorVel,Worker's Compensation,218,100,,percent of total billed charges,,
AMOXICILLIN-POT CLAVULANATE 600-42.9 MG/5 ML ORAL SUSR,,3752,LOCAL,Facility,Both,75 mL,mL,,218,185.3,62.4788,218,First Health Group Corporation,First Health Network,211.46,97,,percent of total billed charges,,
AMOXICILLIN-POT CLAVULANATE 600-42.9 MG/5 ML ORAL SUSR,,3752,LOCAL,Facility,Both,75 mL,mL,,218,185.3,62.4788,218,"Health Partners, Inc.",Commercial,206.228,94.6,,percent of total billed charges,,
AMOXICILLIN-POT CLAVULANATE 600-42.9 MG/5 ML ORAL SUSR,,3752,LOCAL,Facility,Outpatient,75 mL,mL,,218,185.3,62.4788,218,"Health Partners, Inc.",Medicare Advantage,106.82,49,,percent of total billed charges,,
AMOXICILLIN-POT CLAVULANATE 600-42.9 MG/5 ML ORAL SUSR,,3752,LOCAL,Facility,Inpatient,75 mL,mL,,218,185.3,62.4788,218,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
AMOXICILLIN-POT CLAVULANATE 600-42.9 MG/5 ML ORAL SUSR,,3752,LOCAL,Facility,Both,75 mL,mL,,218,185.3,62.4788,218,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),130.8,60,,percent of total billed charges,,
AMOXICILLIN-POT CLAVULANATE 600-42.9 MG/5 ML ORAL SUSR,,3752,LOCAL,Facility,Both,75 mL,mL,,218,185.3,62.4788,218,"Health Partners, Inc.",State of Minnesota Advantage Program,177.67,81.5,,percent of total billed charges,,
AMOXICILLIN-POT CLAVULANATE 600-42.9 MG/5 ML ORAL SUSR,,3752,LOCAL,Facility,Both,75 mL,mL,,218,185.3,62.4788,218,"Health Partners, Inc.",State Public Programs,109,50,,percent of total billed charges,,
AMOXICILLIN-POT CLAVULANATE 600-42.9 MG/5 ML ORAL SUSR,,3752,LOCAL,Facility,Both,75 mL,mL,,218,185.3,62.4788,218,Humana Insurance Company,Commercial PPO,207.1,95,,percent of total billed charges,,
AMOXICILLIN-POT CLAVULANATE 600-42.9 MG/5 ML ORAL SUSR,,3752,LOCAL,Facility,Outpatient,75 mL,mL,,218,185.3,62.4788,218,Humana Insurance Company,Medicare PPO,106.82,49,,percent of total billed charges,,
AMOXICILLIN-POT CLAVULANATE 600-42.9 MG/5 ML ORAL SUSR,,3752,LOCAL,Facility,Inpatient,75 mL,mL,,218,185.3,62.4788,218,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
AMOXICILLIN-POT CLAVULANATE 600-42.9 MG/5 ML ORAL SUSR,,3752,LOCAL,Facility,Both,75 mL,mL,,218,185.3,62.4788,218,Medica,Individual & Family,216.038,99.1,,percent of total billed charges,,
AMOXICILLIN-POT CLAVULANATE 600-42.9 MG/5 ML ORAL SUSR,,3752,LOCAL,Facility,Outpatient,75 mL,mL,,218,185.3,62.4788,218,Medica,Medica Advantage Solution,108.564,49.8,,percent of total billed charges,,
AMOXICILLIN-POT CLAVULANATE 600-42.9 MG/5 ML ORAL SUSR,,3752,LOCAL,Facility,Inpatient,75 mL,mL,,218,185.3,62.4788,218,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
AMOXICILLIN-POT CLAVULANATE 600-42.9 MG/5 ML ORAL SUSR,,3752,LOCAL,Facility,Outpatient,75 mL,mL,,218,185.3,62.4788,218,Medica,Medical Assistance,97.228,44.6,,percent of total billed charges,,
AMOXICILLIN-POT CLAVULANATE 600-42.9 MG/5 ML ORAL SUSR,,3752,LOCAL,Facility,Inpatient,75 mL,mL,,218,185.3,62.4788,218,Medica,Medical Assistance,,,,,Included in per diem rate,
AMOXICILLIN-POT CLAVULANATE 600-42.9 MG/5 ML ORAL SUSR,,3752,LOCAL,Facility,Outpatient,75 mL,mL,,218,185.3,62.4788,218,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,108.564,49.8,,percent of total billed charges,,
AMOXICILLIN-POT CLAVULANATE 600-42.9 MG/5 ML ORAL SUSR,,3752,LOCAL,Facility,Inpatient,75 mL,mL,,218,185.3,62.4788,218,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
AMOXICILLIN-POT CLAVULANATE 600-42.9 MG/5 ML ORAL SUSR,,3752,LOCAL,Facility,Both,75 mL,mL,,218,185.3,62.4788,218,"Multiplan, Inc.","Multiplan, Inc.",204.92,94,,percent of total billed charges,,
AMOXICILLIN-POT CLAVULANATE 600-42.9 MG/5 ML ORAL SUSR,,3752,LOCAL,Facility,Outpatient,75 mL,mL,,218,185.3,62.4788,218,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,196.418,90.1,,percent of total billed charges,,
AMOXICILLIN-POT CLAVULANATE 600-42.9 MG/5 ML ORAL SUSR,,3752,LOCAL,Facility,Inpatient,75 mL,mL,,218,185.3,62.4788,218,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
AMOXICILLIN-POT CLAVULANATE 600-42.9 MG/5 ML ORAL SUSR,,3752,LOCAL,Facility,Both,75 mL,mL,,218,185.3,62.4788,218,"Preferred One Administrative Services, INC.",PPO,214.948,98.6,,percent of total billed charges,,
AMOXICILLIN-POT CLAVULANATE 600-42.9 MG/5 ML ORAL SUSR,,3752,LOCAL,Facility,Outpatient,75 mL,mL,,218,185.3,62.4788,218,PrimeWest Health,Minnesota Senior Health Options (MSHO),112.161,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
AMOXICILLIN-POT CLAVULANATE 600-42.9 MG/5 ML ORAL SUSR,,3752,LOCAL,Facility,Inpatient,75 mL,mL,,218,185.3,62.4788,218,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
AMOXICILLIN-POT CLAVULANATE 600-42.9 MG/5 ML ORAL SUSR,,3752,LOCAL,Facility,Outpatient,75 mL,mL,,218,185.3,62.4788,218,PrimeWest Health,MinnesotaCare,111.9648,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
AMOXICILLIN-POT CLAVULANATE 600-42.9 MG/5 ML ORAL SUSR,,3752,LOCAL,Facility,Inpatient,75 mL,mL,,218,185.3,62.4788,218,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
AMOXICILLIN-POT CLAVULANATE 600-42.9 MG/5 ML ORAL SUSR,,3752,LOCAL,Facility,Both,75 mL,mL,,218,185.3,62.4788,218,Sanford Health Plan,Sanford Health Plan,200.56,92,,percent of total billed charges,,
AMOXICILLIN-POT CLAVULANATE 600-42.9 MG/5 ML ORAL SUSR,,3752,LOCAL,Facility,Outpatient,75 mL,mL,,218,185.3,62.4788,218,"UCare Health, Inc.",Individual & Family Plan,122.843,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
AMOXICILLIN-POT CLAVULANATE 600-42.9 MG/5 ML ORAL SUSR,,3752,LOCAL,Facility,Inpatient,75 mL,mL,,218,185.3,62.4788,218,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
AMOXICILLIN-POT CLAVULANATE 600-42.9 MG/5 ML ORAL SUSR,,3752,LOCAL,Facility,Outpatient,75 mL,mL,,218,185.3,62.4788,218,"UCare Health, Inc.",Medical Assistance,110.0246,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
AMOXICILLIN-POT CLAVULANATE 600-42.9 MG/5 ML ORAL SUSR,,3752,LOCAL,Facility,Inpatient,75 mL,mL,,218,185.3,62.4788,218,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
AMOXICILLIN-POT CLAVULANATE 600-42.9 MG/5 ML ORAL SUSR,,3752,LOCAL,Facility,Outpatient,75 mL,mL,,218,185.3,62.4788,218,"UCare Health, Inc.",Medicare Advantage,110.0246,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
AMOXICILLIN-POT CLAVULANATE 600-42.9 MG/5 ML ORAL SUSR,,3752,LOCAL,Facility,Inpatient,75 mL,mL,,218,185.3,62.4788,218,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
AMOXICILLIN-POT CLAVULANATE 600-42.9 MG/5 ML ORAL SUSR,,3752,LOCAL,Facility,Outpatient,75 mL,mL,,218,185.3,62.4788,218,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),110.0246,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
AMOXICILLIN-POT CLAVULANATE 600-42.9 MG/5 ML ORAL SUSR,,3752,LOCAL,Facility,Inpatient,75 mL,mL,,218,185.3,62.4788,218,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
AMOXICILLIN-POT CLAVULANATE 600-42.9 MG/5 ML ORAL SUSR,,3752,LOCAL,Facility,Both,75 mL,mL,,218,185.3,62.4788,218,UnitedHealthcare,Individual & Family,204.92,94,,percent of total billed charges,,
AMOXICILLIN-POT CLAVULANATE 600-42.9 MG/5 ML ORAL SUSR,,3752,LOCAL,Facility,Outpatient,75 mL,mL,,218,185.3,62.4788,218,UnitedHealthcare,Medicare Advantage,106.82,49,,percent of total billed charges,,
AMOXICILLIN-POT CLAVULANATE 600-42.9 MG/5 ML ORAL SUSR,,3752,LOCAL,Facility,Inpatient,75 mL,mL,,218,185.3,62.4788,218,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
AMOXICILLIN-POT CLAVULANATE 600-42.9 MG/5 ML ORAL SUSR,,3752,LOCAL,Facility,Outpatient,75 mL,mL,,218,185.3,62.4788,218,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,104.64,48,,percent of total billed charges,,100% of DHS outpatient percentage
AMOXICILLIN-POT CLAVULANATE 600-42.9 MG/5 ML ORAL SUSR,,3752,LOCAL,Facility,Inpatient,75 mL,mL,,218,185.3,62.4788,218,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
AMOXICILLIN 400 MG/5 ML ORAL SUSR,,16338,LOCAL,Facility,Both,75 mL,mL,,37,31.45,10.6042,37,Aetna,Commercial,34.04,92,,percent of total billed charges,,
AMOXICILLIN 400 MG/5 ML ORAL SUSR,,16338,LOCAL,Facility,Outpatient,75 mL,mL,,37,31.45,10.6042,37,Aetna,Medicare Advantage,18.13,49,,percent of total billed charges,,
AMOXICILLIN 400 MG/5 ML ORAL SUSR,,16338,LOCAL,Facility,Inpatient,75 mL,mL,,37,31.45,10.6042,37,Aetna,Medicare Advantage,,,,,Included in per diem rate,
AMOXICILLIN 400 MG/5 ML ORAL SUSR,,16338,LOCAL,Facility,Both,75 mL,mL,,37,31.45,10.6042,37,Aetna,PPO,34.41,93,,percent of total billed charges,,
AMOXICILLIN 400 MG/5 ML ORAL SUSR,,16338,LOCAL,Facility,Both,75 mL,mL,,37,31.45,10.6042,37,America's PPO,America's PPO,35.5311,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
AMOXICILLIN 400 MG/5 ML ORAL SUSR,,16338,LOCAL,Facility,Both,75 mL,mL,,37,31.45,10.6042,37,BlueCross BlueShield Minnesota, Federal Employee Program,36.408,98.4,,percent of total billed charges,,
AMOXICILLIN 400 MG/5 ML ORAL SUSR,,16338,LOCAL,Facility,Both,75 mL,mL,,37,31.45,10.6042,37,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,37,100,,percent of total billed charges,,
AMOXICILLIN 400 MG/5 ML ORAL SUSR,,16338,LOCAL,Facility,Both,75 mL,mL,,37,31.45,10.6042,37,BlueCross BlueShield Minnesota,High Value Network Plan,33.3,90,,percent of total billed charges,,
AMOXICILLIN 400 MG/5 ML ORAL SUSR,,16338,LOCAL,Facility,Outpatient,75 mL,mL,,37,31.45,10.6042,37,BlueCross BlueShield Minnesota,Medicare Advantage,18.13,49,,percent of total billed charges,,
AMOXICILLIN 400 MG/5 ML ORAL SUSR,,16338,LOCAL,Facility,Inpatient,75 mL,mL,,37,31.45,10.6042,37,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
AMOXICILLIN 400 MG/5 ML ORAL SUSR,,16338,LOCAL,Facility,Both,75 mL,mL,,37,31.45,10.6042,37,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,32.7709,88.57,,percent of total billed charges,,
AMOXICILLIN 400 MG/5 ML ORAL SUSR,,16338,LOCAL,Facility,Both,75 mL,mL,,37,31.45,10.6042,37,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,10.6042,28.66,,percent of total billed charges,,
AMOXICILLIN 400 MG/5 ML ORAL SUSR,,16338,LOCAL,Facility,Outpatient,75 mL,mL,,37,31.45,10.6042,37,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),18.13,49,,percent of total billed charges,,
AMOXICILLIN 400 MG/5 ML ORAL SUSR,,16338,LOCAL,Facility,Inpatient,75 mL,mL,,37,31.45,10.6042,37,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
AMOXICILLIN 400 MG/5 ML ORAL SUSR,,16338,LOCAL,Facility,Both,75 mL,mL,,37,31.45,10.6042,37,CorVel,Worker's Compensation,37,100,,percent of total billed charges,,
AMOXICILLIN 400 MG/5 ML ORAL SUSR,,16338,LOCAL,Facility,Both,75 mL,mL,,37,31.45,10.6042,37,First Health Group Corporation,First Health Network,35.89,97,,percent of total billed charges,,
AMOXICILLIN 400 MG/5 ML ORAL SUSR,,16338,LOCAL,Facility,Both,75 mL,mL,,37,31.45,10.6042,37,"Health Partners, Inc.",Commercial,35.002,94.6,,percent of total billed charges,,
AMOXICILLIN 400 MG/5 ML ORAL SUSR,,16338,LOCAL,Facility,Outpatient,75 mL,mL,,37,31.45,10.6042,37,"Health Partners, Inc.",Medicare Advantage,18.13,49,,percent of total billed charges,,
AMOXICILLIN 400 MG/5 ML ORAL SUSR,,16338,LOCAL,Facility,Inpatient,75 mL,mL,,37,31.45,10.6042,37,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
AMOXICILLIN 400 MG/5 ML ORAL SUSR,,16338,LOCAL,Facility,Both,75 mL,mL,,37,31.45,10.6042,37,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),22.2,60,,percent of total billed charges,,
AMOXICILLIN 400 MG/5 ML ORAL SUSR,,16338,LOCAL,Facility,Both,75 mL,mL,,37,31.45,10.6042,37,"Health Partners, Inc.",State of Minnesota Advantage Program,30.155,81.5,,percent of total billed charges,,
AMOXICILLIN 400 MG/5 ML ORAL SUSR,,16338,LOCAL,Facility,Both,75 mL,mL,,37,31.45,10.6042,37,"Health Partners, Inc.",State Public Programs,18.5,50,,percent of total billed charges,,
AMOXICILLIN 400 MG/5 ML ORAL SUSR,,16338,LOCAL,Facility,Both,75 mL,mL,,37,31.45,10.6042,37,Humana Insurance Company,Commercial PPO,35.15,95,,percent of total billed charges,,
AMOXICILLIN 400 MG/5 ML ORAL SUSR,,16338,LOCAL,Facility,Outpatient,75 mL,mL,,37,31.45,10.6042,37,Humana Insurance Company,Medicare PPO,18.13,49,,percent of total billed charges,,
AMOXICILLIN 400 MG/5 ML ORAL SUSR,,16338,LOCAL,Facility,Inpatient,75 mL,mL,,37,31.45,10.6042,37,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
AMOXICILLIN 400 MG/5 ML ORAL SUSR,,16338,LOCAL,Facility,Both,75 mL,mL,,37,31.45,10.6042,37,Medica,Individual & Family,36.667,99.1,,percent of total billed charges,,
AMOXICILLIN 400 MG/5 ML ORAL SUSR,,16338,LOCAL,Facility,Outpatient,75 mL,mL,,37,31.45,10.6042,37,Medica,Medica Advantage Solution,18.426,49.8,,percent of total billed charges,,
AMOXICILLIN 400 MG/5 ML ORAL SUSR,,16338,LOCAL,Facility,Inpatient,75 mL,mL,,37,31.45,10.6042,37,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
AMOXICILLIN 400 MG/5 ML ORAL SUSR,,16338,LOCAL,Facility,Outpatient,75 mL,mL,,37,31.45,10.6042,37,Medica,Medical Assistance,16.502,44.6,,percent of total billed charges,,
AMOXICILLIN 400 MG/5 ML ORAL SUSR,,16338,LOCAL,Facility,Inpatient,75 mL,mL,,37,31.45,10.6042,37,Medica,Medical Assistance,,,,,Included in per diem rate,
AMOXICILLIN 400 MG/5 ML ORAL SUSR,,16338,LOCAL,Facility,Outpatient,75 mL,mL,,37,31.45,10.6042,37,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,18.426,49.8,,percent of total billed charges,,
AMOXICILLIN 400 MG/5 ML ORAL SUSR,,16338,LOCAL,Facility,Inpatient,75 mL,mL,,37,31.45,10.6042,37,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
AMOXICILLIN 400 MG/5 ML ORAL SUSR,,16338,LOCAL,Facility,Both,75 mL,mL,,37,31.45,10.6042,37,"Multiplan, Inc.","Multiplan, Inc.",34.78,94,,percent of total billed charges,,
AMOXICILLIN 400 MG/5 ML ORAL SUSR,,16338,LOCAL,Facility,Outpatient,75 mL,mL,,37,31.45,10.6042,37,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,33.337,90.1,,percent of total billed charges,,
AMOXICILLIN 400 MG/5 ML ORAL SUSR,,16338,LOCAL,Facility,Inpatient,75 mL,mL,,37,31.45,10.6042,37,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
AMOXICILLIN 400 MG/5 ML ORAL SUSR,,16338,LOCAL,Facility,Both,75 mL,mL,,37,31.45,10.6042,37,"Preferred One Administrative Services, INC.",PPO,36.482,98.6,,percent of total billed charges,,
AMOXICILLIN 400 MG/5 ML ORAL SUSR,,16338,LOCAL,Facility,Outpatient,75 mL,mL,,37,31.45,10.6042,37,PrimeWest Health,Minnesota Senior Health Options (MSHO),19.0365,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
AMOXICILLIN 400 MG/5 ML ORAL SUSR,,16338,LOCAL,Facility,Inpatient,75 mL,mL,,37,31.45,10.6042,37,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
AMOXICILLIN 400 MG/5 ML ORAL SUSR,,16338,LOCAL,Facility,Outpatient,75 mL,mL,,37,31.45,10.6042,37,PrimeWest Health,MinnesotaCare,19.0032,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
AMOXICILLIN 400 MG/5 ML ORAL SUSR,,16338,LOCAL,Facility,Inpatient,75 mL,mL,,37,31.45,10.6042,37,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
AMOXICILLIN 400 MG/5 ML ORAL SUSR,,16338,LOCAL,Facility,Both,75 mL,mL,,37,31.45,10.6042,37,Sanford Health Plan,Sanford Health Plan,34.04,92,,percent of total billed charges,,
AMOXICILLIN 400 MG/5 ML ORAL SUSR,,16338,LOCAL,Facility,Outpatient,75 mL,mL,,37,31.45,10.6042,37,"UCare Health, Inc.",Individual & Family Plan,20.8495,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
AMOXICILLIN 400 MG/5 ML ORAL SUSR,,16338,LOCAL,Facility,Inpatient,75 mL,mL,,37,31.45,10.6042,37,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
AMOXICILLIN 400 MG/5 ML ORAL SUSR,,16338,LOCAL,Facility,Outpatient,75 mL,mL,,37,31.45,10.6042,37,"UCare Health, Inc.",Medical Assistance,18.6739,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
AMOXICILLIN 400 MG/5 ML ORAL SUSR,,16338,LOCAL,Facility,Inpatient,75 mL,mL,,37,31.45,10.6042,37,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
AMOXICILLIN 400 MG/5 ML ORAL SUSR,,16338,LOCAL,Facility,Outpatient,75 mL,mL,,37,31.45,10.6042,37,"UCare Health, Inc.",Medicare Advantage,18.6739,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
AMOXICILLIN 400 MG/5 ML ORAL SUSR,,16338,LOCAL,Facility,Inpatient,75 mL,mL,,37,31.45,10.6042,37,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
AMOXICILLIN 400 MG/5 ML ORAL SUSR,,16338,LOCAL,Facility,Outpatient,75 mL,mL,,37,31.45,10.6042,37,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),18.6739,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
AMOXICILLIN 400 MG/5 ML ORAL SUSR,,16338,LOCAL,Facility,Inpatient,75 mL,mL,,37,31.45,10.6042,37,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
AMOXICILLIN 400 MG/5 ML ORAL SUSR,,16338,LOCAL,Facility,Both,75 mL,mL,,37,31.45,10.6042,37,UnitedHealthcare,Individual & Family,34.78,94,,percent of total billed charges,,
AMOXICILLIN 400 MG/5 ML ORAL SUSR,,16338,LOCAL,Facility,Outpatient,75 mL,mL,,37,31.45,10.6042,37,UnitedHealthcare,Medicare Advantage,18.13,49,,percent of total billed charges,,
AMOXICILLIN 400 MG/5 ML ORAL SUSR,,16338,LOCAL,Facility,Inpatient,75 mL,mL,,37,31.45,10.6042,37,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
AMOXICILLIN 400 MG/5 ML ORAL SUSR,,16338,LOCAL,Facility,Outpatient,75 mL,mL,,37,31.45,10.6042,37,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,17.76,48,,percent of total billed charges,,100% of DHS outpatient percentage
AMOXICILLIN 400 MG/5 ML ORAL SUSR,,16338,LOCAL,Facility,Inpatient,75 mL,mL,,37,31.45,10.6042,37,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
CEFADROXIL 500 MG/5 ML ORAL SUSR,,17251,LOCAL,Facility,Both,75 mL,mL,,266,226.1,76.2356,266,Aetna,Commercial,244.72,92,,percent of total billed charges,,
CEFADROXIL 500 MG/5 ML ORAL SUSR,,17251,LOCAL,Facility,Outpatient,75 mL,mL,,266,226.1,76.2356,266,Aetna,Medicare Advantage,130.34,49,,percent of total billed charges,,
CEFADROXIL 500 MG/5 ML ORAL SUSR,,17251,LOCAL,Facility,Inpatient,75 mL,mL,,266,226.1,76.2356,266,Aetna,Medicare Advantage,,,,,Included in per diem rate,
CEFADROXIL 500 MG/5 ML ORAL SUSR,,17251,LOCAL,Facility,Both,75 mL,mL,,266,226.1,76.2356,266,Aetna,PPO,247.38,93,,percent of total billed charges,,
CEFADROXIL 500 MG/5 ML ORAL SUSR,,17251,LOCAL,Facility,Both,75 mL,mL,,266,226.1,76.2356,266,America's PPO,America's PPO,255.4398,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
CEFADROXIL 500 MG/5 ML ORAL SUSR,,17251,LOCAL,Facility,Both,75 mL,mL,,266,226.1,76.2356,266,BlueCross BlueShield Minnesota, Federal Employee Program,261.744,98.4,,percent of total billed charges,,
CEFADROXIL 500 MG/5 ML ORAL SUSR,,17251,LOCAL,Facility,Both,75 mL,mL,,266,226.1,76.2356,266,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,266,100,,percent of total billed charges,,
CEFADROXIL 500 MG/5 ML ORAL SUSR,,17251,LOCAL,Facility,Both,75 mL,mL,,266,226.1,76.2356,266,BlueCross BlueShield Minnesota,High Value Network Plan,239.4,90,,percent of total billed charges,,
CEFADROXIL 500 MG/5 ML ORAL SUSR,,17251,LOCAL,Facility,Outpatient,75 mL,mL,,266,226.1,76.2356,266,BlueCross BlueShield Minnesota,Medicare Advantage,130.34,49,,percent of total billed charges,,
CEFADROXIL 500 MG/5 ML ORAL SUSR,,17251,LOCAL,Facility,Inpatient,75 mL,mL,,266,226.1,76.2356,266,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
CEFADROXIL 500 MG/5 ML ORAL SUSR,,17251,LOCAL,Facility,Both,75 mL,mL,,266,226.1,76.2356,266,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,235.5962,88.57,,percent of total billed charges,,
CEFADROXIL 500 MG/5 ML ORAL SUSR,,17251,LOCAL,Facility,Both,75 mL,mL,,266,226.1,76.2356,266,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,76.2356,28.66,,percent of total billed charges,,
CEFADROXIL 500 MG/5 ML ORAL SUSR,,17251,LOCAL,Facility,Outpatient,75 mL,mL,,266,226.1,76.2356,266,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),130.34,49,,percent of total billed charges,,
CEFADROXIL 500 MG/5 ML ORAL SUSR,,17251,LOCAL,Facility,Inpatient,75 mL,mL,,266,226.1,76.2356,266,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
CEFADROXIL 500 MG/5 ML ORAL SUSR,,17251,LOCAL,Facility,Both,75 mL,mL,,266,226.1,76.2356,266,CorVel,Worker's Compensation,266,100,,percent of total billed charges,,
CEFADROXIL 500 MG/5 ML ORAL SUSR,,17251,LOCAL,Facility,Both,75 mL,mL,,266,226.1,76.2356,266,First Health Group Corporation,First Health Network,258.02,97,,percent of total billed charges,,
CEFADROXIL 500 MG/5 ML ORAL SUSR,,17251,LOCAL,Facility,Both,75 mL,mL,,266,226.1,76.2356,266,"Health Partners, Inc.",Commercial,251.636,94.6,,percent of total billed charges,,
CEFADROXIL 500 MG/5 ML ORAL SUSR,,17251,LOCAL,Facility,Outpatient,75 mL,mL,,266,226.1,76.2356,266,"Health Partners, Inc.",Medicare Advantage,130.34,49,,percent of total billed charges,,
CEFADROXIL 500 MG/5 ML ORAL SUSR,,17251,LOCAL,Facility,Inpatient,75 mL,mL,,266,226.1,76.2356,266,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CEFADROXIL 500 MG/5 ML ORAL SUSR,,17251,LOCAL,Facility,Both,75 mL,mL,,266,226.1,76.2356,266,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),159.6,60,,percent of total billed charges,,
CEFADROXIL 500 MG/5 ML ORAL SUSR,,17251,LOCAL,Facility,Both,75 mL,mL,,266,226.1,76.2356,266,"Health Partners, Inc.",State of Minnesota Advantage Program,216.79,81.5,,percent of total billed charges,,
CEFADROXIL 500 MG/5 ML ORAL SUSR,,17251,LOCAL,Facility,Both,75 mL,mL,,266,226.1,76.2356,266,"Health Partners, Inc.",State Public Programs,133,50,,percent of total billed charges,,
CEFADROXIL 500 MG/5 ML ORAL SUSR,,17251,LOCAL,Facility,Both,75 mL,mL,,266,226.1,76.2356,266,Humana Insurance Company,Commercial PPO,252.7,95,,percent of total billed charges,,
CEFADROXIL 500 MG/5 ML ORAL SUSR,,17251,LOCAL,Facility,Outpatient,75 mL,mL,,266,226.1,76.2356,266,Humana Insurance Company,Medicare PPO,130.34,49,,percent of total billed charges,,
CEFADROXIL 500 MG/5 ML ORAL SUSR,,17251,LOCAL,Facility,Inpatient,75 mL,mL,,266,226.1,76.2356,266,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
CEFADROXIL 500 MG/5 ML ORAL SUSR,,17251,LOCAL,Facility,Both,75 mL,mL,,266,226.1,76.2356,266,Medica,Individual & Family,263.606,99.1,,percent of total billed charges,,
CEFADROXIL 500 MG/5 ML ORAL SUSR,,17251,LOCAL,Facility,Outpatient,75 mL,mL,,266,226.1,76.2356,266,Medica,Medica Advantage Solution,132.468,49.8,,percent of total billed charges,,
CEFADROXIL 500 MG/5 ML ORAL SUSR,,17251,LOCAL,Facility,Inpatient,75 mL,mL,,266,226.1,76.2356,266,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
CEFADROXIL 500 MG/5 ML ORAL SUSR,,17251,LOCAL,Facility,Outpatient,75 mL,mL,,266,226.1,76.2356,266,Medica,Medical Assistance,118.636,44.6,,percent of total billed charges,,
CEFADROXIL 500 MG/5 ML ORAL SUSR,,17251,LOCAL,Facility,Inpatient,75 mL,mL,,266,226.1,76.2356,266,Medica,Medical Assistance,,,,,Included in per diem rate,
CEFADROXIL 500 MG/5 ML ORAL SUSR,,17251,LOCAL,Facility,Outpatient,75 mL,mL,,266,226.1,76.2356,266,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,132.468,49.8,,percent of total billed charges,,
CEFADROXIL 500 MG/5 ML ORAL SUSR,,17251,LOCAL,Facility,Inpatient,75 mL,mL,,266,226.1,76.2356,266,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
CEFADROXIL 500 MG/5 ML ORAL SUSR,,17251,LOCAL,Facility,Both,75 mL,mL,,266,226.1,76.2356,266,"Multiplan, Inc.","Multiplan, Inc.",250.04,94,,percent of total billed charges,,
CEFADROXIL 500 MG/5 ML ORAL SUSR,,17251,LOCAL,Facility,Outpatient,75 mL,mL,,266,226.1,76.2356,266,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,239.666,90.1,,percent of total billed charges,,
CEFADROXIL 500 MG/5 ML ORAL SUSR,,17251,LOCAL,Facility,Inpatient,75 mL,mL,,266,226.1,76.2356,266,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
CEFADROXIL 500 MG/5 ML ORAL SUSR,,17251,LOCAL,Facility,Both,75 mL,mL,,266,226.1,76.2356,266,"Preferred One Administrative Services, INC.",PPO,262.276,98.6,,percent of total billed charges,,
CEFADROXIL 500 MG/5 ML ORAL SUSR,,17251,LOCAL,Facility,Outpatient,75 mL,mL,,266,226.1,76.2356,266,PrimeWest Health,Minnesota Senior Health Options (MSHO),136.857,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
CEFADROXIL 500 MG/5 ML ORAL SUSR,,17251,LOCAL,Facility,Inpatient,75 mL,mL,,266,226.1,76.2356,266,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CEFADROXIL 500 MG/5 ML ORAL SUSR,,17251,LOCAL,Facility,Outpatient,75 mL,mL,,266,226.1,76.2356,266,PrimeWest Health,MinnesotaCare,136.6176,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
CEFADROXIL 500 MG/5 ML ORAL SUSR,,17251,LOCAL,Facility,Inpatient,75 mL,mL,,266,226.1,76.2356,266,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
CEFADROXIL 500 MG/5 ML ORAL SUSR,,17251,LOCAL,Facility,Both,75 mL,mL,,266,226.1,76.2356,266,Sanford Health Plan,Sanford Health Plan,244.72,92,,percent of total billed charges,,
CEFADROXIL 500 MG/5 ML ORAL SUSR,,17251,LOCAL,Facility,Outpatient,75 mL,mL,,266,226.1,76.2356,266,"UCare Health, Inc.",Individual & Family Plan,149.891,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
CEFADROXIL 500 MG/5 ML ORAL SUSR,,17251,LOCAL,Facility,Inpatient,75 mL,mL,,266,226.1,76.2356,266,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
CEFADROXIL 500 MG/5 ML ORAL SUSR,,17251,LOCAL,Facility,Outpatient,75 mL,mL,,266,226.1,76.2356,266,"UCare Health, Inc.",Medical Assistance,134.2502,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CEFADROXIL 500 MG/5 ML ORAL SUSR,,17251,LOCAL,Facility,Inpatient,75 mL,mL,,266,226.1,76.2356,266,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
CEFADROXIL 500 MG/5 ML ORAL SUSR,,17251,LOCAL,Facility,Outpatient,75 mL,mL,,266,226.1,76.2356,266,"UCare Health, Inc.",Medicare Advantage,134.2502,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CEFADROXIL 500 MG/5 ML ORAL SUSR,,17251,LOCAL,Facility,Inpatient,75 mL,mL,,266,226.1,76.2356,266,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
CEFADROXIL 500 MG/5 ML ORAL SUSR,,17251,LOCAL,Facility,Outpatient,75 mL,mL,,266,226.1,76.2356,266,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),134.2502,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
CEFADROXIL 500 MG/5 ML ORAL SUSR,,17251,LOCAL,Facility,Inpatient,75 mL,mL,,266,226.1,76.2356,266,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
CEFADROXIL 500 MG/5 ML ORAL SUSR,,17251,LOCAL,Facility,Both,75 mL,mL,,266,226.1,76.2356,266,UnitedHealthcare,Individual & Family,250.04,94,,percent of total billed charges,,
CEFADROXIL 500 MG/5 ML ORAL SUSR,,17251,LOCAL,Facility,Outpatient,75 mL,mL,,266,226.1,76.2356,266,UnitedHealthcare,Medicare Advantage,130.34,49,,percent of total billed charges,,
CEFADROXIL 500 MG/5 ML ORAL SUSR,,17251,LOCAL,Facility,Inpatient,75 mL,mL,,266,226.1,76.2356,266,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
CEFADROXIL 500 MG/5 ML ORAL SUSR,,17251,LOCAL,Facility,Outpatient,75 mL,mL,,266,226.1,76.2356,266,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,127.68,48,,percent of total billed charges,,100% of DHS outpatient percentage
CEFADROXIL 500 MG/5 ML ORAL SUSR,,17251,LOCAL,Facility,Inpatient,75 mL,mL,,266,226.1,76.2356,266,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Telemedicine Facility Fee,,Q3014,HCPCS,Facility,Both,,,,77,65.45,22.0682,77,Aetna,Commercial,70.84,92,,percent of total billed charges,,
Telemedicine Facility Fee,,Q3014,HCPCS,Facility,Outpatient,,,,77,65.45,22.0682,77,Aetna,Medicare Advantage,37.73,49,,percent of total billed charges,,
Telemedicine Facility Fee,,Q3014,HCPCS,Facility,Inpatient,,,,77,65.45,22.0682,77,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Telemedicine Facility Fee,,Q3014,HCPCS,Facility,Both,,,,77,65.45,22.0682,77,Aetna,PPO,71.61,93,,percent of total billed charges,,
Telemedicine Facility Fee,,Q3014,HCPCS,Facility,Both,,,,77,65.45,22.0682,77,America's PPO,America's PPO,73.9431,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Telemedicine Facility Fee,,Q3014,HCPCS,Facility,Both,,,,77,65.45,22.0682,77,BlueCross BlueShield Minnesota, Federal Employee Program,75.768,98.4,,percent of total billed charges,,
Telemedicine Facility Fee,,Q3014,HCPCS,Facility,Both,,,,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,77,100,,percent of total billed charges,,
Telemedicine Facility Fee,,Q3014,HCPCS,Facility,Both,,,,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,High Value Network Plan,69.3,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
Telemedicine Facility Fee,,Q3014,HCPCS,Facility,Outpatient,,,,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,Medicare Advantage,37.73,49,,percent of total billed charges,,
Telemedicine Facility Fee,,Q3014,HCPCS,Facility,Inpatient,,,,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Telemedicine Facility Fee,,Q3014,HCPCS,Facility,Both,,,,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,68.1989,88.57,,percent of total billed charges,,
Telemedicine Facility Fee,,Q3014,HCPCS,Facility,Both,,,,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,22.0682,28.66,,percent of total billed charges,,
Telemedicine Facility Fee,,Q3014,HCPCS,Facility,Outpatient,,,,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),37.73,49,,percent of total billed charges,,
Telemedicine Facility Fee,,Q3014,HCPCS,Facility,Inpatient,,,,77,65.45,22.0682,77,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Telemedicine Facility Fee,,Q3014,HCPCS,Facility,Both,,,,77,65.45,22.0682,77,CorVel,Worker's Compensation,77,100,,percent of total billed charges,,
Telemedicine Facility Fee,,Q3014,HCPCS,Facility,Both,,,,77,65.45,22.0682,77,First Health Group Corporation,First Health Network,74.69,97,,percent of total billed charges,,
Telemedicine Facility Fee,,Q3014,HCPCS,Facility,Both,,,,77,65.45,22.0682,77,"Health Partners, Inc.",Commercial,72.842,94.6,,percent of total billed charges,,
Telemedicine Facility Fee,,Q3014,HCPCS,Facility,Outpatient,,,,77,65.45,22.0682,77,"Health Partners, Inc.",Medicare Advantage,37.73,49,,percent of total billed charges,,
Telemedicine Facility Fee,,Q3014,HCPCS,Facility,Inpatient,,,,77,65.45,22.0682,77,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Telemedicine Facility Fee,,Q3014,HCPCS,Facility,Both,,,,77,65.45,22.0682,77,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),46.2,60,,percent of total billed charges,,
Telemedicine Facility Fee,,Q3014,HCPCS,Facility,Both,,,,77,65.45,22.0682,77,"Health Partners, Inc.",State of Minnesota Advantage Program,62.755,81.5,,percent of total billed charges,,
Telemedicine Facility Fee,,Q3014,HCPCS,Facility,Both,,,,77,65.45,22.0682,77,"Health Partners, Inc.",State Public Programs,38.5,50,,percent of total billed charges,,
Telemedicine Facility Fee,,Q3014,HCPCS,Facility,Both,,,,77,65.45,22.0682,77,Humana Insurance Company,Commercial PPO,73.15,95,,percent of total billed charges,,
Telemedicine Facility Fee,,Q3014,HCPCS,Facility,Outpatient,,,,77,65.45,22.0682,77,Humana Insurance Company,Medicare PPO,37.73,49,,percent of total billed charges,,
Telemedicine Facility Fee,,Q3014,HCPCS,Facility,Inpatient,,,,77,65.45,22.0682,77,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Telemedicine Facility Fee,,Q3014,HCPCS,Facility,Both,,,,77,65.45,22.0682,77,Medica,Individual & Family,76.307,99.1,,percent of total billed charges,,
Telemedicine Facility Fee,,Q3014,HCPCS,Facility,Outpatient,,,,77,65.45,22.0682,77,Medica,Medica Advantage Solution,38.346,49.8,,percent of total billed charges,,
Telemedicine Facility Fee,,Q3014,HCPCS,Facility,Inpatient,,,,77,65.45,22.0682,77,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Telemedicine Facility Fee,,Q3014,HCPCS,Facility,Outpatient,,,,77,65.45,22.0682,77,Medica,Medical Assistance,34.342,44.6,,percent of total billed charges,,
Telemedicine Facility Fee,,Q3014,HCPCS,Facility,Inpatient,,,,77,65.45,22.0682,77,Medica,Medical Assistance,,,,,Included in per diem rate,
Telemedicine Facility Fee,,Q3014,HCPCS,Facility,Outpatient,,,,77,65.45,22.0682,77,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,38.346,49.8,,percent of total billed charges,,
Telemedicine Facility Fee,,Q3014,HCPCS,Facility,Inpatient,,,,77,65.45,22.0682,77,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Telemedicine Facility Fee,,Q3014,HCPCS,Facility,Both,,,,77,65.45,22.0682,77,"Multiplan, Inc.","Multiplan, Inc.",72.38,94,,percent of total billed charges,,
Telemedicine Facility Fee,,Q3014,HCPCS,Facility,Outpatient,,,,77,65.45,22.0682,77,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,69.377,90.1,,percent of total billed charges,,
Telemedicine Facility Fee,,Q3014,HCPCS,Facility,Inpatient,,,,77,65.45,22.0682,77,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Telemedicine Facility Fee,,Q3014,HCPCS,Facility,Both,,,,77,65.45,22.0682,77,"Preferred One Administrative Services, INC.",PPO,75.922,98.6,,percent of total billed charges,,
Telemedicine Facility Fee,,Q3014,HCPCS,Facility,Outpatient,,,,77,65.45,22.0682,77,PrimeWest Health,Minnesota Senior Health Options (MSHO),39.6165,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Telemedicine Facility Fee,,Q3014,HCPCS,Facility,Inpatient,,,,77,65.45,22.0682,77,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Telemedicine Facility Fee,,Q3014,HCPCS,Facility,Outpatient,,,,77,65.45,22.0682,77,PrimeWest Health,MinnesotaCare,39.5472,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Telemedicine Facility Fee,,Q3014,HCPCS,Facility,Inpatient,,,,77,65.45,22.0682,77,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Telemedicine Facility Fee,,Q3014,HCPCS,Facility,Both,,,,77,65.45,22.0682,77,Sanford Health Plan,Sanford Health Plan,70.84,92,,percent of total billed charges,,
Telemedicine Facility Fee,,Q3014,HCPCS,Facility,Outpatient,,,,77,65.45,22.0682,77,"UCare Health, Inc.",Individual & Family Plan,43.3895,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Telemedicine Facility Fee,,Q3014,HCPCS,Facility,Inpatient,,,,77,65.45,22.0682,77,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Telemedicine Facility Fee,,Q3014,HCPCS,Facility,Outpatient,,,,77,65.45,22.0682,77,"UCare Health, Inc.",Medical Assistance,38.8619,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Telemedicine Facility Fee,,Q3014,HCPCS,Facility,Inpatient,,,,77,65.45,22.0682,77,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Telemedicine Facility Fee,,Q3014,HCPCS,Facility,Outpatient,,,,77,65.45,22.0682,77,"UCare Health, Inc.",Medicare Advantage,38.8619,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Telemedicine Facility Fee,,Q3014,HCPCS,Facility,Inpatient,,,,77,65.45,22.0682,77,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Telemedicine Facility Fee,,Q3014,HCPCS,Facility,Outpatient,,,,77,65.45,22.0682,77,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),38.8619,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Telemedicine Facility Fee,,Q3014,HCPCS,Facility,Inpatient,,,,77,65.45,22.0682,77,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Telemedicine Facility Fee,,Q3014,HCPCS,Facility,Both,,,,77,65.45,22.0682,77,UnitedHealthcare,Individual & Family,72.38,94,,percent of total billed charges,,
Telemedicine Facility Fee,,Q3014,HCPCS,Facility,Outpatient,,,,77,65.45,22.0682,77,UnitedHealthcare,Medicare Advantage,37.73,49,,percent of total billed charges,,
Telemedicine Facility Fee,,Q3014,HCPCS,Facility,Inpatient,,,,77,65.45,22.0682,77,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Telemedicine Facility Fee,,Q3014,HCPCS,Facility,Outpatient,,,,77,65.45,22.0682,77,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,36.96,48,,percent of total billed charges,,100% of DHS outpatient percentage
Telemedicine Facility Fee,,Q3014,HCPCS,Facility,Inpatient,,,,77,65.45,22.0682,77,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Sup Short Leg Splint (Adult) Fiberglass,,Q4046,HCPCS,Facility,Both,,,,46,39.1,13.1836,46,Aetna,Commercial,42.32,92,,percent of total billed charges,,
Sup Short Leg Splint (Adult) Fiberglass,,Q4046,HCPCS,Facility,Both,,,,46,39.1,13.1836,46,Aetna,Commercial,42.32,92,,percent of total billed charges,,
Sup Short Leg Splint (Adult) Fiberglass,,Q4046,HCPCS,Facility,Outpatient,,,,46,39.1,13.1836,46,Aetna,Medicare Advantage,22.54,49,,percent of total billed charges,,
Sup Short Leg Splint (Adult) Fiberglass,,Q4046,HCPCS,Facility,Outpatient,,,,46,39.1,13.1836,46,Aetna,Medicare Advantage,22.54,49,,percent of total billed charges,,
Sup Short Leg Splint (Adult) Fiberglass,,Q4046,HCPCS,Facility,Inpatient,,,,46,39.1,13.1836,46,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Sup Short Leg Splint (Adult) Fiberglass,,Q4046,HCPCS,Facility,Inpatient,,,,46,39.1,13.1836,46,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Sup Short Leg Splint (Adult) Fiberglass,,Q4046,HCPCS,Facility,Both,,,,46,39.1,13.1836,46,Aetna,PPO,42.78,93,,percent of total billed charges,,
Sup Short Leg Splint (Adult) Fiberglass,,Q4046,HCPCS,Facility,Both,,,,46,39.1,13.1836,46,Aetna,PPO,42.78,93,,percent of total billed charges,,
Sup Short Leg Splint (Adult) Fiberglass,,Q4046,HCPCS,Facility,Both,,,,46,39.1,13.1836,46,America's PPO,America's PPO,44.1738,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Sup Short Leg Splint (Adult) Fiberglass,,Q4046,HCPCS,Facility,Both,,,,46,39.1,13.1836,46,America's PPO,America's PPO,44.1738,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Sup Short Leg Splint (Adult) Fiberglass,,Q4046,HCPCS,Facility,Both,,,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota, Federal Employee Program,45.264,98.4,,percent of total billed charges,,
Sup Short Leg Splint (Adult) Fiberglass,,Q4046,HCPCS,Facility,Both,,,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota, Federal Employee Program,45.264,98.4,,percent of total billed charges,,
Sup Short Leg Splint (Adult) Fiberglass,,Q4046,HCPCS,Facility,Both,,,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,46,100,,percent of total billed charges,,
Sup Short Leg Splint (Adult) Fiberglass,,Q4046,HCPCS,Facility,Both,,,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,46,100,,percent of total billed charges,,
Sup Short Leg Splint (Adult) Fiberglass,,Q4046,HCPCS,Facility,Both,,,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,High Value Network Plan,41.4,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
Sup Short Leg Splint (Adult) Fiberglass,,Q4046,HCPCS,Facility,Both,,,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,High Value Network Plan,41.4,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
Sup Short Leg Splint (Adult) Fiberglass,,Q4046,HCPCS,Facility,Outpatient,,,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Medicare Advantage,22.54,49,,percent of total billed charges,,
Sup Short Leg Splint (Adult) Fiberglass,,Q4046,HCPCS,Facility,Outpatient,,,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Medicare Advantage,22.54,49,,percent of total billed charges,,
Sup Short Leg Splint (Adult) Fiberglass,,Q4046,HCPCS,Facility,Inpatient,,,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Sup Short Leg Splint (Adult) Fiberglass,,Q4046,HCPCS,Facility,Inpatient,,,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Sup Short Leg Splint (Adult) Fiberglass,,Q4046,HCPCS,Facility,Both,,,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,40.7422,88.57,,percent of total billed charges,,
Sup Short Leg Splint (Adult) Fiberglass,,Q4046,HCPCS,Facility,Both,,,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,40.7422,88.57,,percent of total billed charges,,
Sup Short Leg Splint (Adult) Fiberglass,,Q4046,HCPCS,Facility,Both,,,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,13.1836,28.66,,percent of total billed charges,,
Sup Short Leg Splint (Adult) Fiberglass,,Q4046,HCPCS,Facility,Both,,,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,13.1836,28.66,,percent of total billed charges,,
Sup Short Leg Splint (Adult) Fiberglass,,Q4046,HCPCS,Facility,Outpatient,,,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),22.54,49,,percent of total billed charges,,
Sup Short Leg Splint (Adult) Fiberglass,,Q4046,HCPCS,Facility,Outpatient,,,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),22.54,49,,percent of total billed charges,,
Sup Short Leg Splint (Adult) Fiberglass,,Q4046,HCPCS,Facility,Inpatient,,,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Sup Short Leg Splint (Adult) Fiberglass,,Q4046,HCPCS,Facility,Inpatient,,,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Sup Short Leg Splint (Adult) Fiberglass,,Q4046,HCPCS,Facility,Both,,,,46,39.1,13.1836,46,CorVel,Worker's Compensation,46,100,,percent of total billed charges,,
Sup Short Leg Splint (Adult) Fiberglass,,Q4046,HCPCS,Facility,Both,,,,46,39.1,13.1836,46,CorVel,Worker's Compensation,46,100,,percent of total billed charges,,
Sup Short Leg Splint (Adult) Fiberglass,,Q4046,HCPCS,Facility,Both,,,,46,39.1,13.1836,46,First Health Group Corporation,First Health Network,44.62,97,,percent of total billed charges,,
Sup Short Leg Splint (Adult) Fiberglass,,Q4046,HCPCS,Facility,Both,,,,46,39.1,13.1836,46,First Health Group Corporation,First Health Network,44.62,97,,percent of total billed charges,,
Sup Short Leg Splint (Adult) Fiberglass,,Q4046,HCPCS,Facility,Both,,,,46,39.1,13.1836,46,"Health Partners, Inc.",Commercial,43.516,94.6,,percent of total billed charges,,
Sup Short Leg Splint (Adult) Fiberglass,,Q4046,HCPCS,Facility,Both,,,,46,39.1,13.1836,46,"Health Partners, Inc.",Commercial,43.516,94.6,,percent of total billed charges,,
Sup Short Leg Splint (Adult) Fiberglass,,Q4046,HCPCS,Facility,Outpatient,,,,46,39.1,13.1836,46,"Health Partners, Inc.",Medicare Advantage,22.54,49,,percent of total billed charges,,
Sup Short Leg Splint (Adult) Fiberglass,,Q4046,HCPCS,Facility,Outpatient,,,,46,39.1,13.1836,46,"Health Partners, Inc.",Medicare Advantage,22.54,49,,percent of total billed charges,,
Sup Short Leg Splint (Adult) Fiberglass,,Q4046,HCPCS,Facility,Inpatient,,,,46,39.1,13.1836,46,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Short Leg Splint (Adult) Fiberglass,,Q4046,HCPCS,Facility,Inpatient,,,,46,39.1,13.1836,46,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Short Leg Splint (Adult) Fiberglass,,Q4046,HCPCS,Facility,Both,,,,46,39.1,13.1836,46,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),27.6,60,,percent of total billed charges,,
Sup Short Leg Splint (Adult) Fiberglass,,Q4046,HCPCS,Facility,Both,,,,46,39.1,13.1836,46,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),27.6,60,,percent of total billed charges,,
Sup Short Leg Splint (Adult) Fiberglass,,Q4046,HCPCS,Facility,Both,,,,46,39.1,13.1836,46,"Health Partners, Inc.",State of Minnesota Advantage Program,37.49,81.5,,percent of total billed charges,,
Sup Short Leg Splint (Adult) Fiberglass,,Q4046,HCPCS,Facility,Both,,,,46,39.1,13.1836,46,"Health Partners, Inc.",State of Minnesota Advantage Program,37.49,81.5,,percent of total billed charges,,
Sup Short Leg Splint (Adult) Fiberglass,,Q4046,HCPCS,Facility,Both,,,,46,39.1,13.1836,46,"Health Partners, Inc.",State Public Programs,23,50,,percent of total billed charges,,
Sup Short Leg Splint (Adult) Fiberglass,,Q4046,HCPCS,Facility,Both,,,,46,39.1,13.1836,46,"Health Partners, Inc.",State Public Programs,23,50,,percent of total billed charges,,
Sup Short Leg Splint (Adult) Fiberglass,,Q4046,HCPCS,Facility,Both,,,,46,39.1,13.1836,46,Humana Insurance Company,Commercial PPO,43.7,95,,percent of total billed charges,,
Sup Short Leg Splint (Adult) Fiberglass,,Q4046,HCPCS,Facility,Both,,,,46,39.1,13.1836,46,Humana Insurance Company,Commercial PPO,43.7,95,,percent of total billed charges,,
Sup Short Leg Splint (Adult) Fiberglass,,Q4046,HCPCS,Facility,Outpatient,,,,46,39.1,13.1836,46,Humana Insurance Company,Medicare PPO,22.54,49,,percent of total billed charges,,
Sup Short Leg Splint (Adult) Fiberglass,,Q4046,HCPCS,Facility,Outpatient,,,,46,39.1,13.1836,46,Humana Insurance Company,Medicare PPO,22.54,49,,percent of total billed charges,,
Sup Short Leg Splint (Adult) Fiberglass,,Q4046,HCPCS,Facility,Inpatient,,,,46,39.1,13.1836,46,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Sup Short Leg Splint (Adult) Fiberglass,,Q4046,HCPCS,Facility,Inpatient,,,,46,39.1,13.1836,46,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Sup Short Leg Splint (Adult) Fiberglass,,Q4046,HCPCS,Facility,Both,,,,46,39.1,13.1836,46,Medica,Individual & Family,45.586,99.1,,percent of total billed charges,,
Sup Short Leg Splint (Adult) Fiberglass,,Q4046,HCPCS,Facility,Both,,,,46,39.1,13.1836,46,Medica,Individual & Family,45.586,99.1,,percent of total billed charges,,
Sup Short Leg Splint (Adult) Fiberglass,,Q4046,HCPCS,Facility,Outpatient,,,,46,39.1,13.1836,46,Medica,Medica Advantage Solution,22.908,49.8,,percent of total billed charges,,
Sup Short Leg Splint (Adult) Fiberglass,,Q4046,HCPCS,Facility,Outpatient,,,,46,39.1,13.1836,46,Medica,Medica Advantage Solution,22.908,49.8,,percent of total billed charges,,
Sup Short Leg Splint (Adult) Fiberglass,,Q4046,HCPCS,Facility,Inpatient,,,,46,39.1,13.1836,46,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Sup Short Leg Splint (Adult) Fiberglass,,Q4046,HCPCS,Facility,Inpatient,,,,46,39.1,13.1836,46,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Sup Short Leg Splint (Adult) Fiberglass,,Q4046,HCPCS,Facility,Outpatient,,,,46,39.1,13.1836,46,Medica,Medical Assistance,20.516,44.6,,percent of total billed charges,,
Sup Short Leg Splint (Adult) Fiberglass,,Q4046,HCPCS,Facility,Outpatient,,,,46,39.1,13.1836,46,Medica,Medical Assistance,20.516,44.6,,percent of total billed charges,,
Sup Short Leg Splint (Adult) Fiberglass,,Q4046,HCPCS,Facility,Inpatient,,,,46,39.1,13.1836,46,Medica,Medical Assistance,,,,,Included in per diem rate,
Sup Short Leg Splint (Adult) Fiberglass,,Q4046,HCPCS,Facility,Inpatient,,,,46,39.1,13.1836,46,Medica,Medical Assistance,,,,,Included in per diem rate,
Sup Short Leg Splint (Adult) Fiberglass,,Q4046,HCPCS,Facility,Outpatient,,,,46,39.1,13.1836,46,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,22.908,49.8,,percent of total billed charges,,
Sup Short Leg Splint (Adult) Fiberglass,,Q4046,HCPCS,Facility,Outpatient,,,,46,39.1,13.1836,46,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,22.908,49.8,,percent of total billed charges,,
Sup Short Leg Splint (Adult) Fiberglass,,Q4046,HCPCS,Facility,Inpatient,,,,46,39.1,13.1836,46,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Sup Short Leg Splint (Adult) Fiberglass,,Q4046,HCPCS,Facility,Inpatient,,,,46,39.1,13.1836,46,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Sup Short Leg Splint (Adult) Fiberglass,,Q4046,HCPCS,Facility,Both,,,,46,39.1,13.1836,46,"Multiplan, Inc.","Multiplan, Inc.",43.24,94,,percent of total billed charges,,
Sup Short Leg Splint (Adult) Fiberglass,,Q4046,HCPCS,Facility,Both,,,,46,39.1,13.1836,46,"Multiplan, Inc.","Multiplan, Inc.",43.24,94,,percent of total billed charges,,
Sup Short Leg Splint (Adult) Fiberglass,,Q4046,HCPCS,Facility,Outpatient,,,,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,41.446,90.1,,percent of total billed charges,,
Sup Short Leg Splint (Adult) Fiberglass,,Q4046,HCPCS,Facility,Outpatient,,,,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,41.446,90.1,,percent of total billed charges,,
Sup Short Leg Splint (Adult) Fiberglass,,Q4046,HCPCS,Facility,Inpatient,,,,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Sup Short Leg Splint (Adult) Fiberglass,,Q4046,HCPCS,Facility,Inpatient,,,,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Sup Short Leg Splint (Adult) Fiberglass,,Q4046,HCPCS,Facility,Both,,,,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PPO,45.356,98.6,,percent of total billed charges,,
Sup Short Leg Splint (Adult) Fiberglass,,Q4046,HCPCS,Facility,Both,,,,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PPO,45.356,98.6,,percent of total billed charges,,
Sup Short Leg Splint (Adult) Fiberglass,,Q4046,HCPCS,Facility,Outpatient,,,,46,39.1,13.1836,46,PrimeWest Health,Minnesota Senior Health Options (MSHO),23.667,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Sup Short Leg Splint (Adult) Fiberglass,,Q4046,HCPCS,Facility,Outpatient,,,,46,39.1,13.1836,46,PrimeWest Health,Minnesota Senior Health Options (MSHO),23.667,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Sup Short Leg Splint (Adult) Fiberglass,,Q4046,HCPCS,Facility,Inpatient,,,,46,39.1,13.1836,46,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Short Leg Splint (Adult) Fiberglass,,Q4046,HCPCS,Facility,Inpatient,,,,46,39.1,13.1836,46,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Short Leg Splint (Adult) Fiberglass,,Q4046,HCPCS,Facility,Outpatient,,,,46,39.1,13.1836,46,PrimeWest Health,MinnesotaCare,23.6256,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Sup Short Leg Splint (Adult) Fiberglass,,Q4046,HCPCS,Facility,Outpatient,,,,46,39.1,13.1836,46,PrimeWest Health,MinnesotaCare,23.6256,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Sup Short Leg Splint (Adult) Fiberglass,,Q4046,HCPCS,Facility,Inpatient,,,,46,39.1,13.1836,46,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Sup Short Leg Splint (Adult) Fiberglass,,Q4046,HCPCS,Facility,Inpatient,,,,46,39.1,13.1836,46,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Sup Short Leg Splint (Adult) Fiberglass,,Q4046,HCPCS,Facility,Both,,,,46,39.1,13.1836,46,Sanford Health Plan,Sanford Health Plan,42.32,92,,percent of total billed charges,,
Sup Short Leg Splint (Adult) Fiberglass,,Q4046,HCPCS,Facility,Both,,,,46,39.1,13.1836,46,Sanford Health Plan,Sanford Health Plan,42.32,92,,percent of total billed charges,,
Sup Short Leg Splint (Adult) Fiberglass,,Q4046,HCPCS,Facility,Outpatient,,,,46,39.1,13.1836,46,"UCare Health, Inc.",Individual & Family Plan,25.921,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Sup Short Leg Splint (Adult) Fiberglass,,Q4046,HCPCS,Facility,Outpatient,,,,46,39.1,13.1836,46,"UCare Health, Inc.",Individual & Family Plan,25.921,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Sup Short Leg Splint (Adult) Fiberglass,,Q4046,HCPCS,Facility,Inpatient,,,,46,39.1,13.1836,46,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Sup Short Leg Splint (Adult) Fiberglass,,Q4046,HCPCS,Facility,Inpatient,,,,46,39.1,13.1836,46,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Sup Short Leg Splint (Adult) Fiberglass,,Q4046,HCPCS,Facility,Outpatient,,,,46,39.1,13.1836,46,"UCare Health, Inc.",Medical Assistance,23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Short Leg Splint (Adult) Fiberglass,,Q4046,HCPCS,Facility,Outpatient,,,,46,39.1,13.1836,46,"UCare Health, Inc.",Medical Assistance,23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Short Leg Splint (Adult) Fiberglass,,Q4046,HCPCS,Facility,Inpatient,,,,46,39.1,13.1836,46,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Sup Short Leg Splint (Adult) Fiberglass,,Q4046,HCPCS,Facility,Inpatient,,,,46,39.1,13.1836,46,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Sup Short Leg Splint (Adult) Fiberglass,,Q4046,HCPCS,Facility,Outpatient,,,,46,39.1,13.1836,46,"UCare Health, Inc.",Medicare Advantage,23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Short Leg Splint (Adult) Fiberglass,,Q4046,HCPCS,Facility,Outpatient,,,,46,39.1,13.1836,46,"UCare Health, Inc.",Medicare Advantage,23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Short Leg Splint (Adult) Fiberglass,,Q4046,HCPCS,Facility,Inpatient,,,,46,39.1,13.1836,46,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Short Leg Splint (Adult) Fiberglass,,Q4046,HCPCS,Facility,Inpatient,,,,46,39.1,13.1836,46,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Short Leg Splint (Adult) Fiberglass,,Q4046,HCPCS,Facility,Outpatient,,,,46,39.1,13.1836,46,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Short Leg Splint (Adult) Fiberglass,,Q4046,HCPCS,Facility,Outpatient,,,,46,39.1,13.1836,46,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Short Leg Splint (Adult) Fiberglass,,Q4046,HCPCS,Facility,Inpatient,,,,46,39.1,13.1836,46,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Short Leg Splint (Adult) Fiberglass,,Q4046,HCPCS,Facility,Inpatient,,,,46,39.1,13.1836,46,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Short Leg Splint (Adult) Fiberglass,,Q4046,HCPCS,Facility,Both,,,,46,39.1,13.1836,46,UnitedHealthcare,Individual & Family,43.24,94,,percent of total billed charges,,
Sup Short Leg Splint (Adult) Fiberglass,,Q4046,HCPCS,Facility,Both,,,,46,39.1,13.1836,46,UnitedHealthcare,Individual & Family,43.24,94,,percent of total billed charges,,
Sup Short Leg Splint (Adult) Fiberglass,,Q4046,HCPCS,Facility,Outpatient,,,,46,39.1,13.1836,46,UnitedHealthcare,Medicare Advantage,22.54,49,,percent of total billed charges,,
Sup Short Leg Splint (Adult) Fiberglass,,Q4046,HCPCS,Facility,Outpatient,,,,46,39.1,13.1836,46,UnitedHealthcare,Medicare Advantage,22.54,49,,percent of total billed charges,,
Sup Short Leg Splint (Adult) Fiberglass,,Q4046,HCPCS,Facility,Inpatient,,,,46,39.1,13.1836,46,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Sup Short Leg Splint (Adult) Fiberglass,,Q4046,HCPCS,Facility,Inpatient,,,,46,39.1,13.1836,46,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Sup Short Leg Splint (Adult) Fiberglass,,Q4046,HCPCS,Facility,Outpatient,,,,46,39.1,13.1836,46,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,22.08,48,,percent of total billed charges,,100% of DHS outpatient percentage
Sup Short Leg Splint (Adult) Fiberglass,,Q4046,HCPCS,Facility,Outpatient,,,,46,39.1,13.1836,46,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,22.08,48,,percent of total billed charges,,100% of DHS outpatient percentage
Sup Short Leg Splint (Adult) Fiberglass,,Q4046,HCPCS,Facility,Inpatient,,,,46,39.1,13.1836,46,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Sup Short Leg Splint (Adult) Fiberglass,,Q4046,HCPCS,Facility,Inpatient,,,,46,39.1,13.1836,46,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Sup Bandage Paste Unna Boot,,Q4050,HCPCS,Facility,Both,,,,15,12.75,4.299,15,Aetna,Commercial,13.8,92,,percent of total billed charges,,
Sup Bandage Paste Unna Boot,,Q4050,HCPCS,Facility,Outpatient,,,,15,12.75,4.299,15,Aetna,Medicare Advantage,7.35,49,,percent of total billed charges,,
Sup Bandage Paste Unna Boot,,Q4050,HCPCS,Facility,Inpatient,,,,15,12.75,4.299,15,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Sup Bandage Paste Unna Boot,,Q4050,HCPCS,Facility,Both,,,,15,12.75,4.299,15,Aetna,PPO,13.95,93,,percent of total billed charges,,
Sup Bandage Paste Unna Boot,,Q4050,HCPCS,Facility,Both,,,,15,12.75,4.299,15,America's PPO,America's PPO,14.4045,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Sup Bandage Paste Unna Boot,,Q4050,HCPCS,Facility,Both,,,,15,12.75,4.299,15,BlueCross BlueShield Minnesota, Federal Employee Program,14.76,98.4,,percent of total billed charges,,
Sup Bandage Paste Unna Boot,,Q4050,HCPCS,Facility,Both,,,,15,12.75,4.299,15,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,15,100,,percent of total billed charges,,
Sup Bandage Paste Unna Boot,,Q4050,HCPCS,Facility,Both,,,,15,12.75,4.299,15,BlueCross BlueShield Minnesota,High Value Network Plan,13.5,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
Sup Bandage Paste Unna Boot,,Q4050,HCPCS,Facility,Outpatient,,,,15,12.75,4.299,15,BlueCross BlueShield Minnesota,Medicare Advantage,7.35,49,,percent of total billed charges,,
Sup Bandage Paste Unna Boot,,Q4050,HCPCS,Facility,Inpatient,,,,15,12.75,4.299,15,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Sup Bandage Paste Unna Boot,,Q4050,HCPCS,Facility,Both,,,,15,12.75,4.299,15,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,13.2855,88.57,,percent of total billed charges,,
Sup Bandage Paste Unna Boot,,Q4050,HCPCS,Facility,Both,,,,15,12.75,4.299,15,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,4.299,28.66,,percent of total billed charges,,
Sup Bandage Paste Unna Boot,,Q4050,HCPCS,Facility,Outpatient,,,,15,12.75,4.299,15,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),7.35,49,,percent of total billed charges,,
Sup Bandage Paste Unna Boot,,Q4050,HCPCS,Facility,Inpatient,,,,15,12.75,4.299,15,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Sup Bandage Paste Unna Boot,,Q4050,HCPCS,Facility,Both,,,,15,12.75,4.299,15,CorVel,Worker's Compensation,15,100,,percent of total billed charges,,
Sup Bandage Paste Unna Boot,,Q4050,HCPCS,Facility,Both,,,,15,12.75,4.299,15,First Health Group Corporation,First Health Network,14.55,97,,percent of total billed charges,,
Sup Bandage Paste Unna Boot,,Q4050,HCPCS,Facility,Both,,,,15,12.75,4.299,15,"Health Partners, Inc.",Commercial,14.19,94.6,,percent of total billed charges,,
Sup Bandage Paste Unna Boot,,Q4050,HCPCS,Facility,Outpatient,,,,15,12.75,4.299,15,"Health Partners, Inc.",Medicare Advantage,7.35,49,,percent of total billed charges,,
Sup Bandage Paste Unna Boot,,Q4050,HCPCS,Facility,Inpatient,,,,15,12.75,4.299,15,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Bandage Paste Unna Boot,,Q4050,HCPCS,Facility,Both,,,,15,12.75,4.299,15,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),9,60,,percent of total billed charges,,
Sup Bandage Paste Unna Boot,,Q4050,HCPCS,Facility,Both,,,,15,12.75,4.299,15,"Health Partners, Inc.",State of Minnesota Advantage Program,12.225,81.5,,percent of total billed charges,,
Sup Bandage Paste Unna Boot,,Q4050,HCPCS,Facility,Both,,,,15,12.75,4.299,15,"Health Partners, Inc.",State Public Programs,7.5,50,,percent of total billed charges,,
Sup Bandage Paste Unna Boot,,Q4050,HCPCS,Facility,Both,,,,15,12.75,4.299,15,Humana Insurance Company,Commercial PPO,14.25,95,,percent of total billed charges,,
Sup Bandage Paste Unna Boot,,Q4050,HCPCS,Facility,Outpatient,,,,15,12.75,4.299,15,Humana Insurance Company,Medicare PPO,7.35,49,,percent of total billed charges,,
Sup Bandage Paste Unna Boot,,Q4050,HCPCS,Facility,Inpatient,,,,15,12.75,4.299,15,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Sup Bandage Paste Unna Boot,,Q4050,HCPCS,Facility,Both,,,,15,12.75,4.299,15,Medica,Individual & Family,14.865,99.1,,percent of total billed charges,,
Sup Bandage Paste Unna Boot,,Q4050,HCPCS,Facility,Outpatient,,,,15,12.75,4.299,15,Medica,Medica Advantage Solution,7.47,49.8,,percent of total billed charges,,
Sup Bandage Paste Unna Boot,,Q4050,HCPCS,Facility,Inpatient,,,,15,12.75,4.299,15,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Sup Bandage Paste Unna Boot,,Q4050,HCPCS,Facility,Outpatient,,,,15,12.75,4.299,15,Medica,Medical Assistance,6.69,44.6,,percent of total billed charges,,
Sup Bandage Paste Unna Boot,,Q4050,HCPCS,Facility,Inpatient,,,,15,12.75,4.299,15,Medica,Medical Assistance,,,,,Included in per diem rate,
Sup Bandage Paste Unna Boot,,Q4050,HCPCS,Facility,Outpatient,,,,15,12.75,4.299,15,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,7.47,49.8,,percent of total billed charges,,
Sup Bandage Paste Unna Boot,,Q4050,HCPCS,Facility,Inpatient,,,,15,12.75,4.299,15,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Sup Bandage Paste Unna Boot,,Q4050,HCPCS,Facility,Both,,,,15,12.75,4.299,15,"Multiplan, Inc.","Multiplan, Inc.",14.1,94,,percent of total billed charges,,
Sup Bandage Paste Unna Boot,,Q4050,HCPCS,Facility,Outpatient,,,,15,12.75,4.299,15,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,13.515,90.1,,percent of total billed charges,,
Sup Bandage Paste Unna Boot,,Q4050,HCPCS,Facility,Inpatient,,,,15,12.75,4.299,15,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Sup Bandage Paste Unna Boot,,Q4050,HCPCS,Facility,Both,,,,15,12.75,4.299,15,"Preferred One Administrative Services, INC.",PPO,14.79,98.6,,percent of total billed charges,,
Sup Bandage Paste Unna Boot,,Q4050,HCPCS,Facility,Outpatient,,,,15,12.75,4.299,15,PrimeWest Health,Minnesota Senior Health Options (MSHO),7.7175,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Sup Bandage Paste Unna Boot,,Q4050,HCPCS,Facility,Inpatient,,,,15,12.75,4.299,15,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Bandage Paste Unna Boot,,Q4050,HCPCS,Facility,Outpatient,,,,15,12.75,4.299,15,PrimeWest Health,MinnesotaCare,7.704,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Sup Bandage Paste Unna Boot,,Q4050,HCPCS,Facility,Inpatient,,,,15,12.75,4.299,15,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Sup Bandage Paste Unna Boot,,Q4050,HCPCS,Facility,Both,,,,15,12.75,4.299,15,Sanford Health Plan,Sanford Health Plan,13.8,92,,percent of total billed charges,,
Sup Bandage Paste Unna Boot,,Q4050,HCPCS,Facility,Outpatient,,,,15,12.75,4.299,15,"UCare Health, Inc.",Individual & Family Plan,8.4525,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Sup Bandage Paste Unna Boot,,Q4050,HCPCS,Facility,Inpatient,,,,15,12.75,4.299,15,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Sup Bandage Paste Unna Boot,,Q4050,HCPCS,Facility,Outpatient,,,,15,12.75,4.299,15,"UCare Health, Inc.",Medical Assistance,7.5705,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Bandage Paste Unna Boot,,Q4050,HCPCS,Facility,Inpatient,,,,15,12.75,4.299,15,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Sup Bandage Paste Unna Boot,,Q4050,HCPCS,Facility,Outpatient,,,,15,12.75,4.299,15,"UCare Health, Inc.",Medicare Advantage,7.5705,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Bandage Paste Unna Boot,,Q4050,HCPCS,Facility,Inpatient,,,,15,12.75,4.299,15,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Bandage Paste Unna Boot,,Q4050,HCPCS,Facility,Outpatient,,,,15,12.75,4.299,15,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),7.5705,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Bandage Paste Unna Boot,,Q4050,HCPCS,Facility,Inpatient,,,,15,12.75,4.299,15,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Bandage Paste Unna Boot,,Q4050,HCPCS,Facility,Both,,,,15,12.75,4.299,15,UnitedHealthcare,Individual & Family,14.1,94,,percent of total billed charges,,
Sup Bandage Paste Unna Boot,,Q4050,HCPCS,Facility,Outpatient,,,,15,12.75,4.299,15,UnitedHealthcare,Medicare Advantage,7.35,49,,percent of total billed charges,,
Sup Bandage Paste Unna Boot,,Q4050,HCPCS,Facility,Inpatient,,,,15,12.75,4.299,15,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Sup Bandage Paste Unna Boot,,Q4050,HCPCS,Facility,Outpatient,,,,15,12.75,4.299,15,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,7.2,48,,percent of total billed charges,,100% of DHS outpatient percentage
Sup Bandage Paste Unna Boot,,Q4050,HCPCS,Facility,Inpatient,,,,15,12.75,4.299,15,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Sup Cl Cast Supplies, For Unlisted Types And Materials Of Casts",,Q4050,HCPCS,Facility,Both,,,,51,43.35,14.6166,51,Aetna,Commercial,46.92,92,,percent of total billed charges,,
"Sup Cl Cast Supplies, For Unlisted Types And Materials Of Casts",,Q4050,HCPCS,Facility,Outpatient,,,,51,43.35,14.6166,51,Aetna,Medicare Advantage,24.99,49,,percent of total billed charges,,
"Sup Cl Cast Supplies, For Unlisted Types And Materials Of Casts",,Q4050,HCPCS,Facility,Inpatient,,,,51,43.35,14.6166,51,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Sup Cl Cast Supplies, For Unlisted Types And Materials Of Casts",,Q4050,HCPCS,Facility,Both,,,,51,43.35,14.6166,51,Aetna,PPO,47.43,93,,percent of total billed charges,,
"Sup Cl Cast Supplies, For Unlisted Types And Materials Of Casts",,Q4050,HCPCS,Facility,Both,,,,51,43.35,14.6166,51,America's PPO,America's PPO,48.9753,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Sup Cl Cast Supplies, For Unlisted Types And Materials Of Casts",,Q4050,HCPCS,Facility,Both,,,,51,43.35,14.6166,51,BlueCross BlueShield Minnesota, Federal Employee Program,50.184,98.4,,percent of total billed charges,,
"Sup Cl Cast Supplies, For Unlisted Types And Materials Of Casts",,Q4050,HCPCS,Facility,Both,,,,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,51,100,,percent of total billed charges,,
"Sup Cl Cast Supplies, For Unlisted Types And Materials Of Casts",,Q4050,HCPCS,Facility,Both,,,,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,High Value Network Plan,45.9,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
"Sup Cl Cast Supplies, For Unlisted Types And Materials Of Casts",,Q4050,HCPCS,Facility,Outpatient,,,,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,Medicare Advantage,24.99,49,,percent of total billed charges,,
"Sup Cl Cast Supplies, For Unlisted Types And Materials Of Casts",,Q4050,HCPCS,Facility,Inpatient,,,,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Sup Cl Cast Supplies, For Unlisted Types And Materials Of Casts",,Q4050,HCPCS,Facility,Both,,,,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,45.1707,88.57,,percent of total billed charges,,
"Sup Cl Cast Supplies, For Unlisted Types And Materials Of Casts",,Q4050,HCPCS,Facility,Both,,,,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,14.6166,28.66,,percent of total billed charges,,
"Sup Cl Cast Supplies, For Unlisted Types And Materials Of Casts",,Q4050,HCPCS,Facility,Outpatient,,,,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),24.99,49,,percent of total billed charges,,
"Sup Cl Cast Supplies, For Unlisted Types And Materials Of Casts",,Q4050,HCPCS,Facility,Inpatient,,,,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Sup Cl Cast Supplies, For Unlisted Types And Materials Of Casts",,Q4050,HCPCS,Facility,Both,,,,51,43.35,14.6166,51,CorVel,Worker's Compensation,51,100,,percent of total billed charges,,
"Sup Cl Cast Supplies, For Unlisted Types And Materials Of Casts",,Q4050,HCPCS,Facility,Both,,,,51,43.35,14.6166,51,First Health Group Corporation,First Health Network,49.47,97,,percent of total billed charges,,
"Sup Cl Cast Supplies, For Unlisted Types And Materials Of Casts",,Q4050,HCPCS,Facility,Both,,,,51,43.35,14.6166,51,"Health Partners, Inc.",Commercial,48.246,94.6,,percent of total billed charges,,
"Sup Cl Cast Supplies, For Unlisted Types And Materials Of Casts",,Q4050,HCPCS,Facility,Outpatient,,,,51,43.35,14.6166,51,"Health Partners, Inc.",Medicare Advantage,24.99,49,,percent of total billed charges,,
"Sup Cl Cast Supplies, For Unlisted Types And Materials Of Casts",,Q4050,HCPCS,Facility,Inpatient,,,,51,43.35,14.6166,51,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Sup Cl Cast Supplies, For Unlisted Types And Materials Of Casts",,Q4050,HCPCS,Facility,Both,,,,51,43.35,14.6166,51,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),30.6,60,,percent of total billed charges,,
"Sup Cl Cast Supplies, For Unlisted Types And Materials Of Casts",,Q4050,HCPCS,Facility,Both,,,,51,43.35,14.6166,51,"Health Partners, Inc.",State of Minnesota Advantage Program,41.565,81.5,,percent of total billed charges,,
"Sup Cl Cast Supplies, For Unlisted Types And Materials Of Casts",,Q4050,HCPCS,Facility,Both,,,,51,43.35,14.6166,51,"Health Partners, Inc.",State Public Programs,25.5,50,,percent of total billed charges,,
"Sup Cl Cast Supplies, For Unlisted Types And Materials Of Casts",,Q4050,HCPCS,Facility,Both,,,,51,43.35,14.6166,51,Humana Insurance Company,Commercial PPO,48.45,95,,percent of total billed charges,,
"Sup Cl Cast Supplies, For Unlisted Types And Materials Of Casts",,Q4050,HCPCS,Facility,Outpatient,,,,51,43.35,14.6166,51,Humana Insurance Company,Medicare PPO,24.99,49,,percent of total billed charges,,
"Sup Cl Cast Supplies, For Unlisted Types And Materials Of Casts",,Q4050,HCPCS,Facility,Inpatient,,,,51,43.35,14.6166,51,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Sup Cl Cast Supplies, For Unlisted Types And Materials Of Casts",,Q4050,HCPCS,Facility,Both,,,,51,43.35,14.6166,51,Medica,Individual & Family,50.541,99.1,,percent of total billed charges,,
"Sup Cl Cast Supplies, For Unlisted Types And Materials Of Casts",,Q4050,HCPCS,Facility,Outpatient,,,,51,43.35,14.6166,51,Medica,Medica Advantage Solution,25.398,49.8,,percent of total billed charges,,
"Sup Cl Cast Supplies, For Unlisted Types And Materials Of Casts",,Q4050,HCPCS,Facility,Inpatient,,,,51,43.35,14.6166,51,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Sup Cl Cast Supplies, For Unlisted Types And Materials Of Casts",,Q4050,HCPCS,Facility,Outpatient,,,,51,43.35,14.6166,51,Medica,Medical Assistance,22.746,44.6,,percent of total billed charges,,
"Sup Cl Cast Supplies, For Unlisted Types And Materials Of Casts",,Q4050,HCPCS,Facility,Inpatient,,,,51,43.35,14.6166,51,Medica,Medical Assistance,,,,,Included in per diem rate,
"Sup Cl Cast Supplies, For Unlisted Types And Materials Of Casts",,Q4050,HCPCS,Facility,Outpatient,,,,51,43.35,14.6166,51,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,25.398,49.8,,percent of total billed charges,,
"Sup Cl Cast Supplies, For Unlisted Types And Materials Of Casts",,Q4050,HCPCS,Facility,Inpatient,,,,51,43.35,14.6166,51,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Sup Cl Cast Supplies, For Unlisted Types And Materials Of Casts",,Q4050,HCPCS,Facility,Both,,,,51,43.35,14.6166,51,"Multiplan, Inc.","Multiplan, Inc.",47.94,94,,percent of total billed charges,,
"Sup Cl Cast Supplies, For Unlisted Types And Materials Of Casts",,Q4050,HCPCS,Facility,Outpatient,,,,51,43.35,14.6166,51,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,45.951,90.1,,percent of total billed charges,,
"Sup Cl Cast Supplies, For Unlisted Types And Materials Of Casts",,Q4050,HCPCS,Facility,Inpatient,,,,51,43.35,14.6166,51,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Sup Cl Cast Supplies, For Unlisted Types And Materials Of Casts",,Q4050,HCPCS,Facility,Both,,,,51,43.35,14.6166,51,"Preferred One Administrative Services, INC.",PPO,50.286,98.6,,percent of total billed charges,,
"Sup Cl Cast Supplies, For Unlisted Types And Materials Of Casts",,Q4050,HCPCS,Facility,Outpatient,,,,51,43.35,14.6166,51,PrimeWest Health,Minnesota Senior Health Options (MSHO),26.2395,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Sup Cl Cast Supplies, For Unlisted Types And Materials Of Casts",,Q4050,HCPCS,Facility,Inpatient,,,,51,43.35,14.6166,51,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Sup Cl Cast Supplies, For Unlisted Types And Materials Of Casts",,Q4050,HCPCS,Facility,Outpatient,,,,51,43.35,14.6166,51,PrimeWest Health,MinnesotaCare,26.1936,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Sup Cl Cast Supplies, For Unlisted Types And Materials Of Casts",,Q4050,HCPCS,Facility,Inpatient,,,,51,43.35,14.6166,51,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Sup Cl Cast Supplies, For Unlisted Types And Materials Of Casts",,Q4050,HCPCS,Facility,Both,,,,51,43.35,14.6166,51,Sanford Health Plan,Sanford Health Plan,46.92,92,,percent of total billed charges,,
"Sup Cl Cast Supplies, For Unlisted Types And Materials Of Casts",,Q4050,HCPCS,Facility,Outpatient,,,,51,43.35,14.6166,51,"UCare Health, Inc.",Individual & Family Plan,28.7385,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Sup Cl Cast Supplies, For Unlisted Types And Materials Of Casts",,Q4050,HCPCS,Facility,Inpatient,,,,51,43.35,14.6166,51,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Sup Cl Cast Supplies, For Unlisted Types And Materials Of Casts",,Q4050,HCPCS,Facility,Outpatient,,,,51,43.35,14.6166,51,"UCare Health, Inc.",Medical Assistance,25.7397,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Sup Cl Cast Supplies, For Unlisted Types And Materials Of Casts",,Q4050,HCPCS,Facility,Inpatient,,,,51,43.35,14.6166,51,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Sup Cl Cast Supplies, For Unlisted Types And Materials Of Casts",,Q4050,HCPCS,Facility,Outpatient,,,,51,43.35,14.6166,51,"UCare Health, Inc.",Medicare Advantage,25.7397,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Sup Cl Cast Supplies, For Unlisted Types And Materials Of Casts",,Q4050,HCPCS,Facility,Inpatient,,,,51,43.35,14.6166,51,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Sup Cl Cast Supplies, For Unlisted Types And Materials Of Casts",,Q4050,HCPCS,Facility,Outpatient,,,,51,43.35,14.6166,51,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),25.7397,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Sup Cl Cast Supplies, For Unlisted Types And Materials Of Casts",,Q4050,HCPCS,Facility,Inpatient,,,,51,43.35,14.6166,51,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Sup Cl Cast Supplies, For Unlisted Types And Materials Of Casts",,Q4050,HCPCS,Facility,Both,,,,51,43.35,14.6166,51,UnitedHealthcare,Individual & Family,47.94,94,,percent of total billed charges,,
"Sup Cl Cast Supplies, For Unlisted Types And Materials Of Casts",,Q4050,HCPCS,Facility,Outpatient,,,,51,43.35,14.6166,51,UnitedHealthcare,Medicare Advantage,24.99,49,,percent of total billed charges,,
"Sup Cl Cast Supplies, For Unlisted Types And Materials Of Casts",,Q4050,HCPCS,Facility,Inpatient,,,,51,43.35,14.6166,51,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Sup Cl Cast Supplies, For Unlisted Types And Materials Of Casts",,Q4050,HCPCS,Facility,Outpatient,,,,51,43.35,14.6166,51,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,24.48,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Sup Cl Cast Supplies, For Unlisted Types And Materials Of Casts",,Q4050,HCPCS,Facility,Inpatient,,,,51,43.35,14.6166,51,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Sup Skin Subsititute (Dermagraft) Per 1 Sq Cm,,Q4106,HCPCS,Facility,Both,,,,2168,1842.8,621.3488,2168,Aetna,Commercial,1994.56,92,,percent of total billed charges,,
Sup Skin Subsititute (Dermagraft) Per 1 Sq Cm,,Q4106,HCPCS,Facility,Outpatient,,,,2168,1842.8,621.3488,2168,Aetna,Medicare Advantage,1062.32,49,,percent of total billed charges,,
Sup Skin Subsititute (Dermagraft) Per 1 Sq Cm,,Q4106,HCPCS,Facility,Inpatient,,,,2168,1842.8,621.3488,2168,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Sup Skin Subsititute (Dermagraft) Per 1 Sq Cm,,Q4106,HCPCS,Facility,Both,,,,2168,1842.8,621.3488,2168,Aetna,PPO,2016.24,93,,percent of total billed charges,,
Sup Skin Subsititute (Dermagraft) Per 1 Sq Cm,,Q4106,HCPCS,Facility,Both,,,,2168,1842.8,621.3488,2168,America's PPO,America's PPO,2081.9304,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Sup Skin Subsititute (Dermagraft) Per 1 Sq Cm,,Q4106,HCPCS,Facility,Both,,,,2168,1842.8,621.3488,2168,BlueCross BlueShield Minnesota, Federal Employee Program,2133.312,98.4,,percent of total billed charges,,
Sup Skin Subsititute (Dermagraft) Per 1 Sq Cm,,Q4106,HCPCS,Facility,Both,,,,2168,1842.8,621.3488,2168,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,2168,100,,percent of total billed charges,,
Sup Skin Subsititute (Dermagraft) Per 1 Sq Cm,,Q4106,HCPCS,Facility,Both,,,,2168,1842.8,621.3488,2168,BlueCross BlueShield Minnesota,High Value Network Plan,1951.2,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
Sup Skin Subsititute (Dermagraft) Per 1 Sq Cm,,Q4106,HCPCS,Facility,Outpatient,,,,2168,1842.8,621.3488,2168,BlueCross BlueShield Minnesota,Medicare Advantage,1062.32,49,,percent of total billed charges,,
Sup Skin Subsititute (Dermagraft) Per 1 Sq Cm,,Q4106,HCPCS,Facility,Inpatient,,,,2168,1842.8,621.3488,2168,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Sup Skin Subsititute (Dermagraft) Per 1 Sq Cm,,Q4106,HCPCS,Facility,Both,,,,2168,1842.8,621.3488,2168,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1920.1976,88.57,,percent of total billed charges,,
Sup Skin Subsititute (Dermagraft) Per 1 Sq Cm,,Q4106,HCPCS,Facility,Both,,,,2168,1842.8,621.3488,2168,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,621.3488,28.66,,percent of total billed charges,,
Sup Skin Subsititute (Dermagraft) Per 1 Sq Cm,,Q4106,HCPCS,Facility,Outpatient,,,,2168,1842.8,621.3488,2168,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),1062.32,49,,percent of total billed charges,,
Sup Skin Subsititute (Dermagraft) Per 1 Sq Cm,,Q4106,HCPCS,Facility,Inpatient,,,,2168,1842.8,621.3488,2168,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Sup Skin Subsititute (Dermagraft) Per 1 Sq Cm,,Q4106,HCPCS,Facility,Both,,,,2168,1842.8,621.3488,2168,CorVel,Worker's Compensation,2168,100,,percent of total billed charges,,
Sup Skin Subsititute (Dermagraft) Per 1 Sq Cm,,Q4106,HCPCS,Facility,Both,,,,2168,1842.8,621.3488,2168,First Health Group Corporation,First Health Network,2102.96,97,,percent of total billed charges,,
Sup Skin Subsititute (Dermagraft) Per 1 Sq Cm,,Q4106,HCPCS,Facility,Both,,,,2168,1842.8,621.3488,2168,"Health Partners, Inc.",Commercial,2050.928,94.6,,percent of total billed charges,,
Sup Skin Subsititute (Dermagraft) Per 1 Sq Cm,,Q4106,HCPCS,Facility,Outpatient,,,,2168,1842.8,621.3488,2168,"Health Partners, Inc.",Medicare Advantage,1062.32,49,,percent of total billed charges,,
Sup Skin Subsititute (Dermagraft) Per 1 Sq Cm,,Q4106,HCPCS,Facility,Inpatient,,,,2168,1842.8,621.3488,2168,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Skin Subsititute (Dermagraft) Per 1 Sq Cm,,Q4106,HCPCS,Facility,Both,,,,2168,1842.8,621.3488,2168,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),1300.8,60,,percent of total billed charges,,
Sup Skin Subsititute (Dermagraft) Per 1 Sq Cm,,Q4106,HCPCS,Facility,Both,,,,2168,1842.8,621.3488,2168,"Health Partners, Inc.",State of Minnesota Advantage Program,1766.92,81.5,,percent of total billed charges,,
Sup Skin Subsititute (Dermagraft) Per 1 Sq Cm,,Q4106,HCPCS,Facility,Both,,,,2168,1842.8,621.3488,2168,"Health Partners, Inc.",State Public Programs,1084,50,,percent of total billed charges,,
Sup Skin Subsititute (Dermagraft) Per 1 Sq Cm,,Q4106,HCPCS,Facility,Both,,,,2168,1842.8,621.3488,2168,Humana Insurance Company,Commercial PPO,2059.6,95,,percent of total billed charges,,
Sup Skin Subsititute (Dermagraft) Per 1 Sq Cm,,Q4106,HCPCS,Facility,Outpatient,,,,2168,1842.8,621.3488,2168,Humana Insurance Company,Medicare PPO,1062.32,49,,percent of total billed charges,,
Sup Skin Subsititute (Dermagraft) Per 1 Sq Cm,,Q4106,HCPCS,Facility,Inpatient,,,,2168,1842.8,621.3488,2168,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Sup Skin Subsititute (Dermagraft) Per 1 Sq Cm,,Q4106,HCPCS,Facility,Both,,,,2168,1842.8,621.3488,2168,Medica,Individual & Family,2148.488,99.1,,percent of total billed charges,,
Sup Skin Subsititute (Dermagraft) Per 1 Sq Cm,,Q4106,HCPCS,Facility,Outpatient,,,,2168,1842.8,621.3488,2168,Medica,Medica Advantage Solution,1079.664,49.8,,percent of total billed charges,,
Sup Skin Subsititute (Dermagraft) Per 1 Sq Cm,,Q4106,HCPCS,Facility,Inpatient,,,,2168,1842.8,621.3488,2168,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Sup Skin Subsititute (Dermagraft) Per 1 Sq Cm,,Q4106,HCPCS,Facility,Outpatient,,,,2168,1842.8,621.3488,2168,Medica,Medical Assistance,966.928,44.6,,percent of total billed charges,,
Sup Skin Subsititute (Dermagraft) Per 1 Sq Cm,,Q4106,HCPCS,Facility,Inpatient,,,,2168,1842.8,621.3488,2168,Medica,Medical Assistance,,,,,Included in per diem rate,
Sup Skin Subsititute (Dermagraft) Per 1 Sq Cm,,Q4106,HCPCS,Facility,Outpatient,,,,2168,1842.8,621.3488,2168,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,1079.664,49.8,,percent of total billed charges,,
Sup Skin Subsititute (Dermagraft) Per 1 Sq Cm,,Q4106,HCPCS,Facility,Inpatient,,,,2168,1842.8,621.3488,2168,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Sup Skin Subsititute (Dermagraft) Per 1 Sq Cm,,Q4106,HCPCS,Facility,Both,,,,2168,1842.8,621.3488,2168,"Multiplan, Inc.","Multiplan, Inc.",2037.92,94,,percent of total billed charges,,
Sup Skin Subsititute (Dermagraft) Per 1 Sq Cm,,Q4106,HCPCS,Facility,Outpatient,,,,2168,1842.8,621.3488,2168,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1953.368,90.1,,percent of total billed charges,,
Sup Skin Subsititute (Dermagraft) Per 1 Sq Cm,,Q4106,HCPCS,Facility,Inpatient,,,,2168,1842.8,621.3488,2168,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Sup Skin Subsititute (Dermagraft) Per 1 Sq Cm,,Q4106,HCPCS,Facility,Both,,,,2168,1842.8,621.3488,2168,"Preferred One Administrative Services, INC.",PPO,2137.648,98.6,,percent of total billed charges,,
Sup Skin Subsititute (Dermagraft) Per 1 Sq Cm,,Q4106,HCPCS,Facility,Outpatient,,,,2168,1842.8,621.3488,2168,PrimeWest Health,Minnesota Senior Health Options (MSHO),1115.436,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Sup Skin Subsititute (Dermagraft) Per 1 Sq Cm,,Q4106,HCPCS,Facility,Inpatient,,,,2168,1842.8,621.3488,2168,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Skin Subsititute (Dermagraft) Per 1 Sq Cm,,Q4106,HCPCS,Facility,Outpatient,,,,2168,1842.8,621.3488,2168,PrimeWest Health,MinnesotaCare,1113.4848,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Sup Skin Subsititute (Dermagraft) Per 1 Sq Cm,,Q4106,HCPCS,Facility,Inpatient,,,,2168,1842.8,621.3488,2168,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Sup Skin Subsititute (Dermagraft) Per 1 Sq Cm,,Q4106,HCPCS,Facility,Both,,,,2168,1842.8,621.3488,2168,Sanford Health Plan,Sanford Health Plan,1994.56,92,,percent of total billed charges,,
Sup Skin Subsititute (Dermagraft) Per 1 Sq Cm,,Q4106,HCPCS,Facility,Outpatient,,,,2168,1842.8,621.3488,2168,"UCare Health, Inc.",Individual & Family Plan,1221.668,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Sup Skin Subsititute (Dermagraft) Per 1 Sq Cm,,Q4106,HCPCS,Facility,Inpatient,,,,2168,1842.8,621.3488,2168,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Sup Skin Subsititute (Dermagraft) Per 1 Sq Cm,,Q4106,HCPCS,Facility,Outpatient,,,,2168,1842.8,621.3488,2168,"UCare Health, Inc.",Medical Assistance,1094.1896,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Skin Subsititute (Dermagraft) Per 1 Sq Cm,,Q4106,HCPCS,Facility,Inpatient,,,,2168,1842.8,621.3488,2168,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Sup Skin Subsititute (Dermagraft) Per 1 Sq Cm,,Q4106,HCPCS,Facility,Outpatient,,,,2168,1842.8,621.3488,2168,"UCare Health, Inc.",Medicare Advantage,1094.1896,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Skin Subsititute (Dermagraft) Per 1 Sq Cm,,Q4106,HCPCS,Facility,Inpatient,,,,2168,1842.8,621.3488,2168,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Sup Skin Subsititute (Dermagraft) Per 1 Sq Cm,,Q4106,HCPCS,Facility,Outpatient,,,,2168,1842.8,621.3488,2168,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),1094.1896,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Sup Skin Subsititute (Dermagraft) Per 1 Sq Cm,,Q4106,HCPCS,Facility,Inpatient,,,,2168,1842.8,621.3488,2168,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Sup Skin Subsititute (Dermagraft) Per 1 Sq Cm,,Q4106,HCPCS,Facility,Both,,,,2168,1842.8,621.3488,2168,UnitedHealthcare,Individual & Family,2037.92,94,,percent of total billed charges,,
Sup Skin Subsititute (Dermagraft) Per 1 Sq Cm,,Q4106,HCPCS,Facility,Outpatient,,,,2168,1842.8,621.3488,2168,UnitedHealthcare,Medicare Advantage,1062.32,49,,percent of total billed charges,,
Sup Skin Subsititute (Dermagraft) Per 1 Sq Cm,,Q4106,HCPCS,Facility,Inpatient,,,,2168,1842.8,621.3488,2168,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Sup Skin Subsititute (Dermagraft) Per 1 Sq Cm,,Q4106,HCPCS,Facility,Outpatient,,,,2168,1842.8,621.3488,2168,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,1040.64,48,,percent of total billed charges,,100% of DHS outpatient percentage
Sup Skin Subsititute (Dermagraft) Per 1 Sq Cm,,Q4106,HCPCS,Facility,Inpatient,,,,2168,1842.8,621.3488,2168,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
EPIFIX ALLOGRAFT 2X3CM  GS-5230,,Q4186,HCPCS,Facility,Both,,,,579.575,492.63875,166.106195,579.575,Aetna,Commercial,533.209,92,,percent of total billed charges,,
EPIFIX ALLOGRAFT 2X3CM  GS-5230,,Q4186,HCPCS,Facility,Outpatient,,,,579.575,492.63875,166.106195,579.575,Aetna,Medicare Advantage,283.99175,49,,percent of total billed charges,,
EPIFIX ALLOGRAFT 2X3CM  GS-5230,,Q4186,HCPCS,Facility,Inpatient,,,,579.575,492.63875,166.106195,579.575,Aetna,Medicare Advantage,,,,,Included in per diem rate,
EPIFIX ALLOGRAFT 2X3CM  GS-5230,,Q4186,HCPCS,Facility,Both,,,,579.575,492.63875,166.106195,579.575,Aetna,PPO,539.00475,93,,percent of total billed charges,,
EPIFIX ALLOGRAFT 2X3CM  GS-5230,,Q4186,HCPCS,Facility,Both,,,,579.575,492.63875,166.106195,579.575,America's PPO,America's PPO,556.5658725,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
EPIFIX ALLOGRAFT 2X3CM  GS-5230,,Q4186,HCPCS,Facility,Both,,,,579.575,492.63875,166.106195,579.575,BlueCross BlueShield Minnesota, Federal Employee Program,570.3018,98.4,,percent of total billed charges,,
EPIFIX ALLOGRAFT 2X3CM  GS-5230,,Q4186,HCPCS,Facility,Both,,,,579.575,492.63875,166.106195,579.575,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,579.575,100,,percent of total billed charges,,
EPIFIX ALLOGRAFT 2X3CM  GS-5230,,Q4186,HCPCS,Facility,Both,,,,579.575,492.63875,166.106195,579.575,BlueCross BlueShield Minnesota,High Value Network Plan,521.6175,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
EPIFIX ALLOGRAFT 2X3CM  GS-5230,,Q4186,HCPCS,Facility,Outpatient,,,,579.575,492.63875,166.106195,579.575,BlueCross BlueShield Minnesota,Medicare Advantage,283.99175,49,,percent of total billed charges,,
EPIFIX ALLOGRAFT 2X3CM  GS-5230,,Q4186,HCPCS,Facility,Inpatient,,,,579.575,492.63875,166.106195,579.575,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
EPIFIX ALLOGRAFT 2X3CM  GS-5230,,Q4186,HCPCS,Facility,Both,,,,579.575,492.63875,166.106195,579.575,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,513.3295775,88.57,,percent of total billed charges,,
EPIFIX ALLOGRAFT 2X3CM  GS-5230,,Q4186,HCPCS,Facility,Both,,,,579.575,492.63875,166.106195,579.575,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,166.106195,28.66,,percent of total billed charges,,
EPIFIX ALLOGRAFT 2X3CM  GS-5230,,Q4186,HCPCS,Facility,Outpatient,,,,579.575,492.63875,166.106195,579.575,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),283.99175,49,,percent of total billed charges,,
EPIFIX ALLOGRAFT 2X3CM  GS-5230,,Q4186,HCPCS,Facility,Inpatient,,,,579.575,492.63875,166.106195,579.575,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
EPIFIX ALLOGRAFT 2X3CM  GS-5230,,Q4186,HCPCS,Facility,Both,,,,579.575,492.63875,166.106195,579.575,CorVel,Worker's Compensation,579.575,100,,percent of total billed charges,,
EPIFIX ALLOGRAFT 2X3CM  GS-5230,,Q4186,HCPCS,Facility,Both,,,,579.575,492.63875,166.106195,579.575,First Health Group Corporation,First Health Network,562.18775,97,,percent of total billed charges,,
EPIFIX ALLOGRAFT 2X3CM  GS-5230,,Q4186,HCPCS,Facility,Both,,,,579.575,492.63875,166.106195,579.575,"Health Partners, Inc.",Commercial,548.27795,94.6,,percent of total billed charges,,
EPIFIX ALLOGRAFT 2X3CM  GS-5230,,Q4186,HCPCS,Facility,Outpatient,,,,579.575,492.63875,166.106195,579.575,"Health Partners, Inc.",Medicare Advantage,283.99175,49,,percent of total billed charges,,
EPIFIX ALLOGRAFT 2X3CM  GS-5230,,Q4186,HCPCS,Facility,Inpatient,,,,579.575,492.63875,166.106195,579.575,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
EPIFIX ALLOGRAFT 2X3CM  GS-5230,,Q4186,HCPCS,Facility,Both,,,,579.575,492.63875,166.106195,579.575,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),347.745,60,,percent of total billed charges,,
EPIFIX ALLOGRAFT 2X3CM  GS-5230,,Q4186,HCPCS,Facility,Both,,,,579.575,492.63875,166.106195,579.575,"Health Partners, Inc.",State of Minnesota Advantage Program,472.353625,81.5,,percent of total billed charges,,
EPIFIX ALLOGRAFT 2X3CM  GS-5230,,Q4186,HCPCS,Facility,Both,,,,579.575,492.63875,166.106195,579.575,"Health Partners, Inc.",State Public Programs,289.7875,50,,percent of total billed charges,,
EPIFIX ALLOGRAFT 2X3CM  GS-5230,,Q4186,HCPCS,Facility,Both,,,,579.575,492.63875,166.106195,579.575,Humana Insurance Company,Commercial PPO,550.59625,95,,percent of total billed charges,,
EPIFIX ALLOGRAFT 2X3CM  GS-5230,,Q4186,HCPCS,Facility,Outpatient,,,,579.575,492.63875,166.106195,579.575,Humana Insurance Company,Medicare PPO,283.99175,49,,percent of total billed charges,,
EPIFIX ALLOGRAFT 2X3CM  GS-5230,,Q4186,HCPCS,Facility,Inpatient,,,,579.575,492.63875,166.106195,579.575,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
EPIFIX ALLOGRAFT 2X3CM  GS-5230,,Q4186,HCPCS,Facility,Both,,,,579.575,492.63875,166.106195,579.575,Medica,Individual & Family,574.358825,99.1,,percent of total billed charges,,
EPIFIX ALLOGRAFT 2X3CM  GS-5230,,Q4186,HCPCS,Facility,Outpatient,,,,579.575,492.63875,166.106195,579.575,Medica,Medica Advantage Solution,288.62835,49.8,,percent of total billed charges,,
EPIFIX ALLOGRAFT 2X3CM  GS-5230,,Q4186,HCPCS,Facility,Inpatient,,,,579.575,492.63875,166.106195,579.575,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
EPIFIX ALLOGRAFT 2X3CM  GS-5230,,Q4186,HCPCS,Facility,Outpatient,,,,579.575,492.63875,166.106195,579.575,Medica,Medical Assistance,258.49045,44.6,,percent of total billed charges,,
EPIFIX ALLOGRAFT 2X3CM  GS-5230,,Q4186,HCPCS,Facility,Inpatient,,,,579.575,492.63875,166.106195,579.575,Medica,Medical Assistance,,,,,Included in per diem rate,
EPIFIX ALLOGRAFT 2X3CM  GS-5230,,Q4186,HCPCS,Facility,Outpatient,,,,579.575,492.63875,166.106195,579.575,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,288.62835,49.8,,percent of total billed charges,,
EPIFIX ALLOGRAFT 2X3CM  GS-5230,,Q4186,HCPCS,Facility,Inpatient,,,,579.575,492.63875,166.106195,579.575,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
EPIFIX ALLOGRAFT 2X3CM  GS-5230,,Q4186,HCPCS,Facility,Both,,,,579.575,492.63875,166.106195,579.575,"Multiplan, Inc.","Multiplan, Inc.",544.8005,94,,percent of total billed charges,,
EPIFIX ALLOGRAFT 2X3CM  GS-5230,,Q4186,HCPCS,Facility,Outpatient,,,,579.575,492.63875,166.106195,579.575,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,522.197075,90.1,,percent of total billed charges,,
EPIFIX ALLOGRAFT 2X3CM  GS-5230,,Q4186,HCPCS,Facility,Inpatient,,,,579.575,492.63875,166.106195,579.575,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
EPIFIX ALLOGRAFT 2X3CM  GS-5230,,Q4186,HCPCS,Facility,Both,,,,579.575,492.63875,166.106195,579.575,"Preferred One Administrative Services, INC.",PPO,571.46095,98.6,,percent of total billed charges,,
EPIFIX ALLOGRAFT 2X3CM  GS-5230,,Q4186,HCPCS,Facility,Outpatient,,,,579.575,492.63875,166.106195,579.575,PrimeWest Health,Minnesota Senior Health Options (MSHO),298.1913375,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
EPIFIX ALLOGRAFT 2X3CM  GS-5230,,Q4186,HCPCS,Facility,Inpatient,,,,579.575,492.63875,166.106195,579.575,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
EPIFIX ALLOGRAFT 2X3CM  GS-5230,,Q4186,HCPCS,Facility,Outpatient,,,,579.575,492.63875,166.106195,579.575,PrimeWest Health,MinnesotaCare,297.66972,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
EPIFIX ALLOGRAFT 2X3CM  GS-5230,,Q4186,HCPCS,Facility,Inpatient,,,,579.575,492.63875,166.106195,579.575,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
EPIFIX ALLOGRAFT 2X3CM  GS-5230,,Q4186,HCPCS,Facility,Both,,,,579.575,492.63875,166.106195,579.575,Sanford Health Plan,Sanford Health Plan,533.209,92,,percent of total billed charges,,
EPIFIX ALLOGRAFT 2X3CM  GS-5230,,Q4186,HCPCS,Facility,Outpatient,,,,579.575,492.63875,166.106195,579.575,"UCare Health, Inc.",Individual & Family Plan,326.5905125,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
EPIFIX ALLOGRAFT 2X3CM  GS-5230,,Q4186,HCPCS,Facility,Inpatient,,,,579.575,492.63875,166.106195,579.575,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
EPIFIX ALLOGRAFT 2X3CM  GS-5230,,Q4186,HCPCS,Facility,Outpatient,,,,579.575,492.63875,166.106195,579.575,"UCare Health, Inc.",Medical Assistance,292.5115025,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
EPIFIX ALLOGRAFT 2X3CM  GS-5230,,Q4186,HCPCS,Facility,Inpatient,,,,579.575,492.63875,166.106195,579.575,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
EPIFIX ALLOGRAFT 2X3CM  GS-5230,,Q4186,HCPCS,Facility,Outpatient,,,,579.575,492.63875,166.106195,579.575,"UCare Health, Inc.",Medicare Advantage,292.5115025,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
EPIFIX ALLOGRAFT 2X3CM  GS-5230,,Q4186,HCPCS,Facility,Inpatient,,,,579.575,492.63875,166.106195,579.575,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
EPIFIX ALLOGRAFT 2X3CM  GS-5230,,Q4186,HCPCS,Facility,Outpatient,,,,579.575,492.63875,166.106195,579.575,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),292.5115025,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
EPIFIX ALLOGRAFT 2X3CM  GS-5230,,Q4186,HCPCS,Facility,Inpatient,,,,579.575,492.63875,166.106195,579.575,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
EPIFIX ALLOGRAFT 2X3CM  GS-5230,,Q4186,HCPCS,Facility,Both,,,,579.575,492.63875,166.106195,579.575,UnitedHealthcare,Individual & Family,544.8005,94,,percent of total billed charges,,
EPIFIX ALLOGRAFT 2X3CM  GS-5230,,Q4186,HCPCS,Facility,Outpatient,,,,579.575,492.63875,166.106195,579.575,UnitedHealthcare,Medicare Advantage,283.99175,49,,percent of total billed charges,,
EPIFIX ALLOGRAFT 2X3CM  GS-5230,,Q4186,HCPCS,Facility,Inpatient,,,,579.575,492.63875,166.106195,579.575,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
EPIFIX ALLOGRAFT 2X3CM  GS-5230,,Q4186,HCPCS,Facility,Outpatient,,,,579.575,492.63875,166.106195,579.575,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,278.196,48,,percent of total billed charges,,100% of DHS outpatient percentage
EPIFIX ALLOGRAFT 2X3CM  GS-5230,,Q4186,HCPCS,Facility,Inpatient,,,,579.575,492.63875,166.106195,579.575,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Sup Epifix, Per Sq Cm",,Q4186,HCPCS,Facility,Both,,,,382,324.7,109.4812,382,Aetna,Commercial,351.44,92,,percent of total billed charges,,
"Sup Epifix, Per Sq Cm",,Q4186,HCPCS,Facility,Outpatient,,,,382,324.7,109.4812,382,Aetna,Medicare Advantage,187.18,49,,percent of total billed charges,,
"Sup Epifix, Per Sq Cm",,Q4186,HCPCS,Facility,Inpatient,,,,382,324.7,109.4812,382,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Sup Epifix, Per Sq Cm",,Q4186,HCPCS,Facility,Both,,,,382,324.7,109.4812,382,Aetna,PPO,355.26,93,,percent of total billed charges,,
"Sup Epifix, Per Sq Cm",,Q4186,HCPCS,Facility,Both,,,,382,324.7,109.4812,382,America's PPO,America's PPO,366.8346,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Sup Epifix, Per Sq Cm",,Q4186,HCPCS,Facility,Both,,,,382,324.7,109.4812,382,BlueCross BlueShield Minnesota, Federal Employee Program,375.888,98.4,,percent of total billed charges,,
"Sup Epifix, Per Sq Cm",,Q4186,HCPCS,Facility,Both,,,,382,324.7,109.4812,382,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,382,100,,percent of total billed charges,,
"Sup Epifix, Per Sq Cm",,Q4186,HCPCS,Facility,Both,,,,382,324.7,109.4812,382,BlueCross BlueShield Minnesota,High Value Network Plan,343.8,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
"Sup Epifix, Per Sq Cm",,Q4186,HCPCS,Facility,Outpatient,,,,382,324.7,109.4812,382,BlueCross BlueShield Minnesota,Medicare Advantage,187.18,49,,percent of total billed charges,,
"Sup Epifix, Per Sq Cm",,Q4186,HCPCS,Facility,Inpatient,,,,382,324.7,109.4812,382,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Sup Epifix, Per Sq Cm",,Q4186,HCPCS,Facility,Both,,,,382,324.7,109.4812,382,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,338.3374,88.57,,percent of total billed charges,,
"Sup Epifix, Per Sq Cm",,Q4186,HCPCS,Facility,Both,,,,382,324.7,109.4812,382,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,109.4812,28.66,,percent of total billed charges,,
"Sup Epifix, Per Sq Cm",,Q4186,HCPCS,Facility,Outpatient,,,,382,324.7,109.4812,382,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),187.18,49,,percent of total billed charges,,
"Sup Epifix, Per Sq Cm",,Q4186,HCPCS,Facility,Inpatient,,,,382,324.7,109.4812,382,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Sup Epifix, Per Sq Cm",,Q4186,HCPCS,Facility,Both,,,,382,324.7,109.4812,382,CorVel,Worker's Compensation,382,100,,percent of total billed charges,,
"Sup Epifix, Per Sq Cm",,Q4186,HCPCS,Facility,Both,,,,382,324.7,109.4812,382,First Health Group Corporation,First Health Network,370.54,97,,percent of total billed charges,,
"Sup Epifix, Per Sq Cm",,Q4186,HCPCS,Facility,Both,,,,382,324.7,109.4812,382,"Health Partners, Inc.",Commercial,361.372,94.6,,percent of total billed charges,,
"Sup Epifix, Per Sq Cm",,Q4186,HCPCS,Facility,Outpatient,,,,382,324.7,109.4812,382,"Health Partners, Inc.",Medicare Advantage,187.18,49,,percent of total billed charges,,
"Sup Epifix, Per Sq Cm",,Q4186,HCPCS,Facility,Inpatient,,,,382,324.7,109.4812,382,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Sup Epifix, Per Sq Cm",,Q4186,HCPCS,Facility,Both,,,,382,324.7,109.4812,382,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),229.2,60,,percent of total billed charges,,
"Sup Epifix, Per Sq Cm",,Q4186,HCPCS,Facility,Both,,,,382,324.7,109.4812,382,"Health Partners, Inc.",State of Minnesota Advantage Program,311.33,81.5,,percent of total billed charges,,
"Sup Epifix, Per Sq Cm",,Q4186,HCPCS,Facility,Both,,,,382,324.7,109.4812,382,"Health Partners, Inc.",State Public Programs,191,50,,percent of total billed charges,,
"Sup Epifix, Per Sq Cm",,Q4186,HCPCS,Facility,Both,,,,382,324.7,109.4812,382,Humana Insurance Company,Commercial PPO,362.9,95,,percent of total billed charges,,
"Sup Epifix, Per Sq Cm",,Q4186,HCPCS,Facility,Outpatient,,,,382,324.7,109.4812,382,Humana Insurance Company,Medicare PPO,187.18,49,,percent of total billed charges,,
"Sup Epifix, Per Sq Cm",,Q4186,HCPCS,Facility,Inpatient,,,,382,324.7,109.4812,382,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Sup Epifix, Per Sq Cm",,Q4186,HCPCS,Facility,Both,,,,382,324.7,109.4812,382,Medica,Individual & Family,378.562,99.1,,percent of total billed charges,,
"Sup Epifix, Per Sq Cm",,Q4186,HCPCS,Facility,Outpatient,,,,382,324.7,109.4812,382,Medica,Medica Advantage Solution,190.236,49.8,,percent of total billed charges,,
"Sup Epifix, Per Sq Cm",,Q4186,HCPCS,Facility,Inpatient,,,,382,324.7,109.4812,382,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Sup Epifix, Per Sq Cm",,Q4186,HCPCS,Facility,Outpatient,,,,382,324.7,109.4812,382,Medica,Medical Assistance,170.372,44.6,,percent of total billed charges,,
"Sup Epifix, Per Sq Cm",,Q4186,HCPCS,Facility,Inpatient,,,,382,324.7,109.4812,382,Medica,Medical Assistance,,,,,Included in per diem rate,
"Sup Epifix, Per Sq Cm",,Q4186,HCPCS,Facility,Outpatient,,,,382,324.7,109.4812,382,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,190.236,49.8,,percent of total billed charges,,
"Sup Epifix, Per Sq Cm",,Q4186,HCPCS,Facility,Inpatient,,,,382,324.7,109.4812,382,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Sup Epifix, Per Sq Cm",,Q4186,HCPCS,Facility,Both,,,,382,324.7,109.4812,382,"Multiplan, Inc.","Multiplan, Inc.",359.08,94,,percent of total billed charges,,
"Sup Epifix, Per Sq Cm",,Q4186,HCPCS,Facility,Outpatient,,,,382,324.7,109.4812,382,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,344.182,90.1,,percent of total billed charges,,
"Sup Epifix, Per Sq Cm",,Q4186,HCPCS,Facility,Inpatient,,,,382,324.7,109.4812,382,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Sup Epifix, Per Sq Cm",,Q4186,HCPCS,Facility,Both,,,,382,324.7,109.4812,382,"Preferred One Administrative Services, INC.",PPO,376.652,98.6,,percent of total billed charges,,
"Sup Epifix, Per Sq Cm",,Q4186,HCPCS,Facility,Outpatient,,,,382,324.7,109.4812,382,PrimeWest Health,Minnesota Senior Health Options (MSHO),196.539,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Sup Epifix, Per Sq Cm",,Q4186,HCPCS,Facility,Inpatient,,,,382,324.7,109.4812,382,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Sup Epifix, Per Sq Cm",,Q4186,HCPCS,Facility,Outpatient,,,,382,324.7,109.4812,382,PrimeWest Health,MinnesotaCare,196.1952,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Sup Epifix, Per Sq Cm",,Q4186,HCPCS,Facility,Inpatient,,,,382,324.7,109.4812,382,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Sup Epifix, Per Sq Cm",,Q4186,HCPCS,Facility,Both,,,,382,324.7,109.4812,382,Sanford Health Plan,Sanford Health Plan,351.44,92,,percent of total billed charges,,
"Sup Epifix, Per Sq Cm",,Q4186,HCPCS,Facility,Outpatient,,,,382,324.7,109.4812,382,"UCare Health, Inc.",Individual & Family Plan,215.257,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Sup Epifix, Per Sq Cm",,Q4186,HCPCS,Facility,Inpatient,,,,382,324.7,109.4812,382,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Sup Epifix, Per Sq Cm",,Q4186,HCPCS,Facility,Outpatient,,,,382,324.7,109.4812,382,"UCare Health, Inc.",Medical Assistance,192.7954,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Sup Epifix, Per Sq Cm",,Q4186,HCPCS,Facility,Inpatient,,,,382,324.7,109.4812,382,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Sup Epifix, Per Sq Cm",,Q4186,HCPCS,Facility,Outpatient,,,,382,324.7,109.4812,382,"UCare Health, Inc.",Medicare Advantage,192.7954,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Sup Epifix, Per Sq Cm",,Q4186,HCPCS,Facility,Inpatient,,,,382,324.7,109.4812,382,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Sup Epifix, Per Sq Cm",,Q4186,HCPCS,Facility,Outpatient,,,,382,324.7,109.4812,382,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),192.7954,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Sup Epifix, Per Sq Cm",,Q4186,HCPCS,Facility,Inpatient,,,,382,324.7,109.4812,382,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Sup Epifix, Per Sq Cm",,Q4186,HCPCS,Facility,Both,,,,382,324.7,109.4812,382,UnitedHealthcare,Individual & Family,359.08,94,,percent of total billed charges,,
"Sup Epifix, Per Sq Cm",,Q4186,HCPCS,Facility,Outpatient,,,,382,324.7,109.4812,382,UnitedHealthcare,Medicare Advantage,187.18,49,,percent of total billed charges,,
"Sup Epifix, Per Sq Cm",,Q4186,HCPCS,Facility,Inpatient,,,,382,324.7,109.4812,382,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Sup Epifix, Per Sq Cm",,Q4186,HCPCS,Facility,Outpatient,,,,382,324.7,109.4812,382,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,183.36,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Sup Epifix, Per Sq Cm",,Q4186,HCPCS,Facility,Inpatient,,,,382,324.7,109.4812,382,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Sup Cl Puraply Am, Per Square Centimeter",,Q4196,HCPCS,Facility,Both,,,,765,650.25,219.249,765,Aetna,Commercial,703.8,92,,percent of total billed charges,,
"Sup Cl Puraply Am, Per Square Centimeter",,Q4196,HCPCS,Facility,Outpatient,,,,765,650.25,219.249,765,Aetna,Medicare Advantage,374.85,49,,percent of total billed charges,,
"Sup Cl Puraply Am, Per Square Centimeter",,Q4196,HCPCS,Facility,Inpatient,,,,765,650.25,219.249,765,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Sup Cl Puraply Am, Per Square Centimeter",,Q4196,HCPCS,Facility,Both,,,,765,650.25,219.249,765,Aetna,PPO,711.45,93,,percent of total billed charges,,
"Sup Cl Puraply Am, Per Square Centimeter",,Q4196,HCPCS,Facility,Both,,,,765,650.25,219.249,765,America's PPO,America's PPO,734.6295,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Sup Cl Puraply Am, Per Square Centimeter",,Q4196,HCPCS,Facility,Both,,,,765,650.25,219.249,765,BlueCross BlueShield Minnesota, Federal Employee Program,752.76,98.4,,percent of total billed charges,,
"Sup Cl Puraply Am, Per Square Centimeter",,Q4196,HCPCS,Facility,Both,,,,765,650.25,219.249,765,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,765,100,,percent of total billed charges,,
"Sup Cl Puraply Am, Per Square Centimeter",,Q4196,HCPCS,Facility,Both,,,,765,650.25,219.249,765,BlueCross BlueShield Minnesota,High Value Network Plan,688.5,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
"Sup Cl Puraply Am, Per Square Centimeter",,Q4196,HCPCS,Facility,Outpatient,,,,765,650.25,219.249,765,BlueCross BlueShield Minnesota,Medicare Advantage,374.85,49,,percent of total billed charges,,
"Sup Cl Puraply Am, Per Square Centimeter",,Q4196,HCPCS,Facility,Inpatient,,,,765,650.25,219.249,765,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Sup Cl Puraply Am, Per Square Centimeter",,Q4196,HCPCS,Facility,Both,,,,765,650.25,219.249,765,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,677.5605,88.57,,percent of total billed charges,,
"Sup Cl Puraply Am, Per Square Centimeter",,Q4196,HCPCS,Facility,Both,,,,765,650.25,219.249,765,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,219.249,28.66,,percent of total billed charges,,
"Sup Cl Puraply Am, Per Square Centimeter",,Q4196,HCPCS,Facility,Outpatient,,,,765,650.25,219.249,765,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),374.85,49,,percent of total billed charges,,
"Sup Cl Puraply Am, Per Square Centimeter",,Q4196,HCPCS,Facility,Inpatient,,,,765,650.25,219.249,765,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Sup Cl Puraply Am, Per Square Centimeter",,Q4196,HCPCS,Facility,Both,,,,765,650.25,219.249,765,CorVel,Worker's Compensation,765,100,,percent of total billed charges,,
"Sup Cl Puraply Am, Per Square Centimeter",,Q4196,HCPCS,Facility,Both,,,,765,650.25,219.249,765,First Health Group Corporation,First Health Network,742.05,97,,percent of total billed charges,,
"Sup Cl Puraply Am, Per Square Centimeter",,Q4196,HCPCS,Facility,Both,,,,765,650.25,219.249,765,"Health Partners, Inc.",Commercial,723.69,94.6,,percent of total billed charges,,
"Sup Cl Puraply Am, Per Square Centimeter",,Q4196,HCPCS,Facility,Outpatient,,,,765,650.25,219.249,765,"Health Partners, Inc.",Medicare Advantage,374.85,49,,percent of total billed charges,,
"Sup Cl Puraply Am, Per Square Centimeter",,Q4196,HCPCS,Facility,Inpatient,,,,765,650.25,219.249,765,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Sup Cl Puraply Am, Per Square Centimeter",,Q4196,HCPCS,Facility,Both,,,,765,650.25,219.249,765,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),459,60,,percent of total billed charges,,
"Sup Cl Puraply Am, Per Square Centimeter",,Q4196,HCPCS,Facility,Both,,,,765,650.25,219.249,765,"Health Partners, Inc.",State of Minnesota Advantage Program,623.475,81.5,,percent of total billed charges,,
"Sup Cl Puraply Am, Per Square Centimeter",,Q4196,HCPCS,Facility,Both,,,,765,650.25,219.249,765,"Health Partners, Inc.",State Public Programs,382.5,50,,percent of total billed charges,,
"Sup Cl Puraply Am, Per Square Centimeter",,Q4196,HCPCS,Facility,Both,,,,765,650.25,219.249,765,Humana Insurance Company,Commercial PPO,726.75,95,,percent of total billed charges,,
"Sup Cl Puraply Am, Per Square Centimeter",,Q4196,HCPCS,Facility,Outpatient,,,,765,650.25,219.249,765,Humana Insurance Company,Medicare PPO,374.85,49,,percent of total billed charges,,
"Sup Cl Puraply Am, Per Square Centimeter",,Q4196,HCPCS,Facility,Inpatient,,,,765,650.25,219.249,765,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Sup Cl Puraply Am, Per Square Centimeter",,Q4196,HCPCS,Facility,Both,,,,765,650.25,219.249,765,Medica,Individual & Family,758.115,99.1,,percent of total billed charges,,
"Sup Cl Puraply Am, Per Square Centimeter",,Q4196,HCPCS,Facility,Outpatient,,,,765,650.25,219.249,765,Medica,Medica Advantage Solution,380.97,49.8,,percent of total billed charges,,
"Sup Cl Puraply Am, Per Square Centimeter",,Q4196,HCPCS,Facility,Inpatient,,,,765,650.25,219.249,765,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Sup Cl Puraply Am, Per Square Centimeter",,Q4196,HCPCS,Facility,Outpatient,,,,765,650.25,219.249,765,Medica,Medical Assistance,341.19,44.6,,percent of total billed charges,,
"Sup Cl Puraply Am, Per Square Centimeter",,Q4196,HCPCS,Facility,Inpatient,,,,765,650.25,219.249,765,Medica,Medical Assistance,,,,,Included in per diem rate,
"Sup Cl Puraply Am, Per Square Centimeter",,Q4196,HCPCS,Facility,Outpatient,,,,765,650.25,219.249,765,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,380.97,49.8,,percent of total billed charges,,
"Sup Cl Puraply Am, Per Square Centimeter",,Q4196,HCPCS,Facility,Inpatient,,,,765,650.25,219.249,765,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Sup Cl Puraply Am, Per Square Centimeter",,Q4196,HCPCS,Facility,Both,,,,765,650.25,219.249,765,"Multiplan, Inc.","Multiplan, Inc.",719.1,94,,percent of total billed charges,,
"Sup Cl Puraply Am, Per Square Centimeter",,Q4196,HCPCS,Facility,Outpatient,,,,765,650.25,219.249,765,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,689.265,90.1,,percent of total billed charges,,
"Sup Cl Puraply Am, Per Square Centimeter",,Q4196,HCPCS,Facility,Inpatient,,,,765,650.25,219.249,765,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Sup Cl Puraply Am, Per Square Centimeter",,Q4196,HCPCS,Facility,Both,,,,765,650.25,219.249,765,"Preferred One Administrative Services, INC.",PPO,754.29,98.6,,percent of total billed charges,,
"Sup Cl Puraply Am, Per Square Centimeter",,Q4196,HCPCS,Facility,Outpatient,,,,765,650.25,219.249,765,PrimeWest Health,Minnesota Senior Health Options (MSHO),393.5925,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Sup Cl Puraply Am, Per Square Centimeter",,Q4196,HCPCS,Facility,Inpatient,,,,765,650.25,219.249,765,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Sup Cl Puraply Am, Per Square Centimeter",,Q4196,HCPCS,Facility,Outpatient,,,,765,650.25,219.249,765,PrimeWest Health,MinnesotaCare,392.904,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Sup Cl Puraply Am, Per Square Centimeter",,Q4196,HCPCS,Facility,Inpatient,,,,765,650.25,219.249,765,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Sup Cl Puraply Am, Per Square Centimeter",,Q4196,HCPCS,Facility,Both,,,,765,650.25,219.249,765,Sanford Health Plan,Sanford Health Plan,703.8,92,,percent of total billed charges,,
"Sup Cl Puraply Am, Per Square Centimeter",,Q4196,HCPCS,Facility,Outpatient,,,,765,650.25,219.249,765,"UCare Health, Inc.",Individual & Family Plan,431.0775,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Sup Cl Puraply Am, Per Square Centimeter",,Q4196,HCPCS,Facility,Inpatient,,,,765,650.25,219.249,765,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Sup Cl Puraply Am, Per Square Centimeter",,Q4196,HCPCS,Facility,Outpatient,,,,765,650.25,219.249,765,"UCare Health, Inc.",Medical Assistance,386.0955,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Sup Cl Puraply Am, Per Square Centimeter",,Q4196,HCPCS,Facility,Inpatient,,,,765,650.25,219.249,765,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Sup Cl Puraply Am, Per Square Centimeter",,Q4196,HCPCS,Facility,Outpatient,,,,765,650.25,219.249,765,"UCare Health, Inc.",Medicare Advantage,386.0955,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Sup Cl Puraply Am, Per Square Centimeter",,Q4196,HCPCS,Facility,Inpatient,,,,765,650.25,219.249,765,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Sup Cl Puraply Am, Per Square Centimeter",,Q4196,HCPCS,Facility,Outpatient,,,,765,650.25,219.249,765,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),386.0955,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Sup Cl Puraply Am, Per Square Centimeter",,Q4196,HCPCS,Facility,Inpatient,,,,765,650.25,219.249,765,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Sup Cl Puraply Am, Per Square Centimeter",,Q4196,HCPCS,Facility,Both,,,,765,650.25,219.249,765,UnitedHealthcare,Individual & Family,719.1,94,,percent of total billed charges,,
"Sup Cl Puraply Am, Per Square Centimeter",,Q4196,HCPCS,Facility,Outpatient,,,,765,650.25,219.249,765,UnitedHealthcare,Medicare Advantage,374.85,49,,percent of total billed charges,,
"Sup Cl Puraply Am, Per Square Centimeter",,Q4196,HCPCS,Facility,Inpatient,,,,765,650.25,219.249,765,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Sup Cl Puraply Am, Per Square Centimeter",,Q4196,HCPCS,Facility,Outpatient,,,,765,650.25,219.249,765,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,367.2,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Sup Cl Puraply Am, Per Square Centimeter",,Q4196,HCPCS,Facility,Inpatient,,,,765,650.25,219.249,765,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
LIDOCAINE HCL 4 % TOP CREAM,,110637,LOCAL,Facility,Both,76.5 g,g,,51,43.35,14.6166,51,Aetna,Commercial,46.92,92,,percent of total billed charges,,
LIDOCAINE HCL 4 % TOP CREAM,,110637,LOCAL,Facility,Outpatient,76.5 g,g,,51,43.35,14.6166,51,Aetna,Medicare Advantage,24.99,49,,percent of total billed charges,,
LIDOCAINE HCL 4 % TOP CREAM,,110637,LOCAL,Facility,Inpatient,76.5 g,g,,51,43.35,14.6166,51,Aetna,Medicare Advantage,,,,,Included in per diem rate,
LIDOCAINE HCL 4 % TOP CREAM,,110637,LOCAL,Facility,Both,76.5 g,g,,51,43.35,14.6166,51,Aetna,PPO,47.43,93,,percent of total billed charges,,
LIDOCAINE HCL 4 % TOP CREAM,,110637,LOCAL,Facility,Both,76.5 g,g,,51,43.35,14.6166,51,America's PPO,America's PPO,48.9753,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
LIDOCAINE HCL 4 % TOP CREAM,,110637,LOCAL,Facility,Both,76.5 g,g,,51,43.35,14.6166,51,BlueCross BlueShield Minnesota, Federal Employee Program,50.184,98.4,,percent of total billed charges,,
LIDOCAINE HCL 4 % TOP CREAM,,110637,LOCAL,Facility,Both,76.5 g,g,,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,51,100,,percent of total billed charges,,
LIDOCAINE HCL 4 % TOP CREAM,,110637,LOCAL,Facility,Both,76.5 g,g,,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,High Value Network Plan,45.9,90,,percent of total billed charges,,
LIDOCAINE HCL 4 % TOP CREAM,,110637,LOCAL,Facility,Outpatient,76.5 g,g,,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,Medicare Advantage,24.99,49,,percent of total billed charges,,
LIDOCAINE HCL 4 % TOP CREAM,,110637,LOCAL,Facility,Inpatient,76.5 g,g,,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
LIDOCAINE HCL 4 % TOP CREAM,,110637,LOCAL,Facility,Both,76.5 g,g,,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,45.1707,88.57,,percent of total billed charges,,
LIDOCAINE HCL 4 % TOP CREAM,,110637,LOCAL,Facility,Both,76.5 g,g,,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,14.6166,28.66,,percent of total billed charges,,
LIDOCAINE HCL 4 % TOP CREAM,,110637,LOCAL,Facility,Outpatient,76.5 g,g,,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),24.99,49,,percent of total billed charges,,
LIDOCAINE HCL 4 % TOP CREAM,,110637,LOCAL,Facility,Inpatient,76.5 g,g,,51,43.35,14.6166,51,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
LIDOCAINE HCL 4 % TOP CREAM,,110637,LOCAL,Facility,Both,76.5 g,g,,51,43.35,14.6166,51,CorVel,Worker's Compensation,51,100,,percent of total billed charges,,
LIDOCAINE HCL 4 % TOP CREAM,,110637,LOCAL,Facility,Both,76.5 g,g,,51,43.35,14.6166,51,First Health Group Corporation,First Health Network,49.47,97,,percent of total billed charges,,
LIDOCAINE HCL 4 % TOP CREAM,,110637,LOCAL,Facility,Both,76.5 g,g,,51,43.35,14.6166,51,"Health Partners, Inc.",Commercial,48.246,94.6,,percent of total billed charges,,
LIDOCAINE HCL 4 % TOP CREAM,,110637,LOCAL,Facility,Outpatient,76.5 g,g,,51,43.35,14.6166,51,"Health Partners, Inc.",Medicare Advantage,24.99,49,,percent of total billed charges,,
LIDOCAINE HCL 4 % TOP CREAM,,110637,LOCAL,Facility,Inpatient,76.5 g,g,,51,43.35,14.6166,51,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LIDOCAINE HCL 4 % TOP CREAM,,110637,LOCAL,Facility,Both,76.5 g,g,,51,43.35,14.6166,51,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),30.6,60,,percent of total billed charges,,
LIDOCAINE HCL 4 % TOP CREAM,,110637,LOCAL,Facility,Both,76.5 g,g,,51,43.35,14.6166,51,"Health Partners, Inc.",State of Minnesota Advantage Program,41.565,81.5,,percent of total billed charges,,
LIDOCAINE HCL 4 % TOP CREAM,,110637,LOCAL,Facility,Both,76.5 g,g,,51,43.35,14.6166,51,"Health Partners, Inc.",State Public Programs,25.5,50,,percent of total billed charges,,
LIDOCAINE HCL 4 % TOP CREAM,,110637,LOCAL,Facility,Both,76.5 g,g,,51,43.35,14.6166,51,Humana Insurance Company,Commercial PPO,48.45,95,,percent of total billed charges,,
LIDOCAINE HCL 4 % TOP CREAM,,110637,LOCAL,Facility,Outpatient,76.5 g,g,,51,43.35,14.6166,51,Humana Insurance Company,Medicare PPO,24.99,49,,percent of total billed charges,,
LIDOCAINE HCL 4 % TOP CREAM,,110637,LOCAL,Facility,Inpatient,76.5 g,g,,51,43.35,14.6166,51,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
LIDOCAINE HCL 4 % TOP CREAM,,110637,LOCAL,Facility,Both,76.5 g,g,,51,43.35,14.6166,51,Medica,Individual & Family,50.541,99.1,,percent of total billed charges,,
LIDOCAINE HCL 4 % TOP CREAM,,110637,LOCAL,Facility,Outpatient,76.5 g,g,,51,43.35,14.6166,51,Medica,Medica Advantage Solution,25.398,49.8,,percent of total billed charges,,
LIDOCAINE HCL 4 % TOP CREAM,,110637,LOCAL,Facility,Inpatient,76.5 g,g,,51,43.35,14.6166,51,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
LIDOCAINE HCL 4 % TOP CREAM,,110637,LOCAL,Facility,Outpatient,76.5 g,g,,51,43.35,14.6166,51,Medica,Medical Assistance,22.746,44.6,,percent of total billed charges,,
LIDOCAINE HCL 4 % TOP CREAM,,110637,LOCAL,Facility,Inpatient,76.5 g,g,,51,43.35,14.6166,51,Medica,Medical Assistance,,,,,Included in per diem rate,
LIDOCAINE HCL 4 % TOP CREAM,,110637,LOCAL,Facility,Outpatient,76.5 g,g,,51,43.35,14.6166,51,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,25.398,49.8,,percent of total billed charges,,
LIDOCAINE HCL 4 % TOP CREAM,,110637,LOCAL,Facility,Inpatient,76.5 g,g,,51,43.35,14.6166,51,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
LIDOCAINE HCL 4 % TOP CREAM,,110637,LOCAL,Facility,Both,76.5 g,g,,51,43.35,14.6166,51,"Multiplan, Inc.","Multiplan, Inc.",47.94,94,,percent of total billed charges,,
LIDOCAINE HCL 4 % TOP CREAM,,110637,LOCAL,Facility,Outpatient,76.5 g,g,,51,43.35,14.6166,51,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,45.951,90.1,,percent of total billed charges,,
LIDOCAINE HCL 4 % TOP CREAM,,110637,LOCAL,Facility,Inpatient,76.5 g,g,,51,43.35,14.6166,51,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
LIDOCAINE HCL 4 % TOP CREAM,,110637,LOCAL,Facility,Both,76.5 g,g,,51,43.35,14.6166,51,"Preferred One Administrative Services, INC.",PPO,50.286,98.6,,percent of total billed charges,,
LIDOCAINE HCL 4 % TOP CREAM,,110637,LOCAL,Facility,Outpatient,76.5 g,g,,51,43.35,14.6166,51,PrimeWest Health,Minnesota Senior Health Options (MSHO),26.2395,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
LIDOCAINE HCL 4 % TOP CREAM,,110637,LOCAL,Facility,Inpatient,76.5 g,g,,51,43.35,14.6166,51,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LIDOCAINE HCL 4 % TOP CREAM,,110637,LOCAL,Facility,Outpatient,76.5 g,g,,51,43.35,14.6166,51,PrimeWest Health,MinnesotaCare,26.1936,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
LIDOCAINE HCL 4 % TOP CREAM,,110637,LOCAL,Facility,Inpatient,76.5 g,g,,51,43.35,14.6166,51,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
LIDOCAINE HCL 4 % TOP CREAM,,110637,LOCAL,Facility,Both,76.5 g,g,,51,43.35,14.6166,51,Sanford Health Plan,Sanford Health Plan,46.92,92,,percent of total billed charges,,
LIDOCAINE HCL 4 % TOP CREAM,,110637,LOCAL,Facility,Outpatient,76.5 g,g,,51,43.35,14.6166,51,"UCare Health, Inc.",Individual & Family Plan,28.7385,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
LIDOCAINE HCL 4 % TOP CREAM,,110637,LOCAL,Facility,Inpatient,76.5 g,g,,51,43.35,14.6166,51,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
LIDOCAINE HCL 4 % TOP CREAM,,110637,LOCAL,Facility,Outpatient,76.5 g,g,,51,43.35,14.6166,51,"UCare Health, Inc.",Medical Assistance,25.7397,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LIDOCAINE HCL 4 % TOP CREAM,,110637,LOCAL,Facility,Inpatient,76.5 g,g,,51,43.35,14.6166,51,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
LIDOCAINE HCL 4 % TOP CREAM,,110637,LOCAL,Facility,Outpatient,76.5 g,g,,51,43.35,14.6166,51,"UCare Health, Inc.",Medicare Advantage,25.7397,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LIDOCAINE HCL 4 % TOP CREAM,,110637,LOCAL,Facility,Inpatient,76.5 g,g,,51,43.35,14.6166,51,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
LIDOCAINE HCL 4 % TOP CREAM,,110637,LOCAL,Facility,Outpatient,76.5 g,g,,51,43.35,14.6166,51,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),25.7397,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
LIDOCAINE HCL 4 % TOP CREAM,,110637,LOCAL,Facility,Inpatient,76.5 g,g,,51,43.35,14.6166,51,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
LIDOCAINE HCL 4 % TOP CREAM,,110637,LOCAL,Facility,Both,76.5 g,g,,51,43.35,14.6166,51,UnitedHealthcare,Individual & Family,47.94,94,,percent of total billed charges,,
LIDOCAINE HCL 4 % TOP CREAM,,110637,LOCAL,Facility,Outpatient,76.5 g,g,,51,43.35,14.6166,51,UnitedHealthcare,Medicare Advantage,24.99,49,,percent of total billed charges,,
LIDOCAINE HCL 4 % TOP CREAM,,110637,LOCAL,Facility,Inpatient,76.5 g,g,,51,43.35,14.6166,51,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
LIDOCAINE HCL 4 % TOP CREAM,,110637,LOCAL,Facility,Outpatient,76.5 g,g,,51,43.35,14.6166,51,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,24.48,48,,percent of total billed charges,,100% of DHS outpatient percentage
LIDOCAINE HCL 4 % TOP CREAM,,110637,LOCAL,Facility,Inpatient,76.5 g,g,,51,43.35,14.6166,51,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
ALBUTEROL SULFATE 90 MCG/ACTUATION INHL HFAA,,17736,LOCAL,Facility,Both,8 g,g,,226,192.1,64.7716,226,Aetna,Commercial,207.92,92,,percent of total billed charges,,
ALBUTEROL SULFATE 90 MCG/ACTUATION INHL HFAA,,17736,LOCAL,Facility,Outpatient,8 g,g,,226,192.1,64.7716,226,Aetna,Medicare Advantage,110.74,49,,percent of total billed charges,,
ALBUTEROL SULFATE 90 MCG/ACTUATION INHL HFAA,,17736,LOCAL,Facility,Inpatient,8 g,g,,226,192.1,64.7716,226,Aetna,Medicare Advantage,,,,,Included in per diem rate,
ALBUTEROL SULFATE 90 MCG/ACTUATION INHL HFAA,,17736,LOCAL,Facility,Both,8 g,g,,226,192.1,64.7716,226,Aetna,PPO,210.18,93,,percent of total billed charges,,
ALBUTEROL SULFATE 90 MCG/ACTUATION INHL HFAA,,17736,LOCAL,Facility,Both,8 g,g,,226,192.1,64.7716,226,America's PPO,America's PPO,217.0278,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
ALBUTEROL SULFATE 90 MCG/ACTUATION INHL HFAA,,17736,LOCAL,Facility,Both,8 g,g,,226,192.1,64.7716,226,BlueCross BlueShield Minnesota, Federal Employee Program,222.384,98.4,,percent of total billed charges,,
ALBUTEROL SULFATE 90 MCG/ACTUATION INHL HFAA,,17736,LOCAL,Facility,Both,8 g,g,,226,192.1,64.7716,226,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,226,100,,percent of total billed charges,,
ALBUTEROL SULFATE 90 MCG/ACTUATION INHL HFAA,,17736,LOCAL,Facility,Both,8 g,g,,226,192.1,64.7716,226,BlueCross BlueShield Minnesota,High Value Network Plan,203.4,90,,percent of total billed charges,,
ALBUTEROL SULFATE 90 MCG/ACTUATION INHL HFAA,,17736,LOCAL,Facility,Outpatient,8 g,g,,226,192.1,64.7716,226,BlueCross BlueShield Minnesota,Medicare Advantage,110.74,49,,percent of total billed charges,,
ALBUTEROL SULFATE 90 MCG/ACTUATION INHL HFAA,,17736,LOCAL,Facility,Inpatient,8 g,g,,226,192.1,64.7716,226,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
ALBUTEROL SULFATE 90 MCG/ACTUATION INHL HFAA,,17736,LOCAL,Facility,Both,8 g,g,,226,192.1,64.7716,226,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,200.1682,88.57,,percent of total billed charges,,
ALBUTEROL SULFATE 90 MCG/ACTUATION INHL HFAA,,17736,LOCAL,Facility,Both,8 g,g,,226,192.1,64.7716,226,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,64.7716,28.66,,percent of total billed charges,,
ALBUTEROL SULFATE 90 MCG/ACTUATION INHL HFAA,,17736,LOCAL,Facility,Outpatient,8 g,g,,226,192.1,64.7716,226,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),110.74,49,,percent of total billed charges,,
ALBUTEROL SULFATE 90 MCG/ACTUATION INHL HFAA,,17736,LOCAL,Facility,Inpatient,8 g,g,,226,192.1,64.7716,226,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
ALBUTEROL SULFATE 90 MCG/ACTUATION INHL HFAA,,17736,LOCAL,Facility,Both,8 g,g,,226,192.1,64.7716,226,CorVel,Worker's Compensation,226,100,,percent of total billed charges,,
ALBUTEROL SULFATE 90 MCG/ACTUATION INHL HFAA,,17736,LOCAL,Facility,Both,8 g,g,,226,192.1,64.7716,226,First Health Group Corporation,First Health Network,219.22,97,,percent of total billed charges,,
ALBUTEROL SULFATE 90 MCG/ACTUATION INHL HFAA,,17736,LOCAL,Facility,Both,8 g,g,,226,192.1,64.7716,226,"Health Partners, Inc.",Commercial,213.796,94.6,,percent of total billed charges,,
ALBUTEROL SULFATE 90 MCG/ACTUATION INHL HFAA,,17736,LOCAL,Facility,Outpatient,8 g,g,,226,192.1,64.7716,226,"Health Partners, Inc.",Medicare Advantage,110.74,49,,percent of total billed charges,,
ALBUTEROL SULFATE 90 MCG/ACTUATION INHL HFAA,,17736,LOCAL,Facility,Inpatient,8 g,g,,226,192.1,64.7716,226,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ALBUTEROL SULFATE 90 MCG/ACTUATION INHL HFAA,,17736,LOCAL,Facility,Both,8 g,g,,226,192.1,64.7716,226,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),135.6,60,,percent of total billed charges,,
ALBUTEROL SULFATE 90 MCG/ACTUATION INHL HFAA,,17736,LOCAL,Facility,Both,8 g,g,,226,192.1,64.7716,226,"Health Partners, Inc.",State of Minnesota Advantage Program,184.19,81.5,,percent of total billed charges,,
ALBUTEROL SULFATE 90 MCG/ACTUATION INHL HFAA,,17736,LOCAL,Facility,Both,8 g,g,,226,192.1,64.7716,226,"Health Partners, Inc.",State Public Programs,113,50,,percent of total billed charges,,
ALBUTEROL SULFATE 90 MCG/ACTUATION INHL HFAA,,17736,LOCAL,Facility,Both,8 g,g,,226,192.1,64.7716,226,Humana Insurance Company,Commercial PPO,214.7,95,,percent of total billed charges,,
ALBUTEROL SULFATE 90 MCG/ACTUATION INHL HFAA,,17736,LOCAL,Facility,Outpatient,8 g,g,,226,192.1,64.7716,226,Humana Insurance Company,Medicare PPO,110.74,49,,percent of total billed charges,,
ALBUTEROL SULFATE 90 MCG/ACTUATION INHL HFAA,,17736,LOCAL,Facility,Inpatient,8 g,g,,226,192.1,64.7716,226,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
ALBUTEROL SULFATE 90 MCG/ACTUATION INHL HFAA,,17736,LOCAL,Facility,Both,8 g,g,,226,192.1,64.7716,226,Medica,Individual & Family,223.966,99.1,,percent of total billed charges,,
ALBUTEROL SULFATE 90 MCG/ACTUATION INHL HFAA,,17736,LOCAL,Facility,Outpatient,8 g,g,,226,192.1,64.7716,226,Medica,Medica Advantage Solution,112.548,49.8,,percent of total billed charges,,
ALBUTEROL SULFATE 90 MCG/ACTUATION INHL HFAA,,17736,LOCAL,Facility,Inpatient,8 g,g,,226,192.1,64.7716,226,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
ALBUTEROL SULFATE 90 MCG/ACTUATION INHL HFAA,,17736,LOCAL,Facility,Outpatient,8 g,g,,226,192.1,64.7716,226,Medica,Medical Assistance,100.796,44.6,,percent of total billed charges,,
ALBUTEROL SULFATE 90 MCG/ACTUATION INHL HFAA,,17736,LOCAL,Facility,Inpatient,8 g,g,,226,192.1,64.7716,226,Medica,Medical Assistance,,,,,Included in per diem rate,
ALBUTEROL SULFATE 90 MCG/ACTUATION INHL HFAA,,17736,LOCAL,Facility,Outpatient,8 g,g,,226,192.1,64.7716,226,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,112.548,49.8,,percent of total billed charges,,
ALBUTEROL SULFATE 90 MCG/ACTUATION INHL HFAA,,17736,LOCAL,Facility,Inpatient,8 g,g,,226,192.1,64.7716,226,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
ALBUTEROL SULFATE 90 MCG/ACTUATION INHL HFAA,,17736,LOCAL,Facility,Both,8 g,g,,226,192.1,64.7716,226,"Multiplan, Inc.","Multiplan, Inc.",212.44,94,,percent of total billed charges,,
ALBUTEROL SULFATE 90 MCG/ACTUATION INHL HFAA,,17736,LOCAL,Facility,Outpatient,8 g,g,,226,192.1,64.7716,226,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,203.626,90.1,,percent of total billed charges,,
ALBUTEROL SULFATE 90 MCG/ACTUATION INHL HFAA,,17736,LOCAL,Facility,Inpatient,8 g,g,,226,192.1,64.7716,226,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
ALBUTEROL SULFATE 90 MCG/ACTUATION INHL HFAA,,17736,LOCAL,Facility,Both,8 g,g,,226,192.1,64.7716,226,"Preferred One Administrative Services, INC.",PPO,222.836,98.6,,percent of total billed charges,,
ALBUTEROL SULFATE 90 MCG/ACTUATION INHL HFAA,,17736,LOCAL,Facility,Outpatient,8 g,g,,226,192.1,64.7716,226,PrimeWest Health,Minnesota Senior Health Options (MSHO),116.277,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
ALBUTEROL SULFATE 90 MCG/ACTUATION INHL HFAA,,17736,LOCAL,Facility,Inpatient,8 g,g,,226,192.1,64.7716,226,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ALBUTEROL SULFATE 90 MCG/ACTUATION INHL HFAA,,17736,LOCAL,Facility,Outpatient,8 g,g,,226,192.1,64.7716,226,PrimeWest Health,MinnesotaCare,116.0736,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
ALBUTEROL SULFATE 90 MCG/ACTUATION INHL HFAA,,17736,LOCAL,Facility,Inpatient,8 g,g,,226,192.1,64.7716,226,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
ALBUTEROL SULFATE 90 MCG/ACTUATION INHL HFAA,,17736,LOCAL,Facility,Both,8 g,g,,226,192.1,64.7716,226,Sanford Health Plan,Sanford Health Plan,207.92,92,,percent of total billed charges,,
ALBUTEROL SULFATE 90 MCG/ACTUATION INHL HFAA,,17736,LOCAL,Facility,Outpatient,8 g,g,,226,192.1,64.7716,226,"UCare Health, Inc.",Individual & Family Plan,127.351,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
ALBUTEROL SULFATE 90 MCG/ACTUATION INHL HFAA,,17736,LOCAL,Facility,Inpatient,8 g,g,,226,192.1,64.7716,226,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
ALBUTEROL SULFATE 90 MCG/ACTUATION INHL HFAA,,17736,LOCAL,Facility,Outpatient,8 g,g,,226,192.1,64.7716,226,"UCare Health, Inc.",Medical Assistance,114.0622,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ALBUTEROL SULFATE 90 MCG/ACTUATION INHL HFAA,,17736,LOCAL,Facility,Inpatient,8 g,g,,226,192.1,64.7716,226,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
ALBUTEROL SULFATE 90 MCG/ACTUATION INHL HFAA,,17736,LOCAL,Facility,Outpatient,8 g,g,,226,192.1,64.7716,226,"UCare Health, Inc.",Medicare Advantage,114.0622,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ALBUTEROL SULFATE 90 MCG/ACTUATION INHL HFAA,,17736,LOCAL,Facility,Inpatient,8 g,g,,226,192.1,64.7716,226,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
ALBUTEROL SULFATE 90 MCG/ACTUATION INHL HFAA,,17736,LOCAL,Facility,Outpatient,8 g,g,,226,192.1,64.7716,226,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),114.0622,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
ALBUTEROL SULFATE 90 MCG/ACTUATION INHL HFAA,,17736,LOCAL,Facility,Inpatient,8 g,g,,226,192.1,64.7716,226,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
ALBUTEROL SULFATE 90 MCG/ACTUATION INHL HFAA,,17736,LOCAL,Facility,Both,8 g,g,,226,192.1,64.7716,226,UnitedHealthcare,Individual & Family,212.44,94,,percent of total billed charges,,
ALBUTEROL SULFATE 90 MCG/ACTUATION INHL HFAA,,17736,LOCAL,Facility,Outpatient,8 g,g,,226,192.1,64.7716,226,UnitedHealthcare,Medicare Advantage,110.74,49,,percent of total billed charges,,
ALBUTEROL SULFATE 90 MCG/ACTUATION INHL HFAA,,17736,LOCAL,Facility,Inpatient,8 g,g,,226,192.1,64.7716,226,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
ALBUTEROL SULFATE 90 MCG/ACTUATION INHL HFAA,,17736,LOCAL,Facility,Outpatient,8 g,g,,226,192.1,64.7716,226,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,108.48,48,,percent of total billed charges,,100% of DHS outpatient percentage
ALBUTEROL SULFATE 90 MCG/ACTUATION INHL HFAA,,17736,LOCAL,Facility,Inpatient,8 g,g,,226,192.1,64.7716,226,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
BRINZOLAMIDE-BRIMONIDINE 1-0.2 % OPHT DRPS,,106364,LOCAL,Facility,Both,8 mL,mL,,893,759.05,255.9338,893,Aetna,Commercial,821.56,92,,percent of total billed charges,,
BRINZOLAMIDE-BRIMONIDINE 1-0.2 % OPHT DRPS,,106364,LOCAL,Facility,Outpatient,8 mL,mL,,893,759.05,255.9338,893,Aetna,Medicare Advantage,437.57,49,,percent of total billed charges,,
BRINZOLAMIDE-BRIMONIDINE 1-0.2 % OPHT DRPS,,106364,LOCAL,Facility,Inpatient,8 mL,mL,,893,759.05,255.9338,893,Aetna,Medicare Advantage,,,,,Included in per diem rate,
BRINZOLAMIDE-BRIMONIDINE 1-0.2 % OPHT DRPS,,106364,LOCAL,Facility,Both,8 mL,mL,,893,759.05,255.9338,893,Aetna,PPO,830.49,93,,percent of total billed charges,,
BRINZOLAMIDE-BRIMONIDINE 1-0.2 % OPHT DRPS,,106364,LOCAL,Facility,Both,8 mL,mL,,893,759.05,255.9338,893,America's PPO,America's PPO,857.5479,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
BRINZOLAMIDE-BRIMONIDINE 1-0.2 % OPHT DRPS,,106364,LOCAL,Facility,Both,8 mL,mL,,893,759.05,255.9338,893,BlueCross BlueShield Minnesota, Federal Employee Program,878.712,98.4,,percent of total billed charges,,
BRINZOLAMIDE-BRIMONIDINE 1-0.2 % OPHT DRPS,,106364,LOCAL,Facility,Both,8 mL,mL,,893,759.05,255.9338,893,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,893,100,,percent of total billed charges,,
BRINZOLAMIDE-BRIMONIDINE 1-0.2 % OPHT DRPS,,106364,LOCAL,Facility,Both,8 mL,mL,,893,759.05,255.9338,893,BlueCross BlueShield Minnesota,High Value Network Plan,803.7,90,,percent of total billed charges,,
BRINZOLAMIDE-BRIMONIDINE 1-0.2 % OPHT DRPS,,106364,LOCAL,Facility,Outpatient,8 mL,mL,,893,759.05,255.9338,893,BlueCross BlueShield Minnesota,Medicare Advantage,437.57,49,,percent of total billed charges,,
BRINZOLAMIDE-BRIMONIDINE 1-0.2 % OPHT DRPS,,106364,LOCAL,Facility,Inpatient,8 mL,mL,,893,759.05,255.9338,893,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
BRINZOLAMIDE-BRIMONIDINE 1-0.2 % OPHT DRPS,,106364,LOCAL,Facility,Both,8 mL,mL,,893,759.05,255.9338,893,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,790.9301,88.57,,percent of total billed charges,,
BRINZOLAMIDE-BRIMONIDINE 1-0.2 % OPHT DRPS,,106364,LOCAL,Facility,Both,8 mL,mL,,893,759.05,255.9338,893,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,255.9338,28.66,,percent of total billed charges,,
BRINZOLAMIDE-BRIMONIDINE 1-0.2 % OPHT DRPS,,106364,LOCAL,Facility,Outpatient,8 mL,mL,,893,759.05,255.9338,893,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),437.57,49,,percent of total billed charges,,
BRINZOLAMIDE-BRIMONIDINE 1-0.2 % OPHT DRPS,,106364,LOCAL,Facility,Inpatient,8 mL,mL,,893,759.05,255.9338,893,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
BRINZOLAMIDE-BRIMONIDINE 1-0.2 % OPHT DRPS,,106364,LOCAL,Facility,Both,8 mL,mL,,893,759.05,255.9338,893,CorVel,Worker's Compensation,893,100,,percent of total billed charges,,
BRINZOLAMIDE-BRIMONIDINE 1-0.2 % OPHT DRPS,,106364,LOCAL,Facility,Both,8 mL,mL,,893,759.05,255.9338,893,First Health Group Corporation,First Health Network,866.21,97,,percent of total billed charges,,
BRINZOLAMIDE-BRIMONIDINE 1-0.2 % OPHT DRPS,,106364,LOCAL,Facility,Both,8 mL,mL,,893,759.05,255.9338,893,"Health Partners, Inc.",Commercial,844.778,94.6,,percent of total billed charges,,
BRINZOLAMIDE-BRIMONIDINE 1-0.2 % OPHT DRPS,,106364,LOCAL,Facility,Outpatient,8 mL,mL,,893,759.05,255.9338,893,"Health Partners, Inc.",Medicare Advantage,437.57,49,,percent of total billed charges,,
BRINZOLAMIDE-BRIMONIDINE 1-0.2 % OPHT DRPS,,106364,LOCAL,Facility,Inpatient,8 mL,mL,,893,759.05,255.9338,893,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
BRINZOLAMIDE-BRIMONIDINE 1-0.2 % OPHT DRPS,,106364,LOCAL,Facility,Both,8 mL,mL,,893,759.05,255.9338,893,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),535.8,60,,percent of total billed charges,,
BRINZOLAMIDE-BRIMONIDINE 1-0.2 % OPHT DRPS,,106364,LOCAL,Facility,Both,8 mL,mL,,893,759.05,255.9338,893,"Health Partners, Inc.",State of Minnesota Advantage Program,727.795,81.5,,percent of total billed charges,,
BRINZOLAMIDE-BRIMONIDINE 1-0.2 % OPHT DRPS,,106364,LOCAL,Facility,Both,8 mL,mL,,893,759.05,255.9338,893,"Health Partners, Inc.",State Public Programs,446.5,50,,percent of total billed charges,,
BRINZOLAMIDE-BRIMONIDINE 1-0.2 % OPHT DRPS,,106364,LOCAL,Facility,Both,8 mL,mL,,893,759.05,255.9338,893,Humana Insurance Company,Commercial PPO,848.35,95,,percent of total billed charges,,
BRINZOLAMIDE-BRIMONIDINE 1-0.2 % OPHT DRPS,,106364,LOCAL,Facility,Outpatient,8 mL,mL,,893,759.05,255.9338,893,Humana Insurance Company,Medicare PPO,437.57,49,,percent of total billed charges,,
BRINZOLAMIDE-BRIMONIDINE 1-0.2 % OPHT DRPS,,106364,LOCAL,Facility,Inpatient,8 mL,mL,,893,759.05,255.9338,893,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
BRINZOLAMIDE-BRIMONIDINE 1-0.2 % OPHT DRPS,,106364,LOCAL,Facility,Both,8 mL,mL,,893,759.05,255.9338,893,Medica,Individual & Family,884.963,99.1,,percent of total billed charges,,
BRINZOLAMIDE-BRIMONIDINE 1-0.2 % OPHT DRPS,,106364,LOCAL,Facility,Outpatient,8 mL,mL,,893,759.05,255.9338,893,Medica,Medica Advantage Solution,444.714,49.8,,percent of total billed charges,,
BRINZOLAMIDE-BRIMONIDINE 1-0.2 % OPHT DRPS,,106364,LOCAL,Facility,Inpatient,8 mL,mL,,893,759.05,255.9338,893,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
BRINZOLAMIDE-BRIMONIDINE 1-0.2 % OPHT DRPS,,106364,LOCAL,Facility,Outpatient,8 mL,mL,,893,759.05,255.9338,893,Medica,Medical Assistance,398.278,44.6,,percent of total billed charges,,
BRINZOLAMIDE-BRIMONIDINE 1-0.2 % OPHT DRPS,,106364,LOCAL,Facility,Inpatient,8 mL,mL,,893,759.05,255.9338,893,Medica,Medical Assistance,,,,,Included in per diem rate,
BRINZOLAMIDE-BRIMONIDINE 1-0.2 % OPHT DRPS,,106364,LOCAL,Facility,Outpatient,8 mL,mL,,893,759.05,255.9338,893,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,444.714,49.8,,percent of total billed charges,,
BRINZOLAMIDE-BRIMONIDINE 1-0.2 % OPHT DRPS,,106364,LOCAL,Facility,Inpatient,8 mL,mL,,893,759.05,255.9338,893,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
BRINZOLAMIDE-BRIMONIDINE 1-0.2 % OPHT DRPS,,106364,LOCAL,Facility,Both,8 mL,mL,,893,759.05,255.9338,893,"Multiplan, Inc.","Multiplan, Inc.",839.42,94,,percent of total billed charges,,
BRINZOLAMIDE-BRIMONIDINE 1-0.2 % OPHT DRPS,,106364,LOCAL,Facility,Outpatient,8 mL,mL,,893,759.05,255.9338,893,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,804.593,90.1,,percent of total billed charges,,
BRINZOLAMIDE-BRIMONIDINE 1-0.2 % OPHT DRPS,,106364,LOCAL,Facility,Inpatient,8 mL,mL,,893,759.05,255.9338,893,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
BRINZOLAMIDE-BRIMONIDINE 1-0.2 % OPHT DRPS,,106364,LOCAL,Facility,Both,8 mL,mL,,893,759.05,255.9338,893,"Preferred One Administrative Services, INC.",PPO,880.498,98.6,,percent of total billed charges,,
BRINZOLAMIDE-BRIMONIDINE 1-0.2 % OPHT DRPS,,106364,LOCAL,Facility,Outpatient,8 mL,mL,,893,759.05,255.9338,893,PrimeWest Health,Minnesota Senior Health Options (MSHO),459.4485,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
BRINZOLAMIDE-BRIMONIDINE 1-0.2 % OPHT DRPS,,106364,LOCAL,Facility,Inpatient,8 mL,mL,,893,759.05,255.9338,893,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
BRINZOLAMIDE-BRIMONIDINE 1-0.2 % OPHT DRPS,,106364,LOCAL,Facility,Outpatient,8 mL,mL,,893,759.05,255.9338,893,PrimeWest Health,MinnesotaCare,458.6448,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
BRINZOLAMIDE-BRIMONIDINE 1-0.2 % OPHT DRPS,,106364,LOCAL,Facility,Inpatient,8 mL,mL,,893,759.05,255.9338,893,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
BRINZOLAMIDE-BRIMONIDINE 1-0.2 % OPHT DRPS,,106364,LOCAL,Facility,Both,8 mL,mL,,893,759.05,255.9338,893,Sanford Health Plan,Sanford Health Plan,821.56,92,,percent of total billed charges,,
BRINZOLAMIDE-BRIMONIDINE 1-0.2 % OPHT DRPS,,106364,LOCAL,Facility,Outpatient,8 mL,mL,,893,759.05,255.9338,893,"UCare Health, Inc.",Individual & Family Plan,503.2055,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
BRINZOLAMIDE-BRIMONIDINE 1-0.2 % OPHT DRPS,,106364,LOCAL,Facility,Inpatient,8 mL,mL,,893,759.05,255.9338,893,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
BRINZOLAMIDE-BRIMONIDINE 1-0.2 % OPHT DRPS,,106364,LOCAL,Facility,Outpatient,8 mL,mL,,893,759.05,255.9338,893,"UCare Health, Inc.",Medical Assistance,450.6971,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BRINZOLAMIDE-BRIMONIDINE 1-0.2 % OPHT DRPS,,106364,LOCAL,Facility,Inpatient,8 mL,mL,,893,759.05,255.9338,893,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
BRINZOLAMIDE-BRIMONIDINE 1-0.2 % OPHT DRPS,,106364,LOCAL,Facility,Outpatient,8 mL,mL,,893,759.05,255.9338,893,"UCare Health, Inc.",Medicare Advantage,450.6971,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BRINZOLAMIDE-BRIMONIDINE 1-0.2 % OPHT DRPS,,106364,LOCAL,Facility,Inpatient,8 mL,mL,,893,759.05,255.9338,893,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
BRINZOLAMIDE-BRIMONIDINE 1-0.2 % OPHT DRPS,,106364,LOCAL,Facility,Outpatient,8 mL,mL,,893,759.05,255.9338,893,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),450.6971,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
BRINZOLAMIDE-BRIMONIDINE 1-0.2 % OPHT DRPS,,106364,LOCAL,Facility,Inpatient,8 mL,mL,,893,759.05,255.9338,893,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
BRINZOLAMIDE-BRIMONIDINE 1-0.2 % OPHT DRPS,,106364,LOCAL,Facility,Both,8 mL,mL,,893,759.05,255.9338,893,UnitedHealthcare,Individual & Family,839.42,94,,percent of total billed charges,,
BRINZOLAMIDE-BRIMONIDINE 1-0.2 % OPHT DRPS,,106364,LOCAL,Facility,Outpatient,8 mL,mL,,893,759.05,255.9338,893,UnitedHealthcare,Medicare Advantage,437.57,49,,percent of total billed charges,,
BRINZOLAMIDE-BRIMONIDINE 1-0.2 % OPHT DRPS,,106364,LOCAL,Facility,Inpatient,8 mL,mL,,893,759.05,255.9338,893,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
BRINZOLAMIDE-BRIMONIDINE 1-0.2 % OPHT DRPS,,106364,LOCAL,Facility,Outpatient,8 mL,mL,,893,759.05,255.9338,893,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,428.64,48,,percent of total billed charges,,100% of DHS outpatient percentage
BRINZOLAMIDE-BRIMONIDINE 1-0.2 % OPHT DRPS,,106364,LOCAL,Facility,Inpatient,8 mL,mL,,893,759.05,255.9338,893,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
FERRIC SUBSULFATE 0.2 TO 0.22 GRAM/ML TOP SOLA,,108646,LOCAL,Facility,Both,8 mL,mL,,80,68,22.928,80,Aetna,Commercial,73.6,92,,percent of total billed charges,,
FERRIC SUBSULFATE 0.2 TO 0.22 GRAM/ML TOP SOLA,,108646,LOCAL,Facility,Outpatient,8 mL,mL,,80,68,22.928,80,Aetna,Medicare Advantage,39.2,49,,percent of total billed charges,,
FERRIC SUBSULFATE 0.2 TO 0.22 GRAM/ML TOP SOLA,,108646,LOCAL,Facility,Inpatient,8 mL,mL,,80,68,22.928,80,Aetna,Medicare Advantage,,,,,Included in per diem rate,
FERRIC SUBSULFATE 0.2 TO 0.22 GRAM/ML TOP SOLA,,108646,LOCAL,Facility,Both,8 mL,mL,,80,68,22.928,80,Aetna,PPO,74.4,93,,percent of total billed charges,,
FERRIC SUBSULFATE 0.2 TO 0.22 GRAM/ML TOP SOLA,,108646,LOCAL,Facility,Both,8 mL,mL,,80,68,22.928,80,America's PPO,America's PPO,76.824,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
FERRIC SUBSULFATE 0.2 TO 0.22 GRAM/ML TOP SOLA,,108646,LOCAL,Facility,Both,8 mL,mL,,80,68,22.928,80,BlueCross BlueShield Minnesota, Federal Employee Program,78.72,98.4,,percent of total billed charges,,
FERRIC SUBSULFATE 0.2 TO 0.22 GRAM/ML TOP SOLA,,108646,LOCAL,Facility,Both,8 mL,mL,,80,68,22.928,80,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,80,100,,percent of total billed charges,,
FERRIC SUBSULFATE 0.2 TO 0.22 GRAM/ML TOP SOLA,,108646,LOCAL,Facility,Both,8 mL,mL,,80,68,22.928,80,BlueCross BlueShield Minnesota,High Value Network Plan,72,90,,percent of total billed charges,,
FERRIC SUBSULFATE 0.2 TO 0.22 GRAM/ML TOP SOLA,,108646,LOCAL,Facility,Outpatient,8 mL,mL,,80,68,22.928,80,BlueCross BlueShield Minnesota,Medicare Advantage,39.2,49,,percent of total billed charges,,
FERRIC SUBSULFATE 0.2 TO 0.22 GRAM/ML TOP SOLA,,108646,LOCAL,Facility,Inpatient,8 mL,mL,,80,68,22.928,80,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
FERRIC SUBSULFATE 0.2 TO 0.22 GRAM/ML TOP SOLA,,108646,LOCAL,Facility,Both,8 mL,mL,,80,68,22.928,80,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,70.856,88.57,,percent of total billed charges,,
FERRIC SUBSULFATE 0.2 TO 0.22 GRAM/ML TOP SOLA,,108646,LOCAL,Facility,Both,8 mL,mL,,80,68,22.928,80,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,22.928,28.66,,percent of total billed charges,,
FERRIC SUBSULFATE 0.2 TO 0.22 GRAM/ML TOP SOLA,,108646,LOCAL,Facility,Outpatient,8 mL,mL,,80,68,22.928,80,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),39.2,49,,percent of total billed charges,,
FERRIC SUBSULFATE 0.2 TO 0.22 GRAM/ML TOP SOLA,,108646,LOCAL,Facility,Inpatient,8 mL,mL,,80,68,22.928,80,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
FERRIC SUBSULFATE 0.2 TO 0.22 GRAM/ML TOP SOLA,,108646,LOCAL,Facility,Both,8 mL,mL,,80,68,22.928,80,CorVel,Worker's Compensation,80,100,,percent of total billed charges,,
FERRIC SUBSULFATE 0.2 TO 0.22 GRAM/ML TOP SOLA,,108646,LOCAL,Facility,Both,8 mL,mL,,80,68,22.928,80,First Health Group Corporation,First Health Network,77.6,97,,percent of total billed charges,,
FERRIC SUBSULFATE 0.2 TO 0.22 GRAM/ML TOP SOLA,,108646,LOCAL,Facility,Both,8 mL,mL,,80,68,22.928,80,"Health Partners, Inc.",Commercial,75.68,94.6,,percent of total billed charges,,
FERRIC SUBSULFATE 0.2 TO 0.22 GRAM/ML TOP SOLA,,108646,LOCAL,Facility,Outpatient,8 mL,mL,,80,68,22.928,80,"Health Partners, Inc.",Medicare Advantage,39.2,49,,percent of total billed charges,,
FERRIC SUBSULFATE 0.2 TO 0.22 GRAM/ML TOP SOLA,,108646,LOCAL,Facility,Inpatient,8 mL,mL,,80,68,22.928,80,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
FERRIC SUBSULFATE 0.2 TO 0.22 GRAM/ML TOP SOLA,,108646,LOCAL,Facility,Both,8 mL,mL,,80,68,22.928,80,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),48,60,,percent of total billed charges,,
FERRIC SUBSULFATE 0.2 TO 0.22 GRAM/ML TOP SOLA,,108646,LOCAL,Facility,Both,8 mL,mL,,80,68,22.928,80,"Health Partners, Inc.",State of Minnesota Advantage Program,65.2,81.5,,percent of total billed charges,,
FERRIC SUBSULFATE 0.2 TO 0.22 GRAM/ML TOP SOLA,,108646,LOCAL,Facility,Both,8 mL,mL,,80,68,22.928,80,"Health Partners, Inc.",State Public Programs,40,50,,percent of total billed charges,,
FERRIC SUBSULFATE 0.2 TO 0.22 GRAM/ML TOP SOLA,,108646,LOCAL,Facility,Both,8 mL,mL,,80,68,22.928,80,Humana Insurance Company,Commercial PPO,76,95,,percent of total billed charges,,
FERRIC SUBSULFATE 0.2 TO 0.22 GRAM/ML TOP SOLA,,108646,LOCAL,Facility,Outpatient,8 mL,mL,,80,68,22.928,80,Humana Insurance Company,Medicare PPO,39.2,49,,percent of total billed charges,,
FERRIC SUBSULFATE 0.2 TO 0.22 GRAM/ML TOP SOLA,,108646,LOCAL,Facility,Inpatient,8 mL,mL,,80,68,22.928,80,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
FERRIC SUBSULFATE 0.2 TO 0.22 GRAM/ML TOP SOLA,,108646,LOCAL,Facility,Both,8 mL,mL,,80,68,22.928,80,Medica,Individual & Family,79.28,99.1,,percent of total billed charges,,
FERRIC SUBSULFATE 0.2 TO 0.22 GRAM/ML TOP SOLA,,108646,LOCAL,Facility,Outpatient,8 mL,mL,,80,68,22.928,80,Medica,Medica Advantage Solution,39.84,49.8,,percent of total billed charges,,
FERRIC SUBSULFATE 0.2 TO 0.22 GRAM/ML TOP SOLA,,108646,LOCAL,Facility,Inpatient,8 mL,mL,,80,68,22.928,80,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
FERRIC SUBSULFATE 0.2 TO 0.22 GRAM/ML TOP SOLA,,108646,LOCAL,Facility,Outpatient,8 mL,mL,,80,68,22.928,80,Medica,Medical Assistance,35.68,44.6,,percent of total billed charges,,
FERRIC SUBSULFATE 0.2 TO 0.22 GRAM/ML TOP SOLA,,108646,LOCAL,Facility,Inpatient,8 mL,mL,,80,68,22.928,80,Medica,Medical Assistance,,,,,Included in per diem rate,
FERRIC SUBSULFATE 0.2 TO 0.22 GRAM/ML TOP SOLA,,108646,LOCAL,Facility,Outpatient,8 mL,mL,,80,68,22.928,80,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,39.84,49.8,,percent of total billed charges,,
FERRIC SUBSULFATE 0.2 TO 0.22 GRAM/ML TOP SOLA,,108646,LOCAL,Facility,Inpatient,8 mL,mL,,80,68,22.928,80,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
FERRIC SUBSULFATE 0.2 TO 0.22 GRAM/ML TOP SOLA,,108646,LOCAL,Facility,Both,8 mL,mL,,80,68,22.928,80,"Multiplan, Inc.","Multiplan, Inc.",75.2,94,,percent of total billed charges,,
FERRIC SUBSULFATE 0.2 TO 0.22 GRAM/ML TOP SOLA,,108646,LOCAL,Facility,Outpatient,8 mL,mL,,80,68,22.928,80,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,72.08,90.1,,percent of total billed charges,,
FERRIC SUBSULFATE 0.2 TO 0.22 GRAM/ML TOP SOLA,,108646,LOCAL,Facility,Inpatient,8 mL,mL,,80,68,22.928,80,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
FERRIC SUBSULFATE 0.2 TO 0.22 GRAM/ML TOP SOLA,,108646,LOCAL,Facility,Both,8 mL,mL,,80,68,22.928,80,"Preferred One Administrative Services, INC.",PPO,78.88,98.6,,percent of total billed charges,,
FERRIC SUBSULFATE 0.2 TO 0.22 GRAM/ML TOP SOLA,,108646,LOCAL,Facility,Outpatient,8 mL,mL,,80,68,22.928,80,PrimeWest Health,Minnesota Senior Health Options (MSHO),41.16,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
FERRIC SUBSULFATE 0.2 TO 0.22 GRAM/ML TOP SOLA,,108646,LOCAL,Facility,Inpatient,8 mL,mL,,80,68,22.928,80,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
FERRIC SUBSULFATE 0.2 TO 0.22 GRAM/ML TOP SOLA,,108646,LOCAL,Facility,Outpatient,8 mL,mL,,80,68,22.928,80,PrimeWest Health,MinnesotaCare,41.088,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
FERRIC SUBSULFATE 0.2 TO 0.22 GRAM/ML TOP SOLA,,108646,LOCAL,Facility,Inpatient,8 mL,mL,,80,68,22.928,80,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
FERRIC SUBSULFATE 0.2 TO 0.22 GRAM/ML TOP SOLA,,108646,LOCAL,Facility,Both,8 mL,mL,,80,68,22.928,80,Sanford Health Plan,Sanford Health Plan,73.6,92,,percent of total billed charges,,
FERRIC SUBSULFATE 0.2 TO 0.22 GRAM/ML TOP SOLA,,108646,LOCAL,Facility,Outpatient,8 mL,mL,,80,68,22.928,80,"UCare Health, Inc.",Individual & Family Plan,45.08,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
FERRIC SUBSULFATE 0.2 TO 0.22 GRAM/ML TOP SOLA,,108646,LOCAL,Facility,Inpatient,8 mL,mL,,80,68,22.928,80,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
FERRIC SUBSULFATE 0.2 TO 0.22 GRAM/ML TOP SOLA,,108646,LOCAL,Facility,Outpatient,8 mL,mL,,80,68,22.928,80,"UCare Health, Inc.",Medical Assistance,40.376,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FERRIC SUBSULFATE 0.2 TO 0.22 GRAM/ML TOP SOLA,,108646,LOCAL,Facility,Inpatient,8 mL,mL,,80,68,22.928,80,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
FERRIC SUBSULFATE 0.2 TO 0.22 GRAM/ML TOP SOLA,,108646,LOCAL,Facility,Outpatient,8 mL,mL,,80,68,22.928,80,"UCare Health, Inc.",Medicare Advantage,40.376,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FERRIC SUBSULFATE 0.2 TO 0.22 GRAM/ML TOP SOLA,,108646,LOCAL,Facility,Inpatient,8 mL,mL,,80,68,22.928,80,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
FERRIC SUBSULFATE 0.2 TO 0.22 GRAM/ML TOP SOLA,,108646,LOCAL,Facility,Outpatient,8 mL,mL,,80,68,22.928,80,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),40.376,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
FERRIC SUBSULFATE 0.2 TO 0.22 GRAM/ML TOP SOLA,,108646,LOCAL,Facility,Inpatient,8 mL,mL,,80,68,22.928,80,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
FERRIC SUBSULFATE 0.2 TO 0.22 GRAM/ML TOP SOLA,,108646,LOCAL,Facility,Both,8 mL,mL,,80,68,22.928,80,UnitedHealthcare,Individual & Family,75.2,94,,percent of total billed charges,,
FERRIC SUBSULFATE 0.2 TO 0.22 GRAM/ML TOP SOLA,,108646,LOCAL,Facility,Outpatient,8 mL,mL,,80,68,22.928,80,UnitedHealthcare,Medicare Advantage,39.2,49,,percent of total billed charges,,
FERRIC SUBSULFATE 0.2 TO 0.22 GRAM/ML TOP SOLA,,108646,LOCAL,Facility,Inpatient,8 mL,mL,,80,68,22.928,80,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
FERRIC SUBSULFATE 0.2 TO 0.22 GRAM/ML TOP SOLA,,108646,LOCAL,Facility,Outpatient,8 mL,mL,,80,68,22.928,80,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,38.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
FERRIC SUBSULFATE 0.2 TO 0.22 GRAM/ML TOP SOLA,,108646,LOCAL,Facility,Inpatient,8 mL,mL,,80,68,22.928,80,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
TRIAMCINOLONE ACETONIDE 0.1 % TOP CREAM,,7915,LOCAL,Facility,Both,80 g,g,,70,59.5,20.062,70,Aetna,Commercial,64.4,92,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.1 % TOP CREAM,,7915,LOCAL,Facility,Both,80 g,g,,48,40.8,13.7568,48,Aetna,Commercial,44.16,92,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.1 % TOP CREAM,,7915,LOCAL,Facility,Outpatient,80 g,g,,70,59.5,20.062,70,Aetna,Medicare Advantage,34.3,49,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.1 % TOP CREAM,,7915,LOCAL,Facility,Outpatient,80 g,g,,48,40.8,13.7568,48,Aetna,Medicare Advantage,23.52,49,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.1 % TOP CREAM,,7915,LOCAL,Facility,Inpatient,80 g,g,,70,59.5,20.062,70,Aetna,Medicare Advantage,,,,,Included in per diem rate,
TRIAMCINOLONE ACETONIDE 0.1 % TOP CREAM,,7915,LOCAL,Facility,Inpatient,80 g,g,,48,40.8,13.7568,48,Aetna,Medicare Advantage,,,,,Included in per diem rate,
TRIAMCINOLONE ACETONIDE 0.1 % TOP CREAM,,7915,LOCAL,Facility,Both,80 g,g,,70,59.5,20.062,70,Aetna,PPO,65.1,93,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.1 % TOP CREAM,,7915,LOCAL,Facility,Both,80 g,g,,48,40.8,13.7568,48,Aetna,PPO,44.64,93,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.1 % TOP CREAM,,7915,LOCAL,Facility,Both,80 g,g,,70,59.5,20.062,70,America's PPO,America's PPO,67.221,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
TRIAMCINOLONE ACETONIDE 0.1 % TOP CREAM,,7915,LOCAL,Facility,Both,80 g,g,,48,40.8,13.7568,48,America's PPO,America's PPO,46.0944,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
TRIAMCINOLONE ACETONIDE 0.1 % TOP CREAM,,7915,LOCAL,Facility,Both,80 g,g,,70,59.5,20.062,70,BlueCross BlueShield Minnesota, Federal Employee Program,68.88,98.4,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.1 % TOP CREAM,,7915,LOCAL,Facility,Both,80 g,g,,48,40.8,13.7568,48,BlueCross BlueShield Minnesota, Federal Employee Program,47.232,98.4,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.1 % TOP CREAM,,7915,LOCAL,Facility,Both,80 g,g,,70,59.5,20.062,70,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,70,100,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.1 % TOP CREAM,,7915,LOCAL,Facility,Both,80 g,g,,48,40.8,13.7568,48,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,48,100,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.1 % TOP CREAM,,7915,LOCAL,Facility,Both,80 g,g,,70,59.5,20.062,70,BlueCross BlueShield Minnesota,High Value Network Plan,63,90,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.1 % TOP CREAM,,7915,LOCAL,Facility,Both,80 g,g,,48,40.8,13.7568,48,BlueCross BlueShield Minnesota,High Value Network Plan,43.2,90,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.1 % TOP CREAM,,7915,LOCAL,Facility,Outpatient,80 g,g,,70,59.5,20.062,70,BlueCross BlueShield Minnesota,Medicare Advantage,34.3,49,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.1 % TOP CREAM,,7915,LOCAL,Facility,Outpatient,80 g,g,,48,40.8,13.7568,48,BlueCross BlueShield Minnesota,Medicare Advantage,23.52,49,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.1 % TOP CREAM,,7915,LOCAL,Facility,Inpatient,80 g,g,,70,59.5,20.062,70,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
TRIAMCINOLONE ACETONIDE 0.1 % TOP CREAM,,7915,LOCAL,Facility,Inpatient,80 g,g,,48,40.8,13.7568,48,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
TRIAMCINOLONE ACETONIDE 0.1 % TOP CREAM,,7915,LOCAL,Facility,Both,80 g,g,,70,59.5,20.062,70,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,61.999,88.57,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.1 % TOP CREAM,,7915,LOCAL,Facility,Both,80 g,g,,48,40.8,13.7568,48,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,42.5136,88.57,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.1 % TOP CREAM,,7915,LOCAL,Facility,Both,80 g,g,,70,59.5,20.062,70,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,20.062,28.66,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.1 % TOP CREAM,,7915,LOCAL,Facility,Both,80 g,g,,48,40.8,13.7568,48,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,13.7568,28.66,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.1 % TOP CREAM,,7915,LOCAL,Facility,Outpatient,80 g,g,,70,59.5,20.062,70,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),34.3,49,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.1 % TOP CREAM,,7915,LOCAL,Facility,Outpatient,80 g,g,,48,40.8,13.7568,48,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),23.52,49,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.1 % TOP CREAM,,7915,LOCAL,Facility,Inpatient,80 g,g,,70,59.5,20.062,70,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
TRIAMCINOLONE ACETONIDE 0.1 % TOP CREAM,,7915,LOCAL,Facility,Inpatient,80 g,g,,48,40.8,13.7568,48,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
TRIAMCINOLONE ACETONIDE 0.1 % TOP CREAM,,7915,LOCAL,Facility,Both,80 g,g,,70,59.5,20.062,70,CorVel,Worker's Compensation,70,100,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.1 % TOP CREAM,,7915,LOCAL,Facility,Both,80 g,g,,48,40.8,13.7568,48,CorVel,Worker's Compensation,48,100,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.1 % TOP CREAM,,7915,LOCAL,Facility,Both,80 g,g,,70,59.5,20.062,70,First Health Group Corporation,First Health Network,67.9,97,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.1 % TOP CREAM,,7915,LOCAL,Facility,Both,80 g,g,,48,40.8,13.7568,48,First Health Group Corporation,First Health Network,46.56,97,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.1 % TOP CREAM,,7915,LOCAL,Facility,Both,80 g,g,,70,59.5,20.062,70,"Health Partners, Inc.",Commercial,66.22,94.6,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.1 % TOP CREAM,,7915,LOCAL,Facility,Both,80 g,g,,48,40.8,13.7568,48,"Health Partners, Inc.",Commercial,45.408,94.6,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.1 % TOP CREAM,,7915,LOCAL,Facility,Outpatient,80 g,g,,70,59.5,20.062,70,"Health Partners, Inc.",Medicare Advantage,34.3,49,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.1 % TOP CREAM,,7915,LOCAL,Facility,Outpatient,80 g,g,,48,40.8,13.7568,48,"Health Partners, Inc.",Medicare Advantage,23.52,49,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.1 % TOP CREAM,,7915,LOCAL,Facility,Inpatient,80 g,g,,70,59.5,20.062,70,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
TRIAMCINOLONE ACETONIDE 0.1 % TOP CREAM,,7915,LOCAL,Facility,Inpatient,80 g,g,,48,40.8,13.7568,48,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
TRIAMCINOLONE ACETONIDE 0.1 % TOP CREAM,,7915,LOCAL,Facility,Both,80 g,g,,70,59.5,20.062,70,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),42,60,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.1 % TOP CREAM,,7915,LOCAL,Facility,Both,80 g,g,,48,40.8,13.7568,48,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),28.8,60,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.1 % TOP CREAM,,7915,LOCAL,Facility,Both,80 g,g,,70,59.5,20.062,70,"Health Partners, Inc.",State of Minnesota Advantage Program,57.05,81.5,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.1 % TOP CREAM,,7915,LOCAL,Facility,Both,80 g,g,,48,40.8,13.7568,48,"Health Partners, Inc.",State of Minnesota Advantage Program,39.12,81.5,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.1 % TOP CREAM,,7915,LOCAL,Facility,Both,80 g,g,,70,59.5,20.062,70,"Health Partners, Inc.",State Public Programs,35,50,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.1 % TOP CREAM,,7915,LOCAL,Facility,Both,80 g,g,,48,40.8,13.7568,48,"Health Partners, Inc.",State Public Programs,24,50,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.1 % TOP CREAM,,7915,LOCAL,Facility,Both,80 g,g,,70,59.5,20.062,70,Humana Insurance Company,Commercial PPO,66.5,95,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.1 % TOP CREAM,,7915,LOCAL,Facility,Both,80 g,g,,48,40.8,13.7568,48,Humana Insurance Company,Commercial PPO,45.6,95,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.1 % TOP CREAM,,7915,LOCAL,Facility,Outpatient,80 g,g,,70,59.5,20.062,70,Humana Insurance Company,Medicare PPO,34.3,49,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.1 % TOP CREAM,,7915,LOCAL,Facility,Outpatient,80 g,g,,48,40.8,13.7568,48,Humana Insurance Company,Medicare PPO,23.52,49,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.1 % TOP CREAM,,7915,LOCAL,Facility,Inpatient,80 g,g,,70,59.5,20.062,70,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
TRIAMCINOLONE ACETONIDE 0.1 % TOP CREAM,,7915,LOCAL,Facility,Inpatient,80 g,g,,48,40.8,13.7568,48,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
TRIAMCINOLONE ACETONIDE 0.1 % TOP CREAM,,7915,LOCAL,Facility,Both,80 g,g,,70,59.5,20.062,70,Medica,Individual & Family,69.37,99.1,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.1 % TOP CREAM,,7915,LOCAL,Facility,Both,80 g,g,,48,40.8,13.7568,48,Medica,Individual & Family,47.568,99.1,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.1 % TOP CREAM,,7915,LOCAL,Facility,Outpatient,80 g,g,,70,59.5,20.062,70,Medica,Medica Advantage Solution,34.86,49.8,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.1 % TOP CREAM,,7915,LOCAL,Facility,Outpatient,80 g,g,,48,40.8,13.7568,48,Medica,Medica Advantage Solution,23.904,49.8,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.1 % TOP CREAM,,7915,LOCAL,Facility,Inpatient,80 g,g,,70,59.5,20.062,70,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
TRIAMCINOLONE ACETONIDE 0.1 % TOP CREAM,,7915,LOCAL,Facility,Inpatient,80 g,g,,48,40.8,13.7568,48,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
TRIAMCINOLONE ACETONIDE 0.1 % TOP CREAM,,7915,LOCAL,Facility,Outpatient,80 g,g,,70,59.5,20.062,70,Medica,Medical Assistance,31.22,44.6,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.1 % TOP CREAM,,7915,LOCAL,Facility,Outpatient,80 g,g,,48,40.8,13.7568,48,Medica,Medical Assistance,21.408,44.6,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.1 % TOP CREAM,,7915,LOCAL,Facility,Inpatient,80 g,g,,70,59.5,20.062,70,Medica,Medical Assistance,,,,,Included in per diem rate,
TRIAMCINOLONE ACETONIDE 0.1 % TOP CREAM,,7915,LOCAL,Facility,Inpatient,80 g,g,,48,40.8,13.7568,48,Medica,Medical Assistance,,,,,Included in per diem rate,
TRIAMCINOLONE ACETONIDE 0.1 % TOP CREAM,,7915,LOCAL,Facility,Outpatient,80 g,g,,70,59.5,20.062,70,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,34.86,49.8,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.1 % TOP CREAM,,7915,LOCAL,Facility,Outpatient,80 g,g,,48,40.8,13.7568,48,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,23.904,49.8,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.1 % TOP CREAM,,7915,LOCAL,Facility,Inpatient,80 g,g,,70,59.5,20.062,70,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
TRIAMCINOLONE ACETONIDE 0.1 % TOP CREAM,,7915,LOCAL,Facility,Inpatient,80 g,g,,48,40.8,13.7568,48,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
TRIAMCINOLONE ACETONIDE 0.1 % TOP CREAM,,7915,LOCAL,Facility,Both,80 g,g,,70,59.5,20.062,70,"Multiplan, Inc.","Multiplan, Inc.",65.8,94,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.1 % TOP CREAM,,7915,LOCAL,Facility,Both,80 g,g,,48,40.8,13.7568,48,"Multiplan, Inc.","Multiplan, Inc.",45.12,94,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.1 % TOP CREAM,,7915,LOCAL,Facility,Outpatient,80 g,g,,70,59.5,20.062,70,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,63.07,90.1,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.1 % TOP CREAM,,7915,LOCAL,Facility,Outpatient,80 g,g,,48,40.8,13.7568,48,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,43.248,90.1,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.1 % TOP CREAM,,7915,LOCAL,Facility,Inpatient,80 g,g,,70,59.5,20.062,70,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
TRIAMCINOLONE ACETONIDE 0.1 % TOP CREAM,,7915,LOCAL,Facility,Inpatient,80 g,g,,48,40.8,13.7568,48,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
TRIAMCINOLONE ACETONIDE 0.1 % TOP CREAM,,7915,LOCAL,Facility,Both,80 g,g,,70,59.5,20.062,70,"Preferred One Administrative Services, INC.",PPO,69.02,98.6,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.1 % TOP CREAM,,7915,LOCAL,Facility,Both,80 g,g,,48,40.8,13.7568,48,"Preferred One Administrative Services, INC.",PPO,47.328,98.6,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.1 % TOP CREAM,,7915,LOCAL,Facility,Outpatient,80 g,g,,70,59.5,20.062,70,PrimeWest Health,Minnesota Senior Health Options (MSHO),36.015,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
TRIAMCINOLONE ACETONIDE 0.1 % TOP CREAM,,7915,LOCAL,Facility,Outpatient,80 g,g,,48,40.8,13.7568,48,PrimeWest Health,Minnesota Senior Health Options (MSHO),24.696,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
TRIAMCINOLONE ACETONIDE 0.1 % TOP CREAM,,7915,LOCAL,Facility,Inpatient,80 g,g,,70,59.5,20.062,70,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
TRIAMCINOLONE ACETONIDE 0.1 % TOP CREAM,,7915,LOCAL,Facility,Inpatient,80 g,g,,48,40.8,13.7568,48,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
TRIAMCINOLONE ACETONIDE 0.1 % TOP CREAM,,7915,LOCAL,Facility,Outpatient,80 g,g,,70,59.5,20.062,70,PrimeWest Health,MinnesotaCare,35.952,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
TRIAMCINOLONE ACETONIDE 0.1 % TOP CREAM,,7915,LOCAL,Facility,Outpatient,80 g,g,,48,40.8,13.7568,48,PrimeWest Health,MinnesotaCare,24.6528,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
TRIAMCINOLONE ACETONIDE 0.1 % TOP CREAM,,7915,LOCAL,Facility,Inpatient,80 g,g,,70,59.5,20.062,70,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
TRIAMCINOLONE ACETONIDE 0.1 % TOP CREAM,,7915,LOCAL,Facility,Inpatient,80 g,g,,48,40.8,13.7568,48,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
TRIAMCINOLONE ACETONIDE 0.1 % TOP CREAM,,7915,LOCAL,Facility,Both,80 g,g,,70,59.5,20.062,70,Sanford Health Plan,Sanford Health Plan,64.4,92,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.1 % TOP CREAM,,7915,LOCAL,Facility,Both,80 g,g,,48,40.8,13.7568,48,Sanford Health Plan,Sanford Health Plan,44.16,92,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.1 % TOP CREAM,,7915,LOCAL,Facility,Outpatient,80 g,g,,70,59.5,20.062,70,"UCare Health, Inc.",Individual & Family Plan,39.445,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
TRIAMCINOLONE ACETONIDE 0.1 % TOP CREAM,,7915,LOCAL,Facility,Outpatient,80 g,g,,48,40.8,13.7568,48,"UCare Health, Inc.",Individual & Family Plan,27.048,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
TRIAMCINOLONE ACETONIDE 0.1 % TOP CREAM,,7915,LOCAL,Facility,Inpatient,80 g,g,,70,59.5,20.062,70,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
TRIAMCINOLONE ACETONIDE 0.1 % TOP CREAM,,7915,LOCAL,Facility,Inpatient,80 g,g,,48,40.8,13.7568,48,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
TRIAMCINOLONE ACETONIDE 0.1 % TOP CREAM,,7915,LOCAL,Facility,Outpatient,80 g,g,,70,59.5,20.062,70,"UCare Health, Inc.",Medical Assistance,35.329,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TRIAMCINOLONE ACETONIDE 0.1 % TOP CREAM,,7915,LOCAL,Facility,Outpatient,80 g,g,,48,40.8,13.7568,48,"UCare Health, Inc.",Medical Assistance,24.2256,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TRIAMCINOLONE ACETONIDE 0.1 % TOP CREAM,,7915,LOCAL,Facility,Inpatient,80 g,g,,70,59.5,20.062,70,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
TRIAMCINOLONE ACETONIDE 0.1 % TOP CREAM,,7915,LOCAL,Facility,Inpatient,80 g,g,,48,40.8,13.7568,48,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
TRIAMCINOLONE ACETONIDE 0.1 % TOP CREAM,,7915,LOCAL,Facility,Outpatient,80 g,g,,70,59.5,20.062,70,"UCare Health, Inc.",Medicare Advantage,35.329,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TRIAMCINOLONE ACETONIDE 0.1 % TOP CREAM,,7915,LOCAL,Facility,Outpatient,80 g,g,,48,40.8,13.7568,48,"UCare Health, Inc.",Medicare Advantage,24.2256,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TRIAMCINOLONE ACETONIDE 0.1 % TOP CREAM,,7915,LOCAL,Facility,Inpatient,80 g,g,,70,59.5,20.062,70,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
TRIAMCINOLONE ACETONIDE 0.1 % TOP CREAM,,7915,LOCAL,Facility,Inpatient,80 g,g,,48,40.8,13.7568,48,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
TRIAMCINOLONE ACETONIDE 0.1 % TOP CREAM,,7915,LOCAL,Facility,Outpatient,80 g,g,,70,59.5,20.062,70,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),35.329,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TRIAMCINOLONE ACETONIDE 0.1 % TOP CREAM,,7915,LOCAL,Facility,Outpatient,80 g,g,,48,40.8,13.7568,48,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),24.2256,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TRIAMCINOLONE ACETONIDE 0.1 % TOP CREAM,,7915,LOCAL,Facility,Inpatient,80 g,g,,70,59.5,20.062,70,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
TRIAMCINOLONE ACETONIDE 0.1 % TOP CREAM,,7915,LOCAL,Facility,Inpatient,80 g,g,,48,40.8,13.7568,48,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
TRIAMCINOLONE ACETONIDE 0.1 % TOP CREAM,,7915,LOCAL,Facility,Both,80 g,g,,70,59.5,20.062,70,UnitedHealthcare,Individual & Family,65.8,94,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.1 % TOP CREAM,,7915,LOCAL,Facility,Both,80 g,g,,48,40.8,13.7568,48,UnitedHealthcare,Individual & Family,45.12,94,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.1 % TOP CREAM,,7915,LOCAL,Facility,Outpatient,80 g,g,,70,59.5,20.062,70,UnitedHealthcare,Medicare Advantage,34.3,49,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.1 % TOP CREAM,,7915,LOCAL,Facility,Outpatient,80 g,g,,48,40.8,13.7568,48,UnitedHealthcare,Medicare Advantage,23.52,49,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.1 % TOP CREAM,,7915,LOCAL,Facility,Inpatient,80 g,g,,70,59.5,20.062,70,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
TRIAMCINOLONE ACETONIDE 0.1 % TOP CREAM,,7915,LOCAL,Facility,Inpatient,80 g,g,,48,40.8,13.7568,48,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
TRIAMCINOLONE ACETONIDE 0.1 % TOP CREAM,,7915,LOCAL,Facility,Outpatient,80 g,g,,70,59.5,20.062,70,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,33.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
TRIAMCINOLONE ACETONIDE 0.1 % TOP CREAM,,7915,LOCAL,Facility,Outpatient,80 g,g,,48,40.8,13.7568,48,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,23.04,48,,percent of total billed charges,,100% of DHS outpatient percentage
TRIAMCINOLONE ACETONIDE 0.1 % TOP CREAM,,7915,LOCAL,Facility,Inpatient,80 g,g,,70,59.5,20.062,70,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
TRIAMCINOLONE ACETONIDE 0.1 % TOP CREAM,,7915,LOCAL,Facility,Inpatient,80 g,g,,48,40.8,13.7568,48,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
TRIAMCINOLONE ACETONIDE 0.1 % TOP OINT,,12632,LOCAL,Facility,Both,80 g,g,,62,52.7,17.7692,62,Aetna,Commercial,57.04,92,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.1 % TOP OINT,,12632,LOCAL,Facility,Outpatient,80 g,g,,62,52.7,17.7692,62,Aetna,Medicare Advantage,30.38,49,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.1 % TOP OINT,,12632,LOCAL,Facility,Inpatient,80 g,g,,62,52.7,17.7692,62,Aetna,Medicare Advantage,,,,,Included in per diem rate,
TRIAMCINOLONE ACETONIDE 0.1 % TOP OINT,,12632,LOCAL,Facility,Both,80 g,g,,62,52.7,17.7692,62,Aetna,PPO,57.66,93,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.1 % TOP OINT,,12632,LOCAL,Facility,Both,80 g,g,,62,52.7,17.7692,62,America's PPO,America's PPO,59.5386,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
TRIAMCINOLONE ACETONIDE 0.1 % TOP OINT,,12632,LOCAL,Facility,Both,80 g,g,,62,52.7,17.7692,62,BlueCross BlueShield Minnesota, Federal Employee Program,61.008,98.4,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.1 % TOP OINT,,12632,LOCAL,Facility,Both,80 g,g,,62,52.7,17.7692,62,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,62,100,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.1 % TOP OINT,,12632,LOCAL,Facility,Both,80 g,g,,62,52.7,17.7692,62,BlueCross BlueShield Minnesota,High Value Network Plan,55.8,90,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.1 % TOP OINT,,12632,LOCAL,Facility,Outpatient,80 g,g,,62,52.7,17.7692,62,BlueCross BlueShield Minnesota,Medicare Advantage,30.38,49,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.1 % TOP OINT,,12632,LOCAL,Facility,Inpatient,80 g,g,,62,52.7,17.7692,62,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
TRIAMCINOLONE ACETONIDE 0.1 % TOP OINT,,12632,LOCAL,Facility,Both,80 g,g,,62,52.7,17.7692,62,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,54.9134,88.57,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.1 % TOP OINT,,12632,LOCAL,Facility,Both,80 g,g,,62,52.7,17.7692,62,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,17.7692,28.66,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.1 % TOP OINT,,12632,LOCAL,Facility,Outpatient,80 g,g,,62,52.7,17.7692,62,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),30.38,49,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.1 % TOP OINT,,12632,LOCAL,Facility,Inpatient,80 g,g,,62,52.7,17.7692,62,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
TRIAMCINOLONE ACETONIDE 0.1 % TOP OINT,,12632,LOCAL,Facility,Both,80 g,g,,62,52.7,17.7692,62,CorVel,Worker's Compensation,62,100,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.1 % TOP OINT,,12632,LOCAL,Facility,Both,80 g,g,,62,52.7,17.7692,62,First Health Group Corporation,First Health Network,60.14,97,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.1 % TOP OINT,,12632,LOCAL,Facility,Both,80 g,g,,62,52.7,17.7692,62,"Health Partners, Inc.",Commercial,58.652,94.6,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.1 % TOP OINT,,12632,LOCAL,Facility,Outpatient,80 g,g,,62,52.7,17.7692,62,"Health Partners, Inc.",Medicare Advantage,30.38,49,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.1 % TOP OINT,,12632,LOCAL,Facility,Inpatient,80 g,g,,62,52.7,17.7692,62,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
TRIAMCINOLONE ACETONIDE 0.1 % TOP OINT,,12632,LOCAL,Facility,Both,80 g,g,,62,52.7,17.7692,62,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),37.2,60,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.1 % TOP OINT,,12632,LOCAL,Facility,Both,80 g,g,,62,52.7,17.7692,62,"Health Partners, Inc.",State of Minnesota Advantage Program,50.53,81.5,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.1 % TOP OINT,,12632,LOCAL,Facility,Both,80 g,g,,62,52.7,17.7692,62,"Health Partners, Inc.",State Public Programs,31,50,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.1 % TOP OINT,,12632,LOCAL,Facility,Both,80 g,g,,62,52.7,17.7692,62,Humana Insurance Company,Commercial PPO,58.9,95,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.1 % TOP OINT,,12632,LOCAL,Facility,Outpatient,80 g,g,,62,52.7,17.7692,62,Humana Insurance Company,Medicare PPO,30.38,49,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.1 % TOP OINT,,12632,LOCAL,Facility,Inpatient,80 g,g,,62,52.7,17.7692,62,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
TRIAMCINOLONE ACETONIDE 0.1 % TOP OINT,,12632,LOCAL,Facility,Both,80 g,g,,62,52.7,17.7692,62,Medica,Individual & Family,61.442,99.1,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.1 % TOP OINT,,12632,LOCAL,Facility,Outpatient,80 g,g,,62,52.7,17.7692,62,Medica,Medica Advantage Solution,30.876,49.8,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.1 % TOP OINT,,12632,LOCAL,Facility,Inpatient,80 g,g,,62,52.7,17.7692,62,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
TRIAMCINOLONE ACETONIDE 0.1 % TOP OINT,,12632,LOCAL,Facility,Outpatient,80 g,g,,62,52.7,17.7692,62,Medica,Medical Assistance,27.652,44.6,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.1 % TOP OINT,,12632,LOCAL,Facility,Inpatient,80 g,g,,62,52.7,17.7692,62,Medica,Medical Assistance,,,,,Included in per diem rate,
TRIAMCINOLONE ACETONIDE 0.1 % TOP OINT,,12632,LOCAL,Facility,Outpatient,80 g,g,,62,52.7,17.7692,62,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,30.876,49.8,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.1 % TOP OINT,,12632,LOCAL,Facility,Inpatient,80 g,g,,62,52.7,17.7692,62,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
TRIAMCINOLONE ACETONIDE 0.1 % TOP OINT,,12632,LOCAL,Facility,Both,80 g,g,,62,52.7,17.7692,62,"Multiplan, Inc.","Multiplan, Inc.",58.28,94,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.1 % TOP OINT,,12632,LOCAL,Facility,Outpatient,80 g,g,,62,52.7,17.7692,62,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,55.862,90.1,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.1 % TOP OINT,,12632,LOCAL,Facility,Inpatient,80 g,g,,62,52.7,17.7692,62,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
TRIAMCINOLONE ACETONIDE 0.1 % TOP OINT,,12632,LOCAL,Facility,Both,80 g,g,,62,52.7,17.7692,62,"Preferred One Administrative Services, INC.",PPO,61.132,98.6,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.1 % TOP OINT,,12632,LOCAL,Facility,Outpatient,80 g,g,,62,52.7,17.7692,62,PrimeWest Health,Minnesota Senior Health Options (MSHO),31.899,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
TRIAMCINOLONE ACETONIDE 0.1 % TOP OINT,,12632,LOCAL,Facility,Inpatient,80 g,g,,62,52.7,17.7692,62,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
TRIAMCINOLONE ACETONIDE 0.1 % TOP OINT,,12632,LOCAL,Facility,Outpatient,80 g,g,,62,52.7,17.7692,62,PrimeWest Health,MinnesotaCare,31.8432,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
TRIAMCINOLONE ACETONIDE 0.1 % TOP OINT,,12632,LOCAL,Facility,Inpatient,80 g,g,,62,52.7,17.7692,62,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
TRIAMCINOLONE ACETONIDE 0.1 % TOP OINT,,12632,LOCAL,Facility,Both,80 g,g,,62,52.7,17.7692,62,Sanford Health Plan,Sanford Health Plan,57.04,92,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.1 % TOP OINT,,12632,LOCAL,Facility,Outpatient,80 g,g,,62,52.7,17.7692,62,"UCare Health, Inc.",Individual & Family Plan,34.937,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
TRIAMCINOLONE ACETONIDE 0.1 % TOP OINT,,12632,LOCAL,Facility,Inpatient,80 g,g,,62,52.7,17.7692,62,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
TRIAMCINOLONE ACETONIDE 0.1 % TOP OINT,,12632,LOCAL,Facility,Outpatient,80 g,g,,62,52.7,17.7692,62,"UCare Health, Inc.",Medical Assistance,31.2914,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TRIAMCINOLONE ACETONIDE 0.1 % TOP OINT,,12632,LOCAL,Facility,Inpatient,80 g,g,,62,52.7,17.7692,62,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
TRIAMCINOLONE ACETONIDE 0.1 % TOP OINT,,12632,LOCAL,Facility,Outpatient,80 g,g,,62,52.7,17.7692,62,"UCare Health, Inc.",Medicare Advantage,31.2914,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TRIAMCINOLONE ACETONIDE 0.1 % TOP OINT,,12632,LOCAL,Facility,Inpatient,80 g,g,,62,52.7,17.7692,62,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
TRIAMCINOLONE ACETONIDE 0.1 % TOP OINT,,12632,LOCAL,Facility,Outpatient,80 g,g,,62,52.7,17.7692,62,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),31.2914,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TRIAMCINOLONE ACETONIDE 0.1 % TOP OINT,,12632,LOCAL,Facility,Inpatient,80 g,g,,62,52.7,17.7692,62,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
TRIAMCINOLONE ACETONIDE 0.1 % TOP OINT,,12632,LOCAL,Facility,Both,80 g,g,,62,52.7,17.7692,62,UnitedHealthcare,Individual & Family,58.28,94,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.1 % TOP OINT,,12632,LOCAL,Facility,Outpatient,80 g,g,,62,52.7,17.7692,62,UnitedHealthcare,Medicare Advantage,30.38,49,,percent of total billed charges,,
TRIAMCINOLONE ACETONIDE 0.1 % TOP OINT,,12632,LOCAL,Facility,Inpatient,80 g,g,,62,52.7,17.7692,62,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
TRIAMCINOLONE ACETONIDE 0.1 % TOP OINT,,12632,LOCAL,Facility,Outpatient,80 g,g,,62,52.7,17.7692,62,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,29.76,48,,percent of total billed charges,,100% of DHS outpatient percentage
TRIAMCINOLONE ACETONIDE 0.1 % TOP OINT,,12632,LOCAL,Facility,Inpatient,80 g,g,,62,52.7,17.7692,62,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
MICONAZOLE NITRATE 2 % TOP POWD,,5604,LOCAL,Facility,Both,85 g,g,,32,27.2,9.1712,32,Aetna,Commercial,29.44,92,,percent of total billed charges,,
MICONAZOLE NITRATE 2 % TOP POWD,,5604,LOCAL,Facility,Outpatient,85 g,g,,32,27.2,9.1712,32,Aetna,Medicare Advantage,15.68,49,,percent of total billed charges,,
MICONAZOLE NITRATE 2 % TOP POWD,,5604,LOCAL,Facility,Inpatient,85 g,g,,32,27.2,9.1712,32,Aetna,Medicare Advantage,,,,,Included in per diem rate,
MICONAZOLE NITRATE 2 % TOP POWD,,5604,LOCAL,Facility,Both,85 g,g,,32,27.2,9.1712,32,Aetna,PPO,29.76,93,,percent of total billed charges,,
MICONAZOLE NITRATE 2 % TOP POWD,,5604,LOCAL,Facility,Both,85 g,g,,32,27.2,9.1712,32,America's PPO,America's PPO,30.7296,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
MICONAZOLE NITRATE 2 % TOP POWD,,5604,LOCAL,Facility,Both,85 g,g,,32,27.2,9.1712,32,BlueCross BlueShield Minnesota, Federal Employee Program,31.488,98.4,,percent of total billed charges,,
MICONAZOLE NITRATE 2 % TOP POWD,,5604,LOCAL,Facility,Both,85 g,g,,32,27.2,9.1712,32,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,32,100,,percent of total billed charges,,
MICONAZOLE NITRATE 2 % TOP POWD,,5604,LOCAL,Facility,Both,85 g,g,,32,27.2,9.1712,32,BlueCross BlueShield Minnesota,High Value Network Plan,28.8,90,,percent of total billed charges,,
MICONAZOLE NITRATE 2 % TOP POWD,,5604,LOCAL,Facility,Outpatient,85 g,g,,32,27.2,9.1712,32,BlueCross BlueShield Minnesota,Medicare Advantage,15.68,49,,percent of total billed charges,,
MICONAZOLE NITRATE 2 % TOP POWD,,5604,LOCAL,Facility,Inpatient,85 g,g,,32,27.2,9.1712,32,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
MICONAZOLE NITRATE 2 % TOP POWD,,5604,LOCAL,Facility,Both,85 g,g,,32,27.2,9.1712,32,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,28.3424,88.57,,percent of total billed charges,,
MICONAZOLE NITRATE 2 % TOP POWD,,5604,LOCAL,Facility,Both,85 g,g,,32,27.2,9.1712,32,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,9.1712,28.66,,percent of total billed charges,,
MICONAZOLE NITRATE 2 % TOP POWD,,5604,LOCAL,Facility,Outpatient,85 g,g,,32,27.2,9.1712,32,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),15.68,49,,percent of total billed charges,,
MICONAZOLE NITRATE 2 % TOP POWD,,5604,LOCAL,Facility,Inpatient,85 g,g,,32,27.2,9.1712,32,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
MICONAZOLE NITRATE 2 % TOP POWD,,5604,LOCAL,Facility,Both,85 g,g,,32,27.2,9.1712,32,CorVel,Worker's Compensation,32,100,,percent of total billed charges,,
MICONAZOLE NITRATE 2 % TOP POWD,,5604,LOCAL,Facility,Both,85 g,g,,32,27.2,9.1712,32,First Health Group Corporation,First Health Network,31.04,97,,percent of total billed charges,,
MICONAZOLE NITRATE 2 % TOP POWD,,5604,LOCAL,Facility,Both,85 g,g,,32,27.2,9.1712,32,"Health Partners, Inc.",Commercial,30.272,94.6,,percent of total billed charges,,
MICONAZOLE NITRATE 2 % TOP POWD,,5604,LOCAL,Facility,Outpatient,85 g,g,,32,27.2,9.1712,32,"Health Partners, Inc.",Medicare Advantage,15.68,49,,percent of total billed charges,,
MICONAZOLE NITRATE 2 % TOP POWD,,5604,LOCAL,Facility,Inpatient,85 g,g,,32,27.2,9.1712,32,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
MICONAZOLE NITRATE 2 % TOP POWD,,5604,LOCAL,Facility,Both,85 g,g,,32,27.2,9.1712,32,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),19.2,60,,percent of total billed charges,,
MICONAZOLE NITRATE 2 % TOP POWD,,5604,LOCAL,Facility,Both,85 g,g,,32,27.2,9.1712,32,"Health Partners, Inc.",State of Minnesota Advantage Program,26.08,81.5,,percent of total billed charges,,
MICONAZOLE NITRATE 2 % TOP POWD,,5604,LOCAL,Facility,Both,85 g,g,,32,27.2,9.1712,32,"Health Partners, Inc.",State Public Programs,16,50,,percent of total billed charges,,
MICONAZOLE NITRATE 2 % TOP POWD,,5604,LOCAL,Facility,Both,85 g,g,,32,27.2,9.1712,32,Humana Insurance Company,Commercial PPO,30.4,95,,percent of total billed charges,,
MICONAZOLE NITRATE 2 % TOP POWD,,5604,LOCAL,Facility,Outpatient,85 g,g,,32,27.2,9.1712,32,Humana Insurance Company,Medicare PPO,15.68,49,,percent of total billed charges,,
MICONAZOLE NITRATE 2 % TOP POWD,,5604,LOCAL,Facility,Inpatient,85 g,g,,32,27.2,9.1712,32,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
MICONAZOLE NITRATE 2 % TOP POWD,,5604,LOCAL,Facility,Both,85 g,g,,32,27.2,9.1712,32,Medica,Individual & Family,31.712,99.1,,percent of total billed charges,,
MICONAZOLE NITRATE 2 % TOP POWD,,5604,LOCAL,Facility,Outpatient,85 g,g,,32,27.2,9.1712,32,Medica,Medica Advantage Solution,15.936,49.8,,percent of total billed charges,,
MICONAZOLE NITRATE 2 % TOP POWD,,5604,LOCAL,Facility,Inpatient,85 g,g,,32,27.2,9.1712,32,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
MICONAZOLE NITRATE 2 % TOP POWD,,5604,LOCAL,Facility,Outpatient,85 g,g,,32,27.2,9.1712,32,Medica,Medical Assistance,14.272,44.6,,percent of total billed charges,,
MICONAZOLE NITRATE 2 % TOP POWD,,5604,LOCAL,Facility,Inpatient,85 g,g,,32,27.2,9.1712,32,Medica,Medical Assistance,,,,,Included in per diem rate,
MICONAZOLE NITRATE 2 % TOP POWD,,5604,LOCAL,Facility,Outpatient,85 g,g,,32,27.2,9.1712,32,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,15.936,49.8,,percent of total billed charges,,
MICONAZOLE NITRATE 2 % TOP POWD,,5604,LOCAL,Facility,Inpatient,85 g,g,,32,27.2,9.1712,32,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
MICONAZOLE NITRATE 2 % TOP POWD,,5604,LOCAL,Facility,Both,85 g,g,,32,27.2,9.1712,32,"Multiplan, Inc.","Multiplan, Inc.",30.08,94,,percent of total billed charges,,
MICONAZOLE NITRATE 2 % TOP POWD,,5604,LOCAL,Facility,Outpatient,85 g,g,,32,27.2,9.1712,32,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,28.832,90.1,,percent of total billed charges,,
MICONAZOLE NITRATE 2 % TOP POWD,,5604,LOCAL,Facility,Inpatient,85 g,g,,32,27.2,9.1712,32,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
MICONAZOLE NITRATE 2 % TOP POWD,,5604,LOCAL,Facility,Both,85 g,g,,32,27.2,9.1712,32,"Preferred One Administrative Services, INC.",PPO,31.552,98.6,,percent of total billed charges,,
MICONAZOLE NITRATE 2 % TOP POWD,,5604,LOCAL,Facility,Outpatient,85 g,g,,32,27.2,9.1712,32,PrimeWest Health,Minnesota Senior Health Options (MSHO),16.464,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
MICONAZOLE NITRATE 2 % TOP POWD,,5604,LOCAL,Facility,Inpatient,85 g,g,,32,27.2,9.1712,32,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
MICONAZOLE NITRATE 2 % TOP POWD,,5604,LOCAL,Facility,Outpatient,85 g,g,,32,27.2,9.1712,32,PrimeWest Health,MinnesotaCare,16.4352,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
MICONAZOLE NITRATE 2 % TOP POWD,,5604,LOCAL,Facility,Inpatient,85 g,g,,32,27.2,9.1712,32,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
MICONAZOLE NITRATE 2 % TOP POWD,,5604,LOCAL,Facility,Both,85 g,g,,32,27.2,9.1712,32,Sanford Health Plan,Sanford Health Plan,29.44,92,,percent of total billed charges,,
MICONAZOLE NITRATE 2 % TOP POWD,,5604,LOCAL,Facility,Outpatient,85 g,g,,32,27.2,9.1712,32,"UCare Health, Inc.",Individual & Family Plan,18.032,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
MICONAZOLE NITRATE 2 % TOP POWD,,5604,LOCAL,Facility,Inpatient,85 g,g,,32,27.2,9.1712,32,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
MICONAZOLE NITRATE 2 % TOP POWD,,5604,LOCAL,Facility,Outpatient,85 g,g,,32,27.2,9.1712,32,"UCare Health, Inc.",Medical Assistance,16.1504,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MICONAZOLE NITRATE 2 % TOP POWD,,5604,LOCAL,Facility,Inpatient,85 g,g,,32,27.2,9.1712,32,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
MICONAZOLE NITRATE 2 % TOP POWD,,5604,LOCAL,Facility,Outpatient,85 g,g,,32,27.2,9.1712,32,"UCare Health, Inc.",Medicare Advantage,16.1504,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MICONAZOLE NITRATE 2 % TOP POWD,,5604,LOCAL,Facility,Inpatient,85 g,g,,32,27.2,9.1712,32,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
MICONAZOLE NITRATE 2 % TOP POWD,,5604,LOCAL,Facility,Outpatient,85 g,g,,32,27.2,9.1712,32,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),16.1504,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MICONAZOLE NITRATE 2 % TOP POWD,,5604,LOCAL,Facility,Inpatient,85 g,g,,32,27.2,9.1712,32,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
MICONAZOLE NITRATE 2 % TOP POWD,,5604,LOCAL,Facility,Both,85 g,g,,32,27.2,9.1712,32,UnitedHealthcare,Individual & Family,30.08,94,,percent of total billed charges,,
MICONAZOLE NITRATE 2 % TOP POWD,,5604,LOCAL,Facility,Outpatient,85 g,g,,32,27.2,9.1712,32,UnitedHealthcare,Medicare Advantage,15.68,49,,percent of total billed charges,,
MICONAZOLE NITRATE 2 % TOP POWD,,5604,LOCAL,Facility,Inpatient,85 g,g,,32,27.2,9.1712,32,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
MICONAZOLE NITRATE 2 % TOP POWD,,5604,LOCAL,Facility,Outpatient,85 g,g,,32,27.2,9.1712,32,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,15.36,48,,percent of total billed charges,,100% of DHS outpatient percentage
MICONAZOLE NITRATE 2 % TOP POWD,,5604,LOCAL,Facility,Inpatient,85 g,g,,32,27.2,9.1712,32,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
TROLAMINE SALICYLATE 10 % TOP CREAM,,20287,LOCAL,Facility,Both,85 g,g,,25,21.25,7.165,25,Aetna,Commercial,23,92,,percent of total billed charges,,
TROLAMINE SALICYLATE 10 % TOP CREAM,,20287,LOCAL,Facility,Outpatient,85 g,g,,25,21.25,7.165,25,Aetna,Medicare Advantage,12.25,49,,percent of total billed charges,,
TROLAMINE SALICYLATE 10 % TOP CREAM,,20287,LOCAL,Facility,Inpatient,85 g,g,,25,21.25,7.165,25,Aetna,Medicare Advantage,,,,,Included in per diem rate,
TROLAMINE SALICYLATE 10 % TOP CREAM,,20287,LOCAL,Facility,Both,85 g,g,,25,21.25,7.165,25,Aetna,PPO,23.25,93,,percent of total billed charges,,
TROLAMINE SALICYLATE 10 % TOP CREAM,,20287,LOCAL,Facility,Both,85 g,g,,25,21.25,7.165,25,America's PPO,America's PPO,24.0075,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
TROLAMINE SALICYLATE 10 % TOP CREAM,,20287,LOCAL,Facility,Both,85 g,g,,25,21.25,7.165,25,BlueCross BlueShield Minnesota, Federal Employee Program,24.6,98.4,,percent of total billed charges,,
TROLAMINE SALICYLATE 10 % TOP CREAM,,20287,LOCAL,Facility,Both,85 g,g,,25,21.25,7.165,25,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,25,100,,percent of total billed charges,,
TROLAMINE SALICYLATE 10 % TOP CREAM,,20287,LOCAL,Facility,Both,85 g,g,,25,21.25,7.165,25,BlueCross BlueShield Minnesota,High Value Network Plan,22.5,90,,percent of total billed charges,,
TROLAMINE SALICYLATE 10 % TOP CREAM,,20287,LOCAL,Facility,Outpatient,85 g,g,,25,21.25,7.165,25,BlueCross BlueShield Minnesota,Medicare Advantage,12.25,49,,percent of total billed charges,,
TROLAMINE SALICYLATE 10 % TOP CREAM,,20287,LOCAL,Facility,Inpatient,85 g,g,,25,21.25,7.165,25,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
TROLAMINE SALICYLATE 10 % TOP CREAM,,20287,LOCAL,Facility,Both,85 g,g,,25,21.25,7.165,25,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,22.1425,88.57,,percent of total billed charges,,
TROLAMINE SALICYLATE 10 % TOP CREAM,,20287,LOCAL,Facility,Both,85 g,g,,25,21.25,7.165,25,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,7.165,28.66,,percent of total billed charges,,
TROLAMINE SALICYLATE 10 % TOP CREAM,,20287,LOCAL,Facility,Outpatient,85 g,g,,25,21.25,7.165,25,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),12.25,49,,percent of total billed charges,,
TROLAMINE SALICYLATE 10 % TOP CREAM,,20287,LOCAL,Facility,Inpatient,85 g,g,,25,21.25,7.165,25,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
TROLAMINE SALICYLATE 10 % TOP CREAM,,20287,LOCAL,Facility,Both,85 g,g,,25,21.25,7.165,25,CorVel,Worker's Compensation,25,100,,percent of total billed charges,,
TROLAMINE SALICYLATE 10 % TOP CREAM,,20287,LOCAL,Facility,Both,85 g,g,,25,21.25,7.165,25,First Health Group Corporation,First Health Network,24.25,97,,percent of total billed charges,,
TROLAMINE SALICYLATE 10 % TOP CREAM,,20287,LOCAL,Facility,Both,85 g,g,,25,21.25,7.165,25,"Health Partners, Inc.",Commercial,23.65,94.6,,percent of total billed charges,,
TROLAMINE SALICYLATE 10 % TOP CREAM,,20287,LOCAL,Facility,Outpatient,85 g,g,,25,21.25,7.165,25,"Health Partners, Inc.",Medicare Advantage,12.25,49,,percent of total billed charges,,
TROLAMINE SALICYLATE 10 % TOP CREAM,,20287,LOCAL,Facility,Inpatient,85 g,g,,25,21.25,7.165,25,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
TROLAMINE SALICYLATE 10 % TOP CREAM,,20287,LOCAL,Facility,Both,85 g,g,,25,21.25,7.165,25,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),15,60,,percent of total billed charges,,
TROLAMINE SALICYLATE 10 % TOP CREAM,,20287,LOCAL,Facility,Both,85 g,g,,25,21.25,7.165,25,"Health Partners, Inc.",State of Minnesota Advantage Program,20.375,81.5,,percent of total billed charges,,
TROLAMINE SALICYLATE 10 % TOP CREAM,,20287,LOCAL,Facility,Both,85 g,g,,25,21.25,7.165,25,"Health Partners, Inc.",State Public Programs,12.5,50,,percent of total billed charges,,
TROLAMINE SALICYLATE 10 % TOP CREAM,,20287,LOCAL,Facility,Both,85 g,g,,25,21.25,7.165,25,Humana Insurance Company,Commercial PPO,23.75,95,,percent of total billed charges,,
TROLAMINE SALICYLATE 10 % TOP CREAM,,20287,LOCAL,Facility,Outpatient,85 g,g,,25,21.25,7.165,25,Humana Insurance Company,Medicare PPO,12.25,49,,percent of total billed charges,,
TROLAMINE SALICYLATE 10 % TOP CREAM,,20287,LOCAL,Facility,Inpatient,85 g,g,,25,21.25,7.165,25,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
TROLAMINE SALICYLATE 10 % TOP CREAM,,20287,LOCAL,Facility,Both,85 g,g,,25,21.25,7.165,25,Medica,Individual & Family,24.775,99.1,,percent of total billed charges,,
TROLAMINE SALICYLATE 10 % TOP CREAM,,20287,LOCAL,Facility,Outpatient,85 g,g,,25,21.25,7.165,25,Medica,Medica Advantage Solution,12.45,49.8,,percent of total billed charges,,
TROLAMINE SALICYLATE 10 % TOP CREAM,,20287,LOCAL,Facility,Inpatient,85 g,g,,25,21.25,7.165,25,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
TROLAMINE SALICYLATE 10 % TOP CREAM,,20287,LOCAL,Facility,Outpatient,85 g,g,,25,21.25,7.165,25,Medica,Medical Assistance,11.15,44.6,,percent of total billed charges,,
TROLAMINE SALICYLATE 10 % TOP CREAM,,20287,LOCAL,Facility,Inpatient,85 g,g,,25,21.25,7.165,25,Medica,Medical Assistance,,,,,Included in per diem rate,
TROLAMINE SALICYLATE 10 % TOP CREAM,,20287,LOCAL,Facility,Outpatient,85 g,g,,25,21.25,7.165,25,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,12.45,49.8,,percent of total billed charges,,
TROLAMINE SALICYLATE 10 % TOP CREAM,,20287,LOCAL,Facility,Inpatient,85 g,g,,25,21.25,7.165,25,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
TROLAMINE SALICYLATE 10 % TOP CREAM,,20287,LOCAL,Facility,Both,85 g,g,,25,21.25,7.165,25,"Multiplan, Inc.","Multiplan, Inc.",23.5,94,,percent of total billed charges,,
TROLAMINE SALICYLATE 10 % TOP CREAM,,20287,LOCAL,Facility,Outpatient,85 g,g,,25,21.25,7.165,25,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,22.525,90.1,,percent of total billed charges,,
TROLAMINE SALICYLATE 10 % TOP CREAM,,20287,LOCAL,Facility,Inpatient,85 g,g,,25,21.25,7.165,25,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
TROLAMINE SALICYLATE 10 % TOP CREAM,,20287,LOCAL,Facility,Both,85 g,g,,25,21.25,7.165,25,"Preferred One Administrative Services, INC.",PPO,24.65,98.6,,percent of total billed charges,,
TROLAMINE SALICYLATE 10 % TOP CREAM,,20287,LOCAL,Facility,Outpatient,85 g,g,,25,21.25,7.165,25,PrimeWest Health,Minnesota Senior Health Options (MSHO),12.8625,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
TROLAMINE SALICYLATE 10 % TOP CREAM,,20287,LOCAL,Facility,Inpatient,85 g,g,,25,21.25,7.165,25,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
TROLAMINE SALICYLATE 10 % TOP CREAM,,20287,LOCAL,Facility,Outpatient,85 g,g,,25,21.25,7.165,25,PrimeWest Health,MinnesotaCare,12.84,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
TROLAMINE SALICYLATE 10 % TOP CREAM,,20287,LOCAL,Facility,Inpatient,85 g,g,,25,21.25,7.165,25,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
TROLAMINE SALICYLATE 10 % TOP CREAM,,20287,LOCAL,Facility,Both,85 g,g,,25,21.25,7.165,25,Sanford Health Plan,Sanford Health Plan,23,92,,percent of total billed charges,,
TROLAMINE SALICYLATE 10 % TOP CREAM,,20287,LOCAL,Facility,Outpatient,85 g,g,,25,21.25,7.165,25,"UCare Health, Inc.",Individual & Family Plan,14.0875,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
TROLAMINE SALICYLATE 10 % TOP CREAM,,20287,LOCAL,Facility,Inpatient,85 g,g,,25,21.25,7.165,25,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
TROLAMINE SALICYLATE 10 % TOP CREAM,,20287,LOCAL,Facility,Outpatient,85 g,g,,25,21.25,7.165,25,"UCare Health, Inc.",Medical Assistance,12.6175,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TROLAMINE SALICYLATE 10 % TOP CREAM,,20287,LOCAL,Facility,Inpatient,85 g,g,,25,21.25,7.165,25,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
TROLAMINE SALICYLATE 10 % TOP CREAM,,20287,LOCAL,Facility,Outpatient,85 g,g,,25,21.25,7.165,25,"UCare Health, Inc.",Medicare Advantage,12.6175,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TROLAMINE SALICYLATE 10 % TOP CREAM,,20287,LOCAL,Facility,Inpatient,85 g,g,,25,21.25,7.165,25,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
TROLAMINE SALICYLATE 10 % TOP CREAM,,20287,LOCAL,Facility,Outpatient,85 g,g,,25,21.25,7.165,25,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),12.6175,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
TROLAMINE SALICYLATE 10 % TOP CREAM,,20287,LOCAL,Facility,Inpatient,85 g,g,,25,21.25,7.165,25,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
TROLAMINE SALICYLATE 10 % TOP CREAM,,20287,LOCAL,Facility,Both,85 g,g,,25,21.25,7.165,25,UnitedHealthcare,Individual & Family,23.5,94,,percent of total billed charges,,
TROLAMINE SALICYLATE 10 % TOP CREAM,,20287,LOCAL,Facility,Outpatient,85 g,g,,25,21.25,7.165,25,UnitedHealthcare,Medicare Advantage,12.25,49,,percent of total billed charges,,
TROLAMINE SALICYLATE 10 % TOP CREAM,,20287,LOCAL,Facility,Inpatient,85 g,g,,25,21.25,7.165,25,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
TROLAMINE SALICYLATE 10 % TOP CREAM,,20287,LOCAL,Facility,Outpatient,85 g,g,,25,21.25,7.165,25,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,12,48,,percent of total billed charges,,100% of DHS outpatient percentage
TROLAMINE SALICYLATE 10 % TOP CREAM,,20287,LOCAL,Facility,Inpatient,85 g,g,,25,21.25,7.165,25,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
MENTHOL 4 % TOP GEL,,106776,LOCAL,Facility,Both,89 mL,mL,,46,39.1,13.1836,46,Aetna,Commercial,42.32,92,,percent of total billed charges,,
MENTHOL 4 % TOP GEL,,106776,LOCAL,Facility,Outpatient,89 mL,mL,,46,39.1,13.1836,46,Aetna,Medicare Advantage,22.54,49,,percent of total billed charges,,
MENTHOL 4 % TOP GEL,,106776,LOCAL,Facility,Inpatient,89 mL,mL,,46,39.1,13.1836,46,Aetna,Medicare Advantage,,,,,Included in per diem rate,
MENTHOL 4 % TOP GEL,,106776,LOCAL,Facility,Both,89 mL,mL,,46,39.1,13.1836,46,Aetna,PPO,42.78,93,,percent of total billed charges,,
MENTHOL 4 % TOP GEL,,106776,LOCAL,Facility,Both,89 mL,mL,,46,39.1,13.1836,46,America's PPO,America's PPO,44.1738,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
MENTHOL 4 % TOP GEL,,106776,LOCAL,Facility,Both,89 mL,mL,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota, Federal Employee Program,45.264,98.4,,percent of total billed charges,,
MENTHOL 4 % TOP GEL,,106776,LOCAL,Facility,Both,89 mL,mL,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,46,100,,percent of total billed charges,,
MENTHOL 4 % TOP GEL,,106776,LOCAL,Facility,Both,89 mL,mL,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,High Value Network Plan,41.4,90,,percent of total billed charges,,
MENTHOL 4 % TOP GEL,,106776,LOCAL,Facility,Outpatient,89 mL,mL,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Medicare Advantage,22.54,49,,percent of total billed charges,,
MENTHOL 4 % TOP GEL,,106776,LOCAL,Facility,Inpatient,89 mL,mL,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
MENTHOL 4 % TOP GEL,,106776,LOCAL,Facility,Both,89 mL,mL,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,40.7422,88.57,,percent of total billed charges,,
MENTHOL 4 % TOP GEL,,106776,LOCAL,Facility,Both,89 mL,mL,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,13.1836,28.66,,percent of total billed charges,,
MENTHOL 4 % TOP GEL,,106776,LOCAL,Facility,Outpatient,89 mL,mL,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),22.54,49,,percent of total billed charges,,
MENTHOL 4 % TOP GEL,,106776,LOCAL,Facility,Inpatient,89 mL,mL,,46,39.1,13.1836,46,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
MENTHOL 4 % TOP GEL,,106776,LOCAL,Facility,Both,89 mL,mL,,46,39.1,13.1836,46,CorVel,Worker's Compensation,46,100,,percent of total billed charges,,
MENTHOL 4 % TOP GEL,,106776,LOCAL,Facility,Both,89 mL,mL,,46,39.1,13.1836,46,First Health Group Corporation,First Health Network,44.62,97,,percent of total billed charges,,
MENTHOL 4 % TOP GEL,,106776,LOCAL,Facility,Both,89 mL,mL,,46,39.1,13.1836,46,"Health Partners, Inc.",Commercial,43.516,94.6,,percent of total billed charges,,
MENTHOL 4 % TOP GEL,,106776,LOCAL,Facility,Outpatient,89 mL,mL,,46,39.1,13.1836,46,"Health Partners, Inc.",Medicare Advantage,22.54,49,,percent of total billed charges,,
MENTHOL 4 % TOP GEL,,106776,LOCAL,Facility,Inpatient,89 mL,mL,,46,39.1,13.1836,46,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
MENTHOL 4 % TOP GEL,,106776,LOCAL,Facility,Both,89 mL,mL,,46,39.1,13.1836,46,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),27.6,60,,percent of total billed charges,,
MENTHOL 4 % TOP GEL,,106776,LOCAL,Facility,Both,89 mL,mL,,46,39.1,13.1836,46,"Health Partners, Inc.",State of Minnesota Advantage Program,37.49,81.5,,percent of total billed charges,,
MENTHOL 4 % TOP GEL,,106776,LOCAL,Facility,Both,89 mL,mL,,46,39.1,13.1836,46,"Health Partners, Inc.",State Public Programs,23,50,,percent of total billed charges,,
MENTHOL 4 % TOP GEL,,106776,LOCAL,Facility,Both,89 mL,mL,,46,39.1,13.1836,46,Humana Insurance Company,Commercial PPO,43.7,95,,percent of total billed charges,,
MENTHOL 4 % TOP GEL,,106776,LOCAL,Facility,Outpatient,89 mL,mL,,46,39.1,13.1836,46,Humana Insurance Company,Medicare PPO,22.54,49,,percent of total billed charges,,
MENTHOL 4 % TOP GEL,,106776,LOCAL,Facility,Inpatient,89 mL,mL,,46,39.1,13.1836,46,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
MENTHOL 4 % TOP GEL,,106776,LOCAL,Facility,Both,89 mL,mL,,46,39.1,13.1836,46,Medica,Individual & Family,45.586,99.1,,percent of total billed charges,,
MENTHOL 4 % TOP GEL,,106776,LOCAL,Facility,Outpatient,89 mL,mL,,46,39.1,13.1836,46,Medica,Medica Advantage Solution,22.908,49.8,,percent of total billed charges,,
MENTHOL 4 % TOP GEL,,106776,LOCAL,Facility,Inpatient,89 mL,mL,,46,39.1,13.1836,46,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
MENTHOL 4 % TOP GEL,,106776,LOCAL,Facility,Outpatient,89 mL,mL,,46,39.1,13.1836,46,Medica,Medical Assistance,20.516,44.6,,percent of total billed charges,,
MENTHOL 4 % TOP GEL,,106776,LOCAL,Facility,Inpatient,89 mL,mL,,46,39.1,13.1836,46,Medica,Medical Assistance,,,,,Included in per diem rate,
MENTHOL 4 % TOP GEL,,106776,LOCAL,Facility,Outpatient,89 mL,mL,,46,39.1,13.1836,46,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,22.908,49.8,,percent of total billed charges,,
MENTHOL 4 % TOP GEL,,106776,LOCAL,Facility,Inpatient,89 mL,mL,,46,39.1,13.1836,46,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
MENTHOL 4 % TOP GEL,,106776,LOCAL,Facility,Both,89 mL,mL,,46,39.1,13.1836,46,"Multiplan, Inc.","Multiplan, Inc.",43.24,94,,percent of total billed charges,,
MENTHOL 4 % TOP GEL,,106776,LOCAL,Facility,Outpatient,89 mL,mL,,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,41.446,90.1,,percent of total billed charges,,
MENTHOL 4 % TOP GEL,,106776,LOCAL,Facility,Inpatient,89 mL,mL,,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
MENTHOL 4 % TOP GEL,,106776,LOCAL,Facility,Both,89 mL,mL,,46,39.1,13.1836,46,"Preferred One Administrative Services, INC.",PPO,45.356,98.6,,percent of total billed charges,,
MENTHOL 4 % TOP GEL,,106776,LOCAL,Facility,Outpatient,89 mL,mL,,46,39.1,13.1836,46,PrimeWest Health,Minnesota Senior Health Options (MSHO),23.667,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
MENTHOL 4 % TOP GEL,,106776,LOCAL,Facility,Inpatient,89 mL,mL,,46,39.1,13.1836,46,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
MENTHOL 4 % TOP GEL,,106776,LOCAL,Facility,Outpatient,89 mL,mL,,46,39.1,13.1836,46,PrimeWest Health,MinnesotaCare,23.6256,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
MENTHOL 4 % TOP GEL,,106776,LOCAL,Facility,Inpatient,89 mL,mL,,46,39.1,13.1836,46,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
MENTHOL 4 % TOP GEL,,106776,LOCAL,Facility,Both,89 mL,mL,,46,39.1,13.1836,46,Sanford Health Plan,Sanford Health Plan,42.32,92,,percent of total billed charges,,
MENTHOL 4 % TOP GEL,,106776,LOCAL,Facility,Outpatient,89 mL,mL,,46,39.1,13.1836,46,"UCare Health, Inc.",Individual & Family Plan,25.921,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
MENTHOL 4 % TOP GEL,,106776,LOCAL,Facility,Inpatient,89 mL,mL,,46,39.1,13.1836,46,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
MENTHOL 4 % TOP GEL,,106776,LOCAL,Facility,Outpatient,89 mL,mL,,46,39.1,13.1836,46,"UCare Health, Inc.",Medical Assistance,23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MENTHOL 4 % TOP GEL,,106776,LOCAL,Facility,Inpatient,89 mL,mL,,46,39.1,13.1836,46,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
MENTHOL 4 % TOP GEL,,106776,LOCAL,Facility,Outpatient,89 mL,mL,,46,39.1,13.1836,46,"UCare Health, Inc.",Medicare Advantage,23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MENTHOL 4 % TOP GEL,,106776,LOCAL,Facility,Inpatient,89 mL,mL,,46,39.1,13.1836,46,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
MENTHOL 4 % TOP GEL,,106776,LOCAL,Facility,Outpatient,89 mL,mL,,46,39.1,13.1836,46,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),23.2162,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
MENTHOL 4 % TOP GEL,,106776,LOCAL,Facility,Inpatient,89 mL,mL,,46,39.1,13.1836,46,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
MENTHOL 4 % TOP GEL,,106776,LOCAL,Facility,Both,89 mL,mL,,46,39.1,13.1836,46,UnitedHealthcare,Individual & Family,43.24,94,,percent of total billed charges,,
MENTHOL 4 % TOP GEL,,106776,LOCAL,Facility,Outpatient,89 mL,mL,,46,39.1,13.1836,46,UnitedHealthcare,Medicare Advantage,22.54,49,,percent of total billed charges,,
MENTHOL 4 % TOP GEL,,106776,LOCAL,Facility,Inpatient,89 mL,mL,,46,39.1,13.1836,46,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
MENTHOL 4 % TOP GEL,,106776,LOCAL,Facility,Outpatient,89 mL,mL,,46,39.1,13.1836,46,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,22.08,48,,percent of total billed charges,,100% of DHS outpatient percentage
MENTHOL 4 % TOP GEL,,106776,LOCAL,Facility,Inpatient,89 mL,mL,,46,39.1,13.1836,46,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Home Health Housekeeping,,S5130,HCPCS,Facility,Both,,,,7.5,6.375,2.1495,7.5,Aetna,Commercial,6.9,92,,percent of total billed charges,,
Home Health Housekeeping,,S5130,HCPCS,Facility,Outpatient,,,,7.5,6.375,2.1495,7.5,Aetna,Medicare Advantage,3.675,49,,percent of total billed charges,,
Home Health Housekeeping,,S5130,HCPCS,Facility,Inpatient,,,,7.5,6.375,2.1495,7.5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Home Health Housekeeping,,S5130,HCPCS,Facility,Both,,,,7.5,6.375,2.1495,7.5,Aetna,PPO,6.975,93,,percent of total billed charges,,
Home Health Housekeeping,,S5130,HCPCS,Facility,Both,,,,7.5,6.375,2.1495,7.5,America's PPO,America's PPO,7.20225,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Home Health Housekeeping,,S5130,HCPCS,Facility,Both,,,,7.5,6.375,2.1495,7.5,BlueCross BlueShield Minnesota, Federal Employee Program,7.38,98.4,,percent of total billed charges,,
Home Health Housekeeping,,S5130,HCPCS,Facility,Both,,,,7.5,6.375,2.1495,7.5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,7.5,100,,percent of total billed charges,,
Home Health Housekeeping,,S5130,HCPCS,Facility,Both,,,,7.5,6.375,2.1495,7.5,BlueCross BlueShield Minnesota,High Value Network Plan,6.75,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
Home Health Housekeeping,,S5130,HCPCS,Facility,Outpatient,,,,7.5,6.375,2.1495,7.5,BlueCross BlueShield Minnesota,Medicare Advantage,3.675,49,,percent of total billed charges,,
Home Health Housekeeping,,S5130,HCPCS,Facility,Inpatient,,,,7.5,6.375,2.1495,7.5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Home Health Housekeeping,,S5130,HCPCS,Facility,Both,,,,7.5,6.375,2.1495,7.5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,6.64275,88.57,,percent of total billed charges,,
Home Health Housekeeping,,S5130,HCPCS,Facility,Both,,,,7.5,6.375,2.1495,7.5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,2.1495,28.66,,percent of total billed charges,,
Home Health Housekeeping,,S5130,HCPCS,Facility,Outpatient,,,,7.5,6.375,2.1495,7.5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),3.675,49,,percent of total billed charges,,
Home Health Housekeeping,,S5130,HCPCS,Facility,Inpatient,,,,7.5,6.375,2.1495,7.5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Home Health Housekeeping,,S5130,HCPCS,Facility,Both,,,,7.5,6.375,2.1495,7.5,CorVel,Worker's Compensation,7.5,100,,percent of total billed charges,,
Home Health Housekeeping,,S5130,HCPCS,Facility,Both,,,,7.5,6.375,2.1495,7.5,First Health Group Corporation,First Health Network,7.275,97,,percent of total billed charges,,
Home Health Housekeeping,,S5130,HCPCS,Facility,Both,,,,7.5,6.375,2.1495,7.5,"Health Partners, Inc.",Commercial,7.095,94.6,,percent of total billed charges,,
Home Health Housekeeping,,S5130,HCPCS,Facility,Outpatient,,,,7.5,6.375,2.1495,7.5,"Health Partners, Inc.",Medicare Advantage,3.675,49,,percent of total billed charges,,
Home Health Housekeeping,,S5130,HCPCS,Facility,Inpatient,,,,7.5,6.375,2.1495,7.5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Home Health Housekeeping,,S5130,HCPCS,Facility,Both,,,,7.5,6.375,2.1495,7.5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),4.5,60,,percent of total billed charges,,
Home Health Housekeeping,,S5130,HCPCS,Facility,Both,,,,7.5,6.375,2.1495,7.5,"Health Partners, Inc.",State of Minnesota Advantage Program,6.1125,81.5,,percent of total billed charges,,
Home Health Housekeeping,,S5130,HCPCS,Facility,Both,,,,7.5,6.375,2.1495,7.5,"Health Partners, Inc.",State Public Programs,3.75,50,,percent of total billed charges,,
Home Health Housekeeping,,S5130,HCPCS,Facility,Both,,,,7.5,6.375,2.1495,7.5,Humana Insurance Company,Commercial PPO,7.125,95,,percent of total billed charges,,
Home Health Housekeeping,,S5130,HCPCS,Facility,Outpatient,,,,7.5,6.375,2.1495,7.5,Humana Insurance Company,Medicare PPO,3.675,49,,percent of total billed charges,,
Home Health Housekeeping,,S5130,HCPCS,Facility,Inpatient,,,,7.5,6.375,2.1495,7.5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Home Health Housekeeping,,S5130,HCPCS,Facility,Both,,,,7.5,6.375,2.1495,7.5,Medica,Individual & Family,7.4325,99.1,,percent of total billed charges,,
Home Health Housekeeping,,S5130,HCPCS,Facility,Outpatient,,,,7.5,6.375,2.1495,7.5,Medica,Medica Advantage Solution,3.735,49.8,,percent of total billed charges,,
Home Health Housekeeping,,S5130,HCPCS,Facility,Inpatient,,,,7.5,6.375,2.1495,7.5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Home Health Housekeeping,,S5130,HCPCS,Facility,Outpatient,,,,7.5,6.375,2.1495,7.5,Medica,Medical Assistance,3.345,44.6,,percent of total billed charges,,
Home Health Housekeeping,,S5130,HCPCS,Facility,Inpatient,,,,7.5,6.375,2.1495,7.5,Medica,Medical Assistance,,,,,Included in per diem rate,
Home Health Housekeeping,,S5130,HCPCS,Facility,Outpatient,,,,7.5,6.375,2.1495,7.5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,3.735,49.8,,percent of total billed charges,,
Home Health Housekeeping,,S5130,HCPCS,Facility,Inpatient,,,,7.5,6.375,2.1495,7.5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Home Health Housekeeping,,S5130,HCPCS,Facility,Both,,,,7.5,6.375,2.1495,7.5,"Multiplan, Inc.","Multiplan, Inc.",7.05,94,,percent of total billed charges,,
Home Health Housekeeping,,S5130,HCPCS,Facility,Outpatient,,,,7.5,6.375,2.1495,7.5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,6.7575,90.1,,percent of total billed charges,,
Home Health Housekeeping,,S5130,HCPCS,Facility,Inpatient,,,,7.5,6.375,2.1495,7.5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Home Health Housekeeping,,S5130,HCPCS,Facility,Both,,,,7.5,6.375,2.1495,7.5,"Preferred One Administrative Services, INC.",PPO,7.395,98.6,,percent of total billed charges,,
Home Health Housekeeping,,S5130,HCPCS,Facility,Outpatient,,,,7.5,6.375,2.1495,7.5,PrimeWest Health,Minnesota Senior Health Options (MSHO),3.85875,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Home Health Housekeeping,,S5130,HCPCS,Facility,Inpatient,,,,7.5,6.375,2.1495,7.5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Home Health Housekeeping,,S5130,HCPCS,Facility,Outpatient,,,,7.5,6.375,2.1495,7.5,PrimeWest Health,MinnesotaCare,3.852,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Home Health Housekeeping,,S5130,HCPCS,Facility,Inpatient,,,,7.5,6.375,2.1495,7.5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Home Health Housekeeping,,S5130,HCPCS,Facility,Both,,,,7.5,6.375,2.1495,7.5,Sanford Health Plan,Sanford Health Plan,6.9,92,,percent of total billed charges,,
Home Health Housekeeping,,S5130,HCPCS,Facility,Outpatient,,,,7.5,6.375,2.1495,7.5,"UCare Health, Inc.",Individual & Family Plan,4.22625,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Home Health Housekeeping,,S5130,HCPCS,Facility,Inpatient,,,,7.5,6.375,2.1495,7.5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Home Health Housekeeping,,S5130,HCPCS,Facility,Outpatient,,,,7.5,6.375,2.1495,7.5,"UCare Health, Inc.",Medical Assistance,3.78525,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Home Health Housekeeping,,S5130,HCPCS,Facility,Inpatient,,,,7.5,6.375,2.1495,7.5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Home Health Housekeeping,,S5130,HCPCS,Facility,Outpatient,,,,7.5,6.375,2.1495,7.5,"UCare Health, Inc.",Medicare Advantage,3.78525,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Home Health Housekeeping,,S5130,HCPCS,Facility,Inpatient,,,,7.5,6.375,2.1495,7.5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Home Health Housekeeping,,S5130,HCPCS,Facility,Outpatient,,,,7.5,6.375,2.1495,7.5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),3.78525,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Home Health Housekeeping,,S5130,HCPCS,Facility,Inpatient,,,,7.5,6.375,2.1495,7.5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Home Health Housekeeping,,S5130,HCPCS,Facility,Both,,,,7.5,6.375,2.1495,7.5,UnitedHealthcare,Individual & Family,7.05,94,,percent of total billed charges,,
Home Health Housekeeping,,S5130,HCPCS,Facility,Outpatient,,,,7.5,6.375,2.1495,7.5,UnitedHealthcare,Medicare Advantage,3.675,49,,percent of total billed charges,,
Home Health Housekeeping,,S5130,HCPCS,Facility,Inpatient,,,,7.5,6.375,2.1495,7.5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Home Health Housekeeping,,S5130,HCPCS,Facility,Outpatient,,,,7.5,6.375,2.1495,7.5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,3.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
Home Health Housekeeping,,S5130,HCPCS,Facility,Inpatient,,,,7.5,6.375,2.1495,7.5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Housing Services-Housekeeping Per 15 Minutes,,S5130,HCPCS,Facility,Both,,,,7.5,6.375,2.1495,7.5,Aetna,Commercial,6.9,92,,percent of total billed charges,,
Housing Services-Housekeeping Per 15 Minutes,,S5130,HCPCS,Facility,Outpatient,,,,7.5,6.375,2.1495,7.5,Aetna,Medicare Advantage,3.675,49,,percent of total billed charges,,
Housing Services-Housekeeping Per 15 Minutes,,S5130,HCPCS,Facility,Inpatient,,,,7.5,6.375,2.1495,7.5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Housing Services-Housekeeping Per 15 Minutes,,S5130,HCPCS,Facility,Both,,,,7.5,6.375,2.1495,7.5,Aetna,PPO,6.975,93,,percent of total billed charges,,
Housing Services-Housekeeping Per 15 Minutes,,S5130,HCPCS,Facility,Both,,,,7.5,6.375,2.1495,7.5,America's PPO,America's PPO,7.20225,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Housing Services-Housekeeping Per 15 Minutes,,S5130,HCPCS,Facility,Both,,,,7.5,6.375,2.1495,7.5,BlueCross BlueShield Minnesota, Federal Employee Program,7.38,98.4,,percent of total billed charges,,
Housing Services-Housekeeping Per 15 Minutes,,S5130,HCPCS,Facility,Both,,,,7.5,6.375,2.1495,7.5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,7.5,100,,percent of total billed charges,,
Housing Services-Housekeeping Per 15 Minutes,,S5130,HCPCS,Facility,Both,,,,7.5,6.375,2.1495,7.5,BlueCross BlueShield Minnesota,High Value Network Plan,6.75,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
Housing Services-Housekeeping Per 15 Minutes,,S5130,HCPCS,Facility,Outpatient,,,,7.5,6.375,2.1495,7.5,BlueCross BlueShield Minnesota,Medicare Advantage,3.675,49,,percent of total billed charges,,
Housing Services-Housekeeping Per 15 Minutes,,S5130,HCPCS,Facility,Inpatient,,,,7.5,6.375,2.1495,7.5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Housing Services-Housekeeping Per 15 Minutes,,S5130,HCPCS,Facility,Both,,,,7.5,6.375,2.1495,7.5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,6.64275,88.57,,percent of total billed charges,,
Housing Services-Housekeeping Per 15 Minutes,,S5130,HCPCS,Facility,Both,,,,7.5,6.375,2.1495,7.5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,2.1495,28.66,,percent of total billed charges,,
Housing Services-Housekeeping Per 15 Minutes,,S5130,HCPCS,Facility,Outpatient,,,,7.5,6.375,2.1495,7.5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),3.675,49,,percent of total billed charges,,
Housing Services-Housekeeping Per 15 Minutes,,S5130,HCPCS,Facility,Inpatient,,,,7.5,6.375,2.1495,7.5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Housing Services-Housekeeping Per 15 Minutes,,S5130,HCPCS,Facility,Both,,,,7.5,6.375,2.1495,7.5,CorVel,Worker's Compensation,7.5,100,,percent of total billed charges,,
Housing Services-Housekeeping Per 15 Minutes,,S5130,HCPCS,Facility,Both,,,,7.5,6.375,2.1495,7.5,First Health Group Corporation,First Health Network,7.275,97,,percent of total billed charges,,
Housing Services-Housekeeping Per 15 Minutes,,S5130,HCPCS,Facility,Both,,,,7.5,6.375,2.1495,7.5,"Health Partners, Inc.",Commercial,7.095,94.6,,percent of total billed charges,,
Housing Services-Housekeeping Per 15 Minutes,,S5130,HCPCS,Facility,Outpatient,,,,7.5,6.375,2.1495,7.5,"Health Partners, Inc.",Medicare Advantage,3.675,49,,percent of total billed charges,,
Housing Services-Housekeeping Per 15 Minutes,,S5130,HCPCS,Facility,Inpatient,,,,7.5,6.375,2.1495,7.5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Housing Services-Housekeeping Per 15 Minutes,,S5130,HCPCS,Facility,Both,,,,7.5,6.375,2.1495,7.5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),4.5,60,,percent of total billed charges,,
Housing Services-Housekeeping Per 15 Minutes,,S5130,HCPCS,Facility,Both,,,,7.5,6.375,2.1495,7.5,"Health Partners, Inc.",State of Minnesota Advantage Program,6.1125,81.5,,percent of total billed charges,,
Housing Services-Housekeeping Per 15 Minutes,,S5130,HCPCS,Facility,Both,,,,7.5,6.375,2.1495,7.5,"Health Partners, Inc.",State Public Programs,3.75,50,,percent of total billed charges,,
Housing Services-Housekeeping Per 15 Minutes,,S5130,HCPCS,Facility,Both,,,,7.5,6.375,2.1495,7.5,Humana Insurance Company,Commercial PPO,7.125,95,,percent of total billed charges,,
Housing Services-Housekeeping Per 15 Minutes,,S5130,HCPCS,Facility,Outpatient,,,,7.5,6.375,2.1495,7.5,Humana Insurance Company,Medicare PPO,3.675,49,,percent of total billed charges,,
Housing Services-Housekeeping Per 15 Minutes,,S5130,HCPCS,Facility,Inpatient,,,,7.5,6.375,2.1495,7.5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Housing Services-Housekeeping Per 15 Minutes,,S5130,HCPCS,Facility,Both,,,,7.5,6.375,2.1495,7.5,Medica,Individual & Family,7.4325,99.1,,percent of total billed charges,,
Housing Services-Housekeeping Per 15 Minutes,,S5130,HCPCS,Facility,Outpatient,,,,7.5,6.375,2.1495,7.5,Medica,Medica Advantage Solution,3.735,49.8,,percent of total billed charges,,
Housing Services-Housekeeping Per 15 Minutes,,S5130,HCPCS,Facility,Inpatient,,,,7.5,6.375,2.1495,7.5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Housing Services-Housekeeping Per 15 Minutes,,S5130,HCPCS,Facility,Outpatient,,,,7.5,6.375,2.1495,7.5,Medica,Medical Assistance,3.345,44.6,,percent of total billed charges,,
Housing Services-Housekeeping Per 15 Minutes,,S5130,HCPCS,Facility,Inpatient,,,,7.5,6.375,2.1495,7.5,Medica,Medical Assistance,,,,,Included in per diem rate,
Housing Services-Housekeeping Per 15 Minutes,,S5130,HCPCS,Facility,Outpatient,,,,7.5,6.375,2.1495,7.5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,3.735,49.8,,percent of total billed charges,,
Housing Services-Housekeeping Per 15 Minutes,,S5130,HCPCS,Facility,Inpatient,,,,7.5,6.375,2.1495,7.5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Housing Services-Housekeeping Per 15 Minutes,,S5130,HCPCS,Facility,Both,,,,7.5,6.375,2.1495,7.5,"Multiplan, Inc.","Multiplan, Inc.",7.05,94,,percent of total billed charges,,
Housing Services-Housekeeping Per 15 Minutes,,S5130,HCPCS,Facility,Outpatient,,,,7.5,6.375,2.1495,7.5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,6.7575,90.1,,percent of total billed charges,,
Housing Services-Housekeeping Per 15 Minutes,,S5130,HCPCS,Facility,Inpatient,,,,7.5,6.375,2.1495,7.5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Housing Services-Housekeeping Per 15 Minutes,,S5130,HCPCS,Facility,Both,,,,7.5,6.375,2.1495,7.5,"Preferred One Administrative Services, INC.",PPO,7.395,98.6,,percent of total billed charges,,
Housing Services-Housekeeping Per 15 Minutes,,S5130,HCPCS,Facility,Outpatient,,,,7.5,6.375,2.1495,7.5,PrimeWest Health,Minnesota Senior Health Options (MSHO),3.85875,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Housing Services-Housekeeping Per 15 Minutes,,S5130,HCPCS,Facility,Inpatient,,,,7.5,6.375,2.1495,7.5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Housing Services-Housekeeping Per 15 Minutes,,S5130,HCPCS,Facility,Outpatient,,,,7.5,6.375,2.1495,7.5,PrimeWest Health,MinnesotaCare,3.852,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Housing Services-Housekeeping Per 15 Minutes,,S5130,HCPCS,Facility,Inpatient,,,,7.5,6.375,2.1495,7.5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Housing Services-Housekeeping Per 15 Minutes,,S5130,HCPCS,Facility,Both,,,,7.5,6.375,2.1495,7.5,Sanford Health Plan,Sanford Health Plan,6.9,92,,percent of total billed charges,,
Housing Services-Housekeeping Per 15 Minutes,,S5130,HCPCS,Facility,Outpatient,,,,7.5,6.375,2.1495,7.5,"UCare Health, Inc.",Individual & Family Plan,4.22625,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Housing Services-Housekeeping Per 15 Minutes,,S5130,HCPCS,Facility,Inpatient,,,,7.5,6.375,2.1495,7.5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Housing Services-Housekeeping Per 15 Minutes,,S5130,HCPCS,Facility,Outpatient,,,,7.5,6.375,2.1495,7.5,"UCare Health, Inc.",Medical Assistance,3.78525,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Housing Services-Housekeeping Per 15 Minutes,,S5130,HCPCS,Facility,Inpatient,,,,7.5,6.375,2.1495,7.5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Housing Services-Housekeeping Per 15 Minutes,,S5130,HCPCS,Facility,Outpatient,,,,7.5,6.375,2.1495,7.5,"UCare Health, Inc.",Medicare Advantage,3.78525,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Housing Services-Housekeeping Per 15 Minutes,,S5130,HCPCS,Facility,Inpatient,,,,7.5,6.375,2.1495,7.5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Housing Services-Housekeeping Per 15 Minutes,,S5130,HCPCS,Facility,Outpatient,,,,7.5,6.375,2.1495,7.5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),3.78525,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Housing Services-Housekeeping Per 15 Minutes,,S5130,HCPCS,Facility,Inpatient,,,,7.5,6.375,2.1495,7.5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Housing Services-Housekeeping Per 15 Minutes,,S5130,HCPCS,Facility,Both,,,,7.5,6.375,2.1495,7.5,UnitedHealthcare,Individual & Family,7.05,94,,percent of total billed charges,,
Housing Services-Housekeeping Per 15 Minutes,,S5130,HCPCS,Facility,Outpatient,,,,7.5,6.375,2.1495,7.5,UnitedHealthcare,Medicare Advantage,3.675,49,,percent of total billed charges,,
Housing Services-Housekeeping Per 15 Minutes,,S5130,HCPCS,Facility,Inpatient,,,,7.5,6.375,2.1495,7.5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Housing Services-Housekeeping Per 15 Minutes,,S5130,HCPCS,Facility,Outpatient,,,,7.5,6.375,2.1495,7.5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,3.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
Housing Services-Housekeeping Per 15 Minutes,,S5130,HCPCS,Facility,Inpatient,,,,7.5,6.375,2.1495,7.5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Housing Services-Noon Meal Package,,S5170,HCPCS,Facility,Both,,,,220,187,63.052,220,Aetna,Commercial,202.4,92,,percent of total billed charges,,
Housing Services-Noon Meal Package,,S5170,HCPCS,Facility,Outpatient,,,,220,187,63.052,220,Aetna,Medicare Advantage,107.8,49,,percent of total billed charges,,
Housing Services-Noon Meal Package,,S5170,HCPCS,Facility,Inpatient,,,,220,187,63.052,220,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Housing Services-Noon Meal Package,,S5170,HCPCS,Facility,Both,,,,220,187,63.052,220,Aetna,PPO,204.6,93,,percent of total billed charges,,
Housing Services-Noon Meal Package,,S5170,HCPCS,Facility,Both,,,,220,187,63.052,220,America's PPO,America's PPO,211.266,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Housing Services-Noon Meal Package,,S5170,HCPCS,Facility,Both,,,,220,187,63.052,220,BlueCross BlueShield Minnesota, Federal Employee Program,216.48,98.4,,percent of total billed charges,,
Housing Services-Noon Meal Package,,S5170,HCPCS,Facility,Both,,,,220,187,63.052,220,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,220,100,,percent of total billed charges,,
Housing Services-Noon Meal Package,,S5170,HCPCS,Facility,Both,,,,220,187,63.052,220,BlueCross BlueShield Minnesota,High Value Network Plan,198,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
Housing Services-Noon Meal Package,,S5170,HCPCS,Facility,Outpatient,,,,220,187,63.052,220,BlueCross BlueShield Minnesota,Medicare Advantage,107.8,49,,percent of total billed charges,,
Housing Services-Noon Meal Package,,S5170,HCPCS,Facility,Inpatient,,,,220,187,63.052,220,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Housing Services-Noon Meal Package,,S5170,HCPCS,Facility,Both,,,,220,187,63.052,220,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,194.854,88.57,,percent of total billed charges,,
Housing Services-Noon Meal Package,,S5170,HCPCS,Facility,Both,,,,220,187,63.052,220,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,63.052,28.66,,percent of total billed charges,,
Housing Services-Noon Meal Package,,S5170,HCPCS,Facility,Outpatient,,,,220,187,63.052,220,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),107.8,49,,percent of total billed charges,,
Housing Services-Noon Meal Package,,S5170,HCPCS,Facility,Inpatient,,,,220,187,63.052,220,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Housing Services-Noon Meal Package,,S5170,HCPCS,Facility,Both,,,,220,187,63.052,220,CorVel,Worker's Compensation,220,100,,percent of total billed charges,,
Housing Services-Noon Meal Package,,S5170,HCPCS,Facility,Both,,,,220,187,63.052,220,First Health Group Corporation,First Health Network,213.4,97,,percent of total billed charges,,
Housing Services-Noon Meal Package,,S5170,HCPCS,Facility,Both,,,,220,187,63.052,220,"Health Partners, Inc.",Commercial,208.12,94.6,,percent of total billed charges,,
Housing Services-Noon Meal Package,,S5170,HCPCS,Facility,Outpatient,,,,220,187,63.052,220,"Health Partners, Inc.",Medicare Advantage,107.8,49,,percent of total billed charges,,
Housing Services-Noon Meal Package,,S5170,HCPCS,Facility,Inpatient,,,,220,187,63.052,220,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Housing Services-Noon Meal Package,,S5170,HCPCS,Facility,Both,,,,220,187,63.052,220,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),132,60,,percent of total billed charges,,
Housing Services-Noon Meal Package,,S5170,HCPCS,Facility,Both,,,,220,187,63.052,220,"Health Partners, Inc.",State of Minnesota Advantage Program,179.3,81.5,,percent of total billed charges,,
Housing Services-Noon Meal Package,,S5170,HCPCS,Facility,Both,,,,220,187,63.052,220,"Health Partners, Inc.",State Public Programs,110,50,,percent of total billed charges,,
Housing Services-Noon Meal Package,,S5170,HCPCS,Facility,Both,,,,220,187,63.052,220,Humana Insurance Company,Commercial PPO,209,95,,percent of total billed charges,,
Housing Services-Noon Meal Package,,S5170,HCPCS,Facility,Outpatient,,,,220,187,63.052,220,Humana Insurance Company,Medicare PPO,107.8,49,,percent of total billed charges,,
Housing Services-Noon Meal Package,,S5170,HCPCS,Facility,Inpatient,,,,220,187,63.052,220,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Housing Services-Noon Meal Package,,S5170,HCPCS,Facility,Both,,,,220,187,63.052,220,Medica,Individual & Family,218.02,99.1,,percent of total billed charges,,
Housing Services-Noon Meal Package,,S5170,HCPCS,Facility,Outpatient,,,,220,187,63.052,220,Medica,Medica Advantage Solution,109.56,49.8,,percent of total billed charges,,
Housing Services-Noon Meal Package,,S5170,HCPCS,Facility,Inpatient,,,,220,187,63.052,220,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Housing Services-Noon Meal Package,,S5170,HCPCS,Facility,Outpatient,,,,220,187,63.052,220,Medica,Medical Assistance,98.12,44.6,,percent of total billed charges,,
Housing Services-Noon Meal Package,,S5170,HCPCS,Facility,Inpatient,,,,220,187,63.052,220,Medica,Medical Assistance,,,,,Included in per diem rate,
Housing Services-Noon Meal Package,,S5170,HCPCS,Facility,Outpatient,,,,220,187,63.052,220,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,109.56,49.8,,percent of total billed charges,,
Housing Services-Noon Meal Package,,S5170,HCPCS,Facility,Inpatient,,,,220,187,63.052,220,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Housing Services-Noon Meal Package,,S5170,HCPCS,Facility,Both,,,,220,187,63.052,220,"Multiplan, Inc.","Multiplan, Inc.",206.8,94,,percent of total billed charges,,
Housing Services-Noon Meal Package,,S5170,HCPCS,Facility,Outpatient,,,,220,187,63.052,220,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,198.22,90.1,,percent of total billed charges,,
Housing Services-Noon Meal Package,,S5170,HCPCS,Facility,Inpatient,,,,220,187,63.052,220,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Housing Services-Noon Meal Package,,S5170,HCPCS,Facility,Both,,,,220,187,63.052,220,"Preferred One Administrative Services, INC.",PPO,216.92,98.6,,percent of total billed charges,,
Housing Services-Noon Meal Package,,S5170,HCPCS,Facility,Outpatient,,,,220,187,63.052,220,PrimeWest Health,Minnesota Senior Health Options (MSHO),113.19,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Housing Services-Noon Meal Package,,S5170,HCPCS,Facility,Inpatient,,,,220,187,63.052,220,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Housing Services-Noon Meal Package,,S5170,HCPCS,Facility,Outpatient,,,,220,187,63.052,220,PrimeWest Health,MinnesotaCare,112.992,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Housing Services-Noon Meal Package,,S5170,HCPCS,Facility,Inpatient,,,,220,187,63.052,220,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Housing Services-Noon Meal Package,,S5170,HCPCS,Facility,Both,,,,220,187,63.052,220,Sanford Health Plan,Sanford Health Plan,202.4,92,,percent of total billed charges,,
Housing Services-Noon Meal Package,,S5170,HCPCS,Facility,Outpatient,,,,220,187,63.052,220,"UCare Health, Inc.",Individual & Family Plan,123.97,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Housing Services-Noon Meal Package,,S5170,HCPCS,Facility,Inpatient,,,,220,187,63.052,220,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Housing Services-Noon Meal Package,,S5170,HCPCS,Facility,Outpatient,,,,220,187,63.052,220,"UCare Health, Inc.",Medical Assistance,111.034,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Housing Services-Noon Meal Package,,S5170,HCPCS,Facility,Inpatient,,,,220,187,63.052,220,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Housing Services-Noon Meal Package,,S5170,HCPCS,Facility,Outpatient,,,,220,187,63.052,220,"UCare Health, Inc.",Medicare Advantage,111.034,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Housing Services-Noon Meal Package,,S5170,HCPCS,Facility,Inpatient,,,,220,187,63.052,220,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Housing Services-Noon Meal Package,,S5170,HCPCS,Facility,Outpatient,,,,220,187,63.052,220,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),111.034,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Housing Services-Noon Meal Package,,S5170,HCPCS,Facility,Inpatient,,,,220,187,63.052,220,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Housing Services-Noon Meal Package,,S5170,HCPCS,Facility,Both,,,,220,187,63.052,220,UnitedHealthcare,Individual & Family,206.8,94,,percent of total billed charges,,
Housing Services-Noon Meal Package,,S5170,HCPCS,Facility,Outpatient,,,,220,187,63.052,220,UnitedHealthcare,Medicare Advantage,107.8,49,,percent of total billed charges,,
Housing Services-Noon Meal Package,,S5170,HCPCS,Facility,Inpatient,,,,220,187,63.052,220,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Housing Services-Noon Meal Package,,S5170,HCPCS,Facility,Outpatient,,,,220,187,63.052,220,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,105.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
Housing Services-Noon Meal Package,,S5170,HCPCS,Facility,Inpatient,,,,220,187,63.052,220,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Housing Services-Per Meal Charge,,S5170,HCPCS,Facility,Both,,,,7,5.95,2.0062,7,Aetna,Commercial,6.44,92,,percent of total billed charges,,
Housing Services-Per Meal Charge,,S5170,HCPCS,Facility,Outpatient,,,,7,5.95,2.0062,7,Aetna,Medicare Advantage,3.43,49,,percent of total billed charges,,
Housing Services-Per Meal Charge,,S5170,HCPCS,Facility,Inpatient,,,,7,5.95,2.0062,7,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Housing Services-Per Meal Charge,,S5170,HCPCS,Facility,Both,,,,7,5.95,2.0062,7,Aetna,PPO,6.51,93,,percent of total billed charges,,
Housing Services-Per Meal Charge,,S5170,HCPCS,Facility,Both,,,,7,5.95,2.0062,7,America's PPO,America's PPO,6.7221,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Housing Services-Per Meal Charge,,S5170,HCPCS,Facility,Both,,,,7,5.95,2.0062,7,BlueCross BlueShield Minnesota, Federal Employee Program,6.888,98.4,,percent of total billed charges,,
Housing Services-Per Meal Charge,,S5170,HCPCS,Facility,Both,,,,7,5.95,2.0062,7,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,7,100,,percent of total billed charges,,
Housing Services-Per Meal Charge,,S5170,HCPCS,Facility,Both,,,,7,5.95,2.0062,7,BlueCross BlueShield Minnesota,High Value Network Plan,6.3,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
Housing Services-Per Meal Charge,,S5170,HCPCS,Facility,Outpatient,,,,7,5.95,2.0062,7,BlueCross BlueShield Minnesota,Medicare Advantage,3.43,49,,percent of total billed charges,,
Housing Services-Per Meal Charge,,S5170,HCPCS,Facility,Inpatient,,,,7,5.95,2.0062,7,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Housing Services-Per Meal Charge,,S5170,HCPCS,Facility,Both,,,,7,5.95,2.0062,7,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,6.1999,88.57,,percent of total billed charges,,
Housing Services-Per Meal Charge,,S5170,HCPCS,Facility,Both,,,,7,5.95,2.0062,7,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,2.0062,28.66,,percent of total billed charges,,
Housing Services-Per Meal Charge,,S5170,HCPCS,Facility,Outpatient,,,,7,5.95,2.0062,7,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),3.43,49,,percent of total billed charges,,
Housing Services-Per Meal Charge,,S5170,HCPCS,Facility,Inpatient,,,,7,5.95,2.0062,7,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Housing Services-Per Meal Charge,,S5170,HCPCS,Facility,Both,,,,7,5.95,2.0062,7,CorVel,Worker's Compensation,7,100,,percent of total billed charges,,
Housing Services-Per Meal Charge,,S5170,HCPCS,Facility,Both,,,,7,5.95,2.0062,7,First Health Group Corporation,First Health Network,6.79,97,,percent of total billed charges,,
Housing Services-Per Meal Charge,,S5170,HCPCS,Facility,Both,,,,7,5.95,2.0062,7,"Health Partners, Inc.",Commercial,6.622,94.6,,percent of total billed charges,,
Housing Services-Per Meal Charge,,S5170,HCPCS,Facility,Outpatient,,,,7,5.95,2.0062,7,"Health Partners, Inc.",Medicare Advantage,3.43,49,,percent of total billed charges,,
Housing Services-Per Meal Charge,,S5170,HCPCS,Facility,Inpatient,,,,7,5.95,2.0062,7,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Housing Services-Per Meal Charge,,S5170,HCPCS,Facility,Both,,,,7,5.95,2.0062,7,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),4.2,60,,percent of total billed charges,,
Housing Services-Per Meal Charge,,S5170,HCPCS,Facility,Both,,,,7,5.95,2.0062,7,"Health Partners, Inc.",State of Minnesota Advantage Program,5.705,81.5,,percent of total billed charges,,
Housing Services-Per Meal Charge,,S5170,HCPCS,Facility,Both,,,,7,5.95,2.0062,7,"Health Partners, Inc.",State Public Programs,3.5,50,,percent of total billed charges,,
Housing Services-Per Meal Charge,,S5170,HCPCS,Facility,Both,,,,7,5.95,2.0062,7,Humana Insurance Company,Commercial PPO,6.65,95,,percent of total billed charges,,
Housing Services-Per Meal Charge,,S5170,HCPCS,Facility,Outpatient,,,,7,5.95,2.0062,7,Humana Insurance Company,Medicare PPO,3.43,49,,percent of total billed charges,,
Housing Services-Per Meal Charge,,S5170,HCPCS,Facility,Inpatient,,,,7,5.95,2.0062,7,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Housing Services-Per Meal Charge,,S5170,HCPCS,Facility,Both,,,,7,5.95,2.0062,7,Medica,Individual & Family,6.937,99.1,,percent of total billed charges,,
Housing Services-Per Meal Charge,,S5170,HCPCS,Facility,Outpatient,,,,7,5.95,2.0062,7,Medica,Medica Advantage Solution,3.486,49.8,,percent of total billed charges,,
Housing Services-Per Meal Charge,,S5170,HCPCS,Facility,Inpatient,,,,7,5.95,2.0062,7,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Housing Services-Per Meal Charge,,S5170,HCPCS,Facility,Outpatient,,,,7,5.95,2.0062,7,Medica,Medical Assistance,3.122,44.6,,percent of total billed charges,,
Housing Services-Per Meal Charge,,S5170,HCPCS,Facility,Inpatient,,,,7,5.95,2.0062,7,Medica,Medical Assistance,,,,,Included in per diem rate,
Housing Services-Per Meal Charge,,S5170,HCPCS,Facility,Outpatient,,,,7,5.95,2.0062,7,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,3.486,49.8,,percent of total billed charges,,
Housing Services-Per Meal Charge,,S5170,HCPCS,Facility,Inpatient,,,,7,5.95,2.0062,7,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Housing Services-Per Meal Charge,,S5170,HCPCS,Facility,Both,,,,7,5.95,2.0062,7,"Multiplan, Inc.","Multiplan, Inc.",6.58,94,,percent of total billed charges,,
Housing Services-Per Meal Charge,,S5170,HCPCS,Facility,Outpatient,,,,7,5.95,2.0062,7,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,6.307,90.1,,percent of total billed charges,,
Housing Services-Per Meal Charge,,S5170,HCPCS,Facility,Inpatient,,,,7,5.95,2.0062,7,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Housing Services-Per Meal Charge,,S5170,HCPCS,Facility,Both,,,,7,5.95,2.0062,7,"Preferred One Administrative Services, INC.",PPO,6.902,98.6,,percent of total billed charges,,
Housing Services-Per Meal Charge,,S5170,HCPCS,Facility,Outpatient,,,,7,5.95,2.0062,7,PrimeWest Health,Minnesota Senior Health Options (MSHO),3.6015,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Housing Services-Per Meal Charge,,S5170,HCPCS,Facility,Inpatient,,,,7,5.95,2.0062,7,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Housing Services-Per Meal Charge,,S5170,HCPCS,Facility,Outpatient,,,,7,5.95,2.0062,7,PrimeWest Health,MinnesotaCare,3.5952,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Housing Services-Per Meal Charge,,S5170,HCPCS,Facility,Inpatient,,,,7,5.95,2.0062,7,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Housing Services-Per Meal Charge,,S5170,HCPCS,Facility,Both,,,,7,5.95,2.0062,7,Sanford Health Plan,Sanford Health Plan,6.44,92,,percent of total billed charges,,
Housing Services-Per Meal Charge,,S5170,HCPCS,Facility,Outpatient,,,,7,5.95,2.0062,7,"UCare Health, Inc.",Individual & Family Plan,3.9445,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Housing Services-Per Meal Charge,,S5170,HCPCS,Facility,Inpatient,,,,7,5.95,2.0062,7,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Housing Services-Per Meal Charge,,S5170,HCPCS,Facility,Outpatient,,,,7,5.95,2.0062,7,"UCare Health, Inc.",Medical Assistance,3.5329,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Housing Services-Per Meal Charge,,S5170,HCPCS,Facility,Inpatient,,,,7,5.95,2.0062,7,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Housing Services-Per Meal Charge,,S5170,HCPCS,Facility,Outpatient,,,,7,5.95,2.0062,7,"UCare Health, Inc.",Medicare Advantage,3.5329,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Housing Services-Per Meal Charge,,S5170,HCPCS,Facility,Inpatient,,,,7,5.95,2.0062,7,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Housing Services-Per Meal Charge,,S5170,HCPCS,Facility,Outpatient,,,,7,5.95,2.0062,7,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),3.5329,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Housing Services-Per Meal Charge,,S5170,HCPCS,Facility,Inpatient,,,,7,5.95,2.0062,7,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Housing Services-Per Meal Charge,,S5170,HCPCS,Facility,Both,,,,7,5.95,2.0062,7,UnitedHealthcare,Individual & Family,6.58,94,,percent of total billed charges,,
Housing Services-Per Meal Charge,,S5170,HCPCS,Facility,Outpatient,,,,7,5.95,2.0062,7,UnitedHealthcare,Medicare Advantage,3.43,49,,percent of total billed charges,,
Housing Services-Per Meal Charge,,S5170,HCPCS,Facility,Inpatient,,,,7,5.95,2.0062,7,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Housing Services-Per Meal Charge,,S5170,HCPCS,Facility,Outpatient,,,,7,5.95,2.0062,7,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,3.36,48,,percent of total billed charges,,100% of DHS outpatient percentage
Housing Services-Per Meal Charge,,S5170,HCPCS,Facility,Inpatient,,,,7,5.95,2.0062,7,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Housing Services-Supper Meal Package,,S5170,HCPCS,Facility,Both,,,,180,153,51.588,180,Aetna,Commercial,165.6,92,,percent of total billed charges,,
Housing Services-Supper Meal Package,,S5170,HCPCS,Facility,Outpatient,,,,180,153,51.588,180,Aetna,Medicare Advantage,88.2,49,,percent of total billed charges,,
Housing Services-Supper Meal Package,,S5170,HCPCS,Facility,Inpatient,,,,180,153,51.588,180,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Housing Services-Supper Meal Package,,S5170,HCPCS,Facility,Both,,,,180,153,51.588,180,Aetna,PPO,167.4,93,,percent of total billed charges,,
Housing Services-Supper Meal Package,,S5170,HCPCS,Facility,Both,,,,180,153,51.588,180,America's PPO,America's PPO,172.854,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Housing Services-Supper Meal Package,,S5170,HCPCS,Facility,Both,,,,180,153,51.588,180,BlueCross BlueShield Minnesota, Federal Employee Program,177.12,98.4,,percent of total billed charges,,
Housing Services-Supper Meal Package,,S5170,HCPCS,Facility,Both,,,,180,153,51.588,180,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,180,100,,percent of total billed charges,,
Housing Services-Supper Meal Package,,S5170,HCPCS,Facility,Both,,,,180,153,51.588,180,BlueCross BlueShield Minnesota,High Value Network Plan,162,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
Housing Services-Supper Meal Package,,S5170,HCPCS,Facility,Outpatient,,,,180,153,51.588,180,BlueCross BlueShield Minnesota,Medicare Advantage,88.2,49,,percent of total billed charges,,
Housing Services-Supper Meal Package,,S5170,HCPCS,Facility,Inpatient,,,,180,153,51.588,180,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Housing Services-Supper Meal Package,,S5170,HCPCS,Facility,Both,,,,180,153,51.588,180,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,159.426,88.57,,percent of total billed charges,,
Housing Services-Supper Meal Package,,S5170,HCPCS,Facility,Both,,,,180,153,51.588,180,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,51.588,28.66,,percent of total billed charges,,
Housing Services-Supper Meal Package,,S5170,HCPCS,Facility,Outpatient,,,,180,153,51.588,180,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),88.2,49,,percent of total billed charges,,
Housing Services-Supper Meal Package,,S5170,HCPCS,Facility,Inpatient,,,,180,153,51.588,180,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Housing Services-Supper Meal Package,,S5170,HCPCS,Facility,Both,,,,180,153,51.588,180,CorVel,Worker's Compensation,180,100,,percent of total billed charges,,
Housing Services-Supper Meal Package,,S5170,HCPCS,Facility,Both,,,,180,153,51.588,180,First Health Group Corporation,First Health Network,174.6,97,,percent of total billed charges,,
Housing Services-Supper Meal Package,,S5170,HCPCS,Facility,Both,,,,180,153,51.588,180,"Health Partners, Inc.",Commercial,170.28,94.6,,percent of total billed charges,,
Housing Services-Supper Meal Package,,S5170,HCPCS,Facility,Outpatient,,,,180,153,51.588,180,"Health Partners, Inc.",Medicare Advantage,88.2,49,,percent of total billed charges,,
Housing Services-Supper Meal Package,,S5170,HCPCS,Facility,Inpatient,,,,180,153,51.588,180,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Housing Services-Supper Meal Package,,S5170,HCPCS,Facility,Both,,,,180,153,51.588,180,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),108,60,,percent of total billed charges,,
Housing Services-Supper Meal Package,,S5170,HCPCS,Facility,Both,,,,180,153,51.588,180,"Health Partners, Inc.",State of Minnesota Advantage Program,146.7,81.5,,percent of total billed charges,,
Housing Services-Supper Meal Package,,S5170,HCPCS,Facility,Both,,,,180,153,51.588,180,"Health Partners, Inc.",State Public Programs,90,50,,percent of total billed charges,,
Housing Services-Supper Meal Package,,S5170,HCPCS,Facility,Both,,,,180,153,51.588,180,Humana Insurance Company,Commercial PPO,171,95,,percent of total billed charges,,
Housing Services-Supper Meal Package,,S5170,HCPCS,Facility,Outpatient,,,,180,153,51.588,180,Humana Insurance Company,Medicare PPO,88.2,49,,percent of total billed charges,,
Housing Services-Supper Meal Package,,S5170,HCPCS,Facility,Inpatient,,,,180,153,51.588,180,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Housing Services-Supper Meal Package,,S5170,HCPCS,Facility,Both,,,,180,153,51.588,180,Medica,Individual & Family,178.38,99.1,,percent of total billed charges,,
Housing Services-Supper Meal Package,,S5170,HCPCS,Facility,Outpatient,,,,180,153,51.588,180,Medica,Medica Advantage Solution,89.64,49.8,,percent of total billed charges,,
Housing Services-Supper Meal Package,,S5170,HCPCS,Facility,Inpatient,,,,180,153,51.588,180,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Housing Services-Supper Meal Package,,S5170,HCPCS,Facility,Outpatient,,,,180,153,51.588,180,Medica,Medical Assistance,80.28,44.6,,percent of total billed charges,,
Housing Services-Supper Meal Package,,S5170,HCPCS,Facility,Inpatient,,,,180,153,51.588,180,Medica,Medical Assistance,,,,,Included in per diem rate,
Housing Services-Supper Meal Package,,S5170,HCPCS,Facility,Outpatient,,,,180,153,51.588,180,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,89.64,49.8,,percent of total billed charges,,
Housing Services-Supper Meal Package,,S5170,HCPCS,Facility,Inpatient,,,,180,153,51.588,180,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Housing Services-Supper Meal Package,,S5170,HCPCS,Facility,Both,,,,180,153,51.588,180,"Multiplan, Inc.","Multiplan, Inc.",169.2,94,,percent of total billed charges,,
Housing Services-Supper Meal Package,,S5170,HCPCS,Facility,Outpatient,,,,180,153,51.588,180,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,162.18,90.1,,percent of total billed charges,,
Housing Services-Supper Meal Package,,S5170,HCPCS,Facility,Inpatient,,,,180,153,51.588,180,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Housing Services-Supper Meal Package,,S5170,HCPCS,Facility,Both,,,,180,153,51.588,180,"Preferred One Administrative Services, INC.",PPO,177.48,98.6,,percent of total billed charges,,
Housing Services-Supper Meal Package,,S5170,HCPCS,Facility,Outpatient,,,,180,153,51.588,180,PrimeWest Health,Minnesota Senior Health Options (MSHO),92.61,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Housing Services-Supper Meal Package,,S5170,HCPCS,Facility,Inpatient,,,,180,153,51.588,180,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Housing Services-Supper Meal Package,,S5170,HCPCS,Facility,Outpatient,,,,180,153,51.588,180,PrimeWest Health,MinnesotaCare,92.448,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Housing Services-Supper Meal Package,,S5170,HCPCS,Facility,Inpatient,,,,180,153,51.588,180,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Housing Services-Supper Meal Package,,S5170,HCPCS,Facility,Both,,,,180,153,51.588,180,Sanford Health Plan,Sanford Health Plan,165.6,92,,percent of total billed charges,,
Housing Services-Supper Meal Package,,S5170,HCPCS,Facility,Outpatient,,,,180,153,51.588,180,"UCare Health, Inc.",Individual & Family Plan,101.43,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Housing Services-Supper Meal Package,,S5170,HCPCS,Facility,Inpatient,,,,180,153,51.588,180,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Housing Services-Supper Meal Package,,S5170,HCPCS,Facility,Outpatient,,,,180,153,51.588,180,"UCare Health, Inc.",Medical Assistance,90.846,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Housing Services-Supper Meal Package,,S5170,HCPCS,Facility,Inpatient,,,,180,153,51.588,180,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Housing Services-Supper Meal Package,,S5170,HCPCS,Facility,Outpatient,,,,180,153,51.588,180,"UCare Health, Inc.",Medicare Advantage,90.846,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Housing Services-Supper Meal Package,,S5170,HCPCS,Facility,Inpatient,,,,180,153,51.588,180,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Housing Services-Supper Meal Package,,S5170,HCPCS,Facility,Outpatient,,,,180,153,51.588,180,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),90.846,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Housing Services-Supper Meal Package,,S5170,HCPCS,Facility,Inpatient,,,,180,153,51.588,180,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Housing Services-Supper Meal Package,,S5170,HCPCS,Facility,Both,,,,180,153,51.588,180,UnitedHealthcare,Individual & Family,169.2,94,,percent of total billed charges,,
Housing Services-Supper Meal Package,,S5170,HCPCS,Facility,Outpatient,,,,180,153,51.588,180,UnitedHealthcare,Medicare Advantage,88.2,49,,percent of total billed charges,,
Housing Services-Supper Meal Package,,S5170,HCPCS,Facility,Inpatient,,,,180,153,51.588,180,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Housing Services-Supper Meal Package,,S5170,HCPCS,Facility,Outpatient,,,,180,153,51.588,180,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,86.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
Housing Services-Supper Meal Package,,S5170,HCPCS,Facility,Inpatient,,,,180,153,51.588,180,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Sup Splint, Prefabricated, Wrist Or Ankle",,S8451,HCPCS,Facility,Both,,,,41,34.85,11.7506,41,Aetna,Commercial,37.72,92,,percent of total billed charges,,
"Sup Splint, Prefabricated, Wrist Or Ankle",,S8451,HCPCS,Facility,Outpatient,,,,41,34.85,11.7506,41,Aetna,Medicare Advantage,20.09,49,,percent of total billed charges,,
"Sup Splint, Prefabricated, Wrist Or Ankle",,S8451,HCPCS,Facility,Inpatient,,,,41,34.85,11.7506,41,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Sup Splint, Prefabricated, Wrist Or Ankle",,S8451,HCPCS,Facility,Both,,,,41,34.85,11.7506,41,Aetna,PPO,38.13,93,,percent of total billed charges,,
"Sup Splint, Prefabricated, Wrist Or Ankle",,S8451,HCPCS,Facility,Both,,,,41,34.85,11.7506,41,America's PPO,America's PPO,39.3723,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Sup Splint, Prefabricated, Wrist Or Ankle",,S8451,HCPCS,Facility,Both,,,,41,34.85,11.7506,41,BlueCross BlueShield Minnesota, Federal Employee Program,40.344,98.4,,percent of total billed charges,,
"Sup Splint, Prefabricated, Wrist Or Ankle",,S8451,HCPCS,Facility,Both,,,,41,34.85,11.7506,41,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,41,100,,percent of total billed charges,,
"Sup Splint, Prefabricated, Wrist Or Ankle",,S8451,HCPCS,Facility,Both,,,,41,34.85,11.7506,41,BlueCross BlueShield Minnesota,High Value Network Plan,36.9,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
"Sup Splint, Prefabricated, Wrist Or Ankle",,S8451,HCPCS,Facility,Outpatient,,,,41,34.85,11.7506,41,BlueCross BlueShield Minnesota,Medicare Advantage,20.09,49,,percent of total billed charges,,
"Sup Splint, Prefabricated, Wrist Or Ankle",,S8451,HCPCS,Facility,Inpatient,,,,41,34.85,11.7506,41,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Sup Splint, Prefabricated, Wrist Or Ankle",,S8451,HCPCS,Facility,Both,,,,41,34.85,11.7506,41,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,36.3137,88.57,,percent of total billed charges,,
"Sup Splint, Prefabricated, Wrist Or Ankle",,S8451,HCPCS,Facility,Both,,,,41,34.85,11.7506,41,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,11.7506,28.66,,percent of total billed charges,,
"Sup Splint, Prefabricated, Wrist Or Ankle",,S8451,HCPCS,Facility,Outpatient,,,,41,34.85,11.7506,41,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),20.09,49,,percent of total billed charges,,
"Sup Splint, Prefabricated, Wrist Or Ankle",,S8451,HCPCS,Facility,Inpatient,,,,41,34.85,11.7506,41,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Sup Splint, Prefabricated, Wrist Or Ankle",,S8451,HCPCS,Facility,Both,,,,41,34.85,11.7506,41,CorVel,Worker's Compensation,41,100,,percent of total billed charges,,
"Sup Splint, Prefabricated, Wrist Or Ankle",,S8451,HCPCS,Facility,Both,,,,41,34.85,11.7506,41,First Health Group Corporation,First Health Network,39.77,97,,percent of total billed charges,,
"Sup Splint, Prefabricated, Wrist Or Ankle",,S8451,HCPCS,Facility,Both,,,,41,34.85,11.7506,41,"Health Partners, Inc.",Commercial,38.786,94.6,,percent of total billed charges,,
"Sup Splint, Prefabricated, Wrist Or Ankle",,S8451,HCPCS,Facility,Outpatient,,,,41,34.85,11.7506,41,"Health Partners, Inc.",Medicare Advantage,20.09,49,,percent of total billed charges,,
"Sup Splint, Prefabricated, Wrist Or Ankle",,S8451,HCPCS,Facility,Inpatient,,,,41,34.85,11.7506,41,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Sup Splint, Prefabricated, Wrist Or Ankle",,S8451,HCPCS,Facility,Both,,,,41,34.85,11.7506,41,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),24.6,60,,percent of total billed charges,,
"Sup Splint, Prefabricated, Wrist Or Ankle",,S8451,HCPCS,Facility,Both,,,,41,34.85,11.7506,41,"Health Partners, Inc.",State of Minnesota Advantage Program,33.415,81.5,,percent of total billed charges,,
"Sup Splint, Prefabricated, Wrist Or Ankle",,S8451,HCPCS,Facility,Both,,,,41,34.85,11.7506,41,"Health Partners, Inc.",State Public Programs,20.5,50,,percent of total billed charges,,
"Sup Splint, Prefabricated, Wrist Or Ankle",,S8451,HCPCS,Facility,Both,,,,41,34.85,11.7506,41,Humana Insurance Company,Commercial PPO,38.95,95,,percent of total billed charges,,
"Sup Splint, Prefabricated, Wrist Or Ankle",,S8451,HCPCS,Facility,Outpatient,,,,41,34.85,11.7506,41,Humana Insurance Company,Medicare PPO,20.09,49,,percent of total billed charges,,
"Sup Splint, Prefabricated, Wrist Or Ankle",,S8451,HCPCS,Facility,Inpatient,,,,41,34.85,11.7506,41,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Sup Splint, Prefabricated, Wrist Or Ankle",,S8451,HCPCS,Facility,Both,,,,41,34.85,11.7506,41,Medica,Individual & Family,40.631,99.1,,percent of total billed charges,,
"Sup Splint, Prefabricated, Wrist Or Ankle",,S8451,HCPCS,Facility,Outpatient,,,,41,34.85,11.7506,41,Medica,Medica Advantage Solution,20.418,49.8,,percent of total billed charges,,
"Sup Splint, Prefabricated, Wrist Or Ankle",,S8451,HCPCS,Facility,Inpatient,,,,41,34.85,11.7506,41,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Sup Splint, Prefabricated, Wrist Or Ankle",,S8451,HCPCS,Facility,Outpatient,,,,41,34.85,11.7506,41,Medica,Medical Assistance,18.286,44.6,,percent of total billed charges,,
"Sup Splint, Prefabricated, Wrist Or Ankle",,S8451,HCPCS,Facility,Inpatient,,,,41,34.85,11.7506,41,Medica,Medical Assistance,,,,,Included in per diem rate,
"Sup Splint, Prefabricated, Wrist Or Ankle",,S8451,HCPCS,Facility,Outpatient,,,,41,34.85,11.7506,41,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,20.418,49.8,,percent of total billed charges,,
"Sup Splint, Prefabricated, Wrist Or Ankle",,S8451,HCPCS,Facility,Inpatient,,,,41,34.85,11.7506,41,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Sup Splint, Prefabricated, Wrist Or Ankle",,S8451,HCPCS,Facility,Both,,,,41,34.85,11.7506,41,"Multiplan, Inc.","Multiplan, Inc.",38.54,94,,percent of total billed charges,,
"Sup Splint, Prefabricated, Wrist Or Ankle",,S8451,HCPCS,Facility,Outpatient,,,,41,34.85,11.7506,41,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,36.941,90.1,,percent of total billed charges,,
"Sup Splint, Prefabricated, Wrist Or Ankle",,S8451,HCPCS,Facility,Inpatient,,,,41,34.85,11.7506,41,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Sup Splint, Prefabricated, Wrist Or Ankle",,S8451,HCPCS,Facility,Both,,,,41,34.85,11.7506,41,"Preferred One Administrative Services, INC.",PPO,40.426,98.6,,percent of total billed charges,,
"Sup Splint, Prefabricated, Wrist Or Ankle",,S8451,HCPCS,Facility,Outpatient,,,,41,34.85,11.7506,41,PrimeWest Health,Minnesota Senior Health Options (MSHO),21.0945,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Sup Splint, Prefabricated, Wrist Or Ankle",,S8451,HCPCS,Facility,Inpatient,,,,41,34.85,11.7506,41,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Sup Splint, Prefabricated, Wrist Or Ankle",,S8451,HCPCS,Facility,Outpatient,,,,41,34.85,11.7506,41,PrimeWest Health,MinnesotaCare,21.0576,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Sup Splint, Prefabricated, Wrist Or Ankle",,S8451,HCPCS,Facility,Inpatient,,,,41,34.85,11.7506,41,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Sup Splint, Prefabricated, Wrist Or Ankle",,S8451,HCPCS,Facility,Both,,,,41,34.85,11.7506,41,Sanford Health Plan,Sanford Health Plan,37.72,92,,percent of total billed charges,,
"Sup Splint, Prefabricated, Wrist Or Ankle",,S8451,HCPCS,Facility,Outpatient,,,,41,34.85,11.7506,41,"UCare Health, Inc.",Individual & Family Plan,23.1035,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Sup Splint, Prefabricated, Wrist Or Ankle",,S8451,HCPCS,Facility,Inpatient,,,,41,34.85,11.7506,41,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Sup Splint, Prefabricated, Wrist Or Ankle",,S8451,HCPCS,Facility,Outpatient,,,,41,34.85,11.7506,41,"UCare Health, Inc.",Medical Assistance,20.6927,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Sup Splint, Prefabricated, Wrist Or Ankle",,S8451,HCPCS,Facility,Inpatient,,,,41,34.85,11.7506,41,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Sup Splint, Prefabricated, Wrist Or Ankle",,S8451,HCPCS,Facility,Outpatient,,,,41,34.85,11.7506,41,"UCare Health, Inc.",Medicare Advantage,20.6927,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Sup Splint, Prefabricated, Wrist Or Ankle",,S8451,HCPCS,Facility,Inpatient,,,,41,34.85,11.7506,41,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Sup Splint, Prefabricated, Wrist Or Ankle",,S8451,HCPCS,Facility,Outpatient,,,,41,34.85,11.7506,41,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),20.6927,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Sup Splint, Prefabricated, Wrist Or Ankle",,S8451,HCPCS,Facility,Inpatient,,,,41,34.85,11.7506,41,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Sup Splint, Prefabricated, Wrist Or Ankle",,S8451,HCPCS,Facility,Both,,,,41,34.85,11.7506,41,UnitedHealthcare,Individual & Family,38.54,94,,percent of total billed charges,,
"Sup Splint, Prefabricated, Wrist Or Ankle",,S8451,HCPCS,Facility,Outpatient,,,,41,34.85,11.7506,41,UnitedHealthcare,Medicare Advantage,20.09,49,,percent of total billed charges,,
"Sup Splint, Prefabricated, Wrist Or Ankle",,S8451,HCPCS,Facility,Inpatient,,,,41,34.85,11.7506,41,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Sup Splint, Prefabricated, Wrist Or Ankle",,S8451,HCPCS,Facility,Outpatient,,,,41,34.85,11.7506,41,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,19.68,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Sup Splint, Prefabricated, Wrist Or Ankle",,S8451,HCPCS,Facility,Inpatient,,,,41,34.85,11.7506,41,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Swim Plug (Single),,V5249,HCPCS,Facility,Both,,,,42,35.7,12.0372,42,Aetna,Commercial,38.64,92,,percent of total billed charges,,
Swim Plug (Single),,V5249,HCPCS,Facility,Outpatient,,,,42,35.7,12.0372,42,Aetna,Medicare Advantage,20.58,49,,percent of total billed charges,,
Swim Plug (Single),,V5249,HCPCS,Facility,Inpatient,,,,42,35.7,12.0372,42,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Swim Plug (Single),,V5249,HCPCS,Facility,Both,,,,42,35.7,12.0372,42,Aetna,PPO,39.06,93,,percent of total billed charges,,
Swim Plug (Single),,V5249,HCPCS,Facility,Both,,,,42,35.7,12.0372,42,America's PPO,America's PPO,40.3326,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Swim Plug (Single),,V5249,HCPCS,Facility,Both,,,,42,35.7,12.0372,42,BlueCross BlueShield Minnesota, Federal Employee Program,41.328,98.4,,percent of total billed charges,,
Swim Plug (Single),,V5249,HCPCS,Facility,Both,,,,42,35.7,12.0372,42,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,42,100,,percent of total billed charges,,
Swim Plug (Single),,V5249,HCPCS,Facility,Both,,,,42,35.7,12.0372,42,BlueCross BlueShield Minnesota,High Value Network Plan,37.8,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
Swim Plug (Single),,V5249,HCPCS,Facility,Outpatient,,,,42,35.7,12.0372,42,BlueCross BlueShield Minnesota,Medicare Advantage,20.58,49,,percent of total billed charges,,
Swim Plug (Single),,V5249,HCPCS,Facility,Inpatient,,,,42,35.7,12.0372,42,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Swim Plug (Single),,V5249,HCPCS,Facility,Both,,,,42,35.7,12.0372,42,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,37.1994,88.57,,percent of total billed charges,,
Swim Plug (Single),,V5249,HCPCS,Facility,Both,,,,42,35.7,12.0372,42,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,12.0372,28.66,,percent of total billed charges,,
Swim Plug (Single),,V5249,HCPCS,Facility,Outpatient,,,,42,35.7,12.0372,42,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),20.58,49,,percent of total billed charges,,
Swim Plug (Single),,V5249,HCPCS,Facility,Inpatient,,,,42,35.7,12.0372,42,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Swim Plug (Single),,V5249,HCPCS,Facility,Both,,,,42,35.7,12.0372,42,CorVel,Worker's Compensation,42,100,,percent of total billed charges,,
Swim Plug (Single),,V5249,HCPCS,Facility,Both,,,,42,35.7,12.0372,42,First Health Group Corporation,First Health Network,40.74,97,,percent of total billed charges,,
Swim Plug (Single),,V5249,HCPCS,Facility,Both,,,,42,35.7,12.0372,42,"Health Partners, Inc.",Commercial,39.732,94.6,,percent of total billed charges,,
Swim Plug (Single),,V5249,HCPCS,Facility,Outpatient,,,,42,35.7,12.0372,42,"Health Partners, Inc.",Medicare Advantage,20.58,49,,percent of total billed charges,,
Swim Plug (Single),,V5249,HCPCS,Facility,Inpatient,,,,42,35.7,12.0372,42,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Swim Plug (Single),,V5249,HCPCS,Facility,Both,,,,42,35.7,12.0372,42,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),25.2,60,,percent of total billed charges,,
Swim Plug (Single),,V5249,HCPCS,Facility,Both,,,,42,35.7,12.0372,42,"Health Partners, Inc.",State of Minnesota Advantage Program,34.23,81.5,,percent of total billed charges,,
Swim Plug (Single),,V5249,HCPCS,Facility,Both,,,,42,35.7,12.0372,42,"Health Partners, Inc.",State Public Programs,21,50,,percent of total billed charges,,
Swim Plug (Single),,V5249,HCPCS,Facility,Both,,,,42,35.7,12.0372,42,Humana Insurance Company,Commercial PPO,39.9,95,,percent of total billed charges,,
Swim Plug (Single),,V5249,HCPCS,Facility,Outpatient,,,,42,35.7,12.0372,42,Humana Insurance Company,Medicare PPO,20.58,49,,percent of total billed charges,,
Swim Plug (Single),,V5249,HCPCS,Facility,Inpatient,,,,42,35.7,12.0372,42,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Swim Plug (Single),,V5249,HCPCS,Facility,Both,,,,42,35.7,12.0372,42,Medica,Individual & Family,41.622,99.1,,percent of total billed charges,,
Swim Plug (Single),,V5249,HCPCS,Facility,Outpatient,,,,42,35.7,12.0372,42,Medica,Medica Advantage Solution,20.916,49.8,,percent of total billed charges,,
Swim Plug (Single),,V5249,HCPCS,Facility,Inpatient,,,,42,35.7,12.0372,42,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Swim Plug (Single),,V5249,HCPCS,Facility,Outpatient,,,,42,35.7,12.0372,42,Medica,Medical Assistance,18.732,44.6,,percent of total billed charges,,
Swim Plug (Single),,V5249,HCPCS,Facility,Inpatient,,,,42,35.7,12.0372,42,Medica,Medical Assistance,,,,,Included in per diem rate,
Swim Plug (Single),,V5249,HCPCS,Facility,Outpatient,,,,42,35.7,12.0372,42,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,20.916,49.8,,percent of total billed charges,,
Swim Plug (Single),,V5249,HCPCS,Facility,Inpatient,,,,42,35.7,12.0372,42,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Swim Plug (Single),,V5249,HCPCS,Facility,Both,,,,42,35.7,12.0372,42,"Multiplan, Inc.","Multiplan, Inc.",39.48,94,,percent of total billed charges,,
Swim Plug (Single),,V5249,HCPCS,Facility,Outpatient,,,,42,35.7,12.0372,42,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,37.842,90.1,,percent of total billed charges,,
Swim Plug (Single),,V5249,HCPCS,Facility,Inpatient,,,,42,35.7,12.0372,42,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Swim Plug (Single),,V5249,HCPCS,Facility,Both,,,,42,35.7,12.0372,42,"Preferred One Administrative Services, INC.",PPO,41.412,98.6,,percent of total billed charges,,
Swim Plug (Single),,V5249,HCPCS,Facility,Outpatient,,,,42,35.7,12.0372,42,PrimeWest Health,Minnesota Senior Health Options (MSHO),21.609,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Swim Plug (Single),,V5249,HCPCS,Facility,Inpatient,,,,42,35.7,12.0372,42,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Swim Plug (Single),,V5249,HCPCS,Facility,Outpatient,,,,42,35.7,12.0372,42,PrimeWest Health,MinnesotaCare,21.5712,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Swim Plug (Single),,V5249,HCPCS,Facility,Inpatient,,,,42,35.7,12.0372,42,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Swim Plug (Single),,V5249,HCPCS,Facility,Both,,,,42,35.7,12.0372,42,Sanford Health Plan,Sanford Health Plan,38.64,92,,percent of total billed charges,,
Swim Plug (Single),,V5249,HCPCS,Facility,Outpatient,,,,42,35.7,12.0372,42,"UCare Health, Inc.",Individual & Family Plan,23.667,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Swim Plug (Single),,V5249,HCPCS,Facility,Inpatient,,,,42,35.7,12.0372,42,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Swim Plug (Single),,V5249,HCPCS,Facility,Outpatient,,,,42,35.7,12.0372,42,"UCare Health, Inc.",Medical Assistance,21.1974,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Swim Plug (Single),,V5249,HCPCS,Facility,Inpatient,,,,42,35.7,12.0372,42,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Swim Plug (Single),,V5249,HCPCS,Facility,Outpatient,,,,42,35.7,12.0372,42,"UCare Health, Inc.",Medicare Advantage,21.1974,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Swim Plug (Single),,V5249,HCPCS,Facility,Inpatient,,,,42,35.7,12.0372,42,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Swim Plug (Single),,V5249,HCPCS,Facility,Outpatient,,,,42,35.7,12.0372,42,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),21.1974,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Swim Plug (Single),,V5249,HCPCS,Facility,Inpatient,,,,42,35.7,12.0372,42,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Swim Plug (Single),,V5249,HCPCS,Facility,Both,,,,42,35.7,12.0372,42,UnitedHealthcare,Individual & Family,39.48,94,,percent of total billed charges,,
Swim Plug (Single),,V5249,HCPCS,Facility,Outpatient,,,,42,35.7,12.0372,42,UnitedHealthcare,Medicare Advantage,20.58,49,,percent of total billed charges,,
Swim Plug (Single),,V5249,HCPCS,Facility,Inpatient,,,,42,35.7,12.0372,42,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Swim Plug (Single),,V5249,HCPCS,Facility,Outpatient,,,,42,35.7,12.0372,42,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,20.16,48,,percent of total billed charges,,100% of DHS outpatient percentage
Swim Plug (Single),,V5249,HCPCS,Facility,Inpatient,,,,42,35.7,12.0372,42,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Bte Earmold,,V5264,HCPCS,Facility,Both,,,,102,86.7,29.2332,102,Aetna,Commercial,93.84,92,,percent of total billed charges,,
Bte Earmold,,V5264,HCPCS,Facility,Outpatient,,,,102,86.7,29.2332,102,Aetna,Medicare Advantage,49.98,49,,percent of total billed charges,,
Bte Earmold,,V5264,HCPCS,Facility,Inpatient,,,,102,86.7,29.2332,102,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Bte Earmold,,V5264,HCPCS,Facility,Both,,,,102,86.7,29.2332,102,Aetna,PPO,94.86,93,,percent of total billed charges,,
Bte Earmold,,V5264,HCPCS,Facility,Both,,,,102,86.7,29.2332,102,America's PPO,America's PPO,97.9506,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Bte Earmold,,V5264,HCPCS,Facility,Both,,,,102,86.7,29.2332,102,BlueCross BlueShield Minnesota, Federal Employee Program,100.368,98.4,,percent of total billed charges,,
Bte Earmold,,V5264,HCPCS,Facility,Both,,,,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,102,100,,percent of total billed charges,,
Bte Earmold,,V5264,HCPCS,Facility,Both,,,,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,High Value Network Plan,91.8,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
Bte Earmold,,V5264,HCPCS,Facility,Outpatient,,,,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,Medicare Advantage,49.98,49,,percent of total billed charges,,
Bte Earmold,,V5264,HCPCS,Facility,Inpatient,,,,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Bte Earmold,,V5264,HCPCS,Facility,Both,,,,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,90.3414,88.57,,percent of total billed charges,,
Bte Earmold,,V5264,HCPCS,Facility,Both,,,,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,29.2332,28.66,,percent of total billed charges,,
Bte Earmold,,V5264,HCPCS,Facility,Outpatient,,,,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),49.98,49,,percent of total billed charges,,
Bte Earmold,,V5264,HCPCS,Facility,Inpatient,,,,102,86.7,29.2332,102,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Bte Earmold,,V5264,HCPCS,Facility,Both,,,,102,86.7,29.2332,102,CorVel,Worker's Compensation,102,100,,percent of total billed charges,,
Bte Earmold,,V5264,HCPCS,Facility,Both,,,,102,86.7,29.2332,102,First Health Group Corporation,First Health Network,98.94,97,,percent of total billed charges,,
Bte Earmold,,V5264,HCPCS,Facility,Both,,,,102,86.7,29.2332,102,"Health Partners, Inc.",Commercial,96.492,94.6,,percent of total billed charges,,
Bte Earmold,,V5264,HCPCS,Facility,Outpatient,,,,102,86.7,29.2332,102,"Health Partners, Inc.",Medicare Advantage,49.98,49,,percent of total billed charges,,
Bte Earmold,,V5264,HCPCS,Facility,Inpatient,,,,102,86.7,29.2332,102,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Bte Earmold,,V5264,HCPCS,Facility,Both,,,,102,86.7,29.2332,102,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),61.2,60,,percent of total billed charges,,
Bte Earmold,,V5264,HCPCS,Facility,Both,,,,102,86.7,29.2332,102,"Health Partners, Inc.",State of Minnesota Advantage Program,83.13,81.5,,percent of total billed charges,,
Bte Earmold,,V5264,HCPCS,Facility,Both,,,,102,86.7,29.2332,102,"Health Partners, Inc.",State Public Programs,51,50,,percent of total billed charges,,
Bte Earmold,,V5264,HCPCS,Facility,Both,,,,102,86.7,29.2332,102,Humana Insurance Company,Commercial PPO,96.9,95,,percent of total billed charges,,
Bte Earmold,,V5264,HCPCS,Facility,Outpatient,,,,102,86.7,29.2332,102,Humana Insurance Company,Medicare PPO,49.98,49,,percent of total billed charges,,
Bte Earmold,,V5264,HCPCS,Facility,Inpatient,,,,102,86.7,29.2332,102,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Bte Earmold,,V5264,HCPCS,Facility,Both,,,,102,86.7,29.2332,102,Medica,Individual & Family,101.082,99.1,,percent of total billed charges,,
Bte Earmold,,V5264,HCPCS,Facility,Outpatient,,,,102,86.7,29.2332,102,Medica,Medica Advantage Solution,50.796,49.8,,percent of total billed charges,,
Bte Earmold,,V5264,HCPCS,Facility,Inpatient,,,,102,86.7,29.2332,102,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Bte Earmold,,V5264,HCPCS,Facility,Outpatient,,,,102,86.7,29.2332,102,Medica,Medical Assistance,45.492,44.6,,percent of total billed charges,,
Bte Earmold,,V5264,HCPCS,Facility,Inpatient,,,,102,86.7,29.2332,102,Medica,Medical Assistance,,,,,Included in per diem rate,
Bte Earmold,,V5264,HCPCS,Facility,Outpatient,,,,102,86.7,29.2332,102,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,50.796,49.8,,percent of total billed charges,,
Bte Earmold,,V5264,HCPCS,Facility,Inpatient,,,,102,86.7,29.2332,102,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Bte Earmold,,V5264,HCPCS,Facility,Both,,,,102,86.7,29.2332,102,"Multiplan, Inc.","Multiplan, Inc.",95.88,94,,percent of total billed charges,,
Bte Earmold,,V5264,HCPCS,Facility,Outpatient,,,,102,86.7,29.2332,102,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,91.902,90.1,,percent of total billed charges,,
Bte Earmold,,V5264,HCPCS,Facility,Inpatient,,,,102,86.7,29.2332,102,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Bte Earmold,,V5264,HCPCS,Facility,Both,,,,102,86.7,29.2332,102,"Preferred One Administrative Services, INC.",PPO,100.572,98.6,,percent of total billed charges,,
Bte Earmold,,V5264,HCPCS,Facility,Outpatient,,,,102,86.7,29.2332,102,PrimeWest Health,Minnesota Senior Health Options (MSHO),52.479,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Bte Earmold,,V5264,HCPCS,Facility,Inpatient,,,,102,86.7,29.2332,102,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Bte Earmold,,V5264,HCPCS,Facility,Outpatient,,,,102,86.7,29.2332,102,PrimeWest Health,MinnesotaCare,52.3872,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Bte Earmold,,V5264,HCPCS,Facility,Inpatient,,,,102,86.7,29.2332,102,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Bte Earmold,,V5264,HCPCS,Facility,Both,,,,102,86.7,29.2332,102,Sanford Health Plan,Sanford Health Plan,93.84,92,,percent of total billed charges,,
Bte Earmold,,V5264,HCPCS,Facility,Outpatient,,,,102,86.7,29.2332,102,"UCare Health, Inc.",Individual & Family Plan,57.477,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Bte Earmold,,V5264,HCPCS,Facility,Inpatient,,,,102,86.7,29.2332,102,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Bte Earmold,,V5264,HCPCS,Facility,Outpatient,,,,102,86.7,29.2332,102,"UCare Health, Inc.",Medical Assistance,51.4794,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Bte Earmold,,V5264,HCPCS,Facility,Inpatient,,,,102,86.7,29.2332,102,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Bte Earmold,,V5264,HCPCS,Facility,Outpatient,,,,102,86.7,29.2332,102,"UCare Health, Inc.",Medicare Advantage,51.4794,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Bte Earmold,,V5264,HCPCS,Facility,Inpatient,,,,102,86.7,29.2332,102,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Bte Earmold,,V5264,HCPCS,Facility,Outpatient,,,,102,86.7,29.2332,102,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),51.4794,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Bte Earmold,,V5264,HCPCS,Facility,Inpatient,,,,102,86.7,29.2332,102,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Bte Earmold,,V5264,HCPCS,Facility,Both,,,,102,86.7,29.2332,102,UnitedHealthcare,Individual & Family,95.88,94,,percent of total billed charges,,
Bte Earmold,,V5264,HCPCS,Facility,Outpatient,,,,102,86.7,29.2332,102,UnitedHealthcare,Medicare Advantage,49.98,49,,percent of total billed charges,,
Bte Earmold,,V5264,HCPCS,Facility,Inpatient,,,,102,86.7,29.2332,102,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Bte Earmold,,V5264,HCPCS,Facility,Outpatient,,,,102,86.7,29.2332,102,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,48.96,48,,percent of total billed charges,,100% of DHS outpatient percentage
Bte Earmold,,V5264,HCPCS,Facility,Inpatient,,,,102,86.7,29.2332,102,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Batteries,,V5266,HCPCS,Facility,Both,,,,1.25,1.0625,0.35825,1.25,Aetna,Commercial,1.15,92,,percent of total billed charges,,
Batteries,,V5266,HCPCS,Facility,Outpatient,,,,1.25,1.0625,0.35825,1.25,Aetna,Medicare Advantage,0.6125,49,,percent of total billed charges,,
Batteries,,V5266,HCPCS,Facility,Inpatient,,,,1.25,1.0625,0.35825,1.25,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Batteries,,V5266,HCPCS,Facility,Both,,,,1.25,1.0625,0.35825,1.25,Aetna,PPO,1.1625,93,,percent of total billed charges,,
Batteries,,V5266,HCPCS,Facility,Both,,,,1.25,1.0625,0.35825,1.25,America's PPO,America's PPO,1.200375,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Batteries,,V5266,HCPCS,Facility,Both,,,,1.25,1.0625,0.35825,1.25,BlueCross BlueShield Minnesota, Federal Employee Program,1.23,98.4,,percent of total billed charges,,
Batteries,,V5266,HCPCS,Facility,Both,,,,1.25,1.0625,0.35825,1.25,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,1.25,100,,percent of total billed charges,,
Batteries,,V5266,HCPCS,Facility,Both,,,,1.25,1.0625,0.35825,1.25,BlueCross BlueShield Minnesota,High Value Network Plan,1.125,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
Batteries,,V5266,HCPCS,Facility,Outpatient,,,,1.25,1.0625,0.35825,1.25,BlueCross BlueShield Minnesota,Medicare Advantage,0.6125,49,,percent of total billed charges,,
Batteries,,V5266,HCPCS,Facility,Inpatient,,,,1.25,1.0625,0.35825,1.25,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Batteries,,V5266,HCPCS,Facility,Both,,,,1.25,1.0625,0.35825,1.25,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,1.107125,88.57,,percent of total billed charges,,
Batteries,,V5266,HCPCS,Facility,Both,,,,1.25,1.0625,0.35825,1.25,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,0.35825,28.66,,percent of total billed charges,,
Batteries,,V5266,HCPCS,Facility,Outpatient,,,,1.25,1.0625,0.35825,1.25,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),0.6125,49,,percent of total billed charges,,
Batteries,,V5266,HCPCS,Facility,Inpatient,,,,1.25,1.0625,0.35825,1.25,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Batteries,,V5266,HCPCS,Facility,Both,,,,1.25,1.0625,0.35825,1.25,CorVel,Worker's Compensation,1.25,100,,percent of total billed charges,,
Batteries,,V5266,HCPCS,Facility,Both,,,,1.25,1.0625,0.35825,1.25,First Health Group Corporation,First Health Network,1.2125,97,,percent of total billed charges,,
Batteries,,V5266,HCPCS,Facility,Both,,,,1.25,1.0625,0.35825,1.25,"Health Partners, Inc.",Commercial,1.1825,94.6,,percent of total billed charges,,
Batteries,,V5266,HCPCS,Facility,Outpatient,,,,1.25,1.0625,0.35825,1.25,"Health Partners, Inc.",Medicare Advantage,0.6125,49,,percent of total billed charges,,
Batteries,,V5266,HCPCS,Facility,Inpatient,,,,1.25,1.0625,0.35825,1.25,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Batteries,,V5266,HCPCS,Facility,Both,,,,1.25,1.0625,0.35825,1.25,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),0.75,60,,percent of total billed charges,,
Batteries,,V5266,HCPCS,Facility,Both,,,,1.25,1.0625,0.35825,1.25,"Health Partners, Inc.",State of Minnesota Advantage Program,1.01875,81.5,,percent of total billed charges,,
Batteries,,V5266,HCPCS,Facility,Both,,,,1.25,1.0625,0.35825,1.25,"Health Partners, Inc.",State Public Programs,0.625,50,,percent of total billed charges,,
Batteries,,V5266,HCPCS,Facility,Both,,,,1.25,1.0625,0.35825,1.25,Humana Insurance Company,Commercial PPO,1.1875,95,,percent of total billed charges,,
Batteries,,V5266,HCPCS,Facility,Outpatient,,,,1.25,1.0625,0.35825,1.25,Humana Insurance Company,Medicare PPO,0.6125,49,,percent of total billed charges,,
Batteries,,V5266,HCPCS,Facility,Inpatient,,,,1.25,1.0625,0.35825,1.25,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Batteries,,V5266,HCPCS,Facility,Both,,,,1.25,1.0625,0.35825,1.25,Medica,Individual & Family,1.23875,99.1,,percent of total billed charges,,
Batteries,,V5266,HCPCS,Facility,Outpatient,,,,1.25,1.0625,0.35825,1.25,Medica,Medica Advantage Solution,0.6225,49.8,,percent of total billed charges,,
Batteries,,V5266,HCPCS,Facility,Inpatient,,,,1.25,1.0625,0.35825,1.25,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Batteries,,V5266,HCPCS,Facility,Outpatient,,,,1.25,1.0625,0.35825,1.25,Medica,Medical Assistance,0.5575,44.6,,percent of total billed charges,,
Batteries,,V5266,HCPCS,Facility,Inpatient,,,,1.25,1.0625,0.35825,1.25,Medica,Medical Assistance,,,,,Included in per diem rate,
Batteries,,V5266,HCPCS,Facility,Outpatient,,,,1.25,1.0625,0.35825,1.25,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,0.6225,49.8,,percent of total billed charges,,
Batteries,,V5266,HCPCS,Facility,Inpatient,,,,1.25,1.0625,0.35825,1.25,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Batteries,,V5266,HCPCS,Facility,Both,,,,1.25,1.0625,0.35825,1.25,"Multiplan, Inc.","Multiplan, Inc.",1.175,94,,percent of total billed charges,,
Batteries,,V5266,HCPCS,Facility,Outpatient,,,,1.25,1.0625,0.35825,1.25,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,1.12625,90.1,,percent of total billed charges,,
Batteries,,V5266,HCPCS,Facility,Inpatient,,,,1.25,1.0625,0.35825,1.25,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Batteries,,V5266,HCPCS,Facility,Both,,,,1.25,1.0625,0.35825,1.25,"Preferred One Administrative Services, INC.",PPO,1.2325,98.6,,percent of total billed charges,,
Batteries,,V5266,HCPCS,Facility,Outpatient,,,,1.25,1.0625,0.35825,1.25,PrimeWest Health,Minnesota Senior Health Options (MSHO),0.643125,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Batteries,,V5266,HCPCS,Facility,Inpatient,,,,1.25,1.0625,0.35825,1.25,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Batteries,,V5266,HCPCS,Facility,Outpatient,,,,1.25,1.0625,0.35825,1.25,PrimeWest Health,MinnesotaCare,0.642,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Batteries,,V5266,HCPCS,Facility,Inpatient,,,,1.25,1.0625,0.35825,1.25,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Batteries,,V5266,HCPCS,Facility,Both,,,,1.25,1.0625,0.35825,1.25,Sanford Health Plan,Sanford Health Plan,1.15,92,,percent of total billed charges,,
Batteries,,V5266,HCPCS,Facility,Outpatient,,,,1.25,1.0625,0.35825,1.25,"UCare Health, Inc.",Individual & Family Plan,0.704375,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Batteries,,V5266,HCPCS,Facility,Inpatient,,,,1.25,1.0625,0.35825,1.25,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Batteries,,V5266,HCPCS,Facility,Outpatient,,,,1.25,1.0625,0.35825,1.25,"UCare Health, Inc.",Medical Assistance,0.630875,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Batteries,,V5266,HCPCS,Facility,Inpatient,,,,1.25,1.0625,0.35825,1.25,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Batteries,,V5266,HCPCS,Facility,Outpatient,,,,1.25,1.0625,0.35825,1.25,"UCare Health, Inc.",Medicare Advantage,0.630875,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Batteries,,V5266,HCPCS,Facility,Inpatient,,,,1.25,1.0625,0.35825,1.25,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Batteries,,V5266,HCPCS,Facility,Outpatient,,,,1.25,1.0625,0.35825,1.25,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),0.630875,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Batteries,,V5266,HCPCS,Facility,Inpatient,,,,1.25,1.0625,0.35825,1.25,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Batteries,,V5266,HCPCS,Facility,Both,,,,1.25,1.0625,0.35825,1.25,UnitedHealthcare,Individual & Family,1.175,94,,percent of total billed charges,,
Batteries,,V5266,HCPCS,Facility,Outpatient,,,,1.25,1.0625,0.35825,1.25,UnitedHealthcare,Medicare Advantage,0.6125,49,,percent of total billed charges,,
Batteries,,V5266,HCPCS,Facility,Inpatient,,,,1.25,1.0625,0.35825,1.25,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Batteries,,V5266,HCPCS,Facility,Outpatient,,,,1.25,1.0625,0.35825,1.25,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,0.6,48,,percent of total billed charges,,100% of DHS outpatient percentage
Batteries,,V5266,HCPCS,Facility,Inpatient,,,,1.25,1.0625,0.35825,1.25,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Swim Plugs (Pair),,V5267,HCPCS,Facility,Both,,,,67,56.95,19.2022,67,Aetna,Commercial,61.64,92,,percent of total billed charges,,
Swim Plugs (Pair),,V5267,HCPCS,Facility,Outpatient,,,,67,56.95,19.2022,67,Aetna,Medicare Advantage,32.83,49,,percent of total billed charges,,
Swim Plugs (Pair),,V5267,HCPCS,Facility,Inpatient,,,,67,56.95,19.2022,67,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Swim Plugs (Pair),,V5267,HCPCS,Facility,Both,,,,67,56.95,19.2022,67,Aetna,PPO,62.31,93,,percent of total billed charges,,
Swim Plugs (Pair),,V5267,HCPCS,Facility,Both,,,,67,56.95,19.2022,67,America's PPO,America's PPO,64.3401,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Swim Plugs (Pair),,V5267,HCPCS,Facility,Both,,,,67,56.95,19.2022,67,BlueCross BlueShield Minnesota, Federal Employee Program,65.928,98.4,,percent of total billed charges,,
Swim Plugs (Pair),,V5267,HCPCS,Facility,Both,,,,67,56.95,19.2022,67,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,67,100,,percent of total billed charges,,
Swim Plugs (Pair),,V5267,HCPCS,Facility,Both,,,,67,56.95,19.2022,67,BlueCross BlueShield Minnesota,High Value Network Plan,60.3,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
Swim Plugs (Pair),,V5267,HCPCS,Facility,Outpatient,,,,67,56.95,19.2022,67,BlueCross BlueShield Minnesota,Medicare Advantage,32.83,49,,percent of total billed charges,,
Swim Plugs (Pair),,V5267,HCPCS,Facility,Inpatient,,,,67,56.95,19.2022,67,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Swim Plugs (Pair),,V5267,HCPCS,Facility,Both,,,,67,56.95,19.2022,67,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,59.3419,88.57,,percent of total billed charges,,
Swim Plugs (Pair),,V5267,HCPCS,Facility,Both,,,,67,56.95,19.2022,67,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,19.2022,28.66,,percent of total billed charges,,
Swim Plugs (Pair),,V5267,HCPCS,Facility,Outpatient,,,,67,56.95,19.2022,67,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),32.83,49,,percent of total billed charges,,
Swim Plugs (Pair),,V5267,HCPCS,Facility,Inpatient,,,,67,56.95,19.2022,67,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Swim Plugs (Pair),,V5267,HCPCS,Facility,Both,,,,67,56.95,19.2022,67,CorVel,Worker's Compensation,67,100,,percent of total billed charges,,
Swim Plugs (Pair),,V5267,HCPCS,Facility,Both,,,,67,56.95,19.2022,67,First Health Group Corporation,First Health Network,64.99,97,,percent of total billed charges,,
Swim Plugs (Pair),,V5267,HCPCS,Facility,Both,,,,67,56.95,19.2022,67,"Health Partners, Inc.",Commercial,63.382,94.6,,percent of total billed charges,,
Swim Plugs (Pair),,V5267,HCPCS,Facility,Outpatient,,,,67,56.95,19.2022,67,"Health Partners, Inc.",Medicare Advantage,32.83,49,,percent of total billed charges,,
Swim Plugs (Pair),,V5267,HCPCS,Facility,Inpatient,,,,67,56.95,19.2022,67,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Swim Plugs (Pair),,V5267,HCPCS,Facility,Both,,,,67,56.95,19.2022,67,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),40.2,60,,percent of total billed charges,,
Swim Plugs (Pair),,V5267,HCPCS,Facility,Both,,,,67,56.95,19.2022,67,"Health Partners, Inc.",State of Minnesota Advantage Program,54.605,81.5,,percent of total billed charges,,
Swim Plugs (Pair),,V5267,HCPCS,Facility,Both,,,,67,56.95,19.2022,67,"Health Partners, Inc.",State Public Programs,33.5,50,,percent of total billed charges,,
Swim Plugs (Pair),,V5267,HCPCS,Facility,Both,,,,67,56.95,19.2022,67,Humana Insurance Company,Commercial PPO,63.65,95,,percent of total billed charges,,
Swim Plugs (Pair),,V5267,HCPCS,Facility,Outpatient,,,,67,56.95,19.2022,67,Humana Insurance Company,Medicare PPO,32.83,49,,percent of total billed charges,,
Swim Plugs (Pair),,V5267,HCPCS,Facility,Inpatient,,,,67,56.95,19.2022,67,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Swim Plugs (Pair),,V5267,HCPCS,Facility,Both,,,,67,56.95,19.2022,67,Medica,Individual & Family,66.397,99.1,,percent of total billed charges,,
Swim Plugs (Pair),,V5267,HCPCS,Facility,Outpatient,,,,67,56.95,19.2022,67,Medica,Medica Advantage Solution,33.366,49.8,,percent of total billed charges,,
Swim Plugs (Pair),,V5267,HCPCS,Facility,Inpatient,,,,67,56.95,19.2022,67,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Swim Plugs (Pair),,V5267,HCPCS,Facility,Outpatient,,,,67,56.95,19.2022,67,Medica,Medical Assistance,29.882,44.6,,percent of total billed charges,,
Swim Plugs (Pair),,V5267,HCPCS,Facility,Inpatient,,,,67,56.95,19.2022,67,Medica,Medical Assistance,,,,,Included in per diem rate,
Swim Plugs (Pair),,V5267,HCPCS,Facility,Outpatient,,,,67,56.95,19.2022,67,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,33.366,49.8,,percent of total billed charges,,
Swim Plugs (Pair),,V5267,HCPCS,Facility,Inpatient,,,,67,56.95,19.2022,67,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Swim Plugs (Pair),,V5267,HCPCS,Facility,Both,,,,67,56.95,19.2022,67,"Multiplan, Inc.","Multiplan, Inc.",62.98,94,,percent of total billed charges,,
Swim Plugs (Pair),,V5267,HCPCS,Facility,Outpatient,,,,67,56.95,19.2022,67,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,60.367,90.1,,percent of total billed charges,,
Swim Plugs (Pair),,V5267,HCPCS,Facility,Inpatient,,,,67,56.95,19.2022,67,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Swim Plugs (Pair),,V5267,HCPCS,Facility,Both,,,,67,56.95,19.2022,67,"Preferred One Administrative Services, INC.",PPO,66.062,98.6,,percent of total billed charges,,
Swim Plugs (Pair),,V5267,HCPCS,Facility,Outpatient,,,,67,56.95,19.2022,67,PrimeWest Health,Minnesota Senior Health Options (MSHO),34.4715,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Swim Plugs (Pair),,V5267,HCPCS,Facility,Inpatient,,,,67,56.95,19.2022,67,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Swim Plugs (Pair),,V5267,HCPCS,Facility,Outpatient,,,,67,56.95,19.2022,67,PrimeWest Health,MinnesotaCare,34.4112,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Swim Plugs (Pair),,V5267,HCPCS,Facility,Inpatient,,,,67,56.95,19.2022,67,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Swim Plugs (Pair),,V5267,HCPCS,Facility,Both,,,,67,56.95,19.2022,67,Sanford Health Plan,Sanford Health Plan,61.64,92,,percent of total billed charges,,
Swim Plugs (Pair),,V5267,HCPCS,Facility,Outpatient,,,,67,56.95,19.2022,67,"UCare Health, Inc.",Individual & Family Plan,37.7545,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Swim Plugs (Pair),,V5267,HCPCS,Facility,Inpatient,,,,67,56.95,19.2022,67,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Swim Plugs (Pair),,V5267,HCPCS,Facility,Outpatient,,,,67,56.95,19.2022,67,"UCare Health, Inc.",Medical Assistance,33.8149,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Swim Plugs (Pair),,V5267,HCPCS,Facility,Inpatient,,,,67,56.95,19.2022,67,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Swim Plugs (Pair),,V5267,HCPCS,Facility,Outpatient,,,,67,56.95,19.2022,67,"UCare Health, Inc.",Medicare Advantage,33.8149,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Swim Plugs (Pair),,V5267,HCPCS,Facility,Inpatient,,,,67,56.95,19.2022,67,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Swim Plugs (Pair),,V5267,HCPCS,Facility,Outpatient,,,,67,56.95,19.2022,67,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),33.8149,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Swim Plugs (Pair),,V5267,HCPCS,Facility,Inpatient,,,,67,56.95,19.2022,67,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Swim Plugs (Pair),,V5267,HCPCS,Facility,Both,,,,67,56.95,19.2022,67,UnitedHealthcare,Individual & Family,62.98,94,,percent of total billed charges,,
Swim Plugs (Pair),,V5267,HCPCS,Facility,Outpatient,,,,67,56.95,19.2022,67,UnitedHealthcare,Medicare Advantage,32.83,49,,percent of total billed charges,,
Swim Plugs (Pair),,V5267,HCPCS,Facility,Inpatient,,,,67,56.95,19.2022,67,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Swim Plugs (Pair),,V5267,HCPCS,Facility,Outpatient,,,,67,56.95,19.2022,67,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,32.16,48,,percent of total billed charges,,100% of DHS outpatient percentage
Swim Plugs (Pair),,V5267,HCPCS,Facility,Inpatient,,,,67,56.95,19.2022,67,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Ear Impression,,V5275,HCPCS,Facility,Both,,,,54,45.9,15.4764,54,Aetna,Commercial,49.68,92,,percent of total billed charges,,
Ear Impression,,V5275,HCPCS,Facility,Outpatient,,,,54,45.9,15.4764,54,Aetna,Medicare Advantage,26.46,49,,percent of total billed charges,,
Ear Impression,,V5275,HCPCS,Facility,Inpatient,,,,54,45.9,15.4764,54,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Ear Impression,,V5275,HCPCS,Facility,Both,,,,54,45.9,15.4764,54,Aetna,PPO,50.22,93,,percent of total billed charges,,
Ear Impression,,V5275,HCPCS,Facility,Both,,,,54,45.9,15.4764,54,America's PPO,America's PPO,51.8562,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Ear Impression,,V5275,HCPCS,Facility,Both,,,,54,45.9,15.4764,54,BlueCross BlueShield Minnesota, Federal Employee Program,53.136,98.4,,percent of total billed charges,,
Ear Impression,,V5275,HCPCS,Facility,Both,,,,54,45.9,15.4764,54,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,54,100,,percent of total billed charges,,
Ear Impression,,V5275,HCPCS,Facility,Both,,,,54,45.9,15.4764,54,BlueCross BlueShield Minnesota,High Value Network Plan,48.6,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
Ear Impression,,V5275,HCPCS,Facility,Outpatient,,,,54,45.9,15.4764,54,BlueCross BlueShield Minnesota,Medicare Advantage,26.46,49,,percent of total billed charges,,
Ear Impression,,V5275,HCPCS,Facility,Inpatient,,,,54,45.9,15.4764,54,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Ear Impression,,V5275,HCPCS,Facility,Both,,,,54,45.9,15.4764,54,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,47.8278,88.57,,percent of total billed charges,,
Ear Impression,,V5275,HCPCS,Facility,Both,,,,54,45.9,15.4764,54,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,15.4764,28.66,,percent of total billed charges,,
Ear Impression,,V5275,HCPCS,Facility,Outpatient,,,,54,45.9,15.4764,54,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),26.46,49,,percent of total billed charges,,
Ear Impression,,V5275,HCPCS,Facility,Inpatient,,,,54,45.9,15.4764,54,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Ear Impression,,V5275,HCPCS,Facility,Both,,,,54,45.9,15.4764,54,CorVel,Worker's Compensation,54,100,,percent of total billed charges,,
Ear Impression,,V5275,HCPCS,Facility,Both,,,,54,45.9,15.4764,54,First Health Group Corporation,First Health Network,52.38,97,,percent of total billed charges,,
Ear Impression,,V5275,HCPCS,Facility,Both,,,,54,45.9,15.4764,54,"Health Partners, Inc.",Commercial,51.084,94.6,,percent of total billed charges,,
Ear Impression,,V5275,HCPCS,Facility,Outpatient,,,,54,45.9,15.4764,54,"Health Partners, Inc.",Medicare Advantage,26.46,49,,percent of total billed charges,,
Ear Impression,,V5275,HCPCS,Facility,Inpatient,,,,54,45.9,15.4764,54,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ear Impression,,V5275,HCPCS,Facility,Both,,,,54,45.9,15.4764,54,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),32.4,60,,percent of total billed charges,,
Ear Impression,,V5275,HCPCS,Facility,Both,,,,54,45.9,15.4764,54,"Health Partners, Inc.",State of Minnesota Advantage Program,44.01,81.5,,percent of total billed charges,,
Ear Impression,,V5275,HCPCS,Facility,Both,,,,54,45.9,15.4764,54,"Health Partners, Inc.",State Public Programs,27,50,,percent of total billed charges,,
Ear Impression,,V5275,HCPCS,Facility,Both,,,,54,45.9,15.4764,54,Humana Insurance Company,Commercial PPO,51.3,95,,percent of total billed charges,,
Ear Impression,,V5275,HCPCS,Facility,Outpatient,,,,54,45.9,15.4764,54,Humana Insurance Company,Medicare PPO,26.46,49,,percent of total billed charges,,
Ear Impression,,V5275,HCPCS,Facility,Inpatient,,,,54,45.9,15.4764,54,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Ear Impression,,V5275,HCPCS,Facility,Both,,,,54,45.9,15.4764,54,Medica,Individual & Family,53.514,99.1,,percent of total billed charges,,
Ear Impression,,V5275,HCPCS,Facility,Outpatient,,,,54,45.9,15.4764,54,Medica,Medica Advantage Solution,26.892,49.8,,percent of total billed charges,,
Ear Impression,,V5275,HCPCS,Facility,Inpatient,,,,54,45.9,15.4764,54,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Ear Impression,,V5275,HCPCS,Facility,Outpatient,,,,54,45.9,15.4764,54,Medica,Medical Assistance,24.084,44.6,,percent of total billed charges,,
Ear Impression,,V5275,HCPCS,Facility,Inpatient,,,,54,45.9,15.4764,54,Medica,Medical Assistance,,,,,Included in per diem rate,
Ear Impression,,V5275,HCPCS,Facility,Outpatient,,,,54,45.9,15.4764,54,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,26.892,49.8,,percent of total billed charges,,
Ear Impression,,V5275,HCPCS,Facility,Inpatient,,,,54,45.9,15.4764,54,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Ear Impression,,V5275,HCPCS,Facility,Both,,,,54,45.9,15.4764,54,"Multiplan, Inc.","Multiplan, Inc.",50.76,94,,percent of total billed charges,,
Ear Impression,,V5275,HCPCS,Facility,Outpatient,,,,54,45.9,15.4764,54,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,48.654,90.1,,percent of total billed charges,,
Ear Impression,,V5275,HCPCS,Facility,Inpatient,,,,54,45.9,15.4764,54,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Ear Impression,,V5275,HCPCS,Facility,Both,,,,54,45.9,15.4764,54,"Preferred One Administrative Services, INC.",PPO,53.244,98.6,,percent of total billed charges,,
Ear Impression,,V5275,HCPCS,Facility,Outpatient,,,,54,45.9,15.4764,54,PrimeWest Health,Minnesota Senior Health Options (MSHO),27.783,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Ear Impression,,V5275,HCPCS,Facility,Inpatient,,,,54,45.9,15.4764,54,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ear Impression,,V5275,HCPCS,Facility,Outpatient,,,,54,45.9,15.4764,54,PrimeWest Health,MinnesotaCare,27.7344,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Ear Impression,,V5275,HCPCS,Facility,Inpatient,,,,54,45.9,15.4764,54,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Ear Impression,,V5275,HCPCS,Facility,Both,,,,54,45.9,15.4764,54,Sanford Health Plan,Sanford Health Plan,49.68,92,,percent of total billed charges,,
Ear Impression,,V5275,HCPCS,Facility,Outpatient,,,,54,45.9,15.4764,54,"UCare Health, Inc.",Individual & Family Plan,30.429,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Ear Impression,,V5275,HCPCS,Facility,Inpatient,,,,54,45.9,15.4764,54,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Ear Impression,,V5275,HCPCS,Facility,Outpatient,,,,54,45.9,15.4764,54,"UCare Health, Inc.",Medical Assistance,27.2538,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ear Impression,,V5275,HCPCS,Facility,Inpatient,,,,54,45.9,15.4764,54,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Ear Impression,,V5275,HCPCS,Facility,Outpatient,,,,54,45.9,15.4764,54,"UCare Health, Inc.",Medicare Advantage,27.2538,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ear Impression,,V5275,HCPCS,Facility,Inpatient,,,,54,45.9,15.4764,54,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Ear Impression,,V5275,HCPCS,Facility,Outpatient,,,,54,45.9,15.4764,54,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),27.2538,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Ear Impression,,V5275,HCPCS,Facility,Inpatient,,,,54,45.9,15.4764,54,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Ear Impression,,V5275,HCPCS,Facility,Both,,,,54,45.9,15.4764,54,UnitedHealthcare,Individual & Family,50.76,94,,percent of total billed charges,,
Ear Impression,,V5275,HCPCS,Facility,Outpatient,,,,54,45.9,15.4764,54,UnitedHealthcare,Medicare Advantage,26.46,49,,percent of total billed charges,,
Ear Impression,,V5275,HCPCS,Facility,Inpatient,,,,54,45.9,15.4764,54,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Ear Impression,,V5275,HCPCS,Facility,Outpatient,,,,54,45.9,15.4764,54,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,25.92,48,,percent of total billed charges,,100% of DHS outpatient percentage
Ear Impression,,V5275,HCPCS,Facility,Inpatient,,,,54,45.9,15.4764,54,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Aid Check,,V5299,HCPCS,Facility,Both,,,,22,18.7,6.3052,22,Aetna,Commercial,20.24,92,,percent of total billed charges,,
Aid Check,,V5299,HCPCS,Facility,Outpatient,,,,22,18.7,6.3052,22,Aetna,Medicare Advantage,10.78,49,,percent of total billed charges,,
Aid Check,,V5299,HCPCS,Facility,Inpatient,,,,22,18.7,6.3052,22,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Aid Check,,V5299,HCPCS,Facility,Both,,,,22,18.7,6.3052,22,Aetna,PPO,20.46,93,,percent of total billed charges,,
Aid Check,,V5299,HCPCS,Facility,Both,,,,22,18.7,6.3052,22,America's PPO,America's PPO,21.1266,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Aid Check,,V5299,HCPCS,Facility,Both,,,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota, Federal Employee Program,21.648,98.4,,percent of total billed charges,,
Aid Check,,V5299,HCPCS,Facility,Both,,,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,22,100,,percent of total billed charges,,
Aid Check,,V5299,HCPCS,Facility,Both,,,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota,High Value Network Plan,19.8,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
Aid Check,,V5299,HCPCS,Facility,Outpatient,,,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota,Medicare Advantage,10.78,49,,percent of total billed charges,,
Aid Check,,V5299,HCPCS,Facility,Inpatient,,,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Aid Check,,V5299,HCPCS,Facility,Both,,,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,19.4854,88.57,,percent of total billed charges,,
Aid Check,,V5299,HCPCS,Facility,Both,,,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,6.3052,28.66,,percent of total billed charges,,
Aid Check,,V5299,HCPCS,Facility,Outpatient,,,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),10.78,49,,percent of total billed charges,,
Aid Check,,V5299,HCPCS,Facility,Inpatient,,,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Aid Check,,V5299,HCPCS,Facility,Both,,,,22,18.7,6.3052,22,CorVel,Worker's Compensation,22,100,,percent of total billed charges,,
Aid Check,,V5299,HCPCS,Facility,Both,,,,22,18.7,6.3052,22,First Health Group Corporation,First Health Network,21.34,97,,percent of total billed charges,,
Aid Check,,V5299,HCPCS,Facility,Both,,,,22,18.7,6.3052,22,"Health Partners, Inc.",Commercial,20.812,94.6,,percent of total billed charges,,
Aid Check,,V5299,HCPCS,Facility,Outpatient,,,,22,18.7,6.3052,22,"Health Partners, Inc.",Medicare Advantage,10.78,49,,percent of total billed charges,,
Aid Check,,V5299,HCPCS,Facility,Inpatient,,,,22,18.7,6.3052,22,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Aid Check,,V5299,HCPCS,Facility,Both,,,,22,18.7,6.3052,22,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),13.2,60,,percent of total billed charges,,
Aid Check,,V5299,HCPCS,Facility,Both,,,,22,18.7,6.3052,22,"Health Partners, Inc.",State of Minnesota Advantage Program,17.93,81.5,,percent of total billed charges,,
Aid Check,,V5299,HCPCS,Facility,Both,,,,22,18.7,6.3052,22,"Health Partners, Inc.",State Public Programs,11,50,,percent of total billed charges,,
Aid Check,,V5299,HCPCS,Facility,Both,,,,22,18.7,6.3052,22,Humana Insurance Company,Commercial PPO,20.9,95,,percent of total billed charges,,
Aid Check,,V5299,HCPCS,Facility,Outpatient,,,,22,18.7,6.3052,22,Humana Insurance Company,Medicare PPO,10.78,49,,percent of total billed charges,,
Aid Check,,V5299,HCPCS,Facility,Inpatient,,,,22,18.7,6.3052,22,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Aid Check,,V5299,HCPCS,Facility,Both,,,,22,18.7,6.3052,22,Medica,Individual & Family,21.802,99.1,,percent of total billed charges,,
Aid Check,,V5299,HCPCS,Facility,Outpatient,,,,22,18.7,6.3052,22,Medica,Medica Advantage Solution,10.956,49.8,,percent of total billed charges,,
Aid Check,,V5299,HCPCS,Facility,Inpatient,,,,22,18.7,6.3052,22,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Aid Check,,V5299,HCPCS,Facility,Outpatient,,,,22,18.7,6.3052,22,Medica,Medical Assistance,9.812,44.6,,percent of total billed charges,,
Aid Check,,V5299,HCPCS,Facility,Inpatient,,,,22,18.7,6.3052,22,Medica,Medical Assistance,,,,,Included in per diem rate,
Aid Check,,V5299,HCPCS,Facility,Outpatient,,,,22,18.7,6.3052,22,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,10.956,49.8,,percent of total billed charges,,
Aid Check,,V5299,HCPCS,Facility,Inpatient,,,,22,18.7,6.3052,22,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Aid Check,,V5299,HCPCS,Facility,Both,,,,22,18.7,6.3052,22,"Multiplan, Inc.","Multiplan, Inc.",20.68,94,,percent of total billed charges,,
Aid Check,,V5299,HCPCS,Facility,Outpatient,,,,22,18.7,6.3052,22,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,19.822,90.1,,percent of total billed charges,,
Aid Check,,V5299,HCPCS,Facility,Inpatient,,,,22,18.7,6.3052,22,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Aid Check,,V5299,HCPCS,Facility,Both,,,,22,18.7,6.3052,22,"Preferred One Administrative Services, INC.",PPO,21.692,98.6,,percent of total billed charges,,
Aid Check,,V5299,HCPCS,Facility,Outpatient,,,,22,18.7,6.3052,22,PrimeWest Health,Minnesota Senior Health Options (MSHO),11.319,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Aid Check,,V5299,HCPCS,Facility,Inpatient,,,,22,18.7,6.3052,22,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Aid Check,,V5299,HCPCS,Facility,Outpatient,,,,22,18.7,6.3052,22,PrimeWest Health,MinnesotaCare,11.2992,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Aid Check,,V5299,HCPCS,Facility,Inpatient,,,,22,18.7,6.3052,22,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Aid Check,,V5299,HCPCS,Facility,Both,,,,22,18.7,6.3052,22,Sanford Health Plan,Sanford Health Plan,20.24,92,,percent of total billed charges,,
Aid Check,,V5299,HCPCS,Facility,Outpatient,,,,22,18.7,6.3052,22,"UCare Health, Inc.",Individual & Family Plan,12.397,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Aid Check,,V5299,HCPCS,Facility,Inpatient,,,,22,18.7,6.3052,22,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Aid Check,,V5299,HCPCS,Facility,Outpatient,,,,22,18.7,6.3052,22,"UCare Health, Inc.",Medical Assistance,11.1034,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Aid Check,,V5299,HCPCS,Facility,Inpatient,,,,22,18.7,6.3052,22,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Aid Check,,V5299,HCPCS,Facility,Outpatient,,,,22,18.7,6.3052,22,"UCare Health, Inc.",Medicare Advantage,11.1034,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Aid Check,,V5299,HCPCS,Facility,Inpatient,,,,22,18.7,6.3052,22,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Aid Check,,V5299,HCPCS,Facility,Outpatient,,,,22,18.7,6.3052,22,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),11.1034,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Aid Check,,V5299,HCPCS,Facility,Inpatient,,,,22,18.7,6.3052,22,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Aid Check,,V5299,HCPCS,Facility,Both,,,,22,18.7,6.3052,22,UnitedHealthcare,Individual & Family,20.68,94,,percent of total billed charges,,
Aid Check,,V5299,HCPCS,Facility,Outpatient,,,,22,18.7,6.3052,22,UnitedHealthcare,Medicare Advantage,10.78,49,,percent of total billed charges,,
Aid Check,,V5299,HCPCS,Facility,Inpatient,,,,22,18.7,6.3052,22,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Aid Check,,V5299,HCPCS,Facility,Outpatient,,,,22,18.7,6.3052,22,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,10.56,48,,percent of total billed charges,,100% of DHS outpatient percentage
Aid Check,,V5299,HCPCS,Facility,Inpatient,,,,22,18.7,6.3052,22,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Battery Tester,,V5299,HCPCS,Facility,Both,,,,8,6.8,2.2928,8,Aetna,Commercial,7.36,92,,percent of total billed charges,,
Battery Tester,,V5299,HCPCS,Facility,Outpatient,,,,8,6.8,2.2928,8,Aetna,Medicare Advantage,3.92,49,,percent of total billed charges,,
Battery Tester,,V5299,HCPCS,Facility,Inpatient,,,,8,6.8,2.2928,8,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Battery Tester,,V5299,HCPCS,Facility,Both,,,,8,6.8,2.2928,8,Aetna,PPO,7.44,93,,percent of total billed charges,,
Battery Tester,,V5299,HCPCS,Facility,Both,,,,8,6.8,2.2928,8,America's PPO,America's PPO,7.6824,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Battery Tester,,V5299,HCPCS,Facility,Both,,,,8,6.8,2.2928,8,BlueCross BlueShield Minnesota, Federal Employee Program,7.872,98.4,,percent of total billed charges,,
Battery Tester,,V5299,HCPCS,Facility,Both,,,,8,6.8,2.2928,8,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,8,100,,percent of total billed charges,,
Battery Tester,,V5299,HCPCS,Facility,Both,,,,8,6.8,2.2928,8,BlueCross BlueShield Minnesota,High Value Network Plan,7.2,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
Battery Tester,,V5299,HCPCS,Facility,Outpatient,,,,8,6.8,2.2928,8,BlueCross BlueShield Minnesota,Medicare Advantage,3.92,49,,percent of total billed charges,,
Battery Tester,,V5299,HCPCS,Facility,Inpatient,,,,8,6.8,2.2928,8,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Battery Tester,,V5299,HCPCS,Facility,Both,,,,8,6.8,2.2928,8,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,7.0856,88.57,,percent of total billed charges,,
Battery Tester,,V5299,HCPCS,Facility,Both,,,,8,6.8,2.2928,8,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,2.2928,28.66,,percent of total billed charges,,
Battery Tester,,V5299,HCPCS,Facility,Outpatient,,,,8,6.8,2.2928,8,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),3.92,49,,percent of total billed charges,,
Battery Tester,,V5299,HCPCS,Facility,Inpatient,,,,8,6.8,2.2928,8,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Battery Tester,,V5299,HCPCS,Facility,Both,,,,8,6.8,2.2928,8,CorVel,Worker's Compensation,8,100,,percent of total billed charges,,
Battery Tester,,V5299,HCPCS,Facility,Both,,,,8,6.8,2.2928,8,First Health Group Corporation,First Health Network,7.76,97,,percent of total billed charges,,
Battery Tester,,V5299,HCPCS,Facility,Both,,,,8,6.8,2.2928,8,"Health Partners, Inc.",Commercial,7.568,94.6,,percent of total billed charges,,
Battery Tester,,V5299,HCPCS,Facility,Outpatient,,,,8,6.8,2.2928,8,"Health Partners, Inc.",Medicare Advantage,3.92,49,,percent of total billed charges,,
Battery Tester,,V5299,HCPCS,Facility,Inpatient,,,,8,6.8,2.2928,8,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Battery Tester,,V5299,HCPCS,Facility,Both,,,,8,6.8,2.2928,8,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),4.8,60,,percent of total billed charges,,
Battery Tester,,V5299,HCPCS,Facility,Both,,,,8,6.8,2.2928,8,"Health Partners, Inc.",State of Minnesota Advantage Program,6.52,81.5,,percent of total billed charges,,
Battery Tester,,V5299,HCPCS,Facility,Both,,,,8,6.8,2.2928,8,"Health Partners, Inc.",State Public Programs,4,50,,percent of total billed charges,,
Battery Tester,,V5299,HCPCS,Facility,Both,,,,8,6.8,2.2928,8,Humana Insurance Company,Commercial PPO,7.6,95,,percent of total billed charges,,
Battery Tester,,V5299,HCPCS,Facility,Outpatient,,,,8,6.8,2.2928,8,Humana Insurance Company,Medicare PPO,3.92,49,,percent of total billed charges,,
Battery Tester,,V5299,HCPCS,Facility,Inpatient,,,,8,6.8,2.2928,8,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Battery Tester,,V5299,HCPCS,Facility,Both,,,,8,6.8,2.2928,8,Medica,Individual & Family,7.928,99.1,,percent of total billed charges,,
Battery Tester,,V5299,HCPCS,Facility,Outpatient,,,,8,6.8,2.2928,8,Medica,Medica Advantage Solution,3.984,49.8,,percent of total billed charges,,
Battery Tester,,V5299,HCPCS,Facility,Inpatient,,,,8,6.8,2.2928,8,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Battery Tester,,V5299,HCPCS,Facility,Outpatient,,,,8,6.8,2.2928,8,Medica,Medical Assistance,3.568,44.6,,percent of total billed charges,,
Battery Tester,,V5299,HCPCS,Facility,Inpatient,,,,8,6.8,2.2928,8,Medica,Medical Assistance,,,,,Included in per diem rate,
Battery Tester,,V5299,HCPCS,Facility,Outpatient,,,,8,6.8,2.2928,8,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,3.984,49.8,,percent of total billed charges,,
Battery Tester,,V5299,HCPCS,Facility,Inpatient,,,,8,6.8,2.2928,8,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Battery Tester,,V5299,HCPCS,Facility,Both,,,,8,6.8,2.2928,8,"Multiplan, Inc.","Multiplan, Inc.",7.52,94,,percent of total billed charges,,
Battery Tester,,V5299,HCPCS,Facility,Outpatient,,,,8,6.8,2.2928,8,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,7.208,90.1,,percent of total billed charges,,
Battery Tester,,V5299,HCPCS,Facility,Inpatient,,,,8,6.8,2.2928,8,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Battery Tester,,V5299,HCPCS,Facility,Both,,,,8,6.8,2.2928,8,"Preferred One Administrative Services, INC.",PPO,7.888,98.6,,percent of total billed charges,,
Battery Tester,,V5299,HCPCS,Facility,Outpatient,,,,8,6.8,2.2928,8,PrimeWest Health,Minnesota Senior Health Options (MSHO),4.116,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Battery Tester,,V5299,HCPCS,Facility,Inpatient,,,,8,6.8,2.2928,8,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Battery Tester,,V5299,HCPCS,Facility,Outpatient,,,,8,6.8,2.2928,8,PrimeWest Health,MinnesotaCare,4.1088,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Battery Tester,,V5299,HCPCS,Facility,Inpatient,,,,8,6.8,2.2928,8,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Battery Tester,,V5299,HCPCS,Facility,Both,,,,8,6.8,2.2928,8,Sanford Health Plan,Sanford Health Plan,7.36,92,,percent of total billed charges,,
Battery Tester,,V5299,HCPCS,Facility,Outpatient,,,,8,6.8,2.2928,8,"UCare Health, Inc.",Individual & Family Plan,4.508,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Battery Tester,,V5299,HCPCS,Facility,Inpatient,,,,8,6.8,2.2928,8,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Battery Tester,,V5299,HCPCS,Facility,Outpatient,,,,8,6.8,2.2928,8,"UCare Health, Inc.",Medical Assistance,4.0376,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Battery Tester,,V5299,HCPCS,Facility,Inpatient,,,,8,6.8,2.2928,8,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Battery Tester,,V5299,HCPCS,Facility,Outpatient,,,,8,6.8,2.2928,8,"UCare Health, Inc.",Medicare Advantage,4.0376,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Battery Tester,,V5299,HCPCS,Facility,Inpatient,,,,8,6.8,2.2928,8,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Battery Tester,,V5299,HCPCS,Facility,Outpatient,,,,8,6.8,2.2928,8,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),4.0376,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Battery Tester,,V5299,HCPCS,Facility,Inpatient,,,,8,6.8,2.2928,8,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Battery Tester,,V5299,HCPCS,Facility,Both,,,,8,6.8,2.2928,8,UnitedHealthcare,Individual & Family,7.52,94,,percent of total billed charges,,
Battery Tester,,V5299,HCPCS,Facility,Outpatient,,,,8,6.8,2.2928,8,UnitedHealthcare,Medicare Advantage,3.92,49,,percent of total billed charges,,
Battery Tester,,V5299,HCPCS,Facility,Inpatient,,,,8,6.8,2.2928,8,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Battery Tester,,V5299,HCPCS,Facility,Outpatient,,,,8,6.8,2.2928,8,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,3.84,48,,percent of total billed charges,,100% of DHS outpatient percentage
Battery Tester,,V5299,HCPCS,Facility,Inpatient,,,,8,6.8,2.2928,8,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Dri-Aid,,V5299,HCPCS,Facility,Both,,,,13,11.05,3.7258,13,Aetna,Commercial,11.96,92,,percent of total billed charges,,
Dri-Aid,,V5299,HCPCS,Facility,Outpatient,,,,13,11.05,3.7258,13,Aetna,Medicare Advantage,6.37,49,,percent of total billed charges,,
Dri-Aid,,V5299,HCPCS,Facility,Inpatient,,,,13,11.05,3.7258,13,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Dri-Aid,,V5299,HCPCS,Facility,Both,,,,13,11.05,3.7258,13,Aetna,PPO,12.09,93,,percent of total billed charges,,
Dri-Aid,,V5299,HCPCS,Facility,Both,,,,13,11.05,3.7258,13,America's PPO,America's PPO,12.4839,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Dri-Aid,,V5299,HCPCS,Facility,Both,,,,13,11.05,3.7258,13,BlueCross BlueShield Minnesota, Federal Employee Program,12.792,98.4,,percent of total billed charges,,
Dri-Aid,,V5299,HCPCS,Facility,Both,,,,13,11.05,3.7258,13,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,13,100,,percent of total billed charges,,
Dri-Aid,,V5299,HCPCS,Facility,Both,,,,13,11.05,3.7258,13,BlueCross BlueShield Minnesota,High Value Network Plan,11.7,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
Dri-Aid,,V5299,HCPCS,Facility,Outpatient,,,,13,11.05,3.7258,13,BlueCross BlueShield Minnesota,Medicare Advantage,6.37,49,,percent of total billed charges,,
Dri-Aid,,V5299,HCPCS,Facility,Inpatient,,,,13,11.05,3.7258,13,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Dri-Aid,,V5299,HCPCS,Facility,Both,,,,13,11.05,3.7258,13,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,11.5141,88.57,,percent of total billed charges,,
Dri-Aid,,V5299,HCPCS,Facility,Both,,,,13,11.05,3.7258,13,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,3.7258,28.66,,percent of total billed charges,,
Dri-Aid,,V5299,HCPCS,Facility,Outpatient,,,,13,11.05,3.7258,13,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),6.37,49,,percent of total billed charges,,
Dri-Aid,,V5299,HCPCS,Facility,Inpatient,,,,13,11.05,3.7258,13,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Dri-Aid,,V5299,HCPCS,Facility,Both,,,,13,11.05,3.7258,13,CorVel,Worker's Compensation,13,100,,percent of total billed charges,,
Dri-Aid,,V5299,HCPCS,Facility,Both,,,,13,11.05,3.7258,13,First Health Group Corporation,First Health Network,12.61,97,,percent of total billed charges,,
Dri-Aid,,V5299,HCPCS,Facility,Both,,,,13,11.05,3.7258,13,"Health Partners, Inc.",Commercial,12.298,94.6,,percent of total billed charges,,
Dri-Aid,,V5299,HCPCS,Facility,Outpatient,,,,13,11.05,3.7258,13,"Health Partners, Inc.",Medicare Advantage,6.37,49,,percent of total billed charges,,
Dri-Aid,,V5299,HCPCS,Facility,Inpatient,,,,13,11.05,3.7258,13,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Dri-Aid,,V5299,HCPCS,Facility,Both,,,,13,11.05,3.7258,13,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),7.8,60,,percent of total billed charges,,
Dri-Aid,,V5299,HCPCS,Facility,Both,,,,13,11.05,3.7258,13,"Health Partners, Inc.",State of Minnesota Advantage Program,10.595,81.5,,percent of total billed charges,,
Dri-Aid,,V5299,HCPCS,Facility,Both,,,,13,11.05,3.7258,13,"Health Partners, Inc.",State Public Programs,6.5,50,,percent of total billed charges,,
Dri-Aid,,V5299,HCPCS,Facility,Both,,,,13,11.05,3.7258,13,Humana Insurance Company,Commercial PPO,12.35,95,,percent of total billed charges,,
Dri-Aid,,V5299,HCPCS,Facility,Outpatient,,,,13,11.05,3.7258,13,Humana Insurance Company,Medicare PPO,6.37,49,,percent of total billed charges,,
Dri-Aid,,V5299,HCPCS,Facility,Inpatient,,,,13,11.05,3.7258,13,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Dri-Aid,,V5299,HCPCS,Facility,Both,,,,13,11.05,3.7258,13,Medica,Individual & Family,12.883,99.1,,percent of total billed charges,,
Dri-Aid,,V5299,HCPCS,Facility,Outpatient,,,,13,11.05,3.7258,13,Medica,Medica Advantage Solution,6.474,49.8,,percent of total billed charges,,
Dri-Aid,,V5299,HCPCS,Facility,Inpatient,,,,13,11.05,3.7258,13,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Dri-Aid,,V5299,HCPCS,Facility,Outpatient,,,,13,11.05,3.7258,13,Medica,Medical Assistance,5.798,44.6,,percent of total billed charges,,
Dri-Aid,,V5299,HCPCS,Facility,Inpatient,,,,13,11.05,3.7258,13,Medica,Medical Assistance,,,,,Included in per diem rate,
Dri-Aid,,V5299,HCPCS,Facility,Outpatient,,,,13,11.05,3.7258,13,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,6.474,49.8,,percent of total billed charges,,
Dri-Aid,,V5299,HCPCS,Facility,Inpatient,,,,13,11.05,3.7258,13,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Dri-Aid,,V5299,HCPCS,Facility,Both,,,,13,11.05,3.7258,13,"Multiplan, Inc.","Multiplan, Inc.",12.22,94,,percent of total billed charges,,
Dri-Aid,,V5299,HCPCS,Facility,Outpatient,,,,13,11.05,3.7258,13,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,11.713,90.1,,percent of total billed charges,,
Dri-Aid,,V5299,HCPCS,Facility,Inpatient,,,,13,11.05,3.7258,13,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Dri-Aid,,V5299,HCPCS,Facility,Both,,,,13,11.05,3.7258,13,"Preferred One Administrative Services, INC.",PPO,12.818,98.6,,percent of total billed charges,,
Dri-Aid,,V5299,HCPCS,Facility,Outpatient,,,,13,11.05,3.7258,13,PrimeWest Health,Minnesota Senior Health Options (MSHO),6.6885,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Dri-Aid,,V5299,HCPCS,Facility,Inpatient,,,,13,11.05,3.7258,13,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Dri-Aid,,V5299,HCPCS,Facility,Outpatient,,,,13,11.05,3.7258,13,PrimeWest Health,MinnesotaCare,6.6768,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Dri-Aid,,V5299,HCPCS,Facility,Inpatient,,,,13,11.05,3.7258,13,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Dri-Aid,,V5299,HCPCS,Facility,Both,,,,13,11.05,3.7258,13,Sanford Health Plan,Sanford Health Plan,11.96,92,,percent of total billed charges,,
Dri-Aid,,V5299,HCPCS,Facility,Outpatient,,,,13,11.05,3.7258,13,"UCare Health, Inc.",Individual & Family Plan,7.3255,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Dri-Aid,,V5299,HCPCS,Facility,Inpatient,,,,13,11.05,3.7258,13,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Dri-Aid,,V5299,HCPCS,Facility,Outpatient,,,,13,11.05,3.7258,13,"UCare Health, Inc.",Medical Assistance,6.5611,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Dri-Aid,,V5299,HCPCS,Facility,Inpatient,,,,13,11.05,3.7258,13,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Dri-Aid,,V5299,HCPCS,Facility,Outpatient,,,,13,11.05,3.7258,13,"UCare Health, Inc.",Medicare Advantage,6.5611,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Dri-Aid,,V5299,HCPCS,Facility,Inpatient,,,,13,11.05,3.7258,13,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Dri-Aid,,V5299,HCPCS,Facility,Outpatient,,,,13,11.05,3.7258,13,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),6.5611,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Dri-Aid,,V5299,HCPCS,Facility,Inpatient,,,,13,11.05,3.7258,13,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Dri-Aid,,V5299,HCPCS,Facility,Both,,,,13,11.05,3.7258,13,UnitedHealthcare,Individual & Family,12.22,94,,percent of total billed charges,,
Dri-Aid,,V5299,HCPCS,Facility,Outpatient,,,,13,11.05,3.7258,13,UnitedHealthcare,Medicare Advantage,6.37,49,,percent of total billed charges,,
Dri-Aid,,V5299,HCPCS,Facility,Inpatient,,,,13,11.05,3.7258,13,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Dri-Aid,,V5299,HCPCS,Facility,Outpatient,,,,13,11.05,3.7258,13,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,6.24,48,,percent of total billed charges,,100% of DHS outpatient percentage
Dri-Aid,,V5299,HCPCS,Facility,Inpatient,,,,13,11.05,3.7258,13,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Earhold Air Blower,,V5299,HCPCS,Facility,Both,,,,10,8.5,2.866,10,Aetna,Commercial,9.2,92,,percent of total billed charges,,
Earhold Air Blower,,V5299,HCPCS,Facility,Outpatient,,,,10,8.5,2.866,10,Aetna,Medicare Advantage,4.9,49,,percent of total billed charges,,
Earhold Air Blower,,V5299,HCPCS,Facility,Inpatient,,,,10,8.5,2.866,10,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Earhold Air Blower,,V5299,HCPCS,Facility,Both,,,,10,8.5,2.866,10,Aetna,PPO,9.3,93,,percent of total billed charges,,
Earhold Air Blower,,V5299,HCPCS,Facility,Both,,,,10,8.5,2.866,10,America's PPO,America's PPO,9.603,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Earhold Air Blower,,V5299,HCPCS,Facility,Both,,,,10,8.5,2.866,10,BlueCross BlueShield Minnesota, Federal Employee Program,9.84,98.4,,percent of total billed charges,,
Earhold Air Blower,,V5299,HCPCS,Facility,Both,,,,10,8.5,2.866,10,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,10,100,,percent of total billed charges,,
Earhold Air Blower,,V5299,HCPCS,Facility,Both,,,,10,8.5,2.866,10,BlueCross BlueShield Minnesota,High Value Network Plan,9,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
Earhold Air Blower,,V5299,HCPCS,Facility,Outpatient,,,,10,8.5,2.866,10,BlueCross BlueShield Minnesota,Medicare Advantage,4.9,49,,percent of total billed charges,,
Earhold Air Blower,,V5299,HCPCS,Facility,Inpatient,,,,10,8.5,2.866,10,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Earhold Air Blower,,V5299,HCPCS,Facility,Both,,,,10,8.5,2.866,10,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,8.857,88.57,,percent of total billed charges,,
Earhold Air Blower,,V5299,HCPCS,Facility,Both,,,,10,8.5,2.866,10,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,2.866,28.66,,percent of total billed charges,,
Earhold Air Blower,,V5299,HCPCS,Facility,Outpatient,,,,10,8.5,2.866,10,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),4.9,49,,percent of total billed charges,,
Earhold Air Blower,,V5299,HCPCS,Facility,Inpatient,,,,10,8.5,2.866,10,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Earhold Air Blower,,V5299,HCPCS,Facility,Both,,,,10,8.5,2.866,10,CorVel,Worker's Compensation,10,100,,percent of total billed charges,,
Earhold Air Blower,,V5299,HCPCS,Facility,Both,,,,10,8.5,2.866,10,First Health Group Corporation,First Health Network,9.7,97,,percent of total billed charges,,
Earhold Air Blower,,V5299,HCPCS,Facility,Both,,,,10,8.5,2.866,10,"Health Partners, Inc.",Commercial,9.46,94.6,,percent of total billed charges,,
Earhold Air Blower,,V5299,HCPCS,Facility,Outpatient,,,,10,8.5,2.866,10,"Health Partners, Inc.",Medicare Advantage,4.9,49,,percent of total billed charges,,
Earhold Air Blower,,V5299,HCPCS,Facility,Inpatient,,,,10,8.5,2.866,10,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Earhold Air Blower,,V5299,HCPCS,Facility,Both,,,,10,8.5,2.866,10,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),6,60,,percent of total billed charges,,
Earhold Air Blower,,V5299,HCPCS,Facility,Both,,,,10,8.5,2.866,10,"Health Partners, Inc.",State of Minnesota Advantage Program,8.15,81.5,,percent of total billed charges,,
Earhold Air Blower,,V5299,HCPCS,Facility,Both,,,,10,8.5,2.866,10,"Health Partners, Inc.",State Public Programs,5,50,,percent of total billed charges,,
Earhold Air Blower,,V5299,HCPCS,Facility,Both,,,,10,8.5,2.866,10,Humana Insurance Company,Commercial PPO,9.5,95,,percent of total billed charges,,
Earhold Air Blower,,V5299,HCPCS,Facility,Outpatient,,,,10,8.5,2.866,10,Humana Insurance Company,Medicare PPO,4.9,49,,percent of total billed charges,,
Earhold Air Blower,,V5299,HCPCS,Facility,Inpatient,,,,10,8.5,2.866,10,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Earhold Air Blower,,V5299,HCPCS,Facility,Both,,,,10,8.5,2.866,10,Medica,Individual & Family,9.91,99.1,,percent of total billed charges,,
Earhold Air Blower,,V5299,HCPCS,Facility,Outpatient,,,,10,8.5,2.866,10,Medica,Medica Advantage Solution,4.98,49.8,,percent of total billed charges,,
Earhold Air Blower,,V5299,HCPCS,Facility,Inpatient,,,,10,8.5,2.866,10,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Earhold Air Blower,,V5299,HCPCS,Facility,Outpatient,,,,10,8.5,2.866,10,Medica,Medical Assistance,4.46,44.6,,percent of total billed charges,,
Earhold Air Blower,,V5299,HCPCS,Facility,Inpatient,,,,10,8.5,2.866,10,Medica,Medical Assistance,,,,,Included in per diem rate,
Earhold Air Blower,,V5299,HCPCS,Facility,Outpatient,,,,10,8.5,2.866,10,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,4.98,49.8,,percent of total billed charges,,
Earhold Air Blower,,V5299,HCPCS,Facility,Inpatient,,,,10,8.5,2.866,10,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Earhold Air Blower,,V5299,HCPCS,Facility,Both,,,,10,8.5,2.866,10,"Multiplan, Inc.","Multiplan, Inc.",9.4,94,,percent of total billed charges,,
Earhold Air Blower,,V5299,HCPCS,Facility,Outpatient,,,,10,8.5,2.866,10,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,9.01,90.1,,percent of total billed charges,,
Earhold Air Blower,,V5299,HCPCS,Facility,Inpatient,,,,10,8.5,2.866,10,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Earhold Air Blower,,V5299,HCPCS,Facility,Both,,,,10,8.5,2.866,10,"Preferred One Administrative Services, INC.",PPO,9.86,98.6,,percent of total billed charges,,
Earhold Air Blower,,V5299,HCPCS,Facility,Outpatient,,,,10,8.5,2.866,10,PrimeWest Health,Minnesota Senior Health Options (MSHO),5.145,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Earhold Air Blower,,V5299,HCPCS,Facility,Inpatient,,,,10,8.5,2.866,10,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Earhold Air Blower,,V5299,HCPCS,Facility,Outpatient,,,,10,8.5,2.866,10,PrimeWest Health,MinnesotaCare,5.136,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Earhold Air Blower,,V5299,HCPCS,Facility,Inpatient,,,,10,8.5,2.866,10,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Earhold Air Blower,,V5299,HCPCS,Facility,Both,,,,10,8.5,2.866,10,Sanford Health Plan,Sanford Health Plan,9.2,92,,percent of total billed charges,,
Earhold Air Blower,,V5299,HCPCS,Facility,Outpatient,,,,10,8.5,2.866,10,"UCare Health, Inc.",Individual & Family Plan,5.635,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Earhold Air Blower,,V5299,HCPCS,Facility,Inpatient,,,,10,8.5,2.866,10,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Earhold Air Blower,,V5299,HCPCS,Facility,Outpatient,,,,10,8.5,2.866,10,"UCare Health, Inc.",Medical Assistance,5.047,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Earhold Air Blower,,V5299,HCPCS,Facility,Inpatient,,,,10,8.5,2.866,10,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Earhold Air Blower,,V5299,HCPCS,Facility,Outpatient,,,,10,8.5,2.866,10,"UCare Health, Inc.",Medicare Advantage,5.047,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Earhold Air Blower,,V5299,HCPCS,Facility,Inpatient,,,,10,8.5,2.866,10,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Earhold Air Blower,,V5299,HCPCS,Facility,Outpatient,,,,10,8.5,2.866,10,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),5.047,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Earhold Air Blower,,V5299,HCPCS,Facility,Inpatient,,,,10,8.5,2.866,10,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Earhold Air Blower,,V5299,HCPCS,Facility,Both,,,,10,8.5,2.866,10,UnitedHealthcare,Individual & Family,9.4,94,,percent of total billed charges,,
Earhold Air Blower,,V5299,HCPCS,Facility,Outpatient,,,,10,8.5,2.866,10,UnitedHealthcare,Medicare Advantage,4.9,49,,percent of total billed charges,,
Earhold Air Blower,,V5299,HCPCS,Facility,Inpatient,,,,10,8.5,2.866,10,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Earhold Air Blower,,V5299,HCPCS,Facility,Outpatient,,,,10,8.5,2.866,10,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,4.8,48,,percent of total billed charges,,100% of DHS outpatient percentage
Earhold Air Blower,,V5299,HCPCS,Facility,Inpatient,,,,10,8.5,2.866,10,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
"Earhood, Filtered",,V5299,HCPCS,Facility,Both,,,,13,11.05,3.7258,13,Aetna,Commercial,11.96,92,,percent of total billed charges,,
"Earhood, Filtered",,V5299,HCPCS,Facility,Outpatient,,,,13,11.05,3.7258,13,Aetna,Medicare Advantage,6.37,49,,percent of total billed charges,,
"Earhood, Filtered",,V5299,HCPCS,Facility,Inpatient,,,,13,11.05,3.7258,13,Aetna,Medicare Advantage,,,,,Included in per diem rate,
"Earhood, Filtered",,V5299,HCPCS,Facility,Both,,,,13,11.05,3.7258,13,Aetna,PPO,12.09,93,,percent of total billed charges,,
"Earhood, Filtered",,V5299,HCPCS,Facility,Both,,,,13,11.05,3.7258,13,America's PPO,America's PPO,12.4839,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
"Earhood, Filtered",,V5299,HCPCS,Facility,Both,,,,13,11.05,3.7258,13,BlueCross BlueShield Minnesota, Federal Employee Program,12.792,98.4,,percent of total billed charges,,
"Earhood, Filtered",,V5299,HCPCS,Facility,Both,,,,13,11.05,3.7258,13,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,13,100,,percent of total billed charges,,
"Earhood, Filtered",,V5299,HCPCS,Facility,Both,,,,13,11.05,3.7258,13,BlueCross BlueShield Minnesota,High Value Network Plan,11.7,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
"Earhood, Filtered",,V5299,HCPCS,Facility,Outpatient,,,,13,11.05,3.7258,13,BlueCross BlueShield Minnesota,Medicare Advantage,6.37,49,,percent of total billed charges,,
"Earhood, Filtered",,V5299,HCPCS,Facility,Inpatient,,,,13,11.05,3.7258,13,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
"Earhood, Filtered",,V5299,HCPCS,Facility,Both,,,,13,11.05,3.7258,13,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,11.5141,88.57,,percent of total billed charges,,
"Earhood, Filtered",,V5299,HCPCS,Facility,Both,,,,13,11.05,3.7258,13,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,3.7258,28.66,,percent of total billed charges,,
"Earhood, Filtered",,V5299,HCPCS,Facility,Outpatient,,,,13,11.05,3.7258,13,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),6.37,49,,percent of total billed charges,,
"Earhood, Filtered",,V5299,HCPCS,Facility,Inpatient,,,,13,11.05,3.7258,13,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
"Earhood, Filtered",,V5299,HCPCS,Facility,Both,,,,13,11.05,3.7258,13,CorVel,Worker's Compensation,13,100,,percent of total billed charges,,
"Earhood, Filtered",,V5299,HCPCS,Facility,Both,,,,13,11.05,3.7258,13,First Health Group Corporation,First Health Network,12.61,97,,percent of total billed charges,,
"Earhood, Filtered",,V5299,HCPCS,Facility,Both,,,,13,11.05,3.7258,13,"Health Partners, Inc.",Commercial,12.298,94.6,,percent of total billed charges,,
"Earhood, Filtered",,V5299,HCPCS,Facility,Outpatient,,,,13,11.05,3.7258,13,"Health Partners, Inc.",Medicare Advantage,6.37,49,,percent of total billed charges,,
"Earhood, Filtered",,V5299,HCPCS,Facility,Inpatient,,,,13,11.05,3.7258,13,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Earhood, Filtered",,V5299,HCPCS,Facility,Both,,,,13,11.05,3.7258,13,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),7.8,60,,percent of total billed charges,,
"Earhood, Filtered",,V5299,HCPCS,Facility,Both,,,,13,11.05,3.7258,13,"Health Partners, Inc.",State of Minnesota Advantage Program,10.595,81.5,,percent of total billed charges,,
"Earhood, Filtered",,V5299,HCPCS,Facility,Both,,,,13,11.05,3.7258,13,"Health Partners, Inc.",State Public Programs,6.5,50,,percent of total billed charges,,
"Earhood, Filtered",,V5299,HCPCS,Facility,Both,,,,13,11.05,3.7258,13,Humana Insurance Company,Commercial PPO,12.35,95,,percent of total billed charges,,
"Earhood, Filtered",,V5299,HCPCS,Facility,Outpatient,,,,13,11.05,3.7258,13,Humana Insurance Company,Medicare PPO,6.37,49,,percent of total billed charges,,
"Earhood, Filtered",,V5299,HCPCS,Facility,Inpatient,,,,13,11.05,3.7258,13,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
"Earhood, Filtered",,V5299,HCPCS,Facility,Both,,,,13,11.05,3.7258,13,Medica,Individual & Family,12.883,99.1,,percent of total billed charges,,
"Earhood, Filtered",,V5299,HCPCS,Facility,Outpatient,,,,13,11.05,3.7258,13,Medica,Medica Advantage Solution,6.474,49.8,,percent of total billed charges,,
"Earhood, Filtered",,V5299,HCPCS,Facility,Inpatient,,,,13,11.05,3.7258,13,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
"Earhood, Filtered",,V5299,HCPCS,Facility,Outpatient,,,,13,11.05,3.7258,13,Medica,Medical Assistance,5.798,44.6,,percent of total billed charges,,
"Earhood, Filtered",,V5299,HCPCS,Facility,Inpatient,,,,13,11.05,3.7258,13,Medica,Medical Assistance,,,,,Included in per diem rate,
"Earhood, Filtered",,V5299,HCPCS,Facility,Outpatient,,,,13,11.05,3.7258,13,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,6.474,49.8,,percent of total billed charges,,
"Earhood, Filtered",,V5299,HCPCS,Facility,Inpatient,,,,13,11.05,3.7258,13,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
"Earhood, Filtered",,V5299,HCPCS,Facility,Both,,,,13,11.05,3.7258,13,"Multiplan, Inc.","Multiplan, Inc.",12.22,94,,percent of total billed charges,,
"Earhood, Filtered",,V5299,HCPCS,Facility,Outpatient,,,,13,11.05,3.7258,13,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,11.713,90.1,,percent of total billed charges,,
"Earhood, Filtered",,V5299,HCPCS,Facility,Inpatient,,,,13,11.05,3.7258,13,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
"Earhood, Filtered",,V5299,HCPCS,Facility,Both,,,,13,11.05,3.7258,13,"Preferred One Administrative Services, INC.",PPO,12.818,98.6,,percent of total billed charges,,
"Earhood, Filtered",,V5299,HCPCS,Facility,Outpatient,,,,13,11.05,3.7258,13,PrimeWest Health,Minnesota Senior Health Options (MSHO),6.6885,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
"Earhood, Filtered",,V5299,HCPCS,Facility,Inpatient,,,,13,11.05,3.7258,13,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Earhood, Filtered",,V5299,HCPCS,Facility,Outpatient,,,,13,11.05,3.7258,13,PrimeWest Health,MinnesotaCare,6.6768,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
"Earhood, Filtered",,V5299,HCPCS,Facility,Inpatient,,,,13,11.05,3.7258,13,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
"Earhood, Filtered",,V5299,HCPCS,Facility,Both,,,,13,11.05,3.7258,13,Sanford Health Plan,Sanford Health Plan,11.96,92,,percent of total billed charges,,
"Earhood, Filtered",,V5299,HCPCS,Facility,Outpatient,,,,13,11.05,3.7258,13,"UCare Health, Inc.",Individual & Family Plan,7.3255,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
"Earhood, Filtered",,V5299,HCPCS,Facility,Inpatient,,,,13,11.05,3.7258,13,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
"Earhood, Filtered",,V5299,HCPCS,Facility,Outpatient,,,,13,11.05,3.7258,13,"UCare Health, Inc.",Medical Assistance,6.5611,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Earhood, Filtered",,V5299,HCPCS,Facility,Inpatient,,,,13,11.05,3.7258,13,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
"Earhood, Filtered",,V5299,HCPCS,Facility,Outpatient,,,,13,11.05,3.7258,13,"UCare Health, Inc.",Medicare Advantage,6.5611,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Earhood, Filtered",,V5299,HCPCS,Facility,Inpatient,,,,13,11.05,3.7258,13,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
"Earhood, Filtered",,V5299,HCPCS,Facility,Outpatient,,,,13,11.05,3.7258,13,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),6.5611,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
"Earhood, Filtered",,V5299,HCPCS,Facility,Inpatient,,,,13,11.05,3.7258,13,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
"Earhood, Filtered",,V5299,HCPCS,Facility,Both,,,,13,11.05,3.7258,13,UnitedHealthcare,Individual & Family,12.22,94,,percent of total billed charges,,
"Earhood, Filtered",,V5299,HCPCS,Facility,Outpatient,,,,13,11.05,3.7258,13,UnitedHealthcare,Medicare Advantage,6.37,49,,percent of total billed charges,,
"Earhood, Filtered",,V5299,HCPCS,Facility,Inpatient,,,,13,11.05,3.7258,13,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
"Earhood, Filtered",,V5299,HCPCS,Facility,Outpatient,,,,13,11.05,3.7258,13,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,6.24,48,,percent of total billed charges,,100% of DHS outpatient percentage
"Earhood, Filtered",,V5299,HCPCS,Facility,Inpatient,,,,13,11.05,3.7258,13,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Earhook,,V5299,HCPCS,Facility,Both,,,,10,8.5,2.866,10,Aetna,Commercial,9.2,92,,percent of total billed charges,,
Earhook,,V5299,HCPCS,Facility,Outpatient,,,,10,8.5,2.866,10,Aetna,Medicare Advantage,4.9,49,,percent of total billed charges,,
Earhook,,V5299,HCPCS,Facility,Inpatient,,,,10,8.5,2.866,10,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Earhook,,V5299,HCPCS,Facility,Both,,,,10,8.5,2.866,10,Aetna,PPO,9.3,93,,percent of total billed charges,,
Earhook,,V5299,HCPCS,Facility,Both,,,,10,8.5,2.866,10,America's PPO,America's PPO,9.603,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Earhook,,V5299,HCPCS,Facility,Both,,,,10,8.5,2.866,10,BlueCross BlueShield Minnesota, Federal Employee Program,9.84,98.4,,percent of total billed charges,,
Earhook,,V5299,HCPCS,Facility,Both,,,,10,8.5,2.866,10,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,10,100,,percent of total billed charges,,
Earhook,,V5299,HCPCS,Facility,Both,,,,10,8.5,2.866,10,BlueCross BlueShield Minnesota,High Value Network Plan,9,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
Earhook,,V5299,HCPCS,Facility,Outpatient,,,,10,8.5,2.866,10,BlueCross BlueShield Minnesota,Medicare Advantage,4.9,49,,percent of total billed charges,,
Earhook,,V5299,HCPCS,Facility,Inpatient,,,,10,8.5,2.866,10,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Earhook,,V5299,HCPCS,Facility,Both,,,,10,8.5,2.866,10,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,8.857,88.57,,percent of total billed charges,,
Earhook,,V5299,HCPCS,Facility,Both,,,,10,8.5,2.866,10,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,2.866,28.66,,percent of total billed charges,,
Earhook,,V5299,HCPCS,Facility,Outpatient,,,,10,8.5,2.866,10,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),4.9,49,,percent of total billed charges,,
Earhook,,V5299,HCPCS,Facility,Inpatient,,,,10,8.5,2.866,10,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Earhook,,V5299,HCPCS,Facility,Both,,,,10,8.5,2.866,10,CorVel,Worker's Compensation,10,100,,percent of total billed charges,,
Earhook,,V5299,HCPCS,Facility,Both,,,,10,8.5,2.866,10,First Health Group Corporation,First Health Network,9.7,97,,percent of total billed charges,,
Earhook,,V5299,HCPCS,Facility,Both,,,,10,8.5,2.866,10,"Health Partners, Inc.",Commercial,9.46,94.6,,percent of total billed charges,,
Earhook,,V5299,HCPCS,Facility,Outpatient,,,,10,8.5,2.866,10,"Health Partners, Inc.",Medicare Advantage,4.9,49,,percent of total billed charges,,
Earhook,,V5299,HCPCS,Facility,Inpatient,,,,10,8.5,2.866,10,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Earhook,,V5299,HCPCS,Facility,Both,,,,10,8.5,2.866,10,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),6,60,,percent of total billed charges,,
Earhook,,V5299,HCPCS,Facility,Both,,,,10,8.5,2.866,10,"Health Partners, Inc.",State of Minnesota Advantage Program,8.15,81.5,,percent of total billed charges,,
Earhook,,V5299,HCPCS,Facility,Both,,,,10,8.5,2.866,10,"Health Partners, Inc.",State Public Programs,5,50,,percent of total billed charges,,
Earhook,,V5299,HCPCS,Facility,Both,,,,10,8.5,2.866,10,Humana Insurance Company,Commercial PPO,9.5,95,,percent of total billed charges,,
Earhook,,V5299,HCPCS,Facility,Outpatient,,,,10,8.5,2.866,10,Humana Insurance Company,Medicare PPO,4.9,49,,percent of total billed charges,,
Earhook,,V5299,HCPCS,Facility,Inpatient,,,,10,8.5,2.866,10,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Earhook,,V5299,HCPCS,Facility,Both,,,,10,8.5,2.866,10,Medica,Individual & Family,9.91,99.1,,percent of total billed charges,,
Earhook,,V5299,HCPCS,Facility,Outpatient,,,,10,8.5,2.866,10,Medica,Medica Advantage Solution,4.98,49.8,,percent of total billed charges,,
Earhook,,V5299,HCPCS,Facility,Inpatient,,,,10,8.5,2.866,10,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Earhook,,V5299,HCPCS,Facility,Outpatient,,,,10,8.5,2.866,10,Medica,Medical Assistance,4.46,44.6,,percent of total billed charges,,
Earhook,,V5299,HCPCS,Facility,Inpatient,,,,10,8.5,2.866,10,Medica,Medical Assistance,,,,,Included in per diem rate,
Earhook,,V5299,HCPCS,Facility,Outpatient,,,,10,8.5,2.866,10,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,4.98,49.8,,percent of total billed charges,,
Earhook,,V5299,HCPCS,Facility,Inpatient,,,,10,8.5,2.866,10,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Earhook,,V5299,HCPCS,Facility,Both,,,,10,8.5,2.866,10,"Multiplan, Inc.","Multiplan, Inc.",9.4,94,,percent of total billed charges,,
Earhook,,V5299,HCPCS,Facility,Outpatient,,,,10,8.5,2.866,10,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,9.01,90.1,,percent of total billed charges,,
Earhook,,V5299,HCPCS,Facility,Inpatient,,,,10,8.5,2.866,10,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Earhook,,V5299,HCPCS,Facility,Both,,,,10,8.5,2.866,10,"Preferred One Administrative Services, INC.",PPO,9.86,98.6,,percent of total billed charges,,
Earhook,,V5299,HCPCS,Facility,Outpatient,,,,10,8.5,2.866,10,PrimeWest Health,Minnesota Senior Health Options (MSHO),5.145,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Earhook,,V5299,HCPCS,Facility,Inpatient,,,,10,8.5,2.866,10,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Earhook,,V5299,HCPCS,Facility,Outpatient,,,,10,8.5,2.866,10,PrimeWest Health,MinnesotaCare,5.136,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Earhook,,V5299,HCPCS,Facility,Inpatient,,,,10,8.5,2.866,10,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Earhook,,V5299,HCPCS,Facility,Both,,,,10,8.5,2.866,10,Sanford Health Plan,Sanford Health Plan,9.2,92,,percent of total billed charges,,
Earhook,,V5299,HCPCS,Facility,Outpatient,,,,10,8.5,2.866,10,"UCare Health, Inc.",Individual & Family Plan,5.635,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Earhook,,V5299,HCPCS,Facility,Inpatient,,,,10,8.5,2.866,10,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Earhook,,V5299,HCPCS,Facility,Outpatient,,,,10,8.5,2.866,10,"UCare Health, Inc.",Medical Assistance,5.047,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Earhook,,V5299,HCPCS,Facility,Inpatient,,,,10,8.5,2.866,10,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Earhook,,V5299,HCPCS,Facility,Outpatient,,,,10,8.5,2.866,10,"UCare Health, Inc.",Medicare Advantage,5.047,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Earhook,,V5299,HCPCS,Facility,Inpatient,,,,10,8.5,2.866,10,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Earhook,,V5299,HCPCS,Facility,Outpatient,,,,10,8.5,2.866,10,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),5.047,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Earhook,,V5299,HCPCS,Facility,Inpatient,,,,10,8.5,2.866,10,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Earhook,,V5299,HCPCS,Facility,Both,,,,10,8.5,2.866,10,UnitedHealthcare,Individual & Family,9.4,94,,percent of total billed charges,,
Earhook,,V5299,HCPCS,Facility,Outpatient,,,,10,8.5,2.866,10,UnitedHealthcare,Medicare Advantage,4.9,49,,percent of total billed charges,,
Earhook,,V5299,HCPCS,Facility,Inpatient,,,,10,8.5,2.866,10,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Earhook,,V5299,HCPCS,Facility,Outpatient,,,,10,8.5,2.866,10,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,4.8,48,,percent of total billed charges,,100% of DHS outpatient percentage
Earhook,,V5299,HCPCS,Facility,Inpatient,,,,10,8.5,2.866,10,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Huggies,,V5299,HCPCS,Facility,Both,,,,22,18.7,6.3052,22,Aetna,Commercial,20.24,92,,percent of total billed charges,,
Huggies,,V5299,HCPCS,Facility,Outpatient,,,,22,18.7,6.3052,22,Aetna,Medicare Advantage,10.78,49,,percent of total billed charges,,
Huggies,,V5299,HCPCS,Facility,Inpatient,,,,22,18.7,6.3052,22,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Huggies,,V5299,HCPCS,Facility,Both,,,,22,18.7,6.3052,22,Aetna,PPO,20.46,93,,percent of total billed charges,,
Huggies,,V5299,HCPCS,Facility,Both,,,,22,18.7,6.3052,22,America's PPO,America's PPO,21.1266,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Huggies,,V5299,HCPCS,Facility,Both,,,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota, Federal Employee Program,21.648,98.4,,percent of total billed charges,,
Huggies,,V5299,HCPCS,Facility,Both,,,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,22,100,,percent of total billed charges,,
Huggies,,V5299,HCPCS,Facility,Both,,,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota,High Value Network Plan,19.8,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
Huggies,,V5299,HCPCS,Facility,Outpatient,,,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota,Medicare Advantage,10.78,49,,percent of total billed charges,,
Huggies,,V5299,HCPCS,Facility,Inpatient,,,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Huggies,,V5299,HCPCS,Facility,Both,,,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,19.4854,88.57,,percent of total billed charges,,
Huggies,,V5299,HCPCS,Facility,Both,,,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,6.3052,28.66,,percent of total billed charges,,
Huggies,,V5299,HCPCS,Facility,Outpatient,,,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),10.78,49,,percent of total billed charges,,
Huggies,,V5299,HCPCS,Facility,Inpatient,,,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Huggies,,V5299,HCPCS,Facility,Both,,,,22,18.7,6.3052,22,CorVel,Worker's Compensation,22,100,,percent of total billed charges,,
Huggies,,V5299,HCPCS,Facility,Both,,,,22,18.7,6.3052,22,First Health Group Corporation,First Health Network,21.34,97,,percent of total billed charges,,
Huggies,,V5299,HCPCS,Facility,Both,,,,22,18.7,6.3052,22,"Health Partners, Inc.",Commercial,20.812,94.6,,percent of total billed charges,,
Huggies,,V5299,HCPCS,Facility,Outpatient,,,,22,18.7,6.3052,22,"Health Partners, Inc.",Medicare Advantage,10.78,49,,percent of total billed charges,,
Huggies,,V5299,HCPCS,Facility,Inpatient,,,,22,18.7,6.3052,22,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Huggies,,V5299,HCPCS,Facility,Both,,,,22,18.7,6.3052,22,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),13.2,60,,percent of total billed charges,,
Huggies,,V5299,HCPCS,Facility,Both,,,,22,18.7,6.3052,22,"Health Partners, Inc.",State of Minnesota Advantage Program,17.93,81.5,,percent of total billed charges,,
Huggies,,V5299,HCPCS,Facility,Both,,,,22,18.7,6.3052,22,"Health Partners, Inc.",State Public Programs,11,50,,percent of total billed charges,,
Huggies,,V5299,HCPCS,Facility,Both,,,,22,18.7,6.3052,22,Humana Insurance Company,Commercial PPO,20.9,95,,percent of total billed charges,,
Huggies,,V5299,HCPCS,Facility,Outpatient,,,,22,18.7,6.3052,22,Humana Insurance Company,Medicare PPO,10.78,49,,percent of total billed charges,,
Huggies,,V5299,HCPCS,Facility,Inpatient,,,,22,18.7,6.3052,22,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Huggies,,V5299,HCPCS,Facility,Both,,,,22,18.7,6.3052,22,Medica,Individual & Family,21.802,99.1,,percent of total billed charges,,
Huggies,,V5299,HCPCS,Facility,Outpatient,,,,22,18.7,6.3052,22,Medica,Medica Advantage Solution,10.956,49.8,,percent of total billed charges,,
Huggies,,V5299,HCPCS,Facility,Inpatient,,,,22,18.7,6.3052,22,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Huggies,,V5299,HCPCS,Facility,Outpatient,,,,22,18.7,6.3052,22,Medica,Medical Assistance,9.812,44.6,,percent of total billed charges,,
Huggies,,V5299,HCPCS,Facility,Inpatient,,,,22,18.7,6.3052,22,Medica,Medical Assistance,,,,,Included in per diem rate,
Huggies,,V5299,HCPCS,Facility,Outpatient,,,,22,18.7,6.3052,22,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,10.956,49.8,,percent of total billed charges,,
Huggies,,V5299,HCPCS,Facility,Inpatient,,,,22,18.7,6.3052,22,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Huggies,,V5299,HCPCS,Facility,Both,,,,22,18.7,6.3052,22,"Multiplan, Inc.","Multiplan, Inc.",20.68,94,,percent of total billed charges,,
Huggies,,V5299,HCPCS,Facility,Outpatient,,,,22,18.7,6.3052,22,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,19.822,90.1,,percent of total billed charges,,
Huggies,,V5299,HCPCS,Facility,Inpatient,,,,22,18.7,6.3052,22,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Huggies,,V5299,HCPCS,Facility,Both,,,,22,18.7,6.3052,22,"Preferred One Administrative Services, INC.",PPO,21.692,98.6,,percent of total billed charges,,
Huggies,,V5299,HCPCS,Facility,Outpatient,,,,22,18.7,6.3052,22,PrimeWest Health,Minnesota Senior Health Options (MSHO),11.319,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Huggies,,V5299,HCPCS,Facility,Inpatient,,,,22,18.7,6.3052,22,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Huggies,,V5299,HCPCS,Facility,Outpatient,,,,22,18.7,6.3052,22,PrimeWest Health,MinnesotaCare,11.2992,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Huggies,,V5299,HCPCS,Facility,Inpatient,,,,22,18.7,6.3052,22,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Huggies,,V5299,HCPCS,Facility,Both,,,,22,18.7,6.3052,22,Sanford Health Plan,Sanford Health Plan,20.24,92,,percent of total billed charges,,
Huggies,,V5299,HCPCS,Facility,Outpatient,,,,22,18.7,6.3052,22,"UCare Health, Inc.",Individual & Family Plan,12.397,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Huggies,,V5299,HCPCS,Facility,Inpatient,,,,22,18.7,6.3052,22,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Huggies,,V5299,HCPCS,Facility,Outpatient,,,,22,18.7,6.3052,22,"UCare Health, Inc.",Medical Assistance,11.1034,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Huggies,,V5299,HCPCS,Facility,Inpatient,,,,22,18.7,6.3052,22,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Huggies,,V5299,HCPCS,Facility,Outpatient,,,,22,18.7,6.3052,22,"UCare Health, Inc.",Medicare Advantage,11.1034,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Huggies,,V5299,HCPCS,Facility,Inpatient,,,,22,18.7,6.3052,22,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Huggies,,V5299,HCPCS,Facility,Outpatient,,,,22,18.7,6.3052,22,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),11.1034,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Huggies,,V5299,HCPCS,Facility,Inpatient,,,,22,18.7,6.3052,22,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Huggies,,V5299,HCPCS,Facility,Both,,,,22,18.7,6.3052,22,UnitedHealthcare,Individual & Family,20.68,94,,percent of total billed charges,,
Huggies,,V5299,HCPCS,Facility,Outpatient,,,,22,18.7,6.3052,22,UnitedHealthcare,Medicare Advantage,10.78,49,,percent of total billed charges,,
Huggies,,V5299,HCPCS,Facility,Inpatient,,,,22,18.7,6.3052,22,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Huggies,,V5299,HCPCS,Facility,Outpatient,,,,22,18.7,6.3052,22,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,10.56,48,,percent of total billed charges,,100% of DHS outpatient percentage
Huggies,,V5299,HCPCS,Facility,Inpatient,,,,22,18.7,6.3052,22,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Telephone Pad,,V5299,HCPCS,Facility,Both,,,,10,8.5,2.866,10,Aetna,Commercial,9.2,92,,percent of total billed charges,,
Telephone Pad,,V5299,HCPCS,Facility,Outpatient,,,,10,8.5,2.866,10,Aetna,Medicare Advantage,4.9,49,,percent of total billed charges,,
Telephone Pad,,V5299,HCPCS,Facility,Inpatient,,,,10,8.5,2.866,10,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Telephone Pad,,V5299,HCPCS,Facility,Both,,,,10,8.5,2.866,10,Aetna,PPO,9.3,93,,percent of total billed charges,,
Telephone Pad,,V5299,HCPCS,Facility,Both,,,,10,8.5,2.866,10,America's PPO,America's PPO,9.603,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Telephone Pad,,V5299,HCPCS,Facility,Both,,,,10,8.5,2.866,10,BlueCross BlueShield Minnesota, Federal Employee Program,9.84,98.4,,percent of total billed charges,,
Telephone Pad,,V5299,HCPCS,Facility,Both,,,,10,8.5,2.866,10,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,10,100,,percent of total billed charges,,
Telephone Pad,,V5299,HCPCS,Facility,Both,,,,10,8.5,2.866,10,BlueCross BlueShield Minnesota,High Value Network Plan,9,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
Telephone Pad,,V5299,HCPCS,Facility,Outpatient,,,,10,8.5,2.866,10,BlueCross BlueShield Minnesota,Medicare Advantage,4.9,49,,percent of total billed charges,,
Telephone Pad,,V5299,HCPCS,Facility,Inpatient,,,,10,8.5,2.866,10,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Telephone Pad,,V5299,HCPCS,Facility,Both,,,,10,8.5,2.866,10,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,8.857,88.57,,percent of total billed charges,,
Telephone Pad,,V5299,HCPCS,Facility,Both,,,,10,8.5,2.866,10,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,2.866,28.66,,percent of total billed charges,,
Telephone Pad,,V5299,HCPCS,Facility,Outpatient,,,,10,8.5,2.866,10,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),4.9,49,,percent of total billed charges,,
Telephone Pad,,V5299,HCPCS,Facility,Inpatient,,,,10,8.5,2.866,10,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Telephone Pad,,V5299,HCPCS,Facility,Both,,,,10,8.5,2.866,10,CorVel,Worker's Compensation,10,100,,percent of total billed charges,,
Telephone Pad,,V5299,HCPCS,Facility,Both,,,,10,8.5,2.866,10,First Health Group Corporation,First Health Network,9.7,97,,percent of total billed charges,,
Telephone Pad,,V5299,HCPCS,Facility,Both,,,,10,8.5,2.866,10,"Health Partners, Inc.",Commercial,9.46,94.6,,percent of total billed charges,,
Telephone Pad,,V5299,HCPCS,Facility,Outpatient,,,,10,8.5,2.866,10,"Health Partners, Inc.",Medicare Advantage,4.9,49,,percent of total billed charges,,
Telephone Pad,,V5299,HCPCS,Facility,Inpatient,,,,10,8.5,2.866,10,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Telephone Pad,,V5299,HCPCS,Facility,Both,,,,10,8.5,2.866,10,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),6,60,,percent of total billed charges,,
Telephone Pad,,V5299,HCPCS,Facility,Both,,,,10,8.5,2.866,10,"Health Partners, Inc.",State of Minnesota Advantage Program,8.15,81.5,,percent of total billed charges,,
Telephone Pad,,V5299,HCPCS,Facility,Both,,,,10,8.5,2.866,10,"Health Partners, Inc.",State Public Programs,5,50,,percent of total billed charges,,
Telephone Pad,,V5299,HCPCS,Facility,Both,,,,10,8.5,2.866,10,Humana Insurance Company,Commercial PPO,9.5,95,,percent of total billed charges,,
Telephone Pad,,V5299,HCPCS,Facility,Outpatient,,,,10,8.5,2.866,10,Humana Insurance Company,Medicare PPO,4.9,49,,percent of total billed charges,,
Telephone Pad,,V5299,HCPCS,Facility,Inpatient,,,,10,8.5,2.866,10,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Telephone Pad,,V5299,HCPCS,Facility,Both,,,,10,8.5,2.866,10,Medica,Individual & Family,9.91,99.1,,percent of total billed charges,,
Telephone Pad,,V5299,HCPCS,Facility,Outpatient,,,,10,8.5,2.866,10,Medica,Medica Advantage Solution,4.98,49.8,,percent of total billed charges,,
Telephone Pad,,V5299,HCPCS,Facility,Inpatient,,,,10,8.5,2.866,10,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Telephone Pad,,V5299,HCPCS,Facility,Outpatient,,,,10,8.5,2.866,10,Medica,Medical Assistance,4.46,44.6,,percent of total billed charges,,
Telephone Pad,,V5299,HCPCS,Facility,Inpatient,,,,10,8.5,2.866,10,Medica,Medical Assistance,,,,,Included in per diem rate,
Telephone Pad,,V5299,HCPCS,Facility,Outpatient,,,,10,8.5,2.866,10,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,4.98,49.8,,percent of total billed charges,,
Telephone Pad,,V5299,HCPCS,Facility,Inpatient,,,,10,8.5,2.866,10,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Telephone Pad,,V5299,HCPCS,Facility,Both,,,,10,8.5,2.866,10,"Multiplan, Inc.","Multiplan, Inc.",9.4,94,,percent of total billed charges,,
Telephone Pad,,V5299,HCPCS,Facility,Outpatient,,,,10,8.5,2.866,10,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,9.01,90.1,,percent of total billed charges,,
Telephone Pad,,V5299,HCPCS,Facility,Inpatient,,,,10,8.5,2.866,10,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Telephone Pad,,V5299,HCPCS,Facility,Both,,,,10,8.5,2.866,10,"Preferred One Administrative Services, INC.",PPO,9.86,98.6,,percent of total billed charges,,
Telephone Pad,,V5299,HCPCS,Facility,Outpatient,,,,10,8.5,2.866,10,PrimeWest Health,Minnesota Senior Health Options (MSHO),5.145,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Telephone Pad,,V5299,HCPCS,Facility,Inpatient,,,,10,8.5,2.866,10,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Telephone Pad,,V5299,HCPCS,Facility,Outpatient,,,,10,8.5,2.866,10,PrimeWest Health,MinnesotaCare,5.136,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Telephone Pad,,V5299,HCPCS,Facility,Inpatient,,,,10,8.5,2.866,10,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Telephone Pad,,V5299,HCPCS,Facility,Both,,,,10,8.5,2.866,10,Sanford Health Plan,Sanford Health Plan,9.2,92,,percent of total billed charges,,
Telephone Pad,,V5299,HCPCS,Facility,Outpatient,,,,10,8.5,2.866,10,"UCare Health, Inc.",Individual & Family Plan,5.635,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Telephone Pad,,V5299,HCPCS,Facility,Inpatient,,,,10,8.5,2.866,10,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Telephone Pad,,V5299,HCPCS,Facility,Outpatient,,,,10,8.5,2.866,10,"UCare Health, Inc.",Medical Assistance,5.047,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Telephone Pad,,V5299,HCPCS,Facility,Inpatient,,,,10,8.5,2.866,10,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Telephone Pad,,V5299,HCPCS,Facility,Outpatient,,,,10,8.5,2.866,10,"UCare Health, Inc.",Medicare Advantage,5.047,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Telephone Pad,,V5299,HCPCS,Facility,Inpatient,,,,10,8.5,2.866,10,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Telephone Pad,,V5299,HCPCS,Facility,Outpatient,,,,10,8.5,2.866,10,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),5.047,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Telephone Pad,,V5299,HCPCS,Facility,Inpatient,,,,10,8.5,2.866,10,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Telephone Pad,,V5299,HCPCS,Facility,Both,,,,10,8.5,2.866,10,UnitedHealthcare,Individual & Family,9.4,94,,percent of total billed charges,,
Telephone Pad,,V5299,HCPCS,Facility,Outpatient,,,,10,8.5,2.866,10,UnitedHealthcare,Medicare Advantage,4.9,49,,percent of total billed charges,,
Telephone Pad,,V5299,HCPCS,Facility,Inpatient,,,,10,8.5,2.866,10,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Telephone Pad,,V5299,HCPCS,Facility,Outpatient,,,,10,8.5,2.866,10,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,4.8,48,,percent of total billed charges,,100% of DHS outpatient percentage
Telephone Pad,,V5299,HCPCS,Facility,Inpatient,,,,10,8.5,2.866,10,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Tubing Change,,V5299,HCPCS,Facility,Both,,,,15,12.75,4.299,15,Aetna,Commercial,13.8,92,,percent of total billed charges,,
Tubing Change,,V5299,HCPCS,Facility,Outpatient,,,,15,12.75,4.299,15,Aetna,Medicare Advantage,7.35,49,,percent of total billed charges,,
Tubing Change,,V5299,HCPCS,Facility,Inpatient,,,,15,12.75,4.299,15,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Tubing Change,,V5299,HCPCS,Facility,Both,,,,15,12.75,4.299,15,Aetna,PPO,13.95,93,,percent of total billed charges,,
Tubing Change,,V5299,HCPCS,Facility,Both,,,,15,12.75,4.299,15,America's PPO,America's PPO,14.4045,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Tubing Change,,V5299,HCPCS,Facility,Both,,,,15,12.75,4.299,15,BlueCross BlueShield Minnesota, Federal Employee Program,14.76,98.4,,percent of total billed charges,,
Tubing Change,,V5299,HCPCS,Facility,Both,,,,15,12.75,4.299,15,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,15,100,,percent of total billed charges,,
Tubing Change,,V5299,HCPCS,Facility,Both,,,,15,12.75,4.299,15,BlueCross BlueShield Minnesota,High Value Network Plan,13.5,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
Tubing Change,,V5299,HCPCS,Facility,Outpatient,,,,15,12.75,4.299,15,BlueCross BlueShield Minnesota,Medicare Advantage,7.35,49,,percent of total billed charges,,
Tubing Change,,V5299,HCPCS,Facility,Inpatient,,,,15,12.75,4.299,15,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Tubing Change,,V5299,HCPCS,Facility,Both,,,,15,12.75,4.299,15,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,13.2855,88.57,,percent of total billed charges,,
Tubing Change,,V5299,HCPCS,Facility,Both,,,,15,12.75,4.299,15,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,4.299,28.66,,percent of total billed charges,,
Tubing Change,,V5299,HCPCS,Facility,Outpatient,,,,15,12.75,4.299,15,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),7.35,49,,percent of total billed charges,,
Tubing Change,,V5299,HCPCS,Facility,Inpatient,,,,15,12.75,4.299,15,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Tubing Change,,V5299,HCPCS,Facility,Both,,,,15,12.75,4.299,15,CorVel,Worker's Compensation,15,100,,percent of total billed charges,,
Tubing Change,,V5299,HCPCS,Facility,Both,,,,15,12.75,4.299,15,First Health Group Corporation,First Health Network,14.55,97,,percent of total billed charges,,
Tubing Change,,V5299,HCPCS,Facility,Both,,,,15,12.75,4.299,15,"Health Partners, Inc.",Commercial,14.19,94.6,,percent of total billed charges,,
Tubing Change,,V5299,HCPCS,Facility,Outpatient,,,,15,12.75,4.299,15,"Health Partners, Inc.",Medicare Advantage,7.35,49,,percent of total billed charges,,
Tubing Change,,V5299,HCPCS,Facility,Inpatient,,,,15,12.75,4.299,15,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Tubing Change,,V5299,HCPCS,Facility,Both,,,,15,12.75,4.299,15,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),9,60,,percent of total billed charges,,
Tubing Change,,V5299,HCPCS,Facility,Both,,,,15,12.75,4.299,15,"Health Partners, Inc.",State of Minnesota Advantage Program,12.225,81.5,,percent of total billed charges,,
Tubing Change,,V5299,HCPCS,Facility,Both,,,,15,12.75,4.299,15,"Health Partners, Inc.",State Public Programs,7.5,50,,percent of total billed charges,,
Tubing Change,,V5299,HCPCS,Facility,Both,,,,15,12.75,4.299,15,Humana Insurance Company,Commercial PPO,14.25,95,,percent of total billed charges,,
Tubing Change,,V5299,HCPCS,Facility,Outpatient,,,,15,12.75,4.299,15,Humana Insurance Company,Medicare PPO,7.35,49,,percent of total billed charges,,
Tubing Change,,V5299,HCPCS,Facility,Inpatient,,,,15,12.75,4.299,15,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Tubing Change,,V5299,HCPCS,Facility,Both,,,,15,12.75,4.299,15,Medica,Individual & Family,14.865,99.1,,percent of total billed charges,,
Tubing Change,,V5299,HCPCS,Facility,Outpatient,,,,15,12.75,4.299,15,Medica,Medica Advantage Solution,7.47,49.8,,percent of total billed charges,,
Tubing Change,,V5299,HCPCS,Facility,Inpatient,,,,15,12.75,4.299,15,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Tubing Change,,V5299,HCPCS,Facility,Outpatient,,,,15,12.75,4.299,15,Medica,Medical Assistance,6.69,44.6,,percent of total billed charges,,
Tubing Change,,V5299,HCPCS,Facility,Inpatient,,,,15,12.75,4.299,15,Medica,Medical Assistance,,,,,Included in per diem rate,
Tubing Change,,V5299,HCPCS,Facility,Outpatient,,,,15,12.75,4.299,15,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,7.47,49.8,,percent of total billed charges,,
Tubing Change,,V5299,HCPCS,Facility,Inpatient,,,,15,12.75,4.299,15,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Tubing Change,,V5299,HCPCS,Facility,Both,,,,15,12.75,4.299,15,"Multiplan, Inc.","Multiplan, Inc.",14.1,94,,percent of total billed charges,,
Tubing Change,,V5299,HCPCS,Facility,Outpatient,,,,15,12.75,4.299,15,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,13.515,90.1,,percent of total billed charges,,
Tubing Change,,V5299,HCPCS,Facility,Inpatient,,,,15,12.75,4.299,15,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Tubing Change,,V5299,HCPCS,Facility,Both,,,,15,12.75,4.299,15,"Preferred One Administrative Services, INC.",PPO,14.79,98.6,,percent of total billed charges,,
Tubing Change,,V5299,HCPCS,Facility,Outpatient,,,,15,12.75,4.299,15,PrimeWest Health,Minnesota Senior Health Options (MSHO),7.7175,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Tubing Change,,V5299,HCPCS,Facility,Inpatient,,,,15,12.75,4.299,15,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Tubing Change,,V5299,HCPCS,Facility,Outpatient,,,,15,12.75,4.299,15,PrimeWest Health,MinnesotaCare,7.704,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Tubing Change,,V5299,HCPCS,Facility,Inpatient,,,,15,12.75,4.299,15,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Tubing Change,,V5299,HCPCS,Facility,Both,,,,15,12.75,4.299,15,Sanford Health Plan,Sanford Health Plan,13.8,92,,percent of total billed charges,,
Tubing Change,,V5299,HCPCS,Facility,Outpatient,,,,15,12.75,4.299,15,"UCare Health, Inc.",Individual & Family Plan,8.4525,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Tubing Change,,V5299,HCPCS,Facility,Inpatient,,,,15,12.75,4.299,15,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Tubing Change,,V5299,HCPCS,Facility,Outpatient,,,,15,12.75,4.299,15,"UCare Health, Inc.",Medical Assistance,7.5705,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Tubing Change,,V5299,HCPCS,Facility,Inpatient,,,,15,12.75,4.299,15,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Tubing Change,,V5299,HCPCS,Facility,Outpatient,,,,15,12.75,4.299,15,"UCare Health, Inc.",Medicare Advantage,7.5705,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Tubing Change,,V5299,HCPCS,Facility,Inpatient,,,,15,12.75,4.299,15,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Tubing Change,,V5299,HCPCS,Facility,Outpatient,,,,15,12.75,4.299,15,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),7.5705,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Tubing Change,,V5299,HCPCS,Facility,Inpatient,,,,15,12.75,4.299,15,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Tubing Change,,V5299,HCPCS,Facility,Both,,,,15,12.75,4.299,15,UnitedHealthcare,Individual & Family,14.1,94,,percent of total billed charges,,
Tubing Change,,V5299,HCPCS,Facility,Outpatient,,,,15,12.75,4.299,15,UnitedHealthcare,Medicare Advantage,7.35,49,,percent of total billed charges,,
Tubing Change,,V5299,HCPCS,Facility,Inpatient,,,,15,12.75,4.299,15,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Tubing Change,,V5299,HCPCS,Facility,Outpatient,,,,15,12.75,4.299,15,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,7.2,48,,percent of total billed charges,,100% of DHS outpatient percentage
Tubing Change,,V5299,HCPCS,Facility,Inpatient,,,,15,12.75,4.299,15,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Tubing Change-Libbyhorn,,V5299,HCPCS,Facility,Both,,,,22,18.7,6.3052,22,Aetna,Commercial,20.24,92,,percent of total billed charges,,
Tubing Change-Libbyhorn,,V5299,HCPCS,Facility,Outpatient,,,,22,18.7,6.3052,22,Aetna,Medicare Advantage,10.78,49,,percent of total billed charges,,
Tubing Change-Libbyhorn,,V5299,HCPCS,Facility,Inpatient,,,,22,18.7,6.3052,22,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Tubing Change-Libbyhorn,,V5299,HCPCS,Facility,Both,,,,22,18.7,6.3052,22,Aetna,PPO,20.46,93,,percent of total billed charges,,
Tubing Change-Libbyhorn,,V5299,HCPCS,Facility,Both,,,,22,18.7,6.3052,22,America's PPO,America's PPO,21.1266,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Tubing Change-Libbyhorn,,V5299,HCPCS,Facility,Both,,,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota, Federal Employee Program,21.648,98.4,,percent of total billed charges,,
Tubing Change-Libbyhorn,,V5299,HCPCS,Facility,Both,,,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,22,100,,percent of total billed charges,,
Tubing Change-Libbyhorn,,V5299,HCPCS,Facility,Both,,,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota,High Value Network Plan,19.8,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
Tubing Change-Libbyhorn,,V5299,HCPCS,Facility,Outpatient,,,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota,Medicare Advantage,10.78,49,,percent of total billed charges,,
Tubing Change-Libbyhorn,,V5299,HCPCS,Facility,Inpatient,,,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Tubing Change-Libbyhorn,,V5299,HCPCS,Facility,Both,,,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,19.4854,88.57,,percent of total billed charges,,
Tubing Change-Libbyhorn,,V5299,HCPCS,Facility,Both,,,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,6.3052,28.66,,percent of total billed charges,,
Tubing Change-Libbyhorn,,V5299,HCPCS,Facility,Outpatient,,,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),10.78,49,,percent of total billed charges,,
Tubing Change-Libbyhorn,,V5299,HCPCS,Facility,Inpatient,,,,22,18.7,6.3052,22,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Tubing Change-Libbyhorn,,V5299,HCPCS,Facility,Both,,,,22,18.7,6.3052,22,CorVel,Worker's Compensation,22,100,,percent of total billed charges,,
Tubing Change-Libbyhorn,,V5299,HCPCS,Facility,Both,,,,22,18.7,6.3052,22,First Health Group Corporation,First Health Network,21.34,97,,percent of total billed charges,,
Tubing Change-Libbyhorn,,V5299,HCPCS,Facility,Both,,,,22,18.7,6.3052,22,"Health Partners, Inc.",Commercial,20.812,94.6,,percent of total billed charges,,
Tubing Change-Libbyhorn,,V5299,HCPCS,Facility,Outpatient,,,,22,18.7,6.3052,22,"Health Partners, Inc.",Medicare Advantage,10.78,49,,percent of total billed charges,,
Tubing Change-Libbyhorn,,V5299,HCPCS,Facility,Inpatient,,,,22,18.7,6.3052,22,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Tubing Change-Libbyhorn,,V5299,HCPCS,Facility,Both,,,,22,18.7,6.3052,22,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),13.2,60,,percent of total billed charges,,
Tubing Change-Libbyhorn,,V5299,HCPCS,Facility,Both,,,,22,18.7,6.3052,22,"Health Partners, Inc.",State of Minnesota Advantage Program,17.93,81.5,,percent of total billed charges,,
Tubing Change-Libbyhorn,,V5299,HCPCS,Facility,Both,,,,22,18.7,6.3052,22,"Health Partners, Inc.",State Public Programs,11,50,,percent of total billed charges,,
Tubing Change-Libbyhorn,,V5299,HCPCS,Facility,Both,,,,22,18.7,6.3052,22,Humana Insurance Company,Commercial PPO,20.9,95,,percent of total billed charges,,
Tubing Change-Libbyhorn,,V5299,HCPCS,Facility,Outpatient,,,,22,18.7,6.3052,22,Humana Insurance Company,Medicare PPO,10.78,49,,percent of total billed charges,,
Tubing Change-Libbyhorn,,V5299,HCPCS,Facility,Inpatient,,,,22,18.7,6.3052,22,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Tubing Change-Libbyhorn,,V5299,HCPCS,Facility,Both,,,,22,18.7,6.3052,22,Medica,Individual & Family,21.802,99.1,,percent of total billed charges,,
Tubing Change-Libbyhorn,,V5299,HCPCS,Facility,Outpatient,,,,22,18.7,6.3052,22,Medica,Medica Advantage Solution,10.956,49.8,,percent of total billed charges,,
Tubing Change-Libbyhorn,,V5299,HCPCS,Facility,Inpatient,,,,22,18.7,6.3052,22,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Tubing Change-Libbyhorn,,V5299,HCPCS,Facility,Outpatient,,,,22,18.7,6.3052,22,Medica,Medical Assistance,9.812,44.6,,percent of total billed charges,,
Tubing Change-Libbyhorn,,V5299,HCPCS,Facility,Inpatient,,,,22,18.7,6.3052,22,Medica,Medical Assistance,,,,,Included in per diem rate,
Tubing Change-Libbyhorn,,V5299,HCPCS,Facility,Outpatient,,,,22,18.7,6.3052,22,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,10.956,49.8,,percent of total billed charges,,
Tubing Change-Libbyhorn,,V5299,HCPCS,Facility,Inpatient,,,,22,18.7,6.3052,22,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Tubing Change-Libbyhorn,,V5299,HCPCS,Facility,Both,,,,22,18.7,6.3052,22,"Multiplan, Inc.","Multiplan, Inc.",20.68,94,,percent of total billed charges,,
Tubing Change-Libbyhorn,,V5299,HCPCS,Facility,Outpatient,,,,22,18.7,6.3052,22,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,19.822,90.1,,percent of total billed charges,,
Tubing Change-Libbyhorn,,V5299,HCPCS,Facility,Inpatient,,,,22,18.7,6.3052,22,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Tubing Change-Libbyhorn,,V5299,HCPCS,Facility,Both,,,,22,18.7,6.3052,22,"Preferred One Administrative Services, INC.",PPO,21.692,98.6,,percent of total billed charges,,
Tubing Change-Libbyhorn,,V5299,HCPCS,Facility,Outpatient,,,,22,18.7,6.3052,22,PrimeWest Health,Minnesota Senior Health Options (MSHO),11.319,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Tubing Change-Libbyhorn,,V5299,HCPCS,Facility,Inpatient,,,,22,18.7,6.3052,22,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Tubing Change-Libbyhorn,,V5299,HCPCS,Facility,Outpatient,,,,22,18.7,6.3052,22,PrimeWest Health,MinnesotaCare,11.2992,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Tubing Change-Libbyhorn,,V5299,HCPCS,Facility,Inpatient,,,,22,18.7,6.3052,22,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Tubing Change-Libbyhorn,,V5299,HCPCS,Facility,Both,,,,22,18.7,6.3052,22,Sanford Health Plan,Sanford Health Plan,20.24,92,,percent of total billed charges,,
Tubing Change-Libbyhorn,,V5299,HCPCS,Facility,Outpatient,,,,22,18.7,6.3052,22,"UCare Health, Inc.",Individual & Family Plan,12.397,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Tubing Change-Libbyhorn,,V5299,HCPCS,Facility,Inpatient,,,,22,18.7,6.3052,22,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Tubing Change-Libbyhorn,,V5299,HCPCS,Facility,Outpatient,,,,22,18.7,6.3052,22,"UCare Health, Inc.",Medical Assistance,11.1034,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Tubing Change-Libbyhorn,,V5299,HCPCS,Facility,Inpatient,,,,22,18.7,6.3052,22,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Tubing Change-Libbyhorn,,V5299,HCPCS,Facility,Outpatient,,,,22,18.7,6.3052,22,"UCare Health, Inc.",Medicare Advantage,11.1034,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Tubing Change-Libbyhorn,,V5299,HCPCS,Facility,Inpatient,,,,22,18.7,6.3052,22,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Tubing Change-Libbyhorn,,V5299,HCPCS,Facility,Outpatient,,,,22,18.7,6.3052,22,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),11.1034,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Tubing Change-Libbyhorn,,V5299,HCPCS,Facility,Inpatient,,,,22,18.7,6.3052,22,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Tubing Change-Libbyhorn,,V5299,HCPCS,Facility,Both,,,,22,18.7,6.3052,22,UnitedHealthcare,Individual & Family,20.68,94,,percent of total billed charges,,
Tubing Change-Libbyhorn,,V5299,HCPCS,Facility,Outpatient,,,,22,18.7,6.3052,22,UnitedHealthcare,Medicare Advantage,10.78,49,,percent of total billed charges,,
Tubing Change-Libbyhorn,,V5299,HCPCS,Facility,Inpatient,,,,22,18.7,6.3052,22,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Tubing Change-Libbyhorn,,V5299,HCPCS,Facility,Outpatient,,,,22,18.7,6.3052,22,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,10.56,48,,percent of total billed charges,,100% of DHS outpatient percentage
Tubing Change-Libbyhorn,,V5299,HCPCS,Facility,Inpatient,,,,22,18.7,6.3052,22,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,
Wax Loop,,V5299,HCPCS,Facility,Both,,,,5,4.25,1.433,5,Aetna,Commercial,4.6,92,,percent of total billed charges,,
Wax Loop,,V5299,HCPCS,Facility,Outpatient,,,,5,4.25,1.433,5,Aetna,Medicare Advantage,2.45,49,,percent of total billed charges,,
Wax Loop,,V5299,HCPCS,Facility,Inpatient,,,,5,4.25,1.433,5,Aetna,Medicare Advantage,,,,,Included in per diem rate,
Wax Loop,,V5299,HCPCS,Facility,Both,,,,5,4.25,1.433,5,Aetna,PPO,4.65,93,,percent of total billed charges,,
Wax Loop,,V5299,HCPCS,Facility,Both,,,,5,4.25,1.433,5,America's PPO,America's PPO,4.8015,96.03,,percent of total billed charges,,"97% of charge, less 1% management fee"
Wax Loop,,V5299,HCPCS,Facility,Both,,,,5,4.25,1.433,5,BlueCross BlueShield Minnesota, Federal Employee Program,4.92,98.4,,percent of total billed charges,,
Wax Loop,,V5299,HCPCS,Facility,Both,,,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Blue Cross Blue Plus,5,100,,percent of total billed charges,,
Wax Loop,,V5299,HCPCS,Facility,Both,,,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,High Value Network Plan,4.5,90,,percent of total billed charges,,"90% of BCBS commercial rate, plus MN Care tax - see disclaimer for more information"
Wax Loop,,V5299,HCPCS,Facility,Outpatient,,,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,2.45,49,,percent of total billed charges,,
Wax Loop,,V5299,HCPCS,Facility,Inpatient,,,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Medicare Advantage,,,,,Included in per diem rate,
Wax Loop,,V5299,HCPCS,Facility,Both,,,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Advantage Health Plan,4.4285,88.57,,percent of total billed charges,,
Wax Loop,,V5299,HCPCS,Facility,Both,,,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,Minnesota Health Care Programs,1.433,28.66,,percent of total billed charges,,
Wax Loop,,V5299,HCPCS,Facility,Outpatient,,,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),2.45,49,,percent of total billed charges,,
Wax Loop,,V5299,HCPCS,Facility,Inpatient,,,,5,4.25,1.433,5,BlueCross BlueShield Minnesota,SecureBlue (Minnesota Senior Health Options),,,,,Included in per diem rate,
Wax Loop,,V5299,HCPCS,Facility,Both,,,,5,4.25,1.433,5,CorVel,Worker's Compensation,5,100,,percent of total billed charges,,
Wax Loop,,V5299,HCPCS,Facility,Both,,,,5,4.25,1.433,5,First Health Group Corporation,First Health Network,4.85,97,,percent of total billed charges,,
Wax Loop,,V5299,HCPCS,Facility,Both,,,,5,4.25,1.433,5,"Health Partners, Inc.",Commercial,4.73,94.6,,percent of total billed charges,,
Wax Loop,,V5299,HCPCS,Facility,Outpatient,,,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,2.45,49,,percent of total billed charges,,
Wax Loop,,V5299,HCPCS,Facility,Inpatient,,,,5,4.25,1.433,5,"Health Partners, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Wax Loop,,V5299,HCPCS,Facility,Both,,,,5,4.25,1.433,5,"Health Partners, Inc.",Minnesota Senior Health Options (MSHO),3,60,,percent of total billed charges,,
Wax Loop,,V5299,HCPCS,Facility,Both,,,,5,4.25,1.433,5,"Health Partners, Inc.",State of Minnesota Advantage Program,4.075,81.5,,percent of total billed charges,,
Wax Loop,,V5299,HCPCS,Facility,Both,,,,5,4.25,1.433,5,"Health Partners, Inc.",State Public Programs,2.5,50,,percent of total billed charges,,
Wax Loop,,V5299,HCPCS,Facility,Both,,,,5,4.25,1.433,5,Humana Insurance Company,Commercial PPO,4.75,95,,percent of total billed charges,,
Wax Loop,,V5299,HCPCS,Facility,Outpatient,,,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,2.45,49,,percent of total billed charges,,
Wax Loop,,V5299,HCPCS,Facility,Inpatient,,,,5,4.25,1.433,5,Humana Insurance Company,Medicare PPO,,,,,Included in per diem rate,
Wax Loop,,V5299,HCPCS,Facility,Both,,,,5,4.25,1.433,5,Medica,Individual & Family,4.955,99.1,,percent of total billed charges,,
Wax Loop,,V5299,HCPCS,Facility,Outpatient,,,,5,4.25,1.433,5,Medica,Medica Advantage Solution,2.49,49.8,,percent of total billed charges,,
Wax Loop,,V5299,HCPCS,Facility,Inpatient,,,,5,4.25,1.433,5,Medica,Medica Advantage Solution,,,,,Included in per diem rate,
Wax Loop,,V5299,HCPCS,Facility,Outpatient,,,,5,4.25,1.433,5,Medica,Medical Assistance,2.23,44.6,,percent of total billed charges,,
Wax Loop,,V5299,HCPCS,Facility,Inpatient,,,,5,4.25,1.433,5,Medica,Medical Assistance,,,,,Included in per diem rate,
Wax Loop,,V5299,HCPCS,Facility,Outpatient,,,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,2.49,49.8,,percent of total billed charges,,
Wax Loop,,V5299,HCPCS,Facility,Inpatient,,,,5,4.25,1.433,5,Medica,Minnesota Senior Health Options  (MSHO) Medica DUAL Solution,,,,,Included in per diem rate,
Wax Loop,,V5299,HCPCS,Facility,Both,,,,5,4.25,1.433,5,"Multiplan, Inc.","Multiplan, Inc.",4.7,94,,percent of total billed charges,,
Wax Loop,,V5299,HCPCS,Facility,Outpatient,,,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,4.505,90.1,,percent of total billed charges,,
Wax Loop,,V5299,HCPCS,Facility,Inpatient,,,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PHCP/PIC/PAS,,,,,Included in DRG payment,
Wax Loop,,V5299,HCPCS,Facility,Both,,,,5,4.25,1.433,5,"Preferred One Administrative Services, INC.",PPO,4.93,98.6,,percent of total billed charges,,
Wax Loop,,V5299,HCPCS,Facility,Outpatient,,,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),2.5725,51.45,,percent of total billed charges,,105% of Medicare outpatient fee schedule
Wax Loop,,V5299,HCPCS,Facility,Inpatient,,,,5,4.25,1.433,5,PrimeWest Health,Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Wax Loop,,V5299,HCPCS,Facility,Outpatient,,,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,2.568,51.36,,percent of total billed charges,,107% of DHS outpatient percentage
Wax Loop,,V5299,HCPCS,Facility,Inpatient,,,,5,4.25,1.433,5,PrimeWest Health,MinnesotaCare,,,,,Included in per diem rate,
Wax Loop,,V5299,HCPCS,Facility,Both,,,,5,4.25,1.433,5,Sanford Health Plan,Sanford Health Plan,4.6,92,,percent of total billed charges,,
Wax Loop,,V5299,HCPCS,Facility,Outpatient,,,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,2.8175,56.35,,percent of total billed charges,,115% of Medicare outpatient percentage
Wax Loop,,V5299,HCPCS,Facility,Inpatient,,,,5,4.25,1.433,5,"UCare Health, Inc.",Individual & Family Plan,,,,,Included in per diem rate,
Wax Loop,,V5299,HCPCS,Facility,Outpatient,,,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Wax Loop,,V5299,HCPCS,Facility,Inpatient,,,,5,4.25,1.433,5,"UCare Health, Inc.",Medical Assistance,,,,,Included in per diem rate,
Wax Loop,,V5299,HCPCS,Facility,Outpatient,,,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Wax Loop,,V5299,HCPCS,Facility,Inpatient,,,,5,4.25,1.433,5,"UCare Health, Inc.",Medicare Advantage,,,,,Included in per diem rate,
Wax Loop,,V5299,HCPCS,Facility,Outpatient,,,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),2.5235,50.47,,percent of total billed charges,,103% of Medicare outpatient percentage
Wax Loop,,V5299,HCPCS,Facility,Inpatient,,,,5,4.25,1.433,5,"UCare Health, Inc.",Minnesota Senior Health Options (MSHO),,,,,Included in per diem rate,
Wax Loop,,V5299,HCPCS,Facility,Both,,,,5,4.25,1.433,5,UnitedHealthcare,Individual & Family,4.7,94,,percent of total billed charges,,
Wax Loop,,V5299,HCPCS,Facility,Outpatient,,,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,2.45,49,,percent of total billed charges,,
Wax Loop,,V5299,HCPCS,Facility,Inpatient,,,,5,4.25,1.433,5,UnitedHealthcare,Medicare Advantage,,,,,Included in per diem rate,
Wax Loop,,V5299,HCPCS,Facility,Outpatient,,,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,2.4,48,,percent of total billed charges,,100% of DHS outpatient percentage
Wax Loop,,V5299,HCPCS,Facility,Inpatient,,,,5,4.25,1.433,5,UnitedHealthcare,Minnesota Medicaid and CHIP Benefit Plans,,,,,Included in per diem rate,